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Pathology > Week 5: Respiratory System Pathology Part 1 > Flashcards

Week 5: Respiratory System Pathology Part 1 Flashcards

1
Q

Normal CXR Radiographic Appearance

A
  • no rotation
  • scapulae are outside lung fields
  • full inspiration
  • sharp outlines of the heart and diaphragm are visualized
  • adequate density
  • visible lung markings
  • collimation to include apices to the costophrenic angles
  • prev CXR provide baseline
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2
Q

Cystic Fibrosis

A
  • also called mucoviscidosis
  • it is a hereditary disease caused by a defective gene, chromosome 7
  • characterized by secretions of excessively vicious mucous by all exocrine glands
  • the thick mucous secreted by mucous in trachea and bronchi blocks air passages and can cause areas of collapsed lung, recurring pulmonary infections (mucous traps pathogens) and cysts and abscesses
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3
Q

Cystic fibrosis Radiographic Appearance

A
  • generalized irregular thickening of linear makings throughout lungs
  • mucoid impactions (accumulated mucous) which appears as opaque on x-ray
  • hyperinflation
  • CT often determines progression and assess lung damage
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4
Q

IRDS - Hyaline Membrane Disease Radiographic Appearance

A
  • under-aeration
  • finely granular appearance of pulmonary parenchyma
  • air bronchogram develops (small airways dilate and show clearly against non-functioning/collapsed parts of the lungs)
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5
Q

IRDS - Hyaline Membrane Disease

A
  • idiopathic respiratory disease syndrome (IRDS)
  • most common breathing disorder in new borns, typically premature newborns
  • under-aeration, hypoxia and increasing respiratory distress after birth
  • produces atelectasis (collapsed or partially collapsed lung) because of lack of surfactant which caused the alveoli to close
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6
Q

Croup

A
  • Viral infections in young children that proceeds inflammatory obstructive swelling to the subglottic portion of trachea
  • breathing sounds like a harsh grating sound or a braking cough
  • as it progresses it causes inflammatory edema and spasm which may cause laryngeal obstruction
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7
Q

Croup Radiographic Appearance

A

AP soft tissue neck shows tapered narrowing of subglottic airway (hourglass shape = steeple sign) due to edematous swelling

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8
Q

Epiglottitis

A
  • acute infection of the epiglottis (often in children) which causes thickening of epiglottis tissue and surrounding pharyngeal structures
  • patient may present with signs of tripod position, drooling, stridor, dyspnea or tachypnea
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9
Q

Epiglottitis Radiographic Appearance

A
  • lateral soft tissue neck x-ray shows rounded thickening of the epiglottic shadow; approximate size of an adult thumb
  • can cause obstruction so prompt action needed
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10
Q

Pneumonia

A
  • acute infection/inflammation of the lung commonly caused by bacteria or viruses, sometimes because of aspiration
  • symptoms: fever, productive cough, chest pain, shortness of breath, fatigue and general malaise
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11
Q

Alveolar Pneumonia

A
  • inflammatory exudate (fluid made of protein) replaces air in the alveoli, inflammation spreads from one alveoli to another
  • may involve pulmonary segments or either lobe
  • also called air space pneumonia
  • generally caused by bacteria
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12
Q

Alveolar Pneumonia Radiographic Appearance

A
  • white radiopaque areas of exudate consolidation contained within a lobe (affected area appears white)
  • may see air bronchogram sign
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13
Q

Air Bronchogram Sign

A

bronchus are still getting air (showing dark on image) but a pathological process in the alveoli is causing something other than air to fill them up so they show lighter on image
 = air filled bronchial tree against airless lung parenchyma


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14
Q

Bronchopneumonia

A

inflammation originates in the bronchi or bronchial mucosa and spreads to the alveoli
- bronchial inflammation can cause airway obstruction leading to atelectasis with loss of lung volume
-often bacterial

