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1
Q

2 types of lipomatous lesion involving a joint

A
  • intra-articular lipoma (very rare)
  • lipoma arborescens (more common)
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2
Q

Types of ovarian tumor

A
  • surface epithelial-stromal tumor / epithelial carcinoma
    • serous
    • endometroid
    • mucinous
    • Brenner tumor - transitional-type epithelial cells with longitudinal nuclear grooves (coffee bean nuclei) lying in abundant fibrous stroma
    • transitional cell carcinoma
  • sex cord-stromal tumor
    • granulosa
    • sertoli-leydig cell
  • germ cell tumor
    • teratoma
    • dysgerminoma - LDH
    • endodermal sinus tumor - AFP
    • choriocarcinoma - beta-hCG
  • mixed tumors
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3
Q

Neurogenic tumors

A

Arising from:

  • peripheral nerves or nerve sheath
    • neurofibroma
    • neurilemmoma
  • sympathetic ganglia
    • ganglioneuroma
    • neuroblastoma
  • paraganglial cells
    • pheochromocytoma
    • chemodectoma
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4
Q

Most common cause of a posterior mediastinal mass in patients with neurofibromatosis?

A

Anterior and lateral thoracic meningocele

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5
Q

How do you tell bronchiectatic airways from cystic lung disease on CXR?

A
  • bronchiectatic airways - can contain air fluid levels
  • cystic lung disease - should not contain air fluid levels unless there is secondary infection
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6
Q

Saying:

“hazinessness along the walls of vessels and ill-definition of the bronchi”.

A

“hazinessness along the walls of vessels and ill-definition of the bronchi”.

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7
Q

Difference in location of NSIP and UIP

A
  • UIP is strictly peripheral/subpleural
  • NSIP can be central
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8
Q

When the aorta is tortuous…

A

It can pull the left lung and pleura to the right along with it

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9
Q

PJP

A

Usually just GGO

NO discrete nodules

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10
Q

What should you see at the level of superior hila

i.e., at the level of carnia?

A

Right: apical segment bronchus

Left: apicoposterior segment bronchus

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11
Q

Superior segment bronchus in lower lobes take off at which level?

A

Bronchi of the superior segments of the lower lobes

take off at the same level as the

RML and lingular bronchus take off/bifurcation

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12
Q

Phlegmasia cerulea dolens

= painful blue edema

Uncommon severe form of DVT

A

Phlegmasia alba dolens

= painful white edema

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13
Q

Phthisis bulbi

A
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14
Q

Bronchial abnormality detected on CT

A
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15
Q

Bronchogenic tumors

A
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16
Q

Difference b/t hilar lymphadenopathy caused by

lymphoma/TB vs sarcoidosis?

A
  • lymphoma/TB - often asymmetric LAD
  • sarcoidosis - often symmetric LAD
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17
Q

Types of mediastinitis

A
  • Acute mediastinitis
    • related to esophageal perforation or spread of infection
    • patient +++ sick
  • Granulomatous mediastinitis
    • TB, fungal (histo/cocci), sarcoid
    • often asymmetric LAD (except sarcoid - symmetric LAD)
    • calcification and fibrosis common
  • Sclerosing/fibrosing mediastinitis
    • similar process as retroperitoneal LAD
    • calcification does NOT occur*
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18
Q

Thyroid tumor

A
  • Although the primary site of carcinoma within the thyroid may be iodine avid, pulmonary metastases may not be secondary to tumor dedifferentiation.
  • US characteristics include hypoechogenicity (solid), internal vascularity, presence of microcalcifications, and a nodule that is taller than it is wide.
  • Microcalcifications, also known as psammoma bodies, are round, laminar, crystalline calcific deposits of 10–100 um. They are one of the most specific features of thyroid malignancy, with a specificity of 85–95%, and are most common in the papillary variant.
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19
Q

Sayings:

“Extensive mediastinal adenopathy as described. In addition there are multiple tiny indeterminate pulmonary nodules.

This in combination with the abdominal findings would render a neoplastic process the diagnosis of exclusion-metastatic disease from an occult primary, or lymphoma.

Given the enhancement of the lymph nodes, plasma cell subtype type of Castleman’s disease would be a lesser consideration. “

A

“Extensive mediastinal adenopathy as described. In addition there are multiple tiny indeterminate pulmonary nodules.

This in combination with the abdominal findings would render a neoplastic process the diagnosis of exclusion-metastatic disease from an occult primary, or lymphoma.

