Chest Flashcards
1
Q
By convention, lateral X-rays are taken in which position?
A
Left lateral
2
Q
normal thickness pst wall bronchus intermedius
A
<3mm
3
Q
the black hole
A
left upper lobe bronchus
4
Q
what runs through the black hole?
A
bronchus intermedius
5
Q
how much higher is left hilum point/angle vs right?
A
1cm
6
Q
Hilar point/angle
A
crossing of RUL pulm v and RLL pulm a
7
Q
inferior hilar window
A
btw RUL bronchus and bronchus intermedius
8
Q
retrotracheal/raider triangle obliterated in what testable setting?
A
aberrant right subclavian artery
9
Q
pointy parts mechanical valves point in which direction?
A
toward direction of BF
10
Q
PM lead through which valve?
A
TV
11
Q
bigger: MV vs AV?
A
MV
12
Q
azygos lobe fissure-how many layers of pleura?
A
azygos v displaced laterally
-covered by 4 layers pleura
13
Q
how many segments R vs L
A
R-10
L-8
14
Q
pig/tracheal bronchus
A
RUL bronchus off trachea
-asyx, air trapping, recurrent inf
15
Q
cardiac bronchus-where does it come off, syx’s
A
supernumerary BLIND ENDING bronchus off bronchus intermedius
-asyx, recurr infs
16
Q
superior mediastinum
A
thoracic inlet–>sterno-manubrial junction
17
Q
contents pst mediastinum
A
es, thoracic duct, desc aorta
18
Q
MC pulmonary v anatomic variation
A
v drains right middle lobe
-matters to electrophysiologist in setting of ablation
19
Q
Proximal interruption of pulmonary artery
A
- Congenital absence of R > L PA w/ more distal pulmonary vasculature –> hemithorax volume loss
- opposite side of AA
- ass: PDA. Left PA: TOF, Truncus
- recurrent infections (lack of bs)
20
Q
patterns of atelectasis
A
- obstructive/absorptive
- compressive/relaxation/passive
- fibrotic/cicatrization
- adhesive
21
Q
superior triangle sign
A
RUL (RLL?) atelectasis –> mediastinal vess pulled R –> trianglular opacity R of trachea
22
Q
right middle lobe syndrome
A
chronic RML atelectasis via MAI
23
Q
S Sign of Golden
A
RUL central obstr
24
Q
luftsichel sign
A
LUL central obstr
25
non visualization aortic knob
LUL atelectasis
26
peaking of diaphragm
-volume loss --> pulmonary ligament
27
flat waste sign
flattened hilum & heart border in LLL atelectasis
28
cervicothoracic sign
obliteration pst junction line (above clavicles) --> pst mediastinal mass
29
pulmonary vs mediastinal origin angles w/ lung
acute=pulm
| obtuse=mediastinal
30
lobar PNA-types
- SP
- legionella
- klebsiella
- proteus
- morganella
31
BW: bulging fissure
klebsiella
| -exuberant inflamm
32
Staph Aureus PNA appearance
bronchopulmonary- BL, patchy opacities, abscess
| -MRSA-no classic findings
33
anthrax classic app
- hemorrhagic lymphadenitis, mediastinitis, hemothorax
| - med widening
34
klebsiella vs conventional PNA
+inflamm, PE, empyema, cavity
- EtOH, nursing home
- "current jelly" sputum
35
H influenza PNA-app, who
bronchitis +/- BL LL bronchopneumonia
| -COPD, ø spleen
36
pseudomonas-app, who
- icu on vent. CF/1˚ ciliary dyskinesia
- patchy opacities, abs, Pl Eff common (small)
areas of ground-glass attenuation - tends to involve multiple lobes and may demonstrate an upper zonal predilection 4
bronchial wall thickening
peribronchial infiltration and areas of consolidation.
37
legionella-who, appearance
-COPD, crappy air conditioners
-per sublobar opacities surr by GG
+cavitation in immunosuppressed
*xray lag behind resolution of symptoms
38
xray lag behind resolution of symptoms
legionella
39
mcc pulmonary cavitation/abscess
aspiration PNA
40
aspiration PNA-where, img, compl
- R side. Supine: pst lobes. Upright: basal lower lobes
- MCC pulmonary cavitation, abs
- mc compl=empyema --> bronchopleural fistula
41
mc complication of aspiration PNA
empyema --> bronchopleural fistula
42
actinomycosis-how, img
- dental procedure --> mandible osteoporosis --> aspiration
- per lower lobes
- aggressive + rib OM, cw invasion
43
mycoplasma pulmonary findings
reticular + TIB
44
nocardia PNA
- 50% immcompr, common s/p cardiac transplant. AIDS < 50
- consolidation/mass, nod w/ surr reticulation +/- cav
- PlEff
- +/- inv pleura, cw, mediastinum
* necrotizing in imm compr
45
pulmonary considerations s/p bone marrow tx
- infection (50%, MCC death)
- Graft vs Host
- PTLD
46
Pulmonary graft vs host-phases
- Acute (20-100d)- GI, skin, liver.
