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Chest > General, Atelectasis & Congenital > Flashcards

General, Atelectasis & Congenital Flashcards

1
Q

What are the anatomic divisions of the tracheobronchial tree?

A

R/L primary main bronchi –> lobar bronchi –> segmental bronchi –> terminal bronchioles –> respiratory bronchioles –> alveolar ducts –> alveolar sacs –> alveoli

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2
Q

True or false: the trachea cartilaginous rings are “O” shaped.

A

False. They are C/U shaped and are covered posteriorly by a flat band of muscle/connective tissue.

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3
Q

What is the difference between the right and left main stem bronchus?

A

Right – wider, shorter & more vertical

Left – narrower, longer & horizontal

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4
Q

What are the pores of Kohn?

A

Small communications between adjacent pulmonary alveoli.

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5
Q

What is an advantage and disadvantage of the pore of Kohn?

A

Advan: Collateral pathway for for gaseous transit when there’s proximal obstruction.

Disadvan: Pathway for dissemination of infection or malignancy.

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6
Q

What does the right B7 segment correspond to using the Boyden system?

A

Right medial segment of the lower lobe.

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7
Q

What does the left B4 segment correspond to using the Boyden system?

A

Left superior segment of the lingula “lobe”.

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8
Q

What does the right B4 segment correspond to using the Boyden system?

A

Right lateral segment of the middle lobe.

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9
Q

What are the canals of Lambert?

A

Direct communication between the alveoli and bronchioles.

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10
Q

Which hilar shadow is higher and why?

A

Left (90%) – because the pulmonary artery ascends over the left main and upper lobe bronchus

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11
Q

On a lateral chest view, which main stem bronchus is visualized more superiorly?

A

The right main stem bronchus.

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12
Q

What are the 4 components of the parietal pleura?

A

a) costal part
b) mediastinal part
c) diaphragmatic part
d) Cervical part

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13
Q

The apex of the lung is above which rib level?

A

1st

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14
Q

True or False: The major fissure starts at the T5 level?

A

True. It terminates at the anterior diaphragm.

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15
Q

True or False: Majority of people have complete normal fissures.

A

False. Majority have incomplete fissures.

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16
Q

At what level does the minor fissure run?

A

4th anterior rib

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17
Q

What % of the pop’n has an azygous lobe?

A

1%

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18
Q

What is the inferior accessory lobe/fissure?

A

Separates medial basal segment from rest of lower lobe.

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19
Q

What is the superior accessory fissure?

A

Separates superior segment of lower lobe from rest of basal segments.

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20
Q

On what side is the superior accessory fissure?

A

Both but R>L

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21
Q

What is the left minor fissure?

A

Separates lingula from rest of upper lobe.

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22
Q

Which accessory fissure is the M/C?

A

The inferior accessory fissure.

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23
Q

What are the 3 normal openings (for passage of vessels/organs) in the diaphragm called and at what levels do they occur?

A

a) Inferior vena cava hiatus (T8)
b) Esophageal hiatus (T10)
c) Aortic hiatus (T12)

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24
Q

What does the diaphragm attach to peripherally?

A

Ribs 6-12

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25
Q

What is the normal excursion of the diaphragms?

A

~3.5cm –> differences do not correlate with vital capacity

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26
Q

What % of diaphragm scalloping is normal? What side do they commonly occur?

A

5%; M/C on right

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27
Q

What is the ratio of air to soft tissue density in the lung?

A

11:1

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28
Q

What are 3 chest disease patterns that may present with air bronchograms?

A

a. Consolidation
b. Atelectasis
c. Interstitial thickening

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29
Q

What are the two major subtypes of atelectasis?

A

a. Obstructive Atelectasis – cause resorption atelectasis
- endobronchial lesions
- extrinsic bronchial compression
b. Non-obstructive Atelectasis
- relaxation
- adhesive
- cicatrization

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30
Q

What is the M/C form of atelectasis?

A

Resorption –> resorption of gas distally d/t a proximal obstruction

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31
Q

A resorptive collapse can be seen radiographically within what time frame?

