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[PBR] Pulmo Imaging > Mediastinum And Hila > Flashcards

Mediastinum And Hila Flashcards

1
Q

Modality of choice for patients with probable vascular lesion, confirming cystic nature of lesions that have high attenuation due to proteinaceous contents and distinguishing thymic hyperplasia from thymic neoplasms

A

MRI

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2
Q

3 compartments of mediastinum

A

Anterior (prevascular), middle (visceral), posterior (paravertebral)

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3
Q

Most common thoracic inlet mass seen in older patients

A

Tortous arterial structures, in particular the confluence of the right brachiocephalic and right subclavian arteries or left subclavian artery bulging laterally into upper lobe to produce a thoracic inlet mass

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4
Q

Tortuous vessel is usually associated with tracheal deviation towards what side

A

Side of the mass

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5
Q

Most goiters and other inlet masses displace the trachea towards what side

A

Contralaterally

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6
Q

Uncommon vascular cause of anterior mediastinal or prevascular mass

A

Aneurysm arising from the right sinus of valsalva or an ascending aortic aneurysm

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7
Q

A prevascular mass arising from the ascending aorta as seen on lateral chest radiography that contains curvilinear calcification should suggest

A

Ascending aortic aneurysm or foregut cyst

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8
Q

Thyroid goiters, either uninodular or multinodular arise from the lower pole of the thyroid or thyroid isthmus, and can enter the superior mediastinum where

A

Anterior to the trachea 80%, to the right and posterolateral to the trachea 20%

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9
Q

Parathyroid glands can be found near the thoracic inlet at what area particularly

A

In or about the thymus

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10
Q

Most ectopic parathyroid lesions are what size?

A

Small adenomas (<3cm)

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11
Q

Uncommon masses comprised of dilated lymphatic channels

A

Lymphangiomas

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12
Q

Cystic or cavernous form of lymphangioma which is most commonly discovered in infancy and is often associated with chromosomal abnormalities, including Turner syndrome and trisomies 13,18 and 21

A

Cystic hygroma

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13
Q

Second most common primary mediastinal neoplasms in adults after lymphoma

A

Thymomas

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14
Q

Thymomas are rare in patients at what age

A

Under 20

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15
Q

Diseases associated with thymomas

A

Myasthenia gravis, pure red cell aplasia, hypogammaglobulinemia, grave disease and lupus

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16
Q

Thymomas are seen as oval, smooth or lobulated soft tissue masses arising near the

A

Origin of great vessels at the base of the heart

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17
Q

Recognized routes of spread of thymoma to the pleural space

A

Drop metastasis to dependent portions of pleural space

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18
Q

Route of spread of pleural tumor into retroperitoneum

A

Transdiaphragmatic spread

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19
Q

Rare lesions that represent remnants of the thymopharyngeal duct and contain thin or gelatinous fluid

A

Congenital unilocular thymic cysts

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20
Q

Postinflammatory in nature and have been associated with AIDS, prior radiation or surgery, and autoimmune conditions such as Sjogren syndrome, myasthenia gravis and aplastic anemia

A

Acquired multiloculat thymic cysts

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21
Q

Rare and benign thymic neoplasm that consists primarily of fat with intermixed rests of normal thymic tissue. These masses are asymptomatic and therefore are typically large when first detected

A

Thymolipoma

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22
Q

Rare and malignant neoplasms believed to arise from thymic cells of neural crest origin (amine precursor uptake and decarboxylation or kulchitsky cells)

A

Thymic carcinoid

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23
Q

Enlargement of thymus that is normal on gross and histologic examination. It occurs primarily in children as a rebound effect in response to an antecedent stress, discontinuation of chemotherapy, or treatment of hypercortisolism

A

Thymic hyperplasia

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24
Q

How many percent of patients with nodular sclerosing subtype of Hodgkin disease has the thymus involved

A

40-50%

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25
Q

Most common primary mediastinal neoplasm in adults

A

Hodgkin disease or NHL

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26
Q

Hodgkin disease involves the thorac in what percent of patients at the time of PE

A

85%

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27
Q

90% of patients with Intrathoracic involvement from hodgkin disease involves what 2 part of the thorax

A

Anterior mediastinal and hilar nodal groups

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28
Q

Most frequent site of a localized nodal mass in patients with Hodgkin disease in the mediastinum, particularly those with nodular sclerosing type

