This document discusses various diagnostic procedures used in respiratory disease. It covers bedside pleural procedures like thoracentesis and closed pleural biopsy. Thoracic surgical procedures like thoracoscopy, thoracotomy and mediastinoscopy are described. Bronchoscopic procedures like bronchoscopy, bronchoalveolar lavage, brushing and biopsy are summarized. Transbronchial needle aspiration and endobronchial ultrasound guided procedures are also covered. Medical imaging techniques like chest x-ray, CT, MRI and PET are briefly discussed.
CT GUIDED LUNG BIOPSY.pptx,lung mass is malignant (cancerous) or benignRukamaneeYadav
A lung biopsy is a procedure where samples of lung tissue are removed to determine if lung disease or cancer is present. It can be performed using closed or open methods, with closed methods using a biopsy needle through the skin and open biopsies done during surgery. CT scan is used to guide the biopsy needle into the lesion. Reasons for a lung biopsy include evaluating abnormalities seen on imaging and diagnosing lung conditions. The procedure involves cleaning the skin, administering local anesthesia, inserting the biopsy needle into the lung while imaging is used for guidance, and applying pressure after removal. Potential risks include bleeding, pain, and infection.
This document provides information about computed tomography (CT) scans of the chest, including high-resolution CT. It describes what a chest CT is used for, how it is performed, what the equipment looks like, benefits, and normal findings. A chest CT can detect abnormalities in the lungs, chest wall, heart and blood vessels. It is performed by positioning the patient on a table that slides into a donut-shaped machine. Rotating x-rays create cross-sectional images which are analyzed to diagnose conditions like lung cancer, pneumonia and tumors.
The document provides an overview of cystic lung diseases and discusses a systematic approach to evaluating cystic lung lesions on CT scans. It begins by defining pulmonary cysts and differentiating them from cavities. It then categorizes cysts based on their location, number, distribution, and associated CT findings. The document outlines a 5-question approach to systematically evaluate cystic lung lesions: 1) Are they true cysts? 2) Are cysts subpleural? 3) Are cysts solitary or multifocal without other findings? 4) Are cysts associated with nodules? 5) Are cysts associated with ground glass opacities? It then provides examples of specific diseases that present with various cyst patterns, such as
Computer radiography and digital radiographyAnand Rk
The document compares computed radiography (CR) and digital radiography (DR). CR uses imaging plates that are scanned after exposure to produce images, similar to conventional film but with digital output. DR directly captures digital images using flat panel detectors or CCD cameras, allowing for immediate viewing and faster workflow. DR provides advantages like decreased radiation exposure and costs compared to CR and conventional film due to digital processing and elimination of chemical processing. Both CR and DR represent advancements over conventional film radiography by producing digital images.
This document provides an overview of CT imaging of the chest and interpretation of lung pathology. It discusses lung anatomy, bronchopulmonary segments, and the mediastinum. It then covers the utility of CT chest for evaluating lung diseases, different CT protocols, and interpretation of common lung patterns including reticular, nodular, ground glass, consolidation, emphysema, cysts and bronchiectasis. Key aspects of the secondary lobule and structured approach to HRCT interpretation are also summarized.
8th Edition of the TNM Classification for Lung CancerMauricio Lema
The International Association for the Study of Lung Cancer proposed changes to the TNM classification system for lung cancer in its 8th edition:
- The T descriptor was modified so that tumor size increases in 1 cm increments from T1a to T2b rather than combining sizes.
- Exploratory subgrouping was proposed for N descriptors to distinguish single from multiple lymph node metastases in the future.
- The M descriptor was modified to separate M1 into M1a, M1b for single extra-thoracic metastases, and M1c for multiple extra-thoracic metastases.
- The changes aim to provide more detailed staging information to guide therapy decisions for lung cancer patients.
Bronchoscopy is a technique used to visually examine the inside of the airways. It can be performed using rigid or flexible scopes inserted through the nose, mouth or trachea. The first bronchoscopy was performed in 1897 using a rigid tube. Flexible fiberoptic bronchoscopes were developed in the 1960s, allowing better visualization of smaller airways. Bronchoscopy is used for diagnostic and therapeutic purposes such as evaluating lung abnormalities, taking biopsy samples, and treating conditions like airway tumors or bleeding. Complications can include pneumothorax, hemorrhage, or respiratory issues in high-risk patients.
CT GUIDED LUNG BIOPSY.pptx,lung mass is malignant (cancerous) or benignRukamaneeYadav
A lung biopsy is a procedure where samples of lung tissue are removed to determine if lung disease or cancer is present. It can be performed using closed or open methods, with closed methods using a biopsy needle through the skin and open biopsies done during surgery. CT scan is used to guide the biopsy needle into the lesion. Reasons for a lung biopsy include evaluating abnormalities seen on imaging and diagnosing lung conditions. The procedure involves cleaning the skin, administering local anesthesia, inserting the biopsy needle into the lung while imaging is used for guidance, and applying pressure after removal. Potential risks include bleeding, pain, and infection.
This document provides information about computed tomography (CT) scans of the chest, including high-resolution CT. It describes what a chest CT is used for, how it is performed, what the equipment looks like, benefits, and normal findings. A chest CT can detect abnormalities in the lungs, chest wall, heart and blood vessels. It is performed by positioning the patient on a table that slides into a donut-shaped machine. Rotating x-rays create cross-sectional images which are analyzed to diagnose conditions like lung cancer, pneumonia and tumors.
