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Surgery > Radiology > Flashcards

Radiology Flashcards

1
Q

Xray feature of duodenal obstruction?

A

C-shaped dilated bowel >3cm

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2
Q

Xray feature of jejunal and ileal obstruction? (4)

A

• Dilated >3cm
• Central gas filled bowel
• stack of coins appearance: plicae circularis/ valvulae conniventes more prominent and pass completely across width of bowel, regularly spaced
• no gas in colon

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3
Q

Xray feature of colon obstruction? (3)

A

• Dilatation caecum > 9 cm or colon >6 cm
• peripherally located
• incomplete bands (haustrations due to Taenia coli) spaced irregularly, doesn’t cross whole diameter

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4
Q

Xray feature of sigmoid volvulus ?

A

Coffee bean sign: massive colon distention with dilated loop of bowel running diagonal across abdomen from right to left

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5
Q

Radiographic feature of caecal volvulus ? (3)

A

• Gas filled ileum with or without distended caecum - No longer in rif
• “fetal” appearance
• barium enema shows bird beak deformity

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6
Q

Radiographic feature of intussusception ?

A

Ileocolic: evidence of small/large bowel obstruction with absent caecal gas shadow (barium enema = claw sign)

Caecal: coiled spring sign

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7
Q

Xray feature inflammatory bowel disease ? (3)

A

• Thumbprinting: mucosal thickening of haustra due to inflammed oedema. Appear like thumbprints projecting into lumen = ischaemic bowel
• lead-pipe featureless colon: loss normal haustra markings (esp uc )
• Toxic megacolon : bowel wall oedema with thumbprinting, and pseudopolyps or “mucosal islands”

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8
Q

Xray features gallstone ileus? (2)

A

•Pneumobilia (cholecystoduodenal fistula)
• opacity near ileocecal value

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9
Q

Xray features pneumoperitoneum?

A

Rigler’s double wall sign - obvious “thick” bowel wall due to extra-luminal air

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10
Q

Ultrasound feature cholelithiasis?

A

Acoustic shadowing

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11
Q

Identify pathology picture 1

A

Coiled spring sign: intussusception or other causes small bowel obstruction

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12
Q

Nome the apparatus in picture 2

A

Sengstaken Blakemore tube used to control variceal bleed after self expanding metal stent or rubber band ligation has failed

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13
Q

Identify pathology picture 3

A

Stack of coins (prominent valvulae conniventes) and string of pearls (rows gas bubbles trapped between valvulae conniventes) sign: small bowel obstruction

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14
Q

Identify pathology picture 4

A

Stack of coins (prominent valvulae conniventes) sign: small bowel obstruction

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15
Q

Identify pathology picture 5

A

Coffee bean sign: sigmoid volvulus

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16
Q

Name 5 differences on xray between sigmoid and Cecal volvulus

A

See picture 6

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17
Q

Identify pathology picture 7

A

Coffee bean sign: sigmoid volvulus

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18
Q

Identify pathology picture 8

A

Fetal appearance distended large bowel from right lower to left upper: Cecal volvulus
Proximal dilated small bowel.

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19
Q

CT features of acute interstitial oedematous pancreatitis?

A

• Homogenous enhancement of pancreas
• peri-paneneatic fat stranding
• peri-pancreatic fluid may be present

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20
Q

CT features of acute necrotising pancreatitis?

A

Early CT scan may underestimate degree of necrosis: difficult to Differentiate oedema and necrosis
After first week any non-enhancing area of pancreatic parenchyma can be considered to be parenchyma necrosis

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21
Q

CT features pancreatic pseudocyst? (5)

A

• Well-defined wall
• fluid collection in peri-pancreatic tissue high in amylase
• contains no solid material
• can only be diagnosed 4 weeks after acute pancreatitis, takes time for wall to form (more common in chronic than acute pancreatitis)
• disruption of main pancreatic duct or intra-hepatic branch can lead to leakage of pancreatic fluid with persistent localised fluid collection

