Airways disease and emphysema

Question 1

normal pattern of tracheal branching in pigs, consists of an accessory bronchus to all or a portion of the right upper lobe that arises from the lateral tracheal wall within 2cm of tracheal carina

Answer 1

tracheal bronchus or bronchus suis

Question 2

tracheal bronchus most often supplies what lung segment

Answer 2

right upper lobe

Question 3

characterized by atresia of a segmental or subsegmental bronchus with a normal distal airway

Answer 3

bronchial atresia

Question 4

caused by congenital or acquired abnormalities of the elastic membrane or cartilaginous rings of the trachea

Answer 4

focal tracheal dilatation

Question 5

aka paratracheal air cysts, which may be congenital or acquired

Answer 5

tracheoceles

Question 6

tracheoceles occur almost exclusively in the______ trachea because the pressure gradient from the extrathoracic trachea to the atmosphere with the Valsalva maneuver favors their formation in this region

Answer 6

cervical

Question 7

circular lucencies along the right posterolateral trachea at the thoracic inlet in CT may represent

Answer 7

tracheoceles

Question 8

most common cause of extrinsic mass effect on the trachea is a

Answer 8

tortuous or dilated aortic arch or brachiocephalic artery

Question 9

Presents as a typical hourglass deformity of trachea on frontal radiography

Answer 9

Tracheal stenosis

Question 10

Patients with extrathoracic tracheomalacia, most often at the site of a prior tracheostomy, demonstrate tracheal narrowing on inspiration or expiration?

Answer 10

Inspiration

Question 11

Patients with intrathoracic tracheomalacia usually from prior endotracheal intubation, have tracheal narrowing on inspiration or expiration?

Answer 11

Expiration

Question 12

This entity can produce a necrotizing granulomatous inflammation of the tracheal and central bronchi, leading to focal cervical narrowing, or in advanced disease, narrowing of the entire length of trachea. Its diagnosis is made by radiographic demonstration of tracheal narrowing in association with upper airway and renal involvment and characteristic findings on biopsy

Answer 12

Granulomatosis with polyangitis

Question 13

Endotracheal and endobronchial tb are usually associated with

Answer 13

Cavitary tb

Question 14

tracheal scleroma is a chronic granulomatous disorder caused by infection with

Answer 14

Klebsiella rhinoscleromatis

Question 15

diffuse tracheal narrowing may be seen with what tracheal conditions

Answer 15

saber-shealth trachea, amyloidosis, tracheobronchopathia, osteochondroplastica, relapsing polychondritis, GPA or tracheal scleroma

Question 16

can cause diffuse tracheal narrowing but is mostly seen in the cervical trachea

Answer 16

GPA or tracheal scleroma

Question 17

rare condition in which there is incomplete septation of the cartilage rings, producing a long segment tracheal narrowing or “napkin ring” trachea

Answer 17

congenital tracheal stenosis

Question 18

congenital tracheal stenosis is often associated with other congenital cardiovascular anomalies in particular,

Answer 18

anomalous origin of left PA from right PA (PA sling)

Question 19

a fixed deformity of the intrathoracic trachea in which the coronal diameter is diminished to less than 2/3 of the sagittal diameter

Answer 19

saber-sheath trachea

Question 20

saber sheath trachea commonly affects

Answer 20

older men with COPD

Question 21

causes mass-like circumferential deposits that irregularly narrow the tracheal lumen seen in CT. It is characterized by deposition of a fibrillar protein polysaccharide complex in various organs

Answer 21

amyloidosis

Question 22

rare disorder characterized by the presence of multiple submucosal osseous and cartilaginous deposits within the trachea abd central bronchi or elderly men. the lesions arise as enchondromas from the tracheal and bronchial cartilage, and then project internally to produce nodular submucosal deposits that irregularly narrow the tracheal tumen and have a characteristic appearance and feel on bronchoscopy

