Cardiothoracic Flashcards
What are the imaging features of sarcoidosis?
Bilateral hila + right paratracheal lymph nodes
Perilymphatic nodules with upper lobe predominance
Late : upper lobe fibrosis + traction bronchiectasis
What are the causes of right heart failure?
Left heart failure (most common)
Chronic PE
Right-sided valve issues (tricuspid regurgitation)
Interstitial lung disease related to smoking with poorly defined apical centrilobular nodules
Respiratory bronchiolitis-interstitial lung disease
(RB-ILD)
What is the most common interstitial lung disease in scleroderma?
Non-specific interstitial penumonia
(NSIP)
Interstitial lung disease with lower lobe, peripheral predominance and sparing of the immediate subpleural lung.
Non-specific interstitial pneumonia
(NSIP)
What is the differential for perilymphatic pulmonary nodules?
Sarcoidosis (90%)
Silicosis
Lymphangitic spread of cancer
How can you differentiate between cancer and progressive massive fibrosis on MRI?
Cancer = T2 bright
PMF = T2 dark
Silicosis increases your risk of which infection?
TB
(by 3-fold)
Which type of emphysema is seen in alpha-1-antitrypsin deficiency?
Panlobular with lower zone predominance
Which of the following options is negative on thallium201 scan?
- Kaposi 2. Lymphoma 3. PCP
- PCP
Which of the following options is negative on gallium67 scan?
- Kaposi 2. Lymphoma 3. PCP
- Kaposi
Which of the following options is positive on both gallium67 and thallium201 scan?
- Kaposi 2. Lymphoma 3. PCP
- Lymphoma
Lymphocytic interstitial pneumonitis (LIP) is associated with which conditions?
Sjogren’s (most common)
HIV ← answer if in a child
SLE
RA
Castleman
Birt Hogg Dube cystic lung disease has what kind of cysts?
Thin-walled oval cysts
Lymphangiomyomatosis (LAM) is associated with which kind of pleural effusions?
Chylous
What is the most common cardiac manifestation of tuberous sclerosis?
Rhabdomyoma
Lymphangiomyomatosis (LAM) is associated with which phakomatosis?
Tuberous sclerosis
What are the patient and radiology characteristics of Langerhan’s cell histiocytosis (LCH)?
Smokers aged 20-30
Centrilobular nodules with upper lobe predominance which cavitate into cysts
Which conditions classically spare the costophrenic angles?
Langerhans cell histiocytosis (LCH)
Hypersensitivity pneumonitis
Extralobar sequestration is associated with which other anomalies?
Congenital cystic adenomatoid malformation (CCAM)
Congenital diaphragmatic hernia
Vertebral anomalies
Congenital heart disease
Pulmonary hypoplasia
Which lung segment is most common segment for intralobar pulmonary sequestration?
Posterior segment of the left lower lobe
Which condition, intralobar or extralobar sequestration, presents in adolescence or adulthood with recurrent pneumonia?
Intralobar
Which condition, intralobar or extralobar sequestration presents in infancy with respiratory compromise?
Extralobar
Poland syndrome results in aplasia/hypoplasia of pec major (most common), pec minor, 2-5th ribs and breast/nipple. What other associations are there?
Upper limb abnormalities (small hand + brachysyndactyly, simian crease)
Where does a persistent left SVC normally drain?
Coronary sinus
What syndrome is associated with pulmonary arteriovenous malformations (AVM)?
Hereditary haemorrhagic telangiectasia
(Osler-Weber-Rendu syndrome)
Which lung segment is most commonly involved in bronchial atresia?
Apical-posterior segment of the left upper lobe
AIDs patient with lung nodules, pleural effusion and lymphadenopathy. What is the most likely diagnosis?
Lymphoma
(almost exclusively high grade NHL, CD4 < 100)
Carcinoid heart disease can occur in which cancers without liver metastases?
Bronchial carcinoid tumour
Ovarian carcinoid tumour
What scan can be carried out to localise a carcinoid tumour?
Octreotide scan
Which cardiac valves can be affected in GI carcinoid syndrome?
Tricuspid & pulmonary
Which cancers can cause the classic “cannonball” metastases?
