Index

Page numbers followed by “f” indicate figures, and “t” indicate tables.

A

Abscess, lung, as complication of pneumonia, 279, 293–294

Acid-base disturbances, 54, 54t

Acid-base status

analysis of, 369t, 370 ventilatory response to, 220

Acidosis

metabolic, 54, 54t

ventilatory response to, 220 respiratory, 54, 54t

Acinus, 1

Acquired immunodeficiency syndrome (AIDS), 319–325 etiology and pathogenesis of, 320

infectious complications of, 321–323 bacterial pneumonia as, 323 fungal, 323

mycobacterial, 322–323

Pneumocystis jiroveci pneumonia as, 321–322 viral, 323

inflammatory disease complicating, 324–325 Kaposi sarcoma complicating, 324

lung cancer complicating, 324 non-Hodgkin lymphoma complicating, 324 noninfectious complications of, 324–325

nontuberculous mycobacterial disease and, 306

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pulmonary infiltrates, diagnostic evaluation of, 325 pulmonary vascular disease complicating, 325

Acute cough, 23–24

Acute interstitial pneumonia (AIP), 152 pathology of, 129

Acute lung injury, 336

Acute-on-chronic respiratory failure, 332

Acute respiratory alkalosis, 54

Acute respiratory distress syndrome, 125, 336–348 clinical features of, 344–345

definition of, 337t

diagnostic approach to, 345–346 etiology of, 339–341, 340t exudative phase of, 342

injury via pulmonary circulation causing, 340–341 mortality rate in, 345

pathogenesis of, 341–342 pathology of, 342–343 pathophysiology of, 343–344 proliferative phase of, 343 treatment of, 346–347

Acute respiratory failure, 331 classification of, 331–332

Adaptive immune responses, in lung defense, 269–271 defects in, 273–274

Adenocarcinoma, of lung, 247–248, 248f, 255t chest radiograph in, 254f

Adhesion molecules, in PMN adhesion, 269

Adrenergic nervous system. see Sympathetic nervous system, in airway control Adventitious breath sounds, 29

AIDS. see Acquired immunodeficiency syndrome

AIP. see Acute interstitial pneumonia

Air bronchogram, 35

Aluminum, 136

Alveolar-arterial oxygen difference (AaDo2), 14, 15f Alveolar damage, diffuse

in ARDS, 342 causes of, 340t

Alveolar epithelium, repair of, 121

Alveolar flooding, in ARDS, 343

Alveolar fluid, regulation of, 121

Alveolar gas

composition, continuum of, 13f equation, 14

Alveolar hypoventilation, 224

in COPD, mechanisms of, 97–98

Alveolar interstitium, fluid movement in, physiology of, 337–339, 338f Alveolar macrophages

depressed function of, 272 in lung defense, 268–269

Alveolar pattern, on chest radiograph, 35, 36f

Alveolar proteinosis, pulmonary, 162–163, 162f

Alveolar structure, 119, 120f

Alveolar ventilation, 5, 16 in ARDS, 344

Alveolar vessels, 167–168, 168f

Alveolar volume (VA), 5

Alveolar wall, in gas exchange, 119, 120f

Alveolitis

allergic, extrinsic, 141

in diffuse parenchymal lung disease, 125 sampling the cell population of, 134

fibrosing, cryptogenic, 148 in sarcoidosis, 155

Aminoglycosides, for pneumonias, 281

Amiodarone, parenchymal lung disease from, 144–145

Amniotic fluid embolism, ARDS and, 341

Amyotrophic lateral sclerosis, respiratory pump and, 233

Anaerobic bacteria

pneumonia from, 278 antibiotics for, 281

Anatomic dead space, 5

Anergy, in sarcoidosis, 156

Angiography

computed tomographic, in pulmonary embolism diagnosis, 176, 177f computed tomographic pulmonary, 38

pulmonary, 41, 41f Angiomyolipomas, 159

Angiotensin-converting enzyme (ACE), elevated levels of, in sarcoidosis, 157 Angiotensin-converting enzyme (ACE) inhibitors, cough from, 23

Anthrax, 295

Antibiotics

for bronchiectasis, 111 for cystic fibrosis, 115

Antibiotic susceptibility, of pneumonias, 279–281

Antibody deficiencies, pulmonary complications of, 327

Anticoagulant therapy, for pulmonary embolism, 179

Antigen-induced asthma, 71f

Antigen-presenting cells (APCs), 141

Anti-inflammatory drugs, for asthma, 80–81t, 82–83

Antimicrobial peptides

impairment of, 272 in lung defense, 267

α1-antiprotease, in emphysema pathogenesis, 90 Antiretroviral therapy (ART), 320 α1-antitrypsin, 90

Anxiety

dyspnea in, 21–22

in respiratory muscle weakness, 234

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Aortic body chemoreceptors, for oxygen, 218

ARDS, PEEP in, 350–351, 354–355

Arsenic exposure, lung cancer and, 244

Arterial blood gas analysis, 187

Arterial blood gases, 53–55, 54t in ARDS, 344

in asthma, 77

guidelines for interpretation and sample problems, 369, 370, 371 in obesity, 240

in pneumonia, 279

in pulmonary embolism, 176 Arterial blood, oxygen content of, 9 Arterial deficiency pattern, in COPD, 100

Arthritis, rheumatoid, pulmonary parenchymal involvement in, 153 Asbestos exposure, lung cancer and, 244

Asbestosis, 139–140, 139f, 140f

Aspergilloma, 25, 312–313

Aspergillosis, 311–314

Aspergillus, 312–313

Aspiration

of microorganisms, in lower respiratory tract, 276 needle, transbronchial, in lung cancer staging, 255–256

