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1

Patients with Sjogren syndrome are at increased risk for developing what diffuse lung diseases

Lymphocytic interstitial pneumonitis (LIP). Non-Hodgkin pulmonary lymphoma.

2

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.

3

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).

4

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.

5

Acute Interstitial Pneumonia

Diffuse ground-glass opacity and consolidation with air bronchograms. Linear opacities, honeycombing, and traction bronchiectasis are uncommon.

6

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.

7

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.

8

Respiratory Bronchiolitis-Associated Interstitial Lung Disease

Typically young, heavy smokers. Scattered ground-glass opacities. Small centrilobular nodules with upper lobe predominance.

9

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.

10

Neurofibromatosis ILD

Generally asymmetric upper lung bullae. Generally symmetric lower lung interstitial fibrosis.

11

Tuberous Sclerosis (TS) ILD

Indistinguishable from LAM. Symmetric bilateral reticular or reticulonodular opacities. Scattered lung cysts. Normal to increased lung volumes. Pneumothorax is common

12

Lymphangioleiomyomatosis

Exclusively in women. Lung cysts separated by interlacing bundles of smooth muscle. May obstruct lymphatics causing chylothorax. Poor prognosis.

13

Alveolar Septal Amyloidosis

Simulates silicosis or lung sarcoidosis. Upper lung reticulonodular opacities.

14

Chronic Aspiration Pneumonia

Irregular reticular interstitial opacities.

15

3 major pneumoconioses

Asbestosis. Silicosis. CWP.

16

Asbestosis

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.

17

Silicosis

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.

18

Coal Worker's Pneumoconiosis

Predominantly upper lung reticulonodular or small nodular opacities.

19

Rare Pneumoconioses

Berylliosis. Aluminum. Hard metal (cobalt, tungsten).

20

Hypersensitivity Pneumonitis

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.

21

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.

22

Sarcoidosis ILD

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.

23

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.

24

Wegener Granulomatosis

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.

25

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

26

Hypereosinophilic syndrome

Male predominance. Blood eosinophilia. Cardiomegaly. Pulmonary edema. Pleural effusions. Pulmonary parenchymal infiltration with eosinophils may produce interstitial or airspace opacities.

27

Eosinophilic Lung Disease Associated With Autoimmune Diseases

Wegener granulomatosis. Sarcoidosis. Rheumatoid lung disease. Polyarteritis nodosa. Allergic angiitis and granulomatosis.

28

Eosinophilic Lung Disease of Identifiable Etiology

Drugs (Nitrofurantoin and Penicillins). Parasites (Ascaris lumbricoides, Strongyloides stercoralis).

29

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.

30

Alveolar microlithiasis

Deposition of minute calculi within alveolar spaces. Confluent bilateral dense micronodular opacities. So-called black pleura sign. Apical bullous disease is common.

31

Diffuse pulmonary ossification

Formation of bone within lung parenchyma. Associations: Mitral stenosis. UIP. Amyloidosis.

32

Tracheocele

Paratracheal air cysts. True diverticula. Occur at weakened posterior membrane of cervical trachea.

33

Tracheal bronchus

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.

34

Primary neoplasms of trachea

Malignant: Squamous cell carcinoma. Adenoid cystic carcinoma (cylindroma). Benign: Chondroma.ÿFibroma.ÿSquamous cell papilloma.ÿHemangioma.

35

Tracheal Narrowing

Saber-sheath trachea. Amyloidosis. Tracheobronchopathia osteochondroplastica. Relapsing polychondritis. Wegener granulomatosis. Tracheal scleroma.

36

Tracheal dilation

Tracheobronchomegaly (Mounier-Kuhn syndrome). Tracheomalacia. Interstitial pulmonary fibrosis.

37

Saber-sheath trachea

Coronal diameter is less than two thirds of sagittal diameter. Affects older men with chronic obstructive pulmonary disease (COPD).

38

Tracheobronchopathia osteochondroplastica

Multiple submucosal osseous and cartilaginous deposits within trachea and central bronchi of elderly men. Spares membranous posterior wall of trachea.

39

Relapsing polychondritis

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.

40

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.

41

Tracheobronchomalacia

Diffuse tracheal and central bronchial dilation. Congenital or acquired (COPD, Chronic bronchitis, Cystic fibrosis, Relapsing polychondritis).

42

Fallen lung sign

Subtended lung remains collapsed against lateral chest wall. Secondary to bronchial injury. Responds poorly to chest tube evacuation.

43

Broncholithiasis

Calcified material within bronchus. Usually from eroding calcified lymph nodes (Histoplasmosis or TB).

44

Asthma

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.

45

Chronic bronchitis

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.

46

Bronchiectasis

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.

47

Cystic fibrosis

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.

48

Dysmotile cilia syndrome

May result in Rhinitis. Sinusitis. Bronchiectasis. Dysmotile spermatozoa and sterility. Situs inversus. Dextrocardia.

49

Kartagener syndrome triad

Sinusitis. Situs inversus.. Bronchiectasis.

50

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.

51

Emphysema

Permanent enlargement of airspaces distal to terminal bronchiole. Destruction of alveolar walls without obvious fibrosis.

