Lymphocytic interstitial at increased risk for developing what diffuse lung diseases Patients with Sjogren syndrome arepneumonitis (LIP). Non-Hodgkin pulmonary lymphoma. Young to middle-aged man with spine changes (kyphosis, spinal ankylosis). Increased lung volumes. Upper lobe fi Ankylosing spondylitis lung involvement UIP. terms provide the most precise method of classifying the idiopathic interstitial pneumonias These histologic Acute interstitial pneumonia (AIP). COP. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) Most common of Usual Interstitial Pneumonia the idiopathic interstitial pneumonias. Most cases are sporadic. 30% of cases associated with co Diffuse ground-glass opacity and consolidation with air bronchograms. Linear opacities, honeycombing, and tract Acute Interstitial Pneumonia Viral infection (influenza, adenovirus, measles). Conditions associated with BOOP, organizing pneumonia. Toxic fume inhalation (sulfur dioxide, chlorine). Collagen vascular Organizing Pneumonia CryptogenicIdiopathic form of organizing pneumonia. Most common finding: Patchy consolidation or ground-glass opacity wi Bronchiolitis-Associated Interstitial Lung Disease RespiratoryTypically young, heavy smokers. Scattered ground-glass opacities. Small centrilobular nodules with upper lobe pre 95% are cigarette smokers. Desquamative Interstitial Pneumonia Cannot be radiologically distinguished from UIP. Bibasilar reticular opacities. Normal o Generally asymmetric upper lung bullae. Generally symmetric lower lung interstitial fibrosis. Neurofibromatosis ILD Indistinguishable Tuberous Sclerosis (TS) ILD from LAM. Symmetric bilateral reticular or reticulonodular opacities. Scattered lung cysts. Norm Exclusively in women. Lung cysts separated by interlacing bundles of smooth muscle. May obstruct lymphatics cau Lymphangioleiomyomatosis Simulates silicosis Alveolar Septal Amyloidosis or lung sarcoidosis. Upper lung reticulonodular opacities. Irregular reticular interstitial opacities. Chronic Aspiration Pneumonia Asbestosis. Silicosis. CWP. 3 major pneumoconioses Asbestosis Pleura: Parietal pleural plaques. Pleural effusion. Localized visceral pleural fibrosis. Diffuse pleural fibrosis. Mesoth Silicosis Mining, ceramic work, and sandblasting. Upper lobe and parahilar nodules. Nodule calcification may occur. Egg sh Predominantly upper Coal Worker's Pneumoconiosis lung reticulonodular or small nodular opacities. Berylliosis. Rare Pneumoconioses Aluminum. Hard metal (cobalt, tungsten). Inhaled antigenic Hypersensitivity Pneumonitisorganic dusts: Farmer's lung (moldy hay). Humidifier lung (thermophilic bacteria). Bird-fancier's 0 Normal chest Lung Sarcoidosis staging radiograph. 1 Bilateral hilar lymph node enlargement. 2 Bilateral hilar lymph node enlargement an ILD Sarcoidosis Common findings: Symmetric hilar adenopathy allows distinction from malignancy and TB. Symmetric mid and up Cell high association with LangerhansVery Histiocytosis of Lung cigarette smoking. Mid and upper lung centrilobular small nodules. In late stages may Necrotizing granulomatous vasculitis involving upper and lower respiratory tracts and kidneys. Discrete nodules o Wegener Granulomatosis Symptoms and radiographic abnormalities last longer than 1 month. Predilection for women. Responds to cortico Chronic Eosinophilic Pneumonia Male predominance. Blood eosinophilia. Cardiomegaly. Pulmonary edema. Pleural effusions. Pulmonary parenchy Hypereosinophilic syndrome Lung Disease Associated Sarcoidosis. Rheumatoid lung EosinophilicWegener granulomatosis. With Autoimmune Diseases disease. Polyarteritis nodosa. Allergic angiitis and granulo Lung (Nitrofurantoin and Penicillins). EosinophilicDrugs Disease of Identifiable Etiology Parasites (Ascaris lumbricoides, Strongyloides stercoralis). Lipoproteinaceous material deposits within alveoli. Predilection for males in their 20s to 40s. Bilateral symmetric Pulmonary alveolar proteinosis Deposition Alveolar microlithiasis of minute calculi within alveolar spaces. Confluent bilateral dense micronodular opacities. So-called bl Formation of bone Diffuse pulmonary ossification within lung parenchyma. Associations: Mitral stenosis. UIP. Amyloidosis. Tracheocele Paratracheal air cysts. True diverticula. Occur at weakened posterior membrane of cervical trachea. Bronchus Tracheal bronchus suis. Accessory bronchus to all or a portion of right upper lobe. Arises from right lateral tracheal wall wit Malignant: Squamous cell carcinoma. Adenoid cystic carcinoma (cylindroma). Benign: Chondroma. Fibroma. Squa Primary neoplasms of trachea Saber-sheath trachea. Amyloidosis. Tracheobronchopathia osteochondroplastica. Relapsing polychondritis. Wege Tracheal Narrowing Tracheobronchomegaly (Mounier-Kuhn syndrome). Tracheomalacia. Interstitial pulmonary fibrosis. Tracheal dilation Coronal diameter is less than two thirds of sagittal diameter. Affects older men with chronic obstructive pulmona Saber-sheath trachea Multiple submucosal osseous and Tracheobronchopathia osteochondroplastica cartilaginous deposits within trachea and central bronchi of elderly men. Spare Systemic autoimmune disorder. Affects cartilage of earlobes, nose, larynx, tracheobronchial tree, joints, and large Relapsing polychondritis Congenital. (Mounier-Kuhn syndrome) TracheobronchomegalyAssociated with Ehlers-Danlos syndrome. Men under age 50. Trachea and central bronchi measure gre Diffuse tracheal and central bronchial dilation. Congenital or acquired (COPD, Chronic bronchitis, Cystic fibrosis, R Tracheobronchomalacia Subtended lung remains collapsed against lateral chest wall. Secondary to bronchial injury. Responds poorly to ch Fallen lung sign Calcified material within bronchus. Usually from eroding calcified lymph nodes (Histoplasmosis or TB). Broncholithiasis Asthma Transient bronchial narrowing. Peribronchial cuffing and tram tracking. Air trapping: Hyperinflation, Flattening or Excess Chronic bronchitis production of sputum on most days for at least 3 months in 2 consecutive years. 50% have normal chest ra Permanent dilation of bronchi. Cylindric bronchiectasis: mild diffuse dilation. Varicose bronchiectasis: cystic dilati Bronchiectasis Production of abnormally thick, tenacious mucus. Recurrent infection commonly with Pseudomonas aeruginosa o Cystic fibrosis May result in Dysmotile cilia syndromeRhinitis. Sinusitis. Bronchiectasis. Dysmotile spermatozoa and sterility. Situs inversus. Dextrocardia. syndrome triad Kartagener Sinusitis. Situs inversus.. Bronchiectasis. Hypersensitivity reaction to Allergic bronchopulmonary aspergillosisAspergillus. Asthma, blood eosinophilia, bronchiectasis with mucus plugging, and circu Emphysema Permanent enlargement of airspaces distal to terminal bronchiole. Destruction of alveolar walls without obvious Airspace distention in central portion of lobule. Spares distal portions of the lobule. Upper lobe predominance. As Centrilobular emphysema Distention of Panlobular emphysema airspaces throughout lobule. Destruction of central respiratory bronchioles and peripheral alveolar s Distention of Paraseptal emphysema peripheral airspaces adjacent to interlobular septa. Spares centrilobular region. Generally involves Lung irregular emphysema Paracicatricial or destruction associated with fibrosis. No consistent relationship to a given portion of the lobule. Commonly a Diffuse hyperlucency (panlobular). Flattening and depression of hemidiaphragms. Increased retrosternal airspace Emphysema findings Arterial deficiency: versus increased markings Arterial deficiency emphysema Predominantly panlobular emphysema. Hyperinflated lungs with peripheral vascular attenuat Thin-walled cystic space > 1 cm in diameter. Found within lung parenchyma. Bulla defined be seen in diseases that cause chronic upper lobe fibrosis, such spondylitis. Bullae may Sarcoidosis. Pulmonary Langerhans cell histiocytosis. Ankylosingas Isolated bullae Primary bullous disease without intervening emphysema or interstitial lung disease. Associated with: Marfan or Ehlers-Dan Tree-in-bud opacities. Generally due to infection: Viral. Atypical. Mycobacterial. CT findings and associations of infectious bronchiolitis Tree-in-bud opacities. Bronchial dilation and thickening. CT findings of diffuse panbronchiolitis Centrilobular and geographic ground-glass opacities. Cigarette smoking. CT findings and associations of Respiratory bronchiolitis–associated interstitial lung disease Centrilobular ground-glass nodules. pneumonitis (subacute) CT findings and associations of Hypersensitivity Air trapping on expiratory scans. Inhaled organic antigen. Centrilobular ground-glass nodules. Rheumatoid arthritis. Sjögren syndrome. CT findings and associations of Follicular bronchiolitis Mosaic attenuation with air trapping on expiratory scans. Bronchial