Unit 4 - Wk 7 Anatomy

Front 1

Back 1

Pulmonary Edema w batwing/butterfly apperance
Note the sparing of the peripheral lung fields

Front 2

Back 2

NODULAR PATTERN OF MILIARY TUBERCULOSIS. Multiple small (1-3 mm)
nodules are distributed diffusely throughout the lungs. Notice the extension
into the periphery of the lung fields. Milia (Latin milium, grain of millet seed or
wheat).

Front 3

Back 3

LINEAR OPACITIES OF NONSPECIFIC INTERSTITIAL PNEUMONIA. This PA
view shows coarse reticular (linear) opacities distributed more in the lower lungs
than in the upper areas.

Front 4

Back 4

LYMPHANGIOLEIOMYOMATOSIS. Note the presence of thin-walled cysts in
the lungs. Latin lympha = water + Greek αγγειον aggeion vessel +
Greek λειο leio = smooth + Greek μυς mys = muscle + Greek ωμα oma = tumor
+ osis = condition of. Proliferation of the smooth muscle in the wall of the
lymphatic vessels.

Front 5

Back 5

HONEYCOMBING PATTERN IN THE USUAL INTERSTITIAL PNEUMONITIS
OF SCLERODERMA. Thick walled cysts are seen in the bases of both lungs. Notice
the dilated esophagus (e).

Front 6

Back 6

Granuloma w/ caseation (tissue changes into dry, amorphous mass resembling cheese)

Front 7

Back 7

Sarcoidosis; absence of caseation

Front 8

Back 8

PULMONARY ALVEOLAR PROTEINOSIS. CT. Interlobular interstitial thickening
(reticular opacities). Thickened interlobular septa (hexagons) and a fine reticular
pattern are visible within the lobules.

Front 9

Back 9

PULMONARY ALVEOLAR PROTEINOSIS. Note the predominance in the right
middle and both lower lobes. Note the absence of enlargement of the heart
shadow.

Front 10

A 23 year-old man in
good health presented
with left-sided chest
pain of sudden onset
and dyspnea. The
pain was sharp in
character, and more
severe on inspiration.
physical exam showed
decreased air entry
in the left upper chest,
which was hyper-
resonant on percus-
sion.

Back 10

Spontaneous Pneumothorax; CHEST RADIOGRAPH. Note the hyperlucent left lung field. Note the collapsed
left lung (arrows).

Front 11

A 55 year-old non-smoker
presented with intermittent
hemoptysis and purulent
sputum for 1 year. The
patient had no fever.
Physical examination
demonstrated finger
clubbing and coarse
expirations over the left
lung base.

Back 11

PA CHEST RADIOGRAPH
showing clusters of
cystic spaces containing
air-fluid levels (arrows)
in the left mid and lower
zones due to retained
secretions in dilated
bronchioles in bronchi-
ectasis.

Front 12

Back 12

CYSTIC BRONCHIECTASIS. AXIAL CT
IMAGES. Upper panel. Note air-fluid
levels in bronchioles that have undergone
dilatation (white arrow).

Front 13

Back 13

Lower panel. Note the “tram track” sign
(arrows) of bronchiectasis due to the
dilatation of bronchiole.

Front 14

Back 14

BRONCHIECTASIS AXIAL CT THORAX. Note the cystic dilatations of the bronchioles.
Note the signet ring sign (arrows) representing the enlarged bronchiole and its adjacent
Vessels.

Front 15

Back 15

LEFT LOWER LOBE ATELACTASIS. A triangular opacity is seen behind the heart
on the posteroanterior view (arrowheads). The heart is shifted to the left (arrow).

Front 16

Back 16

ATELECTASIS RIGHT UPPER
LOBE. CT. Upper figure: the
oblique fissure is displaced
forwards (arrowheads). Lower
figure: the horizontal fissure
is displaced around a large central
mass (larger black arrowheads).
The remaining right middle lobe
(large white arrowheads) and the
right lower lobe (posteriorly) are
hyperinflated and their vessels
spread apart

Front 17

Back 17

END-STAGE LUNG DISEASE WITH HONEYCOMBING caused by rheumatoid
lung with diffuse fibrosis. Posteroanterior chest radiograph showing multiple
cystic spaces.

