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FRCR Part Dhá > Thoracic > Flashcards

Thoracic Flashcards

1
Q

finterface of the right lung and mediastinal reflection of azygous vein?

A

Azygo-oesophageal recess

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2
Q

Meeting of the parietal and visceral pleural reflection anteromedially?

A

Anterior junctional line

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3
Q

meeting of the pleural surfaces of the upper lobes behind the oesophagus ?

A

Posterior junctional line

Above the clavicles

Cervicothoracic sign = if above the clavicles in the posterior mediastinum

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4
Q

Right wall of the trachea agaisnt the right lung?

A

right paratracheal line

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5
Q

Right lung meeting against posterior mediastinal soft tissue?

A

right paraspinal stripe

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6
Q

What is luftsichel sign on CXR?

A

Ongoing aeration of the superior most segment if left lower lobe in upper lobe collapse

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7
Q

DDx for unilateral hyperlucent hemithorax?

A

-Rotation (lucent side closer to the tube ie away from the plate)

Lung
- Airway obstruction/FB
-PTx

Chest wall =
- Mastectomy
- Ploand syndrome
- Polio

Swyer-james
- unilateral hyperlucent lung on radiography and air-trapping and bronchiectasis on CT

Alpha-1-antitrypsin
- Pan lobular basal emphysema

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8
Q

AIDs with CD4 <200, perihilar GGO, sparing the periphery, pneumatoceles (thin walled) ?

A

PCP

Can have PTx

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9
Q

Lung infection with CD4 200-400?

A

Pyogenic - commonest Strep pneumonia
TB

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10
Q

CD4 count less <150

A

<150
Fungal -
- Cryptococcal - cavity formation, concurrent cerebral
- Histoplasmosis - no CXR apperacnes (50%)

<100
CMV and Kaposi sarcoma

<50
MAC , Lymphoma

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11
Q

Causes of persistent opacities in AIDS patients

A

Lymphoma
Kaposi - ‘Flame shaped’ perihilar

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12
Q

Tree in bud opacities and and cylindric bronchiectasis of the right middle lobe or lingula?

A

MAC

Tree in bud - terminal bronchiole filled with radiopaque material

Other causes
TB (Pus)
CF, ABPA (mucus)
Cells - Breast and gastric cancer
Aspiration
CMV (bronchial wall thickening)

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13
Q

Signs of invasive asperigillus ?

A

Halo sign
=Nodule/mass/consolidation surrounded by ground-glass opacity related to hemorrhage

Air crescent sign
=Crescent-shaped gas collection within nodule, mass, or consolidation

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14
Q

Nodule or mass within preexisting cavity

A

Aspergilloma

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15
Q

Central upper lobe saccular bronchiectasis with mucoid impaction (finger in glove). Known asthmatic?

A

ABPA

‘Migratory’ airway consolidation

Central bronchiectasis, peripheral bronchi clasically spared

Cavity formation possible in later stage

Dense mucoid impaction - High-attenuating (>70–100 HU) bronchial contents represent fungal debris

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16
Q

Aggressive fungal infection that invades the mediastinum, pleura and chest wall?

A

Mucormycosis

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17
Q

Peripheral nodular and wedges shaped densities. Lower lobe predominant. cavity formation

A

Septic emboli

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18
Q

CAVITY mnemonic?

A

*Cancer (Squamous)
*Auto-immune (Wegners, Rheumatoid/caplan)
*Vascular - Septic emboli
*Infection - TB, staph, strep
*Truama - pneumatoceles
Y - Young - CPAM, Sequestrations

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19
Q

What bacteria is classic for lemierre syndrome?

A

Fusobacterium Necrophorum

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20
Q

Peripheral grouns glass/subsolid nodule in the upper lobe. Non-smoker. which type of lung cancer?

A

Adenocarcinoma

Associated with lung fibrosis

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21
Q

Central mass with cavitation, smoker. which type of lung cancer ?

