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1
Q

Good saying… From REW

“MRI of the left knee demonstrates tricompartmental osteoarthritis, severe in the medial tibiofemoral and patellofemoral compartments, with early lateral tibiofemoral compartment arthritis. “

A

Good saying… From REW

“MRI of the left knee demonstrates tricompartmental osteoarthritis, severe in the medial tibiofemoral and patellofemoral compartments, with early lateral tibiofemoral compartment arthritis. “

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2
Q

Good saying… from REW:

Suspected chronic full-thickness radial tear of the posterior horn of the medial meniscus extending to the root insertion, with medial meniscal degeneration and extrusion. Although a tear such as this can predispose to medial compartment osteoarthritis secondary to meniscal dysfunction from disruption of the longitudinally orientated fibers responsible for meniscal “hoop strength”, maceration and tearing of the medial meniscus is not unexpected given the severity of the osteoarthritis.

A

Good saying… from REW:

Suspected chronic full-thickness radial tear of the posterior horn of the medial meniscus extending to the root insertion, with medial meniscal degeneration and extrusion. Although a tear such as this can predispose to medial compartment osteoarthritis secondary to meniscal dysfunction from disruption of the longitudinally orientated fibers responsible for meniscal “hoop strength”, maceration and tearing of the medial meniscus is not unexpected given the severity of the osteoarthritis.

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3
Q

“A smaller triangular shaped segmental fragment”

A

“A smaller triangular shaped segmental fragment”

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4
Q

Knee Joint Effusion…

A

Knee Joint Effusion…

  • behind the quadriceps tendon, b/t 2 fat planes
  • if the soft tissue/fluid density measures < 5mm, no significant joint effusion
  • if > 5mm, + joint effusion
  • if > 10mm, large joint effusion
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5
Q

Typical appearance of DCIS

A

Typical appearance of DCIS

  • Mammo: fine, linear branching pattern; in a linear or segmental distribution
  • U/S: nonspecific; may see hypoechoic region +/- calcs
  • MR: non-masslike, linear or segmental enhancement
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6
Q

Normal upper limits for plantar fascia thickness?

A

Normal upper limits for plantar fascia thickness?

5mm!!!

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7
Q

DDx for intraventricular masses

Primary tumors:

  • Ependymomas: Fourth ventricle
  • Central neurocytoma: Lateral ventricle
  • Subependymoma: Frontal horn or fourth
  • Ventricle

Intraventricular meningiomas: Left atrium

  • Choroid plexus papilloma
    • Child: Left atrium
    • Adult: Fourth ventricle

Metatastasis:

  • Most common are renal and lung carcinoma.
  • Lymphoma

Infection: Tuberculoma and neurocysticercosis

A
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8
Q

Supralateral hoffa’s fat pad impingement syndrome is associated with

patella alta

A

Supralateral hoffa’s fat pad impingement syndrome is associated with

patella alta

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9
Q

Finding of hemophilia in the knee

  • hyperdense knee effusion - hemorrhage and/or hemosiderin
  • widened intercondylar notch
  • squared inferior margin of the patella
  • bulbous femoral condyles
  • flattened condylar surfaces
A

Findings of hemophilia in the elbow

  • hyperdense elbow joint effusion
  • radial head overgrowth
  • widening of trochlear notch
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10
Q

Lateral discoid meniscus >>> medial meniscus

A
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11
Q

Cartwheel

A
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12
Q

A cartwheel is a sideways rotary movement of the body. It is performed by bringing the hands to the floor one at a time while the body inverts. When both hands are on the floor, the legs travel over the body and feet return to the floor one at a time, ending with the performer standing upright.

A
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13
Q

Causes of anterior compression of the cord at the cervicomedullary junction?

  • synovial cyst
  • rheumatoid pannus
  • epidural abscess/hematoma
  • clival tumor
  • vertebral artery dolichoectasia
A

Causes of anterior compression of the cord at the cervicomedullary junction?

