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RRC Cards > Chest > Flashcards

Chest Flashcards

1
Q

UIP Pattern

A
  • subpleural, basal
  • heterogeneous dist’n
  • reticulation
  • honeycombing
  • traction bronchiectasis
  • costophrenic angles
  • absence of features of other dx
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2
Q

Inconsistent with UIP pattern

A
  • upper-mid lungs
  • peri-bronchovascular
  • GGO > reticular
  • consolidation
  • micronodules
  • multiple cysts
  • diffuse mosaic/air-trapping
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3
Q

NSIP

A
  • peripheral, basal
  • spares subpleural
  • consolidation
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4
Q

acute HP

A
  • soft GGO nodules
  • loose granulomas
  • centrilobular
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5
Q

subacute HP

A
  • mosaic attenuation
  • GGO & air trapping
  • no emphysema or fibrosis
  • no bronchiectasis
  • centrilobular
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6
Q

subacute to chronic HP

A
  • bronchocentric
  • upper lungs
  • bronchiectasis
  • honeycomb
  • GGO in bases
  • centrilobular
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7
Q

respiratory bronchiolitis ILD

A
  • upper lungs
  • GGO
  • emphysema
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8
Q

eosinophilic pneumonia

A
  • dense, peripheral consolidation
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9
Q

stages of sarcoidosis

A
  1. lymphadenopathy
  2. LN & lung disease
  3. lung involvement only
  4. fibrosis (upper lungs)
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10
Q

which involves mediastinum more? hodgkins or nonhodgkins lymphoma

A

hodgkins - 75% involve mediastinum

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11
Q

spherical vs oblong morphology of paravertebral mass

A
  • spherical = peripheral nerve

- oblong = sympathetic ganglion

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12
Q

pulmonary hypertension

A

mean pulm arterial pressure >25 mmHg (mPAP)

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13
Q

pulmonary hypertension groups

A
  1. pulmonary arterial hypertension (structural narrowing)
  2. left sided heart disease
  3. lung disease or hypoxia
  4. chronic thromboembolic PH/PA obstruction
  5. multifactorial
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14
Q

lymphangioleiomyomatosis associated with what?

A

tuberous sclerosis

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15
Q

most common autoimmune disorder w/ LIP

A

adult: sjogren
peds: HIV

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16
Q

interstitial lung disease most commonly associated with rheumatoid arthritis

A

UIP

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17
Q

Rasmussen aneurysm

A

complication of pulmonary TB

pulmonary artery aneurysm adjacent or within a tuberculous cavity

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18
Q

scimitar syndrome

A

aka hypogenetic lung syndrome

  • pulmonary hypoplasia + PAPVR
  • acyanotic L to R shunt
  • hypoplastic right lung drained by an anomalous pulm v into systemic venous system (IVC, R atrium, portal v)
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19
Q

tracheobronchopathia osteochondroplastica

A

affects cartilage of lower 2/3 of trachea & proximal bronchi
nodular thickening +/- calc’n
anterior & lateral walls of trachea
- spares posterior (membranous) wall (like relapsing polychondritis, but more nodular)

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20
Q

relapsing polychondritis

A

recurrent multisystemic inflam’n of cartilaginous structures: tracheobronchial tree, ear, nose, larynx, peripheral jts
smooth thickening of anterior & lateral walls of trachea + luminal narrowing
- spares posterior (membranous) wall (like TO, but more smooth)

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21
Q

tracheobronchial amyloidosis

A

focal or diffuse submucosal deposition of amyloid in tracheobronchial tree
irregular nodular soft tissue thickening
- circumferential (involves posterior wall of trachea, like sarcoidosis)
obstructive effects: atelectasis, hyperinflation

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22
Q

tracheobronchial granulomatosis with polyangiitis

A

subglottic stenosis with soft tissue thickening of tracheal wall
+/- peripheral involvement, long segment stenosis

consider if airway wall thickening/stenosis with lung nodules & glomerulonephritis

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23
Q

galaxy sign

A

coalescent granuloma, classically pulmonary sarcoid (also TB)
satellite micronodules along margins of larger nodular opacities (consolidation or GGO)

