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Clinical Radiology 2A > Cardiothoracic > Flashcards

Cardiothoracic Flashcards

1
Q

What are the imaging features of sarcoidosis?

A

Bilateral hila + right paratracheal lymph nodes

Perilymphatic nodules with upper lobe predominance

Late : upper lobe fibrosis + traction bronchiectasis

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2
Q

What are the causes of right heart failure?

A

Left heart failure (most common)

Chronic PE

Right-sided valve issues (tricuspid regurgitation)

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3
Q

Interstitial lung disease related to smoking with poorly defined apical centrilobular nodules

A

Respiratory bronchiolitis-interstitial lung disease

(RB-ILD)

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4
Q

What is the most common interstitial lung disease in scleroderma?

A

Non-specific interstitial penumonia

(NSIP)

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5
Q

Interstitial lung disease with lower lobe, peripheral predominance and sparing of the immediate subpleural lung.

A

Non-specific interstitial pneumonia

(NSIP)

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6
Q

What is the differential for perilymphatic pulmonary nodules?

A

Sarcoidosis (90%)

Silicosis

Lymphangitic spread of cancer

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7
Q

How can you differentiate between cancer and progressive massive fibrosis on MRI?

A

Cancer = T2 bright

PMF = T2 dark

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8
Q

Silicosis increases your risk of which infection?

A

TB

(by 3-fold)

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9
Q

Which type of emphysema is seen in alpha-1-antitrypsin deficiency?

A

Panlobular with lower zone predominance

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10
Q

Which of the following options is negative on thallium201 scan?

  1. Kaposi 2. Lymphoma 3. PCP
A
  1. PCP
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11
Q

Which of the following options is negative on gallium67 scan?

  1. Kaposi 2. Lymphoma 3. PCP
A
  1. Kaposi
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12
Q

Which of the following options is positive on both gallium67 and thallium201 scan?

  1. Kaposi 2. Lymphoma 3. PCP
A
  1. Lymphoma
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13
Q

Lymphocytic interstitial pneumonitis (LIP) is associated with which conditions?

A

Sjogren’s (most common)

HIV ← answer if in a child

SLE

RA

Castleman

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14
Q

Birt Hogg Dube cystic lung disease has what kind of cysts?

A

Thin-walled oval cysts

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15
Q

Lymphangiomyomatosis (LAM) is associated with which kind of pleural effusions?

A

Chylous

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16
Q

What is the most common cardiac manifestation of tuberous sclerosis?

A

Rhabdomyoma

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17
Q

Lymphangiomyomatosis (LAM) is associated with which phakomatosis?

A

Tuberous sclerosis

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18
Q

What are the patient and radiology characteristics of Langerhan’s cell histiocytosis (LCH)?

A

Smokers aged 20-30

Centrilobular nodules with upper lobe predominance which cavitate into cysts

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19
Q

Which conditions classically spare the costophrenic angles?

A

Langerhans cell histiocytosis (LCH)

Hypersensitivity pneumonitis

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20
Q

Extralobar sequestration is associated with which other anomalies?

A

Congenital cystic adenomatoid malformation (CCAM)

Congenital diaphragmatic hernia

Vertebral anomalies

Congenital heart disease

Pulmonary hypoplasia

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21
Q

Which lung segment is most common segment for intralobar pulmonary sequestration?

A

Posterior segment of the left lower lobe

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22
Q

Which condition, intralobar or extralobar sequestration, presents in adolescence or adulthood with recurrent pneumonia?

A

Intralobar

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23
Q

Which condition, intralobar or extralobar sequestration presents in infancy with respiratory compromise?

A

Extralobar

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24
Q

Poland syndrome results in aplasia/hypoplasia of pec major (most common), pec minor, 2-5th ribs and breast/nipple. What other associations are there?

A

Upper limb abnormalities (small hand + brachysyndactyly, simian crease)

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25
Q

Where does a persistent left SVC normally drain?

A

Coronary sinus

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26
Q

What syndrome is associated with pulmonary arteriovenous malformations (AVM)?

A

Hereditary haemorrhagic telangiectasia

(Osler-Weber-Rendu syndrome)

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27
Q

Which lung segment is most commonly involved in bronchial atresia?

A

Apical-posterior segment of the left upper lobe

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28
Q

AIDs patient with lung nodules, pleural effusion and lymphadenopathy. What is the most likely diagnosis?

A

Lymphoma

(almost exclusively high grade NHL, CD4 < 100)

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29
Q

Carcinoid heart disease can occur in which cancers without liver metastases?

A

Bronchial carcinoid tumour

Ovarian carcinoid tumour

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30
Q

What scan can be carried out to localise a carcinoid tumour?

A

Octreotide scan

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31
Q

Which cardiac valves can be affected in GI carcinoid syndrome?

