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Chest Imaging > Pulmonary Infection > Flashcards

Pulmonary Infection Flashcards

1
Q

Most host defense mechanisms in the airways exist at what levels

A

Pharynx, trachea, central bronchi

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2
Q

Once the organisms penetrate the lung parenchyma, what is or are activated? Cellular immunity? Humoral? Or both?

A

Both

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3
Q

3 potential routes responsible for producing pneumonia

A

Via the tracheobronchial tree, pulmonary vasculature or via direct spread from infection in the mediastinum, chest wall or upper abdomen

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4
Q

3 radiographic patterns of pneumonia

A

Lobar pneumonia, lobular or bronchopneumonia, atypical pneumonia

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5
Q

Typical of pneumococcal pulmonary infection. In this pattern of disease, the inflammatory exudate begins within the distal airspaces

A

Lobar pneumonia

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6
Q

Inflammatory process (pathophysiology) in lobar pneumonia

A

Spreads via the pores of Kohn and canals of Lambert to produce nonsegmental consolidation

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7
Q

Most common pattern of disease and is most typical of staphylococcal pneumonia

A

Bronchopneumonia

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8
Q

Radiographically, at appears as multifocal opacities that are roughly lobular in configuration produce a “patchwork quilt” appearance because of the interspersion of normal and diseased lobules

A

Bronchopneumonia

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9
Q

In the early stages of bronchopneumonia, the inflammation is centered primarily

A

In and around lobular bronchi

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10
Q

Pattern of pneumonia most often the result of viral and mycoplasma pulmonary infection, there is inflammatory thickening of bronchiolar and alveolar walls and pulmonary interstitium

A

Atypical pneumonia

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11
Q

Segmental and subsegmental atelectasis from small airways obstruction is common in this pattern of pneumonia

A

Atypical pneumonia

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12
Q

At what part of the lungs is severely affected by hematogeneous spread of infection

A

Lung bases

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13
Q

Patterns of disease in strep pneumoniae, legionella, klebsiella and haemophilis influenzae

A

Lobar/sublobar consolidation and air bronchograms

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14
Q

Patterns of disease in staph aureus, pseudomonas, e. Coli, anaerobes, actinomyces

A

Lobular/patchy consolidation, absence of air bronchograms, bronchial wall thickening

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15
Q

Pattern of disease in mycoplasma and chlamydia

A

Ill-defined nodular/patchy opacities, reticular opacities, bronchial wall thickening

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16
Q

Pattern of disease in nocardia

A

Nodules/masses and consolidation

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17
Q

Pathogen common in elderly, alcoholics, compromised hosts, sickle disease and patients who had undergone splenectomy

A

Streptococcus pneumonia

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18
Q

Pathogen of pneumonia that tends to begin in the lower lobes or the posterior segments of upper lobes

A

Pneumococcal pneumonia

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19
Q

2 forms of tb that are recognized clinically and radiographically

A

Primary tb and postprimary or reactivation disease

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20
Q

Tuberculosis differs from normal response to bacterial organism, in that it involves

A

Cell-mediated immunity (delayed hypersensitivity)

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21
Q

typical radiographic appearance of acute pneumococcal pneumonia

A

lobar consolidation

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22
Q

cavitation in pneumococcal pneumonia is rare, with the exception of infections caused by what serotype

A

serotype 3

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23
Q

important cause of nosocomial pneumonia, and typically affects debilitated patients

A

staphylococcus aureus

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24
Q

pathogen responsible for hematogeneous spread to the lungs in patients with endocarditis or indwelling catheters and IV drug users

A

staph aureus

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25
Q

bilateral bronchopneumonia which may be complicated with abscess are usually seen in what pathogen

A

staph aureus

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26
Q

pneumatoceles are common in what pathogen

A

staph aureus

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27
Q

pneumatoceles may be distinguished from abscesses by what features

A

thin walls, rapid change in size, tendency to develop during late phase of staph aureus infection

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28
Q

pleural effusion is common in staph pneumonia or uncommon?

