Leicester course notebook notes Flashcards
Iodine 131 is used. If seen in another organ of a patient post thyroidectomy which organ would make you suspect there is malignant spread? (Options: Lung, Liver, bladder, stomach, salivary gland)
Lung does uptake but only minimally.
Liver, gb, urinary tract,
stomach, breast.
High DWI signal and Low ADC in frontal parietal lobe. High DWI and high ADC signal in medial posterior temporal lobe
What are the locations of insult.
What are the timeframes of the insult
Fronto parietal - MCA
Medial posterior temporal- PCA
High DWI and Low ADC - acute infarct
High DWI and High ADC - old
Temporal lobe blood supply
anterior portion is MCA
posterior is PCA
Patient with a facial rash, seizures and splenic adenoma. What is the other associated finding?(options: bilateral scwhanomas, optic glioma, angioma, haemangioblastoma, SEGA
(Answer: ?Giant cell astrocytoma secondary to tuberous sclerosis) (tuberous scerlosis was not mentioned in the stem)
Tarlov Cyst?
also called perineural cysts
Extra dural, but contain neural tissue
common 5%, mostly women.
wyrinx ax to
myelomeningocele and ciahri I and II
Dandy walker syndrome
Klipper-Feil
do mucoceles enhance
in the peripherary only (variable if they do not)
Peripheral enhancement of mass in maxillary sinus with dumbbell protrusion from osteum.
peripheral enhacning mass in the sinus is a mucocele
dubell protrusion would be considered an atrochonal mass but these require no contrast, expand the ostium rather than be a dumbell
Juvenile nasopharyngeal angiofibroma
asphenopalatine foramen
which is the medial border of the pterygoopalatine fossa
what are the MRI features of saggital sinus thrombosis
iso T1, hypo T2 (mimic a flow void)
subacute will be high T1.
carotid dissection best MR iaging
T1 - no contrast
CT haemorrhage, how does density change
blood is iso to brain at 2 weeks.
MRI findings of mesial temporal sclerosis
reduced hippocampal volume: hippocampal atrophy
increased T2 signal
what are the fisher scores for sub arachnoid haemorrhage
1 - no blood seen
2 - <1mm
3 - >1mm
4 - intraventricular
Carotid artery stenosis score
Normal - <125cm/s
50% - 130cm
> 230cm /s 70% stenosis .
skull fracture, likley nerves to damage
1 and 2
Thyroid US parameters for U5 badnessx
solid hypoechoic with a lobulated or irregular outline and microcalcification
papillary carcinoma
solid hypoechoic with a lobulated or irregular outline and globular calcification
medullary carcinoma
intranodular vascularity
taller than wide axially (AP>ML)
characteristic associated lymphadenopathy
normal pituitary on MRI
The posterior pituitary has
-intrinsic high T1 signal
- hypointense signal on T2 weighted images
Anterior is iso on both T1 and T2
craniopharyngioma in kids
Adamantinomatous craniopharyngiomas are WHO grade 1 tumors of the pituitary region typically presenting as cystic masses with peripheral calcifications in children.
wet keratin
papillary craniopharyngioma
adults
plagiocephaly
lamboid and/or coronal
chiari 1 is ax to
Klippel Feil
how does penumbra relate to DWI and PWI
Penumbra is PWI area that is bigger than the DWI
cn7 NORMAL ENHANCEMENT LOCATION for normal nerve
CANICULAR
and between tympanic and mastoid
MS plaques on T2
bright
rubella infction congenital
deaf and blind
VSD and Tet of Fallot
ventricular megaly with periventricular calc
CMV brain infeciton congential
basal calc
periventricular calc
cerebral atrophy
do meningiomas haemorrhage
nno
do meningiomas cause local oedema
60% of them do yes
describe anatomy of the basal ganglia
caudate nucleus, pallidus and putamen
Striatum - all three
Lentifrom nucleus is - pallidus and putamen
Neostriatum is caudate and pallidus.
