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  1. Pulmonary Infections
    1. Bronchopneumonia is multifocal, heterogeneous inflammatory involvement of distal airways, with distribution along vessels is usually absent and volume loss is common with occasional pneumatocele formation.
    2. Chest Radiograph Frontal projection reveals multiple patchy focal fluffy infiltrates in both lungs suggestive of Bronchopneumonia.
  1. Lobar pneumonia is usually the localized disease. It spreads rapidly via the pores of Kohn and canals of Lambert across segmental boundaries producing a uniform consolidation in lung parenchyma. It spares distal airways.
  2. Chest Radiograph Frontal projection : Reveals haziness in right upper zone obscuring the right mediastinal contour, limited inferiorly by sharp margin, suggestive of RUL consolidation – Typical LOBAR Pneumonia.
  1. Pulmonary Tuberculosis
    Mycobacterium tuberculosis infection
    1. Primary TB:
      1. Ghon’s complex                
      2. Pleural/pericardial involvement        
      3. Tuberculoma                  
      4. Regional adenopathy    
      5. Milliary TB                  
      6. Extrapulmonary TB
    2. Secondary TB (Post primary TB):
      1. Acinar consolidation              
      2. Tuberculoma (caseation)    
      3. Cavitation                  
      4. Endobronchial spread          
      5. Milliary TB
Extra Edge
  • QGhon’s focus (primary focus of TB)  often present in mid zone of lung, located peripherally in subpleural region and right side is affected more than left. Associated hilar adenopathy common.
  • Simon’s focus  during early bacillemia, seeding may occur in lung apex.
  • Puhl’s lesion  the commonest site of isolated lesion of chronic pulmonary TB is apex of the lung because the blood flow is sluggish at the apex and diffusion is poor.
  • Ashman’s focus  Infraclavicular lesion of chronic pulmonary TB

Low density in a neck lymph node in an adult with head and neck cancer is characteristic of metastatic disease until proven otherwise. Q

  1. Characterization Of Mediastinal Node In Various Diseases:
    1. Sarcoidosis is the common cause of intrathoracic lymph node enlargement, the hilar nodes being enlarged in almost all cases. The important diagnostic feature of adenopathy in sarcoidosis is its symmetry.
    2. Lymph node enlargement due to malignant lymphoma and leukemia is bilateral but asymmetrical, hilar node enlargement is rare without accompanying mediastinal node enlargement, posterior mediastinal nodes are infrequently involved and paracardiac nodes are rarely involved but become vital as sites of recurrent disease.
    3. Lymph node enlargement due to tuberculosis or fungal infection may affect any of the nodal groups in hila or mediastinum. Dense calcification is frequent both in nodes that stay enlarged and in those that shrink. A low-density centre with rim-enhancement of the enlarged node is a useful pointer towards the diagnosis of TB.
    4. A rare cause of strikingly uniform contrast enhancement is Castleman’s disease.
    5. Sometimes there is a ring of calcification at the periphery of node—so-called 'eggshell calcification' that is a particular feature of sarcoidosis and silicosis. Q

Egg Shell calcification in lymph nodes:

a. Silicosis

b. Sarcoidosis

c. Coal workers pneumoconiosis

d. Lymphoma following radiotherapy

e. Histoplasmosis

f. Progressive massive fibrosis

g. TB

h. Coccidiomycosis

  1. Mycobacterium avium intracellular complex (MAC) infection: CXRQ
  1. Patchy unilateral/bilateral air-space consolidation
  2. Small or nodular lesions
  3. Bronchiectasis
  4. Cavitations (thick or thin walled)
  5. Middle lobe syndrome
  • Pneumocystis jerovecii:
  1. Common in immunocompromised patients
  2. High risk if CD4 counts in HIV positive patients are below 200/mcL
  1. Patchy bilateral perihilar ‘ground-glass’ opacity
  2. Central or perihilar distribution is characteristic
  3. Pneumatocele and Pneumothorax in 10% cases, especially after aerosolized pentamidine therapy.
HRCT: Interlobular septal thickening (resolving) and Centrilobular nodules.
  1. Hydatid Disease of lung: Radiological signs:
    1. Meniscus/double arch/moon/crescent sign due to thin radiolucent crescent in uppermost part of cyst. Q
    2. Combo sign due to air fluid level inside endocyst and air between pericyst and endocyst.
    3. Collapsed membranes inside the cyst outlined by air causing ‘serpent’ sign.
    4. Completely collapsed crumpled cyst membrane floating on the cyst fluid produces “water Lilly” sign of Camalotte. Q
    5. Cyst in cyst sign.
  2. Foreign Body Aspiration
    1. Due to straighter, broader and short right bronchus with only 250 angle of bifurcation, foreign body aspiration is common on right side. However the right and left main stem bronchi are same and above said thing are not true for children.
    2. Aspiration pneumonitis or aspiration of foreign body in supine position usually affects posterior segment of right upper lobe or the foreign body will be lodged into posterior segment bronchus of right upper lobe. Q
    3. While the foreign body aspirated in upright position will be lodged into superior or apical segment of right lower lobe (gravity dependent areas usually affected). 

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