Pleura, chest wall, diaphragm and miscellaneous chest disorders Flashcards
(236 cards)
1
Q
Parietal and visceral pleura meet at the
A
Hila
2
Q
Thin double layered fold at the medial lung base inferior to the inferior pulmonary veins termed the
A
Pulmonary ligament
3
Q
Normal amount of fluid in the pleural space
A
2-5 ml
4
Q
Formation of pleural fluid follows
A
Starling law and depends upon hydrostatic and oncotic forces in both systemic capillaries of the parietal pleura and pleural space
5
Q
Under normal conditions, pleural fluid is formed by
A
Filtration from systemic capillaries in the parietal pleura and resorbed via parietal pleural lymphatics
6
Q
Most common condition to produce a transudative pleural effusion
A
Congestive heart failure
7
Q
Unilateral effusion is more common on what side
A
Right
8
Q
Chf produce unilateral or bilateral PE?
A
Bilateral
9
Q
3 Parenchymal infections that typically result in empyema formation are
A
Bacterial pneumonia,
septic emboli,
lung abscess
10
Q
2 Most common causes of parapneumonic effusion and empyema
A
Staph aureus and gram neg pneumonias
11
Q
Stage of PPE: visceral pleura inflammation causes increased capillary permeability and pleural fluid accumulation
A
Stage 1 exudative
12
Q
Stage of PPE: develops 2-3 weeks after initial pleural fluid formation and is characterized by ingrowth of fibroblasts over the pleura, which produces pleural fibrosis and entraps lung
A
Stage 3 parapneumonic effusion
13
Q
Stage of PPE: fibrinopurulent pleural fluid collection containing bacteria and neutrophils.fibrin deposition on the visceral and parietal pleura impairs fluid resorption and produces loculations
A
Stage 2
14
Q
Effusion in TB are more common in what group of people?
A
Young adults with pulmonary disease and HIV positive individuals with severe immunodeficiency
15
Q
Pleural fluid composition in TB
A
Straw colored, greater than 70% lymphocytes and a low glucose concentration
16
Q
Mechanism of effusion in CHF, parapneumonic efffusion, permeability pulmonary edema, lung transplantation
A
Increased interstitial fluid production
17
Q
Type of effusion in CHF, PPE, permeability pulmonary edema and lung transplantation
A
Transudate
18
Q
Mechanism of effusion in LV or RV failure, SVC syndrome, pericardial tamponade
A
Increased hydrostatic pressure
19
Q
Type of effusion in LV or RV failure, SVC syndrome, pericardial tamponade
A
Transudate
20
Q
Increased capillary permeability produces what type of effusion
A
Exudative
21
Q
Mechanism and type of effusion in low protein states
A
Decreased capillary oncotic pressure, transudative
22
Q
Mechanism and type of effusion in malignancy
A
Impaired fluid resorption, exudative
23
Q
Elevated systemic venous pressure produces what type of effusion
A
Transudative
24
Q
On CT, it is elliptic in shape and is seen most often within the posterior (costal pleura) and inferior (subpulmonic) pleural space
A
Empyema
25
Treatment of empyema
External drainage
26
Treatment for lung abscess
Postural drainage and antibiotics
27
Effusions that have intrinsic high attenuation or the presence of a fluid-fluid level caused by dependent cellular blood elements represents
Hemorrhagic effusions
28
Cardiogenic, hypoproteinemic, myxedematous, cirrhotic and nephrotic syndrome produce what type of effusion
Transudative
29
Infecfion, infarction, neoplasm and inflammation produce what type of effusion
Exudative
30
6 Tumors most commonly associated with PE (in order)
Lung carcinoma > breast carcinoma > pelvic tumor > gastric cancer > lymphoma
31
Shape of empyema as compared with lung abscess
Empyema- oval; lung abscess- round
32
Margin of empyema as compared to lung abscess
Empyema- thin, smooth (split pleura sign); lung abscess- thick and irregular
33
Angle with chest wall of empyema as compared to lung abscess
Empyema- obtuse; lung abscess- acute
34
Effect on lung of empyema as compared to lung abscess
Empyema- compression; lung abscess- consumption
35
Hemothorax produce CT attenuation more than
80 HU
36
Acute hemothorax is treated by
Thoracostomy tube
37
Treatment of hemothorax with persistent bleeding or hypotension
Thoracotomy
38
Esophageal perforatjon from prolonged vomiting (boerhaave syndrome) or as complication of esophageal dilatation may produce a pleural effusion, most commonly on what side
Left
39
