Moduel 1: Thoracics Flashcards
1
Q
opacification of the Raider triangle
A
aberrant right subclavian artery
2
Q
metallic valves
how to tell mitral from aortia
A
mitral is bigger
3
Q
pacemaker wire going through a valve means it is the
A
tricupsid
4
Q
most superior valve is the
A
pulmonary valve
5
Q
what is luftsichel sign
A
collapse of the left upper lobe
compensatory expansion of the lower lobe, the superior part of which forms and air sickle shape around the left mediasitnum
6
Q
the lingula is a part of which lobe
A
the left upper lobe
7
Q
list the right teritiary bronchi
A
Apical
Posterior
anterior
medal and lateral
superior
posterior
lateral
anterior
medial
8
Q
list the left tertiary bronchi
A
Anterior
apicoposteiror
superior
inferior
superior
posterior
lateral
anteromedialbasal
9
Q
chest radiograph
hilum overlay sign is what
A
hilum mass obliterates the silhouette of the pulmonary vessels
10
Q
mass differentiatebetween being pulmonary or from mediasitnum
A
loko at the shouldering angle.
acute is from the lung
mediastinal ill be obtuse
11
Q
how many layers of pleura does an azygoes lobe have?
A
4
12
Q
why does azygoes lobe have 4 layers of pleura
A
folded in on itself
13
Q
what is a trcheal bonrhcus
when to call it a pig bronchus
A
bronchus off the trachea. can get infections.
if whole if right upper lobe is from this then pig bronchus
14
Q
what is proximal interruption of the pulmonary artery
A
congenital absence of one pulmonary artery
but more distal vasculature is present
15
Q
proximal interruption of pulmonary artery
exists on what side
ax to
A
exists opposite to aortic arch side
ax to PDA, TOF and trunchus
16
Q
strep pneumo favours where
A
lower lobes.
17
Q
most common form of pnumonia in AIDS patient sis
A
strep pneumoniae
18
Q
Endocarditis patients, bacteria can travel to lungs an make an abscess
Classic Bug
A
Staph A
19
Q
anthrax pneumonia apperance
A
mediastinal widerning, pleural effusion
haemorrhagic lymphadenitis
mediastinitis
20
Q
BULGING fissure pneumonia
A
Klebsiella
21
Q
Which patient stypically get a klebsiella infeciton
A
alcoholics and nuring home patients.
22
Q
klebiella sputum is
A
current jelly
23
Q
H. Influenza seen in
A
COPDers
aplenia
24
Q
H Flu will appear as
A
bronchitis
bilateral lower lobe bronchopneumoinia(sometimes)
25
Pseudomonas affects who?
ICU
CF
Primary cilicary dyskinesia.
pleural effusions common
26
Pseudomonas get what in the lung
abscess formation and patchy opacitites
27
appearance of legionella on radiograph
peripheral and sublobar arispace opacity
28
who gets legionella
COPD
Polutes air conditioners.
immunocompromised will caviate
29
actinomycosis is what appearance to the lungs?
peripheral airspace changes
can be aggresveia and invade ribs
30
mycoplasma chest radiograph appearance
fine reticular pattern
tree in bud
patchy opacities
31
story for an actinomycosis
dental procedure gone wrong with mandible osteomyelitis and aspiration
32
what is the time split for post bone marrow
graft vs host
Acute 20 - 100
chronic 100+
33
acute graft vs host manifests in which organs
extra pulmonary]]so skin, liver, GI tract
34
chronic graft vs host disease presents in which organs
lungs
lymphocytic infiltration of the airways and obliterative bronchiolitis
35
post bone marrow transplant
patients are susceptible to diseases based on time frame.
what are the timeframes?
