Random 12 Flashcards
- capsular artery
- centripetal artery
- recurrent artery
- transmediastinal artery
- transmediastinal vein
- capsular artery
- centripetal artery
- recurrent artery
- transmediastinal artery
- transmediastinal vein
Caroli’s disease
- central dot sign = cystic lesions with central solid components containing blood flow
- complications
- biliary stones
- bild duct obstruction
- cholangitis
- liver abscess
- hepatic fibrosis –> portal hypertension
- cholangiocarcinoma
- the kidneys may also be affected with a variety of cystic diseases
Longitudinal gray-scale and color Doppler views of the thumb in a patient with a palpable mass along the volar surface.
- 2nd most common mass lesion in the hand (most common = ganglion cyst)
- solid with internal vascularity
- intimately associated with tendon sheath
- a benign disorder of proliferative synovium arising from the tendon sheaths
- histologically identical to PVNS
- women > men
Gangrenous cholecystitis
- focal mucosal ulceration
- sloughed mucosal membranes
- a focal bulge in the gallbladder wall.
- This is likely due to the combined effects of progressive increase in intraluminal pressure and focal weakening of the gallbladder wall
- patients will often have NEGATIVE Murphy’s sign
Tubular Ectasia of the Rete Testes
- The rete testes are a complex collection of small tubules that are located in the mediastinum of the testis. Fluid from the seminiferous tubules drains into the rete testis and then exits the rete testis via the efferent ductules. The efferent ductules then converge into the head of the
epididymis. - Tubular ectasia of the rete testes is believed to be caused by some degree of outflow obstruction of the seminiferous fluid. Perhaps this is the reason why it is frequently associated with testicular cysts and spermatoceles of the epididymal head. It is also more commonly seen in patients with a history of inguinal surgery, such as hernia repairs and vasectomies.
- The key to making the diagnosis and distinguishing tubular ectasia of the rete testes from cystic testicular tumors is to note the bilateral involvement when present and to recognize the elongated shape on long-axis views of the testis.
Renal artery stenosis
- 5% of total number of patients with HTN
- criteria
- PSV > 180-200cm/sec
- Renal/aortic ratio > 3.0-3.5
Pleomorphic parotid adenoma
- most common parotid neoplasm - parotid pleomorphic adenoma
- women > men
*
Salivary gland neoplasms
- 85% occur in parotid gland
- The chance of malignancy increases
as the size of the gland decreases- parotid gland < submandibular gland < sublingual gland
- most common parotid neoplasm
- pleomorphic adenoma - solid, homogeneous, hypoechoic
- 2nd most common parotid neoplasm
- Warthins tumor - heterogeneous hypoechoic mass with cystic components
The gray-scale view shows a complex fluid
collection arising from the right kidney. In addition,
there is a simple-appearing, round, cystic structure
within the otherwise complex collection. The
power Doppler view shows flow in the apparent
cyst. All of these findings are consistent with a
pseudoaneurysm and adjacent hematoma.
Always put color Doppler on a “simple-appearing” cyst to make suer it is not something else!!!
Always put color Doppler on a “simple-appearing” cyst to make suer it is not something else!!!
DDx for “peritoneal masses” on US
- peritoneal carcinomatosis
- mesothelioma
- endometriomas
- splenosis
- lymphadenopathy
Testicular epidermoid cyst
- benign germ cell neoplasm
- monodermal teratoma - only ectodermal components
- appearance
- well-marginated lesoins that are typically hypoechoic
- hyperechoic rim with complete or partial rim of calcification
- onion ring/peel appearance
Renal vein thrombosis
Slowly progressive thrombosis allows for the
development of venous collaterals, and incomplete
thrombosis allows for maintained venous outflow so
that effects on the kidney may be absent or minimal.
On the other hand, complete and rapid thrombosis
results in hemorrhagic infarction of the kidney.
Slowly progressive thrombosis allows for the
development of venous collaterals, and incomplete
thrombosis allows for maintained venous outflow so
that effects on the kidney may be absent or minimal.
On the other hand, complete and rapid thrombosis
results in hemorrhagic infarction of the kidney.
It is also important to realize that in native kidneys, arterial inflow may be affected only minimally. This likely is related to venous collaterals that develop and provide continued venous outflow despite venous thrombosis in the main renal vein. In transplants, collateral flow is not possible, so complete RVT results in marked alteration in the arterial signal. This usually produces a classic to-and-fro pattern with pandiastolic arterial flow reversal.