A

1 hour

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32
Q

How long does it take all the air to disappear in atelectasis?

A

18-24hrs (other sources say 24-48hrs)

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33
Q

Lungs collapse quicker if the lungs are filled with MORE or LESS oxygen?

A

more –> faster absorption into alveolar capillaries

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34
Q

What are 2 types of relaxation atelectasis?

A

a. Passive

b. Compressive

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35
Q

What is passive atelectasis?

A

Retraction of lung tissue d/t a mass effect of air or fluid collection within the pleural space.

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36
Q

What are you likely to see in a collapsed lung in cases of passive atelectasis?

A

Air bronchograms (indicates collapse is not resorptive)

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37
Q

What is compressive atelectasis?

A

Intrapulmonary mass compresses adjacent lung parenchyma.

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38
Q

What is adhesive atelectasis?

A

Collapse in the presence of open airways (eg. inactivation of surfactant).

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39
Q

What is the function of surfactant?

A

Keeps surface tension low and thus prevents collapse of lung.

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40
Q

What is cicatrization atelectasis and what are the two subtypes?

A

Collapse d/t underlying, irreversible infectious or inflammatory process which causes fibrosis.

Local – eg. scarring in upper lobe from TB
Generalized – eg. diffuse interstitial fibrosis

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41
Q

What is platelike atelectasis?

A

Form of adhesive atelectasis.
Alveolar collapse from various causes: general anesthesia, surgery, trauma, phrenic nerve paralysis, mucus plugging, asthma.

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42
Q

What are the aka’s for platelike atelectasis (including the eponym)?

A
  • Discoid
  • Liner
  • Subsegmental
  • Fleischner Lines
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43
Q

What are the aka’s for round atelectasis?

A
  • folded lung
  • Blesovsky syndrome
  • atelectatic pseudotumor
44
Q

What is the cause of round atelectasis?

A

Form of passive atelectasis – infolding of a redundant pleura.
Local pleuritis caused by irritants such as asbestos or other pleural diseases/thickening.

45
Q

What radiographic sign can be associated with round atelectasis?

A

Comet-tail sign

46
Q

How does CT contrast help in differentiating between round atelectasis and a lung tumor?

A

It doesn’t. They both enhance.

47
Q

What are the direct signs of atelectasis?

A

a. Displacement of interlobular fissures

b. Crowding of bronchovascular structures. (DI Chest)

48
Q

What are the indirect signs of atelectasis?

A

a. Elevation of diaphragm
b. Mediastinal displacement
c. Compensatory overinflation
d. Hilar displacement

49
Q

What are specific radiographic signs of a right upper lobe collapse?

A

a. juxtaphrenic peak
b. golden S sign
c. R hilum elevated

50
Q

What are specific radiographic signs of a right middle lobe collapse?

A

a. silhouette sign of R cardiac border

b. inferior displacement of minor fissure & anterior displacement of major fissure

51
Q

What are specific radiographic signs of a left upper lobe collapse?

A

a. Luftsichel sign
b. silhouette sign of left cardiac border and aortic knob
c. vertical major fissure

52
Q

What is middle lobe syndrome in reference to atelectasis?

A

Chronic/recurrent non-obstructive middle lobe collapse d/t chronic inflammatory disease.

53
Q

What is the flat waist sign?

A

Flatten of the aortic knob and main pulmonary artery d/t severe collapse of left lower lobe.

54
Q

What is corona radiata in reference to lung nodules?

A

Linear spicules/strands radiating outwards from a pulmonary nodule. Usually specific for malignant lung cancer.

55
Q

What is rigler’s notch in reference to lung nodules?

A

Indentation in a solid lung mass, representing a feeding vessel –> signifies bronchial carcinoma

(Although, can also be seen in granulomatous infections.)

56
Q

What is the difference between a pulmonary air cavity and a pulmonary abscess (except for the contents)?

A

Cavity communicates with the bronchial tree, allowing for air to replace necrotic material.

57
Q

What does the wall thickness of a pulmonary cavity signify?

A

The thicker the wall, the higher malignant risk.

