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AIR WAY DISEASEImaging aspect
Tonny K.Sudarmo
Bag.Radiologi FKUI.
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GROUP
1. Air Space Enlargement.
2. Alveolar Filling disorders.
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AIR SPACE ENLARGEMENT
Definition:
An increased in air space size as
compared with airspace of normal
lung.
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AIR SPACE ENLARGEMENT
Simple air space enlargement.Congenital :
Congenital lobar over inflation
Down Syndrome
Acquired:
Secondary to loss of volume
Associated with aging
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Emphysema
Centroacinar
Paraacinar
Distal emphysema
Bullae
Airspace enlargement with fibrosis
Bronchiectasis
Irregular or paracicatrical emphysema
Honey combing ( end-stage) lung
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Air space enlargement
Emphysema
Bronchiectasis
Bullae
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EMPHYSEMA
Characterized by:
Enlarged of the air space distal to the
terminal bronchiole, with destruction of their
wall, and without obvious fibrosis.
Parenchyma distal to the terminal
bronchioleacinus or primary lobe. Large cystic area or bullae develop ( bullous
emphysema)
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TB = Terminal bronchioles
RB = Respiratory bronchiolesA = Alveoli
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A. Acinus
B. Centrilobular
C. Panacinar
D. Paraseptal
E. irregular
AD = Alveolar Duct
AS = Alveolar Sacs
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Type.
a. . Centrilobular
- Destruction is limited to the central part of the
lobule.
- Peripheral alveolar ducts and alveoli may
escape unscathed.- Apex upper lobe, spreads down as the disease
progress.
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Centrilobular
Early
Advance
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Normal acinus Centri acinar
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Type
b. Panlobular.
- Show distention and destruction of the whole
lobule.
- No regional preference, or is more common in
the lower lobes.
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Normal
Panacinar
Panlobular
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Type
c. Distal (paraseptal) emphysema.
- Alveolar duct and sacs are dominantly involved.
- Found deep to pleura and adjacent lobular septa.
- Associated with spontaneous pneumothorax.
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Emphysema
CT observation
- Decreased in lung attenuation.
- Decreased in the diameter and number of
pulmonary vessel
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Emphysema
Technique :
Using High Resolution CT
- Collimation 1 mm.
- High spatial frequency reconstructionalgorithm.
- Scan interval 10 mm.
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Emphysema
The Image
Window level - 600 to - 700 H
Window width 1500 to 1700 H.
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Centriacinar Emphysema
CT Findings :
- Focal area of decreased attenuation without
discernable wall.
- Focal arteriole at or near the center of
emphysema ( interior vessel)
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Centriacinar
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Panacinar Emphysema
CT Findings :
- Large area of decreased attenuation with poorly
defined lateral margin.
- Pulmonary vessel decreased in diameter and
number.
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Panlobular emphysema
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Panlobular emphysema
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Distal Acinar Emphysema
CT Findings :
- Focal area of decreased attenuation in the
sub pleura areas with upper lobe predominance.
- Thin wall and no interior vessel.
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Paraseptal
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Distal
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Paraseptal emphysema
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Paraseptal emphysema
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Bullae
A bulla is an airspace in the lung more
than 1 cm in diameter in the distended
state.
Cl ifi ti
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Classification
Type I :
- Sub pleural and are found in the absence of emphysema.- Multiple and very large.
- Compromise lung function by compression of the
remaining normal lung.
Type II :- Sub pleura but associated with emphysema in the rest of
lung.
Type III :- Located within the lung rather than sub pleural.
- Also associated with emphysema in the rest of the lung.
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Bulla emphysema
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Bulla emphysema
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BRONCHIECTASIS
Defined as permanent abnormal dilatation
of bronchi, but bronchial dilatation also
occur in chronic bronchitis.
Not frequently bronchiectasis and
emphysema occur together
REID CLASSIFICATION
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REID CLASSIFICATION
Group 1: Cylindrical bronchiectasisBronchiole minimally dilated
All bronchi and bronchioles are occluded by purulent material.
Branching bronchial tree is within normal limits.
Group 2: Varicose Bronchiectasis
Characterized by localized bulbous areas of bronchial dilatation.Reduced visible bronchial subdivision from the hilum to periphery.
Group 3: Saccular of cystic bronchiectasis
Grossly distorted bronchi with large saccular terminations filled withpurulent secretion.
Number of bronchial division from hilus to periphery is greatly
reduced.
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CT DIAGNOSIS OF BRONCHIECTASIS
Primary signIdentification of enlarged internal bronchial diameter
Failure if an airway to taper while progressing toward
periphery.Identification of airway in the extreme lung periphery
Indirect sign
Bronchial wall thickening
Mucus impaction
Focal air trapping
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Dilated bronchus run parallelto the plane of
CT Section
Tram track ( Cylindrical Br.)
Beaded appearance ( Varicose Br.)
String of cyst or cluster of cyst ( Cystic Br.)
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Dilated bronchus run perpendicular
to the plane of CT section
Signet ring sign :
Ring structure with internal diameter larger
than that of its accompanying pulmonary arterybranches.
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Mucus impaction seen as:
Nodular density(in cross section)
Tubular or branching structure
- Beaded, glove finger, Y or V shaped
(in the plane of the section)
Air trappingseen as :Mosaic attenuation
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SPECIAL TOPIC
CHRONIC OBSTRUCTIVE LUNG DISEASE.
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Common pathophysiologic abnormality
Persistent increase resistance tobronchial air flow
A. Lumen is partly blocked
B. Wall is thickened
C. Abnormality is outside
I d i
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Increased resistance
Condition:
1. Inside the lumen
occluded by excessive secretion, edema,
aspiration, foreign bodies
2. In the wall of the airway
Loss of elastic recoil, hipertrophic mucous
gland, inflamation/edema.
3. In the peribronchial regionLoss of radial traction, edema, externalcompression.
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Chronic Obstructive Group:
1. Pulmonary Emphysema
2. Chronic Bronchitis
3. Asthma
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Cardinal Symptoms :
1. Cough
2. Dysnea
3. Wheeze
Air flow :
1. Forced expiratory volume in
one second ( FEV1)
2. Forced Vital Capacity (FVC)
Lesion associated with chronic airflow obstruction
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Lesion associated with chronic airflow obstruction
BronchiMucous gland enlargement
Smooth muscle hyperplasiaCartilage atrophy
Inflamation
BronchiolesUsual chronic airflow obstruction
Inflamation
Bronchiolar narrowing
Bronchiolar obliteration
Fibrosis
Muscle increaseGoblet cell metaplasia
Mucus plugging
Bronchiolar totousity
Loss of alveolar attachment
Pigmentation
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Special form of bronchiolitis
-Viral infection, toxic chemical and gasses, rheumatoid arthritis.
- Diffuse pan-bronchiolitis, graft-vs-host disease, heart / lung
- Tranplantation, follicular bronchitis/bronchiolitis, mineral
dust associated bronchiolitis, cryptogenic bronchiolitis
Acinus
- Respiratory bronchiolitis
- Emphysema
- Respiratory airspace enlargement
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A. Interlobular septal
thickening
B. Intralobular interstitialthickening
C. Hineycombing
D. Centrilobular
E. Interstitial nodules
F. Cavitary nodules
G. Airspace nodules
H. Ground glass opacity
I. Lobular emphysema
J. Panlubular
K. Lung cyst