chestradiologyflash Flashcards
Patients with Sjogren syndrome are at increased risk for developing what diffuse lung diseases
Lymphocytic interstitial pneumonitis (LIP). Non-Hodgkin pulmonary lymphoma.
Ankylosing spondylitis lung involvement
Young to middle-aged man with spine changes (kyphosis, spinal ankylosis). Increased lung volumes. Upper lobe fibrobullous disease. Simulates postprimary fibrocavitary Tb or mycetoma formation.
These histologic terms provide the most precise method of classifying the idiopathic interstitial pneumonias
UIP. Acute interstitial pneumonia (AIP). COP. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). DIP. Nonspecific interstitial pneumonia (NSIP).
Usual Interstitial Pneumonia
Most common of the idiopathic interstitial pneumonias. Most cases are sporadic. 30% of cases associated with collagen vascular or immunologic disorder. Findings: Irregular septal or subpleural thickening. Intralobular lines. Honeycombing. Traction bronchiectasis. Typically most severe in peripheral and basal lungs.
Acute Interstitial Pneumonia
Diffuse ground-glass opacity and consolidation with air bronchograms. Linear opacities, honeycombing, and traction bronchiectasis are uncommon.
Conditions associated with BOOP, organizing pneumonia.
Viral infection (influenza, adenovirus, measles). Toxic fume inhalation (sulfur dioxide, chlorine). Collagen vascular disease (rheumatoid arthritis and SLE). Organ transplantation (bone marrow, lung, and heart-lung). Drug reactions. Chronic aspiration.
Cryptogenic Organizing Pneumonia
Idiopathic form of organizing pneumonia. Most common finding: Patchy consolidation or ground-glass opacity with subpleural or peribronchial distribution. Scattered nodular opacities may be present.
Respiratory Bronchiolitis-Associated Interstitial Lung Disease
Typically young, heavy smokers. Scattered ground-glass opacities. Small centrilobular nodules with upper lobe predominance.
Desquamative Interstitial Pneumonia
95% are cigarette smokers. Cannot be radiologically distinguished from UIP. Bibasilar reticular opacities. Normal or midly decreased lung volumes. May have ground-glass opacities. Honeycombing is rare.
Neurofibromatosis ILD
Generally asymmetric upper lung bullae. Generally symmetric lower lung interstitial fibrosis.
Tuberous Sclerosis (TS) ILD
Indistinguishable from LAM. Symmetric bilateral reticular or reticulonodular opacities. Scattered lung cysts. Normal to increased lung volumes. Pneumothorax is common
Lymphangioleiomyomatosis
Exclusively in women. Lung cysts separated by interlacing bundles of smooth muscle. May obstruct lymphatics causing chylothorax. Poor prognosis.
Alveolar Septal Amyloidosis
Simulates silicosis or lung sarcoidosis. Upper lung reticulonodular opacities.
Chronic Aspiration Pneumonia
Irregular reticular interstitial opacities.
3 major pneumoconioses
Asbestosis. Silicosis. CWP.
Asbestosis
Pleura: Parietal pleural plaques. Pleural effusion. Localized visceral pleural fibrosis. Diffuse pleural fibrosis. Mesothelioma. Lung parenchyma: Interlobular septal thickening. Interstitial fibrosis (asbestosis). Rounded atelectasis. Bronchogenic carcinoma. Lower lung predominance.
Silicosis
Mining, ceramic work, and sandblasting. Upper lobe and parahilar nodules. Nodule calcification may occur. Egg shell calcification of hilar lymph nodes. Silicoproteinosis like alveolar proteinosis has increased susceptibility to TB.
Coal Worker’s Pneumoconiosis
Predominantly upper lung reticulonodular or small nodular opacities.
Rare Pneumoconioses
Berylliosis. Aluminum. Hard metal (cobalt, tungsten).