52

Centrilobular emphysema

Airspace distention in central portion of lobule. Spares distal portions of the lobule. Upper lobe predominance. Associated with cigarette smoking.

53

Panlobular emphysema

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.

54

Paraseptal emphysema

Distention of peripheral airspaces adjacent to interlobular septa. Spares centrilobular region. Generally involves subpleural regions of upper lobes.

55

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.

56

Emphysema findings

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.

57

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.

58

Bulla defined

Thin-walled cystic space > 1 cm in diameter. Found within lung parenchyma.

59

Bullae may be seen in diseases that cause chronic upper lobe fibrosis, such as

Sarcoidosis. Pulmonary Langerhans cell histiocytosis. Ankylosing spondylitis.

60

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.

61

CT findings and associations of infectious bronchiolitis

Tree-in-bud opacities. Generally due to infection: Viral. Atypical. Mycobacterial.

62

CT findings of diffuse panbronchiolitis

Tree-in-bud opacities. Bronchial dilation and thickening.

63

CT findings and associations of Respiratory bronchiolitis?associated interstitial lung disease

Centrilobular and geographic ground-glass opacities. Cigarette smoking.

64

CT findings and associations of Hypersensitivity pneumonitis (subacute)

Centrilobular ground-glass nodules. Air trapping on expiratory scans. Inhaled organic antigen.

65

CT findings and associations of Follicular bronchiolitis

Centrilobular ground-glass nodules. Rheumatoid arthritis. Sj”gren syndrome.

66

CT findings and associations of Constrictive bronchiolitis

Mosaic attenuation with air trapping on expiratory scans. Bronchial dilation (late). Transplant patients. Drug reactions. Inhalation injury.

67

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.

68

Infectious causes of pleural effusion?

Bacterial/mycobacterial. Viral. Fungal. Parasitic.

69

Cardiovascular causes of pleural effusion?

Heart failure. Pericarditis. Superior vena cava obstruction. Postcardiac surgery. Myocardial infarction. Pulmonary embolism.

70

Neoplastic causes of pleural effusion?

Bronchogenic carcinoma. Metastases. Lymphoma. Pleural or chest wall neoplasms (mesothelioma).

71

Immunologic causes of pleural effusion?

Systemic lupus erythematosus. Rheumatoid arthritis. Sarcoidosis (rare). Wegener granulomatosis.

72

Inhalational cause of pleural effusion?

Asbestosis.

73

Trauma causes of pleural effusion?

Blunt or penetrating chest trauma.

74

Abdominal disease causes of pleural effusion?

Cirrhosis (hepatic hydrothorax). Pancreatitis. Subphrenic abscess. Acute pyelonephritis. Ascites (from any cause). Splenic vein thrombosis.

75

Miscellaneous causes of pleural effusion?

Drugs. Myxedema. Ovarian tumor.

76

Pleural effusion from congestive heart failure features

Transudative. Bilateral, right larger than left. Isolated right effusion twice as common as isolated left effusion.

77

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.

78

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.

79

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.

80

Most common intrathoracic manifestation of rheumatoid arthritis

Pleural effusion.

81

Most common causes of chylothorax are

Malignancy. Iatrogenic trauma. TB

82

Left chylothorax versus right chylothorax?

Left chylothorax: Injury to upper duct. Right chylothorax: Injury to lower duct.

83

Bronchopleural Fistula

Communication between lung and pleural space. If bronchus involved, may result in empyema. If peripheral airspace (bronchiole) involved, may result in intractable pneumothorax.

84

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.

85

Secondary Spontaneous Pneumothorax

COPD. Asthma. Valsalva (cocaine, marijuana, labor). Sarcoidosis. Langerhans cell histiocytosis. Lymphangioleiomyomatosis. Necrotizing pneumonia. Abscess. Mechanically ventilated patients.

86

Catamenial pneumothorax

Rare recurrent pneumothoraces. Occurs with menses. Pleural endometrial implants. Treated with OCPs.

87

Most common cause of tension pneumothorax

Iatragenic trauma in mechanically ventilated patients.

88

Causes of pleural thickening

Pneumonia. Pulmonary infarct. Trauma. Asbestos exposure (bilateral).

89

Causes of pleural calcification

Visceral pleura:ÿHemothorax,ÿEmpyema (tuberculosis). Parietal pleura:ÿÿAsbestos exposure (bilateral).

90

Causes of pleural/extrapleural masses

Benign:ÿFibroma.ÿLipoma.ÿNeurofibroma.ÿMalignant:ÿMetastases (usually multiple).ÿÿMesothelioma (usually diffuse pleural thickening). Other: Loculated pleural effusion/empyema. Hematoma.

91

Fluid within calcified pleural layers seen on CT suggests

Active empyema. Most commonly within patients with prior TB.

92

Fibrothorax

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.

93

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.

94

Benign and malignant Asbestos-Related Pleural Diseases

Benign: Pleural plaques. Pleural effusions. Diffuse pleural fibrosis. Malignant: Mesothelioma.

95

When viewed en face, calcified pleural plaques appear as

Geographic opacities. Llikened to a holly leaf.

96

Poland syndrome

Autosomal recessive disorder. Unilateral absence of sternocostal head of pectoralis major. Ipsilateral syndactyly. Rib anomalies.

