Pulmonary Radiology Part 2

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Pulmonary Radiology Part 2
2013-02-12 01:26:07
Pulmonary II

radiology part two
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  1. Pulmonary edema

    • Signs and Sx:
    • -DOE
    • -Orthopnea
    • -Paroxysmal nocturnal respiratory distress
    • -Weight gain
    • -Lower extremity edema
    • -Cough
    • -Hemoptosis

    • Etiologies:
    • -Cardiogenic
    • -Neurogenic
    • -Increased permeability (toxin-inhalation, high-altitude sickness, aspiration, contusion, fat embolism)

    • Image findings:
    • -Patchy infiltrates
    • -Kerly B lines
    • -Interlobular fissure thickening
    • -Pleural fluid
    • -Redistribution (increased size of vessels to the upper lobes)
    • -Parahilar zone bronchial cuffing
    • -Parahilar vessels less distinct
    • Pulmonary edema
    • (Pt is laying down; haziness is almost confluent)
    • Pulmonary effusion (right posterior)
    • Pulmonary edema (left lung field)

  2. Pulmonary Embolism

    • Etiologies:
    • -Venous (postsurgical, bed rest, trauma, neoplasm)
    • -Foreign body (bone marrow after long bone fracture, Amniotic)
    • -Septic emboli
    • -Air

    • Image findings:
    • -Radiograph, can be normal (Hampton's Hump: pleural base cone shaped opacity)
    • -CT, most common way to diagnose: filling defects in the pulmonary artery
    • -VQ mismatch
    • -Pulmonary angiogram: gold standard
  3. Asthma

    • Imaging findings:
    • -75% normal radiographs
    • -Bronchial wall thickening
    • -Hyperinflation
    • -Mosaic attenuation (CT)
    • -Atelectasis (rarely)

  4. COPD

    • Image finding:
    • -Poor sensitivity in early disease (25% normal)
    • -Later: hyperinflation, increased AP diameter, flattening of hemidiaphragms
    • -Bullae
    • -Peripheral olligemia (emphysema)
    • -Bronchial wall thickening
    • -Pulmonary artery hypertension
    • -Saber sheath trachea (highly sensitive)
    • -Centrilobular lucencies (CT)

    • Lung cancer
    • Etiology: most common cause of cancer mortality worldwide
    • -Cigarette smoking accounts for 90% of all lung cancers
    • -NO current screening test

    • Image findings:
    • -Radiograph: almost always need additional imaging
    • -CT: 
    • -Positron emission tomography: improved detection (sensitivity)
    • -MRI: only useful for chest wall or mediastinal tumors

    • Cystic fibrosis
    • Image findings:
    • -Hyperinflation
    • -Peribronchial cuffing with tramlines or tram tracks
    • -Bronchiectasis and opacities (Upper lung predominant)
    • -Signet ring sign (dilated bronchus abutting a PA branch)

  5. Pneumonia

    • Image findings:
    • -Focal segmental/lobar opacity (in the setting of fever and productive cough)
    • -parapneumonic effusions (loculated empyema)
    • -Signs of volume loss will help to differentiate from atelectasis (i.e. elevated hemidiaphragm and acute angle of mainstem bronchus)

  6. Tuberculosis

    • Image findings:
    • -Primary: lobar airspace consolidation wiht accompanying unilateral lymphadenopathy and pleural efusion

    -Post Primary: Cavitary lesions, fibrosis, retraction of the hila; usually affecting the lung apices (upper lobes or superior segment of lower lobes)

    -Miliary: innumerable diffuse tiny nodules measuring 2-3mm (predominantly upper lobe)

  7. Fungal lung disease

    • Image findings:
    • -Varying manifestations

    Histo: lamellated or diffuse Ca++ of a nodule. Ipsilateral LAD

    Blasto: Lung nodules/mass or consolidation. Cavitation in 15-29%,

    Cocci: Cavitating segmental or lobar consolidation in an endemic area

    • Aspergillosis
    • -invasive: lobar or peribronchial consolidation
    • -Semi-invasive: nodule, mass, or consolidation
    • -Aspergilloma: fungus ball or sponge-like mass of mycelia filling cavity

    • Ddx:
    • -lung cancer
    • -infectious abscess
    • -inflammatory
    • -trauma
    • -silicosis
  8. Classic PCP findings (immunocompromised pt)

    • findings:
    • -Ground glass opacity - diffuse, symmetric
    • -Peripheral sparing
    • -Thin walled cysts with upper lobe distribution
    • -Predisposition to pneumonia
  9. Bronchiectasis (but poor image)

    • -Thickened cystic bronchi containing air fluid levels, tramlines or tram tracks
    • -signet ring sign (dilated bornchus adjacent to a PA branch)
    • -Severity ranges from cylindrical to varicose (string of pearls), to saccular (cluster of grapes)

    • Location:
    • -CF: upper lobe, central and peripheral
    • -ABPA: central asymmetric bilateral
    • -TB: upper lobe predominant unilateral
    • -Atypical mycobacterium: RML and lingular predominance
    • -Viral: lower lobe predominance
  10. Lung transplant

    • Findings:
    • -Post surgical: clips hilum and pleura
    • -Thoracotomy changes
    • -If unilateral - abnormal contralateral lung
    • -Rejection - hypersensitivity pneumonitis: peripheral ground glass

    • Diffuse parenchymal lung disease
    • 1. IPF

    • Findings:
    • -Upper lobe: silicosis, pneumoconiosis, Sarcoidosis, EG (architectural distortion, bronchiectasis, nodules)
    • -Lower lobe: idiopathic pulmonary fibrosis, rheumatoid (honeycombing, fibrosing, pleural based)
  11. Poland's syndrome

    -hard to tell if the lucent side is abnormal or the dense side is abnormal

    Poland's syndrome has congenital malformation; pts lack pectoralis major and minor
  12. Thoracic scoliosis
  13. Endotracheal tube

    • -optimal location is 2-7 cm above corina
    • -"hose moves with nose" - moving the nose down (forward flexion at the neck), moves the tube down closer to the corina

    • Locating the corina:
    • -find the aortic arch; continue the arch to draw a circle
    • -the corina is at the base of that circle
  14. Tracheostomy tube