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Soft Tissue Interp > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Do solitary masses have a silhouette sign??

A

Silhouette sign is unlikely

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2
Q

Do solitary masses exhibit air bronchogram??

A

Air bronchogram unlikely

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3
Q

Is atelectasis possible with solitary masses?

A

Atelectasis possible

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4
Q

What is the DDX list for solitary masses? (8)

A 
Bronchogenic carcinoma
Hematogenous metastasis
Hamartoma
Tuberculoma, other granuloma
Lung abscess
Hydatid cyst
Hematoma
Bronchopulmonary sequestration
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5
Q

What % of patients under 30 have a possibility of a malignant solitary mass?

A

<1%

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6
Q

What % of patients 30-45 have a possibility of a malignant solitary mass?

A

15%

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7
Q

What % of patients older than 45 have a possibility of a malignant solitary mass?

A

50%

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8
Q

What are some benign types of calcifications? (4)

A

Diffuse

Central

Popcorn

Concentric

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9
Q

What are some questionable types of calcifications? (2)

A

Stippled and Eccentric

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10
Q

What are different types of bronchogenic carcinoma? (4)

A

Adenocarcinoma
Squamous cell carcinoma
Small (a.k.a. oat cell) carcinoma
Large cell carcinoma

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11
Q

What is the most frequently diagnosed maligancy and what age is it most commonly diagnosed?

A

Bronchogenic carcinoma and 55-60 y.o.

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12
Q

What % of lung cancer deaths associated with smoking are caused by bronchogenic carcinoma?

A

80-85% of lung cancer deaths associated with smoking

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13
Q

What are some bronchogenic carcinoma signs and symptoms (7)

A 
Cough
Wheezing
Dyspnea
Hemoptysis
Chest pain
Weight loss
Asymptomatic
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14
Q

What are some complications of bronchogenic carcinoma?

A 
Phrenic nerve palsy
- Hemidiaphragm paralysis
Superior vena caval syndrome
-Swelling of neck, face
-Dizziness
-Vision change
-Syncope
-Stupor
Recurrent laryngeal nerve palsy
-Hoarseness
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15
Q

What is the treatment of bronchogenic carcinoma?

A

Surgery
Chemotherapy
Radiation therapy
Combination

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16
Q

What is the prognosis of bronchogenic carcinoma?

A

Dependent on

  • Stage at presentation
  • General health
  • Age
  • Histological type of tumor
  • Growth rate
  • Therapy
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17
Q

What are some radiographic findings of bronchogenic carcinoma?

A 
Solitary mass
- Mediastinal
- Apical
- Lung field
Atelectasis possible
Hilar enlargement possible
Cavitation possible
Pleural effusion possible
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18
Q

What do pancoast tumors present as? (3)

A 
Squamous cell or adenocarcinoma
Mass in apex
- Look for rib or vertebra destruction
Clinical presentation
-Horner’s syndrome
-Arm / shoulder pain
-Asymptomatic
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19
Q

Where are possible primary sites that cause mets?

A

Breast, kidney, ovary, testis, colon, thyroid, sarcoma, malignant melanoma

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20
Q

What is the appearance of mets? (5)

A 
Multiple masses (95%)(5% solitary)
Often smooth, rounded
Uniform or variable size
Pleural effusion possible
Pleural mass possible
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21
Q

What is the most common benign tumor?

A

Hamartoma

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22
Q

What does a hamartoma contain?

A

Normal tissue elements, unorganized

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23
Q

What is the peak incidence age of hamartomas?

A

Peak incidence 50-60 y.o.

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24
Q

Are hamartoma’s usually found centrally or peripherally?

A

Peripherally

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25
Q

Are syymptoms common with hamartomas?

A

Symptoms rare

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26
Q

What are the radiographic findings of a hamartoma? (3)

A

Solitary mass
Usually < 4cm
Popcorn calcification possible

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27
Q

What are the 3 granuloma infections?

A

Tuberculosis
Histoplasmosis
Coccidiodomycosis

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28
Q

What does TB look like?

