Systemic Disorders of the Lung

8/8/2019 Systemic Disorders of the Lung

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Systemic disorders and the lung

ByProf. Hatem El Mallawany

Systemic disorders and the lung

ByProf. Hatem El Mallawany

Professor and Head of Chest Department

Faculty of Medicine

Alexandria University

Professor and Head of Chest Department

Faculty of Medicine

Alexandria University


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The lung is a common site ofdisease in several disorders whichprimarily affect other organs.

Such involvement can arise as partof the underlying systemic

disorder, or as a complication of itstreatment.

The lung is a common site ofdisease in several disorders whichprimarily affect other organs.

Such involvement can arise as partof the underlying systemic

disorder, or as a complication of itstreatment.


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Respiratory manifestations of

systemic diseases andconditions

Respiratory manifestations of

systemic diseases andconditions Rheumatic fever:

It can lead to the followingpulmonary manifestations:

Rheumatic pneumonia (treatment asrheumatic activity).

Pulmonary edema or pleural effusion

(from congestive heart failure).

Pulmonary hemosiderosis.

Pulmonary infarction.

Rheumatic fever:

It can lead to the followingpulmonary manifestations:

Rheumatic pneumonia (treatment asrheumatic activity).

Pulmonary edema or pleural effusion

(from congestive heart failure).

Pulmonary hemosiderosis.

Pulmonary infarction.


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Rheumatoid disease: It can lead to the following pulmonary

manifestations: Pleural thickening and pleural effusion.

Interstitial fibrosis.

Rheumatoid nodule in coal worker (Caplanssyndrome).

Lung nodules (single or multiple).

Pleuroperocarditis.

Pulmonary hypertension.

Increased incidence of respiratory infections.

Rheumatoid disease: It can lead to the following pulmonary

manifestations: Pleural thickening and pleural effusion.

Interstitial fibrosis.

Rheumatoid nodule in coal worker (Caplanssyndrome).

Lung nodules (single or multiple).

Pleuroperocarditis.

Pulmonary hypertension.

Increased incidence of respiratory infections.


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Sjogren syndrome I.e. Siccasyndrome which is a rheumatoidvariant affecting the lacrimalglands and salivary glands(keratoconjunctivitis sicca).

It causes decrease in the secretionof the mucus glands of bronchi andthus leads to dry cough, Secondar

infection and even pneumonia.

Sjogren syndrome I.e. Siccasyndrome which is a rheumatoidvariant affecting the lacrimalglands and salivary glands(keratoconjunctivitis sicca).

It causes decrease in the secretionof the mucus glands of bronchi andthus leads to dry cough, Secondar

infection and even pneumonia.


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Systemic Lupus Erythematosis (SLE):

It can lead to the following pulmonary

manifestations: Pleural effusion, pleural thickening which may be

unilateral or bilateral (LE cells and antinuclearfactor are positive in the pleural aspirate).

Interstitial fibrosis (IF).

Pneumonic consolidation either directly due toSLE or due to secondary infection.

Pericarditis.

Increased incidence of pulmonary embolism.

Systemic Lupus Erythematosis (SLE):

It can lead to the following pulmonary

manifestations: Pleural effusion, pleural thickening which may be

unilateral or bilateral (LE cells and antinuclearfactor are positive in the pleural aspirate).

Interstitial fibrosis (IF).

Pneumonic consolidation either directly due toSLE or due to secondary infection.

Pericarditis.

Increased incidence of pulmonary embolism.


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Scleroderma (Progressive SystemicSclerosis):

It can lead to the following pulmonarymanifestations: Interstitial fibrosis (IF).

Dyspnea due to changes (fibrosis) in the chestwall and diaphragm rather than the lungs.

Aspiration (chemical) pneumonia from spill-overfrom the dilated esophegus (which has decreasedperistalisis).

Scleroderma (Progressive SystemicSclerosis):

It can lead to the following pulmonarymanifestations: Interstitial fibrosis (IF).

Dyspnea due to changes (fibrosis) in the chestwall and diaphragm rather than the lungs.

Aspiration (chemical) pneumonia from spill-overfrom the dilated esophegus (which has decreasedperistalisis).