The document provides an overview of cystic lung diseases and discusses a systematic approach to evaluating cystic lung lesions on CT scans. It begins by defining pulmonary cysts and differentiating them from cavities. It then categorizes cysts based on their location, number, distribution, and associated CT findings. The document outlines a 5-question approach to systematically evaluate cystic lung lesions: 1) Are they true cysts? 2) Are cysts subpleural? 3) Are cysts solitary or multifocal without other findings? 4) Are cysts associated with nodules? 5) Are cysts associated with ground glass opacities? It then provides examples of specific diseases that present with various cyst patterns, such as
Computer radiography and digital radiographyAnand Rk
The document compares computed radiography (CR) and digital radiography (DR). CR uses imaging plates that are scanned after exposure to produce images, similar to conventional film but with digital output. DR directly captures digital images using flat panel detectors or CCD cameras, allowing for immediate viewing and faster workflow. DR provides advantages like decreased radiation exposure and costs compared to CR and conventional film due to digital processing and elimination of chemical processing. Both CR and DR represent advancements over conventional film radiography by producing digital images.
This document provides an overview of CT imaging of the chest and interpretation of lung pathology. It discusses lung anatomy, bronchopulmonary segments, and the mediastinum. It then covers the utility of CT chest for evaluating lung diseases, different CT protocols, and interpretation of common lung patterns including reticular, nodular, ground glass, consolidation, emphysema, cysts and bronchiectasis. Key aspects of the secondary lobule and structured approach to HRCT interpretation are also summarized.
8th Edition of the TNM Classification for Lung CancerMauricio Lema
The International Association for the Study of Lung Cancer proposed changes to the TNM classification system for lung cancer in its 8th edition:
- The T descriptor was modified so that tumor size increases in 1 cm increments from T1a to T2b rather than combining sizes.
- Exploratory subgrouping was proposed for N descriptors to distinguish single from multiple lymph node metastases in the future.
- The M descriptor was modified to separate M1 into M1a, M1b for single extra-thoracic metastases, and M1c for multiple extra-thoracic metastases.
- The changes aim to provide more detailed staging information to guide therapy decisions for lung cancer patients.
Bronchoscopy is a technique used to visually examine the inside of the airways. It can be performed using rigid or flexible scopes inserted through the nose, mouth or trachea. The first bronchoscopy was performed in 1897 using a rigid tube. Flexible fiberoptic bronchoscopes were developed in the 1960s, allowing better visualization of smaller airways. Bronchoscopy is used for diagnostic and therapeutic purposes such as evaluating lung abnormalities, taking biopsy samples, and treating conditions like airway tumors or bleeding. Complications can include pneumothorax, hemorrhage, or respiratory issues in high-risk patients.
The document discusses angiography procedures and equipment. It describes the personnel involved including radiologists, nurses, and technologists. It outlines the angiography room setup and various equipment used, including x-ray generators, tubes, injectors, and digital imaging systems. Key steps of the Seldinger technique for vascular catheter insertion are provided. Post-procedure care and risks are also summarized.
This document provides an overview of cardiac catheterization procedures. It discusses how cardiac catheterization can be used to measure intracardiac pressures, oxygen saturation, and cardiac output. It also describes how it is used for angiography, angioplasty, valvuloplasty, and cardiac biopsy. Key indications for cardiac catheterization include valve disease, heart muscle disease, heart failure, congenital heart disease, and suspected cardiomyopathy. The document outlines techniques for measuring pressures in the heart chambers and great vessels, as well as complications. It also discusses coronary angiography and digital subtraction angiography.
This document discusses angiography and angioplasty procedures. It explains that angiography uses imaging techniques to visualize blood vessels, while angioplasty widens narrowed vessels. The document outlines different types of each procedure and describes how they are performed. It also discusses stents, which are used to prop open vessels after angioplasty and discusses advantages and disadvantages of various stent materials.
This document outlines an approach to evaluating mediastinal pathology using radiological imaging. It begins with definitions of the mediastinum and schemes for dividing it anatomically. It then describes how to approach lesions based on their location in the anterior, middle, or posterior mediastinum. Common pathologies are discussed for each division, including lymphadenopathy, thymomas, cysts, and vascular lesions. Radiological investigations like chest x-rays, CT, MRI, and biopsies are outlined. Specific conditions such as retrosternal goiters, germ cell tumors, lipomatosis, and hernias are also summarized.
Mediastinoscopy & mediastinotomy indications & techniquesAbdulsalam Taha
The mediastinum is the central compartment of the chest. Its boundaries and compartments are well known.Although, it contains the most vital organs of the body; it is often a forgotten compartment. Involvement of mediastinal nodes has a dramatic prognostic and therapeutic impact in patients with non-small cell lung cancer. Cervical mediastinoscopy remains the most important technique for staging of the mediastinum.
The technique of extended mediastinoscopy and redo mediastinoscopy are described as well. Indications, technique and complications are discussed.
Lung cancer causes due to various reasons. once it is identified at initial stage it can be cured by surgery.Get to know about types of surgery for lung cancer.
An endoscope is a thin, flexible tube used in endoscopy procedures to examine the inside of the body. It has a light and camera at the end to provide visuals. Endoscopes come in different shapes depending on the part of the body being examined. They are used to diagnose diseases in organs like the esophagus, stomach, and colon. Endoscopy allows doctors to view areas that cannot otherwise be seen. Proper cleaning, disinfection and storage of endoscopes is important for patient safety.
Digital subtraction angiography (DSA) is a fluoroscopy technique that uses iodinated contrast media and subtraction of bone structures to clearly visualize blood vessels. During a DSA procedure, a catheter is inserted into an artery and guided to the vessel of interest before injecting contrast dye and acquiring images. Multiple frames are taken in rapid succession and a mask image is subtracted from subsequent images, leaving an unobscured view of the opacified vessels. DSA allows for both diagnostic evaluation of vessels and interventional procedures such as angioplasty and stent placement.
This document discusses chest x-ray interpretation and provides guidance on evaluating x-rays. It explains that tissue density determines how an x-ray beam penetrates, with denser tissues appearing whiter and less dense tissues appearing blacker. It also outlines different chest x-ray views and factors to consider like patient orientation, age, gender, and rotation. Abnormalities are described as appearing too white, too black, too large, or in the wrong place. The document stresses a systematic approach of identifying, localizing, describing lesions, and providing differential diagnoses.
