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Chest Imaging > Pleura, chest wall, diaphragm and miscellaneous chest disorders > Flashcards

Pleura, chest wall, diaphragm and miscellaneous chest disorders Flashcards

1
Q

Parietal and visceral pleura meet at the

A

Hila

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2
Q

Thin double layered fold at the medial lung base inferior to the inferior pulmonary veins termed the

A

Pulmonary ligament

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3
Q

Normal amount of fluid in the pleural space

A

2-5 ml

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4
Q

Formation of pleural fluid follows

A

Starling law and depends upon hydrostatic and oncotic forces in both systemic capillaries of the parietal pleura and pleural space

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5
Q

Under normal conditions, pleural fluid is formed by

A

Filtration from systemic capillaries in the parietal pleura and resorbed via parietal pleural lymphatics

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6
Q

Most common condition to produce a transudative pleural effusion

A

Congestive heart failure

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7
Q

Unilateral effusion is more common on what side

A

Right

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8
Q

Chf produce unilateral or bilateral PE?

A

Bilateral

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9
Q

Parenchymal infections that typically result in empyema formation are

A

Bacterial pneumonia, septic emboli, lung abscess

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10
Q

Most common causes of parapneumonic effusion and empyema

A

Staph aureus and gram neg pneumonias

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11
Q

Stage of PPE: visceral pleura inflammation causes increased capillary permeability and pleural fluid accumulation

A

Stage 1 exudative

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12
Q

Stage of PPE: develops 2-3 weeks after initial pleural fluid formation and is characterized by ingrowth of fibroblasts over the pleura, which produces pleural fibrosis and entraps lung

A

Stage 3 parapneumonic effusion

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13
Q

Stage of PPE: fibrinopurulent pleural fluid collection containing bacteria and neutrophils.fibrin deposition on the visceral and parietal pleura impairs fluid resorption and produces loculations

A

Stage 2

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14
Q

Effusion in TB are more common in

A

Young adults with pulmonary disease and HIV positive individuals with severe immunodeficiency

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15
Q

Pleural fluid composition in TB

A

Straw colored, greater than 70% lymphocytes and a low glucose concentration

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16
Q

Mechanism of effusion in CHF, parapneumonic efffusion, permeability pulmonary edema, lung transplantation

A

Increased interstitial fluid production

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17
Q

Type of effusion in CHF, PPE, permeability pulmonary edema and lung transplantation

A

Transudate

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18
Q

Mechanism of effusion in LV or RV failure, SVC syndrome, pericardial tamponade

A

Increased hydrostatic pressure

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19
Q

Type of effusion in LV or RV failure, SVC syndrome, pericardial tamponade

A

Transudate

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20
Q

Increased capillary permeability produces what type of effusion

A

Exudative

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21
Q

Mechanism and type of effusion in low protein states

A

Decreased capillary oncotic pressure, transudative

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22
Q

Mechanism and type of effusion in malignancy

A

Impaired fluid resorption, exudative

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23
Q

Elevated systemic venous pressure produces what type of effusion

A

Transudative

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24
Q

On CT, it is elliptic in shape and is seen most often within the posterior (costal pleura) and inferior (subpulmonic) pleural space

A

Empyema

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25
Q

Treatment of empyema

A

External drainage

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26
Q

Treatment for lung abscess

A

Postural drainage and antibiotics

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27
Q

Effusions that have intrinsic high attenuation or the presence of a fluid-fluid level caused by dependent cellular blood elements represents

A

Hemorrhagic effusions

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28
Q

Cardiogenic, hypoproteinemic, myxedematous, cirrhotic and nephrotic syndrome produce what type of effusion

A

Transudative

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29
Q

Infecfion, infarction, neoplasm and inflammation produce what type of effusion

A

Exudative

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30
Q

Tumors most commonly associated with PE

A

Lung carcinoma, breast carcinoma, pelvic tumors, gastric carcinoma and lymphoma

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31
Q

Shape of empyema as compared with lung abscess

A

Empyema- oval; lung abscess- round

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32
Q

Margin of empyema as compared to lung abscess

A

Empyema- thin, smooth (split pleura sign); lung abscess- thick and irregular

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33
Q

Angle with chest wall of empyema as compared to lung abscess

A

Empyema- obtuse; lung abscess- acute

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34
Q

Effect on lung of empyema as compared to lung abscess

A

Empyema- compression; lung abscess- consumption

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35
Q

Hemothorax produce CT attenuation more than

A

80 HU

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36
Q

Acute hemothorax is treated by

A

Thoracostomy tube

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37
Q

Treatment of hemothorax with persistent bleeding or hypotension

A

Thoracotomy

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38
Q

Esophageal perforatjon from prolonged vomiting (boerhaave syndrome) or as complication of esophageal dilatation may produce a pleural effusion, most commonly on what side

