Comprehensive Radiographic Pathology: Chapter 3: Respiratory System Flashcards

Primary function of the respiratory system is the intake of oxygen and the removal of carbon dioxide from the blood.

-nasopharynx

-oropharynx

-larynx

provide structure for the passage of air into the lower respiratory system

-trachea -bronchi -bronchioles

composed of tubular structures responsible for conducting air from the upper respiratory structures

Alveoli are the smallest functional unit of the respiratory system where the actual gas exchange occurs.

the inner layer of pleura that surrounds each lung

outer layer of pleura lying closer to the ribs and chest wall

• Endotracheal tube • Central venous catheter • Swan-Ganz catheter • Transvenous cardiac pacemaker

A tube that serves as an artificial airway and is inserted through the patient's mouth or nose. It passes through the throat and into the air passages to help breathe. To do this it must pass through the patient's vocal cords. The patient will be unable to speak as long as the ETT is in place. The ventilator connects to this tube. A hollow tube, approximately 10 inches long, with an inflatable cuff near one end that is inserted and positioned in the trachea. After the tube has been positioned, the cuff is inflated to maintain the tube's position so the patient can breathe through the tube

A tube positioned too low usually extends into the right main stem bronchus, where it eventually leads to atelectasis of the left lung.

A tube positioned too high or in the esophagus causes the inspired air to enter the stomach, causing severe gastric dilation and a high likelihood of regurgitation of gastric contents and aspiration pneumonia.

tip of tube 5 to 7 cm above the carina

a blood-vessel access device usually inserted into the subclavian or jugular vein with the distal tip resting in the superior vena cava just above the right atrium; used for long-term intravenous therapy or parenteral nutrition

tip of the catheter should be in the superior vena cava

internal jugular vein placement right atrium- possible arrhythmias or perforation pneumothorax with placement infusion of fluid into mediastinum or pleural space

soft, flexible catheter that is inserted through a vein into pulmonary artery. used to provide continuous measurements of pulmonary artery pressure. can exercise with device but patient should avoid activities that increase pressure on injection site

right or left main pulmonary artery seen radiographic lie within the borders of the mediastinum

pulmonary infarction

cardiac pacemaker using a pacing electrode or wire passed through a vein into the chambers of the heart that stimulates and maintains a normal heart rate; may be permanent or temporary

Overexposed to demonstrate the tip of the electrode at the apex of the right ventricle

coronary sinus placement-needs a lateral chest image to distinguish perforation at the initial intersection

a catheter used for long-term intravenous access and inserted in the basilic or cephalic vein just above or below the antecubital space with the tip of the catheter resting in the superior vena cava use for home therapy in patients undergoing chemotherapy

Cystic fibrosis is characterized by the secretion of excessively viscous mucus by all the exocrine glands; it also affects the pancreas and digestive system.

It is caused by a defective gene in the middle of chromosome 7.

respiratory involvement

bronchi

irregular thickening of linear marking throughout the lung

hyperinflation

CT demonstrates structural damage and disease progression

• prophylactic antibiotics
• chest Physiotherapy
• bronchodilators

Hyaline membrane disease is also known as idiopathic respiratory
distress syndrome (IRDS).

Hyaline membrane disease is one of the most common causes of respiratory distress in the newborn, primarily premature.

It is caused by a lack of surfactant in immature lungs.

Alveoli

Minute granular densities in the parenchyma

air bronchogram

artificial surfactant admitted to the lungs via a saline solution

positive-pressure ventilation

Croup is primarily a viral infection of young children that produces
inflammatory obstructive swelling localized to the subglottic portion
of the trachea.

It is characterized by a barking cough.

subglottic trachea larynx

smooth, tapered narrowing

Steeple sign

Staind, mist tent, 02

Epiglottis infections cause thickening of the epiglottic tissue and the surrounding pharyngeal structures. Epiglottitis is most commonly caused by Haemophilus influenzae in children.

Incidence has decreased due to routine childhood immunization.

supraglottic area or supraglottis

rounded thickening epiglottic tissue

ER - intubation

antibiotics for the infection

• Pneumonia
• Anthrax
• Lung Abscess
• Tuberculosis
• Pulmonary Mycosis
• Respiratory Syncytial Virus (RSV)
• Severe Acute Respiratory Syndrome (SARS)

Pneumonia is an inflammation of the lung that can be caused by a
variety of organisms, most commonly bacteria and viruses.

• Alveolar, or air-space, pneumonia
• Bronchopneumonia
• Interstitial pneumonia

Inflammatory exudate that replaces air in the alveoli, so that the affected part of the lung is no longer air containing but rather appears solid.