Lung cancer is classified into two main types - non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). NSCLC makes up about 80% of cases and can be further divided into squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. SCLC accounts for 10-15% of lung cancers and grows more quickly. The main symptoms are cough, chest pain, and coughing up blood. Risk factors include smoking, asbestos exposure, and radiation exposure. Diagnosis involves tests such as sputum analysis, biopsies, CT scans, and PET scans to determine the cancer type and stage. Treatment options depend on the cancer type and stage but may include surgery, chemotherapy
The document provides an introduction to patient monitoring in anesthesia. It discusses the importance of monitoring to detect potential issues and outlines the key physiological parameters that should be monitored, including circulation, ventilation, oxygenation, and temperature. It also describes the various equipment and methods used for monitoring these parameters in both the past and present.
MRI is useful for evaluating respiratory diseases in several ways:
1) It can replace CT scans for conditions like lung cancer screening, complicated chest masses, and pulmonary embolism in young or pregnant patients where reducing radiation exposure is important.
2) MRI provides better soft tissue contrast than CT, allowing more accurate assessment of conditions like mediastinal invasion by lung tumors or chest wall masses.
3) In addition to anatomical imaging, MRI can evaluate lung function by assessing perfusion, ventilation, and respiratory mechanics, which has benefits for diseases like cystic fibrosis and COPD.
4) However, CT remains better than MRI for imaging certain conditions like small pulmonary nodules, interstitial lung diseases, and emp
VATS is a minimally invasive surgical procedure used to diagnose and treat lung and chest conditions. It involves 1-inch incisions between the ribs rather than large incisions. The surgeon inserts surgical instruments and a camera to view internal organs on a monitor. VATS has advantages over open thoracotomy such as less pain, shorter recovery time, and lower costs. It is used for lung biopsies, cancer staging, lung resection, and other procedures. Patients are positioned laterally for access and proper positioning of instruments is important for effective surgery. VATS has reduced risks compared to open thoracotomy.
Pulmonary Ventilation and Perfusion Scan@Saudi_nmc
This document summarizes a pulmonary ventilation/perfusion scan that was performed on an 80-year-old female patient with a history of hypertension and newly diagnosed Burkett's lymphoma. The scan involved nuclear medicine tests to evaluate lung ventilation and perfusion. The findings showed a heterogeneous pattern of tracer distribution in the left lung with multiple matched defects seen on both the perfusion and ventilation scans, suggesting a pulmonary embolism. The conclusion was that the scan results were consistent with the patient's current symptoms of potential pulmonary embolism.
Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) are procedures to treat coronary artery disease. PTCA involves inserting a catheter with a tiny balloon into a blocked coronary artery. The balloon is inflated to compress fatty deposits and enlarge the artery. Sometimes a stent is placed to keep the artery open. CABG is used for more severe or multi-vessel disease. A healthy blood vessel is grafted around blockages to bypass them and restore blood flow to the heart. Both procedures help relieve chest pain but CABG has better long-term outcomes for more extensive disease.
SELDINGER TECHNIQUE & INTERVENTIONAL RADIOLOGYRiyas M K
its a basic introduction about Seldinger technique and Intervetional radiology.In interventional radiology, procedures generally start with the Seldinger technique to access the vasculature, using a needle through which a guidewire is inserted, followed by navigation of catheters within the vessels.
The document discusses pleural effusion, which is the accumulation of fluid in the pleural space. Common causes include pneumonia, tuberculosis, pulmonary infarction, and malignant diseases. The fluid can be classified as a transudate or exudate based on biochemical analysis. Diagnosis involves chest x-ray, ultrasound, or CT scan to detect fluid levels. Diagnostic thoracentesis allows classification and identification of causative organisms if infected. Treatment focuses on draining large fluid volumes and addressing the underlying cause.
An endoscopy is a procedure that uses an endoscope, a long flexible tube with a light and camera, to examine the inside of the body. The endoscope is inserted through the mouth or with a small incision and passed into organs like the esophagus, stomach, or intestines. Images from the endoscope's camera are displayed on a monitor. Endoscopies are used to investigate symptoms like abdominal pain or weight loss and can be used to perform biopsies or minor surgeries. Different types of endoscopies examine different organs like the lungs, uterus, or bladder. Endoscopes have fiber optic cables to transmit light and images and can include channels for tools or air/water.
This document discusses various pulmonary interventions including non-vascular interventions like thoracentesis, pneumothorax drainage, lung abscess drainage, pericardial effusion drainage, and biopsies. Vascular interventions discussed include bronchial artery embolization and SVC stenting. Specific procedures are described in detail such as lung abscess drainage involving image-guided catheter placement, mediastinal abscess drainage, pericardial effusion drainage, transthoracic needle aspiration, pleural biopsy, endobronchial ultrasound, mediastinoscopy, and transtracheal oxygen therapy. Interventions in bronchoscopy including diagnostic and therapeutic procedures are also summarized.
Tracheobronchial tree anatomy and bronchoscopySrikanthK120
This document discusses the anatomy and bronchoscopic examination of the tracheobronchial tree. It begins with the surgical anatomy of the trachea, including its length, cartilage rings, and blood supply. It then describes the branching pattern and segments of the main bronchi and lungs. Different types of bronchoscopy are explained, including rigid, flexible, and interventional bronchoscopy. Various bronchoscopic procedures are outlined such as foreign body removal, biopsy, washing, and endobronchial ultrasound-guided sampling of lymph nodes. Embryological development of the tracheobronchial tree and lungs is also summarized.
The document discusses angiography procedures and equipment. It describes the personnel involved including radiologists, nurses, and technologists. It outlines the angiography room setup and various equipment used, including x-ray generators, tubes, injectors, and digital imaging systems. Key steps of the Seldinger technique for vascular catheter insertion are provided. Post-procedure care and risks are also summarized.