A

Left

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39
Q

Elevated salivary amylase levels, low pH within the pleural fluid is diagnostic for

A

Esophageal perforation

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40
Q

PE in SLE is of what type, and is usually associated with

A

Exudative; pleuritic chest pain, cardiomegaly, pericardial effusion, hypertension, renal failure or lupus associated endocarditis or myocarditis

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41
Q

Most common intrathoracic manifestation of RA and is frequently seen in male patients following the onset of joint disease

A

Pleural effusion

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42
Q

True or false: PE in RA may occur independently from pulmonary parenchymal involvement

A

True

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43
Q

Effusions in RA are what type

A

Exudative

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44
Q

True or false: rheumatoid effusions may persist unchanged for years

A

True

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45
Q

Autoimmune syndromes producing pleural or pericardial effusions have been described following

A

Myocardial infarction ( dressler syndrome) or cardiac surgery (postpericardiotomy syndrome)

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46
Q

Autoimmune syndromes (Dressler and postpericardiotomy syndromes) produce what type of effusion

A

Serosanguinous exudative

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47
Q

peritoneal fluid may enter the pleural space via

A

transdiaphragmatic lymphatic channels or through defects in the diaphragm

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48
Q

transdiaphragmatic channels are larger on what side

A

right

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49
Q

effusions caused by acute or chronic pancreatitis are most often on what side

A

left; because of the proximity of the pancreatic tail to the left hemidiaphragm

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50
Q

type of effusion associated with pancreatitis

A

exudative and may be bloody

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51
Q

high concentration of amylase in pleural fluid should suggest what etiology of effusion

A

pancreatitis, malignancy or esophageal perforation

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52
Q

subphrenic abscess, along with diaphragmatic paresis, basilar atelectasis and pleural effusion may be secondary to

A

complicated abdominal surgery or perforation of hollow viscus

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53
Q

pelvic and abdominal tumors that may produce PE

A

ovarian fibroma (Meigs syndrome), pancreatic, lymphoma, uterine leiomyomas

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54
Q

type of effusion in Meigs syndrome

A

transudative; resolves after removal of pelvic tumor

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55
Q

pleural collection containing triglycerides in the form of chylomicrons

A

chylothorax

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56
Q

chylothorax happens due to

A

rupture of thoracic duct contents secondary to malignancy, iatrogenic trauma or TB

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57
Q

thoracic duct originates from

A

cisterna chyli at the level of the first lumbar vertebra and ascends along the right paravertebral space, entering the thorax via the aortic hiatus

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58
Q

thoracic duct inserts at what hiatus

A

aortic hiatus

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59
Q

the thoracic duct ascends and crosses from right to left at the level of

A

T6 alongside the upper esophagus

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60
Q

disruption of the upper thoracic duct caused by direct trauma or obstruction produces effusion on what side

A

left

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61
Q

lower intrathoracic duct rupture produces effusion at what side

A

right

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62
Q

triglyceride levels exceeding 110mg/dL in pleural fluid represents

A

chylothorax

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63
Q

effusion in pulmonary embolism may be associated with elevation of the ipsilateral diaphragm and peripheral wedge-shaped opacities called

A

Hamptom hump

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64
Q

PE characteristics from pulmonary embolism

A

typically small, unilateral, serosanguineous exudate

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65
Q

drugs that may cause PE

A

methysergide, phenytoin, isoniazid, hydralizine, procainamide, nitrofurantoin

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66
Q

characteristics of PE that has a moderate to high risk for poor outcome

A

large, loculated collections with positive gram stains or cultures and pH <7.20

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67
Q

treatment options for parapneumonic effusions

A

intrapleural fibrinolytic therapy using tPA with concomitant DNAse, video-assisted thoracoscopic surgery or thoracotomy with decortication

