CHEST Flashcards
Pneumothorax causes
Primary spontaneous
- marfans, Ehlers danlos
- alpha 1 antitrypsin
- homocystinuria
Secondary spontanoues
- cystic lung disease
- parenchymal necrosis (infection, neoplasm, radiation)
- catamenial (recurrent during menstruation, associated with endometriosis of pleura)
Iatrogenic/trauma
Catamenial pneumothorax
recurrent pneumoo during menstruation, related to endometriosis of the pleura
Buffalo pneumothorax
bilateral due to abnormal communication of the pleural spaces
Tension pnuemothorax features
Increased intercostal spaces
Contralateral mediastinal shift
Depression of the hemidiaphragm
Pneumomediastinum causes
Trauma
Surgical
Oesophageal perf
Tracheobronchial perf
Vigorous excercise
Asthma
Barotruama
Infection
Interstitial lung disease
CTD
Pneumomediastinum imaging
SC emphysema
Pneumopericardium
Ring around artery sign
Tubular artery sign
Double bronchial wall sign
Continuous diaphragm
Extra pleural
Naclerio v sign
Thymic wing sign
Haystakc sign - gas crossing superior mediastinum
Pneumopericardium cuases
PPV
surgery
penetrating trauma
Infectious pericarditis
fistula
Haemothorax causes
Malignancy
- usually wall, but also soft tissue sarc, hcc, lung
Spontaneous
Anticoags
Vascular rupture
Endometriosis (catamenial)
Pleural adhesions
Haemophilia
CTD
Bony exostoses
Haemopericardium causes
ruptured MI
Ruptured LV aneurysm
Dissection
Pericarditis
Trauma
Malignancy
Ruptured CA aneurysm
post thrombolysis
Oesophageal perforation causes and complications
Post instrumentation
Radiation oesophagitis
Trauma
FB ingestation
Malignancy
Post vomiting (Boerhaave)
Acute necrosis
Complications
- mediastinitis
- pleural distula
- pneumonia
- empyema
- sepsis
Boerhaave syndrome path
Macklers triad - vomting, chest pain, SC emphysema
Forceful ejection of gastric contents in an unrelaxed oesophagus against a closed upper sphincter/cricophyaryngeus
vertically orietated, usually left posterolateral, usually 3-6cm above oesophageal hiatus
Bronchiolitis imaging and classification
Centrilobular micronodules
Bronchial wall thickening
Bronchiolectasis
Mosaic attenuation
Inflammatory
- infectious
- HP
- RB/RBILD
- follicular
- panbronchiolitis
Fibortic
- constrictive
Granulomatous bronch
Diffuse panbronch
Infective bronchiolitis is and causes
inflammatory bronchiolitis with definite infective precip
Viruses
- RSV, children
bacterial
mycobacterial
- tb
- atypical
funcal
- asperfillus, immunosupp
Infective bronchiolitis imaging
Centrilobular nodules
tree in bud
wall thickening
can ahve GGO
Hypersensitivity pneumonitis is
also known as extrinsic allerfic alveolitis
group of immune mediated pulmonary disorders characterised by inflamm and/or fibrotic reaction affeecting the lung parenchyma and small airways
dx relied on exposure hx, signs/sx, abrnoaml exam, abrnoaml pft and radiographic eval
can be non fibrotic or fibrotic
Hypersensitivity pneumonitis imaging
XR
- poorly defined opacities
- fine reticulation maybe
- later; fibrosis, more severe in the upper lobes
HRCT
Non fibrotic
Typical
- GGO, mosaic attenuation
- centrilobular nodules
- air traumming
- basal sparing
Fibrotic
Typical
- coarse retics, traction b and honeycombing
- rnadom, mid zone or lower sparing dsitrbutch
- centrilobular nodules, GGO
- mosaic attenuation, three density pattern
Compatible
- UIP
- extensive GGO
- variant distribution; peribronch, subpler, upper
- centribloobar nodules
- three density
Respiratory bronchiolitis is and imaging
a histo finding often seen in heavy tobacco smokers
mild chronic inflamm and pigmented macrophages
can have some fibrosis
imaging
- can be nothing
- minor patchy ggo
- ill defined centrilobular nodules, upper zone
Respiratory bronchiolitis interstitial lung disease is
a smoking related ild, closely related to RB but more severe
pigment laden macrophages. fibrosis extending bryond the tissues. similar to DIP
RB ILD imaging
GGO, slight upper zonal
poorly defined centrilobular nodules
can have lower zones affected
can ave subpleural fibrosis
other changes of smoking
patchy hypoattenuation lower zones
ddx
- NSIP
- HP
Follicular bronchiolitis is, assoc, path and imaging
non neoplastic primary polyclonal b cell hyperplasia of the bronchus assoc lymphoid tissue due to chronic exposure to antigens in those with underlying collagen vascular or immune deficiency diseases
assoc
- collagen vasc, ctd
- immunodeficiencyy states
- idiopathic
Imaging
- ground glass centrilobular nodules of 3mm in lower lobes
- variblay assoc peribronchial nodules
- TIB sometimes
- parenchymal cysts somtimes
Diffuse panbronchiolitis is and imaging
also ref to as diffuse asian panbronchiolitis
idiopathic progfressive inflammatory small airways obstructive lung disease
striking predilection to asians, middle aged, non smokers
imaging
- peripherobasilar predilection
- centrilobular opacities with branching lines TIB
- basal predominent bronchiectasis
- mosaic atenuation with air trapping
Obliterative bronchiolitis is
also known as bronchiolitis obliterans or constrictive bronchiolitis
bronchiolar inflammation with sumucosal peribronchial fibrosis assoc with luminal stenoissi and occlusions
assoc
- ibd
- ra
- medications
- post transplant
- swyer james
Bronchiolitis obliterans causes
CRITTS
COP
RA
Infectious
Transplant
Toxins
Sarcoid/Swyer james
Obliterative bronchilitis imaging
sharply defined areas of decreased attenuation
bronchiectasis
bronchial wall thickeing
ggo’s
Bronchiectasis aetiology
idiopathic
Impaired host defences
- cf
- pcd
- primary immunodeficiency disorder
- HIV/AIDS
Post infective
Allergic/autoimmune
- abpa
- ctd
- ibd
Obstruction
- asthma or copd
- neoplasm
- fb’s
Congenital
- mounier kuhn
- williams campbell
others
- chronic aspiration
- traction bronch
- radiation induced
- post transplant
Central bronchiectasis causes
ABPA
Mounier Kuhn/congnietal tracheobronchomegaly
CF
Williams campbell
Upper lobe bronchiectasis
CF
TB
Traction in
- radiation
- sarcoid
- silicosis/pneumoconioses
ABPA
Chronic hypersens
Right middle lobe bronchiectasis
non tb MAC
middle lobe syndrome in children
Lower lobe bronchiectasis
Post infective
Aspiration
Immunodeficiency
Primary ciliary dyskinesia
CF is and general manifestations
an autosomal recessive genetic disease that affects exocrine function
pulmonary
- bronchiectasis
- ptcx
- infection
- pah
Pancreas
- insuff
- fatty replacement
- pancreatitis
- pancreatic cysts
Liver
- steatosis
- cirrhosis
- portal hypertension
Biliary
- cholelithiasis
- microgallbladder
- sclerosing cholangitis
GIT
- DIOS
- meconium ileus
- rectal prolapse
- gord
Head and neck
- sinusitis
- nasal polyposis
GU
- seminla vesicle agen
- testicular microlithasis
- hypoplasia ductus
- hypoplasia epididymi
CF path
homozygous defect of the CFTR gene on 7q31.2
encodes a transmembrane protein known as CFTR, regulates passages of chloride across cell membranes
Primary ciliary dyskinesia is and clinical
also known as immotile cilia syndrome. congenital defect in the ultrastructure of cilia that renders them incapable of normal movements. autosomal recessive.
clinical
- chronic sinusitis and otitis media
- bronchiectasis
- impaired fertibility; none in males, sub in females
dx
- beat analysis
- electron microscopic ultrastructural analysis of cilia
Primary ciliary dyskinesia path and assoc
complete or partial dyneian arm absnece
radial spoke defect
microtubular transposition
assoc
- kartageners
- young syndrome
- pectus
- hydrocephalus
- congenital heart disease
- bilairy atresia
Kartageners syndrome is
a subset of pcd. characterised by a clinical triad of
- situs inversus
- chronic sinusitis
- bronchiectasis
- also; telecanthus, infertility in men, subfert in women
ABPA is
allergic bronchopulmonary asperfillosis. mild end of the spectrum of dsisease caused by pulmonary aspergillosis. can be classified as an eosinophilic lung disease
typically have asthma, pulmonary opacities, central bronchiectasis, blood eosinophilia, ige
Mounier Kuhn syndrome is
trachobronchomegaly. absence of elastic fibres and smooth muscle within the wall of the trachea and main bronchi
trachea >3cm, 2 cm above arch
Williams campbell syndrome is
a rare form of congenital cystic bronchiectasis in which the distal bronchial cartilage is defectieve
cystic central bronchiectasis, usually symmetricla and bilateral
4th to 6th order bronchi
exp; collapse of affected bronchi
Types of atelectasis and their causes
Resorptive
- obstruction
Passive
- ptx, effusion
Compressive
- space occupying lesion
Cicatrisation
- scarring, reducing expansion
Adhesive
- surfactant def
Gravity dependant
Osteophyte induced
Round
- asbetos
Linear
- splinting/not breathing
Round atelectasis is and imaging
infolding of redundant pleura, giving a false mass like appearance
imaging
- round or oval
- adjacent to pleura
- pleural abnormality
- comet tail sign
- crow feet
- typical parenchymal enhancement
Tracheobronchial stenosis causes
Malignant
Non malignant
- papillomatosis
Infective/inflamm
- endobronchial tb
- GPA
- relapsing polychondritis
- tracheobronchial amyloid
- sarcoid
Other
- post op
- intubation
- TBPOCP
- broncholithiasis
- keutel syndrome
Respiratory papillomatosis is
occurrence of multiple squamous cell papillomas involving the respiratory epithelium, most commonly larynx. can be whole tress.
can be juvenile or adult
assoc with hpv infective
can cavitate
Granulomatosis with polyangitis upper resp tract manifestations
Sinusitis
Nasal septal perf
Subglottic stenosis
lacrimal gland involvemnt
sclerosing osteitis of the nasal cavity
sinonasal mucosal ulcers
Relapsing polychondritis is and imaging
rare multisystem disease characterised by recurrent inflammation of cartilaginous structures in the body.
imaging
- subgflottic stenosis/airway narrowing
- sparing of the postrior wall
- increased wall attenuation/calcifications
ddx
- TBPOCP; nodular
- amyloid; involves posterior wall
Tracheobronchopathia osteochondroplastica is and imaging
rare idiopathic non neoplastic tracheobronchial anomaly
osseous or cartilaginous nodules in airway walls., can be focal or diffuse. spares posterior wall.
imaging
- nodular thickening of wall
- spares posterior
- small discrete endophytic nodules
- can have calcs
Laryngomalacia is
common cause of noisy breathing in infants. results of congenital abnormality of the cartilage in the larynx that results in dynamic partial supraglottic collapse of the larynx during breathing.
assoc with gord.
