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PART 2 > CHEST > Flashcards

CHEST Flashcards

1
Q

Pneumothorax causes

A

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

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2
Q

Catamenial pneumothorax

A

recurrent pneumoo during menstruation, related to endometriosis of the pleura

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3
Q

Buffalo pneumothorax

A

bilateral due to abnormal communication of the pleural spaces

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4
Q

Tension pnuemothorax features

A

Increased intercostal spaces
Contralateral mediastinal shift
Depression of the hemidiaphragm

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5
Q

Pneumomediastinum causes

A

Trauma
Surgical
Oesophageal perf
Tracheobronchial perf
Vigorous excercise
Asthma
Barotruama
Infection
Interstitial lung disease
CTD

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6
Q

Pneumomediastinum imaging

A

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

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7
Q

Pneumopericardium cuases

A

PPV
surgery
penetrating trauma
Infectious pericarditis
fistula

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8
Q

Haemothorax causes

A

Malignancy
- usually wall, but also soft tissue sarc, hcc, lung

Spontaneous

Anticoags

Vascular rupture

Endometriosis (catamenial)

Pleural adhesions

Haemophilia

CTD

Bony exostoses

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9
Q

Haemopericardium causes

A

ruptured MI

Ruptured LV aneurysm

Dissection

Pericarditis

Trauma

Malignancy

Ruptured CA aneurysm

post thrombolysis

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10
Q

Oesophageal perforation causes and complications

A

Post instrumentation
Radiation oesophagitis
Trauma
FB ingestation
Malignancy
Post vomiting (Boerhaave)
Acute necrosis

Complications
- mediastinitis
- pleural distula
- pneumonia
- empyema
- sepsis

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11
Q

Boerhaave syndrome path

A

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

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12
Q

Bronchiolitis imaging and classification

A

Centrilobular micronodules
Bronchial wall thickening
Bronchiolectasis
Mosaic attenuation

Inflammatory
- infectious
- HP
- RB/RBILD
- follicular
- panbronchiolitis
Fibortic
- constrictive
Granulomatous bronch
Diffuse panbronch

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13
Q

Infective bronchiolitis is and causes

A

inflammatory bronchiolitis with definite infective precip

Viruses
- RSV, children
bacterial
mycobacterial
- tb
- atypical
funcal
- asperfillus, immunosupp

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14
Q

Infective bronchiolitis imaging

A

Centrilobular nodules
tree in bud
wall thickening
can ahve GGO

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15
Q

Hypersensitivity pneumonitis is

A

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

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16
Q

Hypersensitivity pneumonitis imaging

A

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

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17
Q

Respiratory bronchiolitis is and imaging

A

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

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18
Q

Respiratory bronchiolitis interstitial lung disease is

A

a smoking related ild, closely related to RB but more severe

pigment laden macrophages. fibrosis extending bryond the tissues. similar to DIP

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19
Q

RB ILD imaging

A

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

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20
Q

Follicular bronchiolitis is, assoc, path and imaging

A

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

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21
Q

Diffuse panbronchiolitis is and imaging

A

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

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22
Q

Obliterative bronchiolitis is

A

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

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23
Q

Bronchiolitis obliterans causes

A

CRITTS

COP
RA
Infectious
Transplant
Toxins
Sarcoid/Swyer james

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24
Q

Obliterative bronchilitis imaging

A

sharply defined areas of decreased attenuation
bronchiectasis
bronchial wall thickeing
ggo’s

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25
Q

Bronchiectasis aetiology

A

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

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26
Q

Central bronchiectasis causes

A

ABPA

Mounier Kuhn/congnietal tracheobronchomegaly

CF

Williams campbell

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27
Q

Upper lobe bronchiectasis

A

CF

TB

Traction in
- radiation
- sarcoid
- silicosis/pneumoconioses

ABPA

Chronic hypersens

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28
Q

Right middle lobe bronchiectasis

A

non tb MAC

middle lobe syndrome in children

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29
Q

Lower lobe bronchiectasis

A

Post infective

Aspiration

Immunodeficiency

Primary ciliary dyskinesia

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30
Q

CF is and general manifestations

A

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

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31
Q

CF path

A

homozygous defect of the CFTR gene on 7q31.2

encodes a transmembrane protein known as CFTR, regulates passages of chloride across cell membranes

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32
Q

Primary ciliary dyskinesia is and clinical

A

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

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33
Q

Primary ciliary dyskinesia path and assoc

A

complete or partial dyneian arm absnece
radial spoke defect
microtubular transposition

assoc
- kartageners
- young syndrome
- pectus
- hydrocephalus
- congenital heart disease
- bilairy atresia

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34
Q

Kartageners syndrome is

A

a subset of pcd. characterised by a clinical triad of
- situs inversus
- chronic sinusitis
- bronchiectasis
- also; telecanthus, infertility in men, subfert in women

