Aunt Minnies Flashcards
Thoracic Aortic Dissection (type A)
- widened, lobulated mediastinal contour
Dissection With Aortic Arch Involvement
-) MR images demonstrate the intimomedial dissection flap (arrows) with delineation of the true (T) and false (L) lumens. The true lumen (T) is smaller and demonstrates acute angles with the dissection flap, while the larger false lumen (F) demonstrates obtuse angles at interface with the flap. Note also the small pericardial and left pleural effusions, most evident in A. Sagittal reformat (C) shows the dissection extending into the arch but not involving the ascending aorta.
Sinus of Valsalva Aneurysm.
-Coronal oblique CTA in a patient with chest pain and no significant past medical history shows a large aneurysm arising from the left sinus of Valsalva (A, arrow) . Still image from a coronary angiography shows that the large sinus of Valsalva aneurysm stretches and narrows the left anterior descending coronary artery (B, arrow)
Pseudocoarctation.
PA chest radiograph (A) demonstrates a rounded density (white arrow) superior to the aortic arch (black arrow) . On sagittal CT (B), the aortic arch and proximal descending thoracic aorta are elongated and folded on themselves (white arrow), producing focal kinking (white arrow) but without significant narrowing
Type B Interrupted Aortic Arch
-3D VR shows a type B interrupted aorta arch with the ascending aorta (dashed yellow arrow) giving rise to the right brachiocephalic artery (yellow arrowhead) and left common carotid artery (LCCA, white arrowhead). The aortic arch is absent, or interrupted, after the origin of the LCCA (white arrow). The left subclavian artery (dashed white arrow) arises from the descending thoracic aorta which received flow through a large patent ductus arteriosus (yellow arrow)
Cervical Arch With Aberrant Left Subclavian Artery.
-Coronal oblique MIP CT image shows the ascending aorta extending high into the right supraclavicular region (red arrows) with a rightsided cervical arch (yellow arrow). Similar to other right arches with an aberrant subclavian artery, the first vessel of the aorta is the left common carotid artery (yellow arrowheads) followed by the right common carotid artery (white arrow) and right subclavian artery (not visualized). The last branch off the aorta is the aberrant left subclavian artery (black arrow)
Double Aortic Arch
-Axial MIP image in a 1-month-old baby with severe stridor and vomiting (A) shows a double aortic arch creating a vascular ring and causing compression of the trachea (black arrow). Additionally, lateral view from an esophagram (B) shows marked compression of the posterior wall of the esophagus (black arrow).
Double Aortic Arch
-PA chest radiograph in an adult (A) with mild dysphagia demonstrates two bilateral indentations on the lower trachea (*), a slightly larger and more superior right indentation (red arrow) and slightly smaller and more inferior left indentation (white arrow). Coronal CT image (B) shows that the indentations represent a larger and more superior right aortic arch (red arrow) and smaller and more inferior left aortic arch (white arrow). Axial MIP image (C) shows the double aortic arch. The right arch is larger than the left arch, which is common.
Four-Vessel Arch
-Oblique sagittal MIP CT demonstrates separate origin of the left vertebral artery (3) between the left common carotid artery (2) and left subclavian artery (4) . The brachiocephalic artery (1) is the first branch off the arch.
Two-Vessel Arch (BovineArch)
-3D volume-rendered image of the aortic arch shows common origin (*) of the brachiocephalic artery and left common carotid artery.
ductus diverticulum” or “ductus bump”
Subclavian Steal
-Coronal MIP CT demonstrates NARROWING of the proximal left subclavian artery secondary to large noncalcified atherosclerotic plaque (arrow). Normal origins of the vertebral arteries (*) from the ipsilateral subclavian arteries. Patient presented with diminished left upper extremity pulses.
Quadricuspid Aortic Valve
Unicuspid Aortic Valve
-CT image transverse to the aortic valve demonstrates a single, eccentric opening/commissure (arrow, A), indicating an unicuspid valve
Ulcerated Plaque
-Parasagittal (A) and axial (B) CT images of the aorta show extensive layering, mixed but predominantly noncalcified plaque throughout the thoracic aorta (white arrows). In certain areas, contrast can be seen extending into the plaque (yellow arrows) but does not extend beyond the intima, which is demarcated by a thin calcification along the aortic wall (white arrowheads).
Penetrating Atherosclerotic Ulcer (PAU
-contrast outpouching in the mid-descending thoracic aorta (white arrow) which extends beyond the calcified intima (yellow arrow), consistent with a PAU. Noncontrast CT image (B) just inferior to this level shows subtle high attenuation in the aortic wall (white arrow) due to adjacent hematoma.
Proximal Descending Aorta Pseudoaneurysm.
