Thorax Flashcards
(43 cards)
Types of bronchiolitis
Cellular
Constrictive fibrotic
Findings in constrictive fibrotic bronchiiolitis
Causes?
DD?
Air trapping
Mosaic attenuation.
Cause:
-post transplant
-connective tissue disease
-infection
-inhalation
-DIPNECH
DD: other fibrosing constrictive bronchiolitis
-Asthma
-Panlobular emphysema
Causes for bronchiectasis?
-Idiopathic
-Post infectious, most common, chronic or recurrent. Typical or atypical mycobacteria, staphylo, pertusis, pseudomonna, viral, fungal.
-Congenital: CF, primary cilliary dyskinesia, alfa 1 antitrypsin deficiency, williams-campbell syndrome, Mounier Kuhn syndrome.
-Immune mediated: ABPA, toxic inhalation, collagen, AIDS, ARDS.
-Obstructive: COPD, asthma, proximal obstruction .
Types of bronchiectasis (morphology)
Dx findings
Dx:
-Xray:** tram-track **opacities (Linear opacities that correspond to dilated airways and thickened airway walls)
-Rounded or branching tubular lucencies and cystic spaces that represent dilated airways;± air-fluid levels
-HRCT/thin CT: Best tool
Direct sign:
-↑ bronchoarterial ratio (B/A); signet ring sign (B/A > 1.5)
- Lack of bronchial tapering: Earliest and most sensitive sign
- Bronchiolectasis: Visualization of airway within 1 cm of costal pleura or abutting mediastinal pleura
Other associations:
-Bronchial wall thickening± mucoid impaction, fluid-filled bronchi
-Centrilobular nodules (tree-in-bud opacities)
-Mosaic attenuation (inspiratory) and air-trapping (expiratory) due to constrictive bronchiolitis
Diffuse Bronchiectasis, location and entities?
-Central
Allergic bronchopulmonary aspergillosis (ABPA),Mounier-Kuhn,Williams-Campbell
-Peripheral: Upper lobe predominant
Cystic fibrosis (CF), mycobacterial infection, non-TB, sarcoidosis, HP, AS.
-Peripheral: Lower lobe predominant
Pulmonary fibrosis (UIP, NSIP), chronic aspiration, immunodeficiency, autoimmune/collagen vascular disease,α-1 antitrypsin deficiency
-Peripheral: Middle lobe/lingular predominant
Atypical mycobacterial infection,primary ciliary dyskinesia (PCD),acute respiratory distress syndrome (ARDS)
-Peripheral: Diffuse involvement
Bronchiolitis obliterans syndrome (post-transplant)
Most common ILD pattern in RA
Findings in RA-ILD
UIP/ NSIP/ OP
Necrotic nodules
Airways: OB, bronchiectasis bronchiolectasis
pleural effusion, thickening.
Characteristic UIP pattern in CTD?
Straight line sign
Anterior uppler lobe fibrosis
Lower lobe exuberant honeycomb
CTD-ILD: which disease one is most likelty to express as NSIP
Scleroderma.
CTD-ILD in myositis, ILD expression?
OP+ NSIP
lung expression in LES
Serositis»_space;» ILD (less likely)
Crazy Paving causes:
C: COP, Cancer
R: respiratory distress acute
A: Alveolar proteinosis
Z: zipper/fat= lipoid neumonia
Y: pulmonary haemorrage
P: PCP
Hemorrhagic metastasis to lung
RCC
Melanoma
Angiosarcoma
Choriocarcinoma
Cavitating mets
SCC
AdenoCA
Sarcoma
Name histological stages of lobar pneumonia
-Congestion: 2-6hs, vascular engorgement, intraalveolar edema fluid + bacterial proliferation + some N.
Macro: Red bogy heavy lung.
-Red hepatisation: 12hs, massive exudation (RBCs, neutrophils & fibrin) filling alveolar spaces = red, firm, airless lung (liver-like consistency = hepatisation)
-Grey hepatisation: 1-10d. Fibrinopurulent exudate. Disintegration of red cells.
Greyish-brown, dry surface to lung
-Resolution: Exudate broken down (progressive enzymatic digestion) , produces granular, semifluid debris , ingested by macrophages, expectorated or organised (by fibroblasts)
Extension to pleura (pleuritis) often present- long-term fibrous thickening and/or permanent adhesions (organisation)
Name at least 5 most common bacterial causes for community acquired pneumonia?
Which one is the single most common?
- *Streptococcus pneumoniae *– most common
- Mycoplasma
- Haemophilus influenzae (type B most virulent, hence vaccine),
- Moraxella catarrhalis (esp. elderly & COPD),
- Staphylococcus aureus (post-viral or IVDU; assoc. w/ lung abscess & empyema),
- Pseudomonas aeruginosa (usually HAP hospital acquired pneumonia but occurs in CF & immuncompromised),
- Klebsiella pneumoniae (chronic alcoholics)
Mention at least 5 clinical settings where pneumonia can arise
At least 7 specific clinical settings:
-Community acquired acute pneumonia
-Hospital acquired pneumonia
-Health care associated pneumonia
-Aspiration pneumonia
-Chronic pneumonia
-Necrotizing pneumonia
-Pneumonia in immunocompromised host.
Mechanism when local pulmonary defence is compromised?
-Loss or supression of cough reflex
-Dysfunction of mucociliary apparatus
-Accumulation of secretions
-Interference w/phagocytosis
-Pulmonary congestion and oedema
-Cell mediated deficiency
-Congenital innate immunity.
Which are the patterns of distribution in bacterial pneumonia?
-Lobar pneumonia
-Bronchopneumonia
Lobar pneumonia:
Population affected , most common cause, path.
Lobar pneumonia:
-Typically in healthy subjects.
-S. Pneumoniae most common. Klebsiela, legionella, H.I, Mycoplasmas, TB.
-Path: affects alveolar space (exudate/transudate/blood cells) leads to consolidation + air bronchogram.
Bronchopneumonia:
Population affected , most common cause, path.
-At risk patients: young/elderly, OH, post op, supressed cough, immunosupressed, viral.
-Cause: S. Aureus, HI, viral
-Path: affects respiratory epithelium: foci of suppurative peribronchiolar inflammation in terminal bronchiles. Neutrophil-rich exudate filling bronchi/bronchioles and alveolar spaces.
Macro: granular grey-red-yellow foci.
Complications of bacterial pneumonia?
- Tissue destruction/necrosis = abscess formation (pneumococcus & klebsiella),
- Spread of infection to pleural cavity and fibrinosuppurative reaction = empyema,
- Bacteraemia systemic dissemination (heart valves, pericardium, brain, kidneys, spleen, joints causing abscesses, endocarditis, meningitis, suppurative arthritis)
What organism is typically associated if patient has CF?
And what organism classically associate w/malnourised OH? Second most common in this population?
Pseudomona Aeruginosa.
Klebsiella pneumonia - thick sputum.
Moraxella catarrhalis 2nd most common in this population.
Most common cuase of Gram Neg pneumonia?
Klebsiella