This document provides an overview of cardiac catheterization procedures. It discusses how cardiac catheterization can be used to measure intracardiac pressures, oxygen saturation, and cardiac output. It also describes how it is used for angiography, angioplasty, valvuloplasty, and cardiac biopsy. Key indications for cardiac catheterization include valve disease, heart muscle disease, heart failure, congenital heart disease, and suspected cardiomyopathy. The document outlines techniques for measuring pressures in the heart chambers and great vessels, as well as complications. It also discusses coronary angiography and digital subtraction angiography.
This document discusses angiography and angioplasty procedures. It explains that angiography uses imaging techniques to visualize blood vessels, while angioplasty widens narrowed vessels. The document outlines different types of each procedure and describes how they are performed. It also discusses stents, which are used to prop open vessels after angioplasty and discusses advantages and disadvantages of various stent materials.
This document outlines an approach to evaluating mediastinal pathology using radiological imaging. It begins with definitions of the mediastinum and schemes for dividing it anatomically. It then describes how to approach lesions based on their location in the anterior, middle, or posterior mediastinum. Common pathologies are discussed for each division, including lymphadenopathy, thymomas, cysts, and vascular lesions. Radiological investigations like chest x-rays, CT, MRI, and biopsies are outlined. Specific conditions such as retrosternal goiters, germ cell tumors, lipomatosis, and hernias are also summarized.
Mediastinoscopy & mediastinotomy indications & techniquesAbdulsalam Taha
The mediastinum is the central compartment of the chest. Its boundaries and compartments are well known.Although, it contains the most vital organs of the body; it is often a forgotten compartment. Involvement of mediastinal nodes has a dramatic prognostic and therapeutic impact in patients with non-small cell lung cancer. Cervical mediastinoscopy remains the most important technique for staging of the mediastinum.
The technique of extended mediastinoscopy and redo mediastinoscopy are described as well. Indications, technique and complications are discussed.
Lung cancer causes due to various reasons. once it is identified at initial stage it can be cured by surgery.Get to know about types of surgery for lung cancer.
An endoscope is a thin, flexible tube used in endoscopy procedures to examine the inside of the body. It has a light and camera at the end to provide visuals. Endoscopes come in different shapes depending on the part of the body being examined. They are used to diagnose diseases in organs like the esophagus, stomach, and colon. Endoscopy allows doctors to view areas that cannot otherwise be seen. Proper cleaning, disinfection and storage of endoscopes is important for patient safety.
Digital subtraction angiography (DSA) is a fluoroscopy technique that uses iodinated contrast media and subtraction of bone structures to clearly visualize blood vessels. During a DSA procedure, a catheter is inserted into an artery and guided to the vessel of interest before injecting contrast dye and acquiring images. Multiple frames are taken in rapid succession and a mask image is subtracted from subsequent images, leaving an unobscured view of the opacified vessels. DSA allows for both diagnostic evaluation of vessels and interventional procedures such as angioplasty and stent placement.
This document discusses chest x-ray interpretation and provides guidance on evaluating x-rays. It explains that tissue density determines how an x-ray beam penetrates, with denser tissues appearing whiter and less dense tissues appearing blacker. It also outlines different chest x-ray views and factors to consider like patient orientation, age, gender, and rotation. Abnormalities are described as appearing too white, too black, too large, or in the wrong place. The document stresses a systematic approach of identifying, localizing, describing lesions, and providing differential diagnoses.
Lung cancer is classified into two main types - non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). NSCLC makes up about 80% of cases and can be further divided into squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. SCLC accounts for 10-15% of lung cancers and grows more quickly. The main symptoms are cough, chest pain, and coughing up blood. Risk factors include smoking, asbestos exposure, and radiation exposure. Diagnosis involves tests such as sputum analysis, biopsies, CT scans, and PET scans to determine the cancer type and stage. Treatment options depend on the cancer type and stage but may include surgery, chemotherapy
The document provides an introduction to patient monitoring in anesthesia. It discusses the importance of monitoring to detect potential issues and outlines the key physiological parameters that should be monitored, including circulation, ventilation, oxygenation, and temperature. It also describes the various equipment and methods used for monitoring these parameters in both the past and present.
MRI is useful for evaluating respiratory diseases in several ways:
1) It can replace CT scans for conditions like lung cancer screening, complicated chest masses, and pulmonary embolism in young or pregnant patients where reducing radiation exposure is important.
2) MRI provides better soft tissue contrast than CT, allowing more accurate assessment of conditions like mediastinal invasion by lung tumors or chest wall masses.
3) In addition to anatomical imaging, MRI can evaluate lung function by assessing perfusion, ventilation, and respiratory mechanics, which has benefits for diseases like cystic fibrosis and COPD.
4) However, CT remains better than MRI for imaging certain conditions like small pulmonary nodules, interstitial lung diseases, and emp
VATS is a minimally invasive surgical procedure used to diagnose and treat lung and chest conditions. It involves 1-inch incisions between the ribs rather than large incisions. The surgeon inserts surgical instruments and a camera to view internal organs on a monitor. VATS has advantages over open thoracotomy such as less pain, shorter recovery time, and lower costs. It is used for lung biopsies, cancer staging, lung resection, and other procedures. Patients are positioned laterally for access and proper positioning of instruments is important for effective surgery. VATS has reduced risks compared to open thoracotomy.
Pulmonary Ventilation and Perfusion Scan@Saudi_nmc
This document summarizes a pulmonary ventilation/perfusion scan that was performed on an 80-year-old female patient with a history of hypertension and newly diagnosed Burkett's lymphoma. The scan involved nuclear medicine tests to evaluate lung ventilation and perfusion. The findings showed a heterogeneous pattern of tracer distribution in the left lung with multiple matched defects seen on both the perfusion and ventilation scans, suggesting a pulmonary embolism. The conclusion was that the scan results were consistent with the patient's current symptoms of potential pulmonary embolism.
Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) are procedures to treat coronary artery disease. PTCA involves inserting a catheter with a tiny balloon into a blocked coronary artery. The balloon is inflated to compress fatty deposits and enlarge the artery. Sometimes a stent is placed to keep the artery open. CABG is used for more severe or multi-vessel disease. A healthy blood vessel is grafted around blockages to bypass them and restore blood flow to the heart. Both procedures help relieve chest pain but CABG has better long-term outcomes for more extensive disease.
