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FRCR 2A > Thoracics > Flashcards

Thoracics Flashcards

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1
Q

Obstructive (absorptive) atelectasis

A

Complete obstruction of airway. Caused by FB, mucous plugging, tumour

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2
Q

What is the classic cause of compressive atelectasis?

A

Pleural effusion

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3
Q

What are the 4 types of atelectasis?

A
  1. Compressive
  2. Obstructive
  3. Fibrotic
  4. Adhesive
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4
Q

Radiology appearances of Strep pneumoniae pneumonia?

A

Lobar consolidation with lower lobe predominance
(Most common cause of CAP)

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5
Q

Radiology appearances of S. aureus pneumonia?

A

Bilateral patchy opacities, bronchopneumonia, abscess formation

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6
Q

Radiology appearances of Klebsiella pneumonia?

A

Bulging fissure from inflammation, cavities, empyema, effusions
(Alcoholism, nursing home resident)

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7
Q

Radiology appearances of H. influenzae pneumonia?

A

Bronchitis, lower lobe bronchopneumonia
(COPD, asplenia)

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8
Q

Radiology appearances of Pseudomonas?

A

Patchy opacities, abscess formation, small pleural effusions
(ICU and CF patients)

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9
Q

Radiology appearances of Legionella?

A

Peripheral and sublobar airspace opacity. Can develop cavities if immunocompromised.
(COPD)

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10
Q

Radiology appearances of aspiration pneumonia?

A

Airspace opacification and cavitation. Upper lobe if supine, lower if upright
(Empyema is the most common complication)

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11
Q

Radiology appearances of Actinomycosis

A

Airspace opacification peripherally in the lower lobes. Complicated by rib osteomyelitis and chest wall invasion
(Post complicated dental procedure)

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12
Q

Radiology appearances of Mycoplasma?

A

Fine reticular pattern, tree-in-bud, Swyer-James
(Most common cause of CAP in 5 - 20 y/o)

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13
Q

Most common cause of pneumonia in AIDS?

A

Strep pneumoniae

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14
Q

Most common nosocomial cause of pneumonia?

A

Pseudomonas

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15
Q

What are the radiology characteristics of bronchiolitis obliterans?

A
  1. Mosaic attenuation
  2. Air trapping in expiratory phase
  3. Bronchial dilatation
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16
Q

GvHD - pulmonary manifestation?

A

ACUTE - rare, favours extrapulmonary features
CHRONIC - bronchiolitis obliterans

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17
Q

Radiology appearances of PCP infection?

A
  1. Groundglass opacities
  2. Cysts of variable size
  3. Pneumothorax
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18
Q

What are the likely causative pneumonia organisms in AIDS with a CD4 < 100?

A

CMV
Disseminated fungal infection
Mycobacterial infection

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19
Q

Groundglass appearances in AIDS - differentials? (2)

A
  1. PCP
  2. CMV (CD4 < 100)
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20
Q

Focal airspace opacity in AIDS - differentials? (3)

A
  1. S pneumoniae (commonest)
  2. TB (if low CD4)
  3. Kaposi or lymphoma if chronic
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21
Q

Pulmonary TB - types?

A
  1. Primary
  2. Primary progressive
  3. Latent
  4. Post-primary (reactivation)
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22
Q

Radiology appearances of primary TB?

A

Ghon focus/complex, unilateral lymphadenopathy, consolidation, pleural effusion
(Cavitation rarer, tends to be seen in primary progressive)

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23
Q

Radiology appearances of post-primary (reactivation) TB?

A

Upper lobe or lower lobe superior segment consolidation, nodules, cavitation, Rasmussen aneurysm

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24
Q

Worsening clinical status of a patient with TB on a background of AIDS who has been recently started on HAART - diagnosis?

A

Immune reconstitution inflammatory syndrome
(Rx: steroids)

