Download - Resp Spotters p.singh
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Sarcoid granulomas are the hall mark of this disease .
Distributed primarily along the lymphatics in (most helpful in making apathologic diagnosis)
-peri bronchovascular interstitial space (both in perihilar region and lobularcore)
-interlobular septa Subpleural interstitial space
CXR-
Symmetric,bilateral hilar and paratracheal lymphadenopathy with or withoutconcomitant parenchymal abnormalities(60-70%)
HRCT-1) Small nodules in perilymphatic distribution,visible in relation to:
peribronchovascular regions adjacent to perihilar vessels and bronchi,fissures, subpleural regions, interlobular septa, centrilobular regions.
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upper lobe predominance is common.2) nodular thickening of perihilar and PBV interstitium
3) subpleural nodules-typical of sarcoidosis
4) irregular or nodular interlobular septal thickening-apparent in majority
5) Centrilobular nodules
6) Confluence of granulomas large opacities suggestive of frank consolidation
7) patchy areas of ground glass opacities superimposed on a background ofinterstitial nodules or fibrosis
8) regular or nodular bronchial wall thickening and bronchial luminalabnormalities
9) Few patients-mosaic perfusion on inspiratory HRCT notedAir trapping on expiratory HRCT due to endoluminal or submucosal sarcoidgranulomas or fibrotic obstruction of airways is more common.
10) Lymph node calcification not uncommon
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Chronic changes-
1) Fibrosis becomes prominent
2) Irregular reticular opacities (along the perihilar bronchovascular bundles) and
irregular septal thickening3) Most common early HRCT finding of fibrosis with lung destruction-posterior
displacement of main and upper lobe bronchi
Progressive fibrosis-masses of fibrous tissue ,more in upper lobes with tractionbronchiectasis
Honeycombing and lung cysts-less common
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D/D-
1)Pulmonary lymphangitic carcinomatosis
2)Silicosis
3)Coal workers pneumoconiosis
4)Berryliosis
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Unknown etiologyFamilial occurrence (50%)
Symptoms-progressive shortness of breath
Characterized by widespread intra-alveolar calcifications, representing microliths orcalcospheres
CXR-1) Fine micronodulation diffusely involving both lungs (sharply defined nodules
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HRCT-
1) Calcific nodules(< 1mm) , sometimes confluent seen predominantly along thecardiac borders and dorsal (posterior) portions of lower lung zones (insubpleural parenchyma and in association with bronchi and vessels)
Perilobular and centrilobular distribution of calcification seen
2) calcific interlobular septal thickening commonly noted
3) Intraparenchymal cysts and paraseptal emphysema
-in children and patients with early disease-ground glass opacity or reticulationmay be predominant finding (calcification inconspicuous)
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D/D of diffuse pulmonary calcification-
1)metastatic pulmonary calcification
2)renal failure
3)previous infection-varicella,histoplasmosis
4)pulmonary ossification in lung fibrosis
5)amyloidosis
6)sarcoidosis
7)pneumoconiosis
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Neuroendocrine tumors (< 5% of all pulmonary tumors)
TYPICAL CARCINOIDS ATYPICAL CARCINOIDS
- 85-90% 10-15%
- pneumonia, hemoptysis common rare
- arise centrally in main,lobar arise peripherally in the lungor segmental bronchi
-Predominantly intraluminal with a polypoid worse outcome
configuration, may grow within the lumen
of bronchus in a tooth-pastelike fashion
-Predom.extraluminal (ice-berg lesions)
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may secrete ACTH in sufficient quantities to cause cushings syndrome
CXR and CT-
- Majority arise in larger bronchi and cause partial or complete bronchialobstruction resulting in atelectasis
Tumor visible as a hilar mass in about 25% patients
- small tumors in lobar, segmental and sub segmental bronchi- cause mucusdistension of bronchi beyond obstruction (bronchocele) - dominant feature
-10-20% present as solitary pulmonary nodule - nodule is well defined, round,oval , lobulated or notched usually with smooth edge
