What is the primary function of the respiratory system?
Primary function of the respiratory system is the intake of oxygen and the removal of carbon dioxide from the blood.
What are the components of the upper respiratory system?
What is the function of the upper respiratory system?
provide structure for the passage of air into the lower respiratory system
What are the components of the lower respiratory system?
-trachea -bronchi -bronchioles
What are bronchioles composed of? What is the function?
composed of tubular structures responsible for conducting air from the upper respiratory structures
What are the smallest functional unit of the respiratory system? What happens here?
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
Chest radiographs are used to verify the proper placement of the following devices: (4 internal devices)
• Endotracheal tube • Central venous catheter • Swan-Ganz catheter • Transvenous cardiac pacemaker
Endotracheal Tube (ETT)
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
proper ET tube placement
What complication could happen if an ET tube is too low?
A tube positioned too low usually extends into the right main stem bronchus, where it eventually leads to atelectasis of the left lung.
What complication could happen if an ET tube is too high?
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.
correct endotracheal tube placement
tip of tube 5 to 7 cm above the carina
central venous catheter
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
correct central venous pressure catheter placement
tip of the catheter should be in the superior vena cava
central venous pressure catheter complications
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
correct Swan-Ganz catheter placement
right or left main pulmonary artery seen radiographic lie within the borders of the mediastinum
Swan-Ganz catheter complications
Transvenous cardiac pacemaker is used to
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
correct transvenous cardiac pacemaker
Overexposed to demonstrate the tip of the electrode at the apex of the right ventricle
transvenous cardiac pacemaker complications
coronary sinus placement-needs a lateral chest image to distinguish perforation at the initial intersection
peripherally inserted central catheter (PICC)
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
What is cystic fibrosis characterized by?
Cystic fibrosis is characterized by the secretion of excessively viscous mucus by all the exocrine glands; it also affects the pancreas and digestive system.
What is cystic fibrosis caused by?
It is caused by a defective gene in the middle of chromosome 7.
Ninety percent of the morbidity and mortality related to cystic fibrosis occurs as a result of __________________.
Where can cystic fibrosis be located?
cystic fibrosis chest x-ray
irregular thickening of linear marking throughout the lung
CT demonstrates structural damage and disease progression
What is the treatment for Cystic Fibrosis?
- prophylactic antibiotics
- chest Physiotherapy
What is hyaline membrane disease also known as?
Hyaline membrane disease is also known as idiopathic
distress syndrome (IRDS).
Hyaline membrane disease is one of the most common causes of respiratory distress in the ______, primarily _______.
Hyaline membrane disease is one of the most common causes of respiratory distress in the newborn, primarily premature.
What is hyaline membrane disease caused by?
It is caused by a lack of surfactant in immature lungs.
Where is hyaline membrane disease located?
hyaline membrane disease x-ray
Minute granular densities in the parenchyma
What is the treatment for hyaline membrane disease?
artificial surfactant admitted to the lungs via a saline solution
What type of infection is croup?
Croup is primarily a viral infection of young children that
inflammatory obstructive swelling localized to the subglottic portion
of the trachea.
How is croup characterized?
It is characterized by a barking cough.
Where is croup located?
subglottic trachea larynx
croup x-ray appearance
smooth, tapered narrowing
What is this called?
What is the treatment for croup?
Staind, mist tent, 02
What does epiglottis cause? What is it caused by?
Epiglottis infections cause thickening of the epiglottic tissue and the surrounding pharyngeal structures. Epiglottitis is most commonly caused by Haemophilus influenzae in children.
What has caused epiglottis to decrease?
Incidence has decreased due to routine childhood immunization.
What is the location for epiglottis?
supraglottic area or supraglottis
rounded thickening epiglottic tissue
What is the treatment for epiglottitis?
ER - intubation
antibiotics for the infection
Inflammatory Disorders of the Lower Respiratory System
• Lung Abscess
• Pulmonary Mycosis
• Respiratory Syncytial Virus (RSV)
• Severe Acute Respiratory Syndrome (SARS)
What is pneumonia?
Pneumonia is an inflammation of the lung that can be caused by
variety of organisms, most commonly bacteria and viruses.
Pneumonia produces three radiographic patterns:
• Alveolar, or air-space, pneumonia
• Interstitial pneumonia
what is alveolar pneumonia? Location?
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.
Lobe / segment opacification
alveolar pneumonia(pneumococcal) treatment
what is bronchopneumonia? Location?
Typified by staphylococcal infection is primarily an inflammation
in the bronchi. Produces small patches on consolidation.
bronchial Airway / alveoli
patchy opacification with air bronchogram
What is Interstitial Pneumonia? Location?
