Chest (Core Qs & Others) Flashcards
Mesotheliomas most commonly arise from where?
Pleura
Mesotheliomas have a strong association to what substance?
Asbestos fibers
Radiographic apparence of mesotheliomas can include
Pleural effusion Pleural opacity Pleural thickening Decreased lung volume Mediastinal lymphadenopathy Rib destruction
Name the stages of sarcoidosis in the lungs
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)
The “golden S sign” is typically seen where?
Upper right lobe
What is the main suspicion when we see a “golden S sign”
Primary bronchogenic carcinoma
What is the primary suspicion when we see a apical pulmonary mass?
Primary lung malignancy, typically non-small cell lung carcinoma
Which organism is the most common cause for community acquired pneumonia?
Strep. Pneumoniae
Which pneumonia causing organism is most likely to create cavitations?
Klebsiella pneumoniae
What is the triad associated with Kartageners syndrome?
Situs inversus
Chronic sinusitis
Bronchiectasis
What is the classic triad associated with Wegeners granulomatosis (aka granulomatous with polyangiitis)
Lung involvement (95%) Upper respiratory tract/sinuses (75-90%) Kidney involvement (80%)
What is the “1, 2, 3” sign associated with sarcoidosis?
Lymphadenopathy at bilateral hilar regions and the right paratracheal stripe region
Which primary lung carcinoma is most likely to have cavitations?
Squamous cell carcinoma (non-small cell)
Progressive massive fibrosis is often associated with which type of pneumoconiosis?
Coal workers pneumoconiosis
What glycemic abnormality is associated with mesothelioma?
Hypoglycemia (40%)
Which pneumoconiosis is indistinguishable from pulmonary sarcoidosis?
Berylliosis (prolonged exposure to beryllium)
What does RUL atelectasis typically look like?
Collapses superior and medial
Superior displacement of minor fissure
Creates upper paramediastinal density
What does RLL atelectasis typically look like?
Often looks like a triangle shape
Located at the lower zone of the right lung
What does LUL atelectasis typically look like?
Collapses anteriorly
Maintains contact with anterior costal pleural surface
Associated with the “Luftsichel” sign
What does LLL atelectasis typically look like?
Increased density adjacent to cardiac shadow
What is the 2 most common causes for cavitations within the lung?
Necrotic neoplasm
Lung abscesses
Which view is the most sensitive for looking at a pleural effusion?
Lateral decubitus view with the involved side down
If an upper mediastinal mass is clearly seen above the clavicles, it is most likely located where?
Posterior mediastinum (“cervicothoracic” sign)
If an upper mediastinal mass is indistinct above the clavicles, it is most likely located where?
Anterior mediastinum (“cervicothoracic” sign)
Differential diagnosis list for upper lung fibrosis
"ST CASH" Sarcoidosis Tuberculosis Cystic fibrosis Ankylosing spondylitis Silicosis Histiocytosis
Differential diagnosis list for lower lung fibrosis
"BAD RASH" Bronchiectasis Aspiration Desquamative interstitial pneumonia (DIP) Rheumatoid arthritis Asbestosis Scleroderma Hamman-Rich syndrome (acute pneumonitis)
Describe the “hilum overlay” sign
If the hilum is visible when superimposed with a pulmonary mass, the mass is not within the middle mediastinum
Describe the “galaxy” sign in the lungs
Coalescent granuloma
Central cavitation may occur
Surrounding ground glass opacity
What are 2 diseases associated with the “Galaxy” sign?
Sarcoidosis
Tuberculosis
Describe the “bat wing” sign in the lungs
Bilateral, asymmetric, perihilar region enlargement.
Most commonly caused by pulmonary edema
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
What is the most radiosensitive tissue in both males and females?
Bone marrow
On evaluating growth of a rounded nodule, what percentage of increase in diameter is roughly equal to doubling of tissue volume?
25%
What is the most common iodinated IV contrast complication in myasthenia gravis?
