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Radiology at Harvard Medical School
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Radiology at Harvard Medical School

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Questions and Answers

What does the presence of multiple random nodules on an axial CT indicate in the case of metastatic colon cancer?

  • Nodules predominantly develop due to cell lymphoma.
  • Nodules arise from intra-pleural infections.
  • Nodules are primarily due to viral infections.
  • Nodules likely occur via hematogenous spread. (correct)
  • Which condition is characterized by innumerable tiny random nodules resembling millet seeds on an axial CT?

  • Viral pneumonia.
  • Atypical mycobacterial infection.
  • Aspiration pneumonia.
  • Miliary tuberculosis. (correct)
  • What typically causes tree-in-bud nodules on an axial CT?

  • Metastatic spread of tumors.
  • Interstitial lung disease.
  • Airway obstructions.
  • Mucus, pus, or fluid impacting bronchioles. (correct)
  • Which infections are commonly associated with tree-in-bud nodules?

    <p>Mycobacterium tuberculosis and atypical mycobacteria.</p> Signup and view all the answers

    What patterns of nodules might suggest lymphangitic carcinomatosis?

    <p>Tree-in-bud patterns in larger central airways.</p> Signup and view all the answers

    Which statement accurately describes the tree-in-bud pattern on an axial CT?

    <p>Nodules appear in a linear connection akin to a tree's branches.</p> Signup and view all the answers

    What distinguishes miliary nodules from other patterns of lung nodules?

    <p>Random distribution of tiny nodules.</p> Signup and view all the answers

    In which situation would random nodules likely not appear?

    <p>Localized bacterial pneumonia.</p> Signup and view all the answers

    Which condition is characterized by uniformly distributed, thin-walled cysts in the lungs?

    <p>Lymphangioleiomyomatosis (LAM)</p> Signup and view all the answers

    What differentiates cysts from emphysema?

    <p>Cysts do not have anything inside</p> Signup and view all the answers

    Which syndrome is an autosomal dominant genetic disorder associated with renal and pulmonary cysts?

    <p>Birt-Hogg-Dube syndrome</p> Signup and view all the answers

    Which complication can occur as a result of pulmonary cysts?

    <p>Spontaneous pneumothoraxes</p> Signup and view all the answers

    Which infectious agents are primarily associated with ventilator-associated pneumonia (VAP)?

    <p>Gram-negative rods such as Pseudomonas and Acinetobacter</p> Signup and view all the answers

    Pneumonia in immunocompromised patients can involve which additional pathogens?

    <p>Opportunistic infections including Pneumocystis and fungi</p> Signup and view all the answers

    What characterizes lymphoid interstitial pneumonia (LIP)?

    <p>It is characterized by lymphocytic infiltrate and multiple cysts.</p> Signup and view all the answers

    Which of the following describes a bulla in the context of lung pathology?

    <p>An air-filled emphysematous space measuring &gt;1 cm</p> Signup and view all the answers

    What is a potential risk associated with benign papillomas?

    <p>They may transform into carcinoma.</p> Signup and view all the answers

    What causes multiple papillomas, such as laryngotracheal papillomatosis?

    <p>HPV infection acquired at birth.</p> Signup and view all the answers

    Which condition is characterized by the destruction of alveolar walls?

    <p>Centrilobular emphysema.</p> Signup and view all the answers

    What role does alpha-1-antitrypsin play in the lungs?

    <p>It neutralizes excess elastase.</p> Signup and view all the answers

    Where is centrilobular emphysema primarily found in the lungs?

    <p>Predominantly in the upper lobes.</p> Signup and view all the answers

    Which of the following best describes the effect of excess elastase on lung tissue?

    <p>It causes lung destruction.</p> Signup and view all the answers

    What is a distinguishing feature of paraseptal emphysema?

    <p>It has anteromedial distribution.</p> Signup and view all the answers

    Which of the following lesions is NOT typically considered benign?

    <p>Malignant tumors.</p> Signup and view all the answers

    What is the most common cause of lobar pneumonia?

    <p>Bacterial infections</p> Signup and view all the answers

    Which type of pneumonia is characterized by patchy peribronchial consolidation?

    <p>Bronchopneumonia</p> Signup and view all the answers

    What condition is indicated by the presence of an infectious mass-like opacity in children?

    <p>Round pneumonia</p> Signup and view all the answers

    What does an empyema specifically refer to?

    <p>Infection within the pleural space</p> Signup and view all the answers

    In which stage of empyema is simple drainage an adequate treatment?

    <p>Free-flowing exudative effusion</p> Signup and view all the answers

    Which bacteria is typically associated with the formation of pulmonary abscesses?

    <p>Pseudomonas</p> Signup and view all the answers

    Which condition results in ground glass opacities on a CT scan?

    <p>Interstitial pneumonia</p> Signup and view all the answers

    How does a parapneumonic effusion differ from an empyema?

    <p>Parapneumonic effusion is sterile</p> Signup and view all the answers

    Who is the Fellowship Program Director for Abdominal Imaging and Intervention?

