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Thoracic Flashcards

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1
Q

Interlobular fissures

A

Minor: RUL from RML (seen on frontal and lateral)
Major: only on lateral
Azygos: accessory RUL apical or posterior are encased

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2
Q

Atelectasis

A

Collapse
Direct: fissure displacement/ vascular crowding
Indirect: diaphragm elevation/rib crowding/ mediastinal shift/ overinflation of contralateral lobe/hilar displacement

Central bronchial obstruction: no air bronchogram
Subsegmental: air bronchogram

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3
Q

Obstructive atelectasis

A 
Bronchial obstruction
Lobar
More quickly in patient with supplemental O2
Imaging: volume loss
ICU patient: consolidation
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4
Q

Obstructive atelectasis in peds

A

Foreign body

Hyperexpanded

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5
Q

Subsegmental atelectasis

A

After surgery
General illness
Mucus obstruction

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6
Q

Relaxation atelectasis

A

Adjacent to a lesion causing mass effect
Pleural effusion
Pneumothorax
Pulmonary mass

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7
Q

Adhesive atelectasis

A

Surfactant deficiency
NRDS
ARDS

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8
Q

Cicatricial atelectasis

A

Architectural distortion by fibrosis

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9
Q

Lobar atelectasis

A 
Central bronchial obstruction
Mucus plugging (acute)
Neoplasm (chronic)
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10
Q

LUL atelectasis

A

Luftsichel sign

Crescent of air ( between aorta and hyperexpanded superior LLL)

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11
Q

RUL atelectasis

A

Reverse S sign of golden
suspicious for malignancy
Juxtaphrenic peak sign: traction of inf accessory fissure

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12
Q

LLL atelectasis

A

Triangular retrocardiac opacity
Loss of left heart border
Left hilum down
Flat waist sign

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13
Q

RLL atelectasis

A

Mirror of LLL collapse

Wedge shaped retrocardiac opacity

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14
Q

RML atelectasis

A

Silhouetting of right heart border

Lateral view: wedge shape opacity anteriorly

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15
Q

Round atelectasis

A 
Focal
Always with adjacent pleural abnormalities 
Common: posterior lower lobes
1. Abnormal pleura
2.peripheral opacity
3. Round opacity
4. Volume loss
5. Curved pulmonary vessels and bronchi( comet tail sign)
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16
Q

Secondary pulmonary nodule

A

Central artery—> acinar artery
Central bronchus—> respiratory bronchioles
Vein and lymphatic—> periphery
Interlobular septa encases SPL

12 acini per SPL

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17
Q

Consolidation an ground glass

A

Abnormal alveoli

GG—> only on CT

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18
Q

Consolidation

A

Filling of alveoli with liquid
Vessels are not visible
Air bronchogram

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19
Q

Acute consolidation

A

Pneumonia
Hemorrhage
ARDS ( non carcinogenic pulmonary edema)
Pulmonary edema

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20
Q

Chronic consolidation

A 
Bronchioalveolar carcinoma ( mucinous subtype)
Organizing pneumonia ( granulation polyps)
Chronic eosinophilic pneumonia ( upper lobe distribution)
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21
Q

Ground glass opacification

A

Partial filling of alveoli
Wall thickening
Atelectasis

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22
Q

Acute ground glass

A

Pulmonary edema
Pneumonia (atypical)
Hemorrhage
ARDS

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23
Q

Chronic ground glass

A

Bronchioalveolar carcinoma
Organizing pneumonia ( round/ peripheral)
Chronic eosinophilic pneumonia ( upper lobe)
Idiopathic pneumonia
Hypersensitivity pneumonitis ( type 3)
Alveolar proteinosis ( central sparing of periphery)

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24
Q

Central ground glass opacity

A

Pulmonary edema
Alveolar hemorrhage
Pneumocystis jiroveci pneumonia
Alveolar proteinosis

