mnemonics Flashcards
A mnemonic for causes of nasopharyngeal masses is:
SAIL
S: squamous cell carcinoma
A: antrochoanal polyp (extending from sinonasal cavity)
I: inverted papilloma (extending from sinonasal cavity)
L: lymphoma
Acro-osteolysis
PINCHFO
For band acro-osteolysis its backwards
P - Psoriasis/pyknodystosis
I - injury - frostbite, thermal burn
N - neuropathy - diabetes
C - collagen vascular disease - scleroderma/raynauds
H - hyperparathyroidism
F - familial - Hajdu-Cheney syndrome
O -`Other - polyvinyl exposure
Eccentric bone lesions
GCT
Chondroblastoma
ABC
NOF
Chondromyxoid fibroma
Central bone lesions
SBC
enchondroma
FD
Bone forming lesions
Enostosis (BONE ISLAND) - osteopoikilosis = autosomal dominant syndrome with multiple bone islands and keloid formation
osteoma - Gardner syndrome = autosomal dominant multiple osteomas, intestinal polyposis and st dermoids
Melorheostosis - non neoplastic proliferation of thickened and irregular cortex with a typical candle wax appearance
(intense uptake on bone scan). Clinically presents with pain, decreased ROM, Leg bowing and leg length discrepancy
osteoid osteoma - nidus, surrounded by reactive bone sclerosis
osteoblastoma - same as above but >2cm
osteosarcoma - conventional, telangiectatic, parosteal (cauliflower like exophytic lesion) and periosteal
Cartilage forming lesions
Synovial chondromatosis - intra-articular lobulated cartilaginous nodules
Enchondroma - rings and arcs calcification - ddx = medullary bone infarct
Osteochondroma - continuity with cortex and communication with medullary cavity, arises from metaphysis and grows away from epiphysis. Cartilage cap >2cm suggests malignant transformation
Chrondroblastoma - eccentric in the epiphysis
Chondormyxoid fibroma - eccentric tibial or femoral metaphysis around the knee. Sclerotic margins on xray and high signal on T2
Chondrosarcoma - conventional (intramedullary) is most common, typically expansile in medullary bone, ring and arc chondroid matrix, thickening and endosteal scalloping of the cortex. associated soft tissue mass.
Fibrous origin lesions
NOF - aka fibroxanthoma. NOF and fibrous cortical defect = same lesion. NOF usually larger and symptomatic
lucent lesion with narrow zone of transition, sclerotic margin and no matrix calcification. CT or MRI may show cortical disruption or thinning representing replacement of cortex by fibrous tissue.
Malignant fibrous histiocytoma (MFH) aka undifferentiated pleomorphic sarcoma not otherwise specified.
Fibrous dysplasia - can be mono or polyostotic. long bones - central and metaphyseal. most common complication = pathologic fracture (femoral neck)
in ribs/long bones matrix is indistinct and ground glass
pelvic bones = cystic
skull base - expansile looks like pagets
Lesions of vascular origin
Hemangioma - trabecullar thickening
corduroy striations or polka dot sign
Angiosarcoma - looks and acts aggressively
GCT - epiphyseal lucent lesion, eccentric, and articular. Arises from the metaphysis but crosses the closed epihyseal plate to involve the epiphysis.
Eosinophilic granuloma - LCH - abnormal proliferation of histiocytes. children 5-10 yrs. skull - bevelled edge
mandible/maxilla - floating tooth from reabsorption of alveolar bone. spine - vertebra plana. Long bones - destructive radiolucent lesion with aggressive periosteal (lamellated) reaction, may look like lymphoma or ewing sarcoma
Ewing sarcoma - small round cell tumour in children/adolescents, male predominance. Aggressive lesion with aggressive periosteal reaction and soft tissue mass
Multiple myeloma/plasmacytoma - multiple lytic lesions. Negative on bone scan. Solitary tumour = plasmacytoma.
Lymphoma - aggressive lytic lesion or ivory/sclerotic vertebral body. often has adjacent soft tissue mass
Fat (lipo-) lesions
Lipoma - intraosseous - most common sites are calcaneus, subtrochanteric region of femur, distal tibie/fibula and metatarsals.
Liposarcoma - large size, thick septations, globular or nodular soft tissue, or composition containing <75% fat.
Notochord lesions
Chordoma - spheno-occipital, body of C2 or sacrococcygeal. Highly destructive with irregular scalloped borders. May have calcs, due to necrosis
Lesions of unknown cell origin
SBC aka unicameral bone cyst. hollow or fluid filled and typically found in proximal diaphysis of humerus or femur. no periosteal rxn. fallen fragment sign. always central
fluid fluid level. trtment injection with methylprednisolone
ABC - expansile multicystic lesion. composed of blood filled sinusoids and solid fibrous elements. can be central or eccentric. can occur in posterior elements of spine.
