Chest ImagingCentrilobular emphysema
emphysema, that results from cigarette smoking. It mainly involves the upper lung zones. Pathologically, it predominantly affects the central portion of the acini (centriacinar
emphysema), and therefore involves the central portion of the lobule. On high
resolution CT scan, centrilobular
emphysema is characterized by the presence of multiple, small round areas of abnormally low attenuation, distributed throughout the lungs, but commonly having an upper lobe predominance (
Fig.1). The emphysematous spaces often appear to be grouped near the centre of secondary lobules surrounding the centrilobular arterial branches. Even when the centrilobular location of low attenuation areas is not recognized on HRCT scans, the presence of multiple, small areas of
emphysema scattered throughout the lung is diagnostic of centrilobular
emphysema. In most cases, the emphysematous spaces lack visible walls. With more severe centrilobular
emphysema, areas of destruction can become confluent. In such a situation, the centrilobular distribution of abnormalities is no longer depictable on HRCT scans; the appearance can mimic the appearance of
panlobular emphysema.
PG
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HRCT showing small areas of centrilobular emphysema in an asymptomatic smoker. The emphysematous spaces have no perceptible wall. Some centrilobular vessels are visible in the centre of the emphysematous spaces.
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Centrilobular emphysema, Fig.1 | |