A

common, that may rapidly result in epyema

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29
Q

gram neg bacteria that are most often responsible for pneumonia

A

enterobacteriaceae family (e.coli, klebsiella, proteus, serratia), pseudomonas, haemophilus influenzae, legionella

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30
Q

gram neg pneumonia that occurs predominantly in older alcoholic men and debilitated hospitalized patients. appears as a homogeneous lobar opacification containing air bronchograms

A

Klebsiella pneumoniae

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31
Q

These features, when present, can held distinguish klebsiella pneumonia from pneumococcal pneumonia

A
  • volume of involved lobe may be increased by the exuberant inflammatory exudate, producing a bulging interlobar fissure
  • abscess may develop, with cavity formation, which is uncommon with pneumococcal pneumonia
  • incidence of pleural effusion and empyema is higher
  • pulmonary gangrene, however, rare
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32
Q

most common pathogen of pneumonia in patients with COPD, alcoholism, DM and those with an anatomic functional splenectomy

A

Haemophilus influenzae

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33
Q

Most often cause bronchitis, atho it may extend to produce bilateral lower lobe bronchopneumonia

A

Haemophilus influenzae

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34
Q

pneumonia that most often affects debilitated patients, particularly those requiring mech ventilation

A

pseudomonas aeruginosa

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35
Q

presents as patchy opacities with abscess formation, which mimic staphylococcal pneumonia, are common when the infection reaches the lung via the tracheobronchial tree. pleural effusion are common and are usually small

A

pseudomonas aeruginosa

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36
Q

gram neg bacillus commonly found in air conditioning and humidifier systems

A

legionella pneumonia

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37
Q

characteristic radiographic pattern is airspace opacification, which is initially peripheral and sublobar. In some patients, the airspace opacities appear as round pneumonia. The infection progresses to lobar or multilobar involvement despite the initiation of antibiotic therapy. At peak of disease, parenchymal involvement is usually bilateral

A

legionella pneumonia

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38
Q

the radiographic resolution of this type of gram neg pneumonia is often prolonged and lag behind symptomatic improvement

A

legionella pneumonia

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39
Q

the majority of anaerobic lung infections arise from

A

aspiration of infected oropharyngeal contents

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40
Q

most common organisms in aspirated infected oropharyngeal contents causing pneumonia are

A

gram neg bacilli bacteroides and fusobacterium

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41
Q

true or false, all anaerobic pulmonary infections produce a similar radiographic appearance

A

true

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42
Q

when aspiration occurs in the supine position, what segments are predominantly involved

A

posterior segments of upper lobes and superior segments of lower lobes

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43
Q

aspiration in erect position leads to involvement of what segments

A

lower lobes

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44
Q

typical radiographic appearance of anaerobic pulmonary infections include

A

peripheral lobular and segmental airspace opacities, cavitation with areas of consolidation, discrete lung abscesses, hilar and/or mediastinal lymph node enlargement, empyema with or without bronchopleural fistula formation

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45
Q

an anaerobic gram positive filamentous bacterium that is a normal inhabitant of the human oropharynx. it causes disease when it gains access to devitalized or infected tissues that facilitate its growth. most commonly follows dental extractions, manifesting as mandibular osteomyelitis or soft tissue abscess. lung findings include nonsegmental airspace opacities in the periphery of the lower lobes. In some cases, the infection manifest as mass-like opacity, mimicking a lung cancer

A

actinomycosis

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46
Q

true or false: thoracic actinomycosis is characterized by its ability to spread to contiguous tissues without regard for normal anatomic barriers

A

true

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47
Q

most common atypical pneumonia and account for 10% to 15% of all community-acquired pneumonia

A

mycoplasma

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48
Q

pattern of mycoplasma pneumonia

A

unilateral, tends to involve lower lobes, fine reticular pattern, may progress to patchy segmental ground glass or airspace opacities which may coalesce to produce lobar consolidation

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49
Q

Granulomas are usually well formed by what weeks, coinciding with the development of delayed hypersensitivity

A

1-3 weeks

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50
Q

Consists of a calcified parenchymal focus (ghon lesion) and a nodal calcification

A

Ranke complex

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51
Q

Discrete nodular opacities that may develop in primary TB but are more common in postprimary tb

A

Tuberculomas

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52
Q

Tuberculous pleural effusion is made by demonstrating granulomas on parietal pleural biopsy or detecting _____ in pleural fluid samples

A

Elevated adenosine deaminase

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53
Q

Detection of necrotic lymph node enlargement in a patient with TB suggests active or inactive disease

A

Active disease

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54
Q

Hilar enlargement in tb are usually unilateral or bilateral?

