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Case review > CHEST/MSK > Flashcards

CHEST/MSK Flashcards

1
Q

PCOS criteria

A

polycystic ovarian morphology with clinical and endocrine dysf(x)
- >25 follicles/ovary
- >10 cc Ov vol
- peripheral follicles, ‘string of pearls’

often b/lateral, sometimes unilateral.
insulin resistance, androgen hypersecretion

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2
Q

what lobe hypertrophies in budd chiari?

A

caudate

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3
Q

ow is chemical fat saturation achieved?

A

applying a narrow bandwidth 90° pulse specific for Larmor frequency of fat followed by a excitation pulse

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4
Q

dysmorphic liver (scarring/distortion) with biliary tree dilation DDx

A

PSC
cholangioCA
PV thrombophlebitis (mimic - thrombosed veins mimic dilated ducts)

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5
Q

DDx small calcified renal lesions

A

renal calculi
vascular calcs
calcified renal lesion (cysts, masses)
renal papillary necrosis
recurrent renal infections (also TB)
nephrocalcinosis
medullary sponge kidney

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6
Q

nephrocalcinosis subtypes

A

medullary and cortical

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7
Q

causes of medullary calcinosis

A

usually hyperPTH, RTA, medullary sponge kidney

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8
Q

medullary calcinosis features

A

punctate Ca2+ localized to renal pyramids; usually extensive and bilateral
+/- calcs in collecting system
kidneys usually normal size/function

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9
Q

nephrocalcinosis causes and features

A

shock, hypotension
small kidneys, irregular cortical calcs, often impaired Fx

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10
Q

medullary sponge kidney multiple calcs in dilated tubules

A

multiple tiny calcs in dilated tubules
dilated tubules best seen on the pyelographic phase

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11
Q

what is a reverse Bankart?

A

detachment of the posteroinferior labrum with avulsion of the posterior capsular periosteum

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12
Q

Bankart lesion definition

A

injuries to the anteroinferior aspect of the glenoid labral complex
- Bankart: injury to labrum and GH capsule/ligs.
- Bony bankart involves # of the AI glenoid

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13
Q

Perthes lesion

A

chondrolabral detachment with periosteal stripping of the scapula; the labral fragment remains attached to periosteum

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14
Q

what is ALPSA

A

anterior labroligamentous periosteal sleeve avlusion
- labral tear remaining attached to periosteum of glenoid

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15
Q

GLAD

A

glenolabral articular disruption
- labral tear with anteroinferior articular cartilage injury `

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16
Q

ALSA VS PERTHES

A

both labral tears with the labral fragment remaining attached to periosteum.. ALPSA (anterior labroligamentous periosteal sleeve avulsion) is displaced

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17
Q

Segond vs Arcuate sign

A

segond: avulsion of anterolateral tibia (more medial and anterior fragment)
arcuate sign: fibular head avulsion

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18
Q

arcuate uterus

A

incomplete absorption of the uterovaginal septum. MILD anomaly.
- mild, smooth indentation in the fundal endometrium with NORMAL OUTER CONTOUR

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19
Q

didelphys uterus

A

Duplication of the uterinne horns, and duplication of cervix.
fundal cleft >1CM

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20
Q

bicornuate uterus

A

partial fusion failure of the paramesonephric ducts resulting in uterus divided into 2 horns.
- bicollis = 2 cervixes.
- unicolis = 1 cervix

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21
Q

bilateral diffuse nodular heterogeneity with fine calcs in parotid gland

A

Sjogren’s. also RA, SLE, SS

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22
Q

what is the urachus?

A

remnant of fetal allantoic stalk; connection btw bladder dome and umbilicus

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23
Q

reasons to treat renal AML?

A

size, hemorrhage

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24
Q

causes of SVC occlusion

A

central venous catheters
malignancy

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25
Q

What is May-Thurner syndrome?

A

compression L CIV by right CIA

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26
Q

common presenting symptom of renal A aneurysm

A

hypertension (commonly they get microemboli)

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27
Q

what is Budd Chiari?

A

congestive hepatopathy 2/2 hepatic vein occlusion

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28
Q

calcified soft tissue mass differential

A

dystrophic calcification
MO/HO/injection granuloma
focal - phlebolith, arterial calc
metastatic calcification (due to elevated serum calcium)
osteosarc, synovial osteochondromatosis

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29
Q

what is synovial osteochondromatosis (aka osteochondromatosis)

A

primary or secondary
loose intra-articular cartilagenous bodies which may/not be calcified

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30
Q

Primary synovial chondromatosis is ? what joints?