New/progressive acute respiratory compromise
What is responsible for creating a juxtaphrenic peak?
Inferior pulmonary ligament (this is associated with upper lung volume loss)
What forms the medial border of the right paratracheal stripe?
Trachea
What forms the lateral border of the right paratracheal stripe?
Medial pleura
On a lateral chest radiograph, what creates a rounded lucency just inferior to the tracheal shadow?
Left mainstem bronchus
An anatomical variant at the tracheobronchial tree, arising from the medial aspect of the bronchus intermedius is called what?
Cardiac bronchus
What is the upper limit of normal for the tracheoesophageal space?
5mm
What is the name of the fissure that separates the medial basal bronchopulmonary segment from the other lower lobe segments?
Inferior accessory fissure
Within the intercostal spaces, what is the cranial-to-caudal order of the neuromuscular bundle?
Vein-Artery-Nerve
Where is the neurovascular bundle located within the intercostal space?
Along the undersurface of the superior rib
What structure does the thoracic duct typically drain into?
Left subclavian vein and internal jugular vein confluence
Which body region is not typically drained via the thoracic duct?
Right upper extremity
In which decade of life is the fatty replacement of the thymus complete in all patients?
8th decade of life
What forms the superior margin of the azygoesophageal recess?
Azygos arch
On a chest CT, ground glass attenuation with interlobar septal thickening is known as what pattern?
Crazy-paving pattern
Which pathology is specifically associated with the “crazy-paving” pattern?
Pulmonary alveolar proteinosis
The “finger-in-glove” appearance is characteristic of what pathology?
Allergic bronchopulmonary aspergillosis (ABPA)
Which diagnosis best correlations with the “galaxy” sign?
Sarcoidosis
What structure forms the superior borders of the aortic-pulmonary window?
Aortic arch
Pulmonary infarctions most commonly involves which type of vessels?
Pulmonary arteries
A dilated and debris-filled esophagus seen on a chest CT is most commonly associated with which diagnosis?
Scleroderma
What is the maximum size limit of a pulmonary bleb?
1.0cm
Describe a “signet ring” sign seen on a chest CT
A dilated bronchus with a smaller adjacent pulmonary artery
What creates the appearance of well-demarcated bowel loops?
Air on both sides of the bowel wall
What is the optimum position of an endotracheal tube in an adult patient?
Midthoracic trachea
What is the primary indication for placement of biventricular pacemaker?
Heart failure
What is a “deep sulcus” sign seen on a chest radiograph?
Seen on a supine chest x-ray, it indicates possible pneumothorax
Where it the air located associated with the “deep sulcus” sign?
Anterior lateral pleural space
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
What is the appearance of the pulmonary arteries in someone with pulmonary hypertension?
Enlarged pulmonary arteries
What are some other abnormal radiographic findings in someone with pulmonary hypertension?
Enlarged right atrium
Pruning of peripheral pulmonary vessels
Prominent pulmonary outflow track
Obstruction of which landmark on a chest radiograph do we typically see with patent ductus arteriosus?
Obstruction of the aortopulmonary window
The “medial breast margin” sign is associated with which congenital deformity?
Pectus excavatum
What are 2 other possible differential diagnosis for pericardial fat pad?
Pericardial cyst
Morgagni hernia
What are the pertinent positives/negatives that should be mentioned with pulmonary masses?
Solitary/multiple Location Cavitations Calcifications Homogenous/hetrogenous Osseous involvement
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
Describe catamenial pneumothorax
Spontaneous pneumothorax associated with endometriosis
Right-sided predominance
How would you describe pulmonary emphysema?
Permanent enlarged airspaces with alveolar destruction
What are common radiographic findings in COPD?
Lung hyperinflation Increased intercostal spaces Small heart Flattened hemidiaphragms Barrel chest Narrowing of intrathoracic trachea
What is the most common risk factor associated with emphysema?
Smoking
What morphological type of emphysema is the most common?
Centrilobar