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ST2 Radiology > Chest > Flashcards

Chest Flashcards

1
Q

Which diseases cause egg shell calcification

A

Post radiotherapy lymphoma
Sarcoidosis
Amyloidosis
Silicosis
TB
Histoplasmosis

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2
Q

What is the follow up for a solid nodule measuring >8mm in a low risk patient

A

<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

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3
Q

What is the follow up of a ground glass nodules measuring >6mm

A

<6mm: No routine follow up required
>6mmCT at 6-12 months to confirm persistence then CT every 2 years until 5 years.

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4
Q

What is the halo sign in the lungs and what does it represent

A

Ground glass opacification surrounding a lung nodule or mass. Represents haemorrhage.

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5
Q

What is the most common cause of a benign solitary pulmonary nodule

A

1) Infectious granulomas (70-80%)
2) Harmatomas

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6
Q

What are the 4 patterns of benign calcification of a pulmonary nodules

A
  1. Laminated
  2. Diffuse solid calcification
  3. Central
  4. Popcorn calcification
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7
Q

What does popcorn calcification most likely present in a pulmonary nodule

A

Harmatoma

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8
Q

On CT-contrast Chest imaging of pulmonary nodules, why might you get a false negative

A

Large pulmonary nodules with central-non cavitating lesions or adenocarcinomas.

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9
Q

What are the main features of IPF

A

Bibasal subplueral reticular pattern fibrosis with HONEYCOMBING.
Traction bronchiectasis

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10
Q

What is RB-ILD and DIP associated with?

A

Smoking

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11
Q

What are the classic HRCT findings for a patient with DIP ?

A

Ground glass opacification in the lower lobes, peripheral and patchy

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12
Q

What conditions are associated with lymphocytic interstitial pneumonias

A

Child - AIDS
Adult - Sjogrens

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13
Q

Are Centrilobular nodules a features of RB-ILD ?

A

Yes

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14
Q

What does traction bronchiectasis indicate?

A

Fibrosis and therefore ILD - IPF or NSIP

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15
Q

what is an askin tumour ?

A

a ewings sarcoma of the chest wall.

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16
Q

what are the types of atelectasis ?

A

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

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17
Q

what is the sign of left upper lobe collapsed

A

luftsichel sign - (air sickle) - air cresent sign due to the expanded superior left lower lobe abutting the aorta

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18
Q

what is the sign of right upper lobe collapse ?

A

golden S sign

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19
Q

what is the juxtaphrenic peak sign ?

A

peaking of a heme-diaphragm due to collapse of a segment of lung - usually middle

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20
Q

what is the cause of the flattened waist sign ?

A

flattening of the left heart boarder due to posterior shift of hilarity structures and resultant cardiac rotation

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21
Q

what is round atelectasis ?

A

focal atelectasis with a round morphology - that always have an adjacent pleural abnormality - e.g. pleural effusion/thickening or plaque

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22
Q

what is the criteria for round atelectasis ?

A
  1. round morphology
  2. pleural abnormality
  3. opacity in contact with the pleura
  4. commet tail sign of the vessels
  5. volume loss of the hemithorax
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23
Q

what is consolidation?

A

complete filling of affected alveoli due to either water,pus,blood or cells

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24
Q

what is the differential list for acute consolidation?

A

Pneumonia
ARDS - (non cardiac pulmonary oedema)
Pulmonary edema from heart failure if severe
pulmonary haemorrahge

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25
Q

What is the differential list for chronic consolidation

A

Adenocarcinoma
lymphoma
organising pneumonia
chronic eosinophilic pneumonia - inflammatory prossess characterised by eosinophils - causing the alveolar to fill up in the upper lobes

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26
Q

what is organising pneumonia ?

A

non specific inflammatory response characterised by granulation polyps which fill the distal airways causing rounded, peripheral, nodular consolidation

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27
Q

what causes ground glass opacification?

A

partial filling of the alveolar
thickening of the alveolar wall
reduced aeration of alveoli

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28
Q

what are the differentials for acute GGO?

A

pneumonia - usually atypical such as Pneumocystic jiroveci pneumonia, or viral
pulmonary edema
haemorrhage
ARDS

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29
Q

what are the differentials for chronic GGO

A

lung adenocarcinoma
organising pneumonia
chronic eosinophilic pneumonia
interstitial lung disease
hypersensitivity pneumonitis

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30
Q

what is the differential for smooth interlobular thickening ?

