Investigations in chest medicine - PowerPoint PPT Presentation

1 / 37
About This Presentation
Title:

Investigations in chest medicine

Description:

Investigations in chest medicine Dr. Aya Abdel Dayem Lecturer of chest diseases Ain Shams University Egypt Ibn Sina college Sputum examination Clear and colorless ... – PowerPoint PPT presentation

Number of Views:118
Avg rating:3.0/5.0
Slides: 38
Provided by: Sam6166
Category:

less

Transcript and Presenter's Notes

Title: Investigations in chest medicine


1
Investigations in chest medicine
  • Dr. Aya Abdel Dayem
  • Lecturer of chest diseases
  • Ain Shams University Egypt
  • Ibn Sina college

2
Sputum examination
  • Clear and colorless ( chronic bronchitis)
  • Yellow to green( pulmonary infection )
  • Red( haemoptysis)
  • Black (smoke, coal )
  • Send the sample to laboratory for microscopic,
    culture and cytology
  • AAFB

3
Tuberculin skin test
  • Tuberculin skin test TB antigen is injected to
    intradermally and the cell-mediated response
    48-72 h is recorded. A positive test indicates
    that the patient has immunity. It may indicate
    previous exposure of BCG. A strong positive test
    probably means active infection. False negative
    test occur in immunosuppression, including
    miliary TB, sarcoid, AID, lymphoma.

4
Tuberculin skin test
  • Mantoux Test Serial dilutions of antigens
    provide 1, 10, and 100, tuberculin units (TU),
    respectively. The test is ve if it produces gt
    10mm induration, and ve if lt5 mm. This test is
    overrated in diagnosing TB and its use is
    controversial.
  • I f active TB is strongly suspected, use 1 TU. If
    it is positive, infection is likely. Otherwise,
    interpret in the clinical context.

5
Lung volumes
  • Tidal volume
  • FRC
  • VC
  • RV
  • TLC

6
Spirometry
  • It measures changes in lung volume by recording
    changes in the volume of air exchanged through
    the air way opening.
  • Forced expiratory volume in 1 s (FEV)
  • Forced vital capacity (FVC)
  • FEVI/FVC 75

7
Spirometry
  • Obstructive defect
  • FEV1is reduced more than the FVC
  • The FEV/FVC is lt75
  • Asthma
  • COPD
  • Bronchiectasis
  • Cystic fibrosis

8
Spirometry
  • Restrictive defect
  • FVC reduced
  • The FEV /FVC ratio is normal.
  • Sarcoidosis
  • Pneumoconiosis
  • Obesity
  • Connective tissue disease
  • Pleural effusion

9
Peak expiratory flow (PEF)
  • Is measured by a maximal forced expiration
    through a peak flow meter.
  • The best of three.
  • Diffuse airways obstruction.
  • Monitoring course of asthma.

10
Oximetry
  • Pulse oximetry
  • Peripheral O2saturation
  • Two light emitting diodes detector.

11
Arterial blood gas (ABG)
  • Analysis heparin zed blood is taken from radial,
    brachial, femoral artery .
  • PH
  • PaCO2
  • PaO2

12
Acid base balance
  • Normal PH 7.35-7.45
  • ?A PH lt7.35 acidosis
  • A PHgt7.45 alkalosis

13
Acid base balance
  • PaO2 is 10.5-13.5-kpa
  • Ventilation perfusion mismatch
  • Hypoventilation
  • Abnormal diffusion
  • Right to left shunt
  • Sever hypoxia Pao2lt8kpa

14
Acid base balance
  • PaCO2 is a 4.5-6.0 kpa
  • A PaCO2lt4.5 kpa hyperventilation
  • A PaCO2 gt6.0 kpa hypoventilation

15
Radiology
  • Chest x ray
  • Posteroanterior view (PAV)
  • Trachea central
  • Heart lt 1/2the width of the thorax

16
Radiology (CXR)
  • Mediastinum
  • widened
  • Retrosternal goiter
  • Lymph node enlargement
  • Tumor
  • Aortic aneurysm
  • Cyst
  • Paravertebral mass (TB)
  • Oesophageal dilation

17
Radiology (CXR)
  • The diaphragm
  • Right side is usually higher
  • High
  • Lung volume loss
  • Stroke
  • Phrenic nerve palsy
  • Hepatomegaly
  • Subphrenic lesion

18
Radiology (CXR)
  • Lung fields
  • Nodular shadows
  • Neoplasia metastases, lung carcinoma, adenoma
    hamartoma)
  • Infection (pneumonia, hydatid, septic emboli)
  • Granulomas (military TB, sarcoidsis)
  • Pneumoconiosis

