Chest (Core Qs & Others) Flashcards
1
Q
Mesotheliomas most commonly arise from where?
A
Pleura
2
Q
Mesotheliomas have a strong association to what substance?
A
Asbestos fibers
3
Q
Radiographic apparence of mesotheliomas can include
A
Pleural effusion Pleural opacity Pleural thickening Decreased lung volume Mediastinal lymphadenopathy Rib destruction
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)
5
Q
The “golden S sign” is typically seen where?
A
Upper right lobe
6
Q
What is the main suspicion when we see a “golden S sign”
A
Primary bronchogenic carcinoma
7
Q
What is the primary suspicion when we see a apical pulmonary mass?
A
Primary lung malignancy, typically non-small cell lung carcinoma
8
Q
Which organism is the most common cause for community acquired pneumonia?
A
Strep. Pneumoniae
9
Q
Which pneumonia causing organism is most likely to create cavitations?
A
Klebsiella pneumoniae
10
Q
What is the triad associated with Kartageners syndrome?
A
Situs inversus
Chronic sinusitis
Bronchiectasis
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%)
12
Q
What is the “1, 2, 3” sign associated with sarcoidosis?
A
Lymphadenopathy at bilateral hilar regions and the right paratracheal stripe region
13
Q
Which primary lung carcinoma is most likely to have cavitations?
A
Squamous cell carcinoma (non-small cell)
14
Q
Progressive massive fibrosis is often associated with which type of pneumoconiosis?
A
Coal workers pneumoconiosis
15
Q
What glycemic abnormality is associated with mesothelioma?
A
Hypoglycemia (40%)
16
Q
Which pneumoconiosis is indistinguishable from pulmonary sarcoidosis?
A
Berylliosis (prolonged exposure to beryllium)
17
Q
What does RUL atelectasis typically look like?
A
Collapses superior and medial
Superior displacement of minor fissure
Creates upper paramediastinal density
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
19
Q
What does LUL atelectasis typically look like?
A
Collapses anteriorly
Maintains contact with anterior costal pleural surface
Associated with the “Luftsichel” sign
20
Q
What does LLL atelectasis typically look like?
A
Increased density adjacent to cardiac shadow
21
Q
What is the 2 most common causes for cavitations within the lung?
A
Necrotic neoplasm
Lung abscesses
22
Q
Which view is the most sensitive for looking at a pleural effusion?
A
Lateral decubitus view with the involved side down
23
Q
If an upper mediastinal mass is clearly seen above the clavicles, it is most likely located where?
A
Posterior mediastinum (“cervicothoracic” sign)
24
Q
If an upper mediastinal mass is indistinct above the clavicles, it is most likely located where?
A
Anterior mediastinum (“cervicothoracic” sign)
25
Differential diagnosis list for upper lung fibrosis
```
"ST CASH"
Sarcoidosis
Tuberculosis
Cystic fibrosis
Ankylosing spondylitis
Silicosis
Histiocytosis
```
26
Differential diagnosis list for lower lung fibrosis
```
"BAD RASH"
Bronchiectasis
Aspiration
Desquamative interstitial pneumonia (DIP)
Rheumatoid arthritis
Asbestosis
Scleroderma
Hamman-Rich syndrome (acute pneumonitis)
```
27
Describe the "hilum overlay" sign
If the hilum is visible when superimposed with a pulmonary mass, the mass is not within the middle mediastinum
28
Describe the "galaxy" sign in the lungs
Coalescent granuloma
Central cavitation may occur
Surrounding ground glass opacity
29
What are 2 diseases associated with the "Galaxy" sign?
Sarcoidosis
| Tuberculosis
30
Describe the "bat wing" sign in the lungs
Bilateral, asymmetric, perihilar region enlargement.
| Most commonly caused by pulmonary edema
31
Describe the "flat waist" sign
Flattened contour of the aortic knob and pulmonary artery. Seen in severe collapse of LLL, left displacement and rotation of the heart
32
What is the most radiosensitive tissue in both males and females?
Bone marrow
33
On evaluating growth of a rounded nodule, what percentage of increase in diameter is roughly equal to doubling of tissue volume?