- calcification or ossification CT helpful , more common in centrally located andlarger tumors
multiple nodular type or curvilinear
-marked Contrast enhancement
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**bronchial lumen can be seen to widen as it approaches the tumor(not seen inbronchial carcinoma)
MRI ( T2 wt or STIR seq) - helpful in small tumors which are difficult todistinguish from larger vessels
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Form of obliterative bronchiolitis commonly resulting from viral injury to thedeveloping lung (before the age of 8yrs)
Virus- adenovirus , measles virus
Nonviral causes- mycoplasma pneumoniae , pertusis
Non-infectious hydrocarbon ingestion
Reflects a combination of hypoplasia of pulmonary vasculature and obliterativebronchiolitis
CXR-1) Unilateral transradiancy (due to reduced lung perfusion)
Size and no. of mid lung and peripheral vessels are reduced on affected side
2) Contralateral plethoric lung (due to increased blood flow)
3) Small hilum on involved side (but lung volume is normal or only slightly decreased)
4) mediastinum- may show some shift to affected side
5) Ipsilateral air trapping- key finding
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CT-
More commonly shows bilateral abnormalities
1) Confirms unilateral transradiancy - transradiant regions are ofteninhomogenous, containing a patchwork of local decreased attenuation andhypovascular areas interspersed with lung of normal density
2) air-trapping
3) bronchiectasis- frequent finding
4) areas of collapse and scarring
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D/D-
1)Congenital hypoplastic lung
2)Congenital lobar emphysema
3)Pulmonary artery hypoplasia
4)Proximal interruption of pulmonary artery
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Common in potential blood- forming organs like liver, spleen and lymph nodes inpatients with anemia
Thoracic manifestations rare
usually consist ofparavertebral soft tissue
masses(caused by extrusion of marrow through the thinned cortex of theposterior ribs)
Pt. may be asymptomatic or paraplegia from cord compression
Common anemias resulting in EMH congenital hemolytic anemias-thalassemia,hereditary spherocytosis,sickle celldisease
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CXR-1) Focal paravertebral masses (usu. in lower of thorax) - masses are well marginated,
bilateral, contain no calcification, show no rib destruction
2) Foci of EMH can also be seen as subpleural masses adjacent to ribs - adjacent boneusually normal or shows findings of marrow expansion
CT
1) helpful in demonstrating lace-like marrow expansion in adjacent bones
2) heterogenous or homogenous soft tissue attenuation masses
some fat may be present within the mass
calcification uncommon
MRI-
1) masses are usually heterogenous
show increased signal intensity on T1 wt images
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Tuberculosis is one of the important causes of miliary nodulation of lung andprompt diagnoses and treatment are vital
Results from hematogenous dissemination of disease
RADIOGRAPHIC FINDINGS -
Widespread fine nodules , unifomly distributed and equal in size
As there is a threshold below which nodules are invisible , miliary TB can bepresent in patients with normal chest radiograph
More readily detected with HRCT and have a random distribution in relation tosecondary pulmonary lobule
Miliary TB does not leave residual calcification
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D/D OF MILIARY MOTTLING
1)Silicosis
2)Histoplasmosis
3)Metastases
4)Hemochromatosis
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Diagnostic criteria- Acute febrile illness of < 5 days duration
Hypoxemic respiratory failure
alveolar or alveolar / interstitial chest radiographic opacity
BAL eosinophil level of > 25% (key to diagnosis , greatly raised 30-80%) Prompt or complete response to steroids without relapse on withdrawl
Absence of parasitic , fungal and other infections
Av age at presentation-30 yrs
No gender predilection h/o asthma or atopy may or may not be present
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CXR-1) Shows mixed alveolar / interstitial pattern - bilateral
2) Septal thickening
3) Pleural effusion - 70% cases-bilateral more common than unilateral
(above findings seen in absence of clinical cardiac failure or overhydration)HRCT-