Adamantinoma - low grade malignant tumour, tibia, soap bubble appearance - ddx FD
Lesions that have fluid fluid levels ?
SBC
ABC
GCT
Telangiectatic osteosarcoma
Osseous mets
lytic lesions (5)
Blastic lesions (5)
Lytic
- lung
- breast (can be both)
- Thyroid
- Kidney
- stomach/colon (can be both)
Blastic
- breast (can be both)
- prostate, seminoma
- TCC
- mucinous tumors
- carcinoid
Hyperparathyroidism - imaging hallmarks
Skull: Salt and pepper
Hands: subperiosteal reabsorption radial aspect of 2nd and 3rd middle phalanges
Clavicle: subperiosteal reaction of distal clavicle
Knee: subperiosteal bone resorption medial proximal tibia metaphysis.
Teeth: loss of lamina dura
Anywhere: brown tumours
everywhere: diffuse osteopenia
Hypothyroidism findings
delay in skeletal and dental maturity
bullet shaped vertebral bodies and wormian bones in the skull
SUFE
Hypoparathyroidism
metastatic deposit of calcium
subcutanoues tissues and basal ganglia
Pseudohypoparathyroidism
CLASSIC - short MC of either the 4th or 5th digit or the thumb.
Osteopetrosis
deficiency in osteoclastic carbonic anhydrase - leads to inability of osteoclasts to resorb bone
Diffuse marked sclerosis of the entire skeleton
Gauchers disease
autosomal recessive
defect in glucocerebrosidase leading to abdnormal deposition of cerebroside in macropahges called gaucher cells
Gaucher cells cause bone infarcts, medullary expansion and hepatosplenomegaly
Erlenmeyer flask deformity
H-shaped vertebral bodies
Sickle cell
autosomal recessive
beta chain hemoglobin
sickle shaped rbc causing microvascular occlusion
bone infarcts, increased risk of osteomyelitis, marrow expansion/hyperplasia
Thalassemia
autosomal recessive
alpha or beta hemoglobin
bone infarcts, marrow hyperplasia, infection.
hair on end striations
widening and squaring of the phalanges and metacarpals
erlenmyer flask deformity
Myelofibrosis
progressive fibrosis of BM in older patients
splenomegaly
diffusely sclerotic bones
Mastocytosis
abnormal proliferation of mast cells
diffuse osteoporosis or sclerosis
Lucent epiphyseal lesion - includes patella, carpal bones, calcaneus
GEIChA
GCT
Eosiniphilic granuloma
Infection
Chondroblastoma
ABC
Expansile lytic rib lesion
FAMEB
FD
ABC
Mets, myleoma, Plasmacytoma
Enchondroma
Brown tumour
Kohler disease (children)
Mueller-Weiss (adults)
Osteonecrosis of the navicular
Freiberg’s infraction
AVN of the 2nd MT head
Bucket handle meniscal tear
more common in medial meniscus
absent bow tie sign
if fragment flips anteriorly = double delta sign (either meniscus)
if fragment flips posterior = double PCL sign (medial meniscus only)
Discoid meniscus
more common laterally
PVNS
benign hyperplastic proliferation of the synovium within the joint
Bakers cyst is located between ?
SemiMembranousus and Medial head of gastrocnemius
Baker’s M&M
classic location for stress fracture in femur
fractures due to bisphosphonate use
Inferomedial neck
lateral femoral diaphyseal and transverse diaphyseal fractures.
Spondylolysis
fracture of the pars interarticularis - leads to spondylolisthesis
Basion dental interval =
Atlanto-dental interval =
<12 mm
< 2.5 mm in adults
< 5 mm in children
SLAP
GLAD
Superior labrum anterior posterior tear - centered at the attachement of the bicepos tendon - anterior-posterior of the superior labrum
Glenoid labral articular disruption - superficial tear of the anterior-inferior labrum
suprascapular nerve entrapment at the suprascapular notch causes atrophy of ?
Suprascapular nerve entrapment at the spinoglenoid nothc causes atrophy of ?
Both supraspinatus and infraspinatus
infraspinatus muscle only
Essex-Lopresti fracture-dislocation involves?
Monteggia
Galeazzi
1) radial head fracture and tearing of the interosseous membrane with ulnar dislocation at the distal radioulnar joint.
2) Mid diaphyseal ulnar fracture and radial head dislocation
3) radial diaphyseal fracture and distal ulnar dislocation,
Kienboch disease = ?
