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A DDx > CHEST DDx > Flashcards

CHEST DDx Flashcards

1
Q

Intra parenchymal Cystic lung Disease:

A

Associated GGO:

  • PJP infection in setting of AIDs: bilateral thin walled upper zone cysts. Gallium +ve.
  • DIP: smoker

Associated Nodules:

  • LIP: CT disorder (SKE, Sjogrens, RA) or HIV.
  • Amyloid: Sjogrens or MM
  • LCH: young smoker, bizarre cysts, spares costophrenic angles.

Multifocal / Diffuse:

  • LAM (tuberous sclerosis)
  • LCH
  • Lymphoid Interstitial Pneumonia: CT disorder
  • Birt Hogg Dube: lower lobes subpleural, bilateral renal chromophobe RCC, oncocytomas, and facial fibrofolliculomatosis.
  • Infection: atypical bacteria, staph, coccidiomycosis.
  • Adenocarcinoma.

LCH: bizarre shaped, thick walled
LAM: round shaped, thin walled
Birt Hogg Dube: oval shaped, thin walled.

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2
Q

Nodular Lung Disease:

A

Sub pleural nodules: Diffuse - Random pattern:

  • Miliary Infection: TB, Mycobacterium, Histioplasmosis.
  • Haematogenous Mets.

Sub Pleural Nodules: patchy, subpleural, peribronchovascular, interlobular septa - Perilymphatic pattern:

  • Sarcoidosis: upper zone, symmetric, peribronchovascular, hilar nodes.
  • Lymphangetic Carcinomatosis: smooth / nodular septal thickening.
  • Silicosis / coal workers pneumoconiosis: upper zone posterior, symmetrical.

No subpleural nodules, with Tree and Bud Opacity:

  • Infection: acute, typical and atypical, if cavitary - TB.
  • Aspiration
  • Infectious bronchiolitis: air trapping
  • CF bronchiectasis
  • ABPA setting of asthma, finger in glove.

No subpleural nodules, with no tree and bud opacity:

  • Infection: acute, GGO
  • aspiration: acute, dependent
  • Oedema: acute, GGO
  • Haemorrhage: acute, GGO.
  • Hypersensitivity Pneumonitis: GGO, mid/upper zone, but can be diffuse in CC plane wi inflammatory HP, mosaic attenuation, sparing costophrenic angles.
  • Respiratory Bronchiolitis ILD: chronic, smoker, uuper zones, GGO.
  • Follicular Bronchiolitis: RA or Sjogrens, or immunosuppressed.
  • Invasive Mucinous Adenocarcinoma: Chronic, soft tissue with consolidation and lucent bubbly appearance, multi lobar.
  • LCH: soft tissue nodules with cysts / cavitations, young smoker, upper zones, sparing costophrenic angles.
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3
Q

Acute GGO:

A 
Infection - usually atypical
Oedema - usually dependent
Acute lung injury / ARDS
Haemorrhage
Aspiration
Acute hypersensitivity pneumonitis
Acute eosinophilic pneumonia
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4
Q

Chronic GGO:

A 
Hyper sensitivity pneumonitis
NSIP
DIP / RB
LIP / Follicular bronchiolitis
Invasive mucinous adenocarcinoma
Organising pneumonia
Eosinophilic pneumonia
Sarcoidosis
Lipoid pnuemonia
Alveolar proteinosis
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5
Q

Peripheral distribution GGO:

A 
NSIP
DIP
OP
Eosinophilic pneumonia
Atypical or viral pneumonia
Oedema - usually non cardiogenic.
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6
Q

Patchy geographic GGO with central predominance:

A 
Hypersensitivity pneumonitis
RB
LIP
Follicular bronchiolitis
OP
Sarcoidosis
Alveolar proteinosis
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7
Q

Unilateral / highly asymmetric distribution of GGO:

A

Invasive pulmonary mucinous adenocarcinoma

Lipoid pneumonia

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8
Q

GGO with mosaic perfusion / air trapping:

A

Hypersensitivity pneumonitis

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9
Q

Crazy paving

A

ACUTE:

  • oedema
  • atypical infections
  • diffuse alveolar damage / ARDS
  • Haemorrhage
  • Acute hypersensitivity pneumonitis
  • Acute eosinophilic pneumonia.

