Flashcards in chestradiologyflash Deck (374):
Patients with Sjogren syndrome are at increased risk for developing what diffuse lung diseases
Lymphocytic interstitial pneumonitis (LIP). Non-Hodgkin pulmonary lymphoma.
Ankylosing spondylitis lung involvement
Young to middle-aged man with spine changes (kyphosis, spinal ankylosis). Increased lung volumes. Upper lobe fibrobullous disease. Simulates postprimary fibrocavitary Tb or mycetoma formation.
These histologic terms provide the most precise method of classifying the idiopathic interstitial pneumonias
UIP. Acute interstitial pneumonia (AIP). COP. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). DIP. Nonspecific interstitial pneumonia (NSIP).
Usual Interstitial Pneumonia
Most common of the idiopathic interstitial pneumonias. Most cases are sporadic. 30% of cases associated with collagen vascular or immunologic disorder. Findings: Irregular septal or subpleural thickening. Intralobular lines. Honeycombing. Traction bronchiectasis. Typically most severe in peripheral and basal lungs.
Acute Interstitial Pneumonia
Diffuse ground-glass opacity and consolidation with air bronchograms. Linear opacities, honeycombing, and traction bronchiectasis are uncommon.
Conditions associated with BOOP, organizing pneumonia.
Viral infection (influenza, adenovirus, measles). Toxic fume inhalation (sulfur dioxide, chlorine). Collagen vascular disease (rheumatoid arthritis and SLE). Organ transplantation (bone marrow, lung, and heart-lung). Drug reactions. Chronic aspiration.
Cryptogenic Organizing Pneumonia
Idiopathic form of organizing pneumonia. Most common finding: Patchy consolidation or ground-glass opacity with subpleural or peribronchial distribution. Scattered nodular opacities may be present.
Respiratory Bronchiolitis-Associated Interstitial Lung Disease
Typically young, heavy smokers. Scattered ground-glass opacities. Small centrilobular nodules with upper lobe predominance.
Desquamative Interstitial Pneumonia
95% are cigarette smokers. Cannot be radiologically distinguished from UIP. Bibasilar reticular opacities. Normal or midly decreased lung volumes. May have ground-glass opacities. Honeycombing is rare.
Generally asymmetric upper lung bullae. Generally symmetric lower lung interstitial fibrosis.
Tuberous Sclerosis (TS) ILD
Indistinguishable from LAM. Symmetric bilateral reticular or reticulonodular opacities. Scattered lung cysts. Normal to increased lung volumes. Pneumothorax is common
Exclusively in women. Lung cysts separated by interlacing bundles of smooth muscle. May obstruct lymphatics causing chylothorax. Poor prognosis.
Alveolar Septal Amyloidosis
Simulates silicosis or lung sarcoidosis. Upper lung reticulonodular opacities.
Chronic Aspiration Pneumonia
Irregular reticular interstitial opacities.
3 major pneumoconioses
Asbestosis. Silicosis. CWP.
Pleura: Parietal pleural plaques. Pleural effusion. Localized visceral pleural fibrosis. Diffuse pleural fibrosis. Mesothelioma. Lung parenchyma: Interlobular septal thickening. Interstitial fibrosis (asbestosis). Rounded atelectasis. Bronchogenic carcinoma. Lower lung predominance.
Mining, ceramic work, and sandblasting. Upper lobe and parahilar nodules. Nodule calcification may occur. Egg shell calcification of hilar lymph nodes. Silicoproteinosis like alveolar proteinosis has increased susceptibility to TB.
Coal Worker's Pneumoconiosis
Predominantly upper lung reticulonodular or small nodular opacities.
Berylliosis. Aluminum. Hard metal (cobalt, tungsten).
Inhaled antigenic organic dusts: Farmer's lung (moldy hay). Humidifier lung (thermophilic bacteria). Bird-fancier's lung (avian proteins). Acute and chronic forms. Chronic disease findings: Interlobular and intralobular interstitial thickening. Honeycombing, Traction bronchiectasis. May spare costophrenic angles.
Lung Sarcoidosis staging
0 Normal chest radiograph. 1 Bilateral hilar lymph node enlargement. 2 Bilateral hilar lymph node enlargement and parenchymal disease 3. Parenchymal disease only. 4 Pulmonary fibrosis.
Common findings: Symmetric hilar adenopathy allows distinction from malignancy and TB. Symmetric mid and upper lung reticulonodular opacities. Perilymphatic interstitial nodules, 3 to 10 mm.
Langerhans Cell Histiocytosis of Lung
Very high association with cigarette smoking. Mid and upper lung centrilobular small nodules. In late stages may develop cysts or bullae. Risk of pneumothorax. Nodule-cyst evolution: Nodule to Cavitated nodule to Thick-walled cyst to Thin-walled cyst.
Necrotizing granulomatous vasculitis involving upper and lower respiratory tracts and kidneys. Discrete nodules or masses with central necrosis and cavitation. May mimic Goodpasture syndrome and idiopathic pulmonary hemorrhage. Tracheal or bronchial lesions may be present. c-ANCA positive.
Chronic Eosinophilic Pneumonia
Symptoms and radiographic abnormalities last longer than 1 month. Predilection for women. Responds to corticosteroid therapy, improving within 4 to 7 days. Peripheral, homogeneous, ill-defined areas of consolidation that may parallel the chest wall
Male predominance. Blood eosinophilia. Cardiomegaly. Pulmonary edema. Pleural effusions. Pulmonary parenchymal infiltration with eosinophils may produce interstitial or airspace opacities.
Eosinophilic Lung Disease Associated With Autoimmune Diseases
Wegener granulomatosis. Sarcoidosis. Rheumatoid lung disease. Polyarteritis nodosa. Allergic angiitis and granulomatosis.
Eosinophilic Lung Disease of Identifiable Etiology
Drugs (Nitrofurantoin and Penicillins). Parasites (Ascaris lumbricoides, Strongyloides stercoralis).
Pulmonary alveolar proteinosis
Lipoproteinaceous material deposits within alveoli. Predilection for males in their 20s to 40s. Bilateral symmetric perihilar airspace opacification. Crazy paving CT finding: Geographic ground-glass opacities with thickened interlobular and intralobular septa. Prone to superinfection with Nocardia, Aspergillus, Cryptococcus, and atypical mycobacteria.
Deposition of minute calculi within alveolar spaces. Confluent bilateral dense micronodular opacities. So-called black pleura sign. Apical bullous disease is common.
Diffuse pulmonary ossification
Formation of bone within lung parenchyma. Associations: Mitral stenosis. UIP. Amyloidosis.
Paratracheal air cysts. True diverticula. Occur at weakened posterior membrane of cervical trachea.
Bronchus suis. Accessory bronchus to all or a portion of right upper lobe. Arises from right lateral tracheal wall within 2 cm of tracheal carina. Associated with congenital tracheal stenosis and aberrant left pulmonary artery.
Primary neoplasms of trachea
Malignant: Squamous cell carcinoma. Adenoid cystic carcinoma (cylindroma). Benign: Chondroma.ÿFibroma.ÿSquamous cell papilloma.ÿHemangioma.
Saber-sheath trachea. Amyloidosis. Tracheobronchopathia osteochondroplastica. Relapsing polychondritis. Wegener granulomatosis. Tracheal scleroma.
Tracheobronchomegaly (Mounier-Kuhn syndrome). Tracheomalacia. Interstitial pulmonary fibrosis.
Coronal diameter is less than two thirds of sagittal diameter. Affects older men with chronic obstructive pulmonary disease (COPD).
Multiple submucosal osseous and cartilaginous deposits within trachea and central bronchi of elderly men. Spares membranous posterior wall of trachea.
Systemic autoimmune disorder. Affects cartilage of earlobes, nose, larynx, tracheobronchial tree, joints, and large elastic arteries. Diffuse smooth wall thickening of the wall of trachea and central bronchi with luminal narrowing.