Most commonly produced by viral and mycoplasmal infections. The inflammatory process mostly involves the walls and lining of the alveoli.
alveoli / interstitium
what is Honeycomb lung?
demonstrated on a CT as cyst-like spaces and dense fiber-optic walls
Interstitial Pneumonia xray
linear or reticular pattern
interstitial pneumonia treatment
what is anthrax caused by? location?
Anthrax is caused by Bacillus anthracis.
• It can survive for decades in the soil without a host.
throughout both lungs
Anthrax image appearance
mediastinal widening with associated pleural effusions without infiltrates
Anthrax is easy/hard to transmitted and unlikely/highly fatal.
It is easily transmitted and highly fatal.
There are three ways to contract anthrax:
- 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
What is a lung abscess? most common location?
Lung abscess is a necrotic area of pulmonary parenchyma
purulent (puslike) material.
most common in right lung
What is most likely the cause of lung abscess?
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.
lung abscess x-ray
encapsulated opaque Mass with air-fluid level
lung abscess treatment
appropriate antibiotic for specific organism, aid in expectoration of purulent material
what is tuberculosis caused by?
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.
how is TB spread? (mode of transmission)
primary pulmonary tuberculosis Imaging appearance
consolidation is homogeneous dents and well-defined
hilar enlargement without parenchymal involvement
demonstrates ghon lesion
primary pulmonary tuberculosis location
lobar or segmental
hilar and midiastinal lymph nodes
parenchymal, hilar, and mediastinal nodes
military tuberculosis location
throughout the lungs, and possible spread to other organs
military tuberculosis Imaging appearance
innumerable find discrete nodules uniformly throughout the lung
tuberculous pneumonia location
parenchymal and nodal
tuberculous pneumonia Imaging appearance
necrotic cavities in large abscess
secondary tuberculosis location
upper lobes and posterior segment
secondary tuberculosis Imaging appearance
extensive fibrotic exchanges with possible calcification
any part of lung commonly in periphery and upper lobes
tuberculoma Imaging appearance
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)
what kind of infection is pulmonary mycosis?
Pulmonary mycosis is a fungal infection of the lung.
The most common systemic fungal infections in North America are
histoplasmosis x ray
primary histoplasmosis location
hilar lymph nodes
primary histoplasmosis Imaging appearance
hilar lymph node enlargement and/or calcification
chronic histoplasmosis location
chronic histoplasmosis Imaging appearance
zones of parenchymal consolidation
Respiratory Syncytial Virus(RSV) is the most common cause of ________.
RSV is the most common cause of bronchiolitis.
what does RSV attack? what does it cause?
RSV attacks the lower respiratory tract, causes necrosis of the
epithelium of the bronchi and bronchioles, and causes bronchiolitis.
what causes bronchial obstruction?
Bronchial obstruction occurs due to necrotic material and edema that
what is bronchiolitis produce?
Bronchiolitis produces bronchial spasm, and interstitial pneumonia
occurs as a
result of the obstruction.
Respiratory Syncytial Virus(RSV) location
Respiratory Syncytial Virus(RSV) Imaging appearance
hyperinflation with diffuse increased interstitial markings
severe cases demonstrate focal areas of atelectasis
Respiratory Syncytial Virus(RSV) treatment
no treatment needed in most cases antibiotic and antiviral drugs(ribavirin)
where did the first case of Severe Acute Respiratory Syndrome SARS appear?
First case appeared in China.
SARS is transmitted by _______ or _____ contact.
• No known transmissions since 2004
direct or droplet
Severe Acute Respiratory Syndrome SARS location
throughout both lungs
Severe Acute Respiratory Syndrome SARS Imaging appearance
early focal infiltrates progressing to generalized patchy interstitial infiltrates
Severe Acute Respiratory Syndrome SARS treatment
bacterial and antiviral agents, other treatment regimen similar to those for atypical pneumonia
what is COPD?
COPD includes several conditions in which chronic obstruction of
airways leads to an ineffective exchange of respiratory gases and
makes breathing difficult.
• Chronic bronchitis
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
emphysema Imaging appearance
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
asthma Imaging appearance
no evidence unless during acute attack
bronchial narrowing / hyperlucent lungs
exclusive other processes
preventative and rescue bronchial dilators
sarcoidosis? who does it affect?
Sarcoidosis is a multisystem granulomatous disease of
cause that is most often detected in young adults.
nonspecific or unknown cause of multi-system granulomatous disease
sarcoidosis Imaging appearance
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
of irritating particles.
