This document defines and describes various thoracic imaging terms related to the lungs. It discusses air bronchograms, air crescents, air trapping, and other terms. For each term, it provides a definition and brief explanation of what the term refers to in radiographic images of the lungs. The document is intended as a reference for radiologists and others to understand common findings seen in chest x-rays and CT scans related to lung pathology.
Gamal Rabie Agmy, MD provides definitions and descriptions of various cavitary lung lesions and cystic mediastinal structures in 3 sentences or less:
Bullae are thin-walled air spaces greater than 1 cm in size that result from destruction and dilatation of distal airspaces. Pneumatoceles are thin-walled lung cysts less than 1 mm thick resulting from staph infection and necrosis. Honeycombing describes multiple cysts less than 1 cm in diameter in a background of fibrosis, representing end-stage lung disease.
Glossary of thoracic imaging terms part 1Gamal Agmy
This document defines and describes various thoracic imaging terms related to the lungs. It discusses signs seen on imaging for conditions such as atelectasis, including loss of lung volume demonstrated by shifts in mediastinum, fissures, and hila. Specific types of atelectasis are described, such as absorption, relaxation, adhesive, and compression atelectasis. Other terms defined include bulla, cysts, cavities, pneumatocele, honeycombing, and findings related to diseases like pulmonary fibrosis, sarcoidosis, and lymphadenopathy. Diagrams are provided to illustrate imaging appearances of various conditions.
There are several types of atelectasis that can occur: absorption, relaxation, adhesive, cicatricial, and round. Atelectasis causes signs of loss of lung volume such as shift of mediastinum, elevation of diaphragm, crowding of ribs, and movement of fissures and hilar structures. On imaging, atelectasis appears as a homogeneous density and causes asymmetry of the hemithorax on the affected side. The document also discusses characteristics, patterns, and radiographic findings of various cavitary lung lesions.
CT scans are useful for diagnosing IPF by identifying patterns of lung fibrosis including reticular abnormalities, honeycombing, and subpleural basal predominance. The presence of these patterns, especially honeycombing, can help predict patient outcomes. However, CT may miss 1/3 of IPF cases so it must be interpreted along with clinical features. Nuclear imaging tests like gallium scans are generally not helpful for established IPF while PET scans may detect lung inflammation correlating with fibrosis seen on CT.
This document contains descriptions and images related to various chest radiographic findings. It discusses topics like atelectasis, consolidation, masses, pneumothorax, vascular markings and abnormalities of the heart and lungs. Examples provided include lung cancer, tuberculosis, pneumonectomy and other pathologies. Key radiographic signs are defined to aid in diagnosis, such as the silhouette sign, S-shaped fissure and tracheal shift.
Radiological Presentation of Pulmonary PathologyGamal Agmy
This document discusses various radiographic signs seen on chest x-rays and CT scans related to different types of lung collapse and cystic lung lesions. It describes signs such as the flat waist sign seen in left lower lobe collapse, the juxtaphrenic peak sign seen in upper lobe collapse, and the fallen lung sign seen with bronchial fractures. It also discusses cystic lung patterns seen in conditions like lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. Different characteristics of cysts such as their size, distribution and appearance on imaging are described for these various conditions.
This document discusses the CT anatomy and imaging of the mediastinum. It outlines 6 objectives, including describing the CT anatomy of the mediastinum, pneumomediastinum, mediastinal lymphadenopathy, radiological description of mediastinal compartments, differential diagnosis of mediastinal disease, and interventional supply. It then provides detailed descriptions and images of the different mediastinal compartments and lymph node stations.
Assessment of Dyspnea by Chest UltrasoundGamal Agmy
1) The document discusses using ultrasound to assess dyspnea by examining both shallow and deep chest structures using high-frequency or low-frequency probes.
2) Key signs of a normal lung include the presence of the pleural line and A lines, while the presence of B lines or confluent B lines indicate interstitial syndrome or thick fluid in the alveoli.
3) Pathologies like pneumonia, pneumothorax, pulmonary embolism and congestive heart failure can be identified using ultrasound by examining lung sliding, comet tail artifacts, and the appearance of the pleural line and lung parenchyma.
Gamal Rabie Agmy, MD provides definitions and descriptions of various cavitary lung lesions and cystic mediastinal structures in 3 sentences or less:
Bullae are thin-walled air spaces greater than 1 cm in size that result from destruction and dilatation of distal airspaces. Pneumatoceles are thin-walled lung cysts less than 1 mm thick resulting from staph infection and necrosis. Honeycombing describes multiple cysts less than 1 cm in diameter in a background of fibrosis, representing end-stage lung disease.
Glossary of thoracic imaging terms part 1Gamal Agmy
This document defines and describes various thoracic imaging terms related to the lungs. It discusses signs seen on imaging for conditions such as atelectasis, including loss of lung volume demonstrated by shifts in mediastinum, fissures, and hila. Specific types of atelectasis are described, such as absorption, relaxation, adhesive, and compression atelectasis. Other terms defined include bulla, cysts, cavities, pneumatocele, honeycombing, and findings related to diseases like pulmonary fibrosis, sarcoidosis, and lymphadenopathy. Diagrams are provided to illustrate imaging appearances of various conditions.
There are several types of atelectasis that can occur: absorption, relaxation, adhesive, cicatricial, and round. Atelectasis causes signs of loss of lung volume such as shift of mediastinum, elevation of diaphragm, crowding of ribs, and movement of fissures and hilar structures. On imaging, atelectasis appears as a homogeneous density and causes asymmetry of the hemithorax on the affected side. The document also discusses characteristics, patterns, and radiographic findings of various cavitary lung lesions.
CT scans are useful for diagnosing IPF by identifying patterns of lung fibrosis including reticular abnormalities, honeycombing, and subpleural basal predominance. The presence of these patterns, especially honeycombing, can help predict patient outcomes. However, CT may miss 1/3 of IPF cases so it must be interpreted along with clinical features. Nuclear imaging tests like gallium scans are generally not helpful for established IPF while PET scans may detect lung inflammation correlating with fibrosis seen on CT.
This document contains descriptions and images related to various chest radiographic findings. It discusses topics like atelectasis, consolidation, masses, pneumothorax, vascular markings and abnormalities of the heart and lungs. Examples provided include lung cancer, tuberculosis, pneumonectomy and other pathologies. Key radiographic signs are defined to aid in diagnosis, such as the silhouette sign, S-shaped fissure and tracheal shift.
Radiological Presentation of Pulmonary PathologyGamal Agmy
This document discusses various radiographic signs seen on chest x-rays and CT scans related to different types of lung collapse and cystic lung lesions. It describes signs such as the flat waist sign seen in left lower lobe collapse, the juxtaphrenic peak sign seen in upper lobe collapse, and the fallen lung sign seen with bronchial fractures. It also discusses cystic lung patterns seen in conditions like lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. Different characteristics of cysts such as their size, distribution and appearance on imaging are described for these various conditions.
This document discusses the CT anatomy and imaging of the mediastinum. It outlines 6 objectives, including describing the CT anatomy of the mediastinum, pneumomediastinum, mediastinal lymphadenopathy, radiological description of mediastinal compartments, differential diagnosis of mediastinal disease, and interventional supply. It then provides detailed descriptions and images of the different mediastinal compartments and lymph node stations.
Assessment of Dyspnea by Chest UltrasoundGamal Agmy
1) The document discusses using ultrasound to assess dyspnea by examining both shallow and deep chest structures using high-frequency or low-frequency probes.
2) Key signs of a normal lung include the presence of the pleural line and A lines, while the presence of B lines or confluent B lines indicate interstitial syndrome or thick fluid in the alveoli.
3) Pathologies like pneumonia, pneumothorax, pulmonary embolism and congestive heart failure can be identified using ultrasound by examining lung sliding, comet tail artifacts, and the appearance of the pleural line and lung parenchyma.
The document provides an overview of the pathology of lung diseases as seen on chest x-rays, including signs, appearances and common causes of conditions such as consolidation, pleural effusion, atelectasis, pneumothorax, lung masses, fibrosis and infections like tuberculosis. Differential diagnoses are also provided for various lung abnormalities seen on x-rays.
This document discusses radiology signs of pneumomediastinum. It begins by defining pneumomediastinum and listing potential sources where air can originate from, both intrathoracic and extrathoracic. It then describes several common radiographic signs seen with pneumomediastinum, including the thymic sail sign, ring around the artery sign, and ginkgo leaf sign. Examples of each sign are shown through radiograph and CT images. Other signs like the continuous diaphragm sign, tubular artery sign, and Naclerio's V sign are also defined. The document emphasizes the importance of recognizing these signs on imaging for diagnosing pneumomediastinum.
Radiological imaging of pleural diseases Pankaj Kaira
The document discusses the anatomy, imaging, and common diseases of the pleura. It begins by describing the normal anatomy of the pleural layers and thickness. Common pleural diseases are then reviewed, including pleural effusions, pneumothorax, hemothorax, and empyema. Imaging findings on chest x-ray, ultrasound, CT, and MRI are provided for diagnosing and characterizing various pleural conditions. Key signs that help differentiate pleural, pulmonary, and extra-pleural masses are also outlined.
1. The document discusses various types of pleural effusions seen on imaging. It describes how small effusions initially accumulate in the costophrenic angles and can be seen on lateral but not frontal views.
2. As effusions increase in size, they become visible on frontal views and spread upward in the thorax. Large effusions can obscure the entire hemithorax.
3. Effusions can have atypical distributions such as loculated collections or positions between the lung and diaphragm that mimic hemidiaphragm elevation. Loculated effusions are commonly seen in fissures.
