WlwG Vascular/IR/NM Flashcards
True vs false aneurysm? 4 differences
True aneurysm: Wall intact, wide neck, due to MI/congenital/myocarditis. Low risk of rupture, high risk of THROMBUS. Involves all 3 wall layers.
False pseudoaneurysm: Wall ruptured, narrow neck/saccular outpouching, due to MI/trauma/infn/syphilis. High risk of RUPTURE. 1-2 wall layers.
Signs of Penetrating ulcer
HTN patient with atherosclerotic plaques eroding the aortic wall BETWEEN CALCIFICATIONS causing outpouching sac.
Ascending aorta aneurysm >40 year old, dx and cause
Cystic medial necrosis: >40 year old with vessel wall degeneration, thus ascending aortic aneurysms. Due to HTN/connective tissue diseases.
Ascending aorta aneurysm <30 year old, dx and cause
Syphilitic aortitis: <30 year old with inflammation/fibrosis/aneurysm of ASCENDING aorta > abdominal aorta.
Cause of ascending aortic calcifications
Takayasu or Syphilis
Cause of descending aortic calcifications
Atherosclerosis, descending aorta aneurysm/haematoma/dissection due to HTN
T1-hyper CT-hyper crescent shape in vessel
Intra-mural haematoma, from HTN/atherosclerosis
Dissection: Stanford A vs B location and management
Stanford A (ascending aorta, Tx surgery), Stanford B (descending aorta distal to LEFT SUBCLAVIAN, Tx medical control of HTN).
Ix Trans-Oesophageal echo (TOE) if stable, Aortography/Coronary angiography if Stanford A or unstable type B.
Dissection: Stanford A vs B location and investigation
Stanford A (ascending aorta, Tx surgery), Stanford B (descending aorta distal to LEFT SUBCLAVIAN, Tx medical control of HTN).
Ix Trans-Oesophageal echo (TOE) if stable, Aortography/Coronary angiography if Stanford A or unstable type B.
Signs of aorto-iliac occlusion
Hip and thigh claudication, impotence, reduced femoral pulses. Ix arteriography.
Signs of abdominal aortic coarctation
<30 year old with HTN, claudication, abdominal angina, renal failure.
Signs of Hypothenar-Hammer syndrome
Thrombosis of ulnar artery at Guyon’s canal after trauma/excessive vibration/hand sports. Pain/sensitivity/cyanosis commonly over 4-5th fingers.
Signs of Thoracic outlet syndrome
Compression of brachial plexus or subclavian vessels, usually at scalene triangle, costoclavicular space or pectoralis tunnel.
Signs of Paget-Schroetter syndrome
Upper limb DVT of axillary of subclavian VEIN due to repetitive shoulder sports, upper limb pain/swelling symptoms (“Page a SAD Sporter” = Subclavian/Axillary DVT in sports).
Signs of Subclavian steal syndrome
Subclavian artery occlusion with reversal of flow in vertebral artery. Results in dizziness/visual/motor/sensory changes, worst on neck movement. Tx angioplasty/stent.
Signs of Subclavian vein thrombosis
Either spontaneous or Paget-Schroetter disease, due to impingement of vein between anterior scalene muscle, first rib, subclavian tendon. Tx anticoagulation/surgery.
Signs of Brachiocephalic vein obstruction
UNILATERAL ARM/FACE swelling in DIALYSIS patient (compared to SVCO which is bilateral).
Signs of Popliteal artery entrapment syndrome
In young athletes with cold feet/calf numbness/tingling. May also trap popliteal vein causing leg cramps/swelling. Due to gastrocnemius muscle abnormal positioning.
Signs of Cystic adventitial degeneration
T2-hyper mucous CYSTS in the wall of the popliteal artery in young males, causing claudication.
Signs of Arterial thromboembolism
(“P’s”) Pain, Pallor, Pulselessness, Paresthesia, Paralysis. Due to cardiac mural thrombus, MI, arrhythmia, aneurysms. Tx embolectomy.
Signs of May Thurner
“LID” = Left common Iliac vein DVT from compression by right common iliac artery, thus swollen left leg +/- PE.
