Questions Flashcards
What pressures need proving in ARDs
partial pressure of arterial 02 / inspired 02 to be <200mmhg with no evidence of heart failure
what can ARDS mimic without knowing the PA 02 / Fi02 level
heart failure pulmonary oedema
PIOPED II study was for what condition?
PE
Low probability and negative PE do what
No need for anticoag or anything else
High probability and negatvie CTPA do what?
MR angiography or venous ultrasound
how do you differentiate between RBILD and DIP
RBILD is nodular, in the centrilobular region with upper lobe GGO
DIP is lower lobe and peripheral, sometimes cystic within GGO
what are the complications of bronchial artery embolization?
Can knock off branches to spine, oesophagus and develop chest pain
also operative complications
most common malignant oesophageal malignancy
SSC
Aseptic lymphocyte-dominated vasculitis associated lesion (ALVAL) from what
metal on metal implant
McCune-Albright syndrome - this almost always only affects girls and consists of a triad of
cafe-au-lait spots, precocious puberty (or other endocrine pathology), and polyostotic fibrous dysplasia. The cafe-au-lait pigmentation is often on the back and can commonly be seen to respect the midline.
Juxta-articular osteoporosis, marginal erosions, gradual reduction of the joint space
Phemester triad
triad in TB
This disease is more similar to osteopoikilosis than the other bony dysplasias. It is inherited in an autosomal dominant fashion, but can arise sporadically too. It causes striking longitudinal striations in the metaphyseal regions of the long bones but patients are generally asymptomatic and it is usually therefore an incidental finding. The appearance is said to resemble stalks of celery.
Osteopathia striata
This benign condition leads to multiple small oval bone islands forming around the skeleton. Purportedly, once the epiphyses have fused the number remains static. They can show mildly increased uptake on a nuclear medicine bone scan. Whereas a bone island may exist in isolation or near isolation, the finding of multiple such lesions suggests the diagnosis of osteopoikilosis.
Osteopoikilosis
Cirrhosis – the presence of the excess iron in the liver leads to unusual signal properties on an MRI scan. Iron is paramagnetic and causes spin dephasing. T2* and T2 sequences are particularly vulnerable to this effect but lower than expected signal will be seen on all sequences. Importantly the signal from the spleen and bone marrow should be normal. By contrast they will be involved in cases of transfusional siderosis.
Generalised osteoporosis
Hook like osteophytes on the radial aspect of the metacarpal heads – these are highly characteristic
Chondrocalcinosis, particularly affecting the knees
Insulin dependent diabetes
Congestive cardiomyopathy
Skin pigmentation
Haemachromatosis
This is a non-comminuted fracture at the base of the thumb metacarpal, which requires operative fixation due to the action of Abductor Pollicis Longus causing dorsolateral dislocation.
Bennet
This describes a comminuted fracture through the proximal thumb metacarpal.
Rolando
Women over the age of 55 is the typical demographic for SIFK but it does also occur in men. It is the adult equivalent to osteochondritis dessicans of the knee. Typically the medial condyle is affected and often there is an associated meniscal tear. On x-ray the appearances are of medial femoral condyle flattening with or without a subchondral radiolucent area. On MRI bone marrow oedema can be seen (high signal on STIR sequences).
sonk - Subchondral insufficiency fractures of the knee
Enlargement of the paranasal sinuses – 75%
Posterior vertebral scalloping – 30%
Widening of the terminal tufts
Heel pad thickness >25mm
Premature osteoarthritis
Enlargement and erosion of the sella
Hyperostosis of the inner table of the skull
acromegaly
the name given to the symptoms caused by compression of the tectal plate. These are highly testable and the main feature is paralysis of vertical gaze.
Parinaud syndrome is
NF1 get what in brina
optic glioma
plexiform neurofibromaas
CNS hamartomas
NF1 for skeletal
sphenoid bone dysplasia
tibia bowing
posterior vertebrla scalloping
NF1 eyes and skin
Lisch nodule
Cafe au lait
xillary freckling
NF2 get what
central
schwannomas
meningiomas
ependymomas
a very nasty condition which develops a few weeks or months after a patient has received Gadolinium in patients with acute or chronic renal failure, in particular post liver or kidney transplant patients (NB. hepatorenal syndrome). No particular therapy for it has been found to be effective. Dyspnoea has been described in association with
Nephrogenic systemic fibrosis
the ossicles, lateral semicircular canal (Known by some as the Clint Eastwood sign) and lateral epitympanic wall (i.e. scutum) are often involved.
Cholesteatoma
Serpiginous flow voids over the surface of the cord are the main described feature on MRI.
dural AVFs
caused by either a vertebral artery occlusion or PICA occlusion.
Lateral Medullary Syndrome (Wallenburg syndrome)
The anterior choroidal artery arises from the
internal carotid artery
MRI blood over time
hyper acute - T1 iso T2 bright
acute - dark dark
easrly subacute - T1 bright, T2 dark
late subacute - bright bright
chronic - dark dark
Bilateral caudate lobe atrophy is which neurodegenerative disease
Huntingdons
High T2 and FLAIR in the thalami is what neurodegenerative disease?
Wenickes
Abnormal signal in the putamen and lateral thalami
which neuro degenerative diseease
Wilson disease
Medial caudate nuclei and putamina high t2 /FLAIR
what neuro degen condition
CJD
What happens in Keans - Saye syndrome
what are the MRI changes
basal ganglia changes
Leigh syndrome affects who and where in the brain are the MRI changes
kids
putamina
which part of the substntia nigra are involved in Parkinson
pars compacta
(thinned or blurred)
In Picks disease, precuneus is….
spared
Lewi Body dementia can spare the
Hippocampi
Brown-Sequard syndrome
damage to the dorsal columns leads to ipsilateral loss of touch sensation
contralateral loss of pain and temperature sensation due to damage to the lateral spinothalamic tracts (contralateral since these ascend after having crossed). There is also ipsilateral motor function loss.
lateral medullary syndrome is also called
wallenberg syndrome
what is lateral medullary syndrome caused by
cause by vertebral artery occlusion or PICA occlusion
Browns tumours are a feature of which systemic disease
hyperparathyroidism
in MS, involvement of which anatomical location is highly specific to MS
especially when differentiating to small vessel ischaemic changes
middle cerebellar peduncle
Thalamic involvement when querying MS might instead point to which condition?
