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Radiology oral boards review > Chest > Flashcards

Chest Flashcards

1
Q

Ddx for solitary pulmonary nodule

A

granuloma, neoplasm, hamartoma, round pneumonia, AVM

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2
Q

Ddx for multiple pulmonary nodules

A

mets, granulomatous dz (TB or fungal), septic emboli, Wegener granulomatosis

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3
Q

What is Wegener’s granulomatosis?

A

a multi-system systemic necrotizing non-caeseating granulomatous vasculitis affecting small to medium sized arteries, capillaries and veins 1, and the lungs are the most frequently involved organ, seen in 95% of cases

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4
Q

Appearance of pulmonary Wegener’s?

A

Highly varied, most commonly nodules +/- cavitation (irregular, thick-walled), hemorrhage, less commonly reticulonodular or peripheral wedge-shaped opacities

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5
Q

Ddx cavitary lung mass

A

Infxn: TB (reactivation), fungal disease, pulmonary abscess (if widespread, possibly septic emboli)
squamous cell ca,
wegener’s, RA,

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6
Q

Ddx miliary lung nodules

A

miliary TB, fungal dz, mets (thyroid), pneumoconiosis (silicosis - upper lobe fibrosis/nodules), old varicella, sarcoid

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7
Q

Ddx centrilobular nodules

A

Infectious bronchiolitis (MAI, TB), hypersensitivity pneumonitis (esp. if gg), endobronchial spread of tumor, RB-ILD (smokers), LCH (early), pneumoconiosis (silicosis or coal-workers’ - look for eggshell LN calcs)

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8
Q

Ddx cystic lung disease

A

emphysema, LAM (women of reproductive age), pulmonary LCH (smokers: cavitating nodules, irregular, varying sizes), PCP, LIP (peribronchovascular)
post-infectious blebs
Child: hydrocarbons

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9
Q

Ddx lower-lobe predominant ILD

A

UIP, collagen vascular dz (scleroderma, RA, SLE), asbestos-related lung dz, drug toxicity (eg chemo)

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10
Q

Ddx upper-lobe predominant ILD

A

postprimary TB, sarcoidosis, CF, pneumoconiosis (silicosis or coal workers’), LCH (smokers)

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11
Q

Ddx hyperlucent lung

A

chest wall abnl (on x-ray), Swyer-James, acute asthma, airway obstruction, PE (oligemia), bronchial atresia (central mass or nodule, may see mucoid impaction)

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12
Q

What is Swyer-James syndrome?

A

post-infectious obliterative bronchiolitis, generally characterized on radiographs by a unilateral small lung with hyperlucency and air trapping, CT shows the affected lung as being hyperlucenct with diminished vascularity

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13
Q

Ddx anterior mediastinal mass

A

Lymphoma, Thymic lesion (thymoma, thymic carcinoma), germ cell neoplasm, (goiter, but usually you can tell it’s from the neck)

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14
Q

Ddx middle mediastinal mass

A

LAN, vascular abnormality, foregut duplication cyst, pericardial cyst, HH

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15
Q

Ddx posterior mediastinal mass

A

Neurogenic tumor (neuroblastoma in kids, ganglioneuroma in older), lymphoma, cyst (neurenteric, foregut duplication cyst, extramedullary hematopoiesis

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16
Q

Differences between intralobular and extralobular sequestration

A

Intralobular has pulmonary venous drainage and tends to get infected. Extralobar has systemic drainage and rarely gets infected

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17
Q

What’s Lemierre syndrome?

A

Lemierre syndrome refers to rare thrombophlebitis of the jugular veins with distant metastatic sepsis seen in the setting of initial oropharyngeal infection (pharyngitis / tonsillitis +/- peri tonsillar abscess)

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18
Q

reverse batwing sign is likely:

A

Chronic eosinophilic pna

COP, vasculitis, aspiration, contusion, infarction

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19
Q

Halo sign around lung nodule: most likely? Other possibilities?

A

Halo is hemorrhage. Classically angioinvasive aspergillosis.
Others: TB, other fungal (mucor, coccidio, crypto), Wegener’s, mets

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20
Q

finger in glove =

A

allergic bronchopulmonary aspergillosis (ABPA) - overreaction to aspergillus
also bronchial atresia, CF with mucus impaction

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21
Q

crazy paving ddx:

A 
Alveolar proteinosis
Sarcoid
NSIP
Organizing pneumonia (COP)
Infection (PCP, viral, Mycoplasma, bacterial)
Neoplasm (adeno)
Pulmonary hemorrhage
Edema (heart failure, ARDS, AIP)
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22
Q

Pulmonary LCH: who? Appearance?