Early neutropenic (0 - 30 days)
early (30 - 90)
late (>90)
36
Early neutropenic (0 - 30 days)
early (30 - 90)
late (>90)
post bone marrow tranplant pulmonary findings by differnetials
Early neutropenic (0 - 30 days)
- oedema
- haemorrhage
- drug induced lung injury
-fungal pneumonia
early (30 - 90)
- PCP, CMV
late (>90)
- Bronchiolitis obliterans, COP
37
infections in AIDS by CD4 count
what are they
>200 - bacterial and TB
<200 - PCP, atypical mycobacterial
<100 - CMV, disseminated fungal, mycobacterial
38
CT patterns in AIDS
focal airspace opacity
ddx
Bacterial (strep pneumonia)
TB if low CD4
chronic opacity - lymphoma/Kaposi
39
CT patterns in AIDS
muti focal air space opacity
ddx
bacterial or fungal
40
CT patterns in AIDS
GGO
ddx
PCP (or CMV if CD4 <100)
41
PCP aids infection will appear as
GGO.
bilatearlly in perihilar region
SPARES the peripheries
42
HIV
flame shaped perihilar region
Kaposi sarcoma
43
HIV persisten opacities think
lymphoma
44
Lung cysts in HIV
LIP
45
HIV
Hypervascular lymph nodes
Castlemans or Kaposi
giant lymph node hyperplasia, is an uncommon benign B-cell lymphoproliferative condition is castylemans
46
what are the diferent types of TB based on timiing
Primary
Primary progressive
Latent
Post primary
47
Primary TB - what happens
inhale a bug
form a granuloma(Ghon focus) (can get nodal expansion)
if node calcifies called a Rnke Complex.
if node bursts then get endobronchial spread or miliary.
48
primary progressive TB
what happens
local progression WITH CAVITATION
49
what is latent TB
Positive PPD, negative CXR, no symptoms
50
post primary TB
what happens to cause
endogenous reactivation of latent TB
evidence of progression, ie cavity. Adjacent vessels can get aneurysms
51
how to treate immune reconstituition inflamatory syndrome
give steroids
52
when do people get pleural effusions with TB
3-6 months after primary infection.
need to biopsy as often culture negative
53
two non TB mycobateriums to know about are
MAC
Kansasii
54
types of lung pattern for non TB mycobacterium
Cavitatory
- MAC
Bronchiectatic
-lady windemere(also MAC)
HIV patients
- low immune system, lots of infections
Hypersensitivity pneumonitis
- hot tub lung. GGO centrilobular nodules
55
lady windemere lung will look like
Middle lobe and lingula
bronchiectasis and tree in bud
56
who gets invasive aspergillus
immunosupressed
57
what is a halo sign
consolidative mass with a halo of GGO around it
58
what does the air crescent sign mean ?
healing as the ball has gotten smaller
59
allergic bronchopulmonary aspergilloma affects which patients
asthmatics
get finger in glove
60
if there is fungal invasion of the mediastinum pleura chest wall
Mucomycosis
61
bone marrow transplant patient can get CMV between 30 - 90 days
how will it appear on chest xr
multiple nodules
ground glass
consolidative
62
measles chest radiograph
multifocal ground glass opacities with small nodular opacities
63
influenza appearance
coalsecent lower lobe opacity
64
SARS appearance on radiograph
GGO
lower lobe
65
ebstein barr causes
big spleen
large lymph nodes
66
complictions of septic emboli
wedge shaped infarctions
cavitations
empyema
pneumothroax
67
Mnemonic for causes of CAVITY
CANCER (SCC)
Auto Immune (Caplan, wegners)
Vascular - Septic emboli / bland emboli
I - infection (TB)
T - Truama - pneumatoceles
Y - young - conenital CCAMS, sequestrations
68
what is lemierre syndrome ?
jugular vein thrombosis with septic emboli
69
bacteria responsible for lemierre syndrome
Fusobacterium necrophorum
70
nodule vs mass based on size
<3cm
71
benign nodule calcifications patterns
Solid
laminated
central
popcorn
72
benign nodule doubling times
super fast (1 month)
super slow (16 months)
73
dodgy nodule
features
GGO
air bronchogram through it
spiculated margins
74
PET nodule
hot / cold for GGO/nodule
GGO - cold likely cancer, hot infection
Solid - hot can be cnacner, infection, grnaulomatous
75
four types of lung cancer are
SCC
Small cell
large cell
Adenocarcinoma
76
SCC lung cancer
centrally located
smoking risk
cavitate
can get ectopic PTH production
77
Small cell lung cancer
central.
some lymphadenopathy.