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Pleural thickening or pleural effusion.Scleroderma is one of the non-metastatic extra-thoracic manifestations of bronchial carcinoma.

Pulmonary edema secondary to heart failure fromsystemic (renal) hypertension.

Bronchiectasis.

N.B: CREST syndrome is a type ofscleroderma in which there calcinosis of softtissues, Raynauds phenomena, esophagealimmobility, Sclerodactly i.e. changes andulcers in the fingers.

Pleural thickening or pleural effusion.Scleroderma is one of the non-metastatic extra-thoracic manifestations of bronchial carcinoma.

Pulmonary edema secondary to heart failure fromsystemic (renal) hypertension.

Bronchiectasis.

N.B: CREST syndrome is a type ofscleroderma in which there calcinosis of softtissues, Raynauds phenomena, esophagealimmobility, Sclerodactly i.e. changes andulcers in the fingers.


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Dermatomyositis

It can lead to interstitial pulmonaryfibrosis, pneumonia and respiratorymuscle weakness which in turn cancause hypoventilation.

Dermatomyositis

It can lead to interstitial pulmonaryfibrosis, pneumonia and respiratorymuscle weakness which in turn cancause hypoventilation.


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Stevens-Johnson syndrome(erythema multiforme):

Miliary or nodular shadows, areas ofconsolidation or Mycoplasma (primaryatypical) pneumonia. It is provoked

by drugs as aspirin andsulphonamides.

Stevens-Johnson syndrome(erythema multiforme):

Miliary or nodular shadows, areas ofconsolidation or Mycoplasma (primaryatypical) pneumonia. It is provoked

by drugs as aspirin andsulphonamides.


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Polyarteritis nodosa (PAN):

It can lead bronchial asthma,pulmonary eosinophilia and renalhypertension (vasculitis). If a similarcondition is associated withgranuloma and ulceration in theupper respiratory tract, it is describedas Wegeners granulmatosis).

Polyarteritis nodosa (PAN):

It can lead bronchial asthma,pulmonary eosinophilia and renalhypertension (vasculitis). If a similarcondition is associated withgranuloma and ulceration in theupper respiratory tract, it is describedas Wegeners granulmatosis).


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If a condition similar to PAN occurswith marked eosinophilia, more

asthmatic attacks, increased bloodIgE level, extravascular granulomas(not present in PAN), more systemicmanifestations and more lung

involvement, it is described as Churg-Strauss Syndrome which isallergic angiitis and granulomatosis.

If a condition similar to PAN occurswith marked eosinophilia, more

asthmatic attacks, increased bloodIgE level, extravascular granulomas(not present in PAN), more systemicmanifestations and more lung

involvement, it is described as Churg-Strauss Syndrome which isallergic angiitis and granulomatosis.


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Pulmonary vasculitis:

PAN, Wegeners granulomatosis, Churg-

Strauss syndrome (necrotizing angiitis),giant cell arteritis, rheumatoid arthritis,scleroderma and sarcoidosis arecomponents of the group of diseasesdescribed as Pulmonary vasculitis. Almostevery disease known to affect systemicarteries may involve the pulmonarycirculation as well.

Pulmonary vasculitis:

PAN, Wegeners granulomatosis, Churg-

Strauss syndrome (necrotizing angiitis),giant cell arteritis, rheumatoid arthritis,scleroderma and sarcoidosis arecomponents of the group of diseasesdescribed as Pulmonary vasculitis. Almostevery disease known to affect systemicarteries may involve the pulmonarycirculation as well.


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This group also includes Behcets diseasecharacterized by orogenital mucocutaneous

ulcers. Fever, arthritis, erythema multiform(Stevens-Johnson syndrome), vasculitis,thrombophlebitis, and occlusion of bloodvessels such as retinal vessels (leading toblindness), renal vessels (leading to

uremia), peripheral vessels (leading to deepvein thrombosis and pulmonaryembolization) or superior vena cava (SVC)thus leading to SVC obstruction syndrome.

