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DDx > Chest > Flashcards

Chest Flashcards

0
Q

Pulmonary renal syndromes (haemorrhage + nephritis)

A

• Goodpasture syndrome (anti-GBM positive)
• Wegener disease (ANCA positive; nodules are
more common than ASD)
• SLE
• Henoch-Schönlein purpura
• Polyarteritis nodosa
• Penicillamine hypersensitivity

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1
Q

Solitary pulmonary nodule

A

Granulomatous: tuberculoma, histoplasmoma, cryptococcus, coccidiodomycosis

Malignant: lung cancer, solitary metastasis

Benign: carcinoid, hamartoma

Infectious/inflammatory: pneumonia, hydatid, rounded atelectasis, Wegener’s, sarcoid, organising pneumonia

Congenital: sequestration, bronchogenic cyst, intrapulmonary lymph node

Vascular: haematoma, AVM

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2
Q

Causes of ARDS

A
  • Massive pneumonia
  • Trauma
  • Shock
  • Sepsis
  • Pancreatitis
  • Drug overdose
  • Near-drowning
  • Aspiration
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3
Q

Chronic airspace disease

A

Tumors
• Bronchioalveolar carcinoma • Lymphoma

Inflammation
• Tuberculosis, fungus
• Eosinophilic pneumonia
• Pneumonitis, BOOP/COP
• Alveolar sarcoid (mimics ASD)

Other causes
• Alveolar proteinosis
• Pulmonary hemorrhage
• Lipoid pneumonia, chronic aspiration

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4
Q

Multiple pulmonary nodules

A

Metastases

Abscesses (pyogenic e.g. Staph, Klebsiella; immunocompromised e.g. Nocardia, Legionella)

Infectious: TB, fungus, aspergillosis, histoplasmosis

Inflammatory: sarcoidosis, rheumatoid nodules, silicosis,

Wegener’s, necrotising vasculitis, histiocytosis

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5
Q

Miliary pattern

A

Hematogenous infection: TB, histoplasmosis
Metastases: thyroid, melanoma, breast, choriocarcinoma
Eosinophilic granuloma
Silicosis
Sarcoid

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6
Q

Calcified lung nodules, > 1mm

A

Metastases
- Medullary thyroid cancer, mucinous or osteogenic metastases

Infection

  • Previous varicella pneumonia
  • Histoplasmosis, coccidioidomycosis, TB

Parasites
- Schistosomiasis

Other
- Silicosis, CWP

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7
Q

Calcified lung nodules, < 1mm

A

Alveolar microlithiasis
Chronic pulmonary venous hypertension
“Metastatic” calcification from severe renal
disease

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8
Q

Cavitating lesion

A

Abscess
• Pyogenic: Staphylococcus > Klebsiella > Streptococcus
• Immunocompromised: Legionella, Nocardia

Cavitated tumor
• SCC (primary SCC > head and neck SCC > sarcoma metastases)
• Sarcoma
• Lymphoma
• TCC of the bladder

Cavitated granulomatous mass (often multiple)
• Fungus: Aspergillus, coccidioidomycosis (thin
wall)
• TB
• Sarcoid, Wegener disease, rheumatoid nodules
• Necrotizing granulomatous vasculitis

Cavitated posttraumatic hematoma

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9
Q

Small cystic disease

A 
• Eosinophilic granuloma
• Lymphangioleiomyomatosis
• Cystic form of PCP
• Honeycombing in any end-stage interstitial
disease
• LIP
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10
Q

Interstitial disease

A

Fluid

  • Pulmonary edema
  • Venous obstruction (thrombosis)

Inflammation

  • Infectious (interstitial pneumonias)
  • Viral
  • Granulomatous (TB, fungal) PCP