Tracheobronchomalacia is
a common incidental finding in older patients manifesting as increased tracheal diameter and tendency to collapse on expiration
seen with
- aging
- copd
- prolonged intubation
- infection
- asthma
> 50% collapse on exp. >3cm diameter dilation.
Pulmonary hypoplasia is
deficient or incomplete development of parts of the lungs.
intrathoracic causes
- cdh
- extralobar sequestration
- agenesis diaphragm
- mediastinal masses
- decreased perfusion
extrathoracic causes
- oligohydramnios (potter, PPROM)
- skeletal dysplasias
- large abdominal mass
- neuromulscular conditions
Community acquired pneumonia is and causes
pneumonia contract in gen pop or within 48 hours or admission
aetiology
- strep (effusions, empyema)
- staph (cavitation, ptx)
- MRSA (necrotising)
- legionella (CNS, renal impairment, diarrhea, transaminitis)
- klebsiella (cavitation, empyema, leucopenia, bulgey)
- lots others
Hospital acquired pnemonia is and causes
also known as nosocomial, occur 48 hours after admission
aetiology
- early; strep, h influenxza
- late; pseudomonsa, kelbsiella, acinetobacter
Aspiration pneumonia general pattern
recumbent
- posterior upper lobes, superior lower lobes
erect
- bilateral basal, middle lobe, lingula
can be acute or chronic
Acute aspiration pneumonitis imaging
centrilobular nodules, TIB
GGO
airway plugging
atelectasis
consolidation
Chronic aspiration pneumonitis imaging
dependant regions
centrilobular nodules
GGO
lung distortion
- septal lines
- bronchiectasis, lower zone
- bronchial wall thickening
Viral pneumonia causes and imaging
RNA viruses
- influenza
- parainfluenza
- RSV
- measles, mumps
- corona
- picorna/rhino
DNA
- adeno
- herpes
- CMV
- VZV
- EBPV
- HPV
imaging
- bilateral, perihilar peribrohcial thickening and interstitial infiltrates
- can have effusions, nodes, ptx
COVID imaging
primary findings are of atypical pneumonia or organising pneumonia
XR
- can be normal
- opacities
- bilateral peripheral lower
CT
- peripehral bilateral GGO
- crazy pavy
- consolidation
- atypical; nodes, effusions, nodules, tib, ptx, atoll, caviation
BTSI Covid reporting
Classic
- lower lobe and peripheral opacities bilateral
Indeterminate
- doesnt fit classic
Non C19
- ptx, lobar, effusions, oedema
Normal
RSNA CT appearance
Typical
- peripheral bilateral GGO +/- consolidation +/- intralobular lines
- multifocal GGO rounded +/0 consol +/- intralobular lines
- reverse halo or other OP signs
Indeterminate
- absent typical and
- GGO/consol lacking specific distribution and shape
Atypical
- absence of typical and indeterminate and
- isolated lobar or segmental
- discrete nodules
- cavitation
- thickening with pleural effusion
Negative
CMV infection is, imaging and ddx
viral pneumonitis from CMV. typicall immunocompromised. can be latent and reactivated
imaging
- GGO
- small nodules
- confluent consol,. lower
- bronchiectasis
- reticulation
ddx
- pjp; intrapulm cysts, more apical, more homogenous
- other viruses
Varicella pneumonia imaging and ddx
multiple ill and well defined nodules diffusely
nodules with surrounding opacity
can calcify and persistent as well def, random, 2-3mm calcifications
ddx; very dense miliary opacities
- healed varicella
- pulmonary haemosiderosis
- repeated haemorrhage eg goodpastures
- idiopathic
- silicosis
- pulmonary aleveolar microlithisis
- calcified mets
Atypical pneumonia is, causes and imaging
radiological pattern associated with atypical bacterial aetiologies often confined to pulmonary interstiiumn. can also be seen with viruses and fungal pathogens
Mycoplasma; young, close comm
Chlamydia; young
legionella; immunocomp, exposure to contaminated water
Coxiella; livestock, q fever
imaging
- XR; patchy reticular or reticulonodular opacities. perihilar
- CT; GGO lobular distribution. effusions, GG nodules. bronchial wall thicnkeing
Bacterial pneumonia causes and imaging
strep
staph
kleb
h influ
morax
imaging
- focal segmental ie bronchopnuemoa
- or lobar opacities
bulging fissure
kleb
strep
pseudomonosa
staph
less commonly; legionellla, mycobacterium
also; adeno, abscess, haemorrhage
traversal of fissures
malignancy
infection; tb, actino, nocardio, sterp, blasto, mucomycosis
Necrotising pneumonia is and causes
pneumonia with necrosis of the tissue
staph; young, immunocompetent
kleb
enterobacter
nocardia
actinomyces
pseudomonas
penumococus
h influenzae
imaging
- low attenuation and non enhancement
Cavitating pneumonia is
a complication of severe necrotising pneumonia
kids; strep, aspergillus, legionella, staph
adults; pneumococcal, kleb
Lung abscess is and causes
circumscribed pus in lungs. can be acute or chronic.
usually from liquifactive necrosis
primary; from infection
- aspiration, necrotising or chronic. tb. immuno def
- staph, kleb, pseudo, proteus
- candida, legionall, pjp
Secondary;
- obstruction/malignancy
- haematogenous spread
- direct extension
Lung abscess imaging and ddx
imaging
- cavity with gas fluid level
- similar on ap and lateral
ddx
- empyema
- bronchogenic carcinoma
- mets
- cavitating ghranulamatous disease eg gpa
- large infected pneumatocele
- cavitating pnuemoa
- tb
- hioatus hernia
Pulmonary aspergillosis includes
aspergilloma
abpa
invasive aspergillosis
- subacute inviasive
- airway invasive
- angioinvasive
obstructive bronchopulmonary aspergillosis
chronic cavitatory or fibrosing
Aspergillomas are and aetiology
mass like fungal balls composed of aspergillus. non invasive form.
occurs in patients with normal immunity but structury abnormal lungs iwth preexisting cavities
- tb
- sarcoid
- bronchiectasis
- other; bronchogenic cyst, sequestration, pjp assoc pneumatocoeles
ASpergilloma imaging
mass within a cavity
air around takes cresvent shape (monod)
mobile on positioning
soft tissue attenuation, can have calcs
Subacute invasive pulmonary aspergillosis is
a subacute to chronic localised and indolent form of invasive aspergillosis. patients with depressed immune system, but not profoundly immunocompromised.
Subacute invasive pulmonary aspergillosis imaging
upper zones
begins as opacity
eventrually necrotic part separates, forming air crescent
eventually cavity with or without mycetoma
Airway invasive aspergillosis is
invasive aspergillosis that affects the airways as the major feature
occurs in immunocompromised neutropenic patients, like AIDS
Airway invasive aspergillosis imaging
spectrum depending on if its obstructive, bronchiolitis or bronchopneumonia
obstructive
- may be normal
- tracheal or bronchial wall thickening
bronchiolitis
- centrilobular nodules
- tree in bud
- patchy dsitribution
bronchopneumonia
- peribronchial consolidation
- rarely lobar consol
Angioinvasive aspergillosis is
the most severe and aggressive form of invasive. occurs in profoundly immunocompromised patients
hyphae invade pulmonary arteries resulting in pulmonary necrosis and haemorrhage. may go systemic, affectivng kidneys, gut, cns
Angioinvasive aspergillosis imaging
xray
- solitary or multiple p[ulmonary nodules/masses
- wedge like opacities from infarction
- air crescent when healing
CT
- solitary or multiple nodules/masses
- halo of haemorrhage
- reverse halo may also be seen
- peripheral wedge like opacities
- can invade adjacent structures
- air crescent as necrotic lung separates from parenchyma
- can cavitate
Reverse halo sign causes
central ground glass with surrounding conosolidation
fungal pneumonia
- mucomycosis
- invasive aspergillosis
- other fungals
other infections
- tb
- bacterial pneumonia
- corona
pulmonary infarction
gpa
sarcoid
lipoid pneumonitis
neoplasms
- nsclc
- lymphomatoid granulomatosis
iatrogenic
- ablation
- radiation
Halo sign aetiology
ground glass around nodule or mass
fungi
- aspergillosis
- mucormycosis
- crypto
- coccidiodomycosis
- candiasis
septic embolism
mycobacterial
- tb
- non tb
rickettsie
coxiella
viral
- hsv
- vzv
- cmv
malignancy
- adenocarcinoma
- squamous
- kaposi
- lymphoma
- mets; angiosarc, choriocarc, osteosarc, melanoma
non neopalstic/infection/inflamm
- infarction
- gpa
- eosinophilic lung disease
- organising pneumonia
- endometriosis
thoracic histoplasmosis imaging
can be normal
can be non spec
histoplasmoma
- well defined nodule with central calc “target”, pathognomic
acute
- airspace opacity/consol with multiple segments or lobes
- forms histoplasmomas as healing
Pulmonary crytpococcis is
a form of fungal infection. inhalation of fungal spores. immunocompromised typically, but also competent with exposed to avian droppings
Pulmonary cryptococcus imaging
several patterns
- clustered nodular
- soliday nodular/mass with or without cavitation
- scattered nodules
- peribronchovascular consol
most commonly nodules, multiple, small, well defined
pulmonary mycormycosis is
an opportunistic fungal infection. encountered in patients with prolonged neutropaenia.
