Random_3 Flashcards
How to confirm intrapancreatic ectopic splenic tissue?
Denatured RBC scan
Malignant degeneration of dermoid cyst
2%
SCC most common
How to differentiate
pulmonary hypertension
from
shunt vascularity
- pulmonary arterial hypertension - vascularity does not go beyond 2/3 into the periphery; pruning
- shunt - shunt vascularity; no pruning
Most common septal defect in Down Syndrome?
AVSD
endocardial cushion defect
goose neck appearance
Types of dural AVF
- Arterial supply from ICA - pial supply
- Arterial supply from ECA, e.g., - occipital artery
- drains directly into the dural venous sinus
What to suspect in a young patient presenting with acute intracranial hemorrhage (ICH)?
AVM
Orbital trauma with wooden foreign body
- For orbital trauma, CT is the first-line modality for imaging evaluation, and it can be helpful to evaluate for the presence of intra-orbital foreign bodies.
- A wood foreign body can be difficult to differentiate from subcutaneous gas and fracture fragments.
- The appearance of wood on CT depends on its hydration;
- Dry pine (dead or cut) is less dense - can look like air density
- While fresh pine is more dense, depending on the degree of air and water content
- Dry wood can be distinguished from air by a reticulated matrix.
DDx for unilateral sacroilitis
- Infection/septic joint***
- OA
- gout
- psoriasis
Synovial sarcoma
- 4th most common sarcoma
- young patients
- close to the knee
- T2 - triple sign - low/intermediate/high signal intensity
- “bunch of grapes” sign
- fluid-fluid level due to internal hemorrhage
Well-corticated juxta-articular erosions
- PVNS
- synovial osteochondromatosis
- gout
- amyloid (also low signal intensity on MR, but not as low as PVNS)
Lesser trochanter avulsion fracture
- always pathologic fracture
- unless HIGH speed MVC
Natural plain film stages of AVN
- sclerosis (relative to normal bone density, whch would be decreased to due to bone resportion secondary hyperemia)
- subchodnral lucency
- collapse
- fragmentation
- end-stage degenerative changes
Important places to look for acute fractures in a foot x-ray
- calcaneus
- anterior process
- posterior tuberosity
- talus
- lateral process
- metatarsals
- base of the 5th MT
Branches of the RCA
- Conus branch
- SA node branch
- Acute marginal branch(s)
- PDA
- posteral lateral branch
What % is considered significant stenosis in coronary arteries?
- Left main > 50% is significant
- Reminder > 75%
senescent changes
senescent changes
Bennett fracture
vs
Rolando fracture
- Bennett - intraarticular fracture of the 1st MC (thumb)
- always associated with subluxation/dislocation of the 1st MC relative to carpal bones
- Rolando - comminuted Bennett fracture
Carcinoid tumors
Can cause intussusception
Upstream bowel will be abnormal-looking due to the intussusception
Achalasia
Mechanium and Causes
- Achalasia - esophageal motility disorder (dismotility)
- absent primary peristalsis
- incomplete relaxation of the LES
- Causes
- Primary - idiopathic - most common*
- loss of normal ganglion cells in the esophageal myenteric plexuses
- Secondary
- malignant tumor at the GE junction
- Chagas’ disease
- Primary - idiopathic - most common*
Median arcuate ligament syndrome
- Diaphgramatic cura compressing the celiac axis
- Breathing in - Okay
- Breathing out - Crux angulation compresses
AS with transverse fracture through the ankylosed spine
Can act like “pseudoarthrosis”
Most common manifestation of rheumatoid arthritis in the chest
Pleural effusions
Complete occlusion of the distal aorta
and proximal iliac arteries
Leriche syndrome
- triad
- absent femoral pulse
- claudication
- impotence
- atrophy/trophic changes
- collaterals
- sup-inf epigastric arteries
- iliolumbar arteries
- paraspinal arteries
Lemierre’s disease
Fusobacterium necrophorum
Sinus venosus ASD
Male breast cancer
1%
of all breast cancer diagnosis
Male breast abscess
Abscess in the male breast is a relatively rare finding, so a more worrisome diagnosis, such as malignancy, must always be excluded.
Achilles tendon rupture
- Achilles tendon is the most commonly injured tendon of the ankle.
- Tears most commonly occur approximately 2-6 cm proximal to the calcaneal insertion – avascular / watershed zone of the tendon.
