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B&H Flashcards

1
Q

How to evaluate proper CXR technique?

A

PRIM

  • penetration
  • rotation
  • inspiration
  • motion
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2
Q

Utility of lateral decubitus CXR

A
  • detect small pleural effusion on ispilateral side (5ml)
  • detect small PTX on contralateral side (15ml)
  • detect the free-flowing nature of pleural effusions
  • detect air-trapping in check valve bronchial obstruction in a patient who is unable to cooperate for inspiratory/expiratory CXR
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3
Q

Normal tracheal caliber

A
  • 25 mm in men
  • 21 mm in women
  • coronal : sagittal = 0.6 : 1.0
    • if ratio < 0.6, then saber sheath trachea
    • COPD
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4
Q

Maximal thickness of right paratracheal strip and posterior tracheoesophageal stripe?

A
  • right paratracheal stripe < 4mm
  • posterior tracheoesophageal stripe < 5mm
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5
Q

Bronchioles

A

terminal bronchioles –>

respiratory bronchioles –>

alveolar ducts and alveolar sacs

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6
Q

Pulmonary alveolar epithelial cellls

(pneumocytes)

A
  • Type 1 pnemocytes
    • 95%
    • invisible by light microscope
    • incapable of mitosis/repair
  • Type 2 pneumocytes
    • 5%
    • visible by microscpe
    • capable of mitosis, produces type 1 pneumocytes
    • produces surfactant
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7
Q

Where does the minor fissure projects on a frontal PA CXR?

A

level of the right 4th rib

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8
Q

Azygos fissure

A
  • due to incomplete migration of the azygos vein to its normal position at the right tracheobronchial angle
  • 4 layers of pleura
    • 2 visceral
    • 2 parietal
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9
Q

Bronchial artery

A
  • Right - 1 - posteriorly from aorta
  • Left - 2 - anteriorly from aorta
  • 2/3 - drains into the pulmonary venous system via the bronchial veins - small right to left shunt
  • 1/3 - drains in to the azygos and hemiazygos systems
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10
Q

Approach to CXR

A
  1. Soft tissues
  2. Bones
  3. Mediastinum
  4. Lungs
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11
Q

Convexity to the azygoesophageal recess

A
  • superior third - subcrinal lymph node or mass
  • middle third - confluence of right pulmonary veins or the right border of the left atrium
    • left atrial dilatation produces double density interface
  • inferior third - sliding hiatal hernia
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12
Q

Pectus excavatum

A
  • leftward cardiac displacement
  • loss of the interface betwen right heart border and medial right middle lobe
  • not to be confused with RML pneumonia
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13
Q

Aortic nipple

A

left superior intercostal vein

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14
Q

Heart borders on CXR

A
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15
Q

Left atrial appendage

A
  • should be concave
  • straightening or convexity is seen in patients with rheumatic mitral valve disease and left atrial enlargement
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16
Q

Good inspiration

A

10th posterior rib

6th anterior rib

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17
Q

Pericardium

A
  • thin line represents the pericardial layers between the epicardial and pericardial fat
  • nodularity or >2mm thick is abnormal
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18
Q

Diaphragmatic opening

A
  • aortic hiatus
  • esophageal hiatus
  • IVC hiatus
  • foramen of Morgagni
  • foramen of Bochdalek
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19
Q

Aortic hiatus

A
  • aorta
  • thoracic duct
  • azygos and hemiazygos veins
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20
Q

Esophageal Hiatus

A
  • esophagus
  • vagus nerve
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21
Q

Airspace communications

A
  • pores of Kohn - intralveolar channels
  • canals of Lambert - bridging terminal bronchioles with alveoli
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22
Q

Bat wing airspace opacities

A
  • pulmonary edema
  • pulmonary hemorrhage
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23
Q

Ventilated pts recieving 100% O2 can have completely collapsed lung in a few minutes

  • bronchogenic carcinoma/endobronchial lesion
  • endotracheal tube malposition
  • mucus plugging
  • foreign bodies
A

