Chest Flashcards
Anterior Mediastinal Mass
1) Thymus
- Thymic cyst (congenital or s/p XRT)
- Nodular hyperplasia
- Lymphoma/Leukemia
- Thymolipoma
- Thymoma
- Thymic carcinoma
2) Lymphoma
3) Germ Cell Tumor
- Teratoma
- Seminoma
- Non-Seminomatous GCT
4) Thyroid
- Goiter
- Thyroid cancer
5) Epicardial Cyst
6) Morgagni Hernia
7) Ascending Aortic Aneurysm
8) Prominent Epicardial Fat Pad
- Fat necrosis
Middle Mediastinal Mass
1) Lymphadenopathy
- Mets
- Lymphoma
- Granulomatous infection
- Castleman’s
2) Foregut Duplication Cyst
- Bronchogenic cyst
- Esophageal cyst
3) Aortic Aneurysm
4) Abscess
5) Hematoma
6) Esophageal Tumor
7) Tracheal Tumor
8) Fibrosing Mediastinitis (Histo, TB)
9) Mediastinal Lipomatosis
10) Large PAs d/t Pulmonary HTN
11) Hiatal Hernia
12) Neurenteric Tumor
- Schwannoma
- Paraganglioma
13) Cardiac Tumor
Posterior Mediastinal Mass
1) Neurenteric Tumor
- Schwannoma
- Paraganglioma
- Neuroblastoma
- Ganglioneuroma
2) Vertebral Neoplasm
- ABC
- Mets
- Myeloma
- Chondrosarcoma
- Osteosarcoma
3) Extramedullary Hematopoiesis
4) Paraspinal Abscess
5) Lateral Thoracic Meningocele (NF1)
6) Foregut Duplication Cyst
7) Esophageal Varices
8) Bochdalek Hernia
Fatty Mediastinal Masses
1) Thymolipoma
2) Teratoma
3) Mediastinal Lipomatosis
4) Prominent Epicardial Fat Pad
- Fat necrosis
5) Diaphragmatic Hernia w/ Fat
6) Lipoma/Liposarcoma
Complex Cystic Mediastinal Masses
1) Foregut Duplication cyst
2) Cystic Thymolipoma
3) Cystic Teratoma
4) Aneurysm
5) Pericardial Recess
6) Hematoma
7) Abscess
8) Necrotic Met
9) Cystic Degeneration of Lymphoma
Right Cardiophrenic Mass
1) Epicardial Cyst
2) Prominent Epicardial Fat Pat
3) Morgagni Hernia
4) Cardiac Tumor
5) Thymolipoma
6) Lymph Node
Diffuse Mediastinal Widening
1) Vascular
- Hematoma
- Aortic rupture
- Aortic dissection
- Aneurysm
2) Infection
- Mediastinitis
- Abscess
3) Tumors
- Lymphadenopathy
- Lymphoma
4) Mediastinal Lipomatosis
Pneumomediastinum
1) Chronic Lung Dz
- Asthma
- COPD
2) Trauma
- Barotrauma
- Tracheobronchial injury
- Vomiting (Boerhaave’s Syndrome)
3) Positive Pressure Ventilation
4) Post-op
5) Air from Other Compartments
- Cervical
- Abdomen
Infectious Mediastinitis
1) Esophageal Perforation
- Endoscopy
- Tumor
- Boerhaave’s syndrome
2) Bacterial
- Lungs/LN/pleura
- Cervical/Abdomen
3) Post-op
Fibrosing Mediastinitis
1) Granulomatous Infection
- Histo (most common)
- TB
- Sarcoid
2) Autoimmune
- SLE
- RA
3) Sclerosing Mediastinitis (idiopathic)
4) Drugs
- Methysergide (for migraines)
5) IgG4
Bilateral Hilar/Mediastinal Lymphadenopathy
1) Lymphoma
2) Sarcoidosis
3) Infection (typical, atypical)
4) Fungal Infections
- Histo
- Coccidiodes
5) Pneumoconiosis
6) Mets (extra-thoracic 1ry)
Unilateral Hilar/Mediastinal Enlargement
1) TB
2) Lung ca
3) Lymphoma
4) PE
5) Pulmonary AVF
6) Partial Absence Left Pericardium
7) Lymphoma
8) Post-Stenotic (PA stenosis)
Hilar/Mediastinal Lymphadenopathy in AIDS
1) Lymphoma
2) Kaposi’s Sarcoma
3) Bacterial Infection
4) Fungal Infection
5) TB
Mediastinal Calcification
1) LNs
- TB
- Sarcoidosis
- Pneumoconiosis