This group also includes Behcets diseasecharacterized by orogenital mucocutaneous

ulcers. Fever, arthritis, erythema multiform(Stevens-Johnson syndrome), vasculitis,thrombophlebitis, and occlusion of bloodvessels such as retinal vessels (leading toblindness), renal vessels (leading to

uremia), peripheral vessels (leading to deepvein thrombosis and pulmonaryembolization) or superior vena cava (SVC)thus leading to SVC obstruction syndrome.


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SarcoidosisSarcoidosis Sarcoidosis is a multi-system

granulomatous disorder of unknownetiology which is characterized byformation of non-caseating granuloma.

It can affect almost every organ in thebody.

Its variable clinical, immunological and

biochemical manifestations have beenintensively studied over the lasthundred years since the disorder wasfirst recognized.

Sarcoidosis is a multi-systemgranulomatous disorder of unknownetiology which is characterized byformation of non-caseating granuloma.

It can affect almost every organ in thebody.

Its variable clinical, immunological and

biochemical manifestations have beenintensively studied over the lasthundred years since the disorder wasfirst recognized.


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The most common presenting featuresare bilateral hilar lymphadenopathy,pulmonary infiltrations and skin or eyelesions, but the spectrum of clinicalpresentation is very wide and maymimic other diseases.

An acute onset with erythema nodosum

and bilateral hilar lymphadenopathyheralds a benign self-limiting coursewhich can often be shortened bycorticosteroid therapy.

The most common presenting featuresare bilateral hilar lymphadenopathy,pulmonary infiltrations and skin or eyelesions, but the spectrum of clinicalpresentation is very wide and maymimic other diseases.

An acute onset with erythema nodosum

and bilateral hilar lymphadenopathyheralds a benign self-limiting coursewhich can often be shortened bycorticosteroid therapy.


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An insidious onset is usually followed bythe development of progressive fibrosis

and organ damage.T

his may bemodified but not necessarily prevented,by corticosteroid therapy.

Granulomas are commonly distributedthroughout the body without causingsignificant organ dysfunction but maybe concentrated in one or more organswith striking clinical effects.

An insidious onset is usually followed bythe development of progressive fibrosis

and organ damage.T

his may bemodified but not necessarily prevented,by corticosteroid therapy.

Granulomas are commonly distributedthroughout the body without causingsignificant organ dysfunction but maybe concentrated in one or more organswith striking clinical effects.


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Renal diseases

Renal diseases

Renal diseases can lead to the followingpulmonary manifestations: Pulmonary edema (cardiogenic or non-

cardiogenic i.e. ARDS). If this pulmonaryedema becomes repeated, it can lead tohemosiderosis.

Interstitial fabrosis. Pleural effusion or uremic pleurisy (dry

pleurisy) Pericarditis or pericardial effusion. Uremic pneumonitis or pneumonia and

recurrent infections.

Renal diseases can lead to the followingpulmonary manifestations: Pulmonary edema (cardiogenic or non-

cardiogenic i.e. ARDS). If this pulmonaryedema becomes repeated, it can lead tohemosiderosis.

Interstitial fabrosis. Pleural effusion or uremic pleurisy (dry

pleurisy) Pericarditis or pericardial effusion. Uremic pneumonitis or pneumonia and

recurrent infections.


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Metastatic pulmonary infarctions. Dialysis can lead to pleural effusion. This

can occur in peritoneal dialysis as well as in

hemodialysis. Hemodialysis can lead to air or pulmonary

embolism. Peritoneal dialysis can lead tobasal atelectasis (from elevation of thediaphragm).

In renal transplant, immunosuppressivetherapy is described to avoid rejection ofthe transplanted kidney. This canpredispose to recurrent pulmonaryinfection.

Metastatic pulmonary infarctions. Dialysis can lead to pleural effusion. This

can occur in peritoneal dialysis as well as in

hemodialysis. Hemodialysis can lead to air or pulmonary

embolism. Peritoneal dialysis can lead tobasal atelectasis (from elevation of thediaphragm).

In renal transplant, immunosuppressivetherapy is described to avoid rejection ofthe transplanted kidney. This canpredispose to recurrent pulmonaryinfection.


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Pulmonary hemorrhage can occur inGoodpastures syndrome in other

types of vasculitis. Perinephric or cortical abscess can

lead to staphylococcal pneumoniathrough hematogenous spread of this

infection.

