GA - Anatomic Radiology

Question 1

What Is Zenker’s Diverticulum?

Answer 1

It is the formation of a false Diverticulum at the weak area of the hypopharynx (before the esophagus) known as Killian’s Triangle

Symptoms include difficulty swallowing, halitosis (bad breath, due to food getting stuck in the pouch), and cough

Diagnosed via fluoroscopic barium esophagography

Endoscopy should NOT be performed if Zenker’s diverticulum is suspected, as it can cause a rupture

Question 2

What is a hiatal hernia?

Answer 2

Abdominal structures herniating into the thoracic cavity

2 Types: Paraesophageal and Sliding

Paraesophageal Hernia: Fundus of the stomach is displaced, but the Gastroesophageal Junction is unaffected

Sliding Hernia: Cardia of the stomach is displaced; Gastroesophageal Junction is elevated.

Question 3

What is Barium Enema X-Ray and what is used for?

Answer 3

Barium Enema X-ray is when a paitent is given an enema of barium rich fluid

It is used to examine for conditions affecting the large intestine (such as polyps and inflammatory bowel disease)

“Lead Pipe Sign” - which is where the colon appears like a lead pipe and is lacking Haustral markings - is indicative for Long-Standing Ulcerative Colitis

Question 4

What is achalasia?

Answer 4

Lower Esophageal Sphincter fails to relax

Symptoms: Difficulty swallowing - liquids and solids

Can be autoimmune or can be infectious (Chagas Disease)

Barium Swallow X-Ray is used to look for “Bird Beak Sign” - esophagus resembles a bird beak

Question 5

What is ERCP and what is it used for?

Answer 5

Endoscopic Retrograde Cholangio-Pancreatography
- Modality of choice for visualization of the biliary tree

Flexible tube is passed endoscopically to the 2nd part of the duodenum where it injects a contrast dye into the Ampulla of Vater

ERCP is also used as a treatment modality. It can perform stenting if there is a gall stone obstruction, improving drainage.

Question 6

What is Digital Subtraction Angiography and what is it used for?

Answer 6

Catheter is inserted and dye is injected to provide contrast visualization of arterial supply to a particular region

Helps identify compromised blood flow

Question 7

What is ultrasonography and what is it used for?

Answer 7

Uses high frequency sound waves to produce images of internal structures

Gold standard for diagnosing Cholelithiasis (gallstones)

Question 8

What is Cholelithiasis?

Answer 8

Gallstones

Presents with upper right quadrant pain, can radiate to shoulder

Positive Murphy’s sign (palpate under costal margine while instructing patient to inhale; if patient abruptly stops inhalation due to pain = positive sign)

Diagnosed using Ultrasound (Only 20% of gallstones are visible on X-ray)

Question 9

What are the significant aspects of CT imaging?

Answer 9

Radiation

Fast - Takes 5 minutes

Best spatial resolution (thinner images, resolve small things that are close to each other)

Good for looking at solid organs and fat planes
Good for overall look of pelvic organs (but limited detail)
EXCELLENT for calcification (ie small renal stones)

Uses Iodine IV contrast

Question 10

What are the significant aspects of MRI imaging?

Answer 10

No radiation

Slow - takes more than 20 minutes

Best tissue resolution (different tissues have different concentrations of hydrogen)

Good for characterization of lesions
EXCELLENT for pelvic organs
Not Good for calcification

Uses Gadolinium IV contrast