The document discusses the blood supply of the lungs, which includes the bronchial circulation and pulmonary circulation.
The bronchial circulation supplies oxygenated blood to the bronchi and lungs from the systemic circulation. The pulmonary circulation supplies deoxygenated blood from the right ventricle to the lungs where gas exchange occurs in the pulmonary capillaries before oxygenated blood returns to the left atrium.
The document provides details on the development, anatomy, pressures, and functions of both the bronchial and pulmonary circulations in fetal, neonatal and adult stages. It also discusses factors that regulate pulmonary vascular resistance and the role of the pulmonary circulation in gas exchange, filtering blood, and acting as a reservoir for the left vent
Gas exchange between the alveoli and the pulmonary capillary blood occurs by diffusion, as will be discussed in the next chapter. Diffusion of oxygen and carbon dioxide occurs passively, according to their concentration differences across the alveolar-capillary barrier. These concentration differences must be maintained by ventilation of the alveoli and perfusion of the pulmonary capillaries.
Alveolar ventilation brings oxygen into the lung and removes carbon dioxide from it. Similarly, the mixed venous blood brings carbon dioxide into the lung and takes up alveolar oxygen. The alveolar Image not available. and Image not available. are thus determined by the relationship between alveolar ventilation and pulmonary capillary perfusion. Alterations in the ratio of ventilation to perfusion, called the Image not available., will result in changes in the alveolar Image not available. and Image not available., as well as in gas delivery to or removal from the lung.
Alveolar ventilation is normally about 4 to 6 L/min and pulmonary blood flow (which is equal to cardiac output) has a similar range, and so the Image not available. for the whole lung is in the range of 0.8 to 1.2. Image not available. However, ventilation and perfusion must be matched on the alveolar-capillary level, and the Image not available. for the whole lung is really of interest only as an approximation of the situation in all the alveolar-capillary units of the lung. For instance, suppose that all 5 L/min of the cardiac output went to the left lung and all 5 L/min of alveolar ventilation went to the right lung. The whole lung Image not available. would be 1.0, but there would be no gas exchange because there could be no gas diffusion between the ventilated alveoli and the perfused pulmonary capillaries.
Oxygen is delivered to the alveolus by alveolar ventilation, is removed from the alveolus as it diffuses into the pulmonary capillary blood, and is carried away by blood flow. Similarly, carbon dioxide is delivered to the alveolus in the mixed venous blood and diffuses into the alveolus in the pulmonary capillary. The carbon dioxide is removed from the alveolus by alveolar ventilation. As will be discussed in Chapter 6, at resting cardiac outputs the diffusion of both oxygen and carbon dioxide is normally limited by pulmonary perfusion. Thus, the alveolar partial pressures of both oxygen and carbon dioxide are determined by the Image not available. If the Image not available. in an alveolar-capillary unit increases, the delivery of oxygen relative to its removal will increase, as will the removal ...
Like heartbeat, breathing must occur in a continuous, cyclic pattern to sustain life processes.
Inspiratory muscles must rhythmically contract and relax to alternately fill the lungs with air and empty them.
The rhythmic pattern of breathing is established by cyclic neural activity to the respiratory muscles
Gas exchange between the alveoli and the pulmonary capillary blood occurs by diffusion, as will be discussed in the next chapter. Diffusion of oxygen and carbon dioxide occurs passively, according to their concentration differences across the alveolar-capillary barrier. These concentration differences must be maintained by ventilation of the alveoli and perfusion of the pulmonary capillaries.
Alveolar ventilation brings oxygen into the lung and removes carbon dioxide from it. Similarly, the mixed venous blood brings carbon dioxide into the lung and takes up alveolar oxygen. The alveolar Image not available. and Image not available. are thus determined by the relationship between alveolar ventilation and pulmonary capillary perfusion. Alterations in the ratio of ventilation to perfusion, called the Image not available., will result in changes in the alveolar Image not available. and Image not available., as well as in gas delivery to or removal from the lung.
