Ch 1 & 3 Flashcards
The pattern of the body’s response to some form of injury that causes a deviation from or variation of normal conditions
Disease
5 causes of disease
Hereditary (genes) Trauma Infectious organisms Vascular processes Metabolic processes
Measurable or objective manifestations
Signs
Feelings that the patient describes - subject manifestations
Symptoms
Without subjective or objective manifestations
Asymptomatic
Identification of disease process
Diagnosis
Study of the cause of the disease process
Etiology
Underlying cause is unknown
Idiopathic
Probable patient outcome
Prognosis
Linked combination of signs and symptoms
Syndrome
Disease caused by physician or treatment
Iatrogenic
Contracted from the acute care facility
Nosocomial infections
Contracted in a public setting outside of the acute care favility
Community-acquired infections
The initial response of body tissues local injury
Inflammation
5 clinical signs of inflammation
Rubor Calor Tumor Dolor Loss of function
Rubor
Redness
Calor
Heat
Tumor
Swelling
Dolor
Pain
4 events that occur in inflammatory response
Alterations in blood flow and vascular permeability Migration of circulating white blood cells to the interstitium of the injured tissue Phagocytosis and enzymatic digestion of dead cells and tissue elements Repair of injury by regeneration of normal parenchymal cells or proliferation of granulation tissue and eventual scar formation
Allows fluids/cells to pass from one tissue to another tissue or location
Permeable membrane
Fibrous scar replaces destroyed tissue
Granulation tissue
Thick, yellow fluid called pus (dead white cells)
Pyogenic bacteria
Localized, usually encapsulated, collection of fluid
Abscess
Potential involvement of other organs and tissues in the body by organisms invading the blood vessels
Bacteremia
The accumulation of abnormal amounts of fluid in the intercellular tissue spaces or body cavities Ambulatory patients tend to accumulate fluid in tissues around the ankles and lower legs; in non-ambulatory/sedentary patients the edema fluid collects most prominently in the lower back, sacral area and lungs
Edema
Generalized edema occurs with pronounced swelling of subcutaneous tissues throughout the body
Anasarca
Localized lymphatic obstruction resulting in localized edema
Elephantiasis
Refers to an interference with the blood supply to an organ or part of an organ and deprives cells and tissues of oxygen and nutrients Blood unable to flow like it should and cells aren’t getting the oxygen they should
Ischemia
Occlusions
Clots
3 things ischemia may be caused by
Atherosclerosis Thrombotic occlusion Embolic occlusion
Narrowing of an artery
Atherosclerosis
A localized area of ischemic necrosis within a tissue or organ; produced by occlusion of either arterial supply or venous drainage
Infarction
2 most common infarctions
Myocardial - heart Pulmonary - lungs
The rupture of a blood vessel that allows blood to escape externally or internally within surrounding tissues or a cavity
Hemorrhage
Hemorrhage/accumulation of blood trapped in body tissues A hemorrhage bleeding into tissues results in this
Hematoma
The changes in the number and size of cells, their differentiation, and their arrangement May develop in response to physiologic stimuli Numerous terms associated with this
Alterations of cell growth
An abnormal proliferation of cells that are no longer controlled by the factors that govern the growth of normal cells May be benign or malignant (cancer) From the Latin word for “new growth”
Neoplasia
Reduction in the size or number of cells in an organ or tissue with a corresponding decrease in function
Atrophy
Increase in the size of the cells of a tissue or organ in response to a demand for increased function
Hypertrophy
Increase in the number of cells in a tissue or organ
Hyperplasia
Loss of uniformity of individual cells and their architectural orientation
Dysplasia
Ungoverned abnormal proliferation of cells
Neoplasia
A study of neoplasms (tumors/cancer)
Oncology
Growth which closely resembles its cells of origin in structure and function
Benign
Neoplastic growth that invades and destroys adjacent structures
Malignant
Malignant neoplasms travel to distant sites, initial growth travels through the bloodstream and grows somewhere else
Metastasize
Malignant neoplasm of epithelial cell origin
Carcinoma
Undifferentiated cell growth without form (bizarre)
Anaplastic
Highly malignant tumor originating from connective tissue
Sarcoma
Major route of carcinoma to metastasize in lymphatic system
Lymphatic spread
Malignant tumors that have invaded the circulatory system and travel as a neoplastic emboli, bloodstream
Hematogenous spread
Assessment of aggressiveness or degree of malignancy, cancerous tumors have different grades
Grading
Extensiveness of tumor at the primary site Presence or absence of metastases to lymph nodes and distant organs
Staging
Study of determinants of disease events in given populations
