Pay It Forward Flashcards
Most often injured artery especially at sites of fixation
Internal carotid
Refers to increase in blood volume
Hyperemia
Refers to increase in tissue fluid
Cerebral edema
Often the only reliable evidence of the site of impact
Scalp soft-tissue swelling
Most common manifestation of scalp injury
Subgaleal hematoma
Most commonly caused by fracture of the thin medial orbital wall
Orbital emphysema
Most common isolated maxillary fracture
Fracture of the maxillary alveolus
Most common isolated sinus fracture
Anterolateral wall of the maxillary antrum
Most common form of primary brainstem injury
Diffuse axonal injury (DAI)
Most common skeletal injury in child abuse
Long bone fractures
Most commonly recognized intracranial complication from child abuse
Subdural hematomas
Most common intra-axial manifestation of head injury related to child abuse
Diffuse brain swelling
Views requested in facial trauma
Cadwell, Waters, Cross table lateral and Submentovertex / Submental vertex view
Most common type of fracture of orbits due to trauma
Blowout fracture
Most common type of blow out fracture
Inferior blowout fracture
Le fort fracture that is described as “floating palate”
Le Fort 1
Le Fort fracture described as “pyramidal”
Le fort 2
Le Fort fracture described as “craniofacial dysfunction”
Le Fort 3
Le Fort fracture described as “dish face deformity”
Le Fort 2
Simple mandibular fractures are most commonly found in the
Ramus and condyle
This type of mandibular fracture exhibits cortical ring sign, which is a well coordinated density above the condylar neck on lateral view
Subcondylar fractures
The most common site of isolated injury to the mandible
Mandibular angle
Most malignant grade of astrocytoma
Grade IV
Most malignant form of astrocytoma
Glioblastoma multiforme
Most common type of glioma
Glioblastoma multiforme
Most common hemorrhagic neoplasms in the brain
GBM, Metastasis, Oligodendroglioma
Ring enhancing lesions on contrast
“MAGIC-DR”
First three (3) are MOST COMMON
M - Metastasis
A - Abscess
G - Glioma
I - Infarct (Subacute phase)
C - Contusion
D - Demyelinating disease
R - Radiation Necrosis
Calcified Glial Tumors
“Old A.G.E”
Old = Oligodendroglioma
A = Astrocytoma
G = GBM
E = Ependymoma
Most common tumor seen in patients with chronic temporal lobe epilepsy
Ganglioglioma
Most common location of ganglioglioma
Temporal lobe
Known as the ghost tumor. This intra axial tumor is exquisitely sensitive to steroid and radiotherapy initially, only to rebound with a vengeance
Primary CNS lymphoma
This tumor is composed of small blue cells with a high nucleus to cytoplasm ratio packed tightly together in the perivascular spaces
Primary CNS lymphoma
Most common tumor associated with medically refractory partial complex seizures
Dysembryoplastic neuroepithelial tumor (DNET)
Most common site for intracranial neoplasms in the pediatric population
Posterior fossa, Cerebellum
Most common primary cerebellar neoplasm in the adult population
Hemangioblastoma
Most common pediatric CNS malignancy (High Grade, Grade IV)
Medulloblastoma
Most common pediatric posterior fossa tumor
Pilocytic astrocytoma
Most common site of metastasis of Medulloblastoma
Bone
Most common pediatric CNS tumor (Low Grade, Grade I)
Pilocytic Astrocytoma
Most common location of Pilocytic Astrocytoma
Cerebellum (60%)
Most common tumor seen in NF-1
Pilocytic Astrocytoma
Most common extra-axial neoplasm of adults
Meningioma
Most common location of meningioma
Parasagittal or convexity locations (50%)
Most common location of meningioma in children
Ventricles
Most common location of meningioma in the spine
Thoracic spine
MRI Imaging findings to determine extra-axial nature of a tumor
- Prominent pial blood vessel flow voids (80%)
- CSF clefts around the tumor margins
- Broad dural base (KEY IMAGING FEATURE)
Most common primary vascular supply of meningioma
Middle Meningeal Artery, from the external carotid circulation
How many types of meningioma have been discovered by the WHO and how many are classified under each grade?
Total of 15 types
9 are Grade I
3 are Grade II
3 are Grade III
Most common form/transmission of metastasis of extra-axial tumors
Dural metastasis
Subdural lesions = hematogenous
Spinal lesions = via Batson’s venous plexuses
This extra axial tumor was previously considered “angioblastic meningioma”. Arises from modified pericapillary smooth muscle cells (pericytes of Zimmerman). Similar imaging to meningioma BUT has a narrow base attachment and is multilobulated (Instead of BROAD dural base and hemispheric)
Hemangiopericytoma
Ependymomas are most commonly found in
Fourth ventricle
Most common extra-axial mass in an adult
Meningioma
Most common primary tumors to spread to the ventricle where the choroid plexus is the most highly vascular part of the ventricular system
Lung carcinoma, RCC
An intraventricular tumor of neuroepithelial lineage arising from the septum pellucidum or the ventricular wall. Has numerous areas of cystic change giving the mass a “swiss cheese” morphology. Hyperintense on both t1 and t2
Central neurocytoma
An intraventricular tumor rising from the ependymal lining of the ventricular system in the sub ependymal layer. Hypointensity on t1 hyperintensity on t2
Subependymoma
An intraventricular tumor discovered in the region of the foramen of monro with strong association to tuberous sclerosis. Iso to slightly hyperintense on t1 and hyperintense on t2
Subependymal giant cell astrocytoma
Phenomenon associated with colloid cyst. Tilting of the head forward will reproduce acute severe headache
Brun phenomenon (Colloid cyst)
This lesion is not a true intraventricular neoplasm. Mimics a neoplasm. Characteristically occurs in the anterior superior portion of the third ventricle near the foramen of Monro. Presents with acute onset of severe headache
Colloid cyst
Most common type of neoplasms of the pineal gland
Giant cell tumors
Most common intracranial germ cell tumor
Germinoma
Most common sellar masses
Pituitary adenoma/s
Pituitary adenoma <10mm in size
Microadenoma
Pituitary adenoma
>10mm in size
Pituitary Macroadenoma
Most common of the secreting adenomas and presents with amenorrhea, galactorrhea, or impotence
Prolactinoma
Most common suprasellar mass in the pediatric population
Craniopharyngioma
TORCH Infections
T = Toxoplasmosis
O = Others ( Syphilis, Varicella)
R = Rubella
C = CMV
H = Herpes simplex, HIV
Most common cause of congenital CNS infection
Cytomegalovirus
Frontal sinusitis in children complicated by osteomyelitis with subperiosteal, epidural, and subdural abscesses
Pot puffy tumor
Congenital infection with primarily periventricular pattern of injury and dystrophic calcifications. Patients have hepatosplenomegaly, jaundice, chorioretinitis, deafness and cerebral involvement.
Cytomegalovirus
Congenital infection with scattered dystrophic calcifications in the white matter, basal ganglia and cortex. Necrotizing encephalitis of the fetal brain occurs. Patients present with microcephaly, chorioretinitis, and mental retardation.
Toxoplasmosis
Congenital infection associated with diffuse encephalitis with infarction presenting on cranial ultrasound as diffuse brain swelling and patchy areas of hypodensity in the white matter and cortex, with relative sparing of the basal ganglia, thalamus and posterior fossa structures. CSF analysis revealed pleocytosis (increased cell count), increased protein and decreased glucose.
Herpes simplex
Most common form of CNS tuberculosis
Tuberculous meningitis
Most common opportunistic FUNGAL CNS infections
- Cryptococcus
- Aspergillosis
- Candidiasis
- Mucormycosis
Most frequently reported CNS fungal infection
Cryptococcosis
Most common cause of sporadic encephalitis
Herpes simplex encephalitis
Most common opportunistic CNS infection
Toxoplasmosis
Most common fungal infection in hiv-positive patients
CNS cryptococcosis
Most common intracranial neoplasm in patients with AIDS
Primary CNS lymphoma
Region of the brain that is most severely involved in HIV encephalopathy
Centrum semiovale
Region of the brain that is spared in HIV encephalopathy
“No sHIVs (weapon) allowed in the grey courtroom”
Cortical gray matter
Region of the brain that is spared in herpes simplex encephalitis
Putamen
“Walang Herpes yung Puta”
“Yung Puta Walang Herpes”
Herpes simplex encephalitis spares Putamen
Most common manifestation of HIV infection of the brain on neuroimaging studies
Diffuse atrophy
This is the favored site of CNS toxoplasmosis
Basal ganglia
Difference between DEMYELINATION versus DYSMYELINATION
DEMYELINATION = Acquired, Adult, Affects normal myelin
DYSMYELINATION = Inherited, Pedia, Affects formation and maintenance of myelin
This refers to small infarcts (5-10mm) occurring within the basal ganglia typically over two-thirds of the putamina
Lacunae / Lacunar infarcts
Most common fatal encephalitis
Herpes encephalitis
Most common neurodegenerative disease
Alzheimer disease
Most common cause of dementia
Alzheimer disease
Most common of the leukodystrophies
Metachromatic leukodystrophy
This is also called subacute necrotizing encephalomyelopathy. Involves a mitochondrial enzyme defect. In contrast to Wernicke encephalopathy, there is sparing of the mammillary bodies
Leigh disease
This is also known as hepatolenticular degeneration. There is an inborn error of copper metabolism that is associated with hepatic cirrhosis and degenerative changes of the basal ganglia.
Wilson disease
Intracorneal deposit of copper is virtually diagnostic of the Wilson disease when present
Kayser-Fleischer ring
The most common basal ganglia disorder and one of the leading causes of neurologic disability in individuals older than age 60
Parkinson disease
This neurotransmitter is deficient in parkinson’s disease due to dysfunction of the neuronal system specifically pars compacta of the substantia nigra
Dopamine
Postinfectious and postvaccinal encephalomyelitis. Typically occurs after a viral illness or vaccination.
Acute Disseminated Encephalomyelitis (ADEM)
Reactivated slowly progressive infection caused by the measles virus. Presents with patchy areas of periventricular demyelination as well as lesions of the basal ganglia.
Subacute Sclerosing Panencephalitis
Represents a reactivation of a latent JC polyomavirus. Seen in immunocompromised individuals and typically involves the deep cerebral white matter with subcortical U-fiber involvement but spares cortex and deep gray matter.
Progressive Multifocal Leukoencephalopathy (PML)
Presents as subacute encephalitis in immunocompromised patients. Characterized clinically by a progressive dementia without focal neurologic signs. Causes focal or diffuse white matter hyperintensities on T2WI.