Paraneoplastic syndromes can occur like Lambert Eaton (Acth)
78
Large cell lung cancer appears as
large and peripheral (4cm + )
79
adeno lung cancer
location and
ax
peripheral and upper lobes
ax with lung fibrosis
80
what are the subtypes of adenocarcinoma
atypical adenomatous hyperplasia of lung (AAH)
- precursor
Adenocarcinoma in situ (ACIS)
- <3cm
Minimally invasive adenocarcinoma (MIA)
- <3cm but <5mm stromal invasion
81
what stage of lung cancer is unresectable ?
3B
82
what makes something 3B
Supraclavicular, contralateral mediastinum, sclaene hilar adenopathy
Tumour invading different lobes
Malignant pleural efffusion
83
lobe malignnacy for T3 T4 and M1
T3 is two in same lobe
T4 is two in same lung
M1 is different lungs
84
bronchopleural fistula sing
intially increase pleural fluid but then decreases
85
types of mets to the lungs by behaviour
Direct invations
haematogenous mets
lymphangetic carcinomatosis
86
why do mets favour the lower lobes
greater blood supply
87
cannonball mets from
rcc
choriocarcinoma (testicle)
88
carcinoids can be calssfied based on
location
- bronchial and peripheral
histroloy
- typical, atypical
89
Lymphangetic carcinomatosis will have what appearance on imaging
nodular thickening of the interlobular septa and subpleural interstitium
does NOT distort the pulmonary lobule (as per IPF)
classically bronchogenic cancer, cervical and others
90
what cancer is this
occurs in bronchus, mre common in trachea than carcinoid
adenoid cystic
Second most common after squamous cell carinoma
91
types of pulmonary lymphoma
Primary
secondary
HIV
PTLD
92
Primary lymphoma in lung is what type?
usually non hodkin
low grade MALToma
93
primary lymphoma of lung defined as
lack of extrathoracic involvement for 3 months.
94
Secondary lymphoma in lung
much more common.
NHL more likely, but HL if involving the lung.
95
Secondary NHL vs secondary HL
NHL more common.
HL more likely to have intrathoracic disease at presenetaiton
NHL - no mediastinal disease
96
PTLD lymphoma
Post-transplant lymphoproliferative disorders
when does it affect
within a year of tranpslace.
B cell lymphoma related to EB virus.
97
AIDS related pulmonary lymphoma
is what type
high grade NHL
realtes to EBV.
often in low CD4<100.
98
AIDS patient with lungnodules, pleural effusion, lymphadenopathy
lymphoma
99
a bloody pleural effusion is common in
kapsoi sarcoma
100
Kaposi sarcoma vs lymphoma on Nuclear medicine
Kaposi
Gallium NEGATIVE
Lymphoma
gallium positive
101
Kaposi hiots when CD4 is less than
200
102
flame shaped hilar opacities is
Kaposi sarcoma
103
microscopic fat and popcorn calcifications
can be hot on PET
dx is
Hamartoma
104
what to do with hamartoma
nothing
105
What is bronchial atrewsia
blind ending bronchus, finger in glove.
distal lung hyperinflated from collateral drift and air trapping
apical posterior segment of the left upper lobe
106
AVM: when to treat
afferent vessel is 3mm (though disputed)
107
persistent left SVC will drain in to t
coronary sinus
108
Swyer James cuases what
unilateral lucent lung
post infectious obliterative bronchiolitis
109
why is extralobar considered the worse sequestration
get fewer infecitons due to pleural covering however the associations are worse
CCAM, diaphragmatic hernia, vertebral anomalies, congenital heart diseases, pulmonary hypoplasia
110
CCAM is what
malfromation of adenomatoid stuff replacing norma lung.
