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99 Cards in this Set
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Anterior mediastinal masses
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Retrosternal goiter
Elongated/aneurysmal dilatation of the innominate artery Thymic masses Germ cell neoplasms Lymphoma Ascending aortic aneurysm Rare: lymphangioma, mesenchymal tumors, parathyroid tumors, Morgagni’s hernia, Castleman’s disease |
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Thymic masses:
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thymoma (>40 y/o)
nodular hyperplasia lymphoma/leukemia carcinoma carcinoid thymolipoma thymic cyst (congenital, s/p XRT in Hodgkin’s disease) |
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Middle mediastinal masses
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Lymph node enlargement
Bronchogenic cyst Bronchogenic carcinoma Aortic aneurysm Esophageal carcinoma, duplication cyst Chronic mediastinitis (TB, histoplasmosis) Tracheal neoplasms: adenoid cystic carcinoma, mixed salivary gland tumor, carcinoid, SCC, adenocarcinoma Castleman’s disease (usually hyaline vascular type) Liposarcoma |
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Posterior mediastinal masses
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Neurogenic neoplasm: neurofibroma, schwannoma, neuroblastoma, ganglioneuroblastoma, ganglioneuroma
Vertebral neoplasm: osteochondroma, ABC, chondrosarcoma, osteosarcoma, Ewing’s sarcoma, myeloma, metastases Abscess Descending aortic aneurysm Extramedullary hematopoiesis Lateral thoracic meningocele: NF-1 |
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Fatty mediastinal masses
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Neoplasm: lipoma/sarcoma, thymolipoma, teratoma
Other: medistinal lipomatosis, herniated fat, epicardial fat pad, extramedullary hematopoiesis, chylolymphatic cyst Mediastinal lipomatosis Lipoma/liposarcoma Thymolipoma Morgagni’s hernia with omentum Epicardial fat pad Paraesophageal hernia with fat Extramedullary hematopoiesis (rarely fatty) Chylolymphatic cyst Teratoma |
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Cystic Mediastinal masses
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Thymic cyst
Cystic degeneration of thymic Hodgkin’s lymphoma Germ cell tumors Foregut cyst Neurenteric cyst Meningocele Pancreatic pseudocyst Lymphangioma Abscess Hematoma Goiter, cystic elements |
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Diffuse mediastinal widening
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Lipomatosis
Lymphoma Small cell bronchogenic carcinoma Mediastinitis Anaplastic/poorly differentiated SCC Hematoma |
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Pneumomediastinum (7)
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Spontaneous: asthma, coughing, decompression during diving
Barotrauma Tracheobronchial injury Vomiting (Boerhaave’s syndrome) Extension from retroperitoneum or neck Post-operative (<1 week NL) Positive-pressure ventilation |
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AS HIT mnemonic:
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Pneumomediastinum:
asthma spontaneous hyaline membrane disease iatrogenic (surgery, chest tube) trauma (esophageal rupture) |
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Mediastinitis, infectious
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Esophageal perforation: endoscopy, tumor, Boerhaave’s syndrome
Post-operative infection Cervical infection spreading caudally |
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Mediastinitis, fibrosing
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Histoplasmosis
TB Autoimmune disease (may be associated with retroperitoneal fibrosis, sclerosing cholangitis, Reidel’s thyroiditis, orbital pseudotumor) Methysergide |
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Bilateral hilar/mediastinal lymphadenopathy
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Sarcoidosis
Bronchogenic carcinoma (usually unilateral) Lymphoma TB (usually unilateral) Histoplasmosis Coccidiodomycosis (usually unilateral) Mycoplasma pneumonia Viral disease Bacterial infection (usually unilateral) Leukemia Metastases from extrathoracic primaries Silicosis Cystic fibrosis Langerhan’s cell histiocytosis |
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Hilar/mediastinal lymphadenopathy in AIDS
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Kaposi’s sarcoma
TB, MAI Lymphoma Cryptococcus |
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Unilateral hilar enlargement
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TB, coccidiodomycosis, histoplasmosis
Bronchogenic carcinoma Lymphoma Surgical shunt Post-stenotic from pulmonary valvular stenosis, pulmonary artery coarctation Pulmonary embolism Partial absence of left pericardium Pulmonary AVF |