HIV encephalopathy
Most common electrolyte abnormality associated with central pontine myelinolysis
Hyponatremia
Most common cause of Wernicke encephalopathy and Korsakoff syndrome
Thiamine (B1) deficiency secondary to poor oral intake in SEVERE CHRONIC ALCOHOLISM
Refers to a supraclinoid obliterative arteriopathy that occurs primarily in children and idiopathic in nature. Also known as “Puff of smoke”
Moyamoya disease
Clinical triad of Wernicke encephalopathy
- Ocular movement abnormalities
- Ataxia
- Confusion
Persistent learning and memory deficits present in Wernicke encephalopathy
Wernicke-Korsakoff syndrome
What is the dysmyelinating disease with the following description:
- autosomal recessive pattern
- arylsulfatase deficiency
- infantile type (MC)
- 2 y/o, gait disorder, mental deterioration
- progressive with sparing of subcortical U-fibers
Metachromatic Leukodystrophy
This type of hydrocephalus occurs when there is obstruction within the ventricular system and prevent CSF from exiting the ventricles
Non-communicating hydrocephalus
This type of hydrocephalus has an obstruction that is beyond the ventricular system it is located instead within the subarachnoid space
Communicating hydrocephalus
Most sensitive indicator for hydrocephalus
Enlargement of the temporal horns
Most frequent causes of acute hydrocephalus
Subarachnoid hemorrhage and meningitis
Colloid cyst typically block CSF flow in what level / portion
3rd ventricle
Pineal tumors and tectal gliomas typically obstruct CSF flow at what level / portion
Aqueduct
Ependymoma and medulloblastomas typically interrupt CSF flow at the level of the
4th ventricle
Source of the majority of hemorrhages in premature infants
Germinal matrix
Most common clinical finding of ischemic perinatal stroke
Focal neonatal seizures
Most common cause for small amounts subarachnoid, subdural blood, or interventricular blood in the term newborn
Normal delivery / Traumatic normal delivery
Most severe form of holoprosencephaly
Alobar holoprosencephaly
Form of holoprosencephaly with an appearance of a horseshoe or cup-shaped interior rind of brain tissue, dominant single monoventricle that communicates with a posterior cyst. The corpus callosum interhemispheric fissure and falx cerebri or entirely absent.
Alobar holoprosencephaly
Most severe malformation resulting from an arrest of neuronal migration. Also known as “smooth brain”
Lissencephaly
“gLISSENingly smooth”
Most common chiari malformation
Chiari I (1)
Most rare chiari malformation
Chiari III (3)
“rar3st chiari malformation”
Most common of the phakomatoses
Neurofibromatosis Type 1 (Von Recklinghausen disease)
Chiari malformation associated with myelomeningocele/s
Chiari II (2)
“Dalawang Yelo”
Chiari II - myelomeningocele
Chiari malformation associated with encephaloceles
Chiari III (3)
“3nc3phaloc3l3s”
Chiari malformation associated with cerebellar hypoplasia
Chiari IV (4)
Chiari malformation associated with cerebellar agenesis with occipital lobe herniation
Chiari V (5)
Chiari malformation associated with normal posterior fossa
Chiari IV (4)
Most common neurologic symptom of tuberous sclerosis
Epilepsy
Most frequent brain lesions seen in tuberous sclerosis
Subependymal hamartomas
Most common pathology involved in the paranasal sinuses and nasal cavity
Sinusitis
Autosomal dominant disorder associated with retinal angiomas and cerebellar and spinal hemangioblastomas
Von Hippel-Lindau Syndrome (VHL)
A syndrome also known as Encephalotrigeminal angiomatosis, Associated with Port-wine nevus and Pial angiomatosis (gyral calcification, gyral atrophy and gliosis)
Sturge-Weber Syndrome
Most common sinus involved with mucus retention cyst
Maxillary sinus
Most common sinus involved with Mucocele
Frontal sinus
Most common disease involving the temporal bone
Cholesteatoma
Most common type of cholesteatoma, congenital or acquired?
Acquired (98%)
Most common site for formation of an acquired cholesteatoma
Superior portion of tympanic membrane (Pars flaccida = retracts easily)
Most common benign neoplasm arising of the minor salivary glands
Pleomorphic adenoma (Benign mixed-cell tumor)
Most common MINOR salivary gland malignancy
Adenoid cystic carcinoma
Most common malignancy of the aerodigestive tract
Squamous cell carcinoma
Most common variation in the vascular anatomy of the neck
Asymmetry of the internal jugular veins (RIGHT vein is LARGER)
Principal malignancy of the carotid space
Squamous cell nodal metastasis
Most common tumor of the parotid gland
Pleomorphic adenoma (Benign mixed cell tumors)
A mass in the carotid space will displace the parapharyngeal space in what direction?
Anteriorly
Mnemonic for Normal:
“a Carrot Must Pair Superficially on my P.A.L.M”
Carrot = Carotid space ( P = Posterior to PPS)
Must = “Must”icator space ( A = Anterior to PPS)
Pair = “Pair”otid space ( L = Lateral to PPS)
Superficially = Superficial mucosal space ( M = Medial to PPS)
This neck space serves as a potential conduit for the spread of tumor or infection from the pharynx to the mediastinum. A.k.a “Danger space”
Retropharyngeal space
These structures give rise to most pathologies in the prevertebral space
Cervical vertebral bodies
Most common tumor of the optic nerve and typically occurs during the first decade of life
Optic nerve glioma
This tumor arises from hemangioendothelial cells of the arachnoid layer of the optic nerve sheath. It assumes a circular configuration and grows into a linear fashion along the optic nerve. It demonstrates a tram track pattern of linear contrast enhancement. It may be extensively calcified.
Optic sheath meningioma
Most common cause of intraorbital mass lesion in the adult
Idiopathic inflammatory pseudotumor
The most frequent cause of unilateral or bilateral proptosis in adults
Thyroid ophthalmopathy (Graves disease)
Muscles involved in decreasing order of frequency in graves’ disease
“IM SLow”
“I’M SLow”
Inferior rectus (most involved)
Medial rectus
Superior rectus
Lateral rectus (least involved)
Most common primary ocular malignancy in the pediatric age group and presents characteristically with leukocoria and a calcified ocular mass
Retinoblastoma
Most common neck malignancy in the pediatric age group
Lymphoma
Most common congenital neck lesion in children
Thyroglossal duct cyst
Most common midline neck mass
Thyroglossal duct cyst
Most branchial cleft cysts arise from which branchial cleft
Second branchial cleft (95%)
Classic symptoms of Myelopathy
“kapag Myelopathy, B.A.W.a.S”
“kapag Myelopathy, B.A.W.a.S”
- Bladder & Bowel Incontinence
- Ataxia
- Weakness
and
- Spasticity
Most common spinal causes of pain and neurologic deficit are
- Disc herniations
- Uncovertebral joint spurring
Most common spinal cord “inflammatory” disorder
Multiple sclerosis
Most common cause of intramedullary lesions
Multiple sclerosis
Currently the most common cause of arachnoiditis
Iatrogenic
Most common site of hematogenous infectious seeding in the spine
Vertebral body
Most common cause of spine infection in adults
Staphylococcus aureus
This is also known as tuberculosis of the spine. Associated with slow collapse of one or more vertebral bodies resulting in acute kyphosis or “gibbus” deformity. Cord compression may occur as a result of this gibbus deformity
Pott disease / Pott’s disease
The term “cold abscess” describes large spinal abscesses without severe pain or frank pus is associated with what disease?
Pott disease / Pott’s disease
Most common spinal cord tumor in adults
Ependymomas
Most common spinal cord tumor in children
Astrocytoma
Most common intradural tumor in the thoracic region and represents roughly 25% of all adult intraspinal tumors
Meningioma
Most common intraspinal mass. It is also the most common nerve sheath tumor
Schwannoma
Classic cause of spinal intradural extramedullary metastases
Subarachnoid seeding of primary CNS neoplasm
Spinal cord split into two hemicords by a sagittal bony or cartilaginous spur. Most occur in the lower thoracic region and are accompanied by vertebral segmentation abnormalities
Diastematomyelia
Most common site in the spine for root avulsion
Cervical spine
Most common cause of neuroforaminal stenosis
Degenerative disease of the facets with bony hypertrophy
Most common cause of central canal stenosis and lateral recess stenosis
Degenerative disease of the facets with bony hypertrophy
Most common modic type endplate changes
Modic type 2
- replacement of red marrow with fatty yellow marrow
- T1 High, T2 High
Other Modic Types:
Modic type 1
- marrow edema and inflammation
- response to degenerative disc disease
- can also be a sign of infection
- T1 Low, T1 High
Modic type 3
- Bony sclerosis
- T1 Low, T2 Low
Most common form of atelectasis
Obstructive or resorptive
Most common causes of endobronchial obstruction and secondary resorptive atelectasis
- bronchogenic carcinoma
- foreign bodies
- mucus plugs
- malpositioned endotracheal tube
Type of atelectasis associated with chronic tuberculosis
Cicatricial atelectasis
Type of atelectasis associated with surfactant deficiency
Adhesive atelectasis
The only DIRECT radiographic finding of lobar atelectasis
Displacement of an interlobar fissure
Type of atelectasis that is usually found along the inferior and posterior costal pleural surfaces adjacent to an area of pleural fibrosis or plaque formation. Identified also by a curvilinear bronchovascular tube or “comet tail” entering the anterior inferior margin of the mass
Round atelectasis
Atelectasis of this lobe produces the S sign of golden
Right upper lobe atelectasis
What sign will be produced when there is collapse of the right upper lobe superiorly and medially, superomedial displacement of the minor fissure and anteromedial displacement of the major fissure
S sign of Golden
What lobes are atelectatic when there is obstruction of the bronchus intermedius by a mucus plug or tumor
Combined right middle and right lower lobe atelectasis
Which lung lobe is commonly collapsed in patients with large hearts and in postoperative patients, particularly, who have had coronary bypass surgery
Left lower lobe atelectasis
Pulmonary edema and interstitial pneumonitis will present with this type of reticular pattern of opacities
Fine reticular “Ground glass pattern”
Pulmonary fibrosis will most commonly present with this type of reticular pattern of opacities
Medium reticular “Honeycombing”
Nodular opacities <2 mm
Miliary opacities
Nodular opacities 2-7mm
Micronodules
Nodular opacities 7-30mm
Nodules
Nodular opacities >30mm
Masses
Diseases that give rise to TRUE RETICULONODULAR opacities
- Silicosis
- Sarcoidosis
- Lymphangitic carcinomatosis
What type of kerley lines are obliquely oriented, course toward the hila, measure 2-6 cm long and with <1 mm thickness.
Kerley A lines
What type of Kerley lines are peripherally located, coarse, perpendicular to and contact the pleural surface, and measure about 1-2 cm.