Hypersensitivity Pneumonitis
Inhaled antigenic organic dusts: Farmer’s lung (moldy hay). Humidifier lung (thermophilic bacteria). Bird-fancier’s lung (avian proteins). Acute and chronic forms. Chronic disease findings: Interlobular and intralobular interstitial thickening. Honeycombing, Traction bronchiectasis. May spare costophrenic angles.
Lung Sarcoidosis staging
0 Normal chest radiograph. 1 Bilateral hilar lymph node enlargement. 2 Bilateral hilar lymph node enlargement and parenchymal disease 3. Parenchymal disease only. 4 Pulmonary fibrosis.
Sarcoidosis ILD
Common findings: Symmetric hilar adenopathy allows distinction from malignancy and TB. Symmetric mid and upper lung reticulonodular opacities. Perilymphatic interstitial nodules, 3 to 10 mm.
Langerhans Cell Histiocytosis of Lung
Very high association with cigarette smoking. Mid and upper lung centrilobular small nodules. In late stages may develop cysts or bullae. Risk of pneumothorax. Nodule-cyst evolution: Nodule to Cavitated nodule to Thick-walled cyst to Thin-walled cyst.
Wegener Granulomatosis
Necrotizing granulomatous vasculitis involving upper and lower respiratory tracts and kidneys. Discrete nodules or masses with central necrosis and cavitation. May mimic Goodpasture syndrome and idiopathic pulmonary hemorrhage. Tracheal or bronchial lesions may be present. c-ANCA positive.
Chronic Eosinophilic Pneumonia
Symptoms and radiographic abnormalities last longer than 1 month. Predilection for women. Responds to corticosteroid therapy, improving within 4 to 7 days. Peripheral, homogeneous, ill-defined areas of consolidation that may parallel the chest wall
Hypereosinophilic syndrome
Male predominance. Blood eosinophilia. Cardiomegaly. Pulmonary edema. Pleural effusions. Pulmonary parenchymal infiltration with eosinophils may produce interstitial or airspace opacities.
Eosinophilic Lung Disease Associated With Autoimmune Diseases
Wegener granulomatosis. Sarcoidosis. Rheumatoid lung disease. Polyarteritis nodosa. Allergic angiitis and granulomatosis.
Eosinophilic Lung Disease of Identifiable Etiology
Drugs (Nitrofurantoin and Penicillins). Parasites (Ascaris lumbricoides, Strongyloides stercoralis).
Pulmonary alveolar proteinosis
Lipoproteinaceous material deposits within alveoli. Predilection for males in their 20s to 40s. Bilateral symmetric perihilar airspace opacification. Crazy paving CT finding: Geographic ground-glass opacities with thickened interlobular and intralobular septa. Prone to superinfection with Nocardia, Aspergillus, Cryptococcus, and atypical mycobacteria.
Alveolar microlithiasis
Deposition of minute calculi within alveolar spaces. Confluent bilateral dense micronodular opacities. So-called black pleura sign. Apical bullous disease is common.
Diffuse pulmonary ossification
Formation of bone within lung parenchyma. Associations: Mitral stenosis. UIP. Amyloidosis.
Tracheocele
Paratracheal air cysts. True diverticula. Occur at weakened posterior membrane of cervical trachea.
Tracheal bronchus
Bronchus suis. Accessory bronchus to all or a portion of right upper lobe. Arises from right lateral tracheal wall within 2 cm of tracheal carina. Associated with congenital tracheal stenosis and aberrant left pulmonary artery.
Primary neoplasms of trachea
Malignant: Squamous cell carcinoma. Adenoid cystic carcinoma (cylindroma). Benign: Chondroma.ÿFibroma.ÿSquamous cell papilloma.ÿHemangioma.
Tracheal Narrowing
Saber-sheath trachea. Amyloidosis. Tracheobronchopathia osteochondroplastica. Relapsing polychondritis. Wegener granulomatosis. Tracheal scleroma.
