• XRT
• Cystic Fibrosis
• Ankylosing Spondylitis
• Silicosis
• Sarcoid
• EG
• Tuberculosis - post 1°, not miliary (miliary is lower lobe)

• Bronchiectasis
• Aspiration
• Drugs (Ritalin, Bleomycin)/Dermatomyositis
• Asbestosis
• Scleroderma
• Rheumatoid
• IPF
• DIP
• Lymphangitic Carcinomatosis

• Sarcoidosis
  • Upper lung perilymphatic nodules
    • Interlobular
    • Peribronchial
  • Coalescent masses secondary to fibrosis
• Silicosis/Coal Worker's Pneumoconiosis
  • Upper lung nodules
    • Subpleural
    • Centrilobular
  • Progressive massive fibrosis (PMF)
  • Paracicatricial emphysema
• Idiopathic pleuroparenchymal fibroelastosis
  • Extensive subpleural and pleural fibrosis
• Familial pulmonary fibrosis
  • Upper lung or diffuse zonal distribution
• Hypersensitivity pneumonitis
  • Ground glass
  • Air trapping
  • Exposure history

• Aspiration (mimic)
  • Ground-glass or consolidation
  • Often dependent
  • May be peribronchovascular
  • Transient bronchial dilation
• Usual interstitial pneumonitis/Idiopathic pulmonary fibrosis
  • Subpleural and basilar predominant
  • Reticular opacities
  • Bronchiolectasis
  • Honeycombing
• Diffuse pulmonary hemorrhage
  • Ground-glass consolidation
  • Spares lung periphery
  • May progress to fibrosis if recurrent
• Nonspecific interstitial pneumonitis
  • Ground-glass and reticulation
  • Basilar
  • Peripheral sparing highly suggestive
  • Usually secondary
    • Collagen vascular disease
    • Drugs
    • Chronic hypersensitivity pneumonitis
• Organizing pneumonia (not cryptogenic)
  • Consolidation
  • Transient bronchial dilation
  • Reverse halo sign
  • Perilobular pattern
  • Usually secondary
    • Collagen vascular disease (Myopathies and RA)
    • Aspiration
    • Radiation
    • Drugs
    • Lung or stem cell transplant

• Obliterative Bronchiolitis
  • Air trapping
  • Mosaic attenuation
  • Bronchial wall thickening and dilation
• Lymphocytic Interstitial Pneumonitis
  • Peribronchovascular cysts
  • Pericystic dots

• LAM - uniform cysts
• EG (Call it Langerhans Cell Histiocytosis, the chest guys like that) - bizarre cysts w/ small nodules
• PCP
• LIP
• IPF (honeycombing)
• Papillomatosis

• Cystic Fibrosis
• Immunodeficiency
  • The most common congenital conditions involve B-lymphocyte functions—specifically, hypogammaglobulinemia. An aggressive form of bronchiectasis has been described in patients with acquired immunodeficiency syndrome (AIDS).
• Traction
  • Associated with pulmonary fibrosis
• Kartagener's
• ABPA
• Mournier-Kuhn/Williams-Campbell (both are lower lobe; Mournier-Kuhn has tracheal widening, Williams-Campbell does not)
• Others
  • Infection: Typical organisms include Klebsiella species, Staphylococcus aureus, Mycobacterium tuberculosis, Mycoplasma pneumoniae, nontuberculous mycobacteria, Mycobacterium avium-intracellulare complex, measles, pertussis, influenza, respiratory syncytial virus, herpes simplex virus, and certain types of adenovirus.
  • Bronchial obstruction: Obstruction occurs as a result of endobronchial tumors, broncholithiasis, bronchial stenosis resulting from infections, encroachment of hilar lymph nodes, and foreign body aspiration.
  • Young syndrome
  • Alpha-1 Antitrypsin deficiency
  • Lung and bone marrow transplants
  • Rheumatoid arthritis and Sjögren syndrome
  • Bronchopulmonary sequestration
  • Swyer-James syndrome (unilateral hyperlucent lung)
  • Yellow nail syndrome

• Resolving Edema
• Resolving Multifocal PNA
• Eosinophilic Pneumonia/Loffler's
• COP (has peripheral clear zone)
• Hypersensitivity Pneumonitis
• Drug Toxicity
• Bronchioloalveolar CA

