Unit 3: Thoracic Pathology PPT
Chest Tubes
for Pneumothorax • Inserted into the chest wall between ribs (depends) • Allows drainage (air & fluid).
Interstitium
gaps between structures (alveoli)
blood in pleural space
hemothorax
Fluid in the plural space
pleural effusion
air in the pleural space
pneumothorax
Segmental Atelectasis
segment that looks like a slice of Pizza w/ the point aiming toward the Hilum (Entire lobe that collapses)
Pneumonia
• 6th leading cause of deaths (all age groups) • 40% of hospital deaths. • An acute infection of the lung parenchyma impairing gas exchange (Bacterial or Viral). • Bacterial treatment = Anitibiotics. • Viral Treatment = Symptomatic relief. • Radiographically: Appears soft, patchy, ill defined alveolar densities. • R/O PCP?
Lung Cancer (Primary)
• 80% deaths are smokers. • Single nodule arising from 4 cell types... 1. Small cell 2. Large cell 3. Squamous cell 4. Adenocarcinoma. Will have one single mass ** Usually found in the Hilar region. If found in the bronchi, a bronchoscopy may be done for biopsy.
What is Aspiration? Where will foreign objects most likely be lodged?
• Breathing in a foreign object (food into the airway) • the Right bronchi because more vertical and wider
Chronic Obstructive Pulmonary Disease (Emphysema)
• Bronchial wall becomes thick w/ mucus buildup. • Lungs are hyperinflated.
Tension Pneumothorax
• Creates a shift in the mediastinum • Causes a collapse lung • Very serious condition
Congestive Heart Failure (CHF)
• Due to heart disease. (Big heart) • Abnormal sodium & water retention. • Radiographically - Pleural effusion, cardiomegaly, reversal of pulmonary vascular ratio. • May see a pseudotumor CHF should not measure more than half of the Thoracic cavity
Pleural Effusion
• Fluid in the pleural space. • "Blunted" costophrenic angles. • Lat. Decub films are used (Is it loculated? occurs when fluid fills this gap and separates the lungs from the chest wall). • Treatment: Thorocentesis or chest tube.
Pulmonary Edema
• Fluid replaces air in the alveoli • Concentrated in the Hilar area "Butterfly wings" sign
Coccidioidomycosis (Valley Fever)
• Fungal infection found in warm, dry areas. • Inhaling soil containing the fungus (earthquakes & disruption of the soil). • Also found in bird droppings. • Treatment: Antibiotics & bed rest. - diffuse Bilateral Infiltrate (image: more [ ] on the left side)
Pulmonary Artery Catheter (Swan-Ganz)
• Inserted into subclavian vein. • Evaluates cardiac function, measures pulmonary wedge pressure or lt. Atrial pressure. • Also used to inject meds. & cardiac output.
Central Venous Pressure Line
• Inserted into the subclavian - distal SVC. • Used for Injecting meds, measurement of central venous pressure, & provides info on the rt. Side of heart. Short term: Above Corina Long term: Below Corina
What are the functions of the Respiratory System?
• Oxygenate blood. • Removal of the body's waste products (CO2) -Pulse Oxymeter
Primary vs. Metastatic
• Primary CA = single nodue. • Metastatic = multiple nodules. Lung Cancer that spread from somewhere else
Consolidation
• Process of becoming solid or having a thick appearance. • Absorbing X-rays
Chronic Obstructive Pulmonary Disease (Emphysema & Chronic Bronchitis)
• Signs of emphysema are radiolucent appearing lungs. (Big barrel lung) • Hyperinflated lungs. • Flattened diaphragm. • Large Bullae. • Barrel chested (Anterior to Posterior).
Tuberculosis (Mycobacterium Tuberculosis)
• Spread by droplet inhalation. • May be dormant for decades. • Loves the apices of lungs. • Pt. Should be in respiratory isolation. • What view would best demonstrate TB? • Treatment: Meds (DOT) Direct Observation Therapy
Line Placements • How will you adjust your technique?? • What are you looking for??
• Techniques should be increased ⬆ ⬆KVP and lower MAS • ...