  • synovial cyst
  • rheumatoid pannus
  • epidural abscess/hematoma
  • clival tumor
  • vertebral artery dolichoectasia
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14
Q

normal volar tilt of radius

A

0-22 degrees

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15
Q

Sinus of valsalva aneurysm

  • M:F= 4:1
  • associated with ventricular septal defects, aortic insufficiency, and bicuspid aortic valve
  • congenital form - most often involving the right coronary sinus
  • secondary form - most often involving the left coronary sinus (endocarditis, trauma, syphilis, TB)
  • complications
    • right coronary sinus - rupture into RV - aortocardiac shunt
    • left - rupture into the RA
    • other - heart block, aortic regurg, MI, etc
A
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16
Q

Rhizotomy

A

A rhizotomy (/raɪˈzɒtɵmi/ ry-ZOT-ə-mee) is a term chiefly referring to a neurosurgical procedure that selectively destroys problematic nerve roots in the spinal cord, most often to relieve the symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy.

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17
Q

Segments of the ICA

A
  1. cervical
  2. petrous
    1. caroticotympanic artery
    2. vidian artery
  3. lacerum
  4. cavernous
    1. meningohypophyseal artery
    2. inferolateral artery
  5. clinoid
  6. ophthalmic
    1. ophthalmic artery
    2. superior hypophyseal artery
  7. communicating
    1. posterior communicating artery
    2. anterior choroidal artery
    3. ACA
    4. MCA
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18
Q

What to do with a trauma cervical spine when:

  • there is a lot of degenerative changes
  • no acute fracture?
A

Suggest MR cervical spine if there is cervical myelopathy

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19
Q

How do you tell the difference b/t medial vs lateral femoral condyle

on a lateral xray of the knee???

A

Lateral femoral condyle’s sulcus terminalis involves the weight bearing area

Medial femoral condyle’s sulcus terminalis is usually more anterior

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20
Q

If there is absolutely no residual ACL fiber remaining

A

It is likely a CHRONIC ACL tear

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21
Q

Elbow ligament and tendon insertion/attachment sites

  • biceps
  • brachialis
  • lateral collateral ligament
  • annular ligament
  • lateral ulnar collateral ligament
  • ulnar collateral ligament
A

Elbow ligament/tendon insertion/attachment sites

  • biceps - radial tuberosity
  • brachialis - coronoid process of ulna
  • lateral collateral ligament - lateral radial head
  • annular ligament - volar and dorsal aspects of the sigmoid notch of the ulna
  • lateral ulnar collateral ligament - supinator crest of the ulna
  • ulnar collateral ligament - sublime tubercle of ulna (medial aspect of the coronoid process)
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22
Q

most common histologic type of RCC

A

clear cell RCC is most common

80%

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23
Q

Timing of …

  • corticomedullary phase
  • nephrographic phase
  • delayed phase
A

Timing of …

  • corticomedullary phase
    • 70 sec
    • corticomedullary phase of the kidneys = portal venous phase
  • nephrographic phase
    • 100-120 sec
  • delayed phase
    • > 5 min
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24
Q

What size criteria of RCC changes management / staging?

A
  • < 3cm, can be done with RFA or cryo
  • < 7cm, stage 1
  • > 7cm, stage 2
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25
Q

Ostitis

A

Ostitis

= general term to describe any inflammatory condition of the bone

= “osteitis” NOT equal to “osteomyelitis” - osteomyelitis means infection

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26
Q

When assessing OCD, describing “no in-situ fragment”

A

in-situ fragment means an OC fragment that is about to come loose

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27
Q

Good saying… from TL

“to further elucidate…”

A

Good saying… from TL

“to further elucidate…”

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28
Q

DDx for ostitis with cortical thickening

A

DDx for ostitis with cortical thickening

  • osteoid osteoma
  • chronic cortical osteomyelitis
  • stress fracture/reaction
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29
Q

Good short DDx for soft tissue sarcomas

A

Good short DDx for soft tissue sarcomas

  • MFH / malignant fibrous histiocytoma
  • fibrosarcoma
  • liposarcoma
  • synovial sarcoma
  • extra-skeletal osteosarcoma/chondrosarcoma
  • rhabdosarcoma
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30
Q

DDx for iliac wing lesions

A

DDx for iliac wing lesions

  • aneurysmal bone cyst
  • fibrous dysplasia
  • intraosseous lipoma
  • subperiosteal hematoma
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31
Q

What extra-axial CSF space is that???