Elevated salivary amylase levels, low pH within the pleural fluid is diagnostic for
Esophageal perforation
40
PE in SLE is of what type, and is usually associated with (7)
Exudative;
```
pleuritic chest pain,
cardiomegaly,
pericardial effusion,
hypertension,
renal failure or
lupus associated endocarditis or
myocarditis
```
41
Most common intrathoracic manifestation of RA and is frequently seen in male patients following the onset of joint disease
Pleural effusion
42
True or false: PE in RA may occur independently from pulmonary parenchymal involvement
True
43
Effusions in RA are what type
Exudative
44
True or false: rheumatoid effusions may persist unchanged for years
True
45
Autoimmune syndromes producing pleural or pericardial effusions have been described following
Myocardial infarction ( dressler syndrome) or cardiac surgery (postpericardiotomy syndrome)
46
Autoimmune syndromes (Dressler and postpericardiotomy syndromes) produce what type of effusion
Serosanguinous exudative
47
peritoneal fluid may enter the pleural space via
transdiaphragmatic lymphatic channels or through defects in the diaphragm
48
transdiaphragmatic channels are larger on what side
right
49
effusions caused by acute or chronic pancreatitis are most often on what side
left; because of the proximity of the pancreatic tail to the left hemidiaphragm
50
type of effusion associated with pancreatitis
exudative and may be bloody
51
high concentration of amylase in pleural fluid should suggest what etiology of effusion
pancreatitis, malignancy or esophageal perforation
52
subphrenic abscess, along with diaphragmatic paresis, basilar atelectasis and pleural effusion may be secondary to
complicated abdominal surgery or perforation of hollow viscus
53
pelvic and abdominal tumors that may produce PE
- ovarian fibroma (Meigs syndrome),
- pancreatic,
- lymphoma,
- uterine leiomyomas
54
type of effusion in Meigs syndrome
transudative; resolves after removal of pelvic tumor
55
pleural collection containing triglycerides in the form of chylomicrons
chylothorax
56
chylothorax happens due to
rupture of thoracic duct contents secondary to malignancy, iatrogenic trauma or TB
57
thoracic duct originates from
cisterna chyli at the level of the first lumbar vertebra and ascends along the right paravertebral space, entering the thorax via the aortic hiatus
58
thoracic duct inserts at what hiatus
aortic hiatus
59
the thoracic duct ascends and crosses from right to left at the level of
T6 alongside the upper esophagus
60
disruption of the upper thoracic duct caused by direct trauma or obstruction produces effusion on what side
left
61
lower intrathoracic duct rupture produces effusion at what side
right
62
triglyceride levels exceeding 110mg/dL in pleural fluid represents
chylothorax
63
effusion in pulmonary embolism may be associated with elevation of the ipsilateral diaphragm and peripheral wedge-shaped opacities called
Hamptom hump
64
PE characteristics from pulmonary embolism
typically small, unilateral, serosanguineous exudate
65
drugs that may cause PE
```
Pleural inflammation
•Methysergide
Lupus-like syndrome (HIPP)
•Phenytoin
•Isoniazid
•Hydralazine
•Procainamide
Nitrofurantoin – a pleuropulmonary disease with eosinophilia
```
66
characteristics of PE that has a moderate to high risk for poor outcome
large, loculated collections with positive gram stains or cultures and pH <7.20
67
treatment options for parapneumonic effusions
- intrapleural fibrinolytic therapy using tPA with concomitant DNAse,
- video-assisted thoracoscopic surgery or thoracotomy with decortication
68
malignant PE most often require what treatment
closed drainage and pleural sclerosis with talc
69
True or false: talc pleurodesis can cause FDG-PET positive nodularity that is a source of false-negative PET evaluations
true
70
postcardiac injury patients (Dressler syndrome) that developed effusion are treated by
NSAIDs
71
communication between the lung and the pleural space that often originates from a peripheral airway
bronchopleural fistula
72
often develops from dehiscence of a bronchial stump following lobectomy or pneumonectomy, or as a result of a necrotizing pulmonary infection
bronchopleural fistulas
73
etiology of primary spontaneous pneumothorax
no identifiable etiology
74
presents as crescentic nondependent lucency that parallels the chest wall and displaces the visceral pleural line centrally
