Pathology Test 3 PDF

Pathology Test 3 Lecture 12 Croup Croup Viral infection, affects young children( 6 months and 3 years) Starts with cold-like symptoms and progresses to inflammation of the subglottic area of the trachea Obstructive Swelling: Viral infection causes swelling and inflammation in the subglottic region...

Pathology Test 3 Lecture 12 Croup Croup Viral infection, affects young children( 6 months and 3 years) Starts with cold-like symptoms and progresses to inflammation of the subglottic area of the trachea Obstructive Swelling: Viral infection causes swelling and inflammation in the subglottic region of the trachea, which can lead to partial obstruction of the airway Stridor: High-pitched, harsh breathing sound heard during inspiration (breathing in)common symptom of croup due to the narrowed airway Hourglass Shape on AP Radiograph: The narrowing of the subglottic area can create the appearance of an hourglass shape to the airway- This can help in the diagnosis of croup Treatment: Cool Mist: Breathing in cool mist from a humidifier or a shower can help alleviate symptoms by reducing airway inflammation. Medical Intervention: In more severe cases, significant breathing difficulties, medical intervention may be necessary- use of nebulized epinephrine or oxygen therapy. Corticosteroids: Corticosteroids, such as dexamethasone or prednisolone, are often prescribed to reduce airway inflammation and improve breathing in children with croup- they are especially recommended for moderate to severe cases. Epiglottis Epiglottis: Haemophilus influenzae type B (Hib) was a common cause of acute epiglottitis in the past. However, due to Hib vaccine, the incidence of Hib-related epiglottitis has significantly decreased, and other bacteria, like Streptococcus pneumoniae or Streptococcus pyogenes, can also be responsible for this condition Thickening of Epiglottis Tissue: In acute epiglottitis, there is rapid inflammation and swelling of the epiglottis and the surrounding pharyngeal structures This can lead to airway obstruction and is a medical emergency. Change in Appearance: May appear significantly enlarged and inflamed On a lateral (side) view, it can resemble the shape of an adult's thumb, in contrast to its normal, smaller appearance, which might be likened to an adult's little finger. Prompt Attention & Intubation Acute epiglottitis is a life-threatening condition because the swelling can quickly obstruct the airway, making it difficult to breathe. In severe cases, intubation or even a tracheostomy may be necessary to secure the airway and allow the patient to breathe. Treatment: Antibiotics: are administered to treat the bacterial infection and prevent its spread. Corticosteroids: may be used to reduce the inflammation in the airway. Epiglottis vs Croup Croup Epiglottis Age 6 months-3 years (peak at 2 years) 2-6 years (peak at 2-4 years) Cause Viral infections- parainfluenza viruses Haemophilus influenzae type B (Hib) bacteria, but other bacteria can also cause it. Symptoms Barking cough, hoarseness, and inspiratory stridor (a high-pitched, noisy breathing sound) Sudden onset of severe sore throat, fever, difficulty swallowing, and drooling. Fever Not a prominent feature Common Severity Mild- moderate (low death rate) Can be life-threatening Airway obstruction Complete obstruction is rare Rapidly progress to complete airway obstruction, making it a medical emergency. Anatomy Involves inflammation of the subglottic portion of the trachea (narrowest part). Inflammation and swelling of the epiglottis, and sometimes the surrounding structures. Intrabronchial Foreign Bodies Patient Population: Typically affects children. Visibility: Opaque foreign bodies can be directly observed, while non-opaque ones are diagnosed by observing secondary signs in the lung. Common Location: Most often found in the right main bronchus and the lower lobes. Complete Obstruction (Major Bronchus): Consequences - Reabsorption of trapped air leads to alveolar collapse. - Atelectasis (airlessness) of the affected segment/lobe- If extensive, there may be a shift of structures to the affected side (heart/mediastinum). Partial Obstruction: Check Valve Phenomenon - Air goes in on inspiration. - Air does not come out on expiration. - Hyperinflation leads to a shift of structures to the normal side. - Chest PA & Lat X-rays during inspiration and expiration may show the affected side staying inflated on expiration. How to View Chest Radiograph 1. 2. 3. 4. 5. 6. - Patient Information: Start by confirming the patient's identity and ensuring you have the correct image. Technical Factors: Check the quality of the image, ensuring it is properly exposed and focused. Orientation: Verify that the radiograph is correctly oriented, with the patient's right side on the right side of the image. Trace the Diaphragm: Begin at the lung bases and follow the contour of the diaphragm on both sides. Look for any abnormalities or free air under the diaphragm. Check the Size/Shape of the Heart: Assess the size and shape of the cardiac silhouette; Look for any enlargement or abnormalities. Check the Position of the Heart & Mediastinum: Evaluate the position of the heart within the chest cavity. Note any shift or rotation of the heart. Assess the mediastinum for any masses or widening. How to View Chest Radiograph 7. Examine the Mediastinum: Focus on the central area of the chest. Look for signs of mediastinal masses, lymphadenopathy, or other abnormalities. 