1
Q
- Granuloma - Neoplasm (bronchogenic carcinoima, solitary met) - Hamartoma = Round pneumonia (under 8yo) = AVM
A
Solitary Pulmonary Nodule
2
Q
- Mets
- Granulomas (TB or fungal)
- Septic emboli
= Wegener’s
= Rheumatoid
A
Multiple Pulmonary Nodules
3
Q
- TB
- Fungal disease
- Sqaumous cell carcinoma
= Pyogenic infection (abscess or septic emboli)
= Wegener’s
= Rheumatoid arthritis
A
Cavitary Pulmonary Nodule
4
Q
- TB - Fungal disease - Mets = Pneumoconioses = Healed Varcicella
A
Milary Pulmonary Nodule
5
Q
- Infectious bronchiolitis (MAC, TB) - Hypersensitivity pneumonitits - Endobronchial spread of tumor = RB-ILD = Pneumoconioses
A
Centrilobular Pulmonary Nodules
6
Q
- Emphysema - LAM - LCH/EG = Pneumocystis pneumonia = LIP
A
Cystic Lung Disease
7
Q
- Idiopathic pulmonary fibrosis/UIP - Collagen vascular dz (scleroderma) - Asbestos-related lung dz = drug toxicity
A
Lower Lobe Interstitial Disease
8
Q
- TB - Sarcoidosis - Cystic Fibrosis = Pneumoconioses = LCH
A
Upper Lobe Interstitial Disease
9
Q
- Chest wall abnormality (Polan, mastectomy) - Swyer-James - Acute asthma = Airway obstruction = PE = Pneumothorax
A
Hyperlucent Lung
10
Q
- Lymphoma - Thymic lesion - Thyroid lesion = Germ cell neoplasm (teratoma)
A
Anterior Mediastinal Mass
11
Q
- Lymphadenopathy - Vascular abnormality (aneurysm) - Congenital cyst / bronchogenic cyst = hiatal hernia
A
Middle Medistinal Mass
12
Q
- Neurogenic tumor - Lymphoma - Developmental cyst (neuroenteric cyst) = extramedullary hematopoiesis = mediastinal hematoma
A
Posterior Mediastinal Mass
13
Q
- Cryptogenic Organizing Pneumonia - Pulmonary Alveolar Proteinosis - Bronchioloalveolar Cell Carcinoma [BAC] = Chronic Eosinophilic Pneumonia = Lipoid Pneumonia
A
Chronic Airspace Disease
14
Q
- Cryptogenic Organizing Pneumonia - Eosinophilic Pneumonia - Pulmonary Infarction = Pulmonary Contusion = Alveolar Sarcoidosis
A
Peripheral Airspace Disease
15
Q
- Pulmonary edema - Atypical infection - Pulmonary hemorrhage = ARDS = Alveolar proteinosis = Vasculitis
A
Ground Glass Opacification
16
Q
- Infection - Lymphoma - Sarcoidosis = Mets = Pneumoconioses
A
Mediastinal/Hilar lymphadenopathy
17
Q
- Asbestos related pleural disease - Fibrothorax (prior infex or hemorrhage) - Iatrogenic (pleurodesis)
A
Calcified Pleural Disease
18
Q
- Postinfectious (bacterial, TB, MAC) - Cystic Fibrosis - ABPA = Obstructive lesion/mass = Ciliary dyskinesia
A
Bronchiectasis
19
Q
- Sarcoidosis - Lymphangitic spread of tumor - Pneumoconioses = Lymphoproliferative disorder
A
Perilymphatic Pulmonary Nodules
20
Q
- Pleural mets - Empyema - Mesothelioma = Fibrous tumor of the pleura = Fibrothorax
A
Pleural Based Mass
21
Q
- PCP - TB - Fungal infection = Invasive aspergillosis = Kaposi Sarcoma = Pulmonary lymphoma
A
Parenchymal Disease in an HIV patient
22
Q
- True LV aneurysm - False LV aneurysm - Pericardial cyst/ mass = Calcified pericarditis
A
Abnormal left ventricular contour
23
Q
- Thrombus - Mets - Benign Neoplasm (myxoma, rhabdomyoma) = Malignant neoplasm (sarcoma, lymphoma)
A
Cardiac mass
24
Q
- Infarction/scar - Myocarditis - Cardiac mass = Infiltrative disease (amyloid, granulomatous)
A
Delayed myocardial enhancement
25
- Lipoma - Lipomatous hypertrophy of the interatrial septum - Arrhythmogenic RV dysplasia
Cardiac wall fatty deposit
26
- Lymphangitic carcinomatosis - lymphoma - sarcoid - pulmonary edema
Unilateral interstitial lung disease
27
- Histo - Healed varicella - silicosis
Multiple diffuse calcified nodules
28
- Sarcoid (upper lobe) - EG (upper lobe) - UIP (lower lobe, idiopathic) - Asbestosis (lower lobe) - Pneumoconiosis (upper lobes) - Scleroderma (lower lobe)
Honeycombing
29
- ABPA (asthmatics) - Noninvasive (normal people, fungus ball) - Semi invasive (mild immunosuppressed) - Invasive (very compromised, ill defined pulm nodules)
4 types of Asprergillus
30
- PAP - BAC - lipoid pneumonia - Drug induced pneumonitis
Crazy Paving
31
- COP - sarcoid - BAC - Eosinophilic pneumonia
Peripheral ground glass opacification
32
1. Thymus (thymoma, carcinoma, thymolipoma) 2. Germ cell neoplasm (teratoma) 3. Lymphoma 4. Throid (goiter, cancer) 5. Vascular abnormality (aneurysm)
Anterior Mediastinal Mass
33
1. Infection (fungal, bacterial) 2. Wegener's ganulomatosis 3. Septic emboli 4. Cavitary Mets 5. Rheumatoid Nodules 6. Pulmonary lacerations
Multiple cavitary lesions
34
1. Edema 2. Hemorrhage 3. Infection (PCP) 4. Hypersensitivity Pneumonitis 5. Drug Toxcicity/Inhalation
Ground Glass Opacities - Acute
35
1. BAC 2. NSIP 3. LIP
Ground Glass Opacities - Chronic
36
1. Neoplasm (squamous, adnoid cystic, mucoepidermoid) 2. Papillomatosis 3. Tracheopathica Osteoplastica 4. Saroidosis, Amyloidosis, Relapsing Polychondritis
Endotracheal mass
37
1. Mesothelioma 2. Pleural Mets 3. Fibrous tumor of pleura 4. Lipoma 5. Empyema/loculated effusion 6. Infection / empyema necessitans
Pleual Mass
38
1. Esophageal injury/rupture 2. Pulmonary/tracheal trauma 3. Rupture of bleb, asthma, severe coughing 4. Barotrauma 5. Surgery 6. Retropharyngeal infection
Pneumomediastinum causes
39
1. UIP / IPF 2. CVD (scleroderma, rheumatoid) 3. Aspiration 4. Asbestosis 5. Durg toxicity (methotrexate, chemo, busulfan)
Basilar Fibrosis
40
1. Sarcoidosis 2. Lymphoma 3. Mets 4. Small cell lung cancer 5. Infections (TB) 6. Castleman's Dz
Bilateral hilar adenonopathy
41
1. Miliary TB / Histo 2. Hematogenous mets (thyroid, renal) 3. Silicosis 4. EG
Small nodules, random distribution
42
1. Neruogenic tumor (schwannoma, neurofibroma, paraganglioma, ganglioneuroma) 2. Hematoma 3. Abscess (Pott's dz) 4. Vascular (aortic aneurysm) 5. Extramedullary hematopoesis
Posterior Mediastial Mass
43
1. Cystic Fibrosis 2. Kartagener's / Ciliary Dyskinesia 3. Chronic aspiration 4. Chroinic infection 5. Inhalation injury
Bronchiectasis
44
1. Maligancy (primary and mets) 2. Hamartoma 3. AVM 4. Infection 5. Fluid/effusion 6. Round atelectasis (a/w asbestos exposure)
Solitary Lung Mass
45
1. Esophagus (mass, tic, hiatal hernia) 2. Varicies 3. Foregut cyst 4. Lymphadenopathy 5. Pericardial mass/ cyst 6. LV pseudoanerysm 7. Aortic or PA aneurysm
Middle Mediastinal Mass
46
1. Edema 2. Hemorrhage / Contusion 3. Infection 4. Drug toxicity 5. Hypersensitivity Pneumontis
Bilateral Patchy Opacities - Acute
