1. Chest p64-65 (Congenital)

Question 1

Bronchial Atresia - Anatomy

Answer 1

Most commonly apical-posterior segment of left upper lobe.

Question 2

Bronchial Atresia - imaging (2)

Answer 2

Blind ending bronchus, filled with mucus (finger in glove).
Distal lung hyperflated (from collateral drift and air trapping).

Question 3

AVM - Cause (3)

Answer 3

Can occur sporadically.
HHT or Osler Weber Rendu

Question 4

AVM - anatomy

Answer 4

more common in lower lobes (more vascularity)

Question 5

AVM - clinical

Answer 5

Can be source of right to left shunt (source of stroke/brain abscess)

Question 6

AVM - Rx

Answer 6

Treat once afferent vessel is 3mm

Question 7

Persistent left SVC - anatomy (4)

Answer 7

Usually only significant if a line is inserted, line sits left paramedian.
Usually drains into coronary sinus.
5% drain into left atrium, causing mild right to left shunt (CT shows pacemaker or line going into right heart from left.

Question 8

Persistent left SVC - Trivia

Answer 8

Commonest congenital venous abnormality of the chest.

Question 9

Swyer-James - anatomy (3)

Answer 9

Classic unilateral left lung.
Occurs after viral lung infection in childhood, causing post infective obliterative bronchiolitis.
Size of affected lobe is smaller (not hyperexpanded).

Question 10

Poland - anatomy (2)

Answer 10

Unilateral absence of pectoral muscle.
Associated with small arms/hands.

Question 11

Poland - imaging

Answer 11

CXR shows hyperlucent chest on affected side.

Question 12

Sequestration - types (2)

Answer 12

Intralobar (no pleural cover) and Extralobar (has pleural cover).
Cannot tell difference radiographically.

Question 13

Intralobar sequestration (5)

Answer 13

More common (75%),
Presents in adolescents with recurrent infections.
Most commonly left lower lobe posterior segment (2/3), rarely affects upper lobes.
Rarely associated with other developmental abnormalities.
Pulmonary venous drainage

Question 14

Extralobar sequestration (4)

Answer 14

Less common (25%),
Presents in infancy with respiratory compromise (mainly due to associated abnormalities)
Rarely infected as it has own pleural covering.
Systemic venous drainage.

Question 15

Extralobar sequestration - associations (5)

Answer 15

CCAM (Congenital cystic adenomatoid malformation),
Congenital diaphragmatic hernia,
Vertebral anomalies,
Congenital heart disease,
Pulmonary hypoplasia

Question 16

CCAM - anatomy (3)

Answer 16

Malformation of adenomatoid which replaces normal lung.
Usually only affects one lobe.
Communicate with airway, therefore filling with air.

Question 17

CCAM - types (3)

Answer 17

Type 1 = cystic
Type 3 = solid,
Type 2 = intermediate

Question 18

CCAM - Rx (2)

Answer 18

90% decrease in size by third trimester.
Rx is surgical removal, due to risk of malignant transformation (retropulmonary blastoma, rhabdomyosarcoma)

Question 19

Systemic artery feeding a CCAM?

Answer 19

Not a CCAM, it’s a sequestration.