Respiratory Flashcards
Define asbestosis.
Long-term inflammation and scarring of the lungs caused by inhalation of asbestos fibres.
Define mesothelioma.
Aggressive tumour of mesothelial cells that usually occurs in the pleura (90%), and sometimes in peritoneum, pericardium or testes.
What are the presenting symptoms of asbestosis?
o Progressive dyspnoea
What are the presenting symptoms of mesothelioma?
o Most common symptoms = SOB, Chest pain (dull, diffuse, developing), Weight loss
o Fatigue
o Fever
o Night sweats
o Bone pain
o Abdominal pain
o Sometimes Bloody sputum – if tumour invades blood vessel
What are the clinical signs of mesothelioma on examination?
o Occasional palpable chest wall mass
o Finger clubbing - due to underlying asbestosis (pulmonary fibrosis)
o Recurrent pleural effusions
o Signs of metastases = Lymphadenopathy, Hepatomegaly, Bone tenderness
o Abdominal pain/obstruction (peritoneal malignant mesothelioma)
o Pneumothorax - rare
What are the appropriate investigations for asbestosis?
o Mainly off history and exam
o CXR = Reticular-nodular shadowing +/- pleural plaques
What are the appropriate investigations for mesothelioma?
o CXR/CT = Pleural thickening/effusion, Bloody pleural fluid, May show pleural mass and rib destruction
o MRI and PET
o Pleural fluid cytology
o Pleural biopsy = Diagnosis is made on histology, usually following a thoracoscopy (pleural biopsy) - often done post-mortem -> Biopsy of the tumour can be immunostained with a stain that reacts with calretinin
What are the clinical signs of abestosis on examination?
o Clubbing
o Fine end-inspiratory crackles
Define aspergillus lung disease.
Lung disease associated with Aspergillus fungal infection.
o 5 different ways this group of fungi can affect the lungs:
- Asthma = Type I hypersensitivity (atopic) reaction to fungal spores
- Allergic bronchopulmonary aspergillosis (ABPA) = Type I and Type III hypersensitivity reactions to Aspergillus fumigatus
- Aspergilloma = Fungus ball within a pre-existing cavity (often caused by TB or sarcoidosis)
- Invasive aspergillosis
- Extrinsic allergic alveolitis (EAA) = Sensitivity to Aspergillus clavatus (‘malt worker’s lungs’)
What are the presenting symptoms of aspergillus lung disease?
o Aspergilloma = Mostly asymptomatic - can cause cough, haemoptysis (potentially massive), lethargy, weight loss
o ABPA = Difficult to control asthma, Recurrent episodes of pneumonia with wheeze, cough, sputum, dyspnoea, fever and malaise
o Invasive Aspergillosis = Dyspnoea, Rapid deterioration, Septic picture
What are the clinical signs of aspergillus lung disease on examination?
o Tracheal deviation with very large aspergillomas
o Dullness in affected lung
o Reduced breath sounds
o Wheeze (in ABPA)
o Cyanosis (possible in invasive aspergillosis)
What are the appropriate investigations for aspergillus lung disease?
o Aspergilloma
- CXR = May show a round mass with a crescent of air around it, usually found in the upper lobes - CT or MRI if CXR is unclear
- Strongly positive serum precipitins
- Aspergillus skin test = positive in 30%
o ABPA
- Immediate skin test reactivity to Aspergillus antigens
- Aspergillus-specific IgE radioallergosorbent test
- Bloods = Eosinophilia, Raised total serum IgE, Raised specific serum IgE and IgG to A. fumigatus
o Sputum Culture
- CXR = Transient patchy shadows, Segmental collapse or consolidation, Distended mucous-filled bronchi, Signs of complications (fibrosis in upper lobes or bronchiectasis)
- CT = Lung infiltrates, Central bronchiectasis
- Lung Function Tests = Reversible airflow limitation, Reduced lung volumes/gas transfer
o Invasive Aspergillosis
- Cultures from bronchoalveolar lavage/sputumand Histological examination
- CT = Nodules surrounded by a ground-glass appearance (halo sign) due to haemorrhage into the tissue surrounding the fungal invasion
Define bronchiectasis.
Lung airway disease characterised by chronic bronchial dilation as well as impaired mucociliary clearance and frequent bacterial infections.
What are the risk factors/causes of bronchiectasis?
o Idiopathic (50%)
o Congenital = CF, Young’s syndrome, Primary ciliary dyskinesia, Kartagener’s syndrome, Alpha-1 antitrypsin deficiency
o Post-infection - e.g. pneumonia, whooping cough, TB, measles, pertussis, bronchiolitis
o Host immunodeficiency = Hypogammaglobulinaemia, HIV
o Obstruction of bronchi - e.g. foreign body, tumour, enlarged lymph nodes
o GORD
o Inflammatory disorders - e.g. rheumatoid arthritis, UC
o Allergic bronchopulmonary aspergillosis (ABPA)
- Presents in childhood
What are the presenting symptoms of bronchiectasis?
o Persistent cough with copious purulent sputum - worsened by lying flat
o Intermittent haemoptysis
o Breathlessness
o Chest pain
o Malaise
o Fever - especially if recurrent episodes
o Weight loss
o Symptoms usually begin after an acute respiratory illness
o All symptoms worsen during acute exacerbations
What are the appropriate investigations for bronchiectasis?
o Sputum = Culture and sensitivity
o CXR = Dilated bronchi, Fibrosis, Atelectasis, Pneumonic consolidations - can be normal
o High-Resolution CT = Gold Standard - Helps assess extent and distribution of disease, Shows dilated bronchi with thickened walls
o Bronchography - rarely used
o Spirometry usually shows obstructive image = should assess reversibility
o Others = Sweat electrolytes (for cystic fibrosis), Serum Ig, Mucociliary clearance study, Aspergillus precipitins or skin-prick test
