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Chest Imaging > Chest (Core Qs & Others) > Flashcards

Chest (Core Qs & Others) Flashcards

1
Q

Mesotheliomas most commonly arise from where?

A

Pleura

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2
Q

Mesotheliomas have a strong association to what substance?

A

Asbestos fibers

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3
Q

Radiographic apparence of mesotheliomas can include

A 
Pleural effusion
Pleural opacity
Pleural thickening
Decreased lung volume
Mediastinal lymphadenopathy
Rib destruction
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4
Q

Name the stages of sarcoidosis in the lungs

A

Stage 0: normal chest x-ray
Stage I: hilar/mediastianl enlargement
Stage II: hilar/mediastinal enlargement with parenchymal disease
Stage III: parenchymal disease only
Stage IV: end stage lung disease (pulmonary fibrosis)

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5
Q

The “golden S sign” is typically seen where?

A

Upper right lobe

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6
Q

What is the main suspicion when we see a “golden S sign”

A

Primary bronchogenic carcinoma

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7
Q

What is the primary suspicion when we see a apical pulmonary mass?

A

Primary lung malignancy, typically non-small cell lung carcinoma

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8
Q

Which organism is the most common cause for community acquired pneumonia?

A

Strep. Pneumoniae

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9
Q

Which pneumonia causing organism is most likely to create cavitations?

A

Klebsiella pneumoniae

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10
Q

What is the triad associated with Kartageners syndrome?

A

Situs inversus
Chronic sinusitis
Bronchiectasis

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11
Q

What is the classic triad associated with Wegeners granulomatosis (aka granulomatous with polyangiitis)

A 
Lung involvement (95%)
Upper respiratory tract/sinuses (75-90%)
Kidney involvement (80%)
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12
Q

What is the “1, 2, 3” sign associated with sarcoidosis?

A

Lymphadenopathy at bilateral hilar regions and the right paratracheal stripe region

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13
Q

Which primary lung carcinoma is most likely to have cavitations?

A

Squamous cell carcinoma (non-small cell)

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14
Q

Progressive massive fibrosis is often associated with which type of pneumoconiosis?

A

Coal workers pneumoconiosis

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15
Q

What glycemic abnormality is associated with mesothelioma?

A

Hypoglycemia (40%)

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16
Q

Which pneumoconiosis is indistinguishable from pulmonary sarcoidosis?

A

Berylliosis (prolonged exposure to beryllium)

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17
Q

What does RUL atelectasis typically look like?

A

Collapses superior and medial
Superior displacement of minor fissure
Creates upper paramediastinal density

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18
Q

What does RLL atelectasis typically look like?

A

Often looks like a triangle shape

Located at the lower zone of the right lung

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19
Q

What does LUL atelectasis typically look like?

A

Collapses anteriorly
Maintains contact with anterior costal pleural surface
Associated with the “Luftsichel” sign

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20
Q

What does LLL atelectasis typically look like?

A

Increased density adjacent to cardiac shadow

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21
Q

What is the 2 most common causes for cavitations within the lung?

A

Necrotic neoplasm

Lung abscesses

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22
Q

Which view is the most sensitive for looking at a pleural effusion?

A

Lateral decubitus view with the involved side down

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23
Q

If an upper mediastinal mass is clearly seen above the clavicles, it is most likely located where?

A

Posterior mediastinum (“cervicothoracic” sign)

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24
Q

If an upper mediastinal mass is indistinct above the clavicles, it is most likely located where?