dilation (late). Transplant patients. Drug react CT findings and associations of Constrictive bronchiolitis Pleural/serum protein ratio Transudative pleural effusion lab valuesless than 0.5. Pleural/serum LDH ratio less than 0.6. Pleural LDH less than 200 IU/L. Bacterial/mycobacterial. Infectious causes of pleural effusion?Viral. Fungal. Parasitic. Heart failure. Pericarditis. Superior vena cava obstruction. Postcardiac surgery. Myocardial infarction. Pulmonary Cardiovascular causes of pleural effusion? Bronchogenic carcinoma. Neoplastic causes of pleural effusion?Metastases. Lymphoma. Pleural or chest wall neoplasms (mesothelioma). Systemic lupus erythematosus. Immunologic causes of pleural effusion? Rheumatoid arthritis. Sarcoidosis (rare). Wegener granulomatosis. cause of pleural effusion? InhalationalAsbestosis. Blunt pleural effusion? Trauma causes ofor penetrating chest trauma. Cirrhosis (hepatic hydrothorax). Pancreatitis. Subphrenic abscess. Acute pyelonephritis. Ascites (from any cause). Abdominal disease causes of pleural effusion? Drugs. Myxedema. Ovarian tumor. Miscellaneous causes of pleural effusion? Transudative. Bilateral, right larger than left. Pleural effusion from congestive heart failure features Isolated right effusion twice as common as isolated left effusion. CT that are fairly specific for of presence of an Loculations. Soft effusion Findings on Thickening and enhancementthe parietal pleura. exudative pleuraltissue lesions along parietal pleura outlined by p Lung carcinoma. Breast with pleural effusion are, in order of frequency, Tumors most commonly associatedcarcinoma. Pelvic tumors (ovarian fibroma = Meigs syndrome). Gastric carcinoma. Lympho Empyema: Oval. Oriented longitudinally. Thin. Smooth (split pleura sign). Obtuse chest wall angle. Compresses lun Lung abscess versus empyema? Pleural effusion. Most common intrathoracic manifestation of rheumatoid arthritis Malignancy. chylothorax are Most common causes ofIatrogenic trauma. TB Left versus right chylothorax? Left chylothoraxchylothorax: Injury to upper duct. Right chylothorax: Injury to lower duct. Communication between lung and pleural space. If bronchus involved, may result in empyema. If peripheral airsp Bronchopleural Fistula Often occurs in young or Primary spontaneous pneumothoraxmiddle-aged men. Predilection of taller individuals. Results from bleb or bulla rupture, us COPD. Asthma. Valsalva (cocaine, marijuana, labor). Sarcoidosis. Langerhans cell histiocytosis. Lymphangioleiomyo Secondary Spontaneous Pneumothorax pneumothorax Catamenial Rare recurrent pneumothoraces. Occurs with menses. Pleural endometrial implants. Treated with OCPs. Iatragenic trauma in mechanically ventilated patients. Most common cause of tension pneumothorax Pneumonia. Pulmonary infarct. Trauma. Asbestos exposure (bilateral). Causes of pleural thickening Visceral pleura: Hemothorax, Empyema (tuberculosis). Parietal pleura: Asbestos exposure (bilateral). Causes of pleural calcification Benign: Fibroma. Lipoma. Causes of pleural/extrapleural massesNeurofibroma. Malignant: Metastases (usually multiple). Mesothelioma (usually diffuse calcified pleural Most commonly suggests Fluid withinActive empyema.layers seen on CT within patients with prior TB. FibrothoraxPleural thickening extending over more than one fourth of the costal pleural surface. Commonly results from reso Metastatic adenocarcinoma (lung, breast, of four conditions: Malignant pleural disease is most often caused by oneovary, kidney, GI tract). Invasive thymoma or thymic carcinoma. Mesot malignant Asbestos-Related Pleural Diseases Benign and Benign: Pleural plaques. Pleural effusions. Diffuse pleural fibrosis. Malignant: Mesothelioma. Geographic opacities. Llikened to a holly leaf. When viewed en face, calcified pleural plaques appear as Autosomal recessive disorder. Unilateral absence of sternocostal head of pectoralis major. Ipsilateral syndactyly. R Poland syndrome Lipoma Most common benign neoplasm of chest wall Fibrosarcomas. Liposarcomas. Most common malignant soft tissue neoplasms of the chest wall in adults. Askin tumor. Arises from primitive neuroectodermal rests. Very aggressive A rare malignant neoplasm arising from the chest wall of children and young adults with a poor prognosis. Abscess. Hematoma. Lipoma. Hemangioma. Desmoid tumor. Benign chest wall lesions Coarctation of aorta. Aortic thrombus. Takayasu arteritis. SVC syndrome. Neurofibromatosis. Inferior rib notching causes Paralysis. Suprior rib notching cause Osteochondroma. Enchondroma. Osteoblastoma. Benign rib neoplasms, most common first Chondrosarcoma. Most common primary rib malignancy Most Rib malignancies common: Myeloma. Metastatic carcinoma. Primary malignancies: Chondrosarcoma. Osteogenic sarcoma. Fi Breast cancer. lesions to ribs Most common metastatic Lung cancer. Renal metastases are Thyroid carcinoma. Expansile lytic rib cell carcinoma. seen most commonly from metastases are most commonly Sclerotic ribBreast cancer. Prostate cancer. seen in TB. Actinomycosis. Nocardiosis. Pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include Congenital Sprengel deformity hypoplastic and elevated scapula. syndrome. Klippel-Feil Sprengel deformity (hypoplastic, elevated scapula). Omovertebral bone. Fused cervical vertebrae. Hemivertebrae Rheumatoid arthritis: Well-defined pointed distal clavicle. Hyperparathyroidism: Irregular and wide distal clavicle Erosion of the distal clavicles Sickle cell anemia. H-shaped or Lincoln log vertebrae on lateral chest radiographs Renal osteosclerosis. Rugger jersey appearance to thoracic spine on lateral chest radiographs Marfan syndrome. Poland syndrome. Osteogenesis imperfecta. Congenital such as Pectus excavatum is commonly associated with congenital connective tissue disorders,scoliosis. Outward Pectus carinatum bowing of sternum. May be congenital or acquired. of the diaphragm EventrationCongenital absence or underdevelopment of diaphragmatic musculature. Localized elevation of anteromedial hem Surgical injury or neoplastic involvement of Unilateral diaphragmatic paralysis is usually caused by phrenic nerve. Neuromuscular disturbance. not effort related may be caused by Bilateral Diaphragmatic Elevation that is Intrathoracic or intra-abdominal disease. Herniation through embryonic pleuroperitoneal canal. Neonates present with large hernias with lung hypoplasia a Bochdalek Hernia Parasternal diaphragm defect. Invariably right sided. Asymptomatic cardiophrenic angle mass. Morgagni Hernia Benign: Lipomas. Fibromas. Schwannomas. Neurofibromas. Leiomyomas. Echinococcal cysts and extralobar seque Primary diaphragmatic tumors Usually seen in infancy. Cystic adenomatoid malformation One or several large cysts lined with respiratory epithelium with scattered mucous glands Central bronchial mucocele with peripheral hyperlucency in a young, asymptomatic patient. Bronchial atresia presentation Intralobar sequestration: Single large artery from infradiaphragmatic aorta. Pulmonary vein drainage. Extralobar Intralobar and extralobar sequestration blood supply and drainage Variant of hypoplastic lung Hypogenetic lung-scimitar syndrome with abnormal venous drainage to the IVC just above or below right hemidiaphragm. S Extensive bilateral aspiration pneumonitis Three radiographic patterns ofairspace opacification. Diffuse but discrete airspace nodular opacities. Irregular parenchymal o Older patients with Exogenous lipoid pneumonia swallowing disorders or gastroesophageal reflux. Use mineral oil as a laxative or inhale oily no Lupus-like syndrome (procainamide, isoniazid, hydralazine). Nitrofurantoin. Bleomycin. Methotrexate. Amiodaron Drug that cause drug induced chest diseases diagnosis of hamartoma can a smooth or lobulated border A confidentNodule less than 2.5 cm with be made when HRCT shows and containing focal fat. May have popcorn calcificatio Granular cell from neural elements in the central airways or lung parenchyma. The skin is the most common site f Benign neoplasm arising myoblastoma. Most common type of lung cancer (nonsmokers, too). Arise from bronchiolar or alveolar epithelium. Irregular or s Bronchogenic adenocarcinoma features Grows cell carcinoma (BAC) Bronchioloalveolaralong bronchiolar and alveolar walls (lepidic growth). May appear as: Solitary nodule. Focal ground-glass op Arises centrally within Squamous cell carcinoma featureslobar or segmental bronchi. Central necrosis with cavitation may be seen. Generally presen Arises centrally within main or lobar bronchi from bronchial neuroendocrine (Kulchitsky) cells. Hematogenous diss Small cell carcinoma features Large peripheral mass. Large cell bronchogenic carcinoma radiographic feature Asbestos exposure. Previous Hodgkin lymphoma. Radon exposure. Viral infection. Diffuse