Renal cell
Choriocarcinoma (testicle)
Which cancers cause lymphangitic calcinomatosis?
Bronchogenic (most common)
Breast
Stomach
Pancreas
Prostate
What is the bacterium responsible in the majority of cases of Lemierre syndrome?
Fusobacterium necrophorum
What is the syndrome characterised by seropositive rheumatoid arthritis and pulmonary fibrosis?
Caplan syndrome
Fungal infection with invasion of the mediastinum, pleura & chest wall?
Mucormycosis
What are the 6 major criteria for ABPA?
Asthma
Central bronchiectasis
Pulmonary opacities (transient or chronic)
Blood eosinophilia
Skin reactivity to Aspergillus antigen
Increase serum IgE
What is the treatment for immune reconstitution inflammatory syndrome?
Steroids
What are the risk factors for immune reconstitution inflammatory syndrome?
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)
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?
Immune reconstitution inflammatory syndrome
(IRIS)
An aneurysm in the context of a TB cavity is called what?
Rasmussen aneurysm
What are the 2 main differentials for hypervascular lymph nodes in AIDs patients?
Kaposi sarcoma
Castleman disease
AIDs patient with lung cysts, ground glass opacification and pneumothorax. What is the likely diagnosis?
PCP
What is the most likely diagnosis in a patient with AIDs and “flame-shaped” perihilar opacification?
Kaposi sarcoma
Ground glass opacification in a patient with AIDs. What is the most likely diagnosis?
PCP
(could be CMV if PCP not an option and CD4 < 100)
What is the most common cause of pneumonia in AIDs patients?
Strep. penumoniae
Pneumonia following dental procedure with osteomyelitis/chest wall invasion?
Actinomycosis
Bacterial pneumonia common in patients in ICU on ventilator, CF and primary ciliary dyskinesia?
Pseudomonas
Bacterial pneumonia which causes “currant jelly sputum”?
Klebsiella
An aberrant right subclavian artery will cause obliteration of what on a lateral CXR?
Retrotracheal triangle aka Raider triangle
What are the imaging features of proximal interruption of the pulmonary artery?
Only one pulmonary artery
Absence of the PA on the opposite side of the aortic arch
Volume loss of one hemithorax
What is proximal interruption of the pulmonary artery associated with?
Patent ductus arteriosus.
Interrupted left pulmonary artery associated with tetralogy of Fallot + truncus arteriosus.
Thymoma is associated with what?
Myasthenia gravis
Pure red cell aplasia
Hypogammaglobinemia
Empyema necessitans, where an empyema invades into chest wall and soft tissues is classically caused by what?
TB (70%)
Actinomyces is 2nd most common
“Shrinking lung” is associated with which condition?
SLE
(most common chest manifestation is pleuritis with/without effusion)
Which syndrome is characterised by primary ciliary dyskinesia and situs inversus?
Kartagener syndrome
What are the features of primary ciliary dyskinesia?
Chronic sinusitis
Conductive hearing loss
Bilateral lower lobe bronchiectasis
50% have Kartagener’s syndrome
Impaired fertility
Irregular focal/short segment thickening of trachea/main bronchi with calcification. What is the most likely diagnosis?
Amyloidosis
Circumferential thickening of the trachea with no calcification C-ANCA positive.
What is the most likely diagnosis?
Granulomatosis with polyangiitis
(Wegener’s)
Diffuse thickening of the trachea with sparing the posterior membrane and no calcification.
What is the most likely diagnosis?
Relapsing polychondritis
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?
Tracheobronchopathia osteochondroplastica
“Headcheese” is used to describe the imaging feature of which condition?
Chronic hypersensitivity pneumonitis
(Describes GGO, consolidation, air trapping and normal lungs)
What are the causes of cryptogenic organising pneumonia (COP)?
Idiopathic
Infection
Drugs (amiodarone)
Collagen vascular disease
Fumes
What are the imaging features of cryptogenic organising pneumonia?
Patchy airspace or GGO in a peripheral or peri-bronchial distribution
Reverse halo/ atoll sign
Patients with pulmonary alveolar proteinosis are at increased risk of what infection?
