3.2: Week 3 pt 2 highlights

Question 1

What are the 3 Ts of masses in the anterior mediastinum?

Answer 1

Thyroid mass
Teratoma
Thymoma
Lymphoma

Question 2

What is the most common cause of mediastinal mass overall?

Answer 2

Lymphadenopathy

Question 3

Thymomas arise near where?

Answer 3

Junction of the heart and great vessels

Question 4

Myasthenia gravis is assoc. with?

Answer 4

Thymomas

Question 5

When do teratomas usually occur? What is the most common type?

Answer 5

Usually occur before middle-age; cystic

Question 6

1) ________ is the most common source of masses in the middle mediastinum
2) What else can produce this?

Answer 6

1) LAD
2) Malignancy and produce LAD

Question 7

Posterior mediastinum is from the posterior border of the heart to the anterior border of the ________________

Answer 7

vertebral column

Question 8

Differentiate between a nodule and mass

Answer 8

< 3 cm is a nodule
> 3 cm is a mass

Question 9

If a nodule/ mass is small, then it may be___________ or _______

Answer 9

solid or subsolid

Question 10

Subsolid masses may have an entirely or partially “ground glass” appearance, which refers to increased attenuation (whiter area) on CT, in which the ________________ are preserved rather than obliterated by it

Answer 10

vessels and lung tissue

Question 11

Solitary Nodule <3 cm:
1) Subsolid nodules may represent _______________
2) Solid and unchanged over ____ years are likely benign; no further imaging

(starred slide; important)

Answer 11

1) adenocarcinoma
2) 2 yrs

Question 12

Solitary nodule <3cm: Subsolid and unchanged over _____ years are likely benign; no further imaging

(starred slide; important)

Answer 12

5

Question 13

Solitary nodule <3cm:
1) Is calcification usually a good thing?
2) What 3 margin characteristics all suggest malignancy?
3) Gradual increase in size over time is _____________

Answer 13

1) Usually benign
2) Lobulation, spiculation, and shagginess
3) ominous

Question 14

Solitary nodule < 3 cm:
What 3 Sx should factor greatly into the eval of any nodule?

Answer 14

Hemoptysis, unexplained weight loss and hoarseness

Question 15

What lobe is high risk?

Answer 15

Upper lobe

Question 16

Hamartomas are ________________ tumors of disorganized tissue containing fat and calcium

Answer 16

peripheral

Question 17

Bronchogenic Carcinoma: What are some complications?

Answer 17

1) Direct extension and Metastasis
2) Rib destruction
3) Hilar /Mediastinal adenopathy: May be the harbinger of a not yet visible tumor
4) Bone metastasis

Question 18

Will have to use _______________ with bx to determine the source of a metastatic neoplasm to the lung

Answer 18

bronchoscope

Question 19

You need a CT angiogram for what?

Answer 19

Pulmonary Embolus

Question 20

CXR is a very poor tool for diagnosing what?

Answer 20

PE; many false negatives on CXR

Question 21

Differentiate bulla and blebs

Answer 21

1) Bulla are large (>1 cm) air-containing lesions in the lung, visible on CXR
-usually assoc. w emphysema
2) Blebs are usually < 1 cm, often not visible on CXR
-Occur often in the apex

Question 22

How do you tell Lung cysts (pneumatoceles) apart from bulla?

Answer 22

Walls are thicker

Question 23

________ have the thickest walls of all air containing lesions

Answer 23

Cavities

Question 24

Key word on CXR for ________________ is “tram-tracks”

Answer 24

bronchiectasis

Question 25

Bronchiectasis usually occurs where?

Answer 25

In lower lobes

Question 26

Bronchiectasis (CT): 1) Define tram tracks 2) Give another sign and define it

Answer 26

1) Thickened dilated bronchial walls 2) Signet ring sign: Bronchus larger than its associated pulmonary artery

Question 27

List the causes of a Pneumothorax

Answer 27

1) Spontaneous: tall thin men 20-40 yo. 2) Traumatic 3) Diseases that decrease lung compliance 4) Rupture of an alveolus or bronchiole

Question 28

Who is most likely to have a spontaneous pneumothorax?

Answer 28

Tall thin men 20-40 y/o

Question 29

What can mimic PTX?

Answer 29

Large bulla

Question 30

The presence of an air-fluid interface in the pleural space indicates what?

Answer 30

pneumothorax

Question 31

A must for the diagnosis of PTX is?

Answer 31

Visualization of the visceral pleural line

Question 32

Convex curve of the visceral pleural line paralleling the contour of the chest wall indicates?

Answer 32

PTX

Question 33

Absence of lung markings distal to the visceral pleural line usually means the pt has what?

Answer 33

PTX

Question 34

A PTX often has a deep sulcus sign of an _____________ displaced costophrenic sulcus seen on a supine chest

Answer 34

inferiorly

Question 35

List 2 examples of Trauma-Related Parenchymal Lung Abnormalities

Answer 35

Pulmonary contusions Pulmonary lacerations (aka traumatic pneumatocele)

Question 36

Pulmonary contusions: Airspace disease that lingers more than 72 hours should raise suspicion of another process, such as?

Answer 36

aspiration, pneumonia, or a pulmonary laceration.

Question 37

Pulmonary laceration/ traumatic pneumatocele: How long do they take to clear?

Answer 37

May take weeks to months to clear

Question 38

Pulm. laceration: If it is completely filled with blood, it will appear as a solid, usually _____ mass.

Answer 38

ovoid

Question 39

Pulmonary lacerations: If it is partially filled with blood and partially filled with air, it may contain a visible ______________ or demonstrate a _________ sign as the blood begins to form a clot and pull away from the wall of the laceration.

Answer 39

air-fluid level; crescent

Question 40

What is more common < 40 yo?

Answer 40

Pulmonary Interstitial Emphysema

Question 41

What finding confers high risk for impending pneumothorax?

Answer 41

Pulmonary Interstitial Emphysema

Question 42

Pneumopericardium: What causes it?

Answer 42

Penetrating injury to the pericardium

Question 43

Pneumopericardium produces a continuous band of lucency that encircles the heart that extends no higher than what?

Answer 43

The root of the great vessels