Session 1.2f - Gray's Anatomy for Students - Thorax - Regional anatomy - Pleural cavities - Lungs Flashcards
https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780702051319000031?scrollTo=%23hl0002009 (204 cards)
1
Q
What are the lungs?
A
Two organs of respiration
2
Q
What do the lungs lie on either side of?
A
The mediastinum
3
Q
What are the lungs surrounded by?
A
The right and left pleural cavities
4
Q
How does air enter and leave the lungs?
A
Via main bronchi
5
Q
Main bronchi are branches of ___
A
the trachea.
6
Q
What delivers deoxygenated blood to the lungs?
A
The pulmonary arteries
7
Q
The pulmonary arteries deliver _______ blood to the lungs from the ___ ___ __ _ ____
A
deoxygenated blood to the lungs from the right ventricle of the heart.
8
Q
Where does oxygenated blood return to the heart?
A
The left atrium
9
Q
How does oxygenated blood return to the left atrium?
A
Via the pulmonary veins
10
Q
Which lung is larger?
A
The right lung is normally a little larger than the left
11
Q
Why is one lung bigger than the other?
A
The right lung is normally larger because the middle mediastinum, containing the heart, bulges more to the left than to the right.
12
Q
What does each lung have?
A
A half-cone shape, with a base, apex, two surfaces and three borders (Fig. 3.39).
13
Q
Where is the base of the lung?
A
The BASE sits on the diaphragm.
14
Q
Where is the apex of the lung?
A
The APEX projects above rib I and into the root of the neck.
15
Q
What are the two surfaces of the lung?
A
- COSTAL SURFACE
- MEDIASTINAL SURFACE
16
Q
Where is the costal surface of the lung?
A
Lies immediately adjacent to the ribs and intercostal spaces of the thoracic wall.
17
Q
Where is the mediastinal surface of the lung?
A
Lies against the mediastinum anteriorly and the vertebral column posteriorly
18
Q
What does the mediastinal surface of the lung contain?
A
The comma-shaped hilum of the lung, through which structures enter and leave.
19
Q
What does the hilum of the lung do?
A
Allows structures to enter and leave.
20
Q
What are the three borders of the lung?
A
- INFERIOR BORDER
- ANTERIOR and
- POSTERIOR BORDERS
21
Q
Describe the inferior border of the lung.
A
Sharp and separates the base from the costal surface
22
Q
What do the anterior and posterior borders separate?
A
The costal surface from the medial surface.
23
Q
Which border(s) of the lung are sharp?
A
Anterior
Inferior
24
Q
Which border(s) of the lung are smooth and rounded?
A
Posterior
25
Fig. 3.39
Label and caption the image.
Right lung, left lung
- Anterior border
- Costal surface
- Apex
- Hilum
- Bronchus
- Pulmonary artery
- Pulmonary veins
- Posterior border
- Mediastinal surface
- Inferior border
- Base (diaphragmatic surface)
Lungs.
26
Describe the relationship of the lungs and structures contained in the overlying area.
The lungs lie directly adjacent to, and are indented by the structures.
27
The heart and major vessels form bulges in the ____
mediastinum
28
The heart and major vessels of the mediastinum indent the ___ ____ of the ____
medial surfaces of the lung.
29
The ribs indent the ____ _____ of the lung.
Costal surfaces
30
Pathology, such as _______, or abnormalities in one structure can affect ___ _______ _________.
Tumours; the related structure
31
Describe the root of each lung.
A short tubular collection of structures that together attach the lung to structures in the mediastinum (Fig. 3.40).
32
What is the root of the lung covered by?
A sleeve of mediastinal pleura that reflects onto the surface of the lung as visceral pleura.
33
The region outlined by the mediastinal pleural reflection onto the ______ surface of the lung is the _____, where structures enter and leave.
Medial, HILUM.
34
Fig. 3.40
Label and caption the image.
Right lung, left lung
- Hilum
- Pulmonary artery
- Pulmonary veins
- Root
- Bronchus
- Pulmonary ligament
- Pulmonary artery (deoxygenated blood)
- Pulmonary veins (oxygenated blood)
Roots and hila of the lungs.
35
What projects inferiorly from the root of the lung?
A thin blade-like fold of pleura
36
Where does the pleura projecting inferiorly from the root of the lung extend?
From the hilum to the mediastinum
37
The thin blade-like fold of pleura that projects inferiorly from the root of the lung is known as what?
