Chest DDX

TNM Staging

T0Tx - sputumT1 - < 3 cm, distal to MSBT2 - > 3cm, > 2cm from carina, 1 pleural layer (visceral)T3 - < 2cm from but not at carina, chest wallT4 - carina, vital structures, effusion, separate nodules same lobe
N0N1 - Ipsilateral hilarN2 - Ipsilateral mediastinal, subcarinalN3 - Contralateral, scalene, supraclavicular
Stage IIIb - Nonresectable T4 and/or N3

Bullous Lung Disease

SEA VICH
SarcoidEGAS
Vanishing LungIVDACTD - Marfan Ehler DanlosHIV

Rib Lesion

FLAME COOF
FDLCHABCM/MEnchondroma
ChondrosarcomaOsteochondromaOsteosarcomaFibrosarcoma

Anterior Mediastinal Mass

Lymphoma/LeukemiaGerm Cell tumor (STECY) if < 40 yoThymic Thymoma ( > 40 yo, #1 in adults), Cyst, hyperplasia stress/steroids, tumorThyroid Goiter, CAVascular

If border irregular, consider giving more weight to CA.

Middle Mediastinal Mass

CLAN
Congenital - CystLymphadenopathy* - EBV, Castleman, GranulomatousAorta Anomaly - Neoplasm - Small Cell, L/L, Mets: GU, H & N, Breast, Melanoma
*Dense Lymphadenopathy - careful regarding carcinoid Granulomatous Treated Lymphoma Osteosarcoma Pneumoconiosis

Posterior Mediastinal Mass

Nerovascular tumorVertebral body - abscess, tumorVascular - hematoma, aneurysmDevelopmental - hernia, bronchogenic or esophageal duplication cyst

Hilar Adenopathy

GNIC
Granulomatous - sarcoid TB/FungalNeoplasm - Small Cell Mets Lymphoma/LeukemiaInfection - EBV HIVCastleman - benign hyperplasia

PVH*

MILF
MR - normal size trunkInflow - HLHS, LV Mass, Cor Triatiatum, MS (normal trunk if acute), TAPVR 3, CoarctationLow Oncotic Pressure* -Failure of LV -

Asymmetrical Pulmonary Edema

NORM!
Neoplasm/NodeObstructed PA - contralateral PV - ipsilateralReexpansion edemaMitral regurgitation (RUL)

PCWP and Hydrostatic edemaNl - 10 mmHgCephalization - 15Interstitial - 20Air Space - 25

Peripheral GG/Airspace/Nodules Brochiectasis

What causes COP? CIA Vs RTD
CVDIdiopathicAspiration
ViralFumesTransplant - Heart, Lung, Bone MarrowDrugs

Peripheral Reticular Opacity

FUC Fibrotic NSIPUIP - IPF & Asbestosis Bleomycin CVD (RA Scleroderma)Chronic HP

Diffuse Reticular Pattern

ELI
Edema - cardiogenicLymphangetic Carcinomatosis - adenocarcinoma/lymphomaIntertitial Pneumonia - viral/mycoplasma

Central Curvilinear Reticular - Cystic

BronchiectasisFibrosisPCP LAM/TS LCH LIP*

*LIP Adult - CVD Peds - HIV

Bilateral Pleural Effusions

HAPIE Heart - CHF Pericarditis MI Dressler (pleuritis pericarditis pneumonitis fever)Asbestos related pleural diseasePEImmune - SLE RA WegenerExtrathoracic - Cirrhosis Meigs Myxedema Drugs

Unilateral Pleural Effusions

A BITCH
Abdomen - Pyelonephritis, Splenic, Pancreatitis, Abscess, Hepatitis
BoerhaaveInfarct/Infection - PE, TB, empyemaTumor - Fibroma, MalignancyChylothorax* - Iatrogenic, LymphomaHemothorax - Iatrogenic, Trauma
*Lymphatics ascend L1 to T6 on the right, then turn toward the left at T6

Diffuse Pleural Disease

Smooth - TEA TransudativeExudativeAsbestos related pleural disease
Lumpy LoculationsPlaquesMesotheliomaMets - Thymoma Adenocarcinoma (Lung breast ovary kidney GI)Splenosis