Pulmonary hemorrhage can occur inGoodpastures syndrome in other

types of vasculitis. Perinephric or cortical abscess can

lead to staphylococcal pneumoniathrough hematogenous spread of this

infection.


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Gastrointestinal diseasesGastrointestinal diseases The following pulmonary manifestations

can be associated with gastrointestinal

diseases: Tracheo-esophageal fistula can cause

aspiration pneumonia or lung abscess.

Gastrogenous cysts (gastroenteric or

enterogenous cysts) arising from theesophagus appear as posterior mediastinallesion.

The following pulmonary manifestationscan be associated with gastrointestinal

diseases: Tracheo-esophageal fistula can cause

aspiration pneumonia or lung abscess.

Gastrogenous cysts (gastroenteric or

enterogenous cysts) arising from theesophagus appear as posterior mediastinallesion.


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Hiatal hernia appears as a posteriormediastinal shadow with air-fluid

levels. Phayngo-esophageal diverticulum

(Zenkers diverticulum) appears as asuperior mediastinal shadow an can

lead to recurrent aspirationpneumonia.

Hiatal hernia appears as a posteriormediastinal shadow with air-fluid

levels. Phayngo-esophageal diverticulum

(Zenkers diverticulum) appears as asuperior mediastinal shadow an can

lead to recurrent aspirationpneumonia.


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Pulmonary manifestations of

intestinal disorders

Pulmonary manifestations of

intestinal disorders Intestinal disorders

Ulcerative colitis

Crohns disease.

Celiac disease

Intestinal disorders

Ulcerative colitis

Crohns disease.

Celiac disease

Pulmonarymanifestations: Airways parenchyma

(localized large airwaystenoses, bronchiectasis,chronic bronchitis,fibrosing alveolitis,organizing pneumonia).

Airways diseases (asabove).

Extrinsic allergicalveolitis, pulmonaryhemosiderosis,tuberculosis, atopicdisease.

Pulmonarymanifestations: Airways parenchyma

(localized large airwaystenoses, bronchiectasis,chronic bronchitis,fibrosing alveolitis,organizing pneumonia).

Airways diseases (asabove).

Extrinsic allergicalveolitis, pulmonaryhemosiderosis,tuberculosis, atopicdisease.


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Liver disordersLiver disorders Cirrhosis:

Hepatic cirrhosis may be associated with cyanosis,finger clubbing, and arterial oxygen desaturation

caused by multiple miscroscopic pulmonaryarteriovenous shuncts. Arteriovenous fistulas maynot be identified on a chest radiograph or in lungbiopsy specimens. Typically the gas transfer factor isreduced, and the hypoxemia cannot be abolished bygiving patients 100% oxygen. Two-dimensional

echocardioghraphy with contrast may confirm thediagnosis by demonstrating an intrapulmonary shunt.

Cirrhosis: Hepatic cirrhosis may be associated with cyanosis,

finger clubbing, and arterial oxygen desaturation

caused by multiple miscroscopic pulmonaryarteriovenous shuncts. Arteriovenous fistulas maynot be identified on a chest radiograph or in lungbiopsy specimens. Typically the gas transfer factor isreduced, and the hypoxemia cannot be abolished bygiving patients 100% oxygen. Two-dimensional

echocardioghraphy with contrast may confirm thediagnosis by demonstrating an intrapulmonary shunt.


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Fibrosing alveolitis:

Associations between fibrosing

alveolitis and primary biliary cirrhosisand chronic active hepatitis havebeen suggested.

Fibrosing alveolitis:

Associations between fibrosing

alveolitis and primary biliary cirrhosisand chronic active hepatitis havebeen suggested.


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Pancreatic disordersPancreatic disorders Acute respiratory insufficiency:

May occur in acute pancreatitis, and isthought to be the major factor in 25% of

deaths from this condition. In survivors,recovery appears to be complete with littlephysiological evidence of lung damage.

Pleural effusion: Occurs in up to 15% of patients with acute

pancreatitis and is typically on the left sideand painless (60%). Effusions are bilateralin 30% of patients and on the right side in10%.

