Recognizing diseases of the chest. Flashcards
Ddx for anterior mediastinal masses
Substernal thyroid masses Lymphoma Thymoma Teratoma Lymphoma is sometimes called “terrible lymphoma” so that all of the diseases in the list start with the letter T.
Most frequently encountered anterior mediastinal mass in practice
enlarged substernal thyroid mass –usually a multi nodular goiter
whenever you see anterior mediastinal mass that displaces trachea, think:
enlarged substernal thyroid
Most common cause of mediastinal mass overall
Lymphadenopathy
Anterior mediastinal lymphadenopathy is most common in what disease?
Hodgkin, especially nodular sclerosing. Mediastinal lymphadenopathy in HD is usually BL and asymmetrical
Thymomas are associated with what other disease?
Myasthenia gravis – 35% of the time. 13% of pts with MG will be found to have a thymoma. Importance lies in pts with MG lies in the favorable prognosis for pts with MG after thymectomy.
ID.
Massive thymoma.
ID.
This is a thymoma. Smooth or lobulated mass that arises near junction of heart and great vessels which may contain calcifcation.
Posterior mediastinum is the site of masses representing ____ ?
Extramedullary hematopoiesis. Most importantly, it is the home of tumors of NEURAL origin (i.e., in the paravertebral gutters).
ID.
Neurofibroma –arising from schwann cell of nerve sheath
Which type of pulmonary CA grows the most rapidly? Which is the slowest?
ID abnormality. Which disease is this found in?
Scalloping of verteral bodies in NF. Diverticula of thecal sac caused by dysplasia of the meninges that leads to erosion of adjacent bone through pulsations transmitted via spinal fluid.
ID abnormality.
TB granulomas – common sequelae of prior, usually subclinical, TB infecion and homogenously calcified.
ID abnormality.
Hamartoma of lung – peripherally located tumor of disorganizd lung itssue that classically contains fat and “popcorn calcification”
ID abnormality.
Bronchogenic CA with hilar adenopathy (
ID black oval.
Hampton HUMP. Wedge shaped peripheral airspace density associated with filling defects in both the left and right pulm arteries.
What disease does this pt have?
Centriacinar emphysema –focal destruction limited to resp bronchioles and central portions of acinus. Associated with cigarette smoking; most severe in UPPER lobes.
What dz does this pt have?
Panacinar emphysema involves entire alveolus distal to the terminal bronchiole, is most severe in LOWER lung zones and generally develops in pts with homozygous alpha1 antitrypsin deficiency.
What dz does this pt have?
Paraseptal emphysema –least common form of emphysema. Involves distal airway structures, alveolar ducts, and sacs, tends to be subpleural, and may cause pneumothorax. They also have subpleural bullae.
ID what is shown by white arrows.
This is tram-tracking –parallel line opacities due to thickened dilated bronchial walls seen in bronchiectasis 2/2 usually CF or Kartageners.
