Chest Flashcards by Ravi Kana

Lung cancer T1 staging?

T1 = tumour <1-3cm

T1a - <1cm
T1b = 1-2cm
T1c = 2-3cm

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Lung cancer T2 staging?

T2 = tumour 3-5cm

T2a = 3-4cm
T2b = 4-5cm

Or T1 with:
- involvement of trachea (NOT carina)
- Involvement of the pleura

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Lung cancer T3 staging?

T3 = tumour 5-7cm

or T1/2 with involvement of:
- chest wall
- phrenic nerve
- pericardium

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Lung cancer T4 staging?

T4 = tumour >7cm

or T1-3 with involvement of:
- vertebral body
- great vessels
- mediastinum/heart
- oesophagus
- carina
- diaphragm

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Lung cancer N staging?

N0- no nodes
N1 - ipsilateral peribronchial / hilar / intrapulmonary nodes
N2 - ipsilateral mediastinal or subcarinal nodes
N3 - CONTRAlateral mediastinal, hilar, or any supraclavicular nodes.

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Lung cancer M staging?

M0 - no distant metastasis
M1 - distant metastasis present
- M1a - separate tumour nodules in contralateral lobe, or pleural/pericardial nodules.
- M1b - single extra thoracic metastasis in a single organ or single extra-thoracic node.
- M1c - multiple extra-thoracic metastasis

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Post bone marrow transplant pulmonary findings?

Neutropenic phase (<1 month) - Pulmonary oedema, haemorrhage, fungal

Early (1-3 months, immunosuppressed) - PCP, CMV

Late (>3 months) - COP, Bronchiolitis obliterans

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HIV patient presents with cough. CXR has fine reticular interstitial change.
CT has diffuse ground glass with pneumatoceles. Diagnosis?

PCP pneumonia

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Patient has upper lobe calcified granuloma and large calcified hilar lymph nodes. Diagnosis?

Ranke complex - Healed primary TB.

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Elderly COPD patient develops upper lobe cavitary lesions and consolidation. Tree in bud consolidation is seen elsewhere.
Diagnosis?

Classic Mycobacterium Avium Intracellulare Complex

Non classic would be Lady Windermere disease

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Signs of invasive aspergillus Vs normal aspergilloma?

Halo sign - ground glass around aspergilloma

Air Cresent sign - cresent of air above mass (pulmonary necrosis)

Invasive aspergillus is normally seem in immunosuppressed patients

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What is the most common cavitating lung cancer?

Squamous cell cancer

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Lambert Eaton syndrome is most commonly associated with what lung cancer?

Small cell lung ca

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Patient post pneumonectomy is shown to have the pneumonectomy space fill with progressively more air.

What is the post surgical diagnosis?

Broncho-pleural fistula.

Normally the space should fill with fluid not air.

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Chest findings in LCH

Upper and mid zone predominant
Irregular shaped nodules and thick walled cysts .
Smoking related

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Features of LAM

Diffuse uniform distribution
Thin walled round cysts
Young women

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Features of LIP

Mid and lower zone predominant
Thin walled round cysts
Perivascular distribution

Associated with Sjogrens and HIV

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Patient presents with chronic productive cough and recurrent chest infections. CT shows massive tracheobronchomegaly. Diagnosis?

Mounier-Kuhn

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Where do cardiac fibroelastomas normally occur?

Cardiac valves

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What is Carney Complex?

Cardiac myxomas and skin pigmentation (blue naevi)

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Most commonly malignant adult primary cardiac tumour?

Cardiac angiosarcoma
Typically seen in the right atrium

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Most common paediatric cardiac tumour

Rhabdomyoma
High association with tuberous sclerosis

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Key features of malignant mesothelioma?

Pleural thickening extending to the medial surface of the pleura (near the heart)
Pleural thickness >1cm
Extension into the fissure

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What is empyema necessitans and what condition is it seen with?

Empyema that eats into the soft tissues
Seen with TB

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What are thymomas associated with?

Myasthenia gravis

What is the classical imaging appearances of PAPVR, and what is it associated with?

One of the pulmonary veins drains into the right atrium instead of left Scimitar sign Associated with sinus venosus ASD

What thoracic disease is Behcet disease associated with?

Becets is chronic vasculitis of unknown origin Associated with pulmonary artery aneurysms

How do you differentiate pneumomediastinum Vs pneumopericardium?

Pneumopericardium does not extend above the great vessels

Classic imaging appearance of transposition of great vessels?

Egg on string appearance (egg shaped heart)

Classic CXR appearance of Tetralogy of Fallow?

Boot shaped heart

Classic CXR imaging appearance of TAPVR?

Snowman heart

Classic CXR imaging appearance of Epstein anomaly?

Box heart Associated with: Turner's Downs syndrome ASD

What maternal disease is patent ductus arteriosus associated with?