Aspirin-exacerbated respiratory disease, 77–78

Aspirin sensitivity, 77–78

Assist-control mode of ventilation, 353, 354f

Asthma, 69–87

acquired (environmental) factors in, 70–71 allergen exposure in, 73–75 antigen-induced, 71f

anti-inflammatory drugs for, 80–81t, 82–83 bronchial thermoplasty for, 84 bronchodilators for, 80–81t, 80–82 chemical mediators in, 73t

classification by severity, 78–79t clinical features of, 77–78 diagnostic approach to, 78–80 drug therapy in, 80–81t etiology/pathogenesis of, 69–75 exercise and, 75

genetics and, 70 histamine in, 73–74 inhaled irritants, 75

late-phase asthmatic response in, 74–75, 74f leukotrienes in, 74, 74f

management strategy for, 78–79t, 84 occupational, 77–78

pathogenesis of, 72t pathology of, 75–76 pathophysiology of, 76–77 phenotypes of, 72–73 predisposition to, 70–71 provocative stimuli in, 73–75

respiratory tract infections and, 75 treatment of, 80–81t, 80–84

triad, 77–78 Asthmatic bronchitis, 88

Atelectrauma, complicating mechanical ventilation, 357–358

Atopy, 70

Atypical mycobacteria, 302

Atypical pneumonia, 281

B

Bacille Calmette-Guérin (BCG) vaccination, for tuberculosis, 302–303

Bacillus anthracis, inhalation anthrax from, 295 “Back pressure,” 184

Bacteria, causing pneumonia, 276, 287–291

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chlamydophila pneumoniae, 291 gram-negative, 289–290

Legionella pneumophila, 290–291 mycoplasma pneumoniae, 291f

Staphylococcus aureus, 288–289, 289f

Streptococcus pneumoniae, 287–288

Bacterial pneumonia, treatment of, 279–280

BAL. see Bronchoalveolar lavage

Barotrauma, from positive pressure ventilation, 357 Basal cells, 61

Basement membrane, of alveolar wall, 121

Bellows, 21

Berylliosis, 140–141

Beryllium, 136, 140–141

Bicarbonate, carbon dioxide transport in blood as, 10 Biologic agents, 80, 144

Biopsy

in diffuse parenchymal lung disease diagnosis, 134–135 endobronchial, 44

lung, 45b

pleural, closed, in pleural effusion diagnosis, 200 transbronchial, 44

in sarcoidosis diagnosis, 156–157, 157b Bioterrorism, respiratory infections associated with, 295–296 Birbeck granules, in pulmonary Langerhans cell histiocytosis, 158

Blastomyces dermatitidis, 311

Blastomycosis, 311

Blood clot, in pulmonary circulation, 172

Blood flow, pulmonary, 7, 7f

distribution of, 168–169

increased, pulmonary hypertension from, 183–184 Bloodstream, bacterial access to parenchyma via, 276 Blood tests, for latent tuberculosis, 302–303

pathology of, 109, 109f pathophysiology of, 109 treatment of, 111–112

Bronchioles, respiratory, function of, in diffuse parenchymal lung disease, 133 Bronchiolitis obliterans with organizing pneumonia (BOOP), 129, 151–152 Bronchioloalveolar carcinoma, 247–248

Bronchitis

asthmatic, 88

nonasthmatic eosinophilic, 23 Bronchoalveolar lavage (BAL), 42

alveolitis in diffuse parenchymal lung disease, 134 Bronchoconstriction

in asthma, 69 exercise-induced, 75

in pulmonary embolism, 174–175 Bronchodilators

for asthma, 80–81t, 80–82 for bronchiectasis, 111 for cystic fibrosis, 115

Bronchogenic carcinoma, 246

Bronchography, in bronchiectasis diagnosis, 110, 111f

Bronchophony, 29–30

Bronchopneumonia, 277, 277f

Bronchopulmonary aspergillosis, allergic, 312

Bronchopulmonary drainage, for cystic fibrosis, 115

Bronchoscopy

in lung cancer, 254–255, 255f in patient evaluation, 41–43, 42f

in tracheobronchial specimen collection, 43–44 virtual, 38

Bronchovesicular breath sounds, 29

Bronchus-associated lymphoid tissue, 270

Bubonic plague, 295

therapy of, principles of, 257–259

Candida albicans, 314

Candidiasis, oral, as AIDS complication, 323

Capillaries, pulmonary, 165–166

permeability of, increased, in ARDS, 341 Capillary system, 165–166

Carbaminohemoglobin, in carbon dioxide transport, 10–11 Carbapenems, for pneumonias, 281

Carbon dioxide dissolved, 11

partial pressure of, in respiratory failure, 331 radiolabeled, detection of, in tuberculosis diagnosis, 304 retention of, mechanism of, in COPD, 97–98

sensitivity to, depressed, 226 transport of, 10–11, 11f

Carcinoid syndrome, 259–260

Carcinoid tumors, bronchial, 24, 259–260

Carcinoma

anterior mediastinal, 209 bronchioalveolar, 247–248 bronchogenic, 246 lepidic, 247–248

middle mediastinal, 209–210 scar, 244–245

Cardiac output, pulmonary vascular resistance and, 166 Cardiogenic pulmonary edema, 185–186, 338 Cardiopulmonary exercise testing, 186

Cardiovascular disease, dyspnea in, 21

Carotid body chemoreceptor, 218

cART. see Combination antiretroviral therapy Caseating granuloma, 125

Caseous necrosis, in tuberculosis, 301

Catheter

in blastomycosis, 311 in COPD, 100, 100f

in cystic fibrosis, 114, 114f

in diffuse parenchymal lung disease, 134 in idiopathic pulmonary fibrosis, 151, 152b interstitial pattern on, 35, 36f

in kyphoscoliosis, 237f in lung cancer, 251, 254f

in mediastinal masses, 210f

in patient evaluation, 32–36, 33f, 34f, 35f, 36f, 37f in pleural effusion, 198, 199f, 200f

of Pneumocystis cysts, 315, 315f, 316f in Pneumocystis pneumonia, 315, 316f in pneumomediastinum, 213f

in pneumonia, 279, 279f, 292f in pneumothorax, 202–203, 203f

in pulmonary hypertension, 187, 187f, 188f

in pulmonary Langerhans cell histiocytosis, 158–159 of Streptococcus aureus pneumonia, 289f

of Streptococcus pneumoniae pneumonia, 288f in tuberculosis, 303, 303f

in unilateral diaphragmatic paralysis, 236f Chest wall

diseases of, respiratory pump and, 237–240, 237f irreversible, in respiratory failure, 335 mechanical aspects of, 2–5, 3f, 4f

receptors in, 218

stiff, in obesity, 238–239 Cheyne-Stokes breathing, 223, 224–225, 225f

pathogenesis of, 224–225

Children, respiratory tract infections in, COPD and, 92 Chills, shaking, in pneumonia, 278

