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

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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

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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