Pleura, chest wall, diaphragm and miscellaneous chest disorders Flashcards
Parietal and visceral pleura meet at the
Hila
Thin double layered fold at the medial lung base inferior to the inferior pulmonary veins termed the
Pulmonary ligament
Normal amount of fluid in the pleural space
2-5 ml
Formation of pleural fluid follows
Starling law and depends upon hydrostatic and oncotic forces in both systemic capillaries of the parietal pleura and pleural space
Under normal conditions, pleural fluid is formed by
Filtration from systemic capillaries in the parietal pleura and resorbed via parietal pleural lymphatics
Most common condition to produce a transudative pleural effusion
Congestive heart failure
Unilateral effusion is more common on what side
Right
Chf produce unilateral or bilateral PE?
Bilateral
3 Parenchymal infections that typically result in empyema formation are
Bacterial pneumonia,
septic emboli,
lung abscess
2 Most common causes of parapneumonic effusion and empyema
Staph aureus and gram neg pneumonias
Stage of PPE: visceral pleura inflammation causes increased capillary permeability and pleural fluid accumulation
Stage 1 exudative
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
Stage 3 parapneumonic effusion
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
Stage 2
Effusion in TB are more common in what group of people?
Young adults with pulmonary disease and HIV positive individuals with severe immunodeficiency
Pleural fluid composition in TB
Straw colored, greater than 70% lymphocytes and a low glucose concentration
Mechanism of effusion in CHF, parapneumonic efffusion, permeability pulmonary edema, lung transplantation
Increased interstitial fluid production
Type of effusion in CHF, PPE, permeability pulmonary edema and lung transplantation
Transudate
Mechanism of effusion in LV or RV failure, SVC syndrome, pericardial tamponade
Increased hydrostatic pressure
Type of effusion in LV or RV failure, SVC syndrome, pericardial tamponade
Transudate
Increased capillary permeability produces what type of effusion
Exudative
Mechanism and type of effusion in low protein states
Decreased capillary oncotic pressure, transudative
Mechanism and type of effusion in malignancy
Impaired fluid resorption, exudative
Elevated systemic venous pressure produces what type of effusion
Transudative
On CT, it is elliptic in shape and is seen most often within the posterior (costal pleura) and inferior (subpulmonic) pleural space
Empyema
Treatment of empyema
External drainage
Treatment for lung abscess
Postural drainage and antibiotics
Effusions that have intrinsic high attenuation or the presence of a fluid-fluid level caused by dependent cellular blood elements represents
Hemorrhagic effusions
Cardiogenic, hypoproteinemic, myxedematous, cirrhotic and nephrotic syndrome produce what type of effusion
Transudative
Infecfion, infarction, neoplasm and inflammation produce what type of effusion
Exudative
6 Tumors most commonly associated with PE (in order)
Lung carcinoma > breast carcinoma > pelvic tumor > gastric cancer > lymphoma
Shape of empyema as compared with lung abscess
Empyema- oval; lung abscess- round
Margin of empyema as compared to lung abscess
Empyema- thin, smooth (split pleura sign); lung abscess- thick and irregular
Angle with chest wall of empyema as compared to lung abscess
Empyema- obtuse; lung abscess- acute
Effect on lung of empyema as compared to lung abscess
Empyema- compression; lung abscess- consumption
Hemothorax produce CT attenuation more than
80 HU
Acute hemothorax is treated by
Thoracostomy tube
Treatment of hemothorax with persistent bleeding or hypotension
Thoracotomy
Esophageal perforatjon from prolonged vomiting (boerhaave syndrome) or as complication of esophageal dilatation may produce a pleural effusion, most commonly on what side
Left
Elevated salivary amylase levels, low pH within the pleural fluid is diagnostic for
