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FRCR 2A > Chest > Flashcards

Chest Flashcards

1
Q

3 causes of chronic consolidation?

A

Adenocarcinoma in situ/minimally invasive adenocarcinoma/invasive adenocarcinoma

Organizing pneumonia

Chronic eosinophilic pneumonia

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2
Q

4 causes of central ground glass opacities?

A

Pulmonary oedema

Alveolar haemorrhage

Pneumocystis jiroveci pneumonia (PCP) - cancer, HIV, transplant

Alveolar proteinosis

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3
Q

Fibrosing mediastinitis

  1. Causes?
  2. Pathologic mechanism?
  3. Imaging appearance?
A
  1. Idiopathic (?IgG4), TB, histoplasmosis, radiation, sarcoid, drugs
  2. Causes compression of mediastinal structures
  3. Increased mediastinal soft tissue/mass, obliteration of mediastinal fat, calcification within mass or calcified nodes, may be focal lung abnormalities - opacities, septal thickening
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4
Q

8 causes of pulmonary hypertension?

A
  1. Primary (idiopathic) arterial hypertension
  2. Chronic thromboembolic pulmonary HTN
  3. Pulmonary veno-occlusive disease
  4. Chronic hypoxia - COPD, interstitial fibrosis, sleep apnoea
  5. Pulmonary venous HTN secondary to left-sided heart disease incl. aortic/mitral pathology
  6. Left-to-right sided shunt (ASD, VSD)
  7. Sarcoid
  8. Fibrosing mediastinitis
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5
Q

A few key points about staging of lung cancer:
- General cut off point for surgical resection?
- stage IV can be resected when?

A
  • Tends to be stage IIB/IIIA - when there is contralateral nodal involvement or tumour >7cm
  • solitary adrenal or brain metastasis
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6
Q

Solid pulmonary nodules

  • at what size do they not need follow up?
  • when to do a Brock score?
  • what is a raised Brock score and what to do next?
  • when can you discharge a solid nodule from follow up?
A
  • <5 mm
  • solid nodule >8 mm
  • > 10% - do a PET-CT
  • if the nodule is stable (<25% increase on volumetry, VDT >600 days)
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7
Q

Aspergillus - categories of pulmonary disease?

A
  1. Allergic bronchopulmonary aspergillosis (asthmatics, CF)
  2. Aspergilloma - in a pre-existing lung cavity (Monod sign)
  3. Subacute invasive pulmonary aspergillosis. Affects the debilitated, diabetic, etoh, COPD. Upper lobe consolidation → cavitation, pleural thickening
  4. Airway-invasive. Severely immunocompromised patients. Centrilobular and tree-in-bud nodularity.
  5. Angio-invasive. Severely immunocompromised. Halo sign (haemorrhagic infarction of surrounding lung), air crescent sign (air from retraction of infarcted lung - a good sign!)
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8
Q

Lady Windermere syndrome

A

Right middle lobe or lingula lobe bronchiectasis and tree-in-bud change in an older female, non-smoker, with cough, weight-loss, low-grade fever. Secondary to atypical Mycobacteria (avium intracellulare, kansasii).

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9
Q

Imaging manifestations of primary TB?

A

Nothing
Ill-defined consolidation
Adenopathy (peripheral enhancement, central low attenuation)
Pleural effusion
Miliary disease

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10
Q

Aspergillosis imaging findings?

A

Fleeting pulmonary opacities
Mucoid impaction - “finger in glove”
Bronchiectasis
Centrilobular nodules

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11
Q

Causes of lymphangitis carcinomatosis?

A

Certain Cancers Spread By Plugging The Lymphatics

Cervix
Colon
Stomach
Breast
Pancreas
Thyroid
Lung

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12
Q

Chest x-ray signs of PE

A

Westermark sign - regional oligaemia
Hampton’s hump - wedge shaped peripheral opacity
Fleischner sign - enlargement of the pulmonary arteries

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13
Q

4 causes of UIP pattern?