- Treated lymphoma
2) Teratoma
3) Fibrosing Mediastinitis
4) Contrast (pseudocalcification)
Egg Shell Calcification
1) Silicosis
2) Sarcoidosis
3) Rare –> Tx lymphoma, Coal workers lung
Solitary Pulmonary Nodule
1) Malignant Tumor
- Lung carcinoma
- Single met
- Lymphoma
- Carcinoid
2) Benign Tumor
- Hamartoma
- Lipoma
- Chondroma
- Intraparenchymal LN
- Bronchogenic cyst (15% peripheral)
3) Infectious
- Granuloma
- Round pneumonia
- Fungal ball
4) Inflammatory
- Vasculitis
- Rheumatoid nodule
5) Vascular
- Infarct
- AVM
6) Splenosis
Multiple Pulmonary Nodules
1) Malignant
- Invasive adenocarcinoma
- Mets –> breast, RCC, GI, ovary, testicle, sarcomas
- Lymphoma
2) Infectious
- TB
- Fungal
- Viral
- Laryngeal papillomatosis
3) Inflammatory
- Sarcoid
- Rheumatoid nodules
- GPA
- LCH
- LIP
- Mucoid impaction
4) Misc
- Trauma
- AVMs
- Multiple hamartomas
Milliary Nodules
1) Miliary TB
2) Sarcoidosis
3) Disseminated Fungal Infection
4) Mets (thyroid, melanoma, choriocarcinoma)
5) Pneumoconioses
6) Viral Pneumonias (varicella)
7) LCH
Calcified Pulmonary Nodules
1) Infectious
- TB
- Sarcoid
- Varicella
2) Hamartoma
3) Pneumoconiosis
4) Amyloidosis
5) Pulmonary Alveolar Microlithiasis
6) Metastatic Pulmonary Calcification
Thick-Walled Cavitary Nodule
1) Necrotizing Pneumonia
- TB
- NTM
- Aspiration
- Fungal
- Bacterial –> Staph, Klebsiella, Pseudomonas
2) Septic Emboli
3) 1ry Lung Cancer
4) Mets
5) Vasculitis
6) Necrobiotic Rheumatoid Nodule
7) LCH
8) Congenital Lesions
- CPAM
- Sequestration
9) Pneumatoceles
10) Papillomatosis
11) Cavitating Infarct
Thin-Walled Lung Cavities
1) Blebs/Bullae
2) Pneumatocele
3) Congenital Lung Cyst
4) Cystic Bronchiectasis
Cavities w/ Air-Fluid Levels
1) Cavitating Lung Cancer
2) GPA
3) Mycetoma
4) Abscess
5) Infected Bullae
6) Infected Lung Cyst
7) Necrobiotic Rheumatoid Nodule
8) Infection of Pre-Existing Cavity
Lung Cysts
1) LAM
2) LCH
3) LIP
4) PJP
5) Birt-Hogg-Dube
6) DIP
Centrilobular Nodules
1) Bronchopneumonia
2) RB-ILD
3) HP
4) Pneumoconiosis
5) Follicular Bronchiolitis
Perilymphatic Nodules
1) Sarcoidosis
2) Lymphangitic Carcinomatosis
3) Pneumoconiosis
4) Lymphoma
5) Kaposi’s Sarcoma
Random Nodules
1) Milliary TB
2) Fungal Infection
3) Mets
4) Invasive Adenocarcinoma
5) LCH
6) Septic Emboli
Crazy Paving
1) Pulmonary Alveolar Proteinosis
2) ARDS
3) Hemorrhage
4) Lipoid Pneumonia
5) Drug Rxn
6) ADenocarcinoma
7) PJP
8) Organizing Pneumonia
Nodular Septal Thickening
1) Lymphangitic Carcinomatosis
2) Sarcoidosis
3) Pneumoconiosis
Smooth Septal thickening
1) Pulmonary Edema
2) Hemorrhage
3) PAP
4) PJP
5) Fibrosis
Lymphangitic Carcinomatosis
1) Unilateral
- Lung Ca
2) Bilateral
- Breast
- Prostate
- Colon
- Stomach
Acute Consolidation
1) Infection
2) Hemorrhage
3) Edema
4) ARDS
Chronic Consolidation
1) Organizing pneumonia
2) Chronic Eosinophilic Pneumonia
3) Invasive Adenocarcinoma
4) Lymphoma
5) Sarcoidosis
6) DIP
Unilateral ILD
1) Lymphangitic Carcinomatosis
2) Re-Expansion Edema
3) Post-XRT
4) ILD Post-Transplant
Basal ILD