pneumothorax
75
signs of pneumothorax on supine radiography include
```
Non-dependently and indiscernible increased lucency over the lower thorax and upper abdomen
Hyper lucent upper abdomen
Deep sulcus sign
Double diaphragm sign
Epicardial fat pad sign
Unusually sharp heart border
```
oUpright radiography
Non-dependent lucency that parallel the chest wall and displaces the visceral pleural line medially
76
most common cause of pneumothorax
trauma
77
2 mechanisms of pneumothorax formation from blunt chest trauma
acute increase in intrathoracic pressure results in extra alveolar interstitial air because of alveolar disruption, which tracks peripherally and ruptures into the pleural space;
laceration of the tracheobronchial tree
78
primary spontaneous pneumothorax most often occurs in
young or middle aged men, propensity for tall, thin individuals
79
treatment for primary spontaneous pneumothorax
closed tube drainage, thoracoscopic bullectomy
80
most common etiology for secondary spontaneous pneumothorax
COPD
81
most common malignancies to produce pneumothorax
sarcomas
osteogenic sarcoma, lymphoma, germ cell malignancies
82
most common connective tissue disease producing pneumothorax
marfan syndrome; usually from rupture of apical bullae
83
rare type of recurrent pneumothorax that occurs with menstruation
catamenial pneumothorax
84
age of patients affected by catamenial pneumothorax
fourth decade
85
cause of catamenial pneumothorax
cyclical necrosis of pleural endometrial implants which creates an air leak between the lung and pleura
86
side of predilection of pneumothorax in catamenial pneumothorax
right
87
true or false: catamenial pneumothorax resolves spontaneously
true
88
catamenial pneumothorax is managed by
inducing amenorrhea
89
critical condition that most often results from iatrogenic trauma in mechanically ventilated patients
tension pneumothorax
90
tension pneumothorax results from
check-valve pleural defect that allows air to enter but not exit the pleural space
91
4 clinical presentation of tension pneumothorax
tachypnea,
tachycardia,
cyanosis,
hypotension
92
true or false: contralateral mediastinal shift from pneumothorax does not invariably indicate tension, since an imbalance in the degree of negative intrapleural pressure can produce shift in the absence of tension. therefore, tension pneumothorax remains a clinical diagnosis
true
93
it is the end result of peripheral parenchymal and pleural inflammatory disease with pneumonia as the most common cause
localized pleural thickening
94
common cause of pleural calcifications
prior hemothorax or empyema (TB), pleural fibrosis
95
pleural calcifcation is most often unilateral and involves the
visceral pleura
96
bilateral calcified parietal pleural plaques are often due to
asbestos exposure
97
the presence of fluid within calcified pleural layers seen on CT suggests an active empyema and is most often seen in patients with
prior TB infection
98
true or false: focal pleural masses are usually benign neoplasms such as lipomas
true
99
fat attenuation of what HU is diagnostic for thoracic lipomas
-60 to -100 HU
100
an uncommon cause of pleural tumor that appears as well-defined, spherical or oblong masses that arise from subpleural mesenchymal cells and are benign in approximately 80% of cases
localized fibrous tumors of pleura
101
these tumors are occasionally attached to the pleura by a narrow pedicle, a finding that is virtually pathognomonic and accounts for changes in intrapleural location occasionally seen with changes in patient positioning
sharply defined soft tissue mass with tapered obtuse margins
localized fibrous tumors of pleura
102
associated conditions with localized fibrous tumors of pleura
hypertrophic pulmonary osteoarthropathy and hypoglycemia
103
pleural thickening extending over more than 1/4 of the costal pleural surface
fibrothorax (diffuse pleural fibrosis)
104
most commonly results from resolution of an exudative PE (including asbestos-related effusions), empyema or hemothorax
fibrothorax
105
if fibrothorax causes a restrictive ventilatory defect, what is the treatment to restore function to the underlying lung
pleurectomy (decortication)
106
irregular or nodular pleural thickening, usually in association with a pleural effusion, may represent a benign or malignant process?