8. Check the Hilum: Evaluate the hila (the central portion of each lung where blood vessels, bronchi, and lymph nodes enter). Ensure there are no masses or enlarged lymph nodes. 9. Check the Lungs: Examine the lung fields for any abnormalities such as masses, nodules, or infiltrates. Assess the lung markings for symmetry. 10. Evaluate Ribs/Clavicle/Rotation: Check the alignment of the ribs and clavicles. Assess for any signs of rotation or displacement. 11. Count 10 Ribs: Count the ribs on each side to ensure symmetry. This can help identify any deformities or abnormalities in the chest wall. 12. Clinical Correlation: Finally, consider the clinical history and symptoms of the patient. Relate any findings on the chest radiograph to the patient's overall clinical picture. End of Lecture 12 How to View Chest Radiograph 1. - 2. 3. - Upper Retrosternal Area & Retrocardiac Area: Both areas have the same density, implies that when looking at the upper retrosternal (behind the sternum) and retrocardiac (behind the heart) regions on the chest radiograph, they appear similar in terms of radiographic density. This could be due to the presence of structures with similar X-ray attenuation in these areas. Superimposition of Ribs Posterior to Vertebrae: This indicates that the ribs, when viewed posteriorly (towards the back), overlap or superimpose over the vertebrae. Superimposition can sometimes make it challenging to distinguish between individual ribs and vertebrae in the image. Open Thoracic Intervertebral Disc Spaces: The intervertebral disc spaces between the vertebrae in the thoracic region appear open or visible. This might be a normal finding but can also be relevant if there are concerns about disc pathology or vertebral alignment. Lecture 13 Atelectasis Diminished Air, Reduced Lung Volume: Atelectasis results in a decrease in the amount of air in the affected part of the lung, leading to reduced lung volume on imaging studies. Airless Lung - Platelike Streaks to Collapse: The collapsed lung may appear as platelike streaks on imaging, progressing to a more complete collapse if not addressed. This can be visualized on chest radiographs or other imaging modalities. Displacement of Interlobar Fissures - Bowed Contour: The interlobar fissures, which separate the lobes of the lung, may be displaced and show a bowed contour due to the collapse of one or more lobes. Ipsilateral Lung Compensation - Elevation of Hemidiaphragm, Displacement of Heart, Mediastinal Structures: The healthy lung on the same side compensates for the collapsed lung by causing the elevation of the hemidiaphragm and displacement of the heart and other mediastinal structures toward the affected side. Treatment Goal - Removal of Pulmonary Secretions and Re-expansion: The primary goal in treating atelectasis is to remove any secretions that may be blocking the airways and to promote re-expansion of the collapsed lung tissue. This can involve techniques such as chest physiotherapy, bronchoscopy, or other interventions depending on the underlying cause. Atelectasis as a Common Result of Bronchial Obstruction: Atelectasis often occurs as a consequence of bronchial obstruction. This obstruction can be caused by various factors such as mucus plugs, tumors, foreign bodies, or external compression. Lecture 13 Endotracheal Tube Placement: 5-7 cm above the carina: The endotracheal tube should ideally be positioned approximately 5-7 cm above the carina, which is the point where the trachea bifurcates into the mainstem bronchi. Clinical Evaluation: Bilateral Breath Sounds, Symmetrical Thoracic Expansion, Palpation of Tube at Sternal Notch: After placement, clinical evaluation is crucial. This includes listening for bilateral breath sounds to ensure the tube is in the trachea, assessing for symmetrical thoracic expansion during ventilation, and palpating the tube at the sternal notch to confirm its position. Daily Chest X-ray: Periodic chest X-rays are often performed to verify the placement of the endotracheal tube and assess for any potential complications or changes in position. 