47
1. BAC 2. Sarcoidosis 3. COP / BOOP 4. Eosinophilic Pneumonia 5. PAP 6. NSIP
Bilateral Patchy Opacities - Non-Acute
48
- Azygous continuation of IVC - Obstruction of vena cava - Tricuspid insufficiency - Rt sided heart failure
Causes of azygous vein enlargement
49
- Pulmonary embolism - Extrinsic compression of PA (mass, aortic aneurysm [Ehlor-Danlos, Marfan's, syphilis]) - Aortic dissection
Causes of unilateral absent perfusion on VQ scan
50
- silicosis - sarcoidosis - Coal worker's pneumoconisosis - ankylosing spondylitis - EG - cystic fibrosis
Upper Lung Chronic Infiltrative Disease
51
- Cystic medial necrosis (marfan's, Ehlers-Danlos) - atherosclerosis - syphilis
Causes of ascending aortic aneurysms [>4cm]
52
- kidney - melanoma - thyroid - breast - colon
Common extrathoracic sites with endobronchial mets
53
- radiation fibrosis - mediastinal lipomatosis - vascular abnormalites (coarc)
Bilaterally enlarged apical caps
54
- Bronchogenic carcinoma - lymphoma - extrapleural hematoma - abscess - radiation fibrosis
Unilateral apical cap
55
Cryptococcus
In an HIV + patient, what fungal infection presents with pulmonary nodules, pleural effusion, and lymph node enlargement?
56
- maligancy - cystic fibrosis - IPF - localized fibrous lesions of the pleura
Disorders that are associated with Hypertrophic Pulmonary Osteoarthropathy
57
Cylindrical Varicoid Cystic/Saccular
Three types of bronchiectasis (Reid classification)
58
Cystic Fibrosis Williams-Campbell Immotile cilia syndrome Mounier-Kuhn Primary hypogammaglobulinemia
Congenital disorders associated with bronchiectasis
59
- Loffler's syndrome - Chronic eosinophilic pneumonia - BOOP - pulmonary infarcts - vasculitides
Peripheral distribution of consolidation
60
1. centrilobular 2. paraseptal 3. panlobular 4. paracicatricial
4 types of emphysema
61
Alpha-1-antitrypsin Ritalin lung IV methylphenidate
Panlobular emphysema with basilar predominance
62
- mosaic perfusion - bronchial dilation - air trapping
CT findings of bronchiolitis obliterans
63
- bone marrow txplant - viral infections - toxic inhalation - rheumatoid arthritis - lung txplant - IBD
Conditions associated with bronchilitis obliterans
64
1. curvilinear subpleural lines 2. thickened septal lines 3. subpleural dependent density 4. parenchymal bands 5. honeycombing
5 CT findings of asbestosis
65
ground glass opacification with smooth septal thickening in a geographic distribution
Define crazy paving
66
- BOOP - Loffler's syndrome - chronic eosinophilic pneumonia - pulmonary infarcts - vasculitidies
Peripheral pattern of consilidation
67
- Left to right shunt (Vein of Galen, hemangioendothelioma) - Coarctation - Hypoplastic left heart - narrow proximal Aorta, MV, and LV - Arrhythmia - Cardiomyopathy
CHF in a newborn
68
- Hypersensitivity pneumonitis - Sarcoid - Acute on chronic PE - GVHD/CVD (BO and OP)
Head Cheese (air trapping, normal lung, GGO)
69
Think small airways disease - BO - Asthma
Mosaic Attenuation with air traping
70
- Chronic PE (pulmonary HTN and enlarged RVH) - Vasculitis - Fibrosing mediastinitis (ST around aorta, RVH, RVE)
Mosaic attenuation with no air trapping
71
- TOF - Ebsteins - Severe pulmonary stenosis - Tricuspid atresia
Neonate with CHD with decreased pulmonary vascularity
72
- D-transposition - Truncus arteriosis - TAPVR - VSD - ASD - PDA
Neonate with CHD and increased pulmonary vascularity
73
- hypoplastic L heart - coarcation - ?TAPVR
Neonate with CHD and pulmonary venous HTN
74
- Neurogenic - ARDS - Near drowning - Re-expansion pulmonary edema - Acute inhalational injury
Noncardiogenic edema
75
- Pericardial effusion - oreo cookie sign - Bicuspid aortic valve, aortic stenosis - Coarctation - figure of 3 sign, rib notching (ddx NF) - Extrathoracic shunt - Vein of galen, hemangioendothelioma - Cardiomyopathy - infiltrating (sarcoid,amyloid,HOCM) - Cardiomyopathy - ischemic/infarction - Kawasaki - coronary artery aneurysms - Cor tritriatrium
Acyanotic, no shunt vascularity, big heart, +/- edema
76
Obstructive, Relaxation, Adhesive, Cicatricial
Types of Atelectasis
77
Crescent of air on frontal CXR, interface between aorta and hyperexpanded superior segment of LLL
Luftsichel sign
78
Diffuse cysts , round in shape, thin walled, diffuse, female childbearing age, assoc with tuberous sclerosis 1%
Lymphangiomyomatosis findings and association
79
RUL atelectasis, usually due to obstructing mass
Golden's S sign
80
LLL atelectasis with downward shift of hilar structures causing flattening of left heart border and cardiac rotation
Flat waist sign
81
1) abnormal adjacent pleura (effusion or pleural thickening/plaque); 2) peripheral, touching pleura; 3) round or elliptical; 4) volume loss in lobe; 5) comet tail sign (pulmonary vessels and bronchi leading to opacity)
Signs of round atelectasis
82
Pneumonia (atypical in GGO such as viral or PJP) Pulmonary hemorrhage/edema ARDS
Ddx of acute consolidation/GGO
83
-Mucinous adenocarcinoma -Organizing pneumonia -Chronic eosinophilic pneumonia **GGO add** Idiopathic pneumonia Hypersensitivity pneumonitis Alveolar proteinosis
Ddx of chronic consolidation/GGO
84
Pulmonary hemorrhage Pulmonary edema - cardiogenic PJP Alveolar proteinosis
Ddx of GGO in central distribution
85
Organizing pneumonia Chronic eosinophilic pneumonia Atypical pneumonia Pulmonary edema - noncardiogenic
DDx for peripheral consolidation/GGO
86
Smooth - pulmonary edema/hemorrhage, Alveolar proteinosis, Atypical pneumonia Nodular - Sarcoid, lymphangitic carcinomatosis
Interlobular septal thickening types and ddx
87
Alveolar proteinosis PJP Organizing pneumonia Mucinous adenocarcinoma Lipoid pneumonia ARDS Pulmonary hemorrhage
Ddx for crazy paving
88
Subpleural sparing --Infectious - endobronchial TB or MAI, bronchopneumonia, atypical PNA --Inflammatory - HSP, RB-ILD, diffuse panbronchiolitis, silicosis, hot tub lung (rxn to atypical mycobacterium like HSP)
Ddx of Centrilobular pulmonary nodules
89
Sarcoid Pneumoconiosis Lymphangitic carcinomatosis
Ddx of perilymphatic nodules
90
Fungal Miliary TB
Interstitial lung disease, nodules, acute
91
Silicosis Sarcoidosis LCH Lymphangitic carcinomatosis
Interstitial lung disease, nodular, chronic
92
Silicosis Sarcoid Treated lymphoma
Eggshell calcifications in lungs
93
