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Kim's > H&N > Flashcards

H&N Flashcards

1
Q

intraconal mass

A 
melanoma - most common globe mass in adult, mushroom shape ⬆t2⬇t1, c+
retinoblastoma
mets
meningioma
lymphoma
vascular  - haemangioma
optic nn glioma
pseudo tumor - mm and tendon
cellulitis
Graves - mm only
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2
Q

extraconal mass

A

MOLD
mets
Others - rhabdomyosarcoma, lymphangioma (kids 1st decade, don’t involute like neck), plexiform neuro fibroma, pseudo tumor, haemangioma
Lacrimal gland/Lymphoma (DWI +, homogeneous c+)/LCH
Dermoid (anterior medial angle..fat containing)

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3
Q

Lacrimal gland mass

A

lateral to globe
50% inflammatory - wegeners
50% neoplastic - lymphoma, pleomotphoc adenoma

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4
Q

destructive lesion in mandible

A

Mets
myeloma
EG - older kids and young adults, pseudo tumor. punched out lyric erosion
severe peridontal infection

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5
Q

glomus tumour

A

carotid body- ICa/ECA bifurcation. most common, middle aged. can be bilateral. assoc. NF1, TS, MEN II, VHL
glomus vagale- behind carotid, IJV goes back and ICa/ECa forward (not splayed). painless.
jugulare tympanicum - Arnold nn (X). between cochlear promintory and jug foramen
tympanicum - cochlear promontory and middle ear. arises Jacobs nn (IX) . most common middle ear tumour.

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6
Q

J shaped sella

A 
hydrocephalus 
mucopolysaccharides
Achondroplasia
pituitary mass
idiopathic - 5%
neuro fibroma toss
Optic chasm glioma
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7
Q

WM lesion HIV

A

vascular - rxt, vasculitis
Infection- PML (asymmetric, subcortical u fibres), HIV encephalitis, CMV (spares u fibres), toxoplasmosis, HSV, tb, cryptococcus
Demyelination, pres
Neoplasm - lymphoma, glomatosis cerebri

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8
Q

BG lesion HIV…… VINT

A

Vascular - hypoxia, aa or deep vv infarct
Infection - crypotococcus, toxo
Toxic/metabolic- CO, drugs, osmotic Demyelination
Neoplasm - lymphoma, glioma

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9
Q

HIV encephalopathy vs PML

A

PML - 3 Ps
peripheral, patchy, posterior
Encephalitis - symmetrical frontal atrophy

both have very little to no mass effect and no c+

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10
Q

PHACE

A 
Posterior fossa malformation
Haemangioma
Arterial anomalies
Coarctation of aorta
E. Occur anomalies
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11
Q

Lymphangioma. what is it

A

benign lymphatic malformation of vascular origin
90% kids <2yo. h&n most common
lots of interconnecting cysts. homogeneous on CT fluid density.
Cavernoma (small microcysts), cystic hygroma (macrocysts), simple capillary and lymphovascular

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12
Q

infantile haemangioma

A

benign vascular neoplasm
small or absent at birth, grows in first year then involutes
C+, intermediate/high T2, NO phleboloiths
associated PHACE

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13
Q

salivary and parotid tumour

A

benign:
pleomorphic adenoma (most common parotid. also in salivary and Lacrimal. lobular low density/echo +/- ca+ & necrosis)
warthins (cystadenoma. bilateral and multifical, cystic/solid. assoc smoking and rxt)
other adenomas
Oncocytoma

Malig:
mucoepidermoid carcinoma ( most common parotid. sq cells)
adenoid cystic carcinoma (small. most common minor salivary. no sq. cells) Lymphoma
adenoca and scc

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14
Q

Kimura disease

Castleman’s disease

A

Kimura. inflamm salivary, parotid and submandibulars. 20-40yo Asians

castlemans. lymphoid hyperplasia. young adults and kids (unifocal) or HIV (multifocal). thorax 》abdo》neck

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15
Q

Nasal mass

A

Juvenile angio fibroma. exclusive to teenage males. sphenopalatine fossa. v. vascular (maxillary aa)
Nasopharygeal ca. 20s and >60yo peaks. Chinese, African kids. EBV and HPV assoc. fossa rosenmeuller
Inverting papilloma. sq. epithelium inverts into mucosa to give cerebriform appearance. Lat wall or max sinus. smokers
Polyp. lateral wall and roof. chronic irritation. can be up to 4cm.

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16
Q

cholesteatoma vs cholesterol granuloma

A

granuloma is T1 high

cholesteatoma t1 low. don’t C+

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17
Q

Piriform and vallecula

A

VP
Vallecula higher
Piriform lower

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18
Q

Brachial cleft cysts

A
  1. EAC - posteroinferoir to pinna @ angle mandible. adj. to parotid.
  2. Tonsilar sinus - Most common.Tonsillar fossa mid SCM ant to mm, deep to ICA at level of mandible
  3. Piriform recess - Posterior triangle. posterior to margin of scm
  4. Piriform apex - lateral to thyroid
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19
Q

Jaw cystic lesion associated with teeth

A

periapical cyst. root, unilocular. most common

dentigenous. crown of unerrupted. unilocular. young adult
amenoblastoma. expansile soap bubble 30-50yo. C+ nodule. unerrupted tooth. locally aggressive
keratocysts. expansile uni or multilocular soap. unerrupted tooth. cheesy debris within

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20
Q

Jaw cystic lesion not associated with teeth

A 
ABC. soap bubble <20yo
SBC. post trauma
EG. kids. aggressive
FD. GG matrix
Mets
Brown tumour. hyperparathyroid. floating teeth (loss of dura lamina)
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21
Q

globe mass. young

A

young:
Retinoblastoma (+/- ca+. <3yo. trilateral - bilateral retinoblastoma and pineal blastoma)
Fibroplasia. O2 damage to eye. asymmetric globe. hx premi
Phakoma. TS

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22
Q

globe mass adult

A

melanoma
retinal detachment
haematoma
mets

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23
Q

CADASIL

A

Cerebral autosomal dominant arteriopathy with subcortical infarcts

periventricular WM signal leukoencephalopathy with patch foci elsewhere of WM change/ infarcts
external capsule infarcts/signal is suggestive
Temporal pole signal changes are characteristic
can have an acute focus of infarct as hx is transient episodes of weakness, headaches and mood swings/changes
bilateral and reasonably symmetrical WM sig changes, infarcts patchy and asymmetric

