Ucsf: Video I 77 Part 1 Lung Masses

Front 1

What is a chest mass

Back 1

a discrete mass which is greater than 3 cm

Front 2

What findings are associated with round atelectasis

Back 2

volume loss
contact with pleura
abnormal pleura
swirling vessels and bronchi

Front 3

Is round atelectasis usually next to the pleura

Back 3

yes

Front 4

What is abnormalities of the pleura are typically associated with rounded atelectasis

Back 4

plaque or effusion

Front 5

What is another name for swirling vessels and bronchi associated with rounded atelecasis

Back 5

comet tail sign

Front 6

Should the pt get follow up for round atelectasis

Back 6

yes to exclude a mass

Front 7

Can round atelectasis and consolidation be mistaken for masses

Back 7

yes

Front 8

What are common infections that cause a mass like appearance
(rounded pna)

Back 8

strep is the mc but almost any pathogen can cause it

Front 9

Can round pna look like a peripheral lung cancer

Back 9

yes

Front 10

What are some congenital lesions in the chest that can appear as masses
5

Back 10

CCAM/ CPAM
congenital diaphragmatic hernia
sequestration
bronchiogenic cyst
AVM

Front 11

How does a CCAM appear on US

Back 11

an echogenic mass which may displace the heart

Front 12

What are the 3 types of CCAMS

Back 12

type 1 single or multiple large cyst
Type 2 multiple cyst less than 2cm
Type 3 solid appearing microcyst (looks like solid mass)

Front 13

What are two conditions that CCAMS may be associated with

Back 13

pulmonary hypoplasia and fetal hydrops

Hydrops fetalis usually stems from fetal anemia, when the heart needs to pump a much greater volume of blood to deliver the same amount of oxygen. This anemia can have either an immune or non-immune cause. Non-immune hydrops can also be unrelated to anemia, for example if a tumor or congenital cystic adenomatoid malformation increases the demand for blood flow. The increased demand for cardiac output leads to heart failure, and corresponding edema

Front 14

How does a CCAM appear in an adult

Back 14

areas of cystic hyperlucency with reccurent infections

Front 15

What is the most common locatoin of a diaphragmatic hernia

Back 15

posterior lateral on the left

Front 16

How does a diaphragmatic hernia appear at birth

Back 16

solid until air is swallowed

Front 17

Can CCAM and diaphragmatic hernias cause pulmonary hypoplasia

Back 17

yes

Front 18

Do CCAM and congential diaphragmatic hernia occur MC on the left

Back 18

yes

Front 19

What is a pulmonary sequestration

Back 19

developmental anomally resulting in disorganized lung parenchyma

Front 20

What are the 2 main types of pulmonary sequestration

Back 20

intralobar and extralobar

Front 21

Where do pulmonary sequestrations MC occur

Back 21

left lung base

Front 22

What is more common intralobar or extralobar

Back 22

intralobar

Front 23

Where does a intralobar sequestration occur

Back 23

with in the visceral pleura

Front 24

What is the supply of blood for the intralobar sequestration

Back 24

thoracic aorta

Front 25

What does a intralobar sequestration drain into

Back 25

the pulmonary vein

Front 26

What is the common presentation of a pulmonary sequestration

Back 26

as an adult with recurrent resp infections

Front 27

What is the appearance of an intralobar sequestration

Back 27

variable; mass, cluster of cyst or hyperlucent lung

Front 28

What is the usual appearance of an extralobar sequestration

Back 28

most commonly solid but can contain cyst or even be hyperlucent

Front 29

What is more common intralobar or extralobar

Back 29

intralobar

Front 30

Does an extralobar pulmonary sequestraton have its own pleura

Back 30

yes

Front 31

What is the blood supply and drainage of an extralobar sequestration

Back 31

abdominal arteries will supply it and systemic veins tend to drain it (not pulmonary)

