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33 Cards in this Set
- Front
- Back
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Adenocarcinoma |
Most common cancer in smokers and non Progression: Atypical adenomatous hyperplasia--> Adenocarcinoma in situ--> Adenocarcinoma Ground Glass CT of AAH and AIS SOLID CT for adenocarcinoma AIS malignant, not invasive AAH neither malignant nor invasive 3 growth patterns: -PERIPHERAL, with pleural retractions -central, of the bronchus -PNA-like AIS, looks like consolidation |
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Squamous Cell Carcinoma |
CENTRAL Cavitation with Necrosis! Often smoking Hx |
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Small Cell Carcinoma |
100% of pts are smokers CENTRAL MASS +/-SVC syndrome Often caught LATE, poor prog Tx -Early: concurrent Chemo/XRT -Late: Chemo (Cisplatin+etoposide) |
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Hypertrophic Pulmonary Osteoarthropathy |
Lung Cancer Paraneoplastic Syndrome
New bone formation/periosteal thickening Seen in LONG bones, DIGIT CLUBBING |
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SIADH |
Lung Cancer Paraneoplastic Syndrome Low serum Na+ High urine Na+ |
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Hypercalcemia |
Lung Cancer Paraneoplastic Syndrome |
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Cushing |
Lung Cancer Paraneoplastic Syndrome -production of ACTH-like substance |
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Lambert-Eaton Myasthenic Syndrome |
Lung Cancer Paraneoplastic Syndrome Muscle weakness INCREASING strength throughout the day (unlike in MG) |
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Lung Cancer Treatment |
#1 is SMOKING CESSATION Surgery if possible Definitive XRT if tumor >5 cm Stereotactic Body Radiation Therapy (SBRT) if tumor is <5 cm Ablation if tumor is <3cm Cisplatin and Etoposide for Extensive SCLC Chemo+XRT for Limited SCLC |
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Lung Cancer Screening (2 criteria and method) |
1) Age 55-74 2) 30 pack year smoking history Screen with LOW DOSE CT |
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Idiopathic Pulmonary Fibrosis (DPLD/ILD) |
Poor median survival (2-4 yrs) Chronic, insidious, progressive SOB Crackles Clubbing Restrictive PFT Decreased DLCO UIP pathology! (though not specific to IPF) Tx -Pirfenidone -Nintedanib -Lung Transplant |
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Non-Specific Interstitial PNA |
Both clinical and pathological definition NOT progressive like IPF Much better prognosis SOB Crackles Clubbing Restrictive PFT Decreased DLCO Associated with AUTOIMMUNE disease Tx -good response to CORTICOSTEROIDS |
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Constrictive Bronchiolitis |
Peribronchiolar fibrosis -constricts/obliterates bronchiole lumen Obstructive PFT +/- decreased DLCO Poor response to Tx Causes -hydrophobic gases (sulfur, nitrogen oxides) -middle east burn pits (soldiers) -diacetyl (popcorn, cookie, coffee workers) |
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Agents causing Pneumoconiosis |
Asbestos Silica Coal Beryllium |
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Asbestosis |
UIP histology -patchy, non-uniform broad collagen scarring -geographic heterogeneity -foci of organization -honeycombing Asbestos bodies stain with IRON slow progression, NO CURE Pleural calcified/white plaques indicate asbestos EXPOSURE but not disease |
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Asbestos Lung Disease |
Non-malignant -asbestosis (ILD) -pleural thickening (benign) -rounded atelectasis -benign pleural effusion Malignant -mesothelioma (ONLY WITH ASBESTOS!) -Lung cancer |
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Silicosis |
CRYSTALLINE (quartz) silica has REDOX toxicity Risk: -agriculture -mining -artificial granite countertop work ACUTE Silicosis -hypoxia, go to ED, looks like PNA clinically CHRONIC Silicosis -CXR with mesh/granular opacities +/- DOE, cough -20 year latency Accelerated Silicosis -when seen within 10 years of exposure Progressive Massive Fibrosis -masses >1 cm -Obstruction AND Restriction -looks like advanced Sarcoid |
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Coal Workers' Pneumoconiosis |
Direct cytotoxicity of coal -alveolar macrophage activation -TNFa, IL-1 OBSTRUCTIVE LFTs Chronic, progressive lung scarring, cough, SOB Path shows COAL MACULE 1 day of mining = 1 pack of cigarettes Seen in coal MINERS (not coal powerplant) seen in YOUNG workers in HOT SPOTS |
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Berylliosis |
Chronic granulomatous disease Risk: -NUCLEAR POWER -aerospace materials -golf club -metal machining |
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Hypersensitivity Pneumonitis |
Granulomatous lung disease Primarily inflammatory, not infectious Risk: -BIRDS -HOT TUBS CT Findings -ACTIVE HP: ground glass -CHRONIC HP: centrilobular nodularity |
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Sarcoidosis |
Systemic Granulomatous Disease Targets Lungs and Lymphatics TH1, IFNg, IL-2 Restrictive PFTs +/-Obstruction Non-necrotizing, well-formed granulomas -MUST BIOPSY SARCOID Lofgren Syndrome Herefordt Syndrome |
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Lofgren Syndrome |
Seen in Sarcoidosis (often the presenting symptoms) Chest/hilar lymphadenopathy Erythema nodosum Arthritis |
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Herefordt Syndrome |
Seen in Sarcoidosis Fever Parotid enlargement Facial palsy Anterior uveitis |
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Obstructive Sleep Apnea |
Upper airway closed off CHEST WALL MOVEMENT/EFFORT No breathing |
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Central Sleep Apnea |
lack of BRAINSTEM CONTROL decreased chest wall movement and air flow |
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Pulmonary Imaging: Atelectasis |
Lucency with WELL-DEFINED borders next to opacity Indicates collapsed lung Causes -BRONCHIAL CARCINOMA (exam!!) -mucus plug in ventilated or asthmatic patients (ABPA) -malpositioned ET tube -foreign body aspiration |
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Pulmonary Imaging: Alveolar |
Fluffy, cloud-like No fluid level, will not change with position Causes -pus (infection) -fluid (pulmonary edema) -alveolar hemorrhage -cancer?? -iatrogenic aspiration |
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Pulmonary Imaging: Interstitial |
Web-like, Reticular, Linear Prominence of PV and lymphatics Causes -increased lymphatic drainage -inflammation leading to fibrosis -asbestosis silicosis -hypersensitivity pneumonitis -Sarcoidosis -IPF |
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Pulmonary Imaging: Nodules |
<3 cm Occur along interstitium May be discrete or linear (reticular) Causes -Sarcoidosis -silicosis -RA -Wegener's granulomatosis -metastasis or lymphoma -miliary TB -fungal infection -septic emboli |
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Pulmonary Imaging: Masses |
>3 cm Discrete and surrounded by lung Causes -lung CA -carcinoid -metastasis -OP -hemartoma -abscess |
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Pulmonary Imaging: Cysts |
Cysts: thin walled lucency (<3mm wall) Causes -bronchogenic cysts -pneumatocele -emphysema |
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Pulmonary Imaging: Cavitations |
thick walled lucency (>3mm wall) -often result of necrosis Causes -Staph -TB -Fungal -Neoplasm -Lung Infarct |
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Pulmonary Imaging: Bronchiectasis |
Abnormal dilation of the bronchi and bronchioles Many rings, C shapes, and lucent tubes radiating out from bronchial tree Causes -CYSTIC FIBROSIS -secondary to infection |
