Chest Flashcards

Lymphocytic interstitial pneumonitis (LIP). Non-Hodgkin pulmonary lymphoma.

Young to middle-aged man with spine changes (kyphosis, spinal ankylosis). Increased lung volumes. Upper lobe fibrobullous disease. Simulates postprimary fibrocavitary Tb or mycetoma formation.

UIP. Acute interstitial pneumonia (AIP). COP. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). DIP. Nonspecific interstitial pneumonia (NSIP).

Most common of the idiopathic interstitial pneumonias. Most cases are sporadic. 30% of cases associated with collagen vascular or immunologic disorder. Findings: Irregular septal or subpleural thickening. Intralobular lines. Honeycombing. Traction bronchiectasis. Typically most severe in peripheral and basal lungs.

Diffuse ground-glass opacity and consolidation with air bronchograms. Linear opacities, honeycombing, and traction bronchiectasis are uncommon.

Viral infection (influenza, adenovirus, measles). Toxic fume inhalation (sulfur dioxide, chlorine). Collagen vascular disease (rheumatoid arthritis and SLE). Organ transplantation (bone marrow, lung, and heart-lung). Drug reactions. Chronic aspiration.

Idiopathic form of organizing pneumonia. Most common finding: Patchy consolidation or ground-glass opacity with subpleural or peribronchial distribution. Scattered nodular opacities may be present.

Typically young, heavy smokers. Scattered ground-glass opacities. Small centrilobular nodules with upper lobe predominance.

95% are cigarette smokers. Cannot be radiologically distinguished from UIP. Bibasilar reticular opacities. Normal or midly decreased lung volumes. May have ground-glass opacities. Honeycombing is rare.

Generally asymmetric upper lung bullae. Generally symmetric lower lung interstitial fibrosis.

Indistinguishable from LAM. Symmetric bilateral reticular or reticulonodular opacities. Scattered lung cysts. Normal to increased lung volumes. Pneumothorax is common

Exclusively in women. Lung cysts separated by interlacing bundles of smooth muscle. May obstruct lymphatics causing chylothorax. Poor prognosis.

Simulates silicosis or lung sarcoidosis. Upper lung reticulonodular opacities.

Irregular reticular interstitial opacities.

Asbestosis. Silicosis. CWP.

Pleura: Parietal pleural plaques. Pleural effusion. Localized visceral pleural fibrosis. Diffuse pleural fibrosis. Mesothelioma. Lung parenchyma: Interlobular septal thickening. Interstitial fibrosis (asbestosis). Rounded atelectasis. Bronchogenic carcinoma. Lower lung predominance.

Mining, ceramic work, and sandblasting. Upper lobe and parahilar nodules. Nodule calcification may occur. Egg shell calcification of hilar lymph nodes. Silicoproteinosis like alveolar proteinosis has increased susceptibility to TB.

Predominantly upper lung reticulonodular or small nodular opacities.

Berylliosis. Aluminum. Hard metal (cobalt, tungsten).

Inhaled antigenic organic dusts: Farmer's lung (moldy hay). Humidifier lung (thermophilic bacteria). Bird-fancier's lung (avian proteins). Acute and chronic forms. Chronic disease findings: Interlobular and intralobular interstitial thickening. Honeycombing, Traction bronchiectasis. May spare costophrenic angles.

0 Normal chest radiograph. 1 Bilateral hilar lymph node enlargement. 2 Bilateral hilar lymph node enlargement and parenchymal disease 3. Parenchymal disease only. 4 Pulmonary fibrosis.

Common findings: Symmetric hilar adenopathy allows distinction from malignancy and TB. Symmetric mid and upper lung reticulonodular opacities. Perilymphatic interstitial nodules, 3 to 10 mm.

Very high association with cigarette smoking. Mid and upper lung centrilobular small nodules. In late stages may develop cysts or bullae. Risk of pneumothorax. Nodule-cyst evolution: Nodule to Cavitated nodule to Thick-walled cyst to Thin-walled cyst.

Necrotizing granulomatous vasculitis involving upper and lower respiratory tracts and kidneys. Discrete nodules or masses with central necrosis and cavitation. May mimic Goodpasture syndrome and idiopathic pulmonary hemorrhage. Tracheal or bronchial lesions may be present. c-ANCA positive.

Symptoms and radiographic abnormalities last longer than 1 month. Predilection for women. Responds to corticosteroid therapy, improving within 4 to 7 days. Peripheral, homogeneous, ill-defined areas of consolidation that may parallel the chest wall

Male predominance. Blood eosinophilia. Cardiomegaly. Pulmonary edema. Pleural effusions. Pulmonary parenchymal infiltration with eosinophils may produce interstitial or airspace opacities.

Wegener granulomatosis. Sarcoidosis. Rheumatoid lung disease. Polyarteritis nodosa. Allergic angiitis and granulomatosis.

Drugs (Nitrofurantoin and Penicillins). Parasites (Ascaris lumbricoides, Strongyloides stercoralis).

Lipoproteinaceous material deposits within alveoli. Predilection for males in their 20s to 40s. Bilateral symmetric perihilar airspace opacification. Crazy paving CT finding: Geographic ground-glass opacities with thickened interlobular and intralobular septa. Prone to superinfection with Nocardia, Aspergillus, Cryptococcus, and atypical mycobacteria.

Deposition of minute calculi within alveolar spaces. Confluent bilateral dense micronodular opacities. So-called black pleura sign. Apical bullous disease is common.

Formation of bone within lung parenchyma. Associations: Mitral stenosis. UIP. Amyloidosis.

Paratracheal air cysts. True diverticula. Occur at weakened posterior membrane of cervical trachea.

Bronchus suis. Accessory bronchus to all or a portion of right upper lobe. Arises from right lateral tracheal wall within 2 cm of tracheal carina. Associated with congenital tracheal stenosis and aberrant left pulmonary artery.

Malignant: Squamous cell carcinoma. Adenoid cystic carcinoma (cylindroma). Benign: Chondroma. Fibroma. Squamous cell papilloma. Hemangioma.