A

Tricuspid & pulmonary

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32
Q

Which cancers can cause the classic “cannonball” metastases?

A

Renal cell

Choriocarcinoma (testicle)

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33
Q

Which cancers cause lymphangitic calcinomatosis?

A

Bronchogenic (most common)

Breast

Stomach

Pancreas

Prostate

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34
Q

What is the bacterium responsible in the majority of cases of Lemierre syndrome?

A

Fusobacterium necrophorum

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35
Q

What is the syndrome characterised by seropositive rheumatoid arthritis and pulmonary fibrosis?

A

Caplan syndrome

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36
Q

Fungal infection with invasion of the mediastinum, pleura & chest wall?

A

Mucormycosis

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37
Q

What are the 6 major criteria for ABPA?

A

Asthma

Central bronchiectasis

Pulmonary opacities (transient or chronic)

Blood eosinophilia

Skin reactivity to Aspergillus antigen

Increase serum IgE

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38
Q

What is the treatment for immune reconstitution inflammatory syndrome?

A

Steroids

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39
Q

What are the risk factors for immune reconstitution inflammatory syndrome?

A

Low CD4 count (< 50)

High plasma HIV RNA (before therapy)

Rapid decrease in CD4 count of HIV RNA following initiation of therapy

Initiation of HAART soon after diagnosis. of an opportunistic infection (TB, PML, cryptococcus, Kaposi)

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40
Q

A patient with AIDs is started on antiretroviral therapy. 1 month later they have worsening symptoms despite improvements in CD4 counts and falling viral load. What is the diagnosis?

A

Immune reconstitution inflammatory syndrome

(IRIS)

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41
Q

An aneurysm in the context of a TB cavity is called what?

A

Rasmussen aneurysm

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42
Q

What are the 2 main differentials for hypervascular lymph nodes in AIDs patients?

A

Kaposi sarcoma

Castleman disease

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43
Q

AIDs patient with lung cysts, ground glass opacification and pneumothorax. What is the likely diagnosis?

A

PCP

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44
Q

What is the most likely diagnosis in a patient with AIDs and “flame-shaped” perihilar opacification?

A

Kaposi sarcoma

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45
Q

Ground glass opacification in a patient with AIDs. What is the most likely diagnosis?

A

PCP

(could be CMV if PCP not an option and CD4 < 100)

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46
Q

What is the most common cause of pneumonia in AIDs patients?

A

Strep. penumoniae

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47
Q

Pneumonia following dental procedure with osteomyelitis/chest wall invasion?

A

Actinomycosis

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48
Q

Bacterial pneumonia common in patients in ICU on ventilator, CF and primary ciliary dyskinesia?

A

Pseudomonas

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49
Q

Bacterial pneumonia which causes “currant jelly sputum”?

A

Klebsiella

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50
Q

An aberrant right subclavian artery will cause obliteration of what on a lateral CXR?

A

Retrotracheal triangle aka Raider triangle

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51
Q

What are the imaging features of proximal interruption of the pulmonary artery?

A

Only one pulmonary artery

Absence of the PA on the opposite side of the aortic arch

Volume loss of one hemithorax

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52
Q

What is proximal interruption of the pulmonary artery associated with?

A

Patent ductus arteriosus.

Interrupted left pulmonary artery associated with tetralogy of Fallot + truncus arteriosus.

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53
Q

Thymoma is associated with what?

A

Myasthenia gravis

Pure red cell aplasia

Hypogammaglobinemia

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54
Q

Empyema necessitans, where an empyema invades into chest wall and soft tissues is classically caused by what?

A

TB (70%)

Actinomyces is 2nd most common

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55
Q

“Shrinking lung” is associated with which condition?

A

SLE

(most common chest manifestation is pleuritis with/without effusion)

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56
Q

Which syndrome is characterised by primary ciliary dyskinesia and situs inversus?

A

Kartagener syndrome

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57
Q

What are the features of primary ciliary dyskinesia?

A

Chronic sinusitis

Conductive hearing loss

Bilateral lower lobe bronchiectasis

50% have Kartagener’s syndrome

Impaired fertility

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58
Q

Irregular focal/short segment thickening of trachea/main bronchi with calcification. What is the most likely diagnosis?

A

Amyloidosis

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59
Q

Circumferential thickening of the trachea with no calcification C-ANCA positive.

What is the most likely diagnosis?

A

Granulomatosis with polyangiitis

(Wegener’s)

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60
Q

Diffuse thickening of the trachea with sparing the posterior membrane and no calcification.

What is the most likely diagnosis?

A

Relapsing polychondritis

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61
Q

Cartilaginous and osseous nodules within the submucosa of the trachea and bronchial walls with sparing of the posterior membrane.

