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183 Cards in this Set
- Front
- Back
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What is the ddx for an anterior mediastinal mass
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thymic lesion
germ cell tumor lymphoma thyroid goiter/mass vascular abnormality |
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What are 6 different types of thymic lesions
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thymoma, thymic hyperplasia, carcinoid, carcinoma, cyst, lymphoma, thymolipoma
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What age group tends to get NHL
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less than 40
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What age group tends to get hodgkins
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bimodal: 15-40 and >70
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What age group gets teratomas
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young
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When do thymic lesions tend to occur
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>40 years
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Describe the findings of an anterior mediastinal seminoma on a CECT
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Contrast-enhanced axial CT scan shows an ill-defined anterior mediastinal mass with irregular borders that is infiltrating the mediastinal fat
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Describe a thymolipoma
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Thymolipoma. large anterior mediastinal mass displacing the mediastinal vascular structures
project into the thorax thorax. Thymolipoma. CT scan of the chest shows a large anterior mediastinal mass displacing the mediastinal vascular structures to the right and projecting into the left thorax. The tumor is composed of both soft tissue and fat, and a few punctate calcifications are present. |
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What is a present in a thymolipoma
3 |
soft tissue
fat punctate calcifications |
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Where is the MC extragonal site for a germ cell tumor
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the anterior mediastinum
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What percent of anterior mediastinal germ cells are benign teratomas or dermoid
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70%
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What are the malignant germ cell tumor that can go to the mediastinum
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seminoma
chorioCa embryonal cell CA yolk sac tumor |
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What is the appearance of a teratoma/dermoid
4 |
predominately cystic with well defined margins, calcs, fat/fluid levels
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What causes the majority of mediastinal masses in adults
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Thymoma is the Majority of anterior mediastinal masses in adults
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What is a thymoma associated with
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myasthenia gravis, red cell aplasia, hypogammaglobulinemia
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What percent of patients with mg have thymoma
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15%
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What percent of patient with thymoma have mg
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40
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What percent of thymoma have ca
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20%
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Can a thymoma be invasive
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yes, 30% are invasive and extend beyond the fibrous capsule and locally to the pleura.
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What is more common of an anterior mediastinal mass; hodgkins or NHL
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hodgkins
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What is the most common finding of anterior mediastinal lymphoma
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single soft tissue mass or large lobulated mass of conglomerate LN
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What should you look for if you suspect lymphoma
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LN in other compartments of the body outside the chest
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If a tumor has calcification is it Lymphoma
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no, if it is untreated
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Where is the thyroid related to the other anterior mediastinal masses
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Behind the great vessels while others are in front
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What are the 3 anterior mediastinal masses that come from the thyroid
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Most are goiters, rest are adenomas and neoplasms
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What way do goiters push the trachea on plain film
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to the right
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What are 4 factors that favor an anterior mediastinal mass that is thryoid in origin
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continuity with thyroid, foci of high attenuation on NCCT, foci of heterogeneous attenuation, intense and prolonged enhancement on CECT
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What is the most classic case of bronchiogenic carcinoma
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RUL atelectasis with endobronchial/hilar mass
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What is the reverse sign of golden
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central endobronchial lesion causing RUL collapse
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What is another classic presentation of bronchiogenic carcinoma on plain filma
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hilar or medistinal adenopathy with a solitary pulmonary nodule
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What are the 4 types of bronchiogenic carcinoma
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small cell, large cell, adeno, squamous
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Where do adenocarcinoma and large cell carcinoma tend to be located in the lung
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peripherally
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Where do SCC and small cell tend to be located in the lung
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centrally
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What stages of lung cancer are unresectable and what requires surgery
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Stage 3B and 4, unresectable
Stage 3A and below, surgery |
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What is the cause of aortic dissection
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Separation of intima from media
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Where do most aortic dissection arise from
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Almost all arise either in ascending aorta 1 cm above sinotubular ridge or in descending aorta just beyond aortic isthmus
