Chest/ airways Flashcards
Signs seen in croup (2)
- Steeple sign on frontal cxr- loss of normal lateral convexities of subglottic trachea 2. Ballooning of hypopharynx on lateral view
Retro pharyngeal abscess on plain film
Soft tissue thickening - could be positional. If in doubt repeat with extended neck view.
DDx for retropharyngeal swelling (4)
- Abscess 2. Cellulitis 3. Lymphoma 4. Foregut duplication cyst
Linear soft tissue filling defect within the airways in a 6-10 year old kid
Exudative Tracheitis
Multiple laryngeal nodules due to HPV infection
Laryngeal papillomatosis
Laryngeal papillomatosis causes which type of cancer?
Laryngeal squamous cell may cause cavitating lung masses
Excessive expiratory airway collapse from weakness of tracheobonchial cartilage
Tracheobronchomalacia
Lateral x ray: marked swelling of epiglottis- thumb sign
Epiglottitis
7% of patients with subglottic haemangioma have ……. syndrome
PHACES: Posterior fossa- Dandy Walker Haemangioma Arterial anomalies Coarctation of aorta/ Cardiac defect Eye abnormalities Subglottic haemangioma
subglottic haemangioma vs croup
Croup: Symmetrical narrowing with loss of shoulder on both sided (steeple Sign) n subglottic haemangioma: loss of just one of the sides (favours the left side)
……………… is the only vascular anomaly that causes stridor in a patient with a normal (left) aortic arch.
The pulmonary artery (PA) sling: Aberrant left pulmonary artery, also known as pulmonary sling: left PA arising from the right PA and passing above the right main bronchus and in between the trachea and oesophagus. It may lead to compression and focal stenosis of the trachea.
The three most important vascular causes of stridor are:
- double aortic arch, 2. right arch with aberrant left subclavian artery, and 3. pulmonary sling.
On the frontal view, a right arch with aberrant left subclavian artery produces a ……………..impression/deviation of the trachea by the right aortic arch.
On the frontal view, a right arch with aberrant left subclavian artery produces a LEFTWARD impression/deviation of the trachea by the right aortic arch.
Pulmonary artery sling is associated with tracheal anomalies including …….. (2)
- tracheomalacia 2. bronchus suis (RUL bronchus originating from trachea).
what does left aortic arch with an aberrant right subclavian artery cause?
Does not cause STRIDOR. DYSPHAGIA may result, which is called dysphagia lusoria
What is the lesion? Pouch like aneurysmal dilation of proximal portion of aberrant right subclavian artery?
Diverticulum of Kommerell
What are the associations of pulmonary sling? (5)
- Hypoplastic right lung 2. Horseshoe lung 3. TE fistula 4. Imperforate anus 5. Complete tracheal ring
RF for transient tachypnoea of Newborn (TTN)? (2)
History of C section Maternal diabetes/asthma Maternal sedation
Findings in TTN
Interstitial markings and fluid in the fissure starts at 6 hours, peak at 1 dayand done by 3 days.
Lung volumes in TTN
Normal or increased.
Who is affected by RDS?
- Pre term infants <34 weeks. 2. Less commonly term babies with maternal diabetes
Lung volume in RDS
Reduced
What is the diagnosis? Associated with RDS , barotrauma dissects through the immature alveoli into interstitial space and along the lymphatic pathway
Pulmonary interstitial emphysema (PIE)
RDS vs B haemolytic pneumonia
Both get reduced lung volume and bilateral granular opacities. No Pleural effusion in RDS
How can you exclude RDS?
A normal CXR at 6 hrs excludes RDS
What are the risks associated with RDS? (2)
- Pulmonary haemorrhage 2. PDA
BUZZWORD: Linear lucencies
PIE (pulmonary interstitial Emphysema) Impending sign for pneumothorax.
What is bronchopulmonary dysplasia?
RDS + 1 week= BPD or chronic lung disease of prematurity Clinically defined as abnormal CXR and persistent need for O2 at 36 post-conceptual weeks or at 28 days of life, although one may suspect BPD prior to 28 days of life.
What is the diagnosis? Prolonged ventillation in a tiny (1Kg) , premature kid ( <32 weeks) CXR: band like opacities
BPD- bronchopulmonary dysplasia
Which babies are susceptible to get meconium aspiration?
term/ post term secondary to stress (hypoxia)
What is the diagnosis? “Ropy appearance” of asymmetric lung densities. Hyperinflation with alternative areas of atelectasis
Meconium aspiration
What is the diagnosis? History of prolonged ruptures of membrane or known maternal infection
neonatal pneumonia
What is the diagnosis? Granular opacities with bilateral pleural effusion and low lung volumes.
