Flashcards in Chest Deck (104)
Ddx for solitary pulmonary nodule
granuloma, neoplasm, hamartoma, round pneumonia, AVM
Ddx for multiple pulmonary nodules
mets, granulomatous dz (TB or fungal), septic emboli, Wegener granulomatosis
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
Appearance of pulmonary Wegener's?
Highly varied, most commonly nodules +/- cavitation (irregular, thick-walled), hemorrhage, less commonly reticulonodular or peripheral wedge-shaped opacities
Ddx cavitary lung mass
Infxn: TB (reactivation), fungal disease, pulmonary abscess (if widespread, possibly septic emboli)
squamous cell ca,
Ddx miliary lung nodules
miliary TB, fungal dz, mets (thyroid), pneumoconiosis (silicosis - upper lobe fibrosis/nodules), old varicella, sarcoid
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)
Ddx cystic lung disease
emphysema, LAM (women of reproductive age), pulmonary LCH (smokers: cavitating nodules, irregular, varying sizes), PCP, LIP (peribronchovascular)
Ddx lower-lobe predominant ILD
UIP, collagen vascular dz (scleroderma, RA, SLE), asbestos-related lung dz, drug toxicity (eg chemo)
Ddx upper-lobe predominant ILD
postprimary TB, sarcoidosis, CF, pneumoconiosis (silicosis or coal workers'), LCH (smokers)
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)
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
Ddx anterior mediastinal mass
Lymphoma, Thymic lesion (thymoma, thymic carcinoma), germ cell neoplasm, (goiter, but usually you can tell it's from the neck)
Ddx middle mediastinal mass
LAN, vascular abnormality, foregut duplication cyst, pericardial cyst, HH
Ddx posterior mediastinal mass
Neurogenic tumor (neuroblastoma in kids, ganglioneuroma in older), lymphoma, cyst (neurenteric, foregut duplication cyst, extramedullary hematopoiesis
Differences between intralobular and extralobular sequestration
Intralobular has pulmonary venous drainage and tends to get infected. Extralobar has systemic drainage and rarely gets infected
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)
reverse batwing sign is likely:
Chronic eosinophilic pna
(COP, vasculitis, aspiration, contusion, infarction)
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
finger in glove =
allergic bronchopulmonary aspergillosis (ABPA) - overreaction to aspergillus
also bronchial atresia, CF with mucus impaction
crazy paving ddx:
Organizing pneumonia (COP)
Infection (PCP, viral, Mycoplasma, bacterial)
Edema (heart failure, ARDS, AIP)
Pulmonary LCH: who? Appearance?
Young (20-40), Hx of SMOKING
Early: small peribronchiolar nodules
Late: multiple irregularly-shaped cysts
mid and upper lung predilection
Bilateral paraspinal masses
extramedullary hematopoeisis, NF, lymphadenopathy
lymphangitic carcinomatosis from lung ca, met non-lung ca (breast)
Atoll sign: aka? ddx?
also regular pna, TB, fungal, Wegener's, sarcoid
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)
centrilobular ground-glass nodules
Hypersensitivity pneumonitis, atypical infection (PCP, mycoplasma)
mosaic attenuation ddx:
Black is abnl: obstructive small airways disease (asthma, obliterative bronchiolitis in lung transplant rejection, CF)
White is abnl: ground glass (hypersensitivity pna, PCP, eosinophilic PNA, hemorrhage)
appearance of NSIP on CT
patchy, reticulonodular, ground glass, mostly subpleural. Can get some fibrosis in fibrotic subtype