Interstitial edema Atypical pneumonia (viral, PJP)
Interstitial,lung disease, reticular, acute
94
Fibrosis Emphysema Cystic lung dz Bronchiectasis
Interstitial lung disease, reticular, chronic
95
Sarcoid Chronic HSP Cystic fibrosis Prior TB Ankylosing spondylitis XRT Silicosis
Fibrosis, upper lobe distribution
96
UIP, NSIP Connective tissue disorders with UIP-like findings Chronic aspiration End stage asbestosis
Fibrosis, lower lobe distribution
97
Lymphangitic carcinomatosis Lymphoma Kaposi's sarcoma Amyloid - rare
Interstitial lung disease, septal lines, chronic
98
Pulmonary edema Atypical infections
Interstitial lung disease, septal lines, acute (Kerley B lines)
99
Mycobacterium TB or atypical mycobacterium, bacterial or aspiration pneumonia, airway invasive aspergillus
Tree in bud nodules
100
Hematogenous metasteses, septic emboli, pulmonary LCH
Random nodules
101
Disseminated TB, fungal or hematogenous mets
Miliary nodules
102
Solitary - primary bronchogenic carcinoma (cavitary adenocarcinoma or squamous cell), TB (upper lobe) Multiple - septic emboli, vasculitis, mets (squamous cell or uterine)
Cavitary lesion, solitary and multiple
103
Solitary - bulla, bleb, pneumatocoele Multiple - lymphangiomyomatosis, emphysema, pulmonary LCH, diffuse cystic Bronchiectasis, PJP pneumonia, lymphoid interstitial pneumonia
Lung cysts , solitary and multiple
104
Ground glass attenuation surrounding consolidation. Ddx angioinvasive aspegillosis, hemorrhage met, Wegeners granulomatosis, Kaposi's sarcoma, viral infection
Halo sign in pulmonary
105
Relapsing polychondritis - usu involves ears and nose in middle age female Tracheobrochopathi osteochondroplastica - nodular with calcifications
Tracheal thickening, diffuse, sparing of posterior trachea
106
TB - smooth long segment Amyloid - nodular +/- calcifications Wegeners granulomatosis - subglottic stenosis Sarcoid - hilar LAD, differing presentations
Tracheal thickening, diffuse, circumferential
107
Apical, posterior, anterior
RUL segments?
108
Lateral and medial
RML segments?
109
Superior, Lateral, Anterior, Posterior, Medial
RLL and LLL segments?
110
Apical posterior. Anterior. Superior lingula. Inferior lingula.
LUL segments.
111
***
**In lower lobes, medial and anterior are anterior, posterior and lateral are posterior
112
RUL from RML. Fine horizontal line.
Minor fissure?
113
1%. RUL apical or posterior segments are encased in their own parietal and visceral pleura
Azygos lobe?
114
Subsegmental atelectasis. Dont see them in obstructive atelectasis because airways are obstructed of course.
In which type of atelectasis would you expect to see air bronchograms?
115
Obstruction of small peripheral bronchi usually due to secretions
Subsegmental atelectasis?
116
***
**Obstructive atelectasis happens more quickly in patients breathing supplemental oxygen because its absorbed from the alveoli quicker than nitrogen. Obstructive atelectasis happens when oxygen from air is absorbed by blood and not replaced.
117
***
**In general obstructive atelectasis is associated with volume loss, but in critically ill ICU patients, there may be rapid transudation of fluid into obstructed alveoli, causing superimposed consolidation
118
This is what is seen adjacent to a mass or pleural effusion causing mass effect
Relaxation atlectasis?
119
Lack of surfactant. RDS. ARDS.
Adhesive atelectasis?
120
Volume loss from architectural distortion of lung parenchyma by fibrosis
Cicatrical atelectasis?
121
Mucus plugging
Acute lobar atelectasis?
122
Obstructing central tumor must be ruled out
Lobar atelectasis in an outpatient?
123
Luftsichel sign. Crescent of air on the frontal radiograph representing the interface between the aorta and the hyperexpanded superior segment of LLL
What sign in LUL atelectasis?
124
Reverse S sign of Golden.
Sign in RUL collapse?
125
Peridiaphragmatic triangular opacity caused by diaphragmatic traction from an inferior accessory fissure or an inferior pulmonary ligament
Juxtraphrenic peak sign?
126
Heart rotates and the L hilum is pulled down.
What do you see in LLL collapse?
127
Flat waist sign describes flattening of the L heart border as a result of downward shift of hilar structures
What sign in LLL collapse?
128
***
**RLL collapse is a mirror image of LLL collapse
129
You may only seen loss of R heart border.
RML atelectasis?
130
Focal atelectasis with a round morphology, always associated with an adjacent pleural abnormality
Round atelectasis?
131
All five have to met. Adjacent pleura has to be abnormal. Opacity must be peripheral and in contact with pleura. Must be round or elliptical. Volume loss in affected lobe. Pulmonary vessels and bronchi leading into the opacity must be curved causing comet tail
Diagnostic criteria for round atelectasis?
132
Centrilobular artery and central bronchus.
Center of each secondary pulmonary lobule?
133
Pulmonary veins and lymphatics
Periphery of each pulmonary lobule?
134
Between 1-2.5 cm
Size of SPL?
135
***
**Only call ground glass on CT
136
Complete filling of the affected alveoli with a liquidlike substance- Blood, pus, water, or cells
Histology of consolidation?
137
***
**Can't see pulmonary vessels through the consolidatoin on unenhnaced CT, but you can with ground glass opacification (GGO)
138
Pneumonia. Pulmonary Hemorrhage. ARDS. Pulmonary edema.
Differenential of acute consolidation?
139
BAC. Organizing pneumonia. Chronic eosinophilic pneumonia.
Differential of chronic consolidation?
140
Upper lobes
Distribution of chronic eosinophilic pneumonia?
141
Incomplete filling of alveoli (blood, pus, water, or cells). Alveolar wall thickneing, or reduced aeration.
Histology of ground glass opacification?
142
Edema. Pna (Atypical more common). Pulm hemorrhage. ARDS.
Differential of acute GGO?
143
BAC. Organizing pneumonia. Chronic eosinophilic pneumonia. Idiopathic pneumonias. HP (subacute phase). Alveolar proteinosis.
Chronic GGO differential?
144
Edema. Alveolar hemorrhage. Pneumocystis Jiroveci. Alveolar proteinosis.
Central distribution of GGO?
145
Organizing pna. Chronic eosinophilic (upper lobes). Atypical or viral pna. Edema (noncardiac, cardiac will be central)
Peripheral consolidation or GGO?
146
Edema
By far, most common cause of smooth interlobular septal thickening?