Nocardia
What are the CT findings of chronic rejection (bronchiolitis obliterans syndrome) following lung transplant?
Air trapping
Bronchiectasis
Bronchial wall thickening
Interlobular septal thickening
What is the most common opportunistic infection following lung transplant?
CMV
(2-4 months after transplant)
What is the imaging features of acute rejection following lung transplant?
Ground glass opacities and intralobular septal thickening.
(No ground glass → no rejection)
Hot quadrate sign is seen in what pathology?
SVC obstruction
What are the 3 main causes of pulmonary artery aneurysms?
Iatrogenic from swan ganz catheter
Behcet’s (also have mouth/genital ulcers)
Chronic PE
What are the causes of fibrosing mediastinitis (soft tissue mass with calcifications infiltrating fat planes)?
Idiopathic
Histoplasmosis
TB
Radiation
Sarcoid
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?
Down’s syndrome
What is the difference between lipomatous hypertrophy of the intra-atrial septum and a lipoma?
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
What are the branches of the left main coronary artery?
Circumflex (divides into obtuse marginals which supply lateral margin)
Left anterior descending (divides into septal branches and diagonals)
What are the branches of the right main coronary artery?
Acute marginal
AV node branch
Posterior descending artery (in most people)
What is meant by malignant origin of the left coronary artery?
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.
Reversal of flow in the left coronary artery as the pressure decreases in the pulmonary circulation, termed STEAL syndrome, is caused by what?
Anomalous left coronary artery from the pulmonary artery (ALCAPA)
What are the causes of coronary artery aneurysms?
Atherosclerosis (most common cause in adults)
Kawasaki (most common in children)
Iatrogenic
Velocity encoded CINE MR imaging/ velocity mapping/ phase contrast imaging is an MR technique for what?
Quantifying the velocity of flowing blood
What is the most common congenital heart disease?
Bicuspid aortic valve
(if not an option chose VSD)
What is the differential for aortic stenosis?
Atherosclerosis (degenerative)
William’s syndrome
Rheumatic heart disease
Bicuspid aortic valve
Williams syndrome is characterised by what features?
Craniofacial dysmorphism
Short stature
Intellectual disability
Supravalvular aortic stenosis
Pulmonary artery stenosis
Renal artery stenosis
Hypercalcaemia
What is the most common associated defect with aortic coarctation?
Bicuspid aortic valve
What are the associations with a bicuspid aortic valve?
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
What are the causes of aortic regurgitation?
Aortic root dilatation (HTN/ Marfans)
Aortic dissection
Bicuspid aortic valve
Bacterial endocarditis
What is the most common cause of mitral stenosis?
Rheumatic heart disease
What are the imaging features of mitral stenosis?
Left atrial enlargement
(double density sign, splaying of the carina, posterior oesophageal displacement)
Isolated right upper lobe pulmonary oedema is associated with what?
Mitral regurgitation
What are the causes of acute mitral regurgitation?
Myocardial infarction with papillary muscle rupture (most commonly posteromedial papillary muscle)
Infective endocarditis
Chordae tendinae rupture in myxomatous degeneration
What are the causes of chronic mitral regurgitation?
Annular calcification
Myxomatous degeneration
Previous infective/ inflammatory illness
Dilated cardiomyopathy
Hypertrophic obstructive cardiomyopathy
What are the causes of pulmonary stenosis?
Noonan syndrome
Williams syndrome
Tetralogy of Fallot
What are the features of Alagille syndrome?
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
Peripheral pulmonary artery stenosis can be seen in what syndrome?
Alagille syndrome
What are the causes of pulmonary regurgitation?
Congenital valve disease repair (TOF)
Pulmonary arterial hypertension
What are the causes of tricuspid regurgitation?
Pulmonary arterial hypertension (most common cause in adults)
Ebstein anomaly (most common congenital cause)
Endocarditis
Carcinoid syndrome
What is Ebstein anomaly?
Abnormal tricuspid valve which is displaced apically into the right ventricle resulting in atrialisation of part of the ventricle above the valve.
What are the imaging features of Ebstein anomaly?