Saber-sheath trachea. Amyloidosis. Tracheobronchopathia osteochondroplastica. Relapsing polychondritis. Wegener granulomatosis. Tracheal scleroma.

Tracheobronchomegaly (Mounier-Kuhn syndrome). Tracheomalacia. Interstitial pulmonary fibrosis.

Coronal diameter is less than two thirds of sagittal diameter. Affects older men with chronic obstructive pulmonary disease (COPD).

Multiple submucosal osseous and cartilaginous deposits within trachea and central bronchi of elderly men. Spares membranous posterior wall of trachea.

Systemic autoimmune disorder. Affects cartilage of earlobes, nose, larynx, tracheobronchial tree, joints, and large elastic arteries. Diffuse smooth wall thickening of the wall of trachea and central bronchi with luminal narrowing.

Congenital. Associated with Ehlers-Danlos syndrome. Men under age 50. Trachea and central bronchi measure greater than 3.0 cm and 2.5 cm.

Diffuse tracheal and central bronchial dilation. Congenital or acquired (COPD, Chronic bronchitis, Cystic fibrosis, Relapsing polychondritis).

Subtended lung remains collapsed against lateral chest wall. Secondary to bronchial injury. Responds poorly to chest tube evacuation.

Calcified material within bronchus. Usually from eroding calcified lymph nodes (Histoplasmosis or TB).

Transient bronchial narrowing. Peribronchial cuffing and tram tracking. Air trapping: Hyperinflation, Flattening or inversion of diaphragm, Attenuation of peripheral vascular markings. Prominence of the retrosternal airspace. Complications: Pneumomediastinum. Pneumothorax, Subpleural blebs from expiratory air dissection.

Excess production of sputum on most days for at least 3 months in 2 consecutive years. 50% have normal chest radiographs. Some patients show peribronchial cuffing or tram tracks.

Permanent dilation of bronchi. Cylindric bronchiectasis: mild diffuse dilation. Varicose bronchiectasis: cystic dilation interrupted by focal areas of narrowing. Cystic bronchiectasis: localized saccular dilation. Caused by chronic inflammation with cartilage damage and dilation. Localized bronchiectasis is most commonly a result of prior TB. Generalized bronchiectasis is seen in cystic fibrosis. Central bronchiectasis: Allergic bronchopulmonary aspergillosis. Cystic fibrosis. Bronchial atresia. Acquired central bronchial obstruction.

Production of abnormally thick, tenacious mucus. Recurrent infection commonly with Pseudomonas aeruginosa or Staphylococcus aureus. Severe bronchiectasis. Hyperinflation with predominantly upper lobe bronchiectasis and mucus plugging.

May result in Rhinitis. Sinusitis. Bronchiectasis. Dysmotile spermatozoa and sterility. Situs inversus. Dextrocardia.

Sinusitis. Situs inversus.. Bronchiectasis.

Hypersensitivity reaction to Aspergillus. Asthma, blood eosinophilia, bronchiectasis with mucus plugging, and circulating antibodies to Aspergillus antigen. Proximal upper lobe bronchiectasis with mucoid impaction. Finger in glove appearance.

Permanent enlargement of airspaces distal to terminal bronchiole. Destruction of alveolar walls without obvious fibrosis.

Airspace distention in central portion of lobule. Spares distal portions of the lobule. Upper lobe predominance. Associated with cigarette smoking.

Distention of airspaces throughout lobule. Destruction of central respiratory bronchioles and peripheral alveolar sacs and alveoli. Predilection of lower lobes. Associated with alpha-1 antitrypsin deficiency.

Distention of peripheral airspaces adjacent to interlobular septa. Spares centrilobular region. Generally involves subpleural regions of upper lobes.

Lung destruction associated with fibrosis. No consistent relationship to a given portion of the lobule. Commonly associated with old granulomatous inflammation.

Diffuse hyperlucency (panlobular). Flattening and depression of hemidiaphragms. Increased retrosternal airspace (panlobular > centrilobular). Bulla. Enlarged central pulmonary arteries. Right heart enlargement (centrilobular). Loss of pulmonary capillary bed.

Arterial deficiency: Predominantly panlobular emphysema. Hyperinflated lungs with peripheral vascular attenuation and bullae. Pink Puffers. Increased markings: Increased linear parenchymal markings. Small airways thickening of chronic bronchitis. Bullae uncommon. Blue Bloaters.

Thin-walled cystic space > 1 cm in diameter. Found within lung parenchyma.

Sarcoidosis. Pulmonary Langerhans cell histiocytosis. Ankylosing spondylitis.

Isolated bullae without intervening emphysema or interstitial lung disease. Associated with: Marfan or Ehlers-Danlos syndromes. Intravenous drug use. HIV infection. Vanishing lung syndrome.

Tree-in-bud opacities. Generally due to infection: Viral. Atypical. Mycobacterial.

Tree-in-bud opacities. Bronchial dilation and thickening.

Centrilobular and geographic ground-glass opacities. Cigarette smoking.

Centrilobular ground-glass nodules. Air trapping on expiratory scans. Inhaled organic antigen.

Centrilobular ground-glass nodules. Rheumatoid arthritis. Sjögren syndrome.

Mosaic attenuation with air trapping on expiratory scans. Bronchial dilation (late). Transplant patients. Drug reactions. Inhalation injury.

Pleural/serum protein ratio less than 0.5. Pleural/serum LDH ratio less than 0.6. Pleural LDH less than 200 IU/L.

Bacterial/mycobacterial. Viral. Fungal. Parasitic.

Heart failure. Pericarditis. Superior vena cava obstruction. Postcardiac surgery. Myocardial infarction. Pulmonary embolism.

Bronchogenic carcinoma. Metastases. Lymphoma. Pleural or chest wall neoplasms (mesothelioma).

Systemic lupus erythematosus. Rheumatoid arthritis. Sarcoidosis (rare). Wegener granulomatosis.

Asbestosis.

Blunt or penetrating chest trauma.