Pure O2 is absorbed fast by the lungs

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24
Q

Only direct radiographic sign of lobar atelectasis

A

Dispacement of an interlobar fissure

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25
Indirect signs of lobar atelectasis
* increased density of the atelectic lung * bronchovascular crowding * ipsilateral diaphgragm elevation * ipsilateral tracheal/mediastinal shift * hilar elevation in upper lobe atelectasis * hilar depression in lower lobe atelectasis * compensatory hyperinflation of other lobes * shifting granuloma - towards the collapsed side * ipsilateral small hemithorax - close proximity of the ribs - only if chronic atelectasis
26
Rounded atelectasis
* pleural disease/thickening * curvilinear bronchovascular bundle/comet tail * acute angle with the pleura * enhances following IV contrast
27
LUL collapse/atelectasis
* best seen in lateral projection * lateral - major fissure shifts anteriorly and marginating a long narrow band of increased opacity paralleling the anterior chest wall - the collapsed LUL * frontal - a veil of increased opacity over the left upper hemithorax * Luftsichel sign - air sickel sign - overinflated superior segment of LLL interposed b/t aortic arch and the collasped LUL
28
29
Lobar atelectasis vs Lobar pneumonia
* atelectasis - volume loss; no airbronchogram - no air is the cause of the collapse * consolidation - volume preserved - with pus and exudate; airbronchogram - consolidation orginates from the alveolar space
30
Mucoid impaction aka Bronchocele
* non-obstructive bronchiectasis * cystic fibrosis * ABPA * obstructive bronchiectasis * endobronchial tumor * bronchial atresia
31
Pneumatocele
* thin-walled, gas-containing structures representing distended airspaces distal to a check-valve obstruction of a bronchus or bronchiole * common - Staph aureus, trauma * generally resolve in 4 - 6 mons
32
Focal lucent pulmonary lesions
* cavity - necrosis; communicating with airway * \> 1mm thick * abscess, neoplasm * bulla * \< 1mm thick * \> 1cm in diameter * bleb * \< 1cm in diameter * in visceral pleural surface, apical * air cyst * intraparenchymal gas collection * \> 1mm thick * pneumatocele * thin-walled cystic lesion * staph infection or post-traumatic * self-resolving
33
Non-pulmonary causes of unilateral pulmonary hyperlucency
* pt rotation - increased density over the lung rotated away from the cassette * Poland syndrome - congenital absence of pectoralis muscle * mastectomy
34
Poland Syndrome
35
True/pulmonary unilateral hyperlucent lung
* primary vascular abnormality * pulmonary artery hypoplasia * lobar resection * pulmonary arterial obstruction * shuting of blood away from abnormal lung * check-valve effect from endobronchial mass/foreign body * Swyer-James syndome
36
Swyer-James syndrome * Adenoviral infection during infancy * asymmetric bronchiolitis obliterans --\> secondary decreased vascularity --\> collateral air drift and airtrapping * Unilateral hyperlucent lung * Small or normal-sized hemithorax * Overinflation of contralateral lung * Diminutive pulmonary hilum * Decreased peripheral pulmonary arteries * Mediastinal shift toward the hyperlucent thorax
37
DDx of unilateral hyperlucent thorax
* technical * rotation * chest wall * mastectomy * Poland syndrome * vasculature * pulmonary artery hypoplasia/stenosis * pulmonary embolism * pleural disease * anterior ptx * airways * emphysema * large bulla * endobronchial obstruction/FB * congenital lobar emphysema * post-infectious bronchiolitis obliterans - Swyer-James syndrome
38
Presence of calcification within an untreated mediastinal mass virtually excludes what?
Lymphoma
39
Pneumomediastinum * most common finding is air outlining the left heart border * contnous diaphgram sign
40
Upper limits of interlobar pulmonary artery
* men 17mm * women 15mm
41
