Chest Flashcards
cystic lung disease
(oval/circular, uniform thin-walled, typically measuring 1mm in thickness but up to 4mm; no mural irregularity, not cavitary)
- LAM
- LIP
- LCH (late stage)
- light chain deposition disease (very rare)
- cystic metastases (eg sarcoma)
- pneumatocele from prior infx (pneumocystis, S.aureus, coccidio; should resolve over time and not be so numerous as true cystic lung disease)
- Birt-Hogg-Dube (very rare)
centrilobular ground glass nodules
small ill-defined “smudgy” GG nodules measuring 3-5mm, peribronchovascular inflammation
- HP
- RB (smoking related)
rare:
- follicular bronchiolitis
- pulmonary capillary hemangiomatosis (cause of PAH)
- plexogenic arteriopathy (must have PAH)
(Not MMPH: random)
(Not DIPNECH: random, not diffuse)
(Not diffuse panbronchiolitis: also has TIB nodules + bronchiectasis)
localized multifocal centrilobular tree in bud nodularity
- infectious bronchiolitis (endobronchial spread of infx)
- aspiration
- endobronchial spread of malignancy
- mucous impaction (inflammatory secretions in underlying congenital airway disorders): CF, PCD
- not diffuse panbronchiolitis in pure TIB DDx (should also have GG nodules and bronchiectasis)
pure GGO - acute
patchy or ill-defined areas of increased attenuation, preserved bronchial and vascular markings
- pulm edema (noncardiogenic)
- hemorrhage (vasculitis-GPA; illicit drugs-crack/cocaine, meth)
- infection (immunocomp-PJP; viral-HSV, CMV; atypical-mycoPLASMA, chlamydia, legionella)
**NOT CAP (staph/strep), mycobacteria, fungal - subacute HP
- drug reaction (results in pulmonary edema, hemorrhage, pneumonitis)
(acute eosinophilic pneumonia: young females, poor prognosis)
pure GGO - chronic
patchy or ill-defined areas of increased attenuation, preserved bronchial and vascular markings
- cellular NSIP (patchy, peripheral, peribronchovascular)
- DIP (usually lower zone involvement; smokers)
- LIP (classic also has cystic lung dz + hx CTD e.g. Sjogren’s)
- chronic HP (esp if upper lobe fibrosis)
- malignancy (adenocarcinoma spectrum of disease)
- organizing pneumonia (peripheral or peribronchovascular - rare)
- chronic eosinophilic pneumonia (peripheral)
crazy paving - acute
scattered or diffuse ground glass opacity with superimposed interlobular septal thickening and intralobular lines
- pulm edema (cardiogenic, illicit drugs)
- hemorrhage (vasculitis-GPA, Churg-Strauss [EGPA], SLE, Goodpasture; illicit drugs-crack, cocaine; anticoagulants)
- infection (immunocomp-PJP; viral-HSV, CMV; atypical-mycoPLASMA, chlamydia, legionella)
- drug reaction
- acute eosinophilic pneumonia
(ARDS (AIP/DAD) - if in ICU)
(similar to acute GGO DDx except:
- cardiogenic pulmonary edema vs. noncardiogenic
- no subacute HP)
crazy paving - chronic
scattered or diffuse ground glass opacity with superimposed interlobular septal thickening and intralobular lines
- pulmonary alveoloar proteinosis
- chronic pulm edema (cardiogenic)
- lipoid pneumonia
- invasive adenocarcinoma (NOT adenoca spectrum)
- fibrotic NSIP (peripheral or peribronchovascular, e.g. not patchy or diffuse)
- organizing pneumonia (peripheral or peribronchovascular)
- chronic eosinophilic pneumonia (peripheral)
(alveolar sarcoidosis)
mosaic attenuation
geographic areas of differential attenuation
(can use liver window to show heterogeneity in lung parenchyma)
if hyperattenuating areas are abN → GGO ddx
if hypoattenuating areas are abN (vessels in abN lucent areas are too few in number or small in caliber) → “mosaic perfusion”:
1. airway causes (abN ventilation → reflex vasoconstriction)
- small airway (bronchiolitis obliterans, asthma, COPD, HP, chronic bronchitis/small airway infx/mucus plugging)
- large airway (CF, bronchiectasis)
2. small vessel (vascular obstruction)
- chronic PE
- pulm artery hypertension
- vasculitis
multiple large nodules/opacities
same as “multifocal masslike air space opacities” DDx
- malignancy (mets, multifocal primary bronchogenic ca, lymphoma, Kaposi)
- atypical infection (fungal, mycobacteria)
- Wegner/GPA
- sarcoid
- organizing pneumonia
(not CMV: small ≤ 10mm)
multiple peribronchovascular opacities/consolidation
“peribronchovascular”:
- not lobar, segmental, lobular
- inner 2/3 of lung; i.e. not peripheral
- not patchy, random
- bronchopneumonia
- aspiration
- lymphoma/lymphoprolif disorder
- multifocal primary adenoca
- organizing pneumonia
- Wegner/GPA
- sarcoid
- Kaposi
branching tubular structure on CXR
bronchocele/mucocele - postinfectious - CF - ABPA - bronchial atresia pulmonary AVM pulmonary vein varix
reverse halo (atoll sign)
central ground glass with rim of consolidation
- OP (classic)
- vasculitis (Wegener/GPA)
- pulmonary infarct
