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52 terms

Vascular and other pulmonary disorders and Carcinoma of the Lung

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Where do pulmonary emboli normally arise
veins in the legs - their significance depends upon the size and the basic health of the patient
What is a saddle embolus
large embolus that straddles the bifurcation of the pulmonary artery - it is typically fatal
-Clinically they will have chest pain, dsypnea, faint or absent pulse, low BP, and tachycardia
What is a paradoxical embolus
embolus that travels through a cardiac defect and embolizes to organs supplied by the systemic circulation
-patent with a probe patent foramen ovale
PE rarely cause an infract but if they do what is the typical pattern
wedge-shaped and hemorrhagic
What factors predispose a patient to a PE
bed rest, recent surgery, trauma, estrogen, disorders of hyper coagulability, cancer
Define pulmonary hypertension
elevated pulmonary artery pressure (greater than 25% of systolic)
What type of patient typically has primary (idiopathic) pulmonary hypertension
mostly a disease of young women (20-40)
-causes is unknown (some anti-obesity drugs cause this), hypertrophy of pulmonary vessels
What is the cause of secondary pulmonary hypertension
cardiac disease (Left ventricular failure, mitral valve disease, congenital malformations), or pulmonary disease (COPD, fibrosis, or recurrent pulmonary emboli)
CLASSICALLY how does Goodpasture's present
combination of hemoptosis and hematuria
-disease is due to an increase in circulating antibody against the collagen basement membrane
What is the other pulmonary/renal disease
Wegner's Granulomatosis
Define Wegner's granulomatosis
disease of airway/lung and kidney
-vasculitis
involves the ANCAs -
What is atelectasis
collapse of the lungs
What is the implications of atelectasis
creates a shunting of blood which can lead to a V/Q mismatch
What are the three types of atelectasis
resorption - caused by airway obstruction and absorption of DISTAL airspaces
compression - extrinsic compression such as pleural fluid
contraction - peripheral pleural scarring
Left sided heart failure is
leads to left sided pressures - resulting in pulmonary edema which can DAMAGE the pulmonary capillaries
-can lead to the creation of hemosiderin-filled MACs
What is a pleural effusion
common in heart failure and any condition where fluid accumulates in the body
What is pleuritis
common in lobar pneumonia - friction generated by the involved pleura and is felt by the patient as pain with every breath taken
Pneumothorax
abnormal collection of air and gas in the pleural space - typically causes a collapse of the lung due to air in the pleural space
What is the leading cause of cancer death in the US
lung cancer - prostate and breast are more common, but they have better treatment options therefore lung cancer causes more deaths
What gas is associated with lung cancer
Radon
Does asbestos have a higher risk of lung cancer
yes 5X increased risk and this is even more if this patient smokes
What other factors are associated with lung cancer
TB, fibrotic lung disease, metal exposure, air pollution
Lung cancer is classified as either
central or peripheral
Central lung cancer arises from
bronchogenic - arises in the LARGE bronchus
-typically the result of SMOKING
Peripheral lung cancer arises from
the more distal small bronchioles
-often associated with a scar
What are the two "cell" types of cancer
large or small
What are the types of large cell cancer
adenocarcinoma, squamous cell carcinoma, undifferentiated
What are the features of large cell adenocarcinoma
most common
-most common non-smoking woman
-many are PERIPHERAL tumors
frequently DESMOPLASTIC - 'scar cancer" - can also arise from a preexisting scar (TB, fibrotic lung)
Squamous cell carcinoma
high incidence with cigarette smoking
-CENTRAL tumor
-COMMONLY associated with PTH and hyperCALCEMIA
Squamous cell carcinoma is associated with
Keritinization and/or intercellular bridges
Large cell undifferentiated carcinoma
mostly smokers, AGGRESSIVE tumor, large tumor with frequent necrosis
Small cell carcinoma
highly correlated with cigarette smoking
surgery DOES NOT improve surival
chemotherapy is can improve mortality (but only 20% survive to five-years)
tumors are usually CENTRAL
What cells are associated with small cell carcinoma
small oval or fusiform cells
-cells probably originate from Kulchitsky cell - a neuroendocrine cell
What ectopic hormones are associated with small cell carcinoma
ADH and ACTH
Lung metastatic disease is more common than primary, what cancer are the usual suspects
breast, colon, and renal cancer
What are the carcinoid tumors
-oid means "like" - serotonin producing
no relation to cigarette smoking or other causative factors
Carcinoid tumors clinical features
Neuroepithelial tumor with biogenic amine and polypeptide production (ACTH); carcinoid syndrome (5-HT)
Are carcinoid tumors malignant
typically, they are benign (90%)
-atypical carcinoids are aggressive variant
What is the pathology of carcinoid tumors
obstruct the bronchus -
What are the clinical features of mesothelioma
symptoms are gradual, pain, dyspnea, pleural effusions
-median survival is 1 years - lymph nodes and blood borne metastases occur late
What is the pathology of mesothelioma
Pleural plaques that encase the lung
-may mimic either adenocarcinoma or fibroblastic lesions
-ferruginous bodies (asbestos bodies) occur in lung
What is the epidemiology of mesothelioma
80% occur in the pleura
-relation to asbestos exposure
-small asbestos fibers go deep into the lung tissue and produce fibrosis of lungs and pleura
What are the BENIGN pulmonary lesions
Hamartoma, Sarcoidosis, Vascular anomalies, Infectious processes
How do you detect and diagnose Lung cancer
Silent disease, cough (75%), weight loss, chest pain, dyspnea, Pneumonia that fails to heal, hemoptysis, and hoarseness
What lymph nodes are involved in the spread of pulmonary disease
PERIHILAR(1ST), paratracheal nodes, supraclavicular nodes, and other organs
What does paraneoplastic syndromes mean? what are they in relation to pulmonary carcinoma
substances from a distance
-cushings (ACTH) and SIADH -small cell carcinoma
-hypercalcemia (PTH production) - Squamous cell carcinoma
Where are some of the CLASSIC locations of spread in pulmonary carcinoma
Superior vena caval, Pancoast (apex), Horner's syndrome (Ptosis, miosis)
Which cancers have the highest association with smoking? weaker association?
squamous cell and small cell (oat cell) - highest correlation
adenocarcinoma has a weaker association
Which cancers have a central location
squamous and small cell (oat cell)
Which cancer has peripheral location
adenocarcinoma
Which cancers do you try and resect surgically
all the large cell types - squamous cell, undifferentiated large cell, and adenocarcinoma
Which cancers is your only treatment option for small cell carcinoma
chemotherapy