SELDINGER TECHNIQUE & INTERVENTIONAL RADIOLOGYRiyas M K
its a basic introduction about Seldinger technique and Intervetional radiology.In interventional radiology, procedures generally start with the Seldinger technique to access the vasculature, using a needle through which a guidewire is inserted, followed by navigation of catheters within the vessels.
The document discusses pleural effusion, which is the accumulation of fluid in the pleural space. Common causes include pneumonia, tuberculosis, pulmonary infarction, and malignant diseases. The fluid can be classified as a transudate or exudate based on biochemical analysis. Diagnosis involves chest x-ray, ultrasound, or CT scan to detect fluid levels. Diagnostic thoracentesis allows classification and identification of causative organisms if infected. Treatment focuses on draining large fluid volumes and addressing the underlying cause.
An endoscopy is a procedure that uses an endoscope, a long flexible tube with a light and camera, to examine the inside of the body. The endoscope is inserted through the mouth or with a small incision and passed into organs like the esophagus, stomach, or intestines. Images from the endoscope's camera are displayed on a monitor. Endoscopies are used to investigate symptoms like abdominal pain or weight loss and can be used to perform biopsies or minor surgeries. Different types of endoscopies examine different organs like the lungs, uterus, or bladder. Endoscopes have fiber optic cables to transmit light and images and can include channels for tools or air/water.
This document discusses various pulmonary interventions including non-vascular interventions like thoracentesis, pneumothorax drainage, lung abscess drainage, pericardial effusion drainage, and biopsies. Vascular interventions discussed include bronchial artery embolization and SVC stenting. Specific procedures are described in detail such as lung abscess drainage involving image-guided catheter placement, mediastinal abscess drainage, pericardial effusion drainage, transthoracic needle aspiration, pleural biopsy, endobronchial ultrasound, mediastinoscopy, and transtracheal oxygen therapy. Interventions in bronchoscopy including diagnostic and therapeutic procedures are also summarized.
Tracheobronchial tree anatomy and bronchoscopySrikanthK120
This document discusses the anatomy and bronchoscopic examination of the tracheobronchial tree. It begins with the surgical anatomy of the trachea, including its length, cartilage rings, and blood supply. It then describes the branching pattern and segments of the main bronchi and lungs. Different types of bronchoscopy are explained, including rigid, flexible, and interventional bronchoscopy. Various bronchoscopic procedures are outlined such as foreign body removal, biopsy, washing, and endobronchial ultrasound-guided sampling of lymph nodes. Embryological development of the tracheobronchial tree and lungs is also summarized.
Bronchoscopy is a procedure that uses a thin, flexible tube called a bronchoscope to examine the airways. The bronchoscope is inserted through the nose or mouth and into the lungs. This allows doctors to visually examine the lungs for abnormalities and take samples. Bronchoscopy can be used for both diagnostic purposes to examine the lungs as well as therapeutic purposes, such as removing tumors or foreign objects from the airways. The procedure involves sedation of the patient and monitoring during insertion and examination of the lungs.
Bronchoscopy and pleuroscopy are minimally invasive endoscopic procedures used to diagnose and treat lung diseases. Bronchoscopy involves inserting a thin, lighted tube with a camera through the mouth or nose into the lungs, while pleuroscopy accesses the pleural space between the lungs through a small incision in the chest. Both procedures allow doctors to directly examine the lungs and collect samples, and have benefits of providing quick results without the need for surgical cuts or long hospital stays.
Bronchoscopy allows direct visualization of the airways using rigid or flexible instruments. It is used as both a clinical and research tool for examining airway anatomy, sampling the airways, and performing therapeutic procedures. Developments in flexible bronchoscopes have made bronchoscopy a widely used technique in pulmonary medicine. Rigid bronchoscopy is generally performed by ENT surgeons for procedures like foreign body removal or biopsy collection. Flexible bronchoscopy allows examination of the entire respiratory tract using fiberoptic instruments in a variety of sizes. Bronchoscopy is indicated for conditions like atelectasis, recurrent pneumonia, or suspected airway abnormalities, and allows for procedures like lavage, brushings, and biopsy. It is performed using light anesthesia with monitoring
This document provides information on the anesthetic management of three bronchoscopic procedures: rigid bronchoscopy, mediastinoscopy, and endobronchial ultrasound-guided biopsy. Rigid bronchoscopy requires general anesthesia or IV sedation and involves risks of airway obstruction and desaturation that require close monitoring. Mediastinoscopy carries risks of hemorrhage, nerve injury, and pneumothorax that may require emergent intervention. Endobronchial ultrasound-guided biopsy is typically performed with conscious sedation using topical anesthesia and sedatives administered through a bronchoscope.
This document discusses pulmonary interventional radiology procedures. It covers percutaneous lung biopsy techniques and indications. Minimally invasive image-guided procedures are described for draining fluid collections in the lungs and chest. Percutaneous transcatheter embolization is discussed as the standard treatment for pulmonary arteriovenous malformations to reduce risks. Various embolic agents, advantages, and recanalization risks are summarized.
Medical thoracoscopy (MT) is a minimally invasive procedure that uses rigid or semi-rigid thoracoscopes to directly visualize the pleural surfaces. It has diagnostic and therapeutic applications. The document discusses the history, techniques, indications, and innovations of MT. It notes that MT has a high diagnostic yield for conditions like tuberculosis and malignancies. Local anesthesia with conscious sedation is commonly used. Complications can include infection, bleeding, and re-expansion pulmonary edema. Ongoing studies are exploring modifications to MT techniques and applications in complex parapneumonic effusions.
EBUS is a bronchoscopy technique that uses ultrasound to visualize structures within and around the airway. It has high sensitivity and accuracy for mediastinal staging of lung cancer. There are different types of EBUS probes with varying frequencies that allow for better penetration depth or resolution. EBUS has many clinical applications including lymph node sampling. It has advantages such as being minimally invasive and allowing sampling of small lymph nodes. Complications are rare. EBUS improves lung cancer staging and diagnosis of other lung conditions.
