Chest Pathology

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Chest Pathology

• Dr. Vicki Shaver

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Terms to Know Radiolucent

• Dark air pattern
• Results from beam penetrating part
• Minimal patient attenuation

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Radiodense

• White pattern
• Results from beam attenuation
• Represents solid structure or fluid within the
  area of interest

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Other terms

• Infiltrate
• Any ill-defined radio-density
• Consolidation
• White solid area
• Pneumonia or pleura effusion

• Dyspnea
• Difficulty breathing
• Apnea
• Without breathing

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Vascular Markings

• Lymphatics, vessels, lung tissue
• Increased markings in CHF
• Absent markings in pneumothorax

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Congenital Disorders

• The stuff kids are born with

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Cystic Fibrosis

• Inherited childhood disease
• Thick mucosal accumulations
• Abnormal saliva and sweat secretions

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Hyaline Membrane Disease

• Respiratory distress syndrome
• Leading cause of infant mortality
• Inadequate ventilation
• Surfactant

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Inflammatory Disorders

• Acquired disease that produces an inflammatory
  response

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Croup

• Viral infection
• Laryngitis and spasm
• Bark like cough

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Alveolar Pneumonia

• Acute infection of lung parenchyma
• Organisms cause exudate
• Radiopaque
• Involve segment or lobes

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Bronchopneumonia

• Infection of bronchi
• Produces small patches of consolidation
• Gradual onset
• Usually
• bacterial

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Interstitial Pneumonia

• Viral or fungal infections
• Distribution diffuse
• Pt c/o flu symptoms

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Aspiration pneumonia

• Esophageal or gastric contents into lung
• Foreign material causes infection

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Lung Abscess

• Necrotic lung that contains pus
• Usually has an air fluid level within the cavity

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Tuberculosis

• Mycobacterium tb
• Bacterial infection
• Spread by droplet spray
• Has many radiographic appearances/stages

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Histoplasmosis

• Diffuse markings of infection
• Caused by bird droppings

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COPD

• Chronic Obstructive Pulmonary Disease
• Emphysema
• Asthma
• Chronic Bronchitis

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Emphysema

• Brittle alveolar sacs
• Expand and burst
• Minimal perfusion
• Lungs compensate by becoming larger
• Barrel chest

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Asthma

• Spasm of bronchi
• Triggered by allergies
• Infection or exercise
• Wheezing
• Coughing
• Difficulty breathing

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Bronchiectasis

• Permanent dilation of bronchi
• Destruction of elastic properties of lung
• Chronic productive cough

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Pneumoconiosis

• Extended occupational exposure to foreign
  particles
• Silicosis
• Asbestosis
• Anthracosis -coal

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Neoplasms

• New growths
• Benign or malignant

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Adenoma

• Hemoptysis
• Blood in sputum
• Associated with recurring pneumonia

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Carcinoma

• Primary lung cancer appears as dense mass
• Malignancy has fuzzy border
• Many cell types
• Surgery and chemo

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Pulmonary Metastases

• Secondary to other cancer location

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Vascular Disorders
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Pulmonary embolism

• Blood clots which break loose from veins
• Travel to lung and lodge in place
• Severe chest pain
• Looks like a wedge

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Pulmonary Embolus

• Blood clots
• Lodged in lung
• Painful and may threaten life

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Pulmonary Edema

• Butterfly sign
• Collection of fluid in lungs secondary to CHF

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Misc. Disorders
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Atelectasis

• Collapse of all or part of lung
• Lung does not expand
• Referred to as plate-like atelectasis

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ARDS

• Adult Resp Distress Syndrome
• Severe distress
• Usually in pt with many other disorders
• May be fatal

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Pneumothorax

• Air in the pleural cavity
• Causes collapse of segment of lung
• May require chest tube
• Spontaneous vs traumatic

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Pleural Effusion

• Accumulation of fluid in pleural space
• CHF
• PE
• TB

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Empyema

• Pus in pleural space

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Ports and Tubes

• Endotracheal tubes
• Used to establish ventilation
• Should be below vocal cords and no close than 2
  cm to carina
• Approx at aortic knob

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Chest tubes

• Provide drainage of pleural cavity
• Evacuate air from pleural space
• Remember to keep this below chest

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Dobhoff Tubes

• Small, fine, flexible feeding tube with weighted
  tip
• Too thin for BASO4
• CXR to see diaphragms at 1 density
• Tube in R bronchus

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Pacemaker Insertion

• Pacer leads are electrically insulated wires
• Tip is in direct contact with rt. Ventricle
• Battery packs last from 5-10 years

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Swan-Ganz

• Venous catheter
• Used to measure pulmonary artery pressure

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Hickman Catheter

• Central venous line
• Used for oncology
• Double or triple port system

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Infusiport

• Central venous line
• Single or double lumen
• Blunt needle access
• Less risk of infection/ easy maintenance

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PICC Lines

• Percutaneous IV central catheter
• Small diameter inserted through anticubital
• Treated like a peripheral line

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