What is the most likely diagnosis?

A

Tracheobronchopathia osteochondroplastica

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62
Q

“Headcheese” is used to describe the imaging feature of which condition?

A

Chronic hypersensitivity pneumonitis

(Describes GGO, consolidation, air trapping and normal lungs)

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63
Q

What are the causes of cryptogenic organising pneumonia (COP)?

A

Idiopathic

Infection

Drugs (amiodarone)

Collagen vascular disease

Fumes

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64
Q

What are the imaging features of cryptogenic organising pneumonia?

A

Patchy airspace or GGO in a peripheral or peri-bronchial distribution

Reverse halo/ atoll sign

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65
Q

Patients with pulmonary alveolar proteinosis are at increased risk of what infection?

A

Nocardia

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66
Q

What are the CT findings of chronic rejection (bronchiolitis obliterans syndrome) following lung transplant?

A

Air trapping

Bronchiectasis

Bronchial wall thickening

Interlobular septal thickening

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67
Q

What is the most common opportunistic infection following lung transplant?

A

CMV

(2-4 months after transplant)

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68
Q

What is the imaging features of acute rejection following lung transplant?

A

Ground glass opacities and intralobular septal thickening.

(No ground glass → no rejection)

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69
Q

Hot quadrate sign is seen in what pathology?

A

SVC obstruction

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70
Q

What are the 3 main causes of pulmonary artery aneurysms?

A

Iatrogenic from swan ganz catheter

Behcet’s (also have mouth/genital ulcers)

Chronic PE

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71
Q

What are the causes of fibrosing mediastinitis (soft tissue mass with calcifications infiltrating fat planes)?

A

Idiopathic

Histoplasmosis

TB

Radiation

Sarcoid

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72
Q

A calcified papillary muscle, seen on prenatal ultrasound as an echogenic focus in the left ventricle and usually goes away by the third trimester is associated with an increased incidence of what?

A

Down’s syndrome

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73
Q

What is the difference between lipomatous hypertrophy of the intra-atrial septum and a lipoma?

A

Lipomatous hypertrophy spares the fossa ovalis creating a “dumbbell appearance”

It can also be hot on PETCT because it is often made of brown fat

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74
Q

What are the branches of the left main coronary artery?

A

Circumflex (divides into obtuse marginals which supply lateral margin)

Left anterior descending (divides into septal branches and diagonals)

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75
Q

What are the branches of the right main coronary artery?

A

Acute marginal

AV node branch

Posterior descending artery (in most people)

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76
Q

What is meant by malignant origin of the left coronary artery?

A

When the LCA arises from the right coronary sinus and courses between the aorta and pulmonary artery

This can get compressed and lead to sudden cardiac death.

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77
Q

Reversal of flow in the left coronary artery as the pressure decreases in the pulmonary circulation, termed STEAL syndrome, is caused by what?

A

Anomalous left coronary artery from the pulmonary artery (ALCAPA)

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78
Q

What are the causes of coronary artery aneurysms?

A

Atherosclerosis (most common cause in adults)

Kawasaki (most common in children)

Iatrogenic

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79
Q

Velocity encoded CINE MR imaging/ velocity mapping/ phase contrast imaging is an MR technique for what?

A

Quantifying the velocity of flowing blood

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80
Q

What is the most common congenital heart disease?

A

Bicuspid aortic valve

(if not an option chose VSD)

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81
Q

What is the differential for aortic stenosis?

A

Atherosclerosis (degenerative)

William’s syndrome

Rheumatic heart disease

Bicuspid aortic valve

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82
Q

Williams syndrome is characterised by what features?

A

Craniofacial dysmorphism

Short stature

Intellectual disability

Supravalvular aortic stenosis

Pulmonary artery stenosis

Renal artery stenosis

Hypercalcaemia

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83
Q

What is the most common associated defect with aortic coarctation?

A

Bicuspid aortic valve

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84
Q

What are the associations with a bicuspid aortic valve?

A

Dilatation of the ascending aorta (most frequent)

Congenital heart diseases (ASD/VSD, PDA, hypoplastic left heart, coarctation)

Turner syndrome

Cystic medial necrosis

Autosomal dominant polycystic kidney disease

Intracranial aneurysm

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85
Q

What are the causes of aortic regurgitation?

A

Aortic root dilatation (HTN/ Marfans)

Aortic dissection

Bicuspid aortic valve

Bacterial endocarditis

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86
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

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87
Q

What are the imaging features of mitral stenosis?

A

Left atrial enlargement

(double density sign, splaying of the carina, posterior oesophageal displacement)

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88
Q

Isolated right upper lobe pulmonary oedema is associated with what?

A

Mitral regurgitation

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89
Q

What are the causes of acute mitral regurgitation?