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35
Q

ABPA is

A

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

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36
Q

Mounier Kuhn syndrome is

A

trachobronchomegaly. absence of elastic fibres and smooth muscle within the wall of the trachea and main bronchi

trachea >3cm, 2 cm above arch

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37
Q

Williams campbell syndrome is

A

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

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38
Q

Types of atelectasis and their causes

A

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

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39
Q

Round atelectasis is and imaging

A

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

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40
Q

Tracheobronchial stenosis causes

A

Malignant

Non malignant
- papillomatosis

Infective/inflamm
- endobronchial tb
- GPA
- relapsing polychondritis
- tracheobronchial amyloid
- sarcoid

Other
- post op
- intubation
- TBPOCP
- broncholithiasis
- keutel syndrome

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41
Q

Respiratory papillomatosis is

A

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

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42
Q

Granulomatosis with polyangitis upper resp tract manifestations

A

Sinusitis
Nasal septal perf
Subglottic stenosis

lacrimal gland involvemnt
sclerosing osteitis of the nasal cavity
sinonasal mucosal ulcers

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43
Q

Relapsing polychondritis is and imaging

A

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

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44
Q

Tracheobronchopathia osteochondroplastica is and imaging

A

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

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45
Q

Laryngomalacia is

A

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.

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46
Q

Tracheobronchomalacia is

A

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.

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47
Q

Pulmonary hypoplasia is

A

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

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48
Q

Community acquired pneumonia is and causes

A

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

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49
Q

Hospital acquired pnemonia is and causes

A

also known as nosocomial, occur 48 hours after admission

aetiology
- early; strep, h influenxza
- late; pseudomonsa, kelbsiella, acinetobacter

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50
Q

Aspiration pneumonia general pattern

A

recumbent
- posterior upper lobes, superior lower lobes

erect
- bilateral basal, middle lobe, lingula

can be acute or chronic

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51
Q

Acute aspiration pneumonitis imaging

A

centrilobular nodules, TIB
GGO
airway plugging
atelectasis
consolidation

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52
Q

Chronic aspiration pneumonitis imaging

A

dependant regions
centrilobular nodules
GGO
lung distortion
- septal lines
- bronchiectasis, lower zone
- bronchial wall thickening

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53
Q

Viral pneumonia causes and imaging

A

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

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54
Q

COVID imaging

A

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

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55
Q

BTSI Covid reporting

A

Classic
- lower lobe and peripheral opacities bilateral
Indeterminate
- doesnt fit classic
Non C19
- ptx, lobar, effusions, oedema
Normal

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56
Q

RSNA CT appearance

A

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

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57
Q

CMV infection is, imaging and ddx

A

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

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58
Q

Varicella pneumonia imaging and ddx

A

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

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59
Q

Atypical pneumonia is, causes and imaging

A

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

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60
Q

Bacterial pneumonia causes and imaging

A

strep
staph
kleb
h influ
morax

imaging
- focal segmental ie bronchopnuemoa
- or lobar opacities

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61
Q

bulging fissure

A

kleb
strep
pseudomonosa
staph

less commonly; legionellla, mycobacterium

also; adeno, abscess, haemorrhage

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62
Q

traversal of fissures

A

malignancy

infection; tb, actino, nocardio, sterp, blasto, mucomycosis

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63
Q

Necrotising pneumonia is and causes

A

pneumonia with necrosis of the tissue

staph; young, immunocompetent
kleb
enterobacter
nocardia
actinomyces
pseudomonas
penumococus
h influenzae

imaging
- low attenuation and non enhancement

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64
Q

Cavitating pneumonia is

A

a complication of severe necrotising pneumonia

kids; strep, aspergillus, legionella, staph

adults; pneumococcal, kleb

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65
Q

Lung abscess is and causes

A

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

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66
Q

Lung abscess imaging and ddx

A

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

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67
Q

Pulmonary aspergillosis includes

A

aspergilloma
abpa
invasive aspergillosis
- subacute inviasive
- airway invasive
- angioinvasive
obstructive bronchopulmonary aspergillosis
chronic cavitatory or fibrosing

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68
Q

Aspergillomas are and aetiology

A

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

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69
Q

ASpergilloma imaging

A

mass within a cavity
air around takes cresvent shape (monod)
mobile on positioning
soft tissue attenuation, can have calcs

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70
Q

Subacute invasive pulmonary aspergillosis is

A

a subacute to chronic localised and indolent form of invasive aspergillosis. patients with depressed immune system, but not profoundly immunocompromised.