Focal Pleural Lesion

Thick Pneumonia Asbestos Trauma Infarct
Calcium Empyema Hemothorax TB *Asbestos
Mass Loculation - Blood Pus Water Neoplasm - Met Mesothelioma Lipoma, Fibrous Tumor of Pleura, Neofibroma

*Asbestos only bilateral
Transudative Pleural Effusions
HypoproteinemiaNephrotic SyndromeVolume OverloadLV Failure

DefinitionLDHPleural:Serum Ratio LDH < 0.5 Protein < 0.6

Miliary Nodules

TB/Fungal -Mets - Thyroid, Melanoma, Breast Varicella - these are dense if chronic

Centrilobular Nodules - ill defined ground Glass

F SHREW
Follicular Bronchiolitis - CVD, AIDS
Subacute HPRB-ILDEGWegener

Ground Glass Nodules with Hyperinflation and/or "Y" tubular Branching - Constrictive Bronchiolitis

CVDViral - Child - RSV/Adenovirus (SJS) leads to samll lung/hilum and air trapping Adult - Asian Panbronchiolitis, RB-ILD
Fumes -Transplant - Drugs -

Cavitary Nodules

IN VTR ("In a Vermonter")
Infection - Staph, TB/Fungal, Nocardia, Aspirgillosis, Septic EmboliNeoplasm - SCCA, Sarcoma
Vasculitis - Wegener, Angiocentric lymphomaTrauma - Hematoma, cystRA

Tracheal Narrowing*

Focal - STOWSclerodermaTracheomalacia - Tracheostomy, ETTOGD - Sarcoid, TB, FungalWegener
Diffuse - STAR WARSSaber sheathTracheobronchiopathia osteochonroplastica - no Ca++ on posterior membraneAmyloid - may have Ca++ on posterior membraneRelapsing polychondritis - cauliflower ear, saddle noseWegeneRScleroderma
*Collapse occurs during- End Inspiration for Extrathoracic trachea End Expiration for Intrathoracic trachea

Tracheal Dilitation

TracheomalaciaFibrosisTracheocele - (focal)Tracheobronchomegaly - (diffuse) EDS, cough causes collapse

Bronchiectasis

Local/Peripheral - TF SCANTB/SJSFolicular BronchitisSarcoidCA/CarcinoidAtresiaNode
Diffuse - AI @ UCDABPA in CF/Asthma cured by steroidsInfection SJSUIPCFDysmotile cilia (situs inversus totalis/sinusitis/sterile males)

Ground Glass Opacities - Chronic

Minimal Fibrosis - CHAFD Cellular NSIPHP - EAA in a non-smoker, drug)Alveolar Proteinosis -Follicular Bronchiolitis/*LIP -DIP/RB-ILD -
Significant Fibrosis - Fibrotic NSIP (not prominant honeycombing), CVDUIP** - Fibrosing alveolitisChronic HP
*LIP HIV - Peds CVD - Adults
**UIP IPF Asbestosis Bleomycin - drugs CVD

Mosaic Attenuation

Vessel Size Equal in Lucent and Opacified Areas - CHAFD Cellular NSIPHP - EAA in a non-smoker, drug)Alveolar Proteinosis -Follicular Bronchiolitis/*LIP -DIP/RB-ILD Smaller Vessels in Lucent Region
Air Trapping - ABCAsthma -BO/pan-Bronchiolitis -CF -
No Air Trapping - PPAHPVH

Upper Lobe Disease

SET PARC
Sarcoid/SilicosisEG (smoker)/EAA (nonsmoker)TB/Fungal
PCPAS/NF-1RadiationCF

Peripheral Disease

Multifocal - EPIC SUCSEosinophilic PNAInfarctContusion
SarcoidUIPCOPSeptic Emboli
Focal/Multifocal -Wegener/PEAACoke

Multifocal Opacities - Chronic

ANGIO
Alveolar ProteinosisNeoplasm - Lymphoma (gallium pos), BACGranulomatous - TB/Fungal, Sarcoid - look for adenopathyInflammatory - COP, EPOld age - Chronic aspiration, lipoid PNA
If....Peribronchovascular - KSHIV - KS, Septic emboli

Multifocal Opacities - Acute

Blood - pulmonary hemorrhagePus - PNA, aspiration, varicella zozterWater - edemaCells - EP

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