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25
Radiology findings of TB in HIV
CD4 > 200: reactivation pattern, cavitation CD4 <200: primary progressive pattern, including adenopathy, consolidation, miliary spread (haematogeneous) Lobar pattern is not usually seen in HIV
26
Cavitatory (Classic) MAC: aetiology and radiology?
Old males, smokers, COPD Rad - upper lobe cavitating lesion with adjacent nodules (mimics reactivated TB)
27
Lady Windermere syndrome (Non-classic MAC) - radiology?
Middle lobe and lingula bronchiectasis, tree-in-bud opacities (Old white lady, 'not lady-like to cough')
28
Non-tuberculous mycobacterial infection and HIV - commonest radiology finding?
Mediastinal lymphadenopathy (CD4 < 100)
29
Radiology of hypersensitivity pneumonitis (hot tub lung)?
Groundglass centrilobular nodules
30
What are the 3 types of Aspergillosis?
1. Aspergilloma (normal immune system) 2. Invasive aspergillosis (immunocompromised) 3. Hyper-immune/ABPA
31
Radiology of Aspergilloma (normal immune)?
Fungal ball within a pre-existing cavity, moving with position
32
Radiology of Invasive Aspergillosis (immunocompromised)?
1. Halo sign: consolidative mass with surrounding groundglass halo 2. Air crescent sign: seen within consolidative mass, indicating healing
33
ABPA - radiology and diagnosis?
Upper lobe central saccular bronchiectasis with mucosal impaction ('finger in gloove'). Requires raised IgE and skin test for diagnosis
34
Acute CT findings in Covid-19?
Bilateral subpleural groundglass opacities with bronchovascular thickening Lower lobe predominance Crazy paving Reverse halo sign
35
Radiology findings of influenza?
Coalescent lower lobe opacity (pleural effusion rare)
36
Radiology appearances of septic emboli?
Multifocal peripheral and basal nodules Cavitations Feeding vessel sign (Empyema and pneumothorax are complications)
37
Lemierre syndrome
Jugular venous thrombosis with septic emboli secondary to recent ENT infection/surgery (Fusobacterium necropharum)
38
Cavity differentials ('CAVITY')
Cancer (squamous cell) Auto-immune (GPA, rhematoid) Vascular (septic emboli) Infection (e.g. TB) Trauma Young/congenital
39
Red flag malignant features of a pulmonary nodule?
Corona radiata sign Air bronchogram Mixed solid/groundglass Eccentric/stippled calcification
40
What are the 'benign' calcification patterns in SPNs? (4)
1. Diffuse 2. Central 3. Laminated 4. Popcorn
41
What are the exceptions to the benign calcification pattern in SPNs?
1. Diffuse pattern can be seen in osteosarcoma/chondrosarcoma 2. Popcorn and central pattern can be seen in GI tumours and previous chemotherapy
42
Benign features of SPNs?
1. Stable growth at two years 2. Polygonal shape 3. Solid-only lesion 4. Enhancement of <15 HU
43
PET-CT findings of groundglass nodules - infection vs cancer
Infection: hot Cancer: cold
44
What size of peri-fissural lymph node would meet criteria for follow-up?
> 10 mm
45
Non-small cell squamous carcinoma characteristics?
Central location (squamous...'squeezed into the middle') Smoking association Paraneoplastic - ectopic PTH Rad - cavitation
46
Non-small cell large cell carcinoma characteristics
Peripheral location ('LA on the coast') Poor prognosis
47
Non-small cell adenocarcinoma characteristics
Peripheral location Most common subtype and most common to present as SPN Most common in a non-smoker Rad - upper lobe
48
Small cell lung carcinoma characteristics
Central location Strong smoking association Poor prognosis Paraneoplastic syndromes Rad - lymphadenopathy (may be only sign), SVC obstruction
49
Most common lung cancer in a non-smoker?
Non-small cell adenocarcinoma
50
Which lung cancers are peripherally located?
Non-small cell large cell Non-small cell adenocarcinoma (LA is on the coast)
51
Adenocarcinoma in situ spectrum
Atypical adenomatous hyperplasia (AAH) > Adenocarcinoma in situ (AIS) > Minimally invasive adenocarcinoma (MIA) > Invasive mucinous adenocarcinoma (BAC)
52
PET-CT appearances of BAC/adenocarcinoma in situ?
Cold
53
Pancoast tumour presentation
Pain along C8, T1, T2 Horner syndrome Atrophy of hand muscles
54
Pancoast tumour causes
NSCLC (apical) Metastasis Neural tumors of the brachial plexus Radiation fibrosis Infection
55
Nodal disease (N) staging for lung cancer
Via PET-CT N1: Ipsilateral hilar nodes N2: Ipsilateral mediastinal or subcarinal nodes N3: Contralateral nodes