Epidemiology
Rate that an illness or abnormality occurs
Morbidity
Reflects the number of deaths by disease per population
Mortality
Result from the abnormality in the DNA that pass from generation to the next through the genetic information contained in the nucleus of each cell Ex: breast cancer
Hereditary diseases
Genetic information contained in the nucleus of each cell passed to the next generation
Hereditary process
Forty-four chromosomes other than X and Y
Autosomes
Always produce an effect
Dominant genes
Manifest themselves when a person is homozygous for the trait
Recessive genes
Alterations in the DNA structures that may become permanent hereditary changes if they affect the gonadal cells May have a minimal effect and be virtually undetectable or may be so serious that they’re incompatible with life, causing the death of the fetus and spontaneous abortion
Mutations
3 things mutations may result from
Radiation Chemicals Viruses
The most common hereditary abnormality that leads to a metabolic block that results either in a decreased amount of a substance needed for normal function or in an accumulation of a metabolic intermediate that may cause injury
Enzyme deficiency
Provides a powerful defense against invading organisms by allowing it to recognize antigens and produce antibodies to counteract them
Immune reaction
What are some examples of active immunity?
The vaccines given to prevent smallpox, polio, measles, tetanus and diphtheria
A person forms antibodies to counteract an antigen in the form of a vaccine or toxoid
Active immunity
3 types of immune ractions
Anaphylactic Cytotoxic reaction Delayed
Either the antigen is a component of a cell or it attaches to the wall of red blood cells, white blood cells, platelets, or vascular endothelial cells
Cytotoxic reactions
2 examples of cytotoxic reactions
The transfusion reaction occurring after the administration of ABO- incompatible blood Erythroblastosis fetalis (the hemolytic anemia of the Rh-positive newborn whose Rh-negative mother has produced anti-Rh antibodies
Foreign substance that evokes an immune response; ex: bacteria, viruses, fungi, and toxins
Antigen
Immunoglobulin responding to the antigen; make harmless
Antibody
Protected against antigens; antibodies bringing with antigens to make harmless
Immune
Contact with dead or deactivated microorganisms to form antibodies
Vaccine
Treated toxin with antigenic power to produce immunity by creating antibodies
Toxoid
Hypersensitive reaction resulting in a histamine release; causes sudden death to patients who are hypersensitive to the sting of bees, wasps, and other insects, and to medications such as penicillin, and contrast
Anaphylactic reaction
4 examples of anaphylactic reactions
Hypotension Shock Urticaria Bronchiolar spasm Laryngeal edema
Vascular collapse; acute peripheral circulatory failure
Shock
Urticaria
Hives
Low blood pressure
Hypotension
Hypersensitive
“Allergic”
Protection utilized when delivering healthcare services for any person
Standard precautions
Gowns, gloves, masks, shoe covers, and eye protection used to prevent transmission of potential infectious agents
Personal protective equipment (PPE)
Additional protective equipment to prevent the spread of highly infectious pathogens through contact, droplet, or airborne transmission
Transmission-based precautions
3 forms of protection from infectious disease exposure
Standard precautions from CDC Use appropriate PPE Utilize transmission-based precautions
Caused by human immunodeficiency viruses (HIV); characterized by a profound and sustained impairment of cellular immunity that results in recurrent of sequential opportunistic infections and a particularly aggressive form of Kaposi’s sarcoma
Acquired Immunodeficiency Syndrome (AIDS)
2 high risk populations for AIDS
Young homosexual men Intravenous (IV) drug abusers
10 examples of additive (increased attenuation) diseases of the skeletal system
Acromegaly Acute kyphosis Hydrocephalus Marble bone Metastasis (osteosclerotic) Osteochondroma Osteoma Paget’s disease Proliferative arthritis Sclerosis
12 examples of destructive (decreased attenuation) diseases of the skeletal system
Acute osteomyelitis Active tuberculosis Atrophy Carcinoma Degenerative arthritis Giant cell tumor Gout Hemangioma Metastasis (osteolytic) Multiple myeloma Neuroblastoma New bone (fibrosis)
11 examples of additive (increased attenuation) diseases of the respiratory system
Arrested TB (calcification) Atelectasis Bronchiectasis Edema Empyema (pus) Encapsulated abscess Hydropneumothorax Malignancy Miliary TB Pleural effusion Pneumonia
2 examples of destructive (decreased attenuation) diseases of the respiratory system
Emphysema Pneumothorax
4 examples of additive (increased attenuation) diseases of the circulatory system
Aortic aneurysm Ascites Cirrhosis of the liver Enlarged heart
What is an example of an additive (increased attenuation) disease of the soft tissue?
