How does giant compressive emphysema develop as a complication of COVID-19. What are the symptoms, diagnostic methods, and treatment options for this rare condition. How does giant emphysema impact the prognosis of severe COVID-19 patients.

Understanding Giant Compressive Emphysema in COVID-19

Giant compressive emphysema (GCE) is an uncommon but potentially severe complication that can occur in patients with COVID-19 pneumonia. This condition involves the formation of an abnormally large air-filled space in the lung that compresses surrounding tissues. While emphysema is typically associated with chronic lung diseases, its occurrence in COVID-19 patients without pre-existing respiratory conditions presents a unique clinical challenge.

What is Giant Compressive Emphysema?

Giant compressive emphysema refers to an extremely large emphysematous bulla or air-filled space in the lung, typically measuring over 10 cm in diameter. In the context of COVID-19, this complication can develop rapidly and cause significant respiratory distress by compressing healthy lung tissue and displacing mediastinal structures.

How does GCE differ from typical emphysema?

• Size: GCE involves much larger air spaces than typical emphysema
• Onset: Can develop acutely in COVID-19 rather than chronically
• Compression: Causes significant compression of surrounding structures
• Patient profile: Can occur in younger patients without lung disease history

Pathophysiology of Giant Emphysema in COVID-19

The exact mechanisms leading to giant emphysema in COVID-19 patients are not fully understood. However, several factors likely contribute to its development:

Potential mechanisms of GCE formation in COVID-19:

1. Severe inflammation and tissue damage from viral infection
2. Alveolar rupture due to increased respiratory effort
3. Altered lung compliance and air trapping
4. Possible weakening of lung tissue structure by the virus
5. Cytokine storm leading to excessive tissue breakdown

The SARS-CoV-2 virus may cause direct damage to alveolar walls and surrounding tissues, creating weakened areas prone to air trapping and expansion. The intense inflammatory response seen in severe COVID-19 cases could further contribute to tissue destruction and remodeling, potentially leading to the formation of large air-filled spaces.

Clinical Presentation and Diagnosis of GCE in COVID-19

Recognizing giant compressive emphysema as a complication of COVID-19 requires a high index of suspicion, especially in patients experiencing worsening respiratory symptoms or chest pain. The clinical presentation may include:

Common symptoms of GCE in COVID-19 patients:

• Sudden onset or worsening of dyspnea
• Chest pain, often pleuritic in nature
• Tachypnea and increased work of breathing
• Decreased oxygen saturation
• Tympanic percussion note over the affected area

Diagnosis of giant compressive emphysema relies heavily on imaging studies, particularly computed tomography (CT) scans. CT imaging allows for accurate visualization of the emphysematous space, its size, and its impact on surrounding structures.

Key diagnostic features on CT imaging:

1. Large air-filled space, typically > 10 cm in diameter
2. Compression of adjacent lung parenchyma
3. Mediastinal shift towards the contralateral side
4. Flattening or inversion of the ipsilateral hemidiaphragm
5. Associated ground-glass opacities or consolidations typical of COVID-19 pneumonia

Treatment Approaches for Giant Compressive Emphysema in COVID-19

Managing giant compressive emphysema in the context of COVID-19 presents unique challenges. Treatment strategies must address both the underlying viral infection and the mechanical complications of the emphysema. The approach typically involves a combination of medical management and potential surgical intervention.

Medical management options:

• Oxygen therapy to maintain adequate saturation
• Corticosteroids to reduce inflammation
• Antibiotics to prevent secondary bacterial infections
• Anticoagulation to reduce risk of thrombotic events
• Bronchodilators if bronchospasm is present

In cases where medical management is insufficient or the emphysema causes severe compression, surgical intervention may be necessary. The timing and type of intervention depend on the patient’s overall condition and the severity of compression.

Surgical and interventional options:

1. Chest tube drainage for initial decompression
2. Video-assisted thoracoscopic surgery (VATS) for bulla resection
3. Open thoracotomy for complex cases
4. Endobronchial valve placement in selected patients

The decision to pursue surgical intervention must carefully weigh the potential benefits against the risks, particularly in critically ill COVID-19 patients.

Prognosis and Long-term Outcomes

The development of giant compressive emphysema in COVID-19 patients often signals a poor prognosis, particularly when occurring in the context of severe or critical disease. The condition can lead to prolonged hospitalization, increased need for mechanical ventilation, and higher mortality rates.

