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Radiology > Thoracic > Flashcards

Thoracic Flashcards

1
Q

Interlobular fissures

A

Minor: RUL from RML (seen on frontal and lateral)
Major: only on lateral
Azygos: accessory RUL apical or posterior are encased

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2
Q

Atelectasis

A

Collapse
Direct: fissure displacement/ vascular crowding
Indirect: diaphragm elevation/rib crowding/ mediastinal shift/ overinflation of contralateral lobe/hilar displacement

Central bronchial obstruction: no air bronchogram
Subsegmental: air bronchogram

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3
Q

Obstructive atelectasis

A 
Bronchial obstruction
Lobar
More quickly in patient with supplemental O2
Imaging: volume loss
ICU patient: consolidation
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4
Q

Obstructive atelectasis in peds

A

Foreign body

Hyperexpanded

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5
Q

Subsegmental atelectasis

A

After surgery
General illness
Mucus obstruction

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6
Q

Relaxation atelectasis

A

Adjacent to a lesion causing mass effect
Pleural effusion
Pneumothorax
Pulmonary mass

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7
Q

Adhesive atelectasis

A

Surfactant deficiency
NRDS
ARDS

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8
Q

Cicatricial atelectasis

A

Architectural distortion by fibrosis

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9
Q

Lobar atelectasis

A 
Central bronchial obstruction
Mucus plugging (acute)
Neoplasm (chronic)
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10
Q

LUL atelectasis

A

Luftsichel sign

Crescent of air ( between aorta and hyperexpanded superior LLL)

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11
Q

RUL atelectasis

A

Reverse S sign of golden
suspicious for malignancy
Juxtaphrenic peak sign: traction of inf accessory fissure

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12
Q

LLL atelectasis

A

Triangular retrocardiac opacity
Loss of left heart border
Left hilum down
Flat waist sign

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13
Q

RLL atelectasis

A

Mirror of LLL collapse

Wedge shaped retrocardiac opacity

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14
Q

RML atelectasis

A

Silhouetting of right heart border

Lateral view: wedge shape opacity anteriorly

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15
Q

Round atelectasis

A 
Focal
Always with adjacent pleural abnormalities 
Common: posterior lower lobes
1. Abnormal pleura
2.peripheral opacity
3. Round opacity
4. Volume loss
5. Curved pulmonary vessels and bronchi( comet tail sign)
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16
Q

Secondary pulmonary nodule

A

Central artery—> acinar artery
Central bronchus—> respiratory bronchioles
Vein and lymphatic—> periphery
Interlobular septa encases SPL

12 acini per SPL

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17
Q

Consolidation an ground glass

A

Abnormal alveoli

GG—> only on CT

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18
Q

Consolidation

A

Filling of alveoli with liquid
Vessels are not visible
Air bronchogram

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19
Q

Acute consolidation

A

Pneumonia
Hemorrhage
ARDS ( non carcinogenic pulmonary edema)
Pulmonary edema

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20
Q

Chronic consolidation

A 
Bronchioalveolar carcinoma ( mucinous subtype)
Organizing pneumonia ( granulation polyps)
Chronic eosinophilic pneumonia ( upper lobe distribution)
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21
Q

Ground glass opacification

A

Partial filling of alveoli
Wall thickening
Atelectasis

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22
Q

Acute ground glass

A

Pulmonary edema
Pneumonia (atypical)
Hemorrhage
ARDS

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23
Q

Chronic ground glass

A

Bronchioalveolar carcinoma
Organizing pneumonia ( round/ peripheral)
Chronic eosinophilic pneumonia ( upper lobe)
Idiopathic pneumonia
Hypersensitivity pneumonitis ( type 3)
Alveolar proteinosis ( central sparing of periphery)

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24
Q

Central ground glass opacity

A

Pulmonary edema
Alveolar hemorrhage
Pneumocystis jiroveci pneumonia
Alveolar proteinosis

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25
Q

Peripheral ground glass

A

Organizing pneumonia
Chronic eosinophilic pneumonia ( upper lobes)
Atypical/viral pneumonia
Pulmonary edema ( non cardiogenic)

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26
Q

Smooth interlobular septal thickening

A 
Pulmonary vein dilation:
Pulmonary edema
Pulmonary alveolar proteinosis 
Pulmonary hemorrhage 
Atypical pneumonia
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27
Q

Nodular interlobular septal thickening

A

Infiltration of peripheral lymphatic:
Lymphangitic carcinomatosis
Sarcoidosis (noncaseating granulomas)

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28
Q

Crazy paving

A 
Interlobular septal thickening plus ground glass opacification
Alveolar proteinosis 
Pneumocystis jiroveci pneumonia 
Organizing pneumonia 
Bronchioalveolar carcinoma (mucinous)
Lipoid pneumonia 
ARDS
Pulmonary hemorrhage
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29
Q