Given the enhancement of the lymph nodes, plasma cell subtype type of Castleman’s disease would be a lesser consideration. “

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20
Q

Sayings:

“DDx would include…, and less likely, …”

“Consider…, if clinically relevant.”

A

“DDx would include…, and less likely, …”

“Consider…, if clinically relevant.”

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21
Q

Most common location of tracheal bronchus

i.e., “pig bronchus”

A

RUL

usually the apical segment of the RUL

associated with recurrent infections

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22
Q

Bronchial atresia

A
  • LUL most common location*
  • local narrowing or obliteration of a lobar/segmental/subsegmental bronchus
  • mucus plugging in bronchi distal to the obstruction - tubular, branching, or ovoid mucus plug - “finger in glove”
  • air trapping in the lobe b/c collateral air flow - hyperlucent or hypovascular
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23
Q

DDx for “finger in glove” appearance

A
  • ABPA
  • congenital bronchial atresia
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24
Q

Most common location for pulmonary sequestration?

A

Posteromedially on the left

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25
Q

Pulmonary AVM is associated with which syndrome?

A

Osler-Weber-Rendu syndome

aka

Hereditary hemorrhagic telangiectasia

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26
Q

“2 faces” of AVM

A
  • a single dilated vascular sac - smooth, sharply defined, round or oval nodule (most common)
  • a tangle of dilated tortuous vessels - lobulated or serpiginous mass
  • most common location of pulmonary AVM - immediately subpleural
  • with contrast - rapid and dense opacification –> rapid washout
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27
Q

Intralobular vs Extralobular

pulmonary sequestration

A
  • Intralobar - infection - adults
  • Extralobar - infants and children
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28
Q

4 features of hypogenetic lung syndrome

scimitar syndrome

A
  1. hypoplasia of the right lung/lobe/segment
  2. hypoplasia of the right pulmonary artery
  3. PAPVR draining the RUL or entire right lung to the IVC or RA
  4. *systemic arterial supply to a portion of the hypoplastic right lung (often the lower lobe)*
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29
Q

4 features of rounded atelectasis

A
  1. ipsilateral pleural disease - thickening or effusion
  2. volume loss - atelectasis
  3. comet tail sign - swirling of bronchovascular structures
  4. *extensive contact with the pleural surface*
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30
Q
A
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31
Q

“air crescent sign”/”monod sign”

in angioinvasive aspergillosis vs

aspergilloma/mycetoma

A

angioinvasive aspergilloma

  • infarcted and necrotic lung pulling away from the remainder of the lung within the cavity
  • air crescent sign

aspergilloma/mycetoma

  • fungus ball occupying a pre-existing cavity
  • also called “monod sign”
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32
Q

What does “satellite nodules” indicate?

A

A granulomatous process

  • TB
  • fungal
  • sarcoidosis (“Sarcoid Galaxy” Sign)
  • etc
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33
Q

Approach to ground glass opacity

A
  • differentiate which is abnormal - GGO or lucent lung?
    • usually GGO is abnormal
    • lucent lung is abnormal if the vessels are diminished
  • acute vs chronic
    • acute
      • infection (atypical - PCP)
      • edema
      • hemorrhage
      • subacute HSP
    • chronic
      • PAP
      • BAC
      • fibrosis - UIP/NSIP
      • DIP
      • lipoid pneumonia
      • bronchiolitis obliterans
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34
Q

3 lung diseases with cysts as the primary manifestation

A

3L’s

  • LAM
  • Langerhans histiocytosis/EG
  • LIP (Sjogren’s syndrome)
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35
Q

Causes for pulmonary alveolar proteinosis

PAP

A
  • idiopathic - most often
  • exposure to dusts (silica)
  • hematologic/lymphatic malignancy
  • chemotherapy
  • PAP is associated with what infection?
    • nocardia
    • mycobacteria
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36
Q

DDx for bronchiolitis obliterans organizing pneumonia

organizing pneumonia

(peripheral distribution, atoll sign)

A

IIADE

  • idiopathic - cryptogenic organizing pneumonia
  • infection
  • autoimmune
  • drug toxicity/toxins
  • eosinophilic pneumonia
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37
Q

Lymphangiomyomatosis

LAM

is associated with…

A

Tuberous sclerosis (TS)

  • LAM
  • exclusively child-bearing age women
  • associated with
    • lymphadenopathy
    • chylothorax
    • pneumothorax
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38
Q

The presence of air within the empyema is due to:

A
  • recent thoracentesis (most common)
  • bronchopleural fistula
  • gas-forming organism
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39
Q

Empyema necessitatis

A
  • extension of an empyema to involve the chest wall
  • TB - 2/3 of the cases
  • actinomyces
  • nocardia
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40
Q

Saying:

“asbestos related pleural disease”

A

“asbestos related pleural disease”

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41
Q

Which layer of pleura is involved in

asbestos related pleural disease?