- Plain film findings are non-specific because the Achilles tendon is not visualized directly by radiography. However, it is outlined anteriorly by the Kager’s fat pad. Findings may include extensive posterior soft tissue swelling and posterior concavity of the Kager’s fat pad.
- MRI is diagnostic and shows high signal with disruption of the normal tendon. Tears more prominent on fluid sensitive sequences and range in spectrum from:
- Interstitial tears – high signal parallel to long axis of tendon. However, the surrounding tendon fibers are intact.
- Partial tears – Heterogenous high signal and tendon thickening without complete disruption
- Complete tears – Complete disruption where tendon fibers may overlap or be distracted. Will have fluid between torn fibers (as in our case)
- Ultrasound can also distinguish complete from partial tears with a 92% accuracy
Lymphoma
- Central hypodense areas likely represent necrosis
- Unusual to have calcifications unless in the case of treated lymphoma
Most common cause of a pancreatic mass lesion in pediatric population?
Lymphoma
Bone lesions that are always on the DDx
- Infection - osteomyelitis
- Mets/myeloma - if >40 yo
- EG - if younger pts
- Osseous lymphoma
3 most common tumors in pediatric population
- leukemia
- brain tumors
- lymphoma
Rx in HL vs NHL
Radiation therapy plays a little role in the routine management of pediatric NHL as opposed to HL.
Mediastinal radiation is not commonly used for patients with mediastinal masses from NHL except in the emergent treatment of symptomatic superior vena cava obstruction or airway obstruction. Even in these cases, low-dose radiation is usually used.
Causes of infiltrative/restrictive cardiomyopathy
- amyloidosis
- sarcoidosis
- hemochromatosis
- glycogen stoarge disease
Perineural spread of tumor
- Although perineural tumor spread most commonly involves the trigeminal and facial nerves, it can affect any nerve, including less well-known connections between the trigeminal and facial nerves (like the auriculotemporal nerve).
- Connection b/t CNV and CNVII - auriculotemporal nerve
- Imaging findings
- thickening of nerve
- abnormal enhancement of nerve
- obliteration of perineural fat pads
- neuroforaminal widening/destruction
- Tumors tend to spread perineurally
- adenoid cystic carcinoma
- squamous cell carcinoma of skin
- Involvement of auriculotemporal nerve - causes TMJ dysfunction
- Auriculotemporal nerve
- best seen on axial images
- coronal images allow for visualization of tumor extension along V3 –> foramen ovale –> Meckel cave
Adenoid cystic carcinoma of the parotid gland
- large, heterogeneously enhancing mass
- low attenuation areas - central necrosis
- extension into the parapharyngeal space
- obliteration of the normal fat pad medial to the right mandibular ramus - tumor infiltration
Adenoid cystic carcinoma of the right parotid gland
- T1 - large, hypointense mass extends posterior to the right mandibular ramus (*) into the right parapharyngeal space
- T1 Post Gad FS - enhancement of the right lateral pterygoid muscle - direct tumor invasion or acute/subacute muscular denervation
*
Perineural spread of adenoic cystic carcinoma
- T2 coronal
- markedly widened foramen ovale (yellow arrow)
- obliteration of normal CSF intensity within the right Meckel cave (green arrow), compared to normal CSF intensity within the left Meckel cave (white arrow)
- perineural spread along V3
- Anatomical sketch
- aruciulotemporal nerve is formed by 2 roots arising from V3 below the skull base
- auriculotemporal nerve course around the middle meningeal artery
- auriculotemporal nerve extends parallel to the posterior ramus of the mandible, to join facial nerve within the substance of the parotid gland
- auriculotemporal nerve is usually not visualized - when clearly seen, concerning for perineural tumor spread
Stages of blood product
- Intracellular oxyHb - hyperacute
- IB
- Intracellular deoxyHb - acute
- ID
- 1-2 days
- Intracellular metHb - early subacute
- BD
- 2-7 days
- Extracellular metHb - late subacute
- BB
- 7-14 days days
- Extracellular hemosiderin - chronic
- DD
- > 14-28 days
Upper lobe predominant lung disease
ST CASH
- S - sarcoidosis
- T - TB
- C - CF
- A - AS - ankylosing spondylosis
- S - silicosis
- H - hystiocytosis X - Langerhans