Severe cardiomegaly with right atrial enlargement (“box-shaped” heart)
Tricuspid regurgitation
A right aortic arch with mirror branching is associated with what?
Tetralogy of Fallot (most common)
Truncus arteriosus (2nd most common)
Tricuspid atresia
Transposition of the great arteries
What is a Kommerell diverticulum?
Bulbous origin of an aberrant subclavian artery
(either left with right arch or right with left arch)
Cyanotic heart anomaly characterised by agenesis of the tricuspid valve and right ventricular inlet.
Tricuspid atresia
What are the associations with tricuspid atresia?
ASD or PFO (almost always for circulation to be complete)
VSD
Transposition of the great arteries
Right-sided aortic arch
Asplenia
What is the most common vascular ring?
Double aortic arch
What is the difference between subclavian steal syndrome and subclavian steal phenomenon?
Syndrome also has associated cerebral ischaemic symptoms
What are the causes of subclavian steal syndrome?
Atherosclerosis (most common)
Takayasu arteritis (most common if young)
Radiation
Preductal coarctation of the aorta
Small mass attached to the inter-atrial septum by a small stalk which is iso/ hypointense on T1 weighted imaging. What is the diagnosis?
Atrial myxoma
(most common location is the left atrium)
“Egg on a string” classically describes the CXR appearance of which congenital heart disease?
Transposition of the great arteries
“Snowman appearance” classically describes the CXR appearance of which congenital heart disease?
Supra-cardiac total anomalous pulmonary venous return (TAPVR)
“Boot-shaped” classically describes the CXR appearance of which congenital heart disease?
Tetralogy of Fallot
“Figure of 3” classically describes the CXR appearance of which congenital heart disease?
Coarctation of the aorta
“Box-shaped” classically describes the CXR appearance of which congenital heart disease?
Ebstein anomaly
“Scimitar sword” classically describes the CXR appearance of which congenital heart disease?
Partial anomalous pulmonary venous return (PAPVR) with pulmonary hypoplasia
What is truncus arteriosus?
Cyanotic congenital heart disease in which a single trunk supplies both the pulmonary and systemic circulation (cotruncal anomaly)
Almost always associated with a VSD
Right sided aortic arch with increased pulmonary vasculature. What is the diagnosis?
Truncus arteriosus
Right sided aortic arch with decreased pulmonary vasculature. What is the diagnosis?
Tetralogy of Fallot
What is Tetralogy of Fallot?
Right ventricular outflow obstruction
Ventricular septal defect (VSD)
Right ventricular hypertrophy
Overriding aorta
Tetralogy of Fallot is associated with which extra-cardiovascular conditions?
Congenital lobar emphysema
DiGeorge syndrome
Fetal rubella syndrome
Prune belly syndrome
Tracheo-oesophageal fistula
VACTERL association
In which congenital heart diseases will the child be cyanotic?
Tetralogy of Fallot
Total anomalous pulmonary venous return (TAPVR)
Transposition of the great arteries
Truncus arteriosus
Tricuspid atresia
What is transposition of the great arteries?
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
What is L-type transposition of the great arteries?
“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
Following a LeCompte Maneuver, a patient has their pulmonary arteries draped over the aorta.
What was this procedure carried out for?
Corrected D-transposition of the great arteries
What is the most common VSD?
Membranous (just below the aortic valve)
What is a patent ductus arteriosus?
Persistent patency of the ductus arteriosus, a normal connection of the fetal circulation between the aorta and the pulmonary arterial system.
What is the most common type of ASD?
Secundum
Which syndrome would you find an ASD and upper limb anomalies?
Holt-Oram syndrome
Secundum ASD and atrioventricular septal defects (AKA endocardial cushion defect) is associated with which syndrome?
Down’s syndrome
A sinus venosus ASD is associated with what congenital heart disease?
Partial anomalous pulmonary venous return
Unroofed coronary sinus is strongly associated with which normal variant?
Persistent left SVC
What is partial anomalous pulmonary venous return?
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)
What is total anomalous pulmonary venous return?
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
Right sided PAPVR is associated with what?
Sinus venosus type ASD
Right sided PAPVR with pulmonary hypoplasia.
What is the diagnosis?
