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radiology > Chest > Flashcards

Chest Flashcards

1
Q

By convention, lateral X-rays are taken in which position?

A

Left lateral

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2
Q

normal thickness pst wall bronchus intermedius

A

<3mm

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3
Q

the black hole

A

left upper lobe bronchus

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4
Q

what runs through the black hole?

A

bronchus intermedius

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5
Q

how much higher is left hilum point/angle vs right?

A

1cm

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6
Q

Hilar point/angle

A

crossing of RUL pulm v and RLL pulm a

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7
Q

inferior hilar window

A

btw RUL bronchus and bronchus intermedius

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8
Q

retrotracheal/raider triangle obliterated in what testable setting?

A

aberrant right subclavian artery

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9
Q

pointy parts mechanical valves point in which direction?

A

toward direction of BF

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10
Q

PM lead through which valve?

A

TV

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11
Q

bigger: MV vs AV?

A

MV

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12
Q

azygos lobe fissure-how many layers of pleura?

A

azygos v displaced laterally

-covered by 4 layers pleura

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13
Q

how many segments R vs L

A

R-10

L-8

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14
Q

pig/tracheal bronchus

A

RUL bronchus off trachea

-asyx, air trapping, recurrent inf

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15
Q

cardiac bronchus-where does it come off, syx’s

A

supernumerary BLIND ENDING bronchus off bronchus intermedius

-asyx, recurr infs

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16
Q

superior mediastinum

A

thoracic inlet–>sterno-manubrial junction

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17
Q

contents pst mediastinum

A

es, thoracic duct, desc aorta

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18
Q

MC pulmonary v anatomic variation

A

v drains right middle lobe

-matters to electrophysiologist in setting of ablation

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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)
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20
Q

patterns of atelectasis

A
  • obstructive/absorptive
  • compressive/relaxation/passive
  • fibrotic/cicatrization
  • adhesive
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21
Q

superior triangle sign

A

RUL (RLL?) atelectasis –> mediastinal vess pulled R –> trianglular opacity R of trachea

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22
Q

right middle lobe syndrome

A

chronic RML atelectasis via MAI

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23
Q

S Sign of Golden

A

RUL central obstr

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24
Q

luftsichel sign

A

LUL central obstr

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25
Q

non visualization aortic knob

A

LUL atelectasis

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26
Q

peaking of diaphragm

A

-volume loss –> pulmonary ligament

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27
Q

flat waste sign

A

flattened hilum & heart border in LLL atelectasis

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28
Q

cervicothoracic sign

A

obliteration pst junction line (above clavicles) –> pst mediastinal mass

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29
Q

pulmonary vs mediastinal origin angles w/ lung

A

acute=pulm

obtuse=mediastinal

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30
Q

lobar PNA-types

A
  • SP
  • legionella
  • klebsiella
  • proteus
  • morganella
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31
Q

BW: bulging fissure

A

klebsiella

-exuberant inflamm

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32
Q

Staph Aureus PNA appearance

A

bronchopulmonary- BL, patchy opacities, abscess

-MRSA-no classic findings

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33
Q

anthrax classic app

A
  • hemorrhagic lymphadenitis, mediastinitis, hemothorax

- med widening

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34
Q

klebsiella vs conventional PNA

A

+inflamm, PE, empyema, cavity

  • EtOH, nursing home
  • “current jelly” sputum
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35
Q

H influenza PNA-app, who

A

bronchitis +/- BL LL bronchopneumonia

-COPD, ø spleen

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36
Q

pseudomonas-app, who

A
  • 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.

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37
Q

legionella-who, appearance

A

-COPD, crappy air conditioners
-per sublobar opacities surr by GG
+cavitation in immunosuppressed
*xray lag behind resolution of symptoms

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38
Q

xray lag behind resolution of symptoms

A

legionella

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39
Q

mcc pulmonary cavitation/abscess

A

aspiration PNA

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40
Q

aspiration PNA-where, img, compl

A
  • R side. Supine: pst lobes. Upright: basal lower lobes
  • MCC pulmonary cavitation, abs
  • mc compl=empyema –> bronchopleural fistula
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41
Q

mc complication of aspiration PNA

A

empyema –> bronchopleural fistula

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42
Q

actinomycosis-how, img

A
  • dental procedure –> mandible osteoporosis –> aspiration
  • per lower lobes
  • aggressive + rib OM, cw invasion
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43
Q

mycoplasma pulmonary findings

A

reticular + TIB

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44
Q

nocardia PNA

A
  • 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
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45
Q

pulmonary considerations s/p bone marrow tx

A
  • infection (50%, MCC death)
  • Graft vs Host
  • PTLD
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46
Q

Pulmonary graft vs host-phases

A
  • Acute (20-100d)- GI, skin, liver.

- Chronic (>100 d)-lymphocytic infiltration of aw & obliterative bronchiolitis

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47
Q

Bmarrow Tx pulmonary findings time divisions

A
  • early neutropenic (0-30d)
  • early (30-90d)
  • late (>90d)
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48
Q

Early neutropenic s/p bmarrow tx-time frame & pulm findings

A
  • <30 d
  • pulm edema, hemorrhage, drug induced lung injury
  • fungal PNA (invasive aspergillosis)
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49
Q

Early pulm findings s/p bmarrow tx-time frame & pulm findings

A
  • 30-90 d

- PCP, CMV

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50
Q

Late pulm findings s/p bmarrow tx-time frame & pulm findings

A
  • > 90

- bronchiolitis obliterates, cryptogenic orgz pna

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51
Q

CD4 >200

A
  • bacterial

- Tb

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52
Q

CD4 <200

A

PCP, atypical mycobacterium

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53
Q

CD4 <100

A

CMV, disseminated fungal, mycobacterial

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54
Q

PCP classic findings

A
  • central/perihilar UL gg opacities

- +/- thin walled cystic in gg opacities (30%)

