Respiratory Flashcards
What is a pulmonary embolus?
A blockage in the pulmonary arterial system
Usually associated with a deep vein thrombosis (DVT) develops in the deep veins of the lower limb
Can be caused by fat, air, tumour tissue
PE/DVT risk factors
Above 50
Prolonged immobilisation
Pregnancy
Malignancy
Genetic predisposition
Large clots
Treatment for DVT and PE
Blood thinning drugs - intravenous heparin followed by oral warfarin
How does a PE present on a CXR?
Cannot make out costophrenic angle - area appears opaque/white
PE not usually seen on CXR - but small pleural effusion may be seen
PE - incidence, prevalence, epidemiological, aetiology, clinical features
incidence - 50,000 in UK in year 2013/14
prevalence - M=F
epidemiological - increases with age, 30% greater in male
aetiology - Virchow a triad - venous stasis, vessel wall damage, hypercoagulability
clinical features - chest pain, dyspnoea, tachypnoea
Why would a CT be needed after PE is ruled out on CXR?
High D-dimer score
What is a VQ scan?
Ventilation-perfusion scan is a nuclear medicine scan that uses radioactive material to examine airflow and blood flow in the lungs
What is d-dimer?
D dimer is a fibrin degradation found in blood after blood clot is degraded
What is a pneumothorax?
Collapsed lung - air escapes lung
Air fills space outside of lung between lung and chest wall creating pressure and lung cannot expand as much
What are the two types of Pneumothorax?
 spontaneous
Tension
What can have an affect on the symptoms of a Pneumothorax?
Size of the air leak at the speed of which occurs
How can a severe pneumothorax be diagnosed compared to a milder case?
A severe pneumothorax may be diagnosed through a physical exam
In a milder case must be diagnosed through a CT
What can cause a spontaneous pneumothorax thorax?
Rupture of subpleural bleb
COPD
Cystic fibrosis
Lung cancer/mets
Oesophageal cancer
Pneumonia
Long abscess

What can cause a Tension pneumothorax?
Central venous access
Lung biopsy
Post laparoscopy
Blunt trauma/rib fracture
Artificial ventilation
Why wouldn’t pneumothorax be classed as a tension pneumothorax?
The area of damage tissue creates a one-way valve leading to a severe oxygen shortage and a low BP, progressing to cardiac arrest unless treated
What typically occurs when there is a small spontaneous Pneumothorax?
Small pneumothorax is typically resolved by themselves especially in those with no underlying lung disease
How can a larger pneumothorax or pneumothorax is with severe symptoms be treated?
The air may be aspirated with a syringe or a one-way chest drain is inserted to allow the air to escape
What method of treatment may be used as treatment if there is a significant risk of repeated episodes of pneumothorax?
Pluerodesis Which is sticking the lung along the Chest wall
Surgical measure
What is a lobar collapse?
The collapse of an entire lobe of the lung
What is lobar collapse - how does it happen?
Occurs due to proximal occlusion of a bronchus causing a loss of aeration (loss of supply of air)
The remaining air is gradually absorbed and the one loses its volume
What are risk factors/ causes of lobar collapse?
Bronchogenic CA - bronchus (adult, smokers)
In young adult or older child - asthma - mucus plugging of the major airways
If an infant inhaled in foreign body such as a peanut
Retention of secretions is a frequent cause of postop collapse
In ventilated patients including neonates collapse when the ET tube is inserted too far entering one main Bronchos
What is a radiological signs of lobar collapse?
Can include:
Tracheal displacement towards the side of collapse
mediastinal shift towards the side of collapse
elevation of the hemidiaphragm
reduced vessel count on the side of the collapse
herniation of the opposite lung across the midline
A hillar mass, which also suggests carcinoma as the cause
other evidence of malignant disease (example rib metastasis, lymphangitis, effusion)
The presence of a foreign body; however these are very easy to see the presence of
ET tube is it cited to low?
What is consolidation?
What pathologies consolidation a common sign of?
Clinical term for solidification into form dense mass
Consolidation is a common sign in pneumonia
What is another example of consolidation?
Alveolar spaces become filled with fluid
This fluid can be pulmonary oedema inflammatory exudate, puss, inhaled water or blood
What is pneumonia?
It’s an inflammatory condition of the lung
What is the cause of pneumonia?
Usually caused by infection with viruses or bacteria
What are the symptoms of pneumonia?
Cough shortness of breath chest pain pyrexia and hypoxic
pneumonia incidence, and risk factors
Affects 7% of the world population
It’s a leading cause of death in developing countries elderly very young and chronically ill
How does pneumonia progress?
(Radiological appearances)
As pneumonia progresses more of the Longfield will appear patchy white
I.E consolidation will be more widespread
Maybe appearance of air bronchogram
Volume of lung may appear increased
What is an air bronchogram?
