1 - Respiratory Idone.

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Respiratory Pathology I

Lungs, Clinical Features of

Lung diseases,

Terminolo ies Atelectasis


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Lung-1

Primary respiratory infections are common inclinical practice

Cigarette smoking, air pollution and other

environmental inhalants have caused asthma,chronic bronchitis and emphysema to rise

Lung cancer is the most common lethal visceralcancer in men and women.

Lungs are secondarily involved in almost every

dying patient (some degree of edema, atelectasisor pneumonia)


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Lung-1

Normal Lung

Clinical features of lung diseases

- Symptoms

- Signs

- Lab. investigations

-Imaging studies

Terminology of Lung Disease


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Normal Lung

Function: exchange of gasesbetween inspired air and blood Right lung - 3 lobes

Left lung- 2 lobes

Double arterial supply to lungs(pulmonary and bronchial arteries)


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Clinical symptoms of lung

disease Dyspnea - aware, obstruction

Cyanosis - >5-gm / dl reduced Hb

Chest pain- parietal pleura


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Clinical symptoms of lung

disease Cough - dry, productive

Sputum - purulent, frothy

Hemoptysis - Tb, Carcinoma, Left

heart failure


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Asymptomatic

A 22 year old man was screened before the start ofmilitary service

He was asymptomatic, otherwise well, non-smokerand no pulmonary symptoms

Chest radiograph showed a mass in the left upperlung


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Follow up

Pathological examination of tissue obtained by means ofpercutaneous biopsy revealed cartilage and spindle-cellmesenchymal stroma, confirming the diagnosis.

Two years later, the patient remains well, and the tumor isunchanged.Pulmonary hamartoma is a benign lung tumor that shouldbe considered when an incidental solitary pulmonary

nodule is identified.Popcorn calcifications within a well-circumscribedpulmonary nodule are highly suggestive of pulmonarychondroid hamartoma. NEJM 2009


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Clinical signs of lung

diseasePhysical Examination of Chest:

movement - symmetry

accessory muscles of respiration

palpation

percussion auscultation


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Investigations:

Sputum, BAL, Pleural fluid

Microbes; culture and sensitivity

malignant cellsFNAC

CT guided biopsy

Pleural biopsy/Pleural tap

VATS wedge resections(video assisted thoracicSurgery ,VATS)


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Imaging

Chest X- ray

CT scan

MRI

Bronchography

Arteriography


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Investigations

Bronchoscopy:

- visualize,

-cytology

- biopsy

- broncho alveolar lavage


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Investigations

Ventilation scan

Perfusion scan

V/Q ratio


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Tests of pulmonary function

Arterial blood gases (pCO 2 , pO2 )

Spirometry - Ventilatory function- Total Lung Capacity

- Vital Capacity

Residual Volume


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Tests of pulmonary function

Forced Vital Capacity - FVC

Forced Expiratory Volume in firstsecond - FEV1

FEV1 : FVC ratio (normal > 75%)


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Interpreting Spirometry -

definitionsFVC (forced vital

capacity)

The maximum volume of air which can be

exhaled or inspired

FEV1 (forced

expired volume

in one second)

Volume expired in the first second of maximal

expiration after a maximal inspiration and is a

useful measure of how quickly lungs can be

emptied , normal if >80%

PEFR

(peak flow)

Measured in L/min by peak flow meter and L/sec

on pulmonary function testing

FEV1/FVC Ratio of the volume in one second to total

volume

COPD if


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Severity of COPD

Based on Spirometry

FEV1/FVC FEV1

Mild 80%

Moderate 80% and >50%

Severe


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Respiratory failure

Fall in pO 2

Rise in pCO 2


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AtelectasisIncomplete expansion (neonatal atelectasis)

or

Collapse of previously inflated lung

producing relatively airless parenchyma

Types

Resorption, Compression, Contraction


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Atelectasis


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Resorption Atelectasis

Complete obstruction of an airway, whichleads to resorption of oxygen trapped inthe alveoli

Caused by excessive secretions (mucousplugs) or exudates with in smaller bronchi

Often found in bronchial asthma, chronicbronchitis, bronchiectasis, postoperativestates, and aspiration of foreign bodies

Mediastinum shifts towards atelectaticlung


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Compression Atelectasis

Compression atelectasis: pleural cavity ispartially or completely filled by fluid

exudate, tumor, blood, or air

Tension pneumothorax Cardia failure Pts. develop pleural effusion

Abnormal elevation of the diaphragminduces basal atelectasis

Mediastinum shifts away from the affectedlung


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Contraction Atelectasis

Contraction atelectasis: local orgeneralized fibrotic changes in thelung or pleura prevent full

Expansion.Contraction atelectasis is irreversible.The other types of atelectasis areReversible.

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