| - Chronic (>100 d)-lymphocytic infiltration of aw & obliterative bronchiolitis
47
Bmarrow Tx pulmonary findings time divisions
- early neutropenic (0-30d)
- early (30-90d)
- late (>90d)
48
Early neutropenic s/p bmarrow tx-time frame & pulm findings
- <30 d
- pulm edema, hemorrhage, drug induced lung injury
- fungal PNA (invasive aspergillosis)
49
Early pulm findings s/p bmarrow tx-time frame & pulm findings
- 30-90 d
| - PCP, CMV
50
Late pulm findings s/p bmarrow tx-time frame & pulm findings
- >90
| - bronchiolitis obliterates, cryptogenic orgz pna
51
CD4 >200
- bacterial
| - Tb
52
CD4 <200
PCP, atypical mycobacterium
53
CD4 <100
CMV, disseminated fungal, mycobacterial
54
PCP classic findings
- central/perihilar UL gg opacities
| - +/- thin walled cystic in gg opacities (30%)
55
AIDS + gg
PCP
56
aids + opacity
strep pna=MC
- CD4 low-Tb
- chronic-lymphoma or capos
57
aids + persistent opacities
lymphoma
58
aids + flame shaped perihilar opacity
kaposi sarcoma
59
aids + lung cysts
lip (pediatric)
60
Aids + lung cysts + gg + PTX
PCP
61
aids + hyper vascular LNs
castleman or kaposi
62
aids + MF airspace opacities
bacterial or fungal
63
aids + gg
PCP
| -<100 and PCP as answer choice not provided: CMV
64
4 phases of Tb
- 1˚
- 1˚ disseminated
- latent
- 2˚/post 1˚/reactivation
65
immune reconstitution inflammatory syndrome
- worsening of syx's in AIDS + Tb once started on HAART
| - rx: steroids
66
1˚ Tb MOA:
inhalation --> necrosis --> immune mediated attack --> granuloma (ghon focus) --> nodal expansion --> Ca (ranke complex) --> atelectasis (obstr)
- -> rupture: endobronchial (aw) or hematog (bv) spread =1˚ progressive spread
- pleural effusions
- cav uncommon
67
Tb LAD in kids
-bulky
68
what determines MOA of TB 1˚ progressive spread?
if node ruptured into aw (endobronchial spread) or bv (hematog spread)
69
RFs for 1˚ progressive spread in Tb
- HIV (MC)
- other imm suppr: tx, steroids
- jejunoileal bypass, subtotal gastrectomy, silicosis
70
Latent Tb
- (+) PPD, (-) CXR, ø syx's
- vaccination
- PPD conversion = 9 mo INH
71
Tb post primary/reactivation
* progression MC
- UL/sup LL cavitation + nodular opac (endobronchial spread)
- Hematog spread --> miliary pattern
- Rasmussen aneurysm-pulm a's near cavity
72
AIDS + Tb
- CD4 >200-reactivation (cavitation)
- CD4 <200- 1˚ progressive (adenopathy, consolidation, biliary)
- NOT lobar
73
non-TB mycobacterium to know-orgm names
- M avium-intracellulare complex
- M Kansasii
- M absessus
74
cavity/classic type non-tb myco
old white male smoker. looks like reactivation Tb
75
non-classic/bronchiectatis type non-tb myco
RML & lingular TIB + cylindrical bronchiectasis
76
HIV type non-tb myco
CD4 <100
GI --> blood --> mediastinal LAD (MC)
+other pulm findings bc often mixed with other inf
+SMG, HMG
77
Hypersensitivty type non-tb myco
CL gg opacities
78
3 types of aspergillus
1) normal immune-aspergilloma
2) suppressed immune- invasive, "air crescent sign", halo sgx
3) hyperimmune-bronchiectasis + finger in glove
79
aspergilloma
aspergillum ball in EXISTING cavity
| *moves w/ positional change
80
invasive aspergilloma-who, classic sgx's
- AIDS, tx
- peripheral wedge shaped infarcts +
- air crescent sign-healing 2-3 wk s/p rx
- halo sign
81
Allergic broncho pulmonary aspergillosis-ing features and dx criteria
UL, central bronchiectasis saccular bronchiectasis + finger in glove
-diagnosis requires:
1) serum IgE (+) OR (+) Asp hypersensitivity skin test
+
2) total IgE >1000,
82
mucormycosis
- invasive fungus
- impaired immunity (DM, steroids, aids)
- face + lungs + medisatinal, pleural, cw invasion
83
CMV PNA who
- reactivation s/p bmarr tx
| - infusion of CMV positive marrow/other blood products
84
cmv PNA img
mult nodules, gg or consolidation
85
measles pna
Mult gg opacities + smaller nodules
- bf or after skin
- compl + in pregnant or immunocompromised
86
influenza PNA
coalescent LL opacities, Pl Eff rare
| -ie: think covid 19 vibe
87
varicella-appearance
mult peripheral nodular opacities
| -Ca when healed
88
varicella peds vs adults
- peds: chickenpox
| - adults (immcompr)=pna
89
EBV ass
-ass w/ PTLD (pst transplant lymphoproliferative disorders) and ARL
90
EBV pna
LAD + SMG. lungs uncommonly affected.
91
MC radiographic abN of EBV
SMG
92
COVID-19 acute vs chronic
- Acute (<14 d): BL per GGO, bronchovascular thickening. Crazy paving & reverse halo
- chronic (>14d): fibrous stripes
93
CAVITY
```
Cancer (SCC)
AutoImmune (granulomatosis w/ polyangiits, RA, Caplan)
Vascular (SE, bland emb)
Inf (Tb, SA, aspiration)
Trauma-pneumatoceles
Young (CCAM, sequestration)
```
94
Lung cancer RFs
- age (v rare <40yo)
- smoking (90% of lung cancer cases)
- copd (even if you didn't smoke)
- exposure-arsenic, nicke, uranium, asbestos, chromium, beryllium, radon
- family hx
- fibrosis-10x the risk
95
who gets screened for lung cancer?
-55-80 yo + 30 pack yr hx (currently or quit in last 15 yrs
96
CT dose recommendation for lung cancer screening
CTDI vol < 3mGy
97
what's considered "growth" for lung nodule?
1.5 mm in 1 yr
98
What scoring system is used in lung cancer screening?
LUNG RADS
99
how do you score findings in lung cancer screening?
One nodule (most suspicious)
100
Can you be enrolled in lung cancer screening with a history of lung cancer?
Treated, remote (>5 yrs) and must fall into normal inclusion criteria (55-80 yo + 30 pack yr)
101
Fleischer Society Overview
- incidental SOLID nodule
- >35 yo w/o known or suspected malignancy, imm compromise
- risk stratification (mild, intermediate, high)-RFs & nodule characteristics
- f/u based on arbitrary guess of cancer risk >1%
- thin slice CT (<1.5mm)
102
how to measure nodule for FS?
avg diam (short + long/2)
103
Fleichner Society RFs to consider
smoking, cancer hx, family hx, age, exposures
104
what to do with perifissural nodules re: FS
nothing
105
how are nodules stratified re: FS
number & risk
| -risk= nodule char + pt RFs
106
likely of malignancy re: nodule density
- mixed > gg > solid
| - solitary > mult
107
SPN benign morph Ca
1) solid/diffuse
2) laminated
3) central
4) popcorn
108
SPN malignant morph Ca
- eccentric
- popcorn + GI
- solid + osteosarcoma
109
What makes you think benign SPN?