Tracheobronchomegaly (Mounier-Kuhn syndrome)
Congenital. Associated with Ehlers-Danlos syndrome. Men under age 50. Trachea and central bronchi measure greater than 3.0 cm and 2.5 cm.
Diffuse tracheal and central bronchial dilation. Congenital or acquired (COPD, Chronic bronchitis, Cystic fibrosis, Relapsing polychondritis).
Fallen lung sign
Subtended lung remains collapsed against lateral chest wall. Secondary to bronchial injury. Responds poorly to chest tube evacuation.
Calcified material within bronchus. Usually from eroding calcified lymph nodes (Histoplasmosis or TB).
Transient bronchial narrowing. Peribronchial cuffing and tram tracking. Air trapping: Hyperinflation, Flattening or inversion of diaphragm, Attenuation of peripheral vascular markings. Prominence of the retrosternal airspace. Complications: Pneumomediastinum. Pneumothorax, Subpleural blebs from expiratory air dissection.
Excess production of sputum on most days for at least 3 months in 2 consecutive years. 50% have normal chest radiographs. Some patients show peribronchial cuffing or tram tracks.
Permanent dilation of bronchi. Cylindric bronchiectasis: mild diffuse dilation. Varicose bronchiectasis: cystic dilation interrupted by focal areas of narrowing. Cystic bronchiectasis: localized saccular dilation. Caused by chronic inflammation with cartilage damage and dilation. Localized bronchiectasis is most commonly a result of prior TB. Generalized bronchiectasis is seen in cystic fibrosis. Central bronchiectasis: Allergic bronchopulmonary aspergillosis. Cystic fibrosis. Bronchial atresia. Acquired central bronchial obstruction.
Production of abnormally thick, tenacious mucus. Recurrent infection commonly with Pseudomonas aeruginosa or Staphylococcus aureus. Severe bronchiectasis. Hyperinflation with predominantly upper lobe bronchiectasis and mucus plugging.
Dysmotile cilia syndrome
May result in Rhinitis. Sinusitis. Bronchiectasis. Dysmotile spermatozoa and sterility. Situs inversus. Dextrocardia.
Kartagener syndrome triad
Sinusitis. Situs inversus.. Bronchiectasis.
Allergic bronchopulmonary aspergillosis
Hypersensitivity reaction to Aspergillus. Asthma, blood eosinophilia, bronchiectasis with mucus plugging, and circulating antibodies to Aspergillus antigen. Proximal upper lobe bronchiectasis with mucoid impaction. Finger in glove appearance.
Permanent enlargement of airspaces distal to terminal bronchiole. Destruction of alveolar walls without obvious fibrosis.
Airspace distention in central portion of lobule. Spares distal portions of the lobule. Upper lobe predominance. Associated with cigarette smoking.
Distention of airspaces throughout lobule. Destruction of central respiratory bronchioles and peripheral alveolar sacs and alveoli. Predilection of lower lobes. Associated with alpha-1 antitrypsin deficiency.
Distention of peripheral airspaces adjacent to interlobular septa. Spares centrilobular region. Generally involves subpleural regions of upper lobes.
Paracicatricial or irregular emphysema
Lung destruction associated with fibrosis. No consistent relationship to a given portion of the lobule. Commonly associated with old granulomatous inflammation.
Diffuse hyperlucency (panlobular). Flattening and depression of hemidiaphragms. Increased retrosternal airspace (panlobular > centrilobular). Bulla. Enlarged central pulmonary arteries. Right heart enlargement (centrilobular). Loss of pulmonary capillary bed.
Arterial deficiency emphysema versus increased markings emphysema.
Arterial deficiency: Predominantly panlobular emphysema. Hyperinflated lungs with peripheral vascular attenuation and bullae. Pink Puffers. Increased markings: Increased linear parenchymal markings. Small airways thickening of chronic bronchitis. Bullae uncommon. Blue Bloaters.
Thin-walled cystic space > 1 cm in diameter. Found within lung parenchyma.
Bullae may be seen in diseases that cause chronic upper lobe fibrosis, such as
Sarcoidosis. Pulmonary Langerhans cell histiocytosis. Ankylosing spondylitis.
Primary bullous disease
Isolated bullae without intervening emphysema or interstitial lung disease. Associated with: Marfan or Ehlers-Danlos syndromes. Intravenous drug use. HIV infection. Vanishing lung syndrome.
CT findings and associations of infectious bronchiolitis
Tree-in-bud opacities. Generally due to infection: Viral. Atypical. Mycobacterial.
CT findings of diffuse panbronchiolitis
Tree-in-bud opacities. Bronchial dilation and thickening.
CT findings and associations of Respiratory bronchiolitis?associated interstitial lung disease
Centrilobular and geographic ground-glass opacities. Cigarette smoking.
CT findings and associations of Hypersensitivity pneumonitis (subacute)
Centrilobular ground-glass nodules. Air trapping on expiratory scans. Inhaled organic antigen.
CT findings and associations of Follicular bronchiolitis
Centrilobular ground-glass nodules. Rheumatoid arthritis. Sj”gren syndrome.
CT findings and associations of Constrictive bronchiolitis
Mosaic attenuation with air trapping on expiratory scans. Bronchial dilation (late). Transplant patients. Drug reactions. Inhalation injury.
Transudative pleural effusion lab values
Pleural/serum protein ratio less than 0.5. Pleural/serum LDH ratio less than 0.6. Pleural LDH less than 200 IU/L.
Infectious causes of pleural effusion?
Bacterial/mycobacterial. Viral. Fungal. Parasitic.
Cardiovascular causes of pleural effusion?
Heart failure. Pericarditis. Superior vena cava obstruction. Postcardiac surgery. Myocardial infarction. Pulmonary embolism.
Neoplastic causes of pleural effusion?
Bronchogenic carcinoma. Metastases. Lymphoma. Pleural or chest wall neoplasms (mesothelioma).
Immunologic causes of pleural effusion?
Systemic lupus erythematosus. Rheumatoid arthritis. Sarcoidosis (rare). Wegener granulomatosis.
Inhalational cause of pleural effusion?
Trauma causes of pleural effusion?
Blunt or penetrating chest trauma.
Abdominal disease causes of pleural effusion?
Cirrhosis (hepatic hydrothorax). Pancreatitis. Subphrenic abscess. Acute pyelonephritis. Ascites (from any cause). Splenic vein thrombosis.
Miscellaneous causes of pleural effusion?
Drugs. Myxedema. Ovarian tumor.
Pleural effusion from congestive heart failure features
Transudative. Bilateral, right larger than left. Isolated right effusion twice as common as isolated left effusion.
Findings on CT that are fairly specific for the presence of an exudative pleural effusion
Thickening and enhancement of parietal pleura. Loculations. Soft tissue lesions along parietal pleura outlined by pleural fluid.
Tumors most commonly associated with pleural effusion are, in order of frequency,
Lung carcinoma. Breast carcinoma. Pelvic tumors (ovarian fibroma = Meigs syndrome). Gastric carcinoma. Lymphoma.
Lung abscess versus empyema?
Empyema: Oval. Oriented longitudinally. Thin. Smooth (split pleura sign). Obtuse chest wall angle. Compresses lung. Requires drainage. Abscess: Round. Thick and irregular wall. Acute chest wall angle. Consumes lung. Antibiotics and postural drainage to treat.
Most common intrathoracic manifestation of rheumatoid arthritis
Most common causes of chylothorax are
Malignancy. Iatrogenic trauma. TB
Left chylothorax versus right chylothorax?
Left chylothorax: Injury to upper duct. Right chylothorax: Injury to lower duct.
Communication between lung and pleural space. If bronchus involved, may result in empyema. If peripheral airspace (bronchiole) involved, may result in intractable pneumothorax.
Primary spontaneous pneumothorax
Often occurs in young or middle-aged men. Predilection of taller individuals. Results from bleb or bulla rupture, usually within upper lungs.
