Upper Lobe Lung Diseases - STAR CHASERS Mnemonic

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Upper Lobe Lung Diseases - STAR CHASERS Mnemonic



S - Silicosis

T - Tuberculosis

A - Ankylosing Spondylitis

R - Radiation

C - Cystic Fibrosis 

H - Hypersensitivity Pneumonitis, Histoplasmosis

A - Aspergillus/ABPA

S - Sarcoidosis

E - Eosinophilic pneumonitis

R - Regurgitant MV

S - Smoke inhalation



Etiology:

Lung Apex:

 • Relatively overventilated (ratio of ventilation to perfusion: 3:1), and the base is relatively overperfused (ratio: 0.6:1).

 • Therefore, conditions caused by inhalation of toxic substances primarily affect the apices of the lung.

 • Lymphatics clear smaller particles

 • Lymphatic particle clearance ↓ at the apices thus granulomatous disorders, such as tuberculosis or sarcoidosis, appear predominantly in the upper lobes

 • Metabolic factors, such as regional uptake of oxygen, elimination of CO2 & pH in the lung, differ due to inequalities of the V/Q ratio. These factors contribute to the upper zone predisposition of conditions such as metastatic pulmonary calcification and tuberculosis.

 • ↑ Mechanical stress of the pulmonary apices caused by a rigid chest cage may result in fibrobulous apical lesions, as in patients with ankylosing spondylitis.



Pulmonary Diseases With Upper Lobe Predominance:

 • Inhaled injurious gases:

	- Smoke inhalation

	- Centrilobular emphysema

 • Impaired mucociliary clearance:

	- Cystic Fibrosis

 • Inhaled particulates:

	- Pneumoconioses

	- Silicosis

	- Coal worker pneumoconiosis

	- Berylliosis

 • Miscellaneous pneumoconioses:

	- Hard metal disease, kaolinosis, bauxite pneumoconiosis, fuller’s earth disease

 • Inhaled antigens:

	- Hypersensitivity pneumonitis

	- Allergic bronchopulmonary aspergillosis

	- Chronic eosinophilic pneumonia

 • Granulomatous diseases:

	- Tuberculosis

	- Sarcoidosis

	- Langerhans cell histiocytosis

	- Bronchocentric granulomatosis

 • Abnormal perfusion kinetics:

	- Right-sided localized pulmonary edema in acute mitral regurgitation

	- Neurogenic pulmonary edema

 • Metabolic diseases:

	- Metastatic pulmonary calcification

 • Increased mechanical stress:

	- Ankylosing spondylitis



Ref: American Journal of Roentgenology. 2013;200: W222-W237. 10.2214/AJR.12.8961



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Contributed by

Ravi Singh K
@rav7ks
Academic Hospitalist and Program Director @SinaiBmoreIMRes,  Medicine clerkship director GW School of Medicine and Health Sciences RMC at Sinai, Clinical reasoning,Simulation and POCUS enthusiast - https://twitter.com/rav7ks
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