Thyoid in a patient with neck pain
Dx: subacute thyroditis
If there is no neck pain, then think of cancer
Page kidney
- subcapsular hematoma/fluid collection causes compression
- elevated resistive index/RI
- can lead to hypertension
What are the tendons passing behind the
medial malleolus
vs
lateral malleolus
- passing behind medial malleolus
- Tom-Dick-Harry
- posterior tibial
- flexor digitorium longus
- flexor hallucis longus
- passing behind lateral malleolus
- peroneal longus
- peroneal brevis
Adenomyomatosis
- cholesterol crystals in the Rokitansky-Aschoff sinuses
- bright comet-tail artifacts
- due to a hyperplastic condition of the gb wall - characterized by small mucosal diverticula that protrude into a thickened layer of muscle - the mucosal diverticula are called Rokitansky-Aschoff sinuses
- men = women
- no malignant potential
- involvement - diffuse, segmental, or focal
- diffuse - may not be apparent
- segmental - may have midwall involvement - hourglass appearance
- focal - often fundal
Acquired cystic disease of the kidneys
NOTE: atrophic, echogenic kidneys!!!
vs inherited polycystic kidney disease!!!
Emphysematous cholecystitis
- dirty shadow, ring down artifact
- more common in men - diabetics, vascualr dz
- surgical rx
Hashimoto thyroiditis
aka
Chronic autoimmune lymphocytic thyroiditis
- most common cause of hypothyroidism in US
- women > men
- autoantibodies against thyroglobulin
- associated with increased risk of thyroid lymphoma
The normal portal vein travels
deep to the hepatic artery. Periportal collaterals
travel anterior to the hepatic artery.
The normal portal vein travels
deep to the hepatic artery. Periportal collaterals
travel anterior to the hepatic artery.
Prominent renal papillary tips
- differential diagnosis of nonshadowing soft tissue masses in the renal calyces
- sloughed papillae
- blood clots
- fungus balls
- TCC
- malakoplakia
- leukoplakia
- cholesteatoma
- prominent papillary tips
- always seen with hydronephrosis
- The normal renal pyramids are cone shaped, with the apex of the cone directed toward the calyx. The rounded
apex, or papillary tip, protrudes into the calyx, producing the typical cuplike appearance seen on intravenous
urograms. However, in the setting of hydronephrosis, the calyx may distend with urine, and the papillary tip can become surrounded by the urine in the calyceal fornices. When viewed in long axis, the morphology of the papillary tip is usually easily visible, and its origin is
recognizable. When viewed in short axis, the papillary tip can simulate a pathologic filling defect in the collecting system. This pitfall is very unusual in native kidneys
and slightly more common in renal transplants.
Focal testicular atrophy
- Focal hypoechoic striations and bandlike regions radiating from the periphery of the testis toward the mediastinum.
- Due to focal tubular atrophy and fibrosis
*
HA thrombosis following liver transplant
- Significant hepatic artery stenosis and hepatic artery thrombosis with collateral flow can be detected with Doppler scanning by noting a blunted arterial waveform distal to the stenosis. Blunting can be quantified in several ways.
- The easiest is by measuring the resistive index. If the resistive index is less than 0.4, the waveform should be considered severely blunted, and a diagnosis of hepatic artery stenosis or thrombosis should be made.
- In this case, the left hepatic artery serves as a collateral receiving blood from the left gastric artery
- Since the bile ducts are dependent on hepatic arterial supply, arterial thrombosis causes biliary ischemia and can produce strictures or complete necrosis of the ducts.
What to check for when you are worried about
hydronephrosis
urinary obstruction
ureteric stone?
Ureteral jets
Ureteral jets become abnormal before the renal RI
Normal RI of hepatic artery in transplant liver
Normal RI of intrerenal artery
- normal RI in hepatic artery in transplant liver >0.4
- if RI < 0.4, proximal HA stenosis/thrombosis
- normal RI in ntra-renal artery 0.5-0.7
Hepatic spectral waveforms
of
hepatic vein
and
portal vein
- Inversion of the systolic peak indicates the presence of tricuspid regurgitation.
- Recall that there should be antegrade flow out of the liver at all times except during right atrial contraction. In fact, the antegrade flow is divided into a systolic
component, which is usually larger, and a diastolic component, which is usually smaller. In this case, there is only one antegrade component (below the baseline). - In the normal liver, the portal venous system is isolated from the right atrial pulsations by the hepatic parenchyma. Therefore, the normal portal venous
waveform is only minimally pulsatile. However, when the sinusoids become congested, the right atrial pulsations
can be transmitted to the portal vein, and the portal vein waveform becomes abnormally pulsatile. Since some degree of portal vein pulsatility is normal,
especially in otherwise healthy thin patients, the point at which a pulsatile portal vein should be called abnormal
is not precisely defined. However, if the maximum velocity drops below zero, then right-side heart dysfunction should be considered.
