Chest Flashcards
(172 cards)
1
Q
Which diseases cause egg shell calcification
A
Post radiotherapy lymphoma
Sarcoidosis
Amyloidosis
Silicosis
TB
Histoplasmosis
2
Q
What is the follow up for a solid nodule measuring >8mm in a low risk patient
A
<6mm - no follow- up
6-8mm - CT at 6-12 months then consider CT at 18-24 months
8 mm - Consider Ct at 3 months or tissue sampling or PET/CT
3
Q
What is the follow up of a ground glass nodules measuring >6mm
A
<6mm: No routine follow up required
>6mmCT at 6-12 months to confirm persistence then CT every 2 years until 5 years.
4
Q
What is the halo sign in the lungs and what does it represent
A
Ground glass opacification surrounding a lung nodule or mass. Represents haemorrhage.
5
Q
What is the most common cause of a benign solitary pulmonary nodule
A
1) Infectious granulomas (70-80%)
2) Harmatomas
6
Q
What are the 4 patterns of benign calcification of a pulmonary nodules
A
- Laminated
- Diffuse solid calcification
- Central
- Popcorn calcification
7
Q
What does popcorn calcification most likely present in a pulmonary nodule
A
Harmatoma
8
Q
On CT-contrast Chest imaging of pulmonary nodules, why might you get a false negative
A
Large pulmonary nodules with central-non cavitating lesions or adenocarcinomas.
9
Q
What are the main features of IPF
A
Bibasal subplueral reticular pattern fibrosis with HONEYCOMBING.
Traction bronchiectasis
10
Q
What is RB-ILD and DIP associated with?
A
Smoking
11
Q
What are the classic HRCT findings for a patient with DIP ?
A
Ground glass opacification in the lower lobes, peripheral and patchy
12
Q
What conditions are associated with lymphocytic interstitial pneumonias
A
Child - AIDS
Adult - Sjogrens
13
Q
Are Centrilobular nodules a features of RB-ILD ?
A
Yes
14
Q
What does traction bronchiectasis indicate?
A
Fibrosis and therefore ILD - IPF or NSIP
15
Q
what is an askin tumour ?
A
a ewings sarcoma of the chest wall.
16
Q
what are the types of atelectasis ?
A
4 types:
1. obstructive - central bronchial obstruction causing collapse
2. passive /relaxation - relaxation of lung next to a lesion
3. cicatrical - architectural, e.g. fibrosis
4. adhesive
17
Q
what is the sign of left upper lobe collapsed
A
luftsichel sign - (air sickle) - air cresent sign due to the expanded superior left lower lobe abutting the aorta
18
Q
what is the sign of right upper lobe collapse ?
A
golden S sign
19
Q
what is the juxtaphrenic peak sign ?
A
peaking of a heme-diaphragm due to collapse of a segment of lung - usually middle
20
Q
what is the cause of the flattened waist sign ?
A
flattening of the left heart boarder due to posterior shift of hilarity structures and resultant cardiac rotation
21
Q
what is round atelectasis ?
A
focal atelectasis with a round morphology - that always have an adjacent pleural abnormality - e.g. pleural effusion/thickening or plaque
22
Q
what is the criteria for round atelectasis ?
A
- round morphology
- pleural abnormality
- opacity in contact with the pleura
- commet tail sign of the vessels
- volume loss of the hemithorax
23
Q
what is consolidation?
A
complete filling of affected alveoli due to either water,pus,blood or cells
24
Q
what is the differential list for acute consolidation?