Cirrhosis (hepatic hydrothorax). Pancreatitis. Subphrenic abscess. Acute pyelonephritis. Ascites (from any cause). Splenic vein thrombosis.

Drugs. Myxedema. Ovarian tumor.

Transudative. Bilateral, right larger than left. Isolated right effusion twice as common as isolated left effusion.

Thickening and enhancement of parietal pleura. Loculations. Soft tissue lesions along parietal pleura outlined by pleural fluid.

Lung carcinoma. Breast carcinoma. Pelvic tumors (ovarian fibroma = Meigs syndrome). Gastric carcinoma. Lymphoma.

Empyema: Oval. Oriented longitudinally. Thin. Smooth (split pleura sign). Obtuse chest wall angle. Compresses lung. Requires drainage. Abscess: Round. Thick and irregular wall. Acute chest wall angle. Consumes lung. Antibiotics and postural drainage to treat.

Pleural effusion.

Malignancy. Iatrogenic trauma. TB

Left chylothorax: 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 airspace (bronchiole) involved, may result in intractable pneumothorax.

Often occurs in young or middle-aged men. Predilection of taller individuals. Results from bleb or bulla rupture, usually within upper lungs.

COPD. Asthma. Valsalva (cocaine, marijuana, labor). Sarcoidosis. Langerhans cell histiocytosis. Lymphangioleiomyomatosis. Necrotizing pneumonia. Abscess. Mechanically ventilated patients.

Rare recurrent pneumothoraces. Occurs with menses. Pleural endometrial implants. Treated with OCPs.

Iatragenic trauma in mechanically ventilated patients.

Pneumonia. Pulmonary infarct. Trauma. Asbestos exposure (bilateral).

Visceral pleura: Hemothorax, Empyema (tuberculosis). Parietal pleura:  Asbestos exposure (bilateral).

Benign: Fibroma. Lipoma. Neurofibroma. Malignant: Metastases (usually multiple).  Mesothelioma (usually diffuse pleural thickening). Other: Loculated pleural effusion/empyema. Hematoma.

Active empyema. Most commonly within patients with prior TB.

Pleural thickening extending over more than one fourth of the costal pleural surface. Commonly results from resolution of an exudative pleural effusion (including asbestos-related effusions), Empyema, or Hemothorax. Pleurectomy (decortication) may be necessary to restore function.

Metastatic adenocarcinoma (lung, breast, ovary, kidney, GI tract). Invasive thymoma or thymic carcinoma. Mesothelioma. Rarely non-Hodgkin lymphoma.

Benign: Pleural plaques. Pleural effusions. Diffuse pleural fibrosis. Malignant: Mesothelioma.

Geographic opacities. Llikened to a holly leaf.

Autosomal recessive disorder. Unilateral absence of sternocostal head of pectoralis major. Ipsilateral syndactyly. Rib anomalies.

Lipoma

Fibrosarcomas. Liposarcomas.

Askin tumor. Arises from primitive neuroectodermal rests. Very aggressive with a poor prognosis.

Abscess. Hematoma. Lipoma. Hemangioma. Desmoid tumor.

Coarctation of aorta. Aortic thrombus. Takayasu arteritis. SVC syndrome. Neurofibromatosis.

Paralysis.

Osteochondroma. Enchondroma. Osteoblastoma.

Chondrosarcoma.

Most common: Myeloma. Metastatic carcinoma. Primary malignancies: Chondrosarcoma. Osteogenic sarcoma. Fibrosarcoma.

Breast cancer. Lung cancer.

Renal cell carcinoma. Thyroid carcinoma.

Breast cancer. Prostate cancer.

TB. Actinomycosis. Nocardiosis.

Congenital hypoplastic and elevated scapula.

Sprengel deformity (hypoplastic, elevated scapula). Omovertebral bone. Fused cervical vertebrae. Hemivertebrae. Kyphoscoliosis. Rib anomalies.

Rheumatoid arthritis: Well-defined pointed distal clavicle. Hyperparathyroidism: Irregular and wide distal clavicle.

Sickle cell anemia.

Renal osteosclerosis.

Marfan syndrome. Poland syndrome. Osteogenesis imperfecta. Congenital scoliosis.

Outward bowing of sternum. May be congenital or acquired.

Congenital absence or underdevelopment of diaphragmatic musculature. Localized elevation of anteromedial hemidiaphragm in older individuals.

Surgical injury or neoplastic involvement of phrenic nerve.

Neuromuscular disturbance. Intrathoracic or intra-abdominal disease.

Herniation through embryonic pleuroperitoneal canal. Neonates present with large hernias with lung hypoplasia and respiratory distress. Adults present with small hernias, mostly on the left side (liver thought to be protective).

Parasternal diaphragm defect. Invariably right sided. Asymptomatic cardiophrenic angle mass.

Benign: Lipomas. Fibromas. Schwannomas. Neurofibromas. Leiomyomas. Echinococcal cysts and extralobar sequestrations may be found within the diaphragm. Metastatic invasion more common than primary malignancy (Fibrosarcoma): Lower lobe bronchogenic carcinoma. Mesothelioma.

Usually seen in infancy. One or several large cysts lined with respiratory epithelium with scattered mucous glands, smooth muscle, and elastic tissue. Round, air-filled masses that compress adjacent lung and mediastinum.

Central bronchial mucocele with peripheral hyperlucency in a young, asymptomatic patient.

Intralobar sequestration: Single large artery from infradiaphragmatic aorta. Pulmonary vein drainage. Extralobar sequestration: Small branches systemic arteries and occasionally pulmonary arteries. Systemic venous drainage (inferior vena cava, azygos, or hemiazygos veins).

Variant of hypoplastic lung with abnormal venous drainage to the IVC just above or below right hemidiaphragm. Small right hemithorax with diaphragmatic elevation or eventration. Dextroposition of heart. Herniation of left lung anteriorly into right hemithorax.

Extensive bilateral airspace opacification. Diffuse but discrete airspace nodular opacities. Irregular parenchymal opacities that are not obviously airspace.