Tracheal dilation
Tracheobronchomegaly (Mounier-Kuhn syndrome). Tracheomalacia. Interstitial pulmonary fibrosis.
Saber-sheath trachea
Coronal diameter is less than two thirds of sagittal diameter. Affects older men with chronic obstructive pulmonary disease (COPD).
Tracheobronchopathia osteochondroplastica
Multiple submucosal osseous and cartilaginous deposits within trachea and central bronchi of elderly men. Spares membranous posterior wall of trachea.
Relapsing polychondritis
Systemic autoimmune disorder. Affects cartilage of earlobes, nose, larynx, tracheobronchial tree, joints, and large elastic arteries. Diffuse smooth wall thickening of the wall of trachea and central bronchi with luminal narrowing.
Tracheobronchomegaly (Mounier-Kuhn syndrome)
Congenital. Associated with Ehlers-Danlos syndrome. Men under age 50. Trachea and central bronchi measure greater than 3.0 cm and 2.5 cm.
Tracheobronchomalacia
Diffuse tracheal and central bronchial dilation. Congenital or acquired (COPD, Chronic bronchitis, Cystic fibrosis, Relapsing polychondritis).
Fallen lung sign
Subtended lung remains collapsed against lateral chest wall. Secondary to bronchial injury. Responds poorly to chest tube evacuation.
Broncholithiasis
Calcified material within bronchus. Usually from eroding calcified lymph nodes (Histoplasmosis or TB).
Asthma
Transient bronchial narrowing. Peribronchial cuffing and tram tracking. Air trapping: Hyperinflation, Flattening or inversion of diaphragm, Attenuation of peripheral vascular markings. Prominence of the retrosternal airspace. Complications: Pneumomediastinum. Pneumothorax, Subpleural blebs from expiratory air dissection.
Chronic bronchitis
Excess production of sputum on most days for at least 3 months in 2 consecutive years. 50% have normal chest radiographs. Some patients show peribronchial cuffing or tram tracks.
Bronchiectasis
Permanent dilation of bronchi. Cylindric bronchiectasis: mild diffuse dilation. Varicose bronchiectasis: cystic dilation interrupted by focal areas of narrowing. Cystic bronchiectasis: localized saccular dilation. Caused by chronic inflammation with cartilage damage and dilation. Localized bronchiectasis is most commonly a result of prior TB. Generalized bronchiectasis is seen in cystic fibrosis. Central bronchiectasis: Allergic bronchopulmonary aspergillosis. Cystic fibrosis. Bronchial atresia. Acquired central bronchial obstruction.
Cystic fibrosis
Production of abnormally thick, tenacious mucus. Recurrent infection commonly with Pseudomonas aeruginosa or Staphylococcus aureus. Severe bronchiectasis. Hyperinflation with predominantly upper lobe bronchiectasis and mucus plugging.
Dysmotile cilia syndrome
May result in Rhinitis. Sinusitis. Bronchiectasis. Dysmotile spermatozoa and sterility. Situs inversus. Dextrocardia.
Kartagener syndrome triad
Sinusitis. Situs inversus.. Bronchiectasis.
Allergic bronchopulmonary aspergillosis
Hypersensitivity reaction to Aspergillus. Asthma, blood eosinophilia, bronchiectasis with mucus plugging, and circulating antibodies to Aspergillus antigen. Proximal upper lobe bronchiectasis with mucoid impaction. Finger in glove appearance.
Emphysema
Permanent enlargement of airspaces distal to terminal bronchiole. Destruction of alveolar walls without obvious fibrosis.
Centrilobular emphysema
Airspace distention in central portion of lobule. Spares distal portions of the lobule. Upper lobe predominance. Associated with cigarette smoking.
Panlobular emphysema
Distention of airspaces throughout lobule. Destruction of central respiratory bronchioles and peripheral alveolar sacs and alveoli. Predilection of lower lobes. Associated with alpha-1 antitrypsin deficiency.
