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Interstitial and Occupational Lung Disease Flashcards

0
Q

Features of pleural plaque on CT

A

Well defined borders
Associated with ribs
Lower zones mainly
Smooth pleural thickening

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1
Q

Features of asbestosis lung

A 
Pleural plaques
Pleural effusion
Pleural thickening
Folded stele tasks
Interstitial lung fibrosis

Holly leaf appearance on cxr

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2
Q

Features of diffuse pleural thickening

A

Smooth uninterrupted layer of thickened pleura. Extends over one quarter of chest wall

> 3mm thick
8cm cranio caudial
5cm lateral

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3
Q

What is the comet tail sign

A

Folded or round atelectasis seen in asbestosis. Sub pleural. Bronchi and vessels appear to be drawn into it

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4
Q

HRCT features of asbestosis

A

Sub pleural branching opacities
Sub pleural curvilinear opacities
Parenchyma bands
Honeycomb change

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5
Q

Simple vs Complicated Pneumoconiosis

A

Simple: coal pigments 1-5mm no fibrosis

Complicated: coal pigment plus area > 1cm of fibrosis

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6
Q

CXR findings of coal workers pneumoconiosis

A

Multiple small round opacities. Upper and mid zones

Hilar lymph node enlargement.

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7
Q

Describe caplans syndrome

A

CWP in rheumatoid patients. Multiple well defined nodules in apices.

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8
Q

Features of silicosis

A

Small. Sharply defined. Nodules. Perilymphatic. Upper and mid zones. Lymph node calcification. PMF

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9
Q

Features of silicoproteinosis

A

Centrilobular ground glass nodules. Crazy paving

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10
Q

Features of siderosis

A

Reticule nodular opacities widespread though out the lung.

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11
Q

Describe the appearances of IPF

A

Increased risk bronchogenic carcinoma.

CXR: basal bilateral peripheral reticular and small rounded opacities. Lung volume loss.

HTCT: sub pleural cystic air spaces. Honeycombing. Traction Dilatation. Starts posterior lung bases. Mid zone lateral. Upper zone anterior.

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12
Q

Features of non specific interstitial pneumonitis

A

CXR: mid and lower zone infiltrates

HRCT: symmetrical bilateral ground glass opacity bases. Traction Dilatation. Consolidation.

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13
Q

Features of respiratory Bronchiolitis associated interstitial lung disease.

A

CXR: patchy ground glass on lower zones.

HRCT: patchy ground glass. Low attenuation centrilobular nodules. Patches of low attenuation die to air trapping.

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14
Q

Features of desquamative interstitial pneumonitis

A

Patchy ground glass shadowing lower peripheral zones

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15
Q

Features of acute interstitial pneumonitis

A

CXR: Bilateral patchy air space opacificaton. Air bronchi grams. Sparing the costophrenic angles

HRCT: ground glass. Air space consolidation. Bronchial Dilatation.

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16
Q

Features of cryptogenic organising pneumonia.

A

Occurs 3months after LRTI

CXR: patchy sub pleural area of consolidation bilaterally. Areas of cavitation

HRCT: consolidation around main bronchi. Ground glass. Multiple nodules. Band opacities. Ring opacities surrounding secondary lobules.

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17
Q

Features of hypersensitivity pneumonitis

A

Centrilobular nodules. Areas of GGO. Mosaic perfusion.

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18
Q

CXR features of sarcoidosis

A

Bilateral hilar lymphadenopathy

Differentials:
TB (unilateral)
Lymphoma (anterior mediastinum and paratracheal)

Nodules: upper mid zone
Reticulonodular: nodule plus inter lobar thickening
Airspace consolidation: upper zone

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19
Q

Features of sarcoidosis on HRCT

A

Bilateral hilar lymphadenopathy
Can compress bronchi causing lobar atelectasis.
Egg shell calcification

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20
Q

HRCT features of sarcoidosis

A

Irregular small nodules. Around lymph vessels. Bronchi vascular margins. Inter lobule septae. Give a beading appearance to septae.