This document discusses Congenital Cystic Adenomatoid Malformation (CCAM), a rare pulmonary developmental abnormality. It describes the characteristics and types of CCAM including pathogenesis, imaging findings, prognosis, management, and differentiation from other conditions. Key points:
1) CCAM is comprised of pulmonary tissue with abnormal bronchial proliferation forming cysts. It occurs in 1 in 25,000 live births and is usually limited to one lobe.
2) Prenatal ultrasound can detect cystic or solid masses. Larger lesions with hydrops carry a poorer prognosis. Fetal interventions like shunting may be considered.
3) Surgical resection is often needed after birth for large or symptomatic
Radiological presentation of chest diseases gamal agmyGamal Agmy
This document discusses various radiographic signs seen on chest x-rays. It begins by defining atelectasis as the loss of air in the alveoli, requiring a density representing lung devoid of air and signs of loss of lung volume. It then describes different types of atelectasis including absorption, relaxation, adhesive, cicatricial, and round atelectasis. General signs of loss of lung volume from atelectasis are also outlined, such as mediastinal shift, elevated diaphragm, drooping shoulder, and crowded ribs. The document emphasizes how movement of fissures can help identify atelectasis and requires a lateral chest x-ray view.
The document discusses pulmonary embolism (PE) and its diagnosis using lung ultrasound (LUS). It provides details on the diagnostic criteria for PE using LUS, including findings of typical lung lesions that indicate confirmed or probable PE. It also summarizes the sensitivity and specificity reported in studies on using LUS to diagnose PE. The document further discusses non-thrombotic causes of pulmonary embolism and the ultrasound appearance of various lung pathologies.
This document provides an overview of transthoracic sonography and its applications in evaluating the lungs and chest. It includes descriptions of normal lung anatomy as seen on ultrasound and discusses various pathologies such as pneumonia, pulmonary embolism, COPD and lung cancer. Imaging techniques like assessing lung sliding and the presence of comet tail artifacts are described for evaluating diseases like pneumonia. Other applications covered include using ultrasound to identify pleural effusions, pneumothorax, chest wall abnormalities and for guiding procedures. In summary, the document outlines the role of ultrasound in evaluating pulmonary and chest wall diseases and conditions.
Post operative chest by Dr. Sundar SuwalMilan Silwal
This document provides an overview of the expected postoperative chest appearances and potential complications following various thoracic surgeries including thoracotomy, pneumonectomy, lobectomy, segmentectomy, cardiac surgery, and general surgeries with thoracic complications. It describes the typical radiographic findings in the immediate postoperative period and as healing progresses over weeks and months. Complications discussed include pulmonary edema, bronchopleural fistula, empyema, lobar torsion, and gossypiboma among others. Accurate identification of postoperative changes and complications is important for timely diagnosis and management.
Pleural diseases chest radiology part 2drneelammalik
Ultrasonography is used to diagnose pneumothorax by examining the lungs at the midclavicular and anterior axillary lines for the presence of pleural sliding and comet tail artifacts. The absence of both findings suggests a pneumothorax is present. Pneumothorax can be open, closed, or valvular depending on whether air moves freely in and out or builds pressure on expiration. Asbestos exposure can lead to pleural plaques appearing as calcified thickening on imaging, increasing the risk of lung cancer and mesothelioma.
Radiological diagnostics of Respiratory systemEneutron
This document discusses various radiological diagnostic methods for examining the respiratory system, including direct visualization methods, radiographic methods, analytic methods, special contrast methods, functional methods, and others such as fluoroscopy, MRI, and ultrasound. It describes techniques such as bronchography and CT scans. Pathological findings are outlined, including signs of air-free opacity, clarification, and vascular changes. Syndromes of various pulmonary diseases are also detailed.
The document discusses abnormalities that may appear on a chest x-ray and how to interpret them. It describes findings related to the lung parenchyma including consolidations, interstitial diseases, nodules, cavities, and calcifications. It also covers pleural abnormalities such as effusions, thickening, and plaques. Key signs are explained like air bronchograms, silhouetting, and Kerley lines which provide clues to diagnose conditions like pneumonia.
The document contains findings from 14 radiology cases summarized in 3 sentences or less:
Case 1 describes bilateral symmetrical bulky hila and a diagnosis of sarcoidosis stage 1. Case 2 finds large rounded nodules with calcification, a diagnosis of pneumoconiosis with progressive massive fibrosis. Case 3 finds left upper lobe hyperinflation and herniation in a young child, diagnosed as congenital lobar emphysema.
This document provides guidance on interpreting neonatal chest x-rays. It describes the expected positioning of various tubes and lines and how their positioning appears on x-rays. It then discusses the radiographic findings of various pulmonary and cardiac conditions commonly seen in neonates, such as respiratory distress syndrome, pneumonia, transient tachypnea of the newborn, bronchopulmonary dysplasia, pulmonary hypoplasia, and various congenital heart defects. For each condition, it explains the typical appearance on chest x-ray and signs such as cardiomegaly, increased/decreased pulmonary vascularity, and lung opacities or clearing that can help with diagnosis.
This document provides an overview of how to interpret a normal chest x-ray and describes various imaging views and findings. It discusses the appearance of the heart, lungs, diaphragm and other structures on a posteroanterior view. Additional views like lateral films and inspiratory/expiratory films are mentioned. Common differentials like Kerley lines and the silhouette sign are also summarized.
This document discusses differentials and radiological signs of conditions presenting with a unilateral hypertransradiant hemithorax. It provides two mnemonics, SAFE POEM and CRAWLS, listing potential causes such as rotation, pneumothorax, emphysema, bullous lung disease, Swyer-James syndrome, pulmonary embolism, and abnormalities of the chest wall or contralateral lung. For each condition, the document describes associated radiographic findings and example images. It aims to educate radiologists on evaluating and differentially diagnosing this common pediatric chest x-ray finding.
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
This document provides information on sarcoidosis, including its definition, epidemiology, etiology, clinical presentation, complications, diagnosis, and management. Some key points:
- Sarcoidosis is a granulomatous disease involving multiple organ systems that is thought to be due to an abnormal immune response in genetically predisposed individuals.
- Lungs are involved in over 90% of cases. Other commonly involved organs include lymph nodes, eyes, and skin.
- Diagnosis is based on compatible clinical presentation plus histological evidence of non-caseating granulomas. Bronchoalveolar lavage can also provide supportive evidence.
- Treatment is usually not needed for asymptomatic cases but may involve cort
The document provides an overview of the pathology of lung diseases as seen on chest x-rays, including signs, appearances and common causes of conditions such as consolidation, pleural effusion, atelectasis, pneumothorax, lung masses, fibrosis and infections like tuberculosis. Differential diagnoses are also provided for various lung abnormalities seen on x-rays.
This document discusses radiology signs of pneumomediastinum. It begins by defining pneumomediastinum and listing potential sources where air can originate from, both intrathoracic and extrathoracic. It then describes several common radiographic signs seen with pneumomediastinum, including the thymic sail sign, ring around the artery sign, and ginkgo leaf sign. Examples of each sign are shown through radiograph and CT images. Other signs like the continuous diaphragm sign, tubular artery sign, and Naclerio's V sign are also defined. The document emphasizes the importance of recognizing these signs on imaging for diagnosing pneumomediastinum.
Radiological imaging of pleural diseases Pankaj Kaira
The document discusses the anatomy, imaging, and common diseases of the pleura. It begins by describing the normal anatomy of the pleural layers and thickness. Common pleural diseases are then reviewed, including pleural effusions, pneumothorax, hemothorax, and empyema. Imaging findings on chest x-ray, ultrasound, CT, and MRI are provided for diagnosing and characterizing various pleural conditions. Key signs that help differentiate pleural, pulmonary, and extra-pleural masses are also outlined.
1. The document discusses various types of pleural effusions seen on imaging. It describes how small effusions initially accumulate in the costophrenic angles and can be seen on lateral but not frontal views.
2. As effusions increase in size, they become visible on frontal views and spread upward in the thorax. Large effusions can obscure the entire hemithorax.
3. Effusions can have atypical distributions such as loculated collections or positions between the lung and diaphragm that mimic hemidiaphragm elevation. Loculated effusions are commonly seen in fissures.
This document discusses Congenital Cystic Adenomatoid Malformation (CCAM), a rare pulmonary developmental abnormality. It describes the characteristics and types of CCAM including pathogenesis, imaging findings, prognosis, management, and differentiation from other conditions. Key points:
1) CCAM is comprised of pulmonary tissue with abnormal bronchial proliferation forming cysts. It occurs in 1 in 25,000 live births and is usually limited to one lobe.
2) Prenatal ultrasound can detect cystic or solid masses. Larger lesions with hydrops carry a poorer prognosis. Fetal interventions like shunting may be considered.
3) Surgical resection is often needed after birth for large or symptomatic
Radiological presentation of chest diseases gamal agmyGamal Agmy
This document discusses various radiographic signs seen on chest x-rays. It begins by defining atelectasis as the loss of air in the alveoli, requiring a density representing lung devoid of air and signs of loss of lung volume. It then describes different types of atelectasis including absorption, relaxation, adhesive, cicatricial, and round atelectasis. General signs of loss of lung volume from atelectasis are also outlined, such as mediastinal shift, elevated diaphragm, drooping shoulder, and crowded ribs. The document emphasizes how movement of fissures can help identify atelectasis and requires a lateral chest x-ray view.
The document discusses pulmonary embolism (PE) and its diagnosis using lung ultrasound (LUS). It provides details on the diagnostic criteria for PE using LUS, including findings of typical lung lesions that indicate confirmed or probable PE. It also summarizes the sensitivity and specificity reported in studies on using LUS to diagnose PE. The document further discusses non-thrombotic causes of pulmonary embolism and the ultrasound appearance of various lung pathologies.
