Imaging of Chronic Obstructive Airways Disease

COPD Talk

Transcript

1. Imaging of Chronic Obstructive Pulmonary Disease (COPD) Howard Mann, M.D. Department of Radiology and Imaging Sciences University of Utah
2. Clinical definition1 Lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. 1. Global Initiative for Chronic Obstructive Lung Disease (GOLD)
3. Clinical indicators of possible COPD
7. Increased RV (a static lung volume) in COPD
11. Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification
12. COPD and associated conditions Chronic Bronchitis The presence of a chronic productive cough for 3 months in each of 2 successive years, provided that other causes of chronic cough have been ruled out Emphysema The destruction of alveolar walls and the permanent enlargement of the airspaces distal to the terminal bronchioles, without obvious fibrosis Asthma Reversible smooth muscle contraction that narrows the airway lumen, limiting expiratory airflow and resulting in symptoms including wheeze, cough, and exertion dyspnea
13. Anatomic-pathologic findings in COPD Small airway (<2mm) narrowing
15. Imaging in COPD Airway abnormalities • saber-sheath trachea • central airway mucus • bronchial outpouchings • bronchial wall thickening • bronchiectasis • [centrilobular ground-glass nodules] • airway malacia and excessive dynamic collapse Airspace abnormalities • large emphysematous bullae • centrilobular emphysema • paraseptal emphysema • panacinar emphysema Hyperinflation (increased FRC) and air-trapping
16. Phenotypes in COPD • Airway-dominant phenotype • Emphysema-dominant phenotype • Mixed phenotype
18. Hyperinflation in COPD The effects on lung volumes correlate well with functional capacity and symptoms Static hyperinflation • diminished elastic recoil of emphysematous lung • significant in severe bullous emphysema • may not be a feature in airway-dominant phenotype Dynamic hyperinflation • inability to exhale all inspired air through narrowed airways
19. Assessing lung inflation
23. Hyperinflation and bullous emphysema T10
24. Airway abnormalities in COPD Saber-sheath trachea
25. Airway abnormalities in COPD Central airway mucus
26. Airway abnormalities in COPD Bronchial outpouchings
27. Airway abnormalities in COPD Bronchial wall thickening Normal individuals: 90th percentile at 60%
32. Air-trapping in COPD • visual (volume and attenuation) • quantitative: Pixels <-856 H.U.
34. Air-trapping from narrowed small airways in COPD
35. Clinical Case
37. INSP EXP
38. Airway malacia and excessive dynamic airway collapse
40. Dynamic Airway Collapse
41. Emphysema — analyze the pulmonary vessels Note: Irregular narrowing and tapering in upper lobes, R > L
42. Corresponding computed tomography
43. Another clinical example
44. Centrilobular emphysema
46. minIP imaging in the detection of mild centrilobular emphysema
48. Panacinar emphysema
50. Paraseptal emphysema
52. Giant bullous emphysema (vanishing lung disease) • bullae occupy a third or more of the lung • may be a severe form of paraseptal emphysema • usually in young smokers • selected patient may be candidates for bullectomy: bullae surrounded by “normal- but-compressed” lung
53. • Once an area of parenchymal “weakness” in the lung reaches a certain size, it will result in a space that will fill preferentially • elastic recoil of surrounding lung will produce retraction of lung away from it and enlarge the space • the efforts of the chest wall to inflate the adjacent lung leads to hyperinflation and symptoms • the effect of bullectomy is akin to effects of darning a sock: to restore its architecture and mechanical linkage with the chest wall, while allowing deflated lung to regain its elastic properties
56. Lung volume reduction surgery Choosing patients who may benefit Heterogeneous distribution of emphysema: Emphysema in the upper lung zones, with emphysema-free lung in the lower lung zones
57. Non-surgical lung volume reduction Intra-bronchial valves
58. This patient has diminished DLCO but normal spirometry
59. Combined emphysema and fibrosis syndrome FEV1 may be normal and DLCO diminished
61. α-1 antitrypsin deficiency (1-2% cases of COPD) Basilar panlobular emphysema
62. Precocious emphysema due to intravenous drug abuse Ritalin abuse Basilar panlobular emphysema