Chest and Lung abnormalities

Asthma (reactive airway disease)

1.) small airway obstruction due to inflammation and hyperreactive airways

2.) triggers: allergens, anxiety, cold air, exercise

3.) edema, mucous secretion, bronchoconstriction, episodes of dyspnea, may have chest pain

4.) tachypnea, coughing, wheezing and hypoxemia

Atelectasis

1.) incomplete expansion of the lung at birth or the collapse of the lung at any age

2.) compression or obstruction resulting in resorption of air, often postoperative

3.) findings based on airless area of lungs → increased vibration, dullness and no breath sounds

Bronchitis

1.) inflammation of the large airways

2.) acute: MC viral (chest cold) → fever, productive/non-productive cough, dyspnea, chest pain, fatigue

3.) chronic: MC smoking (fumes, pollution, toxic gasses)

4.) greater involvement may have rhonchi, wheezing, occasional crackles

E-Cigarette or Vaping injury

1.) respiratory failure with low blood oxygen levels from inhalation of vapors of nicotine and/or other substances

2.) acute lung inflammation, dyspnea with non-productive cough, with chest and abdomen pain

3.) tachypnea, tachycardia, fever, hypoxemia

Pleurisy (pleuritis)

1.) inflammatory process involving the visceral and parietal pleura

2.) secondary to PE, infection or connective tissue disease

3.) sometimes associated with neoplasm or asbestosis, chest pain when breathing, friction rub may be felt by the patient and/or auscultated

4.) rapid shallow respiration, decreased breath sounds

Pleural Effusion

1.) excessive Non purulent fluid in the pleural space, due to heart failure, infection, renal insufficiency, CT disease, neoplasm and trauma

2.) cough, dyspnea, chest pain

3.) dullness to percussion, decreased tactile fremitus, decreased breath sounds

Empyema

1.) Purulent exudative fluid collected in the pleural space, not free-flowing so collects in pleural space

2.) commonly from infected adjacent tissues (pneumonia), fever, tachypnea, cough, chest pain, dyspnea

3.) decreased breath sounds, dullness to percussion, absent tactile fremitus (friction rub)

Lung Abscess

1.) usually a well circumscribed fluid containing cavity with an air-fluid interface, typically unilateral when caused by aspiration

2.) MC caused by aspiration of food or infected material from upper respiratory or dental sources of infection

3.) malaise, fever, shortness of breath

4.) percussion dull, decreased breath sounds, may have pleural friction rub, cough may produce purulent, foul smelling sputum (Stroke patients at risk)

Pneumonia

1.) inflammatory response of the bronchioles and alveoli to an infective agent, infection of the pulmonary parenchyma

2.) cough, pleuritic chest pain, dyspnea, chills, rigor, sometimes nausea and vomiting

3.) right lower lobe infection an cause right lower quadrant pain

4.) fever, tachypnea, tachycardia, crackles, rhonchi, dullness to percussion, increased fremitus, vocal resonance

Influenza

1.) viral infection of the lung → interstital inflammation and necrosis; more susceptible to secondary bacterial infections

2.) cough, fever, malaise, headache, coryza, possible sore throat

3.) crackles, wheezes, rhonchi, tachypnea (unchanged vibration, resonant percussion)

4.) high morbidity and mortality

Covid-19

1.) viral infection caused by severe acute respiratory syndrome coronavirus 2

2.) transmitted through respiratory secretions even before symptomatic

3.) fever, cough, malaise, headache, dyspnea, loss of sense of smell and taste

4.) crackles, wheezes, rhonchi, tachypnea

TB

1.) chronic infectious disease that most often begins in the lung but may then have widespread manifestations

2.) spread by coughing and sneezing, may spread locally or throughout the body

3.) asymptomatic in the latent period; fever, cough (blood streaked), weight loss, night sweats, increased risk with travel to endemic regions

Pneumothorax

1.) presence of air or gas in the pleural cavity

2.) due to trauma or spontaneous rupture of a bleb

3.) tension pneumothorax → increasing pressure in pleural space, asymptomatic at first then dyspnea and chest pain

4.) mediastinal shift, tracheal deviation, hyperresonant percussion, decreased tactile fremitus, decreased breath sounds

Hemothorax

1.) presence of blood in the pleural cavity, trauma, medical procedures

2.) may be hemopneumothorax if air is also present

3.) decreased breath sounds, dull percussion, decreased tactile fremitus, tachycardia and hypotension possible

Lung cancer

1.) generally refers to bronchogenic carcinoma, a malignant tumor that evolves from bronchial epithelial structures