A

Anterior mediastinum (“cervicothoracic” sign)

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25
Q

Differential diagnosis list for upper lung fibrosis

A 
"ST CASH"
Sarcoidosis
Tuberculosis
Cystic fibrosis
Ankylosing spondylitis
Silicosis
Histiocytosis
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26
Q

Differential diagnosis list for lower lung fibrosis

A 
"BAD RASH"
Bronchiectasis
Aspiration
Desquamative interstitial pneumonia (DIP)
Rheumatoid arthritis
Asbestosis
Scleroderma 
Hamman-Rich syndrome (acute pneumonitis)
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27
Q

Describe the “hilum overlay” sign

A

If the hilum is visible when superimposed with a pulmonary mass, the mass is not within the middle mediastinum

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28
Q

Describe the “galaxy” sign in the lungs

A

Coalescent granuloma
Central cavitation may occur
Surrounding ground glass opacity

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29
Q

What are 2 diseases associated with the “Galaxy” sign?

A

Sarcoidosis

Tuberculosis

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30
Q

Describe the “bat wing” sign in the lungs

A

Bilateral, asymmetric, perihilar region enlargement.

Most commonly caused by pulmonary edema

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31
Q

Describe the “flat waist” sign

A

Flattened contour of the aortic knob and pulmonary artery. Seen in severe collapse of LLL, left displacement and rotation of the heart

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32
Q

What is the most radiosensitive tissue in both males and females?

A

Bone marrow

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33
Q

On evaluating growth of a rounded nodule, what percentage of increase in diameter is roughly equal to doubling of tissue volume?

A

25%

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34
Q

What is the most common iodinated IV contrast complication in myasthenia gravis?

A

New/progressive acute respiratory compromise

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35
Q

What is responsible for creating a juxtaphrenic peak?

A

Inferior pulmonary ligament (this is associated with upper lung volume loss)

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36
Q

What forms the medial border of the right paratracheal stripe?

A

Trachea

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37
Q

What forms the lateral border of the right paratracheal stripe?

A

Medial pleura

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38
Q

On a lateral chest radiograph, what creates a rounded lucency just inferior to the tracheal shadow?

A

Left mainstem bronchus

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39
Q

An anatomical variant at the tracheobronchial tree, arising from the medial aspect of the bronchus intermedius is called what?

A

Cardiac bronchus

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40
Q

What is the upper limit of normal for the tracheoesophageal space?

A

5mm

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41
Q

What is the name of the fissure that separates the medial basal bronchopulmonary segment from the other lower lobe segments?

A

Inferior accessory fissure

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42
Q

Within the intercostal spaces, what is the cranial-to-caudal order of the neuromuscular bundle?

A

Vein-Artery-Nerve

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43
Q

Where is the neurovascular bundle located within the intercostal space?

A

Along the undersurface of the superior rib

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44
Q

What structure does the thoracic duct typically drain into?

A

Left subclavian vein and internal jugular vein confluence

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45
Q

Which body region is not typically drained via the thoracic duct?

A

Right upper extremity

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46
Q

In which decade of life is the fatty replacement of the thymus complete in all patients?

A

8th decade of life

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47
Q

What forms the superior margin of the azygoesophageal recess?

A

Azygos arch

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48
Q

On a chest CT, ground glass attenuation with interlobar septal thickening is known as what pattern?

A

Crazy-paving pattern

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49
Q

Which pathology is specifically associated with the “crazy-paving” pattern?

A

Pulmonary alveolar proteinosis

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50
Q

The “finger-in-glove” appearance is characteristic of what pathology?

A

Allergic bronchopulmonary aspergillosis (ABPA)

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51
Q

Which diagnosis best correlations with the “galaxy” sign?

A

Sarcoidosis

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52
Q

What structure forms the superior borders of the aortic-pulmonary window?

A

Aortic arch

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53
Q

Pulmonary infarctions most commonly involves which type of vessels?

A

Pulmonary arteries

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54
Q

A dilated and debris-filled esophagus seen on a chest CT is most commonly associated with which diagnosis?

A

Scleroderma

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55
Q

What is the maximum size limit of a pulmonary bleb?

A

1.0cm

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56
Q

Describe a “signet ring” sign seen on a chest CT

A

A dilated bronchus with a smaller adjacent pulmonary artery

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57
Q

What creates the appearance of well-demarcated bowel loops?