Factors influencing prognosis:

• Severity of underlying COVID-19 pneumonia
• Size and location of the emphysematous space
• Degree of compression on surrounding structures
• Timing of diagnosis and intervention
• Patient’s overall health and comorbidities

Long-term outcomes for survivors of giant compressive emphysema in COVID-19 remain unclear due to the novelty of this complication. Many patients may require extended rehabilitation and ongoing respiratory support, including long-term oxygen therapy.

Prevention and Risk Reduction Strategies

While it may not be possible to completely prevent the occurrence of giant compressive emphysema in COVID-19 patients, certain strategies may help reduce the risk or mitigate the severity of this complication:

Potential risk reduction approaches:

1. Early diagnosis and treatment of COVID-19 to prevent severe lung damage
2. Careful management of mechanical ventilation to avoid barotrauma
3. Regular monitoring of lung compliance and airway pressures
4. Prompt investigation of sudden changes in respiratory status
5. Consideration of prone positioning to improve ventilation distribution

Ongoing research into the pathophysiology of COVID-19 lung injury may reveal additional preventive strategies in the future.

Future Research Directions and Unanswered Questions

The occurrence of giant compressive emphysema as a complication of COVID-19 raises several important questions and areas for future research:

Key areas for investigation:

• Molecular mechanisms of lung tissue destruction in COVID-19
• Genetic or environmental factors predisposing to GCE development
• Optimal timing and methods for surgical intervention
• Long-term pulmonary function outcomes in survivors
• Potential role of antifibrotic therapies in preventing or treating GCE

Continued reporting and analysis of cases will be crucial to better understand this rare but significant complication of COVID-19. Collaborative research efforts and long-term follow-up studies will help elucidate the full spectrum of COVID-19’s impact on lung structure and function.

Implications for Clinical Practice and Patient Care

The recognition of giant compressive emphysema as a potential complication of COVID-19 has several important implications for clinical practice and patient care:

Recommendations for healthcare providers:

1. Maintain a high index of suspicion for GCE in COVID-19 patients with worsening respiratory status
2. Perform early CT imaging when GCE is suspected
3. Develop protocols for rapid assessment and management of suspected cases
4. Ensure multidisciplinary collaboration between pulmonologists, radiologists, and thoracic surgeons
5. Provide comprehensive patient education on potential long-term respiratory effects

Healthcare systems should be prepared to manage the acute presentation of GCE and provide long-term follow-up care for affected patients. This may involve establishing specialized post-COVID clinics and rehabilitation programs focused on respiratory recovery.

Patient education and support:

• Explain the nature of GCE and its relationship to COVID-19
• Discuss potential treatment options and their risks/benefits
• Provide guidance on respiratory exercises and ongoing management
• Offer psychological support to address anxiety related to breathing difficulties
• Connect patients with support groups or resources for long-term COVID-19 effects

By increasing awareness of this complication and implementing appropriate management strategies, healthcare providers can work to improve outcomes for patients affected by giant compressive emphysema in the context of COVID-19.

Giant compressive emphysema: a rare complication of COVID-19 | BMC Infectious Diseases

• Case report
• Open Access
• Published: 30 December 2021

• Julien Rakotoson¹,
• Johary Andriamizaka Andriamamonjisoa 
  ORCID: orcid.org/0000-0002-5736-8514²,
• Mandimbisoa Noely Oberlin Andriamihary⁵,
• Solohery Jean Noël Ratsimbazafy³,
• Roger Dominique Randrianarimalala³,
• Rivo Andry Rakotoarivelo⁴ &
• …
• Stéphane Ralandison¹ 

BMC Infectious Diseases
volume 21, Article number: 1283 (2021)
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Abstract

Background

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a new ribonucleic acid (RNA) beta-coronavirus, responsible for a worldwide pandemic. Very few cases of SARS-COV-2-related emphysema have been described, except among patients with chronic obstructive pulmonary disease. The thoracic CT scan is the key examination for the diagnosis and allows to evaluate the severity of the pulmonary involvement. The prognosis of the patient with giant emphysema (GE) on coronavirus disease 2019 (COVID-19) in critical or severe form remains poor. We report an original case of COVID-19 pneumonia, critical form, complicated by a giant compressive left emphysema of 22.4 cm in a young subject without respiratory comorbidities.

Case presentation

A 34-year-old man was hospitalized for left laterothoracic pain. He had no prior medical history. The physical examination revealed tympany on percussion of the left lung. The CT scan confirmed COVID-19 pneumonia with 95% lung involvement. Also, the presence of a voluminous left sub pleural emphysema of 22.4 cm with compression of the ipsilateral pulmonary parenchyma as well as the mediastinal structures towards the right side. The diagnosis COVID-19 pneumonia, critical form, complicated by a compressive left giant emphysema was made. He was put on oxygen, a dual antibiotic therapy, a corticotherapy, and curative doses of enoxaparin. A thoracic drainage surgery was performed at 24th day of hospitalization, which confirmed the giant emphysema. The patient remains on long-term oxygen therapy.

