Chest ImagingPanlobular emphysema
classically associated with
alpha 1 antitrypsin deficiency, although it may also be seen without such deficiency in smokers, in the elderly, and distal to
bronchial and bronchiolar obliteration (see
emphysema). Pathologically, it involves all the components of the acinus more or less uniformly, and as a result involves the entire lobule. On
HRCT scan, panlobular
emphysema is characterized by widespread areas of abnormally low attenuation expressing the uniform destruction of the
pulmonary lobule.
Pulmonary vessels in the affected lung appear fewer and smaller than normal. Panlobular
emphysema is almost always most severe in the lower lobes (
Fig.1). While the characteristic appearances of extensive lung destruction and the associated paucity of
vascular markings are often easily recognized, mild and even moderately severe panlobular
emphysema can be very subtle and difficult to detect radiologically.
PG
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HRCT showing severe panlobular emphysema predominantly distributed within the lower lobes. The linear opacities represent thickening of the remaining interlobular septa by discrete fibrosis.
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Panlobular emphysema, Fig.1 | |