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1
Q

Usual origin of bronchial arteries?

A

Descending Aorta at level of carina

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2
Q

Size cutoff for bronchial artery dilatation on CT (ex. Chronic PE)

A

> 2mm

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3
Q

Disease associated with multiple pulmonary AVMs

A

HHT

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4
Q

Define massive and submassive PE

A

Massive:

Systolic pressure less than 90 or drop of more than 40

Submassive:

Hemodynamically stable but echocardio evidence of RV strain

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5
Q

What is rassmussen’s aneurysm

A

Pulmonary artery aneurysm adjacent to or within a tuberculous cavity

there is a progressive weakening of the arterial wall as granulation tissue replaces both the adventitia and the media. This is then gradually replaced by fibrin, resulting in thinning of the arterial wall, pseudoaneurysm formation, and subsequent rupture with haemorrhage.

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6
Q

What is pulmonary epithelioid haemangioendothelioma

A

Rare vascular tumor of the lung with low malignant potential

Multiple lung nodules in a random bilateral distribution

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7
Q

What is the cutoff between the ascending and descending aorta?

A

Origin of the left subclavian artery

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8
Q

What is the mean pulmonary artery pressure in pulmonary hypertension?

A

> 25 mmHg

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9
Q

What are the causes of vaso-occlusive/constrictive pulmonary hypertension? (6)

A 
chronic hemolytic anemia
IV talcosis (IV drug users)
Schistosomiasis
Tumor thromboembolism
Chronic thromboembolism
Mediastinal fibrosis
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10
Q

What left sided cardiac diseases cause pulmonary hypertension?

A

Myocardial failure
Valvular disorder (mitral, aortic)
Atrial or ventricular mass/thrombus

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11
Q

How does pulmonary capillary hemangiomatosis lead to pulmonary hypertension?

A

Quasi neoplastic proliferation of pulmonary capillaries, causing decrease of drainage into capillary bed. High pressures are subsequently backed up to the pulmonary artery, causing pulmonary hypertension

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12
Q

How does pulmonary veno-occlusive disease lead to pulmonary hypertension?

A

Spontaneous thrombosis in the pulmonary veins, which travel in the interlobular septa, which limits drainage of blood through the pulmonary veins. There is secondary dilatation of the capillary bed and reflux of pressure into the pulmonary arteries, causing pulmonary hypertension.

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13
Q

What features allow you to differentiate tumor embolism into the pulmonary arteries as opposed to bland pulmonary thromboembolism?

A

In tumor thrombus, there are beaded multifocal intravascular filling defects, expanding the vessel, with progression over time. There can be enhancement

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14
Q

What is the most common source of lymphangitic carcinoma?

A

Lung adenocarcinoma

second most common is breast cancer

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15
Q

What are the CT findings of lymphangitic carcinoma?

A 
Thickened septa +/- beading
Bronchovascular bundle thickening
Polygonal lines
Reticular lines
Subpleural beading
Pulmonary nodules usually coexist
unilateral and focal

It is important to look closely for beading and nodules as it allows differentiation with pulmonary edema, which is smooth.

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16
Q

What are the most common causes of cavitary pulmonary metastases?

A 
Squamous cell cancer
    - H&N
    - Lung
    - cervical
GI Adenocarcinoma
TCC
Sarcoma
Post-chemotherapy (other primaries)
17
Q

What are the most common causes of hemorrhagic pulmonary metastases?

A

Angiosarcoma
Choriocarcinoma
RCC
Melanoma

18
Q

What are the most common causes of hemorrhagic pulmonary nodules?

A 
Fungal Infection
Candidiasis
Vasculitis
Lymphoma
Metastases
19
Q

TRUE OR FALSE

In the followup of pulmonary metastases, the development of peritumoral hemorrhage or cavitation is a sign of response

A

FALSE

It can be observed post-treatment, but does not imply tumor response.

20
Q

What are the most common causes of calcified pulmonary metastases?

A 
Sarcoma
    - osteo, chondro, synovial
ADK
     - ovary, gastric, thyroid
Giant cell tumor
21
Q

What are the most common causes of endobronchial metastases?

A

Breast
Colorectal
Melanoma
RCC

22
Q

What are the most common causes of pleural-based metastases?

A 
Lung
Breast
Ovary
Stomach
Lymphoma
23
Q

What are the thoracic imaging findings of Behcet disease?

A 
Thrombosis
Pulmonary artery aneurysms
infarction
Hemorrhage
Arteriovenous shunt
Intracardiac thrombus
24
Q

What are the most common ANCA positive vasculitides?