A

Air on both sides of the bowel wall

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58
Q

What is the optimum position of an endotracheal tube in an adult patient?

A

Midthoracic trachea

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59
Q

What is the primary indication for placement of biventricular pacemaker?

A

Heart failure

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60
Q

What is a “deep sulcus” sign seen on a chest radiograph?

A

Seen on a supine chest x-ray, it indicates possible pneumothorax

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61
Q

Where it the air located associated with the “deep sulcus” sign?

A

Anterior lateral pleural space

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62
Q

With patent ductus arteriosus, which heart chambers are predominantly enlarged on a chest radiograph?

A

Left atrium and left ventricle if not complicated

Cardiomegaly is usually present

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63
Q

What is the appearance of the pulmonary arteries in someone with pulmonary hypertension?

A

Enlarged pulmonary arteries

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64
Q

What are some other abnormal radiographic findings in someone with pulmonary hypertension?

A

Enlarged right atrium
Pruning of peripheral pulmonary vessels
Prominent pulmonary outflow track

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65
Q

Obstruction of which landmark on a chest radiograph do we typically see with patent ductus arteriosus?

A

Obstruction of the aortopulmonary window

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66
Q

The “medial breast margin” sign is associated with which congenital deformity?

A

Pectus excavatum

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67
Q

What are 2 other possible differential diagnosis for pericardial fat pad?

A

Pericardial cyst

Morgagni hernia

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68
Q

What are the pertinent positives/negatives that should be mentioned with pulmonary masses?

A 
Solitary/multiple
Location 
Cavitations
Calcifications 
Homogenous/hetrogenous 
Osseous involvement
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69
Q

What are some findings of tension pneumothorax?

A

Depression of hemidiaphragm of the involved side
Widened intercostal spaces of the involved side
Lack of lung markings distal to pleural lining
Shift of mediastinal structures

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70
Q

Describe catamenial pneumothorax

A

Spontaneous pneumothorax associated with endometriosis

Right-sided predominance

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71
Q

How would you describe pulmonary emphysema?

A

Permanent enlarged airspaces with alveolar destruction

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72
Q

What are common radiographic findings in COPD?

A 
Lung hyperinflation
Increased intercostal spaces 
Small heart 
Flattened hemidiaphragms
Barrel chest
Narrowing of intrathoracic trachea
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73
Q

What is the most common risk factor associated with emphysema?

A

Smoking

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74
Q

What morphological type of emphysema is the most common?

A

Centrilobar

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75
Q

What type of deficiency is associated with emphysema?

A

Alpha-1-antitrypsin deficiency

76
Q

Which organism is a common cause of nosocomial pneumonia with a high mortality rate in critically ill patients?

A

Pseudomonas aeruginosa

77
Q

Which 3 population is most at risk for community-acquired staph. aureus MRSA infection?

A

IV drug users
Prisoners
Low socioeconomic status

78
Q

In the setting of septic emboli, what is the most common cardiac source of infection?

A

Tricuspid valve

79
Q

What is the most common infectious agent to cause septic emboli?

A

Staph. aureus

80
Q

Which age group is most susceptible to legionella pneumophila?

A

Immunocompromised patients over 50 years old

81
Q

Which CT finding would be more characteristic in mycobacterium avian complex (MAC) compared to mycobacterium abscesses?

A

Consolidation

82
Q

What type of infection is associated with the “CT halo” sign (solid nodule with surrounding ground glass)?

A

Angioinvasive infection, especially aspergillus

83
Q

Diffuse lower lung distribution of bronchiectasis is most likely seen as sequelae from what?

A

Prior infection or chronic aspiration

84
Q

What is the most likely pathogen in the setting of a community-acquired pneumonia in an immunocompromised patient?

A

Strep. pneumonia

85
Q

The “bulging fissure” sign is associated with which pathogen?

A

Klebsiella

86
Q

Mixed anaerobic infectious organisms is the most common cause of what finding on chest radiographs?

