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conglomerate backup
radiology oral boards
4067
Medical
Post-Graduate
06/16/2013

Additional Medical Flashcards

 


 

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Term
implant defect
Definition
1. intracapsular rupture
2. extracapsular rupture
3. radial fold
1. gel bleed
2. herniation
Term
mri enhancement patterns
Definition
1. type 1 persistent kinetics
2. type 2 plateau kinetics
3. type 3 washout kinetics
1. inital phase
Term
complex cystic mass in lactating woman
Definition
1. galactocele
2. abscess
3. fibroadenoma
1. hematoma
2. lactating adenoma
3 fibrocystic change
Term
coarse calcifications in a partially circumscribed mass
Definition
1. degenerating fibroadenoma
2. fat necrosis
3. oil cyst
1. hematoma
2. abscess
Term
benign-appearing calcification; rim, punctate and round forms
Definition
1. calcified oil cyst
2. dystrophic calcifications
3. dermal calcifications
1. fibrocystic change
2. hyalinized fibroadenoma calcification
Term
malignant-appearing calcifications; linear, branching forms
Definition
1. ductal carcinoma in situ/invasive ductal carcinoma
2. vascular calcifications
3. secretory calcifications
1. milk of calcium
2. fibrocystic change
Term
fatty breast lesion
Definition
1. hamartoma (fibroadenolipoma)
2. lipoma
3. galactocele
1. fat necrosis
2. oil cyst
Term
well-circumscribed mass in a premenopausal woman
Definition
1. fibroadenoma
2. cyst
3. intramammary lymph node
1. breast carcinoma
2. papilloma
Term
unilateral skin thickening
Definition
1. inflammatory breast cancer
2. mastitis
3. invasive breast cancer
1. post surgical or post-radiation changes
2. superior vena cava syndrome
3. lymphedema
Term
axillary lymphadenoopathy
Definition
1. breast cancer with lymph node spread
2. lymphoma
3. reactive lymphadenopathy
1. metastatic disease from remote primary
2. connective tissue and granulomatous disorders
3. Castleman disease
Term
Mass with central lucency
Definition
1. radial scar
2. invasive ductal cancer
3. tubular carcinoma
1. fat necrosis
2. post surgical scar
Term
well circumscribed solid breast mass
Definition
1. fibroadenoma
2. intramammary lymph node
3. hamartoma (fibroadenolipoma)
1. circumscribed breast carcinoma
2. papilloma
Term
well circumscribed cystic breast mass
Definition
1. papilloma/papillary carcinoma
2. seroma
3. cyst with debris
1. hematoma
2. abscess
Term
ductal mass
Definition
1. intraductal papilloma
2. intracystic papillary carcinoma
3. ductal carcinoma in situ
1. dilated duct with debris
Term
post-operative changes
Definition
1. post surgical architectural distortion
2. recurrent cancer
3. fat necrosis
1. radial scar
2. tubular carcinoma
Term
bilateral skin thickening
Definition
1. congestive heart failure
2. superior vena cava obstruction
3. bilateral lymphedema
1. psoriasis
2. renal failure and volume overload
Term
breast mass in male
Definition
1. gynecomastia
2. breast cancer
3. lipoma
1. hematoma
2. abscess
3. metastatic disease
Term
circumscribed cancer
Definition
1. invasive ductal carcinoma NOS
2. mucinous carcinoma
3. medullary carcinoma
1. papillary carcinoma
2. ductal carcinoma in situ
Term
developing asymmetry
Definition
1. invastive ductal carcinoma
2. invasive lobular carcinoma
3. pseudoangiomatous stromal hyperplasia
1. asymmetric breast tissue
2. stromal fibrosis
3. fat necrosis
Term
ill definted, infiltrative breast mass
Definition
1. infiltrating ductal carcinoma
2. infiltrating lobular carcinoma
3. postsurgical scar
1. fibrosis
Term
breast lesion with nipple discharge
Definition
1. intraductal papilloma
2. mammary duct ectasia
3. breast carcinoma (ductal or papillary)
1. fibrocystic change
2. galactorrhea
Term
unilateral nipple/skin changes
Definition
1. Paget disease of the nipple
2. mastitis
3. inflammatory breast carcinoma
1. nipple adenoma
2. eczema of the breast
Term
superficial breast mass
Definition
1. sebacesous cyst
2. epidermal inclusion cyst
3. focal infection
1. breast carcinoma
2. lymphoma
3. steatocystoma multiplex
Term
large breast mass
Definition
1. phyllodes tumor
2. fibroadenoma
2. circumscribed breast carcinoma
1. hematoma
2. abscess
Term
complex cystic mass
Definition
1. abscess
2. hematoma
3. cystic neoplasm
1. fat necrosis
2. cyst with debris
Term
solitary pulmonary nodule
Definition
1. granuloma
1. neoplasm
a. bronchogenic carcinoma:
1) adenocarcinoma: more peripheral
2) SCC and small cell carcinoma;more central
b. mets
1. hamartoma: can have fat and popcorn calcifications
1. round pneumonia (under 8): pores of Kohn and canals of Lambert
1. AVM: associated with Osler Weber Rendu disease (hereditary hemorrhagic telangiectasias). tx: embolization with coils.
Term
multiple pulmonary nodules
Definition
1. metastatic disease
2. granulomatous disease (TB, fungal, sarcoid)
3. septic emboli: may see "feeding vessel sign". vessels coursing directly to the center of a nodule.
4. Wegener disease: vasculitis affecting sinuses, lungs and kidneys. C-ANCA positive.
5. rheumatoid arthritis: rheumatoid nodules
Term
cavitary pulmonary nodule
Definition
1. TB
2. fungal: histoplasmosis in Ohio and MIssisippi river valleys, coccidioidomycosis: southwestern US.
3. squamous cell carcinoma
a. primary
b. metastatic: in male from head and neck; in female from cervix
1. pyogenic infection (pulmonary abscess, septic emboli-might be able to see the "feeding vessel sign")
2. Wegener disease: vasculitis affecting sinus, lungs and kidneys, C ANCA positive.
3. necrobiotic rheumatoid arthritis: rheumatoid nodules can occur though pleural effusion is most common pulmonary manifestation.
Term
miliary pulmonary nodules
Definition
1. TB
2. fungal disease
a. if immunocompetent: histoplasmosis if in ohio and missisippi valley or coccidiodomycosis in southwest US. also blastomycosis.
b. if immunocompromised: aspergillus, candida, cryptococcus.
3. metastatic disease: thyroid, renal melanoma
1. pneumoconiosis like silicosis and coal worker's pneumoconiosis. late complication of silicosis is progressive massive fibrosis.
2. healed varicela: calcified miliary pulmonary nodules.
Term
centrilobular pulmonary nodules
Definition
1. infectious bronchiolitis (MAI, TB)
2. hypersensitivity pneumonitis
a. farmer's lung: moldy hay
b. bird fancier's lung: avian proteins
c. humidifier lung: thermophilic bacteria
3. endobronchial spread of tumor
4. respiratory bronchiolitis associated interstitial lung disease: usually upper lobe centrilobular ggo (fyi: dip is lower lobe peripheral ggo)
2. pneumoconiosis like silicosis and coal worker's pneumoconiosis. can be perilymphatic or centrilobular. usually upper lobe. progressive massive fibrosis (can be caused by pneumoconiosis): conglomerate masses of dense fibrosis usually in the upper lobes.
Term
cystic lung disease
Definition
1. emphysema: centrilobular (upper lobes), paraseptal (upper lobes), panlobular (lower lobes. associated with alpha 1 antitrypsin deficiency)
2. lymphangioleiomyomatosis: women of reproductive age. smooth thin walls. throughout lung. chylous pleural effusions. associated with tuberous sclerosis.
3. Langerhans cell histiocytosis (LCH): smokers. irregular thick walls. upper lobes.
1. pneumocystis pneumonia: ggo with or without thin walled cysts, pneumatoceles
2. lymphocytic interstitial pneumonitis (LIP): can be due to AIDS, particularly in children and Sjogren syndrome. thin walled cysts, ggo, nodules.
Term
lower lobe interstitial disease
Definition
1. idiopathic pulmonary fibrosis/usual interstitial pneumonia
2. collagen vascular disease (scleroderma, RA, SLE)
3. asbestos related lung disease: when pulmonary fibrosis, then called asbestosis.
4. drug toxicity: amiodarone can also cause lower lobe ILD with dense opacities.
badass: bronchiectasis, asbestosis, desquamative interstial pna, alpha 1 antitrypsin antibody deficiency, scleroderma, sickle cell disease
Term
upper lobe interstitial disease
Definition
1. TB
2. sarcoid
3. cystic fibrosis
1. pneumoconioses
2. langerhans cell histiocytosis
casset: cystic fibrosis, Ank Spond, sarcoid, silicosis, EG (LCH), TB
Term
hyperlucent lung
Definition
1. chest wall abnormality
a. mastectomy
b. Poland syndrome: absence of pectoralis muscle
2. Swyer-James syndrome: insult to developing lung (classically viral)
3. Acute asthma attack
4. airway obstruction:
5. pulmonary embolism: ipsilateral
5. hypoplastic pulmonary artery: on the side contralateral to hyperlucent lung
6. pneumothorax especially in supine patient.
Term
anterior mediastinal mass
Definition
1. lymphoma: in thorax, usually Hodgkin's
2. thymic lesion
3. thyroid lesion
1. germ cell neoplasm: teratoma (mature-dermoid or immature), seminoma (called germinoma in pineal region or dysgerminoma in ovary) (- b hcg, - afp), yolk sac tumors (+afp), choriocarcinoma (+b hcg), embryonal cell tumors (conflicting results on markers so maybe don't memorize, but one source showed +b hcg, +afp)
Term
middle mediastinal mass
Definition
1. lymphadenopathy: enhancing nodules seen in Castleman dz, hypervascular mets, TB and sometimes sarcoid.
2. vascular abnormality
a. aortic aneurysm > 4cm: fusiform usually due to atherosclerotic disease, saccular usually due to infection.
b. pulmonary artery aneurysm: can be due to pulmonary artery htn.
3. congenital cysts like bronchogenic cyst, esophageal duplication cyst (fyi: neuroenteric cyst is in posterior mediastinum and associated with vertebral anomalies)
4. hiatal hernia
5. esophageal cancer.
Term
posterior mediastinal mass
Definition
1. cervicothoracic sign: if above the superior clavicle then in posterior mediastinum or neck. anterior mediastinum ends below the superior clavicle.
1. neurogenic tumor: ganglioneuroma, neuroblastoma, ganglioneuroblastoma.
1. paragganglioma
2. lymphoma
3. developmental cyst (neuroenteric cyst or bronchogenic cyst).