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24
Q

organizing pneumonia histology

A
  • Masson bodies: polypoid plugs of loosely organized granulation tissue within alveoli and alveolar ducts
  • foamy macrophages
  • fibroblast proliferation
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25
Q

organizing pneumonia causes

A
  • infection
  • connective tissue disorder
  • toxic inhalational
  • drug toxicity
  • transplant: heart, lung, bone marrow
  • cryptogenic (dx of exclusion)

same list as bronchiolitis obliterans

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26
Q

organizing pneumonia distribution

A

peripheral
peribronchovascular
perilobular arcade (surrounding the secondary pulmonary lobule)

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27
Q

organizing pneumonia morphology

A

consolidation (+/- migratory)
ground glass (immunocompromised)
reverse halo/atoll sign: central GGO w rim of consolidation
streaky/bandlike, oblong, irregular margins

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28
Q

Churg-Strauss syndrome

A

aka eosinophilic granulomatosis w polyangiitis (EGPA)

dx criteria (4/6 + bx vasculitis):

  • asthma: almost all pts
  • blood eosinophilia (>10% of total WBC)
  • transient peripheral consolidation/GGO
  • neuropathy (mono/poly)
  • paranasal sinus abN: pain or radiographic
  • extravascular eosinophils on bx
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29
Q

“asbestosis” term

A

specific term: presence of lung FIBROSIS secondary to asbestos exposure
- i.e. not synonymous w asbestos-related pleural dz

  • consider asbestosis if ILD & pleural plaques
  • fibrosis w/o pleural plaques does not exclude asbestosis
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30
Q

simple/classic silicosis

A

centrilobular nodules <1cm
- upper and posterior lung
- spares bronchovascular and septal regions (cf. sarcoid)
hilar/mediastinal LN w peripheral/egg shell calc’n

asymptomatic
10-50 year latency (w low level exposure)
if remove exposure, dz likely won’t progress

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31
Q

complicated silicosis

A 
conglomerate nodules/masses >1cm
- central migration to hilum with time
progressive massive fibrosis
- with calc'n (more than sarcoidosis)
- paracicatricial emphysema, risk for PTX

symptomatic
even if exposure removed, dz will likely progress

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32
Q

coal workers pneumoconiosis

A

exposure to coal dust free of silica (washed coal)
appearance similar to silicosis
- simple: centrilobular nodules <1cm
- complicated: conglomerate nodules/masses >1cm with PMF

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33
Q

Caplan syndrome

A

seropositive rheumatoid arthritis + upper lobe predominant nodules/pneumaconiosis (classically CWP)

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34
Q

accelerated silicosis

A

high concentration exposure
5 years or less
quicker progression from simple to complicated form of silicosis

35
Q

acute silicosis/silicoproteinosis

A
  • crazy paving pattern, resembles alveolar proteinosis
  • central “butterfly” alveolar opacities w air bronchograms
  • hilar/mediastinal lymphadenopathy
  • rapid progression over months
  • evolution to fibrosis w severe architectural distortion, bullae, PTX
36
Q

asbestosis

A

UIP pattern (histologically similar) + hx asbestos exposure
+/- calcified pleural plaques, round atelectasis
parenchymal bands, radial bands

37
Q

pleural plaques

A
  • localized (not diffuse) pleural thickening; generally w shoulders
  • favour 4th-8th intercostal spaces, mediastinal & diaphragmatic pleura
  • spare apices and costophrenic angles
  • can be calcified or non calcified
38
Q

asbestosis vs IPF

A

both cause UIP pattern
IPF: more advanced, progresses more rapidly, digital clubbing
asbestosis: slower progression, asbestos related pleural disease

39
Q

malignant pleural thickening in mesothelioma

A

> 1cm thick
nodular
circumferential
affect mediastinal pleura more often

40
Q

beryllium disease

A

looks like sarcoidosis:

  • starts as bilat mediastinal/hilar LN
  • +/- lungs: upper, initially nodular dz, eventually scars
  • extrathoracic manifestations rare (cf. sarcoid)

dx with beryllium sensitization test (BES) test

41
Q

lung cyst def’n

A

parenchymal lucency/low attenuation w well-defined interface with N lung

  • uniform thin wall, 1-2mm (some sources: up to 3-4 mm)
  • ovoid in shape (NOT multilobulated or dumbbell shaped)
  • usu <1cm in diameter
  • should not increase in size over time
  • solitary or multifocal
42
Q

pulmonary LCH - clinical

A

cigarette smoke exposure >95% (rxn to antigen)
M>F 20-40 yrs
peribronchiolar infiltration by Langerhans cells
often asymptomatic, cough, dyspnea
secondary spontaneous PTX
unpredictable course: spontaneous resolution vs PH, lung transplantation

