Week 219 - Haemoptysis 2 (pulmonary circulation) Flashcards
Week 219
Define “Bronchopulmonary Segment”
This refers to one of ten segments in the right lung, and eight segments in the left lung. Each segment is a discrete anatomical and functional unit separated from the others by a layer of connective tissue.
- “The Right Honourable 3’s stuck 2 middle fingers up to the 5 insiders.”*
- “The left is fair, 4 up, 4 down”*
Week 219
Which arteries supply the lung parenchyma?
The Lung Parenchyma is supplied by the Bronchial arteries.
Week 219
Bronchial arteries drain into either ___ or _____.
Bronchial arteries drain into either bronchial or pulmonary veins. Thrombosis in these vessels can be associated with massive haemoptysis.
Week 219
Which branch of the major arterial vessels supplies the right lung?
One artery arising from the third right posterior intercostal artery, a branch of the aorta.
Week 219
Which branches of the major arterial vessels supplies the left lung?
Two Arteries
- Superior arises from antero-medial surface of the aortic arch just lateral to the carina and posterior to the left main bronchus.
- Inferior arises from aorta parallel to its superior counterpart, but at a point that is inferior to the left main bronchus.
Week 219
From where does the pulmonary trunk arise?
The right ventricle.
Week 219
The pulmonary circulation differs from the systemic circulation in which way?
Arteries - carry deoxygenated blood
Veins - Carry oxygenated blood.
Week 219
Label the image. Which lung is this?
This is the hilum of the left lung.
- A PULMONARY ARTERY
- B BRONCHIAL ARTERIES
- C PRIMARY BRONCHUS
- D SUPERIOR AND INFERIOR LOBAR BRONCHI
- E BRONCHOPULMONARY LYMPH NODES
- F SUPERIOR AND INFERIOR PULMONARY VEINS
Week 219
Label the image. Which lung is this?
This is the Hilum of the right lung.
- A SUPERIOR LOBAR BRONCHUS
- B PULMONARY ARTERY
- C BRONCHUS INTERMEDIUS
- D BRONCHIAL ARTERIES
- E BRONCHOPULMONARY LYMPH NODES
- F SUPERIOR AND INFERIOR PULMONARY VEINS
Week 219
What is the Ligamentum arteriosum?
This is a tiny ligament, that connects the arch of the aorta to the left pulmonary artery. Good in spotters.
Week 219
Which nerve hooks around the ligamentum arteriosum?
The Recurrent laryngeal nerve.
Week 219
The Ligamentum arteriosum represents the remnant of which foetal structure?
The foetal ductus arteriosus. A Patent ductus arteriosus (PDA) represents 5-10% of all congenital cardiac abnormalities.
Week 219
What are the main differences between venous and arterial blood gas results?
- SAO2 and PO2Is higher in arterial.
- CO2 levels are a little higher in venous blood.
- Other results are pretty much the same.
Week 219
What is Virchow’s triad?
Thrombosis may follow an alteration in:
- Blood flow
- Blood constituents
- Endothelium (due to injury)
Week 219
Peripheral venous emboli in the lung are what shape?
Wedge shaped.
Week 219
What are the sources of **venous emoblism, **and which two major pathologies could they cause?
Pulmonary Embolism:
- **DVT ** in leg, pelvic veins or prostatic venous plexus.
Stroke Risk:
- **Paradoxical emboli **cross from right heart to left through shunts, e.g. Atrial Septal Defect, Ventricular Septal Defect, Patent Foramen Ovale.
Week 219
Which three coagulopathies are the most common causes of thrombophilic pulmonary thrombo-embolism (PE)?
- Factor V Leiden
- Prothrombin mutation
- Deficiencies of protein S and C, and antithrombin III
Week 219
What are the signs and symptoms of Deep vein thrombosis?
- Increased swelling one or both legs
- Pain and tenderness
- Increased skin temperature and erythema
- Dilated superficial veins
- _But may be silent and inconspicuous _
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What are the differential diagnoses for a Deep Vein Thrombosis (DVT)?
Differential diagnoses include:
- Superficial thrombophlebitis
- Haematoma due to trauma or torn muscle
- Cellulitis
- Ruptured Baker’s cyst
- Dependent oedema (cardiac failure, nephrotic syndrome, liver cirrhosis, lymphatic obstruction)
Week 219
What is this?
This is a Bakers Cyst.
Week 219
What is this?
This is Cellulitis.
Week 219
What are the risk factors for Deep Vein Thrombosis?
- Prolonged immobilisation
- Myocardial infarction and heart failure
- Tissue damage in surgery, burns, fractures
- Cancer esp pancreas
- Nephrotic syndrome
- Oral contraceptives
- Smoking
- Genetic factors
Week 219
Other than a thromboembolism, what (other) types of venous embolisation are there?
- Fat embolism: in fractures. May cause rash, confusion, neurological signs, thrombocytopaenia, anaemia
- Gas embolism from rapid ascent from scuba dives (either air or nitrogen) or knife injuries to head and neck
- Amniotic fluid embolism: 1 in 50,000 deliveries
- Tumour embolism: usually seen in lung.
- Schistosomiasis; worms in pelvic veins and portal veins release eggs which are carried to the liver causing granulomatous scars resulting in portal hypertension
Week 219
What does this image show? Label it.
This is a (Tumour) Pulmonary Embolus.
- A Wall of pulmonary artery
- B Tumour Embolus
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What is this? What does the arrow point to?
This is an embolism caused by the egg of a Schistoma worm.
The arrow is pointing to a Schistoma ova (egg).
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What is this?
This is a fat embolism.
Week 219
Name Six (6) sources of arterial emboli.
Week 219
What are the four major causes of atheromatous plaques?
- Hypertension
- Hyperlipidaemia
- Cigarette smoking
- Diabetes mellitus
Week 219
What are the effect of altered flow on the development of atheromatous plaques?
Week 219
What is Polycythaemia rubra vera?
An increase in all cell types. Can lead to thrombosis.
Week 219
Name some causes of secondary polycythaemia.
- Altitude
- COPD
- Cardiac shunts
Week 219
There are five physiological outcomes of thrombosis - what are they?
- Resolution: thrombus may be dissolved by endogenous fibrinolytic proteins or administration of Streptokinase
- Organisation: macrophages remove fibrin clot which is replaced by fibrous scar tissue
- Recanalisation: new channels may form within the organising thrombus
- Embolism: detachment from wall. The fragment/s float away until they lodge in a smaller vessel
- Propagation: extension of thrombus along the vessel as seen in DVT
What does this image show?
This is a recanalised thrombus.
Week 219
What is this?
Right pleural effusion
Week 219
What is this?
Left pneumothorax
Week 219
What is the best Investigation for suspected pulmonary embolism?
CTPA- best test generally. High sensitivity and specificity. Detects other pathology
Week 219
What are the arrows pointing to?
What type of imaging is this?
The arrows are pointing to Pulmonary Emboli. The imaging technique is CTPA.
Week 219
A Patient collapses with sudden chest pain. This is their CTPA. What can you see?
There are emboli here. This patient is having a P.E.
What can you see?
A Normal CXR!
What can you see?
PE
Week 219
What can you see?
PE