This document provides an overview of transthoracic sonography and its applications in evaluating the lungs and chest. It includes descriptions of normal lung anatomy as seen on ultrasound and discusses various pathologies such as pneumonia, pulmonary embolism, COPD and lung cancer. Imaging techniques like assessing lung sliding and the presence of comet tail artifacts are described for evaluating diseases like pneumonia. Other applications covered include using ultrasound to identify pleural effusions, pneumothorax, chest wall abnormalities and for guiding procedures. In summary, the document outlines the role of ultrasound in evaluating pulmonary and chest wall diseases and conditions.
Post operative chest by Dr. Sundar SuwalMilan Silwal
This document provides an overview of the expected postoperative chest appearances and potential complications following various thoracic surgeries including thoracotomy, pneumonectomy, lobectomy, segmentectomy, cardiac surgery, and general surgeries with thoracic complications. It describes the typical radiographic findings in the immediate postoperative period and as healing progresses over weeks and months. Complications discussed include pulmonary edema, bronchopleural fistula, empyema, lobar torsion, and gossypiboma among others. Accurate identification of postoperative changes and complications is important for timely diagnosis and management.
Pleural diseases chest radiology part 2drneelammalik
Ultrasonography is used to diagnose pneumothorax by examining the lungs at the midclavicular and anterior axillary lines for the presence of pleural sliding and comet tail artifacts. The absence of both findings suggests a pneumothorax is present. Pneumothorax can be open, closed, or valvular depending on whether air moves freely in and out or builds pressure on expiration. Asbestos exposure can lead to pleural plaques appearing as calcified thickening on imaging, increasing the risk of lung cancer and mesothelioma.
Radiological diagnostics of Respiratory systemEneutron
This document discusses various radiological diagnostic methods for examining the respiratory system, including direct visualization methods, radiographic methods, analytic methods, special contrast methods, functional methods, and others such as fluoroscopy, MRI, and ultrasound. It describes techniques such as bronchography and CT scans. Pathological findings are outlined, including signs of air-free opacity, clarification, and vascular changes. Syndromes of various pulmonary diseases are also detailed.
The document discusses abnormalities that may appear on a chest x-ray and how to interpret them. It describes findings related to the lung parenchyma including consolidations, interstitial diseases, nodules, cavities, and calcifications. It also covers pleural abnormalities such as effusions, thickening, and plaques. Key signs are explained like air bronchograms, silhouetting, and Kerley lines which provide clues to diagnose conditions like pneumonia.
The document contains findings from 14 radiology cases summarized in 3 sentences or less:
Case 1 describes bilateral symmetrical bulky hila and a diagnosis of sarcoidosis stage 1. Case 2 finds large rounded nodules with calcification, a diagnosis of pneumoconiosis with progressive massive fibrosis. Case 3 finds left upper lobe hyperinflation and herniation in a young child, diagnosed as congenital lobar emphysema.
This document provides guidance on interpreting neonatal chest x-rays. It describes the expected positioning of various tubes and lines and how their positioning appears on x-rays. It then discusses the radiographic findings of various pulmonary and cardiac conditions commonly seen in neonates, such as respiratory distress syndrome, pneumonia, transient tachypnea of the newborn, bronchopulmonary dysplasia, pulmonary hypoplasia, and various congenital heart defects. For each condition, it explains the typical appearance on chest x-ray and signs such as cardiomegaly, increased/decreased pulmonary vascularity, and lung opacities or clearing that can help with diagnosis.
This document provides an overview of how to interpret a normal chest x-ray and describes various imaging views and findings. It discusses the appearance of the heart, lungs, diaphragm and other structures on a posteroanterior view. Additional views like lateral films and inspiratory/expiratory films are mentioned. Common differentials like Kerley lines and the silhouette sign are also summarized.
This document discusses differentials and radiological signs of conditions presenting with a unilateral hypertransradiant hemithorax. It provides two mnemonics, SAFE POEM and CRAWLS, listing potential causes such as rotation, pneumothorax, emphysema, bullous lung disease, Swyer-James syndrome, pulmonary embolism, and abnormalities of the chest wall or contralateral lung. For each condition, the document describes associated radiographic findings and example images. It aims to educate radiologists on evaluating and differentially diagnosing this common pediatric chest x-ray finding.
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
This document provides information on sarcoidosis, including its definition, epidemiology, etiology, clinical presentation, complications, diagnosis, and management. Some key points:
- Sarcoidosis is a granulomatous disease involving multiple organ systems that is thought to be due to an abnormal immune response in genetically predisposed individuals.
- Lungs are involved in over 90% of cases. Other commonly involved organs include lymph nodes, eyes, and skin.
- Diagnosis is based on compatible clinical presentation plus histological evidence of non-caseating granulomas. Bronchoalveolar lavage can also provide supportive evidence.
- Treatment is usually not needed for asymptomatic cases but may involve cort
The document discusses various types of interstitial lung disease (ILD), their causes, symptoms, and management. Common features of ILD include pulmonary inflammation and scarring of the lungs due to abnormal tissue repair. Specific diseases mentioned include idiopathic pulmonary fibrosis and hypersensitivity pneumonitis caused by environmental exposures. Symptoms of ILD include shortness of breath, cough, and fatigue. Management involves avoiding irritants, breathing exercises, medications, oxygen therapy, and pulmonary rehabilitation.
1. The document describes the anatomical locations and classifications of mediastinal lymph nodes. It discusses 10 different lymph node stations located in the mediastinum, including the supraclavicular, upper and lower paratracheal, prevascular, subaortic, para-aortic, subcarinal, paraesophageal, pulmonary ligament, and hilar lymph nodes.
2. Conventional mediastinoscopy allows biopsy of stations 2L, 2R, 4L, 4R, and 7 while extended mediastinoscopy provides access to deeper stations 5 and 6. Endoscopic ultrasound with fine needle aspiration provides sampling of stations 7, 8, and 9.
3. Accurate lymph node
Bronchial Thermoplasty (BT) Novel Treatment for Patients with Severe AsthmaBassel Ericsoussi, MD
Do our Asthma Patients Know What They Are Missing?Now, A Revolutionary Procedure Can Help Them Lead A Fuller Life.
Bronchial Thermoplasty (BT) Novel Treatment For Patients With Severe Asthma
Chest ultrasonograhy techanical aspects and interpretationGamal Agmy
Chest ultrasonography uses sound waves to form images of the chest. It has two main applications - evaluating lung sliding and comet tail artifacts to diagnose pneumothorax, and assessing the lung parenchyma where B-lines indicate interstitial syndrome and coalescent B-lines indicate alveolar edema. The frequency of the ultrasound probe determines its resolution and penetration, with high frequency having better resolution for shallow structures and low frequency having greater penetration for deep structures. Chest ultrasonography is a useful tool for pulmonary and critical care physicians to evaluate patients at the bedside in the ICU.
The document discusses interstitial lung disease (ILD), including its common features, types, causes, diagnostic approach and treatment. It describes various ILD types such as idiopathic pulmonary fibrosis and sarcoidosis. Imaging and biopsy are used to diagnose ILD and determine prognosis. Treatment involves identifying and removing environmental causes, suppressing inflammation, and managing complications like right heart failure.
Interpretation of arterial blood gases:Traditional versus Modern Gamal Agmy
This document discusses the interpretation of arterial blood gases and acid-base disorders. It begins by outlining the Handerson-Hasselbalch equation and normal blood gas values. It then defines respiratory failure and describes the four types based on PaO2 and PaCO2 levels. The document details how to evaluate oxygen status, ventilation, and acid-base disorders from a blood gas analysis. It provides examples of metabolic and respiratory acidosis and alkalosis, explaining compensation mechanisms. Mixed disorders and a step-wise approach to interpretation are also outlined. Three sample problems are worked through as examples.
This document discusses controversial issues in non-invasive ventilation. It begins by explaining the normal ventilatory balance and how respiratory failure causes an imbalance. It then discusses how mechanical ventilation can unload the respiratory muscles.
It defines non-invasive positive pressure ventilation (NPPV) and notes that not all ventilators are suitable for each indication. It reviews different interfaces like facial masks, nasal masks, nasal prongs, and others. It also discusses a study comparing the physiologic effects of different interfaces.
The document continues by looking at the rationale for using positive pressure ventilation in cardiogenic pulmonary edema. It reviews several clinical trials that show benefits of NPPV over standard treatment in acute cardiogenic pulmonary edema and respiratory failure
Approach To Diffuse Parenchymal Lung DiseasesGamal Agmy
This document provides an overview of interstitial lung diseases (ILD) or diffuse parenchymal lung diseases (DPLD). It begins by defining the pulmonary interstitium and describing how disease can expand this space. Clinical presentation typically includes dyspnea and cough. The approach involves determining if the cause is known or idiopathic. Radiographic findings on CXR can provide clues but have limitations. HRCT is more sensitive and can show reticular, ground glass, nodular or cystic patterns. Making a diagnosis involves a multidisciplinary approach including history, physical exam, radiography, pulmonary function tests, labs and possibly tissue sampling. Specific conditions discussed include IPF, sarcoidosis, and D
This document discusses diffuse parenchymal lung diseases (DPLD), also known as interstitial lung diseases. It describes the different categories and subtypes of DPLD, including idiopathic interstitial pneumonias (IIP) such as idiopathic pulmonary fibrosis (IPF). IPF is the most important subtype of IIP, with a poor prognosis. The document outlines approaches to diagnosing and treating IPF.
Sonography in early diagnosis of chest diseasesGamal Agmy
Chest sonography can be a useful tool for critically ill patients in the ICU. It allows for point-of-care imaging of the lungs without needing to transport patients. Sonography can identify pleural effusions, alveolar consolidations, and pneumothorax by looking for signs like the presence of air bronchograms or the loss of lung sliding. It can also detect interstitial edema through the appearance of B-lines or comet tail artifacts. Overall, sonography provides a portable means of evaluating pulmonary abnormalities at the bedside for critically ill patients.