Alveolar ventilation is normally about 4 to 6 L/min and pulmonary blood flow (which is equal to cardiac output) has a similar range, and so the Image not available. for the whole lung is in the range of 0.8 to 1.2. Image not available. However, ventilation and perfusion must be matched on the alveolar-capillary level, and the Image not available. for the whole lung is really of interest only as an approximation of the situation in all the alveolar-capillary units of the lung. For instance, suppose that all 5 L/min of the cardiac output went to the left lung and all 5 L/min of alveolar ventilation went to the right lung. The whole lung Image not available. would be 1.0, but there would be no gas exchange because there could be no gas diffusion between the ventilated alveoli and the perfused pulmonary capillaries.
Oxygen is delivered to the alveolus by alveolar ventilation, is removed from the alveolus as it diffuses into the pulmonary capillary blood, and is carried away by blood flow. Similarly, carbon dioxide is delivered to the alveolus in the mixed venous blood and diffuses into the alveolus in the pulmonary capillary. The carbon dioxide is removed from the alveolus by alveolar ventilation. As will be discussed in Chapter 6, at resting cardiac outputs the diffusion of both oxygen and carbon dioxide is normally limited by pulmonary perfusion. Thus, the alveolar partial pressures of both oxygen and carbon dioxide are determined by the Image not available. If the Image not available. in an alveolar-capillary unit increases, the delivery of oxygen relative to its removal will increase, as will the removal ...
Like heartbeat, breathing must occur in a continuous, cyclic pattern to sustain life processes.
Inspiratory muscles must rhythmically contract and relax to alternately fill the lungs with air and empty them.
The rhythmic pattern of breathing is established by cyclic neural activity to the respiratory muscles
Slideshow is from the University of Michigan Medical School's M1 Cardiovascular / Respiratory sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1Cardio
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lecture 4: in this subject we will see a general idea about the pulmonary circulation which is important, any pathological disease wether from the lung or not will affect the lung blood circulation and perhaps the systemic circulation that may leads dyspnea.
The lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax). The trachea (windpipe) conducts inhaled air into the lungs through its tubular branches, called bronchi. The bronchi then divide into smaller and smaller branches (bronchioles), finally becoming microscopic.
The bronchioles eventually end in clusters of microscopic air sacs called alveoli. In the alveoli, oxygen from the air is absorbed into the blood. Carbon dioxide, a waste product of metabolism, travels from the blood to the alveoli, where it can be exhaled. Between the alveoli is a thin layer of cells called the interstitium, which contains blood vessels and cells that help support the alveoli.
Pulmonary circulation pressure,zone-1,2,3 of pulmonary blood flow,capillary dynamics,effects of ventilation perfussion ratio on alveolar gas concentration,abnormalities
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. •Blood supply of lung includes-
BRONCHIAL CIRCULATION- comprising of bronchial
arteries and veins
PULMONARY CIRCULATION- comprising of
pulmonary arteries and veins
3. Differences
• Bronchial arteries supplies oxygenated blood
pumped from the left ventricle- systemic circulation
relatively smaller diameter, high pressure
•Pulmonary arteries supplies deoxygenated blood
pumped from the right ventricle . This circulation
relatively larger diameter, low pressure
4.
5. DEVELOPMENT
•By the completion of 16th
week intrauterine life, the
preacinar structures of bronchi, pulmonary vessels,
bronchial arteries are developed
•Pulmonary trunk developed from 6th
primitive
branchial arch
•Vessels developed from mesenchymal tissue
6.
7. Fetal and neonatal circulation
•Before birth, lungs receive about 10 to 15 percent
of right ventricle output
•In comparison to adult circulation, fetal circulation
has
More vascular resistance
High initial tone
Greater vascular reactivity
Reactive hyperemia
•PGs, endothelins and NO plays an important role in
regulating fetal circulation.
8. •After first breath there is marked drop in PVR
Due to:
Increased Po2
Expansion of the lungs
9. Bronchial circulation
• It is a part of systemic circulation
• It contains 1-2 percent of cardiac output
BRONCHIAL ARTERIES
Origin
• The left BA (superior & inferior) usually arise directly from the
thoracic aorta at the level of T5&T6 vertebra
• The origin of the right bronchial artery is variable; in order of
frequency,
it may arise from
• right posterior intercostal artery (usually the 3rd),
• a common trunk shared with the left superior bronchial artery, or
• directly from the aorta.
