Ucsf: Video I 72 Part 1 Pleura And Chest Wall

Front 1

What is the DDX for pneumothorax

Back 1

traumatic
iatrogenic
alveolar ruptures
bronchopulmonary fistula
spontaneous
Catamenial

Front 2

What are some common underlying etiology to alveolar rupture resulting in pneumonthorax
2

Back 2

ARDS
Asthma

Front 3

What are some causes of a bronchopleural fistula
4

Back 3

abscess, mets, PCP, lymphangioleiomyomatosis

Front 4

What is a classic sign a pneumothorax on plain film

Back 4

deep sulcus sign

Front 5

If you suspect a pneumothorax on plain film what could you do to further evaluate

Back 5

put the patient in a lateral decubitus view
(suspected side up)

Front 6

What are 3 characteritics of an intraparenchymal lung lesion

Back 6

spherical, borders well defined, acute angles with periphery

Front 7

What are 3 characteristics of extraparenchymal

Back 7

elipitical
portion of border ill defined
obtuse angle with the periphery

Front 8

Why is parenchymal lesion round and a pleural lesion eliptical

Back 8

in the lung the lesion will grow in all directions equally
if a lesion is growing in the pleura part of it is limited in growth and will then form an eliptical shape

Front 9

When a lung lesion touches the periphery (chest wall area) what angles do they typically have

Back 9

acute angles

Front 10

When a pleural lesion touches the periphery what angle does it typically have

Back 10

obtuse, bc it is growing out of it and is not being compressed into it.

Front 11

How would a plasmacytoma present in the chest

Back 11

a mass projecting into the lung parenchyma

Front 12

Can a lung mass loss its acute angle

Back 12

yes, if it becomes very large or starts to invade adjacent tissue

Front 13

What is the ddx for pleural/chest wall mass
8

Back 13

loculated pleural effusion
mesenchmal tumors
localized fibrous tumor of pleura
mesothelioma
nerve sheath tumor
myeloma and other bone tumors
mets

Front 14

What are 2 examples of benign mesenchymal tumors

Back 14

lipoma, leimyoma

Front 15

What are 3 examples of malignant mesencymal tumors

Back 15

fibrosarcoma
leimyosarcoma
MFH

Front 16

What are 3 ways mesothelioma can present

Back 16

pleural effusion
solitary pleural mass
pleural thickening

Front 17

How do localized fibrous tumor of the pleura present

Back 17

large pleural mass

Front 18

What percent of localized fibrous tumors of the pleura are malignant

Back 18

30%

Front 19

What is the SS of a localized fibrous tumor of the pleura

Back 19

Chest pain
hypoglycemia
HPO?

Front 20

What are the CT findings of a localized fibrous tumor of the pleura

Back 20

solitary pleural mass
necrosis
calcification
hetergenous enhancement
large feeding vessels

Front 21

What does HPO stand for

Back 21

hypertrophic pulmonary osteoarthropathy

Front 22

Does a fibrous pleural tumor have significant enhancement

Back 22

yes

Front 23

Does a fibrous pleural tumor have necrosis and calcification all the time

Back 23

no, it may or may not have either

Front 24

What is classic for a fibrous pleural tumor

Back 24

its large size

Front 25

What is the most common cause of a psuedotumor

Back 25

a fluid collection in the fissure of someone with pulmonary edema

Front 26

What is the classic sign on frontal plain film of a patient with subpulmonic effusion

Back 26

a peaked diaphragm which is peaked laterally

Front 27

What is often confused with diaphragmatic elavation

Back 27

RML/RLL collapes

Front 28

What besides RML/RLL collapsed could also be confused with diaphragmatic elevation

Back 28

subpulomonic effusion

Front 29

How do you differentiated RML/RLL collapse, subpulmonic effusion, and diaphragmatic elevatin

Back 29

the peak of the diaphragm
RLL/RML peak is medially adjacent to the heart,
Diaphragmatic elevation is central and subpulmonic effusion is lateral

Front 30

What are some pathological causes of diaphragmatic elevation
5

Back 30

lung fibrosis
splenic hematoma,
peritoneal tumor
intrinsic disease of muscle
phrenic nerve paralysis

Front 31

If there is an effusion and the pleural is thick, enhancing or nodular what can you determine

Back 31

it is an exudative pleural effusion

Front 32

Do exudative pleural effusion cause enhancing and thickening of the pleura

Back 32

yes

Front 33

What are 3 classic causes of an empyema

Back 33

staph, strep, TB

Front 34

What is an empyema?