A

Parietal pleura

diaphragmatic pleural often involved

42
Q

Features of malignant involvement of the pleura

A
  • nodular thickening
  • >1cm in thickness
  • involving mediastinal pleura
  • concentric pleural thickening that encases the lung
43
Q

Localized fibrous tumor of the pleura

A
  • arises from visceral pleura
  • associated with
    • chest pain
    • hypoglycemia
    • hypertrophic pumonary osteoarthropathy - HPOA
  • 70% benign, 30% malignant
44
Q

thymoma drop mets

A

usually NOT associated with pleural effusion

45
Q

DDx for pleural calcifications

A
  • prior asbestos exposure
  • prior empyema - TB most comon
  • resolved hemothorax
  • talc pleurodesis
46
Q

Borders of the axillary space

A
  • anterior - pectoralis major and minor
  • posterior - latissimus dorsi, teres major, subscapularis
  • medial - chest wall, serratus anterior
  • lateral - coracobrachialis, biceps
47
Q

Diaphragmatic hiatus

A
  • aortic hiatus
    • aorta
    • azygos
    • hemiazygos
    • thoracic duct
    • intercostal arteries
    • splanchnic nerves
  • esophageal hiatus
    • esophagus
    • vagus nerves
    • small blood vessels
  • IVC hiatus
    • IVC
48
Q

Abnormality?

A

Left atrial appendage thrombus in A-Fib

  • Most common arrhythmia - atrial fibrillation
  • Most common site of thrombus formation in patients with atrial fibrillation - left atrial appendage
  • Test of choice to detect LA appendage thrombus - TEE
  • Pulmonary vein ostia - overwhelmingly are the origin of ectopic activity initiating atrial fibrillation
  • Identification of atrial thrombus is important as it is an absolute contraindication to radiofrequency ablation therapy.
  • Cardiac CT is most frequently used for anatomical mapping prior to ablation of arrhythmogenic foci and also has a very high sensitivity for the detection of thrombi.
49
Q

Left paraspinal line often follows the course of the tortuous aorta

A

Left paraspinal line often follows the course of the tortuous aorta

50
Q

DDx for acute interlobular septal thickening

A
  • edema
  • acute eosinophilic pneumonia
  • pulmonary veno-occlusive disease
51
Q

ARDS

vs

cardiogenic pulmonary edema

A
  • cardiogenic edema often has pleural effusions
  • ARDS/non-cardiogenic edema has less pleural effusion
52
Q

Reverse westmark sign

A

infarcted lung (secondary to PE) within atectatic lung - due to relative hypoperfusion

53
Q

What lung tumor often gives you dense bone mets?

A

Carcinoid

54
Q

Cephalohematoma

A
  • Cephalohematoma is a traumatic SUBPERIOSTEAL hemorrhage due to rupture of blood vessels between the skull and the periosteum, and it is confined by cranial sutures.
  • They are thought to result from birth trauma, with risk factors including prolonged and difficult deliveries. They usually increase in size after birth.
  • On CT or MR imaging, these typically appear as crescent-shaped lesions adjacent to the outer table of the calvarium, confined by cranial sutures and possibly calcified. MR signal intensity is dependent on age of the blood products.
  • Patients with cephalohematoma are typically managed conservatively. They can occasionally become infected, possibly requiring antibiotics and/or I&D. These typically resolve over months with skull growth and bony remodeling; prolonged resorption can lead to calcification.
55
Q

Most common pattern of ILD?

A

UIP - 40%

NSIP - 20%

smoking related (RB/DIP) - 20%

organizing pneumonia - 20%

56
Q

Diagnostic criteria for UIP

A
  • subpleural, basal predominance
  • reticular abnormality
  • honeycoming with or without traction bronchiectasis
  • absence of features inconsistent with UIP

“Possible” UIP

  • absence of honeycombing (only present in 70-80% of patients with UIP)
57
Q

Diagnostic criteria for NSIP

  • better survival than UIP
  • usually associated with an underlying condition
    • collagen vascular disease
    • drug toxcities (e.g. nitrofurantoin)
    • hypersensitivity pneumonitis (environmenta exposure)
  • 2 types
    • fibrotic - most common
    • cellular
A
  • basal predominance
  • ***more perivascular; but subpleural sparing***
  • confluent pattern
  • volume loss
  • groundglass
  • reticular
  • traction bronchiectasis
  • consolidation +/- honeycombing rare
58
Q

Best predictor of NSIP

as opposed to UIP etc?

