CR Chest Opening Round Flashcards
Case 1
What are the only two specific and reliable signs of benignancy?
1) Absolute absence of growth for 2 yrs
2) Benign pattern of Calcification
Case 1
What are the size criteria for a T1a and T1b Lesion in the TNM staging system?
T1a –> 0-2 cm
T2a –> 2-3 cm
Case 1
What are 4 benign patterns of calcification in a SPN?
- Central
- Diffuse
- Lamellar
- Popcorn
Case 1
TNM T2a?
TNM T2b?
3-5 cm
5-7 cm
Case 1
TNM T3
> 7 cm
Case 2
Name 5 causes of ptx?
Trauma / Barotrauma
Iatrogenic
Spontaneous
COPD
Tumor - metastatic sarcoma
Infection - lung abscess, septic infarcts
Chronic Infiltrative Lung Dz - PLCH, Lymphangiomatosis
Case 3
AZG positioning of CVC
Reposition
Venous Rupture is most common complication
Left-sided insertion increases risk
Case 4
Are asbestos pleural plaques premalignant?
No
- Diffuse bilateral, asymptomatic
Case 4
Asbestos professions
Mining Insulation Textile Construction Ship Building Brake lining, manufacturing, and repair
Case 5
Which level of the spine is most susceptible to spinal fractures?
Thoracolumbar junction (T12 - L2)
Case 6
Two major radiographic features of emphysema?
Overinflation
Reduced Vascularity
Case 6
Best radiographic indicator of lung overinflation?
Flattening of the diaphragm
Case 7
What infection is most commonly associated with a miliary pattern?
TB
Case 7
How is miliary TB disseminated to the lung?
Hematogenously
Case 7
Aside from TB, what other infection presents with a miliary pattern?
Fungal Infection
Case 7
Name 4 non-infectious entities that present with a miliary pattern?
Pneumoconioses (silicosis)
Langerhans Cell Histiocytosis (PLCH)
Sarcoid
Mets (thyroid and melanoma)
Case 7
Lung mets with miliary pattern?
Thyroid
Melanoma
Case 9
What are two primary signs of atelectasis?
Opacification
Displacement of Fissures
Case 9
Name five secondary signs of atelectasis
Elevated Hemidiaphragm Mediastinal Shift Displacement of the hilum Compensatory Hyperinflation Crowded Vessels
Case 10
Primary vs Secondary PAH
Men vs Women
Primary - cause is unknown
Secondary - cause is known
Women (typically age
Case 10
Name the 3 PAH Mechanisms and give examples of each
1) Increased pulmonary blood flow
- -> Left to Right Shunt
2) Decreased Cross Sectional area of Pulmonary vasculature
- -> Chronic PE
3) Increased Resistance to Pulmonary Venous Drainage
- -> Mitral Valve Dz
Case 12
Bilateral symmetric lymph node enlargement?
Sarcoid
- 50% Lung parenchymal dz (upper and mid lungs)
- 50% Asymptomatic at presentation
- Unknown etiology / Widespread Non-caseating granulomas
- 20% Interstitial Fibrosis
Case 13
When does a pulmonary contusion appear / resolve?
Appears Early - within 6 hrs
Resolves within 7 days
Typically demonstrates subpleural sparing of the peripheral 1-2mm of the lungs
Case 14
What is the most common mechanism for pneumomediastinum?
Alveolar Rupture - 2ndry to Inc Alv Pressure
- Mechanical Ventilation / Blunt Trauma / Coughing / Vomiting / Valsalva
Other causes of Pneumomediastinum
- Tracheal Perforation / Esophageal Rupture / Air from Neck or retroperitoneum
Case 15
Four features of Malignant pleural thickening
> 1 cm in thickness
Nodular
Circumfrential
Involvement of Mediastinal Pleura
Case 15
Which is most common: Pleural metastasis or Malignant Mesothelioma
Mets
Case 15
Pleural Calcifications in Mesothelioma
Latency Period from exposure to malignancy
20%
Between 30 and 40 yrs
Case 16
How much fluid to see blunting of CPA?
200 cc on PA
75 cc on lateral
Lateral decubitus will identify 5cc
Case 16
Causes of Exudate
Infection
Infarction
Neoplasm
Inflammatory Disorders
Case 16
Causes of Transudates
CHF Low Protein Myxedema Cirrhosis Nephrotic Syndrome Constrictive Pericarditis
Case 18
Most helpful feature for differentiating a pleural from extrapleural mass?
Rib abnormalities such as destruction or remodeling
Case 18
Two most common causes of extra-pleural mass with rib destruction in an adult patient?
Mets
Melanoma
Case 18
Two causes of hypervascular chest wall masses?
Thyroid Carcinoma
Renal Cell Carcinoma
Case 20
Anterior junction line
Lower
Posterior junction line higher
Case 21
Major risk factors for developing esophageal carcinoma?
Smoking
Alcohol
Case 21
Two most common cell types of esophageal neoplasm?
Adeno CA
Squamous CA
A tracheoesophageal stripe >5mm is suspicious!
Case 21
Most common benign esophageal neoplasm?