Pulmonary mycormycosis imaging
non spec; solitary nodule, lobular consoidation, cavitatory lesion or disseminated
ct
- ggo
- reverse halo or birds nest
- peripehral capsule thicker than op
Pneumocystis jiroveci pneumonia is
an atypical pulmonary infection, most common opportunistic pathogen in patients with AIDS
PJP imaging
Xray
- non spec
- pneumatocoeles
- subpleural blebs
- fine reticular interstial changes
- perihilar distribution
CT
- GGO; perihilar typically
- reticular opactieis
- cray paving
- pneumatocoeles
Atypical
- consol
- nodules
- nodes
- effusions
PJP ddx
viral pneumonitis
- cmv
- covid
TB
angioinvasive aspergillosis
IRIS
cysts
- LCH
- LAM
- bronchiectasis
- honeycomb
Reticulonodular
- sarcoid
- gpa
- pneumoconioses
- hp
- kaposis
Pulmonary tb types
Primary
Post primary
Miliary
Tracheal/bronchial
Pleural
Primary pulmonary tb imaging
anywhere in lung
non spec; consolidation, from small to lobar
cavitation uncommon
tuberculoma form, calcify, ghon complex
ipsilateral hilar and mediastinal nodes
low density nodes
can have effusions
cal have calfiied nodes “ranke complex”
Post primary tb imaging
occurs years later, typically in decreased immune states
posterior upper lobes or superior lower lobes
patchy consolidation or ill defined nodular opacities
likely to cavitate
endobronchial spread; tree in bud
hilar nodal involvement
tuberculomas
Miliary tb imaging
represents haematogenous spread
can be primary or post primary
tiny nodules, uniform size and distribution
Non TB mycobacterial infection is
pulmonary infection from non tb mycobacterium. there are loads.
risk factors
- chronic lung disease
- older females
- immunodef
- gord
common ones
- abscessus
- avium intracelulare
- chelonae
- chiaemra
- malmoense
- parascrofulaceum
Pulmonary mycobacterium avium complex is and assoc
non tb mycobacterial infection
assoc
- elderly women
- middle ages males /smokers/dreinkes
- immunocomp
- cf
- alpha 1 anti
- bronchiectasis, copd, pneumoconioses
Pulmonary MAC types and imaging
three forms
- upper lobe fibrocavitary
- nodular bronchiectatic
- mixed
fibrocavitary
- thin walled cavities
- upper
- fibrosis dominent, with endobronchial features elsewhere
nodular bronchiectatic
- bronchiectasis and nodules
- no predilection for upper lobes
xray
- bronchiectasis
- airspace sopacities
- upper zone cavities
CT
- bronchiectasis and wall thicekning
- ggo
- centrilobular/tib nodules
- patchy consolidation
- pleural thickening
- upper lobe cavitation
Pulmonary hydatid imaging
can be transdiaphragmatic or haematogenous
CT
- multiple or solitary cyst
- unilateral or bilateral
- typically lower lobes
uncomplicated cysts
- well defined
- round
- hypodense
complicated
- meniscus or air crescent sign
- cumbo sign or onion peel sign
- water lily sign
- adjacent consolidation
MR
T1 hypo T2 hyper
Pulmonary hydatid signs
Air bubble; gas within the peripher of pulmonary mass
Air crescent
Onion peel/cumbo; gas between endocyst and pericyst
water lily/camalote; detachment of the endocyst membrane
Solitary pulmonary nodule ddx
Malignant
- bronchogenic carc
- met
- lymphoma
- carcinoid
Benign
- hamartoma
- chondroma
- meningioma
Inflammatory
- granuloma
- abscess
- rheumatoid
- pseduotumou
- round pneumonia
Congeintal
- AVM
- cyst
- atresia with impaction
Misc
- infarct
- lymph node
- mucoid impaction
- haematoma
- mayloid
- vein/nipp/cutaenous/fracture
Squamous cell carcinoma quick path
30% all lung ca
heavy smokig
used to be most common, now its adeno
tend to be central
subtypes
- papillary
- clear cell
- small cell
- basaloid
immunopheotype
- p63
- neg ttf1
Lung adenocarcinoma path (including types)
most common lung ca.
preinvasive
- atypical adenomatous hyperplasia
- locaslied, small usually <0.5cm
- focal prolif of atypical cells
- adenocarcinoma in situ
- <3cm
- only lepidic with no stromal, vascular or pleural invasion and no necrosis
minimally invasive
- localised <3cm
- pure lepidic or predominant
- <5mm stromal invasion
- non mucinous, mucinous, mixed
Invasive adenocarcinoma >5mm invasion (predominant comprising histology)
- lepidic
- acinar
- papillary
- micropapillary predominant
- solid predominant
- variants; invasive mucinous (separate catergory), colloid, fetal, enteric
AAH lung
localised small cell prolif <5mm, atypical typr 2 pnuematocytes
Adenocarc in situ
<3cm
no pattern except lepidic
no invasion
non mucinous, mucinous or miced
pure gg nodule or part solid
Minimally invasive adeno
<3cm, purely lepidic or <5mm stromal
no necrosis, lymphatic, vascular or pleural
non mucinous, mucinous, mixed
Lepidic predominant adeno
> 3cm, >5mm lymphatic, vascular or pleural
non mucinous lepidic growth pattern
invasive mucinous adeno
commonly multicentric, multilobar, bilateral
originate from columnar mucus cells
kras present
egfr absent
Small cell lung cancer is
a subtype of bronchogenic carcinoma. neuroendocrine tumours. rapid growth, highly malignant, widely metastasise
arises from bronchial mucosa. commonly necroses, invased and has paraneoplastic syndromes
Small cell lung ca imaging
central, mediastinal involvment, direct invasion
Large cell lung cancer
one of the non small cell.
loss of ck5/6 staining
ck14 positive
lack of moc 31
positive egfr, pdgfr alpha and ckit
large nuclei with moderate cytoplasm
Bronchial carcnoid is, path and imaging
carcinoid tumours related ot bronchus. can be central or peripheral. range from low to high range aggressiveness
tend to be central in TB tree. usually bronchial
assoc; men 1, cushings
xray
- round or oval
- sharp margins
- airway compression/atelectasis
CT
- single hilar or perihilar
- well deined
- usually 2-5cm
- marked enhancement
- calcs occassionally
Lymphangitis carcinomatosis aetiolgoy and imaging and ddx ehy not
adenos lie
- breast
- lung
- stomach
- colon, prostate, cervical, thyroid
- and a bunch others
imaging
- nodular interlobular septal thickening
- thickening of the bronchvascular interstitium, irregular
- dot in a box
- other; subpleural noduels, effusions, hilar and nodal enlargement
ddx
- sarcoid
- viral pnuemonia
- pulmonary oedema
- radiation pnuemonitis
- lip
Pulmonary hamartoma is and imaging
benign neoplasm. composed of cartialge, ct, muscle, fat and bone. common
typically peripheral, can be endobronchial
imaging
- well circumscribed
- smooth or lobulted
- 60% fat
- 30% popcorn calcs
Peripheral pulmonary carcinoid vs hamartoma
carcinoids
- higher attenuation
- more lobulation
- more distal nodulairt
- atelectasis
- distal trapping
- more extension/bronchial invovmment
- marked enhancement
Fat containing pulmonary nodule
hamartoma
lipoma
myelolipoma
lipoid pneumonia
lipsarc met
renal cell met
Hyperattenuating pulm nodule ddx
granuloma
hamartoma
bronchogenic carcinoma
carcinoid
mets; mucinous adeno, dystrophic calc, bone froming
Pulmonary lyphoma is
parenchymal lymphoma
can be primary or secondary
primary
- usually non hodg
- maltoma, high grade b cell
secondary
- hodg or non hodg
also
- post transplant lymphoproliferative disorders PTLD
- AIDS related lymphoma
Pulmonary lymphoma imaging
variable
mass like consolidation; no cavaitation no bronchograms
pleural origin
nodules <1cm
peribronchial thickneing
effusions
nodes
DIPNECH is
rare pulmonary disorder at the benign end of neuroendocrine cell proliferation spectum of preinvasive lesions of the lungs
women, middle age, non smokers
imaging
- bronchocentric solid circumscribed nodules
- all lobes
- commonly lower, peripehral or more diffuse
- lobular/regional air trapping
- nodular bronchial wall thickening
ddx
- adeno
- mets
- follicular bronchilitis
- pulmonary hypertension/cteph
Pulmonary oedema causes
Cardiogenic
- heart failure
- MR
- AS
- arrhythmias
- myocardial
Non cardiogenic
- fluid overload
- oedema with asthma
- post obstructive
- PE
- near drowning
- ARDS
- drugs
- altitude
- neurogenic
- reperfusion
- lung transplant
- reexpansion
Non cardiogenic oedema causes
NOT CARDIAC
Near drowning
O2 therapy
Trauma/transfusion
CNS
Allergic alveolitis
Renal failure
Drugs
Inhaled toxins
Altitude
Contusion
Unilateral pulmonary oedema causes
ipsilateral pathology
- mitral valve regurg
- patient positioning
- re-expansion
- pulmonary vein occlsuion
- coengenital or surgical shunt
contralateral perfusion abnormality
- PE
- PA hypoplasia
- swyer james syndrome
- bullae
ARDS is
a form of acute lung injury occuring as a result of a severe pulmonary injury that causes alveolar damage hetergenously throughout the lung. can be pulmonary or systemic.
similar clinical and histo to acute interstitial pneuymonitis
UIP is and causes
a histo and radiology pattern of interstitial lung disease, the hallmark pattern for IPF.