Back 34

infected pleural effusion/pus

Front 35

Do empyema become located?

Back 35

yes

Front 36

What are 3 causes of air density in a pleural collection

Back 36

thoracentesis
bronchopleural fistula
gas-forming organisms (uncommon)

Front 37

Are empyemas exudative or transudative

Back 37

exudative

Front 38

What is the split pleura sign

Back 38

the visceral and parietal pleura are split and both are thick and enhancing

Front 39

What is the treatment for an empyema

Back 39

draining

Front 40

What is the treatment for an abscess in the chest wall

Back 40

abx

Front 41

Why do you not want to drain an abscess

Back 41

it may lead to a bronchopleural fistula

Front 42

What are features of a malignant pleural disease

Back 42

pleura is greater than 1 cm
mediastinal pleural thickening
circumferential thickening
pleural nodularity
chest wall invasion

Front 43

Does mediastinal pleural thickening and pleural nodularity point towards malignancy

Back 43

yes

Front 44

What is the thickeness of the pleura that makes it more likely to be a malignant pleural disease

Back 44

greater than 1 cm

Front 45

If the pleura is thickened all the way around does this point towards malignancy

Back 45

yes

Front 46

If there is pleural nodularity with an effusion is that specific for malignancy

Back 46

yes

Front 47

Do pleural plaques from asbestosis often have calcification

Back 47

yes

Front 48

Are pleural plaques from asbestos often ill defined

Back 48

yes, (most pleural lesions are ill defined)

Front 49

What type of pleural effusion does asbestos cause

Back 49

exudative (enhancement of parietal and visceral pleura)

Front 50

What are the earliest feature of asbestos related pleural desease

Back 50

exudative effusion

Front 51

What do pleural plaques look like on CT

Back 51

elevated wedges, high density with or without calcification

Front 52

What is asbestosis?

Back 52

this is the fibrotic lung disease associated with asbetos exposure NOT the pleural thickening or effusion

Front 53

What commonly happens to lung parenchyma adjacent to an effusion

Back 53

atelectasis

Front 54

What is a sign of volume loss

Back 54

bending of the fissures, swirled vessels

Front 55

What is swirled vessels associated with

Back 55

atelectasis (seen in the sagital or coronal more easily)

Front 56

What is rounded atelectasis associated with

Back 56

adjacent to the pleura that is diseased (thickened or there is a pleural effusion)

Front 57

What is swirling vessels

Back 57

vessels being distorted by volume loss in rounded atelectais

Front 58

What does fibrothorax look like

Back 58

very thick pleura and is densely calcified (different than mesothelioma)

Front 59

What is the cause of fibrothorax
3

Back 59

old tb
prior pleural hematoma
old empyema

Front 60

What are 3 causes of malignant pleural thickening

Back 60

mets
mesothelioma
thymoma

Front 61

What are some causes of mets to the pleural space

Back 61

lung
breast
GI
melanoma

Front 62

Does mesothelioma have extensive thickening of the pleura

Back 62

yes, nodular circumferential

Front 63

Does mediastinal thickening of the pleura point towards malignancy

Back 63

yes

Front 64

What are the 3 types of mesothelioma

Back 64

epitheloid, sarcomatoid, mixed

Front 65

What is the latency period of mesothelioma

Back 65

20-40 after abestosis

Front 66

Can mesothelioma present with enhancing nodules, with pleural effusion

Back 66

yes

Front 67

What does enhancing nodules with pleural effusion typically caused by

Back 67

mets to the pleural space (MC from the lung)