Edema
2 divisions of the respiratory system
Upper tract Lower respiratory system
Located outside the thorax and lower tract found within the thoracic cavity Provides structure for the passage of air into the lower respiratory system
Upper tract of the respiratory system
3 parts the upper tract of the respiratory system consists of
Nasopharynx Oropharynx Larynx
Composed of tubular structures responsible for conducting air from the upper respiratory structures
Lower respiratory system
3 parts the lower respiratory system consists of
Trachea Bronchi Bronchides
What is the primary function of the respiratory system?
The intake of oxygen into blood and the removal of body waste in the form of carbon dioxide from the blood
The smallest functional unit of the respiratory system where the actual gas exchange occurs
Alveoli
What is respiration controlled by?
The medulla at the base of the brain
2 different blood supplies of the lung
Pulmonary circulation Bronchial
Low-pressure, low-resistance system through which oxygen enters and carbon dioxide exits the circulatory system
Pulmonary circulation
A part of the high-pressure systemic circulation, supplies oxygenated blood to nourish/support the lung tissue
Bronchial
2 layers of pleura (double-walled membrane) that encase the lung
Visceral pleura Parietal pleura
Inner layer of pleura that adheres to the lung
Visceral pleura
Lines the inner chest wall (thoracic cavity)
Parietal pleura
Potential space between the layers of pleura which normally contains only a small amount of fluid to lubricate the surfaces to prevent friction as the lungs expand and contract; the airtight space between the lungs and chest wall has a pressure slightly less than that in the lungs, this difference in pressure acts like a vacuum to prevent the lungs from collapsing
Pleural space
5 devices chest radiographs are used to verify the proper placement of
Endotracheal tube Central venous catheter Swan-Ganz catheter Transvenous cardiac pacemaker PICC line
Accumulation of fluid in the pleural space; an inflammatory or neoplastic process that involves the pleura may produce fluid within the potential space Caused by numerous pathologies; most commonly congestive heart failure, pulmonary embolism, infections such as pneumonia or TB, lung cancer or other cancers that have metastasized to the lungs or the pleura, abdominal diseases, recent surgeries, ascites, subphrenic abscess, pleurisy, liver disease, or kidney disease Because one side is so full of fluid, it pushes all the structures to the other side Best seen on lateral decubitus (fluid level)
Pleural effusion
Flow directed catheter that consists of a central channel for measuring pulmonary capillary wedge (PCW) pressure and a second smaller channel connected to an inflatable balloon at the catheter tip, can also measure cardiac output and central venous pressure (CVP)
Swan-Ganz Catheter
For blood pressure; inserted into the subclavian vein or a more peripheral vein in the upper extremity are extremely useful for measurement of the CVP and for providing a conduit for the rapid infusion of fluid or chronic hyperalimentation
Central venous (CV) catheter
Long-term venous access device used for home therapy and for patients undergoing chemotherapy
Peripherally inserted central catheter (PICC)
Method of choice for maintaining cardiac rhythm in patients with heart block or bradyarrythmias
Transvenous cardiac pacemaker
What is the correct placement of an endotracheal tube?
Tip of tube 5-7 cm above the carina
2 complications of incorrect placement of an endotracheal tube
Low placement: atelectasis High placement: air entering the stomach
What is the correct placement of a central venous (CV) pressure catheter?
Tip of catheter should be in the superior vena cava
4 complications of incorrect placement of a CV pressure catheter
Internal jugular vein placement Right atrium: possible arrhythmias or perforation Pneumothorax with placement Infusion of fluid into mediastinum or pleural space
What is the correct placement of a Swan-Ganz catheter?
