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RRC DDx 2 > Chest > Flashcards

Chest Flashcards

1
Q

Cystic lung disease

A

LAM
LIP
LCH (late stage)
Light chain deposition disease (very rare)
Cystic metastases (e.g. sarcoma)
Pneumatocele from prior infection (pneumocystis, S.aureus, coccidioidomycosis; should resolve over time and not be so numerous as true cystic lung disease)
Birt-Hogg-Dube (very rare)

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2
Q

Centrilobular ground glass nodules

A 
HP
RB
Follicular bronchiolitis
Pulmonary capillary hemangiomatosis (cause of PAH)
Plexiform arteriopathy (must have PAH)
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3
Q

Localized multifocal tree-in-bud nodularity

A

Infectious bronchiolitis (endobronchial spread of infection)
Aspiration
Endobronchial spread of malignancy
Mucous impaction/inflammatory secretions in underlying congenital airway disorders: CF, PCD

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4
Q

Diffuse centrilobular tree-in-bud nodularity

A 
Infectious panbronchiolitis (endobronchial spread of infection) - airway
Inhalational panbronchiolitis (toxic/chemical) - airway
Foreign body granulomatosis - vascular
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5
Q

Acute pure ground glass opacity

A
  1. Pulmonary edema (noncardiogenic)
  2. Hemorrhage (vasculitis-GPA; illicit drugs-cocaine/crack, meth)
  3. Infection (immunocompromised-PJP; viral-HSV, CMV, COVID; atypical-mycoPLASMA, chlamydia, legionella) – NOT CAP (staph/strep), mycobacteria, fungal
  4. Subacute HP
  5. Drug reaction (results in pulmonary edema, hemorrhage, pneumonitis)
  6. (Acute eosinophilic pneumonia: young females, poor prognosis)
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6
Q

Chronic pure ground glass opacity

A
  1. Cellular NSIP (patchy, peripheral, peribronchovascular)
  2. DIP (usually lower zone involvement; smokers)
  3. LIP (classic also has cystic lung dz + hx CTD e.g. Sjogren’s)
  4. Chronic HP (especially if upper lobe fibrosis)
  5. Malignancy (adenocarcinoma spectrum of disease)
  6. Organizing pneumonia (peripheral or peribronchovascular - rare)
  7. Chronic eosinophilic pneumonia (peripheral)
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7
Q

Crazy paving - acute

A
  1. Pulmonary edema (cardiogenic, illicit drugs)
  2. Hemorrhage (vasculitis-GPA, Churg Strauss (EGPA), SLE, Goodpasture; illicit drugs-cocaine/crack; anticoagulants)
  3. Infection (immunocompromised-PJP; viral-HSV, CMV, COVID; atypical-mycoPLASMA, chlamydia, legionella)
  4. Drug reaction
  5. Acute eosinophilic pneumonia
  6. (ARDS (AIP/DAD) – if in ICU)

(Similar to acute GGO DDx except:

  • cardiogenic pulmonary edema vs. noncardiogenic
  • no subacute HP)
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8
Q

Crazy paving - chronic

A
  1. Pulmonary alveolar proteinosis
  2. Chronic pulmonary edema (cardiogenic)
  3. Lipoid pneumonia
  4. Invasive adenocarcinoma (NOT adenocarcinoma spectrum)
  5. Fibrotic NSIP (peripheral or peribronchovascular, e.g. not patchy or diffuse)
  6. Organizing pneumonia (peripheral or peribronchovascular)
  7. Chronic eosinophilic pneumonia (peripheral)
  8. (Alveolar sarcoidosis)
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9
Q

Mosaic attenuation

A 
If hyperattenuating areas are abnormal - GGO DDx
If hypoattenuating areas are abnormal (vessels in abN lucent areas are too few in number or small in caliber) - “Mosaic perfusion”
1. Airway causes (abnormal ventilation -> reflex vasoconstriction)
*Small airway*
• Bronchiolitis obliterans
• Asthma
• COPD
• HP
• Chronic bronchitis/small airway infection/mucus plugging
*Large airway* 
• CF
• Bronchiectasis
2. Small vessel (vascular obstruction)
-Chronic PE
-Pulmonary arterial hypertension
-Vasculitis
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10
Q

Multiple large nodules/opacities

A
  1. Malignancy (metastasis, multifocal primary bronchogenic carcinoma, lymphoma, Kaposi sarcoma)
  2. Atypical infection (fungal, mycobacteria)
  3. Wegener/GPA
  4. Sarcoidosis
  5. Organizing pneumonia
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11
Q

Multifocal mass-like air space opacities

A
  1. Malignancy (metastasis, multifocal primary bronchogenic carcinoma, lymphoma, Kaposi sarcoma)
  2. Atypical infection (fungal, mycobacteria)
  3. Wegener/GPA
  4. Sarcoidosis
  5. Organizing pneumonia
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12
Q