Secondary Spontaneous Pneumothorax
COPD. Asthma. Valsalva (cocaine, marijuana, labor). Sarcoidosis. Langerhans cell histiocytosis. Lymphangioleiomyomatosis. Necrotizing pneumonia. Abscess. Mechanically ventilated patients.
Rare recurrent pneumothoraces. Occurs with menses. Pleural endometrial implants. Treated with OCPs.
Most common cause of tension pneumothorax
Iatragenic trauma in mechanically ventilated patients.
Causes of pleural thickening
Pneumonia. Pulmonary infarct. Trauma. Asbestos exposure (bilateral).
Causes of pleural calcification
Visceral pleura:ÿHemothorax,ÿEmpyema (tuberculosis). Parietal pleura:ÿÿAsbestos exposure (bilateral).
Causes of pleural/extrapleural masses
Benign:ÿFibroma.ÿLipoma.ÿNeurofibroma.ÿMalignant:ÿMetastases (usually multiple).ÿÿMesothelioma (usually diffuse pleural thickening). Other: Loculated pleural effusion/empyema. Hematoma.
Fluid within calcified pleural layers seen on CT suggests
Active empyema. Most commonly within patients with prior TB.
Pleural thickening extending over more than one fourth of the costal pleural surface. Commonly results from resolution of an exudative pleural effusion (including asbestos-related effusions), Empyema, or Hemothorax. Pleurectomy (decortication) may be necessary to restore function.
Malignant pleural disease is most often caused by one of four conditions:
Metastatic adenocarcinoma (lung, breast, ovary, kidney, GI tract). Invasive thymoma or thymic carcinoma. Mesothelioma. Rarely non-Hodgkin lymphoma.
Benign and malignant Asbestos-Related Pleural Diseases
Benign: Pleural plaques. Pleural effusions. Diffuse pleural fibrosis. Malignant: Mesothelioma.
When viewed en face, calcified pleural plaques appear as
Geographic opacities. Llikened to a holly leaf.
Autosomal recessive disorder. Unilateral absence of sternocostal head of pectoralis major. Ipsilateral syndactyly. Rib anomalies.
Most common benign neoplasm of chest wall
Most common malignant soft tissue neoplasms of the chest wall in adults.
A rare malignant neoplasm arising from the chest wall of children and young adults
Askin tumor. Arises from primitive neuroectodermal rests. Very aggressive with a poor prognosis.
Benign chest wall lesions
Abscess. Hematoma. Lipoma. Hemangioma. Desmoid tumor.
Inferior rib notching causes
Coarctation of aorta. Aortic thrombus. Takayasu arteritis. SVC syndrome. Neurofibromatosis.
Suprior rib notching cause
Benign rib neoplasms, most common first
Osteochondroma. Enchondroma. Osteoblastoma.
Most common primary rib malignancy
Most common: Myeloma. Metastatic carcinoma. Primary malignancies: Chondrosarcoma. Osteogenic sarcoma. Fibrosarcoma.
Most common metastatic lesions to ribs
Breast cancer. Lung cancer.
Expansile lytic rib metastases are seen most commonly from
Renal cell carcinoma. Thyroid carcinoma.
Sclerotic rib metastases are most commonly seen in
Breast cancer. Prostate cancer.
Pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include
TB. Actinomycosis. Nocardiosis.
Congenital hypoplastic and elevated scapula.
Sprengel deformity (hypoplastic, elevated scapula). Omovertebral bone. Fused cervical vertebrae. Hemivertebrae. Kyphoscoliosis. Rib anomalies.
Erosion of the distal clavicles
Rheumatoid arthritis: Well-defined pointed distal clavicle. Hyperparathyroidism: Irregular and wide distal clavicle.
H-shaped or Lincoln log vertebrae on lateral chest radiographs
Sickle cell anemia.
Rugger jersey appearance to thoracic spine on lateral chest radiographs
Pectus excavatum is commonly associated with congenital connective tissue disorders, such as
Marfan syndrome. Poland syndrome. Osteogenesis imperfecta. Congenital scoliosis.
Outward bowing of sternum. May be congenital or acquired.
Eventration of the diaphragm
Congenital absence or underdevelopment of diaphragmatic musculature. Localized elevation of anteromedial hemidiaphragm in older individuals.
Unilateral diaphragmatic paralysis is usually caused by
Surgical injury or neoplastic involvement of phrenic nerve.
Bilateral Diaphragmatic Elevation that is not effort related may be caused by
Neuromuscular disturbance. Intrathoracic or intra-abdominal disease.
Herniation through embryonic pleuroperitoneal canal. Neonates present with large hernias with lung hypoplasia and respiratory distress. Adults present with small hernias, mostly on the left side (liver thought to be protective).
Parasternal diaphragm defect. Invariably right sided. Asymptomatic cardiophrenic angle mass.
Primary diaphragmatic tumors
Benign: Lipomas. Fibromas. Schwannomas. Neurofibromas. Leiomyomas. Echinococcal cysts and extralobar sequestrations may be found within the diaphragm. Metastatic invasion more common than primary malignancy (Fibrosarcoma): Lower lobe bronchogenic carcinoma. Mesothelioma.
Cystic adenomatoid malformation
Usually seen in infancy. One or several large cysts lined with respiratory epithelium with scattered mucous glands, smooth muscle, and elastic tissue. Round, air-filled masses that compress adjacent lung and mediastinum.
Bronchial atresia presentation
Central bronchial mucocele with peripheral hyperlucency in a young, asymptomatic patient.
Intralobar and extralobar sequestration blood supply and drainage
Intralobar sequestration: Single large artery from infradiaphragmatic aorta. Pulmonary vein drainage. Extralobar sequestration: Small branches systemic arteries and occasionally pulmonary arteries. Systemic venous drainage (inferior vena cava, azygos, or hemiazygos veins).
Hypogenetic lung-scimitar syndrome
Variant of hypoplastic lung with abnormal venous drainage to the IVC just above or below right hemidiaphragm. Small right hemithorax with diaphragmatic elevation or eventration. Dextroposition of heart. Herniation of left lung anteriorly into right hemithorax.
Three radiographic patterns of aspiration pneumonitis
Extensive bilateral airspace opacification. Diffuse but discrete airspace nodular opacities. Irregular parenchymal opacities that are not obviously airspace.
Exogenous lipoid pneumonia
Older patients with swallowing disorders or gastroesophageal reflux. Use mineral oil as a laxative or inhale oily nose drops. Fat density opacity.
Drug that cause drug induced chest diseases
Lupus-like syndrome (procainamide, isoniazid, hydralazine). Nitrofurantoin. Bleomycin. Methotrexate. Amiodarone.
A confident diagnosis of hamartoma can be made when HRCT shows
Nodule less than 2.5 cm with a smooth or lobulated border and containing focal fat. May have popcorn calcification.
Benign neoplasm arising from neural elements in the central airways or lung parenchyma. The skin is the most common site for these tumors.
Granular cell myoblastoma.
Bronchogenic adenocarcinoma features
Most common type of lung cancer (nonsmokers, too). Arise from bronchiolar or alveolar epithelium. Irregular or spiculated appearance. ccur in the lung periphery.
Bronchioloalveolar cell carcinoma (BAC)
Grows along bronchiolar and alveolar walls (lepidic growth). May appear as: Solitary nodule. Focal ground-glass opacity. May mimic pneumonia or bilateral nodular airpsace processes.
Squamous cell carcinoma features
Arises centrally within lobar or segmental bronchi. Central necrosis with cavitation may be seen. Generally presents as hilar mass and atelectasis.
Small cell carcinoma features
Arises centrally within main or lobar bronchi from bronchial neuroendocrine (Kulchitsky) cells. Hematogenous dissemination. Hilar/mediastinal mass.
Large cell bronchogenic carcinoma radiographic feature
Large peripheral mass.
