Jennifer Taylor Rozak @Jen_Rozak on GrepMed

Algorithm for nodular pattern The algorithm to distinguish perilymphatic, random and centrilobular nodules is the following: - Look for the presence of pleural nodules. These are often easiest to see along the fissures. - If pleural nodules are absent or few in number, the distribution is likely centrilobular. - If pleural nodules are visible, the pattern is either random (miliary) or perilymphatic. - If there are pleural nodules and also nodules along the central bronchovascular interstitium and along interlobular septa, you are dealing with a periplymphatic distribution. - If the nodules are diffuse and uniformly distributed, it is likely a random distribution. #Diagnosis #Radiology #Pulmonary #HRCT #CTChest #NodularPattern #Nodular #Pattern #MultipleNodules #Nodules #Differential #Algorithm #RadiologyAssistant

Differential diagnosis The table summarizes the most common diseases, that present with consolidation. Chronic diseases are indicated in red. A way to think of the differential diagnosis is to think of the possible content of the alveoli: - Water - transudate. - Pus - exsudate. - Blood - hemorrhage. - Cells - tumor, chronic inflammation. Another way to think of consolidation, is to look at the pattern of distribution: - Diffuse - perihilar (batwing) or peripheral (reversed batwing). - Lobar or focal. - Multiple - usually multiple ill-defined densities. Now it is obvious that some diseases can have more than one pattern. For instance a lobar pneumonia caused by streptococcus pneumoniae may become diffuse if the patient does not respond to the treatment. Other examples are organizing pneumonia (OP) and chronic eosinophilic pneumonia. These diseases typically present as multifocal consolidations, but sometimes they may become diffuse. OP is organizing pneumonia. When it is idiopathic it is called cryptogenic (COP). The old name is BOOP - Bronchiolitis Obliterans Organizing Pneumonia. The new name for BAC - bronchoalveolar carcinoma is adenocarcinoma in situ. #Diagnosis #Radiology #Pulmonary #CXR #Consolidation #Lobar #Diffuse #Multifocal #Differential #Table #RadiologyAssistant

Upper lung zone preference is seen in: - Inhaled particles: pneumoconiosis (silica or coal) - Smoking related diseases (centrilobular emphysema - Respiratory bronchiolitis (RB-ILD) - Langerhans cell histiocytosis - Hypersensitivity pneumonitis - Sarcoidosis Lower zone preference is seen in: - UIP - Aspiration - Pulmonary edema #Diagnosis #Radiology #Pulmonary #HRCT #ChestCT #Differential #Table #Distribution #Upper #Lower #RadiologyAssistant

Histoplasmosis - Histoplasma capsulatum Found in Spelunkers. Caves. Bat and Bird droppings Distribution: Mississippi and Ohio River Valleys Clinical: • Most patients remain asymptomatic • Disseminated infection more common in immunocompromised • Primary infection: Flu-like • Chronic infection: TB-like Treatment: • Antifungal #Histoplasmosis #Histoplasma #Diagnosis #Distribution #Diagnosis

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Diagnosis Algorithm Defined as pulmonary hypertension (mPAP > 25) > 6 months after initial PE. The typical flow of diagnosis is that patients with symptoms of exercise intolerance, dyspnea get an echo which shows pulmonary hypertension, and then eventually get CTPE or V/Q scan to evaluate. Note that this diagnosis is often overlooked given there may be no overt history of PE #CTEPH #Diagnosis #Algorithm #Pulmonary #Hypertension

Since these risk factors are numerous and have different effects on the malignancy risk, it is proposed to assess final risk categories concerning the probability of malignancy [8](Table). #Diagnosis #EBM #Radiology #Pulmonary #Fleischner #Probability #Malginancy #PulmonaryNodule #RadiologyAssistant

Size A solitary pulmonary nodule (SPN) is defined as a single intraparenchymal lesion less than 3 cm in size and not associated with atelectasis or lymphadenopathy. A lesion greater than 3 cm in diameter is called a mass. This distinction is made, because lesions greater than 3 cm are usually malignant, while smaller lesions can be either benign or malignant. Swensen et al studied the relationship between the size of a SPN and the chance of malignancy in a cohort at high risk for lung cancer (1). Their findings are listed in the table on the left. They concluded that benign nodule detection rate is high, especially if lesions are small. Of the over 2000 nodules that were less than 4 mm in size, none was malignant. #EBM #Radiology #Pulmonary #SolitaryPulmonaryNodule #MalignancyRisk #Malignancy #MalignancyRate #Rate #RadiologyAssistant

Endobronchial Valve Opening and Closing on Bronchoscopy Dr. See-Wei Low @seeweilow #Endobronchial #Valve #Opening #Closing #Bronchoscopy #Clinical #Lung #Pulmonary

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Balloon Visualization - Mechanical Ventilation Pressures - PIP, PPlat, PEEP Peak Inspiratory Pressure (PIP): Dynamic pressure needed to fully inflate the lung (Overcome resistive and elastic forces of the lung) Airway Resistance: PIP – Plateau Pressure (Normally <5cmH20 unless excessive airway resistance) Inspiratory Pause: Ventilator Maneuver to Measure Plateau Pressure Plateau Pressure (PPlat): Alveolar distending pressure (Static pressure which reflects lung compliance) #MechanicalVentilation #Pressures #PPlat #PEEP #CriticalCare #Diagnosis #Balloon #Pathophysiology #Pulmonary

Connective tissue disease-associated interstitial lung diseases LIP: lymphoid interstitial pneumonia. NSIP: nonspecific interstitial pneumonia. OP: organizing pneumonia. I-JIP: usual interstitial pneumonia. AIP: acute interstitial pneumonia. SSc: systemic sclerosis. DM/PM : dermatomyositis/polymyositis. PSS: Sjogren syndrome. RA: rheumatoid arthritis SLE : systemic lupus. MCTD : mixed connective tissue disease. By Dr. Florence Delestre (Fellow in Internal Medicine, Paris, France) - Dr. Benjamin Terrier @ https://twitter.com/TerrierBen #ConnectiveTissueDiseases #ILD #LungDisease #CTILD #Diagnosis #Differential #Comparison #Table #Pulmonary #Rheumatology #Associations