Chest Flashcards
Smallest anatomical unit visible on HRCT
Secondary lobule of Miller
Def inferior accessory fissure
Separates medial basal seg from remainder of lower lobe
Def superior accessory fissue
Seperates superior seg from basal segmnet of right lower lobe
MC bug to cause non-segmental pneumonia
Strep pneumonia
MC batwing hilar consolidation
Hydrostatic pulmonary edema
What are Kerley lines and desc A and B
Interlobar septal thickening, A = Longer more medial hilar directed, B = Perpendicular to pleura and short
Desc cavitary lesions wall thickness to say benign vs malignant
Benign : <4mm, Malignant >15mm
Cause of passive atelactasis
Loss of lung volume
MC cause of round atelectasis
Asbestos patients
2 direct signs of atelectasis
Displaced interlobar fissue and crowded vessels/brocnhi
Def Potters syndrome
Renal agenesis, AbN facies, limb AbN, Pulmonary hypoplasia
Interlobal bronchopulmonary sequestrum
Defined triangular opacity in posterior costophrenic, usually on the left
MC loc for a bronchogenic cyst
mediastinal
MC loc for a pulmonary bronchogenic cyst
Medial 1/3rd of lower lobes
Def Congenital adenomatoid malformation
AbN pulmonary tissue with gross cyst formation
Desc Cor trintriatum
Heart with 3 atriums, causes venous obstruction
TAPVR shunt direction
Goes right to left. required to live. By patent foramen ovale or ASD
Hypoplastic lung with PAPVR in the right lung
Scimitar lung
Rendu-Osler-Weber syndrome is AKA
hereditary hemorrhagic telangiectasia. AVM is various tissues, likes the lower lobes
Sandstorm appearance on CXR
Pulmonary alveolar microlithiasis
Rad for Gaucher dz
Reticulonodular or miliary pattern that is diffuse and bilateral
Occulocutaneous albanism, defect in platelet function and accumulation of ceroid pigment in the body
Hermansky-Pudlak syndrome
MC location of edema in air-space disease
periphery
MC CAP
Strep pneumoniae
Rad DDx between Strep, Staph and Klebsiella
Strep - Nonsegmental, touches visceral-pleural surface, only 1 lobe affected
Staph - Segmental, touches fissure, usually more than 1 lobe
Klebsiella - Bulging fissure, cavitation, pleural effusion, currant jelly sputum
Yersinia Pestis is AKA
Black Plague
MC opportunistic bug in CF pts
Burkholderia Cepacia
MC cause of tracheobronchitis in ventilator pts
Pseudomonas aeruginosa
Rad finding of H. influenza
Bronchopenumonia that is patchy/segmental, pleural effusion
TB affects which nodes the most
Hilar
MC fungal ball
Aspergillus
% of cavitary post primary TB
20-45%; likes Apical posterior segment of UL
MC complication of post primary TB
Pericarditis
Lady Windermere syndrome
Older female, focal bronchietactasis, patchy nodules with cavitation
Histoplasmosis likes which lobe
Lowers lobes, calcifications
Pneumocystis jiruvici affects what lobes
Bi lower lobes
MC form of invasive aspergillosis
Angioinvasive aspergillosis (Pts usually have leukemia)
Type of influenza causing pneumonia
Type A
Extrapulmonary complications of Mycoplasm, rash, fever, stomatitis, opthalmis
Steven-Juhusin
SCC is ass’d with what virus
HPV
MC type of bronchogenic CA
AdenoCA
2nd MC type of bronchogenic CA
SCC
Lung cancer that likes the center
Small cell and SCC
% of small pulmonary nodules are malignant
40%
Max size of a nodule
3cm
What type of calcification indicates benign
Diffuse, laminated or central
MC pulmonary cancer to cavitate
SCC
Pulmonary cancer to show airspace (pneumonia) pattern
bronchoalveolar
Lung cancer to bone mets %
40%
Which subtype of lung cancer likes to go to the liver
Small cell CA
Myasthenia gravis-like symptoms, but affects proximal mucles rather than distal
Lambert-Eaton myasthenic syndrome
MC primary pulmonary neoplasm in kids/child
carcinoid
How often do carcinoid tumors calcify
5%
MC tracheobronchial gland neoplasm
adenoid cystic carcinoma
Tracheobronchial papilloma is found in what age and where
1-3 YO, trachea
Secondary NHL location and cavitation?