ADEM
which form of CJD is the most common
sporadic
(85%)
familial is only 10%
Variant CJD will look like what on MRI
thalamuc will have high signal hockey stick sign
Autoimmune encephalitis can be a result of which phenomenon
where does it affect
limbic system
paraneoplastic syndrome
post viral thyroiditis is called what
De Quervains thyroiditis
anatomy of the eye regions can be split into…
Globe
Extra conal
Conal
intraconal
Pathology affecting the eye globe
retinoblastoma
melanoma
haemorrhage detachement
IgG4 endophthalmitis
Which eye conditions can affect all the eye compartment s
Sarcoidosis
Pseudotumour
Lymphoproliferative lesion
what are the eye conal pathologies
Rhabdomyosarcoma
Thyroid eye disease
Intraconal pathology
optic nerve
haematoma / angioma
glomus tympanicum can cause what symptom
tinnitus
most common posterior fossa tumour in kids
medullobnlastoma
Features of a spinal cord infarction vs subacute combined degeneration
which is a V shpape
subacute dorsal columss only
infarction will be whole column, often length down 2 vertebral bodies.
Acute infarction on DWI are
bright
with low ADC map values (restrict)
Cavernoma classicaly appearance is
popcorn
bright lobulated centre and rim of hypointensity.
Cerebral amyloid angiopath can give rise to
micro-haemorrhages at GW junciton
Causes of opaque maxillary antrum
Malignant - carcinoma / lymphoma
inflammatory - sinusitis, allergies, mucocele
other - FD, Cysts, Wegeners,
traumatic -
arachnoiditis
thickened nerve roots
why ?
Nerve roots adhere to the aspect of the space.
infection secondary to surgery / meningitis / subarachnoid haemorrhage.
Limbic system is made up of
Olfactory
parahippocampal gyrus
Hippocampus
cingulate gyrus
subcallosal gyrus
amygdala
septum pallucidem
hypothalamus
anterior thalamic nuclei
mamillary bodies
Anti - onconeuroantibody
Breast
Anti-amphiphysin
yo
ri
Anti - onconeuroantibody
Lung
hum ri, amphysisi, zic4
anna3
pca2
antivgkc
vgcc
nachr
Anti - onconeuroantibody
thymoma
GAD
CV2/CRMP5
VGKC
AChR
Anti - onconeuroantibody
Hodgkin lymphoma
Tr
mGluR1
Anti - onconeuroantibody
Colon
none
Legg Calve Perthese disease
age
best radiograph view
4- 12
frog leg
Duration of symtpoms for JIA
6 weeks
Infantile haemangioendothelioma
age
ax symptoms
features on image
<6month
heart failure
low platelets
vascular lesion
calc within
age for hepatoblastoma
6m - 3y
imaging appearance for hepatoblastoma
rim nehancement
HCC age in children
> 5
imaging appearance of HCC in kids
central scar that can calcify
which ovarian tumour produces oestrogen and pregesterone
Leydig Sertoli
Yolk sac tumour size
normally large at presentation
Granulose cell tumours produce oestrogen
what symptoms does this causes
irregular or post menopausal bleeding
tuberous sclerosis tria
epilepsy
facial angiofibroma
mental retardation
Neuroblastoma vs Wilms tumour
Peak age
Sign on kidney
midline crossing
calc
IVC
Neuro
- 2 years, drooping lily sign, crosses midline, calc is stippled, encases IVC
Wilms
- 3 - 4, claw sign, doesn’t cross midline, calc is less common /curvilinear, displaces ivc
ring enhacning lesions
mnemonic
Dr MAGIC
Demyelinating
radiation necrosis
mets
abscess
glioma
infarction
contusion
pyloric stenosis, most specific sign
string sign
narrow track of barium passing through a long pyloric canal
fibromatosisi coli is what
fibrous thickening of the SCm muscle, often after a difficult birth
no acutal mass
hirschsprung biospy which type
suction biopsy below transition point
(Pivot shift)
- High signal on STIR to the lateral femoral condyle and posterolateral tibial plateau with an associated tear of the anterior cruciate ligament tear
(Clip injury) - injury and MRI signal to which bones
- High T2 signal to the anterior aspect of the lateral femoral condyle and lateral tibial plateau with an anterior cruciate ligament and medial collateral ligament tear
Neuroendocrine tumour
Blueberry muffin syndrome
Metastatic cutaneous deposits
Opsomoclonus
neuroendocinre tumour
rapid jerky eye.
Neuroendocrine tumour
Hutchinson syndrome
limping due to bony metastases
wilms vs neuroblastoma
invade or encase IVC
wilms invades
Glomus tumours are what
benign vascular tumours which arise in patients in their 40s and 50s.
tender blue/red nodule under the finger nail.
what is a subungual exostosis
bone outgrowth.
adolescent
cortical and medullary continuity.
ring and arc calc
enchondroma
Acute idiopathic scrotal wall oedema syndrome
age
what is it
under 10
skin hypersensitivity but get unilateral scrotal wall swelling
risk factors for NEC
Prem
low birth weight
heart disease
jirschsprungs
perinatal asphyxia
The patient will be youngish, with a temporal lobe lesion (in fact approximately a third are frontal lobe lesions), a history of epilepsy (often refractory) and the lesion is described as bubbly – here given as multiple cysts. The lack of oedema or enhancement is also typical.
DNET
Auto Rec PKD ax to what
hepatic fibrosis
pancreatic fibrosis
caroli disease
portal hypertension
neonatal septic arthritis
bug
group D strep
sinus mucocele vs tumours
what sign
peripheral enhacnemetn typical for mucocele
renal masses by age
neonate
vs
pre-school
neonate - MDK, mesoblastic nephroma, nephroblastomatosis
pre-school
- Multilocular cystic (boys)
wilms
lymphomaea
heart disease is worse in which heterotaxy?
right sided - 80% die by 1 year
which heterotaxy is horsehoe ax with
Right sided
First branchial cleft cyst located
periparotid region
A third branchial cleft cyst is situated at
the base of the sternocleidomastoid muscle.
appearance of a cystic hygroma
multi loculated
found in the posterior triangle
what is a bochdalek hernia
hernia in diaphragm
morgani hernia
small diaphragm hernia at the front
contain mesenteric fat only
fibrous dysplasia in the skull
Fibrous dysplasia can affect the skull. It is usually described as having a ground glass appearance with cortical expansion and a swell-defined sclerotic margin.
timeframe for bronchopyulmonay dysplasia in neonate
28 days of being ventilated
cysts in communication with each other
MDK vs hydronephris
MDK they do not communicate so this would be hydronephrosis
Renal masses by age
Neonate:
Multicystic dysplastic kidney (second most common neonatal renal mass)
Mesoblastic nephroma (most common SOLID neonatal renal mass)
Nephroblastomatosis (can be a precursor to Wilms tumour)
Renal masses by age
Pre-school:
Multilocular cystic nephroma (affects boys, slightly younger than Wilms)
Wilms tumour (most common SOLID mass of childhood)
Lymphoma (can affect teenagers and adults as well)
An 18-month-old presents with abdominal enlargement and respiratory difficulty. The serum AFP is noted to be negative and endothelial growth factor is normal. A CT scan demonstrates a very large multicystic hepatic mass with no evidence of calcification. There is no evidence of any calcification or haemorrhage within the mass.
