Pulmonary Vascular Conditions Flashcards
What is the major source of emboli?
deep vein in lower extremity
Where do infarcts from emboli M/C occur?
Lower lobes
What is the Westermark’s sign?
Focal peripheral lucency beyond the occluded vessel (in non-infarcted cases).
What is the named radiographic sign of the pulmonary hemorrhage seen in contact with pleural surfaces in the lower lobes?
What is the named radiographic sign of a resolving pulmonary hemorrhage?
Hampton’s hump
Melting sign
What is the Fleschner sign?
Increase diameter of pulmonary artery >16mm associated with acute pulmonary embolism that resolves.
What is knuckle sign?
Abrupt tapering of occluded vessel distally.
What is a tram track sign?
Appearance of contrast flowing around an embolus.
Which predisposing conditions are likely sources for septic emboli?
a) drug addiction
b) alcoholism
c) immunologic deficient
d) congenital heart disease (shunts)
What % of pulmonary infarcts from septic emboli cavitate?
50%
What is the triad associated with fat emoblism syndrome?
a) respiratory distress
b) mental disturbances
c) petechial skin rash
What the radiogaphic appearance of a pulmonary infarct from a fat emboli?
- initially normal
- MULTIFOCAL, scattered homogeneous opacities
- More diffuse
What are 2 causes of marrow embolism?
a) strong convulsions that dislodge fragments of hemopoietic tissue
b) fracture
What is a rare but fatal type of pulmonary embolism seen in pregnancy and describe what it is?
Amniotic fluid emboli
- flakes of fetal skin and mucin from fetal meconium enter the maternal circulation during pregnancy through tears in the uterine veins and reaches the lungs
What is the name for a neoplastic embolism that disseminates through the lymphatic vessels into the lungs?
lymphangitic carcinomatosa
Air in the artery is called what?
Arterial gas embolism (AGE)
What is the normal relationship of the pressure in arteries and veins in comparison to atmospheric pressure? How does this change with an air embolism?
Artery & vein pressure»_space; atmospheric pressure …. therefore, gas entering a vessel is not common
In order for a gas embolism to take place, this pressure must be reversed (typically in an injured blood vessel).
Which activity/sport is known to reverse the pressure gradient between arteries and atmospheric pressure?
Breath-holding while ascending from scuba diving –> forces lung air into pulmonary arteries.
Blood pressure must be higher than how many mmHg at rest to be considered as pulmonary arterial hypertension?
25mmHg (and > 30mmHg at exercise)
What are known radiological signs of pulmonary arterial hypertension?
a. Cardiac enlargement
b. Central pulmonary artery enlargement
c. Rapid tapering of distal vessels
What is a rule of thumb that can be used on CT to diagnose pulmonary arterial hypertension?
When the diameter of main pulmonary artery exceeds that of the ascending aorta.
What is Eisenmenger syndrome?
A left-to-right shunt that eventually turns into a right-to-left shunt.
What is one of the M/C cardiac causes of pulmonary hypertension?
Left-sided heart failure
What is the M/C lung condition to cause pulmonary hypertension?
COPD –> narrowing of pulmonary arteries (d/t low blood oxygen levels)
What are some lung disorders that can cause pulmonary hypertension?
- cystic fibrosis
- sarcoidosis
- Langerhans’ cell granulomatosis
- pulmonary fibrosis
- pulmonary embolism
- schistosomiasis
Which is M/C…precapillary or postcapillary hypertension?
Postcapillary
What is cor pulmonale?
Right ventricular hypertrophy (and subsequent failure) as a result of an underlying respiratory problem (eg. tissue damage, vasoconstriction etc.)
What is the “bat’s wing” or “butterfly” appearance on chest x-ray?
Perihilar shadowing from pulmonary edema.
What are the two broad categories for pulmonary edema?
Cardiogenic and non-cardiogenic
What are some causes for cardiogenic edema?
- Cardiac (congestive) heart failure
- Cardiomyopathy
- Coronary artery disease
- Mitral stenosis
- Renal failure
What are some causes for non-cardiogenic edema?
- smoke inhalation
- ARDS
- high altitude pulmonary edema
- head trauma
What are the radiographic differences between cardiogenic and non-cardiogenic pulmonary edema?
Cardiogenic
- central predominance
- air bronchograms rare
- pleural effusion
- increased cardiothoracic ratio
- peribronchial cuffing
- septal lines (eg. Kerley lines)
Non-cardiogenic
- central & peripheral pulmonary vascular pattern normal
- air bronchograms
- LITTLE peribronchial cuffing, pleural effusions, septal lines