1 - 4
1 - macrocystic
2 - <2cm
3 - microcystic
4 - looks like 1
5 -
111
list some cystic lung disease
LCH
LAM
Brit dog dube
LIP
PCP
112
LCH
affects
location
spares
young smokers
centrilobular nodules in upper lobes.
spares the costophrenic angles
113
what spares the costophrenic angles
LCH and hypersensitivity pneumonitis
114
Lymphangiomyomatosis is ax with
Tuberous sclerosis
estrogen (favours woem nof child bearing age)
115
lymphocytic interstitial pneumonaitis
- what is it
benign lymphoproliferative disorder in the lung
116
LIP ax
SLE, RA, Sjogrens, HIV
Castlemans .
in a kid then HIV
117
PCP buzzword
GGO, hilar and mid lung zones
118
types of emphysema
centri-lobular
pan-lobular
para-septal
119
pan-lobular emphysema favours where
lower lobes
120
ax for pan-lobular emphysema
alpha 1 antitrypsin
121
par-septal found where
adjacent to the pleura and septal line.
peripheral distribuion in the secondary pulmonary lobule
122
saber sheath trachea is considered pathognomonic of
COPD
123
vanishing lung syndrome is ax with
20% have alpha antitrypsin deficiency
bullousemphysema
124
inhaled substance end up in which part of the lung
upper lobes
125
location of pneumoconiosis nodules
centrilobular - from inhalation
perilymphatic
126
how ti dfferentiat e Asbestosis from UIP
pareital pleural thickening in asbestosis
127
What are the benign asbestosis related changes
pleural effusion
plaques (spare the apices)
128
Malignant mesothelioma
features
extention in to the fissure
pleural ring
129
who gets silicosis
miners
130
What is PMF
progressive massive fibrosis
large masses in the upper lobe with radiating strans
131
Silicotuberculosisi
silicosis raises chances of TB
if cavitation in setting of silicosis then think TB
132
nodule pattern is perilymphatic
ddx
sarcoid
lymphangitic spread of CA
Silicosis
133
Random nodule pattern
ddx
Miliary TB
Mets
Fungal
134
Centrilobular nodule pattern
Infection
RB- ILD
Hypersnesitivity pneumonitis
135
interlobular septal thickening
usually from
pulmonary oedema
136
honeycombing is a hallmark of
UIp
137
how to distinguish between the honeycombing and paraseptal emphysema
two to three rows --> honeycombing
138
If idiopathic interstitial penumonia aren't diseases what are they
lung reactions to lung injury
139
When UIP lung s are considered idiopathic what are they called
IPF
140
first finding for UIP
reticular pattern in the posterior costophrenic angle
141
UIP pattern
Apical to basal gradient
traction bronchiectasis
honeycombing
heterogenous in histoloy
142
NSIP histology
homogenous inflammation / fibrosis
143
NSIP pattern is seen in what
vascular disease and drug reaction
144
Types of NSIP
cellular / fibrotic
145
If NSIP and GGO
cellular
146
if NSIP
GGO and reticulation
Cellular or fibrotic
147
NSIP
Reticulation and traction bronchiectasis
Fibrotic NSIP
148
NSIP
Honeycombing
uncommon
149
Location for NSIP
lower lobe posterior
peripheral predominance
spares immeidate subpleural lung
GGO
150
Which fibrosis do scleroderma get
NSI P
151
Smoking related lung fibrosis are
RB-ILD
DIP
152
pattern in RB- ILD
apical centrilobular GG nodules
153
pattern in DIP
diffuse GGO, patchy, subpleural distribution
small cystic spaces
154
Sarcoid elevated blood marker
ACE
calcium
155
Sarcoid appearanc e
perilymphatic nodules
upper lobe predominance
156
which infection common in end stage sarcoid
aspergillomas
157
3 stages to CHF
redistribution - big vascular pedicle, big heart
interstitial - Kerley Lines, duffing, central vessels contour
alveolar - airpsace fluffy opacity. pleural effusion
158
TIMEframe for lung transplant complications
Immediate - less than 24 hours
Early complications - 24 hrs to 1 week
intermediate complicaiton - 1 week to 2 months
late complications - 2-4 months
later complications > 4 months
159
Lung transplant immediate
Donor recipient mismatch
Hyperacture rejection - HLA and ABO antigens. rapid and fatal.