The PULMONARY LIGAMENT
38
What does the pulmonary ligament do?
Stabilise the position of the inferior lobe and may also accomodate the down-and-up translocation of structures in the root during breathing.
39
Where do the vagus nerves pass in the mediastinum?
Immediately posterior to the roots of the lungs
40
Where do the phrenic nerves pass in the mediastinum?
Immediately anterior to them
41
What is found within each root and located in the hilum?
- a pulmonary artery
- two pulmonary veins
- a main bronchus
- bronchial vessels
- nerves
- lymphatics
42
Describe the anatomical location of the pulmonary artery, veins and bronchi.
Generally, the pulmonary artery is superior at the hilum, the pulmonary veins are inferior, and the bronchi are somewhat posterior in position.
43
Which of these is most superior?
Pulmonary artery
Pulmonary veins
Bronchi
Pulmonary artery
| at the hilum
44
Which of these is most inferior?
Pulmonary artery
Pulmonary veins
Bronchi
Pulmonary veins
45
Which of these is most posterior?
Pulmonary artery
Pulmonary veins
Bronchi
Bronchi
46
Where does the lobar bronchus to the superior lobe branch on the right side?
From the main bronchus in the root
47
Where does the lobar bronchus to the superior lobe branch on the left side?
Within the lung itself
48
The lobar bronchus to the superior lobe is superior to ___?
The pulmonary artery
49
The right lung has _ lobes and _ fissures.
Three lobes and two fissures (Fig. 3.41A).
50
The right lobes are ____ _____ against each other because they are ____, almost to the hilum, by _____ of ____ ____
Normally, the lobes are freely movable against each other because they are separated, almost to the hilum, by invaginations of visceral pleura.
51
What are the fissures of the lung formed by?
Invaginations of thevisceral pleura
52
What are the fissures of the right lung?
- OBLIQUE FISSURE
| - HORIZONTAL FISSURE
53
What is the oblique fissure?
The OBLIQUE FISSURE separates the INFERIOR LOBE (LOWER LOBE) from the SUPERIOR LOBE and the MIDDLE LOBE OF THE RIGHT LUNG
54
What is the horizontal fissure?
The HORIZONTAL FISSURE separates the superior lobe (UPPER LOBE) from the middle lobe.
55
Fig. 3.41A
Label and caption the image.
- Superior lobe
- Horizontal fissure
- Middle lobe
- Oblique fissure
- Inferior lobe
Right lung
56
Fig. 3.41B
Label and caption the image. Label anterior and posterior.
- SUBCLAVIAN ARTERY
- SUBCLAVIAN VEIN
- Right brachiocephalic vein
- Left brachiocephalic vein
- SUPERIOR VENA CAVA
- Pulmonary artery
- Pulmonary veins
- HEART
- INFERIOR VENA CAVA
- Diaphragm
- AZYGOS VEIN
- OESOPHAGUS
- Bronchus
- Bronchus to superior lobe
- Rib I
Major structures related to the right lung.
57
Where can the approximate position of the oblique fissure be found?
On a patient, in quiet respiration, this can be marked by a curved lin eon the thoracic wall that begins roughly at the spinous process of the vertebra TIV level of the spine, crosses the fith interspace laterally, and then follows the contour of rib VI anteriorly.
58
Where is the horizontal fissure found?
This follows the fourth intercostal space from the sternum until it meets the oblique fissure as it crosses rib V.
59
Why is it important to know the orientations of the oblique and horizontal fissures?
These determine where clinicians should listen for lung sounds from each lobe.
60
Where is the largest surface of the superior lobe in contact with?
The upper part of the anterolateral wall and the apex of this lobe projects into the root of the neck.
61
Where does the surface of the middle lobe lie mainly?
Adjacent to the lower anterior and lateral wall.
62
Where is the surface of the inferior lobe in contact with?
The costal surface is in contact with the posterior and inferior walls.
63
Where should you position your stethoscope to listen to lung sounds?
When listening to lung sounds from eaach of the lobes, it is important to position the stethoscope on those areas of the thoracic wall related to the underlying positions of the lobes.
64
What does the medial surface of the right lung lie adjacent to?
A number of important structures in the mediastinum and the root of the neck (Fig. 3.41B).
65
What are the structures that lie adjacent to the medial surface of the right lung?
- Heart
- Inferior vena cava
- Superior vena cava
- Azygos vein
- Oesophagus
66
Where do the right subclavian artery and vein run in relation to the lung?