Classification of thymic tumors
* benign - thymoma * invasive * non-invasive (encapsulated) * malignant - thymic carcinoma
42
Typical age of thymoma
45-50 years old
43
What is thymoma associated with
Myasthenia gravis and other autoimmune dz * pure red cell aplasia * graves disease * sjogren's syndrome
44
Low grade vs high grade thymomas
High grade thymomas * larger * irregular margins * heterogenous enhancement * necrosis * calcification * mediastinal nodal metastases * drop metastasis to the dependent portions of the pleural space\*
45
DDx of thymic masses
* thymoma - invasive vs noninvasive * thymic carcinoma * thymic cyst * thymolipoma * thymic hyperplasia * thymic neuroendocrine tumors * thymic lymphoma
46
Thymic cyst
* Congenital * unilocular * rare * Acquired * multilocular * AIDS, post-radiation/sx, Sjogren syndrome, MG, aplastic anemia * may mimic cystic degeneration of thymoma
47
Thymolipoma
* pliable nature * envelopes the heart and diaphgram * curable if resected
48
Thymic neuroendocrine tumor aka Thymic carcinoid
* most common histology - thymic carcinoid * carcinoid -\> atypical caricnoid -\> small cell * 40% - cushing syndrome due to ectopic ADTH secretion * can't be distinguished from thymoma on CT
49
Thymic hyperplasia
* most common in children * rebound effect in response to * an antecedent stress * discontinuation of chemoRx * treatment of hypercortisolism
50
Thymic lymphoma
* most ocmmonly involved in nodular sclerosing subtype of Hodgkins dz * presence of other lymphadenopathy suggest the Dx
51
Hodgkin disease vs NHL
* Hodgkin disease * almost always involves mediastinal/hilar nodes * contiguous nodal spread * localized - radiation * widespread - chemo Rx * NHL * only involves one mediastinal/nodal group * multifocal disorder; unpredictable * Calcification in untreated lymphoma is extremely uncommon * Lung parenchymal involvement is due to direct extranodal extension from hilar nodes along the bronchovascular lymphatics
52
Solid teratoma vs cystic teratoma
solid teratoma - usually malignant - exclusively in male
53
What does mediastinal lymphadenopathy look like for patients with lymphoma?
bilateral LAD but asymmetric
54
Isolated posterior mediastinal LAD
Usually only seen in patients with NHL
55
Sarcoidosis vs Lymphoma and metastases
* sarcoidosis - bilateral and symmetric; * enlarged lymph nodes do NOT coalesce * lymphoma/mets - bilateral but asymmetric * intranodal tumor extends through the nodal capsule to form conglomerate enlarged nodal masses
56
Castleman disease
Angiofollicular lymph node hyperplasia aka Castleman disease * intense enhancement
57
Foregut cysts
* bronchogenic cyst * enteric cyst * complications * secondary infection * rapid enlargement due to hemorrhage * CT appearance * well-defined, thin-walled mass * fluid density 0-10 HU * does not enhance * \> 40 HU due to mucoid material, milk of calcium, blood
58
Pericardial cyst
* right anterior cardiophrenic angle * CT - smooth, sharply marginated, low-attenuation mass * MR or US - subxyphoid approach - simple cyst
59
Lymph nodes with central calcification
* TB * Fungal
60
Lymph nodes with peripheral calcification aka eggshell calcification
* sarcoidosis * silicosis/CWP
61
Lymph nodes that are hypervascular intensely enhancing
* carconoid tumor/small cell carcinoma * Kaposi sarcoma * metastases * RCC * thyroid * Castlman disease
62
Lymph nodes that are centrally necrotic
* mycobacteria/TB * fungus * metastases * squamous cell carcinoma * seminoma * lymphoma
63
DDx for anterior mediastinal mass
* thymic masses * thyroid masses * germ cell neoplasms * lymphoma/lymph nodes * ectopic parathyroid mass * mesenchymal tumor * lipoma * hemangioma * leiomyoma * liposarcoma * angiosarcoma
64
DDx of middle medistinal mass
