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Panlobüler amfizem

Panlobular emphysema

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Panlobüler amfizem: yayımlanmış olgu görüntüsü, aksiyel kesit
Görüntü konuyu kısmen gösteriyor; bulgunun bir bölümü seçilebilir.

4 adım

Görüntü: Oikonomou A, Prassopoulos P., “Mimics in chest disease: interstitial opacities.” 2013, Fig. 43. PMC3579994 · doi:10.1007/s13244-012-0207-7 · CC BY-NC 4.0. Değişiklik: yeniden boyutlandırıldı.

Özet

Panlobüler amfizem, sekonder pulmoner lobül boyunca yaygın alveoler yıkımla seyreder; lobülün normal yapıları silikleşebilir. Alt lob baskınlığı görülebilir ve alfa-1 antitripsin eksikliğiyle ilişkilidir, ancak BT dağılımı tek başına etiyolojiyi kanıtlamaz. İnce kesit inspiratuvar BT’de geniş veya yaygın düşük atenüasyon alanları ve damar dallarında seyrelme görülebilir. Hafif hastalıkta korunmuş parankimle yoğunluk farkı silik kalabileceğinden, bulgunun atlanması amfizem yaygınlığının olduğundan az değerlendirilmesine yol açabilir.

Faz ve pencere

HRCT tanısal
İnspirasyonda ince kesit akciğer görüntülerinde sekonder pulmoner lobül boyunca yaygın düşük atenüasyon ve o alanda seyrelmiş damar dalları aranır; alt loblarda belirgin olabilir. Panlobüler amfizem paterninin değerlendirilmesinde HRCT kullanılabilir.

Önerilen pencereler: Akciğer (G 1500 / M -600).

BT bulguları

  • Panlobüler (panasiner) amfizemde asinüsün respiratuvar bronşiollerden alveollere uzanan bölümleri homojen biçimde genişler; HRCT’de sekonder pulmoner lobül boyunca panlobüler ya da belirsiz yaygın düşük atenüasyon görülebilir.
  • Yaygın parankim yıkımında korunmuş akciğerle yoğunluk farkı sentrilobüler küçük odaklardakinden daha az çarpıcı olabilir.
  • Alt lob ve bazal zonlarda belirginleşme klasik dağılımdır; tüm hastalarda bu dağılım görülmez.
  • Yıkımın bulunduğu bölgelerde periferal pulmoner damarlar incelmiş ve seyrek görünür (pruning).
  • İleri evrede küçük lobüler odaklar birleşerek geniş alanlı parankim lucensisine dönüşebilir.
  • Panlobüler amfizemde HRCT’de lobüler düşük atenüasyon veya belirsiz yaygın düşük atenüasyon görülebilir.

Ölçütler ve sınıflamalar

Sekonder lobüle göre anatomik amfizem alt tipi
Panlobüler amfizem asinüs boyunca homojen hava boşluğu genişlemesiyle, sentrilobüler tip sekonder lobül merkezindeki genişlemeyle, paraseptal tip ise plevra komşuluğundaki pulmoner lobüllerin etkilenmesiyle tanımlanır. Panlobüler yıkım BT’de sekonder pulmoner lobül boyunca yaygın düşük atenüasyon şeklinde izlenebilir.

Normalde

Normal alt loblarda sekonder pulmoner lobüller arasında benzer parankim atenüasyonu ve düzenli dallanan pulmoner damar yapısı korunur. İki alt lobu ve şüpheli alanın merkez-perifer dağılımını karşılaştırın; panlobüler yıkımda düşük atenüasyon lobülün tamamına yayılabilir ve damar dalları seyrekleşebilir.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s1278; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Sentrilobüler amfizem
respiratuvar bronşiol çevresindeki merkezî lucensiler ve aralarda kalan korunmuş lobüler parankim ayırıcıdır.
Paraseptal amfizem
plevra veya interlobüler septa boyunca dizilen subplevral hava boşlukları ön plandadır.
Obliteratif bronşiolit
HRCT’de azalmış atenüasyon veya mozaik atenüasyon paterniyle görülebilir.
Pulmoner Langerhans hücreli histiyositoz
nodüler veya kistik lezyonlarla ve sigara öyküsüyle ilişkili olabilir.
Obliteratif bronşiolitte mozaik atenüasyon görülebilir; panlobüler amfizem de azalmış atenüasyonla izlenebildiğinden, düşük atenüasyon tek başına bu iki durumu ayırt ettirmez.

Tuzaklar

  • Alfa-1 antitripsin eksikliği bazal baskın panlobüler amfizemle ilişkilidir.
  • BT'de teknik ve hasta etmenleri yalancı bulgulara yol açabileceğinden, akciğer yoğunluğunu teknik kaliteyi dikkate alarak değerlendirin.
  • Ağır sentrilobüler yıkım birleşerek tüm lobüle yayılmış izlenimi verebilir; damar-bronşiol merkezindeki küçük korunmuş adacıkları ara.
  • Hafif panlobüler değişiklikte lobüler sınır ve normal akciğerle kontrast silik olabilir; tek bir küçük alan yerine seri kesitlerdeki damar örüntüsünü izle.

Kendini dene

  1. Sekonder pulmoner lobül boyunca homojen hava boşluğu genişlemesi hangi amfizem alt tipini tanımlar?

    Cevabı göster

    Panlobüler amfizem. Panlobüler amfizemde hava boşlukları sekonder pulmoner lobül boyunca homojen genişler; sentrilobüler tip lobül merkezinde, paraseptal tip plevra komşuluğundaki lobüllerde tanımlanır.

  2. Alfa-1 antitripsin eksikliğiyle klasik olarak ilişkilendirilen amfizem paterni hangisidir?

    Cevabı göster

    Bazal baskın panlobüler amfizem. Kaynak, alfa-1 antitripsin eksikliğinde bazal baskın panlobüler amfizem paternini tanımlar. Sentrilobüler ve paraseptal paternler farklı anatomik dağılımlarla tanımlanır.

İlgili konular

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 10 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.