A

Unilateral

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55
Q

During the primary tuberculous infection, there is homogeneous dissemination of the organism to regions with

A

High partial pressure of oxygen; these include the lung apices, renal medullae and bone marrow

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56
Q

Reactivation tb tends to occur at what lung regions

A

Apical and posterior segments of upper lobes and the superior segments of the lower lobes

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57
Q

Important radiographic feature of postprimary infection and usually indicates active and transmissible disease

A

Cavitation

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58
Q

Erosion of a cavitary focus into a branch of pulmonary artery can produce an aneurysm called

A

Rasmussen aneurysm

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59
Q

Parenchymal healing of tb are associated with

A

Fibrosis, bronchiectasis and volume loss (cicatrizing atelectasis) in the upper lobes

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60
Q

Late complications of pulmonary TB

A

Interstitial fibrosis, which can cause pulmonary insufficiency and secondary pulmonary arterial hypertension, bronchiectasis, mycetoma formation, erosion of a calcified peribronchial lymph node (broncholith), bronchostenosis

61
Q

Size of pulmonary nodules in miliary tb

A

2-3 mm

62
Q

Most common organisms responsible for pulmonary disease caused by atypical mycobacterial infection are

A

Mycobacterium avium intracellulare or mycobacterium kansasii

63
Q

Radiographic features of the most common form of this pulmonary infection are often indistinguishable from tb, with chronic fibrocavitary opacities involving the upper lobes. While cavitation is common, PE, lymph node enlargement and miliary spread are distinctly unusual

A

Pulmonary mycobacterium avium-intracellulare infection

64
Q

Second pattern of disease with MAI in middle-aged and elderly women presents with

A

Small centrilobular nodules and bronchiectasis, often in middle lobe and lingular distribution

65
Q

Third form of MAI infection reflects a hypersensitivity reaction to inhaled MAI in hot water systems and has been termed “hot-tub” lung. Imaging features include

A

Hypersensitivity pneumonitis with centrilobular ground glass nodules and ground glass opacities

66
Q

Standard treatment for pulmonary MAI

A

Combination of 3 antibiotics for a minimum of one year

67
Q

Pattern of viral pneumonia

A

Nonspecific, demonstrates a pattern of bronchopneumonia or reticulonodular opacities

68
Q

Resolution of viral pneumonia is usually complete, but permanent sequelae may be seen including

A

Bronchiectasis, constrictive bronchiolitis (which may produce a unilateral hyperlucent lung or Swyer-James syndrome), and pulmonary fibrosis

69
Q

In most cases of influenza, disease is confined to the

A

Upper respiratory tract

70
Q

In elderly persons, those with underlying cardiopulmonary disease or immunocompromised, and in pregnant women, influenza may cause

A

Severe hemorrhagic pneumonia

71
Q

In adults with influenza pneumonia, there is often what pattern of opacities

A

bilateral lower lobe patchy airspace opacification, ground-glass or airspace opacities with centrilobular nodules

72
Q

Bacterial superinfection with what organisms contributes to a fulminating course that may to death in influenza pneumonia

A

Streptococcus or staphylococcus organisms

73
Q

Common causes of epidemic viral pneumonia in children. Presents as patchy airspace opacities, bronchial wall thickening and centrilobular nodules and tree-in-bud opacities

A

Respiratory syncytial virus and parainfluenza

74
Q

Patients on immunosuppresive therapy or with lymphoma are at greatest risk. Presents as diffuse bilateral ill-defined nodular opacities 5-10mm in diameter. These opacities usually resolve completely, altho in some patients they involute and calcify to produce innumerable small (2-3 mm) calcified nodules

A

Varicella zoster

75
Q

Frequent cause of upper and occasionally lower respiratory tract infection. Hyperinflation and bronchopneumonia accompanied by lobar atelectasis are most frequent radiographic manifestations, however in children, it may present as lobar or segmental consolidation

