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70 Cards in this Set
- Front
- Back
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ddx: posterior mediastinal mass
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neurogenic tumor
foregut duplication cyst vascular lesion lateral thoracic meningocele esophageal lesion lymphadenopathy extramedullary hematopoesis |
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ddx: middle mediastinal mass
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lymphadenopathy(TB, fungus, sarcoid, tumor)
bronchogenic cyst vascular primary lung tumor |
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ddx: mediastinal and hilar lymphadenopathy
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lymphoma
bronchogenic ca sarcoid TB/fungus renal ca testicular ca head and neck squamous ca |
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ddx: pericardial effusion
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HICCUP
-heart attack (post mi, dressler's syndrome) -infection -cancer -collagen vascular disease -uremia -post-op |
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what characterizes a thymoma (5)
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most common adult anterior mediastinal mass
calcify infrequently peak age 40-60 1/3 have myasthenia gravis 40% with myasthenia gravis have thymoma |
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intra- vs extralobar sequestration
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extra has: own pleura
systemic venous drainage persent earlier (infancy) |
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what are causes of pulmonary arterial HTN
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L to R shunt
L sided valvular lesion chronic lung disease chronic PE idiopathic |
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ddx: global cardiac enlargement
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dilated cardiomyopathy
multivalvular disease ebstein's anomaly |
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what are patterns of pulmonary sarcoid
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90% bilateral perihilar small nodules
3% large nodules 3% pleural disease |
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ddx: cavitary lesion
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CAVITY(E)
cancer abscess vasculitis (wegener's) infarct TB/fungus emboli |
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what are causes of eosinophilic pneumonia
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loeffler's syndrome
chronic eosinophilic pneumonia hypereosinophilic syndrome churg-strauss ABPA parasitic drug reaction |
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what infections are associated with alveolar proteinosis
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nocardia
cryptococcus aspergillus |
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ddx: CXR out of proportion to clinical findings
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sarcoid
pneumoconiosis alveolar proteinosis alveolar microlithiasis BOOP |
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ddx: unilateral interstitial pattern
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lymphangitis carcionomatosa
pulmonary edema (atypical) aspiration XRT |
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ddx: endobronchial metastasis
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renal
breast colon |
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ddx: cardiophrenic angle mass
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pericardial cyst
fat pad lipoma lymph node hernia aneurysm (ventricle or aorta) |
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what are patterns of involvement of lung by rheumatoid
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nodules
interstitial disease pleural effusion |
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what is caplan's syndrome
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rheumatoid arthritis and pneumoconiosis with nodules
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ddx: dilated cardiomyopathy
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MIA TAG
myocarditis ischemia alcohol thyroid/thiamine deficiency adiamycin glycogen storage disease |
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ddx: pleural effusion
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TINCUP
trauma infection neoplasm collagen vascular disease uremia pancreatitis |
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what is the most common cancer to cause a pancoast syndrome
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squamous cell lung ca
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what is the most common cancer to cause SVC syndrome
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small cell ca
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what are the causes of SVC syndrome
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neoplasm
fibrosing mediastinitis *pearl* lymphoma usually does not obstruct |
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ddx: cardiac mass
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thrombus, myxoma
lipoma rhabdomyoma fibroma teratoma angiosarcoma rhabdomyosarcoma metastasis *pearl* mets are 20x more common than primary malignancy |
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what are paraneoplastic syndromes of...
- squamous cell - small cell - carcinoid |
hypercalcemia = squamous cell
SIADH, cushing's syndrome = small cell carcinoid syndrome = carcinoid *pearl* also remember any cancer may cause neuromyopathy, thrombophlebitis, hypertrophic pulmonary osteoarthropathy |
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what is the most common cause of unilateral pleural effusion worldwide
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TB
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what are causes of pulmonary mass with an air bronchogram
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lymphoma
bronchoalveolar cell ca sarcoid |
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what features make a pulmonary mass benign
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stable in size over 2 years
calcification over 200 HU fat density |
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what cancers cause lymphangitis carcinomatosa
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lung
breast stomach pancreas |
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ddx: tracheobronchial lesion
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3 benign:
papilloma hemangioma hamartoma 3 malignant: squamous cell ca adenoca mets (melanoma, thyroid, esophageal) |
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ddx: chronic air space disease
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VER(Y) FAT BALLS
vasculitis eosinophici pneumonia Rx (drugs) fungus alveolar proteinosis TB BOOP/bronchoalveolar cell ca actinomycosis lipoid pneumonia lymphoma sarcoid |
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ddx: tracheomalacia
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primary
post intubation/trauma COPD trauma infection relapsing polychronditis |
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ddx: multiple pulmonary nodules
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MARS BE WHAT
mets AMV rheumatoid sarcoid BOOP emboli (septic) wegener's histoplasmosis amyloid TB |
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ddx: acute air space disease
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A HEIDI
AIDS/aspiration hemorrhage edema infection drugs inhalational injury |
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ddx: lymphadenopathy in chest
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TB/fungus
lymphoma sarcoid metastasis bronchogenic carcinoma castleman's disease |
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ddx: high resolution CT mosaic pattern
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alveolar proteinosis
bronchoalveolar ca PCP DIP/UIP vasculitis |
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what are causes of pleural effusion in AIDS
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lymphoma
TB kaposi's community acquired pneumonia |
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what are findings in kaposi's sarcoma
