Lung Flashcards
Lung lesions should be identified on at least _____ orthogonal radiographs.
2
What are the predominat radiographic patterns for the lung?
B.A.Ni.V.Ui.
Bronchial
Alveolar
Nodular interstitial
Vascular
Unstructured interstitial
What are the types of distribution of lung patterns?
The LOCAL LOBAR had a GENERAL warning about DIFFUSE customers having SYMMETRICAL and ASYMMETRICAL intentions in your CRAINAL, CAUDAL, DORSAL AND VENTRAL areas. They have been seen on the HILAR, south CENTRAL, and in the PERIPHERAL subdivisions. It doesn’t matter if you are a UNILATERAL or a BILATERAL.
- Local- confined to a single lung lobe
- Lobar - lung lobe margin is visible
- General- involving all lung lobes
- Diffuse (involving 2 or more lobes)
- Symmetrical vs. Asymmetrical
- Cranial or caudal, dorsal or ventral
- Hilar, central, or peripheral
- Unilateral vs. Bilateral
Types of lung opacites:
Gas, fat/ fluid (check of a line), soft tissue, mineral, or metal
Homogenous (same) or heterogenous (different)
Nodules are described by:
Number- solitary, multiple, numerous
Nargination - well-difined or ill-defined
Shape- rounded or irregular
Opacity-soft tissue or mineral
Lung patterns are used to describe the pattern that is PREDOMINATELY affecting the lung AT THAT TIME!! The patterns are:
B.A.Ni.V.Ui.
Bronchial
alveolar
Nodular interstitial
vascularture
Unstructured interstitial
6 lung lobes
Bronchopulmonary segments
Right cranial
– Right middle
– Right caudal
– Accessory
– Left caudal
– Left cranial
• Cranial part
• Caudal part
What is the conducting zone and respiratory zone of the lung?
Bronchovascular bundle (conducting zone)
Pulmonary parenchyma (respiratory zone)
Pulmonary blood vessels
In the primary pulmonary alveolus what is the difference between an interstital patter and an alveolar pattern?
LungLobe
Bronchopulmonary segment
– Secondary pulmonary lobule
» Pulmonary acinus
Primary pulmonary lobuleAlveolus
Wall (interstitial pattern)
Space (alveolar pattern)
Where is the “imaging limit” in the lung lobe?
LungLobe
Bronchopulmonary segment
– Secondary pulmonary lobule
» Pulmonary acinus Imaging limit
Primary pulmonary lobuleAlveolus
Wall (interstitial pattern)
Space (alveolar pattern)
Which views do you use for cardiac vs. respiratory cases?
RLAT and DV Cardiac cases
LLAT and VD Respiratory cases
In small-animals, see lung lesions best in the “up” lung
Other lesions best when placed close to the detector
What are the Principles of Radiographic Interpretation?
Assuming proper
Examination
Positioning
Exposure
No superimposition of collar, wet hair, etc.
Breed conformation
Age related changes and body conformation
Pulmonary patterns are a combination of signs which are?
Degree of lung expansion–Reduced, normal, or increased
The opacity of the lung–Increased or decreased
Appearance of increased opacity–Alveolar, interstitial, bronchial, vascular
Macroscopic distribution of altered opacity–Cranioventral, diffuse, lobar, focal, etc
Additional signs
Incomplete lung expansion is often considered as only a technical complication, but can also be caused by?
Commonly due to normal exhalation
Can be a component of the disease process
Reduced or absent gas exchange
Clue to the underlying pathology
Obscure pathology
Spurious pathology–Cardiomegaly–Increased lung opacity
Some signs of incomplete lung expansion are?
Decreased lung size
Increased opacity Lobar sign Crowding of ribs
Air bronchogram sign Positive silhouette sign
Poorly defined margins of vessels Mediastinal shift (toward collapse)
Crowding and reorientation of pulmonary blood vessels
Compensatory hyperinflation
Bronchial rearrangement
Cardiac rotation
Displacement of diaphragm
Rounded pulmonary margins
Displacement of pleural fissures
Changed location of abnormal structures
What is the difference between anectasis vs. atelectasis vs. collapse?
