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Chest > ILD > Flashcards

ILD Flashcards

1
Q

DDx for cystic lung disease

A
  • Cystic bronchiectasis
  • Bullae
  • Langerhans cell histiocytosis
  • Lymphangioleiomyomatosis
  • Laryngotracheal papillomatosis
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2
Q

Causes of cystic bronchiectasis

A
  • Pneumonia
  • Chronic bronchitis
  • Asthma (allergic bronchopulmonary aspergillosis)
  • Bronchial atresia
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3
Q

Cystic Bronchiectasis

A
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4
Q

Cystic Bronchiectasis

A
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5
Q

1 French is ?

A

1/3 mm in diameter

1/3 x French in mm

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6
Q

Position of a chest tube

A
  • directed anterosuperiorly to evacuate a pneumothorax
  • directed posteroinferiorly for fluid collections
  • Malpositioned chest tube
    • within the interlobar fissure
    • abut the mediastinum
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7
Q

Types of chest tubes

A
  • Thoracostomy chest tube
  • Pigtail catheter - for empyema drainage
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8
Q

Position of an endotracheal tube

A
  • 5 cm above the tracheal carina
  • when extending the neck, upward excursion of 2cm
  • when flexing the neck, downward excursion of 2cm
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9
Q

Idean position of a esophageal pH probe

A

distal esophagus, just above the gastroesophageal junction

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10
Q

Bronchial stents

A

Used in patietns who have undergone lung transplantation and have developed a stricture at the anastomosis between the native tracheobronchial tree and the transplanted one

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11
Q

Swan-Ganz catheter

A

Pulmonary artery catheter

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12
Q

Which valve?

A

3 finger rule

T-A-M

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13
Q

Epicardial pacing wires

A
  • placed at the time of cardiac surgery for immediate packmaker access, should the need arise
  • simply pulled out through the incision when the patient is ready for discharge
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14
Q

Types of coronary artery stents

A
  • balloon-expandable
  • self-expandable
  • thermally expandable
  • stainless steel
  • nitinol
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15
Q

Types of sternotomy

A
  • median sternotomy - vertical incision
  • calmshell sternotomy - horizontal incision - transplant
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16
Q

Intraaortic balloon pump (IABP)

A
  • 25 cm long inflatable balloon mounted on a catheter
  • intraduced via a femoral artery
  • tip of the catheter is placed just distal to the take off of the left SCA
  • inflated with CO2
  • balloon is inflated during ventricular diastole
    • augment diastolic coronary artery perfusion
    • reduce LV afterload
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17
Q

Maximal thickness of right paratracheal strip

A

4mm

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18
Q

Contents of the AP window

A
  • mediastinal fat
  • left vagus nerve
  • left recurrent laryngeal nerve
  • left bronchial artery
  • ligamentum arteriosum
  • lymph nodes
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19
Q

Where to search for an abrnomality in a patient with vocal cord and left diaphragm paralysis?

A

AP window

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20
Q

Azygoesophageal recess

A
  • Right superior convexity may be seen in children and younger adults but is abnormal in the elderly.
  • Abnormal contour and convexity may be due to
    • lymphadenopathy
    • hiatal hernias
    • bronchopulmonary-foregut malformations
    • esophageal neoplasms
    • pleural abnormalities
    • cardiomegaly with left atrial enlargement
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21
Q

Posterior wall of bronchus intermedius

A
  • projects through the LUL bronchus
  • maximal thickness 3mm
  • bandlike thickening of the posterior wall of BI is often due to pulmonary edema
  • other causes
    • lung carcinoma
    • LAD
    • metastatic disease
    • TB
    • sarcoidosis
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22
Q

Most common pattern of interstitial lung disease (ILD) in patients with rheumatoid arthritis

A

UIP

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23
Q

Reserve Halo / Atoll Sign

A

COP

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24
Q

Most common pattern of interstitial lung disease (ILD) in scleroderma

A

NSIP

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25
Q

Pattern of distal clavicle resoprtion in patients with RA

A

“penciling” of undersurface

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26
Q

How to distinguish UIP from NSIP

A
  • UIP - basal and subpleural predominance; honeycombing
  • NSIP - basal but NOT subpleural; NO honeycombing; more volume loss and traction bronchiectasis
27
Q

Most common manifestation in chest in patients with SLE and RA?