Front 18

Back 18

High resolution CT demonstrates subpleural honeycomb spaces
that are more marked on the right side

Front 19

A biopsy of the solitary pulmonary nodule was performed. The results are shown
above. The biopsy revealed the presence of small dark blue cells with minimal
cytoplasm.

Back 19

Small cell carcinoma


Small cell carcinomas are composed of round to fusiform cells with scant
cytoplasm. These are neuroendocrine tumors derived from the neuroendocrine cells
of the lung, so they may express a wide variety of polypeptide hormones including
parathyroid hormone-related peptide, antidiuretic hormone (ADH), and adreno-
corticotrophic hormone (ACTH)(resulting in Cushing’s Syndrome).

Front 20

Which nerve carries information from the carotid sinus?

Back 20

Glossopharyngeal

Front 21

Which nerve carries information from the aortic arch?

Back 21

Baroreceptors for vagus

Front 22

Which nerve slows down the heart and which kind of receptors does it use?

Back 22

Vagal efferents from the nucleus retroambigus; it uses M2 muscarinic cholinergic receptors

Front 23

A 75 year-old male diabetic was brought to the emergency department following
a stroke. The patient exhibited hoarseness and dysphagia. Which nucleus was damaged?

Back 23

Nucleus ambiguus; Denervation of the intrinsic muscles of the larynx results in hoarseness (dysphonia).
Denervation of the muscles of the soft palate, pharynx, and esophagus account
for dysphagia. All of these muscles are innervated by neurons that have their
cell bodies in the nucleus ambiguus. This patient had a lateral medullary syndrome
of Wallenberg which was due to interruption of the posterior inferior cerebellar artery
(PICA). He had other symptoms as well.

Front 24

A 54 year-old woman secretary presents with insidious onset of shortness of breath,
chest pain, and fatigue.

Back 24

The radiographic and pathological findings are consistent with sarcoidosis.
Asthma would not produce the radiographic findings, nor would it produce such
a biopsy result. The pathological findings of a non-caseating granuloma are
consistent only with sarcoid.

Front 25

A 45 year-old man presents with a persistent productive cough. The cough has
been present for several weeks, but the patient has recently noted that his sputum
Has assumed a greenish color. The patient notes that he has had a productive
cough for the past several years. He has a 50 pack-year history of cigarette
smoking. The man is febrile (101o F). Coarse rhonchi and wheezes can be
appreciated bilaterally. The patient’s radiograph fails to demonstrate the presence
of any masses. No hyperlucency of his lung fields, barrel chest or flattening of the
diaphragm are noted. Diagnosis?

Back 25

The diagnosis of chronic bronchitis requires the presence of chronic productive cough
of at least three months duration. The chronic bronchitis is consistent with the history
of cigarette smoking, and history of excessive mucus production over many years.
The green sputum and fever suggest the presence of an infection superimposed
over the chronic bronchitis.

The smoking history is consistent with bronchogenic carcinoma. However, the absence
of hemoptysis, weight loss and the absence of radiographic masses suggest that it is not
present.

Front 26

Emphysema Characteristics

Back 26

Barrel chest, hyperlucency of the lungs

Front 27

Hemoptysis, weight loss, and radiographic mass

Back 27

Bronchogenic carcinoma

Front 28

Pink Puffer

Back 28

Emphysema

Front 29

Blue Bloaster

Back 29

Chronic Bronchitis

Front 30

Stimulation of which receptor is responsible for the sputum seen in chronic bronchitis?

Back 30

M3 Muscarinic Cholinergic Receptor; cause glandular secretions

Front 31

Where is the location of the cell body of the neuron whose stimulation directly
causes the production of mucus involved in this patient’s sputum?

Back 31

Pulmonary Plexus; autonomic plexus formed from pulmonary branches of vagus nerve and the sympathetic trunk.
It supplies the Bronchial tree.

