rapids and cases Flashcards
Perthes lesion
2 mc after bankart
labroligamentous avulsion with medially stripped periosteum
ALPSA
ant labrolig periosteal sleeve avulsion
tear of anteroinf labrum without rupture of scapular periosteum; inf GH, labrum and periosteum are stripped
GLAD lesion
glenolabral articul disruption
superfic tear of ant labrum attached to fragment of articu cartilage without stripping
Scurvy bone findings
osteoporosis subperiost haemor wimberger sign - line around epi white line of frankel - meta metaphyseal beaking - pelkan
Kummell disease
delayed post traumatic collapse
intravertebral vacuum cleft ( osteonecrosis
steroids
congenital unilat pedicle absence
overgrowth/sclerosis of contralate
asympto
widening of neural foramen
TP always abnormal
sarcoid in bones
10% affected lacelike phalangeal acro osteolysis soft tissue swelling rapidly destructive ask for CXR!
thalassaemia bone findings
MC/MT/phala widening, squaring, thinned cortices, coarse trabeculae
Skull- widened diploe, hair on end
PNS - obliterated sinuses, incisors pushed forward ‘ rodent facies’
dens fracture types
A - tip LC
B- across base of dens : MC, high rte of non , C1-2 fusion
C- subdental across body of axis; Rx halo
gamekeepers, skiers thumb - do MRI
steners
tear of UCL of 1st MCPJ
if torn ligament is superficial to Adductor policis aponeurosis > Steners lesion > prevents apposition to bone >surgery
maisonneuve #
prox fibular #
wideneing of medial mall jt space, post malleolar #
leptomeningeal cyst
growing #
< 3y, depressed skull #
pia arach herniates through tear
elliptical with bevelled edges
DDx - dermoid, epidermoid, encephaloceo, post surgical defect
calcaneonavicular coalition
talocalcaneal coa
young,
osseos, cartila, both
calcaneonavicu - anteater nose sign
talocalc -
c sign,
talar beak ( due to stress on talonav joint)
pincer type FA impingement
acetabular over coverage
anterior margin of acet projecting lateral to post margin ( cross over sign )
boeler angle
line anterior cal facet - post calcan facet - post cal tuberosity
20-40 deg
calcaneal pitch
angle formed by intersection of line along plantar aspect of calcaneus and line parallel to floor
normal 20-30
< 20 hindfoot equinus
>30 hindfoot calcaneus
Haglund Xd
retrocalcaneal bursitis
achilles tendionopathy
retroachilles bursitis
exostosis of posterosuperior calcaneus
macrodactyly
cong 6
acq 3
congenital lymphangioma, haemangioma klippel trenauny weber Ollier NF1 proteus
Acquired:
dactylitis
osteoid osteoma
melorheostosis
features of metastatic vertebral #
T1 low/T2 high, T2 high halo ( fluid in osteo) posterior bulging no fracture line soft tissue componenet DWI +ve CE +ve multiple levels, also abnormal signal without # any vertebrae can be involved posterior elements involved out phase - high SI - no fat cortical destruction
superficial siderosis brain
ch recurrent haemorrhages - AVM, tumours, post op
hearing loss, cerebellar dysfunc
pyramidal tract signs
mental deterio
H & N dermoid cyst
2-3rd decades m=f 7% H & N lateral eyebrow MC 10% floor of mouth 5% malignant change to SCC excise - above myol- intraoral
CT : ‘marbles’ due to coalescence of fat - pathognomonic
Huntington disease
diffuse cortical atrophy
caudate and putamen most affected
heart shaped frontal horns
Temporal bone #
types 2
Longitudinal 70-90%
parallels long axis of PTB
conductive hearing loss, disloc ossicl, CSF otorhinorrhoea
Tranverse # perpendicular occiput/frontal blow sensorineural HL sev vertigo, nystagmus FN palsy 30-50%
DNET
benign supratentorial partial complex seizures occ cystic focal cortical lesion MC temporal hypodense CT T1 hypoin, T2 hyper bright rim sign FLAIR minimal CE bubbly appearance
DDx ganglioglioma, low grade astro, PXA
spinal cord infarction
artery of Adamkiwicz T8- conus
central high T2 signal
initial cord expansion later atrophy
owl eye appearance
Cowden disaese
Lhermitte duclos disease ( cerebell gangliocytoma - striated mass) half have cowden AD phakomatosis colonic polyps cutaneos tumours meningioma glioma thyroid/Br neoplasms