A

Myocardial infarction with papillary muscle rupture (most commonly posteromedial papillary muscle)

Infective endocarditis

Chordae tendinae rupture in myxomatous degeneration

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90
Q

What are the causes of chronic mitral regurgitation?

A

Annular calcification

Myxomatous degeneration

Previous infective/ inflammatory illness

Dilated cardiomyopathy

Hypertrophic obstructive cardiomyopathy

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91
Q

What are the causes of pulmonary stenosis?

A

Noonan syndrome

Williams syndrome

Tetralogy of Fallot

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92
Q

What are the features of Alagille syndrome?

A

Paucity/ stenosis of the intrahepatic biliary ducts

Renal anomalies (cystic kidney disease, small kidneys, nephrocalcinosis)

Hypoplasia of the posterior semicircular canal

Butterfly vertebrae

Coarctation of the aorta

Peripheral pulmonary artery stenosis

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93
Q

Peripheral pulmonary artery stenosis can be seen in what syndrome?

A

Alagille syndrome

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94
Q

What are the causes of pulmonary regurgitation?

A

Congenital valve disease repair (TOF)

Pulmonary arterial hypertension

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95
Q

What are the causes of tricuspid regurgitation?

A

Pulmonary arterial hypertension (most common cause in adults)

Ebstein anomaly (most common congenital cause)

Endocarditis

Carcinoid syndrome

96
Q

What is Ebstein anomaly?

A

Abnormal tricuspid valve which is displaced apically into the right ventricle resulting in atrialisation of part of the ventricle above the valve.

97
Q

What are the imaging features of Ebstein anomaly?

A

Severe cardiomegaly with right atrial enlargement (“box-shaped” heart)

Tricuspid regurgitation

98
Q

A right aortic arch with mirror branching is associated with what?

A

Tetralogy of Fallot (most common)

Truncus arteriosus (2nd most common)

Tricuspid atresia

Transposition of the great arteries

99
Q

What is a Kommerell diverticulum?

A

Bulbous origin of an aberrant subclavian artery

(either left with right arch or right with left arch)

100
Q

Cyanotic heart anomaly characterised by agenesis of the tricuspid valve and right ventricular inlet.

A

Tricuspid atresia

101
Q

What are the associations with tricuspid atresia?

A

ASD or PFO (almost always for circulation to be complete)

VSD

Transposition of the great arteries

Right-sided aortic arch

Asplenia

102
Q

What is the most common vascular ring?

A

Double aortic arch

103
Q

What is the difference between subclavian steal syndrome and subclavian steal phenomenon?

A

Syndrome also has associated cerebral ischaemic symptoms

104
Q

What are the causes of subclavian steal syndrome?

A

Atherosclerosis (most common)

Takayasu arteritis (most common if young)

Radiation

Preductal coarctation of the aorta

105
Q

Small mass attached to the inter-atrial septum by a small stalk which is iso/ hypointense on T1 weighted imaging. What is the diagnosis?

A

Atrial myxoma

(most common location is the left atrium)

106
Q

“Egg on a string” classically describes the CXR appearance of which congenital heart disease?

A

Transposition of the great arteries

107
Q

“Snowman appearance” classically describes the CXR appearance of which congenital heart disease?

A

Supra-cardiac total anomalous pulmonary venous return (TAPVR)

108
Q

“Boot-shaped” classically describes the CXR appearance of which congenital heart disease?

A

Tetralogy of Fallot

109
Q

“Figure of 3” classically describes the CXR appearance of which congenital heart disease?

A

Coarctation of the aorta

110
Q

“Box-shaped” classically describes the CXR appearance of which congenital heart disease?

A

Ebstein anomaly

111
Q

“Scimitar sword” classically describes the CXR appearance of which congenital heart disease?

A

Partial anomalous pulmonary venous return (PAPVR) with pulmonary hypoplasia

112
Q

What is truncus arteriosus?

A

Cyanotic congenital heart disease in which a single trunk supplies both the pulmonary and systemic circulation (cotruncal anomaly)

Almost always associated with a VSD

113
Q

Right sided aortic arch with increased pulmonary vasculature. What is the diagnosis?

A

Truncus arteriosus

114
Q

Right sided aortic arch with decreased pulmonary vasculature. What is the diagnosis?

A

Tetralogy of Fallot

115
Q

What is Tetralogy of Fallot?

A

Right ventricular outflow obstruction

Ventricular septal defect (VSD)

Right ventricular hypertrophy

Overriding aorta

116
Q

Tetralogy of Fallot is associated with which extra-cardiovascular conditions?

A

Congenital lobar emphysema

DiGeorge syndrome

Fetal rubella syndrome

Prune belly syndrome

Tracheo-oesophageal fistula

VACTERL association

117
Q

In which congenital heart diseases will the child be cyanotic?

