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Quick Specifics: Respiratory System

  1. Sign/specific feature
    1. Hydatid cyst of lung
      1. Meniscus / Moon/ Air crescent / Double arch sign
      2. Cumbo sign
      3. Water lilly / Camalotte sign
      4. Serpent sign / Rising sun sign
      5. Empty cyst sign
    2. Mediastinal nodes of histoplasmosis
      1. Popcorn calcification
    3. Pulmonary thrombo-embolism
      1. Westermark sign
      2. Hapton’s hump
      3. Palla sign
      4. Fleishner lines
      5. Felson’s sign
    4. Thymic enlargement
      1. Sail sign
      2. Mulvay Wave sign
      3. Notch sign
    5. Rounded atelectasis
      1. Comet tail sign
    6. RUL collapse secondary to a central mass
      1. Golden S sign
    7. LUL collapse
      1. Luftsichel sign
    8. LLL collapse
      1. Broncholobar sign
    9. Pneumo-mediastinum
      1. Ring around artery sign
      2. Continuous diaphragm sign
      3. Tubular artery sign
      4. Double bronchial wall sign
      5. V sign of Naclerio
      6. Spinnaker sail sign
    10. Pneumothorax
      1. Deep sulcus sign
      2. Visceral pleural line
    11. Epiglottitis
      1. Thumb sign
    12. Croup
      1. Steeple sign
    13. Aspergilloma
      1. Air crescent sign
      2. Monod sign
    14. Klebsiella pneumonia
      1. Bulging fissure sign
    15. Pulmonary edema on CXR
      1. Batwing sign
    16. Diaphragmatic rupture
      1. Collar sign
      2. Dependant viscera sign
    17. Pulmonary septic emboli
      1. Feeding vessel sign
    18. ABPA
      1. Finger in glove sign
    19. Aspergillosis
      1. Halo sign
    20. Subacute hypersensitivity pneumonitis
      1. Head cheese sign
    21. RUL atelectasis
      1. Juxtaphrenic peak sign
    22. Cryptogenic organized pneumonia
      1. Reversed halo sign
    23. COPD
      1. Saber sheath trachea
    24. Alveolar microlithiasis
      1. Sandstorm lungs
    25. Bronchiectasis
      1. Signet ring sign
    26. RLL atelectasis
      1. Superior triangle sign
    27. Empyema
      1. Split pleura sign
    28. Endobronchial spread in TB
      1. Tree in bud sign on HRCT
  2. Pneumocystis carinii pneumonia (PCP)
    Pneumocystis carinii pneumonia infection is common in children as in adults.
    The child is usually pyrexial and hypoxemic and may rapidly progress to respiratory failure.
    Pneumothorax may complicate mechanical ventilation due to rupture of pneumatoceles.
    The CXR shows progressive bilateral infiltrate evolving to bilateral diffuse airspace opacification.
    1. In general, CXR in most patients shows bilateral, diffuse, symmetrical, fine to medium reticular opacities.
    2. These infiltrates may be confined to one to two lobes or segments of lung.
    3. Sometimes upper lobe predominance may be seen which may be possibly enhanced by use of inhaled pentamidine.
    4. Unusual radiographic presentation includes:
      1. Diffuse or focal miliary nodules
      2. Focal airspace consolidation
      3. Solitary or multiple well formed nodules
      4. Moderate to thick walled cavitary nodules
      5. Normal chest film
      6. Pneumatoceles in 10% cases (thin walled)
      7. Pneumothorax in 5% cases with or without bronchopleural fistula
    5. The radiographic appearance often gets worse during the first three days of therapy, especially with IV trimethoprim (the drug of choice for P. carinii infection) probably due to the over-hydration pulmonary edema and due to the inflammatory reaction related to dead and dying parasite.
  3. Features of various histological types of lung carcinoma

 

Features

Adenocarcinoma

Squamous

Small cell

Large cell

1

%

50%

30-25

15%

<5%

2

Sex

Most common bro. Ca of female

-

-

-

3

Smokers

-

Strong asso.

Strong asso.

Strong Asso.

4

Location

Almost invariably peripheral,

Central (2/3)

90% central

Large

 

 

Frequent in scars, upper lobar distribution

SPN (1/3)

 

Peripheral

5

Metastasis

Early mets, low

Lowest mets

High mets

Early mets

6

Growth rate

Slow GR

Slowest

Rapid

Rapid

7

Malignant potential

Intermediate

Least

High

Internal

8

Pancoast tumor (chest wall invasion)

-

Most common

-

-

9

Calcification

1%

+

-

-

10

Cavitation

-

+

-

-

11

Paraneoplastic syndrome

-

-

Most common

-

12

Lung to lung metastasis

Most common

-

-

-

13

Mediastinal

+/-

-

-

+

14

Scar cancer

-

+

-

-

15

SVC syndrome

-

+(most common)

-

-


Extra Edge

Mediastinal masses

Middle mediastinal

Posterior mediastinal

Anterior mediastinal

1) Thymic lesions (most common)

2) Teratoma

3) Thyroid/parathyroid

4) Lymphoma

5) Aneurysm of asc aorta

6) Cysts-cystic hygroma,  bronchogenic cyst,  pseudopancreatic cyst

7) Extralobar sequestration

8) Mesenchymal tumors

9) Mediastinal lipomatosis

10) Morgagni hernia

11) Sternal tumor

1. Lymphadenopathy (common)

2. Foregut cyst

3. Hiatal hernia

4. Aneurysm of arch of aorta

5. Esophageal tumor

6. Carcinoma of trachea

7. Pericardial lesions

8. Hematoma

1) Neurogenic tumor (most common)

2) Infectious spondylitis (pyogenic, TB)

3) Aneurysm of descending aorta

4) Esophageal varices

5) Hematoma

6) Neuroenteric & bronchogenic cyst

7) Extramedullary hematopoiesis


Extra Edge

Diseases

Investigation of choice

1. Congenital heart disease

Transesophageal echocardiography

2. Portal hypertension

Ultrasonography, computed tomography

3. Mitral valve disease

Echo cardiac graphy

4. Mediastinal fibrosis

CT, magnetic resonance imaging

5. COPD

Pulmonary function tests

6. Obstructive sleep apnea

Sleep aphea study

7. Pulmonary fibrosis

High-resolution chest CT

8. Interstitial pneumonitis

→ Transbronchial or open-lung biopsy

9. Pulmonary thromboembolic disease

Contrast-enhanced Spiral CT

10. Sarcoidosis

Lung or lymph node biopsy





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