97

Most common benign neoplasm of chest wall

Lipoma

98

Most common malignant soft tissue neoplasms of the chest wall in adults.

Fibrosarcomas. Liposarcomas.

99

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.

100

Benign chest wall lesions

Abscess. Hematoma. Lipoma. Hemangioma. Desmoid tumor.

101

Inferior rib notching causes

Coarctation of aorta. Aortic thrombus. Takayasu arteritis. SVC syndrome. Neurofibromatosis.

102

Suprior rib notching cause

Paralysis.

103

Benign rib neoplasms, most common first

Osteochondroma. Enchondroma. Osteoblastoma.

104

Most common primary rib malignancy

Chondrosarcoma.

105

Rib malignancies

Most common: Myeloma. Metastatic carcinoma. Primary malignancies: Chondrosarcoma. Osteogenic sarcoma. Fibrosarcoma.

106

Most common metastatic lesions to ribs

Breast cancer. Lung cancer.

107

Expansile lytic rib metastases are seen most commonly from

Renal cell carcinoma. Thyroid carcinoma.

108

Sclerotic rib metastases are most commonly seen in

Breast cancer. Prostate cancer.

109

Pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include

TB. Actinomycosis. Nocardiosis.

110

Sprengel deformity

Congenital hypoplastic and elevated scapula.

111

Klippel-Feil syndrome.

Sprengel deformity (hypoplastic, elevated scapula). Omovertebral bone. Fused cervical vertebrae. Hemivertebrae. Kyphoscoliosis. Rib anomalies.

112

Erosion of the distal clavicles

Rheumatoid arthritis: Well-defined pointed distal clavicle. Hyperparathyroidism: Irregular and wide distal clavicle.

113

H-shaped or Lincoln log vertebrae on lateral chest radiographs

Sickle cell anemia.

114

Rugger jersey appearance to thoracic spine on lateral chest radiographs

Renal osteosclerosis.

115

Pectus excavatum is commonly associated with congenital connective tissue disorders, such as

Marfan syndrome. Poland syndrome. Osteogenesis imperfecta. Congenital scoliosis.

116

Pectus carinatum

Outward bowing of sternum. May be congenital or acquired.

117

Eventration of the diaphragm

Congenital absence or underdevelopment of diaphragmatic musculature. Localized elevation of anteromedial hemidiaphragm in older individuals.

118

Unilateral diaphragmatic paralysis is usually caused by

Surgical injury or neoplastic involvement of phrenic nerve.

119

Bilateral Diaphragmatic Elevation that is not effort related may be caused by

Neuromuscular disturbance. Intrathoracic or intra-abdominal disease.

120

Bochdalek Hernia

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).

121

Morgagni Hernia

Parasternal diaphragm defect. Invariably right sided. Asymptomatic cardiophrenic angle mass.

122

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.

123

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.

124

Bronchial atresia presentation

Central bronchial mucocele with peripheral hyperlucency in a young, asymptomatic patient.

125

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).

126

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.

127

Three radiographic patterns of aspiration pneumonitis

Extensive bilateral airspace opacification. Diffuse but discrete airspace nodular opacities. Irregular parenchymal opacities that are not obviously airspace.

128

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.

129

Drug that cause drug induced chest diseases

Lupus-like syndrome (procainamide, isoniazid, hydralazine). Nitrofurantoin. Bleomycin. Methotrexate. Amiodarone.

130

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.

131

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.

132

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.

133

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.

134

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.

135

Small cell carcinoma features

Arises centrally within main or lobar bronchi from bronchial neuroendocrine (Kulchitsky) cells. Hematogenous dissemination. Hilar/mediastinal mass.

136

Large cell bronchogenic carcinoma radiographic feature

Large peripheral mass.

137

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.

138

Most common radiographic findings from endobronchial tumor obstruction.

Resorptive atelectasis. Obstructive pneumonitis.

139

Majority of pancoast tumors, histology type

SCC. Adenocarcinoma.

140

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.

141

CT angiogram sign and BAC

Filling of airspaces with mucoid material produced by malignant cells creates low-density airspace opacification surrounding enhanced pulmonary arteries.

142

Typical radiologic findings of lymphangitic carcinomatosis

Linear and reticulonodular opacities. Peribronchial cuffing. Subpleural edema or pleural effusion.

143

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.

144

Two patient groups of small cell lung cancer

Disease limited to one hemithorax (limited disease). Contralateral lung or extrathoracic spread (extensive disease).

145

Two most common primary tracheal malignancies

SCC > Adenoid cystic carcinoma

146

Tracheal mass size and malignancy

Masses > 2 cm are likely to be malignant. Less than 2 cm are more likely benign.

147

Other, less common primary tracheal malignancies

Mucoepidermoid carcinoma. Carcinoid tumor. Adenocarcinoma. Lymphoma. Small cell carcinoma. Leiomyosarcoma. Fibrosarcoma. Chondrosarcoma.

148

Primary malignant neoplasms of the central bronchi include

Squamous cell carcinoma. Small cell carcinoma. Carcinoid tumor. Bronchial gland tumors (adenoid cystic carcinoma, mucoepidermoid carcinoma).

149

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.

150

A benign neoplasm comprised of disorganized epithelial and mesenchymal elements normally found in the bronchus or lung.