A

Tetralogy of Fallot

Total anomalous pulmonary venous return (TAPVR)

Transposition of the great arteries

Truncus arteriosus

Tricuspid atresia

118
Q

What is transposition of the great arteries?

A

The aorta arises from the right ventricle and the pulmonary trunk arises from the left ventricle

Presents in first 24 hours of life with cyanosis

Survival requires ASD, VSD or PDA

119
Q

What is L-type transposition of the great arteries?

A

“Lucky type”

Congenitally corrected TGA where the right atrium connects with the left ventricle and the left atrium connects with the right ventricle

A PDA is therefore not required

120
Q

Following a LeCompte Maneuver, a patient has their pulmonary arteries draped over the aorta.

What was this procedure carried out for?

A

Corrected D-transposition of the great arteries

121
Q

What is the most common VSD?

A

Membranous (just below the aortic valve)

122
Q

What is a patent ductus arteriosus?

A

Persistent patency of the ductus arteriosus, a normal connection of the fetal circulation between the aorta and the pulmonary arterial system.

123
Q

What is the most common type of ASD?

A

Secundum

124
Q

Which syndrome would you find an ASD and upper limb anomalies?

A

Holt-Oram syndrome

125
Q

Secundum ASD and atrioventricular septal defects (AKA endocardial cushion defect) is associated with which syndrome?

A

Down’s syndrome

126
Q

A sinus venosus ASD is associated with what congenital heart disease?

A

Partial anomalous pulmonary venous return

127
Q

Unroofed coronary sinus is strongly associated with which normal variant?

A

Persistent left SVC

128
Q

What is partial anomalous pulmonary venous return?

A

Where 1 (or more) pulmonary veins drain into the right heart

(most common: right upper pulmonary vein connects to RA/ SVC. Often associated with a sinus venosus ASD)

129
Q

What is total anomalous pulmonary venous return?

A

Cyanotic heart disease where all of the pulmonary veins drain into the right side of the heart

Requires a large PFO or ASD (less commonly) for survival

130
Q

Right sided PAPVR is associated with what?

A

Sinus venosus type ASD

131
Q

Right sided PAPVR with pulmonary hypoplasia.

What is the diagnosis?

A

Scimitar syndrome

132
Q

There are 3 types of TAPVR. Which is the most common?

A

Type 1: supracardiac (gives snowman appearance)

133
Q

There are 3 types of TAPVR.

Which type gives full on pulmonary oedema appearance in the newborn?

A

Type 3: infracardiac (veins drain below the diaphragm)

134
Q

Of the patients with asplenia who also have congenital heart disease (approx 50%), how many have TAPVR?

A

100%

85% also have endocardial cushion defect (AV canal/ atrioventricular septal defect)

135
Q

What is the most common complication following surgery for tetralogy of Fallot?

A

Pulmonary regurgitation

136
Q

Which ribs are involved in rib notching, secondary to aortic coarctation?

A

4-8th ribs

(does NOT involve 1st and 2nd as those are supplied by the costocervical trunk)

137
Q

What pathology gives you a tri-atrium heart?

A

Cor triatriatum sinistrum

(abnormal pulmonary vein draining into the left atrium with an unnecessary fibromuscular membrane that causes a sub-division of the left atrium)

138
Q

What is a stunned myocardium?

A

Dysfunction of the myocardium which persists after restoration of blood flow following an acute injury

(MI or reperfusion injury)

139
Q

What are the imaging features of a stunned myocardium?

A

Abnormal wall motion

Normal perfusion on Thallium and Sestamibi

140
Q

What is a hibernating myocardium?

A

Chronic process resulting from severe coronary arterial disease causing chronic hypoperfusion

There will be areas of decreased contractility and perfusion even when resting

Reversible with revascularisation

141
Q

What are the imaging features of hibernating myocardium?

A

Areas of decreased perfusion and contractibility

Increased tracer uptake on PETCT

Redistribution of Thallium

142
Q

How is delayed cardiac imaging performed to look for infarction?

A

Inversion recovery technique to null normal myocardium followed by gradient echo.
Bright on T1 = dead.

143
Q

How can you differentiate acute from chronic MI?

A

Acute: delayed enhancement, normal thickness myocardium, increased T2 from oedema

Chronic: delayed enhancement, thinned myocardium, T2 dark (scar)

144
Q

Microvascular obstruction, where islands of dark tissue are seen in amongst late Gd enhancement (i.e contrast is unable to get to these regions) is a poor prognostic finding seen in which kind of MI?

A

Acute

It’s NOT seen in chronic infarct

145
Q

Ventricular aneurysms can occur secondary to MI. What are the features of a TRUE aneurysm?

