Scanning electronmicroscopic morphometry of emphysema in humans.

We quantitated the holes in alveolar walls in 11 nonemphysematous lungs and in 11 lungs with mild emphysema, all of which were removed at surgery. We found that in the nonemphysematous lungs, 94.1% of the holes were smaller than 10 microns in diameter and only 0.2% were larger than 20 microns. In the lung parenchyma distant from emphysema, both the maximum diameter of the holes and the diameter of alveoli increased. In the parenchyma between emphysema, the areas of alveolar walls represented by holes also increased, as did the average hole area and number of holes per alveolus. We found that alveolar holes in the regions between emphysema correlated better with pulmonary function tests than did those in regions distant from emphysema. The maximum diameter of holes and the number of holes per alveolus correlated with functional residual capacity, residual volume, closing capacity expressed as a proportion of total lung capacity (CC/TLC), and static recoil pressure of the lung at TLC. Emphysema correlated with CC/TLC and with the transpulmonary pressure at 90% TLC. Bronchiolar lesions were not related to pulmonary function tests. Our data provide support for the hypothesis that the tissue surrounding emphysematous lesions contributes to loss of recoil.