malignant
107
5 malignant tumors with propensity to metastasize to the pleura include
adenocarcinomas of the lung, breast, ovary, kidney and GI tract
KBLOG
108
malignant mesothelioma is almost exclusively seen in
asbestos exposed individuals
109
malignant pleural disease is most often caused by one of four conditions, namely
metastatic adenocarcinoma,
invasive thymoma or thymic carcinoma,
mesothelioma and
rarely lymphoma
110
when pleural thickening is circumferential and nodular, greater than 1 cm in thickness, and/or involves the mediastinal pleura, the disease is likely benign or malignant
malignant pleural disease
111
most common benign manifestation of asbestos inhalation
pleural plaques
112
how many year from asbestos exposure before plaques develop
20-30 years
113
asbestos plaques are found on
parietal pleura, most commonly over the diaphragm and lower posterolateral chest wall
114
when viewed en face, calcified plaques from asbestos exposure may appear as geographic areas of opacity that have been likened to a
holly leaf
115
plaques from asbestosis if unilateral, is usually on what side
left
116
earliest manifestation of asbestosis and occurs 10 to 20 years after the initial exposure
pleural effusion
117
may follow asbestos-related pleural effusion or result from the confluence of pleural plaques
diffuse pleural thickening
118
appears as smooth thickening of the pleura, involving the lower thorax, with blunting of the costophrenic sulci
diffuse pleural thickening
119
dose-related phenomenon in asbestos exposure
Pleural effusion
120
true or false: malignant mesothelioma does not appear to be a dose-related phenomenon
true
121
fiber type of asbestos that is often implicated in the development of malignant mesothelioma
crocidolite
122
3 pathologic types of mesothelioma
epithelial, sarcomatous and mixed types
123
most common pathologic form of mesothelioma and is associated with better prognosis
epithelial
124
true or false, in mesothelioma, adenopathy is seen in ipsilateral hilum and mediastinum in apprixmately 50% of patients
true
125
an autosomal recessive disorder characterized by unilateral absence of sternocostal head of the pectoralis major, ipsilateral syndactyly and rib anomalies
Poland syndrome
126
2 most common organisms responsible for chest wall abscesses
staphylococcus and TB
127
lipomas may be intrathoracic or extrathoracic, or they may project partially within and outisde the thorax, called
dumbell lipoma
128
most common primary malignant soft tissue neoplasms of the chest wall in adults
fibrosarcomas and liposarcomas
129
rare malignant neoplasm arising from the chest wall of children and young adults is _____, which arises from primitive neuroectodermal rests in the chest wall
askin tumor
130
most common congenital anomalies of ribs are
bony fusion and bifid ribs
131
extremely rare congenital anomalies where an accessory rib arises from a vertebral body or the posterior surface of a rib and extends inferolaterally into the thorax
intrathoracic ribs
132
intrathoracic ribs are usually on what side
right
133
conditions that are associated with thin, wavy, "ribbon" ribs
osteogenesis imperfecta and neurofibromatosis
134
cervical rib arises usually from
7th cervical vertebral body
135
happens when the cervical rib or associated fibrous bands compress the subclavian artery, producing secondary ischemic symptoms or compress the subclavian vein and brachial plexus, producing pain, weakness, and swelling of the upper extremity and potentially subclavian vein thrombosis (Paget von Schroetter syndrome)
thoracic outlet syndrome
136
treatment for cervical rib causing thoracic outlet syndrome
surgical resection
137
much more common rib area of rib notching due to enlargement of one or more of the structures that lie in the subcostal grooves (intercostal nerve, artery or vein)
inferior rib notching
138
most common cause of bilateral inferior rib notching is
coarctation of the aorta distal to the origin of the left subclavian artery
139
2 other causes of aortic obstruction that can lead to inferior rib notching aside from coarctation of the aorta