Toxo post contrast enhacnement
nodular and ring pattern
what are the liver fatty lesions
HCC
Adenoma
AML
types of hepatic adenoma
inflammatory - common and bleedy
HNF1alpha - second commonest, ax with the pill
b catenin - ax with FAP and anabolic steroids
Adenoma contrast enhancenemt
arterial enhance, hold onto the contrast until delayed when they go iso
Is AFP alwasys high in HCC
no
only 60%
Liver differentials for a hypervascular lesion
HCC
FNH
Adenoma
NET
cholangiocarcinoma enhancement pattern
gradual
irregular peripheral enhancement at beginning
capsular retraction and intra hepatic duct dilatation
why does a cirrhotic liver not get mets
portal hypertension
autoimmune pancreatitis - symptoms
no pain
weight loss
jaundice
new dm
bowel accordiion sign
pseudomembranous colitits
oesophagus stricture in upper oesophagus
plummer vinson - risk of cancer
iron deficient anaemia
HNPPC is ax with what syndrome
Lynch
Paeds UTI - what is counted as repeat UTI
3 lower
2 upper
1 upper and 1 lower
what constitutes paeds UTI atypical
non ecoli
not responded to abx
high Cr
brachicephaly
loss of coronol sutures
oxycephaly
coronol and saggital is lost
turricephaly
all of them
when to do a 1hr paeds CT head
?NAI
seizure
GCS low
?fracture
neuro deficit
or multiple of
- mechanism
- >3 vomitting
- LOC
paeds trauma - CT abdo if
bruising
tenderness
tachy unexplained
cystic bones lesions
FOGMACHINES
FD
Osteblastoma
GCT
Mets
ABC
Chondroblastoma
Hyperparathyroidism browns tumour
Infection
NOF
EG / Enchondroma
Simple bone cyst
Sequestrations difference in arterial feeding
INtra - one large systemic feeding
Extra - systemic but multiple small ones
CPM
intra seq
extra seq
which will appear as an echogenic mass
CPM
Extra
cut offs for secondary sexual charachteristics for boys and girls by age
boys < 8
girls <9
where is a cannatal cyst found
at the level of the frontal horns
anterior to foramen of munro
need to differentiate from periventricular leukomalacia and pseudocysts of the germinal matrix
what are pseudocysts of the germinal matrix
next to the foramen munro
pre term or term
caviating cysts of the germinal matrix, often due to haemorrhage.
where are subependymal cysts found
under/by the germinal matrix (under the ventricles)
PVL nenoate has to be under how many weeks
34
who looks after LCH patients
oncology
differential for infundibulum thickneing
Germinoma
LCH
in adults
neurosarcoid
mets
lymphoma
hypophysitis
causes of vertebra plana
infection
mets/myeloma
EG
Lymphoma
Trauma
atrial appendages - which is tubular
LEFT
hyparterial bronchus is found
polysplenia
ie in L heterotaxy
Hyparterial means bronchus under the artery.
higher left hilum as pulmonary vessel rides over the top
baby
group b strep cxr appearance
patchy bilateral
?effusion
posterior vertebrla scalloping and middle beaking
achondroplasia
small SI joints with notches
achondroplasia
hypoplasia of C1 arch
downs
rectosigmoid junction ratio should be
> 1
what is a rhabdoid tumour?
in kidneys affects kids age 1-2
big mass, v aggressive.
how to differnetiate rhabdoid from WIlms
when differentiating from Wilms
subcapsular fluid collections
tumour lobules separated by hypoattenuating areas of necrosis or haemorrhage
calcifications
liver
mesenchymal hamartoma has what appearance
cystic
mesenchymal hamartoma lesions are found in what age group
infant
doulbe aortic arch impression is higher on the
right
features of decreased success rate in intusseption
trapped fluid
low vascularity
pathological leadpoint
sbo
old child
rectal bleeding
long duratin of symptoms
what is the imaging pattern for skeletal survey
do within 72hours and follow up in 11-14 days.
