6. lung lumps and bumps

list the pathologies that are masses/obstructions of the respiratory system

lung carcinoma, lung abscess, empyema, TB, cystic fibrosis, croup, epiglottitis

describe the features of a lung neoplasm

a solitary nodule, can be benign or metastatic, risk of malignancy increases with age, nodules are usually resected in older pts

what does a lung nodule look like when its malignant

irregular and spiculated margins

what does a lung nodule look like when its benign

has well defined borders

what is the most common lung carcinoma

bronchogenic carcinoma

what are the two types of bronchogenic carcinoma

small cell lung cancer, non-small cell lung cancer

for bronchogenic carcinoma, which % of cases are small cell lung cancer

20%

for bronchogenic carcinoma, which % of cases are non-small cell lung cancer

80%

bronchogenic carcinoma classification

neoplastic

bronchogenic carcinoma: benign or malignant

malignant

bronchogenic carcinoma etiology

idiopathic, linked to smoking + inhalation of carcinogens

T or F: bronchogenic carcinoma is the most common primary malignant lung neoplasm

true

where does bronchogenic carcinoma arise from

mucosa of the bronchial tree

where in the body is non-small cell lung cancer (bronchogenic carcinoma) located

major central bronchi, periphery of bronchial tree, alveoli

where in the body is small cell lung cancer (bronchogenic carcinoma) located + what does this cause

hilum area = enlargement of lymph nodes

what pathologies could bronchogenic carcinoma lead to if it obstructs the airways (2)

atelectasis, pneumonia

where does bronchogenic carcinoma metastasize to (in order of most common to least)

bone, liver, brain, adrenal glands

bronchogenic carcinoma signs and symptoms

persistent cough, chest pain, dyspnea, unintentional weight loss, hemoptysis, mets, nail clubbing (due to hypoxia)

bronchogenic carcinoma radiographic appearance on CXR

radiopaque lesion or enlarged hilum

bronchogenic carcinoma radiographic appearance on CT

detects mediastinal shift, hilar masses, bronchial narrowing

how to diagnose bronchogenic carcinoma

detection of cancer cells in sputum, biopsy during bronchoscopy or under CT/fluoro guidance

bronchogenic carcinoma tx

surgical resection, radiation therapy, chemo in palliative care

bronchogenic carcinoma prognosis

poor; easily spreads to lymph nodes unless its a solitary nodule

pulmonary metastases develop in __% of pts with cancer

33%

how do pulmonary metastases spread

via vascular or lymphatic system, or by proximity to an organ

list the most common cancers that will metastasize to the lung (to cause pulmonary metastases)

musculoskeletal tumors, myeloma, breast, GI, thyroid, urogenital

pulmonary metastases radiographic appearance

25% appear as solitary nodules within the lungs

benefit of CT for pulmonary metastases

it can detect nodules that weren’t seen in the CXR, and it aids in Tx decisions

benefit of PET scans for pulmonary metastases

can detect mets + differentiate between benign and malignant lesions

pulmonary metastases tx

only as palliative: surgical resection, radiation, chemo

lung abscess classification

inflammatory

define what a lung abscess is

a cavity within the lungs that is partially filled with pus, with a thick fibrous wall

which lung are lung abscesses more common in; why

right lung: right bronchus = more vertical

lung abscess etiology

may occur as a complication of bacterial pneumonia, fungal infection of the lungs, inhalation of foreign material, immunocompromised pts (AIDS), cancer tx pts, pt who experienced near-drowning or aspiration, may occur secondary to carcinoma of bronchus, septic emboli

lung abscess pathogenesis

organism invades the lung parenchyma and is encapsulated with a fibrous wall. causes; aspiration (most common), tumor (malignant), embolism (infected blood clot), pneumonia, inhalation (infected material)

lung abscess signs and symptoms

fever and chills, foul-smelling sputum, rapid HR, deep cough, bloody sputum, fatigue, can travel to the brain = brain abscess

lung abscess radiographic appearance on CXR and CT

spherical shape with thick/irregular limits of parietal and visceral pleura. destruction of vascular and bronchial structures

for lung abscesses, what can CT help r/o in terms of other pathologies it could be (1)

empyema

lung abscess tx

antibiotics/antifungals, bronchoscopy for drainage, surgery to abscess drainage or removal of infected lobe

empyema alternative names

pleural empyema, pyothorax

empyema classification

inflammatory, traumatic

empyema etiology

infected fluid escapes into the pleural cavity from the lung

empyema pathogenesis

infection/abscess in the lung breaks through the visceral pleura (pneumonia), traumatic (stabbing), iatrogenic infection (thoracic surgery, instrumentation in the chest)

empyema signs and symptoms

fever, night sweats, difficulty breathing, chest pain, cough

empyema diagnosis

CXR, CT scan, thoracentesis to test the fluid

empyema radiographic appearance on CXR

locates the area of interest, cannot differentiate from pleural effusion, may see atelectasis if it’s compressing lung tissue

empyema radiographic appearance on CT

mass on chest wall that won’t enhance with contrast, may have air/fluid level if communicating with chest parenchyma. split sign: differentiation between visceral and parietal pleura

how does empyema look different from an abscess on CT

abscess = sharp angles where it meets with the chest wall, will be round. empyema = round where it meets with the chest wall

empyema tx

meds for infection control, small ones can be aspirated, large ones may require chest tubes for drainage