Ipf or non ipf interstitial lung diseasesGamal Agmy
This document discusses interstitial lung diseases (ILDs) and idiopathic interstitial pneumonias (IIPs). It describes the pulmonary interstitium and different subdivisions. Idiopathic pulmonary fibrosis (IPF) is characterized by a usual interstitial pneumonia (UIP) pattern on histology with honeycombing and fibroblastic foci. Other IIPs include nonspecific interstitial pneumonia (NSIP), desquamative interstitial pneumonia (DIP), cryptogenic organizing pneumonia (COP), and lymphocytic interstitial pneumonia (LIP). Accurate IIP diagnosis requires a multidisciplinary approach including pulmonologists, radiologists and pathologists given limitations of
This document discusses idiopathic pulmonary fibrosis (IPF), a chronic, progressive fibrosing interstitial pneumonia of unknown cause associated with a histopathologic pattern of usual interstitial pneumonia (UIP). It defines IPF and outlines the diagnostic criteria, which involves ruling out known causes, abnormal pulmonary function tests, characteristic radiologic findings on high-resolution computed tomography (HRCT), and surgical lung biopsy showing UIP pattern. HRCT features that are consistent and inconsistent with UIP are described. Guidelines for management of IPF are provided, including recommendations for pirfenidone and nintedanib based on recent clinical trials. Lung transplantation is the only treatment that increases long-term survival for patients with IPF.
Diffuse alveolar haemorrhage (DAH) is characterized by bleeding into the alveolar spaces caused by disruption of the alveolar-capillary basement membrane due to injury or inflammation of the small blood vessels in the lungs. Common initial symptoms include cough, hemoptysis, fever, and dyspnea. Diagnostic tests show increased DLCO on PFTs and progressively more hemorrhagic bronchoalveolar lavage samples. Treatment focuses on treating the underlying cause with glucocorticoids as the mainstay along with additional immunosuppressive agents or plasma exchange depending on the cause.
Approach To Diffuse Parenchymal Lung DiseasesGamal Agmy
This document provides an overview of interstitial lung diseases (ILD), also known as diffuse parenchymal lung diseases (DPLD). It begins by defining the pulmonary interstitium and reviewing the spectrum of ILD. Common clinical presentations are discussed. The document then reviews approaches to diagnosis, including history, physical exam, imaging like chest x-ray and CT, pulmonary function tests, and lung sampling. Common radiographic patterns seen in ILD like ground glass, reticulation, nodules and cysts are also summarized.
Tracheostomy:When to perform and How to manage?Gamal Agmy
Tracheostomy is an ancient surgical procedure that can be traced back to Egyptian tablets from 3600 BC. It involves creating an opening in the trachea to allow direct access to the breathing tube. The document discusses the history, indications, techniques, management and outcomes of tracheostomy. It provides details on open surgical tracheostomy techniques as well as percutaneous dilational tracheostomy. Factors such as cannula choice, cuff management, replacement, humidification and weaning are reviewed for long-term tracheostomy care. Tracheostomy is indicated for patients requiring prolonged mechanical ventilation, inability to clear secretions or upper airway obstruction.
This document summarizes recent literature on critical care topics including mechanical ventilation modes, ARDS, sepsis, and ultrasound use in the ICU. It reviews evidence on early tracheostomy timing, novel ventilation strategies like APRV and HFOV, updates to the ARDS definition, low tidal volume ventilation recommendations, and the Surviving Sepsis Campaign guidelines. It also discusses predicting ARDS outcomes, high versus low PEEP, limitations of plateau pressure, and rescue strategies like ECMO.
Unilateral pleural effusion in liver cirrhosis, congestive heart failure and ...Gamal Agmy
This study evaluated 320 patients with congestive heart failure, 214 with liver cirrhosis, and 94 with nephrotic syndrome who presented with pleural effusions. The study aimed to assess the diagnostic value of biochemical criteria to distinguish transudates from exudates, evaluate the effect of diuretic therapy on these parameters, and identify the causes of left-sided exudative pleural effusions in these patients. The results showed that serum-pleural albumin gradient was the most sensitive and specific test. Diuretics can affect Light's criteria and misclassify transudates. Common causes of left exudative effusions were pulmonary embolism in heart failure and nephrotic syndrome, and tuberculosis
This document describes the spectrum of pulmonary aspergillosis, which can be subdivided into 5 categories: 1) saprophytic aspergillosis, 2) hypersensitivity reaction, 3) semi-invasive aspergillosis, 4) airway-invasive aspergillosis, and 5) angioinvasive aspergillosis. Each category is described in terms of common clinical manifestations, risk factors, and treatment options when applicable. The categories range from non-invasive fungal growth to invasive infections seen in immunocompromised patients.
This document discusses atelectasis, which is the loss of air in the alveoli. There are several types of atelectasis described, including absorption, relaxation, compression, adhesive, cicatricial, and round atelectasis. Signs of atelectasis on imaging include shifts of mediastinal structures, changes in fissure positions, loss of lung volumes, and compensatory hyperinflation of the remaining lung. Specific radiographic findings are outlined for different types of lobar and segmental atelectasis. CT further aids in characterization of atelectatic regions and any associated abnormalities.
This document provides descriptions and radiographic signs of various pulmonary conditions seen on chest x-rays and CT scans. It includes definitions of terms like secondary lobule and centrilobular emphysema. Specific pathologies covered include Langerhans cell histiocytosis, lymphangioleiomyomatosis, pulmonary fibrosis patterns, and lymphocytic interstitial pneumonia. Radiographic findings are presented for different conditions along with accompanying CT images to illustrate signs like cysts, nodules, and reticulation. Differential diagnoses are discussed based on imaging appearance.
This document discusses various radiological signs seen on chest imaging. It describes signs such as the "S curve of golden" seen with masses adjacent to fissures, the "pulmonary artery overlay sign" seen when the interlobar pulmonary artery is visible behind or in front of a mass. Other signs discussed include those seen with conditions such as achalasia of the esophagus, pneumomediastinum, and extrapulmonary masses. The document also summarizes CT findings associated with various pulmonary diseases and abnormalities.
This document discusses various radiographic signs seen on chest x-rays and CT scans. It describes signs such as the air bronchogram sign which indicates alveolar disease filling the surrounding alveoli and making bronchi visible. It also discusses signs seen in conditions like atelectasis, consolidation, and pneumomediastinum. Many signs provide clues to the location and characteristics of lung lesions, abnormalities of the diaphragm and heart borders, and pathology within the lungs.
This document discusses several radiographic signs seen on chest x-rays and CT scans. It describes signs such as the air bronchogram sign which indicates alveolar disease filling the surrounding alveoli and making bronchi visible. It also discusses signs seen in various lung pathologies like atelectasis, consolidation, and pneumomediastinum. Examples of specific signs mentioned include the halo sign seen in invasive pulmonary aspergillosis, the luftsichel sign seen in left upper lobe collapse, and the cervicothoracic sign used to locate mediastinal lesions.
Radiological Presentation of Chest Diseases Gamal Agmy
This document discusses various radiographic signs seen on chest x-rays. It begins by defining atelectasis as the loss of air in the alveoli, requiring a density representing lung devoid of air and signs of loss of lung volume. It then describes different types of atelectasis including absorption, relaxation, adhesive, cicatricial, and round atelectasis. General signs of loss of lung volume from atelectasis are also outlined, such as mediastinal shift, elevated diaphragm, drooping shoulder, and crowded ribs. The document emphasizes how movement of fissures can help identify atelectasis and requires a lateral view.
Radiological signs in chest medicine part 2Gamal Agmy
This document describes several radiographic signs seen on chest x-rays and CT scans. It provides brief definitions and explanations for signs such as the ginkgo leaf sign, Golden S sign, holly leaf sign, coin lesion, and reverse halo sign among others. Each sign provides clues to possible underlying conditions based on their appearance on imaging studies.
Radiological signs in chest medicine Part 1Gamal Agmy
This document discusses various radiological signs seen on chest imaging. It provides examples of different signs seen on chest x-ray and CT scan related to masses, atelectasis, vascular structures, esophageal disorders, pneumomediastinum, extrapulmonary masses, interstitial lung disease, and pulmonary nodule patterns. It also discusses CT features of different lung diseases and conditions including sarcoidosis, Langerhans cell histiocytosis, lymphangioleiomyomatosis, and others. Finally, it examines histopathological definitions and CT appearance of various types of emphysema.
This document discusses the radiographic findings of complete opacification of one hemithorax seen on a chest x-ray. It notes that the position of the mediastinum and trachea can help narrow the differential diagnosis. Specifically:
- If the trachea is pulled towards the opacified side, possibilities include pneumonectomy, total lung collapse, pulmonary agenesis, or pulmonary hypoplasia.
- If the trachea remains central, consolidation, pulmonary edema/ARDS, a pleural mass, or chest wall mass should be considered.
- If the trachea is pushed away from the opacified side, a pleural effusion, diaphragmatic hernia,
The document discusses lung collapse (atelectasis) and consolidation. Collapse is a loss of lung volume while consolidation involves fluid filling the alveoli. Collapse can be caused by obstruction of airways or loss of contact between the lungs and chest wall. Consolidation is seen in conditions like pneumonia. Specific patterns of collapse and consolidation are seen on chest x-rays depending on the affected lung lobe. Signs like fissure shifts and volume changes in the unaffected lobes help identify the collapsed lobe.
This document discusses pulmonary atelectasis, which is the collapse of lung tissue. It can occur during general anesthesia and in critically ill patients. During anesthesia, atelectasis is commonly caused by compression of the lungs or absorption of oxygen, while in critically ill patients it may be due to acute lung injury or surfactant depletion. The effects of atelectasis include decreased lung compliance and impaired oxygenation. Prevention techniques include positive pressure ventilation with PEEP and recruitment maneuvers. Treatment involves techniques to reopen collapsed lung regions.
