Panlobular emphysema

Panlobular emphysema is a morphological descriptive type of emphysema that is depicted by permanent destruction of the entire acinus distal to the respiratory bronchioles with no "obvious" associated fibrosis.

Pathology

Panacinar emphysema is characterised by permanent destruction of the airspaces (alveoli) distal to the respiratory bronchioles. The pathogenesis relates to an intrinsic imbalance in the activity of protease/elastase released and inhibitor of protease - alpha-1 antitrypsin.

Microscopically emphysema is depicted by abnormally enlarged alveoli with floating alveolar septa but as the disease progress the lung parenchyma are further destroyed and intervening alveoli wall becomes harder to find. The term "panlobular" refer to involvement of the entire acinus in contrast the centrilobular distribution in smoker. Macroscopically panlobular emphysema affects the lower lobes more severely.

Two distinct patterns have been described 2:

  • localized form: multilobular distribution
  • diffuse form: distribution not related to the zonal anatomy of the lung

Panlobular emphysema can either involve the entire lung in a rather homogeneous manner, or it may show lower lobe predominance 4.

Aetiology 

Radiographic features

HRCT Chest

The entire lung appears darker with attenuation of bronchovascular markings. The lung volumes are increased and distinct spaces of low attenuation may not be seen.

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Article Information

rID: 21965
System: Chest
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Panacinar emphysema
  • Pan-lobular emphysema
  • Pan-lobular emphysematous change
  • Pan-acinar emphysema
  • Panlobular emphysema (PLE)
  • Pan-lobular emphysematous changes

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Cases and Figures

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    Panlobular emphys...
    Figure 1: panlobular emphysema illustration
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    Case 1: with AAT deficiency
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    Emphysema

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    Case 2
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    Case 3
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