Older patients with swallowing disorders or gastroesophageal reflux. Use mineral oil as a laxative or inhale oily nose drops. Fat density opacity.

Lupus-like syndrome (procainamide, isoniazid, hydralazine). Nitrofurantoin. Bleomycin. Methotrexate. Amiodarone.

Nodule less than 2.5 cm with a smooth or lobulated border and containing focal fat. May have popcorn calcification.

Granular cell myoblastoma.

Most common type of lung cancer (nonsmokers, too). Arise from bronchiolar or alveolar epithelium. Irregular or spiculated appearance. ccur in the lung periphery.

Grows along bronchiolar and alveolar walls (lepidic growth). May appear as: Solitary nodule. Focal ground-glass opacity. May mimic pneumonia or bilateral nodular airpsace processes.

Arises centrally within lobar or segmental bronchi. Central necrosis with cavitation may be seen. Generally presents as hilar mass and atelectasis.

Arises centrally within main or lobar bronchi from bronchial neuroendocrine (Kulchitsky) cells. Hematogenous dissemination. Hilar/mediastinal mass.

Large peripheral mass.

Asbestos exposure. Previous Hodgkin lymphoma. Radon exposure. Viral infection. Diffuse interstitial or localized lung fibrosis.

Resorptive atelectasis. Obstructive pneumonitis.

SCC. Adenocarcinoma.

Arm pain and muscular atrophy due to brachial plexus involvement. Horner syndrome (ptosis, anhydrosis, miosis) from involvement of sympathetic chain. Shoulder pain from chest wall invasion.

Filling of airspaces with mucoid material produced by malignant cells creates low-density airspace opacification surrounding enhanced pulmonary arteries.

Linear and reticulonodular opacities. Peribronchial cuffing. Subpleural edema or pleural effusion.

Unilateral or asymmetric involvement of lungs suggests lung cancer rather than an extrapulmonary site.

Disease limited to one hemithorax (limited disease). Contralateral lung or extrathoracic spread (extensive disease).

SCC > Adenoid cystic carcinoma

Masses > 2 cm are likely to be malignant. Less than 2 cm are more likely benign.

Mucoepidermoid carcinoma. Carcinoid tumor. Adenocarcinoma. Lymphoma. Small cell carcinoma. Leiomyosarcoma. Fibrosarcoma. Chondrosarcoma.

Squamous cell carcinoma. Small cell carcinoma. Carcinoid tumor. Bronchial gland tumors (adenoid cystic carcinoma, mucoepidermoid carcinoma).

Prefers right upper and middle lobes. Well-defined smooth or lobulated nodules or masses. Iceberg tumor: small intrabronchial and large extraluminal soft tissue component.

Pulmonary hamartoma.

Thickened septal lines of lymphangiti carcinomatosis do not distort the pulmonary lobule.

Infiltration of pulmonary interstitium by mature lymphocytes. CT findings: Diffuse ground-glass opacity. Poorly defined centrilobular nodules. Thin-walled cysts. Associations: Sjogren syndrome. Hypogammaglobulinemia. Multicentric Castleman disease. AIDS.

Spectrum of entities. Ranging from benign polyclonal lymphoid proliferation to aggressive non-Hodgkin lymphoma.

Rare malignant tumor affecting children and young adults. Histology simulates fetal lung at 10 to 16 weeks’ gestation. Tend to be extremely large at presentation.

Typical of pneumococcal pulmonary infection. Inflammatory process spreads via pores of Kohn and canals of Lambert to produce nonsegmental consolidation. Air bronchograms are common.

Most common pattern of pneumonia. Typical of staphylococcal pneumonia. Inflammation centered around lobular bronchi. Multifocal opacities produce patchwork quilt of scattered normal and diseased lobules. No air bronchograms due to exudate within bronchi.

Viral and mycoplasma infection. Inflammatory thickening of bronchial and bronchiolar walls and pulmonary interstitium. Peribronchial cuffing and reticulonodular opacities.

Thin walls. Rapid change in size. Generally develop during late phase of infection.

Calcified parenchymal focus (Ghon lesion) and lymph nodel calcification. Primary TB.

Reactivation occurs in apical and posterior segments of upper lobes and superior segments of lower lobes. Ill-defined patchy and nodular opacities. Cavitation usually indicates active and transmissible disease.

Erosion of cavitary focus into pulmonary artery branch can produce an aneurysm.

May complicate primary or reactivation disease. Hematogenous dissemination. Diffuse bilateral 2- to 3-mm pulmonary nodules.

Aspergillus. Candida. Cryptococcus.

Aspergilloma or mycetoma within preexisting cavities. Semi-invasive (chronic necrotizing) aspergillosis in mildly impaired immunity. Invasive pulmonary aspergillosis in neutropenia. Allergic bronchopulmonary aspergillosis in hyperimmunity.

Inside out: Endocyst, produces daughter cyts. Exocyst (chitinous layer), protective membrane. Pericyst, surrounding compressed, fibrotic lung.

Decreased attenuation surrounding a dense, mass-like opacity. Relatively specific for invasive aspergillosis in a neutropenic patient.

PCP

Thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting costal pleura.

Interstitial edema.   Lymphangitic carcinomatosis.   Sarcoidosis.   Idiopathic pulmonary fibrosis (IPF) (other forms of usual interstitial pneumonia UIP).

IPF (UIP). Asbestosis. Alveolar proteinosis. Hypersensitivity pneumonitis.

Pulmonary edema.   Sarcoidosis.   Lymphangitic carcinomatosis.

Pulmonary edema (smooth).   Sarcoidosis (nodular).   Lymphangitic carcinomatosis (smooth or nodular).

Hypersensitivity pneumonitis.  Bronchiolitis obliterans with organizing pneumonia (BOOP)/cryptogenic organizing pneumonia (COP).  Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD).

Asbestosis.   IPF (UIP).

Asbestosis.   IPF (UIP).   Sarcoidosis.

IPF (UIP).   Asbestosis.  Hypersensitivity pneumonitis (chronic).  Sarcoidosis.