A

self-limiting, benign process characterized by synovial metaplasia and proliferation resulting in intra-articular cartilaginous loose bodies
- knee (70%), hip (20%), elbow/shoulder

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31
Q

secondary synovial chondromatosis

A

intraarticular loose bodies secondary to joint pathology (trauma, OA, infection neuropathic osteoarthropathy)

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32
Q

what is a neuropathic (charcot) joint?

A

progressive degen/destructive joint disorder in pt with altered pain/proprioception
- 2/2 DM, neuro disorders/spine injury, MS, steroid use,

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33
Q

DDx of intra-articular loose bodies

A

osteochondral # or osteophyte fragment
synovial chondromatosis
meniscal calcification
tenosynovial GCT
osteochondritis dissecans

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34
Q

Osteochondritis dissecans

A

separation of an osteochondral fragment from the bone, with gradual fragmentation of the articular surface forming OC defect
- associated with intraarticular loose bodies
- associated with repetitive trauma
- MC affecting: knee (95% of all cases are femoral condyle), ankle, capitellum, glenoid

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35
Q

Brown Tumor features

A

osseous manifestation of HPT; reparative, not neoplastic
- identical to GCT histologically
- common sites: mandible, clavicle, ribs, pelvis.
- well defined, pure lytic lesion without reactive bone changes. osseous expansion but not destructive

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36
Q

DDx for lytic bone lesion

A

fibrous dysplasia/cortical defect
enchondroma/EG
GCT /BCT
NOF
Osteoblastoma
Met/MM
ACB/UBC
infection/infarction
chondroblastoma

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37
Q

‘rat bite erosion’

A

gout

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38
Q

gull wing erosion

A

‘erosive’ OA

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39
Q

multiple enchondromas

A

Maffuci (soft tissue hemangiomas) and Ollier disease

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40
Q

what are enchondromas

A

benign tumor of hyaline cartilage originating in medullary bone

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41
Q

enchondroma imaging features

A

genographically central bone lesion in long bones (50% hands/feet, prox humerus/femur/prox tib), mixed lucent/sclerotic, no complete cortex destruction of ST mass if no path #. on MR - lobulated high SI
DDx: low grade CS

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42
Q

Hypoechoic spleen lesion DDx

A

infarction, hematoma, abscess, metastasis. lymphoma, lymphangioma (cystic), angiosarcoma, hemangiopericytoma, hemangioendothelioma, littoral cell angioma

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43
Q

splenic metastasis features

A

usually seen in disseminated metastatic dz (Ov, Breast, lung, CRC, melanoma)
usually multiple hypoechoic masses, may have hyperE rim

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44
Q

Unique feature about subependymoma?

A

enhancement is unusual!!

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45
Q

round, dense, highly cellular and enhancing mass in the 4th ventricle?

A

likely medulloblastoma (esp if child)
ATRT can be very similar if <3yo

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46
Q

most common malignant pediatric brain tumor

A

medulloblastoma

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47
Q

comet-tail sign (lung)

A

round atelectasis

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48
Q

Sinonasal GPA involvement occurs in ? % of patients

A

> 75%

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49
Q

sarcoid involves sinonasal cavities in ? % of patients

A

20%

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50
Q

lumbar region IDEM lesion in adults DDx

A

myxopapillary ependymoma
meningioma (iso to cord T1, T2, unusually in conus location)
mets
NST

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51
Q

mucinous tumors of the pancreas - what age?

A

MIDDLE age

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52
Q

imaging features of mucinous panc lesions

A

usually body-tail
- cystic lesion with fewere and larger internal septations than serous.
- middle age women

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53
Q

serous pancreas cystadenoma

A

innumerable microcysts in encapsulated pancreastic mass.
elderly

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54
Q

what is SAPHO?

A

synovitis, acne, pustulosis, hyperostosis, osteitis
- rare chronic inflammatory d/o of skin, bone, joints

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55
Q

what is Lofgren’s syndrome?

A

acute clinical presentation of systemic sarcoidosis
- fever, erythema nodosum, bilateral hilar LA

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56
Q

avascular necrosis of the navicular in peds vs adults - name?