"BALD ASS VR" B - Bronchiectasis A - Aspiration L - Lymphangitic Carcinomatosis D - DIP, Drugs A - Asbestosis, A-1 Antitrypsin dz S - Sarcoidosis S - Scleroderma V - Viral Pneumonia R - RA, Other CTDs (Dermatomyositis, Polymyositis)
Upper ILD
1) Sarcoidosis
2) Pneumoconiosis
3) HP
4) TB
5) LCH
6) Ankylosing Spondylitis
7) Idiopathic Pleuropulmonary Fibroelastosis
Large Lung Volumes
1) COPD
2) CF
3) LAM
4) LCH
5) Asthma
6) Bronchiolitis
Tree-in-Bud Nodules
1) TB
2) NTM Infection
3) Airway-Invasive Aspergillosis
4) ABPA
5) Aspiration
6) CF, PCD
Finger-in-Glove Opacities
1) ABPA
2) Bronchial Atresia
3) CF
Unilateral Hyperlucent Lung
1) Chest Wall
- Mastectomy
- Poland Syndrome
2) PTX (supine)
3) Vascular
- Interruption/Hypoplasia of PA
- Massive PE
4) Central Airway Obstruction w/ Air Trapping
- FB
- CLE
- Bronchial Atresia
- Bronchiolitis Obliterans
5) Giant Bullous Emphysema (young male)
Complete Opacification of Pneumothorax
"FAT CHANCE" F - Fibrothorax A - Adenomatoid Malformation T - Trauma (hemothorax) C - Collapse H - Hernia A - Agenesis of lung N - Neoplasm (mesothelioma) C - Consolidation E - Effusion
Unilateral Elevated Hemithorax
1) Diaphragmatic Paralysis
- Iatrogenic
- Tumor
- Trauma
2) Eventration
3) Subpulmonic Effusion
4) Atelectasis
5) Lung Resection
6) Hypoplastic Lung
7) Traumatic Rupture of Diaphragm
Bilateral Elevated Hemithorax
1) Shallow Inspiration
2) Restrictive Lung Dz
3) Abdominal Cause
- Pregnancy
- Mass
- Ascites
4) Muscle Weakness
- SLE
- Myasthenia gravis
- ALS
Unilateral Small Lung
1) Swyer-James
2) Proximal Interruption of PA
3) Scimitar Syndrome
4) Lobectomy
5) Mass Effect
- CDH
- CPAM
- Sequestration
PTX w/ Otherwise Normal CXR
1) Spontaneous (tall thin man)
2) Apical Blebs
3) Trauma
4) Mets
5) Underlying Lung Dz
- LCH
- LAM
- Asthma
Unilateral Pleural Effusion w/ Normal Lungs
1) Pleural Mets (breast, lung)
2) TB
3) Collagen Vascular Dz
- SLE
- RA
3) PE
4) Trauma
5) Chylothorax
6) Pancreatitits
7) Post-Pericardiotomy Syndrome
8) Asbestos-Related Pleuritis
9) Mesothelioma
10) Peritoneal Dialysis
Left Pleural Effusion
1) Pancreatitis
2) PE
3) Trauma
4) Boerhaave’s Syndrome
5) Constrictive Pericarditis
6) Left Heart Failure
7) Subphrenic Abscess
Right Pleural Effusion
1) Left Heart Failure
2) Cirrhosis
3) Ascites
4) Subphrenic Abscess
Bronchiolitis Obliterans
1) Post-Lung Transplant
2) GVHD (in BMT)
3) Idiopathic
4) Infection
5) Drug Toxicity
6) Autoimmune Dz (RA, Sjogren)
Fleeting Infiltrates
1) Drug Rxn
2) Organizing Pneumonia
3) Eosinophilic Lung Dz
4) ABPA
Peripheral Opacities
1) Eosinophilic Lung Dz
2) Organizing Pneumonia
3) HP
4) Vasculitis
5) COVID
6) Fungal Infecions
7) Hemorrhagic Mets
8) Septic Emboli
9) Resolving Pulmonary Edema
Nodule w/ Air Bronchogram
1) Adenocarcinoma
2) Vasculitis
3) Sarcoidosis
4) Kaposi’s Sarcoma
5) Lymphoma
Diffuse Interstitial Disease
"SCHLITZ" S - Sarcoidosis C - Collagen vascular dz H - Histiocytosis L - Lymphangitic carcinomatosis I - Idiopathic pulmonary fibrosis T - Tuberous sclerosis Z - Pneumoconiosis
Chronic GGO
1) Adenocarcinoma
2) Organizing Pneumonia
3) Chronic Eosinophilic Pneumonia