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68
Q

malignant PE most often require what treatment

A

closed drainage and pleural sclerosis with talc

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69
Q

True or false: talc pleurodesis can cause FDG-PET positive nodularity that is a source of false-negative PET evaluations

A

true

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70
Q

postcardiac injury patients (Dressler syndrome) that developed effusion are treated by

A

NSAIDs

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71
Q

communication between the lung and the pleural space that often originates from a peripheral airway

A

bronchopleural fistula

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72
Q

often develops from dehiscence of a bronchial stump following lobectomy or pneumonectomy, or as a result of a necrotizing pulmonary infection

A

bronchopleural fistulas

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73
Q

etiology of primary spontaneous pneumothorax

A

no identifiable etiology

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74
Q

presents as crescentic nondependent lucency that parallels the chest wall and displaces the visceral pleural line centrally

A

pneumothorax

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75
Q

signs of pneumothorax on supine radiography include

A

hyperlucent upper abdomen (particularly on the right over the normally dense liver), the “deep sulcus” and “double diaphgram” sign, epicardial fat pad sign (for left pneumothorax), and an unusually sharp heart border

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76
Q

most common cause of pneumothorax

A

trauma

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77
Q

2 mechanisms of pneumothorax formation from blunt chest trauma

A

acute increase in intrathoracic pressure results in extra alveolar interstitial air because of alveolar disruption, which tracks peripherally and ruptures into the pleural space; laceration of the tracheobronchial tree

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78
Q

primary spontaneous pneumothorax most often occurs in

A

young or middle aged men, propensity for tall, thin individuals

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79
Q

treatment for primary spontaneous pneumothorax

A

closed tube drainage, thoracoscopic bullectomy

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80
Q

most common etiology for secondary spontaneous pneumothorax

A

COPD

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81
Q

most common malignancies to produce pneumothorax

A

osteogenic sarcoma, lymphoma, germ cell malignancies

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82
Q

most common connective tissue disease producing pneumothorax

A

marfan syndrome; usually from rupture of apical bullae

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83
Q

rare type of recurrent pneumothorax that occurs with menstruation

A

catamenial pneumothorax

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84
Q

age of patients affected by catamenial pneumothorax

A

fourth decade

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85
Q

cause of catamenial pneumothorax

A

cyclical necrosis of pleural endometrial implants which creates an air leak between the lung and pleura

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86
Q

side of predilection of pneumothorax in catamenial pneumothorax

A

right

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87
Q

true or false: catamenial pneumothorax resolves spontaneously

A

true

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88
Q

catamenial pneumothorax is managed by

A

inducing amenorrhea

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89
Q

critical condition that most often results from iatrogenic trauma in mechanically ventilated patients

A

tension pneumothorax

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90
Q

tension pneumothorax results from

A

check-valve pleural defect that allows air to enter but not exit the pleural space

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91
Q

clinical presentation of tension pneumothorax

A

tachypnea, tachycardia, cyanosis, hypotension

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92
Q

true or false: contralateral mediastinal shift from pneumothorax does not invariably indicate tension, since an imbalance in the degree of negative intrapleural pressure can produce shift in the absence of tension. therefore, tension pneumothorax remains a clinical diagnosis

A

true

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93
Q

it is the end result of peripheral parenchymal and pleural inflammatory disease with pneumonia as the most common cause

A

localized pleural thickening

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94
Q

common cause of pleural calcifications

A

prior hemothorax or empyema (TB), pleural fibrosis

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95
Q

pleural calcifcation is most often unilateral and involves the

A

visceral pleura

96
Q

bilateral calcified parietal pleural plaques are often due to

A

asbestos exposure

97
Q

the presence of fluid within calcified pleural layers seen on CT suggests an active empyema and is most often seen in patients with

A

prior TB infection

98
Q

true or false: focal pleural masses are usually benign neoplasms such as lipomas

A

true

99
Q

fat attenuation of what HU is diagnostic for thoracic lipomas

A

-60 to -100 HU

100
Q

uncommon cause of pleural tumor that appears as well-defined, spherical or oblong masses that arise from subpleural mesenchymal cellas and are benign in approximately 80% of cases

A

localized fibrous tumors of pleura

101
Q

these tumors are occasionally attached to the pleura by a narrow pedicle, a finding that is virtually pathognomonic and accounts for changes in intrapleural location occasionally seen with changes in patient positioning

