Random Shii Flashcards
Most common type of endoleak?
Type 2
Filling of sac by feeder artery eg IMA or lumbar artery
Type 4 endoleak
“4 is through the pores”
Doesn’t happen in modern stents.
Endoleak requiring urgent intervention
Type 1 & 3
High flow types. Most common type 2 often managed expectantly.
Type of embolisation for embolising a tumour…
Liquid agent.
Blocks all end arterioles.
Why do you do angio run before placing IVC filter?
4 reasons…
- Confirm IVC patency
- Measure size needed
- Confirm no double (left sided) IVC
- Check renal vein position
*Infrarenal filter placement preferred
Contraindications for TIPS
Severe (right) heart failure. (Need an echocardiogram prior to undertaking).
Severe encephalopathy.
Best response to fibroid embolisation…
• Submucosal (subserosal do poorly).
• Enhancing “cellular” type (degenerated do poorly).
• Small fibroids.
particle embolisation usually (not coils or glue)
Fibroids which can’t be emobilised and need surgery
Pedunculated
Risk of detachment
Snowman sign on CXR
TAPVR
AKA figure of 8 sign.
Rheumatic heart disease:
What valves are affected?
Mitral stenosis
Aortic stenosis
“Rheu-MA-tic”
String of beads sign - brain MRI
Watershed infarcts
Massive splenomegaly
• CML
• Myelofibrosis
• Gaucher’s
• Malaria
Meigs syndrome
• Ovarian fibroma
• Ascites
• Pleural effusion
Most common site of ectopic pregnancy
Ampullary portion of fallopian tube
Cystic lesion anterolateral wall of the upper vagina
Gartner duct cyst
• May contain proteinaceous fluid with variable T1.
• Association with Wunderlich syndrome (renal agenesis/ectopia)
Feeding vessel or vascular pedicle
(Gynae)
Endometrial polyp
Breast cancer type with Paget’s disease of the breast
DCIS
PDOG lesions with drug resistant epilepsy (3)
PD-G
- PXA (pleomorphic xantho)
- DNET
- Ganglioglioma
*Oligo does not as grows too fast
Peripheral lobar microbleeds and convexity SAH
Cerebral amyloid angiopathy
• Friable leptomeningeal/cortical vessels.
• Common cause of lobar ICH in elderly.
• BP is NORMAL. Hypertensive angiopathy is CENTRAL.
Hypertensive vs amyloid angiopathy
Hypertensive is central.
———————————-
Amyloid is peripheral.
Old lady. Oestrogen producing ovarian tumour.
Thecoma
Ovarian tumour in child with precocious puberty
Granulosa cell tumour
• Subtype of sex cord stromal tumour.
• Sponge-like appearance on MRI.
• Association with Maffucci’s & Ollier’s
Brain tumours associated with Turcot’s syndrome
Medulloblastoma
Glioblastoma
Most common intramedullary spinal cord tumour in adults
Ependymoma
• 60% of adult spinal tumours
• Average 4 vertebral body lengths
• T2 hyperintense and enhances
Most common intramedullary spinal cord tumour in kids
Astrocytoma
• 60% of paeds spinal tumours (2nd most common overall)
• Peak age is 30 yrs
• Longer (average length 4-7 vertebrae)
Forceps delivery and neck swelling
Fibromatosis colli
Compartment syndrome > pressure necrosis > fibrosis of sternocleidomastoid
Present at few weeks of age. May be little to see on US.
Most common lesion in trigone of lateral ventricle in an adult
Meningioma
Triad of:
- Abdominal wall hypoplasia
- Bilateral cryptorchidism
- Pelvicalyceal dilatation and renal dysplasia
Prune belly syndrome
A.k.a Eagle-Barrett syndrome
Wrinkled/shrivelled abdomen - looks like a prune
Prune belly syndrome associations
Down’s syndrome
Malrotation
Wolman disease
Deposition of fat in multiple organs.
Hepatosplenomegaly and enlarged calcified adrenals.
Usually fatal with death in infancy.
Spinal lesion occurring at the conus or filum terminale
Myxopapillary ependymoma
Average age 35 yrs. Most common lumbar spinal tumour.