CHRONIC:

  • Alveolar proteinosis (Favoured Dx)
  • Hyper sensitivity pneumonitis
  • NSIP
  • DIP / RB
  • LIP / Follicular bronchiolitis
  • Invasive mucinous adenocarcinoma
  • Organising pneumonia
  • Eosinophilic pneumonia
  • Sarcoidosis
  • Lipoid pnuemonia
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10
Q

GGO with centrilobular nodules:

A

Hypersensitivity pneumonitis
RB
Follicular bronchiolitis
Invasive mucinous adenocarcinoma

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11
Q

GGO with signs of fibrosis (honey combing, traction bronchiectasis, irregular reticulation)

A

NSIP
Hypersensitivity Pneumonitis
Indeterminate UIP.

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12
Q

Peripheral distribution chronic consolidation:

A

Chronic eosinophilic pneumonia
Organising pneumonia (Polymyositis / dermatomyositis)
COVID
PEs

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13
Q

Causes of organising Pneumonia:

A 
Cryptogenic organising pneumonia
Drugs
CT disease
Toxic Inhalation
Immunodeficiencies
Graft vs Host.
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14
Q

DDx for organising pneumonia / Atoll sign:

A

Chronic eosinophilic pneumonia
Hypersensitivity pneumonitis: centrilobular nodules.
Infections - fungal: neutropenia.
Granulomatosis polyangiitis.
Pulmonary infarction: peripheral wedge shaped

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15
Q

Head Cheese Sign:

A

Hypersensitivity - most likely!
Respiratory bronchiolitis / desquamative interstitial pneumonia
Follicular bronchiolitis / lymphoid interstitial pneumonia
Atypical infections
Sarcoid
2 seperate processes: oedema and asthma.

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16
Q

Upper lobe predominant fibrosis: “ STROLA”C

A 
Sarcoidosis
TB
Radiation
Occupation: pneumoconioses
LCH
Ankylosing spondylitis
Chronic HP
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17
Q

Lower lobe predominant fibrosis:

A 
UIP / Idiopathic pulmonary fibrosis
Connective tissue disease
Drug fibrosis
Asbestosis
Hypersensitivity pneumonitis (mid zones, can be diffuse)
Chronic aspiration.
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18
Q

Reticulonodular pattern: “VOTE SSSX”

A

ACUTE:

  • Viral (lymphadenopathy)
  • Oedema (effusion)
  • TB (middle to upper lobe predominance, lymphadenopathy)
  • Eosinophilic pneumonia / HP

CHRONIC:

  • Sarcoidosis (middle to upper lobe, lymphadenopathy)
  • Silicosis (middle to upper lobe, lymphadenopathy)
  • Secondaries (carcinomatosis, effusion, lymphadenopathy)
  • Langerhans Histiocystosis X (normal to increased lung volumes, middle to upper lobe).
  • Asbestosis: pleural thickening / calcification.
  • LAM: associated pneumothorax.
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19
Q

Mid to upper zone bronchiectasis:

A

CF
ABPA
TB

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20
Q

Lower zone bronchiectasis:

A

Chronic infection
Aspiration
Immunodeficiency
Primary ciliary dyskinesia

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21
Q

Tree in Bud opacities:

A

Bacterial infection
mycobacterial infection
Fungal ingection
Viral infection

Cystic fibrosis
ABPA
Primary ciliary dyskineasia
Immunodeficiency

Diffuse panbrochiolitis
Follicular bronchiolitis
Invasive mucinous adenocarcinoma

Aspiration

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22
Q

CT findings of parenchymal lung disease as cause of pulmonary HTN

A

Fibrosis, emphysema, or cystic lung disease

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23
Q

CT findings of chronic pulmonary thromboembolism as cause of pulmonary HTN:

A

Pulmonary artery filling defects or occlusion, mosaic perfusion.

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24
Q

CT findings of idiopathic pulmonary HTN:

A

Dilated main pulmonary artery, centrilobular nodules of GGO

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25
Q

CT findings of pulmonary veino-occlusive disease as cause of pulmonary HTN:

A

Smooth interlobular septal thickening, dilated main pulmonary artery, normal sized pulmonary veins

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26
Q

CT findings of pulmonary capillary haemangiomatosis as cause of pulmonary HTN:

A

Centrilobular nodules of ground glass opacity, progression of findings after treatment with vasodilators.

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27
Q

CT findings of IV injection of oral medications as cause of pulmonary HTN:

A

Diffuse small homogenous branching centrilobular nodules.

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28
Q

CT findings of sickle cell disease as cause of pulmonary HTN:

A

Dense bones, rugger jersey spine

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29
Q

CT findings of liver disease as cause of pulmonary HTN:

A

Small nodular liver

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30
Q

CT findings of left sided heart disease as cause of pulmonary HTN:

A

Left atrial or ventricular dilation, smooth interlobular septal thickening.