Pulmonary hamartoma.

151

A feature that helps distinguish lymphangitic carcinomatosis from interstitial fibrosis,

Thickened septal lines of lymphangiti carcinomatosis do not distort the pulmonary lobule.

152

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.

153

Posttransplant lymphoproliferative disorder (PTLD)

Spectrum of entities. Ranging from benign polyclonal lymphoid proliferation to aggressive non-Hodgkin lymphoma.

154

Pulmonary blastoma

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.

155

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.

156

Bronchopneumonia features

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.

157

Interstitial pneumonia features

Viral and mycoplasma infection. Inflammatory thickening of bronchial and bronchiolar walls and pulmonary interstitium. Peribronchial cuffing and reticulonodular opacities.

158

Pneumatoceles may be distinguished from abscesses by

Thin walls. Rapid change in size. Generally develop during late phase of infection.

159

Ranke complex

Calcified parenchymal focus (Ghon lesion) and lymph nodel calcification. Primary TB.

160

Postprimary 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.

161

Rasmussen aneurysm

Erosion of cavitary focus into pulmonary artery branch can produce an aneurysm.

162

Miliary TB

May complicate primary or reactivation disease. Hematogenous dissemination. Diffuse bilateral 2- to 3-mm pulmonary nodules.

163

Opportunistic fungal lung pathogens

Aspergillus. Candida. Cryptococcus.

164

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.

165

Pulmonary echinococcal cysts are composed of three layers:

Inside out: Endocyst, produces daughter cyts. Exocyst (chitinous layer), protective membrane. Pericyst, surrounding compressed, fibrotic lung.

166

CT halo sign

Decreased attenuation surrounding a dense, mass-like opacity. Relatively specific for invasive aspergillosis in a neutropenic patient.

167

Most common AIDS-defining opportunistic infection.

PCP

168

Interlobular (Septal) Lines

Thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting costal pleura.

169

Interlobular (septal) lines DDx:

Interstitial edema. ÿ Lymphangitic carcinomatosis. ÿ Sarcoidosis. ÿ Idiopathic pulmonary fibrosis (IPF) (other forms of usual interstitial pneumonia UIP).

170

Intralobular lines ILD DDx

IPF (UIP). Asbestosis. Alveolar proteinosis. Hypersensitivity pneumonitis.

171

Thickened fissures ILD DDx

Pulmonary edema. ÿ Sarcoidosis. ÿ Lymphangitic carcinomatosis.

172

Peribronchovascular interstitial thickening

Pulmonary edema (smooth). ÿ Sarcoidosis (nodular). ÿ Lymphangitic carcinomatosis (smooth or nodular).

173

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).

174

Subpleural lines ILD DDx

Asbestosis. ÿ IPF (UIP).

175

Parenchymal bands ILD DDx

Asbestosis. ÿ IPF (UIP). ÿ Sarcoidosis.

176

Honeycombing

IPF (UIP). ÿ Asbestosis.ÿ Hypersensitivity pneumonitis (chronic).ÿ Sarcoidosis.

177

Thin-walled cysts ILD DDx

Eosinophilic granuloma (EG). Lymphangioleiomyomatosis.ÿ Tuberous sclerosis.ÿ Neurofibromatosis (pneumatocele). (emphysema).

178

Micronodules, random distribution ILD DDx

Miliary tuberculosis or histoplasmosis.ÿ Hematogenous metastases.ÿ Silicosis/coal worker's pneumoconiosis (CWP).ÿ EG.

179

Micronodules, perilymphatic distribution ILD DDx

Sarcoidosis. ÿ Lymphangitic carcinomatosis.ÿ Silicosis/CWP.

180

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.

181

Traction bronchiectasis ILD DDx

Sarcoidosis. ÿ Silicosis/CWP.

182

Conglomerate mass ILD DDx

Sarcoidosis.ÿ Silicosis.ÿ CWP.ÿ Radiation fibrosis.

183

Subpleural Lines

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.

184

Parenchymal bands

Nontapering linear opacities, 2 to 5 cm in length. Extend from lung to contact pleural surface. Asbestosis. IPF. Sarcoidosis.

185

Honeycombing

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.

186

Thin-walled cysts

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

187

Micronodules

1- to 3-mm. Sharply marginated. Round opacities seen on HRCT. Represent conglomerates of granulomas or tumor cells within the interstitium.

188

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.

189

Traction bronchiectasis

Fibrosis causes traction on the walls of bronchi, resulting in irregular dilation.

190

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.

191

ILDs Lower zone distribution

Idiopathic pulmonary fibrosis.ÿ Asbestosis.ÿ Rheumatoid lung.ÿ Scleroderma.ÿ Neurofibromatosis.ÿ Dermatomyositis/polymyositis.ÿ Chronic aspiration.

192

ILDs normal or increased lung volumes

Sarcoidosis.ÿ Eosinophilic granuloma.ÿ Lymphangioleiomyomatosis.ÿ Tuberous sclerosis.ÿ Interstitial disease superimposed on emphysema.

