The Radiological Spectrum of Aging and Emphysematous Lungs

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Abstract

Emphysema of the lungs is becoming recognized as the most common condition to produce pulmonary disability in later life (37). Recently changing clinical and pathologic concepts (20, 24, 29, 30, 36) point up the need for re-evaluation of the classic criteria of radiologic interpretation. A variety of diagnostic methods, including history, physical examination, radiographic studies, and various pulmonary function tests are used in the appraisal of emphysematous patients. Limitations in the reliability of history and physical findings are considered elsewhere (31). Pulmonary function tests are valuable in assessing the degree of functional impairment (14), but in many instances are not as readily available as radiography. Accordingly, a study was performed to ascertain the radiologic features of emphysematous and normal aging subjects on plain films, the ability of competent observers to detect such changes, and the reliability of present criteria in differentiating aging and emphysematous patients. This work is one part of a continuing multi-disciplinary study of emphysema (1–6, 31). Emphysema is derived from the Greek word “emphysao” which means “inflate” or “blow up” (38). With the development of more precise knowledge of pulmonary pathology and physiology, the term pulmonary emphysema has come to refer to “obstructive lung disease” of a chronic nature (25). This is reflected in the recent definition by the American Thoracic Society (35): “Emphysema is an anatomic alteration of the lung characterized by an abnormal enlargement of the air spaces distal to the terminal non-respiratory bronchiole accompanied by destructive changes in the alveolar walls.” Hyperinflation (overinflation) is a general term which refers to overdistention of the lungs from any cause (35). Hyperinflation is characterized by enlargement and rounding of the thorax and compression and displacement of surrounding structures (5, 19,28). Although hyperinflation may be a manifestation of pulmonary emphysema, it may also be observed in normal subjects with a large vital capacity, as a manifestation of the normal aging process, and in asthma or any other condition producing airway obstruction. Physiologic aging changes, e.g., the barrel configuration of the chest, may suggest emphysema (Figs. 1 and 2) and yet be associated with no significant physiologic or pathologic alteration (18, 23, 28). These patients are sometimes reported on radiographic examination of the chest as having senile emphysema which, according to the current definition of emphysema, is a misnomer. Therefore, the extent to which normal aging changes could be differentiated radiographically from emphysema was considered. Methods and Materials The evaluation of radiographic signs and diagnosis reported here was based on the interpretation of radiographs of aging and emphysematous patients as practiced in the daily routine of physicians devoting full time to radiology.

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