A
Pneumonia
ARDS - (non cardiac pulmonary oedema)
Pulmonary edema from heart failure if severe
pulmonary haemorrahge
25
What is the differential list for chronic consolidation
Adenocarcinoma
lymphoma
organising pneumonia
chronic eosinophilic pneumonia - inflammatory prossess characterised by eosinophils - causing the alveolar to fill up in the upper lobes
26
what is organising pneumonia ?
non specific inflammatory response characterised by granulation polyps which fill the distal airways causing rounded, peripheral, nodular consolidation
27
what causes ground glass opacification?
partial filling of the alveolar
thickening of the alveolar wall
reduced aeration of alveoli
28
what are the differentials for acute GGO?
pneumonia - usually atypical such as Pneumocystic jiroveci pneumonia, or viral
pulmonary edema
haemorrhage
ARDS
29
what are the differentials for chronic GGO
lung adenocarcinoma
organising pneumonia
chronic eosinophilic pneumonia
interstitial lung disease
hypersensitivity pneumonitis
30
what is the differential for smooth interlobular thickening ?
pulmonary edema
lymphangitis carcinomatosis
31
what's the differential for nodular interlobular thickening ?
lymphangitis carcinomatosis
sarcoidosis
32
what is an infectious cause of centrilobular nodules?
viral pneumonia
33
what is an inflammatory cause of centrilobular nodules ?
hypersensitivity pneumonitis
34
what is hypersensitivity pneumonitis ?
type 3 mediated immune réponse to an inhale organic compound
35
what is pulmonary capillary hemangiomatosis and what does it look like on CT?
vascular pathology characterised by abnormal capillary proliferation leading to pulmonary hypertension, looks like centrilobular nodules
36
what is the most common cause of perilymphatic nodules
sarcoidosis
37
what causes solitary cavitary lesions?
squamous cell carcinoma > adenocarcinoma
TB
Fungal pneumonia
Cavitary bacterial pneumonia
38
what is the differential for multiple cavitary lesions?
septic emboli - usually peripheral
vasculitis - GPA
metastases - squamous cell
39
what is lymphangioleiomyomatosis
diffuse, cystic lung disease due to smooth muscle proliferation of the distal airways . results in bilateral, similar shaped cysts of similar size. usually associated with a pleural effusion - chylous effusion
40
what is the classic finding of pulmonary langerhans cells histocytosis
Nodules + bizarre-shaped pulmonary cysts in upper and mid lung zones in cigarette smokers
41
which condition is associated with lymphoid interstitial pneumonia
sjogrens syndrome
42
what syndrome lines pulmonary cysts with renal cell carcinoma - chromophobe
birt-hogg-dube syndrome
43
what causes predominantly upper lobe pulmonary fibrosis
end stage sarcoidosis
chronic hypersensitivity pneumonitis
end stage silicosis
44
what is ranke complex
calcified gohn focus and mediastinal lymph nodes
45
what is mycobacterium avium complex
a non tuberculosis, mycobacterium that affects people usually with pre-existing pulmonary disease or old ladies
46
when does pneumocystis jiroveci cause pneumonia
when the CD4 sound < 200
47
what is the classic CT finding of PJP
bilateral perihilar airspace opacities with peripheral sparing
48
what is the CD4 count in patients who develop cryptococcus neoformans pneumonia
< 100
49
what is a specific finding of ABPA ?
high attenuation mucus within a bronchiectatic airway - resulting in a finger in glove
50
what is the treatment of an aspergilomma ?
embolisation or resection
51
what is an aspergilloma ?
aspergillus fungal hyphae and cellular debris. they form in pre-existing lung cavities
52
what is the Monod sign
curvilinear air surrounding the aspergilloma
53
what is the air cresent sign
seen in patients with angioinvasive aspergillosis crescent of air from retraction of infarcted lung that occurs with recovery of neutrophil count
54
what is angioinvasive aspergillosis
aggressive infection whereby there is invasion and occlusion of the arterioles and small pulmonary arteries by fungal hyphae. seen only in neutropenic patients.
55
what is the most common cause of lobar pneumonia
streptococcus
Klebsillea - for alcoholic or immune patients
56
What is the most common cause of bronchial pneumoniac
staph. aureus
also pneumococcus and klebsillea
57
what does viral pneumonia usually look like ?
bilateral and with hyperinflation - due to bronchial constricition leading to air trapping
58
what is the halo sign ?
seen in angioinvasive aspergillosis - a mass with a peripheral ground glass appearance - demonstrating pulmonary haemorrahge
59
what is a normal CD4 count ?
