Core Thorax Flashcards
Bronchial segmental anatomy
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).
Accesory fissures
- 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.
Atelectasis causes
- Obstructive.
- Relaxative.
- Adhesive.
- Cicatricial.
Left upper lobe atelectasis
- Luftsichel sign.
- Veil-like opacity on frontal RX, anterior displacement of major fissure and anterior collapsed lung on lateral RX.
Right upper lobe atelectasis
- Golden S sign.
- Right upper lobe opacity with superior displacement of the minor fissure.
Juxtaphrenic peak sign
- 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.
Left lower lobe atelectasis
- Left triangular retrocardiac opacity.
- Flat waist sign: flattening of the left heart border (posterior shift of hiliar structures and cardiac rotation).
Right lower lobe atelectasis
- Right triangular retrocardiac opacity.
- Loss of definition of right hemi-diaphragm.
Right middle lobe atelectasis
- Silhouetting of the right heart border.
- Lateral RX triangular opacity anteriorly.
Round atelectasis criteria (5)
- 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).
Elementos del lobulillo secundario
Bronquiolo terminal, respiratorio, ducto alveolar, saco alveolar, alveolo, arteria pulmonar, septo interlobulillar, vena pulmonar, vasos linfáticos centrolobulillares y septales.
Fill elements of consolidation
Pus, blood, water and cells
Acute consolidation differential diagnosis (5)
- Pneumonia.
- Pulmonary edema.
- Aspiration.
- ARDS.
- Pulmonary hemorrhage.
Chronic consolidation differential diagnosis (4)
- Lymphoma.
- Organizing pneumonia.
- Lung adenocarcinoma.
- Chronic eosinophilic pneumonia.
Acute ground glass opacification differential diagnosis (4)
- Pneumonia.
- Pulmonary edema.
- Pulmonary hemorrhage.
- ARDS.
Chronic ground glass opacification DD (5)
- Hypersensibility pneumonitis.
- Lung adenocarcinoma.
- Chronic eosinophilic pneumonia.
- Organizing pneumonia.
- ILD.
Peripheral ground glass or consolidation DD (3)
- Chronic eosinophilic pneumonia.
- Organizing pneumonia.
- Pulmonary infarction.
Interlobular septal thickening - smooth DD (2)
- Pulmonary edema.
- Lymphangitis carcinomatosis.
Interlobular septal thickening - nodular DD (2)
- Lymphangitis carcinomatosis.
- Sarcoidosis.
Crazy paving DD (7)
- Pulmonary alveolar proteinosis.
- Pulmonary edema.
- Pulmonary hemorrhage.
- ARDS.
- P. jiroveccii pneumonia.
- Adenocarcinoma.
- Lipoid pneumonia.
Centrilobular nodules DD (5)
- Subacute hipersensitivity pneumonitis.
- Pulmonary capillary hemangiomatosis.
- Infectious bronchiolitis.
- Aspiration bronchiolitis.
- Metastatic calcification.
Perilymphatic nodules (3)
- Sarcoidosis.
- Pneumoconiosis (Silicosis or coal pneumoconiosis).
- Limphangitic carcinomatosis.
Random nodules - Miliary pattern DD (3)
- Metastasic disease.
- Disseminated fungal infection.
- Disseminated mycobacterial infection.
Tree-in-bud opacities DD (5)
- Mycobacterium infection.
- Pneumonia.
- Aspiration pneumonia.
- Limphangitis carcinomatosis.
- Vascular abnormalities (metastases, pulmonary artery aneurysms).
Solitary cavitary lesion DD (4)
- TBC.
- Cavitary bacterial pneumonia.
- Fungal pneumonia.
- Primary bronchogenic carcinoma
Multiple cavitary lesions DD (3)
- Septic emboli.
- Vasculitis (Ex: Granulomatosis with polyangiitis).
- Metastases.
Cystic lung disases DD (6)
- Lymphangioleiomyomatosis,
- Lymphoid interstitial pneumonia.
- Pulmonary langerhans hystiocytosis.
- Amyloidosis.
- Birt-Hogg-Dubbe syndrome.
- Pneumocystic jiroveci pneumonia.
Single cyst DD (3)
- Bulla (>1 cm).
- Bleb (<1 cm).
- Pneumatocele.
Low lobe fibrotic changes DD
- UIP.
- NSIP.
- Other causes of UIP (Asbestosis and AR).
Uppler lobe fibrotic changes DD (3)
- End-stage sarcoidosis.
- Chronic hypersensibility pneumonitis.
- End-stage silicosis
Lobar pneumonia
- Lobar consolidation.
- Air bronchograms.
- Usually bacterial in origin.
Bronchopneumonia
- Patchy peribronchial consolidation with air-space opacities.
- Caused by aspiration, bacterial and viral pneumonias.
Interstitial pneumonia
- Ground glass opacities.
- Atypical bacteria (Mycoplasma pneumoniae, chlamydia), viral or pneumocystis jirovecci.
Round pneumonia
- Children.
- Usually due to S. pneumoniae.
- Infection in retained due to incomplete formation of pores of Kohn.
Complications of pneumonia (5)
- Pulmonary abscess.
- Pneumatocele.
- Empyema.
- Empyema neccesitans.
- Bronchopleural fistula.
Empyema characteristics
- 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.
Empyema neccesitans
- Extiension of the empyema to the chest wall.
-Most common due to TBC or Actinomyces.
Pneumatocele
- Thin-walled, gas-filled cyst, that may be post traumatic or as a sequela of pneumonia.
Bronchopleural fistula
- Abnormal communication between the airway and the pleural space.
- Causes: Surgery, lung abscess, empyema, trauma.
Tuberculosis phases
- Inicial disease (contained disease or primary TBC).
- Latent infection.
- Reactivation (post primary).
Primary TBC
- Infection from the first exposure to TBC.
- Imaging: Lobar consolidation, pleural effusion and lymphadenopathy, miliary disease.
- Ghon focus and Ranke complex.
- Cavitation is rare.
Ghon focus
Initial focus of parenchymal infection, usually located in the upper part of the lower lobe or lower part of the upper lobe.
Ranke complex
Ghon focus + Lymphadenopathy.
Reactivation (post-primary) TBC
- 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.
Tuberculoma
Well-defined rounded opacity consisting of a peripheral fibrous wall with central caseation, usually in the upper lobes.
Healed tuberculosis
- Apical scarring.
- Upper lobe volume loss.
- Superior hiliar retraction.
- Calcified granulomas.
Miliary tuberculosis
- Diffuse random distribution nodules seen in hematogenously disseminated TB.
Atypical mycobacteria infection
- 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.
Hot-tub lung
- Hypersensitivity pneumonitis due to atypical mycobacteria.
- Imaging similar to HP, but with centrilobular nodules.
Viral pneumonia
- Centrilobular nodules, tree-in-bud opacities, patchy ground glass opacities and peribronchial consolidations.
COVID19 infection
- Bilateral, dependent, lower-lobe predominant ground glass opacities or consolidation.
Pneumocystis jirovecci pneumonia
- 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.
Cryptococcus neoformans infection
- 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.
Aspergillus infection types (5)
- Allergic bronchopulmonary aspergillosis.
- Saprohyptic aspergillosis (Aspergilloma).
- Semi-invasive (chronic necrotizing) aspergillosis.
- Airway-invasive aspergillosis.
- Angio-invasive aspergillosis.