Front 32

Where are the cell bodies of the sensory neurons in the larger airways whose
stimulation causes increased mucus production and bronchoconstriction?

Back 32

Inferior vagal (nodose) ganglion; It is chiefly visceral afferent in function concerning sensation of heart, larynx, lungs and alimentary tract from the pharynx to the transverse colon.

Front 33

Where are the cell bodies of the sensory neurons in the bronchioles whose
stimulation causes mucus secretion and bronchoconstriction?

Back 33

Dorsal root ganglion; The cell bodies of these neurons are located in the dorsal root ganglia from T1 to
T6.

Front 34

Profuse diaphoresis is directly produced by increased activity in a type of
neuron. Where is the location of the cell body of this neuron?

Back 34

Sympathetic paravertebral ganglion

Front 35

In terms of the patient’s diaphoresis, increased activity of which type of receptor
would be noted in this patient?

Back 35

M3 muscarinic cholinergic receptor; causes glandular secretions

Front 36

Orthopnea

Back 36

More comfortable sitting up than lying down

Front 37

Pt with increased sympathetic hyperactivity and hypertension which fluctuated in an episodic fashion.

Back 37

Pheochromocytoma; tumor of the suprarenal gland which secretes NE and E in an episodic fashion

Front 38

A two year-old female child is brought to the emergency department because of a “spell”.
Her mother complains that the child has trouble breathing when she plays. She further
relates that the child has difficulty in feeding. Upon physical examination, the child is
moderately cyanotic and small for her age. She squats during the physical examination.
She has clubbing of her fingers and toes. A heart murmur is present. Blood analysis
demonstrates the presence of polycythemia. Her radiographic study is shown below

Note boot shaped heart and right sided aortic arch

Back 38

Tetralogy of Fallot; The four components of the tetralogy of Fallot are pulmonary stenosis due to
obstruction of the right ventricular outflow tract); ventricular septal
defect, dextroposition of the aorta (overriding aorta), and right ventricular
hypertrophy.

Cyanosis is often a first sign but is often not present at birth

Front 39

Back 39

TETRALOGY OF FALLOT. LEFT. Drawing of the heart. Note the small pulmonary
arterial trunk (pulmonary stenosis) and a large aorta resulting from unequal partitioning
of the truncus arteriosus. Note hypertrophy of right ventricle and persistent ductus
arteriosus. RIGHT. Coronal section of the heart. Note the pulmonary valvular stenosis,
ventricular septal defect (VSD), overriding aorta, and hypertrophy of the right ventricle.
This case also presents infundibular stenosis.

Front 40

Back 40

Lung lymphatics

Note how both the superficial and deep lymphatic plexuses drain to the bronchopulmonary nodes located at the hilium of the lung

Front 41

Back 41

Bronchopulmonary nodes of the superior and middle lobes of the right lung drain to the right superior tracheobronchial nodes;

Bronchopulmonary nodes of the right lower lobe drain to the right inferior tracheobronchial nodes

Front 42

Why is the left lower lobe lymphatics feeding to both the right and left superior tracheobronchial nodes clinically dangerous?

Back 42

Cancers involving the left lower lobe carry a worse prognosis than those involving other lobes, bc youd have to deflate both lungs to remove the tracheobronchial lymph nodes on both sides

Front 43

Back 43

Lymphatic drainage of the larynx and trachea

Front 44

Back 44

Lymphatic Drainage of the LArynx and Trachea

Front 45

Kerley A vs B lines

Back 45

A: radiate out from hila to periphery of lung
B: shorter lines that contact and are perpendicular to the lateral pleural (pulmonary edema)

Front 46

Back 46

Kerley B Lines; Note that these occur in the lower
lobe, and are short and fine. Note
that these lines reach the pleural
edge and are perpendicular to the
lateral margin of the pleura; seen in pulmonary edema

Front 47

Note the redness of the skin, swelling
of the head and neck, engorgement of the neck veins, and the development of collateral circulation in the veins of the chest wall.

Back 47

Superior Vena Cava Syndrome due to obstruction of the superior vena cava by a bronchial carcinoma;