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Where is the aortic isthmus
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that part of the aorta between the origin of the brachiocephalic trunk, or the left subclavian artery, and that of the ductus arteriosus which is partly constricted in the fetus; it marks the partial separation of fetal blood flow derived from right and left ventricles,
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What is the complication that may occur if an aortic dissection progresses proximaly
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pericardial tamponade, aortic insufficiency, coronary occlusion
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What are the 2 classification of aortic dissection
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Debakey 1 = ascending + descending, 2 = ascending only, 3 = descending only
Stanford A = any dissection involving ascending, B = descending only |
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What is the treatment for an aortic dissection
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ascending = surgical repair, descending = BP control
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What is a sign of aortic dissection in an aortogram
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double barrel aorta
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What is the criteria for repair of an aortic dissection in a type B
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persistent symptoms despite medical treatment
aortic size greater than 5-6 cm or greater than 1cm/yr impending or frank rupture malperfusion uncontrollable htn |
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Describe the findings of a dissection on a plain film
6 |
wide mediastinum
seperation of CA from wall or the aorta double knob sign prominent knob left apical cap displacement of trachea and esophagus, pleural effusion |
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What causes an left apical cap in aortic dissection
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If the parietal
pleura is intact, the blood may track cephalad along the course of the left subclavian artery between the parietal pleura and the extrapleural soft tissues, resulting in an extrapleural apical ca |
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What are the CT/MR fidings of aortic dissection
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linear filling defect representing an intimal flap
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What renal artery is typicaly fed by the false lumen
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left renal artery
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What iliac artery is typicaly fed by the false lumen
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left> right iliac
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What should always be evaluated if the dissection is close to the aortic valve
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coronary arteries
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When are most atrial septal defects found
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older child or adult
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When are most VSD found
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neonates
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What is the MC ASD
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ostium secundum
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Where is the defect of an ostium secundum type ASD
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central portion of the fossa ovalis
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What are the XR findings of ASD
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shunt vascularity
enlarged pulm arteries enlarged RV enlarged RA |
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What is eisenmengers syndrome
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chronic right sided pressure with resulting right to left shunt
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What happens to the heart size in when a pt develops eisenmengers syndrome
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it will decrease in size
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Are the pulmonary arteries enlarged and calcificied by the time a pt develops eisenmengers
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yes
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What is the MC type of ASD
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ostium secundum
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What is the 2nd MC type of ASD
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Ostium primum
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Where is Ostium primum located
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located lower portion of the atrial septum
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What is a sinus venosus atrial septal defect
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least common type of ASD and the defect is located in the upper portion of the atrial septum
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What is often associated with sinus venosus type of ASD
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PAPV return
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What is the DDX of a convex (dilated) main PA
4 |
HTN
Pulmnonic stenosis Left to right shunt Pulmonary artery aneurysm |
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What occurs to the peripheral vasculature in a pt with a dilated main PA as a result of HTN
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pruning/rapid tapering of peripheral vasculature
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What are the 3 L-->R shunts that result in dilation of the main PA
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VSD, ASD, PDA
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What are the findings of VSD on plain film
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similar to ASD, w/shunt vascularity,
↑ PAs, sometimes Eisenmenger; should have LA dilation |
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What is a major difference between VSD and ASD on plain film
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LA dilation with VSD
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Describe the findings of ASD
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shunt vascularity, cardiomegaly w/enlarged LA/LV/Ao
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What is enlarged in PDA
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all chambers and PA
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What is the diagnositic pressures for diagnosing PA hypertension
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Systolic PAP >30
Mean PAP > 18 |
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What are 3 chronic findings in a pt with pulmonary artery hypertension
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enlarged central PAs
enlarged RV PA calcificatio |
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Name the 3 main categories of causes of PA htn
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pre-capillary
capillary post capillary |
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What r 2 causes of pre capillary
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obstruction from thromboembolism
tumor |