2.) tobacco smoke, radon, asbestos, radiation, may be asymptomatic or cough/wheezing, hemoptysis

3.) nonspecific weight loss, fever, night sweats, may develop pneumonia and or pleural effusion

4.) if large enough: decreased breath sounds, dull percussion, increased tactile fremitus

Pulmonary Embolism

1.) embolic occlusion of pulmonary arteries, from dislodged thrombosis from deep veins of the legs

2.) risk factors: Age, venous thromboembolism, surgery, heart, cancer, fracture of the pelvis/leg, obesity, bed rest, long trips

3.) pleuritic chest pain, fever, hypoxia, tachycardia

4.) difficult to diagnose: wells PE prediction rule, D-dimer test = test for protein fragment from blood clot formation and breakdown

Wells PE prediction rule

1.) 3 points if clinical signs of DVT → leg swelling and pain with palpation of deep veins

2.) 3 points if alternative diagnosis less likely than PE; 1.5 points if heart rate > 100bpm

3.) 1.5 if immobilization > 3 days or surgery in previous 4 weeks; 1.5 points if previous PE or DVT

4.) 1 point if hemoptysis, 1 point if malignancy with treatment in last 6 months

Wells PE prediction rule: interpretation

1.) score < 2 suggests low risk of PE (<7%)

2.) score 2-6 suggests intermediate risk of PE

3.) score >6 suggests high risk of PE (>45%)

Cor Pulmonale

acute or chronic condition involving right-sided heart failure

with COPD, asthma, cystic fibrosis, bronchiectasis

Pulmonary edema: cardiogenic

heart failure (many causes) leading to backup of circulation in lungs

Pulmonary edema: non-cardiogenic

1.) acute respiratory distress syndrome (ARDS), upper airway obstruction, altitude sickness, neurogenic, lung transplant, capillary leak syndrome (autoimmune)

2.) fluid in airways: dyspnea, tachypnea, pink frothy sputum, hypoxemia, crackles (best heard in lower lung fields)

Epiglottitis

1.) acute, life-threatening infection involving the epiglottis and surrounding tissues

2.) sore throat, difficulty swallowing, muffled voice, drooling, fever, stridor

Croup (laryngotracheal bronchitis)

1.) viral infection, most often in children 1.5-3 years

2.) upper respiratory symptoms, mild fever, harsh barking cough, labored breathing, retractions, hoarseness, stridor

Diaphragmatic hernia

1.) result of an imperfectly structured diaphragm, occurs once in slightly more than 2000 live births

2.) 90% = left (liver on right)

3.) may lead to severe respiratory distress. bowel sounds in chest

Cystic fibrosis

1.) autosomal recessive disorder of exocrine glands involving the lungs, pancreas, and sweat glands

2.) thick mucus, clogged bronchi, bronchiectasis, cysts, salty sweat, malabsorption with poor weight gain

3.) develops barrel chest

Tracheomalacia

1.) lack of rigidity or a floppiness of the trachea or airway, difficulty breathing, (wheezing, stridor)

2.) findings of respiratory distress develop with airway collapse or severe compromise

3.) benign and self-limited with increasing age

Bronchiolitis

1.) bronchiolar (Small airway) inflammation leading to hyperinflation

2.) most often in infants younger than 6 months, most commonly due to RSV

3.) begins with URI infection, infant with poor feeding, vomiting, diarrhea, tachypnea, retractions, cyanosis, wheezing, grunting. decreasing breath sounds, hyperinflation, hyperresonant percussion

COPD

1.) nonspecific designation that includes a group of respiratory problems in which cough, chronic and often excessive sputum production, and dyspnea are prominent features

2.) not limited to older adults → smokers at greatest risk

3.) emphysema, bronchiectasis, and chronic bronchitis are the main conditions that are included in this group

Emphysema

1.) condition in which the lung lose elasticity and alveoli enlarge in a way that disrupt function

2.) MC due to smoking, dyspnea, barrel chested, decreased breath sounds, some crackles and wheezes, hyperresonant percussion, decreased tactile fremitus

Bronchiectasis

1.) chronic dilation of the bronchi or bronchioles is caused by repeated pulmonary infections and bronchial obstruction

2.) frequently with cystic fibrosis, cough with large amounts of sputum, hemoptysis, tachypnea, clubbing, crackles, rhonchi

Chronic Bronchitis

large airway inflammation, usually a result of chronic irritant exposure

more commonly a problem for patients older than 40