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25
Peripheral ground glass
Organizing pneumonia Chronic eosinophilic pneumonia ( upper lobes) Atypical/viral pneumonia Pulmonary edema ( non cardiogenic)
26
Smooth interlobular septal thickening
``` Pulmonary vein dilation: Pulmonary edema Pulmonary alveolar proteinosis Pulmonary hemorrhage Atypical pneumonia ```
27
Nodular interlobular septal thickening
Infiltration of peripheral lymphatic: Lymphangitic carcinomatosis Sarcoidosis (noncaseating granulomas)
28
Crazy paving
``` Interlobular septal thickening plus ground glass opacification Alveolar proteinosis Pneumocystis jiroveci pneumonia Organizing pneumonia Bronchioalveolar carcinoma (mucinous) Lipoid pneumonia ARDS Pulmonary hemorrhage ```
29
Centrilobular nodules
Opacification of centrilobular bronchiole CT: multiple small nodules , never extend to the pleura Infection: atypical mycobacteria ( MAC), endobronchial spread of TB Bronchopneumonia, atypical pneumonia Inflammation: hypersensitivity pneumonitis (subacute) , respiratory bronchialitis interstitial lung disease, hot tub lung, diffuse panbronchiolitis ( lymphoid hyperplasia, Asians) , silicosis ( upper lobe, perlymphatic nodules)
30
Perilymphatic nodules
Subpleural, peribronchovascular, septal Sarcoidosis (upper lobe, galaxy sign) Pneumoconioses Lymphangitic carcinomatosis
31
Random nodules
``` Hematogenous metastasis Septic emboli (cavitate) Pulmonary langerhan’s cell histiocytosis (smoking/ random nodule—>irregular cyst) ``` Miliary pattern—>disseminated TB, fungal infection, hematogenous metastases
32
Tree in bud nodules
Small airways infection Mycobacteria TB and atypical mycobacteria Bacterial pneumonia Aspiration pneumonia Airway invasive aspergillus ( immunocompromised)
33
Solitary cavitary
wall thickness<4mm is benign >15 mm malignant Primary bronchogenic carcinoma (squamous more than adenocarcinoma) TB—> upper lobe
34
Multiple cavitary nodules
Septic emboli Vasculitis ( Wegener) Metastases (squamous cell carcinoma and uterine carcinosarcoma)
35
Multiple Cystic lung disease
Lymphangioleiomyomatosis (LAM)—> diffuse with chylous effusion Emphysema—>upper lobes, smokers PLCH—>cyst+nodules—> upper lobes Diffuse cystic bronchiectasis : upper—> cystic fibrosis / diffuse or lower—> congenital or post infectious Pneumocystis jiroveci pneumonia Lymphoid interestitial pneumonia—> Sjogren / alveolar distortion
36
Single cyst lung disease
Bulla Bleh —> continguous with pleura <1cm ( rupture—> spontaneous pneumothorax) Pneumatocele—>prior lung trauma or infection
37
Lower lobe fibrotic changes
Idiopathic pulmonary fibrosis —> bibasilar fibrosis, basilar honeycombing End stage asbestosis—> pleural plaques Nonspecific interestitial pneumonia (NSIP)—> collagen vascular disease or drug reaction/ cellular and fibrotic form/ basal fibrosis, no honeycombing
38
Upper lobe fibrotic changes
End stage sarcoidosis Chronic hypersensitivity pneumonitis End stage silicosis
39
Community acquired pneumonia
S. Pneumonia Mycoplasma—> varied appearance Legionella—> elderly patients / peripheral progress to lobar and multi focal Klebsiella—> alcoholics and aspiration/ voluminous/bulging fissure
40
Hospital acquired pneumonia (HAP)
MRSA | Pseudomonas
41
Health care associated pneumonia
Nursing homes >2 days hospitalization Similar to HAP
42
Ventilator associated pneumonia
Mechanical ventilator Polymicrobial Pseudomonas Acinetbacter
43
Pneumonia in immunocompromised
Pneumocystis Aspergillus Nocardia CMV
44
Lobar pneumonia
Bacterial Most common CAP air bronchogram
45
Lobular pneumonia
Patchy consolidation Poor defined airspace opacity S. Aureus
46
Interstitial pneumonia
Inflammatory cells in interstitial tissue Diffuse patchy or GG viral , mycoplasma, chlamydia, pneumocystis
47
Round pneumonia
Children Streptococcus pneumoniae Due to incomplete formation of pores of Kohn
48
Pulmonary Abscess
Staph aureus, pseudomonas, anaerobics Air-fluid level Spherical
49
Pulmonary gangrene
Extensive necrosis and sloughing
50
Empyema
Pleural space 1. Free flowing exudative effusion—> aspiration 2. Development of fibrous strands—> large bore chest tube and fibrinolytic 3. Solid and jelly like—> surgery Split pleura sign—> enhancing parietal and visceral pleura DDx: malignant effusion, mesothelioma,fibrothorax,talc pleurodesis
51
Pneumatocele
Thin walled, gas filled | Post traumatic, sequela of pneumonia ( Staph aureus, pneumocystis)
52
Bronchopleural Fistula