160
Early complications post lung transplant
reperfusion injury - peak day 4.
air leak - more than 7 days continuous leak.
161
Intermediate complications post lung transplant
Acute rejection - GGO and interlobular thickening.
bronchial anastomotic complications - leaks occur in the first month, stenosis can develop later.
162
Late complications post transplant
CMV infeciton
GGO
tree in bud
163
Late complications post lung transplant
Chronic rejection
cryptogenic organizing pneumonia
PTLD
upper lobe fibrosis
164
Post lung tranpalnt
air trapping on expiraiton at 6 months
chronic rejection
/ bronchiolitis obliterans
165
what is the most common recurrent primary disease after transplant
sarcoid
166
Pulmonary alveolar proetinosis pattern
Craz paving pattern
167
what is crazy paving
interlobular septal thickening with GGO
168
how to treat pulmonary Alveolar Proetinosis
bronchoalveolar lavage
169
Crazsy paving
ddx
oedema
haemorrhage
BAC
Acute interstitial pneumonia
and of course Pulmonary alveolar proteinosis
170
fat density in the consolidaiton
lipoid pneumonia
171
with organizing pneumonia
if the cause is not known
Crytpogenic
172
Causes of orgnaizing pnuemonia
idiopathic
infection
drugs
collagen vascular disease
fumes
173
appearance of COP
patchy air space consolidaiton or GGO
peripheral / peribronchial distribution
174
What is the Atoll sign
consolidaiotn around GGO
175
difference in location of Chronic Esingophilic pneumonia and COP
CEP likes apices
176
lung transplant complications
what are the timings?
Immediate - 24 hours
Early - 1 week
Intermediate - 2 months
late - 4 months
Later - 4 month ++
177
immediate massive homogenous infiltration due to
hyperacute rejection
HLA and ABO antigens, rapid and fatal
178
ground glass opacities, intrtalobular sepctal thickening. Intermediate complications for lung tranplsant
acute rejection
improves with steroids
179
COP pattern of GGO
peripheral and peribronchial
180
stages of hypersenstivity pneumonitits
acute
subacute
chronic
181
HP in subacute phase will look like
patchy ground glass opacities.
ill defined centrilobular ground glass nodules
mosaic perfusion
air trapping
182
Chronic HP will look like
UIP wth air trapping
183
reverse halo ddx
COP
fungal pneumonia
TB
Wegeners
Pulmonary infarct
184
Halo sign
ddx
invasive aspergillosis
other fungus
haemorrhagic mets
wegeners
185
normal transverse diameter of trachea
no more than 2.5cm
186
three questions about trachea disease to asnwer
posterior membrane
focal or diffuse
calcification
187
spares the posterior membrane
diffuse thickneing of trachea
what disease
relapsing polychondritis
188
focal subglottic curcumferential stenosis, hourglass configuration to trachea
post intubation stenosis
189
ciurcumferential thickneing of traceha, focal or long segment.
no calc.
wegeners
190
spares posterior membrane. cartilaginous osseous nodules in the submucosa of tracheal and bronchial walls
Tracheobronchopathia Osteochondraplastica
191
tracheal tumours types
SCC - most common, prefers lower
Adnoid cystic
Mets
Squamous cell papilloma - most common benign
192
cystic fibrosis starts as what and finishes as what
bronchiectasis - cylindrical and end as varicoid
predminnace to upper lobes
193
primary ciliary dyskinesia get what other issues
fertility issues
mastoid ieffusions
conductive hearing loss
only 50% have kartageners
194
what is kartageners
PCD and situs inversus
195
massive dilated traches
mounier-kuhn
196
where will you find tree in bud
5 - 10 mm from the pleural surface
ax centrilobular nodules
197
what is follicular bronchiolitis?
inflammatory process seen in RA/ Sjogrens.
centrilobular ground glass nodules with bornhcial dilation
198
what is constrictive bronchiolitis?
