Chest Flashcards
Which diseases cause egg shell calcification
Post radiotherapy lymphoma
Sarcoidosis
Amyloidosis
Silicosis
TB
Histoplasmosis
What is the follow up for a solid nodule measuring >8mm in a low risk patient
<6mm - no follow- up
6-8mm - CT at 6-12 months then consider CT at 18-24 months
8 mm - Consider Ct at 3 months or tissue sampling or PET/CT
What is the follow up of a ground glass nodules measuring >6mm
<6mm: No routine follow up required
>6mmCT at 6-12 months to confirm persistence then CT every 2 years until 5 years.
What is the halo sign in the lungs and what does it represent
Ground glass opacification surrounding a lung nodule or mass. Represents haemorrhage.
What is the most common cause of a benign solitary pulmonary nodule
1) Infectious granulomas (70-80%)
2) Harmatomas
What are the 4 patterns of benign calcification of a pulmonary nodules
- Laminated
- Diffuse solid calcification
- Central
- Popcorn calcification
What does popcorn calcification most likely present in a pulmonary nodule
Harmatoma
On CT-contrast Chest imaging of pulmonary nodules, why might you get a false negative
Large pulmonary nodules with central-non cavitating lesions or adenocarcinomas.
What are the main features of IPF
Bibasal subplueral reticular pattern fibrosis with HONEYCOMBING.
Traction bronchiectasis
What is RB-ILD and DIP associated with?
Smoking
What are the classic HRCT findings for a patient with DIP ?
Ground glass opacification in the lower lobes, peripheral and patchy
What conditions are associated with lymphocytic interstitial pneumonias
Child - AIDS
Adult - Sjogrens
Are Centrilobular nodules a features of RB-ILD ?
Yes
What does traction bronchiectasis indicate?
Fibrosis and therefore ILD - IPF or NSIP
what is an askin tumour ?
a ewings sarcoma of the chest wall.
what are the types of atelectasis ?
4 types:
1. obstructive - central bronchial obstruction causing collapse
2. passive /relaxation - relaxation of lung next to a lesion
3. cicatrical - architectural, e.g. fibrosis
4. adhesive
what is the sign of left upper lobe collapsed
luftsichel sign - (air sickle) - air cresent sign due to the expanded superior left lower lobe abutting the aorta
what is the sign of right upper lobe collapse ?
golden S sign
what is the juxtaphrenic peak sign ?
peaking of a heme-diaphragm due to collapse of a segment of lung - usually middle
what is the cause of the flattened waist sign ?
flattening of the left heart boarder due to posterior shift of hilarity structures and resultant cardiac rotation
what is round atelectasis ?
focal atelectasis with a round morphology - that always have an adjacent pleural abnormality - e.g. pleural effusion/thickening or plaque
what is the criteria for round atelectasis ?
- round morphology
- pleural abnormality
- opacity in contact with the pleura
- commet tail sign of the vessels
- volume loss of the hemithorax
what is consolidation?
complete filling of affected alveoli due to either water,pus,blood or cells
what is the differential list for acute consolidation?
Pneumonia
ARDS - (non cardiac pulmonary oedema)
Pulmonary edema from heart failure if severe
pulmonary haemorrahge
What is the differential list for chronic consolidation
Adenocarcinoma
lymphoma
organising pneumonia
chronic eosinophilic pneumonia - inflammatory prossess characterised by eosinophils - causing the alveolar to fill up in the upper lobes
what is organising pneumonia ?
non specific inflammatory response characterised by granulation polyps which fill the distal airways causing rounded, peripheral, nodular consolidation
what causes ground glass opacification?
partial filling of the alveolar
thickening of the alveolar wall
reduced aeration of alveoli
what are the differentials for acute GGO?
pneumonia - usually atypical such as Pneumocystic jiroveci pneumonia, or viral
pulmonary edema
haemorrhage
ARDS
what are the differentials for chronic GGO
lung adenocarcinoma
organising pneumonia
chronic eosinophilic pneumonia
interstitial lung disease
hypersensitivity pneumonitis
what is the differential for smooth interlobular thickening ?
