Resp - ILD Flashcards by Gareth M

Calcified Mediastinal Lymph Nodes
Egg Shell Calcification

Tuberculosis
Histoplasmosis
Amyloidosis (rare)
Metastases: papillary/medullary thyroid cancer, osteosarcoma, mucinous adenocarcinoma

egg-shell calcification**
Silicosis and coal workers pneumoconiosis
Sarcoidosis

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Alpha 1 antitrypsin deficiency

Deficient liver glycoprotein

CT features
CT - panacinar emphysema at bases +/- bronchiectasis
Cirrhosis

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Describe LAM
Lymphangioleiomyomatosis
Patient demographic?
CT findings
Differential

Non-smoking women childbearing age +/- history spontaneous pneumthorax

CT features
Normal lung with small cystic spaces
Chylous pleural effusion
Normal lung volumes

Differential
Histiocytosis - associated with smoking, small nodules and small cysts, pneumothorax.
Increased lung volumes

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What lobe is affected in congential lobar overinflation?

Usually left upper lobe

Why? Undeveloped bronchial cartilage, and subsequent air trapping

Hyperlucency on CXR, and mediastinal shift.

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What is Swyer-James Syndrome?

Normal development of infant lung impeded by bronchiolitis, with superadded infection.
Air trapping makes CXR lucent.

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Unilateral Hyperlucency on CXR

Congential lobar overinflation (cartilage)
Swyer-James (infant bronchiolitis)
Large PE
Poland syndrme

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Anterior junctional line

Formed by meeting of parietal and visceral pleura anteromedially

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Posterior junctional line

Meeting of pleural surfaces of upper lobes behind oesophagus.

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Azygo-oesophageal recess

Right lung and mediastinal reflection of azygous vein

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Right paratracheal line
Right paraspinal stripe

*Right paratracheal line right wall trachea and right lung
**Right paraspinal stripe **- right lung and posterior medialstinal soft tissue

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Reverse Halo Sign

Cryptogenic Organising Pneumonia (BOOP)

Others:
GPA
Sarcoidosis
Peumocystis carinii pneumonia

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Halo sign

Invasive aspergillosis
(Central nodule with surrounding ground glass - haemorrhage)

Others
* Haemorrhagic mets
* Bronchoalveolar carcinoma
* Mycobacterials
* Hypersensitivity pneumonitis

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What is Monrod sign

Air crescent surrounding aspergilloma

(Aspergilloma forms in immunocompetent patients with pre existing lung cavities)

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Upper Zone Involvement

B - Beryllosis
R - Radiation
E - Eosinophilic granuloma (LCH) and EAA
A- Ank Spondylitis, amiodarone
S - Sarcoidosis
T - TB
S - Silicosis

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Lower Zone Involvement

B - Bronchiectasis
A - Aspiration Pneumonia
D - Drugs and DIP
A - Asbestosis
S - Scleroderma (and RA)

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Asbestosis features

Bilateral calcified pleural plaques
Spares CP angles
(mediastinum involvement - mesothelioma)

Unilateral pleural plaques - previous insult eg surgery, empyema.

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Crazy paving
(interlobular septal thickening and GGO)

Alveolar proteinosis

Others:
Goodpastures (haemorrhage)
Idiopathic pulmonary haemosiderosis -iron deposition
Sarcoidosis

Goodpasture syndrome presents glomerulonephritis/haemoptysis (anti-GBM)

Sarcoid Demographic
CT Features

Young, female, black, hypercalcaemia
Garland triad, egg shell calcification, traction bronchiectasis, upper lobe predominance, perilymphatic nodules.

LCH v LAM

q2 table

What gives cystic change, nodules, upper lobe predominant, INCREASES lung volume, pneumothorax

LCH -strong association with smoking, Spares CP angles.

To different from LAM
-LAM no volume change
-chylous effusion

Upper lobe GGO, reticulations, increased liver density. History of AF..

What is it?

Am(iod)arone induced lung and liver disease.

CT features
- increased liver density

10% develop lung disease
- GGO, reticulations, consolidation, pleural effusion.

What spares CP angles?

LCH
Asbestosis

Name the condition;
1. Heavy smoking
2. Centrilobular nodules
3. GGO

RBILD

Respiratory Bronchiolitis Interstitial Lung Disease - upper lobe dominant

Addition: DIP Desquamative interstitial pneumonia is though of as end spectrum of RB-ILD

Recreational drugs
Particulate matter, hyperdense centilobular matter
Cavitating lung lesions
Apical bull/pneumothorax
Perihilar airspace opacification
LRTI
Nasal septal destruction
Lung abscess/pseudoaneurysm

Particulate matter, hyperdense centilobular matter - Talcosis
Cavitating lung lesions - Septic emboli, non-sterile IV
Apical bull/pneumothorax - inhalational drugs
Perihilar airspace opacification - cocaine, heroin, meth
LRTI - Aspiration
Nasal septal destruction - snorting cocaine
Lung abscess/pseudoaneurysm - injection site.

