Pattern of Pneumonia:
- Starts in peripheral alveoli
- Bacterial
- Airspace pattern, Silhouette sign, Air bronchogram sign
Lobar pneumonia
MC infectious disease in the world
Pneumonia
MC cause of Lobar pneumonia
Streptococcus pneumonia
Pattern of Pneumonia:
- Starts in mucosa of bronchi & bronchioles; spreads to alveoli
- Viral pneumonia
Interstitial/Lobular pneumonia
MC Cause of Bronchopneumonia (segmental)
Staphylococcus aureus
MC type of pneumonia in post-primary (reactivation) TB
Cavitary Pneumonia
TB that is MC in children
- Little or no symptoms
- MC in upper lobes
- Ranke (primary) complex: hilar lymph node calcification + ghon tubercle
Primary TB
TB that is MC in adults as reactivation or continuation of primary disease
- Cavitation is common
- Possible pleural effusion
- MC right side of posterior & apical segments of upper lobes
Post-Primary (Reinfective) TB
Type of TB that is due to hematogenous dissemination
- uncommon
- small nodules scattered thru-out both lungs
Miliary TB
Air in pleural space
- parietal pleura is intact while visceral pleura retracts toward hilum with the collapsing lung
Pneumothorax
Air that has dissected into the pleurae, small, and not seen on a film. If it ruptures –> spontaneous pneumothorax
Blem
With tension pneumothorax, mediastinal shifts _____ d/t fluid
Away
What is the best view to view Pneumothorax
PA Chest with Expiration
Key clinical sign for recognizing Subcutaneous Emphysema
Crackles upon palpation
MC Anterior Mediastinal Masses
- Lymphoma (T-cells) — MC
- Thymoma — 2nd MC
- Teratoma
- Substernal Thyroid
Thymic hyperplasia in adults is due to:
- High does cortisone therapy
- Chemotherapy
- Myasthenia Gravis
- aka Coin Lesion
- Nodule: 3cm
- Water Density
Solitary Pulmonary Nodule (SPN)
What are some things that can mimic an SPN:
- Clothing, screen, film artifacts (water on inside)
- Skin or chest wall lesions (moles, nipples, etc)
- Hair artifacts
- Bone lesions
- Healing rib fractures
- Pleural or mediastinal lesions
How does the size of a SPN determine if it’s benign or malignant?
Rarely Malignant: 5cm
3 MC types of pulmonary scars:
- TB
- Histoplasmosis
- Coccidiomycosis
MC benign lung tumor
Hamartoma
MC primary lung tumor
Bronchial Carcinoid Tumor aka Bronchial Adenoma
Nodule or mass with irregular borders
- 50% are lobulate
- 16% cavitate
- Pleural tail / Comet tail (99% chance malignant)
Bronchogenic Carcinoma
MC cell type of a Pancoast Tumor
- MC to cause airway obstruction
- Usually central
Squamous Bronchogenic Carcinoma
MC cell type of small peripheral bronchi
- slow growth = large when discovered
Adenocarcinoma
Metastasizes quickly to regional lymph nodes
- most aggressive & worst prognosis
Small Cell / Oat Cell
Grows the quickest
- periphery
- large size
- pleural effusion & pleural involvement are common
Large Cell Carcinoma
Mass in the lung apex
Pancoast Tumor
superior sulcus tumor
Best view to see Pancoast Tumor
Apical Lordotic View
What are the MC cell types for Pancoast Tumor
MC = Squamous cell
2nd MC = Adenocarcinoma
MC spread of Metastatic Lung Disease
- single/multiple well defined nodules
Blood (MC) — Hematogenous
Spread of Metastatic Lung Disease
- Reticular nodular interstitial pattern, very small nodules
Lymphatic
A chronic irreversible dilation of the airspaces distal to the terminal bronchiole with associated destruction of their walls
Emphysema
Radiographic findings of Emphysema
- Sagittal dimension of chest increased
- Low flat diaphragm
- Pseudoblunting of costophrenic angles
- Heart: small, vertical, elongated
- Retrosternal clear space > 4.5cm
- Horizontal anterior ribs & increased intercostal spaces
- Hyperlucent lungs
- Loss of vascular markings in periphery
MC fungal disease in USA
- Mississippi & Ohio valleys, Appalachian Mts
- bird & bat excremate in dirt
- pulmonary changes similar to TB
Histoplasmosis (h.capsulatum)
Saprophytic fungus that abides in dirt, but is often airborne
- Endemic SW USA (desert)
- San Juanquin Valley fever
Coccidiomycosis (c.immitis)
Collection of air within the visceral pleura
Dissection of air from the lung into the interstitium, then along septal lines and into the pleura
Bleb
- Chronic bronchitis, smoking
- Due to recurrent inflammation, scarring & fibrosing
- Bronchovasicular structures/markings have irregular/accentuated contour
Dirty Chest
A group of more than 200 disorders characterized by inflammation of the pulmonary interstitium & related structures
- Only about 15% have identifiable cause, most of which are due to environmental exposure to certain agents
Interstitial Lung Disease
- Increased risk of mesothelioma (mc pleural based tumor)
- XRay: interstitial pattern, linear opacities start in lung base & move to apex, pleural effusion
- MC cause of plaques & calcification
- Starts over the domes of the diaphragm
- MC cause of pulmonary fibrosis
Asbestosis
fibrogenic pneumoconiosis
Fibrogenic Pneumoconiosis
- Rock drilling, mining, foundries, etc
- XRay: Silicon Nodules, Egg-Shell calcification of Lymph Nodes
Silicosis
Fibrogenic Pneumoconiosis:
- Caplan’s Syndrome: pneumoconiosis & RA
Coal Workers
Which conditions are non-fibrogenic pneumoconiosis?
Siderosis
Baritosis
Stannosis
Iron oxide, welders
Siderosis
Due to inhaled organic dusts
Extrinsic Allergic Alveolitis
Moldy sugar cane
Bagassosis
Bird excreta (pigeon)
Bird Fanciers Lung
Moldy hay
Farmers Lung
Redwood dust
Sequoiosis
Cotton Dust
Byssinosis
MC Primary tumor of pleura
Pleural Mesothelioma
3 reasons for enlarged heart:
- Cardiomegaly
- Pericardial Effusion
- Extra-cardiac causes that mimic
MC benign tumor of the heart
Myxoma
75% in left atrium
4 Key Radiographic signs:
- Thickening of interlobular septa (Kerley B Lines)
- Peribronchial Cuffing
- Fluid in the fissures
- Pleural Effusion
Pulmonary Interstitial Edema
3 Key radiographic signs:
- Fluffy, indistinct, patchy airspace densities
- Bat wing/butterfly wing appearance ***
- Pleural effusion
Pulmonary Alveolar Edema
These key signs indicate what:
- Kerley’s Lines
- Fluid in Fissure
- Peribronchial Cuffing
- Pleural Effusion
- “Viking Horn Sign” (cephalization of blood flow)
Pulmonary Edema asso w/ CHF
Thoracic aorta in aging patient
- Loss of elasticity: slight elongation & dilation
- Ascending arch more convex at upper right heart border
- Transverse arch bc prominent
Thoracic Aortic Aneurysm is MC
descending
Congenital syndrome due to cilia dyskinesia
- Situs inversus: all organs transposed
Kartagener Syndrome
