Random_4 Flashcards
DDx for sclerotic bone mets
6 BEES LOVE POLLEN
- brain - medulloblastoma
- breast
- bronchogenic - lung
- bone
- bowel
- bladder
- lymphoma
- prostate
Orbital exenteration
Orbital exenteration
Pelvic exenteration (or pelvic evisceration) is a radical surgical treatment that removes all organs from a person’s pelvic cavity.
Renal lesions
- <20 HU - renal cysts
- 20-80 HU - worrisome
- > 80 HU - likely benign
Tooth numbering
2-1-3
- 2 incisors - central and lateral incisors
- 1 canine
- 2 premolars
- 3 molars
Dolichoectasia
dolicho - elongated
ectasia - dilated
Stroke - what to look for if the patient has left sided numbness?
- right post-central gyrus (sensory gyrus)
- white matter tracts
- thalamus
“reversal of normal cervical lordosis, likely positional”
“reversal of normal cervical lordosis, likely positional”
Supernumerary unerupted tooth
Supernumerary unerupted tooth
Male urethral anatomy
- prostatic
- membranous
- bulbar
- penile
Pleurodesis
Pleurodesis
- talc
- 4-8% resp failure
- bleomycin
- abx
- more expensive, less commonly used
Scheuermann disease
- young male patients
- lower thoracic and lumber spine
- kyphosis
- at least 3 vertebral bodies
- endplate irregularities
- vertebral disc space narrowing
Patella baja and patella alta
- measurement = length of patella/distance b/t distal patella to tibial tuberosity
- normal = 0.8 - 1.2
- < 0.8 - patellar alta
- > 1.2 - patellar baja
- most common cause of patella alta - traumatic patellar tendon rupture
Patellar tendon rupture
- most common cause of patella alta
- most commonly in proximal 1/3 of tendon
- risk factors
- steroid injectin
- previous bone-patellar tendon-bone ACL graft harvesting
- cerebral palsy
- juvenile RA
- collagen vascular disease
- cerebral palsy
Apical hypertrophic cardiomyopathy (HCM)
- HCM - autosomal dominant diesase of myocardium
- Apical HCM - ApHCM - relatively rare form of HCM - involving LV apex
- ApHCM
- more common in Japan - 13-25% of all cases of HCM in Japan
- “spade-like” configuration of LV cavity at end-systole
- focal LGE at LV apex - areas of fibrosis and increased myocardial collagen
- diffuse LGE –> increased risk of sudden cardiac death
Coronary veins
- left marginal vein, posterior LV vein
- right marginal vein
- oblique vein of Marshall - posterior wall of LA - joins great cardiac vein to form coronary sinus at the valve of Vieussens
- small cardiac vein - right AV groove - along RCA
- middle cardiac vein - posterior interventricular groove - along PDA
- great cardiac vein - along anterior interventricular groove and left AV groove - along LAD and LCX
- coronary sinus - final drainage into RA
Spontaneous coronary artery dissection
- Rare
- Risk factors
- pregnancy and post-partum - hormone related; just like increased incidence of symptomatic splenic artery aneurysm
- connective tissue disease - Marfan’s syndrome, Ehlers-Danlos syndrome
- cocaine use
Cardiac volvulus
- rare, but fatal condition
- most common due to right intrapericardial pneumonectomy
- DDx
- mislabelled CXR
- cardiac herniation
Right aortic arch
- most common configuration - right aortic arch with aberrant left SCA
- right arotic arch with aberrant left SCA forms a vascualr ring - the invisible left ligamentum arteriosum completes the ring
- 2nd most common mirror image aortic arch - associated with CHD (ToF and truncus arteriosus)
- 3rd most common - isolated L SCA
- steal phenomenon from the left vertebral artery
- in the right aortic arch with aberrant left SCA, the order of arteries arising from the arch
- left CCA
- right CCA
- right SCA
- left SCA - aberrant
4 possible courses of an aberrant LCA arising from the right sinus of Valsalva
- retro-aortic
- anterior free wall - anterior to the RVOT
- interarterial - malignant
- septal - artery divides below the right infundibulum and courses within the interventricular septum surfacing at the mid anterior wall
IVC aneurysm
- most often congenital
- can be acquired - right heart pressure, tricuspid pathology, constrictive pericarditis
