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Imaging chest and abd > Final > Flashcards

Final Flashcards

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1
Q

What condition causes incomplete lung inflation?

A

Atelectasis

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2
Q

Which type of atelectasis is resorptive and due to airway obstruction?

A

Obstructive- tumor

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3
Q

Which type of atelectasis is intrapulmonary?

A

Compressive- mass (bulla)

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4
Q

Which type of atelectasis is extrapulmonary?

A

Passive- pleural mass- pneumothorax

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5
Q

What is bronchietasis?

A

Chronic, irreversible dilation of bronchi

Thickened walls, altered Lu volume

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6
Q

What is a well defined radiodense mass with a thin wall?

A

Bronchogenic cyst- appears cystic if it communicated with airway following infection

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7
Q

What is a chronic dilation of the air space distal to the bronchi (secondary lobule) with acinar wall destruction that leads to aggregate air spaces?

A

Emphysema

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8
Q

What are commonly seen on imaging in a patient with emphysema?

A
  • Bilaterally flat with increased hemidiaphragm
  • Lu over inflation
  • increased radiolucency
  • increased retrosternal space
  • accentuated kyphosis
  • increased intercostal spaces
  • prominent hilar vasculature
  • narrow heart shadow
  • bullae
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9
Q

What is acquired valvular heart disease secondary to?

A

Arteriosclerosis
HTN
Rheumatic fever (MC in developing countries)

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10
Q

Acquired valvular heart disease on radiograph would show?

A

Changes in heart shadow shape or size

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11
Q

Aortic aneurysm has what type of dilation?

A

Saccular or fusiform dilation of vessel

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12
Q

What are some causes of aortic aneurysm?

A

Atherosclerosis (MC), HTN, smoking, syphilis, mycoses, trauma, congenital

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13
Q

Aortic aneurysm imaging findings include:

A
  • Mass following contour of vessel
  • mediastinal widening
  • displacement of calcified wall plaques
  • US, CT, MRI, angiography provide further evaluation
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14
Q

What size of aortic aneurysm is usually a symptomatic and rarely ruptures?

A

< 5cm

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15
Q

Where are the locations for thoracic aortic aneurysm?

A

Ascending 25%
Aortic arch 25%
Descending 50%

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16
Q

When excess pulmonary fluid distends the interstitial markings of the lung fields its called?

A

Kerley’s lines- typically transient but may become chronic following fibrosis

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17
Q

Which kerley’s lines are straight, long and in upper lung parenchyma, btw hilum and pleura?

A

A lines

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18
Q

Which Kerley’s lines are straight, short in lower lung periphery perpendicular to the pleural space?

A

B lines

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19
Q

Which Kerley’s lines are a fine network of interlacing, linear lines occasionally seen in the central interstitial areas of the lung?

A

C lines

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20
Q

With CHF, left-sided failure congests what?

A

Pulmonary tissues

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21
Q

With CHF, right-sided failure congests what?

A

Body tissues, sparing pulmonary tissues

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22
Q

What are s/s of CHF?

A

Engorged neck veins, pitting edema, SOB, chronic and non-productive cough

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23
Q

CHF radiograph findings

A
  • Enlarged heart- left ventricular and atrial enlargement
  • Kerley’s lines
  • pleural effusion
  • pulmonary edema (batwing or butterfly)
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24
Q

How do you determine if heart is enlarged on radiograph?

