Test # 1 Pathology Study Guide

Disease Processes
AAA (Abdominal Aortic Aneurysm)
a localized dilatation (ballooning) of the abdominal aorta
 occur below the origin of the renal arteries (below the kidneys)
 can increase and rupture leading to massive hemorrhage which can be fatal
 appears curvilinear calcification in the wall of an aneurysm
 can be treated by surgical graft or stent placement

achondroplasia
most common form of dwarfism
 defective ossification of the growth plate
 intelligence is not impaired but individuals have short limbs and trunk, normal size head

adenocarcinomas
arise in the peripheral area of the lung (outside areas of the lung)
 spreads to the other lung as well as liver, kidney, bone, and the brain
 slower growing tumor
 tends to have a more favorable outcome
 radiographs can reveal obstruction or atelectasis but can’t predict cell type but can detect
a lesion 2 years before symptoms occur

aneurysm
localized dilatation of an artery usually involving the aorta
 saccular- involves only 1 side of the arterial wall
 fusiform – bulging of the entire circumference of the vessel wall
 appears as curvilinear calcification in the wall of an aneurysm
 can be treated by surgical graft or stent placement

ankylosing spondylitis
rheumatoid arthritis that affects males in the 3 rd decade of life
 referred to as “bamboo spine” because it usually affects the spine and SI joints
 begins in the lumbar area first as low back pain then moves up to the thoracic and cervical
areas
 it can involve the aorta
 vertebral bodies look square rather than cylindrical

atelectasis
a collapse of all or part of the lung
 can be acute (quick onset) or chronic (long term)
 caused by obstruction of a bronchus caused by fluid consolidation, or iatrogenic
(misplaced endotracheal tube), pleural effusion (fluid accumulation within the pleural
space)
 mimics pneumonia
 appears as plate-like streaks, increased density

atherosclerosis

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thickening and hardening of the arteries from fatty (plaque) build up

 can cause narrowing or complete occlusion of arteries
 can cause stroke (CVA) or myocardial infarction (MI)
 appears as calcifications on plain films; filling defects on arteriograms

bone cyst
idiopathic
 more prevalent in young males
 75% are found in distal femur and proximal tibia and humerus
 some relationship to trauma or hemorrhagic disorder
 appear lytic lucency in the central part of the long bone with thinning of the cortex,
accompanied by symmetrical expansion
 can be unicameral (solitary cavity), multicameral/multilocular (contain numerous cavities),
aneurysmal ) usually unicameral and can become very large – assoc. with a fracture)

bronchiectasis
weakening of the wall of the bronchus due to chronic inflammation becoming permanently
dilated
 affects the lower lobes bilaterally
 appears as a peribronchial thickening
 areas of ateletasis
 “honeycomb pattern”
 PFT (pulmonary function test) - group of tests that measure how well the lungs take in and
release air and how well they move gases such as oxygen from the atmosphere into the
body's circulation

bursitis
inflammatory of the bursae, small fluid-filled sacs located near the joints that reduce the friction
caused by movement
 repeated physical activity commonly causes bursitis
 trauma, rheumatoid arthritis, gout or infections can also cause inflammation
 more common in the shoulder
 appears as calcified tendonitis

CAD (Coronary Artery Disease)

narrowing, usually caused by fatty deposits on the arterial wall, of the coronary arteries causes
oxygen deprivation of the myocardium and ischemic heart disease
 angina pectoris (CP) is due to oxygen insufficiency
 normal CXR except for possible calcifications of CHF
 surgical bypass graft or stent placement
 can use nitroglycerin to help relieve pain by dilating the vessels
 #1 killer

CHF (Congestive Heart Failure)

inability of the heart to supply sufficient blood flow to meet the body's needs
 left sided: cardiac enlargement, pulmonary edema, and pulmonary effusion
 right sided: widened mediastinum and elevated right half of the diaphragm