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Mediastinal calcification
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Lymph node, treated lymphoma
Granulomatous disease: histoplasmosis, TB, coccidiomycosis Silicosis Contrast material (pseudo calcification) Sarcoidosis Teratoma |
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Egg shell calcification
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Silicosis
Sarcoidosis Pneumoconiosis of coal workers (rare) Lymphoma after radiation (rare) |
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Cardiac calcification
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Aortic/mitral valves
Coronary arteries Annulus of aortic/mitral valves (C- or J-shaped) Pericardium (constrictive pericarditis) Myocardium Endocardium (thrombus) Tumors (myxoma, rare) |
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Focal tracheal mass
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Inflammatory polyp/papilloma: after instrumentation or tracheotomy
Mixed salivary gland tumor: adenoid cystic carcinoma, mucoepidermoid carcinoma Tracheal SCC, adenocarcinoma, small cell carcinoma Invasion from cancer of lung, larynx, thyroid, esophagus Metastases: RCC, breast, colon, melanoma Lymphoma Other tumors: neurogenic, smooth muscle, fibromas, hemangiomas, chondromas Hematoma Papillomatosis Rare causes: Rheumatoid, sarcoidosis, coccidioidomycosis, scleroderma, Wegener’s granulomatosis, foreign body, amyloidosis |
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Diffuse tracheal narrowing
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Saber-sheath trachea (COPD)
Relapsing polychondritis Tracheopathia osteochondroplastica (50 y/o male) Amyloidosis Others: RA, scleroderma, Wegener’s granulomatosis |
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Focal tracheal narrowing
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Traumatic stricture: post-intubation or tracheotomy
Neoplasms Infectious/inflammatory masses: TB, histoplasmosis, Wegener’s granulomatosis Extrinsic compression: vascular ring, neoplasm, goiter Vascular ring, pulmonary sling Congenital complete tracheal ring (rare) |
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Tracheomalacia
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Overinflated ETT cuff
Trauma XRT TE fistula Complication of surgical repair Relapsing polychondritis Extrinsic mass effect |
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Bronchial obstruction
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MEAT FACE mnemonic:
Mucous plug Endobronchial granulomatous disease: broncholith in TB, histoplasmosis Adenoma TB Foreign body Amyloidosis, atresia (bronchial) Carcinoma (primary) Endobronchial metastases: renal, thyroid, melanoma, breast, colon |
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Lobar/segmental atelectasis
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Intraluminal: foreign body, mucous plug (CF, asthma with ABPA, post-operative), bronchial metastasis (RCC, breast, colon, melanoma)
Mural: non-small cell carcinoma, bronchial adenoma, carcinoid tumor, hamartoma, non-infectious granulomatous disease (sarcoidosis, Wegener’s granulomatosis), infectious granulomatous disease (TB, fungal infections), collagen vascular disease (rheumatoid bronchostenosis), congenital bronchial atresia, bronchiectasis, trauma (fractured bronchus), middle lobe syndrome (TB, MAI), lymphadenopathy |
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Solitary pulmonary nodule, <3 cm
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Malignant neoplasm: bronchogenic carcinoma, lymphoma, sarcoma, carcinoid (peripheral in 20%), pleural fibroma, solitary metastasis from colon, kidney, ovary, testes, melanoma
Inflammation/infection: granuloma from post-primary TB, histoplasmosis, coccidiodomycosis, cryptococcus, hydatid cyst, round atelectasis, plasma cell granuloma (child), rheumatoid nodule Benign neoplasm: hamartoma, lipoma, fibroma, neurogenic tumor, intraparenchymal lymph node Splenosis or endometrial tissue AVM, hemangioma, pulmonary vein varix Infarct Bronchogenic cyst (peripheral in 15%) or pulmonary sequestration Caplan’s syndrome (RA & coal worker’s pneumoconiosis) Progressive massive fibrosis Pseudo mass: rib fracture with callus, pulmonary vein end-on |
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Solitary mass, >3cm
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Brochogenic carcinoma
Tuberculoma, histoplasmoma Hydatid cyst (uncommon) Hamartoma Abscess Bronchoalveolar cell carcinoma Solitary metastasis Rheumatoid nodule Bronchogenic cyst PMF |
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Lung CA T1:
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<3 cm nodule
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Synchronous lung cancers occur how often?
