Thoracic Flashcards
Recite the light’s criteria for exudative effusion
EXUDATIVE if
- Pleural protein/serum protein >0.5
- Pleural LDH/Serum LDH >0.6
- Pleural LDH > 2/3 of the upper limit of serum LDH
What is the mainstay CXR view in the evaluation of pleural effusion
CXR PA
What is the volume of effusion which presents with CP angle blunting?
200 to 500mL
Diagnostic modality that is able to characterize pleural effusion and detect septations
Chest UTZ
What diagnostic modality can be used for unclear etiology of pleural effusion
Throacoscopy/VATS
[Etiology based on the color of pleural fluid]
black
aspergillus
[Etiology based on the color of pleural fluid]
chocolate sauce
Anaerobic liver abscess
[Etiology based on the color of pleural fluid]
yellow-greenish
Rheumatoid
[Stage of Empyema]
swelling of pleura, presence of discharge, thin exudative fluid
Stage I
[Stage of Empyema]
Heavy fibrin deposit with turbid or purulent fluid; fibrin layer becomes heavier and pleural fluid is grossly turbid/purulent
Stage II
[Stage of Empyema]
loculations are seen during this stage
Stage II
transitional stage
[Stage of Empyema]
thick pus; presence of fibroblast and capillaries with lung trapping
Stage III
___ refers to the condition where there is dissection of pus into the chest wall
Empyema necessatatis
What are the clinical factors that favor a benign solitary pulmonary nodule
- Age <40
- Nonsmoker
- No history of malignant disease
- Previous history of TB, Wegener granulomatosis
- Lives in area endemic for histoplasmosis
- Immunosuppressed
- Nodule size is unchanged for 2 years or more
What are the clinical factors in favor of malignant solitary pulmonary nodule
- Age >40 years
- History of cigarette smoking >20-25 years
- Previous history of malignant disease
- Family history of lung CA
- Presence of cough, hemoptysis
- Presence of constitutional symptoms
What are the radiologic features that favor a benign SPN?
- Stability for 2 years
- Diameter <3cm
- Well-defined border
- Heavier density
- Specific patterns for calcifications
What are the radiographic features that favor malignant SPN?
- Evidence of growth of the lesion within 2 years or less
- Volume doubling time 1-8 months
- Size >3cm
- Irregular contours and margins
- Umbilication of border
What is the range of Hounsfield unit that is most suspicious for malignancy
50 to 150
Low HU unit
High HU unit = generally benign
What are reliable signs suggesting that the lesion is benign based on CT
- Dense central core of calcification
- Laminated pattern with calcium in concentric layers
- Popcorn type o calcification
What is the most appropriate approach for diagnosis of indeterminate SPN
Invasive methonds
- Video assisted thoracoscopic surgery
- Open lung biopsy
[Paraneoplastic syndromes]
SIADH
Small cell lung CA
[Paraneoplastic syndromes]
Hypercalcemia
Squamous cell Ca
___ triangle where the brachial artery and subclavian artery pass through this space
interscalene triangle
Prior to entering the subcoracoid space, the subclavian vein and artery, and brachial plexus pass through this space
Costoclavicular triangle
Most common location of abdominal aortic aneurysm
Infrarenal aorta
What is the most important predictor of AAA?
size of the aneurysm
What is the preferred imaging study used to screen AAA because of its high sensitivity and specificity?
Abdominal UTZ
What imaging modality is preferred to detect and measure the diameter of an AAA?
CT Aortogram (abdominal CT)
What is the recommended screening for AAA for both sexes?
- Men >65 years old
What is the recommended screening for AAA in patient’s with history of ruptured AAA?
55 years old in both men and women
Repair of asymptomatic AAA is reserved for ___ diameter
5 to 5.5cm in diameter
Where is the most common location of thoracic aortic aneurysm?
- Aortic root or ascending aortic aneurysm
What are the CXR findings suggestive of Thoracis AA?
- Widened mediastinum
- Prominent aortic knob
- Displaced trachea
What imaging modality that is widely used for detection of aortic dissection?
Transesophageal echocardiography