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55
Q

AIDS + gg

A

PCP

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56
Q

aids + opacity

A

strep pna=MC

  • CD4 low-Tb
  • chronic-lymphoma or capos
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57
Q

aids + persistent opacities

A

lymphoma

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58
Q

aids + flame shaped perihilar opacity

A

kaposi sarcoma

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59
Q

aids + lung cysts

A

lip (pediatric)

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60
Q

Aids + lung cysts + gg + PTX

A

PCP

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61
Q

aids + hyper vascular LNs

A

castleman or kaposi

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62
Q

aids + MF airspace opacities

A

bacterial or fungal

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63
Q

aids + gg

A

PCP

-<100 and PCP as answer choice not provided: CMV

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64
Q

4 phases of Tb

A
  • 1˚
  • 1˚ disseminated
  • latent
  • 2˚/post 1˚/reactivation
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65
Q

immune reconstitution inflammatory syndrome

A
  • worsening of syx’s in AIDS + Tb once started on HAART

- rx: steroids

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66
Q

1˚ Tb MOA:

A

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
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67
Q

Tb LAD in kids

A

-bulky

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68
Q

what determines MOA of TB 1˚ progressive spread?

A

if node ruptured into aw (endobronchial spread) or bv (hematog spread)

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69
Q

RFs for 1˚ progressive spread in Tb

A
  • HIV (MC)
  • other imm suppr: tx, steroids
  • jejunoileal bypass, subtotal gastrectomy, silicosis
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70
Q

Latent Tb

A
  • (+) PPD, (-) CXR, ø syx’s
  • vaccination
  • PPD conversion = 9 mo INH
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71
Q

Tb post primary/reactivation

A
  • progression MC
  • UL/sup LL cavitation + nodular opac (endobronchial spread)
  • Hematog spread –> miliary pattern
  • Rasmussen aneurysm-pulm a’s near cavity
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72
Q

AIDS + Tb

A
  • CD4 >200-reactivation (cavitation)
  • CD4 <200- 1˚ progressive (adenopathy, consolidation, biliary)
  • NOT lobar
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73
Q

non-TB mycobacterium to know-orgm names

A
  • M avium-intracellulare complex
  • M Kansasii
  • M absessus
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74
Q

cavity/classic type non-tb myco

A

old white male smoker. looks like reactivation Tb

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75
Q

non-classic/bronchiectatis type non-tb myco

A

RML & lingular TIB + cylindrical bronchiectasis

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76
Q

HIV type non-tb myco

A

CD4 <100
GI –> blood –> mediastinal LAD (MC)
+other pulm findings bc often mixed with other inf
+SMG, HMG

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77
Q

Hypersensitivty type non-tb myco

A

CL gg opacities

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78
Q

3 types of aspergillus

A

1) normal immune-aspergilloma
2) suppressed immune- invasive, “air crescent sign”, halo sgx
3) hyperimmune-bronchiectasis + finger in glove

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79
Q

aspergilloma

A

aspergillum ball in EXISTING cavity

*moves w/ positional change

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80
Q

invasive aspergilloma-who, classic sgx’s

A
  • AIDS, tx
  • peripheral wedge shaped infarcts +
  • air crescent sign-healing 2-3 wk s/p rx
  • halo sign
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81
Q

Allergic broncho pulmonary aspergillosis-ing features and dx criteria

A

UL, central bronchiectasis saccular bronchiectasis + finger in glove
-diagnosis requires:
1) serum IgE (+) OR (+) Asp hypersensitivity skin test
+
2) total IgE >1000,

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82
Q

mucormycosis

A
  • invasive fungus
  • impaired immunity (DM, steroids, aids)
  • face + lungs + medisatinal, pleural, cw invasion
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83
Q

CMV PNA who

A
  • reactivation s/p bmarr tx

- infusion of CMV positive marrow/other blood products

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84
Q

cmv PNA img

A

mult nodules, gg or consolidation

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85
Q

measles pna

A

Mult gg opacities + smaller nodules

  • bf or after skin
  • compl + in pregnant or immunocompromised
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86
Q

influenza PNA

A

coalescent LL opacities, Pl Eff rare

-ie: think covid 19 vibe

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87
Q

varicella-appearance

A

mult peripheral nodular opacities

-Ca when healed

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88
Q

varicella peds vs adults

A
  • peds: chickenpox

- adults (immcompr)=pna

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89
Q

EBV ass

A

-ass w/ PTLD (pst transplant lymphoproliferative disorders) and ARL

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90
Q

EBV pna

A

LAD + SMG. lungs uncommonly affected.

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91
Q

MC radiographic abN of EBV

A

SMG

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92
Q

COVID-19 acute vs chronic

A
  • Acute (<14 d): BL per GGO, bronchovascular thickening. Crazy paving & reverse halo
  • chronic (>14d): fibrous stripes
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93
Q

CAVITY

A 
Cancer (SCC)
AutoImmune (granulomatosis w/ polyangiits, RA, Caplan)
Vascular (SE, bland emb)
Inf (Tb, SA, aspiration)
Trauma-pneumatoceles
Young (CCAM, sequestration)
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94
Q

Lung cancer RFs

A
  • 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
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95
Q

who gets screened for lung cancer?

A

-55-80 yo + 30 pack yr hx (currently or quit in last 15 yrs

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96
Q

CT dose recommendation for lung cancer screening

A

CTDI vol < 3mGy

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97
Q

what’s considered “growth” for lung nodule?

A

1.5 mm in 1 yr

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98
Q

What scoring system is used in lung cancer screening?

A

LUNG RADS

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99
Q

how do you score findings in lung cancer screening?

A

One nodule (most suspicious)

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100
Q

Can you be enrolled in lung cancer screening with a history of lung cancer?

A

Treated, remote (>5 yrs) and must fall into normal inclusion criteria (55-80 yo + 30 pack yr)

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101
Q

Fleischer Society Overview

A
  • 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)
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102
Q

how to measure nodule for FS?

