Diseases of the Chest

Question 1

what is the margin of the mediastinum?

Answer 1

laterally: medial borders of each lung
anteriorly: sternum / anterior chest wall
post: spine

Question 2

what is ddx of ant. mediastinal mass?

Answer 2

• thyroid goiter (trachial deviation)
• lymphoma: lobulated, polycyclic, asymmetric
• thymoma: well-marginated mass (hx of myasthenia gravis) near great vessels / heart
• teratoma: clear margins, fat, calcium on CT

Question 3

what happens with thyroid goiters and contrast injections?

Answer 3

-contrast is made of iodine, so thyroid goiters take up a lot of contrast

Question 4

what are features of sarcoidosis on xray?

Answer 4

• bilateral hilar / R paratracheal adenopathy

- bronchopulmonary nodes peripherally

Question 5

what are features of lymphoma on xray?

Answer 5

• mediastinal adnopathy associated w/ assymetric hilar enlargement
• central hilar nodes

Question 6

how are sarcoidosis / lymphomas different on xray?

Answer 6

-pleural effusion + anterior mediastinal adenopathy more common in lymphoma

Question 7

what masses are found in the posterior mediastinum?

Answer 7

• neural tissue in origin (mostly rare)

- neurofibroma, schwannoma / neurilemmoma, ganglioneuroma, neuroblastoma

Question 8

what are signs of a benigng vs. malignant solitary pulmonary n odule?

Answer 8

• size: <4 mm = benign
• calcification: central, laminar, diffuse calcification = benign
• shape: spiculated, lobulation = malignancy
• change over time

Question 9

what are benign causes of lung lesions?

Answer 9

• granulomas (TB / histoplasmosis)
• hamartomas: popcorn calcification
• rheumatoid nodules, AVMs, granulomatous vasculitities

Question 10

how do pancoast tumors present?

Answer 10

• soft-tissue mass in lung apex
• squamous / adenocarcinoma
• adjacent rib destruction
• invasion of brachial plexus + Horner syndrome
• SVC obstruction

Question 11

how do you differentiate b/w differnt causes of cavitary lung lesions?

Answer 11

1) squamous cell bronchogenic carcinoma: thick wall / nodular interior margin
2) TB = upper lobe cavity, smooth inner margin, thin-walled
3) staph abscess = thickened wall, very small cavity of smooth margin

Question 12

what is the hallmark lesion of bronchiectasis?

Answer 12

signet ring sign: bronchus w/ a thickened wall becomes larger than pulmonary artery

Question 13

what is bronchiectasis?

Answer 13

localized, irreversible dilatation of the bronchial tree

Question 14

what causes bronchiectasis?

Answer 14

• usually necrotizing bacterial infxn (klebsiella / staph aureus)
• cystic fibrosis
• Kartagener syndrome
• allergic bronchopulmonary aspergillosis
• Swyer-James syndrome (unilateral hyperlucent lung)