Respiratory Flashcards
(94 cards)
Features of UIP
Basal and subpleural predominant Honeycombing/reticular opacities (+ secondary signs of fibrosis (not part of 'high confidence' criteria)) Absence of; - extensive groundglass opacity, - segmental or lobar consolidation, - Bilateral cysts - Mosaic perfusion or air trapping - Profuse micronodules
Differential diagnosis of UIP
IPF (most common)
Connective tissue disease (eg RA)
Drug toxicity (rare)
Asbestosis (rare)
Difference between UIP and NSIP
NSIP has more secondary signs of fibrosis (traction bronchiectasis, reticulation), and relative sparing of subpleural lung.
Traction bronchiectasis without honeycombing (most likely differentials
NSIP
Sarcoidosis
HSP
Acute symptoms + groundglass opacity + Intralobular interstitial thickening
Pulmonary oedema
Infection
Diffuse alveolar damage (eg drug toxicity)
Haemorrhage
Chronic symptoms + groundglass opacity + intralobular interstitial thickening
HSP
NSIP
UIP (rare to have GGO)
Nodular distribution in sarcoidosis
Perilymphatic
Typically peribronchovascular and subpleural
Upper lobe predominant
Galaxy sign
Nodular distribution in Lymphangitic carcinomatosis
Perilymphatic
Typically interlobular septa > subplerual/peribronchovascular
May have lower lobe predominance due to increased blood flow.
Nodular distribution in silicosis or coal workers pneumoconiosis
Both look similar but have different histology
Usually centrilobular > subpleural/interlobular septa (dust cleared by lymphatics in the alveoli first)
Upper lobe predominant and posterior lung.
GGO centrilobular nodules + chronic symptoms
HP (antigen exposure)
RB (smokers)
Follicular bronchiolitis (immunosuppressed)
GGO centrilobular nodules + acute symptoms
Atypical (viral/myco) pneumonia (typicals also possible)
Pulmonary oedema
Pulmonary haemorrhage
Differentials for perilymphatic nodules
Sarcoidosis
Neoplasm
Silicosis / coal workers lung
Differentials for random nodules
Miliary infection
Neoplasm
Differentials for centrilobular nodules
Infection Hypersensitivity pneumonitis Mucinous adencarcinoma Respiratory bronchiolitis Oedema Haemorrhage
Groundglass opacity in acute setting
Infection (atypicals) Oedema Acute lung injury Haemorrhage Aspiration Hypersensitivity pneumonitis (acute) Acute eosinophilic pneumonia
Chronic groundglass opacity with peripheral distribution
Interstitial pneumonia
- NSIP (subpleural sparing)
- DIP (smokers)
- UIP
Most common differentials for groundglass opacity in chronic setting
Hypersensitivity pneumonitis
NSIP
DIP
Differentials of mosaic attenuation
HSP Asthma Constrictive Bronchiolitis (bronchiolitis obliterans) Vasculitis Chronic PE
Differentials of headcheese sign
Groundglass + mosaic attenuation
HSP (by far most common) DIP and RB Follicular bronchiolitis and lymphoid IP Sarcoidosis Atypical infections 2 different processes. (Eg oedema and asthma)
Cystic lung disease, top 3 differentials
LAM (lymphangioleiomyomatosis)
LCH (Langerhans cell histiocytosis)
LIP (Lymphoid Interstital pneumonia)
Key points about LIP
Associated with connective tissue diseases, most commonly sjögrens disease
Lung bases
Up to a dozen cysts
Adjacent to vessels
Key points about LCH
Smoking related disease
Upper lobe predominant
Irregular cysts
Nodules (GGO or solid) may precede
Key points about LIP
Associated with connective tissue diseases, most commonly sjögrens disease
Lung bases
Up to a dozen cysts
Adjacent to vessels
Key features of immunodeficiency (pulmonary changes)
Includes congenital (agammaglobulinaemia, hypogammaglobulinaemia), acquired (AIDS), ciliary diskinesia Lower lobe predominant large airways changes. May have some small airways changes as well (particularly with ciliary diskinesia).