147
Edema. PAP. Pulm hemorrhage. Atypical pna. (Same diff as central GGO)
Diff for smooth interlobular septal thickening?
148
Lymphangitic carcinomatosis. Sarcoidosis.
Nodular, irregular, or assymetric septal thickening?
149
Interlobular septal thickening with superimposed GGO
Crazy paving?
150
Filling of alveoli with proeinaceous material and septal thickening caused by lymphatics taking up the same material
Why does PAP cause crazy paving?
151
PAP. Pneumocystic Jiroveci. Organizing pna. BAC (mucinous). Lipoid pneumonia. ARDS. Pulm Hemorrhage.
Differential for crazy paving? (7)
152
***
**Centrilobular nodules never extend to the pleural surface
153
Endobronchial spread of TB or atypical mycobacteria. Bronchonpneumonia. Atypical pneumonia (esp. mycoplasma)
Infectious causes of centrilobular nodules?
154
HSP and RB ILD are most common. Otehrwise Hot tub lung, diffuse panbronchiolitis, and silicosis.
Inflammatory causes of centrilobular nodules?
155
Chronic inflammatory disorder characterized by lymphoid hyperplasia of the walls of respiratory bronchioles, usually patients are Asian.
Diffuse panbronchiolitis?
156
Type III
What type of hypersensitivity reaction is HSP?
157
Subpleural. Peribronchovascular. Septal.
Three locations of perilymphatic nodules?
158
Sarcoid.
Most common cause of perilymphatic nodules?
159
Sarcoid. Confluent perilymphatic nodules.
Galaxy sign?
160
Pneumoconioses and lymphangitic carcinomatosis.
Other causes of perilymphatic nodules?
161
Mets. Septic emboli. Pulmonary LCH.
Random nodule distribution?
162
Diseminated TB. Diseminated fungal infection. Diseminated mets.
Miliary pattern of nodules?
163
***
**Most effusions associated with pneumonia are not empyemas but instead are a sterile effusion caused by increaed capillary permeability
164
***
**Treatment of BPF is very contraversial and individualized
165
***
**Miliary TB can be primary or reactivation TB
166
***
**Normal CT rules out P Jiroveci but it can hide in a normal chest radiograph
167
Impacted bronchioles, nodules are the impacted terminal bronchioles.
What are the linear branching structures in the tree in bud pattern? The nodules?
168
Small airways infection
Tree in bud are almost always associated with what?
169
Mycobacteria. Bacterial pna. Aspiration pna. Airway invasive aspergillosis
Diff for tree in bud nodules?
170
Under 4 mm will be benign and over 15 mm will be malignant
Wall thickness for definite benign or malignant cavitary lesions?
171
Cancer or infection
Solitary cavitary lesion is almost always what?
172
Carcinoma (SCC or adno, usually SCC). TB (Upper lobe cavitation). Septic emboli. Vasculitis (Wegeners). Metastases.
Diff for cavitary lesions?
173
LAM. Emphysema (upper lobe in a smoker). Pulmonary LCH (cysts and nodules in upper lungs). Diffuse cystic bronchiectasis. Pneumocystis jiroveci. LIP
Diff for multiple lung cysts?
174
Bulla is big, larger than 1 cm, occupies at least 30% of volume of the thorax. Bleb is an air filled structure contiguous with pleura less than 1 cm
Bulla vs bleb?
175
IPF. End stage asbestosis. NSIP.
Diff for lower lobe fibrotic changes?
176
Collagen vascular disease or drug reaction.
NSIP usually associated with what?
177
Cellular and fibrotic.
Two types of NSIP?
178
NO
Honeycombing in NSIP?
179
Fibrotic
Which type of NSIP causes basilar fibrosis?
180
End stage sarcoidosis. Chronic hypersensitivity pneumonitis. End stage silicosis.
Upper lobe firbosis differential?
181
Mycoplasma. Viral. Chlamydia.
Types of pneumonia which affect young otherwise healthy patients?
182
Elderly smokers. Severe infections
Who gets legionella?
183
Alcoholics and aspirators
Who gets klebsiella?
184
Voluminous inflammatory exudates causing the bulging fissure sign.
Klebsiella leads to what?
185
MRSA and resistent gram negatives including pseudomonas
Most important pathogens in HAP?
186
Usually polymicrobial but pseudomonas and acinetobacter are useful
Pathogens in VAP?
187
Patchy consolidation with poorly defined airspace opacities usually involving several lobes. Usually S Aureus.
What is bronchopneumonia?
188
Inflammatory cells in the interstitial tissues of the alveolar septa. Atypical agents.
Interstitial pneumonia?
189
Children. Incomplete pohrs of Kohn. S. Pneumonia.
What causes round pneumonia?
190
Necrosis or sloughing of a pulmonary segment or lobe, severe manifestation of pulmonary abscess.
Pulmonary gangrene?
191
1- Free flowing exudative effusion- treat with needle aspiration or simple drain. 2- Development of fibrous strands- Large bore chest tube and fibrinolytic therapy. 3- Fluid becomes solid and jelly like- Requires surgery.
3 Stages of Empyema?
192
***
**Most effusions associated with pneumonia are not empyemas but instead are a sterile effusion caused by increaed capillary permeability
193
Surgery. More rare causes are lung abscess, empyemia, trauma.
Most common cause of bronchopleural fistula?
194
New or increasing gas in a pleural effusion.
Imaging of BPF?
195
***
**Treatment of BPF is very contraversial and individualized
196
Extension of empyema to chest wall, usually due to TB. Can also be caused by Nocardia and Actinomyces
Empyema necessitans?
197
Contained disease. Primary TB.
Initial exposure to TB can lead to what two clinical outcomes?
198
90%. Results in calcified granulomas and/or calcified hilar lymph nodes. Normal immune patients will sequester the bacilli with a caseating granuloma.
Describe contained TB?
199
Host cannot contain the organism- Seen in immunocompromised and children
Describe primary TB?
200
15%
What percentage of primary TB have normal radiographs?
201
Ill defined consolidation. Pleural effusion. Lymphadenopathy. Miliary disease.
4 Imaging features of pulmonary primary TB?
202
Lower lobes and RML.
Most common lobes for primary TB?
203
Initial focus of parenchymal infection.
Ghon Focus?
204
Ghon focus and lymphadenopathy
Ranke complex?
205
Rare in primary TB. Common in reactivation TB.
Which TB gets cavitation?
206
Low attenuation centrally and peripheral enhancement.
Adeonpathy in TB?
207
Primary. Rare in post primary.
Which TB gets adenopathy?
208
Upper lobe apical and posterior segments.
Where does reactivation TB usually occur?
209
Cavitation and lack of adenopathy. Focal upper lobe consolidation and endobronchial spread (Tree in bud) is common.
Reactivation TB in an immunocompetent patient?
210
Low attenuation adenopathy. May mimic immune reconstitution syndrome seen in HIV patients.
Reactivation TB in an immunocompromised patient?
211
Well defined rounded opacity in the upper lobes
Tuberculoma?
212
Apical scarring with upper lobe volume loss and superior hilar retraction.
Healed TB?
213
Containment of initial infection by a delayed hypersensitivity response.
Calcified granulomas signify what?
214
***
**Miliary TB can be primary or reactivation TB
215
Bronchiectasis and tree in bud nodules in the RML or lingula.
Classic radiographic findings of Lady Windermere syndrome?
216
Elderly woman with cough, low grade fever and weight loss
Clinical presentation of Lady Windermere syndrome?