A

Squamous

Ectopic PTH
Cushings

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22
Q

Central lung malignancy with central lymphadenopathy. Associated with lambert eaton. which type of lung cancer?

A

Small cell

Paraneoplastic syndromes
- SIADH
- Lamber eaton = proximal weakness
- Limbic encephalitis

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23
Q

you can use PET for assessing SPN greater than 1cm. If ground glass, what would PET uptake be if malignancy?

A

Cold

Hot in infection

if solid malignancy then hot (SUV> 2.5)

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24
Q

Benign pleural lesion associated with hypertrophic pulmonary osteoarthropathy?

A

Pleural fibroma

Malignant lesion would be lung cancer (non -small cell)

Pleural fibroma aka benign mesothelioma
-T1 MR hypointense; T2 MR hyperintense; contrast enhancement on CT avid

About
14%–30% undergo malignant degeneration. Surgical excision is curative.

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25
Q

Round atelectasis can mimic a lung mass. What features differentiate?

A

Comet tail sign
Adjacent to thickened pleural (assoacited with asbestosis) +/- Ca2+

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26
Q

lung mass with fat density, peripheral and popcorn calcifications?

A

Hamartoma

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27
Q

Endobronchial lesion, calcification. Histroy of wheeze. Avid enhancement.

A

Carcinoid

Cold on PET (false negative)
Carcinoid syndrome in chest is uncommon versus abdominal. if present Left sided valves destroyed

Atypical carcinoid are rare and can have no enhancement

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28
Q

Stage 3B lung cancer (N3 or T4) is unresectable, what features?

A

Unresectable =
-supraclavicular, scalene or contralateral mediastinal or hilar lymphadenopathy
- Tumour in same lung but different lobes (T4)
- Tumour in two different lungs (M1a)
- Malignant pleurant effusion (M1)

Nb - that tumours in the same lobe is (T3)

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29
Q

Early vs later radiation pneumonitis appearances?

A

Early (1-3 months)
- Homogenous or patchy GGO

Late
- Dense consolidation, traction bronchiectasis and volume loss

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30
Q

Post pneumonectomy, contralateral tracheal shift, reduction on height of fluid on sequential films. what is the complication?

A

Bronchopleural fistula

Can confirm on Xenon gas nuclear med

Normal appearances -
air fluid level at day4/5, by 14 days 100% fluid filled
ipsilateral tracheal shift
Diaphragm elevation

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31
Q

Young adult, post pneumonectomy, exertional SOB, hyper expansion of lung displaces and rotates the heart anticlockwise. what is complication?

A

Post-pneumonectomy syndrome

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32
Q

6 months post transplant. Mosaic attenuation, air-trapping, bronchial wall thickening, bronchiectasis ?

A

Bronchiolitis obliterans

Findings more** Prominet on expiratory phase (air trapping) **

associated bleomycin toxicity, IBD, RA, post BMT

33
Q

Post-transplant complications in hours, 4-24hrs, 7-10 days, weeks, months, anytime

A

Hours = hyperacute rejection

4-24 hrs = Reperfusion injury - (perihilar bat opacifications and effusions.)

(second week) = Acute rejection (GGO (basal), septal thickening, pleural effusions

Weeks = drugs - (GGO)

Months - Lymphoid interstitial pneumonitis (GGO + centrilobular nodules + thin-walled cysts)

Anytime - bacterial, PCP, aspergillus

34
Q

Thoracic duct injury above and below T5/T6 - which side is the pleural effusion?

A

Above = Left

Below = Right

crosses midline at t5/t6 to drain into junction left SCV and IJV

35
Q

Lobar condolidation, in bone marrow transplant, cavitation, no lymph node enlargement. what is the infection?

A

Nocardiosis

36
Q

Lobar pneumonia in alcoholic/immunocompromised?

A

Klebsiella

**Strep commonest in non-immunocompromised **

37
Q

Organism causes bronchopneumonia?

