FRCR Part Dhá > Thoracic > Flashcards

Thoracic Flashcards

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1
Q

finterface of the right lung and mediastinal reflection of azygous vein?

A

Azygo-oesophageal recess

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2
Q

Meeting of the parietal and visceral pleural reflection anteromedially?

A

Anterior junctional line

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3
Q

meeting of the pleural surfaces of the upper lobes behind the oesophagus ?

A

Posterior junctional line

Above the clavicles

Cervicothoracic sign = if above the clavicles in the posterior mediastinum

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4
Q

Right wall of the trachea agaisnt the right lung?

A

right paratracheal line

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5
Q

Right lung meeting against posterior mediastinal soft tissue?

A

right paraspinal stripe

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6
Q

What is luftsichel sign on CXR?

A

Ongoing aeration of the superior most segment if left lower lobe in upper lobe collapse

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7
Q

DDx for unilateral hyperlucent hemithorax?

A

-Rotation (lucent side closer to the tube ie away from the plate)

Lung
- Airway obstruction/FB
-PTx

Chest wall =
- Mastectomy
- Ploand syndrome
- Polio

Swyer-james
- unilateral hyperlucent lung on radiography and air-trapping and bronchiectasis on CT

Alpha-1-antitrypsin
- Pan lobular basal emphysema

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8
Q

AIDs with CD4 <200, perihilar GGO, sparing the periphery, pneumatoceles (thin walled) ?

A

PCP

Can have PTx

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9
Q

Lung infection with CD4 200-400?

A

Pyogenic - commonest Strep pneumonia
TB

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10
Q

CD4 count less <150

A

<150
Fungal -
- Cryptococcal - cavity formation, concurrent cerebral
- Histoplasmosis - no CXR apperacnes (50%)

<100
CMV and Kaposi sarcoma

<50
MAC , Lymphoma

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11
Q

Causes of persistent opacities in AIDS patients

A

Lymphoma
Kaposi - ‘Flame shaped’ perihilar

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12
Q

Tree in bud opacities and and cylindric bronchiectasis of the right middle lobe or lingula?

A

MAC

Tree in bud - terminal bronchiole filled with radiopaque material

Other causes
TB (Pus)
CF, ABPA (mucus)
Cells - Breast and gastric cancer
Aspiration
CMV (bronchial wall thickening)

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13
Q

Signs of invasive asperigillus ?

A

Halo sign
=Nodule/mass/consolidation surrounded by ground-glass opacity related to hemorrhage

Air crescent sign
=Crescent-shaped gas collection within nodule, mass, or consolidation

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14
Q

Nodule or mass within preexisting cavity

A

Aspergilloma

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15
Q

Central upper lobe saccular bronchiectasis with mucoid impaction (finger in glove). Known asthmatic?

A

ABPA

‘Migratory’ airway consolidation

Central bronchiectasis, peripheral bronchi clasically spared

Cavity formation possible in later stage

Dense mucoid impaction - High-attenuating (>70–100 HU) bronchial contents represent fungal debris

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16
Q

Aggressive fungal infection that invades the mediastinum, pleura and chest wall?

A

Mucormycosis

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17
Q

Peripheral nodular and wedges shaped densities. Lower lobe predominant. cavity formation

A

Septic emboli

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18
Q

CAVITY mnemonic?

A

*Cancer (Squamous)
*Auto-immune (Wegners, Rheumatoid/caplan)
*Vascular - Septic emboli
*Infection - TB, staph, strep
*Truama - pneumatoceles
Y - Young - CPAM, Sequestrations

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19
Q

What bacteria is classic for lemierre syndrome?

A

Fusobacterium Necrophorum

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20
Q

Peripheral grouns glass/subsolid nodule in the upper lobe. Non-smoker. which type of lung cancer?

A

Adenocarcinoma

Associated with lung fibrosis

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21
Q

Central mass with cavitation, smoker. which type of lung cancer ?

A

Squamous

Ectopic PTH
Cushings

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22
Q

Central lung malignancy with central lymphadenopathy. Associated with lambert eaton. which type of lung cancer?

A

Small cell

Paraneoplastic syndromes
- SIADH
- Lamber eaton = proximal weakness
- Limbic encephalitis

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23
Q

you can use PET for assessing SPN greater than 1cm. If ground glass, what would PET uptake be if malignancy?

A

Cold

Hot in infection

if solid malignancy then hot (SUV> 2.5)

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24
Q

Benign pleural lesion associated with hypertrophic pulmonary osteoarthropathy?

