Learning objectives
To review surgical or bronchoscopic treatment for severe emphysema.
To describe preoperative characterization of emphysema by HRCT and to define the specific abnormalities that guide the choice of optimal procedure.
To show the regular morphological changes that follow the procedures and to describe the complications as detected by chest x-ray and HRCT.
Background
COPD is characterized by incompletely reversible expiratory airflow obstruction,
and its severity is rated according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification,
which defines four stages of disease,
according to the post-bronchodilator airflow limitation.
HRCTallows the categorization of COPD patients into subtypes that are distinguished accordingly to differentstructural and functional alterations [1];two main phenotypes are described,
namelybronchitic or emphysematous.
Bronchitic COPD has worse prognosis because of the high frequency of exacerbation.
Conversely,
emphysematous COPD is more stable,
although poorly treatable.
Indeed,...
Findings and procedure details
1.
Lung volume reduction surgery (LVRS)
The surgical removal of emphysematous tissue has the purpose of revert ventilation in residual healthy parenchyma [2],
specifically in patients suffering from upper-lobes predominant emphysema (Fig.
1); therefore,
the pre-operative assessment of emphysema through visual scoring or by quantitative analysis of CT images is needed; the latter precisely calculates the percentage of emphysematous tissue,
thus guiding the correct strategy [3].
Two different surgical approaches can be performed,
namely the video-assisted thoracoscopic surgery (VATS) and the median sternotomy (MS) surgery...
Conclusion
Radiologists should be familiar with HRCT imaging aspects related to this noninvasive treatment option for pulmonary emphysema,
which are being increasingly performed in referral centers.
Personal information
Gianluca Milanese
Division of Radiology,
Department of Surgical Sciences,
University of Parma,
Parma,
Italy
[email protected]
Mario Silva
Division of Radiology,
Department of Surgical Sciences,
University of Parma,
Parma,
Italy
[email protected]
Andrea Borghesi
Department of Radiology,
University of Brescia,
Brescia,
Italy
[email protected]
Michela Bezzi
Interventional Pulmonology,
Careggi University Hospital,
Florence,
Italy
[email protected]
Martina Bonifazi
Pulmonary Diseases Unit,
Department of Internal Medicine,
Azienda Ospedaliero-Universitaria "Ospedali Riuniti",
Ancona,
Italy.
Department of Biomedical Sciences and Publich Health,
Università Politecnica delle Marche,
Ancona,
Italy
[email protected]
Mauro Novali
Cattedra di Malattie...
References
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Brantigan OC,
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A surgical approach to pulmonary emphysema.
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Coxson HO,
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et al.
Selection of patients for lung volume reduction surgery using a power law analysis of the computed tomographic scan....