- fat
- rapid doubling (<1 mo)
- slow doubling (>16 mo, 2 yrs=B9)
110
what makes you think cancer in setting of SPN?
- spiculated ("corona radiata sgx")
- air bronchogram (5x MC in malignant SPN, 50% adenoCa)
- mixed density
111
when do you use PET for SPN? What SUV is considered HOT? when do you think cancer vs B9?
- >1 cm
- SUV > 2.5
- solid: hot=CA, cold-not
- gg: hot=inf, cold=CA
112
Lung CA MC loc?
- UL (70%)-exc LL fibr
| - R (1.5x)
113
SPN in setting hot h/n CA?
-1˚ > met (sim RFs)
114
nodule decreasing in size: mal or b9?
either! (mal if increasing density)
115
Paraneoplastic syndromes of lung cancer
- nonSC: parathyroid
| - SC: SIADH, ACTH, Lambert eaton (often bf dx)
116
Lambert eaton
proximal weakness from abN release acetylcholine at NMJ
117
TTF-1 (thyroid transcription factor 1) and lung CA
-not expressed in non-small cell squamous
118
MC lung CA subtype to present as SPN
Adeno
119
MC and least common lung CA subtypes
- MC= AdenoCa (35%)
| - LC= non-SC large (15%)
120
Lung AdenoCA loc and known ass
- Upper lobe, per
| - pulm fibrosis
121
LA is on the Coast
Large & Adeno favor peripheral locs
122
lung CA loc based on syx
central=hemoptysis
| -per=pleuritic cp
123
MC 1˚ lung CA to cause SVC obstr & PNS?
small cell
124
Small cell lung CA img
central LAD
125
spectrum of adenocarcinoma
- pre-invasive
- AAH: atypical adenomatous HP of lung
- ACIS (Adeno In Situ)
- minimally invasive adenoCA (MIA)
- Invasive mucinous adenoCA
126
Atypical adenomatous HP of lung (AAH) vs Adeno In Situ (ACIS) vs minimally invasive (MIA)
- AAH: <5mm, mild, gg
- ACIS: <3cm, mixed
- MIA: <3 + stromal invasion (<5mm) (>5mm=lepidic)
127
superior sulcus/pancoast tumor-cause, pres, img modality used to stage, ci to sx
- non-SC
- shoulder pain
- staging: MRI (brachial plexus)
- CI to surgery:
- 50% VB
- spinal canal
- upper brachial plexus (C8+)
- diaph paralysis (C3-5)
- distal mets
128
measuring a nodule for lung CA staging
- solid=max diam
| - mixed- solid part
129
staging multiple lesions in lung CA
- synchronus-others=mets, changes stage
| - metachronous- stage individually
130
important nodal stage for lobectomy/resection
Stage 3B=N3 or T4, surgically unresectable
131
level 1 vs 2 nodes in lung CA
- border: lower level of clavicles/upper border of manubrium
- level 1= above, N3
- level 2= below, N2
132
who gets wedge resection in lung Ca
stage 1A/B, per & <2cm
133
wedge resection vs lobectomy
wedge = better pulm reserve
134
bronchopleural fistula s/p pneumonectomy
-post op space progressively filling w/ air rather than fluid
135
compensatory emphysema (post pneumonectomy syndrome)
-hyperexpansion of lung to compensate fo absence of other
136
pulmonary radiation changes
- immediate-bubbles
- early (1-3mo)-homogenous patchy ggo.
- late-dense consol, traction bronchiectasis, volume loss
* linear
- rib fx
137
lung CA recurrence
High (2yrs)
- loc: per of radiation bed, regional LNs, bronchial stump
- app: enhancing, enlarging round lesion along resection line/bronchial stump. New LNs (>1cm), new persistent PlEff
138
mc benign lung mass
hamartoma
139
pulmonary hamartoma classic app
- fat (60%) & popcorn Ca
- hot on PET
- uncommonly endobronchial
140
MC lung tumor in AIDs
- Kaposi sarcoma (requires CD4 <200)- MC
| - lymphoma-2nd MC
141
MC liver neoplasm in AIDS
Kaposi sarcoma
142
kaposi sarcoma pulmonary img, consistency of pl eff
- slow growing flame shaped opacities in asyx pts
- bloody Pl Eff (50%)
- thall+, gall (-)
143
MC pulm mets via dir invasion
- es
- lymphoma
- malignant GC
GEL
144
order of commonness: pulm met, pleural met, mesothelioma pulm met
-in that order
145
mc img hematogenous mets to lungs
-mult round, smooth-bordered, randomly distr LL nodules
146
cannonball mets-which cancers?
RCC, chorioCA (testicle)
147
lymphangitic carcinomatosis causes
- bronchogenic CA=MC
| - breast, stomach, pancreas, prostate (paint brush paint brush serosa)
148
lymphangitic carcinomatosis vs fibrosis
LC does not distort lobule
149
pulmonary lymphoma 4 flavors
- 1˚
- 2˚,
- AIDS
- PTLD
150
1˚ pulmonary lymphoma-time frame to qualify, type
- >3 mo's w/o extrathoracic involvement
| - rare, NHL (MALToma)
151
2˚ pulmonary lymphoma-HL vs NHL lung parenchyma involvement and percent cases Intrathoracic at time of presentation
- pulm inv of systemic lymphoma
- NHL>HL
- HL = LN + parenchyma (40%), 85% Intrathoracic at pres
- NHL-parenchyma (25%), 45% Intrathoracic at pres
152
pulm PTLD-what, when, img
-bcell lymphoma ass w/ EB virus s/p solid or stem cell tx
-~1 yr (later=more aggressive)
-well-defined nods/mass, patchy as consol, halo, interlobular thick
+/- nodal dx
153
AIDS related pulmonary lymphoma (ARPL)-ass, CD4 county, img, other findings
- high grade NHL, EBV ass
- CD4<100
- MC img: mult per nods (1-5cm), PlEff, LAD
- extranodal common: CNS, bmarr, lung, liver, bowel
154
thallium vs gallium in kaposi vs lymphoma vs toxo
- Kaposi: Thall+, Gall (-)
- lymphoma: Thall + , Gall +, PET+
- toxo: thall -, gall +
155
Poland syndrome
UL abscent pectoral major & minor +/- weird limbs
156
bronchial atresia
- in utero vascular insult --> SHORT SEGM lobar, segm, subsegmental bronchus
- LUL apical pst segm
- MC= hyperinflated lobe (via collateral flow through pores of Kohn and canals of Lambert)
- decreased pulm vasc
- hilar nodule (branching, finger in glove)
- asyx, recurr pna
157
ddx mucous plug in bronchial atresia
endobronchial tumor.