A

Pleural effusions

pericardial effusion

28
Q

When can you most often see lymphocytic interstitial pneumonia (LIP)?

A
  • Sjogren’s syndrome
  • thin-walled cysts
  • perivascular cysts - with vessels along the walls of the cysts
29
Q

2012 ATS-ERS Classification of idiopathic interstitial pneumonia (IIP)

A
  • Chronic fibrosing IP
    • UIP
    • NSIP
  • Smoking-related IP
    • Respiratory bronchiolitis
    • RB-ILD
    • Desquamative IP
  • Acute/subacute IP
    • Organizing pneumonia/OP
    • Diffuse alveolar damage/DAD
  • Rare entity
    • Lymphoid IP pattern (lymphocytic IP)
30
Q

Most common IIP?

A
  • UIP - 40%
  • NSIP - 20%
31
Q

DDx of UIP

A
  • Causes unknown - IPF
  • Causes known - other causes
  • If inconsistent - biopsy
32
Q

Diagnostic criteria for UIP

A
  • subpleural and basal predominance
  • reticular abnormality
  • HONEYCOMBING
  • with or without traction bronchiectasis
  • absence of features inconsistent with UIP
33
Q

Diagnostic criteria for NSIP

A
  • better survival than UIP
  • often associated with collagen vascular disease/HP/drugs
  • basal predominance
  • subpleural SPARING - peribronchovascular
  • confluent pattern
  • volume loss - inferior displacement of the major fissures
  • reticular
  • groundglass opacity
  • traction bronchiectasis
  • NO honeycoming
34
Q

Underlying disease in NSIP

A
  • collagen vascular disease
  • environmental exposures - HP
  • drugs
  • smoking
35
Q

Smoking-related lung disease

A
  • Respiratory bronchiolitis - RB
    • centrilobular nodules
    • patchy GGO
  • RB-ILD
    • reticular marking
    • GGO
  • DIP
    • GGO
    • cysts within the GGO
36
Q

Organizing pneumonia / OP

A
  • subpleural/peribronchial
  • patchy consolidation
  • GGO
  • peribronchial thickening
  • reverse halo sign/Atoll sign
37
Q

Causes of Organizing Pneumonia

A
  • Cryptogenic
  • CVD
  • drug toxicity
  • aspiration
  • infection
38
Q

Approach to micronodular disease

A
  • Distribution
    • centrilobular
    • perilymphatic
    • random
39
Q

Centrilobular nodules

A
  • does not extend to the interlobular septum and pleural surface
  • further features
    • solid/discrete - silicosis/CWP, pulmonary LCH, infection, aspiration, metastases
    • tree-in-bud - linear opacities connecting the nodules - infection (TB, NTMB), viral; aspiration
    • GGO - centrilobular “opacities” - HSP, bronchiolitis (RB, infection/viral), BAC, OP/NSIP, edema/vasculitis
40
Q

Perilymphatic nodules

A
  • peribronchiovascular, peri-interlobular septal, subpleural, peri-fissural
  • sarcoidosis
  • lymphangtic carcinomatosis
  • rare: silicosis/CWP, lymphocytic IP, amyloidosis
41
Q

Random nodules

A
  • disseminated infection (miliary TB, histoplasmosis)
  • sarcoidosis
  • hematogeneous metastatic disease
  • rare - LCH, silicosis/CWP
42
Q

Sarcoidosis nodules

A
  • perilymphatic (most common)
  • random
43
Q

Pulmonary fibrosis of sarcoidosis

A
  • upper lobe predominance
  • traction bronchiectasis - airway distortion
44
Q

Air crescent sign

vs

Monod sign

A

Air crescent sign - angioinvasive aspergillosis

Monod sign - aspergillosis/mycetoma

45
Q

Causes of Acute Lung Injury (ALI) and

Acute Respiratory Distress Syndrome (ARDS)

