Q Bank Chest

Front 1

Accessory fissures
Accessary fissure

Back 1

Azygos fissure
Inferior accessory fissure
Superior accessory fissure
Left minor fissure

Front 2

Azygos fissure

Back 2

defining azygos lobe: parts of the apical or posterior segments of RUL
consists of four layers of pleura (two parietal and two visceral)
contains the arch of the azygos vein inferiorly
Frontal film: a curvilinear appearance adjacent to the right mediastinum, convex laterally; "teardrop" appearance of the azygos vein at the inferior extent of the fissure
CT: a thin, curved line, extends from the right brachiocephalic vein anteriorly, to a position adjacent to the right posterolateral aspect of T4 or T5 vertebral body

Front 3

Inferior accessory fissure

Back 3

seperates the medial basal segment of either lower lobe from the remaining basal segments.
CXR: extending superiorly and medially from the medial third of the hemidiaphragm
CT: extending laterally and anteriorly from the region of inferior pulmonary ligament to joint the major fissure

Front 4

Superior accessory fissure

Back 4

demarcates the superior segmental from the remainder of the lower lobe.
More common on the right
about the same level as the minor fissure

Front 5

left minor fissure

Back 5

10% of normal lung
separating the lingula from the remainder of the LUL

Front 6

Hilum Overlay Sign 代表意義

Back 6

The mass does not arise from the hilum, 且大多數lesion會位在anterior mediastinum

Front 7

Lordotic view的目的

Back 7

要看清楚兩側的pulmonary apex

Front 8

何謂Luftsichel sign

Back 8

superior seg of lower lobe causes a crescent lucency btw the aortic arch and the atelectic upper lobe

Front 9

IABP (intra-aortic balloon pump) 正確位置

Back 9

Position:Tip just distal to the Lt subclavian artery

Front 10

Congenital absence of right pulmonary artery (cxr)

Back 10

Ipsilateral small lung volume with tracheal deviation, hemidiaphragm elevation, hyperaerated left lung and right side narrowed intercostal spaces.
Loss of normal right pulmonary vascularity.

disruption of normal embryonic development of the primitive sixth aortic arch results in an anomaly in the pulmonary arteries.
Abnormalities in the rotation and migration of the primitive arch may result in agenesis of one pulmonary artery.
Absence of the left pulmonary artery tends to be associated with an intracardiac defect, particularly the Tetralogy of Fallot.
Absence of the right pulmonary artery is usually not associated with any other anomaly of the heart or great vessels.
aortic arch is usually on the side opposite to the absent pulmonary artery.

Front 11

Accessory cardiac bronchus

Back 11

from the medial wall of the bronchus intermedius or RLL bronchus, extend inferiorly and medially toward the mediastinum.
A short, blind-ending bronchial stump without associated alveolar tissue; or a longer bronching bronchus with rudimentary tissue.

Front 12

Pulmonary actinomycosis invading chest wall

Back 12

D/D:
tuberculosis empyema necessitatis

Front 13

Cystic adenoid carcinoma of trachea
Adenoid cystic carcinoma, trachea;
Adenoid cystic carcinoma, lower trachea and left main bronchus.
Cylindroma

Back 13

originating from tracheal mucous glands, often from the posterolateral tracheal wall
Age peak: 4th–5th decade
typical Hx of refractory “asthma”
endotracheal mass with extratracheal extension; resembling an iceberg in that the intraluminal component of the tumor is much smaller than the extraluminal component.
a diffuse or circumferential wall thickening of the trachea, a soft-tissue mass filling the airway.
striking tendency toward submucosal extension and manifest with circumferential and infiltrative growth.
The longitudinal extent of the tumor is greater than its transaxial extent.
more aggressive than carcinoid with propensity for local invasion + distant metastases (lung, bone, brain, liver) in 25%

Front 14

Alpha-1 antitrypsin deficiency

Back 14

lower lobe predominant, panlobular emphysema
Bullae common (33%), bronchial wall thickening and bronchiectasis (40%)
single gene chromosome 14
symptoms rarely develop before age 55
Hepatosplenomegaly, may lead to cirrhosis

Front 15

Amiodarone therapy
Amiodarone intoxication

Amiodarone pulmonary toxication
(Drug-induced pneumonitis)

Back 15

1. Amiodarone: triiodinated compound, tx for arrhythmias
2. hyperdense liver on CT (MR appearance of the liver is normal)
3. hypersensitivity pneumonitis or interstitial/alveolar pneumonitis
4. induce NSIP

Front 16

Amyloidosis(cxr, SLE hx)

Back 16

Primary or secondary to chronic malignancies or inflammatory disease
Bleeding common due to amyloid deposition in vessels (造成血管fragility)
Multiple calcified tracheal or pulmonary nodules

Front 17

Arterial sequestration (???)

Anomalous systemic arteries without sequestration ??

Back 17

13741394
72M, hemoptysis
anomalous artery from aorta to a normal lung

4167357, 34M
cough with hemoptysis

The anomalous artery was smaller in diameter, running caudally at its origin, tortuous until it ran cranially to the proximal lower lobe like a "swan neck-shaped" curve, and then it was dilated aneurysmatically running along with a normal pulmonary artery into all the basal segments.

Front 18

Aspergillosis

Back 18

A. fumigatus
1. Invasive aspergillosis
(1) Angioinvasive aspergillosis
(2) Airway invasive aspergillosis (Aspergillus bronchopneumonia)
(3) Acute tracheobronchitis
2. Semi-invasive aspergillosis (chronic necrotizing aspergillosis)
3. Allergic aspergillosis
4. Aspergilloma

Front 19

Mackline effect

Back 19

Mecklin effect:
the sequence of events in the development of pneumomediastinum as follows: (1) alveolar rupture, (2) air dissection along the bronchovascular sheath, and (3) free air reaching the mediastinum.

