glandular calcifications

Question 1

what is gallstone aka?

Answer 1

cholelithiasis

Question 2

are gallstones usually seen on film?

Answer 2

only 10-20% are radiopaque (positive) the rest are not seen

Question 3

why aren’t gallstones typically seen on x-ray?

Answer 3

most made of cholesterol and the cholesterol composition can’t be seen

Question 4

how can you tell in a gallstone is old or new?

Answer 4

old ones are laminated

like a tree, the older the stone, the more rings it has

Question 5

how do gallstones typically present?

Answer 5

usually there are multiple stones with faceted (flat) surfaces and a peripheral rim of calcification

Question 6

what are lucent internal branching cracks filled with nitrogen gas that may be seen internally called and why are they called that?

Answer 6

“mercedes benz” or “crow foot” sign due to their Y shape

Question 7

what causes the mercedes benz/ crow foot sign?

Answer 7

old stones dehydrate and shrink

Question 8

what quadrant are gallstones typically located?

Answer 8

RUQ

Question 9

where would you see gallstones on a lateral film?

Answer 9

anterior to the spine

Question 10

are gallstones typically symptomatic or asymptomatic?

Answer 10

asymptomatic 30-50% of the time

Question 11

what size gallstone can pass through the ducts easily?

Answer 11

5mm or less

Question 12

what are 3 causes a patient may experience pain from a gallstone?

Answer 12

1 recurrent cholecystitis
2 obstruction of a duct (usually cystic duct)
3 perforation of GB wall with fistula formation, usually onto duodenum or colon

Question 13

gas found in the ducts as streaks of air are called?

Answer 13

pneumobilia

Question 14

when a large stone causes bowel obstruction it is called what and where is it typically located?

Answer 14

usually in the terminal ileum

*gallstone ileus

Question 15

what is a rare and worst case scenario associated with gallstones?

Answer 15

carcinoma

Question 16

if the gallbladder lumen contains high % of Ca carbonate and appears very dense, what would you suspect?

Answer 16

milk of calcium bile-rare

Question 17

what would upright films demonstrate with milk of calcium bile?

Answer 17

horizontal fluid level

Question 18

porcelain or petrified gallbladder may be due to?

Answer 18

chronic cholecystitis

Question 19

a thin linear calcification in the muscular wall or submucosal layer of the gallbladder is known as?

Answer 19

porcelain or petrified gallbladder

Question 20

what is the shape of a porcelain/petrified gallbladder?

Answer 20

pear shaped, oval or round

Question 21

porcelain gallbladder has what type of obstruction?

Answer 21

cystic duct obstruction and may not be visible

Question 22

carcinoma occurs in what percent of porcelain gallbladder cases?

Answer 22

20%

Question 23

what is the usual treatment of porcelain gallbladder?

Answer 23

removal prophylactically

Question 24

many punctate (stippled) densities form in the pancreatic duct, you would suspect?

Answer 24

pancreatic calcifications

Question 25

how do pancreatic calcifications present?

Answer 25

75% on both sides of the spine, they cross the midline

Question 26

what is usually the cause of pancreatic calcifications?

Answer 26

chronic inflammatory process (chronic pancreatitis);

almost always found in chronic alcoholics (6+ years) (chronic pancreatitis)

Question 27

what are other more rare causes of pancreatic calcification?

Answer 27

1 chronic calcifying pancreatitis 
2 nutritional pancreatitis 
3 HPT
4 cystic fibrosis
5 hereditary 

rarely pancreatic calcifications are cystic (usually pseudocysts)

Question 28

adrenal gland calcifications are located where?

Answer 28

paraspinally at about L1

Question 29

where are adrenal gland calcifications seen on the lateral view?

Answer 29

over the spine like the kidneys

Question 30

patterns of adrenal gland calcification are?

Answer 30

punctuate and cystic

Question 31

adrenal gland calcification’s etiology?

Answer 31

can be benign or malignant

Question 32

what type of adrenal calcification is often seen in children?

Answer 32

neonatal hemorrhage-punctuate

Question 33

what is the adrenal calcification pattern seen with post traumatic hemorrhage in adults?

Answer 33

punctuate and cystic

Question 34

what is the adrenal calcification pattern seen with TB and histoplasmosis?

Answer 34

punctuate but TB can be cystic too

Question 35

31% of cortical malignancies contain what?

Answer 35

calcium

Question 36

lymph node calcifications commonly originate from?

Answer 36

post infectious granulomas

Question 37

how do lymph node calcifications appear?

Answer 37

small solid calcifications that are clumped into clusters

• mulberry like
• often multiple but can be singular

Question 38

where are lymph node calcifications seen on an AP film?

Answer 38

close to the psoas muscles on AP film

Question 39

what are the most common calcific abdominal lymphatics?

Answer 39

mesenteric nodes

Question 40

where are mesenteric calcifications seen on a lateral film?

Answer 40

anterior to the spine

Question 41

which lymph node calcification is close to the spine at about L2-L4 and is rare?

Answer 41

para-aortic node calcification

Question 42

what are all lymph node calcifications caused by?

Answer 42

healed infections, most all from TB

Question 43

are lymph node calcifications clinically significant?

Answer 43

no, all are thought to be insignificant

Question 44

what is the MC location of lymph node calcifications?

Answer 44

hilar region of the chest