Kerley B lines
Kerly lines that represent thickened peripheral subplural interlobular septa
Kerley B lines
Kerly lines that correspond to thickening of connective tissues sheets within the lung which contain lymphatic communications between the perivenous and bronchoarterial lymphatics
Kerley A lines
Ker-lymph-A-tics = kerly A lines
Most common cavitary pulmonary lesions
Lung abscess and necrotic neoplasm
A collection of gas <1 cm in size within the layers of the visceral pleura. It is usually found in the apical portion of the lung. Its rupture can lead to spontaneous pneumothorax
Blebs
Gas collection within the pulmonary parenchyma >1 cm in diameter and a thin wall of <1 mm thick. It represents a focal area of parenchymal destruction like emphysema and may contain fibrous strands, residual blood vessels, or alveolar septa.
Bullae
Thin-walled gas containing structures that represent distended airspaces distal to a check valve obstruction of a bronchus or bronchiole. It is most commonly secondary to staphylococcal pneumonia
Pneumatoceles
Any well-circumscribed intrapulmonary gas collection with a smooth thin wall >1 mm thick
Air cyst (Brant 5th ed)
This syndrome involves congenital absence of the pectoralis muscle which produce a unilateral pulmonary hyperlucency
Poland syndrome
P-oland syndrome
P-ectoralis muscle absence
P-ulmonary lucency (unilateral)
This syndrome is a condition that follows adenoviral infection during infancy. It is also known as unilateral hyperlucent lung. This will produce a TRUE unilateral hyperlucent lung.
Swyer-James syndrome
Diseases that may manifest as bilateral hyperlucent lungs
- Emphysema
- Asthma
- PS associated with TOF
- Obstruction of pulmo circulation (PAH, Chronic thromboembolic disease)
Most common finding of pneumomediastinum
Air outlining the left heart border
Air dissects between the pericardium above the central diaphragm below to allow visualization of central portion of the diaphragm
Continuous diaphragm sign
This sign indicates that a mass is superimposed on the hilum and normal hilar vessels can be seen through the density
Hilum overlay sign
This sign indicates enlargement of the intrahilar vascular structures. Vascular structures converge only as far as the lateral margin the increased higher density
Hilum/Hilar convergence sign
To differentiate pleural effusion from ascites on Axial CT
Pleural Effusion displaces Crus LATERALLY “PE.C.LAT”
Ascites displaces CRUS MEDIALLY (Opposite of Pleural effusion)
“A.C.MED)
Most common thoracic inlet mass seen in older patients
Tortuous arterial structures / Tortuous aorta
Enlargement of a thymus that is normal on gross and histologic examination. This occurs primarily in children as a rebound effect.
Thymic hyperplasia
This is a neuroendocrine tumor of the thymus. It is a rare malignant neoplasm believed to arise from the thymic cells of neural crest origin (APUD or Kulchitsky cells). Carcinoid tumor is the most common histologic type.
Thymic carcinoid
In lymphoma, this is the most frequent site of a localized nodal mass in which portion of the mediastinum particularly those of nodular sclerosing type
Anterior mediastinum
Most common subtypes of non-hodgkin’s lymphoma
Lymphoblastic lymphoma and diffuse large b-cell lymphoma
This type of lymphoma most commonly involves the middle mediastinal and hilar lymph nodes
Non-hodgkin lymphoma
This type of lymphoma most commonly involves the anterior mediastinal and hilar nodal groups
Hodgkin lymphoma
H-odgkin = H-arap (Anterior and Hilar nodal groups)
This is the most common primary mediastinal neoplasm in adults
Lymphoma, either Hodgkin or Non-Hodgkin
Treatment for localized intrathoracic hodgkin disease
Radiation / Radiotherapy
Treatment for non-hodgkin’s lymphoma and widespread hodgkin disease
Chemotherapy (Better response rates for Hodgkin than NHL)
“Radio Hud” Radiotherapy for Hodgkins
“Kimochi, Non-hentai!” Chemotherapy for Non-Hodgkins
Most common benign mediastinal germ cell neoplasm
Teratoma
Most common type of teratoma seen in the mediastinum
Cystic or mature teratoma
This neoplasm contains only elements derived from the ectodermal germinal cyst
Dermoid cyst
This type of teratoma commonly contains tissues of epidermal, dermal, and endodermal origins
Mature or Cystic teratoma
Most common malignant germ cell neoplasm
Seminoma
Most common source of metastases to the middle mediastinal nodes
Bronchogenic carcinoma
Bronchogenic carcinoma will metastasize specifically to which middle mediastinal nodes?
Paratracheal and aorticopulmonary nodes
Pericardial cysts most commonly arise from
Anterior cardiophrenic angle (right sided lesions twice as common as left cardiophrenic angle)
Neurogenic tumors arising from intercostal nerves
Neurofibroma, Schwannoma
Neurogenic tumors arising from the sympathetic ganglia
Ganglioneuroma, Ganglioneuroblastoma, Neuroblastoma
Neurogenic tumors arising from paraganglionic cells
Pheochromocytoma, Chemodectoma
Non-functioning paraganglioma
Chemodectomas
Functioning paraganglioma
Pheochromocytoma
Most common structure in a hiatal hernia sac
Stomach
Cardia in SLIDING HERNIA “Sliding Car”
Fundus in PARAESOPHAGEAL HERNIA “PARA is FUN to use (Counterstrike)”
Paraspinal masses produced by expansion of the vertebral body or posterior elements
Multiple myeloma, Aneurysmal bone cyst
Most common primary malignancies that metastasize to the thoracic spine
Bronchogenic, breast, or renal cell carcinoma
Most common posterior mediastinal mass in patients with neurofibromatosis
Meningocele
Most common cause of chronic sclerosing fibrosing mediastinitis
Granulomatous infection secondary to histoplasma capsulatum
Other less common causes include:
Tuberculous, Radiotherapy, Drugs
Most commonly affected structure in chronic sclerosing fibrosing mediastinitis
Superior vena cava (75% of symptomatic patients)
SVC syndrome manifests with…
Jugular venous distention, Cyanosis, Edema, Headache, Epistaxis
Most serious and potentially fatal manifestation of chronic sclerosing fibrosing mediastinitis
Obstruction of central pulmonary veins
Most common cause of mediastinal hemorrhage
Trauma
Most common source of pneumomediastinum
Air from the lungs
Pneumomediastinum - Extra-alveolar air collects within bronchovascular interstitium which dissects centrally to the hilum and mediastinum
Macklin effect
Substernal chest pain caused by intramediastinal extension of infections
Ludwig angina
Extrathoracic neoplasm with the highest incidence of intrathoracic nodal metastases
Malignant melanoma
Most common thoracic radiographic manifestation of lymphoma
Hilar and mediastinal lymph node enlargement
Most common form of pulmonary edema
Hydrostatic pulmonary edema (Normal capillary permeability)
PCWP range with findings of constriction of lower vessels and enlargement of upper lobe vessels
PCWP 12-18 mmHg (Mild elevation)
PCWP range with findings of interstitial edema, loss of vascular definition, peribronchial cuffing, and Kerley lines
PCWP 19-25 mmHg (Progressive elevation)
PCWP range with findings of alveolar filling with radiographic findings of bilateral airspace opacities in the perihilar and lower lung zones
PCWP above 25 mmHg
PCWP normal range
PCWP 8-12 mmHg
Most common finding in pulmonary embolism without infarction
Peripheral airspace opacities and linear atelectasis
Sign of pulmonary embolism - Regional oligemia (decreased pulmo blood flow) and has the highest positive predictive value / highest sensitivity
Westermark sign
Pulmonary embolism - peripheral wedge of airspace opacity and implies lung infarction
Hampton hump
Pulmonary embolism - sign of enlarged Pulmonary Artery
Fleischner sign
Hallmark of pulmonary embolism
Ventilation/perfusion mismatch (V/Q mismatch)
Traditionally considered to be the gold standard in the diagnosis of pulmonary embolism
Pulmonary angiography
Widely considered the first-line diagnostic modality for the evaluation of suspected pulmonary embolism
MDCT
Most common cause of pulmonary arterial hypertension
Increase in resistance to pulmonary blood flow
Identification of feeding and draining vessels emanating from the hilar aspect of a solitary pulmonary nodule is pathognomonic of this
Pulmonary Arteriovenous malformation (AVM)
Presence of halo of ground glass opacity encircling a solitary pulmonary nodule in an immunocompromised or neutropenic patient
Invasive pulmonary aspergillosis
A nodule or mass adjacent to an area of pleural thickening with a “comet tail” of bronchi and vessels entering the higher aspect of the mass and associated with lobar volume loss
Round atelectasis
The single most important factor in characterizing the lesion as benign or indeterminate
Internal density of a mass/nodule
Most common type of lung cancer, accounting for 1/3 of all bronchogenic carcinoma
Adenocarcinoma
Most common subtype of lung cancer in non-smokers
Adenocarcinoma
Most malignant neoplasms arising from bronchial neuroendocrine (Kulchitzky) cells and are alternatively referred to as Kulchitzky cell cancers or KCC-3
Small cell carcinoma
“Kulit-zky ng mga Maliit na bata” (Kulchitzky cells, Small Cell Carcinoma)
Bronchogenic carcinoma associated with cavitation of solitary malignant nodules
Squamous cell carcinoma
Bronchogenic carcinoma associated with air bronchograms or bubbly lucency within a nodular mass
Adenocarcinoma
Most common cause of SVC syndrome
Lung cancer
Most common primary tracheal malignancy
Squamous cell carcinoma
Majority of tracheal neoplasms arise from which portion of the trachea
Distal trachea, within 3 to 4 cm of the tracheal carina
Most common types of thyroid malignancy to invade the trachea
Papillary and follicular carcinoma
Most common pattern of pulmonary infection
Lobular or bronchopneumonia
Most common cause of multifocal patchy airspace opacities
Bronchopneumonia
Pulmonary infection represents radiographically as multifocal opacities that are roughly lobular in configuration which produce a “patchwork quilt” appearance because of the interspersion of normal and diseased lobules
Lobular or bronchopneumonia
Typical radiographic appearance for acute pneumococcal pneumonia
Lobar consolidation
In children, pneumococcal pneumonia present as a spherical opacity simulating a parenchymal mass
Round pneumonia
Most common type of pneumonia in hospitalized and debilitated patients
Staphylococcus aureus pneumonia
This type of pneumonia may develop following hematogenous spread to the lung in patients with endocarditis or indwelling catheters and in intravenous drug users
Staphylococcus aureus pneumonia
In this type of pneumonia, children may develop pneumatocele information
Staphylococcus aureus pneumonia
Used as an agent of bioterrorism in the united states. CT scan will show high attenuation lymphadenopathy and pleural effusion secondary to hemorrhage. Radiographic manifestations include:
- hemorrhagic lymphadenitis and mediastinitis
- hemorrhagic pleural effusions
Bacillus anthracis (Anthrax)
Pneumonia with bulging interlobular fissure. “Bulging fissure” sign. Incidence of effusion and empyema is higher
Klebsiella pneumoniae
Pneumonia with etiologic agent commonly found in air conditioning and humidifier systems. Produces airspace opacification that is initially peripherally located and sublobar
Legionnaires disease, L. Pneumophilia
Anaerobic gram positive filamentous bacterium. Part of normal flora of human oropharynx. Most commonly follows dental extractions manifesting as mandibular osteomyelitis or a soft tissue abscess.
