[Panlobular emphysema. Value of radiology to assess the need for surgery (author's transl)].

Surgical decompression in 12 patients with panlobular emphysema and severe respiratory insufficiency, over the last 5 years, gave encouraging postoperative results. Preoperative radiological examination results were well correlated with findings during operation. Signs of thoracic distention and diffuse peripheral hypovascularization were noted in all cases. Furthermore, at least on the affected side, all patients showed avascular zones presenting as large bullae or as bullous zones extending over at least half of the hemothorax region, and compression signs affecting the lung parenchyma, the mediastinum, and the diaphragm. Radiological investigation is essential for assessing the need for operation, as it remains the only method which can demonstrate the part played by the bullae and the rest of the parenchyma in the alteration of respiratory function. Data can be obtained by standard radiological examinations with dynamic films on forced inspiration and expiration, and by computed tomography. However, pulmonary angiography gives a more precise evaluation of the vascularization of the remaining parenchyma, which is important when choosing the side to be operated upon, or that which should be operated upon first in cases of bilateral symmetrical lesions.