217
MAI. M. Kansasii
Organisms in Lady Windermere syndrome?
218
Hypersensitivity pneumonitis in response to atypical mycobacteria which are often found in hot tubs. Patient is otherwise healthy, no active infection. Imaging is similar to other causes of HP with centrilobular nodules.
What is hot tub lung?
219
Fibrosing mediastinitis, infection of lymph nodes leading to pulmonary venous obstruction, bronchial stenosis, and pulmonary artery stenosis.
Rare complication of histoplasmosis?
220
TB- Upper lobe fibrocavitary consolidation
Chronic histoplasmosis can mimic what?
221
Bacterial pna. Consider TB if CD4 count is low.
Focal airspace opacity in an immunocompromised patient?
222
CD4 less than 200
Who gets pneumocystic jiroveci?
223
Bilateral perihilar airspace opacities with peripheral sparing.
Classic radiographic findings of P Jiroveci?
224
Perihilar GGO sometimes with crazy paving.
Classic CT of P Jiroveci?
225
***
**Normal CT rules out P Jiroveci but it can hide in a normal chest radiograph
226
Upper lobe pneumotoceles which may predispose to pneumothorax or pneumomediastinum.
P Jiroveci has a propensity to lead to what?
227
Cryptococcus
Most common fungal infection in AIDS patients?
228
Cryptococcus meningitis
Pulmonary infection with cryptococcus usually coexists with what?
229
Less than 100
CD4 in cryptococcus?
230
Wide range: GGO, Focal consolidation, cavitating nodules, miliary diseaes, lymphadenopathy, effusions
Imaging of cryptococcus?
231
Individuals with abnormal immunity or pre-existing pulmonary disease
Aspergillus only affects who?
232
ABPA, Aspergilloma (Saprophytic), Semi invasive. Airway invasive. Angioinvasive.
Types of aspergillus infection?
233
Hypersensitivity reaction to aspergillus in patients with long standing asthma
What is allergic bronchopulmonary aspergillosis and who gets it?
234
Recurrent wheezing, low grade fever, cough, sputum production. Sputum contains fragments of aspergillus hyphae.
Presentation of ABPA?
235
Upper lobe bronchiectasis and mucoid impaction which can be high attenuation or even calcified
Key finding on CT of ABPA?
236
Finger in glove
Combination of mucoid impaction within bronchiectatic airways represents what sign?
237
An aspergilloma develops in a pre-existing cavity.
What is saprophytic aspergillosis?
238
***
**Imaging of patient in different positions causes the aspergilloma to move
239
TB and sarcoid.
Most common causes of a pre-existing cavity?
240
Hemoptysis
Most common symptom of aspergilloma?
241
Crescent of air outlines the mycetoma against the wall of the cavity.
Monod sign?
242
Necrotizing granulomatous inflammation (analogous in pathology to reactivation tb) in response to chronic aspergillus infection.
What is semi-invasive aspergillosis?
243
Debilated, diabetic, alcoholic, and COPD patients
Who gets semi-invasive aspergillosis?
244
Segmental areas of consolidation, often with cavitatoin and pleural thickening, which progress slowly over months or years
CT of semi-invasive aspergillosis?
245
Infection deep to the airway epithelial cells
What is airway invasive aspergillosis?
246
Only the immunocompromised, including neutropenic and AIDS patients
Who gets airway invasive aspergillosis?
247
From bronchiolitis to bronchopneumonia
Spectrum of clinical disease in airway invasive aspergillosis?
248
Centrilobular and tree in bud nodules. Also bronchopneumonia which is indistinguishable from other causes of bronchopneumonia
CT findings of airway invasive aspergillosis?
249
Aggressive infection characterized by invasion and occlusion of arterioles and smaller pulmonary arteries by fungal hyphae.
What is angioinvasive aspergillosis?
250
Severely immunocompromised patients, including patients on chemotherapy, stem cell or solid organ trasplant recipients, and in AIDS
Who gets angioinvasive aspergillosis?
251
Represents a crescent of air from retraction of infarcted lung. Good prognostic sign indicating patient is in recovery phase.
Air cresent sign in angioinvasive aspergillosis?
252
Dilated lymphatic channels radiating from hila, clinically insignificant
What do Kerley A lines represent?
253
Radiate from periphery- Thickened interlobular septa
Kerley B lines?
254
Vascular redistribution (increased caliber of the upper lobe vessels compared to lower lobe vessels). Interstitial edema. Alveolar edema (Pleural effusions and cardimegaly are usually present)
3 stages of pulmonary edema radiographically?
255
Intrathoracic- Patchy. Nonthoracic- Diffuse.
GGO in intrathoracic causes of edema vs non thoracic causes?
256
Aggressive thoracentesis- reexpansion of lung in a state of collapse for more than 3 days
When does reexpasion pulmonary edema occur?
257
Transverse width of the upper mediastinum
Vascular pedicle?
258
Interface of the SVC and R mainstem bronchus.
Right border of vascular pedicle?
259
Lateral border of the takeoff of the subclavian from the aorta
L border of the vascular pedicle?
260
Less than 58 mm
Normal vascular pedicle width?
261
***
**Vascular pedicle widths of 63 and 70 have been proposed as cutoffs for increased pulmonary capillary wedge pressure
262
***
**ET Tube can be slightly lower in situations with low pulmonary compliance like ARDS to reduce barotrauma
263
1% of patients. Increased risk of venous perforation and thrombosis
Look at pics of azygous malposition of catheter, what risks? What percentage of patients have azygous malposition.
264
Rupture or pseudoanerysm. Also intracardiac catheter knot and arrythmias are other complications of swan ganz catheters
Risks of Swan Ganz distal to proximal interlobar pulmonary artery? General risks of Swan Ganz.
265
80-90%
Tobacco is thought to cause what percentage of lung cancers?
266
***
**Asbestos increases lung ca risk by 5 and is synergistic with smoking
267
***
**Pulmonary fibrosis increases lung ca risk by 10
268
***
**Scarring also increases risk
269
GG nodule
More likely malignant, solid or gg nodule?
270
Central. Laminar. Diffuse.
What types of calcification are benign?
271
Hamartoma
What nodules have popcorn calcification?
272
Non round is usually benign
Shape of pulmonary nodule and correlation with ca?
273
Infection
Clustering of nodules suggests?
274
18% of malignancy.
Nodule .8-3cm?
275
Very high chance of malignancy
Nodules over 3 cm?
276
Irregular edge or spiculated margin
Margins which are concerning?
277
26%
Doubling in volume corresponds to what increase in diameter?
278
***
**Decrease in size of a suspicious nodule isn't sufficient to diagnose benignity, can occur with collpase of aerated alveoli or necrosis
279
Small cell
Histology of lung ca with the worst prognosis?
280
Adneocarcinoma
Most common histological subtype of lung ca?
281
Peripheral
Adenocarcinoma, central or peripheral?
282
TTF-1 (Thyroid transcription factor). Positive in adenocarcinoma and negative in pulmonary mets
Pathologic marker of adenocarcinoma of the lung?
283
Main lobar or segmental bronchi. Causes symptoms early due to bronchial obstruction.
Majority of SCC arise from where?
284
BAC. Spreading of malignant cells using the alveolar walls as a scaffold
Lepidic growth?
285
Most other types of lung cancer. Cancer growth by invasion and destruction of lung parenchyma.
Hilic growth?
286
Negative
BAC on PET?
287
***
**New classification of BAC- Going to ignore this
288
Nonmucinous
Better prognosis, nonmucinous or mucinous BAC?
