الفهرس 
Chapter 1: Gross anatomy of the lungOnly 14 pages are availabe for public view
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Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of chronic
morbidity and is the 12th leading cause of disability in the world. It is defined in
functional terms as a slowly progressive disorder characterized by airflow limitation that
does not change markedly over several months.
Multi-detector computed tomography (MDCT) has been used for the diagnosis of
COPD with favorable results. MDCT scanners provide noninvasive methods to study
lung pathology in COPD.
The purpose of the study was to assess the role of MDCT in patients with COPD.
This was a prospective study conducted during the period from 1st September
2021 to 1st February 2022 on 30 patients who were clinically suspected of COPD and
were referred to the Radiology Department of Tanta Insurance Hospital for further
assessment by multi-detector computed tomography of the chest.
The important findings of this study were the followings:
The age of patients ranged from 40 to 78 years with a mean ± SD of 61.4 ± 8.1
years, and the majority of patients aged from 60 to 70 years old. Also, we found
that males were more predominant than females (80% vs 20%, respectively).
Smoking is the dominating risk factor for COPD in our study representing 76.7%.
According to CAT score, 50% of COPD patients recorded high CAT scoring and
the 50% reported severe CAT scoring.
According to the modified dyspnea scale, the majority of COPD patients were
classified as Grade 3, followed by Grade 4 and Grade 2, representing 60%, 30%,
and 10%, respectively.
Pulmonary function tests ratio (PFT) ranged from 49% to 66% with a mean ± SD
of 57.0 ± 4.2%.
MDCT demonstrated characteristic findings of COPD, including increased
pulmonary vasculature, bronchial wall thickening, lung hyperinflation, increased
the anteroposterior diameter of the chest, Barrel chest, irregularity of Bronchovascular
markings, elongated trachea, flatting of diaphragm, para-septal
emphysema, and centrilobular emphysema.
Using MDCT, the right lung density measurement was as follows, upper lobe with
a mean ± SD (-909.9 ± 57.4), middle lobe with a mean ± SD (-904.1 ± 49.3), and
lower lobe with a mean ± SD (-854.0 ± 49.8) while the left lung density
measurement was as following, upper lobe with a mean ± SD (-926.0 ± 61.0), left
lingula with a mean ± SD (-904.8 ± 49.3) and lower lobe with a mean ± SD (-
866.1 ± 42.6).
COPD patients were classified phenotypically into airway dominant, emphysema
dominant, and mixed, representing 50%, 30%, and 20%, respectively. We reported
that MDCT is significantly able to differentiate between the three phenotypes.
There were significant positive correlations between PFT and upper, middle, and
lower lobes of the left lung densities while no correlation between PFT and lung
density was detected on the all lobes of right lung.
We found a statistically significant association between lung density and COPD
phenotype was reported (p<0.001). There was a statistically significant difference
between airway phenotype and both emphysema (p= 0.0002) and mixed (p= 0.026)
phenotypes as regards lung density. While no statistically significant difference
between emphysema phenotype and mixed phenotype regarding lung density.