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24
Q

HSV 1 and 2

A

HSV 1 causes encephalitis
HSV 2 causes meningitis

HSV 2 more common in <10yo as get it from mum

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25
Q

mri changes in infarct

T2, DWI, ADC

A

DWI within mins (cytotoxic oedema)
T2 increases in 3-6hrs
ADC reduces, but begins to normalize 7-10 days
?+/- mass effect and flow voids

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26
Q

acute infarct

A

embolism. AF, endocarditis, atherosclerosis, air or fat
thrombus. perforators (lacunar), acute plaque rupture
dissection. FLAIR high rim, crescent vessel. younger, trauma. vert aa intra>extra, ICS just above bulb most common place
Vasculitis. peripheral and multiple
Infection. TB vasculitis. also have basal subarach signal or tuberculoma
Moya Moya. 4 yo and 30yo. supraclinoid ICA puff of smoke on DSA
CADASIL. 30yo inherited stroke disorder with multiple strokes and leukomalacia/leukodystrophy
Transient Global amnesia. 24hr sudden memory loss that resolves. punctuate foci of high T2 posterior hippocampus. middle aged.

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27
Q

artery of percheron

A

single aa supplying thalami from PCA
infarct of medial thalami and rostral midbrain
often not seen on MRA or CTA

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28
Q

lateral medullary syndrome

ddx

A

vertigo, falling, facial pain and horners
vertebral aa or PICA infarct

DDX
wallerian degen
Demyelination.  adem, Ms
vascular. capillary or cavernous
brainstem glioma. kids
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29
Q

TGA

Transient Global amnesia

A

self limiting over 24 hours
hight T2 posterior hippocampus (just behind temp horn on axial)
middle aged

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30
Q

Medial thalami high T2 ddx

A

aa percheron
tip of basilar syndrome. occlusion at tip
bilateral int cerebral vv thrombus
any cause of BG signal. CO, BGL, hypoxia, osmotic Demyelination, wilsons, cjd

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31
Q

multifocal infarct

A

vasculitis. peripheral
encephalitis (ie tb)
emboli (do echo. RA, AF)
CADASIL. usually starts temp lobes and spares occipital and orbitofrontal
MELAS. cortical and brainstem. Posterior parietal and occipital.

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32
Q

MELAS

A

Mitochondrial myopathy
Encephalopathy
Lactic acidosis
Stroke like episodes

Lesions usually posterior and cross vascular territories
BG lesions +/- Ca+ also
recurrent stroke like episodes.

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33
Q

CADASIL

A

Cerebral AD Arteriopathy with Subcortical Infarct and Leukoencephalopathy
diffuse subcortical WM and lacunar high T2!!
multiple lacunar infarcts
temporal lobes!! also paramedian anterior frontal and eternal capsule all classic

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34
Q

Venous infarct

A

No vascular territory
peripheral
gyriform and heterogenous

check. mastoiditis, sinusitis, preg, dehydration, low BP, hypercoag

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35
Q

cavernous sinus thrombosis

A

high density C- with filling defects or lack of flow void on post C+
Do MRV
sx. CN 3 palsy, exopthalmous
Sinusitis, orbital infection, dental abscess, hypercoag state, compression of sinus (tumour, trauma)

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36
Q

Carotico-cavernous fistula

A

C+ of cav sinus and ICA at same time
enl. sup ophthalmic vv
enl. ocular mm
exopthalmous

due to trauma (typically 2 weeks after), ruptured aneurysm, collagen deficiency or FMD

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37
Q

Herniation
subfalcine
Uncle
Tonsil

A

Subfalcine. ACA infarct
Uncle. PICA PCA CN 3 duret
Tonsil. Hydrocephalus. >5mm adult. >7mm child

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38
Q

SAH

A 
aneurysm
vascular malformation 
trauma
vasculopathy
perimesencephalic. ? venous, around midbrain and Pons

vasospasm 3-7/7

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39
Q

multiple aneurysms

A

Adult PCKD
Amyloid angiopathy. >60yo
Congenital collagen vascular. Marfan, ehlers danlos, FMD
Infection, emboli (septic)

ddx. Multiple cavernous malformations, DSI, small vessel HTN (Basal ganglia)

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40
Q

vascular malformations

A

high flow:
Dural AVM or AV fistula
low flow:
Cavernoma (assoc with cap telengectasia and venous malformations) angio occult
Capillary telengectasia. Pons > cortex > cord
Venous. palm tree

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41
Q

HTN bleed locations

A

BG > Pons > thalamus > cerebellum

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42
Q

ICA variants

A 
HOT Pepper
Hypoglossal
Otic
Trigeminal. most common. prepontine cistern
Proatlantic
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43
Q

HSV/HHV

A

HHV is mesial temporal lobe. reactivation
HSV in neonates is whole brain with sparing medial temp and inferior frontal. haem uncommon. + skin lesions and dissemination systemic. HSV II
HSV kids/young adults. Limbic, medial temp, insular cortex and Inferolateral frontal. Asymmetric bikateral. BG spared. +/- oedema and haem. DWI + but < infarct.

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44
Q

Temporal lobe signal

A

HSV encephalitis. bilateral. asymmetric. BG spared
Post ictal
MCA infarct. unilateral. BG involved
Limbic encephalitis. autoimmune paraneoplastic (SCLC, testes, ovarian, breast, thymus). Bilateral asymmetrical. BG involved
Mesial temp sclerosis. vol loss
Viral encephalitis. HSV, EBV, VZV Status epilepticus Post rxt
Lesions. DNET, oligo, Ganglioglioma, PXa, astrocytoma, Lymphoma, Glomatosis cerebri. extensive >3 lobes.

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45
Q

Pachymeningeal/Dural C+

A

Infection, tumour, Post op, Hypotension, Sarcoid, TB, Venous thrombus

Infection. Strep. post op. check skull base post trauma or paranasal sinus/mastoiditis
Hypotension. slumped cerebellum, tonsillitis herniation, Dural sinus distended. check CSG leak, Dural tear
Venous thrombus. hyperdense
Sarcoid/Tb. basal, CN 3,4, 6. Sarcoid can Ca+. Tb +/- vasculitis (BG infarct), tuberculoma (infratent kids, corticomedullar adults)
Tumour. Primary or 2ndry
-Primary. Meningioma, en plaque (adj hyperostosis, no erosion). Haemagiopericytoma (No Ca+, erodes bone, spoke wheel “+ central flow void). Solitary fiborous tumour (lobular and well cx. T2 &T1 is to mm)
-2ndry metz. Drop mets, breast, prostate, lymphoma. Check cisterna CN 5 and Intracanal CN 7 and 8.

