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Radiology > Cardiothoracics > Flashcards

Cardiothoracics Flashcards

1
Q

Haemophilus Pneumonia

A

Children, immunocomprimised and COPD

  • LL prediliction
  • Bronchopneumonia
  • Empyema
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2
Q

Adenomcarcinoma

A
  • Most common lung cancer
  • 75% solitary peripheral lesions
  • Irregular and spiculate and associated with fibrosis
  • Can occur as SPN or groundglass opacity.

SUBTYPE - Bronchioloalveolar cell carcinoma in situ (BAC) = growth along preexisting bronchiloar and alveolar walls. Can spread via the airways.

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3
Q

Adenovirus

A

Predominantly upper but can be LRTI

Adults = Overinflation bronchopenumonia accompanied by lobar atelectasis.

Children = Lobar/Segemental consolidation.

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4
Q

AIP

A
  • Rapid progression from cough, fever, dyspnea —>severe hypoxia requiring mechanichal ventilation.
  • ARDS
  • diffuse alveolar damage with minimal mature collagen deposition.

CT:

  • Diffuse GG opacity and consolidation.
  • AP denisty gradient
  • Fibrosis can develop but stabilizes.
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5
Q

Alpha 1 Antitrypsin Deficiency

A
  • Early adulthood
  • Panacinar emphysema - lower lobe predominance
  • Bronchiectasis
  • Cirrhosis
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6
Q

Amebiasis

A

Entamoeba histolytica

  • GI tract and liver
  • Right basal atelctasis and pleural effsuion as result of direct spread from liver abscess.
  • Can result in empyema and pneumonia.
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7
Q

Carney’s Syndrome

A
  • Multiple cardiac myxomas
  • Extracardiac myxomas
    • Breast
    • testes
    • thyroid
    • brain
    • adrenal
  • Pituitary adenoma
  • psamammomaotous melanotic schwanoma
  • Testicular tumours
  • Blue naevi skin pigmentation
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8
Q

Carney’s Triad

A

Pulmonary chondromas

Gastric Leiomyosarcoma

Extraadrenal paraganglioma

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9
Q

Castleman’s Disease

A
  • Benign lympoprliferative disorder.
  • Unicentric
    • Children and young adults
    • Solitary mediatinal mass with hyalinised vascular supply
  • Multicentric
    • HIV
    • Multiple oragans and symptomatic.
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10
Q

Causes of cavitating lung lesions… CAVITY

A

C = Cancer (Squamous cell carcinoma – either bronchogenic or metastatic, or adenocarcinoma)

A = Autoimmune granulomas (Wegener granulomatosis and Rheumatoid arthritis granulomas)

V = Vascular (septic emboli)

I = Infection (abscess, TB or cavitating pneumonias [strep, staph, aspergillus, legionella, klebsiella])

T = Trauma – pneumatocoeles

Y = Youth (ie congenital – CPAM, sequestration, bronchogenic cyst) These all form cysts, not true cavities as such.

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11
Q

Churg-Strauss

A

Eosinophilic granulomatosis with polyangiitis (EGPA)

  • 30-50yo
  • Present with asthma (extrapulmonary signs = sinusitis, diarrhoea, skin purpura, and/or arthralgias)
  • pANCA marker
  • CT:
    • Random distribution of GG/Consol
    • Centrilobular nodules and bronchial wall thickeining
    • rarely cavities
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12
Q

Congenital lobar overinflation

A
  • Males 3:1
  • Underdevelopment of affected lobe bronchial cartilage.
  • affected lobar bronchus fails to stay open in expiration
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13
Q

COP (Cryptogenic Organising Pneumonia)

A
  • Wide spread deposition of granulation tissue in peribronchiolar airspace and bronchioles.
  • Bronchiolitis Obliterans with Organising Pneumonia (BOOP) is the same but in cases of:
    • viral infection
    • toxic fume inhilation
    • collagen vascular disease
    • organ transplant
    • drug reactions
    • chronic aspirations
  • PFT: Restrictive, reduced lung volume and increased DLCO
  • Histologically uniform changes in affected lung.