Neonatal pneumonia- B haemolytic strep
Re Congenital Diaphragmatic Hernia (CDH) 1. What type is more common? 2. Primary complication
- Left posterior defect- Bochdalek (B is at the Back) 2. Pulmonary hypoplasia of the affected side
What is associated with CDH? (3)
- Bowel malrotation 95% 2. Neural tube defect 3. Congenital heart disease
Congenital lobar emphysema (CLE) usually affects which lobes?
Upper and middle lobes
What is treatment for CLE
Lobectomy
What is bronchial atresia?
The bronchi distal to the atretic segment become filled with mucus that ultimately forming a tubular mucocele. The distal airways are ventilated through collateral pathways and demonstrate air trapping, resulting in local hyperinflation.
Where does the blood supply for CPAM come from?
Pulmonary circulation Sequestration gets its blood supply from systemic circulation
Define sequestration:
aberrant lung tissue with systemic blood supply, usually from aorta.
Common location for sequestration
LLL
Two types of sequestration:
Intralobar Extralobar
Define intralobar sequestration:
Inside pleura With pulmonary venous drainage
Define extralobar sequestration
External to pleura, with systemic venous drainage May be near adrenal, mimicking an adrenal mass
Define Scimitar syndrome
This is PAPVR from RLL pulm veins into either RA or IVC
X ray findings for bronchiolitis
hyperexpanded lungs (best seen as flattening of the diaphragms) and increased peribronchial markings.
Causes of BO (Bronchiolitis Obliterans)
- post-transplant in origin, 2. postinfectious (typically following viral or atypical bacterial pneumonia), or 3. related to toxin or drug exposures
CT signs of small airway disease (3)
- Air trapping on expiratory views. 2. Mosaic perfusion. 3. Bronchiectasis and bronchial wall thickening
Define Swyer James syndrome
abnormality of pulmonary development secondary to BO, which leads to a unilateral hyperlucent lung with volume loss.
Define COP (cryptogenic organising pneumonia)
COP is the clinical syndrome of organising pneumonia (OP) of unknown cause. OP may be secondary to infection, drug reaction, or inhalation. OP may also be a complication of stem cell transplant, but much less commonly than BO.
The atoll or reverse halo sign is thought to be relatively specific for ………. and features a central lucency surrounded by ground glass.
OP
Causes of bronchiectasis (6)
- Cystic fibrosis. 2. Allergic bronchopulmonary aspergillosis. 3. Post-infectious. 4. Tracheobronchomegaly (Mounier–Kuhn). 5. Aspiration. 6. Intralobar sequestration, possibly due to recurrent infections.
signet-ring sign
Bronchiectasis
Unilateral hyperlucent lung with Acute shortness of breath? Persistent expansion of dependent lung on decubitus views?
Endobronchial foreign body
Unilateral hyperlucent lung with Acute shortness of breath? Pleural line?
pneumothorax
Unilateral hyperlucent lung with Prior history of bronchiolitis obliterans?
Swyer James McLeod
Unilateral hyperlucent lung with Primarily upper and middle lobes?
Congenital lobar emphysema
Unilateral hyperlucent lung with History of recurrent infections?
CPAM with large cyst
Unilateral hyperlucent lung with Abnormality of the chest wall on the physical exam or lateral radiograph? History of arm/hand anomalies?
Poland syndrome
What is poland syndrome?
It is autosomal recessive. unilateral congenital absence (complete or partial) of the pectoralis major muscle. Associated anomalies of the ipsilateral arm and hand, including short metacarpals and syndactyly (joined fingers),
Anterior mediastinal masses: (4)
• Lymphoma. • Germ cell tumor. • Thymoma (very rare in children). Normal thymus
Middle mediastional masses (3)
• Foregut duplication cyst. • Neurenteric cysts, associated with vertebral anomalies. • Lymphadenopathy.
Posterior mediastinal masses
Neurogenic tumors, including neuroblastoma, ganglioneuroblastoma, and ganglioneuroma.
Spinnaker sign
Seen in pneumomediastinum and represents the thymus lifted off the mediastinum by the ectopic air.