Esophageal perforation
PE in SLE is of what type, and is usually associated with (7)
Exudative;
pleuritic chest pain, cardiomegaly, pericardial effusion, hypertension, renal failure or lupus associated endocarditis or myocarditis
Most common intrathoracic manifestation of RA and is frequently seen in male patients following the onset of joint disease
Pleural effusion
True or false: PE in RA may occur independently from pulmonary parenchymal involvement
True
Effusions in RA are what type
Exudative
True or false: rheumatoid effusions may persist unchanged for years
True
Autoimmune syndromes producing pleural or pericardial effusions have been described following
Myocardial infarction ( dressler syndrome) or cardiac surgery (postpericardiotomy syndrome)
Autoimmune syndromes (Dressler and postpericardiotomy syndromes) produce what type of effusion
Serosanguinous exudative
peritoneal fluid may enter the pleural space via
transdiaphragmatic lymphatic channels or through defects in the diaphragm
transdiaphragmatic channels are larger on what side
right
effusions caused by acute or chronic pancreatitis are most often on what side
left; because of the proximity of the pancreatic tail to the left hemidiaphragm
type of effusion associated with pancreatitis
exudative and may be bloody
high concentration of amylase in pleural fluid should suggest what etiology of effusion
pancreatitis, malignancy or esophageal perforation
subphrenic abscess, along with diaphragmatic paresis, basilar atelectasis and pleural effusion may be secondary to
complicated abdominal surgery or perforation of hollow viscus
pelvic and abdominal tumors that may produce PE
- ovarian fibroma (Meigs syndrome),
- pancreatic,
- lymphoma,
- uterine leiomyomas
type of effusion in Meigs syndrome
transudative; resolves after removal of pelvic tumor
pleural collection containing triglycerides in the form of chylomicrons
chylothorax
chylothorax happens due to
rupture of thoracic duct contents secondary to malignancy, iatrogenic trauma or TB
thoracic duct originates from
cisterna chyli at the level of the first lumbar vertebra and ascends along the right paravertebral space, entering the thorax via the aortic hiatus
thoracic duct inserts at what hiatus
aortic hiatus
the thoracic duct ascends and crosses from right to left at the level of
T6 alongside the upper esophagus
disruption of the upper thoracic duct caused by direct trauma or obstruction produces effusion on what side
left
lower intrathoracic duct rupture produces effusion at what side
right
triglyceride levels exceeding 110mg/dL in pleural fluid represents
chylothorax
effusion in pulmonary embolism may be associated with elevation of the ipsilateral diaphragm and peripheral wedge-shaped opacities called
Hamptom hump
PE characteristics from pulmonary embolism
typically small, unilateral, serosanguineous exudate
drugs that may cause PE
Pleural inflammation •Methysergide Lupus-like syndrome (HIPP) •Phenytoin •Isoniazid •Hydralazine •Procainamide Nitrofurantoin – a pleuropulmonary disease with eosinophilia
characteristics of PE that has a moderate to high risk for poor outcome
large, loculated collections with positive gram stains or cultures and pH <7.20
treatment options for parapneumonic effusions
- intrapleural fibrinolytic therapy using tPA with concomitant DNAse,
- video-assisted thoracoscopic surgery or thoracotomy with decortication
malignant PE most often require what treatment
closed drainage and pleural sclerosis with talc
True or false: talc pleurodesis can cause FDG-PET positive nodularity that is a source of false-negative PET evaluations
true
postcardiac injury patients (Dressler syndrome) that developed effusion are treated by
NSAIDs
communication between the lung and the pleural space that often originates from a peripheral airway
bronchopleural fistula
often develops from dehiscence of a bronchial stump following lobectomy or pneumonectomy, or as a result of a necrotizing pulmonary infection