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coarctation of the aorta

narrowing of the aorta at the distal arch that most commonly occurs just beyond the branching of
the blood vessels to the head and arms resulting in decreased blood to the abdomen and legs
 rib notching usually involving the posterior 4 th to 8th ribs occurring from pressure erosion
by dilated and pulsating intercostal collateral vessels.
 has a “figure 3” caused by the aortic knob

congenital hip dysplasia

malformation of the acetabulum rather than the femoral head
 more common in first born females
 possible cause – certain hormones that relax the maternal ligaments in preparation for
labor may also cause laxity of the infant’s ligaments around the capsule of the hip joint
 AP – hips will not be aligned

COPD (Chronic Obstructive Pulmonary Disorder)

obstruction of the airways leads to an ineffective exchange of respiratory gases and makes
breathing difficult
 causes include preexisting diseases such s bronchitis, emphysema, asthma as well as
cigarette smoking, air pollution long-term exposure to irritants
 cardiac silhouette is elongated, aortic arch is predominantly visible
 diaphragms usually flattened
 increased radiolucency noted bilaterally in the lower lung fields
 has a “fuzziness” or dirty chest appearance and may include tram lines (may look like O2
lines)
 also reveals emphysema with COPD

croup
viral infection of young children
 bark-like cough
 laryngitis with laryngeal spasm
 obstruction of upper airway (subglottic portion of trachea) in neck
 AP soft tissue neck is done to demonstrate narrowing of subglottic region

dissection
separation of layers

DJD (Degenerative Joint Disease) or Osteoarthritis

extremely common generalized disorder characterized pathologically by loss of joint cartilage and
reactive new bone formation
 caused by wear and tear and aging
 secondary causes are repeated traumatized or subjected to abnormal stresses
 affects weight bearing joints such as spine, hip, knee, ankle
 appears as irregular narrowing of joint space with small bony spurs (steophytes)

DVT (Deep Vein Thrombosis)

clot occurring in the lower extremities

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 major source of potentially fatal pulmonary embolism

 can be a sign for pancreatic, lung, or GI cancer
 contrast venography shows closed off or blocked veins
 treatment includes anticoagulants , bed rest, thrombolytic (breaking down of blood clot)

emphysema
the most common chronic disease of the lung
 usually associated with COPD
 dilatation of the air spaces accompanied by destruction of walls of the alveoli
 environmental
 “barrel chested” appears on CXR as large, oversized lungs with increased blackening or
radiolucency
 destruction of the distal bronchioles where the lung bases appear flat
 lower technique to see any masses

empyema
pus in the pleural space from the spread of an adjacent infection
 indistinguishable from pleural effusion
 loculated fluid appears as an air-fluid level within it

epiglottitis
thickening of epiglottic tissue and the surrounding pharyngeal structures ; acute infections of the
epiglottis (flap of cartilage at the base of the tongue that covers the opening to the air passages
when swallowing, preventing food or liquids from entering the windpipe trachea)
 acute infections most commonly in children are caused by Haemophilus influenzae
 affects the supraglottic area or supraglottis
 appears as rounded thickening epiglottic shadow

gout
disorder in the metabolism of purine (a component of nucleic acids) in which an increase in the
blood level of uric acid leads to the deposition of uric acid crystals in the joints, cartilage, and
kidney
 primary gout is caused by several inherited enzyme defects that cause overproduction of
uric acid
 secondary gout, hyperuricemia is caused by an overproduction of uric acid, which in turn
may be caused by increased turnover of nucleic acids, drugs, or a decrease in the
excretion of uric acid resulting in kidney failure
 affects the first metatarsophalangeal joint and may attack any joint
 appears as joint inflammation (effusion) or urate crystals (tophi) in joint space

HTN (Hypertension)
high blood pressure
 leading cause of strokes and CHF
 cardiac output of systolic (highest pressure in the peripheral arteries that occurs when the
left ventricle contracts) and diastolic (lower pressure in the peripheral arteries when the
left ventricle is relaxing and filling with blood from the left atrium)
 arteriography – detects renovascular lesions

