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52 Cards in this Set
- Front
- Back
What are the 3 patterns of nodules that are seen on HRCT? |
perilymphatic
random centrilobular |
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Where are the nodules seen in perilymphatic distribution
3 |
around the lymphatics: subpleural, peribronchovascular, interlobular septa
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What is the overall appearance of perilymphatic nodules
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patchy
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What is the cause of perilymphatic nodules in 95% of cases
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sarcoid
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What is the ddx for perilymphatic nodules
6 |
sarcoidosis
lymphangitic spread of tumor silicosis CWP (ooal workers pneumoconiosis) amyloidosis LIP (lymphoid interstial pna) |
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What percent of patients with sarcoid have mediastinal nodes
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60-90%
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Are the nodes symmetrical in sarcoid?
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yes
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Is hilar adenompathy also common in sarcoid
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yes
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What percent of sarcoid is actually seen on plain film?
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50%
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Name 3 types of pneumoconiosis
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CWP
asbestosis silicosis |
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What is the most common type of hypersensitivity pneumonitis?
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bird fanciers or farmers lung (from mold)
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What part of the lung does sarcoid tend to effect predominately
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upper lung zones
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What is the galaxy sign in sarcoid?
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large upper lobe mass with surrounding satellite nodules
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What happens in late stage sarcoid
4 |
upper lobe fibrosis, fibrotic masses , traction bronchiectasis, cyst, emphysema
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What is the 1-2-3-4 sign
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right paratracheal, right hilar, left hilar, left aorticopulmonary window
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What causes the large mass in sarcoid?
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a congoleration of perilymphatic nodules
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Can late sarcoid cause large cystic lesions in the upper lobes
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yes
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Can an aspergilloma end up in one of these large sarcoid cyst
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yes
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What pneumonconiosis may cause similar symptoms to sarcoid
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silicosis (perilymphatic)
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Can the galaxy sign be seen in silicosis
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yes
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Does silicosis have an upper lobe predominance
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yes
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What is seen in end-stage silicosis
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upper-lobe fibrotic masses
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Can sarcoid and silicosis be difficult to differentiate
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yes
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When are Egg shell calcification typically seen
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silicosis, sarcoid and TB
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Are random nodules ever subpleural
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yes, but not as much as in perilymphatic
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What are three characteristics of random nodules
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random
uniform distribution subpleural |
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What is the ddx for random nodules
4 |
miliary tb
miliary fungal infections hematogenous mets sarcoid |
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Is sarcoid commonly random
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no
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Can you see miliary tb on cxr
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yes
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If a pt has random nodules and HIV what should be suspected
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miliary cocci or miliary tb
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What are the characteristics of centrilobular nodules
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they occur in the centrilobular are of the secondary lobules by the centrilobular bronchiole or artery
centered 5-10mm from the pleura evenly spaced |
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What is the similarity between random nodules and centrilobular nodules
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they both may be uniform
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Can centrilobular nodules be diffuse or patchy
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yes
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What type of nodules will you suspect if there is subpleural nodules
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random and perilymphatic
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What if you see nodules that are subpleural, patch or non-uniform?
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perilymphatic and sarcoid, silicosis or lymphangitic carcinoma would be suspected
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What if you see diffuse and uniform pattern of nodules and also subpleural nodules
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random nodules (milliary TB, hematogenous Mets)
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What if you see no pleural nodules
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centrilobular nodules
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What type of nodular pattern will a hypersensitivty give?
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centrilobular
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What is the ddx of centrilobular nodules
9 |
bronchiolitis
endobronchial spread bronchopneumonia HP endobronchial spread of tumor pneumoconiosis (silicosis) edema (uncommon) hemorrrhage (uncommon) vasculitis (uncommon) |
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What two types of patterns can silicosis give
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perilymphatic (MC) or centrilobular (uncommon)
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What are two types of causes of bronchiolitis
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infectious or inflammatory
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What is the mcc of centrilobular nodules
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bronchiolitis
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Is the centrilobular distribution with bronchopneumonia usually patchy
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yes
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What is the nodular distribution of non-miliary TB?
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centrilobular
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What should you suspect if there are centrilobular nodules and a cavitary lesion
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TB
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What should you suspect if there is centrilobular nodules, and GGO?
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BAC
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What causes the tree in bud appearance
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dilatation and impaction of the centrilobular airway
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What makes up the buds of the tree in bud
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the centrilobular nodules
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What makes up the tree of the tree in bud sign
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the dilated and impacted centrilobular airway
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What does a tree in bud sign mean
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there is an infectious cause (specific)
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What is the ddx of the tree in bud sign
9 |
endobronchial spread of TB or MAC
bronchopneumonia bronchiestasis or bronchitis CF aspiration (rare) ABPA or asthma (rare) BAC (rare) |
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What are 4 rare causes of the tree in bud
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aspiration
ABPA or asthma BAC |