10 to 20% Need to be Repositioned: It's not uncommon for endotracheal tubes to require repositioning. This could be due to factors such as patient movement, tube migration, or changes in respiratory status. Placement Too Low - Right Bronchus: If the endotracheal tube is positioned too low, it may enter the right mainstem bronchus instead of the trachea. This can result in uneven ventilation between the two lungs. Placement Too High - Esophagus: If the endotracheal tube is placed too high, it may enter the esophagus instead of the trachea. This can lead to ineffective ventilation and potential complications. Lecture 13 Pneumothorax Accumulation of air in the pleural cavity, causing partial or complete lung collapse. Causes: Can result from subpleural bulla, spontaneous factors, trauma, or iatrogenic causes. Neonatal hyaline membrane disease is a contributing factor. Symptoms: Shortness of breath (SOB), chest pain, and dyspnea are common. Radiographic Features: Hallmark: Demonstration of the visceral pleural line. Imaging Views: Upright position, Inspiration and expiration views to assess dynamic changes. Expiration - manual technique - increase MAs by 1/3. Decubitus view to confirm the presence of free air. Size Matters: Small Pneumothorax: May reabsorb spontaneously and can be observed without intervention. Larger Pneumothorax: Requires prompt chest tube drainage with suction to re-expand the lung. Tension Pneumothorax: Definition: Medical emergency characterized by lung collapse, depression of the hemithorax, and shifting of heart and mediastinal structures to the opposite side. Complications: Compromised cardiac output; can be fatal. Requires immediate intervention, typically with needle decompression followed by chest tube insertion. Lecture 13 Pneumothorax Lecture 13 Pleural Effusion Accumulation of fluid in the pleural space Causes: Non-specific finding; associated with conditions such as congestive heart failure, pulmonary embolism, infection (TB), pleurisy, connective tissue disorders, abdominal diseases, surgery, ascites, subphrenic abscess, and pancreatitis. Radiographic Findings: Early Signs: Blunting of costophrenic angles. Best Seen On: Lateral views for small effusions. Large Effusion: May obscure diaphragm and heart borders. Massive Effusion: May compress lung and displace heart and mediastinum. Characteristics Based on Size: Small Pleural Effusion: Deeper posterior costophrenic angles on lateral views. Up to 400 mL of pleural fluid may not produce blunting on frontal views. Difficulties in Small Effusions: Pleural thickening and fibrosis can make small effusions challenging to detect. Horizontal beam, decubitus with affected side down, and linear opacity along the dependent chest wall may help visualize small effusions. Loculated effusions can mimic solid masses. Specific Considerations: Mimicking Elevated Hemidiaphragm: Pleural effusion collecting below the inferior surface of the lung can mimic an elevated hemidiaphragm. Congestive Heart Failure: Interlobar fissure appearance, round oval density, and the potential to mimic a solitary pulmonary nodule. Repeat X-rays may be needed for resolution. Thoracentesis may be performed for diagnosis and therapeutic purposes. Lecture 13 Pleural Effusion Lateral for small effusions Lecture 13 Pulmonary Edema and Infarct Accumulation of fluids in intercellular spaces or body cavities. Types: - Localized: Associated with an inflammatory reaction. - Generalized: Pronounced swelling of subcutaneous tissues throughout the body. Gravity Influence: - Gravity plays a role in where edema is evident. Potential Locations: - Pleural and pericardial effusion, peritoneal ascites. Symptoms: - May produce minimal symptoms but can be fatal. Difficult Outcomes: - Pulmonary edema, pericardial effusion, and brain involvement can have challenging outcomes. Ischemia and Necrosis: - Edema may be associated with ischemia (interrupted blood supply to tissue) and, in severe cases, necrosis (tissue death). Lecture 13 Pulmonary Edema and Infarct Infarct: - Localized area of necrosis within tissue. Common Locations: - Myocardial and pulmonary infarcts are most common. Causes: - Volvulus, hernia, trapped viscous under peritoneal adhesion. Complications: - Can lead to gangrene. Risk Factors: - Elderly individuals with atherosclerosis or impaired cardiac function. Trigger Events: - Can result from surgical procedures or delivery. Lecture 13 Central Venous Catheter Placement: Subclavian or peripheral vein in the upper extremity. Purpose: Measures Central Venous Pressure (CVP). Serves as a portal for the rapid infusion of fluids, medications, or nutrition. Optimal Location: Brachiocephalic vein joins the Superior Vena Cava (SVC) or within the SVC. Confirmation: Chest X-ray is used to confirm placement. Potential Risks: Internal jugular vein or right atrium puncture may lead to arrhythmias and perforation. Risk of pneumothorax. Perivascular placement. Puncture of the subclavian artery. Risk of air embolism. Lecture 13 Central Venous Catheter PICC (Peripherally Inserted Central Catheter): Type: Venous access device or port. Use: Designed for long-term use, often for chemotherapy. Placement: Superior vena cava. Swan-Ganz Catheters: Function: Monitors heart function and blood flow (pressures). Can be used to direct medications directly into the heart. Insertion: Can be inserted at the bedside. Routes: Internal jugular, subclavian, or femoral vein to right atrium, right ventricle, into the pulmonary artery. Balloon Inflation: Balloon inflated to keep it wedged. Common Considerations: Repositioning: Approximately 1/3 may need to be repositioned due to incorrect placement or patient motion. Risk Factors: Inherent risks