A

Pleural fibroma

Malignant lesion would be lung cancer (non -small cell)

Pleural fibroma aka benign mesothelioma
-T1 MR hypointense; T2 MR hyperintense; contrast enhancement on CT avid

About
14%–30% undergo malignant degeneration. Surgical excision is curative.

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25
Round atelectasis can mimic a lung mass. What features differentiate?
Comet tail sign Adjacent to thickened pleural (assoacited with asbestosis) +/- Ca2+
26
lung mass with fat density, peripheral and popcorn calcifications?
Hamartoma
27
Endobronchial lesion, calcification. Histroy of wheeze. Avid enhancement.
Carcinoid Cold on PET (false negative) Carcinoid syndrome in chest is uncommon versus abdominal. if present Left sided valves destroyed Atypical carcinoid are rare and can have no enhancement
28
Stage 3B lung cancer (N3 or T4) is unresectable, what features?
Unresectable = -supraclavicular, scalene or contralateral mediastinal or hilar lymphadenopathy - Tumour in same lung but different lobes (T4) - Tumour in two different lungs (M1a) - Malignant pleurant effusion (M1) Nb - that tumours in the same lobe is (T3)
29
Early vs later radiation pneumonitis appearances?
Early (1-3 months) - Homogenous or patchy GGO Late - Dense consolidation, traction bronchiectasis and volume loss
30
Post pneumonectomy, contralateral tracheal shift, reduction on height of fluid on sequential films. what is the complication?
Bronchopleural fistula Can confirm on Xenon gas nuclear med Normal appearances - air fluid level at day4/5, by 14 days 100% fluid filled ipsilateral tracheal shift Diaphragm elevation
31
Young adult, post pneumonectomy, exertional SOB, hyper expansion of lung displaces and rotates the heart anticlockwise. what is complication?
Post-pneumonectomy syndrome
32
6 months post transplant. Mosaic attenuation, air-trapping, bronchial wall thickening, bronchiectasis ?
Bronchiolitis obliterans Findings more** Prominet on expiratory phase (air trapping) ** associated bleomycin toxicity, IBD, RA, post BMT
33
Post-transplant complications in hours, 4-24hrs, 7-10 days, weeks, months, anytime
Hours = hyperacute rejection 4-24 hrs = Reperfusion injury - (perihilar bat opacifications and effusions.) (second week) = Acute rejection (GGO (basal), septal thickening, pleural effusions Weeks = drugs - (GGO) Months - Lymphoid interstitial pneumonitis (GGO + centrilobular nodules + thin-walled cysts) Anytime - bacterial, PCP, aspergillus
34
Thoracic duct injury above and below T5/T6 - which side is the pleural effusion?
Above = Left Below = Right crosses midline at t5/t6 to drain into junction left SCV and IJV
35
Lobar condolidation, in bone marrow transplant, cavitation, no lymph node enlargement. what is the infection?
Nocardiosis
36
Lobar pneumonia in alcoholic/immunocompromised?
Klebsiella **Strep commonest in non-immunocompromised **
37
Organism causes bronchopneumonia?
Staph (commonest) pneumococcus haemophilus
38
Viral pneumonia apperances?
like bronchopneumonia affects airways and interstitium Differentiate from bacterial = Air trapping = hyperinflation on CXR
39
Round pneumonia?
Young children Pneumoccous, strep Spherical area posterior lower lobes
40
Peripheral soft tissue nodule/mass, abuts pleura, obtuse angle, episodic hypoglycaema?
Fibrous Tumor of the Pleura
41
Egg shell calcifications nodes ?
Silicosis Coal workers pneumoconiosis Sarcoidosis Treated lymphoma Mediastinal lymph node calcification Tuberculosis Histoplasmosis Amyloidosis (rare) Metastases: papillary/medullary thyroid cancer, osteosarcoma, mucinous adenocarcinoma
42
Feeding vessel sign ?
Mets Septic emboli
43
Type of emphysema?
Centrilobular -smoking, apical segments Panacinar - Alpha1-antitrpysin , bases Paraspetal - Subpleural, bullous formation, spontaneous PTx
44
Neonate hyperlucent LUL, mass effect on mediastinum and contralateral mediastinal shift ?
Congenital lobar overinflation Bronchus unable to remain open in expiration, leading to air trapping No discrete cyst or feeding vessels
45
Honeycombing, basilar predominant, traction bronchiectasis, distortion of architecture, smoking association?
UIP Spare the costophrenic angles
46
Basilar GGO, subpleural sparing, younger, steroid responsive?
