Chest Flashcards
Air leak in chest tube
”- Continuous air bubbles in the Pleur-evac chamber represent an air leak, either from the A) drainage tubing or from the B) lung itself and thus is worrisome for a bronchopleural fistula.
- Drainage of a lung abscess carries an increased risk of creating a bronchopleura fistula as compared to drainage of empyema.
- The international normalized ratio (INR) should generally be < 1.5 prior to placement of a chest tube.
- In the paravertebral region the intercostal vessels course off of the ribs and are thus more prone to injury if this route is chosen for chest tube placement.”
Influenza pneumonia
“The axial CT demonstrates innumerable centrilobular and ““tree-in-bud”” nodules in the lungs bilaterally.
- Imaging findings typically encountered in influenza pneumonia are nonspecific for the disease and may be seen in many other entities.
- The most common findings on CT include mosaic attenuation, lobular ground-glass opacity and consolidation, and centrilobular and ““tree-in-bud”” nodules.
- Acute pneumonia may rapidly progress to acute respiratory distress syndrome (ARDS).
- Influenza pneumonia represents most viral infections in immunocompetent patients, and severe pneumonia is most common in infants and immunocompromised patients.
- Superimposed bacterial infection does occur and may result in cavitation in cases of Staphylococcal pneumonia or pleural effusion.”
What is the most common tracheal malignancy? Ddx is MATCH
“A) Squamous cell carcinoma is the most common primary tracheal neoplasm
- tracheal neoplasm seen as an irregular-shaped polypoid or sessile lesion indicates squamous cell carcinoma. . One third of squamous cell carcinoma patients have mediastinal or pulmonary metastases at diagnosis. Forty percent of squamous cell carcinomas are associated with past, present, or future carcinoma of the oropharynx, larynx, or lung.
- Tracheal neoplasms represent approximately 0.1% of all chest neoplasms; two third of them are either squamous cell carcinoma or adenoid cystic carcinoma. Synchronous or metachronous 2nd primaries are common (up to 40%).
- Keep in mind that the presence of calcium does not distinguish benign from malignant tracheal tumors.”
Acute mediastinitis
“Mediastinitis can arise as a complication of 1) esophageal tear, 2) following chest surgery or instrumentation, or3) from direct intrathoracic extension of a cervical or retroperitoneal process.
- Chest CT is the imaging examination of choice for assessing suspected mediastinitis. CT findings of mediastinitis include nonorganized mediastinal fluid, mediastinal fat stranding, and the evolution of a mediastinal abscess.
- Mortality rates can be high, so early treatment is necessary.
- Complications include a generalized sepsis syndrome, empyema, and fistulae between adjacent organs.”
When do you use a clamshell sternotomy?
“The location and appearance of the sternal wires is typical of the post-surgical changes of the ““clamshell”” sternotomy for bilateral sequential lung transplantation. This affords excellent exposure of the mediastinum and both pleural spaces.
- None of the other procedures employs this form of incision.”
Wegeners granulomatosis summary
“Tracheal wall thickening is seen in 15% of Wegener granulomatosis cases. Bronchial wall thickening (also seen here) is seen in 50-60% of cases. A focal appearance is seen more than a diffuse appearance. Subglottic narrowing is the most common finding, but is not shown in this example. Tracheobronchial narrowing will be smooth or irregular; the tracheobronchial narrowing in this case is irregular.
- Wegener granulomatosis is a systemic necrotizing granulomatous vasculitis of small to medium-sized vessels. Wegener granulomatosis may produce tracheobronchial stenosis without other features of the disease. Associated lung findings that may be present include nodules and masses, cavitary lesions, consolidation, and ground-glass opacities.”
Artery of adamkiewicz and other eponymous arteries
”- Bronchial arteries: 1 on right, 2 on left
- beware arteri of adamkiewicz (usually on left at T9-12 but variable) 0 has hairpin turn
The dominant anterior spinal artery, also known as the great anterior radicular or medullary artery (of Adamkiewicz), classically
- arises from the left T-10 intercostal artery; however, the origin of the vessel is variable arising 63% of the time between T-9 through T-12 levels and 12% of the time between T-6 and T-8.
- It originates from a left rather than a right intercostal artery in 73% of cases.
- The artery is described as having a characteristic ““hairpin”” turn.
- Care must be taken when evaluating and embolizing intercostal and bronchial arteries so as to prevent inadvertent nontarget delivery of particles into the anterior spinal artery, as that could result in transverse myelitis and paraplegia.
- The artery of Bernasconi and Cassinari is better known as the tentorial artery, which is 1 of 3 branches of the meningohypophyseal artery.
- The artery of Desproges-Gotteron is the posterior radiculomedullary artery, also known as the “conus artery,” which arises from the internal iliac artery or its branches, such as the iliolumbar artery.
- The recurrent artery of Heubner, also known as the medial striate artery, is the largest perforating arterial branch that arises from the proximal anterior cerebral artery.”
A 64-year-old woman has carcinoid syndrome. Which valvular abnormalities would be most likely to occur?
Tricuspid regurgitation is the most common valvular abnormality associated with carcinoid heart disease. Pulmonic stenosis is also common; however it is less common than tricuspid regurgitation. Left-sided heart involvement is much less common than right-sided involvement due to vasoactive substances released by the primary tumor in the lung draining directed into the right heart, or alternatively, when secretion of vasoactive substances from hepatic metastases overloads the liver’s capacity to metabolize them.
What is virchow triad?
1) slow flow, 2) endothelial injury, 3) hypercoagulability
What are the direct and indirect signs of volume loss (atalectasis) on CXR?
"Direct: displaced fissue, opacified lobe indirect: - elevaton of the hemithorax - mediastinal shift - Displaced hilim - decrease between ribs - crowded vessels"
what are the causes of pulmonary hypertension?
“Idiopathic: most common
Volume related: Left-to-right shunt
pressure related:
- Post-capillary (venous): Mitral valve disease
- capillary: chronic PE,
pre-capillary (arterial): connective tissues disesae”
What are the 3 signs associated with pneumothorax on supine radiographs?
“Deep sulcus
double diaphragm
sharp diaphragmatic contour”
“What is a Ranke complex?
Ghon complex?”
“Ghon: Nodule caused in primary infection (superior segment of Lower lobe OR inferior upper/middle lobe)
Ranke: calcified Nodule + LN
“
what are signs of bronchiectasis on CT
“1) Bronchi>artera
2) bronchi within periphery of lung
3) lack of tapering”
“Memorize: What blood work/laboratory work do you recommend for:
1) Wegeners? PAN?
2) suspected bronchopleural fistula?
3) carcinoids?
4) CF?
5) sarcoid
6) kaposi sarcoma
7) PBC - primary biliary cirrhosis”
“1) Wegeners: cANCA (PAN is pANCA –> P for P)
2) bronchopleural fistula: xenon-ventilation study
3) Carcinoids - octreotide
4) Sweat-chloride test
5) ACE levels and Calcium
6) HH8
7) anti-mitochondrial antibodies”
