Cardiothoracic

Question 1

IgG4 related disease manifestations

Answer 1

• autoimmune pancreatitis
• retroperitoneal fibrosis
• fibrosing mediastinitis
• inflammatory aortic aneurysm
• inflammatory orbital pseudotumor
• Riedels thyroiditis
• sclerosing cholangitis (majority have UC)

Question 2

Ddx?

Answer 2

Tree in bud pattern (BAAM)
- bronchopneumonia
- aspiration pneumonia
- allergic aspergillosis
- mycobacterium tuberculosis

rarely:
- vasculitis
- tumor emboli (breast, stomach)
- embolic material from IVDU

Question 3

Cavitating lung lesion ddx

Answer 3

• cancer
  — SCC or SCC mets
• Infection
  — septic emboli (also bland emboli)
  — abscess
  — TB
• autoimmune
  — granulomatosis with polyangiitis
  — rheumatoid nodules
• traumatic pmeumatocoeles

Question 4

Crazy paving ddx

Answer 4

Common:
- pulmonary oedema (most common)
- acute respiratory distress syndrome (ARDS)
- bacterial pneumonia
- pulmonary alveolar proteinosis (PAP)

Less common causes:
- drug-induced pneumonitis
- radiation pneumonitis
- pulmonary haemorrhage
- Goodpasture syndrome
- Pneumocystis jirovecii pneumonia, COVID-19, pulmonary cryptococcosis, cryptogenic organising pneumonia
- invasive mucinous adenocarcinoma of the lung
- alveolar sarcoidosis

Question 5

Miliary nodule pattern ddx

Answer 5

• infectious (TB, histoplasmosis)
• metastases (thyroid, testicular, renal)
• inflammatory (sarcoidosis, silicosis)

Question 6

Peribronchovascular nodularity / nodular septal thickening ddx

Answer 6

• sarcoidosis (young adults, consider stage re lymph node, parenchymal lung change, fibrosis
• lymphoma
• lymphangitic spread of carcinoma
• Kaposi sarcoma (HHV-8 and HIV associated, ddx PCP and lymphoma)

Question 7

Delayed patchy nodular gadolinium enhancement of the myocardium not confined to a vascular distribution ddx

Answer 7

• amyloidosis
• sarcoidosis
• myocarditis

Question 8

Unilateral lucent hemithroax ddx

Answer 8

• rotation (side spinous process closer to is lucent)
• contralateral increased density
• pneumothorax
• chest wall abnormality (Poland syndrome, pec flap/atrophy)
• reduced perfusion (large PE, pulmonary artery obstruction from tumor/mass effect
• reduced perfusion from air trapping (Swyer James, bullae, foreign body, CLO, endobronchial tumor)

Question 9

Unilateral lucent hemithroax ddx

Answer 9

• rotation (side spinous process closer to is lucent)
• contralateral increased density
• pneumothorax
• chest wall abnormality (Poland syndrome, pec flap/atrophy)
• reduced perfusion (large PE, pulmonary artery obstruction from tumor/mass effect
• reduced perfusion from air trapping (Swyer James, bullae, foreign body, CLO, endobronchial tumor)

Question 10

Lung transplant ddx

Answer 10

• cystic fibrosis
• LAM
• LCH
• interstitial lung disease
• alpha-1 antitrypsin disease
• Pulmonary arterial hypertension
• tuberous sclerosis

Question 11

Sudden cardiac death in a young person ddx

Answer 11

• hypertrophic cardiomyopathy
• abherrant coronary artery origins (RCA origin from left coronary sinus of Valsalva, with interarterial intramural course most common)

Question 12

Infections that cross tissue planes

Answer 12

• tuberculosis
• actinomycosis (a/w IUD in pelvis, oral flora aspirated in chest)

Question 13

Pulmonary hypertension ddx

Answer 13

• pulmonary parenchymal disease (pulmonary fibrosis, emphysema, cystic fibrosis)
• pulmonary vessels (chronic pulmonary thromboembolism)
• cardiac (L>R shunts, mitral stenosis)
• connective tissue disorders (Scleroderma with dilated oesophagus)

And consequences…
- right heart strain

Question 14

Nodule with surrounding ground glass ‘halo’ ddx

Answer 14

• invasive aspergillosis
• other fungus (also gives Atoll)
• hemorrhagic mets
• adenocarcinoma in situ/invasive (formerly bronchoalveolar carcinoma)
• granulomatosis with polyangiitis (also gives Atoll)

Question 15

ground glass nodule with rim of consolidation ddx (Atoll)

Answer 15

• cryptogenic organising pneumonia
• TB
• pulmonary infarct
• invasive fungal and GPA (seen in both nodule w/halo and Atoll)