Scimitar syndrome
There are 3 types of TAPVR. Which is the most common?
Type 1: supracardiac (gives snowman appearance)
There are 3 types of TAPVR.
Which type gives full on pulmonary oedema appearance in the newborn?
Type 3: infracardiac (veins drain below the diaphragm)
Of the patients with asplenia who also have congenital heart disease (approx 50%), how many have TAPVR?
100%
85% also have endocardial cushion defect (AV canal/ atrioventricular septal defect)
What is the most common complication following surgery for tetralogy of Fallot?
Pulmonary regurgitation
Which ribs are involved in rib notching, secondary to aortic coarctation?
4-8th ribs
(does NOT involve 1st and 2nd as those are supplied by the costocervical trunk)
What pathology gives you a tri-atrium heart?
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)
What is a stunned myocardium?
Dysfunction of the myocardium which persists after restoration of blood flow following an acute injury
(MI or reperfusion injury)
What are the imaging features of a stunned myocardium?
Abnormal wall motion
Normal perfusion on Thallium and Sestamibi
What is a hibernating myocardium?
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
What are the imaging features of hibernating myocardium?
Areas of decreased perfusion and contractibility
Increased tracer uptake on PETCT
Redistribution of Thallium
How is delayed cardiac imaging performed to look for infarction?
Inversion recovery technique to null normal myocardium followed by gradient echo.
Bright on T1 = dead.
How can you differentiate acute from chronic MI?
Acute: delayed enhancement, normal thickness myocardium, increased T2 from oedema
Chronic: delayed enhancement, thinned myocardium, T2 dark (scar)
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?
Acute
It’s NOT seen in chronic infarct
Ventricular aneurysms can occur secondary to MI. What are the features of a TRUE aneurysm?
Mouth is wider than body
Myocardium is intact
Antero-lateral wall
Ventricular aneurysms can occur secondary to MI. What are the features of a FALSE aneurysm?
Mouth is narrow compared to body
Myocardium is NOT intact
Posterior-lateral wall
higher risk of rupture
Dressler syndrome is seen how long after a myocardial infarction?
4-6 weeks
What is the symptoms of Dressler syndrome?
Pleuritic chest pain, fever, malaise
Pericardial effusion
Leucocytosis/ raised inflammatory markers
What is the differential for restrictive cardiomyopathy?
Amyloid (most common)
Endocardial fibroelastosis
Haemochromatosis
What are the imaging features of cardiac amyloidosis?
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”
What are the imaging features of cardiac sarcoidosis?
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
What is the most common primary malignancy of the heart in adults?
Angiosarcoma
What is the imaging features of a cardiac angiosarcoma?
“Sun-ray appearance”
Commonly right atrium involving the pericardium
Bulky and heterogenous
How would you differentiate an atrial myxoma from a thrombus?
Myxoma will enhance
Myxoma will be attached to the inter-atrial septum
Atrial myxoma is associated with what syndrome?
Carney complex
What is the most common fetal cardiac tumour and what are the imaging appearances?
Rhabdomyoma
Typically arise within the ventricular myocardium (left more common)
Isointense to myocardium on T1, mildly hyperintense on T2 and no enhancement
What are the imaging features of a cardiac fibroma (2nd most common cardiac tumour in childhood)?
Most common location is left ventricle and interventricular septum
Dark on T1/T2 imaging
Enhance avidly
What is the definition of adenocarcinoma in situ in the lung?
< 3cm
No features of necrosis or invasion
What is the definition of minimally invasive adenocarcinoma of the lung?
< 3cm
< 5mm of stromal invasion
What is the first branch of the SMA?
Inferior pancreaticoduodenal artery
What arteries make up the arc of Riolan?
Left colic (from IMA) to middle colic (from SMA)
Which branches of the internal iliac arteries are from the posterior divisions?
Iliolumbar
Lateral sacral
Superior gluteal
What is the relationship of the subclavian vessels with the anterior scalene muscle?
The subclavian veins runs anterior to the muscle, the artery runs posterior
When does the subclavian artery become the axillary artery?
At the 1st rib
When does the axillary artery become the brachial artery?
