Ucsf: Video I 79 Part 1 Pulmonary Self Assessment

Front 1

In the mosaic pattern which lung is abnormal; the lucent or opacified lung

Back 1

lucent lung

Front 2

How do you determine if the lucent lung is the abnormal lung and the pattern is mosaic
4

Back 2

if there is a sharp distiction between the lung densities and geographic.
if on expiratory films the opacified lung becomes more prominent
vessel size discrepancy (greater in opacified section of the lung)

Front 3

If the vessels are larger in the opacified lung than the lucent lung what is the pattern

Back 3

mosaic pattern

Front 4

What causes a mosaic perfusion pattern

Back 4

air trapping

Front 5

What is the ddx of mosaic pattern

Back 5

small airway and small vessel disease

Front 6

How do you differentiate the cause of mosaic pattern (small airway disease or small vessel disease)

Back 6

by doing an inspiratory and expiratory film. If a pt has increased density of the opacified lung during expiration than it is from small airway disease

Front 7

What is a more common cause of mosaic pattern; small airway or small vessel disease

Back 7

small airway is far more common

Front 8

What is the differential diagnosis of mosaic pattern that is caused by small airway disease

Back 8

asthma
HP
constrictive bronchiolitis (bronchiolitis obliterans)

Front 9

What is the pathology that results in the mosaic pattern from small vessel disease

Back 9

chronic PE

Front 10

What are 3 findings on HRCT of mosaic pattern

Back 10

geographic (with sharp borders)
increased density of opacified lung during inspiration
bigger vessels in opacified area

Front 11

Does the opacified portion of the mosaic pattern resulting form small airways disease have a lobular appearance

Back 11

yes

Front 12

What is the ddx of GGO centrilobular disease

Back 12

HP (by far the most common)
RB if they are a smoker
viral infection
follicular bronchiolitis

Front 13

What are conditions when follicular bronchiolitis may occur

Back 13

collagen disease, immunosupression

Front 14

What is the DDX of dense centrilobular disease

Back 14

endobronchial spread of infection (by far most common)
aspiration
BAC
vascular causes

Front 15

What are two types of centrilobular nodulars

Back 15

GGO centrilobular nodules
dense centrilobular nodules

Front 16

Can vascular abnormalities cause dense centrilobular nodules

Back 16

yes, edema or hemorrhage

Front 17

What are some causes of diffuse tracheal wall thickening
7

Back 17

sarcoid
amyloid
relapsing polychondritis
wegners
infection
tracheobronchopathia osteochondroplastica (nodular)
IBD

Front 18

What types of infection can cause diffuse tracheal wall thickening
3

Back 18

aspergillus
klebsiella
rhinoscleromatis

Front 19

what are the 'oids' that can cause diffuse tracheal wall thickening
3

Back 19

sarcoid
amyloid
weg'noid'

Front 20

How does tracheobronchopathia osteochondroplastica appear on CT

Back 20

nodular thickening

Front 21

What does tracheal wall thickening look like on plain film

Back 21

enlarged paratracheal stripe

Front 22

Does relapsing polychondritis spare the posterior tracheal membrane

Back 22

yes

Front 23

What are the 4 that should be on the top of the differential for diffuse tracheal thickening

Back 23

the 'oids' (sarcoid, amyloid, weg'noid)
and relapsing polychondritis (spares posterior membrane)

Front 24

What is the differential for cystic bronchiectasis of the lower lobes

Back 24

post viral (child)
kartageners
william campell (A rare disorder involving a reduction or absence of cartilage in the bronchi which affects lung functioning)
tracheobronchomegally

