General Flashcards by Ryan Di Geronimo

Pulmonary Lobes

Right Upper Lobe 
Right Middle Lobe 
Right Lower Lobe 
Left Upper Lobe 
Left Lower Lobe

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Right upper lobe segments

(AAP) clockwise

- Apical
- Anterior 
- Posterior

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Right middle lobe segment

(LM) clockwise
- Lateral
  - Medial

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Right Lower Lobe Segment

(SM-PAL) going clockwise

- Superior 
- Medial Basal
- Posterior Basal
- Anterior Basal
    - Lateral Basal

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Left Upper Lobe Segment

(ISAA) going clockwise

- Apical Posterior 
- Apical Anterior 
- Superior Lingula 
    - Inferior Lingula

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Left Lower Lobe Segment

(SM-PAL) going clockwise

- Superior 
- Medial Basal
- Posterior Basal
- Anterior Basal
- Lateral Basal

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Azygous Fissure

Accessory fissure present in less than 1% of patients, seen in the presence of an azygos lobe. An azygos lobe is an anatomic variant where the right upper lobe apical or posterior segments are encased in their own parietal and visceral pleura

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Atelectasis

Loss of lung volume due to decreased aeration

Synonymous with Collapse

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Direct Signs of Atelectasis

Due to lobar volume loss and include:

- Displacement of the fissures 
    - Vascular crowding

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Indirect Signs of Atelectasis

Due to the effect of volume loss on adjacent structures

    - Elevation of the diaphragm 
- Rib crowding on the side the volume loss 
- Mediastinal shift to the side with volume loss 
- Over-inflation of adjacent or contralateral lobes 
- Hilar displacement

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Air bronchograms are not seen in atelectasis when

The cause of the atelectasis is central bronchial obstruction, but air bronchograms can be seen in subsegmental atelectasis.

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Subsegmental atelectasis

Is caused by obstruction of small peripheral bronchi, usually by secretions

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What are the four mechanisms of atelectasis

ORCA

- Obstructive 
- Relaxation 
    - Cicatricial
- Adhesive

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When Does Obstructive Atelectasis Occur

Occurs when alveolar gas is absorbed by blood circulating through the alveolar capillaries but is not replaced by inspired air due to bronchial obstruction

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Obstructive atelectasis occurs more quickly when the patient is breathing supplemental oxygen why?

Oxygen is absorbed from the alveoli more rapidly than nitrogen

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In children airway obstruction is often due to aspirated foreign objects. What do you see on xray

In contrast to adults, the affected side becomes hyper-expanded in children due to the ball-valve effect

Subsegmental atelectasis is a subtype of obstructive atelectasis commonly seen after surgery or general illness
what is it due to?

Mucus obstruction of the small airways

What is relaxation/compressive atelectasis

-Atelectasis is caused by relaxation of the lung adjacent to an intrathoracic lesion causing mass effect, such as pleural effusion, pneumothorax, or pulmonary mass

What is adhesive atelectasis

-Due to surfactant deficiency. Most commonly seen in neonatal respiratory distress syndrome but can also be seen in ARDS

What is Cicatricial atelectasis

-Volume loss from architectural distortion of the lung parenchyma by fibrosis

Cause of Lobar Atelectasis

-Usually caused by central bronchial obstruction (obstructive atelectasis) which may be secondary to mucus plugging or an obstructing neoplasm

Pathology of Lobar Atelectasis on the basis of whether it is acute versus chronic

If the lobar atelectasis occurs acutely, mucus plugging is the most likely cause
If the lobar atelectasis is seen in an outpatient setting an obstructing central tumor must be ruled out

-Lobar atelectasis or collapse of an entire lobe has characteristic appearances depending on which of the five lobes is collapsed

Frontal Radiograph
The upper lobes go up
The right middle lobe compresses in
The lower lobe compresses medially

Lateral Radiograph
The upper and lower lobes form a superior and inferior sandwich and the right middle lobe forms a medial sandwich

Left upper lobe collapse

-The luftsichel (air-sickle in german) sign of left upper lobe collapse is a crescent of air seen on frontal radiograph which represents the interface between the aorta and the hyper expanded superior segment of the left lower lobe

Left lower lobe collapse:

In left lower lobe collapse, the heart slightly rotates and the left hilum is pulled down The flat wrist sign describes the flattening of the left heart border as a result of downward shift of the hilar structures and resultant cardiac rotation

Right upper lobe atelectasis

The reverse S sign of Golden is seen in right upper lobe collapse caused by an obstructing mass. The central convex margins of the mass form a reverse S. Although the sign describes a reverse S, it is commonly known as Golden’s S sign. Similar to left upper lobe collapse, a right upper lobe collapse should raise concern for an underlying malignancy, especially with a Golden’s S sign present. The juxtaphrenic peak sign is a peridiaphragmatic triangular opacity cased by diaphragmatic traction from an inferior accessory fissure or an inferior pulmonary ligament

Right middle lobe atelectasis

The findings of right middle lobe atelectasis can be subtle on the frontal radiographs. Silhouetting of the right heart border by the collapsed medial segment of the middle lobe may be the only clue. The lateral radiograph shows a wedge shaped opacity anteriorly

Right lower lobe atelectasis

Right lower lobe atelectasis is the mirror image of left lower atelectasis The collapsed lower lobe appears as a wedge shaped retrocardiac opacity

What is round atelectasis

- Round atelectasis is focal atelectasis with a round morphology that is always associated with adjacent pleural abnormality such as (PPP) - pleural effusion - pleural thickening or plaque - pleural neoplasm

Where is round atelectasis most common

Round atelectasis is most common in the posterior lower lobes

What Are the five diagnoses that are required to diagnosis round atelectasis

- Adjacent pleura must be abnormal - Opacity must be peripheral and in contact with the pleura - Opacity must be round or elliptical - Volume loss must be present in the affected lobe - Pulmonary vessels and bronchi leading into the opacity must be curved-this is the comet tail sign

What is the elemental unit of lung function

The secondary pulmonary lobule (SPL) is the elemental unit of lung function

What does each SPL contain

Each SPL contains a central artery (centrilobular artery) and a central bronchus, each branching many times to ultimately produce acinar arteries and respiratory bronchioles

What is the acinus

Basic unit of gas exchange, containing several generations of branching respiratory bronchioles, alveolar ducts, and alveoli

How many acini for secondary lobule unit

There are generally 12 or fewer acini per secondary lobule

Connective Tissue that encases each SPL is called

Interlobular Septa

Thickening of the interlobular Septa can be from

Enlargement of either the venous or lymphatic spaces