chest “

2-a

abcess

2nd suppurative syndrome

Bronchiectasis
3 5
By definition :
permenant dilatation of bronchi 
Etiology
1ry and 2ry congenital and acquired 
acquired
Acquired bronchiectasis
infection and fibrosis
bronchial obstruction
infection and fibrosis
descend bronchii durin inspiration elastic fibres bronchial wall 
expiration elastic fibers stretch
inspiration is active and expiration is passive recoil
elastic fibers with replacement , damage of elastic fibers infection 
descend during inspiration bronchi fibrous tissue
recoil during expiration

wall of bronchi inflammation Infection

Tb and asperigillous
bronchiectasis and fibrosis
 bronchial obstruction
complete partial 
bronchiectasis partial 

valve like actions

valve like mechanism bronchiectasis
complete “ Total obstruction “ : 

stagnant secretions pressure : Proximally
infection and fibrosis
negative pressure equal to -6 pleura Distally :
pressure 3 01
 7
pressure pressure 
“ alveoli collapse alveoli pleura
negative 8 pressure “
bronchiectasis suction and retraction of the wall pressure

bronchiectasis complete obstruction

Proximally : Stagnant secretions  fibrosis and infections “ pressure increase 0
proximally “
Distally : collapse  pressure of pleura  Traction wall of bronchus 2

Bronchial obstruction ?
2 , wall 2 , lumen 2
lumen 2 0
Foreign body 
Secretions 

wall 2 2
Bronchogenic carcinoma 
Stricture 

 bronchus 2 3
Lymph node 
Tumor 

Congenital bronchiectasis

isolated 0
lobe bronchiectasis 
Immunoglobulin deficiency 2
congenital hypogammaglobinema3 
Immotile cilia syndrome I 3
secretions cilia 
stasis of bronchus cilia motility of cilia dimin
infection and fibrosis  secretions

cilia bronchus syndrome 

stagnant secretion immotile cilia
In sinus  sinusitis 
Fallopian tube  infertility 
Sperm  infertility 
immotile cilia + dextrocardia = kartgner’s syndrome 
situs inversus totalis 
Bilateral kidney ?
right kidney

etiology

Pathology
Bronchiectasis is bilateral basal disease
exceptions
foreign body , isolated , or bronchogenic unilateral 
carcinoma
 bilateral ? unilateral bronchial obstruction **
bronchogenic carcinoma unilateral bilateral 
bilateral
infection bronchiectasis 
unilateral basal Bilateral 
TB apical ? basal 

bilateral basal bronchiectasis

‫ اما كدا اسمه‬fusiform ‫ اسمه‬.. ‫ و ده كدا‬, saccular =D
Cylidierical

pus lumen
congested musoca ,
replaced by fibrous tissue elastic fibers wall

wall  ‫ و بعد كدا ال‬. mucosa  congested ‫ بعد كدا ال‬, lumen contain pus 
elastic fibers is replaced by fibrous tissue
pleurisy overlying pleura 

Symptoms :
Dyspnea , cough -0
productive .. cough ‫اوصفلي ال‬
.. sputum ‫طيب و ال‬
yellowish → suppuritive 
Foul odour → anaerobes 
Excessive in amount 
leaning forworad
leaning forward or lying position sputum lying backward
on back
Pain 2
due to pleurisy
 damaged **
pneuomothorax compensatory empsyema

Ruptued pneuomothorax pleurisy pain **

compensatory emphysema

Constitutional symptoms 3
wheezes and haempotysis 4
hempotysis bronchiectasis haempotysis only 
TB only
Bronchiectasis sicca hemorrhagica 
haempotysis dry Sicca **
present viscid caseous material TB
only with hempotysis

Symptoms of cause and complications 5

examination 
cavities and fibrosis basal part
emphysema and narrow bronchi

bronchii basal part sputum 

bronchitis infected sputum , bronchi expectoration
narrow bronchi

Inspection :
: Shape
retraction bulge 
Movement :
Restricted on affected side * 
Apex :
normal 
Skin :
‫مافيش‬
 Palpation :
Trachea  central 
Tenderness  on affected side 
TVF   basal &  in upper part 
Apical Pulsation  normal 
rub and rhonci 

Percussion :
dull resonant

auscultation :
Bronchial breathing , crepittions , rhonci and whierping pectrileqy 
vesicular breathing 

General :
chronic infection
Bad general condition , fatigue and loss of weight and lower limb edema
cor pulmonale and amylodosis fibrosis L.L edema ?
hypoproteinema proteins sputum

investigations
lab ?
Blood  CBC  leucocytosis and  C Reactive ptn 0
Congenital gammaglobinema immunoglobulin
Sputum : culture and sensitivity 2
Tuberclin 3

Radiological
Xray
honey comb abcess base pus cavities 0
cavities
tram line appearance thickened wall of bronchi 2
=D

emphysema  hyper translucent 3

And definitely CT is more diagnostic than X Ray

trachea
dilated xray
trachea
It was very strange 

=D
pleural pressure
 pneuomothorax

CT
foreign body chroncoscope
pus  culture and sensitivity **
foreign body

Treatment
symptomatic treatment
Antipyretic , analgesic and mucolytcs 
clindamycin metronidazole for anaerobes antibiotic 
ciprofloxacin antibiotic 
sutrim **
amoxicillin **
antibiotic acc to culture and sensitivity
surgically ? 
unilateral  maybe bronchogenic carcinoma 
symptoms endanger his life like severe mepotysis 
failed medical treatment 
abcess bronchiectasis
Aspiration pneumona
 MCQ
polycystic Lung , Mucovisidosis and cystic fibrosis 3
mucovisidosis

