Respiratory System

What is asthma?

The widespread narrowing of the airway

What physiological changes are caused by asthma?

• Swelling of mucous membranes

• Excess mucous secretions

• Smooth muscle spasm

What is the radiographic appearance of asthma?

Can only be seen during an acute attack:

• Bronchial narrowing

• Hyperlucent lungs

Name the pathology

Asthma

What are the diseases included in COPD?

• Bronchitis

• Emphysema

• Asthma

• Bronchiectasis

What is atelectasis?

Non-aeration collapse of part or whole lung (deflated alveoli)

What can cause atelectasis?

Anything that reduces air entry to alveoli including:

• Pneumothorax

• Excess secretions

• Tumor

• Abscess

• Bronchial narrowing

• ET tube misplacement

How does atelectasis appear on an xray?

• Increased density in area of collapse following lobe fissures

• Ipsilateral overinflation

Name the pathology

Atelectasis

Name the pathology

Atelectasis

What is bronchiectasis?

Permanent dilation of one or more large bronchi due to destruction of muscular and elastic components

What can cause bronchiectasis?

Complications from bronchitis

What is the radiological appearance of bronchiectasis?

• Loss of definition in interstitial markings

• Oval or circular cysts

• Interstitial fibrosis

Bronchiectasis radiographic sigh

Honeycomb pattern

Name the pathology

Bronchiectasis

Name the pathology

Bronchiectasis

What is bronchitis?

Chronic inflammation of bronchi causing thickening and excessive mucus

What are the manifestations of bronchitis?

• Blue bloaters - blue skin, deep breaths but still hypoxic

• Severe coughing

Radiographic appearance of bronchitis

50% of patients have no changes on xray

• Dirty chest - increased lower lung markings

• Tram lines - parallel tubular lines

Name the pathology

Bronchitis

Bronchitis may eventually lead to what other pathology?

Emphysema

What are the three lung neoplasms?

• Solitary pulmonary nodule

• Bronchogenic carcinoma

• Pulmonary metastases

A solitary nodule is found on a cxr, what are the next steps?

• CT to confirm location

• PET scan

• Fine needle aspiration biopsy

Name the pathology

Solitary pulmonary nodule

Name the pathology

Solitary pulmonary nodule

Should you use contrast in a scan for a pulmonary nodule?

If the nodule is smaller than 3 cm - no

If the nodule is greater than 3 cm (a mass) - yes

What is bronchogenic carcinoma?

Primary cancer of bronchial tree

What are the risk factors of bronchogenic carcinoma?

Carcinogen inhilation

How is bronchogenic carcinoma confirmed?

Bronchoscopy, biopsy

What is the radiographic appearance of bronchogenic carcinoma?

• Mass off a main bronchus

• May have air-fluid levels

• Possible rib destruction

What cancers most commonly metastasize to the lungs?

Carcinomas of:

• Breast

• Prostate

• Colon

• Thyroid

Sarcomas of:

• Muscle

• Skeleton

What modalities are used to assess pulmonary metastasis?

• Gold star = CT

• Assess metabolism (benign vs malignant) = PET

Name the pathology

Mets

Name the pathology

Mets

Name the pathology

Mets

What is COPD?

A category of processes which obstruct gas exchange

Another name for cystic fibrosis

Mucoviscidosis

What is cystic fibrosis?

Defect of chromosome 7 causing excessive production of mucous

What organs are affected by cystic fibrosis?

All organs with exocrine glands:

• Sweat glands

• Goblet cells of GI tract

• Respiratory tract

• Pancreas

What are the secondary pathologies caused by cystic fibrosis?

• Lung collapse

• Recurrent infections

• Bronchiectasis

• Cysts and abscesses

• Failure to gain weight

Radiographic appearance of cystic fibrosis?

• Hyperinflation of lungs

  • Irregular thickening of lung markings

Name the pathology

Cystic fibrosis

Name the pathology

Cystic fibrosis

What is croup?

Obstructive, inflammatory swelling og subglottic trachea

What symptoms are associated with croup?

• Stridor

• Barking cough

What image would best display croup? how would the image appear?

AP soft tissue neck with smooth, tapered hourglass shape

Name the pathology

Croup

What is epiglottitis

Acute infection of epiglottis and surrounding supraglottic pharyngeal structures

Demographic of epiglottitis?

Children

What is the usual cause of epiglottitis?

