Final Flashcards
What condition causes incomplete lung inflation?
Atelectasis
Which type of atelectasis is resorptive and due to airway obstruction?
Obstructive- tumor
Which type of atelectasis is intrapulmonary?
Compressive- mass (bulla)
Which type of atelectasis is extrapulmonary?
Passive- pleural mass- pneumothorax
What is bronchietasis?
Chronic, irreversible dilation of bronchi
Thickened walls, altered Lu volume
What is a well defined radiodense mass with a thin wall?
Bronchogenic cyst- appears cystic if it communicated with airway following infection
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?
Emphysema
What are commonly seen on imaging in a patient with emphysema?
- 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
What is acquired valvular heart disease secondary to?
Arteriosclerosis
HTN
Rheumatic fever (MC in developing countries)
Acquired valvular heart disease on radiograph would show?
Changes in heart shadow shape or size
Aortic aneurysm has what type of dilation?
Saccular or fusiform dilation of vessel
What are some causes of aortic aneurysm?
Atherosclerosis (MC), HTN, smoking, syphilis, mycoses, trauma, congenital
Aortic aneurysm imaging findings include:
- Mass following contour of vessel
- mediastinal widening
- displacement of calcified wall plaques
- US, CT, MRI, angiography provide further evaluation
What size of aortic aneurysm is usually a symptomatic and rarely ruptures?
< 5cm
Where are the locations for thoracic aortic aneurysm?
Ascending 25%
Aortic arch 25%
Descending 50%
When excess pulmonary fluid distends the interstitial markings of the lung fields its called?
Kerley’s lines- typically transient but may become chronic following fibrosis
Which kerley’s lines are straight, long and in upper lung parenchyma, btw hilum and pleura?
A lines
Which Kerley’s lines are straight, short in lower lung periphery perpendicular to the pleural space?
B lines
Which Kerley’s lines are a fine network of interlacing, linear lines occasionally seen in the central interstitial areas of the lung?
C lines
With CHF, left-sided failure congests what?
Pulmonary tissues
With CHF, right-sided failure congests what?
Body tissues, sparing pulmonary tissues
What are s/s of CHF?
Engorged neck veins, pitting edema, SOB, chronic and non-productive cough
CHF radiograph findings
- Enlarged heart- left ventricular and atrial enlargement
- Kerley’s lines
- pleural effusion
- pulmonary edema (batwing or butterfly)
How do you determine if heart is enlarged on radiograph?
Cardiothoracic ratio is larger than 50% on PA chest
Transverse cardiac diameter divided by transverse chest diameter
Where do you measure the transverse chest diameter?
Widest portion, above the Costophrenic angles to the inner rib margins
Free pleural diffusion vs loculated?
Free- gravity dependent
Loculated- secondary to fibrosis
What condition causes free or loculated collections of transudate, exudate or blood or chyle in pleural space?
Pleural effusion
What is fluid accumulation in the extravascular space of the lungs?
Pulmonary edema
Pulmonary edema has both interstitial and air space patterns, which is early and which is late?
Interstitial- early
Air space- late
What are 2 causes of pulmonary edema?
Left-sided heart disease- common
Renal failure- excess fluid
Radiograph findings for interstitial pulmonary edema? (Early)
Septal lines- radiodense, Kerley’s
Hilar haze- loss of vessel definition
Peribronchovascular haze- loss of bronchi definition
Subpleural edema- fluid under visceral pleura
Alveolar/ air space pulmonary edema radiograph finding
Butterfly, sunburst, batwing or fan shaped radiodense lines radiating from the hilum
Air-bronchogram sign
Progression of pulmonary edema from CHF
Normal -> enlarged heart -> interstitial pattern -> alveolar pattern
Where do pulmonary thromboembolism arise from?
Venous circulation and bone marrow
Most from deep veins of lower extremities
Most emboli resolve- 15% show infarct, usually lower lobes
What factors increase embolism risk?
Surgery
Obesity and HTN
Prolonged standing and bed rest
What percent of pulmonary thromboembolism show lung changes?
10-15%
80% go unrecognized
Radiograph findings for pulmonary thromboembolism?
Large pulmonary arteries
Oligemia distal to embolism- pleural based radiodensity due to infarct
Radiodensity resolves
What is bronco-pneumonia?
Acute inflammation of lungs and bronchioles
What are symptoms of bronchi-pneumonia?
Fever, chills, cough with purulent, bloody sputum, severe chest pain
What can bronchi-pneumonia lead to?
Pleural effusion, empyema lung abscess, respiratory failure, CHF
What is lobar pneumonia?
Infection in 1 or more of the 5 lobes, causes consolidation
What are symptoms of lobar pneumonia?
Fever, chills, cough, RUSTY sputum, cyanosis, nausea, vomit, pleurisy
What causes inflammation of lungs and bronchi from inhaling a foreign object?
Aspiration pneumonia
What is the most common bacterial community acquired agent?
Streptococcus pneumoniae- common nosocomial pneumonia
Usually lobar
Who are predisposed to primary TB infection?
Alcoholics, diabetics and patients on corticosteroids
Which TB typically has no radiographic findings?
