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76 Cards in this Set
- Front
- Back
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Smooth assymetric septal thickening
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Lymphangitic spread of lung ca
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Pathology / Syndrome / Assoc diseases
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UIP / IPF / CVD, drugs, asbestos
NSIP / NSIP / CVD, drugs OP / COP / inf, CVD, drugs, fumes, HP DIP / DIP / smoking, fumes |
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UIP
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heterogeneous fibrosis
reticulation, traction brochiectasis, honeycombing (subpleural) (70%) GGO uncommon Lower lobes UIP = IPF mean survival 3yrs treatment of little value |
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Honeycombing / UIP DDx:
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collagen disease (rhematoid arthritis, scleroderma)
asbestosis drug- related fibrosis chronic hypersenstivity pneumonitis |
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NSIP
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-less common that UIP
-homogenous fibrosis -GGO and reticular opacities -GGO alone = cellular -GGO + reticulation = fibrotic -SPARING of subpleural lung -lower lobes -good response to Rx |
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RB-ILD and DIP
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-continuum of same disease (DIP more extensive)
-all cases related to smoking -steroids; good prognosis -localized and centrilobular GGO in RB-ILD -diffuse, patchy GGO in DIP |
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Acute consolidation DDx
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-pneumonia
-edema -hemorrhage (SLE) -diffuse alveolar damage (ARDS) |
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Chronic consolidation DDx
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-organizing pneumonia (OP)
-chronic eosinophilic pneumonia -broncioalveolar carcinoma (BAC) |
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Organizing Pneumonia
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-common
-several months cough, low-grade fever, dyspnea -patchy airspace consolidation (90%) -large nodules (15%) -peripheral distribution -"atoll" or "reverse halo sign" -steroid tx; good prognosis |
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Chronic eosinophilic pneumonia
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-peripheral eosinophilia usually present
-hx of asthma in half -identical to OP in appearance -peripheral GGO or consolidation -upper lobes -rapid response to steroids |
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GGO: acute
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same as acute consolidation
-edema -hemorrhage -atypical pna (PCP, viral) -diffuse alveolar hemorrhage (ARDS) |
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GGO: chronic
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-interstitial pneumonias (NSIP, DIP)
-HP -OP -Chronic eosinohphilic pna -BAC |
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Hypersensitivity pneumonitis
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-common
-patchy GGO (most) -ill-defined centrilobular nodules (half) -mosaic perfusion -diffuse |
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Crazy paving pattern
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GGO and septal thickening
Acute: -edema, infection, hemorrhage, ARDS, HP Chronic: -alveolar proteinosis** (symmetric, geographic) |
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Perilymphatic nodules
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subpleural and peribronchovascular
sarcoidosis lymphangitic spread of tumor silicosis and CWP (uncommon) remember egg-shell calcificaitons in silicosis |
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Sarcoid
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-mediastinal nodes (60-90%)
-lung dx on CXR in half -perilymphatic nodules -upper lobes -upper lobe masses and satellite nodules, "galaxy sign" -Late: fibrosis -1-2-3 pattern on CXR = right paratracheal, right hilar, left hilar |
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Random nodules
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-miliary TB
-miliary fungal infections -hematogenous mets |
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Centrilobuar nodules
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GGO (indistinct):
-HP (most likely) -respiratory bronchiolitis (smoking) -atypical infections (acute symptoms - viral) Dense, patchy: -endobronchial spread of infection (bacteria, TB, MAC) -aspiration -endobronchial spread of tumor (BAC) |
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tree-in-bud
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-dilation and impaction of centrilobular airways
-assoc with centrilobular nodules -infection: -endobronchial spread of TB, MAC -bronchopneumonia -bronchitis -cystic fibrosis |
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Langerhan's cell hstiocytosis
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-irregular thick or thin walled cysts
-upper lobes |
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Lymphangiomyomatosis (LAM)
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-round, thin walled cysts
-diffuse -only in women of childbearing age -1% of pts with tuberous sclerosis |