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What is the pathophysiology of capillary interstial lung dz
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↑ capillary resistance from interstitial lung disease,
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Name 3 causes of capillary PA htn
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primary pulm htn
COPD longterm widespread airspace dz Eisenmengers and left to right shunts |
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What is the cause of Post capillary PA htn
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obstruction to venous drainage from the LV
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What is the ddx of post capillary pulm artery htn
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LV failure
restrictive cardiomyopathy mitral stenosis hypoplastic left heart pulmonary veno-occlusive dz fibrosing mediastinitis |
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What is the ddx of micronodular dz
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mets
infection sarcoid silicosis hypersensitivity pneumonitis |
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What are 2 common mets that have a micronodular pattern
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thyroid
melanoma |
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What are 3 infectious causes of micronodular dz
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tb, fungal, healed varicella
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What is a interchangeable word for micronodular
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miliary
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What happens to varicella infection of the lung after it has healed
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calcifies
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What are 2 lung dz that can be micronodular but also can be upper lobe and cause egg shell Ca
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sarcoid/silicosis
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can a subacute hypersensitivity pneumonitis be miliary in appearance
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yes
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Describe the findings of ACUTE hypersensitivity pneumonitis
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lower lobe consolidation
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Describe the findings of a SUBACUTE hypersensitity pneumonitis
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uppper lobe centrilobular nodules
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Describe the findings of Chronic hypersensitiviy pneumonitis
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upper lobe interstitial fibrosis
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What is the size definition of a micronodule
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less than 5 mm
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What is the ddx of macronoules of the lung (greater than 5 mm)
5 |
tumor
infection collagen vascular vascular sarcoid amyloid |
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What are the tumors that tend to cause macronodules of the lungs
3 |
mets
lymphoma bronchiogenic CA |
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What infectious processes can cause macronodules
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fungal
tb parasites |
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What are 2 collagen vascular dz that may cause macronodules of the lung
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wegners
RA |
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What vascular dz may result in macronodules of the lung
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septic emboli
infarcts AVM |
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Do the metastatic lesion of osteosarcoma contain bone and are therefore dense
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yes
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What is a common cause of AVMs of the lungs in younger pts
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osler weber rendu syndrome
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Mets from RCC tend to form what kind of lesions in the lung
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cannon ball mets
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What is the MC presentation of coccidiodomycosis
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Cavitating segmental or lobar consolidation in an endemic area
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Can coccidiodomycosis cause multiple lung nodules
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yes
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What is the evolution of lung disease of coccidiodomycosis
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Foci of consolidation that can evolve into nodule(s) or thin-walled cyst
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Can cryptococcus form a consolidation
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yes
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What is a cavity of a lung
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Cavity refers to an air containing lesion with a relatively thick wall (> 4 mm) or within an area of a surrounding opacity or mass
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What do must lung abscess form from
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Consolidation from pneumonia typically evolves into abscess cavity over 7-14 days
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What is the MC location of a lung abscess
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Location: Gravitationally dependent segments after aspiration
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What is the radiographic appearance of a lung abscess
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Spherical thick-walled cavity with smooth inner margin surrounded by consolidated lung
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What is the ddx of a lung cavity
6 |
CAVITY
Carcinoma-SCC Abscess-fungal/bacterial/TB Vascular-septic emboli Inflammatory-rheumatoid nodule Trauma-resolving contusion Young-bronchogenic cyst |
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Can lymphoma and amyloid both have a nodular appearance
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yes
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What is the ddx of perilymphatic nodules disease
6 |
A SKILL
Amyloid Sarcoid Kaposi’s Infection (PCP) Lymphoma Lymphang carcinomatosis |
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Where does perilymphatic nodules tend to go
3 |
subpleural, peribronchovascular, septal nodules
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What is the classic cause of perilymphatic nodules
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sarcoid
(lymphangetic spread of cancer is 2nd mc) |
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What is the ddx of random distribution of nodules
6 |
MISSLE
Mets Infection Sarcoid Silicosis Lymphoma EG |
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Where do centrilobular nodules tend to occur
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occur in relation to centrilobular artery or bronchiole, centered 5-10 mm from pleura
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What is the ddx of centrilobular nodules
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HERB HAS GAS