Paraseptal emphysema
Distention of peripheral airspaces adjacent to interlobular septa. Spares centrilobular region. Generally involves subpleural regions of upper lobes.
Paracicatricial or irregular emphysema
Lung destruction associated with fibrosis. No consistent relationship to a given portion of the lobule. Commonly associated with old granulomatous inflammation.
Emphysema findings
Diffuse hyperlucency (panlobular). Flattening and depression of hemidiaphragms. Increased retrosternal airspace (panlobular > centrilobular). Bulla. Enlarged central pulmonary arteries. Right heart enlargement (centrilobular). Loss of pulmonary capillary bed.
Arterial deficiency emphysema versus increased markings emphysema.
Arterial deficiency: Predominantly panlobular emphysema. Hyperinflated lungs with peripheral vascular attenuation and bullae. Pink Puffers. Increased markings: Increased linear parenchymal markings. Small airways thickening of chronic bronchitis. Bullae uncommon. Blue Bloaters.
Bulla defined
Thin-walled cystic space > 1 cm in diameter. Found within lung parenchyma.
Bullae may be seen in diseases that cause chronic upper lobe fibrosis, such as
Sarcoidosis. Pulmonary Langerhans cell histiocytosis. Ankylosing spondylitis.
Primary bullous disease
Isolated bullae without intervening emphysema or interstitial lung disease. Associated with: Marfan or Ehlers-Danlos syndromes. Intravenous drug use. HIV infection. Vanishing lung syndrome.
CT findings and associations of infectious bronchiolitis
Tree-in-bud opacities. Generally due to infection: Viral. Atypical. Mycobacterial.
CT findings of diffuse panbronchiolitis
Tree-in-bud opacities. Bronchial dilation and thickening.
CT findings and associations of Respiratory bronchiolitis?associated interstitial lung disease
Centrilobular and geographic ground-glass opacities. Cigarette smoking.
CT findings and associations of Hypersensitivity pneumonitis (subacute)
Centrilobular ground-glass nodules. Air trapping on expiratory scans. Inhaled organic antigen.
CT findings and associations of Follicular bronchiolitis
Centrilobular ground-glass nodules. Rheumatoid arthritis. Sj”gren syndrome.
CT findings and associations of Constrictive bronchiolitis
Mosaic attenuation with air trapping on expiratory scans. Bronchial dilation (late). Transplant patients. Drug reactions. Inhalation injury.
Transudative pleural effusion lab values
Pleural/serum protein ratio less than 0.5. Pleural/serum LDH ratio less than 0.6. Pleural LDH less than 200 IU/L.
Infectious causes of pleural effusion?
Bacterial/mycobacterial. Viral. Fungal. Parasitic.
Cardiovascular causes of pleural effusion?
Heart failure. Pericarditis. Superior vena cava obstruction. Postcardiac surgery. Myocardial infarction. Pulmonary embolism.
Neoplastic causes of pleural effusion?
Bronchogenic carcinoma. Metastases. Lymphoma. Pleural or chest wall neoplasms (mesothelioma).
Immunologic causes of pleural effusion?
Systemic lupus erythematosus. Rheumatoid arthritis. Sarcoidosis (rare). Wegener granulomatosis.
Inhalational cause of pleural effusion?
Asbestosis.
Trauma causes of pleural effusion?
Blunt or penetrating chest trauma.
Abdominal disease causes of pleural effusion?
Cirrhosis (hepatic hydrothorax). Pancreatitis. Subphrenic abscess. Acute pyelonephritis. Ascites (from any cause). Splenic vein thrombosis.
Miscellaneous causes of pleural effusion?
Drugs. Myxedema. Ovarian tumor.
Pleural effusion from congestive heart failure features
Transudative. Bilateral, right larger than left. Isolated right effusion twice as common as isolated left effusion.
Findings on CT that are fairly specific for the presence of an exudative pleural effusion
Thickening and enhancement of parietal pleura. Loculations. Soft tissue lesions along parietal pleura outlined by pleural fluid.
