Emphysema, Centrilobular

Emphysema, Centrilobular

Jud W. Gurney, MD, FACR

Axial HRCT shows low-attenuation foci of centrilobular emphysema within the outlines of a secondary pulmonary lobule image.

Gross pathology shows early centrilobular emphysema image from the destruction of a respiratory bronchiole. The septa image outline the edge of the secondary pulmonary lobule.


Abbreviations and Synonyms

  • Centrilobular emphysema (CLE), centriacinar emphysema (CAE), chronic obstructive pulmonary disease (COPD), proximal acinar emphysema, vanishing lung


  • Emphysema: Abnormal permanent enlargement of any or all parts of acinus, accompanied by destruction of alveolar tissue but without fibrosis

    • CLE: Enlargement and destruction of respiratory bronchioles within secondary pulmonary lobule (SPL)

  • COPD: Presence of airflow obstruction caused by chronic bronchitis or emphysema

    • Airflow obstruction is generally progressive; may be accompanied by airway hyper-reactivity and may be partially reversible

    • Includes asthma, chronic bronchitis, emphysema, and bronchiectasis

    • CLE most common form of emphysema associated with symptomatic or fatal chronic airway obstruction


General Features

  • Best diagnostic clue: Well-defined holes in centrilobular portion of SPL

  • Patient position/location: Predominantly involves upper lung zones

CT Findings

  • Morphology

    • Small localized rounded areas of low attenuation within centrilobular region of SPL

    • Centrilobular artery may be identified in emphysematous lung

    • Wall is indiscernible; thin walls may be seen in larger emphysematous spaces, probably secondary to relaxation atelectasis of adjacent lung

    • Borders of SPL are preserved in mild disease

    • Bulla: Emphysematous space, commonly subpleural, > 1 cm diameter

  • Distribution

    • Upper lung zones show predominant disease

    • Axial plane: CLE more severe centrally than in peripheral lung

  • Quantification of extent of emphysema either subjective or objective

    • Subjective usually sufficient for clinical practice

  • Subjective visual grading

    • Normal, trivial (< 5% lung affected)

    • Mild emphysema (5-25%), moderate (26-50%), marked (51-75%), severe (> 75%)

  • Objective: Pixel density (density mask)

Sep 20, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on Emphysema, Centrilobular
Premium Wordpress Themes by UFO Themes