RAD PATHOLOGY Lesson 3 Chapter 3 Part 1

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Radiographic Pathology - Respiratory System Part 1

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Hostos Community College XRA 220 – Radiographic Pathology:

Hostos Community College XRA 220 – Radiographic Pathology Lesson #3 Chapter #3 Respiratory System Part #1 Facilitator: M.Livingston BSHSc RT

Review:

Review Name 2 diagnostic exams that would be ordered for a CVA ? A 48 y/o male with a HX of hypercholesteremia may have in his future a series of diagnostic imaging exams. Name some. If a person has nephrolithiasis , which exam would be ideal? What is a CT number ? What exam uses pulse sequences to detect pathology? How is fusion imaging used in detecting pathology?

Objectives:

Objectives Review basic anatomy and physiology of the Respiratory System Classify common diseases in terms of their attenuation of x-rays Differentiate the more common pathological conditions affecting the respiratory system and their radiographic manifestations. Recognize common medical complications in the clinical settings involving the respiratory system

PowerPoint Presentation:

Common Respiratory Associated Infections

Upper Respiratory Anatomy:

Upper Respiratory Anatomy Pharynx Larynx Epiglottis

Respiratory Anatomy:

Respiratory Anatomy Trachea Carina Left and Right Main Bronchi Bronchioles Alveoli Cilia/Mucous lining

Lobes of the Lungs:

Lobes of the Lungs RUL RML RLL LUL LLL Fissures Diaphragm Phrenic Nerve

“Silhouette sign” of the left heart border Which lobe is involved?:

“Silhouette sign” of the left heart border Which lobe is involved?

Chest Structures:

Chest Structures Mediastinum Lymphatic Hilum Posterior—Descending aorta and thoracic vertebrae Middle—Heart and great vessels, esophagus, and trachea Anterior—Thyroid and thymus glands Ribs Sternum

Alveolar Anatomy:

Alveolar Anatomy Oxygen and Blood Exchange

Vascular Anatomy:

Vascular Anatomy MPA Pulmonary Arteries Pulmonary Veins In what vessels would an embolus lodge?

Putting it All Together:

Putting it All Together

Physiology:

Physiology Function to oxygenate blood and remove waste External respiration takes place within the alveoli (true lung parenchyma)air-blood exchange. O 2 attaches to hemoglobin molecule – internal respiration GAS EXCHANGE TAKES PLACE IN THE ALVEOLI Medulla oblongata basically detects carbon dioxide (CO 2 ) and Oxygen (O 2 ) levels in the bloodstream and determines respiratory and cardiovascular rate

Pleuratic Pressure:

Pleuratic Pressure When lungs fill with air, they depress the diaphragm (expansion of lungs) This creates increase pressure with the pleural cavity When lungs deflate, diaphragm returns to relaxed state There is now a decrease in pressure in the pleural cavity A difference in pressure acts like a vacuum to prevent the lungs from collapsing

Chest Anatomy:

Chest Anatomy Thoracic cavity Pleural cavities Parietal pleura Visceral pleura

Pleural Effusion Between Parietal and Visceral Pleura:

Pleural Effusion Between Parietal and Visceral Pleura

Pleural Effusion:

Pleural Effusion

The Standard CXR:

The Standard CXR Taken in Full Inspiration Poor expansion may cause heart to appear enlarged Lung bases may be difficult to evaluate from poor expansion Proper breathing instruction avoids Valsalva effect – causes compression and decrease in heart size and pulmonary vasculature High kVp used

Looking at a CXR for Pathology:

Looking at a CXR for Pathology Chest is divided into divisions Divisions represent major Bronchial and Vascular structures within the lung. Opacities and “ silhouette signs ” noted

Do you see a silhouette sign?:

Do you see a silhouette sign?

Imaging Considerations:

Imaging Considerations Radiography Exposure factors Film screen CR DR Additive and subtractive pathologies AEC Positions and projections of the chest

Imaging Considerations:

Imaging Considerations Soft tissues of the chest May vary with patient age, sex, and pathologic conditions Pectoral muscles Breast shadows Breast prosthesis (implants) Nipple shadows

BREAK:

BREAK

Internal Devices:

Internal Devices ETT (Endotracheal Tube) – Allows for airway management , suctioning, and mechanical ventilation CXR performed to evaluate placement (Tip placed 5cm to 7cm above carina ) Risk of perforation or placement in esophagus

CVP:

CVP CVP lines – placed in the subclavian vein. Optimal location is where brachiocephalic vein joins the SVC Complication - pleura covering the apex of the lung in close proximity to subclavian vein – Pneumothorax may occur Another complication is infusion of medication into the mediastinum or pleural space Upright CXR is of the upmost importance !

