Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘lung’ Category

Reading V/Q scans

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Normal

  • perfusion and ventilation is uniform in both lungs
  • hila, aorta, fissues appear as defects
  • wash out in 2-3 minutes ventilation

Bilateral perfusion defects

  • PE
  • Extrinsic compression of pulmonary artery
  • Physiologic response from decreased or absent ventilation
  • pleural effusion

Unilateral perfusion defects

  • mucus plug
  • compression of pulmonary artery by tumor
  • fibrosing mediastinitis
  • PE
  • massive effusion
  • pneumonitectomy

Ventilation abnormalities

  • Chronic lung disease
  • mucus plug
  • airspace disease

Matched Defect

  • COPD
  • airspace disease
  • tumors and other mass lesions
  • asthma
  • pleural effusion
  • lung infarction

Mismatched defect

  • PE
  • Pulmonary artery compression
  • radiation therapy
  • vasculitis

Reverse mismatched defect

  • pneumonia
  • alveolar pulmonary edema
  • mucus plug

Interpretation and Probability

Modified PIOPED criteria link

Written by lmwong

January 26, 2010 at 9:13 am

AIDS Chest Differential

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Focal Lung Disease

  • Bacterial pneumonia
  • PCP
  • Mycobacterial/fungal infection
  • Non-Hodgkin lymphoma

Diffuse lung disease

  • PCP
  • PCP + infection
  • Mycobacterium tuberculosis
  • Fungal infection
  • NSIP
  • Lymphocytic interstitial pneumonia
  • Kaposi sarcoma

Nodules

  • Non-Hodgkin lymphoma
  • Kaposi sarcoma
  • Septic emboli
  • Mycobacterial/fungal infection

Adenopathy

  • Mycobacterial/fungal infection
  • Kaposi Sarcoma
  • Non-Hadgkin lymphoma
  • PCP

Pleural Effusion

  • Kaposi Sarcoma
  • Mycobacterial/fungal infection
  • Non-Hadgkin lymphoma
  • Pyogenic empyema
  • PCP

Written by lmwong

January 19, 2010 at 11:58 pm

Rounded Atelectasis

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  • peripheral lobar collapse
  • ~ pleural disease
  • abuts area of pleural thickening
  • comet tail sign = crowded vessels and bronchi extending to hilum
  • ~ asbestos exposure and smoking
  • may need FNA biopsy to exclude bronchogenic carcinoma

read more

Written by lmwong

January 19, 2010 at 11:25 pm

Posted in chest, lung, pulmonary

Multiple Calcified Lymph Nodes

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  • TB
  • histoplasmosis
  • sarcoidosis
  • silicosis
  • metastasis: mucinous adenocarcinoma, treated lymphoma, osteosarcoma

Written by lmwong

January 19, 2010 at 11:07 pm

Wegener’s Granulomatosis

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  • necrotizing vasculitis
  • upper respiratory tracts, lungs, renal glomeruli
  • lungs
    • multiple pulmonary nodules; 50% cavitate, angiocentric
    • diffuse alveolar consolidation = hemorrhage
  • +cANCA
  • Rx: cyclophosphamide and steroids

Written by lmwong

January 19, 2010 at 7:54 pm

Congenital Cystic Adenomatoid Malformation

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  • Type 1
    • big cysts (2-10 cm)
  • Type 2
    • multiple small cysts
    • renal and cardiac anomalies
  • Type 3
    • solid
  • any lobe
  • alveoli replaced by adenomatoid
  • surgical resection
  • 70% present during 1st week of life
  • 10% diagnosed after 1st year
  • supplied by pulmonary artery; systemic supply rare
  • can involve entire lobe
  • prenatal diagnosis
    • polyhydramnios
    • fetal hydrops
    • solid or cystic mass in fetal thorax
  • excise affected lobe

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Written by lmwong

January 18, 2010 at 10:02 am

Increased Pulmonary Vascularity in kids

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  • Endocardial cushion defect
  • ASD
  • Patent Ductus arteriosus (enlarged LA and aorta)
  • VSD (enlarged LA and normal aorta)

Written by lmwong

January 16, 2010 at 10:58 am

Thin Walled Lung Cysts

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  • Eosinophilic granuloma
  • Lymphangioleiomyomatosis (LAM)
    • upper
    • uniform size
    • women in reproductive years
    • can rupture –> pneumothorax
  • Tuberous sclerosis
  • Neurofibromatosis
  • LIP

histiocytosis X

  • peribronchiolar distribution
  • nodules become cysts
  • ~ smoking
  • upper lobes
  • CPA spared
cystic lung disease

    Written by lmwong

    January 16, 2010 at 10:56 am

    Pulmonary Diseases in Newborn

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    High volume, streaky

    1. meconium aspiration
    2. TTN
    3. neonatal PNA

    Low volume, granular

    1. surfactant deficiency
    2. beta-hemolytic streptococcal PNA

    Written by lmwong

    January 16, 2010 at 10:50 am

    Pulmonary Sequestration

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    • pulmonary tissue without normal connection to bronchial tree
    • anomalous arterial blood supply, from aorta; must document for surgery
    • recurrent PNA
    • solid to multiloculated cystic masses
    • MC in LLL
    • Intralobar
      • more common
      • no extra pleural covering
      • left side; 2/3 posterobasal segment LLL, adjacent to diaphragm
      • arterial supply from thoracic aorta
      • older children and adults
    • Extralobar
      • extra pleural covering
      • associated anomalies
      • arterial supply from abdominal aorta
      • infancy
      • presents as mass lesion