1. extramedullary hematopoiesis usually from chronic anemia from sickle cell disease, thalassemia, hypersplenism.
2. mediastinal hematoma
Term
chronic air space disease
Definition
1. cryptpgenic organizing pneumonia: lower lobe.
2. chronic eosinophilic pneumonia: upper lobe.
3. bronchiolo alveolar cell carcinoma (adenocarcinoma in situ)
4. pulmonary alveolar proteinosis
5. lipoid pneumonia
Term
peripheral air space disease
Definition
1. cryptogenic organizing pneumonia (lower lobe)
2. eosinophilic pneumonia (upper lobe)
3. pulmonary infarct
1. pulmonary contusion
2. alveolar sarcoidosis
Term
ground glass opacification
Definition
1. pulmonary edema
2. atypical infection: pneumocystis, CMV, RSV
3. pulmonary hemorrhage
4. acute respiratory distress syndrome
[aside: remember stuff easily forgotten with mnemonic PP VD H C. Pee Pee VD, Herpes Cured
protein alveolar proteinosis, pneumoconiosis (silicosis, coal worker's pneumoconiosis), vascular (AVM-Osler Weber Rendu) or vasculitis (Wegener's or Churg Strauss), Drugs, hypersensitivity pneumonitis, collagen vascular disease (RA, scleroderma, lupus)]
5. alveolar proteinosis
6. vasculitis (Churg Strauss, Wegener's granulomatosis)
Term
mediastinal/hilar lymphadenopathy
Definition
1. infection:
2. lymphoma: if there is no superior mediastinal lymphadenopathy then Hodgkin's lymphoma unlikely. calcification can occur after treatment.
3. sarcoidosis:
1. metastatic disease
2. pneumoconioses: silicosis and coal worker's pneumoconiosis.
aside: TB (caseating necrosis) and sarcoid (non-caseating)
Term
calcified pleural disease
Definition
1. asbestos related pleural disease. if pulmonary interstitial fibrosis then called asbestosis. exposure to asbestos can lead to mesothelioma (pleural thickening and/or pleural effusion). asbestos related pleural disease tends to be bilateral
2. fibrothorax: due to pyothorax, hemothorax, effusion.
3. iatrogenic: talc pleurodesis
Term
bronchiectasis
Definition
1. post infectious: viral: bacterial, TB, MAC=MAI ("Lady Windermere" syndrome. affects RML and lingula)
2. cystic fibrosis
3. allergic bronchopulmonary aspergillosis (ABPA): "finger in glove" opacities with typically increased attenuation (> 100 HU)
1. obsructive lesion/mass due to aspiration, hilar adenopathy or endobronchial tumors
2. ciliary dyskinesia: kartagener's is a variant of ciliary dyskinesia with situs inversus, sinusitis, bronchiectasis, infertility
Term
perilymphatic pulmonary nodules
Definition
1. sarcoidosis
2. lymphangitic spread of tumor
3. pneumoconioses like silicosis and coal workers pneumoconiosis. can have eggshell calcifications of LN and progressive massive fibrosis.
4. lymphoproliferative disorder like lymphoma, post transplant lymphoproliferative disorder (PTLD) and lymphocytic interstitial pneumonitis (LIP in children with AIDS and Sjogren syndrome)
Term
pleural based mass
Definition
1. pleural based metastatic disease
2. empyema
3. mesothelioma: related to prior asbestos exposure. presents as pleural effusion or irregular nodular pleural thickening. can also have calcification. can involve mediastinal pleura and usually > 1 cm.
1. fibrous tumor of the pleura: associated with hypertrophic osteoarthropathy and hypoglycemia. low T1 and T2.
2. fibrothorax: hemothorax, pyothorax, effusion. usually doesn't involve mediastinal pleura. usually < 1 cm.
Term
parenchymal disease in an HIV patient
Definition
1. pneumocystis pneumonia: ggo and possibly cysts
2. tuberculosis: usually upper lobe.
3. fungal infection: histoplasmosis and coccidiodomycosis
1. invasive aspergillosis: CT "halo" sign: consolidation surrounded by ggo. "air crescent" sign in healing phase.
2. kaposi sarcoma
3. pulmonary lymphoma: AIDS related lymphoma is usually non-Hodgkins. LIP (lymphocytic interstitial pneumonitis)
Term
abnormal left ventricular contour
Definition
1. true left ventricular aneurysm: due to myocardial infarction. true myocardial wall. medical mgt. wide neck > 50% of aneurysm diameter.
2. false left ventricular aneurysm: due to myocardial infarction. rupture of myocardium. contained by pericardial adhesions. propensity to rupture. tx: resection. narrow neck < 50% of aneurysm diameter.
3. pericardial cyst/mass/thrombus.
a. cyst: low T1 (can be high if proteinaceous material), high T2
b. tumor: usually low T1 and high T2. malignant enhances more than benign tumors.
c. thrombus: depends on age of thrombus. doesn't enhance.
d. mets: variable appearance.
4. calcific percarditis: can be due to TB, uremic or viral pericarditis.
Term
cardiac mass
Definition
1. thrombus: doesn't enhance
2. metastatic disease: variable appearance.
3. benign cardiac neoplasm
a. atrial myxoma: LA attached to interatrial septum. hypointense on gradient. iso to cardiac muscle on T1 and heterogeneously enhances.
b. rhabdomyoma: attached to interventricular septum. associated with tuberous sclerosis
4. malignant cardiac neoplasm
a. sarcoma
b. primary cardiac lymphoma
Term
delayed myocardial enhancement
Definition
1. infarction/scar: if enhancement is greater than 50% of wall thickness then unlikely to benefit from revascularization. delayed images acquired at 10-20 min. vascular distribution. subendocardial or transmural.
2. myocarditis: can be from infection, drugs, toxins, and systemic diseases. does not correspond to a vascular distribution. midportion of myocardium.
3. cardiac mass
4. infiltrative disease (amyloidosis, glycogen storage disease, sarcoid, lymphoma)
Term
cardiac wall fatty deposition
Definition
1. lipoma: encapsulated.
2. lipomatous hypertrophy of the interatrial septum: can cause supraventricular arrhythmias. not encapsulated and insinuates into fossa ovalis.
3. arrhythmogenic right ventricular dysplasia: can cause arrhythmias and sudden death. MRI alone is not sufficient for diagnosis.
Term
dense liver
Definition
GI WATT
1. Gold therapy: for RA
2. Iron. primary or secondary hemochromatosis
a. primary: liver hepatocytes, pancreas and skin (bronze diabetes), heart, msk system. autosomal recessive.
b. secondary: liver kupffer cells, spleen, bone marrow. due to iron overload. secondary may also be called hemosiderosis if due to transfusions.
3. Wilson's disease
4. amiodarone therapy: can also cause high density in the lungs
5. type I and IV glycogen storage disease
6. thoratrast
Term
nodular liver contour
Definition
1. cirrhosis: regenerating nodules (high T1, low T2, if hcc or metastatic high T2)
a. micronodular: due to alcohol
b. macronodular: due to hepatitis
2. pseudocirrhosis: treated with chemotherapy metastatic disease: breast, lung, colorectal cancer. tx'd.
3. Budd-Chiari syndrome: caudate hypertrophy.
4. schistosoma japonicum: turtleback appearance of the liver.
Term
esophageal diverticulum
Definition
a. pharyngeal: called pharnygeal pouches. usually lateral. a. Zenker: posterior and above cricopharyngeus muscle. in killian triangle or killian's dehiscence.
a. Killian-Jamieson: lateral and below the cricopharyngeus muscle. in Killian Jamieson space.
a. Mid-esophageal: traction (granulomatous dz like TB) or pulsion (due to motor abnormalities)
a. epiphrenic: distal esophagus.
a. pseudodiverticulosis: usually due to chronic reflux. candida often cultured, but not causative factor.
Term
solitary hypodense, hypovascular mass
Definition
1. hepatic cyst
2. solitary met: if calcs, mucinous adenocarcinoma of colon, stomach, or ovary
3. hepatic abscess:
a. pyogenic
a. amebic: tendency to rupture
a. echinococcal: hytatid cysts with daughter cysts within the larger cyst.
4. cholangiocarcinoma
5. biliary cystadenoma: can transform into cystadenocarcinoma
6. hepatic laceration.
Term
multiple hypodense hepatic lesions
Definition
1. hepatic cysts. if multiple, consider,
a. autosomal dominant polycystic kidney disease
b. Caroli's disease ( can look like "cysts, but is dilated biliary ducts. has central dot sign, which is dilated biliary duct surrounding portal radicles)
2. mets:
a. if calcs, mucinous adenocarcinoma of colon, stomach, or ovary
b. if child, neuroblastoma, Wilm's, leukemia
3. hepatic abscess:
a. pyogenic
a. amebic: tendency to rupture
a. echinococcal: hytatid cysts with daughter cysts within the larger cyst.
4. cholangiocarcinoma: risk factors
a. primary sclerosing cholangitis, parasitic liver flukes (clonorchis sinensis), choledochal anomalies (caroli disease), prior thoratrast exposure. delayed enhancement.
5. biliary cystadenoma: can transform into cystadenocarcinoma
Term
right upper quadrant cystic mass in child
Definition
1. choledochal anomaly: Todani classification:
I: mc. fusiform dilatation of common duct
II: cbd diverticulum
III: choledochocele: near duodenum
IVA: intra and extrahepatic ductal dilatation
IVB: extrahepatic ductal dilatation
V: intrahepatic ductal dilatation. Caroli's disease
2. cystic lesions of the pancreas
a. pancreatic pseudocyst: consider non accidental or accidental trauma
b. cystic pancreatic neoplasm
3. GI duplication cyst/diverticulum
4. ovarian cystic lesion
5. mesenteric cyst
Term
esophageal submucosal masses/thickened folds
Definition
1. varices: serpentine filling defects which change
a. uphill: due to portal vein hypertension. distal esophagus involved.
b. downhill:common cause due to SVC syndrome. proximal esophagus involved.
2. reflux esophagitis
3. varicoid esophageal carcinoma
4. lymphoma: submucosal
Term
esophageal dilatation
Definition
1. achalasia: Bird's beak appearance
a. can be due to Chagas disease or fungal infection
b. eventually opens
2. pseudo-achalasia:
a. due to esophageal/gastric carcinoma
b. shouldering
3. scleroderma: patulous GE junction
4. esophagitis with stricture
a. benign appearing stricture:
1) reflux stricture: just above GE junction. Zollinger Ellison syndrome (gastrinoma) can cause stricture)
2) Barrett stricture: mid esophagus
3) caustic stricture: usually long and narrow. can be due to prolonged NGT
4) radiation stricture: h/o radiation tx