11. Bronchial artery branching pattern
Cauldwell et al - four patterns:
11
Type I
Type II
Type III
Type IV
Cauldwell EW, Siekert RG, Lininger RE, Anson BJ.The bronchial arteries: an
anatomic study of 105 human cadavers. Surg Gynecol Obstet 1948; 86:395–412.
12. Type I • Incidence: 40.6%
• Left:2
• Right: 1 {intercostobronchial
trunk (ICBT)}
12
Single rt.branch
Lt. 2 br.arties
Sup.left
bronchial
artert
Inf.Left
bronchial
artery.
Right
bronchial
artery
.
13. Type II
• Incidence: 21.3%
• Left:
1 left Bronchial Artery
• Right: 1intercostobronchial
trunk
13
Single Lft.bron.art
Single.Rt.ICBT
14. Type III
• Incidence: 20.6%
• Left:2
• Right : 2
(1intercostobronchial trunk & 1
Right bronchial artery)
14
Left sup.& Left Inf .bronchial
artery.
Right
ICBT
Right Bronchial
artery
.
15. Type IV
• Incidence: 9.7%
• Left: 1
• Right: 2
(one intercostobronchial trunk
and one bronchial artery)
15
Single Left
artery
Rt.ICBT
Rt.Bron.art.
16. • Normal BA measure < 1.5 mm in diameter at their
origin and 0.5 mm at their point of entry into a BPS
• BA >2 mm at CT is
most likely abnormal ,
upto 8mm in hypertrophied
17. Distribution to lung
• The br. A supply blood to the bronchi and connective
tissue of the lungs. They end at the level of the
respiratory bronchioles. They anastomose with the
branches of the pulmonary arteries, and together, they
supply the visceral pleura of the lung
Functions
• It has features of nutrient circulation
• they supply the lungs with oxygenated blood
• It also participates in air conditioning of the inspired
air.
18. Bronchial veins
•There is typically a single bronchial vein at
each hilum, formed from the superficial bronchial
veins with deep bronchial veins, draining into the
pulmonary veins.
Deep bronchial veins
•The deep bronchial veins form from intrabronchial
venous plexuses. These vein drains either directly
into the left atrium or into thepulmonary vein.
Within the lung there are significant anastmoses
with the intrapulmonary pulmonary veins.
19. • Superficial bronchial veins
• The superficial bronchial veins consist of a subpleural
venous network which receive tributaries from extra-
pulmonary bronchi, hilar lymph nodes and the vaso
vasorum of the hilar pulmonary vessels and unite to
form a single bronchial vein at each hilum.
• on the right, they drain into the azygos vein. On the left
they drain into the left superior intercostal
vein, accessory hemiazygos vein or left brachiocephalic
vein. At the hilum they communicate with the
pulmonary veins.
22. •The bronchial circulation proliferates beyond the
limits in the following conditions:
Pulmonary atresia
bronchiectasis
lung abscess
lung cancer
• In chronic MS, Haemoptysis occurs from bronchial
veins
24. PULMONARY CIRCULATION
Pulmonary artery
Arises from the infundibulum of the right ventricle
at pulmonary valve and runs posteriorly slightly
upwards and divide below the aortic arch in to right
and left
Right pulmonary artery runs laterally under aortic
arch and posterior to ascending aorta and superior
venacava before dividing at the hilum into upper,
middle and lower branches ,to supply upper, middle
and lower lobes respectively
25. •Left pulmonary artery runs laterally, upwards and
posteriorly,anterior to descending aorta and
connected to ligamentum arteriosum.
•It divides into upper and lower branches; they
supply upper and lower lobes
•Sub divides in a variable pattern on both sides
26. •Counting from peripheral small arteries to the main
pulmonary trunk, there are 17 orders of branching
on both sides.
•Pulmonary arteries breaking up to pulmonary
capillaries that form network around the alveolus.