A

Cardiothoracic ratio is larger than 50% on PA chest

Transverse cardiac diameter divided by transverse chest diameter

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25
Where do you measure the transverse chest diameter?
Widest portion, above the Costophrenic angles to the inner rib margins
26
Free pleural diffusion vs loculated?
Free- gravity dependent | Loculated- secondary to fibrosis
27
What condition causes free or loculated collections of transudate, exudate or blood or chyle in pleural space?
Pleural effusion
28
What is fluid accumulation in the extravascular space of the lungs?
Pulmonary edema
29
Pulmonary edema has both interstitial and air space patterns, which is early and which is late?
Interstitial- early | Air space- late
30
What are 2 causes of pulmonary edema?
Left-sided heart disease- common | Renal failure- excess fluid
31
Radiograph findings for interstitial pulmonary edema? (Early)
Septal lines- radiodense, Kerley's Hilar haze- loss of vessel definition Peribronchovascular haze- loss of bronchi definition Subpleural edema- fluid under visceral pleura
32
Alveolar/ air space pulmonary edema radiograph finding
Butterfly, sunburst, batwing or fan shaped radiodense lines radiating from the hilum Air-bronchogram sign
33
Progression of pulmonary edema from CHF
Normal -> enlarged heart -> interstitial pattern -> alveolar pattern
34
Where do pulmonary thromboembolism arise from?
Venous circulation and bone marrow Most from deep veins of lower extremities Most emboli resolve- 15% show infarct, usually lower lobes
35
What factors increase embolism risk?
Surgery Obesity and HTN Prolonged standing and bed rest
36
What percent of pulmonary thromboembolism show lung changes?
10-15% 80% go unrecognized
37
Radiograph findings for pulmonary thromboembolism?
Large pulmonary arteries Oligemia distal to embolism- pleural based radiodensity due to infarct Radiodensity resolves
38
What is bronco-pneumonia?
Acute inflammation of lungs and bronchioles
39
What are symptoms of bronchi-pneumonia?
Fever, chills, cough with purulent, bloody sputum, severe chest pain
40
What can bronchi-pneumonia lead to?
Pleural effusion, empyema lung abscess, respiratory failure, CHF
41
What is lobar pneumonia?
Infection in 1 or more of the 5 lobes, causes consolidation
42
What are symptoms of lobar pneumonia?
Fever, chills, cough, RUSTY sputum, cyanosis, nausea, vomit, pleurisy
43
What causes inflammation of lungs and bronchi from inhaling a foreign object?
Aspiration pneumonia
44
What is the most common bacterial community acquired agent?
Streptococcus pneumoniae- common nosocomial pneumonia | Usually lobar
45
Who are predisposed to primary TB infection?
Alcoholics, diabetics and patients on corticosteroids
46
Which TB typically has no radiographic findings?
Primary- typically resolves completely
47
Which condition causes lymphadenopathy with or without parenchymal consolidation in central lung?
primary TB
48
What is ranke complex?
Hilar and parenchymal ghon tubercles
49
Which TB has upper lobe distribution with parenchymal involvement causing incomplete consolidation with strand-like radiodensities and cavitations?
Secondary TB
50
Which TB is more likely to have superinfections by fungus?
Secondary
51
Describe acute histoplasmosis fungus infection
Acute can be symptomatic or asymptomatic, usually benign and self-limiting
52
Chronic histoplasmosis infection is usually only seen in patients with?
Underlying lung infection
53
How is histoplasmosis diagnosed?
Antigen testing, serology, fungal cultures
54
Histoplasmosis radiograph findings?
Lymphadenopathy (like TB) Solitary pulmonary nodule Histoplasmoma
55
What is a central, bull's eye calcification in a pulmonary nodule?
Histoplasmoma
56
Multiple, scattered discrete calcific densities are seen with?
Miliary histoplasmosis- same appearance as miliary TB
57
Bronchogenic carcinoma is carcinoma of the lung _______ not lung _______
Airways; parenchyma
58
What is the leading cause of cancer related deaths among both men and women?
Bronchogenic carcinoma
59
What are the 4 types of bronchogenic lung cancer?
Squamous cell (epidermoid) Small (oat) cell Adenocarcinoma Large cell
60
A hilar mass is most common in which cancer?
Squamous cell
61
Mass that is 4cm or less is most likely in which cancer?
Adenocarcinoma
62
Mass more than 4cm most likely?
Large cell but could be squamous or adenocarcinoma
63
Bronchogenic carcinoma clinical findings
80% btw 40-70 25% without sx at recognition Wheezing, cough, hemoptysis
64
Malignancy more likely
Age Size Rarely calcify
65
What rules out malignancy?
Benign pattern of calcium
66
60% of lung cancer lesions are?
Central, near the hilum Present as hilar enlargement or secondary findings Poor prognosis
67
What are secondary findings of central lung cancer lesions?
Atelectasis | S sign of golden
68
40% of lung cancer lesions are?
Peripheral, lateral to hilum Appear as non-calcified nodule or mass Better prognosis
69
Nodule vs mass
Nodule <3cm | Mass >3cm
70
What is Pancoast tumor aka?
Superior sulcus tumor
71
Where is a Pancoast tumor?
Bronchogenic tumor in the lung apex
72
What does a Pancoast tumor present with?
Apical radiodensity Horner's sx TOS Rib or vertebral destruction
73
Malignancies of lymphocytes and histiocytes are known as?
Lymphomas
74
Intrathoracic and mediastinal involvement more common with which lymphoma?
Hodgkin's disease but non-hodgkins also
75
Which lymphoma has Reed sternberg cells?
Hodgkins
76
Hodgkin's age distribution?
15-34 and over 45
77
Non-hodgkins age distribution?
30-70
78
Lymphoma sx
Indolent and rapidly progessing | Painless lymphadenopathy, fever, night sweats, unexplained weight loss
79
How does lymphoma spread?
From nodes to Lu tissue via lymphatics
80
Lymphoma parenchymal involvement is usually?
Nodular
81
What is most common metastasis?
Blood-borne
82
What are common locations of metastatic disease?
Lung, liver, bone marrow
83
Multiple, bilateral, well-defined peripheral nodules 1-5 mm seen with?
Metastatic lung disease
84
What is malignancy related to asbestos exposure, directly related to duration and intensity?
Pleural mesothelioma- much less common
85
Anterior mediastinal mass DDx?
Teratoma Thymoma, thymic hyperplasia Thyroid lesions Terrible lymphoma
86
What is a collection of air in the pleural space?
Pneumothorax
87
Which pneumothorax is common in young adults, bleb rupture?
Spontaneous
88
Allergic lung disease aka
Extrinsic allergic alveolitis Hypersensitivity pneumonitis Inhalation of organic dusts
89
What does extrinsic allergic alveolitis cause?
Granulomatous and interstitial lung disease
90
Pulmonary disease caused by inhalation of inorganic dust is called?
Pneumoconiosis- Non-fibrogenic (benign) Fibrogenic
91
Non-fibrogenic pneumoconiosis types
Siderosis (iron) | Silicosis (silicon)
92
Fibrogenic pneumoconiosis types
Coal workers | Asbestosis
93
What causes reticulonodular egg shell calcifications of lymph nodes?
Silicosis
94
Chest wall lesion DDx
``` Abscess- painful Hematoma- history of trauma Pleural fluid- free or loculated transudate Rib fix- offset of rib vortices Rib tumor- expansive Body wall neoplasms ```
95
Enlarged hilum caused by bronchogenic carcinoma?
Unilateral
96
Enlarged hilum caused by mets?
Unilateral or bilateral
97
Enlarged hilum caused by granulomas?
Small, often calcified
98
Enlarged hilum caused by lymphoma?
Usually mediastinal involvement
99
Intrathoracic calcifications
Pulmonary- mostly granulomas Cardiovascular- valve or artery, rare Hamartoma, teratoma Pneumoconioses
100
MRI is good for?
Vascular definition
101
Linear tomography?
Removes obstruction of overlying structures
102
Most useful special imaging?
CT- complex anatomy

Imaging chest and abd (1 decks)

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