Conclusion

The COVID-19 has polymorphic manifestations, pneumonia is the most important one. There are relatively few reports associating COVID-19 and emphysema; furthermore, reports associating COVID-19 and giant emphysema are extremely scarce. CT scans can confirm the diagnosis and differentiate it from a pneumothorax. The pulmonary prognosis of the association of COVID-19 in its severe or critical form with giant emphysema remains poor.

Peer Review reports

Background

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel single-stranded ribonucleic acid (RNA) beta-coronavirus, which emerged in China in December 2019, responsible for the coronavirus disease 2019 (COVID-19), which is causing the current global pandemic [1]. Despite the polymorphism of this disease, pulmonary involvement remains the predominant presentation causing hypoxemic lung disease [2, 3]. Emphysema is the consequence of an irreversible destruction of the pulmonary parenchyma, with damage to the respiratory bronchiole and alveolar walls, causing an enlargement of the airways and responsible for chronic respiratory insufficiency. Giant emphysema (GE), on the other hand, causes acute respiratory failure and a severe compressive phenomenon. Since the pandemic, very few cases of SARS-COV-2 related emphysema have been described, except among patients with chronic obstructive pulmonary disease (COPD) [2, 3]. Our aim is to report an original case of GE on SARS-CoV-2 lung disease, in a young subject without comorbidity.

Case presentation

A 34-year-old man was hospitalized in Antananarivo-Madagascar for left laterothoracic pain associated with dyspnea. He reported no cigarette nor alcohol consumption, and denied any prior medical history including diabetes, hypertension, and respiratory diseases. He has no known respiratory history. There was no family history of alpha-1 antitrypsin deficiency, no notion of pneumothorax or spontaneous emphysema. He had been presenting for 10 days with headaches, diffuse arthromyalgia, and a hacking cough in a febrile context. Two days before his admission, the patient suffered from significant asthenia, followed by progressive dyspnea, chest pain aggravated by coughing and change of position.

The physical examination revealed pulsed oxygen saturation (SpO2) of 77%, polypnea of 35 cycles per minute, blood pressure of 160/80 mmHg, heart rate of 117 beats per minute, temperature of 36.7 °C, and body mass index (BMI) of 23.1 kg/m². The patient was obnubilated, had difficulty speaking, with signs of acute respiratory distress, condensation syndrome of the entire right lung, auscultatory silence and tympany on percussion of the left lung. There was no subcutaneous snowy crepitus of the thoracic region. There was right deviation of regular heart sounds, turgidity of the jugular veins, without edema of the lower extremities or ascites.

Lab analyses made in the 2nd day of hospitalization showed a hyperleukocytosis of 27 × 10³ k/µL, including 96% (25 × 10³ k/µL) neutrophils, 2% (0.54 × 10³ k/µL) lymphocytes, a discrete thrombocytosis of 475 × 10³ k/µL, and a C-reactive protein of 75 mg/L. Renal and hepatic tests were unremarkable. D-dimer was elevated to 2571 ng/mL. The nasopharyngeal COVID-19 polymerase chain reaction (PCR) performed on the 3rd day of hospitalization was positive. Human immunodeficiency virus (HIV) serology was negative. The chest X-ray at the patient’s bed on the 2nd day of hospitalization showed an alveolar syndrome of the right lung with right deviation of the mediastinum and clarity of the right lung except at the apex (Fig. 1).

Fig. 1

Chest CT scan without contrast injection: the chest X-ray at the patient’s bed showed an alveolar syndrome of the right lung (arrow: right/up) with right deviation of the mediastinum (arrow: right/down) and clarity of the right lung except at the apex (arrow: left)

Full size image

The diagnosis of COVID-19 was made, with a doubt on the complication: left emphysema or left pneumothorax. He was put on oxygen at 20 L/min through a high-flow nasal cannula connected to an oxygen cylinder; a dual antibiotic therapy with ceftriaxone slow direct intravenous 1 g daily for 10 days, associated with a roxythromycin 150 mg tablet, twice daily for 10 days; a corticotherapy with dexamethasone intravenous direct: 24 mg daily for 3 days, then 12 mg daily for 7 days, then 8 mg daily for 7 days, then 4 mg daily for 6 day. A potassium supplementation with 600 mg × 3 dose per day for 22 days; and curative doses of enoxaparin subcutaneous 0.6 ml every 12 h for 10 days. The evolution was favorable with disappearance of signs of respiratory distress, with a SpO2 of 92% under 8 L of oxygen at 14th day of hospitalization.