•Media of the vessels consists of elastic fibrils(5 or
6layers) with smooth muscle fibers, collagen and
mucopolysaccharide ground substance.
30. Pulmonary veins
•Four in number two on each side
They commence in a capillary network upon the
walls of the air sacs, where they are continuous
with capillary ramifications of the pulmonary artery
and joining together form a single trunk for each
lobule
31. •On right side two in number - because middle lobe
vein joined with upper lobe vein
•On left side two in number
•These four veins perforate the fibrous layer of the
pericardium and opens separately in to upper and
back of the left atrium
•Pulmonary artery—de-oxygenated
•Pulmonary veins—only veins which carry oxygenated
blood
32.
33. Functions of the pulmonary
circulation
•Respiratory and non-respiratory
•Respiratory- gas exchange
•Non-respiratory
•Blood filter
•Blood reservoir
•Metabolic
•Nutrient
34. Gas exchange
The pulmonary artery branches rapidly give rise to
nearly 300 million capillaries
Gas exchange between alveolar gases and blood
occur within the lung capillaries by simple diffusion.
Oxygen diffuses from the alveolus to pulmonary
capillary blood, ,Co2 diffuses in the reverse
direction, as determined by their concentration
gradient
35. Blood filter
•Micro vessels are so numerous, that effectively
serves as a filter to entrap the foreign materials
present in the blood
•This filter mechanism prevent entry of potentially
harmful particles in to systemic circulation
•Entrapped materials can be removed by enzymatic
process, macrophages or absorption into lymphatic
system
36. Reservoir of blood for left ventricle
•Pulmonary circulation is very compliant and
accommodate about 500 ml of blood in an adult
•This can serve as a reservoir for left ventricle
particularly during times when output exceeds venous
return
•The cardiac output can increase rapidly by drawing
upon pulmonary blood volume without depending on
instantaneous increase in venous return
37. Metabolic function of the pulmonary
circulation
•Uptake or metabolic conversion of vasoactive
substances into circulation done by endothelial
cells.
•Conversion of Angiotensin I to angiotensin II
38. Neurohumoral function of lung
Angiotensinogen
ANGIOTENSIN I
ANGIOTENSIN II
RENIN
CONVERTING
ENZYME
PERIPHERAL
VASOCONSTRICTION
ALDOSTERONE
SECRETION
INCREASED BLOOD PRESSURE
39. Pulmonary vascular resistance
•Normal pulmonary circulation is a low resistance, high
compliant vascular bed
•Calculated by using
• R=P.PA-P.LA/QT
•Normal value of R for pulmonary circulation is 0.1 mm
hg/L/min
In humans residing at high altitude, will have high PVR,
because muscular media of the small pulmonary arteries
and arterioles becomes thicker.
40. Pulmonary vascular pressures
•Pulmonary pressure drop along the length of
pulmonary vascular tree
•Since pulmonary capillary pressure can’t be
measured directly, they are generally estimated to
be intermediate between the mean pulmonary
arterial and pulmonary wedge pressures
41. •Pulmonary capillary flow recorded by using
Body plethysmograph
Nitrous oxide method
Average pul. Art. Pressure is about 10-12 mm Hg(1/8 th
of systemic circulation)
During systole 20-30 mm of Hg
diastole 5 to 10mm of Hg
Ageing associated with slight increase in pulmonary
arterial pressure
42. LEFT ATRIAL AND PULMONARY WEDGE
PRESSURE
•In intact, unanaesthetized humans, the mean left
atrial pressure is about 5 to 10 mm Hg.
•It is measured by advancing a cardiac catheter
through the right side of the heart and pulmonary
arterial tree until it impacts in a small precapillary
vessel
43. Pulmonary blood volume
•It is about 10 percent of total systemic circulation
•Measured by using indicator dilution principle
•70 kg human male contains approximately 400-500
ml
44. •This value is useful for
1.Determination of the mechanical behavior of lung.
