LUNGS AND AIRSPACE Flashcards
Acinar Nodules (acinar shadow/airspace nodule)
Definition: Consolidation/ground glass change within the acinum (structures distal to the terminal bronchiole) –> essentially centrilobular
- Pneumonia
- Aspiration
- Oedema
- Haemorrhage
- Malignancy
Apical opacity
Common:
1. Apical Scarring - wedge/triangular/cresenteric
2. Pneumonia: TB, atypical infection
3. Radiation Fibrosis
4. Pancoast tumour
RARE BUT IMPORTANT:
- Mets
- Hematoma
Air Bronchograms
Common:
1. Pneumonia
2. Non-obstructive atelectasis
3. Pulmonary oedema
Less common:
- Malignancy (Adenocarcinomoa)
- Lymphoma
- Pulmonary hemorrhage
- ARDS
Rare but important:
- Organizing pneumonia
- Sarcoid
Architectural Distortion
Abnormal displacement of pulmonary structures (bronchi/vessels/fissures/septa) with volume loss
Common:
- Radiation fibrosis
- IPF: UIP/NSIP
- Sarcoid
Less common:
- Inflammatory: Hypersensitivity pneumonitits
- Pneumoconiosis: Silicosis, asbestosis
- Drug induced lung disease
- ARDS
- TB
Atelectasis
Obstructive (resorptive)
- Endobronchial secretions
- Endobronchial neoplasm
- Foreign body/Malpositioned ET
Compressive/passive:
- Plueral effusion
- pneumothorax
- Pleural mass/thickening
Adhesive:
- Surfactant deficiency
- Radiation pneumonitits
- Infarct
Cicatrization:
- TB
- IPF: UIP/NSIP
- Sarcoid
- Radiation fibrosis
Bullous disease
1. Bullous Emphysema
2. Giant bullous emphysema
3. Sarcoid (rare)
4. Proteus syndrome (v rare)
Airspace calcification
1. Healed infection: TB, histioplasmosis, varicella
2. Pneumoconiosis: silicosis, coal
3. Sarcoid
4. Metastatic calcinosis
5. Amyloid
6. Calcified mets
7. Lung Ca
Rare but important:
- Diffuse pulmonary ossification
- Alveolar microlithiasis
Lung Cavity
Definition:
- Gas filled space usually associated with consolidation/mass/nodule.
- Thick walled (>2mm)
- More irregular than cysts
1. Abscess
2. Malignancy: primary (SCC, adenocarcinoma, large cell carcinoma) and Secondary(SCC head/neck, renal, GIT, pancreatic)
3. Infection: TB, MAC, fungal, septic emboli
4. Infarct
5. inflammatory: Wegener’s, RA
Consolidation
Common:
- Infection
- Oedema
- Hemorrhage
- Aspiration
- Infarct
- Contusion
- OP
Rare but important:
- Chronic eosinophilic pneumonia
- Malignancy: (invasive mucinous adenocarcinomam, lymphoma)
- Lipoid pneumonia
- Intralobar sequestration
- Sarcoid
Lung Cyst
Definition:
- Perceptible thin wall <2mm
- Spherical lucency
- not applicable to bulla, bleb, cavity
Common:
- Pneumatocele
- Honey combing
- Incidental cyst
Less common:
- LCH
- LAM (associated with Tuberosclerosis)
- Lymphoid interstitial pneumonia
- Desquamative interstitial pneumonia
Rare but important:
- NF-1
- CPAM
- Tracheobronchial papillomatosis
- Light chain deposition syndrome
- Birt-Hogg-Dube syndrome
Lung lucencies
COMMON:
- Emphysema
- Pneumatocoele
- Pneumothorax
- Constrictive bronchiolitis
- Pulmonary hypertension
RARE But important:
- Bronchial atresia
- Pulmonary sequestration
- CPAM
- Swyer-james-Mcleod syndrome
Migratory Opacities
Infectious/inflammtory eitiology favoured over malignancy.