25%
34
What is the most common iodinated IV contrast complication in myasthenia gravis?
New/progressive acute respiratory compromise
35
What is responsible for creating a juxtaphrenic peak?
Inferior pulmonary ligament (this is associated with upper lung volume loss)
36
What forms the medial border of the right paratracheal stripe?
Trachea
37
What forms the lateral border of the right paratracheal stripe?
Medial pleura
38
On a lateral chest radiograph, what creates a rounded lucency just inferior to the tracheal shadow?
Left mainstem bronchus
39
An anatomical variant at the tracheobronchial tree, arising from the medial aspect of the bronchus intermedius is called what?
Cardiac bronchus
40
What is the upper limit of normal for the tracheoesophageal space?
5mm
41
What is the name of the fissure that separates the medial basal bronchopulmonary segment from the other lower lobe segments?
Inferior accessory fissure
42
Within the intercostal spaces, what is the cranial-to-caudal order of the neuromuscular bundle?
Vein-Artery-Nerve
43
Where is the neurovascular bundle located within the intercostal space?
Along the undersurface of the superior rib
44
What structure does the thoracic duct typically drain into?
Left subclavian vein and internal jugular vein confluence
45
Which body region is not typically drained via the thoracic duct?
Right upper extremity
46
In which decade of life is the fatty replacement of the thymus complete in all patients?
8th decade of life
47
What forms the superior margin of the azygoesophageal recess?
Azygos arch
48
On a chest CT, ground glass attenuation with interlobar septal thickening is known as what pattern?
Crazy-paving pattern
49
Which pathology is specifically associated with the "crazy-paving" pattern?
Pulmonary alveolar proteinosis
50
The "finger-in-glove" appearance is characteristic of what pathology?
Allergic bronchopulmonary aspergillosis (ABPA)
51
Which diagnosis best correlations with the "galaxy" sign?
Sarcoidosis
52
What structure forms the superior borders of the aortic-pulmonary window?
Aortic arch
53
Pulmonary infarctions most commonly involves which type of vessels?
Pulmonary arteries
54
A dilated and debris-filled esophagus seen on a chest CT is most commonly associated with which diagnosis?
Scleroderma
55
What is the maximum size limit of a pulmonary bleb?
1.0cm
56
Describe a "signet ring" sign seen on a chest CT
A dilated bronchus with a smaller adjacent pulmonary artery
57
What creates the appearance of well-demarcated bowel loops?
Air on both sides of the bowel wall
58
What is the optimum position of an endotracheal tube in an adult patient?
Midthoracic trachea
59
What is the primary indication for placement of biventricular pacemaker?
Heart failure
60
What is a "deep sulcus" sign seen on a chest radiograph?
Seen on a supine chest x-ray, it indicates possible pneumothorax
61
Where it the air located associated with the "deep sulcus" sign?
Anterior lateral pleural space
62
With patent ductus arteriosus, which heart chambers are predominantly enlarged on a chest radiograph?
Left atrium and left ventricle if not complicated
| Cardiomegaly is usually present
63
What is the appearance of the pulmonary arteries in someone with pulmonary hypertension?
Enlarged pulmonary arteries
64
What are some other abnormal radiographic findings in someone with pulmonary hypertension?
Enlarged right atrium
Pruning of peripheral pulmonary vessels
Prominent pulmonary outflow track
65
Obstruction of which landmark on a chest radiograph do we typically see with patent ductus arteriosus?
Obstruction of the aortopulmonary window
66
The "medial breast margin" sign is associated with which congenital deformity?
Pectus excavatum
67
What are 2 other possible differential diagnosis for pericardial fat pad?
Pericardial cyst
| Morgagni hernia
68
What are the pertinent positives/negatives that should be mentioned with pulmonary masses?
```
Solitary/multiple
Location
Cavitations
Calcifications
Homogenous/hetrogenous
Osseous involvement
```
69
What are some findings of tension pneumothorax?
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
70
Describe catamenial pneumothorax
Spontaneous pneumothorax associated with endometriosis
| Right-sided predominance
71
How would you describe pulmonary emphysema?