A

avg diam (short + long/2)

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103
Q

Fleichner Society RFs to consider

A

smoking, cancer hx, family hx, age, exposures

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104
Q

what to do with perifissural nodules re: FS

A

nothing

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105
Q

how are nodules stratified re: FS

A

number & risk

-risk= nodule char + pt RFs

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106
Q

likely of malignancy re: nodule density

A
  • mixed > gg > solid

- solitary > mult

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107
Q

SPN benign morph Ca

A

1) solid/diffuse
2) laminated
3) central
4) popcorn

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108
Q

SPN malignant morph Ca

A
  • eccentric
  • popcorn + GI
  • solid + osteosarcoma
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109
Q

What makes you think benign SPN?

A
  • fat
  • rapid doubling (<1 mo)
  • slow doubling (>16 mo, 2 yrs=B9)
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110
Q

what makes you think cancer in setting of SPN?

A
  • spiculated (“corona radiata sgx”)
  • air bronchogram (5x MC in malignant SPN, 50% adenoCa)
  • mixed density
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111
Q

when do you use PET for SPN? What SUV is considered HOT? when do you think cancer vs B9?

A
  • > 1 cm
  • SUV > 2.5
  • solid: hot=CA, cold-not
  • gg: hot=inf, cold=CA
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112
Q

Lung CA MC loc?

A
  • UL (70%)-exc LL fibr

- R (1.5x)

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113
Q

SPN in setting hot h/n CA?

A

-1˚ > met (sim RFs)

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114
Q

nodule decreasing in size: mal or b9?

A

either! (mal if increasing density)

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115
Q

Paraneoplastic syndromes of lung cancer

A
  • nonSC: parathyroid

- SC: SIADH, ACTH, Lambert eaton (often bf dx)

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116
Q

Lambert eaton

A

proximal weakness from abN release acetylcholine at NMJ

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117
Q

TTF-1 (thyroid transcription factor 1) and lung CA

A

-not expressed in non-small cell squamous

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118
Q

MC lung CA subtype to present as SPN

A

Adeno

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119
Q

MC and least common lung CA subtypes

A
  • MC= AdenoCa (35%)

- LC= non-SC large (15%)

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120
Q

Lung AdenoCA loc and known ass

A
  • Upper lobe, per

- pulm fibrosis

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121
Q

LA is on the Coast

A

Large & Adeno favor peripheral locs

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122
Q

lung CA loc based on syx

A

central=hemoptysis

-per=pleuritic cp

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123
Q

MC 1˚ lung CA to cause SVC obstr & PNS?

A

small cell

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124
Q

Small cell lung CA img

A

central LAD

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125
Q

spectrum of adenocarcinoma

A
  • pre-invasive
    • AAH: atypical adenomatous HP of lung
    • ACIS (Adeno In Situ)
  • minimally invasive adenoCA (MIA)
  • Invasive mucinous adenoCA
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126
Q

Atypical adenomatous HP of lung (AAH) vs Adeno In Situ (ACIS) vs minimally invasive (MIA)

A
  • AAH: <5mm, mild, gg
  • ACIS: <3cm, mixed
  • MIA: <3 + stromal invasion (<5mm) (>5mm=lepidic)
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127
Q

superior sulcus/pancoast tumor-cause, pres, img modality used to stage, ci to sx

A
  • 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
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128
Q

measuring a nodule for lung CA staging

A
  • solid=max diam

- mixed- solid part

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129
Q

staging multiple lesions in lung CA

A
  • synchronus-others=mets, changes stage

- metachronous- stage individually

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130
Q

important nodal stage for lobectomy/resection

A

Stage 3B=N3 or T4, surgically unresectable

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131
Q

level 1 vs 2 nodes in lung CA

A
  • border: lower level of clavicles/upper border of manubrium
  • level 1= above, N3
  • level 2= below, N2
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132
Q

who gets wedge resection in lung Ca

A

stage 1A/B, per & <2cm

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133
Q

wedge resection vs lobectomy

A

wedge = better pulm reserve

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134
Q

bronchopleural fistula s/p pneumonectomy

A

-post op space progressively filling w/ air rather than fluid

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135
Q

compensatory emphysema (post pneumonectomy syndrome)

A

-hyperexpansion of lung to compensate fo absence of other

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136
Q

pulmonary radiation changes

A
  • immediate-bubbles
  • early (1-3mo)-homogenous patchy ggo.
  • late-dense consol, traction bronchiectasis, volume loss
  • linear
  • rib fx
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137
Q

lung CA recurrence

A

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
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138
Q

mc benign lung mass

A

hamartoma

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139
Q

pulmonary hamartoma classic app

A
  • fat (60%) & popcorn Ca
  • hot on PET
  • uncommonly endobronchial
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140
Q

MC lung tumor in AIDs

A
  • Kaposi sarcoma (requires CD4 <200)- MC

- lymphoma-2nd MC

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141
Q

MC liver neoplasm in AIDS

A

Kaposi sarcoma

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142
Q

kaposi sarcoma pulmonary img, consistency of pl eff

A
  • slow growing flame shaped opacities in asyx pts
  • bloody Pl Eff (50%)
  • thall+, gall (-)
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143
Q

MC pulm mets via dir invasion

A
  • es
  • lymphoma
  • malignant GC

GEL

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144
Q

order of commonness: pulm met, pleural met, mesothelioma pulm met

A

-in that order

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145
Q

mc img hematogenous mets to lungs

A

-mult round, smooth-bordered, randomly distr LL nodules

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146
Q

cannonball mets-which cancers?