A

Racemose form of neurocysticercosis in the

left MCA cistern!!!

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32
Q

The most common location for intraventricular neurocysticercosis?

A

The most common location for intraventricular neurocysticercosis is the fourth ventricle. It can cause obstructive hydrocephalus and ventriculitis.

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33
Q

Stages of neurocysticercosis

A

Stages of neurocysticercosis

  • vesicular
    • lava viable, no inflammation
  • colloid vesicular
    • scolex begins to degenerate
    • hyperdense on CT
    • T1 and T2 hyper on MR
    • perilesional edema and enhancement
  • granular nodular
    • scolex dead, mineralize
  • calcified nodular
    • calcified nodules
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34
Q

What are the two KEY questions to ask when approaching

an abnormal CXR?

A

What are the 2 KEY questions to ask when approaching an abnormal CXR?

  • acute vs chronic (ask for priors)
  • patient’s immune status
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35
Q

What to always think about when approaching a trauma patient with abnormal CXR?

A

Aspiration

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36
Q

Insertion sites of the rectus femoris muscle?

A

Insertion of rectus femoris muscle

  • direct head - AIIS
  • indirect head - posterosuperior aspect of acetabulum
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37
Q

Pencil-in-cup deformity can be seen in…?

A

Pencil-in-cup deformity can be seen in…

  • psoriatic arthritis (mainly in hands)
  • reactive arthritis (mainly in feet)
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38
Q

“Ivory phalanx” is seen in…

A

“Ivory phalanx” is seen in…

psoriatic arthritis

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39
Q

DDx for distal clavicular resportion??

A

DDx for distal clavicular resorption? - SHIRT

  • Scleroderma
  • Hyperparathyroidism
  • Infection
  • RA
  • Trauma (weightlifters)
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40
Q

What is the bone lesion that you always forget

so that it is important to always keep in mind???

A

Enchondroma

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41
Q

Hyperparathyroidism leads to what changes in hands

besides subperiosteal resorption of the radial aspects of the middle phalanges of the 2nd and 3rd digits?

A

Acro-osteolysis

42
Q

Which part of the bone does GCT arise from??

A

Metaphyseal side of the physeal plate

43
Q

What is the longitudinal split of peroneus brevis tendon associated with?

A

Boomerang shape of the peroneus brevis tendon

Longitudinal split of the peroneus brevis tendon is associated with:

  • ankle inversion injury (when the peroneus brevis tendon is entrapped b/t the peroneus longus tendon and the lateral malleous)
  • associated with ATFL tear
44
Q

Anatomy of the amygdala vs hippocampus

A
45
Q

Lowest rate of lower GI bleed to be detected by

NM scan vs angiograhy?

A

NM for LGIB - 0.05-0.1 cc/min
CT angio for LGIB - 0.5-1.0 cc/min

46
Q

Subtypes of RCC

A

Subtypes of RCC

  • clear cell - most common 80%
  • papillary - second most common, less enhancing
  • medullary - sickle cell trait patients
47
Q
A

parosteal lipoma

  • 40-70y/o males
  • long bones
  • consists mostly of fat and has an associated bony component
  • not contiguous with adjacent medullary cavity - distinguishes it from an osteochondroma
48
Q

Cryptogenic organizing pneumonia

COP

=

Bronchiolitis obliterans organizing pneumonia

BOOP

A

histologically, it is called bronchiolitis obliterans organizing pneumonia / BOOP

when BOOP cause is unknown - idiopathic BOOP

= cryptogenic organizing pneumonia / COP

49
Q

Causes of panlobular emphysema

A

Causes of panlobular emphysema

  • alpha-1 antitrypsin deficiency
  • smoking
  • IV Ritalin abuse
50
Q

ROUND pneumonia

A

ROUND atelectasis

51
Q

Primary malignancies that can cause

miliary pulmonary nodular metastases?

A

Primary malignancies that can cause miliary metastases?

