Difference between revisions of "Emphysema"

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#redirect [[Medical_lung_diseases#Emphysema]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Emphysema_low_mag.jpg
| Width      =
| Caption    = Emphysematous changes. [[H&E stain]].
| Synonyms  =
| Micro      = alveoli too large, thin septa (no interstitial thickening)
| Subtypes  = centriacinar (centrilobular) emphysema, panacinar (panlobular) emphysema, distal (paraseptal) acinar emphysema, irregular emphysema
| LMDDx      =
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = usually upper lobe predominant - blebs, bullae
| Grossing  =
| Site      = [[lung]]
| Assdx      = +/-pneumothorax
| Syndromes  = [[Alpha-1 antitrypsin deficiency]], others
| Clinicalhx = +/-[[smoking]]
| Signs      = barrel-shaped chest
| Symptoms  = shortness of breath
| Prevalence = common
| Bloodwork  =
| Rads      = hyperinflation, Saber-sheath trachea (associated with COPD)
| Endoscopy  =
| Prognosis  = dependent on underlying cause
| Other      =
| ClinDDx    =
| Tx        = stop smoking, bullectomy
}}
'''Emphysema''' is a common [[medical lung diseases|medical lung disease]] strongly associated with [[smoking]].


''Chronic obstructive pulmonary disease'', abbreviated ''COPD'', redirects here.
==General==
*Usually due to [[smoking]].
*Often lumped together with ''[[chronic bronchitis]]'' and called ''chronic obstructive pulmonary disease (COPD)''.<ref name=Ref_PCPBoD8_386>{{Ref PCPBoD8|368}}</ref>
*May cause [[pneumothorax]] - especially in young adults.<ref>{{Ref PPP|296}}</ref>
Causes of emphysema other than smoking:<ref name=pmid12546267>{{Cite journal  | last1 = Lee | first1 = P. | last2 = Gildea | first2 = TR. | last3 = Stoller | first3 = JK. | title = Emphysema in nonsmokers: alpha 1-antitrypsin deficiency and other causes. | journal = Cleve Clin J Med | volume = 69 | issue = 12 | pages = 928-9, 933, 936 passim | month = Dec | year = 2002 | doi =  | PMID = 12546267 | URL = http://www.ccjm.org/cgi/pmidlookup?view=long&pmid=12546267 }}</ref>
*[[Alpha-1 antitrypsin deficiency]].
*[[Connective tissue diseases]].
**[[Marfan syndrome]].
**[[Ehlers-Danlos syndrome]].
*[[IVDU]].
*[[HIV]].
===Pathologic classification===
Based on morphology:<ref name=Ref_PCPBoD8_368>{{Ref PCPBoD8|368}}</ref>
#Centriacinar (centrilobular) emphysema - associated with heavy smoking.
#Panacinar (panlobular) emphysema - associated with [[alpha-1 antitrypsin deficiency]].
#Distal (paraseptal) acinar emphysema - associated with spontaneous pneumothorax.
#Irregular emphysema - usu. insignificant.
Note:
* Why does smoking lead to centriacinar emphysema?
** The bad stuff from smoking gets enters the acinus at the centre; ergo, this is the location of the most damage.
==Gross==
*Holes (blebs, bullae), usually upper lung field predominant.
*Lungs may overlap the heart.<ref name=Ref_PCPBoD8_369>{{Ref PCPBoD8|369}}</ref>
Notes:
*Bleb = (small) [[vesicle]].<ref>URL: [http://dictionary.reference.com/browse/bleb http://dictionary.reference.com/browse/bleb]. Accessed on: 3 August 2011.</ref>
*Bulla = large vesicle.<ref>URL: [http://dictionary.reference.com/browse/bulla http://dictionary.reference.com/browse/bulla]. Accessed on: 3 August 2011.</ref>
===Images===
<gallery>
Image:Centrilobular emphysema 865 lores.jpg |Centrilobular emphysema. (WC/Edwin Ewing Jr.)
</gallery>
===Radiology===
*''Saber-sheath trachea'' - a finding associated with ''COPD''.<ref name=pmid26912770>{{cite journal |authors=Tunsupon P, Dhillon SS, Harris K, Alraiyes AH |title=Saber-sheath trachea in a patient with severe COPD |journal=BMJ Case Rep |volume=2016 |issue= |pages= |date=February 2016 |pmid=26912770 |pmc=4769447 |doi=10.1136/bcr-2016-214648 |url=}}</ref>
**Trachea's anterior to posterior dimension:left to right dimension is >2:1.<ref>{{cite journal |authors=Webb EM, Elicker BM, Webb WR |title=Using CT to diagnose nonneoplastic tracheal abnormalities: appearance of the tracheal wall |journal=AJR Am J Roentgenol |volume=174 |issue=5 |pages=1315–21 |date=May 2000 |pmid=10789785 |doi=10.2214/ajr.174.5.1741315 |url=}}</ref>
*Barrel-shaped chest.<ref name=pmid30604704>{{cite journal |vauthors=Sarkar M, Bhardwaz R, Madabhavi I, Modi M |title=Physical signs in patients with chronic obstructive pulmonary disease |journal=Lung India |volume=36 |issue=1 |pages=38–47 |date=2019 |pmid=30604704 |pmc=6330798 |doi=10.4103/lungindia.lungindia_145_18 |url=}}</ref>
==Microscopic==
Features:<ref name=Ref_PCPBoD8_369>{{Ref PCPBoD8|369}}</ref>
*Large alveoli.
*Thin septa (no interstitial thickening).
===Images===
<gallery>
Image:Emphysema_low_mag.jpg | Emphysema. (WC)
</gallery>
==See also==
*[[Medical lung diseases]].
*[[Smoking]].
==References==
{{Reflist|2}}
[[Category:Medical lung diseases]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 15:18, 24 November 2021