43
Q

pulmonary LCH - imaging

A

progression: nodules -> cavitating nodules -> irregular cysts w bizarre shapes
emphysema, fibrobullous dz
upper lobe, spare costophrenic sulci

*consider PLCH in adult smokers w upper lung dominant small nodular &/or cystic lung disease

44
Q

centrilobular emphysema

A
  • MC form of emphysema
  • cigarette smoking
  • upper lobes & superior seg lower lobes
  • centrilobular low attenuation, no discernible wall +/- visualize central lobular artery
45
Q

paraseptal emphysema

A
  • alveolar ducts & sacs in periphery & peribronchovascular
  • upper lung
  • single tier of cystic spaces, separated by intact interlobular septa
  • tall/thin young adults, Marfan/Ehler Danlos, smokers, IVDU, HIV
  • gravity + incr neg pressure at apices, spont PTX
46
Q

panlobular emphysema

A
  • all components of acinus (entire 2/2 lobule)
  • basal predominant
  • alpha-1 antitrypsin deficiency
  • other: smokers, elderly, IVDU (methylphenidate/Ritalin)
  • diffuse regions of low attenuation w paucity of vascular structures
47
Q

lung ossification

A

metaplastic bone formation in lung parenchyma
2 patterns:
- nodular: longstanding mitral valve stenosis
- dendriform pattern: chronic inflammation, interstitial fibrosis

48
Q

metastatic calcification (pulmonary)

A

Ca2+ deposition in otherwise N tissue:

  • diffuse, stippled, or circumferential
  • clustered into rosettes, resemble mulberries
  • poorly defined centrilobular nodules
  • upper lobes: higher pH, calcium is less soluble in alkaline environment
  • bone scan positive

hypercalcemic states (CKD, hemodialysis dependence)

49
Q

bronchiectasis - types

A

cylindrical: nontapering uniform diameter, “tram-tracking”
varicose bronchiectasis: alternating dilation/narrowing, “string of pearls”
cystic bronchiectasis: marked rounded dilation, “cluster of grapes”

50
Q

Williams-Campbell syndrome

A

rare congenital central cystic bronchiectasis
defective cartilage in 4th–6th order (central) bronchi
- preservation of trachea and main bronchi
distal regions of abN lucency (air trapping vs. bronchiolitis)
central bronchi balloon on inspiration, collapse on expiration
- helps diff from other causes of cystic bronchiectasis

51
Q

allergic bronchopulmonary aspergillosis

A

severe central bronchiectasis with mucous plugging

occurs in cystic fibrosis and asthma
- if new consolidations or mucoid impactions in CF or asthma, consider ABPA

52
Q

ABPA diagnostic criteria

A 
"ASPER"
Asthma
Specific Serum antibodies (IgE, IgG) to Aspergillus
Proximal (central) bronchiectasis
Elevated IgE (> 1000 ng/mL)
Reactive skin test (wheal)

if proximal bronchiectasis absent, dx = “seropositive ABPA”

53
Q

mosaic attenuation

A

geographic areas of differential attenuation

  • if hyperattenuating areas are abN -> ground-glass ddx
  • if hypoattenuating areas are abN (too few or too small vessels) -> “mosaic perfusion”
54
Q

associations with LAM

A
  • chylothorax

- pneumothorax

55
Q

typical airway feature of granulomatosis polyangiitis

A

subglottic stenosis

circumferential thickening trachea

56
Q

classic Kaposi sarcoma features

A

“flame-shaped” nodules/opacities in peribronchovascular distribution

57
Q

most common location bronchogenic cyst

A

subcarinal

58
Q

secondary pulmonary lobule

A

bronchiole and pulmonary artery

59
Q

organisms causing empyema necessitans

A

BATMAN breaks through barriers

Blastomyces
Actinomyces
Tuberculosis (75% of cases)
Mucor
Aspergillus
Nocardia
60
Q

causes DIP

A
  • smoking
  • nitrofurantoin
  • busulphan
  • sulfasalazine
  • connective tissue disease
  • dust inhalation
61
Q

sparing costophrenic angles

A
  • LCH

- HP

62
Q

benign calcification patterns in pulmonary nodule

A

diffuse, central, laminated, popcorn if <3cm

exceptions: if >3cm (can be malignant), if known primary tumor
e. g. diffuse pattern in osteosarcoma or chondrosarcoma; central & popcorn pattern in GI-tumors, also hx of chemotherapy

