## Centriacinar (Centrilobular) Emphysema **Key Point:** Centriacinar emphysema is characterized by selective destruction of the **proximal alveoli (respiratory bronchioles)** while the **distal alveoli remain relatively intact**. ### Pathological Features - Affects the central portion of the acinus - Respiratory bronchioles are preferentially destroyed - Alveolar ducts and distal alveoli are spared - Results in a patchy, irregular appearance on microscopy ### Clinical Association **High-Yield:** Centriacinar emphysema is **strongly associated with cigarette smoking** and is the predominant pattern in smokers with COPD. ### Comparison with Panacinar Emphysema | Feature | Centriacinar | Panacinar | |---------|--------------|----------| | **Pattern** | Proximal alveoli destroyed | Uniform destruction | | **Location** | Central acinus | Entire acinus | | **Primary Association** | Cigarette smoking | Alpha-1 antitrypsin deficiency | | **Distribution** | Upper lobes, apical segments | Lower lobes, basilar segments | | **Severity** | Often mild to moderate | Usually severe | **Clinical Pearl:** The distinction between centriacinar and panacinar emphysema is important for determining the underlying etiology — smoking versus genetic deficiency — and guides counseling and management strategies. [cite:Robbins 10e Ch 15]
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