Chest Random Facts

Question 1

Cervicothoracic sign

Answer 1

If a superior mass is well marg0inated by the lungs, it is in the posterior mediastinum

Question 2

Thoracoabdominal sign

Answer 2

If an inferior mass is well marginated by the lungs, then it is in the posterior mediastinum

Question 3

Hilar overlay sign

Answer 3

If hilar vessels are seen crossing through the mass, then it is in either the anterior or posterior mediastinum (not the middle mediastinum)

Question 4

Upper lobe predominant lesions

Answer 4

STCASH

• Sarcoidosis
• TB
• CF
• Ankylosing spondylitis
• Silicosis
• Histiocytosis X

Question 5

Lower lobe predominant lesions

Answer 5

U BAD ASS

• UIP - basal/subpleural, costophrenic angle
• Bronchiectasis
• Asbestosis
• Drugs
• Aspiration
• Scleroderma
• SLE

Question 6

Signs for silicosis/CWP

Answer 6

• eggshell calcification of lymph nodes
• progressive massive fibrosis (PMF)

Question 7

A bump on the right superior medistinum

Answer 7

May just be tortuous ascending aorta

Question 8

RUL bronchus and carina at the same level

Answer 8

RUL bronchus and carina at the same level

Question 9

Asymmetric main and left pulmonary artery dilatation with sparing of the right pulmonary artery

DDx?

Answer 9

• Rheumatic heart disease - mitral stenosis
• Pulmonary stenosis
• Pulmonary atresia
• Carcinoid syndrome
• Tetraology of Fallot

Question 10

Thymoma

Answer 10

• drop mets in the pleural space
• mediastinal LAD uncommon

Question 11

Right ventricular hypertrophy

Answer 11

• Heart rotates - straightens up the left heart border
• Obliterates the retrosternal air space
  *

Question 12

How to tell different types of valve replacement

Answer 12

middle 3 fingers

T-A-M

Question 13

An air-fluid level on CXR

how do you localize it?

Answer 13

• if the air fluid level is same length on PA and lateral projection, it’s probably in the lung parenchyma - abscess
• if it is wider on one projection, narrower on the other, it’s probably in the pleural space

Question 14

approach to work through patchy GGO

or

mosaic attenuation

Answer 14

• decide which is abnormal, the GGO or lucent part?
• if GGO is abnormal - infection, inflammation, edema, etc
• if lucency is abnormal
  
  • may be small airway disease or small vessel disease
  • if there is air trapping on expiratory view – small airway trapping
  • if there is no air trapping - then more likely small vessel

Question 15

DDx for peripheral conslidations

Answer 15

• COP
• eosinophilic pneumonia
• churg-strauss syndrome

Question 16

Inexorable

Answer 16

Impossible to stop or prevent

Question 17

Esophageal cancer nodal spread

Answer 17

• subcarinal
• paraesophageal
• gastrohepatic
• celiac axis

Question 18

Right cardiophrenic angle mass

Answer 18

• epicardial fat pad
• pericardial cyst
• Morgagni hernia
• cardiophrenic lymph node/lymphoma

Question 19

Pericardial calcification

Answer 19

• most likely inflammatory in nature
  
  • viral - most common
  • TB
  • uremic
  • post-cardiac Sx
• Thin, egg-shell like calcification is more often associated with viral infection or uremia
• Calcification from old TB is often thick, confluent, and irregular in appearance, especially when compared with myocardial calcification

Question 20

Answer 20

Pericardial calcification