eMedicine Specialties > Pulmonology > Obstructive Airways Diseases
Emphysema: Multimedia
Updated: Oct 26, 2009
Multimedia
 | Media file 1: Gross pathology of bullous emphysema shows bullae on the surface of the lungs. |
 | Media file 2: Gross pathology of emphysema shows bullae on the lung surface. |
 | Media file 3: At high magnification, loss of airway walls and dilated airspaces are observed in emphysema. |
 | Media file 4: Chest radiograph shows hyperinflation, flattened diaphragms, increased retrosternal space, and hyperlucency of the lung parenchyma in emphysema. |
 | Media file 5: A CT scan shows emphysematous bullae in upper lobes. |
 | Media file 6: Diffuse emphysema secondary to cigarette smoking. |
 | Media file 7: Pressure-volume curve is drawn for a patient with restrictive lung disease and obstructive disease and is compared to healthy lungs. |
 | Media file 8: Flow-volume curve of lungs with emphysema shows marked decrease in expiratory flows, hyperinflation, and air trapping (patient B) compared to a patient with restrictive lung disease, who has reduced lung volumes and preserved flows (patient A). |
 | Media file 9: Forced expiratory volume in 1 second (FEV1) can be used to evaluate the prognosis in patients with emphysema. The benefit of smoking cessation is shown here because the deterioration in lung function parallels that of a nonsmoker, even in late stages of the disease. |
 | Media file 10: A CT scan showing severe emphysema and bullous disease. |
 | Media file 11: An emphysematous lung shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on posteroanterior (PA) film. |
 | Media file 12: An emphysematous lung shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on lateral chest radiograph. |
 | Media file 13: The differential diagnosis of unilateral hyperlucent lung includes pulmonary arterial hypoplasia and Swyer-James syndrome. The expiratory chest radiograph exhibits evidence of air trapping and is helpful in making the diagnosis. Swyer-James syndrome is unilateral bronchiolitis obliterans, which develops during early childhood. |
 | Media file 14: Lateral chest radiograph of Swyer-James syndrome may demonstrate some of the features of emphysema. |
More on Emphysema |
| Overview: Emphysema |
| Differential Diagnoses & Workup: Emphysema |
| Treatment & Medication: Emphysema |
| Follow-up: Emphysema |
 Multimedia: Emphysema |
| References |
| « Previous Page |
References
Global Initiative for Chronic Obstructive Pulmonary Disease. Caverley P, Augusti A, Anzueto, et al, eds. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Medical Communications Resources; 2008.
Adams PF, Barnes PM, Vickerie JL. Summary health statistics for the U.S. population: National Health Interview Survey, 2007. Vital Health Stat 10. Nov 2008;1-104. [Medline].
Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. Sep 1 2007;370(9589):741-50. [Medline].
Menezes AM, Perez-Padilla R, Jardim JR, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. Nov 26 2005;366(9500):1875-81. [Medline].
Centers for Disease Control and Prevention. Deaths from chronic obstructive pulmonary disease--United States, 2000-2005. MMWR Morb Mortal Wkly Rep. Nov 14 2008;57(45):1229-32. [Medline].
Silverman EK, Weiss ST, Drazen JM, et al. Gender-related differences in severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med. Dec 2000;162(6):2152-8. [Medline].
Crothers K, Butt AA, Gibert CL, Rodriguez-Barradas MC, Crystal S, Justice AC. Increased COPD among HIV-positive compared to HIV-negative veterans. Chest. Nov 2006;130(5):1326-33. [Medline].
[Guideline] US Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: US Preventive Services Task Force Reaffirmation Recommendation Statement. Ann Int Med. Apr 21 2009;150(8):551-555. [Full Text].
COMBIVENT Inhalation Aerosol Study Group. In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone. An 85-day multicenter trial. COMBIVENT Inhalation Aerosol Study Group. Chest. May 1994;105(5):1411-9. [Medline].
Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. Feb 22 2007;356(8):775-89. [Medline].
O'Donnell DE, Flüge T, Gerken F, et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J. Jun 2004;23(6):832-40. [Medline].
Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. Oct 9 2008;359(15):1543-54. [Medline].
Brusasco V, Hodder R, Miravitlles M, Korducki L, Towse L, Kesten S. Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD. Thorax. May 2003;58(5):399-404. [Medline].