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46
Q

Leptomeningeal/pial C+

A

Ventriculitis. Thick C+ ventricle wall with IV debris

Infection, neuro cutaneous, haem, tumor, ruptured dermoid
Infection. Viral, bacterial, Tb (basal), Cryptococcus ( + foci BG)
Neuro cutaneous. surge webber
Haem. SAH, Superficial siderosis (recurrent SAH with haemosiderin depo, dark on SWI)
Tumour. Leukaemia, seeding, mets (breast, prostate, melanoma)
Ruptured dermoid. Fat in Subarach space.

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47
Q

WM disease, High T2

A

Vascular, Infection, Neoplasm, Demyelination

Vascular.
- Small vessel disease
- vasculitis. FMD, Tb, Moya moya
- CADASIL. Stokes with leukodystrophy
- PRES. Loss of autoreg with high BP. 3 patterns, watershed, parieto-occ, sup frontal
Infection.
- PML. Asymmetric. 4Ps. Periventricular, Patchy, Peripheral subcortical, Posterior. JC virus Demyelination. CD4 <100
- HIV encephalitis
- CMV
Sever hypoglycemia
Fahrs disease. chronic encephalitis with seizures. kids. unilateral vol loss with High T1 WM. no C+
Neoplasm.
- Lymphoma
- Glomatosis cerebri. little mass effect. >3lobes
Demyelination.
- MS. No thalami involved
- ADEM. Patchy, +/- thalami. less periventricular. Infection or immunization 2wk ago

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48
Q

MS Macdonalds criteria

A

Dissemination in time and place
Time. 1. new lesion form previous, 2. Asymmetric C+ lesions
Place. T2 bright. 1. Periventricular, 2. Juxta cortical, 3. Infratent, 4. Spine

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49
Q

MS varients

A

Tumefactive. Aggressive large >3cm lesions. C shape C+
Marburg. Extensive Tumefactive. death <1yo
Balo. Target demyleinating lesion
Devics. Bilateral optic nn oedema with spinal foci >3 levels Susac. corpus callosum only

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50
Q

DDx WM patch lesions/MS

A
  1. Prominent perivascular space
  2. Vascular. Small vessel disease. Infarct. Vasculitis. RCVS (Reversible cerebrovascular Syndrome, 20yo beaded COW angio Thundercats headache).
  3. Infection. Encephalitis (HSV, HIV, PML, Viral), Lyme disease
  4. Tumour. Glomatosis (GbM)
  5. ADEM. responds to steroids
  6. Central pontine myelinosis. 2nd to rapid Na+ correction. Central Pons
  7. Chemo/rxt. Acute. patchy mass like c+ with oedema. Chronic. atrophy
  8. PRES. Occ, parietal and brainstem watershed
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51
Q

Dermoid cf epidermoid

A

D. Midline, lobular, fat +/- Ca+. NO DWI. Rupture 》 Subarach fat and aseptic meningitis
E. Off midline..dirty CSF. DWI +, no C+, no Ca+

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52
Q

Vasogenic vs cytotoxic oedema

A

V. VW, WM finger like projections. leaky BBB. DWI -

C. GM and WM. Faulty Na+/K+ pump. DWI +. Ischaemia

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53
Q

Focal vol loss brain

A

Alzhiemers. Hippocampal 》temporal lobe 》Parietal and frontal
Picks. Front temporal <40yo. Occ spared
Parkinson. Generalized atrophy. Reduce BG T2
Progressive Supranuclear Nn Palsy. Tectum, GP, frontal and midbrain atrophy. Midbrain <1/4 Pons sag. Hotcross bun T2 Midbrain
Huntington. Caudate head atrophy with sq. frontal horns

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54
Q

Hydrocephalus

A

Obstructive. Disproportionate enl depending on where obst is
1. tumour
2. aqueduct stenosis
3. haemorrhage
4. ventriculitis
5. colloid cyst
Non obstructive.
1. reduced reabsorption CSF (haem, meningitis)
2. Increased production CSF(Choroid plexus, ependymoma)
3. Increased venous pressure. Vv galen malformation, vv obstruction

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55
Q

HIV WM Lesion

A

Vascular, Infection, Neoplasm
Vascular
1. Rxt
2. Vasculitis
3. PRES
Infection. CD4 <100
1. PML. 3Ps. Patchy asymmetric, posterior, peripheral. Multifocal high T2
2. Toxoplasmosis. Corticomedullar junction and BG. more widespread than CMV. Can mimic lymphoma
3. CMV. Periventricular thin T2 /rim c+
4. Cryptococcus. 1. gelatinous soap bubble pseudo cyst mass parenchymal, 2. BG small cryptococcomas with peripheral c+. 3. basal meningeal C+. look at cheat for nodules or mass
5. Aspergillus, candida. Haem and stroke
Neoplasm. Lymphoma. cross midline, periventricular. can be heterogenous with c+ rim in immunocompromised

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56
Q

congenital infection

A

TORCH
Toxoplasmosis. more widespread than CMV. Focal Ca+. BG, periventricular and cortex
CMV. Periventricular ca+. Extensive if weakly inter utero inf
Rubella. Microcephaly. Parenchymal ca+
HSV. diffuse WM and GM

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57
Q

inherited WM diseases

A

Periventricular WM high T2 》 Vol loss

  1. Lysosomal. Metachromatic leukodystrophy. diffuse symmetric WM 2-3yo
  2. Peroxisomal. Adrenoleukodystrophy. adrenal insufficiency, leukodystrophy and testicular small. posterior symmetric WM
  3. Mitochondrial. Leigh (Central GM and brainstem high T2. death <2yo). MELAS (<40yo multiple strokes with parieto-occ WM
  4. Amino acid. Canavan (Big head size, jeez, death <2yo yo, spares BG), CADASIL (strokes and leukodystrophy. starts temp 》widespread but spares Occ and cortex) Krabbe disease. AR WM disease. Periventricular and deep grey matter. <2yo and adult onset.
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58
Q

C+ rim

A

MAGIC DR

Mets
Abscess
GbM
Infarct 
Contusion
Demyelination. C shape
Radiation necrosis
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59
Q

cortical signal

A

Gyriform. T1 high chronic. T2 high acute

  1. Cortical laminar necrosis. cerebral hypoperfusion (BG also), hypoxia, status epileptic (medial temp lobes), hypoglycemia (Occ bilateral also), anaemia
  2. Meningitis
  3. Early CJD
  4. Encephalitis
  5. Neoplasm. Oligodendroglioma, DNET, Ganglioglioma
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60
Q

