OBSTRUCTIVE LUNG DISEASES

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

OBSTRUCTIVE AIRWAY DISEASES:

OBSTRUCTIVE AIRWAY DISEASES Dr Neelam Malik Nishtar hospital Radiology Department

Slide3:

Chronic bronchitis is defined in clinical terms as a chronic cough without demonstrable cause,with expectoration on most days during atleast three consecutive months for more than two consecutive years

bronchitis:

bronchitis

Slide8:

Asthma refers to widespread narrowing of the bronchi which is paroxysmal and reversible

asthma:

asthma

Slide11:

Emphysema is defined as an increase beyond the normal in the size of air spaces distal to terminal bronchioles,with dilatation and destruction of their walls.

Slide13:

Clinically and radiologically a patient may have manifestations of more than one kind of chronic obstructive airways disease.

ASTHMA:

ASTHMA Hyper-reactivity of the larger airways to variety of stimuli causing narrowing of the bronchi,wheezing and often dyspnea. Extrinsic astma with history of allergy and intrinsic asthma precipitated by exercise,emotions and infection.

Slide17:

Role of radiology in asthma is limited Most asthmatics show normal CXR during remissions

Slide18:

During an asthmatic attack a chest xray may show signs of hyperinflation with depression of diaphragm and expansion of retrosternal air. mediastinal emphysema may occur secondary to rupture at terminal bronchiolar level or beyond and occasionally this may lead to pneumothorax

OBSTRUCTIVE AIRWAY DISEASES:

OBSTRUCTIVE AIRWAY DISEASES

Slide20:

Chronic bronchitis is defined in clinical terms as a chronic cough without demonstrable cause,with expectoration on most days during atleast three consecutive months for more than two consecutive years

bronchitis:

bronchitis

Slide25:

Asthma refers to widespread narrowing of the bronchi which is paroxysmal and reversible

asthma:

asthma

Slide28:

Emphysema is defined as an increase beyond the normal in the size of air spaces distal to terminal bronchioles,with dilatation and destruction of their walls.

Slide30:

Clinically and radiologically a patient may have manifestations of more than one kind of chronic obstructive airways disease.

ASTHMA:

ASTHMA Hyper-reactivity of the larger airways to variety of stimuli causing narrowing of the bronchi,wheezing and often dyspnea. Extrinsic astma with history of allergy and intrinsic asthma precipitated by exercise,emotions and infection.

Slide34:

Role of radiology in asthma is limited Most asthmatics show normal CXR during remissions

Slide35:

During an asthmatic attack a chest xray may show signs of hyperinflation with depression of diaphragm and expansion of retrosternal air. mediastinal emphysema may occur secondary to rupture at terminal bronchiolar level or beyond and occasionally this may lead to pneumothorax

Mechanism of pneumomediastinum:

Mechanism of pneumomediastinum

Vertical and Paratracheal Lucent Streaks in pneumomediastinum:

Vertical and Paratracheal Lucent Streaks in pneumomediastinum Vertical lucent streak along the left side of the heart and the aortic arch, showing the pleura as a fine opaque line (long arrows). Linear paratracheal lucent streak (short arrows).

Continuous diaphragm sign, example:

Continuous diaphragm sign, example

Slide39:

Lateral chest radiograph (close-up view of hilar area) in a 17-year-old boy with asthma with spontaneous pneumomediastinum shows a well-defined lucency (arrows) along the right pulmonary artery due to mediastinal air Agarwal P P Radiology 2006;241:943-944 ©2006 by Radiological Society of North America

Slide40:

Peripheral pulmonary vessels appear normal but if the central pulmonary arteries are enlarged irreversible pulmonary arterial hypertension is probably present.

Slide41:

Role of radiology is to exclude complications like infections,atelectasis due to mucus blugging or pneumothorax.