5) achalasia: stricture opens transiently (pseudoachalasia has a fixed stricture). complication of achalasia: scc and candida infection
6) blistering skin disorders: can be due to epidermolysis bullosa dystrophica or benign mucous membrane pemphigoid
a. malignant appearing stricture:
1) carcinoma: Shouldered margin
2) pseudoachalasia: looks like achalasia, but the stricture is fixed (in achalasia, the stricture will open)
3) lymphoma (extrinsic compression by adenopathy)
5. post surgical changes (vagotomy):
Term
esophageal pseudo-diverticuli
Definition
1. reflux esophagitis
2. candida esophagitis
3. drug induced esophagitis: level of aortic arch or distal esophagus
4. superficial spreading carcinoma: rare form of SCC
Term
esophageal ulcers
Definition
1. reflux esophagitis
2. viral esophagitis (CMV-large, HIV-large, HSV-small)
3. drug induced esophagitis
4. caustic esophagitis especially alkaline substances
2. esophageal carcinoma
Term
solid pancreatic mass
Definition
1. pancreatic adenocarcinoma: usually hypovascular
2. islet cell tumor: mc insulinoma. others: gastrinoma (associated with Zollinger Ellison syndrome), VIPoma, somatostatinoma, nonfunctioning islet cell tumor
3. solid and papillary epithelial neoplasm: solid and cystic areas.
4. lymphoma
5. metastatic disease: breast, lung, melanoma, renal cell
Term
solid renal mass
Definition
1. renal cell carcinoma
a. bilateral, consider VHL.
b. best visualized on the nephrographic phase.
2. oncocytoma: spoke-wheel pattern of enhancement.
3. angiomyolipoma: has fat
a. if < 4 cm, conservative mgt
b. if > 4 cm, partial nephrectomy often recommended.
c. if bleeding, can treat with embolization then partial nephrectomy when stabilized.
d. if multiple, consider tuberous sclerosis.
4. transitional cell carcinoma
5. lymphoma: often presents as multiple low density renal masses
Term
multiple bilateral renal masses
Definition
1. lymphoma: usually presents as bilateral low density masses.
2. renal infection: early abscess formation can mimic a solid renal mass.
3. renal cell carcinoma: if multiple, consider VHL
4. angiomyolipoma
a. if < 4 cm, conservative mgt
b. if > 4 cm, partial nephrectomy often recommended.
c. if bleeding then can embolize then tx with partial nephrectomy when stabilized.
d. if multiple, consider tuberous sclerosis.
5. metastatic disease: other than lymphoma, metastatic disease not common.
Term
cystic renal mass
Definition
1. complex renal cyst
a. can be the result of hemorrhage or infection
2. cystic neoplasm
a. if adult, RCC
b. if child, Wilm's tumor
3. Multilocular cystic nephroma
a. bimodal: young boys, middle aged women
b. cannot distinguish from cystic RCC or cystic Wilm's tumor
c. classically, extends into renal pelvis
4. multicystic dysplastic kidney
a. multicystic dysplastic kidney can be focal and look like cystic neoplasm
b. usually multicystic dysplastic kidney affects entire kidney, which is nonfunctioning.
5. abscess
Term
retroperitoneal mass
Definition
1. retroperitoneal hemorrhage
a. usually from aorta or renal vessels.
2. retroperitoneal abscess
3. lymphadenopathy
a. lymphoma non-H > Hodgkin's
b. metastatic disease especially testicular neoplasms
c. displace the aorta anteriorly
4. retroperitoneal fibrosis
a. deviates ureters medially
5. retroperitoneal sarcoma like liposarcoma
a. when large, displaces abdominal structures including the renal collecting system.
Term
cortical nephrocalcinosis
Definition
1. acute renal cortical necrosis due to
a. severe acute hypotension
b. toxins like amphotericin B or ingested ethylene glycol (antifreeze)
2. chronic glomerulonephritis due to
a. diabetic nephropathy
b. lupus nephritis
c. membranous glomerulonephritis.
3. chronic transplant rejection
4. oxalosis: can also cause medullary nephrocalcinosis, but ~more cortical nephrocalcinosis.
a. primary: autosomal recessive. fatal in early life.
b. secondary: related to altered bile metabolism from resection or chronic disease of small bowel like in Crohn's disease.
5. Alport syndrome: hereditary nerve deafness and nephritis. can also cause medullary nephrocalcinosis, but ~more cortical nephrocalcinosis.
Term
medullary nephrocalcinosis
Definition
1. medullary sponge kidney
a. paintbrush appearance.
2. renal tubular acidosis, type I
3. papillary necrosis
a. dd POSTCARD (pyelonephritis, obstruction, sickle cell dz, tb, cirrhosis, analgesics, renal vein thrombosis, diabetes)
b. "lobster claw" and "ball on a tee" configuration of the renal pyramids on IVP
c. filling defects on IVP
4. furosemide (newborn)
5. chronic hypercalcemia. can also cause cortical nephrocalcinosis but more ~medullary nephrocalcinosis.. 6. oxalosis: can also cause medullary nephrocalcinosis, but ~more cortical nephrocalcinosis.
a. primary: autosomal recessive. fatal in early life.
b. secondary: related to altered bile metabolism from resection or chronic disease of small bowel like in Crohn's disease.
7. Alport syndrome: hereditary nerve deafness and nephritis. can also cause medullary nephrocalcinosis, but ~more cortical nephrocalcinosis.
Term
striated nephrogram
Definition
1. pyelonephritis
2. lymphoma
3. urinary obstruction
4. hypotension
5. renal vein thrombosis
a. some causes: nephrotic syndrome or dehydration and sepsis in children
6. consider renal contusion if trauma
Term
papillary necrosis
Definition
1. can appear as medullary sponge kidney
2. "lobster claw" and "ball on a tee" appearance and filling defects on IVP
3. dd POSTCARD: pyelonephritis, obstruction, sickle cell dz, tb, analgesics, renal vein thrombosis, diabetes
Term
staghorn calculus
Definition
1. xanthogranulomatous pyelonephritis (XGP):
a. obstructing calculus like staghorn calculus
b. chronic inflammation with lipid laden "foamy" macrophages
c. enlarged kidney
d. tx: abx and nephrectomy.
2. pyonephrosis with obstructing stone:
a. this may be seen with xgp
b. tx: urgent percutaneous decompression as 25-50% mortality rate.
3. calcified RCC and calcified TCC are rare.
Term
renal cortical defect
Definition
1. reflux nephropathy:
damage can be from sterile or infected reflux (usually infected reflux)
2. chronic pyelonephritis
3. renal infarct: cortical rim sign (due to intact collateral circulation to the capsular or subcapsular region)
4. vasculitis:
a. polyarteritis nodosa: multiple microaneurysms and stenosis/occlusions
b. lupus
c. drug abuse like speed kidney (multiple aneurysms in the kidney and visceral organs)
5. partial nephrectomy
Term
renal pelvic mass
Definition
1. transitional cell carcinoma
2. multilocular cystic nephroma
a. bimodal: boys < 5y, women > 50 y
b. classically extends into renal pelvis
3. medullary carcinoma
a. higher risk for medullary ca in pt with sickle cell trait
4. renal cell carcinoma
Term
medial and lateral deviation of the ureters
Definition
medial deviation of the ureters
1. retroperitoneal fibrosis:
a. usually idiopathic (Ormond's)
b. can be due to medications, radiation tx, neoplasm
c. low T1 and T2
2. psoas muscle hypertrophy
3. pelvic lipomatosis: compression of bladder and rectum can occur due to the increased unencapsulated fat (looks almost normal). occurs in middle aged AA men.
4. post operative changes (e.g. lymph node dissection for testicular cancer)
5. retrocaval ureter: r ureter (only R) passes medially and posterior to the IVC at around L4
6. LN
7. pelvic hematoma (p 141 top 3 bk)
lateral deviation of the ureters
1. retroperitoneal hematoma
2. pelvic mass e.g. fibroid uterus
3. AAA
4. LN
Term
ureteral filling defect
Definition
1. transitional cell carcinoma
a. associated with exposure to: aromatic amines (smoking, rubber/dye industry), cyclophosphamide
2. radiolucent calculi (ic smux: indinavir, cystine (faintly radiopaque) struvite, matrix, urate, xanthine)
3. pyeloureteritis cystica (if involves renal pelvis and ureters. if only involves ureteritis cystica then only involves ureters.) (aside: if involves bladder then cystitis cystica. chronic inflammation can also lead to cystitis glandularis.)
a. benign condition
b. no malignant potential
c. associated with chronic inflammation, which may have been initiated by a chronic UTI
4. blood clot
5. fungus ball: mc cause: candida
6. metastatic disease
7. leukoplakia: filling defects. white plaques due to cornified squamous epithelium.
8. malakoplakia: filling defects. soft plaque from chronic granulomatous condition.
Term
renal migration anomalies
Definition
1. horseshoe kidney
a. associated with turner's syndrome and ellis van creveld syndrome (hair, teeth, nail abnormalities, acromelia)
b. arrest of cranial migration due to IMA
c. isthmus can be fibrotic or functioning renal tissue
d. horseshoe kidney susceptible to trauma, obstruction, reflux, infection, stones
e. increased risk of Wilm's tumor
2. cross fused ectopia:
a. usually the left kidney crosses to the right side.
b. vascular supply to ectopic kidney is anomalous
c. ureter insertion on bladder is normal.
d. predisposed to obstruction, reflux, infection, stones, trauma
3. ectopic kidney:
a. usually in the pelvis.
b. associated with UPJ obstruction, reflux, stasis, infection, stones
4. renal duplication: Weigert Meyer rule
a. upper pole moiety: obstructs, ureterocele, inserts ectopically (inferior and medial to normal)
b. lower pole moiety: refluxes, inserts normally
Term
bladder filling defect
Definition
1. transitional cell carcinoma
a. associated with aromatic amines (smoking and rubber/dye industry) and cyclophosphamide
b. other bladder tumors:
1) scc: associated with chronic infection or inflammation
2) adenocarcinoma: associated with urachal remnants
2. fungus ball: mc candida
3. blood clot
4. radiolucent calculi
I C SMUX
indinavir, cystine (may be slightly radiopaque), struvite, matrix (protein), urate, xanthine.
5. extrinsic compression from benign or malignant tumor or LN etc.
Term
bilateral renal cysts
Definition