A

Cavitations and lung abscesses

87
Q

What is the most common radiologic presentation of Epstein-Barr virus infection?

A

Lymphadenopathy

88
Q

What is the most common cause of lobar consolidation in an HIV patient?

A

Bacterial pneumonia

89
Q

Diffuse, ill-defined pulmonary nodules with a skin rash is most likely caused by what?

A

Varicella pneumonia

90
Q

What is the most common residual appearance of healed varicella pneumonia?

A

Diffuse calcified tiny pulmonary nodules

91
Q

What is the most common location for skin rashes to appear in those with sarcoidosis?

A

Shins and ankles

92
Q

The earliest sign of asbestosis on HRCT is what?

A

Curvilinear subpleural lines

93
Q

Cavitation is least common in which type of lung metastasis?

A

Adenocarcinoma

94
Q

Cavitation is most commonly seen in which primary lung carcinoma?

A

Squamous cell carcinoma (non-small cell)

95
Q

Radiographic findings of beryllium disease is not distinguishable from which other pathology?

A

Sarcoidosis

96
Q

What is a well-recognized etiology of nonspecific interstitial pneumonia (NSIP)?

A

Connective tissue disease

97
Q

The most common malignancy associated with lymphangitis carcinomatosis is what?

A

Bronchogenic adenocarcinoma

98
Q

The “head cheese” sign is most highly associated with which disease?

A

Hypersensitivity pneumonitis

99
Q

Describe the “reverse halo” sign on chest CT

A

A peripheral rim of consolidation with central ground glass opacity

100
Q

What is a “pig bronchus”?

A

Abnormal origin of the right upper lobe bronchus that serves the entire upper lobe

101
Q

What is the most common primary malignant neoplasm of the trachea?

A

Squamous cell carcinoma

102
Q

What is the most common hematogenously spread metastatic lesion to involve the trachea?

A

Melanoma

103
Q

What percentage of patients with immotile cilia syndrome has situs inversus totalis?

A

50%

104
Q

What type of emphysema is the most common?

A

Cicatricial

105
Q

Which cause of consolidation would support Goodpasture syndrome?

A

Pulmonary hemorrhage

106
Q

Which autoimmune disorder has the highest risk of pulmonary embolism?

A

Systemic lupus erythematosus

107
Q

What is the most common thoracic complication of systemic lupus erythematosus?

A

Pleural effusion

108
Q

Sjogren syndrome is an autoimmune disease that affect which glands?

A

Salivary and lacrimal glands

109
Q

Cavitation of pulmonary nodules occurs in what percentage of granulomatosis with polyangiitis (Wegeners syndrome) cases?

A

50%

110
Q

What percentage of cases with rheumatoid nodules demonstrate cavitations on CT?

A

50%

111
Q

Pneumoconiosis with rheumatoid arthritis is called what syndrome?

A

Caplan syndrome

112
Q

Obliterative bronchiolitis is most commonly associated with which collagen vascular disorder?

A

Rheumatoid arthritis

113
Q

The “luftsichel” sign is associated with what chest radiograph finding?

A

Left upper lobe collapse

114
Q

What is responsible for creating the “air crescent” or “luftsichel” sign?

A

superior segment of left upper lobe

115
Q

What is a differential diagnosis list for anterior-superior mediastinal mass?

A 
"5 Ts"
Thymus
Thyroid
Teratoma 
Lymphoma ("terrible lymphoma")
Thoracic aortic aneurysm
116
Q

What is a direct radiographic sign of volume loss?

A

Displacement of fissure

117
Q

What is the most likely cause of atelectasis?

A

Mucus plug

118
Q

Where is the “golden s” sign typically seen on a chest radiograph?

A

Right upper lobe

119
Q

What is the significance of a “golden s” sign?

A

Lobar atelectasis most likely caused by a central mass

120
Q

What underlying etiology should be excluded with a massive pleural effusion?