A

localized fibrous tumors of pleura

102
Q

associated conditions with localized fibrous tumors of pleura

A

hypertrophic pulmonary osteoarthropathy and hypoglycemia

103
Q

pleural thickening extending over more tham 1/2 of the costal pleural surface

A

fibrothorax (diffuse pleural fibrosis)

104
Q

most commonly results from resolution of an exudative PE (including asbestos-related effusions), empyema or hemothorax

A

fibrothorax

105
Q

if fibrothorax causes a restrictive ventilatory defect, what is the treatment to restore function to the underlying lung

A

pleurectomy (decortication)

106
Q

irregular or nodular pleural thickening, usually in association with a pleural effusion, may represent a benign or malignant process?

A

malignant

107
Q

malignant tumors with propensity to metastasize to the pleura include

A

adenocarcinomas of the lung, breast, ovary, kidney and GI tract

108
Q

malignant mesothelioma is almost exclusively seen in

A

asbestos exposed individuals

109
Q

malignant pleural disease is most often caused by one of four conditions, namely

A

metastatic adenocarcinoma, invasive thymoma or thymic carcinoma, mesothelioma and rarely lymphoma

110
Q

when pleural thickening is circumferential and nodular, greater than 1 cm in thickness, and/or involves the mediastinal pleura, the disease is likely benign or malignant

A

malignant pleural disease

111
Q

most common benign manifestation of asbestos inhalation

A

pleural plaques

112
Q

how many year from asbestos exposure before plaques develop

A

20-30 years

113
Q

asbestos plaques are found on

A

parietal pleura, most commonly over the diaphragm and lower posterolateral chest wall

114
Q

when viewed en face, calcified plaques from asbestos exposure may appear as geographic areas of opacity that have been likened to a

A

holly leaf

115
Q

plaques from asbestosis if unilateral, is usually on what side

A

left

116
Q

earliest manifestation of asbestosis and occurs 10 to 20 years after the initial exposure

A

pleural effusion

117
Q

may follow asbestos-related pleural effusion or result from the confluence of pleural plaques

A

diffuse pleural thickening

118
Q

appears as smooth thickening of the pleura, involving the lower thorax, with blunting of the costophrenic sulci

A

diffuse pleural thickening

119
Q

dose-related phenomenon in asbestos exposure

A

Pleural effusion

120
Q

true or false: malignant mesothelioma does not appear to be a dose-related phenomenon

A

true

121
Q

fiber type of asbestos that is often implicated in the development of malignant mesothelioma

A

crocidolite

122
Q

3 pathologic types of mesothelioma

A

epithelial, sarcomatous and mixed types

123
Q

most common pathologic form of mesothelioma and is associated with better prognosis

A

epithelial

124
Q

true or false, in mesothelioma, adenopathy is seen in ipsilateral hilum and mediastinum in apprixmately 50% of patients

A

true

125
Q

an autosomal recessive disorder characterized by unilateral absence of sternocostal head of the pectoralis major, ipsilateral syndactyly and rib anomalies

A

Poland syndrome

126
Q

most common organisms responsible for chest wall abscesses

A

staphylococcus and TB

127
Q

lipomas may be intrathoracic or extrathoracic, or they may project partially within and outisde the thorax, called

A

dumbell lipoma

128
Q

most common primary malignant soft tissue neoplasms of the chest wall in adults

A

fibrosarcomas and liposarcomas

129
Q

rare malignant neoplasm arising from the chest wall of children and young adults is _____, which arises from primitive neuroectodermal rests in the chest wall

A

askin tumor

130
Q

most common congenital anomalies of ribs are

A

bony fusion and bifid ribs

131
Q

extremely rare congenital anomalies where an accessory rib arises from a vertebral body or the posterior surface of a rib and extends inferolaterally into the thorax

A

intrathoracic ribs

132
Q

intrathoracic ribs are usually on what side

A

right

133
Q

conditions that are associated with thin, wavy, “ribbon” ribs

A

osteogenesis imperfecta and neurofibromatosis

134
Q

cervical rib arises usually from

A

7th cervical vertebral body

135
Q

happens when the cervical rib or associated fibrous bands compress the subclavian artery, producing secondary ischemic symptoms or compress the subclavian vein and brachial plexus, producing pain, weakness, and swelling of the upper extremity and potentially subclavian vein thrombosis (Paget von Schroetter syndrome)