1) Areas of consolidation and ground glass opacity - 30% cases upper lungpredominance of parenchymal abnormalities
2) Thickened interlobular septa and bronchovascular bundles
3) pleural effusion - large or small
Survival with appropriate management is 100%
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Cryptogenic form of eosinophilic lung disease
3rd to 7th decade
F:M=2:1
50% pts are atopic, 40% asthmatics, 5-10% have allergic rhinitis and nasalpolyps
symptoms similar to TB
Blood eosinophilia-common(90%) but not universal
Sputum eosinophilia
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CXR-Peripheral, non-segmental homogenous consolidation sometimes with an air
bronchogram (classic pattern seen in 2/3rd pts)
Opacities lie against the chest wall and may surround the lung or just occupy oneor two zones particularly the apices
If they resolve they usually recur in the same place (i.e rarely truly migratory)Mixed peripheral and central consolidation-common pattern
CT-
Shows strikingly peripheral , multifocal consolidation or ground glass opacity
Pts scanned within 1 month of onset of symptoms: bilateral subpleuraldistribution
Pts scanned > 1 month after onset of symptoms: patchy consolidation withperipheral opacities (* but the subpleural zone is clear )
Dense bandlike structures parallel and about 1-2 cms deep to chest wall,whichmay traverse the fissures ( in more chronic cases and also in resolving phase )
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CHARACTERSTIC FEATURES- Blood eosinophilia
Absent or mild signs and symptoms
One or more fairly homogenous non-segmental pulmonary consolidations thatare transitory and/or migratory-tendency to be peripherally located
Spontaneous clearing of consolidations
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caused by failure of relaxation of lower esophageal sphincter resulting in esophagealdilatation
CXR-
1) Esophageal dilation is best appreciated on lateral chest x-ray, fluid - filled dilatedesophagus is seen to displace the trachea and carina forward
-When esophagus is dilated , it displaces the displaces the lung behind the right halfof trachea (forming posterior tracheal stripe), so the posterior tracheal stripeappears thickened on lateral chest radiograph
* if thickened post.tracheal stripe is seen in association with anterior bowing oftrachea and anterior displacement of carina (esophageal dilation can beconfidentally diagnosed )
2) Frontal radiograph - absence of air in in the expected location of stomachbubble
-Air-fluid level within the dilated esophagus is noted
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D/D OF ESOPHAGEAL DILATION-1) Motility disorders
2) Destruction of the myenteric plexus by the tumor at esophago gastricjunction- carcinoma esophagus , submucosal esophageal neoplasms like GIST,chest wall leiomyomas and leiomyosarcomas
3) Distal obstruction stricture , extrinsic compression
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Most common oppurtunistic infection in HIV infected patientsCXR-
1) diffuse bilateral or alveolar infiltrates or both (85% cases)
2) Fine to medium reticular or nodular opacities or ill-defined hazy consolidation(most characterstic appearance)
3) About 10% patients show air-filled cysts or pneumatoceles , typically involvingupper lobe
HRCT-* patchy or diffuse bilateral ground glass opacity
* consolidation
* thick-walled , irregular or septated cysts or cavities
centrilobular opacities
interlobular septal thickening
Small (centrilobular or diffuse) or large nodules (rare)
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Central , perihilar or upper lobe distribution
Pneumothorax related to cysts
Bronchiectasis or bronchilolectasis
Acute phase of PCP- scattered foci of ground glass opacities with septalthickening
Resolving disease or subacute infection- reticular opacities representingthickened interlobular septa and intralobular lines seen in association withground glass opacity (crazy-paving)
Chronic PCP- interstial fibrosis and honey-combing
* spontaneous pneumothorax in in AIDS pt is virtually diagnostic of pcp (may bethe first radiographic manifestation
* calcification is more typical of disseminated PCP
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Also k/a extrinsic allergic alveolitis - is a pulmonary syndrome caused byrepeated exposure and sensitization to a variety of organic and chemicalantigens