bronchopleural fistulas
etiology of primary spontaneous pneumothorax
no identifiable etiology
presents as crescentic nondependent lucency that parallels the chest wall and displaces the visceral pleural line centrally
pneumothorax
signs of pneumothorax on supine radiography include
Non-dependently and indiscernible increased lucency over the lower thorax and upper abdomen Hyper lucent upper abdomen Deep sulcus sign Double diaphragm sign Epicardial fat pad sign Unusually sharp heart border
oUpright radiography
Non-dependent lucency that parallel the chest wall and displaces the visceral pleural line medially
most common cause of pneumothorax
trauma
2 mechanisms of pneumothorax formation from blunt chest trauma
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
primary spontaneous pneumothorax most often occurs in
young or middle aged men, propensity for tall, thin individuals
treatment for primary spontaneous pneumothorax
closed tube drainage, thoracoscopic bullectomy
most common etiology for secondary spontaneous pneumothorax
COPD
most common malignancies to produce pneumothorax
sarcomas
osteogenic sarcoma, lymphoma, germ cell malignancies
most common connective tissue disease producing pneumothorax
marfan syndrome; usually from rupture of apical bullae
rare type of recurrent pneumothorax that occurs with menstruation
catamenial pneumothorax
age of patients affected by catamenial pneumothorax
fourth decade
cause of catamenial pneumothorax
cyclical necrosis of pleural endometrial implants which creates an air leak between the lung and pleura
side of predilection of pneumothorax in catamenial pneumothorax
right
true or false: catamenial pneumothorax resolves spontaneously
true
catamenial pneumothorax is managed by
inducing amenorrhea
critical condition that most often results from iatrogenic trauma in mechanically ventilated patients
tension pneumothorax
tension pneumothorax results from
check-valve pleural defect that allows air to enter but not exit the pleural space
4 clinical presentation of tension pneumothorax
tachypnea,
tachycardia,
cyanosis,
hypotension
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
true
it is the end result of peripheral parenchymal and pleural inflammatory disease with pneumonia as the most common cause
localized pleural thickening
common cause of pleural calcifications
prior hemothorax or empyema (TB), pleural fibrosis
pleural calcifcation is most often unilateral and involves the
visceral pleura
bilateral calcified parietal pleural plaques are often due to
asbestos exposure
the presence of fluid within calcified pleural layers seen on CT suggests an active empyema and is most often seen in patients with
prior TB infection
true or false: focal pleural masses are usually benign neoplasms such as lipomas
true
fat attenuation of what HU is diagnostic for thoracic lipomas
-60 to -100 HU
an uncommon cause of pleural tumor that appears as well-defined, spherical or oblong masses that arise from subpleural mesenchymal cells and are benign in approximately 80% of cases
localized fibrous tumors of pleura
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
sharply defined soft tissue mass with tapered obtuse margins
localized fibrous tumors of pleura
associated conditions with localized fibrous tumors of pleura
hypertrophic pulmonary osteoarthropathy and hypoglycemia
pleural thickening extending over more than 1/4 of the costal pleural surface
fibrothorax (diffuse pleural fibrosis)
most commonly results from resolution of an exudative PE (including asbestos-related effusions), empyema or hemothorax
fibrothorax
if fibrothorax causes a restrictive ventilatory defect, what is the treatment to restore function to the underlying lung
pleurectomy (decortication)
irregular or nodular pleural thickening, usually in association with a pleural effusion, may represent a benign or malignant process?