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1-2%
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localized fibrous tumor of the pleura affects
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visceral pleura
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Multiple nodules/masses, any size
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Neoplasm: Mets, lymphoma, papillomatosis, BAC, hamartoma;
Infection: TB, fungal, viral, PCP inflammatory: sarcoid, RA, EG; Other: amyloid, AVMs, trauma, mucous |
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Miliary nodules, <10mm
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TB, histoplasmosis, coccidiodomycosis, blastomycosis, South American paracocci
Hematogenous metastases: thyroid, melanoma, choriocarcinoma, osteosarcoma Inhalational lung disease: silicosis, pneumoconiosis of coal workers, berylliosis Viral pneumonias: varicella Multifocal BAC Sarcoidosis Langerhan’s cell histiocytosis Rare: microlithiasis, hemosiderosis, amyloidosis |
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TEMPS BV mnemonic:
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miliary nodules:
TB/fungal EG metastases pneumoconioses silicosis sarcoidosis BAC viral pneumonia |
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Calcified pulmonary nodules
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HAM TV’s mnemonic:
Histoplasmosis, hamartoma Amyloidosis, alveolar cell carcinoma Mitral stenosis (pulmonary ossification), metastases (thyroid, osteosarcoma, mucinous adenocarcinoma) TB Varicella Silicosis |
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Cavities, thick-walled
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Bronchogenic carcinoma: SCC, BAC/adenocarcinoma (rare), others never
Primary lymphoma (rare) Metastases: SCC of head and neck, cervix, esophagus |
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Cavities, thin-walled
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Blebs, bullae, Traumatic lung cyst/Pneumatocele, bronchogenic cyst, Congenital cyst
Other: mets, papillomatosis, bronchiectasis, emphysema |
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Cavities with air-fluid level
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Cavitating bronchogenic carcinoma
TB Mycetoma Pulmonary bullae, infected or non-infected Infected lung cyst Lung laceration with liquefied hematoma Infected sequestration Necrobiotic rheumatoid nodule Cavitary pulmonary infarct Infection of pre-existing cavity Wegener’s granulomatosis |
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Consolidation, lobar/segmental
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Pneumonia
Infarction Lung contusion Focal edema: positional, RUL with rupture of anterior mitral valve leaflet (MR) Radiation BAC Lymphoma Alveolar proteinosis Hemorrhage |
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Pulmonary Edema (PCWP in mmHg)
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Vascular redistribution (12-17)
Interstitial edema (18-25) Alveolar edema (>25) Often occurs in CHF, volume overload, renal failure |
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Atypical pneumonia:
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Mycoplasma
Chlamydia psittaci Coxiella burnetti |
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Viral pneumonia:
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adenovirus
varicella influenza RSV measles parainfluenza |
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Lofgren’s syndrome (features (3) and prognosis):
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Sarcoidosis with erythema nodosum and arthralgias
carries a good prognosis |
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CD4 >200:
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TB
bacterial pneumonias (staphylococcus, H. influenza, mycoplasma, legionella) |
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CD4 200-50:
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PCP
Kaposi’s sarcoma |
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CD4 <50 (3):
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CMV
MAI AIDS-related lymphoma |
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AIDS with pleural effusion, LAD, airspace consolidation:
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Kaposi’s sarcoma (201Tl positive)
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XRT pneumonitis occurs at
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1-3 months
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XRT fibrosis occurs at
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9-12 months
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Tubular densities
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Mucoid impaction (ABPA, CF)