289
Solid or gg nodule with air bronchograms
Imaging of nonmucinous BAC?
290
Chronic consolidation.
Imaging of mucinous BAC?
291
Describes prominent appearance of enhancing pulmonary vessels seen in low attenuation mucin rich consolidation of mucinous BAC
CT angiogram sign?
292
Small cell (after adeno and scc)
Third most common histologic subypte of lung cancer?
293
Neuroendocrine
In small cells, neoplastic cells are of what origin?
294
Smoking
Small cell associated with what?
295
Central bronchi with invasion through the bronchial wall, typically presenting as a large hilar or perihilar mass.
Where dose small cell tend to occur?
296
***
**Small cell is considered disemminated disease, rarely amenable to surgery
297
***
**Large cell is a wastebasket diagnosis for tumors which aren't squamous, adenocarcinoma, or small cell
298
Smoking
Large cell associated with what?
299
Periphery as a large mass
Where do large cell carcinomas usually occur?
300
Endobronchial mass distal to the carina which may cause obstructive atelectasis. Up to 20% of cases present as a pulmonary nodule
Common presentation of carcnoid?
301
Typical- without mets has an excellent prognosis (92% survival over 5 years). Atypical has a worse prognosis and arises in periphery.
Describe two subtypes of carcinoid?
302
DIPNECH- Extremely uncommon precursor lesion to typical carcinoid tumor, characterized by mutiple foci of neurondocrine hyperplasia or tumorlets (Carcinoid foci less than 5 mm) and bronchiolitis obliterans
What is diffuse idiopathic pulmonary neuroendocrine cell hyperplasia?
303
Adenocarcinoma, including BAC
50% of cancrs presenting as a solitary pulmonary nodule is what?
304
SCC and Small cell
Hilar mass is a common presentation of which lung cancers?
305
***
**Tapered bronchus is highly specific for lung cancer
306
Lung ca occuring in the lung apex
What is a superior sulcus tumor?
307
Type of superior sulcus tumor with involvement of the sympathetic ganglia causing Horner syndrome
What is a pancoast tumor?
308
Ipsilateral ptosis, miosis, anhidrosis
Horner syndrome?
309
T3
What stage is a superior sulcus tumor?
310
Diffuse spread of neoplasm through the pulmonary lymphatics, typically seen in late stage disease. Nodular interlobular septal thickening, usually asymmetric
What is lymphangitic carcinomatosis?
311
M1a- meaning it precludes curative resection. Have to do cytologic evaluation to be sure.
What stage is a malignant effusion?
312
Early stages up to IIB and sometimes IIIA. Can do neoadjuvant or adjuvant chemo and radiotherapy also.
Surgery is performed for what stages of lung cancer?
313
Contralteral or supraclavicular lymph nodes.
What makes a tumor IIIb or unresectable?
314
***
**Skipped lung cancer staging. Probably need to review later?
315
WHO Class 1 entities
When can you use pulmonary arterial hypertension instead of pulmonary hypertension?
316
Pulmonary arterial systolic pressure greater than 25 at rest or 30 during exercise.
Definition of pulmonary arterial hypertension?
317
When pulmonary capillary wedge pressure is greater than 18
When are elevated pulmonary venous pressures present?
318
Chronic thromboembolic disease, chronic respiratory disease, chronic heart disease, idipathic causes
Causes of pulmonary hypertension?
319
Pre-capillary and Post-capillary.
Most common classification of pulmonary hypertension?
320
Causes clear up to the pulmonary parenchyma.
Precapillary is what?
321
Problems with pulmonary veins or pulmonary venous pressure.
Postcapillary is what?
322
Pulmonary arterial hypertension. Pulmonary venous hypertension. Pulmonary hypertension associated with chronic hypoxemia. Pulmonary hypertension due to thromboembolic disease. Pulmonary hypertension due to miscellaneous disorders.
5 classes of pulmonary hypertension according to WHO?
323
Primary (Idiopathic or familial). Congenital L to R shunts. Pulmonary venous or capillary involvement such as pulmonary venoocclusive disease and pulmonary capillary hemangiomatosis
Causes of grade 1 pulmonary hypertension?
324
L sided heart disease.
Causes of grade 2 pulmonary hypertension?
325
Sarcoid, compression of vessels, etc.
Causes of grade 5 pulmonary hypertension?
326
Pulmonary artery calcifications
Pathognominic for pulmonary artery hypertension?
327
Mosaic attenuation due to perfusion abnormalities
Lungs in pulmonary hypertension?
328
Confirms that a hilar mass is in fact a pulmonary artery. There is a convergence of hilar pulmonary artery branches into an enlarged pulmonary artery
Hilum convergence sign?
329
Visualization of hilar vessels thorugh a mass- indicates that a mass is actually present.
Hilum overlay sign?
330
Anterior mediastinum, never middle.
Where is mass in hilum overlay sign?
331
Enlarged centrally. Taper distally.
Imaging of pulmonary arteries in pulmonary hypertension?
332
In wall of muscular arteries in pulmonary hypertension- Focal disruption of the elastic lamina by an obstructing plexus of endothelial channels. Relative paucity of prostacyclins and nitric oxide expressed by endothelial cells
Plexiform lesion?
333
Fibrotic obliteration of the pulmonary veins and venules.
Pulmonary veno-occlusive disease?
334
May be idiopathic but is associated with pregnancy, drugs, and bone marrow transplant
Associations of pulmonary veno-occlusive disease?
335
Pulmonary arterial enlargement. Pulmonary edema and gg centrilobular nodules are often present
Imaging of pulmonary veno-occlusive disease?
336
Surgical thromboendartectomy (similar to carotid endarterectomy)
Treatment of chronic thromboembolic pulmonary hypertension?
337
Histoplasmosis and TB
Most common cause of fibrosing mediastinitis?
338
Increased mediastinal soft tissue often with calcified lymph nodes due to prior granulomatous infection
Imaging of fibrosing mediastinitis?
339
Widening of pulmonary arteries due to clot
Fleishner sign?
340
Peripheral wedge shaped opacity representing pulmonary infarct.
Hamptoms hump?
341
Regional oligemia in lung distal to pulmonary artery thrombus
Westermark sign?
342
Form alveolar wall and participate in gas exchange
Type 1 pneumocytes?
343
Produce surfactant, which prevents atelectasis
Type 2 pneumocytes?
344
2-4 years
Mean survival of interstitial pulmonary fibrosis
345
AIP
Only interstitial pneumonia with a worse prognosis than pulmonary fibrosis?
346
IPF
Clinical syndrome of UIP?
347
Collagen vascular disease (RA more than scleroderma). Drug injury. Asbestosis.
Other triggers of lung injury that may result in a UIP pattern?
348
Less fibrotic change in NSIP
NSIP vs UIP histology
349
NSIP responds to steroids
Treatment difference between NSIP and UIP?
350
NSIP
Most common pulmonary manifestation in patients with collagen vascular disase?
351
Ground glass opacities, nearly always bilateral
Important imaging feature of NSIP?
352
Features GGO with fine reticulation and traction bronchiectasis
Fibrotic NSIP appearance?
353
Fibrotic
Which NSIP has worse prognosis?
354
GGO without much fibrotic changes
Cellular NSIP appearance?
355
Fibrotic
Which NSIP is more common?
356
Sparing of immediate subpleural lung
Very specific but uncommon finding in NSIP?
357
Cryptogenic organizing pneumonia- Clinical syndrome of organizing pneumonia without known cause
What is COP?
