Pulmonology Flashcards
4 types of CT scans
- cCT (conventional)
- HRCT (high-resolution)
- hCT (helical): single-section and multidetector (MDCT)
- electron beam
used to see anatomy, but not great for lungs
conventional CT
used when dz is suspected by H&P, but CXR is either normal or only slightly abnormal (ILD, emphysema (from a1-antitrypsin deficiency), bronchiectasis, lymphangitic spread of malignancy)
HRCT (high-resolution)
first place to start when you suspect ILD or BRONCHIECTASIS
HRCT (high-resolution)
does hCT (helical): single-section use IV CONTRAST?
yes
best method for performing CT-pulmonary angiography, and why
- multidetector (MDCT)
- see subsegmental emboli better than single-section
3 advantages of multidetector (MDCT)
- scan large sections on single breath
- collecting images of specific blood vessels
- “high resolution”
CT buzzwords:
- diagnose ILD or bronchiectasis
HRCT (high-resolution)
CT buzzwords:
- w/u solitary pulmonary nodule
hCT or HRCT
CT buzzwords:
- diagnose PE
CTPA (which can be done by MDCT)
when is MRI useful when evaluating pulmonary disease?
- evaluating tumors near adjacent blood vessels or nerves
- for determining what is TUMOR and what is NOT
- ATYPICAL clinical features and NON-diagnostic HRCT
- need to exclude neoplastic and infectious causes of an interstitial pattern
- what test should be done?
lung biopsy
when should a lung bx be done?
- ILD
- lymphangitic spread of cancer
- eosinophilic PNA
- vasculitis
- certain infections
is NO LONGER routinely used in evaluating ILDs
lung bx
when is lung bx used in evaluating ILDs?
atypical cases when HRCT is NOT diagnostic
findings in bronchoalveolar lavage:
- normal findings
- < 1% neutrophils
- < 16% lymphocytes
- no eosinophils
findings in bronchoalveolar lavage:
- IPF
- collagen vascular disease
- asbestosis
- suppurative infections
- granulomatosis w/ polyangiitis
- ARDS
increased neutrophils
findings in bronchoalveolar lavage:
- hypersensitivity pneumonitis
- sarcoidosis
increased lymphocytes
findings in bronchoalveolar lavage:
- acute and chronic eosinophilic PNA
- some ARDS
- Churg-Strauss
- Loffler syndrome
- tropical eosinophilia
- parasite infection (esp. ascariasis)
- TB
- collagen vascular disease
- malignancy
- drug reactions
increased eosinophils
- 95% sensitive for PJP in AIDS pts
- CMV PNA (inclusion bodies)
- disseminated TB
- fungal infection
- diagnosing PNA in ARDS pts
diagnosis of specific types of PNAs
findings in bronchoalveolar lavage:
- alveolar proteinosis
- turbid
- PAS-positive material
findings in bronchoalveolar lavage:
- Langerhans cell histiocytosis
Langerhans cells
findings in bronchoalveolar lavage:
- diffuse alveolar hemorrhage
- bloody
- large amount of hemosiderin in alveolar macrophages
findings in bronchoalveolar lavage:
- cytotoxic lung injury
hyperplastic and atypical type 2 pneumocytes