193

ILDs Honeycombing

Idiopathic pulmonary fibrosis.ÿ Sarcoidosis.ÿ Eosinophilic granuloma.ÿ Rheumatoid lung.ÿ Scleroderma.ÿ Pneumoconiosis.ÿ Hypersensitivity pneumonitis.ÿ Chronic aspiration.ÿ Radiation fibrosis.

194

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.

195

Hilar/mediastinal lymph node enlargement

Sarcoidosis.ÿ Lymphangitic carcinomatosis.ÿ Lymphoma.ÿ Hematogenous metastases.ÿ Tuberculosis. Fungal infection.ÿ Silicosis.

196

ILDs Pleural disease

Asbestosis (plaques).ÿ Lymphangitic carcinomatosis (effusion).ÿ Rheumatoid lung disease (effusion/thickening).ÿ Lymphangioleiomyomatosis (chylous effusion).

197

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

198

Caplan syndrome

Thick walled cavitating lung nodules. Rheumatoid arthritis patients with hypersensitivity to inhaled dust particles (coal, silica, asbestos).

199

Scleroderma ILD findings

Interlobular septal thickening. Ground-glass opacities. Honeycombing. Lower lung predominance. Patulous esophagus.

200

Interstitial pulmonary edema CXR findings?

Intrapulmonary vascular shadows. Peribronchial cuffing. Tram tracking.

201

Kerley A and B lines?

Kerley A lines thickening of central connective tissue septa. Kerley B lines thickening of peripheral interlobular septa.

202

Alveolar pulmonary edema localized to the right upper lung may be seen in patients with

Severe mitral regurgitation.

203

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).

204

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.

205

ARDS

Respiratory failure due to increased capillary permeability edema. Associated with increased lung stiffness (noncompliance).

206

Common causes of ARDS

Shock. Severe trauma. Burns. Sepsis. Narcotic overdose. Pancreatitis.

207

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.

208

Causes of neurogenic pulmonary edema

Head trauma. Seizure. Increased intracranial pressure.

209

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).

210

Goodpasture syndrome

Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody.

211

Idiopathic Pulmonary Hemorrhage

Indistinguishable from Goodpasture syndrome. Pulmonary hemorrhage and anemia in patient with normal renal function and urinalysis. No antiglomerular basement membrane antibodies.

212

Vasculitides that can cause pulmonary hemorrhage

Wegener granulomatosis. Systemic lupus erythematosus. Rheumatoid arthritis. Polyarteritis nodosa.

213

D-dimer

Sensitive, but not specific marker of venous thrombosis.

214

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.

215

Radiographic features that suggest infarction in PE

Small pleural effusion and pleura-based wedge-shaped opacity (Hampton hump).

216

Nonthrombotic pulmonary embolism causes

Air embolism. Macroscopic fat embolism. Methylmethacrlate embolization from vertebroplasty. Radioactive seed embolization from prostate brachytherapy.

217

PAH is defined as a systolic pressure in the pulmonary artery exceeding

30 mm Hg.

218

Typical radiographic findings of PAH are

Enlarged main and hilar pulmonary arteries that taper rapidly toward lung periphery. RV enlargement.

219

PAH measurements of proximal interlobar pulmonary artery (CXR) and main pulmonary artery (CT)

Interlobar pulmonary artery > 16 mm. Main pulmonary artery > 28.6 mm.

220

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).

221

Shunt vascularity on chest radiographs

Enlargement of both central and peripheral pulmonary arteries.

222

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.

223

Multiple pulmonary nodules of similar size and appearance are almost always

Metastases. Granulomas.

224

Pulmonary nodule is defined as

Round or oval opacity 4 to 30 mm in diameter.

225

Pulmonary mass is defined as

Round opacity greater than 3 cm.

226

Differential in a patient under the age of 35, particularly a nonsmoker without a history of malignancy,

Granuloma. Hamartoma, Inflammatory lesion.

227

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.

228

Studies have shown that bronchogenic carcinoma has a doubling time of

Between 1 month and 2 years.

229

Presence of small satellite nodules around the periphery of a dominant pulmonary nodule is strongly suggestive of

Benign disease, particularly granulomatous infection.

230

Presence of a halo of ground-glass opacity encircling an SPN in an immunocompromised, neutropenic patient should suggest the diagnosis of

Invasive pulmonary aspergillosis.

231

Comet tail of bronchi and vessels entering the hilar aspect of the mass, and associated with lobar volume loss is characteristic of

Round atelectasis.

232

Complete or central calcification within an SPN is specific for

Healed granuloma from tuberculosis or histoplasmosis.

233

Concentric or laminated calcification of an SPN

Granuloma and allows confident exclusion of neoplasm.

234

Popcorn calcification within a pulmonary nodule is diagnostic of

Pulmonary hamartoma.

235

Fat within an SPN is diagnostic of a

Pulmonary hamartoma.

236

Enhancement of malignant SPNs

15 H.

237

Most common thoracic inlet masses?

Thyroid masses. Lymphomatous nodes. Lymphangiomas.

238

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).

239

Lymphangioma?

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.

240

Anterior mediastinal masses?

Thymic neoplasms. Lymphoma. Germ cell neoplasms. Primary mesenchymal tumors.

241

Thymoma versus thymic carcinoma

Thymomas may be encapsulated (noninvasive) or invasive. Thymic carcinomas, epithelial component shows signs of frank malignancy.