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71
Q

Subacute invasive pulmonary aspergillosis imaging

A

upper zones
begins as opacity
eventrually necrotic part separates, forming air crescent
eventually cavity with or without mycetoma

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72
Q

Airway invasive aspergillosis is

A

invasive aspergillosis that affects the airways as the major feature

occurs in immunocompromised neutropenic patients, like AIDS

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73
Q

Airway invasive aspergillosis imaging

A

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

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74
Q

Angioinvasive aspergillosis is

A

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

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75
Q

Angioinvasive aspergillosis imaging

A

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

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76
Q

Reverse halo sign causes

A

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

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77
Q

Halo sign aetiology

A

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

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78
Q

thoracic histoplasmosis imaging

A

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

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79
Q

Pulmonary crytpococcis is

A

a form of fungal infection. inhalation of fungal spores. immunocompromised typically, but also competent with exposed to avian droppings

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80
Q

Pulmonary cryptococcus imaging

A

several patterns
- clustered nodular
- soliday nodular/mass with or without cavitation
- scattered nodules
- peribronchovascular consol

most commonly nodules, multiple, small, well defined

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81
Q

pulmonary mycormycosis is

A

an opportunistic fungal infection. encountered in patients with prolonged neutropaenia.

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82
Q

Pulmonary mycormycosis imaging

A

non spec; solitary nodule, lobular consoidation, cavitatory lesion or disseminated

ct
- ggo
- reverse halo or birds nest
- peripehral capsule thicker than op

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83
Q

Pneumocystis jiroveci pneumonia is

A

an atypical pulmonary infection, most common opportunistic pathogen in patients with AIDS

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84
Q

PJP imaging

A

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

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85
Q

PJP ddx

A

viral pneumonitis
- cmv
- covid
TB
angioinvasive aspergillosis
IRIS

cysts
- LCH
- LAM
- bronchiectasis
- honeycomb

Reticulonodular
- sarcoid
- gpa
- pneumoconioses
- hp
- kaposis

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86
Q

Pulmonary tb types

A

Primary
Post primary
Miliary
Tracheal/bronchial
Pleural

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87
Q

Primary pulmonary tb imaging

A

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”

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88
Q

Post primary tb imaging

A

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

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89
Q

Miliary tb imaging

A

represents haematogenous spread
can be primary or post primary
tiny nodules, uniform size and distribution

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90
Q

Non TB mycobacterial infection is

A

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

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91
Q

Pulmonary mycobacterium avium complex is and assoc

A

non tb mycobacterial infection

assoc
- elderly women
- middle ages males /smokers/dreinkes
- immunocomp
- cf
- alpha 1 anti
- bronchiectasis, copd, pneumoconioses

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92
Q

Pulmonary MAC types and imaging

A

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

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93
Q

Pulmonary hydatid imaging

A

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

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94
Q

Pulmonary hydatid signs

A

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

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95
Q

Solitary pulmonary nodule ddx

A

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

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96
Q

Squamous cell carcinoma quick path

A

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

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97
Q

Lung adenocarcinoma path (including types)

A

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

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98
Q

AAH lung

A

localised small cell prolif <5mm, atypical typr 2 pnuematocytes

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99
Q

Adenocarc in situ

A

<3cm
no pattern except lepidic
no invasion
non mucinous, mucinous or miced

pure gg nodule or part solid

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100
Q

Minimally invasive adeno

A

<3cm, purely lepidic or <5mm stromal
no necrosis, lymphatic, vascular or pleural
non mucinous, mucinous, mixed

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101
Q

Lepidic predominant adeno

A

> 3cm, >5mm lymphatic, vascular or pleural
non mucinous lepidic growth pattern

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102
Q

invasive mucinous adeno

A

commonly multicentric, multilobar, bilateral

originate from columnar mucus cells

kras present
egfr absent

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103
Q

Small cell lung cancer is

A

a subtype of bronchogenic carcinoma. neuroendocrine tumours. rapid growth, highly malignant, widely metastasise

arises from bronchial mucosa. commonly necroses, invased and has paraneoplastic syndromes

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104
Q

Small cell lung ca imaging

A

central, mediastinal involvment, direct invasion

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105
Q

Large cell lung cancer

A

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

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106
Q

Bronchial carcnoid is, path and imaging

A

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

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107
Q

Lymphangitis carcinomatosis aetiolgoy and imaging and ddx ehy not

A

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

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108
Q

Pulmonary hamartoma is and imaging

A

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

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109
Q

Peripheral pulmonary carcinoid vs hamartoma

A

carcinoids
- higher attenuation
- more lobulation
- more distal nodulairt
- atelectasis
- distal trapping
- more extension/bronchial invovmment
- marked enhancement