DWI +

A

Acute isch stroke
- ADC normalizes in 7/7
- DWI normalizes in 2/52 Infection. abscess, empyema or herpes (cf glioma), cjd
Mass, non malig. epidermoid, Choroid plexus cyst, rxt necrosis
Neoplasia. lymphoma, medulloblastoma, PNET, germ cell, pineoblastoma, meningioma (mild)
Demyelination. MS, osmotic demyelination, DAI, status epilepticus, hypoglycaemia, wernikes

Cytotoxic oedema (usually isch)

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61
Q

Corpus Callosum lesion

A 
GBM. butterfly
Lymphoma
Lipoma
MS
Radiation necrosis. No C+
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62
Q

BG high T1

A

Manganese. hepatic encephalopathy, TPN. Ca+. hyper and hypo parathyroid or pseudohypo Toxic. HIE, CO, hyperglycaemic episode Congenital. Farhs, wilsons, NF 1 hamartoma
Haem or Haem infarct. HTN

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63
Q

BG High T2

A

Bilateral.

  1. Hypoxia
  2. Osmotic Demyelination
  3. Wernikes
  4. CO1
  5. BGL decrease
  6. CJD
  7. Venous thrombus. deep cerebral vv

Unilateral.

  1. Keto acidosis
  2. Hepatic encephalopathy
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64
Q

Ca mass. Can My Dear Old Elephants Age Gracefully

A 
Meningioma
Oligodendroglioma
Ependymoma
Astrocytoma. GBM
Craniopharyngioma kid                                                                                                  Vascular. avm, aneurysm,  sturge webber                      TS subependymal nodules                                                Tuberculoma                                                                                                                             ......
Mets. adenoca, post Rx
Pineal germinoma or Germ cell tumor
Chordoma. rings and arcs. central locatn
dermoid. Fat
DNET. cortical, medial temporal, kids. bunch of grapes
Central neurocytoma. IV bubbly attach septum Pell 
Choroid plexus papilloma
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65
Q

Temporal bone #

A

Transverse. sensorineural. Labyrinth. Facial nn

Longitudinal. Ossicle. Tympanicum membrane (develop cholesteatoma later)

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66
Q

Mastoiditis complications

A

Coalescent. Infection causes resorption of bone
》Abscess, meningitis, Vv thrombus
Bezold abscess. Mastoiditis erodes laterally into SCM and trapezius
》Jug vv thrombus

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67
Q

haemorrhagic mets

A 
melanoma
chorioca
RCC
Thyroid
Primary. GBM or oligodendroglioma
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68
Q

hyperdense mass

A

tumour.
-meningioma
-medulloblastoma
-lymphoma
-Craniopharyngioma
-ependymoma
-melanoma
aneurysm
colloid cyst
haematoma <10/7

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69
Q

brain cysts

A

arachnoid
epidermoid. dirty CSF. dwi+
porencephalic. c/w ventricles or subarach space. gloss 2nd insult IU
neuroglial. CSF density that doesn’t c/w vent or subarach. epithelial lined. frontal lobes > anywhere else neural axis
IV ependymal
choroid plexus

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70
Q

dark T2

A

ca+ or haem

cavernoma
mets 2nd haem
ca+ tumour
solitary fibrous tumour. looks like meningioma but dark on T2

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71
Q

Cortical based signal

A 
oligodendroglioma 
DNET. bubbly in temp lobes
ganglioglioma
non tumour. 
- HSV enceph
- post ictal
-cerebritis
-infarct
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72
Q

Supra sella Para sella mass

A

SATCHMO Sphenoid sinus mass. Mucocele, chordoma, SCC.
Sarcoid Aneurysm.
Adenoma (pituitary macro) Teratoma Craniopharyngioma
Hypothalamic glioma
Hamartoma tuber cinerum
Histiocytosis (LCH)
Meningioma Mets
Optic glioma

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73
Q

multiple cavernomas

A

rxt, HHT, familial multiple cavernoma malformation sx, blue rubber blew naevus sx

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74
Q

transient lesions of splenium

A

epilepsy, ADEM/MS, DAI, hypoglycemia, PRES.

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75
Q

DDX gullian barree

A

viral neuritis or chemical neuritis

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76
Q

epidural haematoma

A

over anticoagulation, trauma, LP, AVM, pregnancy, tumour Posterior to thecal sac. blooms. do angio if ?avm

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77
Q

diffuse marrow infiltration

A

T1 VB should be greater than mm or disc. if not:

  • Red marrow conversion (athletes, smokers), not as low - Mets. patchy. breast, prostate. - Leukaemia
  • Myelodysplasia. look at spleen - Thalassemia. kids, extramedullary Haematopoiesis
  • CML
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78
Q

Thickened fulim

A

Cons ends t12/l1 - Lipoma, tethered, arachnoiditis, gullian barre,CIPD

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79
Q

Extradural lipomatosis

A

obesity or steroids.

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80
Q

OPLL

A

dish, Ank spon

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81
Q

Vasculitis by aa size

A

Large. Giant cell (>60yo), Takayasu (<60yo) Med. PAN, kawasaki, FMD Small. IgA, Microscopic polyangitis, EG with polyangitis Variable. Bechets DDX. RCVS or Moya moya

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82
Q

cerebellar atrophy

A

etoh, msa, long term anticonvulsant (thick skull also), post rxt, superficial siddherosis, farhs (bg Calc also).

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83
Q

hyperdense mass

A
  • tumour. meningioma, medulloblastoma, lymphoma, Craniopharyngioma, ependymoma, mets (melanoma, rcc, thyroid). - haematoma - giant aneurysm - colloid cyst
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84
Q

cystic brain lesion

A

arachnoid, neuroglial (epithelial lines and doesn’t cw ventricles or csf), Porencephalic (glosis 2nd insult, cw vents), epidermoid (dirty csf), cryptococcus (gelatinous bg, soap bubble, cxr mass), abscess, tumefactive MS, neurocistercycosis (multiple stages)

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85
Q

tumours that ca+

A

old elephants age gracefully. oligodendrocytes, ependymoma, astrocytoma, GBM.
extra axial. meningioma, chordoma (centre), chondrosarcoma (off centre), Craniopharyngioma

86
Q

dark on t2/CT hyper

A

ca+ or haem. cavernoma, solitary fibrous tumour, tumor that haem or ca+, lymphoma, medulloblastoma, neuroblastoma