-large saccular pseudoaneurysm (P) along the inferior aspect of the aortic arch and descending thoracic aorta. A relatively narrow neck (yellow arrows) connects the aorta to the pseudoaneurysm. This represents a contained aortic rupture.
pericardial cyst
-PA (A) and lateral (B) radiographs in a 59-year-old woman with a cough shows a smooth, ovoid mass in the right cardiophrenic sulcus (white a
Ddx: pericardial diverticula (with connection to fluid in pericardial space)
Pericardial Effusion
- The cardiac silhouette is markedly enlarged and has a rounded, globular appearance
Ventricular Septal Defect (VSD)
-Cardiac enlargement that is predominantly left sided with increased pulmonary vascularity are.
- Lateral view demonstrates left atrial enlargement (arrows).
Atrial Septal Defect (ASD)
- Cardiomegaly, mild right atrial enlargement, and increased pulmonary vascularity
- Lateral view shows a normal LA and fullness in the retrosternal region (arrow) caused by right ventricular enlargement
Patent Ductus Arteriosus (PDA)
-The heart is enlarged, with left-sided prominence with increased pulmonary vascularity AND prominent aorta (arrow).
Transposition of the Great Vessels (TGV)
-oval heart shape with a prominent apex and variable cardiomegaly and a narrow upper mediastinum
- “EGG ON A STRING”
Total Anomalous Pulmonary Venous Return
“SNOWMAN” Appearance
Cor Triatriatum
- Sagittal MR image reveals the membrane (arrow) within the left atrium into which the common pulmonary vein enters, resulting in pulmonary venous obstruction.
Persistent Truncus Arteriosus
-Oval cardiomegaly, INCREASED pulmonary vascularity, a concave pulmonary artery segment (arrow), and a RIGHT AORTIC ARCH.
Tetralogy of Fallot
“Boot-shaped” heart
ASD
*hypervascular, right-sided cardiomegaly, unenlarged LA
TAPVR type 1
*Snowman sign
*type 1; supracardiac; (most common type)
Ebstein Anomaly
*water bottle sign
TGV (transposition of the great vessel)
*egg-on-a-string appearance
Mitral Valve Prosthetic
*Aortic valve prosthetic (more superior and medial ring)
*sternotomy wires
Pulmonary Stenosis with Post-Stenotic Dilation
VSD
*hypervascular; left-sided cardiomegaly
Aortic Stenosis
-tortuous ascending aorta, mild LV enlargement
Mitral Valve Stenosis
-DOUBLE DENSITY sign: enlarged LA
Ebstein Anomaly
*Atrialization of the right ventricle
Coarctation With Rib Notching
-affects 4th to 8th POSTERIOR rib (localized type); seen in adults
-juxtaductal; narrowing @ or just distal to the DA
Ramus Intermedius
-The left main coronary artery (white arrowhead) shows that the vessel trifurcates into the left anterior descending (red arrow), left circumflex (black arrow), and ramus intermedius branches (white arrow) .
- A ramus intermedius is present in 20–30% of the population and may be a diminutive vessel, or as in this case, a large caliber vessel.
Napkin-Ring Sign.
-Transverse (A) and longitudinal (B) images through the mid-LCx show positive remodeling with only a mild stenosis.
-The positive remodeling demonstrates a few areas of low attenuation plaque (yellow arrow). In addition, there is fine linear enhancement along the periphery of the noncalcified plaque, creating a “napkin-ring” sign (white arrows, A, B). This is another finding suggestive of a “vulnerable plaque
Coronary Artery Aneurysms.
-Sagittal oblique MPR image through the RCA shows extensive atherosclerotic disease with multiple RCA aneurysms (white arrows).
-The partially visualized LAD is also aneurysmal (white arrowhead)
Cardiac Lipoma
-Axial CT image (A) with multiplanar reconstructions in the threechamber (B) and short-axis (C) views demonstrates a hypodense intramural mass (arrow) in the apical interventricular septal segment. Axial SSFP MR image (D) demonstrates peripheral “India ink” artifact (arrow) indicating the presence of a fat-containing lesion. These findings are most consistent with an intramyocardial lipoma.
Valvular Papillary Fibroelastoma
-Multiplanar CT images in the three-chamber (A), LVOT (B), and aortic valve (C) views demonstrate a pedunculated mass (arrow) arising from the commissure between the left and right aortic valve leaflets.
Rhabdomyoma
Cardiac Fibroma
- demonstrates hypointense signal on T1W images (B), hypointense signal on T2W images (C) without and with fat saturation (D), lack of contrast enhancement during perfusion (E)
Cardiac Hemangioma
-Multiple cardiac MR images in the two-chamber view demonstrate an exophytic large mass (arrow) arising from the left ventricular apex which demonstrated iso- to mildly hyperintense signal on the SSFP (A) and T1W images (B), and intense enhancement on the postcontrast imaging (C
Cardiac Paraganglioma
-Axial postcontrast ECG-gated CT (A) demonstrates an avidly enhancing mediastinal mass situated between the ascending aorta and main pulmonary artery (arrow). Sagittal (B) and coronal (C) oblique CT-reconstructed images demonstrate invasion of the mass (arrow) into the right ventricular outflow tract (arrowhead). The lesion (arrow) demonstrates hyperintense signal on T2W fat-saturation MR axial images
Cardiac Hamartoma.
