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ILD Flashcards

1
Q

DDx for cystic lung disease

A
  • Cystic bronchiectasis
  • Bullae
  • Langerhans cell histiocytosis
  • Lymphangioleiomyomatosis
  • Laryngotracheal papillomatosis
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2
Q

Causes of cystic bronchiectasis

A
  • Pneumonia
  • Chronic bronchitis
  • Asthma (allergic bronchopulmonary aspergillosis)
  • Bronchial atresia
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3
Q

Cystic Bronchiectasis

A
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4
Q

Cystic Bronchiectasis

A
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5
Q

1 French is ?

A

1/3 mm in diameter

1/3 x French in mm

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6
Q

Position of a chest tube

A
  • directed anterosuperiorly to evacuate a pneumothorax
  • directed posteroinferiorly for fluid collections
  • Malpositioned chest tube
    • within the interlobar fissure
    • abut the mediastinum
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7
Q

Types of chest tubes

A
  • Thoracostomy chest tube
  • Pigtail catheter - for empyema drainage
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8
Q

Position of an endotracheal tube

A
  • 5 cm above the tracheal carina
  • when extending the neck, upward excursion of 2cm
  • when flexing the neck, downward excursion of 2cm
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9
Q

Idean position of a esophageal pH probe

A

distal esophagus, just above the gastroesophageal junction

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10
Q

Bronchial stents

A

Used in patietns who have undergone lung transplantation and have developed a stricture at the anastomosis between the native tracheobronchial tree and the transplanted one

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11
Q

Swan-Ganz catheter

A

Pulmonary artery catheter

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12
Q

Which valve?

A

3 finger rule

T-A-M

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13
Q

Epicardial pacing wires

A
  • placed at the time of cardiac surgery for immediate packmaker access, should the need arise
  • simply pulled out through the incision when the patient is ready for discharge
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14
Q

Types of coronary artery stents

A
  • balloon-expandable
  • self-expandable
  • thermally expandable
  • stainless steel
  • nitinol
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15
Q

Types of sternotomy

A
  • median sternotomy - vertical incision
  • calmshell sternotomy - horizontal incision - transplant
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16
Q

Intraaortic balloon pump (IABP)

A
  • 25 cm long inflatable balloon mounted on a catheter
  • intraduced via a femoral artery
  • tip of the catheter is placed just distal to the take off of the left SCA
  • inflated with CO2
  • balloon is inflated during ventricular diastole
    • augment diastolic coronary artery perfusion
    • reduce LV afterload
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17
Q

Maximal thickness of right paratracheal strip

A

4mm

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18
Q

Contents of the AP window

A
  • mediastinal fat
  • left vagus nerve
  • left recurrent laryngeal nerve
  • left bronchial artery
  • ligamentum arteriosum
  • lymph nodes
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19
Q

Where to search for an abrnomality in a patient with vocal cord and left diaphragm paralysis?

A

AP window

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20
Q

Azygoesophageal recess

A
  • Right superior convexity may be seen in children and younger adults but is abnormal in the elderly.
  • Abnormal contour and convexity may be due to
    • lymphadenopathy
    • hiatal hernias
    • bronchopulmonary-foregut malformations
    • esophageal neoplasms
    • pleural abnormalities
    • cardiomegaly with left atrial enlargement
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21
Q

Posterior wall of bronchus intermedius

A
  • projects through the LUL bronchus
  • maximal thickness 3mm
  • bandlike thickening of the posterior wall of BI is often due to pulmonary edema
  • other causes
    • lung carcinoma
    • LAD
    • metastatic disease
    • TB
    • sarcoidosis
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22
Q

Most common pattern of interstitial lung disease (ILD) in patients with rheumatoid arthritis

