RESPIRATORY PATHOLOGY

• A pleural rub helps diagnose pleurisy, pneumonia, and other conditions affecting the. lungs. This condition occurs where the pleural layers are inflamed and have lost their lubrication.
• Fine, crackling or bubbling sounds, commonly heard during inspiration when there is fluid in the alveoli; also called crackles
• Rales are commonly associated with bronchitis, pneumonia, and heart failure (HF). Rales that do not clear after a cough may indicate pulmonary edema or fluid in the alveoli due to HF or acute respiratory distress syndrome (ARDS).
• Rhonchi indicate inflammation and congestion of the bronchi caused by inflammation,mucus, or a foreign body that partially obstructs the bronchi.
• Stridor is characteristic of the upper respiratory disorder called croup. It is also caused by an allergic reaction, airway injury, throat abscess, or laryngitis
• Wheezes occur in such conditions as asthma, croup, hay fever, and emphysema
• coryza - Acute inflammation of nasal passages accompanied by profuse nasal discharge; also called a cold
• influenza - Acute, contagious respiratory infection characterized by sudden onset of fever, chills, headache, and muscle pain
• pertussis - Acute infectious disease characterized by a cough with a sound like a “whoop”; also called whooping cough
• sudden infant death syndrome (SIDS) - Completely unexpected and unexplained death of an apparently well, or virtually well, infant; also called crib death
• Bronchopneumonia:

  • This type of pneumonia is caused by a bacterial infection

  that originates in the airway and spreads out to the alveoli.

  • It produces an immune response within the lungs that causes

  the alveolar sacs to fill with an exudate.

  Radiographically, this appears as a patchy consolidation

  within the lungs.
• Aspiration Pneumonia:

  • This type of pneumonia occurs as the result of the patient

  inhaling a foreign material into their bronchial tree.

  • It is often caused by a swallowing dysfunction.
• Lung Abscess:

  • A lung abscess is a walled-off, necrotic area of lung tissue containing pus.

  • It is usually a complication of alcoholism but it can also be

  caused by bacterial pneumonia.

  • The use of antibiotics is the primary course of treatment but

  in some instances, a needle aspiration may be indicated
• Tuberculosis (TB) or Consumption:

  • TB is caused by inhaling mycobacteria.

  • It is spread primarily by air droplets but may be spread by

  inhaling dried mycobacteria as well.

  • Diagnosis

  A TB skin test (Mantoux/PPD) is the method of choice to

  determine exposure.

  Small, red bumps will appear within 72 hours after the

  injection if the patient has been exposed to TB.

  Future TB skin tests are no longer necessary as the

  patient will always test positive.
• Tuberculosis (TB) or Consumption:

  • A positive test result will be confirmed with a sputum

  test (AFB) and the presence of the active disease can be

  ruled out with a chest radiograph.

  Yearly chest radiographs may be ordered to rule out the

  active disease.

  • Isoniazid is a common medication prescribed to treat the

  active disease and it must be taken for at least six

  months.
• Primary TB:

  • This refers to the initial attack of TB and it does not cause

  noticeable symptoms in the early stages.

  Fortunately, the victim is not contagious at this point.

  • In healthy patients, the body’s normal immune system will

  take the mycobacteria to lymph nodes where it will be

  neutralized.

  If this fails to occur, the mycobacteria can multiply and

  this then marks the onset of active TB.

  Patients experience symptoms such as coughing,

  hemoptysis, night sweats, fever, and weight loss.

  The patient is now at a contagious point in the

  progression of the disease.
• Primary TB:

  • In an attempt to neutralize the infection the body’s

  immune system will form a wall around the mycobacteria.

  • This walled off area will usually appear as a tubercle or a

  calcification in the upper lung fields on a radiograph.
• Secondary or Reinfection TB:

  • The proliferation of dormant mycobacteria within the

  tubercles marks the onset of secondary TB.

  • Large scars and cavitation will form within the lungs as the

  body struggles to once again contain the infection.

  The net result is the permanent loss of lung tissue and

  lung volume.