Centrilobular nodules

A

Opacification of centrilobular bronchiole
CT: multiple small nodules , never extend to the pleura
Infection: atypical mycobacteria ( MAC), endobronchial spread of TB
Bronchopneumonia, atypical pneumonia
Inflammation: hypersensitivity pneumonitis (subacute) , respiratory bronchialitis interstitial lung disease, hot tub lung, diffuse panbronchiolitis ( lymphoid hyperplasia, Asians) , silicosis ( upper lobe, perlymphatic nodules)

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30
Q

Perilymphatic nodules

A

Subpleural, peribronchovascular, septal
Sarcoidosis (upper lobe, galaxy sign)
Pneumoconioses
Lymphangitic carcinomatosis

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31
Q

Random nodules

A 
Hematogenous metastasis
Septic emboli (cavitate)
Pulmonary langerhan’s cell histiocytosis (smoking/ random nodule—>irregular cyst)

Miliary pattern—>disseminated TB, fungal infection, hematogenous metastases

32
Q

Tree in bud nodules

A

Small airways infection
Mycobacteria TB and atypical mycobacteria
Bacterial pneumonia
Aspiration pneumonia
Airway invasive aspergillus ( immunocompromised)

33
Q

Solitary cavitary

A

wall thickness<4mm is benign >15 mm malignant
Primary bronchogenic carcinoma (squamous more than adenocarcinoma)
TB—> upper lobe

34
Q

Multiple cavitary nodules

A

Septic emboli
Vasculitis ( Wegener)
Metastases (squamous cell carcinoma and uterine carcinosarcoma)

35
Q

Multiple Cystic lung disease

A

Lymphangioleiomyomatosis (LAM)—> diffuse with chylous effusion
Emphysema—>upper lobes, smokers
PLCH—>cyst+nodules—> upper lobes
Diffuse cystic bronchiectasis : upper—> cystic fibrosis / diffuse or lower—> congenital or post infectious
Pneumocystis jiroveci pneumonia
Lymphoid interestitial pneumonia—> Sjogren / alveolar distortion

36
Q

Single cyst lung disease

A

Bulla
Bleh —> continguous with pleura <1cm ( rupture—> spontaneous pneumothorax)
Pneumatocele—>prior lung trauma or infection

37
Q

Lower lobe fibrotic changes

A

Idiopathic pulmonary fibrosis —> bibasilar fibrosis, basilar honeycombing
End stage asbestosis—> pleural plaques
Nonspecific interestitial pneumonia (NSIP)—> collagen vascular disease or drug reaction/ cellular and fibrotic form/ basal fibrosis, no honeycombing

38
Q

Upper lobe fibrotic changes

A

End stage sarcoidosis
Chronic hypersensitivity pneumonitis
End stage silicosis

39
Q

Community acquired pneumonia

A

S. Pneumonia
Mycoplasma—> varied appearance
Legionella—> elderly patients / peripheral progress to lobar and multi focal
Klebsiella—> alcoholics and aspiration/ voluminous/bulging fissure

40
Q

Hospital acquired pneumonia (HAP)

A

MRSA

Pseudomonas

41
Q

Health care associated pneumonia

A

Nursing homes
>2 days hospitalization
Similar to HAP

42
Q

Ventilator associated pneumonia

A

Mechanical ventilator
Polymicrobial
Pseudomonas
Acinetbacter

43
Q

Pneumonia in immunocompromised

A

Pneumocystis
Aspergillus
Nocardia
CMV

44
Q

Lobar pneumonia

A

Bacterial
Most common CAP
air bronchogram

45
Q

Lobular pneumonia

A

Patchy consolidation
Poor defined airspace opacity
S. Aureus

46
Q

Interstitial pneumonia

A

Inflammatory cells in interstitial tissue
Diffuse patchy or GG
viral , mycoplasma, chlamydia, pneumocystis

47
Q

Round pneumonia

A

Children
Streptococcus pneumoniae
Due to incomplete formation of pores of Kohn

48
Q

Pulmonary Abscess

A

Staph aureus, pseudomonas, anaerobics
Air-fluid level
Spherical

49
Q

Pulmonary gangrene

A

Extensive necrosis and sloughing

50
Q

Empyema

A

Pleural space

  1. Free flowing exudative effusion—> aspiration
  2. Development of fibrous strands—> large bore chest tube and fibrinolytic
  3. Solid and jelly like—> surgery

Split pleura sign—> enhancing parietal and visceral pleura
DDx: malignant effusion, mesothelioma,fibrothorax,talc pleurodesis

51
Q

Pneumatocele

A

Thin walled, gas filled

Post traumatic, sequela of pneumonia ( Staph aureus, pneumocystis)

52
Q

Bronchopleural Fistula

A

Rupture of visceral pleura
Surgery common cause
Lung abscess, empyema, trauma

New or increasing gas in pleural effusion

53
Q

Empyema necessitans

A

Extension of empyema to chest wall
Secondary to TB
Nocardia, actinomyces

54
Q

TB exposure

A
  1. Contained (90%)—> calcified granulomas, calcified hilar lymph node
  2. Primary tuberculosis—> children, immunocompromised
  3. Reactivation
55
Q

