CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH EMPHYSEMA AND GIANT BULLAE IN A SMOKER

Radiation diagnosis in evaluating chronic obstructive pulmonary disease (COPD) is used to distinguish clinically similar diseases and to identify concomitant pathological changes. Highresolution computed tomography (HRCT) is employed for detailed analysis of the status of the lung. HRCT can visualize primarily centrilobular, panlobular, paraseptal, and bullous emphysema and bronchiectases, is of great importance in the anatomical characteristics of the disease and in the identification of the phenotype of COPD.

The paper describes a clinical case of COPD with bullous emphysema in a 60-year-old man. The CT pattern presents with lower-density bilateral multiple centrilobular avascular areas without clear boundaries, as well as by paraseptal emphysema areas, also localized mainly in the lower segments of both lungs, with thin-walled air cavities occupying up to one third of the hemithorax on both sides. CT made it possible to visualize upperlobular centrolobular emphysema, pulmonary bullae, to estimate their sizes, and to identify compression atelectasis in the adjacent lung areas. The differential diagnosis included bronchiectasis disease, histiocytosis X, and lung carcinoma.

This clinical case demonstrates that HRCT is the method of choice for differential diagnosis, a follow-up, and assessment of the results of treatment for COPD with a preponderance of bullous emphysema, including in the presence of a doubtful radiographic pattern.

1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available at: http://goldcopd.org (accessed 25 September 2017).

2. Lang M.R., Fiaux G.W., Gillooly M. et al. Collagen content of alveolar wall tissue in emphysematous and non-emphysematous lungs. Thorax. 1994; 49: 319–26.

3. Тюрин И.Е. Визуализация хронической обструктивной болезни легких. Практическая пульмонология. 2014; 2: 40–6. [Tyurin I.E. Medical visualization of chronic obstructive pulmonary disease. Prakticheskaya Pulmonologiya (Practical Pulmonology). 2014; 2: 40–6 (in Russ.).]

4. Розенштраух Л.С., Виннер М.Г. Дифференциальная рентгенодиагностика заболеваний органов дыхания. М.; 1991. [Rozenshtraukh L.S., Vinner M.G. Differential X-ray diagnostics of lung diseases. Moscow; 1991 (in Russ.).]

5. Lynch D.A., Austin J.H., Hogg J.C., Grenier P.A., Kauczor H.U., Bankier A.A. et al. CT-definable subtypes of chronic obstructive pulmonary disease: a statement of the Fleischner Society. Radiology. 2015; 277 (1): 192–205. DOI: 10.1148/radiol.2015141579

6. Thurlbeck W.M., Müller N.L. Emphysema: definition, imaging, and quantification. Am. J. Roentgenol. 1994; 163: 1017–25.

7. Burgener F.A. Differential diagnosis in computed tomography. 2nd ed. Stuttgart, New York; 2012.

8. Mathers C.D., Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3 (11): e442. DOI: 10.1371/journal.pmed.0030442

9. Lamprecht B., McBurnie M.A., Vollmer W.M. et al. COPD in never smokers: results from the population-based burden of obstructive lung disease study. Chest. 2011; 139(4): 752–63.

10. Власов П.В., Кармазановский Г.Г., Шейх Ж.В., Вилявин М.Ю. Кисты и кистоподобные образования легких. Медицинская визуализация. 2005; 1: 82–94. [Vlasov P.V., Karmazanovskiy G.G., Sheykh Zh.V., Vilyavin M.Yu. Cysts and cyst-like lesions of lungs. Meditsinskaya Vizualizatsiya (Medical Visualization). 2005; 1: 82–94 (in Russ.).]

11. Власов П.В., Нуднов Н.В., Шейх Ж.В. Компьютерно-томографическая семиотика в пульмонологии. Медицинская визуализация. 2010; 6: 75–83. [Vlasov P.V., Nudnov N.V., Sheykh Zh.V. CT features in pulmonology. Meditsinskaya Vizualizatsiya (Medical Visualization).2010; 6: 75–83 (in Russ.).]

12. Яковлев В.Н., Араблинский А.В., Шейх Ж.В., Федченко Г.Г., Дунаев А.П., Котельникова У.В. и др. Полостные и кистозные образования в легких. Медицинская визуализация. 2012; 2: 44–51. [Yakovlev V.N., Arablinskiy A.V., Sheykh Zh.V., Fedchenko G.G., Dunaev A.P., Kotel’nikova U.V. et al. Cavitary and cyst-like lesions in lungs. Meditsinskaya Vizualizatsiya (Medical Visualization). 2012; 2: 44–51 (in Russ.).]

13. Яковлев В.Н., Шейх Ж.В., Араблинский А.В., Алексеев В.Г., Синопальников А.И., Дунаев А.П., Дребушевский Н.С. Диагностика полостных образований легких. Клиническая медицина. 2012; 7: 59–61. [Yakovlev V.N., Sheykh Zh.V., Arablinskiy A.V., Alekseev V.G., Sinopal’nikov A.I., Dunaev A.P., Drebushevskiy N.S. Diagnostics of cavitary lesions of lungs. Klinicheskaya Meditsina (Clinical Medicine). 2012; 7: 59–61 (in Russ.).]

14. Котельникова У.В., Федченко Г.Г., Яковлев В.Н., Шейх Ж.В., Дунаев А.П., Араблинский А.В. и др. Значимость спиральной компьютерной томографии и эндоскопии в диагностике пневмонии у больных хроническим бронхитом. Материалы VI Всероссийского национального конгресса лучевых диагностов и терапевтов «Радиология – 2012». Российский электронный журнал лучевой диагностики. 2012; 2 (2, Прил.): 263–4. [Kotel’nikova U.V., Fedchenko G.G., Yakovlev V.N., Sheykh Zh.V., Dunaev A.P., Arablinskiy A.V. et al. Value of SCT and endoscopy in diagnostics of pneumonia and chronic bronchitis. Abstract of VI Russian National Congress of Radiologists and Radiotherapists “Radiologiya – 2012”. Rossiyskiy Elektronnyy Zhurnal Luchevoy Diagnostiki (Russian Electronic Journal of Radiology). 2012; 2 (2, Suppl.): 263–4 (in Russ.).]