A

Subpleural sparing

59
Q

Best predictor of chronic hypersensitive pneumonitis?

A
  • lack of upper lung predominance
  • upper and mid lung predominance
60
Q

RB

RB-ILD

difference: with vs without clinical symptoms

A
  • “dirty lung” appearance
  • centrilobular nodules
  • groundglass
  • +/- emphysema
61
Q

DIP

A
  • basal, peripheral predominance
  • groundglass
  • reticular
  • cysts
62
Q

Organizing pneumonia

causes

IIADE

  • idiopathic
  • infectious
  • autoimmune/collagen vascular disease; aspiration
  • drugs
  • eosinophilic
A
  • subpleural/peribronchial
  • consolidation
  • groundglass
  • perilobular thickening/irregular thickening of the interlobular septa
  • reverse halo/atoll sign - peripheral conslidation and central ggo
63
Q

Overall most common pattern of ILD in patients with collagen vascular disease

A

NSIP

64
Q

Most common pattern of ILD in rheumatoid arthritis

A

UIP

65
Q

Most common pattern of ILD in patients with scleroderma

A

fibrotic NSIP

pulmonary HTN WITH OR WITHOUT lung disease

66
Q

SLE and ILD

A
  • fibrotic ILD uncommon in patients with SLE
  • if ILD does occur - NSIP, UIP
67
Q

LIP is most common associated with which collagen vascular disease?

A

Sjogrens

68
Q

Causes of ALI and ARDS

A
  • Pulmonary
    • infection - bacterial, viral, fungal (PCP)
    • near-drowning
    • toxic fume inhalation
    • lung contusion
  • Extra-pulmonary
    • systemic sepsis
    • non-thoracic trauma
    • hypertransfusion (TRALI)
    • cardiopulmonary bypass
69
Q

Typical appearance of ALI and ARDS

A

A gradient

dependent lungs are more dense (areas of more edematous, atelectatic lungs)

but dependent lungs being atelectatic, are protected from barotrauma from high pressure ventilation

70
Q

Breast angiosarcoma

A
  • 2 types of angiosarcoma:
    • primary - typically affects women at a younger age, usually in the third or fourth decade of life. There are no known risk factors for primary angiosarcoma
    • secondary - older women; related to prior radiation and lymphedema
  • The most common presentation of angiosarcoma of the breast is a palpable, rapidly enlarging, unilateral, painless mass with possible associated bluish discoloration of the overlying skin.
  • The prognosis for angiosarcoma depends upon the tumor grade.
71
Q

Types of centrilobular “stuff”

A
  • discrete centrilobular nodules
    • silicosis/CWP; siderosis (welder - iron deposition)
    • infection
    • aspiration
  • centrilobular nodules with a tree-in-bud appearance (nodules + linear stuff)
    • infection
    • aspiration
    • centrilobular spread of tumor
  • centrilobular groundglass
    • subacute hypersensitivity pneumonitis
    • respiratory bronchiolitis - RB/RB-ILD
    • infection (viral)
    • follicular bronchiolitis
72
Q

Pulmonary hypertension

vs

Pulmonary arterial hypertension

A
  • pulmonary hypertension
    • resting meanPAP > 25mmHg
    • of any cause
  • pulmonary arterial hypertension
    • subgroup of pulmonary hypertension with a normal pulmonary venous pressure (wedge pressure < 15mmHg)
73
Q

Pulmonary arterial dilatation and calcification

A

common in patients with longstanding left to right shunt

74
Q

Pulmonary veno-occlusive disease

PVOD

A
  • idiopathic
  • associated with
    • collagen vascular dz (scleroderma)
    • bone marrow transplant
    • HIV
    • sarcoid
    • langerhans cell histocytosis
    • smoking
    • cytotoxic drugs and radiation
  • age mean = 40y/o
  • m=f
  • imaging
    • smooth interlobular septal thickening
    • GGO centrilobular nodules
    • mediastinal LAD
    • enlarged right heart chambers
75
Q