Donohue JF, van Noord JA, Bateman ED, et al. A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol. Chest. Jul 2002;122(1):47-55. [Medline].
[Best Evidence] Calverley PM, Rabe KF, Goehring UM, Kristiansen S, Fabbri LM, Martinez FJ. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials. Lancet. Aug 29 2009;374(9691):685-94. [Medline].
Spencer S, Calverley PM, Burge PS, Jones PW. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J. May 2004;23(5):698-702. [Medline].
Wood-Baker RR, Gibson PG, Hannay M, Walters EH, Walters JA. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. Jan 25 2005;CD001288. [Medline].
Walters JA, Walters EH, Wood-Baker R. Oral corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. Jul 20 2005;CD005374. [Medline].
[Best Evidence] Sin DD, Tashkin D, Zhang X, et al. Budesonide and the risk of pneumonia: a meta-analysis of individual patient data. Lancet. Aug 29 2009;374(9691):712-9. [Medline].
Petty TL. The National Mucolytic Study. Results of a randomized, double-blind, placebo-controlled study of iodinated glycerol in chronic obstructive bronchitis. Chest. Jan 1990;97(1):75-83. [Medline].
[Best Evidence] Sasaki T, Nakayama K, Yasuda H, et al. A randomized, single-blind study of lansoprazole for the prevention of exacerbations of chronic obstructive pulmonary disease in older patients. J Am Geriatr Soc. Aug 2009;57(8):1453-7. [Medline].
Hubbard RC, Crystal RG. Augmentation therapy of alpha 1-antitrypsin deficiency. Eur Respir J Suppl. Mar 1990;9:44s-52s. [Medline].
Naunheim KS, Wood DE, Mohsenifar Z, et al. Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the National Emphysema Treatment Trial Research Group. Ann Thorac Surg. Aug 2006;82(2):431-43. [Medline].
[Guideline] Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update--a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. Jul 2006;25(7):745-55. [Medline].
Hurst JR, Donaldson GC, Quint JK, Goldring JJ, Baghai-Ravary R, Wedzicha JA. Temporal clustering of exacerbations in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. Mar 1 2009;179(5):369-74. [Medline].
Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. Jan 25 2003;326(7382):185. [Medline].
Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. May 2007;131(5 Suppl):4S-42S. [Medline].
Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. Mar 4 2004;350(10):1005-12. [Medline].
Anthonisen NR. Prognosis in chronic obstructive pulmonary disease: results from multicenter clinical trials. Am Rev Respir Dis. Sep 1989;140(3 Pt 2):S95-9. [Medline].
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. Nov 16 1994;272(19):1497-505. [Medline].
Brenes GA. Anxiety and chronic obstructive pulmonary disease: prevalence, impact, and treatment. Psychosom Med. Nov-Dec 2003;65(6):963-70. [Medline].
Burrows B, Bloom JW, Traver GA, Cline MG. The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med. Nov 19 1987;317(21):1309-14. [Medline].
Chapman KR. Therapeutic algorithm for chronic obstructive pulmonary disease. Am J Med. Oct 21 1991;91(4A):17S-23S. [Medline].
Davis RM, Novotny TE. The epidemiology of cigarette smoking and its impact on chronic obstructive pulmonary disease. Am Rev Respir Dis. Sep 1989;140(3 Pt 2):S82-4. [Medline].
Dunn WF, Nelson SB, Hubmayr RD. Oxygen-induced hypercarbia in obstructive pulmonary disease. Am Rev Respir Dis. Sep 1991;144(3 Pt 1):526-30. [Medline].
Fabbri LM, Luppi F, Beghé B, Rabe KF. Update in chronic obstructive pulmonary disease 2005. Am J Respir Crit Care Med. May 15 2006;173(10):1056-65. [Medline].
Ferguson GT, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med. Apr 8 1993;328(14):1017-22. [Medline].
Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J. Jun 25 1977;1(6077):1645-8. [Medline].
Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. Sep 2006;28(3):523-32. [Medline].
Karpel JP, Kotch A, Zinny M, Pesin J, Alleyne W. A comparison of inhaled ipratropium, oral theophylline plus inhaled beta-agonist, and the combination of all three in patients with COPD. Chest. Apr 1994;105(4):1089-94. [Medline].
