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Fundamentals Torax > Core Thorax > Flashcards

Core Thorax Flashcards

1
Q

Bronchial segmental anatomy

A

Boyden classification:

Right lung: LSD (Apical, posterior, anterior), LMD (lateral, medial), LID (superior, basal medial, anterior, lateral posterior).

Left lung: LSI (Apicoposterior, anterior, superior, inferior lingula), LII (superior, basal anteromedial, lateral, posterior).

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1
Q

Accesory fissures

A
  • Azygos fissure: 1% of patients, LSD apical.
  • Superior accesory fissure: 5% of patients, LID superior / basal.
  • Inferior accesory fissure: 12% of patients, LID medial/rest.
  • Left minor fissure: 8% of patients, lingula/LSI.
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2
Q

Atelectasis causes

A
  • Obstructive.
  • Relaxative.
  • Adhesive.
  • Cicatricial.
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3
Q

Left upper lobe atelectasis

A
  • Luftsichel sign.
  • Veil-like opacity on frontal RX, anterior displacement of major fissure and anterior collapsed lung on lateral RX.
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4
Q

Right upper lobe atelectasis

A
  • Golden S sign.
  • Right upper lobe opacity with superior displacement of the minor fissure.
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5
Q

Juxtaphrenic peak sign

A
  • Perodiaphragmatic triangular opacity caused by diaphragmatic traction from an inferior accesory fissure or an inferior pulmonary ligament.
  • Seen in upper lobe volume loss of any cause.
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6
Q

Left lower lobe atelectasis

A
  • Left triangular retrocardiac opacity.
  • Flat waist sign: flattening of the left heart border (posterior shift of hiliar structures and cardiac rotation).
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7
Q

Right lower lobe atelectasis

A
  • Right triangular retrocardiac opacity.
  • Loss of definition of right hemi-diaphragm.
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8
Q

Right middle lobe atelectasis

A
  • Silhouetting of the right heart border.
  • Lateral RX triangular opacity anteriorly.
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9
Q

Round atelectasis criteria (5)

A
  • Adjacent pleura must be abnormal.
  • Opacity must be peripheral and in contact with pleura.
  • Opacity must be round or elliptical.
  • Volume loss must be present in the affected lobe.
  • Pulmonary vessels and bronchi leading into the opacity must be curved (comet tail sign).
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10
Q

Elementos del lobulillo secundario

A

Bronquiolo terminal, respiratorio, ducto alveolar, saco alveolar, alveolo, arteria pulmonar, septo interlobulillar, vena pulmonar, vasos linfáticos centrolobulillares y septales.

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11
Q

Fill elements of consolidation

A

Pus, blood, water and cells

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12
Q

Acute consolidation differential diagnosis (5)

A
  • Pneumonia.
  • Pulmonary edema.
  • Aspiration.
  • ARDS.
  • Pulmonary hemorrhage.
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13
Q

Chronic consolidation differential diagnosis (4)

A
  • Lymphoma.
  • Organizing pneumonia.
  • Lung adenocarcinoma.
  • Chronic eosinophilic pneumonia.
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14
Q

Acute ground glass opacification differential diagnosis (4)

A
  • Pneumonia.
  • Pulmonary edema.
  • Pulmonary hemorrhage.
  • ARDS.
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15
Q

Chronic ground glass opacification DD (5)

A
  • Hypersensibility pneumonitis.
  • Lung adenocarcinoma.
  • Chronic eosinophilic pneumonia.
  • Organizing pneumonia.
  • ILD.
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16
Q

Peripheral ground glass or consolidation DD (3)

A
  • Chronic eosinophilic pneumonia.
  • Organizing pneumonia.
  • Pulmonary infarction.
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17
Q

Interlobular septal thickening - smooth DD (2)

A
  • Pulmonary edema.
  • Lymphangitis carcinomatosis.
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18
Q

Interlobular septal thickening - nodular DD (2)

A
  • Lymphangitis carcinomatosis.
  • Sarcoidosis.
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19
Q

Crazy paving DD (7)

A
  • Pulmonary alveolar proteinosis.
  • Pulmonary edema.
  • Pulmonary hemorrhage.
  • ARDS.
  • P. jiroveccii pneumonia.
  • Adenocarcinoma.
  • Lipoid pneumonia.
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20
Q

Centrilobular nodules DD (5)

A
  • Subacute hipersensitivity pneumonitis.
  • Pulmonary capillary hemangiomatosis.
  • Infectious bronchiolitis.
  • Aspiration bronchiolitis.
  • Metastatic calcification.
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21
Q

Perilymphatic nodules (3)

A
  • Sarcoidosis.
  • Pneumoconiosis (Silicosis or coal pneumoconiosis).
  • Limphangitic carcinomatosis.
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22
Q

Random nodules - Miliary pattern DD (3)

A
  • Metastasic disease.
  • Disseminated fungal infection.
  • Disseminated mycobacterial infection.
23
Q

Tree-in-bud opacities DD (5)

A
  • Mycobacterium infection.
  • Pneumonia.
  • Aspiration pneumonia.
  • Limphangitis carcinomatosis.
  • Vascular abnormalities (metastases, pulmonary artery aneurysms).
24
Q

Solitary cavitary lesion DD (4)

A
  • TBC.
  • Cavitary bacterial pneumonia.
  • Fungal pneumonia.
  • Primary bronchogenic carcinoma
25
Q

Multiple cavitary lesions DD (3)

A
  • Septic emboli.
  • Vasculitis (Ex: Granulomatosis with polyangiitis).
  • Metastases.
26
Q