Multiple peribronchovascular opacities/consolidation

A
  1. Bronchopneumonia (bacterial, viral, mycobacterial, fungal)
  2. Aspiration
  3. Lymphoma/lymphoproliferative disorder
  4. Multifocal adenocarcinoma
  5. Organizing pneumonia
  6. Wegener/GPA
  7. Sarcoidosis
  8. Kaposi sarcoma
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13
Q

Reverse halo sign/atoll sign

A 
Organizing pneumonia (classic)
Vasculitis: Wegener/GPA
Pulmonary infarction
Fungal (S.American paracoccidioidomycosis, Zygomycosis/mucormycosis)
COVID
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14
Q

Halo sign

A 
Invasive fungus (aspergillosis-classic; mucormycosis)
Septic emboli
Hemorrhagic metastases
Viral: CMV, HSV
Vasculitis: Wegener/GPA
Organizing pneumonia (rare)
Eosinophilic pneumonia (rare)
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15
Q

Perilymphatic nodules

3 locations: subpleural, peribronchovascular, septal

A

Lymphangitic carcinomatosis
Lymphoma
Sarcoidosis
Silicosis & coal worker pneumoconiosis

Kaposi sarcoma (rare)
Lymphoid interstitial pneumonitis (rare) 
Amyloidosis (rare)
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16
Q

Miliary pulmonary nodules (on CXR)

A

Disseminated mycobacterial/fungal infection
Hematogenous metastases – papillary thyroid, pancreas, renal cell, melanoma
Pneumoconiosis – silicosis/CWP
Sarcoidosis

Miliary PJP

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17
Q

Bronchiectasis

A 
Postinfectious
- Bacterial: Pseudomonas, staph, pertussis
- Mycobacterial: TB, MAC
- Viral
- Mycoplasma
Immunodeficiency
- Congenital: SCID, hypogammaglobulinemia
- Acquired: HIV
Mucociliary clearance abnormality
- Cystic fibrosis (abnormal mucus)
- Primary ciliary dyskinesia (abnormal cilia)
- Young syndrome
Bronchial obstruction
- Bronchial atresia
- Endobronchial tumour
- Foreign body
- Chronic aspiration
Bronchial wall abnormality
- Mounier-Kuhn (1st-4th order)
- Williams-Campbell (4th-6th order)
Immune reactions
- ABPA
- Asthma
- Lung transplant rejection
- Graft vs. host disease
Systemic disease
- Alpha 1 antitrypsin deficiency
- Collagen vascular disease
- IBD
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18
Q

Organizing pneumonia/constrictive bronchiolitis causes

A

Post infectious: viral, bacterial, mycoplasma, PJP
Post toxic/inhalational injury: smoke, NO2
Connective tissue disorder: Sjogren, rheumatoid arthritis, SLE, scleroderma
Post transplant: lung, heart, heart-lung, bone marrow
Drug reaction: amiodarone, bleomycin, cyclophosphamide, methotrexate, nitrofurantoin
Idiopathic (i.e. COP)

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19
Q

Reticulonodular opacities on CXR

A

Bronchiectasis/bronchial wall thickening
Emphysema/smoking-related changes with superimposed acute airspace disease
Langerhans cell histiocytosis

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20
Q

Peripheral airspace disease / reverse batwing

A

Organizing pneumonia
Chronic eosinophilic pneumonia
Sequela of extensive pulmonary thromboembolic disease / pulmonary infarcts

(Infection: COVID)
(Vasculitis)
(Multifocal adenocarcinoma)

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21
Q

Focal interlobular septal thickening

A

Lymphangitic carcinomatosis
Lymphoma
Kaposi sarcoma
Sarcoidosis

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22
Q

Mediastinal adenopathy

A 
Lymphoma
Metastasis
Infection – mycobacterial/fungal
Sarcoidosis
(Castleman, etc.)
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23
Q

Irregular opacity diffuse lung disease – “Dog’s breakfast DDx”

A 
Diffuse malignancy
- Multifocal primary 
- Disseminated pulmonary lymphoma
- Not metastasis
Atypical disseminated infection
Organizing pneumonia
24
Q

Cavitary lesion

A

Cavitary neoplasm – metastasis, primary bronchogenic cancer, invasive adenocarcinoma, lymphoma
Infection – mycobacterial/fungal, septic emboli, nocardia/actinomyces
Vasculitis – Wegener

Rheumatoid arthritis
Tracheobronchopapillomatosis (peribronchovascular)
Langerhans cell histiocytosis

If solitary cavitary lesion, add: congenital (sequestration, CPAM, bronchogenic cyst)