Low density in temporal lobe, insula and inferolateral frontal lobe but sparing of basal ganglia
HSV encephalitis
Stroke mimic but basal ganglia spared
WAGR syndrome
W - Wilms tumour
A - Aniridia (absence of iris)
G - Genitourinary anomalies
R - Retardation
Most common congenital diaphragmatic hernia
Bochdalek
Bochdalek hernia location
• Left sided in 85% (Bochda-L-ek)
• Posterolateral (Back-dalek)
• Pulmonary hypoplasia
Morgagni hernia
• Right sided 95%
• Anterior
• Rare
Gastroschisis
• Small right sided defect (~4cm)
• No surrounding membrane
• Malrotated
• Association with raised AFP
Omphalocele
A.k.a. Exomphalos
• Midline
• Larger defect
• Covering membrane (may be ascites)
• Liver herniation more common
• Association with other anomalies (Downs, Turners, Klinefelters, Beckwith-Wiedman and other issues)
• Worse prognosis
JC virus
Progressive multifocal leukoencephalopathy
Adult. Female. Retrobulbar mass with enopthalmos.
Breast cancer
Infiltrative retrobulbar mass. Enophthalmos is characteristic.
Lesion of mandible with tooth resorption
Ameloblastoma
Radiolucency around the CROWN of an unerupted/impacted tooth
DENTIGEROUS CYST
• Cyst encloses the crown
• Association with ameloblastoma and can become one
ADEM
(Acute disseminated encephalomyelitis)
Post-viral or vaccination. Typically 1-2 weeks.
Autoimmune demyelination that improves with steroids.
Very difficult to differentiate from MS.
Krabbe disease
Posterior white matter + cerebellum + spinal cord
Crabs are SLOW (behind) and low (inferior)
Metabolic disturbance and mimic of infarct in pons
Osmotic demylination syndrome/central pontine myelinolysis
• Low density CROSSING MIDLINE
• Restricted diffusion
• High T2 trident shaped
May also be extrapontine which can occur simultaneously or in isolation.
Bilateral optic neuritis + transverse myelitis + aquaporin 4 antibodies
Neuromyelitis optica
Longitudinally extensive spinal cord lesion with expansion from swelling.
Empty thecal sac
Arachnoiditis
Nerve roots adhere to dura.
Can alternatively clump together mimicking a mass.
Iatrogenic and infectious eg TB causes.
Involvement of medial thalami, periaqueductal grey matter and mamillary bodies
Wernicke’s encephalopathy
Ashkenazi Jews are predisposed to…
Canavan’s
Gaucher’s disease
Tay-Sachs disease
Gaucher’s disease
• Accumulation of fatty substance in RETICULOENDOTHELIAL SYSTEM.
• ERLENMEYER flask deformity.
• Diagnosed by BONE MARROW ASPIRATE.
• Cause of MASSIVE SPLENOMEGALY. 95% have splenomegaly.
• Anaemia, large joint stiffness and pain if symptomatic.
Lytic bone mets
RCC (also expansile)
Lung Cancer
Thyroid Cancer
Melanoma
Breast Cancer (typically mixed)
NHL
Widened growth plate and metaphyseal cupping in child
Rickets
Also:
Delayed fontanelle closure
Poor epiphyseal mineralisation
Bowing deformity
Prostatic utricle cyst
Pear shaped
Communication with urethra
Intraprostatic
Order of occular muscle involvement in thyroid eye disease
I’M SLow
Inferior rectus
Medial rectus
Superior rectus
Lateral rectus
Tendinous insertions spared.
Mnemonic for calcified glial tumours
”Old Elephants Age Gracefully”
O - Oligodendroglioma
E - Ependymoma
A - Astrocytoma
G - Glioblastoma
(In order of decreasing incidence)
NF-1 mnemonic
CAFE SPOT
C: Café-au-lait spot (>6 in 1 yr)
A: Axillary or inguinal freckling
F: Fibromas (& FASI)
E: Eye hamartomas (Lisch nodules)
S: Skeletal abnormality eg sphenoid wing
P: Positive family history
OT: Optic Tumour
F: 2 neurofibromas or 1 plexiform neurofibroma
Most likely site of tear/transection of aorta?