Mesenchymal hamartoma
wilson disease is inherited in what pattern?
autosomal recessive
what neuro symptoms do wilsons patients get
dysarthria
tremor
lentiform nucleus copper deposition
why is liver MRI normal in Wilsons
fatty depsoition is blaance dout by the paramagnetic effeects of copper
Musculoskeletal manifestations of wilsons
Generalised osteoporosis, subarticular cysts, chondrocalcinosis and arthropathy which can mimic CPPD
Kasabach-Merritt sequence
platelet trapping in haemangioendothelioma
prior to a HIDA scan for biliary atresia what can be given that speeds up biliary excretion
phenobarbitol
A 7-month-old boy with uncontrollable crying and vomiting is brought to A and E by his parents. He subsequently undergoes a CT which shows a hyperdense mass with intense homogeneous enhancement. The mass is sitting in the trigone of the left lateral ventricle. It is large but smooth with a lobulated border and no evidence of invasion. There are small foci of calcification. The lateral ventricle is dilated. On MRI there is isointensity on T1 and hyperintensity on T2 relative to the white matter, with punctate foci of T2 hypointensity.
Choroid plexus papilloma
in children predominate in the 4th ventricle, show T1 hypointensity with foci of high T2 signal.
Ependyomoma
Galeazzi fracture
Dislocation at the distal radio-ulnar joint in association with a radial fracture
kissing ovaries sign
from endometriosis
On an MRI scan a T2 low signal plaque may be seen between/around them.
appearance of a chondroblastoma
long bones
lucent, lobulated lesion, thin sclerotic margin,
Ovarian germ cell tumours include
teratomas, yolk sac tumours, choriocarcinomas and mixed germ cell tumour
embryonal carcinoma and dysgerminomas
ovary mass
elevation of AFP levels although this would be more classically associated with a
yolk sac tumour
difference between dermoid and teratoma
a dermoid is composed only of dermal and epidermal elements (which are both ectodermal in origin), whereas teratomas also comprise mesodermal and endodermal elements.
what are the nenatal cardiac duct dependant lesions
Duct dependent lesions:
Hypoplastic left heart syndrome
Severe coarctation
Interrupted arch
Pulmonary atresia
Severe Ebsteins anomaly
TGA (if no VSD)
age for wilms / nephrobalstoma
preschool 4
Neuroblastoma secretes what
chatacholamines or VIP
which neuroblastoma stage does best
IV
Mutilocular cystic nephroma has what appearance
mass of cysts
thick fibrous capsule
Mesoblastic nephroma affects what age and appears
neonate
solid
Predisposing syndromes for Wilms
Beckwith-Wiedemann syndrome - macroglossia, hemihypertrophy, visceromegaly, omphalocoele
DRASH syndrome - progressive glomerulonephritis and male pseudohermaphroditism
WAGR syndrome - Wilms tumour, aniridia, GU abnormalities, mental retardation
Perlman syndrome - polyhydramnios, macrocephaly, visceromegaly
Golabi-Behmel syndrome - macrostomia, macroglossia, occular hypertelorism
Bronchial atresia can affect any segment but which is classical
apicoposterior segment of the left upper lobe is absolutely classical, as is the age of the patient.
leighs disease is what kind of disease
sporadic mitochondrial genetic disease
Kearns-Sayre syndrome is another mitochondrial disorder which is associated with WHAT IN THE BRAIN
Subcortical calcifications and basal ganglia siderotic deposits.
Birt-Hogg-Dube syndrome is a very rare condition which predisposes to WHCI HKIDNEY LESIONS
chromophobic RCCs
what are branchial cleft cysts and how are they numbered
abnormalities from embryology.
1 is deep
2 is at the mandible / ear lboe
3 and 4 are below and idfficult to distinguish betwene on imagagin. around hyoid
conotruncal anomaly is what
It is an anomaly of the vessels leading from the heart
ovary
small (<3 cm) thick walled, rounded, cystic structure with peripheral vascularity
corpus luteal cyst
how to investigate endometriosis
TV ultrasound
commonest location of ectoic pregnancy
Ampulla of Fallopian tube
What are some differentials for an endobronchial lesions
SCC
mets
carcinoid
hamartoma
TA is ax with what conditions
DiGeorge
CHARGE
VSD
Right sided arch
differentials for cavitating neoplastic culprits
bronchogenic carcinoma (SCC)
metastatic squamous cell carcinoma
adenocarcinoma (Colon + breast)
what is may-thurner syndrome
left leg selling and thrombosis.
right common iliac ARTERY crosses over the left common iliac vein - compression
The azygo-oesophageal recess is formed by the interface of the
right lung and the mediastinal reflection of the azygos vei
The anterior junctional line is formed by the meeting of the
parietal and visceral pleura anteromedially.
posterior junctional line is formed by the meeting of the
pleural surfaces of the upper lobes behind the oesophagus.
right paratracheal line is formed by
the right wall of the trachea against the right lung.
IPF and NSIP
architecture pattern
IPF - macrocystic honeycombing
NSIP - GGO
IPF and NSIp
location of disease
IPF - apicobasilar gradient
NSIP - peripheral
IPF and NSIP
bronchiectasis / nodules
IPF - traction bornchiectasis s
NSIP - no nodules
IPF and NSIP
smoking association
IPF. - there is an assocation
NSIP - no association
Lung nodule follow up should not be done what what nodules
Calcification – diffuse, central, laminated or popcorn patterns
Perifissural nodules
<5mm maximum diameter nodules
<80mm3 nodules
BTS nodule guidlines for follow up
sizes
<5mm
5-6mmm
> 6mm
solid nodule, no follow up, 12 months, 3 months
sub-solid nodule - no follow up if <5 but then (3 months, 12 months, 2 years, 4 years)
azygo-oesophageal recess is formed by the interface of the
right lung and the mediastinal reflection of the azygos vein
anterior junctional line is formed by the meeting of
the parietal and visceral pleura anteromedially
posterior junctional line is formed by
the meeting of the pleural surfaces of the upper lobes behind the oesophagus.
