what is the morphology of emphysema?

Morphology of Emphysema—croscopic and Microscopic Features

Emphysema is a chronic lung condition under the umbrella of Chronic Obstructive Pulmonary Disease (COPD), defined by permanent enlargement of airspaces distal to the terminal bronchioles, along with destruction of alveolar wawalls d no obvious fibrosis.

Here’s a breakdown of its morphology, both gross (macroscopic) and microscopic.

Microscopic (Histological) Features of Emphysema

1. Destruction of Alveolar Walls

  • Loss of alveolar septa, resulting in abnormally large air spaces.

  • Fewer capillaries → reduced surface area for gas exchange.

2. Enlarged Alveolar Spaces

  • Abnormally dilated air sacs (alveoli, alveolar ducts, and respiratory bronchioles).

  • Loss of the normal architecture of the lung parenchyma.

3. Thinned and Ruptured Alveolar Septa

  • No significant fibrosis (distinguishing it from other interstitial lung diseases).

4. Airspace Coalescence

  • Adjacent alveoli merge due to septal destruction → formation of bullae or blebs (especially in paraseptal emphysema).

5. Inflammatory Infiltrate

  • Mild to moderate infiltration by macrophages, neutrophils, and CD8+ T cells.

 Macroscopic (Gross) Features of Emphysema

1. Overinflated (Hyperexpanded) Lungs

  • Lungs appear large, pale, and voluminous.

  • They may overlap the heart and protrude out of the rib cage.

2. Loss of Normal Lung Elasticity

  • Lungs feel softer and more pliable than normal.

3. Large Subpleural Bullae or Blebs

  • Most evident in paraseptal emphysema.

  • These air-filled spaces can rupture, causing spontaneous pneumothorax.

4. Dilated Airspaces

  • CThe cutsurface shows large open spaces where normal alveoli should be.

Types of Emphysema with Morphological Notes

Type Area Affected Common Cause Gross/Microscopic Feature
Centriacinar Central parts of acinus (respiratory bronchioles) Smoking Mostly in upper lobes, black pigment, sparing of distal alveoli
Panacinar Entire acinus α1-antitrypsin deficiency Uniform destruction, mainly in lower lobes
Paraseptal Distal part of acinus near pleura Unknown or idiopathic, common in tall young males Subpleural bullae, risk of pneumothorax
Irregular Irregular acinus involvement Associated with scarring Asymptomatic, often incidental finding

 Summary

Morphology of emphysema involves:

  • Enlarged airspaces

  • Destruction of alveolar walls

  • No fibrosis

  • Bullae and blebs in advanced stages

  • Hyperinflated lungs on gross examination


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