radcards chest radiology
Terms
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- ddx: posterior mediastinal mass
-
neurogenic tumor
foregut duplication cyst
vascular lesion
lateral thoracic meningocele
esophageal lesion
lymphadenopathy
extramedullary hematopoesis - ddx: middle mediastinal mass
-
lymphadenopathy(TB, fungus, sarcoid, tumor)
bronchogenic cyst
vascular
primary lung tumor - ddx: mediastinal and hilar lymphadenopathy
-
lymphoma
bronchogenic ca
sarcoid
TB/fungus
renal ca
testicular ca
head and neck squamous ca - ddx: pericardial effusion
-
HICCUP
-heart attack (post mi, dressler's syndrome)
-infection
-cancer
-collagen vascular disease
-uremia
-post-op - what characterizes a thymoma (5)
-
most common adult anterior mediastinal mass
calcify infrequently
peak age 40-60
1/3 have myasthenia gravis
40% with myasthenia gravis have thymoma - intra- vs extralobar sequestration
-
extra has: own pleura
systemic venous drainage
persent earlier (infancy) - what are causes of pulmonary arterial HTN
-
L to R shunt
L sided valvular lesion
chronic lung disease
chronic PE
idiopathic - ddx: global cardiac enlargement
-
dilated cardiomyopathy
multivalvular disease
ebstein's anomaly - what are patterns of pulmonary sarcoid
-
90% bilateral perihilar small nodules
3% large nodules
3% pleural disease - ddx: cavitary lesion
-
CAVITY(E)
cancer
abscess
vasculitis (wegener's)
infarct
TB/fungus
emboli - what are causes of eosinophilic pneumonia
-
loeffler's syndrome
chronic eosinophilic pneumonia
hypereosinophilic syndrome
churg-strauss
ABPA
parasitic
drug reaction - what infections are associated with alveolar proteinosis
-
nocardia
cryptococcus
aspergillus - ddx: CXR out of proportion to clinical findings
-
sarcoid
pneumoconiosis
alveolar proteinosis
alveolar microlithiasis
BOOP - ddx: unilateral interstitial pattern
-
lymphangitis carcionomatosa
pulmonary edema (atypical)
aspiration
XRT - ddx: endobronchial metastasis
-
renal
breast
colon - ddx: cardiophrenic angle mass
-
pericardial cyst
fat pad
lipoma
lymph node
hernia
aneurysm (ventricle or aorta) - what are patterns of involvement of lung by rheumatoid
-
nodules
interstitial disease
pleural effusion - what is caplan's syndrome
- rheumatoid arthritis and pneumoconiosis with nodules
- ddx: dilated cardiomyopathy
-
MIA TAG
myocarditis
ischemia
alcohol
thyroid/thiamine deficiency
adiamycin
glycogen storage disease - ddx: pleural effusion
-
TINCUP
trauma
infection
neoplasm
collagen vascular disease
uremia
pancreatitis - what is the most common cancer to cause a pancoast syndrome
- squamous cell lung ca
- what is the most common cancer to cause SVC syndrome
- small cell ca
- what are the causes of SVC syndrome
-
neoplasm
fibrosing mediastinitis
*pearl* lymphoma usually does not obstruct - ddx: cardiac mass
-
thrombus, myxoma
lipoma
rhabdomyoma
fibroma
teratoma
angiosarcoma
rhabdomyosarcoma
metastasis
*pearl* mets are 20x more common than primary malignancy -
what are paraneoplastic syndromes of...
- squamous cell
- small cell
- carcinoid -
hypercalcemia = squamous cell
SIADH, cushing's syndrome = small cell
carcinoid syndrome = carcinoid
*pearl* also remember any cancer may cause neuromyopathy, thrombophlebitis, hypertrophic pulmonary osteoarthropathy - what is the most common cause of unilateral pleural effusion worldwide
- TB
- what are causes of pulmonary mass with an air bronchogram
-
lymphoma
bronchoalveolar cell ca
sarcoid - what features make a pulmonary mass benign
-
stable in size over 2 years
calcification over 200 HU
fat density - what cancers cause lymphangitis carcinomatosa
-
lung
breast
stomach
pancreas - ddx: tracheobronchial lesion
-
3 benign:
papilloma
hemangioma
hamartoma
3 malignant:
squamous cell ca
adenoca
mets (melanoma, thyroid, esophageal) - ddx: chronic air space disease
-
VER(Y) FAT BALLS
vasculitis
eosinophici pneumonia
Rx (drugs)
fungus
alveolar proteinosis
TB
BOOP/bronchoalveolar cell ca
actinomycosis
lipoid pneumonia
lymphoma
sarcoid - ddx: tracheomalacia
-
primary
post intubation/trauma
COPD
trauma
infection
relapsing polychronditis - ddx: multiple pulmonary nodules
-
MARS BE WHAT
mets
AMV
rheumatoid
sarcoid
BOOP
emboli (septic)
wegener's
histoplasmosis
amyloid
TB - ddx: acute air space disease
-
A HEIDI
AIDS/aspiration
hemorrhage
edema
infection
drugs
inhalational injury - ddx: lymphadenopathy in chest
-
TB/fungus
lymphoma
sarcoid
metastasis
bronchogenic carcinoma
castleman's disease - ddx: high resolution CT mosaic pattern
-
alveolar proteinosis
bronchoalveolar ca
PCP
DIP/UIP
vasculitis - what are causes of pleural effusion in AIDS
-
lymphoma
TB
kaposi's
community acquired pneumonia - what are findings in kaposi's sarcoma
-
nodular lesions
interstitial lung disease
lymphadenopathy
effusions - what are pulmonary complications of AIDS (10)
-
PCP
TB
MAI
fungus
community acquired pneumonia
viral
kaposi's sarcoma
lymphoma