* lymph node masses * malignancy * infection * idiopathic - sarcoidosis/Castleman * foregut or mesothelial cysts * bronchogenic cyst * pericardial cyst * foregut duplication cyst * tracheal and central bronchial lesions * diaphragmatic hernias * Morgagni hernia * traumatic diaphragmatic hernia * vascular lesions * arterial * venous
65
DDx of posterior mediastinal mass
* neurogenic tumors * esophageal lesions * foregut cysts * vertebral lesions * lateral thoracic meningocele * pancreatic pseudocyst
66
Neurogenic tumors in the posterior mediastinum
* peripheral (intercostal) nerves * neurofibroma * schwannoma * sympathetic ganglia * ganglioneuroma - benign * ganglioneuroblastoma * neuroblastoma - highly malignant, \< 5yo * paraganglion cells * chemodectoma * pheochromocytoma
67
Multiple lesions in the mediastinum, particularly bilateral apicoposterior mass
neurofibromatosis
68
Dumbbell neurofibroma * tumor extension from paravertebral space into the spinal canal via an enlarged intervertebral foramen * high T2, high post gad
69
Esophageal pulsion diverticulum
* proximal * at cervicothoracic junction * Zenker's diverticulum * distal * juxtadiaphgramatic mss with an air-fluid level
70
Hiatal hernia 2 types
* sliding hernia - gastric cardia * paraesophageal hernia - gastric fundas
71
Lateral thoracic meningocele is associated with which syndrome?
Neurofibromatosis
72
Most common posterior mediastinal mass in patients with neurofibromatosis
lateral thoracic meningocele
73
Location of tear in Boerhaave syndrome
* vertical tear * left posterolateral wall * esophagogastric junction
74
75
Causes of chronic sclerosing/fibrosing mediastinitis
* histoplasmosis * TB * radiation * drugs - methysergide
76
Most commonly affect structure in chronic sclerosing/fibrosing mediastinitis
* SVC
77
Most common CXR finding of chronic sclerosing/fibrosing mediastinitis
asymmetric, lobulated widening of the upper mediastinum
78
Most common cause of pneumomediastinum
air from the lungs * sudden rise in intrathoracic and intraalveolar pressure * air dissecting along the bronchovascular interstitium * dissects centrally - pneumomediastinum * Macklin effect * dissects peripherally - pneumothorax
79
Causes of pneumomediastinum
* alveolar rupture * tracheal/bronchial * esophageal * fistula formation * recent sx - sternotomy, thoracotomy * pneumoperitoneum * along the internal mammary vascular sheaths * pneumoretroperitoneum * along the aortic hiatus * subc emphysema in the neck, stab wound, laryngeal fracture * dissect along the retrophayngeal space, prevertebral space, or along the great vessel sheaths
80
pneumomediastinum
81
Ludwig angina
* infection of the floor of the mouth extending inferiorly to involve the mediastinum * retrosternal chest pain
82
Hilar mass is often obscured by
adjacent lung collapse obstructive pneumonits
83
Posterior mediastinal involvement in extrathoracic malignancy
* RCC, testicular cancer * retroperitoneal nodes --\> thoracic duct --\> posterior mediastinal nodes * if valve incompetency --\> anterior, hilar lymph nodes
84
Primary vs Secondary pulmonary lymphoma
* Primary - parenchymal and pleural involvement * Secondary - intrathoracic lymph node involvement
85
Post-primary TB does NOT have?
Hilar or mediastinal lymphadenopathy
86
Classic findings of pneumonic plague
Hyperdense mediastinal and hilar LAD on unenhanced CT due ot intronodal hemorrhage
87
What viral infections give medistinal and hilar LAD
Mononucleosis Measles
88
Most common cause of BILATERAL hilar adenopathy?
small cell carcinoma melanoma lymphoma (Hodgkin dz)
89
DDx for small hilum (hila)
* Unilateral * absence or hypoplasia of PA * hypoplastic or hypogenetic lung - Scimitar syndrome * Swyer-James syndrome * lobar atelectasis * lobar resection * compression or invasion of PA * Bilateral * emphyema/COPD * obstruction of the main PA flow * sclerosing mediastinitis * valvular pulmonary stenosis * embstein anomaly
90
Pulmonary edema