TB-MP

  • thyroid
  • breast
  • melanoma
  • pancreatic
52
Q

What to ask when faced with an abnormal CXR?

A

Acute vs chronic? ask for priors!!!

Ask for immune status!!!

53
Q

Rx / embolization criteria for pulmonary AVM

A

Embolization criteria for pulmonary AVM

  • AVM size > 2cm
  • feeding artery size > 3mm
54
Q

3 different types of ASD

  • septum primum
  • septum secundum (most common)
  • sinus venosus
A
55
Q
A
56
Q

What’s the most reliable way in telling whether a ventricle

is the LV?

A

LV: fibrous continuity of the AV and semilunar valves

57
Q

Natural course of LV rhabdomyoma

A

usually involute with time

may become T1 hyperintense, almost like fat

58
Q

LA myxoma is seen in which syndrome?

A

Carney complex***

  • AKA - LAMB syndrome
  • autosomal dominant
  • cardiac and skin myxomas
  • hyperpigmentation of skin
  • endocrine activity

NOTE: Carney complex is distinct from Carney triad

  • Carney triad (CT) is a multiple endocrine neoplasia (MEN) syndrome, characterized by the coexistence of three types of neoplasms, mainly in young women
  • gastric gastrointestinal stromal tumor
  • pulmonary chondroma
  • extra-adrenal paraganglioma
59
Q

Cor triatriatum

A

Cor triatriatum

  • 2 types
  • classical cor triatriatum (cor atriatum sinistrum): commoner
  • cor triatriatum dexter
  • In the classical type, there is abnormal incorporation of pulmonary venous structures into the left atrium with an unnecessary fibromuscular membraneous sub division through the atrial chamber. - cause of pulmonary hypertension in children
  • With cor atriatum dexter a similar scenario is seen through the right atrium. Sometimes (favourably) fenestrations within the membrane may allow some passage of blood flow.
60
Q

Utility of MCA Doppler

A

Utility of MCA Doppler

  • MCA velocity
    • test for fetal anemia
    • in the setting of e.g., maternal antibodies
    • if the fetus is anemic, the blood will be thinner and the MCA velocity will be higher
    • higher MCA velocity is abnormal
  • MCA PI
    • in the setting of IUGR
    • esp with the presence of increased UA PI
    • if there is IUGR, UA PI will increase
    • fetus will compensate by reducing MCA PI to preserve and redistribute blood flow to the brain
    • therefore, reduced MCA PI is an indication of IUGR
    • if untreated, eventually the fetus will decompensate and MCA PI will increase –> demise
61
Q

If a woman has a bicornuate or didelphyic uterus and

one horn gets a pregnancy

A

The other horn will also demonstrate decidual reaction b/c of the hormonal changes…

62
Q

peroneal nerve anatomy and etc

A

peroneal nerve

  • sciatic nerve runs along the thigh to the knee
  • sciatic nerve divides into tibial and common peroneal nerves at the popliteal fossa
  • common peroneal nerve runs along the posterolateral margin of the fibular neck and enters the fibular canal
  • common peroneal nerve trifurcates at or distal to the fibular neck
    • deep peroneal nerve
    • superficial peroneal nerve
    • recurrent or articular branch
  • causes of peroneal nerve compression
    • trauma
    • extrinsic compression, e.g., extrinsic ganglion cyst
    • intrinsic compression, e.g., intraneural ganglia
  • result in
    • denervation injury in the anterior compartment
63
Q

hibernating myocardium

vs

stunned myocardium

A

stunned myocardium

  • dysfunctional, dyskinetic myocardium
  • due to repeated episodes of acute ischemia
  • but shows normal or near-normal perfusion
  • revascularization is not usually needed

hibernating myocardium

  • dysfunctional, dyskinetic myocardium
  • from chronic ischemia
  • shows “fixed” perfusion defect on Th or mibi scan (just like fixed myocardial infarct/scar)
  • but actually still metabolic active, but has switched from normal free fatty acid metabolism to anaerobic glucose metabolism given the chronic ischemia
  • will show perfusion on F-18-FDG PET/CT –> the gold standard for myocardial viability study!!!
64
Q

