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. 2015 Jul;84(7):1413-8.
doi: 10.1016/j.ejrad.2015.03.010. Epub 2015 Mar 18.

Paraseptal emphysema: Prevalence and distribution on CT and association with interstitial lung abnormalities

Tetsuro Araki  1 , Mizuki Nishino  2 , Oscar E Zazueta  3 , Wei Gao  4 , Josée Dupuis  5 , Yuka Okajima  2 , Jeanne C Latourelle  6 , Ivan O Rosas  3 , Takamichi Murakami  7 , George T O'Connor  8 , George R Washko  3 , Gary M Hunninghake  3 , Hiroto Hatabu  2
Affiliations

Paraseptal emphysema: Prevalence and distribution on CT and association with interstitial lung abnormalities

Tetsuro Araki et al. Eur J Radiol. 2015 Jul.

Abstract

Objective: To investigate the prevalence and distribution of paraseptal emphysema on chest CT images in the Framingham Heart Study (FHS) population, and assess its impact on pulmonary function. Also pursued was the association with interstitial lung abnormalities.

Materials and methods: We assessed 2633 participants in the FHS for paraseptal emphysema on chest CT. Characteristics of the participants, including age, sex, smoking status, clinical symptoms, and results of pulmonary function tests, were compared between those with and without paraseptal emphysema. The association between paraseptal emphysema and interstitial lung abnormalities was investigated.

Results: Of the 2633 participants, 86 (3%) had pure paraseptal emphysema (defined as paraseptal emphysema with no other subtypes of emphysema other than paraseptal emphysema or a very few centrilobular emphysema involved) in at least one lung zone. The upper zone of the lungs was almost always involved. Compared to the participants without paraseptal emphysema, those with pure paraseptal emphysema were significantly older, and were more frequently male and smokers (mean 64 years, 71% male, mean 36 pack-years, P<0.001) and had significantly decreased FEV1/FVC% (P=0.002), and diffusion capacity of carbon monoxide (DLCO) (P=0.002). There was a significant association between pure paraseptal emphysema and interstitial lung abnormalities (P<0.001).

Conclusions: The prevalence of pure paraseptal emphysema was 3% in the FHS population, predominantly affects the upper lung zone, and contributes to decreased pulmonary function. Cigarette smoking, aging, and male gender were the factors associated with the presence of paraseptal emphysema. Significant association between paraseptal emphysema and interstitial lung abnormalities was observed.

Keywords: CT; Interstitial lung abnormalities; Paraseptal emphysema.

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Figures

Figure 1
Figure 1
Paraseptal emphysema in a 54-year-old male smoker. (a) A trans-axial CT image shows subpleural low-attenuation areas predominantly in medial to posterior margin of lung parenchyma with interlobular septa. (b) A coronal reconstructed image shows the involvement of upper and middle lung zones with paraseptal emphysema. The participant reported no respiratory symptoms.
Figure 1
Figure 1
Paraseptal emphysema in a 54-year-old male smoker. (a) A trans-axial CT image shows subpleural low-attenuation areas predominantly in medial to posterior margin of lung parenchyma with interlobular septa. (b) A coronal reconstructed image shows the involvement of upper and middle lung zones with paraseptal emphysema. The participant reported no respiratory symptoms.
Figure 2
Figure 2
Coexistence of paraseptal emphysema and interstitial lung abnormalities in a 75-year-old female participant. (a) A trans-axial CT image at the upper zone shows subpleural low-attenuation lesions anteriorly (arrows), which is compatible to mild paraseptal emphysema. (b) Another trans-axial CT image at the lower lung zone shows subpleural ground-glass and reticular opacities extending lateral to anterior areas. The participant reported no respiratory symptoms but pulmonary function test revealed airflow obstruction.
Figure 2
Figure 2
Coexistence of paraseptal emphysema and interstitial lung abnormalities in a 75-year-old female participant. (a) A trans-axial CT image at the upper zone shows subpleural low-attenuation lesions anteriorly (arrows), which is compatible to mild paraseptal emphysema. (b) Another trans-axial CT image at the lower lung zone shows subpleural ground-glass and reticular opacities extending lateral to anterior areas. The participant reported no respiratory symptoms but pulmonary function test revealed airflow obstruction.
See this image and copyright information in PMC

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