interstitial edema --\> alveolar (airspace) edema --\> impaired oxygen and CO2 exchange
91
Kerley lines
* Kerley A - central connective tissue septal thickening * Kerley B - peripheral interlobular septal thickening * Kerley C - network of thickened interlobular septa
92
Causes of unilateral pulmonary edema
* positional - pt is decubitus; may shift with pt positioning * protective effect - one pulmonary arterial flow is diminished by pulmonary embolus or extrinsic compression * re-expansion pulmonary edema from ipsilateral pleurocentesis
93
Cause of alveolar pulmonary edema localized to RUL
Severe mitral valve regurgitation
94
Causes of pulmonary edema
* hydrostatic pulmonary edema * increased capillary permeability edema (ARDS) * neurogenic pulmonary edema * high-altitude pulmonary edema * re-expansion pulmonary edema * acute upper airway obstruction edema * amniotic fluid embolism * fat embolism
95
Neurogenic pulmonary edema
* following head trauma, seizure, increased ICP * massive sympathetic discharge from the brain *
96
High-altitude pulmonary edema
* response to hypoxia * scattered areas of pulmonary arterial spasm - pulmonary arterial hypertension * over flow of lood at thigh pressure to uninvolved areas * daage of capillary endothelium and increased permeability edema * PATCHY in distribution
97
Re-expansion pulmonary edema
* negative intrapleural pressure * free-radical injury upon reperfusion after prolonged collapse and ischemia
98
Causes of pulmonary hemorrhage
* spontaneous * thrombocytopenia * hemophilia * anticoagulant therapy * trauma * pulmonary contusion * embolic * pulmonary embolism/infarction * fat embolism * vasculitis * autoimmune * Goodpasture syndrome * Wegener's granulomatosis * idiopathic pulmonary hemorrhage * SLE/RA * infectious * gram-ve bacteria * influenza * aspergillosis * mucormycosis * drugs * penicillamine\*
99
Goodpasture syndrome
* cytotoxic Ab directed at the renal glomerular basement membranes and cross reacts with alveolar basement membrane * young adult male * recurrent hemorrhage leads to pulmonary fibrosis * Dx - immunofluorescent studies of renal or lung tissue - smooth wavy line of fluorescent staining along the basement membrane
100
Goodpasture syndrome vs Idiopathic pulmonary hemorrhage
* Goodpasture syndrome * young male * anti-GBM Ab * renal and pulmonary involvment * Idiopathic pulmonary hemorrhage * children, equal sex distribution * no anti-GMB Ab * no renal involvement
101
Pulmonary hemorrhage can lead to
Elevated CO diffusion capacity
102
Most common finding on CXR in patients with PE
* Majority - abnormal * most common finding - atelectasis - Type 2 pneumocytes ischemic -\> surfactant deficiency * Westermark sign * Hampton hump * 40% - normal * Utility of performing CXR * rule out pneumonia, PTX * aid VQ scan
103
How to distinguish regular pulmonary arterial hypertension from the presence of a left-to-right shunt?
* PAH - pruning - enlarged main and hilar pulmonary arteries that taper rapidly toward the lung periphery * Left-to-right shunt - pulm vascular resitance drops initially - enlargement of both central and periphal pulmonary arteries producing "shunt vascularity" * later on, medial hyperplasia and intimal fibrosis --\> regular PAH pruning
104
Shunt vascualrity
Initially if there is a left to right shunt, pulm vascular resistance drops to accomodate - shunt vascularity later, as medial hyperplasia and intimal fibrosis -\> increased pulm vascular resistance --\> pruning
105
Pulmonary capillary hemangiomatosis PCH
proliferation of capillaries throughout the pulmonary interstitium --\> venular obstruction \> increased pressure to pulmonary arterial side with medial hypertrophy and obliteration of vesel lumina CXR - pulmonary artery hypertension but NO pulmonary venous hypertension
106
What kind of margin is strongly suggestive of malignancy
* notched/lobulated margin * spiculated margin