typical radiotracer normal organ uptake

  • gallium
  • thallium
  • octreotide
  • MIBG
  • Technetium
A

radiotracer normal organ uptake

  • gallium
    • lacrimal glands*** (look like eyes)
    • nasopharynx
    • liver, bowel, skeleton
  • thallium
    • heart
  • octreotide
    • spleen, kidneys
  • MIBG
    • parotid gland***
    • heart
    • thyroid
    • liver, bowel
  • Tc
    • salivary gland
    • thyroid
    • stomach
65
Q

special use of

gallium

vs

thallium

A
  • gallium –> lymphoma / HCC / vertebral osteomyelitis-disciitis/ PCP lung infection / sarcoidosis
  • thallium –> kaposi sarcoma / lymphoma
66
Q

cancers that are NOT FDG-avid (not good for PET)

A

cancers that are not FDG-avid, not good for PET/CT

  • prostate cancer
  • RCC
  • bladder cancer
  • carcinoid
  • mucinous cancers
67
Q

“to the left of…”

“to the right of…”

A

“to the left of…”

“to the right of…”

68
Q

Compaction of embolization coils for cerebral aneurysm

A
  • The coils placed in intracranial aneurysms can compact, leading to recurrence of the aneurysm. Pulsatile blood flow creates a water hammer effect on the coil mass, leading to compaction of the mass followed by reopening of the aneurysm lumen.
  • This complication usually occurs in the first 6 months after coil placement. Follow-up imaging demonstrates compaction of the embolization coils (decrease in volume of the coil mass) and increased or recurrent filling of the aneurysm compared with the immediate post-embolization studies.
  • Factors that contribute to a cerebral aneurysm recurrence from coil compaction include large aneurysm size*, *presence of thrombus*, and *low coil-packing density.
    • the thrombus can eventually dissolve and lead to free space where blood can reaccumulate
69
Q

Hydrocarbon aspiration pneumonia

(fire-eater lung)

A
  • History is essential to make the diagnosis of hydrocarbon aspiration since initial chest radiographs are often normal or nonspecific.
  • Evolution to cavitation* and *pleural effusion is common. Patients are often only mildly symptomatic and do not require exhaustive workup or intervention.
  • Despite the graphic early imaging findings, long-term sequelae such as pulmonary fibrosis are uncommon.
  • When aspirated, these substances dissolve surfactant and activate macrophages leading to a prolonged inflammatory reaction. This has been confirmed by bronchoalveolar lavage and electron microscopy, which demonstrates macrophages with lipoid inclusions and a paucity of microorganisms.
70
Q

ductal carcinoma - tubular subtype

usually small but spiculated in appearance

but very slow growing, can be stable for years

A

ductal carcinoma - tubular subtype

usually small but spiculated in appearance

but very slow growing, can be stable for years

71
Q

Phyllodes tumor

  • like a large fibroadenoma
  • 25% malignant; 20% of these metastasize - to lung and bone
  • well-circumscribed masses; can have T2 hyperintense cystic spaces
A

Phyllodes tumor

  • like a large fibroadenoma
  • 25% malignant; 20% of these metastasize - to lung and bone
  • well-circumscribed masses; can have T2 hyperintense cystic spaces
72
Q

DDx for solid but very hypoechoic breast masses

without much spiculations/desmoplastic reactions?

A

DDx for solid, very hypoechoic breast masses on U/S

without much spiculations or desmoplastic reactions?

  • medullary/mucinous subtype of ductal carcinoma
  • ductal carcinoma NOS but high grade
  • lymphoma
73
Q

Expression:

“in-and-of-itself”…

A

Expression:

“in-and-of-itself”…

74
Q

Subcoracoid impingement

  • Subcoracoid impingement is an uncommon, nevertheless important cause of anterior shoulder pain and chronic impingement syndrome, which can be idiopathic, traumatic, or iatrogenic in etiology. Diagnosis is mainly clinical; however, it can be suggested on MRI.
  • A coracohumeral interval of less than 6.8 mm on axial MRI may suggest, but not establish, the radiological diagnosis of subcoracoid impingement.
    • shortest distance between the lesser tuberosity and the coracoid process (coracohumeral interval).
    • coracohumeral interval = shortest distance b/t lesser tuberosity and coracoid process.
  • Physical exam findings, response to lidocaine, secondary signs on MRI (cystic changes, tendinopathy and/or tear, bone marrow edema) are paramount in establishing the diagnosis.
  • Pain can be elicited by flexion, adduction, and internal rotation.
A
75
Q

What are the components of the “biceps pulley”?