NSIP Absent honeycombing Bilateral ground-glass &/or reticular opacities ± traction bronchiectasis/bronchiolectasis Subpleural sparing ± peribronchovascular fibrosis associated with CREST - dilated oesophagus RA sjorgens chemo HIV
47
NSIP vs UIP
48
Features of Desquamative interstitial pneumonia (DIP)?
Smoker Bilateral, lower zone predominant ground-glass opacities ± subpleural **intralobular lines/retiuclations ** Small, round,** thin-walled** (2-4 mm in diameter) Spectrum/similar HRCT to RB-ILD + centrilobular nodules + upper lobe predominated
49
Female, 60, Ground-glass opacities, Centrilobular nodules , thin-walled Cysts?
Lymphoid Interstitial Pneumonia - LIP **DIffuse ** GGO clears with treatment **Associated with Sjogren's** + PCP, Hep B, EV + AIDs
50
Female, 30, with diffuse thin-walled lung cysts, spontaneous pneumothorax, effusions. Non-smoker?
Lymphangioleiomyomatosis (LAM) **Diffuse no lobe predominant** Premenopausal. **NORMAL lung volumes** Chylous pleural effusions increased lung volumes ***Associated with tuberous sclerosis - 1/3rd have AMLs***
51
20-30, male, nodules + bizarre-shaped thick pulmonary cysts in cigarette smokers. Increased lung volumes ?
Pulmonary Langerhans cell histiocytosis (PLCH) **Predominant upper lobes** normal lung volumes Smokers M:F = Effusions are rare **Sparing costophrenic angles**
52
Bilateral basilar predominant lentiform cysts, liver and skin lesions?
Birt-hogg-dube Bilateral basilar predominant lentiform cysts abutting pleura, septa, and pulmonary vessels Bilateral Renal oncocytomas + **chromophobe RCC
53
Multifocal ground-glass opacities and consolidations. Some with peripheral consolidation around central ground glass nodule?
COP Reverse halo sign Associated with -CF -Methotrexate - post-transplant - connective tissue
54
Afro-Caribbean, female, 20. Subpleural nodules upper zone. Bilateral hilar and mediastinal lymph nodes?
Sarcoidosis Bilateral hilar and right paratracheal lymphadenopathy in up to 95% of cases Garland triad = 1,2,3 sign = lymph nodes both hilum and right paratracheal Traction bronchiectasis Perilymphatic nodules UPPER lobes Lofgren’s syndrome is an acute form of sarcoidosis characterised by erythema nodosum, bilateral hilar lymphadenopathy and polyarthralgia.
55
According to BTS guidelines first presentation nodules, features that require no follow up?
Calcification Perifissural <5mm <80mm3
56
Diffuse or patchy parenchymal opacities (ground-glass &/or consolidation) associated with bilateral septal thickening and pleural effusion. Known Asthma
Acute eosinophilic pneumonia -Ground-glass opacities (100%) -crazy-paving pattern -mosaic attenuation; may mimic pulmonary edema Reverse pulmonary oedema pattern (peripheral) acute type I hypersensitivity reaction triggered by variable causes (inhalational exposure, drugs, infections) Chronic eosinophilic pneumonia (CEP): Peripheral homogeneous consolidations (100%) Allergic bronchopulmonary aspergillosis (ABPA): Central upper lobe bronchiectasis ± high-attenuation mucous plugs (30%)
57
Upper lobe predominant - BREASTS?
Berylliosis Radiation / RB-ILD Extrinsic allergic alveolitis and Eosionphilic granuluma (LCH) Ankylosing spondylitis/ ABPA Sarcoidosis TB Silicosis Nb ++ all pneumoconiosis Caplans syndrome Centrilobular emphysema CF
58
Lower lobe predominant - BADAS
Bronchiectasis Asbestosis DIP/Drugs Aspiration Scleroderma (+ RA !!!) + Panlobular emphysema (alpha 1) + RA (Caplans upper lobes and less common) + UIP and NSIP
59
Centrilobular hyperdense micronodules in recretional drug user?
Talcosis
60
Where does asbestosis typically spare?
Costophrenic angle Pleural effusion often first sign but **bilateral calcified plaques most common presentation** If mediastinal pleura - ?mesothelioma If unilateral - ? previous Sx or Empyema Crocidolite = very fine fibre results in blue asbestosis = very severe pleural disease
61
Features of Extrinsic allergic alveolitis?
Acute/Nonfibrotic: Centrilobular ground-glass nodules and air-trapping Mosiac attenutation Chronic: Dyspnoea, clubbing etc Fibrotic: Upper lobe **peribronchovascular fibrosis**
62
Features of alveolar proteinosis ?
Crazy paving sign and ground glass opacities
63
Features of TB?