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110
Q

Fat containing pulmonary nodule

A

hamartoma
lipoma
myelolipoma
lipoid pneumonia
lipsarc met
renal cell met

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111
Q

Hyperattenuating pulm nodule ddx

A

granuloma
hamartoma
bronchogenic carcinoma
carcinoid
mets; mucinous adeno, dystrophic calc, bone froming

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112
Q

Pulmonary lyphoma is

A

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

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113
Q

Pulmonary lymphoma imaging

A

variable

mass like consolidation; no cavaitation no bronchograms
pleural origin
nodules <1cm
peribronchial thickneing
effusions
nodes

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114
Q

DIPNECH is

A

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

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115
Q

Pulmonary oedema causes

A

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

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116
Q

Non cardiogenic oedema causes

A

NOT CARDIAC

Near drowning
O2 therapy
Trauma/transfusion
CNS
Allergic alveolitis
Renal failure
Drugs
Inhaled toxins
Altitude
Contusion

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117
Q

Unilateral pulmonary oedema causes

A

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

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118
Q

ARDS is

A

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

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119
Q

UIP is and causes

A

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

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120
Q

UIP imaging

A

CT
- honeycombing
- subpleural reticular opacitiies
- traction bronciectasis
- lung distortion
- GGO(less than reticulation)
- volume loss
- basal predominant

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121
Q

IPF is

A

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

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122
Q

NSIP is and causes

A

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

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123
Q

NSIP imaging

A

CT
- ggo; symmetrical, all zones or basal
- subplerual sparing
- reticular opacitieis
- bronchovascular thickening
- traction b
- volume loss
- microcystic honeycombing sometimes

124
Q

Acute interstitial pneumonitis is

A

also known as hamman rich syndrome. rapidly progressive non infectious interstitial lung disease of unknown aetiology. only acute idiopathic interstitial pneumonia.

125
Q

AIP imaging

A
  • similar to ARDS initially
  • GGO, bilateral and symmetric
  • traction bronchiectasis
  • parecnhymal architectural disotrotion
  • airspace consolidation
126
Q

Organising pneumonia is and secondary causes

A

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

127
Q

Cryptogenic organising pneumonia imaging

A

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

128
Q

Diffuse pulmonary haemorrhage is and assoc

A

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

129
Q

Diffuse pulmonary haemorrhage iamging

A

bilateral consolidation with apical sparing
ggo/crazy pavy/ consolidation
later; diffuse nodules, interlobular septal thickening due to lymphatic haemosiderin

130
Q

Goodpasture syndrome is

A

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

131
Q

Goodpasture imaging

A

XR
- bilateral coalescent airspace opacitieis
- resolves in 2 weeks

ct
- ggo, progress to crazy paving
- hilar nodes
- no interlobular in acute phase

132
Q

Pulmonary haemosiderosis is and causes

A

iron deposition within the lungs

can be primary
- goodpastures
- heiner; hypersens to cow milk protein
- idiopathic

or secondary
- often due to mitral stenosis

133
Q

Pulmonary haemosiderosis imaging

A

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,

134
Q

Heiner syndroime is

A

a rare form of primary pulmonary haemosiderosis associated with an allergy to cows milk

includes;
- rectal blood loss
- pulmonary infiltrates
- hypoproteinemia

135
Q

Lane Hamilton syndrome

A

rare concurrent association of idiopathic pulmonary haemosiderosis and coeliac disease

136
Q

LAM is

A

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.

137
Q

LAM imaging

A

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

138
Q

Birt Hogg Dube syndrome is

A

a multisystem disease characterised by fibrofolliculomas, lung cysts, increased risk of renal tumorus

139
Q

Birt Hogg Dube imaging

A

Lung cysts
Lower zone
Bilateral
Subpleural
thin walled, varaible sized

140
Q

Desquamative interstitial pneumonia is

A

an interstitial pneumonia, though to represent end stage RBILD. associated with heavy smoking.

141
Q

DIP imaging

A

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

142
Q

Pulmonary langerhans imaging

A

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

143
Q

Lymphoid interstitial pneumonitis is and assoc

A

benign lymphoproliferative disorder. subtype of interstitial lung disease.

assoc
- sjogrens (most common)
- aids
- autoimune thyroid
- SLE
- castlemanns
- CVID
- RA
- pulmonary amyloid

144
Q

LIP imaging

A

CT
- mid to lower
- thickening bornchovascualr bbundles
- interstitial trhickening
- small variable pulmonary ondules
- GGO
- scattered cysts, tend to be pervascular or subpleural

145
Q

Lipoid pnuemonia is and assoc

A

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

146
Q

Lipoid pnuemonia imaging

A

low attenuation within the consolidated area reflecting fat content
dependant lung
ossific foci in affected region
can have crazy paving

147
Q

Puylmonary alveolar proteinosis is

A

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

148
Q

Pulmonary alveolar proteinosis imaging

A

XR
- batwing
- diffuse pulmonary opacities
- diffuse consolidation
- reticulonoular