The thoracic scanner was done late at 15th day of hospitalization because of the dependence on oxygen therapy and the impossibility of moving the patient with a worsening of desaturation at the least movement. In addition, the radiology center is not on site, requiring a trip with an ambulance that has a capacity of 10 L of portable oxygen. The injection of contrast medium is not done because of the patient’s lack of money. The result of the CT scan is in favor of a viral pneumonia on SARS-CoV-2 with pulmonary involvement of about 95% of the parenchyma, by the presence of ground glass opacities with multilobar and multisegmental internal reticulations. Also, the presence of a voluminous left sub pleural emphysema of 22.4 cm with compression of the ipsilateral pulmonary parenchyma as well as the mediastinal structures towards the right side. At the same time, we note the presence of some pulmonary emphysema bullae on the right side (Figs. 2, 3).

Fig. 2

(Coronal and axial section): ground glass opacities with multilobar and multisegmental internal reticulations with pulmonary involvement about 95% suggestive of SARS-Cov-2 infection (arrow: right/up). Voluminous left sub pleural emphysema of 22.4 cm and some pulmonary emphysema bullae on the right (arrow: left. Fig. 3, arrow: left). Compression of the ipsilateral lung parenchyma and deviation of the mediastinal structures to the right side by a compressive phenomenon are noted

Full size image

Fig. 3

(Coronal and sagittal section): ground glass opacities with multilobar and multisegmental internal reticulations with pulmonary involvement about 95% suggestive of SARS-Cov-2 infection (Fig. 2, arrow: right/up). Voluminous left sub pleural emphysema of 22.4 cm and some pulmonary emphysema bullae on the right (Fig. 2, arrow: left. arrow: left). Compression of the ipsilateral lung parenchyma and deviation of the mediastinal structures to the right side by a compressive phenomenon are noted

Full size image

The diagnosis of COVID-19 pneumonia, critical form, complicated by a compressive left GE was made. Pneumothorax was ruled out by the presence of lung parenchyma at the apex and the left pulmonary base. Also, the absence of retraction of the left lung on the pulmonary hilum.

However, the tympanism of the left lung thorax and the deviation of the heart sounds persisted. On the 22nd day of hospitalization: the patient remained oxygenorequerent with SpO2 at 94% under 2 L of oxygen and desaturation at the slightest effort. A thoracic surgery was performed at 24th day of hospitalization, which confirmed the GE. The Surgery was done under general anesthesia with mechanical ventilation by a thoracotomy, then a bullectomy followed by placement of a chest tube. The chest tube was removed on day 6 of the operation. The operation was successfully performed to overcome the acute respiratory status. Nevertheless, the patient remains on long-term oxygen therapy by nasal cannula. The patient survived 2 months after his thoracic drainage, following a recurrence severe acute pneumonia.

Discussion and conclusions

In the absence of pathological lungs, COVID-19 can cause giant emphysema. The severity is related to the size of the emphysema, which is a source of compressive phenomenon. The CT scan is the key examination for diagnostic confirmation. The prognosis of the association remains poor.

Emphysema is a lung disease, characterized by the irreversible destruction of the respiratory bronchiole and the alveolar wall that lines the lungs. This leads to an enlargement of the distal airways with the formation of intra-parenchymal air bubbles [4]. It is purely related to COVID-19 if an infected patient has no history of chronic obstructive pulmonary disease or a history of familial alpha-1 antitrypsin deficiency. The association of emphysema with COVID-19 was less described in the first wave in 2020, but seems to be more numerous in the 2nd wave of 2021. Our case finds its originality in relation to the size of the emphysema, voluminous, measuring 22.4 cm long axis and its acquired character related to COVID-19. Also, because of the young age of our patient, non-smoker, which can eliminate the aggravation of pre-existing emphysema or blebs ruptures.

