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Daria Manos CAR 2016
Resident Case Review
CHEST
CAR 2016 • Daria Manos
Disclosure
• Speakers bureau, Roche
CAR 2016 • Daria Manos
• 1. Recognize common and critical chest radiograph and computed tomography signs and use these clues to formulate an appropriate differential diagnosis.
• 2. Choose a single most likely diagnosis based on imaging appearance and provided clinical information.
• 3. Provide management recommendations influence by imaging interpretation.
• All objectives address CanMEDS medical expert, communicator, health advocate and collaborator roles.
• Presentation Summary • Rapid fire chest radiographs and CTs will be presented in a lively multiple
choice, single best answer format followed by a brief discussion of each case. The focus will be on common and critical imaging patterns relevant for both certification exams and independent practice.
CAR 2016 • Daria Manos
A. Loculated pleural effusion B. Hilar mass C. Diaphragmatic paralysis D. Pneumonia
Best diagnosis?
CAR 2016 • Daria Manos
CAR 2016 • Daria Manos
Best method for tissue?
CAR 2016 • Daria Manos
Where is the lesion? A. Pleura B. Lung C. Mediastinum D. Hilum
CAR 2016 • Daria Manos
A. Pleura B. Lung C. Mediastinum D. Hilum
CAR 2016 • Daria Manos
Differential? A. Malignancy B. Abscess C. Vasculitis D. Angioinvasive aspergillosis
CAR 2016 • Daria Manos
CAR 2016 • Daria Manos
A. Vascular redistribution B. Cystic Fibrosis C. Langerhans cell histiocytosis D. Mycoplasma Pneumonia
CAR 2016 • Daria Manos
A. Vascular redistribution B. Cystic Fibrosis C. Langerhans cell histiocytosis D. Mycoplasma Pneumonia
CAR 2016 • Daria Manos
CAR 2016 • Daria Manos
A. Artifact of low lung volumes B. Pulmonary Fibrosis C. Cardiogenic pulmonary edema D. Noncardiogenic pulmonary edema
CAR 2016 • Daria Manos
A. Collagen Vascular Disease B. Idiopathic Pulmonary Fibrosis C. Sarcoid D. COPD
CAR 2016 • Daria Manos
23 year old with 4 weeks fever and night sweats
A. Tuberculosis B. Sarcoid C. Eosinophilic Pneumonia D. Community Acquired Pneumonia
CAR 2016 • Daria Manos
23 year old with 4 weeks fever and night sweats
How can serology help?
CAR 2016 • Daria Manos
CAR 2016 • Daria Manos Daria Manos
Chronic Eosinophilic Pneumonia
Reverse halo, atoll sign, perilobular consolidation, lobular sparing
How can serology help?
CAR 2016 • Daria Manos
A. UIP B. Interstitial edema C. Lymphangitic carcinomatosis D. Langerhans cell histiocystosis
35 year old man
CAR 2016 • Daria Manos
A. LAM B. Empysema C. Sarcoid D. Langerhans cell histiocystosis
CAR 2016 • Daria Manos
HIV, IVDU, fever, respiratory distress
A. perilymphatic B. centrilobular C. random D. subpleural
What micronodular pattern?
CAR 2016 • Daria Manos
Tree-in-bud nodularity Centrilobular – small artery or small airway
CAR 2016 • Daria Manos
HIV, IVDU, fever, respiratory distress
A. Bacterial B. Pneumocystis jiroveci pneumonia C. Septic emboli D. IV talcosis
Most likely diagnosis?
CAR 2016 • Daria Manos
45 yo in ED with 3-day history of increasing dyspnea but no cough or chest pain.
A. Pulmonary edema B. NSIP C. DIP D. Infectious E. Pulmonary hemorrhage
CAR 2016 • Daria Manos
A. Pulmonary edema B. NSIP C. DIP D. Infectious E. Pulmonary hemorrhage
1 year earlier
CAR 2016 • Daria Manos
A. Pulmonary edema B. NSIP C. DIP D. Infectious E. Pulmonary hemorrhage
How confirm diagnosis?
CAR 2016 • Daria Manos
A. Hemothorax B. Pneumothorax C. Diaphragmatic injury D. Pulmonary contusion E. Massive aspiration
CAR 2016 • Daria Manos
CAR 2016 • Daria Manos
35 year old woman
CAR 2016 • Daria Manos
A. Bronchopneumonia B. Multifocal adenocarcinoma C. Pneumocystis jiroveci D. Sarcoid E. NSIP
CAR 2016 • Daria Manos
A. Bronchopneumonia B. Multifocal adenocarcinoma C. Pneumocystis jiroveci D. Sarcoid E. NSIP
CAR 2016 • Daria Manos
45 yo with increasing fatigue, some fever
CAR 2016 • Daria Manos
A. Adenocarcinoma B. Lipoid pneumonia C. Lymphoma D. Organizing Pneumonia
2 months later
CAR 2016 • Daria Manos
A. Granulomatosis with polyangitis
B. Metastatic colon cancer C. Angioinvasive apergillosis D. Bronchogenic carcinoma
50 year old male, non-smoker with hemoptysis, no known comorbidities
CAR 2016 • Daria Manos
A. Swyer James B. Pulmonary embolism C. Mediastinal mass D. Atelectasis
Why is the left lung hyperlucent?
CAR 2016 • Daria Manos
A. Swyer James B. Pulmonary embolism C. Mediastinal mass D. Atelectasis
2 years earlier
CAR 2016 • Daria Manos
CAR 2016 • Daria Manos
45 year old woman, incidental finding on Abdominal series
A. Lung B. Hilar nodes C. Left main pulmonary artery D. Mediastinum
CAR 2016 • Daria Manos
Most likely diagnosis?
CAR 2016 • Daria Manos
A. Organizing Pneumonia B. NSIP C. UIP D. DIP
What is the pattern?
CAR 2016 • Daria Manos
A. Organizing Pneumonia B. NSIP C. UIP D. DIP
What is the pattern?
CAR 2016 • Daria Manos
A. Metastases B. Tuberculosis C. Langerhans cell histiocytosis D. Mycoplasma Pneumonia
35 yo with increasing dyspnea
CAR 2016 • Daria Manos
A. Metastases B. Tuberculosis C. Langerhans cell histiocytosis D. Mycoplasma Pneumonia
CAR 2016 • Daria Manos
Challenge eye test
CAR 2016 • Daria Manos
Challenge eye test
CAR 2016 • Daria Manos
CAR 2016 • Daria Manos
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Thank you and good luck!