Actinomyces israelii
Most common atypical pneumonia
Mycoplasma pneumonia
An important radiographic feature and indicates active and transmissible disease in tuberculosis
Cavitation
Tuberculous infiltrates can erode into a branch of pulmonary artery can produce aneurysm and cause hemoptysis
Rasmussen aneurysm
Consists of a calcified parenchymal nodule (Ghon complex) and nodal calcification
Ranke complex in Primary TB
Most common organism responsible for atypical mycobacterial infection
Mycobacterium avium-intracellulare (MAI) or M.kansasii
Most common cause of viral pneumonia in adults
Influenza
Most common method of pleuropulmonary involvement by amoebiasis
Direct intrathoracic extension from a hepatic abscess
Etiologic agent involved in most cases of human hydatid disease
Echinococcus granulosis
Definitive hosts for Echinococcosis / Hydatid cyst
Dogs
Intermediate hosts for Echinococcosis / Hydatid cyst
Sheep
Accidental hosts for Echinococcosis / Hydatid cyst
Humans
Most important parasitic infections of humans worldwide
Schistosomiasis
Most common complication of pneumonia and it is seen in 50% of patients
Parapneumonic effusion
Most common cause of pneumonia in immunocompromised hosts
Bacterial pneumonia
The most common non-tuberculous mycobacterial infection in patients with AIDS
Mycobacterium avium intracellulare (MAI)
Most common cause of fungal infection in the AIDS population
Cryptococcosis, C.neoformans
- a budding yeast commonly found in soil and bird droppings
Most serious consequence of cryptococcosis
Meningitis
The most common AIDS defining opportunistic infection. Most common in patient with AIDS usually those in the late stages of HIV infection with CD4 counts of < 200 cells/mm3
Pneumocystis jiroveci pneumonia (formerly Pneumocystis carinii pneumonia, PCP)
This obligate intracellular protozoan has cats as definitive hosts and spreads via ingestion of material contaminated by oocyst containing stool
Toxoplasma gondii, Toxoplasmosis
Most common pleural manifestation of rheumatoid disease and is found in 20% of patients
Pleuritis
Syndrome wherein nodules develop in the lungs of coal miners and silica or asbestos workers with rheumatoid arthritis as a hypersensitivity response to inhaled dust particles
Caplan syndrome
Sicca syndrome
Dry eyes (Xerophthalmia/Keratoconjunctivitis sicca)
Dry nose (Xerorhinia)
Dry mouth (Xerostomia)
Autoimmune disorder of middle-aged women and characterized by the Sicca syndrome
Sjogren syndrome
Most common pulmonary manifestation of Sjogren syndrome
Interstitial fibrosis
Most common of the idiopathic interstitial pneumonia
Usual interstitial pneumonia (UIP)
Type of interstitial pneumonia with a histologic feature of temporal heterogeneity, wherein different stages of the disease are seen simultaneously within the different portions of the lung.
Usual interstitial pneumonia (UIP)
Type of interstitial pneumonia also known as Hamman-Rich syndrome. It is an acute aggressive form of idiopathic interstitial pneumonitis and fibrosis. Histologic findings of diffuse alveolar damage with minimal mature collagen deposition which are diffuse and temporarily homogeneous. Manifests as ARDS with diffuse GGO and consolidation with air bronchograms.
Acute interstitial pneumonia
Chronic interstitial lung disease with pathology of smooth muscle proliferation in peribronchovascular and parenchymal interstitium.
Tuberous sclerosis (TS)
Classic triad of tuberous sclerosis (in Chronic interstitial lung disease)
“MR S.Ad Tubero”
- Mental retardation
- Seizures
- Adenoma sebaceum
”MR S.Ad Tubero”
Mental Retardation, Seizures, ADenoma sebaceum, TUBEROus sclerosis
Chronic interstitial lung disease with pathology of smooth muscle proliferation within lymphatic channels
Lymphangioleiomyomatosis (LAM)
Chronic interstitial lung disease with development of chylothorax, chyloperitoneum or chylopericardium. May also produce chylous pleural effusions that are large and recurrent
Lymphangioleiomyomatosis (LAM)
Chronic interstitial lung disease that has a characteristic apple green color when stained with congo red under polarized light
Alveolar septal amyloidosis
Chronic interstitial lung disease with manifestations of cutaneous cafe au lait spots, cutaneous and subcutaneous neurofibromas, scalloping of the posterior aspect of vertebral bodies with kyphoscioliosis. “Ribbon rib” and rib notching may be seen as well.
Neurofibromatosis
Most common pleural manifestation of Asbestos inhalation
Parietal pleural plaques
Type of idiopathic eosinophilic lung disease disease also known as loffler syndrome. This is a transient pulmonary process characterized by pulmonary infiltration with eosinophilic exudates. Opacities have been described as “fleeting” because there is a tendency for rapid clearing and one area with new involvement in other areas.
Simple pulmonary eosinophilia
Drugs associated with pulmonary eosinophilia
“Nitro Pencil”
Nitrofurantoin and penicillin
Nitro-furantoin, Pencil-lin
Parasitic infections associated with pulmonary eosinophilia
“A Scar is Strong”
Ascaris lumbricoides, Strongyloides stercoralis
This type of idiopathic eosinophilic disease is a systemic disorder with a male predominance. Characterized by multiple organ damage from eosinophilic infiltration.
There is marked and prolonged blood eosinophilia. Associated with cardiac involvement causing CHF, Cardiomegaly, Pulmonary edema and Pleural effusions
Hypereosinophilic syndrome
Drug that cause diffuse alveolar damage
“Sabi ni mommy, nasa B.G.C. DAD MO”
B-leomycin
G-old
C-yclophosphamide
Diffuse Alveolar Damage
M-itomycin
O-piates
Drugs causing Usual Interstitial Pneumonia
“B.A.N.Me” (Banh mi)
B-leomycin
A-miodarone (If with pulmonary edema, this drug is likely the culprit)
N-itrofurantoin
Me-thotrexate
Lipoproteinaceous material surfactant deposits in abnormal amounts within air space of the lungs. Associated with acquired defect of alveolar macrophages that fail to phagocytose surfactant resulting in accumulation of surfactant within alveolar spaces. Alveoli filled with lipoproteinaceous material that stains deep pink with periodic acid-Schiff.
Pulmonary alveolar proteinosis (PAP)
PAP
P-hagocytose failure
P-rogressive dyspnea
P-ink (Deep) on P-eriodic acid-Schiff
P-eripheral nodules
P-eripheral airspace opacification that is bilateral and symmetric
Disorder characterized by deposition of minute calculi within the alveolar spaces. Produces a radiographic finding of confluent bilateral dense micronodular opacities (because of high interest of density) or “Black pleura sign”
Alveolar microlithiasis
Black pleura sign
= represent subpleural sparing of pulmonary calcification that occurs in the alveoli centrally. Seen as a strip of tangential peripheral lucency underlying the ribs as compared with adjacent diffusely dense calcified lung.
A congenital tracheal anomaly that is a true diverticula that represents herniation at the tracheal air column through a weakened posterior tracheal membrane
Tracheoceles / Paratracheal air cysts
Fixed deformity of the intrathoracic trachea in which the coronal diameter is diminished to less than two-thirds of the sagittal diameter. The tracheal wall is uniformly thickened and there is calcification of the cartilaginous rings. Present in older men with COPD.
Saber-sheath trachea
Characterized by presence of multiple submucosal osseous and cartilaginous deposits within the trachea and central bronchi of elderly men. The calcified plaques usually involve the anterior and lateral walls of the trachea with SPARING of the membranous POSTERIOR WALL of the trachea which lacks cartilage.
Tracheobronchopathia Osteochrondroplastica
A systemic autoimmune disorder that commonly affects the cartilages in tracheobronchial tree, larynx, ear, nose, joints and large elastic arteries. Diagnosis made by noting RECURRENT inflammation at TWO OR MORE cartilaginous sites, most commonly the pinna of the ear (producing cauliflower ears) and the bridge of the nose (producing a saddle nose deformity)
Relapsing polychondritis
A congenital disorder of the elastic and smooth muscle components of the tracheal wall. Abnormal compliance of the trachea and central bronchial collapse during coughing predisposing to recurrent pneumonia and bronchiectasis. On frontal radiographs, trachea and central bronchi measure greater than 3.0 and 2.0 cm respectively and coronal diameter.
Tracheobronchomegaly (Mounier-Kuhn syndrome)
Most common type of emphysema
Centrilobular emphysema
Most common etiologic factor associated with emphysema
Cigarette smoking
Type of emphysema that is associated with deficiency of the serum protein alpha 1 antitrypsin (alpha 1 protease inhibitor)
Panlobular emphysema
“pANTItrypsin deficiency”
Most important plain radiographic finding in emphysema and reflects the loss of lung elastic recoil
Hyperinflation
Refers to an inflammation of the small non-cartilaginous airways
Bronchiolitis
Most common condition to produce a transudative pleural effusion
Congestive heart failure
Most common cause of parapneumonic effusion and empyema
Staphylococcus aureus and gram-negative pneumonia
Most common intrathoracic manifestation of rheumatoid arthritis
Pleural effusion
Most common cause of pneumothorax
Trauma
Most common predisposing condition of secondary spontaneous pneumothorax
COPD
Most common connective tissue disease producing pneumothorax; usually from rupture of an apical bullae
Marfan syndrome
Most common inflammatory disease causing localized pleural thickening
Pneumonia
Defined as pleural thickening extending over more than 1/4 of the costal pleural surface. Most commonly results from resolution of an exudative pleural effusion, empyema, or hemithorax. May be seen as subpleural extension of diffuse interstitial fibrosis or encompass the entire lung producing entrapment.
Fibrothorax
Most common benign manifestation of asbestos inhalation
Pleural plaques
Earliest manifestation of asbestos-related pleural disease
Pleural effusion
Type of fiber most often implicated in malignant mesothelioma and is most commonly encountered since it is most used in the industry
Crocidolite
Most common histologic type of malignant mesothelioma and has the best prognosis among the different types
Epithelial
Most common organisms responsible for chest wall abscesses
Staphylococcus and Mycobacterium tuberculosis
Most common benign neoplasm of the chest wall
Lipoma
Most common malignant soft tissue neoplasms of the chest wall in adults
Fibrosarcomas and Liposarcomas
Most common congenital anomalies of the ribs
Bifid ribs and bony fusion
Most common cause of bilateral inferior rib notching
Coarctation of the aorta
Which ribs are UNINVOLVED in rib notching?
