PDF Version Differential Diagnosis of Pulmonary Infiltrates in ICU Patients. Windows Vista 64-Bit X64 Recovery Disc Download. Silvia Blanco. Antoni Torres The complexity of patients in the intensive. OBJECTIVE. The purpose of this article is to review the imaging features of necrotizing fasciitis and its potential mimics. Key imaging features are emphasized to. Lung nontumor Acute respiratory distress syndrome ARDS diffuse alveolar damage DAD. Chapter 1. 0 Respiratory System. STRUCTURE AND FUNCTIONMorton Lippmann. The respiratory system extends from the breathing zone just outside of the nose and mouth through the conductive airways in the head and thorax to the alveoli, where respiratory gas exchange takes place between the alveoli and the capillary blood flowing around them. Its prime function is to deliver oxygen O2 to the gas exchange region of the lung, where it can diffuse to and through the walls of the alveoli to oxygenate the blood passing through the alveolar capillaries as needed over a wide range of work or activity levels. In addition, the system must also 1 remove an equal volume of carbon dioxide entering the lungs from the alveolar capillaries 2 maintain body temperature and water vapour saturation within the lung airways in order to maintain the viability and functional capacities of the surface fluids and cells 3 maintain sterility to prevent infections and their adverse consequences and 4 eliminate excess surface fluids and debris, such as inhaled particles and senescent phagocytic and epithelial cells. It must accomplish all of these demanding tasks continuously over a lifetime, and do so with high efficiency in terms of performance and energy utilization. The system can be abused and overwhelmed by severe insults such as high concentrations of cigarette smoke and industrial dust, or by low concentrations of specific pathogens which attack or destroy its defence mechanisms, or cause them to malfunction. Its ability to overcome or compensate for such insults as competently as it usually does is a testament to its elegant combination of structure and function. A 62yearold man presents with a threeday history of progressive dyspnea, nonproductive cough, and lowgrade fever. His blood pressure is 10060 mm Hg, his heart. A posterioranterior PA chest Xray is the standard view used other views lateral or lordotic or CT scans may be necessary. In active pulmonary TB, infiltrates. Pulmonary edema may be classified as increased hydrostatic pressure edema, permeability edema with diffuse alveolar damage DAD, permeability edema without DAD, or. Lunge/ima/InfAlvInfThA13_4.JPG' alt='Patchy Opacity And Infiltrates' title='Patchy Opacity And Infiltrates' />
Mass Transfer The complex structure and numerous functions of the human respiratory tract have been summarized concisely by a Task Group of the International Commission on Radiological Protection ICRP 1. The conductive airways, also known as the respiratory dead space, occupy about 0. They condition the inhaled air and distribute it, by convective bulk flow, to the approximately 6. WqMK8cizeUcJWc4iIEcfaQ127018' alt='Patchy Opacity And Infiltrates Meaning' title='Patchy Opacity And Infiltrates Meaning' />
As tidal volumes increase, convective flow dominates gas exchange deeper into the respiratory bronchioles. In any case, within the respiratory acinus, the distance from the convective tidal front to alveolar surfaces is short enough so that efficient CO2 O2 exchange takes place by molecular diffusion. By contrast, airborne particles, with diffusion coefficients smaller by orders of magnitude than those for gases, tend to remain suspended in the tidal air, and can be exhaled without deposition. Figure 1. 0. 1 Morphometry, cytology, histology, function and structure of the respiratory tract and regions used in the 1. ICRP dosimetry model A significant fraction of the inhaled particles do deposit within the respiratory tract. The mechanisms accounting for particle deposition in the lung airways during the inspiratory phase of a tidal breath are summarized in figure 1. Particles larger than about 2 m in aerodynamic diameter diameter of a unit density sphere having the same terminal settling Stokes velocity can have significant momentum and deposit by impaction at the relatively high velocities present in the larger airways. Particles larger than about 1 m can deposit by sedimentation in the smaller conductive airways, where flow velocities are very low. Finally, particles with diameters between 0. This volumetric exchange occurs because of the variable time constants for airflow in the different segments of the lungs. Patchy Opacity And Infiltrates In The LungDue to the much longer residence times of the residual air in the lungs, the low intrinsic particle displacements of 0. Figure 1. 0. 2 Mechanisms for particle deposition in lung airways The essentially particle free residual lung air that accounts for about 1. The number of particles deposited and their distribution along the respiratory tract surfaces are, along with the toxic properties of the material deposited, the critical determinants of pathogenic potential. The deposited particles can damage the epithelial andor the mobile phagocytic cells at or near the deposition site, or can stimulate the secretion of fluids and cell derived mediators that have secondary effects on the system. Soluble materials deposited as, on, or within particles can diffuse into and through surface fluids and cells and be rapidly transported by the bloodstream throughout the body. Aqueous solubility of bulk materials is a poor guide to particle solubility in the respiratory tract. Solubility is generally greatly enhanced by the very large surface to volume ratio of particles small enough to enter the lungs. Furthermore, the ionic and lipid contents of surface fluids within the airways are complex and highly variable, and can lead to either enhanced solubility or to rapid precipitation of aqueous solutes. Furthermore, the clearance pathways and residence times for particles on airway surfaces are very different in the different functional parts of the respiratory tract. The revised ICRP Task Groups clearance model identifies the principal clearance pathways within the respiratory tract that are important in determining the retention of various radioactive materials, and thus the radiation doses received by respiratory tissues and other organs after translocation. The ICRP deposition model is used to estimate the amount of inhaled material that enters each clearance pathway. These discrete pathways are represented by the compartment model shown in figure 1. Figure 1. 0. 3 Compartment model to represent time dependent particle transport from each region in 1. ICRP model. Particle transport rate constants shown beside the arrows are reference values in d. Compartment numbers shown in the lower right hand corner of each compartment box are used to define clearance pathways. Thus, the particle transport rate from bb. BB1 is denoted m. They correspond to the anatomic compartments illustrated in figure 1. Table 1. 0. 1 Respiratory trract regions as defined in particle deposition models. Anatomic structures included. ACGIH Region. ISO and CEN Regions. ICRP Task Group Region. ICRP Task Group Region. Nose, nasopharynx Mouth, oropharynx, laryngopharynx. Head airways HARExtrathoracic ENasopharynx NPAnterior nasal passages ET1All other extrathoracic ET2 Trachea, bronchi. Latest Networking Devices Pdf there. Tracheobronchial TBRTracheobronchial BTracheobronchial TBTrachea and large bronchi BBBronchioles to terminal bronchioles Bronchioles bb Respiratory bronchioles, alveolar ducts, alveolar sacs, alveoli. Gas exchange GERAlveolar APulmonary PAlveolar interstitial AI Extrathoracic airways As shown in figure 1. ICRP 1. 99. 4 into two distinct clearance and dosimetric regions the anterior nasal passages ET1 and all other extrathoracic airways ET2 that is, the posterior nasal passages, the naso and oropharynx, and the larynx. Particles deposited on the surface of the skin lining the anterior nasal passages ET1 are assumed to be subject only to removal by extrinsic means nose blowing, wiping and so on. The bulk of material deposited in the naso oropharynx or larynx ET2 is subject to fast clearance in the layer of fluid that covers these airways. The new model recognizes that diffusional deposition of ultrafine particles in the extrathoracic airways can be substantial, while the earlier models did not.