CARDIOVASCULAR SYSTEM

• Respiratory System Menu


  • Bronchopneumonia
  • Aspiration Pneumonia
  • Lung Abscess
  • Tuberculosis
  • Primary Tuberculosis
  • Secondary Tuberculosis
  • Miliary Tuberculosis
  • Multi-drug Resistant TB
  • Plumbage
  • Thoracoplasty
  • Histoplasmosis
  • Bronchiectasis
  • COPD
  • Emphysema
  • Pneumoconiosis
  • Pulmonary Embolus
  • Lung Cancer
  • Bronchogenic Carcinoma
  • Pulmonary Metastasis
  • Pulmonary Edema
  • Atelectasis
  • Pneumothorax
  • Subcutaneous Emphysema
  • Pleural Effusion
  • Infant Respiratory Distress Syndrome
• Bronchopneumonia


  Bacterial infection that originates in the airway and spreads out to the alveoli, produces an immune response within the lungs that causes the alveolar sacs to fill with an exudate, appears as a patchy consolidation within the lungs
• Aspiration Pneumonia


  Occurs as the result of the patient inhaling a foreign material into their bronchial tree, often caused by a swallowing dysfunction
• Lung Abscess


  Walled-off, necrotic area of lung tissue containing pus, usually a complication of alcoholism but can also be caused by bacterial pneumonia, treated primarily with antibiotics but may require needle aspiration
• Tuberculosis (TB) or Consumption


  Caused by inhaling mycobacteria, spread primarily by air droplets, diagnosed through TB skin test (Mantoux/PPD) and sputum test (AFB), treated with Isoniazid for at least six months
• Primary TB


  Initial attack of TB that does not cause noticeable symptoms in the early stages, if the body's immune system fails to neutralize the mycobacteria, the onset of active TB occurs with symptoms like coughing, hemoptysis, night sweats, fever, and weight loss
• Secondary or Reinfection TB


  Proliferation of dormant mycobacteria within the tubercles, results in large scars and cavitation within the lungs, patients with compromised immune systems like HIV are at higher risk
• Miliary or Hematogenous TB


  Mycobacteria enter the circulatory system by eroding the pulmonary vein, can seed in organs like the liver and spleen, presents with a uniform distribution of fine densities in both lungs resembling millet seeds, a serious condition that is almost always fatal if left untreated
• Multi-drug Resistant TB


  Type of TB that is resistant to two or more medications, often found in HIV positive patients due to compromised immune system, can also occur when patients do not take prescriptions properly
• TB Treatment: Plumbage


  Prior to isoniazid, a common treatment was to collapse the lung to allow it to "rest", had no value in fighting the disease, one method was to surgically insert ping pong balls into the pleural space
• TB


  Named because of its radiographic appearance to millets, which are a group of small-seeded species of cereal crops or grains
• Miliary TB


  • Uniformly distributed grainy or millet-like appearance of the lung fields caused by the hematogenous characteristic of this disease
• This is a magnified view of the previous image
• Multi-drug Resistant TB


  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
• Multi-drug resistant TB can also occur when patients do not take their prescriptions properly
• TB Treatment: Plumbage


  1. Prior to the discovery of isoniazid, early methods to treat patients with TB relied heavily upon rest and isolation in sanatoriums

  2. A common treatment was to collapse the lung in order to allow it to "rest"

  3. This technique had absolutely no value in fighting this disease

  4. 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

  5. This technique was know as plumbage
• The spherical lucencies on this radiograph are actually ping pong balls that have been surgically inserted into the patient's thorax to prevent the mediastinal structures from shifting into the empty right lung field
• TB Treatment: Thoracoplasty


  1. Another type of treatment for TB prior to the use of effective medications was a procedure called a thoracoplasty

  2. This technique involved removing some of the ribs from the chest wall in order to cause the upper lobe of the lung to collapse

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

  4. Physicians generally would only remove 2 or 3 at a time and as a result, the patient would have to endure several surgeries
• The deformity seen on the right side of this patient's thorax is the result of an antiquated method to treat TB called thoracoplasty
• This is a magnified view of the previous image of a thoracoplasty
• Histoplasmosis


  • Condition that 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
• The radiopaque calcifications found within the lung fields of this patient are caused by a fungal infection called histoplasmosis, which has a similar radiographic appearance to that of TB
• Bronchiectasis


  • Characterized by an irreversible dilation of the bronchi caused by a bacterial infection
  • It usually affects the base of both lungs
  • Signs and symptoms 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)

  • A term used to describe two lung diseases, chronic bronchitis and emphysema
  • These two diseases tend to coexist and pertain to an obstruction of the normal flow of air within the lungs
  • Smoking is the primary risk factor for COPD, with up to 90% of COPD related deaths related to smoking
• Emphysema


  • A type of COPD 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 but it can also be caused by pollution or an inherited lack of an enzyme called alpha-1-antitrypsin
• Note the "barrel-chest" look on the lateral chest radiograph and the loss of the normally "dome-shaped" diaphragm
• This patient has emphysema with marked oligemia which is a lack of blood volume, resulting in a lack of lung markings (blood vessels) in the upper lung fields
• This patient suffers from a large ruptured bulla in the right lower lung field, often referred to as bullous emphysema
• Normal CT of the lung has a uniform density that is traversed by vessels and airways
• The lungs here show multiple, large, black, radiolucent, emphysematous spaces. The small, rounded, radiopaque circles and adjacent circles with black centers represent arteries and airways, respectively
• This is another CT scan that clearly demonstrates severe bullous emphysema
• Pneumoconiosis


  • An occupational disease where dust or particulate matter is inhaled, causing the formation of pulmonary fibrosis
  • Types include silicosis (caused by inhaling silicon dioxide), asbestosis (caused by inhaling asbestos dust), and black lung disease (caused by inhaling coal dust)
  • Patients possess very distinct radiopaque pleural plaques
• The patchy lung consolidations are the result of inhaling dust or particulate matter over a period of time
• This patient suffers from a chronic exposure to asbestos, with pleural plaques that are characteristic of asbestosis
• This is a different patient but a better representation of the pleural plaques characteristic of asbestosis
• Pulmonary Embolus (PE)


  • Often caused by blood clots that break off from veins in the legs, forming 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 patient with blood clots in the veins of their legs is said to have a condition called deep vein thrombosis (DVT)
  • A PE is most often seen in elderly, bedridden patients, and in postoperative patients
  • A chest X-ray may demonstrate an area of consolidation commonly referred to as "Hampton's Hump"
• Symptoms of Pulmonary Embolus

  • Chest Pain
  • Dyspnea (Shortness of Breath)
  • Cough
  • Hemoptysis (coughing up blood)
  • Dyspnea (difficulty breathing)
  • Pneumothorax (lung collapse)
  • Cyanosis (blue discoloration)
• Diagnostic tests for Pulmonary Embolus

  • Arterial Blood Gas
  • Pulse Oximetry
  • Routine Chest X-ray
  • Ventilation/Perfusion Scan in Nuclear Medicine
  • Pulmonary Arteriogram
  • CT Angiogram of the Chest
  • Doppler Ultrasound to Detect DVT
• Treatment options for Pulmonary Embolus

  • Blood Thinners (heparin)
  • Thrombolytic Therapy (streptokinase/urokinase) to Dissolve the Clot
  • Insertion of an Inferior Vena Cava Filter
  • Surgery