aortic thrombosis and Takayasu arteritis
140
most common type of neurofibromatosis that can be a nonvascular cause of inferior rib notching
multiple intercostal neurofibromas in NF1
141
associated thoracic findings in neurofibromatosis, aside from rib notching
ribbon ribs, thoracic kyphoscoliosis, scalloping of the posterior aspect of vertebral bodies due to dural ectasia
142
most common associated condition with superior rib notching
paralysis
143
possible mechanism involved in superior rib notching
disturbance in osteoclastic and osteoblastic activity and the stress effect of the intercostal muscles
144
what postion or projection best displays the fracture line in the posterolateral ribs
posterior oblique radiographs
145
fracture of these ribs indicate severe trauma and should prompt a careful evaluation for associated great vessel and visceral injury
first 3 ribs; because they are well protected by the clavicles, scapulae, shoulder girdles
146
rib fractures at these levels may be associated with injury to the liver or spleen
10th, 11th or 12th ribs
147
sever blunt trauma to the rib cage, in which multiple contiguous ribs are fractured in more than one place is termed
flail chest
148
results in a free segment of the chest wall that moves paradoxically inward on inspiration and outward on expiration
flail chest
149
multiple contiguous healed rib fractures, particularly if bilateral, should suggest
chronic alcoholism or a prior MVA
150
bilateral symmetric anterolateral fractures should suggest injury from
chest compression during CPR
151
most common site of involvement by monostotic fibrous dysplasia
ribs
152
typical appearance is an expansile lesion in the posterior aspect of the rib with a lucent or ground glass density; rarely the lesion is sclerotic
monostotic fibrous dysplasia
153
polyostotic fibrous dysplasia can result in
severe restrictive pulmonary disease
154
langerhans cell histiocytosis can cause rib lytic lesions at what age group
under age 30
155
brown tumors from hyperparathyroidism can also produce what type of rib lesions
lytic
156
most common benign neoplasm of ribs
osteochondromas
157
2 other common causes of benign rib neoplasms aside from osteochondromas
enchondromas and osteoblastomas
158
most common primary rib malignancy
chondrosarcoma
159
myeloma can produce solitary or multiple lytic lesions, and can also cause permeative bone destruction that is indistinguishable from severe osteoporosis. This associated finding is a clue to its diagnosis
presence of soft tissue mass
160
most common metastatic lesions to ribs are from
lung and breast cancer
161
expansile lytic rib metastases are seen most commonly from (2)
renal cell and thyroid carcinoma
162
sclerotic rib metastasis are most commonly seen in
breast and prostate carcinoma
163
blastic rib metastasis can be found in
lung cancer and carcinoid tumor
164
4 pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include
TB,
fungus,
actinomycosis and
nocardiosis
TFAN
165
female costal cartilage ossification involves the
central portion of the cartilage, extending from the rib toward the sternum in the shape of a solitary finger
166
male costal cartilage ossification involves the
peripheral portion of the cartilage and has the appearance of two fingers "peace" sign
167
costal cartilage ossification do not apply in what rib
first rib
168
identified when the scapula is superiorly displaced from its normal position and the inferior portion is superiorly displaced from the chest wall
winged scapula
169
this deformity typically results from disruption of innervation by the long thoracic nerve to the serratus anterior muscle that helps maintain scapular contact with the chest wall
winged scapula
170
metastatic disease to the scapula is recognized by the presence of lytic destructive lesions, which are commonly from (2)
lung and breast cancer
171
commonly fracture segment of the clavicle in blunt trauma
distal third
172
2 conditions that can produce erosion of the distal clavicles
RA and hyperparathyroidism
173
distal clavicle is sharply defined in what condition, and tapers to a point