adrenoleukodystrophy
XL R
nl head size
5 -10 yrs
adrenal insuff, abnormal sk pigmentation
periatrail WM + splenium
No grey matter involvement
Lemierre Xd
septic jugular vein thrombophelbitis after oropharyngeal infections tonsillitis etc life threatening young
MEN 2
medullary thyroid ca - always
phaeochromocytoma - common
a - parathyroid hyperplasia
b - mucosal neuromas
septo optic dysplasia
mildest form of holoprosencephaly hypoplas ON absence of septum pel squared off frontal horns endocrine abnormlaities migration anomalies schizencepha 50% periventricular cysts
Bilateral coloboma
outpouching of posterior globe
CHARGE Xd
clay shoveller #
# one or more spinous processes mc C7
Hoffa #
posterior tangential # of one or both femoral condyles
can be invisible on frontal
Chauffeur # aka Hutchisons
radial styloid #
Tillaux #
Maisonneuve
avulsion of anterolateral margin of distal tibia
SalterH type 3
Maisonneuve
medial malleolus
Prox fibula
Cottons #
Trimalleolar #
Aviators #
neck of talus
Hangmans #
C2 hyperentension pedicles of C2 with anterolisthesis of C2 on C3 no deficit teardrop # inferior aspect of C2/3
Malgaigne #
unstable pelvic # 14%
vertical shearing ant + post arches
pubic rami and sacral #
Chopart fracture
fracture dislocation of midtarsal joints (sup disloc navi and cuboid
Jefferson #
burst fracture of C1
bilateral lateral mass offset
no neuro deficit
Barton
Dorsal rim distal radius with intraarticular ext
Potts #
lower end of fibula and medial malleolus
non traumatic ICH
Underlying lesion : tumour, AVM, cavernoma, aneurysm
Amyloid angio
Dural VT
Hypertensive angio
coagulopathy
capillary telangiectasia
do not touch brainstem radiation no T2 brush like CE dark on SWI
caroticocavernous fistula
dilated SOV proptosis enlarged EOM retrobulbar FS bowed CS can be indirect - low flow
miliary mets
thyroid ca RCC breast melanoma pancreatic osteosarc trophoblastic
Miliary opacities
Afebrile
(TB) both (fungal) both varicella healed mets sarcoid pneumoconiosis -siol/Cwp haemosiderosis HP can be febrile LCH PAProteinosis multifocal micronod pneumocyte hyperplasia
cannonball mets
5
RCC chorio prostate synovial endometrial
primaries which freq met to lungs
6
chorio ewings melanoma osteo testicular thyroid
MC primaries which give pulmonary mets
Breast CRC RCC uterine leiomyo H + N SCC
Bezolds abscess
rare complication of acute suppurative mastoiditis
infection erodes mastoid tip and extends into neck/SCM
Abscess formation
torticollis
also ass with cholesteatomas
Basilar invagination
PF ROACH
PAgets FD Rickets/OM/ Osteogenesis Achondroplasia Cleidocranial Hyperpara
posterior vertebral body scalloping
congenital
dural ectasia
increased canal pressure
OI
mucopolysacc
achondroplasia
NF
Ehlers
Marfan
Syrinx
spinal canal tumour
cholesteatoma
key sequence
DWI restriction
beware epidermoid
subchondral osteonecrosis of knee
now called subchondral insufficiency # of knee
post op
stress related
diff location to OCD but similar appearance
Hemitruncus arteriosus
main PA continues as LPA
RPA arises from Asc Ao
Xd associated with gallstones
Bouveret - gastric outlet obstruction from GS
Mirizzi
Gilbert - congenital enzyme def > GS
Modified Fisher Scale Grading for SAH
I - thin < 1mm , no IVH/ICH
2 - thin < 1mm, IVH
3 - thick > 1 mm, no IVH
4 - thick , IVH
AICA vascular loops in CP angle
Types
I - lying in CPA not entering IAC
II - extending < 50% of length of IAC
III - > 50% of length of IAC
Achondroplasia
key findings
Skull Chest Limbs/hands Spine Pelvis
Skull : macrocephaly Frontal bossing NARROWED FM comm hydrocephalus large AF
Chest:
ant rib flaring
Short AP Diameter
Pelvis Tombstone ilia horizontal acetabulum champagne pelvis trident acetabulum
Limbs/hands Rhizomelic shortening/ bowing/ shortening MC/MT Trumpet shaped tubular bones Trident hand Chevron sign ( inverted V epiphyses)
Spinal
bullet shaped vertebra
posterior vertebral scalloping
prog decrease in interpedicular distance
check for FM narrowing!