AVN of the lunate
Neurofibramatosis 1
CAFE SPOT
chromosome 17 - (17 letters in neurofibramatosis)
1:3000
autosomal dominant
Cafe au lait spots
axillary or inguinal freckling
fibromas - (neurofibroma) plexiform
eye harmartoma - lisch nodules - pigmented nodules of the iris
skeletal abnormalities - sphenoid wing dysplasia
postive family history
optic tumour - gliomas of the optic nerve
peripheral nerve sheath tumour - plexiform neurofibroma
pheochromocytoma
sphenoid wing dysplasia, posterior vertebral scalloping, rib notching, tibial bowing
Brain neoplasms -
Optic nerve glioma
juvenile pilocytic astrocytoma
brainstem glioma
Also associated with multiple extra-cranial neoplasms
Wilms tumour, Rhabdomyosarcoma, AML, leiomyosarcoma
Neurofibromatosis 2
MISME
22 letters for NF type 2
chromosome 22
Multiple inherited schwannomas
meningioma
ependymoma
Paeds thoracic tumours
pleuropulmonary blastoma - 3 types - cystic, mixed cystic solid and purely solid
Inflammatory myofibroblastic tumour
Mesenchymal hamartoma -
MEN 1
Pit para panc
pituitary adenoma
parathyroid proliferative disease
pancreatic endocrine tumours
MEN 2 A
PMP
Pheochromocytoma
Medullary thyroid ca
Parathyroid hyperplasia
MEN 2 B
PMMM
Pheochromocytoma
Medullary thyroid ca
Mucosal neuroma
Marfinoid habitus
Carney Complex
MEN syndrome
Cardiac myxoma
Skin pigmentation
Carney Triad
3 tumours
Extra-adrenal paraganglioma
GIST
Pulmonary chondroma
Pheochromocytoma
medullary
MR -Variable T1/T2 signal due to hemorrhage, cystic degeneration, and necrosis
Traditional classic imaging feature: T2 (“light bulb”) hyperintensity
Hypervascular solid components
assoc autosomal dominant familial syndromes
von Hippel-Lindau, multiple endocrine neoplasia 2, neurofibromatosis type 1
Classic teaching: Rule of 10s (or 10% tumor)
10% extraadrenal (paraganglioma) 10% bilateral 10% malignant 10% extraabdominal 10% familial 10% pediatric 10% silent 10% autosomal dominant transmission
DDX - adrenal adenoma
adrenal carcinoma
adrenal mets and lymphoma
Ewing sarcoma
aggressive permeative lesion in diaphysis of a child
second most common malignant primary bone tumors of childhood after osteosarcoma, typically arising from the medullary cavity with the invasion of the Haversian system. Ewing sarcomas usually present as moth-eaten, destructive, and permeative lucent lesions in the shaft of long bones, with a large soft tissue component and typical onion skin periostitis. These tumors may also involve flat bones and can appear sclerotic in up to 30% of cases.
Wilms tumour
Wilms tumor, also known as nephroblastoma, is a malignant pediatric renal tumor.
x-linked Adrenoleukodystrophy
Lack of oxidation of long chain fatty acids that results in a severe inflammatory demyelination
spares subcortical u-fibres
Involves symmetric occipital white matter and splenium of corpus callosum
Metachromatic leukodystrophy
autosomal recessive lysosomal storage disorder
white matter diffusely affected
Bilateral symmetric periventricular change - butterfly pattern
spares u-fibres
Alexander disease (fibrinoid leukodystrophy)
Rosenthal fibres
Involves subcortical u-fibres, basal ganglia and enhances
involves frontal white matter
Starts in frontal region and extends posteriorly.
Involves u-fibers early in disease
Canavan disease (spongiform degeneration of white matter)
CaNAAvan
Prevelant in Jewish
Autosomal recessive due to gene mutation leading to deficiency of N-acetylasparta and accumulation of NAA in brain, CSF and plasma and urine
Bilateral diffuse symmetrical white matter involvement
involves subcortical u-fibres, basal ganglia, thalamus
Spares CC, caudate and internal capsule
No enhancment
diffuse white matter involvement
5 Congenital heart defects associated with cyanosis
T’s (right –> left shunt)
Tetralogy of fallot
transposition of the great arteries - 90% NOT associated with a syndrome. Common in diabetic mother
truncus arteriosus
total anomalous pulmonary venous return (TAPVR - pulmonary and systemic veins all drain into the right atrium)
tricuspid valve abnormalities
Egg on a string XR
Boot shaped heart
Snowman
Figure 3
Box shaped
TGA
TOF - VSD, Obstruction of right ventricle outflow, aorta overides VSD, right ventricular hypertrophy
TAPVR
Co-arctation
Ebstein
Giant cell arteritis
Medium vessel vasculitis
Small vessel vasculitis
Temporal arteritis
Takayasu - granulomatous vasculitis of medium + large art (aortic arch)
Polyarteritis nodosa - kidneys (spares lungs)
p-ANCA
Kawasaki - Self-limited small and medium vessel vasculitis in young children that can lead to coronary artery aneurysms
Churg-Strauss syndrome - small vessel necrotizing vasculitis in patients with asthma and eosinophilia - ANCA + 40%
Bechet - small to medium neutrophilic vasculitis - Chronic, idiopathic, relapsing-remitting, multisystem vascular-inflammatory disease characterized by recurrent orogenital ulcerations and uveitis
Left to right shunt - acyanotic congenital heart defects
ASD - 90% secundum
VSD - 90% in membranous intraventricular septum
PDA
TREVOR disease
osteochondroma that points towards the joint
Causes of rugger jersey spine ?
