Transcript Respiratory System Pathology 91 Spring 2010 DRAFT Respiratory System Anatomy 1. Divided into: 1. 2. _____________________________ _____________________________ 2. Thoracic cavity 1. 2. 3. RT & LT pleural cavities ___________________ Lined by parietal pleura 3.

Respiratory System
Pathology 91
Spring 2010
DRAFT
Respiratory System Anatomy
1. Divided into:
1.
2.
_____________________________
_____________________________
2. Thoracic cavity
1.
2.
3.
RT & LT pleural cavities
___________________
Lined by parietal pleura
3. Visceral pleura __________________to the lung tissue
4. Bones of thorax assist in __________& ____________
5. Sinuses
1.
2.
________________________________
________________________________
2
Upper & Lower Respiratory Tracts
1. Upper
1.
2.
3.
4.
___________
Mouth
___________
Larynx
2. Lower
1.
2.
3.
4.
___________
Bronchi
___________
Lungs
3
Mediastinum
1. Anterior
1.
_____________________
2. Middle
1. __________________
2. __________________
3. __________________
3. Posterior
1. __________________
4
Mediastinum Frontal Radiograph
1.
2.
3.
4.
5.
6.
Superior vena cava
RT atrium
Inferior vena cava
Arch of aorta
LT pulmonary trunk
LT pulmonary artery
shadow
7. Auricle of LT atrium
8. LT ventricle
9. LT cardiophrenic angle
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Retrieved from :www.liv.ac.uk/.../mbchb/hrtatk/images/ha1.jpg
The Importance of CXR’s
1. It is the ________ __________ diagnostic exam
2. It becomes ___________________
3. ____________________techniques
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Poor Inspiration vs.
Sufficient Inspiration
1. Sufficient inspiration
2. Average movement of lungs and diaphragm
between inspiration and expiration is ________
7
Film Screen vs. CR / DR
and Technique Considerations
1. ____________ techniques
1.
Consistent Techniques
1. Use PSP plates
2. Daily radiographs
1.
2.
Analyze changes in
pathology after treatment
Or the progression the
disease
1.
They offer a wider latitude
2. ___________ is increased
to decrease PT dose
3. Must have optimal
___ and ____
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Additive & Subtractive Pathologies
1. Additive
1. ____________________
1. Subtractive1. _____________________
2. Requires an __________ 2. These pathologies
in exposure factors
increase ____________
in the chest
3. These are pathologies
that
_________________ to
normal aerated chest
1. EX: emphysema
3. ____________ exposure
factors required
1. EX: pneumonia
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Additive and Subtractive Examples
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Technique Adjustments for Different
Image Receptors
1. Film Screen
1. ________________________
2. kVp adjustments changes ________________
2. With a digital system
1. _______________ should be adjusted
2. To ______________________ PT dose
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AEC Sensors and Pathologies
1. AEC requires careful thought in regards to where
pathology is in relation to sensors
2. Portable AEC
1. consistent exposure accuracy
2. less sensors
3. Sensors should be carefully selected
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AEC Sensors and Pathologies
1. AEC requires careful thought in regards to where
pathology is in relation to sensors
2. Portable AEC
1. consistent exposure accuracy
2. less sensors
3. Sensors should be carefully selected
13
CXR Projections
PA: Upright vs. Recumbent
1. Upright:
2. Recumbent:
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AP CXR’s
 Usually seen in Portable exams
 Best to be performed upright to demonstrate
air/fluid levels
 Maintain beam perpendicular to plane of IR
 To prevent foreshortening of the heart
 Use 72”
 To reduce heart magnification
 Longer SID reduces magnification
 Short OID reduces magnification (this is why PA is
preferred)
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Lateral CXR
 Left lateral places heart
closer to IR
 Heart is on left
 72” SID for reduced
heart magnification
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Lateral Decubitus CXR
For diagnosis of free air in the pleural space or pleural fluid 18
Lordotic Chest
 Useful in demonstrating
apical regions of the lung
 Apices are normally
obscured by bony
structures
 TB likes to reside in apices
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Soft tissues
of chest
 Can see pectoral muscles
 Breast shadows
 Sometimes breasts obscure
costophrenic angles
 Nipple shadows
 Implants
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Mediastinal Radiographs
and Pathologies
Sail Sign
1. Mediastinum appears
large
1. __________________
2. Radiographic
appearance:
1. AP: ________________
2. Lateral:__________
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Sail Sign
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Mediastinal Emphysema
(Pneumomediastinum)
1. Sudden rise in
__________________that
causes alveolar rupture.