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meniscal tear
a tear in the cartilages, or menisci, that are located between the femur and tibia bones in the
lower leg
 common cause of knee pain due to the lack of cushion
 caused by acute trauma, but tears more frequently reflect a degenerative process caused
by the chronic trauma inherent in human knee function
 MRI – tears have a high signal intensity

MI (Myocardial Infarction)
an episode in which some of the heart's blood supply is severely cut off or restricted, causing the
heart muscle to suffer and die (necrosis) from lack of oxygen
 commonly known as a heart attack
 can result from atherosclerosis, a thrombus, or a spasm of a coronary artery
 onset of MI is characterized by a crushing, viselike chest pain that may radiate to the left
arm, neck, jaw, or epigastrium and sometimes stimulates the sensation of acute
indigestion or a gallbladder attack
 appear s vessel calcifications

multiple myeloma
a widespread malignancy of plasma cells that may be associated with bone destruction, bone
marrow failure, hypercalcemia, renal failure, and recurrent infection
 mainly it is a cancer of the plasma cells in bone marrow that affects people between ages
40-70
 causes little or no stimulation of new bone formation
 appears as multiple punched-out lesions

osteoarthritis
common generalized disorder characterized pathologically by loss of joint cartilage and reactive
new bone formation
 causes are wear and tear of the aging process
 affects the weight-bearing joints such as the hip, spine, knee, ankle, and also the ip joints
of the fingers
 appears as irregular narrowing of joint space with small bony spurs (steophytes)

osteochondromas
a benign projection of bone with a cartilaginous cap
 occurs in the epiphyseal plate and grows laterally
 can convert to malignancy if it becomes thicker and contains calcifications
 contains cortex an medullary portion
 appearance: tumor runs parallel to long bone and points away from nearest joint

osteogenic sarcoma
malignant tumor composed of osteoblasts that produce osteoids and spicules of calcified bones
 metaphysis of long bone and most common in the knee
 arise in persons of age 10 – 25 or older persons who have preexisting bone disorder
 “sunburst” pattern or Codman’s triangle

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 mixed destructive/sclerotic lesion with soft tissue mass

osteoma
tumor composed of bone tissue
 often arise in the outer table of the skull, the paranasal sinuses (especially frontal and
ethmoid), and the mandible
 appear as well-circumscribed, extremely dense, round lesions that are rarely larger than 2
cm in diameter
 no treatment needed

osteomylitis
bone infection usually the spread of bacteria from a distant location. can spread through the bone
from the periosteum, cortex, and marrow causing bone destruction; can also lead to an abscess
 soft tissue swelling with loss of the fat planes, eventual loss of cortical margins, patchy
destruction of cancellous bone (latticework)
 bone scans and MRI are very useful for progression

osteopetrosis
failure of resorption of cartilaginous intercellular substance, the growth plate does not mature
resulting in bone retardation and brittleness
 congenital condition having many eponyms (named after)
 marble bones, chalk bones, ivory bones
 thickening and increased density of soft bone (exact opposite of osteoporosis)

osteoporosis
generalized or localized loss of bone mass in the entire skeleton
 result of accelerated bone resorption (osteoclastic process) and a decrease in new bone
replacement (osteoblastic process)
 cortical thinning appears as a relatively dense and prominent thin line

Paget’s disease
osteitis deformans – long bone, vertebrae, and skull deformity
 first the bone is soft and bowing occurs net the bone becomes increasingly hard and
brittle.; also associated with neoplasms such as osteogenic sarcoma
 increased bone expansion and density resembling a cotton-wool appearance

patent ductus arteriosus

vascular connection between pulmonary artery and aorta; during intrauterine life a vessel that
extends from the bifurcation of the pulmonary artery to join the aorta just distal to the left
subclavian artery should close after birth If this stays open (patent) after birth it causes increased
pulmonary blood flow an and excess volume of blood return to the left atrium and ventricle.
 enlargement of left atrium ventricle, and the central pulmonary arteries

pathologic fractures
occurs in a bone that has been weakened by a preexisting condition
 most common cause is metastatic malignancy or multiple myeloma
 appears as vertebral collapse or bone destruction (radiolucency due to underlying cause)