RA
174
distal clavicle is often indistinct and irregular in what condition
hyperparathyroidism
175
primary malignant neoplasms of the clavicle
Ewing or osteogenic sarcoma
176
osteomyelitis of the clavicle is uncommon, and is most often seen in
IV drug users
177
chronic anemia from thalassemia major or sickle disease may result in what manifestations in the thoracic cavity
prevertebral or paravertebral masses of extramedullary hematopoiesis, which represent herniated hyperplastic bone marrow
178
produces characteristic appearance of H-shaped or "Lincoln log" vertebrae on lateral radiographs that is pathognomonic of this disease
sickle cell anemia
179
"rugger jersey" appearance to the thoracic spine on lateral chest films suggests
renal osteosclerosis
180
funnel chest
pectus excavatum
181
pigeon breast
pectus carinatum
182
sternum is inwardly depressed and the ribs protrude anterior to the sternum
pectus excavatum
183
chest wall deformity commonly associated with congenital connective tissue disorders such as Marfan syndrome, Poland syndrome, osteogenesis imperfecta and congenital scoliosis
Pectus excavatum
184
some patients with pectus deformities and systolic murmurs have
mitral valve prolapse
185
a chest wall deformity wherein the heart is displaced to the left and the combination of the depressed soft tissues of the anterior chest wall and the vertically oriented anterior ribs results in loss of the right heart border
pectus excavatum
186
outward bowing of the sternum that may be congenital or acquired
pectus carinatum
187
congenital form of pectus carinatum is commonly seen in what gender
boys, in families with a history of chest wall deformities or scoliosis
188
account for the majority of acquired cases of pectus carinatum include
congenital atrial or ventricular septal defects and severe childhood asthma
189
most common sternal abnormality seen
prior median sternotomy
190
true or false, the vertical lucency representing sternotomy may heal, but in many patients bony union does not occur
true
191
results from congenital absence, underdevelopment or atrophy of the diaphragmatic musculature
unilateral diaphragmatic elevation
192
common cause of diaphragmatic paralysis in male patients and is usually at what side
viral neuritis, right
193
positive fluoroscopic or ultrasonographic sniff test is diagnostic for
diaphragmatic paralysis
194
3 possible causes of bilateral phrenic disruption causing bilateral diaphragmatic paralysis
cervical cord injury,
multiple myeloma,
myopathy associated with SLE
195
3 types of nontraumatic diaphragmatic hernias
esophageal hiatal hernia, bochdalek and morgagni
196
most common form of nontraumatic diaphragmatic hernia
esophageal hiatal hernia
197
represents herniation of a portion of the stomach through the esophageal hiatus
hiatal hernia
198
defect in the hemidiaphragm at the site of embryonic pleuroperitoneal canal
bochdalek hernia
199
a defect in the parasternal portion of the diaphragm
morgagni hernia
200
diagnostic finding for morgagni hernia
presence of omental vessels within a fatty paracardiac mass
201
traumatic hernia affects most commonly what side
left
202
resultant narrowing or "waist" of the herniated intestine as it traverses the diaphragmatic defect differentiates a hernia from
simple diaphragmatic elevation
203
most common primary malignant diaphragmatic lesion
fibrosarcomas
204
represent anomalous outpouchings of the primitive foregut that no longer communicate with the tracheobronchial tree
bronchogenic cysts
205
congenital abnromality resulting from the independent development of a portion of the tracheobronchial tree that is isolated from the normal lung and maintains its fetal systemic arterial supply
bronchopulmonary sequestration
206
form of pulmonary sequestration that is contained within the visceral pleura of the normal lung
intralobar sequestration
207
form of pulmonary sequestration that is enclosed by its own visceral pleural envelope and may be found adjacent to the normal lung or within or below the diaphragm
extralobar sequestration
208
more common form of pulmonary sequestration