A

Anterior mediastinum

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29
Q

2 Most common types of NHL that present with mediastinal masses

A

Lymphoblastic lymphoma and diffuse large B-cell lymphoma

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30
Q

NHL most commonly involves what part of the mediastinum

A

Middle mediastinal and hilar lymph nodes

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31
Q

Uncommonly involve parts of the mediastinum in NHL, but is seen almost exclusively to it only

A

Juxtaphrenic and posterior mediastinal lymph node involvement

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32
Q

True or false: on conventional radiography, lymphoma involving the anterior mediastinum is indistinguishable from thymoma or germ cell neoplasm and presents as a lobulated mass projecting to one or both sides of the mediastinum

A

True

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33
Q

True or false: calcification in untreated lymphoma is extremely uncommon, and its presence within an anterior mediastinal mass should suggest another diagnosis

A

True

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34
Q

Parenchymal lung involvement in mediastinal lymphoma is usually the result of

A

Direct extranodal extension of tumor from hilar nodes along the bronchovascular lymphatics

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35
Q

Patient’s with succesfully treated mediastinal Hodgkin disease often have residual soft tissue density in the affected mediastinal compartments, with ______

A

Dystrophic calcifications commonly seen within treated nodes

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36
Q

Germ cell neoplasms in the anterior mediastinum are due to

A

Arrest of primitive germ cell migration to the gonads during embryological development

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37
Q

Key distinguishing factor in diagnosing primary mediastinal germ cell neoplasm versus metastasis

A

Presence of retroperitoneal lymph node involvement in metastatic gonadal tumor

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38
Q

Most common benign mediastinal germ cell neoplasm is

A

Teratoma

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39
Q

Most common type of teratoma seen in the mediastinum

A

Cystic or mature teratoma

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40
Q

Most germ cell neoplasms in the mediastinum are seen in what age group

A

20 to 40 y.o

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41
Q

Benign germ cell tumors in the mediastinum are more common in what gender; while malignant tumors are almost exclusive in

A

Benign- female

Malignant-males

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42
Q

Most common malignant germ cell tumor in the mediastinum

A

Seminoma

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43
Q

Elevated tumor markers in malignant germ cell tumors

A

Elevated hcg or afp

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44
Q

Lipomas are most commonly seen in what compartment

A

Anterior

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45
Q

Presence of soft tissue elements mixed with fat should raise possibility of what tumor

A

Thymolipoma or liposarcoma

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46
Q

Pathognomonic sign of hemangioma in chest radiographs

A

Recognition of phleboliths within a smooth or lobulated soft tissue mass

Hemangiomas are benign tumors composed of vascular channels and may be associated with the syndrome of hereditary hemorrhagic telangiectasia.

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47
Q

Most middle mediasintal lymph node masses are

A

Malignant, representing metastasis from lung, extrathoracic malignancy or lymphoma

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48
Q

5 Benign causes of middle mediastinal lymph node enlargement include

A
  • Foregut cysts,
  • vascular anomalies or aneurysms,
  • sarcoidosis,
  • mycobacterial and fungal infection and
  • angiofollicular lymph node hyperplasia (castleman disease)
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49
Q

Nodular sclerosing Hodgkin disease commonly results in lymph node enlargement, predominantly within the

A

Anterior mediastinum and thymus

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50
Q

What type of leukemia can cause intrathoracic lymph node enlargement

A

T-lymphocytic varieties

The lymph node enlargement is usually confined to the middle mediastinal and hilar nodes

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51
Q

Most common source of metastases to middle mediastinal nodes is

A

Lung cancer

Paratracheal and aorticopulmonary nodes are most commonly involved

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52
Q

A lymphoproliferative disorder characterized by enlargement of hilar and mediastinal lymph nodes, predominantly in the middle and posterior mediastinal compartments

In the more common hyaline vascular type, the disease is localized to one lymph node region and presents as an asymptomatic mediastinal soft tissue mass.

A

Angiofollicular or giant lymph node hyperplasia, aka Castleman disease

Histologically, there is the replacement of normal nodal architecture with multiple germinal centers and multiple small vessels with hyalinized walls that course perpendicularly toward the germinal centers to give a characteristic “lollipop” appearance on light microscopy.