- Recurrent Aspiration
- Eosinophilic lung disease
- Organising pneumonia
- MAC
- Vascullitis
- Pulmonary hemorrhage
Centrilobular nodules
Common
- Bronchiolitis: Infectious, aspiration, respiratory, follicular (Autoimmune)
- Infectious airways disease
- Mucinous invasive adenocarcinoma
- Hypersenisitivy pneumonitis cluster 1 (acute)
Rare but important
- Diffuse Panbronchiolitis
- OP secondary to inhaled synthetic marijuana
- Vascular
Random nodules
Hematogenous dissemination: Diffuse, no predominance
- Miliary infection: TB, Histioplasmosis
- Hematogenous metastasis: lung/thyroid
- Langerhans Cell Histiocytosis (early stages)
- Sarcoid
Perilymphatic nodules
Subpleural, septal, fissural, peribronchovascular
1. Sarcoidosis: upper lobe predominant typically
2. Lymphangitis carcinomatosis
3. Silicosis
- Rare: LIP, pneumoconiosis, amyloidosis
Peripheral consolidation
- Pneumonia: bacterial, viral, organising pneumonia.
- Lung cancer
- Pulmonary contusion
- Pulmonary infarct
- Rounded atelectasis
- Chronic eosinophilic pneumonia (rare)
Pulmonary Mass
Size >3cm
-
Neoplasm:
- Primary (malignant vs benign)
- Metastatic
- Lymphoma
- Infection:
- Abscess
- TB/mycobaterium
- Fungal (actinomycosis, crptococcus, mucormycosis)
- organising pneumonia
- Infarct
- inflammatory: sarcoid, wegeners
- Silicosis
- Pseudotumour
- Round atelectasis (plerual abnormality, broad based attachement of mass-like consolidation to pleural abnormality, volume loss, comet tai sign)
Rare:
- PAVM
- Behcet disease
- Developmental: Sequestration, bronchogenic cyst
- Pulmonary vein varix
- Hydatid cyst
Solid pulmonary nodule
<3cm in size
Common:
- Granuloma
- Intrapulmonary LN (perifissural vs peribronchial vs intraparenchymal) - triangular
- Mucous plug
- Lung cancer
- Mimics: nipple/skin/osseous lesion
Less common:
- Carcionoid
- Harmatoma
- Solitary met
- Infarct
- Laceration
- Abscess
RARE:
- PAVM
- Amyloidoma
- Pulmonary inflammatory myofibroblastic tumour
Multiple Pulmonary Nodules
-
Malignancy:
- Metastasis
- Lung cancer
- Lymphoma
- Kaposi sarcoma (Rare)
-
Inflammatory:
- Sarcoid
- Wegener
- Rheumatoid nodules
- LCH
-
Infection:
- Bacteria, fungal (angioinvasive), viral, granulomatous (TB, MAC, Histioplasmosis, aspergillosis)
- Septic emboli
- Organising pneumonia
- Pneumoconiosis: silicosis/coal worker
Rare:
- Nodular amyloidosis
- Diffuse idiopathic pulmonary neuroenedocrine cell hyperplasia
Granulomatous lung disese
Infectious:
- Mycobacterium: TB, MAC
- Fungal: aspergillus, histioplasmosis, cyrptococcus, coccidioidomycossis,blastomycosis
- Parasitic
Non-infectious:
- Sarcoid
- ANCA associated vasculitis: wegener’s, Churg-strauss
- Hypersenisitivy pneumonitis
- Rhematoid lung nodules
- LCH
- Erdheim-Chester disease
- Secondary to substance: talc, beryliosis
- Bronchocentric granulomatosis
- Chronic granulmatous disease
- Lymphoproliferative: lymphomatoid granulomatosis, lymphocytic intersitial pneumonitis
Pulmonary nodules + cavitation
Common:
-
Malignancy:
- Lung cancer
- Mets: SCC(head/neck), Adenocarcinoma (GIT/breast), sarcoma
- Lymphoma
- Infarct
- Infection: TB/MAC, Fungal, septic emboli