A

Malignancy

121
Q

What subtype of pleural effusion would you expect most often with malignancy?

A

Exudative

122
Q

What is the most common cause of transudative pleural effusion?

A

Heart failure

123
Q

What is the name of a rare subtype of pleural effusion that is caused by thoracic duct obstruction/lymphatic obstruction?

A

Chylous pleural effusion

124
Q

What imaging feature is most suggestive of bronchopleural fistula?

A

Persistent air fluid level

125
Q

What is an empyema?

A

Infected, purulent collection of fluid within the pleural space

126
Q

What is the preferred management of empyema?

A

Antibiotics and drainage

127
Q

Approximately when do pleural plaques occur after asbestos exposure?

A

20 years

128
Q

Mesothelioma often presents _____ years after exposure to asbestos

A

35-40 years (delayed presentation)

129
Q

What is thoracic splenosis?

A

Autotransplantation of splenic tissue, especially after trauma and displacement of diaphragm tissue

130
Q

What is the test of choice to confirm suspected diaphragmatic paralysis?

A

Fluoroscopic sniff test

131
Q

What 3 differential diagnosis has to be considered when there is a cardiophrenic angle mass?

A

Morgagni hernia
Cardiophrenic fat pad
Cardiophrenic cyst

132
Q

What percentage of hepatic hydrothoraces are bilateral?

A

1-2%

133
Q

Lateral meningoceles are associated with neurofibromatosis type I or type II?

A

Neurofibromatosis type I

134
Q

Chest wall desmoid tumor is most commonly associated with which condition?

A 
Gardner syndrome
Desmoid tumor (aka aggressive fibromatosis) is the most common low grade sarcoma of the chest wall
135
Q

What is the Carney triad?

A

Pulmonary chondromas
Extra-adrenal paraganliomas
Gastointestinal stromal tumors

136
Q

What is Lofgren syndrome?

A

Sarcoidosis with:
Thoracic adenopathy
Erythema nodosum
Arthralgia

137
Q

What is the most common cause of fibrosing mediastinitis in the US?

A

Histoplasmosis

138
Q

What is the most common cause of superior vena cava syndrome?

A

Cancer (90%)

139
Q

Thymomas have a strong association with which condition?

A

Myasthenia gravis

140
Q

What is the most common source of pneumomediastinum in the setting of ARDS?

A

Alveolar rupture

141
Q

Which complication is the most common in the setting of a proximal esophageal rupture?

A

Right pleural effusion

142
Q

What is the most common feature identified on initial radiograph after esophageal perforation?

A

Pneumomediastinum

143
Q

What is the upper limit of normal for volume of pericardial fluid?

A

50ml

144
Q

What is the most common extragonadal location of germ cell tumors?

A

Mediastinum

145
Q

What is the most common tracheal tumor?

A

Squamous cell carcinoma

146
Q

What is the most common neurogenic tumor of the mediastinum?

A

Schwannoma

147
Q

What percentage of intrathoracic goiter lesions are posterior?

A

20-25% (most are located within the anterior mediastinum)

148
Q

In a patient with multiple pulmonary arteriovenous malformations (AVMs), what is the likely underlying diagnosis?

A

Osler-Weber-Rendu syndrome

149
Q

What is the most frequent site of emboli in patients with internal jugular thrombophlebitis?

A

Lungs

150
Q

Unilateral hyper-lucency due to oligemia (reduced total volume of blood) is referred to as what?

A

“Westermark” sign

151
Q

Which 2 signs are associated with pulmonary infarct?

A

“Hampton’s hump”

“Reversed halo (atoll)” sign

152
Q

What is another leading differential diagnosis for “reversed halo” sign other than pulmonary infarct?

A

Organizing pneumonia

153
Q

What is the most common pulmonary arterial manifestation of Behcet disease?

A

Pulmonary artery aneurysm

154
Q

Which 3 locations are most frequently affected by a fat embolism after a traumatic long bone/pelvis fracture?