  • Patients who are HIV positive are at a higher risk of

  developing secondary TB due to their compromised

  immune system.
• Miliary or Hematogenous TB:

  • The mycobacteria can enter the circulatory system by

  eroding the pulmonary vein.

  • If this occurs, it can seed in such organs as the liver and

  spleen through the systemic circulation.

  • Since it is now bloodborne, the bacteria may enter the blood

  flow to the lung and produce innumerable fine densities

  uniformly distributed in both lungs.

  • This presents as a bird seed or “millet” type of

  radiographic appearance and hence the name, miliary TB.

  • This is a serious condition and if left untreated, it is almost

  always fatal.
• Multi-drug Resistant TB:

  • This is a type of TB that is resistant to two or more of the

  medications used to combat TB.

  • This type of TB is often found in HIV positive patients and

  is due to their already compromised immune system.

  • It can also occur when patients do not take their

  prescriptions properly
• TB Treatment: Plumbage

  • Prior to the discovery of isoniazid, early methods to treat

  patients with TB relied heavily upon rest and isolation in

  sanatoriums.

  • A common treatment was to collapse the lung in order to

  allow it to “rest.”

  •This technique had absolutely no value in fighting this

  disease.

  • One method employed to “rest” the lung was to

  surgically insert ping pong balls into the pleural space of

  the upper lung field in order to compress the lung.

  • This technique was know as plumbage.
• TB Treatment: Thoracoplasty

  • Another type of treatment for TB prior to the use of

  effective medications was a procedure called a thoracoplasty

  • This technique involved removing some of the ribs from

  the chest wall in order to cause the upper lobe of the lung

  to collapse.

  • Ideally, a total of 7 to 8 ribs would be removed.

  Physicians generally would only remove 2 or 3 at a time

  and as a result, the patient would have to endure several

  surgeries.
• Histoplasmosis:

  • This condition occurs as the result of inhaling soil and/or

  bat/bird droppings that have been infected with a fungus

  called Histoplasma capsulatum.

  • It has a similar radiographic appearance to TB.

  • Most cases of histoplasmosis are self limiting but in some

  extreme cases, anti-fungal medications may be indicated.
• Bronchiectasis:

  • Bronchiectasis is characterized by an irreversible dilation of

  the bronchi caused by a bacterial infection.

  • It usually affects the base of both lungs.

  • Signs and symptoms of this disease include a chronic

  cough, acute pneumonia, and hemoptysis.

  • Treatment includes controlling infections, postural drainage,

  and surgical resection of the affected area.
• • Chronic obstructive pulmonary disease (COPD) is a term

  used to describe two lung diseases, chronic bronchitis and

  emphysema.

  •These two diseases tend to coexist.

  •They also both pertain to an obstruction of the normal

  flow of air within the lungs.

  •As a result, physicians collectively refer to them as

  COPD.

  • Smoking is the primary risk factor for COPD.

  Up to 90% of COPD related deaths are related to

  smoking
• • Emphysema is a type of COPD that is characterized by a

  chronic destruction of bronchi and alveoli.

  • The destruction and rupture of the alveolar walls will

  lead to the formation of large pockets of empty space

  within the lungs called bulla.

  The net result is a decrease in air flow, hyperaeration

  (barrel chest), and dyspnea.

  • Smoking is the primary risk factor for emphysema but it can

  also be cause by pollution or an inherited lack of an enzyme

  called alpha-1-antitrypsin.
• Pneumoconiosis:

  • This is an occupational disease where dust or particulate

  matter is inhaled.

  • This causes the formation of pulmonary fibrosis.

  • Types:

  • Silicosis is caused by inhaling silicon dioxide (sand).

  • Asbestosis occurs as the result of inhaling asbestos dust.

  • Patients who present with this disease possesses very

  distinct radiopaque pleural plaques.

  • Black lung disease is caused by inhaling coal dust.
• Pulmonary Embolus (PE):

  • Pulmonary emboli are often caused by blood clots that

  break off from veins in the legs.

  These clots form emboli that can obstruct the lumen of

  the pulmonary arteries.

  • Many times this will resolve on its own but large

  obstructions can infarct the lung and lead to death.

  • A PE is most often seen in elderly, bedridden patients, and

  in postoperative patients.

