Rapid Fire Flashcards
When say ‘Subglottic Hemangioma
You Say PHACES Syndrome
When say ‘PH ACES Syndrome
You say Cutaneous Hemangioma
When say ‘Ropy Appearance
You say Meconium Aspiration
When say ‘Post Term Delivery
You Say Meconium Aspiration
When say ‘Fluid in the Fissures
You say Transient Tachypnea
When say ‘History of c-scction
You say Transient Tachypnea
When say ‘Maternal sedation”,
You say Transient Tachypnea
When say ‘Granular Opacities + Premature
You say RDS
When say ‘Granular Opacities + Term + High Lung Volume
You say Pneumonia
When say “Granular Opacities + Term + Low Lung Volume
You say B-Hemolytic Strep
When say ‘Band Like Opacities
You say Chronic Lung Disease (BPD)
When say ‘Linear Lucencies
You say Pulmonary Interstitial Emphysema
When say ‘Pulmonary Hypoplasia
You say diaphragmatic hernia
When say ‘Lung Cysts and Nodules
You Say LCH or Papillomatosis
When say ‘Lower lobe bronchiectasis
You Say Primary Ciliary Dyskinesia
When say ‘Upper lobe bronchiectasis
You Say CF
When say ‘Posterior mediastinal mass (under 2),”
You Say Neuroblastoma
When say ‘No air in the stomach
You say Esophageal Atresia
When say ‘Excessive air in the stomach
You say “H” Type TE fistula
When say ‘Anterior Esophageal Impression
You say pulmonary sling
When say ‘Pulmonary Sling,
You say tracheal stenosis.
When say ‘Single Bubble
You say Gastric (antral or pyloric) atresia
When say ‘Double Bubble
You say duodenal atresia
When say ‘Duodenal Atresia
You say Downs
When say ‘Single Bubble with Distal Gas
You say maybe Mid Gut Volvulus
When say ‘Non-bilious vomiting”,
You say Hypertrophic Pyloric Stenosis
When say ‘Paradoxial aciduria”
You say Hypertrophic Pyloric Stenosis
When say ‘Bilious vomiting - in an infant
You say Mid Gut Volvulus
When say ‘Corkscrew Duodenum
You say Mid Gut Volvulus
When say ‘Reversed SMA and SMV
You say Malrotation
When say ‘Absent Gallbladder
You say biliary atresia
When say ‘Triangle Cord Sign
You say biliary atresia
When say ‘Asplenia
You say “cyanotic heart disease”
When say ‘Infarcted Spleen
You say Sickle Cell
When say ‘Gall Stones
You say Sickle Cell
When say ‘Short Microcolon
You say Colonic Atresia
When say ‘Long Microcolon
You say Meconium ileus or distal ileal atresia
When say ‘Saw tooth colon
You say Hirschsprung
When say ‘Calcified mass in the mid abdomen o f a newborn
you say Meconium Peritonitis
When say ‘Meconium ileus equivalent
you say Distal Intestinal Obstruction Syndrome (CF)
When say ‘Abrupt caliber change o f the aorta below the celiac axis”
You say Hepatic
Hemangioendothelioma,
When 1 say “Cystic mass in the liver o f a newborn,”
you say Mesenchymal Hamartoma
When say Elevated AFP, with mass in the liver o f a newborn
you say Flepatoblastoma
When say Common Bile Duct measures more than 10 mm
You say Choledochal Cyst
When say Lipomatous pseudohypertrophy of the pancreas
You say CF
When say Unilateral Renal Agenesis
You say unicomuate uterus
When say Neonatal Renal Vein Thrombosis
You say maternal diabetes
When say Neonatal Renal Artery Thrombosis
You say Misplaced Umbilical Artery Catheter
When say Flydro on Fetal MRI
You say Posterior Urethral Valve
When say Urachus
You say bladder Adenocarcinoma
When say Nephroblastomatosis with necrosis
you say Wilms
When say Solid Renal Tumor o f Infancy,”
you say Mesoblastic Nephroma
When say Solid Renal Tumor o f Childhood
you say Wilms
When say Midline pelvic mass, in a female
you say Hydrometrocolpos
When say Right sided varicocele
you say abdominal pathology
When say Blue Dot Sign
you say Torsion of the Testicular Appendage
When say Hand or Foot Pain / Swelling in an Infant
You say - sickle cell with hand foot syndrome.
When say ixtratesticular scrotal mass
you say embryonal rhabdomyosarcoma
When say Narrowing o f the interpedicular distance
you say Achondroplasia
When say Platyspondyly (flat vertebral bodies),”
you say Thanatophoric
When say Absent Tonsils after 6 months
You say “Immune Deficiency”
When say Enlarged Tonsils well after childhood (like 12-15)”
You say “Cancer” … probably
lymphatic
When say Mystery Liver Abscess in Kid
You say “Chronic Granulomatous Disease”
When say narrowed B Ring
You say Schatzki (Schat”B ”ki Ring)
When say esophageal concentric rings
You say Eosinophilic Esophagitis
When say shaggy” or “plaque like” esophagus
You say Candidiasis
When say looks like Candida, but an asymptomatic old lady
you say Glycogen Acanthosis
When say reticular mucosal pattern
you say Barretts
When say high stricture with an associated hiatal hernia
you say Barretts
When say abrupt shoulders,
you say cancer
When say Killian Dehiscence
you say Zenker Diverticulum
When say transient, fine transverse folds across the esophagus
you say Feline Esophagus.