A

pulmonary edema
lymphangitis carcinomatosis

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31
Q

what’s the differential for nodular interlobular thickening ?

A

lymphangitis carcinomatosis
sarcoidosis

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32
Q

what is an infectious cause of centrilobular nodules?

A

viral pneumonia

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33
Q

what is an inflammatory cause of centrilobular nodules ?

A

hypersensitivity pneumonitis

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34
Q

what is hypersensitivity pneumonitis ?

A

type 3 mediated immune réponse to an inhale organic compound

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35
Q

what is pulmonary capillary hemangiomatosis and what does it look like on CT?

A

vascular pathology characterised by abnormal capillary proliferation leading to pulmonary hypertension, looks like centrilobular nodules

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36
Q

what is the most common cause of perilymphatic nodules

A

sarcoidosis

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37
Q

what causes solitary cavitary lesions?

A

squamous cell carcinoma > adenocarcinoma
TB
Fungal pneumonia
Cavitary bacterial pneumonia

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38
Q

what is the differential for multiple cavitary lesions?

A

septic emboli - usually peripheral
vasculitis - GPA
metastases - squamous cell

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39
Q

what is lymphangioleiomyomatosis

A

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

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40
Q

what is the classic finding of pulmonary langerhans cells histocytosis

A

Nodules + bizarre-shaped pulmonary cysts in upper and mid lung zones in cigarette smokers

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41
Q

which condition is associated with lymphoid interstitial pneumonia

A

sjogrens syndrome

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42
Q

what syndrome lines pulmonary cysts with renal cell carcinoma - chromophobe

A

birt-hogg-dube syndrome

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43
Q

what causes predominantly upper lobe pulmonary fibrosis

A

end stage sarcoidosis
chronic hypersensitivity pneumonitis
end stage silicosis

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44
Q

what is ranke complex

A

calcified gohn focus and mediastinal lymph nodes

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45
Q

what is mycobacterium avium complex

A

a non tuberculosis, mycobacterium that affects people usually with pre-existing pulmonary disease or old ladies

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46
Q

when does pneumocystis jiroveci cause pneumonia

A

when the CD4 sound < 200

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47
Q

what is the classic CT finding of PJP

A

bilateral perihilar airspace opacities with peripheral sparing

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48
Q

what is the CD4 count in patients who develop cryptococcus neoformans pneumonia

A

< 100

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49
Q

what is a specific finding of ABPA ?

A

high attenuation mucus within a bronchiectatic airway - resulting in a finger in glove

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50
Q

what is the treatment of an aspergilomma ?

A

embolisation or resection

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51
Q

what is an aspergilloma ?

A

aspergillus fungal hyphae and cellular debris. they form in pre-existing lung cavities

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52
Q

what is the Monod sign

A

curvilinear air surrounding the aspergilloma

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53
Q

what is the air cresent sign

A

seen in patients with angioinvasive aspergillosis crescent of air from retraction of infarcted lung that occurs with recovery of neutrophil count

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54
Q

what is angioinvasive aspergillosis

A

aggressive infection whereby there is invasion and occlusion of the arterioles and small pulmonary arteries by fungal hyphae. seen only in neutropenic patients.

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55
Q

what is the most common cause of lobar pneumonia

A

streptococcus
Klebsillea - for alcoholic or immune patients

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56
Q

What is the most common cause of bronchial pneumoniac

A

staph. aureus
also pneumococcus and klebsillea

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57
Q

what does viral pneumonia usually look like ?

A

bilateral and with hyperinflation - due to bronchial constricition leading to air trapping

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58
Q

what is the halo sign ?

A

seen in angioinvasive aspergillosis - a mass with a peripheral ground glass appearance - demonstrating pulmonary haemorrahge

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59
Q

what is a normal CD4 count ?

A

800-1000

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60
Q

In AIDS , when do fungal infections occur ?

A

CD4 < 150

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61
Q

in AIDS when does TB occur ?

A

CD4 200-300

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62
Q

where does Graft vs host disease commonly affect ?

A

the GI tract and the skin

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63
Q

what is nocardia ?