In addition to cigarette smoke, well-recognized risk factors for the development of bronchogenic carcinoma include
Asbestos exposure. Previous Hodgkin lymphoma. Radon exposure. Viral infection. Diffuse interstitial or localized lung fibrosis.
Most common radiographic findings from endobronchial tumor obstruction.
Resorptive atelectasis. Obstructive pneumonitis.
Majority of pancoast tumors, histology type
Pancoast tumor symptoms
Arm pain and muscular atrophy due to brachial plexus involvement. Horner syndrome (ptosis, anhydrosis, miosis) from involvement of sympathetic chain. Shoulder pain from chest wall invasion.
CT angiogram sign and BAC
Filling of airspaces with mucoid material produced by malignant cells creates low-density airspace opacification surrounding enhanced pulmonary arteries.
Typical radiologic findings of lymphangitic carcinomatosis
Linear and reticulonodular opacities. Peribronchial cuffing. Subpleural edema or pleural effusion.
Helps distinguish lymphangitic carcinomatosis due to lung cancer from other metastases
Unilateral or asymmetric involvement of lungs suggests lung cancer rather than an extrapulmonary site.
Two patient groups of small cell lung cancer
Disease limited to one hemithorax (limited disease). Contralateral lung or extrathoracic spread (extensive disease).
Two most common primary tracheal malignancies
SCC > Adenoid cystic carcinoma
Tracheal mass size and malignancy
Masses > 2 cm are likely to be malignant. Less than 2 cm are more likely benign.
Other, less common primary tracheal malignancies
Mucoepidermoid carcinoma. Carcinoid tumor. Adenocarcinoma. Lymphoma. Small cell carcinoma. Leiomyosarcoma. Fibrosarcoma. Chondrosarcoma.
Primary malignant neoplasms of the central bronchi include
Squamous cell carcinoma. Small cell carcinoma. Carcinoid tumor. Bronchial gland tumors (adenoid cystic carcinoma, mucoepidermoid carcinoma).
Carcinoid radiologic features
Prefers right upper and middle lobes. Well-defined smooth or lobulated nodules or masses. Iceberg tumor: small intrabronchial and large extraluminal soft tissue component.
A benign neoplasm comprised of disorganized epithelial and mesenchymal elements normally found in the bronchus or lung.
A feature that helps distinguish lymphangitic carcinomatosis from interstitial fibrosis,
Thickened septal lines of lymphangiti carcinomatosis do not distort the pulmonary lobule.
Lymphocytic interstitial pneumonitis
Infiltration of pulmonary interstitium by mature lymphocytes. CT findings: Diffuse ground-glass opacity. Poorly defined centrilobular nodules. Thin-walled cysts. Associations: Sjogren syndrome. Hypogammaglobulinemia. Multicentric Castleman disease. AIDS.
Posttransplant lymphoproliferative disorder (PTLD)
Spectrum of entities. Ranging from benign polyclonal lymphoid proliferation to aggressive non-Hodgkin lymphoma.
Rare malignant tumor affecting children and young adults. Histology simulates fetal lung at 10 to 16 weeks? gestation. Tend to be extremely large at presentation.
Lobar pneumonia features
Typical of pneumococcal pulmonary infection. Inflammatory process spreads via pores of Kohn and canals of Lambert to produce nonsegmental consolidation. Air bronchograms are common.
Most common pattern of pneumonia. Typical of staphylococcal pneumonia. Inflammation centered around lobular bronchi. Multifocal opacities produce patchwork quilt of scattered normal and diseased lobules. No air bronchograms due to exudate within bronchi.
Interstitial pneumonia features
Viral and mycoplasma infection. Inflammatory thickening of bronchial and bronchiolar walls and pulmonary interstitium. Peribronchial cuffing and reticulonodular opacities.
Pneumatoceles may be distinguished from abscesses by
Thin walls. Rapid change in size. Generally develop during late phase of infection.
Calcified parenchymal focus (Ghon lesion) and lymph nodel calcification. Primary TB.
Reactivation occurs in apical and posterior segments of upper lobes and superior segments of lower lobes. Ill-defined patchy and nodular opacities. Cavitation usually indicates active and transmissible disease.
Erosion of cavitary focus into pulmonary artery branch can produce an aneurysm.
May complicate primary or reactivation disease. Hematogenous dissemination. Diffuse bilateral 2- to 3-mm pulmonary nodules.
Opportunistic fungal lung pathogens
Aspergillus. Candida. Cryptococcus.
Aspergillus lung involvement
Aspergilloma or mycetoma within preexisting cavities. Semi-invasive (chronic necrotizing) aspergillosis in mildly impaired immunity. Invasive pulmonary aspergillosis in neutropenia. Allergic bronchopulmonary aspergillosis in hyperimmunity.
Pulmonary echinococcal cysts are composed of three layers:
Inside out: Endocyst, produces daughter cyts. Exocyst (chitinous layer), protective membrane. Pericyst, surrounding compressed, fibrotic lung.
CT halo sign
Decreased attenuation surrounding a dense, mass-like opacity. Relatively specific for invasive aspergillosis in a neutropenic patient.
Most common AIDS-defining opportunistic infection.
Interlobular (Septal) Lines
Thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting costal pleura.
Interlobular (septal) lines DDx:
Interstitial edema. ÿ Lymphangitic carcinomatosis. ÿ Sarcoidosis. ÿ Idiopathic pulmonary fibrosis (IPF) (other forms of usual interstitial pneumonia UIP).
Intralobular lines ILD DDx
IPF (UIP). Asbestosis. Alveolar proteinosis. Hypersensitivity pneumonitis.
Thickened fissures ILD DDx
Pulmonary edema. ÿ Sarcoidosis. ÿ Lymphangitic carcinomatosis.
Peribronchovascular interstitial thickening
Pulmonary edema (smooth). ÿ Sarcoidosis (nodular). ÿ Lymphangitic carcinomatosis (smooth or nodular).
Centrilobular nodules ILD DDx
Hypersensitivity pneumonitis.ÿ Bronchiolitis obliterans with organizing pneumonia (BOOP)/cryptogenic organizing pneumonia (COP).ÿ Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD).
Subpleural lines ILD DDx
Asbestosis. ÿ IPF (UIP).
Parenchymal bands ILD DDx
Asbestosis. ÿ IPF (UIP). ÿ Sarcoidosis.
IPF (UIP). ÿ Asbestosis.ÿ Hypersensitivity pneumonitis (chronic).ÿ Sarcoidosis.
Thin-walled cysts ILD DDx
Eosinophilic granuloma (EG). Lymphangioleiomyomatosis.ÿ Tuberous sclerosis.ÿ Neurofibromatosis (pneumatocele). (emphysema).
Micronodules, random distribution ILD DDx
Miliary tuberculosis or histoplasmosis.ÿ Hematogenous metastases.ÿ Silicosis/coal worker's pneumoconiosis (CWP).ÿ EG.
Micronodules, perilymphatic distribution ILD DDx
Sarcoidosis. ÿ Lymphangitic carcinomatosis.ÿ Silicosis/CWP.
Ground-glass opacities ILD DDx
Desquamative interstitial pneumonia.ÿ Acute interstitial pneumonia (AIP).ÿ Hypersensitivity pneumonitis. BOOP/COP.ÿ RB-ILD.ÿ Hemorrhage.ÿ Pneumocystis jiroveci pneumonia.ÿ Cytomegalovirus pneumonia.ÿ Alveolar proteinosis.
Traction bronchiectasis ILD DDx
Sarcoidosis. ÿ Silicosis/CWP.
Conglomerate mass ILD DDx
Sarcoidosis.ÿ Silicosis.ÿ CWP.ÿ Radiation fibrosis.
5- to 10-cm-long curvilinear opacities are found within 1 cm of the pleura and parallel the chest wall. Most often seen in patients with asbestosis and, less commonly, IPF.
Nontapering linear opacities, 2 to 5 cm in length. Extend from lung to contact pleural surface. Asbestosis. IPF. Sarcoidosis.
