Chest Flashcards
Lung cancer T1 staging?
T1 = tumour <1-3cm
T1a - <1cm
T1b = 1-2cm
T1c = 2-3cm
Lung cancer T2 staging?
T2 = tumour 3-5cm
T2a = 3-4cm
T2b = 4-5cm
Or T1 with:
- involvement of trachea (NOT carina)
- Involvement of the pleura
Lung cancer T3 staging?
T3 = tumour 5-7cm
or T1/2 with involvement of:
- chest wall
- phrenic nerve
- pericardium
Lung cancer T4 staging?
T4 = tumour >7cm
or T1-3 with involvement of:
- vertebral body
- great vessels
- mediastinum/heart
- oesophagus
- carina
- diaphragm
Lung cancer N staging?
N0- no nodes
N1 - ipsilateral peribronchial / hilar / intrapulmonary nodes
N2 - ipsilateral mediastinal or subcarinal nodes
N3 - CONTRAlateral mediastinal, hilar, or any supraclavicular nodes.
Lung cancer M staging?
M0 - no distant metastasis
M1 - distant metastasis present
- M1a - separate tumour nodules in contralateral lobe, or pleural/pericardial nodules.
- M1b - single extra thoracic metastasis in a single organ or single extra-thoracic node.
- M1c - multiple extra-thoracic metastasis
Post bone marrow transplant pulmonary findings?
Neutropenic phase (<1 month) - Pulmonary oedema, haemorrhage, fungal
Early (1-3 months, immunosuppressed) - PCP, CMV
Late (>3 months) - COP, Bronchiolitis obliterans
HIV patient presents with cough. CXR has fine reticular interstitial change.
CT has diffuse ground glass with pneumatoceles. Diagnosis?
PCP pneumonia
Patient has upper lobe calcified granuloma and large calcified hilar lymph nodes. Diagnosis?
Ranke complex - Healed primary TB.
Elderly COPD patient develops upper lobe cavitary lesions and consolidation. Tree in bud consolidation is seen elsewhere.
Diagnosis?
Classic Mycobacterium Avium Intracellulare Complex
Non classic would be Lady Windermere disease
Signs of invasive aspergillus Vs normal aspergilloma?
Halo sign - ground glass around aspergilloma
Air Cresent sign - cresent of air above mass (pulmonary necrosis)
Invasive aspergillus is normally seem in immunosuppressed patients
What is the most common cavitating lung cancer?
Squamous cell cancer
Lambert Eaton syndrome is most commonly associated with what lung cancer?
Small cell lung ca
Patient post pneumonectomy is shown to have the pneumonectomy space fill with progressively more air.
What is the post surgical diagnosis?
Broncho-pleural fistula.
Normally the space should fill with fluid not air.
Chest findings in LCH
Upper and mid zone predominant
Irregular shaped nodules and thick walled cysts .
Smoking related
Features of LAM
Diffuse uniform distribution
Thin walled round cysts
Young women
Features of LIP
Mid and lower zone predominant
Thin walled round cysts
Perivascular distribution
Associated with Sjogrens and HIV
Patient presents with chronic productive cough and recurrent chest infections. CT shows massive tracheobronchomegaly. Diagnosis?
Mounier-Kuhn
Where do cardiac fibroelastomas normally occur?
Cardiac valves
What is Carney Complex?
Cardiac myxomas and skin pigmentation (blue naevi)
Most commonly malignant adult primary cardiac tumour?
Cardiac angiosarcoma
Typically seen in the right atrium
Most common paediatric cardiac tumour
Rhabdomyoma
High association with tuberous sclerosis
Key features of malignant mesothelioma?
Pleural thickening extending to the medial surface of the pleura (near the heart)
Pleural thickness >1cm
Extension into the fissure
What is empyema necessitans and what condition is it seen with?
Empyema that eats into the soft tissues
Seen with TB
What are thymomas associated with?
Myasthenia gravis
What is the classical imaging appearances of PAPVR, and what is it associated with?
One of the pulmonary veins drains into the right atrium instead of left
Scimitar sign
Associated with sinus venosus ASD
What thoracic disease is Behcet disease associated with?
Becets is chronic vasculitis of unknown origin
Associated with pulmonary artery aneurysms
How do you differentiate pneumomediastinum Vs pneumopericardium?
Pneumopericardium does not extend above the great vessels
Classic imaging appearance of transposition of great vessels?
Egg on string appearance (egg shaped heart)
Classic CXR appearance of Tetralogy of Fallow?
Boot shaped heart
Classic CXR imaging appearance of TAPVR?
Snowman heart
Classic CXR imaging appearance of Epstein anomaly?
Box heart
Associated with:
Turner’s
Downs syndrome
ASD
What maternal disease is patent ductus arteriosus associated with?
Maternal rubella
What is Holt Oram?
ASD and hand/thumb defects
What are the three types of ASD and where are they located?
