This is a severe degree of pulmonary hypertensive change, reducing perfusion. Trichrome stain shows obliteration by purple smooth muscle. Proximal parts have broken walls, with coalescence of the alveolar ducts into large spaces. The alveoli are of normal size. Bullous emphysema in patients with alpha-1 antitrypsin deficiency.
Pleural surfaces show air-filled blebs.
Cut surface of lung in panacinar emphysema. Saccular bronchiectasis in a patient with cystic fibrosis. The saccules are filled with impacted muco-pus. Low power tissue section shows large cystic spaces with fibrotic and inflamed walls. Viscous mucus accumulates and dilates the bronchial glands.