Pulmonary I
Emphysema
The radiographic findings of classic emphysema reflect the overinflation, loss of compliance, and parenchymal destruction that denote the pathophysiology of the disease. The most reliable radiographic sign is decreased vascularity. Other signs are hyperlucency; increased retrosternal clear space; increased lung volume; depression, flattening, or reversal of the curvature of the diaphragm; decreased diaphragmatic excursion; presence of prominent central pulmonary arteries with rapid tapering ("marker") vessels; bowing of the sharply defined trachea ("saber trachea"), and vertical cardiac configuration. Bullae may be present to a greater or lesser extent.
The images above are of a 46 year old male who presents with a 4 day history of increasing SOB and who recalls an episode of sneezing followed by left anterolateral chest wall splinting. He has a history of productive cough and was first diagnosed with emphysema in 1980 (age 30). He was diagnosed with alpha-1-antitrypsin deficiency a few years later. The CXR shows a left pneumothorax witha left pleural effusion. There is a chest tube in the upper left anterior chest. There is diffuse bilateral bullous disease with significantly diminished lung parenchyma. The pneumothorax is probably secondary to a ruptured bullae. The CT demonstrates severe bullous changes throughout, especially in the upper lung fields. There is a small left pleural effusion. There is also a partial collapse of the LLL with a large inferior chest pneumothorax.
Updated: October 8, 19100
Pulmonary I