A

thoracic outlet syndrome

136
Q

treatment for cervical rib causing thoracic outlet syndrome

A

surgical resection

137
Q

much more common rib area of rib notching due to enlargement of one or more of the structures that lie in the subcostal grooves (intercostal nerve, artery or vein)

A

inferior rib notching

138
Q

most common cause of bilateral inferior rib notching is

A

coarctation of the aorta distal to the origin of the left subclavian artery

139
Q

other causes of aortic obstruction that can lead to inferior rib notching aside from coarctation of the aorta

A

aortic thrombosis and Takayasu arteritis

140
Q

most common type of neurofibromatosis that can be a nonvascular cause of inferior rib notching

A

multiple intercostal neurofibromas in NF1

141
Q

associated thoracic findings in neurofibromatosis, aside from rib notching

A

ribbon ribs, thoracic kyphoscoliosis, scalloping of the posterior aspect of vertebral bodies due to dural ectasia

142
Q

most common associated condition with superior rib notching

A

paralysis

143
Q

possible mechanism involved in superior rib notching

A

disturbance in osteoclastic and osteoblastic activity and the stress effect of the intercostal muscles

144
Q

what postion or projection best displays the fracture line in the posterolateral ribs

A

posterior oblique radiographs

145
Q

fracture of these ribs indicate severe trauma and should prompt a careful evaluation for associated great vessel and visceral injury

A

first 3 ribs; because they are well protected by the clavicles, scapulae, shoulder girdles

146
Q

rib fractures at these levels may be associated with injury to the liver or spleen

A

10th, 11th or 12th ribs

147
Q

sever blunt trauma to the rib cage, in which multiple contiguous ribs are fractured in more than one place is termed

A

flail chest

148
Q

results in a free segment of the chest wall that moves paradoxically inward on inspiration and outward on expiration

A

flail chest

149
Q

multiple contiguous healed rib fractures, particularly if bilateral, should suggest

A

chronic alcoholism or a prior MVA

150
Q

bilateral symmetric anterolateral fractures should suggest injury from

A

chest compression during CPR

151
Q

most common site of involvement by monostotic fibrous dysplasia

A

ribs

152
Q

typical appearance is an expansile lesion in the posterior aspect of the rib with a lucent or ground glass density; rarely the lesion is sclerotic

A

monostotic fibrous dysplasia

153
Q

polyostotic fibrous dysplasia can result in

A

severe restrictive pulmonary disease

154
Q

langerhans cell histiocytosis can cause rib lytic lesions at what age group

A

under age 30

155
Q

brown tumors from hyperparathyroidism can also produce what type of rib lesions

A

lytic

156
Q

most common benign neoplasm of ribs

A

osteochondromas

157
Q

other common causes of benign rib neoplasms aside from osteochondromas

A

enchondromas and osteoblastomas

158
Q

most common primary rib malignancy

A

chondrosarcoma

159
Q

myeloma can produce solitary or multiple lytic lesions, and can also cause permeative bone destruction that is indistinguishable from severe osteoporosis. This associated finding is a clue to its diagnosis

A

presence of soft tissue mass

160
Q

most common metastatic lesions to ribs are from

A

lung and breast cancer

161
Q

expansile lytic rib metastases are seen most commonly from

A

renal cell and thyroid carcinoma

162
Q

sclerotic rib metastasis are most commonly seen in

A

breast and prostate carcinoma

163
Q

blastic rib metastasis can be found in

A

lung cancer and carcinoid tumor

164
Q

pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include

A

TB, fungus, actinomycosis and nocardiosis

165
Q

female costal cartilage ossification involves the

A

central portion of the cartilage, extending from the rib toward the sternum in the shape of a solitary finger

166
Q

male costal cartilage ossification involves the

A

peripheral portion of the cartilage and has the appearance of two fingers “peace” sign

167
Q

costal cartilage ossification do not apply in what rib

A

first rib

168
Q

identified when the scapula is superiorly displaced from its normal position and the inferior portion is superiorly displaced from the chest wall

A

winged scapula

169
Q

this deformity typically results from disruption of innervation by the long thoracic nerve to the serratus anterior muscle that helps maintain scapular contact with the chest wall

A

winged scapula

170
Q

metastatic disease to the scapula is recognized by the presence of lytic destructive lesions, which are commonly from