• Carcinoma (SCC, colon, TCC, sarcoma, melanoma, cervical)
• Autoimmune (Rheumatoid, Wegeners)
• Vascular
• Infection (abscess, fungal, TB, echinococcus)
• Trauma
• Young (congenital)

• Pulmonary Alveolar Proteinosis
• Edema
• PCP
• Pneumonia
• ARDS
• Hemorrhage

• Fungal
• Amyloid
• TB
• Sarcoid
• Pneumoconiosis
• Alveolar Microlithiasis
• Mets (ThRAB - thyroid, renal cell, any adenoCA, breast)

• GI Adenocarcinomas
• Breast
• Thymoma

• BAC
• Lymphoma
• Eosinophilic Pneumonia
• COP
• Sarcoid
• Infarct
• Metastatic Pulmonary Calcification
• TB
• Lipoid Pneumonia
• Pulmonary Alveolar Proteinosis

• Endobronchial Spread of Infection (esp TB)
• Bronchiolitis
• Viral/Fungal Infection
• ABPA
• Aspiration
• Atypical Mycobacteria
• Mycoplasma

• Loffler's
• Parasitic Infection

• Aspergilloma
• Echinococcus

• IPF
• Collagen Vascular Disease
• Asbestosis
• Drugs

• Reexpansion Edema
• Gravity
• Mass Obstructing Pulmonary Veins
• Large Contralateral PE

• Colon
• Sarcomas
• Renal Cell
• Testicular
• Breast
• Melanoma

• Mets
  • Renal Cell
• Lymphoma
• Sarcoid

• Renal Cell
• Melanoma
• Breast
• GU Tumors

• Hypersensitivity Pneumonitis
• RB-ILD
• TB/Atypical Infection
• LIP
• Sarcoid

• Sarcoid
• Lymphangitic Carcinomatosis
• Lymphoma
• Kaposi's Sarcoma
• Plus Tree-In-Bud DDx

• Carcinoid
• Adenoid Cystic CA
• Mucoepidermoid CA
• Papilloma
• Fibrous tumors
• Leiomyomas
• Neurofibromas
• SCC (trachea)

• Breast
• Renal
• Melanoma

• Immune-mediated
  • antiglomerular basement membrane antibody disease (Goodpasture syndrome)
  • systemic lupus erythematosus (SLE)
  • Wegener granulomatosis
  • immune complex disease
  • polyarteritis nodosa
  • rheumatoid arthritis
  • Henoch-Schonlein purpura
• Non-immune
  • idiopathic pulmonary hemorrhage (IPH)
  • coagulopathies
  • drugs (penicillamine)

• Pulmonary Neoplasm (Benign or Malignant)
• Chronic Infection (CF, TB)
• R → L Shunt
• Congenital Heart Disease

• Lung
• Breast
• Melanoma
• Lymphoma

• Lung
• Breast
• Gastric
• Pancreatic
• Esophageal

• LV failure
• mitral valve dz
• pulmonary venous occlusion
• pericardial dz
• beta blockers

• Renal Failure
• Fat Emboli
• Neurogenic
• Sepsis
• Volume Overload
• Hypoproteinemia
• Increased Capillary Permeability
  • Aspiration
  • Near-drowning
  • Anaphylaxis

• COPD (saber sheath trachea)
• radiation Δ
• Tracheobronchopathia Osteochondroplastica
• Relapsing Polychondritis
• Tracheomalacia

• COP
• Eosinophilic PNA
• Lymphoma
• Bronchioloalveolar CA

• Hemorrhagic Mets
  • Kaposi's
  • Renal Cell
  • Choriocarcinoma
• Invasive Aspergillus

• Benign
  • Lipoma
  • Fibrous Tumor of Pleura
  • Desmoid
  • Hemangioma
  • Pleural Plaque (i.e. asbestos related pleural disease)
  • Trauma with hematoma
• Malignant
  • Mets
  • Chondrosarcoma
  • Liposarcoma
  • Leiomyosarcoma
  • MFH/Fibrosarcoma
  • Neurogenic Tumors
• Infectious
  • Staph
  • TB
  • Actinomycosis
  • Nocardia

• Pulmonary Sling → L pulm art travels behind trachea
• Right Arch w/ Aberrant L Subclavian

Perform expiratory CT → Is there air trapping?