Chlamydophila pneumoniae, 291

bronchiectasis and, 109 impaired clearance and, 271–272

Circulation, 6–7, 7f

bronchial, anatomy of, 166 Clindamycin, for pneumonias, 281 Clubbing

in asbestosis, 140

in bronchiectasis, 110

in diffuse parenchymal lung disease, 133–134 in pulmonary disease, 31, 31f

Club cells, 61

Coagulation system, activation of, in ARDS, 342

Coal macule, in coal worker’s pneumoconiosis, 138, 138f

Coal worker’s pneumoconiosis, 136, 138–139

Coccidioides immitis, 310

Coccidioidomycosis, 310–311

as AIDS complication, 323

Collagen vascular diseases, pulmonary parenchymal involvement complicating, 152 Combination antiretroviral therapy (cART), 314–315

Community-acquired pneumonia, 282–284 antibiotics for, 280t, 281

diagnostic testing for, 283f

etiology and management of, 282–284 Complement activation, in ARDS, 342 Compliance curve, of lung, 3, 4f

in diffuse parenchymal lung disease vs. normal lung, 122, 123f in emphysema, 96–97, 97f

Compliance of lung, decreased, in ARDS, 344

Complicated silicosis, 137, 138f

Computed tomographic angiography (CTA)

in pulmonary embolism diagnosis, 176, 177f in pulmonary hypertension, 187

Computed tomographic pulmonary angiography (CTPA), 38

in diffuse parenchymal lung disease, 133–134 evaluation and management of, 24

inability, impaired clearance and, 271

ineffective, in respiratory muscle weakness, 233–234 in lung cancer, 251

in pneumonia, 276, 278 Cough variant asthma, 23

Coumarin, for pulmonary embolism, 179 COVID-19 pandemic, 274, 298, 320, 323, 340, 346

infection, 326 pneumonia and, 282

SARS-CoV-2 virus causing, 291–293 vaccination, 323

CPAP. see Continuous positive airway pressure

Crackles, 30, 31t

in diffuse parenchymal lung disease, 133–134 in pneumonia, 278

Crazy paving pattern, in pulmonary alveolar proteinosis, 162 Cromolyn, for asthma, 80–81t, 83

Cryptococcosis, 314

Cryptococcus neoformans, 314

infections from, as AIDS complication, 323 Cryptogenic fibrosing alveolitis, 148

Cryptogenic organizing pneumonia (COP), 129, 129f, 151–152, 152f CTA. see Computed tomographic angiography

CTEPH. see Chronic thromboembolic pulmonary hypertension Cuirass ventilator, 359

Culture, in tuberculosis diagnosis, 303

Cyanosis, in pulmonary disease, 32

Cyclophosphamide, for Wegener granulomatosis, 161 Cylindrical bronchiectasis, 109

Cystic fibrosis, 112–115

chest radiograph in, 114, 114f

clinical features of, 114

diagnostic approach for, 114–115, 114f etiology and pathogenesis of, 112–113, 112t hemoptysis in, 25

pathology of, 113 pathophysiology of, 113–114 treatment of, 115

Cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs, 115

mutations of, 112, 112t Cysts, Pneumocystis, 315, 315f Cytomegalovirus, AIDS and, 273

D

D-dimer testing, in pulmonary embolism diagnosis, 176

Dead space

anatomic, 5

creation of, by pulmonary embolism, 174 physiologic, 6

volume of, 5

Defense mechanisms, lung, 265–274

Defensins, in innate immune system, 267–268

Delayed hypersensitivity, in tuberculosis, 300–301

Dendritic cells, 73

in lung defense, 269

Desquamative interstitial pneumonia (DIP), 150 pathology of, 129, 129f

Diaphragm

fatigue

in COPD, carbon dioxide retention from, 98 respiratory pump and, 235

in inspiration, 220, 221f

paralysis of

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impaired clearance and, 271 respiratory pump and, 235–236, 236f

resting position of, in obesity, 238–239 weakened, impaired clearance and, 271

Diaphragmatic pleura, 193, 194f

Diaphragmatic plication, 236

DIC. see Disseminated intravascular coagulation Dietary factors, lung cancer and, 245

Diffuse alveolar damage in ARDS, 342 causes of, 340t

Diffuse parenchymal lung disease, 122, 124–135 asbestosis as, 139–140, 139f, 140f

associated with known etiologic agents, 136–147 berylliosis as, 140–141

chronic eosinophilic pneumonia as, 161–162, 161f classification of, 125t

clinical features of, 133–134

coal worker’s pneumoconiosis as, 136, 138–139 compliance curve of lung in, 123f

compliance in, 131–132

connective tissue diseases with, 153 diagnostic approach to, 134–135 diffusion impairment in, 132 drug-induced, 143–145, 143t end-stage, pathology of, 129–130, 130f fibrosis in, 124, 125f, 132f

gas exchange consequences of, 133 Goodpasture syndrome as, 160 hypersensitivity pneumonitis as, 141–143 idiopathic interstitial pneumonias as, 126–129

idiopathic pulmonary fibrosis as, 148–151, 149f inhaled inorganic dusts causing, 136–141

in lung defense, 266–267, 266f Dyskinetic cilia syndrome, 271–272 Dyspnea, 18–22

in ARDS, 344

in COPD, 99

differential diagnosis of, 20, 20t

in diffuse parenchymal lung disease, 133–134 exertional, in kyphoscoliosis, 238 mechanisms of, 19

paroxysmal nocturnal, 19 from pleural effusion, 198 in pneumomediastinum, 212 in pneumothorax, 202

in pulmonary embolism, 175 in pulmonary hypertension, 186 in respiratory failure, 332

in respiratory muscle weakness, 233 signs/symptoms distinguished from, 19

E

Echocardiography, 186–187

E-cigarette or vaping use-associated lung injury (EVALI), 339 Effort-dependent portion, 65

Egophony, 29–30

in pneumonia, 278 Eisenmenger syndrome, 183–184

Elastase, in emphysema pathogenesis, 90, 91f

Elastic recoil pressure, 67

Electromagnetic navigational bronchoscopy, 43

ELISA. see Enzyme-linked immunosorbent assay

Embolism, pulmonary, 172–180

Emphysema, 89

arterial deficiency pattern of, 100

exercise testing in, 55–56 on functional level, 46–56 on macroscopic level, 28–43

magnetic resonance imaging in, 38, 39f on microscopic level, 43–46

physical examination in, 28–32 pulmonary angiography in, 41, 41f with pulmonary disease, 28–58 pulmonary function tests in, 46–53 pulse oximetry in, 55, 55f

radionuclide lung scanning in, 38–41, 40f specimen collection for, 43–45 ultrasonography in, 41