CAuses
- IPF
- CTD; RA, scleroderma, polymyositis, mixed
- asbestos
- chronic HP
- radiation
- medications (amiodarone)
- NACA vasculitides
- hermansky pudlak syndrome
UIP imaging
CT
- honeycombing
- subpleural reticular opacitiies
- traction bronciectasis
- lung distortion
- GGO(less than reticulation)
- volume loss
- basal predominant
IPF is
a clinical syndrome, most common pulmonary fibrosis. corresponds to pattern of UIP.
major criteria
- exclusion of other causes
- abrnoamal pft
- define uip pattern
- biopsy showing no other dx
minor
- age >50
- insidious onset
- >3month
- bibasal velcro crackles
NSIP is and causes
second most comon morphologic and pathological pattern of interstitial lung disease. main subtypes
- cellular
- fibrotic
characterised by symmetric and bilateral ggo with fine reticulations and voluem loss with traction b. immediate subpleural sparing a specific features.
causes
- ctd; sle, scleroderma, sjogrens, polymyositis
- autoimmune; ra, pbc, hashimoto, antisynthetase
- drug induced
- hypersensitivity
- healing dad
- relapsing op
- occupational
- gvhd
- igg4
NSIP imaging
CT
- ggo; symmetrical, all zones or basal
- subplerual sparing
- reticular opacitieis
- bronchovascular thickening
- traction b
- volume loss
- microcystic honeycombing sometimes
Acute interstitial pneumonitis is
also known as hamman rich syndrome. rapidly progressive non infectious interstitial lung disease of unknown aetiology. only acute idiopathic interstitial pneumonia.
AIP imaging
- similar to ARDS initially
- GGO, bilateral and symmetric
- traction bronchiectasis
- parecnhymal architectural disotrotion
- airspace consolidation
Organising pneumonia is and secondary causes
a clinicopathologic entity. can be cryptogenic or secondary.
causes
- idiopathic/cryptogenic
- infection; atypical bacteria, bacterial, fungi, viruses, parasites
- drugs
- ibd
- leukaemias, hodgkins
- transplant
- radiotherapy
- rheumatological disorders
Cryptogenic organising pneumonia imaging
xr
- unilateral or bilateral
- patchy
- all zones
- peripheral, subplerural, peribronchovascular
ct
- patchy consol with subplerural/peribronchovascular distributsch
- nodules, usually peribronchial
- bronchial wall thickening
- perilobular pattern with ill defined linear opacitiies
- arcafe like sign of perilobular fibrosis
- ggo/craxy paving
- reverse halo
Diffuse pulmonary haemorrhage is and assoc
a subset of pulmonary haemorrhage where bleeding is diffuse. can also have diffuse alveolar haemorrhage
assoc
- pulmonary vasculitides; gpa, ctd including sle
- post bmt
- all transretinoic acid syndrome
- goodpasture syndrome
- pulmonary haemosiderosis
- coagulative disorders
- haemorrhage complicating multifocal infection
- mets
Diffuse pulmonary haemorrhage iamging
bilateral consolidation with apical sparing
ggo/crazy pavy/ consolidation
later; diffuse nodules, interlobular septal thickening due to lymphatic haemosiderin
Goodpasture syndrome is
antiglomerular basement membrane antibody disease, an autoimmune disease characterised by damage to the alveolar and renal basement membrane by a cytotoxic antibody
type of puolmonary renal syndrome.
cahracterised by pulmonary haemorrhage, glomerulonephritis, circulating antiglomerular basement membrane antibodies
Goodpasture imaging
XR
- bilateral coalescent airspace opacitieis
- resolves in 2 weeks
ct
- ggo, progress to crazy paving
- hilar nodes
- no interlobular in acute phase
Pulmonary haemosiderosis is and causes
iron deposition within the lungs
can be primary
- goodpastures
- heiner; hypersens to cow milk protein
- idiopathic
or secondary
- often due to mitral stenosis
Pulmonary haemosiderosis imaging
small ill defined pulmonary nodules
coarse reticular areas of increased opacity with a bias for middle and lower regions
pulmonary ossification (MS)
- dense 1-5mm nodules, mniddle and lower,
Heiner syndroime is
a rare form of primary pulmonary haemosiderosis associated with an allergy to cows milk
includes;
- rectal blood loss
- pulmonary infiltrates
- hypoproteinemia
Lane Hamilton syndrome
rare concurrent association of idiopathic pulmonary haemosiderosis and coeliac disease
LAM is
a low grade destructive pecomatous tumour resulting from prolierfation of lam cells in the lung kidney and axial lymphatics. caused by mutations in the tsc2 or tsc1 gene. commonly sporadic.
LAM imaging
Chest
- chylothorax
- ptx
- large lungs with scattered cysts
- small nodules (MMPH)
- nodes
- dilated thoracic duct
- myocardial fatty foci
Abdomen
- AMLs (hepatic, adrenal, retroperitoneal)
- chylous ascites
- nodes
Skeletal
- osteoblastic bone lesions
Birt Hogg Dube syndrome is
a multisystem disease characterised by fibrofolliculomas, lung cysts, increased risk of renal tumorus
Birt Hogg Dube imaging
Lung cysts
Lower zone
Bilateral
Subpleural
thin walled, varaible sized
Desquamative interstitial pneumonia is
an interstitial pneumonia, though to represent end stage RBILD. associated with heavy smoking.
DIP imaging
XR
non spec
bilateral interstitial opacities, basal and peripheral
CT
diffuse GGO
bilateral and symmetric
basal and peripehral
patchy
diffuse
can also have small cystic spaces and irregular linear opacities
other smoking related changes
Pulmonary langerhans imaging
XR
diffuse symmetrical reticulonodular pattern with predilection for the mid and upper zones
ill defined nodules
cyst formation
CT
predilection for mid and upper
sparing of the CP recesses
nodules
- few to lows
- 1-10mm
- centrilobular distriobution
- irreular
- cavitaty with thicke walls
cysts
- <10mm
- confluent, with bizarre shapes
GGO/reticular/DIP change
mosaisicm
interlobular septal thickening
emphysema
cna progress to fibrosis
Lymphoid interstitial pneumonitis is and assoc
benign lymphoproliferative disorder. subtype of interstitial lung disease.
assoc
- sjogrens (most common)
- aids
- autoimune thyroid
- SLE
- castlemanns
- CVID
- RA
- pulmonary amyloid
LIP imaging
CT
- mid to lower
- thickening bornchovascualr bbundles
- interstitial trhickening
- small variable pulmonary ondules
- GGO
- scattered cysts, tend to be pervascular or subpleural
Lipoid pnuemonia is and assoc
a form of pneumonia assoc with oily or lipid components within hte pnuemonitis component. can be exogenous or endogenous
risk factors
- NM disorders
- oesophageal abnorms
- cleft palate
- endogenous assoc with lung ca
Lipoid pnuemonia imaging
low attenuation within the consolidated area reflecting fat content
dependant lung
ossific foci in affected region
can have crazy paving
Puylmonary alveolar proteinosis is
lung disease characterised by abnormal alveolar accumulation of surfactant derived lipoproteineceous materail.
can be autotimmune, secondary or congenital
autoimmune
- igg antibodies to gmcsf
secondary
- haem malig
- inhalational lung disease
- immunodef
congenital
Pulmonary alveolar proteinosis imaging
XR
- batwing
- diffuse pulmonary opacities
- diffuse consolidation
- reticulonoular
CT
- crazy paving
Crazy paving ddx
ARDS
Bacterial pneumonia
AIP
PAP
Drugs
Radiation
Haemorrhage
Chronic eosinophilic
UIP
Oedema
INfections
COP
Invasive mucinous adenocarc
Sarcoid
Lipod pnuemonia
Pulmonary veno occlusive disease
Simple pulmonary eosinophilia is
aka lofflers. transient infiltrates, minimal constitutional and elevated count in blood. self limiting.
imaging
- fleeting non segmental air sapce
- uni or bilateral
- peripheral distribution
ddx
- aspiration
- haemorrhage
- vasculitis
- OP
Acute eosinophilic pneumonia imaging
Bilateral GG
Interlobular septal thickening
Pleural eff
BV bundle thickening
Consolidation
Centrilobular nodules
Chronic eosinophilic pneumonia is and imaging
alveoli filling with inflammatory eosinophil rich infiltrate. presents as upper and peripheral predominant chronic consolidation.
Imaging
- XR: reverse bat wing
- consolidation; peripheral mid to upper
- can occ have GGO, pulmonary nodules, reticulation
Eosinophilic granulomatosis with polynagiitis is
small to medium vessel necrotising pulmonary vasculitis. often have renal disease
need four of six;
- asthhma
- blood eosinophilia
- mono/polyneuropathy
- transient infiltrates
- paranasal sinus abnormalities
- extravascular eosinophils on bx
Eosinophilic granulomatosis with polynagiitis imaging
Peripheral or random parenchymal opacification
- often bilateral and can be symmetric
Less common
- centrilobular nodules, bronchial wall thckening and bronchiectasis
- interlobular septal thickening
- cavitation
- mediastinal lymphadenopathy
- paransal sinus sisease
Pulmonary alveolar microlithiasis is and imaging
Rare idiopathic condition characterised by widespread intraalveolar deposition of spherical calcium phosphate microliths
Pulmonary alveolar microlithiasis is believed to be due to a mutation in the SLC34A2 gene that causes inactivation of a sodium-dependent phosphate cotransporter, which is found mainly in alveolar type II cells. This cotransporter normally clears phosphate from degraded surfactant, and when inactivated there is accumulation of phosphate in the alveolus, and calcium phosphate microliths are then thought to form . Might be AR.