Etiology - asspergillus,thermophilic actinomyces, trichosporum,mycobacterium avium complex , isocyanates
CXR-1) Ground glass opacification
2) Fine nodular or reticulonodular pattern (more prominent in sub acute phase)
[ Lower lung predominance ]
3) Chronic cases - fibrosis with upper lobe retraction, reticular opacity, volume
loss and honeycombing may be seen
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HRCT-1) Poorly defined centrilobular nodules - < 5 mm in diameter , profuse throughout
the lung ,but a mid to lower lung zone predominance noted (*ground glassattenuation)
- Usually regress with removal of exposure
2) Ground glass attenuation - most common in AHP- may be patchy or diffuse
- middle lung zone predominance
- may resolve with removal of exposure
3) Lung cysts - 10% of subacute hypersensitivity pneumonitis
4) CHP - fibrosis signified by irregular linear opacities , traction bronchiectasis,lobar volume loss , honey combing
- mid zone predominance( but may be seen in upper or lower lobes )
-emphysema
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5) mosaic attenuation pattern - common6) air- trapping on expiratory imaging may be predominant or only feature
D/D-
1) Smoking related respiratory bronchiolitis
2) When only ground glass opacification present - viral infection , organizingpneumonia , DIP or NSIP
3) when mixed ground glass opacification and air trapping sarcoidosis
Pts with CHP-may exhibit pattern of NSIP
*hypersensitivity pneumonitis should always be considered in the differentialdiagnosis of NSIP and UIP
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Abnormal direct communication between pulmonary artery and vein Most congenital
50-70% located in lower lobes
70% unilateral
36% multiple lesions
Simple and complex AVMCXR-
- sharply defined pulmonary nodule , may have lobulated borders
- Uniform density
- Curvilinear opacities medial to nodule
CECT- best imaging modality- Enhancement of nodule similar to enhancement of other vascular structures
- Large feeding artery and draining vein
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D/D-Pulmonary varix
Systemic artery to pulmonary vein shunt
Retroperitoneal varices
Pulmonary metastasis
Granuloma
Pulmonary pseudotumor
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Common sources Infected venous catheters
Tricuspid valve endocarditis
Septic thrombophlebitis
Indwelling prosthetic devices
*diagnosis may be first suggested at chest CT as abnormalities may be seen onCT even before blood cultures become positive
CXR and CT appearance-
1) Multiple pulmonary opacities - may occur in any portion of lung (but usuallymaximal in lower zones)
-Either round (nodular) in shape or wedge shaped densities based on pleura andpointing towards hilum (like an infarct)
-Frequently cavitate
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Air bronchograms frequently seen in all types of opacity including nodularlesions on CT
2) feeding vessel sign-
Common CT finding of both sterile and infected infarcts
It is a distinct vessel leading to apex of a peripheral area of consolidation
Not specific for embolic sequelae but seen more frequently with septic emboliand sterile thrombo-embolic infarctions than in other conditions
3) Pleural effusion and empyema - common features
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Asbestos exposure noted in almost half the patients Peak age at presentation-40-70yrs
IMAGING FINDINGS-
1) Extensive nodular or lobular thickening of the pleura which may conglomerateto form a circumferential lobular sheet of soft tissue density encasing the lung
- Often runs into fissures accompanied with varying amounts of pleural f luid
* neoplastic encasement of lung fixes the mediastinum ,so mediastinal shiftaway from the site of effusion is not seen in MM
2) Ipsilateral volume loss
3) On CT- soft tissue density of tumor tissue is easily distinguished from adjacentpleural effusion ; but when nodules are tiny the only CT feature may be pleuraleffusion
4) Calcification -rare
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On MRI--T1 wt images - signal intensity slightly greater than muscle
-T2 wt images - moderately greater than muscle
Enhances significantly with gadolinium
