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Imaging chest and abd > Final > Flashcards

Final Flashcards

1
Q

What condition causes incomplete lung inflation?

A

Atelectasis

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2
Q

Which type of atelectasis is resorptive and due to airway obstruction?

A

Obstructive- tumor

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3
Q

Which type of atelectasis is intrapulmonary?

A

Compressive- mass (bulla)

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4
Q

Which type of atelectasis is extrapulmonary?

A

Passive- pleural mass- pneumothorax

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5
Q

What is bronchietasis?

A

Chronic, irreversible dilation of bronchi

Thickened walls, altered Lu volume

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6
Q

What is a well defined radiodense mass with a thin wall?

A

Bronchogenic cyst- appears cystic if it communicated with airway following infection

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7
Q

What is a chronic dilation of the air space distal to the bronchi (secondary lobule) with acinar wall destruction that leads to aggregate air spaces?

A

Emphysema

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8
Q

What are commonly seen on imaging in a patient with emphysema?

A
  • Bilaterally flat with increased hemidiaphragm
  • Lu over inflation
  • increased radiolucency
  • increased retrosternal space
  • accentuated kyphosis
  • increased intercostal spaces
  • prominent hilar vasculature
  • narrow heart shadow
  • bullae
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9
Q

What is acquired valvular heart disease secondary to?

A

Arteriosclerosis
HTN
Rheumatic fever (MC in developing countries)

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10
Q

Acquired valvular heart disease on radiograph would show?

A

Changes in heart shadow shape or size

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11
Q

Aortic aneurysm has what type of dilation?

A

Saccular or fusiform dilation of vessel

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12
Q

What are some causes of aortic aneurysm?

A

Atherosclerosis (MC), HTN, smoking, syphilis, mycoses, trauma, congenital

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13
Q

Aortic aneurysm imaging findings include:

A
  • Mass following contour of vessel
  • mediastinal widening
  • displacement of calcified wall plaques
  • US, CT, MRI, angiography provide further evaluation
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14
Q

What size of aortic aneurysm is usually a symptomatic and rarely ruptures?

A

< 5cm

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15
Q

Where are the locations for thoracic aortic aneurysm?

A

Ascending 25%
Aortic arch 25%
Descending 50%

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16
Q

When excess pulmonary fluid distends the interstitial markings of the lung fields its called?

A

Kerley’s lines- typically transient but may become chronic following fibrosis

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17
Q

Which kerley’s lines are straight, long and in upper lung parenchyma, btw hilum and pleura?

A

A lines

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18
Q

Which Kerley’s lines are straight, short in lower lung periphery perpendicular to the pleural space?

A

B lines

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19
Q

Which Kerley’s lines are a fine network of interlacing, linear lines occasionally seen in the central interstitial areas of the lung?

A

C lines

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20
Q

With CHF, left-sided failure congests what?

A

Pulmonary tissues

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21
Q

With CHF, right-sided failure congests what?

A

Body tissues, sparing pulmonary tissues

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22
Q

What are s/s of CHF?

A

Engorged neck veins, pitting edema, SOB, chronic and non-productive cough

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23
Q

CHF radiograph findings

A
  • Enlarged heart- left ventricular and atrial enlargement
  • Kerley’s lines
  • pleural effusion
  • pulmonary edema (batwing or butterfly)
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24
Q

How do you determine if heart is enlarged on radiograph?

A

Cardiothoracic ratio is larger than 50% on PA chest

Transverse cardiac diameter divided by transverse chest diameter

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25
Q

Where do you measure the transverse chest diameter?

A

Widest portion, above the Costophrenic angles to the inner rib margins

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26
Q

Free pleural diffusion vs loculated?

A

Free- gravity dependent

Loculated- secondary to fibrosis

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27
Q

What condition causes free or loculated collections of transudate, exudate or blood or chyle in pleural space?

A

Pleural effusion

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28
Q

What is fluid accumulation in the extravascular space of the lungs?

A

Pulmonary edema

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29
Q

Pulmonary edema has both interstitial and air space patterns, which is early and which is late?

A

Interstitial- early

Air space- late

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30
Q

What are 2 causes of pulmonary edema?