107
Benign calcifications of pulmonary nodule
* complete calcification * central calcification - bull's eye - histo/TB * concentric/laminated calcification - granuloma * periphralcalcification * popcorn calcification - hamartoma (calcified cartilaginous componenet)
108
Pulmonary nodule that contains fat?
Dx of hamartoma
109
Solitary pulmonary nodules
* neoplasm * bronchogenic carcinoma * hamartoma, bronchial adenoma, granular cell myoblastoma, mesenchymal neoplasm * lymphoma * carcinoid * solitary metastasis * infection * septic embolus * round pneumonia * lung abscess * infectious granuloma * parasitic - echinococcal cyst * inflammation * Wegener's granulomatosis * necrobiotic nodule (rheumatoid lung) * vascular * AVM * PA aneurysm * hematoma * airways * bronchogenic cyst * foregut duplication cyst * sequestration * mucocele * miscellaneous * round atelectasis * amyloidoma
110
Typical findings of a pulmonary hamartoma
* \< 2.5 cm * smooth or lobulated borders * contain focal fat * popcorn calcification - multiple clumps of calcifium dispersed throughout the lesion * rule - hamartomas that contain calcium also contain fat!
111
Bronchogenic carcinoma types
* adenocarcinoma - most common * BAC - lepidic growth\* * grow along pre-existing bronchiolar and alveolar without invasion or distortion of these structures * solitary pulmonary nodule * ground glass opacity * squamous cell carcinoma * hilar mass with obstructive pneumonitis * small cell carcinoma * large cell * large peripheral mass
112
In order for a mass (squamous cell carcinoma) to cavitate, what mus thapen?
Communication of the mass with the bronchial lumen
113
Bronchial neuroendocrine tumors spectrum
* Kulchitsky cells (KCC) * KCC-1 - typical carcinoid tumor * KCC-2 - atypical carcinoid tumor * KCC-3 - small cell carcinoma (most malignant)
114
Where do bronchogenic carcinomas arise from?
* small cell carcinoma and squamous cell carcinoma * central bronchal epitheium * adenocarcinoma and large cell carcinoma * bronchial and alveolar epithelium
115
Manifestation of an endobronchial obstructing lesion
* lobar atelectasis, OR * post-obstructive pneumonitis * preserved volume or even increased volume * bulging conexity/interlobar fissure * "drowned lung" * chronic inflammatory infiltrate - alveolar filling with lipid-laden macrophages - endogeneous lipoid pneumonia * obstructed lung often obscures the underlying mass * collapsed lung - enhancing * mass - hypodense! * distal to the endonbronchial obstructing lesion - mucus plugging - mucus bronchogram
116
How to differentiate a cavitating malignant lesion from a cavitating inflammatory lesion
Cavitating neoplasms tend to be thicker and more nodular than cavitating inflammatory lesions
117
What findings are suggestive of a BAC
air bronchograms bubbly lucencies mixed solid/GGO
118
CT angiogram sign
* Diffuse form of BAC * low-density airspace opacification due to mucoid material produced by the malignant cells * surrounding enhancement pulmonary vessels * Other DDx for CT angiogram sign * BAC * lymphoma * lipoid pneumonia
119
Isolated adrenal masses in patients with NSCLC
Twice likely to be benign adrenal adenomas than metastases * CT * unenhanced CT \< 10 HU * enhanced delayed CT \> 60% washout * MR * chemical shift * PET * high sensitivity - if negative, r/o adrenal mets * but low specificity - if positive, may still be adenoma
120
Pulmonary carcinoid tumor
* right upper and middle lobes * hemoptysis due to hypervascularity * main have * atelectasis or post-obstructive pneumonitis * hyperlucent lung due to collateral air flow and reflex hypoxic vasocontriction * iceberg tumor - small intraluminal and large extraluminal soft tissue component * marked contrast enhancement * may have punctate calcification
121
Morphology of pulmonary metastsis vs bronchogenic carcinoma