A

an infection assocaited with bone marrow transplant and those with AIDS.
you get lobar consolidation and cavitating nodules

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64
Q

what is isolated right upper lobe pulmonary oedema seen in

A

mitral regurgitation secondary to MI causing papillary muscle rupture

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65
Q

where should a dialysis catheter be positioned

A

within the right atrium

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66
Q

what type of lung cancer is not associated with smoking

A

adenocarcinoma

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67
Q

what is the size criteria of a pulmonary nodule ?

A

<3cm

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68
Q

what is the size criteria of a pulmonary mass ?

A

> 3cm

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69
Q

a nodule with popcorn calcification usually indicates?

A

pulmonary harmatoma

70
Q

what describes of a nodule make it sound benign ?

A

calcification
sub pleural location
triangular shaped
small <3mm
clusters suggest infection

71
Q

are subsolid or solid nodules more likely to be malignant.

72
Q

is upper lobe or lower lobe nodules more likely to be malignant ?

A

upper lobe

73
Q

when is follow up not recommended in pulmonary nodules ?

74
Q

what is the most common subtype of lung cancer ?

A

adenocarcinoma

75
Q

which lung cancer does cavitation more likely occur in

A

squamous cell carcinoma

76
Q

in adenocarcinoma, what is lepidic growth ?

A

spread of malignant cells using the alveolar walls as scaffold

77
Q

how does adenocarcinoma of the lung normally present ?

A

speculated / solidatry nodule
ground glass nodule
chronic , diffuse ground glass/consolidation

78
Q

where doe most squamous cell carcinomas arise ?

A

usually bronchial tumours - or hilar lesions

79
Q

how does small cell carcinoma present ?

A

mediastinal or hilar lymphadenopathy

80
Q

how does large cell carcinoma present ?

A

in the lung periphery , as a large solid mass with irregular margins

81
Q

where does lung carcinoid tumour arise from ?

A

neuroendocrine cells in the bronchial walls

82
Q

What is DIPNECH?

A

diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

Syndrome of.
1. multiple hyperplasia of neuroendocrine ells
2. carcinoid tumours
3. bronchiolitis obliterans

83
Q

how does primary lymphoma present ?

A

mass like consolidation

84
Q

how does post transplant lymphoproliferative disorder present ?

A

new pulmonary nodules in a patient after solid organ. transplantation

85
Q

which cancer can present as non resolving consolidation?

A

Adenocarcinoma

86
Q

what is a hilar mass a common presentation of ?

A

squamous cell carcinoma and small cell carcinoma

87
Q

what is a superior sulus tumour ?

A

a lung cancer occurring in the lung apex

88
Q

what is Horners syndrome

A

ipsilateral ptosis, mitosis and anhirdosis

89
Q

what is a pan cost tumour ?

A

superior sulcus tumour with involvement of the sympathetic ganglia causing hardeners syndrome

90
Q

in staging what does a malignant effusion mean ?

A

M1a tumour

91
Q

what stage of lung cancer is unresectable

A

T4/N2, N3 - Stage 111B

92
Q

Lung cancer:
T stage grading

A
  1. <3cm
  2. 3-5
  3. 5-7, metastatic nodules in the same lobe, invasion of chest wall,
  4. > 7 or invasion of mediastinum, great vessels, heart, diaphragm, spine, trace, esophageus
93
Q

Lung cancer :
N staging

A

n1 - same side, hilar or intrapulmonary
N2 - same side mediastinal nodes
N3 - opposite side or supraclaviciular

94
Q

Lung cancer :
M staging

A

M1 a - local thoracic mets
M1 b - sing extra thoracic
M1 c - multiple extrathoacic

95
Q

what is fleischner sign ?

A

widening of the pulmonary arteries due to clot

96
Q

what is Hamptons hump ?

A

peripheral wedge shaped opacity representing pulmonary infarct

97
Q

what is watermark sign

A

regional oligemia in the lung distal to the pulmonary artery thrombus

98
Q

in patients with AIDS, how does histoplasmosis present with ?

A

fever, malaise
CT demonstrates millary appearance plus reticulonodular air space opacification

99
Q

what side of the heart is most commonly affected in carcinoid ?

A

right side of the heart. including affecting the mitral valve due to the hormones secreted

100
Q

what type of mediastinal masses does Hodgkins lymphoma commonly present with ?

A

anterior mediastinal mass

101
Q

what type of nodal spread does Hodgkins lymphoma make ?

A

contiguous

102
Q

what diameter of the pulmonary artery suggests pulmonary hypertension?

