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— | chest [2017/07/07 18:30] (current) – created - external edit 127.0.0.1 | ||
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+ | ====== Nick's Chest Mnemonics ====== | ||
+ | ===== Upper Lobe Interstitial Disease (RadioCASSET) ===== | ||
+ | * XRT | ||
+ | * Cystic Fibrosis | ||
+ | * Ankylosing Spondylitis | ||
+ | * Silicosis | ||
+ | * Sarcoid | ||
+ | * EG | ||
+ | * Tuberculosis - post 1°, not miliary (miliary is lower lobe) | ||
+ | |||
+ | |||
+ | ===== Lower Lobe Interstitial Disease (BADAS RIDL) ===== | ||
+ | * Bronchiectasis | ||
+ | * Aspiration | ||
+ | * Drugs (Ritalin, Bleomycin)/ | ||
+ | * Asbestosis | ||
+ | * Scleroderma | ||
+ | * Rheumatoid | ||
+ | * IPF | ||
+ | * DIP | ||
+ | * Lymphangitic Carcinomatosis | ||
+ | |||
+ | |||
+ | ===== Upper Lobe Predominant Fibrosis ===== | ||
+ | * Sarcoidosis | ||
+ | * Upper lung perilymphatic nodules | ||
+ | * Interlobular | ||
+ | * Peribronchial | ||
+ | * Coalescent masses secondary to fibrosis | ||
+ | * Silicosis/ | ||
+ | * 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 | ||
+ | |||
+ | |||
+ | |||
+ | |||
+ | ===== Lower Lobe Predominant Fibrosis ===== | ||
+ | * Aspiration (mimic) | ||
+ | * Ground-glass or consolidation | ||
+ | * Often dependent | ||
+ | * May be peribronchovascular | ||
+ | * Transient bronchial dilation | ||
+ | * Usual interstitial pneumonitis/ | ||
+ | * 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 | ||
+ | |||
+ | |||
+ | |||
+ | |||
+ | |||
+ | |||
+ | |||
+ | |||
+ | |||
+ | |||
+ | ===== Collagen Vascular Disease Patterns in Interstiital Lung Disease ===== | ||
+ | |||
+ | ^Patterns^Rheumatoid^Scleroderma^PM/ | ||
+ | |UIP|++|++|+|+| | ||
+ | |NSIP|+|++++|++|+| | ||
+ | |Organizing Pneumonia|++|+|++|-| | ||
+ | |Obliterative Bronchiolitis|++|-|-|-| | ||
+ | |Bronchiectasis|++|-|-|++| | ||
+ | |LIP|-|-|-|+++| | ||
+ | |||
+ | * Obliterative Bronchiolitis | ||
+ | * Air trapping | ||
+ | * Mosaic attenuation | ||
+ | * Bronchial wall thickening and dilation | ||
+ | * Lymphocytic Interstitial Pneumonitis | ||
+ | * Peribronchovascular cysts | ||
+ | * Pericystic dots | ||
+ | |||
+ | ===== Cysts (LEP LIP) ===== | ||
+ | * LAM - uniform cysts | ||
+ | * EG (Call it Langerhans Cell Histiocytosis, | ||
+ | * PCP | ||
+ | * LIP | ||
+ | * IPF (honeycombing) | ||
+ | * Papillomatosis | ||
+ | |||
+ | ===== Bronchiectasis (CIT KAM) ===== | ||
+ | * Cystic Fibrosis | ||
+ | * Immunodeficiency | ||
+ | * The most common congenital conditions involve B-lymphocyte functions—specifically, | ||
+ | * Traction | ||
+ | * Associated with pulmonary fibrosis | ||
+ | * Kartagener' | ||
+ | * ABPA | ||
+ | * Mournier-Kuhn/ | ||
+ | * Others | ||
+ | * Infection: Typical organisms include Klebsiella species, Staphylococcus aureus, Mycobacterium tuberculosis, | ||
+ | * Bronchial obstruction: | ||
+ | * 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 | ||
+ | |||
+ | ===== Patchy Peripheral Airspace Disease (RRECH DB) ===== | ||
+ | * Resolving Edema | ||
+ | * Resolving Multifocal PNA | ||
+ | * Eosinophilic Pneumonia/ | ||
+ | * COP (has peripheral clear zone) | ||
+ | * Hypersensitivity Pneumonitis | ||
+ | * Drug Toxicity | ||
+ | * Bronchioloalveolar CA | ||
+ | |||
+ | ===== Cavitary Lesions (CAVITY) ===== | ||
+ | * Carcinoma (SCC, colon, TCC, sarcoma, melanoma, cervical) | ||
+ | * Autoimmune (Rheumatoid, | ||
+ | * Vascular | ||
+ | * Infection (abscess, fungal, TB, echinococcus) | ||
+ | * Trauma | ||