Small (6 to 10 mm) cystic spaces with thick (1 to 3 mm) walls. usually have shared walls . Usually in posterior subpleural regions. End-stage pulmonary fibrosis: IPF (UIP). Chronic hypersensitivity pneumonitis. Occasionally sarcoidosis.
Slightly larger in diameter (10 mm) than honeycomb cysts. Uniform in size. Thinner walls. Do not share walls with adjacent cysts. Cysts of LCH and LAM are usually evenly distributed from central to peripheral portions of upper lobes
1- to 3-mm. Sharply marginated. Round opacities seen on HRCT. Represent conglomerates of granulomas or tumor cells within the interstitium.
Ground-Glass or Hazy Increased Density
Granular appearance with maintained visibility of pulmonary vessels. Absence of air bronchograms. Desquamative interstitial pneumonia (DIP). Pneumocystis jiroveci (formerly P carinii) pneumonia. Acute hypersensitivity pneumonitis. Nonspecific interstitial pneumonia (NSIP). Interstitial pulmonary edema.
Fibrosis causes traction on the walls of bronchi, resulting in irregular dilation.
ILDs Upper zone distribution
Tuberculosis (postprimary). Chronic fungal infection (Histoplasmosis,ÿCoccidioidomycosis). ÿSarcoidosis. ÿEosinophilic granuloma.ÿ Silicosis.ÿ Ankylosing spondylitis.ÿ Hypersensitivity pneumonitis (chronic). Radiation fibrosis from treatment of head and neck malignancy.
ILDs Lower zone distribution
Idiopathic pulmonary fibrosis.ÿ Asbestosis.ÿ Rheumatoid lung.ÿ Scleroderma.ÿ Neurofibromatosis.ÿ Dermatomyositis/polymyositis.ÿ Chronic aspiration.
ILDs normal or increased lung volumes
Sarcoidosis.ÿ Eosinophilic granuloma.ÿ Lymphangioleiomyomatosis.ÿ Tuberous sclerosis.ÿ Interstitial disease superimposed on emphysema.
Idiopathic pulmonary fibrosis.ÿ Sarcoidosis.ÿ Eosinophilic granuloma.ÿ Rheumatoid lung.ÿ Scleroderma.ÿ Pneumoconiosis.ÿ Hypersensitivity pneumonitis.ÿ Chronic aspiration.ÿ Radiation fibrosis.
ILDs miliary nodules
Tuberculosis.ÿ Fungi (Histoplasmosis,ÿCoccidioidomycosis,ÿCryptococcosis). Silicosis.ÿ Metastases (Thyroid carcinoma, Renal cell carcinoma,ÿBronchogenic carcinoma,ÿMelanoma,ÿChoriocarcinoma).ÿ Sarcoidosis.ÿ Eosinophilic granuloma.
Hilar/mediastinal lymph node enlargement
Sarcoidosis.ÿ Lymphangitic carcinomatosis.ÿ Lymphoma.ÿ Hematogenous metastases.ÿ Tuberculosis. Fungal infection.ÿ Silicosis.
ILDs Pleural disease
Asbestosis (plaques).ÿ Lymphangitic carcinomatosis (effusion).ÿ Rheumatoid lung disease (effusion/thickening).ÿ Lymphangioleiomyomatosis (chylous effusion).
Manifestations of Rheumatoid Lung Disease
Pleural effusion. Pleural thickening. Pericarditis. Pericardial effusion. Pulmonary fibrosis (basilar predominance). Necrobiotic nodules (peripheral cavitating nodules, Caplan syndrome). Bronchiolitis obliterans (Hyperinflation) Pulmonary arteritis. Pulmonary arterial hypertension. Right heart enlargement. Pulmonary hemorrhage
Thick walled cavitating lung nodules. Rheumatoid arthritis patients with hypersensitivity to inhaled dust particles (coal, silica, asbestos).
Scleroderma ILD findings
Interlobular septal thickening. Ground-glass opacities. Honeycombing. Lower lung predominance. Patulous esophagus.
Interstitial pulmonary edema CXR findings?
Intrapulmonary vascular shadows. Peribronchial cuffing. Tram tracking.
Kerley A and B lines?
Kerley A lines thickening of central connective tissue septa. Kerley B lines thickening of peripheral interlobular septa.
Alveolar pulmonary edema localized to the right upper lung may be seen in patients with
Severe mitral regurgitation.
Causes of Pulmonary Venous Hypertension and Pulmonary Edema
LV failure. Mitral valve disease (Mitral stenosis, Mitral insufficiency). LA myxoma. Cor triatriatum. Obstruction of central pulmonary veins (fibrosing mediastinitis, pulmonary vein stenosis, pulmonary venous thrombosis). Obstruction of intrapulmonary veins (pulmonary venoocclusive disease).
Radiographic findings of pulmonary venous hypertension are
Enlargement of pulmonary veins (progressive dilation of horizontally oriented pulmonary veins). Redistribution of pulmonary blood flow to upper lungs.
Respiratory failure due to increased capillary permeability edema. Associated with increased lung stiffness (noncompliance).
Common causes of ARDS
Shock. Severe trauma. Burns. Sepsis. Narcotic overdose. Pancreatitis.
ARDS radiographic findings
Patchy peripheral airspace opacities (12-24 hrs). Confluent bilateral airspace opacities with air bronchograms (days). Coarse reticulonodular pattern (week) that may resolve.
Causes of neurogenic pulmonary edema
Head trauma. Seizure. Increased intracranial pressure.
Hemorrhage or hemorrhagic edema of the lung can result from
Trauma. Bleeding diathesis. Infections (invasive aspergillosis, mucormycosis, Pseudomonas, influenza). Drugs (penicillamine). Pulmonary embolism. Fat embolism. ARDS. Autoimmune diseases (Goodpasture syndrome, idiopathic pulmonary hemorrhage, Wegener granulomatosis, systemic lupus erythematosus, rheumatoid arthritis, and polyarteritis nodosa).
Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody.
Idiopathic Pulmonary Hemorrhage
Indistinguishable from Goodpasture syndrome. Pulmonary hemorrhage and anemia in patient with normal renal function and urinalysis. No antiglomerular basement membrane antibodies.
Vasculitides that can cause pulmonary hemorrhage
Wegener granulomatosis. Systemic lupus erythematosus. Rheumatoid arthritis. Polyarteritis nodosa.
Sensitive, but not specific marker of venous thrombosis.
Most common radiographic findings in PE without infarction are
Localized peripheral oligemia with or without distended proximal vessels (Westermark sign). Peripheral airspace opacification. Linear atelectasis.
Radiographic features that suggest infarction in PE
Small pleural effusion and pleura-based wedge-shaped opacity (Hampton hump).
Nonthrombotic pulmonary embolism causes
Air embolism. Macroscopic fat embolism. Methylmethacrlate embolization from vertebroplasty. Radioactive seed embolization from prostate brachytherapy.
PAH is defined as a systolic pressure in the pulmonary artery exceeding
30 mm Hg.
Typical radiographic findings of PAH are
Enlarged main and hilar pulmonary arteries that taper rapidly toward lung periphery. RV enlargement.
PAH measurements of proximal interlobar pulmonary artery (CXR) and main pulmonary artery (CT)
Interlobar pulmonary artery > 16 mm. Main pulmonary artery > 28.6 mm.
In addition to PAH, enlargement of the central pulmonary arteries may be seen in
High cardiac output (anemia, thyrotoxicosis). Left-to-right shunts (ASD, VSD, PDA, PAPVR).
Shunt vascularity on chest radiographs
Enlargement of both central and peripheral pulmonary arteries.
Disorders of the pulmonary arteries that produce PAH include
Chronic PEs. Vasculitis. Pulmonary arteriopathy resulting from long-standing increased pulmonary blood flow from left-to-right shunt.
