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Centriacinar Emphysema

Etiology: • Cigarette smoking responsible for vast majority of centriacinar emphysema

Pathogenesis: • At terminal bronchiole level air flow suddenly diminishes dropping particulates into adjacent alveoli • Neutrophil and macrophage elastases turned on by particulates or other components of smoke • Septal destruction secondary to excess elastase and protease activity

Epidemiology: • Men who smoke heavily • Develops over many years becoming clinically significant in later life

General Gross Description: • Centrilobular or smoker1s emphysema shows air space enlargement mixed with normal airspaces • Largest spaces found in upper portions of all lobes • Black discoloration of walls of spaces • Bronchovascular structures stand out from the parenchyma due to loss of parenchymal tissue • Pillowy soft lungs that may cover the heart

General Microscopic Description: • Enlarged air spaces with broken septae in the central portion of the acinus around the terminal bronchiole • Septal tips have blunt ends • Little fibrosis • Many carbon laden macrophages

Clinical Correlations: • Patients with pure emphysema develop progressive dyspnea and weight loss due to loss of oxygen delivery to periphery. • 3Pink puffer2 with slowed forced expirations

References: • Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of Disease. 5th edition. W.B. Saunders.Philadelphia 1994. pp.683-7.