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Flashcards in Chest Deck (104)
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1

Ddx for solitary pulmonary nodule

granuloma, neoplasm, hamartoma, round pneumonia, AVM

2

Ddx for multiple pulmonary nodules

mets, granulomatous dz (TB or fungal), septic emboli, Wegener granulomatosis

3

What is Wegener's granulomatosis?

a multi-system systemic necrotizing non-caeseating granulomatous vasculitis affecting small to medium sized arteries, capillaries and veins 1, and the lungs are the most frequently involved organ, seen in 95% of cases

4

Appearance of pulmonary Wegener's?

Highly varied, most commonly nodules +/- cavitation (irregular, thick-walled), hemorrhage, less commonly reticulonodular or peripheral wedge-shaped opacities

5

Ddx cavitary lung mass

Infxn: TB (reactivation), fungal disease, pulmonary abscess (if widespread, possibly septic emboli)
squamous cell ca,
wegener's, RA,

6

Ddx miliary lung nodules

miliary TB, fungal dz, mets (thyroid), pneumoconiosis (silicosis - upper lobe fibrosis/nodules), old varicella, sarcoid

7

Ddx centrilobular nodules

Infectious bronchiolitis (MAI, TB), hypersensitivity pneumonitis (esp. if gg), endobronchial spread of tumor, RB-ILD (smokers), LCH (early), pneumoconiosis (silicosis or coal-workers' - look for eggshell LN calcs)

8

Ddx cystic lung disease

emphysema, LAM (women of reproductive age), pulmonary LCH (smokers: cavitating nodules, irregular, varying sizes), PCP, LIP (peribronchovascular)
post-infectious blebs
Child: hydrocarbons

9

Ddx lower-lobe predominant ILD

UIP, collagen vascular dz (scleroderma, RA, SLE), asbestos-related lung dz, drug toxicity (eg chemo)

10

Ddx upper-lobe predominant ILD

postprimary TB, sarcoidosis, CF, pneumoconiosis (silicosis or coal workers'), LCH (smokers)

11

Ddx hyperlucent lung

chest wall abnl (on x-ray), Swyer-James, acute asthma, airway obstruction, PE (oligemia), bronchial atresia (central mass or nodule, may see mucoid impaction)

12

What is Swyer-James syndrome?

post-infectious obliterative bronchiolitis, generally characterized on radiographs by a unilateral small lung with hyperlucency and air trapping, CT shows the affected lung as being hyperlucenct with diminished vascularity

13

Ddx anterior mediastinal mass

Lymphoma, Thymic lesion (thymoma, thymic carcinoma), germ cell neoplasm, (goiter, but usually you can tell it's from the neck)

14

Ddx middle mediastinal mass

LAN, vascular abnormality, foregut duplication cyst, pericardial cyst, HH

15

Ddx posterior mediastinal mass

Neurogenic tumor (neuroblastoma in kids, ganglioneuroma in older), lymphoma, cyst (neurenteric, foregut duplication cyst, extramedullary hematopoiesis

16

Differences between intralobular and extralobular sequestration

Intralobular has pulmonary venous drainage and tends to get infected. Extralobar has systemic drainage and rarely gets infected

17

What's Lemierre syndrome?

Lemierre syndrome refers to rare thrombophlebitis of the jugular veins with distant metastatic sepsis seen in the setting of initial oropharyngeal infection (pharyngitis / tonsillitis +/- peri tonsillar abscess)

18

reverse batwing sign is likely:

Chronic eosinophilic pna
(COP, vasculitis, aspiration, contusion, infarction)

19

Halo sign around lung nodule: most likely? Other possibilities?

Halo is hemorrhage. Classically angioinvasive aspergillosis.
Others: TB, other fungal (mucor, coccidio, crypto), Wegener's, mets

20

finger in glove =

allergic bronchopulmonary aspergillosis (ABPA) - overreaction to aspergillus
also bronchial atresia, CF with mucus impaction

21

crazy paving ddx:

Alveolar proteinosis
Sarcoid
NSIP
Organizing pneumonia (COP)
Infection (PCP, viral, Mycoplasma, bacterial)
Neoplasm (adeno)
Pulmonary hemorrhage
Edema (heart failure, ARDS, AIP)

22

Pulmonary LCH: who? Appearance?

Young (20-40), Hx of SMOKING
Early: small peribronchiolar nodules
Late: multiple irregularly-shaped cysts
mid and upper lung predilection

23

Bilateral paraspinal masses

extramedullary hematopoeisis, NF, lymphadenopathy

24

perilymphatic nodules

Sarcoidosis
lymphangitic carcinomatosis from lung ca, met non-lung ca (breast)
silicosis

25

Atoll sign: aka? ddx?

reverse halo
COP
also regular pna, TB, fungal, Wegener's, sarcoid

26

fibrosing mediastinitis: appearance? Caused by? causes what?

Fibrosis/soft tissue in mediastinum. Can compress vessels (SVC, pulmonary), central airways, or esophagus
Causes - mostly idiopathic, also infection (histoplasmosis!), sarcoid, radiation, drugs (methylsergide)

27

centrilobular ground-glass nodules

Hypersensitivity pneumonitis, atypical infection (PCP, mycoplasma)
Smokers: RB-ILD

28

mosaic attenuation ddx:

Black is abnl: obstructive small airways disease (asthma, obliterative bronchiolitis in lung transplant rejection, CF)
PE
White is abnl: ground glass (hypersensitivity pna, PCP, eosinophilic PNA, hemorrhage)

29

appearance of NSIP on CT

patchy, reticulonodular, ground glass, mostly subpleural. Can get some fibrosis in fibrotic subtype

30

Ddx airspace dz

AIR SPACED
Aspiration, Inhalation, Renal failure (edema), Sarcoid, PNA, Pulmonary hemorrhage, alveolar proteinosis, Collagen Vascular dz, Eosinophilic pna, Drugs