Acute respiratory insufficiency: May occur in acute pancreatitis, and is

thought to be the major factor in 25% of

deaths from this condition. In survivors,recovery appears to be complete with littlephysiological evidence of lung damage.

Pleural effusion: Occurs in up to 15% of patients with acute

pancreatitis and is typically on the left sideand painless (60%). Effusions are bilateralin 30% of patients and on the right side in10%.


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Endocrine disordersEndocrine disorders Obesity:

An increased amount of fat in the

chest wall and abdomen reduces thevolume of the lungs and decreasesthe compliance of the respiratorysystem, particularly when the obese

patient lies flat. Hypoventilationoccurs, especially during rapid eyemovement sleep.

Obesity:

An increased amount of fat in the

chest wall and abdomen reduces thevolume of the lungs and decreasesthe compliance of the respiratorysystem, particularly when the obese

patient lies flat. Hypoventilationoccurs, especially during rapid eyemovement sleep.


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Acromegaly:

Enlargement of the soft tissues of the

nasopharynx may result in upperairways obstruction and sleep-disordered breathing with sleepapnea, excessive nocturnal snoring

and daytime somnolence. This is oneof the major causes of prematuredeath in acromegaly.

Acromegaly:

Enlargement of the soft tissues of the

nasopharynx may result in upperairways obstruction and sleep-disordered breathing with sleepapnea, excessive nocturnal snoring

and daytime somnolence. This is oneof the major causes of prematuredeath in acromegaly.


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Thyroid disorders:

Thyrotoxicosis patients often complain of

breathlessness. This is probably a result ofrespiratory muscle weakness and increasingmetabolic rate. Dyspnea is also a commoncomplaint of hypothyroid patients, probablycaused by congestive cardiac failure,

anemia, pleural effusions, obesity, or anycombination of these.

Thyroid disorders:

Thyrotoxicosis patients often complain of

breathlessness. This is probably a result ofrespiratory muscle weakness and increasingmetabolic rate. Dyspnea is also a commoncomplaint of hypothyroid patients, probablycaused by congestive cardiac failure,

anemia, pleural effusions, obesity, or anycombination of these.


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Diabetes mellitus:

60% of insulin-dependent diabetic patients

have pulmonary function abnormalities(reduced gas-exchange and capillary bloodvolume) due to pulmonary microangiopathy.These changes are not usually evidentclinically. Pulmonary tuberculosis may be

reactivated in diabetes because cell-mediated immunity is decreased.

Diabetes mellitus:

60% of insulin-dependent diabetic patients

have pulmonary function abnormalities(reduced gas-exchange and capillary bloodvolume) due to pulmonary microangiopathy.These changes are not usually evidentclinically. Pulmonary tuberculosis may be

reactivated in diabetes because cell-mediated immunity is decreased.


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Neurological disordersNeurological disorders Severe respiratory disorders can arise

indirectly from disordered ventilatory

control by te brain stem (e.g. Cheyen-Stokes respiration) or from weakness ofthe respiratory muscles. Respiratoryinfections are the terminal event of

many neurological conditions,particularly those with bulbarinvolvement.

Severe respiratory disorders can ariseindirectly from disordered ventilatory

control by te brain stem (e.g. Cheyen-Stokes respiration) or from weakness ofthe respiratory muscles. Respiratoryinfections are the terminal event of

many neurological conditions,particularly those with bulbarinvolvement.


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Lymphadenopathy:

Up to 66% of patients with Hodgkins

disease may have enlargedmediastinal lymph nodes, this is lesscommon in non-Hodgkins disease.Typically, the lymph node

involvement is bilateral andasymmetrical with both hilar andmediastinal lymphadenopathy.

Lymphadenopathy:

Up to 66% of patients with Hodgkins

disease may have enlargedmediastinal lymph nodes, this is lesscommon in non-Hodgkins disease.Typically, the lymph node

involvement is bilateral andasymmetrical with both hilar andmediastinal lymphadenopathy.


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Parenchymal involvement:

Can occur in various hematological

disorders. Approximately 12% of patients with

Hodgkins disease have parenchymalinvolvement at presentation, and 30-40%have it at some stage in their illness. It isalmost invariably accompanied bymediastinal lymph node enlargement.

