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chest [2017/07/07 18:30] (current)
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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)/​Dermatomyositis
 +  * Asbestosis
 +  * Scleroderma
 +  * Rheumatoid
 +  * IPF
 +  * DIP
 +  * Lymphangitic Carcinomatosis
 +
 +
 +===== Upper Lobe Predominant Fibrosis =====
 +  * 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
 +
 +
 +
 +
 +===== Lower Lobe Predominant Fibrosis =====
 +  * 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
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +===== Collagen Vascular Disease Patterns in Interstiital Lung Disease =====
 +
 +^Patterns^Rheumatoid^Scleroderma^PM/​DM^Sjogren^
 +|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,​ the chest guys like that) - bizarre cysts w/ small nodules
 +  * PCP
 +  * LIP
 +  * IPF (honeycombing)
 +  * Papillomatosis
 +
 +===== Bronchiectasis (CIT KAM) =====
 +  * 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
 +
 +===== 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) =====
 +  * 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/​Fungal Infection
 +  * ABPA
 +  * Aspiration
 +  * Atypical Mycobacteria
 +  * Mycoplasma
 +
 +===== Reverse Batwing =====
 +  * Loffler'​s
 +  * 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'​s Sarcoma
 +  * 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'​s
 +    * 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/​Fibrosarcoma
 +    * 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/​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
 +
 +====== 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,​ 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 =====
 +  * pulmonary chondroma
 +  * gastric leiomyosarcoma
 +  * extra-adrenal paraganglioma
 +===== Cowden'​s Disease =====
 +  * 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,​ 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
 +
 +====== 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
chest.txt · Last modified: 2017/07/07 18:30 (external edit)