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53
Q

Multicentric form of castleman disease is most often associated with

A

HIV and human herpes virus 8 infection

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54
Q

Unicentric lesions in castleman disease is treated by

A

resection

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55
Q

multicentric castleman disease with HHV-8 infection is treated by

A

rituximab

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56
Q

multicentric castleman disease with HHV-8 negative disease is treated by

A

siltuximab

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57
Q

common mediastinal lesions that typically present as asymtomatic masses on routine chest radiographs in young adults. CT and MR show findings characteristic of the cystic nature of these lesions

A

Foregut and mesothelial cysts

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58
Q

results from anomalous budding of the tracheonbronchial tree during embryologic development

A

Bronchogenic cysts

59
Q

Majority of bronchogenic cysts (80-90%) arise within the mediastinum in the vicinity of

A

tracheal carina

• Bronchogenic cysts are seen as soft tissue masses
in the subcarinal or right paratracheal space on frontal chest radiographs

60
Q

Method of choice for diagnosis of mediastinal cysts

A

MDCT

61
Q

Arise form the parietal pericardium and contain clear serous fluid surrounded by a layer of mesothelial cells.

A

Pericardial cysts

62
Q

Most often, pericardial cysts arise in the

A

anterior cardiophrenic angle, with right-sided lesions being twice as common

63
Q

Approximately 20% of pericardial cysts arise where

A

more superiorly within the mediastinum

64
Q

3 Differential diagnosis for cardiophrenic angle masses

A

pericardial cyst,
enlarged epipericardial fat pad,
enlarged juxtaphrenic lymph nodes

65
Q

majority of esophageal neoplasms, excluding lesions that arise at the esophagogastric junction are

A

squamous cell carcinomas

66
Q

distal esophageal tumors present in the imaging as

A

distal esophageal dilatation

67
Q

proximal esophageal tumors present in imaging as

A

thickening of the tracheoesophageal stripe

68
Q

imaging diagnosis of esophageal tumors is usually made by

A

barium esophagram and confirmed by endoscopic biopsy

69
Q

benign esophageal lesions that present as smooth, solitary, mediastinal masses, projecting laterally from the posterior mediastinum on frontal chest radiographs

A

leiomyoma and GIST

Several benign esophageal neoplasms, including:
•leiomyoma,
•fibroma, and
•lipoma,

•The absence of esophageal dilatation above the mass helps distinguish benign tumors from carcinoma.

70
Q

leiomyoma and GISTs in the esophagus generally involves what part of the esophagus

A

lower third; from the level of subcarinal space to esophageal hiatus

71
Q

False diverticula representing mucosal outpouchings through defects in the muscular layer of esophagus

A

pulsion diverticula

72
Q

pulsion diverticula arises where

A

cervicothoracic esophageal junction or distal esophagus

73
Q

large proximal pulsion diverticula

A

zenker

74
Q

pulsion diverticular that appear as a retroesophageal superior mediastinal mas containing air-fluid level on upright chest radiographs

A

zenker

75
Q

distal pulsion diverticular presents as

A

juxtadiaphragmatic mass with an air-fluid level projection right of midline

76
Q

esophageal lesion that may produce a mass that courses vertically over the length of the mediastinum, projecting toward the right side on frontal chest radiographs

A

dilated esophagus from functional (achalasia, scleroderma) or anatomic obstruction (stricture, carcinoma)

77
Q

may produce a round or lobulated retrocardiac mass in patients with portal hypertension

A

esophageal varices

78
Q

common cause of mass in the inferior visceral mediastinum

A

hiatal hernia

79
Q

results from separation of the superior margins of diaphragmatic crura and stretching of phrenoesophageal ligament

A

hiatal hernia

80
Q

gastric hernia

A

sliding hernia

81
Q

fundal hernia

A

paraesophageal hernia

82
Q

fluid-filled masses lined by enteric epithelium

A

enteric cysts

83
Q

esophageal cysts usually arise

A

intramurally or immediately adjacent to the esophagus

84
Q

when enteric cyst has a persistent communication with the spinal canal (canal of Kovalevsky) and is associated with congenital defects of thoracic spine (anterior spina bifida, hemivertebrae or butterfly vertebrae, it is termed

A

neuroenteric cyst

85
Q

tumors arising from intercostal nerves

A

schwannoma, neurofibroma

86
Q

tumors arising from sympathetic ganglia

A

ganglioneuroma, ganglioneuroblastoma, neuroblastoma

87
Q

tumors arising from paraganglionic cells

A

Paragangliomas

chemodectomas
pheochromocytomas

88
Q

most common neurogenic tumors in children

A

neuroblastoma and ganglioneuroma

89
Q

neurogenic tumors in adults

A

schwannoma and neurofibroma

90
Q

neurogenic tumor comprised of spindle cells that arise from schwann cells which appears encapsulated and contains interspersed neurons