- fusiform most common
- can be associated with AVF
- most commonly associated with
- left sided IVC
- interruption of infrahepatic IVC with azygous continuation
- most common complication - thrombosis and PE
Most common form of cyanotic congenital heart disease
Tetralogy of Fallot
Most common aortic catastrophe
Ruptured AAA
Aortic dissection
- Standford classification
- Type A - ascending arota and aortic arch
- Type B - discending aorta distal to the left SCA
- Debakey classification
- Type I - ascending aorta, arch, and descending aorta
- Type II - ascending aorta only
- Type III - descending aorta distal to the left SCA
- Type I/II/III - B-A-D
- Type A - surgical emergency
- cardiac tamponade
- coronary artery occlusion
- aortic valvular insufficiency
- Type B - medical management
- unless there is
- intractable pain
- rapidly expanding diameter
- visceral ischemia - kidney, bowel
- impending rupture
Colpocephaly
- Disproportionate enlargement of the occipital horns of the lateral ventricles
- Merely a morphologic description
Patterns of ventricular enlargement
- early obstructive hydrocephalus
- temporal horns are the first to dilate
- Huntington chorea
- ex vacuo ventricular dilatation
- frontal horns are the first to dilate
- colpocephaly
- occipital horns are dilated
- colloid cyst leading to obstructive hydrocephalus
- at the level for foramen of Monro
What conditions are most commonly associated with colpocephaly?
- Chiari II malformation
- dysgenesis of the corpus callosum
Distinguishes the terms
colpocephaly
holoprosencephaly
porencephaly
- colpocephaly
- dilatation of the occipital horns of the lateral ventricles
- holoprosencephaly
- congenital absence of midline structures - spectrum of absence of ventricular separation
- porencephaly
- cystic encephalomalacia potentially communicating with the ventricular system
- due to brain parenchymal destruction in utero
Classic description of the colpocephaly
- tear drop - enlarged occipital horns
- race cars - parallel lateral ventricles near vertex
How to conclude in a report where indication is r/o lymphadenopathy?
No evidence of supradiagphramatic or infradiagphgramtic LAD. No evidence of lymphoproliferative disorder.
Intra-abdominal LAD
No intraperitoneal, retroperitoneal, pelvic, or inguinal LAD.
Difference b/t
BOOP
BO
- BOOP - bronchiolitis obliterans organizing pneumonia = COP - cryptogenic organizing pneumonia
- organizing pneumonia
- peripherally distributed patchy airspace opacities
- restrictive, stenotic airways
- BO - bronchiolitis obliterans - CB - constrictive bronchiolitis
- seen in rejection in lung Tx
- bronchial wall thickening, bronchiectasis, mosaic attenuation, air trapping
- constrictive airway changes!
- bad - poor prognosis
sheet music
sheet music
What sign is used to describe resolving pulmonary infarct?
Ice-cube melting sign
Looks like an ice cube melting peripherally to internally
vs. resolving pneumonia
What percentage of pulmonary infarc will cavitate?
10%
pulmonary scarring is a more common sequela
Good description for central PE
“Bilateral central pulmonary emboli with extension into lobar and segmental branches to both lower lobes.”
Pulmonary embolism
pulmonary infarct
pulmonary caviatation
PE
10% will have pulmonary infarct (if there is poor colalteral blood supply b/t pulmonary and bronchial arteries, esp. in the subpleural region); PE –> acute inflammation, edema, microvascular obstruction, functional intrapulmonary shunting –> decreased vascular supply –> pulmonary infarct
3% of pulmonary infact from PE will cavitate
Primary CNS lymphoma
- occurs in all ages; but more common in younger immunocompromised patietns and immunocompetent pts > 60yo.
- EBV is implicated in 95% of immunocompromised cases
- Rx - not sx. radiation and chemo; steroids improve appearance
- imaging findings
- unenhanced CT - HYPERDENSE masses
- MR
- T2/FLAIR HYPO
- rim enhancement
- may cross midline
UBC and ABC
only for patients < 40 y/o
Most common vascular abnormality in the raider’s triange?
