Focal lung pneumatosis

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Focal lung pneumatosis
Alpha 1-antitrypsine deficiency lung CT scan.JPEG
CT scan of the lung showing bullae in the lower lung lobes of a subject with type alpha-1-antitrypsin deficiency. There is also increased lung density in areas with compression of lung tissue by the bullae.
Specialty Respiratory

A focal lung pneumatosis is an enclosed pocket of air or gas in the lung and includes blebs, bullae, pulmonary cysts, and lung cavities. Blebs and bullae can be classified by their wall thickness. [1]

Contents

The terms above, when referring to sites other than the lungs, often imply fluid content.

Lung cysts are seen in about 8% of the general population, with an increased prevalence in older people, and are not associated with emphysema. [5] They may be part of the aging changes of the lungs, and cause a slight decrease in their diffusing capacity. [5] The presence of multiple pulmonary cysts may indicate a need to evaluate the possibility of bullous or cystic lung diseases. [5] Cavitation indicates workup for serious infection or lung cancer.

Bleb or bulla

The most common disease causing blebs or bullae is paraseptal emphysema though centrilobular emphysema may sometimes be involved. [1]

Other conditions associated with lung bullae are:

Cyst

A pulmonary cyst is not necessarily the same type of cyst seen in many cystic lung diseases. The cyst for example in pneumocystis pneumonia is not the same as the pulmonary cyst.[ citation needed ]

CT scan of lymphocytic interstitial pneumonia with cysts. CT of lymphocytic interstitial pneumonia.jpg
CT scan of lymphocytic interstitial pneumonia with cysts.
CT scan of multiple lung cysts in pneumocystis pneumonia. HRCT of cysts of pneumocystis pneumonia.jpg
CT scan of multiple lung cysts in pneumocystis pneumonia.

Cystic lung diseases include:

Incidental blebs and cysts

A focal lung pneumatosis that is an incidental imaging finding such as on a CT scan, without suspicious findings (such as findings indicating any of the diseases listed above), generally does not indicate further follow-up. [8]

Cavity

Cavitation, in this case aspergilloma). CT of an aspergilloma.png
Cavitation, in this case aspergilloma).

Two infectious diseases that are commonly associated with cavities of lung tissue are Mycobacterium tuberculosis and Klebsiella pneumoniae . The formation of cavities is due to tissue necrosis and creates an environment that allows the pathogen to expand in numbers and spread further. [10]

In the absence of infectious symptoms, a lung nodule with cavitation is a suspected lung cancer. [9]

Related Research Articles

<span class="mw-page-title-main">Pulmonary alveolus</span> Hollow cavity found in the lungs

A pulmonary alveolus, also known as an air sac or air space, is one of millions of hollow, distensible cup-shaped cavities in the lungs where pulmonary gas exchange takes place. Oxygen is exchanged for carbon dioxide at the blood–air barrier between the alveolar air and the pulmonary capillary. Alveoli make up the functional tissue of the mammalian lungs known as the lung parenchyma, which takes up 90 percent of the total lung volume.

<span class="mw-page-title-main">Pneumothorax</span> Abnormal collection of air in the pleural space

A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve is formed by an area of damaged tissue, and the amount of air in the space between chest wall and lungs increases; this is called a tension pneumothorax. This can cause a steadily worsening oxygen shortage and low blood pressure. This leads to a type of shock called obstructive shock, which can be fatal unless reversed. Very rarely, both lungs may be affected by a pneumothorax. It is often called a "collapsed lung", although that term may also refer to atelectasis.

<span class="mw-page-title-main">Bronchus</span> Airway in the respiratory tract

A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi to branch from the trachea at the carina are the right main bronchus and the left main bronchus. These are the widest bronchi, and enter the right lung, and the left lung at each hilum. The main bronchi branch into narrower secondary bronchi or lobar bronchi, and these branch into narrower tertiary bronchi or segmental bronchi. Further divisions of the segmental bronchi are known as 4th order, 5th order, and 6th order segmental bronchi, or grouped together as subsegmental bronchi. The bronchi, when too narrow to be supported by cartilage, are known as bronchioles. No gas exchange takes place in the bronchi.