- mucoid impaction= <25 HU
- bronch for indeterminate lesions
158
avm- moa, where, img, rx
- sporadic (MC), hereditary (HHT/Osler Weber Rendu)
- LL (bf)
- compl: R--> L shunt, stroke,
- rx- afferent vessel >3mm+
159
MC congenital venous anomaly of chest
persistent left SVC --> coronary sinus
| -problem if --> LA (R-->L shunt)
160
Swyer James
post vial obliterative bronchiolitis (via contributive bronchiolitis --> small lung --> compensatory BL UL lucent lung
161
Horse-shoe lung-where, ass
- fusion of LL pst basilar segms behind heart
| - scimitar syndrome
162
Spares costophrenic angles
LCH
HSP
Asbestos pleural plaque
163
Birt Hogg Dupe
- LL pulm cysts (favor paramediastinal region) (closer to kidneys)
- BL oncocytomas
- chromophobic RCCs
164
lymphangiomyomatosis (LAM) ass
Tuberous sclerosis
165
tuberous sclerosis triad
- seizure
- MR
- adenoma sebaceum
* Seizure, Sebaceum, Stupid
166
Lymphocytic interstitial PNA ass
- adult: Sjogren (MC), SLE, RA)
| - kids: HIV
167
vanishing lung syndrome
idiopathic necrosis of lung parenchyma & hyperinflation --> BL UL bullous disease occupying at least 1/3 hemithorax
- young men
- 20˚ alpha 1 antitrypsin deficiency
- compl: tension ptx
168
vanishing lung RFs
- smoking, marijuana
- alpha-1 antitrypsin deficiency
- male
169
saber sheath trachea
coronal narrowing of trachea <2/3 sag diam, sparing extrathoracic portion
***COPD
170
central dot sign
vessel w/i secondary pulm lobule in centrilobular emphysema
171
what to think if you see cavitation in setting of silicosis?
Tb
172
who gets progressive massive fibrosis (PMF)
silicosis, coal workers pneumoconiosis
173
ship yard
asbestosis
174
miners, quarry workers
silicosis
Quarry workers use powerful machinery to dig and drill rock, sand, slate, gravel, and minerals from quarries and mines. They crush, transport, and process these aggregates for use, often on construction sites.
175
washed coal
coal workers pneumoconiosis
176
aircraft/space industries
berylliosis
177
Nitrogen dioxide
silo fillers disease
Silo-filler's disease. “Silo-filler's disease”—a syndrome caused by nitrogen dioxide. Silage gas poisoning: nitrogen dioxide pneumonia, a new disease in agricultural workers. NO2 is derived from the nitrates in corn or hay that are converted to nitrites and oxygen by anaerobic fermentation, which eventually yield NO2.
178
filler tablets
talcosis
179
cancer vs PMF
cancer=T2 bright
| PMF=T2 dark
180
2 types of NSIP
cellular, fibrotic
181
lung fibrosis & cancer
- progressive wall thickening or developing nodule w/I cyst
- favors interface btw fibrotic cyst and N lung
- NELSON trial-we miss them
182
"heterogenous histology"
UIP
183
Sarcoid CXR staging
```
0-N
1-nodes
2-nodes + lung
3-lungs
4-end-stage (fibrosis)
```
184
Lofgren Syndrome
LAD
nOdosum
Feet
"Acute sarcoid"
1) BL hilar LN enlargement
2) arthritis (ankles) (male)
3) erythema nodosum (female)
185
stages of CHF
1) "redistribution"-wedge P 13-18 mmHg
2) interstitial-18-25
3) alveolar-25+
186
sarcoid labs
ACE+
| Ca+
187
pulmonary alveolar proteinosis (PAP)-ass, risk of infection, fibrosis risk, rx
- ass: smoking (in peds: alymphoplasia)
- inf: nocardia 2/ brain abscesses
- 30% risk fibrosis
- rx-bronchoalveolar lavage
188
types of lipoid PNA
- exogenous
| - endogenous-MC. Post obstructive process (CA)--> lipid laden MP
189
acute exogenous lipoid PNA
- childen who accidentally poison themselves w/ hydrocarbons
- fire eating/flame blowing
190
orgz/cryptogenic PNA-MOA, causes, rx
- granulation tissue depo in alveoli --> fibroblast proliferation, ie: not an active inf (abx don't help)
- cryptogenic=not known
- other causes
- inf
- amiodarone
- collagen vasc disease
- fumes
- rx-steroids
191
Upper lobe disease distribution
- CF
- APBP
- Chronic Eusinophilic PNA
- hypersensitivity PNA
- pneumoniosis
- pulmonary lagerhans cell histiocytosis
- RB-ILD
- Sarcoid
- 1˚ Tb
- PCP
- ankylosing spondylitis
192
halo sign
solid surr by gg (hemorrhage/invasion into surr ties)
- invasive aspergillosis (classic)
- other fungus
- hem mets
- adeno in Situ
- wegeners
193
reverse halo
central gg w/ rim of consolidation
- COP (classic)
- tb
- pulm infarct
- covid
- invasive fungal & wegeners (also halo)
194
"headcheese"
hypersensitivity pneumonitis (mix of everything)
195
AW/bronchial disease that spare pst membrane
relapsing polychondritis
| -tracheobronchopathia osteochondroplastica (TBO)
196
AW/bronchial disease that don't spare pst membrane
- amyloid
- post-intubation
- wegeners
197
tracheal thickening relapsing polychondritis
- smooth, diffuse antlat thickening. + Ca if chronic
| - recurr episodes cartilage inflamm, recurr PNA
198
post intubation tracheal thickening
