Since pneumothorax is free in the pleural cavity, emphysema bullous is a trapped air within the lung
parenchyma. There is no hairline demarcation and if it is there it is incomplete.
The bullous may be crossed by streaks of lung tissue. Compare the widening of
the intercostal spaces opposite the bullous area with the others on the same side.
Notice the pressure effect on the diaphragm and on the mediastinal structures due to
presence of ephysematous bullous.
N:B See pneumothorax in the information section and review the cases of emphysema
in the case gallery. Case17, case22, case26 and case27.
Notice also the following x-ray images, x-ray1 and x-ray2.
Increase beyonf normal in the size of air spaces distal to the terminal broncioles arising from destruction of their walls.
**(WHO –AMERICAN THORACIC SOCIETY)
· Dilated air spaces, bridges of alveolar sepate.
· Segmentation and disorganization of the bronchial cartilages with muscular papillary infoldings.
Etiology of Emphysema
1. Natural aging process
2. Air retention due to one way valve mechanism operating in the bronchus.
3. Protease- Anti protease theory