A

Adenovirus

76
Q

endemic fungi that are endemic and most commonly infect normal hosts

A

Histoplasma capsulatum, Coccidiodes immitis, and Blastomyces dematidis

77
Q

opportunistic fungal pathogens in immunocompromised hosts

A

aspergillus, candida, cryptococcus, mucormycosis (zygomycosis)

78
Q

in all cases, fungi elicit what type of reaction

A

necrotizing granulomatous reaction

79
Q

medications used in fungal infection

A

triazoles (fluconazole, intraconazole, voriconazole, posaconazole), lipid-laden amphotericin B and endocardins (caspofungin)

80
Q

radiographic finding tha may be the only indication of prior histoplasmosis infection

A

multiple well defined calcified nodules less than 1 cm in size, with or without calcified hilar or mediastinal lymph nodes

81
Q

histoplasmoma size

A

<3cm

82
Q

histoplasmomas are commonly seen in what lobe of the lungs

A

lower lobes

83
Q

imaging findings in primary TB

A

mediastinal/hilar lymph node enlargement (necrotic), segmental/lobar consolidation, PE, military opacities

84
Q

imaging findings in postprimary TB

A

consolidation with cavitation, centilobular nodules/tree-in-bud densities

85
Q

imaging findings in inactive TB

A

calcified nodules +/- lymph nodes, fibronodular changes in upper lobes

86
Q

imaging findings in fibrocavitary form of non-tubercuous mycobacteria

A

single/multiple cavities, centrilobular nodules, tree-in-bud opacities

87
Q

imaging findings in nondular bronchiectatic form od non-tuberculous mycobacteria

A

cylindrical bronchiectasis (esp ML/lingula), centrilobular nodules, patchy consolidation

88
Q

imaging findings in allergic (“hot-tub lung”) forn of nontuberculous mycobacteria

A

centrilobular ground glass nodules, GGO, air trapping in expiratory CT

89
Q

asymptomatic blood-borne dissemination of H.capsulatum is common, as judged by the frequency of what finding in the spleen in residents of endemic areas

A

calcified splenic granulomas

90
Q

fungal infection endemic to southwestern US nd San Joaquin Valley of California

A

Coccidioidomycosis

91
Q

caused by B.dermatitidis, is a chronic systemic disease primarily affecting the lungs and skin

A

blastomycosis

92
Q

these species are responsible for a spectrum of pulmonary diseases in humans. this includes aspergilloma or mycetoma formation within preexisting cavities, semi-invasive (chronic necrotizing) aspergillosis in patients with mildly impaired immunity, invasive pulmonary aspergillosis in neutropenic lymphoma or leukemia patient, and allergic bronchopulmonary aspergillosis in hyperimmune patient

A

aspergillus

93
Q

is a ball hypahe, mucus, and cellular debris that colonizes a pre-existing bulla or a parenchymal cavity created by some other pathogen or destructive process such as post-primary TB

A

aspergilloma

94
Q

in general, parasitic diseases of the thorax are manifested by what types of invasion/spread of disease

A

direct invasion of lungs and pleura, or less commonly, a hypersensitivity reaction

95
Q

Amoebiasis is usually confined to the GI tract and liver. If the infection remains confined to the subphrenic space, it may result into

A

right PE and basilar atelectasis, from local diaphragmatic inflammation

96
Q

the most common method of pleuropulmonary involvement by amebiasis is by

A

direct intrathoracic extension of infection from a hepatic abscess

97
Q

the cause of most cases of human hydatid disease

A

Echinococcus granulosus

98
Q

this disease is endemic in sheep-raising areas. Dogs, coyotes and wolves are the usual definitive hosts with sheep, goats and cattle acting as intermediate hosts

A

Hydatic disease (echinococcosis)

99
Q

three layers of pulmonary echinococcal cysts

A

exocyst (chitinous layer)- protective membrane
inner endocyst- daughter cysts
surrounding capsule of compressed fibrotic lung known as pericyst

100
Q

pulmonary echinococcal cysts are well-circumscribed, spherical soft tissue masses. In distinction to hepatic cysts, lung cysts do not have