A

Peds: Kohler’s disease
Adults: Muller-Weiss

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57
Q

deforming non-erosive arthropathy (Jacoud’s) is?

A

marked ulnar deviation MCP, reducible
associated with SLE, PsA,

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58
Q

typical findings of gout

A

mono or poly articular, asymmetric.
tophi/soft tissue changes are late findings
para-articular eosions - ‘punched out’, well defined with sclerotic borders
normal mineralization and JS preserved.

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59
Q

central erosions

A

erosive OA

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60
Q

paracentral (both sides of the joint) erosions

A

PsA (Mickey mouse)

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61
Q

marginal erosions

A

RA

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62
Q

hemophilic arthropathy

A

polyarticular process but can be asymmetric
radiodense ST swelling/effusion
osteoporosis/penia, subchondral cystic changes
erosive bone changes, and late stage joint space loss and subluxation

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63
Q

fixed humeral head in internal rotation –> think what?

A

posterior dislocation!

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64
Q

reverse bankart

A

impaction fracture of the posterior glenoid
associated with reverse Hill - Sachs

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65
Q

posterior ankle impingement (os trigonum syndrome)

A

FHL tenosynovitis and increased signal around the os trigonum

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66
Q

synovial osteochondromatosis

A

ossification/calcification of the nodules (bening neoplastic/proliferative nodules of the synovium)
primary (idiopathic) and secondary (OA related) forms
DDx: PVNS, synovial hemangioma, lipoma arborecens

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67
Q

synovial chondromatosis

A

nodularity and proliferation of the synovium, (initial/tranwitional phase of the osteochondromatosis - the 3rd stage is calcification)

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68
Q

Sprengle’s deformity

A

complex congenital deformity of the scapula
elevated/winged scapula - unilateral or bilateral
- associated with Klippel-Feil syndrome, omovertebral bone (cartilage or bone connection between cervical spine and scapula)

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69
Q

Blount’s disease findings

A

congenital tibia vara
osteochondrosis of the the medial proximal epiphysis of the tibia

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70
Q

DDx pediatic tibial bowing

A

Developmental
Ricket’s
Blount’s disease
Osteogenesis imperfecta
osteomyelitis

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71
Q

picture frame vertebra

A

cortical thickening of the vertebral body = Paget’s disease

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72
Q

Maffucci syndrome

A

congenital non-hereditary mesodermal dysplasia
multiple enchondromas and soft tissue malformations (venous, spindle-cell hemangiomas)

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73
Q

lipomatous infiltration of pancreas

A

cystic fibrosis
Shwachman-Diamond syndrome - rare, AD disorder (pancreatic insufficiency, skeletal malformation/metaphyseal chondrodysplasia, bone marrow hypoplasia)

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74
Q

ollier’s disease

A

multiple enchondromas

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75
Q

adult with painful enchondroma?

A

malignant degeneration to chondrosarc

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76
Q

enlarged EOM + diffuse periostiitis - think of what?

A

Grave’s thyroid acropachy

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77
Q

DDx symmetric diffuse periosiitis

A
  • PsA, RA, JIA
  • thyroid acropachy, hypertrophic osteoarthropathy
  • hypervitaminosis A, fluorosis
  • CMRO
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78
Q

DDx symmetric diffuse periosiitis

A
  • PsA, RA, JIA
  • thyroid acropachy, hypertrophic osteoarthropathy
  • hypervitaminosis A, fluorosis
  • CMRO
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79
Q

periosteal reaction of the long bones without an underlying bone lesion is ?

A

hypertrophic osteoarthropathy

80
Q

Parsonage Turner

A

self limiting acute idiopathic brachial neuritis

81
Q

split fat sign

A

lesion within the neurovascular bundle -> nerve sheath tumor (Schwannoma and neurofibroma)

82
Q

NF1 findings

A

skull: sphenoid defect, suture defects
scoliosis/kyphysos
vertebral scallopinnng
bowed tibias
neurofibroma / NSTs
pseudoarthrosis

83
Q

soft tissue calcifiation categories (2)

A

metabolic vs dystrophic (some sort of muscle injury/trauma)

84
Q

dystrophic soft tissue calcifications

A

HO/MO, injection granuloma, parasitic infections

85
Q

metabolic soft tissue calcifications

A

inflammatory APs
renal osteodystrophy
sclero/dermatomyositis

86
Q

progressive massive fibrosis DDx

A

sarcoid
silicosis
coal worker’s pneumoconiosis
talcosis

87
Q

progressive massive fibrosis

A

coalescence of nodules into a mass with calcifications and associated architectural distortion

88
Q

bronchial atresia

A

area of bronchus that does not communicate with the tracheobronchial tree. often mucus clogged
area of hyperexpanded hyperlucent lung.