Eosinophilic granuloma (EG). Lymphangioleiomyomatosis.  Tuberous sclerosis.  Neurofibromatosis (pneumatocele). (emphysema).

Miliary tuberculosis or histoplasmosis.  Hematogenous metastases.  Silicosis/coal worker's pneumoconiosis (CWP).  EG.

Sarcoidosis.   Lymphangitic carcinomatosis.  Silicosis/CWP.

Desquamative interstitial pneumonia.  Acute interstitial pneumonia (AIP).  Hypersensitivity pneumonitis. BOOP/COP.  RB-ILD.  Hemorrhage.  Pneumocystis jiroveci pneumonia.  Cytomegalovirus pneumonia.  Alveolar proteinosis.

Sarcoidosis.   Silicosis/CWP.

Sarcoidosis.  Silicosis.  CWP.  Radiation fibrosis.

5- to 10-cm-long curvilinear opacities are found within 1 cm of the pleura and parallel the chest wall. Most often seen in patients with asbestosis and, less commonly, IPF.

Nontapering linear opacities, 2 to 5 cm in length. Extend from lung to contact pleural surface. Asbestosis. IPF. Sarcoidosis.

Small (6 to 10 mm) cystic spaces with thick (1 to 3 mm) walls. usually have shared walls . Usually in posterior subpleural regions. End-stage pulmonary fibrosis: IPF (UIP). Chronic hypersensitivity pneumonitis. Occasionally sarcoidosis.

Slightly larger in diameter (10 mm) than honeycomb cysts. Uniform in size. Thinner walls. Do not share walls with adjacent cysts. Cysts of LCH and LAM are usually evenly distributed from central to peripheral portions of upper lobes

1- to 3-mm. Sharply marginated. Round opacities seen on HRCT. Represent conglomerates of granulomas or tumor cells within the interstitium.

Granular appearance with maintained visibility of pulmonary vessels. Absence of air bronchograms. Desquamative interstitial pneumonia (DIP). Pneumocystis jiroveci (formerly P carinii) pneumonia. Acute hypersensitivity pneumonitis. Nonspecific interstitial pneumonia (NSIP). Interstitial pulmonary edema.

Fibrosis causes traction on the walls of bronchi, resulting in irregular dilation.

Tuberculosis (postprimary). Chronic fungal infection (Histoplasmosis, Coccidioidomycosis).  Sarcoidosis.  Eosinophilic granuloma.  Silicosis.  Ankylosing spondylitis.  Hypersensitivity pneumonitis (chronic). Radiation fibrosis from treatment of head and neck malignancy.

Idiopathic pulmonary fibrosis.  Asbestosis.  Rheumatoid lung.  Scleroderma.  Neurofibromatosis.  Dermatomyositis/polymyositis.  Chronic aspiration.

Sarcoidosis.  Eosinophilic granuloma.  Lymphangioleiomyomatosis.  Tuberous sclerosis.  Interstitial disease superimposed on emphysema.

Idiopathic pulmonary fibrosis.  Sarcoidosis.  Eosinophilic granuloma.  Rheumatoid lung.  Scleroderma.  Pneumoconiosis.  Hypersensitivity pneumonitis.  Chronic aspiration.  Radiation fibrosis.

Tuberculosis.  Fungi (Histoplasmosis, Coccidioidomycosis, Cryptococcosis). Silicosis.  Metastases (Thyroid carcinoma, Renal cell carcinoma, Bronchogenic carcinoma, Melanoma, Choriocarcinoma).  Sarcoidosis.  Eosinophilic granuloma.

Sarcoidosis.  Lymphangitic carcinomatosis.  Lymphoma.  Hematogenous metastases.  Tuberculosis. Fungal infection.  Silicosis.

Asbestosis (plaques).  Lymphangitic carcinomatosis (effusion).  Rheumatoid lung disease (effusion/thickening).  Lymphangioleiomyomatosis (chylous effusion).

Pleural effusion. Pleural thickening. Pericarditis. Pericardial effusion. Pulmonary fibrosis (basilar predominance). Necrobiotic nodules (peripheral cavitating nodules, Caplan syndrome). Bronchiolitis obliterans (Hyperinflation) Pulmonary arteritis. Pulmonary arterial hypertension. Right heart enlargement. Pulmonary hemorrhage

Thick walled cavitating lung nodules. Rheumatoid arthritis patients with hypersensitivity to inhaled dust particles (coal, silica, asbestos).

Interlobular septal thickening. Ground-glass opacities. Honeycombing. Lower lung predominance. Patulous esophagus.

Intrapulmonary vascular shadows. Peribronchial cuffing. Tram tracking.

Kerley A lines thickening of central connective tissue septa. Kerley B lines thickening of peripheral interlobular septa.

Severe mitral regurgitation.

LV failure. Mitral valve disease (Mitral stenosis, Mitral insufficiency). LA myxoma. Cor triatriatum. Obstruction of central pulmonary veins (fibrosing mediastinitis, pulmonary vein stenosis, pulmonary venous thrombosis). Obstruction of intrapulmonary veins (pulmonary venoocclusive disease).

Enlargement of pulmonary veins (progressive dilation of horizontally oriented pulmonary veins). Redistribution of pulmonary blood flow to upper lungs.

Respiratory failure due to increased capillary permeability edema. Associated with increased lung stiffness (noncompliance).

Shock. Severe trauma. Burns. Sepsis. Narcotic overdose. Pancreatitis.

Patchy peripheral airspace opacities (12-24 hrs). Confluent bilateral airspace opacities with air bronchograms (days). Coarse reticulonodular pattern (week) that may resolve.

Head trauma. Seizure. Increased intracranial pressure.

Trauma. Bleeding diathesis. Infections (invasive aspergillosis, mucormycosis, Pseudomonas, influenza). Drugs (penicillamine). Pulmonary embolism. Fat embolism. ARDS. Autoimmune diseases (Goodpasture syndrome, idiopathic pulmonary hemorrhage, Wegener granulomatosis, systemic lupus erythematosus, rheumatoid arthritis, and polyarteritis nodosa).

Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody.

Indistinguishable from Goodpasture syndrome. Pulmonary hemorrhage and anemia in patient with normal renal function and urinalysis. No antiglomerular basement membrane antibodies.

Wegener granulomatosis. Systemic lupus erythematosus. Rheumatoid arthritis. Polyarteritis nodosa.

Sensitive, but not specific marker of venous thrombosis.

Localized peripheral oligemia with or without distended proximal vessels (Westermark sign). Peripheral airspace opacification. Linear atelectasis.

Small pleural effusion and pleura-based wedge-shaped opacity (Hampton hump).

Air embolism. Macroscopic fat embolism. Methylmethacrlate embolization from vertebroplasty. Radioactive seed embolization from prostate brachytherapy.

30 mm Hg.

Enlarged main and hilar pulmonary arteries that taper rapidly toward lung periphery. RV enlargement.

Interlobar pulmonary artery > 16 mm. Main pulmonary artery > 28.6 mm.

High cardiac output (anemia, thyrotoxicosis). Left-to-right shunts (ASD, VSD, PDA, PAPVR).

Enlargement of both central and peripheral pulmonary arteries.

Chronic PEs. Vasculitis. Pulmonary arteriopathy resulting from long-standing increased pulmonary blood flow from left-to-right shunt.

Metastases. Granulomas.

Round or oval opacity 4 to 30 mm in diameter.

Round opacity greater than 3 cm.

Granuloma. Hamartoma, Inflammatory lesion.

Benign pattern of calcification. Presence of intralesional fat.

Between 1 month and 2 years.

Benign disease, particularly granulomatous infection.

Invasive pulmonary aspergillosis.

Round atelectasis.

Healed granuloma from tuberculosis or histoplasmosis.

Granuloma and allows confident exclusion of neoplasm.

Pulmonary hamartoma.

Pulmonary hamartoma.

15 H.

Thyroid masses. Lymphomatous nodes. Lymphangiomas.

Well-defined margins. Continuity of mass with cervical thyroid. Coarse calcifications. Cystic or necrotic areas. Baseline high CT attenuation (intrinsic iodine content). Intense enhancement (>25 H).

Tumor of dilated lymphatic channels. Cystic or cavernous form (cystic hygroma) is commonly discovered in infancy and is often associated with : Turner syndrome and trisomies 13, 18, and 21.

Thymic neoplasms. Lymphoma. Germ cell neoplasms. Primary mesenchymal tumors.

Thymomas may be encapsulated (noninvasive) or invasive. Thymic carcinomas, epithelial component shows signs of frank malignancy.

Myasthenia gravis. Pure red cell aplasia. Graves disease. Sjogren syndrome. Hypogammaglobulinemia.

Congenital: Remnants of thymopharyngeal duct. Contain thin or gelatinous fluid. Acquired: Postinflammatory. Associations: AIDS, Prior radiation or surgery, Autoimmune conditions (Sjögren syndrome, Myasthenia gravis, Aplastic anemia).

Thymoma. Thymic cyst. Thymolipoma. Thymic hyperplasia. Thymic neuroendocrine tumors. Thymic carcinoma. Thymic lymphoma.

Teratoma (benign and malignant). Seminoma. Embryonal cell carcinoma. Endodermal sinus tumor. Choriocarcinoma.

Lipoma. Hemangioma. Leiomyoma. Liposarcoma. Angiosarcoma.

Anterior mediastinum.

Retroperitoneal lymph node involvement in metastatic gonadal tumors.

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.

Mycobacteria. Fungus.

Silicosis. Sarcoidosis.

Carcinoid tumor/small cell carcinoma. Kaposi sarcoma. Metastases (RCC. Thyroid carcinoma). Castleman disease.

Mycobacteria. Fungus. Metastases (SCC. Seminoma. Lymphoma).

Sarcoidosis: Lobular lymph nodes that do not coalesce. Lymphoma/mets: May form conglomerate enlarged nodal masses.

Angiofollicular lymph node hyperplasia.

Anterior cardiophrenic angles. Right-sided lesions being twice as common as left-sided lesions.

Intercostal nerves: Neurofibroma. Schwannoma. Sympathetic ganglia: Ganglioneuroma. Ganglioneuroblastoma. Neuroblastoma. Paraganglionic cells: Chemodectoma. Pheochromocytoma.

Neuroblastoma. Ganglioneuroma.

Neurofibroma. Schwannoma.

Neurofibromatosis.

Esophageal lesions. Foregut cysts. Vertebral lesion. Lateral thoracic meningocele. Pancreatic pseudocyst.

Histoplasmosis (most common). TB. Radiation therapy. Drugs (methysergide). Idiopathic (autoimmune).

Headache. Epistaxis. Cyanosis. Jugular venous distention. Edema.

Substernal chest pain caused by intramediastinal extension of infection.

Poststenotic dilation from valvular or postvalvular pulmonic stenosis. Pulmonary artery aneurysms. Distension of pulmonary artery by thrombus or tumor.

Behçet disease and Hughes-Stovins syndrome

1: Right paratracheal. 2. Right hilar. 3. Left hilar lymph node enlargement

75%

50% diameter narrowing. Roughly predicts a 75% cross-sectional area reduction.

Define location and size of previous myocardial infarctions. Demonstrate complications of previous infarctions. Establish presence of viable myocardium for possible revascularization. Differentiate acute versus chronic myocardial infarction. Evaluate regional myocardial wall motion and systolic wall thickening. Demonstrate global myocardial function with right ventricular and left ventricular ejection fractions. Demonstrate regional myocardial perfusion. Evaluate papillary muscle and valvular abnormalities.

3 to 14 days.

Onset is typically 1 week to 3 months postinjury. Fever, chest pain, pericarditis, pericardial effusion, and pleuritis, with pleural effusion usually more prominent on the left. Dressler syndrome responds well to anti-inflammatory medications.