A

RCC, chorioCA (testicle)

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147
Q

lymphangitic carcinomatosis causes

A
  • bronchogenic CA=MC

- breast, stomach, pancreas, prostate (paint brush paint brush serosa)

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148
Q

lymphangitic carcinomatosis vs fibrosis

A

LC does not distort lobule

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149
Q

pulmonary lymphoma 4 flavors

A
  • 1˚
  • 2˚,
  • AIDS
  • PTLD
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150
Q

1˚ pulmonary lymphoma-time frame to qualify, type

A
  • > 3 mo’s w/o extrathoracic involvement

- rare, NHL (MALToma)

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151
Q

2˚ pulmonary lymphoma-HL vs NHL lung parenchyma involvement and percent cases Intrathoracic at time of presentation

A
  • pulm inv of systemic lymphoma
  • NHL>HL
  • HL = LN + parenchyma (40%), 85% Intrathoracic at pres
  • NHL-parenchyma (25%), 45% Intrathoracic at pres
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152
Q

pulm PTLD-what, when, img

A

-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

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153
Q

AIDS related pulmonary lymphoma (ARPL)-ass, CD4 county, img, other findings

A
  • high grade NHL, EBV ass
  • CD4<100
  • MC img: mult per nods (1-5cm), PlEff, LAD
  • extranodal common: CNS, bmarr, lung, liver, bowel
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154
Q

thallium vs gallium in kaposi vs lymphoma vs toxo

A
  • Kaposi: Thall+, Gall (-)
  • lymphoma: Thall + , Gall +, PET+
  • toxo: thall -, gall +
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155
Q

Poland syndrome

A

UL abscent pectoral major & minor +/- weird limbs

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156
Q

bronchial atresia

A
  • 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
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157
Q

ddx mucous plug in bronchial atresia

A

endobronchial tumor.

  • mucoid impaction= <25 HU
  • bronch for indeterminate lesions
158
Q

avm- moa, where, img, rx

A
  • sporadic (MC), hereditary (HHT/Osler Weber Rendu)
  • LL (bf)
  • compl: R–> L shunt, stroke,
  • rx- afferent vessel >3mm+
159
Q

MC congenital venous anomaly of chest

A

persistent left SVC –> coronary sinus

-problem if –> LA (R–>L shunt)

160
Q

Swyer James

A

post vial obliterative bronchiolitis (via contributive bronchiolitis –> small lung –> compensatory BL UL lucent lung

161
Q

Horse-shoe lung-where, ass

A
  • fusion of LL pst basilar segms behind heart

- scimitar syndrome

162
Q

Spares costophrenic angles

A

LCH
HSP
Asbestos pleural plaque

163
Q

Birt Hogg Dupe

A
  • LL pulm cysts (favor paramediastinal region) (closer to kidneys)
  • BL oncocytomas
  • chromophobic RCCs
164
Q

lymphangiomyomatosis (LAM) ass

A

Tuberous sclerosis

165
Q

tuberous sclerosis triad

A
  • seizure
  • MR
  • adenoma sebaceum
  • Seizure, Sebaceum, Stupid
166
Q

Lymphocytic interstitial PNA ass

A
  • adult: Sjogren (MC), SLE, RA)

- kids: HIV

167
Q

vanishing lung syndrome

A

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
Q

vanishing lung RFs

A
  • smoking, marijuana
  • alpha-1 antitrypsin deficiency
  • male
169
Q

saber sheath trachea

A

coronal narrowing of trachea <2/3 sag diam, sparing extrathoracic portion
***COPD

170
Q

central dot sign

A

vessel w/i secondary pulm lobule in centrilobular emphysema

171
Q

what to think if you see cavitation in setting of silicosis?

A

Tb

172
Q

who gets progressive massive fibrosis (PMF)

A

silicosis, coal workers pneumoconiosis

173
Q

ship yard

A

asbestosis

174
Q

miners, quarry workers

A

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
Q

washed coal

A

coal workers pneumoconiosis

176
Q

aircraft/space industries

A

berylliosis

177
Q

Nitrogen dioxide

A

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
Q

filler tablets

A

talcosis

179
Q

cancer vs PMF

A

cancer=T2 bright

PMF=T2 dark

180
Q

2 types of NSIP

A

cellular, fibrotic

181
Q

lung fibrosis & cancer

A
  • progressive wall thickening or developing nodule w/I cyst
  • favors interface btw fibrotic cyst and N lung
  • NELSON trial-we miss them
182
Q

“heterogenous histology”

A

UIP

183
Q

Sarcoid CXR staging

A 
0-N
1-nodes
2-nodes + lung
3-lungs
4-end-stage (fibrosis)
184
Q

Lofgren Syndrome

LAD
nOdosum
Feet

A

“Acute sarcoid”

1) BL hilar LN enlargement
2) arthritis (ankles) (male)
3) erythema nodosum (female)

185
Q

stages of CHF

A

1) “redistribution”-wedge P 13-18 mmHg
2) interstitial-18-25
3) alveolar-25+

186
Q

sarcoid labs

A

ACE+

Ca+

187
Q

pulmonary alveolar proteinosis (PAP)-ass, risk of infection, fibrosis risk, rx

A
  • ass: smoking (in peds: alymphoplasia)
  • inf: nocardia 2/ brain abscesses
  • 30% risk fibrosis
  • rx-bronchoalveolar lavage
188
Q

types of lipoid PNA

A
  • exogenous

- endogenous-MC. Post obstructive process (CA)–> lipid laden MP

189
Q

acute exogenous lipoid PNA

A
  • childen who accidentally poison themselves w/ hydrocarbons
  • fire eating/flame blowing
190
Q

orgz/cryptogenic PNA-MOA, causes, rx

A
  • 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
Q

Upper lobe disease distribution

A
  • CF
  • APBP
  • Chronic Eusinophilic PNA
  • hypersensitivity PNA
  • pneumoniosis
  • pulmonary lagerhans cell histiocytosis
  • RB-ILD
  • Sarcoid
  • 1˚ Tb
  • PCP
  • ankylosing spondylitis
192
Q

halo sign

A

solid surr by gg (hemorrhage/invasion into surr ties)