A

Diffuse, localized or mass (single or multiple)

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29
Q

What is histoplasmosis caused by?

A
  • Mold spore inhalation; endemic to central and eastern USA, eastern Canada, Mexico, Central and South America, Africa, SE Asia
  • Asymptomatic or mild to severe URTI
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30
Q

What is coccidiodomycosis caused by?

A
  • Mold spore inhalation; endemic in arid soil of SW USA, Mexico, Central and South America
  • Variable infectious presentation
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31
Q

What do lung abscesses present like?

A

Single or multiple masses

  • > 2cm
  • Usually air-fluid level
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32
Q

What are some predisposing factors of a lung abscess?

A

Predisposing factors

  • Aspiration
  • Alcoholism, neurological disease
  • Intubation
  • Bronchiectasis, bronchial obstruction
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33
Q

What are hydatid cysts caused by?

A

Echinococcus (dog tapeworm); humans are intermediate host

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34
Q

Where do hydatid cysts affect in the body?

A

May involve liver, lung, spleen, kidney, bone, CNS

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35
Q

Where are hydatid cysts most prevalent?

A

Most prevalent Greece, Argentina, New Zealand

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36
Q

What serious complication can come from a ruptured hydatid cyst?

A

anaphylactic shock

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37
Q

What are the ddx for multiple masses?

A 
Pulmonary metastasis
Lymphoma
Granulomatous infection
- TB, histoplasmosis, coccidioidomycosis
Rheumatoid nodules
Wegener’s granulomatosis
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38
Q

Where does Hodgkin’s lymphoma originate?

A

90% originate in lymph nodes; 10% in extranodal lymphoid tissue of lung, GI, skin

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39
Q

What peak ages does Hodgkin’s lymphoma affect?

A

Peak ages 30 and 70 years

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40
Q

Where does Hodgkin’s lymphoma typically present?

A
  • 95% superior mediastinal node involved

- 15% lung masses; 15% pleural effusions

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41
Q

Where does non-Hodgkin’s lymphoma originate?

A

60% originate in lymph nodes; 40% in extranodal lymphoid tissue

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42
Q

How does Hodgkin’s lymphoma typically present?

A
  • Mediastinal and hilar adenopathy

- Lung involvement possible without adenopathy

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43
Q

What can cause an icrease in incidence of non-hodgkin’s lymphoma?

A

Increased incidence with immune suppression

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44
Q

What causes Wegener’s Granulomatosis?

A
  • Systemic; autoimmune; relatively rare

- Perivascular inflammation leads to granuloma formation

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45
Q

How does Wegener’s Granulomatosis usually present?

A

Multiple nodules; cavitation common

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46
Q

how often does wegener’s granulomatosis present with pleural effusion?

A

1/4

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47
Q

Is adenopathy common with wegener’s granulomatosis?

A

No it is rare

48
Q

What lung base change occurs with wegener’s granulomatosis?

A

Interstitial changes in lung bases

49
Q

Ho does interstitial disease usually present?

A
  • Thickened interlobular septa, alveolar walls; interstitial lymph, veins, cells
  • Usually a diffuse pattern of involvement
  • Often combined with consolidation
50
Q

What are the 5 ways that interstitial patterns can present?

A
  • Ground Glass
  • Linear (reticular) - fibrosis
  • Nodular (granulomas)
  • Reticulonodular (inflmmation)
  • Honeycombing (end stage lung disease
51
Q

What are ddx for interstitial?

A 
Pulmonary edema
Infection
- Viral, TB, fungal, PCP
Idiopathic
- IPF, sarcoidosis
Collagen vascular diseases
- RA, scleroderma, AS
Extrinsic agents
- Pneumoconiosis, drugs
Tumors
- Lymphangitic metastasis, eosinophilic granuloma
52
Q

What are disease that decrease radiographic density? (5)

A

Pneumothorax

Emphysema

Cystic disease

  • Congenital
  • Infectious
  • Post-traumatic

Air trapping
- Obstruction (Foreign body)
Asthma (mucous plugs + constriction)
Inspiration vs. expiration films may help

Compensatory hyperexpansion

Congenital

53
Q

What are some radiographic findings of decreased radiographic density?

