L19 Radiology of the Thorax II Flashcards
Chest X-ray which bloops out everywhere
Lymphoma Lymphadenopathy
-goes into both pneumothoraxes
Neurofibroma
makes obtuse angles with rest of lung = coming from pleura or chest wall
invades into rib= weird soft tissue tumour or rising from vessels/nerves = the neurovascular bundle
-nerve is most likely to go wrong
What can lung disease’s effect?
- Pulmonary arteries e.g. vasculitis, Pulmonary Emboli
- Bronchi e.g. Asthma, Bronchitis, Bronchiectasis
- Lung Parenchyma e.g. Pneumonia, Lung cancer, Emphysema, Chronic Intersitial Lung disease
Lung disease’s effecting the Pulmonary arteries
-long flight Vasculitis (very rare) Pulmonary Emboli (sore leg, sitting down for ages, short of breath)
Lung disease’s effecting the Bronchi
Asthma
Bronchitis (smoking)
Bronchiectasis (smoking, viruses in cold conditions)
Lung disease’s effecting the Lung Parenchyma
-vivid in chest X-ray
-clinical conditions
Pneumonia
Lung cancer
Emphysema
Chronic Interstitial Lung Disease
Common Lung Abnormalities
Pneumonia Lung cancer- primary or metastases Trauma Pulmonary Emboli Cardiac Failure (CHF) Chronic Diffuse Lung Diseases
Important Questions if abnormality in the lungs (not mediastinum, pleura or chest wall)
- Pattern of Lung abnormality (to figure cause)
- Focal
- Multifocal
- Diffuse - Acute or Chronic
- history is crucial - Other clues e.g. cardiomegaly
Focal abnormlaity: Lung nodule
little white dust mark= centrally calcified nodule (satellite lesions)
Focal abnormality: Granuloma
granuloma= focal response of lung to fight off infection (TB) (histoplasmosis USA)
Focal abnormality: symptoms
poorly marginated. potentially pneumonia or cancer pacemaker= heart big well defined (not size)= more likely to appear with symptoms of cancer (haemoptosis and weight loss) -weight loss -short breath -productive cough -fever -haemoptosis -chest wall pain if hit pleura/ribs
Lobar collapse
What is blocking the bonchus??
-difficult to differentiate b.w pneumonia or cancer
-Pneumonia more likely to cause complete collapse of a lobe
-tumour in lower lobe bronchus= obstruction behind it
Sreatment: Straight to bronchoscopy or CT scan
-CT to look at liver and do staging + see where cancer is
Pneumonia vs cancer
History, Symptoms, time course (perfect–> queasy)
Exam
CXR appearance
Focal lesion
mass like opasity
-opaque to x-ray (better word than density as means blackness)
-fever? infectious symptoms?
- looks mass like so do follow up chest x-ray to make sure it goes away
-Lateral film = looks like a lobar process
-not total lobar collapse as oblique fissure isnt that high
= lobar pneumonia as good signs of co-infection
Lung total/partial collapse
Partial collapse in pneumonia:
lung isnt expanding well as is full of junk
Complete collapse: can happen in pneumonia but really hints to having tumour to cause the obstruction
Multifocal- including nodules
Acute: -infection ep TB -Staphalococcus pneumonia (multiple lung lesions/nodules, really sick, IV lungs and splat out into lungs and pot. cavitates. IV drug abusers. lungs can be quickly completely destroyed) Subacute or Chronic: -Metastases -Sarcoidosis
Classic appearance
that is ______ until proven otherwise
-multifocal
Staphalococcus Pneumonia
multiple lung lesions/nodules really sick infects lungs and splat out into lungs pot. cavitates. IV drug abusers. lungs can be quickly completely destroyed
TB
Hall marks:
-Multiple nodules (UPPER lobes)
-assoc. with mediastinal lymph nodes (Lymphadeopathy)
-Cavitary lesions w. air fluid level: pot. pleural effusions
cavitating mass is upper lobes
-recently travelled to india
Tb is weird with symptoms.