subglottic circumferential stenosis, hrglass configuration
199
tracheobronchopathia osteochrondroplastia (TBO)
anterolateral cartilaginous/osseous nodules in submucosa of tracheal & bronchial walls
200
amyloid tracheal thickening
circumferential irregular, focal/short segment thickening
| -+Ca
201
Wegener's tracheal thickening
- subglottic circumferential, focal or long segment
| - no Ca
202
tracheal/bronchial tumors
- SCC-MC
- adenoid cystic -2nd MC
- carcinoid
- mets
- squamous call papilloma
203
primary ciliary dyskinesia ass
Kartagener's syndrome )50%)
204
William campbell syndrome
congenital cartilagenous deficiency of 4th-6th order bronchi --> cystic bronchiectasis
205
mounier-kuhn (tracheobronchomegaly)
tracheal dil >3cm
206
follicular bronchiolitis
- inflamm process rel to lymphoid HP
- RA, Sjogrens
- CL gg nodules, scattered bronchial dilation
207
constrictive bronchiolitis
inflamm post virus, tx, drug, inhalation, DIPNECH
- 2/2 mononuclear cells --> granulation tissue --> plug aw
- air trapping
- process seen in Sawyer James
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is an extremely rare pulmonary disorder at the benign end of the neuroendocrine cells proliferation spectrum. It is mainly seen in non-smoker middle-age females with a history of chronic cough or asthma.
208
small aw disease
- infectious bronchiolitis-TIB
- RB-ILD-CL gg nodules. Smokers
- sub acute hypersensitivity pneumonitis-CL gg nodules. Inhal organic
- follicular bronchiolitis-CL gg nods. RA, Sjogrens
- constrictive bronchiolitis-air trapping. viral, rx, drug, inhalation, DIPNECH
209
mc complication aspiration pna
empyema
210
mendelson's syndrome
aspiration gastric acid--> as opacity, massive pulm edema
211
aspiration of water or neutralized gastric contents
"fleeting opacity", resolves in hours
212
aspiration of germs (often mouth bugs)
PNA
213
aspiration of oil (often mineral oil)
lipoid PNA
214
aspiration patterns/syndromes
- gastric acid-opacity, pulm edema
- water/neutralized gastric content-opacity resolves hrs
- bugs (From mouth)-pna, cavitation, abscess, empyema
- oil-lipoid pna
215
ankylosing spondylitis
Upper lobe fibrobullous disease (UL --> BL)
216
shrinking lung
progressive volume loss in pts w/ SLE (SL=SL)
217
what makes breathing worse inhepatopulmonary syndrome vs CHF
HPS: worse sitting up
CHF: worse laying down
218
mc orgn involved with granulomatosis w/ polyangiitis
lung (95%)
| -randomly distr nodules +/- cavitation, gg (hem), pl eff (15%)
219
goodpasture syndrome
- BL coalescent AS opacities (hemorrhage), resolve ~ 2wks
- recurr--> fibrosis
- pulm hemosiderosis-small ill defined nodules
220
Caplan syndrome
RA + silicosis/CWP
| -UL predominance lung nodules +/- cav, pl eff
221
how much pleural fluid to diagnose a pleural effusion on AP film?
175 cc
222
how much pleural fluid to diagnose a pleural effusion on lateral film?
50cc
223
time lag s/p asbestos exposure: pl effusion, plaques, mesothelioma
- pl eff: 5 yrs
- plaques 20-30 yrs (Ca 40yrs)
- lung Ca-~20 yrs
- mesothelioma-30-40 yrs
224
pleural rind along medial surface
mesothelioma
225
Pleural Ca
- asbestosis
- old hemothorax
- old inf
- Tb
- extraskel osteosarcoma
*fibrothorax
226
solitary fibrous tumor of pleura (SFTP)-what, ass
solitary tumor arising from visceral pleura
| -Doege-potter syndrome (hypoglycemia via insulin-like GF) 5%
227
pleural mets-MC CA
- lung (adenoCA)
| - breast, lymphoma
228
pleural mets- MC manifestation
pleural effusion
229
most common benign pleural ST tumor
lipoma
230
subpulmonic effusion
pleural effusion accumulates btw lung base and diaphgram
- R > L
- ski sloping of diaph peak
231
encysted pleural effusion
round shape via collection btw pleural layers
232
empyema vs pulm abscess
- empyema=lentiform, split pleura sign, ct
| - abscess= round, claw sign, abx
233
split pleural sign
- thickening/separation of visceral & parietal pleura
| - empyema
234
why don't you treat pulm abscess w/ chest tube?
risk of bronchopleural fistula
235
who gets empyemas
mc in AIDS
236
emphysematous necessitans-causes
- Tb (70%)
| - actinomyces
237
diaphragmatic paralysis causes
idiopathic 70%
| -lung cancer (phrenic n compression)
238
thymus pathology
- rebound
- cyts
- thymoma
- thymic carcinoma
- thymolipoma
239
thymus rebound vs lymphoma
- Lymphoma hotter on pet
| - thymic rebound drops out on MRI in phase img
240
thymus cyst etiology
- cong
| - acquired (thoracotomy, crx, HIV)
241
thymus cyst img
- UL or ML
| - T2 bright
242
thymoma spectrum. Differentiation.
- non-invasive thymoma --> invasive (30%) --> CA (distal met)
- Ca, invasion mediastinal fat/adj structures=aggressive
- invasive drop met--> pleura, pericardium, RP (img abd!)
