Cardiothoracics Flashcards
(44 cards)
1
Q
Haemophilus Pneumonia
A
Children, immunocomprimised and COPD
- LL prediliction
- Bronchopneumonia
- Empyema
2
Q
Adenomcarcinoma
A
- Most common lung cancer
- 75% solitary peripheral lesions
- Irregular and spiculate and associated with fibrosis
- Can occur as SPN or groundglass opacity.
SUBTYPE - Bronchioloalveolar cell carcinoma in situ (BAC) = growth along preexisting bronchiloar and alveolar walls. Can spread via the airways.
3
Q
Adenovirus
A
Predominantly upper but can be LRTI
Adults = Overinflation bronchopenumonia accompanied by lobar atelectasis.
Children = Lobar/Segemental consolidation.
4
Q
AIP
A
- Rapid progression from cough, fever, dyspnea —>severe hypoxia requiring mechanichal ventilation.
- ARDS
- diffuse alveolar damage with minimal mature collagen deposition.
CT:
- Diffuse GG opacity and consolidation.
- AP denisty gradient
- Fibrosis can develop but stabilizes.
5
Q
Alpha 1 Antitrypsin Deficiency
A
- Early adulthood
- Panacinar emphysema - lower lobe predominance
- Bronchiectasis
- Cirrhosis
6
Q
Amebiasis
A
Entamoeba histolytica
- GI tract and liver
- Right basal atelctasis and pleural effsuion as result of direct spread from liver abscess.
- Can result in empyema and pneumonia.
7
Q
Carney’s Syndrome
A
- Multiple cardiac myxomas
- Extracardiac myxomas
- Breast
- testes
- thyroid
- brain
- adrenal
- Pituitary adenoma
- psamammomaotous melanotic schwanoma
- Testicular tumours
- Blue naevi skin pigmentation
8
Q
Carney’s Triad
A
Pulmonary chondromas
Gastric Leiomyosarcoma
Extraadrenal paraganglioma
9
Q
Castleman’s Disease
A
- Benign lympoprliferative disorder.
- Unicentric
- Children and young adults
- Solitary mediatinal mass with hyalinised vascular supply
- Multicentric
- HIV
- Multiple oragans and symptomatic.
10
Q
Causes of cavitating lung lesions… CAVITY
A
C = Cancer (Squamous cell carcinoma – either bronchogenic or metastatic, or adenocarcinoma)
A = Autoimmune granulomas (Wegener granulomatosis and Rheumatoid arthritis granulomas)
V = Vascular (septic emboli)
I = Infection (abscess, TB or cavitating pneumonias [strep, staph, aspergillus, legionella, klebsiella])
T = Trauma – pneumatocoeles
Y = Youth (ie congenital – CPAM, sequestration, bronchogenic cyst) These all form cysts, not true cavities as such.
11
Q
Churg-Strauss
A
Eosinophilic granulomatosis with polyangiitis (EGPA)
- 30-50yo
- Present with asthma (extrapulmonary signs = sinusitis, diarrhoea, skin purpura, and/or arthralgias)
- pANCA marker
- CT:
- Random distribution of GG/Consol
- Centrilobular nodules and bronchial wall thickeining
- rarely cavities
12
Q
Congenital lobar overinflation
A
- Males 3:1
- Underdevelopment of affected lobe bronchial cartilage.
- affected lobar bronchus fails to stay open in expiration
13
Q
COP (Cryptogenic Organising Pneumonia)
A
- Wide spread deposition of granulation tissue in peribronchiolar airspace and bronchioles.
- Bronchiolitis Obliterans with Organising Pneumonia (BOOP) is the same but in cases of:
- viral infection
- toxic fume inhilation
- collagen vascular disease
- organ transplant
- drug reactions
- chronic aspirations
- PFT: Restrictive, reduced lung volume and increased DLCO
- Histologically uniform changes in affected lung.
CT:
- Patchy GG surronded by dense consilidation = ‘reverse halo’
- Bronchiectasis and bronchial wall thickening.
14
Q
CPAM
A
Congenital pulmonary airway malformations
- Failure of normal bronchoalveolar development with a hamartomatous proliferation of terminal respiratory units in a gland-like pattern
- Type 0 is lethal postnatally
- Type I is the most common.
- Type II, III and IV Are different types of cystic shit.
