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American Journal of Roentgenology, Vol 100, 374-396, Copyright © 1967 by American Roentgen Ray Society

VASCULAR CHANGES IN PULMONARY EMPHYSEMA

THE RADIOLOGIC EVALUATION BY SELECTIVE AND PERIPHERAL PULMONARY WEDGE ANGIOGRAPHY

G. JACOBSON M.D.1, A. F. TURNER M.D.1, O. J. BALCHUM M.D.2, and R. JUNG M.D.2

1 From Department of Radiology, Los Angeles County General Hospital and University of Southern California School of Medicine, Los Angeles, California
2 From Department of Medicine, Los Angeles County General Hospital and University of Southern California School of Medicine, Los Angeles, California

The pulmonary vasculature has been studied in patients with emphysema by selective pulmonary and peripheral pulmonary wedge angiography. Six cases are described in detail illustrating the range of changes which may be encountered. These are: differential blood flow; dilatation of the main pulmonary artery and its major branches and increased attenuation of the larger peripheral arteries; reduction in the number of smaller peripheral arteries, arterioles and veins; obliteration of the capillary bed; and arteriovenous shunts. The extent of involvement may vary greatly from one segment of lung to another with one area being normal and the other markedly abnormal.

The plain roentgenogram of the chest in patients with emphysema may be normal. Hyperinflation and air-trapping are nonspecific findings and may be entirely absent. Reduction in the peripheral pulmonary vessels, the most reliable roentgenologic evidence of emphysema may not be detectable on the chest roentgenogram even though advanced vascular changes are present.

Selective pulmonary angiography and peripheral pulmonary wedge angiography provide the only roentgenologic means of assessing, with a reasonable degree of accuracy, the vascular damage in patients with emphysema. Knowledge of the extent of permanent vascular damage is of great importance in determining the prognosis which can be offered the patient and the improvement which maxy be expected from therapeutic measures.


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Copyright © 1967 by the American Roentgen Ray Society.