1. Chest p86-90 (Airways) Flashcards
Trachea - anatomy (2)
Posterior membrane can bow inward on expiration (normal).
Max diameter should be 2.5cm.
Post intubation stenosis - features
Focal subglottic circumferential stenosis with hourglass configuration.
Relapsing polychondritis - features (3)
Spares posterior membrane. No calcifications.
Diffuse thickening of trachea.
Recurrent episodes of cartilage inflammation and recurrent pneumonia.
Wegener’s - features (trachea) (3)
Circumferential thickening, can be long segment or focal.
No calcifications.
Subglottic involvement is common.
Tracheobronchopathia Osteochondroplastica (TBO) - features (2)
Spares posterior membrane.
Cartilaginous and osseous nodules within the submucosa of trachea and bronchial walls.
Amyloidosis - features (3)
Focal or short segment thickening.
Can involve posterior membrane.
Calcifications are common.
Saber sheath trachea - features
Coronal diameter of less than 2/3 sagittal diameter.
Main bronchi will be normal size.
Tracheal wall will be normal thickness.
Saber sheath trachea - trivia
Associated with COPD
Tracheal tumours - types
Squamous cell,
Adenoid cystic,
Mets,
Squamous cell papilloma
Squamous cell (trachea) - (3)
Most common.
Associated with smoking.
Often multifocal (10%).
Favours lower trachea/proximal bronchus.
Adenoid cystic (trachea) - (3)
2nd most common.
Prefers upper, posterolateral trachea.
Varied appearance: thickening, mass or nodule
Mets (trachea) -
Usually direct extension (lung, thyroid, oesophagus)
Squamous cell papilloma (trachea) (2)
Commonest benign tumour.
Single papilloma - smoking. Multiple papillomas - HIV
Cystic fibrosis - features (5)
Bronchiectasis (Progresses from cylindrical to varicoid).
Apical predominance.
Hyperinflation.
Pulmonary artery hypertension.
Mucus plugging (finger in glove).
Primary ciliary dyskinesia - features (5)
Bilateral lower lobe bronchiectasis.
Chronic sinusitis from early age.
Impaired fertility.
Chronic mastoid effusions and conductive hearing loss.
50% have Kartagener’s syndrome
Kartagener’s syndrome - features (2)
Primary Ciliary Dyskinesia & Situs Inversus
Williams Campbell Syndrome - features (2)
Congenital cystic bronchiectasis.
Due to deficiency in cartilage in 4-6th order bronchi.
Mounier-Kuhn (Tracheobronchomegaly)
Massive trachea (>3cm), not much else
Bronchiolitis - Definition/types (3)
Inflammation of small airways.
Can be infectious (viral pattern in kids).
Can be inflammatory (asthma in kids, RB-ILD in smokers).
Air trapping - imaging (2)
Areas of lung more lucent than others.
Technically can only be called on expiratory phase imaging.
Air-trapping cause (2)
Bronchiolitis obliterans in setting of lung transplant.
Small airway disease (asthma or bronchiolitis)
Tree-in-bud (4)
Associated with small airways disease.
Caused by dilatation and impaction of centrilobular airways.
These are centered 5-10mm from pleural surface, so that’s where tree-in-bud will be.
Usually associated with centrilobular nodules.
Follicular bronchiolitis (3)
Inflammatory process, associated with RA or Sjogrens.
Poorly understood, related to lymphoid hyperplasia.
Centrilobular ground glass nodules with scattered bronchial dilatation.
Constrictive bronchiolitis (3)
Due to viral illness, drugs, transplant or inhalation injury.
Secondary to mononuclear cells –> granulation –> plug the airway.
Air trapping on expiratory imaging.
Aspiration pneumonia (4)
Favours posterior segment of upper lobes and superior segment of lower lobes if supine when aspirating.
Favours basal lower lobes if upright.
May favour right side, like ET tube.
Complications include empyema, which can cause broncho-pleural fistula.
Aspiration of gastric acid
Airspace opacity. Can look like pulmonary oedema if massive
Aspiration of water/neutralised gastric content
Fleeting opacity, resolves in hours
Aspiration of bugs (often mouth bugs) (2)
Pneumonia,
Can get parapneumonic effusion, empyema or broncho-pleural fistula.
Aspiration of oil (often mineral oil)
Lipoid pneumonia. Low density.