25
Pulmonary necrosis without abscess formation
Necrotic malignancy – melanoma, colorectal, etc. Necrotic infection – mycobacterial/fungal, Actinomycosis, Nocardia Vasculitis – Wegener
26
Upper lung zone predominant fibrosis/honeycombing
``` Chronic hypersensitivity pneumonitis Sarcoidosis UIP in atypical distribution Fibrosing organizing pneumonia/DAD TB Ankylosing spondylitis ```
27
Fibrotic NSIP pattern of lung injury
Connective tissue disorders Drug toxicity Idiopathic Sequela of hypersensitivity pneumonitis Consequence of prior diffuse alveolar damage
28
Headcheese
HP Smoking + DIP Mycoplasma
29
Wandering opacities
``` Vasculitis (Churg-Strauss) Acute eosinophilic pneumonia Organizing pneumonia If ground glass: - HP - DIP ```
30
Multiple calcified pulmonary nodules
Calcified pulmonary metastases Histoplasmosis Silicosis Healed varicella pneumonia
31
Calcified pulmonary metastases
``` Papillary thyroid carcinoma Osteosarcoma Chondrosarcoma Synovial sarcoma Giant cell tumour Adenocarcinoma: colon, ovary, breast Treated choriocarcinoma ```
32
Persistent airspace opacity
Suboptimally treated pneumonia / atypical infection Post-obstructive pneumonia Malignancy: invasive adenocarcinoma, lymphoma Chronic eosinophilic pneumonia Organizing pneumonia
33
Unilateral pulmonary edema
Mitral valve regurgitation Re-expansion pulmonary edema Pulmonary vein stenosis
34
Random nodules
``` Mycobacterial/fungal infection Hematogenous metastases (papillary thyroid, pancreatic, RCC, melanoma) ```
35
Lower lung fibrosis
UIP Fibrotic NSIP Asbestosis
36
Chronic ground glass + lung cysts
PJP LIP DIP
37
Endobronchial lesions
Malignant primary (SCC, carcinoid, adenoid cystic, mucoepidermoid) Mets (CKMB – colon, kidney, melanoma, breast) / lymphoma Papilloma Non-neoplastic (mucous plug, foreign body)
38
Tracheal wall thickening
Sparing posterior membrane - Relapsing polychondritis - Tracheobronchopathia osteochondroplastica Circumferential long segment (amyloid, GPA, TB, sarcoid, malignancy/SCC) Circumferential short segment (post-intubation, malignancy/SCC)
39
UIP causes
Connective tissue disease (esp. RA) Asbestosis Drug reaction Idiopathic pulmonary fibrosis
40
NSIP causes (requires subpleural sparing to come down hard)
``` Connective tissue disease (esp. scleroderma) HP (as a cause of fibrotic NSIP) Drug toxicity Consequence of DAD Idiopathic ```
41
Drugs that cause lung injury
``` ABC MN Amiodarone Bleomycin Cyclophosphamide Methotrexate Nitrofurantoin ```
42
Anterior mediastinal mass
Tumour of thymic origin (thymoma / thymic Ca, thymolipoma) Germ cell tumor Lymphoma or other causes of adenopathy, such as metastases or infection Goiter Aneurysm
43
Solid middle mediastinal mass
Neoplasm (esophagus, cardiac / pericardial, vagal / phrenic nerves) Adenopathy Varices / aneurysm
44
Cystic middle mediastinal mass
Cyst (foregut duplication, bronchogenic, pericardial, neurenteric) Collection Echinococcus Pancreatic pseudocyst
45
Posterior mediastinal mass
Primary neoplasm (PNST, ganglio-neuro-blastoma spectrum, sarcoma) Metastatic LAD / lymphoma Paraspinal collection (abscess / phlegmon in discitis/osteomyelitis, hematoma) Neurenteric cyst / meningocele Extramedullary hematopoiesis
46
Fat containing anterior mediastinal mass
Teratoma Thymolipoma Liposarcoma
47
Cardiophrenic angle mass
``` Pericardial fat pad Pericardial cyst Diaphragmatic hernia Adenopathy Mediastinal masses ```
48
Low density adenopathy
Necrotic malignant adenopathy Lymphoma Infection: Mycobacterial / fungal Whipple’s disease
49
High density adenopathy
Hypervascular metastases Castleman’s disease Kaposi’s
50
Calcified adenopathy
``` Prior granulomatous infection Sarcoidosis Pneumoconioses Papillary thyroid cancer mets Treated lymphoma Fibrosing mediastinitis ```
51
Pleural mass
Mesothelioma Mets / lymphoma Solitary fibrous tumor
52
Unilateral hyperlucent lung
Chest wall (mastectomy, Poland syndrome) Pleura (pneumothorax in supine patient) Pulmonary artery (unilateral pulmonary artery obstruction / interruption) Airways (bronchial obstruction / dysplasia) Parenchyma (Swyer-James, congenital lobar overinflation, compensatory hyperinflation)
53
Unilateral hyperdense lung
Unilateral effusion in supine patient | Upper lobe atelectasis
54
Chest wall mass
Primary neoplasm (pleural, osseous, soft tissue) Mets / myeloma / lymphoma Collection Invasive infection (nocardia / actinomyces / mycobacterial / fungal)
55
Unilateral effusion
PE (also peripheral opacity or subsegmental atelectasis) Malignancy Pneumonia

RRC DDx 2 (8 decks)

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