When say bird’s beak
you say achalasia
When say solitary esophageal ulcer
you say CMV or AIDS
When say ulcers at the level o f the arch or distal esophagus
you say Medication induced
When say Breast Cancer + Bowel Hamartomas
you say Cowdens
When say Desmoid Tumors + Bowel Polyps
you say Gardners
When say Brain Tumors + Bowel Polyps
you say Turcots
When say enlarged left supraclavicular node
you say Virchow Node (GI Cancer)
When say crosses the pylorus
you say Gastric Lymphoma
When say isolated gastric varices
you say splenic vein thrombus
When say multiple gastric ulcers
you say Chronic Aspirin Therapy.
When say multiple duodenal (or jejunal) ulcers
you say Zollinger-Ellsion
When say pancreatitis after Billroth 2,
you say Afferent Loop Syndrome
When say Weight gain years after Roux-en-Y
you say Gastro-Gastro Fistula
When say Clover Leaf Sign - Duodenum
you say healed peptic ulcer.
When say ‘Sand Like Nodules in the Jejunum
you say Whipples
When say Sand Like Nodules in the Jejunum + CD4 <100
you say MAI
When say Ribbon-like bowel
you say graft vs host
When say Ribbon like Jejunum,
you say Long Standing Celiac
When say Moulage Pattern,
you say Celiac (moulage = loss o f jejunal folds)
When say Fold Reversal - of jejunum and ileum
you say Celiac
When say Cavitary (low density) Lymph nodes
you say Celiac
When say hide bound” or “Stack or coins
you say Scleroderma
When say Megaduodenum
you say Scleroderma
When say Duodenal obstruction, with recent weight loss
you say SMA Syndrome
When say Coned shaped cecum
you say Amebiasis
When say Lead Pipe
you say Ulcerative Colitis
When say String Sign
you say Crohns
When say Massive circumferential thickening, without obstruction
you say Lymphoma
When say Multiple small bowel target signs
you say Melanoma
When say Obstructing Old Lady Hernia
you say Femoral Hernia
When say sac of bowel
you say Paraduodenal hernia.
When say scalloped appearance of the liver
you say Pseudomyxoma Peritonei
When say HCC without cirrhosis
you say Hepatitis B (or Fibrolamellar HCC)
When say Capsular retraction
you say Cholangiocarcinoma
When say Periportal hypoechoic infiltration + AIDS
you say Kaposi’s
When say sparing o f the caudate lobe
you say Budd Chiari
When say large T2 bright nodes + Budd Chiari
you say Hyperplastic nodules
When say liver high signal in phase, low signal out phase
you say fatty liver
When say liver low signal in phase, and high signal out phase
you say hemochromatosis
When say multifocal intrahepatic and extrahepatic biliary stricture
you say PSC
When say multifocal intrahepatic and extrahepatic biliary strictures + papillary stenosis
you say AIDS
Cholangiopathy.
When say bile ducts full of stones
you say Recurrent Pyogenic Cholangitis
When say Gallbladder Comet Tail Artifact
ou say Adcnomyomatosis
When say lipomatous pseudohypertrophy of the pancreas
you say CF
When say sausage shaped pancreas
you say autoimmune pancreatitis
When say autoimmune pancreatitis
you say IgG4
When say lgG4”
you say RP Fibrosis, Sclerosing Cholangitis, Fibrosing Mediastinitis, Inflammatory Pseudotumor
When say Wide duodenal sweep
you say Pancreatic Cancer
When say Grandmother Pancreatic Cyst”
you say Serous Cystadenoma
When say Mother Pancreatic Cyst
you say Mucinous
When say Daughter Pancreatic Cyst
you say Solid Pseudopapillary
When say bladder stones,”
you say neurogenic bladder
When say pine cone appearance
you say neurogenic bladder
When say urethra cancer
you say squamous cell CA
When say urethra cancer - prostatic portion
you say transitional cell CA
When say urethra cancer - in a diverticulum,”
you say adenocarcinoma
When say long term supra-pubic catheter
you say squamous Bladder CA
When say e-coli infection
you say Malakoplakia
When say vas deferens calcifications
you say diabetes
When I say “calcifications in a fatty renal mass
you say RCC
When 1 say “protrude into the renal pelvis
you say Multilocular cystic nephroma
When I say “no functional renal tissue,”
you say Multicystic Dysplastic Kidney
When 1 say “Multicystic Dysplastic Kidney
you say contralateral renal issues (50%)
When I say “Emphysematous Pyelonephritis
you say diabetic
When I say “Xanthogranulomatous Pyelonephritis
you say staghom stone
When I say “Papillary Necrosis
you say diabetes
When I say “shrunken calcified kidney,”
you say TB (“putty kidney”)
When 1 say “bilateral medulla nephrocalcinosis
you say Medullary Sponge Kidney
When I say “big bright kidney with decreased renal function
you say HIV
When I say “history of lithotripsy
you say Page Kidney
When I say “cortical rim sign
you say subacute renal infarct
When I say “history of renal biopsy
you say AVF
When 1 say “reversed diastolic flow
you say renal vein thrombosis
When 1 say “sickle cell trait
you say medullary RCC
When 1 say “Young Adult, Renal Mass, + Severe HTN
you say Juxtaglomerular Cell Tumor
When 1 say “squamous cell bladder CA
you say Schistosomiasis
When 1 say “entire bladder calcified
you say Schistosomiasis
When 1 say “urachus
you say adenocarcinoma o f the bladder
When I say “long stricture in urethra
you say Gonococcal
When 1 say “short stricture in urethra,”
you say Straddle Injury
When 1 say “Unicomuate Uterus
you say Look at the kidneys
When 1 say “T-Shaped Uterus
you say DES related or Vaginal Clear Cell CA
When I say “Marked enlargement o f the uterus
you say Adenomyosis
When 1 say “Adenomyosis,
you say thickening o f the junctional zone (> 12 mm)
When 1 say “Wolffian duct remnant
you say Gartner Duct Cyst
When I say “Theca Lutein Cysts,”
you say moles and multiple gestations
When I say “Theca Lutein Cysts + Pleural Effusions,”
you say - Hyperstimulation Syndrome (patient on
fertility meds).
