Chronic Cough

Asthma. The airways typically show mucus plugging.

Asthma. Mucous plug with intraluminal inflammatory cells and hyperplasia of airway smooth muscle.

Asthma. The inflammatory cell infiltrate, predominantly eosinophils, extends focally into airspaces.

<bold>Figure 35.2</bold> Back pressure to blood circulation around the eyes leads to dark areas under the eyes in the child with allergic rhinitis.

<bold>Figure 35.5</bold> The child with asthma uses a peak flow meter and keeps track of readings on a daily basis.

FIGURE 1.37. Computed tomography (CT) diagnosis of bronchiectasis. High-resolution CT shows multiple cylindrically dilated bronchi that are not tapering. The diameter is substantially greater than that of adjacent pulmonary vessels (arrows).

FIGURE 14.1. The spectrum of bronchiectasis. The chest x-ray film (A) of a patient with idiopathic bronchiectasis is relatively unremarkable despite the fact that bronchiectasis is seen on an accompanying computed tomographic (CT) scan (B). The patient had obstructive lung disease with persistent bilateral basilar crackles. In contrast, the chest x-ray film (C) of a patient with postinfectious bronchiectasis shows diffuse dilated air spaces that are also well seen on CT scan (D). This patie...

FIGURE 14.2. The signet ring sign. The diagram shows the relationship of the dilated bronchiole and small accompanying pulmonary artery that form a "signet ring" (indicated by an arrow in the computed tomographic scan).

FIGURE 20.3. Chest radiograph (posteroanterior view only) demonstrating the radiographic presentation of miliary tuberculosis.

FIGURE 20.4. Chest radiographs (posteroanterior and lateral views) demonstrating cavitary reactivation of latent tuberculosis infection in the posterior apical segment of the right upper lobe.

Figure 189.1. Chest radiograph demonstrating apical infiltrate with cavitation, typical of pulmonary tuberculosis.

FIGURE 66.1. Photomicrographs of a sputum sample from an asthmatic patient. All of the micrographs were taken of unstained sputum samples pressed between a cover slip and a clear microscope slide. A sample was observed using the 40X objective and the 10X eyepiece. The final magnification of the micrographs is 1860X. (A) The broad arrow points to the brush border of a ciliated epithelial cell. Note the cell's apical nucleus and its pointed tail, which serves to fix the cell to the basement m...

FIGURE 66.1. Photomicrographs of a sputum sample from an asthmatic patient. All of the micrographs were taken of unstained sputum samples pressed between a cover slip and a clear microscope slide. A sample was observed using the 40X objective and the 10X eyepiece. The final magnification of the micrographs is 1860X. (A) The broad arrow points to the brush border of a ciliated epithelial cell. Note the cell's apical nucleus and its pointed tail, which serves to fix the cell to the basement m...

FIG. 2.2. Pulmonary complications. A: Sublobar atelectasis. Asthmatic child with acute asthma attack. Note area of apparent consolidation in the right paratracheal region (arrows). This represents collapse of one portion of the right upper lobe. A subtler finding assisting interpretation is that the minor fissure is slightly elevated. B: Pneumomediastinum. Asthmatic child with pneumomediastinum with air surrounding the small triangular thymus gland (T), extending as linear sheaths into the ...

FIGURE 82.1. Chest radiograph of older child with congestive heart failure. Note cardiac enlargement and evidence of pulmonary venous congestion.

FIG. 16.12. Pulmonary edema: varying causes and configurations. A: Acute glomerulonephritis. Note extensive interstitial pulmonary edema, moderate cardiomegaly, and moderate bilateral pleural effusions. The findings would be difficult to differentiate from acute myocarditis with failure. B: Near drowning. Note extensive fluffy, nodular infiltrates distributed throughout both lungs. In other patients, the infiltrates may be more diffuse or hazy and less nodular. C: Rheumatic pneumonia. This ...

<bold>Fig C 1-24 Pulmonary edema in pulmonary emphysema.</bold> (A) Initial chest radiograph demonstrates a paucity of vascular markings in the right middle and upper zones along with increased interstitial markings elsewhere. (B) With the onset of congestive heart failure, there is patchy interstitial and alveolar edema that does not affect the segments in which the vascularity had been severely diminished.

<bold>Fig C 2-1 Congestive heart failure.</bold> Diffuse bilateral symmetric infiltration of the central portion of the lungs along with relative sparing of the periphery produces the butterfly, or bat's wing, pattern. The margins of the edematous lung are sharply defined. The consolidation is fairly homogeneous and is associated with a well-defined air bronchogram on both sides.⁶

<bold><italic>FIGURE 6.64.</bold></bold> Apical four-chamber view recorded in an elderly patient with long-standing mild systemic hypertension and congestive heart failure due to predominantly diastolic dysfunction. Note the evidence of significant atrial enlargement, which is a marker of long-standing diastolic dysfunction. LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle

Figure 18-41<bold>ACUTE PULMONARY EDEMA. PA Chest.</bold>Observe the bilateral and symmetric alveolar densities in the perihilar zones, creating a characteristic bat-wing appearance (<italic>arrows</bold>). <bold><italic>COMMENT:</bold></bold>fiuffy increased density in a perihilar distribution, creating a batwing or angel-wingpattern. There is relative sparing of themore peripheral zones of the lung ?elds. (1,5) (Fig. 18-41) Airbronchograms become evident as the edema becomes moreopaque. This type of edema most commo...