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31
Q

Asymmetric / focal pulmonary oedema:

A 
Patient position
Asymmetric emphysema / bulls disease.
Mitral regurgitation.
Pulmonary embolism / vascular obstruction
Neurogenic pulmonary oedema
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32
Q

UIP Terminology:

A

Typical UIP pattern:

  • Reticulation
  • Honeycombing
  • Sub pleural / basilar distribution
  • Absence of atypical features.

Probable UIP pattern:

  • Reticulation
  • No honey combing
  • Sub pleural / basilar distribution
  • Absence of atypical features.

CT pattern indeterminate for UP:

  • Findings of fibrosis
  • Variable or diffuse distribution
  • Inconspicuous features suggestive of non-UIP pattern.

CT features most consistent with non-IPF diagnosis:

  • Peribronchovascular distribution
  • Mid - upper distribution
  • Atypical features: mosaic perfusion, air trapping, ground glass opacity, consolidation, nodules, cysts.
  • Etiologies of non IPF fibrotic disease: NSIP, Hypersensitivity pneumonitis, sarcoid, silicosis, coal workers pneumoconioses.
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33
Q

Etiologies of UIP:

A

Idiopathic pulmonary fibrosis
Connective tissue disease
Drug toxicity
Asbestosis

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34
Q

CT findings of NSIP:

A 
Sub pleural, basilar predominant pattern
GGO, 
irregular reticulation, 
traction bronchiectasis
No / minimal honey combing
Immediate sub pleural sparing.
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35
Q

Etiologies of NSIP:

A
  • Idiopathic NSIP
  • Connective tissue disease - check oesphagus ? scleroderma.
  • Drug toxicity
  • Hypersensitivity Pneumonitis
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36
Q

CT Findings of Desquamative Interstitial Pneumonia:

A 
Subpleural basilar predominant
GGO
Cysts or emphysema
Fibrosis may develop over time
May see centrilobular nodules of GGO with a mid to upper zone predominance and mosaic perfusion, implying background of RB.
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37
Q

DDx for symmetrical mediastinal hilar lymphadenopathy:

A

Sarcoid
Pneumoconioses
Amyloidosis
Castleman’s disease

Mets - usually asymmetric, can be seen in mets from GI / GU / Lung / breast cancers and leukaemia.
Lymphoma - usually asymmetric.
Mycobacterial / fungal infection - usually asymmetric.

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38
Q

DDx for patchy consolidation:

A 
Sarcoid
Organising pneumonia
Chronic eosinophilic pneumonia
Invasive mucinous adenocarcinoma
Lymphoma
Lipoid pneumonia
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39
Q

Head cheese sign:

A

Hypersensitivity pneumonitis
Desquamative interstitial pneumonia / respiratory bronchiolitis.
Follicular bronchiolitis / lymphoid interstitial pneumonia
Sarcoidosis
Atypical infections.

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40
Q

Causes of pulmonary Haemorrhage:

A

Pulmonary Renal Syndromes:

  • ANCA +ve vasculitis
  • granulomatosis with polyangiitis
  • Microscopic polyangiitis
  • Anti GBM
  • Auto immune connective tissue disease
  • SLE
  • Polymyositis
  • Scleroderma
  • HSP
  • Drug induced vasculitis
  • idiopathic pulmonary renal syndrome

Without renal disease:

  • Anticoagulation
  • Pulmonary embolism
  • Idiopathic pulmonary haemosiderosis
  • Trauma
  • Bone marrow transplantation.
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41
Q

Chronic Alveolar Lung Disease:

A 
"SALA"
Sarcoidosis
Alveolar proteinosis
Lymphoma / lipoid pneumonia.
Adenocarcinoma in Situ
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42
Q

Middle Mediastinal Mass: 3A’s

A 
Adenopathy:
 - infection (Tb, Histoplasmosis)
 - Neoplasm (lung cancer, Mets, Lymphoma)
 - Sarcoidosis
Aneurysm / vascular
Anomalies:
 - Bronchogenic cyst
 - Pericardial cyst 
 - Oesophageal duplication cyst.
43
Q

Posterior mediastinal Mass:

A

Neural Tumours:

  • Neurogenic: neuroblastoma, ganglioneuroma, ganglioneuroblastoma.
  • Nerve root tumours: schwannoma, neurofibroma, malignant schwannoma.

Paraganglionic tumours: intra thoracic pheochromocytoma.