* pulmonary metastasis - smooth in contour * bronchogenic carcinoma - lobulated and spiculated
122
The likelihood that a solitary pulmonary nodule SPN represents a mets or bronchogenic carcinoma
* if synchronous extrathoracic malignancy - 50% * if prior malignancy - almost always a primary bronchogenic carcinoma
123
How to confirm the Dx of lymphangitic carcinomatosis?
transbronchial bx
124
Nodular lymphoid hyperplasia
Not quite lymphoma yet non-neoplastic reaction proliferation of lymphocytes in the lung
125
Lymphocytic interstitial pneumonitis
* infiltration of the pulmonary interstitium by lymphocytes * associated with * Sjogren syndrome * hypogammaglobulinemia * Castleman syndrome * AIDS * lower lobe predominance * diffuse GGO with poorly defined centrilobular nodules, and thin walled cysts
126
Lymphocytic interstitial pneumonitis LIP
127
Posttranslant lymphoproliferative disorder PTLD
* solitary or multiple sharply marginated nodules or masses * Rx: reduction in immunosuppression
128
Pulmonary kaposi sarcoma
* AIDS patients * pulmonary involvement always follow skin, oropharyngeal, and/or visceral involvement * small to medium, poorly marginated nodular and coarse linear opacities * extending from hilum to mid and lowe rlung * slow progression, relatively asymptomatic
129
How to differentite Kaposi sarcoma vs pneumonia vs lymphoma
* pneumonia - both gallium and thallium avid * lymphoma - gallium avid only * KS - thallium avid only
130
Pulmonary blastoma * young adults * extremely large at presentation
131
3 potential routes of pulmonary infection
* tracheobronchial tree * lobar pneumonia * bronchopneumonia * interstitial pneumonia * pulmonary vasculature * direct extension from the mediastinum, chest wall, and upper abdomen
132
Lobar pneumonia
* pneumococcal infection * exudate begins within distal airspaces * spread through pore of Kohn and canals of Lambert * airways are usually spared * air bronchograms * volume loss unusual
133
Bronchopneumonia
* most common pattern of pneumonia * staphylococcal pneumonia * centered in and around lobular bronchi * multifocal opacities that are roughly lobular in configuration - patchwork quilt * exudate within the bronchi --\> no air bronchograms * when affected areas coalesce, may look like lobar pneumonia
134
Bronchopneumonia
135
Interstitial pneumonia
* viral or mycoplasma infection * inflammatory thickening of bronchial and bronchiolar walls and the pulmonary interstitium --\> CXR airway thickening and reticulonodular opacities * alveolar spaces remain aerated --\> no air bronchograms * semental and subsegmental atelecatsis
136
Bacillus anthracis infection
* hemorrhagic lymphadenitis and mediastinitis - hyperdense lymph nodes * hemorrhagic pleurla effusions - hyperdense * peribronchial opacities
137
Anthrax
138
Legionella pneumophila
* gram negative bacteria * air conditioning and humidifier system * may present as ROUND PNEUMONIA * may progress to lobar or multilobar pneumonia despite the intiation of abx rx * radiographic resolution of pneumonia is often prolonged and lag behind symptomatic improvemen
139
Actinomycosis
* normal anaerobic organism in the human oropharynx * causes disease when gaining access to devitalized or infected tissue * dental - extension from mandibular osteomyelitis * thoraic actinomycosis - spread contiguous tissue - pleura, chest wall, ribs
140
Mycoplasma
* most common atypical pneumonia * CXR - fine reticular pattern --\> segmental airspace --\> lobar consolidatoin * CT - tree-in-bud appearance - bronchiolitis
141
Primary TB
* most often affect children * incidence in adults increases b/c AIDS * most pts with primary TB are asymptomatic * in some patients * Ranke complex - calcified parenchymal focus (Ghon lesion) + nodal calcification * parenchymal consolidation * unilateral pleural effusion * tuberculous empyema - may break thr the parietal pleura to form an extrapleural collection - empyema necessitatis * hematogenous spread of infection during primary TB infection * lung apices * renal medulla * bone marrow