A

Mouth is wider than body

Myocardium is intact

Antero-lateral wall

146
Q

Ventricular aneurysms can occur secondary to MI. What are the features of a FALSE aneurysm?

A

Mouth is narrow compared to body

Myocardium is NOT intact

Posterior-lateral wall

higher risk of rupture

147
Q

Dressler syndrome is seen how long after a myocardial infarction?

A

4-6 weeks

148
Q

What is the symptoms of Dressler syndrome?

A

Pleuritic chest pain, fever, malaise

Pericardial effusion

Leucocytosis/ raised inflammatory markers

149
Q

What is the differential for restrictive cardiomyopathy?

A

Amyloid (most common)

Endocardial fibroelastosis

Haemochromatosis

150
Q

What are the imaging features of cardiac amyloidosis?

A

Intra-atrial septal thickening and biatrial enlargement

Concentric thickening of the left ventricle

Subendocardial delayed myocardial hyperenhancement

Granular echogenic myocardium

Long T1 required. Buzzword: “difficulty suppressing myocardium”

151
Q

What are the imaging features of cardiac sarcoidosis?

A

Nodular or patchy increased signal on T2 and enhanced images, often involving the septum (esp basal) and LV wall

Right ventricle and papillaries rarely involved

Focal wall thickening from oedema

152
Q

What is the most common primary malignancy of the heart in adults?

A

Angiosarcoma

153
Q

What is the imaging features of a cardiac angiosarcoma?

A

“Sun-ray appearance”

Commonly right atrium involving the pericardium

Bulky and heterogenous

154
Q

How would you differentiate an atrial myxoma from a thrombus?

A

Myxoma will enhance

Myxoma will be attached to the inter-atrial septum

155
Q

Atrial myxoma is associated with what syndrome?

A

Carney complex

156
Q

What is the most common fetal cardiac tumour and what are the imaging appearances?

A

Rhabdomyoma

Typically arise within the ventricular myocardium (left more common)

Isointense to myocardium on T1, mildly hyperintense on T2 and no enhancement

157
Q

What are the imaging features of a cardiac fibroma (2nd most common cardiac tumour in childhood)?

A

Most common location is left ventricle and interventricular septum

Dark on T1/T2 imaging

Enhance avidly

158
Q

What is the definition of adenocarcinoma in situ in the lung?

A

< 3cm

No features of necrosis or invasion

159
Q

What is the definition of minimally invasive adenocarcinoma of the lung?

A

< 3cm

< 5mm of stromal invasion

160
Q

What is the first branch of the SMA?

A

Inferior pancreaticoduodenal artery

161
Q

What arteries make up the arc of Riolan?

A

Left colic (from IMA) to middle colic (from SMA)

162
Q

Which branches of the internal iliac arteries are from the posterior divisions?

A

Iliolumbar

Lateral sacral

Superior gluteal

163
Q

What is the relationship of the subclavian vessels with the anterior scalene muscle?

A

The subclavian veins runs anterior to the muscle, the artery runs posterior

164
Q

When does the subclavian artery become the axillary artery?

A

At the 1st rib

165
Q

When does the axillary artery become the brachial artery?

A

At the lower border of teres major

166
Q

When does the external iliac artery become the common femoral artery?

A

Once it gives off the inferior epigastric artery at the inguinal ligament

167
Q

Most gastric varices are formed by which vein?

A

Left gastric vein (coronary vein)

168
Q

Isolated gastric varices are caused by what?

A

Splenic vein thrombosis

169
Q

Where do gastric varices drain?

A

Into the inferior phrenic, then into the left renal vein (forming a gastro-renal shunt)

170
Q

Enlarged left renal vein with enlargement of the IVC at the level of the left renal vein can be caused by what?

A

Splenorenal shunt caused by portal hypertension

Associated with hepatic encephalopathy

NOT associated with GI bleeding

171
Q

What is the most common congenital heart disease associated with a left IVC?

A

ASD

172
Q

Azygous continuation of the IVC is associated with what splenic abnormality?

A

Polysplenia

173
Q

What are the causes of aortic dissection?

A

Hypertension (most common)

Marfans

Turners (aortic valve defects)

Infection

Pregnancy

Cocaine use

174
Q

How do you identify the true lumen in aortic dissection?

A

Continuous with the undissected portion of the aorta

Smaller cross sectional area

Surrounded by calcification (if present)

Usually contains the origin of the coeliac trunk, SMA and right renal artery

175
Q

How do you identify the false lumen in aortic dissection?

A

“Cob-web sign”: linear areas of low attenuation

Larger cross-sectional area

Beak sign

Usually contains the origin of the left renal artery

Surrounds the lumen in type A dissection

176
Q

What are the causes of ascending aortic calcification?