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Lymphangitic interstitial pneumonitis (LIP)
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-round, thin walled cysts
-LIMITED in numbed (can count) -diffuse -assoc with Sjogren's |
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Anterior mediastinal mass
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1. Thymoma = thymic tumors
2. Teratoma = GCTs 3. Terrible lymphoma = lymphoma and node masses 4. Thyroid = thyroid and parathyroid masses (avid enhancement) |
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Thymic epithelial tumors
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-most common primary thymic tumor
-50-60yrs (NOT YOUNG!) -myasthenia gravis in 30-50% Thymoma (non-invasive) -preserved fat planes -smaller -normal pleura -soitary Invasive thymoma, thymic ca -Large, hetero -Pleural effusions, nodules -Seprate LAD |
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Germ Cell Tumors
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2-4th decades; 80% benign, mostly teratomas
Mature teratoma -well defined, mature elements (fat, fluid, calcium) Seminoma -men; mean age 29 -20-40% malignant GCT -large smooth or lobulated, homogeneous mass -sensitive to rad and chemo, good prognosis Nonseminomatous GCT -large, hetero, infiltrative mass |
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Cardiophrenic angle mass
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-Pericardial cyst
-Fat pad -Thymoma and other ant med masses -Morgagni hernia -Lymph node masses -Lipoma |
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Middle Mediastinal Mass
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Bronchogenic cysts (foregut cysts)
Aneurysm TB/sarcoid/histoplasmosis Tumor (squamous cell, oat cell, mets) Lymphoma Esophagus (diverticulum, tumor) |
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Calcified lymph nodes
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Dense: old granulomatous ds, sarcoid
Egg-shell: silicosis or CWP, sarcoid, TB, treated Hodgkin's Uncommon causes (punctate): metastatic ca or sarcoma, untreated lymphoma |
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Low attenuation (necrotic) nodes
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-Infection (TB and fungus)
-Mets (lung ca, extrathoracic) -Lymphoma |
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Enhancing nodes
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-Mets (renal, thyroid, lung, melanoma)
-TB -Rare: Castleman's Differentiate from enhancing masses (substernal thyroid, carcinoid, lymphangioma, hemangioma, paraganglioma) |
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Castleman's disease
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Localized
-Hyaline Vascular type (mostly) -Children, young adults -Ehancing mediastinal mass -Benign course; resection curative Multicentric -Plasma cell type (mostly) -Adults 40-50 -Multiple enhancing nodes; splenomegaly -Aggressive -associeated with POEM syndrome |
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Metastatic tumor
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Mets from extrathoracic primary to mediastinal or hilar nodes uncommon
-Paravertebral nodes = abdomen -Superior med nodes = H&N -Internal mammary = breast, lymphoma -Paracardiac = breast or abd |
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Sarcoid CXR staging
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1. Hilar adenopathy
2. Hilar adenopathy + lung ds 3. Lung ds only 4. Fibrosis |
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Posterior mediastinal mass
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-Neurogenic tumor (nerve sheath, ganglion cell, paraganglioma)
-Foregut cyst -Meningocele -Extramedullary hematopoeisis -Vertebral body tumor (GCT) |
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Neurogenic tumors
most posterior mediastina masses |
Nerve Sheath tumors
-neurofibroma (30), schwannoma (40) -round, 1-2 vertebral body segments -may or may not extend into NF -pressure erosion of adjacent VB or ribs -low attenuation in 70% -hetero enhancement Ganglion cell -neuroblastoma (<5), ganglioneuroblastoma (10), ganglioneuroma (20) -long, sausage-shaped -multiple VB segments -CT appearance similar to NST |
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Cervicothrocic sign on CXR
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Well defined mass at or above the level of the clavicle on CXR -
posterior mediastinum |
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Extramedullary hematopoesis
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-Symmetric, homogenous bilateral paravertebral masses
-Extension of hyperplastic marrow -Hemolytic anemia, thalassemia -Fat visible in masses with improvement |
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Round atelectasis
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-Volume loss
-Contact with the pleura -Abnormal pleura (plaque or effusion) -Swirling of vessels/bronchi ("comet-tail sign") Must get follow-up to exclude cancer! |
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Round pneumonia (mass-like pna)
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-CAP (strep pneumo)
-Fungal (cryptococcus, histo) -Abscess/anaerobic inf Get follow-up! |
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Congenital masses
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-CCAM
-Congenital diaphragmatic hernia -Sequestration -Bronchogenic cysts -AV Malformation |
