Respiratory System

1. Respiratory System Pathology 91 Spring 2010 DRAFT

2. Respiratory System Anatomy • Divided into: • _____________________________ • _____________________________ • Thoracic cavity • RT & LT pleural cavities • ___________________ • Lined by parietal pleura • Visceral pleura __________________to the lung tissue • Bones of thorax assist in __________& ____________ • Sinuses • ________________________________ • ________________________________

3. Upper & Lower Respiratory Tracts • Upper • ___________ • Mouth • ___________ • Larynx • Lower • ___________ • Bronchi • ___________ • Lungs

4. Mediastinum • Anterior • _____________________ • Middle • __________________ • __________________ • __________________ • Posterior • __________________

5. Mediastinum Frontal Radiograph • Superior vena cava • RT atrium • Inferior vena cava • Arch of aorta • LT pulmonary trunk • LT pulmonary artery shadow • Auricle of LT atrium • LT ventricle • LT cardiophrenic angle Retrieved from :www.liv.ac.uk/.../mbchb/hrtatk/images/ha1.jpg

6. The Importance of CXR’s • It is the ________ __________ diagnostic exam • It becomes ___________________ • ____________________techniques

7. Poor Inspiration vs. Sufficient Inspiration • Sufficient inspiration • Average movement of lungs and diaphragm between inspiration and expiration is ________

8. ____________ techniques Consistent Techniques Daily radiographs Analyze changes in pathology after treatment Or the progression the disease Must have optimal ___ and ____ Use PSP plates They offer a wider latitude ___________ is increased to decrease PT dose Film Screen vs. CR / DRand Technique Considerations

9. Additive ____________________ Requires an __________ in exposure factors These are pathologies that _________________ to normal aerated chest EX: pneumonia Subtractive- _____________________ These pathologies increase ____________ in the chest EX: emphysema ____________ exposure factors required Additive & Subtractive Pathologies

10. Additive and Subtractive Examples

11. Technique Adjustments for Different Image Receptors • Film Screen • ________________________ • kVp adjustments changes ________________ • With a digital system • _______________ should be adjusted • To ______________________ PT dose

12. AEC Sensors and Pathologies • AEC requires careful thought in regards to where pathology is in relation to sensors • Portable AEC • consistent exposure accuracy • less sensors • Sensors should be carefully selected

13. AEC Sensors and Pathologies • AEC requires careful thought in regards to where pathology is in relation to sensors • Portable AEC • consistent exposure accuracy • less sensors • Sensors should be carefully selected

14. CXR Projections

15. PA: Upright vs. Recumbent • Upright: • Recumbent:

16. AP CXR’s • Usually seen in Portable exams • Best to be performed upright to demonstrate air/fluid levels • Maintain beam perpendicular to plane of IR • To prevent foreshortening of the heart • Use 72” • To reduce heart magnification • Longer SID reduces magnification • Short OID reduces magnification (this is why PA is preferred)

17. Lateral CXR • Left lateral places heart closer to IR • Heart is on left • 72” SID for reduced heart magnification

18. Lateral Decubitus CXR For diagnosis of free air in the pleural space or pleural fluid

19. Lordotic Chest • Useful in demonstrating apical regions of the lung • Apices are normally obscured by bony structures • TB likes to reside in apices

20. Soft tissuesof chest • Can see pectoral muscles • Breast shadows • Sometimes breasts obscure costophrenic angles • Nipple shadows • Implants

21. Mediastinal Radiographs and Pathologies

22. Sail Sign • Mediastinum appears large • __________________ • Radiographic appearance: • AP: ________________ • Lateral:__________

23. Sail Sign

24. Mediastinal Emphysema(Pneumomediastinum) • Sudden rise in __________________that causes alveolar rupture. • Can be _______________ • Severe coughing, vomiting or straining • Can result from _____ • Endoscopy • Injury

