Focal and Multifocal Lung Diseases Flashcards
If multiple pulmonary nodules are seen on imaging, the etiology is suspected to be this type of cancer
Hematogenous spread from elsewhere in the body (metastasis)
This multifocal pulmonary infiltrate looks like pneumonia but has more hemoptysis and is common in immunosuppressed patients
Invasive aspergillosis
Which cavitary pulmonary infiltrate shows with effusions and air-fluid levels in the cavities?
Pyogenic bacterial pneumonia
Tests for cavitary GPA (Wegener granulomatosis)
cANCA/PR3 or pANCA/MPO
Will also have elevated ESR
Biopsy preferred (renal better than lung)
Describe the cough in segmental/lobar tuberculosis
Non-productive
May have hemoptysis
Which eosinophilic pneumonia will present without peripheral eosinophilia?
Acute eosinophilic pneumonia (too fast to spread)
A ball seen on the peripheral edge of the lung with a comet tail would be seen in this condition
Rounded atelectasis
Are foreign bodies causing segmental/lobar pulmonary blockage more often radiolucent or radiopaque?
90% are radiolucent (don’t show up)
This fungus can cause lung masses up to 10cm in size
Cryptococcus
Tuberculosis infiltrates typically show on chest x-ray with this appearance and in this area of the lungs
Cavitations
In upper lung zones
Size of pulmonary nodules
<3mm (larger is a mass)
True or false. Bacterial pneumonia commonly presents as segmental/lobar infiltrates
False. More commonly focal/multifocal
Wedge shaped infiltrates on chest x-ray (Hampton Hump) suggest this condition
Pulmonary infarction
True or false. A single nodule in the lung is rarely a metastatic malignancy
True
Metastatic carcinomas in the lungs have this classic appearance on imaging
Cannon-ball metastases in lower lobes
This type of eosinophilic pneumonia will present with rales
Acute eosinophilic pneumonia
Most common cause of rapidly growing lung cancers which present with cavitations
Squamous cell carcinoma
(cancer outgrows its blood supply)
Three most common cancers that cause pulmonary metastatic carcinomas
Renal
Prostate
Breast
Describe bronchopulmonary sequestration and how it would look on imaging
Lung area that never developed properly
Well-defined on imaging with no change over time
Treatment for BOOP
Chronic prednisone
In which airways are carcinoid tumors typically found?
Central airways
Radiation pneumonitis typically shows up this long after exposure
1-6 months after radiation
Describe the process that commonly leads to lung lobe torsion
Lungs are moved aside during CABG surgery
Torsion obstructs blood flow
Post-op, patient gets perfusion-reperfusion injury
Aspiration of medications with this ingredient in particular is a medical emergency
Medications containing iron
Patients with bone marrow transplants (neutropenic) are more likely to have this type of pulmonary mass
Invasive pulmonary aspergillosis + mucormycosis
Symptom for patients with pulmonary infarction
Hemoptysis (but continue anticoagulation)
Most common cause of endemic fungal pneumonia (in the midwest)
Histoplasmosis
Patients with this condition have atopy/asthma, neuropathic and skin lesions, high absolute eosinophils, and infiltrates and nodules without cavitations
Granulomatous with polyangiitis (Wegener’s)
Since malignancy can hide in lung infiltrates, imaging should be repeated after this much time to get resolution
6 weeks to 3 months
This focal pulmonary infiltrate looks like pneumonia on chest x-ray, but the patient will have NO symptoms (no fever, chills, or elevated WBCs)
Alveolar cell carcinoma
Treatment for ABPA (allergic bronchopulmonary aspergillus)
Prednisone (treat the asthma)
Chronic eosinophilic pneumonia will show up like this on chest x-ray
“Reverse pulmonary edema” - more white on outside, clear in the center
Mycoplasma pneumonia primarily shows up in these areas of the lungs
Lung bases or right middle lobe
Aspiration of an oily substance can lead to lipoid pneumonia. Diagnosis of which can be confirmed with this test
Oil red O stain
Silicosis in patients with rheumatoid arthritis is called this …
Caplan syndrome
Three causes of BOOP
Rheumatoid arthritis
Graft vs heart disease
Bleomycin
Which type of pulmonary nodule mimics GPA?
Lymphomatoid granulomatosis
Treatments for simple, chronic, and acute eosinophilic pneumonias
Simple = d/c drug cause or treat parasite
Chronic = prednisone
Acute = methylprednisolone
A granulomas solitary pulmonary nodule would look like this on a PET scan
“Flip-flop fungus”
Lymph nodes brighter than nodule
Treatment for cavitary GPA (Wegener’s granulomatosis)
Cyclophosphamide, steroids, rituximab
Telltale symptom for patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Footdrop
Describe the Fleischner criteria
Guidelines for follow-up/management of pulmonary nodules in patients aged 35+
Small satellite nodules seen in the lungs surrounding a larger nodule suggest this type of infection
Fungal infection
Well circumscribed nodules without adenopathy are seen in this condition
Post-transplant lymphoproliferative disorders
Which patients are most at risk of chronic eosinophilic pneumonia?
Females
Age 20-40
With atopic history
Describe the spread pattern of invasive aspergillosis and mucor
Angioinvasive, follows blood vessels
Pulmonary masses in the hilar portion of the lower lung lobes are caused by this
Blastomycosis
IV drug users are most at risk of these types of pulmonary nodules
Bacterial endocarditis spread from right sided heart valve
Typical symptoms (4) for cavitary GPA (Wegener’s granulomatosis)
Lower respiratory tract webbing
Glomerulonephritis
Vasculitis - ulcers/rashes on body
Generally very sick (fever, weight loss, sinus issues)
Simple eosinophilic pneumonia typically shows up in these areas of the lungs
Lower lung fields
This segmental/lobar pulmonary infiltrate shows with a classic fingerlike plugging of airways pattern
ABPA
Allergic Bronchopulmonary Aspergillus
Describe how multifocal pulmonary infiltrates as a result of ankylosing spondylitis would present
Upper lung fibrous infiltrates
Looks like TB (cavitations)
Aspergillus colonization in cavities
Bulky hilar and mediastinal adenopathy is associated with this multifocal pulmonary infiltrate
Hodgkin’s lymphoma
In what way might viral pneumonia appear differently to bacterial pneumonia on chest x-ray?
Viral follows airways, so looks more streaky on chest x-rays
Pulmonary infiltrates seen on a chest x-ray that have a sharp, clean border suggests this condition
Radiation pneumonitis
Most common cause of bacterial pneumonia
Strep pneumoniae (85%)
Pneumonia caused by a worm would show this unique result on a CBC with differential
Eosinophils >60%
Asthma with hypersensitivity to aspergillus causes atelectasis in these areas of the lungs and this type of sputum
Atelectasis in upper lobes
Brown sputum
Echinococcal lesions in the lungs and other organs are typically caused by this type of infection
Parasitic infection
Which pneumonia shows with thick walled upper lobe cavitations without fluid levels?
Suppurative pneumonias
Drugs (3) that can induce simple eosinophilic pneumonia
Nitrofurantoin
Cocaine
Amiodarone
