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Question (11/12/2013):

Title: Mild centrilobular emphysema is seen in the upper lobes.

What do these CT findings mean? Mild centrilobular emphysema is seen in the upper lobes.

There is mixed attenuation patter to both lung parenchymas.

There are small sub centimeter nodules the largest 6 mm that has grown in size in reference to outside studies with measured 4.5 mm.

All of these nodules are noted along the major and minor fissure of the right lung. Similar but smaller nodules are seen along the left major fissure. No masses or consolidations. No pleural thickening or pleural effusions.

Answer:

Thank you very much for your question.

Centrilobular emphysema is an emphysema affecting the central portion of secondary pulmonary lobules, around the central bronchiole, typically involving the superior part of the lungs or lobes; may be related to inflammation of the bronchioles and to the effects of inhaled dust, which aggregates next to respiratory bronchioles; seen in coalworker's pneumoconiosis and (in mild form) asymptomatic city dwellers.

Emphysema is chronic obstructive pulmonary disease (COPD). Emphysema is defined pathologically as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis

Pulmonary emphysema is a irreversible disease that consists of destruction of alveolar walls. It occurs in two forms,centrilobular emphysema, in which the destruction begins at the centre of the lobule, and panlobular (or panacinar) emphysema, in which alveolar destruction occurs in all alveoli within the lobule simultaneously. In advanced cases of either type, this distinction can be difficult to make.

Centrilobular nodules are often centered 5-10 mm from the pleural surface and do not occur in relation to interlobular septa.

Emphysema typically presents as areas of low attenuation without visible walls as a result of parenchymal destruction.

Centrilobular emphysema
o Most common type
o Irreversible destruction of alveolar walls in the centrilobular portion of the lobule
o Upper lobe predominance and uneven distribution
o Strongly associated with smoking



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