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21
Q

Feature of Hodgkin’s lymphoma on CXR

A

Anterior mediastinum lymphadenopathy

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22
Q

Five causes of air space shadowing

A 
Water
Pus
Blood
Cells
Protein
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23
Q

Causes of airspace shadowing due to water

A

Hydrostatic: ccf. Overload. Renal failure

Capillary Leakage: ards

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24
Causes of air space shadowing due to blood
Trauma Good pastures Vasculitis Idiopathic pulmonary haemorrhage
25
Causes of air space shadowing due to cells
Alveolar cell carcinoma | Lymphoma
26
Causes of localised air space opacity
Lobar pneumonia | Round pneumonia
27
Causes of Central diffuse airspace shadowing
Pulmonary odema Atypical infections Lymphangitisncarcinonatosa Alveolar proteinosis
28
Causes of diffuse peripheral airspace shadowing
Eosinophilic lung disease | COP
29
Causes of multiple focal airspace shadowing
``` Alveolar cell carcinoma Lymphoma Pulmonary haemorrhage Wegeners granulomatosis Pulmonary infarcts Alveolar sarcoidosis ```
30
Describe the different appearances of kerley lines
Due to thickening of the inter lobular septum. A lines: Central. few centimeters long B lines: subpleural 1cm
31
Causes of inter lobar septal thickening
Raised pulmonary venous pressure: left ventricular failure. Pull odema. Mitral stenosis. Left atrial myxoma. Pulmonary venoocclusive disease. Tumour: lumphangitis. Sarcoidosis. Depositis: pneumoconiosis
32
Describe types of septal thickening and causes
Smooth: pulmonary odema. Lymphangitis Nodular thickening: sarcoidosis. Lymphangitis Septal thickening with lung distortion: fibrosis
33
How do you distinguish between fluid overload post renal transplant and cardiogenic odema.
Normal heart size
34
Features of Sarcoidosis on CXR and HRCT
Interstitial shadowing middle and upper zones Nodular septal thickening Subpleural nodules. Peribronchovascular thickening Beading of fissures
35
Features of Lymphangitis on CXR
Smooth or Nodular septal thickening ``` Evidence of malignancy: Lung mass Mets Lymphadenopathy Effusions Bone lesions Mastectomy Previous lung surgery ```
36
Signs of pulmonary fibrosis on CXR and HRCT
``` Irregular septal thickening. Honeycombing Volume loss Peripheral and subpleural predominance Asbestos related pleural disease ``` Emohsema Irregular septal thickening Traction bronchiectasis Ground glass fibrosis
37
Signs of pneumoconiosis
``` Septal thickening Lung nodules upper zones Fibrosis Egg shell calcification Progressive massive fibrosis ```
38
What are reticular patterns on a CXR ?
Overlapping. Intersecting lines. Resembling a net. Or mesh. Narrow the differential by noting the zonal distribution and associated signs
39
Features of established fibrosis on HRCT
Traction bronchiectasis Honeycombing Inter lobular septal thickening
40
Differential for reticular pattern on CXR
``` IPF CVD fibrosis Asbestosis Drug induced fibrosis Lymphangitis EAA TB fibrosis Sarcoidosis Pneumoconiosis Radiation induced fibrosis ```
41
Most common cause of reticular pattern on CXR
IPF Peripheral and bases reticular pattern Honeycombing signifies severe disease
42
How do you distinguish between IPF and CVD fibrosis
Look for associated findings RD: clavicle erosion. Shoulder disease. Rheumatoid nodules (caseating) Effusion: RA and SLE. Not SS Oesophageal Dilatation: SS and Crest
43
Features of asbestosis on CXR
Lateral pleural plaques Holly leafs Calcified plaques
44
Common drugs causing pulmonary fibrosis and specific feature of amiodarone
Methotrexate. Amiodarone. Bleomycin. Nitrofurantoin. Amiodarone causes increase attenuation in the liver due to iodine metabolite. Hu 70-94 normal 50-65
45
Feature of. Extrinsic allergic alveolitis
Chronic. Upper zone reticular | Acute and subacute. Bases
46
Features of Sarcoidosis vs TB
Common: reticular upper zone pattern. Lymphadenopathy Difference: sarcoidosis bilateral. Apical sparing.
47
Features of pneumoconiosis
Upper zone predominance. Reticulonodular. Silicosis: egg shell calcification PMR: mass like opacities
48
Features of radiation induced fibrosis
Lung damage only occurs in field of therapy. Sharp line of demarcation. Previous malignancy history.
49
