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The Respiratory System: Anatomy, Physiology, and Pathologies

This chapter explores the anatomy and physiology of the respiratory system, as well the various pathologies that can affect it. It covers congenital diseases, inflammatory processes, and disorders like asthma, bronchitis, and COPD. The radiographic manifestations and imaging modalities used for diagnosis are also discussed.

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The Respiratory System: Anatomy, Physiology, and Pathologies

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  1. Chapter 3 The Respiratory System

  2. Objectives • Identify anatomic structures on both diagrams and radiographs of the respiratory system • Describe the physiology of the respiratory system • Explain how pathologies of the respiratory system affect the patient throughout the life • Describe the various pathologic condition affecting the respiratory system and the radiographic manifestations • Explain how a specific pathologic process will affect the technical factors that the technologist must consider

  3. Objectives—(cont.) • Explain how various imaging modalities used in the diagnosis of pathology of the respiratory system helps in diagnosis

  4. Anatomy Review • Trachea: anterior to esophagus; divides into right and left main bronchi at the carina • Bronchi: right is shorter; wider more vertical (a cause of pathology occurring in the right more often) • Hilum: right should be lower because of the heart

  5. Anatomy Review—(cont.) • Alveoli: functioning unit of the lung found at the end of each bronchiole • Fissures: two on the right and one on the left. Divide the lungs into lobes • Pleural cavity: visceral pleura is lung covering and parietal pleura lines thoracic cavity. Space between is cavity. Important for pathology

  6. Physiology • Purpose: take in oxygen for the body and to rid the body of carbon dioxide • Ventilation: air moving from atmosphere to alveoli • Perfusion: gas exchange of oxygen to blood and CO2 from the blood

  7. Pathology—Congenital • Cystic fibrosis • RDS

  8. Congenital Diseases • Cystic fibrosis: inherited; exocrine glands; thick mucus; frequent and progressive infections; survival 40 years • Respiratory distress syndrome: AKA hyaline membrane disease; premature infants; “ground glass” appearance; “air bronchogram” sign

  9. Cystic Fibrosis RDS

  10. Pathology—Inflammatory Processes • Lung abscess • Adult respiratory distress • Asthma • Atelectasis • Bronchitis • COPD • Croup

  11. More Inflammatory Processes • Pleural effusion • Pneumonia • Respiratory syncytial virus • Pneumoconiosis • Pneumothorax • Pulmonary edema • Pulmonary emboli • TB

  12. Inflammatory Processes • Lung abscesses: embolic-infected blood clot; pneumonic complications of pneumonia; inhalation-inhalation of infected material; air-fluid levels; cavity from sputum • Adult respiratory distress syndrome: sudden respiratory failure; acute alveolar injury; appearance similar to pulmonary edema

  13. Lung Abscess

  14. Asthma • Types: extrinsic allergies; intrinsic stress or anxiety • Symptoms: wheezing; coughing; chest tightening • Radiographic appearance: normal; trapped air; opacity

  15. Atelectasis • Definition: collapse of lung/lobe • Types: obstructive; compressive; passive; adhesive; cicatrizing • Causes: depends on the type; iatrogenic, ET tube placement • Radiographic appearance: different, depends on cause; opaque area; lung edge

  16. Atelectasis due to Obstruction (Cancer)

  17. Atelectasis due to Obstruction (ET Tube)

  18. Bronchitis • Definition: inflammation of bronchioles • Causes: tobacco smoke; industrial air pollution • Chronic bronchitis: repeated bouts over 2 years; sputum production • Related to COPD

  19. Bronchiectasis • Irreversible dilation • Cystic fibrosis is congenital bronchiectasis • Acquired from pulmonary infection • Need bronchoscopy to diagnose

  20. COPD • Definition: pulmonary process caused by the obstruction of air • Two processes: chronic bronchitis and emphysema • Over 10,000,000 people in the United States suffer

  21. Emphysema • Compensatory: lung increases to compensate for decrease elsewhere • Three types of centrilobular: centriacinar (blue bloater); panacinar (pink puffer); paraseptal • These have trapped air • Cause of above: smoking