800-1000
60
In AIDS , when do fungal infections occur ?
CD4 < 150
61
in AIDS when does TB occur ?
CD4 200-300
62
where does Graft vs host disease commonly affect ?
the GI tract and the skin
63
what is nocardia ?
an infection assocaited with bone marrow transplant and those with AIDS.
you get lobar consolidation and cavitating nodules
64
what is isolated right upper lobe pulmonary oedema seen in
mitral regurgitation secondary to MI causing papillary muscle rupture
65
where should a dialysis catheter be positioned
within the right atrium
66
what type of lung cancer is not associated with smoking
adenocarcinoma
67
what is the size criteria of a pulmonary nodule ?
<3cm
68
what is the size criteria of a pulmonary mass ?
>3cm
69
a nodule with popcorn calcification usually indicates?
pulmonary harmatoma
70
what describes of a nodule make it sound benign ?
calcification
sub pleural location
triangular shaped
small <3mm
clusters suggest infection
71
are subsolid or solid nodules more likely to be malignant.
subsolid
72
is upper lobe or lower lobe nodules more likely to be malignant ?
upper lobe
73
when is follow up not recommended in pulmonary nodules ?
<6mm
74
what is the most common subtype of lung cancer ?
adenocarcinoma
75
which lung cancer does cavitation more likely occur in
squamous cell carcinoma
76
in adenocarcinoma, what is lepidic growth ?
spread of malignant cells using the alveolar walls as scaffold
77
how does adenocarcinoma of the lung normally present ?
speculated / solidatry nodule
ground glass nodule
chronic , diffuse ground glass/consolidation
78
where doe most squamous cell carcinomas arise ?
usually bronchial tumours - or hilar lesions
79
how does small cell carcinoma present ?
mediastinal or hilar lymphadenopathy
80
how does large cell carcinoma present ?
in the lung periphery , as a large solid mass with irregular margins
81
where does lung carcinoid tumour arise from ?
neuroendocrine cells in the bronchial walls
82
What is DIPNECH?
diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
Syndrome of.
1. multiple hyperplasia of neuroendocrine ells
2. carcinoid tumours
3. bronchiolitis obliterans
83
how does primary lymphoma present ?
mass like consolidation
84
how does post transplant lymphoproliferative disorder present ?
new pulmonary nodules in a patient after solid organ. transplantation
85
which cancer can present as non resolving consolidation?
Adenocarcinoma
86
what is a hilar mass a common presentation of ?
squamous cell carcinoma and small cell carcinoma
87
what is a superior sulus tumour ?
a lung cancer occurring in the lung apex
88
what is Horners syndrome
ipsilateral ptosis, mitosis and anhirdosis
89
what is a pan cost tumour ?
superior sulcus tumour with involvement of the sympathetic ganglia causing hardeners syndrome
90
in staging what does a malignant effusion mean ?
M1a tumour
91
what stage of lung cancer is unresectable
T4/N2, N3 - Stage 111B
92
Lung cancer:
T stage grading
1. <3cm
2. 3-5
3. 5-7, metastatic nodules in the same lobe, invasion of chest wall,
4. >7 or invasion of mediastinum, great vessels, heart, diaphragm, spine, trace, esophageus
93
Lung cancer :
N staging
n1 - same side, hilar or intrapulmonary
N2 - same side mediastinal nodes
N3 - opposite side or supraclaviciular
94
Lung cancer :
M staging
M1 a - local thoracic mets
M1 b - sing extra thoracic
M1 c - multiple extrathoacic
95
what is fleischner sign ?
widening of the pulmonary arteries due to clot
96
what is Hamptons hump ?
peripheral wedge shaped opacity representing pulmonary infarct
97
what is watermark sign
regional oligemia in the lung distal to the pulmonary artery thrombus
98
in patients with AIDS, how does histoplasmosis present with ?
fever, malaise
CT demonstrates millary appearance plus reticulonodular air space opacification
99
what side of the heart is most commonly affected in carcinoid ?
right side of the heart. including affecting the mitral valve due to the hormones secreted
100
what type of mediastinal masses does Hodgkins lymphoma commonly present with ?
anterior mediastinal mass
101
what type of nodal spread does Hodgkins lymphoma make ?
contiguous
102
what diameter of the pulmonary artery suggests pulmonary hypertension?
