Aunt Minne and ACR Flashcards
Sjogren syndrome
- salivary gland, lacrimal gland
- keratoconjunctivitis sicca (dry eyes)
- xerostomia (dry mouth).
- LIP - lymphocytic interstitial pneumonia
- cysts
- GGO
- solid-appearance consolidations
- retroperitoneal fibrosis
- bilateral hydronephrosis or hydroureter
*
- bilateral hydronephrosis or hydroureter
Klippel-Feil syndrome
- Sprengel deformity of shoulder - hypoplastic scapula
- cervical fusion
- hemivertebrae
- kyphoscoliosis
- rib anomaly
- anamalies of aortic arch and branching vessels
Types of screws
How to protocol a CT for
lower GI bleed?
CT angiogram
- plain (rule out hyperdense bowel contents)
- arterial phase - active extrav
- venous phase - bleeding bigger?
Most common locations for
carotid artery
vertebral artery
dissection?
Carotid
- just below the skull base
Vertebral artery
- 4th portion as it coming out
Classification of segments of the VA:
V1 is proximal to entry into the transverse foramen of C6. V2 is within the transverse foramen from C6 to C2. V3 is from the transverse foramen of C2 but before entry into the dura. V4 is after entry into the dura.
IV contrast and GFR
GFR
normal > 60
lower limit for diabetics > 50
lower limit for normal pts > 30
Perimesencephalic SAH
Venous bleed
usually benign
Anterior choroidal artery arises superior/later
than take off of PCOMM
Anterior choroidal artery arises superior/later
than take off of PCOMM
Hangman’s fracture
A hangman’s fracture is the colloquial name given to a fracture of both pedicles or pars interarticularis of the axis vertebra (C2).
Unilateral opacification of mastoid air cells?
Look for obstructing tumor in the nasopharyngeal space
blocking the opening of the Eustachian tubes at the Fossa of Rosenmuller
If you see some apparent abnormality on GI fluroscopy
e.g. apparent esophageal narrowing
what do you do?
- Confirm its persistent (not transient)
- Comment on mucosal abnormality
Renal Calyceal Diverticulum
- focal eventration/outpouching of the renal calyx into the renal parenchyma
- usually incidental and asymptomatic
- may have stone formation due to stasis, infection, hematuria
- mimics renal cyst on unenhanced images
- delayed post contrast image - layering/pooling of contrast medium on delayed images - pathognomonic
Ovarian cyst follow up guidelines
In premenopausal women, follow-up of a simple cyst (thin-walled, round, and without internal echoes):
- < 5 cm, no follow-up;
- > 5 cm but < 7 cm, yearly follow-up.
In postmenopausal women with a simple ovarian cyst measuring > 1 cm but < 7 cm, yearly follow-up is recommended.
For patients of any age, further evaluation with MRI or surgical consultation should be considered for a simple cyst > 7 cm.
For any cyst containing septations (other than a single thin septation) or nodules, surgical consultation or further evaluation with MRI should be considered regardless of patient age.
- Thin septations (< 3 mm) and nodules without vascular flow suggest neoplasms that are likely benign;
- thick septations and nodules with vascular flow suggest malignancy.
Outlets of the
Pterygopalatine Fossa
- anterior - inferior orbital fissure - infraorbital nerve and artery (infraorbital canal)
- medial - sphenopalatine foramen - nasal cavity
- lateral - pterygomaxillary fissure - infratemporal fossa
- inferior - greater/lesser palatine canal
- posterior - foramen rotundum - V2 - middle cranial fossa
- posterior - pterygoid canal/Vidian canal - froamen lacerum/middle cranial fossa
- posterior - platovaginal canal (pharyngeal) - nasal cavity/nasopharynx
Contents of
Pterygopalatine Fossa
- terminal third of the maxillary artery
- maxillary (V2) of the trigeminal nerve
- pterygopalatine ganglion pass.
A young man presenting with epistaxis and a pterygopalatine mass
Dx?
Juvenile nasopharyngeal angiofibroma
- is the most common benign tumor of the nasopharynx
- Most commonly presenting in young men
- typically originates from the posterolateral wall of the nasal cavity and extends through the sphenopalatine foramen into the PPF.
- From the fossa, the tumor can then spread to the sphenoid, cavernous, or paranasal sinuses, or, rarely, to the parapharyngeal space or pterygoid muscle region.
DDx for persistent umbilical discharge
in a newborn?
- persistent urachal tract - urine leakage from bladder
- A voiding cystourethrogram would demonstrate if there is a fistulous connection from the bladder to the umbilicus
- persistent vitelline tract - fluid and feces leakage from the GI tract
- A Meckel diverticulum is a remnant of the vitelline duct protruding from the ileum.
Multiloculated cystic nephroma
- cystic mass
- may be septated and displacing the normal collecting system.
- compressed collecting system
DDx
- renal cyst
- cystic RCC
- cystic partially differentiated nephroblastoma (CPDN)
Most common breast neoplasm associated with
breast implants?
Anaplastic large cell lymphoma
- T-cell origin, indolent
- capsular mass
- peri-implant seroma
Mycotic aneurysm
- usually peripehral in location
- look for areas of infarction/hemorrhage
- only evident weeks out from endocarditis
- Rx: Abx +/- vessel sacrifice
Indications for V/Q scan
- contrast allergy
- renal failure
- to decrease dose to the breasts - pregnancy or postpartum
When to reduce Tc-99 MAA?