1. autosomal dominant polycystic kidney disease:
a. liver and pancreatic cysts. berry aneurysm which can rupture.
b. no increased risk of RCC
2. end stage renal disease (hemodialysis)
a. kidneys will be atrophic
b. increased risk of RCC
3. von Hippel Lindau disease: renal cysts, rcc, pancreatic cysts, pheochromocytoma, islet cell tumors, liver cysts, retinal and cerebellar hemangioblastomas, epididymal cystadenoma
4. tuberous sclerosis: C-TALRS. cardiac rhabdomyomas, cortical tubers, angiomyolipomas, LAM with chylous effusions, renal cysts, subependymal giant cell astrocytoma at the foramen of Monro
Term
perinephric fluid collection
Definition
anatomy inner to outer: kidney, renal capsule, perinephric/perirenal space, Gerota's fascia (made of anterior and posterior renal fascia: adrenal glands are within Gerota's fascia), anterior and posterior pararenal space
1. hemorrhage
a. if h/o trauma, should follow up to make sure disappears and there is no underlying RCC or angiomyolipoma (tendency to bleed if > 4 cm)
b. page kidney: subcapsular hematoma can compress the kidney and lead to htn.
2. urine:
a. urine leak can lead to urinoma.
b. if see contrast on delayed then urine leak, not hemorrhage.
c. can be due to trauma or obstruction
3. infection: combination of urinary obstruction and infection is emergent indication for percutaneous nephrostomy.
Term
pear shaped bladder
Definition
1. pelvic hematoma
a. look for pelvic fracture and pubic diastasis
2. lymphadenopathy:
a. lymphoma
b. mets
c. primaries e.g. uterine, cervix, prostate ca
3. pelvic lipomatosis:
a. overweight middle aged AAM
b. proliferation of unencapsulated fat
c. mass effect on bladder and rectum
d. associated with cystitis glandularis [aside: chronic inflammation from infection, stones, tumor can cause cystitis glandularis (mucin producing goblet cells) or cystitis cystica (fluid filled cysts)]
4. psoas hypertrophy: more common in athlete's with narrow bony pelvis
5. iliac artery aneurysm can cause a pear shaped bladder if bilateral and large.
Term
prostate enlargement
Definition
Normal MR anatomy of prostate
a. zones: peripheral (high T2), transitional (low T2), central
b. capsule of prostate: (low on T2)
c. seminal vesicles: high on T2 (look serpiginous)
d. neurovascular bundle: in posterior lateral aspect of prostate
1. prostate adenocarcinoma:
a. look for prostate adenocarcinoma (low on T2) in the peripheral zone (normally high on T2)
b. look for invasion of prostate capsule, seminal vesicle invasion (low T2 cancer in a high T2 seminal vesicle) and neurovascular bundle invasion.
c. prostate cancer is hypoechoic on US in the peripheral zone.
2. benign prostatic hypertrophy
a. in transitional zone.
b. bladder base may be elevated
c. the distal ureters may be J shaped.
3. prostatitis
a. inflammation of the prostate
b. chronic prostatitis can be indistinguishable from BPH and prostate adenocarcinoma.
Term
bladder rupture
Definition
bladder is extraperitoneal
1. extraperitoneal bladder rupture
a. usually associated with pelvic fractures
b. tx: bladder decompression, not surgery
c. "molar tooth" appearance on axial CT
2. intraperitoneal bladder rupture
a. blunt trauma to abdomen with distended bladder
b. tx: surgery
c. outlines bowel.
3. intra and extra peritoneal bladder rupture
4. posterior urethral injury
a. can mimic extraperitoneal bladder rupture
Term
bladder wall calcifications
Definition
1. transitional cell carcinoma
2. schistosomiasis: mc cause of bladder wall calcification worldwide
3. cystitis
a. due to chemotherapy (cyclophosphamide) cystitis
b. due to radiation cystitis
c. due to TB
d. chronic inflammation can cause
1) cystitis cystica (submucosal cysts)
2) cystitis glandularis (submucosal glands)
3) also pyeloureteritis cystica (renal pelvis and ureters) or ureteritis cystica (ureters)
4) no malignant potential
4. urachal carcinoma: usually adenocarcinoma
Term
adrenal mass
Definition
1. adrenal myelolipoma (large lesions may hemorrhage) (vs adrenal adenoma)
a. if obvious fat (HU -90 to -30) then adrenal myelolipoma (macroscopic fat). surgery not needed if dx certain.
b. if no obvious fat, but < 10 HU on CT then myelolipoma or lipid rich adenoma.
1) if fat sats out on MR then myelolipoma.
2) if doesn't fat sat out, but drop signal on out of phase imaging (the one with india ink) then lipid rich (microscopic/intracellular fat) adenoma.
3) if doesn't fat sat out and doesn't drop signal on out of phase imaging then lipid poor adenoma or mets. may need bx to differentiate lipid poor adenoma vs mets.
c. if trying to figure out lipid poor adenoma vs mets.
1) if post contrast CT < 35 HU and relative washout > 50% then adenoma.
2) relative washout: post contrast HU - delayed HU/post contrast HU. if relative washout > 50%, then benign adenoma. e.g. post contrast 50 HU, delayed 30 HU. relative washout is (50-30)/50=20/50=40% so this < 50% washout and less likely to be adenoma. adenomas washout quickly.
d. adenoma can cause Cushing syndrome (hypercorticolism) and Conn syndrome (primary hyperaldosteronism)
2. mets
3. adrenal cortical carcinoma:
a. large 5-20 cm
b. can have hemorrhage or calcifications
4. pheochromocytoma
a. high activity on I 131 MIBG (usually use MIBG; see in liver and heart) and Indium 111 octreoscan (kidney and spleen)
b. 10% rule: 10% extra adrenal (mc organ of Zuckerkandl at aortic bifurcation), 10% bilateral, 10% malignant, 10% silent, 10% autosomal dominant
c. associated with: MEN IIA (medullary thyroid, pheochromocytoma, parathyroid tumor), MEN IIB (medullary thyroid, pheochromocytoma, neuromas), VHL, NF1, familial pheochromocytoma
5. hemorrhage:
a. should resolve with time.
b. may develop calcs.
Term
fatty retroperitoneal mass
Definition
1. adrenal myelolipoma
a. if obvious fat then adrenal myelolipoma (macroscopic fat). surgery not needed if dx certain.
b. if no obvious fat, but < 10 HU on CT then myelolipoma or lipid rich adenoma.
1) if fat sats out on MR then myelolipoma.
2) if doesn't fat sat out, but drop signal on out of phase imaging (the one with india ink) then lipid rich (microscopic/intracellular fat) adenoma.
3) if doesn't fat sat out and doesn't drop signal on out of phase imaging then lipid poor adenoma or mets. may need bx to differentiate lipid poor adenoma vs mets.
c. if post contrast CT < 35 HU then adenoma. if < 35 HU then do delayed imaging and calculate relative washout.
1) relative washout: post contrast HU - delayed HU/post contrast HU. if relative washout > 50%, then benign adenoma. e.g. post contrast 50 HU, delayed 30 HU. relative washout is (50-30)/50=20/50=40% so this < 50% washout and less likely to be adenoma. adenomas washout quickly.
d. adenoma can cause Cushing syndrome (hypercorticolism) and Conn syndrome (primary hyperaldosteronism)
e. tx for myelolipoma: if dx is certain, then surgery not needed.
2. retroperitoneal liposarcoma
3. angiomyolipoma:
a. gross fat ( HU -90 to -30) and virtually diagnostic of AML if absence of calcs. if calcs, need to consider rcc even if some fat is seen.
b. associated with TS (cardiac rhabdomyoma, cortical/subcortical Tubers and subependymal nodules, AML, LAM, renal cysts, subependymal giant cell astrocytoma at the foramen of monro
c. tx:
< 4 cm, conservative
> 4 cm, partial nephrectomy
if bleeding, can embolize then partial nephrectomy when stable.
4. RCC: rarely has fat. if has calcs, highly suspicious for RCC
Term
dilated ureter
Definition
1. ureteral obstruction:
a. stones: icsmux (indinavir, cystine (may be slightly radiopque), struvite, matrix, urate, xanthine)
b. strictures: infection (gc), trauma (iatrogenic instrumentation, surgery, regular old trauma)
c. neoplasm: ovarian, uterine, cervical, colonic
2. reflux: grades
I: reflux to ureter
II: reflux to renal pelvis
III: blunting of calyces
IV: mild dilatation and tortuosity
V: severe dilatation and tortuosity
3. primary megaureter
a. usually affects the left ureter
b. two types:
1) obstructing: due to aperistaltic segment
2) refluxing: due to abnormal vesico ureteral junction due to things like short or absent intravesical ureter
4. prune belly syndrome: lack of rectus muscles, cryptorchidism, GU anomalies like megaureter and others
Term
urethral stricture
Definition
Anatomy of the urethra
a. posterior: prostate, membranous
b. anterior: bulbous, penile
c. urogenital diaphragm is at the membranous urethra
d. penoscrotal junction is between the bulbous and penile/penduous urethra
1. urethral trauma
a. straddle injury: bulbous
b. iatrogenic instrument related trauma: bulbomembranous
c. high speed trauma and surgery: posterior urethra (prostatic and membranous)
2. post infectious/post inflammatory stricture
a. due to gc (or TB)
b. distal bulbous urethra due to preponderance of Littre glands
c. surgeon needs to know if extends into membranous urethra because this is where the muscle that determines continence is
3. urethral carcinoma
a. mc: bulbomembranous urethra
b. usually scc
c. usually low T1 and low T2
Term
dd for calyceal clubbing
Definition
1. hydronephrosis
2. vesicoureteral reflux
3. papillary necrosis
Term
dd
1. bilateral enlarged kidneys
2. unilateral enlarged kidney
3. bilateral small kidneys
4. unilateral small kidney
Definition
dd
1. bilateral enlarged kidneys: HAD LAVA. HIV, diabetes (mc), lymphoma/leukemia, vasculitis (lupus, Wegener's, polyarteritis nodosa, Goodpasture's, Henoch Schonlein purpura), autosomal recessive polycystic kidney disease, acute glomerulonephritis, acute interstitial nephritis.
2. unilateral enlarged kidneys: acute arterial occlusion, renal vein thrombosis, pyelonephritis, obstruction
3. bilateral small kidneys: bilateral atherosclerosis, medical renal disease (HTN, chronic glomerulonephritis, analgesic nephropathy)
4. unilateral small kidney: unilateral atherosclerosis, post inflammatory, post-obstructive, reflux atrophy, radiation tx

