CHEST Flashcards
1
Q
Indications for low dose VQ
A
children, pregnant, pulmonary hypertension, right-to-left shunt (immediate brain. and renal uptake)
2
Q
High probability PE on VQ scan
A
x2 large segmental mismatched defects (wedge shaped) >80%
3
Q
Intermediate probability PE
A
> 25% of a segment and < 2 mismatched segmental perfusion defects + normal CXR
4
Q
Low probability PE
A
Non-segmental defects: small effusion , cardiomegaly, elevated diaphragm, ectatic aorta
Any perfusion defect with a substantially larger CXR abnormality
Matched ventilation + perfusion defects + normal chest X-ray
Small subsegmental perfusion defects + chest X-ray
5
Q
Reversed mismatch VQ
A
lobar collapse, pneumonic consolidation, a large pleural effusion and obstructive airway causes
6
Q
Paeds cardiac tumours
A
- Myxoma: interatrial septum, commoner on left/ fossa ovalis, can prolapse through valve, haemorrhage, haemosiderin
*Carney complex- myxomas + skin pigmentation - Rhandomyoma: ventricles, kids, TS, iso/high T1, high T2, hypoenhancing
outflow obstruction - Fibroma: IV septum, kids, central calc, hypo T1/T2, progressive enhancement
Cardiac mets: melanoma, lung, breast
Haemangioma: avid enhancement, any chamber, pericardial effusion
Teratoma: multilocular cystic /solid mass abutting PA and aorta.
Lipoma= RA
7
Q
ARDS
A
NO PLEURAL EFFUSION
patchy, peripheral opacification
> dense confluent consolidation- dependent areas
>becomes fibrotic: reticular opacities- anterior distribution
8
Q
PCP
A
- Hilar/ mid zone GG opacities
- PTX/ pneumoatoceles
- AIDS/ HIV
CD4<200, increased gallium
9
Q
HP features
A
*Subacute: Patchy GG opacities. Ill-defined Centrilobular GG nodules (80%). Subpleural sparing. Often has mosaic perfusion, and air trapping.
*Chronic: Looks like upper zone UIP + Air trappins> traction bronchiectasis + air trapping.
10
Q
Kartageners
A
sinusitis+ bronchiectasis + dextrocardia
- infertility, TGA, pyloric stenosis, post cricoid web
11
Q
Aspegilloma
A
- normal immune system
- fungal ball in pre existing cavity, moves
12
Q
ABPA
A
- seen in asthmatics/ hyperimmune
- finger in glove mucoid impaction + central saccular bronchiectasis
Diagnosis of ABPA requires BOTH:
* Elevated Serum IgE OR a positive skin hypersensitive test
. Elevated Total IgE levels > 1000
13
Q
Airway invasive
A
Neutropenic/ AIDS
centrilobular and tree-in- bud nodules/ bronchopneumonia
14
Q
ANGIOINVASIVE
A
Neutropenic patients
- air crescent sign
- halo sign
15
Q
Mycoplasma CXR
A
commonest young adults
Fine reticular pattern on CXR, Patchy airspace opacity with tree-in-bud
> assoc: Swyer James Mcleod
●● Peribronchial/perivascular infiltrates
●● Patchy consolidation
●● Ground-glass opacification
●● Lower lobes
●● Hilar lymph node enlargement
●● Small effusions in 20%
16
Q
Staph aureus CXR findings
A
Bronchopneumonia - patchy opacities, often bilateral
17
Q
Strep penumonia CXR
A
Lobar Consolidation Strep Pneumo Favors lower lobes.
- severe in sickle cell / AIDS
18
Q
Klebsiella
A
Bulging fissure
More likely to have pleural effusions, empyema, and cavity than conventional pneumonia.
Alcoholics, nursing home
19
Q
Pseudomonas CXR
A
Patchy opacities, with abscess formation, small effusions
ICU on ventilator, CF
20
Q
Post bone marrow transplant- lung findings
A
Early Neutropenic (0-30 days)
Pulmonary Edema, Hemorrhage, Dmg Induced Lung Injury
Fungal Pneumonia (invasive aspergillosis)
Subacute
PCP, cmv
Late
Bronchiolotiis obliterans, COP
Graft vs host disease
- BO
21
Q
TB
A
Primary- lobar consolidation + pleural effusion + lymphadenopathy, Ranke complex. NO CAVITATION
CXR: middle/lower lobe consolidation with ipsilateral lymph node enlargement and effusion.