congenital (bronchial atresia) tumor (carcinoid, bronchogenic carcinoma) AVM Pulmonary vein varix (left atrium) Bronchiectasis |
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Bronchiectasis
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Congenital: bronchial atresia, Kartagener’s syndrome, CF, a-1-antitrypsin disease, Williams-Campbell syndrome, Mournier-Kuhn syndrome, hypogammaglobulinemia, impaired mucocilliary clearance
Post-infectious: measles, Whooping cough, TB, Swyer-James syndrome, ABPA Necrotizing infection: aspiration |
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Bronchiolitis obliterans
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Idiopathic, Infection, Toxic: inhalation, Drugs,
GVHD/Autoimmune disease, S/p lung transplant |
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Fleeting infiltrates
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Allergic reactions
Drugs Parasites Inhaled antigens Loeffler’s syndrome Allergic aspergillosis Recurrent edema Chronic eosinophilic pneumonia with treatment Pneumocystis pneumonia bleeding into the lung |
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Peripheral infiltrates
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Loeffler’s disease (acute eosinophilic pneumonia)
Chronic eosinophilic pneumonia Organizing pneumonia (BOOP) Hypersensitivity pneumonitis Vasculitis Fungal infections Hemorrhagic metastases Septic emboli Resolving pulmonary edema |
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Ground glass opacities
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Hypersensitivity pneumonitis
Acute alveolitis: DIP, IPF, viral pneumonia Organizing pneumonia (BOOP) PCP Alveolar proteinosis Eosinophilic pneumonia Drugs Pulmonary edema |
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Bronchovascular distribution
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Kaposi’s sarcoma
Sarcoidosis Lymphangitic carcinomatosis Lymphoma |
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Increased lung volumes (chronic disease)
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CF
COPD EG LAM/TS |
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Diffuse air space consolidation
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Edema, Pneumonia, Hemorrhage, alveolar proteinosis, Adult respiratory distress syndrome
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Pneumonia:
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PCP
fungus bacteria aspiration |
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Hemorrhage:
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idiopathic pulmonary hemosiderosis (child)
Goodpasture’s syndrome bleeding diathesis anticoagulation therapy renal failure collagen vascular disease (SLE, scleroderma, HSP) trauma bronchiectasis tumor bronchitis |
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Chronic air space consolidation
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Alveolar proteinosis
Lymphoma Pseudolymphoma (small lymphocytic infiltrate similar to lymphoma but stains different immunohistochemically) BAC Sarcoidosis Desquamative interstitial pneumonitis TB, fungus (rare) Lipoid pneumonia (rare) |
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SAD FALL mnemonic
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chronic consolidation:
sarcoidosis alveolar proteinosis DIP fungus/TB alveolar cell carcinoma lymphoma/pseudolymphoma lipoid pneumonia |
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Multifocal or diffuse transient air space consolidation
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Recurrent edema
Recurrent inhalation of toxins Recurrent exposure to extrinsic allergens (hypersensitivity pneumonitis) Recurrent hemorrhage Intermittent treatment of sarcoidosis |
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Diffuse interstitial disease
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SCHLITZ mnemonic:
Sarcoidosis Collagen vascular disease, CF Histiocytosis Lymphangitic carcinomatosis Idiopathic pulmonary fibrosis Tuberous sclerosis Pneumoconioses |
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Basal interstitial disease
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BALD ASS VR mnemonic:
Bronchiectasis Aspiration (including mineral oil) Lymphangitic carcinomatosis Desquamative interstitial pneumonitis, drugs Asbestosis, a-1-antitrypsin disease Sarcoidosis Scleroderma, RA Viral pneumonitis Rheumatoid lung, dermatomyositis/polymyositis |
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Stages of sarcoidosis
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0: NL CXR
1: mediastinal/hilar lymphadenopathy 2: mediastinal/hilar lymphadenopathy and parenchymal disease 3: parenchymal consolidation only 4: honeycomb lung |