Contrast enhanced T1 wt sequences with fat saturation-help distinguish benigndisease and other neoplasms from MM
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D/D-1) Pleural involvement by other malignant tumors - bronchial adenocarcinoma,
breast carcinoma, malignant thymoma and lymphoma
2) Benign conditions eg asbestos related benign pleural effusion, tuberculouspleural thickening,past or present empyema, asbestos related pleural plaques
*circumferential pleural thickening and thickening extending over themediastinal pleura seen in MM (but rare in benign pleural disease)
Uptake of FDG with PET imaging correlates with prognosis
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Due to inhalation of free silica (silicon dioxide)Simple silicosis-
CXR-
1) 1-3 mm round well-defined nodules in the posterior portion of upper 2/3 rd of lungs, symmetric
-Sometimes calcified-With time the nodules increase in size and number and may involve all zones
2) Reticular pattern may also be noted
CT-
1) Centrilobular micronodules
-Upper zone preponderance (spreads anteriorly and inferiorly as the diseaseprogresses
-Subpleurally the nodules may cluster to form pseudoplaques
-Larger nodules may calcify
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CT-Confirms the CXR findings
1) Shows a peripheral zone of paracicatricial emphysema
2) Fibrous bands may be noted extending to pleural surface
3) Round or ovoid masses , outer margin // the chest wall
-Large lesions(5cms or >)show irregular attenuation areas s/o avascularnecrosis and cavitation may occur
-Irregular punctate calcification maybe seen within the lesions
Assymetry between lungs may occur in early PMF
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D/D OF LYMPH NODE CALCIFICATION-1) Benign ds :
** Tuberculous and fungal ds.(histoplasmosis)
** Sarcoidosis
** Silicosis and coal workers pneumoconiosis
** amyloidosis
Pneumocystis jinoveci infection in patients with AIDS
Castleman disease
2) Malignant ds :
** Treated lymphomas and other neoplasmsMetastases from primary tumor osteosarcoma,chondrosarcoma,mucinousadenocarcinoma
[**egg-shell cacification ]
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Complications of silicosis-1) Chronic bronchitis
2) Emphysema-mostly centrilobular (but cicatricial emphysema in PMF)
3) predisposition to mycobacterial infection - pulmonary or extra-pulmonary
4) Increased risk of UIP , scleroderma , rheumatoid arthritis
5) Pleural thickening and round atelectases
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Most frequently the result of rheumatic fever mitral valve disease increases left atrial pressure - transmitted to pulm. veins
-when severe leads to interstitial and alveolar edema.
Parenchymal lung changes - haemosiderosis and intrapulmonary ossifiednodules develop after years of pulm. venous congestion
Sec. pulm. arterial hypertension-pulmonary valve regurgitation , rightventricular dilatation and functional tricuspid regurgitation
CXR-
1) cardinal radiologic feature-selective left atrial enlargement
aneurysmal enlargement of left atrium-is when left atrium reaches to within an
inch or so of chest wall on either side of chest
2) Left atrial appendage is prominent
3) Straightening of left heart border
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CXR-1) pulmonary plethora
2) Figure of 8/snowmans/cottage loafof bread heart-altered cardiacsilhouette by enlarged supracardiac
veins - result in enlarged superiormediastinal shadow with convexlateral borders
3) Later,pulmonary vascular occlusivedisease develops resulting inpulmonary hypertension
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Uncommon congenital anomaly- Septal and posterior leaflets of the tricuspid valve are long and redundant -and
there proximal portion is plastered to the wall of RV particularly along septalwall - result in tricuspid regurgitation
- Proximal portion of RV cavity is atrialized but it contracts synchronously withthe ventricle
- RV performance markedly reduced
patent fortamen ovale or atrial septal defect frequently seen - results inRt-to-lt shunt inducing central cyanosis
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CXR-1) Enlarged globular or square cardiac silhouette
-RA is characterstically markedly enlarged causing a prominent , smoothlyconvex right lateral heart border (with increasing contact with the sternumanteriorly and a bulging posterior border on lateral view )