Primary tuberculosis

A

15%—> no radiologic sign
Imaging: ill-defined consolidation, pleural effusion, lymphadenopathy, miliary
Lower lobes or RML

Ghon focus—> focus of parenchymal infection upper of lower lobe or lower of upper lobe
Ranke complex—> Ghon + LAP

Adenopathy—> common, central hypo and peripheral enhancement

cavitation is rare in primary TB

56
Q

Reactivation TB

A

Adolescents and adults
Upper lobe apical and posterior segments

Immunocompetent—> cavitation and no adenopathy
Tree in the bud—> active endobronchial spread

Immunocompromised—> hypo adenopathy
Tuberculoma—> round opacity in upper lobes

57
Q

Healed TB

A

Apical scarring
Upper lobe volume loss
Superior hilar retraction
Calcified granulomas ( delayed hypersensitivity)

58
Q

Miliary TB

A

Diffuse random nodules

Disseminated TB

59
Q

Atypical mycobacterial infection

A

Elderly woman with cough, fever, weight loss
Mycobacterium Avium intercellulare, M. Kansas I

Imaging: bronchiectasis, tree in bud, RML and lingula

60
Q

Hut tub lung

A

Hypersensitivity pneumonitis

Centrilobular nodules

61
Q

Histoplasma capsulatum

A

Ohio, Mississippi
Bat, bird guano
Calcified granulomas , pulmonary nodules
Chronic—> similar to TB, upper lobes fibrocavitary consolidation
Fibrosing mediastinitis—> pulmonary venous obstruction, bronchial stenosis, pulmonary artery stenosis, calcified lymph nodes

62
Q

Coccidiodes immitis and blastomyces dermatitidis

A

Coccidiodes immitis: southwest, multifocal consolidation,multiple pulmonary nodules, miliary nodules

Blastomyces dermatitidis: central, southeast, multifocal consolidation, ARDS, miliary disease

63
Q

Pneumocystis jiroveci pneumonia

A

CD4<200
Bilateral perihilar airspace opacities with peripheral sparing

CT—> perihilar GG opacification, crazy paving
Upper lobe pneumatoceles —> pneumothorax, pneumomediastinum

64
Q

Cryptococcus neoformans

A

Most common in AIDS
GG, focal consolidation, cavitating nodules
Miliary with LAP or effusion

65
Q

ABPA

A

Hypersensitivity to aspergillus
Long standing asthma
CT—> upper lobes bronchiectasis, mucoid impaction, hyper or calcified (finger in glove)

DDx—> CF

66
Q

Aspergilloma

A

Mycetoma or fungus ball in pre existing pulmonary cavity
Mobile
Monod sign—> crescent of air outlining the mycetoma

67
Q

Semi invasive aspergillosis

A

Necrotizing granulomatous inflammation
Diabetic, alcoholic, debilitated, COPD

Segmental consolidation, cavitation, pleural thickening

68
Q

Airway invasive aspergillosis

A

Airway epithelial cells
Neutropenic and AIDS
Bronchiolitis, bronchopneumonia

CT—> centrilobular and tree in bud nodules

69
Q

Angioinvasive aspergillosis

A

Severely immunocompromised
CT—> halo: GG around consolidation/ DDx: viral, Wegener, Kaposi, metastasis

Air crescent—> good prognostic sign

70
Q

Pulmonary edema

A

Increased pulmonary vein

  1. Vascular redistribution: increased caliber of upper lobe vessels
  2. Interstitial edema: increased interstitial marking, indistinctness of pulmonary vasculature, peribronchial cuffing, Kerley B ( peripheral) and A (radiates from hila)
  3. Alveolar edema: central opacification, pleural effusion, cardiomegaly
71
Q

Pulmonary edema on CT

A

Dependent GG
Interlobular septal thickening
HF—> patchy GG
Sepsis, low protein—> diffuse GG

RUL pulmonary edema—> acute mitral regurgitation

Aggressive thoracentesis—> reexpansion pulmonary edema

72
Q

Vascular pedicure

A

Width of upper mediastinum —> < 58 mm
>63 or 70–> increases pulmonary capillary wedge pressure(>18) and fluid overload
Right border—> interface of SVC and right main bronchus
Left border—> lateral of subclavian origin from aorta

73
Q

Endotracheal tube

A

4-6 cm above carina
Right bronchus direct intubation is more common—>
Complete atelectasis of un intubated lung

74
Q

Central venous catheter

A

Tip in lower SVC or CA junction
Azygos malposition—> venous perforation, thrombosis

Dialysis catheter in right atrium

75
Q

Pulmonary artery catheter

A

Tip in main , right, left pulmonary artery

If distal to proximal interlobar pulmonary artery—> rupture, pseudoaneurysm, intra cardiac catheter knot and arrhythmia

76
Q

Lung cancer risk factors

A

Smoking—> SCC, small cell carcinoma
Berryllium, radon,arsenic,asbestos
Pulmonary fibrosis
Pulmonary scarring

Radiology (3 decks)

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