Isthmus
(Distal to left subclavian artery origin)
Transient non-segmental peripheral consolidation with eosinophilia
Löeffler’s syndrome (simple pulmonary eosinophilia)
Fibrosing mediastinitis
• Cancer mimic in mediastinum. Often calcified.
• Compression or occlusion of mediastinal structures eg SVCO.
• Causes include:
- TB
- Histoplasmosis
- IgG4
Smoke inhalation imaging features
Pulmonary oedema
Child with calcified lung mets and pneumothorax
Metastatic osteosarcoma
Mnemonic for lymphangitis carcinomatosis
”Certain Cancers Spread By Plugging The Lymphatics”
C - cervix
C - colon
S - stomach
B - breast (2nd)
P - prostate and pancreas
T - thyroid
L - lung (1st) and larynx
Child presenting with LIP
HIV
Associated with LIP in an adult
Sjögren’s
*for this reason LIP is more common in women as Sjögren’s is 9x more common in females
*NSIP still most common pattern in Sjögren’s
Traumatic urethral stricture:
Anterior
Straddle injury
Traumatic urethral stricture:
Posterior
Pelvic fracture
“U hurt ur Pee Pee”
Pyloric stenosis measurements
Single muscle thickness >3mm
Longitudinal length >14/15
Pyloric volume >1.5cm 3
*remember Pi (3.1415)
Ground glass and cysts
PCP
LIP
PCP CD4 count
<200
Ground glass and cysts
Main pulmonary artery max diameter
29mm
If 30 or above = PAH
Lung cancer with cavitation
Squamous cell carcinoma
Scoring system for malignant probability of pulmonary nodules
Brock model
Herder score takes into account FDG PET findings too
Dilated thoracic duct
LAM
Gynaecomastia in a man
Central
Retroareolar
Flame shaped
An ECCENTRIC position is highly suspicious for cancer.
T4 RCC
Extension beyond Gerota’s fascia
T3 RCC
Extension beyond kidney but WITHIN Gerota’s fascia:
• T3a - renal vein
• T3b - IVC below diaphragm
• T3c - IVC above diaphragm or IVC wall
T4 renal pelvis cancer eg TCC
Invades perinephric fat or into adjacent organs
Penile calcification
Peyronie’s disease
Fibrous tissue plaques within tunica albuginea causing bent penis with painful erections
Bell clapper deformity
Testicular torsion
High insertion of tunica vaginalis on spermatic cord. Predisposes to torsion. Bilateral in 65-90%.
Nutcracker kidney
• Compression of left renal vein between overlying SMA and aorta.
• Haematuria and loin pain.
Superior quadrantanopia
Aka “pie in the sky”
Temporal lobe lesion
S is next to T
Inferior quadrantanopia
Parietal lobe
IP
Gradenigo syndrome
Triad of:
1. Otitis media
2. Retroorbital pain
3. Abducens (VI) nerve palsy - eye deviated medially
HIV vs PML
“U DON’T want HIV”
• U fibres spared in HIV. Involved in PML.
• Cortical atrophy in HIV.
• HIV is symmetrical. PML asymmetrical.
Pregnant pt with preeclampsia. Bilateral occipital hypo-attention.
PRES
Failure of posterior circulation to auto-regulate with acute changes in BP. Extensive cerebral oedema. Sometimes infarcts or haemorrhages.
*not always posterior or reversible
Most common thyroid cancer
Papillary
• Hypoechoic on US. Punctate calcification. Sometimes cystic.
• Association with bowel polyposis syndromes.
Parasitic infection from pigs
Neurocysticercosis
Adenomatous vs hamartomatous polyps
Get To Fuck | Chinese Communist Party
G - Gardner’s syndrome
T - Turcot syndrome
F - FAP
____________________________
C - Cowden’s syndrome
C - Cronkhite-Canada syndrome
P - Peutz-Jegher’s syndrome
Breast cancer screening age
50-70
*>70s can request screening every 3 years too
400-800 cancers detected for every cancer induced. 20% reduced mortality.