Internal Devices:

Internal Devices Peripherally Inserted Central Catheter (PICC line) placed for long term therapy. IJ Line Placement Complications include thrombosis, infection and perforation.

Internal Devices:

Internal Devices Swan-Ganz Catheter – placed to monitor cardio-pulmonary status on severely ill patients. Measures cardiac output. Placed in Pulmonary Artery. Complications include is pulmonary infarction and clot formation.

Chest Tube:

Chest Tube Chest Tubes- Placed to replace negative pressure in pleural cavity resulting from a pneumothorax Drainage of air or fluid (hemothorax or empyema) Allows the lungs to inflate Tubes that are placed lower are for fluid drainage Higher are for air removal Collection device below the level of chest

Chest Tubes Gone Wild – Subcutaneous Emphysema:

Chest Tubes Gone Wild – Subcutaneous Emphysema

Internal Devices:

Internal Devices Cardiac Pacemakers placed for maintaining cardiac rhythm for patients with arrythmias. Generator is inserted under skin below the clavicle Using fluoroscopy, tip placed at apex of right ventricle An increase in technical factors may be needed to demonstrate the tip of the electrode

Therapeutic Internal Device Placement :

Therapeutic Internal Device Placement Examine the image What type of radiopaque or hyperdense objects do you see? Is the line placed in the proper place? Name the anatomical structures involved What are the risks?

Let’s See How Good You Are?:

Let’s See How Good You Are? Identify as many devices as you can

CONGENITAL / HEREDITARY DISEASES:

CONGENITAL / HEREDITARY DISEASES CYSTIC FIBROSIS ALSO CALLED MUCOVISCIDOSIS SECRETION OF VISCOUS MUCUS OF THE EXOCRINE GLAND MOST COMMON GENETIC DEFECT IN WHITE CHILDREN THICK MUCOUS SECRETED BY MUCOSA IN THE TRACHEA AND BRONCHI AND THIS BLOCKS AIR PASSAGE THIS LEADS TO LUNG COLLAPSE REPEATED INFECTIONS ARE COMMON

HYALINE MEMBRANE DISEASE:

HYALINE MEMBRANE DISEASE AKA.. IODIOPATHIC RESPIRATORY DISTRESS SYNDROME (IRDS) MOST COMMON RESPIRATORY DISTRESS IN NEWBORNS/PREMATURE INFANTS APPEARS WITHIN 6 HOURS OF DELIVERY UNDERAERATION LEADING TO A LACK OF SURFACTANT (MIXTURE OF LIPIDS , PROTEINS AND CARBS THAT CREATE HIGH SURFACE TENSION) Radiographic appearance-severe atelectasis- air bronchogram sign. - ground glass appearance TREATED WITH ARTIFICIAL SURFACTANT

IRDS:

IRDS

Inflammatory Disease Disorders- URI:

Inflammatory Disease Disorders- URI CROUP VIRAL INFECTION IN YOUNG CHILDREN INFLAMMATORY OBSTRUCTION AND SWELLING OF SUBGLOTTIC PORTION OF THE TRACHEA STRIDOR OCCURS OR BARKING COUGH AP/LAT SOFT TISSUE Neck ordered TREATED WITH STEAM, MIST OR OXYGEN

Epiglottis:

Epiglottis INFECTION AND IS CAUSED BY INFLUENZA IN CHILDREN THICKENING OF EPIGLOTTIC TISSUE SUPRAGLOTTIC AREA IS AFFECTED SHOWS ON LATERAL VIEWS TREATED BY INTUBATION AND ANTIBIOTICS AP/LAT SOFT TISSUE Neck ordered

INFLAMMATORY DISORDERS OF THE LOWER RESPIRATORY SYSTEM:

INFLAMMATORY DISORDERS OF THE LOWER RESPIRATORY SYSTEM Pneumonias: Most frequent type of lung infection 6th leading cause of death in U.S. and most common lethal nosocomial infection Causes of pneumonia Terms used: Lobular , segmental, bronchopneumonia, or interstitial Radiographic findings – APPEARS AS AN OPACIFICATION - location of inflammation - pulmonary densities or alveolar infiltrates