15
Q
Dermatomyositis/polymositis
A
- Autoimmune inflammation and distruction of skeletal muscle
- proximal muscle pain and weakness
- skin rash
- respiratory and pharyngeal muscle weakness
- interstitial pneumonitis
- looks like RA, SLE, scleroderma and IPF
- course reticular/nodular opacities in a basal distribution.
16
Q
Eggshell calcification
A
- Fibrosing mediastinitis
- Amyloidosis
- Silicosis
- Sarcoidosis
- Sclerderma
- Post radiotherapy lymphoma
- Histoplasmosis
17
Q
Goodpastures syndrome
A
- Young adult men
- Cough, haemoptysis, dyspnea and fatigue.
- Cytotoxic antibody to renal glomerular basement membrane with cross reactivity to alveolar basement membrane.
- CXR - pulomary oedma
- CT
- acute - GG opacity without spetal thickening
- subacute - rise of reticular opacities owing to resorption of blood products (CRAZY PAVING)
- recurrent - fibrosis
- DDx - Idopathic pulomary haemorrhage
18
Q
Histoplasmosis
A
Histoplasmosis capsulatum
Acute:
- Flu like symptoms
- CXR - normal/non-specific
- Large inoculation
- Widespread 3-4mm nodules
- or solitary <3cm nodule
Chronic:
- In patients with underlying emphysema can casue CLD.
- Bilateral upper lobe cicatrizing atelectasis.
- Calcified lymph nodes
- Fibrosing mediastinitis
Blood borne dissemination: (RARE)
- Lung - Indistinguishable from miliary TB
- Splenic granulomas.
19
Q
Hydatid disease
A
Echinococcus granulosus
- Creates 3 layered cyst in lung which does not calcify. - Well circumscribed soft tissue mass
- Peripheral fibrotic lung along cyst
- Commonly riht lower lobe.
- If percyst ruptures then can develop crescent sign.
20
Q
Lymphangioleiomyomatosis (LAM)
A
- Non smoking women of childbearing age.
- Numerous small cysts surrounded by normal lung
- Chylous pleural effusion.
- Unchanged lung volume.
- Can have spontaneous pneumothorax.
21
Q
Lutembacher syndrome
A
Mitral stenosis with pre-existing ASD —>marked right sided enlargement.
22
Q
Lymphamatoid Granulomotosis
A
- Type of pulmonary lymphoma
- Round nodules in the lower lobes infiltrate small vessels and cause necrosis via obliterative vasculitis
- Multiple nodular opcities +/- cavities.
- CNS and skin involvement is common
- Poor prognosis.
23
Q
Lymphangitis Carcinomatosis
A
- Cancer cells travelling in lymph and infiltrating lung parenchymal connective tissue.
- Smooth thick reticular polygonal network.
-
Certain Cancers Spread By Plugging The Lymphatics
- Cervix
- Colon
- Stomach
- Breast
- Pancreas
- Thyroid
- Larynx & Lung
24
Q
Lymphcytic interstitial pneumonitis
A
- Diffuse lymphod hyperplasia
- lower lobe reticulonodular and linear patern of disease with diffuse ground glass opacities, centrilobular nodules and thin walled cysts.
- Can be treated with steroids
- May result in lymphoma and fibrosis
- In patients with:
- AIDS
- Sjorgrens
- Hypogammaglobuminaemia
- Multicentric Castlemans disease.
25
Most common benign cardiac tumours
1. Atrial myxoma (50%)
2. Fibroma (12%) - may calcify
3. Lipoma
4. Rhabdomyoma - assoc with tuberous sclerosis
5. Hydatid cysts (curvilinear calcification)
26
Most common maligncies to cause lymphangitis carcinomatosis
* breast
* stomach
* pancreas
* prostate
27
Most common neoplasms to met to the heart
1. Breast
2. Lung
3. Melanoma
4. Lymphoma
28
Most common primary cardiac malignant tumours
1. Angiosarcoma
2. Rhabdosarcoma
3. Liposarcoma
4. ...Other sarcomas
29
Mycoplasma Pneumonmia
Most common atypical pneumonia (5-20 yo)
Positive for cold agglutinins (60%)
Rad:
* Reticular pattern
* LL predisposition
* Consolidation
30
Poland syndrome
Hyperlucent lung resulting from hypoplasia/aplasia of the chest wall.
Also assoc with hypoplasia of abnormalities of the ipsilateral breast and upper limb.
31
Rheumatoid lung disease
* Histologically a form of UIP
* Begins as lower lobe alveolitis --\>endstage lower lobe fibrosis (honeycombing)
* Can form lung necrobiotic rhematoid nodules paralell to flares.