A

Young (20-40), Hx of SMOKING
Early: small peribronchiolar nodules
Late: multiple irregularly-shaped cysts
mid and upper lung predilection

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23
Q

Bilateral paraspinal masses

A

extramedullary hematopoeisis, NF, lymphadenopathy

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24
Q

perilymphatic nodules

A

Sarcoidosis
lymphangitic carcinomatosis from lung ca, met non-lung ca (breast)
silicosis

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25
Q

Atoll sign: aka? ddx?

A

reverse halo
COP
also regular pna, TB, fungal, Wegener’s, sarcoid

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26
Q

fibrosing mediastinitis: appearance? Caused by? causes what?

A

Fibrosis/soft tissue in mediastinum. Can compress vessels (SVC, pulmonary), central airways, or esophagus
Causes - mostly idiopathic, also infection (histoplasmosis!), sarcoid, radiation, drugs (methylsergide)

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27
Q

centrilobular ground-glass nodules

A

Hypersensitivity pneumonitis, atypical infection (PCP, mycoplasma)
Smokers: RB-ILD

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28
Q

mosaic attenuation ddx:

A

Black is abnl: obstructive small airways disease (asthma, obliterative bronchiolitis in lung transplant rejection, CF)
PE
White is abnl: ground glass (hypersensitivity pna, PCP, eosinophilic PNA, hemorrhage)

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29
Q

appearance of NSIP on CT

A

patchy, reticulonodular, ground glass, mostly subpleural. Can get some fibrosis in fibrotic subtype

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30
Q

Ddx airspace dz

A

AIR SPACED
Aspiration, Inhalation, Renal failure (edema), Sarcoid, PNA, Pulmonary hemorrhage, alveolar proteinosis, Collagen Vascular dz, Eosinophilic pna, Drugs

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31
Q

DIseases associated with thymoma:

A

30% have myasthenia gravis (15% of myasthenia pts have thymoma)
also aplastic anemia, cushing’s disease, hypogammaglobulinemia

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32
Q

Ddx of enlarged pulmonary arteries:

A

idiopathic/primary
Increased pressures: precap (chronic PE), cap: lung fibrosis/emphysema, postcap: heart stuff (LV failure, mitral stenosis) or Pulmonary veno-occlusive disease (PVOD)
Increased volume: ASD, VSD, AVM, thyrotoxicosis
High flow AND pressure can lead to Eisenmenger’s with reversal of shunt (ASD, VSD, PDA)
Wall prob - vasculitis (Takayasu)

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33
Q

Pulmonary amyloid looks like:

A

Two subtypes: nodular (diffuse nodules, 50% calcify, 0.5-15cm)
diffuse (interlobular septal thickening, alveolar infiltrates) poor prognosis

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34
Q

ping-pong balls in the chest are called:

A

Plombage, old way to fill space treating TB

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35
Q

PCP appearance:

A

ground glass, crazy paving, pneumatoceles in 30%, rarely pleural effusion

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36
Q

Ddx for “tree-in-bud” and what is that

A

infection (incl TB and atypicals, ABPA), aspiration, diffuse panbronchiolitis, CF, tumor (eg met breast)

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37
Q

Ddx subpleural/peripheral opacities

A

*Eosinophilic pna (reverse batwing), COP, lymphoma, alveolar sarcoidosis, drugs, NSIP, pulmonary infarct, multifocal pna

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38
Q

Ground glass / ill-defined opacities (not centrilobular nodules)

A

hypersensitivity pneumonitis, PCP, eosinophilic pna, hemorrhage, DIP (smoker), inhalation injury, adenocarcinoma (Bx if it doesn’t go away on follow-up)

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39
Q

Ddx lower lobe lung fibrosis

A

UIP, NSIP, asbestosis, CVD (collagen vascular disease)

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40
Q

What’s the name for a cardiac mri sequence when the blood is white and it’s moving?

A

SSFP cine (steady state free-procession)

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41
Q

Myocardial delayed enhancement - subendocardial:

A

focal or vascular territory: ischemia

if whole inner surface: amyloid

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42
Q

Myocardial delayed enhancement - transmural

A

ischemia (and if greater than 50% no use in revascularization). Check vascular territory

43
Q

Myocardial delayed enhancement - at anterior and posterior aspect of septum

A

Hypertrophic CardioMyopathy

44
Q

Myocardial delayed enhancement - midwall, patchy

A

myocarditis, amyloidosis, sarcoidosis

45
Q

Myocardial delayed enhancement - subepicardial

A

myocarditis, sarcoid

46
Q

Ddx consolidation

A

Pus: infectious pna, including TB
Blood: hemorrhage
Cells: tumor
Fluid: edema

47
Q

Ddx for perihilar opacity, sparing subpleural/periphary

A

Lymphoma, radiation pneumonitis, fibrosis (eg progressive massive fibrosis in pneumoconiosis), hemorrhage, drug rxn, pneumonia

48
Q

Enlarged/dilated trachea ddx

A

Tracheobronchomalacia, Mounier-Kuhn syndrome (aka tracheobronchomegaly)

49
Q

Ddx for pericardial calcification:

What does it cause?