Causes of cystic lung disease..

LCH (Langerhans Cell Histiocytosis) - smoker, centrilobular nodules, cavitation into cysts, upper lobe/mid zone, spares CP angle Lymphangiomyomatosis (LAM) - child bearing age, TS, thin walled round cysts, uniform distribution, chylothorax. Birthday Hogg Dube - associated with bilateral oncocytomas and chromophobe RCCs. Lower lobe predominant. LIP PCP.

What is associated with Lymphocytic Interstitial Pneumonia (LIP)?

SJOGRENS (+sle + RA) HIV (young) Benign lymphoproliferative disorder lung infiltration.

Ground glass appearance in hilar/mid zone distribution. Can have apical cystic form associated with penumothorax..

PCP (Pneumocystitis pneumonia) Nb AIDS + ground glass change = PCP AIDS + pneumothorax = PCP

Define emphysema

Permanent enlargement of airspaces distal to the terminal bronchioles with alveolar wall destruction. CXR findings: flattened hemi-diaphragm, AP diameter increases, increase retrosternal space. Other: Saber sheath trachea - coronal narrowing. Pathognomonic for COPD. On CT, if Main PA >aorta, (PA/A ratio >1), indicates pulmonary HTN + worse outcome.

Which emphysema is upper lobe predominant, associated with smoking, and common in asymptomatic elderly. Focal lucency with central dot sign (bronchovascuar bundle).

Centrilobular emphysema.

Emphysema - lower lobe predeominant, associated with alpha 1 anti-trypsin

Pan - lobular Usually presents in 60-70s but will present if 30s if smoker

Emphysema with subpleural Lucencies?

Para-septal Less than three bubbles thick.

Describe Asbestosis

This is the lung fibrosis associated with exposure (not exposure itself). Similar appearance to UIP - pleural thickening is the differentiating factor. 20 year latency between exposure + lung ca/mesothelioma. Benign pleural effusion earliest benign related change. Pleural plaque 20-30 years. Calcifications 40yr. Plaques spare spices and CP angles. Round atelectasis is a mass like opacity with associated pleural thickening . 30-40yrs lag time to mesothelioma.

What disease is associated with nodular opacities, +egg shell calcification of the hilar nodes.

Silicosis Who ? Miners and quarry workers Simple form described above. Complicated form - Progressive Massive Fibrosis. This scan also be seen in coal workers pneumonicosis - secondary to exposure to washed coal. Silicosis raises risk of TB x3, so if cavitation think silicotuberculosis

Macrocystic honeycombing +/- bronchiectasis Reticular abnormalities Subpleural basal predominant distribution

Usual Interstitial Pneumonitis When cause is idiopathic it’s Idiopathic pulmonary fibrosis Macrocystic honeycombing, traction bronchiectesis, apicobasilar gradient. CHRONIC HYPERSENSITIVITY v UIP - CHONIC HP involves air trapping (3 or more lobes), mid-upper lobe fibrosis.

Ground glass SUBPLEURAL SPARING Posterior lower lobe predominance

NSIP (Non-specific interstitial pneumonia = is specific) UIP v NSIP UIP - apico to basilar gradient, heterogenous histology, honeycombing, traction bronchiectasis NSIP - slight lower lobe predominance, homogenous , ground glass, (honeycombing if any is microcystic), SUBPLEURAL sparing

African American female, 20-40, non-caseating granuloma, raised ACE, hypercalcaemia. Lofgren syndrome - 1) Bilateral lymph node enlargement 2) Ankle arthritis 3) Erythema nodosum

Sarcoidosis - PERI-LYMPHATIC NODULES - UPPER LOBE PREDOMINANCE Garland Triad, Lambda sign Gallium scan, CT galaxy sign

Most common Lung Cancer

Non Small Cell Adenocarcioma Peripheral tumour. Most common to present at solitary pulmonary nodule. Most common type in non smoker. Associated with pulmonary fibrosis.

Most common central tumours

Non small cell - squamous — cavitation is classic. Paraneoplastic syndrome common with ectopic PTH hormone. Small Cell — Associated with Lambert Eaton (proximal weakness - aCh related). Also related to SIADH. Bad prognosis. Both central - both related to smoking.

What is the largest lung cancer?

Non small cell - Large cell This is peripheral. Least common. Usually large (>4cm). Poor prognosis.

Name 4 types lung cancer? LA on the coast.

Large, non small cell Adenocarcinoma, non small cell Squamous, non small cell. Small

What is Pancoast tumour

Apical tumour with associated syndrome of shoulder pain, C8-T2 radiculopathy, Horner’s syndrome.