Parenchymal involvement:

Can occur in various hematological

disorders. Approximately 12% of patients with

Hodgkins disease have parenchymalinvolvement at presentation, and 30-40%have it at some stage in their illness. It isalmost invariably accompanied bymediastinal lymph node enlargement.


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Pulmonary infiltrates on chest radiograph of apatient with leukemia are more likely to becaused by infection, cardiac failure, or

pulmonary hemorrhage than the leukemia.Pulmonary nodules may occur in patientswhose leukemia relapses.

Cytotoxic drugs have been linked to toxicpulmonary parenchymal side-effects. The mostcommon clinical presentation is withsymptoms and signs suggestive of progressivepulmonary fibrosis, with inspiratory crackles.

Pulmonary infiltrates on chest radiograph of apatient with leukemia are more likely to becaused by infection, cardiac failure, or

pulmonary hemorrhage than the leukemia.Pulmonary nodules may occur in patientswhose leukemia relapses.

Cytotoxic drugs have been linked to toxicpulmonary parenchymal side-effects. The mostcommon clinical presentation is withsymptoms and signs suggestive of progressivepulmonary fibrosis, with inspiratory crackles.


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Pleural involvement:

Pleural effusions occur in

approximately 30% of patients withHodgkins and non-Hodgkinslymphoma, usually in association withintra-thoracic lymphadenopathy.

Effusions may also occur in cases ofleukemia as a consequence of thedisease or of infection.

Pleural involvement:

Pleural effusions occur in

approximately 30% of patients withHodgkins and non-Hodgkinslymphoma, usually in association withintra-thoracic lymphadenopathy.

Effusions may also occur in cases ofleukemia as a consequence of thedisease or of infection.


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Parasitic lung diseasesParasitic lung diseases


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Parasitic lung diseases may becaused by:

Protozoa: leading to:

Amebic lung disease.

Toxoplasmosis.

Pneumocystis carinii pneumonia.


Protozoa: leading to:

Amebic lung disease.

Toxoplasmosis.

Pneumocystis carinii pneumonia.


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Helminths: e.g.:

Cestodes (Hydatid cyst).

Trematodes (Bronchoplulmonarybilharziasis I.e. Schistosomiasis,

paragonimiasis).

Nematodes e.g. ascaris, ancylostoma andfilaria.


Helminths: e.g.:

Cestodes (Hydatid cyst).

Trematodes (Bronchoplulmonarybilharziasis I.e. Schistosomiasis,

paragonimiasis).

Nematodes e.g. ascaris, ancylostoma andfilaria.


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Extension of infection through thediaphragm may result in fibrinosis

pleurisy, pleural effusion or basalpneumonia.

Radiologically, there may be

elevation of the right hemi-diaphragm or obliteration of thecosto-phrenic angle by pleuraleffusion.

Extension of infection through thediaphragm may result in fibrinosis

pleurisy, pleural effusion or basalpneumonia.

Radiologically, there may be

elevation of the right hemi-diaphragm or obliteration of thecosto-phrenic angle by pleuraleffusion.


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Hydatid cystHydatid cyst

The disease is caused by the cestodeEchinococcus granulosus. The definitive host inthe dog or wolf and the intermediate host is a

variety of mammals including man. The adult worm lives in the intestines of the

definitive host for 5-20 months. The terminalsegment detaches from the worm and releasesthe ova with the stools. Ingestion of the ova

(on polluted vegetables, grass or water)causes infection.

The disease is caused by the cestodeEchinococcus granulosus. The definitive host inthe dog or wolf and the intermediate host is a

variety of mammals including man. The adult worm lives in the intestines of the

definitive host for 5-20 months. The terminalsegment detaches from the worm and releasesthe ova with the stools. Ingestion of the ova

(on polluted vegetables, grass or water)causes infection.


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Clinical picture:

Clinical picture depends on whether

the cyst is intact or has ruptured.

Clinical picture:

Clinical picture depends on whether

the cyst is intact or has ruptured.