358
***
**COP used to be called BOOP
359
Responds to steroids with a good prognosis, may resolve completely, although recurrences are common
Treatment and prognosis of COP?
360
Granulation tissue polyps that fill the distal airway and alveoli
Pathologic pattern of OP?
361
Mixed consolidation and ground glass opacities in a peripheral and peribronchovascular distribution
CT of OP?
362
Reverse halo or Atoll sign- Central lucency surrounded by a GG halo
What sign is specific for COP?
363
Halo sign- Invasive aspergillus
Central opacity with peripheral GG?
364
Smoking
RB-ILD associated with what?
365
Pigmented macrophages are found in respiratory bronchioles
Pathological finding in RB-ILD?
366
Centrilobular nodules and patchy GGO.
Key imaging findings of RB-ILD?
367
More random in RB-ILD where it is more peripheral in NSIP
Distribution of GGO in RB-ILD vs NSIP?
368
***
**RB-ILD and DIP represent a continous spectrum of smoking related lung disease
369
In DIP, the brown pigmented macrophages also extend into the alveoli
Pathology of RB-ILD vs DIP?
370
Diffuse basal predominant patchy or subpleural GGO, more extensive than RB-ILD. A few cysts may also be present although predominant abnormality is GGO
Imaging of DIP?
371
Sjogrens, HIV
LIP is very rare, associated with what?
372
DIffuse infiltration of the interstitium by lymphocytes and other immune cells, with resultant distortion of the avleoli.
Histology of LIP?
373
Diffuse or lower lobe predominant GGO with scattered thin walled perivascular cysts, thought to be due to air trapping from peribronchiolar cellular debris
Imaging of LIP?
374
PTX
LIP may be complicated by what in advanced disease?
375
DAD- Diffuse alveolar damage.
AIP is synonomous with what?
376
Clinical syndrome of ARDS
What is AIP?
377
Surfactant destruction
Primary cause of AIP?
378
Early (Exudative) and chronic (Organizing)
Two phases of AIP?
379
Acute, subacute, chronic
Phases of HP?
380
Inflammatory exudate filling the alveoli, manifests on imaging as groundglass or consolidation. Small, ill defined centrilobular nodules.
Acute HP?
381
Centrilobular GG nodules. Mosaic attenuation
Subacute HP?
382
Describes combination of patchy GG and areas of lucency due to mosaic perfusion or air trapping
Head cheese sign?
383
***
**Abnormalities of HP involve entire axial cross section of lung
384
Upper lobe predominant pulmonary fibrosis superimposed on findings of subacute and acute HP
Chronic HP?
385
Can be seen in upper lobes but is uncommon.
Honeycombing in HP?
386
Pneumoconiosis is due to inorganic dust inhalation where HP is organic dust inhalation
Pneumoconioses vs HP?
387
Silicosis and coal workers pneumoconiosis
Two most common pneumoconioses?
388
***
**Findings of CWP and Silicosis are indistinguishable
389
Miners, from inhalation of silica dust
Who gets silicosis?
390
Inhalation of coal dust
CWP is due to what?
391
Upper lobe predominant centilobular and subpleural nodules
Most characteristic finding of uncomplicated disease in silicosis and CWP?
392
Silicosis. Less commonly CWP
Eggshell lymph node calcifications?
393
Large conglomerate masses (Progressive massive fibrosis)
Complications of silicosis or CWP?
394
TB
Both silicosis and CWP have increased risk of?
395
RA and either CWP (more common) or silicosis- represents necrobiotic rheumatoid nodules superimposed on the smaller centrilobualr and subleural nodules of the pneumoconiosis.
Caplan syndrome?
396
Pulmonary fibrosis with a UIP pathology
End stage asbestosis?
397
Lower lobes, the asbestos fibers are too large to be removed by the alveolar macrophages and lymphatic system
Upper or lower lobes for asbestosis? Why?
398
Pleural thickening and plaques (May or may not be calcified).
Clue to asbestos exposure?
399
***
**Even though pleural plaques are due to asbestos exposure, they are not a component of asbestosis, do not lead to fibrosis, and are usually asymptomatic
400
***
**Eosinophilic lung disease is a spectrum of diseases that feature accumulation of eosinophils in the pulmonary airspaces and interstitium
401
Also called Loeffler syndrome- Transient and migratory areas of focal consolidation, with an elevated eosinophilic count in the peripheral smear
Simple pulmonary eosinophilia?
402
***
**Identical appearance to eosinophilia can be seen with parasites and drugs but simple pulmonary eosinophilia is reserved for idiopathic causes
403
Peripheral with upper lobe predominance- pattern can remain unchanged for months.
Consolidation in chronic eosinophlic pneumonia?
404
Steroids- Responds rapidly
Treatment of chronic eosinophilic pneumonia?
405
Systemic small vessel disease associated with asthma and peripheral eosinophilia
Churg Strauss?
406
p ANCA
What is positive in Churg Strauss?
407
Varied, most common appearance is peripheral consolidation or GG
Imaging findings of Churg Strauss?
408
p ANCA. Most common cuase of pulmonary hemorrhage with renal failure
Microscopic polyangiitis is most common cause of what? What is positive?
409
Cnetral predominant GG representing hemorrhage
Imaging of microscopic polyangiitis?
410
Sinusitis, lung involvement, and renal insufficiency
Triad of Wegeners?
411
c ANCA
Lab tests specific for Wegeners?
412
Nasopharyngeal and eustachian tube obstruction. Involvement of trachea and bronchi is common, leading to airway stenosis
Upper airways in Wegeners?
413
Multiple cavitary nodules which don't respond to abx. Intra-cavitary fluid level suggests superimposed infection
Lungs in Wegeners? Superimposed infection?
414
***
**Drugs can elicit numerous pulmonary responses
415
40%
What percentage of patients develop radiographic abnormalities after external radiotherapy?
416
Early stage of radiation injury, can occur within one month of radiotherapy, most severe 3-4 months after treatment. GG centered on radiation port, but can extend out of radiation port
Radiation pneumonitis?
417
Late stage of radiation injury. Fibrosis becomes apparent 6-12 months after therapy. Key imaging finding is distribution of fibrosis and traction bronchiectasis within the radiation port, but may extend out of the port
Radiation fibrosis?
418
Pulmonary fibrosis with honeycombing, slight upper lobe predominance
Pulmonary sarcoidosis may progress to what in lungs?
419
Radiographs only- 0 Normal radiograph. 1- Hilar or mediastinal adenopathy only. 2- Adenopathy with lung changes 3- Lung w/o adenopathy. 4- Endstage fibrosis
Staging of sarcoid?
420
Symmetric addenopathy with stippled or egg shell calcification in up to 50%
Most common radiographic finding in sarcoid?
421
Right paratracheal, R hilar, L hilar- Completely encircles trachea on lateral- donut sign
Where is adenopathy in sarcoid?
422
Upper lobe predominant perilymphatic nodules of variable sizes representing sarcoid granulomas
In addition to lymphadenopathy, most common ct finding in sarcoid?
423
***
May see superimposed GGO in sarcoid
424
Mosaic perfusion due to air trapping
Bronchial involvement of sarcoid?
425
Smoking- Nearly 100% association
Pulmonary LCH associated with?
426
PTX
How may pumonary LCH present?
427
Diabetes insipidus from inflammation of pituitary stalk (hypophysitis), lucent bone lesions, skin involvement.
What other associated findings may be seen with pulmonary LCH?
428
LCH. Malignancy. TB. Fungal. Sarcoid. Gaucher.
Differential for dz affecting bone and lung?