  • invasive aspergillosis (classic)
  • other fungus
  • hem mets
  • adeno in Situ
  • wegeners
193
Q

reverse halo

A

central gg w/ rim of consolidation

  • COP (classic)
  • tb
  • pulm infarct
  • covid
  • invasive fungal & wegeners (also halo)
194
Q

“headcheese”

A

hypersensitivity pneumonitis (mix of everything)

195
Q

AW/bronchial disease that spare pst membrane

A

relapsing polychondritis

-tracheobronchopathia osteochondroplastica (TBO)

196
Q

AW/bronchial disease that don’t spare pst membrane

A
  • amyloid
  • post-intubation
  • wegeners
197
Q

tracheal thickening relapsing polychondritis

A
  • smooth, diffuse antlat thickening. + Ca if chronic

- recurr episodes cartilage inflamm, recurr PNA

198
Q

post intubation tracheal thickening

A

subglottic circumferential stenosis, hrglass configuration

199
Q

tracheobronchopathia osteochrondroplastia (TBO)

A

anterolateral cartilaginous/osseous nodules in submucosa of tracheal & bronchial walls

200
Q

amyloid tracheal thickening

A

circumferential irregular, focal/short segment thickening

-+Ca

201
Q

Wegener’s tracheal thickening

A
  • subglottic circumferential, focal or long segment

- no Ca

202
Q

tracheal/bronchial tumors

A
  • SCC-MC
  • adenoid cystic -2nd MC
  • carcinoid
  • mets
  • squamous call papilloma
203
Q

primary ciliary dyskinesia ass

A

Kartagener’s syndrome )50%)

204
Q

William campbell syndrome

A

congenital cartilagenous deficiency of 4th-6th order bronchi –> cystic bronchiectasis

205
Q

mounier-kuhn (tracheobronchomegaly)

A

tracheal dil >3cm

206
Q

follicular bronchiolitis

A
  • inflamm process rel to lymphoid HP
  • RA, Sjogrens
  • CL gg nodules, scattered bronchial dilation
207
Q

constrictive bronchiolitis

A

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
Q

small aw disease

A
  • 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
Q

mc complication aspiration pna

A

empyema

210
Q

mendelson’s syndrome

A

aspiration gastric acid–> as opacity, massive pulm edema

211
Q

aspiration of water or neutralized gastric contents

A

“fleeting opacity”, resolves in hours

212
Q

aspiration of germs (often mouth bugs)

A

PNA

213
Q

aspiration of oil (often mineral oil)

A

lipoid PNA

214
Q

aspiration patterns/syndromes

A
  • gastric acid-opacity, pulm edema
  • water/neutralized gastric content-opacity resolves hrs
  • bugs (From mouth)-pna, cavitation, abscess, empyema
  • oil-lipoid pna
215
Q

ankylosing spondylitis

A

Upper lobe fibrobullous disease (UL –> BL)

216
Q

shrinking lung

A

progressive volume loss in pts w/ SLE (SL=SL)

217
Q

what makes breathing worse inhepatopulmonary syndrome vs CHF

A

HPS: worse sitting up
CHF: worse laying down

218
Q

mc orgn involved with granulomatosis w/ polyangiitis

A

lung (95%)

-randomly distr nodules +/- cavitation, gg (hem), pl eff (15%)

219
Q

goodpasture syndrome

A
  • BL coalescent AS opacities (hemorrhage), resolve ~ 2wks
  • recurr–> fibrosis
  • pulm hemosiderosis-small ill defined nodules
220
Q

Caplan syndrome

A

RA + silicosis/CWP

-UL predominance lung nodules +/- cav, pl eff

221
Q

how much pleural fluid to diagnose a pleural effusion on AP film?

A

175 cc

222
Q

how much pleural fluid to diagnose a pleural effusion on lateral film?

A

50cc

223
Q

time lag s/p asbestos exposure: pl effusion, plaques, mesothelioma

A
  • pl eff: 5 yrs
  • plaques 20-30 yrs (Ca 40yrs)
  • lung Ca-~20 yrs
  • mesothelioma-30-40 yrs
224
Q

pleural rind along medial surface

A

mesothelioma

225
Q

Pleural Ca

A
  • asbestosis
  • old hemothorax
  • old inf
  • Tb
  • extraskel osteosarcoma

*fibrothorax

226
Q

solitary fibrous tumor of pleura (SFTP)-what, ass

A

solitary tumor arising from visceral pleura

-Doege-potter syndrome (hypoglycemia via insulin-like GF) 5%

227
Q

pleural mets-MC CA

A
  • lung (adenoCA)

- breast, lymphoma

228
Q

pleural mets- MC manifestation

A

pleural effusion

229
Q

most common benign pleural ST tumor

A

lipoma

230
Q

subpulmonic effusion

A

pleural effusion accumulates btw lung base and diaphgram

  • R > L
  • ski sloping of diaph peak
231
Q

encysted pleural effusion

A

round shape via collection btw pleural layers

232
Q

empyema vs pulm abscess

A
  • empyema=lentiform, split pleura sign, ct

- abscess= round, claw sign, abx

233
Q

split pleural sign

A
  • thickening/separation of visceral & parietal pleura

- empyema

234
Q

why don’t you treat pulm abscess w/ chest tube?

A

risk of bronchopleural fistula

235
Q

who gets empyemas

A

mc in AIDS

236
Q

emphysematous necessitans-causes

A
  • Tb (70%)

- actinomyces

237
Q

diaphragmatic paralysis causes

A

idiopathic 70%

-lung cancer (phrenic n compression)

238
Q

thymus pathology

A
  • rebound
  • cyts
  • thymoma
  • thymic carcinoma
  • thymolipoma
239
Q

thymus rebound vs lymphoma

A
  • Lymphoma hotter on pet

- thymic rebound drops out on MRI in phase img

240
Q

thymus cyst etiology

A
  • cong

- acquired (thoracotomy, crx, HIV)

241
Q

thymus cyst img

A
  • UL or ML

- T2 bright

242
Q

thymoma spectrum. Differentiation.