Lower lobes and rarely cavitates
MC HD lymph nodes loc
paratracheal and prearterial
Sex and age of epitheloid hemangioendothelioma
<40 YO female
Pulmonary chondromas, gastric epitheloid leiomyosarcoma and extraadrenal paraganglioma is what triad
Carney’s triad
Age and sex of Carney triad
<40 Female
Chondromas that calcify
30%
2nd MC ST sarcoma in lung
Fibrosarcoma (MC is leiomyosarcoma)
MC loc of fibrosarcoma in lung
Lobar or main bronchi
MC manifestation of thoracic endometriosis
Pneumothorax
% of ppl with extrapulmonary Ca with mets to lungs
30-50%
MC lung mets presentation and lobe predominance
parenchymal nodules and lower lobes
MC and 2nd MC location for colorectal CA mets
- liver 2. lungs
leading cause of respiratory dz in HIV infected adult
Strep pneumonia
% of AIDS pts to get PCP
75%
MC fungus ass’d with systemic infection in HIV patients
Cryptococcus neoformans
Kaposi sarcoma location
Perihilar, Bi/sym
Does HIV increase pulmonary CA
Yes
MC sarcoid stage is
Stage 1
+C agent for sarcoid
gallium-67, shows hilar and paratracheal lymphadenopathy
% of LCH with lung disease
85%
Loc of LCH in lungs
Upper/middle lung zone, sparing costophrenic angle
MC cause of interstitial lung disease
idiopathic pulmonary fibrosis
Diffuse lung disease with diabetes insipidus
LCH, histoplasmosis, sarcoid
MC rad finding in SLE
pleural effusion
Age and sex of rheumatoid disease
Men 50-60 YOA
What antibody is seen in upto 95% of CREST
Anticentromere antibody
Location pulmonary changes in dermato/polymyositis
Sym/Bi, basal
% of pts with ABN CXR in Churg-Straus pts
70%
Small vessel necrotizing vasculitis
Microscopic polyangitis
Artery affected in Takayasu
Aorta and branches
Giant cell arteritis affects
large arteries of the head and neck
Antigen ass’d with Behcet
HLA-B51
Pulmonary findings in Behcet disease
Pulmonary artery aneurysm
Necrotizing vasculities of small vessels, purpura, abd pain, GI hemorrhage, arthritis and glomerulonephritis
Henoch-Schonlein purpura
Henoch-Schonlein purpura VS microscopic polyangitis
HSP - Kids, purpura
MP - 50+
Antigens with goodpasture syndrome
HLA-DR15, Dr4, anti-GBM
MC cause of arterial thrombosis from pulmonary arteries
Infectious pneumonia (Staph aureus), Mets can also do it
Rad Thromboembolism with hem or infarct
Segmental consolidation with volume loss, illdefined parenchymal opacity, MC in RLL
MC bug to cause septic thromboembolism
Staph aureus
MC pulmonary complication of sickle cell anemia
Acute chest syndrome
MC cause of Cor pulmonale
COPD - 80%
Size of main pulmonary artery on CT/MR
29mm
Reversal of the normal L–> R shunt d/t Right heart pressure
Eisenmenger syndrome
MC cause of pulmonary venous HTN
L ventricular hypertrophy
Narrow pulmonary vessels lower lobe, disention in upper loss of sharp vasculature margin, perihilar haze
Pulmonary venous HTN
Primary pulmonary arterial HTN
Enlarged central pulmonary artery, rapid tapering, eripheral oligemia, no overinflation
MC cause of cardiogenic pulmonary edema
Increase pulmonary venous pressure secondary to left heart disease
initial location of ARDS
peripheral
Increase in AP tracheal diameter, COPD
Saber Sheath trachea
Tracheobronchomegaly is AKA
Mounier-Kuhn syndrome
blue bloater vs pink puffer; right heart failure
Blue bloater - COPD
MC lethal genetically transmitted dz in caucasian
CF
Loc of early CF
Periphery 92-3-cm) with hilar nodal enlargement
Bronchiectasis adjacent to a pulmonary artery
Signet ring sign
Mechanical obstruction of genital tract, bronchiectasis and sinusitis
Young’s syndrome
Location of respiratory bronchilitis
Upper lobes
Loc of nodular opacity with silica
Posterior aspect of upper lobe
MC complication of chest trauma
Pulmonary contusion
MC of chylothorax
malignancy
MC cause and loc of secondary spontaneous pneumothorax
COPD, 90% are right sided
HU of liposarcoma
-50
MC cause of acute mediastinitis
bacterial infection
MC cause of chronic mediastinitis
TB/fungal
MC organism in fibrosing mediastinitis
Histoplasma
MC primary neoplasm of anterior mediastinum
Thymoma
MC paraneoplastic syndrome with thymoma
Myasthenia gravis
Teratoma malignancy rate when cystic vs solid
Cystic = Benign Solid = Malignant
MC malignant mediastinal germ cell neoplasm
Seminoma
Giant lymph node hyperplasia is AKA
Castleman dz
MC loc of bronchogenic cyst
Paratracheal/subcarinal
Loc of paraganglioma
Aorticopulmonary and paravertebral
Def aortic nipple
Dilation of left superior intercostal vein