242

Thymoma-associated autoimmune diseases

Myasthenia gravis. Pure red cell aplasia. Graves disease. Sjogren syndrome. Hypogammaglobulinemia.

243

Thymic cysts

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).

244

Thymic masses

Thymoma. Thymic cyst. Thymolipoma. Thymic hyperplasia. Thymic neuroendocrine tumors. Thymic carcinoma. Thymic lymphoma.

245

Germ cell neoplasms

Teratoma (benign and malignant). Seminoma. Embryonal cell carcinoma. Endodermal sinus tumor. Choriocarcinoma.

246

Mesenchymal anterior mediastinal tumors

Lipoma. Hemangioma. Leiomyoma. Liposarcoma. Angiosarcoma.

247

_________ is the most frequent site of a localized nodal mass in patients with Hodgkin disease.

Anterior mediastinum.

248

A key in distinguishing primary from metastatic mediastinal germ cell neoplasm is the presence of

Retroperitoneal lymph node involvement in metastatic gonadal tumors.

249

Benign and malignant teratoma features on CT

Benign: round or oval and smooth in contour. Malignant: irregular, lobulated, or ill-defined margin.

250

Middle mediastinal masses

Foregut and mesothelial cysts. Tracheal and central bronchial neoplasms. Diaphragmatic hernias. Vascular lesions.

251

Differential for central calcification of mediastinal/hilar lymph nodes on CT?

Mycobacteria. Fungus.

252

Differential for peripheral (eggshell)l calcification of mediastinal/hilar lymph nodes on CT?

Silicosis. Sarcoidosis.

253

Differential for hypervascular mediastinal/hilar lymph nodes on CT?

Carcinoid tumor/small cell carcinoma. Kaposi sarcoma. Metastases (RCC. Thyroid carcinoma). Castleman disease.

254

Differential for necrotic mediastinal/hilar lymph nodes on CT?

Mycobacteria. Fungus. Metastases (SCC. Seminoma. Lymphoma).

255

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.

256

Castleman disease also known as

Angiofollicular lymph node hyperplasia.

257

Pericardial cysts most commonly arise in the

Anterior cardiophrenic angles. Right-sided lesions being twice as common as left-sided lesions.

258

Three groups of neurogenic tumors of the posterior mediastinum.

Intercostal nerves: Neurofibroma. Schwannoma. Sympathetic ganglia: Ganglioneuroma. Ganglioneuroblastoma. Neuroblastoma. Paraganglionic cells: Chemodectoma. Pheochromocytoma.

259

Most common posterior mediastinal neurogenic tumors in children

Neuroblastoma. Ganglioneuroma.

260

Most common posterior mediastinal neurogenic tumors in adults

Neurofibroma. Schwannoma.

261

Multiple lesions in the mediastinum, particularly bilateral apicoposterior masses, are virtually diagnostic of

Neurofibromatosis.

262

Posterior mediastinal masses

Esophageal lesions. Foregut cysts. Vertebral lesion. Lateral thoracic meningocele. Pancreatic pseudocyst.

263

Causes of chronic sclerosing (fibrosing) mediastinitis

Histoplasmosis (most common). TB. Radiation therapy. Drugs (methysergide). Idiopathic (autoimmune).

264

SVC syndrome manifestations

Headache. Epistaxis. Cyanosis. Jugular venous distention. Edema.

265

Ludwig angina describes

Substernal chest pain caused by intramediastinal extension of infection.

266

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.

267

Rare vasculitides that may present with pulmonary artery aneurysms

Beh‡et disease and Hughes-Stovins syndrome

268

Sarcoidosis 1-2-3 sign

1: Right paratracheal. 2. Right hilar. 3. Left hilar lymph node enlargement

269

Coronary calcification is detected at angiography in ____% of patients with 50% diameter stenosis.

75%

270

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.

271

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.

272

Myocardial rupture (may occur ______ days after infarction.

3 to 14 days.

273

Dressler syndrome

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.

274

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.

275

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.

276

Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of dilated cardiomyopathy?

LV thin. LV dilated. Decreased contractility. Normal to decreased compliance.

277

Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of hypertrophic cardiomyopathy?

LV thick. LV normal to decreased. Increased contractility. Decreased compliance.

278

Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of restrivice cardiomyopathy?

Normal LV wall. Normal LV cavity. Normal to decreased contractility. Severely decreased compliance.

279

Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of Uhl anomaly?

RV thin. RV dilated. Decreased contractility. Normal to decreased compliance.

280

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).

281

Hypertrophic cardiomyopathy causes?

May be familial (60%). Autosomal dominant with variable penetrance. Associated with neurofibromatosis and Noonan syndrome. Secondary to pressure overload.

282

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.

283

Restrictive cardiomyopathy causes

Infiltrative disorders: Amyloid. Glycogen storage disease. Mucopolysaccharidosis. Hemochromatosis. Sarcoidosis. Myocardial tumor infiltration.

284

What other disease should be ruled out when considering restrictive cardiomyopathy?

Constrictive pericarditis.

285

MR finding in restrictive cardiomyopathy caused by amyloidosis or sarcoidosis?

high signal in the myocardium on T2WIs.

286

Defined as right ventricular failure secondary to pulmonary parenchymal or pulmonary arterial disease.