interstitial or localized l In addition to cigarette smoke, well-recognized risk factors for the development of bronchogenic carcinoma include Resorptive atelectasis. Obstructive pneumonitis. Most common radiographic findings from endobronchial tumor obstruction. pancoast tumors, histology type Majority of SCC. Adenocarcinoma. Arm symptoms Pancoast tumor pain and muscular atrophy due to brachial plexus involvement. Horner syndrome (ptosis, anhydrosis, miosis) Filling and BAC CT angiogram signof airspaces with mucoid material produced by malignant cells creates low-density airspace opacification su Linear and reticulonodular opacities. Peribronchial cuffing. Subpleural edema or pleural effusion. Typical radiologic findings of lymphangitic carcinomatosis Unilateral or asymmetric involvement to lung suggests lung cancer rather than Helps distinguish lymphangitic carcinomatosis dueof lungs cancer from other metastases an extrapulmonary site. Disease of small cell lung cancer Two patient groups limited to one hemithorax (limited disease). Contralateral lung or extrathoracic spread (extensive disease SCC > Adenoid cystic carcinoma Two most common primary tracheal malignancies Masses > 2 malignancy Tracheal mass size and cm are likely to be malignant. Less than 2 cm are more likely benign. Mucoepidermoid carcinoma. Carcinoid Other, less common primary tracheal malignancies tumor. Adenocarcinoma. Lymphoma. Small cell carcinoma. Leiomyosarcom Squamous cell carcinoma. Small bronchi include Primary malignant neoplasms of the central cell carcinoma. Carcinoid tumor. Bronchial gland tumors (adenoid cystic carcinom Prefers right upper Carcinoid radiologic features and middle lobes. Well-defined smooth or lobulated nodules or masses. Iceberg tumor: small Pulmonary hamartoma. A benign neoplasm comprised of disorganized epithelial and mesenchymal elements normally found in the bronchus or lung. Thickened septal lines of lymphangiti carcinomatosis do not distort the pulmonary lobule. A feature that helps distinguish lymphangitic carcinomatosis from interstitial fibrosis, Infiltration of pulmonary Lymphocytic interstitial pneumonitis interstitium by mature lymphocytes. CT findings: Diffuse ground-glass opacity. Poorly de Spectrum of entities. Ranging from benign Posttransplant lymphoproliferative disorder (PTLD) polyclonal lymphoid proliferation to aggressive non-Hodgkin lymphom Rare malignant tumor affecting children and young adults. Histology simulates fetal lung at 10 to 16 weeks’ gestat Pulmonary blastoma Typical of pneumococcal pulmonary infection. Inflammatory process spreads via pores of Kohn and canals of Lam Lobar pneumonia features Most common pattern of pneumonia. Typical of staphylococcal pneumonia. Inflammation centered around lobul Bronchopneumonia features Viral and mycoplasma Interstitial pneumonia features infection. Inflammatory thickening of bronchial and bronchiolar walls and pulmonary inters Thin walls. Rapid change in size. Generally develop during late phase of infection. Pneumatoceles may be distinguished from abscesses by Ranke complex Calcified parenchymal focus (Ghon lesion) and lymph nodel calcification. Primary TB. Postprimary TBReactivation occurs in apical and posterior segments of upper lobes and superior segments of lower lobes. Ill-defi aneurysm Rasmussen Erosion of cavitary focus into pulmonary artery branch can produce an aneurysm. Miliary TB May complicate primary or reactivation disease. Hematogenous dissemination. Diffuse bilateral 2- to 3-mm pulmo Aspergillus. Candida. Cryptococcus. Opportunistic fungal lung pathogens Aspergilloma or mycetoma within preexisting cavities. Semi-invasive (chronic necrotizing) aspergillosis in mildly im Aspergillus lung involvement Inside out: Endocyst, produces daughter cyts. Exocyst (chitinous layer), protective membrane. Pericyst, surroundi Pulmonary echinococcal cysts are composed of three layers: CT halo signDecreased attenuation surrounding a dense, mass-like opacity. Relatively specific for invasive aspergillosis in a neu PCP Most common AIDS-defining opportunistic infection. (Septal) Lines InterlobularThin, short, 1- to 2-cm lines oriented perpendicular to and intersecting costal pleura. (septal) lines DDx: InterlobularInterstitial edema. Lymphangitic carcinomatosis. Sarcoidosis. Idiopathic pulmonary fibrosis (IPF) (other forms o lines ILD DDx IntralobularIPF (UIP). Asbestosis. Alveolar proteinosis. Hypersensitivity pneumonitis. Pulmonary edema. Sarcoidosis. Lymphangitic carcinomatosis. Thickened fissures ILD DDx Pulmonary edema (smooth). Peribronchovascular interstitial thickeningSarcoidosis (nodular). Lymphangitic carcinomatosis (smooth or nodular). Hypersensitivity pneumonitis. Bronchiolitis obliterans with organizing pneumonia (BOOP)/cryptogenic organizing Centrilobular nodules ILD DDx Asbestosis. Subpleural lines ILD DDxIPF (UIP). Asbestosis. IPF Parenchymal bands ILD DDx(UIP). Sarcoidosis. IPF Honeycombing(UIP). Asbestosis. Hypersensitivity pneumonitis (chronic). Sarcoidosis. cysts ILD DDx Thin-walledEosinophilic granuloma (EG). Lymphangioleiomyomatosis. Tuberous sclerosis. Neurofibromatosis (pneumatocele Miliary tuberculosis or histoplasmosis. Hematogenous metastases. Silicosis/coal worker's pneumoconiosis (CWP Micronodules, random distribution ILD DDx Sarcoidosis. Lymphangitic carcinomatosis. Silicosis/CWP. Micronodules, perilymphatic distribution ILD DDx Desquamative DDx Ground-glass opacities ILDinterstitial pneumonia. Acute interstitial pneumonia (AIP). Hypersensitivity pneumonitis. BOOP/CO Sarcoidosis. Silicosis/CWP. Traction bronchiectasis ILD DDx Sarcoidosis. Silicosis. CWP. Radiation fibrosis. Conglomerate mass ILD DDx 5- to Subpleural Lines 10-cm-long curvilinear opacities are found within 1 cm of the pleura and parallel the chest wall. Most often s Nontapering linear opacities, 2 to 5 cm in length. Extend from lung to contact pleural surface. Asbestosis. IPF. Sarc Parenchymal bands Small Honeycombing (6 to 10 mm) cystic spaces with thick (1 to 3 mm) walls. usually have shared walls . Usually in posterior subp cysts Thin-walledSlightly larger in diameter (10 mm) than honeycomb cysts. Uniform in size. Thinner walls. Do not share walls with 1- Micronodules to 3-mm. Sharply marginated. Round opacities seen on HRCT. Represent conglomerates of granulomas or tumo Granular appearance with maintained visibility of pulmonary vessels. Absence of air bronchograms. Desquamative Ground-Glass or Hazy Increased Density Fibrosis causes Traction bronchiectasis traction on the walls of bronchi, resulting in irregular dilation. Tuberculosis (postprimary). Chronic fungal infection (Histoplasmosis, Coccidioidomycosis). Sarcoidosis. Eosinoph ILDs Upper zone distribution Idiopathic pulmonary fibrosis. Asbestosis. Rheumatoid lung. Scleroderma. Neurofibromatosis. Dermatomyositis ILDs Lower zone distribution or increased lung volumes ILDs normalSarcoidosis. Eosinophilic granuloma. Lymphangioleiomyomatosis. Tuberous sclerosis. Interstitial disease superim Idiopathic ILDs Honeycombing pulmonary fibrosis. Sarcoidosis. Eosinophilic granuloma. Rheumatoid lung. Scleroderma. Pneumocon nodules ILDs miliaryTuberculosis. Fungi (Histoplasmosis, Coccidioidomycosis, Cryptococcosis). Silicosis. Metastases (Thyroid carcinom Sarcoidosis. node enlargement Hilar/mediastinal lymph Lymphangitic carcinomatosis. Lymphoma. Hematogenous metastases. Tuberculosis. Fungal infectio disease ILDs PleuralAsbestosis (plaques). Lymphangitic carcinomatosis (effusion). Rheumatoid lung disease (effusion/thickening). Ly Pleural effusion. Pleural Disease Manifestations of Rheumatoid Lungthickening. Pericarditis. Pericardial effusion. Pulmonary fibrosis (basilar predominance). Thick Caplan syndromewalled cavitating lung nodules. Rheumatoid arthritis patients with hypersensitivity to inhaled dust particles Interlobular septal thickening. Ground-glass opacities. Honeycombing. Lower lung predominance. Patulous esoph Scleroderma ILD findings Intrapulmonary vascular shadows. Interstitial pulmonary edema CXR findings? Peribronchial cuffing. Tram tracking. Kerley A Kerley A and B lines?lines thickening of central connective tissue septa. Kerley B lines thickening of peripheral interlobular sep Severe mitral regurgitation. Alveolar pulmonary edema localized to the right upper lung may be seen in patients with LV failure. Mitral Hypertension and Pulmonary Edema Causes of Pulmonary Venousvalve disease (Mitral stenosis, Mitral insufficiency). LA myxoma. Cor triatriatum. Obstruction of c Enlargement of pulmonary veins (progressive are Radiographic findings of pulmonary venous hypertension dilation of horizontally oriented pulmonary veins). Redistribution of ARDS Respiratory failure due to increased capillary permeability edema. Associated with increased lung stiffness (nonco Shock. ARDS Common causes ofSevere trauma. Burns. Sepsis. Narcotic overdose. Pancreatitis. Patchy findings ARDS radiographic peripheral airspace opacities (12-24 hrs). Confluent bilateral airspace opacities with air bronchograms (day Head trauma. Seizure. Increased intracranial pressure. Causes of neurogenic pulmonary edema Trauma. Bleeding diathesis. Infections (invasive aspergillosis, mucormycosis, Pseudomonas, influenza). Drugs (pen Hemorrhage or hemorrhagic edema of the lung can result from Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody. Goodpasture syndrome Indistinguishable from Idiopathic Pulmonary HemorrhageGoodpasture syndrome. Pulmonary hemorrhage and anemia in patient with normal renal f that can granulomatosis. hemorrhage VasculitidesWegener cause pulmonarySystemic lupus erythematosus. Rheumatoid arthritis. Polyarteritis nodosa. D-dimer Sensitive, but not specific marker of venous thrombosis. Localized peripheral oligemia without infarction are Most common radiographic findings in PEwith or without distended proximal vessels (Westermark sign). Peripheral airspace o Small pleural effusion and pleura-based Radiographic features that suggest infarction in PE wedge-shaped opacity (Hampton hump). Air embolism. Macroscopic fat embolism. Methylmethacrlate embolization from vertebroplasty. Radioactive seed Nonthrombotic pulmonary embolism causes 30 as a systolic pressure in the pulmonary artery exceeding PAH is defined mm Hg. Enlarged main and PAH are Typical radiographic findings ofhilar pulmonary arteries that taper rapidly toward lung periphery. RV enlargement. Interlobar proximal interlobar pulmonary artery (CXR) artery > 28.6 mm. PAH measurements ofpulmonary artery > 16 mm. Main pulmonary and main pulmonary artery (CT) High cardiac output (anemia, thyrotoxicosis). Left-to-right shunts (ASD, In addition to PAH, enlargement of the central pulmonary arteries may be seen in VSD, PDA, PAPVR). Enlargement of both central Shunt vascularity on chest radiographs and peripheral pulmonary arteries. Chronic PEs. Vasculitis. Pulmonary arteriopathy resulting from long-standing increased pulmonary blood flow from Disorders of the pulmonary arteries that produce PAH include Metastases. Granulomas. Multiple pulmonary nodules of similar size and appearance are almost always Round is oval opacity Pulmonary nodule or defined as 4 to 30 mm in diameter. Round defined as Pulmonary mass isopacity greater than 3 cm. in a patient Hamartoma, Inflammatory lesion. Differential Granuloma. under the age of 35, particularly a nonsmoker without a history of malignancy, patient over 35 years of age should never intralesional fat. An SPN in a Benign pattern of calcification. Presence ofbe followed radiographically without tissue confirmation unless the les Between 1 month and 2 years. Studies have shown that bronchogenic carcinoma has a doubling time of small disease, particularly granulomatous infection. Presence ofBenignsatellite nodules around the periphery of a dominant pulmonary nodule is strongly suggestive of a halo of ground-glass opacity encircling an SPN in an immunocompromised, neutropenic patient should suggest Presence ofInvasive pulmonary aspergillosis. Round atelectasis. Comet tail of bronchi and vessels entering the hilar aspect of the mass, and associated with lobar volume loss is characteristic Healed granuloma from tuberculosis specific for Complete or central calcification within an SPN isor histoplasmosis. Granuloma and allows confident exclusion of neoplasm. Concentric or laminated calcification of an SPN Pulmonary hamartoma. Popcorn calcification within a pulmonary nodule is diagnostic of Pulmonary hamartoma. Fat within an SPN is diagnostic of a 15 H. Enhancement of malignant SPNs Thyroid masses. masses? Most common thoracic inletLymphomatous nodes. Lymphangiomas. Well-defined margins. Continuity of mass with cervical thyroid. Coarse calcifications. Cystic or necrotic areas. Base Intrathoracic thyroid goiter CT findings? Tumor Lymphangioma? of dilated lymphatic channels. Cystic or cavernous form (cystic hygroma) is commonly discovered in infanc Thymic neoplasms. Anterior mediastinal masses? Lymphoma. Germ cell neoplasms. Primary mesenchymal tumors. Thymomas may be encapsulated (noninvasive) or invasive. Thymic carcinomas, epithelial component shows signs Thymoma versus thymic carcinoma Myasthenia gravis. Pure red cell Thymoma-associated autoimmune diseases aplasia. Graves disease. Sjogren syndrome. Hypogammaglobulinemia. C Thymic cysts ongenital: Remnants of thymopharyngeal duct. Contain thin or gelatinous fluid. Acquired: Postinflammatory. Ass Thymic massesThymoma. Thymic cyst. Thymolipoma. Thymic hyperplasia. Thymic neuroendocrine tumors. Thymic carcinoma. Th Teratoma Germ cell neoplasms (benign and malignant). Seminoma. Embryonal cell carcinoma. Endodermal sinus tumor. Choriocarcinom Lipoma. Hemangioma. tumors Mesenchymal anterior mediastinalLeiomyoma. Liposarcoma. Angiosarcoma. is the most frequent site _________ Anterior mediastinum. of a localized nodal mass in patients with Hodgkin disease. Retroperitoneal lymph node involvement in metastatic gonadal tumors. A key in distinguishing primary from metastatic mediastinal germ cell neoplasm is the presence of malignant teratoma features on CT Benign and Benign: round or oval and smooth in contour. Malignant: irregular, lobulated, or ill-defined margin. Foregut and mesothelial cysts. Tracheal and central bronchial neoplasms. Diaphragmatic hernias. Vascular lesions Middle mediastinal masses for central calcification Differential Mycobacteria. Fungus. of mediastinal/hilar lymph nodes on CT? for peripheral (eggshell)l calcification of mediastinal/hilar lymph nodes on CT? Differential Silicosis. Sarcoidosis. for hypervascular mediastinal/hilar lymph nodes on CT? Differential Carcinoid tumor/small cell carcinoma. Kaposi sarcoma. Metastases (RCC. Thyroid carcinoma). Castleman disease. for necrotic mediastinal/hilar lymph nodes on CT? Differential Mycobacteria. Fungus. Metastases (SCC. Seminoma. Lymphoma). in lymph nodes of sarcoidosis and lymphoma/metastases? Differences Sarcoidosis: Lobular lymph nodes that do not coalesce. Lymphoma/mets: May form conglomerate enlarged noda Angiofollicular lymph Castleman disease also known as node hyperplasia. Anterior cardiophrenic angles. Right-sided lesions being twice as common as left-sided lesions. Pericardial cysts most commonly arise in the Intercostal nerves: Neurofibroma. Schwannoma. Sympathetic ganglia: Ganglioneuroma. Ganglioneuroblastoma. N Three groups of neurogenic tumors of the posterior mediastinum. Neuroblastoma. Ganglioneuroma. Most common posterior mediastinal neurogenic tumors in children Neurofibroma. Schwannoma. Most common posterior mediastinal neurogenic tumors in adults Neurofibromatosis. Multiple lesions in the mediastinum, particularly bilateral apicoposterior masses, are virtually diagnostic of Esophageal lesions. Posterior mediastinal masses Foregut cysts. Vertebral lesion. Lateral thoracic meningocele. Pancreatic pseudocyst. Histoplasmosis (most common). TB. Radiation therapy. Drugs (methysergide). Idiopathic (autoimmune). Causes of chronic sclerosing (fibrosing) mediastinitis Headache. Epistaxis. SVC syndrome manifestations Cyanosis. Jugular venous distention. Edema. Substernal chest pain caused by intramediastinal extension of infection. Ludwig angina describes Poststenotic dilation from enlargement incluce Causes of unilateral pulmonary artery valvular or postvalvular pulmonic stenosis. Pulmonary artery aneurysms. Distension of Behçet disease and Hughes-Stovins syndrome Rare vasculitides that may present with pulmonary artery aneurysms 1-2-3 sign Sarcoidosis 1: Right paratracheal. 2. Right hilar. 3. Left hilar lymph node enlargement 75% Coronary calcification is detected at angiography in ____% of patients with 50% diameter stenosis. 