Endotracheal Tubes (ET) • Inserted through the pt's nose or mouth. • What's it used for?
• To manage the PT's Airway for Ventilation • Placement: should be Below Vocal Cord and above Corina @ T5 or slightly above that
Congestive Heart Failure (Pseudotumor)
• a relatively rare benign tumor located in the lungs • located within pulmonary fissures
(NG Tube) • Why is it called a NG tube?
•Nasogastric Tube • Relieves small bowel obstruction. (Causes a lot of air in the bowel) • Feeding.
Infiltrate
An area of increased density or opacification within normal lung tissue (blood, pus, or other fluid).
Edema
Fluid
HAPD
High Altitude Performance Demonstrator • Due to high altitudes
What view would best demonstrate TB?
Lordotic X-Ray
What is used to stop DVT?
"Greenfield Filter" looks like birdie (shuttlecock)
Lung abcess
- Spherical lesion with pus inside lung tissue due to necrotic pulmonary tissue caused by bacteria (mouth anaerobes/poor oral hygiene). - formed by disintegrating tissue fistula- opens up into something else - More common in art. Lung due to its vertical orientation of the art. Main bronchi Treatment: Antibiotics
Lung Empyema
- an accumulation of pus in the pleural cavity - from a lung infection - treatment: IV antibiotics & drain insertion any Pyle is pus
Pulmonary Emboli (PE)
- caused by a DVT that breaks loose and travels to the lungs - dyspnea & chest pain - Nuc med = modality of choice "Greenfield Filter" used to stop DVT CXR- (negative) may be seen as a wedged shaped infiltrate
ARDS
Acute Respiratory Distress Syndrome • Acute form of congestion & edema (dyspnea, tachychardia, hypoxia) -may be caused by infection aspiration or trauma
Chronic Obstructive Pulmonary Disease (Chronic Bronchitis)
Due to smoking, industrial & air pollution.
Lung Cancer (Metastatic)
Metastatic-> spread • Multiple lesions seen on radiograph. (cotton ball) • Primary tumor sites may be... -Breast, GI tract, Female reproductive tract & Kidneys. • Malignant tumors are rarely calcified. • Spread through blood stream, lymphatic system, local invasion, direct biopsies or other surgical procedures. Aerobic Cancers- could take off from exposure to O2
Lumen
Opening or middle of a vessel
What does PICC stand for?
Peripherally Inserted Central Catheter
R/O PCP
Pneumocystis pneumonia a serious infection caused by the fungus Pneumocystis jirovecii. Most people who get PCP have a medical condition that weakens their immune system, like HIV/AIDS, or take medicines (such as corticosteroids) that lower the body's ability to fight germs and sickness.
For massive pleural effusion will look like hemothorax but how can you tell the difference?
Pt. History was the Pt stabbed? -> Hemothorax Pt cough pain for week? -> pleural effusion Both require chest tube
Diffuse
Spreading or scattering
Acute
Sudden onset
Where do you center for a chest x-ray?
T7
Parenchyma
The essential parts of the lung (alveoli, bronchi, vessels)
Which Vw of chest would best show a pneumothorax?
Upright PA Chest
what does ARDS look like radiographically?
Widespread diffuse consolidation in the lungs
Pneumothorax
air in the pleural cavity (Parietal & Visceral Pleura) cause: Traumatic or Sx., lung alveoli or bronchial injury, bacteria • radiolucency w/ no vascular markings
Mediastinum
area between the lungs contains: Heart, Great Vessels (inferior/superior vena cava, large pulmonary arteries and veins) Thymus, esophagus, trachea
Atelectasis
collapsed lung (air pushed on tissue) • The partial or total collapse of the lung Cause: Obstruction, Tissue compression, post-Sx. Treatment: Re-expand the collapsed lung Radiographically: appears platelike, parallel to diaphragm
Hematopsis
coughing up blood
DVT
deep vein thrombosis blood clot that travels (thrombus) to the lung from a vein in the leg, is a blockage of the lung's main artery or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream
What are the 2 types of COPD?
emphysema and chronic bronchitis
Pus in the plural space
empyema
