adult chest disease

8/6/2019 Adult Chest Disease

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Adult Chest Disease

KT/V


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Scope

Pulmonary infections

Diseases of the airways

Diffuse lung disease


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Pulmonary infections

Acute pneumonia

Pulmonary tuberculosis

Other myobacterial pulmonary infections Branching bacteria

Fungal infections


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Acute pneumonia

Bacterial pneumonias

Mycoplasma pneumonias

Viral pneumonias

Chlamydial and rickettsial pneumonias

Lung abscess

Aspiration and inhalation


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Streptococcus pneumoniae

Most common causein all age groups

Lobar consolidation

Air bronchogram

May proceed to

pleural effusion andempyema


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Staphylococcus aureus

Superinfection ininfluenza

Hematogenous Bronchopneumonia

Multiple patchy

consolidation,cavitation


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Klebsiella pneumonia

Lobarconsolidation

Right, upper lobe

Increased volume bulging offissures

Cavitation


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Klebsiella pneumonia

Lobarconsolidation

Right, upper lobe

Increased volume bulging offissures

Cavitation


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Legionnaires disease

Spreadingconsolidation

One lobeopposite lung

Slow resolution


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Pseudomonas and E.coli

Chronic lungdisease- COPD, CF

Long term ATB

Basalbronchopneumonia


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Melioidosis

Burkholderiapseudomellei

Endemic area

Disseminatesepticemia

Consolidation Necrotizing pneumonia


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Mycoplasma pneumoniae

Atypical bacteria

Young adults

Fine reticular ornodular shadows

consolidation


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Viral pneumonias

Distal bronchi and bronchioles

Interstitial process with destruction ofepithelium, edema and lymphocyticinfiltration

Radiological appearances

Peribronchial shadowing

Reticulonodular shadowing

Patchy or extensive consolidation


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Influenza virus

Secondary

bacterialinfection


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Varicella zoster

Adults morethan children

Acute:widespreadnodular

shadows Recovery:

calcify nodules


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Lung abscess

Suppuration andnecrosis of pulmonarytissue

Causes Most common:

aspiration of upper RStract

Air-fluid level:communication with theairways


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Aspiration

Mendelsons

syndrome

aspiration of acidgastric contents:

bronchospasm

edema hypoxia


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Pulmonary tuberculosis

Primary pulmonary TB

Most common: lowerlobe, subpleural lines

Primary complex

Peripheral consolidation(Ghon focus)

Regional lymph nodes


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Post primary infection

Apex of upper or lowerlobe lordotic view

Progress to

consolidation, cavities Fibrosis and volume

loss: healing

Cavities, bronchiectasis Chronic cavities

colonized by aspergillus


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Miliary TB Hematogenous spread of

infection Small discrete nodules 1-2

mm in diameter Tuberculoma Localized granuloma Solitary well-defined

nodule up to 5 cm

Lymphadenopathy Hilar and mediastinal:

primary infection

Pleural changes

Pleural effusion

Pleural thickening

Pneumothorax Airway involvement


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Pulmonary TB


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Nocardiosis

Nonsegmentalcavitating pneumonia

Pleural effusion,empyema

Immunocompromised


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Fungal infection

Histoplasmosis

Calcified hilar ormediastinal nodes

Later progression:fibrosis andcavitation

Fibrosingmediastinitis


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Aspergillosis

Allergicbronchopulmonaryaspergillosis (ABPA)

Aspergilloma Ball or mycetoma freein the cavity

Mobile ball whenchange position

DDx: blood clot,cavitating tumor, lungabscess


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Invasive aspergillosis

Immunocompromisedpatient

Bronchopneumonia,multiple nodules

HRCT: Halo sign

Aspergillosis


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AIDS

Infectious

PCP

Mycobacterial

Fungal

Noninfectious

Kaposi sarcoma

LIP

lymphoma


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Pneumocystis jiroveci

Most common inCD4


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TB

Early stages: reactivation TB

Later: primary TB

Fungal

Disseminated disease


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Kaposis sarcoma

Ill-defined nodules

Pleural effusions lymphadenopathy


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Lymphocytic interstitial pneumonitis

