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Chapter 02_32_58_F 2/20/06 2:36 PM Page 33 2 Chest Radiology Includes plain film diagnosis, CT, MRI, and interventional techniques used in the diagnosis of diseases of the lungs, pleura, and mediastinum including the heart and great vessels. LYMPHANGITIC CARCINOMATOSIS “CERTAIN CANCERS SPREAD BY PLUGGING THE LYMPHATICS” Cervix Colon Stomach Breast Pancreas Thyroid Larynx From: Radiology: The Oral Boards Primer By: A. Mehta and D. P. Beall © Humana Press Inc., Totowa, NJ 33 Chapter 02_32_58_F 2/20/06 2:36 PM Page 34 34 Radiology: The Oral Boards Primer BRONCHIOLITIS OBLITERANS CRITTERS COP/BOOP Rheumatoid Infectious-Swyer James Transplant Toxins Sarcoid MULTIPLE NODULES OR MASS >3 CM DAYS OF THE WEEK: MTWTFSS Mets/Carcinoma/Lymphoma TB/granuloma Wegeners Rheumatoid nodules/Round pneumonia Fungal Sarcoid Septic pulmonary emboli Chapter 02_32_58_F 2/20/06 2:36 PM Page 35 Chapter 2 / Chest Radiology COIN LESION <3 CM CHANGE Carcinoma/Congenital Hamartoma/Hematoma AVM/Abscess Neoplasm–mets Granuoma Esoteric-TB pneumonia 35 Chapter 02_32_58_F 2/20/06 2:36 PM Page 36 36 Radiology: The Oral Boards Primer A CT scan should be done to assess: Ca2+ pattern Benign: solid, lamellated, central Malignant: stippled, any other pattern. Density: fat - Hamartoma Margins: Spiculated suggestive of carcinoma Enhancement Four 1-min images >15HU suggestive Growth CAVITY CAVITY Carcinoma-SCC Abscess-fungal/bacterial/TB Vascular-septic emboli Inflammatory-rheumatoid nodule Trauma-resolving contusion Young-bronchogenic cyst Chapter 02_32_58_F 2/20/06 2:36 PM Chapter 2 / Chest Radiology CAVITY (continued) Page 37 37 Chapter 02_32_58_F 2/20/06 2:36 PM Page 38 38 Radiology: The Oral Boards Primer BRONCHOVASCULAR SPREAD SKILL Sarcoid Kaposi Infection–PCP/TB Lymphoma Lymphagitic spread UNILATERAL HYPERLUCENT LUNG POEMS Poland syndrome/Pneumothorax Oligemia/Obstruction (PE) Emphysema Mastectomy Swyer James Chapter 02_32_58_F 2/20/06 2:36 PM Page 39 Chapter 2 / Chest Radiology ACUTE INTERSTITIAL DISEASE (RETICULAR) HELP Hypersensitivity pneumonitis Edema-Inhalation injuries Lymphoproliferative Pneumonia-atypicals, PCP 39 Chapter 02_32_58_F 2/20/06 2:36 PM Page 40 40 Radiology: The Oral Boards Primer CHRONIC INTERSTITIAL DISEASE (RETICULAR) PAGE CHUCK AT THE CIA RIGHT NOW, THERE’S DRUGS UPPER LUNG ZONES Pneumoconiosis Ankylosing spondylitis Granulomatous Eosinophillic Sarcoid/Silicosis MID LUNG ZONES Chronic Hypersensitivity Chapter 02_32_58_F 2/20/06 2:36 PM Chapter 2 / Chest Radiology LOWER LUNG ZONES Collagen vascular disease IPF Asbestos Rheumatoid NF Drug toxicity Page 41 41 Chapter 02_32_58_F 2/20/06 2:36 PM Page 42 42 Radiology: The Oral Boards Primer ACUTE AIRSPACE DISEASE HELP LEGALIZE HEMP DIFFUSE Hemorrhage Edema Lymphoproliferative—esoteric Pneumonia FOCAL Hemorrhage-contusion/PE Edema-inhalation (crack) MI (RUL) Pneumonia Chapter 02_32_58_F 2/20/06 2:36 PM Page 43 Chapter 2 / Chest Radiology CHRONIC AIRSPACE DISEASE PEBBLES PAP/PCP/Pedema Eosinophillic pneumonia BAC BOOP Lymphoma Esoteric-Wegener’s/TB