First two ribs
First and second intercostal arteries arise from the superior intercostal branch of the costocervical trunk of the subclavian artery, therefore do not communicate with the descending thoracic aorta.
Most common non-vascular cause of inferior rib notching
Multiple intercostal neurofibromas in Neurofibromatosis type 1
Most common site in the bony thorax involved by monostatic fibrous dysplasia
Ribs
Most common benign neoplasm of the ribs in adults
Osteochondroma
Most common primary rib malignancy
Chondrosarcoma
Most common metastatic lesions to ribs
Bronchogenic and breast carcinoma
Most commonly produce sclerotic rib metastases
Breast and prostate carcinoma
This congenital deformity involves a hypoplastic scapula and is elevated
Sprengel deformity
The scapula is superiorly displaced and its inferior portion is posteriorly displaced. It results from disruption in the innervation of the serratus anterior muscle (long thoracic nerve) that maintains the scapula against the chest wall
Winged scapula, Winging of the scapula
Most commonly fractured portion of the clavicle in blunt trauma
Distal third
Primary malignant neoplasms of the clavicle
Ewing or Osteogenic sarcoma
H-shaped or “Lincoln log” vertebrae on lateral chest and is pathognomonic of this disease
Sickle cell anemia
“Lincoln’s Sickle cut H-shaped Log”
Lincoln Log vertebrae, Sickle cell anemia, H-shaped vertebrae
“Rugger jersey” appearance of the thoracic spine on lateral chest films
Hyperparathyroidism, Renal osteodystrophy
“Sandwich vertebral body” or “Sandwich vertebrae” represents densely sclerotic endplates of vertebral bodies distinctive for which disease
Osteopetrosis, a benign autosomal dominant disorder
Paradoxical superior movement of the diaphragm with sniffing. A result of the effects of negative intrathoracic pressure on a flaccid diaphragm during inspiration is diagnostic
Positive sniff test
Usually done for Diaphragmatic paralysis (Unilateral or Bilateral)
Most common type of diaphragmatic hernia
Hiatal hernia
Most common structure to herniate in a hiatal hernia
Stomach
Least common type of diagphragmatic hernia
Morgagni hernia
Most common primary malignant diaphragmatic lesion
Fibrosarcoma
Most commonly involved segment of lung in bronchial atresia
Apicoposterior segment of the left upper lobe
Most commonly involved segment of the lung in neonatal lobar hyperinflation (congenital lobar emphysema)
Left upper lobe (most common)
Right middle lobe (2nd most common)
Right upper lobe (3rd)
Congenital abnormality resulting from the INDEPENDENT development of a portion of the tracheobronchial tree that is ISOLATED from the normal lung and maintains its fetal systemic arterial supply. The isolated lung is cystic and bronchiectatic. Patients will present with recurrent pneumonia.
Bronchopulmonary sequestration
Type of bronchopulmonary sequestration:
- Contained within visceral pleura of normal lung
- Present with pneumonia (most)
- Found in lower lobes
- Supplied by a single large artery
Intralobar sequestration
More common than extralobar (3:1)
Most common pulmonary symptoms of arteriovenous malformations
Hemoptysis and dyspnea
This syndrome describes massive aspiration of gastric contents
Mendelson syndrome
Used to monitor response to chemotherapy of lymphoma
CT and Fluorodeoxyglucose (FDG) PET
Replaced by FDG PET in the initial diagnosis and staging of thoracic lymphoma
SPECT - Radionuclide scintigraphy with gallium-67
Superior to CT or MRI in distinguishing recurrent tumor from fibrosis in both hodgkins and non-hodgkins lymphoma
PET
Diagnostic for functioning neoplasms such as pheochromocytoma
PET radionuclide iodine-131
Diagnostic for pulsion diverticula
Barium swallow
Used for staging of esophageal carcinoma
CT scan
Provides a definitive diagnosis of mediastinal lipomatosis
CT scan
Provides superior accuracy in the nodal staging of lung CA
PET
Useful in characterizing pleural effusions in patients with lung cancer as malignant
PET
Used to detect metastases of bronchogenic carcinoma
Technetium 99, radionuclide bone scanning or whole-body FDG-PET
Methods used to distinguish adenomas from malignant (primary metastatic) adrenal lesions
CT scan, Chemical shift MRI, FDG-PET, FNAB
Best imaging modality to follow response of metastases to chemotherapy
CT scan
Modality used to distinguish Kaposi sarcoma from pneumonia and non-hodgkin’s lymphoma
Combined thallium and gallium lung scanning
Diagnosis of PCP in AIDS
Sputum samples or bronchoalveolar lavage fluid specimens with methanamine silver staining
Method of choice for the diagnosis of a mediastinal cyst
CT scan
Modality of choice for imaging a suspected neurofibroma
MRI
Diagnostic technique of choice for lateral thoracic meningoceles
MRI
Radiologic study of choice for the diagnosis of acute mediastinitis
MDCT
Modality of choice for the diagnosis of chronic sclerosing mediastinitis
CT scan
First-line diagnostic modality for the evaluation of suspected pulmonary embolism
MDCT
Traditional considered to be the gold standard in the diagnosis of pulmonary embolism
Pulmonary angiography
Procedure of choice for tissue sampling of a solitary pulmonary nodule
Transthoracic needle biopsy
Modality of choice for imaging tracheal neoplasms
CT scan
Modality of choice for evaluation of pulmonary metastases
Helical CT
Definitive diagnostic procedure as it demonstrates relationship of mass with pulmonary arterial vasculature
Contrast enhanced CT scan
Diagnostic imaging modality of choice for broncholithiasis
Thin section CT scan
Modality of choice in the evaluation of malignant mesothelioma and depicts the extent of pleural involvement and invasion of the chest wall and mediastinum
CT scan
Modality of choice in the evaluation of sternal wound infection
CT scan
Most common histologic type of thymic carcinoid
Carcinoid tumor
Most common primary mediastinal neoplasm in adults
Hodgkin or non hodgkin lymphoma
Most common subtype of non hodgkin lymphoma
Lymphoblastic lymphoma and diffuse large b-cell lymphoma
Most common benign mediastinal germ cell neoplasm
Teratoma
Most common type of teratoma seen in the mediastinum
Cystic or mature teratoma
Most common malignant germ cell neoplasm
Seminoma
Most common source of metastasis to middle mediastinal nodes
Bronchogenic carcinoma
Most common structure in the hiatal hernia
Stomach
Most common primary malignancies of thoracic spinal metastases
Bronchogenic, Breast or Renal cell carcinoma
Most common posterior mediastinal mass in patients with neurofibromatosis
Meningocele
Most common cause of chronic sclerosing fibrosing mediastinitis
Granulomatous infection usually secondary to histoplasma capsulatum
Most common affected structure in chronic sclerosing mediastinitis
Superior vena cava
Most common source of pneumomediastinum
Air from lungs
Most common causes of small hila
- Atelectasis
- Lung resection (portion)
- Pulmonary artery hypoplasia
Most common form of pulmonary edema
Hydrostatic pulmonary edema
Most common finding in pulmonary embolism without infarction
Peripheral airspace opacities and linear atelectasis
Most important parasitic infections of humans worldwide
Schistosomiasis
Most common organisms seen in HIV-infected patients
S. pneumoniae
S. aureus
H. influenzae
E. coli
P. aeruginosa
Most common cause of pulmonary arterial hypertension
Increase in resistance to pulmonary blood flow
Most common radiographic finding of lymphoma
Solitary pulmonary nodule or focal airspace opacity
Most common site of granular cell tumor
Skin
Most common type of lung cancer
Adenocarcinoma
Most common subtype of lung cancer in non-smokers
Adenocarcinoma
Most common cause of SVC syndrome
Lung cancer
Most common primary tracheal neoplasm
Squamous cell carcinoma
Most common location of the tracheal neoplasm
Distal trachea , within 3 to 4 cm of the tracheal carina
Most common type of thyroid malignancy to invade the trachea
Papillary and follicular carcinoma
Most common mediastinal malignancies to invade the lung
Esophageal CA
Lymphoma
Malignant Germ Cell Tumor
Any malignancy metastasizing to the mediastinal or hilar lymph nodes
Most common extrathoracic malignancies to produce lymphangitic carcinomatosis
Breast CA
Stomach
Pancreas
Prostate
Most common pattern of disease and pulmonary infection
Lobular or bronchopneumonia
Most common cause of multifocal patchy airspace opacities
Bronchopneumonia
Most common cause of atypical pneumonia
Mycoplasma pneumoniae
Most common organism (nontuberculous mycobacteria) responsible for pulmonary disease
Mycobacterium avium intracellulare or M.kansasii
Most common viral pneumonia in adults
Influenza
Most common lung manifestation of blastomycosis
Homogenous nonsegmental airspace opacification with propensity for upper lobes
Most common method of pleuropulmonary involvement of amoebiasis
Direct intrathoracic extension of infection from a hepatic abscess
Most common complication of pneumonia
Parapneumonic effusion
Most common cause of pneumonia in immunocompromised hosts
Bacteria
Most common AIDS defining opportunistic infection
PCP
Most common cause of irregularity of lung interfaces
UIP and Sarcoidosis
Most common diseases associated with architectural distortion
Sarcoidosis and UIP
Most common radiographic finding of rheumatoid lung disease
Interstitial pneumonitis and fibrosis
Most common pleural manifestation of rheumatoid disease
Pleuritis
Most common manifestation of sjogren syndrome
Interstitial fibrosis
Most common of the idiopathic interstitial pneumonia
Usual interstitial pneumonia
Most common presentation of opacities in sarcoidosis
Bilateral symmetric reticulonodular opacities
Most common cause of pleural thickening
Pneumonia
Most common benign manifestation of asbestos exposure
Pleural plaques
Most common location of pleural plaques in the parietal pleura
Over the diaphragm and lower posterolateral chest wall
Most common benign neoplasm of the chest wall
Lipoma
Most common non vascular cause of inferior rib notching
Multiple intercostal neurofibromas in neurofibromatosis type 1
Most common site of the bony thorax involved by monostatic fibrous dysplasia
Ribs
Most common benign neoplasm of the ribs in adults
Osteochondroma
Most common primary rib neoplasm
Chondrosarcoma
Most common type of diaphragmatic hernia
Esophageal hiatal hernia
Most common subtype of congenital cystic adenomatoid malformation