Aberrant right subclavian artery
Lines on a pelvis Xray
Desmoid tumor
- benign, non-inflammatory fibroblastic tumor
- tendency to local invasion and recurrence; no metastasis
- may be sporadic, or associated with estrogen therapy or FAP
- women to men = 2:1
- locations
- abdominal wall
- root of mesentery
- retroperitoneum
- US - anechoic or hyperechoic masses
- CT - well circumscribed, homogeneously or focal hypodense; enhancing after IV contrast
- MR - T1 low, T2 low
Calcified liver masses
- Infectious
- granulomas (TB) - densely calcified
- hydatid cyst - curvilinear calcification
- Neoplastic
- hemangioma
- HCC
- fibrolamellar carcinoma
- intrahepatic carcinoma
- calcified liver metastases
- most often associated with mucin-producing neoplasms such as colon and ovarian carcinoma
Which tumor causes biliary invasion or periductal spread?
Colorectal
Breast
DISH stands for?
Diffuse Idiopathic skeletal hyperostosis
Most common cause of HD AV fistula dysfunction
- outflow stenosis - narrowing within the venous portion of the fistula
- results in diminished flow and subsequent thrombosis
- cause - neointimeal hyplasia
- PE - diminshed flow or thrill with or without pulsatile flow
- DDx - vasospasm, thrombosis, external compression
- fistulogram - can be done in antegrade or retrograde fashion (from the venous side towards the arterial side - more common)
- Rx - angioplasty or stent
Landmark
Gallbladder
Falciform ligament
- Gallbladder - divides segment V and IVb
- Falciform ligament - divides segment IV and II/III
Multiple pulmonary nodules and pneumothorax in a young patient
metastases from osteosarcoma
“On a whim.”
Done without thinking seriously about the consequences.
Calcific tendonitis
- most common - supraspinatous tendon
- differentiated from degenerative tendonitis based on calcium deposition in the tendon visible on radiographs
- associated with calcium pyrophosphate deposition disease (CPPD)
- deposition of calcium hydroxyapatite crystals
- women, 30-60 y/o
- 4 phases
- formative
- calcific
- resorptive - calcium broken up and phagocytosed by macrophages with associated increased vascularization and tissue edema –> ++ pain
- reparative - function and xray back to normal
- Rx: rest, NSAIDS, steroid injection
Dorsal defect of patella
- Normal variant
- No associated bone marrow edema
DDx of lytic lesions in the posterior elements of the spine
OAT - MM
- osteoblastoma
- ABC
- TB (other infections)
- myeloma
- mets
Febella
vs
Meniscal ossicle
- Febella - posterior lateral
- Meniscal ossicle - posterior medial; associated with meniscal root tear
Osteitis fibrosa cystica (bone resorption)
Secondary to renal osteodystrophy or hyperparathyroidism
Aggressive osteoporosis
- from disuse
- can mimic a permeative lesion, such as Ewing’s sarcoma or multiple myeloma
- intra-cortical process (not an intramedullary process)
- b/c severe cortical patchy or permeative pattern that projects over the medullary space - resembles a medullary permeative process
- how to differentiate - examine the cortex to see if the cortex is solid (true permeative process) or riddled with holes (pseudo-permeative process)
Branches of the internal iliac artery
- posterior division (“SLE”)
- superior gluteal
- lateral sacral
- iliolumbar
- anterior division
- obturator artery
- inferior gluteal artery
- umbilical artery
- uterine artery
- vaginal artery
- inferior vesical artery
- middle rectal artery
- internal pedendal artery
Blood supply to the rectum
- superior rectal artery (IMA)
- middle rectal artery (internal iliac artery - anterior division)
- inferior rectal artery (internal pudendal artery - from internal iliac artery - anterior division)
Right sided aortic arch with aberrant left subclavian artery
- only 5% is symptomatic - airway related symtpoms most common in infancy
- vascular ring is formed
- anterior - ascending aorta
- right - aortic arch
- posterior - descending aorta and aberrant left SCA
- left - ligamentum arteriosum - if the ligamentum arteriosum is tightly constricting –> congenital stridor
- 60% - diverticulum of Kommerell - dilatation of the origin of the aberrant left SCA
- 10% with associated CHD
- vs 90% associated CHD in right side arch with mirror branching pattern!