Exacerbation, definition of, 99

Exercise

asthma and, 75

testing, in patient evaluation, 55–56 Exercise-induced bronchoconstriction, 75 Exertional fatigue, 19

Expiration, muscle activity in, 222

Expiratory effort, maximal, 65–68, 66f

Expiratory pressure, maximal, in respiratory muscle weakness, 233 Extensively drug resistant tuberculosis, 305

Extraalveolar vessels, 167–168, 168f

Extracorporeal membrane oxygenation (ECMO), 347

Extrinsic allergic alveolitis, 141

Exudative pleural fluid, 197–198

F

Factor V Leiden, 173

Farmer’s lung, 141

Fat embolism, ARDS and, 341

Fatigue

diaphragmatic, respiratory pump and, 235 exertional, 19

FEF. see Forced expiratory flow

Ferruginous body, in asbestosis, 139–140, 139f

Fever, in pneumonia, 278

Fibroblastic foci, 128

Fibrosing mediastinitis, 309–310

Fibrosis

in diffuse parenchymal lung disease, 124, 125f, 132f progressive massive

in coal worker’s pneumoconiosis, 138 in silicosis, 137

radiation, 145

Fibrous silicate, asbestosis from, 139

Fixed obstruction, 116

Flow rates, in patient evaluation, 48, 48f

Flow-volume curves

expiratory, 65, 66f

in upper airway obstruction evaluation, 51–53, 53f Flow-volume loop, 51, 52f

Fluid accumulation, mechanisms of, 338–339

Fluid movement, in alveolar interstitium, physiology of, 337–339, 338f

Fluorodeoxyglucose scanning, 40–41

Focal emphysema, in coal worker’s, pneumoconiosis, 138

Forced expiratory flow (FEF), 48

in asthma, 76

Forced expiratory spirogram, 48f, 50f

Forced expiratory volume in 1 second (FEV1), 48 in asthma, 74, 74f

Forced vital capacity (FVC), 48

Fraction of exhaled nitric oxide (FENO), 79–80

Francisella tularensis, tularemia, 287

FRC. see Functional residual capacity

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Fremitus, 28–29, 31t

Friction rub, 30–31

Functional residual capacity (FRC), 3–4 in asthma, 76–77

in COPD, 95–96 decreased, in ARDS, 344

in diffuse parenchymal lung disease, 132 in emphysema, 96–97

factors determining, 95–96 in patient evaluation, 47

Fungal infections, 308–314

as AIDS complication, 323 aspergillosis as, 311–314 blastomycosis as, 311 coccidioidomycosis as, 310–311 cryptococcosis as, 314 histoplasmosis as, 308–310

Fungi

diagnosis of, 45–46

miscellaneous infections caused by, 308–318

G

Gas content, 8

Gas exchange

abnormal, 14–17

in COPD, mechanisms of, 97–98 alveolar wall in, 119, 120f

at capillary-alveolar level, 121

disturbances, in diffuse parenchymal lung disease, 133 effects of, ARDS on, 343

failure of, presentation of, 332 pathogenesis of, 332–334

support of, in ARDS management, 346

Guanylate cyclase stimulators, 189

Guillain-Barré syndrome, respiratory pump and, 232

H

Haemophilus influenzae pneumonia, 281 antibiotics for, 281

Haldane effect, 11

ventilatory control abnormalities secondary to, 226 Halo ethers, lung cancer and, 244

Hamman-Rich syndrome, 152

Hamman sign, 212

Hampton hump, in pulmonary embolism, 176

Hand-Schüller-Christian disease, 158

Hantavirus, 293

Hematopoietic stem cell transplantation, pulmonary complications of, 326 Hemidiaphragm, 235–236, 236f

Hemoglobin, 9

in oxygen transport, 8 Hemoptysis, 24–25

in bronchiectasis, 110 differential diagnosis of, 25t in lung cancer, 251

in pulmonary embolism, 175 Heparin, for pulmonary embolism, 179 Hering-Breuer reflex, 218

Heritable pulmonary arterial hypertension, 183, 189

Heroin, ARDS from, 341

High-resolution computed tomography (HRCT), 150, 150f in bronchiectasis diagnosis, 110, 110f

in COPD diagnosis, 101

in diffuse parenchymal lung disease, 126–127 in lymphangioleiomyomatosis, 159–160

in pulmonary alveolar proteinosis, 162

clinical and therapeutic aspects of, 334–335 pathogenesis of, 332–334, 333f

Hyperinflation

dynamic, in asthma, 76–77 of lungs, in COPD, 100

Hyperirritable airways, 23

Hyperpnea, isocapnic, 80

Hyperresponsiveness, bronchial, in asthma, 71–72 Hypersensitivity, delayed

to beryllium in berylliosis, 141 in tuberculosis, 300–301

Hypersensitivity pneumonitis, 141–143 granulomas in, 126

Hypersomnolence, daytime, in sleep apnea syndrome, 227 Hyperthyroidism, dyspnea in, 21

Hypertrophic osteoarthropathy, 31–32

Hyperventilation, 19

neurologic disorders with, 223 Hypocapnia

in ARDS, 345

in pulmonary embolism, 174 Hypopnea, 226–227 Hypoventilation, alveolar, 224

in COPD, mechanisms of, 97–98 Hypoxemia, 14–16, 15f

in ARDS, 343

mental impairment in, 332 in respiratory failure, 351

Hypoxemic respiratory failure, 331

Hypoxia

feedback system in, 225

pulmonary hypertension in COPD from, 98 pulmonary vascular response to, 169–170

ventilatory response to, 218–220, 219f

I

Idiopathic hypoventilation, 224

Idiopathic interstitial pneumonias, pathology of, 126–129, 127t

Idiopathic pulmonary arterial hypertension (IPAH), 183

Idiopathic pulmonary fibrosis (IPF), 148–151

clinical presentation of, 150 diagnosis of, 150

histologic expression of, 150 pathogenesis of, 148, 149f treatment of, 151

in usual interstitial pneumonia, 125 Immotile cilia syndrome, 271–272 Immune dysregulation, in silicosis, 137b Immune system, of lung

adaptive

defects in, 273–274

in lung defense, 269–271 innate, 269–271

Immunity

cellular

defects in, 270, 273 in lung defense, 271

humoral

defects in, 273

in lung defense, 270

Immunization, against respiratory pathogens, 274

Immunocompromised host

by acquired immunodeficiency syndrome, 319–325

non-human immunodeficiency virus, pulmonary complications of, 325–328 diagnostic evaluation of, 327–328, 328t

inflammatory, treatment of, 326–327

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in organ transplant recipients, 325–326 in primary immunodeficiencies, 327

pulmonary complications in, 319–329 Immunodeficiencies, primary, pulmonary complications of, 327