At the lower border of teres major
When does the external iliac artery become the common femoral artery?
Once it gives off the inferior epigastric artery at the inguinal ligament
Most gastric varices are formed by which vein?
Left gastric vein (coronary vein)
Isolated gastric varices are caused by what?
Splenic vein thrombosis
Where do gastric varices drain?
Into the inferior phrenic, then into the left renal vein (forming a gastro-renal shunt)
Enlarged left renal vein with enlargement of the IVC at the level of the left renal vein can be caused by what?
Splenorenal shunt caused by portal hypertension
Associated with hepatic encephalopathy
NOT associated with GI bleeding
What is the most common congenital heart disease associated with a left IVC?
ASD
Azygous continuation of the IVC is associated with what splenic abnormality?
Polysplenia
What are the causes of aortic dissection?
Hypertension (most common)
Marfans
Turners (aortic valve defects)
Infection
Pregnancy
Cocaine use
How do you identify the true lumen in aortic dissection?
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
How do you identify the false lumen in aortic dissection?
“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
What are the causes of ascending aortic calcification?
Takayasu arteritis
Syphilis
Cystic medial necrosis is associated with which syndrome?
Marfan’s syndrome
Describe a type 1 endoleak?
Leak at the top or the bottom of the graft
Describe a type 2 endoleak?
Filling of the aneurysm sac via feeder arteries
(most likely IMA or a lumbar artery)
Describe a type 3 endoleak?
Defect/ fracture in the graft
Describe a type 4 endoleak?
Porosity of the graft
(doesn’t usually happen with modern grafts)
Describe a type 5 endoleak?
Endotension
What is the most common endoleak?
Type 2
What are the imaging findings of impending aortic aneurysm rupture?
Peri-aortic stranding
Rapid enlargement (>10mm per year)
Draped aorta sign
Focal discontinuity in circumferential wall calcification
Hyperdense crescent sign
What are the vascular features of Marfan’s?
Dilatation of the aortic root
Aortic valve insufficiency/ severe aortic regurgitation
Aortic aneurysm/ dissection
Pulmonary artery dilatation
Which part of the bowel is most commonly involved in aorto-enteric fistula?
3rd and 4th parts of the duodenum
How can you differentiate between aorto-enteric fistula and perigraft infection?
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
What is Leriche syndrome?
Complete occlusion of the aorta, distal to the renal arteries (often secondary to bad atherosclerosis)
What is the triad associated with Leriche syndrome?
Buttock claudication
Absent/ decreased femoral pulses
Impotence
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?
Mid-aortic syndrome
(thought to be secondary to intrauterine insult)
Elongation with narrowing and kinking of the aorta but no pressure gradient, collateral formation or rib notching. What is the diagnosis?
Pseudocoarctation
(area of dilatation may occur distal to the area of narrowing and may be progressive so should be followed up)
What is the most common cause of thoracic outlet syndrome?
Compression by the anterior scalene muscle
What are the causes of TRUE splenic aneurysms?
Pregnancy
Hypertension
Portal hypertension
Cirrhosis
Liver transplant
What is the most common location involved in chronic mesenteric ischaemia?
Splenic flexure
(watershed area of the SMA and IMA)
What are the imaging features of colonic angiodysplasia?
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
Aortic stenosis and colonic angiodysplasia is referred to by which syndrome?
Heyde syndrome
Which arteries are most commonly involved in fibromuscular dysplasia?
Renal arteries (most common)
Carotid arteries
Iliac arteries
“String of beads” description of arteries is seen in which condition?
Fibromuscular dysplasia
What is May-Thurner syndrome?
Compression of the left common iliac vein by the right common iliac artery resulting in DVT
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?
Popliteal entrapment
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.
Klippel-Trenaunay syndrome
What is a normal ankle to brachial index (ABI)?
1.0
At which ABI will patients experience rest pain?
< 0.3
What is the most likely cause of re-stenosis 3-12 months after angioplasty?
Intimal hyperplasia
Takayasu tends to affect which patients?
Young Asian girls, typically aged 15-30
Polyarteritis nodosa (PAN) commonly affects which systems?
Renal (microaneurysms)
Cardiac
GI
Polyarteritis nodosa is associated with what?