They arch over and are related to the superior lobe of the right lung as they pass over the dome of the cervical pleura and into the axilla.
67
What do the right subclavian artery and vein pass over and into?
The dome of the cervical pleura into the axilla.
68
The left lung is _______ than the right lung
Smaller
69
The left lung has ___ lobes separated by _____
Two lobes separated by an oblique fissure (Fig. 3.42A).
70
Describe the oblique fissure of the left lung compared to the right.
The OBLIQUE FISSURE of the left lung is slightly more oblique than the corresponding fissure of the right lung.
71
Fig. 3.42A
Label and caption the image.
- Superior lobe
- Oblique fissure
- Inferior lobe
- Lingula
A. Left lung.
72
Fig. 3.42B
Label and caption the image.
Posterior, Anterior
- Rib I
- Bronchus
- OESOPHAGUS
- THORACIC AORTA
- LEFT SUBCLAVIAN ARTERY
- LEFT BRACHIOCEPHALIC VEIN
- AORTIC ARCH
- Pulmonary artery
- Pulmonary veins
- HEART
- Diaphragm
B. Major structures related to the left lung.
73
Where is the left oblique fissure approximated?
During quiet respiration, it can be marked by a curved line o nthe thoracic wall that begins between the spinous processes of vertebrae TIII and TIV, crosses the fifth interspace laterally, and follows the contour of rib VI anterior.
74
Why is it important to know where the oblique fissure of the lung is?
As with the right lung, the orientation of the oblique fissure determines where to listen for lung sounds from each lobe.
75
What is the largest surface of the left superior lobe in contact with?
The upper part of the anterolateral wall, and the apex of this lobe projects into the root of the neck.
76
What is the costal surface of the left inferior lobe in contact with?
The posterior and inferior walls.
77
Where do you place your stethoscope to listen to left lung sounds?
When listening to lungs sounds from each of the lobes, the stethoscope should be placed on those areas of the thoracic wall related to the underlying positions of the lobes.
78
Describe the inferior portion of the medial surface of the left lung.
Unlike the right lung, it is notched.
79
Why is the inferior portion of the left lung notched, but not the right?
Because of the heart's projection into the left pleural cavity from the middle mediastinum.
80
What can you find from the anterior border of the lower part of the left superior lobe?
A tongue-like extension (the LINGULA OF THE LEFT LUNG) projects over the heart bulge.
81
What is the lungula of the left lung?
A tongue-like extension found at the anterior border of the lower part of the left superior lobe.
82
What does the medial surface of the left lung lie adjacent to?
A number of important structures in the mediastinum and root of the neck (Fig. 3.42B).
83
What structures do the medial surface of the left lung lie adjacent to?
- Heart
- Aortic arch
- Thoracic aorta
- Oesophagus
84
Where do the left subclavian artery and vein pass?
They arch over and are related to the superior lobe of the left lung as they pass over the dome of the cervical pleura and into the axilla.
85
Where do the left and right subclavian artery and vein pass?
They arch over and are related to the superior lobe of the left/right lung respectively as they pass over the dome of the cervical pleura and into the axilla.
86
What is the trachea?
A flexible tube that runs from C6 - T4/5
87
Where does the trachea extend from?
Vertebral level CVI in the lower neck to vertebral level TIV/V in the mediastinum, where it bifurcates into a right and a left main bronchus (Fig. 3.43).
88
How is the trachea held open?
By C-shaped transverse cartilage rings embedded in its wall - the open part of the C facing posteriorly.
89
What makes up the trachea?
C-shaped transverse cartilage rings
90
Describe the structure of the lowest tracheal ring.
It has a hook-shaped structure, the carina, that projects backwards in the midline between the origins of the two main bronchi.
91
What is the carina?
The lowest tracheal ring, that has a hook-shaped structure and projects backwards in the midline.
92
What is the posterior wall of the trachea composed of?
Composed mainly of smooth muscle.
93
Fig. 3.43A
Label and caption the image
- Right main bronchus
- Lobar bronchi
- Segmental bronchi of middle lobe
- Trachea
- Carina
- Left main bronchus
- Lobar bronchi
A. Bronchial tree
94
Fig. 3.43B
Label and caption the image.
- Lateral bronchopulmonary segment of middle lobe of right lung
- Branch of pulmonary artery
- Medial bronchopulmonary segment of middle lobe of right lung
Bronchopulmonary segments
95
Where does the main bronchus pass through the lung?