50% diameter narrowing. Roughly predicts a which flow is restricted reduction. A_____% diameter narrowing is the physiologic point at75% cross-sectional areaenough to result in ischemia under stress co uses? Cardiac MR Define location and size of previous myocardial infarctions. Demonstrate complications of previous infarctions. Estab rupture (may Myocardial 3 to 14 days. occur ______ days after infarction. Onset is Dressler syndrome typically 1 week to 3 months postinjury. Fever, chest pain, pericarditis, pericardial effusion, and pleuritis, myocardium versus stunned myocardium? HibernatingHibernating: High-grade stenosis resulting in chronically ischemic myocardium. May act like postinfarction scar. Im Ischemic cardiomyopathy Causes of dilated cardiomyopathies (most common cause): Chronic ischemia. Prior infarction. Anomalous coronary arteries Wall. Ventricular Cavity. Contractility. Compliance to decreased compliance. Ventricular LV thin. LV dilated. Decreased contractility. Normalfeatures of dilated cardiomyopathy? Wall. Ventricular Cavity. Contractility. Compliance features of hypertrophic cardiomyopathy? Ventricular LV thick. LV normal to decreased. Increased contractility. Decreased compliance. Wall. Ventricular Cavity. LV cavity. Normal to decreased contractility. Severely decreased Ventricular Normal LV wall. Normal Contractility. Compliance features of restrivice cardiomyopathy? compliance. Wall. Ventricular Cavity. Contractility. Compliance features of Uhl anomaly? Ventricular RV thin. RV dilated. Decreased contractility. Normal to decreased compliance. Concentric hypertrophy: may be diffuse, basic types: Hypertrophic cardiomyopathies are divided into twomidventricular, or apical in distribution. Asymmetrical septal hypertroph May be familial (60%). Autosomal dominant with variable penetrance. Associated with neurofibromatosis and No Hypertrophic cardiomyopathy causes? ASH (asymmetric septal hypertrophy)? Features of Hypertrophy of the interventricular septum (>12 to 13 mm). Abnormal ratio of thickness of interventricular septu Infiltrative disorders: Amyloid. Glycogen storage disease. Mucopolysaccharidosis. Hemochromatosis. Sarcoidosis. Restrictive cardiomyopathy causes disease should be ruled What otherConstrictive pericarditis. out when considering restrictive cardiomyopathy? high signal in the myocardium on T2WIs. MR finding in restrictive cardiomyopathy caused by amyloidosis or sarcoidosis? Cor ventricular Defined as rightpulmonale. failure secondary to pulmonary parenchymal or pulmonary arterial disease. destructive pulmonary Etiologies of cor pulmonale includedisease (pulmonary fibrosis and chronic obstructive pulmonary disease). hypoxic pulmonar A Uhl anomaly cquired disorder in infants or adults. Also called arrhythmogenic right ventricular dysplasia. Dilation of RV with m Left-to-right shunts. Poststenotic dilation secondary to pulmonary stenosis. Pulmonary arterial hypertension. Mar Enlargement of pulmonary outflow tract causes diagnosis for pulmonary venous hypertension (mitral Differential Long-standingpulmonary arterial hypertension includesstenosis). Eisenmenger physiology (long-standing left-to-rig Left-to-right shunts. is caused by Increased pulmonary blood flowHigh output states: Volume loading. Pregnancy. Peripheral shunt lesions (arteriovenous malfo Chronic obstructive pulmonary disease. is caused by Decreased pulmonary blood flow with a small heartHypovolemia. Malnourishment. Addison disease. Rheumatic heart usually Mitral stenosis in the adult isdisease. caused by Left ventricular failure. Mitral stenosis. Mitral regurgitation. Aortic stenosis. Aortic regurgitation. Pulmonary veno Causes of Pulmonary Venous Hypertension Mitral regurgitation. Left atrial enlargement, left ventricular enlargement, and bulging of the atrial septum to the right. Intra-atrial thrombi are usually associated with atrial fibrillation, often secondary to rheumatic heart disease. Com Cardiac thrombus features lipomas or lipomatous hypertrophy features IntracardiacHigh T1 signal and fat suppression. Second most common benign cardiac tumor. 50% of primary cardiac tumors. Most common primary benign cardiac tumor. Most (75% to 80%) are in LA. May m Atrial myxoma features Atrial myxoma. Lipoma. Rhabdomyoma (50% to 85% of tuberous sclerosis). Fibromas (12% may calcify). Rare tera Benign cardiac tumors 10 to 20 times more common than primary cardiac tumors. Breast. Lung. Melanoma. Lymphoma. Metastatic cardiac tumor features Angiosarcoma tumors Primary malignant cardiac (most common). Rhabdosarcoma. Liposarcoma. Other sarcomas. pericardial disease features ConstrictiveFibrous or calcific thickening of pericardium. Compromises ventricular filling through restriction of cardiac motion diagnosis cyst. Fat pad. Lipoma. Enlarged lymph Differential Pericardialfor a cardiophrenic angle mass includesnodes. Diaphragmatic hernia. Ventricular aneurysm. Complete pericardium features Congenital absence ofleft-sided absence (55%). Foraminal defects (35%). Total absence (10%). M > F. Complete absence: Hea Pneumoconioises (silicosis). Noninfectious causes of miliary pattern Eosinophilic granuloma. Sarcoidosis. Metastases (Thyroid. Melanoma.) Frontal (200 volume visible mL). Decubitus (5 and Minimal pleural effusionmL). Lateral (75on frontal, lateral, mL) decubitus chest radiographs Posterior junction line. Which junction line, anterior or posterior, extends above the clavicles Refers cavity Define pulmonary to a lucency located wtihin a nodule, mass, or focus of consolidation. Anteromedial, Lateral, segments (from Order of the left lower lobe basilarPosterior (ALP). lateral to medial) on a frontal radiograph Lymph node enlargement. DDx of subcarinal mass on radiograph Bronchogenic cyst. Left atrial enlargement. Parenchymal consolidation with Classic primary TB chest radiograph findings mediastinal and hilar lymph node enlargement. Ranke complexCombination of calcified lung nodule and calcified lymph nodes. Ghon lesionLung nodule that is a residum of primary TB. Usually is calcified. Normal venous wedge pressures mm Hg. lines, effusions, and airspace opacities mm Hg. At what pulmonary 12 mm Hg. Kerley lines 17do KerleyEffusion 20 mm Hg. Airspace opacity 25occur? Recurrent infections. Complications of bronchiectasis Hemoptysis. Mucoid impaction. Atelectasis. Telangiectasias. AVMs. Aneurysms in multiple organ systems (Pulmonary. GI. Cutaneous. CNS) Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) Wedge-shaped peripheral acute consolidation. Linear bands. Parenchymal findings associated with foci ofPE of chronic consolidation may be seen in Focal areas Lipoid pneumonia. Bronchoalveolar cell carcinoma. Lymphoma. Bronchoalveolar cell carcinoma. Diffuse chronic consolidation can be seen in Alveolar proteinosis. Sarcoid. Lipoid pneumonia. Situs invertus. Bronchiectasis. Sinusitis. Kartagener's syndrome (dyskinetic cilia syndrome) triad Multiple lung nodules or masses. Cavitation occurs 50%. Local or diffuse consolidation due to hemorrhage. Wegener's granulomatosis lung findings LCH: Usually associated with nodules and variable appearing cysts. Spares costophrenic angles. Help distinguish LCH from LAM E PCP findings xtensive ground glass opacities in a patchy or geographic pattern. 1/3 have upper lobe predominant cysts of vary Pneumonectomy space fails to fill with fluid. Abrupt decrease in air-fluid level in the pneumonectomy space. New Bronchopleural fistula, postpneumonectomy should be considered if Shoulder pain. Horner's Superior sulcus tumor symptoms syndrome (ptosis, miosis, anhidrosis). Weakness and atrophy of hand muscles. Any involvement of unresectable Deems a superior sulcus tumor vertebral body, brachial plexus, subclavian artery. Smaller Satellite nodules nodules adjacent to a lung mass. Suggests an infectious etiology. lipomatosis causes MediastinalCushing's syndrome. Steroid therapy. Obesity. Form of Rounded atelectasisperipheral lobar atelectasis that develops with pleural disease (commonly asbestosis). Volume loss. Come 4 cm. 6 cm aorta aneurysm Diameter of ascending significant risk of rupture. bleb Bulla versusBulla, sharply demarcated area of emphysema greater than 1 cm. Bleb, gas-containing space within visceral pleur Diffuse discrete pulmonary calcifications. Chest radiograph finding in healed varicella pneumonia N0, No metastatic lymph nodes. N1, Metastatic ipsilateral hilar lymph nodes. N2, Metastatic ipsilateral mediastina Nodal status and stage in NSCLC Neoplastic: Lung cancer (especially small cell carcinoma). Lymphoma. Metastatic carcinoma. Benign: Long-term IV Causes of SVC syndrome 90% Malignant lung neoplasms. Nonneoplastic: Cystic fibrosis. IPF. Localized fibrous lesions of the pleura Neoplastic and nonneoplastic causes of hypertrophic pulmonary osteoarthropathy Double lucency sign. Displacement (>4 mm) of anterior and posterior (epicardial) pericardial fat by pericardial flui Epicardial fat pad sign Interlobar fissures. Pulmonary vessels. Bullae. Areas of (transthoracic needle What obvious structures should be avoided while planning a TTNB severe emphysema. biopsy) Chronic eosinophilic pneumonia. Peripheral consolidation (photographic negative of pulmonary edema) Pulmonary cavity Sloughed lung within a gangrene. Closely associated with Klebsiella. Small airways disease. Mosaic lung attenuation causes Chronic pulmonary embolism. Expiratory images demonstrate air-trapping in of mosaic attenuation Distinguishes small airways disease of chronic PE in settingsmall airways disease. Mounier-Kuhn syndrome. Congenital tracheobronchomegaly Central bronchiectasis. Mucous plugging (finger-in-glove). Atelectasis. Patchy migratory foci of consolidation. Allergic bronchopulmonary