associated with catheter insertion, including complications related to vascular puncture and the potential for infection. End of Lecture 13 Cardiac Pacemaker Cardiac Rhythm Maintenance with Electrode: Objective: To maintain cardiac rhythm using an electrode. Tip Placement: Right Ventricle Apex: The electrode tip may be positioned at the apex of the right ventricle. Coronary Sinus: Alternatively, the tip may be placed in the coronary sinus. Imaging Views: AP and LAT Views: Anterior-posterior and lateral views may be necessary to demonstrate the accurate position of the electrode. Potential Issue: Electrode Fracture and Pace Failure: Concern: There is a risk of electrode fracture. Consequence: Electrode fracture can lead to pace failure, compromising the effectiveness of the cardiac pacing system. Lecture 14 Cardiac Pacemaker Pathophysiology: Thrombo-embolic fragments circulate through the right side of the heart and lodge in the main pulmonary artery (MPA) or its branches. Most common in hospitalized patients, often originating from deep vein thrombosis (DVT) in the legs due to venous stasis. Pathogenesis: Large emboli can lead to decreased return of blood to the pulmonary vein, resulting in decreased cardiac output. Very large emboli can block all pulmonary circulation, leading to shock, cardiac arrest, and potentially death. Respiratory Manifestations: Pulmonary embolism can result in pulmonary infarction and respiratory distress, characterized by sudden shortness of breath and pain. Diagnosis: Chest X-ray (CXR) - non-specific findings. Nuclear Medicine perfusion scan - measures blood flow in the lungs. Ultrasound Leg Doppler - detects thrombus in a thigh vein. High-resolution CT - a useful method for demonstration. Helical CT Angiogram - considered a definitive study, albeit more invasive. Lecture 14 Cardiac Pacemaker Lecture 14 Bronchogenic Carcinoma Bronchogenic carcinoma refers to primary lung cancer that originates from the mucosa of the bronchial tree. Risk Factors: Smoking: The most significant risk factor for developing bronchogenic carcinoma. Inhalation: Exposure to air pollution, exhaust gases, and industrial fumes. Pathogenesis: Arises in a major central bronchus, leading to the gradual narrowing of the bronchial lumen. Consequences include atelectasis (lung collapse) and post-obstruction pneumonia. Metastasis: Bronchogenic carcinoma has a high potential for metastasis via blood and lymphatics. Common sites of metastasis include bones, liver, brain, adrenals, and kidneys. Prognosis: Poor prognosis due to the rapid spread of the cancer. Treatment often involves a combination of chemotherapy and radiation, typically used palliatively to manage symptoms and improve quality of life. Lecture 14 Pulmonary Metastases Common Metastatic Sites to the Lungs: The lungs are a common site for metastasis from primary neoplasms in various organs. The most common metastatic cancers to the lungs arise from primary neoplasms of the breast, esophagus, and stomach. This is often due to direct spread facilitated by the proximity of these organs. Other Organs Contributing to Pulmonary Metastases: Metastases to the lungs can also occur from primary neoplasms in different organ systems, including: Musculoskeletal (MSK) sarcomas Myeloma Urogenital tract Thyroid Colon Incidence: Approximately one-third of patients with cancer develop pulmonary metastases. Modes of Spread: Metastases to the lungs can occur through both blood and lymphatic spread. Patterns of Metastases on Chest Imaging: Patterns on chest imaging can vary according to the primary site of the cancer. Direct spread from organs like the breast, esophagus, and stomach may present with multiple well-circumscribed nodules scattered throughout both lungs. In some cases, a single solitary nodule may mimic the appearance of primary bronchogenic cancer. Lecture 14 Pulmonary Metastases Lecture 14 Lung Abscess - A lung abscess is a localized collection of necrotic (dead) tissue and purulent (pus) material within the lung. It can be caused by various factors, such as aspiration, bacterial pneumonia, bronchial obstruction, foreign bodies, or infections like septic emboli. Clinical Presentation: Symptoms include fever, cough, and production of sputum. In some cases, patients may also experience aspiration, which is the entry of foreign material into the respiratory tract, often affecting the right lung. Radiological Features: Appearance: A lung abscess may present as a spherical density with a dense center and a hazy, poorly defined periphery. Air-Fluid Level: Presence of an air-fluid level indicates communication with the bronchial tree. This is a characteristic feature seen on imaging. Complications: Lung abscesses can have complications, such as the spread of infection to other areas, including the brain, leading to the formation of a brain abscess. Treatment: This may include antibiotics for bacterial infections, drainage of the abscess, and management of any contributing factors like bronchial obstruction or foreign bodies. End of Lecture 14 Severe Acute Respiratory Syndrome - SARS is