Pulmonary capillary hemangiomatosis

PCH

A
  • idiopathic
  • predisposing factors similar to PVOD
  • HRCT imaging features similar to PVOD
    • except that groundglass centrilobular nodules more common*
  • as PVOD, Px worse than PAH
76
Q

Coronary artery dominance

A
  • right dominant - 85%
  • left dominant - 7.5%
  • co-dominant - 7.5%
    • RCA –> PDA; LCX –> PLA
    • RCA and LAD both –> PDA’s
77
Q

Abnormal proximal course of coronary artery

A
  • inter-arterial - malignant - sudden death
    • direction compression by aorta and main PA
    • acute angle of the ostium arising from the aorta
    • slit-like ostium (rather than round)
    • intra-mural course - vessel traveling within the adventitia of the aorta - Rx - unroofing
  • other
    • septal
    • pre-pulmonic
    • retro-aortic
78
Q

Abnormal coronary termination

A
  • coronary-cameral fistula - coronary terminates within a cardiac chamber, often RV
  • coronary-coronary sinus fistula
  • coronary-PA fistula
  • coronary-SVA
  • dilated tortuous coronary arteries

complications

  • right to left shunt
  • steal phenomenon - normal myocardium cannot get enough blood due to shunt
79
Q

Indications for CABG

A
  • left main disease
  • triple vessel disease
  • medically refractory disease
80
Q

Best to evaluate the mitral and tricuspid valves

A
  • 4 chamber view
  • spical displacement of the septal leaflet of the tricuspid valve –> Ebstein anomaly
81
Q

Grades of aortic stenosis

A
  • mild > 1.5cm2
  • moderate 1-1.5cm2
  • severe < 1cm2
82
Q

Mitral valve prolapse

MVP

A
  • MV bowing into the LA by 2mm in systole
  • common cause of MR
83
Q

Counterpulsation IABP

intra-aortic balloon pump

A
  • systole - balloon deflates, allowing systemic perfusion
  • diastole - balloon inflates –> increases afterload (EDP) ==> allowing blood to prefuse the coronary arteries
  • position
    • proximal end should be immediately distal to the left subclavian artery
84
Q

Acute papillary muscle rupture

A
  • acute MI can cause acute rupture of the papillary muscle and/or cordae tendineae
  • acute mitral regurgitation
  • pulmonary edema in the RUL (regurg directed at the right superior pulmonary vein)
85
Q

True vs false LV aneurysm

A
  • True aneurysm
    • apical/apicoanterior
    • rarely ruptures
    • wide mouth/orifice = neck/body dimension = 1
    • pericardial LGE
  • False aneurysm
    • posterior/posterolateral
    • risk of rupture
    • narrow mouth/orifice = neck/body dimension ratio<1
    • mural LGE
86
Q

Cardiomyopathy on CMR

A
  • ischemic dilated cardiomyopathy
    • subendocardial or transmural LGE
  • idiopathic dilated cardiomyopathy
    • poor systolic function
    • dilated ventricles and atria
    • no LGE or linear midwall LGE
  • other non-ischemic non-idiopathic CMP
    • alcohol
    • toxins
    • autoimmune
    • endstage viral myocarditis
      *
87
Q

DDx of arrhythmias and focal systolic dysfunction in a young patient?

A
  • ARVC/ARVD
  • non-compaction
    • failure of compaction of the endocardium during 5-8 wk of embryogenesis
    • over-trabeculated endocardium –> lacy appearance
    • 2:1 ratio - trabeculated/compacted myocardium
    • apex, inferior and lateral walls
    • NO LGE
    • can co-exist with complex CHD
  • cardiac sarcoidosis
88
Q

Viral myocarditis on CMR

A
  • T2 edema
  • pericardial effusion
  • usually focal hypokinesis
  • LGE - subepicardial most typical***; can be nodular or transmural
    • DDx for subepicardial LGE
      • viral myocarditis
      • polymyositis
      • sarcoidosis
      • muscular dystrophy
89
Q

Tako Tsubo cardiomyopathy

A
  • broken heart syndrome
  • reversible
  • severe stress –> catecholamine release –>
  • middle aged women
  • ECG similar to stress induced ischemia
  • akinesia of the mid to apical LV, preserved contractility at the basal LV –> LV ballooning during systoli (octopus pot)
  • NO LGE
90
Q

What do you think about in a patient with both

systolic and diastolic dysfunction?

