Miscellaneous Flashcards
Bronchogenic Cyst
Cyst located adjacent to the trachea- usually at the level of the carina.
- Develops due to lung and foregut development anomalies
- Found incidentally on CT usually with
— Near large airway (trachea, main carina)
— Homogenous
— Water HU (0-15)
Symptoms:
- Usually Asx
- Can result in airway compromise
- Issues with swallowing
- Can also become infected
Management:
- Resection
- Observation
Can be associated with other abnormalities
- Bronchopulmonary sequestration
Pericardial Cyst
Located in the Right Costophrenic angle (majority) others in the left CPA
- Can be cause of trauma however usually congenital
- Usually found incidentally as they are symptomatic.
- Can be found due to compression sx- dizziness, cough, syncope- can cause Right ventricular outflow tract obstruction
- DDX: Malignancy, teratoma, other cyst (thymic, bronchogenic)
—- Differentiate with CT
——- homogenous fluid <20 HU
——- Very rarely septations etc.
Tx: None- observation
EGPA Diagnostic Criteria
4/6 required:
- asthma
- Parasinus disease
- Eosinophilia > 10%
- pulmonary nodules- migratory
- biopsy proven eosinophils
- polyneuropathy/mono-neuropathy
Thoracic Endometrial Syndrome
Catamenial PTX
Catamenial hemothorax
Catmenial hemoptysis
Catmenial lung/pleural nodules
- At time of menses when you see symptoms. 24-48hours after starts
- Pleural based nodules/diaphragmatic implants can cause any of the above.
Favors right side
Diagnosis: with VATS - biopsy
Treatment: hormonal therapy
Causes of pulmonary granulomatous disease
Aspiration
Autoimmune
— crohns, PBC
Drugs
Environmental: pneumonicosis, beryillious, and HP
Infections: fungal/MAC
Sarcoid like reactions: sarcoid, neoplasm, immunodeficiencies
Granulomatous lymphocytic ILD
ILD seen in Immunodeficiencies
Charactertized by cough, dyspnea
HRCT: bronchiolitis, GGO, and LAD
Biopsy (to diagnose)
- Granulomas
- LIP
- Follicular bronchiolitis
Treatment:
- Steroids
- IVIG
- RTX/immunosuppression
Kartager Syndrome (PCD)
Impaired ciliary function
Genetic- lots. of polymorphisms however most common:
—- DNAH5
—- DNALI
SX:
- Situs inversus
- infertility
- sinus infections
- Otitis media
- Pneumonia
- bronchiectasis
Dx:
- Nasal Nitric oxide test
- Confirm with electronicrograph of cilia (nasal)
Management:
- mucociliary clearance - hypertonic saline
- monitor for pulmonary infections and function
Genetics for PAH
- BMPR2 (PAH)
—- variable penetrance - ALK Gene
—- HHT and PH - PVOD
—– EIF2AK4
Risk of Bronchial artery embolization
Transverse myelitis - due to missed target and getting the spinal artery
Chest pain
Dysphagia
bleeding - bronchial venous system circulation rather than pulmonary artery system
Monier kuhn
Presents in third decade of life
Dilation of the main airways - trachea, left right main stem
—- Trachea >3cm or larger than the vertebrate
- normal distal airways
Dilation due to loss of elastic fibers on the major airways and thinning of the smooth muscle
Causes impairment in airway clearance -> results in recurrent infections and bronchiectasis.
Can also result in airway diverticuli
Rare disease that can cause emphysema and bronchiectasis in non-smokers
Treatment: Airway clearance and antibiotics for infection
Alpha Antitrypsin
Can cause bronchiectasis and emphysema
Alpha anti trypsin level <57
if >80 unlikely to cause any disease
Amiodarone Induced Toxicity
Present with fevers (low grade), chills, weight loss, dyspnea in someone with amiodarone dose of 400mg/day and on it for 2months
MOA:
- Immunologic
- Cytotoxic
CT:
- Pneumonitis
- Nodules
- Pleural effusion
Bronch:
- lipid laden Foamy Macrophages (if not present likely not amiodarone toxicity)
Treatment:
- Stop amiodarone
- Steroids for 4-12 months (long taper because long half life of amiodarone)
Dabigatran
- MOA
- Reversal agent
- clearance
Thrombin inhibitor
Reversal Agent: Idarucizumab
Clearance: Kidneys - excreted unchanged. Therefore have to consider renal function in Actions
Risk for post intubation stridor
traumatic intubation
intubation >6days
large tube
female
reintubation after self extubation
If fail cuff leak test- given 20mg steroids and extubate within 4 hours. No need to recheck
cuff leak tes- not neccessary but does reduce rates of reintubation, post ext ubation stridor but will delay extubation
Nintedadib MOA
Potent inhibitor of PDGF, FGF, and VEGF
