General Flashcards
Aunt Minnie: Donut sign on lateral radiograph
(what is center of donut?)
Sarcoid
Center of black hole is left upper lobe bronchus.
Difference between mass and nodule?
Mass is >3cm
Cervicothoracic sign - Mediastinal opacity that is above the clavicles is ___
retrotracheal and posterior.
If it stops at clavicle, its probably and anterior mediastinal mass.
Thoracoabdominal sign
Masses that extend below the dome of the diaphragm are likely in posterior lung or pelural space.
Hilum overlay sign
Anterior (or posterior) mediastinal mass will overlay the pulmonary vessels (You will still see the vessels)
If you can’t see the vessels, that means its in middle mediastinum.
Incomplete border sign
Inner well defined border with outer ill defined border. This means its extrapulmonary
Name an entity which is more rare than pneumomediastium, but also involves air in the heart/chest
Pneumopericardium
Ddx; random nodules (4)
Miliary pattern (3)
Random nodules: Hematogenous mets, TB/Fungal, PLCH, Septic Emboli
Miliary pattern: Disseminated TB, Disseminated fungal, Disseminated mets.
- Perilymphatic nodules (3)
- Centrilobular nodules (5)
- Sarcoid
Lymphangitic carcinomatosis
Silicosis
- Hypersensitivity pneumonitis (Hot tub lung)
RB-ILD
Infection (TB, bronchopneumonia, atypical pneumonia)
Silicosis
Diffuse panbronchiolitis
Gamesmanship: if they show you saggital or coronal or Interstitial lung disease, what should you look for
Look for apical to basal gradient, that is what they are trying to tell you. They may also be showing costophrenic angle sparing
NSIP - Classic imaging findings
- Demographics
- Histologic appearance
- Prognosis and response to steroids
- Associated with what disease?
- 2 types
NSIP - Ground glass, subpleural sparing. Effects posterior and peripheral lobes, like UIP
- Younger patients (40s-50s) compared to IPF
- Thickened alveolar septa from chronic inflammation (less fibrotic change compared to IPF)
- Better prognosis than IPF, but doesn’t respond to steroids
- Scleroderma (Can show dilated esophagus to suggest scleroderma)
- Fibrotic NSIP. Cellular NSIP
IPF - Most common ILD, bad prognosis
- Classic imaging
- Pathologic corresponding name
- Honeycombing, traction bronchiectasis, basilar predominant (Apical to basal gradient)
- Usual interstitial Pneumonia
PCP imaging ddx
Thallium/gallium findings
central/perihilar groundglass in a person w/ CD4 <200. Can have cysts
thallium cold, gallium hot.
Name the sign
lymph node enlargement pattern which has been described in sarcoidosis:
right paratracheal nodes
right hilar nodes
left hilar nodes
Garland triad, AKA 1-2-3 sign AKA Pawnbrokers sign
Monod sign vs. crescent sign
Monod sign - air that surrounds a mycetoma (most commonly an aspergilloma) in a pre-existing pulmonary cavity
Air crescent sign - seen in recovering angioinvasive aspergillosis. The air crescent sign heralds improvement in the condition
Raider triangle (Retrotracheal space) - what are the borders?
anterior: posterior tracheal stripe/tracheo-oesophageal stripe
posterior: thoracic vertebral bodies
inferior: aortic arch
(superior: thoracic inlet)
Castleman’s is associated with what syndrome?
what does it stand for
POEMS Occurs in setting of Plasma cell dyscrasias. A/w Castleman’s. (King’s speech - You read the Poem on top of the castle)
P: polyneuropathy
O: organomegaly
E: endocrinopathy
M: monoclonal gammopathy
S: skin changes (including hyperpigmentation and skin thickening)
Name of syndrome occurs when a patient manipulates and detatches a subcutaneous chest device. (Flips a pacemaker).
Twiddler syndrome
Feeding vessel sign
consists of a distinct vessel leading directly to a nodule or a mass. This sign indicates either that the lesion has a hematogenous origin or that the disease process occurs near small pulmonary vessels.
Aortic nipple
superior intercostal vein. Seen in 10% of patients.
