Radiograma de tórax e tomografia computadorizada na avaliação do enfisema pulmonar

Abstract

Emphysema is a condition of the lung, characterized by the abnormal increase in the size of the airspace distal to the terminal bronchioles. Currently, emphysema is the fourth leading cause of death in the USA, affecting 14 million people. The present article describes the principal tools in the imaging diagnosis of emphysema, from the early days until the present. We describe traditional techniques, such as chest X-ray, together with the evolution of computed tomography (CT) to more advanced forms, such as high resolution CT, as well as three-dimensional CT densitometry and volumetric assessment.

O tórax e o envelhecimento: manifestações radiológicas

“…(22) thickening, and bronchiectasis. (14,15) In patients with COPD, age is a factor that certainly contributes to disease progression. However, the individual roles of age and COPD in barrel chest cannot be determined by imaging tests.…”

Chest radiography and CPOD

“…Chronic obstructive pulmonary disease is the fifth leading cause of admission of patients above the age of 40 to the public health system in Brazil -196,698 admissions into hospital per year, and expenditures of approximately 72 million Reais (1)(2)(3)(4)(5) .…”

“…Such anatomopathological alterations which are caused principally by smoking are found in varibale proportions among individuals affected by the disease, in correlation with clinical manifestations. Pulmonary emphysema (an injury that predominates in the lung parenchyma) and chronic bronchitis (injury affecting principally bronchi and bronchioles) represent the extreme manifestations of such alterations (1)(2)(3)(4)(5) . The correlation between pathological anatomy and radiology in the investigation of enphysema is based on the concept that "excessive transparency at radiology results from an increased volume of air in relation to the amount of pulmonary tissues and blood which X-ray bemams encounter on its way" (1)(2)(3)(4)(6)(7)(8)(9) .…”

“…The performance of plain radiography in the investigation of COPD is quite limited since in the absence of air trapping abnormalities cannot be detected on the image (1)(2)(3)(4)(10)(11)(12) . In such cases, the main alteration corresponds to decreased vasculature which is only noticeable very belatedly in the natural course of disease, besides representing an extremely subjective criterion.…”

“…In the presence of air trapping, the most reliable criteria include: 1. lowered or rectified diaphragm, below and anterior to the sixth intercostal space at maximum inspiration; 2. increased retrosternal clear space (> 3 cm), with persistence at expiration; 3. elongated and verticalized heart, with largest cross-sectional diameter of < 11.5 cm, remaining tapered even with the increase in the right ventricle; 4. the presence of air bubbles may be inferred by the identificaiton of an avascular area of greater radiotransparency, either delimited or not by a thin white line (1)(2)(3)(4)(10)(11)(12) .…”