Chronic Pul Emphysema

Chronic pulmonary emphysema may be defined by many standards but at present is demonstrable directly by morphologic examination. Clinically, the major complaint is dyspnea, and this must be associated with increased expiratory airway resistance and hyperinflation of the lungs with actual destruction of alveolar wall structure . Pathologically, emphysema is a disease affecting the acinus (basic respiratory unit, including respiratory bronchioles and alveoli) with the destruction of alveoli forming abnormally large air spaces, and resulting in a decrease in the amount of elastic tissue, and in the number and size of the capillary bed . The distribution of such alveolar destruction may be (a) centrilobular (centriacinar) or central acinar destruction, (b) panlobular (panacinar) or generalized acinar disease, and (c) paraseptal involving alveoli at the periphery of the acinus. Centrilobular emphysema appears to play a lesser role than panacinar emphysema, which is of more serious consequence. The latter affects lung bases and apices with equal severity. For radiological findings to be established, a grade III pathologic severity is usually present. Patients with chronic bronchitis, in which the x-ray film shows widespread emphysema, are subject to a 50 per cent mortality within 5 years. Interstitial emphysema and the focal emphysema of coal workers have less clinical significance . Blebs and bullae (large, thinwalled cystic air spaces) may occur in any