- fungal (S.American paracoccidiomyocosis, mucormycosis)
- COVID
halo sign
nodule w ground glass around it; represents hemorrhage/invasion into surrounding tissues
- invasive fungus (aspergillosis-classic, mucormycosis)
- hemorrhagic mets
- CMV, HSV
- Wegener/GPA
- lymphomatoid granulomatosis
rib notching
To do
high attenuating lung parenchyma
- amiodarone deposition
- embolism of oil-based iodinated material (from lymphangiography or chemoembolization)
- amyloidosis
- metastatic pulmonary calcification
- talcosis
perilymphatic nodules
- sarcoid
- silicosis & coal-worker pneumoconiosis
- lymphangitic carcinomatosis
- amyloidosis (rare)
- lymphoid interstitial pneumonitis
miliary pulmonary nodules
- Tb
- fungal - histo
- hematogenous mets
honeycombing
- UIP
- asbestosis
- chronic HP
- rheumatoid
calcified pulmonary metastases
osteosarcoma chondrosarcoma mucinous adenocarcinoma (GI tract, ovary, breast) medullary thyroid cancer treated choriocarcinoma synovial sarcoma
progressive massive fibrosis
sarcoidosis silicosis coal worker’s pneumoconiosis talcosis lung cancer
multiple calcified pulmonary nodules
sequela of prior infection:
- histoplasmosis, tuberculosis, varicella (indicates healed disease with fibrosis & dystrophic calc’n)
metastases (separate ddx)
primary lung ca: eccentric, stippled, coarse calc’n may be seen
calcified consolidations
metastatic calcification
amyloidosis
amiodarone pulmonary toxicity
tracheal tumours
squamous cell carcinoma adenoid cystic carcinoma mucoepidermoid carcinoma metastases benign tracheal neoplasms: papilloma, adenoma, hamartoma, chondroma, neurofibroma, leiomyoma, etc.
pulmonary infections that traverse tissue planes
may involve pleura, chest wall, pericardium, mediastinum, SVC
tuberculosis nocardia actinomycosis invasive aspergillosis mucormycosis
multifocal cavitary lesions
septic emboli
infection: parasites, tuberculosis, recurrent respiratory papillomatosis
primary lung cancer: SCC
mets: H&N SCC, mucinous adeno of GI tract, breast, high grade sarcomas
granulomatosis with polyangiitis (GPA)
pulmonary infarctions
air crescent sign
recovering angioinvasive aspergillosis echinococcal cyst TB lung abscess bronchogenic Ca hematoma PJP
migratory/transient consolidations
organizing pneumonia chronic eosinophilic pneumonia acute coccidioidomyocosis Churg-Strauss (EGPA) - peripheral (pulmonary infarction from recurrent emboli)
infections with significant lymphadenopathy
granulomatous infection:
- primary or disseminated TB, histoplasmosis
viral:
- Epstein-Barr
- human T cell lymphotrophic virus type 1-related lymphoproliferative disease
anthrax
fibrosing mediastinitis causes
idiopathic (most, likely IgG4) histoplasmosis (H. capsulatum) tuberculosis sarcoidosis radiation therapy methysergide therapy
posterior mediastinal masses
- neurogenic tumor (neurofibroma, schwannoma, neurolemma)
- spondylodiscitis
- extramedullary hematopoiesis
lymph node eggshell calcifications
- sarcoid
- silicosis
- lymphoma (hodgkins)
- Tb
Pleural calcification
Asbestos Old hemothorax Old infection Tb Extraskeletal osteosarcoma
bronchiectasis
postinfectious: bacteria (Pseudomonas, staph, pertussis), mycobacteria (TB, MAC), virus, mycoplasma
immunodeficiency: congenital (SCID, hypogammaglobulinemia), acquired (HIV)
mucociliary clearance abN: cystic fibrosis (abN mucus), primary ciliary dyskinesia (abN cilia), Young syndrome
bronchial obstruction: bronchial atresia, endobronchial tumour, foreign body, chronic aspiration
bronchial wall abN: Mounier-Kuhn (1-4th order), Williams-Campbell (4-6th order)
immune reactions: ABPA, asthma, lung transplant rejection, graft vs host disease
systemic disease: alpha 1 antitrypsin def, collagen vascular dz, IBD
reverse batwing
chronic eosinophilic pneumonia organizing pneumonia COVID-19 pneumonia (vasculitis) (multifocal pulmonary infarct)
organizing pneumonia / constrictive bronchiolitis causes
post infectious (viral, bacterial, mycoplasma, PJP)
post toxic inhalational injury (smoke, NO2)
collagen vascular disease (Sjogren, RA, SLE, scleroderma)
post transplant (heart, heart lung, bone marrow)
drug reaction (amiodarone, bleomycin, cyclophosphamide, methotrexate, nitrofurantoin)
idiopathic
reticulonodular opacities on CXR (lines, rings, arc shadows); i.e. not reticular and not nodular
- bronchiectasis / bronchial wall thickening
- emphysema / smoking related changes with superimposed acute airspace disease
- Langerhans cell histiocytosis
paraspinal line abnormality
hematoma neurogenic tumour aortic aneurysm extramedullary hematopoiesis esophageal mass osteophyte
azygoesophageal recess abnormality
esophageal mass, hiatal hernia, left atrial enlargement, adenopathy