Primary- typically resolves completely
Which condition causes lymphadenopathy with or without parenchymal consolidation in central lung?
primary TB
What is ranke complex?
Hilar and parenchymal ghon tubercles
Which TB has upper lobe distribution with parenchymal involvement causing incomplete consolidation with strand-like radiodensities and cavitations?
Secondary TB
Which TB is more likely to have superinfections by fungus?
Secondary
Describe acute histoplasmosis fungus infection
Acute can be symptomatic or asymptomatic, usually benign and self-limiting
Chronic histoplasmosis infection is usually only seen in patients with?
Underlying lung infection
How is histoplasmosis diagnosed?
Antigen testing, serology, fungal cultures
Histoplasmosis radiograph findings?
Lymphadenopathy (like TB)
Solitary pulmonary nodule
Histoplasmoma
What is a central, bull’s eye calcification in a pulmonary nodule?
Histoplasmoma
Multiple, scattered discrete calcific densities are seen with?
Miliary histoplasmosis- same appearance as miliary TB
Bronchogenic carcinoma is carcinoma of the lung _______ not lung _______
Airways; parenchyma
What is the leading cause of cancer related deaths among both men and women?
Bronchogenic carcinoma
What are the 4 types of bronchogenic lung cancer?
Squamous cell (epidermoid)
Small (oat) cell
Adenocarcinoma
Large cell
A hilar mass is most common in which cancer?
Squamous cell
Mass that is 4cm or less is most likely in which cancer?
Adenocarcinoma
Mass more than 4cm most likely?
Large cell but could be squamous or adenocarcinoma
Bronchogenic carcinoma clinical findings
80% btw 40-70
25% without sx at recognition
Wheezing, cough, hemoptysis
Malignancy more likely
Age
Size
Rarely calcify
What rules out malignancy?
Benign pattern of calcium
60% of lung cancer lesions are?
Central, near the hilum
Present as hilar enlargement or secondary findings
Poor prognosis
What are secondary findings of central lung cancer lesions?
Atelectasis
S sign of golden
40% of lung cancer lesions are?
Peripheral, lateral to hilum
Appear as non-calcified nodule or mass
Better prognosis
Nodule vs mass
Nodule <3cm
Mass >3cm
What is Pancoast tumor aka?
Superior sulcus tumor
Where is a Pancoast tumor?
Bronchogenic tumor in the lung apex
What does a Pancoast tumor present with?
Apical radiodensity
Horner’s sx
TOS
Rib or vertebral destruction
Malignancies of lymphocytes and histiocytes are known as?
Lymphomas
Intrathoracic and mediastinal involvement more common with which lymphoma?
Hodgkin’s disease but non-hodgkins also
Which lymphoma has Reed sternberg cells?
Hodgkins
Hodgkin’s age distribution?
15-34 and over 45
Non-hodgkins age distribution?
30-70
Lymphoma sx
Indolent and rapidly progessing
Painless lymphadenopathy, fever, night sweats, unexplained weight loss
How does lymphoma spread?
From nodes to Lu tissue via lymphatics
Lymphoma parenchymal involvement is usually?
Nodular
What is most common metastasis?
Blood-borne
What are common locations of metastatic disease?
Lung, liver, bone marrow
Multiple, bilateral, well-defined peripheral nodules 1-5 mm seen with?
Metastatic lung disease
What is malignancy related to asbestos exposure, directly related to duration and intensity?
Pleural mesothelioma- much less common
Anterior mediastinal mass DDx?
Teratoma
Thymoma, thymic hyperplasia
Thyroid lesions
Terrible lymphoma
What is a collection of air in the pleural space?
Pneumothorax
Which pneumothorax is common in young adults, bleb rupture?
Spontaneous
Allergic lung disease aka
Extrinsic allergic alveolitis
Hypersensitivity pneumonitis
Inhalation of organic dusts
What does extrinsic allergic alveolitis cause?
Granulomatous and interstitial lung disease
Pulmonary disease caused by inhalation of inorganic dust is called?
Pneumoconiosis-
Non-fibrogenic (benign)
Fibrogenic
Non-fibrogenic pneumoconiosis types
Siderosis (iron)
Silicosis (silicon)
Fibrogenic pneumoconiosis types
Coal workers
Asbestosis
What causes reticulonodular egg shell calcifications of lymph nodes?
Silicosis
Chest wall lesion DDx
Abscess- painful Hematoma- history of trauma Pleural fluid- free or loculated transudate Rib fix- offset of rib vortices Rib tumor- expansive Body wall neoplasms
Enlarged hilum caused by bronchogenic carcinoma?
Unilateral
Enlarged hilum caused by mets?
Unilateral or bilateral
Enlarged hilum caused by granulomas?
Small, often calcified
Enlarged hilum caused by lymphoma?
Usually mediastinal involvement
Intrathoracic calcifications
Pulmonary- mostly granulomas
Cardiovascular- valve or artery, rare
Hamartoma, teratoma
Pneumoconioses
MRI is good for?
Vascular definition
Linear tomography?
Removes obstruction of overlying structures
Most useful special imaging?
CT- complex anatomy