A

Components of the biceps pulley

  • coracohumeral ligament
  • superior glenohumeral ligament
  • anterior aspect of the supraspinatus tendon, and
  • superior aspect of the subscapularis tendon.
76
Q

bisphosphates related insufficiency fractures

A

most common proximal 1/3 femoral diaphysis

lateral cortical thickening first!!!

can be unilateral or bilateral

therefore, always order contralateral xray

77
Q

Most common locations of Ewing sarcoma

A
  1. femur
  2. pelvis
78
Q

Dr. JHM chest tip:

when you see clearly airway changes on CXR, such as

  • bronchiectasis
  • bronchial wall thickening

States that!!

Because airways changes such as bronchiectasis narrows your DDx down by so much so you won’t be faked out by the “intersitital markings” and go down the path of interstitial lung disease…

A

Dr. JHM chest tip:

when you see clearly airway changes on CXR, such as

  • bronchiectasis
  • bronchial wall thickening

States that!!

Because airways changes such as bronchiectasis narrows your DDx down by so much so you won’t be faked out by the “intersitital markings” and go down the path of interstitial lung disease…

79
Q

Coalescent mastoiditis refers to acute mastoiditis with erosion of the mastoid septae and resulting coalescence of the mastoid air cells.

A Bezold abscess occurs when infection spreads into the neck soft tissues following erosion of the mastoid tip.

A

Coalescent mastoiditis refers to acute mastoiditis with erosion of the mastoid septae and resulting coalescence of the mastoid air cells.

A Bezold abscess occurs when infection spreads into the neck soft tissues following erosion of the mastoid tip.

80
Q

Rigler’s triad

A

Rigler’s triad

  • pneumobilia
  • ectopic gallstone
  • small bowel obstruction
81
Q

What is the most basic AUTOMATIC you are supposed to say when you encounter ANY imaging case???

A

What is the most basic AUTOMATIC you are supposed to say when you encounter ANY imaging case???

Compare with PRIORS!!!!!!!

82
Q

Special names for leukemic infiltrates into solid organs?

A

chloroma

extramedullary myeloblastoma

granulocytic sarcoma

=

extramedullary solid tumors composed of granulocytic precursor cells

83
Q
A
84
Q

What is considered significant post void residual volume?

A

> 50cc

85
Q

What is considered significantly enlarged prostate volume?

A

> 40cc

86
Q

2 recesses in the inferior and anterior aspect of the 3rd ventricle

  • supra-optic recess
  • infundibular recess
A

2 recesses in the inferior and anterior aspect of the 3rd ventricle

  • supra-optic recess
  • infundibular recess
87
Q

Early OB ultrasound, when do you need to change dates?

A

Early OB ultrasound, when do you need to change dates?

  • 9-20 weeks on U/S - discrepancy > 6 days
  • > 20 weeks on U/S - discrepancy > 11 days
88
Q

Ovary size on ultrasound

measurements?

upper limites of ovarian volume?

A
  • Ovary size = 0.523 x A x B x C
  • rough rule of thumb = 4 x 3 x 2cm
  • Upper limits for volume = 10cc
89
Q

PCOS

The revised ASRM/ESHRE Rotterdam consensus* criteria 4 devised in 2003 require *2 of the following 3 criteria for the diagnosis:

  • oligo- or anovulation
  • hyperandrogenism (clinical or biochemical) and
  • polycystic ovaries: on imaging
A

Imaging of PCOS

May show sonographic features of polycystic ovaries = bilateral enlarged ovaries with multiple small follicles: 50%

  • increased ovarian size (>10 cc)
  • 12 or more follicles measuring 2-9 mm
  • follicles of similar size
  • peripheral location of follicles: which can give a string of pearl appearance
  • hyperechoic central stroma
  • the ovarian outline may be slightly irregular ref

Hypo-echoic ovary without individual cysts: 25%
Normal ovaries: 25%

90
Q

Acute subdural bleeds have a high mortality rate, higher even than epidural hematomas and diffuse brain injuries, because the force (acceleration/deceleration) required to cause them causes other severe injuries as well.