When I say “Low level internal echoes
you say Endometrioma
When I say “T2 Shortening,
you say - Endometrioma - “Shading Sign”
When 1 say “Fishnet appearance
you say Hemorrhagic Cyst
When I say “Ovarian Fibroma + Pleural Effusion
you say Meigs Syndrome
When I say “Snow Storm Uterus
you say Complete Mole - 1st Trimester
When I say “Serum (3-hCG levels that rise in the 8 to 10 weeks following evacuation o f molar pregnancy
you say Choriocarcinoma
When I say “midline cystic structure near the back of the bladder o f a man
you say Prostatic Utricle
When 1 say “lateral cystic structure near the back o f the bladder of a man
you say Seminal Vesicle Cyst
When I say “isolated orchitis
you say mumps
When 1 say “onion skin appearance
you say epidermoid cyst
When I say “multiple hypoechoic masses in the testicle
you say lymphoma
When I say “cystic elements and macro-calcifications in the testicle
you say Mixed Germ Cell Tumor
When 1 say “homogenous and microcalcifications
you say seminoma
When 1 say “gynecomastia + testicular tumor
you say Sertoli Leydig
When 1 say “fetal macrosomia,
you say Maternal Diabetes
When I say “one artery adjacent to the bladder,”
you say two vessel cord
Pulmonary Interstitial Emphysema (PIE)
put the bad side down
Bronchial Foreign Body
put the lucency side down (if it stays that way, it’s positive)
Papillomatosis has a small (2%) risk o
scc
Pulmonary sling is the only variant that goes
between the esophagus and the trachea. This is associated
with trachea stenosis.
Thymic Rebound
Seen after stress (chemotherapy) - Can be PET-Avid
Lymphoma - Most common mediastinal mass
in child (over 10)
Anterior Mediastinal Mass with Calcification
Either treated lymphoma, or Thymic Lesion (lymphoma
doesn’t calcify unless treated).
Neuroblastoma is the most common
posterior mediastinal mass in child under 2 (primary thoracic does
better than abd)
Hypertrophic Pyloric Stenosis
NOT at birth, NOT after 3 months (3 weeks to 3 months )
Criteria for HPS
4 mm and 14 mm (4mm single wall, 14mm length).
Annular Pancreas presents as
duodenal obstruction in children and pancreatitis in adults
Most common cause o f bowel obstruction in child over 4
Appendicitis
ntussusception
3 months to 3 years is ok, earlier or younger think lead point
Gastroschisis is ALWAYS
on the right side
Omphalocele has
associated anomalies (gastroschisis does not).
Physiologic Gut Hernia normal at
6-8 weeks
AFP is elevated with
hepatoblastoma
Endothelial growth factor is elevated with
Hemangioendothelioma
Most Common cause o f pancreatitis in a kid
trauma (seatbelt)
Weigert Meyer Rule
Duplicated ureter on top inserts inferior and medial
Most common tumor o f the fetus or infant
Sacrococcygeal Teratoma
Most common cause o f idiopathic scrotal edema
HSP
Most common cause o f acute scrotal pain age 7-14
Torsion o f Testicular Appendages
Bell Clapper Deformity is the etiology for
testicular torsion
SCFE is a
Salter Harris Type 1
Physiologic Periostitis o f the Newborn doesn’t occur in a newborn
seen around 3 months
Acetabular Angle should be
< 30, and Alpha angle should be more than 60
Most Common benign mucosal lesion o f the esophagus
papilloma
Esophageal Webs have increased risk for
cancer, and Plummer-Vinson Syndrome (anemia T web)
Dysphagia Lusoria is from
compression by a right subclavian artery (most patients with aberrant rights
don’t have symptoms).
Achalasia has an increased risk of
squamous cell cancer (20 years later)
Most common mesenchymal tumor o f the G1 tract
GIST
Most common location for GIST
Stomach
Abscesses are almost exclusively seen in
Crohns (rather than UC)
Nodes + UC
Common in the setting o f active disease
Nodes (larger than 1 cm) + Crohns
Cancer
Diverticulosis + Nodes
Cancer (maybe) -> next step endoscopy
Krukenberg Tumor
Stomach (GI) met to the ovary
Menetrier’s involves
fundus and spares the antrum
The stomach is the most common location for
sarcoid (in the Gl tract)
Gastric Remnants have an increased risk o f cancer years after
Billroth
Most common internal hernia
Left sided paraduodenal
Most common site o f peritoneal carcinomatosis
retrovesical space
An injury to the bare area o f the liver can cause a
retroperitoneal bleed
Primary Sclerosing Cholangitis associated with
UC
Extrahepatic ducts are normal with
Primary Biliary Cirrhosis
Anti-mitochondrial Antibodies
positive with primary biliary cirrhosis
Mirizzi Syndrome
the stone in the cystic duct obstructs the CBD
Mirizzi has a 5x increased risk of
GB cancer
Dorsal pancreatic agenesis
associated with diabetes and polysplenia
Hereditary and Tropical Pancreatitis
early age o f onset, increased risk o f cancer
Felty’s Syndrome
Big Spleen, RA, and Neutropenia
Splenic Artery Aneurysm
- more common in women, and more likely to rupture in pregnant women.