Lopez-Majano V, Dutton RE. Regulation of respiration during oxygen breathing in chronic obstructive lung disease. Am Rev Respir Dis. Aug 1973;108(2):232-40. [Medline].
Mannino DM, Watt G, Hole D, Gillis C, Hart C, McConnachie A. The natural history of chronic obstructive pulmonary disease. Eur Respir J. Mar 2006;27(3):627-43. [Medline].
McKay SE, Howie CA, Thomson AH, Whiting B, Addis GJ. Value of theophylline treatment in patients handicapped by chronic obstructive lung disease. Thorax. Mar 1993;48(3):227-32. [Medline].
Medical Research Council Working Party. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet. Mar 28 1981;1(8222):681-6. [Medline].
Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med. Sep 1980;93(3):391-8. [Medline].
O'Donnell DE, Parker CM. COPD exacerbations . 3: Pathophysiology. Thorax. Apr 2006;61(4):354-61.
O'Donnell DE, Sanii R, Anthonisen NR, Younes M. Effect of dynamic airway compression on breathing pattern and respiratory sensation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis. Apr 1987;135(4):912-8. [Medline].
O'Donnell R, Breen D, Wilson S, Djukanovic R. Inflammatory cells in the airways in COPD. Thorax. May 2006;61(5):448-54. [Medline].
Papi A, Luppi F, Franco F, Fabbri LM. Pathophysiology of exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. May 2006;3(3):245-51. [Medline].
Peto R, Speizer FE, Cochrane AL, et al. The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease. Results from 20 years of prospective observation. Am Rev Respir Dis. Sep 1983;128(3):491-500. [Medline].
Petty TL, Finigan MM. Clinical evaluation of prolonged ambulatory oxygen therapy in chronic airway obstruction. Am J Med. Aug 1968;45(2):242-52. [Medline].
Postma DS, Sluiter HJ. Prognosis of chronic obstructive pulmonary disease: the Dutch experience. Am Rev Respir Dis. Sep 1989;140(3 Pt 2):S100-5. [Medline].
Prigmore S. End-of-life decisions and respiratory disease. Nurs Times. Feb 14-20 2006;102(7):56, 59, 61. [Medline].
Ram FS, Rodriguez-Roisin R, Granados-Navarrete A. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;CD004403.
Rutten FH, Cramer MJ, Lammers JW, Grobbee DE, Hoes AW. Heart failure and chronic obstructive pulmonary disease: An ignored combination?. Eur J Heart Fail. Nov 2006;8(7):706-11. [Medline].
Sanders C. The radiographic diagnosis of emphysema. Radiol Clin North Am. Sep 1991;29(5):1019-30. [Medline].
Schachter EN. Cilomilast. Drugs Today (Barc). Apr 2006;42(4):237-47.
Sutherland ER, Martin RJ. Airway inflammation in chronic obstructive pulmonary disease: comparisons with asthma. J Allergy Clin Immunol. Nov 2003;112(5):819-27; quiz 828. [Medline].
Thurlbeck WM. Overview of the pathology of pulmonary emphysema in the human. Clin Chest Med. Sep 1983;4(3):337-50. [Medline].
Thurlbeck WM. Pathophysiology of chronic obstructive pulmonary disease. Clin Chest Med. Sep 1990;11(3):389-403. [Medline].
Tsoumakidou M, Siafakas NM. Novel insights into the aetiology and pathophysiology of increased airway inflammation during COPD exacerbations. Respir Res. May 22 2006;7(1):80.
Vestbo J. Clinical assessment, staging, and epidemiology of chronic obstructive pulmonary disease exacerbations. Proc Am Thorac Soc. May 2006;3(3):252-6. [Medline].
Weitzenblum E, Sautegeau A, Ehrhart M, Mammosser M, Pelletier A. Long-term oxygen therapy can reverse the progression of pulmonary hypertension in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. Apr 1985;131(4):493-8. [Medline].
Further Reading
Keywords
emphysema, chronic obstructive pulmonary disease, COPD, chronic obstructive lung disease, chronic lung, chronic bronchitis, airflow obstruction, centriacinar emphysema, centrilobular emphysema, panacinar emphysema, paraseptal emphysema, distal acinar emphysema, alpha1-antitrypsin deficiency, AAT