Maternal rubella

What is Holt Oram?

ASD and hand/thumb defects

What are the three types of ASD and where are they located?

Ostium primum - lower septum Osteum Secundum - mid septum Sinus venosus - upper septum

What is Tetralogy of Fallow?

RVOT obstruction VSD with an overriding aorta RV hypertrophy

What is the Garland triad?

Classic location of sarcoidosis lymphadenopathy Bilateral hilar enlargement and right paratracheal nodes

What is classically seen (and not seen) in PCP pneumonia?

Pneumatoceles Peri-hilar groundglass Pleural effusions are not a feature

Classic imaging appearance of pulmonary Kaposi Sarcoma

Flame shaped nodular opacities Interlobular septal thickening

Most common left to right shunt in adulthood?

ASD

What is the modified PIOPED criteria for PE on V/Q scan?

High probability - two or more large segmental defects (Large = 75% of segment) Low probability - Up to 3 small subsegmental defects (small <25% of segment) Intermediate probability - anything between low and high probability.

Most common lung cancer in non smokers?

Adenocarcinoma

How does RA present in the lungs?

Pleural thickening/effusions UIP Ground glass Caplan syndrome (RA and Pneumoconiosis)

How do you differentiate intra and extra lobar sequestration?

Intralobar - more common 75%, Pulmonary veinous drainage, does not have separate pleura, recurrent infections Extralobar - Systemic veinous drainage, separate pleural cover

What are the classic imaging features of ARDS on CT?

Pulmonary opacification with a dependent density gradient Widespread groundglass

Classic imaging features of COP?

Patchy peripheral consolidation with reverse halo sign/atoll sign Changes over time (fleeting)

How do you define Goodpastures syndrome?

Groundglass opacities that progress to crazy paving Glomerulonephritis Pulmonary haemorrhage Hilar lymph nodes Antiglomerular basement membrane antibodies

How to differentiate Primary Ciliary Dyskinesia from CF?

CF has upper lobe bronchiectasis PCD has lower lobe bronchiectasis

X-ray findings of coarctation of the aorta?

Figure 3 sign Inferior rib notching

What is pseudocoarctation of the aorta?

Elongation, narrowing or kinking of the aorta, with no pressure gradient, collateral formation, or rib notching.

What is Danon disease?

X linked cardio-skeletal myopathy - Cardiomyopathy - Skeletal myopathy (skeletal muscle weakness) - Intelectual disability

Typical imaging appearance of a cardiac myxoma?

Left atrium attached to the interatrial septum Well defined stalk Calcification is common (due to repeat haemorrhage)

Most common pulmonary manifestation of rheumatoid arthritis?

Pleural disease: - Pleural thickening - Pleural effusions Other - UIP, ground glass, Caplan syndrome

Classic imaging findings of silicosis?

Upper lobe predominant DENSE nodular opacities (more dense than soft tissue) Eggshell calcification of lymph nodes

What is Eisenmenger syndrome?

Uncorrected left to right shunt, causing chronic pulmonary hypertension. This causes increased pulmonary vascular resistance and right ventricular hypertrophy which in turn equalises the pressures in the ventricles and subsequently reverses the shunt.

How can you differentiate between true cardiac aneurysm and false cardiac aneurysm?

True aneurysm have broad neck and contain all the layers of endocardium and epicardium. They can contain mural thrombus which can be calcified. False aneurysms are a rupture of the myocardium which is contained by pericardium.

Typically imagine findings of chronic eosinophilic pneumonia

Reverse bat wing airspace consolidation (Upper lobe, peripheral airspace consolidation)

Classic imaging findings of reactivated TB?

Centrilobular nodules Upper lobe consolidation +/- cavities Tree-in-bud opacities

What are the two peak in incidence for post transplant lymphoproliferative disease?

1 year and 5 years post transplant

What is Kartageners syndrome?

Primary ciliary dyskinesia Situs invertus Bronchiectasis

LAM is associated with which condition?

Tuberous sclerosis

Typical location for a pericardial cyst?

Right cardiophrenic angle

Typical location for a bronchogenic cyst?

Sub carinal (50%) Paratracheal (20%)

Associated conditions with ABPA?

Asthma CF

Classical imaging appearance of ABPA?

Bronchiectasis Finger in glove opacities (mucoid impaction in bronchocele)

BTS solid lung nodule follow-up criteria?

<5mm: - discharge 5-6mm: - CT at 12 months 6-7-8mm: - CT at 3 months >8mm: - low risk - CT 12 months, - high risk - PET CT

Typical imaging findings in Acute eosinophilic pneumonia

Bilateral patchy ground glass opacification Interlobular septal thickening Pleural effusions

What pathology does unilaterally LEFT rib notching suggest?

Coarctation of aorta with aberrant RIGHT subclavian artery

What disease does progressive massive fibrosis occur in?

Pneumoconiosis Silicosis