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CCAM/CPAM
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-hamartomatous mass
-Type 1 - single or multiple large cysts >2cm -Type 2 - multiple small cysts <2 cm -Type 3 - solid appearing microcystic May be assoc. with pulmonary hypoplasia or hydrops In adults, typically appear as areas of cystic hyperlucency, with recurrent infxn |
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Congenital diaphragmatic hernia
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-Most commonly posterolateral (Bochdalek in Back)
-9:1 on left -Appears solid at birth -May result in pulmonary hypoplasia |
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Bronchogenic cyst
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-Cystic anomaly of ventral foregut
(dorsal foregut forms esophagus) -Most common intrathoracic foregut cyst (more common than eso duplication cyst) -Usually contain proteinaceous fluid -Mediastinal 86%, intralobar 14% |
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AVM
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-Failure of formation of pulmonary capillaries
-Assoc with HHT/OWR -Multiple in 1/3 -Right to left shunt, 20% cardiac output for 1cm lesions -Causes dyspnea, cyanosis, clubbing, hemoptysis, paradoxial embolization -Treated with coil embolization |
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Adenocarcinoma
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-Peripheral pulmonary nodule
-Frequent nodal mets to hilum, watch for brain and adrenals |
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BAC
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-more benign cousin of Adeno
-focal area of GGO classic -also get multiple areas of consolidation or miliary pattern in more advanced cases |
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Squamous cell ca
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-central cavitary masses with wall thickness >15mm
-strong assoc with smoking -irregular inner margins |
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Small cell ca
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-Aggressive neuroendocrine tumor
-Tend to arise around the hilum with big, bulky mediastinal masses |
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Tumor Staging for NSCLC
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-Stage 3B and IV are non-operative
-any T + N3 = stage 3B -T4 + any N = stage 3B -any T + any N + M1 = stage IV T4 - invasion of trachea, carina, mediastinum, heart, great vessels, esophagus, spine -malignant pleural or pericardial effusion -malignant satellite nodules N3 -contralateral hilar or mediastinal nodes -scalene and supraclavicular nodes |
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Risks of percutaneous lung bx
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-PTX 20%
-Chest tube required 5-10% -Hemoptysis 5% -Malignant seeding 0.01$ -Air embolism 1% (definitive tx is hyperbaric O2 therapy) |
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Calcified masses
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-metastatic osteosarcoma
-pulmonary alveolar microlithiasis -calcified pleural hematoma -metastatic calcfication -calcified tuberculoma |
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Airway masses
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-squamous cell ca (distal)
-adenoid cystic ca (cylindroma) -carcinoid (vascular) -direct invasion (eg from esophagus or lung primary) -mets (melanoma, breast) -benign tumors (hamartoms, papillomas) |
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Cannonball Mets
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-Term used for smaller number of large mets, typically of GI or GU origin
-Colon ca -Renal ca -Testicular/ovarian ca -Osteosarcoma (often calcifies) |
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Lytic rib lesions
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-Mnemonic FAME
-Fibrous dysplasia -ABC -Mets/myeloma -Enchondroma -Hyperparathyroid / Brown tumor |
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Plasmacytoma
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-typically precees multiple myeloma
-usually originates in bone, causing expansile osteolytic mass -may present as tracheal mass or pulmonary nodules (extramedullary plasmacytoma) |
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Immune-deficient masses
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-PTLD
-Pulmonary lymphoma -Kaposi's sarcoma (flame shaped nodule, most pts with KS in lungs have mucocutaneous ds) -Bronchogenic ca (increased incidence, more aggressive) -Mass-like infection |
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Wegener's granulomatosis
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-Systemic small vessel vasculitis assoc with cough, hemoptysis
-C-anca positive -Multiple nodules or masses, often cavitate (50%) -Look for sinus, renal ds |
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Pancoast tumor
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Apical mass
Bone destruction Horner's syndrome - sympathetic ganglia, myosis (small pupil), ptosis, anyhydrosis (no sweating) |
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Mosaic perfusion (lucent lung abnormal)
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-With expiration, lucent lung stays lucent and dense lung gets denser - signifies air trapping.