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interstitial lung disease, chronic septal thickening
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Chronic pulmonary edema
Lymphangitic carcinomatosis Veno-occlusive disease (rare) Congenital lymphangiectasia (rare) |
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Lymphangitic carcinomatosis
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2 neck, 2 chest, 2 abdomen, 2 pelvis mnemonic:
Thyroid, laryngeal carcinoma Breast, lung Stomach, pancreas, colon Prostate, bladder carcinoma |
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Drug toxicity (chronic pneumonitis/fibrosis)
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Bleomycin
Busulphan BCNU Nitrofurantoin Amiodarone Cyclophosphamide MTX |
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Noncardiogenic pulmonary edema
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Laryngospasm
Aspiration Neurologic (bleed, tumor, trauma), raised intracranial pressure Rapid re-expansion of lung Drug or transfusion reaction Inhalation of noxious agent: smoke, chemicals Heroin Early ARDS due to shock, sepsis, trauma |
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Honeycomb lung
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PISSER mnemonic:
pneumoconiosis IPF sarcoidosis scleroderma EG rheumatoid lung |
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Upper lung fibrosis/hilar elevation
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Post-primary TB
Radiation for breast or head and neck tumors Sarcoidosis in chronic destructive phase PMF Histoplasmosis Langerhan’s cell histiocytosis (uncommon) Ankylosing spondylitis (rare) |
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Upper lung interstitial disease
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CASSET P mnemonic:
CF Ankylosing spondylitis Silicosis, berylliosis (indistinguishable from sarcoidosis) Sarcoidosis EG TB PCP |
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Multiple ill-defined nodules, 5–20mm
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Non-infectious granulomatous disease
Infectious granulomatous disease Metastases BAC Extrinsic allergic alveolitis Pneumoconiosis Drug reaction |
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Non-infectious granulomatous disease:
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Langerhan’s cell histiocytosis
sarcoidosis rheumatoid lung Wegener’s disease |
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Infectious granulomatous disease:
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TB
histoplasmosis coccidiodomycosis viral pneumonia |
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Interstitial markings with pneumothorax (5)
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Langerhan’s cell histiocytosis
Sarcoidosis Any interstitial lung disease CF Lymphangioleiomyomatosis PCP |
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Unilateral hyperlucent lung
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Mastectomy
congenital absence of pectoral muscle (Poland syndrome) Proximal interruption/hypoplasia of the pulmonary artery, massive emboli Central airway obstruction with air trapping brochiolitis obliterans Swyer-James/Macleod syndrome congenital lobar emphysema atelectasis with compensatory hyperinflation Pneumothorax (supine) Giant bullous emphysema (young male) Post-transplant native lung emphysema pleural effusion opposite side |
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Bilateral hyperlucent lungs
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emphysema
a-1-antitrypsin disease methylphenidate abuse |
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Common pneumoconioses with fibrosis (3):
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silcosis
pneumoconiosis of coal workers asbestosis |
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Common pneumoconioses without fibrosis:
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stannosis (tin)
siderosis (iron) barytosis (barium) |
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Allergenic pneumoconioses:
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berylliosis
cadminosis |
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Organic dust pneumoconioses:
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farmer’s lung (fungi)
bagassosis (sugar cane) byssinosis (cotton) bird fancier’s lung (bird proteins) sequoiosis (tree protein) |
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Pneumothorax with otherwise NL CXR
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Blebs, bullae
TB Trauma Metastases: osteosarcoma Asthma Decompression (diving) Langerhan’s cell histiocytosis Spontaneous (tall, thin young male) |
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Spontaneous pneumothorax