Most common types of pneumoconiosis:
• 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
silicosis Imaging appearance
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
asbestos Imaging appearance
pleural thickening with calcified plaques
anthracosis(coal workers pneumoconiosis)
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
anthracosis Imaging appearance
multiple less well-defined nodules of glandular density
for all cases of pneumoconiosis; prevent further exposure, breathe clean air, treat complications
Solitary Pulmonary Nodule (SPN)
SPN is asymptomatic. Incidental finding on CXR.
how could seeing SPN be problematic?
Problematic in that it could represent
• Benign granuloma
• Small neoplasm
• Solitary metastasis
Solitary Pulmonary Nodule (SPN) location
Solitary Pulmonary Nodule (SPN) Imaging appearance
dense or popcorn calcification benign
continued growth malignancy
Low-grade malignant lesions
Bronchial Adenoma Most common symptoms:
Most common symptoms:
• Recurring pneumonia
_____________ is primary carcinoma of the lung.
what does Bronchogenic carcinoma arise from?
It arises from the mucosa of the bronchial tree.
what is Bronchogenic carcinoma linked to?
It is linked to smoking and to the inhalation of cancer-causing
(carcinogens), such as air pollution, exhaust gases, and industrial
most common types of bronchogenic carcinoma
Common types of bronchogenic carcinoma are non-small cell
small cell (oat cell).
Non-small cell types
Non-small cell types = 80% of all lung cancers
• Squamous carcinoma – most common
• Bronchiolar (alveolar cell) carcinoma – least common
how does Squamous carcinoma arise?
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.
__________ _________ is the most common lung pathology
hospitalized patients. It may be fatal.
Pulmonary embolism is the most common lung pathology
hospitalized patients. It may be fatal.
what is the problem with diagnosing pulmonary embolism?
It is asymptomatic in about 80% of cases.
It is difficult to diagnose even in those with symptoms.
what do embolism arise from
More than 95% of embolisms arise from deep vein thrombosis in
pulmonary embolism modality of choice
computed tomography angiogram(CTA)
pulmonary metastases develop from what?
Pulmonary metastases develop from hematogenous or lymphatic
pulmonary metastases most commonly from?
Most commonly from musculoskeletal sarcomas, myeloma,
carcinomas of the breast, urogenital tract, thyroid, and colon.
Carcinomas of the breast, esophagus, or stomach may spread to
Carcinomas of the breast, esophagus, or stomach may spread to
via direct extension due to anatomic proximity.
Septic embolism is a bacterial “shower” that enters
circulation, then gets trapped in the lung.
what do septic embolisms primarily arise from?
Septic embolisms arise primarily from
• Heart – bacterial endocarditis
• Peripheral veins – septic thrombophlebitis
who are septic embolism most common in?
It is more common in IV drug abusers.
Pulmonary arteriovenous (AV) fistula
Pulmonary arteriovenous (AV) fistula is an abnormal
communication between a pulmonary artery and a vein.
Very large or multiple fistulas can cause _____ due to too
venous blood shunting into arterial circulation.
is defined as a condition in which there is diminished
within the lung associated with reduced lung volume.
Atelectasis is caused by bronchial obstruction, which may be due to:
• Foreign body (e.g., peanut, coin, or tooth)
• Mucous plug
Atelectasis Imaging appearance
local increase density; platelike streaks
Mediastinal emphysema is defined as
air within the mediastinum.
Mediastinal emphysema causes include:
• Spontaneous (severe coughing, vomiting, or straining ruptures
• Chest trauma
• Perforation of the esophagus or tracheobronchial tree
• Spread of air along fascial planes in the neck, peritoneal cavity, or
Pneumothorax is the presence of air in the pleural cavity, resulting
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
- Complication of neonatal hyaline membrane disease
is defined as the accumulation of fluid in the pleural space.
early signs of pleural effusion
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
pus in the pleural space.
usual cause of empyema
caused by the spread of an adjacent infection (e.g.,
bacterial pneumonia, subdiaphragmatic abscess, lung abscess, and
• It may occur after thoracic surgery, trauma, or instrumentation of the pleural
Mediastinum is divided into three compartments:
• Anterior – extends from the sternum back to the trachea and the
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
5 Anterior Mediastinal Masses
• Thyroid masses
Middle Mediastinal Masses
• Lymph node disorders:
• Metastatic carcinoma
• Granulomatous processes
• Bronchogenic cysts
• Vascular anomalies
• Masses in the anterior costophrenic angle
Posterior Mediastinal Masses
• Neurogenic tumors
• Neurogenic cysts
• Aneurysms of the descending aorta
• Extramedullary hematopoiesis
Eventration of the diaphragm is a rare congenital abnormality
which one hemidiaphragm (very rarely both) is poorly developed and