Leiomyoma
Case 22
Three benign patterns of calcification
Examples of benign Ca+ pulmonary nodules
Central
Diffuse
Laminar
Popcorn
Granuloma, Hamartoma, AVM, Sequestration, infarct, mucous impaction
Case 22
Malignant patterns of calcification
Stippled
Eccentric
Case 23
Fat density in a SPN
Hamartoma
- Benign
- Can grow
Signs of Hamartoma:
Fat
Fat + Calcification
Popcorn calcification
Case 24
Four substances that may fill the alveolar spaces
Causes of chronic airspace disease
Pus - pneumonia
Protein - alveolar proteinosis
Blood - hemorrhage
Water - edema
BAC, Alveolar proteinosis, lipoid pneumonia, lymphoma, alveolar sarcoid
Case 24
Most common cause of lobar pneumonia in an immunocompetent host?
Streptococcus pneumoniae
Other organisms:
- Klebsiella / Legionella / Mycoplasma
Case 25
Radiation lung changes are called?
Radiation Pneumonitis
Case 25
How long after XRT can you see lung changes?
When does fibrosis occur?
6 to 8 weeks
6-12 months
Case 25
Dilated bronchi within areas of fibrosis after XRT?
Traction bronchiectasis
Case 26
Define ARDS
Clinical diagnosis or acute respiratory failure characterized by profound hypoxia with diffuse opacities
Case 26
Causes of ARDS
Sepsis Pneumonia
Trauma Near Drowning
Aspiration Drug OD
Inhaled Toxins Transfusion
Case 27
Bronchiectasis that is most severe in the upper lobes
2 Radiographic signs of bronchiectasis
Cystic Fibrosis: Autosomal Recessive
Signs
- Tram-tracking
- Ring Shadows
Case 28
Apical Cavity
Post-primary TB
Case 28
General categories of causes of lung cavities
Infection
Malignancy
Vasculitis
Granulomatoses
Case 28
Cell type of lung CA that cavitates
Squamous Cell
Case 28
Specific causes of cavitation in the lungs
TB
Squamous CA
Vasculitides and Granulomatosis
Infarction
Case 29
Most common cause of intracavitary mass
Aspergilloma / Mycetoma
Case 29
What pleural abnormality frequently accompanies a mycetoma?
Pleural Thickening
Case 29
Treatment for asymptomatic aspergilloma
None
Case 29
Therapeutic options for patients with hemoptysis and aspergilloma?
Embolization
Surgical Resection
Direct instillation of amphotericin B
Systemic anti-fungal therapy
Case 30
Four causes of right cardiophrenic angle mass
Lipoma / Pericardial fat pad / Thymolipoma Pericardial cyst Enlarged Epicardial Lymph Nodes Mets Diaphragmatic Hernia - Morgagni's
Case 30
Pericardial Cyst - right or left?
Right Side
Case 30
Do pericardial cysts communicate with the pericardium?
No
They are attached to the parietal pericardium
Case 31
Name the order of left lower lobe basilar segmental bronchi from lateral to medial on a frontal radiograph
Anteromedial, lateral, and posterior
A - L - P
Case 31
Order of the right basilar segmental bronchi from lateral to medial?
Anterior, lateral, posterior, medial
Case 31
RLL Bronchi and numbers
Ant(8) Lat(9) Post(10) Medial(7)
Case 31
LLL Bronchi and numbers
Posterior (10) Lateral (9) Anteromedial (7 and 8)
A - L - P
Case 32
Round Pneumonia
- Organism?
- More common in pedi or adult?
S. pneumoniae
Pedi
Case 33
Two mass features of mediastinal location on CxR?
Obtuse angle with adjacent lung
Smooth Sharp Margins
Case 33
Most common cause of posterior mediastinal mass?
Neurogenic Tumor
Case 33
Neurogenic Tumor
- Peripheral Types
Schwanoma
Neurofibroma
Case 33
Neurogenic Tumor
- Sympathetic Chain
Ganglioneuroma
Neuroblastoma
Case 33
Neurogenic Tumor
- Paraganglia
Pheochromocytoma
Chemodectoma
Case 33
Neurogenic Tumor
- Symphathetic Chain Shape
Fusiform
Vertical
More commonly calcify
- Ganglioneuroma
Case 34
Six causes of total lung atelectasis
Tumor Mucus Plug ET Tube - Right Main Stem Intubation Foreign Body Trauma TB Stenosis
Case 33
Neurogenic Tumor
- Peripheral Nerves shape
Round - Schwanoma
Case 34
Several Causes of hemothorax
Trauma Iatrogenic Anticoagulation Malignancy Catamenial Hemothorax
Case 35
Four CT features of empyema
Lenticular Shape
Obtuse Margins
Split Pleura Sign
Compression of adjacent lung parenchyma
Case 35
Round shape - Lung abscess or Empyema
Lung Abscess
Case 35
Most common cause of air fluid level within a pleural fluid collection?