19
Radiology (CXR)
  • Lung fields
  • Reticular shadows
  • Fibrosis, TB
  • Neoplasia (lymphangitis carcinomatosis)
  • Sarcoidosis
  • Silicosis

20
Radiology (CXR)
  • Lung fields
  • Alveolar shadows
  • LVF
  • Pneumonia
  • Renal failure
  • Liver failure
  • ARDS
  • Drugs ( heroin,cytotoxics)
  • Smoke inhalation

21
Radiology (CXR)
  • Lung fields
  • Ring shadows
  • Air ways seen end-on (pulmonary edema,
    bronchiectasis)
  • Cavitating lesion (abscess)
  • Tumor
  • Pulmonary infarct

22
Radiology (CXR)
  • Lung fields
  • Linear opacities
  • Septa lines
  • Atelectasis

23
Ultrasound
  • Ultrasound is used in the diagnosis and drainage
    of pleural effusions (particularly loculated
    effusions) and empyema

24
Radionuclide scans Ventilation/perfusion (VIQ)
  • Radionuclide scans Ventilation/perfusion (VIQ)
    scans are used to diagnose pulmonary embolism
    (PE) (unmatched perfusion defects are seen). Bone
    scans are used to diagnose bone metastases.

25
Computer tomography (CT)
  • Computer tomography (CT) of the thorax is used
    for diagnosing and staging lung ca. Imaging the
    hilar, mediastinum and pleura, and guiding
    biopsies. Thin (1-1.5mm) section high resolution
    CT (HRCT) is used in the diagnosis of
    interstitial lung disease and bronchiectasis (
    Spiral CT)

26
Pulmonary angiography (CTPA)
  • Pulmonary angiography (CTPA) is used
    increasingly in the diagnosis of PE. Pulmonary
    angiography is also used for diagnosing PE and
    pulmonary hypertension.

27
Fibreoptic Bronchoscopy
  • It is performed under local anesthetic via the
    nose or mouth.
  • Diagnostic Indications suspected lung ca,
    slowly resolving pneumonia, pneumonia in the
    immunosuppressed, interstitial lung disease.
    Bronchial lavage fluid may be sent to the lab for
    microscopy, culture, and cytology. Mucosal
    abnormalities may be brushed (cytology) and
    biopsied (histopathology

28
Fibreoptic Bronchoscopy
  • Therapeutic indications aspiration of mucus
    plugs causing lobar collapse or removal of
    foreign bodies.

29
Fibreoptic Bronchoscopy
  • Pre-procedure investigations
  • FBC
  • CXR
  • Spirometry
  • Pulse oximetry
  • Arterial blood gases (if indicated)
  • Check clotting if recent anticoagulation and a
    biopsy may be performed.

30
Fibreoptic Bronchoscopy
  • Complications
  • Respiratory
  • Depression
  • Bleeding
  • Pneumothorax

31
Bronchoalveolar lavage (BAL)
  • It is performed at the time of bronchoscopy by
    instilling and aspirating a known volume of
    warned buffered 0.9 saline into the distal
    airway.

32
Bronchoalveolar lavage (BAL)
  • Diagnostic indications suspected malignancy,
    pneumonia in the immunosuppressed (especially
    HIV), suspected TB (if sputum negative),
    interstitial lung diseases (eg sarcoidosis,
    extrinsic allergic alveolitis, histocytosis X).

33
Bronchoalveolar lavage (BAL)
  • Therapeutic indications alveolar proteinosis.
  • Complications hypoxia (give supplemental O2),
    transient CXR shadow, infection (rare).

34
Lung Biopsy
  • It may be perfumed in several ways.
  • Percutaneous needle biopsy is performed under
    radiological guidance and is useful for
    peripheral lung and pleural lesions may be
    performed in several ways.

35
Lung Biopsy
  • Transbronchial biopsy performed at bronchoscopy
    may help in diagnosing diffuse lung diseases, eg
    sarcoidosis. If these are unsuccessful, an open
    lung biopsy may be performed under general
    anesthetic.

36
Surgical Procedures
  • They are performed under general anesthetic.
  • Rigid bronchoscopy provides a wide lumen,
    enables larger mucosal biopsies, controlling
    bleeding, and removal of foreign bodies.
  • Mediastinoscopy and mediastinotomy enable
    examination and biopsy of the mediastinal lymph
    nodes/lesions, drainage of pleural effusions, and
    talc pleurodesis.

37
Thank you
Write a Comment
User Comments (0)
About PowerShow.com