Permanent enlarged airspaces with alveolar destruction
72
What are common radiographic findings in COPD?
```
Lung hyperinflation
Increased intercostal spaces
Small heart
Flattened hemidiaphragms
Barrel chest
Narrowing of intrathoracic trachea
```
73
What is the most common risk factor associated with emphysema?
Smoking
74
What morphological type of emphysema is the most common?
Centrilobar
75
What type of deficiency is associated with emphysema?
Alpha-1-antitrypsin deficiency
76
Which organism is a common cause of nosocomial pneumonia with a high mortality rate in critically ill patients?
Pseudomonas aeruginosa
77
Which 3 population is most at risk for community-acquired staph. aureus MRSA infection?
IV drug users
Prisoners
Low socioeconomic status
78
In the setting of septic emboli, what is the most common cardiac source of infection?
Tricuspid valve
79
What is the most common infectious agent to cause septic emboli?
Staph. aureus
80
Which age group is most susceptible to legionella pneumophila?
Immunocompromised patients over 50 years old
81
Which CT finding would be more characteristic in mycobacterium avian complex (MAC) compared to mycobacterium abscesses?
Consolidation
82
What type of infection is associated with the "CT halo" sign (solid nodule with surrounding ground glass)?
Angioinvasive infection, especially aspergillus
83
Diffuse lower lung distribution of bronchiectasis is most likely seen as sequelae from what?
Prior infection or chronic aspiration
84
What is the most likely pathogen in the setting of a community-acquired pneumonia in an immunocompromised patient?
Strep. pneumonia
85
The "bulging fissure" sign is associated with which pathogen?
Klebsiella
86
Mixed anaerobic infectious organisms is the most common cause of what finding on chest radiographs?
Cavitations and lung abscesses
87
What is the most common radiologic presentation of Epstein-Barr virus infection?
Lymphadenopathy
88
What is the most common cause of lobar consolidation in an HIV patient?
Bacterial pneumonia
89
Diffuse, ill-defined pulmonary nodules with a skin rash is most likely caused by what?
Varicella pneumonia
90
What is the most common residual appearance of healed varicella pneumonia?
Diffuse calcified tiny pulmonary nodules
91
What is the most common location for skin rashes to appear in those with sarcoidosis?
Shins and ankles
92
The earliest sign of asbestosis on HRCT is what?
Curvilinear subpleural lines
93
Cavitation is least common in which type of lung metastasis?
Adenocarcinoma
94
Cavitation is most commonly seen in which primary lung carcinoma?
Squamous cell carcinoma (non-small cell)
95
Radiographic findings of beryllium disease is not distinguishable from which other pathology?
Sarcoidosis
96
What is a well-recognized etiology of nonspecific interstitial pneumonia (NSIP)?
Connective tissue disease
97
The most common malignancy associated with lymphangitis carcinomatosis is what?
Bronchogenic adenocarcinoma
98
The "head cheese" sign is most highly associated with which disease?
Hypersensitivity pneumonitis
99
Describe the "reverse halo" sign on chest CT
A peripheral rim of consolidation with central ground glass opacity
100
What is a "pig bronchus"?
Abnormal origin of the right upper lobe bronchus that serves the entire upper lobe
101
What is the most common primary malignant neoplasm of the trachea?
Squamous cell carcinoma
102
What is the most common hematogenously spread metastatic lesion to involve the trachea?
Melanoma
103
What percentage of patients with immotile cilia syndrome has situs inversus totalis?
50%
104
What type of emphysema is the most common?
Cicatricial
105
Which cause of consolidation would support Goodpasture syndrome?
Pulmonary hemorrhage
106
Which autoimmune disorder has the highest risk of pulmonary embolism?
Systemic lupus erythematosus
107
What is the most common thoracic complication of systemic lupus erythematosus?
Pleural effusion
108
Sjogren syndrome is an autoimmune disease that affect which glands?
Salivary and lacrimal glands
109
Cavitation of pulmonary nodules occurs in what percentage of granulomatosis with polyangiitis (Wegeners syndrome) cases?