A

Staph (commonest)
pneumococcus
haemophilus

38
Q

Viral pneumonia apperances?

A

like bronchopneumonia affects airways and interstitium
Differentiate from bacterial = Air trapping = hyperinflation on CXR

39
Q

Round pneumonia?

A

Young children
Pneumoccous, strep
Spherical area posterior lower lobes

40
Q

Peripheral soft tissue nodule/mass, abuts pleura, obtuse angle, episodic hypoglycaema?

A

Fibrous Tumor of the Pleura

41
Q

Egg shell calcifications nodes ?

A

Silicosis
Coal workers pneumoconiosis
Sarcoidosis
Treated lymphoma

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

42
Q

Feeding vessel sign ?

A

Mets
Septic emboli

43
Q

Type of emphysema?

A

Centrilobular
-smoking, apical segments

Panacinar
- Alpha1-antitrpysin , bases

Paraspetal
- Subpleural, bullous formation, spontaneous PTx

44
Q

Neonate hyperlucent LUL, mass effect on mediastinum and contralateral mediastinal shift ?

A

Congenital lobar overinflation

Bronchus unable to remain open in expiration, leading to air trapping

No discrete cyst or feeding vessels

45
Q

Honeycombing, basilar predominant, traction bronchiectasis, distortion of architecture, smoking association?

A

UIP

Spare the costophrenic angles

46
Q

Basilar GGO, subpleural sparing, younger, steroid responsive?

A

NSIP

Absent honeycombing

Bilateral ground-glass &/or reticular opacities ± traction bronchiectasis/bronchiolectasis
Subpleural sparing ± peribronchovascular fibrosis

associated with
CREST - dilated oesophagus
RA
sjorgens
chemo
HIV

47
Q

NSIP vs UIP

A
48
Q

Features of Desquamative interstitial pneumonia (DIP)?

A

Smoker
Bilateral, lower zone predominant ground-glass opacities ± subpleural intralobular lines/retiuclations **
Small, round, thin-walled** (2-4 mm in diameter)

Spectrum/similar HRCT to RB-ILD
+ centrilobular nodules
+ upper lobe predominated

49
Q

Female, 60, Ground-glass opacities, Centrilobular nodules , thin-walled Cysts?

A

Lymphoid Interstitial Pneumonia - LIP

**DIffuse **

GGO clears with treatment

Associated with Sjogren’s
+ PCP, Hep B, EV
+ AIDs

50
Q

Female, 30, with diffuse thin-walled lung cysts, spontaneous pneumothorax, effusions. Non-smoker?

A

Lymphangioleiomyomatosis (LAM)

Diffuse no lobe predominant

Premenopausal.
NORMAL lung volumes
Chylous pleural effusions
increased lung volumes

Associated with tuberous sclerosis - 1/3rd have AMLs

51
Q

20-30, male, nodules + bizarre-shaped thick pulmonary cysts in cigarette smokers. Increased lung volumes ?

A

Pulmonary Langerhans cell histiocytosis (PLCH)

Predominant upper lobes
normal lung volumes
Smokers

M:F =

Effusions are rare
Sparing costophrenic angles

52
Q

Bilateral basilar predominant lentiform cysts, liver and skin lesions?

A

Birt-hogg-dube

Bilateral basilar predominant lentiform cysts abutting pleura, septa, and pulmonary vessels

Bilateral Renal oncocytomas
+ **chromophobe RCC

53
Q

Multifocal ground-glass opacities and consolidations. Some with peripheral consolidation around central ground glass nodule?

A

COP

Reverse halo sign

Associated with
-CF
-Methotrexate
- post-transplant
- connective tissue

54
Q

Afro-Caribbean, female, 20. Subpleural nodules upper zone. Bilateral hilar and mediastinal lymph nodes?

