(4) irregular emphysema – lung is scarred for some other reason Þ inflammatory cells in this region give up abundant amount of elastases Þ elastic destruction adjacent to the area of fibrosis.associated with spontaneous pneumothorax of young adults.seen most commonly along the posterior/anterior margins of the upper lung. (3) distal acinar emphysema (paraseptal) – dilatation of the distal 3 rd respiratory bronchioles, alveolar ducts and sacs.may be seen more commonly in IV drug users.most common form is familial emphysema associated with a 1 antitrypsin abnormalities.more severe in lower zones of the lung bilaterally.(2) panacinar emphysema (panlobular) – destruction throughout the acinus, generally distal to the terminal bronchioles.can be seen in coal workers’ pneumoconioses.most common form of emphysema associated with symptomatic COPD.more severe in the upper zones of the lung bilaterally.(1) proximal acinar emphysema (centrilobular) – loss of elastic tissue in proximal part of acinus (respir.histologically see big holes which result from loss of elastic tissue by the elastases.elastases are found in macrophages (majority) or PMNs – cigarette smoke stimulates elastase release.
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