is CT head a part of the skeletal survey dfor NAI
only if under 1
(otherwise only if head trauma exists)
Berry aneurysms are ax with
Marfans
PCKD
Ehlos Danlos
NF1
does toxoplasmosis have an irregular nodular ring
yes
autoimmune limbic encephalitis ax to
Non small cell lung cancer
Cord ependymoma vs astrocytoma
astrocytoma is ECCENTRIC (ependymoma is middle)
Ependymoma has a haemosiderin cap. also adults.
Progressive supranuclear palsy get what in midbrin
atrophy - hummingbird
Mickey mouse sign
Flattening of the hippocampal digitations
Medial temporal sclerosis
leriche syndrome
abdominal aorta constriction
investigate May Thurners
do MR
Intermittent claudication treatment
conservative exercise programme
CIA occlusion
stent
CFA stenosis or occlusion
surgery CFA endarterectomy
INfrainguinal occlusion / stenosis tx
ANGIOPLASTY
FRESH OCCLUSION WHAT TO DO ?
bypass and thrombectomy
can’t go IR as risk of showering
global endocardial
cardiac mri
AMyloid
systemic sclerosis
post transplant
MRI
IRON OVERLOAD HAEMOCHROMATOSIS/
SSC/THAL
VARIABLE T2 STAR – DECAY TIME
TE <10ms severe
>20 ms normal
T2 hypointesity of
liver
Cardiac MRI tehcniques
Shimming
Parallel imaging
Phase swap
Prospective triggering
Shimming - reduce susceptibility artefact
Parallel imaging - reduce acquisition time
Phase swap - to reduce wrap
Prospective triggering = address heart rate variability
black blood sequence is what type
TSE
White blood seqwuences are what type
SSFP
what is given for stress MRI
Adenosine
myxoma preferred location
interatrial septum
cardiac sarcoma preferred location
right atrium
- Thymoma vs thymic/lymphoid hyperplasia
– MR in characterizing
lesion – please note thymic hyperplasia may be demonstrate increased uptake on FDG PET
thymic hperplasia has fat
bronchogenic vs oesophageal duplication cyst
ODC - thicker wall, contain gastric mucosa. closer to oesophagus
the dilated chamber is the chamber that receives the most blood in
diastole
does LAM have ax to smoking
NO
LAM can be ax with
TS and AML
Birt dog dubbe get what?
Birt Hogg Dube - Very rare, recurrent pneumothoraces, cysts in the lower zones, clear cell RCC,
fibrofolliculomas
eligibility of Nintedanib
vital capacity (FVC) decline ≥10%,
death, lung transplantation, or any 2 of: relative FVC decline ≥5 and
<10%, worsening respiratory symptoms, or worsening fibrosis on
computed tomography of the chest, all within 24 months of diagnosis.
Talcosis can cause emphysema where
lower lobes
names of pancreatitis collections
non infected
Acute pancreatic collection
Pseudocyst at 4 weeks
infected
Acute necrotic collection
wall off necrotic colleciton
Paroxysmal nocturnal haemoglobulinuria can predispose to what
Budd Chiari
Uniclocular pnacreatic cyst with amylase
pseudocystn
Corkscrew oesophagus /rosary beadss
Diffuse oesophageal spasm
hot drinks improve what oesophagus condition
achalsia
carcinoid causes what in the mesentry
reaction
sharp edges to the bowel
Ventral pancreas is the
uncinate and major papilla santorini
Dorsal pancreas form
the body and the wirsrung small pappila
Cronkite canda
polyps and diarrhead
Amyloid causes liver to what
decrease in density
actinomycosis love what in the bowle
the appendix
Tylosis causes
hand and feet
scc oesophagus
Histoplasmosis have what kind of calcification
central calcification
Commonest ype of FMD
medial fibroplasia
malignany in trachea
scc
then adenoid cystic
factors increasing risk of contrast reaction
atopy
asthma
Beta blockers
HF
Age over 50
shelffish allergy
Pancoast tumour is most commonly
SCC
If PA over 2.9cm then
pulmonary hypertension is very likely
appearance of chronic DVT
low size of blood vessel
less echongenic than acute thrombus
RECIST criteria
Complete - gone
Partial - decrease by 30%
progresison - increase by 20%
if multiple lesion can do by sum of the long axis
common posterior spine lesions
Osteblastoma
mets
abc
which arthritis goes for the feet
reactive
causes of erlenmeyer flask
low phosphate
RA
leukaemia
achondroplasia
sickle
thalassaemia
rickets
Synovial osteochondromatosis
vs
Osteochondra Dissecians
OCD is end result of osteochondral defect
synovial osteochondromatosis
- characterised by loose cartilaginous bodies which may, or may not be calcified or ossified. Primary small and non calcified. Secondary they are calcified.