CT
- crazy paving

149
Q

Crazy paving ddx

A

ARDS
Bacterial pneumonia
AIP
PAP

Drugs
Radiation
Haemorrhage
Chronic eosinophilic
UIP
Oedema
INfections
COP
Invasive mucinous adenocarc
Sarcoid
Lipod pnuemonia
Pulmonary veno occlusive disease

150
Q

Simple pulmonary eosinophilia is

A

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

151
Q

Acute eosinophilic pneumonia imaging

A

Bilateral GG
Interlobular septal thickening
Pleural eff
BV bundle thickening
Consolidation
Centrilobular nodules

152
Q

Chronic eosinophilic pneumonia is and imaging

A

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

153
Q

Eosinophilic granulomatosis with polynagiitis is

A

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

154
Q

Eosinophilic granulomatosis with polynagiitis imaging

A

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

155
Q

Pulmonary alveolar microlithiasis is and imaging

A

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

156
Q

Calcified pulmonary nodules ddx

A

healed infection
occupathional disease
calcified mets
hamartomas
met pulmonary calcification
pulmonary haemosiderosis
pulmonary alveolar microlithiasis
sarcoid
calc fibrous pseudotumour
pulmonary amyloidosis

157
Q

Calcified pulmonary nodules ddx

A

healed infection
occupathional disease
calcified mets
hamartomas
met pulmonary calcification
pulmonary haemosiderosis
pulmonary alveolar microlithiasis
sarcoid
calc fibrous pseudotumour
pulmonary amyloidosis
carcinoid

158
Q

Non calcified hyperdense pulmonary nodules ddx

A

inhalational/pneumoconioses
acrylic cement embolism

159
Q

Metastatic pulmonary calcification is and causes

A

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

160
Q

Metastatic pulmonary calcfication imaging

A

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

161
Q

CPFE is

A

a smoking related interstitial lung disease characterised by the coexistence of UIP/NSIP with emphysema

162
Q

Silicosis is and types

A

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)

163
Q

Silicosis imaging

A

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

164
Q

CWP is

A

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.

165
Q

Asbestos related diseases include

A

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

166
Q

Pleural plaques are

A

a common manifestation of asbestos related disease. long latency after exposure.

167
Q

Pleural plaque imaging

A

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”

168
Q

Diffuse pleural thickening causes

A

Diffuse pleural fibrosis
ASbestos related pleural thickening
Malignant pleural effusion
Primary pleural lymphoma
Other neoplasm; invasive thymoma, melanoma etc

169
Q

Fibrothorax is and causes

A

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

170
Q

Asbestosis imaging

A

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

171
Q

Mesothelioma is and path

A

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

172
Q

Mesothelioma imaging

A

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

173
Q

Berylliosis imaging

A

Similar to sarcoid

CT
- nodules
- upper lobe fibrosis
- diffuse interstitial fibrosis
- traction b
- interlobular septabl thickening

174
Q

Radiation pneumonitis

A

is the acute manifestation of radiation induced lung disease. typically 4-12 weeks post.

175
Q

Radiation pneumonitis imaging

A

changes localised to field
GGO/consolidation

other patterns/features
- halo sign
- reversed halo
- nodules
- TIB
- crazy paving
- pleural effusion
- atelectasis
- pulmonary necrosis

176
Q

Radiation induced pulmonary fibrosis is

A

the late manigestation of radiation induced lung disease. typically 6-12 months post

177
Q

Radiation induced pulmonary fibrosis imaging

A

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

178
Q

Radiation induced lung cancer types

A

lung
sarcoma (osteo, MFH)
breast cancer
malignant pleural meso
oesophageal

179
Q

Talcosis is and imaging

A

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

180
Q

Talc induced lung disease types

A

Talcosilicosis
Talcoasbestosis
Talcosis (inhalation)
Pulmonary talc granulomatosis

181
Q

Hard metal pneumoconiosis is

A

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.

182
Q

Pulmonary oedema causes

A

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

183
Q

Pulmonary vein thrombosis is and causes

A

A rare condtion, occuring secondary to
- intrapulm neoplasm
- post surgery
- post RFA
- fibrosing mediastinitis
- mitral stenosis w left atrial clot
- hilar torsion
- hypercoaguability
- idiopathic

184
Q

PE causes and risk factors

A

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

185
Q

PE XR features

A

Fleischner
Hampton
WEstermark
Effusion
Knuckle (cut off)
Palla/Chang

186
Q

Pulmonary hypertension is

A

a resting mean pulm arterial pressure of >25mmhg at right heart catheterisation

187
Q

Pulmonary hypertension imaging

A

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

188
Q

Pulmonary hypertension classification

A

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

189
Q

Swyer James syndrome is

A

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.