Composed of one or several large cysts lined by respiratory epithelium with scattered mucous glands, smooth muscle, and elastic tissue in their walls
Most common cause of extrinsic mass effect in focal tracheal disease
Tortuous or dilated aortic arch or bronchiole cephalic artery
Most common type of emphysema
Centrilobular emphysema
Most common etiologic factor of emphysema
Cigarette smoking
Most common radiographic finding of constrictive bronchiolitis
Diffuse reticulonodular opacities with associated hyperinflation
Most common condition to produce a transitive pleural effusion
Congestive heart failure
Most common cause of parapneumonic effusion and emphysema
Staphylococcus aureus and gram-negative pneumonia
Most common side affected by pleural effusion in esophageal perforation
Left side
Most common intrathoracic manifestation of Rheumatoid Arthritis and is most frequently seen in male patients following the onset of joint disease
Pleural effusion
Most common cause of pneumothorax
Trauma
Most common subtype of malignant mesothelioma
Epithelial
Most common cause of chest wall abscesses
Staphylococcus aureus and mycobacterium tuberculosis
Most common malignant soft tissue neoplasms of the chest wall in adults
Fibrosarcomas and liposarcomas
Most common congenital anomalies of the ribs
Bony fusion and bifid ribs
Most common cause of bilateral inferior rib notching
Coarctation of the aorta distal to the origin of the left subclavian artery
Most common metastatic lesions to the ribs
Bronchogenic and breast carcinoma
Most common type of rib metastases in breast and prostate carcinoma
Sclerotic rib metastases
Most common primary malignancy associated with metastasis to the scapula
Bronchogenic and breast carcinoma
Most common site in the lung that is involved with bronchial atresia
Apicoposterior segment of the left upper lobe
Most common pulmonary symptoms of arteriovenous malformations (AVMs)
Hemoptysis and dyspnea
Most common cause of right heart failure
Left heart failure
Most commonly involved ribs in rib notching
3rd to 8th ribs
Most common location of ventricular aneurysms (What chamber is asked)
Left ventricle, posteroinferior aspect
Most common cause of dilated cardiomyopathy
Ischemic cardiomyopathy
Most common form of cardiomyopathies
Dilated cardiomyopathy
Least frequent form of cardiomyopathy
Restrictive cardiomyopathy
Most common cause of pulmonary venous hypertension
Elevation of the left atrial pressure secondary to left ventricular failure
Most common cause of mitral regurgitation
Mitral valve prolapse
Most common bacterial etiology of bacterial endocarditis BEFORE
Streptococcus viridans
Most common bacterial etiology of bacterial endocarditis now
Staphylococcus aureus
Most common fungal agent followed by aspergillus
Candida albicans
Most common location of cardiac thrombi
Left atrium and left ventricle
Most common location of atrial thrombi
Left atrium, Posterior wall
Most common benign type of cardiac tumor
Atrial myxoma
Second most common benign cardiac tumor
Lipoma
Most common malignant cardiac tumor
Metastatic tumors
Most common primary malignant cardiac tumor
Angiosarcoma
Most common primary neoplasms to metastasize to the heart
“B.L.ack LYfes M.atter” (BLLM)
B-reast
L-ung
LY-mphoma
M-elanoma
Most common abnormality of the pericardium
Pericardial effusion
Most common cause of constrictive pericardial disease
Post-pericardiotomy
Most common location of pericardial cysts
Anterior Cardiophrenic angles, right more common than left
Useful for diagnosing coronary ischemia and myocardial infarcts
Perfusion scans with thallium or new technetium agents
“Cold spot” imaging : Rest perfusion agents
“Hot spot” imaging : technetium pyrophosphate
Myocardial infarction scanning
Used for diagnosing and sizing myocardial infarction
Antimyosin antibody scans
Used to examine wall motion and allow left ventricular ejection fraction calculations
ECG-gated myocardial blood pool studies
Evaluation and quantification of right-to-left cardiac shunts
Technetium macroaggregated albumin or microspheres
Adds wall motion evaluation, ventricular volumes and ejection fraction
ECG-gated SPECT
Assess cardiac metabolism as well as perfusion , enhancing its ability to evaluate cardiomyopathies , ischemic , infarction , and “hibernating” or viable myocardium
PET
Uses a nasogastric tube with a steerable beam that views the heart and aorta from close posterior position provided by the esophagus
Transesophageal echocardiography
Produces a time motion study of cardiac structures
Returning echoes
Anterior structures are displayed at the top of the images; techniques in motion of the myocardium can be evaluated throughout the cardiac cycle
Transthoracic technique
Produced by a narrow ultrasonic beam that is directed at cardiac structures and observed over time or is swept across an area of anatomy
M-mode echocardiograms
Useful in evaluating aortic aneurysms, aortic dissections, injuries, vascular anomalies, central pulmonary emboli, into cardiac muscles, thrombi, pericardial thickening, fluid collections, and pericardial calcifications.
Cardiac MDCT
Provide functional information including wall motion analysis , systolic wall thickening , chamber volumes , stroke volumes , and right and left ventricular ejection fractions , and valvular evaluation
Cardiac MR
Allow prior assessment of resting wall motion abnormalities that are consistent with either profoundly ischemic , stunned, hibernating , or infarcted myocardium
Stress echocardiography
Evaluate the percent of stenosis , number of vessels involved , focal vs diffuse disease , coronary anatomy , ectasia or aneurysm , coronary calcification , and collateral flow
Coronary angiograms and CT coronary angiograms
Useful in detecting some of the long-term complications of ischemic disease including ventricular aneurysm , thinning of myocardium , akinesia , or dyskinesia
Echocardiography
Capable of establishing the patency of CABG
CT coronary angiography
Most accurate at detecting pseudoaneurysms
MRI
Used to identify cardiac masses
CT, Angiography, and Nuclear scintigraphy
Initial mode for evaluation of cardiac masses
Echocardiography
Used to differentiate tumor versus blood clot
MRI using gradient echo techniques
Useful in determining the morphology of cardiac masses
MRI Gradient echo
Excellent for detecting intracardiac tumors and evaluating direct intracardiac extension or pericardial involvement
MRI
Useful in detecting loculated precardial effusions
CT scan
Best imaging modality used to characterize pericardial fluid
MRI
Boot-shaped heart appreciated in the plain chest x-ray PA view
Tetralogy of fallot
Box shaped heart
Ebstein’s anomaly
Cardiac pathology with snowman configuration or snow man sign on CXR PA view
Total anomalous pulmonary venous return type 1 (TAPVR 1)
Egg on its side or apple on a stem configuration on CHEST XRAY PA view
Transposition of the great arteries (TGA)
“Figure of 3” sign on chest x-ray and “reverse figure 3” on barium esophagogram
Juxtaductal coarctation of the aorta
Diverticulum of Kommerel
Aberrant left subclavian artery (ALSA)
“KOMMER (Come here), ALSA (random name of a girl)”
Double density sign on the right side of cardiac silhouette is a sign of what chamber enlargement?
Left Atrium, Left Atrial enlargement
“doubLAE density” sign
Tetralogy of fallot exhibits increased or decreased pulmonary vascularity?
Decreased pulmonary vascularity
A.k.a the Vascular sling. Arises from right PA (posterior aspect) to reach the left lung and crosses mediastinum. A variant of this anomaly is “Ring-Sling” complex - stenosis of right bronchus and hypoplasia of the right lung, “Bridging bronchus”
“ALPA males use SLINGS with RINGS to cross BRIDGES in the BRONX for MEDIA coverage”
Aberrant left pulmonary artery (ALPA)
SLING = Vascular SLING
RING = RING-SLING complex
BRIDGE-ing BRONX-us
MEDIA-stinum
“Atrial escape” and “Walking man sign” pertain to enlargement of what structure?
Left atrium
“The Walking Man Left the Atrium to Escape”
Walking man sign, Left Atrium, Atrial escape
“Hoffman-Riggler sign” pertains to enlargement of what structure?
Left ventricle
Enlargement of the pulmonary outflow tract is an indirect sign of the enlargement of which cardiac chamber?
Right ventricle
Most common cardiac tumor in the neonate and young infant
Rhabdomyoma
Most common cause of pulmonary venous hypertension
Left ventricular failure
Given a radiograph with a small cardiac silhouette and decreased pulmonary blood flow, which should you consider first before anything else?
Hypovolemia, first before congenital causes
What is the most common intracardiac mass?
Thrombi
Type of pulmonary stenosis commonly seen in Tetralogy of Fallot
Infundibular or subvalvular pulmonic stenosis
This pericardial abnormality predisposes to strangulation of cardiac structures (mechanical impairment of cardiac function) and possibility of sudden death
Partial absence / agenesis of pericardium
Atrial septal defect will demonstrate increased or decreased pulmonary vascularity?
Increased pulmonary vascularity
Most common cause of cyanotic congenital heart disease beyond the first 30 days of life
Tetralogy of Fallot
This cardiac anomaly exhibits a functional left-to-right shunt and an obligatory right-to-left shunt
Total anomalous pulmonary venous return type 1 (TAPVR 1)
Most commonly associated with a right-sided aorta in 30 to 35% of cases
Persistent Truncus Arteriosus
Most common cause of congestive heart failure in the first day or two of life
Hypoplastic left heart syndrome
Aneurysm of the ductus arteriosus will produce an unusually large bulge in what location of the mediastinum on plain chest x-ray films
Left upper mediastinum
The most common vascular anomaly
Aberrant right subclavian artery (ARSA)
“most common sARSA is Mang Tomas”
Most cases of Valvular pulmonary stenosis will show increased, decreased or normal pulmonary vascularity?
Normal vascularity
The most important or critical component of tetralogy of Fallot
Pulmonary stenosis
Periaortic hematoma is a direct or indirect sign of aortic injury?
Indirect sign
Direct signs:
- Abnormal contour of aorta
- Change in caliber of aorta
- Contrast extravasation
Double barrel aorta is seen in
Aortic dissection (Intimal flap, 2 lumens)
Most common primary pericardial tumor
Mesothelioma
Most common etiology for renal artery occlusive disease
Atherosclerosis
Anomalous left common carotid artery wall produce anterior or posterior tracheal compression?