A

pericarditis, surgery, radiation, uremia

Causes contstrictive pericarditis (Calcium is Constrictive, look for septal bounce)

50
Q

Ddx tracheal thickening - what do you need to check for?

A

Two types- spares posterior membrane: relapsing polychondritis
TPO (tracheobroncopathia osteochondroplastica) -submucosal chondral or calcified nodules
Diffuse: Wegener’s granulomatosis
sarcoidosis
amyloidosis
post-intubation stenosis (focal)
TB (some other infections)

51
Q

Nodule with surrounding ground glass

A

Wegener’s, hemorrhagic mets, angioinvasive aspergillosis

52
Q

Causes for lobar atelectasis

A

Mucus plug, intrabronchial lesion, extrabronchial lesion, foreign body

53
Q

cardiac wall mass ddx

A

mets, lymphoma, rhabdomyoma (children), angiosarcoma

54
Q

smooth pleural thickening with calcification is called? causes?

A 
Fibrothorax
Causes: tuberculosis
thoracic empyema
asbestos related pleural disease
rheumatoid arthritis
haemothorax
55
Q

Causes of pericardial thickening

A

Viral, rheumatologic, mets (esp if nodular)

56
Q

What is Eisenmenger syndrome?

A

Reversal of a left to right shunt such that there is right to left shunting - VSD, ASD, PDA

57
Q

What problem is associated with aortic coarctation?

A

Bicuspid aortic valve in 50%

Interestingly, pseudocoarct also has 50% bicupid valve

58
Q

Ddx for right cardiophrenic mass

A

Pericardial cyst, fat, Morgagni hernia, LAN, thymoma, pleural tumors

59
Q

Heart valve mass ddx:

A

vegetation, thrombus, papillary fibroelastoma (most common but usually very small), mets, myxoma (rare)

60
Q

Atrial mass ddx:

A

Myxoma (75% LA) - often prolapses -if so, call the clinician (concern for embolization), thrombus, lipoma, mets

61
Q

Hypertrophied septum

A

HCM - likely HOCM. Check for SAM

Rx: EtOH ablation or surgery.

62
Q

When do you image for delayed enhancement cardiac MRI images?

A

10-15 minutes

63
Q

Ddx pneumopericardium

A

Trauma/surgery, infection, tumor with fistula

64
Q

Right-sided aortic arch: types? assocated with anomalies?

A

Mirror image branching: associated with other congenital cardiac anomalies 98% of the time
Aberrant left subclavian artery - associated with other cardiac defects 5-10% of the time

65
Q

dilated aberrant subclavian origin is called:

A

Diverticulum of Kommerell

66
Q

Ddx bronchiectasis:

A 
post-infectious or aspiration
CF (upper)
ciliary dyskinesia/Kartagener's (lower)
ABPA
fibrosis
Mounier-Kuhn
67
Q

What infectious agent is characteristic of CF?

A

pseudomonas

68
Q

How does radiation dose compare for prospective vs retrospective gating of cardiac CT?

A

Prospective is 80% less radiation, requires regular rhythm on EKG
Retrospective is less technically demanding

69
Q

What does carcinoid of the heart involve?

A

fibrous plaques of the tricuspid and pulmonary valve leading to right heart failure

70
Q

What’s a pseudocoarctation?

A

One that is not hemodynamically significant

71
Q

fatty right ventricle wall =

What’s the concern?

A

ARVD - arrythmogenic right ventricular dysplasia (fatty and fibrofatty variants)
Causes sudden death

72
Q

Ddx bronchiectasis

A

CAPT K has Mournier Kuhn
C - cystic fibrosis / congenital cystic bronchiectasis
A - allergic bronchopulmonary aspergillosis (ABPA)
P - postinfectious (most common)
T - TB (granulomatous disease)
K - Kartagener’s syndrome
M - Mounier Kuhn syndrome (tracheobronchomegaly)

73
Q

What’s the snowman sign? What does it mean?

A

Widened superior mediastinum for TAPVR (pt must have a shunt, usually patent foramen ovale)

74
Q

What’s LAM associated with?

A

TS - tuberous sclerosis

75
Q

What’s the difference between a true and false left ventricular aneurysm?

A

True: all layers, not that dangerous. Wide neck, tends to have clot.
False: contained rupture, very dangerous, usually after MI. Narrow neck.