190
Q

Septic emboli is and causes

A

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)

191
Q

Septic emboli imaging

A

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

192
Q

Septic emboli ddx

A

cavitating mets
- squamous, GI adeno, sarcomas, TCC, cervical
necrobiotic mets
gpa
PE
infection

193
Q

Pulmonary AVM is, assoc and classification

A

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)

193
Q

Pulmonary AVM is, assoc and classification

A

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)

194
Q

Pulmonary AVM imaging

A

Dilated vessel
Multiple (HHT)
Serpiginous connection to vessels
Occasional phleboliths

195
Q

Hepatopulmonary syndrome is

A

a clinical syndrome defined by the presence of
- liver disease
- dilation of the pulmonary vasculature
- abnormalities in oxygenation (incr aa gradient)

196
Q

Hepatopulmonary syndrome imaging

A

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

197
Q

Pulmonary capillary haemangiomatosis is

A

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.

198
Q

Pulmonary capillary haemangiomatosis imaging

A

Diffuse bilateral reticulonodular pattern

Enlarged central pulmonary arteries

Mixed lobular GGO

199
Q

Pulmonary veno occlusive disease is and assoc

A

an uncommon variant of primary pulmonary hypertension that preferentially affects the post capillary pulmonary vasculature

assoc
- CTD
- HIV
- sarcoid
- LCH

200
Q

Pulmonary veno occlusive disease imaging

A

Varaible GGO
Interlobular septal thickening
Nodes
Effusions
Enlarged central PAs
Mosaic pattern of lung attenuation
Normal calibre veins

201
Q

Diffuse pulmonary lymphangiomatosis is

A

a rare condition characterised by diffuse proliferation of anastomosing lymphatic channels

202
Q

Diffuse pulmonary lymphangiomatosis imaging

A

Interlobular septal thickening
Peri-bronchovascular thickening
Patchy GGO
Pleural thickening
Pleural effusions
Mediastinal infiltrates

203
Q

Pectus excavatum is and assoc

A

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

204
Q

Pectus excavatum imaging

A

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

205
Q

Pectus carinatum is and association

A

Pigeon chest. chest wall deformity in which the sternum protrudes anteriorly.

assoc
- scoliosis
- cyanotic congenital heart disease
- marfan syndrome

206
Q

Pectus carinatum imaging

A

Middle and lower
- chondrogladiolar

Manubrium and upper
- chondromanubrial
- currarino silverman syndrome

207
Q

Pectus arcuatum is

A

wave like chest. mixed excavatum and carinatum. aka pouter pigeon chest.

208
Q

Scoliosis causes

A

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

209
Q

Pleural effusion types and causes

A

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

210
Q

Pleural effusion ultrasound imaging

A

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

211
Q

Chylothorax causes

A

Malignancy
Iatrogenic
Non surgical trauma

Idiopathic
Congenital thoracic duct ectasia
Lymphangiectasia
Fibrosing mediastinitis
TB
Nephrotic syndrome
TS
Amyloidosis
LAM
Sarcoid
Gorham (shoulder/thoracic osteolysis)

212
Q

Oleothorax is

A

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

213
Q

Oleothorax imaging

A

large dense apical lentiform calcified opacities with accompanied pleural thickening

ddx
- empyema
- haemothorax
- mesothelioma

214
Q

Meigs syndrome is

A

ascites and pleural effusions in assoc with a benign solid ovarian tumour

usually fibroma, or;
- fibrothecoma
- thecoma
- granulosa cell toumnrsou
- brenners tumours

215
Q

Poland syndrome is

A

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)

216
Q

Sprengel deformity is

A

congenital elevation of the scapula

assoc with
- omovertebral bar
- regional muscular atrophy
- klippel feil
- spina bfida, torticollis

217
Q

Aortic valve stenosis aetiology

A

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

218
Q

Heyde syndrome

A

Aortic valve stenosis and GIH

219
Q

Aortic valve regurg is

A

a valvulopathy that describes leaking during diastole that causes blood to flow in the reverse direction

220
Q

Aortic valve regurg causes

A

Root disease
- htn
- bicuspid
- ctd
- dissection
- takayasu
- syphilis

Valvular
- rhd
- calcidic as
- infective endocarditis
- prolapse
- quadricuspid valve
- as
- radiation

221
Q

Mitral stenosis is and causes

A

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

222
Q

Mitral stenosis imaging

A

LAE
Upper zone venous enlargement
Pulmonary oedema
Diffuse pulmonary haemorrhage
Secondary pulmonary haemosiderosis
Pulmonary ossification

