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Chest Imaging

Paraseptal emphysema

can be seen as an isolated phenomenon in young adults often revealed by spontaneous pneumothorax, or can be associated with centrilobular emphysema in older patients. Paraseptal emphysema predominantly involves the air-spaces located in the distal part of the secondary pulmonary lobule and is therefore often marginated by interlobular septa and is more striking in a subpleural location. On HRCT scan, paraseptal emphysema is characterized by areas of low attenuation visible in the subpleural areas, along the peripheral or mediastinal pleura, mainly in the upper lobe, and along the fissures (Fig.1). The emphysematous spaces often have very thin but visible walls mostly corresponding to interlobular septa thickened by associated fibrosis. Even mild paraseptal emphysema is easily detected by HRCT scan. CT may contribute to the early detection of apical subpleural emphysematous spaces in patients with idiopathic spontaneous pneumothorax. Subpleural bullae are frequently associated.

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Fig.1

HRCT scan targeted on the right lung showing multiple paraseptal emphysematous spaces along the peripheral and mediastinal pleura and the major fissure.
Paraseptal emphysema, Fig.1