Hibernating: High-grade stenosis resulting in chronically ischemic myocardium. May act like postinfarction scar. Improved function with revascularization. At risk for acute infarction. Stunned myocardium: Postischemic, dysfunctional myocardium without complete necrosis. Potentially salvageable.

Ischemic cardiomyopathy (most common cause): Chronic ischemia. Prior infarction. Anomalous coronary arteries. Long-term sequelae of myocarditis: Coxsackie virus. Toxins: Ethanol, Adriamycin, Doxorubicin. Metabolic conditions: Mucolipidosis. Mucopolysaccharidosis. Glycogen storage disease. Nutritional deficiencies: Thiamin. Selenium). Infants of diabetic mothers. Muscular dystrophies.

LV thin. LV dilated. Decreased contractility. Normal to decreased compliance.

LV thick. LV normal to decreased. Increased contractility. Decreased compliance.

Normal LV wall. Normal LV cavity. Normal to decreased contractility. Severely decreased compliance.

RV thin. RV dilated. Decreased contractility. Normal to decreased compliance.

Concentric hypertrophy: may be diffuse, midventricular, or apical in distribution. Asymmetrical septal hypertrophy (ASH), also known as idiopathic hypertrophic subaortic stenosis (IHSS).

May be familial (60%). Autosomal dominant with variable penetrance. Associated with neurofibromatosis and Noonan syndrome. Secondary to pressure overload.

Hypertrophy of the interventricular septum (>12 to 13 mm). Abnormal ratio of thickness of interventricular septum to left ventricular posterior wall (>1.3:1). Narrowing of left ventricular outflow tract during systole.

Infiltrative disorders: Amyloid. Glycogen storage disease. Mucopolysaccharidosis. Hemochromatosis. Sarcoidosis. Myocardial tumor infiltration.

Constrictive pericarditis.

high signal in the myocardium on T2WIs.

Cor pulmonale.

destructive pulmonary disease (pulmonary fibrosis and chronic obstructive pulmonary disease). hypoxic pulmonary vasoconstriction resulting from chronic bronchitis, asthma, CNS hypoxia, upper airway obstruction. Acute and chronic pulmonary embolism. Idiopathic pulmonary hypertension. Extrapulmonary diseases affecting pulmonary mechanics such as chest deformities, morbid obesity (pickwickian syndrome), neuromuscular diseases.

Acquired disorder in infants or adults. Also called arrhythmogenic right ventricular dysplasia. Dilation of RV with marked thinning of anterior right ventricular wall. MR may show fatty infiltration of anterior RV free wall. Premature death from early congestive failure or arrhythmias.

Left-to-right shunts. Poststenotic dilation secondary to pulmonary stenosis. Pulmonary arterial hypertension. Marfan syndrome. Takayasu arteritis. Idiopathic dilation of pulmonary artery.

Long-standing pulmonary venous hypertension (mitral stenosis). Eisenmenger physiology (long-standing left-to-right shunts). Pulmonary emboli. Vasculitides (rheumatoid arthritis or polyarteritis nodosa). Primary pulmonary hypertension.

Left-to-right shunts. High output states: Volume loading. Pregnancy. Peripheral shunt lesions (arteriovenous malformations). Hyperthyroidism. Anemia. Leukemia.

Chronic obstructive pulmonary disease. Hypovolemia. Malnourishment. Addison disease.

Rheumatic heart disease.

Left ventricular failure. Mitral stenosis. Mitral regurgitation. Aortic stenosis. Aortic regurgitation. Pulmonary veno-occlusive disease. Congenital heart disease.

Mitral regurgitation.

Intra-atrial thrombi are usually associated with atrial fibrillation, often secondary to rheumatic heart disease. Commonly occurs along posterior wall of LA. Left ventricular thrombi are usually secondary to recent infarction or ventricular aneurysm. Clots typically have low MR GRE signal, whereas tumors have intermediate signal. Clots will not enhance.

High 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 mimic rheumatic valvular disease clinically.

Atrial myxoma. Lipoma. Rhabdomyoma (50% to 85% of tuberous sclerosis). Fibromas (12% may calcify). Rare teratoma.

10 to 20 times more common than primary cardiac tumors. Breast. Lung. Melanoma. Lymphoma.

Angiosarcoma (most common). Rhabdosarcoma. Liposarcoma. Other sarcomas.

Fibrous or calcific thickening of pericardium. Compromises ventricular filling through restriction of cardiac motion. Most common cause is postpericardiotomy. Other causes: Coxsackie B. Tuberculosis. Chronic renal failure. Rheumatoid arthritis. Neoplastic involvement. Radiation pericarditis.

Pericardial cyst. Fat pad. Lipoma. Enlarged lymph nodes. Diaphragmatic hernia. Ventricular aneurysm.

Complete left-sided absence (55%). Foraminal defects (35%). Total absence (10%). M > F. Complete absence: Heart is shifted toward the left, with prominent bulge of right ventricular outflow tract, main pulmonary artery, and left atrial appendage. Partial absence of the pericardium risks strangulation of cardiac structures. Surgical closure of partial defects is usually recommended.

Pneumoconioises (silicosis). Eosinophilic granuloma. Sarcoidosis. Metastases (Thyroid. Melanoma.)

Frontal (200 mL). Lateral (75 mL). Decubitus (5 mL)

Posterior junction line.

Refers to a lucency located wtihin a nodule, mass, or focus of consolidation.

Anteromedial, Lateral, Posterior (ALP).

Lymph node enlargement. Bronchogenic cyst. Left atrial enlargement.

Parenchymal consolidation with mediastinal and hilar lymph node enlargement.

Combination of calcified lung nodule and calcified lymph nodes.

Lung nodule that is a residum of primary TB. Usually is calcified.

Normal 12 mm Hg. Kerley lines 17 mm Hg. Effusion 20 mm Hg. Airspace opacity 25 mm Hg.

Recurrent infections. Hemoptysis. Mucoid impaction. Atelectasis.