http://learningradiology.com/mobile/gu/ddx-gu.htm
Term
1. ovarian mets from stomach or colon primary
2. ovarian fibroma with pleural effusions and ascites
3. rupture of a mucinous tumor (like mucocele of the appendix) causing gelatinous ascites.
Definition
1. Krukenberg tumor
2. Meig's syndrome
3. pseudomyxoma peritonei: there is some controversy whether or not rupture of ovarian tumor is the cause of pseudomyxoma peritonei. Some think that this is actually a mucocele of the appendix with ovarian mets.
Term
dd polypoid mass arising from endometrium
Definition
1. endometrial polyp
2. submucosal fibroid
3. endometrial ca
Term
post procedure arterial abnormality
Definition
1. hematoma
2. pseudoaneurysm ("yin yang" and "to-and-fro" appearance)
3. AV fistula (arterialization of vein)
Term
carotid artery stenosis
Definition
1. atherosclerosis
2. fibromuscular dysplasia (mc variant medial fibroplasia "string of beads")
3. dissection
----
1. iatrogenic
Term
failing renal transplant
Definition
1. fluid collection:
a. immediate post op: seroma, hematoma
b. early post op: urinoma
c. late post op: lymphocele: 4-8w
d. other: abscess
2. renal dysfunction
a. ATN
b. cyclosporine toxicity
c. rejection
3. vascular abnormality
a. renal artery stenosis: peak systolic velocity < 250 cm/s and parvus tardus waveform
b. renal vein thrombosis: reversal of diastolic flow, "to and fro" flow.
4. urinary obstruction: hydronephrosis
Term
digital artery occlusion/ischemia
Definition
1. Raynaud syndrome
2. vasculitis (SLE, Buerger disease (thromboangitis obliterans)-corkscrew collaterals)
3. embolic disease from
a. cardiac
b. arterial thoracic outlet syndrome, (stenosis, occlusion or aneurysm/pseudoaneurysm)
c. hypothenar hammer syndrome (occlusion or aneurysm at the hypothenar eminence-near ulnar A, with digital artery emboli)
3. trauma
4. atherosclerosis
Term
subclavian vein occlusion
Definition
1. prior instrumentation/catheter placement
2. hypercoagulable state
3. Paget-von Scrotter syndrome/Effort thrombosis (venous thoracic outlet syndrome)
Term
great vessel stenosis
Definition
1. atherosclerosis
2. vasculitis (GCA (aortic branch vessels and temporal A),Takayasu arteritis (aortic branch vessels and aorta/pulmonary A)
3. dissection
1. radiation
-----------
Term
Renal artery stenosis
Definition
1. atherosclerosis (usually proximal renal A, tx: stent)
2. fibromuscular dysplasia (usually ~distal renal A, tx: angioplasty)
3 dissection
Term
intraparenchymal renal artery aneurysm
Definition
1. vasculitis
a. polyarteritis nodosa (necrotizing vasculitis of the kidneys, liver, pancreas),
b. Takayasu's arteritis (branchess of the aorta, aorta/pulmonary A)
c. Wegener vasculitis (necrotizing granulomatous vasculitis usually involving the sinus, lung, kidneys)
d. Churg-Strauss syndrome (necrotizing vasculitis usually lung)]
e. lupus
2. mycotic/septic emboli causing pseudoaneurysms
3. trauma
4. Ehlers Danlos syndrome
--------------
1. speed kidney
Term
hypervascular pulmonary mass
Definition
1. arteriovenous malformation
2. bronchogenic carcinoma (adenocarcinoma or SCC)
3. pulmonary carcinoid
4. hyper vascular metastasis (thyroid, renal, sarcoma, melanoma, carcinoid)
5. pulmonary artery aneurysm e.g. TB related aneurysm is Rasmussen aneurysm
Term
infrarenal aortic occlusion
Definition
1. atherosclerosis
2. thrombus/embolus
3. vasculitis (Takayasu arteritis)
1. dissection
Term
popliteal artery occlusion
Definition
1. atherosclerosis
2. embolism
3. trauma
1. thrombosed popliteal artery aneurysm
2. popliteal artery entrapment syndrome (due to medial head of gastrocnemius or popliteus)
3. cystic adventitial disease (mucoid cysts in the adventitia)
Term
extratesticular mass
Definition
1. varicocele (tx: can coil gonadal vein. if varicocele on right, then look for retroperitoneal mass)
2. pyocele
3. hematocele
------
4. hydrocele
Term
inferior vena cava vascular anomaly/abnormality
Definition
1. circumaortic/retroaortic left renal vein
2. megacava
3. duplicated inferior vena cava
1. inferior vena cava thrombosis
Term
hypervascular renal mass
Definition
1. renal cell carcinoma/oncocytoma. if multiple VHL (renal cysts, rcc, pancreatic cysts, pheochromocytoma, islet cell tumors, liver cysts)
2. angiomyolipoma (if > 4 cm can hemorrhage). associated with tuberous sclerosis (cardiac myxomas, cortical tubers, angiomyolipomas, LAM, renal cysts, subependymal giant cell astrocytoma)
3. arteriovenous malformation/fistula. if multiple AVM then Osler Weber Rendu disease (Hemorrhagic hereditary telangiectasias)
Term
prominent paraspinal flow voids
Definition
1. spinal dural arterio-venous fistula
2. spinal cord arteriovenous malformation
3. collateral venous flow from IVC occlusion
1. spinal cord neoplasm with increased vascular flow like hemangioblastoma (also paraganglioma)
----------------
2. CSF pulsations
Term
suprasellar mass in adult
Definition
1. pituitary adenoma (=>10mm is macroadenoma, "snowman"
2. craniopharyngioma (in kids: cysts and calcs; in adults: solid and no calcs)
3. aneurysm (flow voids and pulsation artifact)
4. meningioma (hyperostosis and calcs)
---------
Term
hypervascular cerebral mass/abnormality
Definition
1. arteriovenous malformation
2. aneurysm (tx endovascular coiling or craniotomy with aneurysmal clipping)
3. hypervascular tumor (GBM, meningioma)
4. moyamoya (narrowing of the ICA with formation of collaterals)
-------
Term
aortic dissection due to
Definition
1. hypertension
2. trauma
3. connective tissue disease like Marfan syndrome or Erlos Danlos syndrome
4. unicuspid aortic valve, bicuspid aortic valve, coarctation of the aorta.
-----
1. annuloaortic ectasia (cystic medial necrosis)
Term
causes of lower GI bleeding
Definition
1. diverticula "bowler hat sign" pointing away from lumen. if polyp, then "bowler hat sign" pointing toward lumen.
2. neoplasm.
3. angiodysplasia (AVM)
4. focal colitis
--------
Term
vascular ring/sling
Definition
normal: esophagus is posterior to trachea
1. aberrant right subclavian artery.
a. normal left arch and right subclavian A is posterior to the left subclavian A
b. crosses posterior to esophagus.
2. double aortic arch
a. aortic arch splits
b. surrounds the trachea and esophagus
3. right arch with aberrant left subclavian artery
a. right arch and left subclavian artery arises from diverticulum of kommerell and is last branch from aorta
b. crosses posterior to esophagus.
4. pulmonary sling:
a. left pulmonary artery arises from right pulmonary artery.
b. passes anterior to esophagus (and posterior to trachea)
Term
urinary obstruction
Definition
1. nephrolithiasis
2 neoplasm (TCC)
3. blood clot
4. fungus ball
5. papillary necrosis may cause sloughed papillae. (POSTCARD-pyelonephritis, obstruction, sickle cell, TB, cirrhosis, analgesics, renal vein thombosis, diabetes).
Term
TIPS (transjugular intrahepatic portosystemic shunt) dysfunction
Definition
1. neointimal hyperplasia
2. thrombosis
3. malposition or migration of stent
Term
biliary duct obstruction
Definition
1. choledocholithiasis
2. cholangiocarcinoma (if in hilum, Klatskin tumor)
3. pancreatic adenocarcinoma "double duct sign"
4. chronic pancreatitis
5. primary sclerosing cholangitis (associated with UC. can lead to primary biliary cirrhosis and cholangiocarcinoma)
6. parasitic infection (ascariasis, clonorchis)
Term
traumatic aortic injury
Definition
1. pseudoaneurysm
2. aortic dissection
3. intramural hematoma
4. aortic transection
------
Term
occlusion of celiac trunk, SMA or IMA
Definition
1. atherosclerosis
2. thromboembolic disease
3. vasculitis (Takayasu)
4. median arcuate ligament syndrome (celiac trunk)
5. fibromuscular dysplasia
6. radiation
-------
-------
Term
multiple lytic foci
Definition
1. metastatic disease
2. multiple myeloma
3. lymphoma
1. langerhans cell histiocytosis (in pt less than 30 years)
2. fibrous dysplasia
3. multifocal osteomyelitis
Term
sequestrum
Definition
1. osteomyelitis
2. langerhans cell histiocytosis
3. osteoid osteoma
1. lymphoma
2. fibrosarcoma
Term
newborn periosteal reaction
Definition
1. physiologic periosteal reaction
2. trauma
3. infection (osteomyelitis, TORCH, TB, syphilis
1. prostaglandin therapy
2. Caffey disease (infantile cortical hyperostosis)
Term
Rugger Jersey spine
Definition
1. renal osteodystrophy
2. osteopetrosis
3. Paget disease
1. metastatic disease
2. myelofibrosis
Term
sacroileitis
Definition
1. AS
2. IBD (inflammatory bowel disease)
3. RA
1. psoriatic or reactive arthropathy
2. osteoarthritis
3. septic arthritis
Term
proximal arthritis
Definition
1. rheumatoid arthritis
2. crystalline arthropathy (CPPD, gout)
3. collagen vascular disease (SLE)
1. hemochromatosis
2. infection
Term
distal arthritis
Definition
1. osteoarthritis
2. erosive osteoarthritis
3. psoriatic arthritis
1. reactive arthritis
2. rheumatoid arthritis
Term
erosive arthropathy involving the foot
Definition
1. rheumatoid arthritis
2. gout
3. reactive arthritis
1. infection (septic joint)
2. psoriatic arthritis
Term
chondrocalcinosis
Definition
1. CPPD arthropathy
2. hyperparathyroidsim
3. hemochromatosis
1. Wilson disease
Term
Vertebra plana in a child
Definition
1. langerhans cell histiocytosis
2. leukemia/lymphoma
3. osteomyelitis
1. metastatic disease
Term
126 Wormian bones
Definition
1. idiopathic wormian bones
2. osteogenesis imperfecta
3. cleidocranial dysostosis
1. down syndrome
2. metabolic disease (rickets, hypothyroidism)
Term
Madelung deformity
Definition
1. idiopathic Madelung deformity
2. Turner syndrome
3. Skeletal dysplasia (multiple epiphyseal dysplasia, dyschondrosteosis)
1. trauma
2. infection/septic arthritis
Term
lucent metaphyseal bands
Definition
1. leukemia
2. rickets
3. osteomyelitis
1. neuroblastoma metastatic disease
2. scurvy
3. syphilis
Term
medullary/chondroid lesion
Definition
1. enchondroma
2. bone infarct
3. chrondrosarcoma
1. chronic osteomyelitis
Term
acro osteolysis
Definition
hyperparathryoidism
2. scleroderma
3. trauma (thermal or cold injury)
1. psoriasis
2. Hajdu-Cheney syndrome
pinchfo: psoriasis, injury (cold, heat), neuropathy (leprosy), collagen vascular disease, hyperparathyroidism, familial (Hadju Cheney), other (polyvinyl chloride exposure)
Term
dense effusion
Definition
1. hemarthrosis (hemophilia, post traumatic)
2. juvenile chronic arthritis
3. pigmented villonodular synovitis
1. septic arthritis
2. crystalline arthropathy (gout, CPPD)
Term
loose bodies with erosions
Definition
1. synovial (osteo)chondromatosis
2. pigmented villonodular synovitis
3. rheumatoid arthritis
Term
expansile rib lesion in a child
Definition
1. fibrous dysplasia
2. bone cyst
3. enchondroma
1. langerhans cell histiocytosis
2. ewing sarcoma
3. metastatic disease
Term
posterior element lytic lesion
Definition
1. aneurysmal bone cyst
2. osteoblastoma
3. infection (TB)
1. metastatic disease
2. Langerhans cell histiocytosis
Term
carpal dislocation
Definition
1. perilunate dislocation
2. lunate dislocation
3. midcarpal fracture-dislocation
Term
periarticular soft tissue calcifications
Definition
1. hemangioma
2. myositis ossificans
3. scleroderma
1. arthropathy with calcified soft tissue nodule
2. soft tissue sarcoma
3. tumoral calcinosis
Term
benign expansile lytic lesion
Definition
1. fibrous dysplasia
2. unicameral bone cyst
3. aneurysmal bone cyst
1. giant cell tumor
2. eosinophilic granuloma
Term
sclerotic lesiosn in pelvis
Definition
1. bone island/osteopoikilosis
2. metastatic disease (breast, prostate)
3. paget disease
Term
vertebral body wedge fracture
Definition
1. traumatic fracture
2. insufficiency fracture
3. pathologic fracture
Term
epiphyseal equivalent lesion
Definition
1. chondroblastoma
2. giant cell tumor
3. Langerhans cell histiocytosis
3. intraosseous ganglion cyst
mice gas (mets, infection, chondroblastoma, eg, gct, abc, subchondral cyst)
Term
enhancing orbital mass
Definition
1. hemangioma
2. lymphangioma
3. meningioma
4. mets
5. lymphoma
Term
orbital rim fracture
Definition
1. orbital wall blowout fracture
2. tripod fracture (inferior and lateral wall of the orbit and zygomatic arch)
3. Le Fort Fracture (I, II, III, all involve the pterygoids)
Term
cavernous sinus mass/enhancement
Definition
1. Meningioma
2. Schwannoma
3. Carotid cavernous fistula
4. Tolosa Hunt Syndrome
5. Sarcoidosis
----------
6. Perineural spread of tumor
Term
aggressive sinus disease with bony destruction
Definition
1. invasive fungal sinusitis
2. Wegener granulomatosis
3. sinonasal carcinoma
4. lymphoma
-------
5. cocaine nose
Term
unilateral parotid mass
Definition
1. partoid tumor (pleomorphic adenoma, Warthin tumor, mucoepidermoid carcinoma, adenocystic carcinoma)
2. lymphoma
3. mets
---------
4. branchial cleft cyst (type I)
Term
bilateral parotid masses
Definition
1. parotid tumor like Warthins
2. lymphoma
3. mets
4. Lymphoepithelial lesions in HIV
5. Sjogren syndrome
6. Sarcoidosis
Term
orbital muscle enlargement
Definition
1. thyroid associated orbitopathy
2. orbital pseudotumor
3. lymphoma
4. sarcoidosis
5. infectious myositis
6. mets
Term
clival mass
Definition
1. mets
2. chordoma
3. chondrosarcoma
4. invasive pituitary macroadenoma
5. plasmacytoma
Term
vascular injury to neck
Definition
1. dissection.
2. pseudoaneurysm
3. AVF
4. thrombosis
Term
globe lesion in child
Definition
1. retinoblastoma: calcs. small size globe.
2. peristent hyperplastic primary vitreous. no calcs. small size.
3. coats disease: no calcs, nl size
--------------
4. retinopathy of prematurity
5. toxocariasis
Term
optic nerve enlargement and enhancement
Definition
1. optic nerve glioma
2. optic neuritis
3. optic nerve sheath meningioma
--------------
4. leukemia/lymphoma
5. sarcoidosis
Term
pachymeningeal (dural) enhancement
Definition
1. intracranial hypotension
2. mets
3. pachymeningitis
4. subdural hemorrhage
5. sarcoidosis
Term
middle ear mass
Definition
1. acquired cholesteatoma
2. facial nerve schwannoma
3. glomus tympanicum
4. normal variant vasculature
5. cholesterol granuloma
Term
temporal bone trauma
Definition
1. longitudinal temporal bone fracture
2. transverse " "
3. mixed " "
Term
inner ear congenital malformation
Definition
1. large vestibular aqueduct syndrome
2. cystic cochleovestibular anomaly
3. common cystic cavity
4. cochlear aplasia
5. labyrinthine ossificans
Term
floor of mouth mass
Definition
1. scc
2. infection/abscess
3. ranula
4. congenital thyroid lesions
5. venolymphatic malformation
6. dermoid/epidermoid cyst
Term
aggressive nasal mass in adolescent
Definition
1. juvenile angiofibroma
2. enthesioneuroblastoma
3. hemangioma
4. rhabdomyosarcoma
5. inverted papilloma
6. polyps
Term
cystic neck mass
Definition
1. congenital cyst
2. abscess
3. cystic lymph node
4. lymphatic malformation
5. cystic nerve sheath tumor
Term
jugular foramen mass
Definition
1. meningioma
2. schwannoma
3. paraganglioma
4. mets
5. dehiscent jugular bulb
Term
160 petrous apex lesion
Definition
1. cholesterol granuloma
2. mucocele