INFLAMMATORY DISORDERS OF THE LOWER RESPIRATORY SYSTEM:

INFLAMMATORY DISORDERS OF THE LOWER RESPIRATORY SYSTEM PNEUMONIA’S ALVEOLAR PNEUMONIA BRONCHOPNEUMONIA INTERSTITIAL PNEUMONIA ASPIRATION PNEUMONIA INFLAMMATION OF THE LUNG AND CAUSED BY ORGANISMS LIKE BACTERIA AND VIRUSES

ALVEOLAR PNEUMONIA:

ALVEOLAR PNEUMONIA “AIR SPACE PNEUMONIA” ETIOLOGY: PNEUMOCOCCAL INFECTION INFLAMMATORY EXUDATE THAT REPLACES AIR IN THE ALVEOLI SO THE AFFECTED PART OF THE LUNG HAS NO AIR AND APPEARS RADIOPAQUE SPREADS FROM ONE ALVEOLI TO ANOTHER THIS COULD INVOLVE AN ENTIRE LOBE LOBE/SEGMENT OPACIFICATION TREATED WITH ANTIBIOTICS

BRONCHOPNEUMONIA:

BRONCHOPNEUMONIA ETIOLOGY: STAPHYLOCOCCAL INFECTION INFLAMMATION IN THE BRONCHI or BRONCHILAR MUCOSA AND SPREADS TO THE ADJACENT ALVEOLUS SMALL PATCH APPEARANCE BRONCHIAL INFLAMMATION CAN LEAD TO ATELECTASIS TREATED WITH ANTIBIOTICS

INTERSTITIAL PNEUMONIA:

INTERSTITIAL PNEUMONIA ETIOLOGY:VIRAL AND MYCOPLASMAL INFECTIONS INVOLVES THE LINING OF THE ALVEOLI AND THE INTERSTITIAL STRUCTURES OF THE LUNG APPEARS IN A LINEAR OR RETICULAR PATTERN APPEARS AS MULTIPLE SMALL NODULES IF LEFT UNTREATED INTERSTITIAL PNEUMONIA CAN CAUSE HONEY COMB LUNG AND THIS IS BEST SEEN IN COMPUTED TOMOGRAPHY AS CYST LIKE SPACES TREATED WITH ANTIBIOTICS, REST, HYDRATION AND DEEP BREATHING TECHNIQUES

Aspiration PNA:

Aspiration PNA OCCURS IN PATIENTS WITH ESOPHAGEAL OBSTRUCTION OR NEUROMUSCULAR DISTURBANCES. ASPIRATION OF ESOPHAGEAL OR GASTRIC CONTENTS INTO THE LUNG APPEARS AS MULTIPLE DENSITIES THROUGHOUT BOTH LUNGS POSTERIOR AND LOWER LOBES ARE AFFECTED TREATED WITH ANTIBIOTICS, CORTICOSTEROID Chest radiographs reveal edema appearing as densities radiating from one or both hila into the dependent segments

Inflammatory Diseases:

Inflammatory Diseases Viral (interstitial) pneumonia Most commonly caused by influenza More common than bacterial, but less severe Diagnosis based on clinical findings and serologic tests- radiographic findings are minimal

LUNG ABSCESS:

LUNG ABSCESS A LUNG ABSCESS IS A NECROTIC AREA OF PULMONARY PARENCHYMA CONTAINING PURULENT(PUSLIKE) MATERIAL IS THE RESULT OF BACTERIA, BRONCHIAL OBSTRUCTION, ASPIRATION, FOREIGN BODY, BACTEREMIA AND SEPTIC EMBOLI ASPIRATION IS THE MOST COMMON CAUSE CLINICALLY A PATIENT WILL HAVE FEVER, COUGH AND SMELLY SPUTUM

LUNG ABSCESS:

LUNG ABSCESS LUNG ABSCESS CAN SPREAD TO THE BRAIN CARRIED BY THE BLOOD APPEARS AS A SPHERICAL DENSITY WITH A DENSE CENTER AND POORLY DEFINED PERIPHERY CT CAN ASSIST IN THE DIAGNOSIS

LUNG ABSCESS:

LUNG ABSCESS

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