A 55-year-old male smoker presents with progressive dyspnea. Chest CT shows centrilobular areas of low attenuation without definable walls, predominantly in the upper lobes, with no interstitial thickening. Which pattern best describes this finding?
- A Paraseptal emphysema
- B Centrilobular emphysema ✓
- C Panlobular emphysema
- D Irregular scar emphysema
Correct answer: B. Centrilobular emphysema
Explanation
Centrilobular emphysema is the most common type associated with cigarette smoking and shows foci of lucency centered on the secondary pulmonary lobule, predominantly in the upper lobes, without visible walls on CT. Paraseptal emphysema involves the peripheral subpleural lobules and is associated with spontaneous pneumothorax. Panlobular emphysema is uniform destruction of the entire lobule, classically seen in alpha-1 antitrypsin deficiency and involves lower lobes preferentially.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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