Special Population Flashcards
What is tool used to screen, diagnose lump or symptoms in breast?
Mammography
What is the BI-RADs score in mammography?
5-6 not ideal further eval d/t concern for malignancy, get MRI or biopsy.
Use CAD-computer aided detection software with reporting database
What is seen on Mammography that is normal?
High density ducts- white.
Fibrous breast/thick will be hard to see mass.
What are views of Mammography?
Cranial-caudal. Medial and Lateral-side smush
Describe mass shapes?
Round, Oval. Lobulated-scalloped, Irregular, Architectural Distortion-creates indentation externally
Describe mass shapes?
Circumcised-pick up, Obscured- less edge, Microlobulated- many scallops, Ill defined- very irregular. Spiculated- crab like spikes coming out everywhere
Which margin and shape carry high suspicion on mammography?
Asymmetric density, Lobulated, irregular, architectural distortion microlobulated, ill defined, spiculated, grouped micro-calcifications
What are benin patho on mammography?
Fibroadenomas, cysts, abscess, hematoma, intraductal papilloma,
What are indication for Breast US?
Not indicated for cancer screening
Indication = diagnostic?
CANNOT see Microcalcifications
ONLY for cystic or solid
What will indicate a cyst on Breast US? What is follow up ?
Cyst are Anechoic-black fluid, thin walls.
F/U is MRI or biopsy bc cyst MOST of time are benign BUT NOT ALWAYS
What is reason for Breast MRI?
Indications
- visibility-extent of tumor
- Breast implant rupture
- Young pt’s, high risk -dense tissue
- abnormality that can be felt but not seen on mammogram or ULS
- Mammogram & ULS indeterminate/unsure
- After surgery or radiation - recurrence
What is seen on MRI that is often malignant?
Ring enhanced tumors
What is next step after suspicious mammogram and MRI?
PET SCANS!
- Cancer staging
- Recurrent breast CA
- Best- Large, aggressive tumors
- Looking for mets
What is 1st choice for male breast?
Ultrasound
2nd Mammography- challenging
What’re the imaging options for testicles?
-power Doppler (vascular flow) ultrasound is the procedure of choice
-nuclear medicine scan
-MRI
NEVER CT
INDICATIONS
-torsion -trauma -epididymitis -orchitis -tumors -hernia -hydrocele -abscess
Is a power Doppler the same as the simple color flow?
NOOOOOO! It’s more advanced
What’s the normal appearance for a testicle on ULS?
- fine, homogeneous echo texture
- should have good flow signals on power flow Doppler
Who gets testicular torsion?
Kids and young men
spermatic cord twists and leads to low flow/infarct.
ischemia causes severe pain.
How will testicular torsion appear on ULS?
- heterogenous with hypoechoic areas
- testicular enlarged
- low or no flow signals on Doppler -NO FLOW = SURGICAL EMERGENCY
What’re indications for prostate imaging?
- malignancy
- urinary retention
- strictures
What’re imaging modalities for prostate imaging?
- US bladder for post-void residual
- transrectal US
- CT/MRI
- retrograde urethrogram (good for strictures)
When would we US the bladder vs transrectal?
Bladder: post residual volume, evaluate urinary retention Transrectal: abnormal digital exam, high PSA, masses, calcifications
When is a CT/MRI of the prostate indicated?
- evaluate masses or malignancy
- extent, characteristics of masses
- calcifications
- relationship to adjacent structures
If you see a long bone fracture in an infant/toddler, is that relatively normal?
NO! Long bone fractures require high force and are very uncommon especially if the pt is non-ambulatory
<1yo from fall of bed ABN
What is radiographic evidence of potential past abuse?
- periosteal reaction
- multiple healing sites with callous formation (5-14 callous begins)
What’re suggestive radiologic findings of non-accidental trauma in infants and toddlers?
- healing fractures in various stages w/ periosteal rxs
- posterior rib fractures
- fxs at edges of the metaphysis of long bones
- humeral shaft fx (above the supracondylar area)
- compression fractures of vertbral bodies
- femur, hand, foot fxs if non-ambulatory
- sternum, sternoclavicular joint, acromion, scapula
What is a skeletal survey?
- best is they are < 2 yo
- done down for legal
- 2 views of the skull
- lateral vertical, thoracolumbar spine
- AP views of upper and lower extremities -AP chest, oblique view of ribs
- AP pelvis
Is a bone scan useful in assessing non-accidental trauma?
They are sensitive, but not specific
When would we utilize a head CT w/o contrast for suspected non-accidental trauma in kiddos?
If they present w/ ALOC,
seizure,
retinal hemorrhage
What’s a common mechanism of posterior rib fractures in kiddos?
From squeezing of the chest, grasping, shaking of the lil one
If a 2 yo presents and has a metaphysical corner fracture, what should we be suspicious of?
Highly suggestive for child abuse from shaking, twisting, or pulling Seen in the knees, ankles, elbows or wrists
What’re kid specific conditions to remember?
- toddler’s fracture
- osteogenesis imperfecta
- salter Harris classification
- elbow/wrist ossification
- is osgood-schlatter dz
- slipped capital femoral epiphysis
- legg-calve-perthes disease
What is a toddlers fracture?
- occurs from 1-3 yrs of age
- from a fall running or foot gets caught
- KIDDO WILL NOT WALK
- non-displaced, oblique or spiral fox of distal tibia
- can be very, very subtle
Will an x-ray show a toddlers fracture?
Not always! It may be negative initially, but a callous will form **this is not abuse usually
What is osteogenesis imperfecta?
- failure to form normal collagen
- bone fragility, multiple, frequent fractures
- angulation of long bones and deformities
What’re the characteristics of osteogenesis imperfecta?
- Short stature
- Blue sclera
- Deafness
- Brittle teeth
