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BRONCHIAL ANATOMY
The right main stem bronchus ends
at the lateral origin of the rightupper-lobe bronchus, and the main
stem continues as the bronchus
intermedius, which terminates where
the middle-lobe bronchus originates
anterolaterally and the superior
segmental bronchus to the rightlower-lobe originates.
BRONCHIAL ANATOMY
The main airway continues as the lowerlobe bronchus, which divides into anterior,
lateral, posterior, and medial basal
segmental bronchi.
Divisions on the left are similar except that
there is a short left-upper-lobe bronchus,
which bifurcates into the lingular bronchus
and a short trunk that almost immediately
divides
into
anterior
and
common
apicoposterior segmental airways.
BRONCHIAL ANATOMY
After giving rise to the superior
segmental bronchus to the left lower
lobe, the lower-lobe airway continues
inferiorly, dividing into three or four
basilar segmental bronchi (in some
instances
there
is
a
common
anteromedial bronchus).
The airways, to the subsegmental level,
are visualized with CT scanning when 3to 5-mm thin-section collimation is used.
BRONCHIECTASIS
Bronchiectasis
defined as irreversible dilatation of
the bronchial tree, may cause chronic
sputum production and hemoptysis,
or it may be asymptomatic.
Types:
cylindrical,
varicose,
cystic
1. Dyskinetic Cilia
Syndrome
2. Cystic Fibrosis
CF
a relatively common genetic disorder
Affects the upper and lower respiratory
tracts, pancreas, liver and gallbladder,
intestines, and genital tract.
Approximately one in 1,600 live births
is affected.
autosomal recessive disease
occurspredominantly in Caucasians.
3. Swyer-James
Syndrome
Swyer-James syndrome
(SJS)(also known asSywer-JamesMacLeod syndromeandBret
syndrome) is a rare lung condition
thatmanifests as
unilateral hemithorax lucencyas a
result of post-infectious
obliterative bronchiolitis.
Epidemiology
The condition typically follows a viral
respiratory infection (adenovirus) in
infancy orchildhood
Radiographic Features
Plain film
It is generallycharacterized on radiographs by a
unilateral small lung with hyperlucency and air
trapping2.
CT
CT shows the affected lung as being hyperlucent with
diminished vascularity. The size of the majority of the
affected lobes are smaller although occasionally they
can be normal3. There is usually no anteroposterior
gradient attenuation4.Bronchiectasismay be
present although this is not a universal finding5.
Nuclear medicine
Quantitative ventilation/perfusion lung scan shows a
photopaenic area in the affected aspect.
Broncholithiasis
Bronchiolitis
4 classifications (CT)
(1) centrilobular nodular or branching linear areas
of increased attenuation in patients with infectious
bronchiolitis,
diffuse
panbronchiolitis,
or
bronchiolitis complicating diseases of bronchi;
(2) ground-glass attenuation and consolidation in
patients with bronchiolitis obliterans organizing
pneumonia (BOOP) or respiratory bronchiolitis
associated with smoking;
(3) areas of decreased attenuation and perfusion
in BO; and
(4) bronchiolocentric opacities seen with several
forms of chronic infiltrative lung disease, where CT
may show associated findings for each particular
disease.
Emphysema
Epidemiology
At the time of initial writing, approximately 210 million
people are affected worldwide leading to 3 million
deaths annually.1It is predominantly a disease of
middle to late life owing to the cumulative effect of
smoking and other environmental risk factors. It
traditionally affected more men than women but with
increased smoking and environmental risk factor
exposure among women, the incidence is now equal
between the sexes. Patients with genetic risk factors
such asalpha-1-antitrypsin deficiencymay present
earlier according to phenotype.
Risk factors include:
smoking: by far the most common
alpha-1-antitrypsin (AAT) deficiency
intravenous injection of methylphenidate (Ritalin lung)
Radiographic features
hyperinflation:
vascular changes:
paucity of blood vessels, often distorted
pulmonary arterial hypertension
CT
CT is currently the modality of choice for
detecting emphysema; HRCT is particularly
effective. It should be noted, however, that
there is relatively poor correlation between
autopsy-proven emphysema, pulmonary
function test abnormalities and CT with 20% of
pathology-proven cases not being evident on CT
and 40% of patients with abnormal CT
havingnormal pulmonary function tests.
CT is able to discriminate between centrilobular,
panlobular, and paraseptal emphysema.
Centrilobular emphysema
Centrilobular is by far the most common type
encountered, and is a common finding in
asymptomatic elderly patients. It is
predominantly located in the upper zones of
each lobe (i.e. apical and posterior segments of
the upper lobes, and superior segment of the
lower lobes) andhas a patchy distribution 4. It
appears as focal lucencies(emphysematous
spaces) which measure up to 1 cm in diameter,
located centrally within thesecondary
pulmonary lobule, often with a central or
peripheral dot representing the central
bronchovascular bundle2-4.
Panlobular emphysema
Panlobular emphysema is
predominantly located in the lower
lobes, has a uniform distribution
across parts of thesecondary
pulmonary lobule, which are
homogeneously reduced in
attenuation2-4.
Paraseptal emphysema
Paraseptal emphysema is located adjacent to
the pleura and septal lines with a peripheral
distribution within thesecondary pulmonary
lobule. The affected lobules are almost always
subpleural, and demonstrate small focal
lucencies up to 10 mm in size.
Any lucencylarger than 10 mmshould be
referred to assubpleural blebsorsubpleural
bullae(synonymous)3.
In all three subtypes, the emphysematous
spaces are not bounded by any visible wall 3.