α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12]...
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Transcript of α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12]...
Physiologic correlation
• Boyle's Law P.V = K • Hooke's Law ΔL α ΔT • Laplace's Law ΔP = 2.T/r• Poiseuille's Law R = 8.L.eta/(pi.r4)• The Fanning Equation ΔP α 1/r5
• Fick's Law Vgas α A*ΔP/L• Graham's Law D α sol / MW0.5
• Charles' Law V = K'. T
a
b
cd
d
MorphologyPhysiology
Physiology of lung
1. Perfusion, Q2. Ventilation, V3. Lymph flow, L4. Stress or Strain, S
Relate with gravity.Upper and lower portions are different.
• Vertical physiology• Axial physiology• Physiology of the secondary pulmonary
lobule
Cross-sectional imagingVertical physiology
Vertical Physiology
• Upper lobe predominant:Tbc, Silicosis and Sarcoidosis
(Less lymph flow)
• Lower lobe predominantMetastases, Pulmonary edema
(More perfusion)
Axial physiology
Axial physiology• Pulmonary Cortex vs Medulla
Axial Streaming
100 micron7.5‐80 micron
Silicone injection Bat’s wing
Perfusion• Lung Metastases
Cortex and lower
Perfusion
• Poisoning (Bleomycin), Immune complex in Scleroderma or Rheumatoid
Cortex, Lower, Posterior
Scleroderma
Ventilation• Particle size < 5 micron : Terminal
bronchiole, Alveolar space • Particle size < 1 micron :
Respiratory bronchiole, Alveolar sac
Ventilation
• Large particles : - Restore and excrete by Cilia- Half life : 20 minutes- Affect bronchus
• Small particles : - No cilia in the cortex- Eliminate by Macrophage - Half life : weeks
• - Affect bronchiole (Smoking)
Lymphatic drain
Lymphatic drain
• Depends on gravity and chest movement
• More expansion of anterior than posterior ribs
- Good lymph flow Ventral> Dorsal
Lymphatic drain
• Extravascular fluid drainage
- Cortex > medulla - Bat’s wing sign in
pulmonary edema
Lymphatic drain
• Residual disease usually found in upper, dorsal and central
- Superior segment of lower lobe - Posterior segment of upper lobe
Stress or Stain
• Upper > Lower• Cortex > Medulla• Examples : Cavity, emphysema, bleb
and bulla in upper lobe and superior segment of the lower lobe
Emphysema in upper + peripheral parts
Secondary pulmonary lobuleSecondary pulmonary lobule
• Blood circulation : Core > Periphery (4 times)
• Transit time : Periphery > Core
Bronchopneumonia
• Lobules can be heterogeneous
-Particles finally goes to cortex.-Diseases can appear at anywhere.-Immune-activated chronic inflammation trends to remain at lower, dorsal cortex.-Residuals from immune clearance remain in upper, dorsal medulla.-Cavities trend to appear in peripheral upper.-Physiologic correlation can be better appreciated with CT.