223
Q

Mitral valve regurgitation is and causes

A

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

224
Q

Rheumatic fever is and diagnostic criteria

A

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

225
Q

Rheumatic heart disease is

A

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

226
Q

Infective endocarditis is

A

infection of the endocardium. commonly affects the valve leaflets, chordae tendinae, psothetic valves and implanted devices

227
Q

Dukes criteria

A

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

228
Q

Non bacterial thrombotic endocarditis is

A

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

229
Q

Libman Sacks endocarditis is

A

aka verrucous endocarditis. form of non bacterial thrombotic endocarditis. characterised by large vegetations over endocardial surface and assoc with SLE

230
Q

Pericardial effusion is and causes

A

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

231
Q

Pericardial effusion imaging

A

globular enlargement
water bottle
oreo cookie sign (lat)
cardiogenic pulmonary oedema

232
Q

Haemopericardium causes

A

ruptured MI
rupture LV aneurysm
aortic dissection
pericarditis
trauma
cardiac malignancy
ruptured CA aneurysm
post thrombolysis

233
Q

Pericarditis is, diagnostic criteria and types

A

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

234
Q

Neoplastic pericardial effusion causes

A

primary
- pericardial meso
- angiosarc
- fibrosarc
- pericardial lipoma
- fibroma

secondary
- lung
- breast
- melanoma
- lymphoma/leukaemia
- kaposis

235
Q

Constrictive pericarditis is and causes

A

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

236
Q

ASD associations

A

downs ++++++++
holt oram
ellis van creveld
mv prolapse
lutembacher syndrome
PAPVR/TAPVR

complications
- emboli
- eisenmeiger

237
Q

ASD types

A

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

238
Q

VSD assoc

A

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

239
Q

Patent ductus arteriosus is and associations

A

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

240
Q

PDA treatment

A

Medical
- prostaglandin e1 (keeps open)
- indometacin (closes)

Endovascular closure devices

Surgical clipping or ligation

241
Q

Ebstein anomaly is

A

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

242
Q

Ebstein anomaly associations

A

T13, 21
Turners
Multiple other congenital heart lesions
Conduction abnormalities

Can have TR or TS concurrently

243
Q

Ebstein anomaly imaging

A

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

244
Q

Uhls anomaly is

A

absence of the RV myocardium
normal Tricusp valve

245
Q

Tricuspid atresia is and assoc

A

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

246
Q

Blalock taussig shunt is and indications

A

Shunt from subclavian artery to ipsilateral pulmonary artery

indications
- conditions with RVOT obstruction
- initial staged repair of hypoplastic left heart

247
Q

Modified Fontan procedure is and indications

A

total cavopulmonary anastomosis. systemic venous return from SVC and IVC both supply the pulmonary arteries

248
Q

Hypoplastic left heart syndrome is

A

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

249
Q

Hypoplastic left heart imaging

A

XR
venous congestation
prominent RA border
variable heart size

250
Q

Bicuspid aortic valve is and assoc

A

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

251
Q

Aortic valve stenosis is

A

the most common valvulopathy, narrowing of the valve.

most commonly degenerative calcification. espec with bicuspid valve.

252
Q

Aortic valve stenosis classification

A

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

253
Q

Total anolamous pulmonary venous return is and assoc

A

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

254
Q

TAPVR classification

A

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

255
Q

Tetraology of Fallot is and assoc

A

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)

256
Q

Transposition of the great arteries is and types

A

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

257
Q

Truncus arteriosus is

A

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

258
Q

Double outlet right ventricle is and assoc

A

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

259
Q

Pulmonary artery atresia is and classification

A

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

260
Q

Unilateral pulmonary artery atresia is and assoc

A

a variant of pulmonary artery atresia where the proximal main pulmonary artery is interrupted

assoc
- septal defects
- coaractation
- right arch
- truncus
- tof

261
Q

Unilateral pulmonary artery atresia imaging

A
  • volume loss to ipsilateral lung
  • overinflation and midline shift of the contralateral lung
  • hyperlucent due to oligaemia
262
Q

Partial anomalous pulmonary venous return is

A

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

263
Q

Scimitar syndrome is

A

aka hypogenetic lung syndrome. hypoplastic lung drained by an anomalous vein into the systemic venous system

Combination of pulmonay hypoplasia and PAPVR

264
Q

Congenital pulmonary venolobar syndrome is

A

anomalous pulmonary venous drainage
- scimitar syndrome
pulmonary sequestration
horseshoe lung

265
Q

Pulmonary venous varix is and assoc

A

localised dilatation of a pulmonary vein

assoc
- HHT
- mitral valve disease

266
Q

Coronary artery aneurysm causes

A

Atherosclerosis

Inflammatory
- kawasaki
- mycotic

Non inflammatory
- congenital
- ctd
- trauma
- iatrogenic
- durgs

267
Q

Left ventricular aneurysm is

A

discrete dyskinetic areas of the LV wall with a broad neck. usually anterior or anterolateral wall. contain all layers of the heart wall

