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Thoracic Imaging > Neoplasms, Masses, and Focal Lung Abnormalities > Flashcards

Neoplasms, Masses, and Focal Lung Abnormalities Flashcards

Contains: Lung Cancer, Metastatic Tumors, Lymphoma, Mediastinal Masses, Congenital and Vascular anomalies of the lung, Pulmonary Nodules/Cavities/Cysts

1
Q

What is a congenital pulmonary airway malformation (CPAM) or congenital cystic adenomatoid malformation (CCAM)

A

a bronchiole derived hamartoma consisting of disorganized lung tissue containing cystic structures

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2
Q

What is the lobe predilection for CPAM/CCAM?

A

Lower lobes, however can occur anywhere

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3
Q

What are the arterial and venous sources of CCAM/CPAM?

A

CPAM/CCAM gets both venous and arterial supply from the pulmonary circulation

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4
Q

What is the age of diagnosis for CCAM/CPAM?

A

70% diagnosed in first week of life

10% in the first year

Very Rarely, adult

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5
Q

What is the presentation of Infant versus adult CCAM/CPAM?

A

Respiratory distress in neonates

Recurrent infection in adults

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6
Q

Which types of CCAM/CPAM are the most common?

A

Type 1 - 65%
Type 2 - 20-25%
Type 3 - 10%
Rare - Type 4 and Type 0

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7
Q

What is the characteristics of type 1 CPAM?

A

> =1 cysts, >2 cm
Initially solid > large air-filled multicystic lesion +/- air fluid levels. Can occupy the entire hemithorax

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8
Q

What are the characteristics of type 2 CPAM?

A

multiple cyst, <2 cm
Initially solid (more often)> large air-filled multicystic lesion +/- air fluid levels

Has renal and cardiac abnormalities with poor prognosis

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9
Q

What is the difference between CPAM Type 1 and 2?

A

Type 2 has <2 cm cysts, compared to >2 cm.

Type 2 has associations with renal/cardiac abnormalities

Type has a poor prognosis

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10
Q

What are the characteristics of Type 3 CPAM?

A

Microscopic (<3-5 mm) cysts, appears as solid mass

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11
Q

What distinguishes Type 0 and Type 4 compared to the other types?

A

Histologic diagnosis.

Type 0 looks like Type 3

Type 4 looks like type 1 and 2

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12
Q

What CPAM type is this?

A

Type 1

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13
Q

What type of CPAM is this? CT of neonate

A

Type II CPAM, white arrow shows opacified vessel in the mass

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14
Q

What might a prenatal US of CPAM show?

A

Polyhydramnios, fetal hydrops, solid/cystic mass in fetal thorax

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15
Q

How do you treat CPAM?

A

Excision of affected lobe

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16
Q

What portends a poor prognosis in CPAM?

A

large size, underdevelopment of uninvolved lung, fetal hydrops or congenital anomalies

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17
Q

What is a bronchopulmonary sequestration?

A

disorganized pulmonary tissue due to abnormal budding of the foregut during development without normal pulmonary arterial or bronchial connection

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18
Q

What is the most common type of bronchopulmonary sequestration?

A

Intralobular sequestration

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19
Q

What is the most common location of intralobular sequestrations?

A

Left lung field, in the posterior aspect

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20
Q

What is the arterial blood supply locations for intralobular sequestrations?

A

Descending thoracic aorta is the most common, followed by upper abdominal aorta or intercostal

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21
Q

Systemic or pulmonary: What are the arterial and venous sources of intralobular sequestration?

A

Systemic Arterial, Pulmonary Venous (but can be azygous or hemiazygous)

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22
Q

Does an intralobular sequestration have pleura?

A

No

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23
Q

What would a intralobular sequestration look like on radiographs?

A

A dense pulmonary mass, usually on the left

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24
Q

What would an intralobular sequestration look like on CT?

A

Parenchymal abnormality cystic or well defined +/- air fluid levels. If enhanced you may see an arterial source.

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25
Q

This an angiogram of a dense mass found on CXR. What is the diagnosis?