Specifically egg-shell calcification
Silicosis and coal workers pneumoconiosis
Sarcoidosis
Aneurysm
Distance to the renal arteries –
10mm used to be the absolute minimum landing zone distance required
Aneurysm
aceeptable neck
Angle of the neck – this is measured one of two ways in the literature. Consequently there are two different values for an acceptable angle. A purely straight aneurysm would have a neck angle of either 180o or 0o in each of the different measuring systems. Thus the acceptable neck cut-off values are 120o or 60o in each case.
aneurysm
Common iliac artery (CIA) length –
Ideally the CIA should be longer than 20mm to accommodate the stents used.
Halo sign also seen in
Hameorrhagic mets
bronchioalveolar carcinoma (min invasive adeno)
fungal
mycobaterial infeciton
Wegeners
hypersenstiivty pnuemopnititis
contraindications to GTN on cardiac CT
Systolic blood pressure <100 mmHg
Hypertrophic obstructive cardiomyopathy
Sildenafil usage within the previous 24-48 hours
Aortic stenosis
Profound anaemia
involveme nt of the upper lung zones
BREASTS
Beryllosis
Radiation
EG
Ank spond
Sarcoid
TB
Silicosis
Lower long zone involvement
BADAS
Bronchiectasis
Asp Pneumonia
Drugs and Desquamative interstitial pneumonia
Asbestosis
Scleroderma
Peripheral, associated with CREST/Sjogrens/RA, chemotherapy
NSIP
Patchy. Associated with connective tissue diseases, CF, methotrexate, post-transplant
COP
Smoking, young patients, no bronchiectasis or honeycombing
RBILD
Smoking, GGO, difficult to tell apart from RBILD
DIP
Diffuse pattern, associated with Sjogrens, autoimmune conditions, hep B, EBV, PCP
LIP
Endoleaks types
1 - landing zone
2 - collateral filling of aneurysm sac (eg lumbar arteries).
3 - defect in wall of the graft
4 - poroous fraft material
5 - CATCFH ALL
CT signs of impending aortic aneurymsm rupture
Crescenteric high attenuation on an unenhanced scan - acute mural thrombus is strongly associated with rupture
Focal discontinuity of calcified intima / tangential calcium sign - where the intimal calcification appears to point away (in a tangent) from the expected circumferential course
Draped aorta - the posterior contour of the aorta follows that of the adjacent vertebral body
ddx
mediastinal lymph node calc
Tuberculosis
Histoplasmosis
Amyloidosis (rare)
Metastases: papillary/medullary thyroid cancer, osteosarcoma, mucinous adenocarcinoma
Certain Cancers Spread By Plugging The Lymphatics
Cervix
Colon
Stomach
Breast
Pancreas
Thyroid
Larynx (or lung – bronchogenic)
Cardiac MRI patterns
ischaemic patterns
Subendocardial infarction
transmural infarction
Cardiac MRI patterns
global endocarcdial
ddx
amyloidosis
CREST
Post heart transplant
Cardiac MRI patterns
Midwall
dilated cardiomyopathy
myocarditis
Cardiac MRI patterns
Affecting any of epicardial, miedwall
sarcoidosis
myocarditis
anderson-Fabry
Chagas disease
Adneonsine stress MRI is good for
investigating the presence of ischaemia or infarction
adenosine causes
coronary dilatation
how does adneosine affect a stenosed vessel
if won’t be able to dilate any further if already ischameic
contra indiactions to adneonsine
second or third degree HB
Bronchospaslm
low BP
mI in last 48 hours
arrhythmia uncontrolled
crit AS
Contraindications to thrombolysis include:
Absent sensation or motor function – ie a non-viable limb
Haemorrhage
Brain tumour (due to risk of haemorrhage)
Common findings to both LCH and LAM
Cysts
Spontaenous pneumothorax
Effusions
Young patient
Mediastinal lymph nodes are LCH or LAM
LAM
Honeycombing gound in
LCH or LAM
LCH
This is a rare infection which occurs particularly in bone marrow transplant patients as well as those with AIDs. Lobar consolidation and nodules with cavitation are seen but lymph node enlargement is notably absent.
Nocardia
testicles by age
10s
20s and 30s
Yolk sac tumour/teratoma
Choriocarcinoma
testicles by age
30s
40s
Embryonal cell carcinoma
Seminoma
Gardner syndrome triad
FAP subtype
colonic polyps
osteomas of the skeleton
soft tissue tumours
is is a rare hamartomatous syndrome which is inherited as an autosomal dominant defect on chromosome 10. The polyps are predominantly (but not exclusively) in the rectosigmoid colon. There is an association with fibrocystic disease and fibroadenomas of the breast; around half of patients have breast pathology
Cowden
Colonic carpet of polyps
Stomach hamartomas
Duodenal adenomas
Periampullary carcinoma
Desmoid tumours
FAP
Diarrhoea – colonic polyps
Seizures – glioblastoma
Turcot syndrome
Hamartomatous polyps
Mucocutaneous pigmentation
Increased risk of many cancers
Peutz - Jegher
Thallium is used in the differentiation of lymphoma and Toxoplasmosis
(lymphoma demonstrating increased uptake)
Eggshell calcification
DDX
Fibrosing mediastinitis
Amyloidosis
Pneumoconioses - silicosis and coal workers only. Not seen in most others.
Sarcoidosis
Scleroderma
Treated lymphoma (ie post radiotherapy)
TB
Histoplasmosis
Curiously these occur almost exclusively in women. Anatomically they sit within the presacral or retrorectal fat. They tend to be an incidental diagnosis and can be associated with bony defects within the sacrum. An uncomplicated cyst will return low signal on T1 and high signal on T2 but often they contain mucein whereupon they appear characteristically high in signal on T1 weighted MRI sequences. They can be surprisingly large and are often multiloculated.
tailgut duplication cyst also known as retrorectal cystic hamartoma
A 60-year-old man undergoes ultrasound for investigation of bilateral testicular lumps. Ultrasound reveals bilateral poorly defined areas of low echogenicity suspected to be metastases.
what is it likely to be ?
A mass in the testes of patient older than 50 is more likely to be a secondary tumour than a germ cell tumour. Prostate (35%) is the most common tumour to metastasize to the testicle, followed by lung, then melanoma, colon and renal.
The two main conditions where arthritic changes will be present in the absence of demineralisation are
Psoriatic arthritis and Gout.
