Pathologies of the respiratory system Flashcards
CATEGORIES of PATHOLOGY of respiration system
Pleural
Atelectasis
Obstructive Airways Disease
Consolidation
Lung Masses
Trauma
What does atelectasis mean?
Partial collapse or incomplete inflation of the lung.
Obstructive atelectasis due to tumour, FB or mucus plug
Can witness mediastinal shift
It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid.
What is the pleural?
Pleura is a thin layer of tissue that covers the lungs and also lines the interior wall of the chest cavity.
Between these two layers a serous fluid fills the space. About 10-20mls in the healthy person.
What is dyspnoea?
Shortness of breath — known medically as dyspnoea — is often described as an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation.
What is the parietal pleura?
Parietal pleura lines the inner aspect of the thoracic cavity and the mediastinum. It is thicker and more robust than the visceral pleura.
Its the pleura side that lines your chest.
What is Visceral Pleura?
Lines the surface of the lungs.
What is PNEUMOTHORAX?
We get a leak of air into the pleura cavity. So this causes the differences in pressure within your chest to be misaligned, leaving to air escaping your lung into that plural cavity, causing the lung to shrink and collapse.
Abnormal collection of air in the pleural space between the lung and the chest wall.
What are the symptoms of pneumothorax?
Symptoms = sudden onset of sharp, one-sided chest pain and SOB
If you were to listen to the chest with a stethoscope patient, you would hear decreased sounds of breath on the one side with a numerical set.
What is the difference between primary pneumothorax, secondary pneumothorax and haemothorax?
and Traumatic Pneumothorax
Primary pneumothorax = no lung disease
Secondary pneumothorax = lung disease
Haemothorax - collection of blood in the pleural space and may be caused by blunt or penetrating trauma.
Traumatic Pneumothorax- May be due to traumatic injury, e.g. Rib fracture
Could also be due to surgical intervention e.g.
Thoracotomy, Tracheostomy, Biopsy, NG Perforation
Pneumothorax is more common in who?
More typical men and more typical people who are ectomorphic. So people who are quite tall, slim.
Also quite more common people who have connected tissue disorders like Mart Max disease or Ella Danlos.
PNEUMOTHORAX CXR appearance
When viewing on a chest image, you will see a lack of lung markings to one side of the chest. This makes the lung look black
It can happen to both and this is known as a bilateral pneumothorax. This is rare and often happens during trauma.
They can also be very subtle.
PNEUMOTHORAX CXR appearance
When viewing on a chest image, you will see a lack of lung markings to one side of the chest. This makes the lung look black
It can happen to both and this is known as a bilateral pneumothorax. This is rare and often happens during trauma.
They can also be very subtle.
Pneumothorax on CT
You can see the Lung window to see all the markings clearly. In pneumothorax, there will be a lack of lung markings in an area and it will be black as there is air there.
Lateral Decubitus CXR technique
Patient Preparation
Remove all clothing waist up and put on a hospital gown
Remove any artefacts
Patient Positioning
Lie on the unaffected side for a pneumothorax x-ray (lie on affected side if looking for fluid, e.g. pleural effusion)
Extend arms above head to avoid any superimposition on lung fields
Same checks for rotation as with any chest x-ray
Can be achieved AP or PA
Position patient for 5 minutes prior to exposure to allow air to rise if present
Breathe in… Breathe out… Breathe in (Max Insp)
Place appropriate marker so we know which side is up!
Ensure you add Decubitus annotation when post-processing the image
What is TENSION PNEUMOTHORAX?
A complicated pneumothorax where air enters the pleural cavity but cannot escape due to the formation of a one-way valve at the rupture point. Pressure builds.
Pneumothorax is when air collects in between the parietal and viscera pleurae resulting in lung collapse. It can happen secondary to trauma (traumatic pneumothorax). When mediastinal shifts accompany it, it is called a tension pneumothorax
Tension pneumothorax CXR?
Mediastinal shift, diaphragm lowered. Its similar to normal pneumothorax but the heart shifts the opposite way due to the pressure. So rather the heart being in the middle like a normal chest x-ray its off to the side.
How to treat pneumothorax?
Treatment for a pneumothorax usually involves inserting a needle or chest tube between the ribs to remove the excess air. However, a small pneumothorax may heal on its own.
The drain can be seen on chest x-rays as radiopaque.
What is Pleural Effusion?
Excess fluid accumulation in the pleural cavity
Pressure of fluid can impair breathing
Can be due to a build up of different fluids
Exudate or Transudate
What are the common causes of Pleural effusion?
The most common causes of pleural effusion are congestive heart failure, cancer, pneumonia, and pulmonary embolism.
What does exudate mean?
Means to ooze
Increased permeability of the pleural capillaries or interference with drainage of the pleural space to the lymph nodes
Associated with pulmonary malignancy or lymphatic drainage interference
What does transudate mean?
Increased pressure within the pleural capillaries causing the pressure within the vessels to increase
Associated with heart failure, hypertension, ascites
Pleural effusion appearance on CXR?
small amount-Horizontal Fluid Level /
Blunted Costophrenic Angle, the fluid is white/radiopaque
Large amount- Meniscus Sign, large white lung
Pleural effusion appearance on ultrasound?
Liquid is black on ultrasound, so the area would be black
What is Haemothorax?
Haemothorax is a collection of blood in the space between the chest wall and the lung (pleural cavity) and can be life threatening if untreated.
On CXR it can look like pleural effusion so further imaging (CT) is needed for diagnosing.
Examples of OBSTRUCTIVE AIRWAYS DISEASE?
COPD
EMPHYSEMA
BRONCHIECTASIS
What is emphysema?
Mucus in bronchiole
Long term obstructive lung disease
Loss of airway support and inflammation
Gas exchange is either slowed or stopped due to very reduced movement of gases in the alveoli
Causes change to healthy lung anatomy
Destruction of lung tissue surrounding bronchioles
Capillary networks affected
Shortness of breath due to hyperinflation of the alveoli
Associated hypertension
What causes Emphysema?
Smoking
Risk increases with quantity and length of time
Scarring due to long term irritation and inflammation of the lungs
Rarely;
Fumes
Dust
Air pollution
Genetics
What does emphysema look like on CT?
It looks like almost large area/ or a large bubble called a bullae
EMPHYSEMA CXR appearance
Large overinflated lungs, heart appears long and thin, this happens because the alveoli dilate.
Surgical Emphysema (AKA Subcutaneous Emphysema or Tissue Emphysema), what does it look like on a CXR?
Lucent stripes across soft tissue (this is the air in the tissue)
Usually you can also see the cause e.g Chest drain
Subcutaneous Emphysema on CT appearance?
Black spots/strips/bubbles throughout the soft tissue, it can be on either side of the patient
What is Bronchiectasis? common symptoms?
Bronchiectasis is a long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.
The most common symptoms of bronchiectasis include: a persistent cough that usually brings up phlegm (sputum) shortness of breath. Sometimes the cause is unknown.
Abnormal widening of the airways – up to 4 x size
Increased mucus production
Causes of Bronchiectasis?
A childhood lung infection that damages the bronchi
Underlying immune system disorders
Allergic Bronchopulmonary Aspergillosis
Cystic Fibrosis
Idiopathic