Cystic lung disases DD (6)

A
  • Lymphangioleiomyomatosis,
  • Lymphoid interstitial pneumonia.
  • Pulmonary langerhans hystiocytosis.
  • Amyloidosis.
  • Birt-Hogg-Dubbe syndrome.
  • Pneumocystic jiroveci pneumonia.
27
Q

Single cyst DD (3)

A
  • Bulla (>1 cm).
  • Bleb (<1 cm).
  • Pneumatocele.
28
Q

Low lobe fibrotic changes DD

A
  • UIP.
  • NSIP.
  • Other causes of UIP (Asbestosis and AR).
29
Q

Uppler lobe fibrotic changes DD (3)

A
  • End-stage sarcoidosis.
  • Chronic hypersensibility pneumonitis.
  • End-stage silicosis
30
Q

Lobar pneumonia

A
  • Lobar consolidation.
  • Air bronchograms.
  • Usually bacterial in origin.
31
Q

Bronchopneumonia

A
  • Patchy peribronchial consolidation with air-space opacities.
  • Caused by aspiration, bacterial and viral pneumonias.
32
Q

Interstitial pneumonia

A
  • Ground glass opacities.
  • Atypical bacteria (Mycoplasma pneumoniae, chlamydia), viral or pneumocystis jirovecci.
33
Q

Round pneumonia

A
  • Children.
  • Usually due to S. pneumoniae.
  • Infection in retained due to incomplete formation of pores of Kohn.
34
Q

Complications of pneumonia (5)

A
  • Pulmonary abscess.
  • Pneumatocele.
  • Empyema.
  • Empyema neccesitans.
  • Bronchopleural fistula.
35
Q

Empyema characteristics

A
  • 3 phases: Free flowing exudative effusion, development of fibrous strands and fluid becomes solid and jelly-like.
  • Split pleura sign: Contrast enhanced CT shows enhancement of the thickened visceral and parietal pleural layers.
36
Q

Empyema neccesitans

A
  • Extiension of the empyema to the chest wall.
    -Most common due to TBC or Actinomyces.
37
Q

Pneumatocele

A
  • Thin-walled, gas-filled cyst, that may be post traumatic or as a sequela of pneumonia.
38
Q

Bronchopleural fistula

A
  • Abnormal communication between the airway and the pleural space.
  • Causes: Surgery, lung abscess, empyema, trauma.
39
Q

Tuberculosis phases

A
    1. Inicial disease (contained disease or primary TBC).
    1. Latent infection.
    1. Reactivation (post primary).
40
Q

Primary TBC

A
  • Infection from the first exposure to TBC.
  • Imaging: Lobar consolidation, pleural effusion and lymphadenopathy, miliary disease.
  • Ghon focus and Ranke complex.
  • Cavitation is rare.
41
Q

Ghon focus

A

Initial focus of parenchymal infection, usually located in the upper part of the lower lobe or lower part of the upper lobe.

42
Q

Ranke complex

A

Ghon focus + Lymphadenopathy.

43
Q

Reactivation (post-primary) TBC

A
  • Reactivation of dormant infection acquired earlier in life.
  • Affects upper lobe apical and posterior segments and superior segments of the lower lobes.
  • Imaging: Upper lobe predominant consolidation with cavitation, three in bud, low attenuation adenopathy, tuberculoma.
44
Q

Tuberculoma

A

Well-defined rounded opacity consisting of a peripheral fibrous wall with central caseation, usually in the upper lobes.

45
Q

Healed tuberculosis

A
  • Apical scarring.
  • Upper lobe volume loss.
  • Superior hiliar retraction.
  • Calcified granulomas.
46
Q

Miliary tuberculosis

A
  • Diffuse random distribution nodules seen in hematogenously disseminated TB.
47
Q

Atypical mycobacteria infection

A
  • 3 types: Nodular cavitary form, bronchiectasic form and disseminated form.
  • Lady Windermere syndrome
  • Common pathogens: M. avium intracellulare, M. Kansasii.
  • Imaging: Bronchiectasis and tree-in-bud opacities in the middle lobe and lingula.
48
Q

Hot-tub lung

A
  • Hypersensitivity pneumonitis due to atypical mycobacteria.
  • Imaging similar to HP, but with centrilobular nodules.
49
Q

Viral pneumonia

A
  • Centrilobular nodules, tree-in-bud opacities, patchy ground glass opacities and peribronchial consolidations.
50
Q

COVID19 infection

A
  • Bilateral, dependent, lower-lobe predominant ground glass opacities or consolidation.
51
Q

Pneumocystis jirovecci pneumonia

A
  • CD4 <200 cells/cc in T-cell deficiencies (AIDS, bone marrow or solid organ transplant).
  • Bilateral central airspace opacities of ground glass atenuation with thickening of interlobular septa (crazy paving).
  • Can cause pneumatoceles, pneumothorax and pneumomediastinum.
52
Q

Cryptococcus neoformans infection

A
  • Most common oportunistic fungal infection in AIDS.
  • Coexist with cryptococcal meningitis.
  • Imaging: wide range of appearances: ground glass attenuation, focal consolidation, cavitary nodules, miliary disease, lymphadenopathy or pleura effusion.
53
Q

Aspergillus infection types (5)

A
  • Allergic bronchopulmonary aspergillosis.
  • Saprohyptic aspergillosis (Aspergilloma).
  • Semi-invasive (chronic necrotizing) aspergillosis.
  • Airway-invasive aspergillosis.
  • Angio-invasive aspergillosis.
54
Q
A

Fundamentals Torax (2 decks)

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