Patterns of Lung Disease

Question 1

secondary pulmonary lobule contents

Answer 1

centrilobular artery, central bronchus; pulmonary veins/lymphatics are in the periphery

encased by interlobular septa

1-2.5 cm

Question 2

consolidation (XR/CT) /ground glass opacity (CT) pathophysiology

Answer 2

filling of alveoli with fluid/incomplete aeration, alveolar wall thickening, partial filling of alveoli

Question 3

consolidation causes

Answer 3

acute: pneumonia, pulmonary hemorrhage, ARDS, pulmonary edema
chronic: bronchiooloalveolar carcinoma, organizing pneumonia (peripheral rounded consolidations), chronic eosinophilic pneumonia (upper lobe)

Question 4

pulmonary vessels visible with GGO or consolidation?

Answer 4

GGO: pulmonary vessels visible

Question 5

ground glass opacity causes

Answer 5

acute: pulmonary edema (dependent), pneumonia (PJP), pulmonary hemorrhage, ARDS
chronic: broncioalveolar carcinoma, organizing pneumonia, chronic eosinophilic pneumonia, idiopathic pneumonia, hypersensitivity pneumonia, alveolar proteinosis

Question 6

diffuse/central GGO ddx

Answer 6

pulmonary edema, alveolar hemorrhage, PJP, alveolar proteinosis

Question 7

peripheral GGO/consolidation ddx

Answer 7

organizing pneumonia, chronic eosinophilic pneumonia (upper lobe), atypical/viral pneumonia, pulmonary edema

Question 8

interlobular septal thickening–smooth DDX

Answer 8

pulmonary edema, pulmonary alveolar proteinosis, pulmonary hemorrhage, atypical pneumonia

Question 9

interlobular septal thickening – nodular/irregular/assymmetric DDX

Answer 9

lymphangitic carcinomatosis, sarcoidosis

Question 10

crazy paving

Answer 10

interlobular septal thickening with superimposed ground glass opacities

GGO: alveoli filled with proteinaceous material
interlobular septal thickening: lymphatics take up proteinaceous material

Question 11

crazy paving DDX

Answer 11

alveolar proteinosis, PJP, organizing pneumonia, bronchioloalveolar carcinoma, lipoid pneumonia, ARDS, pulmonary hemorrhage

Question 12

centrilobular nodules

Answer 12

opacification of centrilobular bronchiole at center of SPL

never touch pleural surface

Question 13

infectious ddx for centrilobular nodules

Answer 13

endobronchial spread of TB, bronchopneumonia, atypical pneumonia (mycoplasma)

Question 14

inflammatory ddx: centrilobular nodules

Answer 14

HSP, hot tub lung, RB-ILD, diffuse panbronchiolitis, silicosis

Question 15

perilymphatic nodules locations

Answer 15

subpleural, peribronchovascular, septal

Question 16

perilymphatic nodule DDX

Answer 16

sarcoidosis (upper lobe predominant), pneumoconioses (similar to sarcoid but history of exposure), lymphangitic carcinomatosis

Question 17

galaxy sign

Answer 17

confluent perilymphatic nodules

Question 18

randomly distributed nodules DDX

Answer 18

hematogenous spread

hematogenous mets, pulmonary emboli, pulmonary langerhans cell histiocytosis (has cysts, smoking related disease)

Question 19

miliary pattern nodules DDX

Answer 19

disseminated TB, fungal infection, hematogenous mets

Question 20

tree in bud nodules DDX

Answer 20

small airway infection

mycobacteria TB, bacterial pneumonia, aspiration pneumonia, airway invasive aspergillus

Question 21

tree-in-bud physiology

Answer 21

multiple small nodules connected by linear branching; impacted bronchioles

Question 22

solitary cavitary lesion ddx

Answer 22

primary bronchogenic carcinoma/squamous cell, TB (upper lobe)

thick irregular wall with solid mural component; >15 mm thickness or spiculated usually malignant

Question 23

multiple cavitary nodules ddx

Answer 23

vascular origin usually

septic emboli, vasculitis, metastases (uterine, SCC)

Question 24

cystic lung disease DDX

Answer 24

lymphangioleiomyomatosis, emphysema, pulmonary langerhans cell histiocytosis, diffuse cystic bronchiectasis, pneumocystic jiroveci, lymphoid interstitial pneumonia

Question 25

ddx for single pulmonary cyst

Answer 25

bulla (>1cm), bleb <1cm, pneumatocele

Question 26

lower lobe fibrotic changes ddx

Answer 26

IPF (basilar honeycombing), end stage asbestosis (pleural plaques), nonspecific interstitial pneumonia (collagen vascular disease/drug reaction, no honeycombing)

Question 27

upper lobe fibrotic changes ddx

Answer 27

end stage sarcoidosis, chronic hypersensitivity pneumonitis, end stage silicosis