Insulinoma is the most common
islet cell tumor
Gastrinoma is the most common
islet cell tumor with MEN
Ulcerative Colitis has an increased risk o f colon cancer
(if it involves colon past the splenic flexure). UC involving the rectum only does not increase risk o f CA.
Calcifications in a renal CA
are associated with an improved survival
RCC bone mets are “always”
lytic
There is an increased risk o f malignancy with
dialysis
Horseshoe kidneys are more susceptible to
trauma
Most common location for TCC is the
bladder
Second most common location for TCC is the
upper urinary tract
Upper Tract TCC is more commonly
multifocal (12%) - as opposed to bladder (4%)
The cysts in acquired renal cystic disease improve after renal transplant, although the risk o f renal CA in
the native kidney remains elevated.
In fact, the cancers tend to be more aggressive because o f the
immunosuppressive therapy needed to not reject a transplant.
Weigert Meyer Rule
Upper Pole inserts medial and inferior
Ectopic Ureters are associated with
incontinence in women (not men)
Leukoplakia is
pre-malignant
malakoplakia is not
pre-malignant
Extraperitoneal bladder rupture
is more common, and managed medically
Intraperitoneal bladder rupture
is less common, and managed surgically
Indinavir (HIV medication) stones are the only ones
not seen on CT
Uric Acid stones are not seen
plain film
Endometrial tissue in a rudimentary horn (even one that does NOT communicate) increases the risk o f
miscarriage
Arcuate Uterus does NOT have an increased risk o f
infertility (it’s a normal variant)
Fibroids with higher T2 signal respond better to
UAE
Hyaline Fibroid Degeneration
is the most common subtype
Adenomyosis
favors the posterior wall, spares the cervix
Hereditary Non-Polyposis Colon Cancer (HNPCC)
a 30-50x increased risk o f endometrial
cancer
Tamoxifen increases the risk o f
endometrial cancer, and endometrial polyps
Cervical Cancer that has parametrial involvement (2B)
is treated with chemo/radiation. Cervical
Cancer without parametrial involvement (2A) - is treated with surgery
Vaginal cancer in adults is usually
squamous cell
Vaginal Rhabdomyosarcoma occurs in
children / teenagers
remenopausal ovaries can be hot on PET (depending on the phase o f cycle). Post menopausal ovaries
should Never be hot on PET.
Transformation subtypes
Endometrioma = Clear Cell, Dermoid = Squamous
Postpartum fever can be from
ovarian vein thrombophlebitis
Fractured penis
rupture o f the corpus cavemosum and the surrounding tunica albuginea
Prostate Cancer is most commonly in the
peripheral zone, - ADC dark
BPH nodules are in the
central zone
Hypospadias is the most common association with
prostatic utricle
Seminal Vesicle cysts are associated with
renal agenesis, and ectopic ureters
Cryptorchidism increases the risk o f
cancer (in both testicles), and the risk is not reduced by orchiopexy
Immunosuppressed patients can get
testicular lymphoma -hiding behind blood testes barrier
Most common cause o f correctable infertility in a man is a
varicocele
Undescended testicles are more common in
premies
Membranes disrupted before 10 weeks, increased risk for
amniotic bands
The earliest visualization o f the embryo is the
double bleb sign
Hematoma greater than 2/3 the circumference o f the chorion has a
2x increased risk o f abortion.
Biparietal Diameter
Biparietal Diameter - Recorded at the level o f the thalamus from the outermost edge o f the near skull to the inner table o f the far skull.
Abdominal Circumference
does not include the subcutaneous soft tissues
Abdominal Circumference is recorded at the the level o f the
junction o f the umbilical vein and left
portal vein
Abdominal Circumference is the parameter classically involved with
asymmetric IUGR
Femur Length does NOT include
the epiphysis
Umbilical Artery Systolic / Diastolic Ratio should NOT
exceed 3 at 34 weeks - makes you think preeclampsia and IUGR
A full bladder can mimic a
placenta previa
Nuchal lucency is measured between
12 weeks, and should be < 3 mm. More than 3mm is associated with Downs.
Lemon sign will disappear after
24 weeks
Aquaductal Stenosis is the most common cause
of non-communicating hydrocephalus in a neonate
The tricuspid valve is the most
anterior
The pulmonic valve is the most
superior
There are 10 lung segments on the
right
8 lung segments on the
left
If it goes above the clavicles, it’s in the
osterior mediastinum (cervicothoracic sign)
Azygos Lobe has
4 layers o f pleura
Most common pulmonary vein variant is
a separate vein draining the right middle lobe
Most common cause o f pneumonia in AIDS patient
Strep Pneumonia
Most common opportunistic infection in AIDS
PCP
Aspergilloma is seen in a
normal immune patient
Invasive Aspergillus is seen in an
immune compromised patient
Fleischner Society Recommendations do NOT apply to
patient’s with known cancers
Eccentric calcifications in a solitary pulmonary nodule pattern is considered
the most suspicious
A part solid nodule with a ground glass component is the most
suspicious morphology you can have
Most common early presentation o f lung CA
is a solitary nodule (right upper lobe)
Lung Fibrosis patients (UIP, e tc …) more commonly have
lower lobe CA
Stage 3B lung CA is
unresectable (contralateral nodal in v o lv emen t; ipsilateral or contralateral
scalene or supraclavicular nodal involvement, tumor in different lobes).
The most common cause o f unilateral lymphangitic carcinomatosis
is bronchogenic carcinoma lung
cancer invading the lymphatics
There is a 20 year latency between initial exposure and
development o f lung cancer or pleural mesothelioma
Pleural effusion is the earliest and most common finding with
asbestosis exposure
Silicosis actually raises your risk o
by about 3 fold.
