Solitary pulmonary nodule
- Hamartoma
- Neoplasm (speckled of eccentric calms are suspicious)
- Granuloma
Benign calcification is ** central, diffuse, laminated or popcorn**
Multiple pulmonary nodules
- Mets
- TB or granumomatous disease (Wegners, RA)
- Septic emboli
Haematogenous spread tends to favour lower lobes (mets and infection)
Cavitatory lung mass
- TB (reactivation rather than primary)
- Pulmonary Abscess (usually staph)
- Squamous cell carcinoma (primary and mets)
ALso think of Fungal Histoplasmosis, RA, Wegners
Miliary Nodules
- TB (due to haematogenous spread. 1-3mm micronodules. Immunocom, elderly, children
- Mets
- Fungal infection (aspergillus, cryptococcus, histoplasma)
Miliary upper lobe nodules - think inhalational coal workers pneumoconiosis or silicosis
Miliary nodules due to mets
3 most common primaries?
TRM
- Thyroid
- Renal
- Melanoma
Calcified miliary nodules?
Healed varicella
Centrilobular nodules
Differentials
(think inhalational)
Where are they located?
Located usually 3-5mm away from pleural surface and fisures. Within secondary pulmonary nodule. Can be any size or even ground glass. Distribution of most important.
- Bronchiolitis due to infection (TB and MAI windermere)
- Hypersensivity pneumonitis
- Endobronchial spread of a lung tumour
Also think silicosis (inhalational)
Tree in bud
These are another word for branching centrilobular nodules
Cystic lung disease
- Emphysema
- LAM
- LCH
Collagen vascular diseases
Name some
- RA
- Scleroderma
- SLE
Lower lobe ILD/fibrosis
- UIP most common
- Scleroderma/RA
- Aesbestos related disease
Amiodarone/Belomycin should also be considered
Upper lobe fibrosis
Elevation of the hila due to fibrosis. Coarse interstitial markings
- Reactivation TB (cavitatory nodules and fibrosis)
- Sarcoidosis/Silicosis
- Cystic fibrosis
Unilateral hyperlucent lung
- Poland syndrome
- Mastectomy
- Swyer james (obliterative bronchiolitis)
- Scoliosis
Don;t forget pneumothorax. FB
PE can also give hyperlucent lung due to lack of blood flow
Anterior mediastinal mass
- Thyroid (goitre)
- Lymphoma (Hodgkins usually)
- Teratoma/Seminoma
- Thymoma
Middle Mediastinum mass
- Lymphadenopathy (hilar, paratracheal)
- Thoracic aortic aneurysm
- Bronchogenic cyst (most common cyst)
- Hiatus hernia
Bronhcogenic cyst
Middle mediastinal mass usually
Posterior mediastinal mass
- Neuroblastoma (think if calcification, bony erosion or mets)
- Extramedullary haematopoesis
- Duplication cyst (can include bronchogenic. All looks the same though. Neuroenteric cysts will have spinal malformations)
Lymphoma can also be posterior mediastinal
Extramedullary haematopoesis
Causes?
In patients with severe and chronic anaemia
- Thalassaemia
- Sickle cell
- Hypersplenism
Usually bilateral and asymmetric paraspinal masses
Causes trabecular pattern in bones
How to tell if a mass is in posterior mediastinum on CXR?
Rib erosion or splaying of ribs confirms
Crazy paving differentials
- Pulmonary alveolar proteinosis (filling of alveolar spaces with protein)
Multifocal peripheral consolidation/ground glass
COP
- Cryptogenic organising pneumonia (more lower lobe. Subpleural sparing)
- Eosinophilic pneumonia (upper lobe more than lower. Can look like pulmonary oedema)
Eosinphilic
Ground glass opacification
- Pulmonary oedema
- Pulmonary haemorrhage
- Atypical infection (PCP, CMV)
- ARDS
ARDs vs pulmonary oedema: normal size heart and no pleural effusion in ARDS
Mediastinal and/or hilar lymphadenopathy
- Reactive to infection (TB and fungal nodes calcify)
- Lymphoma
- Sarcoidosis
Consider metastatic disease also
Calcification of the pleura
- Pleural plagues (usually bilateral. spares costophrenic angles)
- Sequelae of previous empyema, healed TB or previous haemothorax
- Talc pleurodesis can mimic calcification