Idiopathic

  • IPF
  • Sarcoid

Collagen vascular disease

  • RA
  • Scleroderma
  • Ankylosing spondylitis

Extrinsic agents

  • Pneumoconiosis (asbestos, silicosis, CWP)
  • Drugs

Tumor
• Interstitial tumors: Eosinophilic granuloma
• Lymphangitic tumor spread
• Desmoplastic reaction to tumor

Proteinaceous material

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11
Q

Crazy paving

A 
Pulmonary alveolar proteinosis
ARDS
PCP
Lipoid pneumonia
Hemorrhage
Bronchoalveolar carcinoma (BAC)
Pulmonary edema
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12
Q

Focal pulmonary haemorrhage

A

PE
Trauma (contusion)
AVM
Cancer (BAC)

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13
Q

Diffuse pulmonary haemorrhage

A

Wegener
Goodpasture (resolves in days to weeks, can result in fibrosis)
Idiopathic (children)
Bone marrow transplant

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14
Q

Peripheral ground glass opacity and consolidation

A 
COP
Infarcts
Septic emboli
Collagen vascular disease
Contusion
DIP
Drug toxicity
Eosinophilic pneumonia
Fibrosis
Sarcoidosis
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15
Q

Honeycombing on HRCT

A 
UIP (idiopathic pulmonary fibrosis)
Scleroderma/RA
Asbestosis
Chronic hypersensitivity pneumonitis
Sarcoidosis
Silicosis
EG
Drug toxicity: bleomycin
16
Q

Diseases spreading along bronchovascular bundle

A 
Sarcoidosis
Lymphoma
Lymphangitic spread of tumor
TB
Kaposi sarcoma
17
Q

Hyperlucent lung

A

Airways

  • Obstruction of airways (air trapping)
  • Emphysema, bullae
  • Large airway obstruction: asthma, mucus plug Small airway obstruction (bronchioli): Swyer-James syndrome (bronchiolitis obliterans)
  • Compensatory hyperexpansion of residual lung after: surgical lobectomy, chronic lobar collapse
  • Cysts
  • Congenital: Hypogenetic lung syndrome, congenital lobar emphysema

Vascular (hyperlucency caused by oligemia)

  • PE
  • Pulmonary artery stenosis

Chest wall abnormalities

  • Mastectomy
  • Poland syndrome (congenital absence of pectoralis muscle)

Pleural
- Pneumothorax

18
Q

Small lung

A

Hypogenetic lung syndrome
Agenesis of pulmonary artery
Chronic atelectasis
Bronchiolitis obliterans (Swyer-James syndrome)

19
Q

Bronchiectasis

A 
Postinfectious (most common)
• Any childhood infection
• Recurrent aspiration
• ABPA: central bronchiectasis
• Chronic granulomatous infection
• Pertussis

Bronchial obstruction
• Neoplasm
• Foreign body

Congenital
• Cystic fibrosis (abnormal secretions)
• Bronchial cartilage deficiency: Campbell syndrome
• Abnormal mucociliary transport: Kartagener
syndrome

20
Q

Upper lobe bronchiectasis

A
  • Cystic fibrosis
  • TB
  • Radiation
  • ABPA (most commonly central)
  • Mounier-Kuhn syndrome
  • Agammaglobulinemia
  • Kartagener syndrome
21
Q

Calcified pleural plaques

A
  • Tuberculosis (usually diffuse plaques)
  • Asbestos-related plaques (usually focal plaques)
  • Fluid (empyema, hematoma)
  • Talc
22
Q

Elevated hemidiaphragm

A

Phrenic nerve paralysis • Tumor • Surgery
Immobility because of pain • Rib fractures
Pleuritis, pneumonia
PE
Abdominal masses, subphrenic collection, abscess
Diaphragmatic hernia
Pleural tumors
Subpulmonic effusion (apparent elevation of hemidiaphragm)

23
Q

Lower lobe bronchiectasis

A

Post infective
Aspiration
Hypogammaglobulinemia
Bronchiolitis obliterans (post transplant)

DDx (5 decks)

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