268
Q

Left ventricular aneurysm imaging

A

focal lateral bulging left heart border
thin cirvilinear calcification
left retrocardiac doubel density
broad neck

ddx
pseudoaneurysm
LV diverticulum

269
Q

Left ventricular pseudoaneurysm

A

false aneurysm resulting from MI and contained myocardial rupture. contained by adherent pericardium or scar tissue. usually has a narrow neck

270
Q

Pericardial agenesis is and assoc

A

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

271
Q

Pericardial agenesis imaging

A

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

272
Q

Pericardial cyst maging

A

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

273
Q

Cardiophrenic angle lesions

A

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

274
Q

Single pleural based mass ddx

A

Tumours
- pleural (SFT, meso)
- mets
- lymphoma
- thymoma
- lipoma

Loculated fluid

Ribs/Chest wall
- Ewings
- Askin

Intercostal nerve lesion

Thoracic splenosis

TB

275
Q

Solitary fibrous tumour of the pleura are

A

rare, pleural based tumours. tend to be benign and slow growing. 30% can be malignant.

assoc
- hypoglycaemia (Doege potter syndrome)
- HPOA

276
Q

SFT of the pleura imaging

A

XR
- pleural based mass
- can be pedunculated
- rare to have effusion/calc/aggressive ft

CT
- can be heerogenous

277
Q

Ewings sarcoma chest wall is and path

A

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

278
Q

Cardiomyopathy classificiation

A

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

279
Q

Cardiac myxoma is and path

A

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

280
Q

Carney complex

A
  • cardiac myxomas
  • extracardiac myxomas
  • skin pigmentation
  • pit adenoma
  • psammomatous melanotic schwannoma
  • testicular tumours (sertoli)
  • osterochondromyoxoma
281
Q

Papillary fibroelastoma of the heart is

A

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

282
Q

Cardiac rhabdomyoma is and assoc

A

benign myocardial tumour. most common fetal cardiac tumour. usually left ventricle.

assoc
- TS (50%)
- congenital renal

283
Q

Cardiac angiosarcoma is and imaging

A

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

284
Q

Cardiac angiosarcoma is and imaging

A

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

285
Q

Parathyroid gland position

A

majority are juxtathyroid and posterior or inferior to the thyroid

ectopic
- mediastinum
- retropharyngeal
- carotid sheath
- intrathyroidal
- thymus, thyroid gland, TE groove

286
Q

Castleman disease is and types

A

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

287
Q

Castleman diseas assoc

A

POEMS syndrome
Osteosclerotic myeloma
Kaposi sarcoma
AIDS
Amyloidosis
Chordoid meningioma

288
Q

Castlemans disease imaging

A

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

289
Q

Lymphatic malformation types and assoc

A

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

290
Q

Lymphatic malformation imaging

A

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

291
Q

Anterior mediastinal mass ddx

A

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

292
Q

Thymic epithelial lesions are, types and assoc

A

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

293
Q

Thymic epithelial lesion imaging

A

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

294
Q

Thymolipoma is, assoc and imaging

A

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

295
Q

Thymic cyst types and imaging

A

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

296
Q

Thymic hyperplasia types and causes

A

Can be true or lymphoid

True
- Rebound
- Radiation
- Burns
- Severe systmic stresses

Lymphoid
- MG
- SLE
- RA
- Scleroderma
- Graves

297
Q

Thymic hyperplasia imaging

A

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

298
Q

Thymic carcinoid tumour is and assoc

A

Carcinoid tumour arising in the thymus. Middle aged guys.

Assoc ; MEN 1

Heterogenous on imaging. Dotatate avid.

299
Q

Mediastinal germ cell tumour types

A

Seminoma

Non seminoma
- embryonal
- chorio
- YS
- teratoma (most common)
- mixed

300
Q

Mediastinal teratoma path

A

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)

301
Q

Mediastinal teratoma imaging

A

Usually anteiro med, but can be elsewhre

Mature
- large and cystic
- fat and calc, FFL level
- septal/rim enhancement
- can rupture

Immature
- solid

302
Q

Mediastinal seminoma is and imaging

A

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

303
Q

DiGeorge syndrome is and mnemonic

A

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

304
Q

Fibrosing mediastinitis is

A

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

305
Q

Fibrosing mediastinitis assoc and causes

A

assoc
- reidels
- retroperitoneal fibrosis
- behcet
- RA
- SLE

Causes
- idiopathic (igg4)
- infection (histo, tb)
-malignancy
- sarcoid
- radiation
- drugs

306
Q

Fibrosing mediastinits imaging

A

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

PART 2 (11 decks)

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