Vasculitis dx: Head artery inflamed
GCA (“giant arteritis”)
Vasculitis dx: Aorta inflammed with pulmonary artery aneurysm/stenosis
Takayasu aortitis
Vasculitis dx: Child aorta inflammation
Cogan
Vasculitis dx: Many nodular micro-aneurysms
PAN (“polyarthritis with nodules”)
Vasculitis dx: Tiny vessel bleeds in lungs and kidney
MPA (“Micro-angiitis”)
Vasculitis dx: Cute child with calcified coronary artery aneurysm
Kawasaki (“Kawaii”)
Vasculitis dx: Many holes in lungs, kidneys, nose
Wegeners/GPA (“Like Hitler”)
Vasculitis dx: Transient consolidations
(ie take a short MC to Chuck out the Stress) = Churg Strauss
Vasculitis dx: Lung/kidney/GI bleed, scrotal, skin purpura
Lung/Kidney/GI bleed (He got knocked) + scrotal (Schonlein) + skin Purpura = HSP
Vasculitis dx: Oral & genital ulcers
Oral & genital ulcers cause Bae Cheated = Behcets
Vasculitis dx: Corkscrew collaterals and fingers
Smoke, Drink (corkscrew collaterals) & eat Burgers with fingers = Buergers
Vasculitis dx: Glomerulonephritis + Pulmonary bleed + Anaemia
Goodpastures
Vasculitis dx: anti-GBM
Goodpastures
IR Embolisation method: GI bleed, temporary
Vasopressin
IR Embolisation method: HCC/trauma, temporary
Gelfoam
IR Embolisation method: Tumours, permanent
Ethyl alcohol
IR Embolisation method: AVM, permanent
CyanoAcrylate
IR Embolisation method: Aneurysm/GI bleed, permanent
Coil
IR Embolisation method: Varicose veins
Endoluminal heat ablation
IR Embolisation method: Varicocele testicular/spermatic vein
Coil
Which Vessel to treat: Haemoptysis
Bronchial artery
Which Vessel to treat: Pulmonary AVM/HHT/Osler Weber
Pulmonary artery
Which Vessel to treat: Massive PE
Pulmonary artery
Which Vessel to treat: Upper GI bleed
Left gastric
Which Vessel to treat: Duodenal ulcer bleed
Gastroduodenal artery (aka greater duodenal artery)
Which Vessel to treat: Pancreas
Coeliac artery
Which Vessel to treat: Renal HTN/trauma/aneurysm
Renal artery
Which Vessel to treat: Middle GI bleed (normal OGD/Colono)
Small bowel AVM
Which Vessel to treat: Distal ileum
Meckels (Ix 99mTc Pertechnetate
Which Vessel to treat: Right lower GI bleed (ascending colon)
Angiodysplasia, Right colic artery
Which Vessel to treat: Left lower GI bleed (sigmoid)
Diverticulosis
Which Vessel to treat: Fibroids
Uterine artery
Which Vessel to treat: Fibroid MRI appearance after embolisation?
Fibroid will subsequently degen after uterine artery embolisation, looking T1-hyper, T2-hypo, non-enhancing. If also endometrium non-enhancing, suspicious for uterine necrosis
Which Vessel to treat: Post-partum haemorrhage
Uterine artery
Which Vessel to treat: Pelvic congestion syndrome
Ovarian and para-uterine VEINS
Which Vessel to treat: Varicocele
Gonadal/testicular/spermatic VEINS
When EVAR for AAA?
Stent if AAA > 5.5cm or growing >0.5 cm per 6 months. Landing zone of >1cm length and <3.2cm wide (not dilated). Risk of cord ischaemia/paraplegia especially near T9-T12 Adamkiewicz region.
Endoleak Type: 1
(Leak out the top/bottom ENDS of stent due to ineffective seal)
Endoleak Type: 2
(OTHERS/Collateral artery from IMA/lumbar artery filling aneurysm)
Endoleak Type: 3
(Leak from BETWEEN stents due to non-overlap or mid-stent due to stent defect)
Endoleak Type: 4
(SEEPAGE through porous graft wall material, rare nowadays)
Endoleak: Management of Type 1-4
Tx: 1 & 3 intervention/surgery, 2 & 4 observe.