- Inflammatory: Sarcoid, Wegeners, LCH, rheumatoid nodules
- Pulmonary lacerations
Rare: invasive tracheobonchial papillomatosis
Large Lung Volume
Common:
- Emphysema
- Asthma
Less common:
- LAM
- LCH
Low lung volume
Common
- Expiratory imaging/poor inspiration
- Atelectasis
- Lung fibrosis
- Surgery
- Pleural disease
- Chest wall process
Less common: neuromuscular/connective tissue disorder
Rare: pumonary hypoplasia
Lucent hemithorax
- Pneumothorax
- Emphysema
- Surgery: mastectomy/lobectomy
- Bronchial obstruction
- Pulmonary embolism
- Swyer-James-McLeod syndrome
- Bronchial atresia
Rare:
- Congenital lobar emphysema
- Poland syndrome
Opaque Hemithorax
Pleural effusion
Pneumonia
Malignancy: lung, endobronchial lesion, pleural
Atelectasis
Pneumonectomy
Luftsichel Sign
-
Central obstructing lesion:
- Primary malignancy: lung, SCC, carcinoid
- Secondary causing ocmpression: lymphoma, medastinal tumour
- Metastasis: RCC, melanoma, colon/breast
- Benign: harmatoma, lipoma
- Endobronchial plug (acute)
-
Bronchial stenosis (rare):
- TB
- Fungal
-
Mimics:
- pneumomediastinum
- Right lung herniation
- Left upper lobectomy
AIr-Cresent Sign
-
Infection:
- Angioinvasive fungal infection
- Mycetoma
- Septic emboli
- COP
- Histioplasmosis
- Inflammatory: Wegeners
- Contusion/laceration
-
Malignancy:
- Lepidic lung adenocarcinoma
- Metastasis
- Iatrogenic: biopsy
Rare:
- Kaposi sarcoma
- Endometriosis
Ground Glass Opacity
Acute:
- Pneumonia
- Pulmonary oedema
- Pulmonary hemorrhage
- Hypersensitivty pneumonitis
- Acute intersitital pneumonia
- Radiation pneumonitis
Chronic:
- ILD: NSIP, smoking related (DIP/respiratory bronchiolitis)
-
Malignancy:
- Adneocarcinoma spectrum
- Lymphoma
- Eosiniophilic pnumonia
- Hypersensitivity pneumonitis
Rare:
- Pulmonary alveolar proteinosis
- Drug reaction
Reversed Halo Sign
Central GGO + surroudnign concentric/crescenteric consolidation
Infection:
- Organising pneumonia
- Fungal: angioinvasive aspergillosis, mucormycosis
- Bacterial: TB, Legionella
- PCP
- Infarct
Inflammatory:
- Sarcoidosis
- Wegeners
Malignancy: adenocarcinoma
Lymphoid granulomatosis
Lipoid pneumonia
Chronic eosinophilic pneumonia
Air-Cresent SIgn
- Angioinvasive fungal infection
- Mycetoma
- Lung cancer
- Pulmonary infarct/gangrene
- Rasmussen anuerysm (Rare): TB, thin PA pseudoaneruysm
- Hydatid cyst: meniscus and water lily sign
Chronic consolidation
-
Malignancy:
- Endobronchial tumour
- Adenocarcinoma
- Lymphoma
- Aspiration
-
Infection:
- Fungal infection
- Organising pneumonia
- Chronic eosinophilic pneumoia
- Sarcoidosis
- Lipoid pneumonia
- Churg-Strauss syndrome
- Pulmonary Alveolar Proteinosis
Mass-like fibrosis
- Sarcoidosis
- Pneumoconiosis: silicosis/coal workers (tend to have calcifications)
- Berylliosis
- Radiation fibrosis
- Hemosiderosis
- Talcosis
Crazy paving
- Pulmonary oedema
- Lymphangitis carciomatosis
- DAD
- Sarcoid
- PJP
- Idiopathic interistial pneumonia
- PAP
- MAlignancy
- AMyloid
- Venooclusive disease/pulmonary vein stenosis
- Erdheim-chester disease
- lipoid pneumonia
- acute eosinophilic pneumonia
