Chest SF
Terms
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- Tracheal stenosis
- short or long segment?
- Tracheal stenosis, short segment
- incubation/tracheostomy, Wegener's, extrinsic compression mass, TB (especially after erosion into airway by broncholith), sarcoidosis.
- Tracheal stenosis with thickening of cartilage rings
- Wegener's (short segment), relapsing polychondritis (long segment)
- tracheal stenosis with wall irregularity
- Wegener's, sarcoidosis, TB, amyloidosis
- subglottic stenosis
- Post intubation or tracheostomy, sarcoidosis
- tracheal wall calcification
- TB, amyloidosis, tracheobronchopathia osteochochondroplastica (TBO)
- tracheal or bronchial collapse on inspiration
- relapsing polychondritis, tracheobronchomegaly (large trachea, though)
- tracheal wall with dense calcifications in cartilagenous ring
- TBO
- diffuse tracheal and bronchial enlargement
- tracheobronchomegaly (Mournier Kuhn), collagen vascular diseases (scleroderma, lupus)
- widening of trachea on AP view, but narrowed on lateral
- saber sheath trachea
- cause of the saber sheath trachea
- COPD, most commonly emphysema
- focal diverticulum coming off of trachea
- tracheocele
- intrinsic tracheal mass
- primary tracheal tumor versus metastasis
- solitary intrinsic tracheal mass
- 90% are malignant
- primary intrinsic tracheal tumors
- common -- Mucoepidermoid and adenoid cystic. Less common -- squamous cell carcinoma and carcinoid.
- Tracheal metastasis
- melanoma, RCCA, breast
- multiple noncalcified tracheal nodules
- laryngeal papillomatosis -- 5% of laryngeal papillomatosis involves endobronchial trachea as well
- endobronchial mass
- bronchogenic carcinoma and all of the tumors affecting trachea (adenoid cystic, Muco Epidermoid, metastases, squamous cell, carcinoid)
- extrinsic tumor invasion into trachea or large bronchus
- bronchogenic lung cancers, thyroid
- cystic bronchiectasis
- cystic fibrosis
- other forms of bronchiectasis
- varicose and cylindrical
- Mosaic perfusion
- must see different levels of attenuation as well as smaller vessels within the dark poorly perfused areas.
- Mosaic perfusion differential
- differential is small airways disease versus small vessel disease.
- Differentiate between them
- perform end-expiratory high-resolution C. T. to look for geographic areas of air trapping. If air trapping is present it is small airways disease. If air trapping is not present, it is small vessel disease.
- No air trapping is present on end-expiratory C. T.
- small vessel disease. Usually chronic PE.
- Air trapping is present on end-expiratory C. T.
- small airways disease. Differential for air trapping is asthma, bronchiolitis obliterans, and hypersensitivity pneumonitis. Can also be due to cystic fibrosis or small airways infection, however, other findings suggesting these entities would be present.
- Terminology on inspiratory versus excretory CT
- Mosaic perfusion on inspiratory, air trapping on expiratory.
- Plain film with numerous cystic lesions best seen centrally, lung expansion, with large anterior clear space on lateral view
- cystic fibrosis
- What should you expect to see on chest section
- cystic fibrosis.
- Thick walled cysts with Mosaic perfusion
- cystic fibrosis.
- C. T. with numerous lung cysts
- immediately check to see if you can find any of the structures branching so you know it's not cystic lung disease. Also look at the general thickness of the walls. Wall thickness should not be so great in cystic lung disease but can be very great and cystic fibrosis. Often you can follow the tubular structures image to image.
- History of eosinophilia
- think ABPA. Also if there is history of chronic asthma or reactivity to Aspergillus antigen.
- Central bronchiectasis
- think ABPA. Bronchiectasis in cystic fibrosis goes close to the periphery whereas in ABPA it stays much more central the walls are thinner and there'll be evidence of mucoid impaction.
- High attenuation tubular structure
- think mucoid impaction
- nodular lung disease on C. T.
- immediately define pattern of distribution.
- C. T. with lots of small lung nodules
- are there pleural based nodules, or is there a small- gap? if there is a thin gap , it is centrilobular.
- There are pleural based nodules
- is the distribution patchy or random.
- Patchy
- if the distribution is patchy and concentrated around the pleural edges, fissures, and bronchovascular bundles, it is a perilymphatic distribution. If it is completely random, it is a random distribution.
- Differential for perilymphatic distribution
- sarcoidosis, lymphangitic spread, silicosis and coalworkers pneumoconiosis.
- Random distribution
- hematogenous spread of infection or cancer. Miliary TB, Miliary fungal infection, hematogenous metastases.
- Centrilobular distribution of nodules
- AIRWAYS DISEASE Differential to start with: Bronchopneumonia, endobronchial spread of MAI or TB, then expand to: BBPEEH -- Bronchopneumonia (most common cause), bronchiolitis (infectious, i.e. viral, or inflammatory), pneumoconioses, endobronchial spread of infection (TB, MAI), endobronchial spread of tumor (bronchoalveolar cell), and hypersensitivity pneumonitis -- with appropriate history
- Centrilobular distribution of nodules seen
- look carefully for tree in bud -- which narrows the differential down to endobronchial spread of infection. Also look for lucencies within the nodules -- implies that the "nodules" are actually bronchioles with thickened walls, consistent with bronchiolitis.
- CT with tree in bud
- AIRWAYS INFECTION bronchopneumonia, endobronchial spread of TB or MAI, bronchitis/bronchiectasis, cystic fibrosis with infection.
- Lymphangitic spread of cancer
- occurs from spread of metastatic disease to the lung or bronchial cancer via the lymphatics. TOTALLY different than bronchioloalveolar cell which spreads endobronchially and causes centrilobular nodules.