Which CT findings are characteristic of panlobular emphysema?

Updated: Mar 13, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Alpha 1-PI deficiency is classically associated with panlobular emphysema, though panlobular emphysema may also be seen in smokers without alpha 1-PI deficiency, in the elderly, and in people with distal bronchial and bronchiolar obliteration. It is almost always most severe in the lower lobes. In severe panlobular emphysema, the characteristic HRCT appearance is that of decreased lung attenuation, with few visible pulmonary vessels in the abnormal regions; bullae or cysts are characteristically absent. Mild and even moderately severe panlobular emphysema can be subtle and difficult to detect. [38]  

A visual classification system from the Fleischner Society grades the severity of parenchymal (nonparaseptal) emphysema as trace, mild, moderate, confluent, and advanced destructive emphysema. Because true panlobular emphysema seems to be uncommon in smoking-related emphysema, this classification applies the terms "confluent emphysema" and "advanced destructive emphysema" to what previously was called panlobular emphysema, and the term panlobular emphysema is used for the emphysema found in patients with alpha-1 antitrypsin deficiency. [39]

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