CT:

  • Patchy GG surronded by dense consilidation = ‘reverse halo’
  • Bronchiectasis and bronchial wall thickening.
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14
Q

CPAM

A

Congenital pulmonary airway malformations

  • Failure of normal bronchoalveolar development with a hamartomatous proliferation of terminal respiratory units in a gland-like pattern
  • Type 0 is lethal postnatally
  • Type I is the most common.
  • Type II, III and IV Are different types of cystic shit.
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15
Q

Dermatomyositis/polymositis

A
  • Autoimmune inflammation and distruction of skeletal muscle
    • proximal muscle pain and weakness
    • skin rash
    • respiratory and pharyngeal muscle weakness
    • interstitial pneumonitis
      • looks like RA, SLE, scleroderma and IPF
      • course reticular/nodular opacities in a basal distribution.
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16
Q

Eggshell calcification

A
  • Fibrosing mediastinitis
  • Amyloidosis
  • Silicosis
  • Sarcoidosis
  • Sclerderma
  • Post radiotherapy lymphoma
  • Histoplasmosis
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17
Q

Goodpastures syndrome

A
  • Young adult men
  • Cough, haemoptysis, dyspnea and fatigue.
  • Cytotoxic antibody to renal glomerular basement membrane with cross reactivity to alveolar basement membrane.
  • CXR - pulomary oedma
  • CT
    • acute - GG opacity without spetal thickening
    • subacute - rise of reticular opacities owing to resorption of blood products (CRAZY PAVING)
    • recurrent - fibrosis
  • DDx - Idopathic pulomary haemorrhage
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18
Q

Histoplasmosis

A

Histoplasmosis capsulatum

Acute:

  • Flu like symptoms
  • CXR - normal/non-specific
  • Large inoculation
    • Widespread 3-4mm nodules
    • or solitary <3cm nodule

Chronic:

  • In patients with underlying emphysema can casue CLD.
  • Bilateral upper lobe cicatrizing atelectasis.
  • Calcified lymph nodes
  • Fibrosing mediastinitis

Blood borne dissemination: (RARE)

  • Lung - Indistinguishable from miliary TB
  • Splenic granulomas.
19
Q

Hydatid disease

A

Echinococcus granulosus

  • Creates 3 layered cyst in lung which does not calcify. - Well circumscribed soft tissue mass
  • Peripheral fibrotic lung along cyst
  • Commonly riht lower lobe.
  • If percyst ruptures then can develop crescent sign.
20
Q

Lymphangioleiomyomatosis (LAM)

A
  • Non smoking women of childbearing age.
  • Numerous small cysts surrounded by normal lung
  • Chylous pleural effusion.
  • Unchanged lung volume.
  • Can have spontaneous pneumothorax.
21
Q

Lutembacher syndrome

A

Mitral stenosis with pre-existing ASD —>marked right sided enlargement.

22
Q

Lymphamatoid Granulomotosis

A
  • Type of pulmonary lymphoma
  • Round nodules in the lower lobes infiltrate small vessels and cause necrosis via obliterative vasculitis
  • Multiple nodular opcities +/- cavities.
  • CNS and skin involvement is common
  • Poor prognosis.
23
Q

Lymphangitis Carcinomatosis

A
  • Cancer cells travelling in lymph and infiltrating lung parenchymal connective tissue.
  • Smooth thick reticular polygonal network.
  • Certain Cancers Spread By Plugging The Lymphatics
    • ​Cervix
    • Colon
    • Stomach
    • Breast
    • Pancreas
    • Thyroid
    • Larynx & Lung
24
Q

Lymphcytic interstitial pneumonitis

A
  • Diffuse lymphod hyperplasia
  • lower lobe reticulonodular and linear patern of disease with diffuse ground glass opacities, centrilobular nodules and thin walled cysts.
  • Can be treated with steroids
  • May result in lymphoma and fibrosis
  • In patients with:
    • AIDS
    • Sjorgrens
    • Hypogammaglobuminaemia
    • Multicentric Castlemans disease.
25
Q

Most common benign cardiac tumours

A
  1. Atrial myxoma (50%)
  2. Fibroma (12%) - may calcify
  3. Lipoma
  4. Rhabdomyoma - assoc with tuberous sclerosis
  5. Hydatid cysts (curvilinear calcification)
26
Q

Most common maligncies to cause lymphangitis carcinomatosis

A
  • breast
  • stomach
  • pancreas
  • prostate
27
Q

Most common neoplasms to met to the heart

A
  1. Breast
  2. Lung
  3. Melanoma
  4. Lymphoma
28
Q

Most common primary cardiac malignant tumours

A
  1. Angiosarcoma
  2. Rhabdosarcoma
  3. Liposarcoma
  4. …Other sarcomas
29
Q

Mycoplasma Pneumonmia

A

Most common atypical pneumonia (5-20 yo)

Positive for cold agglutinins (60%)

Rad:

  • Reticular pattern
  • LL predisposition
  • Consolidation
30
Q

Poland syndrome

A

Hyperlucent lung resulting from hypoplasia/aplasia of the chest wall.

Also assoc with hypoplasia of abnormalities of the ipsilateral breast and upper limb.

