Clinical - Radiology: Chest

Front 1

most specific finding for alveolar process?

Back 1

air bronchograms

Front 2

What is the most specific finding for interstitial lung process

Back 2

Kerley B lines - thickened interlobular septae
--seen in the costophrenic region

Front 3

General DDx for interstitial lung processes (five)

Back 3

Fluid - edema
Blood - hemorrhage
Pus - infection
Tumor - lymphangitic spread
Fibrosis

Front 4

Infections with calcifications; other conditions

Back 4

TB, histo/cocci/blasto
-->sarcoid, silicosis

Front 5

Infections with adenopathy

Back 5

TB, fungal, anthrax, tularemia, plague

Front 6

DDx for white-out of an entire lung; how to differentiate

Back 6

Total lung collapse - mediastinum shifts to ipsilateral side
Large Pleural Effusion - mediastinum shifts to opposite side

Front 7

Non-infectious causes of alveolar pattern on CXR

Back 7

Tumors (lymphoma, bronchoalveolar cell carcinoma); Inflammation (sarcoid, alveolar proteinosis)

Front 8

Peripheral alveolar pattern suggests what?

Back 8

More specific finding: eosinophilic infections

Front 9

Bibasilar alveolar pattern?

Back 9

aspiration pneumonia

Front 10

Hampton's humps

Back 10

geometric wedges of opacity fanning out to the periphery; signifies large PE and infarct

Front 11

Displacement of fissures outlined by pneumonia is indicative of what?

Back 11

volume loss; suspicious for post-obstructive pneumonia, should follow up with bronchoscopy

Front 12

Multilobar alveolar pneumonia?

Back 12

NOT pneumococcus - legionella, gram negatives, aspiration, aspergillus

Front 13

How do you differentiate between sets of ribs and diaphragms on lateral CXR?

Back 13

the right ribs are larger and more posterior; the R diaphragm will travel all the way back to meet them, and is also visible all the way to the front of the chest

Front 14

Infectious causes of interstitial pattern

Back 14

Viral pneumonia - influenza, parainfluenza, adenovirus
Mycoplasma
In immunocompromised: PCP, CMV

Front 15

air crescent - specific for what?

Back 15

invasive aspergillus - retreating infarct

Front 16

Why does someone get a lung abscess?

Back 16

1. aspiration pneumonia
2. poor compliance/treatment
3. obstruction
4. TE fistula
--do a CT to evaluate any time you have an abscess

Front 17

What is the Gohn complex radiologically?

Back 17

Calcification! In the granuloma and in the hilar lymph nodes; remember this is primary TB
-->remember that when TB heals it calcifies, as all granulomas do
-->for some reason miliary TB does not calcify!

Front 18

diffuse punctate calcifications all over the lung;

Back 18

varicella pneumonia after it has healed! When active, it is a necrotizing bronchiolitis. Remember, miliary TB Does not calcify

Front 19

Scarring in the lung apex with strange position of the hilum?

Back 19

volume loss from retraction of TB

Front 20

a pleural effusion that has septations or that is not in dependent portions of the lung?

Back 20

empyema!

Front 21

What is a pleural rind? What is the ddx?

Back 21

Thickening of the pleura, not in a dependent position
--TB
--empyema
--pleural hemorrhage
--mesothelioma
--pleural mets
--pleural fibrosis

Front 22

Describe three "types" of atelectasis and what they look like

Back 22

1. discoid, focal, sub-segmental: focal alveolar collapse
--small focal linear densities
2. Atelectasis and/or infiltrate
--slightly larger, patchy infiltrate
3. Lobar atelectasis/lobar collapse
--dense lobar consolidations
--surroundings respond to volume loss (mediastinum shifts toward, hemidiaphragm lifts)

Front 23

Differentiate between large pleural effusion and lung collapse

Back 23

Mediastinum:
shifts toward a collapse, away from an effusion if at all

Front 24

Medical treatment that may hasten reabsorption of simple pneumothorax?

Back 24

supplemental oxygen

Front 25

Hydropneumothorax

Back 25

a horizontal air-fluid level! Simple pleural effusion will usually have a meniscus

Front 26

What in apices can mimic pneumothorax?

Back 26

bullous emphysema; concave lines give it away

Front 27

Differentiate between pneumopericardium and pneumomediastinum

Back 27

pneumopericardium will always stay below the mid-ascending aorta
pneumomediastinum will often have many black streaky lines involving the superior mediastinum and deep cervical tissue

Front 28

pneumoperitoneum AND Pneumomediastinum?

Back 28

Boerhaave's syndrome

Front 29

R border of the mediastinum, top to bottom

Back 29

brachiocephalic vessels, SVC, ascending aorta, RA

Front 30

L border of the mediastinum, top to bottom

Back 30

brachiocephalic vessels, aortic knob, pulmonary artery, LV

Front 31

What normally lives in the cardiophrenic angles? What can enlarge this area?

Back 31

fat pads
enlarge:
steroid therapy (fat)
lymph nodes
pericardial cysts
pleural tumors

Front 32

What is the bulge on the bottom of the R paratrachael stripe?

Back 32

azygos arch

Front 33

popcorn calcifications in a lung nodule?

Back 33

hamartoma

Front 34

which two lesions cavitate in the lung?

