Radiology Correlations

Question 1

What pattern does bronchopneumonia show on a CT scan?

Answer 1

Tree in bud (bloom) pattern; usually multilobar

Question 2

Lobar pneumonia will typically present with what on CXR?

Answer 2

consolidation which is typically associated with alveolar fluid/exudate

Question 3

What is the bulging fissure sign?

Answer 3

ex. Klebsiella PNA expanding the lung lobe so much it bulges beyond its normal size

Question 4

Abscesses will usually have what on CXR?

Answer 4

air fluid level within the cystic space

Question 5

Which organisms are more likely to cause an abscess in lobar pneumonia?

Answer 5

Klebsiella, Staph aureus and anaerobes

Question 6

What pathology can lead to widening of airways with extension into the peripheral lung fields on CXR?

Answer 6

Bronchiectasis

Question 7

What are the DDX for bronchiectasis?

Answer 7

Cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA), chronic infections (Tb), primary ciliary dyskinesia, Young’s syndrome

Question 8

Situs inverses with dextrocardia may be seen in a subset with pts with what?

Answer 8

primary ciliary dyskinesia (Kartagener syndrome)

Question 9

What causes bat wing infiltrates?

Answer 9

pulmonary edema (central pattern of lung involvement), hypersensitivity pneumonitis, inhalation injury; anything favoring proximal vascular or airway involvement

Question 10

What can cause reverse bat wing infiltrates?

Answer 10

Fibrosis (ex. IPF, sarcoidosis, other ILD with fibrosis); anything favoring peripheral lung involvement

Question 11

Hypersensitivity pneumonitis follows the airways, but sarcoidosis follows what?

Answer 11

lymphatics (increased pleural involvement)

Question 12

What can cause bilateral white out (diffuse lung involvement) on CXR?

Answer 12

ARDS (MC), severe pneumonia, severe atelectasis, diffuse hemorrhage, malignancy (rare)

Question 13

What makes pulmonary nodules white on CT images?

Answer 13

calcification

Question 14

What are the different patterns of calcification?

Answer 14

Diffuse (associated with benign lesions), central, popcorn, laminate, stippled, eccentric

Question 15

What pattern of calcification is associated with histoplasmosis (old granulomas)?

Answer 15

Diffuse, laminated

Question 16

What pattern of calcification is seen with hamartomas?

Answer 16

Popcorn

Question 17

What are some tumor characteristics that would be worrisome for malignancy?

Answer 17

Bigger size is worse, rate of growth (will it become bigger? has it become bigger?), more solid = more worrisome, more irregular border = more worrisome, calcification is more often present with benign tumors

Question 18

What are some pt characteristics that are concerning for malignancy?

Answer 18

Age of pt (younger than 35 much less likely to be cancer), cigarette smokers much more likely to have malignancy, if there is a prior hx of cancer there is a likelihood for the lesion representing metastasis, FHx of lung cancer

Question 19

What are the Fleischner guidelines?

Answer 19

Looks at age, smoker status, size, growing, solid, calcified

Question 20

What factors would suggest that a biopsy is needed?

Answer 20

Increased age, is a smoker, nodule increased in size, nodule is growing, nodule is solid and is not calcified

Question 21

What is atypical about mucinous adenocarcinoma and adenocarcinoma in situ?

Answer 21

can look like pneumonia and can be bilateral

Question 22

What can cause ground glass opacities?

Answer 22

infections, ILD, edema, hemorrhage, neoplasia (such as adenocarcinoma in situ)

Question 23

Airways can dilate within solid tumors causing what?

Answer 23

Bubble lucencies which is concerning for invasive tumor

Question 24

What phenomena can occur with squamous carcinoma?

Answer 24

Cavitation

Question 25

What can cause wedge shaped infiltrates on CXR?

Answer 25

resorption atelectasis (infarcts can also be wedge shaped on CT scan)

Question 26

What can cause resorption atelectasis?

Answer 26

a tumor leading to obstruction (ex. endobronchial squamous carcinoma or endobronchial carcinoid tumor)

Question 27

Squamous carcinoma often occurs centrally due to what?

Answer 27

Its association with damaged airway epithelium

Question 28

In a primary pneumothorax the pleural cavity pressure is what?

Answer 28

Less than the atm pressure

Question 29

In a tension PTX the pleural cavity pressure is what?

Answer 29

Greater than the atm pressure

Question 30

What is a primary PTX?

Answer 30

typically due to a limited introduction of air into the thoracic space; most often due to primary lung pathology

Question 31

What is a tension PTX?

Answer 31

One way unchecked accumulation of air; most often due to chest wall penetration/trauma; mass effect with midline shift

Question 32

Tension PTX are best seen with what type of radiograph?

Answer 32

Expiratory radiograph