-doesnt have to be symptomatic. can be asymptomatic when with TB
-X-ray can be varied
Kidney Removal
- Metastatic spread from renal cancer
- progressively getting short breaths over 6 months
- large lymph nodes in mediastinum
- multiple non-well defined nodules
Diffuse Lung disease questions if diffusely abnormal X-ray
over 200
- Acute vs Chronic: How long has the patient being sick
- Pattern of Distribution
Diffuse Lung Abnormality: Acute
Acute:
FLUID: e.g. Pulmonary Oedema (Congestive heart failure. specific symptoms important/Grade. More short of breath when lying down. Orthopnea. ankle Oedema)
PUS (infection): e.g. Pneumonia (airspace disease everywhere, fever)
BLOOD (rare): e.g. Goodpastures (membrane antibase)
Diffuse Lung Abnormality: Chronic
Chronic (6 months):
Destruction: e.g. Emphysema (smoking destroyed all of lungs- easy to diagnose)
Malignancy
Fibrotic Lung disease >100
Caused by:
1. Bronchoalveolar Cell Carcinoma
2. Alveolar Protonosis (alveoli fill up with gram _ve biofringent material)- Lungs lavarged out every 6months. B. material gets washed out. No cure, keep returning every 6 months. 6 years Lungs then fibrose down –> death
Pulmonary Oedema
Diffuse Lung Abnormality: Acute:
FLUID: e.g. Pulmonary Oedema (Congestive heart failure. specific symptoms important/Grade. More short of breath when lying down. Orthopnea. ankle Oedema)
Acutely unwell overnight
Heart attack: heart just failing and getting rampant pulmonary oedema ECG leads= chest pain Large heart Airspace disease No/Little effusion
Chronicly unwell/ Resolving Pulmonary Oedema
ECG lead
Heart big
Bilateral pleural effusions
doesnt really have the airspace stuff= started to clear into pleural space = resolving pulmonary oedeama
Multifocal SARS
SARS: spanish flu. (Infection)
(the MERS camels middle easten respiratory syndrome and Bird Flu)
Multifocal –> Diffuse
SARs Symptoms: Fever. Dry cough. Multifocal abnormalities
-Not congestive heart failure/Pulmonary oedema as doesnt have orthopnea, elevated jugular vein, ankle odema, chest pain
Tracheoctomay
still have IV (incubated)
Assymetric appearance
Asymetric = more likely to be pneumonia
- attack one part of the lung first –> then spread
- could have congestive heart failure as well
Airless lungs
totally white
Alveolar Protonosis
(alveoli fill up with gram _ve biofringent material)- Lungs lavarged out every 6months. B. material gets washed out. No cure, keep returning every 6 months. 6 years Lungs then fibrose down –> death
To distinguish the >100 diseases
History CRITICAL esp. Acute vs Chronic
Distribution important
Other clues: e.g. nodes, effusions, cardiac size
Ways lung respond to insult
Diseases predominatly effecting the Upper lobes:
- Fibrosis/scarring
- occurs in TB. (scarring during healing)
- lung pulls toward the scar - Silicosis- large scale: patent working in silica mining. Diffuse lung disease but predominately upper lobes. Inhaled so much silica that scarring happens where lungs are Least Airated
- Sarcoidosis
Least airated areas of lungs
- Upper Lobes
- Least airated relative to the Blood supply
- There is more blood in the lower Lobes, (blood) helping to clear away disase-stuff in the lower lobes
Distribution: Chronic Diffuse Lung Disease
Upper Lobes: Tb, Sarcoidosis, Silicosis
Lower Lobes: UIP/Fibrosing Alveolitis (most common diffuse fibrotic lung disease) (peripheral), Asbestosis
Anywhere: Lymphangitic Metastases
UIP and IPF
Usual Interstitial Pneumonitis (peripheral)
Idiopathic Pulmonary Fibrosis/ Fibrosing Alveolitis
-1 year development becoming shorter of breath
- Non specific auditory/ausculatory findings: dry crackles in both of lung bases
-Idiopathic: dont know cause
-feel like lungs are constricting and cant take a big breath
-Gross morphology: characteristic Peripheral Honeycomb lung (CT scan) (almost normal lung centrally)
-Histology: some thickened alveoli septa = decreases diffusing capacity and hence ability to breathe. increases V-Q mismatch
-associated with other CT diseases
-fibrosising= lung gets smaller
CT scan
illustrate that is peripheral
- honeycomb lung in CT
- avoid biopsy of most common diffuse lung disaese (fibrotic lung disease)
- feel like lungs are constricting and cant take a big breath
Connective Tissue Diseases associated with Lung disease
- Rhuematoid Arthritis
- Progressive Systemic sclerosis/Scleroderma
- Systemic Lupus Erythematosis (SLE)
1-3: most likely to show peripheral honeycomb fibrosis - Dermatomyositis/ Polymyositis
- Sjogren’s syndrome
- Asbestosis (effect of asbestosis needles causing similar pattern of peripheral honeycomb lung)
