Chronic Obstructive Pulmonary Disease - COPD
Emphysema

• Proteolytic enzymes secreted by polys and alveolar macrophages are normally inhibited by serum a-1 antitrypsin—but not in emphysema

Centrilobular (centriacinar) Emphysema (CLE)

           • Involves upper lobes

          • Major pathology is in respiratory bronchioles which become dilated

• Alveolar ducts and sacs are spared

         • Slightly more common than PLE

         • Characteristically found in heavy smokers

 Panlobular Emphysema (PLE)

       • Usually affects lower lobes

       • Involves overinflation and destruction of the alveolar sacs

       • More common in aged patients than CLE

       • More common in women than CLE (although both more common in men)

            • Type associated with a-1 antitrypsin deficiency

 Roentgenographic Patterns

 Arterial Deficiency pattern (AD)

         • Overinflation

         • Flattened diaphragm

 Increased Marking pattern (IM)

        • Less or no overinflation

        • Prominent pulmonary vasculature

        • Almost always has pulmonary artery hypertension

• Centrilobular emphysema usually associated with Increased Marking pattern

• Panlobular emphysema usually associated with Arterial Deficiency pattern

• IM are Blue Bloaters; AD are Pink Puffers