a severe respiratory illness that emerged in 2003, causing a global concern that led to interventions by the World Health Organization (WHO). The primary affected region was initially identified in China. Clinical Presentation: Symptoms can range from a non-productive cough to hypoxemia, often progressing to the point of requiring intubation. Fatality rate was reported to be around 3%, making it a serious and potentially life-threatening condition. Symptoms: Besides a cough and hypoxemia, patients with SARS may exhibit other pneumonia-like symptoms. Causative Agent: SARS is caused by a coronavirus with an unknown etiology. Radiological Findings: In the early stages, chest X-rays may appear normal. Later on, focal infiltrates and areas of consolidation may be observed. Prognostic Indicator: The extent of lung involvement on day 7 is considered a prognostic indicator. If it's less than 10%, the chances of survival are improved. Follow-up Imaging: Follow-up images are often necessary to monitor the progress of treatment and assess the resolution of lung involvement. Treatment: Treatment involves a combination of antibacterial and antiviral medications. As of the information cutoff Lecture 15 Pneumonia Pneumonia is an inflammatory condition of the lung that can be caused by various pathogens, including bacteria, viruses, and fungi. It results in the filling of airspaces in the lung with inflammatory exudate. Radiographic Patterns: There are three basic radiographic patterns of pneumonia: 1. Alveolar Pneumonia: Typically associated with pneumococcal pneumonia. Inflammatory exudate replaces air in the alveoli, making the air space appear solid or radiopaque. Can involve pulmonary segments or entire lobes. Hallmark sign: Bronchogram sign, where no bronchi are visible in mediastinal or pleural regions. No volume loss in alveolar pneumonia. 2. Bronchopneumonia: Often associated with staphylococcal or multiple bacterial infections. Starts in bronchi or bronchial mucosa and spreads to alveoli, causing patches of consolidation throughout the lung. Bronchial inflammation can obstruct airways, leading to atelectasis and volume loss. Opacifications are scattered, and there is no air bronchogram. 3. Interstitial Pneumonia: Represents extensive inflammation and is a mixed pattern of the three types of pneumonia. Opacifications occur in the form of consolidation. Antibiotics, rest, hydration, and deep breathing techniques are part of the treatment. Aspiration Pneumonia: Caused by the entry of esophageal or gastric contents into the lungs, often due to gravity. Commonly affects the posterior segments of the upper and lower lobes. Early diagnosis is crucial, and treatment may involve corticosteroids and antibiotics. Prognosis can be grave, especially in bedridden individuals. Lecture 15 Pneumonia Broncho Alveolar Lecture 15 Pneumonia Interstitial Aspiration Interstitialhoney comb lung Lecture 15 Hemothorax Hemothorax refers to the presence or accumulation of a significant amount of blood in the pleural space, which is the space between the lung and the chest wall. Causes: Trauma: Penetrating injuries, such as gunshot or stab wounds. Non-penetrating injuries, including blunt trauma or fractures. Iatrogenic: Resulting from medical procedures, interventions, or complications. Pulmonary Embolism: Blood clots that travel to the lungs, causing damage to blood vessels and leading to bleeding. Rupture of Arteries (AA - Aneurysm): Rupture of a blood vessel, such as an aneurysm, can result in significant bleeding into the pleural space. Malignant Diseases: Cancerous growths, tumors, or lesions in the chest can cause bleeding into the pleural cavity. Spontaneous: Occasionally, hemothorax can occur spontaneously without an obvious cause. Clinical Presentation: Symptoms may include chest pain, difficulty breathing, and decreased breath sounds on the affected side. In severe cases, hemothorax can lead to hypovolemic shock due to the loss of blood. Hemorrhage from the injured lung parenchyma is a common cause. Other vessels, such as intercostal or internal mammary arteries, can also be sites of injury. Diminished or absent breath sounds on the affected side. Severity depends on the amount of blood in the pleural space. Life-threatening cases may require urgent intervention, such as the insertion of a chest tube Diagnosis: Imaging studies such as chest X-rays or CT scans are commonly used to diagnose and assess the extent of hemothorax. Treatment: Treatment depends on the underlying cause and the severity of the condition. It may involve drainage of the blood from the pleural space through a chest tube. In cases of severe bleeding or specific causes like trauma, surgical intervention may be necessary. Prognosis: The prognosis for hemothorax depends on the cause, the amount of blood involved, and the timeliness of intervention. Lecture 15 Hemothorax Lecture 15 Tuberculosis Overview: - Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. - It primarily affects the lungs but can also involve other organs, including the gastrointestinal (GI), genitourinary (GU), and