Emphysema
Diagnosis in short

Emphysematous changes. H&E stain.
LM alveoli too large, thin septa (no interstitial thickening)
Subtypes centriacinar (centrilobular) emphysema, panacinar (panlobular) emphysema, distal (paraseptal) acinar emphysema, irregular emphysema
Gross usually upper lobe predominant - blebs, bullae
Site lung
Associated Dx +/-pneumothorax
Syndromes Alpha-1 antitrypsin deficiency, others
Clinical history +/-smoking
Signs barrel-shaped chest
Symptoms shortness of breath
Prevalence common
Radiology hyperinflation, Saber-sheath trachea (associated with COPD)
Prognosis dependent on underlying cause
Treatment stop smoking, bullectomy

Emphysema is a common medical lung disease strongly associated with smoking.

Chronic obstructive pulmonary disease, abbreviated COPD, redirects here.

General

Causes of emphysema other than smoking:[3]

Pathologic classification

Based on morphology:[4]

  1. Centriacinar (centrilobular) emphysema - associated with heavy smoking.
  2. Panacinar (panlobular) emphysema - associated with alpha-1 antitrypsin deficiency.
  3. Distal (paraseptal) acinar emphysema - associated with spontaneous pneumothorax.
  4. Irregular emphysema - usu. insignificant.

Note:

  • Why does smoking lead to centriacinar emphysema?
    • The bad stuff from smoking gets enters the acinus at the centre; ergo, this is the location of the most damage.

Gross

  • Holes (blebs, bullae), usually upper lung field predominant.
  • Lungs may overlap the heart.[5]

Notes:

Images

  • Centrilobular emphysema. (WC/Edwin Ewing Jr.)

Radiology

  • Saber-sheath trachea - a finding associated with COPD.[8]
    • Trachea's anterior to posterior dimension:left to right dimension is >2:1.[9]
  • Barrel-shaped chest.[10]

Microscopic

Features:[5]

  • Large alveoli.
  • Thin septa (no interstitial thickening).

Images

  • Emphysema. (WC)

See also

References

  1. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 368. ISBN 978-1416054542.
  2. ↑ Leslie, Kevin O.; Wick, Mark R. (2004). Practical Pulmonary Pathology: A Diagnostic Approach (1st ed.). Churchill Livingstone. pp. 296. ISBN 978-0443066313.
  3. ↑ Lee, P.; Gildea, TR.; Stoller, JK. (Dec 2002). "Emphysema in nonsmokers: alpha 1-antitrypsin deficiency and other causes.". Cleve Clin J Med 69 (12): 928-9, 933, 936 passim. PMID 12546267.
  4. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 368. ISBN 978-1416054542.
  5. ↑ 5.0 5.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 369. ISBN 978-1416054542.
  6. ↑ URL: http://dictionary.reference.com/browse/bleb. Accessed on: 3 August 2011.
  7. ↑ URL: http://dictionary.reference.com/browse/bulla. Accessed on: 3 August 2011.
  8. ↑ Tunsupon P, Dhillon SS, Harris K, Alraiyes AH (February 2016). "Saber-sheath trachea in a patient with severe COPD". BMJ Case Rep 2016. doi:10.1136/bcr-2016-214648. PMC 4769447. PMID 26912770. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769447/.
  9. ↑ Webb EM, Elicker BM, Webb WR (May 2000). "Using CT to diagnose nonneoplastic tracheal abnormalities: appearance of the tracheal wall". AJR Am J Roentgenol 174 (5): 1315–21. doi:10.2214/ajr.174.5.1741315. PMID 10789785.
  10. ↑ "Physical signs in patients with chronic obstructive pulmonary disease". Lung India 36 (1): 38–47. 2019. doi:10.4103/lungindia.lungindia_145_18. PMC 6330798. PMID 30604704. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330798/.
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