56
Complications of lung cancer treatment
Bronchopleural fistula Compensatory emphysema Radiation pneumonitis Recurrence
57
Radiology features suggesting recurrence?
Round morphology (not radiation scarring) Enhancing tissue along resection line New lymphadenopathy Persistent pleural effusion
58
Early vs late radiation changes post-lung cancer treatment
EARLY: groundglass LATE: dense consolidation, traction bronchiectasis, volume loss
59
Most common benign lung mass and its radiology?
Pulmonary hamartoma Rad - fat, popcorn calcification, hot on PET-CT
60
Most common lung tumour in AIDS and its radiology?
Kaposi sarcoma Rad - flame-shaped hilar opacities, bloody pleural effusion, NM Thallium positive
61
Canonball metastases - causes?
1. RCC 2. Choriocarcinoma (testes) (Also less commonly prostate and adrenal)
62
Causes of direct invasion metastasis?
Oesophageal Lymphoma Malignant mesothelioma
63
Causes of haematogeneous metastasis?
Breast, thyroid, renal, H+N (Feeding vessel sign)
64
Lymphangitic metastases causes?
Bronchogenic carcinoma (most common) Prostate Stomach Breast Pancreas
65
4 types of pulmonary lymphoma?
1. Primary pulmonary (PPL): NHL usually 2. Secondary: NHL usually 3. PTLD: following transplant/BMT 4. AIDS-related: second most common lung tumour in AIDS. Assoc e EBV
66
What is Poland syndrome?
Unilateral absence of pectoral muscle, resulting in hyperlucent hemithorax
67
Most commonly affected site of congenital bronchial atresia?
Apical-posterior segment of left upper lobe
68
Rad appearances of bronchial atresia?
Hyperinflated lobe and hyperlucency Well-defined ovoid mucocele
69
Aetiology of AVM of lung?
1. HHT (Osler-Weber-Rendu) 90% 2. Acquired: surgery, trauma, cancer
70
What is pulmonary AVM? What direction is the shunt?
High flow, low resistance connection between pulmonary artery and vein. Causes a RIGHT-to-LEFT shunt
71
What is Swyer-James syndrome?
Unilateral lucent lung. Usually post-infectious in childhood, resulting in bronchiolitis obliterens. Size of affected lobe is smaller
72
What syndrome is horseshoe lung associated with?
Schmitar syndrome
73
Pulmonary LCH - aetiology and radiology
Aet: young smokers, 20s-30s Rad: centrilobular nodules, mixture of thin and thick walled cysts
74
Lymphangiomyomatosis (LAM) - aetiology and radiology
Aet: women of reproductive age, tuberous sclerosis Rad: thin-wall round cysts, chylothorax, pleural effusion, PTX
75
Birt-Hogg-Dube syndrome
AD disorder. Triad of: 1. Lung cysts (oval, thin-walled, lower lobes) 2. Renal lesions 3. Cutaneous lesions
76
What disorders is lymphocytic interstitial pneumonitis (LIP) associated with?
Sjogren's, SLE, RA, Castleman's, HIV (in children)
77
Vanishing lung syndrome
Large bullous emphysema, usually young men. Can cause tension PTX
78
Emphysema types?
1. Centrilobular: upper lobe predominant, smoking 2. Panlobular: lower lobe predominant, alpha-1 AT deficiency 3. Para-septal: subpleural
79
What feature distinguishes asbestosis from UIP?
Parietal pleural thickening
80
Most common radiology finding in asbestosis?
Pleural effusion
81
Rad appearances of silicosis?
Multiple pulmonary nodules with calcification - coalesce to pseudoplaque Upper lobe and peri-lymphatic distribution 'Eggshell' peripheral calcification
82
Silicosis complications?
TB Progressive massive fibrosis
83
Rad appearances of silicosis vs coal worker lung (pneumoconiosis)?
Both are upper lobe predominant nodules with peri-lymphatic distribution. Silicosis > pseudoplaques Coal worker > granular nodule appearance
84
Berylliosis rad?
Upper lobe nodules and groundglass. Indistinguishable from sarcoidosis.
85
Progressive massive fibrosis vs cancer on MRI
PMF is T2 dark (cancer is T2 bright)
86
Interlobular septal thickening - smooth vs nodular
Smooth - pulmonary oedema Nodular - lymphangitic spread
87
UIP radiology features
Honeycombing (hallmark) Reticular pattern on CXR Traction bronchiectasis Predominantly subpleural and basal (Biopsy not necessary if definite features)
88
Interstitial disease - UIP vs Non-UIP
UIP DOES NOT respond to steroids (others do). UIP is the commonest and has a poor prognosis
89
NSIP radiology features
Cellular or fibrotic types. Groundglass Reticulations Traction bronchiectasis (fibrotic) Immediate subpleural sparing (Honeycombing is minimal)
90

FRCR 2A (10 decks)

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