Which calcification patterns in lung nodules are malignant? (4 benign, 2 malignant)
Exceptions: osteosarcoma mets can be completely calcified, but is not benign
GI cancer can have popcorn or central calcs
Benign (dense central, popcorn, laminated, diffuse)
Intermediate/malignant (Stippled, Eccentric)
Eggshell calcification in hilar or mediastinal nodes is classic for what disease?
Sarcoidosis (calcification happens late).
localized fibrous tumors of the pleura are associated with what?
hypertrophic pulmonary osteoarthropathy
2 direct and 5 indirect signs of atelectasis.
Direct: displacement of fissures, vascular crowding
indirect; elevation of diaphragm, rib crowding, mediastinal shift to side of volume loss, overinflation of contralateral lobes, hilar displacement.
4 types of atelectasis
obstructive
relaxation (relaxation of lung adjacent to intrathoracic lesion)
adhesive (surfactant)
cicatricial.
- Golden S sign represents what?
name another sign that goes with that finding?
- name the sign that goes with left upper lobe collapse.
- RUL collapse - suspicious for underlying malignancy.
Juxtaphrenic peak sign also seen w/ RUL collapse.
- Luftsichel sign
Describe LLL, RLL, RML collapse on CXR.
LLL - flat waist sign. RLL - mirror image.
RML - blurring of right heart border
5 findings of round atelectasis
Adjacent pleural abnormal
opacity peripheral and in contact with pelura.
Opacity is round/elliptical
Volume loss in affected lobe
Pulmonary vessels and bronchi leading to opacity (comet tail sign)
What 2 things are in center of secondary pulmonary lobule. What 2 things are in periphery?
bronchiole and artery are in center. Vein and lymphatics are in septa.
There are 12 acini per lobule.
4 radiographic criteria for emphysema (you need 2 to call it)
flattening of diaphragms on frontal.
Flattening on lateral.
Distortion of pulmonary architecture.
Increase in retrosternal space.
Patterns of lung disease (4 diffuse patterns, 4 nodule patterns)
Consolidation, GGO (central vs. peripheral) Interlobular septal thickening (smooth vs. nodular), crazy paving.
Centrilobular, peri-lymphatic, random, tree in bud.
- DDX Consolidation (4 acute, 3 chronic)
- DDx GGO (4 acute, 6 chronic)
1A. Acute: Pneumonia, Pulmonary hemorrhage, ARDS, Pulm edema (less common)
1B. Broncho-alveolar carcinoma. COP. Chronic eosinophilic pneumonia.
2A - Same as acute consolidation
2B - Same as chronic consoliadion + idiopathic pneumonias, HSP, alveolar proteinosis.
Hypertrophic osteoarthropathy basics
Hypertrophic osteoarthropathy is characterised by periosteal reaction involving the diaphysis and metadiaphysis of the long bones of distal extremities without an underlying bone lesion. Clubbing of the fingers is seen most commonly in patients with lung, liver, and gastrointestinal disorders. When associated with a pulmonary condition, it is termed hypertrophic pulmonary osteoarthropathy (HPOA).
GGO - diffuse but central (4)
GGO - diffuse but peripheral (4)
- Pulm edema, alveolar hemorrhage, PCP, alveolar proteinosis
- COP, Chronic eosino[hilic pneumonia, atypical/viral pneumonia, pulm edema.
Interlobar septal thickening:
Smooth (4)
Nodular (2)
Smooth: Pulm edema, pulmonary alveolar proteinosis, pulm hemorrhage, atypical pneumoinia
Nodular: Lymphangitic carcinomatosis, sarcoidosis.
Crazy paving (7)
Alveolar proteinosis, PCP, COP, Bronchoalveolar carcinoma, Lipoid pneumonia, ARDS, Pulmonary hemorrhage
Tree-in bud nodules (4 - all infectious)
Mycobacteria TB/atypical mycobacteria. Bacterial pneumonia. Aspiration pneumonia. Airway invasive aspergillosis.
Solitary cavitary lesion (2)
Multiple cavitary nodules (3)
Primary bronchogenic carcinoma (squamous cavitates more than adenocarcinoma). TB.
Multiple cavitary nodules - septic emboli. Vasculitis, mets
Perihilar flame shaped opacity (aunt minnie)
How does it appear in Gallium/thallium tests
Kaposi’s sarcoma
Gallium Cold, thallium Hot
Halo sign vs. Atoll sign
Halo sign: Consolidation in the middle, ground glass peripherally. Invasive Fungal disease.