MRI features of adhesive capsulitits
4
Capsular thickening > 9mm
T2 high in axillary recess
Abnormal ST in rotator interval
Thickening of coracohumeral ligament > 4mm
Vascular malformation types
Tumours
low flow vascul mal
high flow vasc
Tumours:
infantile haemangioma - involute
Low flow:
Venous : phleobliths, CE
Lymphatic
perc sclerotherapy
High flow
AVM - embolisation
Muller Weiss Syndrome
Adult Kohler
adult onset osteonecrosis of navicular
affects lateral aspect
BIRADS risk of malignancy
0 - incomplete 1 - 0% 2 - 0 % - routine FU 3 - < 2% prob benign - 6/12 FU 4a - low suspicion >2 < 10% 4b - mod susp >10<50% 4c - high suspicion > 50 < 95% 5 highly suggestive > 95% 6 bx proven
Biliary hamartomas
von meyenburg complexes
incidental 1-5% small < 1cm benign lesions CT : hypo US hypo, may contain echogenic cholesterol MR : high T2, no or rim CE
Focal hepatic hot spot sign
“hot quadrate (IV)”
SVC obstruction (collateral venous pathway : int mamm>paraumbil>left portal vein)
Focally inc bld flow to segment IV
Tc99m sulphur colloid inc activity
Intense early CE on CT
flip flop enhancement of the liver
Budd Chiari
pancreatic lipomatosis
causes 5
CF Steroids DM Cushings Scqachman diamond Xd
Fat ring sign
mesenteric panniculitis
fat rim around vessels
hepatic honeycomb sign
hepatic melioidosis abscess
Right paraduodenal hernia
through fossa of waldeyer
located behind SMA
Left paraduodenal hernia
fossa of landzert
IMV lies in its anterior wall
MR spect finding in CNS Tuberculosis
Inc lipid lactate peak Reduced NAA (mets, other tumours)
Erlenmeyer flask def
CHONG
C - craniometaphyseal dysplasia H -haemoglobinopathies Osteopetrosis Nieman-Pick Gauchers
Glutaric aciduria Type 1
B/L widened sylvian fissures
mitochondrial
macrocephaly
symm BG lesions
atretic parietal cephalocoele
underlying anomalies : persistent falcine sinus, sinus pericranii, absence of straight sinus
Ass with mat folate def/ valproate use
Leukoencephalopathy with anterior temporal cysts
3
Congenital CMV infection ( periven Ca)
megalencephalic leukoencephalopathy
vanishing white matter disease
Radial scar of the breast
complex sclerosing lesions
Idiopathic
not related to surgery
trauma
archi distortion, central lucency, black star appearance may contain micro ca different on diff projections Ddx - ca, surgical,fat necro Excision biopsy
ass atypical ductal hyper/ca ? upto 50%
bilateral breast skin thickening
CHF nephrotic dermatologic SVC obst lymphatic obstruction scleroderma dermatomyositis
unilat breast skin thickening
inflamm cancer radiation infection/inflamm axillary lLN obstruction occ CHF
reduction mammoplasty
mmg findings
elevated, flatter breast more tissue in LQ elevatged nipple swirled pattern fat necrosis dystrophic ca suture ca skin thickening subareolar fibrotic band
H Shaped vertebrae
SCD
spherocytosis
Gaucher
Thalassaemia
Nail patella Xd
(Fong disease)
4 features
fingernail dysplasia, triangular lunula
absent/hypo patella
posterior iliac horns ( 80%)
dysplastic radial head
centre edge angle for femoral head coverage
vertical line from centre of FH
second line through edge of acetabular roof
angle between them shd be more than 25 degrees. If less then DDH
Rf for HCC
cirrhosis haemachromatosis aflatoxin alpha 1 hepatitis Wilsons
patella baja associations
polio
ch juvenila idio pathic arthirtis
achondroplasia
Bilroth types
2
I - gastroduodenal end-end anastamosis
II - gastrojejunal side-side anastamosis. prox duodenal loop closed off
CT sign of unequivocal prostate enlargement
> 1cm above symphysis pubis
Chest uses of Ga 67 scintigraphy
Sarcoid disease activity
Lymphoma staging
P carinii pneumonia early detection
111 indium oxine WCC scanning
detects areas of infection/inflammation
18-24hrs after injection
superior to Ga67 ( excreted by colon) in abdo imaging
highest radiation dose to spleen ( hotter)
donor blood may be used esp in sev neutropenia but usually own cells
MIBG
‘hot’ scans
all NET Phaeochromocytoma carcinoid ganglioneuroma medullary thyroid ca neuroblastoma
labelled wiht I 123 or 131
image 4-24 hrs (123) or 1-4 days (131)
preferable to octreotide due to renal accumulation of oct
Tc pertechnetate or DTPA in testicular torsion
reduced activity cf thigh/contralteral
nubbin sing - increased activity in internal pudendal artery with abrupt cutoff at testis
ring/bullseye sign - inc activity in dartos muscle with central photpenia
lymphoscintigraphy
Tc nanocolloid
web interspace
dx congenital lymphoedema ( milroys - pooling in foot)
in venous obs - increased drainage
not sensitive for malignant LN but sentinel node is useful
nuclear cisternography
111 in or Tc DTPA injected into subarachnoid space in LS
imaged sequentially up spine
basal cisterns in 2-4 hrs
vertex - 24-48 hrs
normally no or minimal reflux into lateral ventricles ( transient is ok)
scheuermans disease
adolescents thoracic kyphosis > 40 thoracolumbar kyphosis > 30 > 3 vertebral bodies disc narrowing ante disc invagination scoliosis 25% >75 deg surgery
PHACE syndrome
posterior fossa malformation - dandy walker H aemangioma A rterial anomalies C oarctation E ye anomalies S ternal cleft
early u fibre involvement
MS ADEM Alexandre disease PML galactosemia
Late :
Canavan
medulloblastoma
assoc Xd
Turcot - colon plyps/brain tum
Cowden
Li Fraumeni
Gorlin Goltz