Primary -Hallmark is lymphadenopathy -Homogenous consooldiation -compressive atelectasis from compression of adjacent lymph nodes -pleural effusions (30%) Post-primary -Cavitating nodule -tuberculomas
64
Mosaic attenuation causes?
Higher attenuation pathological ie Parenchymal disease ie (GGO) - sarcoidosis, UIP, COP, DIP - No air trapping. =Vessels in the whiter areas = dilated Lower attenuation pathological **- look for vessels constricted/paucity in lucent areas ** 1. Poor ventilation = ***Air-trapping - Exacerbated by expiratory phase - Bronchitis , bronchiectasis, asthma, emphysema, Hypersensitivity pneumonitis 2. Mosaic perfusion - as above but no air trapping - CTEPH, pulmonary hypertension
65
Crazy paving causes?
Alveolar proteinosis ARDS Goodpastures COP Sarcoidosis
66
lobar collapses on CXR ?
67
Anterior mediastinal masses
Thymoma Teratoma Terrible lymphoma Thyroid Germ cell tumours can be fruther subdivded -Teratoma (usually cystic with fat and calcification) -seminoma (bulky and lobulated) -Non-seminomatous Germ Cell Tumour (haemorrhage and necrosis)
68
Two common trachea malignancy and how to differentiate?
1. SCC - Smoker - Lower 2/3rd trachea - ulcerated mass or nodule that projects into tracheal lumen - infiltration mediastinal structures, Frequent regional metastatic lymphadenopathy 2. Adenoid cystic carcinoma - non-smoker - proximal 1/3rd - growth along submucosal and perineural structures Consider Mucoepidermoid carcinoma (MEC) in young patient with endoluminal lesion in segmental airway - lobar or segmental bronchi
69
Basilar GGO, subpleural sparing, younger, steroid responsive?
NSIP Absent honeycombing Bilateral ground-glass &/or reticular opacities ± traction bronchiectasis/bronchiolectasis Subpleural sparing ± peribronchovascular fibrosis associated with CREST - dilated oesophagus RA, sjorgens, chemo
70
Causes of Lymphangitis carcinomatosis?
Certain Cancers Spread By Plugging The Lymphatics Cervix Colon Stomach Breast Pancreas Thyroid Larynx (or lung – bronchogenic) Nb > 50% from breast and most remaining gastric
71
malignant vs benign pleaural lesion
Nodular pleural thickening, involvement of the mediastinal pleura and circumferential involvement of the pleura all point heavily towards a malignant diagnosis. stalk strongly suggests a benign lesion less than 1cm thick, suggests benign pleural plaque
72
carbey triad vs syndrome
Carneys syndrome - FAST Carneys triad - PEG (if you have a bad GIST tumour you might need a PEG tube)
73
Feautres of RB-ILD
Centrilobular nodules GGO Upper/mid zones Smoking No bronchiectasis or honeycombing
74
Complication rates posrt lung Bx
PTx = 25% PTx needing drain = 5-10% Haemoptysis = 3% Air embolus = 0.05% Tumour seeding = 0.05%
75
Middle mediastinal masses?
Fibrosing mediastinitis -partly calcifed mass, especially subcarinal and right partatracheal, - causes vascular compression leading to right heart strain (SVC obsruction)
76
Tracheal stenosis?
Wegners Tracheal wall thickening Circumferential (**involvement of posterior membranous trachea)** Relapsing polychondritis Wall thickening ± calcification that spares posterior membranous wall Tracheobronchomalacia Weakness of central airway walls At least 70% tracheal collapse on expiratory CT saber-sheath trachea narrowing of its coronal diameter and widening of its sagittal diameter snokers/COPD Tracheobronchomegaly a.k.a. Mounier-Kuhn syndrome Marked dilatation of trachea and mainstem bronchi
77
Causes for interlobular septal thikening?
LISA Lymphangitis carcinomatosis (nodular or smooth) - beaded appearance Interstitial oedema (smooth) Sarcoidosis (nodular) Alveolar proteinosis (smooth)
78
Occlusion techniques IR?
see picture
79
bronchiectasis by location
Bronchiectasis with Upper or Mid-Lung Predominance * Cystic fibrosis * ABPA * Sarcoidosis * TB Bronchiectasis with Anterior Predominance * Atypical mycobacterial infection * ARDS Bronchiectasis with Lower Lung Predominance * Pulmonary fibrosis * Chronic aspiration * Kartagener’s syndrome * Common variable immunodeficiency * α1-Antitrypsin deficiency Bronchiectasis with Central Predominance * Mounier–Kuhn syndrome * Williams–Campbell syndrome
FRCR Part Dhá
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