A

neurofibroma

91
Q

neurogenic tumor comprised of spindle cells that arise from schwann cells that is not encapsulated and contains no neuronal elements

A

schwannoma

92
Q

multiple lesions in the mediastinum, particularly bilateral apicoposterior masses, are virtually diagnostic of

A

neurofibromatosis

93
Q

CT demonstration of a tumor extension from the paravertebral space into the spinal canal via an enlarged intervertebral foramen is characteristic of a

A

“dumbbell” neurofibroma

94
Q

modality of choice for imaging suspected neurofibroma

A

MRI

95
Q

malignant neuroblastoma are seen almost exclusively in

A

children under the age of 5

96
Q

these tumors generally present as elongated, vertically oriented paravertebral soft tissue masses with a broad area of contact with the posterior mediastinum

A

ganglioneuroma and neuroblastoma

97
Q

tumors that arise from neural crest or chromaffin cells that lie in proximity to the thoracolumbar sympathetic ganglia of autonomic nervous system

A

mediastinal paragangliomas

98
Q

majority of mediastinal paragangliomas arises in

A

anterior or middle mediastinum

99
Q

Most common primary sites of thoracic spinal metastases

A

bronchogenic, breast or renal cell carcinoma

•Neoplastic processes are usually easily identified by expansion and destruction of vertebral bodies, with sparing of intervertebral disks.

100
Q

important clues to the diagnosis of paravertebral abscess secondary to tuberculosis or bacterial infection

A

narrowing of adjacent disk space and destruction of vertebral endplates

Infectious spondylitis is distinguished from neoplastic processes by the presence of a paravertebral mass centered at the point of maximal bone destruction.

101
Q

extramedullary hematopoiesis in the spine is seen commonly where

A

lower thoracic and upper lumbar

  • Extramedullary hematopoiesis is seen almost exclusively in conditions associated with ineffective production or excessive destruction of erythrocytes, such as:
  • thalassemia major,
  • congenital spherocytosis, and
  • sickle cell anemia.
102
Q

Anomalous herniation of spinal meninges through an intervertebral foramen, resulting in a paravertebral soft tissue mass

A

Lateral thoracic meningoceles

103
Q

Lateral thoracic meningoceles are usually discovered at what age and are more common on what side

A

Middle-aged patients and more common in the right

104
Q

There is high association between lateral meningoceles and

A

Neurofibromatosis

105
Q

Additional clues to the diagnosis of lateral thoracic meningoceles, aside from a round, well-defined paraspinal mass that is indistinguishable from neurofibroma include

A

Rib erosion, enlargement of adjacent neural foramen, vertebral anomalies or kyphoscoliosis

106
Q

When a lateral meningocele is associated with kyphoscoliosis, it is usually found where

A

Apex of the scoliotic curve, on the convex side

107
Q

Diagnostic imaging of choice for lateral thoracic meningocele

A

MRI

108
Q

In mri, lateral thoracic meningocele demonstrate

A

Herniated subarachnoid space

109
Q

Caused by a bacterial infection that most often develops following esophageal perforation or is a complication of cardiothoracic or esophageal surgery

A

Acute mediastinitis

110
Q

Spontaneous esophageal perforation following prolonged vomiting is termed

A

Boerhaave syndrome

111
Q

In this condition, a vertical tear occurs along the left posterolateral wall of the distal esophagus, just above the esophagogastric junction, leading to signs and symptoms of acute mediastinitis

A

boerhaave syndrome

112
Q

Most common chest radiograph findings in acute mediastinitis

A

Widening of superior mediastinum in 65% of patients and pleural effusion in 50%

113
Q

Sensitivity of esophagogram from detecting contrast leakage is highest when the study is obtained within

A

24 hours of perforation

114
Q

Radiologic study of choice for diagnosis of acute mediastinits

A

MDCT

115
Q

Associated with poorest outcome in acute mediastinitis

A

Esophageal perforation

116
Q

hallmarks of chronic fibrosing (sclerosing) mediastinitis are

A

chronic inflammatory changes and mediastinal fibrosis

117
Q

most common cause of chronic fibrosing mediastinitis

A

granulomatous infection, usually secondary to histoplasma capsulatum

  • Idiopathic mediastinal fibrosis,
  • which is probably an autoimmune process, is related to fibrosis in other regions, including the:
  • retroperitoneum,
  • intraorbital fat, and
  • thyroid gland.
118
Q

most commonly affected structure in chronic fibrosing mediastinitis

A

SVC

119
Q

manifests as headache, epistaxis, cyanosis, jugular venous distention, edema of the face, neck and upper extremities