In most extrarenal situations, infection causes an
associated hyperemia. The kidneys are one of the few
organs that respond to infection with a decrease in bloodflow.
In most extrarenal situations, infection causes an
associated hyperemia. The kidneys are one of the few
organs that respond to infection with a decrease in bloodflow.
Urethral diverticulum
- most female urethral diverticulae
develop from an infected paraurethral gland that erodes into the urethra and maintains a persistent patent neck between the urethra and the cavity. - Because these lesions do not contain elements of the urethral wall, they are really pseudodiverticulae.
Arterial supply to bile ducts
The bile ducts possess an arterial plexus on their surface which is supplied from below by ascending marginal vessels derived from the postero-superior pancreaticoduodenal artery.
These marginal vessels end above in the right hepatic artery or its branches. The right and left hepatic ductal systems are supplied by the right and left hepatic arteries and their sectoral or segmental branches. The right and left hepatic arteries communicate freely via the hilar plate arterial plexus. This collateral system allows the blood supply to the right hepatic duct to be maintained after ligation of the right hepatic artery and interruption of the common hepatic duct or excision of the confluence.
Normal portal vein velocity
vs
Normal portal vein velocity following TIPS
Normal portal vein velocity = 15-40 cm/sec
vs
Normal portal vein velocity following TIPS > 30 cm/sec
Normal flow velocity within TIPS
Flow velocity in the TIPS should be rapid. In our experience, the normal range for stent velocity is 90 to 190 cm/sec. Higher and lower velocities should both raise the suspicion of a stenosis.
In this case, The power Doppler view shows incomplete color fill-in of the stent due to hypoechoic tissue along
the wall of the stent. The portal vein waveform shows an abnormally low velocity in the main portal vein (<30 cm/sec). The stent waveforms show an elevated velocity in the mid stent (>190 cm/sec) and a discrepancy of velocities in the proximal and in the mid stent (velocity difference of >100 cm/sec is abnormal).
Renal vein thrombosis
- to-and-fro pattern
- pandiastolic flow reversal
- DDx for this pattern of flow in renal transplant
- renal vein thrombosis
- severe vascular rejection
- tense subcapsular hematoma
- look for lack of venous flow in the hilum
- Unlike native kidneys, there are no venous collaterals in a transplant, so renal vein thrombosis is much more likely to produce infarction. Therefore, this complication is considered a surgical emergency and requires rapid diagnosis.
Killian-Jamieson diverticulum
Killian-Jamieson diverticulum
- KJD results from an outpouching of the esophagus into the Killian-Jamieson space caudal to the cricopharyngeus and lateral to the longitudinal esophageal ligament. The location often results in misdiagnosis as a Zenker diverticulum or thyroid nodule.
- Zenker’s diverticulum - a false diverticulum containing mucosa and submucosa that originates on the posterior wall of the pharyngoesophageal segment as a midline outpouching in Killian dehiscence. Killian dehiscence is the triangular space between the thyropharyngeal portion of the inferior constrictor and the cricopharyngeus muscle. This portion of the pharynx is weak and prone to Zenker diverticula formation. Radiographically, a Zenker diverticulum appears as a sac lying posterior to the cervical esophagus on lateral images and in the midline on frontal images rostral to the cricopharyngeus. The sac shown on the esophagram is anterolateral to the esophagus.
Where does external jugular vein drain into?
The external jugular vein drains into the subclavian vein lateral to the junction of the subclavian vein and the internal jugular vein.
Normal AC and CC joint intervals
- AC = 5mm
- CC = 11mm
What to think about when you see high parietal cortical infarct and white matter changes?
Watershed infarct
Underlying seveve carotid stenosis
maybe superimposed hypotension
Lisfranc ligament diagonally connects the 1st (medial) cuneiform with the base of the 2nd metatarsal
Lisfranc ligament diagonally connects the 1st (medial) cuneiform with the base of the 2nd metatarsal
BANE of my existence
BANE of my existence
Pelvic muscle attachments
associated avulsion injuries
7 up coke down
The anal sphincter is comprised of three layers:
- Internal sphincter: continuance of the circular smooth muscle of the rectum, involuntary and contracted during rest, relaxes at defecation.
- Intersphincteric space.
•External sphincter: voluntary striated muscle, divided in three layers that function as one unit.
These three layers are continuous cranially with the puborectal muscle and levator ani (figure).
.
The puborectal muscle has its origin on both sides of the pubic symphysis, forming a ‘sling’ around the anorectum.
.
Lesser vs Greater Wing of the sphenoid
- B - lesser wing
- C - greater wing
- Chloroma (aka granulocytic sarcoma or extramedullary myeloblastoma) is a rare solid tumor composed of primitive granulocytic precursor cells.