32
Schistosomiasis
*S. Mansoni, S. Jaonicum & S. Haematobium.*
* Waterbourne
* Larvae passing through pulmonary capilaries cause transiet airspace opacities - eosinophilic pneumonia.
* When ova retuning in from systemic infection in to pulmonary arterioles
* induce granulmatous inflammation and fibrosis
* obliterative arteriolitis
* pulmonary hypertension and cor pulmonale
* can resemble miliary TB
33
Small cell carcinoma
* Cental location within the main or lobar bronchi.
* Invade the bronchial wall.
* Hilar or mediastinal mass with extrinsic compression of the bronchi.
* Local lymphadenopathy
34
Squamous cell carcinoma
* Second most common (25%)
* Central locaion within lobar or segmental bronchial wall.
* Invades the bronchial wall.
* Central necrosis / cavitation
* Present with cough and haemoptysis
35
Swyer-James syndrome
Kid/teenager with recurrent LRTIs
Causes hyperlucent affected lung due to airtrapping and brochiectasis resulting in consequential airspace destruction.
36
TB
_PRIMARY_
Majority are asymptomatic with no radiological findings.
If symptomatic Granulomas (Ghon lesions) form in 1-3 weeks. --\> central caseous necosis
Coincides with delayed hypersensitivity.
Mediastinal adenopathy (partcularly in children and immunocomprisimised.)
May from Ranke complex = Ghon focus and calcified nodes
POST PRIMARY
Often symptomatic
ill defined patchy nodular opacities
Cavitation = Active transimissible disease.
Cavity erosion in to pulmonary artery can cause RASMUSSEN aneurism.
Parenchymal heling results in fibrosis, bronchiectasis and volume loss.
complucated by miliary TB.
37
Tracheopathia Osteochondroplastica
Osteocartilagenous submucosal calcified nodules.
Typically involves distal two thirds of trachea and proximal bronchi.
38
Uhl anomaly
*Arrhythmogenic right ventricular dysplasia.*
* Rare aquired cardiomyopathy in infants. - limited to RV
* Thinning of the anterior RV wall with fatty infiltration.
39
UIP
* Macrophages first proliferate in alveolar airspace ---\> thicken the interstitium ---\> Then fuck it up (fibrosis)
* Histologically - different staged of the disease are seen simultaneuosly
* 50-80s affected.
* PFTs = Restrictive disease and reduced diffusing capacity of carbon monoxide (DLCO)
* Idiopathic or assoc w aa vascular collagen disorder (RA etc)
CT:
* bibasilar coarse reticular/reticularnodular obacity followed by honeycombing ---Reduced lung volume.
* interstitial and intraalveolar changes - groundglass
* traction bronchiectasis
*
40
Upper lobe distribution BREASTS
B = Beryllosis
R = Radiation
E = Eosinophilic granuloma (Langerhans cell histiocytosis) and Extrinsic Allergic Alveolitis
A = Ankylosing spondylitis
S = Sarcoidosis
T = Tuberculosis
S = Silicosis
41
Varicella-zoster virus
Immunosupressive therapy or those with lymphoma
acute = diffuse bilateral 5-10 ill defined nodularities
after resolution some invosute and calcify (2-3mm)
42
Klebsiella pneumona
G-ve infection in debiltated or alocoholics
Px with redcurrent jelly productive cough.
Rad:
* Consolidation appears similar to that of infection with S. pneumoniae
* Lobar expansion (bulging fissures)
* Cavitation, 30%–50%, typically multiple
* Massive necrosis (pulmonary gangrene)
* Pleural effusion uncommon
43
CAVITY
**C = cancer**
* bronchogenic carcinoma : most frequently SCC
* cavitatory metastasis : again most frequently SCC
**A = autoimmune granulomas**
* Wegener's granulomatosis
* rheumatoid arthritis (rheumatoid nodules)
**V = vascular**
* pulmonary embolus / pulmonary infarction
**I = infection**
* pulmonary abscess
* TB, fungal, staph aureus, histoplasmosis
**T = trauma**
* pneumatocoeles
**Y = youth**
* CPAM
* pulmonary sequestration
* bronchogenic cyst
44
Cryptococcosis
* Cryptococcus Neoformans
* Pigeon shit
* Common in patients with lymphoma, diabetes, AIDS and roids
* Imaging:
* Pulonary mass/nodules
* Lobar or segemental consolidation
* CNS and other organ stuff