Nitrogen Dioxide exposure is
“Silo Filler’s Disease,” gives you a pulmonary edema pattern.
Reticular pattern in the posterior costophrenic angle
is supposedly the first finding o f UIP on CXR
Sarcoidosis is the most common recurrent primary disease after
lung transplant
Pleural plaque o f asbestosis typically
spares the costophrenic angles
Pleural effusion is the most common manifestation
of mets to the pleura
There is an association with mature teratomas and
klinefelter syndrome
Injury close to the carina is going to cause a
pneumomediastinum rather than a pneumothorax
Hodgkin Lymphoma spreads in a contiguous fashion from the
mediastinum and is most often unilateral.
Non-Hodgkin Lymphoma is typically
bilateral with associated abdominal lymphadenopathy
MRI is superior for assessing
superior sulcus tumors because you need to look at the brachial plexus.
Leiomyoma is the most common
benign esophageal tumor (most common in the distal third).
Esophageal Leiomyomatosis may be associated with
alports syndrome
Bronchial / Tracheal injury must be evaluated with
bronchoscopy
If you say COP also say
eosinophiic pneumonia
If you say BAC also say
lymphoma
Bronchial Atresia is classically in the
LUL
Pericardial cysts MUST be
simple, Bronchogenic cysts don’t have to be simple
PAP follows a rule o f 1 /3s post treatment
1/3 gets better, 1/3 doesn’t, 1/3 progresses to fibrosis
Dysphagia Lusoria presents
later in life as atherosclerosis develops
Carcinoid is COLD on
PET
Wegener’s is now called
Granulomatosis with Polyangiitis
The right atrium is defined by the
IVC
The right ventricle is defined by the
moderator band
The tricuspid papillary muscles insert
on the septum (mitral ones do not).
Lipomatous Hypertrophy o f the Intra-Atrial Septum - can be
PET Avid (it’s brown fat)
LAD gives o ff
diagonals
RCA gives off
acute marginals
LCX give off
obtuse marginals
RCA perfuses
SA and AV nodes most of the time
Dominance is decided by which vessel gives o ff the
posterior descending - it’s the right 85%
LCA from the Right Coronary Cusp
always gets repaired
RCA from the Left Coronary Cusp
repaired if symptoms
Most common location o f myocardial bridging
is in the mid portion o f the LAD.
Coronary Artery Aneurysm - most common cause in adult
atherosclerosis
Coronary Artery Aneurysm - most common cause in child
kawasaki
Left Sided SVC empties into the
coronary sinus
Rheumatic heart disease is the most common cause
of mitral stenosis
Pulmonary Arterial Hypertension is the most common cause of
tricuspid atresia
Most common vascular ring is the
double aortic artch
Most common congenital heart disease is a
VSD
Most common ASD is
the secundum
Infracardiac TAPVR classically shown with
pulmonary edema in a newborn
“L” Transposition type is
congenitally corrected (they are “L”ucky).
“D” Transposition type is
doomed
Truncus is associated with
CATCH-22 (DiGeorge)
Rib Notching from coarctation spares the
1st and 2nd Ribs
Infarct with > 50% involvement is
unlikely to recover function
Microvascular Obstruction is NOT seen in
chronic infarct
Amyloid is the most common cause o f
restricted cariomyopathy
Primary amyloid can be seen in
multiple myeloma
Most common neoplasm to involve the cardiac valves
fibroelastoma
Most commonly the congenital absence o f the pericardium
is partial and involves the pericardium
over the left atrium and adjacent pulmonary artery (the left atrial appendage is the most at risk to
become strangulated).
Glenn shunt
SVC to pulmonary artery (vein to artery)
Blalock-Taussig Shunt
Subclavian Artery to Pulmonary Artery (artery - artery)
Ross Procedure
Replaces aortic valve with pulmonic, and pulmonic with a graft (done for kids).
Aliasing is common with Cardiac MRI. You can fix it by:
(1) opening your FOV, (2) oversampling
the frequency encoding direction, or (3) switching phase and frequency encoding directions.
Giant Coronary Artery Aneurysms
(> 8mm) d o n ’t regress, and are associated with Mis.
Wet Beriberi
(thiamine def) can cause a dilated cardiomyopathy
Most common primary cardiac tumor in children
rhabdomyoma
2nd most common primary cardiac tumor in children
Fibroma
Most common complication o f MI is
myocardial remodeling
Unroofed coronary sinus is associated with
persistent left SVC
Most common source o f cardiac mets
Lung Cancer (lymphoma #2).
A-Fib is most commonly associated with
left atrial enlargement
Most common cause o f tricuspid insufficiency is
RVH (usually from pulmonary HTN / cor
pulmonale).
Artery o f Adamkiewicz comes o ff
on the left side (70%) between T8-L1 (90%)
Arch o f Riolan
middle colic branch o f the SMA with the left colic o f the IMA
Most common hepatic vascular variant
right hepatic artery replaced o ff the SMA
The proper right hepatic artery is
anterior the right portal vein, whereas the replaced right hepatic artery is
posterior to the main portal vein.
Accessory right inferior hepatic vein
most common hepatic venous variant
Anterior tibialis is the
first branch o ff the popliteal
Common Femoral Artery (CFA): Begins at the level o f
inguinal ligament
Superficial Femoral Artery (SFA): Begins once the
CFA gives o ff the profunda femoris
Popliteal Artery: Begins as the
SFA exits the adductor canal
Popliteal Artery terminates as the
anterior tibial artery and the tibioperoneal trunk
Axillary Artery: Begins at
the first rib
Brachial Artery: Begins as it crosses
teres major
Brachial Artery: Bifurcates to the
ulnar and radial artery
lntraosseous Branch: Typically arises from the
ulnar artery
Superficial Arch = From the
ulna
Deep Arch = From the
radius
The “coronary vein,” is the
left gastric vein
Enlarged splenorenal shunts are associated with
hepatic encephalopathy
Aortic Dissection, and intramural hematoma are caused by
HTN (70%)
Penetrating Ulcer is from
atherosclerosis
Strongest predictor o f progression o f dissection in intramural hematoma
Maximum aortic diameter >
5cm.
