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Pulm > 19 Introduction to Chest Radiology 2 > Flashcards

19 Introduction to Chest Radiology 2 Flashcards

1
Q

Pattern approach

  • Puzzle
  • Location
  • Pattern
A
  • Puzzle
    • History
    • Physical exam,
    • Labs
    • PFT
    • CXR / CT
  • Location
    • Lung
    • Pleura
    • Mediastinum
    • Chest wall
  • Pattern
    • Degree of inspiration
    • Lungs too black / white
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2
Q

Radoilogic patterns

  • Lungs are too white
  • Lungs are too black
  • Other
A
  • Lungs are too white
    • Consolidation
    • Ground glass attenuation
    • Atelectasis
    • Reticular / nodular (interstitial disease)
    • Airspace (acinar)
    • Mixed
  • Lungs are too black
    • Air trapping – emphysema
    • Bronchiectasis
  • Other
    • Pulmonary nodule or mass
    • Cyst (multiple): cystic and cavitary disease
    • Pleural effusion
    • Lymphadenopathy
    • Mediastinal widening
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3
Q

Air space

A
  • Gas-containing portion of lung parenchyma, to include acini
  • Exclude the interstitium and purely conductive portion of lung
  • Consolidation: etiology
    • Pneumonia
    • Pulmonary edema
    • Aspiration
    • Near drowning
    • Malignancy
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4
Q

Air space consolidation

A
  • Air in alveoli is replaced by water, blood, pus, or tumor; results in confluent opacity which obscures broncho-vascular margins
  • May be focal, patchy, or diffuse
  • Air-bronchogram: radiologic appearance of an air-containing bronchus, surrounded by consolidated lung
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5
Q

Air space consolidation: differential

  • Edema
  • Infectious
  • Inhalation
  • Neoplasm
  • Metabolic
  • Other
A
  • Edema
    • Fluid overload (heart, renal failure)
  • Infectious
    • Pneumonia
  • Inhalation
    • Aspiration, toxic gases, drowning
  • Neoplasm
    • Adeno CA, lymphoma, mets
  • Metabolic
    • Alveolar proteinosis
  • Other
    • Pulmonary hemorrhage
    • Adult respiratory distress syndrome (ARDS)
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6
Q

Consolidation: radiologic signs

A
  • Silhouette sign (loss of)
    • Loss of normal lung – soft tissue interface
    • Enables anatomic localization
  • Air-bronchogram sign
    • Air filled bronchi are surrounded by consolidated lung
  • Bulging fissure sign
    • Lobar consolidation with copious pus causes bulging of the fissure
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7
Q

“Loss of the silhouette” sign

A
  • Localize lung pathology
  • When air in lung is When air in lung is tissue (pneumonia), the normal interface between lung and heart is lost
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8
Q

Consolidation: strep pneumonia RUL

A
  • Silhouette sign
    • RUL consolidation obscures normal air – soft tissue interface between lung & heart
  • Bulging fissure sign
    • Minor fissure bows downward
  • Air-bronchogram sign
    • Air-filled bronchus is patent
    • Surrounding lung is consolidated
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9
Q

Pneumonia LUL

A
  • In lingula
  • Lobar
  • Lobar on CT
    • Dense LUL consolidation
    • Mild posterior bulging of L major fissure
    • Most LUL airways are filled with pus
    • Several air-bronchograms
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10
Q

“Round” pneumonia: legionella

A
  • More common finding in kids
  • May mimic malignancy
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11
Q

Consolidation

  • Edema
  • Aspiration
  • Drowning
  • Lung cancer
A
  • Edema
  • Aspiration
    • Contents in stomach or oro-pharynx are inhaled into trachea and lungs
    • Results in consolidation of dependent portions of lung
  • Drowning
    • Aspiration of water
    • Consolidation is not always pna
  • Lung cancer
    • Pneumonic form mimics pneumonia
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12
Q

Ground glass opacity

A
  • Hazy increased lung attenuation
  • Preserved broncho-vascular markings / margins
  • Partial filling of alveoli, interstitial thickening, increased capillary blood flow
  • Individual deposits not detectable
  • “Smeared chalk” appearance
  • Edema, pneumonia
  • Pneumocystis pneumonia
    • Pink frothy exudate fills airspaces
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13
Q

Atelectasis

  • Root “ectasia”
    • Aortic ectasia
    • Bronchiectasis
  • Atelectasis
  • Radiologic findings
    • Direct
    • Indirect
A
  • Root “ectasia”: dilation, expansion
    • Aortic ectasia - mildly dilated aorta
    • Bronchiectasis - bronchial dilatation
  • Atelectasis
    • Gr. ateles “imperfect” + ektasis “expansion”
    • “Collapse” of lung, volume loss
  • Radiologic findings
    • Direct
      • Displaced fissure
    • Indirect
      • Increased attenuation
      • Displaced trachea, hilum, heart, diaphragm
      • Hyperinflation of unaffected lung
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14
Q

Atelectasis: definition

A
  • Decreased inflation of a segment, lobe, or lung
  • Results in reabsorption of air
  • Involved lung has decreased volume, increased opacity
  • Due to mucous plug, stricture, tumor, or extrinsic compression of bronchus
  • Non-involved lung responds with over
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15
Q

Atelectasis

  • “Plate-like” atelectasis
  • RUL atelectasis
  • Lobar atelectasis: RML
A
  • “Plate-like” atelectasis
    • Subsegmental
    • Linear
  • RUL atelectasis
    • Decreased inflation of segment, lobe, or lung
    • Reabsorption of air
    • Decreased volume, increased opacity
    • Mucous plug, stricture, tumor or compression of bronchus
    • Non-involved lung responds with over-inflation
  • Lobar atelectasis: RML
    • Silhouette sign
    • Displaced fissures
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16
Q