87
Q

cortical based tumour

A

DOG P - oligodendroglioma (frontal lobes, rare in kids)

  • ganglioglioma (<30yo, temp lobe bubbly, c+, ca+)
  • DNET. (kids and young adults, cystic bunch grapes, no c+ ) - pxa (temp lobe cyst + nodule)
  • non tumor. cerebritis, herpes simplex, post ictal, infarct, encephalitis, haem, abscess
88
Q

supratent tumor adults

A

Glioma. atrocytoma (<20yo, NF 1), GBM (most common) oligodendroglioma (frontal, cortical, ca+) Ependymoma (intra axial supratent, extra axial infratent) choroid plexus papilloma (cauliflower and c+). atrium.
mets. (most common. g/w junction)
lymphoma (solid homogeneous periventricular or cc, 60yo if immunocompetent, otherwise immunocompromised )

89
Q

supratent tumour kids

A

Astrocytoma, ependymoma (frontal lobe, can be massive), Atrt (v aggressive), Craniopharyngioma (cystic/solid + ca+), germ cell (germinoma or teratoma <2yo), ganglioglioma (well cx, peripheral, cystic with nodule), PNET (supratent medulloblastoma, DWI, large and heterogenous, neonates)

90
Q

infratent tumor adults

A

haemangioblastoma (VHL, cystic with nodule, dwi),
mets (most common)
astrocytoma (bigger nodule than haemangioblastoma) lymphoma extra axial. ependymoma (c+), subependymoma (no c+), Choroid plexus (4th vent adults, atrium kids), Dural mets

91
Q

infratent tumour kids

A

Brainstem glioma, ependymoma, medulloblastoma, astrocytoma, haemangioblastoma

92
Q

sella mass

A

find pituitary. if can’t ?pit adenoma.

  • pit macro adenoma. >10mm. asymmetric or convexed pit. don’t c+ with rest of pit. +/- apoplexy. expand to supra sella as dumbell. look for cav sinus invasion, ICA or cn2 encasement
  • pit micro. more likely to be hormonal active. - meningioma - Craniopharyngioma. cystic/solid. crank oil. adenomatous kids, papillary adults. ca+ kids.
  • chordoma (central), chondrosarcoma (off central/clivus) - Mets (rare, breast) - Germinoma - lymphoma
  • Hamartoma tuber cinerum (ectopic gm)
  • glioma.
93
Q

pituitary mass not tumour

A

pituitary cyst, pituitary apoplexy (rapid increase in size, fluid fluid level), rather cleft cyst, lymphocytic hypophysitis (post partum, male with dm, c+, low T2),LCH, ICA aneurysm

94
Q

enlarged pituitary stalk

A

lch. kids and dm neurosarcoid. optic pathway and floor 3rd vent infection. Tb, meningitis tumour. Germinoma, glioma hypothalamus, cns lymphoma, leukaemia, mets

95
Q

cavernous sinus mass

A

CN 3, 4, V1, V2 and 6, sns plexus and ICA Schwannoma, meningioma, extn of nasopharyngeal mass, aneurysm, carotico-cavernous fistula, cavernous sinus thrombus, invasive sinusitis, sarcoidosis, tolosa hunt sx (extends from superior orbital fissure)

96
Q

clivus mass

A

osteoma, chondrosarcoma, plasmacytoma (low to iso t2), intraosseous lymphoma, h&n mass going into clivus

97
Q

pineal mass

A

tectal glioma,
Aqueduct stenosis cystic. pineal cyst, pineocytoma, epidermoid, teratoma (fat/cystic/ca+) germ cell tumor. Germinoma (most common, kids and young adults, Hyperdense on ct, +afp), teratoma (fat, ca+, cystic) pineocytoma (older adults, slow growing), pineoblastoma (larger, blast ca+, heterogeneous, kids. check for retinoblastoma) hamartoma (nf 1)

98
Q

Intraventricular mass

A

oligodendroglioma, lymphoma, mets, central neurocytoma, Choroid plexus papilloma, AV malformation, ependymoma, subependymoma, SEGA

99
Q

Intraventricular calcification

A

Choroid plexus papilloma, meningioma, ependymoma, medulloblastoma, mets, haemagngioblastoma

100
Q

subdural hygroma

A

over shunting, trauma (arachnoid tear), intracranial hypotension.

101
Q

CPA mass

A

SAMES Schwannoma of VII or VIII, arachnoid, aneurysm, meningioma, epidermoid, skull based tumour or infection.

102
Q

petrous apex mass

A

congen- cholesterol granuloma, cholesteatoma, Mucocele, cephalocele inflammatory. petrous apicitis, OM, inflammation pseudotumor, Wegeners tumour. meningioma, paraganglioma, Schwannoma, chondrosarcoma, chordoma, endolymph sac tumour, mets, plasmacytoma, lymphoma, LCH, rhabdomyosarcoma Vascular. carotid aneurysm, intraosseous Dural AVF Osseous. fibrous dysplasia. pagets

103
Q

T1 bright

A

haem, fat (dermoid, lipoma, teratoma, meningioma with fatty degen), melanin (melanoma, also T2 bright), protein (colloid cyst), thrombus

104
Q

multiple small enhancing lesions

A

Mets, tb, sarcoid

105
Q

flow voids in lesion

A

avm, haemangiopericytoma, haemangioblastoma, haem tx of infarct (will dwi also)

106
Q

bubbly multicystic Intraventricular lesion

A

Choroid plexus cyst, central neurocytoma, neurocistercycosis, ependymoma, subependymoma, epidermoid cyst

107
Q

Corpus callosum

A

GBM (butterfly), lymphoma, mets, germinoma, lipoma Non neoplastic. Dai, demyelination (MS, PML, PRES) Other causes high CC. status epilepticus, hypoglycaemia, encephalitis, drug toxicity, stroke (unusual to be bilateral)

108
Q

Temporal lobe epilepsy

A

Mesial temp sclerosis, ganglioglioma, oligo, astrocytoma, Cavernoma, cortical dysplasia, heterotopia

109
Q

Brainstem expansion in kids

A

Glioma, tb (most common world wide), rhombic encephalitis (autoimmune or listeria), ADEM/ms, infarct, haematoma, Fasi (nf1)

110
Q

intra parenchymal haem

A

common. htn, trauma, vascular malformation, aneurysm, prematurity, stroke, amyloid angippathy, coagulopathy, tumour
uncommon. venous infarct, eclampsia or pres, septic emboli, vasculitis, encephalitis, cocain/drugs

111
Q

wm lesions with cortical involvement

A

pres, ADEM, ms, encephalitis, osmotic demyelination, seizure

112
Q

multifocal patchy wm and gm oedema

A

viral encephalitis (hsv1), Ischaemia (watershed or embolic), status epilepticus, limbic encephalitis (paraneoplastic), infiltrating neoplasm (GBM or glomatosis cerebri)

113
Q

diffuse lobar lesion, esp temp

A

isch/infarct, HSV 1, glomatosis cere, limbic encephalitis, status epilepticus, ADEM, vasculitis

114
Q

Bilateral infarct

A

emboli, Venous thrombosis, basilar aa distal (rostrum midbrain, thalami and PCA) aa percheron (medial.thalami or midbrain)
Non infarct mimics. Osmotic demyelination (brainstem and bg), wernikes encephalopathy (mammilary, 3rd vent), global hypoxia, Co poisoning.