Slide42:

High-resolution CT scan obtained in 72-year-old woman with chronic asthma shows bronchial wall thickening (large arrows) with associated narrowing of bronchial lumen. Also noted are subtle areas of decreased attenuation and vascularity (small arrows), Read More: http://www.ajronline.org/doi/full/10.2214/ajr.183.3.1830817

Slide43:

45-year-old woman with asthma and air trapping. High-resolution CT scan obtained at level of aortic arch shows subtle areas (arrows) of decreased attenuation and vascularity. Read More: http://www.ajronline.org/doi/full/10.2214/ajr.183.3.1830817

Slide44:

45-year-old woman with asthma and air trapping. High-resolution CT scan obtained at maximal expiration shows bilateral areas of air trapping with associated decrease (arrows) in vascularity. Presence of parenchymal abnormalities due to airway obstruction is much more readily seen on expiratory scan. Note invagination of posterior tracheal wall, which aids in identifying this as expiratory scan. Read More: http://www.ajronline.org/doi/full/10.2214/ajr.183.3.1830817

Slide45:

56-year-old man with allergic bronchopulmonary aspergillosis. High-resolution MDCT scan obtained at level of lower lobe bronchi shows central bronchiectasis, areas of decreased attenuation and vascularity, and mucoid impaction (arrows). Read More: http://www.ajronline.org/doi/full/10.2214/ajr.183.3.1830817

Slide46:

56-year-old man with allergic bronchopulmonary aspergillosis. Sagittal reformatted image of right lung shows equal severity of upper and lower lobe bronchiectasis and extensive areas of decrease attenuation and vascularity. Also noted are a few small centrilobular nodules (arrows). Read More: http://www.ajronline.org/doi/full/10.2214/ajr.183.3.1830817

Slide47:

Lateral chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Air is noted anterior to the trachea (same

Slide48:

High-resolution CT scan of the thorax obtained during inspiration demonstrates airtrapping in a patient with asthma. Inspiratory findings are normal.

Slide49:

High-resolution CT scan of the thorax obtained during expiration demonstrates a mosaic pattern of lung attenuation in a patient with asthma. Lucent areas (arrows) represent areas of airtrapping (same patient as in the previous image).

Slide50:

Asthma. High-resolution CT scan of the thorax demonstrates central bronchiectasis, a hallmark of allergic bronchopulmonary aspergillosis (right arrow), and the peripheral tree-in-bud appearance of centrilobular opacities (left arrow), which represent mucoid impaction of the small bronchioles.

Slide51:

52-year-old man with asthma and bronchiectasis. High-resolution MDCT scan shows bilateral bronchiectasis (straight arrows) and areas of decreased attenuation and vascularity (curved arrows). Note that bronchi are dilated but are not thick-walled. Read More: http://www.ajronline.org/doi/full/10.2214/ajr.183.3.1830817

Slide52:

52-year-old man with asthma and bronchiectasis. Coronal reformatted image shows ectatic bronchi and areas of decreased attenuation and vascularity in lower lobes (arrows) and normal upper lobes. Read More: http://www.ajronline.org/doi/full/10.2214/ajr.183.3.1830817

Slide53:

HRCT may show bronchial wall thickening, tubular bronchiectasis, mucoid impaction and areas of decreased attenuation in the lung parenchyma.

CHRONIC BRONCHITIS:

CHRONIC BRONCHITIS There is hypertrophy of the mucus secreting glands of the bronchi ,their secretions are more viscous leading to plugging of small airways They are almost always smokers and usually male Other etiologies are pollution and low socioeconomic status

Slide55:

Role of radiology is to detect and assess complications and any coincidental diseases. Pulmonary emphysema is a common complication can be assessed radiographically and corpulmonale can occur

Slide56:

50% patients with chronic bronchitis have a normal CXR .in patients with plain film abnormality the signs are due to emphysema,infection or possibly bronchiectasis.

Slide57:

An appearance which suggests chronic bronchitis is the dirty chest,there is generalized accentuation of bronchovascular markings. Small poorly defined opacities may be seen anywhere in the lungs. The tramline or tubular shadows may also be seen suggesting bronchiectasis

EMPHYSEMA:

EMPHYSEMA Secondary pulmonary lobule

Slide61:

Radiograph of 1-mm lung slice taken from peripheral lower lobe. Two well-defined secondary pulmonary lobules are visible. Lobules are marginated by thin interlobular septa (S) containing pulmonary vein (V) branches. Bronchioles (B) and pulmonary arteries (A) are centrilobular.

