Table of contents
- 1. Imaging
- 1.1. Chest Xray
- 1.2. Chest CT
- 1.3. PET CT
- 1.4. PET Scan
- 1.5. Bronchoscopy
.
Imaging
Chest Xray
- CXR Conditions with upper lobe prominence:
- Sarcoidosis
- Silicosis
- Langerhan Cell Histiocytosis
- Cystic Fibrosis
- Reactivation of TB
- (Chronic hypersensitivity pneumonitis)
- CXR with lower lung zones
- Idiopathic pulmonary fibrosis
- Cryptogenic Organizing Pneumonia
- Asbestosis
- Heart Failure
- Response to treatment:
- Pneumonia
- Heart Failure
- Pneumothorax
Chest CT
- Indicated for:
- ILD
- Bronchiectasis
- Pulmonary Nodules (small)
- Cancer, signs of spread
- Pulmonary Embolus
- Lymphadenopathy
- Characterizing pulmonary nodules (calcifications etc..)
- Contrast CT for:
- Helps see large blood vessels.
- Identify metastasis to liver/adrenals.
- Vascular concerns (dissection, PE)
- Differential for "Ground Glass"
- Atypical Infections
- Viruses (HSV, CMV)
- Fungi (PCP, Aspergilosis [halo sign w/ surrounding groundglass])
- Chronic Interstitial Diseases
- Eosinophilic Pneumonia
- Idiopathic Interstitial Pneumonia (UIP/NSIP/COP etc..)
- Sarcoidosis
- Alveolar Diseases
- Pulmonary Edema (ARDs, Heart failure)
- Pulmonary Hemorrhage
- Hypersensitivity Pneumonitis
- Atypical Infections
PET CT
- PET combined with CT
- Higher Sn and Sp when done together.
- Expensive, but saves pts from unnecessary surgery.
- Using for staging lung cancers.
- FDG (Flurodeoxy glucose) - see if mass is metabolically active.
- If does not light up does not exclude Ca, but makes it less likely.
PET Scan
- Sp 90%, Sp 85% for mediastinal spread.. (30 and 40% for standard CT).
- Not useful for <1cm diameter
- False Positive PET:
- Infection (TB, fungal, other atypical)
- Sarcoidosis.
- False Negative PET:
- Low grade variants of adenocarcinoma
- Carcinoid (both metabolically slow).
Bronchoscopy
- Insert the scope and collect samples.
- Good way to visualize and biopsy central pulmonary lesions.
- Radial US and electromagnetic navigation tools. (tells bronchoscopist which way to go)
- Endobronchial ultrasound... easier to get tissue that was formerly only done via mediastinoscopy.
- Reasons to do Bonchoscopy:
- Tissue Samples
- Under electromagnetic guidance or endobronchial ultrasound (EBUS)
- Can sample: endobronchial, mediastinal, and peripheral nodes
- Peripheral nodules are possible to biopsy if >2cm in diameters. (<2cm likelihood is low <50% success) May need CT-guided percutaneous biopsy.
- Broncho-Alveolar Lavage
- Helps with diagnosis, to obtain cultures
- Normally see alveolar macrophages (95%)
- If other cells can help diagnosis. (i.e. lymphocytosis, eosinophilia, neutrophilia).
- Therapeutic
- Clearance of secretions.
- Foreign bodies.
- Palliative (if airway tumor blocking airway), can debulk tumors and sometimes put stents.
- Tissue Samples
- Safety:
- Risk is low.
- Discuss bleeding, sedation medications, cardiac arrest if limited lung reserve, biopsies can cause pneumothorax.
- Very rare to die from bronchoscopy 1 in 1000.
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