Ghon focus: focus of parenchymal infection> upper part of the lower lobe or the lower part of the upper lobe. can also be MILIARY
Ranke complex: Ghon focus and lymphadenopathy.
Kids= low attenuation adenopathy
Primary progressive: immunocompromised. cavitation occurs at site of primary disease
Reactivation- CD4 >200
Upper lobe apical and posterior segments / superior segments of the lower lobes.
TUBERCULOMA- upper lobe
upper-lobe predominant consolidation + cavitation. Tree-in-bud nodules = active endobronchial spread.
“Rasmussen Aneurysm”-
22
Q
Mycobacterium infection
A
- old man, cavitations, looks like TB- upper lobe cavitary lesion with adjacent nodules
- MAI: old women, CYLINDRICAL bronchiectasis + tree in bud , right middle lobe/ lingula
HIV Patients - CD4s < 50. GI infection disseminated >hepatosplenomegaly. Mediastinal lymphadenopathy=commonest manifestation.
Hot tub lung- HP - GG nodules
23
Q
Cryptococcus
A
Immunocompromised
wide range of appearances ranging from GG to focal consolidation to cavitary nodules, miliary disease, often associated with lymphadenopathy or effusions.
24
Q
CWP
A
●● Diffuse nodules
●● Hilar or mediastinal lymph node enlargement with or without central node calcification (eggshell calcification also sometimes present)
- upper lobe predominant
- PMF T2 DARK
25
Silicosis
- MINERS
- multiple nodular opacities UPPER LOBES
-Egg shell calcifications (less in CWP) >hilar nodes= highly suggestive
- Perilymphatic nodules.
- PMF (can cavitate)- more common than in CWP
26
Centrilobular nodules
*Infecdon
*RB-ILD
*HP
27
Perilymphatic
*Sarcoid (90%),
*Lymphangitic Spread of CA
*Silicosis
28
UIP
Definite UIP Criteria:
Honeycombing (must be present) * +/- traction bronchiectasis
Reticular abnormalities
* Subpleural basal predominant distribution
Assoc: IPF, RA, Asbestosis, Drug toxicity
CF CHRONIC HP- UPPER LOBE FOBROSIS
29
RB ILD
Localized centrilobular ground glass nodules - apical predominant.
30
DIP
peripheral LOWER LOBE predominant ground glass, with small cystic spaces
Smoker
●● Diffuse ground-glass opacification not respecting fissures—this is classic.
●● Deep parenchymal cysts.
●● More commonly a peripheral pattern.
31
PAP
Assoc: SMOKING ++, acute silicosis, haematological malignancy, infection with immunosuppression ( Crypto, Nocardia, Aspergillus)
Interlobular septal thickening and ground glass.
Increased risk norcardia
Black bronchus sign
rx= whole lung bronchoalveolar lavage
32
COP
Patchy air space consolidation or GGO (90%), peripheral or peri-bronchial distribution
REVERSE HALO SIGN
Drug toxicity *AMIODARONE*
Connective tissue disorders, particularly SLE and dermatomyositis
RX= STEROIDS
33
Chronic eosinophilia
Peripheral GGO or consolidation.
*reverse batwing*
UPPER / MIDDLE LOBES
> looks like COP
- crosses fissures
- transient + migratory
hx asthma
34
Pleural mets
Lung, breast cancer, GI, GU
35
Solitary fibrous tumour
Assoc: hypoglycemia or HPOA,
* FTP may be pedunculated, changes position
low FDG uptake on PET.
36
Mesothelioma
- epitheloid type best prognosis
- CT + MRI to help delineate disease extent + FDG PET for nodal disease
37
Bronchiolitis obliterans
post lung + bone marrow transplant
Air trapping on expiratory views.
Mosaic perfusion
Centriloular nodules
Bronchiectasis + bronchial wall thickening.