This document outlines general principles of thoracic surgery, including anatomy of the thoracic cavity and mediastinum, as well as common diagnostic and surgical procedures. It discusses the chest wall, lungs and tracheobronchial tree anatomy. General procedures described include radiologic imaging, endoscopy such as bronchoscopy, mediastinoscopy, and thoracoscopy. Biopsy techniques like needle biopsy and diagnostic thoracentesis are also summarized. Surgical exposures for various diseases via incisions are listed. The document concludes with an overview of managing thoracic trauma non-operatively in most cases.
Pulmonary function tests evaluate lung function through tests such as measuring tidal volume, vital capacity, and forced expiratory volume. Arterial blood gases measure oxygen and carbon dioxide levels to assess ventilation. Imaging studies like chest x-rays, CT scans, and PET scans provide detailed views of the lungs. Sputum cultures identify infectious organisms, and endoscopic procedures like bronchoscopy examine the lungs and allow biopsy of lesions. Nursing care focuses on monitoring for complications from invasive tests and procedures like bleeding, infection, and changes in respiratory status.
Chest CT scans produce cross-sectional images of the body using X-rays and a computer. They allow doctors to examine the chest and its organs in detail. A chest CT may be used to assess tumors, lesions, treatment effects, and to guide biopsies. Risks include radiation exposure and reactions to contrast dye. Chest CTs can be standard, high resolution, or with contrast to examine different structures. Images are typically viewed in axial, coronal, and sagittal planes. Normal and pathological findings are systematically assessed. Common abnormalities include nodules, ground glass opacity, consolidation, and septal thickening.
Medical thoracoscopy, also known as pleuroscopy, is a minimally invasive procedure that allows physicians to access the pleural space to perform diagnostic and therapeutic procedures. It provides high diagnostic yields for pleural effusions and pleural biopsies. Complications are generally minor but precautions must be taken to prevent issues like infection or tumor seeding. Thoracoscopy is now the preferred method for evaluating undiagnosed pleural effusions and certain pneumothorax, empyema, and mesothelioma cases.
Invasive diagnostic methods of chest, the tracheaTejasvi Charan
This document provides information on several minimally invasive diagnostic and surgical procedures for the lungs:
- Endobronchial ultrasound (EBUS) enables doctors to obtain tissue samples from the lungs and lymph nodes without surgery. It provides real-time imaging and can eliminate the need for invasive mediastinoscopy.
- Rigid bronchoscopy and electromagnetic navigational bronchoscopy (ENB) are used to biopsy small or hard to reach lung lesions.
- Thoracentesis and pleural biopsy remove fluid or air from the pleural cavity surrounding the lungs to diagnose diseases. Chest tubes with pleurodesis drain fluid and prevent reaccumulation.
- Video-assisted thoracoscopic surgery (VATS
This document provides an overview of therapeutic bronchoscopy. It discusses the history of bronchoscopy and key figures. It describes the instruments required for rigid bronchoscopy including the bronchoscope itself and accessories. It covers indications for bronchoscopy such as foreign body removal. It details various interventional modalities that can be performed including mechanical debulking, electrocautery, argon plasma coagulation, laser photoresection, stents and others. It also discusses considerations for patient preparation, sedation, monitoring and complications.
1) Flexible bronchoscopy (FOB) is commonly performed in the ICU for both diagnostic and therapeutic purposes. Some key indications include evaluating pneumonia, hemoptysis, thoracic trauma, and airway inhalation injuries.
2) Performing FOB in critically ill ICU patients presents challenges due to risks of hypoxemia, hypercapnia, and hemodynamic changes from airway obstruction. Careful preparation and monitoring is important.
3) Technical considerations for safe FOB in ventilated patients include using a large ETT, adjusting ventilator settings to minimize changes in tidal volume, and applying suction intermittently to avoid severe desaturation. Proper anesthesia and monitoring of vitals is
Endobronchial ultrasonography (EBUS) allows visualization of tissues outside the airway wall using ultrasound probes inserted into the bronchoscope. There are radial and convex probes used for different applications. EBUS is used to stage lung cancer by examining lymph nodes and determining tumor invasion depth. It can also identify peripheral lung lesions. Convex probe EBUS specifically allows real-time guided biopsy of mediastinal structures and lymph nodes. The procedure involves identifying the target with ultrasound imaging and advancing a TBNA needle under real-time visualization to obtain tissue samples for diagnosis. Potential complications are rare and include pneumothorax and bleeding.
A brincoscopy is the direct inspection and observation of the larynx, trachea, and bronchi through flexible or rigid bronchoscope.
Flexible fiber-optic bronchoscope allows for more patient comfort and better visualization of smaller airways and the fiberoptic scope is used more frequently in current practice.
Rigid bronchoscopy is preferred for small children and endobronchial tumour resection.
The purpose of bronchoscopy has diagnostic and therapeutic uses in pulmonary conditions. Diagnostic uses include
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This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
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3. THORACENTESIS
● Percutaneous aspiration of fluid from the pleural space.
● Point-of-care ultrasonography to mark the site of needle puncture
● This reduces the risks of “dry tap” as well as complications such as
pneumothorax.
● Beside palliation of symptoms associated with pleural effusion (most
commonly dyspnea), thoracentesis may be performed for diagnostic
purposes.
● Newer assays such as mesothelin-1 testing for neoplastic diseases (chiefly
mesothelioma)
4. CLOSED PLEURAL BIOPSY
● Percutaneous sampling of the parietal pleural lining.
● This procedure can be performed either “blindly” (typically with an Abrams
needle) or by using imaging guidance such as CT or ultrasound.