elastofibroma affect who
midlde aged women
what is POEMS
Polyneuropathy
Monoclonal gammopathy
skin
endocrine
Nail Patella
posterior iliac horns
atrophy patella
renal dysfuctino
hypoplasia of the radial head
causes of lucent ribs
scurvy
cushings
acromegaly
pectus excavatum is ax with
prem babies
downs
marfans
haemocystinuria
type of ulnar variance in Kienbock
ax with negative ulnar variance
what are the sclerotic mets
prostate
carcinoid
breast
TCC
medulloblastoma
colon
age for Ewings
under 10
disc bulge vs herniation
90 degrees plus is big old bulge
less is herniation
what is pachydermoperiostosis?
Primary hypertrophic osteopaty
stops spontaneously.
bilaterally lower limb periosteal reaciton
Does PVNS erode
not really
do chordoma mets
no
pelvic fractures
malaigne
two fractures same side. vertical fracture.
Chondroblastoma affect who and where
under 30
in the physis.
size of osteoid osteoma
less than 1.5cm
Tranient osteoporosis more common in
men
ax with pregnant women though
Trident hand
achondroplasia
PET SUV values for being partial repsons
15% if 1 cycle chemo
25% if 2 cycles
inverse for progression
oesophageal diverticulum by location
superior - structural like
Midle - traction from mediastinal lung pathology
Inferior - pulsion
liver transplant is considered with what HCC lesion criteria
upto 3 if <3cm
1 if <5cm
CMV favours the c
colon
Slow transit and multiple bowel thin bowel lines
Systemic sclerosis
Caroli ax with
medullary sponge kidney
hepatic fibrosis (caroli syndrome)
ADPCKD
ARPCKD
“central dot” sign: enhancing dots within the dilated intrahepatic bile ducts, representing portal radicles 1
Caroli disease
certain cancers spread by plugging the lymphaTICS
Cervix, Colon, Stomach, Breast, Pancreas, Thyroid, Larynx
Takayasus arteritis
young women
prepulesless phase
pulseless phase
Aorta
The pulmonary arteries are also commonly involved, with the most common appearance being peripheral pruning.
which lung malignancy causes SVCO
bronchogenic
GCA affects who and how
Old patients
Medium to large vessels
lng and smooth
circumferential wall thickening
Hodkins lymphoma typically what Cell
T
NHL typically
B cell
ANti basement membrane
pulmonary haemorrhage
glomerulonephritis
Good pastures
H shaped sacrum uptake
insufficiency fracture
PET signal during a seizure
avid areas
cold when not seizing
Flattening of the hippocampal digitations
Mesial temporal sclerosis
Optic Neuritis unilateral or bilateral
compare it to NMO and anti-MOG encephalitis
Unilateral optic neuritis (and MS if that is the cause)
other ytwo are bilateral
acquaporin 4 is ax with which disese
NMO
autoantibody to it
contraindications for thrombin pseudo aneurysm tx
3mm neck
5cm size
active bleeding
av fistula
Splenic truama scale and treatment
1 - 1cm 10% haematoma
2 - 2cm, 10-50% haematoma.