Answer 22

tracheobronchopathia osteochondroplastica

Question 23

helpful feature in tracheobronchopathia osteochondroplastica that distinguishes this from tracheobronchial amyloid

Answer 23

calcified plaques that can be seen involving the anterior and lateral walls of trachea, with sparing of membranous posterior walls of the trachea which lacks cartilage

Question 24

common associated finding in saber-sheath trachea

Answer 24

upper lobe emphysema

Question 25

systemic autoimmune disorder that commonly affects the cartilage of the earlobes, nose, larynx, tracheobronchial tree, joints and large elastic arteries

Answer 25

relapsing polychondritis

Question 26

early in the disease, tracheal wall inflammation associated with cartilage destruction leads to an abnormally compliant and dilated trachea. Later in the disease, fibrosis leads to diffuse fixed narrowing of trachal lumen

Answer 26

relapsing polychondritis

Question 27

diagnosis is made by noting recurrent inflammation at two or more cartilaginous sites, most commonly the pinnae of the ear (producing cauliflower ears) and the bridge of the nose (producing saddle nose deformity)

Answer 27

relapsing polychondritis

Question 28

congenital disorder of the elastic and smooth muscle components of the tracheal wall

Answer 28

tracheobronchomegaly (Mounier-Kuhn syndrome)

Question 29

tracheobronchomegaly is associated with

Answer 29

ehler-danlos syndrome

Question 30

In tracheobronchomegaly, trachea and central bronchi meaures

Answer 30

Greater than 3.0 and 2.5 cm respectively in coronal diameter

Question 31

Congenital or acquired defect of tracheal cartilage causing soft ess of tracheal cartilage rings and a tendency for airway collapse

Answer 31

Tracheobronchomalacia

Question 32

Congenital disorders most often associated with tracheobronchomalacia

Answer 32

Relapsing polychondritis, ehler danlos syndrome, mucopolysaccharidosis

Question 33

May result from prolonged intubation, prior tracheostomy and extrinsic tracheal compression by mediastinal masses and vascular anomalies

Answer 33

Tracheobronchomegaly

Question 34

Excessive airway collapse of trachea on expiration, seen best on dynamic expiratory CT using low dose CT acquisition performed during forced expiratory maneuver are imaging features of

Answer 34

Tracheobronchomegaly

Question 35

A reduction in the cross-sectional area of the trachea exceeding 50% on the expiratory CT, particularly if there is a crescentic “frown-like” configuration to the trachea in cross section should suggest what diagnosis

Answer 35

Tracheobronchomegaly

Question 36

“Lunate”-shaped trachea, in which the coronal diameter of the trachea exceeds the sagittal diameter on axial CT obtained at normal inspiration

Answer 36

Tracheobronchomegaly

Question 37

Tracheal and bronchial fractures generally involve what part of bronchial tree

Answer 37

Proximal main bronchi (80%) or distal trachea (15%) within 2cm from the carina

Question 38

Most common form of tracheal and bronchial injury

Answer 38

Horizontal laceration or transection parallel to the tracheo bronchial cartilage

Question 39

Presence of calcified material within the tracheobronchial tree, develops from the erosion of a calcified peribronchial lymph node into the bronchial lumen

Answer 39

Broncholithiasis

Question 40

Broncholiths may occlude the airway and lead to

Answer 40

Bronchiectasis, obstructive atelectasis or pneumonia

Question 41

Diseases known collectively as COPD include

Answer 41

Asthma, chronic bronchitis, bronchiectasis and emphysema

Question 42

Common pathophysiology in COPD

Answer 42

Obstruction to expiratory airflow

Question 43

Airway disorder charcterized by rapid onset of bronchial narrowing with spontaneous resolution or improvement as a result of therapy

Answer 43

Asthma

Question 44

Radiographic findings in uncomplicated asthma are primarily the result of

Answer 44

Diffuse airway narrowing

Question 45

Results from excessive production of IgE following exposure to antigenic stimuli, resulting in bronchial smooth muscle contraction, bronchial wall inflammation, excessive mucus production