● Closed pleural biopsy without ultrasound guidance
● Image-guided closed pleural biopsy
5. THORACOSCOPY AND THORACOTOMY
● Spectrum of surgical procedures that involve accessing and operating within
the pleural space, either via one or more small entry ports using
thoracoscopic tools or via larger incisions as in thoracotomy
● Pleuroscopy (also known as medical thoracoscopy) and accesses the pleural
space through a single port for parietal pleural biopsy or for limited
therapeutic purposes such as minor lysis of adhesions, thoracoscopic
pleurodesis, or indwelling pleural catheter placement.
● VATS and RATS are more invasive procedures but with more controlled
environments entailing general anesthesia with single-lung ventilation,
creation of multiple entry ports, and several additional diagnostic and
therapeutic including lung biopsy, lymph node sampling, lobectomy,
decortication, and creation of a pericardial window.
● Open thoracotomy -Clagett window for chronic bronchopleural fistula with
empyema.
6. MEDIASTINOSCOPY AND MEDIASTINOTOMY
● Surgical access to the mediastinum, either through a small port
(mediastinoscopy) or a wider incision (mediastinotomy), enables diagnostic
sampling of mediastinal structures such as mediastinal lymph nodes as part
of lung cancer staging.
● In cases of negative needle-based sampling where suspicion for malignant
nodal involvement remains sufficiently high.
7. BRONCHOSCOPY
● Flexible bronchoscopy enables access to more distal parts of the respiratory
tract.
● The rigid bronchoscope has the added advantage of providing a secure
airway for ventilation; artificial breaths can then be administered through the
scope itself as part of a closed circuit or through open jet ventilation.
● The rigid bronchoscope also provides a conduit for diagnostic or therapeutic
instruments to be passed freely, rather than through the relatively constrained
working channel of a flexible bronchoscope.
8. Bronchoalveolar Lavage
● Gold standard method for obtaining respiratory secretions for hematologic,
biochemical, microbiological, and/or cytologic analyses.
● Advantage and Indications.
● After wedging the bronchoscope in a distal airway in order to prevent fluid
escape around the scope, sterile saline or distilled water is instilled through
the scope’s working channel (typically in one to three aliquots of
approximately 50 mL each).
● Immediately thereafter, suction is applied to aspirate as much of the fluid as
possible.
● This allows sampling of distal airways and lung parenchyma—areas not
directly viewable or accessible.
9. Brushing and Endobronchial Biopsy
● Bronchoscopic brushing is a minimally invasive sampling technique that can
be used to sample the mucosal biofilm for microbiologic analyses as well as
the bronchial epithelial layer for cytologic analyses.
● Endobronchial biopsy allows sampling of abnormal bronchial mucosa and
submucosa for histopathologic analysis (as may be indicated in cases of
endobronchial amyloidosis or sarcoidosis, for example)
10. Transbronchial Biopsy Including Cryobiopsy
● Removing a piece of alveolated lung tissue by passing a sampling tool into
the alveolar space.
● The most commonly employed biopsy tool is flexible forceps, typically 2.0 mm
or 2.8 mm in caliber.
● When random sampling of the lung parenchyma is desired.e.g., to assess for
posttransplant lung rejection, either fluoroscopic guidance or tactile feedback
is commonly used to position the forceps in the subpleural lung parenchyma
● Number of biopsy samples
● Malignant Lung Nodules
● Acute cellular rejection
11. ● An increasingly popular biopsy tool is the cryoprobe, a flexible catheter with a
blunt tip that delivers liquid nitrogen or carbon dioxide over a few seconds to
freeze a portion of lung parenchyma and make it adhere to the probe itself.
● Before the tissue can thaw and detach
● Cryobiopsy has a higher diagnostic yield than forceps biopsy for diffuse
parenchymal illnesses such as idiopathic pulmonary fibrosis but comes with a
higher risk of major bleeding and pneumothorax.
12. Transbronchial Needle Aspiration
● Transbronchial needle aspiration (TBNA) involves using a hollow-bore needle
for obtaining aspirated specimen.
● TBNA has diagnostic sensitivity superior to that of transbronchial biopsy for
malignant peripheral nodules.
● This makes intuitive sense given that the lesion may lie extraluminally and
require traversing the airway wall, which only the needle may be able to
accomplish.
● TBNA + Transbronchial biopsy
13. Endobronchial Ultrasound-Guided Transbronchial Needle
Aspiration
1. Represent a major advance in diagnostic bronchoscopy over the turn of the
twentieth century, largely replacing surgical methods for lymph node
sampling.
2. EBUS-TBNA involves using a specialized flexible bronchoscope that
simultaneously operates a video camera and a convex ultrasound probe
(which is installed at its distal end).
3. Newer variants of this technique involve the use of core needles or mini-
forceps, providing tissue specimens rather than aspirates that can be sent for
histopathologic analysis.
4. Sensitivity
● Lymphoma
● Sarcoidosis(higher if combined with endobronchial and transbronchial
biopsies).
● Epithelial Maligancy.
14. ● Ancillary testing in cases of malignancy, such as immunostaining or genetic
testing.
● Sampling mediastinal structures through the esophagus, which can be a
useful adjunct to EBUS-TBNA as it may provide better access to certain
mediastinal lymph node station.
● Esophageal sampling can be accomplished by
● EBUS-TBNA is accompanied by rapid on-site cytologic evaluation (ROSE),
wherein a portion of the aspirated specimen is immediately examined by a
cytotechnologist or pathologist using rapid staining.
● This rapid assessment, while often inadequate for a definitive final diagnosis,
can be helpful in establishing adequacy of sampled material by providing the
bronchoscopist with real-time feedback on whether additional sampling is
advisable.
15. Guided Peripheral Bronchoscopy
Guided peripheral bronchoscopy involves the use of advanced tools to aid
with one or more of three tasks involved in successful bronchoscopic
sampling of peripherally located lesions, such as lung nodules.
● Navigating to the appropriate lobe/segment/subsegment: Electromagnetic
navigational bronchoscopy (which involves GPS-like feedback as the
bronchoscope is advanced toward the target) and virtual bronchoscopy
(which overlays live endoscopic images onto a CT-derived virtual
bronchoscopic map) can help with successful navigation through the airways.