89
Q

Broad differential for mid to upper lung predominant ILD (SHORTI)

A

sarcoid, HP, occupational exposure, radiation fibrosis, TB/fungal, idiopathic pleuroparenchymal fibroelastosis

90
Q

Lower lung predominant ILD - broad ddx

A

UIP NSIP HP (very unlikely to be occupational, TB/Fungal, IPPFE)

91
Q

broad NSIP pattern

A

peribronchial, subpleural sparing, diffuse GGO without traction bronchiectasis and honeycombing

92
Q

IUP broad pattern

A

basal predominant reticulations, honeycombing, traction bronchiectasis

93
Q

central/peribronchial ILD - broad DDx

A

sarcoid, NSIP, HP, OP

94
Q

peripheral/subpleural ILD broad DDx

A

UIP, NSIP, HP, OP

95
Q

typical pulmonary fibrotic HP major features

A

usually - upper lung predominant (but can vary depending on acuity!!)
coarse reticulations, non-dominant traction B and honeycombing. ill-defined centrilobular nodules and GGOs, mosaic attenuation

96
Q

Mosaic attenuation DDx

A

associated with obstructive small airway dz (CF, bronchiolitis)
occlusive vascular dz (chronic PE)
parenchymal dz

97
Q

definition of HP

A

group of immune-mediated pulmonary disorders causing inflammatory/fibrotic reaction of the lungs
- fibrotic and non-fibrotic types

98
Q

ABPA

A

overreactive immune response to aspergillus antigen in pts with asthma / CF
- high density central mucus plugging and bronchiectasis
- later stages = fibrotic changes

99
Q

isolated air trapping DDx

A

asthma, stem cell transplant, bronchiolitis obliterans, GPA

100
Q

constrictuve bronchiolotis

A

small airway occlusion and destruction
seen in stem-cell tx GVHD, lung transplant rejection, inhalation disease, autoimmune disease, infectious causes (mycoplasma)

101
Q

DDx hyperlucent right lung

A

aspirated FB (put pt in decub)
Poland syndrome
Swyer-James syndrome
large bulla
emphysema
PTX

102
Q

crazy paving pattern ddx

A

pulmonary hemorrhage, alveolar proteinosis, pcp, pul edema

103
Q

UIP categories

A

typical, probable UIP, indeterminate, alternative

104
Q

typical UIP

A

basilar, subpleural, heterogenous, sometimes diffuse.
honeycombing + reticulation + TB

105
Q

probable UIP

A

basilar, subpleural.
reticulation, TB, +/- GGO. NO honeycombing.

106
Q

indeterminant for UIP

A

basilar and subpleural, but sutble findings - mild GGO, some features of fibrosis but no specific etiology

107
Q

alternative Dx to UIP

A

upper/mid lung, peribronchovascular/perilymphatic
no fibrotic changes

108
Q

4 most common causes cystic LD?

A

Lymphangiomyomatosis
pulmonary LCH
lymphocytic interstitial PNA
BHD

109
Q

LAM (lymphangiomyomatosis) demographics

A

female, typically reproductive ages
UNLESS tuberous-sclerosis LAM complex

110
Q

LAM imaging features

A

THIN WALLED uniform shape, diffuse distribution, normal intervening lungs
Associated findings: AMLs (liver/kidney/retroperitoneal), chylous PEff

111
Q

cystic lung disease in female, 40, thin wall, uniform distribution and shape .. likely cause?

A

LAM

112
Q

what is LAM?

A

diffuse of smooth muscle proliferation in the lungs

113
Q

AMLs are associated with?

A

LAM, TS, or TS-LAM!