A

Pulmonary sequestration, the small black arrows show arterial branches from the descending aorta, and venous drainage into the azygous vein. This was most likely an intralobular sequestration

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26
Q

A dense pulmonary mass was found on CXR, CECT of the chest was perform which revealed this abnormality, what is the diagnosis?

A

Intralobular sequestration. There is a dense mass in the posterior left lung, there is a venous supply from the azygous and arterial supply from the descending thoracic aorta

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27
Q

What is the treatment of intralobular sequestration?

A

Surgical excision, or if asymptomatic, conservative

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28
Q

What is the preferred location of extralobular sequestrations?

A

left lung base

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29
Q

What is the arterial supply of extralobular sequestrations?

A

Systemic arterial, venous from azygous or hemiazygous

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30
Q

What is the venous supply of extralobular sequestrations?

A

Systemic arterial, venous from azygous or hemiazygous

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31
Q

What is the difference between Intralobular and extralobular sequestration?

A

Extralobular sequestration does not contain air, has own pleura, earlier diagnosis in infancy or childhood, and contain not pulmonary or bronchial supply.

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32
Q

What are anomalous systemic arteries without sequestration?

A

Not at all related to pulmonary AVMs, these are persistent embryonic aortic branches that supply a portion of the lung.

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33
Q

What are the long term effects of anomalous systemic arteries without sequestration?

A

Left to left arterial shunt, LV enlargement, and CHF can result

34
Q

A pulmonary arteriogram is performed. What is the abnormality?

A

Anomalous systemic artery originating from the aorta, withotu sequestration

35
Q

A smoothly marginated mediastinal mass was found on CXR, CT was performed. What is the abnormality?

A

Bronchogenic cyst, a large round subcarinal mass

36
Q

What are the characteristics of bronchogenic cysts?

A

circumscribed, thin imperceptible wall, cystic mass in the mediastinum (MC)

37
Q

what locations does bronchogenic cysts prefer?

A

near carina, mediastinum, 15% in parenchyma

38
Q

What can bronchogenic cysts develop air fluid levels?

A

If the cyst becomes infected, may produce air fluid levels and mimic an abscess. The other way it can have air is if it has communication with the tracheobronchial tree.

39
Q

What is the frequency of infected bronchogenic cysts?

A

75%

40
Q

Do bronchogenic cysts enhance on CT?

A

No

41
Q

What do bronchogenic cysts look like on MRI?

A

T2 bright (fluid), and T1 bright (if proteinaceous material)

42
Q

What are pericardial cysts?

A

Defects of embryogenesis of the coelomic cavity that causes formation of fluid filled cysts in the thoracic cavity

43
Q

What is the locational preference of pericardial cysts?

A

90% contact diaphragm (65% in the right cardiophrenic angle, 25% in the left cardiophrenic angle)

44
Q

Are pericardial cysts symptomatic?

A

No

45
Q

A round mass was identified on CXR. CT was performed. What is the abnormality?

A

A fluid attenuating round, sharply marginated cyst bordering the right cardiophrenic angle. This was a pericardial cyst

46
Q

A pulmonary nodule was detected on CXR, pulmonary angiogram was performed. What is the abnormality?

A

Arteriovenous malformation with feeding artery and enlarged draining vein

47
Q

What is the definition of a pulmonary AVM

A

a vascular sac with feeding pulmonary artery and draining vein

48
Q

What are the types of pulmonary AVMs?

A

Simple (1 artery/vein)
Complex (>1 feeding artery)

49
Q

What symptoms are associated with pulmonary AVMs?

A

Right to left shunt, hypoxia
Orthodeoxia (hypoxemia in upright position due to more AVMs in lower lobes)
Hemoptysis, hemorrhage, paradoxic embolism

50
Q

What is the disease association of pulmonary AVMs?

A

Hereditary Hemorrhagic telangiectasia (HHT, Osler-Weber-Rendu)

51
Q

What is osler-weber-rendu disease?

