Panlobular and Centrilobular Emphysema

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Abstract
The clinical histories of over 194 cases are correlated with the type and extent of emphysema found in post-mortem lung macrosections. The macrosections were separated into panlobular and centrilobular types and the percentage of emphysema determined from the sections. The cases were divided into 4 groups: patients dying of emphysema alone; of other disease in which emphysema contributed to death; of other disease but with symptoms of emphysema; and of other disease in which no symptoms were present prior to death. About 20% of the lung is emphysematous before symptoms occur, and when 50% is involved death may result. The cases dying of emphysema alone show that cough begins on the average at age 53, and after 5 years dyspnea on exertion appears, followed in 7 years by cardiac failure leading to death at the average age of 68. Four types of onset are recognized: (1) Insidious[long dash]with cough preceding dyspnea on exertion by several years. (2) "Cardiac"[long dash]with dyspnea coming on abruptly, and frequently accompanied by cardiac failure. (3) Asthmatic[long dash]with typical asthmatic attacks for many years before persistent dyspnea on exertion appears. (4) Pneumonic[long dash]with persistent dyspnea on exertion coming on directly following an episode of pneumonia. Clinical differences between panlobular and centrilobular emphysema are not clear-cut but the centrilobular case is usually thin, his heart small, blood pressure low, and the onset insidious. Panlobular cases often have a cardiac onset, are more obese, have higher blood pressure levels, larger hearts, and more frequent cardiac failure. Right ventricular hypertrophy is more common, and the total lung capacity is usually greater in panlobular than in centrilobular emphysema.

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