malignant
5 malignant tumors with propensity to metastasize to the pleura include
adenocarcinomas of the lung, breast, ovary, kidney and GI tract
KBLOG
malignant mesothelioma is almost exclusively seen in
asbestos exposed individuals
malignant pleural disease is most often caused by one of four conditions, namely
metastatic adenocarcinoma,
invasive thymoma or thymic carcinoma,
mesothelioma and
rarely lymphoma
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
malignant pleural disease
most common benign manifestation of asbestos inhalation
pleural plaques
how many year from asbestos exposure before plaques develop
20-30 years
asbestos plaques are found on
parietal pleura, most commonly over the diaphragm and lower posterolateral chest wall
when viewed en face, calcified plaques from asbestos exposure may appear as geographic areas of opacity that have been likened to a
holly leaf
plaques from asbestosis if unilateral, is usually on what side
left
earliest manifestation of asbestosis and occurs 10 to 20 years after the initial exposure
pleural effusion
may follow asbestos-related pleural effusion or result from the confluence of pleural plaques
diffuse pleural thickening
appears as smooth thickening of the pleura, involving the lower thorax, with blunting of the costophrenic sulci
diffuse pleural thickening
dose-related phenomenon in asbestos exposure
Pleural effusion
true or false: malignant mesothelioma does not appear to be a dose-related phenomenon
true
fiber type of asbestos that is often implicated in the development of malignant mesothelioma
crocidolite
3 pathologic types of mesothelioma
epithelial, sarcomatous and mixed types
most common pathologic form of mesothelioma and is associated with better prognosis
epithelial
true or false, in mesothelioma, adenopathy is seen in ipsilateral hilum and mediastinum in apprixmately 50% of patients
true
an autosomal recessive disorder characterized by unilateral absence of sternocostal head of the pectoralis major, ipsilateral syndactyly and rib anomalies
Poland syndrome
2 most common organisms responsible for chest wall abscesses
staphylococcus and TB
lipomas may be intrathoracic or extrathoracic, or they may project partially within and outisde the thorax, called
dumbell lipoma
most common primary malignant soft tissue neoplasms of the chest wall in adults
fibrosarcomas and liposarcomas
rare malignant neoplasm arising from the chest wall of children and young adults is _____, which arises from primitive neuroectodermal rests in the chest wall
askin tumor
most common congenital anomalies of ribs are
bony fusion and bifid ribs
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
intrathoracic ribs
intrathoracic ribs are usually on what side
right
conditions that are associated with thin, wavy, “ribbon” ribs
osteogenesis imperfecta and neurofibromatosis
cervical rib arises usually from
7th cervical vertebral body
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)
thoracic outlet syndrome
treatment for cervical rib causing thoracic outlet syndrome
surgical resection
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)
inferior rib notching
most common cause of bilateral inferior rib notching is
coarctation of the aorta distal to the origin of the left subclavian artery
2 other causes of aortic obstruction that can lead to inferior rib notching aside from coarctation of the aorta
aortic thrombosis and Takayasu arteritis
most common type of neurofibromatosis that can be a nonvascular cause of inferior rib notching
multiple intercostal neurofibromas in NF1
associated thoracic findings in neurofibromatosis, aside from rib notching
ribbon ribs, thoracic kyphoscoliosis, scalloping of the posterior aspect of vertebral bodies due to dural ectasia
most common associated condition with superior rib notching
paralysis
possible mechanism involved in superior rib notching
disturbance in osteoclastic and osteoblastic activity and the stress effect of the intercostal muscles
what postion or projection best displays the fracture line in the posterolateral ribs
posterior oblique radiographs
fracture of these ribs indicate severe trauma and should prompt a careful evaluation for associated great vessel and visceral injury
first 3 ribs; because they are well protected by the clavicles, scapulae, shoulder girdles
rib fractures at these levels may be associated with injury to the liver or spleen
10th, 11th or 12th ribs
sever blunt trauma to the rib cage, in which multiple contiguous ribs are fractured in more than one place is termed
flail chest
results in a free segment of the chest wall that moves paradoxically inward on inspiration and outward on expiration
flail chest
multiple contiguous healed rib fractures, particularly if bilateral, should suggest