A
  • Pulmonary
    • aspiration
    • infection - bacterial, viral, PCP
  • Extra-pulmonary
    • systemic sepsis
    • trauma
    • hyppertransfusion - TRALI
    • cardiopulmonary bypass
46
Q

Typical / atypical pattern of ARDS

A

gradient density from front to back - exptra-pulmonary cause

bilateral abnormality

vs

patchy distribution - pulmonary causes

unilateral abnormality

47
Q

Clinical presentation of HSP

A
  • Acute
    • rapid onset 4-8 hr after exposure
    • self-limited 24-48 hrs
    • fever, chills, cough, dyspnea
    • heavy exposure
  • Chronic
    • insidious onset over months to years
    • chronic progressive
    • chronic cough and SOB
    • low grade, chronic exposure
48
Q

Exposures to cause HSP

A
  • Microbes - thermophillic actinomycetes - hottub lung
  • animals - birds, rodents
  • plant material - soybeans
  • chemicals - paints, plastics
49
Q

Acute HSP

Subacute HSP

Chronic HSP

A
  • Acute HSP - limited CT data
  • Subacute HSP
    • patchy GGO
    • centrilobular GGO nodules
    • mosaic perfusion/air trapping - headcheese sign
  • Chronic HSP
    • fibrosis with/without honeycombing
    • peripheral and central
    • SPARING of costophrenic angles
    • superimposed subacute findings
      • GGO, centrilobular gg nodules
      • mosaic air-trapping
50
Q

DDx for

headcheese sign

and

centrilobular ggo nodules

A
  • HSP
  • RB-ILD, DIP
  • LIP
  • atypical infections
  • edema and asthma
51
Q

Lung cysts

A

1mm thin wall

vs

emphysema - no wall

vs

cavitating mass - thick wall

52
Q

DDx for cystic lung disease

L3ABC

A
  • Langerhans cell histiocytosis (late)
  • Lymphangioleimyomatosis (LAM)
  • lymphocytic interstitial pneumonia (LIP)
  • Amyloidosis/light chain deposition disease
  • Birt Hogg Dube
  • Cystic metastases
53
Q

All cystic lesions - unifying concept

A

bronchiolocentric lesion

54
Q

Langerhans Cell Histocytosis

A
  • Young smokers - 90%
  • centrilobular nodules
  • central lucency or cavitation with time
  • apical to base gradient of severity
    • SPARING costophrenic angles
  • late - air cysts and air trapping
  • rare to have adenopathy and pl effusion
55
Q

Lymphangioleiomyomatosis

LAM

A
  • sporadic or associated with TS
  • exclusively in women!
  • air cysts - no zonal distribution
  • adenopathy
  • patchy GGO - pulm hemorrhage
  • no large nodules
  • find miliary nodules may be seen
  • chylous pleural effusion from lymphatic obstruction
  • pleural effusion
56
Q

Lymphocytic interstitial pneumonia

LIP

A
  • associated with Sjogren’s disease
  • poorly defined centrilobular or peribronchial nodules
  • GG
  • septal thickening
  • perivascular cysts/pericystic dot*
  • mosaic air trapping
57
Q

Amyloidosis

Light chain deposition disease (LCDD)

A
58
Q

Birt-Hogg-Dube Syndrome

A
  • autosomal dominant disorder
  • skin - fibrofolliculomas
  • lungs - lung cysts - basilar and subpleural predominance
  • kidneys - oncocytomas, RCC, etc
59
Q

Cystic pulmonary metastases

A
  • leimyosarcoma
  • synovial cell sarcoma
  • endometrial stromal cell sarcoma
  • angiosarcoma
60
Q

Min IP

Max IP

A

Max IP - nodules and tree-in-bud

Min IP - emphysema

61
Q

Interlobular septal thickening

A
  • venous
    • smooth
    • pulmonary edema
  • lymphatic
    • nodular
    • lymphangitic carcinomatosis
    • sarcoidosis, UIP…
62
Q
A
63
Q
A

Chest (13 decks)

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