Demineralisation arthritis
HORSE
Haemophilia
Ostemalaica
RA / Reiter syndrome
Scleroderma
SLE
No demineralisation in the arthritis
PONGS
Psoritatic arthritis
aosteomyelitis
neuropathic joint
gout
sarcoidosis
Gonococcal infections classically cause what kind of stricture
Gonococcal infections classically cause long strictures. They are most commonly irregular in nature and located in the bulbous urethra. The distal bulbous urethra is most frequently affected.
What is adneomyosis
Thought by some to be a variant on the theme of endometriosis, adenomyosis is the ectopic presence of endometrial tissue within the myometrium
Increased risk of endometrial cancer
Iatrogenic oestrogens
Tamoxifen
Early menarche or late menopause
No children
PCOS
Obesity
Diabetes
what endometrial thickness can you be certain of NO endometrial cancer
. <5mm of endometrial thickness has a 100% negative predictive value for endometrial carcinoma
L3/4
Quadriceps, patella reflex, sensation over knee and shin
L4/5
Dorsiflexion of the foot, ankle eversion, sensation to medial calf
L5/S1
Hip extension, extension of the big toe, ankle inversion, ankle reflex, sensation to sole of foot
risk of AML rupture relates to
siz>40mm
Nabothian cyst are what
blockage of the mucinous glands of cervix.
small yellow bumps on colposcopy. On MRI they are cystic with high T2 signal and can show high T1 signal owing to their mucein content. They are an incidental finding.
Skene duct cyst
retention cysts of the paraurethral ducts and usually they are asymptomatic. On MRI they are seen inferior to the pubic symphysis but lateral to the external urethral meatus. Signal characteristics reflect their cystic nature with high T2 signal but fluid-fluid levels may also be present if there has been intracystic haemorrhage.
Which of the following best describes the most common appearance of renal lymphoma?
multiple bilateral masses, low attenuation as enhance poorly
malignant hepatic masses in kids are
Mets
Wilms/neuroblastoma
Hepatoblastoma
HCC (older kids)
which cardiac malignancy is associated with Tuberous sclerosis?
Rhabdomyoma
how to diagnose a missed torsion
Where ultrasound features of heterogeneous testis with increased peri-testicular flow but absent testicular flow are found in a patient with symptoms lasting longer than 24 hours, a missed torsion can be diagnosed.
features of acromegaly
largement of the paranasal sinuses – 75%
Posterior vertebral scalloping – 30%
Widening of the terminal tufts
Heel pad thickness >25mm
Premature osteoarthritis
Enlargement and erosion of the sella
Hyperostosis of the inner table of the skull
Calcification within a lymph node is most suggestive of
in thyroid mass
Calcification of a malignant thyroid mass is most suggestive of a Papillary thyroid cancer, which is also by far the most common of the thyroid cancers, however medullary thyroid cancers can also give lesional calcification.
Calcification within the lymph nodes is a feature more classical Medullary thyroid cancer, although it has been reported in cases of Papillary thyroid cancer.
demonstrates granular calcification and nodal spread in 50% of cases.
medullary thyroid
unctate calcification and regional lymph nodes in 40% of patients and is of a low reflectivity on ultrasound
papillary
if pleural plaques are bilateral think
exposure to asbestos
post nerve injury inflammation mRI changes in muscle
high T2 (oedema)
Low T1
TB discitis vs staph discitis
TB
- Calc, posterior element involved, insiduous onset, no real loss of disc space, Gibbus deformity, multiple levels.,
Staph
- no calc, posterior elements spares, acute onset, loss of disc space, no gibbus, one level
microadenoma in pituitary on mri
Low T11
What are the IOTA rules
B rules
1 - 5
unilocular cyst, <7mm solid, acoustic shadow, multilocular cyst <10cm, no blood flow
M-rules
1-5
Solid irregular mass, ascites, >3 papillary structures, multilocular solid mass >10cm, blood flow
HCC in a non cirrhotic liver - how ?
in patient with heb B
Long strictures can develop and on a barium swallow the mucosa appears to have a reticular pattern. Tertiary contractions may also be seen.
Barretts oesophagus
differentiate between Askin tumour and pleuropulmonary lastoma
askin eats into ribs
MRI arthrogram
Where should the contrast be injected?
FOR THE WRIST
Dorsal approach to radiocarpal compartment
Menetrier triad
gastric glandular hypertrophy
achlorydia
hypoproteinaemia
MRI there is nodular thickening of the synovium in the suprapatellar space which returns low signal on both T1 and T2 weighted sequences.
PVNS
what is PVNS
Haemorrhagic proliferation of the synovium in a frond-like villonodular fashion gives rise to the classic low signal ‘feathery’ sea-anenome-like finding.
does it restrict does it enhance
recurrent cholesteatoma
Restricts - YEs
enchnace - NO
does it restrict does it enhance
Granulation tissues
Restrict - NO
Enhance - Yes
does it restrict does it enhance
Fluid
No
NO
Cholesteatomas (Acquired or congenital) are histolologically ….
epidermoid cysts
here are two types of acquired cholesteatoma:
Pars flaccida (80%) – classically erodes the scutum and extends superiorly
Pars tensa (20%) – classically erodes the ossicles, extending medially
cholesteatoma vs cholesterol granuloma on MRI
a cholesteatoma on MRI is isointense to brain parenchyma on T1,
a cholesterol granuloma will show high signal in the middle ear on T1 due to the paramagnetic effects of methaemoglobin.
Cholesteatoma will restrict, granuloma wont
blood from an aneurysm of the PCom will extend into
the interpeduncular cistern, ambient cisterns and thereby to the quadrigeminal cistern.
If a patient has a painful ptosis, a PCOM aneurysm should be considered. It will be an
contralateral or ipsilateral
ipsilateral pathology because the Oculomotor nerve is post-ganglionic at this point.
BRCA 1 inheritance is predominantly associated with
ductal carcinomas
BRCA 2 inheritance can be associated with both
lobular and ductal carcinomas
a mass seen on MRI that is not seen on mammography or ultrasound would be a
lobular carcinoma
Bone marrow on MRI
Normal bone marrow
T1 and T2
T1 - high (fatty)
T2 - intermediate
Post radiotherapy bone marrow on MRI
T1 - Very high
T2 - intermediate, can be high if oedema
MRI of bone marrow haemangioma
T1 - high
T2 - high
MRI of abnormal bone marrow (mets, myeloma, regeneration)
T1 - low
T2 - high (fluid)
MRI
blastic mets (prostatem breast, TCC) and myelofibrosis
T1 low
T2 low
lytic or sclerotic mets more likely to enhance with contrast?
lytic
fold thickening and lymph node enlargement - small bowel
dx
small bowel lymphoma
nodular fold thickening with sclerotic bone lesions
mastocytosis
dilatation without increase in fold thickness
coeliac
causes of bony sclerosis
metabolic
hyperparathyroidism
hyperthyroidism
causes of bony sclerosis
congential
Pyknodysostosis
Osteopetrosis
causes of bony sclerosis
malignant
lymphoma
leukaemia
causes of bony sclerosis
haematological
sickel cell
myelofibrosis
mastocystosis
which renal nuclear meidince scan is dynamic
MAG3 and DTPA.