pictures frame vertebrae
sandwich vertebrae
Renal osteodystrophy
hyperparathyroidism
Pagets
ostepetrosis
Pepper pot skull
Raindrop skull
Hyperparathyroid
Multiple myeloma
Renal artery stenosis causes
Atherosclerosis
NF1 - ostium
FMD - distal artery
vasculitis
TS
TSC1 and TSC2
cortical and subcortical tubers
SEGA
Renal AML
Cardiac rhabdomyomas
LAM - rare
VHL
Numerous benign and malignant tumours
RCC
Pheochromocytoma
Pancreatic cysts
CNS - hemangioblastoma
Anterior mediastinal mass (5 T’s)
Thymoma
Teratoma
Thyroid
Terrible lymphoma
Thoracic aorta
VACTERL
Vertebral anomalies
Anal atresia
Cardiovascular anomalies
Tracheo-esophageal fistula
Renal/radial anomalies
Limb defects
Lucent metaphyseal bands
LINE
Leukaemia
Infection (TORCH)
Neuroblastoma mets
Endocrine - Ricket’s ,scurvy
Lucent/lytic bone lesions
FEGNOMASHIC
FD
Enchondroma
GCT
NOF
Osteoblastoma
Mets/myeloma
ABC
SBC
Hyperparathyroidism (brown tumour)
Infection
Chondroblastoma or chondromyxoid fibroma
CAVITY - lung
Cancer - squamous
Autoimmune (wegners, rheum)
Vascular - septic emboli
Infection - TB
Trauma - pneumatocele
Young - Congenital (CCAM, sequestration)
Bleeding mets
MR CT
Melanoma
Renal
carcinoid/cholangioncarcinoma
thyroid
Cortical based tumours
Pl-DOG
Pleomorphic xanthroastrocytoma
DNET - dysembryonic neuroepithelial tumour
Oligodendroglioma
ganglioglioma
TORCH
toxoplasmosis
Other - syphilis, varicella, parvovirus B19
Rubella
CMV
HSV
GOUT mimickers
American Roetengen Ray Society Hooray
Amyloid
RA (cystic)
Reticular histocytosis
Sarcoid
Hyperlipidaemia
Medullary Nephrocalcinosis
HAM HOP
Hyperparathyroidism
Acidosis - renal tubular
Medullary sponge kidney
Hypercalacaemia
Oxalosis
Papillary necrosis
Calcified intracranial masses
CA COME
Chraniopharyngioma
Astrocytoma, aneurysm
Choroid plexus tumour
oligodendroglioma
Meningioma
Ependymoma
Ring enhancing lesion
MAGIC DR
Mets
abscess
glioma
infarct
contusion
demyelination
radiation
Posterior fossa tumours
GAME
Glioma - brainstem
Astrocytoma - pilocytic
medulloblastoma
ependymoma
CPA angle masses
SAME
Schwannoma - enhance
Arachnoid cyst
Meningioma - enchance
Epidermoid cyst - RD
Suprasellar masses
SATCHMO
Sarcoidosis
Adenoma/aneurysm
Teratoma/germinoma, TB
Chraniopharyngioma, Ranthke’s Cleft cyst
Hypothalamic hamartoma, histiocytosis
Meningioma, mets
Optic pathway glioma
Renal papillary necrosis
POSTCARDS
Pyelonephritis (infection)
Obstruction
Sickle cell disease
TB
Cirrhosis
Analgesic abuse
renal vein thrombosis
DM
Systemic vasculitis
Dense bone
3Ms PROOF
Malignancy
Myelofibrosis
Mastocytosis
Sickle cell disease
Pagets
Renal osteodystrophy
Osteopetrosis
Other
Fluorosis
Hepatic lymphoma
What is Post transplant lymphoproliferative disorder
looks like mets - single or multiple masses
is a type of lymphoma caused by ebstein barr virus after solid organ or BM transplant. renal transplant patients most at risk.
Cortical nephrocalcinosis
COAG
Cortical necrosis (acute)
Oxaluria (hyper)
Alport syndrome
(chronic) glomerulonephritis