Lectures 4 and 5 Flashcards
(258 cards)
1
Q
What is a pulmonary nodule?
A
A lesion that is both within and surrounded by pulmonary parenchyma (also called coin lesion)
2
Q
A lesion > __ cm in diameter is called a mass
A
3cm
3
Q
Less than 3 cm in size and not associated with atelectasis or lymphadenopathy
A
Pulmonary Nodule
4
Q
1cm = __ mm
A
10 mm
5
Q
What are some thoracic imaging tools?
A
CXR, Chest CT scan +/- IV contrast, PET/CT scan, chest MRI
6
Q
CXR
A
Fast, inexpensive
7
Q
What can a CXR detect evidence of?
A
Heart failure, pleural/pericardial effusions, pneumonia, lung nodule/mass
8
Q
What is more sensitive than CXRs for detecting small nodules?
A
Chest CT scan
9
Q
What does a chest CT scan provide evidence for?
A
COPD, TB, pneumonia, cancer, congenital abnormalities
10
Q
What clinical symptoms can a chest CT help to diagnose?
A
Cough, SOB, chest pain, fever
11
Q
Standard CT slices are __mm in width
A
5mm
12
Q
High resolution CT scans and CT PE protocol CT scans are what width?
A
1mm
13
Q
Which has more radiation exposure, CXR or chest CT?
A
Chest CT
14
Q
Chest CT scan is not good for which patients?
A
IV contrast allergies and patients >400lbs
15
Q
What does PET stand for
A
Position Emission Tomography
16
Q
What is FDG?
A
Fluordeoxyglucose, contrast used for PET scan
17
Q
What can a PET/CT scan be used for?
A
Diagnosis, staging, and monitoring treatment of cancers
18
Q
What can a PET/CT scan show?
A
Areas of poor cardiac perfusion
19
Q
A PET/CT scan cannot differentiate between what?
A
Inflammation vs malignancy
20
Q
Which type of malignancies exhibit low FDG avidity?
A
Adenocarcinoma in situ (BAC) and carcinoid tumors
21
Q
Lesions smaller than _ to __mm are too small for PET to characterize
A
8-10mm
22
Q
What is a chest MRI utilized to asses?
A
Tumor size, extent, and invasion into other adjacent structures
23
Q
What type of tumors can invade adjacent structures?
A
Mesothelioma and pancoast tumors
24
Q
What is a great study to ascertain tissue planes- fat, muscle, bone, and vessels?
A
Chest MRI
25
Does chest MRI involve radiation?
No exposure to ionizing radiation
26
Chest MRI has limited use for what?
Limit3ed use for solitary pulmonary nodules not adjacent to other structures
27
Chest MRI should not be used for who
Metal implants, pacemakers, claustrophobia
28
Larger lesions are more likely to be what?
Malignant
29
Malignant lesions will have what?
A more irregular or speculated border
30
Benign lesions have what type of border?
Smooth and discrete border
31
Metastatic lesions can have what type of borders?
Smooth and discrete
32
What types of disease can have calcification?
Granulomatous disease and hamartomas
33
Patients with primary tumors, like osteosarcoma or chondrosarcoma may have what?
Pulmonary lesions with calcification
34
Lesions that are malignant tend to have an interval increase in size between what?
4-6 months
35
Nodules that grow very rapidly are more likely what?
Benign
36
What is SUV?
Standardized uptake value
37
Higher than normal physiological uptake is an SUV greater than what?
3
38
There is NOT one radiographic finding that is pathognomonic for what?
Cancer diagnosis
39
Infectious granulomas comprise about __% of all benign nodules
80
40
What are some types of infectious benign granulomas?
Histoplasmosis, coccidiomycosis, mycobacterium
41
Inflammatory nodules compression __% of benign nodules
10%
42
What are some examples of inflammatory benign nodules?
Rheumatoid, Wegener granulomatous is, Sarcoidosis
43
What is a Hamartoma?
Benign tumor of the lung comprised of cartilage, fat, muscle
44
What type of benign lung tumor has “popcorn” calcifications?