aspergillosis radiographic findings Nocardia. Aspergillus. Mucormycetes. Pulmonary alveolar proteinosis susceptible infections Intense and of the pleura enhancement pattern Localized fibrous tumor homogeneous contrast enhancement. Healed varicella. Healed histoplasmosis. Silicosis. Calcified metastases. Calcified fine lung nodules differential Areas of decreased lung attenuation with associated reducting in number and size of vessels. Bronchiectasis. Air t CT findings of Swyer-James syndrome Blind-ending diverticulum arising from medial wall of bronchus intermedius. Rarely presents with recurrent infect Cardiac bronchus Patchy bilateral airspace consolidation with peripheral, subpleural distribution. Poorly defined lung nodules in a p Bronchiolitis obliterans organizing pneumonia CT findings Severe veno-occlusive disease Triad of pulmonarypulmonary artery hypertension. Evidence of pulmonary edema. Normal wedge pressure. Echinococcus cysts: Endocyst ruptures its contents within the ectocyst, floating on top of debris, like a water lily. Water lily sign diagnosis for wall-to-wall heart? Differential Tricuspid regurgitation. Pericardial effusion. Dilated cardiomyopathy. Hypertension. Annuloaortic dissection Common predisposing factors for aortic ectasia: Marfan or Ehlers-Danlos syndrome. Bicuspid aortic valve. Aortic aneurysm. Left subclavian artery. Distal type B. B (Stanford) aortic Anatomic structure separating Type A from Type Proximal type A. dissections findings associated Scoliosis. Chest bone Pectus excavatum. with Marfan syndrome Marfan syndrome. Pectus excavatum associationsEhlers-Danlos syndrome. Mitral valve prolapse. Homocystinuria. Hunter-Hurler syndromes. Coronary artery dissection (myocardial infarction). Carotid artery dissection (stroke). Pericardial hemorrhage (tam 4 life threatening complications of type A aortic dissection Pseudoaneurysm: aneurysms from pseudoaneurysms Helps distinguish ventricle trueInferoposterior location. Narrow neck (less than 50%). Aneurysm: Anteroapical location. Wide Right aortic arch with (right or left is a vascular ring Which aberrant subclavian artery aberrant left)subclavian artery. Left-sided ligamentum arteriosum completes the ring. Neoplastic: Bronchogenic carcinoma. Metastases. Lymphoma. Infectious: Fungal infection (histoplasmosis, fibr Causes of SVC syndrome ASD. Tetralogy of Fallot. P(T)APVR. Persistent left superior vena cava associations Overriding aorta. lesions Tetralogy of Fallot. 4 primary VSD. Pulmonar infundibular stenosis. Right ventricular hypertrophy. Aorta. Right common carotid.Subclavian arteries. Pulmonary arteries. Thoracic vessels. Takayasu arteritis involvement Cardiac surgery. Radiation therapy. Uremic pericarditis. Viral pericarditis (coxsackie). Tuberculous pericarditis. Causes of constritive pericarditis Similar to aorta dissections: type Treatment of intramural hematoma of aorta A (surgically) type B (medically). Sinus of valsalva aneurysm is focal dilation Sinus of valsalva aneurysm versus aortic root dilation of one sinus of Valsalva, not entire root. T TAPVR types ype I: Supracardiac drainage. Snowman heart. Type II: Cardiac. Coronary sinus or right atrium drainage. Type III Atherosclerosis (penetrating ulcer). Infection. Trauma. Iatrogenic. Aortic pseudoaneurysm causes Tetralogy of Fallot. Truncus arteriosus. Mirror-image right aortic arch congential heart disease associations Right scimitar syndrome 4 components of lung hypoplasia. Hypoplastic right pulmonary artery. Right lower lobe systemic arterial supply. PAPVR from r Leftward deviation of the heart without deviation of mediastinum. Prominent left atrial appendage. Lung located Partial congenital absence of the pericardium findings: syndrome associated with interruption of IVC Heterotaxy Bilateral left-sidedness/polysplenia syndrome.with Azygous continuation Invasiveness. Extension outside of heart. Involvement of more than one chamber. Central necrosis or cavitation Features that suggest a primary malignant cardiac tumor Left aberrant course Pulmonary slingpulmonary artery arises from right pulmonary artery and courses between esophagus and trachea. eased lung volumes. Upper lobe fibrobullous disease. Simulates postprimary fibrocavitary Tb or mycetoma formation. d interstitial lung disease (RB-ILD). DIP. Nonspecific interstitial pneumonia (NSIP). c. 30% of cases associated with collagen vascular or immunologic disorder. Findings: Irregular septal or subpleural thickening. Intralobular pacities, honeycombing, and traction bronchiectasis are uncommon. xide, chlorine). Collagen vascular disease (rheumatoid arthritis and SLE). Organ transplantation (bone marrow, lung, and heart-lung). Drug dation or ground-glass opacity with subpleural or peribronchial distribution. Scattered nodular opacities may be present. bular nodules with upper lobe predominance. asilar reticular opacities. Normal or midly decreased lung volumes. May have ground-glass opacities. Honeycombing is rare. itial fibrosis. cities. Scattered lung cysts. Normal to increased lung volumes. Pneumothorax is common uscle. May obstruct lymphatics causing chylothorax. Poor prognosis. is. Diffuse pleural fibrosis. Mesothelioma. Lung parenchyma: Interlobular septal thickening. Interstitial fibrosis (asbestosis). Rounded atele ule calcification may occur. Egg shell calcification of hilar lymph nodes. Silicoproteinosis like alveolar proteinosis has increased susceptibi rmophilic bacteria). Bird-fancier's lung (avian proteins). Acute and chronic forms. Chronic disease findings: Interlobular and intralobular in hilar lymph node enlargement and parenchymal disease 3. Parenchymal disease only. 4 Pulmonary fibrosis. cy and TB. Symmetric mid and upper lung reticulonodular opacities. Perilymphatic interstitial nodules, 3 to 10 mm. small nodules. In late stages may develop cysts or bullae. Risk of pneumothorax. Nodule-cyst evolution: Nodule to Cavitated nodule to Th s and kidneys. Discrete nodules or masses with central necrosis and cavitation. May mimic Goodpasture syndrome and idiopathic pulmon n for women. Responds to corticosteroid therapy, improving within 4 to 7 days. Peripheral, homogeneous, ill-defined areas of consolidatio ral effusions. Pulmonary parenchymal infiltration with eosinophils may produce interstitial or airspace opacities. dosa. Allergic angiitis and granulomatosis. ides stercoralis). ir 20s to 40s. Bilateral symmetric perihilar airspace opacification. Crazy paving CT finding: Geographic ground-glass opacities with thickene cronodular opacities. So-called black pleura sign. Apical bullous disease is common. Amyloidosis. of cervical trachea. from right lateral tracheal wall within 2 cm of tracheal carina. Associated with congenital tracheal stenosis and aberrant left pulmonary ar enign: Chondroma. Fibroma. Squamous cell papilloma. Hemangioma. a. Relapsing polychondritis. Wegener granulomatosis. Tracheal scleroma. pulmonary fibrosis. with chronic obstructive pulmonary disease (COPD). tral bronchi of elderly men. Spares membranous posterior wall of trachea. heobronchial tree, joints, and large elastic arteries. Diffuse smooth wall thickening of the wall of trachea and central bronchi with luminal a and central bronchi measure greater than 3.0 cm and 2.5 cm. hronic bronchitis, Cystic fibrosis, Relapsing polychondritis). hial injury. Responds poorly to chest tube evacuation. Histoplasmosis or TB). ping: Hyperinflation, Flattening or inversion of diaphragm, Attenuation of peripheral vascular markings. Prominence of the retrosternal ai e years. 