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31 Cards in this Set
- Front
- Back
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Hampton's Hump
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highly specific for PE (but low sensitivity).
Wedge shaped, pleural based consolidation signifying lung infarction (only 10% of PE also has lung infarction) typically found in the posterior or lateral costophrenic sulcus of the lung, is homogeneous, and lacks air bronchograms. |
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Westermark sign
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highly specific for PE (but low sensitivity).
a combination of: 1) dilation of the pulmonary arteries proximal to the embolus and 2) collapse of the distal vasculature creating the appearance of a sharp cut off on chest radiography. |
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Causes of Pulm Hemorrhage
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-Vasculitis
a) Autoimmune--Goodpasture, Wegeners, idiopathic b) Infectious--Aspergillus, mucor, gm neg, flu -Trauma -Spontaneous--anticoag, bleeding diathesis -Embolic disesase--PE, fat -Penicillamine (med for Wilson) |
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signs of chronic PE
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webbing
banding eccentric filling defects calcifications mosaic attenuation of lungs (some hyperlucent areas due to mosaic oligemia) |
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signs of pulm venous HTN
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-interlobular septal thickening,
-centrilobular nodular ground-glass opacities, -pleural effusions -interstitial or airspace -pulmonary edema with a normal heart size |
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Wegener's Granulomatosis
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TRIAD: lungs, sinus, kidneys
-nodules (most common 70%)--the multiplicity is highly suggestive-- -thick walled cavitation (usu shaggy inner wall, air-fluid level uncommon) -parenchymal (2/2 hemorrh): 1) consolidation, 2) ground glass. |
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Centrilobular vs. Panlobular Emphysema
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Centrilobular:
* More common in upper lung zones * Small areas of low attenuation in secondary pulmonary lobules * Appearance more heterogeneous * Distinction between normal and emphysematous lung easier Panlobular: - More common in lower lung zones -Enlargement and destruction involving secondary pulmonary lobule, extends to periphery of lobule -Homogenous appearing -assoc with alpha 1 trypsin defic |
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Chordoma
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-from notochordal remnants
-adults>children -sacrococcygeal>spheno-occipital>cervical> lumbar -ST mass that is destroying bone -hypodense on CT -has septations, amorphous Ca++ -hyperdense on T2 -mild enhancement |
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Osteochondroma
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- Benign
- exostosis with continuity of cortex and marrow from nml bone - pedunculated or sessile - painless - suspect malign transform if: thick cartilage cap, dispersed calcif in cap, or ST mass - metaphysis of long bones - peduncle grows away from joint - cartil bright on T2, outlining cap |
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Chondrosarcoma
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-Lytic mass with or without chondroid matrix, cortical destruction, and extension into ST
-PELVIS>ribs/sternum>long bones>spine -Chondroid matrix calcification: Rings and Arcs -Most are medullary type with expansion of medullary cavity, endosteal scalloping, thickening of cortex, cortical destruction with ext into ST's - cartilage is bright on T2 - enhancemt of septa with Ring and Arc |
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Osteoid osteoma
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- well defined lytic to sclerotic lesion (usually radiolucent core) with surrounding sclerosis (thick cortex--periosteal rxn)
- pain at night relieved by NSAIDs - metaphyses of long bones - no malign potential - double density sign on nuc med - in spine: curvature of bone TOWARD lesion - CONTRAST: EARLY arterial and EARLY washout! |
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"geographic"
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Solitary lytic/radiolucent lesion in bone with a distinct margin
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Osteoblastoma
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- well-circumscribed lytic, geographic, expansile lesion, often involving posterior elements of spine
- young patients with painful scoliosis - benign - extensive peritumoral edema - >1.5 cm |
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Anterior mediastinal masses
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- lymphoma
- thyroid - thymus - germ cell tumor - mesenchymal tumor (ie lipoma) |
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Middle mediastinal masses
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- lymphoma
- reactive LN's from pulm infxn (incl fungi, TB) - Lung ca, Mets, Bronchial/tracheal CA - Cysts - Diaphragmatic hernia - Vascular--dilated central veins, aneursym, etc) - Autoimmune--sarcoid, Castleman's |
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air bronchograms in malign
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-bronchoalveolar
-lymphoma |
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Bulging fissure sign in chest
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due to rapidly growing PNA, ie Klebsiella
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Deep Sulcus sign
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IN SUPINE film!!