Intracranial epidermoid cyst
- congenital inclusion cyst - typically within the basal cisterns
- CP angle
- suprasellar cistern
- 4th ventricle
- “white epidermoid cyst” - hyper T1 (protein content), hyper T2
- if rupture - chemical meningitis
- 10-25% may calcify
- MR - usually T1 hypo (due to crystalline cholesterol and calcium), T2 hyper (due to keratin), restricted diffusion on DWI/ADC
- white epidermoid - rarer entity (more textbook epidermoid)
- NOTE: arrachnoid cyst should follow CSF intensity
DDx for CPA masses
- SAME
- schwannoma (acoustic schwannoma > trigeminal schwannoma)
- arachnoid cyst, aneurysm
- meningioma, metastasis
- epidermoid cyst/dermoid cyst, ependymoma
DDx for central enhancing forcus in splenic/hepatic etc laceration in the setting of trauma?
- actve cont
Guidelines for surveillance interval for AAA
- Male
- 3-4cm - q3yr
- 4.0-4.4cm - q2yr
- 4.5-5.4cm - q1yr
- >5.5cm - surgery
- Female
- 4x higher risk of AAA rupture
- >4.5cm - surgery
Etiology of acute mesenteric ischemia
- acute arterial thromboembolism
- global hypotension/splanchinic vasoconstriction
- mesenteric venous thrombosis
*
Central Neurocytoma
- vast majority is intra-ventricular in location
- CT - hyperdense than white matter; punctate calcifications; cystic regions
- MR - T1 iso, T2 hyper, mild to moderate heterogenous enhancement
- calcification and hemorrhage are common
DDx for intraventricular masses
- central neurocytoma
- ependymoma
- subependymoma
- usually no enhancement
- subependymal giant cell astrocytoma
- tuberous sclerosis
- avid enhancement
- choroid plexus papilloma
- intraventricular meningioma
- intraventricular metastasis
- colloid cyst
- oligodendroglioma
When you see an “odd” intracranial infarct, you want to rule out what underlying pathology?
- underlying mass lesion
- AVM
- venous infarct from dural sinus thrombosis
Caudate atrophy is Pathognomonic for what?
Huntington’s Disease
- autosomal dominant
- caudate and putamen atrophy
- passive enlargement of the frontal horns –> box like configuration
- generalized cortical atrophy
Creutzfeldt–Jakob disease
CJD
- types
- sporadic - most common
- variant
- familial
- iatrogenic
- caused by prions
- MRI - may be bilateral, unilateral, symmetric or asymmetric
- T2 hyper - basal ganglia, esp caudate and putamen,
- T2 hyper - thalamus
- hocky stick sign
- pulvinar sign
- T2 hyper - cortex - most common early manifestation
- T2 hyper - white matter
- restricted DWI - most sensitive sign
- hypo-metabolism on FDG/PET
DDx for enophthalmos
- cicatrizing orbital breast cancer metastasis
- fibrosing orbital pseudotumor
*
Embolization material
- permanent
- coil
- glue
- particle
- alcohol
- temporary
When you perform an SMA angiogram, but you see the ciliac artery filling, what does this appearance indicate?
Essentially, collaterals b/t celiac and SMA?
Enlarged pancreatico-duodenal arteries (black arrowheads) in a patient with occlusion of the celiac artery origin. The pancreatico-duodenal arteries are a collateral pathway between the SMA and the celiac artery. The dorsal pancreatic artery (white arrowhead) communicates with both the proximal SMA (via the Arc of Buhler) and the transverse pancreatic artery (white arrow)
- diagnostic of celiac artery stenosis
- chronic established collaterals through
- inferior and superior pancreaticoduodenal anastomosis
- Arc of Buhler
Collaterals b/t SMA and IMA?
- The Arcade of Riolan is the medial,
- The Marginal Artery of Drummond the lateral arcade in the mesentery of the left colon
*
Desmoid (aggressive) fibromatosis
- Desmoid (aggressive) fibromatosis mainly involves the musculature of the trunk and extremities and an infiltrative growth pattern.
- These lesions show characteristic, not necessarily diagnostic, low signal intensity on all pulse sequences, with a tendency to cross fascial boundaries.
- Definitive diagnosis - a core-cut biopsy.
- Surgical resection with the goal of clear margins is the treatment of choice.
5 densities on X-ray
Risk factors of AVN
- trauma
- steroids (including endogeneous steroids - cushing sydnrome)
- lupus/SLE
- sickle cell disease
- alcoholism
- pancreatitis
- pregnancy
Double Line Sign
- MR findings of AVN
- T1 - irregular hypointense rim
- T2
- inner hyerintense
- outer hypointense
- interface b/t the viable and ischemic bone marrow
Relationshp b/t azygos vein and the right mainstem bronchus
Contents of the AP window
- fat
- lymph nodes
- left recurrent laryngeal nerve
- ligamentum arteriosum
Truncus anterior lies anterior to which structure?