Leriche Syndrome Triad
Claudication, Absent/ Decreased femoral pulses, Impotence.
Most common associated defect with aortic coarctation
bicuspid aorta (80%)
Neurogenic compression is the most common subtype of
thoracic outlet syndrome
Splenic artery aneurysm
More common in pregnancy, more likely to rupture in pregnancy.
Median Arcuate Compression
worse with expiration
Colonic Angiodysplasia is associated with
aortic stenosis
Popliteal Aneurysm
30-50% have AAA, 10% o f patient with AAA have popliteal aneurysm, 50-70% of
popliteal aneurysms are bilateral.
Medial deviation o f the popliteal artery by the medial head o f the gastrocnemius
popliteal entrapment
Type 3 Takayasu is the
most common (arch + abdominal aorta)
Most common vasculitis in a kid
HSP (Henoch-Schonlein Purpura)
Tardus Parvus infers stenosis
proximal to that vessel
1CA Peak Systolic Velocity < 125
“No Significant Stenosis” or < 50%
1CA Peak Systolic Velocity 125-230
50-69% Stenosis or “Moderate”
ICA Peak Systolic Velocity > 230
70% Stenosis or “ Severe”
18G needle will accept a
0.038 inch guidewire,
19G needle will allow a
0.035 inch guidewire
Notice that 0.039, 0.035, 0.018 wires are in
inches
3 French
1mm
French size is the (what) of the catheter and sheath
French size is the OUTSIDE o f a catheter and the INSIDE o f a sheath
End Hole Only Catheters
hand injection only
Side Hole + End Hole
Power Injection OK, Coils NOT ok
Double Flush Technique
For Neuro IR — no bubbles ever
“Significant lesion”
A systolic pressure gradient > 10 mm Hg at rest
Things to NOT stick a drain in:
Tumors, Acute Hematoma, and those associated with acute bowel rupture and peritonitis
Renal Artery Stenting for renal failure
tends to not work if the Cr is > 3.
Persistent sciatic artery is
prone to aneurysm
Even if the cholecystostomy tube instantly resolves all symptoms, you need to leave the tube in for
2-6 weeks (until the tract matures), otherwise you are going to get a bile leak.
MELD scores greater than
24 are at risk o f early death with TIPS
The target gradient post TIPS (for esophageal bleeding) is between
9 and 11
Absolute contraindication for TIPS
Heart Failure, Severe Hepatic Failure
Most common side effect o f BRTO is
gross hematuria
Sensitivity = GI Bleed Scan
- lmL/min
Sensitivity Angiography
1.0 mL/min
For Gl Bleed - after performing an embolization o f the GDA (for duodenal ulcer),
you need to do a run o f the SMA to look at the inferior pancreaticoduodenal
Most common cause o f lower Gl bleed is
diverticulosis
TACE will prolong survival better than
systemic chemo
TACE: Portal Vein Thrombosis is considered
a contraindication (sometimes) because o f the risk o f infarcting the liver.
Left Bundle Branch Block needs
a pacer before a Thoracic Angiogram
Never inject contrast through a
Swan Ganz catheter for a thoracic angiogram
You treat pulmonary AVMs at
3 mm
Hemoptysis - Active extravasation is
NOT typically seen with the active bleed
UAE - Gonadotropin-releasing medications (often prescribed for fibroids) should be
stopped for 3
months prior to the case
The general rule for transgluteal is to
avoid the sciatic nerves and gluteal arteries by access through the
sacrospinous ligament medially (close to the sacrum, inferior to the piriformis).
When to pull an abscess catheter; As a general rule
when the patient is better (no fever, WBC
normal), and output is < 20 cc over 24 hours.
If the thyroid biopsy is non-diagnostic
you have to wait 3 months before you re-biopsy
Posterior lateral approach is the move fo
perc nephrostomy
You can typically pull a sheath with an ACT
< 150-180
Artery calcifications (common in diabetics)
make compression difficult, and can lead to a false
elevation o f the AB1.
Type 2 endoleaks are the
most common
Type 1 and Type 3 endoleaks are
high pressure and need to be fixed stat
Venous rupture during a fistula intervention can ofter be treated with
prolonged angioplasty (always leave the balloon on the wire).
Phlegmasia alba
massive DVT, without ischemia and preserved collateral veins
Phlegmasia cerulea dolens
massive DVT, complete thrombosis o f the deep venous system, including the
collateral circulation.
You are more likely to develop Venous Thromboembolism if you are
paraplegic vs tetraplegic
Circumaortic left renal vein
the anterior one is superior, the posterior one is inferior, and the filter should be below the lowest one.
Risk o f DVT is increased with
IVC filters
Filter with clot > 1cm3 o f clot
Filter stays in
Acute Budd Chiari with fulminant liver failure
needs a TIPS
Pseudoaneurysm o f the pancreaticoduodenal artery
Sandwich technique” - distal and proximal
segments o f the artery feeding o ff the artery must be embolized
Median Arcuate Ligament Syndrome - First line is
surgical release of the ligament
Massive Hemoptysis =
Bronchial artery - Particles bigger than 325 micrometers
Acalculous Cholecystitis
Percutaneous Cholecystostomy
Hepatic encephalopathy after TIPS
You can either (1) place a new covered stent constricted in the
middle by a loop o f suture - deployed in the pre-existing TIPS, (2) place two new stents - parallel to each
other (one covered self expandable, one uncovered balloon expandable).