Trio of signs for UIP?

A

Idiopathic pulmonary fibrosis
Collagen vascular disease - rheumatoid arthritis, scleroderma
Drug injury
Asbestosis

Subpleural reticulation
Honeycombing with traction bronchiectasis
Apicobasal gradient

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14
Q

NSIP

  1. 2 forms of NSIP?
  2. Imaging findings?
  3. Most commonly seen in which patients?
  4. Steroid responsive?
A
  1. Fibrotic and cellular - cellular has better prognosis
  2. Bilateral symmetrical ground glass opacities, less prominent fibrotic changes, immediate subpleural sparing (this is v. specific), homogenous lung involvement in a subpleural pattern, microcysts and micronodules
  3. Those with collagen vascular diseases (SLE, scleroderma, RA, polymyositis)
  4. Yes - important to make the diagnosis as better prognosis than UIP/IPF
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15
Q

COP aka BOOP
1. Associations?
2. Steroid-responsive?
3. Imaging findings?

A
  1. Idiopathic, post-infectious, rheumatological conditions, CF, post-transplant, medications (bleomycin, nitrofurantoin)
  2. Very - but frequent relapse on cessation
  3. Peripheral patchy lung consolidation/GGO Atoll sign/reverse halo sign
    Nodules - small centrilobular mimicking HSP
    Larger nodules which cavitate
    Or may be a single mass that mimics lung cancer
    Perilobular fibrosis “arcade sign”

May be bronchial dilatation within consolidation
May be subpleural sparing

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16
Q

RB-ILD - respiratory bronchiolitis-interstitial lung disease

Demographics?

Imaging?

A

Young smokers

Centrilobular nodules and patchy GGO, upper lobes

Continuum with DIP

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17
Q

DIP - desquamative interstitial pneumonia

Imaging?

A

Patchy or subpleural GGO - more extensive that RB-ILD, peripheral predominance

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18
Q

LIP - lymphoid interstitial pneumonia

Causes?
In a child?
Imaging?

A

Idiopathic, HIV, Sjogren’s, autoimmune, infection (HBV, PCP, EBV), Castleman’s

Think HIV

Diffuse (or lower lobe) GGO
Thin-walled perivascular cysts
Pneumothorax

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19
Q

AIP

  1. Clinical features?
  2. Imaging?
A
  1. Bad prognosis, acute onset, Previously fit and well require ventilation in 1-4 weeks.
  2. Bilateral, symmetrical, lower lobe GGO and alveolar consolidation from oedema/haemorrhage, then later fibrotic changes in non-dependent lung
    Classically spares the costophrenic angles
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20
Q

Pleural fibroma
- associations?
- imaging findings?
- management?

A

Hypoglycaemia, HPOA, not asbestosis

Smooth with contrast enhancement

Surgical resection - 1/3 undergo malignant transformation

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21
Q

Hypersensitivity pneumonitis (HSP) - organic!

Imaging findings?

A

Acute - GGO or consolidation
Subacute - ground glass centrilobular nodules, mid to lower zones, mosaicism
Chronic - fibrosis affecting the upper lobes

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22
Q

Coal worker’s pneumoconiosis
- classification?
- CWP imaging findings?
- PMF imaging findings?

A

Simple or complicated - complicated has PMF pulmonary massive fibrosis

Multiple small upper and mid zone opacities +/- calcification; enlarged hilar LNs, which are often calcified

Peripheral upper/mid zone mass >1cm, may be bilateral, may become necrotic + cavitate

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23
Q

Silicosis
- types?
- pathognomonic imaging finding?

A

Classic silicosis - nodules which may coalesce to form PMF

Silicoproteinosis - very similar to alveolar proteinosis, develops with high exposure over a short time

Egg-shell calcification of hilar lymph nodes

24
Q

Eosinophilic lung disease

Simple pulmonary eosinophilia (Loffler syndrome)
- causes?
- imaging findings?

