Lecture 4- Upper Resp. System And Nevk Pathologies Flashcards
Description, causes and symptoms of acute sinusitis
Description: acute inflammation of the paranasal sinus mucosa that lasts less than 4 weeks. If the nasal cavity is also involved it’s called rhino sinusitis
Causes: normally follows an upper respiratory tract t infection
Symptoms: fever, headache, postnatal discharge, abnormal sense of smell.
diagnosis of actue sinusitis
Plain film – nonspecific. On facial views you may see a gas fluid level in the maxillary sinus. Its really hard to see the ethmoid and sphenoid sinuses on these images.
CT – most common imaging method. Allows you to assess extension, causes and possible complications. Findings include, mucosal thickening, gas fluid levels in the sinuses, gas bubbles in the fluid.
MRI - T1 C+ (Gd) will show inflamed mucosa as this enhances while fluid doesn’t
complications, treatment and differential diagnosis od acute sinusitis
Complications
Erosion through bone, orbital extension of the infection, intracranial extension – can lead to meningitis, subdural empyema and abscesses
Treatment
Antibiotics. If it becomes chronic, FESS (functional endoscopic sinus surgery) may be carried out.
Differential diagnosis
Air fluid level due to trauma
Chronic vs acute
description, causes, symptoms of cystic fibrosis (CF)
Description
Genetic disease affecting the lungs, liver, pancreas, small bowel and urogenital system
Causes
Most common genetic disease affecting 1:2000/3500 live births
Symptoms
Lung and upper respiratory system manifestations
Repeated bacterial infections, chronic sinusitis, nasal polyps
diagnosis, complications, treatment and diff diagnosis for cyustic fibroiss
Diagnosis
Generally suspected due to genetic testing of parents or ultrasound findings at antenatal scans. Also tested post birth.
Complications
Life limiting
Increased risk of digestive system cancers, lymphoma, leukaemia
Treatment
For respiratory complications
Physiotherapy for airway clearance
Anti-inflammatory therapy
Antibiotics
Lung transplant
Differential diagnosis
No real differential due to availability of genetic testing.
nasal poylps description, causes and symptoms
Description
Multiple benign polyps in the nasal cavity and paranasal sinuses
Causes
Most commonly seen in adults. Rare in children.
May be associated with cystic fibrosis, asthma, rhinosinusitis
Symptoms
Patient has a feeling of nasal obstruction, facial pain, headache, loss of smell. May also have symptoms of sinusitis
diagnosis, complications, treatment and diff. diagnosis of nasal polyps
Diagnosis
CT is the preferred imaging method but MRI can also be used
You will see extensive mucosal polyps in the nasal cavity and/or sinuses. Usually hypodense.
May see associated bone erosion
May also see sinusitis signs
Complications
Impact on daily life for the patient
Treatment
Steroids.
Surgery if advanced
Differential diagnosis
Other causes of mucosal thickening such as nasopharyngeal cancer.
Foreign body
description, causes and symptoms of retropharyngeal abscess.
Description
Life threatening infection involving the retropharyngeal space. Needs immediate diagnosis
Causes
Most commonly seen in young children (<5yrs)
Commonly a complication of a primary infection elsewhere in the sinuses, ear or nasopharynx.
These areas drain lymph to the retropharyngeal lymph nodes which become infected and develop into an abscess
Symptoms
Nonspecific symptoms of infection
May have stridor and neck swelling
diagnosis of retropharyngeal abscess
Diagnosis
Ultrasound
Point of care has a use for screening.
You will see a complex collection.
Plain film
Useful as patient can be upright
Will see swelling posterior to the pharynx and widening or the paravertebral soft tissue
CT
Speedy – advantage as the patient’s airway may be compromised when laying down
Can assess any narrowing of the airway
It can be difficult to assess the amount of infection or mucosal swelling from CT
MRI
Much better at assessing infection extent
But takes longer and may be difficult for the patient
comp, treatment and diff. diagnosis of retropharyngeal abscess
Complications
Infection can spread into the spine
Complete airway occlusion
Treatment
Surgical drainage
IV antibiotics
If treatment is timely nearly 100% of patient recover fully
Differential diagnosis
Other causes of a mass e.g. tumour
description, causes and symtpoms of pharyngeal diverticulum
Description
Also known as a pharyngeal pouch
Posterior outpouching of the hypopharynx through a weakness in the muscle
Causes
Advancing age
Symptoms
Food and liquid become trapped leading to a sensation of trapped food, dysphagia, regurgitation, chronic cough, aspiration pneumonia
diagnosis, complications, treamtnet and diff. diagnosis of pharyngeal diverticulum
Diagnosis
Barium swallow is the ideal imaging method
You can see the diverticulum at the C5/6 level on the lateral view
Complications
Aspiration pneumonia
Treatment
Endoscopic surgery to resect it
Differential diagnosis
Other causes of patients symptoms
foreign bodies
In America foreign body aspiration is the 4th leading cause of death in younger children.