3. congenital cholesteatoma
4. apical petrositis
5. neoplasm
Term
A. leptomeningeal enhancement
B. pachymeningeal enhancement
Definition
A. leptomeningeal enhancement. pia and arachnoid.
1. meningitis
2. prior subarachnoid hemorrhage
3. subacute infarction
4. leptomeningeal carcinomatosis
5. neurosarcoid, TB, fungal

B. pachymeningeal enhancement. smooth
1. pachymeningits
2. subdural hemorrhage
3. intracranial hypotension
4. mets
5. sarcoid, fungal, TB
Term
confluent white matter lesions in an adult
Definition
1. demyelinating dz (MS, ADEM, lyme disease)
2. progressive multifocal leukoencephalopathy if AIDS
3. neoplasm (glioma, lymphoma)
Term
confuent white matter lesions in a child
Definition
1. demyelinating dz (MS, ADEM, lyme disease)
2. progressive multifocal leukoencephalopathy if AIDS
3. leukodystrophy (metachromatic, Alexander, adrenoleukodystrophy, canavan)
Term
ring enhancing lesion
Definition
Magic dr
Mets
Abscess: pyogenic and other like toxoplasmosis
Glioblastoma multiforme and lymphoma
Infarct
Contusion
Demyelinating disease: e.g. ms, adem, lyme dz
Resolving hematoma/Radionecrosis
Term
pineal region mass
Definition
1. pineal cyst
2. germ cell tumor (germinoma/seminoma, teratoma, dermoid, yolk sac tumor, choriocarcinoma)
3. pineal cell tumor (pineoblastoma, pineocytoma)
Term
sellar/suprasellar mass in child
Definition
1. craniopharyngioma
2. germ cell tumor
3. rathke cleft cyst
-----
4. optic nerve/hypothalamic glioma
5. hypothalamic hamartoma
Term
posterior fossa mass in child
Definition
1. medulloblastoma
2. ependymoma: tongue of tissue going out of the 4th ventricular outflow tract
3. juvenile pilocytic astrocytoma
-------------------
4. brainstem glioma
Term
posterior fossa mass in an adult
Definition
1. infarction
2. metastatic disease
3. hemangioblastoma
-----
4. vascular malformation
5. hypertensive hemorrhage
Term
posterior fossa cyst
Definition
1. mega cisterna magna
2. arachnoid cyst
3. dandy walker malformation
4. joubert syndrome
----------
Term
170 cerebellopontine angle mass
Definition
1. vestibular schwannoma
2. meningioma
3. arachnoid cyst
4. epidermoid cyst
Term
cerebellar tonsillar herniation
Definition
1. arnold chiari malformation
2. ependymoma
3. posterior fossa mass
4. intracranial hypotension
Term
cerebrospinal fluid line cortical cleft
Definition
1. prior infarct with encephalomalacia
2. schizencephaly
3. porencephalic cyst
Term
enhancing intramedullary spinal mass
Definition
1. ependymoma
2. astrocytoma
3. hemangioblastoma
4. mets
5. demyelinating disease
Term
intradural extramedullary spinal mass
Definition
1.nerve sheath tumor
2. meningioma
3. cerebrospinal fluid mets
Term
175 diffuse temporal lobe mass
Definition
1. herpes encephalitis
4. limbic encephalitis
2. ischemia/infarction
3. gliomatosis cerebri
5. status epilepticus
Term
increased T2 signal intensity in basal ganglia/thalami of child
Definition
1. ischemia
2. carbon monoxide poisoning
3. wilson disease
4. mitochondral disorder
5. kernicterus
6. osmotic demyelination: high t2 in central pons
Term
intraparenchymal hemorrhage
Definition
1. vascular malfn
2. hemorrhagic infarct
3. hemorrhagic neoplasm
4. contusion
5. cerebral amyloid disease
Term
corpus callosal lesion
Definition
1. glioblastoma multiforme
2. lymphoma
3. demyelinating disease
4. diffuse axonal injury
5. marchiafava bignami disease
Term
subependymal nodules
Definition
1. tuberous sclerosis
2. heterotopic gray matter
3. TORCH infection
4. mets
Term
massive supratentorial CSF collection in a newborn
Definition
1. massive hydrocephalus
2. hydranencephaly
3. alobar holoprosencephaly
4. agenesis of the corpus callosum with midline interhemipheric cyst
5. bilateral open lip schizencephaly
Term
intraventricular mass
Definition
1. meningioma
2. choroid plexus papilloma/carcinoma
3. central neurocytoma
4. ependymoma/ subependymoma
5. colloid cyst
6. subependymal giant cell astrocytoma
Term
cerebellar atrophy
Definition
1. alcohol abuse
2. anticonvulsant therapy
3. paraneoplastic syndrome
4. sporadic olivopontocerebellar atrophy
5. cerebello-olivary degeneration
6. Friedreich ataxia
Term
spinal cord signal abnormality
Definition
1. demyelinating dz
2. cord contusion
3. intramedullary neoplasm
4. transverse myelitis
5. cord ischemia
Term
cortically enhancing neoplasm
Definition
1. oligodendroglioma
2. pleomorphic xantho astrocytoma
3. ganglioglioma
4. dysembryoplastic neuro epithilial tumor
5. desmoplastic infantile glioma
Term
epidural spinal mass
Definition
1. disk extrusion
2. epidural hematoma
3. epidural abscess
4. mets
5. epidural lipomatosis
6. synovial cyst
Term
prominent periventricular/ basal ganglia cystic lesions
Definition
1. Virchow-Robin spaces
2. lacunar infarct
3. infection
4. cystic neoplasm
5. neuroglial cyst
Term
cortically based cysts with nodule
Definition
1. dnet (dysembryonplastic neuroepithileal tumor)
2. oligodendroglioma
3. ganglioglioma
4. pleomorphic xanthoastrocytoma
Term
188
1. 4th ventricular tumor in child