Lobar/segment

Lobe / segment opacification

antibiotic

Typified by staphylococcal infection is primarily an inflammation that originates
in the bronchi. Produces small patches on consolidation.

bronchial Airway / alveoli

patchy opacification with air bronchogram

antibiotic

Most commonly produced by viral and mycoplasmal infections. The inflammatory process mostly involves the walls and lining of the alveoli.

alveoli / interstitium

demonstrated on a CT as cyst-like spaces and dense fiber-optic walls

linear or reticular pattern

antibiotic

Anthrax is caused by Bacillus anthracis.
• It can survive for decades in the soil without a host.

throughout both lungs

mediastinal widening with associated pleural effusions without infiltrates

It is easily transmitted and highly fatal.

• Cutaneous, through an opening in the skin – most common type
• Inhalation (lungs) – usually fatal without prompt treatment
• Gastrointestinal – caused by ingestion of contaminated meat

high-dose antibiotics and vaccination

Lung abscess is a necrotic area of pulmonary parenchyma containing
purulent (puslike) material.

most common in right lung

Aspiration is the most common cause.

It also may be a complication of pneumonia, bronchial obstruction, a foreign
body, or the hematogenous spread of organisms to the lungs either in a
patient with diffuse bacteremia or as a result of septic emboli.

encapsulated opaque Mass with air-fluid level

appropriate antibiotic for specific organism, aid in expectoration of purulent material

Tuberculosis is caused by Mycobacterium tuberculosis.

It is a rod-shaped bacterium with a protective waxy coat – permits it to live
outside the body for a long time.

droplet

consolidation is homogeneous dents and well-defined

hilar enlargement without parenchymal involvement

demonstrates ghon lesion

pleural effusion

lobar or segmental

hilar and midiastinal lymph nodes

parenchymal, hilar, and mediastinal nodes

pleural cavity

throughout the lungs, and possible spread to other organs

innumerable find discrete nodules uniformly throughout the lung

parenchymal and nodal

necrotic cavities in large abscess

upper lobes and posterior segment

extensive fibrotic exchanges with possible calcification

any part of lung commonly in periphery and upper lobes

single or multiple nodules, 1-3 cm

for all Active cases of tuberculosis treatment is a two drug regimen for 2 months or longer(isoniazid, rifampin, and pyrazinamide)

Pulmonary mycosis is a fungal infection of the lung.

• Histoplasmosis
• Coccidioidomycosis

lower lung

hilar lymph nodes

pulmonary infiltration

granulomatous nodule

hilar lymph node enlargement and/or calcification

upper lobe

zones of parenchymal consolidation

cavitation

calcified granulomas

RSV is the most common cause of bronchiolitis.

RSV attacks the lower respiratory tract, causes necrosis of the respiratory
epithelium of the bronchi and bronchioles, and causes bronchiolitis.

Bronchial obstruction occurs due to necrotic material and edema that result from
the infection(RSV).

Bronchiolitis produces bronchial spasm, and interstitial pneumonia occurs as a
result of the obstruction.

bronchial epithelium

hyperinflation with diffuse increased interstitial markings

interstitial pneumonia

severe cases demonstrate focal areas of atelectasis

no treatment needed in most cases antibiotic and antiviral drugs(ribavirin)

First case appeared in China.

direct or droplet

throughout both lungs

early focal infiltrates progressing to generalized patchy interstitial infiltrates

bacterial and antiviral agents, other treatment regimen similar to those for atypical pneumonia

COPD includes several conditions in which chronic obstruction of the
airways leads to an ineffective exchange of respiratory gases and
makes breathing difficult.

• Chronic bronchitis
• Emphysema
• Asthma

a crippling and debilitating condition in which obstructive and destructive changes in the small Airways(the acini or terminal bronchioles) lead to a dramatic increase in the volume of air in the lungs

emphysema is closely associated with heavy cigarette smoking

destroyed alveolar septa

pulmonary hyperinflation

bulla formation

flattened diaphragm

radiolucent retrosternal space

treatment for symptoms no cure

very common disease in which widespread narrowing of the Airways develops because of an increased responsiveness of the tracheobronchial tree to various stimuli

bronchi

no evidence unless during acute attack

bronchial narrowing / hyperlucent lungs

radiographic appearance

exclusive other processes

preventative and rescue bronchial dilators

Sarcoidosis is a multisystem granulomatous disease of unknown
cause that is most often detected in young adults.

nonspecific or unknown cause of multi-system granulomatous disease

chest radiography- bilateral hilar lymph node enlargement with or without diffuse parenchymal disease

high-resolution CT demonstrates subtle lymphadenopathy in the anterior mediastinal and left paratracheal nodes in parenchymal disease as ground glass attenuation

no treatment of spontaneous recovery occur steroid therapy

Pneumoconiosis is a severe pulmonary disease caused by inhalation
of irritating particles.