The mechanism of our patient’s GE may be different from that of Sun et al. Our patient had the signs of GE on admission (tympany with respiratory distress, and the image of emphysema in the chest X-ray). In other words, emphysema symptoms were the main reason for our patient’s consultation. On the other hand, the case reported by Sun et al. presented the signs of emphysema during hospitalization where the patient had already received oxygen therapy at 20 L/min [5]. COVID-19 itself and its treatment by excessive oxygen flow increase during desaturation could explain the occurrence of emphysema» [6]. The pathogenesis of emphysema primarily involves an inflammatory process in the lungs during various infections. Macrophages (CD 68+), neutrophils and CD8 T cells act on resident cells such as epithelial cells and fibroblasts via mediators (interleukin 8, TNF alpha, leukotriene) of inflammation, destroying the lung parenchyma. This mechanism occurs in the inflammatory phase of COVID-19 with alveolar-interstitial lung disease, in addition to the oxidative stress (formation of free radicals) created by the inflammatory process (2nd mechanism). The 3rd mechanism is an imbalance between pulmonary proteases–antiproteases often of genetic origin. The alpha 1 antitrypsin protein (protease inhibitor) plays a protective role. In case of its deficiency, this role is no longer ensured and the progressive destruction of the pre-existing alveolar walls causes the occurrence of emphysema [7]. This hypothesis is less likely in our case because there is no history of spontaneous pneumothorax in the family.

Any source of increased intra-thoracic pressure (exertion, coughing, constipation …) can aggravate the size of an underlying emphysema or cause the rupture of a pre-existing bleb. Excessive ventilation can also aggravate or cause emphysema. Our patient has presented pulmonary tympany as soon as they admitted and had no invasive ventilation before the thoracic scanner. This eliminates the contribution of ventilation to the development of emphysema in this patient.

Critical CT involvement in COVID-19 is defined as 75% or more lung involvement. Our case presented up to 95% lung involvement, aggravated by the presence of a GE of 22.4 cm. This association increases the risk of mortality of the disease [7, 8].

The CT scan is ideal imaging method for the diagnosis of emphysema and for the evaluation of its impact. It can differentiate between emphysema and pneumothorax or blebs. In case of COVID-19, chest CT has a sensitivity of 91.9% for the diagnosis, considered as a reference examination even in the early stage of the infection [9, 10]. It is therefore essential to perform a chest CT scan for any severe or critical form of COVID-19, to assess the severity of the lung involvement, to look for associated lesions, to have an idea of the prognosis and to provide a means of follow-up. Most COVID-19 related emphysemas described in the literature are small, with possible association with pneumomediastinum and pneumothorax. Regarding the therapeutic management, our patient was receiving oxygen therapy and surgery. The emphysema described in the literature was treated with oxygen therapy only [5]: non-invasive ventilation, high Flow Nasal Cannula and invasive mechanical ventilation [6]. In our case, surgery was necessary in view of the presence of signs of poor tolerance of the GE.

The association of COVID-19 and pulmonary emphysema is less described in the literature. Even more, GE is exceptional. It should be evoked in front of the asymmetry of the pulmonary examination with tympanism and the presence of signs of acute right heart failure. Only the CT scan can confirm the diagnosis and differentiate it from a pneumothorax. The pulmonary prognosis of the association of COVID-19 in its severe or critical form with GE remains poor (Table 1).

Table 1 Summarizing the clinical and laboratory characteristics of patient

Full size table

Availability of data and materials

We cannot put the scanner online with the patient’s information because of the confidentiality rule. On the other hand, imaging with patient information is available at the first author.

Abbreviations

BMI:

Body mass index

COPD:

Chronic obstructive pulmonary disease

COVID-19:

Coronavirus disease 2019

CT:

Computerized tomography

GE:

Giant emphysema

HIV:

Human immunodeficiency virus

RNA:

Ribonucleic acid

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus-2

SpO2:

Pulsed oxygen saturation

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Acknowledgements

We thank the team of the COVID-19 treatment center and the team of the thoracic surgery department of the JRB University Hospital, 101 Antananarivo-Madagascar

Funding

No source of funding, self-financing.

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Authors and Affiliations

1. Department of Rheumatology, Faculty of Medicine Antananarivo, Morafeno University Hospital Toamasina, 501, Toamasina, Madagascar

   Julien Rakotoson & Stéphane Ralandison

2. Department of Infectious Diseases, Faculty of Medicine Antananarivo, Joseph Raseta Befelatanana University Hospital Antananarivo, 101, Antananarivo, Madagascar

   Johary Andriamizaka Andriamamonjisoa

3. Department of Internal Medicine, Faculty of Medicine Antananarivo, Military Hospital Soavinandriana Antananarivo, 101, Antananarivo, Madagascar

   Solohery Jean Noël Ratsimbazafy & Roger Dominique Randrianarimalala

4. Department of Infectious Diseases, Faculty of Medicine Andrainjato Fianarantsoa, University Hospital Tambohobe Fianarantsoa, 301, Fianarantsoa, Madagascar

   Rivo Andry Rakotoarivelo

5. Department of Cardiology, Faculty of Medicine of Antananarivo, Joseph Rasta Befelatanana University Hospital, 101, Antananarivo, Madagascar

   Mandimbisoa Noely Oberlin Andriamihary

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Contributions

RJ, AAJ, AMNO: Draft of the introduction and observation of the clinical case. RSJN, RRD: Draft of the clinical case discussion. RAR, RS: Final correction and revision of bibliographic references. All authors read and approved the final manuscript.

