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Lung Consilidation, Ground Glass Shadowing, Obstructive Emphysema, Collateral Air-draft, Mucocoeles, patterns of Collapse, Lung Torsion and Herniation.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Sometimes air trapping is so great that the affected portion of lung can become larger than normal. Obstructive emphysema may then be noted in normal inspiratory views. This probably happens after coughing when air if forced at a greater than normal pressure into the affected lung, or lobe. Indeed many cases that the author picked up were initially detected on the normal inspiratory PA view, then proceeding to an expiratory view as well.
Tuberculosis in Childhood and Pregnancy
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Lindsay H. Cameron, Jeffrey R. Starke
The symptoms and physical signs of primary pulmonary tuberculosis in children are surprisingly meager considering the degree of radiographic changes often present. The physical manifestations of disease and associated symptoms differ by age of onset (Table 18.1). Young infants and adolescents are more likely to experience signs and symptoms of tuberculosis, while school-age children are more likely to have clinically silent disease. When active case finding is performed, up to 50% of infants and children with radiographically moderate to severe pulmonary tuberculosis have no physical findings. Nonproductive cough and mild dyspnea are the most common symptoms in infants, which is probably due to their smaller airway diameters relative to the parenchymal and lymph node changes in pulmonary tuberculosis. Systemic symptoms such as fever, night sweats, anorexia, and decreased activity are less common. Some infants present with poor weight gain or develop failure to thrive, which may not improve until several months into their treatment course. Pulmonary signs are even less common. Some infants and young children with bronchial obstruction have signs from air trapping such as localized wheezing or decreased breath sounds that may be accompanied by tachypnea or, rarely, respiratory distress. The pulmonary symptoms and signs occasionally are alleviated by antibiotics, suggesting a bacterial superinfection distal to the focus of tuberculous bronchial obstruction, which contributes to the clinical presentation of disease.
Clinical evaluation of the patient with suspected ILD
Published in Muhunthan Thillai, David R Moller, Keith C Meyer, Clinical Handbook of Interstitial Lung Disease, 2017
As outlined in the American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association (ATS/ERS/JRS/ALAT) statement for diagnosis and management of IPF, all patients require a non-contrast, high-resolution computed tomography (HRCT) scan at baseline for diagnosis. Reconstructed slice collimation ≤2 mm is recommended, with ≤1.25 mm slice thickness preferred and reconstructed images spaced at ≤2 cm. Images should be captured at full inspiration to minimize respiratory motion artefact. For the initial evaluation of a patient with suspected ILD, expiratory images are also performed to allow for the assessment of air trapping. Prone images should be collected as these help discern true disease from atelectasis (13). Honeycombing may also be more evident on these views. Follow-up imaging may be required for monitoring of suspicious pulmonary nodules or if there is evidence of clinical deterioration.
Synchronized abdominal compression as a novel treatment of life-threatening preschool asthma
Published in Journal of Asthma, 2020
Eric Y. Chan, Pak-Hong Chan, Gerry M. Yeung, Daniel K. Ng
Three preschool children, who responded well to a new method of active expiration, with life-threatening asthma with severe air trapping despite conventional treatment were presented here. They would have required extracorporeal membrane oxygenation (ECMO) for survival as they were not “ventilatable” with extreme air trapping. However, ECMO might not be available in some countries or the patients might be too ill for transport even for countries with ECMO. Hence, an effective means to decrease air trapping in life-threatening asthma would be helpful. This means could be achieved by manual external chest compression which was reported in intubated asthmatic children with difficult ventilation (1–3). Unfortunately, manual external chest compression posed a risk of affecting cardiac output, in case report (3) and animal study (5). Moreover, continuous manual chest compression was not practical over hours and SAC provided the answer. With SAC, a breath by breath active expiration was provided. The pressure required may be low compared to manual compression which was usually performed after cumulative air stacking. Compared to manual compression, using ventilator would provide a more consistent, gentle, and stable pressure. The hemodynamic status was stable in our cases. For SAC to work, synchronization was mandatory all the time. Hence, the patient must be well sedated and paralyzed. The patient and the ventilator graphics must be closely observed. For ventilator graphics, the flow volume loop and the flow time curve should be closely observed for evidence of desynchronization and adequacy of SAC.
Impulse oscillometry and nitrogen washout test in the assessment of small airway dysfunction in asthma: Correlation with quantitative computed tomography
Published in Journal of Asthma, 2019
Leonello Fuso, Giuseppe Macis, Carola Condoluci, Martina Sbarra, Chiara Contu, Emanuele G. Conte, Giulia Angeletti, Paolo Montuschi
A semi-automated software, GE Advantage Window Thoracic VCAR, was used to analyze all CT scans for quantitative airway morphometry and lung densitometry to detect the remodeling and air trapping. A range from -756 HU to -950 HU was used to study lung densitometry. This range allowed to exclude the influence of the emphysematous portion which can overestimate the extent of air trapping. Air trapping was defined as a percentage of lung voxels less than -756 HU on expiratory CT (19). The parameters considered expression of airway remodeling were: bronchial lumen area (LA), bronchial wall area (WA) and bronchial wall area as percentage of the total bronchial area (WA%). They were calculated on inspiratory scans, in six different segmental bronchi in both right and left lung. The values obtained in the posterior-basal left lower lobe segmental bronchus (LB10) were chosen as representative.
Computed tomography in hypersensitivity pneumonitis: main findings, differential diagnosis and pitfalls
Published in Expert Review of Respiratory Medicine, 2018
Olívia Meira Dias, Bruno Guedes Baldi, Francesca Pennati, Andrea Aliverti, Rodrigo Caruso Chate, Márcio Valente Yamada Sawamura, Carlos Roberto Ribeiro de Carvalho, André Luis Pereira de Albuquerque
The Fleischner Society defines air trapping as ‘parenchymal areas with less than normal increase in attenuation and lack of volume reduction’ as seen on end expiration CT scans [41]. In the context of chronic HP diagnosis, mosaic attenuation is almost always used as a synonym of small airway involvement and air trapping [30,42]. One of the first studies, published by Small et al., attempted to document the distribution of air-trapped areas on CT scans of 20 patients with subacute HP through qualitative assessment; lobular areas that did not increase in attenuation or did not decrease in volume would be considered as areas of air trapping. Air trapping was found in 75% of the patients. There was no correlation between the extent of air-trapping areas with lung function tests [30].