Tumors most commonly associated with pleural effusion are, in order of frequency,
Lung carcinoma. Breast carcinoma. Pelvic tumors (ovarian fibroma = Meigs syndrome). Gastric carcinoma. Lymphoma.
Lung abscess versus empyema?
Empyema: Oval. Oriented longitudinally. Thin. Smooth (split pleura sign). Obtuse chest wall angle. Compresses lung. Requires drainage. Abscess: Round. Thick and irregular wall. Acute chest wall angle. Consumes lung. Antibiotics and postural drainage to treat.
Most common intrathoracic manifestation of rheumatoid arthritis
Pleural effusion.
Most common causes of chylothorax are
Malignancy. Iatrogenic trauma. TB
Left chylothorax versus right chylothorax?
Left chylothorax: Injury to upper duct. Right chylothorax: Injury to lower duct.
Bronchopleural Fistula
Communication between lung and pleural space. If bronchus involved, may result in empyema. If peripheral airspace (bronchiole) involved, may result in intractable pneumothorax.
Primary spontaneous pneumothorax
Often occurs in young or middle-aged men. Predilection of taller individuals. Results from bleb or bulla rupture, usually within upper lungs.
Secondary Spontaneous Pneumothorax
COPD. Asthma. Valsalva (cocaine, marijuana, labor). Sarcoidosis. Langerhans cell histiocytosis. Lymphangioleiomyomatosis. Necrotizing pneumonia. Abscess. Mechanically ventilated patients.
Catamenial pneumothorax
Rare recurrent pneumothoraces. Occurs with menses. Pleural endometrial implants. Treated with OCPs.
Most common cause of tension pneumothorax
Iatragenic trauma in mechanically ventilated patients.
Causes of pleural thickening
Pneumonia. Pulmonary infarct. Trauma. Asbestos exposure (bilateral).
Causes of pleural calcification
Visceral pleura:ÿHemothorax,ÿEmpyema (tuberculosis). Parietal pleura:ÿÿAsbestos exposure (bilateral).
Causes of pleural/extrapleural masses
Benign:ÿFibroma.ÿLipoma.ÿNeurofibroma.ÿMalignant:ÿMetastases (usually multiple).ÿÿMesothelioma (usually diffuse pleural thickening). Other: Loculated pleural effusion/empyema. Hematoma.
Fluid within calcified pleural layers seen on CT suggests
Active empyema. Most commonly within patients with prior TB.
Fibrothorax
Pleural thickening extending over more than one fourth of the costal pleural surface. Commonly results from resolution of an exudative pleural effusion (including asbestos-related effusions), Empyema, or Hemothorax. Pleurectomy (decortication) may be necessary to restore function.
Malignant pleural disease is most often caused by one of four conditions:
Metastatic adenocarcinoma (lung, breast, ovary, kidney, GI tract). Invasive thymoma or thymic carcinoma. Mesothelioma. Rarely non-Hodgkin lymphoma.
Benign and malignant Asbestos-Related Pleural Diseases
Benign: Pleural plaques. Pleural effusions. Diffuse pleural fibrosis. Malignant: Mesothelioma.
When viewed en face, calcified pleural plaques appear as
Geographic opacities. Llikened to a holly leaf.
Poland syndrome
Autosomal recessive disorder. Unilateral absence of sternocostal head of pectoralis major. Ipsilateral syndactyly. Rib anomalies.
Most common benign neoplasm of chest wall
Lipoma
Most common malignant soft tissue neoplasms of the chest wall in adults.
Fibrosarcomas. Liposarcomas.
A rare malignant neoplasm arising from the chest wall of children and young adults
Askin tumor. Arises from primitive neuroectodermal rests. Very aggressive with a poor prognosis.
Benign chest wall lesions
Abscess. Hematoma. Lipoma. Hemangioma. Desmoid tumor.
