Multimedia
 | Media file 1: Chest radiograph of an emphysematous patient shows hyperinflated lungs with reduced vascular markings. Pulmonary hila are prominent, suggesting some degree of pulmonary hypertension (Corrêa da Silva, 2001). |
 | Media file 2: Schematic representation of 1 criterion for defining flattening of the diaphragm on the lateral chest radiograph: drawing a line from the posterior to anterior costophrenic angles and measuring the distance from this line to the apex of the diaphragm. If the height is less than 1.5 cm, the criterion of flattening is fulfilled (Corrêa da Silva, 2001). |
 | Media file 3: Schematic representation of another criterion for defining flattening of the diaphragm on the lateral chest radiograph. When the angle formed by the contact point between the diaphragm and the anterior thoracic wall is more than or equal to 90°, the criterion is fulfilled (Corrêa da Silva, 2001). |
 | Media file 4: Schematic representation of another sign of emphysema on the lateral chest radiograph. When the retrosternal space (defined as the space between the posterior border of the sternum and the anterior wall of the mediastinum) is larger than 2.5 cm, it is highly suggestive of overinflated lungs. This radiograph is from a patient with pectus carinatum, an important differential diagnosis to consider when this space is measured (Corrêa da Silva, 2001). |
 | Media file 5: Close-up image shows emphysematous bullae in the left upper lobe. Note the subpleural, thin-walled, cystlike appearance (Corrêa da Silva, 2001). |
 | Media file 6: A, Frontal posteroanterior (PA) chest radiograph shows no abnormality of the pulmonary vasculature, with normal intercostal spaces and a diaphragmatic dome between the 6th and 7th anterior ribs on both sides. B, Image in a patient with emphysema demonstrating reduced pulmonary vasculature resulting in hyperlucent lungs. The intercostal spaces are mildly enlarged, and the diaphragmatic domes are straightened and below the extremity of the seventh rib (Corrêa da Silva, 2001). |
 | Media file 7: A, Lateral radiograph of the chest shows normal pulmonary vasculature, a retrosternal space within normal limits (<2.5 cm), and a normal angle between the diaphragm and the anterior thoracic wall. B, Lateral view of the chest shows increased pulmonary transparency, increased retrosternal space (>2.5 cm), and an angle between the thoracic wall and the diaphragm >90°. Straightening of the diaphragm can be more evident in this projection than on others (Corrêa da Silva, 2001). |
 | Media file 8: High-resolution CT (HRCT) in a patient after viral bronchiolitis obliterans demonstrates areas of airtrapping, which is predominant in the inferior lobes and associated with bronchiectasis in the left lower lobe. Note that the decreased attenuation caused by the airtrapping can simulate emphysema (Corrêa da Silva, 2001). |
 | Media file 9: Pediatric high-resolution CT (HRCT) shows a hyperinflated right lung with large pulmonary bullae due to congenital lobar emphysema (Corrêa da Silva, 2001). |
 | Media file 10: Algorithmic representation of emphysema that Reid proposed in 1956. |
 | Media file 11: Pulmonary acinus measures 6-10 mm (red or blue). When normal, the distal terminal bronchiole used to define the acinus cannot be resolved on high-resolution CT (HRCT). Image represents the proportion of acini in relation to the lung image. One lobule, as Reid defined it, can have 3-5 acini (red groups). A secondary pulmonary lobule described by the interstitial septa can have as many as 100 acini (blue groups, the biggest one showing a pulmonary lobule containing about 35 acini) (Corrêa da Silva, 2001). |
 | Media file 12: High-resolution CT (HRCT) demonstrates areas of centriacinar emphysema. Note the low attenuation areas without walls due to destruction of the alveoli septae centrally in the acini. Red element shows the size of a normal acinus (Corrêa da Silva, 2001). |
 | Media file 13: High-resolution CT (HRCT) shows large bullae in both inferior lobes due to uniform enlargement and destruction of the alveoli walls causing distortion of the pulmonary architecture (Corrêa da Silva, 2001). |
 | Media file 14: Panacinar emphysema of the left lung in a patient with a right lung transplant. Note the red element showing the size of a normal acinus and its discrepancy with the destroyed and enlarged airspaces of the left lower lobe (Corrêa da Silva, 2001). |
 | Media file 15: High-resolution CT (HRCT) shows bullae distributed in the subpleural spaces including the fissures; this is characteristic of paraseptal emphysema (Corrêa da Silva, 2001). |
 | Media file 16: High-resolution CT (HRCT) shows subpleural bullae consistent with paraseptal emphysema. Red mark shows the size of a normal acinus (Corrêa da Silva, 2001). |
 | Media file 17: High-resolution CT (HRCT) shows enlarged air-spaces or bullae adjoining pulmonary scars, consistent with paracicatricial emphysema. Red mark shows the size of a normal acinus (Corrêa da Silva, 2001). |
 | Media file 18: CT densitovolumetry of a nonsmoker, healthy young patient shows normal lungs. Less than 0.35% of lungs have attenuations below -950 HU (Corrêa da Silva, 2001). |
 | Media file 19: Expiratory CT densitovolumetry in the same patient as in Image 20 shows no areas of airtrapping (Corrêa da Silva, 2001). |
 | Media file 20: CT densitovolumetry in a heavy smoker with emphysema revealed compromise of about 22% of the lung parenchyma (Corrêa da Silva, 2001). |
 | Media file 21: CT densitovolumetry in a patient with lung cancer. Three-dimensional (3D) image shows that the cancer is in the portion of the right lung that was less affected by emphysema in a patient with poor pulmonary function (Corrêa da Silva, 2001). |
 | Media file 22: CT densitovolumetry shows the attenuation mask. Green areas are those with attenuation below the selected threshold (here, -950 HU to evaluate emphysema), and pink areas are those with attenuations above the threshold. Area outside the patient is highlighted in green because of air (Corrêa da Silva, 2001). |
 | Media file 23: CT densitovolumetry demonstrates irregular distribution of the emphysema, with substantial predominance in the left lung (Corrêa da Silva, 2001). |
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Further Reading
Keywords
emphysema, chronic obstructive pulmonary disease, COPD, chronic obstructive lung disease, dyspnea on exertion, air trapping, airtrapping, barrel chest, panlobular emphysema, panacinar emphysema, centrilobular emphysema, centriacinar emphysema, paracicatricial emphysema, paraseptal emphysema, bullous emphysema, pulmonary emphysema
