Resp - ILD Flashcards
- Calcified Mediastinal Lymph Nodes
- Egg Shell Calcification
Tuberculosis
Histoplasmosis
Amyloidosis (rare)
Metastases: papillary/medullary thyroid cancer, osteosarcoma, mucinous adenocarcinoma
egg-shell calcification**
Silicosis and coal workers pneumoconiosis
Sarcoidosis
Alpha 1 antitrypsin deficiency
Deficient liver glycoprotein
CT features
CT - panacinar emphysema at bases +/- bronchiectasis
Cirrhosis
Describe LAM
Lymphangioleiomyomatosis
Patient demographic?
CT findings
Differential
Non-smoking women childbearing age +/- history spontaneous pneumthorax
CT features
Normal lung with small cystic spaces
Chylous pleural effusion
Normal lung volumes
Differential
Histiocytosis - associated with smoking, small nodules and small cysts, pneumothorax.
Increased lung volumes
What lobe is affected in congential lobar overinflation?
Usually left upper lobe
Why? Undeveloped bronchial cartilage, and subsequent air trapping
Hyperlucency on CXR, and mediastinal shift.
What is Swyer-James Syndrome?
Normal development of infant lung impeded by bronchiolitis, with superadded infection.
Air trapping makes CXR lucent.
Unilateral Hyperlucency on CXR
Congential lobar overinflation (cartilage)
Swyer-James (infant bronchiolitis)
Large PE
Poland syndrme
Anterior junctional line
Formed by meeting of parietal and visceral pleura anteromedially
Posterior junctional line
Meeting of pleural surfaces of upper lobes behind oesophagus.
Azygo-oesophageal recess
Right lung and mediastinal reflection of azygous vein
Right paratracheal line
Right paraspinal stripe
*Right paratracheal line right wall trachea and right lung
**Right paraspinal stripe **- right lung and posterior medialstinal soft tissue
Reverse Halo Sign
Cryptogenic Organising Pneumonia (BOOP)
Others:
GPA
Sarcoidosis
Peumocystis carinii pneumonia
Halo sign
Invasive aspergillosis
(Central nodule with surrounding ground glass - haemorrhage)
Others
* Haemorrhagic mets
* Bronchoalveolar carcinoma
* Mycobacterials
* Hypersensitivity pneumonitis
What is Monrod sign
Air crescent surrounding aspergilloma
(Aspergilloma forms in immunocompetent patients with pre existing lung cavities)
Upper Zone Involvement
B - Beryllosis
R - Radiation
E - Eosinophilic granuloma (LCH) and EAA
A- Ank Spondylitis, amiodarone
S - Sarcoidosis
T - TB
S - Silicosis
Lower Zone Involvement
B - Bronchiectasis
A - Aspiration Pneumonia
D - Drugs and DIP
A - Asbestosis
S - Scleroderma (and RA)
Asbestosis features
Bilateral calcified pleural plaques
Spares CP angles
(mediastinum involvement - mesothelioma)
Unilateral pleural plaques - previous insult eg surgery, empyema.
Crazy paving
(interlobular septal thickening and GGO)
- Alveolar proteinosis
Others:
Goodpastures (haemorrhage)
Idiopathic pulmonary haemosiderosis -iron deposition
Sarcoidosis
Goodpasture syndrome presents glomerulonephritis/haemoptysis (anti-GBM)
Sarcoid Demographic
CT Features
- Young, female, black, hypercalcaemia
- Garland triad, egg shell calcification, traction bronchiectasis, upper lobe predominance, perilymphatic nodules.
LCH v LAM
q2 table
What gives cystic change, nodules, upper lobe predominant, INCREASES lung volume, pneumothorax
LCH -strong association with smoking, Spares CP angles.
To different from LAM
-LAM no volume change
-chylous effusion
Upper lobe GGO, reticulations, increased liver density. History of AF..
What is it?
Am(iod)arone induced lung and liver disease.
CT features
- increased liver density
10% develop lung disease
- GGO, reticulations, consolidation, pleural effusion.
What spares CP angles?
LCH
Asbestosis
Name the condition;
1. Heavy smoking
2. Centrilobular nodules
3. GGO
RBILD
Respiratory Bronchiolitis Interstitial Lung Disease - upper lobe dominant
Addition: DIP Desquamative interstitial pneumonia is though of as end spectrum of RB-ILD
Recreational drugs
Particulate matter, hyperdense centilobular matter
Cavitating lung lesions
Apical bull/pneumothorax
Perihilar airspace opacification
LRTI
Nasal septal destruction
Lung abscess/pseudoaneurysm
Particulate matter, hyperdense centilobular matter - Talcosis
Cavitating lung lesions - Septic emboli, non-sterile IV
Apical bull/pneumothorax - inhalational drugs
Perihilar airspace opacification - cocaine, heroin, meth
LRTI - Aspiration
Nasal septal destruction - snorting cocaine
Lung abscess/pseudoaneurysm - injection site.