A

Sarcoidosis

Bilateral hilar and right paratracheal lymphadenopathy in up to 95% of cases

Garland triad = 1,2,3 sign = lymph nodes both hilum and right paratracheal

Traction bronchiectasis
Perilymphatic nodules
UPPER lobes

Lofgren’s syndrome is an acute form of sarcoidosis characterised by erythema nodosum, bilateral hilar lymphadenopathy and polyarthralgia.

55
Q

According to BTS guidelines first presentation nodules, features that require no follow up?

A

Calcification
Perifissural
<5mm
<80mm3

56
Q

Diffuse or patchy parenchymal opacities (ground-glass &/or consolidation) associated with bilateral septal thickening and pleural effusion. Known Asthma

A

Acute eosinophilic pneumonia
-Ground-glass opacities (100%)
-crazy-paving pattern
-mosaic attenuation; may mimic pulmonary edema

Reverse pulmonary oedema pattern (peripheral)

acute type I hypersensitivity reaction triggered by variable causes (inhalational exposure, drugs, infections)

Chronic eosinophilic pneumonia (CEP): Peripheral homogeneous consolidations (100%)

Allergic bronchopulmonary aspergillosis (ABPA): Central upper lobe bronchiectasis ± high-attenuation mucous plugs (30%)

57
Q

Upper lobe predominant - BREASTS?

A

Berylliosis
Radiation / RB-ILD
Extrinsic allergic alveolitis and Eosionphilic granuluma (LCH)
Ankylosing spondylitis/ ABPA
Sarcoidosis
TB
Silicosis

Nb ++
all pneumoconiosis
Caplans syndrome
Centrilobular emphysema
CF

58
Q

Lower lobe predominant - BADAS

A

Bronchiectasis
Asbestosis
DIP/Drugs
Aspiration
Scleroderma (+ RA !!!)

+ Panlobular emphysema (alpha 1)
+ RA (Caplans upper lobes and less common)
+ UIP and NSIP

59
Q

Centrilobular hyperdense micronodules in recretional drug user?

A

Talcosis

60
Q

Where does asbestosis typically spare?

A

Costophrenic angle

Pleural effusion often first sign but bilateral calcified plaques most common presentation

If mediastinal pleura - ?mesothelioma

If unilateral - ? previous Sx or Empyema

Crocidolite = very fine fibre results in blue asbestosis = very severe pleural disease

61
Q

Features of Extrinsic allergic alveolitis?

A

Acute/Nonfibrotic:
Centrilobular ground-glass nodules and air-trapping
Mosiac attenutation

Chronic:
Dyspnoea, clubbing etc
Fibrotic: Upper lobe peribronchovascular fibrosis

62
Q

Features of alveolar proteinosis ?

A

Crazy paving sign and ground glass opacities

63
Q

Features of TB?

A

Primary
-Hallmark is lymphadenopathy
-Homogenous consooldiation
-compressive atelectasis from compression of adjacent lymph nodes
-pleural effusions (30%)

Post-primary
-Cavitating nodule
-tuberculomas

64
Q

Mosaic attenuation causes?

A

Higher attenuation pathological ie Parenchymal disease ie (GGO)
- sarcoidosis, UIP, COP, DIP
- No air trapping.
=Vessels in the whiter areas = dilated

Lower attenuation pathological
**- look for vessels constricted/paucity in lucent areas **

  1. Poor ventilation =
    ***Air-trapping
    - Exacerbated by expiratory phase
    - Bronchitis , bronchiectasis, asthma, emphysema, Hypersensitivity pneumonitis
  2. Mosaic perfusion
    - as above but no air trapping
    - CTEPH, pulmonary hypertension
65
Q

Crazy paving causes?

A

Alveolar proteinosis
ARDS
Goodpastures
COP
Sarcoidosis

66
Q

lobar collapses on CXR ?

