Comprehensive Radiographic Pathology: Chapter 3: Respiratory System Flashcards


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1

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.

2

What are the components of the upper respiratory system?

-nasopharynx

-oropharynx

-larynx

3

What is the function of the upper respiratory system?

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

4

What are the components of the lower respiratory system?

-trachea -bronchi -bronchioles

5

What are bronchioles composed of? What is the function?

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

6

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.

7

viseral pleura

the inner layer of pleura that surrounds each lung

8

parietal pleura

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

9

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

10

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

11

proper ET tube placement

card image
12

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.

13

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.

14

correct endotracheal tube placement

tip of tube 5 to 7 cm above the carina

15

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

16

correct central venous pressure catheter placement

tip of the catheter should be in the superior vena cava

17

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

18

Swan-Ganz catheter

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

19

correct Swan-Ganz catheter placement

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

20

Swan-Ganz catheter complications

pulmonary infarction

21

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

22

correct transvenous cardiac pacemaker

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

23

transvenous cardiac pacemaker complications

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

24

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

25

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.

26

What is cystic fibrosis caused by?

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

27

Ninety percent of the morbidity and mortality related to cystic fibrosis occurs as a result of __________________.

respiratory involvement

28

Where can cystic fibrosis be located?

bronchi

29

cystic fibrosis chest x-ray

card image

irregular thickening of linear marking throughout the lung

hyperinflation

CT demonstrates structural damage and disease progression

30

What is the treatment for Cystic Fibrosis?

  • prophylactic antibiotics
  • chest Physiotherapy
  • bronchodilators
31

What is hyaline membrane disease also known as?

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

32

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.

33

What is hyaline membrane disease caused by?

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

34

Where is hyaline membrane disease located?

Alveoli

35

hyaline membrane disease x-ray

card image

Minute granular densities in the parenchyma

air bronchogram

36

What is the treatment for hyaline membrane disease?

artificial surfactant admitted to the lungs via a saline solution

positive-pressure ventilation

37

What type of infection is croup?

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

38

How is croup characterized?

It is characterized by a barking cough.

39

Where is croup located?

subglottic trachea larynx

40

croup x-ray appearance

card image

smooth, tapered narrowing

41
card image

What is this called?

Steeple sign

42

What is the treatment for croup?

Staind, mist tent, 02

43

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.

44

What has caused epiglottis to decrease?

Incidence has decreased due to routine childhood immunization.

45

What is the location for epiglottis?

supraglottic area or supraglottis

46

epiglottis x-ray

card image

rounded thickening epiglottic tissue

47

What is the treatment for epiglottitis?

ER - intubation

antibiotics for the infection

48

Inflammatory Disorders of the Lower Respiratory System

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

49

What is pneumonia?

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

50

Pneumonia produces three radiographic patterns:

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

51

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.

Lobar/segment

52

alveolar pneumonia(pneumococcal)

card image

Lobe / segment opacification

53

alveolar pneumonia(pneumococcal) treatment

antibiotic

54

what is bronchopneumonia? Location?

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

bronchial Airway / alveoli

55

bronchopneumonia xray

card image

patchy opacification with air bronchogram

56

bronchopneumonia treatment

antibiotic

57

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

58

what is Honeycomb lung?

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

59

Interstitial Pneumonia xray

card image

linear or reticular pattern

60

interstitial pneumonia treatment

antibiotic

61

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

62

Anthrax image appearance

mediastinal widening with associated pleural effusions without infiltrates

63

Anthrax is easy/hard to transmitted and unlikely/highly fatal.

It is easily transmitted and highly fatal.

64

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
65

Anthrax treatment

high-dose antibiotics and vaccination

66

What is a lung abscess? most common location?

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

most common in right lung

67

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.

68

lung abscess x-ray

card image

encapsulated opaque Mass with air-fluid level

69

lung abscess treatment

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

70

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.

71

how is TB spread? (mode of transmission)

droplet

72

tuberculosis x-ray

card image
73

primary pulmonary tuberculosis Imaging appearance

consolidation is homogeneous dents and well-defined

hilar enlargement without parenchymal involvement

demonstrates ghon lesion

pleural effusion

74

primary pulmonary tuberculosis location

lobar or segmental

hilar and midiastinal lymph nodes

parenchymal, hilar, and mediastinal nodes

pleural cavity

75

military tuberculosis location

throughout the lungs, and possible spread to other organs

76

military tuberculosis Imaging appearance

innumerable find discrete nodules uniformly throughout the lung

77

tuberculous pneumonia location

parenchymal and nodal

78

tuberculous pneumonia Imaging appearance

necrotic cavities in large abscess

79

secondary tuberculosis location

upper lobes and posterior segment

80

secondary tuberculosis Imaging appearance

extensive fibrotic exchanges with possible calcification

81

tuberculoma location

any part of lung commonly in periphery and upper lobes

82

tuberculoma Imaging appearance

single or multiple nodules, 1-3 cm

83

tuberculosis treatment

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

84

what kind of infection is pulmonary mycosis?

Pulmonary mycosis is a fungal infection of the lung.

