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