A
  • non-invasive thymoma –> invasive (30%) –> CA (distal met)
  • Ca, invasion mediastinal fat/adj structures=aggressive
  • invasive drop met–> pleura, pericardium, RP (img abd!)
243
Q

thymoma ass

A
  • MG
  • pure red cell aplasia
  • hypogammaglobinemia
244
Q

thymolipoma

A

fatty mass in thymic ST

245
Q

MC thoracic GCT, ass

A
  • teratoma (75%)
  • klinefelter syndrome
  • cystic (90%), fat, teeth
  • small risk malignancy
246
Q

ant mediastinal masses

A
  • lymphoma
  • thymic lesions (Rebound, cyst, thymoma spectrum, thymolipoma)
  • GCT
  • pericardial cyst
  • thyroid lesions
247
Q

fibrosing/sclerotic mediastinitis-types

A
  • granulomatous (MC)-histo, tb, sarcoid

- non granulomatous/idiopathic-AI (SLE, RA, behcet, etc), radiation, methysergide (headache mx). NG ass w/ RP fibrosis

248
Q

granulomatous vs non-gran fibrosing/sclerotic mediastinitis

A
  • granulomatous-ST mass + Ca

- non-gran-infiltrative, lack Ca, enh+

249
Q

compl of fibrosing/sclerotic mediastinitis

A

SVC syndrome

250
Q

mc loc bronchogenic cyst

A

subcarinal (obliterate azygoesophageal line) –> pulm

251
Q

mediastinal lipomatosis-what, ass

A

excess unencapsulated fat w/ steroids, Cushing, obesity

252
Q

middle mediastinal masses

A
  • lymphoma, LAD
  • fibrosing mediastinitis
  • bronchogenic cyst
  • mediastinal lipomatosis
253
Q

pst mediastinal masses

A
  • 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
Q

who gets extramedullary hematopoiesis

A
  • response to bmarrow failing to respond to EPO

- CML, PCV, myelofibrosis, SCD, thalassemia

255
Q

pulmonary artery aneurysm/pseudoaneurysm

A

1) iatrogenic 2/2 SG cath=MC
2) behcets, giant cell vasc
3) chronic PE

256
Q

syndromes ass w/ pulmonary aneursym/pseudoaneurysm

A
  • hughes-stovin syndrome
  • rasmussen aneurysm
  • tetrology of fallot repair
257
Q

hughes stovin syndrome

A
  • recurrent thrombophlebitis

- pulm artery aneurysm and rupture

258
Q

Pulm hypertension

A

> 25 mmHg

259
Q

img pulp htn

A
  • 29+ mmHg
  • PA > aorta, segmental a’s > bronchus
  • eisenmenger phenomenon-mural Ca of central pulm a’s
260
Q

banana and egg

A

visualization of main pulm artery (egg) at level of aortic arch (banana) in setting of PHtn

261
Q

carina crossover

A

right PA crosses carina midline anteriorly rather than more caudal location in setting of PHtn

262
Q

westermark sgx

A

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
Q

fleischner sgx

A

enlarged pulmonary artery

264
Q

hampton’s hump

A

peripheral wedge shaped opacity

265
Q

mc radiographic abN in PE

A

pleural effectivement (30%)

266
Q

PAH + normal wedge

A

pulmonary veno-occlusive dx

267
Q

diaphragmatic injury

A
  • L > R (liver=buffer), pstlat
  • radial orientation, >10 cm
  • “collar/hour glass” and “dependent viscera” sgx’s
268
Q

collar/hour glass sign

A

waist-like appearance of herniated orgn thru injured diaphysis

269
Q

dependent viscera sgx

A

abscent interposition of lungs btw cw and upper abd organs (liver on right, stomach on left)

270
Q

pulmonary trauma

A
  • 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
Q

trachea-bronchial injury-where

A
  • w/i 2 cm of carina
  • close to carina –> PMX (vs PTX)
  • pstlat trachea
272
Q

Macklin effect

A
  • blunt trauma –> alveolar rupture –> air dissection along bronchovascular sheaths–> PMX
  • MCC PMX in trauma
273
Q

flail chest

A
  • 3+ segmental rib fx (more than 1 fx in a rib) OR 5+ adj rib fractures
  • paradoxical motion w/ breathing
274
Q

“inversion/flattening of diaphragm”

A

tension PTX

275
Q

hemothorax density

A

35-70 HU

276
Q

when does malpositioned chest tube occ?

A

background lung disease or pleural adhesions

277
Q

“blood around chest tube”

A

malpositioned

278
Q

complication malpositioned chest tube

A

bronchopleural fistula

279
Q

“persistent fluid collection after pleural drain/tube placement”

A

extra pleural hematoma

280
Q

BW: “displaced extra pleural fat”

A

extra pleural hematoma

281
Q

MC lung injury from blunt trauma

A

pulmonary contusion (alv hemorrhage w/o alveolar disruption)

282
Q

img pulmonary contusion

A
  • opacities, sub pleural sparing

- 6–>72hrs (if longer: aspiration, PNA, laceration)

283
Q

ductus bump

A

normal variant aortic bulge mimicking aortic injury

284
Q

MC areas of aortic injury

A
  • isthmus
  • root
  • diaph hernia
285
Q

fat embolism timing, app, where

A
  • 1-2 d s/p long bone fx
  • pulm edema, no arterial defect!
  • resolves 1-3 wks
  • skin (rash), lungs, brain
286
Q

who’s most at risk and who’s protected from barotrauma?

A
  • COPD

- fibrotic lungs (don’t stretch)

287
Q

Fleishsner Society breakdown of rules

A
  • <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
Q

Mesothelioma causes

A

80% asbestos. NOT dose dependent.

