Chest Imaging

Irregular emphysema

(also called paracicatricial emphysema or irregular air-space enlargement), emphysema that occurs in patients with pulmonary fibrosis. It is commonly seen adjacent to localized parenchymal scars, in diffuse pulmonary fibrosis and in the pneumoconiosis, particularly associated with progressive massive fibrosis. On HRCT scan, irregular emphysema is recognized as areas of abnormally low attenuation areas associated to findings of fibrosis (Fig.1). When fibrosis is only microscopic, radiological distinction between irregular and centrilobular emphysema may be impossible.

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Fig.1

HRCT in a patient with severe silicosis showing bilateral large opacities due to progressive massive fibrosis. Large spaces of irregular emphysema are present between the fibrotic masses and the pleura.
Irregular emphysema, Fig.1