BRONCHIAL ANATOMY AN ANATOMICAL REMINDER ABOUT THE DIFFERENT LOBES AND SEGMENTS

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1 BRONCHIAL ANATOMY AN ANATOMICAL REMINDER ABOUT THE DIFFERENT LOBES AND SEGMENTS Dr Etienne Leroy-Terquem Centre hospitalier de Meulan les Mureaux. France French-cambodian association for pneumology (OFCP)

2

3 Trachea Main right bronchus Main left bronchus

4 Trachea Right superior lobe bronchus Left superior Lobe bronchus

5 Right bronchography

6 Left bronchography

7

8 Small fissura Large oblique fissura Right view

9 Left fissura Left view

10 The fissura are sometimes visible on the lateral view On the front view only small fissura are sometimes visible

11 Small fissura Right superior lobe pneumonia Large oblique fissura posterior part

12

13 Right inferior pneumonia Large oblique fissura

14

15 Small fissura Large fissura Middle lobe pneumonia

16

17 External segment of middle lobe pneumonia

18 External segment of middle lobe pneumonia

19 Left fissura Left superior lobe pneumonia

20

21 Left inferior pneumonia

22 Left inferior pneumonia Left scissura

23

24 Bronchial syndrome

25 Atelectasis Draining bronchus Bronchiectasis

26 Atelectasis These are the consequence of an obstruction of the bronchus by an intrinsic or extrinsic element (foreign body, benign or malignant tumor, acute or chronic inflammatory stenosis compression by adenopathy or tumor ) The alveolar air progressively disappears and the lung tissue retracts. This retraction can involve the segment, the lobe or the entire lung.

27 Main etiologies of atelectasis Bronchial cancer Tuberculosis Extrinsic compression by adenopathy or malignant tumor Foreign body (+++ young children ) Asthma Chronic bronchitis Viral or bacterial pneumonia Atelectasis after thoracic or abdominal surgery, after traumatism Many other rare etiologies: benign tumor, lymphoma, bronchus metastasis, acute bronchiolitis, inflammatory granuloma regardless of the etiology, broncholithiasis, bronchiolitis obliterans, mucoviscidosis

28 ATELECTASIS The radiologic image is a consolidation which is: Systematised (close to a fissura) Retractile (loss of volume) Homogeneous Without aeric bronchogram With a varied size: segment, lobe, entire lung

29 Tobacco = 40 packyears AFB sputum x 3 negative Right superior lobe atelectasis by cancer

30 Right superior lobe atelectasis by cancer

31 Right inferior lobe atelectasis

32 Middle lobe atelectasis

33 Partial atelectasis of the right superior lobe by cancer (Golden sign)

34 Middle lobe and right inferior lobe atelectesis

35 Man, 56 years old. High fever, right abdominal and thoracic pain, Muscular defense of the right hypochondrium, x-ray: Middle lobe atelectasis

36 Liver abcess: the reduction of right hemidiaphragm mobility leads to atelectasis above the diaphragm «passive atelectasis»

37 Similar case: The liver abscess resulted in inferior lobe atelectasis

38 Tobacco = 60 pack-years. Haemoptysis. thoracic pain and dyspnea - AFB sputum x 3 negative Left superior lobe atelectasis by cancer

39 right superior lobe atelectasis by cancer (A. Khallil and coll. EMC 386 C ) Notice the association with a big hilar round mass

40 Tobacco = 40 pack-years. Hemoptisy. Left anterior thoracic pain and cough. Recent weight loss and asthenia - AFB sputum x 3 negative Left superior lobe atelectasis by cancer Notice the round mass on the left hilus

41 The association of an atelectasis with a round mass strongly suggests cancer

42 Left inferior lobe atelectasis

43 1 year old child with TB primary phase. Bilateral adenopathies and left inferior atelectasis: the left mediastinum adenopathies compress left inferior bronchus

44 Retraction Whole left lung atelectasis

45 Pushing back Pleural effusion Left atelectasis Retraction

46 Draining bronchus TB cavity bacterial non-tb abscess +

47

48 TB cavity Notice the draining bronchus and right axillar infiltrate

49 TB cavity with a draining bronchus

50 Bronchectasis This is a bronchus disease characterised by a permanent increase of the bronchus calibre. The cartilaginous framework of the bronchus wall is destroyed or broken up.

51 Bronchectasis Etiologies Localised -Tuberculosis, bacterial or viral infection, especially in children (measles, whooping cough..) - foreign body - Bronchus stenosis, extrinsic compression (adenopathy) Diffuse - Tuberculosis, bacterial or viral infection, especially in children (measles, whooping cough..) mucoviscidosis other congenital diseases: Situs inversus, imotile cilia syndrome Disglobulinemy, chronic immune deficit, chronic autoimmune affections

52 Bronchectasis

53 Bronchectasis

54 Rail picture: Cylindric bronchectasis

55

56 Unilateral bronchiectasis

57

58 Bilateral bronchectasis

59 Bilateral bronchectasis

60 Digital hippocratism is often associated with bronchectasis

61 Woman, 25 years old, cough and chronic expectoration Measles at 6 years old

62

63 Woman, 54 years old, recurrent severe bronchopneumonia at 2 years old

64

65 after antibiotic therapy against Pseudomonas aeruginosa

66 Young woman, 20 years old, recurrent bronchus infections from a very early age, and gradual respiratory deficiency MUCOVISIDOSIS (1 case/ 2000 births in Europe)

67

68 Young boy, TB primary phase at 1 year old (1945)

69 22 years later (1967)

70 60 years later (2006)

71 Bronchectasis post-tb

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