50%
110
What percentage of cases with rheumatoid nodules demonstrate cavitations on CT?
50%
111
Pneumoconiosis with rheumatoid arthritis is called what syndrome?
Caplan syndrome
112
Obliterative bronchiolitis is most commonly associated with which collagen vascular disorder?
Rheumatoid arthritis
113
The "luftsichel" sign is associated with what chest radiograph finding?
Left upper lobe collapse
114
What is responsible for creating the "air crescent" or "luftsichel" sign?
superior segment of left upper lobe
115
What is a differential diagnosis list for anterior-superior mediastinal mass?
```
"5 Ts"
Thymus
Thyroid
Teratoma
Lymphoma ("terrible lymphoma")
Thoracic aortic aneurysm
```
116
What is a direct radiographic sign of volume loss?
Displacement of fissure
117
What is the most likely cause of atelectasis?
Mucus plug
118
Where is the "golden s" sign typically seen on a chest radiograph?
Right upper lobe
119
What is the significance of a "golden s" sign?
Lobar atelectasis most likely caused by a central mass
120
What underlying etiology should be excluded with a massive pleural effusion?
Malignancy
121
What subtype of pleural effusion would you expect most often with malignancy?
Exudative
122
What is the most common cause of transudative pleural effusion?
Heart failure
123
What is the name of a rare subtype of pleural effusion that is caused by thoracic duct obstruction/lymphatic obstruction?
Chylous pleural effusion
124
What imaging feature is most suggestive of bronchopleural fistula?
Persistent air fluid level
125
What is an empyema?
Infected, purulent collection of fluid within the pleural space
126
What is the preferred management of empyema?
Antibiotics and drainage
127
Approximately when do pleural plaques occur after asbestos exposure?
20 years
128
Mesothelioma often presents _____ years after exposure to asbestos
35-40 years (delayed presentation)
129
What is thoracic splenosis?
Autotransplantation of splenic tissue, especially after trauma and displacement of diaphragm tissue
130
What is the test of choice to confirm suspected diaphragmatic paralysis?
Fluoroscopic sniff test
131
What 3 differential diagnosis has to be considered when there is a cardiophrenic angle mass?
Morgagni hernia
Cardiophrenic fat pad
Cardiophrenic cyst
132
What percentage of hepatic hydrothoraces are bilateral?
1-2%
133
Lateral meningoceles are associated with neurofibromatosis type I or type II?
Neurofibromatosis type I
134
Chest wall desmoid tumor is most commonly associated with which condition?
```
Gardner syndrome
Desmoid tumor (aka aggressive fibromatosis) is the most common low grade sarcoma of the chest wall
```
135
What is the Carney triad?
Pulmonary chondromas
Extra-adrenal paraganliomas
Gastointestinal stromal tumors
136
What is Lofgren syndrome?
Sarcoidosis with:
Thoracic adenopathy
Erythema nodosum
Arthralgia
137
What is the most common cause of fibrosing mediastinitis in the US?
Histoplasmosis
138
What is the most common cause of superior vena cava syndrome?
Cancer (90%)
139
Thymomas have a strong association with which condition?
Myasthenia gravis
140
What is the most common source of pneumomediastinum in the setting of ARDS?
Alveolar rupture
141
Which complication is the most common in the setting of a proximal esophageal rupture?
Right pleural effusion
142
What is the most common feature identified on initial radiograph after esophageal perforation?
Pneumomediastinum
143
What is the upper limit of normal for volume of pericardial fluid?
50ml
144
What is the most common extragonadal location of germ cell tumors?
Mediastinum
145
What is the most common tracheal tumor?
Squamous cell carcinoma
146
What is the most common neurogenic tumor of the mediastinum?
Schwannoma
147
What percentage of intrathoracic goiter lesions are posterior?
20-25% (most are located within the anterior mediastinum)
148
In a patient with multiple pulmonary arteriovenous malformations (AVMs), what is the likely underlying diagnosis?
Osler-Weber-Rendu syndrome
149
What is the most frequent site of emboli in patients with internal jugular thrombophlebitis?