  • A chest X-ray may demonstrate an area of consolidation

  that is commonly referred to as “Hampton’s Hump.”
• A patient with blood clots in the veins of their legs is said

  to have a condition called deep vein thrombosis (DVT)
• Pulmonary Embolus (PE):

  • A variety of treatment options are available for a PE.

  • The definitive choice is dependent upon the severity of the

  condition.

  • Treatment options are as follows:

  Blood Thinners (heparin)

  Thrombolytic Therapy (streptokinase/urokinase) to

  Dissolve the Clot

  Insertion of an Inferior Vena Cava Filter

  Surgery
• Lung Cancer:

  • Lung cancer represents approximately 35% of all cancer

  deaths and it is the most common cause of death in both

  men and women.

  • The average onset is age 60.

  • Smokers are 10 times more likely to develop lung cancer

  than non smokers.

  • The most common symptoms of lung cancer are coughing,

  hemoptysis, dyspnea (SOB), and anorexia (weight loss).

  • A biopsy is required to make a definitive diagnosis.

  • Common treatments for lung cancer include surgery,

  radiation therapy, and chemotherapy.
• Bronchogenic Carcinoma:

  • This is a primary lung cancer that arises from the respiratory

  epithelium.

  • It is divided into the following two broad categories:

  Small Cell Lung Cancer (SCLC)

  Non Small Cell Lung Cancer (NSCLC)

  • Bronchogenic carcinoma has a poor prognosis with a 5-year

  survival rate of 12 to 14%.
• Pulmonary Metastasis:

  • Pulmonary metastasis (secondary lung cancer) is much

  more common than primary lung cancer.

  • It primarily occurs via the lymphatic system or the

  circulatory system.

  • It is common from the following types of primary cancer:

  Breast Cancer

  Colon Cancer

  Prostate Cancer

  • Treatment for pulmonary metastasis varies according to the

  type of primary cancer that is involved.
• Pulmonary Metastasis: cotton ball radiographic appearance
• Pulmonary Edema:

  • Pulmonary edema occurs when air within the lungs is

  replaced with fluid.

  • It leads to a decrease in gas exchange and may cause

  respiratory failure.

  • It often occurs secondary to congestive heart failure (CHF)

  or renal failure.

  • Treatment includes the administration of oxygen and

  diuretics.

  • Removing the underlying cause of the pulmonary edema

  is the most important consideration for treatment.
• The congested radiographic appearance of this image is the result of pulmonary edema.
• Atelectasis:

  • Atelectasis refers to a condition where either a portion of or

  the entire lung has collapsed and is without air.

  • It results from a bronchial obstruction that can be caused by

  any of the following conditions:

  Tumor

  Foreign Body

  Mucous Plug

  • This is a common cause for acute atelectasis especially

  postoperatively following chest or abdominal surgery
• Pneumothorax:

  • A tension pneumothorax is a life-threatening condition that

  is caused by a ball-valve type of fistula.

  •A fistula is an abnormal passageway between two

  structures that do not normally connect.

  • Treatment for a pneumothorax often includes the insertion

  of a chest tube.

  • The chest tube will restore the normal “negative

  pressure” within the pleural space thus providing the

  means for the lung to aerate.

  • It will also remove any excess fluid that may have

  accumulated within the pleural space.
• Pneumothorax:

  • A pneumothorax is a condition occurs when air is

  introduced into the pleural space.

  •The net result of this phenomena is a collapsed lung.

  • Common causes of a pneumothorax include the following:

  •Trauma

  - May be the result of a penetrating chest wound.

  - Ruptured Bulla from Emphysema

  • Spontaneous

  - Most commonly found in tall, thin, young males.

  • Iatrogenic

  - May be caused during a thoracentesis or chest tube

  - insertion.
• Subcutaneous Emphysema:

  • Air escaping the patients lungs following a traumatic

  pneumothorax may enter the patients surrounding tissues.

  • This condition is know as subcutaneous emphysema and if

  palpated, it will make a very distinct crackling or popping

  noise that is referred to as crepitation.

  • This air is eventually absorbed by the body