Pneumomediastinum

Mediastinal emphysema (pneumomediastinum) occurs when there has been a disruption in the esophagus or airway and air is trapped in the mediastinum. It may result from chest trauma, endoscopy, or violent vomiting.

Identify by:

The sharp outlining of the hearts anteriour border and increased air in the retrosternal spase.

Subcutaneous Emphysema

When the pneumomediastinum is extensive, air may pass from the mediastinum into the subcutaneous tissues of the chest or neck, resulting in subcutaneous emphysema. Diagnosis of this may be made by feeling air bubbles in the skin of the chest or the neck.

Endotracheal Tube

Inserted through the patient's nose or mouth into the trachea.

Proper position is below the vocal cords and above the carina.

Figure A: Incorrect placement inferior to carina with displacement of the heart shadow.

Figure B: Correct Placement

Chest Tube

Figure shows correct placement of the chest tube in the right lung above the apex.

Inserted through the chest wall between the ribs.

allows drainage of air (e.g., pneumothorax) or fluid (e.g., pleural effusion or hemothorax) from the thoracic cavity and allows the lungs to inflate to help the patient breathe normally

IABDP( Intra Aortic Balloon Pump)

Provides mechanical support of the left ventricle.

Placed in the decending aorta and below the subclavian artery and above the renal arteries.

Central venous pressure (CVP) line

inserted via the subclavian vein, but they can also be placed through the jugular vein, antecubital vein, or femoral vein

Proper insertion places the tip of the CVP catheter in the distal superior vena cava (SVC) just above the right atrium

pulmonary artery catheter (Swan-Ganz catheter)

inserted via the subclavian vein, but other injection sites include the antecubital vein, jugular vein, and femoral vein.

Inflation of the balloon at the tip of the catheter allows the tube to float into a smaller pulmonary artery capillary.

Measures left atrial pressure. It does not enter the heart's left side but is positioned in the pulmonary artery.

Look on the left side to distinguish from CVP line

Hickman Cathetar/Port-a-cath/CVA (central venous access)

inserted via the subclavian vein. (picture inserted through tthe right jugular vein with the tip located within the superior vena cava)

Hickman catheters are open to the outside of the body with the tip of the catheter placed in the SVC.

Port-a-Cath access devices are placed under the skin, just below the clavicle.

Used for chemotherapy patients with poor peripheral venous access, subclavian vein provides ready access to the venous circulation and its blood flow return to the heart.

Cystic Fibrosis

Note: Increased lung volume resulting from generalized obstructive disease and air trapping, which is characteristic of cystic fibrosis. Also seen are areas of irregular aeration with cystic and nodular densities.

Exocrine glands are affected resulting in defects of the salivary glands, small bowel, pancreas, biliary tract, female cervix, and male genital system.

Hyaline Membrane Disease (Respitory Distress Syndrome)

affects infants and is a disorder of prematurity or infants born at less than a 37-week gestation

Notice the “ground glass” appearance of the lungs, especially in the right perihilar area.

Pnemococcal Pneumonia

Pneumococcal (lobar) pneumonia is the most common bacterial pneumonia because this type of bacteria is often present in healthy throats.

Pneumococcal pneumonia generally affects the alveoli of an entire lobe of a lung, without affecting the bronchi themselves.

Chest radiographic images demonstrate a collection of fluid in one or more lobes, with a lateral view serving to identify the degree of segmental involvement

Streptococcal Pneumonia

Radiographic appearance is localized around the bronchi, usually of the lower lobes.

Staphylococcal pneumonia

indicated by multiple large pneumatoceles (thin wall air containing cyst) in the right lung and consolidation of the left lower lobe of the lung.

characteristic sign is the spread of patchy areas localized in and around the bronchi

Legionnaires' disease

showing rounded opacities in the upper half of the right lung and lower two thirds of the left lung.

Outbreaks occur in large buildings in late summer and early fall.

Form of bacterial pneumonia

Aspiration (chemical) pneumonia

caused by acid vomitus aspirated into the lower respiratory tract, resulting in a chemical pneumonitis.

It may follow anesthesia, alcoholic intoxication, or stroke that causes loss of the cough reflex.

images reveal edema produced by the irritation of the air passages, appearing as densities radiating from hila into the dependent segments

Pulmonary tuberculosis/ TB

Circular Lesions are most commonly seen in the apical region of the chest

Fig. A, Tuberculosis (TB) of left upper lobe near left subclavicular region.

Fig. B, Old TB scarring evident in the left apical region just posterior to the clavicle of this female patient.

Tuberculosis

Cavitation in the right lung resulting from expansion of tubercular lesion.

*Still circular and in the apical region of the chest.

Miliary Tuberculosis

demonstrating small, distinct nodules throughout the lung fields.

*Look for tiny dots scattered throughout the lungs.

Chronic obstructive pulmonary disease (COPD)

group of disorders that cause chronic airway obstruction; chronic bronchitis, emphysema, asthma and bronchiectasis.

Hyperinflation of the lungs, increased radiolucence, and barell shaped chest.

Lateral demostrats blunting of kostophrenic angles.

*Watch out for similarities between cystic fibrosis

Emphysema

lung's alveoli become distended, characterized by an increase in the air spaces distal to the terminal bronchioles.

Emphysema appears radiographically as a depressed or flattened diaphragm, abnormally radiolucent lungs, and an increased retrosternal air space (barrel-shaped chest).

*Note look at the diaphragms

Pulmonary emphysema with a giant emphysematous bleb occupying the upper half of the right lung.

Pleural Effusion

It should be regarded not as a disease entity but rather as a sign of an important underlying condition.

exudates: caused by inflammation, such as in the case of pleurisy, a pulmonary embolism, or neoplasm. 

transudates: changes such as those associated with heart failure or ascites.

Pleural Effusion

Sinusitis

Air-fluid level present in the left maxillary sinus reflects sinusitis

Bronchogenic carcinoma

Bronchogenic carcinoma on posteroanterior projection indicated by large right hilar mass

most common fatal primary malignancy in the United States accounting for over 90% of all lung tumors.

four main histologic types: squamous cell, undifferentiated small (oat) cell, undifferentiated large cell, and adenocarcinoma.

Pulmonary metastases from uterine cancer demonstrate multiple lesions with characteristic “cotton ball” appearance.

Malignancy is spread to the lungs from a primary site via five different routes:
(1) through the bloodstream in hematogenous metastases,
(2) through the lymph system in lymphogenous metastases,
(3) by direct extension in local invasion,
(4) through the tracheobronchial system in bronchogenic metastases, and, rarely, by
(5) direct implantation from biopsies or other surgical procedures.