The document summarizes various patterns of lung disease and abnormalities that can be seen on a chest x-ray. It describes how interlobar fissures, lobar collapse, alveolar/interstitial diseases, lung masses/nodules, mediastinal structures, pleural/extrapleural abnormalities like effusions, pneumothorax can present on CXR through specific radiographic signs and findings. Key anatomical structures and their appearances in different lung pathologies are concisely outlined.
This document provides a summary of key findings that may be seen on chest x-rays. It begins with examples of normal chest x-rays and describes the basic knowledge needed to interpret x-rays. It then discusses specific lung diseases and findings, including pleural diseases, pneumothorax, tuberculosis, pneumonia, interstitial pulmonary fibrosis, COPD, sarcoidosis, and pericardial effusion. Each section provides examples of chest x-rays demonstrating the relevant findings. The document is intended as a study aid for medical exams.
This document provides information about interpreting HRCT scans of the chest. It describes bronchial and lobar anatomy, Hounsfield units, and patterns seen on HRCT such as ground glass opacity, consolidation, reticulation, nodules, honeycombing, and vascular anatomy. Common diseases that can cause each pattern are listed, such as sarcoidosis presenting with perilymphatic nodules or pulmonary edema seen as smooth septal thickening. The document emphasizes using patterns and distributions to narrow the differential diagnosis on HRCT scans.
This document provides an overview of chest x-ray basics and interpretation. It discusses key radiographic densities seen on CXRs, different chest x-ray views, and how to assess image quality factors like inspiration, penetration, and rotation. The document then outlines a systematic approach to interpreting CXRs, covering the airways, bones, cardiac structures, diaphragm, effusions, lung fields, and other areas. Common abnormalities are described, such as consolidation, atelectasis, pneumonia, and position of tubes/lines.
- Chest radiography is useful for assessing pulmonary edema, infiltrates, effusions, pneumothorax, and positioning of lines and tubes in intensive care patients. Common findings include air bronchograms, hilar enlargement, Kerley lines, and increased vascular pedicle width.
- Pneumomediastinum is suggested by findings like the continuous diaphragm sign, Naclerio's V sign, and double bronchial wall sign. A pneumothorax may be occult or demonstrated by a pleural line with absent lung markings.
- Proper positioning of central lines is important but can be challenging due to anatomical variability. The tip should lie in the SVC above the pericardial
(1) This document discusses several types of congenital lung anomalies including bronchial anomalies like tracheal bronchi and accessory cardiac bronchi, bronchial isomerism, bronchial atresia, and congenital lobar overinflation.
(2) It also discusses bronchogenic cysts which are congenital malformations of the bronchial tree that present as mediastinal masses. Congenital pulmonary airway malformations (CPAM), previously known as congenital cystic adenomatoid malformation, are characterized by abnormal bronchial proliferation resulting in multicystic lung tissue.
(3) Pulmonary arteriovenous malformations are also discussed which are abnormal direct connections between arteries and veins in the
This document describes various signs seen on chest x-rays that can help diagnose medical conditions:
1. The air bronchogram sign shows the outline of airways filled with fluid or inflammation, seen in conditions like lung consolidation or edema.
2. The spinnaker sign outlines the thymus gland with air, appearing like spinnaker sails on neonatal chest x-rays and indicating pneumomediastinum.
3. The Hampton hump sign shows a wedge-shaped pleural-based consolidation pointing towards the hilum, usually in the lower lobes and indicating healing with scar formation.
Recognizing Atelectasis, Pleural Effusion and Pneumonia3JoshArvinAbrasado
This document provides information on recognizing three common lung conditions: atelectasis, pleural effusion, and pneumonia. It describes the signs and patterns of each condition, including how they appear on chest x-rays. For atelectasis, it outlines different types like subsegmental and compressive atelectasis. For pleural effusion, it discusses characteristics like transudate vs. exudate effusions and how they can be positioned in the lungs. Pneumonia types covered include lobar, segmental, interstitial, round, and cavitary patterns. Localization clues and resolution of these conditions is also addressed.
- The document discusses various patterns seen on HRCT scans of interstitial lung diseases including nodular, reticulation, cystic and tree-in-bud patterns.
- It describes the significance of different patterns and features such as distribution of nodules, characteristics of interlobular septal thickening, honeycombing and intralobular interstitial thickening.
- Differential diagnoses are discussed for each pattern to determine likely disease processes such as pulmonary fibrosis, infections, lymphangitic spread of cancer or sarcoidosis.
Antibiotic Strategy in Lower Respiratory Tract Infections (part 1)Gamal Agmy
This document summarizes guidelines for empiric antibiotic treatment of lower respiratory tract infections such as community-acquired pneumonia. It recommends using a clinical prediction rule like the Pneumonia Severity Index in addition to clinical judgment to determine whether patients should be treated as outpatients or inpatients. For outpatient treatment of CAP, it recommends amoxicillin, doxycycline, or macrolides depending on patient risk factors and local resistance patterns. For inpatient treatment of non-severe CAP without risk of MRSA or Pseudomonas, it recommends beta-lactam plus macrolide or fluoroquinolone monotherapy. It does not recommend routinely adding anaerobic coverage or extended-spectrum antibiotics without
Antibiotic Strategy in Lower Respiratory Tract Infections (part 2)Gamal Agmy
This document provides guidelines for evaluating and treating patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) based on the latest evidence and expert consensus. It discusses recommendations for using clinical scoring systems to decide whether to initiate antibiotics, recommendations for empiric and pathogen-directed antibiotic therapy, evaluating treatment failure, the role of inhaled antibiotics, duration of treatment, and other important management considerations. The overall aim is to guide clinicians in providing appropriate antibiotic treatment while minimizing unnecessary use of antibiotics.
This document provides an overview of the radiological presentation of COVID-19 based on CT scans and chest x-rays. It finds that ground glass opacities are the most common CT finding and often appear bilaterally in the lower lobes in a peripheral or subpleural distribution. Later stages may also show consolidation, septal thickening, and traction bronchiectasis. Chest x-rays are less sensitive than CT early on but can still detect signs of disease progression like bilateral opacities and consolidation. Pediatric cases tend to be milder with fewer abnormal CT findings. The document outlines typical features, frequencies of signs, and comparisons between adult and pediatric presentations.
This document provides information on COVID-19. It describes COVID-19 as an infectious disease caused by SARS-CoV-2. The first cases were seen in Wuhan, China in December 2019. Most people experience mild to moderate symptoms, but older people and those with pre-existing medical conditions are more likely to develop serious illness. Diagnosis is made through PCR testing of respiratory samples. Common CT findings include ground glass opacities and consolidation.
Antibiotic Strategy in Lower Respiratory Tract InfectionsGamal Agmy
This document discusses antibiotic strategy in lower respiratory tract infections. It covers mechanisms of action of antimicrobial drugs, appropriate antibiotic selection and dosing considerations including tissue versus blood concentrations and drug mechanisms of action. It also discusses community acquired pneumonia guidelines for outpatient versus inpatient treatment including durations. Exacerbations of COPD and ventilator associated pneumonia are also summarized.
Imaging of Pulmonary Vascular Lesions ``Gamal Agmy
This document contains a series of questions and answers about the management of pulmonary embolism from Gamal Agmy, a professor of chest diseases. It discusses issues such as when to use thrombolysis for intermediate risk PE, the risks of thrombolysis for patients with recent surgery or stroke, and alternatives to thrombolysis if it is deemed too unsafe. It also addresses questions about managing PE in pregnant patients, PE with right atrial thrombus, and the appropriate use of IVC filters.
Management Dilemmas in Acute Pulmonary Embolism Gamal Agmy
The document discusses 14 clinical dilemmas in the management of acute pulmonary embolism (PE) that were identified by physicians with interests in PE. For each dilemma, the current evidence and guidelines are reviewed and a practical approach is suggested. Some examples of the dilemmas addressed include differentiating between acute and chronic PE, determining which intermediate-risk PE patients should receive thrombolysis, and managing pregnant patients with significant PE.
:Weaning from Mechanical Ventilation :Recent UpdatesGamal Agmy
This document summarizes recent updates on weaning from mechanical ventilation. It discusses that 75% of mechanically ventilated patients can be easily weaned, while 10-15% require a weaning protocol over 24-72 hours and 5-10% require gradual weaning over a longer period. Readiness criteria for weaning include improved respiratory status, absence of organ failure, adequate oxygenation and ventilation. Spontaneous breathing trials are used to assess readiness for weaning and extubation. Noninvasive ventilation can help prevent extubation failure, especially in patients with COPD. Diaphragm ultrasound may help predict weaning outcome, with a diaphragm thickness change over 40% associated with successful weaning.
Oxygen Therapy is not Beneficial in COPD Patients with Moderate HypoxaemiaGamal Agmy
A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation
The Long-Term Oxygen Treatment Trial Research Group*
N Engl J Med. 2016 October 27; 375(17): 1617–1627
1. Several imaging modalities can provide detailed assessment of lung structure and function in asthmatic patients, including CT, MRI, PET, OCT, and EBUS.
2. Measurements from CT such as airway wall thickness, air trapping, and ventilation defects have been shown to correlate with disease severity and control.
3. Imaging measurements can serve as biomarkers to evaluate responses to new therapies like inhaled corticosteroids and anti-IL5 monoclonal antibodies, and determine if treatments are modifying the disease course.