A

Hyperlucency

  • Lobar, segmental, subsegmental, general
  • With or without hyperexpansion

Decreases lung markings

54
Q

What are some pneumothorax radiographic findings?

A 
Visceral pleura visible
No lung markings peripheral to pleura
Possible signs of atelectasis
-Passive / compressive
Upright expiration PA more sensitive
Lateral decubitus may be helpful
55
Q

What are the different types of pneumothorax?

A

Spontaneous and traumatic

56
Q

What population does primary spontaneous pneumothorax occurs in?

A

Tall, thin females

57
Q

What are some causes of secondary spontaneous pneumothorax?

A

Underlying lung disease
Bullae, blebs
Air trapping

58
Q

What is a traumatic pneumothorax caused by?

A

Trauma

Iatrogenic

59
Q

What does a tension pneumothorax do?

A 
Valve effect with progressive accumulation of air
Shift of mediastinum
Leads to vascular compromise
Medical emergency
- Chest tube
60
Q

What is the most common physical finding of primary spontaneous pneumothorax?

A

Tachycardia is most common physical finding

Hypotension, cyanosis and tachycardia may suggest tension pneumothorax

61
Q

What happens during the lung exam of a large pneumothorax?

A
  • Decreased or absent breath sounds on affected side,
  • Decreased chest wall motion,
  • Hyperresonance to percussion,
  • Decreased fremitus
62
Q

What are the risk factors for recurrence for a primary spontaneous pneumothorax? (5)

A 
Pre-existing lung disease
	Tall stature
	Female gender (?)
	Smoking 
	Younger age
63
Q

When do most recurrences of pneumothorax occur?

A

Most recurrences occur within 6 months to two years after initial pneumothorax

64
Q

What are some pneumothorax symptoms? (6)

A

1) Chest pain
2) Dyspnea
3) Onset during rest
4) Diminished breath sounds
5) Decreased tactile fremitus
6) Hyperresonance on percussion
- Larger

65
Q

What are some pneumothorax treatments? (3)

A

1) Chest tube
- All symptomatic cases
- Any >15% loss
- Tension = emergency
2) Monitor
- Asymptomatic and <15% may resolve
3) Recurrence
- UP to 50%
- Increased with altitude extremes
- Smoking increases

66
Q

What is emphysema? (3)

A

1) Enlarged air spaces with destruction of alveolar walls
- Usually due to COPD, usually chronic bronchitis
2) Correlate with functional tests
3) Moderate to severe changes seen on CXR; mild seen on HRCT

67
Q

What are some radiographic changes with emphysema? (5)

A

1) Flattened, depressed hemidiaphragms
2) Hyperlucency
3) Increased retrosternal clear space
4) Increased AP chest diameter
5) Decreased peripheral vascular markings

68
Q

What are some pleural abnormalities? (3)

A

1) Pleural effusion
- Transudate, exudate, blood, pus, lymph
2) Pleural masses
- Loculated effusion
- Neoplasm
- Extrapleural sign
3) Calcifications

69
Q

How much fluid fluid is normally in the pleural space?

A

Normally 2-10 cc of fluid in pleural space;

70
Q

How much fluid is produced by parietal pleura each hour?

A

As much as 100 cc fluid produced by parietal pleura each hour;

71
Q

How does a fluid drain from the pleural space?

A

Fluid drains to visceral pleura via lymphatics;

72
Q

Where does fluid accumulate in the pleural space?

A

> 75 cc accumulates posterior costophrenic blunts

73
Q

How much fluid needs to accumulate for the costophrenic angle to become blunted?

A

200-300 cc accumulates lateral CP become blunted

74
Q

What is a meniscus sign?