Chronic eosinophilic pneumonia
- imaging findings?

A

Idiopathic, parasitic infections, drug reactions

Migratory and transient areas of focal consolidation

Patchy peripheral consolidation “reverse batwing appearance” with upper lobe predominance - unchanged for months

25
Q

Pulmonary vasculitis
- EGPA - associations?
- GPA - classic triad? lung findings? c-anca positive.
- microscopic polyangitis - imaging findings?

A

Asthma, peripheral eosinophilia

Sinusitis, lung involvement, renal impairment. Multiple cavitatory nodules.

Pulmonary haemorrhage

26
Q

Sarcoidosis
- distribution of pulmonary fibrosis secondary to sarcoid?
- most common radiographic findings? most common CT finding?

A
  • mid to upper lobe predominance
  • symmetric adenopathy. Eggshell calcification of lymph nodes.
  • perilymphatic nodules
27
Q

Differential for disease affecting the lungs and bones?

A
  • pulmonary Langerhans cell histiocytosis
  • malignancy
  • TB
  • sarcoid
  • fungal disease
  • Gaucher disease
28
Q

PLCH (pulmonary Langerhans cell histiocytosis)

Demographics?

Imaging findings?
Progression of disease?

A

Young, smokers

Upper lobe cysts - thick walled, bizarre shaped
Nodules
- sparing of the costophrenic sulci
Pneumothorax

Nodules → cavitatory nodules → cysts

29
Q

Causes of crazy paving pattern?

A

Pulmonary oedema
ARDS
Pulmonary alveolar proteinosis
Pulmonary haemorrhage
PCP
OP + NSIP
Mucinous adenocarcinoma
Lipoid pneumonia

30
Q

Lymphangioleiomyomatosis (LAM)
- imaging findings?
- types?
- associations?

A

Smooth, numerous thin-walled round cysts throughout all five lobes of the lungs

Type seen in tuberous sclerosis
Idiopathic type - women of child-bearing age

Pneumothorax and chylous pleural effusion

31
Q

Causes of paraspinal line abnormality?

A

Neurogenic tumour
Osteophyte
Infection/lymphadenopathy
Haematoma secondary to traumatic vertebral fracture
Aortic aneurysm
Extramedullary haematopoiesis
Oesophageal varices

32
Q

Differential for anterior mediastinal mass (prevascular)?

A

Thymic epithelial neoplasm (thymoma/thymic carcinoma)
Thymic cyst
Thymolipoma
Thymic carcinoid

Germ cell tumour - teratoma, seminoma

Lymphoma - HL/NHL
Adenopathy - pneumoconiosis/sarcoid/TB/Castleman’s/metastases

Thyroid lesion - goitre/carcinoma/thyroiditis

33
Q

Causes of vascular metastases?

A

Renal cell ca
Thyroid
Lung
Melanoma
Sarcoma

34
Q

Differential for anterior mediastinal mass (pre-cardiac)?

A

Epicardial fat pad
Pericardial cyst
Morgagni hernia

35
Q

Causes of bronchiectasis?

A

Cystic fibrosis
ABPA
Post infectious
TB/atypical mycobacteria
Agammaglobulinaemia
Immunodeficiency
Kartagener
Mounier-Kuhn syndrome

CAPTAIn Kangaroo has Mounier-Kuhn

36
Q

Differential for nodular and irregular tracheal wall thickening?

A

Amyloidosis
Adenoid cystic carcinoma
Sarcoidosis
Tracheal metastases

37
Q

Airway tumours

Most common primary in adults?
Most common primary in children?
Most common cancers to metastasize to airways?

A

SCC
Endobronchial carcinoid
Breast, thyroid, lung, renal cell ca

38
Q

Benign endobronchial lesions?