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15
Q

Bronchopneumonia Radiographic Appearance

A
  • multiple small patches of consolidation throughout lung fields separated by normal tissue
  • atelectasis may been seen
  • air bronchogram sign usually absent
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16
Q

Interstitial Pneumonia

A
  • inflammation involving the walls and the lining of alveoli and alveoli peta (alveolar supporting structures or structures around alveoli)
  • often viral or mycoplasmal
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17
Q

Interstitial Pneumonia Radiographic Appearance

A
  • linear or reticular (resembles net) pattern throughout lungs from interstitial dispersal of disease
  • CT: honeycomb lung if severe
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18
Q

Aspiration Pneumonia

A

caused by aspiration of esophageal contents (in patients with swallowing issues) or gastric contents (general anesthetic, tracheostomy, coma, trauma)

19
Q

Aspiration Pneumonia Radiographic Appearance

A
  • multiple alveolar densities with wide and diffuse distribution
  • occurs often in posterior segments of upper and lower lobes, especially in bedridden patients
20
Q

Lung Abscess

A
  • necrotic areas of pulmonary parenchyma containing pus like material, it become encapsulated within fibrous walls
  • many potential causes
  • often occurs in right lung from aspiration
  • patients maybe have fever, cough, foul smelling sputum
  • infection can spread to other areas of the body including the brain
21
Q

Lung Abscess Radiographic Appearance

A
  • spherical density with dense center
  • hazy and poorly defined periphery
  • air fluid level if communicates with bronchial tree
22
Q

Tuberculosis

A
  • bacterial infection that primarily affects the lungs but can also affect other systems
  • it is spread by coughing (airborne transmission)
  • primary infection: inflammatory cells collect around bacilli and form a fibrous tubercle/small mass to prevent spread
  • create with antibiotics
  • primary TB may reactivate after healed which is called secondary TB with caseated (cheese like) necrotic areas
23
Q

Primary Tuberculosis Radiographic Appearance

A
  • primary TB often consolidates in the upper lobe of the lung
  • focal parenchyma lesions (well defined, dense)
  • enlarge hilum and mediastinal lymph nodes
  • pleural effusion (fluid) may be present
24
Q

Secondary Tuberculosis Radiographic Appearance

A
  • upper lobes, apices and posterior segments
  • hazy poorly marginated alveolar infiltrate radiating outward form hilum
25
Q

Miliary Tuberculosis

A
  • military: rash or condition resembling millet seeds (small seeds, so grainy appearance)
  • dissemination of the disease throughout the bloodstream
  • many fine, discrete nodules distributed uniformly
26
Q

Tuberculoma

A
  • sharply defined parenchymal nodule containing viable TB bacilli that can develop into primary or secondary TB
  • may caseate (necrotic cheesecake tissue)
  • may remain unchanged for long period of cause active disease
  • radiographic appearance: single or multiple nodules with caseation
27
Q

Respiratory Syncytial Virus
 (RSV)

A
  • affects mostly children, attacks the lower respiratory tract
  • causes necrosis of epithelium of bronchi and bronchioles, bronchiolitis (inflammation of bronchioles), bronchial obstruction from necrotic and edemic materials, bronchospasm and interstitial pneumonia
  • contact or droplet spread, wear PPE
28
Q

Respiratory Syncytial Virus
 (RSV) Radiographic Appearance

A
  • hyperinflation with diffuse increase interstitial markings
  • necrosis of respiratory epithelium appears as interstitial pneumonia if seen
  • atelectasis can be seen in severe cases
29
Q

Severe Acute Respiratory Syndrome
(SARS) (SARS-CoV Disease)

A
  • a viral upper and lower respiratory infection caused by coronavirus
  • symptoms: fever, headache, body aches, respiratory distress, dry cough and may develop pneumonia, hypoxemia
  • contact and droplet precautions
30
Q

Severe Acute Respiratory Syndrome
(SARS) (SARS-CoV Disease) Radiographic Appearance

A
  • focal infiltrates
  • advance to generalized patchy interstitial infiltrates and areas of consolidation (whiteness due to radiopacity)
31
Q