Spinal tumour: mets, primary bone tumour.

Lymphoma
Invasive thymoma

Mesenchymal tumour: fibroma, lipoma, leiomyoma, haemangioma.

Abscess
Extramedullary haematopoiesis.
Oesophageal varices / diverticulum.

*Dont forget extra pulmonary lesions, such as chest wall / pleural.
Chest wall lesion will have a lucent halo surrounding the mass. Lateral will help - check soft tissues.

44
Q

Causes of solitary Pulmonary Nodule:

A

Malignant:

  • lung cancer
  • solitary met
  • Lymphoma
  • Carciniod

Benign Neoplastic:

  • Hamartoma
  • benign connective tissue (lipoma, fibroma)

Inflammatory:

  • Granuloma
  • Lung abscess
  • Rheumatoid nodule
  • Inflammatory pseudotumour

Congenital:

  • AV malformation
  • Lung cyst
  • Bronchial atresia with mucoid impaction

Other:

  • pulmonary infarct
  • intrapulmonary lymph node
  • Mucoid impaction
  • Haematoma
  • amyloidosis.
45
Q

Fast growing pulmonary Mets: “Loves to Multiply Swiftly”

A

Lymphoma
Testicular germ cell tumour
Melanoma
Soft tissue sarcoma.

46
Q

Cancerous solitary nodule growth rate:

A

between 1 - 18months to double in volume = change in diameter by 1.25times previous diameter.

47
Q

Single pulmonary nodule doubling times faster than 1 month:

A

Infection
Infarction
Histiocytic lymphoma
Fast growing Mets: Lymphoma, testicular germ cell, melanoma, soft tissue sarcoma.

48
Q

Single pulmonary nodule doubling time slower than 18 months:

A 
Granuloma
Hamartoma
Bronchial carcinoid
Salivary gland adenoid cystic carcinoma
Thyroid carcinoma mets
Round atelectasis.
49
Q

Causes of multiple pulmonary nodules:

A

Neoplastic:

  • Mets
  • Malignant lymphoma / lymphoma proliferative disease

Inflammatory:

  • Granulomas
  • Fungal and opportunistic infections
  • Septic emboli
  • Rheumatoid nodules
  • Granulomatosis with polyangiitis
  • Sarcoidosis
  • LCH

Congenital:
- AV malformations.

Other:

  • haematomas
  • Pulmonary infarcts
  • Silicosis.
50
Q

Causes of Cavitary pulmonary lesion: CAVITY

A

C: Carcinoma: lung primary (usually single) or Mets (SCC). (usually multiple).

A: Autoimmune: granulomatosis with polyangiitis, RA. usually multiple.

V: Vascular: bland and septic emboli: multiple

I: Infection: mycobacterial and fungal: single, but can be multiple.

T: Trauma: pneumatocele

Y: Young: congenital anomalies such as sequestration, diaphragmatic hernia, bronchogenic cyst.

  • Wall thickness <4mm usually benign
  • Wall thickness > 15mm usually malignant.

**See cavities, look for air crescent sign, and consider underlying aspergilloma or semi invasive aspergillosus.

51
Q

Large unilateral pleural Effusion: “ITCH”

A 
Infection / empyema
Tumour: 
 - primary lung cancer, 
 - mesothelioma, 
 - Mets, 
 - lymphoma.
Chylothorax 
 - secondary to lymphoma or ruptured thoracic duct.
Haemorrhage
 - Trauma
 - Iatrogenic
52
Q

Unilateral Elevated Diaphragm: “PAPER”

A 
Phrenic nerve paralysis:
 - malignant involvement
 - surgical trauma
Atelectasis / Abdominal mass
Post surgical abdominal abscess
Effusion (subpulmonic)
Rupture (trauma)
53
Q

Upper zone lung disease “CA SHRIMP”

A

C: Cystic Fibrosis
A: Ankylosing Spondylitis

S: Sarcoidosis
H: Histiocystosis, LCH
R: Radiation pneumonitis
I: Infection: Tb and fungal included.
M: Metastases
P: Pneumoconioses: CWP and silicosis
54
Q

Egg Shell Calcification: “SIT”

A

Sarcoidosis
Silicosis
Infection: Tb and fungal
Treated Lymphoma

55
Q

Peripheral opacities: “AEIOU”

A 
Alveolar sarcoid
Eosinophilic pneumonia
Infarcts
Organising pneumonia
UIP
contUsions
56
Q

Eosinophilic Lung Disease: “Idiopathic NAACP”