Recurrent variceal bleeding after placement o f a constricted stent
balloon dilation o f the constricted stent
Appendiceal Abscess
Drain placement * just remember that a drain should be used for a mature (walled
off) abscess and no frank pertioneal symptoms
Inadvertent catheterization o f the colon (after trying to place a drain in an abscess)
wait 4 weeks for the
tract to mature - verify by over the wire tractogram, and then remove tube.
DVT with severe symptoms and no response to systemic anticoagulation
Catheter Directed
Thrombolysis
Geiger Mueller
maximum dose it can handle is about lOOmR/h
Activity level greater than 100 mCi o f Tc-99m is considered
a major spill
Activity level greater than 100 mCi o f Tl-201 is considered
a major spill
Activity level greater than 10 mCi o f In-111, is considered to represent
a major spill
Activity level greater than 10 mCi o f Ga-67, is considered
a major spill
An activity level greater than 1 mCi o f 1-131 is considered to constitute
a major spill
Annual Dose limit o f 100 mrem to
the public
Not greater than 2 mrem per hour - in an
unrestricted area
Total Body Dose per Year
5 rem
Total equivalent organ dose (skin is also an organ) per year
50 rem
Total equivalent extremity dose per year
50 rem (500mSv)
Total Dose to Embryo/fetus over entire 9 months
0.5 rem
NRC allows no more than 0.15 micro Ci o f Mo per
1 mili Ci o f Tc, at the time o f administration
Chemical purity (Al in Tc) is done with
PH paper
The allowable amount o f Al is
< 10 micrograms
Radiochemical purity (looking for Free Tc) is done with
thin layer chromatography
Free Tc occurs from
lack o f stannous ions or accidental air injection (which oxidizes)
Prostate Cancer bone mets are uncommon with a PSA less than
10 mg/ml
Flair Phenomenon occurs 2 weeks - 3 months
after therapy
Skeletal Survey is superior (more sensitive) for
lytic mets
AVN - Early and Late is
COLD, Middle (repairing) is Hot.
Particle size for VQ scan is
10-100 micrometers
Xenon is done first during
the VQ scan
Amiodarone - classic
thyroid uptake blocker
Hashimotos increases risk for
lymphoma
Hot nodule on Tc, shouldn’t be considered benign until you show that it’s also hot
on I123. This is the
concept o f the discordant nodule.
History o f methimazole treatment (even years prior) makes 1-131 treatment
more difficult
Methimazole side effect is
neutropenia
In pregnancy PTU is
the blocker of choice
Sestamibi in the parathyroid depends on
blood flow and mitochoncria
You want to image with PET - following therapy at interval of
2-3 weeks for chemotherapy, and 8-12
weeks for radiation is the way to go. This avoids “ stunning” - false negatives, and inflammatory
induced false positive.
111 In Pentetreotide is the most commonly used agent for
somatostatin receptor imaging. The classic
use is for carcinoid tumors
Meningiomas take up
octreotide
In 111 binds to
neutrophils, lymphocytes, monocytes and even RBCs and platelets
Tc99m HMPAO binds to
neutrophils
WBCs may accumulate at post op surgical sites for
2-3 weeks
Prior to MIBG you should
block the thyroid with Lugols Iodine or Perchlorate
Scrotal Scintigraphy
The typical agent is Tc-99m Pertechnetate. This agent is used as both a flow
agent and a pool agent.
Left bundle branch block can cause a
false positive defect in the ventricular septum (spares the apex)
Pulmonary uptake o f Thallium is an indication o f
LV dysfunction
MIBG mechanism is that o f an Analog o
Norepinephrine - actively transported and stored in the neurosecretory granules
MDP mechanism is that o f a
Phosphate analog - which works via Chemisorption
Sulfur Colloid mechanism
Particles are Phagocytized by RES
The order o f tumor prevalence in NF2 is the same as the mnemonic
MSME (schwannoma >
meningioma > ependymoma).
Maldeveloped draining veins is the etiology o f
sturge weber
All phakomatosis (NF 1, NF -2, TS, and VHL) EXCEPT Sturge Weber are
autosomal dominant
Most Common Primary Brain Tumor in Adult
astrocytoma
“Calcifies 90% o f the time”
oligodendroglioma
Restricted Diffusion in Ventricle
Watch out for Choroid Plexus Xanthogranuloma (not a brain
tumor, a benign normal variant)
Pituitary - T1 Big and Bright =
pituitary apoplexy
Pituitary - Normal T1 Bright =
Posterior Part (because o f storage o f Vasopressin , and other storage proteins)
Pituitary - T2 Bright =
rathke cleft cyst
Pituitary - Calcified =
craniopharyngioma
CP Angle - Invades Internal Auditory Canal =
schwannoma
CP Angle - Invades Both Internal Auditory Canals =
schwannoma with NF2
CP Angle - Restricts on Diffusion =
epidermoid
Peds - Arising from Vermis =
medulloblastoma
Peds - “tooth paste” out o f 4th ventricle =
ependymoma
Adult myelination pattern
T 1 at 1 year, T2 at 2 years
Brainstem and posterior limb o f the internal capsule are
are myelinated at birth.
CN2 and CNV3 are not in the
cavernous sinus
Persistent trigeminal artery (basilar to carotid) increases
the risk of aneurysm
Subfalcine herniation can lead to
ACA infarct
ADEM lesions
will NOT involve the calloso-septal interface.