Anectasis-Lungs never expanded
Atelectasis-Lungs previously expanded then collapsed
Collapse-Same as atelectasis, but often used when more severe
Less severity may be indicated by “partial collapse”
Atelectasis or Collapse is related to the physiology of lung expansion. What are those components?
Related to physiology of lung expansion
Elasticity
Compliance
Airway patency
Surface tension
What is Relaxation Atelectasis and what causes it?
Exhalation
Pleural fluid
100% oxygen
Pneumothorax
Shallow breathing
Gravity dependent
Space-occupying lesion
What is Obstructive Atelectasis and what can cause it?
Lung not expanded due to absorption of alveolar gas without replacement due to airway obstruction
Infectious bronchitis or pneumonia
Mucous plugging (eg, asthma)
Ciliary dyskinesia
Foreign body
Neoplasm
What is Cicatrizing Atelectasis and what causes it?
Lungs do not increase in volume under normal respiration due to reduced compliance
Chronic immune-mediated lung disease
Chronic idiopathic fibrosis
Radiation pneumonitis
Chronic pneumonia
What is Adhesive Atelectasis and what causes it?
Lungs do not expand due to lumen surfaces of alveoli sticking from surfactant abnormality
Neonatal respiratory distress syndrome
Acute respiratory distress syndrome
Pulmonary thrombosis
(Surfactants (surface active agents) are compounds that lower the surface tension between two liquids or between a liquid and solid. Surfactants may act as detergents, wetting agents, emulsifiers, foaming agents, and dispersants.)
What is Hypoxic Vasoconstriction and what causes it?
Pulmonary InflammationIncreased vasodilation
Perfusion to non-ventilated lung
V/Q mismatch
Zone 1: V>Q Hypotension Hyperexpanded alveoli
Zone 2: V=Q Normotensive Normally expanded
Zone 3: V<q></q>
V < Q
Decreased oxygen saturation
“Functional R-L shunt”
What is the goal of Ventilation and Perfusion and what is it effected by?
Goal is to match ventilation of air (V) with the perfusion of blood flow (Q) to the lung
Ventilation perfusion quotient (V/Q) is the amount of air that is breathed in and perfused into the blood
V/Q affected by-Gravity, Normal physiology, Disease
- Apex: V/Q = 3 (wasted ventilation); intraplerual pressure most negative
- Base: V/Q = 0.6 (wasted perfusion); intrapleural pressure least negative
- Both ventilation & perfusion are greater at the base of the lung than the apex
Appearance of Increased Lung Opacity are?
Classic description
Interstitial pattern
-Unstructured-Structured-Nodular-Reticular
Alveolar pattern- Alveolar
-Alveolointerstitial-Airspace
Bronchial pattern
Vascular pattern
Mixed pattern
Variable terminology Bronchial
- Bronchointerstitial
—Peribronchial
Vascular
- Bronchovascular
Lung Fields should look like?
Basically, lungs are evaluated for the presence of fluid and air**. Radiographically, air is black. A **normal lung field has a black background with soft tissue structures (vessels) passing through it. Lungs must be evaluated for an increase or decrease in the radiopacity of the parenchyma. These changes can be generalised or localised, diffuse or focal. The two sides of the thorax must be compared in a DV view; they should be of equal opacity. There are four lobes on the right - cranial, middle, caudal, and accessory. There are two left lung lobes - cranial and caudal. The left cranial lobe is further divided into cranial and caudal components.
If an animal is dyspnoeic, do not compromise respiration further by taking a VD view; instead take a DV.
What are the 3 areas of the lungs?
Explain the “directions” of the lungs (cranial, caudal, dorsal, ventral)
- Hilar- near the carina and includes the heart, origins of the major blood vessels and primary bronchi
- Central or (middle) which includes visiblepulmonary vessels and larger lobar bronchi
- Peripheral area at the lungs edges whre there is mostly air and vascular and bronchial markings fade.
Cranial= toward head
Caudal= toward diaphragm
Dorsal = above trachea
Ventral = below trachea
How many lung lobes in the dog and cat?
Six
Right: 4 lobes (cranial, middle, caudal, accessory)
Left: 2 lobes (cranial with cranial and caudal segments and caudal)