A

Lungs
Brain
Skin

155
Q

Which clinical setting is associated with the highest percentage of amniotic fluid embolism?

A

During spontaneous labor

156
Q

A Rasmussen aneurysm refers to what?

A

A mycotic pulmonary artery aneurysm

157
Q

Which tumor is most likely to present with inferior vena cava tumor thrombus?

A

Renal cell carcinoma

158
Q

What is the upper limit of normal for pulmonary artery size on chest CT in a male?

A

30mm

159
Q

What is the upper limit of normal for size of the right interlobar pulmonary artery in women on chest x-ray?

A

15mm

160
Q

What type of pulmonary nodule would likely have the longest doubling time if malignant?

A

Ground-glass nodule

161
Q

What 4 patterns of lung nodule calcification is considered benign?

A

Diffuse
Central
Lamellated
Popcorn

162
Q

What percentage of hamartomas demonstrate intranodular fat?

A

50%

163
Q

What is the most common location of a missed lung cancer on chest radiograph?

A

Peripheral and upper lobe

164
Q

What is the “doughnut” sign and where do you see it?

A

It represents hilar adenopathy and it seen on the lateral chest radiograph as density surrounding the left mainstem bronchi

165
Q

What percentage of bronchial carcinoids cause carcinoid syndrome?

A

<5%

166
Q

What is the reason a tension pneumothorax can quickly become fatal?

A

Decreased venous blood return to the heart

167
Q

A small right apical pneumothorax would be easiest to visualize on which chest radiograph?

A

Upright frontal view

168
Q

What vessel injury is associated with a left posterior sternoclavicular dislocation?

A

Left subclavian vein

169
Q

What is the most commonly aspirated foreign object in children and adults?

A

Food

170
Q

What is the most common aspirated foreign object in a trauma patient with maxillofacial injury?

A

Tooth

171
Q

When a traumatic pseudo-aneurysm of the thoracic aorta is present, what layer of the vessel wall remains intact?

A

Adventitia

172
Q

What is the most common site of acute traumatic aortic injury on CT?

A

Aortic isthmus

173
Q

Double aortic arch is the most common cause of what?

A

Vascular ring

174
Q

What would be the most likely cause of recurrent pneumonias localized to the left lower lobe in a young patient?

A

Pulmonary sequestration

175
Q

What is the most common cause of childhood obliterative brochiolitis (Swyer-James syndrome)?

A

Pediatric adenovirus infection

176
Q

What is Poland syndrome?

A

Congenital unilateral absence of pectoralis major and minor muscles, it is a recognized cause of unilateral hyper-lucent hemithorax

177
Q

What is the most common primary cardiac tumor in adults?

A

Myxoma

178
Q

What is the most common location for a cardiac myxoma?

A

Left atrium (75%)

179
Q

Which pneumoconiosis is most similar to sarcoidosis?

A

Chronic berylliosis

180
Q

On a lateral chest radiograph, which vertebral level does the carina project?

A

T4-T5

181
Q

Name 3 primary malignancies that are likely to metastasize to the lungs

A

Breast cancer
Renal cell carcinoma
Colorectal carcinoma

182
Q

What are some common symptoms seen with superior vena cava syndrome?

A

Facial/neck swelling
Facial flushing
Extremity swelling
Dyspnea

183
Q

What are the 2 main components of COPD?

A

Chronic bronchitis

Emphysema

184
Q

How much fluid is needed to be able to visualize a pleural effusion on an erect chest radiograph?

A

250-600ml

185
Q

What percentage of mesothelioma arise from the pleura?

A

90%

186
Q

What percentage of mesothelioma patients had exposure to asbestos fibers?

A

40-80%

187
Q

Radiographic findings associated with mesothelioma includes the following

A 
Pleural opacity
Decreased lung volume
Pleural effusion
Pleural thickening
Rib destruction
Mediastinal lymphadenopathy
"Meniscus" sign (+)

Chest Imaging (3 decks)

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