-Left border of cardia is also smoothly convex , superiorly it approaches themidline so that the vascular pedicle of the heart is narrow
2) Outline of the heart is sharply defined due to poor pulsation
3) Lungs -oligemic
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D/D-ENLARGED GLOBULAR CARDIA WITH REDUCEDPULSATION WITH PULMONARY OLIGEMIA
1) Endomyocardial fibrosis
2)Uhls anomaly
3) Critical pulmonary stenosis
4) Pericardial effusion
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Self limited viral inflammation of the airways resulting in symmetric subglotticedema and croupy cough
CXR-
AP view - loss of normal shoulders (lateral convexities) of the subglottic tracheasecondary to subglottic edema : steeple sign, pencil tip or inverted V sign
-Symmetric ,subglottic narrowing with narrow portion of the airway extendingmore inferiorly than the level of pyriform sinuses
Lateral radiograph-
Narrowing of subglottic trachea
Loss of definition of subglottic trachea
Hypo pharyngeal overdistension
Normal epiglottis and aryepiglottic fold
Hypopharynx may be collapsed with distension of the lower cervical trachea - ifexpiratory image
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RADIOGRAPHS TAKEN TO EXCLUDE-Aspirated foreign body
Epiglottitis
Exudative tracheitis
Subglottic hemangioma
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Congenital absence of the left pectoralis major and minor muscleCXR-
Pectoralis major produces a broad band-like opacity extending downwards andmedially from axilla
Unilateral absence or hypoplasia of pectoralis major unilateral transradiancy
and an abnormal anterior axillary fold as seen with mastectomy
Accompanied with ipsilateral hand and arm anomalies (particularly syndactyly)with or without pectoralis muscle , rib anomalies , hypoplasia of breast and
nipple( Polands syndrome present in approx. 10% of pts. with syndactyly )
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Ct scan-
Thin-walled fluid- filled cysts
useful for identifying pathognomic features in ruptured or complicated cysts,
like detached or collapsed endocyst membranes and intact daughter cysts
MRallows reliable differentiation of f luid filled cysts from solid tumors
Cysts-low signal intensity on T1 WT images
high signal intensity on T2 WT images
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Aspergillus fumigatus most common causative agent Occurs in pts who are atopic and long standing asthmatics, can occur in non-
asthmatics too
10% prevalence in pts with cystic fibrosis
Slight female preponderance
20-40yrs of age 10% pts of ABPM may have allergic fungal sinusitis
symptoms-
Acute stage-wheeze,dyspnea,cough(often productive &ass. With minorhemoptysis)
50% pts-pleuritic pain,h/o coughing up mucus plugs
Fever,malaise.wt loss
Eosinophilia-mild to moderate
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Radiographic findings-major findingsAcute stage(transient)-
consolidation(80%)-can be massive and homogenous to subsegmental andsmaller opacities
little zonal predilection
cavitation in areas of consolidation :due to bronchiectasis, cavitatory bacterial
infection or mycetoma formationConsolidation is transient, and when clears leaves residual bronchiectasis
20-30%pts with consolidation are asymptomatic
mucoid impaction(30%)- due to retained secretions within the airways
basic opacity:linear sharply demarcated,branched or unbranched band likeshadowthat points to the hilum(tooth-paste shadow),in clusters(bunch of grapes)
usu.proximal airways involved,if distal bronchiectatic airways are involved(glovedfinger shadow)
On ct-appear as band like abnormalities in expected position of bronchi
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Atelectasis(20%)subsegmental,segmental,lobar or may affect whole lung
chronic stage(permanent)-
Bronchiectasis-proximal bronchiectasis (characterstic finding and highlyspecific for ABPA)
Distal airways remain normal and patent
Ct features of bronchiectasis:
segmental or subsegmental bronchi
Cystic or varicose pattern
Thin walled bronchiectatic airways
Associated mucoid impaction(may be hyperattenuating)
Ass.centrilobular nodularity/tree-in-bud pattern
Mid/upper zone volume loss and scarring
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minor findings- Airway wall thickening
Small nodules