A

Takayasu arteritis

Syphilis

177
Q

Cystic medial necrosis is associated with which syndrome?

A

Marfan’s syndrome

178
Q

Describe a type 1 endoleak?

A

Leak at the top or the bottom of the graft

179
Q

Describe a type 2 endoleak?

A

Filling of the aneurysm sac via feeder arteries

(most likely IMA or a lumbar artery)

180
Q

Describe a type 3 endoleak?

A

Defect/ fracture in the graft

181
Q

Describe a type 4 endoleak?

A

Porosity of the graft

(doesn’t usually happen with modern grafts)

182
Q

Describe a type 5 endoleak?

A

Endotension

183
Q

What is the most common endoleak?

A

Type 2

184
Q

What are the imaging findings of impending aortic aneurysm rupture?

A

Peri-aortic stranding

Rapid enlargement (>10mm per year)

Draped aorta sign

Focal discontinuity in circumferential wall calcification

Hyperdense crescent sign

185
Q

What are the vascular features of Marfan’s?

A

Dilatation of the aortic root

Aortic valve insufficiency/ severe aortic regurgitation

Aortic aneurysm/ dissection

Pulmonary artery dilatation

186
Q

Which part of the bowel is most commonly involved in aorto-enteric fistula?

A

3rd and 4th parts of the duodenum

187
Q

How can you differentiate between aorto-enteric fistula and perigraft infection?

A

You can only differentiate if you see contrast from the aorta go into the bowel lumen

Both have perigraft gas, perigraft fluid and oedema and both lose the fat plains between the bowel and the aorta

188
Q

What is Leriche syndrome?

A

Complete occlusion of the aorta, distal to the renal arteries (often secondary to bad atherosclerosis)

189
Q

What is the triad associated with Leriche syndrome?

A

Buttock claudication

Absent/ decreased femoral pulses

Impotence

190
Q

Young adult presents with hypertension, claudication and renal failure. CT shows progressive narrowing of the abdominal aorta and the major branches. What is the diagnosis?

A

Mid-aortic syndrome

(thought to be secondary to intrauterine insult)

191
Q

Elongation with narrowing and kinking of the aorta but no pressure gradient, collateral formation or rib notching. What is the diagnosis?

A

Pseudocoarctation

(area of dilatation may occur distal to the area of narrowing and may be progressive so should be followed up)

192
Q

What is the most common cause of thoracic outlet syndrome?

A

Compression by the anterior scalene muscle

193
Q

What are the causes of TRUE splenic aneurysms?

A

Pregnancy

Hypertension

Portal hypertension

Cirrhosis

Liver transplant

194
Q

What is the most common location involved in chronic mesenteric ischaemia?

A

Splenic flexure

(watershed area of the SMA and IMA)

195
Q

What are the imaging features of colonic angiodysplasia?

A

Right sided

Cluster of small arteries along the antimesenteric border of the colon

Early opacification of dilated draining veins that persist late into the venous phase

196
Q

Aortic stenosis and colonic angiodysplasia is referred to by which syndrome?

A

Heyde syndrome

197
Q

Which arteries are most commonly involved in fibromuscular dysplasia?

A

Renal arteries (most common)

Carotid arteries

Iliac arteries

198
Q

“String of beads” description of arteries is seen in which condition?

A

Fibromuscular dysplasia

199
Q

What is May-Thurner syndrome?

A

Compression of the left common iliac vein by the right common iliac artery resulting in DVT

200
Q

Young man with normal lower limb pulses which decrease with plantar flexion or dorsiflexion of the foot. Imaging shows medial deviation of the popliteal artery. Diagnosis?

A

Popliteal entrapment

201
Q

Syndrome with a triad of port wine naevi, bony/soft tissue hypertrophy and venous malformation, often associated with a persistent sciatic vein. The marginal vein of Servelle (in lateral calf) is said to be pathognomonic.

A

Klippel-Trenaunay syndrome

202
Q

What is a normal ankle to brachial index (ABI)?

A

1.0

203
Q

At which ABI will patients experience rest pain?

A

< 0.3

204
Q

What is the most likely cause of re-stenosis 3-12 months after angioplasty?

A

Intimal hyperplasia

205
Q

Takayasu tends to affect which patients?

A

Young Asian girls, typically aged 15-30

206
Q

Polyarteritis nodosa (PAN) commonly affects which systems?

A

Renal (microaneurysms)

Cardiac

GI

207
Q

Polyarteritis nodosa is associated with what?

A

Hepatitis B

More common in men

208
Q

What is the most common vasculitis in children?

A

Henoch-Schonlein purpura (HSP)

209
Q

Which vasculitis is strongly associated with smokers and the development of corkscrew collateral vessels. Buzzword = auto-amputation

A

Buergers

210
Q

HSP is associated with what?