- pulmonary arterial hypertension
- only one lung
- pediatric patients
- right to left shunt
- usually only 1/1000 arterioles are occluded
Triple scan
abnormal matched
ventilation
perfusion
CXR
= very low probability
Reverse mismatch
ventilation defects
normal perfusion
= very low probability
causes
- bronchial obstruction, mucus plug
- COPD
- pleural effusion
- atelectasis
- pneumonia
PTC
percutaneous transhepatic cholangiography
Parallel ventricle configuration
racecar appearance
absence of corpus callosm
associated with lipoma
- curvilinear
- tubulonodular
Signs of intracranial hypotension
- diffuse pachy meningeal enhancement
- subdural effusions
- brain swelling
- sagging brain
- corpus callosum - drooping penis sign
- rounding of the dural venous sinuses
- tonsillar ectopia
- rounded pituitary gland
Enhancement pattern of CNS lymphoma
- immunocompetent - diffuse enhancement
- immunosuppressed - rim enhancement
Weber ankle fracture classification
Types of gastric volvulus
- organoaxial - higher risk of vascular compromise; associated with diaphragmatic defect
- mesenteroaxial - short axis
Techniques for upper GI series
- start with esophagus
- LAO swollow and follow
- lateral swallow and follow
- then do the stomach and duodenum
- pt prone first - shoot
- pt on to left lat decub and supine - shoot
- then roll another 360 and shoot
- then RAO - contrast in the fundus, duodenal cap double contrast!
- then LAO, double contrast of the gastric cardia and fundus
- lateral
Young patient with RCC
- meduallary RCC
- West African - Sickle cell
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Intrahepatic portosystemic venous shunt
IPSVS
- IPSVS is an uncommon entity that can be incidentally discovered during imaging of an asymptomatic patient or during the work-up of a patient with cirrhosis and/or hepatic encephalopathy.
- IPSVS may be due to persistence of the vitelline and umbilical systems during early embryological development (congenital origin theory) or secondary to trauma, surgery, or cirrhosis (acquired theory).
- Treatment for the asymptomatic patient is not required. Diet control with restricted protein intake and lactulose supplementation is indicated in the symptomatic patient with hepatic encephalopathy. Surgical ligation or transcatheter embolization can be performed in the symptomatic patient refractory to medical management.
Localized fibrous tumor of the pleura
- rare
- women
- 50-70 years old
Leiomyosarcoma
Rhabdomyosarcoma
Chondrosarcoma
- Leiomyosarcoma - older adults
- Rhabdomyosarcoma - children and younger adults
- Chondrosarcoma - can show intratumoral mineralization best seen on CT
Askin Tumor of the Chest Wall
- rare tumor of the Ewing’s sarcoma family
- small blue cell tumor
- children and young adults
- heterogenous mass with pleural effusion and rib invasion/destruction
- Other members of the Ewing sarcoma family of tumors
- Ewing sarcoma
- peripheral primitive neuroectodermal tumor
- neuroepithelioma
- atypical Ewing sarcoma
- Askin tumor
Askin Tumor
- On chest CT, a heterogeneous mass is usually seen due to hemorrhage and necrosis.
- Pleural effusion, along with destructive invasion of the ribs, is also commonly seen.
- Given the nonspecific findings that are typical with Askin tumor, biopsy is necessary for diagnosis.
Pneumatosis intestinalis
- It is important to recognize pneumatosis intestinalis, however, its significance depends on etiology and clincial setting
- primary - 15%
- secondary - 85%
- Bowel necrosis (most common): Necrotizing enterocolitis, bowel infarction, caustic ingestion
- Mucosal disruption: Endoscopy, ulcers, obstruction, inflammatory bowel disease (IBD, bowel anastomoses
- Increased mucosal permeability: Steroids, chemotherapy, immunosuppressive therapy, immunodeficiency states
- Autoimmune: Systemic lupus erythematosus, scleroderma or other collagen vascular diseases
- Pulmonary: Asthma, chronic obstructive pulmonary disease, positive pressure ventilation, pneumothorax or trauma
- Portal venous gas
- Intestinal wall lesions: Ischemia, IBD
- Bowel distention: Endoscopy, obstruction, trauma
- Sepsis: Diverticulitis, cholecystitis, appendicitis, colitis including clostridium difficile infection
Most common primary malignant neoplam of the duodenum
- adenocarcinoma of the duodenum
- almost always 2nd, 3rd, and 4th portions
- distal to the ampulla of the Vater
Most common location for small bowel adenocarcinoma
Duodenum
Chondrodysplasia punctata
- A heterogenous group of disorders in which there are multiple radiographic calcifications within the cartilage of growing bone.
- This is a congenital defect in calcium deposition of endochondral bones.
- Tumoral calcinosis is autosomal dominant
- Multiple or solitary painless periarticular calcific masses with associated hyperphosphatemia
- Well-circumscribed, lobular, amorphous calcific masses in a bursal distribution, usually involving the extensor surfaces of large joints. A “sediment sign” can be seen from layering calcium, resulting in fluid-fluid levels. Pertinent negatives include lack of osseous involvement and lack of noncalcified soft-tissue masses.
- There are many mimics of tumoral calcinosis:
- chronic renal failure
- calcinosis universalis
- calcific tendinitis
- synovial osteochondromatosis
- myositis ossificans
- calcific myonecrosis