Upper airway compromise may present with choking and respiratory distress
More distal obstruction may present with mild wheezing, cough and shortness of breath
Once a foreign body is aspirated into the larynx or proximal trachea there is always the risk of respiratory compromise or further inhalation into the lungs
Most foreign bodies are organic – seeds, nuts etc.
Adults may present with ingestion of a bone – chicken / fish, dentures, hearing aid batteries etc.
what is the preferred imaging method to asssess for FB’s
A lateral and AP soft tissue neck is the preferred imaging method to assess a foreign body in the upper airway.
Patient should be upright to stop any confusion with mucosal thickening
If the patient is unstable a lateral only may be performed
In children who a poor historians this may progress to a CXR and possibly a AXR
Important note – minimise patient and carer anxiety as carrying can exacerbate the patient’s respiratory distress
CT and MRI can be helpful for more accurate location and assessment of complications but are not the first line of imaging
description, causes and symptoms of tonsillitis and complications
Description
Inflammation of any of the tonsils
Causes
Bacterial infection, commonly Strep A
Symptoms
Pain, dysphagia (swallowing difficulties) , fever
diagnosis, complications, treatment and diff. diagnosis of tonsillities and complications
Diagnosis
Imaging is not indicated unless there is concern for complications such as an abscess
CT and MRI will show tonsillar enlargement and if there is an abscess will show a fluid collection
Complications
Peritonsillar abscess (quinsy)
Treatment
Antibiotics. Oral if uncomplicated, IV if there is concern for quinsy\
Differential diagnosis
Other causes of mucosal thickening such as lymphoma
descriotion, causes and symtpoms of hypothyroidism (underactive)
Description
The thyroid does not produce enough thyroid hormone resulting in decreased cellular metabolism.
Causes
Autoimmune diseases such as Hashimoto’s is the most common cause.
Symptoms
Affects nearly every system in the body
SOB
Muscle / joint pain
Weight gain, cold intolerance
diagnosis, complications, treatment and diff. diagnosis for hypothyroidism
Diagnosis
US is the standard imaging method.
Will see an abnormal size of the thyroid gland
An alteration in the thyroid texture and abnormal colour flow patterns
Complications
Depends on body system most affected but can lead to heart arrythmias
Treatment
Drugs to replace the thyroid hormone - levothyroxine
Differential diagnosis
Vast!
description, causes, symptoms of hyperthyroidism (overactive)
Description
The thyroid produces too much thyroid hormone
Causes
Graves disease, radiation or drug induced, tumours
Symptoms
Heart arrythmias most commonly
Goitre
Weight loss
diagnosis, complications, treatment and diff. diagnosis for hyperthyroidism (overactive)
Diagnosis
Generally a blood test
Nuclear medicine thyroid scan to check for cause
Complications
Eye problems such as double vision, pregnancy complications
Treatment
Drugs, radioactive iodine treatment, surgery
Differential diagnosis
description, causes, symmptoms of thyroid cancer
Description
As the name suggests!
Causes
Head and neck radiotherapy
Family history
There are many different types
Symptoms
Usually a palpable mass
diagnosis, complications, treatment and diff. diagnosis of thyroid cancer
Diagnosis
US – seen as a mass with an irregular outline
Often needs a US fine needle aspiration to get a sample
CT is best for staging and to check lymph nodes
MRI has a slightly higher sensitivity than CT
Complications
Patients may be at risk of cancers elsewhere
Treatment
Surgery and radioactive iodine treatment
Differential diagnosis
Abscess or other reason for a mass11
description, causes, symtpoms and diagnosis of enlarged lymoph nodes
Description
Enlarged lymph nodes
Causes
Infection
Neoplastic (due to cancer)
Due to certain drugs
Symptoms
Depends in cause but can cause pain and difficulty in movement
Diagnosis
Can be seen and measured on CT and MRI.
PET will show intense F-FDG uptake