Discontinuing Mechanical Ventilation in ICUGamal Agmy
This document discusses various methods and indices used to assess a patient's ability to be weaned from mechanical ventilation in the ICU, including minute ventilation, maximum inspiratory pressure, respiratory frequency, rapid shallow breathing index, tracheal airway occlusion pressure, and others. It provides recommendations for protocols to minimize sedation, use inspiratory pressure augmentation or preventive noninvasive ventilation for extubation. Diaphragm ultrasound measuring diaphragm thickness change during breathing is also discussed as a potential new method to guide weaning with a cutoff value of over 40% change indicating a likely successful spontaneous breathing trial.
This document provides an overview of ultrasound applications in the intensive care unit and emergency department. It discusses using ultrasound at the bedside for lung imaging as an alternative to radiography. It describes the signs of pneumothorax, pulmonary edema, pulmonary embolism, and lung consolidation seen on ultrasound. The document also reviews using ultrasound to evaluate the inferior vena cava, heart, and pericardial space. Protocols for lung ultrasound and applications in critically ill patients are presented.
This document provides a six-step process for interpreting arterial blood gas (ABG) results. It begins by emphasizing the importance of ABG interpretation for healthcare providers. The six steps include: 1) assessing internal consistency, 2) identifying alkalemia or acidemia, 3) determining if the disturbance is respiratory or metabolic, 4) checking for appropriate compensation, 5) calculating anion gap if needed, and 6) assessing the relationship between anion gap and bicarbonate changes. Common acid-base disorders and their characteristics are also outlined. The goal of the interpretation is to identify primary and concurrent acid-base abnormalities.
1. COPD can be categorized into emphysema-predominant, airway-predominant, and mixed subtypes based on CT imaging findings.
2. CT-based methods allow for quantification of emphysematous changes by measuring areas of low lung attenuation, and can differentiate upper vs lower lung predominant emphysema.
3. Combining CT quantification of emphysema with pulmonary function testing helps characterize COPD phenotypes.
Antibiotic strategies in lower respiratory tract infectionsGamal Agmy
This document discusses strategies for antibiotic treatment of lower respiratory tract infections. It begins by describing the mechanisms of action, spectrum, and bacteriostatic vs bactericidal properties of antimicrobial drugs. It then discusses concepts like antibiotic combinations, synergism, and antagonism. The document continues by outlining methods for determining minimum inhibitory concentration and minimum bactericidal concentration in vitro. It provides guidance on empiric antibiotic treatment strategies for outpatients, inpatients, and ICU patients. It also discusses approaches for suspected multidrug-resistant pathogens. The document concludes by addressing criteria for switching to oral antibiotics and guidelines for treatment duration.
Thoracic Imaging in critically ill patientsGamal Agmy
Chest radiography remains the primary imaging modality for critically ill patients, however images are often limited quality due to patient movement and positioning challenges. Mistakes can occur in assessing conditions like pleural effusions or infiltrates. Routine daily chest x-rays are not recommended for ICU patients unless clinically indicated. Ultrasound is a useful bedside tool for evaluating the lungs, IVC, heart, and detecting pneumothorax. Computed tomography can also be used but requires transporting unstable patients.
Updates in CAP,HAP, VAP, AECOPD and pneumonia severity scoresGamal Agmy
This document discusses antibiotic strategy in pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD). It covers mechanisms of action of antimicrobial drugs, antimicrobial susceptibility testing, patterns of microbial killing, effects of drug combinations, and resistance. It also addresses the clinical diagnosis of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HCAP), severity scoring tools for pneumonia, chest radiograph findings, etiological pathogens, risk factors, and diagnostic testing and empiric treatment strategies for CAP and HCAP based on patient location and severity of illness.
American Thoracic Society Interpretation of ABGGamal Agmy
This document provides a six-step process for interpreting arterial blood gas (ABG) results. It begins by emphasizing the importance of ABG interpretation for healthcare providers. The six steps include: 1) assessing internal consistency, 2) identifying alkalemia or acidemia, 3) determining if the disturbance is respiratory or metabolic, 4) checking for appropriate compensation, 5) calculating anion gap if needed, and 6) assessing the relationship between anion gap and bicarbonate changes. Common acid-base disorders and their characteristics are also outlined. The goal of the interpretation is to identify primary and concurrent acid-base abnormalities.
Assessment of CAP Severity by Pneumonia ScoresGamal Agmy
This document discusses several scoring systems used to assess the severity of community-acquired pneumonia (CAP) and determine appropriate treatment. It describes the CURB-65, CRB-65, Pneumonia Severity Index (PSI), CORB, SMART-COP, and A-DROP scoring systems. Each system assigns points based on various clinical factors like confusion, low blood pressure, elevated heart rate. Higher total scores indicate more severe pneumonia and higher risk of death. The scoring helps guide decisions about hospitalization versus outpatient treatment and identify patients needing intensive care.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
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Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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5 Effective Homeopathic Medicines for Irregular Periods
Thoracic imaging terms part 1
1.
2.
3. Thoracic Imaging Terms
By
Gamal Rabie Agmy , MD , FCCP
Professor of Chest Diseases ,Assiut University
ERS National Delegate of Egypt
4. Air Bronchogram
An air bronchogram is a pattern of air-filled
(low-attenuation) bronchi on a background
of opaque (high-attenuation) airless lung . The
sign implies
(a) patency of proximal airways and
(b) evacuation of alveolar air by means of
absorption (atelectasis) or replacement
(eg, pneumonia) or a combination of these
processes.
(c) In rare cases, the displacement of air is
the result of marked interstitial expansion
(eg, lymphoma) .
5.
6. Air Crescent
An air crescent is a collection of air in a
crescentic shape that separates the wall of
a cavity from an inner mass .The air
crescent sign is often considered
characteristic
of
either
Aspergillus
colonization of preexisting cavities or
retraction of infarcted lung in angioinvasive
aspergillosis .However, the air crescent
sign has also been reported in other
conditions,
including
tuberculosis,
Wegener granulomatosis, intracavitary
hemorrhage, and lung cancer.
7. Air Trapping
Air trapping is retention of air in the lung
distal to an obstruction (usually partial). Air
trapping is seen on end-expiration CT
scans as parenchymal areas with less
than normal increase in attenuation and
lack of volume reduction. Comparison
between inspiratory and expiratory CT
scans can be helpful when air trapping is
subtle or diffuse. Differentiation from areas
of decreased attenuation resulting from
hypoperfusion as a consequence of an
occlusive vascular disorder (eg, chronic
thromboembolism) may be problematic ,
but other findings of airways versus
vascular disease are usually present.
8.
9. Where is the pathology ???????
in the areas with increased density
meaning there is ground glass
in the areas with decreased density
meaning there is air trapping
10. Pathology in black areas
Airtrapping: Airway Disease
Bronchiolitis obliterans (constrictive bronchiolitis)
idiopathic, connective tissue diseases, drug reaction,
after transplantation, after infection
Hypersensitivity pneumonitis
granulomatous inflammation of bronchiolar wall
Sarcoidosis
granulomatous inflammation of bronchiolar wall
Asthma / Bronchiectasis / Airway diseases
11. Airway Disease
what you see……
In inspiration
sharply demarcated areas of seemingly increased
density (normal) and decreased density
demarcation by interlobular septa
In expiration
‘black’ areas remain in volume and density
‘white’ areas decrease in volume and increase in
density
INCREASE IN CONTRAST
DIFFERENCES
13. Aortopulmonary Window
Focal concavity in the left mediastinal
border below the aorta and above the left
pulmonary artery can be seen on a frontal
radiograph . Its appearance may be
modified by tortuosity of the aorta. The
aortopulmonary window is a common site
of lymphadenopathy in a variety of
inflammatory and neoplastic diseases.
19. Apical Cap
The usual appearance is of homogeneous
soft-tissue attenuation capping the extreme lung
apex (uni- or bilaterally), with a sharp or irregular
lower border .Thickness is variable, ranging up to
about 30 mm . An apical cap occasionally mimics
apical consolidation on transverse CT scans.
21. Atelectasis
Reduced volume is seen, accompanied by
increased opacity (chest radiograph) or
attenuation (CT scan) in the affected
part of the lung . Atelectasis is often
associated with abnormal displacement of
fissures,
bronchi,
vessels,diaphragm,
heart, or mediastinum .The distribution can
be lobar, segmental, or subsegmental.
Atelectasis is often qualified by descriptors
such as linear,discoid, or platelike.
22. Atelectasis
The definition of atelectasis is loss of air in the alveoli;
alveoli devoid of air (not replaced).
A diagnosis of atelectasis requires the following:
1-A density, representing lung devoid of air
2-Signs indicating loss of lung volume
23. Types of Atelectasis:
1-Absorption Atelectasis
When airways are obstructed there is no further
ventilation to the lungs and beyond. In the early
stages, blood flow continues and gradually the
oxygen and nitrogen get absorbed, resulting in
atelectasis.
24. Types of Atelectasis:
2-Relaxation Atelectasis
The lung is held close to the chest wall because of the
negative pressure in the pleural space. Once the
negative pressure is lost the lung tends to recoil due
to elastic properties and becomes atelectatic. This
occurs in patients with pneumothorax and pleural
effusion. In this instance, the loss of negative
pressure in the pleura permits the lung to relax, due
to elastic recoil. There is common misconception that
atelectasis is due to compression.
25. Types of Atelectasis:
3-Adhesive Atelectasis :
Surfactant reduces surface tension and keeps the
alveoli open. In conditions where there is loss of
surfactant, the alveoli collapse and become
atelectatic. In ARDS this occurs diffusely to both
lungs. In pulmonary embolism due to loss of blood
flow and lack of CO2, the integrity of surfactant
gets impaired.
27. Types of Atelectasis:
.
5-Round Atelectasis
An instance where the lung gets trapped by
pleural disease and is devoid of air.
Classically encountered in asbestosis.
29. Signs of Loss of Lung Volume:
Generalized
1-Shift of mediastinum: The trachea and heart gets shifted
towards the atelectatic lung.