Enters the root of a lung and passes through the hilum into the lung itself.
96
Describe the difference in structure of the right main bronchus compared to the left main bronchus.
The right main bronchus is wider and takes a more vertical course through the root and hilum than the left main bronchus (Fig. 3.43A)
97
Why is the right and left main bronchus structure clinically significant?
Inhaled foreign bodies tend to lodge more frequently on the right side than on the left, as the right main bronchus is wider and takes a more vertical course.
98
What does the main bronchus divide into?
This divides into LOBAR BRONCHI (secondary bronchi) within the lung.
99
What do the lobar/secondary bronchi supply?
They each supply a lobe
100
Where does the lobar bronchus to the superior lobe on the right side originate?
Within the root of the lung
101
What do the lobar/secondary bronchi divide into?
SEGMENTAL BRONCHI (tertiary bronchi)
102
What do the segmental/tertiary bronchi supply?
Bronchopulmonary segments (Fig. 3.43B)
103
What are the primary, secondary and tertiary bronchi also known as?
1 - Main bronchi
2 - Lobar bronchi
3 - Segmental bronchi
104
What are primary bronchi also known as?
Main bronchi
105
What are secondary bronchi also known as?
Lobar bronchi
106
What are the tertiary bronchi also known as?
Segmental bronchi
107
What do the segmental bronchi ultimately branch into?
Within each bronchopulmonary segment, the segmental bronchi give rise to multiple generations of divisions and, ultimately, to bronchioles.
108
What do bronchioles supply?
These further subdivide and supply the respiratory surfaces.
109
How are the walls of the bronchi held open?
By discontinuous elongated plates of cartilage
110
What is different about the walls of the bronchioles and the walls of the bronchi?
The walls of the bronchi are held open by discontinuous elongated plates of cartilage, but these are not present in bronchioles.
111
What is a bronchopulmonary segment?
The area of lung supplied by a segmental bronchus and its accompanying pulmonary artery branch.
112
Where do tributaries of the pulmonary vein pass?
Tributaries of the pulmonary veins tend to pass intersegmentally between and around the margins of segments.
113
How are bronchopulmonary segments shaped?
Like an irregular cone
114
Where is the apex of the bronchopulmonary segment?
At the origin of the segmental bronchus
115
Where is the base of the bronchopulmonary segment?
Projected peripherally onto the surface of the lung
116
What is the smallest functionally independent region of a lung?
A bronchopulmonary segment
117
What is clinically significant about a bronchopulmonary segment?
It is the smallest area of lung that can be isolated and removed without affecting adjacent regions.
118
How many bronchopulmonary segments are there in each lung?
10 (Fig. 3.44), although some of them fuse in the left lung.
119
Fig. 3.44A
Label and caption the image.
Medial view, Lateral view
SUPERIOR LOBE
MIDDLE LOBE
INFERIOR LOBE
```
Apical segment (S I)
Posterior segment (S II)
Anterior segment (S III)
Lateral segment (S IV)
Medial segment (S V)
Superior segment (S VI)
Medial basal segment (S VII)
Anterior basal segment (S VIII)
Lateral basal segment (S IX)
Posterior basal segment (S X)
```
Bronchopulmonary segments. A. Right lung.
120
Fig. 3.44B
Label and caption the image.
Medial view, Lateral view
SUPERIOR LOBE
INFERIOR LOBE
```
Apicoposterior segment (S I & II)
Anterior segment (S III)
Superior lingular segment (S IV)
Inferior lingular segment (S V)
Superior segment (S VI)
Medial basal segment (S VII)
Anterior basal segment (S VIII)
Lateral basal segment (S IX)
Posterior basal segment (S X)
```
Bronchopulmonary segments. B. Left lung. (Bronchopulmonary segments are numbered and named.)
121
Where do the right and left pulmonary arteries originate from?
The PULMONARY TRUNK
122
What do the pulmonary arteries carry?
Deoxygenated blood to the lungs from the right ventricle of the heart (Fig. 3.45).
123
Fig. 3.45A
Label and caption the image
- RIGHT BRONCHIAL ARTERY (branch from right third posterior intercostal artery)
- RIGHT PULMONARY ARTERY
- Bronchial vessels on posterior surface of bronchi
- RIGHT PULMONARY VEINS
- PULMONARY TRUNK
- Oesophagus
- Aortic arch
- Superior left bronchial artery
- LEFT PULMONARY ARTERY
- Inferior left bronchial artery
- LEFT PULMONARY VEINS
- Pulmonary ligament
- Thoracic aorta
Pulmonary vessels. A. Diagram of an anterior view.