Answer 45

Asthma

Question 46

Hyperinflation producing increased lung volume, flattening or inversion of the diaphragm, attenuation of the peripheral vascular markings and prominence of retrosternal airspace is the result of

Answer 46

Expiratory air trapping

Question 47

Bronchial wall inflammation and thickening appear radiographically as

Answer 47

Peribronchial cuffing and tram tracking

Question 48

Defined as the excess production and expectoration of sputum that occurs on most days for atleast 3 consecutive months in at leasr 2 consecutive years

Answer 48

Chronic bronchitis

Question 49

Commonly affected lobes in chronic bronchitis

Answer 49

Lower lobe bronchi

Question 50

Abnormal permanent dilatation of bronchi

Answer 50

Bronchiectasis

Question 51

3 morphologic groups of bronchiectasis

Answer 51

Cylindrical, varicose, cystic (saccular)

Question 52

Type of bronchiectais Characterized by mild diffuse dilatation of the bronchi

Answer 52

Cylindrical

Question 53

Cystic bronchial dilatation interrupted by focal areas of narrowing, an appearance that has been likened to a string of pearls

Answer 53

Varicose bronchiectasis

Question 54

Appears as clusters of bronchi with marked localized saccular dilatation

Answer 54

Cystic bronchiectasis

Question 55

Characteristic appearance of multiple peripheral thin-walled cysts, with or without air-fluid levels that tend to cluster together in the distribution of a bronchovascular bundle is seen in

Answer 55

Ctstic bronchiectasis

Question 56

Bronchiectatic changes are usually central or peripheral?

Answer 56

Peripheral

Question 57

Central bronchiectasis is seen only in

Answer 57

Allergic bronchopulmonary aspergillosis, cystic fibrosis, bronchial atresia, acquired central bronchial obstruction

Question 58

Triad of kartagener syndrome

Answer 58

Sinusitis, situs inversus, bronchiectasis

Question 59

Post infectious bronchiectasis results from severe childhood pneumonia, usually from what organisms or viruses

Answer 59

Adenovirus, measles, pertussis

Question 60

Allergic bronchopulmonary aspergillosis represents a hypersensitivity reaction to aspergillus antigens and is characterized clinically by

Answer 60

Asthma, blood eosinophilia, bronchiectasis, with mucus plugging and circulating antibodies to aspergillus antigen

Question 61

Term used to describe the effect of severe pulmonary fibrosis on the peripheral airways

Answer 61

Traction bronchiectasis

Question 62

Traction bronchiectasis occurs commonly in what lobes

Answer 62

Upper lobes

Question 63

Defined as an abnormal, permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of alveolar walls and without obvious fibrosis

Answer 63

Emphysema

Question 64

Most common emphysema and is characterized by airspace distension in the central portion of the lobule, with sparing of the more distal portions of the lobule

Answer 64

Centrilobular emphysema

Question 65

Centrilobular emphysema affects what lobe

Answer 65

Upper lobes more than the lower lobes

Question 66

Results in uniform distention of the airspaces throughout the substance of the lobule, from the central respiratory bronchioles to the peripheral alveolar sacs and alveoli

Answer 66

Panlobular emphysema

Question 67

Panlobular emphysema has predilection to what lobe

Answer 67

Lower lobes

Question 68

Seen as selective distention of peripheral airspaces adjacent to interlobular septa, with sparing of the centrilobular region. It is most often seen in the immediate subpleural regions of upper lobes

Answer 68

Paraseptal emphysema

Question 69

Type of emphysema that may coalesce to form apical bullae; rupture of these bullae into the pleural space may give rise to spontaneous pneumothoraces

Answer 69

Paraseptal emphysema

Question 70

Refers to destruction of lung tissue associated with fibrosis that bears no consistent relationship to a given portion of the lobules