lymphocytic interstitial pneumonitis (peds)
interstitial pneumonitis - what are features of LIP
-
widespread reticulonodular infiltrates
lymphadenopathy rare
pleura spared
present in non-AIDS patients (sjogren's) - ddx: benign lung nodule
-
hamartoma
amyloidoma
leiomyoma
lipoma
fibroma
chondroma
pseudotumor - ddx: non-cardiogenic pulmonary edema
-
NOT CARDIAC
-near drowning
-oxygen toxicity
-transfusion/trauma
-CNS shock
-allergic alveolitis/ARDS
-renal
-drugs (TCAs, cocaine, cheomtherapy, PCN)
-inhalation (hydrocarbon, N02, CO)
-aspiration
-collagen vascular disease - ddx: interstitial lung disease
-
PC LIPS ARE BAD
pulmonary edema
collagen vascular disease
lymphangitis carcionmatosa
idiopathic pulmonary fibrosis
pneumoconiosis
sarcoidosis
aspiration
recurrent hemorrhage (hemosiderosis)
eosinophilic pneumonia
BOOP
alveolar proteinosis/asbestosis
drugs (chemotherapy) - how does one differentiate causes of a mosaic lung pattern on high resolution CT
-
vascular disease: decreased vessel size and number, no air trapping
small airways disease: decreased vessel size and number, air trapping
primary lung disease: uniform vessel size and number, no air trapping - ddx: bronchiectasis
-
infection (viral, TB, recurrent bacterial)
aspiration
immunde deficiency (agammablobulinemia, granulomatous disease of childhood)
abnormal struction (williams-campbell)
abnormal mucus (CF)
abnormal clearance (immotile cilia/kartagener's)
obstruction
ABPA
noxious fumes
pulmonary fibrosis - ddx: aortic root dilatation
-
HOMIE
homocystinuria
osteogenesis imperfecta
marfan's
idiopathic
ehrlers-dahnlos - ddx: lymph node calcification
-
TB
radiated lymphoma
thyroid mets
squamous cell mets
mucinous adenoca mets
granulomatous disease - what are pulmonary radiation changes
-
4 acute:
-infiltrate with non-anatomic margins
-minimal volume loss
-4-6 weeks post treatment
-subclinical
*pearl* if < 3 weeks think infection/recurrence
2 chronic:
-fibrosis with straight margins
-6-12 months post treatment
*pearl* if volume increase or effusion think infection/recurrence - ddx: upper lobe interstitial pattern
-
CASSET P
cystic fibrosis
ankylosing spondylitis
silicosis
sarcoidosis
eosinophilic granuloma
TB
PCP - ddx: lower lobe interstitial pattern
-
BADLAS
bronchiectasis
asbestosis
drugs
lymphangitis
aspiration
SLE/collagen vascular disease - ddx: egg shell nodal calcification
-
TLASS
TB/fungus
lymphoma
amyloid
sarcoid
silicosis - what are thoracic presentations of sarcoid
-
nodular
alveolar
lymphadenopathy
pneumothorax
cysts +/- TB or myecetoma
cardiac (25%) - what is the garland triad
- right paratracheal and bilateral hilar adenopathy in sarcoid
- what is the appearance of sarcoid on HRCT
-
central, nodular density
cystic component
bronchoalveolar pattern
upper lobe predominant - what characterizes necrotizing granulomatosis
- noncavitating, multiple masses in lungs only
- what characterizes churgg-strauss
-
aka allergic angitis
young patients
asthmatics
eosinophilia
radiographically mimics EG - what percentage of patients with sarcoid have pleural effusion
- 2%
- what factors suggest an improved prognosis in sarcoid (6)
-
young age
erythema nodosum
white race
normal PFT
low stage
lofgren's syndrome - what factors suggest a bad prognosis in sarcoid (2)
-
black race
lupus pernio - what extra thoracic sites are involved in sarcoid
-
bone - cystic or sclerotic lesions
abdomen - hepatosplenomegaly, liver/spleen nodules
skin - lupus pernio, erythema nodosum
muscle - myositis
myocardium - restrictive cardiomyopathy
CNS - vasculitis, leptomeningeal disease
salivary glands, kidney
stomach - masses - what are indications for steroid therapy in sarcoid
-
rapid onset
hypercalcemia
splenic, orbital, CNS, myocardium masses - what test are used to diagnose sarcoid
-
acetylcholinesterase
kveim-sitzbach
hypercalcemia
decreased FRC on PFTs - what is the prognosis in sarcoid
-
75% resolve with hilar adenopathy alone
10% mortality overall - what percentage of patients with sarcoid are symptomatic
- 20-50%
- what are eponyms used with TB
-
garland triad - bilateral hilar and right paratracheal adenopathy
boeck sarcoid
lofgren syndrome - bilateral hilar adenopathy, erythema nodosum, arthralgia - what characterizes bronchocentric granulomatosis
-
ABPA like radiographically
unilateral
upperlobe
associated with asthma - what distinguishes limited wegener's from wegener's
-
no renal or sinus involvement
better prognosis
females predominant - ddx: multiple thoracic masses in AIDS
-
mycobacteria
kaposi's
fungus
lymphoma
PCP
metastasis - ddx: high density mediastinal masses
-
hypervascular mets
aneurysm
aberrant vessel
castleman's disease
paraganglioma - what are epopnyms used with TB
-
ranke complex - parenchymal opacity and hilar node
simon complex - healed apical lesion
ghon focus - primary TB
rasmussen aneurysm
empyema necessitans - TB with chest wall penetration