114
Q

LAM-TS complex

A

similar genetic defect; overlapping features with lam and TS - cystic LD, AML, sclerotic bone lesions, myocardial deposition of focal fat

115
Q

Characteristic pLCH features

A

upper lung predominant cysts, spares costophrenic <)
- thin and thick walled cysts, bizzare shaped, pulmonary nodules (parenchymal abn)
- associated with smoking.
- can px with spontaneous PTX

116
Q

pLHC progression of nodules

A

nodules –> cavitation –> cystics –> coalescence of cysts with intervening fibrosis

117
Q

LCH osseous manifestations?

A

aggressive appearing lesions, lytic and destructive. the bone can sometimes reform

118
Q

cystic lung disease sparing the costophrenic angles?

A

pLCH

119
Q

Lymphocytic Intersitial PNA features

A
  • benign lymphoproliferative dz
    -oligocystic, thin walled cysts, lower lung predominant
  • GGOs can be present
  • centrilobular nodules may be present
120
Q

LIP connective tissue and autoimmune associations

A

Sjogren, RA, HIV, Castleman’s

121
Q

oligocystic, lower lung predominant cystic lung disease

A

Lymphocytic interstitial PNA

122
Q

Sjogren’s disease and LIP associated with what?

A

primary lung lymphoma

123
Q

what cystic lung disease presents with PTX?

A

BHD, pLCH, LAM

124
Q

BHD features

A

<20 thin walled cysts (can be a SINGLE cyst)
- ovoid/lentiform/ellipsoid shape, associated with fissures/pleura
lower lung predominant

125
Q

BHD triad

A

lung cysts
renal tumors
skin fibrofolliculomas

126
Q

oligocystic lung diseases

A

BHD, LIP

127
Q

differential for epiphyseal bone lesions

A

osteochondroma
chondroblastoma (peds)
GCT (adult)
ABC
OM

128
Q

metaphyseal bone lesions

A

osteochondrona
FCD/NOF
chondromyxoid fibroma
ABC
encondroma
UBC
FD
OM
osteosarc

129
Q

diaphyseal bone lesions

A

osteoid osteoma
chronic OM
FD
LHC
adamantinoma
osteofibrous dysplasia

130
Q

multiple sclerotic lesions in bone

A

osteopoikolosis
treated mets

131
Q

Bone forming tumors - benign DDx

A

bone island (enostosis), osteoid osteoma

132
Q

enostosis definition

A

benign lesion of normal cortical bone, in abnormal location
bony spicules dense, with normal outline

133
Q

osteoid osteoma

A

<30, night pain, disproportionate pain to lesion size
- femur/tibia/posterior elements (painful scoliosis!)
- tumor = nidus. surrounded by reactive sclerosis
- cortical, medullary, subperiosteal
- intra-articular lesions can cause joint effusions and mimic OA!

134
Q

osteoblastoma

A

large osteoid osteoma like lesion (>1,5 cm)
- posterior elements and sacrum
- can be aggressive appearing (mixed lucent/sclerotic)
- long bones - more likely to be OO

135
Q

osteogenic sarcoma

A

usually young, M>F,
femur/tibia/humerus
mixed sclerotic/lucent
aggressive periosteal reaction (Codman’s triangle)

136
Q

Osteogenic sarcoma subtypes

A

conventional
telangiectatic
small cell (looks like FD/FCD!)
low grade central
secondary (to prior radiation)
juxtacortical type (parosteal, periosteal, high grade surface)

137
Q

juxtacortical osteosarcoma types

A

parosteal, periosteal, high grade surface

138
Q

chondrogenic bone tumors - bening DDx

A

OC
chondroma / enchondroma,
osteochondromyxoma
BPOP (bizarre parosteal osteochondromatous proliferation)
subungual exostosis

139
Q

chondrogenic bone tumors - intermediate/local aggressive

A

chondromyxoid fibroma, low grade chondrosarc

140
Q

osteochondroma

A

bony exostosis, continuous with medullary space
cartilage cap thickness important (solitary = low risk, multiple/hereditary types much higher)

141
Q

chondroma subtypes 2

A

= central (enchondroma), periosteal (juxtacortical)

142
Q

enchondroma

A

MC tumor of small bones hands/feet
expansile lucent, some sclerosis
usually asx solitary, may #
multiple (Maffucci/Olliers - malignant risk)

143
Q

chondroblastoma

A

RARE, teens, painful
epiphyseal OR apophyseal, femur most common, also talus and patella
- usually sharp lytic lesion, +/- sclerotic border. matrix 1/3
- on MRI, often lots of BM edema
DDX CLEAR CELL CHONDROSARC