DTPA on cleared by glomeruli, good for egFR.
prostate contrast MRI curves
which is concerning
Type 3 - in and washes out
T1 - is progressive upwards
T2 - is plateau
which colon is most freequently affected by angiodysplasia
caecum and ascending colon
does myositis ossificans affect the bone
No
Multicentric subtype of osteosarcoma
5-10
poor prognosis
Parosteal osteosarcoma
lower grader , 20- 50s
Telangiectatic subtype of osteosarcom a
purely lytic, poor prognosis, fluid - fluid level
which heart block is contraindicated to adenosine
2nd and third
What can cause egg shell calcification of the lymph nodes
Fibrosing mediastinitis
Amyloidosis
Pneumoconioses - silicosis and coal workers only. Not seen in most others.
Sarcoidosis
Scleroderma
Treated lymphoma (ie post radiotherapy)
TB
Histoplasmosis
Carney syndrome
atrial myxoma, facial/buccal pigmentation, sertoli tumours of the testis and multiple other findings.
Carney triad
pulmonary hamartomas, gastric leiomyosarcomas and extra-adrenal paragangliomas
small mass attached to the interatrial septum by a stalk is classical
cardiac mass - what ype
atrial myxoma
A 51-year-old woman undergoes an HRCT which shows diffuse cysts, nodules and bronchial wall thickening.
what is the likely diagnosis
LIP
Hypersensitivity pneu onitis is inhaled and therefore found
in the upper lobes
GGO initially.
Subsequently traction bronchiectasis and honeycombing in non-dependant lung
Bilateral, symmetrical, lower lobes.
Spares costophrenic angles
AIP
Patchy appearance
GGO
Consolidation
Reverse halo appearance
Peripheral, peribronchial.
Basal
COP
RBILD vs DIP
DIP lower lobes
if a lung nodule is less than 5mm
no folow up needed
lung nodule 5 - 6 mm f/u
12 months for solid noudle
sub solid - 3 month, 12 months, 2 years, 4 years,
lung nodule >6mm f/u
solid nodule - 3 months
sub solid 0 same as if it was 5- 6mm
: Certain Cancers Spread By Plugging The Lymphatics
Cervix
Colon
Stomach
Breast
Pancreas
Thyroid
Larynx (or lung – bronchogenic)
Partial anomalous pulmonary venous circulation (PAPVC), scimitar syndrome
usually drains to
IVC
profunda femoris is given off where?
profunda femoris. This is given off posterolaterally just below the femoral sheath 3.5 cm below the inguinal ligament.
A 47-year-old office receptionist presents to her GP with a cough. She is referred for a CXR which shows widening of the right mediastinum and a CT is recommended. There is mediastinal calcification and right heart dilatation. Septal thickening, peribronchial cuffing, and wedges of consolidation are also seen.
Fibrosing mediastinitis
There is a familial preponderance in around 50% of cases. Resultant arrhythmias are usually LBBB or ventricular tachycardia. There is fibro-fatty degeneration of the right ventricular wall as well as right ventricular dilatation.
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
Diffuse subendocardial gadolinium enhancement and diffusely increased T1 myocardial signal are the classical features.
Amyloid
Contra indications to adenosine stress test
Second or third degree heart block
Bronchospasm
Hypotension <90mmHg systolic
Myocardial infarction within 48hrs
Uncontrolled arrhythmia
Severe/critical aortic stenosis
a mnemonic for involvement of the upper zones is BREASTS:
B = Beryllosis
R = Radiation
E = Eosinophilic granuloma (Langerhans cell histiocytosis) and Extrinsic Allergic Alveolitis
A = Ankylosing spondylitis
S = Sarcoidosis
T = Tuberculosis
S = Silicosis
Involvement of the lower zones can be remembered with the mnemonic BADAS:
B = Bronchiectasis
A = Aspiration pneumonia
D = Drugs and Desquamative interstitial pneumonia
A = Asbestosis
S = Scleroderma (and Rheumatoid arthritis)
Caridac MRI
ischaemic will involve the
subendocardial
Cardiac MRI
Epicardial and midwall ddx
Sarcoidosis
myocarditis
Anderson - Fabry
Chagas
Cardiac MRI
Mid wall blotches
HOCM
Cardiac MRI
Mid wall thin line
dilated cardiomyopathy
myocarditits
Contraindications to CT guided lung biopsy are:
Severe COPD
Pulmonary hypertension
Coagulopathy
PLT <50
INR >1.4
Contralateral pneumonectomy
(echinococcal cysts)
imaging of recurrent cholessteatoma
restricts
doesn’t enhance
granulation tissue
no diffusion
enhances
adenoid cystic spread
perineural
spine inverted V
sUB ACUTE COMBINE DDEG
B12 DEF
Ureter - goblet sign
TCC
vause dilatation above and below the lesion in the ureter
Ureteric reflux stages
1 - -5
1 - into the ureter
2 - into the pelvis
3 - widened pelvis
4 - widened calcyes
5 - blunted calcyce, bad
4 and 5 need operating on
What is eagle barrett also called and the triad
prune belly
cryptoorchidism
prune belly
dilated ureters and renal pelvis
renal emphysema
distinguishing between what two patholigies
Pyoitis
- gas in the collecting system
pyelonephritis
- gas in the cortex
over 60s testes mass likely
lymphoma
testes mass in 40year old
Seminoma
What is maklopakia
yellow plawue in kidneys and urters from chronic e coli infetion .