115
Q

multiple swi

A

htn, amyloid angiopathy, cavernomas, vasculitis, DAI, rxt, haem mets (melanoma, thyroid, rcc, chorio), infection (cysticercosis, tuberculoma, fungal, septic emboli)

116
Q

gyriform ca+

A

sturge webber, avm, cortical tubers, laminar necrosis post infarct, meningoencephalitis, rxt/chemo

117
Q

unilateral megaencephaly

A

NF1, McCune Albright, TS, hemimegaencephaly neuronal migration abno

118
Q

BG ca+

A

Metabolic. hypoparathyroid (most coomon), pseudo, hyperparathyroid and hypothyroid Infection. TORCH, Tb, cysticercosis Toxic. anoxia (birth injury), Co, lead, rxt or chemo Congenital. Farhs, NF 1, TS

119
Q

BG low t2

A

iron deposition - Neuro degenerative (Parkinson, alzheimer) - Metabolic (Leigh - dead by 2yo, wilsons, shy drag MSA ) - Demyelination. MS - Insult. chronic hepatic encephalopathy, toxins, childhood hypoxia

120
Q

T2 hyperintense top 3 adult and child

A

adult. Co, osmotic demyelination, wilsons, hypoxia, Venous infect, cjd child. Co, wilsons, hypoxia

121
Q

BG infarct

A

atherosclerosis, htn, vasculitis, moya moya, Venous sinus thrombus (deep system)

122
Q

Bilateral thalami abno

A

Vascular. Lacunar infarct, aa percheron, basilar tip, int. cerebral vv, straight sinus, vasculitis, PRES Infection. ADEM/MS, encephalitis (measles, japanese), varients CJD
Metabolic. Osmotic demyelination, wernikes, Co, wilsons, haemachromatosis, methanol

123
Q

hydrocephalus obstruction causes at arachnoid and skull base

A

Arachnoid. haem, infectious meningitis, carcinomatosis meningitis, chemical meningitis (arachnoiditis, fat, intra thecal meds)
Skull base. chiari, Achondroplasia, dandy walker cyst, arachnoid cyst Unknown. normal pressure hydrocephalus

124
Q

Ependymal/Subependymal C+

A

Neoplasia. Lymphoma, GBM, ependymoma, CSF seeding Ventriculitis. Pyogenic bacteria, CMV (aids), Tb Sturge webber sx

125
Q

Subependymal nodules

A

TS, heterotopic gm

126
Q

Leptomeningeal high FLAIR

A

SAH, meningitis, mets, ruptured dermoid

127
Q

Leptomeningeal C+

A

Vascular. Subacute infarct, sturge webber Infection. Viral or bacterial meningitis, tb Inflamm. Sarcoid, Wegeners, LCH Mets. Haematogenous lung, breast or melanoma, CSF seed or brain 1*, lymphoma

128
Q

Pachymeningeal C+

A

Intracranial hypotension. CSF leak post sx or trauma, shunt, spontaneous Infection. Bacterial, fungal, listeria or Tb, subdural empyema or extradural abscess Neoplasia. Mets to dura, lymphoma, meningioma Inflamm. Sarcoid (nodular), rheumatoid

129
Q

Prominent Dural ca+

A

Physiological Metabolic. hyperparathyroid or long term dialysis Basal cell naevus sx

130
Q

Cerebellar atrophy top 3

A

etoh abuse, anticonvulsant (calvaral thickening), paraneoplastic sx MSA less common

131
Q

MSA categories

A

Olivopontocerebellar, cerebello-olivary atrophy and Friedreich ataxia (spinocerebellar)

132
Q

C+ or enhancing cranial nerves

A

Schwannoma, mets, lymphoma, ms, sarcoid, perineum al invasion (V3 and VII). ** with perineural invasion look for foramen enl and denervated mm

133
Q

Moya moya

A

primary idiopathic, NF1, rxt, Sickle cell, downs syndrome

134
Q

Absent septum pellucidum

A

CHESS Chiari, holproencephaly, encephalocele, Septo optic dysplasia, schizencephaly

135
Q

Agenesis corpus callosum

A

chiari, dandy walker, encephalocele, holprosencephaly, isolated, lipoma, trisomy 18, 13, 15

136
Q

Lytic skull lesion. Mt Hole

A

Mets, Tb, Histiocytosis (LCH), leptomeningeal cyst (growing #), Epidermoid

137
Q

Chiari

A
  1. downward tonsils >5mm, syrinx, klipell feil. 2. myelomeningocele, CC dysgenesis, hydrocephalus, syrinx 3. 2 plus encephalocele
138
Q

DAI 3 locations

A

GW junction, Posterior body and splenium CC, dorsolateral pons

139
Q

3 patterns fungal CNS

A

Basal meningeal +/- hydrocephalus Vasculitis (aspergillosis) +/- thrombosis and haem infarcts Parenchymal invasion/mass

140
Q

Cryptococcus vs candida

A

Cryptococcus is gelatinous pseudocyst in VR spaces Candida is multiple micro abscesses

141
Q

cavernoma vs cap telengectasia

A

Cavernoma has no normal brain tissue between. also assoc with DVA
Cap telengectasia is assoc with Xrt and HHT

142
Q

3 features of neurosarcoid

A

Pachy/leptomeningeal c+ Periventricular WM high T2 Facial nn, optic nn or pit stalk c+

