Thoracic Flashcards

Question

Answer 1

Sarcoidosis -Bilateral hilar and right paratracheal lymphadenopathy (95% of cases) -Perilymphatic nodules -*Mid and upper zones is classic* - End stage = fibrosis and traction bronchiectasis Side notes Garland triad = 1,2,3 sign = lymph nodes both hilum and right paratracheal Lofgren’s syndrome is an acute form of sarcoidosis characterised by erythema nodosum, bilateral hilar lymphadenopathy and polyarthralgia. stage 1: bilateral hilar lymphadenopathy stage 2: bihilar lymphadenopathy and reticulonodular infiltrates of parts or the entire lung stage 3: bilateral pulmonary infiltrates without signs of hilar lymphadenopathy stage 4: fibrotic degeneration of the lung (possibly with upward hilar traction, cystic and/or bullous destruction of the lung)

Answer 2

Acute eosinophilic pneumonia -Ground-glass opacities (100%) -crazy-paving pattern (septal thickening) -mosaic attenuation; may mimic pulmonary edema Asthma Reverse pulmonary oedema pattern (peripheral) acute type I hypersensitivity reaction triggered by variable causes (inhalational exposure, drugs, infections) Chronic eosinophilic pneumonia (CEP): Peripheral homogeneous consolidations (100%) Allergic bronchopulmonary aspergillosis (ABPA): Central upper lobe bronchiectasis ± high-attenuation mucous plugs (30%)

Answer 3

Berylliosis Radiation / RB-ILD Extrinsic allergic alveolitis and Eosionphilic granuluma (LCH) Ankylosing spondylitis/ ABPA Sarcoidosis TB Silicosis Nb ++ all pneumoconiosis Caplans syndrome Centrilobular emphysema CF

Answer 4

Bronchiectasis Asbestosis DIP/Drugs Aspiration Scleroderma (+ RA !!!) + Panlobular emphysema (alpha 1) + RA (Caplans upper lobes and less common) + UIP and NSIP

Answer 5

EAA/hypersensitivity pneumontits Acute/Nonfibrotic: Centrilobular ground-glass nodules and air-trapping Mosiac attenutation Chronic: Dyspnoea, clubbing etc Fibrotic: Upper lobe **peribronchovascular fibrosis**

Answer 6

Crazy paving sign and ground glass opacities DDx Pulmonoary oedema (?cardiomegaly, pleural effusion) ARDS (?anteriorposterior gradient) Alveolar haemmorhage PCP (?cysts) Adenocarcinoma

Answer 7

Primary -Hallmark is lymphadenopathy -Homogenous consooldiation -compressive atelectasis from compression of adjacent lymph nodes -pleural effusions (30%) Tree-in-bud opacities are the most common sign of active tuberculosis on CT. Post-primary -Cavitating nodule -tuberculomas

Answer 8

Higher attenuation pathological ie Parenchymal disease ie (GGO) - sarcoidosis, UIP, COP, DIP - No air trapping. =Vessels in the whiter areas = dilated Lower attenuation pathological **- look for vessels constricted/paucity in lucent areas ** 1. Poor ventilation = ***Air-trapping - Exacerbated by expiratory phase - Bronchitis , bronchiectasis, asthma, emphysema, Hypersensitivity pneumonitis 2. Mosaic perfusion - as above but no air trapping - CTEPH, pulmonary hypertension

Answer 9

Anterior mediastinal mass mediastinal mass that makes obtuse angles with the mediastinal contour. The hilar vessels can be seen through the mass - (hilum overlay sign) and means this is not in the middle mediastinum. The paravertebral line can also be seen, placing this mass in the anterior mediastinum. Thymoma Teratoma/GCT Terrible lymphoma Thyroid Germ cell tumours can be fruther subdivded -Teratoma (usually cystic with fat and calcification) -seminoma (bulky and lobulated) -Non-seminomatous Germ Cell Tumour (haemorrhage and necrosis)

Answer 10

1. SCC - Smoker - Lower 2/3rd trachea - ulcerated mass or nodule that projects into tracheal lumen - infiltration mediastinal structures, Frequent regional metastatic lymphadenopathy 2. Adenoid cystic carcinoma - non-smoker - proximal 1/3rd - growth along submucosal and perineural structures Consider Mucoepidermoid carcinoma (MEC) in young patient with endoluminal lesion in segmental airway - lobar or segmental bronchi

Answer 11

RB-ILD Centrilobular nodules GGO mosiac attenutation SImilar to EAA Upper/mid zones **Smoking ** No bronchiectasis or honeycombing

Answer 12

DDX Lymphadenopathy Foregut duplication cyst Haitus hernia

Answer 13

Wegners Tracheal wall thickening Circumferential (**involvement of posterior membranous trachea)** Relapsing polychondritis Wall thickening ± calcification that **spares posterior membranous wall** Autoimmune disease - polyarthiris, uveitis, vestibulitis Tracheobronchomalacia Weakness of central airway walls At least 70% tracheal collapse on expiratory CT saber-sheath trachea narrowing of its coronal diameter and widening of its sagittal diameter snokers/COPD Tracheobronchomegaly a.k.a. Mounier-Kuhn syndrome Marked dilatation of trachea and mainstem bronchi

Answer 14

LISA Lymphangitis carcinomatosis (nodular or smooth) - beaded appearance Interstitial oedema (smooth) Sarcoidosis (nodular) Alveolar proteinosis (smooth)

Answer 15

Bronchiectasis with Upper or Mid-Lung Predominance * Cystic fibrosis * ABPA * Sarcoidosis * TB Bronchiectasis with Anterior Predominance * Atypical mycobacterial infection * ARDS Bronchiectasis with Lower Lung Predominance * Pulmonary fibrosis * Chronic aspiration * Kartagener’s syndrome * Common variable immunodeficiency * α1-Antitrypsin deficiency Bronchiectasis with Central Predominance * Mounier–Kuhn syndrome - Tracheal dilatation Williams–Campbell syndrome -subsegemental bronchiectasis, central normal

Answer 16

Solitary pulmonary nodule **Granuloma ** - benign patterns of calcification (central, diffuse, popcorn, or laminated). - Calcified hilar and lymph nodes **Neoplasm** - primary lung cancer and metastatic disease may present as a solitary pulmonary nodule or mass (>3 cm) - Irregular borders or suspicious calcifications (speckled, eccentric) - Adenocarcinoma - Solid, Part or GG. Peripheral - Squamous, proclivity to cavitate - Small cell, typically perhilar and lymphadenopathy **Hamartoma** - Comonest benigin aetiology. classic < 4cm , well defined and focal macroscopic fat and popcorn calcifcation Other Differerntials - Round pneumonia - paeds, < 8 - AVM - 90% associated with HHT, look for feeding vessels

Answer 17

Multiple pulmonary nodules **Metastatic** - randomly distributed with a lower lobe predominance, various sizes **Tuberculosis or fungal granulomatous disease** **Septic emboli** - Well defiend and peripheral. 'Vessel Feeding' sign, not specific Ohers - Granulomatosis with polyangitis (GPA) - May cavitate, thick walls with air fluid levels. - Rheumatoid - dissapear after treatment.

Answer 18

Cavitary pulmonary nodule/mass 1. TB - Typically reactivation phase. Multiple cavitations reflecting the increased inflammation and necrosis - Predominantly in the upper lobes (lymphatic clearance lower in lower lobes.) 2. Squamous cell carcinoma (Primary or metastatic) - typically located centrally with involvement of hilar or medistinal lymph nodes. 3. Pyogenic infection (pulmonary abscess, septic emboli) Fungal disease - Histoplasmosis