As Per Gill Om A

8/3/2019 As Per Gill Om A

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MARY HAZEL TE

Post Graduate Intern

12-11-11


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yDIVIDED INTO:

y

NASOPHARYNXy OROPHARYNX

y LARYNGOPHARYNX


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y NASAL PHARYNXy Lies above the soft palate

y posterior portion of the nasal cavity.

y pharyngeal isthmus: the softpalate, the palatopharyngealarches, and the posterior wall of thepharynx.

y ORAL PHARYNXy Superior: soft palate

y Anterior: oral cavityy faucial (oropharyngeal)

isthmusLateral: palatoglossalarches

y Inferior: tongue epiglottis


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y LARYNGEAL PHARYNXy superior border: epiglottis

y inferior border: cricoid cartilage

y

Posterior:arytenoid and cricoidcartilages

y Behind the opening into the larynx

y Lateral wall: thyroid cartilage and

thyrohyoid membrane


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y The true vocal cord is labeled as vocal fold, and the

false vocal cord (a mucosal fold) is labeled as

vestibular fold.

Vestibular fold fixed fold on

each side of the larynx

Vocal fold mobile fold on

each side of the larynx


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y 2 months PTC

y (+) tenderness Left upper breast

y (-) fever

y 1 month PTC

y (+) persistence tenderness Left upper breast

y Consult was done with a private physician

y

Biopsy was done ductal carcinoma


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y (+) PTB (1989) 6 months treatment

y (-) Hypertension

y (-) Diabetes mellitus

y (-) Bronchial Asthma

y (-)Food and Drug Allergies


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y (+) Breast CA sibling

y (-) Hypertension

y (-) Diabetes Mellitus

y (-)Bronchial Asthma


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y Nonsmoker

y Non alcoholic beverage drinker

y Nurse


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yAmbulatory, consious, coherent, not in

cardiopulmonary distress

Vital Signs:

BP: 110/70CR: 78

RR: 20

T: 36.7 C


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yAnicteric sclerae, pinkish conjunctiva

y No cervical lymphadenopathies

y Symmetrical Chest Expansion, Clear breath sounds,

adynamic precordium, normal cardiac rate andryhthm

y Soft, non tender abdomen, (-) goldflamms sign

y Grossly normal extremities


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Invasive ductal carcinoma,

moderately differentiated, LeftPTB 4


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y CBC

y WBC: 19.9

y Neutrophil 97

y Segmenter 95

y Stab 2

y Lymphocyte 3


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y Pulmonary tuberculosis, upper lobes, with cavity formationsand bronchiectatic and cicatricial changes

y Pulmonary nodules, right upper and lower lobes. Granulomaformation primarily considered. Neoplastic process not ruled

out.

y Aspergilloma formation, left upper lobe, considered.

y Anterior carinal and left axillary lymphadenopathies

y Thoracolumbar hypertrophic degenerative osteoarthropathy


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yANATOMY CHEST

major fissure (oblique) is

an important anatomic

landmark in the

interpretation of chestradiographs and computed

tomographic (CT) scans.

RIGHT : upper and middle

lobe

LEFT: upper and lower

lobe


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major fissures as lucent bands of relative

hypovascularity


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At the level of T3


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y Lung Abscess

y Necrosis of the pulmonary tissue and formation of

cavities containing necrotic debris or fluid caused

microbial infection

y Manifestation: fever, cough with sputum production,

night sweats, anorexia and weight loss, may develop

hemoptysis

y Chest Radiographic appearance:

y Irregularly shaped cavity with an air fluid level


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y LUNG ABSCESSy Chest Radiographic

appearance:y Irregularly shaped cavity

with an air fluid level

y CTy Abscess often is a

rounded radiolucent lesion

with a thick wall and an ill-defined irregular margin


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y Neoplasm


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y ASPERGILLOMA

y Aspergillus species

y mode of transmission: inhalation

y a saprophytic growth of Aspergillus that colonizes inthe pulmonary cavities and is usually located in theupper lobes

y Preexisting cavities, cysts, and other air - containingspaces superinfection.


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y Manifestations:

y Manifests as an asymptomatic radiographic

abnormality

y 40-60% - hemoptysis

y Less commonly: cough and fever


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y The characteristic appearance:

y Early stage:

y irregular sponge-like network filling the cavity,

y Later stage:

y one or more rounded masses within a round or ovoid

cavity

y the mass is demarcated on one aspect from the wall of the

cavity by a crescent - shaped collection of air.y In some patients, the mycelial ball moves when the patient

shifts position.


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y Treatment

y Given when patient becomes symptomatic

y Surgical resection

y Oral itraconazole

y CT guided, intracavitary treatment with amphotericin


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THANK YOU

As Per Gill Om A

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