<span class="mw-page-title-main">Chest radiograph</span> Projection X-ray of the chest

A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in medicine.

<span class="mw-page-title-main">Respiratory disease</span> Disease of the respiratory system

Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease.

<span class="mw-page-title-main">Pneumomediastinum</span> Abnormal presence of gas in the thorax

Pneumomediastinum is pneumatosis in the mediastinum, the central part of the chest cavity. First described in 1819 by René Laennec, the condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways, or bowel into the chest cavity. In underwater divers it is usually the result of pulmonary barotrauma.

<span class="mw-page-title-main">Pneumatosis intestinalis</span> Medical condition

Pneumatosis intestinalis is pneumatosis of an intestine, that is, gas cysts in the bowel wall. As a radiological sign it is highly suggestive for necrotizing enterocolitis. This is in contrast to gas in the intestinal lumen. In newborns, pneumatosis intestinalis is considered diagnostic for necrotizing enterocolitis, and the gas is produced by bacteria in the bowel wall. The pathogenesis of pneumatosis intestinalis is poorly understood and is likely multifactorial. PI itself is not a disease, but rather a clinical sign. In some cases, PI is an incidental finding, whereas in others, it portends a life-threatening intra-abdominal condition.

<i>Pneumocystis</i> pneumonia Medical condition

Pneumocystis pneumonia (PCP), also known as Pneumocystis jirovecii pneumonia (PJP), is a form of pneumonia that is caused by the yeast-like fungus Pneumocystis jirovecii.

<span class="mw-page-title-main">High-resolution computed tomography</span> Diagnostic imaging test

High-resolution computed tomography (HRCT) is a type of computed tomography (CT) with specific techniques to enhance image resolution. It is used in the diagnosis of various health problems, though most commonly for lung disease, by assessing the lung parenchyma. On the other hand, HRCT of the temporal bone is used to diagnose various middle ear diseases such as otitis media, cholesteatoma, and evaluations after ear operations.

<span class="mw-page-title-main">Lung nodule</span> Medical condition

A lung nodule or pulmonary nodule is a relatively small focal density in the lung. A solitary pulmonary nodule (SPN) or coin lesion, is a mass in the lung smaller than three centimeters in diameter. A pulmonary micronodule has a diameter of less than three millimetres. There may also be multiple nodules.

<span class="mw-page-title-main">Respiratory bronchiolitis</span> Medical condition

Respiratory bronchiolitis is a lung disease associated with tobacco smoking. In pathology, it is defined by the presence of "smoker's macrophages". When manifesting significant clinical symptoms it is referred to as respiratory bronchiolitis interstitial lung disease (RB-ILD).

<span class="mw-page-title-main">Bleb (medicine)</span> Medical condition

In medicine, a bleb is a blister-like protrusion filled with serous fluid. Blebs can form in a number of tissues by different pathologies, including frostbite and can "appear and disappear within a short time interval".

<span class="mw-page-title-main">Ground-glass opacity</span> Radiologic sign on radiographs and computed tomography scans

Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs. It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis, or a neoplastic process. When a substance other than air fills an area of the lung it increases that area's density. On both x-ray and CT, this appears more grey or hazy as opposed to the normally dark-appearing lungs. Although it can sometimes be seen in normal lungs, common pathologic causes include infections, interstitial lung disease, and pulmonary edema.

<span class="mw-page-title-main">Pulmonary pleurae</span> Serous membrane that lines the wall of the thoracic cavity and the surface of the lung

The pulmonary pleurae are the two opposing layers of serous membrane overlying the lungs, mediastinum and the inside surfaces of the surrounding chest walls.

<span class="mw-page-title-main">Pneumatosis</span> Abnormal presence of air or other gas within tissues

Pneumatosis is the abnormal presence of air or other gas within tissues.

<span class="mw-page-title-main">Emphysema</span> Medical condition

Emphysema is any air-filled enlargement in the body's tissues. Most commonly emphysema refers to the enlargement of air spaces (alveoli) in the lungs, and is also known as pulmonary emphysema.