RUL bronchus
Thoracic and abdominal aortic aneurysm
Intramural hematoma
- acute hemorrhage into the aortic wall
- occurs in the vasa vasorum
- smooth, crescenteric, HYPERDENSE than unenhanced blood - why you need to do unenhanced scan before giving contrast
- patient presents with acute chest pain!
- natural history
- progress to frank dissection (by rupture into the aortic lumen)
- aneurysmal dilatation
- may resolve
- Rx - same as Rx for dissection occuring in the same location
- type A - surgical
- type B - medical
Causes of SVC obstruction
- bronchogenic carcinoma
- granulomatous mediastinitis from histoplasmosis
- sarcoidosis
- TB
- fibrosing mediastinitis
- mediastinal radiation
- central venous catheter with venous thrombosis
Pattern of pulmonary aretery dilatation secondary to pulmonic stenosis?
Causes of pulmonary artery aneurysm
- mycotic aneurysm
- catheter related complications
- Takayasu’s arteritis
- Williams syndrome
- prenatal varicella
- Behcet’s syndrome
HU diagnostic for CT PE
Egg-shell calcification of a lymph node
Low density lymph nodes
(necrotic lymph nodes)
Enhancing/hyperdense lymph nodes
*
Hodgkin’s lymphoma
- cystic or fluid filled necrosis common
- calcification rare, unless treated lymphoma
Half life of positron-emitting Fluorine-18?
Fluorine-18 is a cyclotron-generated, positron-emitting radioisotope.
It has a 110-minute half-life, which makes it suitable for commercial use
18F FDG-PET/CT imaging of dementia
- Alzheimer’s disease - decreased cortical glucose metabolism in bilateral parietal and temporal lobes
- Semantic dementia - bilateral temporal lobes, left side more overtly affected
- Frontotemporal dementia - bilateral frontal lobes and anterior temporal lobes
- Lewy body dementia - bilateral parietal, temporal, and occipital lobes
- Vascular dementia - heterogeneously decreased metabolism throughout the cortical structures
18F-Florbetapir PET/CT for Alzheimer Disease
β Amyloid plaques are a necessary criterion for definitive diagnosis of Alzheimer disease. Historically, β amyloid plaques were only detectable with autopsy specimens. 18F-Florbetapir is a recently FDA-approved PET radiotracer that increases the clinical availability of in vivo detection of β amyloid plaques.
A positive 18F-Florbetapir PET/CT demonstrates cerebral cortical uptake; a negative scan shows only white-matter uptake. Proper scan interpretation requires familiarity with gray-white matter differentiation and ideally being blinded to the patient’s actual clinical history.
DDx for
expanding rib lesion with cortical thickening
Always include … in case of mono-articular process?
PVNS
and
Degenerative changes in the joint
Y-90
- beta-emitting agent
- for TACE of HCC and lymphoma
Most common hepatic lesion in children
- # 1 benign hepatic mass in children - hemangioma
- # 1 malignant hepatic mass in children - hepatoblastoma
- # 2 HCC
DDx in acute intracranial hemorrhage in a young patient
Cerebral AVM
Carotid-cavernous fistula
- classification
- direct - direct communication b/t intracavernous ICA and cavernous sinus
- acute, due to trauma
- young male
- indirect - communication exists via branches of the carotid circulation - either ICA or ECA (meningeal branches)!!!
- insiduous onset
- post-menopausal female
- direct - direct communication b/t intracavernous ICA and cavernous sinus
- other risk factors
- Ehlers-Danlos syndrome
- fibromuscular dysplasia
- symptoms
- proptosis, exophalthalmos
- chemosis, subconjunctival hemorrhage
- progressive visual loss
- pulsatile tinnitus (objective)
- raisd ICP
- SAH, ICH
- imaging
- enlarged superior ophthalmic vein/inferior petrosal sinus
- proptosis, enlarged EOM
- orbital edema
- may show ICH/SAH from ruptured cortical veins!
- Rx
- direct - trans-arterial approach
- coil
- balloon
- occlude cavernous sinus
- indirect - trans-venous approach
- either thr inf. petrosal sinus or sup. ophthalmic v.
- direct - trans-arterial approach