A

UIP

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23
Q

Reserve Halo / Atoll Sign

A

COP

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24
Q

Most common pattern of interstitial lung disease (ILD) in scleroderma

A

NSIP

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25
Pattern of distal clavicle resoprtion in patients with RA
"penciling" of undersurface
26
How to distinguish UIP from NSIP
* UIP - basal and subpleural predominance; honeycombing * NSIP - basal but NOT subpleural; NO honeycombing; more volume loss and traction bronchiectasis
27
Most common manifestation in chest in patients with SLE and RA?
Pleural effusions pericardial effusion
28
When can you most often see lymphocytic interstitial pneumonia (LIP)?
* Sjogren's syndrome * thin-walled cysts * perivascular cysts - with vessels along the walls of the cysts
29
2012 ATS-ERS Classification of idiopathic interstitial pneumonia (IIP)
* Chronic fibrosing IP * UIP * NSIP * Smoking-related IP * Respiratory bronchiolitis * RB-ILD * Desquamative IP * Acute/subacute IP * Organizing pneumonia/OP * Diffuse alveolar damage/DAD * Rare entity * Lymphoid IP pattern (lymphocytic IP)
30
Most common IIP?
* UIP - 40% * NSIP - 20%
31
DDx of UIP
* Causes unknown - IPF * Causes known - other causes * If inconsistent - biopsy
32
Diagnostic criteria for UIP
* subpleural and basal predominance * reticular abnormality * HONEYCOMBING * with or without traction bronchiectasis * absence of features inconsistent with UIP
33
Diagnostic criteria for NSIP
* better survival than UIP * often associated with collagen vascular disease/HP/drugs * basal predominance * subpleural SPARING - peribronchovascular * confluent pattern * volume loss - inferior displacement of the major fissures * reticular * groundglass opacity * traction bronchiectasis * NO honeycoming
34
Underlying disease in NSIP
* collagen vascular disease * environmental exposures - HP * drugs * smoking
35
Smoking-related lung disease
* Respiratory bronchiolitis - RB * centrilobular nodules * patchy GGO * RB-ILD * reticular marking * GGO * DIP * GGO * cysts within the GGO
36
Organizing pneumonia / OP
* subpleural/peribronchial * patchy consolidation * GGO * peribronchial thickening * reverse halo sign/Atoll sign
37
Causes of Organizing Pneumonia
* Cryptogenic * CVD * drug toxicity * aspiration * infection
38
Approach to micronodular disease
* Distribution * centrilobular * perilymphatic * random
39
Centrilobular nodules
* does not extend to the interlobular septum and pleural surface * further features * solid/discrete - silicosis/CWP, pulmonary LCH, infection, aspiration, metastases * tree-in-bud - linear opacities connecting the nodules - infection (TB, NTMB), viral; aspiration * GGO - centrilobular "opacities" - HSP, bronchiolitis (RB, infection/viral), BAC, OP/NSIP, edema/vasculitis
40
Perilymphatic nodules
* peribronchiovascular, peri-interlobular septal, subpleural, peri-fissural * sarcoidosis * lymphangtic carcinomatosis * rare: silicosis/CWP, lymphocytic IP, amyloidosis
41
Random nodules
* disseminated infection (miliary TB, histoplasmosis) * sarcoidosis * hematogeneous metastatic disease * rare - LCH, silicosis/CWP
42
Sarcoidosis nodules
* perilymphatic (most common) * random
43
Pulmonary fibrosis of sarcoidosis
* upper lobe predominance * traction bronchiectasis - airway distortion
44
Air crescent sign vs Monod sign
Air crescent sign - angioinvasive aspergillosis Monod sign - aspergillosis/mycetoma
45
Causes of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS)
* Pulmonary * aspiration * infection - bacterial, viral, PCP * Extra-pulmonary * systemic sepsis * trauma * hyppertransfusion - TRALI * cardiopulmonary bypass
46
Typical / atypical pattern of ARDS
gradient density from front to back - exptra-pulmonary cause bilateral abnormality vs patchy distribution - pulmonary causes unilateral abnormality
47
Clinical presentation of HSP
* Acute * rapid onset 4-8 hr after exposure * self-limited 24-48 hrs * fever, chills, cough, dyspnea * heavy exposure * Chronic * insidious onset over months to years * chronic progressive * chronic cough and SOB * low grade, chronic exposure
48
Exposures to cause HSP
* Microbes - thermophillic actinomycetes - hottub lung * animals - birds, rodents * plant material - soybeans * chemicals - paints, plastics
49
Acute HSP Subacute HSP Chronic HSP
* Acute HSP - limited CT data * Subacute HSP * patchy GGO * centrilobular GGO nodules * mosaic perfusion/air trapping - headcheese sign * Chronic HSP * fibrosis with/without honeycombing * peripheral and central * SPARING of costophrenic angles * superimposed subacute findings * GGO, centrilobular gg nodules * mosaic air-trapping
50
DDx for headcheese sign and centrilobular ggo nodules
* HSP * RB-ILD, DIP * LIP * atypical infections * edema and asthma
51
Lung cysts
1mm thin wall vs emphysema - no wall vs cavitating mass - thick wall
52
DDx for cystic lung disease L3ABC
* Langerhans cell histiocytosis (late) * Lymphangioleimyomatosis (LAM) * lymphocytic interstitial pneumonia (LIP) * Amyloidosis/light chain deposition disease * Birt Hogg Dube * Cystic metastases
53
All cystic lesions - unifying concept
bronchiolocentric lesion
54
Langerhans Cell Histocytosis
* Young smokers - 90% * centrilobular nodules * central lucency or cavitation with time * apical to base gradient of severity * SPARING costophrenic angles * late - air cysts and air trapping * rare to have adenopathy and pl effusion
55
Lymphangioleiomyomatosis LAM
* sporadic or associated with TS * exclusively in women! * air cysts - no zonal distribution * adenopathy * patchy GGO - pulm hemorrhage * no large nodules * find miliary nodules may be seen * chylous pleural effusion from lymphatic obstruction * pleural effusion
56
Lymphocytic interstitial pneumonia LIP
* associated with Sjogren's disease * poorly defined centrilobular or peribronchial nodules * GG * septal thickening * perivascular cysts/pericystic dot\* * mosaic air trapping
57
Amyloidosis Light chain deposition disease (LCDD)
58
Birt-Hogg-Dube Syndrome
* autosomal dominant disorder * skin - fibrofolliculomas * lungs - lung cysts - basilar and subpleural predominance * kidneys - oncocytomas, RCC, etc
59
Cystic pulmonary metastases
* leimyosarcoma * synovial cell sarcoma * endometrial stromal cell sarcoma * angiosarcoma
60
Min IP Max IP
Max IP - nodules and tree-in-bud Min IP - emphysema
61
Interlobular septal thickening
* venous * smooth * pulmonary edema * lymphatic * nodular * lymphangitic carcinomatosis * sarcoidosis, UIP...
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Chest (13 decks)

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