Corresponding author

Correspondence to
Johary Andriamizaka Andriamamonjisoa.

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Consent for publication

The first consent that was sent was signed by the patient’s father, very early during the writing of the manuscript. The patient gave his verbal consent and asked his father to sign him because he was still very dysphenic and was not in a state of signed. On the other hand, now: the patient is already restored and goes much better. So we have reiterated his agreement directly and he agreed to signed. We had the patient’s consent for the publication of the case and the CT images. Please find in PDF file separated written consent and signed by the patient. Note that patient and father have the same name.

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Emphysema Diagnosis | Temple Health

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Conditions

To evaluate you for emphysema, your pulmonologist will likely ask whether you:

• Smoke
• Have had contact with lung irritants, such as air pollution, dust, secondhand smoke or chemical fumes

Your pulmonologist will use a stethoscope to listen for wheezing or other abnormal sounds in your chest.

You may also be asked to undergo some tests to determine whether you have emphysema, including:

Lung Function Tests

Lung function tests measure how much air you can breathe in and out, how fast you can breathe out, and how well your lungs deliver oxygen to the blood.

The most common lung function test is called spirometry, and measures how much air you can breathe out after taking a deep breath and how fast you can expel the air. Emphysema, a type of chronic obstructive pulmonary disease (COPD), cannot be diagnosed without this important test.

Imaging Tests

Chest X-rays may show that the lungs are overinflated but they cannot confirm COPD or emphysema. They may also help your doctor to rule out other causes of shortness of breath.

However, X-ray images may appear normal even if you have emphysema. If you’re considering lung surgery, your doctor might recommend computerized tomography (CT) scans, which provide cross-section images of the body’s organs. The CT scan will show whether or not the airflow obstruction is due to emphysema.

Blood Tests

Blood is taken from an artery in the wrist and can be tested to show how well your lungs are transferring oxygen into the blood and carbon dioxide out of the bloodstream. Also, your doctor may check for low levels of alpha-1-antitrypsin. Some individuals will not make enough of this protein which protects the lung, and they will develop emphysema often at a younger age.

Ready for an Appointment?

If you’re experiencing signs or symptoms of emphysema, request an appointment with a Temple pulmonologist or call 800-TEMPLE-MED (800-836-7536) today.

Learn more about our pulmonologists who diagnose and treat emphysema.

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TIRB#: 26350

• Conditions: Chronic Obstructive Pulmonary Disease (COPD),

  Emphysema

• Investigator: Gerard Criner, MD
• Coordinator: Lii-Yoong Helga Criner

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Immunological Basis for Mepolizumab Activity in COPD

TIRB#: 29478

• Conditions: Chronic Obstructive Pulmonary Disease (COPD)
• Investigator: Gerard Criner, MD
• Coordinator: Dolores Fehrle

View Details

Pulmonary emphysema consultation treatment in St.

Petersburg at the ID-CLINIC medical center

Pulmonary emphysema consultation treatment in St. Petersburg at the ID-CLINIC medical center

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St. Petersburg, Ivana Chernykh st., 25A

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Normally, the alveoli of the lungs are highly elastic, which allows them to expand and fill with oxygen during inhalation, and then contract during exhalation. If the structure of the lung tissue is broken, an irreversible expansion and stretching of the alveoli occurs. This disease is called emphysema. It has a chronic course and significantly impairs the function of external respiration, which results in critical circulatory disorders and other complications.

Typical causes of the disease

According to the mechanism, primary emphysema is distinguished, which develops without visible provoking factors, and secondary, resulting from bronchopulmonary diseases. The main cause of emphysema is chronic obstructive pulmonary disease (COPD), and risk factors include:
● long smoking history
● inhalation of toxic substances
● microcirculatory disorders
● lack of alpha-1 antitrypsin, which prevents the destruction of lung tissue

Rare causes of emphysema

● long-term use of intravenous drugs that contain insoluble excipients that damage pulmonary vessels
● autoimmune vascular inflammation (vasculitis)
● HIV infection, which is an independent precipitating factor for obstructive pulmonary disease and subsequent emphysema
● congenital and hereditary connective tissue diseases

How emphysema is formed

Several pathogenic factors are involved in the development of the disease. First, episodes of bronchial obstruction and hyperdistension of the alveoli cause irreversible changes in the lung tissue. Secondly, the action of irritating factors triggers the release of enzymes and the migration of immune system cells that damage tissues. Thirdly, there is a decrease in the number of capillaries that are responsible for the blood supply to the lung tissue.