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22
Q

CT features of acute necrotic collection in acute pancreatitis? (3)

A

• Nonenhancing regions of pancreas
• collection containing variable amounts of fluid and necrotic tissue that can involve pancreatic parenchyma or peri-pancreatic. May be multiple, may appear located
• difficult to distinguish from acute fluid collection in first week. If after first week any non-enhancing areas, assume to be necrosis

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23
Q

Diagnosis walled off necrosis as a late local complication of acute pancreatitis on imaging? (3)

A

• on CT Encapsulated mature Necrotic tissue contained within well-defined enhancing wall of reactive inflammatory tissue
• May be infected, multiple and present at sites distant from pancreas
• CT may not readily distinguish solid from liquid content and may misdiagnose walled off necrosis as pseudocyst. MRI, transabdominal or endoscopic ultrasound may be needed to distinguish

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24
Q

What does double duct sign on ultrasound or CT indicate?

A

Both CBD and pancreatic duct are dilated
Head of Pancreas or periampullary cancer until proven otherwise

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25
Q

Identify pathology picture 9

A

Cecal volvulus: fetal shape

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26
Q

Identify pathology picture 10

A

Bird beak deformity cut off barium: cecal volvulus (solid arrow)
Dilated cecum lies in epigastrium where there is an air fluid level (open arrow)

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27
Q

Identify pathology picture 11

A

Bird beak appearance: cecal volvulus

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28
Q

Identify pathology picture 12

A

Bird beak deformity: Cecal volvulus

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29
Q

Identify pathology picture 13

A

Absence of air intestines and soft tissue density right: intussusception

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30
Q

Identify pathology picture 14

A

Claw sign barium study: intussusception.

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31
Q

Identify pathology picture 15

A

Thumbprinting = large bowel wall haustra thickening
Usually caused by oedema related to inflammatory bowel disease

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32
Q

Identify pathology picture 16

A

Lead pipe colon sign: classic sign in chronic ulcerative colitis
(Muscularis mucosa hypertrophy)

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33
Q

Identify pathology picture 17

A

Lead pipe colon: ulcerative colitis

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34
Q

Identify pathology picture 18

A

Barium study: total colitis and pseudopolyposis
= inflammatory bowel disease( ulcerative colitis)

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35
Q

Label picture 19 and give diagnosis

A

Toxic megacolon
Left = megacolon
Right - mucosal islands

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36
Q

Identify pathology picture 20

A

Gallstone ileus - rigler triad:
• small bowel obstruction
• gas in biliary tree
• gallstone in rif

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37
Q

Identify pathology picture 21

A

Gallstone ileus - rigler triad:
• small bowel obstruction
• gas in biliary tree
• gallstone in rif

38
Q

Identify whether picture 22 is small or large bowel and why

A

Large bowel: haustra (black arrow) and plicae semilunaris (white)

39
Q

Identify whether picture 23 is small or large bowel and why

A

Small; valvular conneventies

40
Q

Identify pathology picture 24

A

Small bowel obstruction

41
Q

Identify pathology picture 25

A

Large bowel obstruction

42
Q

Identify pathology picture 26

A

Toxic megacolon in patient with ulcerative colitis (lead pipe colon)
Mucosal islands

43
Q

Identify pathology picture 27

A

Rigler’s sign = double wall sign.
Indicate preumoperitoneum

44
Q

Name 5 criteria for a normal cholangiopancreatogram

A

• Normal intrahepatic ducts
• no filling defects
• smooth CBD
• no stricture or narrowing of CBD
• good and free flow of contrast into duodenum

45
Q

Investigations for cholelithiasis? (4)

A

• Ultrasound is best. More sensitive than Ct scan. Strong echogenic rim around stone with posterior acoustic shadowing. Bile should appear as black patch in gallbladder, if not homogenous = sludge
• mrcp: next step if need to work up further
• ercp:therapeutic
• PTC (percutaneous transhepatic cholangiography) or PTBD (biliary drainage): therapeutic

• CT: not sensitive for stones, do to assess complications
• AXR: most stones radiolucent so not great
• HIDA scan: not used commonly except in biliary atresia.