skeletal systems. Key Features: - Protective Waxy Coat: Mycobacterium tuberculosis has a unique protective waxy coat. - Transmission: TB is transmitted through respiratory droplets. - Common Site of Infection: While the lungs are the primary site, TB can affect other organs. - Primary Lesion: The primary lesion involves inflammatory cells and tubercles. - Apices Predilection: TB often affects the apices (upper portions) of the lungs. - Calcification: Over time, calcium deposits may occur in response to TB infection. Lecture 15 Tuberculosis Progression: - The progression of TB is slow. - Lesions may evolve into Swiss cheese-like masses that may liquefy and form cavities. - Small cavities can join to form large cavities with an air-fluid level. - Hemoptysis (coughing up blood) may occur. - In severe cases, TB can be fatal. Diagnosis: - Skin tests, such as the PPD (purified protein derivative) test, are used for diagnosis. - A visible, palpable swelling (10mm in diameter) indicates antibodies to previous exposure. - Lack of exposure or anergic response may occur, especially during acute infection. - Incubation period for TB is 3-6 weeks, with a 2-10 week window for a positive test post-infection. Lecture 15 Tuberculosis Types of Tuberculosis: 1. Primary Tuberculosis: Lobar or segmental involvement. Hilar and mediastinal lymph nodes are affected. Homogeneous consolidation, hilar enlargement, pleural effusion. 2. Military Tuberculosis: Uncommon manifestation spread by blood. Fine discrete nodules uniformly distributed. Common in upper lobes and periphery. Necrotic cavities or large abscesses, extensive fibrotic changes, possible calcification. Single or multiple nodules (1-3 cm) known as tuberculomas or Ghon lesions. 3. Tuberculosis Pneumonia (Secondary Tuberculosis, Tuberculoma): Radiographic appearances include infiltrate filling segment/lobe consolidation. Lordotic views demonstrate lung apex/apices. Enlarged hilar/mediastinal lymph nodes. Pleural effusion is common. Treatment: Treatment courses vary for active and latent TB. Active TB requires a multi-drug regimen for 6-12 months. Latent TB may involve prophylactic treatment based on the strain exposed to, with a single regime and shorter duration. End of Lecture 15 Tuberculosis Primary Tuberculosis Military tuberculosis- fine, discrete uniform Tuberculous pneumonia- possible calcifications Lecture 16 Chronic Bronchitis Symptoms: Severe coughing with sputum: Chronic bronchitis often presents with a persistent cough that produces mucus (sputum). Causes: Respiratory infections, exposure to air pollution, and smoking are common causes of chronic bronchitis. Pathophysiology: Thickening of bronchial walls and bronchioles: Chronic irritation leads to structural changes in the airways, with thickening of the walls. Hyperplasia of mucous glands: Over time, mucous glands can become hyperplastic, contributing to increased mucus production. Diagnostic Findings: Chest X-ray findings: Generalized increase in bronchovascular markings: This can result in a "dirty chest" appearance, particularly in the lower lungs. Tram lines: Thickening of bronchial walls can manifest as tram lines on X-ray images. Excessive mucous: Narrowing of airways, overinflation of the lungs, and a depressed diaphragm may be observed. Management: Symptomatic relief: The primary goal is to improve symptoms and prevent disease progression. Medications: Bronchodilators: These can help open up the airways and improve airflow. Expectorants: These may be used to facilitate the removal of mucus from the airways. Prophylactic antibiotics: In some cases, antibiotics may be prescribed to prevent or treat bacterial infections. Smoking cessation: If applicable, quitting smoking is crucial for managing chronic bronchitis. Pulmonary rehabilitation: This may include exercises and education to improve lung function and overall well-being. Lecture 16 Chronic Bronchitis Increased bronchovascular/ lung markings Tram lines- inflammation Lecture 16 Emphysema Characteristics and Causes: Location of damage: Emphysema primarily affects the acini or terminal bronchioles, resulting in an increase in air volume. Risk factors: Smoking, chronic bronchitis, exposure to air pollution, and irritants of the respiratory tract are common causes. Pathophysiology: Damaged cilia: Impaired mucociliary clearance due to damaged cilia. Mucosal inflammation: Inflammation of the mucosa with excess mucus production, leading to increased airway resistance. Clinical Features: Exhalation difficulty: Overinflation, rupture of alveolar septa, and the formation of bullae (air-containing cystic spaces) contribute to difficulty in exhaling. Cardiac effects: Heart compensation may lead to cardiac enlargement. Complications: Bullae burst can result in pneumothorax (air in the pleural space) and atelectasis (collapsed lung). Radiographic findings: Flattening of diaphragm: A hallmark radiographic sign. Lateral chest X-ray: Shows an increase in size and lucency of retrosternal air space, contributing to a barrel-shaped chest. Reduction in peripheral arteries: Reduction