Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘pulmonary’ Category

Lung Cancer Staging

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New 7th Edition of for Lung Cancer Staging, Radiographics Sept 2010.

Written by lmwong

December 16, 2010 at 4:07 pm

Centrilobular Lung Nodules

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  • bronchiolitis
  • endobronchial spread of TB, MAC
  • bronchopenumonia
  • hypersensitivity pneumonitis
  • endobronchial spread of tumor
  • pneumoconiosis
  • organizing pneumonia (BOOP)
  • histiocytosis
  • edema or vasculitis

Written by lmwong

April 25, 2010 at 5:17 pm

Random Lung Nodules

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  • miliary TB
  • miliary fungal infections
  • hematogenous mets
  • sarcoidosis

Written by lmwong

April 25, 2010 at 5:09 pm

Perilymphatic Lung Nodules

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  • sarcoid
  • lymphangitic spread of tumor
  • silicosis and CWP
  • amyloid
  • LIP

Written by lmwong

April 25, 2010 at 5:00 pm

Right Pneumonectomy Syndrome

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  • occurs most commonly in children and adolescents
  • right posterior deviation of the mediastinum
  • counter-clockwise rotation of heart and great vessels
  • displacement of hyperinflated left lung into right anterior hemithorax
  • develop airway obstruction from compressoin between left pulmonary artery and descening aorta; compression of left main bronchus, distal trachea, or LLL bronchus

Written by lmwong

April 5, 2010 at 9:36 am

Posted in chest, pediatrics, pulmonary

Crazy Paving Pattern

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Thickened inter and intralobular structures, forming polygonal shapes, with no architectural distortion. Diseased lung well demarcated from normal lung forming a geographic pattern.
  • alveolar proteinosis (classically)
  • sarcoidosis
  • pulmonary hemorrhage
  • PCP
  • mucinous bronchoalveolar carcinoma
  • pulmonary venoocculusive disease
  • ARDS

Written by lmwong

April 5, 2010 at 9:33 am

Fleischner Society guidelines for pulmonary nodule follow up

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Low risk patients

  • < or = 4 mm: No follow-up needed.
  • >4 – 6: Follow-up at 12 months. If no change, no further imaging needed.
  • >6 – 8: Initial follow-up CT at 6 -12 months and then at 18 – 24 months if no change.
  • >8: Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy.

High risk patients

  • < or = 4 mm: Follow-up at 12 months. If no change, no further imaging needed.
  • >4-6: Initial follow-up CT at 6 -12 months and then at 18 – 24 months if no change.
  • >6-8: Initial follow-up CT at 3 – 6 months and then at 9 -12 and 24 months if no change.
  • >8: Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy.

Fleischner Society Guidelines: Radiology 2005 Nov; 237:395-400.

Written by lmwong

February 3, 2010 at 12:08 pm

Carcinoid

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  • malignant neuroendocrine tumor
  • SB (Ileum) > lung > thyroid/ovary
  • MC malignancy of appendix
  • carcinoid syndrome = secretion of serotonin:  flushing, diarrhea, wheezing, cramping, peripheral edema
  • findings
    • well defined margins
    • lobulated
    • 30% have calcifications
    • intense contrast enhancement
    • lung: typically central location
    • hot on octreotide scan
  • surgery, adjuvant chemotherapy

read more

Written by lmwong

February 1, 2010 at 2:55 pm

Posted in abdomen, chest, gi, pulmonary

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

Congenital Lobar Emphysema

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  • over expansion of alveoli
  • ball-valve air trapping
  • neontal period to 6 months
  • LUL (MC) > RML > RLL
  • initially, soft tissue density due to retained fluid –> over expansion and hyperlucency
  • thinning of pulmonary vasculature

Written by lmwong

January 24, 2010 at 5:08 pm

Posted in chest, pediatrics, pulmonary

Bronchopulmonary Dysplasia

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  • premature infants less than 1000 g
  • mechanical ventilation and oxygen toxicity
  • after 2 weeks (distinguish from Pulmonary Interstitial Emphysema <2 weeks)
  • persistent hazy density
  • coarse lung markings
  • bubblelike lucencies
  • bandlike opacities
  • Wilson-Mikity syndrome = BPD in absence of mechanical venilation
  • improve with age, minor persistent problems

Written by lmwong

January 24, 2010 at 4:59 pm

Posted in chest, pediatrics, pulmonary

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

read more

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