2 syndromes that can affect the ascending aorta
Marfans and Ehlers-Danlos
MC malignant neoplasm of Diaphragm
Fibrosarcoma
4 defects in TOF
- Pulmonic stenosis, 2. Right ventricular hypertrophy, 3. High VSD, 4. Overriding aorta
Def Ebstein anomaly
Downward displacement of tricuspid valve with enlarged R atrium and small R ventricle
Heart shape in Ebstein anomaly
Box/square shaped
Consistent finding in PDA
Enlarged pulmonary artery
L to R shunts are cyanotic or non-cyanotic
Non-cyanotic
What is Lutembacher syndrome
ASD with mitral stenosis
What enlarges with a VSD
Bi ventricles and L atrium
Common anomaly ass’d with COA
Bicuspid aortic valve (85%)
Williams syndrome is
Mental and physical retardation, Elfin facies, hypercalcemia and peripheral pulmonary artery stenosis
MC type of COA
Distal to the ductus arteriosus
COA can be ass’d with chromosomal syndrome
Turners syndrome
Classification system for rotation anomalies of the heart
Rosenbaum
% of pts with TOF with R aortic arch
25%
% of pts with R aortic arch that have TOF
90%
MC anomaly of the great vessels
Abberant R subclavian
Mc cause of cor pulmonale
Pulmonary emphysema
MC cause of ventricular aneurysm
Coronary a. occulsion
MC loc of a myxoma
L atrium (75%), R atrium (25%)
Loc of cardiac rhabdomyosarcoma or fibrosarcoma
ventricular wall
Age and sex of a Takayasu Pt and rad findings
Young females, large vessel wall calcification
Spyhillitic (leutic) aortitis
Ascending aorta dilation with thin calcification
MC location of traumatic aneurysm in horizontal deceleration
Distal to L subclavian
MC location of traumatic aneurysm in vertical deceleration
Just above the aortic valve
Water bottle heart shape is found in what condition
Pericardial effusion
MC mass involving the pericardium
Pericardial cyst
Nocardia pneumonia is common in
Pulmonary alveolar proteinosis
ABPA rad
Central, upper lobes with saccular bronchiectasis, finger in glove sign
Size of lymph node in SAX b9 vs malignant
b9 <1cm ; malignant >1cm
AdenoCA likes to mets where
Adrenals
Small and large cell CA likes to mets where
Brain, bone and kidney
MC loc of a hamartoma and what is its CT HU
peripheral; fat attenuation (-40 to -120)
What % of Stage 1 sarcoid progresses
15%
Def Heerfordt synd
Parotid gland enlargement, fever, uveitis, CN palsies seen with sarcoid
Sarcoid secondary infxn is
Aspergilosis
Smoking related ILD
DIP
Connective tissue/ autoimmune related ILD
LIP
Hammond-Rich synd is AKA
Acute intersitial pneumonia
Demo for LAM syn
Young female, recurrent pneumothorax, hemoptysis and progressive dyspnea
MC and 2MC sites of involvement in scleroderma
Distal 2/3 of esophagus and lungs
Lung changes in EG pts
Cystic spaces in lung parenchyma, pulmonary nodules, apical reticulonodular pattern, pneumothorax
Extrinsic allergic alveolitis is AKA & rad
Hypersensitivity pneumonitis
Diffuse GGO, reticulonodular interstitial pattern
Loffler syn AKA
Simple pulmonary eosinophilia
% of tracheobronchial tumors are malignant, MC and 2nd MC
90%
SCC
Adenoid cystic carcinoma
tracheobronchomegaly is ass’d with what syndrome
Ehlers-Danlos
GI manifestations of CF
Pancreatic insufficiency, liver cirrhosis and rectal prolapse
Grades of cardiogenic pulmonary edema
Grade 1 - Vascular redistribution (cephaliation)
Grade 2 - Interstitial edema (Kerleys)
Grade 3 - Alveolar edema
Def Fleischner sign
Increase in pulmonary a diameter in acute PE
MC structural cardiac defects
Bicuspid aortic valve and mitral valve prolapse
2nd MC congenital cardiac anomaly
VSD
Rad appearance of eisenmenger physiology
Large pulmonary a, left atrial enlargment, peripheral pulmonary arterial pruning
MC types of ASD
Ostium secundum
ASD is ass’d with what conditions
Holt-Oram, Lutembacher syndrome
Endocardial cushion defect is ass’d with
Downs (21)
What conditions lead to left to right shunt
VSD, PDA, ASD
Seen in PAPVR
Def Noonan syn and what cardiac abN
Short stature, webbed neck and hypogonadism and valvular pulmonary stenosis
Shunt in PRE-ductal COA
Right to left Via PDA or VSD
Shunt in POST-ductal COA
Left to right Via PDA
Egg-on-string heart sign is ass’d with what
Transposition of the great vessels
Def truncus arteriosus and ass’d
Single vessel leaves the heart, needs VSD to survive
MC congenital aortic arch anomaly
L aortic arch and aberrant R subclavian
Abd situs solitus
Liver on R and stomach on L… This is normal
Abd situs ambiguous
Sym liver and midline stomach