E5051. Shrinking Lungs, Growing Concerns? A Radiologist's Perspective on Lung Volume Reduction
  1. Michelle Pisa; Lahey Clinic
  2. Anna Menezes; Lahey Clinic
  3. Anirudh Gautam; Lahey Clinic
  4. Lee Gazourian; Lahey Clinic
  5. Carla Lamb; Lahey Clinic
  6. Babina Gosangi; Lahey Clinic
  7. Richard Thomas; Lahey Clinic
Chronic obstructive pulmonary disease (COPD) is a heterogenous disorder characterized by chronic respiratory symptoms, due to abnormalities of the airways and/or alveoli, leading to airflow obstruction. While tobacco exposure is the most common association for patients with COPD, multiple other factors can also contribute to the development of COPD. Repeated lung injury due to a complex interplay of multiple factors results in chronic changes in the airways and lung parenchyma. Imaging manifestations of these changes include bronchial wall thickening, mucus plugging, bronchiectasis, emphysema (centrilobular, paraseptal, and panacinar patterns), evidence of hyperinflation of lungs, and lymphadenopathy. The COPD foundation system has five grades for COPD. It combines assessment of spirometry, symptoms, number of exacerbations in the past year, oxygenation, emphysema on CT scan or air trapping on lung volumes, presence of chronic bronchitis, and comorbidities. Lung volume reduction (LVR) techniques help to improve lung function and quality of life. These are performed surgically or with bronchoscopy using endobronchial valves. A combination of clinical and radiological criteria is used to include patients for LVR. Newer imaging techniques can objectively score the severity and distribution of emphysema and determine fissure integrity. Complications following LVR include air leak, pneumothorax ex-vacuo, hemothorax, thromboembolism, pneumonia, cardiac arrythmia, and myocardial infarction.

Educational Goals / Teaching Points
1. Describe the pathophysiology, clinical, and anatomical spectrum of COPD. 2. Evaluate pathological changes in COPD and establish appropriate radiological correlations. 3. Understand the role and methods of LVR in managing COPD. 4. Describe the role of radiology in the management of COPD and LVR. 5. Determine patient appropriateness to undergo LVR for COPD management. 6. Discuss possible LVR complications and their radiological appearance.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Fissure integrity, reporting, and emphysema quantification imaging for assessing the possibility of use of a lung volume reduction technique. Imaging and function of endobronchial valves on radiographs and chest CT. Complications of LVR are portrayed on radiographs and chest CT.

In an era with a high prevalence of COPD, most commonly caused due to smoking, techniques such as LVR show promising results. It is of importance to a radiologist to assess the possibility of LVR, the presence and functionality of endobronchial valves in patients who have undergone the procedure and identify possible complications of it.