Term
| What are some tips for differentiating a mediastinal mass from a parenchymal lung mass? |
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Definition
-mediastinal masses will originate in the mediastinum
-if a mass is surrounded by lung tissue in both the frontal and lateral projections, its lies within the lung
-if a mass is surrounded by lung tissue in one, but not in bother projections, it may be in either the lung or the mediastinum |
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Term
| the margin of a mediastinal mass is _________ than that of a mass that originates in the lung |
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Definition
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Term
| What are the 5 diseases that may present in the anterior mediastinum? |
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Definition
4 T's
-thymoma
-teratoma
-terrible lymphoma
-thyroid mass
-AND pericardial cyst |
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Term
| What are two causes of middle mediastinal masses? which is the most common? |
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Definition
-lymphadenopathy: most common, and most often caused by Hodgkin's lymphoma
-aneurysm (pulmonary or aortic aneurysm) |
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Term
| What are 4 pathologies that may be seen in the posterior mediastinum? |
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Definition
-neurogenic tumors (schwannoma, neurofibromas)
-esophageal tumors
-lymphadenopathy
-descending aortic aneurysm |
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Term
| Hilum overlay sign: abnormality is _______ to any structure that the abnormality obscures |
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Definition
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Term
| When would you order a CT of the chest with contrast? |
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Definition
| when evaluating mediastinal structures (lymph nodes, mediastinal masses, lung cancer) |
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Term
| Contrast in the chest is timed to opacify the _________ and _________ soft tissues. THis is (earlier/later) than CT PE and CTA studies |
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Definition
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Term
| What is the most frequently encountered anterior mediastinal mass? how can you differentiate this mass from the other T's? |
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Definition
substernal thyroid masses
they characteristically displace the trachea either to the R or L above the level of the aortic arch, most other anterior mediastinal masses do not do that. |
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Term
| what is the most common cause of mediastinal mass overall??? |
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Definition
| lymphadenopathy (whether from lymphoma, metastatic CA, sarcoid, or TB) |
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Term
| Describe the border with which lymphadenopathy usually presents/ |
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Definition
| a lobulated or polycyclic border because they are composed of several contiguous enlarged lymph nodes |
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Term
| what age group do thymomas typically occur in? |
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Definition
| middle aged adults (generally older age than those with teratomas) |
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Term
| thymomas are associated with ________/_______ about 35% of the time |
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Definition
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Term
| how does a thymoma present on CT? |
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Definition
| smooth or lobulated mass that arises near the junction of the heart and great vessels, which like a teratoma, may contain calcification |
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Term
| what are the size restrictions for calling something a nodule or a mass |
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Definition
<3 cm is a nodule
> 3 cm is a mass |
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Term
| Give 5 characteristics of a benign pulm nodule. |
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Definition
-size (esp < 4 mm), with no change in over 2 years
-calcification
-smooth margins
-decrease FDG uptake on PET scan |
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Term
| Give some malignant features of a pulm nodule. |
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Definition
-size (esp > 5 cm)
-no calcification
-ground glass attenuation
-change in size over time
-SPICULATED, lobulated, or shaggy borders
-increased uptake on PET, on enhanced with contrast |
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Term
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Definition
disorganized lung tissue with fat (60%), diffuse or popcorn calcifications (30%) or both
smooth or lobulated in contour |
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Term
| What is the Fleishner Society Criteria? |
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Definition
| set of evidence based criteria setting guidelines for the follow-up of noncalcified nodules found incidentally during chest CT- only applies to patients with no known malignancy |
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Term
| What are the 3 best radiographic test for a solitary pulm nodule, solid, > 1 cm, with low clinical suspicion for cancer? |
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Definition
CT chest without contrast
FDG-PET/CT whole body
transthoracic needle biopsy |
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Term
| what are the three best tests for a solid nodule, >1 cm, with moderate to high clinical suspicion for CA? |
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Definition
CT chest without contrast
FDG-PET/CT whole body
transthoracic needle biopsy |
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Term
| What is the best test to perform for a solid nodule, <1 cm, with low clinical suspicion for cancer? |
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Definition
| watchful waiting with CT follow up |
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Term
| what is the best study for a solid nodule <1 cm, with moderate to high clinical suspicion for cancer? |
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Definition
| CT chest without contrast |
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Term
| What are 6 common CT findings in lung cancer? |
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Definition
1. irregular or spiculated edge
2. lobulated contour
3. air bronchograms
4. cavitation with THICK, nodular wall (abscess usually have thin wall)
5. > 2 cm
6. ground glass opacification (think BAC) |
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Term
| give some common characteristics of SCLC |
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Definition
|
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Term
| give some characteristics of squamos (NSCLC) |
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Definition
| central and likes to cavitate |
|
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Term
| give some characteristics of adenocarcinoma (NSCLC) |
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Definition
| peripheral, slow growing, most common |
|
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Term
| Give some examples of large cell (NSCLC) |
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Definition
| peripheral, usually > 4cm |
|
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Term
| what are the three best tests for non invasive clinical staging of bronchogenic carcinoma, NSCLC |
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Definition
CT chest without contrast through adrenals
CT chest with contrast through adrenals
FDG-PET/CT skull base to mid-thigh |
|
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Term
| what are the three best tests for staging of SCLC |
|
Definition
