Chest Pathologies 2 PDF

VASCULAR DISEASE Pulmonary Embolism  PULMONARY EMBOLISM more common A dislodged thrombus that occur in the deep venous system of the LE (most common) OR right side of the heart, brachial or cervic...

VASCULAR DISEASE Pulmonary Embolism  PULMONARY EMBOLISM more common A dislodged thrombus that occur in the deep venous system of the LE (most common) OR right side of the heart, brachial or cervical veins (less common) and is deposited in one of the pulmonary arterial vessels less blood flow in lower lobes than upper Potentially fatal condition Most occlusions occur in the lower lobes because of the preferential blood flow to these regions Most common pathologic process involving lungs in hospitalized patients bed riden, less movement can easily get PE  PULMONARY EMBOLISM air, thrombus or fat May be caused by: Heart disease Cancer Post Surgery Prolonged immobility – hospitalized patients, long flights Fat embolism from trauma Smoking Overweight Estrogen replacement therapy (birth control) Pregnancy  PULMONARY EMBOLISM Symptoms: Treatment: Chest pain Anticoagulant Therapy Dyspnea Thrombolytic Therapy for recurrent thrombi Cough IVC filter placement for recurrent thrombi & Tachycardia trauma Unable to lie flat Prevention: Leg pain Light-headed & dizzy Compression stockings Fidget in chair Take breaks from sitting Drinking plenty of water & move around especially while travelling  PULMONARY EMBOLISM Radiographic Appearance: CT scan #1 modality of choice for PE Increased radiolucency distal to the embolus Absence of lung markings distally Characteristic wedge-shaped infiltrate reaching out to the pleura (associated with infarction) Associated with pleural effusion *** There may be negative or inconclusive findings on the chest radiographs *** if not large, wotn show on xray, will show on CT VQ scans in nuclear medicine To indicate a PE on a CT, look for: CT scans Filling defect within the pulmonary artery Cut-off indicating complete obstruction  PULMONARY EMBOLISM Results in: Lung tissue beyond the embolus no longer receives blood Causes ischemia = pulmonary infarct blocks icauses ischemia PULMONARY EMBOLISM wedge shape  PULMONARY EMBOLISM AA R PA pulmonary artery L PA DA 13 seconds SVC then PA and scan before it reaches the aorta PULMONARY EMBOLISM Normal CT Chest PULMONARY EMBOLISM Thrombus in middle of R and L = saddle PE filling defect PULMONARY EMBOLISM  PULMONARY EMBOLISM Thrombus vs Embolus both blood clots fat or air bubbles Thrombus blood Embolus Stationary blood clot that forms in Thrombus that has broken free & is a blood vessel or the heart carried towards the lungs (PE) or brain Stays attached to the vessel wall (STROKE) by the bloodstream where it forms and may either Often it is a blood clot, but can also be partially or completely block blood fat or air bubbles that breaks off from it’s flow original site & moves through the Normally happens when you are bloodstream injured Floats along with the flowing blood until Occur at the site of an ulcerated this is why it gets stuck at it encounters a narrowing in an artery atherosclerotic plaque or the base of the lungs through which it cannot pass wherever the endothelial cells Embolus gets stuck and it blocks the lining the inner surface of an artery artery have been damaged Reduces blood flow to downstream Example – A clot forming in a vein tissues & causes them to become of the leg (DVT) plaque ischemic more dangerous  NEOPLASMS Bronchogenic Carcinoma Primary Pulmonary Mets  PRIMARY MALIGNANT LUNG TUMOR Bronchogenic Carcinoma (Lung Cancer) starts in the lungs/ arises from lungs Primary carcinoma of the lung arises from the mucosa of the bronchial tree Increased incidence in heavy cigarette smokers, inhalation of pollutants & carcinogens Broad term used to describe all lung cancer types that are caused by inhalation of carcinogens 4 main histologic types: Adenocarcinoma – typically arises in periphery of lung Squamous Cell Carcinoma – most common more common Bronchiolar Alveolar Carcinoma – large cell Small Cell Oat Cell Carcinoma – very aggressive  BENIGN VS MALIGNANT Demonstration of fine, hair-like linear streaks radiating from the surface of the opacity suggests malignancy... well circumscribed lesion - benign feathered out with arms need biopsy to confirm  PRIMARY MALIGNANT LUNG TUMOR Radiological Appearance: Broad spectrum of radiographic abnormalities Depend on site of the tumor and relationship to bronchial tree A discreet mass may be undetectable but identified only by a virtue of secondary changes from obstruction or compression of pulmonary bronchus Air way obstruction may indicate a tumor Type text here  BRONCHOGENIC CARCINOMA Lung cancer can spread when cells from the lung tumor break off and are transported to other sites in the body Primary lung cancer metastasizes to: Lymph nodes Liver Adrenal Glands CT Chest often includes adrenal glands always have to go lower Bone Brain  BRONCHOGENIC CARCINOMA Radiological Appearance: Absence of air bronchogram may indicate infiltration into the bronchus and differentiate pneumonia from cancer Enlarged hilum represents either a primary arising in hilar region or metastases from enlarged lymph nodes Cavities, necrosis represent a neoplasm  BRONCHOGENIC CARCINOMA Radiological Appearances and Secondary Effects: Pneumonia Atelectasis Pleural Effusion Technical Factors: Increase mAs 50 % For Fibrous Carcinoma because of radiopaque mases BRONCHOGENIC CARCINOMA Raised LT Hemi diaphragm BRONCHOGENIC CARCINOMA  BRONCHOGENIC CARCINOMA Diagnosis of Bronchogenic Carcinoma: Initial lung X-Ray Gallium scans will demonstrate “hot spots” PET scan best and easiest way, less invasive and see where in the body it may have deposited Sputum Analysis Biopsy of nodule (TTNA) _Transthoracic Needle Aspiration_ Bronchoscopy with biopsy BRONCHOGENIC CARCINOMA mass PRIMARY LUNG LESION lesion  PULMONARY METASTASES Lung lesions that have spread to the lungs from a primary cancer elsewhere in the body 1/3 of cancer patients will develop pulmonary metastases Much more common than primary lung neoplasms  PULMONARY METASTASES Malignancy is spread to the lungs from a primary site elsewhere in the body via five different routes: Haematogenous: bloodstream Lymphatic: lymphatic vessels Direct extension or local invasion by primary lung neoplasm Direct implantation from biopsy or surgery Transcoelemic: seeding of cells through body cavities (i.e. esophagus – stomach – bronchus – breast – diaphragm)  PULMONARY METASTASES 50% of cancers will lead to pulmonary cancer Metastatic spread to the lungs from: Breast Cancer GI tract Melanoma Gynecological Ca Prostate Ca Musculoskeletal Sarcoma Thyroid  PULMONARY METASTASES Radiological Appearance: Multiple well circumscribed round or oval nodules Varies from fine nodules to highly vascular tumors (Example – Thyroid cancer will produce a “snowstorm effect” if they had thyroid cancer The appearance of metastasis depends on the origin  LUNG METASTASES multiple radiolucency between them and cavity inside lung abcess usually just one not multiple LUNG METASTASES  CONGENITAL NEONATAL Cystic fibrosis Hyaline membrane disease – (newborn respiratory distress syndrome)  CYSTIC FIBROSIS Hereditary disease characterized by the secretion of excessively viscous mucous by all the exocrine glands Caused by: Defective gene in the middle of chromosome 7 Affects the pancreas & digestive system 90% morbidity due to respiratory involvement Two types of glands exist in the body Exocrine – secrete substances into a ductal system to an epithelial surface (sweat, salivary, mammary, lacrimal, sebaceous, prostate & mucous) Endocrine – secrete products directly into the bloodstream  CYSTIC FIBROSIS Thick mucous secreted by mucosa in the trachea & bronchi block the air passages Mucous plugs lead to areas of lung collapse (Atelectasis) Recurrent pulmonary infections are common because bacteria adheres to the sticky mucous Before the age of 10, many children develop bronchiectasis, large cysts & abscesses In the pancreas, mucus blocks the ducts and prevents enzymes from the duodenum (impairs digestion of fat = child unable to gain weight = bulky foul smelling stools) 10% of newborns, the thick mucus causes obstruction of the small bowel = can cause bowel perforation = fatal  CYSTIC FIBROSIS thick lung markings Radiographic Appearance: Irregular thickening of linear markings throughout the lungs with hyperinflation Hyperinflation Looks like adult chronic disease CT is the modality of choice to assess disease progression  CYSTIC FIBROSIS Treatment: Prophylactic antibiotics (Reduce risk of lung infections – that can cause permanent lung damage or bronchiectasis) Chest physiotherapy (percussions) in small babies Hand tapping against the chest – prevents lungs from filling by keeping the mucus moving Life expectancy have increased significantly from the 1950’s until today (Pt’s are now expected to live through their late 40’s & early 50’s) Future of Cystic Fibrosis Gene Therapy – Taking a faulty gene and replacing it with a healthy one  HYALINE MEMBRANE DISEASE common in newborn babies Aka Idiopathic respiratory distress syndrome (IRDS) Most common causes of respiratory distress in newborn Occurs primarily in premature infants - Diabetic mothers - Delivery by cesarean section Difficulty in breathing with newborns (Progressive under aeration of lungs due to a lack of surfactant) Surfactant – Substance in the lungs that help keep the alveoli open so you can breathe easily Prevents collapse at the end of respiration & makes it easier for the lungs to expand when you inhale can tell us if u have lack fo surfactant  HYALINE MEMBRANE DISEASE Deficiency leads to collapse of the tiny alveoli with each breath & can lead to widespread atelectasis = leads to inadequate alveolar ventilation Symptoms: Respiratory difficulty at least 1 hour after birth Cyanosis turning blue Grunting sounds Flaring of the nostrils Chest retractions  HYALINE MEMBRANE DISEASE Radiographic Appearance: Widespread minute pulmonary granular opacities “mottling” Ground-glass appearance Caused by collections of thick mucous adhering to the bronchial linings (trapping bacteria & blocking the passage of O2) Air filled bronchial tree – Aka Air Bronchogram sign The bronchi are surrounded by non- aerated alveoli dirty chest appearance, mottling HYALINE MEMBRANE DISEASE Normal CXR vs. IRDS CXR  CONGENITAL DISORDERS know what they are, no need to know images AGENESIS Complete absence of an organ due to absence of primordial tissue APLASIA Failure of an organ to develop or function normally (no development) HYPOPLASIA Underdevelopment or incomplete development ATRESIA Absence or closure of a normal body orifice or passage Esophageal atresia may lead to aspiration pneumonia