142
Post-primary TB
* cough & constitutional sx * vs. 1 TB asymtpomatic * apical and posterior segments of upper lobes; superior segments of lower lobes * cavitation * transbronchial spread * Rasmussen aneurysm - cavitary focus erodes into a branch of the pulmonary artery --\> hemoptysis * granulomatous response - parenchymal healing * fibrosis * bronchiectasis * volume loss - cicatrizing atelectasis * PAH * mycetoma in TB cavity * broncholith - erosion of calcified peribronchial lymph node into the bronchus * bronchostenosis
143
Milliary TB
* can affect both primary or post-primary TB * 2-3 mm nodules - randome distribution * high mortality
144
Atypical mycobacterial infection
* most common - mycobacterium avium intracellulare (MAI) * typical presentation * like post-primary TB * atypical presentation * middle or elderly women * middle lobe and lingula * peribronchial nodules * tree-in-bud
145
Viral pneumonia
* bronchopneumonia or interstitial pneumonia * usually complete resolution * but may have * bronchiectasis * bronchiolitis obliterans - Swyer James Syndrome * interstitial fibrosis
146
Healed varicella pneumonia
147
Varicella-zoster pneumonia
* severe pneumonia in adults * diffuse bilateral ill-defined nodular opacities 5-10 mm * usually resolve completely * in some patients my involute and calcified - innumerable small 2-3mm calcified nodules
148
Spectrum of aspergillus caused pulmonary disease
aspergilloma semi-invasive aspergillosis invasive aspergillosis ABPA
149
Waterlily sign Hydatid disease - echinococcal cyst
150
Rim-enhancing lymph nodes with central necrosis on CT are characteristic finding for what?
TB in an AIDS patient
151
Halo sign * angioinvasive aspergillosis * surrounding edema and hemorrhage
152
What is the most common cause of fungal infection in the AIDS patients?
Cryptococcosis * AIDS-defining opportunistic infection * can affect any immunocompromised hosts * RARELY affect immunocompetent pts * 2 subtypes * cryptococcus neoformans * cryptococcus gattii
153
PJP PCP
* fine reticular or gg pattern * pregressive dz - confluent symmetric a/s opacification * thin0walled cysts * pleural effusion and LAD UNCOMMON
154
Pulmnoary complications post-BMT
* neutropenic phase (0-1mo) * pulmonary edema * alveolar hemorrhage * fungal infection * drug reaction * early phase (1-3mo) * fungal infection * drug reaction * CMV infection * upper resp virus infection * idiopathic pneumonia * acute GVHD * late phase (\>3mo) * bronchiolitis obliterans * BOOP * chronic GVHD * upper resp virus infection * idiopathic pneumonia
155
Subpleural band * parallel the chest wall * asbestosis \>\> IPF
156
Parenchymal band * asbestosis * sarcoidosis * UIP
157
Honeycombing
* lined by bronchiolar epithelium - bronchiectasis * IPF * chronic HSP * occasionally - sarcoidosis
158
Gound glass opacity
* pulmonary alveolar proteinosis * pulmonary hemorrhage * pulmonary edema * infection - PCP, CMV * interstitial lung dz * UIP * NSIP * DIP * HSP * RB-ILD
159
Interstitial lung dz presents as conglomerate masses
* sarcoidosis * silicosis/CWP - PMF * post-radiation fibrosis * IVDU - talcosis, starch
160
Manifestations of RA lung diseases
* serositis * pericardial effusion * pleural effusion * interstitial pneumonitis * UIP * necrobiotic nodules * peripheral cavitating nodules, rheumatoid nodules * Caplan syndrome * bronchiolitis obliterans * COP * pulmonary arteritis * pulmonary arterial hypertension, right heart enlargement * pulm hemorrhage * chest wall * tapered distal clavicles * GH joint arthropathy * rotator tendon atrophy - high riding humeral head * superior rib notching/erosion

Chest (13 decks)

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