Hamartoma
45
What is GGO?
Ground Glass opacities
46
What is the f/u recommendation for a GGO <5mm in size?
Follow up CT scan in 6 months
47
What is the f/u of a GGO 6-10 mm in size?
Follow up CT scan in 3 months
48
What is the f/u recommendation for a GGO >10mm in size?
Recommend biopsy or resection if amenable
49
If GGOs are stable, they are generally followed how often?
Every 3-6 months, for a total of 36 months
50
When was cigarette smoking declared a health hazard?
Saturday January 11, 1964 by the surgeon general
51
What is the biggest risk factor for lung cancer?
Smoking- 85-90%, depends on packs smoked/year
52
What are some other risk factors for lung cancer?
Occupational/environmental and genetic factors, benign lung disease, ionizing radiation, second hand smoke/third hand smoke
53
What occupational/environmental factors can put you at risk for lung cancer?
Radon, asbestos, wood smoke, diesel exhaust, air pollution
54
What types of gases and chemicals are found in cigarettes?
Hydrogen cyanide, carbon monoxide, butane, ammonia, toluene, arsenic, lead, chromium, and cadmium
55
What can cause lung cancer in non smokers?
Secondhand smoke
56
What else has secondhand smoke been associated with?
Heart disease in adults and SIDS, ear infections, and asthma in children
57
What is cotinine?
An alkaloid found in tobacco and is also a metabolite of nicotine
58
What is cotinine used as?
A biomarker for exposure to tobacco smoke
59
Tobacco smoke can cling where?
To walls and ceilings and can be absorbed into carpets, draperies, and furniture upholsteries
60
Smoking accounts for atleast what % of cancer deaths?
30%
61
Smoking increases the risk of what types of cancer?
Nasopharyngeal, laryngeal, bladder, esophageal, pancreas, breast, stomach, colorectal, uterine
62
What are the two main subtypes of lung cancer?
Small cell and non-small cell
63
What are the 3 types of non-small cell?
Adenocarcinoma, squamous cell carcinoma, large cell carcinoma
64
What is a subtype of adenocarcinoma?
Bronchoalveolar carcinoma
65
What are the 3 subtypes of small cell lung cancer?
Classic small cell, large cell neuroendocrine, combined
66
What is the most common type of lung cancer?
Adenocarcinoma
67
90% of all epithelial lung cancers are comprised of what?
Adenocarcinoma, squamous cell carcinoma, large cell carcinoma and small cell carcinoma
68
The remaining 10% of epithelial lung cancers are comprised of what?
Undifferentiated carcinomas, carcinoid, and rarer tumor types
69
Malignant epithelial neoplasm lacking glandular or squamous differentiation
Large cell carcinoma
70
Usually presents are large peripheral mass with prominent necrosis
Large cell carcinoma
71
Tend to occur centrally and are classically associated with a history of smoking
Squamous cell carcinoma
72
Central and peripheral squamous cell carcinomas may show what?
Extensive central necrosis and cavitation
73
Most common type of lung cancer, especially in never smokers
Adenocarcinoma
74
Most commonly found in the lung periphery, but can occur centrally
Adenocarcinoma
75
Bronchioloalveolar carcinoma grows where?
Within the alveoli without invasion and can present as a ground glass opacity
76
What are the subtypes of adenocarcinoma?
BAC, mutinous adenocarcinomas, papillary adenocarcinomas
77
Why is lung cancer so deadly?
Aggressive biology of the disease, lack of an effective screening test, absence of symptoms until locally advanced or metastatic disease is present
78
What is the clinical presentation of lung cancer?
Cough, dyspnea, hemoptysis, recurrent pneumonia’s, weight loss, chest pain
79
Signs and symptoms of more extensive disease
Bone pain, dysphagia, hoarseness, neurological abnormalities, horner’s syndrome, superior vena cava syndrome
80
What are some neurological abnormalities seen in extensive disease?
