Self Assessment Mock 4 Flashcards
Ix to distinguish benign from malignant pleural thickening
18FDG PET/CT
Mets to adrenal gland
Mets:
Lung, breast, melanoma, GI, renal.
Commonly large, heterogenous with central necrosis and haemorrhage.
Carcinoma:
Rarer, calcifies in 30%, can invade renal vein and IVC
Madelung deformity
Bowed, shortened radius with positive ulnar variance and V shaped proximal carpal row.
Causes:
- Hurler
- Infection
- Trauma
- Dyschondrosteosis (e.g. Leri-Weill syndrome)
- Osteochondromatosis (diaphyseal aclasia)
- Congenital (Turner, Nail patella, Achondroplasia)
Ameloblastoma vs others
Age >40, painless hard lump.
Multilocular, bubbly/honeycomb with cystic and solid components which enhance avidly.
Expansile, can cause root resorption
Odontogenic keratocysts - enhance poorly.
Dentigerous cysts and radicular cysts are unilocular, related to crown of unerupted tooth or roots respectively
Medullary sponge kidney
Striated nephrogram (paintbrush appearance) in otherwise well patient.
No further follow up needed
Duodenal atresia, level of obstruction
D2, just distal to Ampulla
CJD
Abnormal signal in thalamus, basal ganglia (esp caudate and putamen) and cortex, with high T2 and diffusion restriction.
Cognitive impairment over months with generalised atrophy
Commonest pleural malignancy
Mets from lung Ca. Breast, ovary and lymphoma are also common mets
Mesothelioma is commonest primary
Commonest cause of gastric mets
Melanoma
Incidental liver lesion on US during pregnancy - Ix
Unenhanced MRI, after first trimester
Neurosarcoidosis
Leptomeningeal thickening and enhancement with basal predominance.
Cranial nerve involvement (facial or optic nerves commonly) differentiates from TB meningitis
Acute eosinophilic pneumonia
Short fever, marked hypoxia.
B/L consolidation and GGO with pleural effusions and interlobular septal thickening.
Normal serum eosinophils unlike chronic. Elevated eosinophuls in bronchoalveolar fluid.
NF1 chest findings
Bibasal fibrosis,
Pectus excavatum,
Posterior vertebral body scalloping,
Ribbon ribs,
Inferior rib notching
AAST liver laceration grading
1: Subcapsular haematona <10% surface area, laceration <1cm deep
2: Subcapsular haematoma 10-50%, intraparenchymal haematoma <10cm, laceration <3cm deep/10cm long
3: Subcapsular haematoma >50%, intraparenchymal haematoma >10cm, laceration >3cm deep and >10cm long, active bleeding within liver parenchyma
4: Active bleeding beyond liver parenchyma, parenchymal disruption of 25-75% of liver lobe
5: Parenchymal disruption of >75% lobe, juxtahepatic venous injuries (IVC, major hepatic vein, etc)
Lipomyelomeningocele
Form of spina bifida.
Contains fat, extends within subcutaneous tissues and has neural arch defects.
Ovarian cystadenomas vs cystadenocarcinoma
Enhancing, nodular, intermediate T1 and T2 areas suggest malignancy.
Commonest malignancy ovarian tumour is serous cystadenocarcinioma - large cystic component with enhancing soft tissue which diffusion restricts.
Mucinous cystadenomas - multiple seprations and more varied signal than serous due to mucin content (stained glass on MRI).
Mural thickening or solid components would suggest mucinous cystadenocarcinoma
Capillary vs cavernous haemangioma
Capillary:
Often affect periorbital or skin surface (strawberry haemangioma), but can be intraorbital causing proptosis.
Increase in size over first few months, then regress.
Lobulated, septated, span intra and extra conal.
Curvilinear flow voids and intense enhancement.
Cavernous
Usually intraconal, in adults.
Rounded, well defined, encapsulated.
Slower, more patchy enhancement
Brodie abscess
Adjacent soft tissue swelling.
Lucent lesion, long axis of bone in metaphysis, with lucent channel extending towards physis in unfused skeleton.
TIPSS procedure - anatomy
Connection made between portal vein and hepatic vein
Osmotic demyelination syndrome - MRI
T2 and flair hyperintensity within the pons, crossing the midline - unlike pontine infarct.
Can restrict diffusion and also affect basal ganglia and subcortical white matter
AML follow-up/Rx
<20mm - can be discharged
20-40mm - follow up with interval imaging
>40mm - referral for embolisation or surgical removal
Also applies in TS associated AMLs
Croup - imaging
Subglottic narrowing, hypopharyngeal distension
Pial vessels peripheral to mass
Suggests intra-axial mass
Causes of chylothorax
Commonest is iatrogenic injury to thoracic duct.
In neonate: thoracic duct atresia, lymphangectasia and other pulmonary abnormalitis.
Turner, Noonan, Downs also associated.
LAM is a common cause in adults