Xray
- sand like calc in lungs
- black pleura sign
CT
- sang like calcs
- crazy pav
- calcified interlobular septa
- subpolerual cysts
- black pleura sign
- ggo
Calcified pulmonary nodules ddx
healed infection
occupathional disease
calcified mets
hamartomas
met pulmonary calcification
pulmonary haemosiderosis
pulmonary alveolar microlithiasis
sarcoid
calc fibrous pseudotumour
pulmonary amyloidosis
Calcified pulmonary nodules ddx
healed infection
occupathional disease
calcified mets
hamartomas
met pulmonary calcification
pulmonary haemosiderosis
pulmonary alveolar microlithiasis
sarcoid
calc fibrous pseudotumour
pulmonary amyloidosis
carcinoid
Non calcified hyperdense pulmonary nodules ddx
inhalational/pneumoconioses
acrylic cement embolism
Metastatic pulmonary calcification is and causes
a form of pulmonary calcification most commonly due to renal failure
causes
- chronic renal failure
- primary and secondary hyperparathyroidism
- sarcoid
- vit d intox
- milk alkali syndrome
- multiple myeloma
Metastatic pulmonary calcfication imaging
CT
- centrilobular fluffy ground glass nodular opacities
- may have ring calcs
- consol with high attenuation
- small dense nodules
- peripheral reticular opacities
- ggo without nodular opacity
CPFE is
a smoking related interstitial lung disease characterised by the coexistence of UIP/NSIP with emphysema
Silicosis is and types
a fibrotic pneumoconioses caused by inhalatio of fine particles of silica. associated with occupations such as mining, quarrying, denim sandblasting and tunnelling.
can be acute or classic (chronic, more common)
Classive can be simple or complicated (by PMF)
Silicosis imaging
Acute
- centrilobular/GGO
- consolidation
Classic simple
- upper zone nodules, perilymphatic
- can have calcs
- hilar and mediastinal nodes
- calc nodes
Classic complicated
- large symmetrical bilateral opacities
- middle/peripheral third lung
- migrating toward hilum
- focal soft tissue masses with irregular margins and calcs surrounded by emphysematous change
Can also have
- UIP pattern
- pleural eff
- pleural thickening
- rounded atelectasis
CWP is
an occupational lung disease caused by exposure to coal dust free of silica (washed)
Can be simple or complicated (PMF). can also be complicated by TB.
Asbestos related diseases include
Benign
- pleural effusions
- pleural plaques
- diffuse pleural thickening
- round atelectasis
- asbestosis
Malignant
- Bronchogenic carcinoma
- Mesothelioma (pleural and extrapleural)
- Renal cell carcinoma
- Laryngeal carcinoma
- GI tumours
Pleural plaques are
a common manifestation of asbestos related disease. long latency after exposure.
Pleural plaque imaging
can be calc or not. can involve visceral plauera, with underlying parenchymal abnorm
typically lower, sparing CP angles and apices. can be medistinal
XR
- incomplete border sign; well defined inner border, tapering outer margin
- holly leaf
CT
- visceral plaural plaques have predilection for interlobar fissures and associated with adjacent parenchymal abnormalities “hairy plaque”
Diffuse pleural thickening causes
Diffuse pleural fibrosis
ASbestos related pleural thickening
Malignant pleural effusion
Primary pleural lymphoma
Other neoplasm; invasive thymoma, melanoma etc
Fibrothorax is and causes
fibrosis within the pleural space, encompassing and restricting. occurs as a secondary inflammatory response.
mediastinal pleura can be spared. marked volume loss. smooth
aetiology
- TB
- empyema
- asbestos
- RA
- haemothorax
- CTD
- uraemia
- drug rxn
- pleurodesis
Asbestosis imaging
CT
- peripheral lower zone
- irregular opacities with fine reticular opacity
- centrilobular dots, peribronchial fibrosis
- subpleural lines, curvilinear
- intralobular linear opacities
Later features
- parenchymal bands
- traction bronchiectasis
- honeycomb fibrosis
Effusions, plaques and nodes also
Mesothelioma is and path
aggressive malignant tumour of the mesothlium. most arise from the pleura but also peritoneal, pericardial, tunica vaginalis
strong assoc with asbestos exposure, esp crocidolite
histo types
- epithelial
- mixed
- sarcomatoid
Mesothelioma imaging
XR
- pleural opacity encasig lung
- reduced volume
- chest wall/rib invovlement
- nodes
- effusion
CT
- pleural mass
- initially adjacent pleural extending to rind like encasement
- local invasion
- mets to local nodes and contralateral lung
-calc 20% (englufed plaques or sarcomatoid with chondro/osteosarc components
MR
- T1 iso to hyper
- T2 iso to hyper
C+ enahcnes
PET
- can help diff between benign and malignant pleural thickening
- assessing for nodal mets
Berylliosis imaging
Similar to sarcoid
CT
- nodules
- upper lobe fibrosis
- diffuse interstitial fibrosis
- traction b
- interlobular septabl thickening
Radiation pneumonitis
is the acute manifestation of radiation induced lung disease. typically 4-12 weeks post.
Radiation pneumonitis imaging
changes localised to field
GGO/consolidation
other patterns/features
- halo sign
- reversed halo
- nodules
- TIB
- crazy paving
- pleural effusion
- atelectasis
- pulmonary necrosis
Radiation induced pulmonary fibrosis is
the late manigestation of radiation induced lung disease. typically 6-12 months post
Radiation induced pulmonary fibrosis imaging
XR
- volume loss
- distortion
- mediastinal shift
- hemidiaphragm elevation
- bronchiectasis
CT
- volume loss
- linear scarring
- chronic consol
- traction bronchiectasis
- hilar vascular displacement
- mediastinal shift
- pleural thickening
- pleural effusion
Cavitation rarely.
Straight edges with highly conformal radiation therapy
Radiation induced lung cancer types
lung
sarcoma (osteo, MFH)
breast cancer
malignant pleural meso
oesophageal
Talcosis is and imaging
a type of pneumoconiosis in IVDU. one of the types of talc induced lung disease.
talc used in prep of tablets. deposit in lungs post injection. fb reaction granulomas.
imaging
- hyperdense micronodules
- GGO
- conflomerate masses PMF like
- panlobular physema
Talc induced lung disease types
Talcosilicosis
Talcoasbestosis
Talcosis (inhalation)
Pulmonary talc granulomatosis
Hard metal pneumoconiosis is
fibrotic pneumoconiosis where precipitant is agent of a fine particulate form of hard metal such as
- cobalt
- tungsten
- implicated alloys
oil well, jet engine. sharpeners of tools, machine operators. diamond polishers.
Pulmonary oedema causes
Cardiac
- LHF
- MR
- AS
- arrhytmias
- Myocardial path
NOT CARDIAC
- near drown
- O2/post intubation
- trauma/transfusion
- CNS
- Allergic alveolitis
- Renal failure
- Drugs
- Inhaled toxins
- Altitude
- Contusion
Pulmonary vein thrombosis is and causes
A rare condtion, occuring secondary to
- intrapulm neoplasm
- post surgery
- post RFA
- fibrosing mediastinitis
- mitral stenosis w left atrial clot
- hilar torsion
- hypercoaguability
- idiopathic
PE causes and risk factors
Causes
- thromboembolism
- gas
- fat
- tumour
- infectious
- amniotic fluid
- iatrogenic
RF
- primary hypercoag
- recent surgery
- prolonged bed rest
- malignancy
- HIV
- C19
- medication
- preg
- known DVT
- venous aneurysms
PE XR features
Fleischner
Hampton
WEstermark
Effusion
Knuckle (cut off)
Palla/Chang
Pulmonary hypertension is
a resting mean pulm arterial pressure of >25mmhg at right heart catheterisation
Pulmonary hypertension imaging
XR
- elevated cardiac apex
- enalrged right atrium
- prominent outflow tract
- pruning of peripheral pulmonary vessels
- ?cause
CT
- Enlarged trunk ?29mm
- PT to aorta ratio
- Enlarged pulmon aa
- Mural calcification
- segmental artery to bronchial diameter ratio
- carina crossover
- egg and banana
- RVH, wall >4mm
- straight IVS
- RV dilatation
- centrilobular GG nodules
- neovascularity
Pulmonary hypertension classification
Group 1 - disorders of PA
- idiopathic
- heritable
- drugs
- CTD/HIV/PH/CHD/Schisto
Group 2 - left heart disease
- systolic
- diastolic
- valve
- outflow
Group 3 - lung disease/hypoxia
- COPD
- ILD
- other
- sleep
Group 4 - CTEPH
Group 5 - unclear/multifactorial
- haem - haemorltic anaemia, myeloprolif, splenectomy
- systemic - sarcoid, histio, LAM
- metabolic - GSD, gauchers, thyroid
- other - fibrosing mediastinitis, tumoural
Swyer James syndrome is
a rare lung condition that manifests as unilateral hemithorax lucency as a result of post infectious obliterative bronchiolitis.
usually a smaller lung with hyperlucency and air trapping. diminished vasc.