CT chest without contrast including upper abdomen
CT chest with contrast including upper abd
MRI hear without and with contrast |
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Term
| What are the three classic findings for a PE |
|
Definition
-wedge shaped peripheral airspace disease (hampton hump)
-focal oligemia (westermark sign)
-prominent central pulmonary artery (knuckle sign) |
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Term
| What does well's criteria tell you? what does a wells score greater than 6 mean? |
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Definition
the likelihood of a patient having a DVT
pt has a high probability and a 38% chance of PE |
|
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Term
| what is the best test for a suspected PE? what is the best test for patients with contraindications to the best test? |
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Definition
CT pulm angiography
V/Q scan |
|
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Term
| what is the best test for suspected PE in a pregnant patient? |
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Definition
|
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Term
| what is the CT PE protocol? |
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Definition
| CT scan through the chest with thin sections times when contrast opacifies (makes white) the pulm arteries (approx 35 secs) thus allowing for detection of hypodense (vlack) pulm arterial filling defects (PE) |
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Term
| what is the number one cause of an aortic aneurysm? |
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Definition
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Term
Define these measurements for an ascending aortic dilatation:
4 cm
5 cm
6 cm |
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Definition
4- ectasia
5- aneurysm
6- surg |
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Term
| what measurement marks a descending aortic aneurysm? |
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Definition
|
|
Term
| what measurement marks a AAA? when is it time for surg? |
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Definition
|
|
Term
| what are the two best tests for acute chest pain, suspected aortic dissection? |
|
Definition
xray of the chest
CTAS chest and abdomen with contrast |
|
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Term
| What is the protocol for a dissection |
|
Definition
1. noncontrast CT from lung apices to aortic bifurcation (intramural hematoma)
2. arterial phase CT from lung apices to aortic bifurcation (scan is timed so the thoracic aorta is best opacified- whitened) |
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Term
| Which is usually whiter on CT, the true or the false lumen? |
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Definition
|
|
Term
| what is the number one cause of aortic dissection? |
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Definition
|
|
Term
| what is the difference in treatment between an ascending aortic dissection and everything else? |
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Definition
ascending aorta= SURG
descending aorta= medical management unless there is something else serious going on |
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Term
| what is the best radiographic study in a pateint older than 40 with acute respiratory illness who is immunocompetent, a patient with dementia, and a patient < 40 with negative physcial sx and no other signs, sx, RFs? |
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Definition
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Term
| How about the same illness with a patient <40 with + PE and/or other RFs, complicated PNA, and suspected SARS? |
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Definition
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Term
| What about a patient with suspected H1N1 who has already had a normal chest radiograph? |
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Definition
| Ct chest without contrast |
|
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Term
| what is the difference between a ground glass opacity and a consolidation? |
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Definition
| you can see vessels through a ground glass opacity |
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Term
| A consolidation is complete filling of alveoli with one of what 4 things? |
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Definition
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Term
| ground glass opacity is a ________ filling of the alveoli with water, pus, blood, or protein |
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Definition
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Term
| what are tree in bud opacities? what are they usually seen in? |
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Definition
centrilobular branching structures that resemble a budding tree. most noticeable in the peripheral lung.
broad DDX, but usually seen in bronchopneumonia |
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Term
| what are the two best radiographic studies for dyspnea w/ suspected cardiac origin? |
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Definition
Xray chest
US echocardiography transthoracic resting |
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Term
| what is the best test for acute non-specific chest pain, low probability of CAD? |
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Definition
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Term
| What are 3 findings of CXR that signal emphysema/overinflation? |
|
Definition
>10 posterior ribs visible
flattening of diaphragms on lateral XR
enlarged retrosternal clear spaces |
|
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Term
| describe the three different pathologic patterns of emphysema: centrilobular, panacinar, and paraseptal |
|
Definition
-centrilobular (centriacinar): focal destruction limited to the respiratory bronchioles and the cnetral portions of the acinus (cigarette smoking)
-panacinar: entire alveoulus distal to the terminal bronchiole- most severe (homozygous alpha 1 antitrypsin deficiency)
-paraseptal: least common; involves distal airways and structures, alveolar ducts, and sacs (bullae may cause PTX) |
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Term
| how can you differentiate a cyst from a bullae? |
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Definition
| cysts have thicker walls, but both are thin walled |
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Term
|
Definition
| irreversible abnormal dilatation of the airways (bronchi and bronchioles) usually from infection, proximal obstruction, or congenital abnormality |
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Term
| what is the hallmark lesion on CT of bronchiectasis? |
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Definition
| signet ring sign: the bronchus; usually with a thickened wall becomes larger than its associated pulmonary artery. |
|
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Term
| what are the two best radiographic studies for chronic dyspnea with suspected pulmonary origin? |
|
Definition
CXR
CT chest without contrast (High resolution CT) |
|
|
Term
| what are the two best studies for hemoptysis |
|
Definition
CXR
ct chest with contrast |
|
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Term
| what is the protocol of a high resolution chest cT? |
|
Definition
CT chest without contrast plus:
-inspiratory images (supine)
-expiratory images (supine)
-inspiratory prone images |
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Term
|
Definition
| stacked subpleural cysts usually located in the lung bases and associated with interstitial fibrosis (restrictive lung disease) |
|
|
Term
| what is the difference between parapneumonic effusion and empyema? |
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Definition
-parapneumonic effusion: fluid in pleural space secondary to pneumonia, abscess, or other infectious etiologies (NO bacteria)
-empyema: plueral effusion with infection/bacteria |
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