THORACIC Section 12: Airways Flashcards
Describe the basic anatomy of the trachea
A bunch of anterior horseshoes of cartilage, with a posterior floppy membrane
The transverse diameter of the trachea should be no more than __ cm.
2.5 cm
Tracheal thickness
1-3 mm
Coronal diameter of less than two thirds the sagittal diamter
Saber-Sheath Trachea
I say “saber-sheath trachea, you say?
COPD
Three big questions to ask in tracheal diseases.
- Does it involve the posterior membrane?
- Is it focal or diffuse?
- Are there calcifications?
Tracheal/Bronchial diseases sparing the posterior membrane
- Relapsing Polychindritis
- Tracheobronchopathia Osteochondroplasia (TBO)
Tracheal/Bronchial diseases NOT sparing the posterior membrane
- Amyloid
- Post intubation
- Wegeners
TRACHEAL DISEASES
- Spares the posterior membrane.
- Diffuse anterior and lateral thickening of the trachea.
- NO calcifications.
- Recurrent Episodes of cartilage inflammation and recurrent pneumonia.
Relapsing Polychondritis
TRACHEAL DISEASES
- Circumferential thickening, which can be focal or long segment.
- NO calcifications
- Subglottic involvement is common
Wegener’s
- Spares the posterior membrane
- Development of cartilaginous and osseous nodules within teh submucosa of the tracheal bronchial walls
Tracheobronchopathia Osterochondroplastica (TBO)
Diagnosis?
Tracheobronchopathia Osterochondroplastica (TBO)
Spares the posterior membrane + cartilaginous and osseous nodules in the submucosa of teh tracheal bronchial walls
TRACHEAL DISEASE
- Irregular focal or short segment thickening,
- Can invovle the posterior membrane
- Calcifications
Amyloidosis
Most common location of Wegeners
Sub-glottic trachea
Recurrent episodes of cartilage inflammation.
Recurrent pneumonia is the most common cause of death
Relapsing Polychondritis
Pulmonary Neuroendocrine Tumors
> 3cm + Peripheral (distal to segmental bronchi) + Age ~60s + Smoking associated
Atypical Carcinoid
(Intermediate Malignant)
Pulmonary Neuorendocrine Tumors
< 3cm + Central (Tracheal bifurcation) + Calcifications in 30% + Age ~ 50s
Typical Carcinoid (Low-Grade Malignant)
Pulmonary Neuorendocrine Tumors
Peripheral Pulmonary mass - 3.5 cm
Large Cell Neuroendocrine Tumor (LNEC)
(Hight Grade Malignant)
Pulmonary Neuorendocrine Tumors
Large central/mediastinal mass involving the hilum
Small Cell Lung Cancer (SCLC)
Pulmonary Neuroendrocrine tumors in the Airway
Typical and Atypical Carcinoid
Bronchial carcinod prefered site of metastasis?
Uveal tract
GI carcinoid preferred site of metastasis?
Extra ocular muscles
2nd most common tracheal malignancy?
Adenoid cystic
Tracheal/Bronchial tumors causing obstructive symptoms and hemoptysis?
Carcinoid
Tracheal malignancy seen in the upper trachea, posterior lateral.
Adenoid
What is the most common tracheal malignancy?
Squamous Cell
Airway malignancy favoring the lower trachea/proximal bronchus
Squamous cell
Most common BENIGN tumor of teh trachea
Suamous Cell Papilloma
When it’s a single papilloma, think of?
Smoking
When it’s multipe papillomas, think of?
HPV
Most common cause of subglottic tracheal stenosis in adult?
Post intubation stenosis
Classic look of Subglottic stenosis
FOCAL subglottic circumferential stenosis.
HOURGLASS configuration
subglottic stenosis + No history of intubation =
A rare cast of adult croup (Acute laryngotracheobronchitis)
Sodium pump doesn’t work and they end up with thick secretions with poor pulmonary clearance.
Damage is done by RECURRENT INFECTIONS
Cystic fibrosis
Cystic Fibrosis pulmonary features?
Bronchiectasis + apical predominance + Hyperinflation + Pulmonary Arterial Hypertension (PAH)
+ Mucus plugging (finger in glove)
Abnormal Mucus, Cilia can’t move it
Cystic Fibrosis
Normal Mucus, Cilia don’t work
Primary Ciliary Dyskinesia
Normal sperm, absent vas deferens
Cystic fibrosis
Abnormal sperm, Normal vas deferens
Primary Ciliary dyskenesia
Chronic mastoid effusion and conducting hearing loss (little ear nerve hair things are fucked up too)
Primary Ciliary Dyskenesia
50% of primary ciliary dyskeneisa patients have this condistion
Kartagener’s Syndrome
Kartagener’s syndrome is a rare, autosomal recessive genetic ciliary disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis.
Upper lobe bronchiectasis
Cystic fibrosis
Congenital cystic bronchiectasis from a deficiency of cartilage in the 4th-6th order bronchi
WIlliams Campbell Syndrome
“That’s one big fucking trachea”
> 3cm dilatation
Mounier-Kuhn (Tracheobronchomegaly)
Inflammation of the small airways
Bronchiolitis
Air trapping in bronchiolitis obliterans is seen in the setting of a ?
lung transplant
Air trapping in small airway disease. Think of?
Asthma and bronchiolitis
Dilatation and impaction of the centrilobular airways
Tree in bud
Small Airway Disease
Tree in bud
Infectious brongiolitis
Small Airway Disease
Smokers + Centrilobular
ground glass nodules
(upper lobe predominant)
RB-ILD
Small Airway Disease
Inhaling dust / other misc
garbage. Centrilobular
Ground glass nodules
Sub-Acute
Hypersensitivity
Pneumonitis
Small Airway Disease
RA and Sjogrens.
Centrilobular ground glass
nodules. Likes lower lobes
Follicular Bronchiolitis
Small Airway Disease
Viral
Drugs
Transplant,
Inhalation
Air-Trapping.
DIPNECH
Constrictive
Bronchiolitis
Aspiration Petterns
Airspace opacity, if massive can look
like pulmonary edema
Aspiration of Gastric Acid
“Mendelson s Syndrome ”
Aspiration Petterns
“Fleeting Opacity”
that resolves in hours
Aspiration of water or
neutralized gastric
contents
Aspiration Petterns
Gives you a real pneumonia, can get
para-pneumonic effusion, empyema,
or even broncho-pleural fistula.
Aspiration of Germs
(often mouth bugs)
Aspiration Petterns
Lipoid Pneumonia. Low density
Aspiration of Oil
(often mineral oil)