Meds assoc: methrotrexate, bleomycin, amiodarone, penicillamine
38
Mosaicism
VESSELS IN LUCENT LUNG = SMALL
Expiration:
Air trapping = stays lucent with no change
Vascular lung = lucent lung becomes more dense
**if vessels size is normal then GG
39
Simple eosinophilic pneumonia/ Lofflers
transient + migratory consolidation
elevated eosinophil count
40
Chronic eosinophilic pneumonia
- patchy and peripheral consolidation
-upper/ mid zones
- crosses fissures (CF COP)
- raised eosinophils
41
COP
- REVERSE HALO
- PERIPHERAL AND PERIBRONCHOVASCULAR consolidation + nodules
> infection, drug reaction, inhalation, connective tissue disorder
42
Malignant pulmonary nodules
> Large size = single most important risk factor for malignancy
> Irregular edge or spiculated margins.
> GG/ cavitatory nodules
* Risk factors for malignancy = older age, heavy smoking, emphysema, pulmonary fibrosis, upper lobe location.
43
Aortic coarctation rib notching
Bilateral = distal to left subclavian
UNILATERAL RIGHT=
>between brachiocephalic + left subclavian OR
>right sided arch + aberrant left subclavian artery distal to coarctation
UNILATERAL LEFT =
> aberrant right subclavian artery arising after the coarctation
44
Takaysau
thoracic+ abdominal aorta, subclavian, carotid, pulmonary arteries, large mesenteric arteries.
Acute: thickened wall, delayed enhancement
Fibrotic: irregular contour ascending aorta + calc
45
Croup
Acute laryngotracheobronchitis
6mo - 4yo
Steeple sign >frontal view - loss of normal shouldering of SUBGLOTTIC TRACHEA, “ballooning” of the hypopharynx lateral view.
46
Epiglottitis
thickening of the epiglottis (thumbprint sign) + aryepiglottic folds
47
Exudative tracheitis
6-10 yo
linear filling defects representing intraluminal membranes may be visible in the subglottic and cervical trachea - candle wax dripping sign
48
Retropharyngeal abscess landmarks
NORMAL:
Prevertebral soft tissues < 0.5 vertebral body width at C1–C3
<1 vertebral body width at C4
49
ARVD
YOUNG MALES
Fibrofatty replacement of RV
● Dilated RV, bulging/ aneursmal dilatation, thinned wall, reduced function
● High T1
● RV dyskinesia or akinesia + increased RV volume / reduced RV EF
● Increased end-diastolic RVOT diameter >32mm
50
Takaysubo
Ballooning of cardiac apex +/- delayed enhancement
Transient akinesia or dyskinesia LV apex without coronary stenosis
51
HOCM
●Autosomal dominant
●Patchy MID MYOCARDIAL LGE
● Reduced diastolic filling/ function
Hyperdynamic systolic function
●Asymmetric SEPTAL hypertrophy variant type can cause LVOT
● End-diastolic wall thickness ≥15 mm + ratio of ≥1.5 compared to lateral wall.
● Wall thickness ≥30 mm= ICD
● SAM of anterior leaflet MV
52
Restrictive cardiomyopathy
Small, stiff, thickened ventricles = impair diastolic filling + dilated atria + dilated IVC.
CAUSES: idiopathic / sarcoidosis/ amyloid hemochromatosis, hypereosinophilic syndrome (e.g., Loeffler’s)
53
Dilated cardiomyoapthy
Diffuse enlargement all chambers
Impaired systolic function
Ischaemic (delayed enhancement vascular distribution) or non ischaemic (idiopathic, alcohol abuse, myocarditis, drug *no enhancement or linear mid-myocardial enhancement*)
ASSOC: MITRAL REGURG
54
Circumferential endocardial enhancement
amyloidosis
scleroderma
cardiac transplantation hypereosinophilic syndrome
55
Mesocardial enhancement
dilated cardiomyopathy myocarditis
sarcoidosis
Chagas disease
HOCM
right ventricular pressure overload
(pulmonary hypertension)
56
Subepicardial enhancement
myocarditis
sarcoidosis
Chagas disease
57
Non compaction
Congenital anomly
LV= spongy appearance, increased trabeculations and deep intertrabecular recesses + thin wall
*prominent ventricular trabeculation*
58
Cardiac sarcoid
MIDWALL/ EPICARDIAL ENHANCEMENT, NON CARDIAC DISTRIBUTION
Increase T2 + early Gd (as well as late Gd)
Focal wall thickening from edema > mimic HOCM
INVOLVES SEPTUM +LV
> can cause restrictive cardiomyopathy
59
Amyloid cardiac features
long TI / difficult to suppress myocardium
Assoc: RA, MM
RESTRICTIVE CM
biatrial enlargement, concentric thickening of LV, reduced systolic function
Delayed SUBENDOCARDIAL enhancement
60
Eosinophilic Cardiomyopathy (Loeffler).