in the number and size of peripheral arteries. Prominent pulmonary arteries: Increased pressure in pulmonary arteries, making them more prominent. Bulla appearance: Thin-walled, air-containing cystic spaces, often found at the apices or bases, compressing normal lung tissue. Dirty chest: Prominent markings on chest X-ray. Management: No cure: Like chronic bronchitis, emphysema has no cure. Symptom relief and prevention of progression: Management aims to relieve symptoms and prevent the disease from worsening. Oxygen supplementation: In advanced cases, oxygen therapy may be necessary to improve oxygen levels. Reducing risk factors: Smoking cessation and avoiding environmental irritants are crucial for managing emphysema. Prognosis: Emphysema is a chronic condition, and the prognosis varies. Early diagnosis and management can help improve symptoms and slow down disease progression. However, advanced stages may have a significant impact on lung function and overall health. Lecture 16 Emphysema Lecture 16 Asthma Prevalence: Asthma is a common respiratory condition characterized by episodic narrowing of the airways. Airway narrowing: The tracheobronchial tree shows an increased response to allergens, leading to the narrowing of the airways. Types: Extrinsic asthma: Triggered by external allergens. Intrinsic asthma: Triggered by internal factors, such as stress or exercise. Pathophysiology: Swelling of mucous membranes: Inflammation leads to swelling of the bronchial mucous membranes. Smooth muscle spasm: Contraction of smooth muscles in bronchial walls further contributes to airway narrowing. Symptoms: Difficulty breathing and expiration, often accompanied by wheezing. Clinical Features: Acute Attack: Increased lung volume: During an acute attack, there can be an increased volume in the hyperlucent lung. Flattening of hemidiaphragm: The hemidiaphragm may flatten. Retrosternal air space: An increase in retrosternal air space may be observed. Pulmonary markings: Normal during acute attacks. Chronic Presentation: Dirty chest: Chronic asthma may present with a "dirty chest," indicating persistent inflammation and mucus production. Management: Preventative and rescue bronchodilators: These are commonly used to manage acute symptoms and prevent exacerbations. Oral medications, Allergy shots: In cases where allergies trigger asthma, immunotherapy (allergy shots) may be recommended. Open airways and prevent infections: Strategies focus on maintaining open airways and preventing respiratory infections, which can exacerbate asthma symptoms. Lecture 16 Bronchiectasis Pathophysiology: Permanent dilation: Bronchiectasis involves the permanent dilation of large bronchi. Destruction of wall components: Elastic and muscular components of the bronchial wall are destroyed. Complications: Bronchitis: Bronchiectasis can be a complication of bronchitis, often bacterial in nature. Preventive measures: Antibiotics and vaccines can help reduce the incidence of bronchiectasis. Clinical Features: Symptoms: Chronic productive cough: Patients often experience a persistent and productive cough. Recurrent pneumonia: Frequent episodes of pneumonia can occur. Hemoptysis: Coughing up blood may also be present. Location: Lower lobes: Bronchiectasis often affects the lower lobes of the lungs and can be bilateral. Diagnostic Findings: Pulmonary Function Tests (PFTs): Decreased gas exchange: PFTs may show decreased gas exchange due to the damaged bronchi. Radiographic Findings: Coarseness: Radiographic images may show coarseness and loss of interstitial markings, indicating retained secretions. Cystic spaces: Oval or circular cystic spaces with air/fluid levels may be visible. Honeycomb pattern: A honeycomb pattern may be observed on imaging. Bronchography: Bronchography, a diagnostic procedure, may be used to visualize and assess the bronchial airways. Management: Preventive Measures: Vaccines: Immunizations, especially against respiratory infections, can help prevent exacerbations. Antibiotics: Long-term or intermittent use of antibiotics may be necessary to manage bacterial infections. Lecture 16 Bronchiectasis Bronchogram shows severe dilation of the basal bronchi of the left lower lobe. Lecture 16 Adult Respiratory Distress Syndrome (ARDS) Characteristics: Severe and unexpected: ARDS is a sudden and severe condition that can be life-threatening. Non-primary lung disease: Patients with ARDS typically do not have underlying lung diseases. Shock lung: ARDS is sometimes referred to as "shock lung." Underlying causes: ARDS can be a result of various medical and surgical disorders. Etiology: Associated conditions: ARDS can be associated with severe pulmonary infections, aspiration of toxins or irritants, or drug overdose. Structure breakdown: The breakdown of lung structures results in the leakage of cells and fluids into the interstitial and alveolar spaces. Clinical Features: Hypoxemia: ARDS is characterized by severe hypoxemia, leading to a low oxygen level in the blood. Diagnostic Findings: Radiographic Findings: Patchy areas of alveolar consolidation: Imaging