A

SVC syndrome

120
Q

most serious and potentially fatal manifestation of fibrosing mediastinitis

A

obstruction of central pulmonary veins, which produces pulmonary edema that may mimic severe mitral stenosis

121
Q

chronic fibrosing mediastinitis present as ____ in chest radiographs

A

asymmetric lobulated widening of the upper mediastinum, most often in the right

122
Q

most common finding in chronic fibrosing mediastinitis

A

enlarged lymph nodes with calcifications

123
Q

In this condition, the mediastinum develops a flat or slightly convex outward contour, unlike the round, lobulated or irregular contour seen with enlarged lymph nodes or localized mediastinal mass

A

mediastinal hemorrhage

124
Q

benign, asymptomatic condition characterized by excessive deposition of fat in the mediastinum

A

mediastinal lipomatosis

• In multiple symmetric lipomatosis, the cardiophrenic angles, paraspinal areas, and the anterior mediastinum are spared.

Periscapular lipomas may also be seen. The trachea is often compressed or displaced by fat in patients with this condition, whereas this is not seen in simple lipomatosis.

125
Q

mechanism of pneumomediastinum formation

A

involves sudden rise in intrathoracic and intra-alveolar pressure that leads to alveolar rupture

126
Q

AKA Macklin effect in pneumomediastinum

A

extra-alveolar air first collects within the bronchovascular interstitium and then dissects centrally to the hilum and mediastinum

127
Q

in boerhaave syndrome, in addition to pneumomediastinum, hydropneumothorax and pneumoperitoneum are mostly seen on what side

A

left

128
Q

describeds the substernal chest pain caused by the intramediastinal extension of neck or laryngeal infections

A

ludwig angina

129
Q

True or false: mediastinal air without infection is generally asymptomatic and does not require treatment

A

true

130
Q

unilateral hilar enlargement resulting from metastatic lymph node involvement is often seen in

A

small cell carcinoma

131
Q

malignancies most often associated with intrathoracic nodal metastases are

A

genitourinary (renal and testicular); head and neck (skin, larynx, thyroid); breast and melanoma

132
Q

lymphatic spread of tumor to retroperitoneal nodes and up the thoracic duct to posterior mediastinum is the mode of spread in

A

renal cell carcinoma and seminoma

133
Q

reflux of tumor emboli in thoracic duct and anterior mediastinal lymph nodes to hilar, paratracheal and intraparenchymal lymphatics are due to

A

incompetent valves

134
Q

extrathoracic neoplasm with highest incidence of intrathoracic nodal metastasis

A

melanoma

135
Q

unilateral hilar or mediastinal lymph node enlargement is a characteristic feature in

A

primary pulmonary tuberculosis

136
Q

other bacterial infections that have been associated with unilateral hilar lymph node enlargement include

A

plaque, tularemia and anaerobic lung abscess

137
Q

viral infections most commonly associated with hilar lymph node enlargement are

A

infectious mononucleosis and measles pneumonia

138
Q

characteristic finding in patients with pneumonic plague

A

detection on unenhanced CT of increased attenuation within hilar and mediastinal nodes that drain regions of parenchymal involvement owing to intranodal hemorrhage

139
Q

most common intrathoracic manifestation of mononucleosis

A

hilar lymph node enlargement

140
Q

vascular disorders that produce unilateral pulmonary artery enlargement include

A
  • postenotic dilatation of left pulmonary artery from valvular or postvalvular pulmonic stenosis,
  • pulmonary artery aneurysms and
  • distention of PA by bland or tumor thrombosis
141
Q

most frequent solid tumors producing bilateral hilar disease are

A

small cell carcinoma of the lung, lymphoma, malignant melanoma

142
Q

Bilateral hilar lymph node involvement by lymphoma is more common in hodgkin or non-hodgkin

A

hodgkin disease

143
Q

severe pulmonary overinflation from emphysema or in those with diminished pulmonary blood flow due to congenital pulmonary outflow obstruction (TOF, ebstein anomaly) or rarely fibrosing mediastinitis may cause what change in the hilum

A

Bilaterally small hila

144
Q

most common causes of small hilum are

A

atelectasis and resection of a portion of lung, hypoplasia of PA often with associated abnormalities of ipsilateral lung (hypogenetic lung syndrome, Swyer-James syndrome)

[PBR] Pulmo Imaging (9 decks)

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