Bilateral Ventricular Thrombus
> Need long TI to see
SUBENDOCARDIAL ENHANCEMENT
61
Constrictive vs restrictive
CONSTRICTIVE (pericardial pathology)
Idiopathic/ TB
* Pericardium >4mm
* Diastolic septal bounce= Sigmoidization of the septum
* No Abnormal Late Gd Myocardial Enhancement on Constrictive Disease
62
Myocarditis
Delayed enhancement of lateral free wall> epicardial or mid wall
wall motion abnormalities
63
Myocardial hibernation vs stunning
Stunning: After acute ishcemic injury
- normal perfusion, abnormal motion
Hibernating: abnormal wall motion + perfusion even at rest, FDG PET- intense uptake, more than normal myocardium + redistribution of thallium.
Infarct/ scar: As above but WILL NOT TAKE UP FDG/ redistribute thallium
64
Cardiac fibroelastoma
Cardiac valves (AV)
Low T2
May predispose to thrombus
65
Cardiac fibroma
Kids
Low T2/ T1
Central calcification= pathognomic
IV septum
Causes obstruction + arrhythmias
Progressive enhancement
66
Rhabdomyoma
Commonest primary in Kids
Ventricles- outflow obstruction/ arrythmias
T1 iso- hyperintense, high T2 hypoenhancing
TS
67
Cardiac myxoma
Adults
LA, Interatrial septum (fossa ovalis), prolapses
Same SI as muscle, High T2
HEMORRHAGE/ NECROSIS COMMON
delayed enhancement
* carney complex- myxomas + skin lesions + endocrine dysfunction
68
Cardiac lipoma
RA
69
Lipomatous hypertrophy interatrial septum
fatty deposits ininter-atrial septum, lateral right heart border
70
Cardiac paraganglioma
left atrium, retroaortic, and AP window
Arterial enhancement ++
71
Commonest malignant primary cardiac tumour?
Angiosarcoma
R side of heart *RA*
“cauliflower-like” heterogeneous appearance > hemorrhage, necrosis- T1 and T2 hypointense foci
72
Cardiac teratoma
Kids
Pericardial attachment
Multilobukated mass near root of PA/ aorta
Can cause pleural effusion
73
Myocarditis
The late Gd enhancement - non-vascular distribution - lateral free wall.
Epicardial or mid wall
74
Perfusion cardiac ischaemia
Stress - Decreased
Rest - normal
FDG uptake - increased
Thallium Resdistribution? yes
Contractility - Normal/ stunned
75
Perfusion Infarct
Stress - Decreased
Rest - Decreased
FDG uptake - Decrased
Thallium Resdistribution? NO
Contractility - Decreased
76
Hibernating myocardium perfusion
> viable but hypoperfused
Stress - Decreased
Rest- Decreased
FDG uptake - INCREASED (MATCHED)
Thallium Resdistribution? Yes
Contractility- Decreased
77
Stunned myocardium Perfusion
> delayed recovery of contractile function despite reperfusion
Stress- normal
Rest- normal
FDG uptake- normal
Thallium Resdistribution? YES
Contractility - decreased
78
Cardiac vascular territories
Inferior = RCA (II, III, AVF)
Septum + Anterior Wall = LAD (I,II,III)
Circumflex = Lateral free wall (IV,V,VI)
79
Origin of posterior descending artery
normally RCA
"Dominant"
80
Coronary Anomalies
- LCA from right coronary sinus (between Aorta + PA)
- ALPACA
(a) Infantile type (die early)
- CHF & dilated cardiomyopathy
(b) Adult (sudden death)
Steal syndrome- reverse flow in LCA as pulm pressure decreases
COMMONEST= aberrant circumflex arising from RCA, travels posteriorly into left AV GROOVE
Myocardial bridging= intramyocardial course of a coronary artery (usually the LAD).