Cor pulmonale.

287

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.

288

Uhl anomaly

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.

289

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.

290

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.

291

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.

292

Decreased pulmonary blood flow with a small heart is caused by

Chronic obstructive pulmonary disease. Hypovolemia. Malnourishment. Addison disease.

293

Mitral stenosis in the adult is usually caused by

Rheumatic heart disease.

294

Causes of Pulmonary Venous Hypertension

Left ventricular failure. Mitral stenosis. Mitral regurgitation. Aortic stenosis. Aortic regurgitation. Pulmonary veno-occlusive disease. Congenital heart disease.

295

Left atrial enlargement, left ventricular enlargement, and bulging of the atrial septum to the right.

Mitral regurgitation.

296

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.

297

Intracardiac lipomas or lipomatous hypertrophy features

High T1 signal and fat suppression. Second most common benign cardiac tumor.

298

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.

299

Benign cardiac tumors

Atrial myxoma. Lipoma. Rhabdomyoma (50% to 85% of tuberous sclerosis). Fibromas (12% may calcify). Rare teratoma.

300

Metastatic cardiac tumor features

10 to 20 times more common than primary cardiac tumors. Breast. Lung. Melanoma. Lymphoma.

301

Primary malignant cardiac tumors

Angiosarcoma (most common). Rhabdosarcoma. Liposarcoma. Other sarcomas.

302

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.

303

Differential diagnosis for a cardiophrenic angle mass includes

Pericardial cyst. Fat pad. Lipoma. Enlarged lymph nodes. Diaphragmatic hernia. Ventricular aneurysm.

304

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.

305

Noninfectious causes of miliary pattern

Pneumoconioises (silicosis). Eosinophilic granuloma. Sarcoidosis. Metastases (Thyroid. Melanoma.)

306

Minimal pleural effusion volume visible on frontal, lateral, and decubitus chest radiographs

Frontal (200 mL). Lateral (75 mL). Decubitus (5 mL)

307

Which junction line, anterior or posterior, extends above the clavicles

Posterior junction line.

308

Define pulmonary cavity

Refers to a lucency located wtihin a nodule, mass, or focus of consolidation.

309

Order of the left lower lobe basilar segments (from lateral to medial) on a frontal radiograph

Anteromedial, Lateral, Posterior (ALP).

310

DDx of subcarinal mass on radiograph

Lymph node enlargement. Bronchogenic cyst. Left atrial enlargement.

311

Classic primary TB chest radiograph findings

Parenchymal consolidation with mediastinal and hilar lymph node enlargement.

312

Ranke complex

Combination of calcified lung nodule and calcified lymph nodes.

313

Ghon lesion

Lung nodule that is a residum of primary TB. Usually is calcified.

314

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.

315

Complications of bronchiectasis

Recurrent infections. Hemoptysis. Mucoid impaction. Atelectasis.

316

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease)

Telangiectasias. AVMs. Aneurysms in multiple organ systems (Pulmonary. GI. Cutaneous. CNS)

317

Parenchymal findings associated with acute PE

Wedge-shaped peripheral foci of consolidation. Linear bands.

318

Focal areas of chronic consolidation may be seen in

Lipoid pneumonia. Bronchoalveolar cell carcinoma. Lymphoma.

319

Diffuse chronic consolidation can be seen in

Bronchoalveolar cell carcinoma. Alveolar proteinosis. Sarcoid. Lipoid pneumonia.

320

Kartagener's syndrome (dyskinetic cilia syndrome) triad

Situs invertus. Bronchiectasis. Sinusitis.

321

Wegener's granulomatosis lung findings

Multiple lung nodules or masses. Cavitation occurs 50%. Local or diffuse consolidation due to hemorrhage.

322

Help distinguish LCH from LAM

LCH: Usually associated with nodules and variable appearing cysts. Spares costophrenic angles.

323

PCP findings

Extensive ground glass opacities in a patchy or geographic pattern. 1/3 have upper lobe predominant cysts of varying sizes and wall thicknesses

324

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.

325

Superior sulcus tumor symptoms

Shoulder pain. Horner's syndrome (ptosis, miosis, anhidrosis). Weakness and atrophy of hand muscles.

326

Deems a superior sulcus tumor unresectable

Any involvement of vertebral body, brachial plexus, subclavian artery.

327

Satellite nodules

Smaller nodules adjacent to a lung mass. Suggests an infectious etiology.

328

Mediastinal lipomatosis causes

Cushing's syndrome. Steroid therapy. Obesity.

329

Rounded atelectasis

Form of peripheral lobar atelectasis that develops with pleural disease (commonly asbestosis). Volume loss. Comet tail (whorled bronchovascular structures).

330

Diameter of ascending aorta aneurysm

4 cm. 6 cm significant risk of rupture.

331

Bulla versus bleb

Bulla, sharply demarcated area of emphysema greater than 1 cm. Bleb, gas-containing space within visceral pleura.

332

Chest radiograph finding in healed varicella pneumonia

Diffuse discrete pulmonary calcifications.

333

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.

334

Causes of SVC syndrome

Neoplastic: Lung cancer (especially small cell carcinoma). Lymphoma. Metastatic carcinoma. Benign: Long-term IV devices (catheters. pacemakers). Fibrosing mediastinitis (Histoplasmosis).