46
Q

Name 3 therapeutic procedures that can be done with ercp

A

• Stone removal (using fogarty balloon catheter or Dormia wire basket)
• sphincherotomy (to relieve obstruction or facilitate removal stone )
• stenting

47
Q

Name 4 complications ercp

A

• Acute pancreatitis
• infection
•Haemorrhage
• perforation

48
Q

Indications percutaneous transhepatic cholangiography PTC? (2)

A

• Diagnostic: high biliary obstruction not well visualised in ercp or previous surgery with altered anatomy eg gastrectomy
• therapeutic: obstructed system that cannot be drained from below

49
Q

Identify pathology picture 28

A

Mucosal thickening on left
Thumbprinting on right
= inflammatory bowel disease

50
Q

Identify apparatus picture 29

A

Nasogastric tube for neonate.

51
Q

Identify pathology picture 30

A

Distended fluid filled stomach, duodenum and small bowel seen on prenatal ultrasound
= congenital bowel obstruction
Left: dilated bowel
Right: small bowel atresia

52
Q

Identify pathology picture 31

A

Xr of neonate:
High bowel obstruction- 2 air fluid levels (stomach and duodenum) with no air in rectum.
= duodenal atresia

53
Q

Identify pathology picture 32

A

High bowel obstruction in neonate

54
Q

Identify pathology picture 33

A

Hirschprung’s disease: massively dilated bowel loops filled with air.
Lateral shoot through = air fluid levels
Low bowel obstruction

55
Q

Identify pathology picture 34

A

High bowel obstruction (ileal atresia)

56
Q

Identify pathology picture 44

A

Incomplete obstruction. Corkscrew sign= malrotation.

57
Q

Identify pathology picture 46

A

Left no air in rectum
Right target sign ultrasound
= paediatric intussusception

58
Q

Identify pathology picture 47

A

Technetium 99m scan: Meckel’s diverticulum

59
Q

Describe breast cancer appearance on ultrasound (6)

A

• Hypoechoic (dark gray)
• irregular shape
• margin not circumscribed. Angular, indistinct, microlobulated, spiculated
• vertical orientation (taller than wide)
• Frequently posterior shadowing
• may have small calcifications in or outside mass

60
Q

Identify pathology picture 50 - breast ultrasound

A

Breast cysts = anechoic oval with circumscribed margin, posterior enhancement, horizontal orientation

61
Q

Identify pathology picture 51 - breast ultrasound

A

Fibroadenoma

• Hypo echoic
• oval or round shape
• circumscribed margin
• horizontal orientation/wider than tall
• sometimes minimal posterior enhancements
• may have gross calcifications

Bottom picture has breast prostheses under muscle

62
Q

Identify pathology picture 52 - breast ultrasound

A

Breast cancer

• Hypoechoic (dark gray)
• irregular shape
• margin not circumscribed. Angular, indistinct, microlobulated, spiculated
• vertical orientation (taller than wide)
• Frequently posterior shadowing
• may have small calcifications in or outside mass

63
Q

Name 5 features esophageal cancer on barium swallow

A

• Irregular apple core stricture
• shouldering
• prox dilatation esophagus
• axis deviation or angulation
• TOF if present (tracheo-esophageal fistula)

64
Q

Identify pathology picture 53 breast ultrasound

A

Breast cancer
• hypoechoic mass with irregular shape
• uncircumscribed border which is angular and indistinct
• small hyperechoic dots (califications)
• no posterior shadowing or enhancement

65
Q

Identify pathology picture 54

A

Breast cancer on in mammogram: stellate irregular with calcifications

66
Q

Identify pathology picture 55 breast ultrasound

A

Breast cancer.
• hyperechoic halo surrounding irregular hypoechoic mass
• vertical orientation
• irregular circumference

67
Q

Identify pathology picture 56 breast ultrasound

A

Fibroadenoma
• oval shape (slight lobulation)
• sharply demarcated
• horizontal orientation
• posterior enhancement