Sarcoid/Septic pulmonary emboli 43 Chapter 02_32_58_F 2/20/06 2:36 PM Page 44 44 Radiology: The Oral Boards Primer GROUND GLASS DIFFUSE OPACITY SHAKE YOUR HIPS IN BED Sarcoid Hypersensitivity—smokers Infection Pneumonitis—DIP Scleroderma/CVD BOOP Edema/aspiration Drug toxicitiy CENTRAL OPACITIES EXTENDING FROM THE HILA OUTWARDS PPPP PAP Pulmonary edema PCP Pneumonia–atypical/influenza Chapter 02_32_58_F 2/20/06 2:36 PM Page 45 Chapter 2 / Chest Radiology MIDDLE MEDIASTINAL MASS HABIT Hernia, Hematoma Aneurysm Bronchogenic cyst/duplication cyst Inflammation (sarcoidosis, histoplasmosis, coccidioidomycosis, primary TB in children) Tumors–remember the five Ls: Lung, especially oat cell Lymphoma Leukemia Leiomyoma Lymph node hyperplasia 45 Chapter 02_32_58_F 2/20/06 2:36 PM 46 Page 46 Radiology: The Oral Boards Primer RETICULAR (CXR)/CYSTIC OPACITIES (CT) ELECT CHIP EG LAM Emphysema CF TS Coccidiomycosis Hydrocarbon Infectious PCP Chapter 02_32_58_F 2/20/06 2:36 PM Page 47 Chapter 2 / Chest Radiology FINGER IN GLOVE OPACITIES CACACA CF Asthma Congential bronchial atresia ABPA Cancer AVM 47 Chapter 02_32_58_F 2/20/06 2:36 PM 48 Page 48 Radiology: The Oral Boards Primer CRAZY PAVING (CT) ACUTE Edema Hemorrhage CHRONIC PAP Sarcoid PCP Fibrosis Chapter 02_32_58_F 2/20/06 2:36 PM Page 49 Chapter 2 / Chest Radiology END-STAGE LUNG (CXR)— ARCHITECTURAL DESTRUCTION TESSA TB EG Sarcoid Silicosis ARDS—The sequela of 49 Chapter 02_32_58_F 2/20/06 2:36 PM Page 50 50 Radiology: The Oral Boards Primer CA2+ NODULES MASH POX Metastatic disease Alveolar microlithiasis Silicosis/siderosis Histoplasmosis Pox (Varicella) TREE IN BUD OPACITIES (CT) MIT Mucous plugging: Aspiration/Kartageners Inflammatory plugging (PUS): TB/MAI Tumor emboli (rare) Chapter 02_32_58_F 2/20/06 2:36 PM Chapter 2 / Chest Radiology NODULES (CT) DIFFUSE MISSLE Mets Infection Sarcoid Silicosis Lymphoma EG Page 51 51 Chapter 02_32_58_F 2/20/06 2:36 PM Page 52 52 Radiology: The Oral Boards Primer PERILYMPHATIC A SKILL Amyloid Sarcoid Kaposi’s Infection (PCP) Lymphoma Lymphang carcinomatosis Chapter 02_32_58_F 2/20/06 2:36 PM Page 53 Chapter 2 / Chest Radiology CENTRILOBULAR HERB HAS GAS Hypersen pneumonitis EG RB-ILD BAC/BOOP GVHD VASculitis 53 Chapter 02_32_58_F 2/20/06 2:36 PM Page 54 54 Radiology: The Oral Boards Primer BRONCHIECTASIS CAPT KANGAROO HAS MOUNIER KUHN Cystic fibrosis ABPA Postinfectious TB Kartagener’s Mounier Kuhn Chapter 02_32_58_F 2/20/06 2:36 PM Page 55 Chapter 2 / Chest Radiology TRACHEAL NEOPLASMS Multiple TRAM Tracheobronchopathia Relapsing polychondritis Metsastasis Single MATCH Mucoepidermoid Adenoid cystic Tracheal SCC Carcinoid Hamartoma 55 Chapter 02_32_58_F 2/20/06 2:36 PM Page 56 56 Radiology: The Oral Boards Primer Cardiac CARDIOMYOPATHY RESTRICTIVE Sarcoid Hemochromatosis Amyloid Endocardial fibroelastosis HYPERTROPHIC Obstructive Nonobstructive Chapter 02_32_58_F 2/20/06 2:36 PM Chapter 2 / Chest Radiology Dilated PERICARDIUM Page 57 57 Chapter 02_32_58_F 2/20/06 2:36 PM 58 Page 58 Radiology: The Oral Boards Primer CA2+ Uremic Viral TB Prior hemorrhage