Immunoglobulin A (IgA), respiratory, in innate immune system, 267 Immunoglobulins, in humoral immunity, 270

IMV. see Intermittent mandatory ventilation Infarction, pulmonary, from pulmonary embolism, 173 Infection

bronchiectasis, 107

complicating lung transplantation, 360 COPD and, 91–92

diagnosis of

molecular biology techniques in, 46 staining and cultures in, 45

opportunistic, in AIDS, 320

pulmonary, pleural effusions from, 197–198 respiratory tract

asthma and, 75 viral, asthma and, 70

Inflammation

airway, in asthma, 71–72

in diffuse parenchymal lung disease, 124, 125f

in lung, suppression of, alveolar macrophages in, 268–269 Inflammatory cells, in lung defense, 268–269

impairment of, 272–273 Inflammatory disease

as AIDS complication, 324–325 pleural effusions in, 197

Influenza virus

immunization against, 274 pneumonia from, 293

Inhalation, of microorganisms, in lower respiratory tract, 276

J

Juxtacapillary receptors, in respiratory control, 218

K

Kaposi sarcoma, as AIDS complication, 324 Kartagener syndrome

bronchiectasis and, 108, 108f impaired clearance in, 271–272

Killer cells, natural, in lung defense, 269

Klebsiella pneumoniae, pneumonia from, 285 Kulchitsky cell. see Pulmonary neuroendocrine cell Kyphoscoliosis, respiratory pump and, 237–238, 237f

L

β-Lactam antibiotics, 281

Lactoferrin, in innate immune system, 267 Lamellar inclusions, in surfactant release, 120–121 Langerhans cell, 158, 269

Langerhans cell histiocytosis, of lung, 158–159, 269 Large cell carcinoma, of lung, 248, 255t

Latent tuberculous infection, definition of, 300 Late-phase asthmatic response in, 74–75, 74f Left atrial pressure, measurement of, 166

Legionella pneumophila diagnosis of, 45–46 pneumonia from, 290–291

Legionnaires’ disease, 284

Lepidic carcinoma, 247–248

Letterer-Siwe disease, 158

Leukocytosis, in pneumonia, 278

Leukotrienes, in asthma, 74, 74f

Liver disease, transudative pleural fluid in, 197

pathogenesis, concepts of, 245–246 pathologic examination for, 46 pathology of, 246–249

prevalence of, 242 screening for, 257

small cell carcinoma as, 248–249, 249f, 249t smoking and, 243–244

squamous cell carcinoma as, 246–247, 247f staging of, 255–256, 256t

therapy of, principles of, 257–259

recipients of, pulmonary complications in, 325–326 Lung volumes, 4–5

in asthma, 76–77

in chest wall and neuromuscular diseases, 234f in diffuse parenchymal lung disease, 132 factors determining, 95–96

in patient evaluation, 47–48, 47f

pulmonary vascular resistance and, 167–168 reduction surgery, for COPD, 103

Lymphadenopathy, hilar, in sarcoidosis, 155

Lymphangioleiomyomatosis, 159–160

Lymphocytes, T, in cellular immunity, 271

Lymphocytic interstitial pneumonia, in Sjögren syndrome, 154 Lymphocytic interstitial pneumonitis, as AIDS

complication, 324–325 Lymphoma

anterior mediastinal, 209 middle mediastinal, 209–210

non-Hodgkin, as AIDS complication, 324 Lysozyme, in innate immune system, 267

M

MAC. see Mycobacterium avium complex

Macklin effect, 212

Macrolide antibiotics

for bronchiectasis, 111 for cystic fibrosis, 115 for pneumonias, 281

Macrophages, alveolar, 121 depressed function of, 272 in lung defense, 268–269

Magnetic resonance imaging (MRI) in mediastinal masses, 211

Mediastinal pleura, 193, 194f, 207

Mediastinitis, fibrosing, 309–310

Mediastinoscopy, suprasternal, in lung cancer staging, 255–256 Mediastinotomy, parasternal, in lung cancer staging, 255–256 Mediastinum, 207 see also Mediastinal masses

air in, 213f

anatomic features of, 207–208, 208t compartments of, borders of, 207, 208f, 208t masses of, 208–212

Mediators

chemical

in asthma, 73, 73t

in pulmonary embolism, 175

from inflammatory cells, in asthma, 71–72 Medullary respiratory generator, 216f Mesothelial cells, on pleural surfaces, 194 Metabolic acidosis, 54, 54t

expected compensation for, 369t ventilatory response to, 220

Metabolic alkalosis, 54, 54t expected compensation for, 369t

Metabolic requirements, ventilatory response to, 220

Methotrexate, 144

Methyl ether exposure, lung cancer and, 244

Methylxanthines, in asthma, 82, 82b

Mica, 136

Middle East respiratory syndrome (MERS), coronavirus (MERS-CoV), 293 Miliary pattern, on chest radiograph, 35–36

Miliary tuberculosis, 299–300, 300f

Minute ventilation, 5

changes in, 226

increased, in pulmonary embolism, 174, 174b Miscellaneous airway disease, 107–118

Mitral stenosis, 190

Mixed apnea, 227

Molecular biology techniques, in respiratory tract infection diagnosis, 46

Mucociliary transport/clearance

impairment of, 271–272 in lung defense, 266–267

Mucor, 314

Mucous glands, enlarged, in chronic bronchitis, 92–93

Multidrug resistant (MDR) tuberculosis, 305

Murmur of tricuspid, 186

Muscles of respiration, 215, 220–222, 221f neuromuscular disease affecting, 232–235

Muscular arteries, 184

Myalgias, by influenza, 293

Myasthenia gravis, respiratory pump and, 233

Mycetoma, 25

Mycobacteria

false-positive tuberculin skin test in, 302 identification of, 45

nontuberculous, 305–306

Mycobacterial infection, as AIDS complication, 322–323

Mycobacterium avium complex (MAC), 305–306 infection from, as AIDS complication, 322–323