81
Features of severe MR
Acute RUL oedema
82
Thymoma
assoc: anaplastic anaemia, MG
Rounded enlargement, commonly with calcification
●Node enlargement + local invasion > malignancy.
●Drop metastases > pleura
83
Tracheobronchial amyloid
Circumferential narrowing
84
Actinomyosis
Following dental extraction
Invades pleura, chest wall
85
PMF vs lung Ca
MRI Low T2, Active fibrosis = FDG avid
86
TRACHEOBRONCHOPATHICA OSTEOCHONDROPLSTICA
Calcified nodules anterior and lateral walls
87
Relapsing polychondirits
Diffuse anterior and lateral thickening of the trachea.
Spares POSTERIOR
recurrent pneumonia
88
Wegeners involvement trachea
C-ANCA+, Sub-glottic trachea
CIRCUMFERENTIAL THICKENING
89
Amyloidosis trachea
Irregular focal or short segment thickening, involves posterior membrane.
Calc = common.
90
Granulomatosis + polyangitis
Wegeners
Sinusitis + lung involvement + renal impairment
cANCA +ve
> cavitating nodules +/- GG halo
91
PAH
>22mmHg
Left sided hear failure (and increased PWP 15mmHg)
92
PAPVR Association
Sinsus Venosus ASD
93
Round atelectasis
Volume loss + comet tail sign (vessels bronchi leading into lesion)
Assoc: Asbestos
94
PCP
CD4 <200
Perihilar GG + pneumatoceles
Assoc: HIV, post bone marrow transplant 30-60d
95
Lymohangitis carcinomatosis causes
Breast, GI, lung , prostate
96
Sickle cell chest
Acute
- Pneumonia/ infarction/ fat embolism
- Mosaic attenuation
- pleural effusion
Chronic: wedge shaped opacities, traction bronchiectasis
97
Lung squamous cell
Central, spiculated mass
Causes central obstruction
> Lobar atelectasis, mucoid impaction, consolidation, and bronchiectasis
CAVITATES
Ectopic PTH
98
Aortic coarctation
*Cardiomegaly
Inferior rib notching
ACYANOTIC
● Cardiomegaly - LVH
● ‘reverse 3 sign,’ pre-stenotic aortic dilatation, the coarctation and post-stenotic dilatation.
● Inferior rib notching
Prominent left heart border
Assoc: Turner syndrome , posterior fossa malformations– hemangiomas–arterial anomalies–cardiac defects–eye (PHACE) syndrome, berry aneurysms.
99
Amiodarone lung
Basal predominant fibrosis +traction bronchiectasis
Bilateral opacities, - ground-glass
Peripheral nodule(s) or masses
pleural thickening / effusion
high attenuation in atelectatic lung, in liver, spleen and heart
100
Mournier Kahn
Dilated trachea + bronchi
101
CF
UPPER LOBE varicose bronchiectasis + hyperinflation
102
Sarcoid chest findings
Perilymphatic nodules upper lobe
> UL fibrosis + traction bronchiectasis
* 1-2-3 Sign - bilateral hila and right paratracheal
* Lambda Sign - same as 1-2-3 > Gallium Scan
* CT Galaxy Sign - upper lobe masses (conglomerate o f nodules) with satellite nodules
Trachea- smooth, nodular, involves posterior membrane
103
Sarcoid CXR staging
Stage 0 = Normal
Stage 1 = Hilar / Mediastinal Nodes Only
Stage 2 = Nodes + Parenchyma Disease
Stage 3 = Parenchymal Disease
Stage 4 = End Stage (Fibrosis)
104
ABPA
SACCULAR bronchiectasis + finger in glove
105
Small cell
SVC obstruction Paraneoplastic syndromes
Early mets
Paraneoplastic Syndromes > SIADH and ACTH
Lambert Eaton- proximal muscle weakness
106
HIV chest infection
CD4<100 - think CMV
CD4<200- Kaposi- commonest lung tumour, hypervascular nodes, flame shaped perihilar opacities, cutaneous purple skin plaques
THALLIUM AVID
<200 PCP
>200 TB
107
Diaphragmatic rupture signs
LEFT more common
● ‘Collar’ sign = focal constriction of herniating viscera at site of
rupture.