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St. Petersburg, Ivan Chernykh st., 25A

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Symptoms of emphysema

Patients experience shortness of breath with difficulty exhaling, first with physical activity, then with minimal movement, and even at rest. To facilitate exhalation, patients fold their lips into a tube and inflate their cheeks, making puffing sounds.
In primary emphysema, such symptoms occur without a previous cough, the patient’s condition remains satisfactory for a long time. If emphysema is secondary, shortness of breath is superimposed on the signs of an already existing bronchopulmonary disease.

Medical consultation

Shortness of breath is an alarming symptom that requires immediate medical attention. If it is not accompanied by an increase in body temperature or other signs of SARS, patients can visit a therapist on their own.
On examination, the doctor pays attention to the barrel-shaped chest, boxed sound on percussion of the lungs, weakened breathing on auscultation of the lungs. Also characteristic is the expansion of the intercostal spaces and bulging in the supraclavicular zones.

Diagnosis of emphysema

● chest x-ray showing diaphragm flattening, poor vascular pattern
● Lung CT for clearer visualization of emphysema areas
● lung function tests: spirography as standard, and body plethysmography to accurately determine lung volumes (as recommended by the American Thoracic Society)
● clinical and biochemical blood test
● blood gas analysis
● analysis for alpha-1 antitrypsin

Treatment of pulmonary emphysema

In the primary form, patients are prescribed breathing exercises, oxygen therapy, and the exclusion of all risk factors, if possible. The secondary form of the disease requires the correction of the underlying pathology, as well as the normalization of the respiratory and cardiovascular systems.
With a critical decrease in the function of external respiration, it is possible to remove enlarged sections of the lung (large bullae), surgery to reduce lung volume, or even lung transplantation.

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At ID-Clinic, patients can get a consultation with a therapist by appointment by submitting an application in the online form on this page. Our administrator will call you back to find a convenient day and time for a medical appointment.

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А12.09.001	Spirography (examination of respiratory function)	1000 ₽
B01.047.007	Reception (examination, consultation) of a general practitioner at home	6000 ₽
B01. 047.002	General practitioner appointment (examination, consultation), 30 min.	2500 ₽
	Online GP consultation	3000 ₽
А12.09.001	Spirography (examination of respiratory function) with bronchodilator	1400 ₽
B01.047.001	General practitioner appointment (examination, consultation), 60 min.	3000 ₽

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• Kiseleva Lyudmila Ivanovna

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I chose this doctor because there was a free appointment on the same day, which was important. The doctor explained all the issues that interested me and put a good treatment. The reception began without delay.

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I came to this clinic for an ultrasound and a consultation. I was advised by Alexei Vasilievich Baranov, he has vast experience and deals specifically with thyroid problems. I’m glad I came across this specialist. Very polite and attentive doctor, and did not look superficially, but in detail and attentively. Advised on the necessary issues and made recommendations. I have been suffering from thyroid gland for several years, but this is the first time I have received such a detailed and thorough consultation.

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I went to the doctor with an already diagnosed diagnosis to prescribe treatment. I can say that it helped quite quickly. The doctor is very polite and friendly, he spent enough time with me. The process of issuing test results is not very clearly organized in the clinic, and the processing time has also been extended. I had to call and find out myself, although I asked to send everything to the post office.

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Wonderful clinic professionally, qualitatively, doctor virologist Svetlana Aleksandrovna Zvontsova sensitive Doctor professional attentive approach to the patient!! We will be treated in the clinic.

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A wonderful person and doctor, sympathetic and understanding. It’s a pleasure to be with him. A qualified specialist who will calmly answer all your questions. Thank you, Georgy Alexandrovich.

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My husband was vaccinated against the coronavirus Sputnik Light. He liked everything, before the vaccination, the doctor examined him, spent enough time, then he vaccinated and gave the necessary recommendations. My husband did not have any complications after vaccination. The clinic arranged everything: the appointment was on time, clean, the staff was friendly.