A

> 3cm
or bigger than the aorta

103
Q

what are pulmonary artery wall calcifications pathagnomic for ?

A

chronic pulmonary artery hypertension due to shunts

104
Q

which drug is associated with pulmonary veno-occlusive diseased (pulmonary hypertension)

105
Q

what are the most common causes of fibrosing mediastinitis ?

A

histoplasmosis and tuberculosis

106
Q

classic features of UIP

A

subpleural reticulations, traction bronchiectasis and honeycombing

107
Q

causes of UIP

A

idiopathic pulmonary fibrosis
asbestosis
collagen vascular disease - RA
Drugs

108
Q

what is NSIP usually caused by

A

underlying collagen vascular disease
such as dermatomyositis, SLE, mixed CTD, sclerodermaa

109
Q

what is a key features of NSIP /

A

ground glass opacification with a peribronchial predominance with sparing of the immediate suppleural lung

110
Q

what does the reverse halo sign indicate ?

A

organising pneumonia = atoll sign.
central lucency with surrounding ground glass halo

111
Q

how does organising pneumonia look on CT ?

A

consolidative / ggo in a peribronchovascular and perihilar distirbution

112
Q

what is the key imaging findings of RB-ILD ?

A

centrilobular nodules in the lung apices -
due to sheets of macrophages filling the terminal airways
and apices - as the smoking pathogens go to the top

113
Q

what is the classic features of a harmatoma ?

A

contains fat
peripherally located
popcorn calcification

114
Q

focal cord paralysis is a common feature in which cancer ?

A

lung cancer

115
Q

which cancers classically cause lymphangitis carcinomatosis ?

A

certain cancers spread by plugging the lymphatics
C -Cervic
C- Colon
S- Stomach
B- Breast
P- Pancreas
T- thyroid
L - lung/Larynx/ Broncho

116
Q

where do most inhaled lung disease affect ?

A

the upper lobes as the lower lobes have better blood supply and more robust blood flow

117
Q

what is hypersensitivity pneumonitis caused by ?

A

inhaled organic angitengs

118
Q

what is pneumoconiosis caused by

A

inorganic dust inhalation

119
Q

what is the most common feature of pneumoconiosis ?

A

multiple upper lobe predominant perilymphatic nodules

120
Q

what is Caplan syndrome

A

RA and either coal workers/silicosis. pneumoconiosis

121
Q

what type of consolidation is seen in chronic eosionphillic pneumonia ?

A

reverse bat wing: patchy , peripheral and upper lobe predominant

122
Q

what is the most common cause or pulmonary haemorhhage

A

microscopic polyangiitis - causing a pulmonary renal syndrome, with progressive renal failure

123
Q

what is granulomatosis with polyangiitis ?

A

small vessel vasculitis
1 - sinusitis
2 - lung disease
3- renal insufficiency
C-ANCA positive

124
Q

when is radiation pneumonitis most severe ?

A

3-4 months after treatment

125
Q

when does radiation fibrosis become apparent ?

A

6-12 months after therapy

126
Q

what is sarcoidosis ?

A

idiopathic non-caseating granulomas which merge to form nodules and masses within the body

127
Q

fibrotic changes to sarcoid most commonly occur where ?

A

mid to upper lobes

128
Q

what are the most common CT lung findings of sarcoid ?

A

egg shell calicifcaiotn lymph nodes
bilateral, symmetrical lymph nodes
upper lobe, perilymphatic nodules of varying sizes - granulomas

129
Q

what happens to the alveoli in pulmonary alveolar proteinosis ?

A

filling of the alveoli with proteinaceous lipid rich material

130
Q

what type of infection are patients with PAP susceptible of ?

131
Q

what is the treatment of PAP

A

whole lung bronchoalveolar lavage

132
Q

what is lymphangioleiomyomatosis.

A

diffuse cystic lung disease caused by bronchiolar obstruction and destructive lung disease

133
Q

what is LAM associated with ?

A

women of child bearing age
presents with spontaneous pneumothorax and a chylrothorax

134
Q

what is birthday-hogg dude syndrome characterised with ?

A

skin non cancerous tumours
chromophobe renal cell carcinoma
renal/pulmonary cysts

135
Q

which nerve pass through the AP window ?

A

phrenic
vagus
recurrent laryngeal nerves

136
Q

what makes the tracheoesophgeal stripe?

