Investigations Of Lung Diseases

Front 1

Main Pulmonary diagnostic procedures

Back 1

• Thoracentesis for pleural effusion
• Bronchoscopy for aspiration
• Chest tube for pneumothorax
• Pleural biopsy for parenchymal diseases (e.g: malignancies)
• Pulmonary function tests
• V/Q test
• CT
  

Front 2

Management of cases in general

Back 2

1. We see if the patient is stable or unstable if the patient has acute symptoms and in distress, he is UNSTABLE (Low BP and tachycardia) and should start ABC
2. After ABC is done and we made sure the patient is stable we go for step D
3. Step D is common in all cases, it is simply to draw blood and do Complete blood work to get ready for step E
4. Step E is the best initial or next step to do and differs from 1 case to another
5. Sometimes step F can be done if Step E was not sufficient to make a diagnosis or failed
   

Front 3

Dx?

Back 3

There is obvious pleural effusion in the left lung that has blunted the costophrenic angle and is pushing the mediastinum and deviating the trachea to the opposite side, it can be parapneumonic if there is infection, Step E here is Thoracentesis

Front 4

How to differentiate between Transudate vs Exudate effusion?

Back 4

• Lights criteria: if 1 or more is positive then it's exudative
• If we see Gross pus then its exudative and parapneumonic effusion / or Gram stain is positive for bacteria
  

Front 5

Indications for Chest tube insertion

Back 5

• Empyema
• Complication parapneumonic effusion
• Hemothorax & pneumothorax
• Symptomatic pleural effusion
  

Front 6

Complications of Thoracentesis

Back 6

• Pneumothorax ( if patient had aspiration )
• Bleeding
• Infection
  

Front 7

What type of dullness is found on Pleural effusion?

Back 7

Stony Dullness

Front 8

If the patient came with Pleural effusion signs and symptoms but he was stable and was chronic, what test should be done in this case?

Back 8

• Thoracentesis won't be helpful here because the situation is more chronic
• Here we do a Pleural biopsy to see for malignancies or granulomatous diseases / TB
  

Front 9

Dx?

Back 9

• History of patient choking suddenly while eating or a baby that swallowed a coin/toy
• This patient is UNSTABLE --> ABC
• Here we should do Bronchoscopy to locate the aspirated material and also to remove it (Plan E)
  

Front 10

Indications of Bronchoscopy

Back 10

• Positive sputum cytology
• Abnormal CXR
• Unexplained cough
• Suspected lung cancer
• Hemoptysis

Anything that can indicate a history of aspiration

Front 11

Spirometry

Back 11

• FVC > 90% of predicted
• FEV1 > 90% of predicted
• FEV1/FVC ratio > 0.7

Decreased in COPD

Normal or increased in Restrictive diseases

Front 12

Lung volumes

Back 12

• TLC > 90% predicted
• RV > 90% predicted

Decreased in restrictive lung diseases , diagnosis of air trapping

Front 13

Diffusion Capacity ( DLco )

Back 13

Decrease indicated loss/damage to gas exchanging surfaces in the lung :

• Emphysema, to distinguish it from Bronchitis or Asthma
• Interstitial lung disease
• Pulmonary vascular disease
  

Front 14

Respiratory muscle strength

Back 14

Not very imp but, Guillain-Barre can cause ascending motor paralysis and cant affect breathing

Front 15

What disease can cause 4 pathologies that can be seen on PFT and spirometry and Disrupted diffusion capacity?

Case from the doctor

Back 15

Interstitial lung diseases from autoimmune or granulomatous diseases , Classic example is Sarcoidosis

Front 16

Indications of HRCT

Back 16

Used to evaluate lung structure in high details for:

• Suspected interstitial lung disease
• Characterization of ILD
• Characterization of solitary pulmonary nodules
• Diagnosis bronchiectasis
  

Front 17

Dx?

Back 17

This is a very advanced case of pulmonary fibrosis, sometimes doctors neglect it and don't auscultate correctly at first patient visit and miss it! , on auscultation, we should hear coarse crackles, however, we till the patient to cough hard to clear secretions because it might be pseudocrackles from the secretions

Front 18

CT Angiography ( Spiral )

Back 18

• Used for critically ill patients
• Children
• Less volume of I.V contrast

It is the best modality for detecting Pulmonary embolus

Front 19

When do we do V/Q test?

Back 19

If we suspect PE and the patient has contraindications to CTA ( Pregnant lady )