Front 20

Esophageal rupture 又稱？Image 上有何特徵？

Back 20

1. Boerhaave syndrome
2. pneumohydrothorax
pneumomediastinum
esophageal rupture

Front 21

Pulmonary botryomycosis

Back 21

rare, "actinomycetoid" tissue response to infection with pyogenic bacteria.

Front 22

年輕人的bronchiectasis

Back 22

cystic fibrosis

Front 23

Bronchial atresia

Back 23

Narrowing or obliteration of a lobar, segmental or subsegmental bronchus
LUL> RUL>RML>lower lobes
Detected incidentally in adults
Mucus plug distal to obstructed bronchi
Distal lung
Lucent
Increased in volume
Air-trapping in expiration
R/O endobronchial lesion

Front 24

Bronchial isomerism

Back 24

bilateral symmetry of the bronchi and associated pulmonary lobe.
May a/w congenital heart disease

Front 25

Asplenia (cxr) CT chest特徵？

Back 25

bilaterally right-sided

Front 26

Polysplenia chest特徵？

Back 26

bilaterally left-sided

Front 27

CAISSON DIS (潛水夫症) WITH PUL EDEMA

Decompression sickness;
divers' disease, the bends or caisson disease

Back 27

the precipitation of dissolved gasses into bubbles inside the body on depressurisation.

Front 28

Calcified lung tumor

Back 28

Metastasis from osteogenic sarcoma, colon, papillary adenocarcinoma(GI)
Fat containing hamartoma
Hemangioma

Front 29

Carcinoid tumor

Back 29

the best-differentiated type of neuroectodermal carcinoma.
Slow-growing, locally invasive.
40-60y, but not uncommon younger than 20y
No association with smoking
Central type: 80%
arising from the main, lobar (most common), or segmental bronchi.
discrete mass lesions in or near the hila.
have a large endobronchial component and appear on CT as intraluminal masses.
associated with bronchial obstruction, atelectasis or consolidation, typically limited to a lobe or segment.
Highly vascular (supplied by bronchial circulation) and dense enhance.
On CT, calcification in 40%.
local extension of typical carcinoid tumors beyond the bronchial wall is common. (most extend through bronchial wall thus involving bronchial lumen + parenchyma (= collar button lesion))
Peripheral nodular or mass: 20%
may be asymptomatic
well-defined, round or oval and slightly lobulated.
Tx: surgical resection. bronchial sleeve resection.

Front 30

Pulmonary lymphangitic carcinomatosis (PLC)

Back 30

cancer hx (e.g. breast, lung, thyroid, prostatic)
smooth and nodular thickening of the septa with preservation of architecture of the secondary pulmonary lobule. LN enlargement. Pleural effusion.

Front 31

Castleman’s disease全名？Classification? CT 特徵？

Back 31

1. Angiofollicular lymphoid hyperplasia; giant benign lymph node hyperplasia
2. Hyaline vascular type (90%) and Plasma cell type (10%)
3. Hyaline vascular type(90%):
localized mediastinal or hilar mass, children or young adult, asymptomatic, benign behavior
4. Plasma cell type (10%) :
multicentric process, 40-50y/o, a/w generalized LAP and hepatosplenomegaly, systeminc illness, progressive

5. CT:dense contrast enhancement, Ca++ are occasionally seen (central, dense, or flocculent)

Front 32

Chicken pox pneumonia
Varicella-zoster virus

Back 32

32058303, 31F, fever, rapid course
5830804, 30M
Varicella--chickenpox, very contagious skin infection.
1/6 with skin infection develop coincident pulmonary infection.
Zoster--shingles.
High fever that is usually rapidly followed by a painful skin rash.
CXR: diffuse small nodules in the range of 5 to 10mm that progress to air-space consolidation rather rapidly. Hilar enlargement. Rare pleural effusion.
(<2% involute and calcify to form innumerable small calcified nodules)
Tx: acyclovir (Untreated adult varicella pneumonia has a 10% fatality rate. It is as high as 40% in pregnant/post partum women and immunosuppressed patients. )

Front 33

Cleidocranial dysplasia
Cleidocranial dysostosis

Back 33

The collarbones are partly or completely missing.
The fontanelles of the skull are late in closing, or never close.
Extra teeth.
Permanent teeth not erupting(長出).
Bossing (= bulging) of the forehead.

Front 34

Cor pulmonale (cxr)

Back 34

hypertrophy of the right ventricle resulting from disease of the lungs
acute cor pulmonale is characterized by dilation and failure of the right side of the heart due to pulmonary embolism
in later stages there is usually right-sided cardiac failure. 

CXR:
Enlargement of the central pulmonary arteries with oligemic peripheral lung fields
Right ventricular hypertrophy
increase of the transverse diameter of the heart shadow to the right on the posteroanterior view
filling of the retrocardiac space on the lateral film
Pulmonary hypertension: increased PA size
Right descending pulmonary a. > 16mm
left pulmonary artery > 18mm

Front 35

Pulmonary cryptococcosis

Back 35

stains by India Ink

well-circumscribed mass (40%) of 2–10 cm in diameter, usually peripheral location
lobar/segmental consolidation (35%)
cavitation (15%)
hilar/mediastinal adenopathy (12%)
calcifications (extremely rare)
interstitial pneumonia (rare, in AIDS patients)