Air bronchograms is a characteristic sign of consolidation
The black lines represent Patent Aryways
What is COPD an umbrella term for?
People with bronchitis, emphysema or both
What does COPD stand for?
Chronic obstructive pulmonary disease
What is bronchitis?
Bronchitis is inflammation of the bronchi
What is emphysema?
Emphysema is damage to the smaller airways and alveoli
what is the main issue of COPD?
Obstructed airflow
What is the most common cause of COPD and how?
Smoking - Smoking causes invitation and scarring thickening of the airways and increasing mucous production
What are the symptoms of COPD?
Cough, breathlessness and frequent chest infections
What is the treatment for COPD?
Stop smoking
Steroids
Antibiotics
Oxygen
Mucolytic (mucous-thinning) medication
Inhalers can be used to ease symptoms
What age group does COPD affect?
Over 35-years-old
Radiological Appearances of COPD?
Hyperexpanded (hyperinflated) lungs
Course lungs (bronchovascular) markings

(COPD) What imaging modality is the best to help categorise the extent of the disease?
High-resolution CT scanning (HRCT)
Why is only supportive treatment offered? For loss of lung
As once lung is lost no regrowth can occur
What is a plural effusion?
An abnormal accumulation of fluid in the pleural space
What what can be a result of a pleural effusion at an excessive amount?
Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation
What are the causes of Plural effusions?
 heart failure
Infection
Malignancy
Infarction
Trauma/surgery
Clinical signs of Plural effusions
 clinical signs occur once her is over 300 mls of accumulated fluid
Shortness of breath
Chest pain
Cough
Fever (Pyrexia)
What are the radiological appearances of Plural effusion?
Fluid accumulation > blunting of cardio phrenic angle
Generalised homogeneous opacity and diffuse haziness as the fluid forms layers posteriorly (ground glass)
Visibility of pulmonary vessels through the haziness
Absence of air bronchogram
What happens on the image if the patient is lying supine When they have a pleural effusion?
The fluid runs along the back of the lung causing an overall white appearance of opacification
What is pulmonary tuberculosis (TB)?
Contagious bacterial infection that involves the lungs but may spread to other organs
What is the cause of TB?
The bacteria Myobacterium tuberculosis (M.TB)
Spread by breathing in air droplets from a cough or sneeze of an infected person
How does TB Recover/react?
Most people will recover from primary TB infection without further evidence of the disease
Infection may remain dormant for years and some people it can reactivate
Who is at the highest risk for active TB?
Elderly/infants
People with weakened immune systems
E.G aids chemotherapy diabetes Or certain medications
The risks of the patient contracting TB increases if the individual does what?
Is in frequent contact with people who have TB
Has poor nutrition
Lives in crowded or unsanitary conditions
What are the radiological appearances of active TB?
infiltrates or consolidations and/or cavities are often seen in the apices
lesions are seen everywhere in the lungs
How is old healed TB presented - XRAYS
presents as pulmonary nodules in the hilar area or upper lobes, with or without fibrotic scars and volume loss
What is Miliary TB?
A form of TB characterised by tiny lesions (1–5mm) throughout the lung fields
Its name comes from a distinctive pattern seen on x-ray of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term “miliary” TB
What organs can TB infect?
May infect any number of organs, including the lungs, liver, and spleen
A complication of 1–3% of all TB cases
what in lung cancer and what may it lead to?
Lung cancer = uncontrolled cell growth in tissues of the lung
Most derived from epithelial cells
Growth may lead to invasion of adjacent tissues/infiltration beyond the lungs = metastasis
What are the symptoms of lung cancer?
Symptoms include:
SOB
Coughing
Haemoptysis
Weight loss
Chest x-ray will show suspicious lesion(s)
What is the most common cause of lung cancer?
Cigarette smoking is the most common cause
what is the lung cancers most deadly/common age group?
Most common cause of cancer-related death in men and women; peak age 40-70 years
what are common primary tumours for the lung mets?
Common primary tumours: breast, renal tract, testis, GI tract, thyroid and bone
what is a common route tumours take to metastasise to the lungs?
Usually by haematogenous route
Radiological appearances of metastatic lung cancer?
Multiple small rounded radio-opaque lesions in both lung fields
Name different medical lines found in the lung field:
Endotracheal Tube (ET) - Airway
Nasogastric tube (NGT) – Feeding
Central Venous Line – This is can be placed via the internal jugular, subclavian or femoral veins. Used for monitoring, administering drugs, nutrients, and fluids
Swan-Ganz Catheter – Placed via the right heart into the pulmonary artery to take capillary wedge pressure. Assesses heart function, temperature and can be used to administer fluids and drugs
Chest Drain - Treatment of pneumothoraces and effusions
Pacemaker – can have 1 or 2 leads