A

1) Blunting of the costophrenic angles due to pleural fluid accumulation (also subpulmonic fluid)
2) Need to determine the underlying cause of the fluid accumulation

75
Q

What are some Pleural Effusion ddx? (9)

A

1) CHF
2) Pneumonia
3) Neoplasm
4) Infection (empyema)
5) Trauma
6) Embolism
7) Connective tissue disease
8) TB
9) Abdominal disease
- Pancreatitis, cirrhosis

76
Q

What are some pleural effusion symptoms? (7)

A
  • Dyspnea
  • Pleuritic chest pain
  • Dry cough
  • Tactile fremitus increased
  • Dullness to percussion
  • Decreased breath sounds
  • Small effusions usually asymptomatic
77
Q

What are some ways to manage pleural effusion? (2)

A

1)Thoracentesis
- Reduces symptoms
- Provides tissue for lab evaluation (Culture & sensitivity,
Histology, Chemistry)
2) Treatment of underlying disease

78
Q

What are some causes of pleural masses? (3)

A

1) Loculated effusion
2) Neoplasm
- Primary: mesothelioma (malignant), fibroma (benign)
- Secondary: breast, bronchus most common
3) Extrapleural sign
- Rib lesion

79
Q

What are some causes of pleural calcifications? (3)

A

1) Asbestos-related pleural disease
- Other inhalation diseases
(Talcosis, Silicosis)
2) Old empyema
- More localized; history
3) Old hemothorax
- More localized; history

80
Q

What are the asbestos related disease findings? (4)

A

1) Pleural plaques
2) Diffuse pleural thickening
3) Pleural effusions
4) Interstitial pulmonary fibrosis

81
Q

What is the most common change in with asbestos related disease?

A

Pleural plaques

82
Q

What is the radiographic finding for pleural plaques?

A

1) 15% visible on CXR

2) May calcify (pathognomonic of asbestos exposure); takes up to 20 years

83
Q

What are the pathoanatomical findings with diffuse pleural thickening?

A

1) May cause respiratory symptoms

2) Thickened fissures; round atelectasis

84
Q

How does interstitial pulmonary fibrosis due to asbestosis appear?

A
  • Reticular, linear
  • Initially subpleural
  • Begins at base, moves to apex
  • Honeycombing late stages
  • No adenopathy
85
Q

What does types of cancer does asbestos increase the risk for?

A

1) 7000x increased incidence of mesothelioma
- 10% lifetime risk
- Usually >30 years after exposure
2) 7x increased risk of bronchogenic CA
- Exponential increase with smoking
3) 3x increased risk of GI neoplasm

86
Q

What is the DDX for unilateral hilar enlargement ?

A

Bronchogenic carcinoma

87
Q

What are the DDX for bilateral hilar enlargement? (3)

A

1) Lymphoma
2) Infection (granulomatous)
3) Sarcoidosis

88
Q

What are the DDX for unilateral hemidiaphragm elevation? (5)

A

1) Atelectasis
2) Phrenic nerve palsy
3) Splinting
4) Eventration
5) Subphrenic inflammation

89
Q

What are the DDX for bilateral hemidiaphragm elevation? (5)

A

1) Poor inspiration
2) Obesity
3) Pregnancy
4) Ascites
5) Hepato-splenomegaly

90
Q

In a normal lateral radiograph of the thorax, what are the borders of the anterior portion of the mediastinum?

A

Sternum to anterior cardiac silhouette = anterior (retrosternal) clear space
- Sternum to posterior heart border

91
Q

In a normal lateral radiograph of the thorax, what are the borders of the middle portion of the mediastinum?

A

Anterior to posterior cardiac silhouette

- Posterior heart border to 1 cm posterior to the anterior vertebral bodies

92
Q

In a normal lateral radiograph of the thorax, what are the borders of the posterior portion of the mediastinum?