Septic emboli is and causes
embolisation of infectious particles into the lungs
Causes
- right infective endocarditis
- infection elsewhere with assoc septal defects
- infected DVT
- infected lines
- post anginal
- periodontal disease
Pathogens
- kleb
- staph
- pseudomonas
- ec oli
- fusobacterium (lemierre)
Septic emboli imaging
XR
- peripheral lower lobe predom
- diffuse nodules, varying cavitation
- effusions common
CT
- subpleural nodular lesions or wedge shaped densities with or without necrosis causes by infarcts
- feeding vessel sign
Septic emboli ddx
cavitating mets
- squamous, GI adeno, sarcomas, TCC, cervical
necrobiotic mets
gpa
PE
infection
Pulmonary AVM is, assoc and classification
a rare vascular anomalies of the lung, in which abnormally dilated vessels provide a right ot left shunt wetween the PA and PV
Assoc
- HHT
- cirrhosis
- schisto
- MS
- trauma
- previous
Classification
- simple
- complex (multiple segmental feeders)
- diffuse (mundreds of malformations)
Pulmonary AVM is, assoc and classification
a rare vascular anomalies of the lung, in which abnormally dilated vessels provide a right of left shunt between the PA and PV
Assoc
- HHT
- cirrhosis
- schisto
- MS
- trauma
- previous cardiac surgery
Classification
- simple
- complex (multiple segmental feeders)
- diffuse (hundreds of malformations)
Pulmonary AVM imaging
Dilated vessel
Multiple (HHT)
Serpiginous connection to vessels
Occasional phleboliths
Hepatopulmonary syndrome is
a clinical syndrome defined by the presence of
- liver disease
- dilation of the pulmonary vasculature
- abnormalities in oxygenation (incr aa gradient)
Hepatopulmonary syndrome imaging
Distal vascular dilatation associated with an abnormally large number of visible terminal vessel branches concentrated in the lower zones
CT
- peripehral arteriolar dilatation on CT
- increased number of terminal branches extending toward the pleura
Two patterns
Type 1
- distal vasc dilatation with subpleural telangiectasia
Type 2
- individual AVMs and nodular dilatation of peripheral pulmonary vessels
Pulmonary capillary haemangiomatosis is
a rare vascular proliferative condition that can lead to pulmonary hypertension.
characterised by multiple angiomatous lesions composed of proliferating capillary vessels in the lung parenchyma.
Pulmonary capillary haemangiomatosis imaging
Diffuse bilateral reticulonodular pattern
Enlarged central pulmonary arteries
Mixed lobular GGO
Pulmonary veno occlusive disease is and assoc
an uncommon variant of primary pulmonary hypertension that preferentially affects the post capillary pulmonary vasculature
assoc
- CTD
- HIV
- sarcoid
- LCH
Pulmonary veno occlusive disease imaging
Varaible GGO
Interlobular septal thickening
Nodes
Effusions
Enlarged central PAs
Mosaic pattern of lung attenuation
Normal calibre veins
Diffuse pulmonary lymphangiomatosis is
a rare condition characterised by diffuse proliferation of anastomosing lymphatic channels
Diffuse pulmonary lymphangiomatosis imaging
Interlobular septal thickening
Peri-bronchovascular thickening
Patchy GGO
Pleural thickening
Pleural effusions
Mediastinal infiltrates
Pectus excavatum is and assoc
also known as funnel chest, congenital chest wall deformity characterised by concave depression of the sternum
assoc
- marfan
- noonan
- ehlers danlos
- nf1
- myotnic dystrophy
- mitral valve prolapse
- more who cares
Pectus excavatum imaging
XR
- blurring of the right heart border
- increased density inferomedial zone
- horizontal posterior ribs
- vertical anterior ribs
- displaced heart to left
- obliteration of descending aortic interface
- widening of the cardiac silhouette
- medial breast margin sign
Pectus carinatum is and association
Pigeon chest. chest wall deformity in which the sternum protrudes anteriorly.
assoc
- scoliosis
- cyanotic congenital heart disease
- marfan syndrome
Pectus carinatum imaging
Middle and lower
- chondrogladiolar
Manubrium and upper
- chondromanubrial
- currarino silverman syndrome
Pectus arcuatum is
wave like chest. mixed excavatum and carinatum. aka pouter pigeon chest.
Scoliosis causes
Idiopathic
Neuromuscular
Congenital bony
Tumour or treatment
Neuromuscular
- CP
- Chiari malformation
- Friedreich ataxia
- Syringomyelia
- spinal dysraphism
Congenital
- Segmentation and fusion abnormalities
- dysplasias
Tumours
- Osteroid osteoma
- osteoblastoma
- mets
- neurofibromas
- meningioma
- Neurofibroma
Infectious
Pleural effusion types and causes
Transudative v exudative
Transudate
protein
>:LDH
>SG
Transudate
- cardiac failure
- nephrotic
- cirrhosis
- dressler syndrome
- trauma
- asbestos
Exudate
- bronchial carc
- mets
- PE and infarct
- pneumonia
- TB
- mesothelioma
- RA
- SLE
Pleural effusion ultrasound imaging
quad sign
- ribs form horizontal margins
- pleural layers form vertical margins
- together draws a quadrilateral shape
sinusoid sign
- insp increase in depth of the effusion
Plankton sign
Chylothorax causes
Malignancy
Iatrogenic
Non surgical trauma
Idiopathic
Congenital thoracic duct ectasia
Lymphangiectasia
Fibrosing mediastinitis
TB
Nephrotic syndrome
TS
Amyloidosis
LAM
Sarcoid
Gorham (shoulder/thoracic osteolysis)
Oleothorax is
a historical treatment method for cavitary tb of the upper lobes of the lungs
intra or extrapleural oil injection to either collapse upper lobe, contral fistulas or prevent persistent tb empeyema/ptx
Oleothorax imaging
large dense apical lentiform calcified opacities with accompanied pleural thickening
ddx
- empyema
- haemothorax
- mesothelioma
Meigs syndrome is
ascites and pleural effusions in assoc with a benign solid ovarian tumour
usually fibroma, or;
- fibrothecoma
- thecoma
- granulosa cell toumnrsou
- brenners tumours
Poland syndrome is
congenital unilateral absence of hte pec major and minor
rarely assoc with
mobius syndrome, (abducens and facial palsy)
morning glory syndrome (eye abnorm)
pierre robin syndrome (facial stuff)
Sprengel deformity is
congenital elevation of the scapula
assoc with
- omovertebral bar
- regional muscular atrophy
- klippel feil
- spina bfida, torticollis
Aortic valve stenosis aetiology
Supravalvular
- congenital eg williams syndrome
- acqured, post op or post aortitis
Valvular
Congenital
- bicuspid valve
- unequal tricuspid valve
- unicommisural valve
- quadricuspid valve
Valvular
Acquired
- rheumatic heart disease
- senile calcification
- radiation
Subvalvular
- subaortic membrane
- shone complex
HOCM
Heyde syndrome
Aortic valve stenosis and GIH
Aortic valve regurg is
a valvulopathy that describes leaking during diastole that causes blood to flow in the reverse direction
Aortic valve regurg causes
Root disease
- htn
- bicuspid
- ctd
- dissection
- takayasu
- syphilis
Valvular
- rhd
- calcidic as
- infective endocarditis
- prolapse
- quadricuspid valve
- as
- radiation
Mitral stenosis is and causes
valvulopathy that describes narrowing of hte opening of the mitral valve
usually acquired via rheumatic heart disease
other causes;
- mitral annular calcification
- congenital
- infective endocarditis
- ctd
- radiation
- left atrial myxoma
- ball valve thrombus
Mitral stenosis imaging
LAE
Upper zone venous enlargement
Pulmonary oedema
Diffuse pulmonary haemorrhage
Secondary pulmonary haemosiderosis
Pulmonary ossification
Mitral valve regurgitation is and causes
valvulopathy that describes leaking of the mitral valve during systole that causes blood to flow in the reverse direction
Causes
Acute
- myocardial infarction with a papillary muscle rupture
- usually posteromedial, sole supply from RCA
- infective endocarditis
- chordae tendinae rupture in myxomatous degeneration
- trauma
Chronic
- annular calcification
- myxomatous degeneration
- prev rhd/endocarditis/ctd
- congenital valvular malformation
- dilated cardiomyopathy
- hocm
Rheumatic fever is and diagnostic criteria
an illness caused by an immunological reaction following group A strep infection
Jones criteria
major
- migr polyarthritis
- pancarditis
- sydenham chorea
- erythema marginatum
- subcut nodules
minor
- fever
- arthralgia
- increased crp/esr
- previous episode of rf or inactive heart disease
- leucocytosis
- ecg changes
Rheumatic heart disease is
acute or chronic cardiac sequelae following rheumatic fever
group a strep infection causes a type 2 hypersensitivity reaction
myocardialc
- myocarditis - dilated cardiomyopathy
- maccallum patch/triangle/plaque
pericardial involvement
- pericarditis
- fibrous pericarditis
- pericardial calcification
valvular
- can be stenosis or regurg
Infective endocarditis is
infection of the endocardium. commonly affects the valve leaflets, chordae tendinae, psothetic valves and implanted devices
Dukes criteria
Need
- 2 major 1 minor or
- 1 major 3 minor or
- 5 minor
Major
- positive cultures, typical agent
- typical microorganism, 2 separate cultures
- positive echo
- new valvular regurg
Minor
- predisposing heart condition OR IVDU
- fever
- vascular phenomena
- immunologic phenomena; osler nodes, glomerulonephritis, roth spots, rheumatoid factor
- microbio evidence not meeting major criteria
- echo evidence not meeting major criteria
Non bacterial thrombotic endocarditis is
aka marantic endocarditis refers to fibrin and platelet aggregations on previously undamaged valves in the absence of bacteraemia
seen in advanced malignancy, ctd, autoimmune disorders and hypercoag states
Libman Sacks endocarditis is
aka verrucous endocarditis. form of non bacterial thrombotic endocarditis. characterised by large vegetations over endocardial surface and assoc with SLE
Pericardial effusion is and causes
excess fluid in the pericardial space
idiopathic
inflamm
- sle
- ra
- scleroderma
- sjogrens
- vasculitis
- post infarction (dresslers syndrome)
infectious
post op/trauma
PAH
radiotherapy
renal disease
malignancy
hypothyroidism
Pericardial effusion imaging