2-Elevation of diaphragm: The diaphragm moves up and
the normal relationship between left and right side gets
altered.
3-Drooping of shoulder.
4-Crowding of ribs: The interspace between the ribs is
narrower compared to the opposite side.
30. Signs of Loss of Lung Volume:
Movement of Fissures
You need a lateral view to appreciate the movement of
oblique fissures. Forward movement of oblique fissure in
LUL atelectasis. Backward movement in lower lobe
atelectasis.
Movement of transverse fissure can be recognized in the
PA film.
31. Signs of Loss of Lung Volume:
Movement of Hilum
The right hilum is normally slightly lower than the left.
This relationship will change with lobar atelectasis.
32. Signs of Loss of Lung Volume:
Compensatory Hyperinflation
Compensatory hyperinflation as evidenced by increased
radiolucency and splaying of vessels can be seen with the
normal lobe or opposite lung.
33. Signs of Loss of Lung Volume:
Alterations in Proportion of Left and
Right Lung
The right lung is approximately 55% and left lung 45%. In
atelectasis this apportionment will change and can be a
clue to recognition of atelectasis. .
34. Signs of Loss of Lung Volume:
Hemithorax Asymmetry
In normals, the right and left hemithorax are equal in size.
The size of the hemithorax will be asymmetrical and
smaller on the side of atelectasis
35. Signs of Loss of Lung Volume:
Generalized
Shift of mediastinum: The trachea and heart gets shifted towards the atelectatic lung.
Elevation of diaphragm: The diaphragm moves up and the normal relationship between left
and right side gets altered.
Drooping of shoulder.
Crowding of ribs: The interspace between the ribs is narrower compared to the opposite side.
Movement of Fissures
You need a lateral view to appreciate the movement of oblique fissures. Forward movement of
oblique fissure in LUL atelectasis. Backward movement in lower lobe atelectasis.
Movement of transverse fissure can be recognized in the PA film.
Movement of Hilum
The right hilum is normally slightly lower than the left. This relationship will change with lobar
atelectasis.
Compensatory Hyperinflation
Compensatory hyperinflation as evidenced by increased radiolucency and splaying of vessels
can be seen with the normal lobe or opposite lung.
Alterations in Proportion of Left and Right Lung
The right lung is approximately 55% and left lung 45%. In atelectasis this apportionment will
change and can be a clue to recognition of atelectasis.
Hemithorax Asymmetry
In normals, the right and left hemithorax are equal in size. The size of the hemithorax will be
asymmetrical and smaller on the side of atelectasis
36. Atelectasis Right Lung
Homogenous density right hemithorax
Mediastinal shift to right
Right hemithorax smaller
Right heart and diaphragmatic silhouette are not identifiable
37. Atelectasis Left Lung
Homogenous density left hemithorax
Mediastinal shift to left
Left hemithorax smaller
Diaphragm and heart silhouette are not identifiable
38. Left Lower Lobe Atelectasis
•
•
•
•
Inhomogeneous cardiac density
Left hilum pulled down
Non-visualization of left diaphragm
Triangular retrocardiac atelectatic LLL
39. Atelectasis Left Lower Lobe
Double density over heart
Inhomogenous cardiac density
Triangular retrocardiac density
Left hilum pulled down
Other findings include:
Pneumomediastinum
40. Atelectasis Left
Upper Lobe
Mediastinal shift to left
Density left upper lung field
Loss of aortic knob and left hilar
silhouettes
Herniation of right lung
Atelectatic left upper lobe
Forward movement of left
oblique fissure "Bowing sign"
41. Atelectasis Left Upper
Lobe
Hazy density over left
upper lung field
Loss of left heart
silhouette
Tracheal shift to left
Lateral
A: Forward movement of
oblique fissure
B: Herniated right lung
C: Atelectatic LUL
42. Atelectasis Right Upper Lobe
Homogenous density right upper lung
field
Mediastinal shift to right
Loss of silhouette of ascending aorta
Lateral
Movement of oblique and transverse
fissures
43. Atelectasis Right Upper Lobe
Homogenous density right upper lung field
Mediastinal shift to right
Loss of silhouette of ascending aorta
Lateral
Movement of oblique and transverse
fissures
44. RML Atelectasis
Vague density in right lower lung field, almost normal
RML atelectasis in lateral view, not evident in PA view
45. Vague density in right lower lung field (almost a normal film).
Dramatic RML atelectasis in lateral view, not evident in PA view. Movement of
transverse fissure.
Other findings include: Azygous lobe
46. Atelectasis Right Lower Lobe
Density in right lower lung field
Indistinct right diaphragm
Right heart silhouette retained
Transverse fissure moved down
Right hilum moved down
47. Adhesive Atelectasis
Alveoli are kept open by the integrity of surfactant. When there is loss
of surfactant, alveoli collapse. ARDS is an example of diffuse alveolar
atelectasis.
Plate-like atelectasis is an example of focal loss of surfactant.
48. Relaxation Atelectasis
The lung is held in apposition to the chest wall because of negative pressure
in the pleura. When the negative pressure is lost, as in pneumothorax or
pleural effusion, the lung relaxes to its atelectatic position. The atelectasis is
a secondary event. The pleural problem is primary and dictates other
radiological findings.
49. Round Atelectasis
Mass like density
Pleural based
Base of lungs
Blunting of costophrenic angle
Pleural thickening
Pulmonary vasculature curving
into the density
Esophageal surgical clips
50. Round Atelectasis
Mass like density
Pleural based
Base of lungs
Blunting of costophrenic angle, pleural thickening
Pulmonary vasculature curving into the density
54. Azygoesophageal Recess
The azygoesophageal recess on a frontal
chest radiograph, is seen as a vertically
oriented interface between the right lower
lobe and the adjacent mediastinum (the
medial limit of the recess). Superiorly, the
interface is seen as a smooth arc with
convexity to the left. Disappearance or
distortion of part of the interface suggests
disease (eg, subcarinal lymphadenopathy).
On CT scans, the recess merits
attentionbecause small lesions located in
the recess will often be invisible on chest
radiographs
55. Acute interstitial pneumonia, or AIP
In the acute phase, patchy bilateral
groundglass opacities are seen , often with
some sparing of individual lobules,
producing a geographic appearance;
dense opacification is seen in the
dependent lung .
In the organizing phase, architectural
distortion, traction bronchiectasis, cysts,
and reticular opacities are seen .
57. Beaded Septum Sign
This sign consists of irregular and nodular
thickening of interlobular septa reminiscent
of a row of beads . It is frequently seen in
lymphangitic spread of cancer and less
often in sarcoidosis .
58. Bleb
Anatomy.—A bleb is a small gas-containing space
within the visceral pleura or in the subpleural lung,
not larger than 1 cm in diameter . CT scans.—A
bleb appears as a thin-walled cystic air space
contiguous with the pleura. Because the arbitrary
(size) distinction between a bleb andbulla is of little
clinical importance, the use of this term by
radiologists is discouraged.
60. Bulla
Definition
•Thin-walled–less than 1 mm
•Air-filled space
•In the lung> 1 cm in size and up to 75% of lung
•Walls may be formed by pleura, septa,
or compressed lung tissue.
•Results from destruction, dilatation and
confluence of airspaces distal to terminal
bronchioles.
61. •Bullous disease may be primary or associated
with emphysema or interstitial lung disease.
• Primary bullous lung disease may be familial
and has been associated with Marfan's, Ehler's
Danlos, IV drug users, HIV infection, and
vanishing lung syndrome.
•Bullae may occasionally become very large
and compromise respiratory function. Thus
has been referred as vanishing lung syndrome,
and may be seen in young men.
66. Pneumatocele is a benign air containing cyst of lung, with
thin wall < 1mm as bulla but with different mechanism
Infection with staph aureus is the commonest cause ( less
common causes are, trauma, barotrauma) lead to necrosis
and liquefaction followed by air leak and subpleural
dissection forming a thin walled cyst.
67. •Honeycombing is defined as multiple cysts < 1cm in diameter,with
well defined walls, in a background of fibrosis, tend to form
clusters and is considered as end stage lung .
•It is formed by extensive interstitial fibrosis of lung with residual
cystic areas.
68.
69. A cyst is a ring
shadow > 1 cm in
diameter and up to
10 cm with wall
thickness from 1-3
mm.
72. A cavity is > 1cm
in diameter, and its
wall thickness is
more than 3 mm.
73. Mechanism
•A central portion necrosis and communicate to bronchus.
•The draining bronchus is visible (arrow). CT (2 mm slice thickness)
shows discrete air bronchograms in the consolidated area.
86. Bronchiectasis
Morphologic criteria on thin-section CT
scans include bronchial dilatation with
respect to the accompanying pulmonary
artery (signet ring sign), lack of tapering
of bronchi, and identification of bronchi
within 1 cm of the pleural surface (27)
(Fig 11). Bronchiectasis may be classified
as cylindric, varicose, or cystic, depending
on the appearance of the affected bronchi.
It is often accompanied by bronchial wall
thickening, mucoid impaction, and smallairways abnormalities
87. Bronchiolectasis
When dilated bronchioles are filled with
exudate and are thick walled, they are
visible as a tree-in-bud pattern or as
centrilobular
nodules.
In
traction
bronchiolectasis, the dilated bronchioles
are seen as small, cystic, tubular
airspaces, associated with CT findings of
fibrosis
88. Bronchocele
bronchocele is a tubular or branching Yor
V-shaped structure that may resemble a
gloved finger (Fig 13). The CT attenuation
of the mucus is generally that of soft tissue
but may be modified by its composition
(eg, high-attenuation material in allergic
bronchopulmonary aspergillosis). In the
case of bronchial atresia, the surrounding
lung may be of decreased attenuation
because of reduced ventilation and, thus,
perfusion.