Multiple pulmonary nodules of similar size and appearance are almost always
Pulmonary nodule is defined as
Round or oval opacity 4 to 30 mm in diameter.
Pulmonary mass is defined as
Round opacity greater than 3 cm.
Differential in a patient under the age of 35, particularly a nonsmoker without a history of malignancy,
Granuloma. Hamartoma, Inflammatory lesion.
An SPN in a patient over 35 years of age should never be followed radiographically without tissue confirmation unless the lesion contains
Benign pattern of calcification. Presence of intralesional fat.
Studies have shown that bronchogenic carcinoma has a doubling time of
Between 1 month and 2 years.
Presence of small satellite nodules around the periphery of a dominant pulmonary nodule is strongly suggestive of
Benign disease, particularly granulomatous infection.
Presence of a halo of ground-glass opacity encircling an SPN in an immunocompromised, neutropenic patient should suggest the diagnosis of
Invasive pulmonary aspergillosis.
Comet tail of bronchi and vessels entering the hilar aspect of the mass, and associated with lobar volume loss is characteristic of
Complete or central calcification within an SPN is specific for
Healed granuloma from tuberculosis or histoplasmosis.
Concentric or laminated calcification of an SPN
Granuloma and allows confident exclusion of neoplasm.
Popcorn calcification within a pulmonary nodule is diagnostic of
Fat within an SPN is diagnostic of a
Enhancement of malignant SPNs
Most common thoracic inlet masses?
Thyroid masses. Lymphomatous nodes. Lymphangiomas.
Intrathoracic thyroid goiter CT findings?
Well-defined margins. Continuity of mass with cervical thyroid. Coarse calcifications. Cystic or necrotic areas. Baseline high CT attenuation (intrinsic iodine content). Intense enhancement (>25 H).
Tumor of dilated lymphatic channels. Cystic or cavernous form (cystic hygroma) is commonly discovered in infancy and is often associated with : Turner syndrome and trisomies 13, 18, and 21.
Anterior mediastinal masses?
Thymic neoplasms. Lymphoma. Germ cell neoplasms. Primary mesenchymal tumors.
Thymoma versus thymic carcinoma
Thymomas may be encapsulated (noninvasive) or invasive. Thymic carcinomas, epithelial component shows signs of frank malignancy.
Thymoma-associated autoimmune diseases
Myasthenia gravis. Pure red cell aplasia. Graves disease. Sjogren syndrome. Hypogammaglobulinemia.
Congenital: Remnants of thymopharyngeal duct. Contain thin or gelatinous fluid. Acquired: Postinflammatory. Associations: AIDS, Prior radiation or surgery, Autoimmune conditions (Sj”gren syndrome, Myasthenia gravis, Aplastic anemia).
Thymoma. Thymic cyst. Thymolipoma. Thymic hyperplasia. Thymic neuroendocrine tumors. Thymic carcinoma. Thymic lymphoma.
Germ cell neoplasms
Teratoma (benign and malignant). Seminoma. Embryonal cell carcinoma. Endodermal sinus tumor. Choriocarcinoma.
Mesenchymal anterior mediastinal tumors
Lipoma. Hemangioma. Leiomyoma. Liposarcoma. Angiosarcoma.
_________ is the most frequent site of a localized nodal mass in patients with Hodgkin disease.
A key in distinguishing primary from metastatic mediastinal germ cell neoplasm is the presence of
Retroperitoneal lymph node involvement in metastatic gonadal tumors.
Benign and malignant teratoma features on CT
Benign: round or oval and smooth in contour. Malignant: irregular, lobulated, or ill-defined margin.
Middle mediastinal masses
Foregut and mesothelial cysts. Tracheal and central bronchial neoplasms. Diaphragmatic hernias. Vascular lesions.
Differential for central calcification of mediastinal/hilar lymph nodes on CT?
Differential for peripheral (eggshell)l calcification of mediastinal/hilar lymph nodes on CT?
Differential for hypervascular mediastinal/hilar lymph nodes on CT?
Carcinoid tumor/small cell carcinoma. Kaposi sarcoma. Metastases (RCC. Thyroid carcinoma). Castleman disease.
Differential for necrotic mediastinal/hilar lymph nodes on CT?
Mycobacteria. Fungus. Metastases (SCC. Seminoma. Lymphoma).
Differences in lymph nodes of sarcoidosis and lymphoma/metastases?
Sarcoidosis: Lobular lymph nodes that do not coalesce. Lymphoma/mets: May form conglomerate enlarged nodal masses.
Castleman disease also known as
Angiofollicular lymph node hyperplasia.
Pericardial cysts most commonly arise in the
Anterior cardiophrenic angles. Right-sided lesions being twice as common as left-sided lesions.
Three groups of neurogenic tumors of the posterior mediastinum.
Intercostal nerves: Neurofibroma. Schwannoma. Sympathetic ganglia: Ganglioneuroma. Ganglioneuroblastoma. Neuroblastoma. Paraganglionic cells: Chemodectoma. Pheochromocytoma.
Most common posterior mediastinal neurogenic tumors in children
Most common posterior mediastinal neurogenic tumors in adults
Multiple lesions in the mediastinum, particularly bilateral apicoposterior masses, are virtually diagnostic of
Posterior mediastinal masses
Esophageal lesions. Foregut cysts. Vertebral lesion. Lateral thoracic meningocele. Pancreatic pseudocyst.
Causes of chronic sclerosing (fibrosing) mediastinitis
Histoplasmosis (most common). TB. Radiation therapy. Drugs (methysergide). Idiopathic (autoimmune).
SVC syndrome manifestations
Headache. Epistaxis. Cyanosis. Jugular venous distention. Edema.
Ludwig angina describes
Substernal chest pain caused by intramediastinal extension of infection.
Causes of unilateral pulmonary artery enlargement incluce
Poststenotic dilation from valvular or postvalvular pulmonic stenosis. Pulmonary artery aneurysms. Distension of pulmonary artery by thrombus or tumor.
Rare vasculitides that may present with pulmonary artery aneurysms
Beh‡et disease and Hughes-Stovins syndrome
Sarcoidosis 1-2-3 sign
1: Right paratracheal. 2. Right hilar. 3. Left hilar lymph node enlargement
Coronary calcification is detected at angiography in ____% of patients with 50% diameter stenosis.
A_____% diameter narrowing is the physiologic point at which flow is restricted enough to result in ischemia under stress conditions.
50% diameter narrowing. Roughly predicts a 75% cross-sectional area reduction.
Cardiac MR uses?
Define location and size of previous myocardial infarctions. Demonstrate complications of previous infarctions. Establish presence of viable myocardium for possible revascularization. Differentiate acute versus chronic myocardial infarction. Evaluate regional myocardial wall motion and systolic wall thickening. Demonstrate global myocardial function with right ventricular and left ventricular ejection fractions. Demonstrate regional myocardial perfusion. Evaluate papillary muscle and valvular abnormalities.
Myocardial rupture (may occur ______ days after infarction.
3 to 14 days.
Onset is typically 1 week to 3 months postinjury. Fever, chest pain, pericarditis, pericardial effusion, and pleuritis, with pleural effusion usually more prominent on the left. Dressler syndrome responds well to anti-inflammatory medications.
Hibernating myocardium versus stunned myocardium?
Hibernating: High-grade stenosis resulting in chronically ischemic myocardium. May act like postinfarction scar. Improved function with revascularization. At risk for acute infarction. Stunned myocardium: Postischemic, dysfunctional myocardium without complete necrosis. Potentially salvageable.
Causes of dilated cardiomyopathies
Ischemic cardiomyopathy (most common cause): Chronic ischemia. Prior infarction. Anomalous coronary arteries. Long-term sequelae of myocarditis: Coxsackie virus. Toxins: Ethanol, Adriamycin, Doxorubicin. Metabolic conditions: Mucolipidosis. Mucopolysaccharidosis. Glycogen storage disease. Nutritional deficiencies: Thiamin. Selenium). Infants of diabetic mothers. Muscular dystrophies.
Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of dilated cardiomyopathy?
LV thin. LV dilated. Decreased contractility. Normal to decreased compliance.
Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of hypertrophic cardiomyopathy?
LV thick. LV normal to decreased. Increased contractility. Decreased compliance.
Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of restrivice cardiomyopathy?
Normal LV wall. Normal LV cavity. Normal to decreased contractility. Severely decreased compliance.
Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of Uhl anomaly?
RV thin. RV dilated. Decreased contractility. Normal to decreased compliance.
Hypertrophic cardiomyopathies are divided into two basic types:
Concentric hypertrophy: may be diffuse, midventricular, or apical in distribution. Asymmetrical septal hypertrophy (ASH), also known as idiopathic hypertrophic subaortic stenosis (IHSS).
Hypertrophic cardiomyopathy causes?
May be familial (60%). Autosomal dominant with variable penetrance. Associated with neurofibromatosis and Noonan syndrome. Secondary to pressure overload.
Features of ASH (asymmetric septal hypertrophy)?
Hypertrophy of the interventricular septum (>12 to 13 mm). Abnormal ratio of thickness of interventricular septum to left ventricular posterior wall (>1.3:1). Narrowing of left ventricular outflow tract during systole.
Restrictive cardiomyopathy causes
Infiltrative disorders: Amyloid. Glycogen storage disease. Mucopolysaccharidosis. Hemochromatosis. Sarcoidosis. Myocardial tumor infiltration.
What other disease should be ruled out when considering restrictive cardiomyopathy?
MR finding in restrictive cardiomyopathy caused by amyloidosis or sarcoidosis?
high signal in the myocardium on T2WIs.
Defined as right ventricular failure secondary to pulmonary parenchymal or pulmonary arterial disease.
Etiologies of cor pulmonale include
destructive pulmonary disease (pulmonary fibrosis and chronic obstructive pulmonary disease). hypoxic pulmonary vasoconstriction resulting from chronic bronchitis, asthma, CNS hypoxia, upper airway obstruction. Acute and chronic pulmonary embolism. Idiopathic pulmonary hypertension. Extrapulmonary diseases affecting pulmonary mechanics such as chest deformities, morbid obesity (pickwickian syndrome), neuromuscular diseases.
Acquired disorder in infants or adults. Also called arrhythmogenic right ventricular dysplasia. Dilation of RV with marked thinning of anterior right ventricular wall. MR may show fatty infiltration of anterior RV free wall. Premature death from early congestive failure or arrhythmias.
Enlargement of pulmonary outflow tract causes
Left-to-right shunts. Poststenotic dilation secondary to pulmonary stenosis. Pulmonary arterial hypertension. Marfan syndrome. Takayasu arteritis. Idiopathic dilation of pulmonary artery.
Differential diagnosis for pulmonary arterial hypertension includes
Long-standing pulmonary venous hypertension (mitral stenosis). Eisenmenger physiology (long-standing left-to-right shunts). Pulmonary emboli. Vasculitides (rheumatoid arthritis or polyarteritis nodosa). Primary pulmonary hypertension.
Increased pulmonary blood flow is caused by
Left-to-right shunts. High output states: Volume loading. Pregnancy. Peripheral shunt lesions (arteriovenous malformations). Hyperthyroidism. Anemia. Leukemia.
Decreased pulmonary blood flow with a small heart is caused by
Chronic obstructive pulmonary disease. Hypovolemia. Malnourishment. Addison disease.
Mitral stenosis in the adult is usually caused by
Rheumatic heart disease.
Causes of Pulmonary Venous Hypertension
Left ventricular failure. Mitral stenosis. Mitral regurgitation. Aortic stenosis. Aortic regurgitation. Pulmonary veno-occlusive disease. Congenital heart disease.
Left atrial enlargement, left ventricular enlargement, and bulging of the atrial septum to the right.
Cardiac thrombus features
Intra-atrial thrombi are usually associated with atrial fibrillation, often secondary to rheumatic heart disease. Commonly occurs along posterior wall of LA. Left ventricular thrombi are usually secondary to recent infarction or ventricular aneurysm. Clots typically have low MR GRE signal, whereas tumors have intermediate signal. Clots will not enhance.
Intracardiac lipomas or lipomatous hypertrophy features
High T1 signal and fat suppression. Second most common benign cardiac tumor.
Atrial myxoma features
50% of primary cardiac tumors. Most common primary benign cardiac tumor. Most (75% to 80%) are in LA. May mimic rheumatic valvular disease clinically.
Benign cardiac tumors
Atrial myxoma. Lipoma. Rhabdomyoma (50% to 85% of tuberous sclerosis). Fibromas (12% may calcify). Rare teratoma.
Metastatic cardiac tumor features
10 to 20 times more common than primary cardiac tumors. Breast. Lung. Melanoma. Lymphoma.
Primary malignant cardiac tumors
Angiosarcoma (most common). Rhabdosarcoma. Liposarcoma. Other sarcomas.
Constrictive pericardial disease features
Fibrous or calcific thickening of pericardium. Compromises ventricular filling through restriction of cardiac motion. Most common cause is postpericardiotomy. Other causes: Coxsackie B. Tuberculosis. Chronic renal failure. Rheumatoid arthritis. Neoplastic involvement. Radiation pericarditis.
Differential diagnosis for a cardiophrenic angle mass includes
Pericardial cyst. Fat pad. Lipoma. Enlarged lymph nodes. Diaphragmatic hernia. Ventricular aneurysm.
Congenital absence of pericardium features
Complete left-sided absence (55%). Foraminal defects (35%). Total absence (10%). M > F. Complete absence: Heart is shifted toward the left, with prominent bulge of right ventricular outflow tract, main pulmonary artery, and left atrial appendage. Partial absence of the pericardium risks strangulation of cardiac structures. Surgical closure of partial defects is usually recommended.
Noninfectious causes of miliary pattern
Pneumoconioises (silicosis). Eosinophilic granuloma. Sarcoidosis. Metastases (Thyroid. Melanoma.)
Minimal pleural effusion volume visible on frontal, lateral, and decubitus chest radiographs
Frontal (200 mL). Lateral (75 mL). Decubitus (5 mL)
Which junction line, anterior or posterior, extends above the clavicles
Posterior junction line.
Define pulmonary cavity
Refers to a lucency located wtihin a nodule, mass, or focus of consolidation.
Order of the left lower lobe basilar segments (from lateral to medial) on a frontal radiograph
Anteromedial, Lateral, Posterior (ALP).
DDx of subcarinal mass on radiograph
Lymph node enlargement. Bronchogenic cyst. Left atrial enlargement.
Classic primary TB chest radiograph findings
Parenchymal consolidation with mediastinal and hilar lymph node enlargement.
Combination of calcified lung nodule and calcified lymph nodes.
Lung nodule that is a residum of primary TB. Usually is calcified.
At what pulmonary venous wedge pressures do Kerley lines, effusions, and airspace opacities occur?
Normal 12 mm Hg. Kerley lines 17 mm Hg. Effusion 20 mm Hg. Airspace opacity 25 mm Hg.
Complications of bronchiectasis
Recurrent infections. Hemoptysis. Mucoid impaction. Atelectasis.
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease)
Telangiectasias. AVMs. Aneurysms in multiple organ systems (Pulmonary. GI. Cutaneous. CNS)
Parenchymal findings associated with acute PE
Wedge-shaped peripheral foci of consolidation. Linear bands.
Focal areas of chronic consolidation may be seen in
Lipoid pneumonia. Bronchoalveolar cell carcinoma. Lymphoma.
Diffuse chronic consolidation can be seen in
Bronchoalveolar cell carcinoma. Alveolar proteinosis. Sarcoid. Lipoid pneumonia.
Kartagener's syndrome (dyskinetic cilia syndrome) triad
Situs invertus. Bronchiectasis. Sinusitis.