Telangiectasias. AVMs. Aneurysms in multiple organ systems (Pulmonary. GI. Cutaneous. CNS)

Wedge-shaped peripheral foci of consolidation. Linear bands.

Lipoid pneumonia. Bronchoalveolar cell carcinoma. Lymphoma.

Bronchoalveolar cell carcinoma. Alveolar proteinosis. Sarcoid. Lipoid pneumonia.

Situs invertus. Bronchiectasis. Sinusitis.

Multiple lung nodules or masses. Cavitation occurs 50%. Local or diffuse consolidation due to hemorrhage.

LCH: Usually associated with nodules and variable appearing cysts. Spares costophrenic angles.

Extensive ground glass opacities in a patchy or geographic pattern. 1/3 have upper lobe predominant cysts of varying sizes and wall thicknesses

Pneumonectomy space fails to fill with fluid. Abrupt decrease in air-fluid level in the pneumonectomy space. New collection of air in previously opacified pneumectomy space. Contralateral mediastinal shift.

Shoulder pain. Horner's syndrome (ptosis, miosis, anhidrosis). Weakness and atrophy of hand muscles.

Any involvement of vertebral body, brachial plexus, subclavian artery.

Smaller nodules adjacent to a lung mass. Suggests an infectious etiology.

Cushing's syndrome. Steroid therapy. Obesity.

Form of peripheral lobar atelectasis that develops with pleural disease (commonly asbestosis). Volume loss. Comet tail (whorled bronchovascular structures).

4 cm. 6 cm significant risk of rupture.

Bulla, sharply demarcated area of emphysema greater than 1 cm. Bleb, gas-containing space within visceral pleura.

Diffuse discrete pulmonary calcifications.

N0, No metastatic lymph nodes. N1, Metastatic ipsilateral hilar lymph nodes. N2, Metastatic ipsilateral mediastinal and subcarinal lymph nodes. N3, Metastatic contralateral mediastinal or hilar lymph nodes.

Neoplastic: Lung cancer (especially small cell carcinoma). Lymphoma. Metastatic carcinoma. Benign: Long-term IV devices (catheters. pacemakers). Fibrosing mediastinitis (Histoplasmosis).

90% Malignant lung neoplasms. Nonneoplastic: Cystic fibrosis. IPF. Localized fibrous lesions of the pleura

Double lucency sign. Displacement (>4 mm) of anterior and posterior (epicardial) pericardial fat by pericardial fluid.

Interlobar fissures. Pulmonary vessels. Bullae. Areas of severe emphysema.

Chronic eosinophilic pneumonia.

Pulmonary gangrene. Closely associated with Klebsiella.

Small airways disease. Chronic pulmonary embolism.

Expiratory images demonstrate air-trapping in small airways disease.

Mounier-Kuhn syndrome.

Central bronchiectasis. Mucous plugging (finger-in-glove). Atelectasis. Patchy migratory foci of consolidation.

Nocardia. Aspergillus. Mucormycetes.

Intense and homogeneous contrast enhancement.

Healed varicella. Healed histoplasmosis. Silicosis. Calcified metastases.

Areas of decreased lung attenuation with associated reducting in number and size of vessels. Bronchiectasis. Air trapping on expiratory images.

Blind-ending diverticulum arising from medial wall of bronchus intermedius. Rarely presents with recurrent infections, hemoptysis, cough, and or dyspnea.

Patchy bilateral airspace consolidation with peripheral, subpleural distribution. Poorly defined lung nodules in a peribronchiolar distribution.

Severe pulmonary 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.

Tricuspid regurgitation. Pericardial effusion. Dilated cardiomyopathy.

Hypertension. Annuloaortic ectasia: Marfan or Ehlers-Danlos syndrome. Bicuspid aortic valve. Aortic aneurysm. Arteritis.

Left subclavian artery. Distal type B. Proximal type A.

Pectus excavatum. Scoliosis.

Marfan syndrome. Ehlers-Danlos syndrome. Mitral valve prolapse. Homocystinuria. Hunter-Hurler syndromes.

Coronary artery dissection (myocardial infarction). Carotid artery dissection (stroke). Pericardial hemorrhage (tamponade). Aortic valve rupture (aortic regurgitation).

Pseudoaneurysm: Inferoposterior location. Narrow neck (less than 50%). Aneurysm: Anteroapical location. Wide neck.

Right aortic arch with aberrant left subclavian artery. Left-sided ligamentum arteriosum completes the ring.

Neoplastic: Bronchogenic carcinoma. Metastases. Lymphoma. Infectious: Fungal infection (histoplasmosis, fibrosing mediastinitis).

ASD. Tetralogy of Fallot. P(T)APVR.

Overriding aorta. VSD. Pulmonar infundibular stenosis. Right ventricular hypertrophy.

Aorta. Right common carotid.Subclavian arteries. Pulmonary arteries.

Cardiac surgery. Radiation therapy. Uremic pericarditis. Viral pericarditis (coxsackie). Tuberculous pericarditis.

Similar to aorta dissections: type A (surgically) type B (medically).

Sinus of valsalva aneurysm is focal dilation of one sinus of Valsalva, not entire root.

Type I: Supracardiac drainage. Snowman heart. Type II: Cardiac. Coronary sinus or right atrium drainage. Type III: Infracardiac. Portal vein, hepatic vein, or ductus venosus drainage (pulmonary edema due to obstruction).

Atherosclerosis (penetrating ulcer). Infection. Trauma. Iatrogenic.

Tetralogy of Fallot. Truncus arteriosus.

Right lung hypoplasia. Hypoplastic right pulmonary artery. Right lower lobe systemic arterial supply. PAPVR from right lung.

Leftward deviation of the heart without deviation of mediastinum. Prominent left atrial appendage. Lung located between aorta and pulmonary artery confirms diagnosis.

Bilateral left-sidedness/polysplenia syndrome.

Invasiveness. Extension outside of heart. Involvement of more than one chamber. Central necrosis or cavitation. Large pericardial effusion.

Left pulmonary artery arises from right pulmonary artery and courses between esophagus and trachea.