Chapter 1 - Pathology Flashcards
Atelectasis (underventilation - alveolar spaces become devoid of air) may be caused by what?
- tumor, inflammation, mucus plug, pneumothorax, embolus, pneumonia
(p. 67)
What are symptoms of atelectasis?
- asymptomatic TO
- cyanosis, dyspnea, pain in affected side
(p. 67)
CT appearance - soft tissue density which clearly enhances because of compressed vessels
Atelectasis (p. 67)
Presence of pleural exudate within pleural cavity
Empyema
Empyema may be caused by what?
Extension of pneumoonic infection
What are symptoms of Empyema?
dyspnea, coughing, chest pain on one side, malaise, fever
CT appearance - convex/concave sicle-shaped appareance between thickened pleural membrane
Empyema
When air is present witin the empyema it is indicative of _____________?
bronchopleural fistula (p.68)
Pleural effusion may be caused by what?
- transudation arising from cardiac insufficiency
- serous or purulent effusions caused by pneumonia
(p. 68)
CT appearance - accumulation of fluid in posterior aspect of lung
pleural effusion (p.68)
Air in pleural cavity, resulting in collapse of lung on affected side
Pneumothorax
Spontaneous pneumothorax is caused by what?
- Result of a rupture of a subpleural bulla
- by weakened area of the lung - esp in tall patients
Traumatic pneumothorax caused by what?
- secondary to rib fractures, contusion, laceration
Tension pneumothorax caused by what?
- Intrapleural pressure exceeds atmospheric pressure in lun during expiration
What are symptoms of pneumothorax?
SOB, sharp chest pain, decreased BP, decreased breath sounds on affected side
How is pneumothorax treated?
Needle aspiration or insertion of chest tube
CT appearance - presence of air in the pleural space and collapsed lung with mediastinal shift towards the affected side.
Pneumothorax
Fairly common (1:1000) congenital defect with a reverse of normal left arch. Often associated with Tetrology of Falot. Asymptomatic and incidental finding
Rt arch with anomalous Lt subclavian artery
Appearance of Helilcal CT - presence of right aortic arch with lt subclavian artery. Descending aorta crosses from right to left and descends in normal location.
Rt arch with anomalous lt subclavian artery
A dilation of aorta greater than _______ would be considered an aneurysm.
4 cm
Greater than ________ a thoracic aneurysm would require surgery.
10 cm
A thoracic aneurysm is usually associated with which disease processes?
arteriosclerosis, hypertension, coronary artery disease, abdominal aneurysms
What are symptoms of thoracic aneurysm?
substernal/back/shoulder pain, SVC sydrome (venous compression)
Appearance of helical CT - dilation of the aorta with possible thrombus
Thoracic aneurysm (p.71)
Hemorrhage of the vasa vasorum (network of small blood vessels that supply the walls of large blood vessels) leading to a tear in the weakened intima.
Aortic dissection (p. 71)
Aortic dissection is associated with what?
arteriosclerosis and hypertension (p. 71)
Describe the 3 types of aortic dissection. Which require medical treament?
Type 1 (32%): entire aorta involved Type 2 (18 %) : ascending aorta is involved Type 3 (50 %) : only descending aorta is involved Type 1 & 2 require surgical intervention, Type 3 rarely requires attention as it rarely goes prox. (p. 71)
Appearance of helical CT - two lumina filled with contrast.
aortic dissection - a non-contrast scan is often performed to rule-out an intramural hematoma (p. 71)
Thickening of pericardial stripe with a serous fluid buildup around the ventricles.
Pericardial effusion (p. 72)
It is a result of CHF and may lead to cardiac tamponade (pressure on heart muschle).
Pericardial effusion (p. 72)
Appearance of routine CT - concentric hypodense opacity surrounding the heart.
Pericardial effusion (p. 72)
Occlusion of pulmonary artery.
pulmonary embolism
PE is caused by what?
DVT
What happens to the patient if the occlusion is >50%
Patient may go in shock with dyspnea and have low blood gas levels. Treated with thrombolysis
CT appearance : filling defect in affected pulmonary artery. May have decreased arterial supply to affected lobe.
PE - CT is 90-100% sensitive to MAIN and SEGMENTAL pulm arteries but NOT for SUBSEGMENTAL arteries.
Budding or branching abnormality of primitive foregut (anterior part of the alimentary canal from mouth to the duodenum) - resulting in cyst containing mucus or clear fluid.
Bronchogenic cyst (p. 73)
It is often associated with spinal abnormalities. Pt may be asymptomatic, stridor and dysphagia.
Bronchogenic cyst (p. 73)
Appearance of CT - smooth round masses usually found in the subcarinal space as an incidental finding. Ct # will be close to water.
Bronchogenic cyst (p. 73)
What are symptoms of bronchial carcinoma?
Asymptomatic OR present with cough or haemoptysis
Which type of bronchial carcinoma: slow growth, usually central, associated with smoking and rarely metastasizes
squamous cell ca (p. 73)
Which type of bronchial carcinoma: slow growth, usually upper lobe, and associated with mets
adenocarcinoma (p. 73)
Which type of bronchial carcinoma: rapid growth, varied location, associated with mets
Small cell ca (p.73)
Which type of bronchial carcinoma: intermediate growth rate, usually peripheral, some mets.
Large cell ca (p. 73)
Appearance of CT - mass with irregular or spiculated edge due to fibrosis. May have lobulated contour and/or central cavitation.
Bronchial carcinoma (p. 73)
Name origin of pulmonary mets in order of frequency.
Breast, kidney, head, neck (p. 74)
Acute inflammation or infection of lung from bacteria or viruses
Pneumonia (p. 74)
This type of pneumonia affects a segment or entire lobe. Symptoms include : cough, sharp chest pains, bloody sputum, increased pulse & respiration.
lobar pneumonia (p. 74)
This type of pneumonia is more common, affects a smaller area with localized inflammation. Greadual, less sever symptoms than lobar.
Bronchopneumonia (p. 74)
Appearance of CT - air spaces of the secondary lobules display multilocular infiltrates. Density orients segmentally.
pneumonia (p. 74)
Chronic dilation of bronchi and bronchioles. Congenital and pediatric disease, sometimes secondary to chronic sinus infection., asthma, pneumonia.
bronchiectasis (p. 75)
Symptoms include : persistant cough (bronchi thicken and secrete mucus), SOB, hemoptysis
bronchiectasis (p. 75)
Appeaerance of CT - bronchi thick walled, usually in posterior basal segments of lower lobe, signet ring sing
bronchiectasis (p. 75)
Circumbscribed, dense mass occurring in reaction to the presence of infection, inflammation, FB. Constitutes majority of solitary pulmonary nodules. Round shat, central calcification = benign nature.
Granuloma (p.75)
Appearance of CT - incidental finding as small calcified nodule
Granuloma (p.75)
Irreversible disorder, increased air space size distal, terminal bronchi - caused by mucus plugs. Caused by natural loss of elasticity and smoking.
Emphysema (p. 76)
Symmptoms : persistant moist cough, wheezing, barrel chest - tx bronchodilators
Emphysema ( p.76)
Appearance of CT - areas of low attenuation, with draped vessels. Dilation retrosternal space and central pulmonary vessels due to arterial pulmonary hypertension.
Emphysema ( p. 76)
Widespread formation granulomas - lead to pulmonary fibrosis. Chronic - asymptomatic, fever, malaise, weight loss, dry cough, hemoptysis
Sarcoidosis ( p. 76)
Appearance of CT - various densities filled with fine nodules as well as hilar lymph node enlargement.
Sarcoidosis ( p. 76)