2 to viral illnes, tx patients, drug reaction ect.
mononuclear cells form granulation tissue and plug the airway.
causes Swyer-Jame's hyperlucent lung
199
List some types of small airways disease
infectious bronchiolitis
RB-ILD
Sub-acute hypersensitivity pneumonitis
follicular bronchiolitis
constrictive bronchiolitis
200
favoured location of aspiration
posteiror segment of upper lobes
superior segment of lower lobes (if supine)
basal lower lobes id upright
201
aspiration of gastric acid cayuses
airspace opacity
202
aspiration of water
fleeting opactiy will resolves in hours
203
aspiration of bugs (eg mouth)
pneumonia,
204
aspiration of oil
lipoid pneumonia (low density)
205
what is caplan syndrome
RA
upper lobe lung nodules can cavitate
pleural effusion
206
Lupus in the lungs
pleural effusion
pericardiac effusions
207
Rheumatoid arthritis in lungs
UIP and COP
lower lobes favoured
208
SCleroderma appearance in lungs
dilated fluid filled osophagus
NSIP>UIP
209
Sjogrens
LIP
extensive ggo with scattered thin walled cysts
210
ANk spond
upper lobe fibrobullous disease
211
shrinking lung affects
lupus
212
what is hepatopulmonary syndrome
liver patients, short of breath when sitting up
due to distal vascular dilation in the lung bases, dilated subpleural vessels that don't taper and instead extend to the pleural surface
213
wegeners lung appearance
nodules with caviation
214
pleural plaque of asbestosis typically spares the
costophrenic anles
215
is mesothelioma dose dependnat
no
216
pleural rind extends int othe fissues
mesothelioma
217
fibrous tumours of the pleura are ax with
hypoglycaemia
hypertrophic osteoarthropathy
218
mets to the pleura what are they likely to be
adeno
lung
breast then lymphoma
219
what to look for in mets to the pleura
pleural effusion
220
features of an empyema
enhacnement of pleura
obvious septations
gas
221
what can cause empyema necessitans
TB
actinomyces
222
what is pancoast syndrome
sholder pain
c8 - t2 radiculopathy
horner syndrome
Normally an SCC
223
what can cause pancoast syndrome
superior sulcus tumour
- SCC or bronchogenic adenocarcinoma
224
large thymus
rebound vs residual lymphoma
PET - lymphoma would be hotter
(both still hot though)
MRI - rebound would drop on in and out, due to fat in it.
225
Thymic cyst on MRI
t2 bright
226
why image the abdomen in thymic cancer
drop met into the pleural and retroperitoneum
227
thymoma ax
Myasthenia gravis
pure red cell aplasia
hypogammaglobulinemia
228
thymolipoma - looks like
fatty mass with interspersed soft tissue
229
association of mature teratomsas with
linefleters
230
what are the middle mediastinal masses
fibrosing mediastinitis
bronchogenic cyst
lymphadenopathy
mediastinal lipomatosis
231
what causes fibrosing mediastinitis
histoplasmosis
or idiopathic
but also tb, radidaiton, sarcoid
232
bronchogenic cyst will cause obliteration of what chest xr line
asygooesophageal line
233
posterior mediastinal masses are
neurogenic
- schwannomas, neurofibroams, malignant peripheral nerve sheath tumour
bone marrow
- Extramedullary haemopeis. CML, PCRV, myelofibrosis, sickle cell, thalassemia
234
causes of a pulmonary artery aneusrysm
iatrogenic
behcets
chronic PE
235
rasmussen aneurysm is what
pseudloaneurysm seocndary to pulmonary TB
236
what is pulmonary veno-occlusive disease
variant pof primary pulmonary hypertension.
post capillary pulmonary vasculature is affected .
Normal edgie pressure.
237
what is the macklin effect?
pneumomdediastinum from truama.
burst alveoli, air dissects backwards.
238
inversion of the ipsilateral diaphragragm
pneumothorax
239
low grade carcinoids will have what kind of FDG
low enhacnement
poorly differentiated/high grade ones will have higher enhancement
240