Answer 70

Paracicatricial or irregular emphysema

Question 71

Form of emphysema that is most often seen in association with old granulomatous inflammation

Answer 71

Paracicatricial or irregular emphysema

Question 72

Deficiency of serum protein alpha 1 antitrypsin (alpha 1 antiprotease inhibitor) and the development of what form of emphysema is well established

Answer 72

Panlobular emphysema

Question 73

Functional hallmarks of emphysema

Answer 73

Decreased airflow and diffusing capacity

Question 74

Most important plain radiographic finding and reflects the loss of lung elastic recoil

Answer 74

Hyperinflation

Question 75

In emphysema, loss of pulmonary capillary bed; associated chronic hypoxemia causes increased pulmonary vascular resistance manifests as

Answer 75

Enlarged central PAs; right heart enlargement (centrilobular)

Question 76

In emphysema, presence of increased peripheral vascular markings (centrilobular) is due to

Answer 76

Small airways disease, increased pulmonary vascularity

Question 77

treatment for emphysema

Answer 77

lung volume reduction surgery

Question 78

this surgical procedure specifically benefits those with mostly upper lobe emphysema and low exercise capacity prior to surgery

Answer 78

lung volume reduction surgery

Question 79

alterantive treatment for patients with emphysema, particularly younger patients with alpha 1 antitrypsin deficiency is

Answer 79

single or double lung transplantation

Question 80

thin walled cystic spaces that exceed 1 cm in diameter and are found within the lung parenchyma

Answer 80

bullae

Question 81

most often represent confluent areas of emphysematous lung and may be seen as part of generalized emphysema

Answer 81

bullae

Question 82

rare cause of lung cysts or bullae is ____, which is an autosomal dominant disorder characterized by skin fibrofolliculomas, malignant renal tumors, and thin-walled lung cysts, the latter predisposing to spontaneous pneumothorax

Answer 82

Birt-Hogg-Dube syndrome

Question 83

an accelerated form of paraseptal emphysema seen in young adult men; can also be associated with primary bullous disease

Answer 83

vanishing lung syndrome

Question 84

non-cartilage bearing bronchioles with a luminal diamter of <2 mm

Answer 84

small airways disease

Question 85

direct signs of small airway disease include

Answer 85

centrilobular nodules, centrilobular tree-in-bud opacities

Question 86

indirect CT signs of small airways disease include

Answer 86

proximal bronchial dilatation, hyperlucent regions due to expiratory air trapping

Question 87

pneumocystic jiroveci produce what opacities

Answer 87

geographic ground-glass opacification

Question 88

refers to an inflammation of the small airways

Answer 88

bronchiolitis

Question 89

infectious bronchiolitis in children are due to

Answer 89

RSV or adenovirus

Question 90

form of bronchiolitis which reflecs a form of diffuse lymphoid hyperplasia of peribronchiolar lymphoid follicles of unclear clinical significance seen in patients with RA or sjogren syndrome

Answer 90

follicular bronchiolitis

Question 91

aka bronchiolitis obliterans, is a subacute disease characterized pathologically by a mononuclear cell inflammatory process within the walls of respiratory bronchiles that leads to the formation of granulation tissue which plugs small airways

Answer 91

constrictive bronchiolitis

Question 92

because postinfectious bronchiolitis obliterans affects the lungs asymmetrically and usually occyrs during a period of lung growth and development, the affected lung is typically small and hyperlucent and the ipsilateral PA is hypoplastic. These findings describe what syndrome

Answer 92

Swyer-James syndrome

Question 93

rare form of constrictive bronchiolitis which is seen in middle-aged women who demonstrate severe airflow limitation and CT findings of air trapping with bronchial thickening and dilatation in association with one or multiple small nodules representing neuroendocrine cell tumorlets or inf the nodules are > 5 mm diameter, carcinoid tumors

Answer 93

diffuse idiopathic pulmonary neuroendocrine cell hyperplasia