Types of emphysema:

Types of emphysema 1)Panacinar It is non selective process in which there is destruction of all of the lung distal to terminal bronchiole. Basal predominance May be associated with centriacinar emphysema and also alpa1 antitrypsisn deficiency.

Slide65:

Radiological features Reduction of pulmonary vascularity peripherally Hyperinflation of the lungs Alteration of the cardiac shadow and central pulmonary arteries

Slide66:

2) Centriacinar emphysema It is a selective process in which there is destruction and dilatation of the respiratory bronchioles,the alveolar ducts,sacs and alveoli are spared until late stage. Upper zone more severely involved Usually found in smokers.

Slide68:

Radiological features This occur principally in chronic bronchitis and uncomplicated coal miners pneumoconiosis. The radiological appearance is that of primary condition .In later stages panacinar and bullous emphysema may become apparent

Slide69:

Hyperintlated both lungs with patchy small areas of abnormal lucencies seen involving the upper and peripheral lobes of both lungs consistent with centrilobular emphysema. There is pneumonic consolidation with air bronchogram formation involving the anterior segment of right upper lobe.

Slide70:

Chest radiograph of an emphysematous patient shows hyperinflated lungs with reduced vascular markings. Pulmonary hila are prominent, suggesting some degree of pulmonary hypertension (Corrêa da Silva, 2001).

Slide71:

Axial CT image obtained in a 66- year-old man with COPD and severe airflow obstruction (percentage of predicted FEV1, 40.8%) shows mild emphysema (relative low-attenuation area with attenuation of −950 HU or lower, 5.8%). Low-attenuation areas representing emphysematous change (“holes”) are indicated by arrowheads.

Slide72:

Axial CT image obtained in an asymptomatic 69-year-old smoker with normal pulmonary function (percentage of predicted FEV1, 87.8%) shows moderate to severe emphysema (arrowheads) (relative low-attenuation area with attenuation of −950 HU or lower, 25.8%).

Slide73:

Emphysema is defined histologically as permanent enlargement of the airspace distal to the terminal bronchioles and destruction of the alveolar wall (20). Areas of the lung that are affected by emphysema have reduced CT attenuation coefficients. Emphysema may be further characterized as centrilobular or panlobular (21). Centrilobular emphysema affects the lobules around the central respiratory bronchioles (22) and is the most common type of smoking-related emphysema. Centrilobular emphysema is typically found in the upper lung zone (23,24). It is depicted on CT images as a low-attenuation area surrounded by normal lung attenuation. Panlobular emphysema uniformly affects the entire secondary lobule (25). It appears as a generalized decrease in CT attenuation, predominantly in the lower lobe (24). The vessels in affected regions of the lung are reduced in number and caliber. Although this pattern is typically associated with α1-antitrypsin deficiency, it also may be seen in severe smoking-related emphysema.

Slide74:

a) Axial CT image obtained in a 72-year-old man with COPD shows multiple low-attenuation areas of emphysema

Slide75:

) Axial CT image obtained with data segmentation shows the same lung field as in a. The total lung parenchymal area (areas with attenuation of −500 to −1024 HU) is depicted in red, and vascular and other structures are shown in gray.

Slide76:

Axial CT image obtained with data segmentation shows the same lung field as in a and b. Voxels with attenuation of −950 HU or lower are depicted in red, and those with attenuation of −500 to −949 HU are depicted in black. (Vascular and other nonparenchymal structures are shown in gray.) To quantify the extent of emphysema, the percentage of the total lung area occupied by voxels with attenuation of −950 HU or lower (ie, the relative low-attenuation area) can be calculated from these segmented CT image data.

Slide77:

Axial CT image obtained in a 68-year-old man with COPD shows multiple areas of low attenuation indicative of emphysema

Slide78:

Axial image obtained with binary segmentation of CT data from the same lung field as in a shows clustered areas with low attenuation of −950 HU or less (black). The total number of low-attenuation clusters was 432 and their mean size was 11.6 mm2, according to calculations performed by using image analysis software.

Slide79:

Axial CT images obtained in a 57-year-old male smoker during inspiration (a

Slide80:

and expiration (b). Air trapping is depicted on the expiratory image as parenchymal areas with abnormally low attenuation (arrowheads in b).

