Ucsf: Video I 78 Part 1 Pulmonary Self Assessment

Front 1

A patient with a history of IV drug abuse and multiple lung nodules

Back 1

septic emboli

Front 2

What part of the lung do the nodules of septic emboli predominate

Back 2

the base of the lungs where there is more blood flow

Front 3

What is an aortic pseudoaneurysm (AKA false aneurysm)

Back 3

this is a contained rupture limited by the adventitia. A pseudoaneurysm, also known as a false aneurysm, is a hematoma that forms as the result of a leaking hole in an artery.

Front 4

What are 2 causes of an aortic psuedoaneurysm

Back 4

trauma or mycotic

Front 5

What do you expect to see in a pulmonary hamartoma on CT

Back 5

popcorn calcification, internal fat

Front 6

If there is calcification inside of a mass what should be considered as a cause

Back 6

hamartoma or granuloma

Front 7

What is hounsfield units for fat on a CT scan

Back 7

less than - 20 HU

Front 8

What percent of hamartomas have fat

Back 8

65%

Front 9

What is the ddx for fat containing masses in the chest

Back 9

hamartoma, lipoma, liposarcoma, lipoid PNA, teratoma, histoplasmoma (a granuloma)

Front 10

Where are squamous cell cavitary lesions commonly located

Back 10

next to the hilum

Front 11

Give three characteristics of a Squamous cell carcinoma cavitary lesion

Back 11

thick walled
irregular
fungating margins

Front 12

What is the DDX for a large cavitary lesion
3

Back 12

Squamous cell carcinoma
TB
Abscess

Front 13

Does coarctation with collateral flow cause rib notching on plain film

Back 13

yes

Front 14

What are the MCC of lobar pna
4

Back 14

staph, strep, klebsiella, (these also cause small cavitary lesions)
H.flu

Front 15

What is classically associated with bulging fissures
2

Back 15

s. pneumo
klebsiella

Front 16

Can TB also cause lobar pna

Back 16

yes

Front 17

What is more likely to cause cavitary pna

Back 17

staph, but strep is so much more common that this is a more common cause.

Front 18

What does the loss of a fat plane with thymoma indicate

Back 18

that the mass is invasive (cant exclude invasiveness by appearnance alone)

Front 19

What percent of thymomas are invasive

Back 19

30-35%

Front 20

What are 3 causes of enhancing masses in the chest that may obstruct airway

Back 20

vascular tumors:
glomus tumor
carcinoid
metastatic breast

Front 21

What is the ddx for airway masses

Back 21

squamous cell carcinoma
adenoid cystic carcinoma (cylindroma)
carcinoid
direct invasion (esophageal or lung primary cancer)
mets
benign tumors

Front 22

What are two benign tumors that may obstruct the airway

Back 22

hamartoma
papilloma

Front 23

What are two metastatic cancers that are vascular that can form airway masses

Back 23

breast
melanoma (add this to ddx of enhancing tumors)

Front 24

What is another name for a cylindroma

Back 24

adenoid cystic carcinoma

Front 25

Can an adenoid cystic carcinoma form an airway mass

Back 25

yes

Front 26

What causes a golden S sign

Back 26

RUL collapse because of a hilar mass

Front 27

Is a golden S sign associated with a hilar mass

Back 27

yes (one of the ones from the previous ddx)

Front 28

What is a luftsichel sign

Back 28

left upper lobe atelectasis

Front 29

What is a juxtaphrenic peak

Back 29

this is upper lobe atelectasis of either side

Front 30

What is a comet tail associated with

Back 30

rounded atelectasis

Front 31

What is a flat waist sign

Back 31

straightening of the left heart border in the setting of LLL atelectasis

Front 32

When is the Juxtaphrenic peak sign seen

Back 32

when there is a lot of apical scarring (TB, head and neck cancer after radiation)

Front 33

What causes a luftsichel sign

Back 33

this is left upper lobe collapse anteriorly causing a slight increase in density of the entire left lung field. There is lucency along the aortic arch

Front 34

What is a give away that the luftsichel sign is present

Back 34

the lucency along the contour of the aortic arch

Front 35

The flat waist sign is associate with what lobe collapse

Back 35

the left lower lobe

Front 36

What are 3 findings of post-primary TB on plain film

Back 36

apical linear opacities
thin walled cavities
change in position of the horizontal fissure bc of scarring

Front 37

What are two characterisitics that differentiate SCC and TB cavitary lesions

Back 37

TB is apical and thin walled
SCC is thick walled and perihilar

Front 38

Describe the cyst of langerhans cell histocytosis
3

Back 38

irregular, variable size, favors the apices

Front 39

What is the ddx for cystic pulmonary lesions
4

Back 39

langerhans cell histiocytosis
LAM
emphysema with superimposed interstial edema
bronchiectasis (tubular)
others

Front 40

What are some 'other' rare causes of cystic pulmonary lesion

Back 40

juvenile tracheolaryngeal papillomatosis
LIP (different than lipiod pna)
Klippel trenaunary syndrome
neurofibromatosis