1mm = 100% benign 
5-15mm = 50% benign/malignant
>15mm = 92% malignant
58
Q

What is the definition of an intrathoracic lesion’s doubling time and what is its significance?

A

Time it takes for a nodule to double its volume. Volume doubling times faster than 1 month and less than 2 years suggest more malignant-type processes.

59
Q

What is the M/C/C of Ca2+ pulmonary nodule?

A

Healed primary granuloma

60
Q

Ca2+ of a pulmonary nodule, classically signifies what about the lesion?

A

Its benign (of course there are exceptions).

61
Q

What are some signs of a Ca2+ non-malignant pulmonary lesion?

A
  • Ca2+ is more peripheral

- Ca2+ is more diffuse & punctate

62
Q

Loculated trapped fluid in the minor fissure that disappears quickly is called?

A

Vanishing tumor sign

63
Q

What are the smallest size objects that can be identified by HRCT?

A

100-400um

64
Q

What is the black bronchus sign?

A

The airways are more obvious (“blackness”) when surrounding parenchyma is ground-glass.

65
Q

Bronchial walls should not be seen within how many cm of the costal pleura?

A

1cm

66
Q

What is the signet ring sign as seen in the chest?

A

bronchial dilatation

67
Q

Which side is pulmonary agenesis most common and which side has the worst prognosis?

What other conditions are associated with pulmonary agenesis?

A

Right = left;
Right worse prognosis

Associated with concomitant heart/skeleton/GI tract/GU malformations.

68
Q

What is the difference between pulmonary aplasia and hypoplasia?

A

Aplasia = absence of lung tissue but rudimentary bronchus present

Hypoplasia = morphology normal; incomplete development; hemithorax smaller

69
Q

What are the 3 subtypes of pulmonary hypoplasia and which one is M/C?

A

a. Primary unilateral pulmonary hypoplasia
b. Primary bilateral pulmonary hypoplasia
c. Secondary pulmonary hypoplasia – M/C

70
Q

What is scimitar syndrome?

A

Hypoplastic lung & right pulmonary artery. Anomalous right pulmonary vein drains into the vena cava (or right atrium or portal vein).

71
Q

What is the M/C/C of unilateral secondary hypoplasia?

A

Intrathoracic compression from a congenital diaphragmatic hernia.

72
Q

What is bronchopulmonary sequestration?

A

Sequestered pulmonary tissue that does not communicate with central airway thru normal bronchial connection. It also receives its blood supply via the systemic circulation rather than pulmonary system.

73
Q

What are the types of bronchopulmonary sequestration? Which one is more common?
Where is the M/C location?

A

Interlobar (75%) & Extralobar (15%)

M/C location = left lower lobe

74
Q

What are the differences btwn intralobar and extralobar sequestration?

A

Intralobar = within normal lung tissue
= pulmonary venous drainage
= other congenital anomalies uncommon
= diagnosed before age 20
= M=F

Extralobar = separate w/ own pleural covering
= systemic venous drainage
= other congenital anomalies frequent
= diagnosed mostly within 1st year
= M:F = 4:1

75
Q

What is the M/C foregut duplication cyst?

A

Congenital bronchial cyst

76
Q

What is congenital bronchial cyst and where is the M/C location?

A

It is a closed budding of the tracheobronchial tree.

M/C location = mediastinum - hilar & carina (as opposed to parenchyma)

77
Q

What is congenital bronchiectasis?

A

Dilation of proximal and medium-sized bronchi caused by destruction of muscular and elastic components of the bronchial wall.

78
Q

What is Williams/Campbell syndrome?

A

Deficiency in amt of cartilage in subsegmental bronchi –> distal airway collapse and bronchiectasis

79
Q

Abnormal lung tissue containing adenomatous tissue within a communicating cyst best describes which condition?

A

Congenital (cystic) adenomatoid malformation (CCAM)

80
Q

Which type of CCAM is M/C and what are its features?