Causes of cystic lung disease..
LCH (Langerhans Cell Histiocytosis) - smoker, centrilobular nodules, cavitation into cysts, upper lobe/mid zone, spares CP angle
Lymphangiomyomatosis (LAM) - child bearing age, TS, thin walled round cysts, uniform distribution, chylothorax.
Birthday Hogg Dube - associated with bilateral oncocytomas and chromophobe RCCs. Lower lobe predominant.
LIP
PCP.
What is associated with Lymphocytic Interstitial Pneumonia (LIP)?
SJOGRENS (+sle + RA)
HIV (young)
Benign lymphoproliferative disorder lung infiltration.
Ground glass appearance in hilar/mid zone distribution. Can have apical cystic form associated with penumothorax..
PCP (Pneumocystitis pneumonia)
Nb AIDS + ground glass change = PCP
AIDS + pneumothorax = PCP
Define emphysema
Permanent enlargement of airspaces distal to the terminal bronchioles with alveolar wall destruction.
CXR findings: flattened hemi-diaphragm, AP diameter increases, increase retrosternal space.
Other:
Saber sheath trachea - coronal narrowing. Pathognomonic for COPD.
On CT, if Main PA >aorta, (PA/A ratio >1), indicates pulmonary HTN + worse outcome.
Which emphysema is upper lobe predominant, associated with smoking, and common in asymptomatic elderly. Focal lucency with central dot sign (bronchovascuar bundle).
Centrilobular emphysema.
Emphysema - lower lobe predeominant, associated with alpha 1 anti-trypsin
Pan - lobular
Usually presents in 60-70s but will present if 30s if smoker
Emphysema with subpleural Lucencies?
Para-septal
Less than three bubbles thick.
Describe Asbestosis
This is the lung fibrosis associated with exposure (not exposure itself).
Similar appearance to UIP - pleural thickening is the differentiating factor.
20 year latency between exposure + lung ca/mesothelioma.
Benign pleural effusion earliest benign related change. Pleural plaque 20-30 years. Calcifications 40yr.
Plaques spare spices and CP angles.
Round atelectasis is a mass like opacity with associated pleural thickening .
30-40yrs lag time to mesothelioma.
What disease is associated with nodular opacities, +egg shell calcification of the hilar nodes.
Silicosis
Who ? Miners and quarry workers
Simple form described above.
Complicated form - Progressive Massive Fibrosis.
This scan also be seen in coal workers pneumonicosis - secondary to exposure to washed coal.
Silicosis raises risk of TB x3, so if cavitation think silicotuberculosis
Macrocystic honeycombing
+/- bronchiectasis
Reticular abnormalities
Subpleural basal predominant distribution
Usual Interstitial Pneumonitis
When cause is idiopathic it’s Idiopathic pulmonary fibrosis
Macrocystic honeycombing, traction bronchiectesis, apicobasilar gradient.
CHRONIC HYPERSENSITIVITY v UIP - CHONIC HP involves air trapping (3 or more lobes), mid-upper lobe fibrosis.
Ground glass
SUBPLEURAL SPARING
Posterior lower lobe predominance
NSIP (Non-specific interstitial pneumonia = is specific)
UIP v NSIP
UIP - apico to basilar gradient, heterogenous histology, honeycombing, traction bronchiectasis
NSIP - slight lower lobe predominance, homogenous , ground glass, (honeycombing if any is microcystic), SUBPLEURAL sparing
African American female, 20-40, non-caseating granuloma, raised ACE, hypercalcaemia.
Lofgren syndrome -
1) Bilateral lymph node enlargement
2) Ankle arthritis
3) Erythema nodosum
Sarcoidosis
- PERI-LYMPHATIC NODULES
- UPPER LOBE PREDOMINANCE
Garland Triad, Lambda sign Gallium scan, CT galaxy sign
Most common Lung Cancer
Non Small Cell Adenocarcioma
Peripheral tumour. Most common to present at solitary pulmonary nodule. Most common type in non smoker. Associated with pulmonary fibrosis.
Most common central tumours
Non small cell - squamous — cavitation is classic. Paraneoplastic syndrome common with ectopic PTH hormone.
Small Cell — Associated with Lambert Eaton (proximal weakness - aCh related). Also related to SIADH. Bad prognosis.
Both central - both related to smoking.
What is the largest lung cancer?
Non small cell - Large cell
This is peripheral. Least common. Usually large (>4cm). Poor prognosis.
Name 4 types lung cancer?
LA on the coast.
Large, non small cell
Adenocarcinoma, non small cell
Squamous, non small cell.
Small
What is Pancoast tumour
Apical tumour with associated syndrome of shoulder pain, C8-T2 radiculopathy, Horner’s syndrome.