  22. Emphysema—(cont.) • Radiographic appearance: hyperlucency; flat diaphragm; elongated heart shadow, barrel chest; tenting indicates long term • Technical caveats: costophrenic angles; over-exposure

  23. Emphysema—(cont.)

  24. Emphysema—(cont.)

  25. Emphysema—(cont.)

  26. Croup • Definition: viral infection; young children; bark cough • Why soft tissue neck radiograph: r/o epiglottitis; AP to make diagnosis • Radiographic appearance: steeple sign

  27. Croup—(cont.)

  28. Pleural Effusion • Definition: fluid in pleural cavity • Causes: CHF; infection; trauma • Radiographic features: opacity at angles; meniscus sign • Radiographic positions: upright; lateral decubitus side down

  29. Pleural Effusion—(cont.)

  30. Pleural Effusion—(cont.)

  31. Pneumonia • Definition: inflammation of the lungs • Types and related causes: bronchopneumonia—Streptococcus or Staphylococcus bacteria; aspiration—inhaled foreign object; viral—virus; lobar—Streptococcus bacteria • Radiographic features: opacity of segment or lobe of lung; overall opacity depending on the type

  32. Pneumonia—(cont.)

  33. RSV • Definition: pneumonia caused by virus • Characteristics: only in children under the age of 3 • Radiographic findings: normal; “dirty” lungs in the parahilar region

  34. Pneumoconiosis • Types and causes: silicosis—silica dust; asbestosis—asbestos rock or insulation; CWP—anthracite, 50% • Radiographic appearance: all are similar; fibrous “eggshell” pattern; diagnosis made by clinical history

  35. Pneumothorax • Definition: air in the pleural cavity • Images to take and why: upright inspiration/expiration; lateral decubitus affected side up • Air rises; expiration allows the pleural cavity to expand • Important radiographic finding: compromise of opposite lung; mediastinal shift

  36. Pneumothorax—(cont.)

  37. Pneumothorax—(cont.)

  38. Pulmonary Edema • Definition: backup of blood in the pulmonary vessels • Causes: pulmonary circulation obstruction; CAD; renal failure • Symptoms: dyspnea; SOB; rapid pulse • Radiographic features: “Kerley B” lines; diffuse increased density • Requires immediate treatment

  39. Pulmonary Emboli • Definition: embolus in the lung • Risk factors: immobility for 72 hours; DVT • Sequence for diagnosis: chest radiograph; CT; nuclear medicine • PE are fatal in over 50% of cases

  40. Tuberculosis • Cause and spread: Mycobacterium tuberculosis; inhalation of particles from infected individual • Two types: primary and secondary • Risk factors: homeless; alcoholic, immigrants; AIDS; prisoners • Radiographic features: primary, lower lobes’ small focal spots; secondary, apices, cavities; healing, streaks

  41. Tuberculosis—(cont.)

  42. TB—(cont.)

  43. TB with Cavity

  44. Lung Cavitation

  45. Pathology Neoplasms • Benign: hamartoma • Malignant • Adenocarcinoma • Squamous cell • Small cell • Metastatic

  46. Neoplasms • Benign: hamartoma • Best seen by: HRCT shows a fat-filled lesion • Radiographic features: “popcorn” calcifications in the lesion • Calcification usually means benign

  47. Hamartoma

  48. Bronchogenic Carcinoma Adenocarcinoma • Definition: 40% of bronchogenic carcinoma; comes from major bronchus • Characteristics: obstruction of bronchus; atelectasis; slow growing; abscess formation

  49. Bronchogenic Carcinoma Squamous Cell Carcinoma • Definition: lesion derives from stratified squamous epithelium • Characteristics: most favorable prognosis; smoking • Radiographic features: cavity; atelectasis of lobe

  50. Bronchogenic Carcinoma Small Cell Carcinoma—(cont.) • Definition: short, spindle-shaped cells that are found in bronchogenic carcinoma; oat cell • Characteristics: comprise 15% of all bronchogenic carcinoma; little cytoplasm in these cells; metastasize to brain; very aggressive; poor prognosis • Radiographic features: coin lesion; single tumor; no calcification

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