2. Can be _______________
1. Severe coughing, vomiting
or straining
3. Can result from _____
1. Endoscopy
2. Injury
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Mediastinal Emphysema
(Pneumomediastinum)
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Treatment of Mediastinal
Emphysema
 Other than
spontaneous:
 Spontaneous:
 If there is no
pneumothorax, no
treatment is necessary
 Usually resolves in a
few days without
complications
 Rupture in esophagus
(usually from vomiting)
 Major bronchus trauma
(trauma)
 Both need prompt
diagnosis & surgical
intervention
 Esophogram can verify a
leak has not occurred.
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Subcutaneous
Emphysema
1. Can be caused by:
1. Severe _____________
2. ___________________
2. Usually in ________
and/or __________
3. Crackling sound or
sensation
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Subcutaneous Emphysema
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Congenital and Hereditary
Diseases
Cystic Fibrosis
Hyaline Membrane Disease
Cystic Fibrosis
 Generalized disorder from a genetic defect that affects the
function of the exocrine glands
 Involves many organs & nearly all exocrine glands
 Other organs affected






Salivary glands
Small bowel
Pancreas
Biliary tract
Female cervix
Male genital organs
 Most lethal genetic disease of white children
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Cystic
Fibrosis
 Diffuse Interstitial
disease
 Nodular densities with
mucoid impaction
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Progression of Cystic Fibrosis
 At birth lungs are normal
 Progression:




Increased secretions from bronchial glands
Leads to obstruction of the bronchial glands
Obstruction leads to staph infections,
Followed by tissue damage:
 atelectasis,(collapsed lung) and emphysema
 Once progression is in motion it is hard to stop
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Cystic
Fibrosis
 Role of Radiography:
 Symptoms
 Chronic couth
 With sputum, vomiting &
disturbed sleep
 Wheezing
 Recurrent Pulmonary
infections
 CXR aid in diagnosis
 Early: bronchial thickening
and hyperinflation
 Progression: brochiectasis,
cyst, atelectasis, scarring,
enlargement of pulmonary
artery and RT ventricle,
overflation of lungs and chest
wall
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Cystic Fibrosis Sinuses
 Sinus x-rays & CT will demonstrate persistent
opacification of sinuses
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Cystic Fibrosis
 Prognosis:
 Determined by degree of
respiratory involvement
 Respiratory failure is
inevitable
 Death 20-30 years of age
 Treatment:




Antimicrobial drugs
Bronchodilators
Respiratory P.T.
With pneumothoraxchest tube
 With hemoptysisembolizing involved
brachial arteries
 Psychotherapy
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Cystic Fibrosis
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Hyaline Membrane Disease
Respiratory Distress Syndrome (RDS)
 Affects
 Premature infants
 Caused by immature surfactant producing
system
 What is surfactant?
 _________________________________________
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RDS : Signs and Symptoms
1. Signs:
1. Rapid & labored breathing
2. Respiratory distress
3. Atelectasis worsening
2. In severe cases acidosis occurs
3. What is acidosis?
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RDS
1. Severe atelectasis with
a air-bronchogram
sign
1. Life threatening
2. ________________
3. Fine granular
appearance known
as ______________
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Hyaline Membrane Disease With
Air bronchogram sign
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Treatment for RDS
1. Proper ___________________________environment
2. Satisfactory tissue _____________________________
1. Monitored by arterial blood gas
3. _____________ ____________________
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Inflammatory Diseases
Pneumonia
1. 6th leading cause of death in U.S.
1. Most common lethal noscomial infection
2. Most frequent type of inflammation in the
lung compromising pulmonary function
3. Causes include:
1. ________________________
2. ________________________
3. ________________________
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Pneumonia: Age related
 Infants & children
 Most common caused
by viral pathogens
 In adolescents & young
adults
 Most common causes
 In adults
 Most common causes:






Streptococcus
Staphylococcus
Pneumococcus
Haemophilus influenza
Chlamydia pneumoniae
Legionella pneumophila
 Bacterial organisms
termed mycoplasma
pneumoniae
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Pneumonia:
Classification by location
1. Lobar pneumonia
1. _____________________________________
2. Segmental pneumonia
1. _____________________________________
3. Bronchopneumonia
1. _____________________________________
4. Interstitial pneumonia
1. _____________________________________
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Lobar
Pneumonia
 Right sided lobar
pneumonia
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Segmental pneumonia
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Bronchopneumonia
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Interstitial Pneumonia
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CXR’s for Pneumonia
 Important in determining location of
pneumonia
 Appears as soft-patchy, ill defined alveolar
infiltrates and pulmonary densities
 Alveolar infiltration results when alveolar air
spaces are filled with fluid or cells
50
Generalized Symptoms
of Pneumonia
 Cough
 Fever
 Sputum production (develops over days)
 Tachypnea
 Crackles during clinical examination
51
Types of Bacterial Pneumonia
 Most common
 Pneumococcal (lobar) pneumonia
 Less common
 Staphylococcal
 Occurs sporadically with epidemics of influenza
 Streptpcoccal
 Less than 1% of bacterial pneumonias
 Legionnaires
 Occurs in late summer- early fall
 Severe bacterial pneumonia
 Occurs in LG buildings such as hotels and hospitals
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Pneumococcal (lobar) Pneumonia