-Axial T1W (A) and short-axis SSFP (B) MR images demonstrate a large intramural isointense lesion (between the arrows) in the anterior and anterolateral segments of the left ventricle, which demonstrates diffuse enhancement on the postcontrast axial image (C) in a patient with a known recurrent hamartoma.
Cardiac Angiosarcoma.
-Axial (A) and coronal (B) postcontrast CT images demonstrate a heterogeneous enhancing mass in the right atrioventricular groove (arrow) with a pericardial effusion (arrowhead). CMR shows a heterogeneous hyperintense lesion on the SSFP (C) and T2W images (D) with avid enhancement on both the perfusion (E) and LGE (F) sequences. The central nonenhancing area within the mass represents necrosis.
Cardiac Lymphoma.
-Postcontrast axial CT (A) and MR SSFP imaging in the fourchamber view (B) demonstrate a multilobulated mass (arrow) in the right atrium extending along the lateral aspect into the right ventricle (arrowhead). It demonstrates isointense signal on the T2W images and minimal to no enhancement on LGE images.
Lipomatous Hypertrophy of the Interatrial Septum.
-Axial CT (A) demonstrates a lowdensity lesion in the interatrial septum (arrow) which is FDG avid on a PET-CT due to the presence of
Starr–Edwards caged ball valve prostheses in the mitral and aortic positions.
mitral annular calcifications
Thymus
HYPERPARATHYROIDISM
subperiosteal resorption along the radial (lateral) aspects of the middle phalanges of the index, middle and ring fingers, a finding virtually pathognomonic.
Armored Brain appearance
longstanding cSDHs, seen as densely calcified bifrontal subdural hematomas
“Mount Fuji” sign
- caused by cortical veins tethering the frontal lobes,
- indicates TENSION PNEUMOCEPHALUS.
Osborn:
T1 and T2 signals of extracellular methemoglobin in parenchymal hge
Zenker Diverticulum
Midesophageal Diverticulum
Epiphrenic Diverticulum
Lückenschädel skull
(a.k.a Lacunar skull or craniolacunae)
-a dysplasia of the membranous skull vault
-associated w/ Chiari II
-inner table is more affected
“zebra stripes”
- alternating hyperdensity (blood) and low density (edema) in the right cerebellum, consistent with remote cerebellar hemorrhage.
Shepherd Crook Deformity
- coxa varus angulation of the proximal femur
Seen in:
- fibrous dysplasia (classically)
-Paget disease of bone
- osteogenesis imperfecta.
Hiatal Hernia
Garland triad, also known as the 1-2-3 sign or pawnbroker’s sign
- Sarcoidosis (stage 1, MC)
- Bilateral hilar and (R) paratracheal lymphadenopathy
A. Dagger sign
B. Trolley Track sign
Seen in Ankylosing Spondylitis
Diagnosis
Parosteal Osteosarcoma
- Large lobulated exophytic, cauliflower-like mass with central dense ossification adjacent to the bone
Ddx:
1. CORTICAL DESMOID- avulsive injury of post. femoral cortex
2. MYOSITIS OSSIFICANS- from prev trauma; pattern of calci: peripheral to central
3. SESSILE OSTEOCHONDROMA- w/ communication of the medullary canal of the bone and cortical tumor
Pseudodislocation sec to joint effusion
calcaneal stress fracture
Mallet Finger
-hyperflexed DIP
Yellow: Buotonnierre deformity
RED: Hitchhikers thumb
Telescoping of fingers
*Arthritis Mutilans
- severe form of many inflammatory arthropathies, most commonlypsoriatic (PsA)andrheumatoid arthritis (RhA)
- hand > feet
saucer-shaped radiolucent cortical irregularity involving the posteromedial aspect of the distal femoral metaphysis at the attachment of the adductor magnus tendon
Myositis Ossificans
Dichorionic, Diamnionic Twin Pregnancy
Intervening membrane is thick
- groove between the membranes at the insertion into the placenta appears thick
MONOchorionic, DIamnionic Twin Pregnancy
- insertion cleanly joins the chorionic plate of the placenta as a THIN, wispy membrane
Placenta Accreta; Swiss Cheese Apperance
Cob Web or Spder Web appearance of HEMORRHAGIC CORPUS LUTEUM cyst
Breast within a Breast
Breast Hamartoma/ Fibroadenolipoma
Normal Chest Radiograph
