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Production Transcript for LECTURE 3- RESPIRATORY SYSTEM PART 2.Movie.640x480.mp4
[00:00:00] >> Jennifer Little: Okay, welcome back to
Part Two. I don't know if we'll get into exciting stuff but I was really hoping to get you interested
to listen to part two of the lecture. But we're going to continue on a little bit more
with some inflammatory diseases, and then we'll get into abscesses, and then a little
bit more infection, and then we'll get into carcinomas of the chest. Pneumoconiosis now
this is a prolonged occupational exposure to certain air particles that can cause severe
pulmonary disease and a spectrum of radiographic findings. Okay, these inhaled particles can
cause a chronic inner [Inaudible] inflammation that leads to pulmonary fibrosis and diffuse,
non-specific radiographic pattern of linear [Inaudible] and nodule throughout the lungs.
[00:01:01] You have three main types here, you have your
silicosis, your anthracosis, and your asbestos. Now your silicosis is often in the upper lobes
and the lung prank ma, and you will see multiple, well-defined, scattered nodules of uniform
density. I should probably -- I think it would be nice to write that down for you all. Upper
-- upper lobes. And you'll see multiple well-defined scattered nodules. You have anthracosis or
black lung disease, and this is found throughout the entire set of lungs. It looks like multiple,
less well-defined nodule of granular density. [00:02:03]
See if we can get another one here. We'll get this one. So this really is throughout
the lungs you have multiple -- less -- really well defined, does that make sense? It's less
well defined. You have a little bit of definition and they are of granular density. They have
asbestos, and this is found in the plural lining and causes a plural thickening, an
tends to have calcified plaques. So I'll put asbestos here underneath. Again, this is found
-- why don't I write that, we'll write plural lining here for you. And then you have obviously
your plural thickening with calcified plaques. [00:03:06]
Now we're going to get to some pictures of that here in just a second. Okay, sore this
is silicosis, have multiple CT images, but you're going to notice again, pretty well
defined, they're scattered nodule of uniform density, and as you can tell they're all pretty
much in the upper lobes. Get my little pen out. You can tell we're in upper lobes. Look
at the level of the heart, we're hitting about halfway through, obviously. This is on the
apexes here of the chest, the small lungs, you're not down -- you haven't seen any bit
of the liver, the diaphragm down towards the bottom of the upper lobes. They're relatively
well defined, this probably isn't the best image, because I think it's a little bit bigger.
[00:04:08] Lose a little bit of this resolution here,
but it's the best I can find that really showed the well-defined uniform density, the same
density throughout, they're in the upper lobes, we can go on for days and days I'm sure, on
this patient, on all of the scattered nodules that they have. Here we have anthracosis.
Okay, you have some less well-defined nodule. But these are going to be located throughout
the lungs. So you have some in the upper part portion, you have some in the lower portion.
And then we have here your asbestosis. Now look again at your plural thickening down
here. And you can see where the arrows are pointing, it's a little hard to tell, but
if you had your lights off or if I were able to adjust the contrast and density of this
image, you could see here where these arrows are pointing -- sorry, I'm trying to draw
a nice arrow for you -- you can see the calcified plaques.
[00:05:21] So if you see just fluid down at the bottom
without calcified plaques and this is not an occupational exposure , it's going to be
plural effusion. Because when the patient lays down all the fluid is going to go you
know, they lay down in the prone position, all the fluid goes to the posterior part of
the chest wall. You'll tend to have a nice fluid level. That's just plural effusion.