 Caused by a bacteria present in healthy
throats
 Making it most common bacterial pneumonia
 When immune system weak bacteria multiplies
and spreads to lung, causing inflammation to
alveoli
 Usually in lobular without affecting bronchus
themselves
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Pneumococcal (lobar) Pneumonia
 Demonstrates a collection of fluid on one or more less
 Lateral view serving to identify segmental involvement
 In a LLD pleural fluid is evident
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Pneumococcal Pneumonia
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Air- Bronchogram sign
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Treatment of
Pneumococcal (lobar) Pneumonia
 Bed rest
 Antibiotics
 Based on lab results
 Age
 Usually resolves in 1 week
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Aspiration Pneumonia
 Caused by acid vomitus aspirated by lower
respiratory tract

 May follow
 anesthesia
 alcoholic intoxication
 stroke
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Aspiration
Pneumonia
 Reveals edema
produced by irritation
of air passages
 Appears as densities
radiating to one or
both hilia
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Treatment of
Aspiration Pneumonia
 Strictly supportive
 Control of hypoxia and secretions
 Replacement of fluids (speech therapist)
 Antimicrobial drugs if infection has occurred
 Based on lab results
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Viral (interstitial) Pneumonia
 Can be caused by various viruses
 Mostly influenza A & B
 Spreads by infected person spreading virus to
a non-immune person
 Most cases are mild and x-ray findings are
minimal
 Diagnosis is based on clinical findings and
serologic tests
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Viral (interstitial) Pneumonia
 Symptoms:
 Dry cough
 Fever
 Complications:
 Secondary to bacterial infections as a result of low
resistance
 Brought on by inflammatory process to the virus
 Treatment:
 Relief of symptoms
 Does not respond to antibiotics
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Interstitial Pneumonia
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Interstitial Pneumonia
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Bronchiectasis
 Permanent dilatation of 1 or more of the large
bronchi
 A result of destruction of the elastic & muscular
components of the bronchial wall
 Can be congenital or acquired
 Typically following and inflammation of the bronchial
walls due to bacterial or viral infections
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Progression of Bronchiectasis
1. Early stages:
1. __________________________
2. __________________________
2. Progresses:
1. __________________________
2. __________________________
3. Later:
1. _________________________
2. Results in an abscess
3. Pt’s may complain of pain, recurrent fevers and SOB
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Bronchiectasis
 Demonstrated increased bronchovascular markings and parallel lines
outlining the bronchi (Tram lines)
 Occasionally ____________________ and cystic areas are present67
Bronchiectasis
1. Bronchograms has been
replaced by high resolution
CT
2. Clearly demonstrates:
1.
2.
3.
4.
Dilated _______________
Destruction of lung
parenchyma
________ of bronchial walls
Obstruction by mucus or air
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CT and Bronchiectasis
 CT has replaced Bronchography
 High resolution CT
 With 1-2 mm slices
 With or without contrast
 Clearly demonstrates dilated airways of 1.5 times larger
than adjacent vessels
 Thickening of bronchial walls & obstruction of airways by
mucous or air
 Helical or spiral CT
 Can offer additional information regarding the extent of
disease & its distribution within the segment of the lung
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Pulmonary TB
 Is an infection caused by inhalation of myobacterium
tuberculosis
 Generally virus affects lungs but can affect other areas of
the body
 PT’s contagious through sputum & air droplets
 Respiratory isolation indicated
 More prevalent in blacks than whites
 Increase in black & Hispanic IV drug users
 Approximately 8 in 100,000 people in the U.S.
developed TB in late 1990’s
 1.7 million people worldwide and 10 million in U.S.
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Progression of TB
 Early stages are asymptomatic (90-95%).
Only identified in mantoux skin test
 Primary means of diagnosis but if positive other
tests are performed because of false positives
 Lung lesions begin to appear (apices)
 Lordotic views of chest for diagnosis
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TB
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TB
Symptoms
 Most common- morning
productive cough
producing minimal mucous
 As disease progresses
cough becomes more
productive
 Pts complain of dyspnea,
spontaneous
pneumothorax, and pleural
effusion
Treatment
 Chemotherapeutic
agents
 Must be treated with 2
antituberculosis drugs
 In extreme cases where
TB is resistant to drug
therapy, surgical
resection of may be
performed
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Miliary TB
1. Initially miliary TB is not identifiable on films
2. Immunosuppressed PT’s infection is much more
aggressive
1. Overwhelms immune system & spreads through lungs
causing pneumonia
2. _____________________________________________
3. Grows very rapidly
1. Without treatment TB pneumonia with result in death
in a few ______________________________________
2. If resistant to drug therapy ________ will die in __ days
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Miliary TB
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COPD- Chronic Obstructive
Pulmonary Disorder
1. Group of disorder that case chronic airway
obstruction
1. 2 most common are _______________&_____________
2. Others are ______________________&______________
2. It is irreversible & results in limited air flow
3. Mortality rate has increased in the past 20 years
due to cigarette smoking.
