Odds & Ends

Question 1

Most common primary tracheal malignancies

Answer 1

1) Squamous cell carcinoma
2) Adenoid cystic carcinoma (4th-5th decades, not associated with smoking, submucosal, circumferential/infiltrative growth)
3) Mucoepidermoid carcinoma (favour airways distal to the trachea)

Question 2

5 main subtypes of pulmonary HTN and causes

Answer 2

1) PAH
PPH (idiopathic), familial, shunts, PVOD, PCH

2) Pulm venous HTN
Left sided heart disease

3) Pulm HTN ass. chronic hypoxemia
Chronic lung disease

4) Pulm HTN due to chronic PE
5) Pulm HTN from miscellaneous d/o (sarcoid, malignancy, fibrosing mediastinitis)

Question 3

Imaging findings in PH

Answer 3

Enlarged PA (>2.9 cm), rapid peripheral tapering
Calcification in chronic setting
Other findings dependant on cause:
- Mosaic attenuation (esp. in CTEPH)

Question 4

Possible causes of PVOD

Answer 4

Pregnancy
Drugs (esp bleomycin)
Bone marrow transplant

Question 5

Plain film findings of PE

Answer 5

Fleischner sign - widening of pulm arteries due to clot
Westermark sign - paucity of vessels in the upper lobes
Hampton’s hump - airspace opacity from infarct

Question 6

Timing and findings in radiation changes

Answer 6

Radiation pneumonitis - Geographic ground glass at radiation port, sharp margins, can start 1 month post (4-12 weeks post rads), most severe 3-4 months post; can be positive on PET/CT

Radiation fibrosis - 6-12 months post radiation, fibrosis and traction bronchiectasis in rad port

Question 7

Causes of exudative effusion

Answer 7

Infection - Parapneumonic, empyema, TB
Mesothelioma
Pleural mets
Collagen vascular disease - i.e. rheumatoid

Question 8

What is post-pneumonectomy syndrome?

Answer 8

Compression of the airway, central bronchus after pneumonectomy, more commonly involves the left mainstem bronchus after RIGHT pneumonectomy

Often occurs in younger” patients, less than 1% of cases

Question 9

Possible appearances of drug reaction

Answer 9

OP, NSIP, HP, AIP/ARDS, Hemorrhage

Treat with steroids, can flare after stopping these

Question 10

What is talcosis? Imaging findings?

Answer 10

• Filler in oral tablets
• Hyperdense micronodules <1 mm, or conglomerate masses like those seen in silicosis
• If panlobular emphsema present - more likely to be from Ritalin injection

Question 11

DDx pleural calcification

Answer 11

Asbestos (bilateral, small plaques)
Prior hemothorax
Prior infection (particularly TB)
Talc pleurodesis

Question 12

What is Kaplan syndrome?

Answer 12

Rheumatoid pneumoconiosis (i.e. patients with rheumatoid who also have CWP, silicosis, etc. )

Large necrobiotic nodules, with more numerous additional nodules and usual changes of pneumoconiosis

Question 13

What is Lofgrens syndrome?

Answer 13

Acute presentation of sarcoid

• lymphadenopathy
• erythema nodosum
• polyarthralgias