A

lung and breast cancer

171
Q

commonly fracture segment of the clavicle in blunt trauma

A

distal third

172
Q

conditions that can produce erosion of the distal clavicles

A

RA and hyperparathyroidism

173
Q

distal clavicle is sharply defined in what condition, and tapers to a point

A

RA

174
Q

distal clavicle is often indistinct and irregular in what condition

A

hyperparathyroidism

175
Q

primary malignant neoplasms of the clavicle

A

Ewing or osteogenic sarcoma

176
Q

osteomyelitis of the clavicle is uncommon, and is most often seen in

A

IV drug users

177
Q

chronic anemia from thalassemia major or sickle disease may result in what manifestations in the thoracic cavity

A

prevertebral or paravertebral masses of extramedullary hematopoiesis, which represent herniated hyperplastic bone marrow

178
Q

produces characteristic appearance of H-shaped or “Lincoln log” vertebrae on lateral radiographs that is pathognomonic of this disease

A

sickle cell anemia

179
Q

“rugger jersey” appearance to the thoracic spine on lateral chest films suggests

A

renal osteosclerosis

180
Q

funnel chest

A

pectus excavatum

181
Q

pigeon breast

A

pectus carinatum

182
Q

sternum is inwardly depressed and the ribs protrude anterior to the sternum

A

pectus excavatum

183
Q

chest wall deformity commonly associated with congenital connective tissue disorders such as Marfan syndrome, Poland syndrome, osteogenesis imperfecta and congenital scoliosis

A

Pectus excavatum

184
Q

some patients with pectus deformities and systolic murmurs have

A

mitral valve prolapse

185
Q

a chest wall deformity wherein the heart is displaced to the left and the combination of the depressed soft tissues of the anterior chest wall and the vertically oriented anterior ribs results in loss of the right heart border

A

pectus excavatum

186
Q

outward bowing of the sternum that may be congenital or acquired

A

pectus carinatum

187
Q

congenital form of pectus carinatum is commonly seen in what gender

A

boys, in families with a history of chest wall deformities or scoliosis

188
Q

account for the majority of acquired cases of pectus carinatum include

A

congenital atrial or ventricular septal defects and severe childhood asthma

189
Q

most common sternal abnormality seen

A

prior median sternotomy

190
Q

true or false, the vertical lucency representing sternotomy may heal, but in many patients bony union does not occur

A

true

191
Q

results from congenital absence, underdevelopment or atrophy of the diaphragmatic musculature

A

unilateral diaphragmatic elevation

192
Q

common cause of diaphragmatic paralysis in male patients and is usually at what side

A

viral neuritis, right

193
Q

positive fluoroscopic or ultrasonographic sniff test is diagnostic for

A

diaphragmatic paralysis

194
Q

possible causes of bilateral phrenic disruption causing bilateral diaphragmatic paralysis

A

cervical cord injury, multiple myeloma, myopathy associated with SLE

195
Q

3 types of nontraumatic diaphragmatic hernias

A

esophageal hiatal hernia, bochdalek and morgagni

196
Q

most common form of nontraumatic diaphragmatic hernia

A

esophageal hiatal hernia

197
Q

represents herniation of a portion of the stomach through the esophageal hiatus

A

hiatal hernia

198
Q

defect in the hemidiaphragm at the site of embryonic pleuroperitoneal canal

A

bochdalek hernia

199
Q

a defect in the parasternal portion of the diaphragm

A

morgagni hernia

200
Q

diagnostic finding for morgagni hernia

A

presence of omental vessels within a fatty paracardiac mass

201
Q

traumatic hernia affects most commonly what side

A

left

202
Q

resultant narrowing or “waist” of the herniated intestive as it traverses the diaphragmatic defect differentiates a hernia from

A

simple diaphragmatic elevation

203
Q

most common primary malignant diaphragmatic lesion

A

fibrosarcomas

204
Q

represent anomalous outpouchings of the primitive foregut that no longer communicate with the tracheobronchial tree

A

bronchogenic cysts

205
Q

congenital abnromality resulting from the independent development of a portion of the tracheobronchial tree that is isolated from the normal lung and maintains its fetal systemic arterial supply

A

bronchopulmonary sequestration

206
Q

form of pulmonary sequestration that is contained within the visceral pleura of the normal lung