+ | * Young (congenital) | ||
+ | |||
+ | ===== Crazy Paving (PEPPAH) ===== | ||
+ | * Pulmonary Alveolar Proteinosis | ||
+ | * Edema | ||
+ | * PCP | ||
+ | * Pneumonia | ||
+ | * ARDS | ||
+ | * Hemorrhage | ||
+ | |||
+ | ===== Miliary Pattern (FAT SPAM) ===== | ||
+ | * Fungal | ||
+ | * Amyloid | ||
+ | * TB | ||
+ | * Sarcoid | ||
+ | * Pneumoconiosis | ||
+ | * Alveolar Microlithiasis | ||
+ | * Mets (ThRAB - thyroid, renal cell, any adenoCA, breast) | ||
+ | ===== Pleural Mets (GIBT) ===== | ||
+ | * GI Adenocarcinomas | ||
+ | * Breast | ||
+ | * Thymoma | ||
+ | |||
+ | ====== Other Differentials ====== | ||
+ | ===== Chronic Patchy Consolidation ===== | ||
+ | * BAC | ||
+ | * Lymphoma | ||
+ | * Eosinophilic Pneumonia | ||
+ | * COP | ||
+ | * Sarcoid | ||
+ | * Infarct | ||
+ | * Metastatic Pulmonary Calcification | ||
+ | * TB | ||
+ | * Lipoid Pneumonia | ||
+ | * Pulmonary Alveolar Proteinosis | ||
+ | |||
+ | ===== Tree-In-Bud ===== | ||
+ | * Endobronchial Spread of Infection (esp TB) | ||
+ | * Bronchiolitis | ||
+ | * Viral/ | ||
+ | * ABPA | ||
+ | * Aspiration | ||
+ | * Atypical Mycobacteria | ||
+ | * Mycoplasma | ||
+ | |||
+ | ===== Reverse Batwing ===== | ||
+ | * Loffler' | ||
+ | * Parasitic Infection | ||
+ | ===== Air Crescent Sign ===== | ||
+ | * Aspergilloma | ||
+ | * Echinococcus | ||
+ | ===== Honeycombing ===== | ||
+ | * IPF | ||
+ | * Collagen Vascular Disease | ||
+ | * Asbestosis | ||
+ | * Drugs | ||
+ | |||
+ | ===== Unilateral Pulmonary Edema ===== | ||
+ | * Reexpansion Edema | ||
+ | * Gravity | ||
+ | * Mass Obstructing Pulmonary Veins | ||
+ | * Large Contralateral PE | ||
+ | |||
+ | ===== Solitary Pulmonary Metastasis ===== | ||
+ | * Colon | ||
+ | * Sarcomas | ||
+ | * Renal Cell | ||
+ | * Testicular | ||
+ | * Breast | ||
+ | * Melanoma | ||
+ | ===== Cannonball Lesions ===== | ||
+ | * Mets | ||
+ | * Renal Cell | ||
+ | * Lymphoma | ||
+ | * Sarcoid | ||
+ | |||
+ | ===== Mets Causing Bilateral Hilar Adenopathy ===== | ||
+ | * Renal Cell | ||
+ | * Melanoma | ||
+ | * Breast | ||
+ | * GU Tumors | ||
+ | |||
+ | |||
+ | |||
+ | ===== Centrilobular Nodules ===== | ||
+ | * Hypersensitivity Pneumonitis | ||
+ | * RB-ILD | ||
+ | * TB/Atypical Infection | ||
+ | * LIP | ||
+ | * Sarcoid | ||
+ | |||
+ | ===== Peribronchovascular Nodules ===== | ||
+ | * Sarcoid | ||
+ | * Lymphangitic Carcinomatosis | ||
+ | * Lymphoma | ||
+ | * Kaposi' | ||
+ | * Plus Tree-In-Bud DDx | ||
+ | |||
+ | |||
+ | ===== Endobronchial Masses ===== | ||
+ | * Carcinoid | ||
+ | * Adenoid Cystic CA | ||
+ | * Mucoepidermoid CA | ||
+ | * Papilloma | ||
+ | * Fibrous tumors | ||
+ | * Leiomyomas | ||
+ | * Neurofibromas | ||
+ | * SCC (trachea) | ||
+ | |||
+ | ===== Endobronchial Mets ===== | ||
+ | * Breast | ||
+ | * Renal | ||
+ | * Melanoma | ||
+ | |||
+ | ===== Causes of Diffuse Pulmonary Hemorrhage ===== | ||
+ | * 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) | ||
+ | ===== Causes of Hypertrophic Pulmonary Osteoarthropathy ===== | ||
+ | * Pulmonary Neoplasm (Benign or Malignant) | ||
+ | * Chronic Infection (CF, TB) | ||
+ | * R -> L Shunt | ||
+ | * Congenital Heart Disease | ||
+ | |||
+ | ===== Cardiac Mets ===== | ||
+ | * Lung | ||
+ | * Breast | ||
+ | * Melanoma | ||
+ | * Lymphoma | ||
+ | |||
+ | ===== Lymphangitic Mets ===== | ||
+ | * Lung | ||
+ | * Breast | ||
+ | * Gastric | ||
+ | * Pancreatic | ||
+ | * Esophageal | ||
+ | |||
+ | ===== Causes of Pulmonary Edema ===== | ||
+ | ==== Cardiogenic ==== | ||
+ | * LV failure | ||