76
Q

Cardiac: the LA is enlarged. What’s the differential, how do you choose?

A

Mitral valve problem:
Normal sized LV: mitral stenosis (or prolapsing myxoma) 2/2 rheumatic heart dz. Look for domed mitral valves.
Larve LV: mitral regurgitation

77
Q

Ddx cardiac mass:

A 
Thrombus
mets, incl. lymphoma
vegitation (valves)
myxoma (most common benign)
angiosarcoma (most common malignant)
78
Q

What’s a significant coronary artery stenosis?

A

For most: 70%

For L main: 50%

79
Q

What cardiac anomalies are most commonly associated with a R aortic arch?

A

TOF, Truncus

80
Q

What’s esophageal rupture called?
What if the mucosa’s just torn?
What are they caused by?

A

Boorhaave’s syndrome - vomiting, endoscopy, surgery

Torn mucosa = Mallory-Weiss (usually vomiting or coughing)

81
Q

How much enhancement can a pulmonary nodule have to be considered probably (95%) benign?

A

less than 15-20 HU

82
Q

endobronchial mass:

A

carcinoid, adenoid cystic, sq. cell, mucoepidermoid

of course, r/o foreign body or mucus

83
Q

What’s it called when a thoracic infection extends into the chest wall?

A

Empyema necessitans (TB, actinomycosis, nocardia)

84
Q

peribronchovascular ill-defined/flame-shaped opacities

A

Kaposi sarcoma

85
Q

causes of unilateral right pulmonary edema

A

MI with rupture of mitral papillary muscle
positional (pt lying on that side)
PE on less affected side
s/p lung transplant w/ reperfusion edema

86
Q

Tracheal mass ddx:

A

Squamous cell ca, adenoid cystic, esophageal cancer eroding, mets (H&N, lung, melanoma, breast, renal)

87
Q

Head cheese sign in lungs

A

Mixed gg and air trapping:
HP
(DIP, mycoplasma/atypical pna)

88
Q

continuous diaphragm sign means:

A

Pneumoperitoneum, pneumopericardium, or pneumomediastinum

89
Q

Causes of pneumomediastinum

A

retroperitoneal air tracking superiorly, asthma, ruptured esophagus (Boorhaave)

90
Q

Scimitar syndrome - describe:

associations?

A

Partial anomalous pulmonary venous return, on R, often hypoplastic R lung.
Associated with pulmonary sequestration

91
Q

what’s the appearance of the ascending aorta in Marfan’s?

A

Annuloaortic ectasia - does not spare the sinotubular ridge

92
Q

what’s the normal thickness of the pericardium?

A

2mm

above 4 is clearly pathologic

93
Q

how do you measure velocity in cardiac MRI?

A

phase contrast

94
Q

Complications of a myocardial bridge?

A

(coronary coursing through myocardium)

vasospasm, angina

95
Q

What’s the middle artery called in trifurcation of the left coronary?

A

Ramus intermedius

96
Q

Dilated, tortuous coronary arteries - what from?

A

ALCAPA - anomalous left coronary artery from the pulmonary artery
causes collateral formation, steal (left coronary to pulmonary), and ischemia

97
Q

LV noncompation - complications?

A

thrombus, failure, arhythmia

98
Q

Name for spade-shaped heart, apical ballooning

A

Takotsubo - stress, not ischemic

Don’t Take it So Bad

99
Q

pulmonary artery aneurysm adjacent or within a tuberculous cavity is called

A

Rasmussen aneurysm

100
Q

What is the galaxy sign in the lung?

A

Sarcoid nodule with multiple, maybe gg satelites (can also be TB)

101
Q

What is stunned myocardium?

What is hybernating myocardium? Should they be revascularized?

A

Stunned has normal or near normal perfusion, but decreased or absent motion temporarily. This does not need revascularization, as it will recover on its own. It is due to ischemia that was relieved (spontaneously or by TPA/cath) before significant injury occurred.
Hibernating is chronically ischemic myocardium which has reduced perfusion and contraction. It will help to revascularize it, it will not recover on its own

102
Q

Ddx for acute airspace disease

A

pneumonia, hemorrhage, pulmonary edema

103
Q

Causes of pulmonary edema:

A

Cardiogenic - usually big heart: L heart failure, mitral regurg, pericardial (effusion, contriction)
Non cardiogenic - usually normal size heart: renal failure, sepsis, near-drowning, neurogenic, inhalational injury, trauma or contusion, radiation, anaphylaxis, drugs, high altitude

104
Q

unilateral interstitial lung disease is most likely

A

lymhangitic carcinomatosis

Radiology oral boards review (10 decks)

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