thoracic Flashcards
What opacity can be seen in Raider Triangle?
aberrant right subclavian
A pacemaker wire going through a valve makes it what valve?
tricuspid
What is a pig bronchus? What is the trigger phrase on exams?
right upper lobe bronchus taking off of trachea
recurrent RUL infection
Where does a cardiac bronchus arise from?
bronchus intermedius
What is the most common pulmonary vein anatomy?
separate vein draining RML
Is the distal vasculature usually present in UAPA?
yes
What is a UAPA usually opposite of?
the aortic arch
Masses above the cervicothoracic junction are located in what part of the mediastinum?
posterior
What pneumonia causing bug is associated with recent dental procedures and/or jaw osteomyelitis?
actinomyces
Flame shaped perihilar opacity in AIDS pt should make you think what?
kaposi sarcoma
What are the four most common cystic causing lung diseases?
LIP
LAM
DIP
BHD
Lung cysts + GGOs + ptx = what disease?
PCP
Hypervascular lymph nodes in an AIDS pt should make you think what?
kaposi or castleman
What is a ghon focus?
TB granuloma
What is a ranke complex?
calcified ghon focus
What feature accompanies primary progression?
cavitation
What feature accompanies primary progression?
cavitation
What is the most common cause of primary progression of TB?
immunosuppression
What two surgeries can cause primary progression of TB?
jejuno-ileal bypass
subtotal gastrectomy
What environmental exposure can cause primary progression of TB?
silicosis
How is immune reconstitution reactivation syndrome treated?
steroids
How does one diagnose pleural involvement of TB?
pleural biopsy
An old man with upper lobe predominant cavitary lesions and adjacent nodules should raise the concern for what disease?
MAC
What are the two signs for angioinvasive aspergilloma?
halo sign
air crescent sign
What does the halo represent regarding the halo sign of angioinvasive aspergilloma?
halo = represents invasive component
What does the air crescent sign represent?
healing
ABPA can occur in what patient class in addition to chronic ashmatics?
CF
Lung Screen CT should have a CT dose less than what?
3 mGy
Growth is considered greater than what size in one year?
1.5 mm
What is the lung rads for an endobronchial lesion?
4a
What type of calcification of SPNs is the most suspicious?
eccentric
Central “popcorn” calcs can be suspicious in the setting of what type of cancer?
GI cancer
Where is a lung cancer most likely to arise in a patient with pulmonary fibrosis?
peripheral/basilar
What paraneoplastic syndrome can be associated with squamous cell lung cancer?
hyper-parathyroid-ism
Is large cell lung cancer more often found centrally or peripherally?
peripheral
What lung cancer is a known associate of pulmonary fibrosis?
adeno
Does adeno prefer a peripheral or central location?
peripheral
What imaging modality to stage a pancoast tumor? Why?
mri
brachial plexus
Can a pulmonary hamartoma be hot on PET?
yes
Is kaposi thallium hot or cold?
thallium hot
Is thallium gallium hot or cold?
cold
What is the triad of AIDS related pulmonary lymphoma?
nodules
pleural effusion
lymphadenopathy
How can poland syndrome look on a chest Xray?
hyper-lucent lung
Will a lung be hyperinflated or deflated distal to a bronchial atresia? Why?
hyperinflated
collateral flow through pores of Kohn
Will a lucent lobe cause by bronchial atresia be hyper-vascular or hypo-vascular?
decreased vascularity
Mucoid impaction is generally below what HU?
< 25 HU
Even though contested, treating an afferent vessel feeding a pulmonary AVM occurs at what size?
> 3mm
Where does a persistent left SVC drain into?
coronary sinus
What is the pathological term for Swyer James?
post infectious obliterative bronchiolitis
Is the lung effected by swyer james bigger or smaller than the unaffected lung?
smaller
What is horseshoe lung associated with?
scimitar syndrome
Pulmonary LCH exclusively effects which type of patient?
smokers
is Pulmonary LCH upper or lower lobe predominate?
upper
What two lung diseases spare the CP angles?
pulmonary LCH
hypersensitivity pneumonitis
What disease is LAM associated with?
tuberous sclerosis
What shape are BHD cysts?
oval
What two things happen in the kidney with BHD?
renal oncocytomas
chromophobe RCC
What disease is seen with LIP 25% of the time?
sjogrens
What drug can cause pan-lobular emphysema?
IV ritalin
What is the pathophysiology behind vanishing lung syndrome?
avascular necrosis
What % of patients with vanishing lung have A1AT?