General rule for causes of upper and lower zone predominance
Upper: inhaled dust causes where ventilation is greatest; pneumoconiosis. Sarcoidosis. Tb. Ank spond. Chronic eaa. Radiation induced. Histoplasmosis. Lower: immunological causes where perfusion is better.; IPF. CVD. Asbestosis. Drug induced fibrosis. Chronic aspiration.
50
CXR differentials for septal lines.
Lymphangitis carinomatosa | Pulmonary odema
51
CXR differentials for honeycombing
End stage pulmonary fibrosis Langerhans cell histocytosis Lymphangioleiomyomatosis
52
CXR differentials for lymadenopathy
``` Sarcoidosis Tb Lymphoma Lymphangitis Silicosis ```
53
Two causes of mosaicism
Increase filling GGO | Deceased perfusion
54
How can mosaicism help identify pulmonary embolism
Areas not perfused will be hypo attenuated. Less vascular markings. Compensatory increase in perfused areas. May extend to pulmonary arterial hypertension. Increase in size of pulmonary outflow tract greater than the aorta
55
Causes of crazy paving?
Alveolar proteinosis Heart failure Lymphangitis carcinomatosa Non specific interstitial pneumonitis
56
Carcinoma associated with Lymphangitis carcinomatosa
Adenocarcinoma of breast, bronchus, stomach, pancreas, cervix and thyroid
57
Causes of tree in bud
Mucus plugging ``` Asthma Aspiration ABPA Bronchiectasis Infectious Bronchiolitis Panbronchiolitis Endobroncial TB ```
58
Causes of predominately central consolidation
Cardiac failure Cancer PCP Alveolar proteinosis
59
Causes of peripheral consolidation
Pneumonias | Poly myosotis
60
Characteristics of sarcoidosis on HRCT
Subpleural nodules. Peribronchovascular nodules. May coalesce to form consolidation. Beading of fissures. Lymphadenopathy
61
Difference between UIP and COP
Both have consolidation. GGO. Small nodules. UIP has added fibrosis
62
Appearances of EAA
Acute: centrilobular nodules. GGO. Can cause consolidation Subacute: more upper lobe. Chronic. Plus fibrosis
63
Presentations of Bronchioloalveolar cell carcinoma
1. Solitary peripheral nodules 2. Pneumonic consolidation. 20%. Nodules same lobe 3. Multiple 5-6 mm nodules
64
Features of Chronic eosinophilic pneumonia
Middle aged women Peripheral consolidation Resolved with steroids Area of consolidation moves around lung.
65
Presentations of Bronchioloalveolar cell carcinoma
1. Solitary peripheral nodules 2. Pneumonic consolidation. 20%. Nodules same lobe 3. Multiple 5-6 mm nodules
66
Features of acute interstitial pneumonia
Rapidly increasing dyspnoea following ? Viral URTI. Bilateral GGO Apical consolidation Phases: Exudative-GGO consolidation Proliferative-traction bronchiectasis Fibrotic-honeycombing Half die in 2months
67
Features of acute interstitial pneumonia
Rapidly increasing dyspnoea following ? Viral URTI. Bilateral GGO Apical consolidation Phases: Exudative-GGO consolidation Proliferative-traction bronchiectasis Fibrotic-honeycombing Half die in 2months
68
Three diseases which are primarily cystic in nature
Langerhans cell histopcytosis Lymphangioleiomyomatoisis Tuberous sclerosis
69
Radiological features of Langerhans cell histiocytosis.
Initially Nodular appearance due to granuloma at terminal bronchioles. Progress to cyst. Cyst due to bronchi Dilatation. Varicose bronchi. Extensive lung destruction and bulbous emphysema. Upper zone predominance. Costophrenic angles are spared.
70
Clinical features of LAM
Lymphangioleiomyomatosis Smooth muscle cell proliferation in bronchi and mediastinum. Women Childbearing age. Numerous thin walled cysts uniform distribution surrounded by normal lung no basal sparing. Later stages chylous effusion due to blockage of lymph drainage.
71
Three mimics of cystic lung disease
Centrilobular emphysema Para septal emphysema Cystic bronchiectasis
72
Pathology of two types of centrilobular emphysema
1. Entire parenchyma of secondary lobule destroyed. Septa are intact. Upper zone. Subtle areas of low attenuation. Without any walls 2. Destruction spreads over septa. However bronchi vascular bundle traverses the cystic space
73
How do you distinguish para septal emphysema from cysts
Para septal emphysema produced single later of subpleural and mediastinal cysts. Upper lobe. Honeycombing. Several layers. Lower zones
74
How to distinguish cystic bronchiectasis from cysts
Signet ring sign due to dilated bronchiole and adjacent arterioles