Mycobacterium avium-intracellulare, 305–306

Mycobacterium tuberculosis, tuberculosis from, 299

Mycoplasmal pneumonia, 290, 291f

antibiotics for, 281

Mycoplasma pneumoniae, 281, 290, 291f

N

Narcotics, ARDS from, 341

Natural killer cells, in lung defense, 269

Necrotizing granuloma, 126

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Necrotizing pulmonary aspergillosis, chronic, 314 “Neomuscularization,” 184

Neoplastic disease, as AIDS complication, 324

Neural control, of airways, 62–64, 63f

Neurologic disease, 223–224

Neuromuscular disease

affecting muscles of respiration, 232–235 in respiratory failure, 335

Neutrophil elastase, in emphysema pathogenesis, 90

Neutrophils, recruitment of, to lungs, in ARDS, 341–342

Nifedipine, 189

NIPPV. see Noninvasive positive pressure ventilation

Nitric oxide, 169–170

inhaled, in ARDS management, 346–347 in pulmonary embolism, 174–175

Nitrofurantoin, parenchymal lung disease from, 144

Nitrogen dioxide, inhaled, ARDS from, 339

Nocturnal dyspnea, paroxysmal, 19

Nocturnal positive pressure ventilation, 240

Nodular pattern, on chest radiograph, 35–36

Nodules, silicotic, 137

Nonadrenergic, noncholinergic inhibitory system, in airway control, 64 Nonasthmatic eosinophilic bronchitis, 23

Noncardiogenic pulmonary edema, 338

Noncaseating granuloma, 125

in sarcoidosis, 155

Non-Hodgkin lymphoma, as AIDS complication, 324

Noninvasive positive pressure ventilation (NIPPV), in respiratory failure, 351 Non-small cell lung cancer, 246, 249t

treatment of, 258–259

Nonspecific interstitial pneumonia (NSIP), 151 pathology of, 128

Nontuberculous mycobacteria, 298–307

false positive tuberculin skin test in, 302–303 Nosocomial pneumonia, management of, 284–285 NSIP. see Nonspecific interstitial pneumonia

Nucleic acid amplification assays, in tuberculosis diagnosis, 304

O

Obesity-hypoventilation syndrome, 238

Obesity, respiratory pump and, 238–240

Obstructive pattern, of pulmonary function, 49–50, 50f

Obstructive sleep apnea, 227, 229f

in obesity, 239, 239f Occupational asthma, 77–78

Occupational factors, in lung cancer, 244

Omalizumab, for asthma, 83

Ondine’s curse, 217, 224

Opportunistic infections, in AIDS, 320

Opsonins, in lung defense, 268, 287–288

Oral candidiasis, as AIDS complication, 323

Organ transplant, recipients of, pulmonary complications in, 325–326

Orthopnea, 19

Oseltamivir, as treatment for influenza, 293

Osteoarthropathy, hypertrophic, 31–32

Oxygen

diffusion of, 7–8 high concentrations of

ARDS from, 343

impaired clearance from, 272 uptake of, by blood in capillaries, 122

Oxygenation

analysis of, 370

support of, in respiratory failure management, 350 Oxygen content, 10b

Oxygen transport, 8–10, 9f

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optimizing, in respiratory failure, 350 Oxyhemoglobin dissociation curve, 9, 9f

P

Palpation, of chest, 28–29

Panacinar (panlobular) emphysema, 93, 93f, 94f

Pancoast tumors, symptoms of, 252

Pancreatic insufficiency, in cystic fibrosis, 113

PAOP. see Pulmonary artery occlusion pressure

PAP. see Pulmonary alveolar proteinosis

Paralysis, diaphragmatic, respiratory pump and, 235–236, 236f Paraneoplastic syndromes, 210, 252–253

Parapneumonic effusion, 197

Parasternal mediastinotomy, 211

in lung cancer staging, 255–256

Parasympathetic nervous system, in airway control, 63 Parenchyma

anatomy of, 337, 338f

destruction of, in tuberculosis, 301 disease of

cough in, 23 hemoptysis in, 24

scarring of, lung cancer and, 244–245 infection of, 275

Parenchymal lung disease drug-induced, 143–145, 143t in pulmonary hypertension, 188

Parietal pleura, 193, 194f inflammation of, chest pain in, 25

Paroxysmal nocturnal dyspnea, 19

Partial pressure, 8

of carbon dioxide, in respiratory failure, 331 of oxygen, in respiratory failure, 331

pneumothorax as, 200–204 Pleural effusion, 196–200

causes of, 197t clinical features of, 198

diagnostic approach to, 198–200, 199f, 200f dyspnea in, 21

etiology of, 196–198 exudative, 196b malignancy in, 198 pathogenesis of, 196 pleural effusions in, 197 transudative, 197 treatment of, 200

Pleural space, 193, 194f air in, 201

fluid in, specimen of, collection of, 45 liquid in

accumulation of, 196

formation and resorption of, 194, 195f Pleuritic chest pain, 25

from pleural effusion, 198 in pulmonary embolism, 175

Pleurodesis, for pleural effusion, 200 PMNs. see Polymorphonuclear leukocytes

Pneumatic splint, nasal, for obstructive sleep apnea, 228 Pneumococcal pneumonia, 278

antibiotics for, 281 therapeutic approach to, 281 vaccination for, 274

Pneumoconiosis

asbestosis as, 139–140 berylliosis as, 140–141 coal worker’s, 136, 138–139

idiopathic, pathology of, 126–129, 127t interstitial, 277, 277f

acute, 152 idiopathic, 151–152

lymphocytic, in Sjögren syndrome, 154 nonspecific, 151

treatment of, 150 usual, 148

intrathoracic complications of, 293–295 legionella, 290–291

lobar, 276–277, 277f mycoplasmal, 290, 291f

nosocomial, management of, 284–285 pathology of, 276–278 pathophysiology of, 278 pneumococcal, 284

presumptive diagnosis of, 282 systemic response to, 278 therapeutic approach

based on clinical setting, 282–285

general principles and antibiotic susceptibility in, 279–281 typical, 281

ventilator-associated, 272, 356–357 Pneumonic plague, 295

Pneumonitis

hypersensitivity, 141–143

lymphocytic interstitial, as AIDS complication, 324–325 radiation, 145

Pneumothorax, 200–204

clinical features of, 202

complicating mechanical ventilation, 357 diagnostic approach to, 202–203, 203f dyspnea in, 21

