Caption: Figure 3: CT images of patients with emphysema condition as (a) minimal or no emphysema; (b) centrilobular emphysema
; (c) paraseptal emphysema; (d) panlobular emphysema.
Maisel, "Are centrilobular emphysema
and panlobular emphysema two different diseases?" Human Pathology, vol.
Because respiratory bronchioles are generally clustered in the center of the secondary lobule, their destruction (proximal acinar destruction) is seen as a hole in the center of the lobule, and hence the synonym centrilobular emphysema
The development of regional airspace disease with scattered areas of radiolucency in a patient with centrilobular emphysema
has previously been described in patients with pneumonia and has been termed a "Swiss Cheese" appearance, which describes non-uniformly perforated emphysematous lung tissue amidst dense consolidation.(7-9) However, both the pathophysiology and imaging of Sponge Lung shows a different appearance.
Choe et al., "A possible role for CD8+ and non-CD8+ cell granzyme B in early small airway wall remodelling in centrilobular emphysema
," Respirology, vol.
C, HRCT image of the same case showing circumscribed areas of paraseptal and centrilobular emphysema
in the upper zones, with associated reticulation extending to the subpleural regions (arrows).
Morphologic lesions of COPD, where reported, are indeed common; for example, 9 of 10 patients with RBILD (90%), described by Moon et al, (4) had centrilobular emphysema (see comments below on imaging).
RB AND CENTRILOBULAR EMPHYSEMA: MORPHOLOGY AND FUNCTIONAL CONSEQUENCES IN COPD
However, alveolar wall fibrosis is also seen as a part of coexisting centrilobular emphysema (Figure 6).