335

Neoplastic and nonneoplastic causes of hypertrophic pulmonary osteoarthropathy

90% Malignant lung neoplasms. Nonneoplastic: Cystic fibrosis. IPF. Localized fibrous lesions of the pleura

336

Epicardial fat pad sign

Double lucency sign. Displacement (>4 mm) of anterior and posterior (epicardial) pericardial fat by pericardial fluid.

337

What obvious structures should be avoided while planning a TTNB (transthoracic needle biopsy)

Interlobar fissures. Pulmonary vessels. Bullae. Areas of severe emphysema.

338

Peripheral consolidation (photographic negative of pulmonary edema)

Chronic eosinophilic pneumonia.

339

Sloughed lung within a cavity

Pulmonary gangrene. Closely associated with Klebsiella.

340

Mosaic lung attenuation causes

Small airways disease. Chronic pulmonary embolism.

341

Distinguishes small airways disease of chronic PE in setting of mosaic attenuation

Expiratory images demonstrate air-trapping in small airways disease.

342

Congenital tracheobronchomegaly

Mounier-Kuhn syndrome.

343

Allergic bronchopulmonary aspergillosis radiographic findings

Central bronchiectasis. Mucous plugging (finger-in-glove). Atelectasis. Patchy migratory foci of consolidation.

344

Pulmonary alveolar proteinosis susceptible infections

Nocardia. Aspergillus. Mucormycetes.

345

Localized fibrous tumor of the pleura enhancement pattern

Intense and homogeneous contrast enhancement.

346

Calcified fine lung nodules differential

Healed varicella. Healed histoplasmosis. Silicosis. Calcified metastases.

347

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.

348

Cardiac bronchus

Blind-ending diverticulum arising from medial wall of bronchus intermedius. Rarely presents with recurrent infections, hemoptysis, cough, and or dyspnea.

349

Bronchiolitis obliterans organizing pneumonia CT findings

Patchy bilateral airspace consolidation with peripheral, subpleural distribution. Poorly defined lung nodules in a peribronchiolar distribution.

350

Triad of pulmonary veno-occlusive disease

Severe pulmonary artery hypertension. Evidence of pulmonary edema. Normal wedge pressure.

351

Water lily sign

Echinococcus cysts: Endocyst ruptures its contents within the ectocyst, floating on top of debris, like a water lily.

352

Differential diagnosis for wall-to-wall heart?

Tricuspid regurgitation. Pericardial effusion. Dilated cardiomyopathy.

353

Common predisposing factors for aortic dissection

Hypertension. Annuloaortic ectasia: Marfan or Ehlers-Danlos syndrome. Bicuspid aortic valve. Aortic aneurysm. Arteritis.

354

Anatomic structure separating Type A from Type B (Stanford) aortic dissections

Left subclavian artery. Distal type B. Proximal type A.

355

Chest bone findings associated with Marfan syndrome

Pectus excavatum. Scoliosis.

356

Pectus excavatum associations

Marfan syndrome. Ehlers-Danlos syndrome. Mitral valve prolapse. Homocystinuria. Hunter-Hurler syndromes.

357

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).

358

Helps distinguish ventricle true aneurysms from pseudoaneurysms

Pseudoaneurysm: Inferoposterior location. Narrow neck (less than 50%). Aneurysm: Anteroapical location. Wide neck.

359

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.

360

Causes of SVC syndrome

Neoplastic: Bronchogenic carcinoma. Metastases. Lymphoma. Infectious: Fungal infection (histoplasmosis, fibrosing mediastinitis).

361

Persistent left superior vena cava associations

ASD. Tetralogy of Fallot. P(T)APVR.

362

Tetralogy of Fallot. 4 primary lesions

Overriding aorta. VSD. Pulmonar infundibular stenosis. Right ventricular hypertrophy.

363

Thoracic vessels. Takayasu arteritis involvement

Aorta. Right common carotid.Subclavian arteries. Pulmonary arteries.

364

Causes of constritive pericarditis

Cardiac surgery. Radiation therapy. Uremic pericarditis. Viral pericarditis (coxsackie). Tuberculous pericarditis.

365

Treatment of intramural hematoma of aorta

Similar to aorta dissections: type A (surgically) type B (medically).

366

Sinus of valsalva aneurysm versus aortic root dilation

Sinus of valsalva aneurysm is focal dilation of one sinus of Valsalva, not entire root.

367

TAPVR types

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).

368

Aortic pseudoaneurysm causes

Atherosclerosis (penetrating ulcer). Infection. Trauma. Iatrogenic.

369

Mirror-image right aortic arch congential heart disease associations

Tetralogy of Fallot. Truncus arteriosus.

370

4 components of scimitar syndrome

Right lung hypoplasia. Hypoplastic right pulmonary artery. Right lower lobe systemic arterial supply. PAPVR from right lung.

371

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.

372

Heterotaxy syndrome associated with interruption of IVC with Azygous continuation

Bilateral left-sidedness/polysplenia syndrome.

373

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.

374

Pulmonary sling aberrant course

Left pulmonary artery arises from right pulmonary artery and courses between esophagus and trachea.