A

Papilloma
Chondroma
Schwannoma
Adenoma
Haemangioma
Lipoma
Leiomyoma
Hamartoma

39
Q

Which cancers metastasize to the pleura?

A

Lung
GI and GU adeno
Invasive thymoma

40
Q

Most common cause of lung metastases in order?

A

Breast
Colon
Renal
Uterus
Head and neck

41
Q

Most common malignancies to present with synchronous lung metastases?

A

Lung
Bowel
Renal cell
Pancreas
Breast
Testis (young men)

42
Q

Drug causes of lung fibrosis

A

Amiodarone
Chemotherapy - Bleomycin, carmustine, cyclophosphamide, busulfan
Methotrexate
Antibiotics - nitrofurantoin, sulfasalazine, amphotericin B, isoniazid
Biological agents

43
Q

Carney Triad

A

Pulmonary chondroma
Gastric leiomyosarcoma (GIST)
Extra-adrenal paragangliomas

44
Q

Carney syndrome

A

Atrial myxoma
Facial/buccal pigmentation
Sertoli tumour testis
Pituitary adenoma

45
Q

Causes of upper zone fibrosis?

A

BREASTS

Berylliosis
Radiation
Eosinophilic granuloma (i.e. LCH) and EEA (i.e. HSP)
Ankylosing spondylitis
Sarcoidosis
TB
Silicosis/CWP

46
Q

Causes of lower zone fibrosis?

A

BADAS

Bronchiectasis
Asbestosis
Drugs and DIP
Aspiration pneumonitis
Scleroderma and rheumatoid arthritis

47
Q

Differential for tree-in-bud on HRCT?

A

Infection
- TB
- MAI
- CMV/RSV
- invasive Aspergillus

Hereditary
- CF
- Kartagener’s

ABPA/asthma

Panbronchiolitis

Aspiration

Tumour invasion

48
Q

Characteristics of ABPA bronchiectasis?

A

Upper zone, central, cystic + varicose bronchiectasis
High attenuation of mucous plugs
Prominent “finger in glove”

And then the same as CF: tree-in-bud, bronchial wall thickening, air trapping

49
Q

Characteristics of CF bronchiectasis?

A

Upper zone bronchiectasis but can be much more diffuse
Air trapping, increased lung volume, mosaicism

Nodular opacities + tree-in-bud

50
Q

Stages of sarcoid on CXR?

A

0 - normal CXR
1 - lymphadenopathy
2 - lymphadenopathy and parenchymal
3 - parenchymal only
4 - fibrosis

51
Q

Causes of lower zone bronchiectasis?

A

Kartagener’s
PCD
Alpha-1 antitrypsin
Immunodeficiency
Chronic aspiration
Pulmonary fibrosis

52
Q

Causes of upper zone bronchiectasis?

A

Sarcoid
TB
CF
ABPA

53
Q

Causes of central bronchiectasis?

A

CF
ABPA
Williams Campbell
Mounier-Kuhn

54
Q

Causes of anterior bronchiectasis?

A

ARDS
Atypical mycobacteria

55
Q

Causes of focal bronchiectasis?

A

Swyer-James
Carcinoma

56
Q

Asbestos-related lung disease

  • earliest feature
  • most common feature
  • location of pleural plaques
  • percentage of plaques calcified?
  • features of fibrosis in asbestosis
A

Pleural effusion - often haemorrhagic

Pleural plaques

Mid-lower chest, paravertebral + diaphragmatic, spare the apices/CP angles

15-50%

Begins as lower zone proccess. Subpleural dots + linear opacities, curvilinear opacities and PARENCHYMAL BANDS. These are more common in asbestos fibrosis than any other pulmonary fibrosis.

57
Q

Differential for centrilobular nodules

A

Non-infective
- HSP
- RB-ILD
- COP
- LIP
- asbestosis/pneumoconioses
- diffuse panbronchiolitis

Infective
- TB
- bronchopneumonia
- ABPA
- CF

FRCR 2A (10 decks)

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