Small airways disease>>>small vessel disease -asthma -HP -Constrictive bronchiolitis (bronchiolitis obliterans) |
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Diffuse tracheal wall thickening
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Sarcoid
Amyoloid Wegenoid (Wegener's) Relapsing polychondritis (assoc. with IBD) |
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Cystic bronchiectasis - lower lungs ddx
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Chronic, severe inflammation of the airways
-Post-viral infection (as a child) -Primary ciliary dyskinesia (Kartagener's - situs inversus, sinusitis, bronchiectasis) -Immunodeficiencies (e.g. agammaglobinemia) |
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Cystic bronchiectasis - upper lobes ddx
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Symmetric
-Cystic fibrosis Assymetric -ABPA (hx of asthma, high density mucous in an impacted bronchus) -TB -Endobronchial tumor |
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Lobar collapse
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Left upper lobe
Luftsichel sign - lucency around the aorta Right upper lobe S-sign of golden - hilar tumor Combing RML/RLL -peak of opacity is medial (not lateral as in subpulmonic effusion) |
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Intralobar sequestration
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-Older patient
-Presents with infection -Solid, cystic, or lucent -Systemic arterial supply -Systemic or pulmonary venous drainage |
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Extralobar sequestration
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-Young patient
-Incidental -Other congenital anomalies -Solid -Systemic arterial supply -Systemic venous drainage |
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Unilateral lucent lung
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Soft tissues - mastectomy
Pleural - ptx Parechyma -bronchial obstruction (aspirated fb, tumor, atresia) -Swyer James - post-infectious bronchiolitis obliterans (small volume, small PA, bronchiectasis) Vascular - PE (dec unilateral vascularity - Westermark's sign) |
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Mediastinal soft tissue infiltration
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Lymphoma/leukemia
Mets (e.g. lung ca) Acute mediastinitis Fibrosing mediastinitis Erdheim Chester |
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Fibrosing mediastinits
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Focal:
-80% -Paratracheal, subcarinal -Often calcified -Assoc with granulomatous inf (e.g. histoplasmosis) Diffuse: -20% -Non-calcified -not assoc. with granulomatous inf -Autoimmune d/o (e.g. retroperitoneal fibrosis) |
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Progressive massive fibrosis
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-Sarcoidosis
-Silicosis -Fungal disease initially most assoc with silicosis, now sarcoid more common |
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Multiple cavitary nodules
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Mets
Infection -septic emboli, fungal disease (aspergillosis), TB Vasculitis - Wegener's |
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Focal lung lucency
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Bronchial obstruction
-Aspirated FB -Endobronchial tumor (carcinoid) -Bronchial stricture (old TB) -Bronchial atresia (missed congenital lobar emphysema, LUL>RUL impacted bronchus, asymptomatic, rec bronchoscopy) Sequestration CCAM |
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Scimitar syndrome
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-PAPVR
-Systemic arterial supply -Pulmonary hypoplasia, small PA -Dextroposition of the heart |
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Tracheal disease
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Relapsing polychondritis
-Spares posterior memebrane -Long segment -No Ca++ Post-intubation, Wegener's: -Circumferential -no CA++ Tracheobronchopathia Osteochondroplastica -spares posterior membrane -nodular -Ca++ Amyloidosis -Ca++ -focal or long -irreg or circ |
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Tracheal neoplasm
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SCC (most common)
Adenoid-cystic (posterior) Mucoepidermoid - airways >> trachea |
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ABPA
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-Hypersensitivity reaction to aspergillus
-Asthma -Elevated IgE -High density mucous plugs |
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Dilated trachea
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Mounier-Kuhn
Sarcoid |