Above two treat conservatively
3 - laceration of 3cm, haematoma over 50%. ruptured subcapsule.
intervention if patient stable
4 - devascularised
5- shattered
last two need surgery
signs of haemodynamic instability
cool, calmmy, decreased cap refill,
altered conscious
SOB
bp above >90 but needing trasnfusions support.
Transient response
above mean dodoy for intervention
May thurners is what combo
right artery over left vein
IVC filter insertion location
distal to renal arteries
IVC indications
pregnant near delivery
pre operative with prox dvt to stop anticoagulation
stomach fundus is supplied by what arteries
short gastric arteries given off by the splenic artery
what is salpingitis isthmic nodosa
nodularity of the isthmic fallopian tube.
ax with inflammaiton and tubual pregnancy
diverticula along the tube
how do you stage cervical cancer - what imaging
MRI with contrast
2b can’t operate on. has gone north
normal endometrial thickness
up to 15mm
post menopausal endometrium should be less than
5mm
unles son tomoxifen - get a pass up to 8mm
ovarian germ cell tumours typically in
kids
Breast screening age range
47 - 73
every 3 years
what is Li Fraumeni syndrome
what imaging do they get
TP53 gene mutated
super sensitive to radiation.
get annual MRI from 20 to 70.
phyllodes on US
posterior acoustic enhancenemtn
age for fibroadenoma
20-40
breast in a breast
hamartoma
periductal mastitis is ax with
smoking and diabetes
silicone that has travelled into the lymph node will appear as
snowstorm
doesn’t mean the implant is ruptured
smooth C shaped tracheal thickening
relapsing polychondritis
trachea
strictures and webbs
GPA
speckled slat and pepper appearance of a mass think
paraganglioma
thyomoma vs thymic hyperplasia
in and out
hyperplasia is normal fatty tissue and so will dorp out
enhancement of neurofibromas and schwannomas
neuro - homongenous
schwannomas - hetero
which is more symtpomatic
osephageal or beronchogenic duplication cyst
bronchogneic
size of vessels in chronic PE
small !
PE
poorest predictor on CT
RV LV ratio
pulmonary veno occlusive disease
what is it
PCWP -
extensive occlusion of pulmonary veins by fbrious tissue
heart failure depsite normal LV. Veins get mashed.
Pulmonary capillary wedge pressure (PCWP) is usually normal
what is pulmonary capillary haemangiomatosis
occlusive disesae causing pul HTN
proliferating capilleries. enlarged central arteries
if a nodule is perifissural otr subpleural what size can you not follow up
10mm
asbestos
hairy plaques and pleural effusion
EXPOSURE
mesothelioma sign
invasion of the fissueres
mediastinum thickening
spares the lung bases
LCH
hypersensitivity
young women
cysts
pneumthoroax
LAM
also spares costophrenic receess
birt dog dubbe get cysts where
LLZ
Chromophobe RCC
repeated pneumothorax
fibrofolliculomas on skin.
Solitary fibrous tumour of lung ax with
hypoglycaemia
hypertrophic pulmonary osteoarthropathy - periosteal reaction of long bones
immunotherapy induced pneumonitis pattern
OP
immunotherapy - pseudo progression
cna get bigger. or new lesions.
need clincial status.
need serial imaging to count on progression for immunothrapy.
black pleura sign is seen in
Pulmonary alceolar microlithiasis
subpleuiral sparing of the microlithiaissois
what is keratosis obturans
expansino and occluisino of EAC by a keratin plug.
younger patients under 40
severe pain and conductive hearing loss
NO bony erosion. compared to EAC cholesteatoma which is soft tissue density
Otitis externa will have surrounding inflammatory fat stranding
why is incus most at risk during choleateatoma
has worxst blood supply
apperance of aberrant internal carotid artery
large vessel in the middle ear
enhancement of cholestrol granuloma
it doesn’t
what is tolosa hunt
idopathic infalmmatory
cavernous sinus and orbital apex.