Anterior tracheal compression
Most common cause of descending thoracic aortic aneurysm
Atherosclerosis
Causes of ascending thoracic aortic aneurysm
- Marfan
- Syphilitic
- Cystic medial necrosis
Most common cause of right heart failure
Left heart failure
A “Wall to wall” heart is associated with which valvular pathology
Tricuspid regurgitation
The earliest radiographic sign of congestive heart failure
Cephalization of pulmonary blood flow
Known as the “malignant” coronary anomaly
Interarterial
From the base of the aorta and pulmonary artery, prone to constriction and sudden cardiac death
Cardiac chamber most commonly involved in idiopathic cardiomyopathy
Left ventricle
“Swinging heart” is seen and what of normality
Pericardial effusion (A very large one, >500 mL)
A 50% reduction in the diameter of a coronary artery corresponds to how much reduction in its cross-sectional area
75%
Required minimum amount of fluid in the pericardial sac to be detected by plain film radiography
200 mL
Most important predisposing factor for aortic dissection
Atherosclerosis
Congenital subclavian steal syndrome is seen in which vascular anomaly
Isolated left subclavian artery
I’L S-teal = I-solated L-eft S-ubclavian Steal syndrome
Most common cause of dilated cardiomyopathy
Ischemia
Non-ischemic causes include:
- Alcoholism
- Diabetes
- Hypertension
Most common cause of renovascular hypertension in patients younger than 40 years old
Fibromuscular disease
Most common cause of renovascular hypertension in adults
Atherosclerosis
Most important indication for coronary ct angiography
To exclude presence of significant coronary artery disease
Majority of thoracic aneurysms involve which segment of the aorta
Ascending aorta
Among the types of total anomalous pulmonary venous return, which is most commonly associated with pulmonary venous hypertension and edema
Type III (3), Infracardiac/Infradiaphragmatic
Type of pulmonary stenosis that will demonstrate post-stenotic dilatation of the pulmonary artery
Valvular
Primary malignancy which has the highest frequency of metastases to the heart
Melanoma
The usual initial chest x-ray finding of a patient with a first episode of acute myocardial infarction
Normal in 50% of cases
This vascular anomaly produces a characteristic indentation of the posterior aspect of the trachea just above the carina and a corresponding indentation of the anterior wall of the barium filled esophagus
Aberrant left pulmonary artery (ALPA)
Transient hypertrophy of the interventricular septum in the subaortic region of the left ventricle occurs in
Diabetic cardiomyopathy of the neonate
This will demonstrate an almost globular enlargement of the cardiac silhouette with almost equal bulging to the right and left of the spine
Pericardial effusion
Most common cause of asymmetric pulmonary edema
Gravitational
In what vascular anomaly is a “Reverse S-shaped” indentation on the esophagus demonstrated in the barium esophagogram
Double aortic arch
Most common course abnormality of the coronary arteries
Myocardial bridging
Most common location of a TRUE left ventricular aneurysm as a complication of acute myocardial infarction
Anterolateral wall
“anTRUElateral wall” True aneurysm
P-osterior wall = P-seudoaneurysm, Retro in location
Threshold of an abnormally thickened pericardium
Greater than or equal to 4 mm
Angiographic hallmark of Buerger disease
Corkscrew appearance of arteries and absence of atherosclerosis findings often at wrists and ankles
DIABETIC = Vascular calcifications involving arteries of all sizes
ATHEROSCLEROSIS = multifocal diffuse luminal irregularities
GIANT CELL ARTERITIS = smooth and long-segment narrowing of axillary and/or brachial arteries
POLYARTERITIS NODOSA = microaneurysms
Most common primary malignant cardiac tumor in children
Rhabdomyosarcoma
Aortic valve stenosis with pressure gradient across the aortic valve greater than 25 mmHg
Mild stenosis
Aortic valve stenosis with pressure gradient across the aortic valve greater than 40-50 mmHg. Mild, moderate, or severe?
Moderate stenosis
Aortic valve stenosis with pressure gradient across the aortic valve greater than 80 mmHg
Severe stenosis
Mitral stenosis with orifice less than 1.5 cm squared
Mild mitral stenosis
Mitral stenosis with orifice less than 1.0 cm squared
Moderate mitral stenosis
Mitral stenosis with orifice less than 0.5 cm squared. Mild, moderate, or severe?
Severe mitral stenosis
Mean pulmonary artery pressure exceeding more than 35 mmHg
Pulmonary arterial hypertension
Chamber enlargement best confirmed by measuring the distance from the mid inferior border of the left main stem bronchus to the right lateral border of the left atrial density. Greater than 7 cm indicates enlargement of this chamber
Left atrial enlargement
Chamber enlargement described as a prominent bulge too far to the right of the spine more than 5.5 cm from midline. There is also elongation of this right chamber convexity to exceed 50% of the mediastinal cardiovascular shadow.
Right atrial enlargement
Cardiac chamber enlargement with the apex pointing downward on PA view
Left ventricular enlargement
This sign is exhibited when the left ventricle extends more than 1.8 cm posterior to the posterior border of the IVC, 2cm cephalad to the intersection of the left ventricle and IVC.
Hoffman-Rigler sign in Left ventricular enlargement
Chamber enlargement described as climbing more than one-third of the sternal length and fill too much of the retrosternal space.
Right ventricular enlargement
“Viking helmet sign” (cardio)
Hilar fullness in Pulmonary venous hypertension
“bat wing” or “butterfly” or “angel wing” configuration of opacities is seen in what
Alveolar edema
Failure of the structure and function of the right ventricle in the absence of left ventricular dysfunction. May occur as right heart failure resulting from a pulmonary disease.
Cor pulmonale
Measurement of pericardial fat stripe indicative of pericardial thickening or effusion
Percardial stripe >2 to 3 mm
Radiolucency surrounding the heart and separated from the lung by a thin white line of pericardium.
Pneumopericardium
Indicates that the heart is in the right hemithorax. Apex of the heart lies to the right, with the long axis of the heart directed from left to right
Dextrocardia
This syndrome is a combination of situs inversus with dextrocardia, bronchiectasis, and sinusitis.
“KART IN D.B.S.oria”
Kartagener syndrome
KART-agener syndrome
IN - versus (Situs)
D-extrocardia
B-ronchiectasis
S-inusitis
Heart is shifted toward the right hemithorax. Associated with hypoplastic right lung and increased incidence of congenital heart disease, particularly left to right shunts.
Dextroposition
Means cardiac apex is to the right but stomach and aortic knob remain on the left. The LV remains on the left but lies anterior to the RV.
Dextroversion
Most common cause of sternal fractures
Usually from MVA, 50% with cardiac contusion
Hyperpigmentation of sternum is associated with…
“D.E.C (Dao Eng Chai)”
D = Dao = Down syndrome (90% of patients)
E = Eng = Engdo = Endocardial cushion defect
C = Complete AV canal
Wavy restrosternal linear opacities are due to and associated with what vascular abnormality?
- Dilated internal mammy arteries associated with Coarctation of the aorta
Pectus excavatum is associated and with increased incidence of…
- Mitral valve prolapse (MVP)
- Marfan syndrome
Barrel shaped chest with pectus carinatum is associated with…
- VSD = ‘V’arrel shaped chest
- Complete AV canal
Scoliosis with “Shield chest” can be seen in…
“M.A.C.Adi”
“M.A.C.Adi.mia”
M = Marfan syndrome
A = Aortic valve disease
C = Coarctation of the aorta
Adi = Aortic Dissection
11 or fewer ribs is associated with…
- Down syndrome
- AV canal
“Ribbon ribs” or bifurcated ribs and overcirculation pattern suggests…
- Truncus arteriosus
Rib notching and inferior rib sclerosis occurs with…
- Coarctation of the aorta
- Blalock-Tausigg procedure
In perfusion scanning with thallium, areas that show hypoperfusion on stress images while filling in on rest images are indicative of…
Ischemia
“cold spot” imaging uses what agents
Rest perfusion agents
“hot spot” imaging uses what agent
Technetium pyrophosphate
Paradoxical septal motion of the interventricular septum on echocardiography may be seen in
- Pericardial effusion
- Cardiac tamponade
- ASD
- Pulmonary hypertension
- Left bundle branch block
- Septal ischemia
- Asthma
Dilatation of the aortic root in echocardiography may be seen in
- Aortic stenosis
- Aortic insufficiency
- Aortic aneurysm
- TOF
Delayed closure of the anterior leaflet of the mitral valve on echocardiography may be suggestive of
MS
High frequency vibration of the anterior leaflet of the mitral valve on echocardiography is known as what phenomenon and is associated with what valvular problem?
Austin Flint phenomenon, AR
E-F slope of the mitral valve that appears flattened and more squared off than the normal M-shape is suggestive of
Mitral stenosis
E-F slope of Tricuspid valve that is DECREASED may be seen in
Tricuspid stenosis
Echocardiography:
E-F slope of Tricuspid valve that is INCREASED may be seen in…
“T.A.E”
T = Tricuspid regurgitation
A = ASD
E = Ebstein anomaly
What percent reduction of cross-sectional area is required to cause a significant reduction in blood flow?
75%
In general, this percentage of cross-sectional narrowing is considered clinically significant and will demonstrate decreased perfusion on stress myocardial perfusion imaging
> 50%
Collateral flow develops when there is this percentage of coronary stenosis
> 85%
Coronary pathology most often seen in the right coronary artery (RCA) as a smooth transient narrowing. 1-2 mm distal to the catheter tip. Patients remain asymptomatic.
Catheter-induced spasm
Angina secondary to prolonged coronary spasm. IV ergonovine may be used in a provocative tests to incite this coronary pathology. It is usually treated medically.
Prinzmetal variant angina
An inflammatory condition of the coronary arteries. Small to medium vessel vasculitis, predominantly in children. Predilection for coronary arteries. Present with fever, congestion of conjunctiva, reddening of lips and oral mucosa, strawberry tongue and swelling of cervical lymph nodes.
Kawasaki disease
“Kawasaki bikes, whether small to medium sized, are close to my heart”
Kawasaki disease, small to medium sized vessels, predilection for coronary arteries (close to my heart)
Normal variant which the coronary arteries penetrate and then emerge from the myocardium rather than running along the surface of the epicardium. Causes arterial constriction during systole which refers to normal flow during diastole.
Myocardial bridging
Coronary artery bypass grafting uses what
Saphenous vein grafts or native internal mammary arteries
This remains a significant problem of stent placement in up to 50% of cases to be occurring within the first six months.
Restenosis
With angioplasty, by balloon dilatation of the stenotic lesion, is considered successful when stenosis is reduced to less than what percentage of diameter narrowing
Less than 50%, <50%
Coronary angiography wall motion:
Diminished contractility or less systolic motion than normal
Hypokinesia
Coronary angiography wall motion:
No systolic wall motion
Akinesia
Coronary angiography wall motion:
Paradoxical wall motion during systole
Dyskinesia
Coronary angiography wall motion:
Delayed contractility
Tardikinesia
Coronary angiography wall motion:
Cardiac motion that is out of phase with the remainder of the myocardium
Asynchrony
Ventricular aneurysms that are lined by thinned and scarred myocardium. Broad mouthed, localized outpouching that do not contract during systole. Typically located near the apex or anterolateral wall.