A

calcified walls

101
Q

echinococcal cysts range in size from __ to __ cm, with predilection to the

A

1-20cm, lower lobes and the right side

102
Q

if the pericyst of echinococcus ruptures, a thin crescent of air will be seen around the periphery of the cyst, producing the ___ sign

A

meniscus or crescent sign

103
Q

if the cyst wall of echinococcus may be seen crumpled and floating within an uncollapsed pericyst, it produces the pathognomonic sign called

A

sign of the camalote or water lily sign

104
Q

result from infection with the lung fluke paragonimus westermani

A

paragonimiasis

105
Q

lung fluke paragonimus are found predominantly in what part of the world, acquired by eating raw crabs or snails

A

eastern asia

106
Q

schistosomiasis is caused by three blood flukes, namely

A

schistosoma mansoni, japonicum and haematobium

107
Q

pathophysiology of schistosomiasis

A

larvae penetrate the skin or oropharyngeal mucosa, travel via the venous circulation to pulmonary capillaries, an acute allergic response in the lungs may develop, presenting as transient airspace opacities (eosinophilic pneumonia), larvae then pass thru the pulmonary capillaries into the systemic circulation, eventually migrate to mesenteric venules (japonicum and mansoni) or bladder venules (haematobium). mature flukes produce ova which may embolize the lungs, where they implant in and around small pulmonary arterioles, induces granulomatous inflammation and fibrosis, leading to obliterative arteriolitis, resulting in pulmonary hypertension and cor pulmonale

108
Q

caused by a nematode Dirofilaria immitis (dog heartworm) presents as an asymptomatic subpleural solitary pulmonary nodule that represents an inflammatory reaction surrounding a dead worm that has embolized from a peripheral vein to lodge in a peripheral pulmonary artery branch

A

Dirofilariasis

109
Q

most common complication of pneumonia

A

parapneumonic effusion

110
Q

type of effusion with low pH, elevated LDH and protein

A

exudative

111
Q

when an empyema collection extends to create an infected subcutaneous collection in the chest wall, it is termed

A

empyema necessitatis

112
Q

organisms most often associated with empyema necessitatis are

A

TB, A. israelii, nocardiosis, fungus and staphylococcal infection

113
Q

most often the result of aspiration of mouth anaerobes with or without aerobes, and is seen 10-14 days following aspiration

A

lung abscess

114
Q

some lung abscesses develop as an embolic complication of

A

septic thrombophlebitis or tricuspid endocarditis

115
Q

appears as nodules or masses typically with central necrosis with or without air-fluid levels, and develop in the gravity dependent portions of the lungs (posterior upper lobes, superior segment, and subpleural regions of the lower lobes)

A

abscess

116
Q

rare complication of severe pulmonary infection when a portion of lung is sloughed. occurs when there is thrombosis of pulmonary vessels

A

pulmonary gangrene

117
Q

pulmonary gangrene can be seen in severe bacterial pneumonia but is more closely associated with

A

invasive pulmonary fungal infection

118
Q

imaging findings of pulmonary gangrene

A

nodule or mass within a cavity with a crescent of air surrounding the sloughed portion of lung

119
Q

rare complication of pulmonary infection or infective endocarditis. presents as lung nodule or mass adjacent to a hilar vessel in a patient with endocarditis or pneumonia

A

mycotic aneurysm

120
Q

uncommon postinfectious form of constrictive bronchiolitis that typically results from a sever viral or mycoplasma infection in infancy or childhood. typical radiologic findings include a hyperlucent lung with normal or small volume, attenuated vasculature, air trapping and occasionally proximal bronchiectasis

A

Swyer-James syndrome

121
Q

bronchial stenosis are most often associated with

A

endobronchial TB or fungal infections such as histoplasmosis

122
Q

reflects presence of an endobronchial calcified nodule, most often seen as a result of erosion of a calcified peribronchial lymph node resulting from histoplasmosis or TB

A

broncholithiasis

123
Q

appears radiologically as mediastinal widening with calcifications. focal mediastinal mass can also be seen. CT typically demonstrates either a localized calcified right paratracheal or subcarinal mass or soft tissue infiltration of the middle mediastinum with compression or obliteration of structures

