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Chest Differential diagnosis > LUNGS AND AIRSPACE > Flashcards

LUNGS AND AIRSPACE Flashcards

1
Q

Acinar Nodules (acinar shadow/airspace nodule)

A

Definition: Consolidation/ground glass change within the acinum (structures distal to the terminal bronchiole) –> essentially centrilobular

  • Pneumonia
  • Aspiration
  • Oedema
  • Haemorrhage
  • Malignancy
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2
Q

Apical opacity

A

Common:

1. Apical Scarring - wedge/triangular/cresenteric

2. Pneumonia: TB, atypical infection

3. Radiation Fibrosis

4. Pancoast tumour

RARE BUT IMPORTANT:

  • Mets
  • Hematoma
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3
Q

Air Bronchograms

A

Common:

1. Pneumonia

2. Non-obstructive atelectasis

3. Pulmonary oedema

Less common:

- Malignancy (Adenocarcinomoa)

- Lymphoma

- Pulmonary hemorrhage

- ARDS

Rare but important:

- Organizing pneumonia

- Sarcoid

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4
Q

Architectural Distortion

A

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
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5
Q

Atelectasis

A

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
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6
Q

Bullous disease

A

1. Bullous Emphysema

2. Giant bullous emphysema

3. Sarcoid (rare)

4. Proteus syndrome (v rare)

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7
Q

Airspace calcification

A

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
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8
Q

Lung Cavity

A

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

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9
Q

Consolidation

A

Common:

  • Infection
  • Oedema
  • Hemorrhage
  • Aspiration
  • Infarct
  • Contusion
  • OP

Rare but important:

  • Chronic eosinophilic pneumonia
  • Malignancy: (invasive mucinous adenocarcinomam, lymphoma)
  • Lipoid pneumonia
  • Intralobar sequestration
  • Sarcoid
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10
Q

Lung Cyst

A

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
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11
Q

Lung lucencies

A

COMMON:

- Emphysema

- Pneumatocoele

- Pneumothorax

- Constrictive bronchiolitis

- Pulmonary hypertension

RARE But important:

- Bronchial atresia

- Pulmonary sequestration

- CPAM

  • Swyer-james-Mcleod syndrome
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12
Q

Migratory Opacities

A

Infectious/inflammtory eitiology favoured over malignancy.

  • Recurrent Aspiration
  • Eosinophilic lung disease
  • Organising pneumonia
  • MAC
  • Vascullitis
  • Pulmonary hemorrhage
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13
Q

Centrilobular nodules

A

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
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14
Q

Random nodules

A

Hematogenous dissemination: Diffuse, no predominance

  • Miliary infection: TB, Histioplasmosis
  • Hematogenous metastasis: lung/thyroid
  • Langerhans Cell Histiocytosis (early stages)
  • Sarcoid
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15
Q

Perilymphatic nodules

A

Subpleural, septal, fissural, peribronchovascular

1. Sarcoidosis: upper lobe predominant typically

2. Lymphangitis carcinomatosis

3. Silicosis

  1. Rare: LIP, pneumoconiosis, amyloidosis
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16
Q

Peripheral consolidation

A
  • Pneumonia: bacterial, viral, organising pneumonia.
  • Lung cancer
  • Pulmonary contusion
  • Pulmonary infarct
  • Rounded atelectasis
  • Chronic eosinophilic pneumonia (rare)
17
Q

Pulmonary Mass

A

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
18
Q

Solid pulmonary nodule

A

<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
19
Q

Multiple Pulmonary Nodules

A
  • 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
20
Q

Granulomatous lung disese

A

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
21
Q

Pulmonary nodules + cavitation

A

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

22
Q

Large Lung Volume

A

Common:

  • Emphysema
  • Asthma

Less common:

  • LAM
  • LCH
23
Q

Low lung volume

A

Common

  • Expiratory imaging/poor inspiration
  • Atelectasis
  • Lung fibrosis
  • Surgery
  • Pleural disease
  • Chest wall process

Less common: neuromuscular/connective tissue disorder

Rare: pumonary hypoplasia

24
Q

Lucent hemithorax

A
  • Pneumothorax
  • Emphysema
  • Surgery: mastectomy/lobectomy
  • Bronchial obstruction
  • Pulmonary embolism
  • Swyer-James-McLeod syndrome
  • Bronchial atresia

Rare:

  • Congenital lobar emphysema
  • Poland syndrome
25
Q

Opaque Hemithorax

A

Pleural effusion

Pneumonia

Malignancy: lung, endobronchial lesion, pleural

Atelectasis

Pneumonectomy

26
Q

Luftsichel Sign

A
  • 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
27
Q

AIr-Cresent Sign

A
  • Infection:
    • Angioinvasive fungal infection
    • Mycetoma
    • Septic emboli
    • COP
    • Histioplasmosis
  • Inflammatory: Wegeners
  • Contusion/laceration
  • Malignancy:
    • Lepidic lung adenocarcinoma
    • Metastasis
  • Iatrogenic: biopsy

Rare:

  • Kaposi sarcoma
  • Endometriosis
28
Q

Ground Glass Opacity

A

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
29
Q

Reversed Halo Sign

A

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

30
Q

Air-Cresent SIgn

A
  • Angioinvasive fungal infection
  • Mycetoma
  • Lung cancer
  • Pulmonary infarct/gangrene
  • Rasmussen anuerysm (Rare): TB, thin PA pseudoaneruysm
  • Hydatid cyst: meniscus and water lily sign
31
Q

Chronic consolidation

A
  • Malignancy:
    • Endobronchial tumour
    • Adenocarcinoma
    • Lymphoma
  • Aspiration
  • Infection:
    • Fungal infection
    • Organising pneumonia
  • Chronic eosinophilic pneumoia
  • Sarcoidosis
  • Lipoid pneumonia
  • Churg-Strauss syndrome
  • Pulmonary Alveolar Proteinosis
32
Q

Mass-like fibrosis

A
  1. Sarcoidosis
  2. Pneumoconiosis: silicosis/coal workers (tend to have calcifications)
  3. Berylliosis
  4. Radiation fibrosis
  5. Hemosiderosis
  6. Talcosis
33
Q
A
34
Q

Crazy paving

A
  • 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

Chest Differential diagnosis (8 decks)

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