Lungs
150
Unilateral hyper-lucency due to oligemia (reduced total volume of blood) is referred to as what?
"Westermark" sign
151
Which 2 signs are associated with pulmonary infarct?
"Hampton's hump"
| "Reversed halo (atoll)" sign
152
What is another leading differential diagnosis for "reversed halo" sign other than pulmonary infarct?
Organizing pneumonia
153
What is the most common pulmonary arterial manifestation of Behcet disease?
Pulmonary artery aneurysm
154
Which 3 locations are most frequently affected by a fat embolism after a traumatic long bone/pelvis fracture?
Lungs
Brain
Skin
155
Which clinical setting is associated with the highest percentage of amniotic fluid embolism?
During spontaneous labor
156
A Rasmussen aneurysm refers to what?
A mycotic pulmonary artery aneurysm
157
Which tumor is most likely to present with inferior vena cava tumor thrombus?
Renal cell carcinoma
158
What is the upper limit of normal for pulmonary artery size on chest CT in a male?
30mm
159
What is the upper limit of normal for size of the right interlobar pulmonary artery in women on chest x-ray?
15mm
160
What type of pulmonary nodule would likely have the longest doubling time if malignant?
Ground-glass nodule
161
What 4 patterns of lung nodule calcification is considered benign?
Diffuse
Central
Lamellated
Popcorn
162
What percentage of hamartomas demonstrate intranodular fat?
50%
163
What is the most common location of a missed lung cancer on chest radiograph?
Peripheral and upper lobe
164
What is the "doughnut" sign and where do you see it?
It represents hilar adenopathy and it seen on the lateral chest radiograph as density surrounding the left mainstem bronchi
165
What percentage of bronchial carcinoids cause carcinoid syndrome?
<5%
166
What is the reason a tension pneumothorax can quickly become fatal?
Decreased venous blood return to the heart
167
A small right apical pneumothorax would be easiest to visualize on which chest radiograph?
Upright frontal view
168
What vessel injury is associated with a left posterior sternoclavicular dislocation?
Left subclavian vein
169
What is the most commonly aspirated foreign object in children and adults?
Food
170
What is the most common aspirated foreign object in a trauma patient with maxillofacial injury?
Tooth
171
When a traumatic pseudo-aneurysm of the thoracic aorta is present, what layer of the vessel wall remains intact?
Adventitia
172
What is the most common site of acute traumatic aortic injury on CT?
Aortic isthmus
173
Double aortic arch is the most common cause of what?
Vascular ring
174
What would be the most likely cause of recurrent pneumonias localized to the left lower lobe in a young patient?
Pulmonary sequestration
175
What is the most common cause of childhood obliterative brochiolitis (Swyer-James syndrome)?
Pediatric adenovirus infection
176
What is Poland syndrome?
Congenital unilateral absence of pectoralis major and minor muscles, it is a recognized cause of unilateral hyper-lucent hemithorax
177
What is the most common primary cardiac tumor in adults?
Myxoma
178
What is the most common location for a cardiac myxoma?
Left atrium (75%)
179
Which pneumoconiosis is most similar to sarcoidosis?
Chronic berylliosis
180
On a lateral chest radiograph, which vertebral level does the carina project?
T4-T5
181
Name 3 primary malignancies that are likely to metastasize to the lungs
Breast cancer
Renal cell carcinoma
Colorectal carcinoma
182
What are some common symptoms seen with superior vena cava syndrome?
Facial/neck swelling
Facial flushing
Extremity swelling
Dyspnea
183
What are the 2 main components of COPD?
Chronic bronchitis
| Emphysema
184
How much fluid is needed to be able to visualize a pleural effusion on an erect chest radiograph?
250-600ml
185
What percentage of mesothelioma arise from the pleura?
90%
186
What percentage of mesothelioma patients had exposure to asbestos fibers?
40-80%
187
Radiographic findings associated with mesothelioma includes the following
```
Pleural opacity
Decreased lung volume
Pleural effusion
Pleural thickening
Rib destruction
Mediastinal lymphadenopathy
"Meniscus" sign (+)
```