HA, syncope, cognitive impairment
81
What is Horner’s syndrome
Ptosis, anhidrosis, miosis
82
What are some diagnostic tools for lung cancer?
CT guided needle biopsy, bronchoscope +/- lavage, endobronchial ultrasound biopsy (EBUS), video-assisted thoracoscopic surgery (VATs), thoracentesis
83
What is the staging of cancer?
TNM
T=tumor
N=nodes
M=metastasis
84
Lung cancers tend to spread via three main routes:
1. Blood
2. Lymphatics
3. Direct invasion
85
Lung cancers commonly metastasize to these areas
Brain, bone, liver, adrenal glands
86
For lung lesions greater than 2cm, the following is recommended:
HMRI or head CT with contrast, PET/CT scan, bone scan
| **if an extrathoracic lesion is detected, further work up will be needed**
87
What is the treatment for stage 1 lung cancer?
Surgical resection; and adjuvant therapy in the future
88
What type of adjuvant therapy is used to treat stage 1 lung cancer?
Chemotherapy/radiation or a combo of both
89
What is the treatment for stage 2 lung cancer?
Surgical resection + adjuvant therapy
90
What is the treatment for stage 3A lung cancer?
Chemoradiation, surgical resection in selected patients
91
What is the future management for someone with stage 3A lung cancer?
Neoadjuvant combined therapy to downstage primary tumor
92
What is the treatment for stage 3B lung cancer?
Chemoradiotherapy
93
What is the treatment for stage 4 lung cancer?
Cisplatin-based chemothearpy* surgical resection if solitary metastasis lesion with resectable primary tumor
94
What are some surgical and non surgical options for lung cancer?
VATs resection, segmentectomy, lobectomy, pneumonectomy, robotic lobectomy, sleeve lobectomy, radiofrequency ablation (RFA), photodynamic therapy (PDT)
95
What type of resection is good for small lesions in the peripheral of the lung?
Wedge resection
96
What is the VATs procedure?
Removing entire lobe, need to isolate 3 structures
97
What are the 3 structures that need to be isolated in a VATs lobectomy?
Bronchus, pulmonary artery and pulmonary vein
98
What is a segmentectomy?
Taking out a smaller segment of the lobe, not as small as wedge but not as large as a lobectomy
99
What is a pneumonectomy used for?
Patients with centrally located tumors close to the bronchus, mesothelioma too
100
What is a sleeve lobectomy used for?
If tumor is sitting on top of or invading the upper lobe airways
101
How does radiofrequency ablation work?
A small barb is inserted into the lesion and small metal wires are opened, the wires heat and burn the tumor
102
What type of procedure can be done on an unresectable lung tumor and for esophageal cancers
Photodynamic therapy
103
How does photodynamic therapy work?
Infuse patient with an ultraviolet sensitive chemical (need to be protected for UV light until procedure), come back 24 hours later and use a bronchoscope with a UV probe and burn/irritate the tumor cells
104
What is a poorly differentiated neuroendocrine tumor that commonly occurs as a large hilar mass with bulky mediating adenopathy?
Small cell carcinoma
105
What type of lung cancer has a rapid doubling time, high growth fraction, and early development of widespread metastases?
Small cell carcinoma
106
Small cell carcinoma is almost exclusively found in who?
Smokers, most commonly heavy smokers
107
What is the two stage system of small cell carcinoma?
Limited disease and extensive disease
108
What is limited disease for small cell carcinoma?
Disease confused to the ipsilateral hemithorax and within a single radiotherapy field
109
What is extensive disease for small cell carcinoma?
Metastatic disease outside the ipsilateral hemithorax
110
What % of patients will have extensive stage small cell carcinoma?
60-70%
111
What % of patients will have limited stage small cell carcinoma?
30-40%
112
What is the prognosis for limited disease small cell carcinoma?
15-20 mos and a 5 year survival rate of 10-13%
113
What is the prognosis for extensive disease small cell carcinoma?
8-13 mos, 5 year survival rate of 1-2%
114
What type of lung cancer is characterized by neuroendocrine differentiation and relatively indolent clinical behavior?