A

the posterior wall of the trachea with the pleural layer of the medial right lung

137
Q

what makes the azygoesphogeal line ?

A

the posterior medial basal segment of the right lower lobe and the oesophagus and azygous vein

138
Q

what condition is a thymoma associated with ?

A

Myasthenia gravis

139
Q

who is at risk of developing a malignant germ cell tumour

A

patients with klinefleter syndrome

140
Q

dense calcification within a lymph node is seen in ?

A

sarcoidosis or post granulomatous disaes

141
Q

low attenuation lymph nodes raises the suspicion of ?

142
Q

avidly enhancing lungs mets include

A

renal cell
thyroid
lung
sarcoma
melanoma

143
Q

what is unicentric castle mans disease present with ?

A

avidly enhancing enlarged lymph node/mass

144
Q

what is multicentricell castle was disease sene in ?

A

patients with HIV and Herpses simplex Visors 8

145
Q

where do morgangi hernias tend to arise ?

A

anterior medial - usually incidental finding, containing minaly fat. may have bowel

146
Q

what is the BTS guidelines follow up for a solid nodule ?

A

5-6mm - f/u in 12 months
>6mm - f/u in 3 months

147
Q

what are the preparations for FDG pet

A

> 4 hours between FDG pet and insulin
No excercsie for 24-48 hours
caffeine and alcohol and nicotine avoided for 12 hours
fasted for 6 hours

148
Q

what tissue types do teratomas commonly have

A

fat fluid and calcificatoin

149
Q

what do seminomas tend to present with

A

no calcification
increased levels of hCG, LDH, or alpha fetoprotein

150
Q

how does a malignant thymoma tend to present ?

A

with drop lesions into the pleura

151
Q

In left lower lobe collapse, on CXR what is obscured ?

A

the descending aorta

152
Q

what is a ganglioneuroma

A

benign tumourr fo sympathic ganglion cells

153
Q

what is a neuroblastoma

A

malignant tumour of ganglion cells seen in early childhood

154
Q

what type of neurogenic tumours typically occur in adults vs childnre

A

adults - peripheral nerves
children - sympathic

155
Q

what are the most common sympathic ganglion tumours in children

A

ganglioneuroma
neuroblastoma
ganglioneuroblastoma

156
Q

how does relapsing polychondritis present and what is it ?

A

idiopathic inflammation of the catilage
causes smooth , tracheal bronchial wall thickening with sparing of the posterior membranous trachea

157
Q

what is the morphological classification of bronchiectasis ?

A

three types
cyclindrical - mild
varicose
cystic - most severe

158
Q

what is the most common cause of bronchiectasis

A

chronic aspiration

159
Q

which congenital connective tissue disorders result in bronchiectasis ?

A

mounier-kuhn
williams-campbell

160
Q

what is the most common primary tracheal malignancy ?

A

squamous cell carcinoma

161
Q

which cancers most commonly metastasis to the lungs ?

A

BReaTH lungs
Breast
renal
Thryroid

(melanoma , sarcoma)

162
Q

which cancners will usually have a lung met at the time of diagnosis ?

A

CHEST
C - choriocarcinoma
Hypernephroma - wilms
Ewings sarcoma
Sarcoma
Testicular tumour

163
Q

what is pulmonary alveolar microlithatisi ?

A

tiny / sand like calcification deposits within the alveolar, classific appearance seen on cxr.
asymptomatic
may cause lung fibrosis

164
Q

what type of lung cancers doesn’t usually show up on PET

A

bronchial carcinoid tumours

165
Q

what is the main cause of pnaacinar emphysema?

A

alpha 1 antitrypsin

166
Q

what is Hypertrophic pulmonary osteoarthropathy (HPOA)

A

periosteal reaction of the long bones in association with lung disease

167
Q

how to firbous tumours of the pleural tend to look like ?

A

pleural based mass which tends to change position
low uptake on FDG

168
Q

which area is usually spared in astestbosis exposure plaques

A

the costophrenic angles

169
Q

which conditions lead to egg shell calcification?

A

silicosis
sarcoidosis

170
Q

which metastasis lead to mediastinal calcificaiton> ?

A

papillary/medullary thyroid cancer,
osteosarcoma
mucinous adenocarcinoma

171
Q

what is the classic wegners triad ?

A

sinusitis
renal disease
lung disesae

ST2 Radiology (13 decks)

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