chronic alcoholism or a prior MVA
bilateral symmetric anterolateral fractures should suggest injury from
chest compression during CPR
most common site of involvement by monostotic fibrous dysplasia
ribs
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
monostotic fibrous dysplasia
polyostotic fibrous dysplasia can result in
severe restrictive pulmonary disease
langerhans cell histiocytosis can cause rib lytic lesions at what age group
under age 30
brown tumors from hyperparathyroidism can also produce what type of rib lesions
lytic
most common benign neoplasm of ribs
osteochondromas
2 other common causes of benign rib neoplasms aside from osteochondromas
enchondromas and osteoblastomas
most common primary rib malignancy
chondrosarcoma
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
presence of soft tissue mass
most common metastatic lesions to ribs are from
lung and breast cancer
expansile lytic rib metastases are seen most commonly from (2)
renal cell and thyroid carcinoma
sclerotic rib metastasis are most commonly seen in
breast and prostate carcinoma
blastic rib metastasis can be found in
lung cancer and carcinoid tumor
4 pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include
TB,
fungus,
actinomycosis and
nocardiosis
TFAN
female costal cartilage ossification involves the
central portion of the cartilage, extending from the rib toward the sternum in the shape of a solitary finger
male costal cartilage ossification involves the
peripheral portion of the cartilage and has the appearance of two fingers “peace” sign
costal cartilage ossification do not apply in what rib
first rib
identified when the scapula is superiorly displaced from its normal position and the inferior portion is superiorly displaced from the chest wall
winged scapula
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
winged scapula
metastatic disease to the scapula is recognized by the presence of lytic destructive lesions, which are commonly from (2)
lung and breast cancer
commonly fracture segment of the clavicle in blunt trauma
distal third
2 conditions that can produce erosion of the distal clavicles
RA and hyperparathyroidism
distal clavicle is sharply defined in what condition, and tapers to a point
RA
distal clavicle is often indistinct and irregular in what condition
hyperparathyroidism
primary malignant neoplasms of the clavicle
Ewing or osteogenic sarcoma
osteomyelitis of the clavicle is uncommon, and is most often seen in
IV drug users
chronic anemia from thalassemia major or sickle disease may result in what manifestations in the thoracic cavity
prevertebral or paravertebral masses of extramedullary hematopoiesis, which represent herniated hyperplastic bone marrow
produces characteristic appearance of H-shaped or “Lincoln log” vertebrae on lateral radiographs that is pathognomonic of this disease
sickle cell anemia
“rugger jersey” appearance to the thoracic spine on lateral chest films suggests
renal osteosclerosis
funnel chest
pectus excavatum
pigeon breast
pectus carinatum
sternum is inwardly depressed and the ribs protrude anterior to the sternum
pectus excavatum
chest wall deformity commonly associated with congenital connective tissue disorders such as Marfan syndrome, Poland syndrome, osteogenesis imperfecta and congenital scoliosis
Pectus excavatum
some patients with pectus deformities and systolic murmurs have
mitral valve prolapse
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
pectus excavatum
outward bowing of the sternum that may be congenital or acquired
pectus carinatum
congenital form of pectus carinatum is commonly seen in what gender
boys, in families with a history of chest wall deformities or scoliosis
account for the majority of acquired cases of pectus carinatum include
congenital atrial or ventricular septal defects and severe childhood asthma
most common sternal abnormality seen
prior median sternotomy
true or false, the vertical lucency representing sternotomy may heal, but in many patients bony union does not occur
true
results from congenital absence, underdevelopment or atrophy of the diaphragmatic musculature
unilateral diaphragmatic elevation
common cause of diaphragmatic paralysis in male patients and is usually at what side
viral neuritis, right
positive fluoroscopic or ultrasonographic sniff test is diagnostic for
diaphragmatic paralysis
3 possible causes of bilateral phrenic disruption causing bilateral diaphragmatic paralysis
cervical cord injury,
multiple myeloma,
myopathy associated with SLE
3 types of nontraumatic diaphragmatic hernias
esophageal hiatal hernia, bochdalek and morgagni
most common form of nontraumatic diaphragmatic hernia
esophageal hiatal hernia