● The aforementioned technologies can also help localize a lesion, although
they are limited by relying on previously acquired CT images that may or may
not accurately represent precisely where the lesion is currently located in a
three-dimensional space.
● Other alternatives-Radial EBUS .
16. ● Alternatively, fluoroscopic imaging can be used to recalibrate the precise
target location on navigational bronchoscopic platforms, potentially improving
localization as well.
● The tools available for peripheral sampling include biopsy forceps, brushes,
and aspiration needles as described above, with TBNA having the highest
diagnostic sensitivity for discrete malignant lesions.
17. MEDICAL IMAGING
Technologies such as x-ray, CT, MRI, and positron emission tomography (PET)
can provide
● Noninvasive assessments of alveolar perfusion
● Metabolic activity of a lung nodule
● Bronchovascular source of hemoptysis
● Earliest disease-related changes in parenchymal structure.
18. CHEST X-RAY
1. The most commonly used CXR images for respiratory medicine are the
posteroanterior (PA) and lateral films in the outpatient setting and
anteroposterior (AP) films for those studies obtained at the bedside.
2. Differing views can be used to examine superimposed structures (for
example, a parenchymal opacity in the retrocardiac space).
● The contours of the chest wall
● Silhouette of the heart
● Great vessels
● Mediastinum
● Appearance of the parenchyma and bronchovascular bundle.
19. ● Many of the smaller structures such as the lymphatics and distal airways are
beyond the ability of conventional x-ray technology to resolve.
● Larger structures such as the pulmonary vasculature may also be indistinct
because of body position and the redistribution of blood flow to more
gravitationally dependent regions.
● Diseases involving these structures may enhance or obscure their
appearance.
● Congestive heart failure where the lymphatics become engorged (Kerley B
lines)
● Nondependent vasculature more prominent (cephalization)
● Outer boundaries of the bronchial walls blurred (bronchial cuffing).
● Thickened interstitium may be due to hydrostatic pulmonary edema, it may
also be indicative of interstitial lung disease or carcinomatosis.
● An elevated hemidiaphragm, fibrosis of the mediastinum, or hyperlucency of
the lung parenchyma all reflect processes that cause dyspnea, but their
treatment and prognosis differ markedly
20. COMPUTED TOMOGRAPHY
● The acquisition of a CT scan involves the same basic process as an x-ray
with a patient placed between a source of photons and a detector, but the
image reconstruction and advanced analytics that can be applied to those
images differ markedly.
● The passage of photons through the body is impeded in proportion to tissue
density.
● This absorption or attenuation of photon passage is measured in Hounsfield
units (HU) and clinical CT scanners are regularly calibrated to a standard
scale with water having an HU of 0 and air –1000 HU.
● A window width and level (the range and center of the range of HU values to
display) is selected to optimize viewing structures of interest.
21. ● The visual interpretation of thoracic CT is based upon the appearance of the
secondary pulmonary lobule.
● Fundamental subunit of the lung consisting of a central airway and pulmonary
artery, parenchyma, and then surrounding interstitium with the lymphatics and
pulmonary veins.
● Processes affecting the small airways such as respiratory bronchiolitis may appear
as centrilobular nodule.
● Parenchymal diseases such as emphysema
● Pathology of the lymphatics or interstitium
● The diagnostic information provided by the appearance of the secondary pulmonary
lobule is further augmented by the distribution of these patterns of injury across the
lung.CLE and PLE
● Interstitial thickening in the apices is more likely to be nonspecific interstitial
pneumonitis (NSIP) while a basal and dependent predominant distribution of that
same process is more consistent with idiopathic pulmonary fibrosis (IPF).
22. ● Finally, morphology of the central airways and vessels can be used to
diagnose disease and estimate its severity.
● Bronchiectatic dilation of the airways may be cylindrical and predominantly in
the lower lobes
● Cystic dilation in the upper lobes
● Focal nonspecific dilation of an airway
● Pathologic dilation of the airways may also be due to disease of the
surrounding parenchyma.
● Because of the mechanical interdependence of the bronchial tree and
parenchyma, conditions that reduce lung compliance may result in traction
bronchiectasis.
● The caliber of the central pulmonary arterial (PA) trunk proximal to its first
bifurcation is directly related to pulmonary arterial pressure.
23. ● PA/A provides a metric of disease severity and in the case of chronic
respiratory diseases such as COPD is prognostic for both acute respiratory
exacerbations and death.
● Assessment of the intraparenchymal pulmonary vasculature is typically
augmented through the intravenous infusion or bolus of iodinated contrast.
● Dark filling voids in otherwise bright white vessels.
24. MAGNETIC RESONANCE IMAGING
● Behavior of protons in a magnetic field.
● A strong magnetic field is applied to align the protons and then a pulse of
radiofrequency current is then applied to the subject.
● This perturbs the protons and the speed at which they subsequently realign
differs based upon the properties of the tissues within the region of interest.
● Abundance of air in the lung creates an artifact that impairs direct assessment
of the parenchyma.
● Gadolinium and is increasingly exploring the use of inhaled agents such as
hyperpolarized noble gas.
● Regions of the lung that are poorly ventilated due to disease of the airways or
distal airspaces have low concentrations of 3He and appear as dark regions
in an otherwise bright blue organ.
● Modality of choice in the pediatric population or clinical situations where
repeated assessments are required.
25. POSITRON EMISSION TOMOGRAPHY
● An image based upon the aggregation of radiolabeled tracers.
● The most common agent used for these purposes is [18F]-fluoro-2-
deoxyglucose (FDG).
● Taken up by cells in direct proportion to their metabolic activity.
● It is most commonly used for the discrimination of benign and malignant lung
nodules, as well as lung cancer staging.
● Given the relatively low resolution of PET, co-registration with CT is common
and the aligned imaging modalities allow the reader to determine the
structural source of heightened metabolic activity.