+ | * mitral valve dz | ||
+ | * pulmonary venous occlusion | ||
+ | * pericardial dz | ||
+ | * beta blockers | ||
+ | ==== Non-cardiogenic ==== | ||
+ | * Renal Failure | ||
+ | * Fat Emboli | ||
+ | * Neurogenic | ||
+ | * Sepsis | ||
+ | * Volume Overload | ||
+ | * Hypoproteinemia | ||
+ | * Increased Capillary Permeability | ||
+ | * Aspiration | ||
+ | * Near-drowning | ||
+ | * Anaphylaxis | ||
+ | |||
+ | ===== Diffuse Tracheal Narrowing ===== | ||
+ | * COPD (saber sheath trachea) | ||
+ | * radiation Δ | ||
+ | * Tracheobronchopathia Osteochondroplastica | ||
+ | * Relapsing Polychondritis | ||
+ | * Tracheomalacia | ||
+ | |||
+ | ===== Chronic Consolidation ===== | ||
+ | * COP | ||
+ | * Eosinophilic PNA | ||
+ | * Lymphoma | ||
+ | * Bronchioloalveolar CA | ||
+ | |||
+ | ===== Halo Sign ===== | ||
+ | * Hemorrhagic Mets | ||
+ | * Kaposi' | ||
+ | * Renal Cell | ||
+ | * Choriocarcinoma | ||
+ | * Invasive Aspergillus | ||
+ | |||
+ | ===== Chest Wall Mass ===== | ||
+ | * 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/ | ||
+ | * Neurogenic Tumors | ||
+ | * Infectious | ||
+ | * Staph | ||
+ | * TB | ||
+ | * Actinomycosis | ||
+ | * Nocardia | ||
+ | |||
+ | ===== Vascular Rings ===== | ||
+ | * Pulmonary Sling -> L pulm art travels behind trachea | ||
+ | * Right Arch w/ Aberrant L Subclavian | ||
+ | |||
+ | |||
+ | ====== Approach to Mosaic Lung Attenuation ====== | ||
+ | Perform expiratory CT -> Is there air trapping? | ||
+ | * Yes -> Small Airway Disease (CHABB) | ||
+ | * Cystic Fibrosis | ||
+ | * Hypersensitivity Pneumonitis | ||
+ | * Asthma | ||
+ | * Bronchiolitis | ||
+ | * Bronchiolitis Obliterans/ | ||
+ | * 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 | ||
+ | |||
+ | ====== Situs ====== | ||
+ | * Solitus = normal | ||
+ | * Inversus = everything inverted; asymptomatic | ||
+ | * Ambiguous = L cardiac apex, R stomach | ||
+ | ===== Polysplenia ===== | ||
+ | * Multiple spleens | ||
+ | * Bilateral L-sidedness | ||
+ | * No IVC; azygous continuation | ||
+ | ===== Asplenia ===== | ||
+ | * No spleen | ||
+ | * Bilateral R-sidedness | ||
+ | * Bilateral liver | ||
+ | |||
+ | ====== Facts ====== | ||
+ | * Int__er__lobular Septa = Kerley B lines | ||
+ | * Int__ra__lobular 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 | ||
+ | ===== Types of Bronchiectasis ===== | ||
+ | * 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 | ||
+ | |||
+ | |||
+ | |||
+ | |||
+ | ===== 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 | ||
+ | |||
+ | ===== Metastatic Pulmonary Calcification ===== | ||
+ | * Associated with ESRD | ||
+ | * Looks like edema on CXR | ||
+ | * MDP bone scan shows extensive uptake | ||
+ | |||
+ | ===== Mediastinal Fibrosis ===== | ||
+ | * also known as chronic fibrosis, fibrosing mediastinitis, | ||
+ | * 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' | ||
+ | * pulmonary chondroma | ||
+ | * gastric leiomyosarcoma | ||
+ | * extra-adrenal paraganglioma | ||
+ | ===== Cowden' | ||
+ | * pulmonary and GI hamartomas | ||
+ | * multiple mucocutaneous lesions | ||
+ | |||
+ | ====== 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, | ||
+ | * 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 | ||
+ | |||
+ | ====== 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; | ||
+ | * Airway component | ||
+ | * Relatively rapid growth | ||
+ | * Recommend biopsy or resection in pts with moderate to high risk of lung CA or solitary metastasis |
chest.txt · Last modified: 2017/07/07 18:30 by 127.0.0.1