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44 Cards in this Set

  • Front
  • Back
Tracheal stenosis
short or long segment?
Tracheal stenosis, short segment
incubation/tracheostomy, Wegener's, extrinsic compression mass, TB (especially after erosion into airway by broncholith), sarcoidosis.
Tracheal stenosis with thickening of cartilage rings
Wegener's (short segment), relapsing polychondritis (long segment)
tracheal stenosis with wall irregularity
Wegener's, sarcoidosis, TB, amyloidosis
subglottic stenosis
Post intubation or tracheostomy, sarcoidosis
tracheal wall calcification
TB, amyloidosis, tracheobronchopathia osteochochondroplastica (TBO)
tracheal or bronchial collapse on inspiration
relapsing polychondritis, tracheobronchomegaly (large trachea, though)
tracheal wall with dense calcifications in cartilagenous ring
diffuse tracheal and bronchial enlargement
tracheobronchomegaly (Mournier Kuhn), collagen vascular diseases (scleroderma, lupus)
widening of trachea on AP view, but narrowed on lateral
saber sheath trachea
cause of the saber sheath trachea
COPD, most commonly emphysema
focal diverticulum coming off of trachea
intrinsic tracheal mass
primary tracheal tumor versus metastasis
solitary intrinsic tracheal mass
90% are malignant
primary intrinsic tracheal tumors
common -- Mucoepidermoid and adenoid cystic. Less common -- squamous cell carcinoma and carcinoid.
Tracheal metastasis
melanoma, RCCA, breast
multiple noncalcified tracheal nodules
laryngeal papillomatosis -- 5% of laryngeal papillomatosis involves endobronchial trachea as well
endobronchial mass
bronchogenic carcinoma and all of the tumors affecting trachea (adenoid cystic, Muco Epidermoid, metastases, squamous cell, carcinoid)
extrinsic tumor invasion into trachea or large bronchus
bronchogenic lung cancers, thyroid
cystic bronchiectasis
cystic fibrosis
other forms of bronchiectasis
varicose and cylindrical
Mosaic perfusion
must see different levels of attenuation as well as smaller vessels within the dark poorly perfused areas.
Mosaic perfusion differential
differential is small airways disease versus small vessel disease.
Differentiate between them
perform end-expiratory high-resolution C. T. to look for geographic areas of air trapping. If air trapping is present it is small airways disease. If air trapping is not present, it is small vessel disease.
No air trapping is present on end-expiratory C. T.
small vessel disease. Usually chronic PE.
Air trapping is present on end-expiratory C. T.
small airways disease. Differential for air trapping is asthma, bronchiolitis obliterans, and hypersensitivity pneumonitis. Can also be due to cystic fibrosis or small airways infection, however, other findings suggesting these entities would be present.
Terminology on inspiratory versus excretory CT
Mosaic perfusion on inspiratory, air trapping on expiratory.
Plain film with numerous cystic lesions best seen centrally, lung expansion, with large anterior clear space on lateral view
cystic fibrosis
What should you expect to see on chest section
cystic fibrosis.
Thick walled cysts with Mosaic perfusion
cystic fibrosis.
C. T. with numerous lung cysts
immediately check to see if you can find any of the structures branching so you know it's not cystic lung disease. Also look at the general thickness of the walls. Wall thickness should not be so great in cystic lung disease but can be very great and cystic fibrosis. Often you can follow the tubular structures image to image.
History of eosinophilia
think ABPA. Also if there is history of chronic asthma or reactivity to Aspergillus antigen.
Central bronchiectasis
think ABPA. Bronchiectasis in cystic fibrosis goes close to the periphery whereas in ABPA it stays much more central the walls are thinner and there'll be evidence of mucoid impaction.
High attenuation tubular structure
think mucoid impaction
nodular lung disease on C. T.
immediately define pattern of distribution.
C. T. with lots of small lung nodules
are there pleural based nodules, or is there a small- gap? if there is a thin gap , it is centrilobular.
There are pleural based nodules
is the distribution patchy or random.
if the distribution is patchy and concentrated around the pleural edges, fissures, and bronchovascular bundles, it is a perilymphatic distribution. If it is completely random, it is a random distribution.
Differential for perilymphatic distribution
sarcoidosis, lymphangitic spread, silicosis and coalworkers pneumoconiosis.
Random distribution
hematogenous spread of infection or cancer. Miliary TB, Miliary fungal infection, hematogenous metastases.
Centrilobular distribution of nodules
AIRWAYS DISEASE Differential to start with: Bronchopneumonia, endobronchial spread of MAI or TB, then expand to: BBPEEH -- Bronchopneumonia (most common cause), bronchiolitis (infectious, i.e. viral, or inflammatory), pneumoconioses, endobronchial spread of infection (TB, MAI), endobronchial spread of tumor (bronchoalveolar cell), and hypersensitivity pneumonitis -- with appropriate history
Centrilobular distribution of nodules seen
look carefully for tree in bud -- which narrows the differential down to endobronchial spread of infection. Also look for lucencies within the nodules -- implies that the "nodules" are actually bronchioles with thickened walls, consistent with bronchiolitis.
CT with tree in bud
AIRWAYS INFECTION bronchopneumonia, endobronchial spread of TB or MAI, bronchitis/bronchiectasis, cystic fibrosis with infection.
Lymphangitic spread of cancer
occurs from spread of metastatic disease to the lung or bronchial cancer via the lymphatics. TOTALLY different than bronchioloalveolar cell which spreads endobronchially and causes centrilobular nodules.