α physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12]...

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Physiologic correlation Boyle's Law P.V = K Hooke's Law ΔL αΔT Laplace's Law ΔP = 2.T/r • Poiseuille's Law R = 8.L.eta/(pi.r 4 ) The Fanning Equation ΔP α 1/r 5 • Fick's Law Vgas α A*ΔP/L Graham's Law D α sol / MW 0.5 Charles' Law V = K'. T a b c d d

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Page 1: α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12] Cases with physiologic correlation... · Morphology Physiology Physiology of lung

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

Page 2: α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12] Cases with physiologic correlation... · Morphology Physiology Physiology of lung

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

Page 3: α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12] Cases with physiologic correlation... · Morphology Physiology Physiology of lung

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

Page 4: α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12] Cases with physiologic correlation... · Morphology Physiology Physiology of lung

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

Page 5: α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12] Cases with physiologic correlation... · Morphology Physiology Physiology of lung

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

Page 6: α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12] Cases with physiologic correlation... · Morphology Physiology Physiology of lung
Page 7: α Physiologic correlation - medinfo2.psu.ac.thmedinfo2.psu.ac.th/pr/chest2012/chest2010/pdf/[12] Cases with physiologic correlation... · Morphology Physiology Physiology of lung

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.