Marchiafava-Bignami progresses from
body -> genu -> splenium
Post Radiation changes don’t start for
2 months (there is a latent period).
Hippocampal atrophy is first with
alheimer dementia
Beaked Tectum =
chiari 2
Beaker Anterior Inferior LI =
Hurlers
Sometimes Beaked Pons =
multi system atrophy
Most common TORCH is
CMV
Toxo abscess does NOT
restrict diffusion
Small cortical tumors can be occult without
IV contrast
JPA and Ganglioglioma can
enhance and are low grade
Nasal Bone is the
most common fx
Zygomaticomaxillary Complex Fracture (Tripod)
is the most common fracture pattern and involves
the zygoma, inferior orbit, and lateral orbit.
Supplemental oxygen can mimic
SAH on FLAIR
Putamen is the most common location for
hypertensive hemorrhage
Restricted diffusion without bright signal on FLAIR should make you think
hyperacute (< 6 hours)
stroke.
Enhancement o f a stroke: Rule o f 3s
starts at day 3, peaks at 3 weeks, gone at 3 months
PAN is the Most Common systemic vasculitis
to involve the CNS
Scaphocephaly is the most common type o f
scaphocephaly
Piriform aperture stenosis is associated with
hypothalamic pituitary adrenal axis issues.
Cholesterol Granuloma is the most common
primary petrous apex lesion
Large vestibular aqueduct syndrome has
absence o f the bony modiolus in 90% o f cases
Octreotide scan will be positive for
esthesioneuroblastoma
The main vascular supply to the posterior nose is the
sphenopalatine artery (terminal internal maxillary artery).
Warthins tumors take up
pertechnetate
Sjogrens gets salivary gland
lymphoma
Most common intra-occular lesion in an adult
melanoma
Enhancement o f nerve roots for 6 weeks after spine surgery
is normal. After that it’s arachnoiditis
Hemorrhage in the cord is the most important factor for
outcome in a traumatic cord injury
Currarino Triad
Anterior Sacral Meningocele, Anorectal malformation, Sarcococcygeal osseous defect
Type 1 Spinal AVF (dural AVF)
is by far the more common.
Herpes spares the
basal ganglia (MCA infarcts do not)
Most common malignant lacrimal gland tumor
adenoid cystic adenocarcinoma
Arthritis at the radioscaphoid compartment is the first sign o f
SNAC or SLAC wrist
SLAC wrist has a
DISI deformity
Pull o f the Abductor pollucis longus tendon is what causes
the dorsolateral dislocation in the Bennett Fx
Carpal tunnel syndrome has an association with
dialysis
Degree o f femoral head displacement predicts risk of
AVN
Proximal pole o f the scaphoid is at risk fo
AVN with FX
Most common cause o f sacral insufficiency fracture
osteoporosis in old lady
Patella dislocation is nearly always
lateral
Tibial plateau fracture is way more common
laterally
SONK favors
medial knee (are of maximum weight bearing)
Normal SI joints excludes
ankylosing spondylitis
Looser Zones are a type o f
insufficiency fx
T score o f -2.5 marks
osteoporosis
First extensor compartment
de Quervains
First and Second compartment
intersection syndrome
Sixth extensor compartment
early RA
Flexor pollicis longus goes through
the carpal tunnel, flexor pollicis brevis does not
The pisiform recess and radiocarpal joint
normally communicate
The periosteum is intact with both
Perthes and ALPSA lesions. In a true bankart it is disrupted.
Absent anterior/superior labrum, + thickened middle glenohumeral ligament
buford complex
Medial meniscus is thicker
posteriorly
TB in the spine
spares the disc space (so can brucellosis).
Scoliosis curvature points away from the
osteoid osteoma
Osteochondroma is the only benign skeletal tumor associated with
radiation
Mixed Connective Tissue Disease requires
serology (Ribonucleoprotein) for Dx
Medullary Bone Infarct will
have fat in the middle
Bucket Handle Meniscal tears are
longitudinal tears
No grid on
mag views
BR-3 =
< 2% chance o f cancer
BR-5
> 95% chance o f cancer
Nipple enhancement can be
normal on post contrast MRI - don’t call it Pagets.
Upper outer quadrant has the highest density o f breast tissue,
and therefore the most breast cancers
Majority o f blood (60%) is via the
internal mammary
Majority o f lymph (97%) is to
axilla
The stemalis muscle can only be seen on
CC view
Most common location for ectopic breast tissue is in the
axilla
The follicular phase (day 7-14) is the best time to have
a mammogram (and MRI).
Breast Tenderness is max around day
27-30
Tyrer Cuzick is the most
comprehensive risk model, but does not include breast density.
If you had more than 20Gy o f chest radiation as a child
you can get a screening MRI
BRCA 2 (more than 1) is seen with
male brease cancer
BRCA 1 is more in
younger patients
BRCA 2 is more in
post menopausal
BRCA 1 is more often a
triple negative CA
Use the LMO for
kyphosis, pectus excavatum, and to avoid a pacemaker / line
Use the ML to help catch
milk of calcium layering
Fine pleomorphic morphology to calcification has the
highest suspicion for malignancy
Intramammary lymph nodes are NOT
in the fibroglandular tissue
Surgical scars should get lighter, if they get denser
think about recurrent cancer.
You CAN have isolated
intracapsular rupture
You CAN NOT have isolated
extra (it’s always with intra).
If you see silicone in a lymph node, you need to recommend
MRI to evaluate for extracapsular rupture
The number one risk factor for implant rupture is
the age of the implant
Tamoxifen causes
a decrease in parenchymal uptake, then a rebound
T2 Bright things
these are usually benign. Don’t forget colloid cancer is T2 bright
