Pathology.—Panacinar emphysema involves all portions of the acinus and secondary pulmonary lobule more or less uniformly (42). It predominates in the lower lobes and is the form of emphysema associated with α1-antitrypsin deficiency.
CT scans.—Panacinar emphysema manifests as a generalized decrease of the lung parenchyma with a decrease in the caliber of blood vessels in the affected lung (97,98) (Fig 46). Severe panacinar emphysema may coexist and merge with severe centrilobular emphysema. The appearance of featureless decreased attenuation may be indistinguishable from severe constrictive obliterative bronchiolitis (99). The term panlobular emphysema is synonymous. (See also emphysema.) [Fleischner Society]