A
  • restrictive/infiltrative cardiomyopathy
  • LV and RV walls can be thick but normal size***
  • marked dilatation of the LA and RA***
  • pleural effusions, pulmonary edema, dilated IVC, hepatic veins and coronary sinus; nutmeg liver
  • need to differentiate from constrictive pericarditis*
    • pericardial thickening and calcification
    • enhanced interventricular dependence with inspiration
91
Q

Cardiac amyloidosis

A
  • thickened LV and RV
  • diffuse hypokinesis
  • LGE - subepicardial*, transmural, mesocardial
    • can be circumferential
    • RV LGE maybe seen
    • poor opacification of lumen
    • difficulty determining inversion time
92
Q

DDx for circumferential subendocardial LGE

A
  • 3 vessel CAD with infarcts
  • amyloidosis
  • eosinophilic cardiomyopathy
  • fabry disease
  • post-cardiac transplant cardiomyopathy
93
Q

Cardiac sarcoidosis

A
  • subepicardial, mesocardial, or transmural
  • nodular, linear, or confluent
  • can be reversible with steroids
  • most common location - LV base, lateral wall, septum
  • pulmonary sarcoidosis almost always present
94
Q

Distinctive pattern of LGE in patients with cardiomyopathy secondary to pulmonary hypertension of any cause

A

LGE at the RV attachment to the septum both anteriorly and inferiorly - due to chronic mechanical shear injury at the attachment sites from pulmonary hypertension

95
Q

Hypertrophic cardiomyopathy

A
  • autosomal dominant, variable penetrance
  • Dx - anteroseptal wall at end distole > 12mm
  • obliteration of LV lumen
  • mesocardial LGE
  • thick and abnormally arranged myocardium
    • myocaridal infarct
    • ventricular arrhythmias (Vfib and sudden death)
  • 4 types
    • diffuse
    • septal
    • apical
    • mid-ventricular
  • systolic anterior motion of the septal leaflet of the mitral valve (SAM)
    • seen with septal* hypertrophic cardiomyopathy/obstructive hypertrophic cardiomyopathy (HOCM)
    • LVOT narrowing –> neg pressure –> Venturi effect - anterior motion of the septal leaflet of the mitral valve –> further narrowing the LVOT – subaortic dephasing jet, eccentric mitral regurg jet
96
Q

Patterns of LGE and Dx

A
  • subendocardial
    • infarct
    • amyloidosis
    • eosinophilic cardiomyopathy
    • cardiac transplant CMP
    • polymyositis
  • mesocardial
    • hypertrophic cardiomyopathy
    • dilated cardiomyopathy
    • pulmonary hypertension
  • subepicardial
    • viral myocarditis
    • sarcoidosis
  • transmural
    • infarction
    • myocarditis (severe)
    • sarcoid (chronic)
  • patchy
    • sarcoid
    • amyloid
    • myocarditis
97
Q

Types of endoleak

A
  • type I - at the stent graft ends - proximal or distal
  • type II - retrograde filling from branch artery
  • type III - damaged integrity of the stent graft

NOTE: endovascular stent graft can only be used for type B dissection; if there is type A dissection, elephant trunk procedure needs to be performed - i.e., open repair of type A and hybrid open and endovascular repair of the discending aorta

98
Q

Cervicothoracic sign

and

Thoracoabdominal sign

A

Cervicothoracic sign

  • if a mediastinal mass is well defined superior to the clavicles, it must be POSTERIOR
  • an anterior mediastinal mass is silhouetted by soft tissues of the neck

Thoracoabdominal sign

  • if a mediastinal mass is well defined / extends below the dome of diaphgram, it must POSTERIOR
  • an anterior mediastinal mass is silhouetted by the diaphgram
99
Q

Hilar overlay sign

and

Hilar convergence sign

A

Hilar overlay sign

  • if hilar vessels project through the the mass, the mass must be either anterior or posterior to the hilum

Hilar convergence sign

  • if vessels converge on the hilar opacity, the opacity is likely a pulmonary artery
  • if vessels course through the hilar opacity, the opacity is likely a mediastinal nodule/mass
100
Q

Distribution of endemic fungal infections

A
  • Histoplasmosis - Mississippi, Ohio, St. Lawrence River Valley –> nodules
  • Blastomycosis - Wisconsin & Minnesota (but entire central and eastern North America) –> consolidation and mass that can cavitate; also bone infection!***
  • Coccidioidomycosis - California, Arizona, San Joaquin Valley –> consolidation coalesce to become nodule
  • Cryptococcosis
    • C. neoformans –> mainly immunosuppressed (opportunistic fungus), HIV
    • C. gattii –> healthy hosts

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