Hepatitis B
More common in men
What is the most common vasculitis in children?
Henoch-Schonlein purpura (HSP)
Which vasculitis is strongly associated with smokers and the development of corkscrew collateral vessels. Buzzword = auto-amputation
Buergers
HSP is associated with what?
Intussusception
Massive scrotal oedema
What are the contraindications to beta-blockers?
2nd/3rd degree heart block
severe asthma
acute chest pain
recent snorting of cocaine
What are the contraindications to nitroglycerine?
hypotension (SBP <100)
severe aortic stenosis
HOCM
phosphodiesterase
What are the branches of the external carotid arteries?
Some Anatomists Like Freaking Out Poor Medical Students
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
Cardiac MRI finds circumferential endocardial fibrosis and biventricular thrombi. What is the most likely diagnosis?
Loeffler endocarditis
Can be distinguished from amyloidosis by the adherent ventricular thrombi. Patients will also have peripheral blood eosinophilia
What are the imaging features of lymphocytic interstitial pneumonitis?
Mid to lower zone predominance
Thickening of bronchovascular bundles and interstitial thickening
Scattered thin walled cysts
Mosaic perfusion with no air trapping. What is the most likely diagnosis?
Pulmonary emboli
What is the most common CT chest finding in patients with history of acute respiratory distress syndrome?
Reticular changes in the anterior/ventral non-dependent lung
What are the radiographic findings of acute rejection following lung transplant?
Ground glass opacity
Heterogeneous peri-hilar opacification
New enlarging pleural effusion with septal thickening
No signs of left ventricular failure
The bronchial tree receives blood from one right and two left bronchial arteries. From which vessel does the single right artery usually arise?
Third posterior right intercostal artery
What are the imaging features of pulmonary hamartomas?
Peripheral
Popcorn calcification
Fat in 50%
What are the imaging features of pulmonary carcinoid?
Tend to be more central and endobronchial in location
Calcification
Rarely cavitate
No fat
Prominent enhancement following contrast
What is the most common pulmonary finding on chest radiograph in rheumatoid arthritis?
Pleural effusion
Which lung segments are separated by the superior accessory fissure?
Apical segment of the lower lobes from the other lower lobe segments
Which lymphoma is usually almost entirely confined to the lymph nodes?
Hodgkins lymphoma
Pulmonary involvement in Hodgkins lymphoma indicates which stage of disease?
Stage IV
What is the dose for a CT pulmonary angiogram relative to a V/Q scan?
CT pulmonary angiogram has a higher total body dose but a lower uterine dose
What are the imaging features of amiodarone lung disease?
Alveolar and interstitial infiltrates and high density areas of consolidation (iodine)
What is hypertrophic obstructive cardiomyopathy?
Diffuse or segmental left ventricular hypertrophy with a non-dilated and hyperdynamic chamber in the absence of another condition to explain the hypertrophy
What are the imaging appearances of hypertrophic obstructive cardiomyopathy?
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
What are the features of Kawasaki disease?
Fever and maculopapular rash
Cervical lymphadenopathy
Coronary artery aneurysms
Myocarditis/ pericarditis/ pericardial effusions/ valvular disease
Where do cardiac fibroelastomas commonly arise and what is the key feature on imaging?
Cardiac valves (80% are aortic or mitral)
Intense enhancement on delayed imaging (this is how they can be differentiated from a vegetation)
Dissection of the cervical portion of the ICA can result in which symptoms?
Partial Horners syndrome (miosis and ptosis)
MCA territory stroke
Aneurysm with the origin at the “dural ring” is found where?
Ophthalmic (supraclinoid) segment of the internal carotid artery
Where are the most common sites of aneurysm formation in the posterior intracranial circulation?
Basilar (most common)
PICA
“Caput medusa” and “large tree with multiple small branches” are terms used to describe what?
Developmental venous anomaly
(associated with cavernous malformations)
What are the imaging features of intracranial cavernous malformations?
“Popcorn- like” with peripheral rim of haemosiderin without intervening normal brain tissue
The “crescent sign” of dissection is seen on which MRI sequence?
T1 (will be bright)