Slide81:

Hyperexpansion and coase bronchovascular markings consistent with COPD.

Slide82:

Chest xrays demonstrates very marked hyperinflation of both lungs. Over 11 posterior ribs are seen, the diaphragms are flattened and there is enlargement of the retrosternal airspace. Pulmonary vasculature not terribly distorted, although there is some prominence of the pulmonary arteries.

Slide83:

Hyperinflated lungs (>10 ribs posteriorly), flattened diagphram, hyperlucency through lung fields bilaterally, narrow mediastinum. A radio-opacity also visible in the right lower zone, right hemidiagphram is not silhouetted out.

Slide85:

The thickness of the space between the ascending aorta and the sternum is normally no more than 2.5cm.

Slide86:

The normal dome of each hemidiaphragm should rise at least 1.5cm above a line connecting the costophrenic angle posteriorly and sternophrenic angle anteriorly.

Slide90:

Schematic representation of 1 criterion for defining flattening of the diaphragm on the lateral chest radiograph: drawing a line from the posterior to anterior costophrenic angles and measuring the distance from this line to the apex of the diaphragm. If the height is less than 1.5 cm, the criterion of flattening is fulfilled (Corrêa da Silva, 2001).

Slide91:

Schematic representation of another criterion for defining flattening of the diaphragm on the lateral chest radiograph. When the angle formed by the contact point between the diaphragm and the anterior thoracic wall is more than or equal to 90°, the criterion is fulfilled (Corrêa da Silva, 2001).

Slide92:

Schematic representation of another sign of emphysema on the lateral chest radiograph. When the retrosternal space (defined as the space between the posterior border of the sternum and the anterior wall of the mediastinum) is larger than 2.5 cm, it is highly suggestive of overinflated lungs. This radiograph is from a patient with pectus carinatum, an important differential diagnosis to consider when this space is measured (Corrêa da Silva, 2001).

Slide93:

Close-up image shows emphysematous bullae in the left upper lobe. Note the subpleural, thin-walled, cystlike appearance (Corrêa da Silva, 2001).

Slide94:

A, Frontal posteroanterior (PA) chest radiograph shows no abnormality of the pulmonary vasculature, with normal intercostal spaces and a diaphragmatic dome between the 6th and 7th anterior ribs on both sides. B, Image in a patient with emphysema demonstrating reduced pulmonary vasculature resulting in hyperlucent lungs. The intercostal spaces are mildly enlarged, and the diaphragmatic domes are straightened and below the extremity of the seventh rib (Corrêa da Silva, 2001).

Slide95:

A, Lateral radiograph of the chest shows normal pulmonary vasculature, a retrosternal space within normal limits (< 2.5 cm), and a normal angle between the diaphragm and the anterior thoracic wall. B, Lateral view of the chest shows increased pulmonary transparency, increased retrosternal space (>2.5 cm), and an angle between the thoracic wall and the diaphragm >90°. Straightening of the diaphragm can be more evident in this projection than on others (Corrêa da Silva, 2001).

Slide96:

High-resolution CT (HRCT) in a patient after viral bronchiolitis obliterans demonstrates areas of airtrapping, which is predominant in the inferior lobes and associated with bronchiectasis in the left lower lobe. Note that the decreased attenuation caused by the airtrapping can simulate emphysema (Corrêa da Silva, 2001).

Slide97:

3) Paraseptal emphysema It involves the periphery of the seconday lobule,usually in the lung periphery.

Slide99:

Para-septal emphysema affects the peripheral parts of the secondary pulmonary lobule, and is usually located adjacent to the pleural surfaces (including pleural fissures) . It is also associated with smoking, and can lead to the formation of subpleural bullae and spontaneous pneumothorax.

Slide100:

This patient presented for CT pulmonary angiogram to investigate possible pulmonary embolus. The image above is a good example of paraseptal emphysema. There is also a background of centrilobular emphysema. Pathological correlation is useful when studying emphysema. Paraseptal emphysema involves the alveolar ducts and sacs at the lung periphery. The emphysematous areas are often surrounded by interlobular septa (hence the name). It may be an incidental finding in young adults, and may be associated with spontaneous pneumothorax. It may also be seen in older patients with centrilobular emphysema (as in this case). Both centrilobular and paraseptal emphysema may progress to bulla formation. A bulla is defined as being at least 1cm in diameter, and with a wall less than 1mm thick. Bullae are thought to arise by air trapping in emphysematous spaces, causing local expansion.

