Images in Clinical Medicine
Centrilobular Emphysema with Predominantly Upper-Lobe Involvement
N Engl J Med 2003; 348:2091May 22, 2003
- Article
Video
Color-Enhanced, Three-Dimensional, Volume-Rendered Image.
A 57-year-old man with severe, disabling end-stage emphysema presented for enrollment in the National Emphysema Treatment Trial. After the completion of pulmonary rehabilitation, he was randomly assigned to the surgery group. Before surgery, the patient was able to walk only 100 to 200 yd (91 to 183 m) on level ground because of dyspnea and could not perform the activities of daily living. Preoperative axial computed tomography showed severe, heterogeneous emphysema that predominantly affected the upper lobes. Color-enhanced, three-dimensional, volume-rendered imaging was used, in which areas in the lungs that are less than or equal to –1000 Hounsfield units (indicative of the presence of emphysematous tissue) appear dark blue, whereas normal-density lung tissue appears whitish orange. This method showed, in this case, a marked predilection of the emphysema for the upper lobes. (A video clip of the volume-rendered image is available, courtesy of the 3D and Image Processing Center of Brigham and Women's Hospital, with the full text of this article at http://www.nejm.org.) The patient underwent bilateral video-assisted thoracoscopic surgery, with resection of the majority of the right upper lobe. One year later, the patient was able to walk a little more than 1 mi (1.6 km).
Andetta R. Hunsaker, M.D.
John J. Reilly, M.D.
Brigham and Women's Hospital, Boston, Massachusetts 02115