    Written by lmwong

    January 16, 2010 at 10:27 am

    Chronic Airspace Consolidation

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    • Eosinophilic Pneumonia
    • BOOP
    • Bronchioalveolar carcinoma
    • Lymphoma
    • lipod pneumonia
    • fungal

    Written by lmwong

    January 13, 2010 at 3:40 am

    Osler-Weber-Rendu disease

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    • hereditary hemorrhagic telangectasia
    • telangectasia
    • AVMs and aneurysms in multiple organ systems (pulmonary, GI, cutaneous, CNS)
    • pulmonary AVMs have lower lobe predominance, medial lung

    Written by lmwong

    January 12, 2010 at 11:46 pm

    Posted in chest, lower, lung, Phalen, pulmonary

    Cardiogenic Pulmonary Edema

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    • wedge pressure 13-17 mmHg = vascular redistribution
    • wedge pressure >17 mmHg = Kerley lines
    • Kerley A = central linear opacities, 2-6 cm
    • Kerley B = peripheral, 2 cm
    • begins in interstitium, moves to airspace
    • radiographic features lag behind clinical
    • enlarged heart size
    • cephalization
    • acutely changing chest pattern; recent normal

    Written by lmwong

    January 12, 2010 at 8:25 pm

    Posted in bat wing, chest, lung, pulmonary

    Tuberculosis

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    • leading cause of death in 19th century
    • decline after WWII
    • steady rise since 1985 (AIDS, immigration)

    primary infection

    • inhaled airborne droplets
    • common in lower lobes
    • bacteria ingested by macrophages, taken to lymph nodes, disseminate through body
    • infection usually contained in normal host
    • consolidation in the bases, chronic
    • lymphadenopathy (R paratracheal, R tracheobronchial, subcarinal)
    • pleural effusion
    • Ghon lesion = area of consolidation regresses to a nodule, disappears or calcifies
    • Rhanke complex = calcified nodule and calcified LAD

    reactivation or post primary TB

    • dormant focus may become active
    • usually 1-2 years after inital exposure
    • lung apex
    • disease in other organs, bones, kidney, brain
    • chronic patchy areas of consolidation
    • cavitation
    • ill defined nodules, numerous, bilateral, 3-5 mm from pleural surface
    • tree-in-bud pattern
    • centrilobular branching linear opacities
    • fibronodular opacitites, calcification
    • considered stable if no change in 6 months

    Other Findings

    • Miliary pattern
    • Pneumothorax
    • Endobronchial TB
    • Tuberculoma (solitary nodule)
    • Tuberculous Empyema
    • Bronchopleural Fistula

    read

    Written by lmwong

    January 12, 2010 at 8:04 pm

    Posted in cavitary, chest, lung, pulmonary

    Honeycombing Differential

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    • IPF (UIP)
    • Asbestosis
    • Hypersensitivity pneumonitis (chronic)
    • Sarcodisosis

    Written by lmwong

    January 12, 2010 at 7:44 pm

    Idiopathic Interstitial Pneumonias

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    • UIP (Usual)
      • foci of normal lung with areas of interstitial infiltrate, active fibrosis and end-stage fibrosis
      • basilar, subpleural
      • irregular linear opacities
      • ground glass attenutation
      • traction bronchiectasis
      • honeycombing
      • chronic infiltrative lung diseases: idiopathic pulmonary fibrosis, asbestosis, connective tissue disorders, drug toxicity
    • NSIP (nonspecific)
    • DIP (Desquamative)
    • RB (respiratory bronchiolitis)
    • LIP (Lymphocytic)
    • AIP (acute)
    • COP (cryptogenic organizing pna)

    read

    Written by lmwong

    January 12, 2010 at 7:43 pm

    Silicosis

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    • fibrotic lung disease
    • occupational exposure: heavy metal mining, sandblasting, foundry work, stone masonry
    • 20 year latency
    • upper lung zone
    • simple
      • 1-10 mm nodules
      • eggshell calcifications
    • complicated
      • nodules become confluent
      • >10 mm
      • upper lung zone, migrate to hila
      • functional lung impairment
      • emphysema
      • progressive massive fibrosis

    Written by lmwong

    January 12, 2010 at 9:15 am

    Posted in chest, lung, pulmonary

    Round Pneumonia

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    • children > adults
    • pneumococcal pneumonia
    • distinguish from bronchogenic carcinoma
      • follow up after appropriate medical treatment
      • history of infectious symptoms

    Written by lmwong

    January 12, 2010 at 3:43 am

    Lung Segments

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    Lower Lobes (lateral to medial)

    • left (ALP)
      • anterior
      • lateral
      • posterior
    • right (ALPM)
      • anterior
      • lateral
      • posterior
      • medial

    source

    Written by lmwong

    January 11, 2010 at 11:50 pm

    Posted in chest, lung, pulmonary

    Cardiophrenic angle mass differential

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    • epicardial fat (fat)
    • pericardial cyst (fluid)
    • Morgagni’s foramen hernia (fat, abdominal contents)
    • lipoma (fat)
    • thymolipoma (fat)
    • enlarged epicardial lymph nodes (soft tissue)

    Written by lmwong

    January 11, 2010 at 11:38 pm