143
Q

3 lesions intracranial NF 1

A

Hamartomas. FASI Gliomas/astrocytoma Plexiform neurofibroma esp CNs

144
Q

3 vascular lesions assoc with NF 1

A

AVM/Aneurysm, Moya moya, coarctation

145
Q

4 TS CNS manifestations

A

Cortical and subcortical tubers Subependymal nodules SEGA Heterotopic GM

146
Q

4 non CNS TS manifestations

A

cardiac rhabdomyoma renal aml, rcc or Oncocytoma Osseous hpoa pulmonary LAM

147
Q

4 non CNS VHL

A

Renal cysts, bilateral RCC Adrenal phaeo (bilateral) Pancreatic cysts or serous cystadenoma Endolymph sac tumour

148
Q

4 most common Intra medullary spinal mass

A

Ependymoma (think NF 2) Astrocytoma (think NF 1 if child) Mets (lung, breast, lymphoma, melanoma) Haemangioblastoma (think VHL)

149
Q

Infective causes of optic neuritis

A

HSV, HIV, toxo

150
Q

Posterior fossa tumour that ca+ in kids

A

Ependymoma 80% Medulloblastoma 20% JP Astrocytoma v rare

151
Q

PML

A

Patchy, peripheral and periventricular Subcortical u fibres, frontal and parietal, brainstem and BG spares optic nn, cortex and spinal cord

152
Q

wernickes encephalopathy

A

High T2 mod thalami, periaqueduct and mammilary bodies

153
Q

aggressive h&n mass

A

rhabdomyosarcoma, lymphoma or scc

154
Q

3 major dementia distribution

A

Alzheimer. temporal and parietal. spares BG and cerebellum Lewy body. Alzhiemers plus pronounced occipital Multi infarct. Asymmetric cortical and BG

155
Q

tethered cord. look for

A

chiari II and meningocele or lipomeningocele

156
Q

Cerebral vv thrombus haemorrhagic territories

A

Initially subcortical WM Venous infarct involves WM, leptomeningeal and cortex Deep GM = Int cerebral vv Temporal lobes = Vv labbe Parasagital = SSS

157
Q

3 metals that are t1 bright

A

Calcium. fahrs Copper. wilsons Manganese

158
Q

subcortical WM infarct crossing many territories

A

CADASIL Emboli. unilateral ICA, bilateral heart

159
Q

VB lesions. CALL HOME

A

Chordoma (rings and arcs), ABC (expansile with thins sclerotic edge), Leukaemia, Lymphoma, Haemangioma, Osteoid osteoma/Osteoblastoma, Mets/Myeloma/Plasmacytoma (minibrain), EG

160
Q

Destructive VB process involving 2 adj VBs

A

Discitis/OM or chrodoma

161
Q

Sacral mass

A

Teratoma (child), chordoma, chondrosarcoma, osteosarcoma, GCT, ewings, abc

162
Q

Increased VB T1

A

Fatty marrow (increased age, osteoporosis, rxt, haemangioma, pagets, modic 2) Haemorrhage

163
Q

Ivory VB

A

Mets (prostate, breast, carcinoid), pagets, lymphoma, mastocytosis (big spleen and liver, lung nodule or sb thickening), chronic infection (loss IV disc ht)

164
Q

Rugger jersey

A

renal osteodystrophy, osteopetrosis, pagets

165
Q

VB plana

A

MELT. Mets/Myeloma, EG, Lymphoma/Leukaemia, Tb/Trauma

166
Q

Bullet VB

A

Achondroplasia, Mucopolysaccharidosis, downs, hypothyroidism

167
Q

H VB

A

sickle cell, thalassemia, gauchers, osteoporosis, OI

168
Q

Posterior VB scalloping

A

Dural ectasia. NF, Marfan, ehlers danlos Increased intraspinal pressure. syrinx, comm hydrocephalus, intramural lesion
Congenital. Achondroplasia, Mucopolysaccharidosis, OI

169
Q

Ca+ IV disc

A

CPPD, haemachromatosis, Hyperparathyroid, ochronosis (wafer like ca+)

170
Q

Atlantoaxial pannus

A

RA (doesn’t ca+), CPPD, gout and HADD (all ca+)

171
Q

Extra Dural mass

A

Epidural space. abscess, haematoma, lymphoma, mets, lipomatosis VB. Haemangioma, chordoma, 1 bone tumour, mets, myeloma, lymphoma Disc. herniation or sequestration Ligament. OPLL, flurosis Nn roots. Schwannoma (also intradural), neurofibroma Facet joint. synovial cyst L4-5 or L5-S1 Paraspinal. nn sheath tumor, Desmoid (deep fibromatosis), sarcoma, lymphoma, neuroblastoma, extramedullary Haematopoiesis

172
Q

causes extramedullary Haematopoiesis

A

Haemolytic anaemia (sickle cell and thalassaemia), myelofibrosis, lymphoma, leukaemia, gauchers

173
Q

Intradural extramedullary

A

Nn sheath. Schwannoma, neurofibroma (Nf 1) Mets - solitary, sugarcoated nodular or thick roots Meningioma (nf 2, thoracic) Lymphoma Paraganglioma Dermoid/ epidermoid, teratoma, lipoma, arachnoid cyst Empyema (subdural) Vascular. AVM/AVF, varices

174
Q

High T1 Intradural

A

epidural lipomatosis, lipoma, dermoid, teratoma. all fat suppress Subacute haem, melanoma

175
Q

Intramedullary lesions cord

A

*** expand the cord and narrow SAS Neoplasm. Ependymoma, astrocytoma, haemangioblastoma, mets Demyelination. MS or ADEM, transverse myelitis (>2VB) Inflamm. Sarcoid, SLE, Tb Trauma. Oedema, contusion Vascular. ischaemia/infarct (central and long segment), AVM, Cavernoma, contusiin

176
Q

Multiple intramedullary lesions

A

Demyelination/MS, sarcoid, haemangioblastoma in VHL, mets

177
Q

Neoplasm of fullim

A

Myxopapillary ependymoma, haemangioblastoma, Astrocytoma, Mets

178
Q

Transverse myelitis

A

Demyelination. MS, ADEM, Neuromyelitis optica (>3vb + optic nn), Idiopathic transverse myelitis (>2/3 cross-section and >2 VBs) Collagen vasc disease. Autoimmune vasculitis or SLE (Central cord 4-5 segments), RA, sarcoid Infection. HSV, CMV Vit B or foliate def AVM Paraneoplastic. Auto antibodies against cord

179
Q

Posterior column lesions

A

MS, contusion, B 12 or Pernicious anaemia, folate def , copper def, hsv, NO toxicity