124
Fig. 3.45B
Label and caption the image.
- Superior vena cava
- Ascending aorta
- Pulmonary trunk
- Right main bronchus
- Oesophagus
- Thoracic aorta
- Left pulmonary artery
Pulmonary vessels. B. Axial computed tomography image showing the left pulmonary artery branching from the pulmonary trunk.
125
Fig. 3.45C
Label and caption the image.
- Superior vena cava
- Ascending aorta
- Pulmonary trunk
- Right pulmonary artery
- Oesophagus
- Thoracic aorta
Pulmonary vessels. C. Axial computed tomography image (just inferior to the image in B) showing the right pulmonary artery branching from the pulmonary trunk.
126
Where does the bifurcation of the pulmonary trunk occur?
To the left of the midline just inferior to vertebral level TIV/V, and anteroinferiorly to the left of the bifurcation of the trachea.
127
Describe the right pulmonary artery compared to the left.
The RIGHT PULMONARY ARTERY is longer than the left and passes horizontally across the mediastinum (Fig. 3.45).
128
Where does the right pulmonary artery pass anteriorly?
Anteriorly and slightly inferiorly to the tracheal bifurcation and anteriorly to the right main bronchus
129
Where does the right pulmonary artery pass posteriorly?
Posteriorly to the ascending aorta, superior vena cava, and upper right pulmonary vein.
130
Where does the right pulmonary artery branch?
The right pulmonary artery enters the root of the lung and gives off a large branch to the superior lobe of the lung.
131
Where does the main branch of the right pulmonary artery continue to?
The main vessel continues through the hilum of the lung
132
What does the main branch of the right pulmonary artery divide into?
This gives off a second (recurrent) branch to the superior lobe, and then divides to supply the middle and inferior lobes.
133
Which pulmonary artery is shorter?
The LEFT PULMONARY ARTERY is shorter than the right.
134
Where does the left pulmonary artery lie?
Anterior to the descending aorta and posterior to the superior pulmonary vein (Fig. 3.45)
135
Where does the left pulmonary artery pass by?
It passes through the root and hilum and branches within the lung
136
What are the pulmonary veins?
On each side a SUPERIOR PULMONARY VEIN and an INFERIOR PULMONARY VEIN carry oxygenated blood from the lungs back to the heart (Fig. 3.45).
137
Where do the pulmonary veins begin?
At the hilum of the lung
138
Where do the pulmonary veins pass through?
The root of the lung
139
Where do the pulmonary veins drain into?
The left atrium
140
What do the bronchial arteries and veins constitute?
The "nutritive" vascular system of the pulmonary tissues (bronchial walls and glands, walls of large vessels, and visceral pleura).
141
What do the bronchial vessels interconnect with?
The lung with branches of the pulmonary arteries and veins.
142
Where do the bronchial arteries originate?
From the thoracic aorta or one of its branches.
143
What bronchial artery arises from the third posterior intercostal artery?
A single RIGHT BRONCHIAL ARTERY normally arises here.
144
A single right bronchial artery normally arises from the third posterior intercostal artery. Where does it occasionally originate?
From the UPPER LEFT BRONCHIAL ARTERY.
145
Where do the two left bronchial arteries arise from?
Two LEFT BRONCHIAL ARTERIES arise directly from the anterior surface of the thoracic aorta - the SUPERIOR LEFT BRONCHIAL ARTERY arises at vertebral level TV, and the inferior one inferior to the left bronchus.
146
Where does the superior left bronchial artery arise?
At vertebral level TV
147
Where does the inferior left bronchial artery arise?
Inferior to the left bronchus
148
Where do the bronchial arteries run?
On the posterior surfaces of the bronchi
149
Where do the bronchial arteries insert?
They ramify in the lungs to supply pulmonary tissues.
150
Where do the bronchial veins drain into?
- Either the pulmonary veins or the left atrium, and
| - Into the azygos vein on the right or into the superior intercostal vein or hemiazygos vein on the left
151
What are structures of the lung and the visceral pleura supplied by?
Visceral afferents and efferents distributed through the anterior pulmonary plexus and posterior pulmonary plexus (Fig. 3.46).