Front 25

What is the ddx for upper lobe bronchiectasis that is symmetric

Back 25

CF

Front 26

What is the ddx for asymmentric upper lobe bronchiectasis

Back 26

TB, ABPA, bronchial atresia, endobronchial tumor or stricture

Front 27

If a pt has a history of asthma and a high density mucus plug

Back 27

abpa

Front 28

A hazy veil like density with left sided volume loss

Back 28

LUL collapse

Front 29

What do you see in left lower lobe collapes

Back 29

a straightening of the left heart border

Front 30

What causes a combine RML and RLL collapse

Back 30

bonchus intermedius obstruction

Front 31

Where are pulmonary sequestrations usually located

Back 31

the left side

Front 32

What is the drainage for an intralobar sequestration

Back 32

systemic arterial supple and drains to the azygous vein

Front 33

Does intralobar have its own pleural covering

Back 33

no, it is with in the normal covering of the lung, extralobar has its own covering

Front 34

What is congenital intralobar or extralobar pulm sequestration

Back 34

extralobar

Front 35

What commonly presents as an adult intralobar or extralobar

Back 35

intralobar (its not congenital so can present later)

Front 36

What is the presentation of a intralobar pulm sequaestration

Back 36

recurrent infections

Front 37

Can intralobar have systemic venous drainage

Back 37

yes, it can have systemic or pulmonary drainage

Front 38

What is the arterial supply for both intralobar and extralobar pulmonary sequestrations

Back 38

systemic

Front 39

What is the density of a pulmonary sequestration

Back 39

solid cystic or lucent

Front 40

Which type of pulmonary sequstration may have pulmonary venous drainage

Back 40

intralobar may have either pulm or systemic venous drainage and extralobar alway has systemic venous drainage

Front 41

How are extralobar sequestration found

Back 41

incidentally during workup for other congenital abnormality

Front 42

What percent of pt with extralobar pulm seqestration have associated abnormalities

Back 42

65%

Front 43

What is crazy paving associated with

Back 43

alveolar proteinosis

Front 44

What are 2 characteristics of crazy paving

Back 44

ggo and inseptal lobular thickening

Front 45

Does crazy paving have to be alveolar proteinosis

Back 45

no, if the pt symptoms are acute is not alveolar proteinosis

Front 46

What are some causes of crazy paving with acute symptoms

Back 46

anything that will cause ggo; viral, hemorrhage, DAD, HP, edema

Front 47

Is crazy paving specific

Back 47

no

Front 48

What are the causes of crazy paving that is chronic

Back 48

BAC
lipoid pna
Alveolar proteinosis

Front 49

What are the characteristics of swyer james syndrome
4

Back 49

unilateral lucent lung
small lung volume
small PA
bronchiectasis

Front 50

What is the ddx of crazy paving
10

Back 50

acute: edema DAD/ARDS/AIP, infection, hemorrhage, hp

chronic: BAC, lipoid pna, alveolar proteinosis.

Front 51

What are the causes of unilateral lucent lung
4

Back 51

pneumo, bronchial obstruction, swyer james syndrome (small volume), pulmonary embolism

Front 52

What are some bronchial obstructions that may result in a unilateral lucent lung

Back 52

tumor, stricture, aspirated foriegn body, atresia

Front 53

What is called when a pulmonary embolism decreases vascularity

Back 53

the westermark sign

Front 54

What is swyer james syndrome

Back 54

post-infectious bronchiolitis obliterans

Front 55

What are the findings in swyer james syndrome
4

Back 55

PA smaller, lung lucent, small lung, bronchiectasis

Front 56

Does swyer james syndrome have bronchiectasis

Back 56

yes

Front 57

What are some examples of infiltrative disease of the soft tissue of the mediastinum
7

Back 57

lymphoma, leukemia, mets, acute mediastinitis, fibrosing mediastinitis, erdheim chester

Front 58

What are the two forms of fibrosing mediastinitis

Back 58

diffuse and focal

Front 59

Which type of fibrosing mediastinitis is more common

Back 59

the focal (80%)