A 
Idiopathic:
 - Acute Eosinophilic pneumonia (Loffler syndrome)
 - Chronic eosinophilic pneumonia
N: Neoplasm:
 - Lung cancer
 - Mets
 - Lymphoma
A: Asthma
A: Allergic disorders:
 - Allergic bronchopulmonary aspergillosis
 - Drug Induced disease
 - Hypersensitivity pneumonitis
C: Collagen vascular granulomatous diseases:
 - Rheumatoid lung disease
 - Churg Strauss syndrome
 - Granulomatosis with Polyangiitis (Wegners)
 - Sarcoidosis
P: Parasitic:
 - Tropical eosinophillia
 - Helminth infectino
 - Fungal infection.
57
Q

Causes of unilateral hyper lucent hemithorax:

A

Patient position: rotation / scoliosis

Chest wall defect:

  • Mastectomy
  • Poland syndrome

Pleural abnormality:

  • ipsilateral pneumothorax
  • Contralateral pleural thickening / effusion

Airway obstruction:

  • Bronchial compression: hilar mass / cardiomegaly
  • Endobronchial obstruction with air trapping
  • Constrictive bronchiolitis
  • Swyer James syndrome: Small hyper lucent lung.
  • Pulmonary emphysema
  • Congenital lobar emphysema

Pulmonary vascular abnormality:

  • PE
  • Pulmonary artery hypoplasia
58
Q

Common extra thoracic sites for lung cancer Metastases: “LABB”

A

L: Liver
A: Adrenals
B: Bone
B: Brain.

59
Q

Post pneumonectomy complications:

A 
Early:
 - Bronchopleural fistula (stump leak)
 - Empyema
 - Haemothorax
 - Chylothorax
Late:
 - Recurrent neoplasm
 - Bronchopleural fistula
 - Empyema
 - Haemothorax
 - Chylothorax.
60
Q

Sparing costophrenic angles:

61
Q

Crazy paving:

A

ACUTE:

  • Oedema
  • PCP
  • Haemorrhage
  • AIP
  • DAD
  • Radiation
  • Acute eosinophilic Pneumonia

SUB ACUTE / CHRONIC:

  • NSIP
  • PAP (Pulmonary Alveolar Proteinosis)
  • COP
  • Haemorrhage
  • adenocarcinoma in situ
  • Lymphangitic tumour
  • Lipoid pneumonia
  • Chronic Eosinophilic pneumonia

FOCAL:

  • Haemorrhage
  • Adenocarcinoma in situ
  • Lymphangitic carcinoma
  • Lipoid pneumonia

UPPER ZONE PREDOMINANT:

  • Chronic eosinophillic pneumonitis
  • PCP

BASILLAR PREDOMINANT:

  • Oedema
  • NSIP
  • COP
  • Lipoid pneumonia.
62
Q

Halo sign: Nodule with GGO around it:

A

Represents haemorrhage of invasion:
“Ask is the patient immunocompromised”
- Invasive aspergillosis
- Other fungus

  • Haemorrhagic Mets
  • Adenocarcinoma in situ
  • Wegners.
63
Q

Atoll Sign: Ground glass opacity with rim of consolidation:

A

COP
Chronic eosinophilic pneumonia
Pulmonary Infarct: peripheral wedge shaped
Invasive fungal - neutropenic
Wegners granulomatosis: cANCA
Hypersensitivity pneumonitis: centrilobular GGO nodules.

64
Q

Pulmonary Sinus and Renal lesions

A

Think Granulomatosis with polyangiitis

65
Q

DDx smooth interlobular septal thickening:

A 
Pulmonary oedema
Lymphangitic carcinomatosis
Lymphoproliferative disease
Amyloidosis (rare)
Pulmonary veno-occlusive disease (rare)
Lymphangiomatosis (rare)

Pulmonary alveolar proteinosis
Pulmonary haemorrhage
atypical pneumonia: pneumocystis jiroveci.

66
Q

DDx nodular interlobular septal thickening: THink peri lymphatic nodules

A 
Lymphangitic carcinomatosis
Sarcoidosis,
Lymphoproliferative disease
Amyloidosis (rare)
Silicosis/ CWP
LIP
67
Q

Fleischner Nodule follow up:

A

SINGLE SOLID NODULE:
< 6mm: Low risk, no follow up.
< 6mm: high risk, optional 12/12 follow up.
6-8mm: follow up 6-12months, repeat 18-24months in high risk patients.
>8mm: CT follow up 3months, PET/CT, or tissue biopsy.

