Newer Aspects of the Pulmonary Vasculature in Chronic Lung Disease

Abstract

Pulmonary vascular topography has been studied at our Institute over the last two years to evaluate more adequately the pulmonary vasculature in obstructive lung disease. This investigation has stressed comparison studies of the various parameters of pulmonary function, full chest laminagraphy, pulmonary angiography and more recently lung scanning. To our knowledge this type of correlation has not been previously reported. Evaluation by lung scanning was made in a preliminary fashion as a further detailed study is in progress.The twofold purpose of this study was: (1) to determine whether there was a correlation of the clinical picture, pulmonary function studies, chest laminagraphy, pulmonary angiography and lung scanning in order to differentiate more adequately bronchial asthma and emphysema, and (2) to delineate more effectively regional impairments of circulation in obstructive lung disease, namely: (a) local (one area-lobe or segment), (b) regional (more than one lobe), (c) unilateral lesions, involving most or all of the one lung and (d) diffuse involvement, with approximately an equal degree of impairment throughout both lungs.By differentiating bronchial asthma from emphysema, we hope to determine more adequately both the diagnosis and prognosis of the types of obstructive lung disease. This is particularly important in younger individuals, in whom the diagnosis of obstructive lung disease is extremely valuable in longterm management. Moreover, by a more exact definition of the extent of abnormal ventilation and perfusion, earlier and more vigorous therapy can be instituted which might possibly prevent or minimize cardiopulmonary complications. Consequently, a greater number of patients might be rehabilitated or maintained as productive workers. Preliminary reports from two medical centers have already lent support to this newer concert.

Inhibition of VEGF receptors causes lung cell apoptosis and emphysema

“…This finding indicates that the drug did not inhibit cell proliferation but preferentially induced apoptosis, which may indeed cause the disappearance of alveolar septal structures in emphysema. Early angiographic studies of patients with pulmonary emphysema showed a reduction in the number and density of small precapillary arteries (27), comparable to the loss of precapillary arterioles in our animal studies.…”

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

“…Various factors, including endothelial dysfunction, inflammation, and hypoxia, have been recognized as potential contributors to the development of secondary pulmonary hypertension in emphysema, but its pathogenesis has not been fully clarified. Nevertheless, it is generally recognized that vascular remodeling of small pulmonary arteries is an essential morphological feature of pulmonary hypertension; narrowing and diminution of the small pulmonary vessels have been shown on conventional angiography in emphysema (4)(5)(6). However, to our knowledge, the in vivo relationship between pulmonary hypertension and the magnitude of small pulmonary vessel morphological change has not been quantitatively assessed in severe emphysema.…”

Quantitatively Assessed Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Patients With Chronic Obstructive Pulmonary Disease: Correlation of Perfusion Parameters With Pulmonary Function Test and Quantitative Computed Tomography

“…1 It has been suggested that airflow limitation causes the amount of oxygen in the blood to decrease, which then causes blood vessels in the lung to constrict. 2 Even though there have been several studies on the perfusion deficit in COPD, [3][4][5][6][7][8][9] the perfusion status in patients with COPD is still not fully understood.…”

“…5 Lung perfusion scintigraphy and dynamic CT scan require the exposure to ionizing radiation and furthermore, lung perfusion scintigraphy has substantial limitations with respect to its spatial and temporal resolution.…”