152
Where do the interconnected anterior and posterior pulmonary plexuses lie?
Anteriorly and posteriorly to the tracheal bifurcation and main bronchi.
153
Describe the relative sizes of the pulmonary plexuses.
The anterior plexus is much smaller than the posterior plexus.
154
Fig. 3.46
Label and caption the image.
- RIGHT VAGUS NERVE
- ANTERIOR PULMONARY PLEXUS
- POSTERIOR PULMONARY PLEXUS
- Oesophageal plexus
- Cervical cardiac nerves
- Left recurrent laryngeal nerve
- LEFT VAGUS NERVE
- Ligamentum arteriosum
- Sympathetic trunk
Pulmonary innervation.
155
Where do branches of the pulmonary plexuses originate?
These ultimately originate from the sympathetic trunks and vagus nerves
156
Where are branches of the pulmonary plexus distributed?
Along branches of the airway and vessels
157
What do visceral efferents from the vagus nerves do?
Constrict the bronchioles
158
What do visceral efferents from the sympathetic system do?
Dilate the bronchioles
159
Where are the lymphatics of the lung found?
Superficial or subpleural
| Deep
160
What are superficial lymph nodes of the lung also known as?
Subpleural
161
Where do the superficial, or subpleural, and deep lymphatics of the lung drain into?
TRACHEOBRONCHIAL NODES (lymph nodes)
162
Where are the tracheobronchial nodes?
Around the roots of lobar and main bronchi and along the sides of the trachea (Fig. 3.47).
163
Where do the tracheobronchial nodes extend from?
As a group, they extend from within the lung, through the hilum and root, and into the posterior mediastinum.
164
Where do the tracheobronchial nodes extend into?
The posterior mediastinum
165
Fig. 3.47
Label and caption the image.
- Thoracic duct
- Tracheobronchial nodes
- Right parasternal lymphatic vessel
- RIGHT BRONCHOMEDIASTINAL TRUNK
- Thoracic duct
- Brachiocephalic node
- LEFT BRONCHOMEDIASTINAL TRUNK
- Left parasternal lymphatic vessel
- Parasternal nodes
- Diaphragm
- Cisterna chyli
Lymphatic drainage of lungs.
166
Where do efferent vessels from the tracheobronchial nodes pass?
Superiorly along the trachea
167
What do tracheobronchial nodes unite with?
Similar vessels from parasternal nodes and brachiocephalic nodes
168
Where are the parasternal and brachiocephalic nodes?
Anterior to brachiocephalic veins in the superior mediastinum
169
What do the parasternal nodes and brachiocephalic nodes form?
The RIGHT and LEFT BRONCHOMEDIASTINAL TRUNKS.
170
What do the bronchomediastinal trunks drain into?
Directly into deep veins at the base of the neck, or may drain into the right lymphatic trunk or thoracic duct.
171
(IN THE CLINIC: Imaging the lungs)
Why is medical imaging of the lungs important?
Because they are one of the commonest sites for disease in the body.
172
(IN THE CLINIC: Imaging the lungs)
At rest, the how much air does the lung exchange?
Up to 5 L of air per minute (while the body is at rest)
173
(IN THE CLINIC: Imaging the lungs)
At rest, the body exchanges up to 5 L of air per minute. What else may this contain?
Pathogens and other potentially harmful elements (e.g., allergens).
174
(IN THE CLINIC: Imaging the lungs)
What techniques are there to visualise the lung?
They range from plain chest radiographs to high-resolution computed tomography (CT)
175
(IN THE CLINIC: Imaging the lungs)
What can high-resolution CT be used for?
Enables precise localisation of a lesion within the lung.
176
(IN THE CLINIC: High-resolution lung CT)
What does HRCT stand for?
High-resolution computed tomography
177
(IN THE CLINIC: High-resolution lung CT)
What is HRCT?
A diagnostic method for assessing the lungs but more specifically the interstitium of the lungs.
178
(IN THE CLINIC: High-resolution lung CT)
What does HRCT involve?
The technique involves obtaining narrow cross-sectional slices of 1 to 2 mm.
179
(IN THE CLINIC: High-resolution lung CT)
What do HRCT scans allow physicians and radiologists to do?
View the patterns of disease and their distribution
180
(IN THE CLINIC: High-resolution lung CT)
What diseases can be easily demonstrated using HRCT?
- Emphysema
- Pneumoconiosis (coal worker's pneumoconiosis)
- Asbestosis
181
(IN THE CLINIC: High-resolution lung CT)
What is pneumoconiosis?
