diseases of the chest / mediastinum

Question 1

mediastinum sections

Answer 1

1) anterior 2) middle 3) posterior

Question 2

what are abnl masses in the anterior mediastinum?

Answer 2

1) substernal thyroid goiter 2) lymphoma 3) thymoma 4) teratoma

Question 3

abnl posterior mediastinum masses?

Answer 3

neurogenic tumors (nerve sheath - benign; other tissues - malignant)

Question 4

middle mediastinum masses?

Answer 4

1) lymphadenopathy (lymphoma) 2) metastatic disease [small cell carcinoma of the lung]

Question 5

solitary pulmonary nodules?

Answer 5

< 4 mm in size; rarely maligant

Question 6

criteria to evaluate solitary pulmonary nodules?

Answer 6

1) calcification 2) nodule margin 3) change in size of time

Question 7

bronchogenic carcinomas present in 1 of 3 ways

Answer 7

1) visualization of the tumor 2) recognizing effects of bronchial obstruction [pneumonitis / atelectasis] 3) recognizing effects of metastasis

Question 8

what is the most common bronchiogeic carcinoma that presents as a mass in the lung?

Answer 8

adenocarcinoma

Question 9

what is a subset of adenocarcinoma, mimicking metastatic disease?

Answer 9

bronchoalveolar carcinoma

Question 10

what type of bronchogenic carcinoma presents with bronchial obstruction?

Answer 10

squamous cell carcinoma (most likely to cavitate)

Question 11

describe small cell carcinoma

Answer 11

aggressive, centrally located, peribronchial, most have metastasized at initial presentation; associated w/ para-neoplastic syndrome (SIADH / cushing’s)

Question 12

what should we think when seeing multiple nodules in the lung?

Answer 12

metastasis via hematogenous spread (common sites of primary: colon, breast, renal, head&neck, bladder, uterine, cervical, melanoma)

Question 13

defining lymphangitic spread

Answer 13

tumor grows in and obstructs lympatics in the lung (looks like pulmonary interstitial edema); primaries that obstruct the lung in this way include: breast, lung, pancreatic cancer

Question 14

Is pulmonary thrombo-embolytic disease easy to detect by conventional radiology?

Answer 14

NO: HIGH FALSE NEGATIVE RATE; in reality, you don’t see hampton hump, westermark sign, knuckle sign

Question 15

what are the 2 types of COPD?

Answer 15

1) chronic bronchitis 2) emphysema

Question 16

which ones do radiologists see?

Answer 16

emphysema = CT/radiographs; chronic bronchitis is a clinical diagnosis

Question 17

bronchiectasis study of choice

Answer 17

CT

Question 18

difference b/w lung nodule / mass

Answer 18

< 3 cm = nodule

> 3 cm = mass

Question 19

what do you see bronchiectasis on xray?

Answer 19

tram tracks, cystic lesions, tubular densities

Question 20

features of lung cancer nodules

Answer 20

3 Cs: calcification, circumference, change over time

Question 21

benign causes of lung nodules (2)

Answer 21

hamartomas; granulomas

Question 22

4 air-containing lesions of the lung

Answer 22

1) blebs, bullae, cysts, and cavity

Question 23

blebs vs. bullae

Answer 23

blebs = small, visceral pleura, apex of lungs, thin-walled;

bullae: > 1cm, lung parenchyma, partially visible, thin-walled, associated w/ emphysema, can dev’t air-fluid level

Question 24

cyst vs. cavity

Answer 24

cyst = lung parenychma or mediastinum, thin-walled, thicker than a bullae
cavity = varies in size, lung parenchyma, due to process that produces necrotic center

Question 25

bronchiectasis

Answer 25

localized / irreversible dilation of bronchial trial, usually due to necrotizing bacterial infection (staph / klebsiella); occurs w/ cystic fibrosis, kartagener’s.

Question 26

hallmark lesions of bronchiectasis CT

Answer 26

signet ring sign (big thick bronchus, larger than associated artery)