• Asbestosis
• Silicosis
• Anthracosis (coal worker’s disease)

most common and best-known work related lung disease. the inhalation of high concentrations of silicon dioxide primarily affects workers engaged in mining, Foundry work, and Sandblasting.

most often upper lobes lung peritoneal

multiple, well-defined, scattered nodules of uniform density

May develop in properly protected workers engaged in manufacturing asbestos products, and handling building materials, or working in with insulation composed of asbestos

pleural lining

pleural thickening with calcified plaques

Coal Miner's, especially those working with hard coal, have an increased suspect ability to develop pneumoconiosis from inhalation of high concentrations of coal dust

throughout lungs

multiple less well-defined nodules of glandular density

for all cases of pneumoconiosis; prevent further exposure, breathe clean air, treat complications

SPN is asymptomatic. Incidental finding on CXR.

Problematic in that it could represent
• Benign granuloma
• Small neoplasm
• Solitary metastasis

throughout lungs

solitary nodule

dense or popcorn calcification benign

continued growth malignancy

Low-grade malignant lesions

Most common symptoms:
• Hemoptysis
• Recurring pneumonia

Bronchogenic carcinoma

It arises from the mucosa of the bronchial tree.

It is linked to smoking and to the inhalation of cancer-causing agents
(carcinogens), such as air pollution, exhaust gases, and industrial
fumes.

Common types of bronchogenic carcinoma are non-small cell and
small cell (oat cell).

Non-small cell types = 80% of all lung cancers
• Squamous carcinoma – most common
• Adenocarcinoma
• Bronchiolar (alveolar cell) carcinoma – least common

the most common type of lung cancer is squamous carcinoma, which typically arises in major Central bronchi and causes granule narrowing of the bronchial lumen.

Pulmonary embolism is the most common lung pathology of
hospitalized patients. It may be fatal.

It is asymptomatic in about 80% of cases.
It is difficult to diagnose even in those with symptoms.

More than 95% of embolisms arise from deep vein thrombosis in the
lower extremities.

computed tomography angiogram(CTA)

Pulmonary metastases develop from hematogenous or lymphatic
spread.

Most commonly from musculoskeletal sarcomas, myeloma, and
carcinomas of the breast, urogenital tract, thyroid, and colon.

Carcinomas of the breast, esophagus, or stomach may spread to lungs
via direct extension due to anatomic proximity.

Septic embolism is a bacterial “shower” that enters pulmonary
circulation, then gets trapped in the lung.

Septic embolisms arise primarily from
• Heart – bacterial endocarditis
• Peripheral veins – septic thrombophlebitis

It is more common in IV drug abusers.

Pulmonary arteriovenous (AV) fistula is an abnormal vascular
communication between a pulmonary artery and a vein.

cyanosis

is defined as a condition in which there is diminished air
within the lung associated with reduced lung volume.

• Neoplasm
• Foreign body (e.g., peanut, coin, or tooth)
• Mucous plug

local increase density; platelike streaks

air within the mediastinum.

• Spontaneous (severe coughing, vomiting, or straining ruptures alveoli,
releasing air)
• Chest trauma
• Perforation of the esophagus or tracheobronchial tree
• Spread of air along fascial planes in the neck, peritoneal cavity, or
retroperitoneal space

Pneumothorax is the presence of air in the pleural cavity, resulting in
a partial or complete collapse of the lung.

• Rupture of a subpleural bulla
• Spontaneous event in an otherwise healthy young adult
• Trauma (e.g., stabbing, gunshot, or fractured rib)
• Iatrogenic causes (e.g., after lung biopsy or the introduction of a chest tube
  for thoracentesis)
• Complication of neonatal hyaline membrane disease

is defined as the accumulation of fluid in the pleural space.

the earliest radiographic finding in pleural effusion is blunting of a normally sharp angle between the diaphragm and the rib cage along with an upward concave border of the fluid level

is defined as a rare accumulation of infected liquid or frank
pus in the pleural space.

caused by the spread of an adjacent infection (e.g.,
bacterial pneumonia, subdiaphragmatic abscess, lung abscess, and
esophageal perforation).
• It may occur after thoracic surgery, trauma, or instrumentation of the pleural
space.

• Anterior – extends from the sternum back to the trachea and the anterior
border of the heart
• Middle – contains the heart , great vessels, central tracheobronchial tree,
lymph nodes, and the phrenic nerves
• Posterior – is the space behind the pericardium

• Thymomas
• Teratomas
• Thyroid masses
• Lipomas
• Lymphoma

• Lymph node disorders:
• Lymphoma
• Metastatic carcinoma
• Granulomatous processes
• Bronchogenic cysts
• Vascular anomalies
• Masses in the anterior costophrenic angle

• Neurogenic tumors
• Neurogenic cysts
• Aneurysms of the descending aorta
• Extramedullary hematopoiesis

Eventration of the diaphragm is a rare congenital abnormality in
which one hemidiaphragm (very rarely both) is poorly developed and
weak.