visid watery mucus Mucus surface 

Water follows sodium sodium water ,
Reabsorption of Na secretion of Na 

Lumen trapping NaCl chloride Na 

channels chloride Chloride channels 
absorption Reabsorbtion of Na Cl
viscid Mucos
Chromosome 7 mucovisidosis 
Chloride channels

record channel

Na will be cholide gene on chromosome 7 

viscid mucus absorbed
bronchi viscid mucus bronchi 

mucus level
Git  Viscid mucus
Intestine  Viscid mucos  intestinal obstruction  meconeum illeus
meconium hard stool mucus
pancrease  viscid pancreatic secretions  obstruction and pancreatitis
Bile  viscid secretions  biliary obstruction

lung polycystic lung Mucovisidosis

excreted Sodium sweat

70mEq/L sweat
70 mEq/L NA 7 **
=D “ 7 71
 Investigations

sodium in sweat 0
DNA analysis 2
karyotyping Karyotyping
chromosome not gene karyotyping 
deleteion
PCR gene defect
karyotyping gene mutation PCR 
soap pubble appearance cavities X Ray 3
pancreatic function test 4

Treatment
Symptomatic treatment 0
antibiotic  chest infection
5 05 – 04
=D 31

Trial of gene tjerapy **

gene therapy studies johns Hopkins
mortality

lung abcess bronchiectasis suppurative lung disease

aspiration pneumonia

6 mediastinum
6 anatomy

mediastinum
area bounded Anteriorly by sternum , posteriorly by thoracic vertebrae and laterally by parietal pleura

lower border of 4th vertebrae angle of Lewis mediastinum **

Inferior an superior mediastinum
lower border of 4th angle of lewis imaginary line
superior and inferioir mediastinum vertebrae
anterioir , middle and posterioir inferioir

Content
content superior mediastinum
3
3 tubes  esophagus , trachea , thoracic duct
=D Thoracic duct vessel
3 vessels  arch of aorta , 2 innominate veins & Superior vena cava
3 nerves  phrenic , vagus and sympathetic chain

lymph node and fat mediastinum +

content of anterior mediastinum

lymph node and fat mediastinum
Thymus gland

content o f Middle mediastinum

Heart
pericardium and phrenic nerve heart 
: aortic and pulmonary heart 
2 bronchi heart 
lymph node and fat mediastinum +

content of posterior mediastinum

2
2 tubes , 2 vessels , 2 nerves
trachea , esophagus and thoracic duct tubes 3 
Esophagus and thoracic duct
vagus and sympathetic chain nerves 3 
superioir vena cava aorta 3 vessels 
bleeding per rectum =D rectum
heart superior vena cava azygos vein aorta

mediastinum
 Mediastinal syndrome
Etiology :
mediatsinal content content 
syndrome

conent
Superioir mediastinum 0
Esophagus esophageal caner
, trachea  bronchogenic carcinoma
thoracic duct  ,
3 nerves
neurofibroma tumor
3 vessels
Aorta  aortic aneurism
Veins 

Fat  lipoma
Lympgh node  lymphoma

Anterior mediastinum 2
Thymus  thymoma
Fat  lipoma
Lympgh node  lymphoma

Middle mediastinum 3
Pericardium  effusion
heart  cardiomegaly
phrenic  neurofibroma

Aortic arch  aneurism

Bronchi  bronchogenic carcinoma

posterioir mediastinum 4
2 tubes
esophagus  esophageal cancer
Thoracic duct
2 nerves  neurofibroma
2 vessels  aortic aneurism
 content
Superioir mediastinum ==? Retrosternal goiter
Posterioir  hiatus hernia
fusion lines midline Anterioir  dermoid cyst  teratoma

Clinical picture
content of mediastinum clinical picture
3tubes , 3 vessels 3 nerves and 3 bones
3 nerves 0
Vagus  -
recurrent laryngeal nerve -
hoarseness of voice
sympathetic chain  -
horner syndrome -
Phrenic  -
cant be compressed -
crush sweeling vagus and sympathetic
sweeling vertebrae nerve against bones
against bone
compression displacement bone phrenic **
against hard surface **
infiltration malignancy

2 nerves 3
intercostals nerves nerve roots spinal cord
pain intercostals neuralgia intercostals nerves brachial plexus
pain in upper limb brachial neuralgia in intercosta space

roots of spinal cord nerve **

3 Tubes
3 tubes 2
Esophagus  dysphagia
Trachea  total  collapse
partial  bronchiectasis or emphysema
Thoracic duct  chylous effusion

3 vessels 3
vessels
diameter Aorta 
 branches
subclavian artery 
unequal pulse , unequal pressure and unilateral clubbing due to ischemia 
pleural effusion Azygos vein 
superior venacava 
S.V.C 
collaterals congested non pulsating neck veins
crossing costal margins superioir and inf ven cava
edema of head and neck and upper limb 
Head and neck edema

Necklaces
neck fitting **
=D 

=D

bones 4
Sternum A
retrosternal chest pain
mediastinal mass 
aortic aneurism retrosternal chest pain
retrosternal pain masses compression on sternum
irritation of nerves stretch wall of aorta
Vertebrae B
para or quadriplegia spinal cord collapse 

Ribs C
Chest pain \

Investigations
Ct , xray , lymphnode biopsy , bronchoscope , radioactive isotope , venograph
tumor symptoms
bronchi dyspnea dysphagia of esophagus

specific investigations swelling MRI

endoscopy esophageal mass MRI
echo heart mass MRI ’
 Mediastinoscope CT CT MRI
, mediastinum
exploration

biopsy or tuberculin or lymph node organ MRI

biopsy

=D

Chest

2-A