Atelectasis

  • Left lung
  • Endobronchial lesions
A
  • Left lung
    • Heart displaced to left
    • R lung is over-inflated
  • Endobronchial lesions
    • Mucus plugs
    • Malpositioned ET tube
    • Foreign bodies
    • Neoplasms
    • Strictures / stenoses
17
Q

Secondary atelectasis

A
  • Compressive
    • Pleural effusion or PTX
    • Huge R effusion
    • R lung atelectasis
  • Pneumothorax
18
Q

Interstitium

A
  • Continuum of loose supporting connective tissue in the lung
    • Broncho-arterial
    • Acinar - between alveoli and capillaries
    • Subpleural - continuous with interlobar septa
  • When diseased, tissues surrounding the air spaces & airways are thickened, with preservation of alveolar air
19
Q

Interstitium

  • Pulmonary edema
  • Pulmonary lobule
A
  • Pulmonary edema
  • Pulmonary lobule
    • Intralobular septa
    • Reticulations
20
Q

Alveolar ducts and pulmonary acinus

  • Microscopic anatomy
  • Fibrosing alveolitis
A
  • Microscopic anatomy
    • Terminal airways
    • Alveolar ducts
    • Acini
  • Fibrosing alveolitis
    • Alveolar collapse
    • UIP / IPF
21
Q

Reticulo-nodular pattern

  • Reticulo-nodular pattern
    • Reticular
    • Nodular
    • Reticulo-nodular
    • Honeycomb
  • Nodular pattern
A
  • Reticulo-nodular pattern (sarcoid)
    • Reticular: interlacing network of fine linear markings that form a mesh & contain air
    • Nodular: discrete, punctate, round 1 - 5 mm deposits
    • Reticulo-nodular: mixture of interstitial linear thickening & nodular deposits
    • Honeycomb: air-containing cystic spaces (5-10 mm) surrounded by thick fibrous walls
  • Nodular pattern
    • Miliary TB
22
Q

Reticular pattern: differential

A
  • Infectious - viruses, PCP
  • Immune - scleroderma, hypersensitivity
  • Edema
  • Inhalational - asbestosis
  • Airways - COPD with increased markings, cystic fibrosis (bronchiectasis)
  • Drug-induced lung disease
  • Pulmonary fibrosis
23
Q

Nodular pattern: differential

A
  • Infectious - miliary TB, fungi, CMV
  • Non-infectious granulomatous - sarcoid
  • Neoplastic - lymphangetic mets, lymphoma
  • Inhalational - silicosis
24
Q

Lungs are too black (and too big)

  • General
  • Emphysema
  • Centrilobular emphysema (CLE)
  • Centri- and pan-lobular COPD
A
  • Retention of excess gas in all or part of lung, especially during expiration
  • Oligemia - reduced pulmonary blood flow
    • Cardiac: pulmonic stenosis or atresia
    • Pulmonary artery HTN
    • Large pulmonary embolism
  • Over-inflation, air-trapping
    • Emphysema
      • Abnormally expanded air spaces distal to terminal bronchiole, with destruction of walls of involved air spaces
    • Centrilobular emphysema (CLE)
      • Punched out black holes
      • No perceptible wall
      • Pulmonary artery (dot) in center
    • Centri- and pan-lobular COPD
    • Central airway obstruction
    • Small airway diseases
25
Q

Air trapping

  • General
  • Panlobular emphysema
  • Bronchiectasis
A
  • General
    • Too big and black
    • Retention of excess gas in all or part of lung, especially during expiration
    • Due to partial airway obstruction or abnormal pulmonary compliance
    • Emphysema: abnormally expanded air spaces distal to terminal bronchiole, with destruction of walls of involved air spaces
  • Panlobular emphysema
    • Large bulla
  • Bronchiectasis
    • Dilation
    • Mixed pattern
26
Q

Cancer

  • Lung transplant
  • Lung cancer
  • Metastatic sarcoma
  • Pulmonary nodule, mass
A
  • Lung transplant
    • We can live on one lung
  • Lung cancer
  • Metastatic sarcoma
    • Nodules, masses, consolidation
  • Pulmonary nodule, mass
    • Marble, baseball
    • Discrete, circular opacity < 3 cm (T1)
    • Arises in lung
    • Mass: > 3 cm (T2)
    • Solitary vs multiple
    • May cavitate
27
Q

Pulmonary nodule or mass: differential

A
  • Developmental - AVM, bronchial cyst
  • Infectious - TB, fungal (granuloma)
  • Neoplastic
    • Benign: hamartoma
    • Malignant: lung CA, lymphoma, met
  • Traumatic - hematoma
  • Immunologic - rheumatoid, Wegener’s
28
Q

Normal tracheo-bronchial tree

29
Q

Problems

  • PET: radioactive glucose
  • Cavitary septic emboli (infected)
A
  • PET: radioactive glucose
  • Cavitary septic emboli (infected)
30
Q

Secondary pulmonary lobule

A
  • Building block of the lung
  • Unit of lung structure, consists of < 12 acini
  • Irregular polyhedral, ~ 1.23 cm
  • Marginated by interlobular septa
    • Pulmonary veins & lymphatics
  • Lobular core
    • Pulmonary arteriole & bronchiole
31
Q

Lymph node enlargement: differential

A
  • Infectious - TB, fungal
  • Non-infectious granulomatous - sarcoid
  • Neoplasm - lung CA, lymphoma, mets
  • Inhalational - silicosis, berylliosis
  • Metabolic - amyloidosis
  • Reactive

Pulm (47 decks)

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