A

Fibrosing mediastinitis (sclerosing mediastinitis)

124
Q

common pulmonary infection in pre-engraftment phase (0-30 days) of hematopoietic stem cell transplant recipients

A

aspergillosis, bacterial infection, RSV pneumonia

125
Q

common pulmonary infection in early post-transplantation phase (30-100 days) of hematopoietic stem cell transplant recipients

A

CMV, pneumocystis jiroveci, aspergillosis

126
Q

common pulmonary infection in late post-transplantation phase (>100days) of hematopoietic stem cell transplant recipients

A

Bacterial, aspergillosis, viral (adenovirus, RSV, varicella zoster, parainfluenza)

127
Q

most common cause of pneumonia in ICC host

A

bacteria

128
Q

most common organisms causing pneumonia in HIV patients are

A

S. pneumoniae, H. influenzae, S. aureus, E.coli and P. aeruginosa

129
Q

most common bacterial pathogens in the non-HIV ICC patients are

A

S. aureus and gram-negative aerobes including Klebsiella, proteus, E. coli, Pseudomonas, enterobacter and serratia

130
Q

renal transplant recipients and patients on high-dose corticosteroids are at increased risk of pneumonia caused by

A

L. pneumophila and legionella micdadei (Pittsburgh agen),

131
Q

usually opportunistic infection in patients on immunosuppressive therapy, those with lymphoma or leukemia and patients with alveolar proteinosis

A

nocardia

132
Q

treatment for nocardiosis

A

sulfonamides

133
Q

in early stages of AIDS (CD4 count >200 cells/mm3), what pattern is seen if afflicted with TB

A

postprimary pattern of upper lobe fibrocavitary disease indistinguishable from that seen in the immunocompetent patient

134
Q

later in the course of AIDS (CD4 counts 50 to 200 cells/mm3), the radiographic features most often associated with primary TB disease are

A

lobar consolidation, mediastinal and hilar lymphadenopathy and PE

135
Q

In advanced AIDS (CD4 <50 cells/mm3), the radiographic findings of TB are

A

atypical and are characterized by diffuse reticular or nodular (military) opacities

136
Q

most common nontuberculous mycobacterial infection in AIDS patients

A

Mycobacterium avium intracellulare

137
Q

common cause of viral pneumonia in patients with impared cell-mediated immunity, specifically renal transplant recipients and lymphoma. it is however uncommon cause of pneumonia in AIDS population

A

CMV

138
Q

usually occurs in severely immunocompromised patients with neutropenia, most commonly those with leukemia or those receiving chemotherapy or corticosteroids. occurs less frequently in AIDS patients, usually in terminal stage of disease

A

aspergillosis

139
Q

these fungal infection tends to invade blood vessels, causing infarction

A

aspergilllosis

140
Q

relatively specific CT finding for invasive aspergillosis in a neutropenic patient

A

demonstration of zone of relative decreased attenuation surrounding a dense, mass-like opacity termed “halo sign”

141
Q

halo in “halo sign” of aspergillosis represent

A

edema and hemorrhage where an air crescent will develop, separating the region of infected, necrotic lung from normal parenchyma

142
Q

budding yeast commonly found in soil and bird droppings. most common cause of fungal infection in AIDS but can affect any IC patient

A

Cryptococcosis

143
Q

most serious complication of cryptococcosis

A

meningitis

144
Q

unusual cause of pneumonia in IC patient. most susceptible are patients with severe neutropenia caused by lymphoma or leukemia in the late stages of disease

A

candidiasis

145
Q

this pulmonary infection is commonly accompanied with paranasal sinus infection, which may extend to involve the brain or meninges. chest radiographic appearances include a solitary nodule or mass or focal airspace opacity which may cavitate

A

mucormycosis (zygomycosis)

146
Q

most common AIDS defining opportunistic infection

A

pneumocystits jiroveci pneumonia

147
Q

PJP presents as

A

fine reticular or ground glass pattern, particularly in the parahilar regions

148
Q

four clinicopathologic forms of toxoplasmosis

A

congenital, ocular, lymphatic and generalized

Chest Imaging (9 decks)

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