A

intralobar sequestration

207
Q

form of pulmonary sequestration that is enclosed by its own visceral pleural envelope and may be found adjacent to the normal lung or within or below the diaphragm

A

extralobar sequestration

208
Q

more common form of pulmonary sequestration

A

intralobar

209
Q

most patients with this type of pulmonary sequestration present with pneumonia

A

intralobar

210
Q

majority of extralobar sequestration are on what side

A

left

211
Q

majority of intralobar sequestration are on what side

A

right

212
Q

intralobar sequestration is supplied by

A

a single large artery that arises from the infradiaphragmatic aorta and enters the sequestered lung via the pulmonary veins, systemic venous drainage can also occur

213
Q

extralobar sequestration is supplied by

A

several small branches from the systemic and occasionally pulmonary arteries, with venous drainage into the systemic venous system (IVC, azygos or hemiazygos veins)

214
Q

definitive diagnosis is made by the demonstration of abnormal systemic arterial supply to the abnormal lung, which is usually accomplished by CT angiography

A

sequestration

215
Q

variant of hypoplastic lung, characterized by an underdeveloped right lung with abnormal venous drainage of the lung to the IVC just above or below the right hemidiaphragm or eventration, dextroposition of heart and herniation of left lung anteriorly into the right hemithorax

A

hypogenetic lung syndrome/scimitar syndrome

216
Q

a disease that is present in approximately 80% of all patients with pulmonary AVMs

A

Osler-Weber-Rendu disease

217
Q

pulmonary AVMs usually shows a solitary pulmonary nodule, in what part of the lung

A

subpleural portions of lower lobes

218
Q

pulmonary contusion opacities stabilizes by ___ hours

A

24 hours

219
Q

improvement in pulmonary contusion happens within how many days

A

2 to 7 days

220
Q

progressive opacities seen more than 48 hours after trauma should raise the suspicion of

A

aspiration pneumonia or developing ARDS

221
Q

what property of the lung quickly transforms the linear laceration of the lung into a round air cyst

A

elastic properties

222
Q

air cysts that result from a check-valve overdistention of the distal lung

A

pneumatocele

223
Q

massive aspiration of gastric contents

A

Mendelson syndrome

224
Q

3 basic radiographic patterns of aspiration pneumonitis

A

extensive bilateral airspace opacification, diffuse but discrete airspace nodular opacities and irregular parenchymal opacities that are not obviously airspace filling in nature

225
Q

aspiration pneumonitis are most often unilateral or bilateral and in what lobes

A

bilateral, predilection for the basal and perihilar regions, usually posterior and segmental

226
Q

radiation induced lung injury are most often seen in 3 clinical situations

A

treated for unresectable lung cancer, treatment of mediastinal lymphoma or thymoma, patients treated for stage I to stage IIIa breast cancer

227
Q

most radiation treatment is limited to ____, as an equivalent dose administered to an entire lung or both lungs would cause serious lung injury

A

1/3 to 1/2 of the lung

228
Q

doses under ___ Gy rarely produce lung injury

A

under 20 Gy

229
Q

doses exceeding ___ Gy, particularly if administered to a significant portion of the lungs, have a significant incidence of radiation pneumonitis

A

30 Gy

230
Q

acute effects of radiation pneumonitis

A

injury to capillary endothelial and pulmonary epithelial cells that line the alveoli

231
Q

develops 4 to 12 weeks following completion of radiation therapy

A

diffuse alveolar damage which produces a cellular, proteinaceous intra-alveolar exudate and hyaline membranes that is indistinguishable histologically from ARDS

232
Q

sharply marginated, localized area of airspace opacification that does not conform to lobar or segmental anatomic boundaries and directly corresponds to radiation port represent

A

radiation pneumonitis

233
Q

radiation pneumonitis produces what type of atelectasis due to loss of surfactant by the damaged type 2 pneumocytes

A

adhesive atelectasis

234
Q

radiation fibrosis appears as

A

coarse linear opacities or occasionally as homogeneous parenchymal opacity with severe cicatrizing atelectasis of the involved poriton of nlung

235
Q

Fibrotic tissue in T2W MR sequence appears

A

low in signal; distinguishes it from recurrent tumor which has high signal

236
Q

bronchiolar lavage aspirate findings in radiation pneumonitis

A

increased number of lymphocytes and absence of malignant cells

Chest Imaging (9 decks)

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