Inferior rib notching causes
Coarctation of aorta. Aortic thrombus. Takayasu arteritis. SVC syndrome. Neurofibromatosis.
Suprior rib notching cause
Paralysis.
Benign rib neoplasms, most common first
Osteochondroma. Enchondroma. Osteoblastoma.
Most common primary rib malignancy
Chondrosarcoma.
Rib malignancies
Most common: Myeloma. Metastatic carcinoma. Primary malignancies: Chondrosarcoma. Osteogenic sarcoma. Fibrosarcoma.
Most common metastatic lesions to ribs
Breast cancer. Lung cancer.
Expansile lytic rib metastases are seen most commonly from
Renal cell carcinoma. Thyroid carcinoma.
Sclerotic rib metastases are most commonly seen in
Breast cancer. Prostate cancer.
Pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include
TB. Actinomycosis. Nocardiosis.
Sprengel deformity
Congenital hypoplastic and elevated scapula.
Klippel-Feil syndrome.
Sprengel deformity (hypoplastic, elevated scapula). Omovertebral bone. Fused cervical vertebrae. Hemivertebrae. Kyphoscoliosis. Rib anomalies.
Erosion of the distal clavicles
Rheumatoid arthritis: Well-defined pointed distal clavicle. Hyperparathyroidism: Irregular and wide distal clavicle.
H-shaped or Lincoln log vertebrae on lateral chest radiographs
Sickle cell anemia.
Rugger jersey appearance to thoracic spine on lateral chest radiographs
Renal osteosclerosis.
Pectus excavatum is commonly associated with congenital connective tissue disorders, such as
Marfan syndrome. Poland syndrome. Osteogenesis imperfecta. Congenital scoliosis.
Pectus carinatum
Outward bowing of sternum. May be congenital or acquired.
Eventration of the diaphragm
Congenital absence or underdevelopment of diaphragmatic musculature. Localized elevation of anteromedial hemidiaphragm in older individuals.
Unilateral diaphragmatic paralysis is usually caused by
Surgical injury or neoplastic involvement of phrenic nerve.
Bilateral Diaphragmatic Elevation that is not effort related may be caused by
Neuromuscular disturbance. Intrathoracic or intra-abdominal disease.
Bochdalek Hernia
Herniation through embryonic pleuroperitoneal canal. Neonates present with large hernias with lung hypoplasia and respiratory distress. Adults present with small hernias, mostly on the left side (liver thought to be protective).
Morgagni Hernia
Parasternal diaphragm defect. Invariably right sided. Asymptomatic cardiophrenic angle mass.
Primary diaphragmatic tumors
Benign: Lipomas. Fibromas. Schwannomas. Neurofibromas. Leiomyomas. Echinococcal cysts and extralobar sequestrations may be found within the diaphragm. Metastatic invasion more common than primary malignancy (Fibrosarcoma): Lower lobe bronchogenic carcinoma. Mesothelioma.
Cystic adenomatoid malformation
Usually seen in infancy. One or several large cysts lined with respiratory epithelium with scattered mucous glands, smooth muscle, and elastic tissue. Round, air-filled masses that compress adjacent lung and mediastinum.
Bronchial atresia presentation
Central bronchial mucocele with peripheral hyperlucency in a young, asymptomatic patient.
Intralobar and extralobar sequestration blood supply and drainage
Intralobar sequestration: Single large artery from infradiaphragmatic aorta. Pulmonary vein drainage. Extralobar sequestration: Small branches systemic arteries and occasionally pulmonary arteries. Systemic venous drainage (inferior vena cava, azygos, or hemiazygos veins).
Hypogenetic lung-scimitar syndrome
Variant of hypoplastic lung with abnormal venous drainage to the IVC just above or below right hemidiaphragm. Small right hemithorax with diaphragmatic elevation or eventration. Dextroposition of heart. Herniation of left lung anteriorly into right hemithorax.
