Radiation pneumonitis

Radiation pneumonitis (Murray)
beginning 3 to 8 weeks after initiation of radiation therapy and may rapidly progress to a fatal outcome in spite of institution of corticosteroids.
The chronic effects of radiation begin 3 to 6 months or later after radiation therapy.
Recently, a form of radiation pneumonitis has been observed outside the treatment fields, usually in patients with breast cancer.
Tissue examination has revealed bronchiolitis obliterans with organizing pneumonitis in these cases.

Organizing pneumonia

organizing pneumonia

1. Secondary Organizing Pneumonia: this is when an identified cause resulted in the pneumonia.
Pneumococcal PNA, atypical bacteria, viral infxns, fungi, parasites
Typically thought that the OP occurs after etiological agent gone and inflammation continues

2. Cryptogenic Organizing Pneumonia: Idiopathic

3. Bronchiolitis Obliterans Organizing Pneumonia: Granulation tissue is present in the bronchiolar lumen

Direct and indirect sign atelectasis

Direct sign atelectasis
-homogenous density
-airless lung
-cloudy of vessle
-shift of fissure

Indirect sign of atelectesis
-narrow rib space ipsilateral
-hyperaeration cotralateral
-mediastinal shift to contralateral
-diaphragm elevate ipsilateral
-compensate hyperaerate ipsilateral non effect lobe cause dissihuette

Noncardiogenic pulmonary edema

Noncardiogenic pulmonary edema + (possible)mechanism
-ARDS
-High altitude pulmonary edema : pulmonary vasoconstriction from alveolar hypoxia + capillary permeability impaired from shear stress
-Neurogenic pulmonary edema : severe catecholamines surge–>shift blood from systemic to pulmonary circulation
-Reexpansion pulmonary edema : mechanical stress to the lung during expansion–>damage capillaries
-Reperfusion pulmonary edema : high permeability lung injury from which proximal thromboembolic obstructions have been removed
-Drug induced
–Opiate : capillary leak from direct toxicity of the drug, hypoxia, and acidosis
–Salicylate toxicity : ALI
–Chemotherapeutic agents eg. cytarabine, gemcitabine, ATRA : direct toxicity and induction of a cytokine-triggered inflammatory response–>leakage
–Radiocontrast : immunologic reaction–>impaired vascular permeability
-Pulmonary embolism : elevating hydrostatic pressures in pulmonary and/or systemic veins +/-lowering pleural pressure due to atelectasis
-Post cardiopulmonary bypass : apply negative pleural pressure–>reexpansion edema, given protamine for reversal heparin effect–>histamine release–>leakage
-Pulmonary venoocclusive disease : postcapillary obstruction–>increase hydrostatic pressure of pulmonary capillary and visceral pleural capillary

hypoxic pulmonary vasoconstriction ใน HAPE มีความไม่สม่ำเสมอ(uneven) ไม่เหมือนกับขณะอยู่ที่ sea level ทำให้หย่อมปอดที่มี arteriolar vasoconstrictionไม่ดีเกิด high flowใน microcirculation–>capilla​ry injury

Churg-strauss

จำไว้ Eo 2 + asthma + neuropathy + (upper + lower –> คล้าย wegner)

สูตรจำ ” P E V ” or ” A E V ”

Nodule in lung cavity

Nodule in cavity

Aspergilloma
Mycetoma
Coccidiomycosis
Squaremous cell CA
Wegner’s

ในชีทอ.อดิศร
Old granuloma + saprophytic growth –> Aspergilloma
Necrotizing infection
Necrotizing tumor
Lung abscess
Liquified infection
Blood clot

Ddx cavitary
C-carcinoma–>typically SCC, metastasis, lymphoma
A-autoimmune–>Wegener’s, Rheumatoid nodule
V-vascular–>emboli (septic or bland)
I-infection–>lung abscess, TB, fungal pneumonia, hydatid cysts
T-trauma–>lung laceration
Y-young(congenital)–>bron​chogenic cyst, cystic adenomatoid malformation, sequestration

หลักการอ่าน Cavity
“S LAW C”
Size
Location
Amount
Wall
Content

Wall thickness
Less than 1mm benign
Less than 4mm 92%benign
5-15 mm 50%malignancy
Morw than 15mm 95%Malignancy
Smooth wall 60%benign
Irrgular wall 80%malignancy

Pulmonary interstitial emphysema PIE

PIE
-Pulmonary interstitial emphysema
-Rupture of pulmonary alveoli results in air passing into the interstitial space of the lung.
-The air has been described as being present in the interstitial spaces, surrounding the bronchovascular bundles, and in the pulmonary lymphatic channels of the interstitium.
-warning sign of other complications of barotrauma, such as pneumothorax.
-In most patients, pulmonary interstitial emphysema is transient, lasting only for several days.
-Rarely, pulmonary interstitial emphysema can persist and form expanding, radiolucent masses. This is known as persistent pulmonary interstitial emphysema.

Type of Atelectesis

Type of Atelectesis

Obstructive atelectasis (resorptive)
Nonobstructive atelectasis
– Relaxation
– Compressive (passive)
– Adhesive
– Replacement
– Cicatrization
– Absorptive
– Rounded

สูตร “R RCA RCA R”

resorptive อุดทำให้ oxygen ดูด ใช้ไปหมด
relax = visceral and parietal pleura แยกกัน
compressive = mass กด or loculated effusion กด
adhesive = loss surfactant
cicartization = scaring/fibrosis
replace = raplace alv with malig cell or other
absorptive = ได้ oxygen conc สูง ขาด nitrogen
round = plate like atelect found in asbestosis นะจ้ะ