68
Q

Identify pathology picture 57 breast Ultrasound

A

Lipoma or fat necrosis.
• ISO or hyperechoic compared to surrounding fat

69
Q

Identify pathology picture 58

A

Invasive ductal carcinoma (most common). Birads 5.
• hyperdense mass
• irregular shape
• speculated margin
• focal skin retraction

70
Q

Name 4 mammogram findings of breast cancer

A

• hyperdense mass
• irregular shape
• spiculated , microlobulated or indistinct margin
• architectural distortion
• may have focal skin retraction

71
Q

Identify pathology picture 59

A

Probable Breast cancer: architectural distortion

72
Q

Identify pathology picture 60

A

Axial contrast CT in arterial phase showing abdominal aortic aneurysm

73
Q

Name the 5 phases of a contrast CT scan

A

• Early arterial phase: 15-20 seconds after injection. Only in arteries
•* late arterial or arterial phase: 20-40 seconds. Optimal enhancement of organs with arterial blood supply
• * portovenous or hepatic phase: 80 seconds. Liver enhances
• nephrogenic phase: 100 seconds. All renal parenchyma enhance. Will only detect small RCC here
• * delayed or washout phase: 6-10 minutes. In fibrotic tissue

74
Q

Advantages in detection of non-contrast CT scan? (3)

A

• Calcifications eg stones, chronic pancreatitis
• fat in liver tumours, adrenal adenoma or myelolipoma
• fat stranding steen in inflammation eg appendicitis, diverticulitis, omental infarct etc

75
Q

What is normal flow on duplex ultrasound?

A

Triphasic

76
Q

What does monophASIC flow on duplex ultrasound indicate?

A

Proximal occlusion

77
Q

What does biphasic flow on duplex ultrasound indicate?

A

Proximal stenosis

78
Q

Detection Benefit of early arterial phase of CT scan? (2)

A

• Aortic dissection
• arterial bleeding

79
Q

Detection Benefit of arterial phase of CT scan? (3)

A

• Liver: HCC, FNH, adenoma
• pancreas: adenocarcinoma, insulinoma
• bowel ischaemia

80
Q

Advantages in detection of porto-venous phase CT scan?

A

Hypovascular liver lesions eg cysts, abscesses, most metastases

81
Q

Advantages in detection of nephrogenic phase CT scan?

A

Renal cell Carcinoma

82
Q

Advantages in detection of delayed phase CT scan? (3)

A

• Liver cholangiocarcinoma
• Liver fibrotic metastasis, usually due to breast cancer
• Kidney transitional cell carcinoma

83
Q

What is enhanced in delayed phase CT scan? (2)

A

• Fibrotic lesions
• kidneys ( not including medulla) and urinary collecting system
Nothing in blood vessels

84
Q

What is enhanced in portovenous phase CT scan? (2)

A

Hepatic parenchyma
Portal vein is bright
Spleen appears homogenous

85
Q

What is enhanced in arterial phase CT scan? (7)

A

• Aorta is bright
• spleen enhanced appearing heterogeneous
• hypervascular lesions
• stomach
• bowel
• pancreas parenchyma
• kidney outer cortex

86
Q

Malignant vs benign ulcers on gastrosopy? (4)

A

• Large > 1 cm vs smaller
• irregular borders vs regular
• elevated border vs flat
•Base discoloration vs clean

87
Q

Identify pathology picture 61

A

Fecolith in appendicitis

88
Q

Identify pathology picture 62

A

Gastroschisis or omphalocaele with ruptured membrane with spring loaded silo bag covering

89
Q

Identify pathology picture 63

A

Cobblestoning on colonoscopy from Chron’s disease

90
Q

Identify pathology picture 64

A

Deep ulcerations on colonoscopy from ulcerative colitis

91
Q

Identify pathology picture 65

A

String sign - terminal ileum narrowed, eventually wall fibrosis and thickening keeping it like that
= Chron’s disease.

Surgery (40 decks)

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