Primary tuberculosis definition of, 300

progressive, definition of, 300 radiographic appearance of, 303

Progressive disseminated histoplasmosis, 309

Progressive massive fibrosis

in coal worker’s pneumoconiosis, 138 in silicosis, 137

Progressive primary tuberculosis, 300

Progressive systemic sclerosis, pulmonary parenchymal involvement in, 152 Prostacyclin derivatives, 189

α1-Protease inhibitor, in emphysema pathogenesis, 90 Protease-antiprotease hypothesis, of emphysema, 90 Protective open lung strategy, for mechanical ventilation, 355 Proteinosis, alveolar, pulmonary, 162–163

Proteolytic enzymes, in emphysema pathogenesis, 90

Prothrombin gene mutation, 173

Proto-oncogenes, lung cancer and, 246

Provocation tests, in asthma diagnosis, 80

Pseudolymphoma, in Sjögren syndrome, 154

Pseudomonas aeruginosa, 110–111, 285

PSV. see Pressure support ventilation

Pulmonary alveolar proteinosis (PAP), 162–163

Pulmonary angiography, 41, 41f

conventional, 178, 178f

Pulmonary arterial hypertension, as AIDS, complication, 325 Pulmonary arterial pressure, elevated, 181

Pulmonary arterial walls, remodeling of, 183

Pulmonary artery, anatomy of, 166

Pulmonary artery balloon occlusion catheter, 166, 167f Pulmonary artery occlusion pressure (PAOP), in ARDS, 345 Pulmonary artery tap, 186

Pulmonary blood flow, 7, 7f

in diffuse parenchymal lung disease, 133 heritable, 189

histologic changes in, 185f idiopathic, 183

in kyphoscoliosis, 237 left heart disease and, 190 lung disease and, 190–191 pathogenesis of, 183–184 pathology of, 184–185

pathophysiology of, 185–186

specific disorders associated with, 188–191 with unclear multifactorial mechanisms, 191 Pulmonary infarction, from pulmonary embolism, 173

Pulmonary infiltrates, 145

diffuse, as AIDS complication, 324–325 Pulmonary Langerhans cell histiocytosis, 158–159 Pulmonary neuroendocrine cell, 61

Pulmonary parenchyma, 119–123 anatomy of, 119–121, 120f physiology of, 121–122 structure of, 120f

Pulmonary vascular bed, 183–184

Pulmonary vascular disease, 21

as AIDS complication, 325

Pulmonary vascular resistance (PVR), 166–168, 167f increased

in ARDS, 344

in pulmonary embolism, 174 Pulmonary vasculature

anatomy of, 165–166 changes in, in ARDS, 344 physiology of, 165–171

aspects of, 170

Reflection coefficient, 196

Reid index, 92–93

Reinfection tuberculosis, definition of, 300

Rejection, complicating lung transplantation, 359–360

Residual volume (RV), 5

in asthma, 76

in COPD, 95–96

in diffuse parenchymal lung disease, 132 in emphysema, 96–97

factors determining, 95–96 in patient evaluation, 47

result of expiratory muscle weakness, 234, 234f Respiratory acidosis, 54, 54t

expected compensation for, 369t Respiratory alkalosis, 54, 54t

in asthma, 77

expected compensation for, 369t

Respiratory bronchiolitis interstitial lung disease, pathology of, 128–129, 129f Respiratory control, 215–222

chemoreceptors in, 217–218, 217f CNS generator in, 215, 216f disorders of

Cheyne-Stokes breathing as, 224–225, 225f secondary to lung disease, 225–226

sleep apnea syndrome as, 226–230 feedback system of, 216, 216f, 224–225 input from other CNS regions in, 217 input from other receptors in, 218 instability of, 225

organization of, 215–218, 216f ventilatory response

to hypercapnia and hypoxia in, 218–220, 219f to other stimuli in, 220

Respiratory disease, aspirin-exacerbated, 77–78

Respiratory distress syndrome, acute, 336–348

Respiratory equations, sample problems using, 363, 364

Respiratory failure, 330–335

acute

classification of, 331–332

noninvasive ventilatory support for, 356 acute-on-chronic, 332

CO2 retention in, 351 chronic

lung transplantation for, 359–360 therapy for, 358–360

ventilatory support, chronic, 358–359 definition of, 330–331

development of, 330

gas exchange abnormalities in, pathogenesis of, 332–334 hypercapnic

clinical and therapeutic aspects of, 334–335 pathogenesis of, 332–334, 333f

hypoxemic, 331

pathogenesis of, 332–333 management of, 349–362

CO2 elimination maintenance in, 350 hypercapnic, 351

hypoxemic, 350–351

mechanical ventilation in, 352–358, 354f reducing work of breathing in, 352 supportive therapy in, 349–352

presentation of, 332 Respiratory generator, 216–217, 216f

Respiratory IgA, in innate immune system, 268

Respiratory infections, associated with bioterrorism, 295–296

Respiratory pump

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disorders of, 232–241, 233t

chest wall diseases as, 237–240, 237f diaphragmatic disease as, 235–237

neuromuscular, affecting muscles of respiration, 232–235 obesity as, 238–240

specific diseases of, 232–233 Respiratory system, 4

anatomy of, 1–2, 2f physiology of, 2–13

carbon dioxide transport in, 10–11, 11f circulation in, 6–7, 7f

diffusion in, 7–8

mechanical aspects of lungs/chest wall in, 2–5, 3f, 4f oxygen transport in, 8–10, 9f

ventilation, 5–6

ventilation-perfusion relationships in, 11–13 Respiratory tract infections

asthma and, 75 childhood, COPD and, 92 viral

asthma and, 70

impaired clearance in, 272

Restrictive pattern, of pulmonary function, 50–51, 50f

Reticular pattern, on chest radiograph, 35

in diffuse parenchymal lung disease, 134 Reticulonodular pattern, on chest radiograph, 35 in diffuse parenchymal lung disease, 134

