Random_10 Flashcards
DDx for pneumatosis intestinalis
- bowel necrosis
- most important and life threatening
- mucosal disruption
- peptic ulcer dz
- endoscopy
- enteric tubes
- trauma
- child abuse
- UC or Crohn’s disease
- increased mucosal permeability - often associated with immunosuppression
- AIDS
- organ transplantation
- chemotherapy
- steroid
- graft vs host dz
- pulmonary conditions - air from disrupted alveoli dissect along the bronchopulmonary interstitium and retroperiteoneum along the visceral vesels to the bowel wall
- COPD
- asthma
- mechanical ventilation
- ptx
- pneumediastinum
Cystic pneumatosis
vs
Linear pneumatosis
- cystic pneumatosis -
- well-defined blebs or grapelike clusters of spherical air collections in the subserosal region
- usually benign
- these air cysts may rupture and result in benign pneumoperitoneum
- linear pneumatosis -
- streaks of gas within and parallel to the bowel wall
- maybe benign or ischemic causes
Sigmoid volvulus
vs
Cecal volvulus
- sigmoid volvulus
- point towards LLQ
- proximal colon and small bowel are dilated
- cecal volvulus
- point towards RLQ
- proximal small bowel dilated
- distal colon collapsed
- vs cecal bascule - folding rather than a twisitng of a mobile cecum
Courses of pelvic muscles
iliopsoas
piriformis
pelvic diaphragm
- Iliopsoas
- psoas m. joins the iliacus m.
- lesser trochanter
- Piriformis
- anterior sacrum to
- greater trochanter
- Pelvic diaphragm
- anterior - levator ani
- posterior - coccygeus
Level of aortic bifurcation
Level of iliac artery bifurcation
- Aorta bifurcates into common iliac arteries at the level of iliac crest
- Common iliac arteries bifurcates at the level of pelvic brim - marked on CT by the transition b/t the convex sacral promontory and the concave sacral cavity
Denonvillier’s fascia
tough barrier b/t the prostate and rectum
preventing spread of disease from one organ to the other
Cervical malignancies
- 85% - squamous carcinoma
- 15% - adenocarcinoma
- low attenuation or isoattenuating compared to normal cervix - reduced vascularity, necrosis or ulceration
- II-b - invasion of the parametrium - no longer surgical candidate
Endometrial malignancy
Hematogenous spread to lung, bone, liver, and brain is much more common with endometrial cancer than cervical cancer
In adnexal torsion, the uterus is usually deviated to the affected side
In adnexal torsion, the uterus is usually deviated to the affected side
Trough sign

Vertical lucency
indicates an impaction from posterior shoulder dislocation
When disc material migrates from the parent disc, it is termed a “sequestered” or “free fragment”
:
When disc material migrates from the parent disc, it is termed a “sequestered” or “free fragment”
By noting the density differences b/t the “mass” and the thecal sac
By noting the density differences b/t the “mass” and the thecal sac
- if “mass” is denser than thecal sac - it is a bulged disc or sequestered disc
- if “mass” is isodense as the thecal sac - it is a Tarlov cyst/perineural cyst or conjoint nerve root
Types of spinal stenosis
Types of spinal stenosis
- central canal stenosis
- lateral recess stenosis
- neuroforaminal stenosis
Central canal stenosis
- most useful CT criteria for diagnosing central canal stenosis - obliteration of epidural fat & flattening of the thecal sac
- most common cause of central canal stenosis - fact degenerative disease
- other causes
- hypertrophy of ligamentum flavum - actually “buckling”
- paget’s disease
- DISH with ossification of the posterior longitudinal ligament
Neuroforaminal stenosis
Causes of neuroforaminal stenosis
- degenerative joint disease
- osteophytes arising from the vertebral body or the facet
- disc protrusion
- postop scar
DDx of diseae entities that have sequestrum
DDx of diseae entities that have sequestrum
- osteomyelitis
- EG
- desmoid tumor
- malignant fibrous histiocytoma
Ortner Syndrome
Cardiovocal hoarseness
- In this syndrome, the LRLN is injured as it loops around the aorta at the aortopulmonary window and along the outer side of the ligamentum arteriosum due to compression or traction caused by changes in the anatomy of the heart or great vessels.
- The left vagus nerve gives rise to the LRLN at the level of the aortic arch, which supplies muscles of the left larynx except the cricothyroid muscle (supplied by the superior laryngeal nerve).
- In isolation, laryngeal findings cannot differentiate RLN palsy from high vagal lesions; however, coincident pharyngeal constrictor atrophy and ballooning of the pharyngeal wall suggest pharyngeal plexus injury due to brain stem or central vagal nerve lesions. Moreover, coincident palsies/atrophy of the trapezius and sternomastoid muscles indicate associated spinal accessory nerve injury with involvement at the jugular foramen or high carotid sheath (above the level of the posterior belly of the digastric muscle).
- Evaluation of the heart, aorta, and supra-aortic thoracic vessels to rule out compression or traction along the thoracic course of RLNs should be part of screening for possible underlying causes of RLN paralysis.
“out of proportion TO…”
“Out of proportion TO…”
Fracture of the lateral talar process
“snowboarder fracture”

- often missed - anterolateral ankle pain related to such a fracture often mimics that of an anterior talofibular ligament sprain. Unfortunately, there is a high likelihood of developing osteoarthritis following lateral talar fractures, thus reinforcing the need for a correct diagnosis and optimal management.
- the lateral process is often identified inferior to the tip of the fibula. Any lucency, as in this index case, should prompt the diagnosis. Detailed evaluation of a well-positioned lateral radiograph with regard to the the angle of Gissane should demonstrate a well-defined smooth “V” shape of the lateral process.
- CT should be suggested for further evaluation if radiographic findings are equivocal, as well as to define the full extent of the fracture.
- lateral process fracture staging system (Hawkins) is:
Type I: Nonarticular chip fracture
Type II: Intra-articular, single fracture line
Type III: Intra-articular, comminuted

Normal and abnormal ankle xrays

Lateral talar process fracture

Gissane’s angle

Gissane’s angle


Left PICA stroke
ALWAYS look at the cerebellar hemispheres!
REMEMBER:
Cerebellar stroke - symptoms are IPSILATERAL!!!
Fibers have already crossed over!
When describing perianal abscess, it is important to differentiate b/t
intra-sphincteric
vs
extra-sphincteric
abscess
When describing perianal abscess, it is important to differentiate b/t
intra-sphincteric
vs
extra-sphincteric
abscess
Cause of post aneurysm coiling headache?
- RARE - delayed rupture of the aneurysm, which may have been ruptured partially during the coiling process
- COMMON - thrombosis of the aneurysm inciting an inflammatory response