180
Q

ocular ca+ adult and child

A

adult. senile at mm insertion, drusen, ptisis bulbi child. retinoblastoma (check pineal and pit), neuroblastoma met, coats (t1 and T2 high), toxo, CMV, detachment (retinal V, Choroidal )(…)

181
Q

intraocular mass

A

Neoplasia
- retinoblastoma. most common kids. ca+ - melanoma
- Mets . breast, lung
- lymphoma
Vascular
- Haemangioblastoma VHL
- Haemangioma - Lymphangioma - Hamartoma. sturge webber , TS, NF, VHL Trauma
- haematoma
- retinal or Choroidal detachment Infection
- CMV
- Posterior scleritis. can be nodular and mistaken for mets Pseudotumor

182
Q

Big globe

A

glaucoma, staphyloma (focal defect off centre posterior due to sclera defect), intraocular mass, NF, Marfan, sturge webber, Coloboma (central bulge at disc)

183
Q

Small eye

A

Trauma, ptisis bulbi, surgery, rxt, torch in utero, diabetic mother, retinopathy of premi, foetal etoh

184
Q

Extra conal lesion

A

bone/dura. mets (prostate), Fibrous dysplasia, LCH, pagets, meningioma, osteoma, abc
ST. infective-Mucocele, haematoma, abscess.
Inflamm- pseudotumor, sarcoid, wegners (look for sinus disease), Neoplasia- lymphoma, mets, rhabdo, dermoid/epidermoid Vascular. capillary or cavernous haemangioma, lymphatic Malformation Nn. Schwannoma, neurofibroma

185
Q

orbital cyst

A

epidermoid/dermoid dacrocystocele mucocele encephalocele lymphangioma

186
Q

ocular mm enl

A

thyroid. I’m slow pseudotumor Wegeners or sarcoid myositis 2nd sinusitis haematoma carotocavernous fistula or thrombus lymphoma or mets

187
Q

tram track optic nn (or doughnut)

A

Meningioma of nn sheath, pseudotumor, sarcoid, mets, lymphoma, increased intracranial pressure

188
Q

polyps

A

Sinonasal. multiple, bilateral, expand sinuses and enl ostia. peripheral c+
Antrochoanal. start max sinus and extend through osteum into nasal cavity or nasopharynx. widen osteum Mucous retention. round, dependent in max sinus. Mucocele. smooth walled expansile mass filling sinus. peripheral rim c+. bone remodeling and thinning

189
Q

nasal septum perforation

A

Wegeners, cocain, inhaled steroids, detective tumour

190
Q

destructive sinonasal lesion

A

Neoplasia. - SCC often T2 low. - Lymphoma. midline - Adenocarcinoma - esthesioneuroblastoma. dumbell mass with waist on crib plate - inverted papilloma. cerebri form. starts lateral nose.
- Mets - Sarcoma. rhabdo in kids Non neoplastic. fungal sinusitis, Wegeners, Mucocele, pseudotumor, cocaine

191
Q

Congenital nasal mass

A

Dermoid cyst. fat containing +/- sinus tract Nasal dermal sinus. from nasal tip. bifid crista Gali
Nasal glioma. ST mass with fibrous connection to intracranial contents Cephalocele Haemangioma. well defined, T2 high with avid c+ Chana atresia. membranes or bony Piriform aperture stenosis. anterior narrowing

192
Q

Middle ear mass

A

Otitis media, cholesteatoma (epidermoid), cholesterol granuloma, glomus tympanicum (paraganglioma) or jugular, facial nn Schwannoma, mets, meningioma

193
Q

Petrous apex lesion

A

common. trapped mucocele, cholesterol granuloma, mets uncommon. cephalocele (cw meckels), endolymph sac, chordoma, Schwannoma, paraganglioma, plasmacytoma, eg

194
Q

Pharyngeal mucosal space mass

A

thornwaldt cyst, cephalocele tonsillitis hyperplasia (c+ septa), mucosal retention cyst, tonsillitis abscess pleomorphic adenoma salivary glands, scc, lymphoma, adenoid cystic ca, adenocarcinoma, rhabdomyosarcoma, mets

195
Q

Neck nodes level

A
  1. ant to submandibulars gland 2. posterior to SMG above hyoid 3. hood to cricoid 4. below cricoid
196
Q

supraglottic, glottic, subglottic

A

division is true vocal cords subglottic have worse prognosis

197
Q

laryngeal mass

A

scc, chondrosarcoma, minor salivary gland tumour Wegeners or sarcoid invasive lesions laryngocele rxt

198
Q

enhancing nodes

A

castle man’s, thyroid ca, Kaposi, lymphoma

199
Q

calcified nodes

A

Tb, fungus, sarcoid, silicosis, thyroid ca, mucinous adenocarcinoma, post rxt lymphoma

200
Q

necrotic neck nodes

A

Mets from scc and papillary thyroid, tb scrofula

201
Q

H&neck vascular masses

A

Haemangioma. - infantile. present at birth - Congenital. grow 1st yr. involute Vascular malformation. - High flow. AVM or AVF. flow voids - Low flow. Capillary, cavernous (phleboliths, no flow void ) lymphatic ( macro or micro-no phleboloiths or flow void)
Haemangioma is vascular tumour (not malformation)

202
Q

Bilateral or multiple parotid lesions

A

sjogrens, benign lymphoepithelial lesion of HIV, parotiditis, sarcoid, warthins, lymphoma, mets

203
Q

Retropharyngeal space mass

A

ICA kissing aa, haemangioma, LN, abscess, lipoma, fibromyxoma (ovoid), scc, lymphoma

204
Q

anterior neck mass cystic

A

thyroglossal duct cyst, brachial cleft, necrotic LN, dermoid, thymic cyst

205
Q

enlarged thyroid

A

multinodular goiter, hashimotos, Graves (homog), ridel (hypoechoic), thyroid ca, lymphoma

206
Q

Benign vs malignant thyroid nodule

A

benign. cystic, hyperechoic, hypo rim, peripheral egg shell Calc or comet tail malignant. hypoechoic, predominantly solid, I’ll defined margins, no halo, microcalc, central vascularity, LN

207
Q

haemangioma signal and us

A

lobular mass well cx with high T2, low T1, avid c+ and no fat sat Echogenic on us

208
Q

Hemimegaencephaly

A

Sturge webber, rasmussen encephalitis, dyke Davidoff mason sx (+ thick skull and falcine displacement).

209
Q

midline nasal septum defect

A

cocaine, steroid spray, trauma, wegeners

210
Q

ant vb scalloping

A

aaa, lymphadenopathy, tb

Kim's (6 decks)

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