4) Interstitial Pneumonias
5) HP
6) PAP
7) Drug Rxn
Central GGO
1) Edema
2) Hemorrhage
3) PJP
4) PAP
Peripheral GGO
1) Organizing Pneumonia
2) Eosinophilic Lung Dz
3) Non-Cardiogenic Edema
Chest Wall Mass
1) Pleural Based Tumors
- Lipoma
- Solitary fibrous tumor
2) Neurogenic Tumor
- Schwannoma/Neurofibroma
- Ganglioneuroma
- Neuroblastoma
3) Bone Tumor
- FD
- Enchondroma
- Osteochondroma
- Ewing’s
- Mets
- Myeloma
- Chondrosarcoma
- Osteosarcoma
4) Extrapleural Hematoma
5) Empyema
6) Mass-Like Infection
- Actinomycosis
- TB
- Blastomycosis
- Nocardia
Cardiac Calcification
1) Aortic/Mitral Valves
2) Coronary Arteries
3) Mitral/Aortic Annulus (“C” or “J” shaped)
4) Pericardium
5) Myocardium
6) Cardiac Tumors
Focal Tracheal Mass
1) Foreign Body
2) Benign Tumors
- Papilloma
- Hamartoma
- Chondroma
- Hemangioma
- Leiomyoma
4) Malignant Tumors
- SCC
- Adenoid cystic carcinoma
- Mucoepidermoid carcionoma
- Mets (lung, thyroid, esophagus, larynx)
Focal Tracheal Narrowing
1) Post-Intubation/Tracheotomy
2) Extrinsic Compression
- Vascular ring
- Neoplasm
- Goiter
3) Neoplasms
4) Amyloid
5) Sarcoid
Diffuse Tracheal Narrowing
Spares Posterior Membrane 1) TBO 2) Relapsing polychondritis Involves Posterior Membrane 1) GPA 2) Amyloidosis 3) Sarcoidosis 4) TB
Tracheal Calcification
1) TBO
2) Amyloidosis
3) Relapsing Polychondritis
Halo Sign
1) Vasculitis
2) Hemorrhagic Mets
3) Invasive Aspergillosis
Feeding Vessel Sign
1) Vasculitis
2) Hematogenous Mets
Reverse Halo Sign
1) Organizing Pneumonia
2) Infarct
3) TB
4) GPA
5) Adenocarcinoma
6) Lymphoma
7) PJP
8) Sarcoid
9) Fungal Infection
Mosaic Attenuation
1) Air Trapping
- Asthma
- Bronchiolitis (infectious, follicular, constrictive)
- HP
- RB-ILD
2) Hypoperfusion
- Chronic PE
- Pulmonary HTN
Progressive Massive Fibrosis
1) Pneumoconiosis
2) Sarcoidosis
Bronchial Obstruction
1) Mucus Plug
- CF
- Asthma
- ABPA
2) Foreign Body
3) Bronchial Atresia
4) Carcinoma
5) Endobronchial Mets (RCC, thyroid, melanoma)
6) Carcinoid
7) Endobronchial TB (broncholith)
High Attenuation Consolidation
1) Amiodarone Toxicity
2) Silicosis
3) Amyloidosis
4) Talcosis
Lobar/Segmental Consolidation
1) Pneumonia
2) Hemorrhage
3) PAP
4) Infarct
5) Focal Edema (rupture of anterior MV leaflet after MI)
6) Radiation
7) Adenocarcinoma
8) Lymphoma
Pulmonary Edema (PCWP mmHg)
1) Vascular Redistribution (12-17)
2) Interstitial Edema (18-25)
3) Alveolar Edema (> 25)
AIDS Diseases (CD4 Count)
> 200 - Pneumonia (most commonly strep) - TB 200-100 - PJP - Atypical mycobacteria - Kaposis sarcoma < 100 - CMV - Disseminated fungal infections - Lymphoma
Drug Toxicity
Common Drugs - Amiodarone - Bleomycin - Cyclophosphamide - Methotrexate Patterns of Dz - NSIP - UIP - ARDS - Pulmonary hemorrhage - Eosinophilic lung dz
BMT Complications
< 30d - Pulmonary edema - Pulmonary hemorrhage - Drug induced injury - Invasive aspergillosis 1-3m - PJP - CMV > 3m - Organizing pneumonia - GVHD (obliterative bronchitis)
DDx Empyema Necessitans
“BATMAN”
- Blastomyces
- Actinomyces
- TB
- Mucor
- Aspergillus
- Nocardia