A

Posterior cardiac silhouette to posterior border of lung field
- From line 1 cm posterior to anterior vertebral bodies to posterior chest wall

93
Q

What are the contents of the anterior mediastinum? (2)

A

1) Thymus gland

2) Lymph nodes

94
Q

What are the pathologies in the anterior mediastinum? (4)

A

1) Retrosternal goiter
2) Hodgkin’s lymphoma
3) Thymic mass
4) Thymoma
-Germ cell tumor
(4 T’s (Thyroid goiter, Thymic mass, Thymoma, Terrible Hodgkin’s Lymphoma)

95
Q

Are thyroid goiter’s more common or thyroid neoplasms?

A

Much more common than thyroid neoplasm

96
Q

What portion of the mediastinum is continuous with the thyroid gland?

A

Superior mediastinum; continuous with thyroid gland

97
Q

What is the most common finding of a CXR that happens with thyroid goiters?

A

Tracheal displacement most common finding on CXR

98
Q

How do you diagnose a thyroid goiter?

A

Dx: nuclear medicine scan; CT with contrast strongly suggestive

99
Q

What is the most common anterior mediastinal mass in adults?

A

Thymoma

100
Q

What specific conditions are common with those that have a thymoma? (2)

A

1) 35% have myasthenia gravis; 15% of MG patients have thymoma;
2) 50% with aplastic anemia have thymoma

101
Q

What % of thymoma are benign?

A

75%

102
Q

What population do thymolipoma occur?

A

children, young adults

103
Q

What conditions can result in benign thymic hyperplasia? (4)

A

1) MG
2) thyrotoxicosis
3) collagen vascular disease, 4) rebound thymic hyperplasia (chemotherapy, Addison’s, acromegaly)

104
Q

What are germ cell tumors?

A

Primitive rest cells; variable malignant potential

105
Q

Which is the most common type of germ cell tumor?

A

Teratoma (70% of germ cell tumors); 20% malignant = teratocarcinoma

106
Q

What are the contents of the middle mediastinum? (7)

A

1) Pericardium
2) Heart
3) Great and pulmonary vessels
4) Phrenic nerve
5) Upper vagus nerves
6) Trachea, primary bronchi
7) Lymph nodes

107
Q

What are the pathologies of the middle mediastinum? (4)

A

1) Lymphadenopathy
2) Bronchogenic carcinoma
3) Aneurysm
4) Bronchogenic cyst

108
Q

Are thoracic aneurysms often symptomatic?

A

Most asymptomatic

109
Q

What are some clinical symptoms of thoracic aneurysm?

A

Clinical symptoms = very large, expanding, or contained rupture

110
Q

What are some causes of thoracic aneurysm?

A

1) Atherosclerosis
2) Connective tissue disease (Marfan’s, etc)
3) Syphilis
4) Posttraumatic
5) Mycotic
6) Aortitis

111
Q

What are the contents of the posterior mediastinum? (7)

A

1) Descending thoracic aorta
2) Esophagus
3) Thoracic duct
4) Azygous, hemiazygous veins
5) Sympathetic ganglia
6) Lower vagus nerves
7) Lymph nodes

112
Q

What are the pathologies of the posterior mediastinum? (6)

A

1) Hiatal hernia
2) Neurogenic tumors
3) Paravertebral masses
4) Meningocele
5) Esophageal masses
6) Aneurysm

113
Q

What hiatal hernia is more common?

A

Sliding (95%), Paraesophageal (5%)

114
Q

What is a sliding hernia and what can it cause??

A
  • GE junction above hemidiaphragm
  • Reflux if large
  • May reduce when upright
  • Esophagitis (25%); duodenal ulcer (20%)
115
Q

What is a paraesophageal hernia and what can it cause??

A
  • GE junction below hemidiaphragm
  • Fundus above diaphragm
  • More complications
116
Q

What is the choice imaging for following up an abnormal plain film in the chest?

A
  • Follow-up for abnormal plain film = CT
  • Masses
  • Mediastinal abnormalities
  • Unexplained pleural effusion or atelectasis
  • Recurrent consolidation, atelectasis, effusion
  • Negative plain film; high clinical suspicion

Soft Tissue Interp (2 decks)

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