A

Granulomatosis with polyangiitis (Wegener)
Microscopic polyangiitis
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

25
Q

TRUE OR FALSE

Cavitation of pulmonary lesions is typical of vasculitis

A

FALSE

It is typical of Wegener’s, but not other vasculitides.

26
Q

What is Constrictive bronchiolitis?

A

AKA Obliterative bronchiolitis or bronchiolitis obliterans.

It is a type of bronchiolitis and refers to bronchiolar inflammation with submucosal peribronchial fibrosis associated with luminal stenosis and occlusions.
The condition is characterised by concentric luminal narrowing of the membranous and respiratory bronchioles as a result of submucosal and peribronchiolar inflammation and fibrosis without any intraluminal granulation tissue or polyps/polyposis. There is an absence of diffuse parenchymal inflammation.

NOT THE SAME THING AS COP

27
Q

What are the causes of constrictive bronchiolitis?

A 
idiopathic
post-infectious
        viral, mycoplasma
noxious fume inhalation
neuroendocrine hyperplasia (pulmonary tumourlets) 
Graft versus host disease/post transplant
Rheumatoid arthritis
Sarcoid/Swyer-James

Mnemonic: CRITTS

28
Q

What are the plain radiograph and CT findings in constrictive bronchiolitis?

A

PLAIN RADIOGRAPH:

Normal or non-specific
Hyperinflation
Attenuation of vascular markings
Reticular/reticulonodular markings

CT SCAN:

Mosaic attenuation pattern (areas of decreased lung attenuation with small vascular markings)
Bronchial dilatation
Bronchial wall thickening
Ground glass opacities

29
Q

What is diffuse alveolar damage?

A

DAD is characterized by capillary endothelial and alveolar epithelial damage which results in exudation of fluid and products of cellular breakdown. It is multifactorial, and can be secondary to infections, inhalants, drugs, shock, sepsis and radiation.

It is the histologic pattern associated with ARDS and acute lung injury.

30
Q

What are the 3 phases of diffuse alveolar damage (histological)?

A

Acute/exhudative phase: First week after initial insult. There is capillary congestion, interstitial and intra-alveolar oedema associated with fibrin and formation of hyaline membranes. Thrombi may develop.

Organizing/proliferative phase: Occurs after 1–2 weeks and is characterised by fibroblast proliferation admixed with scattered mononuclear inflammatory cells, resulting in the formation of organised granulation tissue. Oedema is not prominent during this phase.

Chronic/fibrotic phase: Characterised by features of interstitial fibrosis, including alveolar septal thickening from collagen deposition.

31
Q

What are the imaging findings of Legionella pneumonia?

A

Bilateral multifocal consolidation. Ground glass opacities can be present.
Cavitation can be present in extensive consolidation. Can have subpleural/bronchovascular pattern.
Pleural effusions are common.

32
Q

What is the most common cause of ARDS?

A

Pneumonia

33
Q

What are the imaging findings of the 3 phases of diffuse alveolar damage?

A

Acute exhudative phase: heterogeneous foci of consolidation and ground-glass opacity with a gravitationally dependent gradient, with more consolidation in the posterobasal portions of the lungs. A diffuse crazy-paving pattern can also be seen. Air bronchograms and small pleural effusions are common.

Organizing/proliferative phase: reticulation and traction bronchiectasis may develop, often having an anterior predominance.

Chronic/fibrotic phase: reticulation and traction bronchiectasis may develop, often having an anterior predominance.

Fibrosis can improve, remain stable or progress to honeycombing.

34
Q

What CT findings suggest active lung disease in tuberculosis?

A

Cavitation
Consolidation
Ground glass opacities
Centrilobular opacities

35
Q

What is required to determine disease inactivity on plain chest radiograph in tuberculosis?

A

Radiographic stability 6 months apart

36
Q

What lung pathologies is the reverse halo sign associated with?

A

Mainly associated with COP.

Can also present in:

Vasculitis
Infarct
Sarcoidosis
Invasive fungal infection

And many other pathologies

37
Q

What lung pathologies is the halo sign associated with?

A

Mainly associated with angioinvasive fungal infection (aspergillosis).

Other pathologies:

Other fungi
Septic emboli
TB/MAI
Primary neoplasm/metastases
COP/CEP
Wegener
HP
38
Q

What is the anatomic boundary used to differentiate right from left paratracheal lymphadenopathy?

A

The left lateral wall of the trachea seperates left from right

39
Q

In esophageal carcinoma, what is the determining factor when assessing the N staging of a tumor?

A

The number of involved lymph node stations determines N

Chest/Cardiac (3 decks)

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