We have an occupational exposure, then you're going to turn around, you're going to also
see the calcified plaques. You know, blends a little, let's see. I'll just try to erase
those again so you can seat them a little bit better, the calcified plaques along the
plural lining. So that's your difference between plural effusion, how can you tell, is this
asbestos or plural effusion. One might be plural effusion is more common, but you're
not going to have the calcified plaques. [00:06:28]
Lung abscesses, again, still inflammatory disease, we could probably go on for days
and days on that. Now a lung abscess is a localized area of necrotic surrounded by inflammatory
debris. So this can result from periodontal disease, pneumonia, neoplasms can cause this,
or any other organism that can invade the lungs. Lung abscesses are more common in the
right lung because, again, remember on Slide Two in Part One of the Week Two, Lecture Three
lecture, it's got that vertical orientation of the right bronchi, and remember it's larger,
it has a much wider space for the particles to go into. The critical condition can manifestations
of lung abscesses include fever, you have cough, very foul smelling sputum and expectoration,
thank you, of the [Inaudible]. [00:07:34]
CT is much better at visualizing the abscess because you can see the thick walled capsule
and you can see the air fluid levels within. So if there's pus within the abscess it is
termed the edemas. And if you remember a few slides back, that [Inaudible] is accumulation
of pus within the plural cavity caused by some type of lung infection. the abscess really
is resistant to treatments, but they need -- they need to drain if there's enough fluid
in it or eventually reset the entire abscess, if it doesn't heal itself. And if you have
multiple abscesses they just need to remove an entire segment or a lobe of the lung. Here's
an image of a lung abscess. These are not attached to the bronchi, so these can be found
throughout the lung, upper or lower lobes, excuse me.
[00:08:39] You see it's a little bit thicker border.
Again, you can see the pus within, you can see the air fluid levels within the lung abscess.
The thick walls around it. We'll talk about plural effusion, which I kind of did a little
bit with the asbestos, so I want to make sure that you don't think this patient has asbestos,
it's just plural effusion which is probably a lot more typical, more common for you to
see within your CT rotation, and plural effusion really results when excess fluid collects
within the plural cavity, and it's frequently due to pulmonary or cardiac disease. It's
not really be regarded as a disease, more of a sign of an underlying condition, and
plural effusion is typically caused by the inflammatory pulmonary disease such as pulmonary
embolism, and those types of plural effusions are termed ex-o dates, okay?
[00:09:54] So ex-you dates, again, is when the plural
effusion is caused by some type of inflammatory pulmonary disease such as a pulmonary embolism.
And when plural effusion results from micro vascular changes, such as those associated
with cardiac disease, like heart failure, these are terms transudates, okay? So exudates
and transudates, and exudates, one last time, inflammatory pulmonary disease, I should probably
-- I'll give you -- for inflammatory, pulmonary diseases. And give me another box here. Hmm,
inflammatory cardiac diseases. [00:11:01]
And they're briefly touched on hemo thorax. At the very beginning we talked about tubes,
lines, and catheters, which are hemo thorax is when you have blood in the plural effusion,
and that's usually accompanied by a chest tube which you can take into the MR, we know
that they are typically MR safe and this drains the blood and the fluid from the chest wall.
So the most common reason to have a chest tube is this hemo thorax.
[00:11:45] [ Background sounds ]
[00:11:57] >> So it's radiographic appearance is -- chest
x-rays are obviously the most common radiograph ordered for this because they can order the
cube views where the patient lays on their side and you can image, you can see the fluid
drain to one side or the other. But CT may also be useful to evaluate the lung parenchyma
and search for the reason for the effusion, you know, if there's an abscess, there's a
pneumonia. Some of those things can typically be obscured by the fluid. That's funny, that
says blurred. There we go. So here, blood [Inaudible] of a normally [Inaudible] angle,
typically, grabbing my pen, a [Inaudible] angle, if this is it, all of this would be
dark from the lung. And you can see that there's fluid in there, that's what they call [Inaudible]
of a normally sharp [Inaudible] angle between the diaphragm and the rib cage, and you'll
have a concave level of fluid up here, because it's up against the lobe of the lung.
