Chest Radiology: Airspace and Diffuse Parenchymal Lung Disease

Question 1

Answer 1

confluent opacity- left hemidiaphragm is not continuous

Question 2

characteristic sign of airspace disease

Answer 2

Increased density in lung results
in lack of differentiation from
adjacent soft tissues

• silhouette sign refers to the loss of normal borders between thoracic structures. It is usually caused by an intrathoracic radiopaque mass that touches the border of the heart or aorta.

Question 3

what is the arrow pointing to and what causes it

Answer 3

cavitation

• necrotizing pneumonia
• post infection/TB

Question 4

characteristic signs of atelectasis

Answer 4

• look for mediastinal shift
• traheal shift or heart shift.
• here, the left lobe is collapsin, pulling the heart into the left negative space

Question 5

which one is collapsed? consolidated?

Answer 5

the left picture; heart is being pushed into the right lung side, looks like an expansive masse ffect. trachea also being pushed to right. consolitaiton

in the right picture, this is a lung collapse. the trachea is deviating to the affected sign, indicating a pressure.

Question 6

characteristic sign of subsegmental atelectasis

Answer 6

• part of a segment collpases usually post operatively. vessels should go up and down, but not usually horizontally. If you see horizontal lines parallel to the hemidiaphragm, it’s a subsegmental atelectasis.
• they usually self resolve.

Question 7

definition of interstitial lung disease

Answer 7

disease which affects connective tissues and supporting structures. usually presents as linear or nodular opacities.

Question 8

Kerly lines are a sign of ILD. Kerley B lines can be due to:

Answer 8

congestive heart dailure or lymphanditic carcinomatosis.

Question 9

pathogenesis of Kerley lines

Answer 9

seen when there is thickening of the interlobular septa producing kerley lines.

Question 10

Keryley B lines can be seen in congestive heartfailure when ___ ___ causes thickening of interlobular septa

Answer 10

pulmonary edema

• also can be due to lymphangitic carcinomatosis or fibrosis

Question 12

cause of the kerley B lines in this ct

Answer 12

you can see the sclerotic bone metastasis, probably most due to lymphangitic carcinomatosis

Question 13

sarcoidosis (or silicosis) is usuallt a ___ interstitial lung disease prsentataion

Answer 13

a nordular interstitial lung disease

Question 14

DX/

Answer 14

• nodular ILD
• could be sarcoid because of how the nodules are more in the bottom lung with RANDOM pattern:

Question 15

ddx for upper vs lower lung zone pattern of nodular interstitial lung disease.

Question 16

Answer 16

Effusions. there is blunting of the costophrenic angle

Small free-flowing pleural effusions within the most dependent region of the thoracic cavity, the posterior costophrenic angles

• could be congestive heart failure

Question 18

note: pulmonary edema looks different depending on the pressure.
- in this pic,it’s probably interstitial or alveolar edema.

Answer 18

this person is short of breath with indistinc vasculature on CXR. this is pulmonary venous hypertension. Less hypertesnion than alveolar edema.

Question 19

at what stage of pulmonary edema would you see kerly B lines

Answer 19

mid-late stages of pulmonary edema .there is a higher interstitial pulmonary edema.