1. It is the top _____ most common causes of death in U.S.
2. # of people diagnosed has increased _____ since the 80’s
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Chronic Bronchitis
 Often associated with long term smoking and
exposure to high levels of industrial air
pollution
 Chronic exposure leads to hyperplasia of
mucous glands, hypertrophy of smooth
muscle & thickening of the bronchial wall
 CXR demonstrates hyperinflation of lungs
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Chronic Bronchitis
 Disease progresses slowly over months and
years
 Symptoms:
 Persistent cough & exportation of phlegm &
mucous
 Wheezing, SOB, & arterial hypoxia
 Lungs become hyperinflated and more air is
inhaled than exhaled
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Chronic Bronchitis
Treatment
1. Stop _____________
2. _________________ if
infection has occurred
3. __________________
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Bronchitis
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Tram lines
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Emphysema
1. Lung’s alveoli lose __________________
2. Interference with ___________________
3. Increase in air spaces distal to the ______ bronchioles
4. Destruction of the alveolar _____________________
5. Symptoms include ______________ (most common).
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Emphysema
1. Appears as
__________or________
diaphragm
2. _______________ lungs
3. _________ shaped chest
4. CXR helps differentiate
this disease from others
that have similar
symptoms
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Emphysema
85
Emphysema
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Asthma
1. Widespread ____________ of airways develop
1. Due to _____________ responsiveness to various
allergens
2. Allergens include:
1. House dust, pollen, molds, animal dander, foods
fabrics (__________________________asthma)
2. Exercise, cold, heat, and emotional upset
(________________________________asthma)
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Asthma
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Asthma
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Lung Cancer
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Calcified Nodes
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Croup
 Primarily a viral infection of
young children
 Produces inflammatory
swelling at the subglottic
portion of the trachea
 Causes a stricture that
causes a barking cough
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Croup
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Lung Abscess
 Localized area of dead lung tissue surrounded
by inflammatory debris
 May result from periodontal disease,
neoplasms, pneumonia, or other organisms that
invade lung
 More common in RT lung
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Lung Abscess
 _____________________________________________
 _____________________________________________
95
Lung Collapse (Pneumothorax)
96
Atelectasis
97
Foreign Body
98
Pulmonary Edema
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Histoplasmosis
 Systemic fungal infection caused by a fungus that
thrives in soil
 Especially by bird or bat excreta
 Particularly endemic in Ohio
 Most cases are acute and mild so they are not
diagnosed
 More severe case: Progressive disseminated
histoplasmosis
 It spreads to lungs and leads to cavitory formations
 Cavities resemble TB & are also in apices
 It is an opportunistic infection fro AIDs PT’s & leads to acute
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pneumonia
Histoplasmosis
 CXR shows small
calcifications as a late
manifestation
 4-5 years later
 Diagnosis is made
by lab analysis
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Pleural Effusion
 Results when excess fluid collects on pleural
cavity
 Frequent manifestation of serious thoracic
disease
 Usually pulmonary or cardiac
 It is a sign on an underlying condition
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Pleural Effusion
 CXR’s commonly used to diagnose
 Radiographically demonstrated as blunting of
costophrenic angles
 It occurs as part of the healing process and fibrous changes in
lung tissue may remain after it is resolved.
103
Pneumoconiosis
1. Occupational diseases in which inhalation of dust
in work environment causes pulmonary fibrosis
2. Exposure to substance must be in sufficient
duration & host must be susceptible
3. 3 types of pneumoconiosis:
1. ____________________________
2. ____________________________
3. ____________________________
104
Pneumoconiosis
 X-ray assists in diagnosis and follow up
 Lesions include nodules, cavitation & pleural thickening
105
Asbestos Plaques
106
Congestive Heart Failure (CHF)
107
CT
 Spiral CT has the advantage of imaging the entire
chest with one breath hold
 Allows for better evaluation of the chest including
emboli detection.
 Advances it CT allow high resolution, thin slices (11.5 mm), faster scan times in combination with
dynamic scanning.
 Needle aspirations is commonly performed under
CT guidance.
108
Nuclear Medicine
 Perfusion and ventilation scans are useful in
evaluating chest disease in the case of obstructive
disease and pulmonary emboli
 PET captures info regarding metabolic activity
 Because of cost constraints, PET is not currently
consistently used in the staging of early ling cancers
 Promising modality for the future especially when
combined with CT
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