[00:13:12] But then when you see over here on CT as the
patient lays again prone you'll see the fluid usually fall to the back. So remember again,
asbestos versus plural effusion, you'll see fluid lining the lobes of the lung. But if
it's asbestos you're going to more than likely the patient already knows because they got
the occupational exposure. But you'll see the calcifications, here we don't see any
type of calcifications, we just see fluid and this is -- actually, this plural effusion
is due to this refracture right here, it's a little bit of an incidental finding. So
there's a reason for the plural effusion, it's not necessarily a disease, remember,
it's a result of an underlying condition. So sinusitis, your book classifies, like,
it says sinusitis into the respiratory system, but that's fine, it's probably better to put
it in now than to put it in the neuro system later, when you're talking a lot about the
brain and the central nervous system. [00:14:22]
So it's a nice place for it , but sinusitis really is an infection and inflammation of
the peri nasal sinuses, and that in turn leads to sinusitis, most common cause of acute sinusitis
is due to some type of bacterial infection. So sinusitis often allows for acute -- often
follows, I'm sorry, an acute viral infection of the respiratory tract, and the ethmoid
sinuses tend to be the most commonly effected because of their proximity to the nose. But
we most commonly feel, I think, as a patient if you have sinusitis you'll feel it a lot
in the frontal sinuses as well as in the axillary sinuses. Symptoms typically include nasal
discharge. You have patients with a lot of headaches because the pressure within the
sinuses, you do have tenderness over the nasal cavities.
[00:15:23] If you press on the maxillary sinuses those
would be really tender. Patients could have a tooth ache, and really a general feeling
of vagueness, you know, all over, like, a vague all over body discomfort from sinusitis.
X-ray, if you can see what you need to see in x-ray that's great, but typically, CT tends
to be the modality of choice. And it's really a clear demonstration of the swollen mucus
membranes, and can really better define a degree of sinusitis. So I would be surprised
if you didn't come across multiple sinus CTs while you're in your rotation. Now on the
other hand, we could -- we do a few sinus series MMR, and it's not as common, but for
someone that's had a lot of CT or they have their reasons to want to do MR, maybe to extend
the degree a little bit more under MR, we don't use contrast typically for sinus infections.
[00:16:36] We see the mucosal thickening, we don't necessarily
need it. And it's just some thinner slices pretty much through your sinuses. So it is
-- you do need to know where your sinuses are located because if you're doing CT you
don't need to over radiate the patient because you need to cover the whole grain. You only
need to cover the sinuses and MR. If you can limit the number of slices then you can decrease
the scan time, and that's ultimately what we want too. So here CT was pretty standard
maybe five years or more ago to do two CT scans to the sinuses. One is with the patient
in a supine position, and you can tell they're in the supine because look at the fluid levels
here within this maxillary sinus. It falls down and it falls posterior to the sinus,
but you can see the thickening. [00:17:42]
This is where you can see any kind of deviated septums here, and those can get clogged. And
so we -- those -- that's what we'd typically do, you'd do a supine but you would also do
a prone, where the patient would lay on their stomach, extend their chin all the way out,
probably one of the most uncomfortable positions to lay in. But you can see the level of the
mucus drop down. So I'm thinking of all my sites that we have, we have 13 or 14 clinical
sites, I believe we only have USE that does sinuses in this position still, this supine
and the prone position. Typically, I think radiologists can see what they need to see
in the supine position, if there's fluid, whether you're up right or supine you can
see the fluid, and it will just reconstruct it in different ways as needed. You can see
all of your frontal sinuses over here again, pretty full.
[00:18:45] I would say full of gunk, because I don't
know what else to really call it, it is gunk. So if you do get the CT rotation over at USC,
you will see them do both ways. But if you don't see them do both ways that's probably
the more typical, because the more typical example, because you're going to have to radiate
the patient twice to get technically the same information. So here, you know, it's funny,
sinusitis is most commonly -- it's really an incidental finding when we do a T 2 image
of the brain. A T 2 image of the brain is a routine scan done during a normal brain
MRI. Here we can see the -- this is the right maxillary, I mean the left maxillary versus
the right --