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Fallen lung sign
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-2/2 fractured bronchus
-lung displaced laterally and inferiorly rather than toward hilum |
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Finger in glove sign--chest
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when bronchi are bulging with mucus, pus, etc--form tubular masslike opacities
-from allergic bronchopulmonary Aspergillus |
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Halo sign--Chest
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GGO (hemorrhage) surrounds denser nodule
-signals invasive Aspergillosis, esp in immunocomp |
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Hampton hump sign
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-in PE
-represents subpleural area of infarction |
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Westermark Sign
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-oligemia of lung 2/2 PE--looks hyperlucent
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Lymphangioleiomyomatosis (LAM)
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-ie BALT
=Proliferation of atypical smooth muscle cells in lungs & lymphatics associated with pulmonary cysts -Diffuse bilateral reticular opacities - Thin-walled air-filled pulmonary cysts DIFFUSELY distributed throughout lungs -often get spontaneous PTX from rupture of subpleural cyst -also can get chylothorax -women of childbearing age -assoc with tuberous sclerosis -renal angiomyolipomas in up to 50% |
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Lymphocytic interstitial pneumonitis
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=Lymphoproliferative disorder ranging from follicular bronchiolitis to low-grade lymphoma
- Radiographic findings centered on lymphatic pathways in lung (Peribronchovascular, septa, pleura) o Ground-glass opacities o Centrilobular nodules, poorly defined o Thin-walled cysts, perivascular, 1-30 mm in diameter, do not resolve * Centrilobular nodules may evolve into cysts -Chronic antigenic stimulus elicits lymphoproliferative response, may be: * Idiopathic (rare) * Autoimmune: Sjögren syndrome * Viral infection: HIV (especially in children) * Castleman disease |
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Castleman dz
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* Unusual benign lymphoproliferative hyperplasia of lymph nodes
* Histological: Hyaline vascular (90%), plasma cell (9%) and mixed forms (rare) * Distribution: Localized and multicentric * Localized: Hyaline vascular (90%) and asymptomatic * Multicentric: Plasma cell (80%) and often symptomatic * Localized form * Smooth or lobulated enlarged node * Avid uniform contrast-enhancement is characteristic, especially hyaline vascular type * Multicentric form * Numerous lymph node enlargement of mediastinum and hilum * Pulmonary involvement with ground-glass, septal thickening, centrilobular ill-defined nodules, scattered cysts and bronchovascular wall thickening --Tx--excision |
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Tree in Bud Pattern--Chest
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-2/2 endobronchial spread, usu infectious
-due to: (a) bronchiolar dilatation and (b) impaction of bronchioles with mucus, pus, or other material. |
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Chronic alveolar lung diseases
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BALLS:
-Bronchoalveolar CA -Alveolar proteinosis -Lymphoma -Lipoid PNA -Sarcoidosis |
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Cysterna Chyli
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lymphatic system that drains abd and lower extremities.
-lies behind R. crura -connects to ascending thoracic duct |
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Thoracic duct
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lymphatics
-comes up from cysterna chyli -dumps into L. subclavian v. -Also drains L. head and thorax. |
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Coronary dominance
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determined by the vessel that
LATERAL walls of the left ventricle. In right dominance (the usual situation) the right coronary artery gives rise to the posterior interventricular branch and continues around in the atrioventricular groove, giving branches to the posterolateral wall of the left ventricle. In left-dominant situations the right coronary artery is short, and the left circumflex supplies the posterolateral wall of the left ventricle and gives off the posterior descending artery. |