Ostium primum - lower septum
Osteum Secundum - mid septum
Sinus venosus - upper septum
What is Tetralogy of Fallow?
RVOT obstruction
VSD with an overriding aorta
RV hypertrophy
What is the Garland triad?
Classic location of sarcoidosis lymphadenopathy
Bilateral hilar enlargement and right paratracheal nodes
What is classically seen (and not seen) in PCP pneumonia?
Pneumatoceles
Peri-hilar groundglass
Pleural effusions are not a feature
Classic imaging appearance of pulmonary Kaposi Sarcoma
Flame shaped nodular opacities
Interlobular septal thickening
Most common left to right shunt in adulthood?
ASD
What is the modified PIOPED criteria for PE on V/Q scan?
High probability - two or more large segmental defects (Large = 75% of segment)
Low probability - Up to 3 small subsegmental defects (small <25% of segment)
Intermediate probability - anything between low and high probability.
Most common lung cancer in non smokers?
Adenocarcinoma
How does RA present in the lungs?
Pleural thickening/effusions
UIP
Ground glass
Caplan syndrome (RA and Pneumoconiosis)
How do you differentiate intra and extra lobar sequestration?
Intralobar - more common 75%, Pulmonary veinous drainage, does not have separate pleura, recurrent infections
Extralobar - Systemic veinous drainage, separate pleural cover
What are the classic imaging features of ARDS on CT?
Pulmonary opacification with a dependent density gradient
Widespread groundglass
Classic imaging features of COP?
Patchy peripheral consolidation with reverse halo sign/atoll sign
Changes over time (fleeting)
How do you define Goodpastures syndrome?
Groundglass opacities that progress to crazy paving
Glomerulonephritis
Pulmonary haemorrhage
Hilar lymph nodes
Antiglomerular basement membrane antibodies
How to differentiate Primary Ciliary Dyskinesia from CF?
CF has upper lobe bronchiectasis
PCD has lower lobe bronchiectasis
X-ray findings of coarctation of the aorta?
Figure 3 sign
Inferior rib notching
What is pseudocoarctation of the aorta?
Elongation, narrowing or kinking of the aorta, with no pressure gradient, collateral formation, or rib notching.
What is Danon disease?
X linked cardio-skeletal myopathy
- Cardiomyopathy
- Skeletal myopathy (skeletal muscle weakness)
- Intelectual disability
Typical imaging appearance of a cardiac myxoma?
Left atrium attached to the interatrial septum
Well defined stalk
Calcification is common (due to repeat haemorrhage)
Most common pulmonary manifestation of rheumatoid arthritis?
Pleural disease:
- Pleural thickening
- Pleural effusions
Other - UIP, ground glass, Caplan syndrome
Classic imaging findings of silicosis?
Upper lobe predominant DENSE nodular opacities (more dense than soft tissue)
Eggshell calcification of lymph nodes
What is Eisenmenger syndrome?
Uncorrected left to right shunt, causing chronic pulmonary hypertension.
This causes increased pulmonary vascular resistance and right ventricular hypertrophy which in turn equalises the pressures in the ventricles and subsequently reverses the shunt.
How can you differentiate between true cardiac aneurysm and false cardiac aneurysm?
True aneurysm have broad neck and contain all the layers of endocardium and epicardium. They can contain mural thrombus which can be calcified.
False aneurysms are a rupture of the myocardium which is contained by pericardium.
Typically imagine findings of chronic eosinophilic pneumonia
Reverse bat wing airspace consolidation
(Upper lobe, peripheral airspace consolidation)
Classic imaging findings of reactivated TB?
Centrilobular nodules
Upper lobe consolidation +/- cavities
Tree-in-bud opacities
What are the two peak in incidence for post transplant lymphoproliferative disease?
1 year and 5 years post transplant
What is Kartageners syndrome?
Primary ciliary dyskinesia
Situs invertus
Bronchiectasis
LAM is associated with which condition?
Tuberous sclerosis
Typical location for a pericardial cyst?
Right cardiophrenic angle
Typical location for a bronchogenic cyst?
Sub carinal (50%)
Paratracheal (20%)
Associated conditions with ABPA?
Asthma
CF
Classical imaging appearance of ABPA?
Bronchiectasis
Finger in glove opacities (mucoid impaction in bronchocele)
BTS solid lung nodule follow-up criteria?
<5mm: - discharge
5-6mm: - CT at 12 months
6-7-8mm: - CT at 3 months
>8mm:
- low risk - CT 12 months,
- high risk - PET CT
Typical imaging findings in Acute eosinophilic pneumonia
Bilateral patchy ground glass opacification
Interlobular septal thickening
Pleural effusions
What pathology does unilaterally LEFT rib notching suggest?
Coarctation of aorta with aberrant RIGHT subclavian artery
What disease does progressive massive fibrosis occur in?
Pneumoconiosis
Silicosis