• Yes → Small Airway Disease (CHABB)
  • Cystic Fibrosis
  • Hypersensitivity Pneumonitis
  • Asthma
  • Bronchiolitis
  • Bronchiolitis Obliterans/Obliterative Bronchiolitis
• No → Compare Vessel Disease
  • Equal → Ground Glass Abnormal
    • Hemorrhage
    • PCP
    • NSIP/DIP
    • Hypersensitivity Pneumonitis
    • Edema
    • ARDS
    • Bronchioloalveolar CA
    • Pulmonary Alveolar Proteinosis
  • Ground Glass Vessels Large/Dark Vessels Small → Dark Areas Abnormal
    • Chronic PE
    • Pulmonary HTN

• Solitus = normal
• Inversus = everything inverted; asymptomatic
• Ambiguous = L cardiac apex, R stomach

• Multiple spleens
• Bilateral L-sidedness
• No IVC; azygous continuation

• No spleen
• Bilateral R-sidedness
• Bilateral liver

• Interlobular Septa = Kerley B lines
• Intralobular Septa = reticular lines
• Shaggy Heart Sign = Interstitial Lung Disease
• Semisolid Lesion suggests Bronchioloalveolar CA
• Aortic Nipple = L Superior Intercostal Vein
• Azygous Line Placement = High Risk of Rupture
• Luftsickle Sign = LUL Collapse
  • lucent crescent representing SS LLL
• Abnormal Rotation of Heart → Think Congenital Absence of Pericardium
• Don't forget the relationship b/w osteosarcoma mets and PTX

• Cylindrical → bronchi are minimally dilated and straight and regular
  • CXR will show tram tracking or ring shadows in the distribution of bronchi
• Varicose → string of pearls, with alternating dilation and narrowing
• Cystic → a cluster of cysts ± air fluid levels

• BAC
• mucinous tumors
• GI mets

• begins w/ large, focal, ill-defined opacity
• progresses to bilateral lung involvement w/i first few days
• pleural effusion may be present (30-60%)
• cavitation and lymphadenopathy are rare

• acute → lower lobe consolidation
• subacute → upper lobe nodules
• chronic → upper lobe interstitial fibrosis

• Smoking
• Chronic Fibrosis
• XRT

• Associated with ESRD
• Looks like edema on CXR
• MDP bone scan shows extensive uptake

• also known as chronic fibrosis, fibrosing mediastinitis, chronic mediastinal fibrosis, or cryptogenic mediastinal fibrosis
• histoplasmosis is the most common cause
• can cause SVC obstruction

• Eosinophilia
• Severe Asthma
• Systemic Vasculitis

• Triad of
  1. Chronic liver disease
  2. Increased alveolar-arterial oxygen gradient on room air
  3. Intrapulmonary arteriovenous shunting

• pulmonary chondroma
• gastric leiomyosarcoma
• extra-adrenal paraganglioma

• pulmonary and GI hamartomas
• multiple mucocutaneous lesions

Tumor

• T1 <3 cm, limited to lung
• T2 >3 cm, >2 cm distal to carina
• T3 any size, direct extension into chest wall, superior sulcus, diaphragm, pleura, pericardium, or within 2 cm of carina
• T4 mediastinal (heart, great vessels, esophagus), carinal, brachial plexus, vertebral body invasion or malignant pleural effusion → unresectable

Nodes

• N0 no LN involvement
• N1 ipsilateral hilar nodes
• N2 ipsilateral mediastinal or subcarinal nodes
• N3 contralateral hilar or mediastinal nodes; supraclavicular nodes → unresectable

Mets

• M0 none
• M1 distant mets → unresectable

Important Stages

• Tumor unresectable if T4, N3, or M1
• Stage 3b
  • N3, M0, any T
  • T4, M0, any N
• Stage 4
  • M1, any T, any N

Fleischner Society Criteria

• Microlobulated or spiculated margins
• Bubbly or cystic lucencies; air bronchograms
• Mixed ground glass/solid attenuation; subsolid (mixed attenuation)
• Airway component
• Relatively rapid growth

* Recommend biopsy or resection in pts with moderate to high risk of lung CA or solitary metastasis