Carcinoid tumor
115
What are Carcinoid tumors made out of?
Made up of peptide and amine producing cells
116
Where do carcinoid tumors arise?
GI tract* thymus, lung, ovaries
117
What is the most common primary lung neoplasm in children?
Carcinoid tumor
118
What are the 2 main cell types of carcinoid tumors?
Typical carcinoid ad atypical carcinoid
119
Typical carcinoid cells
Excellent prognosis and are about 4x more common than atypical
120
Atypical carcinoid
Greater tendency to metastasize, dont respond well to treatment options, not good prognosis
121
What do the carcinoid tumors look like?
Round, ovoid opacities and may be hilar or perihilar
122
Carcinoid tumors commonly arise where?
Proximal airways causing bronchial obstruction
123
What are the signs and symptoms of carcinoid tumors?
Cough, wheeze, hemoptysis, recurrent pneumonia, asymptomatic, carcinoid syndrome, acromegaly
124
What is the treatment of choice for carcinoid tumors?
En bloc surgical resection
125
What are the non-surgical treatment for carcinoid tumors?
Intraluminal, bronchoscope resection may be an alternative as well as radiation therapy
126
Is chemo and radiation helpful for metastatic carcinoid tumors?
No, play a very limited role
127
What is also known as a superior sulcus tumor?
Pancoast tumor
128
Tumor located in the pulmonary apex, adjacent to the subclavian vessels
Pancoast tumor/ superior sulcus tumor
129
Where do pancoast tumors typically spread?
Ribs, vertebrae, subclavian vessels, and brachial plexus
| Can also involve the recurrent laryngeal nerve, vagus nerve, and sympathetic ganglion
130
A majority of pancoast tumors are what type of cells?
Squamous cell carcinomas
131
What type of diagnosis if mandatory for pancoast tumors?
Histologic diagnosis is mandatory prior to definitive treatment
132
Why is histologic a diagnosis mandatory for treatment of pancoast tumors?
Because they can be adenocarcinomas, small cell carcinomas, mesothelioma, and lymphomas
133
What is the clinical presentation of pancoast tumors?
*Shoulder pain 44-96%* Horners Syndrome 14-50%
134
What is Horners Syndrome?
Miosis (constriction of pupils) Enophthalmos (sunken eyes) Anhidrosis (lack of sweating) Ptosis (drooping of eyelid)
135
What is the most common treatment for pancoast tumors?
Preoperative chemo/radiation therapy followed by surgical resection
136
What are some examples of cancers that spread to the lungs?
Malignant melanoma, sarcomas, carcinomas of the: breast, kidney, bladder, colon, prostate
137
Covers the lung parenchyma and extends between the lobes
Visceral pleura
138
Covers the inner surface of the thoracic cavity, diaphragm and mediastinum
Parietal pleura
139
The visceral pleura contains no_____ ___, while the parietal pleura does
Pain fibers
140
Intercostal nerves supply what?
The costal pleura and the peripheral portion of the diaphragm
141
The central portion of the diaphragm is supplied by what?
Nerve endings form the phrenic nerve
142
The patient pleura is drained by what?
Lymphatic system in the upper abdomen
143
The visceral pleura is drained by what?
Pulmonary venous system
144
What is the primary function of the pleura?
Provide a smooth surface, which reduces friction as the pleurae move against each other
145
Under normal conditions, there is a small amount of fluid found in the pleural cavity;
Approximately 1-10mLs (0.1-0.2mL/kg)
146
What is the normal pH of pleural fluid?
7.6-7.64
147
What is the protein count for pleural fluid
Less than 2%, 1-2g/dL
148
What is the WBC count for pleural fluid normally?
Fewer than 1000 WBCs per cubic millimeter
149
Pleural fluid has an LDH less than what % of plasma?
50%
150
How if the pleural fluid formed?
Starling’s law of transcapillary exchange
151
What is hydrostatic pressure?
Within the capillaries, pressure as the “pushing force” pushing fluid out of the capillaries
152
What is oncotic pressure?