31
Q

Rheumatoid lung disease

A
  • Histologically a form of UIP
  • Begins as lower lobe alveolitis –>endstage lower lobe fibrosis (honeycombing)
  • Can form lung necrobiotic rhematoid nodules paralell to flares.
32
Q

Schistosomiasis

A

S. Mansoni, S. Jaonicum & S. Haematobium.

  • Waterbourne
  • Larvae passing through pulmonary capilaries cause transiet airspace opacities - eosinophilic pneumonia.
  • When ova retuning in from systemic infection in to pulmonary arterioles
    • induce granulmatous inflammation and fibrosis
    • obliterative arteriolitis
    • pulmonary hypertension and cor pulmonale
    • can resemble miliary TB
33
Q

Small cell carcinoma

A
  • Cental location within the main or lobar bronchi.
  • Invade the bronchial wall.
  • Hilar or mediastinal mass with extrinsic compression of the bronchi.
  • Local lymphadenopathy
34
Q

Squamous cell carcinoma

A
  • Second most common (25%)
  • Central locaion within lobar or segmental bronchial wall.
  • Invades the bronchial wall.
  • Central necrosis / cavitation
  • Present with cough and haemoptysis
35
Q

Swyer-James syndrome

A

Kid/teenager with recurrent LRTIs

Causes hyperlucent affected lung due to airtrapping and brochiectasis resulting in consequential airspace destruction.

36
Q

TB

A

PRIMARY

Majority are asymptomatic with no radiological findings.

If symptomatic Granulomas (Ghon lesions) form in 1-3 weeks. –> central caseous necosis

Coincides with delayed hypersensitivity.

Mediastinal adenopathy (partcularly in children and immunocomprisimised.)

May from Ranke complex = Ghon focus and calcified nodes

POST PRIMARY

Often symptomatic

ill defined patchy nodular opacities

Cavitation = Active transimissible disease.

Cavity erosion in to pulmonary artery can cause RASMUSSEN aneurism.

Parenchymal heling results in fibrosis, bronchiectasis and volume loss.

complucated by miliary TB.

37
Q

Tracheopathia Osteochondroplastica

A

Osteocartilagenous submucosal calcified nodules.

Typically involves distal two thirds of trachea and proximal bronchi.

38
Q

Uhl anomaly

A

Arrhythmogenic right ventricular dysplasia.

  • Rare aquired cardiomyopathy in infants. - limited to RV
  • Thinning of the anterior RV wall with fatty infiltration.
39
Q

UIP

A
  • Macrophages first proliferate in alveolar airspace —> thicken the interstitium —> Then fuck it up (fibrosis)
  • Histologically - different staged of the disease are seen simultaneuosly
  • 50-80s affected.
  • PFTs = Restrictive disease and reduced diffusing capacity of carbon monoxide (DLCO)
  • Idiopathic or assoc w aa vascular collagen disorder (RA etc)

CT:

  • bibasilar coarse reticular/reticularnodular obacity followed by honeycombing —Reduced lung volume.
  • interstitial and intraalveolar changes - groundglass
  • traction bronchiectasis
    *
40
Q

Upper lobe distribution BREASTS

A

B = Beryllosis

R = Radiation

E = Eosinophilic granuloma (Langerhans cell histiocytosis) and Extrinsic Allergic Alveolitis

A = Ankylosing spondylitis

S = Sarcoidosis

T = Tuberculosis

S = Silicosis

41
Q

Varicella-zoster virus

A

Immunosupressive therapy or those with lymphoma

acute = diffuse bilateral 5-10 ill defined nodularities

after resolution some invosute and calcify (2-3mm)

42
Q

Klebsiella pneumona

A

G-ve infection in debiltated or alocoholics

Px with redcurrent jelly productive cough.

Rad:

  • Consolidation appears similar to that of infection with S. pneumoniae
  • Lobar expansion (bulging fissures)
  • Cavitation, 30%–50%, typically multiple
  • Massive necrosis (pulmonary gangrene)
  • Pleural effusion uncommon
43
Q

CAVITY

A

C = cancer

  • bronchogenic carcinoma : most frequently SCC
  • cavitatory metastasis : again most frequently SCC

A = autoimmune granulomas

  • Wegener’s granulomatosis
  • rheumatoid arthritis (rheumatoid nodules)

V = vascular

  • pulmonary embolus / pulmonary infarction

I = infection

  • pulmonary abscess
  • TB, fungal, staph aureus, histoplasmosis

T = trauma

  • pneumatocoeles

Y = youth

  • CPAM
  • pulmonary sequestration
  • bronchogenic cyst
44
Q

Cryptococcosis

A
  • Cryptococcus Neoformans
  • Pigeon shit
  • Common in patients with lymphoma, diabetes, AIDS and roids
  • Imaging:
    • Pulonary mass/nodules
    • Lobar or segemental consolidation
    • CNS and other organ stuff

Radiology (6 decks)

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