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Underlying disease: blebs, interstitial, asthma, CF, mets
Infection: PCP Other: sarcoid, EG Blebs TB Metastasis Asthma Langerhan’s cell histiocytosis Sarcoid Any interstitial disease CF PCP |
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Unilateral pleural effusion with NL lungs
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Pleural metastases: adenocarcinoma of breast, lung
TB Collagen vascular disease: rheumatoid lung, SLE PE Trauma Chylothorax Pancreatitis Meig’s syndrome Post-pericardiotomy syndromes Subphrenic abscess Asbestos-related pleuritis Peritoneal dialysis Viral pleuritis (rare) Mesothelioma |
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Left-sided pleural effusion
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PE
Constrictive pericarditis Aortic dissection with rupture Trauma Boerhaave’s syndrome Pancreatitis Trauma to upper thoracic duct Apical left heart failure |
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Right-sided pleural effusion
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Left heart failure
Cirrhosis S/p liver transplant Subphrenic abscess Ascites |
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Pleural effusion with lung consolidation/mass
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Bronchogenic carcinoma
Lymphoma Metastases Empyema Pancreatitis Pneumonia PE with infarct Trauma with hydrothorax |
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Pneumonia causing pleural effusion:
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anaerobes
staphylococci Klebsiella fungi mycoplasma virus amebic abscess |
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Pleural mass
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Mesothelioma
Metastases from extrathoracic tumor Metastatic lung adenocarcinoma Resolving empyema, hematoma Rib lesion Loculated effusion Extrapleural lipoma Post-inflammatory fibrin ball Transpleural extension of invasive thymoma Splenosis Localized fibrous tumor of the pleura |
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Pleural calcification-Unilateral:
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asbestos pleural plaques
healed bacterial or tuberculous empyema organized hemothorax |
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Pleural calcification-Bilateral:
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asbestosis
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Pleural thickening
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Healed empyema
Resolved hemothorax Resolved asbestos pleuritis Confluent pleural plaques Extrapleural fat SLE S/p thoracic surgery |
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Complete opacification of hemithorax
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FAT CHANCE mnemonic:
Fibrothorax (TB) Adenomatoid malformation Trauma (hemothorax) Collapse Hernia Agenesis of lung Neoplasm: mesothelioma Consolidation Effusion |
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Unilateral elevated hemidiaphragm
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Subpulmonic effusion (pseudo elevation)
Lobar atelectasis S/p resection Congenital small lung Phrenic nerve paralysis Hypoplastic lung (usually right side) Subdiaphragmatic abscess, mass Traumatic rupture of diaphragm Diaphragmatic tumor |
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Phrenic nerve paralysis:
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iatrogenic
bronchogenic carcinoma surgery trauma |
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Diaphragmatic tumor:
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lipoma
lymphoma mesothelioma hernia (Bochdalek, Morgagni) eventration |
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Bilateral elevated hemidiaphragm
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Shallow inspiration
Restrictive lung disease Obesity, pregnancy, ascites, abdominal mass Muscle weakness (from SLE, myasthenia gravis, amyotrophic lateral sclerosis) |
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Chest wall mass
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Mesodermal tumor
Neurogenic tumor Bone tumor Vascular tumor Hematoma Infection: actinomycosis, nocardiasis, blastomycosis, TB |
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Rib lesion with surrounding soft tissue mass
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Metastases
Multiple myeloma Lymphoma Fibrosarcoma Neurofibroma Osteitis: TB, mycosis, nocardiasis, blastomycosis trauma renal osteodystrophy Cushing’s syndrome Radiation |
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Malignant chest wall tumor, child
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Ewing’s sarcoma
Neuroblastoma Askin’s tumor (neuroectodermal small cell tumor) Rhabdomyosarcoma |