243
thymoma ass
- MG
- pure red cell aplasia
- hypogammaglobinemia
244
thymolipoma
fatty mass in thymic ST
245
MC thoracic GCT, ass
- teratoma (75%)
- klinefelter syndrome
- cystic (90%), fat, teeth
- small risk malignancy
246
ant mediastinal masses
- lymphoma
- thymic lesions (Rebound, cyst, thymoma spectrum, thymolipoma)
- GCT
- pericardial cyst
- thyroid lesions
247
fibrosing/sclerotic mediastinitis-types
- granulomatous (MC)-histo, tb, sarcoid
| - non granulomatous/idiopathic-AI (SLE, RA, behcet, etc), radiation, methysergide (headache mx). NG ass w/ RP fibrosis
248
granulomatous vs non-gran fibrosing/sclerotic mediastinitis
- granulomatous-ST mass + Ca
| - non-gran-infiltrative, lack Ca, enh+
249
compl of fibrosing/sclerotic mediastinitis
SVC syndrome
250
mc loc bronchogenic cyst
subcarinal (obliterate azygoesophageal line) --> pulm
251
mediastinal lipomatosis-what, ass
excess unencapsulated fat w/ steroids, Cushing, obesity
252
middle mediastinal masses
- lymphoma, LAD
- fibrosing mediastinitis
- bronchogenic cyst
- mediastinal lipomatosis
253
pst mediastinal masses
- neurogenic=mc (schwannoma=mc, neurofibroma, malignant peripheral n sheath tumors). SNS ganglion tumors MC in peds/young adults (ganglioneuroma, NB, GNB)
- extramedullary hematopoiesis
- hiatal hernia
- desc thoracic aortic aneurysm
- lateral meningocele (ass w/ NF)
- esophageal neoplasm
- foregut dupicliation cyst
- paraspinal abscess
254
who gets extramedullary hematopoiesis
* response to bmarrow failing to respond to EPO
| - CML, PCV, myelofibrosis, SCD, thalassemia
255
pulmonary artery aneurysm/pseudoaneurysm
1) iatrogenic 2/2 SG cath=MC
2) behcets, giant cell vasc
3) chronic PE
256
syndromes ass w/ pulmonary aneursym/pseudoaneurysm
- hughes-stovin syndrome
- rasmussen aneurysm
- tetrology of fallot repair
257
hughes stovin syndrome
- recurrent thrombophlebitis
| - pulm artery aneurysm and rupture
258
Pulm hypertension
>25 mmHg
259
img pulp htn
- 29+ mmHg
- PA > aorta, segmental a's > bronchus
- eisenmenger phenomenon-mural Ca of central pulm a's
260
banana and egg
visualization of main pulm artery (egg) at level of aortic arch (banana) in setting of PHtn
261
carina crossover
right PA crosses carina midline anteriorly rather than more caudal location in setting of PHtn
262
westermark sgx
regional oligemia
focal area of increased translucency due to oligaemia is caused by impaired vascularisation of the lung due to primary mechanical obstruction or reflex vasoconstriction.
263
fleischner sgx
enlarged pulmonary artery
264
hampton's hump
peripheral wedge shaped opacity
265
mc radiographic abN in PE
pleural effectivement (30%)
266
PAH + normal wedge
pulmonary veno-occlusive dx
267
diaphragmatic injury
- L > R (liver=buffer), pstlat
- radial orientation, >10 cm
- "collar/hour glass" and "dependent viscera" sgx's
268
collar/hour glass sign
waist-like appearance of herniated orgn thru injured diaphysis
269
dependent viscera sgx
abscent interposition of lungs btw cw and upper abd organs (liver on right, stomach on left)
270
pulmonary trauma
- diaph injury
- tracheo-bronchial injury
- macklin effect
- boerhaave syndrome
- flail chest
- PTX
- Hemothorax
- extrapleural hematoma
- pulmonary contusion/laceration
- malpositioned chest tube
- aortic rupture
- blunt cardiac injury
- fat embo
- barotrauma
271
trachea-bronchial injury-where
- w/i 2 cm of carina
- close to carina --> PMX (vs PTX)
- pstlat trachea
272
Macklin effect
- blunt trauma --> alveolar rupture --> air dissection along bronchovascular sheaths--> PMX
- MCC PMX in trauma
273
flail chest
- 3+ segmental rib fx (more than 1 fx in a rib) OR 5+ adj rib fractures
- paradoxical motion w/ breathing
274
"inversion/flattening of diaphragm"
tension PTX
275
hemothorax density
35-70 HU
276
when does malpositioned chest tube occ?
background lung disease or pleural adhesions
277
"blood around chest tube"
malpositioned
278
complication malpositioned chest tube
bronchopleural fistula
279
"persistent fluid collection after pleural drain/tube placement"
extra pleural hematoma
280
BW: "displaced extra pleural fat"
extra pleural hematoma
281
MC lung injury from blunt trauma
pulmonary contusion (alv hemorrhage w/o alveolar disruption)
282
img pulmonary contusion
- opacities, sub pleural sparing
| - 6-->72hrs (if longer: aspiration, PNA, laceration)
283
ductus bump
normal variant aortic bulge mimicking aortic injury
284
MC areas of aortic injury
- isthmus
- root
- diaph hernia
285
fat embolism timing, app, where
- 1-2 d s/p long bone fx
- pulm edema, no arterial defect!
- resolves 1-3 wks
- skin (rash), lungs, brain
286
who's most at risk and who's protected from barotrauma?
- COPD
| - fibrotic lungs (don't stretch)
287
Fleishsner Society breakdown of rules
- <6 mm: 12 mo f/u high risk
- 6-8mm: single 6-12mo f/u, mult 3-6mo f/u
- >8 mm: single: PET or bx, mult: 3-6mo
288
Mesothelioma causes
80% asbestos. NOT dose dependent.
289
"pleural ring along medial surface"
mesothelioma
290
gold standard PE diagnosis
catheter angiography
291
utility of D-dimer in PE diagnosis
100% negative predictive value
292
Diagnosis chronic PE
VQ scan
293
pulmonary neuroendocrine tumors
* in order of aw--> not in aw
- typical carcinoid (low grade malignant)
- atypical carcinoid (intermediate grade malignant)
- large & small cell carcinoma (high grade malignant)
294
img pulmonary NE tumors
- typical carcinoid (50 yo)
- central endobronchial (distal to carina, rare in trachea and parenchyma).