● ‘dependent viscera’ sign is where abdominal viscera lie dependently against the
posterior ribs due to loss of diaphragmatic support.
108
Tracheobronchial rupture
Fallen lung sign
109
Hypersensitivity pneumonitis
Animals/ microbes/ chemicals
Acute: Non specific GG/ consolidation/ centrilobular nodules/ mosaicism
Chronic: Peribronchovascular fibrosis mid- upper (UIP + air trapping )
110
LIP
Assoc: Sjogrens
GG + deep cysts
111
NSIP
Assoc:
Scleroderma
Dermatomyositis
SLE
112
Pulmonary AVM
Lower lobes
R>L Shunt
Assoc: abscess, stroke, epistaxis, polycythemia, CHF
Coil embolisation if >3mm
113
Carcinoid
assoc: tricupid + pulmonary valve regurg
can calcify, enhancing, central
GALLIUM AVID, PET -VE
114
DIPNECH
diffuse idiopathic pulmonary neuroendocrine cell hyperplasia – preinvasive form ▸ multiple small nodules <5 mm + mosaic attenuation pattern, known carcinoid tumour
115
Bronchial carcinoid
Cough, wheezing, Cushings
Avid enhancement
CENTRAL, Can cause obstruction/ collapse
116
CXR signs mitrral stenosis
Double right heart border (normal heart size)
UL diversion
Splays carina elevated L bronchus
117
ASD associations
Primum (low in atrial septum near AV): Downs, DiGeorge
Secundum (fossa ovalis): Ebstein
Sinus Venosus (near SVC/IVC): PAPVR
Persistent left sided SVC > drains into coronary sinus > RA
L>R shunt, enlarged heart and pulmonary plethora, ACYANOTIC
118
PDA
CHF
Assoc: maternal rubella
● ‘Shunt vascularity’ (i.e. pulmonary plethora with enlarged pulmonary arteries)
● Cardiomegaly—LA + LV
● Enlarged aorta differentiates from VSD
119
TGA
Commonest cause cyanosis/ CHF newborn
● pulmonary plethora
● Enlarged heart, ‘egg-on-side’ appearance + narrow superior mediastinum
(thymic atrophy)
● Absent aortic knuckle
US: aorta anterior to heart, great vessels exit in parallel
RX= Jantene
120
Ebsteins
Box shaped heart
● Cardiomegaly/right atrial enlargement
● Hypoplastic aorta/pulmonary trunk—
● Oligaemic lungs
ASD always present
121
Lung lymphoma
HL = COMMONEST in chest
HL- supraclavicular nodes
●● Masses, consolidation and nodules
●● Pleural effusions are common
NHL
Plain film
●Hilar or mediastinal lymph node enlargement with a pleural effusion.
CT
●Prevascular/pretracheal nodes = common
● +/- miliary nodules.
122
TAPVR drainage
Supracardiac- vertical vein > brachiocephalic
Infracardiac - IVC
Figure of 8/ snowman sign
Cyanosis + cardiac failure
123
IVDU Endocarditis
Usually affects TRICUSPID
124
Radiation pneumonitis
Early- GG
Late- Traction bronchiectasis + fibrosis, volume loss, dense consolidation
125
Eosinophilic polyangitis
CHURG STRAUSS
athma, eosinophilia, neuropathy, migratory or transient pulmonary opacities, paranasal sinus abnormalities
PAN
p-ANCA +VE
●● Non-segmental, transient peripheral consolidation/ground glass
●● Interlobular thickening
126
TGA
Na
127
CLO
LUL>RML>RUL
CPAM- no preference of lobe
128
Bronchus intermedius tumour
middle + LL collapse
129
Mucinous adenocarcinoma
Low attenuation consolidation- persistent/ progressive
Cavitation
Multicentric, multilobar, may show bilateral involvement, peripheral + subpleural
Assoc: non smoker, women, asian
130
Bronchial atresia
LUL
Mucous plug- hyperinflation distal to this
Geographic hyperlucent lung + air trapping
131
Seuqestration commonest location?