<span class="mw-page-title-main">Bullectomy</span> Surgical removal of bullae from the lung

Bullectomy is a surgical procedure in which dilated air-spaces or bullae in lung parenchyma are removed. Common causes of dilated air-spaces include chronic obstructive pulmonary disease and emphysema. Patients with giant bullae filling half the thoracic volume and compressing relatively normal adjacent parenchyma are recommended for bullectomy. It is also indicated in severe dyspnea, repeated respiratory infections and spontaneous pneumothorax. The size of dilated air-spaces or bullae volume is the most important factor in relation to ventilator capacity post-bullectomy. In cases where the size of bullae are enlarged, bullectomy is indicated if the percentage of forced expiratory volume in one second(FEV1%) is greater than 40% and the regional ventilation over volume dynamic(V/V Dynamic) is greater than 0.5.

<span class="mw-page-title-main">Air bronchogram</span>

An air bronchogram is defined as a pattern of air-filled bronchi on a background of airless lung.

<span class="mw-page-title-main">Lung cavity</span> Medical condition

A lung cavity or pulmonary cavity is an abnormal, thick-walled, air-filled space within the lung. Cavities in the lung can be caused by infections, cancer, autoimmune conditions, trauma, congenital defects, or pulmonary embolism. The most common cause of a single lung cavity is lung cancer. Bacterial, mycobacterial, and fungal infections are common causes of lung cavities. Globally, tuberculosis is likely the most common infectious cause of lung cavities. Less commonly, parasitic infections can cause cavities. Viral infections almost never cause cavities. The terms cavity and cyst are frequently used interchangeably; however, a cavity is thick walled, while a cyst is thin walled. The distinction is important because cystic lesions are unlikely to be cancer, while cavitary lesions are often caused by cancer.

<span class="mw-page-title-main">Crazy paving (medicine)</span> Medical sign on CT of the chest

Crazy paving refers to a pattern seen on computed tomography of the chest, involving lobular septal thickening with variable alveolar filling. The finding is seen in pulmonary alveolar proteinosis, and other diseases. Its name comes from its resemblance to irregular paving stones, called crazy pavings.

References

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  2. 1 2 3 4 5 Dr Daniel J Bell and Dr Yuranga Weerakkody. "Pulmonary cyst". Radiopaedia . Retrieved 2019-05-01.
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  4. 1 2 Katzenstein (2016). Diagnostic atlas of non-neoplastic lung disease : a practical guide for surgical pathologists. New York, NY: Demos Medical Publishing, LLC/Springer Publishing Company. ISBN   978-1-61705-229-3. OCLC   951217791.
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  6. 1 2 3 4 5 6 7 Neerja Gulati (2019-03-11). "Bullectomy". Medscape . Updated: Feb 21, 2019
  7. 1 2 3 4 5 Ferreira Francisco, Flavia Angélica; Soares Souza, Arthur; Zanetti, Gláucia; Marchiori, Edson (2015). "Multiple cystic lung disease". European Respiratory Review. 24 (138): 552–564. doi: 10.1183/16000617.0046-2015 . ISSN   0905-9180. PMC   9487620 . PMID   26621970.
  8. Beddy, Peter; Babar, Judith; Devaraj, Anand (2010). "A practical approach to cystic lung disease on HRCT". Insights into Imaging. 2 (1): 1–7. doi:10.1007/s13244-010-0050-7. ISSN   1869-4101. PMC   3259352 . PMID   22347931.
  9. 1 2 Snoeckx, Annemie; Reyntiens, Pieter; Desbuquoit, Damien; Spinhoven, Maarten J.; Van Schil, Paul E.; van Meerbeeck, Jan P.; Parizel, Paul M. (2017). "Evaluation of the solitary pulmonary nodule: size matters, but do not ignore the power of morphology". Insights into Imaging. 9 (1): 73–86. doi:10.1007/s13244-017-0581-2. ISSN   1869-4101. PMC   5825309 . PMID   29143191.
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