Rupture of visceral pleura Surgery common cause Lung abscess, empyema, trauma New or increasing gas in pleural effusion
53
Empyema necessitans
Extension of empyema to chest wall Secondary to TB Nocardia, actinomyces
54
TB exposure
1. Contained (90%)—> calcified granulomas, calcified hilar lymph node 2. Primary tuberculosis—> children, immunocompromised 3. Reactivation
55
Primary tuberculosis
15%—> no radiologic sign Imaging: ill-defined consolidation, pleural effusion, lymphadenopathy, miliary Lower lobes or RML Ghon focus—> focus of parenchymal infection upper of lower lobe or lower of upper lobe Ranke complex—> Ghon + LAP Adenopathy—> common, central hypo and peripheral enhancement cavitation is rare in primary TB
56
Reactivation TB
Adolescents and adults Upper lobe apical and posterior segments Immunocompetent—> cavitation and no adenopathy Tree in the bud—> active endobronchial spread Immunocompromised—> hypo adenopathy Tuberculoma—> round opacity in upper lobes
57
Healed TB
Apical scarring Upper lobe volume loss Superior hilar retraction Calcified granulomas ( delayed hypersensitivity)
58
Miliary TB
Diffuse random nodules | Disseminated TB
59
Atypical mycobacterial infection
Elderly woman with cough, fever, weight loss Mycobacterium Avium intercellulare, M. Kansas I Imaging: bronchiectasis, tree in bud, RML and lingula
60
Hut tub lung
Hypersensitivity pneumonitis | Centrilobular nodules
61
Histoplasma capsulatum
Ohio, Mississippi Bat, bird guano Calcified granulomas , pulmonary nodules Chronic—> similar to TB, upper lobes fibrocavitary consolidation Fibrosing mediastinitis—> pulmonary venous obstruction, bronchial stenosis, pulmonary artery stenosis, calcified lymph nodes
62
Coccidiodes immitis and blastomyces dermatitidis
Coccidiodes immitis: southwest, multifocal consolidation,multiple pulmonary nodules, miliary nodules Blastomyces dermatitidis: central, southeast, multifocal consolidation, ARDS, miliary disease
63
Pneumocystis jiroveci pneumonia
CD4<200 Bilateral perihilar airspace opacities with peripheral sparing CT—> perihilar GG opacification, crazy paving Upper lobe pneumatoceles —> pneumothorax, pneumomediastinum
64
Cryptococcus neoformans
Most common in AIDS GG, focal consolidation, cavitating nodules Miliary with LAP or effusion
65
ABPA
Hypersensitivity to aspergillus Long standing asthma CT—> upper lobes bronchiectasis, mucoid impaction, hyper or calcified (finger in glove) DDx—> CF
66
Aspergilloma
Mycetoma or fungus ball in pre existing pulmonary cavity Mobile Monod sign—> crescent of air outlining the mycetoma
67
Semi invasive aspergillosis
Necrotizing granulomatous inflammation Diabetic, alcoholic, debilitated, COPD Segmental consolidation, cavitation, pleural thickening
68
Airway invasive aspergillosis
Airway epithelial cells Neutropenic and AIDS Bronchiolitis, bronchopneumonia CT—> centrilobular and tree in bud nodules
69
Angioinvasive aspergillosis
Severely immunocompromised CT—> halo: GG around consolidation/ DDx: viral, Wegener, Kaposi, metastasis Air crescent—> good prognostic sign
70
Pulmonary edema
Increased pulmonary vein 1. Vascular redistribution: increased caliber of upper lobe vessels 2. Interstitial edema: increased interstitial marking, indistinctness of pulmonary vasculature, peribronchial cuffing, Kerley B ( peripheral) and A (radiates from hila) 3. Alveolar edema: central opacification, pleural effusion, cardiomegaly
71
Pulmonary edema on CT
Dependent GG Interlobular septal thickening HF—> patchy GG Sepsis, low protein—> diffuse GG RUL pulmonary edema—> acute mitral regurgitation Aggressive thoracentesis—> reexpansion pulmonary edema
72
Vascular pedicure
Width of upper mediastinum —> < 58 mm >63 or 70–> increases pulmonary capillary wedge pressure(>18) and fluid overload Right border—> interface of SVC and right main bronchus Left border—> lateral of subclavian origin from aorta
73
Endotracheal tube
4-6 cm above carina Right bronchus direct intubation is more common—> Complete atelectasis of un intubated lung
74
Central venous catheter
Tip in lower SVC or CA junction Azygos malposition—> venous perforation, thrombosis Dialysis catheter in right atrium
75
Pulmonary artery catheter
Tip in main , right, left pulmonary artery If distal to proximal interlobar pulmonary artery—> rupture, pseudoaneurysm, intra cardiac catheter knot and arrhythmia
76
Lung cancer risk factors
Smoking—> SCC, small cell carcinoma Berryllium, radon,arsenic,asbestos Pulmonary fibrosis Pulmonary scarring

Radiology (3 decks)

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