Factors that predispose to development of pneumonia are:

Smoking
Alcohol
Upper respiratory tract infections
Recent influenza infection
Corticosteroid therapy
Old age
Pre existing lung disease

Air bronchogram refers to the visualisation of air filled bronchus when the surrounding alveoli are opacified

Causes:

Pulmonary consolidation
Pulmonary oedema
ARDS
Hyaline membrane disease
Alveolar cell carcinoma
Alveolar proteinosis
Sarcoidosis
Lymphoma

Mechanism:

Normally the lung fields are radioluscent and the bronchi are not separately visualised
But in the above mentioned conditions, there is opacification of the alveoli due to various reasons (eg: fluid accumulation is pulmonary oedema)
Due to this reason, the bronchi stands out as radioluscent in contrast to the adjacent alveoli that are radio opaque
Visualisation of air bronchogram helps in identifying the underlying pathology

Superior vena caval syndrome refers to the symptoms that arise due to obstruction to the superior vena cava
90% of superior vena caval syndrome is caused by malignancies
Among malignancies, lung cancer is the most common cause followed by lymphomas
Other causes of superior vena caval syndrome include thymomas, metastatic breast carcinomas, metastatic genitourinary and gastrointestinal cancers
Among different types of lung cancer, small cell variant has the highest chance of causing SVC syndrome
Approximately 8% of patients with small cell lung cancer develop SVC syndome compared to 4% of non small cell lung cancers

Reference:
…

Spot the diagnosis and submit your answer to win exciting prizes! Attempt both questions. Include an explanation to substantiate your diagnosis. Quiz master: Dr. C.P Rauf, Senior Consultant Pulmonologist, Chest Hospital, Calicut. Decision of the quiz master is final and binding on all participants. Contest open only to Indian Residents. Last date for submission of entries – 30th November, 2010. Join the PG Blazer group on Facebook to get the latest updates. If you have any queries, Contact us.

Adenovirus – Bronchiolitis obliterans can occur as sequelae of adenovirus infection in children

Bronchiolitis obliterans is a rare chronic disease of bronchioles and smaller airways.
It is usually seen in the pediatric population after an episode of respiratory tract infection

Pathogenesis:

There is inflammation of the terminal bronchioles, respiratory bronchioles and alveolar ducts followed by obstruction of airway
Abnormal repair of epithelial injury is characteristic of bronchiolitis obliterans

Clinical features:

Initially there is fever, cough and dyspnoea followed by a transient improvement in symptoms
After the initial improvement, there is increased fever, productive cough and signs of respiratory …

Pulmonary function test – Flow volume curve
Click on image for an enlarged view

Spot the diagnosis and submit your answer to win exciting prizes!
Quiz master:  Dr. C.P Rauf, Senior Consultant Pulmonologist, Chest Hospital, Calicut
Decision of the quiz master is final and binding on all participants
Contest open only to Indian Residents
Last date for submission of entries – 23rd November, 2010
Join the PG Blazer group on Facebook to get the latest updates
If you have any queries, Contact us

Update:
Episode 1 of Pulmonology quiz has ended. Thanks to all who participated. The results will be …

X-ray chest posteroanterior view showing homogenous haziness in left lung – upper and mid zones. Elevation of left dome of diaphragm – due to volume loss secondary to bronchus obstruction / diaphragmatic palsy secondary to phrenic nerve involvement. Mediastinal shift to left side. Hyperinflated right lung.

Massive pleural effusion – left side
Click on image for an enlarged view

X-ray chest anteroposterior view showing massive pleural effusion on left side and mediastinal shift to right
Patient presented with symptoms of dyspnoea, cough and fever for 1 week duration
On examination, breath sounds were absent on left side with stony dullness on percussion
Patient’s spouse was an active case of tuberculosis, hence tuberculous pleural effusion was suspected

Chest X-ray showing a mass lesion in the left upper and middle zones
(Click the above image to view an enlarged version)

IPPV is invasive and non-physiological, and hence reserved for cases where non-invasive ventilation is not suitable.

Terminology

PEEP: positive end expiratory pressure
Cycling: change from inspiration to expiration or the reverse. It can be volume cycled, pessure cycled, time cycled or flow cycled.
Modes of ventilation: controlled mode, assist controlled mode, assist mode
Controlled mode – every breath by the ventilator; even if the subject wants breath spontaneously, it is not permitted. Volume and pressure controlled modes are available.
Assist control mode – IMV and SIMV (synchronized intermittent mandatory ventilation). SIMV removes the chance of fighting …