A

Left-sided heart disease- common

Renal failure- excess fluid

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31
Q

Radiograph findings for interstitial pulmonary edema? (Early)

A

Septal lines- radiodense, Kerley’s
Hilar haze- loss of vessel definition
Peribronchovascular haze- loss of bronchi definition
Subpleural edema- fluid under visceral pleura

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32
Q

Alveolar/ air space pulmonary edema radiograph finding

A

Butterfly, sunburst, batwing or fan shaped radiodense lines radiating from the hilum
Air-bronchogram sign

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33
Q

Progression of pulmonary edema from CHF

A

Normal -> enlarged heart -> interstitial pattern -> alveolar pattern

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34
Q

Where do pulmonary thromboembolism arise from?

A

Venous circulation and bone marrow

Most from deep veins of lower extremities

Most emboli resolve- 15% show infarct, usually lower lobes

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35
Q

What factors increase embolism risk?

A

Surgery
Obesity and HTN
Prolonged standing and bed rest

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36
Q

What percent of pulmonary thromboembolism show lung changes?

A

10-15%

80% go unrecognized

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37
Q

Radiograph findings for pulmonary thromboembolism?

A

Large pulmonary arteries
Oligemia distal to embolism- pleural based radiodensity due to infarct
Radiodensity resolves

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38
Q

What is bronco-pneumonia?

A

Acute inflammation of lungs and bronchioles

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39
Q

What are symptoms of bronchi-pneumonia?

A

Fever, chills, cough with purulent, bloody sputum, severe chest pain

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40
Q

What can bronchi-pneumonia lead to?

A

Pleural effusion, empyema lung abscess, respiratory failure, CHF

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41
Q

What is lobar pneumonia?

A

Infection in 1 or more of the 5 lobes, causes consolidation

42
Q

What are symptoms of lobar pneumonia?

A

Fever, chills, cough, RUSTY sputum, cyanosis, nausea, vomit, pleurisy

43
Q

What causes inflammation of lungs and bronchi from inhaling a foreign object?

A

Aspiration pneumonia

44
Q

What is the most common bacterial community acquired agent?

A

Streptococcus pneumoniae- common nosocomial pneumonia

Usually lobar

45
Q

Who are predisposed to primary TB infection?

A

Alcoholics, diabetics and patients on corticosteroids

46
Q

Which TB typically has no radiographic findings?

A

Primary- typically resolves completely

47
Q

Which condition causes lymphadenopathy with or without parenchymal consolidation in central lung?

A

primary TB

48
Q

What is ranke complex?

A

Hilar and parenchymal ghon tubercles

49
Q

Which TB has upper lobe distribution with parenchymal involvement causing incomplete consolidation with strand-like radiodensities and cavitations?

A

Secondary TB

50
Q

Which TB is more likely to have superinfections by fungus?

A

Secondary

51
Q

Describe acute histoplasmosis fungus infection

A

Acute can be symptomatic or asymptomatic, usually benign and self-limiting

52
Q

Chronic histoplasmosis infection is usually only seen in patients with?

A

Underlying lung infection

53
Q

How is histoplasmosis diagnosed?

A

Antigen testing, serology, fungal cultures

54
Q

Histoplasmosis radiograph findings?

A

Lymphadenopathy (like TB)
Solitary pulmonary nodule
Histoplasmoma

55
Q

What is a central, bull’s eye calcification in a pulmonary nodule?

A

Histoplasmoma

56
Q

Multiple, scattered discrete calcific densities are seen with?

A

Miliary histoplasmosis- same appearance as miliary TB

57
Q

Bronchogenic carcinoma is carcinoma of the lung _______ not lung _______

A

Airways; parenchyma

58
Q

What is the leading cause of cancer related deaths among both men and women?

A

Bronchogenic carcinoma

59
Q

What are the 4 types of bronchogenic lung cancer?

A

Squamous cell (epidermoid)
Small (oat) cell
Adenocarcinoma
Large cell

60
Q

A hilar mass is most common in which cancer?

A

Squamous cell

61
Q

Mass that is 4cm or less is most likely in which cancer?

A

Adenocarcinoma

62
Q

Mass more than 4cm most likely?