represents herniation of a portion of the stomach through the esophageal hiatus
hiatal hernia
defect in the hemidiaphragm at the site of embryonic pleuroperitoneal canal
bochdalek hernia
a defect in the parasternal portion of the diaphragm
morgagni hernia
diagnostic finding for morgagni hernia
presence of omental vessels within a fatty paracardiac mass
traumatic hernia affects most commonly what side
left
resultant narrowing or “waist” of the herniated intestine as it traverses the diaphragmatic defect differentiates a hernia from
simple diaphragmatic elevation
most common primary malignant diaphragmatic lesion
fibrosarcomas
represent anomalous outpouchings of the primitive foregut that no longer communicate with the tracheobronchial tree
bronchogenic cysts
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
bronchopulmonary sequestration
form of pulmonary sequestration that is contained within the visceral pleura of the normal lung
intralobar sequestration
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
extralobar sequestration
more common form of pulmonary sequestration
intralobar
most patients with this type of pulmonary sequestration present with pneumonia
intralobar
majority of extralobar sequestration are on what side
left
majority of intralobar sequestration are on what side
right
intralobar sequestration is supplied by
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
extralobar sequestration is supplied by
several small branches from the systemic and occasionally pulmonary arteries, with venous drainage into the systemic venous system (IVC, azygos or hemiazygos veins)
definitive diagnosis is made by the demonstration of abnormal systemic arterial supply to the abnormal lung, which is usually accomplished by CT angiography
sequestration
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
hypogenetic lung syndrome/scimitar syndrome
a disease that is present in approximately 80% of all patients with pulmonary AVMs
Osler-Weber-Rendu disease
pulmonary AVMs usually shows a solitary pulmonary nodule, in what part of the lung
subpleural portions of lower lobes
pulmonary contusion opacities stabilizes by ___ hours
24 hours
improvement in pulmonary contusion happens within how many days
2 to 7 days
progressive opacities seen more than 48 hours after trauma should raise the suspicion of
aspiration pneumonia or developing ARDS
what property of the lung quickly transforms the linear laceration of the lung into a round air cyst
elastic properties
air cysts that result from a check-valve overdistention of the distal lung
pneumatocele
massive aspiration of gastric contents
Mendelson syndrome
3 basic radiographic patterns of aspiration pneumonitis
extensive bilateral airspace opacification,
diffuse but discrete airspace nodular opacities and
irregular parenchymal opacities that are not obviously airspace filling in nature
aspiration pneumonitis are most often unilateral or bilateral and in what lobes
bilateral, predilection for the basal and perihilar regions, usually posterior and segmental
radiation induced lung injury are most often seen in 3 clinical situations
treated for unresectable lung cancer,
treatment of mediastinal lymphoma or thymoma,
patients treated for stage I to stage IIIa breast cancer
most radiation treatment is limited to ____, as an equivalent dose administered to an entire lung or both lungs would cause serious lung injury
1/3 to 1/2 of the lung
doses under ___ Gy rarely produce lung injury
under 20 Gy
doses exceeding ___ Gy, particularly if administered to a significant portion of the lungs, have a significant incidence of radiation pneumonitis
30 Gy
acute effects of radiation pneumonitis
injury to capillary endothelial and pulmonary epithelial cells that line the alveoli
develops 4 to 12 weeks following completion of radiation therapy
diffuse alveolar damage which produces a cellular, proteinaceous intra-alveolar exudate and hyaline membranes that is indistinguishable histologically from ARDS
sharply marginated, localized area of airspace opacification that does not conform to lobar or segmental anatomic boundaries and directly corresponds to radiation port represent
radiation pneumonitis
radiation pneumonitis produces what type of atelectasis due to loss of surfactant by the damaged type 2 pneumocytes
adhesive atelectasis
radiation fibrosis appears as
coarse linear opacities or occasionally as homogeneous parenchymal opacity with severe cicatrizing atelectasis of the involved portion of lung
Fibrotic tissue in T2W MR sequence appears
low in signal; distinguishes it from recurrent tumor which has high signal
bronchiolar lavage aspirate findings in radiation pneumonitis
increased number of lymphocytes and absence of malignant cells