Wegener's granulomatosis lung findings
Multiple lung nodules or masses. Cavitation occurs 50%. Local or diffuse consolidation due to hemorrhage.
Help distinguish LCH from LAM
LCH: Usually associated with nodules and variable appearing cysts. Spares costophrenic angles.
Extensive ground glass opacities in a patchy or geographic pattern. 1/3 have upper lobe predominant cysts of varying sizes and wall thicknesses
Bronchopleural fistula, postpneumonectomy should be considered if
Pneumonectomy space fails to fill with fluid. Abrupt decrease in air-fluid level in the pneumonectomy space. New collection of air in previously opacified pneumectomy space. Contralateral mediastinal shift.
Superior sulcus tumor symptoms
Shoulder pain. Horner's syndrome (ptosis, miosis, anhidrosis). Weakness and atrophy of hand muscles.
Deems a superior sulcus tumor unresectable
Any involvement of vertebral body, brachial plexus, subclavian artery.
Smaller nodules adjacent to a lung mass. Suggests an infectious etiology.
Mediastinal lipomatosis causes
Cushing's syndrome. Steroid therapy. Obesity.
Form of peripheral lobar atelectasis that develops with pleural disease (commonly asbestosis). Volume loss. Comet tail (whorled bronchovascular structures).
Diameter of ascending aorta aneurysm
4 cm. 6 cm significant risk of rupture.
Bulla versus bleb
Bulla, sharply demarcated area of emphysema greater than 1 cm. Bleb, gas-containing space within visceral pleura.
Chest radiograph finding in healed varicella pneumonia
Diffuse discrete pulmonary calcifications.
Nodal status and stage in NSCLC
N0, No metastatic lymph nodes. N1, Metastatic ipsilateral hilar lymph nodes. N2, Metastatic ipsilateral mediastinal and subcarinal lymph nodes. N3, Metastatic contralateral mediastinal or hilar lymph nodes.
Causes of SVC syndrome
Neoplastic: Lung cancer (especially small cell carcinoma). Lymphoma. Metastatic carcinoma. Benign: Long-term IV devices (catheters. pacemakers). Fibrosing mediastinitis (Histoplasmosis).
Neoplastic and nonneoplastic causes of hypertrophic pulmonary osteoarthropathy
90% Malignant lung neoplasms. Nonneoplastic: Cystic fibrosis. IPF. Localized fibrous lesions of the pleura
Epicardial fat pad sign
Double lucency sign. Displacement (>4 mm) of anterior and posterior (epicardial) pericardial fat by pericardial fluid.
What obvious structures should be avoided while planning a TTNB (transthoracic needle biopsy)
Interlobar fissures. Pulmonary vessels. Bullae. Areas of severe emphysema.
Peripheral consolidation (photographic negative of pulmonary edema)
Chronic eosinophilic pneumonia.
Sloughed lung within a cavity
Pulmonary gangrene. Closely associated with Klebsiella.
Mosaic lung attenuation causes
Small airways disease. Chronic pulmonary embolism.
Distinguishes small airways disease of chronic PE in setting of mosaic attenuation
Expiratory images demonstrate air-trapping in small airways disease.
Allergic bronchopulmonary aspergillosis radiographic findings
Central bronchiectasis. Mucous plugging (finger-in-glove). Atelectasis. Patchy migratory foci of consolidation.
Pulmonary alveolar proteinosis susceptible infections
Nocardia. Aspergillus. Mucormycetes.
Localized fibrous tumor of the pleura enhancement pattern
Intense and homogeneous contrast enhancement.
Calcified fine lung nodules differential
Healed varicella. Healed histoplasmosis. Silicosis. Calcified metastases.
CT findings of Swyer-James syndrome
Areas of decreased lung attenuation with associated reducting in number and size of vessels. Bronchiectasis. Air trapping on expiratory images.
Blind-ending diverticulum arising from medial wall of bronchus intermedius. Rarely presents with recurrent infections, hemoptysis, cough, and or dyspnea.
Bronchiolitis obliterans organizing pneumonia CT findings
Patchy bilateral airspace consolidation with peripheral, subpleural distribution. Poorly defined lung nodules in a peribronchiolar distribution.
Triad of pulmonary veno-occlusive disease
Severe pulmonary artery hypertension. Evidence of pulmonary edema. Normal wedge pressure.
Water lily sign
Echinococcus cysts: Endocyst ruptures its contents within the ectocyst, floating on top of debris, like a water lily.
Differential diagnosis for wall-to-wall heart?
Tricuspid regurgitation. Pericardial effusion. Dilated cardiomyopathy.
Common predisposing factors for aortic dissection
Hypertension. Annuloaortic ectasia: Marfan or Ehlers-Danlos syndrome. Bicuspid aortic valve. Aortic aneurysm. Arteritis.
Anatomic structure separating Type A from Type B (Stanford) aortic dissections
Left subclavian artery. Distal type B. Proximal type A.
Chest bone findings associated with Marfan syndrome
Pectus excavatum. Scoliosis.
Pectus excavatum associations
Marfan syndrome. Ehlers-Danlos syndrome. Mitral valve prolapse. Homocystinuria. Hunter-Hurler syndromes.
4 life threatening complications of type A aortic dissection
Coronary artery dissection (myocardial infarction). Carotid artery dissection (stroke). Pericardial hemorrhage (tamponade). Aortic valve rupture (aortic regurgitation).
Helps distinguish ventricle true aneurysms from pseudoaneurysms
Pseudoaneurysm: Inferoposterior location. Narrow neck (less than 50%). Aneurysm: Anteroapical location. Wide neck.
Which aberrant subclavian artery (right or left) is a vascular ring
Right aortic arch with aberrant left subclavian artery. Left-sided ligamentum arteriosum completes the ring.
Causes of SVC syndrome
Neoplastic: Bronchogenic carcinoma. Metastases. Lymphoma. Infectious: Fungal infection (histoplasmosis, fibrosing mediastinitis).
Persistent left superior vena cava associations
ASD. Tetralogy of Fallot. P(T)APVR.
Tetralogy of Fallot. 4 primary lesions
Overriding aorta. VSD. Pulmonar infundibular stenosis. Right ventricular hypertrophy.
Thoracic vessels. Takayasu arteritis involvement
Aorta. Right common carotid.Subclavian arteries. Pulmonary arteries.
Causes of constritive pericarditis
Cardiac surgery. Radiation therapy. Uremic pericarditis. Viral pericarditis (coxsackie). Tuberculous pericarditis.
Treatment of intramural hematoma of aorta
Similar to aorta dissections: type A (surgically) type B (medically).
Sinus of valsalva aneurysm versus aortic root dilation
Sinus of valsalva aneurysm is focal dilation of one sinus of Valsalva, not entire root.
Type I: Supracardiac drainage. Snowman heart. Type II: Cardiac. Coronary sinus or right atrium drainage. Type III: Infracardiac. Portal vein, hepatic vein, or ductus venosus drainage (pulmonary edema due to obstruction).
Aortic pseudoaneurysm causes
Atherosclerosis (penetrating ulcer). Infection. Trauma. Iatrogenic.
Mirror-image right aortic arch congential heart disease associations
Tetralogy of Fallot. Truncus arteriosus.
4 components of scimitar syndrome
Right lung hypoplasia. Hypoplastic right pulmonary artery. Right lower lobe systemic arterial supply. PAPVR from right lung.
Partial congenital absence of the pericardium findings:
Leftward deviation of the heart without deviation of mediastinum. Prominent left atrial appendage. Lung located between aorta and pulmonary artery confirms diagnosis.
Heterotaxy syndrome associated with interruption of IVC with Azygous continuation
Bilateral left-sidedness/polysplenia syndrome.
Features that suggest a primary malignant cardiac tumor
Invasiveness. Extension outside of heart. Involvement of more than one chamber. Central necrosis or cavitation. Large pericardial effusion.