Right or left main pulmonary artery seen radiographically within the borders of the mediastinum
What is a complication of incorrect placement of a Swan-Ganz catheter?
Pulmonary infarction
What is the correct placement of a transvenous cardiac pacemaker?
Overexpose to demonstrate the tip of the electrode at the apex of the right ventricle
2 complications of incorrect placement of a transvenous cardiac pacemaker
Coronary sinus placement: needs a lateral chest image to distinguish Perforation at initial insertion
2 congenital/hereditary disease of the respiratory system
Cystic fibrosis Hyaline membrane disease
Characterized by the secretion of excessively viscous mucus by all the exocrine glands; also affects the pancreas and digestive system Hereditary, additive Common in children Thickening in lungs where it’s not supposed to be Causes generalized irregular thickening of linear markings throughout the lungs Located in the bronchi
Cystic fibrosis
One of the most common causes of respiratory distress in the newborn, primarily premature caused by a lack of surfactant in immature lungs Located in the alveoli
Hyaline membrane disease Idiopathic respiratory distress syndrome (IRDS)
Consists of a mixture of lipids, proteins, and carbohydrates that creates a high surface tension, requiring less force to inflate and maintain the alveoli; without this the lung can collapse
Surfactant
2 inflammatory disorders of the upper respiratory system
Croup Epiglottitis
Inflammatory disorders of the upper respiratory system; primarily a viral infection of young children (because their respiratory system is smaller than adults’s) that produces inflammatory obstructive swelling localized at the subglottic portion of the trachea Many cases come from parainfluenza viruses, while some may come from adenovirus, respiratory syncytial virus (RSV), or rhinovirus Characterized by a barking cough X-rays usually taken as AP and lateral soft-tissue neck; AP radiographs of the lower neck shows a smooth, tapered narrowing of the subglottic airway caused by swelling (steeple sign) Viral usually goes away on its own within one week; bacterial may require antibiotic treatment Located in the subglottic trachea or larynx
Croup
Most commonly caused by Haemophilus influenzae in children Causes a thickening of epiglottic tissue and the surrounding pharyngeal structures Incidence has decreased due to routine childhood immunization Located in the supraglottic area or supraglottis Appear on images as a rounded, thickening epiglottic shadow
Epiglottitis
7 inflammatory disorders of the lower respiratory system
Pneumonia Anthrax Lung abscess Tuberculosis (TB) Pulmonary mycosis Respiratory syncytial virus (RSV) Severe acute respiratory syndrome (SARS)
An inflammation of the lung that can be caused by a variety of organisms, most commonly bacteria and viruses; additive
Pneumonia
4 types of pneumonia
Alveolar/air-space pneumonia Bronchopneumonia Interstitial pneumonia Aspiration pneumonia
Exemplified by pneumococcal pneumonia, it is produced by an organism that causes an inflammatory exudate that replaces air in the alveoli so that the affected part of the lung is no longer air containing but rather appears solid (radiopaque); spreads from one alveolus to the next by the way of communicating channels, and it may involve pulmonary segments or an entire lobe (lobar pneumonia) Pneumonia in the alveoli
Alveolar/air-space pneumonia
Typified by staphylococcal infection and is primarily an inflammation that originates in the bronchi or the bronchiolar mucosa and spreads to adjacent alveoli Tends to produce small patches of consolidation that may be seen radiographically as opacifications that are scattered throughout the lungs
Bronchopneumonia
The inflammatory process predominately involves the walls and lining of the alveoli of the interstitial supporting structures of the lung, the alveoli septa Most commonly produced by viral and mycoplasmal infections The interstitial dispersal of the infection produces a linear or reticular pattern; when seen on end, the thickened interstitium may appear as multiple small nodular densities Left untreated, it may cause “honeycomb lung,” which is demonstrated on CT as cystlike spaces and dense fibrotic walls
Interstitial pneumonia
Caused by the aspiration of esophageal or gastric contents into the lung Causes multiple alveolar densities, which may be distributed widely and diffusely throughout both lungs Located in the alveoli; appears on images as patchy opacifications
Aspiration pneumonia
Caused by Bacillus anthracis, can survive for decades in the soil without a host Easily transmitted and highly fatal Located throughout both lungs