Pulling force; pulling fluid from surrounding tissues into capillaries
153
What is oncotic pressure created by?
The difference in the concentration of solutes in the fluid inside the capillaries as opposed to the outside
154
As fluid leaves the capillaries as a result of hydrostatic pressure, what cannot pass through the walls?
albumin and other large proteins
155
As fluid leaves the capillaries, what rises?
Oncotic pressure, pulling more water into capillaries in order to balance the solute concentration
156
What happens when hydrostatic pressure is greater than oncotic pressure?
Fluid will leave the capillaries
157
What happens when the oncotic pressure is greater than the hydrostatic pressure?
Fluid will enter the capillaries
158
How is the pleural fluid reabsorbed?
Via the lymphatic stomata of the parietal pleura (hypothesis only)
159
Abnormal accumulation of fluid in the pleural cavity
Pleural effusion
160
Pleural effusion is an indicator of what?
A pathological process; a manifestation of an underlying illness
161
WHat is the most common cause of pleural effusions?
Increased hydrostatic pressure- CHF
162
How can pneumonia cause a pleural effusion?
Due to increased capillary permeability
163
How can atelectasis cause a pleural effusion?
Increased (-) intrapleural pressure
164
How can nephrotic syndrome/hypoalbuminemia cause pleural effusions?
Decreased oncotic pressure
165
How can lymphoma cause a pleural effusion?
Decreased visceral pleural drainage
166
How can a mediastinal node cause pleural effusions?
Decreased lymphatic drainage
167
What is the clinical presentation of pleural effusions?
Dyspnea, cough, chest pain, lower extremity edema (CHF), night sweats, fevers, weight loss (TB, malignancy)
168
What physical findings can point to a pleural effusion?
Dullness to percussion, decreased tactile fremitus, diminished or inaudible breath sounds, egophony (E to A transition)
169
How is a pleural effusion diagnosed?
>150mL usually seen on upright chest radiographs as blunting of the costophrenic angle
170
CT scans can detect what?
Very small pleural effusions that can easily be missed by chest radiographs
171
When should a thoracentesis be done?
Worth an effusion of unknown cause
172
What are some C/Is for thoracentesis?
Systemic anticoagulation, area of infected skin on chest wall
173
How much fluid should be drained during a single thoracentesis?
1.5-2.0 L
174
Why should no more than 1.5-2.0 L of fluid be drained with a thoracentesis?
Re-expansion pulmonary edema (RPE)
175
RPE
Hypoxia injury, mechanical stress (can be caused by draining too much fluid during thoracentesis)
176
What are the 4 types of fluid that can accumulate in the pleural space?
1. Serous fluid
2. Chyle
3. Blood
4. Pus
177
Serous fluid accumulating in the pleural space is called what?
Hydrothorax
178
Chyle accumulating int he pleural space is called what?
Chylothorax
179
Blood accumulating in the pleural space is called what?
Hemithorax
180
Pus accumulating in the pleural space is called what?
Empyema
181
Pleural fluid analysis
Protein, LDH, cytology, culture and gram stain, specific gravity, CBCD, glucose, pH
182
What is Light’s criteria used for?
Pleural fluid analysis; transudative or exudative
183
What is Light’s criteria?
Fluid is an exudate if 1 or more of the following criteria are met
184
Criteria for exudative fluid
1. Ratio of pleural fluid level of LDH to serum LDH is >0.6
2. Pleural fluid level of LDH is > 2/3 upper limit of reference range for serum LDH
3. Ratio of pleural fluid level or protein to serum level of protein is > 0.5
185
Transudative effusions are largely due to what?
Imbalances in hydrostatic and oncotic pressures in the chest
186
What can cases a transudative effusion?
CHF, atelectasis, nephrotic syndrome, cirrhosis
187
What are the 2 sub categories of transudative effusions?
Caused by either hypoalbuminemia or cardiovascular issues
188
What type of cardiovascular problems can cause transudative effusion?