Hypersen pneumonitis EG RB-ILD BAC/BOOP GVHD VASculitis |
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What is the tree in bud ddx
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Tree-in-bud DDx: endobronchial spread of TB/MAC, bronchopneumonia, bronchiectasis or bronchitis, cystic fibrosis, panbronchiolitis (rare), aspiration (rare), ABPA or asthma (rare), BAC (rare)
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Do subacute hypersensitivity pneumonitis tend to be centrilobular
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yes
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What are the cardiogenic causes of pulmonary edema
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LV failure
mitral valve dz pulmonary venous occlusion pericardial disease |
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What are the non-cardiogenic causes of pulmonary edema
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increased hydrostatic pressure
decreased oncotic pressure increased capillary permeability |
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What are some causes of increased hydrostatic pressure that may lead to pulmonary edema
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renal failure (excess fluid)
excessive IV fluid neurogenic injury |
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What are some causes of decreased oncotic pressure that may lead to pulmonary edema
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hypoproteinemia
lung reexpansion |
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What are some causes of increased capillary permeability that may lead to pulmonary edema
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aspiration
near drowning trauma radiation drugs anaphylaxis |
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What is the distribution difference of pulmonary edema between permeability issues and all other causes
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Permeability causes usually in peripheral distribution rather than perihilar, and usually do not have associated effusions
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What is a major clue that the pulmonary edema is non cardiogenic
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non-cardiogenic will have a normal sized heart
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What are the 5 classic signs of pulmonary edema on CXR
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cephalization of the vessels
vascular indistinctness and peribronchial thickening kerley lines pleural effusions alveolar edema: symmetric perihilar alveolar opacities |
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What are the 3 stages of heart failure
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redistribution
interstitial edema alveolar edema |
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What are the findings in stage 1 (redistribution)
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cephalization
cardiomegaly broad vascular pedicle |
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What are the findings of stage 2 (interstitial edema)
5 |
kerley b lines
peribronchial cuffing hazy contour of vessels thickened interlobular fissure |
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What are the findings of stage 3 (alveolar edema)
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consolidation
airbronchograms cotton wool appearance pleural effusion |
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What are the findings of primary TB
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consolidation (any lobe but favors lower lobe)
Does not cavitate hilar or mediastinal adenopathy pleural effusion |
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Does primary TB cavitate
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no
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Does the consolidation of primary TB favor the lower lobes
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yes
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What do the LN of primary TB look like
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low density necrotic nodes
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What is a Ghon focus
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calcified parenchymal tuberculoma
(represents the sequelae of primary tuberculosis infection.) |
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What is ranke complex
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Ghon lesion and a
ipsilateral calcified hilar node (sequela of primary TB) |
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Are pts with primary TB often asymptomatic
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yes
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What is the ddx of multiple lung nodules or masses (greater than 3 cm)
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DAYS OF THE WEEK: MTWTFSS
Mets/Carcinoma/Lymphoma TB/granuloma Wegeners Rheumatoid nodules/Round pneumonia Fungal Sarcoid Septic pulmonary emboli |
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What are the cancers that spread to lungs via lymph
7 |
“CERTAIN CANCERS SPREAD BY PLUGGING THE LYMPHATICS”
Cervix Colon Stomach Breast Pancreas Thyroid Larynx |
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What is the ddx for a cavitary lung lesion
6 |
CAVITY
Carcinoma-SCC Abscess-fungal/bacterial/TB Vascular-septic emboli Inflammatory-rheumatoid nodule Trauma-resolving contusion Young-bronchogenic cyst |
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What is the cause of a mediastinal mass
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HABIT
Hernia, Hematoma Aneurysm Bronchogenic cyst/duplication cyst Inflammation (sarcoidosis, histoplasmosis, coccid- ioidomycosis, primary TB in children) Tumors–remember the five Ls: Lung, especially oat cell Lymphoma Leukemia Leiomyoma Lymph node hyperplasia |
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What is the ddx of mediastinal LAD
6 |
mets
lymphoma TB/MAC Sarcoid AIDS related |
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What is the ddx of low density LNs
2 |
TB/MAC
Mets |
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What is the ddx of hypervascular LNs
2 |
Castlemann disease
Kaposi sarcoma |
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What are the 2 types of castleman disease
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hyaline vascular :
commoner ~ 90% more uni-centric plasma cell : often multi-centric less enhancing may be more symptomatic |
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What are the CT findings of castleman syndrome
4 |
commonly seen as a mediastinal mass and rarely as matted lymphadenopathy (with or without a dominant mass) in a single mediastinal compartment
typical arborising calcification may be seen within the mass typically shows intense homogeneous enhancement following contrast dynamic CT demonstrates early rapid enhancement with washout in the delayed phase |
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What is the MC location of reactive TB
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Usually in apical and posterior segments of upper lobes and superior segment of lower lobes
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What are the radiographic lung parenchymal abnormalities seen in reactivatoin TB
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Cavitary nodules are classic finding, but can also just be patchy consolidation