2. dd extra axial lesion

3. attached to septum pellucidum

4. likes to spread by CSF dissemination

5. what non-tumors / tumors can mimic GBM

6. intraventricular tumors
Definition
1. ependymoma (infratentorally, ependymoma is intraventricular . supratentorially, ependymoma is intraparendymal). ependymoma has tongue of tissue going out of the 4th ventricular outflow tract. medulloblastoma (restricted diffusion),

2. meningioma, hemangiopericytoma or chondrosarcoma

3. central neurocytoma (enhances) vs subependymoma (usually doesn't enhance)

4. medulloblastoma, ependymoma, choroid plexus carcinoma, (PNET, pineoblastoma)

5. radiation necrosis, tumefactive multiple sclerosis, toxoplasmosis or lymphoma

6. choroid plexus papilloma/carcinoma, subependymoma, ependymoma, central neurocytoma, meningioma, mets
Term
189
1. pharyngeal mucosal space
2. masticator space
3. parotid space
4. carotid space
5. parapharyngeal space
6. perivertebral space
7. retropharyngeal space
8 posterior cervical space
Definition
1.pharyngeal mucosal space: mucosa (SCC), lymphoid tissue (lymphoma), mets, infection
2. masticator space: bone (osteosarcoma, Ewing's sarcoma), muscle (rhabdomysarcoma), teeth (infection like abscess), nerve (nerve sheath tumor)
3. parotid space: salivary tissue (parotid tumors, parotid inflammatory conditions), lymph nodes only in parotid gland (lymphoma, SCC mets), facial nerve (parotid tumors can spread via CN 7)
4. carotid space: carotid A (carotid body tumor), jugular vein (thrombus of the IJ), CN 9-12 (nerve sheath tumor-neurofibroma, schwannoma)
5. parapharyngeal space has fat. pushed by #1 (post lateral), #2, (posteromedial), #3 (anteromedial), #4 (anterolateral).
6. perivertebral space: vertebrae (mets), disks (disciitis, osteomyelitis), Paraspinous and prevertebral muscles (sarcoma), ---nerves
7. retropharyngeal space (medial to the carotid artery, between perivertebral space and pharyngeal mucosal space): infection, lymphoma, mets
8. posterior cervical space: cystic hygroma, lymphoma, mets--- CN 11
Term
Transient ischemic dilatation
Definition
1. multivessel coronary artery disease.
2. subendocardial ischemia
3. systolic dysfunction
4. misaligned single photon emission computed tomography (SPECT) images
Term
Symmetric "tram track" cortical uptake of the long bones
Definition
1. hypertrophic osteoarthropathy
2. shin/quadriceps/splints
3. chronic venous stasis
Term
poor quality bone scan
Definition
1. off peak gamma camera
2. incorrect radiopharmaceutical administration
3. poor radiopharmaceutical preparation
4. infiltrated dose
Term
extrapulmonary activity on a lung perfusion scan
Definition
1. free technetium 99m
2. right to left shunt
3. retained activity from a different radiotracer study
Term
superscan
Definition
1. metastatic disease
2. metabolic disease
3. paget disease
4. myeloproliferative/marrow infiltrative disorder
Term
increased activity and osseous expansion in the pelvis in adult
Definition
1. paget disease
2. mets
Term
increased activity and osseous expansion in the pelvis in child
Definition
1. ewing sarcoma
2. lymphoma
3. fibrous dysplasia
Term
3 phase positive bone scan
Definition
1. trauma
2. osteomyelitis
3. bone tumor
4. reflex sympathetic dystrophy (RSD)
Term
nonvisualization of the gallbladder on hepatobiliary imaging
Definition
1. acute cholecystitis
2. chronic cholecystitis
3. inadequate patient preparation
4. severe hepatocellular disease
5. high grade biliary obstruction
Term
focal intra abdominal activity on pertechnetate imaging
Definition
1. Meckel diverticulum
2. focal intra-abdominal infectious or inflammatory processes
3. physiologic renal/urinary activity
Term
persistent hepatogram on neonatal hepatobiliary imaging
Definition
1. biliary atresia
2. neonatal hepatitis
3. intrahepatic cholestasis from severe parenchymal disease
Term
persistent focal cervical uptake on delayed sestamibi imaging
Definition
1. parathyroid adenoma
2. thyroid adenoma or carcinoma
3. metastatic lymphadenopathy
Term
intra-abdominal activity on technetium 99m labeled red blood cell (RBC) scan
Definition
1. active gastro intestinal (GI) bleed
2. neoplasm or inflammatory bowel disease
3. genitourinary activity
4. free technetium
Term
decreased cortical 18F fluorodeoxyglucose (FDG) activity in the setting of dementia
Definition
1. alzheimer disease
2. pick disease
3. multi infarct dementia
4. parkingson disease
Term
unilateral absent lung perfusion
Definition
1. external compression (tumor, fibrosing mediastinitis)
2. pulmonary artery anomalies or corrected congenital heart disease
3. massive unilateral pulmonary embolism
4. mucous plug
5. unilateral diffuse parenchymal disease
6. endobronchial lesion (mass or foreign body)
Term
worsening renal function on mercapto-acetyltriglycine 3 (MAG 3) renal scan following Captopril administration
Definition
1. renal artery stenosis
2. unilateral urinary obstruction
3. false positive scan in patients on calcium channel blocker
Term
206
cold nodule on an iodine 123 (I 123) thyroid scan
Definition
1. thyroid carcinoma
2. colloid cyst
3. nonfunctioning adenoma
Term
focal abdominal uptake on indium 111 (In 111) pentreotide scan (Ostreoscan)
Definition
1. neuroendocrine tumor
2. metastatic disease
3. granulomatous disease
Term
absent intracranial activity on a technetium 99m (Tc99m) HMPAO (hexamethylpropyleneamine)
Definition
1. brain death
2. quality control - poor radiopharmaceutical bolus
Term
focal neck uptake on an I 131 post ablation scan
Definition
1. residual thyroid tissue
2. cervical nodal metastases
3. physiologic pharyngeal/esophageal activity
Term
increased mediastinal uptake on gallium scan
Definition
1. malignancy
2. granulomatous disease
3. nonspecific inflammatory/ infectious process
Term
focal increased hepatic uptake on a sulfur colloid scan
Definition
1. focal nodular hyperplasia (FNH)
2. regenerating nodular cirrhosis
3. Budd-Chiari syndrome
4. superior vena cava syndrome
Term
focal bowel uptake on an indium 111 (In 111) labeled WBC scan
Definition
1. infectious enteritis/colitis
2. inflammatory bowel disease
3. GI bleeding
4. swallowed activity from sinusitis/pharyngitis
Term
focal defect on QC images
Definition
1. photomultiplier tube failure
2. crystal defect
3. collimator defect
4. electronic artifact
Term
focal increased activity within an extremity on a bone scan
Definition
1. stress fracture
2. osteomyelitis
3. neoplasm (benign and malignant)
4. fibrous dysplasia
Term
solitary hypermetabolic pulmonary lesionon a positron emission tomography (PET) scan
Definition
1. malignancy
2. active granulomatous disease
3. pulmonary infection/ inflammation
Term
216 neonatal disease with low lung volumes
Definition
1. surfactant deficiency (respiratory distress syndrome is the clinical term). doesn't usually have pleural effusion. complication is pulmonary interstitial emphysema and bronchopulmonary dysplasia
2. beta-hemolytic streptococcal pneumonia. can have pleural effusion.
3. pulmonary hypoplasia. can be caused by oligohydramnios, thoracic dystrophies, intrathoracic herniation of abdominal organs. Potter syndrome (renal agenesis, oligohydramnios, pulmonary hypoplasia)
Term
217 neonatal lung disease wtih increased lung volumes
Definition
1. transient tachypnea of the newborn (TTN): usually term by c section. resolve by 3 d

2. meconium aspiration: usually post term. chemical pneumonitis. can have ptx (air block complication)

3. neonatal pneumonia: klebsiella, listeria, ecoli, (not beta hemolytic strep pna)