25. Mediastinal Emphysema(Pneumomediastinum)

26. Spontaneous: If there is no pneumothorax, no treatment is necessary Usually resolves in a few days without complications Other than spontaneous: Rupture in esophagus (usually from vomiting) Major bronchus trauma (trauma) Both need prompt diagnosis & surgical intervention Esophogram can verify a leak has not occurred. Treatment of Mediastinal Emphysema

27. Subcutaneous Emphysema • Can be caused by: • Severe _____________ • ___________________ • Usually in ________ and/or __________ • Crackling sound or sensation

28. Subcutaneous Emphysema

29. Congenital and Hereditary Diseases Cystic Fibrosis Hyaline Membrane Disease

30. Cystic Fibrosis • Generalized disorder from a genetic defect that affects the function of the exocrine glands • Involves many organs & nearly all exocrine glands • Other organs affected • Salivary glands • Small bowel • Pancreas • Biliary tract • Female cervix • Male genital organs • Most lethal genetic disease of white children

31. Cystic Fibrosis • Diffuse Interstitial disease • Nodular densities with mucoid impaction

32. Progression of Cystic Fibrosis • At birth lungs are normal • Progression: • Increased secretions from bronchial glands • Leads to obstruction of the bronchial glands • Obstruction leads to staph infections, • Followed by tissue damage: • atelectasis,(collapsed lung) and emphysema • Once progression is in motion it is hard to stop

33. Symptoms Chronic couth With sputum, vomiting & disturbed sleep Wheezing Recurrent Pulmonary infections Role of Radiography: CXR aid in diagnosis Early: bronchial thickening and hyperinflation Progression: brochiectasis, cyst, atelectasis, scarring, enlargement of pulmonary artery and RT ventricle, overflation of lungs and chest wall Cystic Fibrosis

34. Cystic Fibrosis Sinuses • Sinus x-rays & CT will demonstrate persistent opacification of sinuses

35. Prognosis: Determined by degree of respiratory involvement Respiratory failure is inevitable Death 20-30 years of age Treatment: Antimicrobial drugs Bronchodilators Respiratory P.T. With pneumothorax- chest tube With hemoptysis- embolizing involved brachial arteries Psychotherapy Cystic Fibrosis

36. Cystic Fibrosis

37. Hyaline Membrane Disease Respiratory Distress Syndrome (RDS) • Affects • Premature infants • Caused by immature surfactant producing system • What is surfactant? • _________________________________________

38. RDS : Signs and Symptoms • Signs: • Rapid & labored breathing • Respiratory distress • Atelectasis worsening • In severe cases acidosis occurs • What is acidosis?

39. RDS • Severe atelectasis with a air-bronchogram sign • Life threatening • ________________ • Fine granular appearance known as ______________

40. Hyaline Membrane Disease With Air bronchogram sign

41. Treatment for RDS • Proper ___________________________environment • Satisfactory tissue _____________________________ • Monitored by arterial blood gas • _____________ ____________________

42. Inflammatory Diseases

43. Pneumonia • 6th leading cause of death in U.S. • Most common lethal noscomial infection • Most frequent type of inflammation in the lung compromising pulmonary function • Causes include: • ________________________ • ________________________ • ________________________

44. Infants & children Most common caused by viral pathogens In adolescents & young adults Most common causes Bacterial organisms termed mycoplasma pneumoniae In adults Most common causes: Streptococcus Staphylococcus Pneumococcus Haemophilus influenza Chlamydia pneumoniae Legionella pneumophila Pneumonia: Age related

45. Pneumonia: Classification by location • Lobar pneumonia • _____________________________________ • Segmental pneumonia • _____________________________________ • Bronchopneumonia • _____________________________________ • Interstitial pneumonia • _____________________________________

46. Lobar Pneumonia • Right sided lobar pneumonia

47. Segmental pneumonia

48. Bronchopneumonia

49. Interstitial Pneumonia

50. CXR’s for Pneumonia • Important in determining location of pneumonia • Appears as soft-patchy, ill defined alveolar infiltrates and pulmonary densities • Alveolar infiltration results when alveolar air spaces are filled with fluid or cells