Haemophilus influenza

What image would best display epiglottitis? how would the image appear?

Lateral soft tissue nexk

Thumb print sign

What is emphysema?

• Injured cilia

• Mucosal inflammation

• Bronchial narrowing

• Air trapping

• Bullae rupture

Blue bloaters and pink puffers?

Blue bloaters - Bronchitis

Pink puffers - Emphysema

Radiographic appearance of emphysema?

Overinflated barrel chest, flat diaphragms

Name the pathology

Emphysema

Name the pathology

Empyema

Name the pathology

Empyema

Name the pathology

Lung abscess

Lung abscess

Necrotic area of pulmonary tissue with a fibrous outer wall

Common causes of lung abscess

• Aspiration

• Bacterial pneumonia

• Bronchi obstruction

• Foreign body

Common causes of pleural effusion:

• CHF

• PE

• TB

• Pleurisy

Common manifestations of pleural effusion

• Chest pain

• Non-productive cough

• Dyspnea

• Orthopnea

Alveolar pneumonia is also called

Air space pneumonia

Pneumococcal pneumonia

What is alveolar pneumonia

Inflammatory exudate replaces air in alveoli

Radiographic appearance of alveolar pneumonia

Homogenous consolidation with air bronchograms (hypodense bronchial tree through hyperdense area of lung)

Name the pathology

Alveolar pneumonia

What is bronchopneumonia

A staph infection originating in the bronchial tree causing patches of consolodation

What can happen if bronchopneumonia is not managed?

• Airway obstruction

• Atelectasis

• Loss of lung volume

Name the pathology

Bronchopneumonia

Interstitial pneumonia

Viral and mycoplasmal infection of alveoli and interstitial tissues

Appearance of interstitial pneumonia

• Linear / reticular pattern

• Shaggy heart sign

• Honeycomb lung

Name the pathology

Interstitial pneumonia

Name the pathology

Aspiration pneumonia

What os pulmonary edema?

Fluid buildup in pulmonary tissues (alveoli)

What can cause pulmonary edema?

• Left sided heart failure = elevated pulmonary venous pressure

• Poison

• Infection

• Medication

• Renal failure

• Exercise at high altitudes

• Heart disease

• Heart attack

Pulmonary edema manifestations

• Coughing (blood)

• Orthopnea

• Doctunal dypsnea

• Wheezing

• Leg edema

• Pale

• LOC

Pulmonary edema radiographic appearance

• Batwing or butterfly shaped hyperdensity

• Decreased pulmonary markings

• Perihilar haze from heart failure

Name the pathology

Pulmonary edema

What is the main cause of pulmonary embolism?

• Lower limb venous stenosis

• Trauma

• Venipuncture

• Indwelling catheter

Manifestations of pulmonary edema

• Cheast pain

• SOB

• Cough

• Shock

• Cardiac arrest

Pulmonary infarct

Ischemic necrosis of lung tissue

What can cause a pulmonary infarct

PE

Radiographic appearance of pulmonary infarct

Wedge sign with apex towards hilum

Name the pathology

Pulmonary infarct

Name the pathology

Pulmonary infarct

Respiratory distress syndrome

sudden life-threatening disorder caused by inhalation of toxins, trauma or overdose, the lung parenchyma dissolves

Respiratory distress syndrome is also called

ARDS

Shock lung

Radiographic appearance of Respiratory distress syndrome

Patchy, ill-defined consolidation between both lungs with normal heart shadow

Name the pathology

Acute respiratory distress syndrome

What is IRDS?

infant respiratory distress syndrome - hyaline membrane disease due to failure to produce surfactant

Name the pathology

IRDS

What is SARS?

Severe acute respiratory syndrome - a serious form of pneumonia in the coronavirus family

SARS symptoms

• Cough

• SOB

• Fever

• Chills

• Aches

SARS radiographic appearance

Similar to pneumonia - patchy infiltrates proceed to consolidation and lack airspace

What is TB

A waxy coat mycobacterium

How is TB spread and how can it be prevented?

Airborn droplets spread through coughing. Can be killed by sunlight

What are the types of TB?

Primary - pulmonary

Secondary - reactivation of dormant disease

Radiographic appearance of primary TB

• Well-defined consolidation

• Hilar enlargement

• Pleural effusion

• Ghon lesion

Name the pathology

TB

Name the pathology

TB