289
Q

“pleural ring along medial surface”

A

mesothelioma

290
Q

gold standard PE diagnosis

A

catheter angiography

291
Q

utility of D-dimer in PE diagnosis

A

100% negative predictive value

292
Q

Diagnosis chronic PE

A

VQ scan

293
Q

pulmonary neuroendocrine tumors

A
  • 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
Q

img pulmonary NE tumors

A
  • 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
Q

syx carcinoid

A
  • hemoptysis (highly vascular)

- obstructive

296
Q

carcinoid nuclear medicine

A
  • ocreotide

- PET cold 25%

297
Q

endobronchial vs GI carcinoid

A
  • endobronchial: Left heart. Uveal tract met

- GI: right heart, extra ocular

298
Q

2nd mc tracheal malignancy

A

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
Q

MC tracheal malignancy

A

SCC

-lower trachea/prox bronch

300
Q

endobronchial mets

A

lung, thyroid, esophagus

301
Q

mc benign tumor of trachea

A

squamous cell papilloma

  • single=smoking
  • mult=HPV-6. (laryngeal MC, trach 5%)
302
Q

Endobronchial tumors

A
  • 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
Q

CF vs 1˚ ciliary dyskinesia

A 
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
Q

Intrathoracic findings lupus

A
  • pl eff, pericardial eff MC

- fibrosis UC. “shrinking lung”

305
Q

collagen vascular induced UIP

A

-sarcoid, RA, scleroderma

306
Q

pulm findings RA

A

UIP or COP

-lower lobe

307
Q

Scleroderma pulmonary

A

NSIP> UIP
LL
-dilated fluid filled es

308
Q

Sjogren pulmonary

A

LIP

309
Q

ankylosing spnondylitis

A

fibrobullous disease UL–>BL

-UL

310
Q

lower lobe diseases

A
  • RA, scleroderma
  • asb-(particles too large to be cleared by lymph)
  • 1˚ciliary dyskinesia
  • 1˚ tb
311
Q

Fleischner sign

A

widening pulmonary arteries due to clot

312
Q

right heart strain numeric suggestions

A

RV:LV >1, >1.5 severe

313
Q

Single pulmonary eusinophlia/Loffler syndrom

A

idiopathic transiet, migratory consolidations (otherwise appears ID to drug rxn, parasites)
-eusinophila

314
Q

eusinophilic lung dx

A
  • single pulmonary eusinophlia

- chronic eusinophilic PNA

315
Q

pulmonary vasculitis

A
  • churg-strauss
  • microscopic polyangiitis
  • wegener granulomatosis
316
Q

churg-strauss/allergic angiitis & granulomatosis img

A
  • transient/migratory peripheral consolidation/gg, interlob wall thickening
  • asthma, peripheral eosinophilia, P-ANCA
    • other orgn (renal fx, arthraligia, myocarditis, pericarditis)
317
Q

p-ACNA

A
  • churg strauss
  • microscopic polyangiitis
  • collagen vascular dx
318
Q

churg-strauss triad

A

1) eusinmophilia
2) necrotizing vasculitis
3) asthma

319
Q

MCC pulmonary hemorrhage w/ renal fx

A

microscopic polyangiitis

-renal (90%)> pulm (10%)

320
Q

microscopic polyangiitis img

A

central gg (hemorrhage)

321
Q

lung hemorrhage and renal dx

A
  • microscopic polyangiitis
  • goodpasture syndrome
  • wegeners/granulomatous polyangiitis
322
Q

orgz PNA pattern drug tox

A

-bleomycin, cyclophosphamide, MTX, amdiodarone, nitrofurantoin, penicllamine

323
Q

lung radiation injury timing

A
  • 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
Q

stage HSP

A

acute
subacute
chronic

325
Q

acute HSP-img

A

inflamm exudate filling alv

-non spec ggo +/- CL nods

326
Q

subacute HSP-img

A

ill define CL gg nodules + mosaic attenuation (air trapping)

-head cheese

327
Q

chronic HSP

A

-UL predominance pulmonary fibrosis + superimposed findings of subacute (gg CL nods + MA)

328
Q

MC radiographic finding sarcoid

A

symmetric adenopathy

329
Q

pneumoconioses acute vs chronic img

A
  • acute-confl ggo +. interlobular thickening, alveolar filling w/ PAS (all proteinosis) (fatal ~ 1yr)
  • chronic-progressive massive fibrosis, hilar/arch distortion
330
Q

sarcoid signs

A
  • 1-2-3 (right paratracheal, bilateral hilar)
  • doughnut-LAD on lat view
  • galaxy sign-perilymphatic nodules coalesce into mass w/ small nods per
331
Q

what other organs may sarcoid involve?

A

-spleen, brain, rarely bone

332
Q

mediastinal stripes

A
  • pst junction line
  • anterior junction line
  • right and left paratracheal stripes
  • right and left paraspinal lines
  • azygoesophageal recess
333
Q

azygoesophageal recess

A

interface formed by contact of posteromedial right lower lobe and retrocardial mediastinum
-es mass, hiatal hernia, LA enlargement, LAD

334
Q

classifications thymoma

A
  • history: low vs high risk

- intact capsule: invasive vs non-invasive

335
Q

thymoma + hemidiaphragm elevation

A

invasive thymoma (phrenic n invasion)

336
Q

ddx eggshell calcification

A
  • silicosis, CWP
  • sarcoid (LC, but probably see more often bc MC as a dx)
  • histoplasmosis
337
Q

very rare causes of focal tracheal stenosis

A

behcet

Crohn

338
Q

bronchiectasis pathway

A

bronchial wall injury (infi/inflamm) –> lumen obstruction –> traction from adj fibrosis

339
Q

bronchiectasis types

A
  • cylindrical-mild dil
  • varicocele-beaded, irregular
  • saccular/cystic-enlarged, ballooned, multiple cysts that may not connect to aw
340
Q