Chronic Obstructive Pulmonary Disease

A
  • includes several conditions of chronic obstruction of airways producing ineffective air exchange and makes breathing difficult
  • leading cause is cigarettes but can also be cause by infection, pollution, exposure to harmful substances (asbestos)
32
Q

Chronic bronchitis (COPD)

A

chronic cough with phlegm from airway inflammation

33
Q

Emphysema (COPD)

A

destruction of alveoli and obstruction of small airways

34
Q

Asthma (chronic) (COPD)

A

bronchiolar spasm with decreased airflow and sometimes obstruction of airway

35
Q

Bronchiectasis (COPD)

A
  • abnormal dilation of the bronchi = widening and hardening (less elasticity)
  • could be due to repeated damage/infections, COPD or comorbidity
36
Q

Acute Bronchitis

A
  • inflammation of the bronchi
  • walls of bronchi and bronchioles thicken, excessive mucous production which leads to obstruction of small airways
  • usually viral but could be bacterial or pollutant exposure
  • lasts about 1-2 weeks
  • radiographic appearance: typically normal images
37
Q

Chronic Bronchitis Radiographic Appearance

A
  • hyper inflations
  • fattened diaphragm
  • parallel tapered lines due to bronchial wall thickening and peri-bronchial inflammation (tram lines)
  • Increased broncho-vascular markings (dirty chest), especially in lower lungs
37
Q

Chronic Bronchitis

A
  • inflammation of the bronco that is recurring or longstanding (must have for months at a time and have for at least over 2 years for it to be chronic)
  • mucous glands become hyperplasticity (increase in number of cells) which can cause narrowing of airways and overinflation of mungs (emphysema)
37
Q

Emphysema

A
  • obstructive and destructive changes in small airways lead to a dramatic increase in volume of air in the lungs
  • from smoking, chronic bronchitis, air pollution, respiratory tract irritants
  • produces excess mucous which plugs airways which increases airway resistance
  • air becomes tapped in lungs, overinflation, alveolar distentions and rupture of alveolar walls because hard to exhale (due to bronchial narrowing)
38
Q

Emphysema Radiographic Appearance

A
  • extremely long lungs (low flattened diaphragm, hyper inflation) with a vertical heart
  • increase in retrosternal airspace size and lucency (barrel chest), increased thickness anterior ro posterior
  • may show dirty chest (increased broncho-vascular markings)
  • CT: destroyed alveoli transform into air filled spaces called bullae, devisions visible
39
Q

Asthma

A
  • very common disease in which the airways become narrowed due to allergens
  • extrinsic asthma: due to house dust, pollen, molds, animal dander, certain fabrics and various foods
  • intrinsic asthma: due to exercise, heat or cold exposure, and emotional upset
  • swelling of bronchial mucous membranes
  • excessive secretions of mucus
  • spasm of smooth muscle wall in the bronchus
  • leads to severe narrowing of the airway
  • breathing difficult, especially expiration = wheezing
  • may evolve into pneumonia
  • most effectively diagnosed clinically
40
Q

Asthma Radiographic Appearance

A
  • normal unless advanced
  • may show hyper lucency, hemidiaphragm flattening, and increase in retrosternal airspace
  • may show “dirty chest”
40
Q

Bronchiectasis

A
  • permanents abnormal dilation of the one or more are bronchi due to destruction of elastic and muscular parts of bronchial walls
  • like bronchitis but permanent
  • due to COPD, autoimmune disease, cystic fibrosis, HIV, or diabetes
  • hard to clear mucous, bacteria can grow in mucous and cause further problems
  • patients typically have chronic productive cough
41
Q

Bronchiectasis Radiographic Appearance

A
  • coarseness and loss of definition (blurring) of interstitial markings (from peri-bronchial fibrosis and retained secretions)
  • oval or circular cystic spaces due to lung destruction, up to 2 cm in diameter – may contain air/fluid levels = honeycomb pattern

Pathology (14 decks)

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