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Signed up for vaccination against coronavirus Sputnik Light. Everything went well, hosted by Efimov Georgy Aleksandrovich. I liked everything, the doctor was very attentive, measured the pressure, temperature, got vaccinated, I endured it easily. And, perhaps, I will also sign up for the next vaccination in this medical center.

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My daughter and I made an appointment with a gynecologist, Tsareva Yulia Gennadievna took her daughter. Yulia Gennadievna is an excellent doctor, very experienced, I myself have addressed to her many times. Previously, I went to her when she worked in a regular clinic, now we specifically found her place of work so that my daughter could visit. Yulia Gennadievna is very attentive, correct.

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I made an appointment with the doctor because she is related to my chronic illness. I was not mistaken that I signed up with her. She helped me figure out my issue and suggested what to do. I really liked the reception and her attitude to her work, because all the attention was paid to me and my problem, so the reception went just fine.

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Pulmonary emphysema – symptoms and treatment at ON CLINIC Ryazan

It is one of the most common chronic lung diseases. It is characterized by a violation of normal gas exchange and difficulty in the breathing process. Pulmonologists note with concern that pulmonary emphysema is becoming more common – the risk of developing this disease is especially high in patients over 55 years of age.

The causes of emphysema include primarily bronchitis in a chronic course. In the vast majority of cases, this form of the disease develops in people of working age – from 30 to 60 years – age; while in men it occurs almost three times more often than in women. Over time, bronchitis is highly likely to lead to complications such as emphysema.

Other factors provoking the development of this disease in a patient:

• smoking;
• residence or stay for a long time in a region with unfavorable environmental conditions;
• employment in enterprises that specialize in the extraction and processing of coal, asbestos, silicon, etc. Inhalation of the smallest particles of these natural minerals is very harmful to the body in general and to lung health in particular;
• the patient has a history of tuberculosis and other diseases affecting the lungs;
• unfavorable heredity – if bullous emphysema was detected in one of the patient’s close relatives, then he is also at risk;
• in addition, in some cases, emphysema, which provokes serious respiratory failure, can develop in the absence of previous pathologies of the respiratory system. In this case, the patient is diagnosed with Primary Emphysema.

How does emphysema develop?

The inflammatory process that continues for a long time provokes the appearance of irreversible changes in the wall of the bronchi. The airways narrow, their conductivity worsens. At the same time, the tissue that makes up the lungs loses its elasticity. Even after the patient makes a full exhalation, they remain in excess of the normal volume of air. The lungs are overstretched, gas exchange in the blood worsens. A decrease in the efficiency of removing carbon dioxide from the patient’s body provokes the development of shortness of breath in him.

The stretched tissue of the bronchi and lungs, which is no longer able to perform its functions, is gradually replaced by connective tissue. This leads to irreversible narrowing of the bronchi. Pathological changes in the lung tissue are air sacs of various diameters, which can be single or scattered over the entire surface of the lungs.

Symptoms of emphysema

The development of this pathology in a patient may be indicated by the presence of the following symptoms:

• shortness of breath, which in especially advanced cases does not disappear even at rest. At first, it appears only in the cold season at the time of physical activity. Patients suffering from shortness of breath are characterized by a short inhalation with effort and a long exhalation. When breathing, they can puff out their cheeks;
• severe pallor of the skin. Moreover, the tongue, lips and nail plates of the patient may have a bluish tint;
• over time, the chest of a patient with emphysema expands and becomes barrel-shaped, and the amplitude of its movements during breathing, on the contrary, decreases;
• the intercostal spaces and the area above the patient’s collarbones may expand and even bulge.

In the absence of treatment, emphysema can provoke the development of severe, threatening his performance and even life-threatening conditions in a patient. It can be pneumothorax, respiratory and heart failure, etc.

Treatment of emphysema in ON CLINIC Ryazan

The most important event, without which the effectiveness of the treatment of pulmonary emphysema prescribed by a doctor tends to zero, is quitting smoking. At the same time, it is precisely the simultaneous rejection of cigarettes that can quickly improve the patient’s condition, and not a gradual decrease in their number.

It is regrettable to realize this, today this disease belongs to the category of incurable. However, the patient’s condition and quality of life can be significantly improved in the following ways:

• oxygen therapy – the use of oxygen cocktails and air inhalation, which includes an increased concentration of oxygen;
• daily performance of special breathing exercises by the patient;
• therapy aimed at treating the underlying disease that provoked the development of emphysema – for example, chronic bronchitis, the presence of which can cause the constant spread of infection throughout the body.

Significantly improve the functioning of areas of the lungs that have not undergone pathological changes, it is possible with the help of surgical intervention to remove “bloated” air sacs.