MIBG is used for
Neuroblastoma tumours
Renal artery stneosis parameters
Peak Systolic > 180cm/s
An RI greater than what is considered to be agood candidate for renal artery intervention
0.7
list the different ovarian neoplastic lesions (3 groups)
Germ Cell
Sex cord
Epithelial
what are the ovary germ cell tumours
Dysgerminoma
Endometrial sinus (aka yolk sac tumour)
Immature teratoma
What are the ovary sex cord tumours
Fibroma/Thecoma/fibrothecoma
Sertoli
Leydig
Granulosa cell tumour (adult and juvenile)
what are the ovarian epithelial tumours
serous and mucinous cystadenocarcinoma
endometroid
clear cell
how to differnetiate serous from mucinous cysteadenocarcinoma
mucinous will be T1 bright from proteinacious content
three categories of ovarian masses
Funcutional
Endometrioma
Neoplasm
What are the functional ovarian masses
Follicular / simple cyst
Corpus luteal cyst
Thea-lutein cyst -
Corpus luteal cyst will appear
complex due to haemorrhage ithin
follicular / simple cyst occur due to
failed ovulation
corpus luteal cyst form due to
failure to involute
measurement parameters for a smiple cyst
<3cm don’t report
3- 5 comment
> 7cm - need f/u (PostMeno 5cM)
need to follow up haemorrhagic cyst for what measurement
> 5cm
if at 6 weeks repeat US of haemorrhagic cyst as not resolved –>
considered an endometrioma
chocolate cyst
indeterminate ovary lesions what to do
pre meno - f/u in 6 weks
post meno –> surgery
OHSS appearance
spoke wheel ovary
>5cm
ascites
with
LFT
WCC
HCT
how many follicles and volume for PCOS
12 follicles
>10ml ovary
bell clapper deformity
testicle on the side
risk torsion
how to distinguish segmental infarciton from mass
may need MRI
doppler flow in testicular haematoma
nil
Features of testicular rupture
capsule disrution
needs urgent surgery
Features of epididymitis
enlarged and increased flow
malignant germ cell tumour types
seminoma
non seminomatous
- mixed
- yolk (AFP)
- Teratoma
- Embryonal
- Choriocarcinoma (BHCG)
how to treat a burnt out germ cell tumour
orchidectomy and chemo
microlithiasis - number of calc
5 per image
benign testicular masses are
epidermoid (keratin filled onion skin)
Sex cord stromal tumours
- Leydig (oestrogen)
- Sertoli (ax with PeutzJaghers and Klinefleters)
marker of medullary thyroid cacner
calcitonin
made by c cells
which cells produce thyroglobulin
follicular cells
medullary sponge kidney si charachterised by
cystic dilatation of collecting tubules
Urine statis predisposes to infection. and stones.
dilated tubules causes the striated paintbrush appearance of renal pyramids
breast
phylloides speed of growth
rapid
painless palpable swelling in his left parotid. USS shows it to be mobile and superficial to the facial nerve. On MRI there is a septated well defined mass in the parotid tail with low intensity on T1 and high intensity on T2.
warthins tumour
hydrocephalis and calcfication in basal ganglia
A 9-month-old boy undergoes an MRI scan for investigation of severe developmental delay. The scan demonstrates basal ganglia calcification with hydrocephalu
think toxo
rather than CMV if there is hydrocephalus
optic nerve meningioma vs glioma
meningioma will enhance with contrast and may have calc as tram track sign, dural tail
glioma will be along the whole length and fusiform
What are the normal parameters and abnormal parameters for a carotid doppler
Normal < 125cm per second
>130 then exepct 50% stenosis
> 230cm per second then consider >70% stenosis
The ring enhancing of toxoplasmosis is what
thin and smooth
What is dandy walker malformation
Decreased vermis and cephalad rotation of the vermian remnant
cystic dilatation of the 4th ventricle
widely spread hemisperes, torcular labmdoid inversion
patients present in first year of life with neuro abnormalities
what is dandy walker variant
hypoplasia of just the vermis with some obstruction of the fourth ventricle
less severe
A high AFP in an ovaria mass should consider what
Leydig Sertoli
Embryonal carcinoma (which is the adult version of yolk sac tumour!)
what are the contraindications to a wide local excision of a breast lump
if cancer is present in more than 1 quadrant – mastectomy
Oesophagitis candida - will affect which bit of the oesophagus and appearance on barium
Longitudinal plaques irregular
Upper half of the oesophagus
history of immunocompromise
can be shaggy if severe
Herpes simplex in the oesophagus appear as
herpes oesophagitis
multiple small ulcers with a halo of oedema
middle third of oesophagus
CMV/HIV oesophagitis
one large flat diamond / oval shaped ulcer
caustic oesophagitis affects which bit
midlde and lower
will get progressive change
Barrett appearance on barium
long stricture
reticular mucosal pattern
what is glycogen aconathosis?
bengin age related squamous hyperplasia
what is klippel feil
renal agenesis
cervical rib
deafness
scoliosis
sprangal shoulder
vertebral body coalition
Sprengla shoulder is ax with
renal abnormalities
Iron toxicitiy in the brain causes what
signal drop out in the basal ganglia
especially the globus pallidus
what is marcharafari bignami
poor nutiriton and alcoholics
affets corpus callosum - necrosis and demyelination
swelling and bright T2 signal
sandwich sign is that is spares the dorsal and vetral aspects of corus callosum
prostate cancer - adeno - will MRI features be what
low T2 and will restrict
which neuro disease is the cingulate island sign seen in
Lewy body dementia
Alzhemiers spares what
the occipital
contrast to lewy body which will ravage this
What are the different criteria for bozniak
1 - simple and smooth
2 - 1-3 septa
2F - 3mm or with septal thickening (6 months and then annually for 5 years)
3 - >4mm wall, irregular - resect
4 - nodule enhancing - resect
what is a normal PSA density
0.1 ng / ml / cc
Coeliac small bowel barium
dilated but with normal folds
scleroderma small bowel barium
dilated with Loooooooooooong transit
ZE on barium
dilated due to plus plus secretion
Lymphoma barium findings
enlarged folds with lymph nodes
Crohns disease on barium
nodular fold thickening
Whipple disease
thickened folds no dilatation
normal transit
what are the features of mastocystosis
high histamine
asthma symptoms
sclerosis
big spleen and .liver
Testicular tumours by age
Yolk sac and teratoma - 10s
Chorio is 20s and 30s
30s Embryonal cell carcinoma (basically adult yolk sac)
40s seminoma
What are the ovarian germ cell tumours
epidermoid / dermoid
stroma ovarii
seminomatous
ovarian teratoma(s): commonest primary benign tumour of ovary and commonest germ cell tumour:
mature (cystic) ovarian teratoma
immature ovarian teratoma
specialised teratomas of the ovary
struma ovarii tumour
ovarian carcinoid tumours
ovarian dysgerminoma
ovarian yolk sac tumour: endodermal sinus tumour
ovarian embryonal carcinoma
ovarian choriocarcinoma
pure primary ovarian choriocarcinoma: extremely rare
malignant mixed germ cell tumour of the ovary
Treatment and prognosis
medial to lateral of the popliteal fossa
AVN
artery
vein then nerve
causes of pneumatoceles
intubation or infection
also truma.