A
67
Q

Anterior mediastinal masses

A

Thymoma
Teratoma
Terrible lymphoma
Thyroid

Germ cell tumours can be fruther subdivded
-Teratoma (usually cystic with fat and calcification)
-seminoma (bulky and lobulated)
-Non-seminomatous Germ Cell Tumour (haemorrhage and necrosis)

68
Q

Two common trachea malignancy and how to differentiate?

A
  1. SCC
    - Smoker
    - Lower 2/3rd trachea
    - ulcerated mass or nodule that projects into tracheal lumen
    - infiltration mediastinal structures, Frequent regional metastatic lymphadenopathy
  2. Adenoid cystic carcinoma
    - non-smoker
    - proximal 1/3rd
    - growth along submucosal and perineural structures

Consider Mucoepidermoid carcinoma (MEC) in young patient with endoluminal lesion in segmental airway - lobar or segmental bronchi

69
Q

Basilar GGO, subpleural sparing, younger, steroid responsive?

A

NSIP

Absent honeycombing

Bilateral ground-glass &/or reticular opacities ± traction bronchiectasis/bronchiolectasis
Subpleural sparing ± peribronchovascular fibrosis

associated with CREST - dilated oesophagus
RA, sjorgens, chemo

70
Q

Causes of Lymphangitis carcinomatosis?

A

Certain Cancers Spread By Plugging The Lymphatics

Cervix
Colon
Stomach
Breast
Pancreas
Thyroid
Larynx (or lung – bronchogenic)

Nb > 50% from breast and most remaining gastric

71
Q

malignant vs benign pleaural lesion

A

Nodular pleural thickening, involvement of the mediastinal pleura and circumferential involvement of the pleura all point heavily towards a malignant diagnosis.

stalk strongly suggests a benign lesion

less than 1cm thick, suggests benign pleural plaque

72
Q

carbey triad vs syndrome

A

Carneys syndrome - FAST

Carneys triad - PEG (if you have a bad GIST tumour you might need a PEG tube)

73
Q

Feautres of RB-ILD

A

Centrilobular nodules
GGO
Upper/mid zones
Smoking
No bronchiectasis or honeycombing

74
Q

Complication rates posrt lung Bx

A

PTx = 25%
PTx needing drain = 5-10%
Haemoptysis = 3%
Air embolus = 0.05%
Tumour seeding = 0.05%

75
Q

Middle mediastinal masses?

A

Fibrosing mediastinitis
-partly calcifed mass, especially subcarinal and right partatracheal,
- causes vascular compression leading to right heart strain (SVC obsruction)

76
Q

Tracheal stenosis?

A

Wegners
Tracheal wall thickening Circumferential (involvement of posterior membranous trachea)

Relapsing polychondritis
Wall thickening ± calcification that spares posterior membranous wall

Tracheobronchomalacia
Weakness of central airway walls
At least 70% tracheal collapse on expiratory CT

saber-sheath trachea
narrowing of its coronal diameter and widening of its sagittal diameter
snokers/COPD

Tracheobronchomegaly
a.k.a. Mounier-Kuhn syndrome
Marked dilatation of trachea and mainstem bronchi

77
Q

Causes for interlobular septal thikening?

A

LISA

Lymphangitis carcinomatosis (nodular or smooth) - beaded appearance
Interstitial oedema (smooth)
Sarcoidosis (nodular)
Alveolar proteinosis (smooth)

78
Q

Occlusion techniques IR?

A

see picture

79
Q

bronchiectasis by location

A

Bronchiectasis with Upper or Mid-Lung Predominance
* Cystic fibrosis
* ABPA
* Sarcoidosis
* TB

Bronchiectasis with Anterior Predominance
* Atypical mycobacterial infection
* ARDS

Bronchiectasis with Lower Lung Predominance
* Pulmonary fibrosis
* Chronic aspiration
* Kartagener’s syndrome
* Common variable immunodeficiency
* α1-Antitrypsin deficiency

Bronchiectasis with Central Predominance
* Mounier–Kuhn syndrome
* Williams–Campbell syndrome

FRCR Part Dhá (11 decks)

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