Lobster claw sign (kidney)
Papillary necrosis
Radiolucent renal calculi
HIV on indinavir
Antibiotics eg amoxicillin, cipro, nitro
Allopurinol
Schistosomiasis organism
Schistosoma haematobium affects urinary tract
Placenta accreta spectrum
• Accreta - villi ATTACH to myometrium
• Increta - villi partially INVADE myometrium
• Percreta - villi PENETRATE through beyond serosa
A-I-P
Single umbilical artery
Trisomy 18 (Edward’s syndrome)
Urethral cancer histology
Prostate - TCC
Elsewhere - SCC
Mayer-Rokitansky-Küster-Hauser syndrome (MRKH)
Congenital absence of the uterus and upper 2/3 vagina.
BUT
Normal ovaries and fallopian tubes
Tamoxifen associated endometrial changes
• Endometrial polyps (8-36%)
• Endometrial hyperplasia (1-20%)
• Cystic endometrial atrophy
• Endometriosis (increased risk endometrial carcinoma)
Name of first breast screening
PREVALENT
Screening starts at 50 so will be 50-53.
Incident is any subsequent screening.
Endometrial thickness in postmenopausal woman
<5mm
Serous vs mucinous cystadenocarcinoma of the ovary
Serous
• Most common malignant ovarian mass
• More likely bilateral
• Peritoneal carcinomatosis
Mucinous
• More likely unilateral & multiloculated.
• Stained glass appearance from varying mucin content of cysts.
• Pseudomyxoma peritonei
• Can rupture
SeHCAT scan
NM study for **bile salt malabsorption••. Used in investigation of diarrhoea.
MEN-1
PPP | Pi-Par-Panc
Pituitary adenoma
Parathyroid adenoma/hyperplasia
Pancreatic neuroendocrine tumour
MEN-2a
PPM
Phaeochromocytoma
Parathyroid hyperplasia
Medullary thyroid cancer
MEN-2b
PMMM
Phaeochromocytoma
Medullary thyroid cancer
Marfanoid habitus
Mucosal neuromas/ganglioneuromas
Fibrosing thyroiditis, IgG4, euthyroid, painless thyroid mass
Riedel thyroiditis
Weigert-Meyer law
UU | IR
Upper moiety - UU / UI
• Ureterocoele and obstruction.
• Ectopic insertion of ureter medial and inferiorly. Upper pole - inferior insertion.
Inferior moiety - IR
• Reflux
• Normal insertion
Penile cancer
SCC
• Associated with HPV
• Enhances but less so than corpus cavernosum & spongiosum
NF-2 mnemonic
MISME
Multiple Inherited Schwannomas, Meningiomas and Ependymomas
Megaureter
> 7mm diameter
Most common parasitic infection worldwide
Ascariasis
Intestinal worms with central alimentary tract. Will ingest barium.
Tapeworms are much longer and have no alimentary tract so cannot ingest barium.
Pattern of infant myelination
UFO
Up - Caudal to cranial
Forwards - Posterior to anterior
Outwards - Deep to superficial
*completes at ~9 months
Max aortic aneurysm diameter before intervention
> 5.5cm inner to inner
Refer to vascular.
> 3cm is abnormal.
Max aortic diameter before intervention needed
>5.5cm inner to inner
Refer to vascular.
>3cm is abnormal. If grown by >1cm in 1 yr may also intervene.
Cephalohaematoma
• Subperiosteal haematoma of the outer skull following birth trauma.
• Cannot cross sutures - this distinguishes them from subgaleal haematoma.
Vessel feeding nasopharyngeal juvenile angiofibroma
Internal maxillary artery - branch of ECA
Lateral neck cyst with beak pointing between ICA and ECA
2nd branchial cleft cyst
UAC position
”T10 to L3 - gets a NO from me!!”
• May be placed high or low as long as not around abdominal aorta branches.
• Dips down into pelvis through umbilical artery -> internal iliac.
UVC position
”T8 or T9? Everything’s FINE!”
• Umbilical vein -> left portal vein -> ductus venosus -> hepatic vein -> IVC
• Tip at junction of IVC and RA.
• Thrombus and liver injury possible.