144
Q

chondromyxoid fibroma features

A

extremely rare. <30
any bone, MC prox tibia
lobulated/oval eccentric lytic lesion, expansile, well defined sclerotic margin in 85%. geographic bone destructionn
no matrix, periosteal rxn

DDx ABC, GCT, chondroblastoma/NOF in younger

145
Q

chondrosarc - location & key features

A

pelvis, long bones, ribs
- may have cartilagenous matrix
larger than enchondromas, endosteal scalloping, periosteal rxn, soft tissue component

146
Q

Fibrous tumors - MSK DDx

A

desmoplastic fibroma (desmoids of bone), fibrosarcoma
NOF/FCD
bening fibrous histiocytoma of bone

147
Q

FCD/NOF

A

NOF is larger, medullary
FCD smaller, cortically based
seen in peds, not in adults (not exclusive)

148
Q

GCT features

A

benign but locally aggressive.
ENDS of long bones. NO matrix. expansile, sharp margins
NO sclerotic border

149
Q

chordoma

A

malignant fibrous lesion, soft tissue component
sacrum and clivus

150
Q

ABC features

A

multiloculated blood-filled, cystic lesion
fluid-fluid levels.
can be primary or arise from GCT/FD/chondroblastoma
expansile, can grow fast, look aggressive

151
Q

UBC features

A

usually prox metadiaphysis long bones, usually <20
pathologic # = fallen fragment

152
Q

fibrous dysplasia

A

preference for long bones
expansile lesion with usually GG matrix
monostotic MC, polyostotic with hormonal syndromes

153
Q

MSK LCH

A

solitary or multiple. variable appearances
aggressive in long bones. in skull, well defined with beveled edge.
consider in any lesion

154
Q

intraosseous ganglion/geode

A

articular ends of long bones. geode if associated with degeneration of the joint

155
Q

Ewing features

A

<20 usually. diaphysis and flat long bones
aggressive, permeative appearance
soft tissue compontnt

156
Q

adamantinoma

A

low grade malignant lesion
usually 20-30yo, prox tibia (anterior cortex!), but also jaw, hands, feet
multilocular (often), slightly expansile, osteolytic lesion with areas of sclerosis, lack periosteal reaction

157
Q

undifferentiated high grade pleomorphic sarcoma

A

long bone meta/diaphysis

158
Q

brown tumor features

A

primary (HPTH) or secondary (renal failure)
represents a reparative cellular process
cellularly identical to GCT
Sites: mandible, clavicle, ribs, pelvis.
XR: well defined, pure lytic lesion without bone rxn. may thin/expand cortex
DDx: GCT, FD

159
Q

diffuse centrilobular micronodules

A

nTB/mTB infection, HP, RB-ILD, pneumoconioses, endobronchial tumor spread

160
Q

NSIP features - histology

A

less common than UIP, histo - homogenous inflammation or fibrosis (UIP is heterogenous)
- cellular and fibroitic
- common pattern in collagen vascular diseases

161
Q

cellular NSIP

A

GGO alone, or GGO + reticulationsparing of the immediate subpleural lung is highly predictive for NSIP

162
Q

fibrotic NSIP

A

GGO+ reticulation +/- traction bronchiectasis

163
Q

what finding is highly specific for NSIP

A

immediate subpleural sparing

164
Q

RB-ILD/DIP association?

A

almost all smoking related

165
Q

RB + symptoms =?

A

RB ILD

166
Q

treatment for RB ILD/DIP

A

STOP SMOKING
steroids

167
Q

RB ILD features

A

intraalveolar macrophages with little fibrosis
GGO, small nodules (ill defined, centriblobular), no particular distribution

168
Q

DDx for pulmonary consolidation

A

Dependent on symptom duration
acute: PNA, edema, hemorrhage, diffuse alveolar injury
Chronic: OP, chronic eosinophilic PNA, mucinous adenoCA

169
Q

organizing PNA features - clinical

A

granulation tissue and patchy PNA
idiopathic, infection, fumes
presents with cough, SOB, fever

170
Q

Organizing PNA imaging features

A

patchy multifocal airspace consolidation/GGOs - often irregular shape
large nodules/masses 15%
peripheral and peribronchial distribution
fibrosis - uncommon, mild.
Atoll (reverse halo) sign - ring shape externally and black inside; highly predictive

171
Q

progressive massive fibrosis

A

formation of large mass-like conglomerates
predominantly upper lobes
associated with pneumoconioses (coal worker and silicosis)

172
Q

chronic eosinophilic PNA

A

idiopathic/known antigen, present with months of cough, SOB, low grade fever
50% have hx asthma. peripheral eosinophilic common.
identical to OP on CT - peripheral GGO, consolidation, upper lobe predominance.
responsive to steroids.