89. Bronchiolitis
This direct sign of bronchiolar inflammation
(eg, infectious cause) is most often seen
as the tree-inbud pattern, centrilobular
nodules, and bronchiolar wall thickening .
90. Bronchocentric
This descriptor is applied to disease that is
conspicuously centered on macroscopic
bronchovascular bundles . Examples of
diseases with a bronchocentric distribution
include sarcoidosis , Kaposi sarcoma , and
organizing pneumonia
91. Broncholith
The imaging appearance is of a small
calcific focus in or immediately adjacent to
anairway (Fig 15), most frequently the right
middle lobe bronchus. Broncholiths are
readily identified on CT scans . Distal
obstructive
changes
may
include
atelectasis,
mucoid
impaction,
and
bronchiectasis.
92. Bulla
An airspace measuring more than 1 cm—
usually several centimeters in diameter,
sharply demarcated by a thin wall that is no
greater than 1 mm in thickness. A bulla is
usually accompanied by emphysematous
changes in the adjacent lung.
Radiographs and CT scans.—
A bulla appears as a rounded focal lucency
or area of decreased attenuation, 1 cm or
more in diameter, bounded by a thin wall .
Multiple bullae are often present and are
associated with other signs of pulmonary
emphysema (centrilobular and paraseptal).
93. Cavity
A cavity is a gas-filled space, seen as a
lucency or low-attenuation area, within
pulmonary consolidation, a mass, or a
nodule . In the case of cavitating
consolidation, the original consolidation
may resolve and leave only a thin wall. A
cavity is usually produced by the expulsion
or drainage of a necrotic part of the lesion
via the bronchial tree. It sometimes
contains a fluid level. Cavity is not a
synonym for abscess.
95. Number:
Multiple bilateral cavities would raise
suspicion for either bronchiogenous or
hematogenous process. You should consider:
Aspiration lung abscess
Septic emboli
Metastatic lesions
Vasculitis (Wegener's)
Coccidioidomycosis, tuberculosis
96. Location:
• Classical locations for aspiration lung abscess
are superior segment of the lower lobes
posterior segments of upper lobes.
• Tuberculous cavities are common in superior
segments of upper and lower lobes or posterior
segments of upper lobes.
• When a cavity in anterior segment is
encountered, a strong suspicion for lung cancer
should be raised. TB and aspiration lung
abscess are rare in anterior segments. Cancer
lung can occur in any segment.
97. Wall Thickness:
• Thick walls are seen in:
– Lung abscess
– Necrotizing squamous cell lung cancer
– Wegener's granulomatosis
– Blastomycosis
98. Wall Thickness:
• Thin walled cavities are seen in:
• Coccidioidomycosis
• Metastatic cavitating squamous cell
carcinoma from the cervix
• M. Kansasii infection
• Congenital or acquired bullae
• Post-traumatic cysts
• Open negative TB
99. Contents:
• The most common cause for air fluid level is
lung abscess. Air fluid levels can rarely be
seen in malignancy and in tuberculous
cavities from rupture of Rasmussen's
aneurysm.
• A fungous ball should make you consider
aspergillosis. A blood clot and fibrin ball will
have the same appearance.
• Floating Water Lily: The collapsed membrane
of a ruptured echinococcal cyst, floats giving
this appearance.
100. Lining of Wall:
The wall lining is irregular and nodular in
lung cancer or shaggy in lung abscess
101. Evolution of Lesion:
Many times review of old films to assess the
evolution of the radiological appearance of
the lesion extremely helpful. Examples
• Infected bullae
• Aspergilloma
• Sub acute necrotizing aspergillosis
• Bleeding from Rasmussen's aneurysm in a
tuberculous cavity
103. Centrilobular
A small dotlike or linear opacity in the center of a normal secondary
pulmonary lobule, most obvious within 1 cm of a pleural surface,
represents the intralobular artery (approximately1 mm in diameter) .
Centrilobular abnormalities include
(a) nodules,
(b) a tree-in-bud pattern indicating small-airways disease,
(c) increased vis-ibility of centrilobular structures due to thickening
or infiltration of the adjacent interstitium, or
(d) abnormal areas of low attenuation caused by centrilobular
emphysema
104. Centrilobular Emphysema
CT findings are centrilobular areas of
decreased attenuation, usually without visible
walls, of nonuniform distribution and
predominantly located in upper lung zones .
The term centriacinar emphysema is
synonymous.
105. Consolidation
Consolidation appears as a homogeneous
increase in pulmonary parenchymal
attenuation that obscures the margins of
vessels and airway walls .An air
bronchogram may be present. The
attenuation characteristics of consolidated
lung are only rarely helpful in differential
diagnosis (eg, decreased attenuation in
lipoid pneumonia and increased in
amiodarone toxicity
106. Crazy-paving Pattern
This pattern appears as thickened
interlobular septa and intralobular lines
superimposed on a background of groundglass opacity , resembling irregularly
shaped paving stones. The crazy-paving
pattern is often sharply demarcated from
more normal lung and may have a
geographic outline. It was originally
reported in patients with alveolar
proteinosis and is also encountered in
other diffuse lung diseases that affect both
the interstitial and airspace compartments,
such as lipoid pneumonia
107. Cyst
A cyst appears as a round parenchymal
lucency or low-attenuating area with a
well-defined interface with normal lung.
Cysts have variable wall thickness but
are usually thin-walled (2 mm) and
occur without associated pulmonary
emphysema . Cysts in the lung
usually contain air but occasionally contain
fluid or solid material. The term is
often used to describe enlarged thinwalled
airspaces
in
patients
with
lymphangioleiomyomatosis or Langerhans
cell
histiocytosis
;
thickerwalled
honeycomb cysts are seen in patients with
end-stage fibrosis .
108. Desquamative Interstitial Pneumonia
or DIP
Ground-glass opacity is the dominant
abnormality and tends to have a basal and
peripheral distribution . Microcystic or
honeycomb changes in the area of groundglass opacity are seen in some cases .
109. Ground-Glass Opacity or GGO
it appears as hazy increased opacity of
lung, with preservation of bronchial and
vascular margins .It is caused by partial
filling of airspaces, interstitial thickening
(due to fluid, cells, and/or fibrosis), partial
collapse of alveoli, increased capillary
blood volume, or a combination of these,
the common factor being the partial
displacement of air .Ground-glass opacity
is less opaque than consolidation, in which
bronchovascular margins are obscured.
110. Halo Sign
The halo sign is a CT finding
of ground-glass opacity surrounding a
nodule or mass .It was first
d e s c r i b e d a s a si g n o f h e mo r r h a g e
a r o u n d f o ci o f i n va si ve a sp er g ill o si s
. The halo sign is nonspecific and
ma y a l so b e ca u se d b y h e mo r r h a g e
associated with other types of nodules
o r b y l ocal pul monar y infiltr ation
b y n e o p l a s m ( e g , a d e n o c a r ci n o ma ) .
111. Honeycombing
On chest radiographs, honeycombing appears as
closely approximated ring shadows, typically 3–10
mm in diameter with walls 1–3 mm in thickness, that
resemble a honeycomb; the finding implies endstage lung disease. On CT scans, the appearance is
of clustered cystic air spaces, typically of
comparable diameters on the order of 3–10 mm but
occasionally as large as 2.5 cm . Honeycombing is
usually subpleural and is characterized by welldefined walls . It is a CT feature of established
pulmonary fibrosis . Because honeycombing is often
considered specific for pulmonary fibrosis and is an
important criterion in the diagnosis of usual
interstitial pneumonia (63), the term should be used
with care, as it may directly impact patient care.
112. Idiopathic pulmonary fibrosis
The typical imaging findings are reticular
opacities and honeycombing, with a
predominantly peripheral and basal
distribution . Ground-glass opacity, if
present, is less extensive than reticular and
honeycombing patterns. The typical
radiologic findings are also encountered in
usual interstitial pneumonia secondary to
specific causes, such as asbestos-induced
pulmonary fibrosis (asbestosis), and the
diagnosis is usually one of exclusion.
113. Infarction
A pulmonary infarct is typically triangular or
dome-shaped, with the base abutting the
pleura and the apex directed toward the
hilum.The
opacity
represents
local
hemorrhage with or without central tissue
necrosis
114. Interlobular septal thickening
This finding is seen on chest radiographs as thin linear
opacities at right angles to and in contact with the lateral
pleural surfaces near the lung bases (Kerley B lines); it is
seen most frequently in lymphangitic spread of cancer or
pulmonary edema. Kerley A lines are predominantly
situated in the upper lobes, are 2–6 cm long, and can be
seen as fine lines radially oriented toward the hila. In recent
years, the anatomically descriptive terms septal lines and
septal thickening have gained favor over Kerley lines. On
CT scans, disease affecting one of the components of the
septa (see interlobular septum) may be responsible for
thickening and so render septa visible. On thin-section CT
scans, septal thickening may be smooth or nodular , which
may help refine the differential diagnosis.
115. Interlobular septum
Interlobular septa appear as thin linear
opacities between lobules ; these septa are
to be distinguished from centrilobular
structures. They are not usually seen in the
healthy
lung
(normal
septa
are
approximately 0.1 mm thick) but are clearly
visible when thickened (eg, by pulmonary
edema).
116. Interstitial emphysema
Interstitial emphysema is rarely recognized
radiographically
in
adults
and
is
infrequently seen on CT scans . It appears
as perivascular lucent or lowattenuating
halos and small cysts
117. Intralobular lines
Intralobular lines are visible as fine linear
opacities in a lobule when the intralobular
interstitial tissue is abnormally thickened .
When numerous, they may appear as a
fine reticular pattern. Intralobular lines may
be seen in various conditions, including
interstitial fibrosis and alveolar proteinosis