MULTIPLE SOLID NODULES:
<6mm: low risk - no follow up.
<6mm: high risk - optional 12/12 follow up.
> 6mm: CT follow up 3-6 months, repeat 18-24 months in high risk.

SUBSOLID SINGLE NODULE:
Single ground glass nodule <6mm: no follow up.
Single ground glass nodule >6mm: CT 6-12 months, then if persists, CT every 2 yrs for 5 years.
Single part solid nodule >6mm: CT 3-6 months, if persists and solid component remains <6mm - annual CT 5 years.

MULTIPLE SUBSOLID NODULES:
Multiple subsolid nodules < 6mm: repeat CT 3-6 months, if stable, consider CT at 2 and 4 years in high risk.
Multiple subsolid nodules >6mm: CT 3-6 months, management based on most suspicous nodule.

68
Q

Lung cancer TNM staging:

A

T1: <3cm, not main bronchus.

T2: 3-5cm, or

  • involves main bronchus
  • Invades visceral pleura
  • Atelectasis / obstructive pneumonitis extending to hilar region.

T3: 5 -7cm, or

  • associated seperate nodules in same lobe
  • Invades chest wall
  • Phrenic nerve
  • Parietal pericardium.

T4: > 7cm, or

  • separate nodules in different ipsilateral node.
  • Invades diaphragm
  • Invades mediastinum
  • Invades heart
  • Invades great vessels
  • Invades trachea
  • Recurrent laryngeal nerve
  • vertebral body
  • Carina.

N1: metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes

N2: metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)

N3: metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

M1a: separate tumour nodule(s) in a contralateral lobe; tumour with pleural or pericardial nodule(s) or malignant pleural or pericardial effusions

M1b: single extrathoracic metastasis, involving a single organ or a single distant (nonregional) node

M1c: multiple extrathoracic metastases in one or more organs

69
Q

Stage groupings:

A

stage Ia
TNM equivalent: T1, N0, M0
5-year survival: up to 92%

stage Ib
TNM equivalent: T2a, N0, M0
5-year survival: 68%

stage IIa
TNM equivalent: T2b, N0, M0
5-year survival: 60%

stage IIb
TNM equivalent: T1/T2, N1, M0 or T3, N0, M0
5-year survival: 53%

stage IIIa
TNM equivalent: T1/T2, N2, M0 or T3/T4, N1, M0 or T4, N0, M0
5-year survival: 36%

stage IIIb
TNM equivalent: T1/T2, N3, M0 or T3/T4, N2, M0
5-year survival: 26%

stage IIIc
TNM equivalent: T3/T4, N3, M0
5-year survival: 13%

stage IVa
TNM equivalent: any T, any N with M1a/M1b
5-year survival: 10%

stage IVb
TNM equivalent: any T, any N with M1c
5-year survival: 0%

70
Q

Airway tumour:

A 
SCC
Adenoid cystic carcinoma
Carinoid
Mucoepidermoid carcinoma
Haemangioma
Glomus tumour
Papilloma
71
Q

Sparing costophrenic angles:

A

LCH

Hypersensitivity pneumonitis

72
Q

Tracheal Diseases DDx:

A 
SPARES POSTERIOR MEMBRANE
Relapsing polychondronitis:
 - Diffuse thickening
 - No Ca++.
 - Recurrent episodes cartilage inflam and pneumonia.

Tracheobronchopathia Osteochondroplastica:

  • Cartilagenous and osseous nodules.
  • Men > 50yrs
INVOLVES POSTERIOR MEMBRANE:
Amyloid:
 - irregular focal or short segment thickening
 - Ca++ common
 - Confined trachea and main bronchi

Post intubation:

  • Focal subglottic circumfrential stenosis
  • Hour glass configuration

Wegners:

  • Circumferential thickening
  • Focal or long segment
  • No Ca++
  • c-ANCA +ve.
73
Q

Pleural plaque calcifications DDX:

A

Asbestos

Old haemothorax
Old infection
TB
–> Fibrothorax secondary to prior Infection / haemorrhage

Extra skeletal osteosarcoma

74
Q

DDx honeycombing:

A 
UIP pattern:
IPF
Connective tissue disease
Drug related fibrosis (cyclophosphamide, nitrofurantoin)
Asbestosis
Hypersensitivity pneumonitis
Sarcoidosis
NSIP - mild honey combing
Other pneumoconiosis
Post ARDS.
75
Q

Fibrotic Lung disease CC distribution DDX:

A

Upper lobe predominant:(STROLA)

  • Sarcoidosis
  • Prior TB
  • Prior Fungal infection
  • Radiation fibrosis
  • Pneumoconioses (silicosis, CWP, beryllium, talc)
  • Pleuroparenchymal fibroelastosis.
  • ankylosing spondylitis.

