Inspiratory reserve volume +

Tidal Volume +

Expiratory reserve Volume

Residual Vol +

Expiratory reserve Vol +

Tidal Volume +

Inspiratory Reserve Vol

Expiratory Reserve Vol +

Residual VOl

-Alveolar wall destruction

-dec lung elasticity

-associated with chronic bronchitis

-mostly irreversible

-major risk factor : smoking

-Inflammation of lung parenchyma, usually from infection

-Alveoli fill with fluid

SYMP: cough, +/- sputum, fevers, chest pain, dyspnea,

Signs: hypoxia, rales, bronchial breath sounds, dullness to percussion

Area of lungs no longer perfused - reduced oxygenation

Symp: dyspnea, CP, hemoptysis

Signs: Tachypnea, hypoxia, pleural rub

1. immobilization

2. Recent lower extremity trauma

3. Cancer

4. Obesity

5. Smoking

6. Pregnancy

7. OCP use

Symp: Dyspnea, chronic cough, hemoptysis, CP, weight loss

Smoking (85% of cases)

Radon

Asbestos

-Lung CA

-TB

-Cystic Fibrosis

-Endocarditis

=Chronic hypoxia

1. Pneumonia

2. Foreign Body Aspiration

3. Pneumothorax

4. CHF

Lung vol and speed of airflow on inspiration and expiration

(FVC, FEV1, tidal Vol, total lung capacity, peak expiratory flow)

Used to diagnose primarly a PE:

Also shows: pneumonia, Lung CA, Aortic dissection

++lood for iodine filling defects in pulm arteries or branches

Continuous, rotating x-ray beam

Higher resolution than normal CT

Used to assess for PE

Ventilation: inhaled radionuclide

Perfusion: IV radionuclide injection

look for V/Q mismatch

pro: Less radiation, no IV contrast

Con: may be inconclusive, doesnt show alt. diagnosis

Used to diagnos PE

Insertion of catheter under flouroscopy into pulmonary arteries followed by dye injection and xrays

-largely replaced by CT

A fibrin-degradation product released by a clot during fibrinolysis

-elevated with PE and DVT

-Sensitive but not specific

-Skip if high probability for PE

Used to identify specific organism causing pneumonia

takes 48 hrs but allows specific antibx therapy choice

Sputum culture

Fiberoptic scope to view airways, search for tumors, foreign bodies, source of hemoptysis

-can obtain biopsies

-low risk

Chest Xray

-usually portable technique heart shadow magnified

Chest Xray

compared to PA film diaphragms are higher lung vol is dec

Chest Xray

Pt. lying down on side-detect Pleural effusion

Densities of the Xray

air:

fat:

Fluid:

soft tissue:

mineral:

air: lungs, gas bubble, trachea, bronchi

Fat: Breasts

Fluid: Vessels, heart

Soft tissue: Muscle, mediastinal strux, diaphragm

Mineral: Bone, aortic calcification

1. penetration: barely see vertebral bodies, see bronchovascular struxs

2. rotation: clavicles

3. inspiration: full inspiration, see 8-10 post ribs

1. Heart and great vessels

2. lungs

3. soft tissue

4. bones

1. cardiac silhouette 1/2 less of thoracic width

2. Atrial and Ventricle borders for enlargement

3. Aortic knob, mediasyinal width, SVC

Xray: Lungs

1. lung fields

2. vasculature

3. costophrenic angle

1. Cardiomegaly

2. Cephalization of pulmonary flow

3. Interstitial edema

4. Kerly B lines

5. Fluid in fissures

6. Pulmonary edema

7. Pleural effusions

Life threatening

mediastinal shift dec venous return

may rapidly lead to cardiac arrest

Tension pneumothorax

needs emergent needle thoracotomy to release air

Collapse or incomplete expansion of part of the lung

Linear or curvilinear increased density on CXR, often associated with vol loss

-can show elevated diaphragm

Can be innocuous of malignant

more likely benign if completely calcified or if stippled or central calcification

Ct and biopsy

Well-defined opacity

++suspicious for malignancy