20%
The interstitial pattern of asbestosis looks like what interstitial disease?
UIP
Is PMF T2 bright or T2 dark?
bright
Silo Fillers disease is caused by what compound?
nitrogen dioxide
What does Silo Fillers Disease look like on CT?
edema
What two structures run in the middle of the secondary pulmonary lobule?
artery and airway
What two structures run in the periphery of the secondary pulmonary lobule?
vein and lymphatics
What is the plain film equivalent of interlobular septal thickeing?
kerley B line
Is UIP homogenous or heterogenous inflammation?
heterogenous
Is NSIP homogenous or heterogenous inflammation?
homo
GGO alone in NSIP is what flavor of classification?
cellular
What finding needs to be present to call it fibrotic type NSIP?
traction bronchiectasis
How does DIP look like on CT?
lower lobe, peripheral GGO with small cystic spaces
What is Stage 1 Sarcoidosis?
hilar and mediastinal nodes only
What is Stage 2 sarcoidosis?
nodes and parechymal disease
What is Stage 3 Sarcoidosis?
parenchyma only
What is Stage 4 Sarcoidosis?
fibrosis
Does sarcoid produce upper or lower lobe fibrosis?
upper
Are the perilymphatic nodules in sarcoid upper or lower lobe predominant?
upper
Swan Ganz catheters are an indirect measurement of what cardiac chamber?
left atria
What is the most common opportunistic infection in a lung transplant PT?
CMV
What disease most commonly recurs in transplanted lungs?
sarcoid
What type of infection is associated with PAP?
nocardia
What exposure is highly associated with PAP?
smoking
What type of interstitial pneumonia looks like PAP?
Acute Interstitial Pneumonia
What is the pathophysiology of endogenous lipoid pneumonia?
obstructive process causing build up of lipid laden macrophages
What is the pathophysiology of organizing pneumonia?
build up of granulation tissue within alveolar spaces from fibroblasts
What is the classic sign of COP?
reverse halo or atoll
Does eosinophilic pneumonia favor the upper or lower lobes?
upper
What interstitial lung disease does chronic hypersensitivity pneumonitis look like?
UIP + air trapping
Where are the fibrotic changes of chronic HP?
mid to upper lobe predoominant
What two diseases spare the posterior trachea?
relapsing polychondritis
TBO
Which disease can produce calcifications, TBO or RP?
TBO
How does RP present?
recurrent pna
Which disease classically involves the posterior trachea?
amyloidosis
Can amyloidosis form calcs?
yes
Does pulmonary carcinoid tend to effect the left or right heart valves?
left
What is more likely to be in the trachea, adenoid cystic or carcinoid?
adenoid cystic
A single papilloma in the trachea should make you think what?
single = smoking
Multiple papilloma in the trachea should make you think what?
HPV
CF begins as what type of bronchiectasis? Progresses to what type?
cylindrical
progresses to varicoid
What can happen reproductively to girls with CF?
ectopics
Does CF or PCD have absent vas deferens?
CF
How does Williams Campbell Syndrome present?
peripheral, cystic bronchiectasis presenting in 4-6th decade
Bronchiolitis obliterans should make you think of what two diseases?
post-transplant rejection of lung
asthma/bronchiolitis
Follicular bronchiolitis is seen with what two diseases?
sjogrens and RA
How does ankylosing spondylitis look when it manifests in the lungs?
“upper lobe fibrobullous disease”
How does Caplan syndrome look like in the lungs?
upper lobe nodules that can cavitate, with out without a pleural effusion
Shrinking Lung should make you think of what disease?
lupus
What does hepatopulmonary look like in the lung bases?
engorged vessels extending into periphery
Solitary Fibrous Tumor of the Pleura can cause what 30% of the time?
hypertrophic osteoarthropathy
What is the latin term for when an empyema eats through the chest wall?
empyema necessitans
What will have fat in it, lymphoma or a large thymus?
large thymus
Will calcs in a thymus make you think a benign or aggressive course?
aggressive
Where do thymomas drop met?
retroperitoneum or pleura
Are immature germ cell tumors of the mediastinum more common in men or women?
men
What three conditions can a thymic cyst be seen with?
after thoracotomy
HIV
chemo
Non-granulomatous mediastinal fibrosis can be associated with what medication?
methylsergide
What are the three neurogenic tumors that can occur in the posterior mediastinum?
schwannoma
neurofibroma
malignant peripheral nerve sheath tumor
What is the Fleischner sign?
enlarged PA
What are the three most common causes of pulmonary artery pseudoaneurysm?
swan
bechet
chronic PE
What causes the hot quadrate sign?