Back 34

TB, squamous cell carcinoma

Front 35

Which type of lesions tend to enhance?

Back 35

Malignant - granulomas enhance, however, lowering specificity

Front 36

how to check for pericardial effusion on CXR?

Back 36

tramtrack sign - on lateral CXR - will see a light gray line between two dark gray lines parallel to and abutting the anterior chest wall - this represents the fluid separating the pericardial and epicardial fat pads

Front 37

Some causes of pericarditis

Back 37

Infectious
Viral- Coxsackie, Influenza, Mumps, HSV, Varicella Zoster Virus, Adenovirus
Pyogenic- postoperative infection , primary pneumococcal infection, empyema
Tuberculous, Mycotic, Syphilitic and Parasitic (rare in developed countries)

Noninfectious
Acute myocardial infarction and Dressler's syndrome (post MI, pericardiotomy)
Uremia- indication for emergency dialysis- usually painless
Neoplasia- radiation or metastases- usually from lung, breast, melanoma and lymphoma
Myxedema
Trauma
Sarcoidosis
Collagen Vascular Disorders- Rheumatic fever, SLE, RA, Scleroderma, Wegener's
Drug-induced- Procainamide, Hydralazine, Isoniazid, Cromolyn, Minoxidil
Amyloid

Front 38

Causes of calcified pericardium?

Back 38

chronic TB or hemorrhagic pericarditis

Front 39

"water bottle heart"

Back 39

pericarditis with effusion - enlarged heart with sagging apex

Front 40

Characteristics of benign lung nodules on CXR or CT

Back 40

fat - hamartoma
calcifications that are organized or popcorn

Front 41

retrosternal pneumonia

Back 41

there should not be opacity between the anterior edge of the heart and the sternum on lateral CXR

Front 42

Who gets bibasilar pneumonia?

Back 42

alcoholics (aspiration)

Front 43

How do you tell the difference between a consolidation and lobar collapse?

Back 43

Look for signs of volume loss - shift of other structures, fissures moving, etc

Front 44

Back 44

Bullous Emphysema

Front 45

Vytorin

Back 45

ezetimibe/simvastatin

ez ET i mibe and SIM va stat in

Hint 45

statin-reduces LDL and tri's--raises HDL

Front 46

What other abnormality besides air is in this KUB?

Back 46

fluid: hydropneumoperitoneum - notice the large air fluid level - often due to huge small bowel perforation

Front 47

Back 47

Bowel Ischemia

Front 48

Back 48

hadioasfja;fj

Front 49

What is this?

Back 49

emphysematous pyelonephritis

Front 50

What is causing the air in the bladder?

Back 50

A fistula

Front 51

What are the arrows? what is the diagnosis?

Back 51

The arrows are the properitoneal flank stripes; limit of the peritoneum; since the gas goes past those, its subcutaneous emphysema

Front 52

Classic signs of Pancoast Tumor

Back 52

Horner's Syndrome
Shoulder and arm pain in C8, T1, T2
Atrophy and Weakness of hand muscles

Front 53

What is the diagnosis?

Back 53

Barrett's Stricture - classic mid esophageal stricture with accompanying ulcer

Front 54

What is the diagnosis?

Back 54

Esophageal varices; only other possibility is carcinosarcoma, which is extremely rare, but has a varicoid appearance on BaSw

Front 55

Most reliable signs of hyperinflation on CXR

Back 55

flattening of the hemidiaphragm, increased size (>2cm) of the retrosternal airspace (between the sternum and chest)

Front 56

What is the diagnosis for the pink arrows? Differential?

Back 56

fibrothorax - prior TB, prior empyema, asbestos exposure, or prior trauma

Front 57

most common cause of a small heart on CXR (tear drop heart)

Back 57

COPD

Front 58

Chronic steroid use in a pulmonary patient can cause what three bone abnormalities?

Back 58

osteopenia, medullary infarcts, hypertrophic osteoarthropathy

Front 59

Weird way to tell apart ascending and descending thoracic aortic anuerisms?

Back 59

Both will show an apical cap and pleural effusion, but the SIDE matters: R side for ascending, L side for descending

Front 60

Stanford Classification of aortic dissection

Back 60

A - ascending
B - descending

Front 61

rachitic rosary

Back 61

string of beads on the ribs - sign of rickets

Front 62

fissural pseudotumor

Back 62

round collection on frontal CXR, elliptical on lateral - actually an effusion stuck in the fissure

Front 63

Which type of lung cancer can look like a pneumonia?

Back 63

bronchoalveolar carcinoma

Front 64

What does a hydatid cyst look like?

Back 64

kind of like an abscess - thin walled cyst but instead of an air fluid level there is a solid sphere on the bottom with a crescentic interface

Front 65

shaggy esophageal mucosa

Back 65

Candida - polypoid filling defects

Front 66

What strange malignancy favors the apices of the lung?

Back 66

Langerhans cell histiocytosis, formerly called Histiocytosis X, is a rare disease wherein histiocytes infiltrate many tissues. The hallmark cell is the Langerhans cell. Isolated bone or chest infiltration may be referred to as eosinophilic granuloma of bone or pulmonary eosinophilic granuloma (PEG), respectively. It is increased in smokers.

Front 67

Which way does the mediastinum shift in mesothelioma?

Back 67

ipsilateral