painful eye movements
scirrus breast mets in the eye
will pull in
lymphangio malformaiton what sign
fluid fluid levels
orbital cavernous haemagnioma what compartment
intraconal
defect in nasal septum thnik
GPA
orbital sarcoid - what sign
anterior uveitis
can get enhacning lacrimal gland with contrast, hypo T1 adn T2.
signs of inverted papilloma
cerebreform enhacnement (brian like)
bone reaction
perineural dsease think
adenoid cystic loves the nerves
pleomorphic mass has what imaging appearance
parotid
lobulated and homogenous enhancement
complete ptosis requires involvement of
sympathetic AND third nerve
myelofibrosis in bones appearance
diffusesly sclerotic
low signal on imaging
Haemachromatosis bones findings
Chondrocalcinosis - TFCC and knees
symmetrical joint loss.
hooks to the m radial ends of 2nd and 3rd metacarpals
what is dermatomyostitis
sheets of calc around muslce plane s
what to do with a lipoma over 6cm
refer to tertiary centre and do an MRI scna
Giant cell tumour (PVNS)
vs
Glomangioma
Glomangioma - vascular, painful. bright on T2 and high enhacnement.
Giant Cell tumour - low T1 and T2, low enhancement, blooming
Cardiac myxoma
more common is sessile or pedunculated
peddunculated
When to use a treadmill test for a patient?
used for risk stratisfication
if angina
can also do calcium scoring
cardiac functional testing can do what
dobutamine stress echo
rhobydicin nuclear medicine study
Contraindications to BB in cardiac studuies
HB 2 and 3
Sick sinus
severe asthma
phaeo
MR heart circle view - territories
A L I S clockwise for anterior, lateral, inferior, Superior
post TAVI hyperattneutating leaflet thickening
Pannus
a vegetation would be mobile
Gorlin syndrome
BCC
medullobasltoma
calcified falx?
odonteogenic keratosis
Cowdens
dysplastic cerebellum gangliocytoma when in association with lermitte duclos
Walls of abscess vs met
thick met
thin avscess
NAA
Cholin
Cr
NAA - stability
Cholin - turnover
Cr - metabolism?
MS high spec peaks are
high Beta glutamic
look this up
GBM
Multifocal
Multicentric
Multifocal - from one source
Multicentrice - number of different sources
cord lesions
myxopapillary ependymoma is found where
in the cord conus
more bleedy
go over the leucodsystrophires
leucodystrophy
X linked
enhancing peri trigonal white matter
leucodystrophy
thalamic calcification
optic nerve
Krabbe
Japanese encephalitis
bilateral thalamic oedema is classic
Cavernous haemagnioma MRI appearance
T2 btight but haemosiderin rim
popcorn calc in it
PML - after MRI what to do
can biopsy
what can toxoplasma do after treatment
bleed”
atypical teratoid / rhaboid tumour
very agressive quick growing.
kids under 2
haemorrhage
can look similar to medulloblastoma but seen in older kids
subependymoma
age group
enhancement
distinguish from subependymal giant cell astrocytoma.
older patients
doesnt enhacne
Size is the most important distinguishing feature compared to SEGA
how does a pilocystic astrocystoma enhacne
nodule and the wall of the cystic component enhances
in comparison to haemangioblastoma which will have only the nodule enhacnign
tx of haemangioblastoma
can embolise and then resect
how to categorise uterine abnormalities
which imaging modality
MR
hydatiform mole
complete
partial
invasive
complete mole
- no foetal parts. complete absence of baby.
- 46XX. super high bcg
partial mole
- foetal parts
- triploid karyotype
counseling and genetic tests looking for triploidy should be offered (chorionic villus sampling or amniocentesis).