85

The most common systemic fungal infections in North America are

• Histoplasmosis
• Coccidioidomycosis

86

histoplasmosis x ray

card image
87

primary histoplasmosis location

lower lung

hilar lymph nodes

88

primary histoplasmosis Imaging appearance

pulmonary infiltration

granulomatous nodule

hilar lymph node enlargement and/or calcification

89

chronic histoplasmosis location

upper lobe

90

chronic histoplasmosis Imaging appearance

zones of parenchymal consolidation

cavitation

calcified granulomas

91

Respiratory Syncytial Virus(RSV) is the most common cause of ________.

RSV is the most common cause of bronchiolitis.

92

what does RSV attack? what does it cause?

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

93

what causes bronchial obstruction?

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

94

what is bronchiolitis produce?

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

95

Respiratory Syncytial Virus(RSV) location

bronchial epithelium

96

Respiratory Syncytial Virus(RSV) Imaging appearance

hyperinflation with diffuse increased interstitial markings

interstitial pneumonia

severe cases demonstrate focal areas of atelectasis

97

Respiratory Syncytial Virus(RSV) treatment

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

98

where did the first case of Severe Acute Respiratory Syndrome SARS appear?

First case appeared in China.

99

SARS is transmitted by _______ or _____ contact.
• No known transmissions since 2004

direct or droplet

100

Severe Acute Respiratory Syndrome SARS location

throughout both lungs

101

Severe Acute Respiratory Syndrome SARS Imaging appearance

early focal infiltrates progressing to generalized patchy interstitial infiltrates

102

Severe Acute Respiratory Syndrome SARS treatment

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

103

what is COPD?

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

104

emphysema

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

105

emphysema cause

emphysema is closely associated with heavy cigarette smoking

106

emphysema location

destroyed alveolar septa

107

emphysema Imaging appearance

pulmonary hyperinflation

bulla formation

flattened diaphragm

radiolucent retrosternal space

108

emphysema treatment

treatment for symptoms no cure

109

asthma

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

110

asthma location

bronchi

111

asthma Imaging appearance

no evidence unless during acute attack

bronchial narrowing / hyperlucent lungs

radiographic appearance

exclusive other processes

112

asthma treatment

preventative and rescue bronchial dilators

113

sarcoidosis? who does it affect?

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

114

sarcoidosis location

nonspecific or unknown cause of multi-system granulomatous disease

115

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

116

sarcoidosis treatment

no treatment of spontaneous recovery occur steroid therapy

117

pneumoconiosis

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

118

Most common types of pneumoconiosis:

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

119

silicosis

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.

120

silicosis location

most often upper lobes lung peritoneal

121

silicosis Imaging appearance

multiple, well-defined, scattered nodules of uniform density

122

asbestosis

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

123

asbestos location

pleural lining

124

asbestos Imaging appearance

pleural thickening with calcified plaques

125

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

126

anthracosis location

throughout lungs

127

anthracosis Imaging appearance

multiple less well-defined nodules of glandular density

128

pneumoconiosis treatment

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

129

Solitary Pulmonary Nodule (SPN)

SPN is asymptomatic. Incidental finding on CXR.

130

how could seeing SPN be problematic?

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

131

Solitary Pulmonary Nodule (SPN) location

throughout lungs

132

Solitary Pulmonary Nodule (SPN) Imaging appearance

solitary nodule

dense or popcorn calcification benign

continued growth malignancy

133

Bronchial Adenoma

Low-grade malignant lesions

134

Bronchial Adenoma Most common symptoms:

Most common symptoms:
• Hemoptysis
• Recurring pneumonia

135

_____________ is primary carcinoma of the lung.

Bronchogenic carcinoma

136

what does Bronchogenic carcinoma arise from?

It arises from the mucosa of the bronchial tree.

137

what is Bronchogenic carcinoma linked to?

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

138

most common types of bronchogenic carcinoma

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

139

Non-small cell types

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

140

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.

141

__________ _________ is the most common lung pathology of
hospitalized patients. It may be fatal.

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

142

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.

143

what do embolism arise from

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

144

pulmonary embolism modality of choice

computed tomography angiogram(CTA)

145

pulmonary metastases develop from what?

Pulmonary metastases develop from hematogenous or lymphatic
spread.

146

pulmonary metastases most commonly from?

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

147

Carcinomas of the breast, esophagus, or stomach may spread to lungs
via ________________.

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

148

septic embolism

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

149

what do septic embolisms primarily arise from?

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

150

who are septic embolism most common in?

It is more common in IV drug abusers.

151

Pulmonary arteriovenous (AV) fistula

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

152

Very large or multiple fistulas can cause _____ due to too much
venous blood shunting into arterial circulation.

cyanosis

153

Atelectasis

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

154

Atelectasis is caused by bronchial obstruction, which may be due to:

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

155

Atelectasis Imaging appearance

local increase density; platelike streaks

156

Mediastinal emphysema is defined as

air within the mediastinum.

157

Mediastinal emphysema causes include:

• 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

158

pneumothorax

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

159

pneumothorax causes

  • 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
160

pleural effusion

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

161

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

162

empyema

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

163

usual cause of empyema

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.

164

Mediastinum is divided into three compartments:

• 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

165

5 Anterior Mediastinal Masses

• Thymomas
• Teratomas
• Thyroid masses
• Lipomas
• Lymphoma

166

Middle Mediastinal Masses

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

167

Posterior Mediastinal Masses

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

168

Eventration

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