Anthrax
3 ways to contract anthrax
Cutaneous- through an opening in the skin, most common Inhalation- lungs, usually fatal without prompt treatment; causes mediastinal widening and often pleural effusion without infiltrates on a chest image Gastrointestinal- caused by ingestion of contaminated meat
A necrotic area of pulmonary parenchyma containing purulent material Aspiration is most common cause; may also be a complication, bronchial obstruction, a foreign body, or the hematogenous spread of organisms to the lungs either in a patient with diffuse bacteremia or as a result of septic emboli Additive Most common in right lung because the right main bronchus is more vertical and larger in diameter Appears on images as an encapsulated opaque mass with air-fluid level
Lung abscess
Caused by Mycobacterium tuberculosis (rod-shaped bacterium with a protective waxy coat that permits it to live outside the body for a long time) Spreads mainly by droplets in the air Different types that show up differently on x-rays
Tuberculosis
A fungal infection of the lung Primary located in the lower lung or hilar lymph nodes; appears on images as pulmonary infiltration, granulomatous nodule, or hilar lymph node enlargement and/or calcification
Pulmonary mycosis
2 most common systemic fungal infections in North America
Histoplasmosis (looks like TB on x-rays) Coccidioidomycosis
Very contagious virus most common in children up to 2 years old Most common cause of bronchiolitis Attacks the lower respiratory tract, causes necrosis of the respiratory epithelium of the bronchi and bronchioles, and causes bronchiolitis Bronchial obstruction occurs due to necrotic material and edema that result from the infection Bronchiolitis produces bronchial spasm, and interstitial pneumonia occurs as a result of the obstruction Located in the bronchial epithelium Appears on images as hyperinflation with diffuse increased interstitial markings, interstitial pneumonia, or severe cases demonstrate focal areas of atelectasis
Respiratory syncytial virus (RSV)
First case appeared in China Causative agent: associated coronavirus of unknown etiology Transmitted by direct or droplet contamination, no known transmission since 2004 Located throughout both lungs Appears on images as early focal infiltrates progressing to generalized patchy interstitial infiltrates Can survive in environment today
Severe acute respiratory syndrome (SARS)
3 diffuse lung diseases
Chronic obstructive pulmonary disease (COPD) Sarcoidosis Pneumoconiosis
Includes several conditions in which chronic obstruction of the airways leads to an ineffective exchange of respiratory gases and makes breathing difficult (chronic bronchitis, emphysema, and asthma) Destructive Caused by: smoking, pollution, exposure to harmful substances, deficiency of Alpha 1 Atritrypsin enzyme No cure; most die from congestive heart failure, pneumonia, flu, or asthma attacks
Chronic obstructive pulmonary disease (COPD)
Crippling and debilitating condition in which obstructive and destructive changes in small airways (the acini or terminal bronchioles) lead to a dramatic increase in the volume of air in the lungs Black lungs and domes of diaphragm look flat Destructive disease, more air Located in the destroyed alveolar septa Appears on images as pulmonary hyperinflation, bulla formation, flattened diaphragm, or radiolucent retrosternal space
Emphysema
As the walls between alveoli are destroyed, these tiny air sacs become transformed into large air-filled spaces
Bullae
Very common, narrowing of the airways develops because of in increased responsiveness of the tracheobronchial tree to various stimuli (allergens) Occurs in the bronchi; appears on images as nothing unless during acute attack, bronchial narrowing/hyperlucent lungs, radiographic appearance, and excludes other processes
Asthma
A multisystem granulomatous disease of unknown cause that is most often detected in young adults; more common in women and African Americans Appears on chest radiography as bilateral hilar lymph node enlargement with or without diffuse parenchymal disease
Sarcoidosis
Chronic inflammation of the bronchi leads to severe coughing with the production of sputum; may be a complication of respiratory infection or the result of long-term exposure to air pollution of cigarette smoking (90%) The walls of the bronchi and bronchioles thicken and produce viscous mucus; over an extended period of time, the mucus glands become hyperplastic Appears on images with no image change in 50% of cases, increased bronchovascular markings, or hyperinflation and depressed diaphragm