2.Provides preload for the left ventricle, acts as a
reservoir
3.As a supply of Hb for alveolar-capillary gas exchange
4.As a source of water and macromolecules that
engage in alveolar-capillary exchange
5.As a potential mechanism for increasing pulmonary
capillary pressures and promoting pulmonary edema.
45. Pulmonary blood volume Increases in
-IV infusion
-immersing the body in water
-by inflation of an antigravity suit
-by negative pressure breathing
-systemic vasoconstriction
-lying down position
46. •Decreases
-when person stands
- After a large venesection
-during positive-pressure breathing
-valsalva maneuver
-systemic vasodilatation
48. •The initial vascular tone of pulmonary
circulation is attributed to balance between
vasodilation and vasoconstriction caused by
various mediators.
•Vasodialtion caused by prostacyclins, nitric
oxide
•Constriction by endothelins..
51. Role of nerves in pulmonary
vasomotor control
•Sympathetic innervation to pulmonary circulation
includes
alpha adrenergic receptors -predominate-(eg:NE)-
constrictor
beta adrenergic receptors-(eg:isoproterenol)-
dilator
•Cholinergic activity does not appear to be implicated
52. Acute hypoxia
•Pressor effect of acute hypoxia on the pulmonary
circulation was given by Euler and Liljestrand
•This pressor effect redirects blood flow to better
ventilated portion
•Acute hypoxia increases pulmonary arterial
pressure, does not affect left atrial pressure, and
little increase in cardiac output
53. •The pressor effect starts within seconds, generally
reaches peak by 3 min, and attenuates gradually as
hypoxia continues
•Acidosis augments pressor response
•This effect Is predominantly at pre-capillary level
(i.e.: small muscular art. and arterioles)
55. Chronic hypoxia
•Ex. High altitude
•It causes remodeling of small pulmonary arteries and
arterioles leading to high PVR,due to muscular media
thickening.
•Acute hypercapnia
-Little response is seen if the pH is maintained
at near normal level
Acidosis causes pulmonary vasoconstriction, where
as alkalosis causes vasodilatation.
58. Gravity determines highest
blood flow at lung base
0 cm
End expiration
+10
cm
-10
cm
Pa > Ppa >Ppv
(cmH2O)
Ppa >Pa >Ppv
Ppa > Ppv >Pa
Palv = 0
59.
60. HEMOPTYSIS
COMMON CAUSES:
•Tuberculosis ( active or inactive)
•Bronchiectasis (including cystic fibrosis)
•Bronchogenic Carcinoma
•Mycetoma ( aspergillloma /Fungal ball)
•Lung abcess
•Mitral stenosis
•Pulmonary Contusion or trauma
61. Tuberculosis
MECHANISMS
•Active tubercular pneumonitis- bronchiolar erosion
•Rupture of Rasmussen’s aneurysm (pulmonary. artery)
•Healed calcified lymphnode - eroding through
bronchial arteries into airway (expectoration of
broncholith)
62. BRONCHIECTASIS
•Pathologically it is destruction of the cartilaginous
support of bronchial wall and bronchial dilatation
owing to parenchymal retraction from alveolar
fibrosis
ANATOMICAL CHANGES:
•Bronchial artery hypertrophy
•Expansion of peribronchial & sub mucosal
bronchiolar arteriolar plexus
•Augmentation of anastomoses with the pulmonary
arterial bed
63. MYCETOMA
MECHANISMS:
•Mechanical trauma of the vascular granulation
tissue by the movement of the fungal ball in the
cavity
•Vascular injury from aspergillus associated
endotoxin
•Aspergillus related proteolytic activity
•Vascular damage from a type 3 hypersensitivity
reaction
65. Systemic artery-pulmonary
vascular communications
• May be congenital or acquired
• Acquired is most common
• Haemodynamically presents as left to right shunt
between coronary,intercostal or internal
mammary and pulmonary circulation
• There will be continuous murmur over the site of
communication
• It maybe a complication of intrathoracic
neoplasm or chronic inflammatory conditions.