75
Four mechanisms of atelectasis
Relaxation Cicatrisation Adhesive Resorptive
76
Features of relaxation atelectasis
Due to space occupying process. Adjacent to the lung. Ie pressure increase Causes: pleural effusion. Pneumothorax. Mass. Gravity
77
Features of cicatrisation atelectasis
Due to lung fibrosis
78
Features of adhesive atelectasis
Lack of surfactant. Alveolar collapse. ``` Ards Pneumonia Pe Smoke inhalation Radiation pneumonitis ``` GGO Consolidation. Volume loss
79
What is the significance of consolidation without air bronchi grams
Suggests bronchial obstruction. Rather than infective consolidation. ? Mass. Golden S sign
80
Features of Resorptive atelectasis
Bronchus blocked. Air reabsorbed into capillaries.
81
Two direct signs of atelectasis
Displacement of inter lobar fissures | Crowding of vessels
82
Indirect signs of atelectasis
``` Local increase in opacity Elevation of hemidiaphragm Mediastinal displacement Compensatory hyperinflation Displacement of the hilim Crowding of the ribs Absence of an air bronchi gram Absence of the inter lobar artery ```
83
Features of right upper line atelectasis on CXR
Elevation of concave minor fissure
84
Features of left upper lobe atelectasis On CXR What is luftsichel sign ?
Veil like opacity over the left lung. Obscured left heart border if linguist region involved. Air crescent in left upper lobe as upper lobe is pulled down and aerated lower lobe fills space
85
What's is the juxtaphrenic peak
Seen in both left and right upper lobe atelectasis Small triangular opacity medial half of diaphragm. Site of inferior accessory ligament.
86
Feature of right middle lobe atelectasis
Obscured right heart border
87
Features of lower lobe atelectasis.
Triangular opacity lower lobe. Blurred diaphragm. Hilum pulled down
88
Feature of right middle and lower lobe collapse
Obstruction of bronchus intermedia. combination of middle and lower lobe collapse. Extends to costophrenic angle
89
Features of segmental atelectasis
No air bronchogram Linear opacity. Volume loss. Need to rule out bronchogenic carcinoma
90
Features of liner atelectasis
Linear opacity extending to pleural. Seen in patients with reduced diaphragm movement. Surgery. Acute abdomen.
91
Feature of rounded atelectasis
Area of folded lung. Occurs adjacent to thickened pleural of any cause. Lung adjacent to thickened pleural becomes atelectic. Produced round oval density. CXR : bronchi vascular bundle radiates toward in a. Curvilinear fashion CT: comet tails
92
On CXR in connective tissue disorders which additional areas should you pay attention to
Joint abnormalities - rheumatoid Oesophageal Dilatation - scleroderma Enlarged pulmonary artery - PAH Soft tissue calcification - dermatomyositis
93
Difference between UIP and NSIP
UIP - rheumatoid. With honeycombing | NSIP - systemic sclerosis and crest. No honeycombing
94
Lymphocytic interstitial pneumonitis is associated with which disorders
Sjogrens AIDs Primary Biliary Cirrhosis
95
In SLE patients what are they more at risk of
VTE
96
Features of systemic sclerosis on CT
Oesophageal Dilatation Subpleural GGO Fibrosis No honeycombing
97
How do you classify causes of pulmonary haemorrhage
``` Diffuse Immunologically mediated Non immunologically mediated Immunocompromised Immune competent ``` Focal
98
Causes of focal pulmonary haemorrhage
``` Chronic bronchitis Tumours Infection Bronchiectasis Local trauma PE Vascular erosis ```
99
Cause of immunologically mediated diffuse pulmonary haemorrhage
``` Good pastures CVD SLE Wegeners Polyarteritis nodosa Microscopic polyarteritis ```
100
Causes of pulmonary haemorrhage in non immunologically mediated immunocompetent
Idiopathic pulmonary haemosiderosis Drugs Tumors - angiosarcoma Haemorrhagic diathesis - antiphospholipid/DIc/TTp
101
Causes of diffuse pulmonary haemorrhage in immunocompromised patient
Coagulopathy Infection in the setting of thrombocytopenia Chemo Hiv kaposis
102
Feature of PAH on CXR
Bilateral hilar opacificaton. Sparing costophrenic angles and apices
103
Differential for crazy paving
``` Bronchioalveolar carcinoma Alveolar proteinosis Lipoid pneumonia Ards PCP Pulmonary haemorrhage Sarcoidosis NSIP Organising pneumonia ```

Thoracic and Respiratory (7 decks)

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