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Radiology > Lecture Thorax 2 > Flashcards

Lecture Thorax 2 Flashcards

1
Q

Questions when evaluating pulmonary parenchyma

A
  1. Inc/dec opacity?
  2. anatomic position (peripheral, mid-zone, hilar)(generalized)?
  3. Mediastinal shift?
  4. Pulmonary patterns?
  5. Severity pulmonary change?
  6. Prioritized differentials based on
    - anatomic position
    - severity
    - pulmonary pattern
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2
Q

Decreased opacity

A
  1. Focal (shape, lobar)
  2. Multifocal
  3. Generalized (hypovolemia most common)
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3
Q

Increased opacity

A
  1. Focal, multifocal, or Generalized
  2. Anatomic location
  3. Mediastinal shift present
  4. Pulmonary pattern
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4
Q

Generalized decreased opacity

A
  1. overexposure
  2. hypovolemia
  3. addisons dz
  4. hyperinflation
  5. air trapping (asthma)
  6. Emphysema
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5
Q

Lobar Decreased Opacity

A
  1. PTE (Pulmonary thrombo-embolism)
  2. Congenital bronchial cyst
  3. Pneumatocoele
  4. Bulla
  5. Hematocoele
  6. Cavitated mass
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6
Q

Bronchiectasis

A

A condition in which the lungs’ airways become damaged, making it hard to clear mucus.

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7
Q

Mass:

Nodule:

A

Greater than or equal to 3cm

Less than 3cm

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8
Q

Mass characteristics

A
  1. > 3cm
  2. Rounded margins
  3. Lobar sign
  4. Border effacement
  5. Can be interstitial, bronchial or alveolar in origin
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9
Q

Alveolar pulmonary patterns: 5 features

A
  1. Uniform soft tissue gray
  2. Presence of air bronchograms
  3. Border effacement of cardiac silhouette or diaphragm
  4. Border effacement of cardiac silhouette or diaphragm
  5. ‘Lobar sign’ - normal lung lobe adjacent to lobe with pathology
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10
Q

Bronchial pulmonary pattern

A
  1. Presence of rings and lines
  2. Generalized
  3. Thickened airway walls create the ‘rings and lines’
  4. Can get thickening with age and ares of discrete dystrophic mineralization within the central airways
  5. Evaluate in the periphery of the lung fields on both the lateral and VD projections
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11
Q

Vascular pulmonary pattern

A
  1. Small arteries and veins
    - hypovolemia
    - Addison’s disease
  2. Enlarged pulmonary veins
    - LHF
  3. Enlarged Pulmonary Arteries
    - heartworm disease
  4. Enlarged PA/PV (over circulation)
    - left to right PDA, VSD
    - Fluid overload
    - AV fistulas (peripheral or central)
    - Cats-LHF
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12
Q

Pulmonary patterns, decreased vessel size

A

Results in overall decreased opacity

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13
Q

Pulmonary pattern: Structured Interstitial Pattern

A
  1. Miliary
  2. LSA
  3. Metastasis
  4. Fungal
  5. Pulmonary nodules
  6. Prior granulomatous pneumonia
  7. Osteomas: osseous metaplasia of sub pleural surface of lung lobes
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14
Q

Pulmonary Nodule fake-outs

A
  1. Nipple
  2. End-on vessel
  3. Cutaneous nodule
  4. Ectoparasite
  5. HW disease (vessels)
  6. Osteomas
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15
Q

Structured interstitial pattern: osteomas roentgen signs

A
  1. Focal pinpoint areas of dystrophic mineralization
  2. Gravity dependent (ventral and cranial distribution)
  3. Collies and Shelties predisposed
  4. Smaller than a met or true soft tissue nodule
  5. Can be very impressive when numerous
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16
Q

Pulmonary pattern: interstitial

A
  1. increased opacity to lung lobe or overall lung field
  2. ‘hazy’ appearance to pulmonary vessels
  3. lack of distinct visualization of caudal vena cava and descending thoracic aorta
  4. structured (nodular or miliary) or unstructured
  5. Usually generalized and moderate to severe
17
Q

Pulmonary pattern caveats

A
  1. Mass lesion doesn’t fit into definitions, except alveolar. Don’t know where mass orginated (bronchus, interstitium, alveoli)
  2. Doesn’t equate with histology or pathology
  3. Anatomic localization almost more important for helping to formulate differentials
  4. Often a continuum and disease can go thorugh interstitial to alveolar states and back again once treated (dz is in transition between patterns)
  5. Avoid Jargon: Broncho-interstial (combo terms not useful); Consolidation (happens on wall street); Infiltrate (cellular term not histo)
18
Q

Cranioventral Distribution

A
  1. Aspiration pneumonia
  2. Bronchopneumonia
  3. Hemorrhage
  4. Lobar collapse or atelectasis
  5. Lobar torsion (right middle)
  6. Compression from cranial mediastinal mass
  7. Primary lung tumor (less common location)
19
Q

Caudodorsal distribution

A
  1. Neurogenic edema
  2. Hemorrhage
  3. Primary lung tumor (most common site)
  4. Heartworms
  5. Pulmonary thrombo-emboli
  6. Septic emboli
  7. Expiration (fat dog or cat)
20
Q

Hilar distribution

A
  1. Left heart failure (dog)
  2. Fungal
  3. Hemorrhage
  4. Lobar mass
  5. Ddx
    - TB LN
    - esophageal abnormality
    - left atrium
21
Q

Generalized distribution

A
  1. PIE/Asthma/Allergic lung disease
  2. Fungal
  3. Hemorrhage
  4. Miliary (LSA, Fungal, Mets)
  5. Severe edema
  6. Near drowning
  7. Smoke inhalation
  8. Artifact
  9. Fibrosis
  10. Lymphoma
  11. Pneumonitis (viral, uremia, pancreatitis, septicemia)
22
Q
A

Pulmonary Thrombo-embolism

23
Q
A

Necrotic mass in Caudal lung lobe

Cavitated

24
Q
A

Air bronchograms

Implies an alveolar pattern

25
Q
A

Lobar sign / alveolar pattern

  • Contralateral shift
  • Border effacement of heart
  • Lobar signs

Lobar sign in the lateral view…caudal border of opacity

26
Q
A

Bronchial pulmonary Pattern

  • Characterized by rings and lines

Generalized increase in opacity

To label Bronchial Patterns:

  • Must evaluate periphery of lung fields on lateral and VD projections
27
Q
A

Structured interstitial pattern

Indicative of metastatic dz

This picture could be a bronchial pattern also

28
Q
A

Osteomas

Structured interstitial pattern

29
Q
A

Caudodorsal unstructured interstitial pattern

Radiology (7 decks)

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