1. Chest p91-94 (Pulmonary manifestations of Systemic Disease, Pleura/chest wall) Flashcards
Collagen vascular disease associated with
Interstitial lung diseases
Lupus - pulmonary manifestations (2)
More pleural and pericardial effusions than other connective tissue diseases.
Can get “Shrinking lung”. Fibrosis is uncommon
RA - pulmonary manifestations (3)
Looks like UIP and COP.
Lower lobes favoured.
Reticulations with or without honeycombing.
Solid opacities which are organising pneumonia.
Scleroderma - pulmonary manifestations (3)
NSIP > UIP.
Lower lobe predominantly.
Dilated, fluid filled oesophagus.
Sjogrens - pulmonary manifestations (2)
LIP,
Extensive ground glass attenuation with scattered, thin walled cysts.
Ankylosing spondylitis - pulmonary manifestations (2)
Upper lobe fibrobullous disease.
Usually unilateral at first, then progresses to bilateral.
Caplan syndrome - features (3)
Rheumatoid nodules & Upper lobe predominant lung nodules.
These nodules can cavitate.
May also be pleural effusions.
Shrinking Lung - features (2)
Progressive loss of lung volume in lupus.
Either due to diaphragm dysfunction or pleuritic chest pain.
Commonest manifestation of SLE in chest
Pleuritis with/without pleural effusion
Hepatopulmonary syndrome - physiology (3)
“shortness of breath when sitting up” in liver patients (opposite to CHF).
Due to distal vascular dilation in lung bases (subpleural telangectasia), when dilated subpleural vessels don’t taper and extend to pleural surface.
When sitting up, these engorge with blood and make pt short of breath.
Hepatopulmonary syndrome - imaging
Tc MAA scan shows shunting with tracer in the brain.
Wegeners - features (4)
Classic triad of upper tract, lung and kidneys.
Lungs most commonly involved (95%).
Most commonly nodules with cavitation, with random distribution and about half of them cavitating.
May see ground glass changes suggesting haemorrhage.
Goodpasture syndrome - definition/trivia (2)
Autoimmune pulmonary and renal syndrome.
Favours young men.
Goodpasture syndrome - features (4)
Bilateral coalescent airspace opacities, look like oedema but are haemorrhage.
Resolves quickly (2 weeks).
Recurrent bleeding episodes can lead to fibrosis or haemosiderosis (iron deposits manifest as small, ill defined nodules)
Pleural plaque - features (3)
Asbestos related.
20-30 year lag time after exposure,
Usually spares costophrenic angles.
Pleural calcifications - non-asbestos causes (4)
Old haemothorax,
Old infection,
TB,
Extraskeletal osteosarcoma
Mesothelioma - trivia (4)
Most common pleural cancer.
80% had asbestos exposure.
30-40 year lag.
Development is NOT dose dependent.
Mesothelioma - features (3)
Buzzword - pleural rind.
Tendency for direct invasion.
Extension into the fissure is highly suggestive.
Fibrous tumours of the pleura - trivia (2)
NOT related to asbestos, smoking or environmental pollutants.
50% found incidentally.
Pleural mets - trivia (3)
Adenocarcinoma is most likely subtype to met to pleura.
Lung Ca is commonest primary (then breast, then lymphoma).
Pleural effusion is commonest manifestation of pleural mets.
Fibrous tumours of the pleura - features (3)
Solitary tumours arising from visceral pleura.
Can get large and cause chest pain.
Associated with hypoglycaemia and hypertrophic osteoarthropathy
Pleural lipoma - trivia (3)
Most common benign soft tissue tumour of pleura.
Don’t cause rib erosion.
Never become Sarcoma.
Pleural lipoma - features (2)
Pts sometimes feel urge to cough.
Differential extra-pleural fat, usually bilateral and symmetric.
Pleural effusion - trivia (3)
175ml to be seen on frontal CXR (75 for lateral).
Can be exudate or transudate (based on Lights criteria).
Elastic/compressive atelectasis of adjacent lung.
Subpulmonic effusion - features (3)
Effusion between lung base & diaphragm.
More common on right, with ski-sloping or lateralisation of the diaphragmatic peak.
Lateral decub to confirm diagnosis.
Empyema - features (3)
Essentially an infected pleural effusion.
More common with AIDS.
Usually more asymmetric. Also feature enhancement of the pleura, septations, or gas.
Empyema vs pulmonary abscess
Empyema is lentiform, pulmonary abscess is round.
Empyema has split pleural sign (thickening & separation of visceral & parietal pleura). Abscess has claw sign (acute angle with pleura).
Empyema is treated with chest tube, abscess is not (risk of bronchopleural fistula).
Empyema Necessitans - features (2)
Empyema invades chest wall and into soft tissues.
Commonly seen in TB (70%) or actinomyces.
Diaphragmatic hernia - features (3)
Congenital or acquired (trauma).
Congenital are commonest in left posterior (Bochdalek), anterior right and small ones (Morgagni) less common.
Traumatic more common on left (Liver acts as a buffer).
Diaphragm paralysis - features (4)
Idiopathic in 70% of cases.
Phrenic nerve compression from lung cancer is common cause in exams.
Right diaphragm is normally higher, so higher left is sus.
Fluoro used to make diagnosis (paradoxical upward movement on sniff test).