LLL
132
NF1 Lung findings
Lower zone fibrosis + upper lobe bullae
133
Aortic dissection
DB I = ascending + descendin
DB II = ascending + arch
IIIA—descending aorta ABOVE diaphragm
IIIB—descending aorta BELOW diaphragm
134
Syphilis aneurysm
ACSENDING aorta
extensive calc
135
Commonest assoc with right sided arch?
TOF
136
Lung cancer staging
T1 <3cm
T2 3-5cm or
* Invades visceral pleura / main bronchus / Causes obstruction (atelectasis or pneumonia)
T3 5-7CM
* Invades the chest wall / pericardium/ phrenic nerve
* 1 or more nodule same lobe
T4 >7CM
* Invades mediastinal fat / great vessels/ diaphragm/ carina
* Has 1 or more satellite nodule in another lobe but same lung
* N1: Ipsilateral hilar or intrapulmonary lymph nodes
* N2: Ipsilateral mediastinal nodes
* N3: Contralateral mediastinal or hilar lymph nodes, or supraclavicular nodes on either side
M1a: Separate tumor nodule contralateral lung/ Malignant pleural or pericardial effusion
* M1b: Single extrathoracic met, incl non-regional node.
* M1c: Multiple extrathoracic metastases in one or more organs.
*1+2 lobectomy
up to T3 = resectable
UP TO IIIA = RESECTABLE
137
Small cell lung
STRONGLY ASSOCIATED WITH SMOKING
Mediastinal / hilar lymphadenopathy / hilar or parahilar mass.
138
Malignant coronary artery anomalies
Anomalous left coronary artery from the pulmonary artery (ALCAPA).
Anomalous right coronary artery from the pulmonary artery (ARCAPA)
Bridging- intramural portion of coronary
Interarterial course (between the aorta and PA) of an anomalous coronary artery is malignant.
139
Kaposi sarcoma
● Ill-defined perihilar/peribronchovascular nodules, surrounded by
ground glass.
● Interlobular septal thickening.
● Enhancing nodes
● Pleural effusions atypical.
THALLIUM -VE
140
HYDATID
Eosionophilia
PLAIN FILM
●● Multiple well-defined, rounded masses
●● LOWER LOBES, air fluid level
CT
●Low density cysts, NO calc
● ‘Water lily’ sign-floating cyst membrane within cyst
● ‘Empty cyst’ sign -cyst contents have expectorated.
141
POST LUNG TRANSPLANT COMPLICATIONS
REPERFUSION SYNDROME
= most common immediate complication <48 hours
●● Perihilar airspace opacification
●● Bibasal pleural effusions
ACUTE TRANSPLANT REJECTION >10 days
●Heterogeneous peri-hilar opacification, septal thickening , right
pleural effusion
BRONCHIOLITIS OBLITERANS
> months, linked to CMV
Plain film/CT
● Increasing bronchiectasis
● Hyperinflated lungs, bronchial thickening and dilatation
● Air trapping, mosaic perfusion and bronchiectasis
142
Superior sulcus tumour
Shoulder pain, C8-T2 radiculopathy, and Homer Syndrome
> MRI to investigate brachial plexus
143
SOLID Pulmonary nodule F/U
SOLID
<6mm- (Single/ multiple):
Low risk, NO F/U
High risk F/U 12 Months
6-8mm
SINGLE: low / high = 6-12m
MULTIPLE: low/ high = 3-6m
>8mm
SINGLE: low/ high= PET/ biopsy
MULTIPLE: low/ high 3-6m
GG Nodules- needs F/U for 5 years
144
SUBSOLID pulmonary nodule F/U
<6mm
SINGLE: No F/U
MULTIPLE: CT 3-6M
>6mm
CT at 6-12 months
CT at 3-6 months
ANNUAL CT EVERY 5 YEARS
Doubling volume< 400 days= high risk malignancy
145