Fluid overload, HF, constrictive pericarditis
189
What can cause hypoalbuminemia, causing a transudative effusion?
Nephrotic syndrome, chronic infection, malabsorption, liver failure
190
What is Meig’s Syndrome?
Ascites, pleural effusion, and a benign ovarian tumor (fibroma)
191
What can cause an exudative fusion?
Disease in any organ
192
Exudative effusions are more commonly a result of what?
Pleura/lung inflammation or impaired lymphatic drainage
193
3 causes of exudative effusions
Pneumonia, malignancy, pulmonary embolism
194
Exudative effusions can be caused by what?
Malignancy, inflammation, infection
195
What types of malignancy can cause exudative effusions?
Bronchial carcinomas, metastases
196
What types of infection can cause exudative effusions?
Acute- empyema
| Chronic- TB
197
What types of inflammation can cause an exudative effusion?
Granulomatous disorders, rheumatoid arthritis, SLE, pulmonary infarct
198
What can cause empyema?
*complication of pneumonia, where bacteria escape into the pleural space*
199
What else can cause an empyema?
Trauma, esophageal rupture, complication of lung surgery, thoracentesis, chest tube placement
200
What is the patho behind an empyema?
Pneumonia -> parapneumonic effusion -> complicated parapneumonic effusion -> empyema
201
5-10% of patients with pneumonia can develop what?
A parapneumonic effusion
202
Empyema fluid analysis
Grossly purulent, pH level less than 7.2, WBC>50,000, glucose <60mg/dL, LDH >1,000
203
What is the treatment for empyema?
Drainage!!!
204
What else is used as treatment for empyema?
Abx therapy with thoracentesis, intrapleural fibrinolytic/Abx infusion, VATs thorascopy with tube drainage, Clagett window, decorticating and pulmonary resection
205
What is a Clagett Window
Open drainage of the empyema cavity
206
What are some causes for a malignant pleural effusion?
Increased capillary permeability, disruption of capillary endothelium, impaired lymphatic drainage, direct invasion of pleural space by tumor, malnourishment or hypoalbuminemia
207
What are the primary sites of MPEs
Lung, lymphoma, breast, ovary
208
What is the life expectancy for an ovarian MPE?
9.4 months
209
What is the life expectancy for a breast MPE?
7.4 months
210
What is the life expectancy for an NSCLCa MPE?
4.3 months
211
What is the life expectancy for a small cell carcinoma MPE?
3.7 months
212
What are some treatment options for an MPE?
Thoracentesis and treatment of malignancy, repeat thoracentesis* tube thoracostomy, chemical pleurodesis, indwelling catheters, pleurectomy/decortication
213
When is a repeat thoracentesis used as treatment for an MPE?
For people who cannot tolerate the chemo or radiation
214
What is a medical procedure in which the pleural space is artificially obliterated by causing the visceral and parietal pleural to stick together?
Pleurodesis
215
What are the two ways to do a pleurodesis?
Instillation of a chemical sclerosis, pleural abrasion (mechanical)
216
What are some indications for a pleurodesis?
Recurrence of effusion or pneumothorax, *lung re-expansion after thoracentesis* symptomatic improvement after thoracentesis* inability to control effusion with chemo
217
What are the sclerosis agents used for a pleurodesis?
Talc, Doxycyline, Bleomycin, Quinacrine, Minocycline
218
We know the3 pleurodesis was successful if...
Adequate pleural drainage from the chest tubes, ability or lung to re-expand fully, uniform distribution of sclerosis agent, apposition of the pleural membranes
219
What two companies make the indwelling catheters used to treat MPEs?
Denver Biomedical makes PleurX and Bard makes Aspira
220
What are some indications for an indwelling catheter?
Rapid recurrence of effusion, failure of lung re-expansion faster thoracentesis, symptomatic improvement after thoracentesis, inability to control effusion with chemo
221
What are some pros of indwelling catheters?
Less pain, shorter hospital stay
222
What are some cons of indwelling catheters?
Obstruction of catheter, risk of infection, loculation of the effusion
223
Presence of air of gas in the pleural cavity is called what?