> 3cm
or bigger than the aorta
103
what are pulmonary artery wall calcifications pathagnomic for ?
chronic pulmonary artery hypertension due to shunts
104
which drug is associated with pulmonary veno-occlusive diseased (pulmonary hypertension)
bleomycin
105
what are the most common causes of fibrosing mediastinitis ?
histoplasmosis and tuberculosis
106
classic features of UIP
subpleural reticulations, traction bronchiectasis and honeycombing
107
causes of UIP
idiopathic pulmonary fibrosis
asbestosis
collagen vascular disease - RA
Drugs
108
what is NSIP usually caused by
underlying collagen vascular disease
such as dermatomyositis, SLE, mixed CTD, sclerodermaa
109
what is a key features of NSIP /
ground glass opacification with a peribronchial predominance with sparing of the immediate suppleural lung
110
what does the reverse halo sign indicate ?
organising pneumonia = atoll sign.
central lucency with surrounding ground glass halo
111
how does organising pneumonia look on CT ?
consolidative / ggo in a peribronchovascular and perihilar distirbution
112
what is the key imaging findings of RB-ILD ?
centrilobular nodules in the lung apices -
due to sheets of macrophages filling the terminal airways
and apices - as the smoking pathogens go to the top
113
what is the classic features of a harmatoma ?
contains fat
peripherally located
popcorn calcification
114
focal cord paralysis is a common feature in which cancer ?
lung cancer
115
which cancers classically cause lymphangitis carcinomatosis ?
certain cancers spread by plugging the lymphatics
C -Cervic
C- Colon
S- Stomach
B- Breast
P- Pancreas
T- thyroid
L - lung/Larynx/ Broncho
116
where do most inhaled lung disease affect ?
the upper lobes as the lower lobes have better blood supply and more robust blood flow
117
what is hypersensitivity pneumonitis caused by ?
inhaled organic angitengs
118
what is pneumoconiosis caused by
inorganic dust inhalation
119
what is the most common feature of pneumoconiosis ?
multiple upper lobe predominant perilymphatic nodules
120
what is Caplan syndrome
RA and either coal workers/silicosis. pneumoconiosis
121
what type of consolidation is seen in chronic eosionphillic pneumonia ?
reverse bat wing: patchy , peripheral and upper lobe predominant
122
what is the most common cause or pulmonary haemorhhage
microscopic polyangiitis - causing a pulmonary renal syndrome, with progressive renal failure
123
what is granulomatosis with polyangiitis ?
small vessel vasculitis
1 - sinusitis
2 - lung disease
3- renal insufficiency
C-ANCA positive
124
when is radiation pneumonitis most severe ?
3-4 months after treatment
125
when does radiation fibrosis become apparent ?
6-12 months after therapy
126
what is sarcoidosis ?
idiopathic non-caseating granulomas which merge to form nodules and masses within the body
127
fibrotic changes to sarcoid most commonly occur where ?
mid to upper lobes
128
what are the most common CT lung findings of sarcoid ?
egg shell calicifcaiotn lymph nodes
bilateral, symmetrical lymph nodes
upper lobe, perilymphatic nodules of varying sizes - granulomas
129
what happens to the alveoli in pulmonary alveolar proteinosis ?
filling of the alveoli with proteinaceous lipid rich material
130
what type of infection are patients with PAP susceptible of ?
nocardia
131
what is the treatment of PAP
whole lung bronchoalveolar lavage
132
what is lymphangioleiomyomatosis.
diffuse cystic lung disease caused by bronchiolar obstruction and destructive lung disease
133
what is LAM associated with ?
women of child bearing age
presents with spontaneous pneumothorax and a chylrothorax
134
what is birthday-hogg dude syndrome characterised with ?
skin non cancerous tumours
chromophobe renal cell carcinoma
renal/pulmonary cysts
135
which nerve pass through the AP window ?
phrenic
vagus
recurrent laryngeal nerves
136
what makes the tracheoesophgeal stripe?
the posterior wall of the trachea with the pleural layer of the medial right lung
137
what makes the azygoesphogeal line ?
the posterior medial basal segment of the right lower lobe and the oesophagus and azygous vein
138
what condition is a thymoma associated with ?