429
Rare, but may resemple DIP
Gaucher in lungs?
430
Nodules associated with airways, as they progress they will cavitate and resultant irregular cysts predominate
First detectable abnormality and progression in LCH?
431
Smoking cessation is critical. Responds to steroids.
Treatment of pulmonary LCH?
432
Upper lobe predominant cysts and irregular peribronchovascular nodules both sparing the costophrenic sulci
So overall findings in LCH?
433
In PAP, there are no effusions and the heart is normal in size
PAP vs pulmonary edema?
434
Superimposed infection, especially with nocardia
Patients with PAP are susceptible to what?
435
Bronchialveolar lavage
Treatment of PAP?
436
1%
What percentage of TS patients have LAM?
437
Women of child-bearing age
Almost all cases of sporadic LAM are in what patients?
438
Estrogen
Some cases of LAM respond to what?
439
PTX, Chylous effusion
LAM is associated with what two things?
440
Cysts are round and regular and affect all five lobes where LCH is just upper lobe
Cysts in LAM vs LCH?
441
Prevascular superiorly and precardiac inferiorly (Precardiac is only a potential space)
Two compartments in anterior mediastinum?
442
***
**Bascially all of the mediastinal structures are in the middle mediastinum including the phrenic, vagus, and recurrent laryngeal nerve
443
Posterior trachea and posterior pericardium
Anterior border of the posterior mediastinum?
444
Formed by four laters of pleura at the anterior junction of the R and L lungs. Projections over the superior 2/3 of the sternum.
Anterior junction line?
445
Anterior mediastinal mass
Abnormal convexity or displacement of the anterior junction line?
446
Four layers of pleura, seen projection through the trachea on frontal view, more superior than the anterior junction line.
Posterior junction line?
447
Posterior
Which extend more superiorly, posterior or anterior lungs?
448
Posterior mediastinal mass
Abnormal convexity or displacement of the posterior junction line?
449
Formed by two layers of pleura where the medial aspect of each lung abuts the lateral wall of the trachea and intervening mediastinal fat
Right and Left paratracheal stripes?
450
Usually pleural thickening, although a paratracheal or tracheal mass can be the cause
Thickening of the R paratracheal stripe?
451
Same diff as on the R except add mediastinal hematoma in setting of trauma
Thickening of the L paratracheal stripe?
452
Only interface seen on lateral view, representing interface of posterior wall of trachea with two pleural layers of the medial right lung
Posterior tracheal stripe?
453
Mach effect
Why do we see R and L paraspinal lines?
454
2 layers of pleura abutting the posterior mediastinum
What forms the paraspinal lines?
455
Posterior mediastinal mass
Paraspinal line abnormality?
456
Interface formed by contact of the posteromedial RLL and retrocardiac mediastinum. Extends from the subcarinal region to the diaphragm inferiorly
Azygoesophageal recess?
457
Esophageal mass, hiatal hernia, L atrial enlargement and adenopathy
Distortion of the azygoesophageal recess?
458
Lymph nodes (most common cause of AP abnormality). L Phrenic nerve. Recurrent laryngeal nerve. L vagus nerve. Ligamentum arteriosum. L bronchial arteries
What lives in the AP window?
459
Anterior mediastinal mass, RV dilatation, Pulmonary artery enlargement
Obliteration of the retrosternal clear space?
460
Emphysema
Increase in retrosternal clear space?
461
From the L superior intercostal vein, not usually seen on radiography. It may be dilated in SVC obstruction as a collateral.
Aortic nipple?
462
Normal posterior junction line because ant junction line isn't always seen
Easiest way to infer an anterior mediastinal mass on cxr?
463
Thymic epithelial neoplasm. Germ cell tumor. Thyroid lesion if it extends above thoracic inlet. Lymphoma.
Anterior mediastinal mass diff dx?
464
Thymoma. Middle aged to older individuals, 45-60.
Most common primary tumor of the anterior mediastinum? Who gets it?
465
33%. 10%
What percentage of thymoma patients have MG? Other way around.
466
MG. Red cell aplasia. Hypogammaglobulinemia. Paraneoplastic syndromes. Malignancies such as lymphoma and thyroid cancer.
Thymomas are associated with what other diseases?
467
Whether capsule is intact
Invasive and non invasive thymoma?
468
30%. May invade adjacent structures.
What percentage of thymomas are invasive?
469
Phrenic nerve invasion
Thymoma with L hemidiaphragm elevation?
470
Drop mets along pleural and pericardial surfaces. Hematogenous mets are very rare.
Where does invasive thymoma spread?
471
***
**Thymomas are classfied into A, AB, B1, B2, B3, C, with C being the worst
472
Thymic carcinoma. Thymic carcinoid. Thymic cyst. Thymolipoma.
Other less common thymic lesions?
473
Histologically malignant. Aggressive. Hematogenous mets. Poor prognosis.
Thymic carcinoma characteristics?
474
Metastatic pattern.
Distinguishing between thymic carcinoma and thymoma on CT?
475
ACTH, causing Cushing syndrome
50% of thymic carcinoids secrete and cause what?
476
MEN 1 and 2
Thymic carcinoid is associated with what?
477
Indistinguishable from thymoma and thymic carcinoma.
Imaging of thymic carcinoid?
478
Preoperative Indium 111 Octreotide.
If carcinoid is suspected, what imaging?
479
Radiation therapy, AIDS, Congenital
Thymic cyst often caused by what?
480
Remnants of the thymopharyngeal duct
When thymic cysts are congenital they arise from what?
481
Anterior mediastinum
Congenital thymic cyst may occur anywhere along the descent of the course of the thymus from neck but usually occur where?
482
Benign fat containing lesion with interspersed soft tissue. Can become really large and drape over the mediastinum.
Characteristics of a thymolipoma?
483
Males
Malignant germ cell tumor- which gender?
484
Fat fluid level. Not commonly seen.
What is specific for a teratoma?
485
Teratoma
Most common anterior mediastinal germ cell tumor?
486
***
**Aorta is in posterior mediastinum, posterior mediastinal mass would silhouette the aorta
487
Seminoma
What is most common malignant mediastinal germ cell tumor?
488
Obscuration of the superior border of the mass implying mass is in continuity with the soft tissues of the neck
Cervicothoracic sign?
489
Continuity with the superior thyroid obviously
Key to diagnosing a thyroid lesion as an anterior mediastinal mass?
490
***
**Calcification is rare in untreated lymphoma.
491
Hodgkins
Lymphoma most commonly in thorax?
492
Usually happens in CWP and silicosis. Less commonly in sarcoid, but sarcoid is more common.
Egg shell calcification?
493
TB. Can also be seen in fungal infection, metastatic disease and sometimes lymphoma
Low attenuation lymph nodes should raise concern for what?
494
Castleman disease. Sarcoid. TB. Vascular mets.
Avid lymph node enhancement?
495
Angiofollicular lymph node hyperplasia- cause of highly vascular thoracic lymph node enlargement, uncertain etiology.
What is castleman disease?
496
Children. Surgical resection.
Who gets localized Castlemen and what is cure?
497
Older patients or AIDS patients.
Who gets multicentric Castleman disease?
498
Systemic illness including fever, anemia, lymphoma. Treat with chemo.
Symptoms of multicentric Castlemans? Treatment?
499
Avidly enhancing lymphadenopathy
Key imaging feature of Castemans?
500
R cardiophrenic angle. Cystic lesion abuts pericardium, can change shape.
Most common location of pericardial cyst? Appearnce.
MSK CORE
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