Front 41

What does LIP commonly present with

Back 41

cyst or small nodules

Front 42

What are problems associated with catheter embolization

Back 42

dysrhytmia, perforation of mycardium leading to tamponade

Front 43

How do you recover a catheter from the heart

Back 43

pigtail catheter to snair it

Front 44

What is potts disease

Back 44

tuberculous spondylitis

Front 45

What is the cause of Potts disease

Back 45

spread of tb via the batsons venous plexus

Front 46

What percent of pt with potts disease have no pulmonary lesions

Back 46

50%

Front 47

What percent of pt with TB will get potts disease

Back 47

less than 1%

Front 48

What is the result of potts disease

Back 48

destruction of vertebrae and adjacent disc

Front 49

How does tb spread once the patient has potts disease in spine via batsons venous comples

Back 49

subligamentous spread

Front 50

In the setting of neutropenia and a pt has a halo sign in the lung apex what is the most likely cause

Back 50

invasive aspergilosis

Front 51

What does the halo sign consist of

Back 51

hemorrhage and infiltrating hyphe

Front 52

What category of pts should fungal infection move up on the ddx

Back 52

immunosuppresed

Front 53

What is the classical cause of upper lobe predominant bronchiectasis in a young pt

Back 53

cf

Front 54

What are the causes of upper lobe bronchiectasis
4

Back 54

CF, TB, Sarcoid, ABPA

Front 55

What are causes of middle lobe brochiectasis

Back 55

MAC (anterior), kartageners (lower lobe too?)

Front 56

What are the causes of central/perihilar bronchiectasis

Back 56

ABPA and william-campells

Front 57

What are the causes of lower lobe bronchiectasis

Back 57

chronic infections/aspiration
traction bronchiectisis in UIP/IPF

Front 58

Does ABPA typically have high density mucous plugs

Back 58

yes

Front 59

If you see an invasive chest wall mass what should immediately come to mind

Back 59

mesothelioma

Front 60

How long does it take for pleural plaques to appear

Back 60

10y +

Front 61

Are pleural plaques alway calcified

Back 61

no

Front 62

How long does it take for mesothelioma to occur

Back 62

20y+

Front 63

How long does it take for Asbestosis to occur

Back 63

20y+

Front 64

What is asbestosis

Back 64

UIP that looks like IPF (difficult to seperate except with the exposure history)

Front 65

Can angioinvasive aspergillosis cause a cavitary mass

Back 65

yes, in neutropenic pts there is necrosis of a the parenchyma which may for a cavity with necrosed tissue inside

Front 66

What is an air crescent sign

Back 66

this is a cavitary mass

Front 67

Can a schwannoma cause a posterior mediastinal mass

Back 67

yes

Front 68

Is a swhannoma a benign or malignant tumor

Back 68

benign and slow growing

Front 69

What are the 2 mcc of neurogenic posterior mediastinal masses

Back 69

schwannoma, neurofibroma

Front 70

What is the MR characteristic of a shwannoma on T1

Back 70

isointense

Front 71

What are 2 mediastinal masses that you must be careful not to biopsy

Back 71

vascular and neurogenic

Front 72

Besides nerve sheath tumors (swhannoma and neurofibroma) what is the second mcc of neurogenic tumors

Back 72

ganglioneuroma

Front 73

What s the ddx for a posterior mediastinal mass
5

Back 73

spine disease
lymphoma
extramedullary hematopoeisis
aortic aneurysm
bochdalek hernia

Front 74

What type of 'spine disease' causes posterior mediastinal mass
3

Back 74

osteo, mets, fractures

Front 75

Does lipoid pna cause chronic consolidations

Back 75

yes (add to ddx)

Front 76

Doe lipoid pna need to be fat density

Back 76

no

Front 77

What is the cause of lipoid pna

Back 77

chronic aspiration of lipid rich material such as mineral oil, vics vapor rub

Front 78

Can lipoid pna lead to fibrosis

Back 78

yes

Front 79

Can PCP eventually cause extensive cystic change to the lung

Back 79

yes, secondary to pneumatoceles

Front 80

What is the typical presentation of PCP

Back 80

fever, dyspnea, hypoxia, cough

Front 81

Where do the pneumatoceles of PCP predominately occur

Back 81

upper lungs

Front 82

Are pt with PCP predisposed to pneumothorax

Back 82

yes, from rupture of a pneumatocele

Front 83

What is the appearance of PCP on plain film

Back 83

GGO 85% of the time

Front 84

What are the findings on HRCT in a pt with MAC

Back 84

tree in bud and bronchiectasis in the anterior middle lobe and lingula

Front 85

What is sternal dehiscence

Back 85

when the surgical site starts to spread apart

Front 86

What are indications that sternal dehiscence is occuring on plein film

Back 86

a lucent line at the surgical site
changes in alignment of the sternotomy wires (move right or left)
fracture or wire seperation

Front 87

What is a cause of diffuse cyst in the lungs with thin walls and some with mural nodules

Back 87

LAM

Front 88

What causes LAM

Back 88

smooth muscle obstruction of the bronchioles

Front 89

What is the prognosis of LAM

Back 89

poor,,,death within 10 y

Front 90

What is a chylothorax often seen in conjunction with

Back 90

LAM

Front 91

What population does LAM typically occur in

Back 91

young women of child bearing age
1% of TS pts

Front 92

Do LAM pts get recurrent pneumothorax

Back 92

yes