hydrocarbon ingestion
features favouring pnematocle over an abscess
smooth inner margins
little if any fluid
thin regular wall
persist despite no symptoms
how long for pnumatoceles to appear vs disappear
take a week to appear
gone within a few months normally
carcinoid syndrome will affect what proportion of people with carcinoid tumour
8%
carcinoid marker is what in the blood
5 - hydroxyindoleacetic acid
what is Hedinger syndrome?
carcinoid heart disease
vasoactive substances aren’t inactivatd by the liver if can bypoass
- eg lung or ovarian vein (primary ovarian carcinoid tumour)
appearance of bladder infalmmatory pseudo utumour
exophytic
ulcerationpost contrast periphery enhances
what is cystitis galndularis
metaplasa of the transitinal cells
chronic inflammaotry disorder
found in the trigone
with contrast, infected bone marrow will
avidly enhance
what is the different between CPPD and Hydroxyapatite Crystal disease
CPPD triad
- chondrocalcinosis
- typical arthropathy
- pain
Hydroxyapatite crystal deposition
- shoulder. calcific tenonitis.
What are the causes of chondrocalcinsois
many
hyperparathyroidism
Gout
Wilson disese
Haemachromatosis
Ochronosis
Truama
OA
Low thyroid
low mangesium
acromegaly
HADD
most common cause of chondrocalcinosis
CPPD
cafe au laits
NF1 and NF2
Blooms
Angiofibroma think
TS
pits in the pals and sole
BCC
multiple teeth
Gorlin
Macroglosia
BWS
Hyperpigmentaiton
NF1
Fanconi
Blooms
Hemihypertrophy
NF1
BWS
KF
Thumb malformation
Fanconi anaemia
hepatoblasomt aax with which syndorme
BWS
FAP
adrenocrortical and breast cancer ax with
Li-Fraumani syndrome
Men 2 what can be done to pre-empt cancer
thyroidectomy
as gestation advances what happens to the echogenicity of the lungs
increases
gets more T2 bright too as more alveolar fluid is made
what is meconium on MRI
bright T1
dark on T2
which lines are disrupted in acetabular fractures
ilioischial - posterior column
iliopectineal for anterior columns
how does SLE cause thrombosis
through anti-phospholipid sydnrome
PAN affects who and where
men in their 60s
renal vasclature. infarction. nultiple aneurysms
present with fever, malaise and weight loss
what is an appendiceal mucocele
just obstruction of the appendix - cna be from a number of causes
appendiceal mucocele due to mucinous tumour bursts can cause what
pseudomyxomoi peritonei
TB vs pyogenic spondylitis
why does TB not form an anterior spinal mass / encase intervertebral artereis
doesn’t go beyond the anterior longitudinal ligament
what is a bladder contusion
This is commonly seen but not classed as true rupture, since it involves an incomplete mucosa tear. It is equivalent to an intramural hematoma
therefore focal thickening !
appearance of eosinophilic cystiis
nodules are echogneic in the bladder wall
NON ossifying fibroma / cortical defect
lucent
thin sclerosis outlining
no periosteal reaction
no involvement o the medullary cavity
low on t1 and t2
they will heal, even if fractured
cortical demsoid found where
postermediual aspect of the distal femur
ct findings in tb meningitis
basal encement of the meninges
high risk CT head factors requiring imaging within 1 hout
GCS 12
or < 15 2 hours after injury
?skull fracture
neuro deficit or seizure
vomitting
risk factors assocaited with LoC that would need CT scanning
65 +
bleeding disorder/ anticoag (would do even without LOC/amensia)
Mechanism is dangerous
30 minutes of retrorage amensia
CT head guidelines or kids
to be done within 1 hour
NAI
seizure
GCS<14
2hours post injury GCS <15
?fracture
Neuro deficit
if less than 1 - if have a bruise bigger than 5cm
paeds - ct head risk factors requiring at least 2 things
LoC - 5 mins
Abnormal drowsiness
3 + vomitting
Dangerous mechanism of injury
Amensia (5 years plsu onl)
Cam impingement affects who
young men
alpha angle in cam
over 55
choledochal cyst types
1 - cbd
2 - diverticulum
3 - into the duodenum
4 - multiple
5 - caroli intrahepatic
appearance of a biliary cystadenocarcinoma
large, right lobe of liver with septations which will enhance with contrast
leukoplakia is charachterised by
passing bit sof soft tissue in urine
what are the common causes of optic canal enlargement?
glioma
meningioma
mets
neurofibromatosis
what is CPAM
multicystic masses of segmental lung tissue with abnormal bronchial proliferation.
what are the types of cpam
1 - large cysts
2 - <2cm cysts. ax with renal agensis, pulmonary sequestration, congenital cardiac anomalies
3 - microcysts, entire lobe. poor prognosis
4 - similar to 1
what is pyknodysostosis (osteopetrosis)
osteosclerosis and short stature
delayed cranial suture closure
frontal bossing
nail hypoplasia
nasal beaking
distal phalanges are SHARP. pencil like
lysosomal storage disease - poor osteoclast function.
PMF vs lung cancer on MRI
T2 - bright cancer. dark fibrosis
pmf is t1 brightish with ring enhancement.
PET - pmf is avidly bright (same as cancer so not useful) - biopsy
superior orbital fissue syndrome vs orbital apex syndrome
post trauma fracture can extend into fissure with disruption of nerve 3-6.
orbital apex sytndrome can damage nerve 2 - unilocular vision los.
what are the common causes of delayed bone age
Constitutional: familial and IUGR
Metabolic: low thyroid, pituitary, gonads, cushings, dm, malnutrition
systemic disease: heart failure, rneal failure, coeliac, crohns, UC and anaemia
syndromes: Trisomies, Noonan, cornelia de lange, cleidocranial dysplasia.
branching lucencies in the liver think
portal gas badness
types of bladder cancer
Sqamous - ax with risk factors like schisto/inflammation
TCC - MOST common, enhance avidly though appearance similar to scc
leimyoma - smooth masses
adeno - midline
what is a pathonemonic feature of second branchial clef tcyst
beaking of fluid between the carotid bifurcation
what is the currarino triad
sacrocoxygeal osseous defect
presacral mass
anorectal malformation