Lower Lobe preodminant:

  • IPF
  • CT disease
  • Drug fibrosis
  • asbestosis
  • Hypersensitivity pneumonitis
  • Chronic aspiration
76
Q

Fibrotic lung disease axial distribution DDX:

A

Sub pleural:

  • IPF
  • CT disease
  • Drug fibrosis
  • asbestosis
  • Post ARDS

Diffuse / central:

  • Sarcoidosis
  • Pneumoconioses
  • HP
  • Chronic aspiration
  • Prior Tb / fungal infection.
77
Q

DDx of mosaic perfusion as an isolated finding:

A 
Asthma
Hypersensitivity pneumonitis
Constrictive bronchiolitis
Chronic PE
Vasculitis.
78
Q

DDx cystic bronchiectasis:

A 
ABPA
CF
Primary ciliary dyskinesia
Immunodeficiency
Childhood infection
Williams Campbell syndrome and Tracheo-bronchomegaly.
79
Q

CXR features of common disorders in AIDS:

A

PCP:

  • No effusions or lymphadenopathy
  • Bilateral perihilar or diffuse alveolar or reticunodular ground glass opacities.
  • Lung cysts, can have PTx.

TB:
- primary or reactivation
Mycobacterium avium intracellulare:

Kaposi sarcoma:

  • associated mucocutaneous nodules
  • Bilaeral perihilar opacities bronchovascular distribution
  • flame shaped opacities
  • Pleural effusions common
  • Kerly B lines common

AIDS related lymphoma:

  • solitary or multiple nodules or masses
  • Pleural and or pericardial effusions
  • lymphadenopathy
  • rapidly progressive.
80
Q

Hilar and mediastinal lymphadenopathy in AIDS:

A 
TB
MAC
Fungal - cryptococcus
Lymphoma
Kaposi
Lung cancer

PCP does NOT cuase lymphadenopathy

81
Q

Fat containing mediastinal mass:

A
  • mediastinal lipomatosis
  • tumours arising from fat (lipoma, liposarcoma, hibernoma)
  • tumours containing fat (teratoma, thymolipoma)
82
Q

DDx for lucent / lytic rib lesion: FAME B

A 
F: Fibrous dysplasia
A: ABC
M: Mets / myeloma
E: Eosinophilic granuloma / Enchondroma
B: Brown Tumour
83
Q

DDx for pleural based mass:

A 
Pleural Metastasis
Empyema
Mesothelioma
Fibrous tumour of pleura
Fibrothorax.
84
Q

Calcifed nodes

85
Q

Enhancing mediastinal nodes

A

Kaposi
Castelmann
Hypervascular mets

86
Q

Unilateral ILD

A

carcinomatosis
oedema
aspiration
Radiation

87
Q

Calcified pulmonary nodules:

A

Micro:

  • Microlithaisis
  • haemasoiderosis
  • Silicosis
  • Amyloid
  • healed varicella

Large

  • Mets
  • Granuloma
  • chondroma
  • metastatic pulmonary Ca++
88
Q

Small Heart

A

Anorexia / cachexia
Adrenal insufficnecy / Addisons
Emphysema
Contrictive pericarditits

89
Q

Mets Ca++

A

BOTM

  • breast
  • osteosarc
  • Thyroid
  • Mucinous colorectal
90
Q

Radiological types of bronchiectasis:

A

Cylindrical
Varicose
Cystic

Traction

  • Central bronchiectasis - think ABPA
91
Q

Unilateral Hilar enlargement:

A

Infection:

  • TB,
  • Viral in kids

Vascular:

  • pulmonary artery stenosis,
  • pulmonary artery aneurysm

Tumour:

  • mets,
  • lymphoma,
  • bronchial carcinoma.
92
Q

Bilateral Hilar enlargement:

A 
Sarcoid
Tumour:
 - Mets
 - LYmphoma
Vascular:
 - pulmonary artery HTN
Infection: Tb
93
Q

Osteolysis distal clavicle: SHIRT Pocket

A 
S: scleroderma
H: hyperparathyroidism 
I: infection (osteomyelitis) 
R: rheumatoid arthritis
T: trauma 
P: progeria
94
Q

Expansile or lytic Rib Lesion: “FAME B”:

A

F: fibrous dysplasia (ground glass)
A: ABC (expansile)
M: Mets / myeloma (soft tissue component)
E: Enchondroma (chondroid matrix) (EG in child)
B: Brown tumour (radiographic signs of secondary hyperPTH).