intralobar
209
most patients with this type of pulmonary sequestration present with pneumonia
intralobar
210
majority of extralobar sequestration are on what side
left
211
majority of intralobar sequestration are on what side
right
212
intralobar sequestration is supplied by
a single large artery that arises from the infradiaphragmatic aorta and enters the sequestered lung via the pulmonary veins, systemic venous drainage can also occur
213
extralobar sequestration is supplied by
several small branches from the systemic and occasionally pulmonary arteries, with venous drainage into the systemic venous system (IVC, azygos or hemiazygos veins)
214
definitive diagnosis is made by the demonstration of abnormal systemic arterial supply to the abnormal lung, which is usually accomplished by CT angiography
sequestration
215
variant of hypoplastic lung, characterized by an underdeveloped right lung with abnormal venous drainage of the lung to the IVC just above or below the right hemidiaphragm or eventration, dextroposition of heart and herniation of left lung anteriorly into the right hemithorax
hypogenetic lung syndrome/scimitar syndrome
216
a disease that is present in approximately 80% of all patients with pulmonary AVMs
Osler-Weber-Rendu disease
217
pulmonary AVMs usually shows a solitary pulmonary nodule, in what part of the lung
subpleural portions of lower lobes
218
pulmonary contusion opacities stabilizes by ___ hours
24 hours
219
improvement in pulmonary contusion happens within how many days
2 to 7 days
220
progressive opacities seen more than 48 hours after trauma should raise the suspicion of
aspiration pneumonia or developing ARDS
221
what property of the lung quickly transforms the linear laceration of the lung into a round air cyst
elastic properties
222
air cysts that result from a check-valve overdistention of the distal lung
pneumatocele
223
massive aspiration of gastric contents
Mendelson syndrome
224
3 basic radiographic patterns of aspiration pneumonitis
extensive bilateral airspace opacification,
diffuse but discrete airspace nodular opacities and
irregular parenchymal opacities that are not obviously airspace filling in nature
225
aspiration pneumonitis are most often unilateral or bilateral and in what lobes
bilateral, predilection for the basal and perihilar regions, usually posterior and segmental
226
radiation induced lung injury are most often seen in 3 clinical situations
treated for unresectable lung cancer,
treatment of mediastinal lymphoma or thymoma,
patients treated for stage I to stage IIIa breast cancer
227
most radiation treatment is limited to ____, as an equivalent dose administered to an entire lung or both lungs would cause serious lung injury
1/3 to 1/2 of the lung
228
doses under ___ Gy rarely produce lung injury
under 20 Gy
229
doses exceeding ___ Gy, particularly if administered to a significant portion of the lungs, have a significant incidence of radiation pneumonitis
30 Gy
230
acute effects of radiation pneumonitis
injury to capillary endothelial and pulmonary epithelial cells that line the alveoli
231
develops 4 to 12 weeks following completion of radiation therapy
diffuse alveolar damage which produces a cellular, proteinaceous intra-alveolar exudate and hyaline membranes that is indistinguishable histologically from ARDS
232
sharply marginated, localized area of airspace opacification that does not conform to lobar or segmental anatomic boundaries and directly corresponds to radiation port represent
radiation pneumonitis
233
radiation pneumonitis produces what type of atelectasis due to loss of surfactant by the damaged type 2 pneumocytes
adhesive atelectasis
234
radiation fibrosis appears as
coarse linear opacities or occasionally as homogeneous parenchymal opacity with severe cicatrizing atelectasis of the involved portion of lung
235
Fibrotic tissue in T2W MR sequence appears
low in signal; distinguishes it from recurrent tumor which has high signal
236
bronchiolar lavage aspirate findings in radiation pneumonitis
increased number of lymphocytes and absence of malignant cells