Three radiographic patterns of aspiration pneumonitis
Extensive bilateral airspace opacification. Diffuse but discrete airspace nodular opacities. Irregular parenchymal opacities that are not obviously airspace.
Exogenous lipoid pneumonia
Older patients with swallowing disorders or gastroesophageal reflux. Use mineral oil as a laxative or inhale oily nose drops. Fat density opacity.
Drug that cause drug induced chest diseases
Lupus-like syndrome (procainamide, isoniazid, hydralazine). Nitrofurantoin. Bleomycin. Methotrexate. Amiodarone.
A confident diagnosis of hamartoma can be made when HRCT shows
Nodule less than 2.5 cm with a smooth or lobulated border and containing focal fat. May have popcorn calcification.
Benign neoplasm arising from neural elements in the central airways or lung parenchyma. The skin is the most common site for these tumors.
Granular cell myoblastoma.
Bronchogenic adenocarcinoma features
Most common type of lung cancer (nonsmokers, too). Arise from bronchiolar or alveolar epithelium. Irregular or spiculated appearance. ccur in the lung periphery.
Bronchioloalveolar cell carcinoma (BAC)
Grows along bronchiolar and alveolar walls (lepidic growth). May appear as: Solitary nodule. Focal ground-glass opacity. May mimic pneumonia or bilateral nodular airpsace processes.
Squamous cell carcinoma features
Arises centrally within lobar or segmental bronchi. Central necrosis with cavitation may be seen. Generally presents as hilar mass and atelectasis.
Small cell carcinoma features
Arises centrally within main or lobar bronchi from bronchial neuroendocrine (Kulchitsky) cells. Hematogenous dissemination. Hilar/mediastinal mass.
Large cell bronchogenic carcinoma radiographic feature
Large peripheral mass.
In addition to cigarette smoke, well-recognized risk factors for the development of bronchogenic carcinoma include
Asbestos exposure. Previous Hodgkin lymphoma. Radon exposure. Viral infection. Diffuse interstitial or localized lung fibrosis.
Most common radiographic findings from endobronchial tumor obstruction.
Resorptive atelectasis. Obstructive pneumonitis.
Majority of pancoast tumors, histology type
SCC. Adenocarcinoma.
Pancoast tumor symptoms
Arm pain and muscular atrophy due to brachial plexus involvement. Horner syndrome (ptosis, anhydrosis, miosis) from involvement of sympathetic chain. Shoulder pain from chest wall invasion.
CT angiogram sign and BAC
Filling of airspaces with mucoid material produced by malignant cells creates low-density airspace opacification surrounding enhanced pulmonary arteries.
Typical radiologic findings of lymphangitic carcinomatosis
Linear and reticulonodular opacities. Peribronchial cuffing. Subpleural edema or pleural effusion.
Helps distinguish lymphangitic carcinomatosis due to lung cancer from other metastases
Unilateral or asymmetric involvement of lungs suggests lung cancer rather than an extrapulmonary site.
Two patient groups of small cell lung cancer
Disease limited to one hemithorax (limited disease). Contralateral lung or extrathoracic spread (extensive disease).
Two most common primary tracheal malignancies
SCC > Adenoid cystic carcinoma
Tracheal mass size and malignancy
Masses > 2 cm are likely to be malignant. Less than 2 cm are more likely benign.
Other, less common primary tracheal malignancies
Mucoepidermoid carcinoma. Carcinoid tumor. Adenocarcinoma. Lymphoma. Small cell carcinoma. Leiomyosarcoma. Fibrosarcoma. Chondrosarcoma.
Primary malignant neoplasms of the central bronchi include
Squamous cell carcinoma. Small cell carcinoma. Carcinoid tumor. Bronchial gland tumors (adenoid cystic carcinoma, mucoepidermoid carcinoma).
Carcinoid radiologic features
Prefers right upper and middle lobes. Well-defined smooth or lobulated nodules or masses. Iceberg tumor: small intrabronchial and large extraluminal soft tissue component.