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nodular lesions
interstitial lung disease lymphadenopathy effusions |
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what are pulmonary complications of AIDS (10)
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PCP
TB MAI fungus community acquired pneumonia viral kaposi's sarcoma lymphoma lymphocytic interstitial pneumonitis (peds) interstitial pneumonitis |
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what are features of LIP
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widespread reticulonodular infiltrates
lymphadenopathy rare pleura spared present in non-AIDS patients (sjogren's) |
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ddx: benign lung nodule
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hamartoma
amyloidoma leiomyoma lipoma fibroma chondroma pseudotumor |
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ddx: non-cardiogenic pulmonary edema
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NOT CARDIAC
-near drowning -oxygen toxicity -transfusion/trauma -CNS shock -allergic alveolitis/ARDS -renal -drugs (TCAs, cocaine, cheomtherapy, PCN) -inhalation (hydrocarbon, N02, CO) -aspiration -collagen vascular disease |
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ddx: interstitial lung disease
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PC LIPS ARE BAD
pulmonary edema collagen vascular disease lymphangitis carcionmatosa idiopathic pulmonary fibrosis pneumoconiosis sarcoidosis aspiration recurrent hemorrhage (hemosiderosis) eosinophilic pneumonia BOOP alveolar proteinosis/asbestosis drugs (chemotherapy) |
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how does one differentiate causes of a mosaic lung pattern on high resolution CT
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vascular disease: decreased vessel size and number, no air trapping
small airways disease: decreased vessel size and number, air trapping primary lung disease: uniform vessel size and number, no air trapping |
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ddx: bronchiectasis
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infection (viral, TB, recurrent bacterial)
aspiration immunde deficiency (agammablobulinemia, granulomatous disease of childhood) abnormal struction (williams-campbell) abnormal mucus (CF) abnormal clearance (immotile cilia/kartagener's) obstruction ABPA noxious fumes pulmonary fibrosis |
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ddx: aortic root dilatation
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HOMIE
homocystinuria osteogenesis imperfecta marfan's idiopathic ehrlers-dahnlos |
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ddx: lymph node calcification
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TB
radiated lymphoma thyroid mets squamous cell mets mucinous adenoca mets granulomatous disease |
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what are pulmonary radiation changes
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4 acute:
-infiltrate with non-anatomic margins -minimal volume loss -4-6 weeks post treatment -subclinical *pearl* if < 3 weeks think infection/recurrence 2 chronic: -fibrosis with straight margins -6-12 months post treatment *pearl* if volume increase or effusion think infection/recurrence |
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ddx: upper lobe interstitial pattern
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CASSET P
cystic fibrosis ankylosing spondylitis silicosis sarcoidosis eosinophilic granuloma TB PCP |
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ddx: lower lobe interstitial pattern
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BADLAS
bronchiectasis asbestosis drugs lymphangitis aspiration SLE/collagen vascular disease |
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ddx: egg shell nodal calcification
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TLASS
TB/fungus lymphoma amyloid sarcoid silicosis |
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what are thoracic presentations of sarcoid
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nodular
alveolar lymphadenopathy pneumothorax cysts +/- TB or myecetoma cardiac (25%) |
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what is the garland triad
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right paratracheal and bilateral hilar adenopathy in sarcoid
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what is the appearance of sarcoid on HRCT
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central, nodular density
cystic component bronchoalveolar pattern upper lobe predominant |
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what characterizes necrotizing granulomatosis
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noncavitating, multiple masses in lungs only
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what characterizes churgg-strauss
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aka allergic angitis
young patients asthmatics eosinophilia radiographically mimics EG |
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what percentage of patients with sarcoid have pleural effusion
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2%
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what factors suggest an improved prognosis in sarcoid (6)
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young age
erythema nodosum white race normal PFT low stage lofgren's syndrome |
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what factors suggest a bad prognosis in sarcoid (2)
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black race
lupus pernio |
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what extra thoracic sites are involved in sarcoid
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bone - cystic or sclerotic lesions
abdomen - hepatosplenomegaly, liver/spleen nodules skin - lupus pernio, erythema nodosum muscle - myositis myocardium - restrictive cardiomyopathy CNS - vasculitis, leptomeningeal disease salivary glands, kidney stomach - masses |
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what are indications for steroid therapy in sarcoid
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rapid onset
hypercalcemia splenic, orbital, CNS, myocardium masses |
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what test are used to diagnose sarcoid
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acetylcholinesterase
kveim-sitzbach hypercalcemia decreased FRC on PFTs |
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what is the prognosis in sarcoid
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75% resolve with hilar adenopathy alone
10% mortality overall |
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what percentage of patients with sarcoid are symptomatic
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20-50%
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what are eponyms used with TB
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garland triad - bilateral hilar and right paratracheal adenopathy
boeck sarcoid lofgren syndrome - bilateral hilar adenopathy, erythema nodosum, arthralgia |
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what characterizes bronchocentric granulomatosis
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ABPA like radiographically
unilateral upperlobe associated with asthma |
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what distinguishes limited wegener's from wegener's
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no renal or sinus involvement
better prognosis females predominant |
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ddx: multiple thoracic masses in AIDS
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mycobacteria
kaposi's fungus lymphoma PCP metastasis |
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ddx: high density mediastinal masses
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hypervascular mets
aneurysm aberrant vessel castleman's disease paraganglioma |
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what are epopnyms used with TB
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ranke complex - parenchymal opacity and hilar node
simon complex - healed apical lesion ghon focus - primary TB rasmussen aneurysm empyema necessitans - TB with chest wall penetration |