globular enlargement
water bottle
oreo cookie sign (lat)
cardiogenic pulmonary oedema
Haemopericardium causes
ruptured MI
rupture LV aneurysm
aortic dissection
pericarditis
trauma
cardiac malignancy
ruptured CA aneurysm
post thrombolysis
Pericarditis is, diagnostic criteria and types
inflammation of the pericardium
criteria
- pericarditic chest pain
- pericardial rubs
- new widespread st elevation and/or pr depression
- new or worsening pericardial effusion
types
- serous
- suppurative (assoc with pneumonia/empuyema)
- tb
- fibrinous
- haemorrhagic
-cconstrictive
- adhesive
Neoplastic pericardial effusion causes
primary
- pericardial meso
- angiosarc
- fibrosarc
- pericardial lipoma
- fibroma
secondary
- lung
- breast
- melanoma
- lymphoma/leukaemia
- kaposis
Constrictive pericarditis is and causes
type of pericarditis characterised by fibrous or calcific constrictive thickening of the pericardium
may follow any type of effusion
idiopathic
pericardial injury
- surgery
- post MI (dresslers)
- radiotherapy
infection
- tb
- viral
- pyogenic
sarcoid
uraemia
CTD
malignancy
ASD associations
downs ++++++++
holt oram
ellis van creveld
mv prolapse
lutembacher syndrome
PAPVR/TAPVR
complications
- emboli
- eisenmeiger
ASD types
secundum (most common)
- usually isolated
primum
- assoc cleft anterior mitral valve
sinus venosus
- assoc with anomalous right pulmonary venous return
coronary sinus type (unroofed)
- assoc heterotaxy syndrome
PFO
VSD assoc
CV
- TOF
- Truncus arteriosus
- double outlet RV
- aortic coarctation
- tricuspid atresia
- AR
- PS
Extra cardiac
- aneuploidy/chromosomal (21/18/13)
- other syndrome incld holt oram
Eisenmenger
Patent ductus arteriosus is and associations
congenital cardiac anomaly with persistent patency of the DA, a normal fetal circulation connection
Assoc
Req for life in a number of structural diseases
- TOF
- Eisenmenger
- Hypoplastic left heart
- Pulmonary atresia
Non cardiac assoc
- prematurity
- surfactant deficiency
- trisomy 18
- trisomy 21
- rubella
PDA treatment
Medical
- prostaglandin e1 (keeps open)
- indometacin (closes)
Endovascular closure devices
Surgical clipping or ligation
Ebstein anomaly is
an uncommon congenital cardiac anomaly characterised by variable developmental anomaly of the tricuspid valve
path
- abnormal tricuspid valve (septal and post leaflets)
- tricuspid valve displaced apically into the RV
- results in atrialisation of parts of the ventricle above the valve
Ebstein anomaly associations
T13, 21
Turners
Multiple other congenital heart lesions
Conduction abnormalities
Can have TR or TS concurrently
Ebstein anomaly imaging
XR
- Severe right cardiomegaly
- box shape
CT
- apical displacement of the septal and posterior leaflets of the tricuspid valve
- atrialisation of the right ventricle
- TR
Uhls anomaly is
absence of the RV myocardium
normal Tricusp valve
Tricuspid atresia is and assoc
a cyanotic congenital cardiac anomaly characterised by agenesis of the tricuspid valve and right ventricular inlet
obligatory ASD or PFO to complete circulation
Small VSD often present
Assoc
- ASD/PFO
- VSD
- TGA
- right arch
- asplenia
Blalock taussig shunt is and indications
Shunt from subclavian artery to ipsilateral pulmonary artery
indications
- conditions with RVOT obstruction
- initial staged repair of hypoplastic left heart
Modified Fontan procedure is and indications
total cavopulmonary anastomosis. systemic venous return from SVC and IVC both supply the pulmonary arteries
Hypoplastic left heart syndrome is
a cyanotic congenital cardiac anomaly. results in underdevelopment of hte left heart structures incl LV, MV, AV, aortic root. ASD or PFO crucial for survival
Hypoplastic left heart imaging
XR
venous congestation
prominent RA border
variable heart size
Bicuspid aortic valve is and assoc
spectrum of deformed aortic valves with two unequally sized leaflets
assoc
- dilation of asc aorta
- other congenital cardiac; ASD/VSD, PDA, hypoplastic LHS, coarctation
- turners
- ADPCKD
Aortic valve stenosis is
the most common valvulopathy, narrowing of the valve.
most commonly degenerative calcification. espec with bicuspid valve.
Aortic valve stenosis classification
can be supravalvular, valvular or subvalvular
Supravalvular
- Congenital (williams)
- acquired (post op, takayasu, syuphillis)
Valvular
- congenital ; bicsupid valve, tricuspid, unicuspid, quadricuspid
- acquired; RHD, senile calcific stenosis, radiation
Subvalvular
- subaortic membrane
- shone complex
- hypertrophic subaortic stenosis assoc with HOCM
Total anolamous pulmonary venous return is and assoc
cyanotic congenital heart anomaly with abnormal drainage anatomy of the entire pulmonary venous system.
required a R2L shunt is required for survival
Assoc
- other cardiac lesions
- heterotaxy
- thoracic lymphangiectasia and pulmonary congestation
TAPVR classification
Depends on site of anomalous venous union
Type 1 supracardiac
- SVC, azygous, brachiocepahlic
Type 2 cardiac
- CS then RA
Type 3 infracardiac
- forms vertical descending vein behind LA
- usually through oesophageal hiatus to DV, PV, HV or IVC
Tetraology of Fallot is and assoc
most common congenital heart condition
consists of
- VSD
- RVOTO
- Overriding aorta
- RVH
Assoc
- right arch
- pulm hypoplasia
- ASD/PDA
- left SVC
- congenital lobar emphysema
- DiGeorge
- VACTERL
- prune belly
- TOF
Treated w
- shunts (palliative)
- primary repair (VSD closure, relief of RVOTO)
Transposition of the great arteries is and types
cyanotic congential cardiac anomaly. ventriculoarterial disocordance.
L loop (congenital corrected)
- also has atrioventricular discordnace
D loop
- incompatible with life without an ASD/VSD/PDA/PFO
Repaired with an arterial switch proceudre
Truncus arteriosus is
a cyanotic congenital heart anomaly in which a single trunk supplies both the pulmonary and systemic circulation
almost always has a vsd to allow. other associ
- right arch
- interrupted arch
- digeorge
- charge
Double outlet right ventricle is and assoc
Congenital cardiac anomaly. both the aorta and PT arise from the right ventricle.
Assoc
- T13, T18
- congenital pulmonary stenosis
- coarctation
- right sided arch
- anomalous pulmonary venous return
- TOF
Pulmonary artery atresia is and classification
a congenital cardiovascular anomaly in which there is complete disruption between the RVOT and the pulmonary trunk
three types
- pulmonary atresia with intact IVS
- pulmonary atresia with VSD
- complex (with complex cardiac malformations)
Assoc
- TOF
- Truncus
- Heterotaxy
Unilateral pulmonary artery atresia is and assoc
a variant of pulmonary artery atresia where the proximal main pulmonary artery is interrupted
assoc
- septal defects
- coaractation
- right arch
- truncus
- tof
Unilateral pulmonary artery atresia imaging
- volume loss to ipsilateral lung
- overinflation and midline shift of the contralateral lung
- hyperlucent due to oligaemia
Partial anomalous pulmonary venous return is
a rare congenital cardiovascular condition in which some of the pulmonary veins drain into the right atrium rather than the left atrium
can be supracardiac, cardiac, infracardiac or mixed types
Scimitar syndrome is
aka hypogenetic lung syndrome. hypoplastic lung drained by an anomalous vein into the systemic venous system
Combination of pulmonay hypoplasia and PAPVR
Congenital pulmonary venolobar syndrome is
anomalous pulmonary venous drainage
- scimitar syndrome
pulmonary sequestration
horseshoe lung
Pulmonary venous varix is and assoc
localised dilatation of a pulmonary vein
assoc
- HHT
- mitral valve disease
Coronary artery aneurysm causes
Atherosclerosis
Inflammatory
- kawasaki
- mycotic
Non inflammatory
- congenital
- ctd
- trauma
- iatrogenic
- durgs
Left ventricular aneurysm is
discrete dyskinetic areas of the LV wall with a broad neck. usually anterior or anterolateral wall. contain all layers of the heart wall
Left ventricular aneurysm imaging
focal lateral bulging left heart border
thin cirvilinear calcification
left retrocardiac doubel density
broad neck
ddx
pseudoaneurysm
LV diverticulum
Left ventricular pseudoaneurysm
false aneurysm resulting from MI and contained myocardial rupture. contained by adherent pericardium or scar tissue. usually has a narrow neck
Pericardial agenesis is and assoc
rare condition where there is absence of the pericardium to varying degrees. if small then known as pericardial defect
assoc
- congenital cardiac (asd/pda/bicuspid/mvs/tof)
- bronchogenic cyst
- pulmonary sequestration
Pericardial agenesis imaging
XR
- elevated cardiac apex
- indistinct right heart border
- prominent pulmonary artery segment
- lucency bw aorta and PT
- increased cardiophrenic space
- “snoopy sign”
CT
- absence of the thin pericardial lining around the heart
- levoposition
MR
- loss of normal pericardium
- levoposition
- increased cardiac mobility
- interposition of the lung; tongue of tissue bw the MPA and aorta
- lung tissue bw heart and other structures
- lung tissue bw diaphragm and base of heart
Pericardial cyst maging
can be anywhere adjacent to the heart, commonly right cardiophrenic angle
XR
- density at the cardiophrenic sulcus
- variable shape/size
ddx
- pericardial diverticulum
- pericardial fat pad
- thymic lesion
- mediastinal teratoma
- morgani hernia
Cardiophrenic angle lesions
Pericardial fat pad
Pericardial cyst
Pericardial fat necrosis
Morganis hernia
Nodes
Pericardial lipomatosis
Neurogenic tumour
Thymoma
RML collapse
RML consol
Fibrous tumour of the pleura
Hydatid
Single pleural based mass ddx
Tumours
- pleural (SFT, meso)
- mets
- lymphoma
- thymoma
- lipoma
Loculated fluid
Ribs/Chest wall
- Ewings
- Askin
Intercostal nerve lesion
Thoracic splenosis
TB
Solitary fibrous tumour of the pleura are
rare, pleural based tumours. tend to be benign and slow growing. 30% can be malignant.