173
Q

GGO DDx

A

acuity of symptoms dependent:
acute: edema, hemorrhage, atypical PNA, diffuse alveolar injury
chronic: interstitial PNA, HP, chronic eosinophilic PNA, OP, atypical infection, alveolar proteinosis

174
Q

subacute HP features - clinical and imaging

A

acute, subA and chronic stage
most show in subacute stage: alveolitis - diffuse/patchy GGO, peribronchiolar granulomas (centrilobular nodules), cellular bronchitis (mosaic perfusion)

175
Q

chronic HP features

A

reticulation and traction bronchiectasis (no honeycoming, no subpleural predominance)
- upper lobes involved most severely

176
Q

perilymphatic nodule location

A

subpleural.
paraseptal and perifissural.
peribronchovascular

177
Q

perilymphatic nodules ddx

A

sarcoid
lymphangitis spread tumor
silicosis and CWP
amyloid
LIP

178
Q

sarcoid stages on CXR

A

0 - normal xr
1- hilar LA
2 - hilar LA + pulmonary nodules
3 - lung findings only
4- fibrosis

179
Q

sarcoid is associated with?

A

aspergillomas!

180
Q

differential for sarcoid

A

silicosis, CWP, end stage fibrosis

181
Q

random nodules description

A

everywhere. no predominant pattern, uniform distribution throughout lung

182
Q

random pulm nodule DDx

A

miliary TB and fungal
hematogenous mets
sarcoid as well!

183
Q

centrilobular nodules description

A

most peripheral nodules will be 5-10 mm away from pleura!
appears diffuse and uniform, but none at the pleural surface

184
Q

multiple nodules ->
- subpleural nodules present: if patchy/nonuniform -> perilymphatic. diffuse and uniform -> random.
- no subpleural -> centrilobular

A

/

185
Q

centrilobular nodule DDx

A

small airways disease: bronchiolitis
endobronchial spread of TB/MAC
HP
RB-ILD
endobronchial tumor spread (mucinous)
bronchoPNA
penumoconioses

186
Q

tree-in-bud nodules description

A

dilation and impaction of centrilobular airways, very common/likely to be infectious
centered peripherally 5-10mm from pleura
associated with centrilobular nodules

187
Q

tree in bud nodule ddx

A

endobronchial TB/MAC
bronchitis/bronchiolitis/bronchoPNA
CF
aspiration
ABPA

188
Q

centrilobular emphysema description

A

upper lobe predominant centrilobular lucencies (enlargement of the airspace with destruction of the alveolar walls)
without defined cyst walls

189
Q

panlobular emphysema description

A

destruction and expansion of the airspace involving entire secondary pulm lobule, diffuse or basal-predominant lucency/loss of lung architecture
(associated with alpha 1 ATD, swyer-james)

190
Q

paraseptal emphysema description

A

morphological subtype of emphysema with lucencies adjacent to the pleural surface measuring up to 10mm. above = subpleural blebs

191
Q

Pulmonary emphysema is defined as ?

A

abnormal permanent enlargement of airspaces distal to the terminal bronchioles accompanied by destruction of the alveolar wall, without obvious fibrosis

192
Q

lung cyst vs emphysema?

A

cysts have a defined wall.

193
Q

ddx for pulmonary cysts

A

honeycombing
emphysema
pneumatocele
HP (rare)
pLCH
LAM/TSLAM
LIP
BHD

194
Q

direct & indirect signs of atelectasis

A

Direct: band-like lung tissue, movement of fissure, vessel crowding
Indirect (movement of other structures): shift of mediastinum/hilum/diaphragm, rib crowding

195
Q

4 types of atelectasis

A

obstructive (gas absorbed but not replaced)
relaxation (passive)
adhesive (surfactant deficiency)
cicatricial (archiectural distortion)

Case review (8 decks)

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