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pericardial effusion
accumulation of fluid within the pericardial space surrounding he heart interfering with cardiac
function
 caused by bacteria, viruses, neoplastic involvement, or idiopathic
 appears as an enlargement of the cardiac silhouette

plaque
fatty material of the inner arterial wall
 develop in the intima and produce progressive narrowing and often complete occlusion of
large and medium-size arteries
 a characteristic of atherosclerosis
 atherosclerotic plaques appear as irregular distributed densities along the course of an
artery and can often calcify

pleural effusions
accumulation of fluid in the pleural space
 common causes are CHF, PE, TB, or abdominal diseases (ascites, pancreatitis)
 appears as costophrenic angle blunting
 fluids look white or opaque and may be free fluid or loculated
 best seen on upright or affected side down decubitus (lateral decubitus)
 removal of air or drain fluid

pneumonia
acute infection of the lung parenchyma
 6-8th leading cause of death
 caused by bacteria, viruses, or fungus
 inflammation by microorganisms
 can cause scarring
 has 4 types of pneumonia:
1. alveolar or air-spaced (lobar): involves mostly the alveoli of an entire love w/o
involving the bronchi; mass of consolidated fluid; lateral view must be
included to establish degree of segmental involvement
2. broncho or bacterial pneumonia (lobular): patchy or irregular distribution of
disease that involves the inflammation of the bronchi and bronchioles, and
alveoli; patchy, irregular distribution is localized on one or more lobes around
the bronchi
3. interstitial or viral or pneumonitis: caused by a virus and no exudate (fluid) is
present; involves the wall and lining of the alveoli and the interstitial
supporting structure; acquired secondarily as a complication from measles,
chicken pox, or flu; Farmer’s lung is the inhalation of crop dust; linear or
reticular (mesh) pattern; honeycomb lung
4. aspiration: esophageal or gastric contents aspirated into the lungs; multiple
alveolar densities; posterior segments of the upper and lower lobes most
commonly affected if bedridden; Not contagious; patchy opacification
pneumothorax
presence of air in the pleural cavity, with partial or complete collapse of the lung
 causes are trauma, lung biopsy, ruptured esophagus, mets

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 no pulmonary markings are apparent

 pleural edge – is the line of visceral pleura forming the lunge edge, which is separated
from the chest wall by air
 both inspiration and expiration projection or decubs to compare
 use manual technique

pulmonary edema
normal fluid accumulation in the pulmonary tissues
 appears as a “butterfly or bat wing”
 vascular markings not sharp
 treatment: reduction of edema

pulmonary embolism
blood clot most often in the lower lobes of the lung
 originates in the deep veins of the legs
 emboli can break loose and travel to the lung and block the pulmonary artery causing
infarction
 potentially fatal
 increased radiolucency distal to the embolus from depressed perfusion of the vessels
 wedge-shaped density at the base of the lung
 usually not seen on CXR
 treatment includes anticoagulants, thrombolytic or vena cava filter placement

rheumatoid arthritis
chronic systemic disease of unknown cause that appears primarily as a noninfectious
inflammatory arthritis of the small joints of the hands and feet
 symmetric destruction affects women 3xs more frequently and the average onset age is
40
 occurs in small joints symmetrically
 CT - synovial inflammation (soft tissue mass) causes narrowing of atlantoaxial articulation

rotator cuff tear

a tear or inflammation of the rotator cuff tendons
 occurs in the shoulder
 us – tear in bursa and inflamed synovium

RSV (Respiratory Syncytial Virus)

attacks the lower respiratory tract in infants and causes necrosis of the respiratory epithelium of
the bronchi and bronchioles
 necrotic material and edema can cause obstruction which leads to interstitial pneumonia
 presents as a cold or flu so not treated properly
 must use PPEs (personal protective equipment) due to it being contagious
 appears as hyperinflation with diffuse increased interstitial markings, “fluffy” infiltrates