Pneumothorax
224
How does air enter into the intrapleural space and cause a pneumothorax?
Through trauma or more commonly through the lung parenchyma across the visceral pleura
225
What are the types of pneumothorax
Primary spontaneous, secondary spontaneous, traumatic, and tension
226
Primary spontaneous PTX occurs in who?
People without underlying lung disease, patients typically aged 18-40 years, tall, thin and often smokers
227
How does a primary spontaneous PTX occur?
Caused by rupture of small pulmonary blebs
228
Secondary spontaneous PTX occurs in who?
Pts with underlying lung disease, COPD most common
229
What are some other causes of secondary spontaneous PTX
Severe asthma, CF, lung infections (TB, necrotizing PNA), sarcoidosis, Marfan syndrome, lung cancer, sarcomas, catemenial PTX
230
Pneumothorax caused by trauma
Most common due to penetration of sharp bony point at a new rib fracture
231
What are some iatrogenic causes of pneumothorax?
Central venous catheter placement, CT guided needle biopsy of lung, thoracentesis, mechanical ventilation
232
Sign and symptoms of PTX
Dyspnea, chest pain, shoulder pain, percussion -> hyperresonant, decreased tactile fremitus, decreased/absent breath sounds
233
What is used to diagnose a pneumothorax?
CXR, CCT, *chest ultrasound*
234
What is the treatment for a PTX?
Conservative management for small PTX, chest decompression via chest tube or pigtail catheter
235
Oxygen and pneumothorax
Supplemental O2 should be given to maintain adequate oxygenation, but it also lowers the partial pressure of nitrogen, which can accelerate the rate of absorption of air from pleura cavity and hasten lung re-expansion
236
What is Graham’s law of diffusion?
Gases move form high to low concentrations
237
What are some other treatments for PTX?
Pleurodesis, surgery- VATs blebectomy
238
What is a tension PTX?
Progressive build-up of air within the pleural space
239
What is a tension PTX usually due to?
Lung laceration via trauma or iatrogenic, which allows air to escape into the pleural space
240
The progressive build up of air in a tension PTX causes what?
Pushes the mediastinum to the opposite hemithorax and obstructs venous return to the heart causing cardiac arrest
241
What is a clinical presentation of a tension PTX?
Diaphoretic/cyanotic, tachycardia, hypotension, chest pain
242
Classic physical exam findings for a tension PTX
Deviation of trachea to contralateral side, hyper-expanded chest, absent breath sounds, distended neck veins
243
What is a common cause of morbidity and mortality in children under the age of 2?
Foreign body aspiration
244
80% of foreign body aspiration occurs in children at what age?
<3 years old, peak incidence of 1-2 years old
245
What are the most common aspirated foreign bodies?
Nuts
246
Infants and toddlers tend to aspirate on what?
Food items
247
Non-food items are more commonly aspirated by who?
Older children
248
What are some factors can make foreign body aspiration more dangerous?
Roundness, failure to break apart easily, smooth slippery surface
249
Signs and symptoms of a foreign body aspiration
*severe respiratory distress, cyanosis, mental status change = medical emergency*
Strider, hoarseness, dyspnea, wheezing
250
What diagnostic tools are useful for foreign body aspiration?
CXR
251
What can a lower airway FBA cause?
Hyperinflated lungs, atelectasis, pneumonia
252
What are late manifestations of an FBA?
Pulmonary abscesses and bronchiectasis
253
What is almost always successful in FB removal?
Rigid/Flexible Bronchoscopy
254
What does Rigid/ Flexible Bronchoscopys allow for?
Control of airway, good visualization, manipulation of object, and ready management of hemorrhage
255
Surgery may be needed if what?
If the FBs cannot be removed
256
Thoracentesis is needed for what?
Any new or unexplained pleural effusion
257
Pleurodesis and indwelling catheters provide excellent treatment options for what?
Patients with recurrent/malignant effusions
258
FBA should be suspected when?
In children who have sudden onset of lower respiratory symptoms