Figure 18-42<bold>CHRONIC PULMONARY EDEMA. PA Chest.</bold>A close-up of the lung base demonstrates pulmonary congestion with a hazy appearance to the aerated lung, multiple Kerley B lines (<italic>arrows</bold>), and a small pleural effusion.<bold><italic>COMMENT:</bold></bold>Pulmonary congestion secondary to congestive cardiac failure displays the features seen here. Ancillary findings include upper lobe venous distension and peribronchial thickening.

A 72-year-old woman in pulmonary edema. The left ventricle is enlarged. The left atrial appendage portion of the left heart border is nearly convex (arrow). The upper lobe vessels are dilated and indistinct. The diffuse and inhomogeneous infiltrates involve the lower lungs, sparing the upper lobes.

<bold>Figure 19-2</bold> Boggy inferior turbinates seen with allergic rhinitis. (Courtesy of Paul S. Matz, MD.)

Cleaved cell (butt) CELL TYPE: Lymphocyte DESCRIPTION: Small, mature lymphocyte with cleaved nucleus CLINICAL CONDITIONS: Pertussis (Whooping cough) Lymphoma CLL

<bold>Figure 4.27. Kerley lines in patients with congestive heart failure. A,</bold> AP radiograph shows prominent interstitial markings in both bases with a fine interlacing pattern. <bold>B,</bold> detail view shows the linear horizontal Kerley B-lines in the periphery. <bold>C</bold> and <bold>D,</bold> detail views of two other patients show similar findings.

<bold>Figure 4.88. Pulmonary edema.</bold> There are fluffy alveolar densities throughout both lungs. The cardiac silhouette is obscured in this patient with congestive heart failure.

<bold>Figure 4.131. Asthma in a child. A,</bold> frontal and <bold>B,</bold> lateral views show hyperinflation. There is peribronchial cuffing (<i>arrows</i>). Note the flat diaphragm in <bold>B.</bold>

<bold>Figure 5.33. Congestive heart failure and pulmonary edema. A.</bold> Frontal view shows mild pulmonary edema and pulmonary venous engorgement. <bold>B.</bold> Detail view shows the edema and prominent septal (Kerley) lines. <bold>C.</bold> Detail view in another patient shows the prominent horizontal Kerley lines.

Back pressure to the blood circulation around the eye orbit from allergic rhinitis may lead to dark areas under the eyes (allergic shiners). The frequent rubbing of the nose in an upward direction can lead to a peculiar horizontal crease (Dennie's line).

Gastroesophageal Reflux Disease (GERD) Labeled

Bronchiectasis. The resected upper lobe shows widely dilated bronchi, with thickening of the bronchial walls and collapse and fibrosis of the pulmonary parenchyma.

Necrotizing granuloma due to M. tuberculosis. A small tuberculous granuloma with conspicuous central caseation is present in the pulmonary parenchyma.

Cavitary tuberculosis. The apex of the left upper lobe shows tuberculous cavities surrounded by consolidated and fibrotic pulmonary parenchyma, which contains small tubercles.

Miliary tuberculosis. Multiple millimeter-sized nodules are scattered throughout the lung parenchyma.

Tuberculous spondylitis (Pott disease). A vertebral body is almost completely replaced by tuberculous tissue. Note the preservation of the intervertebral discs.

Mycobacterium tuberculosis. A smear of a pulmonary lesion shows slender, beaded, acid-fast bacilli.

FIG. 2.2. Pulmonary complications. A: Sublobar atelectasis. Asthmatic child with acute asthma attack. Note area of apparent consolidation in the right paratracheal region (arrows). This represents collapse of one portion of the right upper lobe. A subtler finding assisting interpretation is that the minor fissure is slightly elevated. B: Pneumomediastinum. Asthmatic child with pneumomediastinum with air surrounding the small triangular thymus gland (T), extending as linear sheaths into the ...

FIG. 2.2. Pulmonary complications. A: Sublobar atelectasis. Asthmatic child with acute asthma attack. Note area of apparent consolidation in the right paratracheal region (arrows). This represents collapse of one portion of the right upper lobe. A subtler finding assisting interpretation is that the minor fissure is slightly elevated. B: Pneumomediastinum. Asthmatic child with pneumomediastinum with air surrounding the small triangular thymus gland (T), extending as linear sheaths into the ...

FIG. 16.8. Pulmonary edema: radiographic findings. A: Kerley B lines in interstitial pulmonary edema. These are short opaque lines (arrowhead) seen best along the lateral aspects of the lungs. Thickened interlobular septa from lymphangitic spread of tumor can produce an identical appearance. B: Diffuse alveolar pulmonary edema shows ill-defined opacification in both lungs that is most prominent in the perihilar regions. C: Classical butterfly pattern of pulmonary edema in a uremic patient.

FIGURE 1.31. Positron emission tomography (PET) in staging of lung cancer. A, B: Chest radiographs in a 64-year-old woman show a left hilar mass. C: Computed tomography (CT) confirms a left hilar mass and shows a left effusion. D: PET scan confirms marked increased uptake in the left hilar mass. E: PET also shows diffuse increased uptake in the left pleural space, compatible with malignant pleural effusion. F: In addition, a left supraclavicular node is found on PET that was not identified ...