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Clinical picture of the rupturedcyst:

30% of pulmonary cysts rupture,especially those with a diametergreater than 7 cm. Rupture may occurspontaneously or as a result ofcoughing, sneezing, muscular effort,trauma or as a result of coughing,sneezing, muscular effort, trauma tothe chest or infection.

Clinical picture of the rupturedcyst:

30% of pulmonary cysts rupture,especially those with a diametergreater than 7 cm. Rupture may occurspontaneously or as a result ofcoughing, sneezing, muscular effort,trauma or as a result of coughing,sneezing, muscular effort, trauma tothe chest or infection.


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Treatment:

Surgical excision is the best.

Treatment:

Surgical excision is the best.


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Broncho-Pulmonary

Bilharziasis (Schistosomiasis)

Broncho-Pulmonary

Bilharziasis (Schistosomiasis) This includes:

Verminous pneumonitis i.e. focal

pneumonia caused by the worms ofbilharziasis when reaching the lungs.

Bilharzial granuloma or bilharzialtubercles that represent a distinctivereaction around the ovum after itpenetrates the vessel wall.

This includes:

Verminous pneumonitis i.e. focal

pneumonia caused by the worms ofbilharziasis when reaching the lungs.

Bilharzial granuloma or bilharzialtubercles that represent a distinctivereaction around the ovum after itpenetrates the vessel wall.


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Diastolic overload of the rightventricle can be an additional

factor in the pathogenesis of corpulmonale. Such diastolic overloadis secondary to the different types

of shunts which can occur in thelungs of the bilharzial patients.These include:

Diastolic overload of the rightventricle can be an additional

factor in the pathogenesis of corpulmonale. Such diastolic overloadis secondary to the different types

of shunts which can occur in thelungs of the bilharzial patients.These include:


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Bronchial artery-pulmonary artery shunt:This exposes the right ventricle to the highpressure of the systemic circulation.

Pulmonary artery-pulmonary vein(precapillary) shunt: This can lead tohypoxemia.

Portal vein-pulmonary vein shunt: This type

can also cause hypoxemia in those patients. Porto-systemic shunts.

Bronchial artery-pulmonary artery shunt:This exposes the right ventricle to the highpressure of the systemic circulation.

Pulmonary artery-pulmonary vein(precapillary) shunt: This can lead tohypoxemia.

Portal vein-pulmonary vein shunt: This type

can also cause hypoxemia in those patients. Porto-systemic shunts.


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Pregnancy and the lungPregnancy and the lung


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Chest problems in pregnancyChest problems in pregnancy

Asthma is the most commonpulmonary disease encountered

during pregnancy, occurring inabout 4-6% of pregnant women.

Asthma is the most commonpulmonary disease encountered

during pregnancy, occurring inabout 4-6% of pregnant women.


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But clearly it is wise to confinetreatment to inhaled drugs as far aspossible except during acuteexacerbations.

Many inhalers could be used includingB2 agonists and the recent new Badrenergic agents such as salmetrol and

formoterol, which are more selective forB2 receptors and which have longerduration of action.

But clearly it is wise to confinetreatment to inhaled drugs as far aspossible except during acuteexacerbations.

Many inhalers could be used includingB2 agonists and the recent new Badrenergic agents such as salmetrol and

formoterol, which are more selective forB2 receptors and which have longerduration of action.


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Pyrazinamide is not recommendedbecause of lack of data on the risk for

teratogenicity.

The accepted regimen for therapyincludes Rifampicin, isoniazid and

ethambutol in the initial two-monthphase, followed by seven months ofRifampicin and isoniazid.

Pyrazinamide is not recommendedbecause of lack of data on the risk for

teratogenicity.

The accepted regimen for therapyincludes Rifampicin, isoniazid and

ethambutol in the initial two-monthphase, followed by seven months ofRifampicin and isoniazid.


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Secondly: Coumarin compounds(Warfarin) cross the placental

barrier and are not given in thefirst trimester and if possibleduring the whole pregnancy

especially after the 36th week.

Secondly: Coumarin compounds(Warfarin) cross the placental

barrier and are not given in thefirst trimester and if possibleduring the whole pregnancy

especially after the 36th week.


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Systemic Disorders of the Lung

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