studies may reveal patchy areas of alveolar consolidation. Bilateral involvement: Both lungs are typically affected. Normal heart size: The size of the heart is usually normal. Prognosis and Management: Severity: Can be fatal: ARDS can be a severe and life-threatening condition, and even with medical intervention, it can be fatal. Medical Intervention: Diuretics: Diuretics may be used to manage fluid overload. Oxygen and ventilation: Oxygen therapy and mechanical ventilation are often necessary to support respiratory function. Lecture 16 Subcutaneous Emphysema Causes: Injury to lung or parietal pleura: Subcutaneous emphysema often occurs as a result of an injury to the lung or the parietal pleura (the outer membrane lining the chest cavity). Air into tissues: The injury allows air to escape from the damaged lung or pleura and enter the tissues of the chest wall. Clinical Features: Crackling sound: One of the characteristic features of subcutaneous emphysema is the presence of a crackling sound (crepitus) when the affected area is palpated. This occurs due to the movement of air in the subcutaneous tissue. Streaks of lucency: Imaging studies, such as X-rays, may reveal streaks of lucency outlining muscles, indicating the presence of air in the subcutaneous tissue. Treatment: Minimal treatment: In many cases, subcutaneous emphysema may resolve on its own with minimal intervention. Monitoring: Close monitoring of the patient's condition is essential to ensure there is no underlying worsening or additional complications. Surgical Intervention: Surgical resection: If the air is not absorbed and there is an ongoing source of air leakage, surgical resection may be considered. Blocking off the source: The surgical procedure aims to block off the source of air leakage, preventing further entry of air into the subcutaneous tissues. Lecture 16 Emphysema Etiology: Infection in pleural space: Empyema occurs when the pleural space, the space between the lungs and the chest wall, becomes infected. Spread of infection: It is often a result of the spread of adjacent infections, post-surgery, trauma, or instrumentation in the pleural space. Management: Antibiotics: Treatment typically involves the administration of antibiotics to target and eliminate the infection. Clinical Features: Early Presentation: Appears as pleural effusion: In the early stages, empyema may present as a pleural effusion, which is an abnormal accumulation of fluid in the pleural space. Progression: Loculated, discrete mass: As empyema progresses, the fluid may become loculated, forming a discrete mass within the pleural space. Variation in size: The size of the empyema can vary, ranging from small to large, and it may involve the interlobar fissure. Imaging Findings: Air-fluid level: Imaging studies, such as X-rays or CT scans, may reveal the presence of an air-fluid level within the pleural space, indicating the infection. Diagnostic and Therapeutic Procedures: Needle Aspiration: Fluoroscopy or Ultrasound (US): Needle aspiration, guided by fluoroscopy or ultrasound, may be performed to obtain a sample of the infected fluid for analysis and to relieve pressure within the pleural space. Drainage Tube: Placement of drainage tube: In cases where there is a sinus tract or fistula, or if the empyema is extensive, a drainage tube may be inserted to facilitate the continuous drainage of infected fluid. Lecture 16 Cystic Fibrosis Prevalence: Hereditary: CF is a hereditary disease with a prevalence of approximately 1 in 3600 in Canada. Defective gene: The disease is caused by a defective gene located on chromosome 7. Respiratory Involvement: Viscous mucus: The defective gene leads to the secretion of excessively viscous mucus in the bronchi and trachea. Mucous plugs: These plugs can lead to focal areas of lung collapse, and recurrent pulmonary infections are common. Gastrointestinal Involvement: Pancreatic duct blockage: Mucous plugs can also block the ducts in the pancreas, preventing pancreatic enzymes from entering the duodenum. Digestive impairment: This impairs the digestion of fat, leading to failure to gain weight. Sweat Gland Involvement: Excessive sweating: Sweat gland involvement results in excessive perspiration, leading to the loss of large amounts of sodium, potassium, and chloride. Heat susceptibility: Individuals with CF are susceptible to heat. Diagnosis: Sweat Testing: Part of diagnosis: Excessive chloride on the skin is part of the sweat testing used in the diagnosis of CF. Radiographic findings: Radiographically, there is generalized irregular thickening of linear marks throughout the lungs, combined with hyperinflation, resembling chronic lung disease. Treatment: Prophylactic Antibiotics: Risk reduction: Prophylactic antibiotics are used to reduce the risk of lung disease and permanent damage. Chest Physiotherapy: Improved airflow: Chest physiotherapy is employed to improve airflow, and bronchodilators may be used for this purpose. New Drug - Deoxyribonuclease (Dnase): Pulmonary infection control: Dnase is a new drug that helps control pulmonary infections.