Imaging

Question 1

Approach to imaging

Answer 1

Normal vs abnormal
Predominant pathology eg nodule airway interstitial
Anatomy location eg secondary lobule

Question 2

NSIP

Answer 2

Homogenous expansion alveolar walls with inflammation and fibrosis

CTD
Drugs
GVHD

Ground glass
Basal
Subpleural sparing
Straight edge sign
Reticulation and traction Bronchiectasis
Less honeycombing

Question 3

Sarcoid

Answer 3

Upper lobe predominant
Perilympjatic. Nodules
GGO
BHL
Late fibrotic change UZ

Question 4

UIP

Answer 4

Cause
IPF
Sarcoid
CTD
Drugs
Asbestos

Subpleural
Basal predominant Reticulation and traction Bronchiectasis
Honeycombing

Question 5

HP

Answer 5

GGO
Mosaicism and air trapping
Ill defined centrilobular nodules

Question 6

Organising pneumonia

Answer 6

Infection CTD drugs cancer

Bilateral peripheral consolidation
Migratory
Reverse halo or atol sign
Parenchymal bands
Some can honeycomb

Question 7

PPFE

Answer 7

Familial
Infection CTD chemo

Early
Pleural and parenchymal changes
Early cyst
Pneumomediastinum peripheral consolidation
Mild pleural involvement

Later
Central parenchymal changes disappear
Bronchocentric consolidation
Early fibrosis

Question 8

LAM

Answer 8

Thin walled regular cyst
Throughout lung
No nodules
Renal tumours

Question 9

Emphysema

Answer 9

Paucity of lung marking w bullae and hyperinflation
Hyperinflation air trapping w flat hemiD

Basal A1AT

Other
Centrilobular UL - is proximal and spares distal bronchi - commonest
Paraseptal - peripheral so less symptoms but high risk Ptx
Panacinar - dilation airspace bronchiole to alveoli

Question 10

Cystic

Answer 10

LCH irregular cyst
LAM regular cyst
LIP gg change too
End stage UIP
Burt Hogg Dube

Syndromes
Sawyer James : affected side less volume
Poland : best wall hypoplasia so no pec major/ no breast/ hypoplastic hand and limb
Transplant density difference
Thoracoplasty

Question 11

Ground glass

Answer 11

Fluffy infiltrates
Still see vessels

Inflammation eg sarcoid or HP
Pulmonary oedema or haemorrhage
PAP
Drug induced
Infection PJP

Question 12

Consolidation

Answer 12

Denser infiltrate cannot see vessel

Infection filled by pus
Pulmonary haemorrhage blood
Pulmonary oedema fluid
Adenocarcinoma cancer cells
Cop flitting consolidation due to cancer or infection or inflammatory cells to drugs
PAP - gg change too/ consolidation/ septal lines crazy paving

Question 13

Mediastinum

Answer 13

Anterior
Thymoma
Teratoma
Lymphoma
Thyroid

Middle
Bronchogenic cyst
Vascular
LN

Posterior
Neurogenic eg schwannoma or ganglioma or neurofibroma

Question 14

Pleura

Answer 14

Solitary
Fluid eg effusion or empyema or Haemothorax
Tumour eg Meso or met or neural tumour or lipoma or fibrous tumour

Multiple
Plaques
Loculated pleural effusion
Tumour eg Meso or met or neural lesion

Question 15

Nodules

Answer 15

No pleural nodules eg infection HP RBILD or tumour

Pleural nodules
Sarcoid
Silicosis
Lymphoma

Diffuse nodules inc pleural
Military TB
Mets
LCH
Diffuse fungal eg histo

Perilymphatic
Sarcoid
Lymphangitis
Pneumoconiosis
Asbestos
Silicosis

Centrilobular
Hsp
Ca
RBILD
LCH
PCP

Question 16

Cavitation

Answer 16

Vasculitis
Malignancy
Infection eg tb or bacterial eg kleb or staph aureus
Pulmonary infarction

Question 17

Air trapping

Answer 17

Asthma
COPD
BO

Question 18

Mosaicism

Answer 18

Small airways disease abnormal blacker

Asthma
BO
HP
PE
PH

Question 19

Reticular

Answer 19

Fine lines linear

ILD
Pulmonary oedema
Lymphangitis

Question 20

Honeycombing

Answer 20

End stage fibrosis
Architectural distortion/ bronchial dilation/ volume loss/ honeycombing cyst

UIP
fNSIP
Asbestos
Sarcoid

Question 21

Tree in bud

Answer 21

Mucus fills bronchioles causes dilation

MTB NTM HiB/ viral pneumonia/aspergillosis
CF Yellow nail lymphoma

Focal
Fat/amniotic or tumour

Question 22

Anatomical defect

Answer 22

Sawyer James
Affected side less volume with reduced blood vessel markings, BO, BrE, Trachea deviates to bad side
VQ less ventilation
Hx recurrent LRTI causes BO