Pleural effusions
Pleural thickening
Mycetoma
Small nodules
Linear scars
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92/102
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7/31/2019 Resp Spotters p.singh
93/102
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7/31/2019 Resp Spotters p.singh
94/102
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7/31/2019 Resp Spotters p.singh
95/102
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7/31/2019 Resp Spotters p.singh
96/102
Hamartomatous mass of fibrous tissue and smooth muscles containing cysticspaces lined by columnar or cuboidal respiratory epithelium.cystscommunicate with bronchial tree and fill with air early in life
most commonly presents during infancy or detected prenatally
M>F
Symptoms-respiratory distress in newborn periodRecurrent lung infections
3types:
1)type1- single/multiple cysts2-10 cms in diameter(ciliated respiratory epithelium)
2)type2-multiple cysts
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7/31/2019 Resp Spotters p.singh
97/102
Radiographic findings-Variable appearance ,depending on the size of cysts
Solid to multicystic mass with variable amounts of air and fluid
May cause mass effect
On ct-
Used for characterization of lesion for pre surgical planning
To identify lesions diagnosed prenatally but not evident on chest x-ray
Cyst walls and solid components demonstrate variable enhancement
mass effect demonstrated as mediastinal shift or adjacent lung compression
Will demonstrate cystic spaces even in solid appearing masses on chestradiograph
No evidence of systemic arterial blood supply
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7/31/2019 Resp Spotters p.singh
98/102
On MRI-usually used only in prenatal diagnosis
T1 WT Images-Isointense lesion
T2 WT Images-hyperintense mass
demonstrates mediastinal shift and compression of adjacent lung
may be ass. with fetal hydrops
USG-
For prenatal diagnosis
gray scale-echogenic mass with mass effect on adjacent lung
Fetal hydrops and poly hydramnios may be present
color doppler-no evidence of systemic arterial blood supply
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7/31/2019 Resp Spotters p.singh
99/102
Congenital area of abnormal lung that does not connect to bronchial tree orpulmonary arteries
Involved lung is dysplastic
Arterial supply-systemic source ,arising from descending aorta
Symptoms-recurrent pneumonia like symptoms
cyanosisIntralobar extralobar
within normal lung separate with own pleural covering
Venous drainage-pulmonary systemic
Left side(60-70%) left(90%)
Uncommon ass. congenital anomalies frequentAge at diagnosis-50%by 20 yrs 60% in 1st year
M=F M:F=4:1
Infections-common rare
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7/31/2019 Resp Spotters p.singh
100/102
Radiographic findings-Persistent lower lobe opacity(unchanged over multiple radiographs)-left lower
lobe
If infected-appears as multicystic air containing mass
Extralobar sequestration presents as paraspinal mass
On ct-Opacification of lower lobe lung parenchyma
If infected-cystic air filled components noted
On contrast:systemic arterial supply demonstrated-usually arisesfrom descendingaorta
May have other systemic sources as well
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7/31/2019 Resp Spotters p.singh
101/102
Autosomal recessive multisy stem disorder of exocrine gland function characterized inrespiratory tract byrecurrent infection,chronic obstruction and chronic sinusitis
with nasal polyps
Radiographic findings-
Early:hyperinf lation and/or lobar atelectasis
Increased perihilar markings
Later:upper lobe predominant bronchiectasis
Multiple small ill defined opacities in lung periphery from small airway mucoidimpaction
Persistent atelectasis-subsegmental,segmental or lobar
Recurrent pneumonia
Pulmonary arterial enlargement
Hilar adenopathy
Cor pulmonale
Apical cystic bronchiectasis,bullae
Predisposed to pneumothorax
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7/31/2019 Resp Spotters p.singh
102/102
On ct- More sensitive for detecting mild disease
Bronchial wall thickening and dilatation
Cylindrical,varicose and saccular bronchiectasis
signet ring sign:dilated bronchus in associationwithadjacent artery on axial
images Tree-in-bud pattern-v or y shaped opacities due to secretions within peripheral
small centrilobular bronchioles