TIPS vs BRTO, direction of flow
Trans-jugular Intra-hepatic Porto-systemic Shunt (TIPS):
Shunt blood from portal vein to hepatic vein (‘porto-systemic’), thus REDUCING blood flow to liver.
For portal HTN, oesophageal variceal bleed, hepatorenal syndrome, persistent ascites despite drainage.
Contraindicated in severe liver disease (elevated Bil/ALT)/hepatic encephalopathy/right heart failure.
Balloon-occluded Retrograde Transverse Obliteration (BRTO):
Blocks gastro-renal/gastro-caval shunt, thus reduce blood in gastric varices and INCREASES blood flow to liver (opposite of TIPS).
Thus for gastric varices or hepatic encephalopathy
TIPS vs BRTO, indications
Trans-jugular Intra-hepatic Porto-systemic Shunt (TIPS):
Shunt blood from portal vein to hepatic vein (‘porto-systemic’), thus REDUCING blood flow to liver.
For portal HTN, oesophageal variceal bleed, hepatorenal syndrome, persistent ascites despite drainage.
Contraindicated in severe liver disease (elevated Bil/ALT)/hepatic encephalopathy/right heart failure.
Balloon-occluded Retrograde Transverse Obliteration (BRTO):
Blocks gastro-renal/gastro-caval shunt, thus reduce blood in gastric varices and INCREASES blood flow to liver (opposite of TIPS).
Thus for gastric varices or hepatic encephalopathy
AV fistula, continuous thrill vs pulsatile thrill vs thrill only during systole meanings?
Continuous thrill with mild pulsatility = good. Thrill only during systole = peripheral stenosis. Very pulsatile thrill = central stenosis.
Limb ischaemia: Viable vs threatened vs irreversible
Viable = Arterial and venous waveform present, no sensory loss.
Threatened = Only venous waveform present, partial sensory loss.
Irreversible (i.e amputation) = No waveform present, complete sensory loss.
Limb ischaemia: ABPI criteria
(ankle divide by arm pressure, “in quarters”)
= >1.3 calcified vessel
>0.75 mild
>0.5 moderate
>0.3 moderate-severe
<0.3 severe.
Nuclear Scan for: V/Q, PE
MAA
Nuclear Scan for: Heart
Sestamibi (“Siesta at the Pit/PTH till heart attack”)
Nuclear Scan for: Parathyroid
Sestamibi (“Siesta at the Pit/PTH till heart attack”)
Nuclear Scan for: GIT
Pertechnetate (“Protect ni de gut”)
Nuclear Scan for: Kidney
Mag3
Nuclear Scan for: Bone
MDP, Methylene diphosphonate (“Like bisphosphonate, so bone”)
Nuclear Scan for: Thyroid
I-131 > I-123
Nuclear Scan for: Carcinoid
Octeotride
Nuclear Scan for: Gastrinoma
Octeotride
Nuclear Scan for: Meningioma
Octeotride
Nuclear Scan for: Cancers in general
PET
Nuclear Scan for: Dementia/Seizure
HMPAO or ECF
Nuclear Scan for: CSF
DTPA (“DTF thus fluids”)
Nuclear Med: Indications for V/Q scan
(“PPPP – PE, Pre-op lung function, Pulmonary HTN, Pulmonary thromboendarterectomy”)
Nuclear Med: Reduced ventilation, reduced perfusion, delayed ventilation causes
PE reduced perfusion ie VQ mismatch
Atelectasis reduced ventilation ie reversed VQ mismatch
COPD delayed ventilation washout with matching VQ)
Nuclear Scan for: EGFR
DTPA
Aortic levels: T4, T5, T12-L5
T4: Aortic arch, Angle of louis
T5: Carina
T12: Coelac trunk
L1: SMA, D1
L2: Renal, D2, D4
L3: IMA
L4: Aortic bifurcation
L5: IVC bifurcation