Atoll sign. Ground glass in middle with consolidation in peripheral. COP.
Upper lobe predominant processes. (6)
Lower lobe predominant (5)
CF, inhaled things (other than asbestosis), RB-ILD, Primary lung cancer, ankylosing spondylitis. Sarcoid.
Primary ciliary dyskinesia, asbestosis, hematogenous mets, RA, UIP
Silicosis, calcified conglomorate mass, angelwing pattern.
Progressive massive fibrosis
LAM features.
vs. LCH features
LAM: Homogenous, round. Mostly women. Chylous effusions. If in men, they likely have TS.
LCH: Bizzare shaped cyts. In smokers. Spares the CPAs (because smoking effects upper lungs). Cysts and nodules.
Bronchial stump leak
Usually after pneumonectomy, fluid fills the space. If there is an air leak, then air starts to re-fill the space.
Signs of left atrial enlargement.
Double density on right. Splaying of Carina. Heart goes too far posterior.
- DDx for cystic lung disease (3 L’s + 3 more)
- Ddx for single cyst (3)
- Wildcard zebra with fibromas and kidney lesions
- LAM, PLCH, LIP
emphysema, diffuse cystic bronchiectasis, PCP.
- Bulla, Bleb, pneumatocele
- Birt Hogg Dube
- DDx - lower lobe fibrotic changes (3)
- DDx - upper lobe fibrotic changes (3) (all inhaled)
- IPF, asbestosis, NSIP
- Sarcoid, Chronic HSP, Silicosis.
what is the typical size of acinus
5-10mm
Describe clamshell sternotomy wires
They course over the anterior chest wall and reflect a broad transverse incision across the anterior chest wall and the sternum and (typically) along the anterior 4th intercostal spaces
Focal, relatively high attenuating lesions on pleural surfaces that are seen after a certein malignancy treatment?
Talc Slurry Pleurodesis
Ewing sarcoma family of tumours (ESFT). 3 names. Imaging.
Ewing sarcomas of the chest wall, AKA Askin Tumor, AKA Peripheral PNET.
On imaging, - large extrapulmonary invasive soft tissue masses, heterogeneous, presence of haemorrhage, necrosis, or cystic changes. Intense enhancement. Positive on Nuc medicine tests.
interlobular septal thickening vs. Intralobular septal thickening.
Interlobular septal thickening is what you normally think of as septal thickening, which is thickening of secondary pulmonary lobule.
INTRAlobular septal thickening is thickening of septa WITHIN the secondary pulmonary lobule.
What is this?
Intermediate Stem line
Seen on lateral X-ray, what is the name of the thin vertical line formed by the posterior walls of the right mainstem bronchus and bronchus intermedius.
Broncholithiasis is a/w what?
A/w testicular microlithiasis.
Lipoid Pneumonia
3 types
- Exogenous: old people who like to drink/aspirate mineral oil. Low attenuation/fat density consolidation
- acute exogenous lipoid pneumonia - poison w/ hydrocarbons (fire-eating
- endogenous: post-obstructive process (cancer), causing the building up of lipid laden macrophages.
3 radiographic stages of pulmonary edema
- Vascular redistribution
- Interstitial edema - increased interstitial markings, Kerley B. Kerley A lines, which radiate from the hila.
- Alveolar edema - perihilar opacification, cardiomegaly, pleural effusion.
Intrathoracic causes of pulmonary edema like CHF cause pathcy ground glass, while sysemic pulmonary edema (sepsis, low protein), often causes diffuse GGO.
- What is a classic cause of assymetric RUL pulm edema?
- What is re-expansion pulmonary edema
- Mitral regurgitations secondary to myocardial infarction and papillary muscle rupture
- Re-expansion pulonary edema is a complication of aggressive thoracentesis.
- What is the vascular pedicle?
- Normal vascular pedicle width?
- Transverse width of upper mediastinum (Right border is SVC/Right mainstem bronchus. Left border is lateral border of left subclavian takeoff)
2 .<58mm
(If vascular pedicle is increased in size, it may suggesed increased capillary wedge pressure)
People w/ LAM present w/ what in the pleura?
Chylous effusions
Which lung cancer has mucoid plugging of airways - Dr. P morning session
Carcinoid will have mucous plugging of bronchial airways.
