Definition
A morbid condition of the lung characterized by
abnormally expanded air spaces distal to the terminal bronchiole,
with destruction of the walls of the involved air spaces.
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Radiographic Appearance
Radiographically, this presents as overinflation of all
or a portion of one or both lungs, with or without associated
oligemia. The areas of involved lung are often much better
characterized by CT.
Two main roentgenographic patterns have been recognized: the
"arterial deficiency" (AD) pattern and the "increased markings" (IM)
pattern.
The AD pattern is associated with severe overinflation and
peripheral vascular deficiency (oligemia).
The IM pattern is associated with increased prominence of the
vascular markings, milder overinflation, and frequent pulmonary
artery hypertension or cor pulmonale.
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Pathology
Pathological or physiological enlargement or
overdistention of the air sacs of the lungs. A major cause of
pulmonary insufficiency in chronic cigarette smokers, emphysema is a
progressive disease that commonly occurs in conjunction with chronic
bronchitis. It is found predominantly in people over age 45, but a
genetically based early-onset form also exists. Symptoms are
difficulty in breathing, cough with thick sticky sputum, and a
bluish tinge of the skin. Progressive disease can result in
disability, and in severe cases heart or respiratory failure and
death.The cause of emphysema is almost always smoking. The
disease results in lung function deteriorating three times faster
than the normal aging process. With severe emphysema the lung is
greatly overexpanded. At the end of exhalation, the emphysematous
lung is like a balloon nearly filled to capacity. There is little
room to take a deep breath
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Treatment:
There are various treatments for people suffering with severe
Emphysema. Traditional medical management has involved medicines,
inhalers and oxygen therapy. All patients certainly should stop
smoking.
Pulmonary Rehabilitation
There have been many studies that have shown pulmonary
rehabilitation may increase exercise tolerance and may reduce
shortness of breath. This involves education about emphysema,
relaxation techniques, stretching, and chest wall muscle exercises.
Importantly, this involves walking and exercising. To help improve,
patients must regularly exercise to the point where they are tired
and short of breath.
Surgery
The goal of emphysema surgery is to increase the elasticity of the
lung, decrease it to a more normal size and enable the patient to
breathe deeply once again. The diaphragm, which had been pushed
downward significantly, will resume a normal position and facilitate
breathing. The technique used at Chapman Lung Center involves
removal of the most severely damaged areas of the lung designed to
allow optimal function of less diseased portions of lung tissue. The
overexpanded lung is reduced to a more normal size and once again
there should be room to breath. The procedure employs special
surgical staples covered by tissue (bovine pericardium) designed to
minimize leakage of air from the staple line on the lung. Dr.
Richard J. Fischel has performed approximately 250 emphysema
operations. He has written numerous papers about patient selection,
optimal surgical techniques, postoperative surgical outcome and the
mechanics of improvement following surgery.
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Images
http://uwcme.org/
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Useful Link:
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