- <3cm
- central lumen
- Ca 30%
- homog enh+
- parenchymal=welldefined nodules
- atypical carcinoid (60 yo, smoker)
- peripheral (distal to segm bronchi)
- >3 cm
- partially endobronchial
- enh+
- Large cell (per, 3.5cm)
- SCLC-large central/mediastinal/hilar mass
- DIPNECH-diffuse idiopathic pulmonary neuroendocrine cell HP-multiple lung nodules/tumorlets <5mm
295
syx carcinoid
- hemoptysis (highly vascular)
| - obstructive
296
carcinoid nuclear medicine
- ocreotide
| - PET cold 25%
297
endobronchial vs GI carcinoid
- endobronchial: Left heart. Uveal tract met
| - GI: right heart, extra ocular
298
2nd mc tracheal malignancy
adenoid cystic (low grade, 40 yo, no ass w/ smoking)
- upper trachea (pstlat), main or lobar bronchus
- *perineural, submuc spread
- var app: infil trach & med fat OR nodular stenosis
- HOT on pet
299
MC tracheal malignancy
SCC
| -lower trachea/prox bronch
300
endobronchial mets
lung, thyroid, esophagus
301
mc benign tumor of trachea
squamous cell papilloma
- single=smoking
- mult=HPV-6. (laryngeal MC, trach 5%)
302
Endobronchial tumors
- SCC-mc mal
- adenoid cystic=2nd mc mal
- carcinoid/atypical carcinoid/small cell
- squamous cell papilloma
- mets (breast, renal, lung, thyroid, esophagus) (BREaTh)
- mucoepidermoid
- tracheal lymphoma (MALT), low grade
303
CF vs 1˚ ciliary dyskinesia
```
CF
-abN mucous, cilia cannot move it
-normal sperm, absent vd
-UL bronchiectasis
1˚ CDK
-abN cilia, normal M
-abN sperm (can't swim), N vd
-LL bronchiectasis
```
304
Intrathoracic findings lupus
- pl eff, pericardial eff MC
| - fibrosis UC. "shrinking lung"
305
collagen vascular induced UIP
-sarcoid, RA, scleroderma
306
pulm findings RA
UIP or COP
| -lower lobe
307
Scleroderma pulmonary
NSIP> UIP
LL
-dilated fluid filled es
308
Sjogren pulmonary
LIP
309
ankylosing spnondylitis
fibrobullous disease UL-->BL
| -UL
310
lower lobe diseases
- RA, scleroderma
- asb-(particles too large to be cleared by lymph)
- 1˚ ciliary dyskinesia
- 1˚ tb
311
Fleischner sign
widening pulmonary arteries due to clot
312
right heart strain numeric suggestions
RV:LV >1, >1.5 severe
313
Single pulmonary eusinophlia/Loffler syndrom
idiopathic transiet, migratory consolidations (otherwise appears ID to drug rxn, parasites)
-eusinophila
314
eusinophilic lung dx
- single pulmonary eusinophlia
| - chronic eusinophilic PNA
315
pulmonary vasculitis
- churg-strauss
- microscopic polyangiitis
- wegener granulomatosis
316
churg-strauss/allergic angiitis & granulomatosis img
- transient/migratory peripheral consolidation/gg, interlob wall thickening
- asthma, peripheral eosinophilia, P-ANCA
- + other orgn (renal fx, arthraligia, myocarditis, pericarditis)
317
p-ACNA
- churg strauss
- microscopic polyangiitis
- collagen vascular dx
318
churg-strauss triad
1) eusinmophilia
2) necrotizing vasculitis
3) asthma
319
MCC pulmonary hemorrhage w/ renal fx
microscopic polyangiitis
| -renal (90%)> pulm (10%)
320
microscopic polyangiitis img
central gg (hemorrhage)
321
lung hemorrhage and renal dx
- microscopic polyangiitis
- goodpasture syndrome
- wegeners/granulomatous polyangiitis
322
orgz PNA pattern drug tox
-bleomycin, cyclophosphamide, MTX, amdiodarone, nitrofurantoin, penicllamine
323
lung radiation injury timing
- radiation pneumonitis (1-4 mo, most sev at 4 mo)
- ggo centered on radiation port & beyond
- fibrosis- 6-12 mo
- fibr, traction bronchiectasis w/I radiation port & 20% beyond
- LAD
324
stage HSP
acute
subacute
chronic
325
acute HSP-img
inflamm exudate filling alv
| -non spec ggo +/- CL nods
326
subacute HSP-img
ill define CL gg nodules + mosaic attenuation (air trapping)
| -head cheese
327
chronic HSP
-UL predominance pulmonary fibrosis + superimposed findings of subacute (gg CL nods + MA)
328
MC radiographic finding sarcoid
symmetric adenopathy
329
pneumoconioses acute vs chronic img
- acute-confl ggo +. interlobular thickening, alveolar filling w/ PAS (all proteinosis) (fatal ~ 1yr)
- chronic-progressive massive fibrosis, hilar/arch distortion
330
sarcoid signs
- 1-2-3 (right paratracheal, bilateral hilar)
- doughnut-LAD on lat view
- galaxy sign-perilymphatic nodules coalesce into mass w/ small nods per
331
what other organs may sarcoid involve?