The mortality rate associated with acute subdural hematoma is around 60 to 80%.

A

Acute subdural bleeds have a high mortality rate, higher even than epidural hematomas and diffuse brain injuries, because the force (acceleration/deceleration) required to cause them causes other severe injuries as well.

The mortality rate associated with acute subdural hematoma is around 60 to 80%.

91
Q

Chemotherapy agent for treating GCT

monoclonal Ab?

A

Denosumab

92
Q

Most common location for intraosseous lipoma?

A

Intertrochanteric region!!!

93
Q

placental venous lake

A

placental venous lake

  • Placental venous lakes refer to a phenomenon of formation of sonolucent cystic spaces centrally within the placenta.
  • Finding placental lakes during a second trimester ultrasound scan is not associated with any utero-placental complication or with an adverse pregnancy outcome.
  • They can however be abnormal if very diffuse or if seen very early in pregnancy.
94
Q

placental chorioangioma

A

placental chorioangioma

  • benign vascular tumor
  • most common tumor of the placenta
  • 1% of all pregnancies
  • most often - asymptomatic and incidental finding
    • if large (>4cm) or multiple, may be associated with poor fetal and maternal outcome
  • pathology
    • arise as a malformation of the primitive angioblastic tissue of the placenta
    • perfused by the fetal circulation –> may lead to fetal heart failure and platelet sequestration (thrombocytopenia)
  • imaging
    • often seen as a hypoechoic, rounded mass located near the chorionic plate +/- umbilical cord insertion site.
    • It usually contains anechoic ‘cystic’ areas, and can be seen as distinctly separate to normal surrounding placental tissue
    • some heterogeneous areas caused by degenerative processes/ internal haemorrhage can be seen.
      chorioangiomas can also rarely appear pedunculated
    • Colour Doppler interrogation often demonstrates pulsatile flow within the anechoic ‘cystic’ areas, which actually represent enlarged vascular channels
  • treatment
    • usually just expectant management
95
Q

Hypertrophic olivary degeneration

A

Hypertrophic olivary degeneration

  • Disruption along the dentatorubro-olivary pathway may lead to hypertrophic degeneration of the inferior olivary nucleus.
  • The most common clinical presentation is palatal tremor or myoclonus, which develops 10 to 11 months following the initial insult.
  • The inferior olivary nucleus demonstrates delayed hypertrophy with abnormal T2 signal* on MRI and may *eventually undergo atrophy.
  • Guillain–Mollaret triangle - formed by the red nuclei and dentate nuclei
  • Affects ipsilateral inferior olivary nucleus* and *contralateral dentate nucleus
96
Q

medullary thyroid cancer

A

medullary thyroid cancer

  • neuroendocrine tumor
  • avid for MIBG scan
  • calcitonin secreting –> low serum calcium levels
  • every medullary thyroid cancer should undergo genetic testing
    • 80% sporadic
    • 20% syndromes - MEN-2A and MEN-2B
    • (NOTE: MEN-2B is MEN-2A with mucousal lesions and marfanoid body habitus)
97
Q

Normal uptake of I131-MIBG scan

A

I-131 MIBG scan

  • need Lugol solution to block thyroid uptake
  • normal MIBG uptake
    • salivary gland
    • heart
    • liver
    • spleen
    • bladder (excreted free iodine)
    • colon (20% of cases)
    • faintly within normal adrenal medulla (10% of cases)
98
Q

Adrenal washout values

A

Absolute washout > 60%

Relative washout > 40%

99
Q

cobweb =

A

cobweb = spider web

100
Q

what segment lies in front of the caudate lobe?

A

Segments 4a and 4b.

101
Q
A

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