Thoracic Flashcards
Inspiratory reserve volume
Volume that you can inspire after normal respiration (tidal volume)
Expiratory reserve volume
Amount you can expire after a normal expiration (tidal volume)
Inspiratory Capacity
Inspiratory reserve volume + tidal volume
Functional residual capacity
Expiratory reserve volume + residual volume
Vital capacity
Everything but the residual volume
Obstructive versus restrictive lung disease
Obstructive - Decreased FEV / FVC (airway collapse - emphysema)
Restrictive - Normal FEV / FVC (destruction - fibrosis)
Right versus left hemidiaphragm on lateral view
- Stomach bubble - left
- Right is higher, usually more anterior
Ribs on lateral view
Right ribs are bigger and more posterior
Left upper lobe bronchus, RPA, LPA on lateral view
Left upper lobe bronchus - central dark dot
RPA is anterior and below it
LPA is posterior and above
Supernumerary pulmonary veins
Usually 2 on each side. Most common variant is a RML supernumerary vein. The left superior vein most commonly causes Afib.
Forms of atelectasis
Obstructive (absorptive) - from obstruction
Compressive (relaxation/passive) - from mass effect directly on lungs (pleural effusion)
Fibrotic (cicatrization) - scarring/fibrosis (TB, radiation)
Adhesive - loss of surface tension (loss of surfactant, ARDS)
Hilum overlay sign
If mass near the hilum and Hilar vessels obscured, then there is a mass adjacent to the hilum. If not obscured mass likely in the anterior mediastinum.
Cervicothoracic sign
Mass extends above clavicles - mass is in neck, NOT mediastinum
Incomplete border sign
If border is indistinct, then mass likely from pleura
Strep pneumonia
Lobar consolidation. Most common in AIDS
Klebsiella pneumonia
Bulging fissure. Currant jelly sputum. Alcoholics.
Pseudomonas
CF, Kartagener’s, ICU patient on ventilator
Mycoplasma pneumonia
Most common CAP in 5-20 year old. Associated with SJS. Unilateral lucent lung
Graft versus host disease
Bronchiolitis obliterans - air trapping (mosaic attenuation). Usually presents after 100 days post bone transplant.
Post bone transplant complications
Early neutropenic (0-30 days) - pulmonary edema, DILI, hemorrhage, fungal pneumonia (invasive aspergillosis)
Early (30 - 90 days) - PCP, CMV
Late (> 90 days) - BO, COP
PCP
AIDS patients. Perihilar GGOs sparing periphery. Thin cysts can occur.
AIDS infections by CD4 count
> 200 Strep, TB
< 200 PCP, atypical mycobacterial
< 100 CMV, disseminated fungal, mycobacterial
Primary TB
Ghon complex (Nodule + Ipsi lymphadenopathy).
If calcified Ranke complex
Latent TB
No symptoms, no findings on CXR
Post primary TB (reactivating)
Cavitary lesion in apical or posterior upper lobe and superior lower lobe.
Rasmussen aneurysm
Hot tub lung
Hypersensitivity pneumonitis from MAC.
Centrilobular GGOs.
ABPA
Hyper immune reaction to aspergillosis. Seen with asthma, CF. Finger in glove mucoid bronchiectasis.
Elevated IgE levels
COVID pneumonia
Peripheral GGOs. Can have reverse halo sign.
Lemierre syndrome
Jugular vein thrombosis with septic emboli (ENT surgery, oropharyngeal infection)
Caused by Fusobactyerium necrophorum
FDG activity of solid and GG nodules
Solid nodules (> 1cm) - SUVmax > 2.5, cancer
GG nodules - cold cancer. Hot - likely infectious/inflammatory
Lung cancer trivia
1.5 x more likely in right lung. 70% in upper lobes. Air bronchogram through nodule is very suspicious.
Lung cancer screening
50-80 with >20 pack year hx.
25% reduction in mortality.
CTDIvol < 3 mGy, 75 mGy-cm
Thickness < 2.5 mm
Growth > 1.5 mm
Lung Rads 2
Solid nodules < 6mm
GG nodules < 3.0 cm
Perifissural nodules < 1.0 cm
1 yr f/u
Lung Rads 3
Solid nodule 6-8 mm
Subsequent exam new nodule > 4mm
GG nodule > 3.0 cm
6 month f/u
Lung Rads 4a, b, X
Solid nodules > 8 mm
New solid nodule 6-8 mm
3 month f/u vs PET vs biopsy
Fleischner criteria
Used for pt NOT in lung screening program.
Age > 35
NO known or suspected cancer, and NOT immunocompromised
Same size cutoffs as Lung RADS (<6mm, 6-8mm, >8mm)
Fleischner recommendations
< 6 mm - no f/u if low risk. 1 yr f/u if high risk
6-8 mm - 6-12 month f/u low risk, 3-6 month if high risk
> 8 mm 3-6 month f/u, PET, bx for low and high risk
2 yr stability, stop follow-up. GG nodules (> 6 mm) need 5 years f/u.
Small cell lung cancer
Central lymphadenopathy. Strongly associated with smoking. Most commonly causes SVC obstruction and paraneoplastic syndromes: (Lamber Eaton, SIADH, ACTH).
Adenocarcinoma
Associated with non-smokers and pulmonary fibrosis. GG nodule, slow growing.
Squamous cell lung cancer
Central, association with smoking. Cavitation. Paraneoplastic syndrome PTH. Does not express TTF-1.
Large cell lung cancer
Least common subtype. Usually large, peripheral. Poor prognosis.
CT angiogram sign
Enhancing vessels running through consolidated lungs.
Invasive mucinous adenocarcinoma.
Pancoast tumor
Shoulder pain, radiculopathy, Horner syndrome.
MRI to stage. Not amenable to surgery.
Tumor staging (Lung cancer)
T1 < 3 cm
T2 - 3-5 cm or invades pleura, main bronchus, or causes obstruction
T3 - 5-7 cm or invades chest wall, pericardium, phrenic nerve (paralysis), has one or more satellite lesion in same lung.
T4 - invades diaphragm, great vessels, carina, or satellite lesion in the contra lung. also if it invades intrapericardial portion of the pulmonary vein
Nodal staging (Lung cancer)
PET/CT used for staging.
N1 - ipsilateral lung or hilum
N2 - Ipsilateral mediastinal or subcarinal nodes
N3 - contralateral mediastinal or hilar. Also scalene or supraclavicular nodes.
If above the clavicle or manubrium -> N3 and not resectable*
Contraindications to lobectomy/resection
Invasion through fissure, vasculature, main bronchus, Stage 3B (N3 or T4 disease), malignant effusion.
Kaposi sarcoma
Most common lung cancer in AIDS patients. CD < 200. Flame shaped opacities. Bloody pleural effusion.
Th positive, Ga negative. Lymphoma is Th and Ga positive.
Cancers that like to metastasize to lungs
Kidney, breast, colon, thyroid, head and neck.
Feeding vessel sign.