Myasthenia gravis
139
who is at risk of developing a malignant germ cell tumour
patients with klinefleter syndrome
140
dense calcification within a lymph node is seen in ?
sarcoidosis or post granulomatous disaes
141
low attenuation lymph nodes raises the suspicion of ?
TB
142
avidly enhancing lungs mets include
renal cell
thyroid
lung
sarcoma
melanoma
143
what is unicentric castle mans disease present with ?
avidly enhancing enlarged lymph node/mass
144
what is multicentricell castle was disease sene in ?
patients with HIV and Herpses simplex Visors 8
145
where do morgangi hernias tend to arise ?
anterior medial - usually incidental finding, containing minaly fat. may have bowel
146
what is the BTS guidelines follow up for a solid nodule ?
5-6mm - f/u in 12 months
>6mm - f/u in 3 months
147
what are the preparations for FDG pet
> 4 hours between FDG pet and insulin
No excercsie for 24-48 hours
caffeine and alcohol and nicotine avoided for 12 hours
fasted for 6 hours
148
what tissue types do teratomas commonly have
fat fluid and calcificatoin
149
what do seminomas tend to present with
no calcification
increased levels of hCG, LDH, or alpha fetoprotein
150
how does a malignant thymoma tend to present ?
with drop lesions into the pleura
151
In left lower lobe collapse, on CXR what is obscured ?
the descending aorta
152
what is a ganglioneuroma
benign tumourr fo sympathic ganglion cells
153
what is a neuroblastoma
malignant tumour of ganglion cells seen in early childhood
154
what type of neurogenic tumours typically occur in adults vs childnre
adults - peripheral nerves
children - sympathic
155
what are the most common sympathic ganglion tumours in children
ganglioneuroma
neuroblastoma
ganglioneuroblastoma
156
how does relapsing polychondritis present and what is it ?
idiopathic inflammation of the catilage
causes smooth , tracheal bronchial wall thickening with sparing of the posterior membranous trachea
157
what is the morphological classification of bronchiectasis ?
three types
cyclindrical - mild
varicose
cystic - most severe
158
what is the most common cause of bronchiectasis
chronic aspiration
159
which congenital connective tissue disorders result in bronchiectasis ?
mounier-kuhn
williams-campbell
160
what is the most common primary tracheal malignancy ?
squamous cell carcinoma
161
which cancers most commonly metastasis to the lungs ?
BReaTH lungs
Breast
renal
Thryroid
(melanoma , sarcoma)
162
which cancners will usually have a lung met at the time of diagnosis ?
CHEST
C - choriocarcinoma
Hypernephroma - wilms
Ewings sarcoma
Sarcoma
Testicular tumour
163
what is pulmonary alveolar microlithatisi ?
tiny / sand like calcification deposits within the alveolar, classific appearance seen on cxr.
asymptomatic
may cause lung fibrosis
164
what type of lung cancers doesn't usually show up on PET
bronchial carcinoid tumours
165
what is the main cause of pnaacinar emphysema?
alpha 1 antitrypsin
166
what is Hypertrophic pulmonary osteoarthropathy (HPOA)
periosteal reaction of the long bones in association with lung disease
167
how to firbous tumours of the pleural tend to look like ?
pleural based mass which tends to change position
low uptake on FDG
168
which area is usually spared in astestbosis exposure plaques
the costophrenic angles
169
which conditions lead to egg shell calcification?
silicosis
sarcoidosis
170
which metastasis lead to mediastinal calcificaiton> ?
papillary/medullary thyroid cancer,
osteosarcoma
mucinous adenocarcinoma
171
what is the classic wegners triad ?
sinusitis
renal disease
lung disesae
172