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Do you see upper lobe nodules with volume loss in reactivation TB
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yes
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Can reactivation TB resullt in pleural thickening, hilar retraction, volume loss and nodules
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yes
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When does bronchogenic spread of TB occur
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when cavitary lesion erodes into a bronchus
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Describe the nodules of reactivation tb
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Ill-defined nodules 5-6 mm in diameter, numerous and bilateral
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What is the distribution of the nodules of reactivation TB
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On CT, produces tree-in-bud appearance: centrilobular nodules and centrilobular branching linear opacities
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What is the ddx of centrilobular nodules
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HERB HAS GAS
Hypersen pneumonitis EG RB-ILD BAC/BOOP GVHD VASculitis and TB |
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What is the ddx of tree in bud opacities on CT
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MIT
Mucous plugging: Aspiration/Kartageners Inflammatory plugging (PUS): TB/MAI Tumor emboli (rare) |
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What is miliary TB
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hematogenous dissemination of TB with multiple 1-2 mm tiny interstial nodules
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What is the ddx of reticular/cystic opacities of the chest
9 |
ELECT CHIP
EG LAM Emphysema CF TS Coccidiomycosis Hydrocarbon Infectious PCP |
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What are the most common causes of metastatic lymphangitic carcinomatosis of the lungs
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lung
breast stomach colon |
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What are the CXR of lymphangitic carcinomatosis
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Diffuse reticular or reticulonodular opacities
Thickened septal lines Hilar, mediastinal adenopathy (helpful differential feature) Pleural effusions |
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What should you check for if a pt has reticular markings
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mastectomy
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What are the findings on HRCT for lymphangitic carcinomatosis
3 |
smooth or nodular axial interstitial thickening
septal thickenin nodular (or smooth) thickening of fissures |
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Is scleroderma a cause of IUP or NSIP
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yes
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What are 2 classic findings of IPF/UIP
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honeycombing and traction bronchiectasis
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What are the common causes of chronic interstitial disease of the lower lungs
5 |
PAGES
Collagen vascular disease IPF Asbestos Rheumatoid NF Drug toxicity |
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What are findings of asbestosis
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pleural plaques, occupational hx
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What is the classic associcated findings of scleroderma (non-lung)
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dilated esophagus
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Can rheumatoid arthritis and scleroderma both cause UIP and NSIP
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yes
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What are the associated findings of rheumatoid arthritis to look for
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erosive arthritis
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What is the classic finding for cryptogenic organizing pneumonia
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patchy consolidation
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Can bleomycin cause nodular findings that mimic mets
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yes
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review ucsf cards for UIP, NSIP, COP, RB-ILD, DIP, AIP
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ok
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When a patient has bibasilar fibrosis with traction bronchiectasis and esophageal dilation what should come to mind
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scleroderma
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What are the findings of NSIP
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GGO, reticular opacities, micronodulles, consolidation, microcystic honeycombing
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What is the distribution of NSIP
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no obvious gradient, subpleural and symmetric
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Is NSIP subpleural and symmetric
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yes
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How is NSIP differentiated from UIP
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No gradient in NSIP (mostly basilar in UIP)
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Can NSIP have areas of consolidation
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yes
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Is there GGO, reticular opacities, micronodules, and microcytic honeycombing, micronodulars in NSIP
|
yes
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IMPORTANT: is NSIP predominately subpleural
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yes
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What is the reverse halo sign
|
The reversed halo sign (also known as the atoll sign) is defined as central ground-glass opacity surrounded by denser consolidation of crescentic (forming more than three fourths of a circle) or ring (forming a complete circle) shape of at least 2 mm in thickness.
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When is the reverse halo sign (atoll sign) classicaly seen
|
COP (relatively specific but only seen in 20%)
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What is the idiopathic form of organizing pneumonia
|
COP
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What are the findings of organizing pna
|
patchy air space disease (consolidation 80%, GGO 60%), subpleural or peribronchiolar, effusions/lymphadenopathy uncommon
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What are the secondary causes of organizing pna
|
Collagen vascular disease
Infections Bone marrow transplantation (GVHD) Wegener Toxic inhalation |
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What is the distribution of organizing pna
4 |
patchy
peripheral or peribronchial basal predominance tendency to spare the subpleural space |
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What are the radiographic findings of COP
3 |
airspace consolidation
mild bronchial dilation GGO |
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Does COP have a basal predominance
|
yes
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What is the ddx of peripheral consolidation
|
OP
chronic eosinophilic pna pulmonary infarct pulmonary contusion |