67. Congenital Pulmonary
Arteriovenous Malformation
(PAVM)• AKA pulmonary a-v fistulae = pulmonary a-v aneurysm =
cavernous angiomas of the lung
• Defined as abnormal vascular communications between
pulmonary arteries and veins that lead veno-arterial shunting
There is a close association b/w PAVM and hereditary
hemorrhagic telangiectasia (osler weber rendu syndrome),an
autosomal dominant condition in 50-60% of cases and
the reverse in 5-15% cases
It has been shown that a gene located on
chr 9q3 is strongly associated with the presence of
two conditions
68. •Divided into simple or complex
•Simple PAVMs consist of segmental artery joining
thin-walled aneurysmal sac drained by single vein
(majority of cases)
•Complex PAVMs involves arterial supply from 2
different segmental arteries (only small percentage)
•Can have multiple lesions(20-30%),
•bilateral disease(10%)
•More than half found in lower lung fields
•Sizes vary typically 1-5 cm and can exceed 10cm
69.
70.
71. •Most commonly found in lower lobes adjacent to visceral
pleura
•Presenting features:
dyspnea and epistaxis
Cyanosis and clubbing
Extra cardiac murmur
•Treatment is by excision
72. ANOMALOUS SYSTEMIC
PULMONARY PERFUSION
• Usually from descending thoracic aorta, also from
ascending aorta, innominate, subclavian etc
• Asymptomatic but may present with recurrent hemoptysis
in some cases
CXR shows normal or increased vascular markings in the
vicinity of anomalous vessels
Aortograhy is diagnostic
Treatment consists of surgical ligation, embolisation or
even lung resection to control hemoptysis.
73. ANOMALOUS ORIGIN OF
LEFT PULMONARY ARTERY
•The left pulmonary artery arises in anomalous fashion
from right pulmonary artery
•To reach left lung, it loops around right main bronchus
like a sling and runs b/w trachea and esophagus to
enter left hilum with consequent dyspnoea and
dysphagia
ANOMALOUS PULMONARY VENOUS
DRAINAGE
As a result of persistant communication b/w
embryonic system of cardinal veins and pulmonary
venous plexus, pulmonary veins drain systemically into
ivc.
74. PULMONARY ARTERY
STENOSIS
• Charaterised by coarctation of pulmonary arteries with
poststenotic dilatation
BAUM and his colleagues divided the patients into two
groups
TYPE1: Main pulmonary artery affected; associated with
CVS anomalies
TYPE2: Peripheral branch involved
CXR may show poststenotic dilatation of affected
pulmonary artery branches, oligemia and signs of PAH or
cor pulmonale
Diagnosis confirmed by pulmonary angiography
75.
76.
77. ABSENT UNILATERAL
PULMONARY ARTERY
• Failure of development of either right or left side of primitive
sixth branchial arch so that no communication exists b/w
main pulmonary artery trunk and the lung on affected side,
which receives its blood supply systemically most frequently
bronchial vessels.
Usually associated with CHD
Associated with pulmonary artery hypertension
Diagnosis by CXR, VP-scan, pulmonary arteriography
Treatment usually not possible, although reconstructive
anastomotic surgery and recanalisation possible
in some.
79. ABSENCE OF MAIN PULMONARY ARTERY
The pulmonary artery trunk may be completely absent
as a result of agenesis of primitive sixth branchial arch
or of developmental failure of septum dividing truncus
arteriosus
L-R shunt exists, the lungs being supplied by
bronchial or other systemic aberrant vessels
Poor prognosis, most patients being stillborn or
dying in infancy with pulmonary hypertension.
80. Pulmonary hypertension
•Mean pulmonary artery pressure >25mm Hg
at rest or >30 mm Hg with exercise
•Anatomical changes
Intimal atheromas
Medial hypertrophy
Remodeling of muscular arteries
81. Pulmonary
thromboembolism
•The condition in which blood clot (thrombus or multiple
thrombi) migrate from the systemic circulation to
pulmonary vasculature.
•Most of the clots arise from “ deep veins” of lower &
upper extremity
•Increases right vent. overload - RHF
•Increase in intrapulm. shunting , V/Q mismatch
•Pulm. infarct in 20% of cases in patients with cardiac or
pulmonary disease