A

Intussusception

Massive scrotal oedema

211
Q

What are the contraindications to beta-blockers?

A

2nd/3rd degree heart block

severe asthma

acute chest pain

recent snorting of cocaine

212
Q

What are the contraindications to nitroglycerine?

A

hypotension (SBP <100)

severe aortic stenosis

HOCM

phosphodiesterase

213
Q

What are the branches of the external carotid arteries?

A

Some Anatomists Like Freaking Out Poor Medical Students

Superior thyroid

Ascending pharyngeal

Lingual

Facial

Occipital

Posterior auricular

Maxillary

Superficial temporal

214
Q

Cardiac MRI finds circumferential endocardial fibrosis and biventricular thrombi. What is the most likely diagnosis?

A

Loeffler endocarditis

Can be distinguished from amyloidosis by the adherent ventricular thrombi. Patients will also have peripheral blood eosinophilia

215
Q

What are the imaging features of lymphocytic interstitial pneumonitis?

A

Mid to lower zone predominance

Thickening of bronchovascular bundles and interstitial thickening

Scattered thin walled cysts

216
Q

Mosaic perfusion with no air trapping. What is the most likely diagnosis?

A

Pulmonary emboli

217
Q

What is the most common CT chest finding in patients with history of acute respiratory distress syndrome?

A

Reticular changes in the anterior/ventral non-dependent lung

218
Q

What are the radiographic findings of acute rejection following lung transplant?

A

Ground glass opacity

Heterogeneous peri-hilar opacification

New enlarging pleural effusion with septal thickening

No signs of left ventricular failure

219
Q

The bronchial tree receives blood from one right and two left bronchial arteries. From which vessel does the single right artery usually arise?

A

Third posterior right intercostal artery

220
Q

What are the imaging features of pulmonary hamartomas?

A

Peripheral

Popcorn calcification

Fat in 50%

221
Q

What are the imaging features of pulmonary carcinoid?

A

Tend to be more central and endobronchial in location

Calcification

Rarely cavitate

No fat

Prominent enhancement following contrast

222
Q

What is the most common pulmonary finding on chest radiograph in rheumatoid arthritis?

A

Pleural effusion

223
Q

Which lung segments are separated by the superior accessory fissure?

A

Apical segment of the lower lobes from the other lower lobe segments

224
Q

Which lymphoma is usually almost entirely confined to the lymph nodes?

A

Hodgkins lymphoma

225
Q

Pulmonary involvement in Hodgkins lymphoma indicates which stage of disease?

A

Stage IV

226
Q

What is the dose for a CT pulmonary angiogram relative to a V/Q scan?

A

CT pulmonary angiogram has a higher total body dose but a lower uterine dose

227
Q

What are the imaging features of amiodarone lung disease?

A

Alveolar and interstitial infiltrates and high density areas of consolidation (iodine)

228
Q

What is hypertrophic obstructive cardiomyopathy?

A

Diffuse or segmental left ventricular hypertrophy with a non-dilated and hyperdynamic chamber in the absence of another condition to explain the hypertrophy

229
Q

What are the imaging appearances of hypertrophic obstructive cardiomyopathy?

A

Asymmetric involvement of the interventricular septum is most common (60-70%)

Hypertrophy of the muscle to > 15mm in diastole

“Spadelike” configuration of LV cavity at end diastole

230
Q

What are the features of Kawasaki disease?

A

Fever and maculopapular rash

Cervical lymphadenopathy

Coronary artery aneurysms

Myocarditis/ pericarditis/ pericardial effusions/ valvular disease

231
Q

Where do cardiac fibroelastomas commonly arise and what is the key feature on imaging?

A

Cardiac valves (80% are aortic or mitral)

Intense enhancement on delayed imaging (this is how they can be differentiated from a vegetation)

232
Q

Dissection of the cervical portion of the ICA can result in which symptoms?

A

Partial Horners syndrome (miosis and ptosis)

MCA territory stroke

233
Q

Aneurysm with the origin at the “dural ring” is found where?

A

Ophthalmic (supraclinoid) segment of the internal carotid artery

234
Q

Where are the most common sites of aneurysm formation in the posterior intracranial circulation?

A

Basilar (most common)

PICA

235
Q

“Caput medusa” and “large tree with multiple small branches” are terms used to describe what?

A

Developmental venous anomaly

(associated with cavernous malformations)

236
Q

What are the imaging features of intracranial cavernous malformations?

A

“Popcorn- like” with peripheral rim of haemosiderin without intervening normal brain tissue

237
Q

The “crescent sign” of dissection is seen on which MRI sequence?

A

T1 (will be bright)

Clinical Radiology 2A (8 decks)

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