Slide101:

4) Paracicatricial emphysema Destruction of terminal air spaces adjacent to fibrotic lesions and seen mostly in TB

Slide102:

5) Bullous disease They are usually present in kling in some form of emphysema but occasionally occur in otherwise normal lung.They commonly occur in paraseptal emphysema,and in emphysema associated with scarring but clinically most important are those due to panacinar emphysema.

Slide103:

They appear as round or oval translucencies vary in size from 1cm to occupation of entire hemithorax. They may be single or multiple They are usually peripheral And in those with fibrosis tend to be apical But in COPD found throughout the lungs. Their walls may be visible as smooth curved hairline shadows

Slide104:

They are airfilled and may become infected and filled with fluid, may show fluid level if partially filled or appear solid if completely fluid filled.

Slide105:

High-resolution CT (HRCT) shows large bullae in both inferior lobes due to uniform enlargement and destruction of the alveoli walls causing distortion of the pulmonary architecture (Corrêa da Silva, 2001).

Slide106:

Panacinar emphysema of the left lung in a patient with a right lung transplant. Note the red element showing the size of a normal acinus and its discrepancy with the destroyed and enlarged airspaces of the left lower lobe (Corrêa da Silva, 2001).

Slide107:

High-resolution CT (HRCT) shows bullae distributed in the subpleural spaces including the fissures; this is characteristic of paraseptal emphysema (Corrêa da Silva, 2001).

Slide108:

High-resolution CT (HRCT) shows subpleural bullae consistent with paraseptal emphysema. Red mark shows the size of a normal acinus (Corrêa da Silva, 2001).

Slide109:

High-resolution CT (HRCT) shows enlarged air-spaces or bullae adjoining pulmonary scars, consistent with paracicatricial emphysema. Red mark shows the size of a normal acinus (Corrêa da Silva, 2001).

Slide110:

CT densitovolumetry of a nonsmoker, healthy young patient shows normal lungs. Less than 0.35% of lungs have attenuations below -950 HU (Corrêa da Silva, 2001).

Slide111:

Expiratory CT densitovolumetry shows no areas of airtrapping (Corrêa da Silva, 2001).

Slide112:

CT densitovolumetry in a heavy smoker with emphysema revealed compromise of about 22% of the lung parenchyma (Corrêa da Silva, 2001).

Slide113:

CT densitovolumetry in a patient with lung cancer. Three-dimensional (3D) image shows that the cancer is in the portion of the right lung that was less affected by emphysema in a patient with poor pulmonary function (Corrêa da Silva, 2001).

Slide114:

CT densitovolumetry shows the attenuation mask. Green areas are those with attenuation below the selected threshold (here, -950 HU to evaluate emphysema), and pink areas are those with attenuations above the threshold. Area outside the patient is highlighted in green because of air (Corrêa da Silva, 2001).

Slide115:

CT densitovolumetry demonstrates irregular distribution of the emphysema, with substantial predominance in the left lung (Corrêa da Silva, 2001).

Slide116:

Pulmonary acinus measures 6-10 mm (red or blue). When normal, the distal terminal bronchiole used to define the acinus cannot be resolved on high-resolution CT (HRCT). Image represents the proportion of acini in relation to the lung image. One lobule, as Reid defined it, can have 3-5 acini (red groups). A secondary pulmonary lobule described by the interstitial septa can have as many as 100 acini (blue groups, the biggest one showing a pulmonary lobule containing about 35 acini) (Corrêa da Silva, 2001).

Slide118:

5)Compensatory emphysema 6)Congenital lobar emphysema

CLE:

CLE

Slide126:

Pediatric high-resolution CT (HRCT) shows a hyperinflated right lung with large pulmonary bullae due to congenital lobar emphysema (Corrêa da Silva, 2001).

authorStream Live Help