    <p>Daniel Souza, MD, MSc</p> Signup and view all the answers

    Which contributor is associated with the Division of Emergency Radiology?

    <p>Ellen X. Sun, MD</p> Signup and view all the answers

    Who among the contributors is a Clinical Fellow in Musculoskeletal Radiology?

    <p>Junzi Shi, MD</p> Signup and view all the answers

    Which contributor holds the title of Assistant Professor of Radiology?

    <p>Fiona E. Malone, MD</p> Signup and view all the answers

    What role does Michael L. Steigner serve at Brigham and Women’s Hospital?

    <p>Staff Radiologist, Division of Cardiovascular Imaging</p> Signup and view all the answers

    Which individual is a resident in Radiology at Brigham and Women’s Hospital?

    <p>Fiona E. Malone, MD</p> Signup and view all the answers

    What type of medical professionals are over half of the listed contributors?

    <p>Residents in Radiology</p> Signup and view all the answers

    Which of the following individuals is not affiliated with Harvard Medical School?

    <p>Jaqueline Liu</p> Signup and view all the answers

    Study Notes

    Contributors and Affiliations

    • Lopez, MD, MBA: Assistant Professor of Radiology, Harvard Medical School, Brigham and Women’s Hospital
    • Cory Robinson-Weiss, MD: Clinical Fellow in Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School
    • Yuntong Ma, MD: Resident in Radiology, Brigham and Women’s Hospital, Harvard Medical School
    • Christopher G. Sakellis, MD: Staff Radiologist, Division of Nuclear Medicine, Harvard Medical School
    • Fiona E. Malone, MD: Resident in Radiology, Brigham and Women’s Hospital, Harvard Medical School
    • Junzi Shi, MD: Clinical Fellow in Musculoskeletal Radiology, Brigham and Women’s Hospital, Harvard Medical School
    • Michael L. Steigner: Staff Radiologist, Division of Cardiovascular Imaging, Brigham and Women’s Hospital, Associate Professor of Radiology, Harvard Medical School
    • Daniel Souza, MD, MSc: Fellowship Program Director, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women’s Hospital
    • Ngoc-Anh T. Tran, MD: Resident in Radiology, Brigham and Women’s Hospital, Harvard Medical School
    • Ellen X. Sun, MD: Staff Radiologist, Division of Emergency Radiology, Brigham and Women’s Hospital

    Medical Imaging Findings

    • Random Nodules on CT:

      • Metastatic colon cancer case presented with multiple random nodules abutting the pleural surface.
      • Differential diagnosis includes hematogenous metastases and disseminated infections.
    • Miliary Nodules:

      • Case of miliary tuberculosis displayed innumerable tiny random nodules distributed throughout both lungs.
      • Miliary pattern reflects extensive disease caused by hematogenous spread.

    Specific Nodule Patterns

    • Tree-in-Bud Nodules:

      • Appears as small nodules "budding" from linear branching structures, indicative of mucus-impacted bronchioles.
      • Associated with small airway infections such as atypical mycobacteria or tuberculosis.
    • Cysts in Lungs:

      • Differential for multiple lung cysts includes:
        • Lymphangioleiomyomatosis (LAM), characterized by diffuse, thin-walled cysts.
        • Pulmonary Langerhans cell histiocytosis showing irregular upper lung cysts.
        • Birt-Hogg-Dube syndrome associated with renal and pulmonary cysts.

    Pneumonia Complications

    • Pulmonary Abscess:

      • Result of necrosis due to bacteria such as Staphylococcus aureus, commonly presenting with an air-fluid level.
    • Empyema:

      • Infection in pleural cavity developing through three stages, often requiring surgical intervention in advanced cases.

    Types of Pneumonia

    • Lobar Pneumonia:

      • Consolidation of a single lobe, commonly bacterial in nature.
    • Bronchopneumonia:

      • Patchy consolidation across multiple lobes, caused by various pathogens.
    • Interstitial Pneumonia:

      • Misnomer for ground-glass opacities typically induced by atypical pathogens.
    • Round Pneumonia:

      • Infectious opacity commonly observed in children, often due to Streptococcus pneumoniae.

    Emphysema and Lung Pathology

    • Emphysema Characteristics:

      • Involves destruction of alveolar walls leading to abnormal enlargement of airspaces, linked to macrophage activity and excess elastase.
    • Centrilobular Emphysema:

      • Predominantly affects upper lobes, largely related to smoking.
      • Emphasizes the role of macrophage-mediated inflammation in lung diseases.

    Key Points to Note

    • Accurate diagnosis relies on understanding imaging patterns and context of symptoms.
    • Differential diagnoses are vital to differentiate conditions with similar radiological appearances.
    • The interplay between infections, inflammation, and lung structure (like presence of nodules or cysts) is crucial for clinical evaluation and management.

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    Quiz Team

    Description

    Explore the training and expertise of Harvard Medical School's radiology professionals. This quiz covers various aspects of radiology education, including the roles of residents and clinical fellows. Test your knowledge on the faculty and the institutions associated with advanced imaging practices.

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