Chronic bronchitis
Permanent abnormal dilation of one or more large bronchi as a result of destruction of the elastic and muscular components of the bronchial wall Located in basal segments of the lower lobes
Bronchiectasis
A severe pulmonary disease caused by inhalation of irritating particles
Pneumoconiosis
3 most common types of pneumoconiosis
Asbestosis Silicosis Anthracosis (coal worker’s disease)
4 types of respiratory neoplasms
Solitary pulmonary nodule (SPN) Bronchial adenoma Bronchogenic carcinoma Pulmonary metastases
Most common type of lung cancer, typically arises in the major central lumen Bronchogenic carcinoma non-small cell type
Squamous carcinoma
Asymptomatic, incidental finding on chest x-ray Problematic in that it could represent: benign granuloma, small neoplasm, or solitary metastasis Located throughout lungs Appear on images as solitary nodule, dense or popcorn calcification (benign), or continued growth (malignancy)
Solitary pulmonary nodule (SPN)
Low-grade malignant lesions Appears in a younger age group than bronchogenic carcinoma Most common symptoms: hemoptysis and recurring pneumonia Located in the glandular structure of major segmental bronchi Appear on images as peripheral atelectasis (obstruction) or obstructive pneumonia
Bronchial adenoma
Primary carcinoma of the lung Arises from the mucosa of the bronchial tree Linked to smoking and the inhalation of cancer-causing agents (carcinogens), such as air pollution, exhaust gases, and industrial fumes Common types are non-small cell and small (oat) cell Located in the lung parenchyma Appear on images as an ill-defined solitary lesion, atelectasis with obstruction, hilar enlargement, or cavitation in the upper lung
Bronchogenic carcinoma
3 non-small cell type bronchogenic carcinomas (80% of all lung cancers)
Squamous carcinoma Adenocarcinoma Bronchiolar (alveolar cell) carcinoma (least common)
Develop from hematogenous or lymphatic spread Most commonly from musculoskeletal sarcomas, myeloma, and carcinomas of the breast, urogenital tract, thyroid, and colon Carcinomas of the breast, esophagus, or stomach may spread to lungs via direct extension due to anatomic proximity Located throughout the lungs Appear on images as multiple nodules with sharp margins, miliary/snowstorm nodules, solitary nodule, or coarsened interstitial markings
Pulmonary metastases
3 vascular diseases of the respiratory system
Pulmonary embolism Septic embolism Pulmonary arteriovenous (AV) fistula
Most common lung pathology of hospitalized patient, may be fatal Asymptomatic in about 80% of cases; difficult to diagnose even in those with symptoms More than 95% of embolisms arise from deep vein thrombosis in the lower extremities Blood clots Located most often in the lower lobes Serial images demonstrating progressive enlargement of the affected vessel
Pulmonary embolism
A bacterial “shower” that enters pulmonary circulation, then gets trapped in the lung Arise primarily from the heart (bacterial endocarditis) and peripheral veins (septic thrombophlebitis) More common in IV drug abusers Located in the lung periphery and appears on images as peripheral opacities
Septic embolism
An abnormal vascular communication between a pulmonary artery and a vein Multiple ones are not uncommon; often in other organs as well Very large or multiple can cause cyanosis due to too much venous blood shunting into arterial circulation Located most often in lower lobes and appears on images as defined soft tissue mass
Pulmonary arteriovenous (AV) fistula
A condition in which there is diminished air within the lung associated with reduced lung volume Caused by bronchial obstruction, which may be due to: neoplasm, foreign body, or mucous plug Important iatrogenic cause: improper placement of an endotracheal tube below the level of the tracheal bifurcation Located as an obstruction of segment/lobe or lung collapse Appears on images as local increased density; platelike streaks
Atelectasis
Lung structure breaks down, with massive leakage of cells and fluid into the interstitial and alveolar spaces Hypoxia and severe respiratory impairment results, life threatening Develops in those who have medical and surgical disorders but no major lung disease; most common in patients with nonthoracic trauma who develop hypotension and shock, “shock lung” Located as a lung structure breakdown Appears on images as patchy, ill-defined areas of consolidation
Adult respiratory distress syndrome (ARDS)