A

Autosomal dominant disease consisting of 3 of the 4 criteria:
1. Spontaneous recurrent epistaxis
2. Multiple mucocutaneous telangiectasias
3. Visceral involvement with AVMs
4. First degree relative with HHT

52
Q

What is the radiographic findings of pulmonary AVMs?

A

lobulated but sharply defined pulmonary nodule, pref in lower lobes

53
Q

Maximum Intensity Projection CT was performed. What is the abnormality?

A

Arteriovenous malformation

54
Q

What is the treatment of pulmonary AVMs?

A

embolotherapy

55
Q

What is the most common organism to cause septic emboli?

A

Staph A

56
Q

What are the imaging features of septic emboli?

A

Multiple (rarely solitary) peripheral lesions in various stages of cavitation

57
Q

What are the risk factors or septic emboli?

A

Heart infection, IVDU, or sepsis

58
Q

Multiple pulmonary nodules/opacitites were identified on CXR. A CT was obtained. What is the abnormality?

A

Multiple peripheral nodules are noted with a feeding vessel sign. This was septic emboli

59
Q

A CT was obtained from a clinically declining patient with endocarditis

A

Multiple peripheral pulmonary nodules are noted in various stages of cavitation. This is diffuse septic emboli

60
Q

What is a pulmonary Varix?

A

A dilation or tortuous appearance of pulmonary vein as it enters the left atrium

61
Q

What are the causes of acquires pulmonary vein varices?

A

elevated left atrial pressure, e.g. mitral stenosis

62
Q

What are the four types of teratomas?

A

Mature, Cystic (Dermoid), Immature, Malignant

63
Q

What is the most common type of teratoma?

A

Mature

64
Q

What components might you see in mature teratomas?

A

Fluid in 90%, fat in 75%, Calcification in 50%

65
Q

What is diagnostic of teratomas?

A

Fat fluid level, but only seen in 11% of cases

66
Q

What location is common for pulmonary teratomas?

A

anterior mediastinum, can see mediastinal widening

67
Q

What are the CT findings of teratomas?

A

Internal foci of fat in 75%, calcification in 50%, soft tissue enhancement +/-

68
Q

What are the MRI findings of teratoma?

A

Out of phase drop out of fat signal, fat suppression

69
Q

What is the treatment of teratomas?

A

Excision

70
Q

A cXR was performed on a patient with shortness of breath. What is the abnormality, what would be the differential?

A

mediastinal widening, likely anterior. DDx: included teratoma, lymphoma, thymoma

71
Q

A CXR was completed reveal and anterior mediastinal mass. CT was then done showing this abnormality. What is the diagnosis?

A

Teratoma - large anterior mediastinal mass with fat, soft tissue, calcifications and fluid.

72
Q

What is the definition of a solitary pulmonary nodule?

A

focal spherical lesion in lung <3 cm in size

73
Q

What classifies an SPN as indeterminate?

A

nonbenign calcification pattern and not stable for >2 years

74
Q

What is types of benign calcifications in pulmonary nodules?

A

diffuse, popcorn, central, laminated

75
Q

What are the two most common superior sulcus tumors?

A

Adenocarcinoma and Squamous cell carcinoma

76
Q

What is pancoast syndrome?

A

Due to compression of the brachial plexus and cranial nerve 8, produced horners syndrome and pain/paresthesias of the ipsilateral upper extremity.

77
Q

What is the convex margin measurement cutoff to suggest superior sulcus tumors?

A

> 5mm

78
Q

What are signs of chest wall invasion from tumors?

A

rib destruction or encasement of nerves or bloods vessels

79
Q

What imaging modality should be performed to evaluate neurovascular involvement of superior sulcus tumors?

A

MRI brachial plexus

80
Q

What are most superior sulcus tumors automatically staged as?

A

IIb due to extrathoracic invasion on initial imaging.

81
Q

What are the surgical contraindications of superior sulcus tumor resection?

A

brachial plexus invasion above T1, >50% vertebral body invasion, invasion of esophagus or trachea, distant mets, or N2/N3 nodal mets

82
Q

If you could choose only one MRI sequence for superior sulcus tumors, what would it be?

A

T1

Thoracic Imaging (12 decks)

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