CORE Radiology

Question 1

Peds: Types of upper airway obstruction above level of trachea?

Answer 1

1. Congenital (choanal atresia)
2. Neoplastic (rhabdomyosarcoma)
3. Infectious (peritonsillar abscess)

Question 2

Peds: Upper airway obstruction by anatomic level?

Answer 2

Nasal and nasopharyngeal: Choanal atresia, rhabdomyosarcoma, adenoid hypertrophy

Oropharyngeal: peritonsillar abscess, thyroglossal duct cyst

Question 3

Choanal atresia?

Answer 3

Congenital occlusion of the choanae in posterior nasal cavity

Osseous, membranous, or mixed.

Almost always have osseous involvment 70% mixed, 30% pure bony atresia

Associated with CHARGE syndrome

Question 4

CHARGE syndrome?

Answer 4

Coloboma (gap in iris or retina)

Heart defects

Atresia of choanae

Retardation of development

Genitourinary abnormalities

Ear anomalies

Question 5

Juvenile Nasopharyngeal Angiofibroma (JNA)?

Answer 5

Highly vascular, benign hamartomatous lesion in ADOLESCENT MALES

Originates in sphenopalating foramen and spreads into the nasopharynx and pterygopalatine fossa –> bony remodeling along the way

1° Ddx -> rhabdomyosarcoma (bony destruction)

Question 6

Peds: Ddx of nontraumatic prevertebral soft tissue swelling?

Answer 6

Retropharyngeal abscess

Retropharyngeal cellulitis

Lymphoma

Foregut duplication cyst

Question 7

Vascular ring?

Answer 7

Complete encircling of the trachea and esophagus by the aortic arch or great vessels

Question 8

Vascular sling?

Answer 8

Anomalous course of the left pulmonary artery, which arises aberrantly from the right pulmonary artery and traps the trachea in a “sling” on three sides

Question 9

Peds: 3 most important vascular causes of stridor?

Answer 9

1. Double aortic arch
2. Right arch with aberrant left subclavian a.
3. Pulmonary sling

Question 10

Bronchus suis?

Answer 10

RUL bronchus originates from the trachea

Question 11

Dysphagia lusoria?

Answer 11

Dysphagia as a result of an aberrant right subclavian artery

Question 12

Findings and complications of subfalcine herniation?

Answer 12

Subfalcine herniation of the cingulate gyrus

Can cause compression of the ACA against the falx

Contralateral hydrocephalus from occlusion of the Foramen of Monroe

Question 13

Types of transtentorial herniation?

Answer 13

Downward

Upward

Question 14

Downward transtentorial herniation?

Answer 14

Downward herniation of the medial temporal lobe (incus)

Can cause ipsilateral CN III palsy (eye is down and out)

Can compress the ipsilateral PCA leading to medial temporal lobe and occipital lobe infarcts

Upper brainstem Duret hemorrhages from shearing forces

Ipsilateral paresis on the herniated side secondary to mass effect on the contralateral cerebel peduncle agains Kernhan’s notch

Question 15

Upward transtentorial herniation

Answer 15

Superior herniation of the cerebellar vermis 2/2 posterior fossa mass effect

Complication: obstructive hydrocephalus from compression of the cerebral aqueduct

Question 16

MRI:

T1 shortening vs prolongation

Answer 16

Shortening: makes things brighter –> hyperintense

Prolongation: makes things darker –> hypointense

Question 17

MRI:

T2 shortening vs. prolongation

Answer 17

Shortening: darkens things –> hypointense

Prolongation: brightens –> hyperintense

Question 18

Tissues that are T1 bright

Answer 18

Things that cause T1 shortening (hyperintensity)

Fat

Gadolinium

Proteinaceous material

Some paramagnetic stages of blood (intra and extra cellular)

Melanin

Mineralization (iron, manganese, copper)

Slow flowing blood

Calcium –> rarely when not dispersed in bone, more common to be hypointense though

Question 19

MRI appearance of most brain lesions?

Answer 19

T1: dark/hypointense

T2: bright/hyperintense