TB classification

inflammatory

TB etiology

infection caused by mycobacterium tuberculosis, water droplet transmission via coughing of infected person

TB pathogenesis

after inhalation of infected droplet, inflammation occurs around the bacteria = scarring. can spread to involve GI/GU/skeletal systems

TB signs and symptoms

early TB = asymptomatic, cough, fever, hemoptysis, weight loss

TB radiographic appearance

consolidation may be seen indicating inflammatory process, mediastinal lymph node swelling close to the hilum, Ghon tubercle is a calcified remnant of TB, miliary TB

TB: describe what a Ghon tubercle is

calcified remnant of TB: its a cavity where the infection was, is calcified, and a calcified lymph node is usually present

TB: what does miliary TB look like

small diffuse tubercles scattered over both lungs, millet seed appearance

describe primary TB

historically occurred strictly in children and young adults, now occurs in all populations equally

describe secondary TB

aka reactivation TB. dormant TB re-infects the pt with new secondary lesions in the same area (commonly apices). very destructive in appearance

radiographic appearance of secondary TB

extensive fibrosis and scarring, loss of lung volume

TB tx

antibiotics, or surgery if meds aren’t effective

what is the TB skin test called

PPD: purified protein derivative test

what does a positive TB skin test mean

you have been exposed to mycobacterium tuberculosis bacteria, and further testing is needed to see if its active or latent

cystic fibrosis classification

hereditary

what makes CF hereditary

chromosome 7 defect

CF etiology

excessive secretion of viscous mucous by exocrine glands

CF pathogenesis

thick mucous clogs lungs = SOB. inability to clear mucous leads to lung infections. chronic infections lead to bronchiectasis, cysts, and abscesses. other organs affected = pancreas, liver, sinuses, sweat glands

CF signs and symptoms

wheezing, persistent cough, SOB

CF radiographic appearance on CXR

irregular thickening of the lungs, areas of atelectasis and bronchiectasis and emphysema. hyperinflation = barrel chest

CF radiographic appearance on CT

structural damage (bronchiectasis)

CF tx

physio to remove mucous from lungs, prophylactic antibiotics, bronchodilators, lung transplant, gene therapy (experimental still)

where does croup occur vs epiglottitis

croup = subglottic trachea and larynx, epiglottitis = at the epiglottis or in the supraglottic area

alternative name for croup

acute laryngotracheobronchitis 

croup classification

inflammatory

croup etiology

acute inflammation of the larynx and trachea due to infection (viral)

who does croup affect

children under 6

croup pathogenesis

occurs a few days after the start of an upper resp infection. infection invades laryngeal mucosa, inflammation and edema occur = narrowing of subglottic area

croup signs and symptoms

barking cough, noisy breathing, sore throat, fever, hoarse voice, worse at night

croup radiographic appearance

steeple sign (narrowed subglottic region seen on AP)

croup tx

most cases are mild and resolve in 48 hours, moderate to severe cases may need O2 + nebulizer epinephrine + corticosteroids. intubation needed if very severe

epiglottitis classification

inflammatory (via infection), traumatic (via injury)

epiglottitis etiology

swelling of the epiglottis

epiglottitis etiology: children

bacterial infection: haemophilus influenza type B, or FB ingestion

epiglottitis etiology: adults

burn injury, physical injury to neck, drug smoking (crack), head/neck radiation injury

epiglottitis pathogenesis

epiglottis becomes infected/inflamed/injured, edema causes swelling, airway becomes obstructed

epiglottitis signs and symptoms

rapid onset, sore throat, dysphagia, distress, drooling, no cough

epiglottitis radiographic appearance on xray

thumb sign indicates swollen epiglottis on LAT view

epiglottitis radiographic appearance on CT

usually CT is contraindicated bc it may cause resp distress, but if its done we will see epiglottal swelling

epiglottitis tx for non-acute cases

sitting or semi-sitting, antibiotics (if infection), corticosteroids and/or epinephrine

epiglottitis tx for acute cases

all of the above (antibiotics, corticosteroids, epinephrine) plus intubation: ET tube, cricotomy tube, trachesotomy tube