pulmonary edema
lymphangitis carcinomatosis
what’s the differential for nodular interlobular thickening ?
lymphangitis carcinomatosis
sarcoidosis
what is an infectious cause of centrilobular nodules?
viral pneumonia
what is an inflammatory cause of centrilobular nodules ?
hypersensitivity pneumonitis
what is hypersensitivity pneumonitis ?
type 3 mediated immune réponse to an inhale organic compound
what is pulmonary capillary hemangiomatosis and what does it look like on CT?
vascular pathology characterised by abnormal capillary proliferation leading to pulmonary hypertension, looks like centrilobular nodules
what is the most common cause of perilymphatic nodules
sarcoidosis
what causes solitary cavitary lesions?
squamous cell carcinoma > adenocarcinoma
TB
Fungal pneumonia
Cavitary bacterial pneumonia
what is the differential for multiple cavitary lesions?
septic emboli - usually peripheral
vasculitis - GPA
metastases - squamous cell
what is lymphangioleiomyomatosis
diffuse, cystic lung disease due to smooth muscle proliferation of the distal airways . results in bilateral, similar shaped cysts of similar size. usually associated with a pleural effusion - chylous effusion
what is the classic finding of pulmonary langerhans cells histocytosis
Nodules + bizarre-shaped pulmonary cysts in upper and mid lung zones in cigarette smokers
which condition is associated with lymphoid interstitial pneumonia
sjogrens syndrome
what syndrome lines pulmonary cysts with renal cell carcinoma - chromophobe
birt-hogg-dube syndrome
what causes predominantly upper lobe pulmonary fibrosis
end stage sarcoidosis
chronic hypersensitivity pneumonitis
end stage silicosis
what is ranke complex
calcified gohn focus and mediastinal lymph nodes
what is mycobacterium avium complex
a non tuberculosis, mycobacterium that affects people usually with pre-existing pulmonary disease or old ladies
when does pneumocystis jiroveci cause pneumonia
when the CD4 sound < 200
what is the classic CT finding of PJP
bilateral perihilar airspace opacities with peripheral sparing
what is the CD4 count in patients who develop cryptococcus neoformans pneumonia
< 100
what is a specific finding of ABPA ?
high attenuation mucus within a bronchiectatic airway - resulting in a finger in glove
what is the treatment of an aspergilomma ?
embolisation or resection
what is an aspergilloma ?
aspergillus fungal hyphae and cellular debris. they form in pre-existing lung cavities
what is the Monod sign
curvilinear air surrounding the aspergilloma
what is the air cresent sign
seen in patients with angioinvasive aspergillosis crescent of air from retraction of infarcted lung that occurs with recovery of neutrophil count
what is angioinvasive aspergillosis
aggressive infection whereby there is invasion and occlusion of the arterioles and small pulmonary arteries by fungal hyphae. seen only in neutropenic patients.
what is the most common cause of lobar pneumonia
streptococcus
Klebsillea - for alcoholic or immune patients
What is the most common cause of bronchial pneumoniac
staph. aureus
also pneumococcus and klebsillea
what does viral pneumonia usually look like ?
bilateral and with hyperinflation - due to bronchial constricition leading to air trapping
what is the halo sign ?
seen in angioinvasive aspergillosis - a mass with a peripheral ground glass appearance - demonstrating pulmonary haemorrahge
what is a normal CD4 count ?
800-1000
In AIDS , when do fungal infections occur ?
CD4 < 150
in AIDS when does TB occur ?
CD4 200-300
where does Graft vs host disease commonly affect ?
the GI tract and the skin
what is nocardia ?
an infection assocaited with bone marrow transplant and those with AIDS.
you get lobar consolidation and cavitating nodules
what is isolated right upper lobe pulmonary oedema seen in
mitral regurgitation secondary to MI causing papillary muscle rupture
where should a dialysis catheter be positioned
within the right atrium
what type of lung cancer is not associated with smoking
adenocarcinoma
what is the size criteria of a pulmonary nodule ?
<3cm
what is the size criteria of a pulmonary mass ?
> 3cm