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1

2 types of lipomatous lesion involving a joint

  • intra-articular lipoma (very rare)
  • lipoma arborescens (more common)

2

Types of ovarian tumor

  • surface epithelial-stromal tumor / epithelial carcinoma
    • serous
    • endometroid
    • mucinous
    • Brenner tumor - transitional-type epithelial cells with longitudinal nuclear grooves (coffee bean nuclei) lying in abundant fibrous stroma
    • transitional cell carcinoma
  • sex cord-stromal tumor
    • granulosa
    • sertoli-leydig cell
  • germ cell tumor
    • teratoma
    • dysgerminoma - LDH
    • endodermal sinus tumor - AFP
    • choriocarcinoma - beta-hCG
  • mixed tumors

3

Neurogenic tumors

Arising from: 

  • peripheral nerves or nerve sheath
    • neurofibroma
    • neurilemmoma
  • sympathetic ganglia
    • ganglioneuroma
    • neuroblastoma
  • paraganglial cells
    • pheochromocytoma
    • chemodectoma

4

Most common cause of a posterior mediastinal mass in patients with neurofibromatosis?

Anterior and lateral thoracic meningocele

5

How do you tell bronchiectatic airways from cystic lung disease on CXR?

  • bronchiectatic airways - can contain air fluid levels
  • cystic lung disease - should not contain air fluid levels unless there is secondary infection

6


Saying:

"hazinessness along the walls of vessels and ill-definition of the bronchi".

"hazinessness along the walls of vessels and ill-definition of the bronchi".

7


Difference in location of NSIP and UIP

  • UIP is strictly peripheral/subpleural
  • NSIP can be central

8


When the aorta is tortuous...

It can pull the left lung and pleura to the right along with it

9


PJP

 


Usually just GGO

NO discrete nodules

10

What should you see at the level of superior hila

i.e., at the level of carnia?

Right: apical segment bronchus

Left: apicoposterior segment bronchus

11

Superior segment bronchus in lower lobes take off at which level?

Bronchi of the superior segments of the lower lobes

take off at the same level as the 

RML and lingular bronchus take off/bifurcation

12

Phlegmasia cerulea dolens

= painful blue edema

Uncommon severe form of DVT

Phlegmasia alba dolens

= painful white edema

 

13

Phthisis bulbi

14

Bronchial abnormality detected on CT

15

Bronchogenic tumors

16

Difference b/t hilar lymphadenopathy caused by

lymphoma/TB vs sarcoidosis?

  • lymphoma/TB - often asymmetric LAD
  • sarcoidosis - often symmetric LAD

17

Types of mediastinitis

  • Acute mediastinitis
    • related to esophageal perforation or spread of infection
    • patient +++ sick
  • Granulomatous mediastinitis
    • TB, fungal (histo/cocci), sarcoid
    • often asymmetric LAD (except sarcoid - symmetric LAD)
    • calcification and fibrosis common
  • Sclerosing/fibrosing mediastinitis
    • similar process as retroperitoneal LAD
    • calcification does NOT occur*

18

Thyroid tumor

  • Although the primary site of carcinoma within the thyroid may be iodine avid, pulmonary metastases may not be secondary to tumor dedifferentiation.
  • US characteristics include hypoechogenicity (solid), internal vascularity, presence of microcalcifications, and a nodule that is taller than it is wide. 
  • Microcalcifications, also known as psammoma bodies, are round, laminar, crystalline calcific deposits of 10–100 um. They are one of the most specific features of thyroid malignancy, with a specificity of 85–95%, and are most common in the papillary variant.

19

Sayings:

"Extensive mediastinal adenopathy as described.  In addition there are multiple tiny indeterminate pulmonary nodules. 

This in combination with the abdominal findings would render a neoplastic process the diagnosis of exclusion-metastatic disease from an occult primary, or lymphoma. 

Given the enhancement of the lymph nodes, plasma cell subtype type of Castleman's disease would be a lesser consideration. "

"Extensive mediastinal adenopathy as described.  In addition there are multiple tiny indeterminate pulmonary nodules.

This in combination with the abdominal findings would render a neoplastic process the diagnosis of exclusion-metastatic disease from an occult primary, or lymphoma.

Given the enhancement of the lymph nodes, plasma cell subtype type of Castleman's disease would be a lesser consideration. "

20

Sayings:

"DDx would include..., and less likely, ..."

"Consider..., if clinically relevant."

"DDx would include..., and less likely, ..."

"Consider..., if clinically relevant."

21

Most common location of tracheal bronchus

i.e., "pig bronchus"

RUL

usually the apical segment of the RUL

associated with recurrent infections

22

Bronchial atresia

  • LUL most common location*
  • local narrowing or obliteration of a lobar/segmental/subsegmental bronchus
  • mucus plugging in bronchi distal to the obstruction - tubular, branching, or ovoid mucus plug - "finger in glove"
  • air trapping in the lobe b/c collateral air flow - hyperlucent or hypovascular

23

DDx for "finger in glove" appearance

  • ABPA
  • congenital bronchial atresia

24

Most common location for pulmonary sequestration?

Posteromedially on the left

25

Pulmonary AVM is associated with which syndrome?

Osler-Weber-Rendu syndome

aka

Hereditary hemorrhagic telangiectasia

26

"2 faces" of AVM

  • a single dilated vascular sac - smooth, sharply defined, round or oval nodule (most common)
  • a tangle of dilated tortuous vessels - lobulated or serpiginous mass
  • most common location of pulmonary AVM - immediately subpleural
  • with contrast - rapid and dense opacification --> rapid washout

27

Intralobular vs Extralobular 

pulmonary sequestration

  • Intralobar - infection - adults
  • Extralobar - infants and children

28

4 features of hypogenetic lung syndrome

scimitar syndrome

  1. hypoplasia of the right lung/lobe/segment
  2. hypoplasia of the right pulmonary artery
  3. PAPVR draining the RUL or entire right lung to the IVC or RA
  4. *systemic arterial supply to a portion of the hypoplastic right lung (often the lower lobe)*

29

4 features of rounded atelectasis

  1. ipsilateral pleural disease - thickening or effusion
  2. volume loss - atelectasis
  3. comet tail sign - swirling of bronchovascular structures
  4. *extensive contact with the pleural surface*

30