50% have normal chest radiographs. Some patients show peribronchial cuffing or tram tracks. ricose bronchiectasis: cystic dilation interrupted by focal areas of narrowing. Cystic bronchiectasis: localized saccular dilation. Caused by c y with Pseudomonas aeruginosa or Staphylococcus aureus. Severe bronchiectasis. Hyperinflation with predominantly upper lobe bronchi lity. Situs inversus. Dextrocardia. asis with mucus plugging, and circulating antibodies to Aspergillus antigen. Proximal upper lobe bronchiectasis with mucoid impaction. Fin of alveolar walls without obvious fibrosis. ule. Upper lobe predominance. Associated with cigarette smoking. nchioles and peripheral alveolar sacs and alveoli. Predilection of lower lobes. Associated with alpha-1 antitrypsin deficiency. obular region. Generally involves subpleural regions of upper lobes. portion of the lobule. Commonly associated with old granulomatous inflammation. ms. Increased retrosternal airspace (panlobular > centrilobular). Bulla. Enlarged central pulmonary arteries. Right heart enlargement (centr with peripheral vascular attenuation and bullae. Pink Puffers. Increased markings: Increased linear parenchymal markings. Small airways ociated with: Marfan or Ehlers-Danlos syndromes. Intravenous drug use. HIV infection. Vanishing lung syndrome. ganic antigen. e). Transplant patients. Drug reactions. Inhalation injury. Pleural LDH less than 200 IU/L. Myocardial infarction. Pulmonary embolism. ms (mesothelioma). er granulomatosis. phritis. Ascites (from any cause). Splenic vein thrombosis. mmon as isolated left effusion. along parietal pleura outlined by pleural fluid. rome). Gastric carcinoma. Lymphoma. e chest wall angle. Compresses lung. Requires drainage. Abscess: Round. Thick and irregular wall. Acute chest wall angle. Consumes lung. lt in empyema. If peripheral airspace (bronchiole) involved, may result in intractable pneumothorax. ults from bleb or bulla rupture, usually within upper lungs. histiocytosis. Lymphangioleiomyomatosis. Necrotizing pneumonia. Abscess. Mechanically ventilated patients. ants. Treated with OCPs. s exposure (bilateral). e). Mesothelioma (usually diffuse pleural thickening). Other: Loculated pleural effusion/empyema. Hematoma. face. Commonly results from resolution of an exudative pleural effusion (including asbestos-related effusions), Empyema, or Hemothorax oma or thymic carcinoma. Mesothelioma. Rarely non-Hodgkin lymphoma. esothelioma. alis major. Ipsilateral syndactyly. Rib anomalies. a poor prognosis. fibromatosis. osarcoma. Osteogenic sarcoma. Fibrosarcoma. ervical vertebrae. Hemivertebrae. Kyphoscoliosis. Rib anomalies. Irregular and wide distal clavicle. zed elevation of anteromedial hemidiaphragm in older individuals. rge hernias with lung hypoplasia and respiratory distress. Adults present with small hernias, mostly on the left side (liver thought to be pr nic angle mass. ococcal cysts and extralobar sequestrations may be found within the diaphragm. Metastatic invasion more common than primary maligna um with scattered mucous glands, smooth muscle, and elastic tissue. Round, air-filled masses that compress adjacent lung and mediastin atic patient. monary vein drainage. Extralobar sequestration: Small branches systemic arteries and occasionally pulmonary arteries. Systemic venous d e or below right hemidiaphragm. Small right hemithorax with diaphragmatic elevation or eventration. Dextroposition of heart. Herniation opacities. Irregular parenchymal opacities that are not obviously airspace. al oil as a laxative or inhale oily nose drops. Fat density opacity. mycin. Methotrexate. Amiodarone. fat. May have popcorn calcification. alveolar epithelium. Irregular or spiculated appearance. ccur in the lung periphery. tary nodule. Focal ground-glass opacity. May mimic pneumonia or bilateral nodular airpsace processes. on may be seen. Generally presents as hilar mass and atelectasis. lchitsky) cells. Hematogenous dissemination. Hilar/mediastinal mass. n. Diffuse interstitial or localized lung fibrosis. drome (ptosis, anhydrosis, miosis) from involvement of sympathetic chain. Shoulder pain from chest wall invasion. w-density airspace opacification surrounding enhanced pulmonary arteries. pleural effusion. an extrapulmonary site. horacic spread (extensive disease). mall cell carcinoma. Leiomyosarcoma. Fibrosarcoma. Chondrosarcoma. d tumors (adenoid cystic carcinoma, mucoepidermoid carcinoma). or masses. Iceberg tumor: small intrabronchial and large extraluminal soft tissue component. se ground-glass opacity. Poorly defined centrilobular nodules. Thin-walled cysts. Associations: Sjogren syndrome. Hypogammaglobulinem aggressive non-Hodgkin lymphoma. etal lung at 10 to 16 weeks’ gestation. Tend to be extremely large at presentation. a pores of Kohn and canals of Lambert to produce nonsegmental consolidation. Air bronchograms are common. ammation centered around lobular bronchi. Multifocal opacities produce patchwork quilt of scattered normal and diseased lobules. No a chiolar walls and pulmonary interstitium. Peribronchial cuffing and reticulonodular opacities. r segments of lower lobes. Ill-defined patchy and nodular opacities. Cavitation usually indicates active and transmissible disease. Diffuse bilateral 2- to 3-mm pulmonary nodules. crotizing) aspergillosis in mildly impaired immunity. Invasive pulmonary aspergillosis in neutropenia. Allergic bronchopulmonary aspergil ve membrane. Pericyst, surrounding compressed, fibrotic lung. c for invasive aspergillosis in a neutropenic patient. monary fibrosis (IPF) (other forms of usual interstitial pneumonia UIP). sis (smooth or nodular). ia (BOOP)/cryptogenic organizing pneumonia (COP). Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). Neurofibromatosis (pneumatocele). (emphysema). al worker's pneumoconiosis (CWP). EG. rsensitivity pneumonitis. BOOP/COP. RB-ILD. Hemorrhage. Pneumocystis jiroveci pneumonia. Cytomegalovirus pneumonia. Alveolar pr arallel the chest wall. Most often seen in patients with asbestosis and, less commonly, IPF. eural surface. Asbestosis. IPF. Sarcoidosis. d walls . Usually in posterior subpleural regions. End-stage pulmonary fibrosis: IPF (UIP). Chronic hypersensitivity pneumonitis. Occasiona ner walls. Do not share walls with adjacent cysts. Cysts of LCH and LAM are usually evenly distributed from central to peripheral portions o lomerates of granulomas or tumor cells within the interstitium. f air bronchograms. Desquamative interstitial pneumonia (DIP). Pneumocystis jiroveci (formerly P carinii) pneumonia. Acute hypersensitiv omycosis). Sarcoidosis. Eosinophilic granuloma. Silicosis. Ankylosing spondylitis. Hypersensitivity pneumonitis (chronic). Radiation fibr urofibromatosis. Dermatomyositis/polymyositis. Chronic aspiration. erosis. Interstitial disease superimposed on emphysema. d lung. Scleroderma. Pneumoconiosis. Hypersensitivity pneumonitis. Chronic aspiration. Radiation fibrosis. sis. Metastases (Thyroid carcinoma, Renal cell carcinoma, Bronchogenic carcinoma, Melanoma, Choriocarcinoma). Sarcoidosis. Eosinoph ases. Tuberculosis. Fungal infection. Silicosis. disease (effusion/thickening). Lymphangioleiomyomatosis (chylous effusion). y fibrosis (basilar predominance). Necrobiotic nodules (peripheral cavitating nodules, Caplan syndrome). Bronchiolitis obliterans (Hyperin ensitivity to inhaled dust particles (coal, silica, asbestos). ng predominance. Patulous esophagus. ning of peripheral interlobular septa. a. Cor triatriatum. Obstruction of central pulmonary veins (fibrosing mediastinitis, pulmonary vein stenosis, pulmonary venous thrombosis ulmonary veins). Redistribution of pulmonary blood flow to upper lungs. th increased lung stiffness (noncompliance). acities with air bronchograms (days). Coarse reticulonodular pattern (week) that may resolve. udomonas, influenza). Drugs (penicillamine). Pulmonary embolism. Fat embolism. ARDS. Autoimmune diseases (Goodpasture syndrome mia in patient with normal renal function and urinalysis. No antiglomerular basement membrane antibodies. Polyarteritis nodosa. ermark sign). Peripheral airspace opacification. Linear atelectasis. m vertebroplasty. Radioactive seed embolization from prostate brachytherapy. hery. RV enlargement. reased pulmonary blood flow from left-to-right shunt. ons. Cystic or necrotic areas. Baseline high CT attenuation (intrinsic iodine content). Intense enhancement (>25 H). is commonly discovered in infancy and is often associated with : Turner syndrome and trisomies 13, 18, and 21. epithelial component shows signs of frank malignancy. ogammaglobulinemia. . Acquired: Postinflammatory. Associations: AIDS, Prior radiation or surgery, Autoimmune conditions (Sjögren syndrome, Myasthenia gra ine tumors. Thymic carcinoma. Thymic lymphoma. ermal sinus tumor. Choriocarcinoma. ill-defined margin. ragmatic hernias. Vascular lesions. d carcinoma). Castleman disease. form conglomerate enlarged nodal masses. t-sided lesions. euroma. Ganglioneuroblastoma. Neuroblastoma. Paraganglionic cells: Chemodectoma. Pheochromocytoma. e. Pancreatic pseudocyst. iopathic (autoimmune). y artery aneurysms. Distension of pulmonary artery by thrombus or tumor. ations of previous infarctions. Establish presence of viable myocardium for possible revascularization. Differentiate acute versus chronic myo pericardial effusion, and pleuritis, with pleural effusion usually more prominent on the left. Dressler syndrome responds well to anti-inflam May act like postinfarction scar. Improved function with revascularization. At risk for acute infarction. Stunned myocardium: Postischemi ion. Anomalous coronary arteries. Long-term sequelae of myocarditis: Coxsackie virus. Toxins: Ethanol, Adriamycin, Doxorubicin. Metabo ecreased compliance. . Asymmetrical septal hypertrophy (ASH), also known as idiopathic hypertrophic subaortic stenosis (IHSS). d with neurofibromatosis and Noonan syndrome. Secondary to pressure overload. hickness of interventricular septum to left ventricular posterior wall (>1.3:1). Narrowing of left