-spleen, brain, rarely bone
332
mediastinal stripes
- pst junction line
- anterior junction line
- right and left paratracheal stripes
- right and left paraspinal lines
- azygoesophageal recess
333
azygoesophageal recess
interface formed by contact of posteromedial right lower lobe and retrocardial mediastinum
-es mass, hiatal hernia, LA enlargement, LAD
334
classifications thymoma
- history: low vs high risk
| - intact capsule: invasive vs non-invasive
335
thymoma + hemidiaphragm elevation
invasive thymoma (phrenic n invasion)
336
ddx eggshell calcification
- silicosis, CWP
- sarcoid (LC, but probably see more often bc MC as a dx)
- histoplasmosis
337
very rare causes of focal tracheal stenosis
behcet
| Crohn
338
bronchiectasis pathway
bronchial wall injury (infi/inflamm) --> lumen obstruction --> traction from adj fibrosis
339
bronchiectasis types
- cylindrical-mild dil
- varicocele-beaded, irregular
- saccular/cystic-enlarged, ballooned, multiple cysts that may not connect to aw
340
CAPTAIn Kangaroo has Mounier Kuhn
```
CF (one of MCC)
ABPA
Post infection
Tb/atypical mycobacterium
Agammaglobulinemia
Immunodef
Kartagener
Mounier Kuhn
```
341
tracheoes fistula
SCC
342
mc bronchial tumor in children
carcinoid (v rare in adults)
| -almost always distal to carina)
343
enhancing endobronchial mass
- carcinoid (homog)
- mucoepidermoid CA
- hemangioma
- glomus tumor
344
mucoepidermoid endobronchial tumor
- rare, from tiny salivary glands lining TB tree.
- Younger pts.
- Round/oval, indistinguishable from carcinoid
345
BREaTh Lung
mets to endobronchial tree
| -breast, renal, es, thyroid, lung
346
benign endobronchial lesions
- papilloma=mc
- chondroma
- schwannoma, adenoma, hamartoma, hemangioma, lipoma, leiomyoma
347
pleural based mass that changes position
fibrous tumor of pleura
348
fibrous tumor of pleura-what, img, mx, ass
- pleural based mass
- excised (20-30% mal)
- PET low
- hypoglycemia, hypertrophic pulmonary osteoarthropathy
349
what does cisterns chyli drain?
BL LE and LUE
350
MC sarcoid stage
stage 1. 60% compl resolution
351
significance of right hilum higher than left
-RUL collapse or fibrosis
352
eparterial bronchus vs hyparterial bronchus
- eparterial- R pulm a cross in front of R mainstream bronchus
- hyparterial- L pulm a cross over left bronchus
353
secondary pulmonary lobule size and contents
- 1-2.5 cm
| - contains: terminal bronchiole, artery, 30-50 1˚ pulmonary lobules, v's/lymph
354
role of bronchoalveolar lavage in alveolar proteinosis
-dx and rx
355
gossypiboma
retained FB
356
utility of decubitus views in setting of pleural effusion
obtained when in doubt of presence or absence of effusion and whether it is free layering
357
pleural mets vs mesothelioma
- mets=early enhancing
| - mesothelioma-enhance less intensely and better seen delayed (45s)
358
BL vs UL pleural plaques
- BL-asbestosis
| - UL-trauma, hemothorax, empyema
359
suggestion of life-threatening injury on cxr
- med widening
- PMX
- diaphgragmatic contour abN
360
dose length product
- most accurate reflection of effective radiation dose to a patient from a aCT scan, calculated base on actual exposure parameters used during the scan (although can be estimated prospectively.)
- (CTDI for each slice) x (distance)
- mGy * cm
361
gossypiboma
retained FB
362
utility of decubitus views in setting of pleural effusion
obtained when in doubt of presence or absence of effusion and whether it is free layering
363
pleural mets vs mesothelioma
- mets=early enhancing
| - mesothelioma-enhance less intensely and better seen delayed (45s)
364
BL vs UL pleural plaques
- BL-asbestosis
| - UL-trauma, hemothorax, empyema
365
suggestion of life-threatening injury on cxr
- med widening
- PMX
- diaphgragmatic contour abN
366
dose length product
- most accurate reflection of effective radiation dose to a patient from a aCT scan, calculated base on actual exposure parameters used during the scan (although can be estimated prospectively.)
- (CTDI for each slice) x (distance)
- mGy * cm
367
smoking related lung disease
- LCH
- RB-ILD
- DIP
368
mediastinal widening-next step.
- Acute-CTA
| - chronic-PA and/or compare to prior images
369
course of Right main PA
- behind asc aorta
- anteroinferior to right main stem bronchus
- subdiv into truncus ant and descending artery
370
right pulmonary descending artery supply
-RML, RLL, RUL pst segm (90%)
371
RV:LV ratio for 50% chance death in setting of cPE
2.3
372
"mediastinal invasion"
tumor contact w/ mediastinum of >3cm and ext of tumor into fat
-T4
373
necrobiotic nodules
lower lung caveating or non caveating nodules in pts w/ RA or silicopneumconiosis
374
primary lung lymphoma appearance
consolidations w/ air bronchograms
375
sources of cavitating lung mets
- bladder
| - SCC h/n, uterine cervice
376
appearance: ritalin lung, amiodarone, ibuprofen/nsaids, mercury fumes
- ritralin lung (IV injection oral ritalin)-basal bull ae
- amio-lower lung fibrosis
- ibuprofen/nsaids-eosinophilic PNA
- mercury fumes-ARDS
377
MC loc boerhaave related esophageal rupture
Left posterolateral distal esophagus
378
mediastinal compartment: well demarcated outline in the thorax that becomes indistinct in the neck
anterior
379
injuries to which arteries are life threatening?
internal mammary artery
| intercostal a
380
typical location pulmonary infarcts
peripheral, sub pleural
381
which sequestration sometimes presents with CHF syx's, why?
intralobar with drainage to pulmonary vein via L to L shunt
382
what worsens transient interruption of contrast?
hyperventilation
| deep inspiration just before scan
383
when to treat pulmonary AVM
when to treat pulmonary AVM
384
ARDS related fibrosis
- anterior
| - extensive post inflammatory bronchiectasis
385
risk of lung cancer in fibrosis
4x increased
386
course of azygos v
over right mainstem bronchus
| lies in tracheobronchial angle
387
left mediastinal border above aortic arch
left subclavian artery
388
safest route to biopsy apical mass
posterior (vessels and nerves in supraclavicular region run ant to apical bps)
389
order of basal branch take off
superior, medial, ant, lateral, pst
390
orientation of pulmonary v's
horz
391
how often does left SVC dump into LA?
10%. Not serious enough to cause cyanosis
392
Left SVC ass
cong heart dx (ASD highest)