A

Large cell but could be squamous or adenocarcinoma

63
Q

Bronchogenic carcinoma clinical findings

A

80% btw 40-70
25% without sx at recognition

Wheezing, cough, hemoptysis

64
Q

Malignancy more likely

A

Age
Size
Rarely calcify

65
Q

What rules out malignancy?

A

Benign pattern of calcium

66
Q

60% of lung cancer lesions are?

A

Central, near the hilum
Present as hilar enlargement or secondary findings
Poor prognosis

67
Q

What are secondary findings of central lung cancer lesions?

A

Atelectasis

S sign of golden

68
Q

40% of lung cancer lesions are?

A

Peripheral, lateral to hilum
Appear as non-calcified nodule or mass
Better prognosis

69
Q

Nodule vs mass

A

Nodule <3cm

Mass >3cm

70
Q

What is Pancoast tumor aka?

A

Superior sulcus tumor

71
Q

Where is a Pancoast tumor?

A

Bronchogenic tumor in the lung apex

72
Q

What does a Pancoast tumor present with?

A

Apical radiodensity
Horner’s sx
TOS
Rib or vertebral destruction

73
Q

Malignancies of lymphocytes and histiocytes are known as?

A

Lymphomas

74
Q

Intrathoracic and mediastinal involvement more common with which lymphoma?

A

Hodgkin’s disease but non-hodgkins also

75
Q

Which lymphoma has Reed sternberg cells?

A

Hodgkins

76
Q

Hodgkin’s age distribution?

A

15-34 and over 45

77
Q

Non-hodgkins age distribution?

A

30-70

78
Q

Lymphoma sx

A

Indolent and rapidly progessing

Painless lymphadenopathy, fever, night sweats, unexplained weight loss

79
Q

How does lymphoma spread?

A

From nodes to Lu tissue via lymphatics

80
Q

Lymphoma parenchymal involvement is usually?

A

Nodular

81
Q

What is most common metastasis?

A

Blood-borne

82
Q

What are common locations of metastatic disease?

A

Lung, liver, bone marrow

83
Q

Multiple, bilateral, well-defined peripheral nodules 1-5 mm seen with?

A

Metastatic lung disease

84
Q

What is malignancy related to asbestos exposure, directly related to duration and intensity?

A

Pleural mesothelioma- much less common

85
Q

Anterior mediastinal mass DDx?

A

Teratoma
Thymoma, thymic hyperplasia
Thyroid lesions
Terrible lymphoma

86
Q

What is a collection of air in the pleural space?

A

Pneumothorax

87
Q

Which pneumothorax is common in young adults, bleb rupture?

A

Spontaneous

88
Q

Allergic lung disease aka

A

Extrinsic allergic alveolitis
Hypersensitivity pneumonitis

Inhalation of organic dusts

89
Q

What does extrinsic allergic alveolitis cause?

A

Granulomatous and interstitial lung disease

90
Q

Pulmonary disease caused by inhalation of inorganic dust is called?

A

Pneumoconiosis-
Non-fibrogenic (benign)
Fibrogenic

91
Q

Non-fibrogenic pneumoconiosis types

A

Siderosis (iron)

Silicosis (silicon)

92
Q

Fibrogenic pneumoconiosis types

A

Coal workers

Asbestosis

93
Q

What causes reticulonodular egg shell calcifications of lymph nodes?

A

Silicosis

94
Q

Chest wall lesion DDx

A 
Abscess- painful 
Hematoma- history of trauma 
Pleural fluid- free or loculated transudate
Rib fix- offset of rib vortices
Rib tumor- expansive
Body wall neoplasms
95
Q

Enlarged hilum caused by bronchogenic carcinoma?

A

Unilateral

96
Q

Enlarged hilum caused by mets?

A

Unilateral or bilateral

97
Q

Enlarged hilum caused by granulomas?

A

Small, often calcified

98
Q

Enlarged hilum caused by lymphoma?

A

Usually mediastinal involvement

99
Q

Intrathoracic calcifications

A

Pulmonary- mostly granulomas
Cardiovascular- valve or artery, rare
Hamartoma, teratoma
Pneumoconioses

100
Q

MRI is good for?

A

Vascular definition

101
Q

Linear tomography?

A

Removes obstruction of overlying structures

102
Q

Most useful special imaging?

A

CT- complex anatomy

Imaging chest and abd (1 decks)

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