Rheumatic diseases, systemic, pulmonary parenchymal involvement complicating, 152 Rheumatoid arthritis

pleural effusions in, 198

pulmonary parenchymal involvement in, 153, 153b Rhonchi, 30

in COPD, 99

Rifampin, for tuberculosis, 304

Robotic bronchoscopy, 43

Roflumilast, for COPD, 102

S

Saccular bronchiectasis, 109

Samter syndrome, 77–78

Sarcoidosis, 154–157, 156f

berylliosis and, 141

chest radiograph in, 156b, 156f diagnosis of, 156–157 granulomas in, 126, 126f natural history of, 157 pathogenesis of, 154, 155f treatment of, 157

Sarcoma, Kaposi, as AIDS complication, 324

SARS. see Severe acute respiratory syndrome

SARS-CoV-2 virus, 274, 291–293

Scar carcinoma, 244–245

Scleroderma, 188

pulmonary parenchymal involvement in, 152 Secondary spontaneous pneumothorax, 201 Secretory IgA, in humoral immunity, 270

Secretory leukoprotease inhibitor, in emphysema pathogenesis, 91

Selexipag, 189

Serous cells, 61–62

Severe Acute respiratory syndrome (SARS), 293

Shunting

in ARDS, 343

in hypoxemic respiratory failure, 332 Silhouette sign, 32

Silica, 136

phagocytosis of, 137

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Silicate, fibrous, asbestosis from, 139

Silicosis, 136–137, 137f

Silicotic nodules, 137

Silicotuberculosis, 137

Simple chronic silicosis, 137

Sirolimus, for lymphangioleiomyomatosis, 160

Sjögren syndrome, pulmonary parenchymal involvement in, 154 Sleep apnea, obesity and, 239, 239f

Sleep apnea-hypopnea syndrome, 226–227

Sleep apnea syndrome, 116, 226–230

clinical features of, 227–228 pathophysiology of, 228, 229f treatment of, 228–230

types of, 227

Slow-reacting substance of anaphylaxis, 74

Small cell carcinoma, of lung, 248–249, 249f, 249t chest radiograph in, 253f, 255t

treatment of, 259

SMART (Single Maintenance And Reliever Therapy), 83

Smoking

COPD from, 89–91, 91f prognostic significance of, 99

impaired clearance from, 272 lung cancer and, 243–244

Solitary pulmonary nodule, 260–262, 260t

Sol layer

antimicrobial peptides in, 267 in lung defense, 267

Specimens for diagnostic microscopy collection of, 43–45

processing of, 45–46 Spherules, 310

Sputum

Sympathomimetic agents, for asthma, 80–81t, 80–81

Syncope, in massive pulmonary embolism, 175

Systemic lupus erythematosus

pleural effusions in, 198

pulmonary parenchymal involvement in, 152

Systemic rheumatic diseases, pulmonary parenchymal involvement complicating, 152

T

Tachycardia, in pulmonary embolism, 175

Tachykinins, 64

Tachypnea, 19

in pulmonary embolism, 175 Tactile fremitus, 28–29

Talc, 136

Tension pneumothorax, 201–202, 204f complicating mechanical ventilation, 357

Theophylline, for asthma, 80–81t, 82

Thoracentesis, in pleural effusion diagnosis, 199

Thoracoscopy, for lung tissue biopsy, 45

Thromboembolic pulmonary hypertension, chronic, 191

Thromboembolism, pulmonary, 172

Thrombolytic agents, for pulmonary embolism, 179

Thrush, as AIDS complication, 323

Thymic tumors, 210

Thymomas, 209

Thyroid gland enlargement, 209

Tidal volume (VT), 5

Tiotropium, for asthma, 80–81t, 82

Tissue inhibitors of matrix metalloproteinases, 91

TLC. see Total lung capacity

T lymphocytes, in cellular immunity, 271

Total lung capacity (TLC), 4–5

clinical manifestations of, 301–302 definitions related to, 300

diagnostic approach to, 302–304, 303f disparity in health resources and, 298 etiology and pathogenesis of, 299–300 extensively drug resistant, 305 extrapulmonary, 302

granulomas in, 126 miliary, 299–300 multidrug resistant, 305 pathology of, 300–301 pathophysiology of, 301 pleural effusions from, 197

postprimary, definition of, 300 primary, 299

definition of, 300 progressive, definition of, 300

radiographic appearance of, 303 principles of therapy for, 304–305 reactivation, 299

definition of, 300

radiographic appearance of, 303, 303f reinfection, definition of, 300

systemic manifestations of, 301 vaccine for, development of, 305 worldwide trends in, 298

Tuberculous disease, definition of, 300

Tuberculous infection

definition of, 300 tuberculin skin test for, 302

Tuberous sclerosis complex (TSC), lymphangioleiomyomatosis and, 159 Tularemia, 296

Tumor

hemoptysis in, 25t

Vascular endothelial cells, activation of, in ARDS, 342 Vascular pressures, 7

Vasculitis, granulomatous, in Wegener granulomatosis, 160 Vasoconstriction

pulmonary, hypoxic, 169 in response to hypoxia, 183

Vasodilator testing, 189

VATS. see Video-assisted thoracic surgery

Vein, pulmonary, anatomy of, 166

Venn diagram, 239f

Venous blood, oxygen content of, 10

Ventilation, 5–6

alveolar, in ARDS, 344 Cheyne-Stokes, 224–225, 225f negative-pressure, 359

positive pressure, noninvasive, 356 Ventilation-perfusion mismatch, 226

in ARDS, 343

in diffuse parenchymal lung disease, 133 in hypercapnia, 16

in hypoxemic respiratory failure, 332 in kyphoscoliosis, 238

in obesity, 238–239 in pneumonia, 278

Ventilation-perfusion ratio (V/Q), 12b, 12f spectrum of, 12f

Ventilation-perfusion relationships, 11–13 Ventilation scanning, 39–40 Ventilator-associated pneumonia, 272, 356–357 Ventilatory control disorders, 223–231 Ventilatory response

to hypercapnia and hypoxia, 218–220, 219f

Wegener granulomatosis. see Granulomatosis with polyangiitis Weight loss, in obesity, 240

Westermark sign, 175–176

Wheezing, 30

in asthma, 78 in COPD, 99

Whispered pectoriloquy, 29–30, 31t

Wood units, 166–167

Work of breathing, reducing, in respiratory failure, 352

X

X bodies, in pulmonary Langerhans cell histiocytosis, 158

Y

Yersinia pestis, plague from, 295

Z

Zone of apposition, 220, 221f

Zygomycetes, 314

ZZ genotype, emphysema and, 92

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