True ventricular aneurysm
Ventricular aneurysms that are focal contained ruptures. Often larger but have narrower ostia / narrow mouthed. Most commonly located at the posterior and anterior aspect of the left ventricle
Pseudoaneurysms
Pseudoaneurysms of ventricle = Posteroanterior
True ventricular aneurysms = anTRUElateral
True or false:
Intramural thrombi may be seen in 50% of ventricular aneurysms
True
Cardiac artery calcium screening - Agatson score of 0-10
Very low to low risk
Cardiac artery calcium screening - Agatson score of 11 to 100
Moderate risk
Cardiac artery calcium screening - Agatson score of >400
High risk
Now known to be the leading cause of myocardial infarction
Vulnerable plaque development, sudden rupture, and thrombosis
Indications for coronary angiography include:
“Pilot w/ Abnormal Stress during Unstable flight”
- Angina refractory to medical therapy (Unstable angina)
- High-risk occupations (Pilot)
- Abnormal ECG or stress perfusion tests
True or false:
Use of Internal mammary artery has better long-term results than saphenous vein grafts, and correlated with increased survival.
True
What condition presents with systolic pressure <90 mmHg and typically associated with acute pulmonary edema
Cardiogenic shock
Common especially after inferior wall infarcts, from either ischemia or injury to the AV nodal branch of the RCA
AV block
This complication of myocardial infarction occurs 3 to 14 days after infarction with a high mortality rate approaching 100%. Chest radiograph shows acute cardiac enlargement secondary to leakage of blood into pericardium with acute pulmonary vascular engorgement and right sided cardiac enlargement because of left to right shunt. Pulmonary edema is NOT TYPICAL.
Myocardial rupture
Inferior infarcts are associated with which location of papillary rupture?
Posteromedial papillary rupture
Anterior infarcts are associated with which location of papillary rupture?
Anterolateral papillary rupture
This complication of myocardial infarction is suggested by an abrupt onset of mitral regurgitation with acute pulmonary edema on the radiograph. The left ventricle is only minimally enlarged whereas the left atrium is enlarged quickly.
Papillary muscle rupture
NOTE: Myocardial infarction is PRONE to RUPTURE. If presented with a case of infarct and sudden changes in radiograph such as pulmonary edema or enlargement of ventricles, think RUPTURE.
A.k.a post-myocardial infarction syndrome. Similar to postpericardiotomy syndrome, complicating cardiac surgery. Considered an autoimmune reaction. Responds well with anti-inflammatory medications
Dressler syndrome
Dressler syndrome will present with:
- Fever
- Chest pain
- Pericardial effusion & pericarditis
- Pleural effusion & pleuritis
True or false:
On “cold spot” imaging, acute infarction can be distinguished from remote infarction.
False. It cannot be distinguised from each other.
Myocardium that may act like postinfarction scar but remains viable and may improve in function with revascularisation
Hibernating myocardium
Myocardium that describes post-ischemic, dysfunctional myocardium without complete necrosis which is potentially salvageable
Stunned myocardium
Dilated cardiomyopathy can also be caused by acute myocarditis, most commonly with the etiologic agent
Coxsackie virus
Cardiomyopathy with global cardiomegaly seen on chest radiograph
Dilated cardiomyopathy
Cardiomyopathy with normal sized heart and pulmonary congestion seen on chest radiograph
Restrictive cardiomyopathy
Cardiomyopathy with chest xrays that are normal in 50% and presents with LAE in 30% of cases (because of mitral regurgitation)
Hypertrophic cardiomyopathy
Now described as an acquired disorder in infants or adults and is called Arrhythmogenic right ventricular dysplasia (ARVD). Limited to the RV with dilatation of the RV chamber, marked thinning of the ventricular wall and abnormal RV wall motion. MRI may show fatty infiltration of anterior RV free wall (essentially diagnostic)
Uhl anomaly
Right ventricular failure secondary to pulmonary parenchymal or pulmonary arterial disease. End result is alveolar hypoxia. Chest x-ray will show normal sized heart or mild cardiomegaly or even a small heart. Symptoms include marked dyspnea and decrease exercise endurance out of proportion to pulmonary function tests.
Cor pulmonale
This should be considered whenever the main pulmonary artery and left and right pulmonary arteries are enlarged. Signs of right atrial and ventricular enlargement or hypertrophy or often present. Systolic right ventricular and pulmonary arterial pressures >30 mmHg
Pulmonary arterial hypertension
Acyanotic lesions include
ASD, VSD, PDA, and PAPVR
Clue to Acyanotic lesions:
Most have the letter ‘D’ in their name excluding PAPVR. A good mnemonic is “Dont ‘cyanose (Acyanotic) = asD, vsD, pDa”
Cyanotic lesions include
TGA, TA (Truncus arteriosus), TAPVR, and Endocardial cushion defects
Clue to Cyanotic lesions:
Most have the letter ‘T’ in their name excluding endocardial cushion defect.
Tga, Ta, Tapvr.
Small heart with decreased pulmonary blood flow may be caused by:
- Hypovolemia
- Malnourishment
- COPD
- Addison
Decreased pulmonary blood flow with an enlarged cardiac silhouette include:
- Cardiomyopathy
- Pericardial tamponade
- Ebstein
- Right to left shunts
This valvular heart disease is usually caused by rheumatic heart disease in the adult with 50% of patients giving a history of rheumatic heart fever
Mitral stenosis
The syndrome is a combination of mitral stenosis with a pre-existing atrial septal defect resulting in marked right-sided enlargement.
“Ms. SAD Lutembacher has Marked right sided enlargement”
Lutembacher syndrome
“MS. SAD Lutembacher (some random european-like surname) has Marked right sided enlargement”
- Mitral stenosis
- ASD
- Lutembacher syndrome
- Marked right sided enlargement
Classification of mitral stenosis with <1.5 cm2 area, Normal CXR, Left atrial pressures elevated only on exercise
Mild mitral stenosis
Classification of mitral stenosis with <1.0 cm2 area, LAE, Pulmonary venous hypertension, Dyspnea ON EXERTION is common
Moderate mitral stenosis
Classification of mitral stenosis with <0.5 cm2 area, marked left atrial enlargement, right ventricular enlargement, Kerly lines, Pulmonary edema and patients are often DYSPNEIC AT REST.
Severe mitral stenosis
Mitral regurgitation with normal xray. Classified as mild, moderate, or severe?
Mild Mitral regurgitation
Mitral regurgitation on radiography showing atrial enlargement and pulmonary venous hypertension
Moderate mitral regurgitation
Mitral regurgitation classification (mild, moderate, severe) on radiography showing progressive left atrial enlargement, left ventricular enlargement, pulmonary venous hypertension, and pulmonary edema.
Severe mitral regurgitation
Mitral regurgitation on MRI - Regurgitant jet grading
Turbulent flow extending less than 1/3 the distance to the back wall. What is the grade?
Grade 1
Mitral regurgitation on MRI - Regurgitant jet grading
Turbulent flow extending less than 2/3 the distance to the back wall. What is the grade?
Grade 2
Mitral regurgitation on MRI - Regurgitant jet grading
Turbulent flow extending more than 2/3 the distance to the back wall. What is the grade?
Grade 3
A.k.a “Floppy valve” or Barlow syndrome. Autosomal dominant. More common with pectus excavatum and narrow AP diameters of the chest. “Honking type” murmur or midsystolic click murmur is characteristic. On echocardiogram, characteristic BULGING LEAFLETS (anterior or posterior) during midsystole when valve should remain closed.
Mitral valve prolapse
“Barlow’s Floppy, Honking, Bulging Prolapse”
Most common type of adult aortic valve stenosis, present in 95% of congenital aortic stenosis
Bicuspid aortic valve
Most common valvular heart disease
Aortic stenosis
Most common cause of aortic stenosis
Degeneration of the aortic valve / Degenerative calcification of the aortic valve
Aortic stenosis with orifice of 13-14 mm and greater than 25 mmHg gradient (Mild, Moderate, Severe?)
Mild aortic stenosis
Aortic stenosis with orifice of 8-12 mm and greater than 40-50 mmHg gradient
Moderate aortic stenosis
Aortic stenosis with orifice of <8 mm and >100 mmHg gradient (mild, moderate, severe?)
Severe aortic stenosis
Most common bacterial agent in bacterial endocarditis
Staphylococcus aureus
Radiographic sign for chronic pericardial effusions
Water bottle sign/configuration
Minimum amount of fluid for small pericardial effusion and imaging findings on radiographs
<100 mL, appear as anterior and posterior sonolucent region
Moderate pericardial effusion
100-500 mL, sonolucent zone around the entire ventricle
Very large effusion
> 500 mL, extend beyond the field of view and may be associated with “swinging heart” inside the pericardium
Serous pericardial fluid on MRI
T1 Dark, Gradient echo Bright
Complicated or hemorrhagic effusions on MRI
T1 Bright, Gradient echo Dark
Refers to cardiac chamber compression by pericardial effusion under tension, compromising diastolic filling. Clinical exam shows distended jugular veins, distant heart sounds, pericardial rub. Chest radiograph shows rapid enlargement of cardiac silhouette with relatively normal vascularity. (+) pulsus paradoxus
Cardiac tamponade
Pulsus paradoxus is an exaggeration of the usual drop in systolic pressure greater than 10 mmhg during inspiration. It occurs as a paradoxical motion during right ventricular filling.
This condition is associated with a widely swinging cardiac silhouette on decubitus view.
Congenital absence of the pericardium
Pericardial disease that is associated with the heart shifted towards the left with a prominent bulge of the right ventricular outflow tract, main pulmonary artery, and left atrial appendage. Insinuation of the lung into antero-posterior window and beneath is characteristic
Complete absence of the pericardium
Associated conditions with congenital absence of the pericardium:
“VSD is Sequestering DiapHers during Brunch”
VSD = Ventricular septal defect
Sequestering = Sequestration
Diaphers = DIAP-hragmatic HER-nias
Brunch = Brunchogenic cysts (Bronchogenic cysts)
Type of cardiomyopathy
Ventricular wall - LV thin
Ventricular cavity - LV dilated
Contractility - Decreased
Compliance - Normal to decreased
Dilated cardiomyopathy
Type of cardiomyopathy
Ventricular wall - LV thick
Ventricular cavity - LV normal to decreased
Contractility - Increased
Compliance - Decreased
Hypertrophic cardiomyopathy
Type of cardiomyopathy
Ventricular wall - Normal
Ventricular cavity - Normal
Contractility - Normal to decreased
Compliance - Severely decreased
Restrictive cardiomyopathy
Type of cardiomyopathy
Ventricular wall - RV thin
Ventricular cavity - RV dilated
Contractility - Decreased
Compliance - Normal to decreased
Uhl anomaly (Limited to Right ventricle)
Which ventricle dilatation causes a clockwise rotation of the heart
Right ventricle
Clockwise direction is RIGHTward therefore, RIGHT ventricular dilatation.
Which ventricle dilatation causes a counterclockwise rotation of the heart
Left ventricle
Counter-clockwise is LEFT therefore LEFT ventricular dilatation
Chamber enlargement producing a “droopy” or “saggy” appearance of the cardiac silhouette
Left ventricle
Droopy or sagging is like downward displacement