Air within the mediastinum Causes include: spontaneous (severe coughing, vomiting, or straining ruptures alveoli, releasing air), chest trauma, perforation of the esophagus or tracheobronchial tree, or spread of air along fascial planes in the neck, peritoneal cavity, or retroperitoneal space Air may also extend peripherally and rupture into the pleural space, causing an associated pneumothorax Located as air in bronchovascular sheath Appears on images as radiolucency running parallel to heart border
Mediastinal emphysema (pneumomediastinum)
Free air in the tissues of the chest wall caused by penetrating or blunt injuries that disrupt the lung and parietal pleura Characterized by crepitation (a crackling sound or sensation) on palpation Located in air in surrounding muscle bundles Appears on images as air streaks in muscle bundles
Subcutaneous emphysema
3 disorders of the pleura
Pneumothorax Pleural effusion Empyema
The presence of air in the pleural cavity, resulting in a parietal or complete collapse of the lung Difficulty breathing Causes: rupture of a subpleural bulla, spontaneous event in an otherwise healthy young adult, trauma, iatrogenic causes, or complications of neonatal hyaline membrane disease Treatment: prompt chest tube drainage with suction to remove the air and prevent recurrence Located in air in the pleural space Appears on images as peripheral radiolucency without pulmonary markings
Pneumothorax
A rare accumulation of infected liquid or frank pus in the pleural space Usually caused by the spread of an adjacent infection (e.g., bacterial pneumonia, subdiaphragmatic abscess, lung abscess, and esophageal perforation); may occur after thoracic surgery, trauma, or instrumentation of the pleural space Additive because any kind of fluid is harder to penetrate through Appears on images as a lesion - loculated fluid; possible air-fluid level
Empyema
3 compartments of the mediastinum
Anterior Middle Posterior
Extends from the sternum back to the trachea and the anterior border of the heart
Anterior mediastinum
Contains the heart, great vessels, central tracheobronchial tree, lymph nodes, and phrenic nerves
Middle mediastinum
The space behind the pericardium
Posterior mediastinum
5 anterior mediastinal masses
Thymomas Teratomas Thyroid masses Lipomas Lymphoma
4 middle mediastinal masses
Lymph node disorders Bronchogenic cysts Vascular anomalies Masses in the anterior costophrenic angle
3 lymph node disorders
Lymphoma Metastatic carcinoma Granulomatous processes
4 posterior mediastinal masses
Neurogenic tumors Neurogenic cysts Aneurysms of the descending aorta Extramedullary hematopoiesis
3 disorders of the diaphragm
Diaphragmatic paralysis Eventration of the diaphragm Other causes of elevation of the diaphragm
Caused by any process that interferes with the phrenic nerve Shows on images as the elevation of one or both leaves the diaphragm Results in diminished lung volume Caused by: fluid, obesity, pregnency Location: diaphragm movement Imaging appearance: sniff test to distinguish normal from abnormal
Diaphragmatic paralysis
Rare congenital abnormality in which one hemidiaphragm (very rarely both) is poorly developed and weak Permits the upward movement of abdominal contents into the thoracic cage Usually asymptomatic Occurs more commonly on the left Location: diaphragm poorly developed and elevated Imaging appearance: diaphragm elevation
Eventration of the diaphragm
4 other causes of elevation of the diaphragm
Ascites Obesity Pregnancy Any other process in which the intraabdominal volume is increased
Subcutaneous hematoma greater than 1-2 cm
Ecchymosis
Tumor-like mass of tissue caused by a chronic inflammatory process
Granuloma
Bands that form between tissues and organs, often as a result of injury during surgery
Fibrous adhesions
An excess of blood in the vessels supplying an organ or other part of the body
Hyperemia
Forming pus
Suppurative
In cases in which ischemia continues to progress, resulting in an infarction, necrosis may occur as a result of lack of blood flow Severe arterial disease of the lower extremities may result in necrosis of several toes or a large segment of the foot
Gangrene
Underdevelopment or incomplete development of a tissue or organ
Hypoplastic
Tumor of muscle
Myoma
A cancer in which the tumor cells resemble stratified squamous epithelium, as in lung and head and neck regions
Squamous cell carcinoma
An emotional disorder characterized by an obsessive desire to lose weight by refusing to eat
Anorexia
Difficulty swallowing
Dysphagia
Any new and abnormal growth, especially when the growth is uncontrolled and progressive
Neoplasm
A large membranous tube reinforced by rings of cartilage, extending from the larynx to the bronchial tubes and conveying air to and from the lungs; the windpipe
Trachea