Bronchopleural fistula
Case 36
Two most common causes of rib notching
Neurofibromatosis
Coarctation
Case 36
Osseous manifestations of neurofibromatosis
Widened Neural foramina
Rib Erosion / Notching / Rib Spreading
Scoliosis
Scalloping or posterior aspects of vertebral bodies (dural ectasia)
Case 36
Most common cause of osseous destruction of a rib?
Metastatic Disease
Case 37
Causes of thymic masses
Thymoma Cyst Hyperplasia Carcinoma Thymolipoma Carcinoid
Case 38
Subcarinal mass DDx
Bronchogenic Cyst
Left Atrial Enlargement
Subcarinal Lymph Nodes / Mets
Case 38
Common causes of intrathoracic lymphadenopathy
Malignancy:
- Head and Neck, Breast, Melanoma, Genitourinary
- Lymphoma / Leukemia
Infection:
- TB, fungal, viral, bacterial
Inflammatory:
- Sarcoid, Castleman’s, Angioimmunoblastic
Case 39
Severe Silicosis
Types of Calcification in the lymph nodes
Progressive Massive Fibrosis: confluent opacification
Egg Shell
Case 40
Cause of chronic Infiltrative Lung Dz with a basilar and subpleural distribution
Scleroderma
Case 40
How do NSIP and UIP present?
Examples?
What is the difference between NSIP vs UIP
Both have subpleural distribution of irregular linear opacities, ground-glass attenuation, and traction bronchiolectasis
UIP: IPF, Asbestosis, Conn. tissue dz, drug toxicity
NSIP: Scleroderma
NSIP: unlike UIP honeycombing is absent
Case 40
Soft tissue abnormality with scleroderma
Calcinosis
Case 40
Honeycombing - NSIP vs UIP
UIP Only
Case 41
Combination of calcified lung nodule and calcified lymph nodes
Ranke Complex
Case 41
Lung nodule that occurs at the initial site of parenchymal involvement from primary TB
Ghon Focus
Case 41
Two common radiographic findings associated with primary TB infection
Parenchymal consolidation
Mediastinal and Hilar Lymph Node Enlargement
Case 42 PVWP - Pulm Edema - Pleural Effusion - Alveolar Edema
17 mm Hg
20 mm Hg
25 mm Hg
Case 42
Four radiographic signs of interstitial edema
Peribronchial Cuffing
Indistinct Pulmonary Vessels
Kerley Lines (interlobular septal thickening)
Thickening of the fissures
Case 43
Most common cause of bronchiectasis
Prior infection
Case 43
CT findings of bronchiectasis
Bronchial diameter > adjacent artery Bronchi visible peripherally No tapering of bronchi peripherally Bronchial wall thickening Strings or clusters of cysts w or w/o air-fluid levels
Case 44
Syndrome associated with AVM
Hereditary Hemorrhagic Telangiactasia / Osler Weber Rendu
- Telangiectasias
- AVMs
- Aneurysms
- Pulmonary / Gastrointestinal / Cuteneous / CNS
Case 44
What percentage of AVMs are multiple?
30%
Case 44
Name three symptoms or conditions associated with pulmonary AVMs
Cyanosis (from R to L shunt)
Dyspnea
Stroke
Brain Abscess
Case 45
Causes of Ascending Aortic Aneurysm?
Cystic Medial Necrosis
Syphilis
Case 45
Causes of Arch and Descending Aortic Aneurysm
Atherosclerotic
Mycotic
Post-traumatic
Case 46
DDx for peripheral wedge shaped consolidation
Pulmonary Infarct
Neoplasm
Pneumonia
Hemorrhage
Case 46
Wedge shaped peripheral opacity with feeding vessel
Pulmonary Infarct
- Central Lucencies
Case 46
Incidence of incidentally detected acute pulmonary embolism on postcontrast CT?
1% - 5%
Case 47
DDx multiple lung nodules or masses in pt w AIDS
Infection - fungal, mycobacterial, septic emboli
Neoplasm - lymphoma, Kaposi’s sarcoma
Case 47
Most common type of lymphoma in pt with AIDS
Non-Hodgkins Lymphoma
Case 47
Thoracic lymphoma typically nodal or extranodal in AIDS
Extranodal
Case 48
Most common sites of traumatic aortic transection
Ligamentum Arteriosum
- Half make it to the hospital but die within 1 week
Aortic Root
Diaphragm
Case 48
Direct Signs of Traumatic Aortic Injury
Deformed Contour Intimal Flap Pseudoaneurysm Intramural Thrombus Extravasation
Case 49
Most common cause of thoracic inlet mediastinal mass
- Adult
- Child
Thyroid Goiter: typically calcify
Lymphangioma
Case 50
Chronic Airspace Dz DDx
Lipoid Pneumonia BAC Lymphoma Alveolar Proteinosis Alveolar Sarcoid
Case 50
Lipoid pneumonia most common cause
Aspirated Mineral Oil
- old ladies
Case 51
Situs inversus with bronchiectasis
Kartegners Syndrome
Case 51
Kartegner’s Syndrome triad
Situs Inversus Bronchiectasis - predilection to RML Sinusitis - Infertility - Autosomal Recessive
Case 33
What neurogenic tumor most commonly calcifies?
Ganglioneuroma