SARS (Severe Acute Respiratory Syndrome)

infection spread person-to-person or droplet contact
 nonproductive cough with decreased oxygenation

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 fatality rate is 3%
 appears: no abnormality in early stages, focal infiltrates that progress into patch
infiltrates, then areas of consolidation

small cell/oat cell carcinoma

usually already spread when it is discovered
 enlargement of hilar lymph nodes
 very aggressive – lymph nodes, liver, adrenal glands, bone, brain, and bone marrow
 give wide mediastinum
 associated with smoking

spina bifida
posterior defect of the spinal canal resulting from failure of the posterior elements to fuse
properly
 cervical, thoracic, or lumbar/sacral spine

spondylolisthesis
forward movement of one vertebra on another as a result of fracture of the neural arch resulting
into two parts
 most common in the 5th lumbar in which there is forward shift of L5 on the sacrum
 demonstrated on the L5-S1 spot film.

spondylolysis
loss of bony continuity of the neural arch of a vertebra
 occurs at the junction of the lamina
 usually effecting the 4th and 5th lumbar

squamous carcinoma
most common type of lung cancer
 arises in the major central bronchi
 produces a narrowing of the bronchi and leads to pneumonia
 spread to the lymph nodes which spread throughout the body (bone, brain)
 slow growing
 radiographs can reveal obstruction or atelectasis but can’t predict cell type but can detect
a lesion 2 years before symptoms occur

TB (Tuberculosis)
highly infectious (contagious), inflammatory, and chronic disorder
 most deadly and common major infectious disease today
 can be found in other organs
 transmitted by inhalation of infected droplets such as a cough, spit, sneeze, or speaking
 has nodular lesions, patchy infiltrates, calcium deposits
 CXR’s cannot always distinguish active from inactive
 thought of as vampirism

ventricular septal defect

communication between ventricles (in between ventricles); increased pulmonary blood flow and

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consequently increased pulmonary venous return leading to diastolic overloading and

enlargement of the left atrium and left ventricle
 pulmonary trunk enlargement
 no right ventricular enlargement

Types of Fractures
avulsion
fracture occurring where a joint capsule ligament, tendon, or muscle is pulled from a bone, taking
with it a fragment of the bone to which it was attached; occur at sites of muscle origin. (As in the
olecranon process)

boxer’s
a transverse fracture of the neck of the 5 th metacarpal with volar (palm) angulation of the distal
fragments

closed
a fracture in which the bone does not pierce the skin

Colles’
forked fracture of the distal radius posteriorly and a chip fracture of the ulnar styloid

comminuted
fracture of a bone is which the separated parts are splintered or fragmented

complete
a bone fracture in which the bone is split completely across

compound
a fracture in which the broken bone is exposed through a wound in the skin

compression
a fracture (as of a vertebra) caused by compression of one bone against another

depressed
a fracture especially of the skull in which the fragment is depressed below the normal surface

greenstick
partial bone fracture, usually occurring in children, in which the bone is bent but only broken on
one side

hangman’s
result of acute hyper-extension of the head on the neck

incomplete
a bone fracture extending partly across the bone

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Jefferson
comminuted fracture of the ring to the atlas, involves both the anterior and the posterior arches
and causes displacement of the fragments

open
a fracture in which broken bone fragments lacerate soft tissue and protrude through an open
wound in the skin

Pott’s
complete break of the medial malleolus a type of avulsion fracture
 bimalleolar – fracture of the lateral and medial malleolus
 trimalleolar – has 3 components: the medial and lateral malleolus and the posterior distal
tibia

stress
a fracture of bone caused by repeated application of a heavy load, such as the constant pounding
on a surface by runners, gymnasts, and dancers

subluxaton
partial loss of continuity of the joint surfaces

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