63
Q

round atelectasis - 4 components

A

round/oval pleural mass
swirl of vessels
pleural thickening or effusion
volume loss

64
Q

asbestos fibres w/ higher mesothelioma association

A
  1. crocidolite
  2. amosite

longer, thinner

65
Q

causes pulmonary artery aneurysm

A
  • iatrogenic (swan ganz)
  • infectious/mycotic (rasmussen 2/2 Tb)
  • takayasu
  • behcets
  • hughes stovin syndrome
  • trauma
  • chronic PE
66
Q

causes pulmonary artery stenosis

A
  • post sx repair (TOF)
  • vasculitis (behcet, takaysu)
  • connective tissue disease (ehlers danlos)
  • fibrosing mediastinitis
  • extrinsic compression (mediastinal mass)
  • congenital rubella
  • william’s syndrome
67
Q

is PAPVR a shunt?

A

yes - left to right shunt

68
Q

fibrous tumor pleura is associated with?

A

hypoglycemia

hypertrophic osteoarthropathy

69
Q

Serum markers in sarcoidosis

A

Elevated ACE

Hypercalcemia

70
Q

1-2-3 sign
Lambda sign
Galaxy sign

A

All sarcoid signs

123: bilateral hila and right paratracheal
Lambda: 123 on gallium
Galaxy: mass with satellite modules

71
Q

Cancer versus progressive massive fibrosis on MRI

A

Cancer - T2 bright

PMF - T2 dark

72
Q

Kaposi sarcoma, lymphoma, PCP

Thallium and gallium findings

A

Kaposi:

  • thallium positive
  • gallium negative

Lymphoma

  • thallium positive
  • gallium positive

PCP

  • thallium negative
  • gallium positive

Note: thallium Na/K/ATP pump - “alive” positive
Gallium - iron analogue - inflammatory marker

73
Q

Most common recurrent disease post lung transplant (%)

A

Sarcoidosis - 35%

74
Q

Causes of pan lobular emphysema

A
  • alpha one anti trypsin

- IV ritalin (methylphenidate)

75
Q

Pulmonary arterial hypertension + normal wedge pressure

A

pulmonary veno-occlusive disease

76
Q

Probable UIP pattern

A
  • absent honeycombing *
  • basal, subpleural
  • heterogeneous distribution
  • reticular pattern w/ peripheral traction bronchiectasis
77
Q

Indeterminate for UIP pattern

A
  • variable/diffuse

- evidence of fibrosis w/ some features suggestive of non-UIP pattern

78
Q

GPA airway findings

A
  • subglottic stenosis
  • focal involvement
  • tracheal involvement 15%
  • bronchial involvement 50-60%
79
Q

major findings LIP (lymphocytic interstitial pneumonia)

A
  • basal predom
  • bilat ground glass
  • ill defined centrilobular nodules
  • small subpleural nodules
  • bronchovascular bundle thickening
  • interlob septal thickening
  • thin walled cysts (perivascular & subpleural distribution)

less common: 1-2 cm nodules, consolidation, bronchiectasis, honeycombing

80
Q

Coarctation aorta

A

Associated with turners & bicuspid valve
Have berry aneurysms
Figure3 sign
Rib notching (4th to 8th) - rib 1/2 = Costocervical trunk

81
Q

associations with thymoma

A
  • myasthenia gravis
  • pure red cell aplasia
  • hypogammaglobulinemia
82
Q

nerve sheath tumors vs sympathetic ganglia tumors

A

nerve sheath: neurofibroma, schwannoma, neurolemma

sympathetic: ganglioneuroma, neuroblastoma, ganglioneuroblastoma

83
Q

length nerve sheath & sympathetic ganglia tumors

A

Nerve sheath tumors tend to be one or two rib interspaces in z-axis

Sympathetic ganglia tumors are longer.

84
Q

what structure corresponds to the aortic nipple on CXR

A

left superior intercostal vein

RRC Cards (17 decks)

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