ventricular outflow tract during systole. s. Hemochromatosis. Sarcoidosis. Myocardial tumor infiltration. monary disease). hypoxic pulmonary vasoconstriction resulting from chronic bronchitis, asthma, CNS hypoxia, upper airway obstruction. Ac ar dysplasia. Dilation of RV with marked thinning of anterior right ventricular wall. MR may show fatty infiltration of anterior RV free wal monary arterial hypertension. Marfan syndrome. Takayasu arteritis. Idiopathic dilation of pulmonary artery. hysiology (long-standing left-to-right shunts). Pulmonary emboli. Vasculitides (rheumatoid arthritis or polyarteritis nodosa). Primary pulm shunt lesions (arteriovenous malformations). Hyperthyroidism. Anemia. Leukemia. tic regurgitation. Pulmonary veno-occlusive disease. Congenital heart disease. y to rheumatic heart disease. Commonly occurs along posterior wall of LA. Left ventricular thrombi are usually secondary to recent infarct ost (75% to 80%) are in LA. May mimic rheumatic valvular disease clinically. omas (12% may calcify). Rare teratoma. oma. Lymphoma. ough restriction of cardiac motion. Most common cause is postpericardiotomy. Other causes: Coxsackie B. Tuberculosis. Chronic renal fai Ventricular aneurysm. %). M > F. Complete absence: Heart is shifted toward the left, with prominent bulge of right ventricular outflow tract, main pulmonary art hyroid. Melanoma.) taneous. CNS) dation due to hemorrhage. phrenic angles. per lobe predominant cysts of varying sizes and wall thicknesses the pneumonectomy space. New collection of air in previously opacified pneumectomy space. Contralateral mediastinal shift. ophy of hand muscles. nly asbestosis). Volume loss. Comet tail (whorled bronchovascular structures). taining space within visceral pleura. , Metastatic ipsilateral mediastinal and subcarinal lymph nodes. N3, Metastatic contralateral mediastinal or hilar lymph nodes. c carcinoma. Benign: Long-term IV devices (catheters. pacemakers). Fibrosing mediastinitis (Histoplasmosis). ous lesions of the pleura ) pericardial fat by pericardial fluid. gratory foci of consolidation. ze of vessels. Bronchiectasis. Air trapping on expiratory images. rely presents with recurrent infections, hemoptysis, cough, and or dyspnea. Poorly defined lung nodules in a peribronchiolar distribution. wedge pressure. on top of debris, like a water lily. id aortic valve. Aortic aneurysm. Arteritis. ria. Hunter-Hurler syndromes. oke). Pericardial hemorrhage (tamponade). Aortic valve rupture (aortic regurgitation). rysm: Anteroapical location. Wide neck. eriosum completes the ring. gal infection (histoplasmosis, fibrosing mediastinitis). ackie). Tuberculous pericarditis. or right atrium drainage. Type III: Infracardiac. Portal vein, hepatic vein, or ductus venosus drainage (pulmonary edema due to obstructio emic arterial supply. PAPVR from right lung. eft atrial appendage. Lung located between aorta and pulmonary artery confirms diagnosis. ber. Central necrosis or cavitation. Large pericardial effusion. esophagus and trachea. ma formation. subpleural thickening. Intralobular lines. Honeycombing. Traction bronchiectasis. Typically most severe in peripheral and basal lungs. arrow, lung, and heart-lung). Drug reactions. Chronic aspiration. s may be present. neycombing is rare. ibrosis (asbestosis). Rounded atelectasis. Bronchogenic carcinoma. Lower lung predominance. oteinosis has increased susceptibility to TB. s: Interlobular and intralobular interstitial thickening. Honeycombing, Traction bronchiectasis. May spare costophrenic angles. 3 to 10 mm. Nodule to Cavitated nodule to Thick-walled cyst to Thin-walled cyst. e syndrome and idiopathic pulmonary hemorrhage. Tracheal or bronchial lesions may be present. c-ANCA positive. us, ill-defined areas of consolidation that may parallel the chest wall ound-glass opacities with thickened interlobular and intralobular septa. Prone to superinfection with Nocardia, Aspergillus, Cryptococcus, sis and aberrant left pulmonary artery. and central bronchi with luminal narrowing. Prominence of the retrosternal airspace. Complications: Pneumomediastinum. Pneumothorax, Subpleural blebs from expiratory air dissec ized saccular dilation. Caused by chronic inflammation with cartilage damage and dilation. Localized bronchiectasis is most commonly a r redominantly upper lobe bronchiectasis and mucus plugging. ectasis with mucoid impaction. Finger in glove appearance. ntitrypsin deficiency. es. Right heart enlargement (centrilobular). Loss of pulmonary capillary bed. enchymal markings. Small airways thickening of chronic bronchitis. Bullae uncommon. Blue Bloaters. chest wall angle. Consumes lung. Antibiotics and postural drainage to treat. usions), Empyema, or Hemothorax. Pleurectomy (decortication) may be necessary to restore function. he left side (liver thought to be protective). ore common than primary malignancy (Fibrosarcoma): Lower lobe bronchogenic carcinoma. Mesothelioma. press adjacent lung and mediastinum. onary arteries. Systemic venous drainage (inferior vena cava, azygos, or hemiazygos veins). extroposition of heart. Herniation of left lung anteriorly into right hemithorax. ndrome. Hypogammaglobulinemia. Multicentric Castleman disease. AIDS. normal and diseased lobules. No air bronchograms due to exudate within bronchi. nd transmissible disease. ergic bronchopulmonary aspergillosis in hyperimmunity. g disease (RB-ILD). galovirus pneumonia. Alveolar proteinosis. sensitivity pneumonitis. Occasionally sarcoidosis. om central to peripheral portions of upper lobes i) pneumonia. Acute hypersensitivity pneumonitis. Nonspecific interstitial pneumonia (NSIP). Interstitial pulmonary edema. umonitis (chronic). Radiation fibrosis from treatment of head and neck malignancy. carcinoma). Sarcoidosis. Eosinophilic granuloma. . Bronchiolitis obliterans (Hyperinflation) Pulmonary arteritis. Pulmonary arterial hypertension. Right heart enlargement. Pulmonary hem sis, pulmonary venous thrombosis). Obstruction of intrapulmonary veins (pulmonary venoocclusive disease). diseases (Goodpasture syndrome, idiopathic pulmonary hemorrhage, Wegener granulomatosis, systemic lupus erythematosus, rheumato jögren syndrome, Myasthenia gravis, Aplastic anemia). erentiate acute versus chronic myocardial infarction. Evaluate regional myocardial wall motion and systolic wall thickening. Demonstrate glob drome responds well to anti-inflammatory medications. unned myocardium: Postischemic, dysfunctional myocardium without complete necrosis. Potentially salvageable. Adriamycin, Doxorubicin. Metabolic conditions: Mucolipidosis. Mucopolysaccharidosis. Glycogen storage disease. Nutritional deficiencies: ar outflow tract during systole. oxia, upper airway obstruction. Acute and chronic pulmonary embolism. Idiopathic pulmonary hypertension. Extrapulmonary diseases aff nfiltration of anterior RV free wall. Premature death from early congestive failure or arrhythmias. olyarteritis nodosa). Primary pulmonary hypertension. usually secondary to recent infarction or ventricular aneurysm. Clots typically have low MR GRE signal, whereas tumors have intermediate e B. Tuberculosis. Chronic renal failure. Rheumatoid arthritis. Neoplastic involvement. Radiation pericarditis. outflow tract, main pulmonary artery, and left atrial appendage. Partial absence of the pericardium risks strangulation of cardiac structure teral mediastinal shift. al or hilar lymph nodes. ulmonary edema due to obstruction). n peripheral and basal lungs. e costophrenic angles. ocardia, Aspergillus, Cryptococcus, and atypical mycobacteria. ral blebs from expiratory air dissection. onchiectasis is most commonly a result of prior TB. Generalized bronchiectasis is seen in cystic fibrosis. Central bronchiectasis: Allergic bro pulmonary edema. art enlargement. Pulmonary hemorrhage c lupus erythematosus, rheumatoid arthritis, and polyarteritis nodosa). wall thickening. Demonstrate global myocardial function with right ventricular and left ventricular ejection fractions. Demonstrate regional my e disease. Nutritional deficiencies: Thiamin. Selenium). Infants of diabetic mothers. Muscular dystrophies. sion. Extrapulmonary diseases affecting pulmonary mechanics such as chest deformities, morbid obesity (pickwickian syndrome), neurom whereas tumors have intermediate signal. Clots will not enhance. strangulation of cardiac structures. Surgical closure of partial defects is usually recommended. entral bronchiectasis: Allergic bronchopulmonary aspergillosis. Cystic fibrosis. Bronchial atresia. Acquired central bronchial obstruction. ractions. Demonstrate regional myocardial perfusion. Evaluate papillary muscle and valvular abnormalities. y (pickwickian syndrome), neuromuscular diseases. ed central bronchial obstruction.
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