A

Type 1 (40%)

  • one large cyst surrounded by smaller cysts
  • best prognosis
  • unilateral
81
Q

a) Which type of CCAM presents with stillborn babies?

b) Which type of CCAM is associated with lethal cardiac or renal anomalies?

A

a) Type 3

b) Type 2

82
Q

How does tracheomalacia present on inspiration/expiration films?

A 
Inspiration = Dilation of trachea
Expiration = Collapse of trachea
83
Q

What is the name of a caudally tapered trachea?

A

Funnel/Carrot-shaped trachea

84
Q

What is the triad of findings associated with congenital bronchial atresia?

A

1) Central mucocele
2) Hyperlucency
3) Hypoperfusion

85
Q

What happens to the distal airways/airspaces in congenital bronchial atresia?

A

They develop normally and fill d/t collateral pathways.

86
Q

Where is the M/C location for congenital bronchial atresia?

A

Upper lobes

87
Q

What is Wilson-Mikity syndrome?

A

Found in pre-mature babies with low birth weight and are ventilated. Early development of cystic interstitial emphysema (PIE). (Emphysematous blebs & thickened alveolar walls.)

88
Q

What is the cause for congenital lobar emphysema?

A

Unknown; but 3 theories exist:

1) Immaturity of bronchial cartilage –> bronchial collapse during expiration
2) Endobronchial obstruction – eg. mucosal folds/plugs
3) Bronchial compression from vascular structure

89
Q

What are the clinical & radiographic features of congenital lobar emphysema?

A
  • Males! (3:1)
  • 90% before 6 months
  • overinflation of a lobe
90
Q

What is the VACTERL complex?

A 
V = vertebral anomalies
A = anal atresia
C = cardio anomalies
TE = tracheoesophageal fistuale
R = renal anomalies
L = limb anomalies (radial ray anomalies, syndactyly)
91
Q

What is the M/C type of tracheoesophageal fistuale?

A

Type 3B (fistula between lower segment of trachea and esophagus - H shaped)

92
Q

What is a type 1 tracheoesophageal fistula?

A

Complete absence of esophagus

93
Q

What is the name of the condition where the right side has 2 lobes and the left side has 3?

A

Pulmonary Isomerism

94
Q

Which pulmonary artery is more likely to be absent? Where does the pulmonary blood supply come from on that side instead?

A

Right

Blood supply comes from ascending aorta, aortic arch or right subclavian artery.

95
Q

What is the pulmonary sling?

A

The LEFT pulmonary artery slings behind the trachea (between trachea and esophagus).

96
Q

Which MSK condition is associated with pulmonary artery stenosis or coarctation?

A

Ehlers-Danlos syndrome

97
Q

What is the M/C congenital venous anomaly?

A

A left superior vena cava

98
Q

What is M/C form of an anomalous pulmonary venous drainage?

A

Supracardiac (50%) – drains into left SVC

99
Q

What are other venous drainage options in left to right shunts?

A
  • Right atrium
  • Portal vein (infradiaphragmatic)
  • Mixed
100
Q

Which phakamatosis should you think of with arteriovenous fistulas?

A

Rendu-Osler-Weber (aka. Hereditary Hemorrhagic Telangiectasia)

101
Q

What location is more common for AVMs in the lung?

A

Lower lobes

102
Q

Which congenital pulmonary lymphangiectasis group is most common?

A

Group II – lymphatics fail to regress while lung parenchyma continues to grow
Fatal!

103
Q

What is the name of the condition that results from failure of separation of the GI tract from the primitive neural crest?

A

Neurenteric cyst

104
Q

Where do neurenteric cysts M/C occur and what are they associated with?

A

M/C occur in posterior mediastinum @ level of carina – have an intraspinal component.

There is a high association with vertebral anomalies (eg. butterfly, hemivertebra etc.).

105
Q

Congenital lobar emphysema M/C affects which lobe?

A

Left upper lobe (less commonly R middle lobe)

106
Q

What is the differential diagnosis for a pulmonary miliary pattern?

A
  • TB
  • Histoplasmosis
  • Sarcoidosis
  • Mets
  • Silicosis
  • EG

Chest (12 decks)

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