Emphysema
Dilation and destruction of the terminal air spaces
- Bleb - sub-pleural air space separated from the lung by a thin pleural covering with only minor alveolar communications
- Bullae - larger than a bleb with some destruction of the underlying lung parenchyma
- Either congenital or a complication of COPD
- Seen as vacant on CT with no vessels
- May compress normal lung, with crowding of the normal pulmonary vasculature
Workup
[edit | edit source]- Need to separate the disability from the bullae, from the disability from the chronic emphysema/chronic bronchitis
- DLCO is a good proxy
Treatment
[edit | edit source]- Medical
- Surgical
- Bullae can be resected to leave functioning lung tissue. Simple removal, not generally lobectomy.
- Lung volume reduction surgery, to remove the most emphysematous areas, leaving more space for functional lung. Improves elastic recoil of remaining lung, along with improved aeration and perfusion and chest wall mechanics.
- Indications
- Patients with predominately upper lobe emphysema and low exercise capacity
- Lung transplant
- Various indications