95
Q

Cardiac Mass:

A 
Thrombus
Myxoma:  
 - Commonly left atrium, lobulated, can be Ca++.
 Rhabdomyoma:
 - Children, tuberous sclerosis
 - Ventricle location.
Fibroma:
 - children, ventricular wall, calcified.
Metastatic disease. 
Sarcoma:
 - Aggressive vascular invasion.
96
Q

Calcified pericardium:

A

Thin and linear:

  • Uraemia
  • Viral pericarditis
  • trauma / surgery
  • Collagen vascular disease
  • Radiation

Thick and shaggy:
- TB

97
Q

Bone check:

A

H Shaped vertebrae:

1) Sickle cell disease
- Associated splenic autoinfarction
2) Gaucher disease:
- Spleenomegaly.

Humeral head infarcts: sickle cell.

Absent ribs: lucent mets / surgical resection.

Check scapula and ribs for absent / lucent lesion

98
Q

Diffuse bony sclerosis: 3Ms PROOF

A

M:Malignancy
- Mets
- Lymphoma
- Leukaemia
M: Myelofibrosis (>50yrs, spleenomegaly, extramedullary haematopoiesis).
M: Mastocytosis (thickened small bowel folds with nodules)
S: Sickle Cell Disease (Bone infarcts, H-vertebrae, splenic autoinfarction)

P: Paget disease
R: Renal osteodystrophy (sub periosteal resorption, Rugger jersey spine)
O: Osteopetrosis (diffusely dense, bone in bone, Sandwhich spine)
O: Other:
- Sclerotic dysplasias: osteopoikilosis, melorheostaosis
- Hyperthyroididm
- Hyperparathyroidism
- Pynknodysostosis (short, hypoplastic mandible, pointed and dense chalk pencil like distal phalanges)
F: Fluorosis (ligamentous calcification).

99
Q

Calcified Miliary Nodules

A

Healed Varicella, or histoplasmosis.

Calcified Metastatic disease: Medullary thyroid / Osteosarcoma.

Pneumoconiosis: silicosis / CWP.

Metastatc Pulmonary Calcification: Ca/PO4 metabolism diseases, e.g. renal failure, myeloma.

Pulmonary Haemosiderosis: Mitral stenosis.

Pulmonary alveolar microlithiasis.

100
Q

Miliary Nodules

A

Infection:

  • TB
  • Fungal
  • Viral, such as varicella.

Metastases:

  • Thyroid
  • Renal
  • Breast
  • Osteosarcoma
  • Trophoblastic disease.

Inflammatory / interstitial:

  • Sarcoid
  • Pneumoconioses
  • Hypersensitivity pneumonitis
101
Q

Normal CXR: Check Areas:

A

Neck: clips, displaced trachea

Trachea and Bronchi: Endo-luminal mass, especially if history of “wheeze”

Ribs: notching and Aortic arch: coarctation

Hyper lucent hemithorax: Poland, mastectomy, bronchial atresia, Swyer James, Westermark sign and PE.

Diaphragm: liver and spleen pathology.

Bones: diffuse lucency / density, widening: sclerotics mets, renal osteodystrophy, sickle cell, myelofobrosis, thalaessaemia.

Bones: ribs / spine / scapula: lucent metastasis.

Paravertebral lines

Ask myself:

  • Why is this not Sarcoid
  • Is this Tb
  • Could the patient be immunosuppressed.
102
Q

Carotid Vascular US:

PSV values:

A

Stenosis / narrowing:

Plaque description:
- Hypoechoic plaque associated with laerge amount of lipid and increased risk of embolic event.

Presence of aliasing.

Waveform morphology:
- Spectral broadening.

Wave form values:

PSV < 125cm/s. PSV ratio < 2.0 –> <50% stenosis.

PSV 125-229cm/s. PSV ratio 2-3.9 –> 50-69% stenosis.

PSV >230cm/s. PSV ratio > 4.0 –> > 70% stenosis.
–> if symptomatic, endarterectomy should be considered.

103
Q

Unilateral lung disease:

A

Radiation Treatment: fibrosis

Lymphangitic carinomatosis

Scimitar syndrome
Assymetric oedema
Aspiration

Post lung transplant.

A DDx (14 decks)

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