- Initially named “chloroma” in 1853 due to greenish color of typical forms, caused by high levels of myeloperoxidase in the immature tumor cells. Renamed “granulocytic sarcoma” in 1966, as not all tumor cells are green.
- Chloromas have been observed in patients with acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), and other myeloproliferative disorders.
- Chloromas occur in 2.5% to 9.1% of AML patients and are five times less common in CML patients.
- Location is highly variable, and lesions are often multiple at presentation. Preferentially involve orbits and subcutaneous tissues, but have been described in lymph nodes, paranasal sinuses, bone, spine, pleural and peritoneal cavities, central nervous system, breasts, thyroid, salivary glands, small bowel, lungs, and pelvic organs.
- In the chest, chloroma most commonly involves the mediastinum; less commonly involves the lungs, pleura, pericardium, and hila.
- Commonly manifests as smooth, well-circumscribed, soft-tissue density masses with variable, typically mild enhancement.
- Pleural disease is often associated with pleural effusion.
- Protean pulmonary parenchymal manifestations include focal alveolar consolidation, prominent interstitial septal lines, and pulmonary nodules.
- Lesions often respond rapidly (often resolving within three months) to radiation therapy or to systemic chemotherapy.
Types of odontoid process fracture
Hepatic angiosarcoma
- Although primary hepatic angiosarcoma represents only 2% of primary liver tumors, it is the most common malignant mesenchymal tumor of the liver.
- The imaging features of hepatic angiosarcoma vary. It may present as multiple nodules, a dominant mass, or as a diffusely infiltrating lesion.
- Hepatic angiosarcoma may mimic metastases or benign hemangioma.
- RF: arsenic, thorium dioxide (Thorotrast), and polyvinyl chloride. Most tumors arise in the absence of such exposures.
- most common in males aged 50–70
- Hepatic angiosarcoma is typically hyperechoic on ultrasound
Sinding-Larsen-Johansoon disease
vs
Patellar sleeve fractures
vs
Osgood-Schlatter disease
- Sinding-Larsen-Johansson disease (SLJ) affects the proximal end of the patellar tendon as it inserts into the inferior pole of the patella, and represents a chronic traction injury of the immature osteotendinous junction.
- Patellar sleeve fracture - same age group; avulsion of inferior pole cartilage often with small fracture fragement
- Osgood-Schlatter disease - chronic fatigue injury due to repeated microtrauma to involving the patellar ligament insertion onto the tibial tuberosity.
Tubal ring sign
The tubal ring sign is one of the ultrasound signs of a tubal ectopic. It comprises of an echogenic ring which surrounds an unruptured ectopic pregnancy. It is said to be 95% specific.
Posterior wall of the acetabulum
should always be lateral to
the anterior wall of the acetabulum
AND
they shouldn’t intersect
- POSTERIOR wall of the acetabulum
- ANTERIOR wall of the acetabulum
- roof of the acetabulum
- tear drop
- ilioischial line - posterior column
- iliopectineal line - anterior column
Dysembryoplastic neuroepithelial tumours (DNET)
- slow growing, benign tumor
- arise from cortical or deep gray matter
- arise from secondary germinal layers and are frequently associated with cortical dysplasia
- most common location - temporal lobe
- CT
- hypodense
- no enhancement
- calcification 20-40%
- scalloping of inner table of the skull
- MR
- T1 hypo
- T2 high - “bubbly appearance”
- DWI - no restriction
- T1 post gad - may show enhancement
Haglund deformity
- Haglund syndrome is an important cause of retrocalcaneal pain that is manifested by a triad of features:
- a prominent bursal projection of the posterosuperior calcaneus (the Haglund deformity),
- retrocalcaneal bursitis,
- Achilles insertional tendinopathy.
Haglund syndrome is an important cause of retrocalcaneal pain that is manifested by a triad of features: a prominent bursal projection of the posterosuperior calcaneus (the Haglund deformity), retrocalcaneal bursitis, and Achilles insertional tendinopathy.
It has been proposed that the bony Haglund deformity contributes to impingement of the retrocalcaneal bursa and the distal Achilles tendon.
A soft-tissue prominence is often observed at the posterior heel and has been designated the “pump bump,” owing its name to the classic association of Haglund syndrome with rigid, closed-heel shoes.
Normal hepatic artery waveform
a-s-v-d
a - atrial kick - retrograde flow
s - ventricular systole - rapid atrial filling; largest trough for antegrade flow
v - tricuspid valve close - back to baseline
d - ventricular diastole - rapid atrial emptying; second largest trough for antegrade flow
Hinged knee prosthesis
Relationship b/t choroid and retina?