Mid and lowerzone reticularinfiltrate

Slow progression

No pleural or LNinvolvement


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Lymphoma

Atypicalmediastinal nodalenlargement

Pleural/ pericardialeffusions

Pulmonary

infiltrate/ mass


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Diseases of the airways

Trachea and bronchi

Obstructive airway disease

The lungs: collapse and consolidation


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Tracheal narrowing

Fibrosing mediastinitis TB, histoplasmosis

Wegener, relapsing polychondritis,

sarcoidosis Sabersheath trachea: elderly men, COPD

Normal tracheal wall

Reflex of abnormal intrathoracic pressure Tracheal stenosis

Injury, iatrogenic


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Tracheal narrowing

Primary tumors

Benign: papilloma, fibroma

Malignant: close to carina, squamous

Localized mass or long stricture

Tumors from other site

Locally invasion: thyroid, esophagus or lung

Distant metastasis: melanoma


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Bronchi

Bronchiectasis Irreversible dilatation of one

or more bronchi

Causes

Post infection Kartagener, CF

Tramline shadows or ringshadows

Dilated, fluid-filled bronchi:

gloved finger Air fluid level


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Obstructive airways disease


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Asthma

Remission:normal CXR

Attack: hyperinflation

Depress of the diaphragm

Expansion of retrosternal air space

Complication: PAH, pneumothorax, atelec


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Chronic bronchitis

50% normal CXR

bronchovascular markings

Bronchiectasis Emphysema


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Emphysema

Panacinar

Reduction of pulmonary vascularityperipherally

Hyperinflation of the lungs

Alteration of the cardiac shadow and centralpulmonary arteries

Increase retrosternal air space Long and narrow heart

Cor pulmonale: RV dilatation


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Emphysema

Bullous disease ofthe lungs

Round or ovaltranslucenciesvaring in size

Smooth, curved,

hairline shadowwall


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Emphysema

Unilateral emphysema

Hypertransradiant hemithorax

Childhood viral infection

Expiration: displacement of the mediastinumto the more normal side, restriction of theipsilateral diaphragm


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The Lungs

Collapse

Indirect signs

Elevation of the hemidiaphragm

Mediastinal displacement

Hilar displacement

Compensatory hyperinflation


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Complete collapse of a lung


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RUL collapse


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RML collapse


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Lower lobe collapse


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Lower lobe collapse


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Lingular collapse


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LUL collapse


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Rounded atelectasis

Asbestosexposure

Secondary to

exudativepleural effusion


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Consolidation

Replacement of air by fluid or solidmaterial

Causes

pneumonia,

pulmonary edema

Hemorrhage

Tumor: alveolar-cell CA, lymphoma

Alveolar proteinosis


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Diffuse lung disease

Sarcoidosis

CNT diseases

Systemic vasculitides

Diffuse pulmonary fibrosis

Pulmonary alveolar proteinosis


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Sarcoidosis

Thoracic lymphadenopathy

Bilateral, symmetric hilar enlargement

LN: egg-shell calcification

Parenchymal lung opacities

Multiple nodular opacities: ground glass/miliary shadows

Peribronchovascular and subpleural


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Sarcoidosis


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Connective tissue diseases

SLE

Rheumatoid disease

Systemic sclerosis

DM/PM

Ankylosing spondylitis


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Rheumatoid disease

Pleural effusions

Low glucose, lymphocytepredominate

Pulmonary nodules Asso. Subcutaneous

nodules

Caplans: nodules on

pneumoconiosis Fibrosing alveolitis


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Systemic sclerosis

Pulmonary fibrosis

Pulmonary artery

hypertension Dilated esophagus

Honey comb

change eventually


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DM/PM

Basal fibrosingalveolitis

Associated withanti-synthetasesyndrome

Anti Jo-1 Ab


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Ankylosing spondylitis

Upper lobe fibrosis

Bilateral

Apical pleuralthickening


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Systemic vasculitides

Wegeners

granulomatosis

Pulmonary masses

Diffuse reticular orirregular nodular

Small pleural effusion

Paranasal sinusopacification


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Churg-Strauss Disease

Asthma, eosinophilia

Alveolar consolidations, diffuse coarsereticulation

Wax and wane

Pulmonary infarcts


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Diffuse pulmonary fibrosis

IPF

Langerhans cell histiocytosis

Tuberous sclerosis

Lymphangioleiomyomatosis

Neurofibromatosis

ARDS


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Idiopathic pulmonary fibrosis


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Langerhans cell histiocytosis

Mixture ofdiscretenodules and

cystic spaces Sparing of the

lung base

TS LAM NF


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TS, LAM, NF

Normal lungvolume

Multiple thin-walledcysts

LAM: chylothorax

NF: slow progress pneumothorax

ARDS


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ARDS

P l l l i i


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Pulmonary alveolar proteinosis

Type II pneumocytes overproduce aproteinaceous lipid-rich material

Xray: pulmonary edema

Small, acinar, perihilar opacities

Crazy paving pattern: thickening ofinterlobular septa, ground-glassshadowing


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THE END

adult chest disease

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