Front 60

What is diffuse fibrosing mediastinitis associated with

Back 60

autoimmune disease like retroperitoneal fibrosis

Front 61

Is there calcification in diffuse fibrosing mediastinitis

Back 61

no

Front 62

What is a complication of diffuse fibrosing mediastinitis

Back 62

compression of vessels, or bronchi

Front 63

Is focal mediastinitis more common

Back 63

yes, 80%

Front 64

What is focal fibrosing mediastinitis associated with

Back 64

granulomatous infection such as histoplasmosis

Front 65

What are the two most common location of fibrosing mediastinitis

Back 65

paratracheal and subcarinal

Front 66

If there are nodules predominately around the bronchus and subpleural what is the distribution

Back 66

perilymphatic

Front 67

What is the ddx for perilymphatic nodules
6

Back 67

sarcoid
lymphangitic carcinomatosis
silicosis
CWP
amyloidosis
LIP

Note: sarcoid/silicosis/CWP are also ddx for massive progressive upper lobe fibrosis

Front 68

What are the two most common causes of perilymphatic nodules

Back 68

sarcoid
lymphangitic carcinomatosis

Front 69

What are the more rare causes of perilymphatic nodules
4

Back 69

silicosis/CWP
amyloid
LIP

Front 70

Can sarcoid produce fibrosis

Back 70

yes

Front 71

Where is the fibrosis of sarcoid located

Back 71

strongly upper lobe predominate

Front 72

What is the differential ddx for progressive massive fibrosis of the upper lobe
5

Back 72

silicosis
sarcoid
CWP
fungal disease
talcosis

Front 73

What does progressive massive fibrosis of the upper lobes look like

Back 73

mickey mouse ears

Front 74

where are the nodules in silicosis

Back 74

upper lobe predominate, and posterior

Front 75

Can silicosis cause eggshell calcified nodes

Back 75

yes (so can sarcoid and its much more common)

Front 76

What is the ddx for multiple cavitary nodules
7

Back 76

mets
septic emboli
fungal disease
wegners
rheumatoid
langerhans (small)
tracheobronchial papillomatosis

Front 77

If the wall of a cavitary is less than 5 that is it likely to be benign

Back 77

yes

Front 78

What if the wall of a cavitary is 5-15mm

Back 78

it is non specific

Front 79

if a wall is greater than 15cm is likely malignant

Back 79

yes

Front 80

What are 2 pulmonary presentations of wegners

Back 80

infarction (results in cavitary lesion)
hemorrhage (GGO)

Front 81

What is a common location of the GGO of wegners (from hemorrhage)

Back 81

perihilar

Front 82

Can Wegners also present with airway disease and tracheal wall thickening

Back 82

yes

Front 83

What is the DDX of focal lung luceny
4

Back 83

bronchial obstruction (most common)
sequestration (uncommon to be totally lucent)
CCAM
asysmmetric bullous disease

Front 84

What are the causes of bronchial obstruction

Back 84

aspirated foriegn body
endobronchial tumor (carcinoid)
bronchial stricture
bronchial atresia

Front 85

What is the cause of bronchial atresia

Back 85

a missed congenital lobar emphysema (Congenital lobar emphysema is characterized by progressive overdistention of a lobe.) or congenital

Front 86

Is there an impacted bronchus associate with bronchial atresia

Back 86

yes

Front 87

What is the shape of the impacted bronchus of bronchial atresia

Back 87

round (looks like a mass) or tubular

Front 88

What is bronchial atresia

Back 88

Congenital bronchial atresia is a rare anomaly that results from focal obliteration of a proximal segmental or subsegmental bronchus that lacks communication with the central airways.

Front 89

What is simitar syndrome

Back 89

a partial anomalous pulmonary venous return syndrome

Front 90

What is the arterial supply to lung affected by scimitar syndrome

Back 90

systemic arterial supply

Front 91

Do pt with scimitar syndrome have a small pulmonary artery and small lung

Back 91

yes

Front 92

Is there small lung volume on the side of scimitar syndrome

Back 92

yes

Front 93

What looks like a scimitar (sword) in scimitar syndrome

Back 93

anomalous pulmonary vein

Front 94

Is there situs inverus in scimitar syndrome

Back 94

no, there is dextro position of the heart (its on the right side)