CAPTAIn Kangaroo has Mounier Kuhn

A 
CF (one of MCC)
ABPA
Post infection
Tb/atypical mycobacterium
Agammaglobulinemia
Immunodef
Kartagener
Mounier Kuhn
341
Q

tracheoes fistula

A

SCC

342
Q

mc bronchial tumor in children

A

carcinoid (v rare in adults)

-almost always distal to carina)

343
Q

enhancing endobronchial mass

A
  • carcinoid (homog)
  • mucoepidermoid CA
  • hemangioma
  • glomus tumor
344
Q

mucoepidermoid endobronchial tumor

A
  • rare, from tiny salivary glands lining TB tree.
  • Younger pts.
  • Round/oval, indistinguishable from carcinoid
345
Q

BREaTh Lung

A

mets to endobronchial tree

-breast, renal, es, thyroid, lung

346
Q

benign endobronchial lesions

A
  • papilloma=mc
  • chondroma
  • schwannoma, adenoma, hamartoma, hemangioma, lipoma, leiomyoma
347
Q

pleural based mass that changes position

A

fibrous tumor of pleura

348
Q

fibrous tumor of pleura-what, img, mx, ass

A
  • pleural based mass
  • excised (20-30% mal)
  • PET low
  • hypoglycemia, hypertrophic pulmonary osteoarthropathy
349
Q

what does cisterns chyli drain?

A

BL LE and LUE

350
Q

MC sarcoid stage

A

stage 1. 60% compl resolution

351
Q

significance of right hilum higher than left

A

-RUL collapse or fibrosis

352
Q

eparterial bronchus vs hyparterial bronchus

A
  • eparterial- R pulm a cross in front of R mainstream bronchus
  • hyparterial- L pulm a cross over left bronchus
353
Q

secondary pulmonary lobule size and contents

A
  • 1-2.5 cm

- contains: terminal bronchiole, artery, 30-50 1˚ pulmonary lobules, v’s/lymph

354
Q

role of bronchoalveolar lavage in alveolar proteinosis

A

-dx and rx

355
Q

gossypiboma

A

retained FB

356
Q

utility of decubitus views in setting of pleural effusion

A

obtained when in doubt of presence or absence of effusion and whether it is free layering

357
Q

pleural mets vs mesothelioma

A
  • mets=early enhancing

- mesothelioma-enhance less intensely and better seen delayed (45s)

358
Q

BL vs UL pleural plaques

A
  • BL-asbestosis

- UL-trauma, hemothorax, empyema

359
Q

suggestion of life-threatening injury on cxr

A
  • med widening
  • PMX
  • diaphgragmatic contour abN
360
Q

dose length product

A
  • 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
Q

gossypiboma

A

retained FB

362
Q

utility of decubitus views in setting of pleural effusion

A

obtained when in doubt of presence or absence of effusion and whether it is free layering

363
Q

pleural mets vs mesothelioma

A
  • mets=early enhancing

- mesothelioma-enhance less intensely and better seen delayed (45s)

364
Q

BL vs UL pleural plaques

A
  • BL-asbestosis

- UL-trauma, hemothorax, empyema

365
Q

suggestion of life-threatening injury on cxr

A
  • med widening
  • PMX
  • diaphgragmatic contour abN
366
Q

dose length product

A
  • 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
Q

smoking related lung disease

A
  • LCH
  • RB-ILD
  • DIP
368
Q

mediastinal widening-next step.

A
  • Acute-CTA

- chronic-PA and/or compare to prior images

369
Q

course of Right main PA

A
  • behind asc aorta
  • anteroinferior to right main stem bronchus
  • subdiv into truncus ant and descending artery
370
Q

right pulmonary descending artery supply

A

-RML, RLL, RUL pst segm (90%)

371
Q

RV:LV ratio for 50% chance death in setting of cPE

A

2.3

372
Q

“mediastinal invasion”

A

tumor contact w/ mediastinum of >3cm and ext of tumor into fat
-T4

373
Q

necrobiotic nodules

A

lower lung caveating or non caveating nodules in pts w/ RA or silicopneumconiosis

374
Q

primary lung lymphoma appearance

A

consolidations w/ air bronchograms

375
Q

sources of cavitating lung mets

A
  • bladder

- SCC h/n, uterine cervice

376
Q

appearance: ritalin lung, amiodarone, ibuprofen/nsaids, mercury fumes

A
  • ritralin lung (IV injection oral ritalin)-basal bull ae
  • amio-lower lung fibrosis
  • ibuprofen/nsaids-eosinophilic PNA
  • mercury fumes-ARDS
377
Q

MC loc boerhaave related esophageal rupture

A

Left posterolateral distal esophagus

378
Q

mediastinal compartment: well demarcated outline in the thorax that becomes indistinct in the neck

A

anterior

379
Q

injuries to which arteries are life threatening?

A

internal mammary artery

intercostal a

380
Q

typical location pulmonary infarcts

A

peripheral, sub pleural

381
Q

which sequestration sometimes presents with CHF syx’s, why?

A

intralobar with drainage to pulmonary vein via L to L shunt

382
Q

what worsens transient interruption of contrast?

A

hyperventilation

deep inspiration just before scan

383
Q

when to treat pulmonary AVM

A

when to treat pulmonary AVM

384
Q

ARDS related fibrosis

A
  • anterior

- extensive post inflammatory bronchiectasis

385
Q

risk of lung cancer in fibrosis

A

4x increased

386
Q

course of azygos v

A

over right mainstem bronchus

lies in tracheobronchial angle

387
Q

left mediastinal border above aortic arch

A

left subclavian artery

388
Q

safest route to biopsy apical mass

A

posterior (vessels and nerves in supraclavicular region run ant to apical bps)

389
Q

order of basal branch take off

A

superior, medial, ant, lateral, pst

390
Q

orientation of pulmonary v’s

A

horz

391
Q

how often does left SVC dump into LA?

A

10%. Not serious enough to cause cyanosis

392
Q

Left SVC ass

A

cong heart dx (ASD highest)

radiology (31 decks)

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