SVC obstruction
What muscle separates the tricuspid valve from the pulmonic valve?
crista supraventricularis
Do the papillary muscles of the mitral or tricuspid valve insert on the septum?
tricuspid
What heart structure will lipomatous hypertrophy spare?
fossa ovalis
What heart structure will a interatrial lipoma not spare?
fossa ovalis
What coronary artery gives off the conus branch? What does the conus branch supply?
RCA
ventricular outflow tract
What artery gives off the diagonals?
LAD
What artery gives off the obtuse marginals?
circumflex
What is the definition of a coronary fistula?
abnormal connection between coronary artery and ventricular chamber or great vessels
How does a coronary fistula most often manifest?
coronary aneurysm
HR under what for coronary CT?
60
Is prospective coronary CT axial or helical?
axial
Is retropective coronary CT axial or helical?
helical
Bicuspid aortic valve is an independent risk factor for what abnormality? (something other than stenosis)
aortic aneurysm
What is Ortners syndrome?
LA enlargement compressing recurrent laryngeal nerve
MItral regurgitation can cause isolated pulmonary edema to what lobe?
right upper lobe
Where does ToF cause pulmonic stenosis?
subvalvular
Other than ToF, what two inherited diseases can cause pulmonic stenosis?
williams syndrome and noonan syndrome
Where does Williams syndrome cause pulmonary stenosis?
valvular
Where does Noonas syndrome cause pulmonary stenosis?
supra-valvular
Multivalve pathology should make you think what disease?
post-rheumatic
Does TR cause RV dilation or hypertrophy?
dilation
What is the most common cause of TR in adults?
pulmonary arterial hypertension
What ventricle is hypoplastic with tricuspid atresia?
RV hypoplastic
What type of right arch anatomy has the highest likelihood of other congenital abnormalities? Which anamoly specifically?
mirror image
ToF
What is the most common vascular ring?
double aortic arch
What two congenital anamolies are most common with a right arch?
- ToF
2. Truncus
What is the most common cause of CHF in a newborn?
TAPVR
What is the most common congenital heart disease?
VSD
When does a PDA close functionally? Anatomically?
functional = 24 hours
anatomic = 1 month
What maternal infection can cause a PDA?
maternal rubella
What is the most common type of ASD?
secundum
What is the only type of ASD that may close w/o surgery?
secundum
Can primum type be closed with a closure device?
no
What are the two findings of holt oram?
ASD
hand/thumb defects
What type of ASD do Downs patients most commonly have?
ostium primum
What type of ASD do PAPVR patients most commonly have?
sinus venosus
What are the two findings of Scimitar Syndrome?
- right sided PAPVR
2. lung hypoplasia
How does type III TAPVR present?
full blown pulmonary edema
What is the most common cyanotic HD?
ToF
What is the most common complication follow ToF repair?
pulmonary regurgitation
What cyanotic heart disease is associated with DiGeorge Syndrome?
truncus arteriousus
Cor Triatriatum sinistrum can be the otherwise unexplained cause of what?
pediatric pulmonary hypertension
What does perfusion look like regarding stunned myocardium? Contractility?
perfusion = normal
contractility = bad
Will hibernating myocardium take up thalium and FDG?
yes
Which would occur first, ventricular pseudoaneurysm or aneurysm? What is the typical time frame?
pseudo-aneurysm
3-7 days
What cardiac process may need to use a long Time to Inversion? What buzz phrase?
amyloid
“difficult to suppress myocardium”
Biventricular thrombus should make you think what disease process?
eosinophilic (loeffler) cardiomyopathy
What size defines a thickened pericardium?
> 4mm
Myocarditis will not effect which part of the myocardium?
subendocardial
Will Takotsubo have delayed enhancement?
no
What finding on cardiac MR is an independent risk factor for sudden death in HCM?
patchy midwall late Gd enhancement
Will a left atrial myxoma enhance?
yes
What is the most common fetal cardiac tumor? Where is it located? What disease is it associated with?
rhabdomyoma
LV
TS
What is the most common cardiac neoplasm to involve the valves? What is a known complication?
fibroelastoma
systemic emboli
Where is the most common location for congenital absence of the pericardium? What heart structure is most common to be herniated?
overlying left atrium
left atrial appendage
