Anatomical Determinants of Cor Pulmonale in Emphysema: A Clinicopathological Assessment
Keywords:
Pulmonary Disease, Cor Pulmonale, Emphysema, Anatomical FeaturesAbstract
Background: Emphysema is a major contributor to chronic obstructive pulmonary disease (COPD) and often leads to cor pulmonale due to structural pulmonary vascular changes. Despite advances in imaging, the anatomical basis of right heart failure in emphysema remains underexplored. Objective: To evaluate the anatomical factors associated with cor pulmonale in emphysema, focusing on vascular deformities, arterial compression, and histopathological changes. Methodology: This retrospective cross-sectional study was conducted on 62 autopsy-confirmed emphysema cases at three medical colleges in Lahore. Gross examination, histology, and post-mortem pulmonary arteriography were used to assess emphysema type, right ventricular hypertrophy, vascular deformities, fibrosis, and thromboembolic changes. Data were analyzed descriptively to identify anatomical factors associated with cor pulmonale. Results: This study showed that right ventricular hypertrophy was found in 74.2% of cases, mainly in centrilobular and mixed emphysema. Vascular deformities appeared in 72.6% of cases, intimal fibrosis in 67.7%, and arteriolar narrowing in 50%. Bronchopulmonary anastomoses, vascular compression from emphysematous spaces, and thromboembolic lesions were also commonly noted. Conclusion: The present study concluded that Cor pulmonale in emphysema is caused by several anatomical factors, including vascular deformity, intimal fibrosis, arterial compression, and shunt formation. These structural changes significantly increase right heart strain, adding to the damage from parenchymal destruction. Post-mortem assessments show the importance of recognizing vascular involvement early in emphysema treatment.References
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