Nick's Chest Mnemonics
Upper Lobe Interstitial Disease (RadioCASSET)
Lower Lobe Interstitial Disease (BADAS RIDL)
Upper Lobe Predominant Fibrosis
Sarcoidosis
Silicosis/Coal Worker's Pneumoconiosis
Idiopathic pleuroparenchymal fibroelastosis
Familial pulmonary fibrosis
Hypersensitivity pneumonitis
Ground glass
Air trapping
Exposure history
Lower Lobe Predominant Fibrosis
Aspiration (mimic)
Ground-glass or consolidation
Often dependent
May be peribronchovascular
Transient bronchial dilation
Usual interstitial pneumonitis/Idiopathic pulmonary fibrosis
Diffuse pulmonary hemorrhage
Nonspecific interstitial pneumonitis
Organizing pneumonia (not cryptogenic)
Collagen Vascular Disease Patterns in Interstiital Lung Disease
Patterns | Rheumatoid | Scleroderma | PM/DM | Sjogren |
UIP | ++ | ++ | + | + |
NSIP | + | ++++ | ++ | + |
Organizing Pneumonia | ++ | + | ++ | - |
Obliterative Bronchiolitis | ++ | - | - | - |
Bronchiectasis | ++ | - | - | ++ |
LIP | - | - | - | +++ |
Cysts (LEP LIP)
Bronchiectasis (CIT KAM)
Patchy Peripheral Airspace Disease (RRECH DB)
Resolving Edema
Resolving Multifocal PNA
Eosinophilic Pneumonia/Loffler's
COP (has peripheral clear zone)
Hypersensitivity Pneumonitis
Drug Toxicity
Bronchioloalveolar CA
Cavitary Lesions (CAVITY)
Carcinoma (SCC, colon, TCC, sarcoma, melanoma, cervical)
Autoimmune (Rheumatoid, Wegeners)
Vascular
Infection (abscess, fungal, TB, echinococcus)
Trauma
Young (congenital)
Crazy Paving (PEPPAH)
Miliary Pattern (FAT SPAM)
Pleural Mets (GIBT)
GI Adenocarcinomas
Breast
Thymoma
Other Differentials
Chronic Patchy Consolidation
Tree-In-Bud
Reverse Batwing
Loffler's
Parasitic Infection
Air Crescent Sign
Aspergilloma
Echinococcus
Honeycombing
Unilateral Pulmonary Edema
Colon
Sarcomas
Renal Cell
Testicular
Breast
Melanoma
Cannonball Lesions
Mets Causing Bilateral Hilar Adenopathy
Renal Cell
Melanoma
Breast
GU Tumors
Centrilobular Nodules
Peribronchovascular Nodules
Endobronchial Masses
Carcinoid
Adenoid Cystic CA
Mucoepidermoid CA
Papilloma
Fibrous tumors
Leiomyomas
Neurofibromas
SCC (trachea)
Endobronchial Mets
Causes of Diffuse Pulmonary Hemorrhage
Immune-mediated
Non-immune
Causes of Hypertrophic Pulmonary Osteoarthropathy
Cardiac Mets
Lung
Breast
Melanoma
Lymphoma
Lymphangitic Mets
Lung
Breast
Gastric
Pancreatic
Esophageal
Causes of Pulmonary Edema
Cardiogenic
Non-cardiogenic
Diffuse Tracheal Narrowing
Chronic Consolidation
COP
Eosinophilic PNA
Lymphoma
Bronchioloalveolar CA
Halo Sign
Hemorrhagic Mets
Kaposi's
Renal Cell
Choriocarcinoma
Invasive Aspergillus
Chest Wall Mass
Benign
Malignant
Mets
Chondrosarcoma
Liposarcoma
Leiomyosarcoma
MFH/Fibrosarcoma
Neurogenic Tumors
Infectious
Staph
TB
Actinomycosis
Nocardia
Vascular Rings
Approach to Mosaic Lung Attenuation
Perform expiratory CT → Is there air trapping?
Situs
Polysplenia
Asplenia
No spleen
Bilateral R-sidedness
Bilateral liver
Facts
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
Abnormal Rotation of Heart → Think Congenital Absence of Pericardium
Don't forget the relationship b/w osteosarcoma mets and PTX
Types of Bronchiectasis
Cylindrical → bronchi are minimally dilated and straight and regular
Varicose → string of pearls, with alternating dilation and narrowing
Cystic → a cluster of cysts ± air fluid levels
False Negative Tumors on PET
BAC
mucinous tumors
GI mets
Diseases
Legionella Pneumonia
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
Hypersensitivity Pneumonitis
acute → lower lobe consolidation
subacute → upper lobe nodules
chronic → upper lobe interstitial fibrosis
Causes of Emphysema
Smoking
Chronic Fibrosis
XRT
also known as chronic fibrosis, fibrosing mediastinitis, chronic mediastinal fibrosis, or cryptogenic mediastinal fibrosis
histoplasmosis is the most common cause
can cause SVC obstruction
Churg-Strauss
Eosinophilia
Severe Asthma
Systemic Vasculitis
Hepatopulmonary Syndrome
Triad of
Chronic liver disease
Increased alveolar-arterial oxygen gradient on room air
Intrapulmonary arteriovenous shunting
Carney's Triad
Cowden's Disease
Lung Cancer Staging
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
Important Stages
Recommended Followup for Pulmonary Nodules
Fleischner Society Criteria
Nodule Size | Low-Risk Patient | High-Risk Patient |
< 4 mm | No follow-up needed | Follow-up CT at 12 mo; if unchanged, no further follow-up |
4-6 mm | Follow-up CT at 12 mo; if unchanged, no further follow-up | Initial follow-up CT at 6-12 mo then at 18-24 mo if no change |
6-8 mm | Initial follow-up CT at 6-12 mo then at 18-24 mo if no change | Initial follow-up CT at 3-6 mo then at 9-12 and 24 mo if no change |
> 8 mm | Follow-up CT at around 3, 9, and 24 mo, dynamic contrast enhanced CT, PET, and/or biopsy | Same as for low-risk patient |
Features of Solitary Pulmonary Nodules suspicious for malignancy
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