Front 32

When do extralobar sequestrations tend to present

Back 32

infancy as a mass (not as an adult with recurrent infection like intralobar)

Front 33

What is a way to see if a pulmonary is intralobar or extralobar

Back 33

follow the aorta and see if it gives off a branch; if it does than it is intralobar

Front 34

What is the cause of a bronchogenic cyst

Back 34

cystic anomaly of ventral foregut

Front 35

What forms a esophageal cyst

Back 35

dorsal foregut anomaly

Front 36

What is the mc intrathoracic foregut cyst

Back 36

bronchogenic (more common than esophageal duplication cyst)

DDX for congenital intrathoracic mass: CCAM, diaphragmatic hernia, bronchogenic cyst, sequestration, AVM

Front 37

What is the density of a bronchogenic cyst

Back 37

it will contain fluid or mucus and be water density or higher density

Front 38

What is the MC location for a bronchogenic cyst

Back 38

mediastinal

Front 39

Can a bronchogenic cyst be intrapulmonary

Back 39

yes

Front 40

What is the signal characteristic of a bronchogenic cyst on T2

Back 40

bright signal

Front 41

What is the DDX for a middle mediastinal mass

Back 41

lymphoma or lymphadenopathy
bronchogenic cyst
aneurysm
TB/sarcoid/histo
Lung tumor
esophageal (diverticulum, cyst or tumor)

Front 42

What should be a concern before biopsing a mass in the lung

Back 42

it could be an AVM

Front 43

What is the cause of an AVM

Back 43

failure of formation of pulmonary capillaries

Front 44

What is an AVM associated with
2

Back 44

heriditaty telangiectasia
oslo weber rendu

Front 45

What type of shunt does an AVM cause

Back 45

right to left

Front 46

What percent of the cardiac output goes through an AVM for every 1cm

Back 46

20% of cardiac output

Front 47

What are the clinical SS of a pulomonary AVM

Back 47

dyspnea, cyanosis, clubbing, hemoptysis, paradoxical embolization (to brain)

Front 48

What is the treatment of AVM

Back 48

ballons or coils

Front 49

What type of cancer of the lung is on the rise

Back 49

adenocarcinoma

Front 50

Are adenocarcinomas typically central or peripheral

Back 50

peripheral

Front 51

How do BAC MC present

Back 51

GGO

Front 52

Can BAC present as clusters of nodules that give the appearance of a consolidation

Back 52

yes

Front 53

Can BAC present with a miliary pattern

Back 53

yes (rare)

Front 54

Where do SCC MC present

Back 54

the hilum

Front 55

Describe the typical cavitary features of SCC

Back 55

large irregular and cavitary with wall thickness great than 1.5 cm

Front 56

What has a higher association with smoking scc or adeno

Back 56

scc

Front 57

Is Small cell cancer a neuroendocrine tumor

Back 57

yes

Front 58

Does small cell carcinoma MC present around the hilum

Back 58

yes, big bulky mass

Front 59

What two lung cancers typically present around the hilum

Back 59

squamous and small cell

Front 60

What is the 5 year survival of stage 1, 2 and 3 lung cancer

Back 60

47%
26%
8%

Front 61

What is the 5 year survival of stage 4 lung cancer

Back 61

2%

Front 62

What is an important differentiation in staging of lung cancer

Back 62

stage 3a and stage 3b bc stage 3a is operative and stage 3b is not

Front 63

In the TNM table what scoring makes the patient non-operative

Back 63

T4 or N3 or M1 (all of these are non operative and will lead to 3b or higher)

Front 64

What is T4 disease

Back 64

this is anypart of the chest or spine that can not be surgically resected (carina, mediastinum, heart, great vessels, esophagus, spine)

Front 65

Is malignant pleural or pericardial effusion T4

Back 65

yes

Front 66

Is Malignant satellite nodules T4

Back 66

yes, this means the mass has metasized within the lung and there is probably metastatic disease even if not seen on imaging