assoc
- hypoglycaemia (Doege potter syndrome)
- HPOA
SFT of the pleura imaging
XR
- pleural based mass
- can be pedunculated
- rare to have effusion/calc/aggressive ft
CT
- can be heerogenous
Ewings sarcoma chest wall is and path
malignant tumours affecting children and young adults, originating from bone or soft tissues
large extrapulmonary invasive soft tissue masses that are heterogenous, enhancing, with calc rarely
Cardiomyopathy classificiation
2006 AHA
PRIMARY
Genetic
- hypertrophic
- arrythmogenic
- left non compaction
- conduction def
- ion channelopathies
- mitochondrial
Mixed
- dilated
- resistive
Acquired
- Inflammaotry eg myocard
- stress eg takotsubo
- peripartum/postpartum
- tachy induced
SECONDARY
Infiltrative
- amyloid
- gaucher
- hurler/hunter
Storage
- haemochromotosis
- Fabry
- glycogen storage
- Niemann Pick
Toxic
Endomyocardial
- fibrosis
- loeffler endocarditis
Sarcoid
Autoimmune
- SLE
- scleroderma
- dermatomyositis
- PAN
- RA
Endocrine
- DM
- hypothyr
- hyperthy
- hyperpara
- phaechromocytoma
Neuromusclar conditions
- Friedriches, NF, TS
Nutritional
- Beri beri, pellagra, scurvy
Electrolye imblances
Cardiac myxoma is and path
commonst primary cardiac tumour in adults
present with valvular obstructin, embolic events andor constitutional symptoms
benign neoplastic. usually left atrial attached to the interatrial septa. dystrphic calc from haemorrhage is common. carney complex.
next most common is cardiac lipoma, just a fun fact 4 u elias
Carney complex
- cardiac myxomas
- extracardiac myxomas
- skin pigmentation
- pit adenoma
- psammomatous melanotic schwannoma
- testicular tumours (sertoli)
- osterochondromyoxoma
Papillary fibroelastoma of the heart is
a benign primary cardiac tumour
characterised by papillary growth of stromal tissue with a dense amorphous fibrous core. layer of elastic fibres
occur in relation to aortic or mitral valve
Cardiac rhabdomyoma is and assoc
benign myocardial tumour. most common fetal cardiac tumour. usually left ventricle.
assoc
- TS (50%)
- congenital renal
Cardiac angiosarcoma is and imaging
most common sarcoma of the heart. tend to occur in the right atrium and invovle the pericardium.
type main appearances
- diffusely infiltrating mass along the pericardium
- well defined mass protruding into the cardiac change. heterogenous enahcnement
Cardiac angiosarcoma is and imaging
most common sarcoma of the heart. tend to occur in the right atrium and invovle the pericardium.
type main appearances
- diffusely infiltrating mass along the pericardium
- well defined mass protruding into the cardiac change. heterogenous enahcnement
other sarcomas
- undifferentiated pleomorphic sarcoma
- leiomyosarcoma
- rhabdomyosarcoma
Parathyroid gland position
majority are juxtathyroid and posterior or inferior to the thyroid
ectopic
- mediastinum
- retropharyngeal
- carotid sheath
- intrathyroidal
- thymus, thyroid gland, TE groove
Castleman disease is and types
aka angiofollicular ln hyperplasia or giant ln hyperplasia
uncommon benign b cell lymphoproliferative condition
two subtypes
- unicentric; more common, localised
- multicentric; HIV infection, diffuse nodes, anaemia, splenomegaly, systemic sx
Castleman diseas assoc
POEMS syndrome
Osteosclerotic myeloma
Kaposi sarcoma
AIDS
Amyloidosis
Chordoid meningioma
Castlemans disease imaging
CT
- variable position, typically thorax
- can be one mass or multiple
- intense homogenous enhancement post con
- can have calcs or necrosis
- if multicentric; nodes, hepatosplenomegaly, ascites
Lymphatic malformation types and assoc
Can be
- macrocystic
- microcystic
- mixed
Majority in the head and neck. Can also be
- hepatic
- splenic
- pancreatic
- renal
- retroperitoneal
- mediastinal
Assoc
- lymphangioleiomyomatosis
- Noonan
- Turner
- T13, 18, 21
Lymphatic malformation imaging
US
- multilocular cystic mass
- internal septa
- variable cystic contents
- can have solid foci
- can have flow in septa
CT
- most appear homogenous and cystic
- minimal mass effect
MRI
Fluid fluid levels
T1 variable T2 high
DDX
- haemangioma
- Venous malformation
- cystic teratoma
Anterior mediastinal mass ddx
Thymic
- thymoma
- invasive thymoma
- thymic carcinoma
- thymolipoma
- thymic cyst
- thymic hyperplasia
- thyrmic carcinoid
Thyroid/parathyroid
- thyroid neoplasm
- goitre
- parathyroid neoplasm
Lymphoma
- NH and H
Germ cell
- teratoma
- seminoma
- embryonal
- YS
- chorio
- mixed
Vascular
- thoracic aneurysm
- subclavian aneurysm
Thymic epithelial lesions are, types and assoc
rare tumours arising from the thymus
Can be;
Non invasive
Invasive
- invasive thymoma
- thymic carcinoma
assoc
- MG - 20% of MG have thymoma, 50% of thymoma have MG
- red cell aplasia
- hypogammaglobulinaemia
- SLE
- RA
- Graves
- pernicious anaemia
Thymic epithelial lesion imaging
XR
- anterior mediastinum, slightly lateral
CT
- soft tissue attenuation
- cystic component common
- calcification common
- invasive; mediastinal fat invasion, larger, nodes, pleural seeding
MR
T1 iso to hyper
T2 heterogenous, cystic spaces
I/OOP no drop out
C+ linear enhancement
Thymolipoma is, assoc and imaging
rare benign thymic tumour
assoc
- aplastic anaemia
- hypogammaglobulinaemia
- graves
- HL
- CLL
XR
- anterior med
- if large, can hang down and mold to mediastinum
CT
- almost entirely fatty with some areas of inhomgenous soft tissue
MR
- high T1
- suppresses
Thymic cyst types and imaging
Can be congenital or acquired
Congenital
- rare, derived from patent thymopharyngeal duct
- often unilocular
Acquired
- thoractomy, chem or ray
- uni or multilocular
- inflammatory
CT
- uni or multilocular
- can be lobulated with soft tissue attenuation components
- can have curvilinear wal calc
ddx
- cystic thymoma
- cystic teratoma
- lymphangioma
Thymic hyperplasia types and causes
Can be true or lymphoid
True
- Rebound
- Radiation
- Burns
- Severe systmic stresses
Lymphoid
- MG
- SLE
- RA
- Scleroderma
- Graves
Thymic hyperplasia imaging
Diffuse symmetric enlargement
MR
- decreased signal I/OOP due to chemical shift artifact
Features
- soft tissue masses 7mm
- convex contour >19yo
- soft tissue lobulation
- increased thymic thickness >1.3cm >20yo
- presence of assoc dx
Thymic carcinoid tumour is and assoc
Carcinoid tumour arising in the thymus. Middle aged guys.
Assoc ; MEN 1
Heterogenous on imaging. Dotatate avid.
Mediastinal germ cell tumour types
Seminoma
Non seminoma
- embryonal
- chorio
- YS
- teratoma (most common)
- mixed
Mediastinal teratoma path
GCTs arising from ectopic pluripotent stem cells that fail to migrate from the yolk endoderm to the gonad. contain all three layers.
can be mature, immature or with malignant transformation
adults in children, but more common children. most common germ cell tumour. usually middle aged adults of <1yo.
assoc
- klinefelters
- NLL
- pleomorphic undiff sarc
trichoptysis (virtually pathnogmaonic)
Mediastinal teratoma imaging
Usually anteiro med, but can be elsewhre
Mature
- large and cystic
- fat and calc, FFL level
- septal/rim enhancement
- can rupture
Immature
- solid
Mediastinal seminoma is and imaging
primary malignant germ cell tumours of the mediastinum
bhcg or ldh can be elevated
afp normal
imaging
- bulky, homogenous, lobular
- can have cystic, haemorrhage, necrotic components
- mild enhancement, homogenous
DiGeorge syndrome is and mnemonic
22q11.2 deletion syndrome, or velocardiofacial syndrome
CATCH 22
- Congenital heart/Conotruncal
- Abnormal facies
- Thymic hypoplasia
- Cleft palate/cellular immune def
- Hypoparathyroidism w hypocalc
- 22 chromosome
also assoc with
- choanal atresia
- mondini malformations
- brain melformations
Fibrosing mediastinitis is
a rare non malig collagen/fibrous prolif condition within the mediastinum
chrnoic inflammation and fibrosis. leads to compression of the medastinal strucutres. can be focal or diffuse
Fibrosing mediastinitis assoc and causes
assoc
- reidels
- retroperitoneal fibrosis
- behcet
- RA
- SLE
Causes
- idiopathic (igg4)
- infection (histo, tb)
-malignancy
- sarcoid
- radiation
- drugs
Fibrosing mediastinits imaging
CT
- can be mass like or infiltrative
- calc ln (histo)
- trachobronch narrowing
- endobronc calc
- oeso narrowing
- pulmonary infiltrates
- interstitial pattern
- crazy paving
- svc compression
- enlarged bronchial aa
- pleural thickening/calc