A group of lung diseases caused by inhalation and retention of dusts.
182
(IN THE CLINIC: Bronchoscopy)
What is an endobronchial lesion?
A lesion within a bronchus
183
(IN THE CLINIC: Bronchoscopy)
How may we view an endobronchial lesion in a patient?
Bronchoscopic evaluation of the trachea and its main branches (Fig. 3.48).
184
(IN THE CLINIC: Bronchoscopy)
How is bronchoscopy performed?
The bronchoscope is passed through the nose into the oropharynx and is then directed by a control system past the vocal cords into the trachea.
185
(IN THE CLINIC: Bronchoscopy)
A bronchoscope is directed by a control system past which structures?
The vocal cords into the trachea.
186
(IN THE CLINIC: Bronchoscopy)
What is a bronchoscopy used for?
Inspecting the bronchi
187
(IN THE CLINIC: Bronchoscopy)
What follow-up may be performed in bronchoscopy shows unusual findings?
If necessary, small biopsies are obtained.
188
(IN THE CLINIC: Bronchoscopy)
Fig. 3.48A
Label the image and caption.
- Carina
- Right main bronchus
- Left main bronchus
Bronchoscopic evaluation. A. Of the lower end of the trachea and its main branches.
189
(IN THE CLINIC: Bronchoscopy)
Fig. 3.48B
Label the image and caption.
- Right main bronchus
- Tumour
Bronchoscopic evaluation. B. Of tracheal bifurcation showing a tumour at the carina.
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(IN THE CLINIC: Lung cancer)
Why is it important to stage lung cancer?
Because the treatment depends on its stage.
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(IN THE CLINIC: Lung cancer)
What is the prognosis if a small malignant nodule is found within the lung?
It can sometimes be excised and the prognosis is excellent.
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(IN THE CLINIC: Lung cancer)
When is tumour mass in the lungs a problem?
When a patient presents with a tumour mass that has:
- invaded structures in the mediastinum
- invaded structures in the pleurae
- metastasised
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(IN THE CLINIC: Lung cancer)
When can surgery be performed in lung tumour masses?
If a small malignant nodule is found within the lung
The tumour may be inoperable if the tumour mass has invaded structures in the mediastinum, pleurae or metastasised.
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(IN THE CLINIC: Lung cancer)
If surgery cannot be performed to remove a tumour mass, what is the next line of treatment?
Radiotherapy and chemotherapy
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(IN THE CLINIC: Lung cancer)
How do lung tumours spread?
By lymphatics
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(IN THE CLINIC: Lung cancer)
Where can lung tumours spread to?
Lymph nodes within the hila, mediastinum and root of the neck (because they travel via lymphatics)
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(IN THE CLINIC: Lung cancer)
What is a key factor affecting the prognosis and ability to cure the disease?
The distant spread of metastases
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(IN THE CLINIC: Lung cancer)
What imaging methods are used to assess spread of lung metastases?
Plain radiography (Fig. 3.49A)
Computer tomography (CT; Fig. 3.49B)
Magnetic resonance imaging (MRI)
Radionuclide studies using flurodeoxyglucose positron emission tomography (FDG PET; Fig. 3.49C)
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(IN THE CLINIC: Lung cancer)
What does FDG PET stand for?
Fluorodeoxyglucose Positron Emission Tomography
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(IN THE CLINIC: Lung cancer)
Fig. 3.49A
Label the tumour and caption the image.
Imaging of the lungs.
A. Standard posteroanterior view of the chest showing tumour in upper right lung.
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(IN THE CLINIC: Lung cancer)
Fig. 3.49B
Label the tumour and caption the image.
Imaging of the lungs.
B. Axial CT image of lungs showing tumour in right lung.
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(IN THE CLINIC: Lung cancer)
Fig. 3.49C
Label the tumour and caption the image.
Imaging of the lungs.
C. Radionuclide study using FDG PET showing a tumour in the right lung.
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(IN THE CLINIC: Lung cancer)
What is involved in an FDG PET?
A gamma radiation emitter is attached to a glucose molecule.
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(IN THE CLINIC: Lung cancer)
What does an FDG PET show?
In areas of high metabolic activity (i.e., the tumour), excessive uptake occurs and is recorded by a gamma camera.
(FDG PET involves a gamma radiation emitter is attached to a glucose molecule.)