Poland syndrome
Abnormality pec major so 1/3 breast absent
Rib can be hypoplastic
Hand and limb abnormality

Pneumonectomy
Reduced density
Normally fills with fluid

Question 23

Cavity

Answer 23

Infection eg bacterial or TB or NTM or aspergilloma
Vasculitis eg GPA
Malignancy
Pulmonary infarction post PE

Question 24

Centrilobular nodules along bronchovascular structures with UL predominance

Answer 24

Sarcoid

Ddx
Lymphangitis
Lymphoma
Kaposi sarcoma

Question 25

Diffuse GG changed with soft centrilobular modules

Answer 25

HP

Question 26

Peripheral consolidation with UZ predominance

Answer 26

Eosinophilic pneumonia

Question 27

Subpleural honeycombing with lower zone predominance

Answer 27

UIP eg IPF

Question 28

Multi focal GG pacification with LZ predominance

Answer 28

NSIP

Question 29

Thin walled cysts and small nodules mostly UL bilat

Answer 29

LCH

Question 30

Apical RLL next to which fissure

Answer 30

R oblique

Question 31

Normal transverse diameter of trachea

Answer 31

3cm

Question 32

Tubular abnormality

Answer 32

ABPA AV malformation

Question 33

Nodular pattern with calcification

Answer 33

VZV Histoplasmosis Silicosis

Question 34

Diffuse GG change

Answer 34

Pulmonary oedema Pulmonary haemorrhage AIP form of idio ards Infection eg PCP HP

Question 35

Westermark’s sign

Answer 35

Cutoff blood distal to PE

Question 36

Peripheral consolidation CT

Answer 36

CoP Lofflers Chronic eo pneumonia Pulmonary infarct Vasculitis Bronchoalveolar ca

Question 37

Airway congenital abnormality

Answer 37

Cardiac bronchus comes off BI Tracheal bronchus before carina to RUL

Question 38

Small airways disease including small centrilobular branching opacities and nodules

Answer 38

Tree in bud Impacted bronchioles

Question 39

Low attenuation darker with high then MOSAICISM

Answer 39

Blacker have fewer vessels Seen in expiration then small airway disease vs cteph Ddx Small airways disease Vascular Infiltrative eg pcp

Question 40

LN calcification

Answer 40

TB Histo Silicosis Sarcoid

Question 41

Progressive massive fibrosis UZ

Answer 41

Silicosis Ddx Sarcoid TB Berylosis Coal workers pneumoconiosis

Question 42

Bronchogenic cyst

Answer 42

Subcarinal or near central airways

Question 43

Sequestration

Answer 43

Nonfunctioning pulmonary tissue in isolation tracheobronchial tree and systemic arterial supply Intralobar pleural covering Extralobar no pleural covering

Question 44

GGO and cyst

Answer 44

LIP thin walled cysts along airway PCP proximal and UL

Question 45

Pectus exc

Answer 45

Pseudorml

Question 46

Smoking related ILD

Answer 46

LCH RB-ILD DIP - hazy GGO in LZ

Question 47

Large isolated cyst in young

Answer 47

Ddx Cystic adenomatoid malformation Cystic intralobar sequestration Postinfectious pneumatocele

Question 48

Hilum overlay and cardiac contour different

Answer 48

Pericardial cyst

Question 49

Posterior mediastinum

Answer 49

Apex rib spreading Lower down look behind heart at paratracheal stripe Ddx Neurogenic - schwannoma, neurofibroma, ganglioma Descending aorta Bone marrow Paraspinal abscess

Question 50

Middle mediastinum

Answer 50

Posterior chest No hilum overlay so can’t see hilum so middle med Ddx LN Oesophageal or bronchial Vascular eg aneurysm or azygous or pulmonary vessel Pericardial

Question 51

Hamartoma

Answer 51

Solitary nodule Popcorn calcification Fat No uptake pet Ddx lipoid pneumonia

Question 52

Broncholith

Answer 52

Calcified endobronchial lesion results partial collapse

Question 53

Definitions cyst bleb cavity

Answer 53

Air filled Less than 1cm bleb More than 1cm bulla Thickness More than 4mm cavity More than 8mm cavity CA

Question 54

Cherio sign

Answer 54

Bronchoalveolar Ca Ddx LCH GPA

Question 55

Diffuse GGO with peripheral sparing. No effusions or cardiomegaly

Answer 55

AIP or ARDS DAH or pulm haemorrhage

Question 56

Central Bronchiectasis with mucoid imp action, finger in globe branching opacity from hilum

Answer 56

ABPA

Question 57

Dark or low attenuation with NO WALL

Answer 57

Emphysema

Question 58

Superior vs inferior med

Answer 58

Superior thoracic inlet to T4-5 Thyroid Thymus Aortic arch Oesophageal LN Inferior Anterior Middle posterior

Question 59

Lung vs mediastinum

Answer 59

Mediastinum has an acute angle Lung has an obtuse angle

Question 60

Hilum overlay sign

Answer 60

See hilar vessels through lesion Lesion in mediastinum