4. congenital heart disease
a. acyanotic normal vascularity: Aortic stenosis, coarctation of the aorta, interrupted aortic arch, pulmonary stenosis.
b. acyanotic increased vascularity: asd, vsd, pda, endocardial cushion defect
c. cyanotic decreased vascularity: tetrology of fallot (pulmonary stenosis, overriding aorta, vsd, rvh), tricuspid atresia/stenosis, pulmonary atresia, Ebstein's anomaly (atrialization of the RV), double outlet right ventricle with pulmonary stenosis
d. cyanotic increased vascularity: transposition of the great vessels, total anomalous pulmonary venous return, truncus arteriosus, single ventricle, tricuspid atresia, atrioventricular septal defect, double outlet right ventricle, eisenmenger physiology (left to right shunt turning into a right to left shunt)
Term
cyanotic infant with decreased pulmonary flow
1. tetrology of Fallot
a. characteristics
b. tx
2. pulmonary atresia with vsd
3. tricuspid atresia
4. double outlet right ventricle with pulmonary stenosis
5. Ebstein's anomaly
a. appearance
Definition
1. tetralogy of Fallot
a. (pulmonary stenosis, overriding aorta, vsd, rvh). associated with right aortic arch.
b. Blalock-Taussig shunt (connects subclavian A to the pulmonary A)
2. pulmonary atresia with vsd: considered severe form of tetrology of fallot
3. tricuspid atresia
4. double outlet right ventricle with pulmonary stenosis
5. Ebstein anomaly (atrialization of the right ventricle)
a. giant "box shaped" heart
Term
cyanotic infant with increased pulmonary vasculairty
Definition
1. transposition of the great arteries
2. truncus arteriosus
3. total anomatous pulmonary venous return
4. tricuspid atresia
5. single ventricle
6. double outlet right ventricle
7. Eisenmenger physiology (left to right shunt which turns into right to left shunt)
Term
acyanotic infant with increased pulmonary vascularity
Definition
1. ventricular septal defect
2. atrial septal defect
3. patent ductus arteriosus
4. atrioventricular canal defect
Term
liver mass in an infant
Definition
1. hepatoblastoma: elevated afp, chunky calcifications
2. hemangioendothelioma: vascular shunting can cause high output cardiac failure, fine/coarse calcifications
3. mesenchymal hamartoma: multilocular and cystic
4. metastatic disease: neuroblastoma (hemorrhage and calc), wilm's tumor (hypodense)
5. abscess
6. hematoma
Term
suprarenal mass in a child
Definition
1. neuroblastoma (if unsure of origin, can include Wilms tumor)
2. adrenal hemorrhage
3. subdiaphragmatic sequestration
4. pheochromocytoma
5. congenital adrenal hyperplasia
6. adrenal cortical carcinoma
Term
solid renal mass
Definition
1. Wilms tumor: age 3 years. WAGR syndrome and Beckwith-Wiedemann syndrome.
2. mesoblastic nephroma: newborn. hamartoma
3. nephroblastomatosis: bilateral persistent nephrogenic rests. malignant degeneration into Wilm's tumor.
4. autosomal recessive polycystic kidney disease: bilateral enlarged kidneys. associated with hepatic fibrosis, which is worse if the kidney disease is not as severe.
5. lymphoma
6. renal cell carcinoma: associated with VHL (retinal and cerebellar hemangioblastomas, renal cysts, RCC, pancreatic cysts, pheochromocytoma, islet cell tumors, liver cysts)
7. abscess
Term
cystic renal lesion
Definition
1. hydronephrosis: cystic lesions communicate.
a. unilateral usually due to UPJ obstruction
b. bilateral usually due to posterior urethral valves
2. multicystic dysplastic kidney: cystic lesions do not communicate. associated with contralateral UPJ obstruction. nuclear medicine study negative (other cystic nm studies would show some activity)
3. multilocular cystic nephroma: young boys and older women. multiloculated cystic mass. need to remove because cannot distinguish from cystic Wilms or cystic RCC.
4. autosomal dominant polycystic kidney disease: liver cysts, pancreatic cysts, berry aneurysms
5. cystic Wilms tumor:
a. syndromes: WAGR (Wilms tumor, aniridia, genital anomalies, mental Retardation), Beckwith-Wiedemann (macroglossia, polyhydramnios, enlarged kidneys, hepatomegaly, omphalocele, hemihypertrophy)
b. Wilms tumor vs. neuroblastoma
1) Wilms: no calcs, invades renal vein/IVC, displaces vessels, "claw sign"
2) neuroblastoma: +calcs, doesn't invade renal vein/IVC, surrounds vessels, displaces the kidney
6. cystic RCC: syndrome:
VHL: renal cysts, RCC, pancreatic cysts, pheochromocytoma, islet cell tumors, liver cysts, retinal and cerebellar hemangioblastomas
7. abscess
Term
subglottic narrowing
Definition
1. laryngotracheobronchitis (croup)
2. epiglottitis
3. retropharyngeal abscess
4. aspirated foreign body
5. bacterial tracheitis
6. hemangioma
7. laryngomalacia or tracheomalacia: diagnose on fluoroscopy. soft larynx or trachea respectively. normally the larynx and trachea dilated somewhat on inspiration and collapse somewhat on expiration, but in -malacia, this is exaggerated and there is a lot of narrowing on expiration.
Term
distal bowel obstruction in a neonate
Definition
1. Functional immaturity of the colon, small left colon syndrome, Meconium plug syndrome
2. Hirschsprung disease
3. ileal atresia/stenosis
4. meconium ileus
----------
2. anal atresia-anorectal malformation
Term
bowel wall thickening in an immunocompromised child
Definition
1. pseudomembranous colitis
2. neutropenic colitis/typhlitis
3. graft versus host disease
4. post transplant lymphoproliferative disorder
5. shock bowel
Term
skeletal dysplasia
Definition
1. achondroplasia
2. thanatophoric dysplasia
3. Jeune syndrome
----
4. Ellis van Creveld syndrome
5. chondrodysplasia punctata
Term
double bubble sign
Definition
1. malrotation with midgut volvulus
2. duodenal atresia/stenosis
3. annular pancreas
4. duodenal web
--------------
1. pre-duodenal portal vein
Term
230 posterior vertebral body scalloping
Definition
1. increased intraspinal pressure like from spinal tumors
a. adult: ependymoma
b. child: astrocytoma
2. dural ectasia
a. marfan's
b. erlos danlos
c. neurofibromatosis (because of neurofibromas and meningoceles in NF1)
3. mucopolysaccharidosis
a. Hurler's: inferior vertebral body anterior beaking
b. Morquio's: midportion vertebral body anterior beaking
4. achondroplasia: associated with spinal stenosis (also has rhizomelia, trident hand, decreased interpedicular distance in the lumbar spine, champagne glass pelvic inlet, tombstone iliac bones)
--------
5. normal variant
Term
pre sacral mass
Definition
1. germ cell tumor like sacrococcygeal teratoma. can be part of Currarino triad (presacral mass, scimitar sacrum, anorectal malformations)
2 anterior meningocele: can be seen in neurofibromatosis type I and currarino triad (presacral mass, scimitar sacrum, anorectal malformations)
3. rectal duplication cyst
4. lymphanioangioma
5. adnexal mass
Term
long bone aggressive lesion
Definition
1. osteosarcoma
2. Ewng sarcoma
3. osteomyelitis
4. Langerhans cell histiocytosis
5. metastatic disease
Term
endobronchial lesion in a child
Definition
1. foreign body
a. mc: nuts
b. how check
1) expiratory views: the side that doesn't collapsed has the fb
2) bilateral decubitus views: the dependent (side closer to the ground) should collapse. if it doesn't then it could have foreign body.
3) fluoroscopy
4) CT
2. papilloma:
a. if multiple called papillomatosis
b. associated with HPV 6 and 11 infection
3. carcinoid tumor: hypervascular
4. inflammatory polyp: regress when causative factor (infection, foreign body, inhaled toxin) removed
5. salivary gland neoplasm like mucoepidermoid carcinoma or adenoid cystic carcinoma
Term
234
1. Erlenmeyer flask deformity
2. gracile bone
Definition
1. undertubulated. short and squat. tongs
a. tumor like lesions:
1) paget's
2) FD
3) multiple hereditary exostosis
b. osteopetrosis
c. Niemann Pick's disease
d. gaucher's
e. sickle cell disease
2. overtubulated. gracile bone: long, thin. nimrod.
a. neuromuscular dz/neurofibromatosis
b. immobility
c. marfan's
d. juvenile RA
e. oi
f. dysplasias
Term
lytic skull lesion in a child
Definition
1. Langerhans cell histiocytosis (EG): beveled edge from greater lysis of the inner table compared to the outer table. "button sequestrum" (dead bone in center surrounded by lucency)
2. infection: "button sequestrum"
3. epidermoid cyst
4. leptomeningeal cyst (growing skull fracture due to CSF pulsations from disrupted dura)
5. metastatic disease (e.g. leukemia, neuroblastoma)
Term
236
appearance of avascular necrosis of the femoral head
Definition
1. Legg-Calve Perthes. 5 years old
2. SCFE (slipped capital femoral epiphysis) can result in AVN (10-15 years old)
3. trauma
4. sickle cell disease
5. corticosteroid use
6. Gaucher disease (lysosomal storage disease)
7. Meyer dysplasia (age 2-4 year, asymptomatic, bilateral, boys, can look like Legg Calve Perthes dz)
Term
vascular anomaly with esophageal and tracheal compression
Definition
1. aberrant right subclavian artery (not complete vascular ring)
2. double aortic arch (complete vascular ring-needs surgery)
3. right aortic arch with aberrrant left subclavian artery (if with symptomatic ligamentum arteriosum then need surgery)
4. pulmonary sling (need surgery)
-------
1. innominate artery compression syndrome
Term
esophageal obstruction in a neonate
Definition
1. tracheo esophageal fistula/esophageal atresia:
a. most common type: EA with distal TEF
b. types: stat dx (just describe)
type A: Esophageal atresia only
type B: EA with proximal TEF
type C: EA with distal TEF
type D: EA with proximal and distal TEF
type E: TEF without EA. aka type H
c. association with VACTERL: vertebral body anomaly, anal atresia, cardiac anomalies, TE fistula, esophageal atresia, renal, radial ray Limb anomalies
d. if E/H type fistula suspected then can just put air or do upper GI with iso-osmolar water soluble contrast
2. foreign body:
a. likely to get stuck at thoracic inlet, level of aortic arch and GE junction
3. esophageal duplication cyst
a. usually right sided
b. usually not in communication with the esophagus
4. vascular ring: complete vascular ring can cause dysphagia. esophagram shows posterior and bilateral lateral indentations
a. double aortic arch
b. right arch with aberrant left subclavian A (with ductus/ligamentum arteriosum)
Term
cystic pulmonary mass
Definition
1. congenital lobar emphysema: bronchial obstruction causing progressive lobar emphysema. LUL > RML < RUL
2. congenital pulmonary airway malformation: hamartoma
3. congenital diaphragmatic hernia: usually left sided
4. necrotizing pneumonia: develops due to pna. goes away after pna tx
5. pneumatoceles from infection: develops as a part of healing. persists after pna tx
Term
solid pulmonary mass
Definition
1. round pneumonia: under 8 years old. collateral pathways for air circulation (pores of Kohn and channels of lambert) not well developed.
2. congenital pulmonary airway malformation: 3 types (I: > 2cm cysts, II: smaller cysts. III microcysts which appear solid)
3. sequestration: both types have systemic arterial supply and left lower lobe. tx is resection if symptomatic. LLL > RLL
a. intra lobar (drains into pulmonary venous system, presents later, lacks own pleural covering, not associated with other anomalies. congenital or acquired.
b. extra lobar (drains into systemic venous system, presents earlier, has own pleural covering, associated with other anomalies). congenital.
4. bronchogenic cyst (usually mediastinal, but can be intraparenchymal)
5. AVM
6. bronchial atresia (finger in glove appearance): LUL
7. mets like from neuroblastoma
---------------
1. plasma cell granuloma
Term
dd
unilateral hyperlucent lung
Definition
1. faulty technique: patient rotated
2. absent soft tissue (Poland syndrome, mastectomy)
3. airway obstruction (FB, endobronchial lesion, bronchial compression)
4. emphysema (bullae, congenital lobar emphysema, unilateral transplant)
5. Swyer James syndrome
6. PE
7. ptx
8. compensatory overinflation
9. pulmonary artery hypoplasia
Term
dd neonatal non pulmonary chest masses
1. mediastinal
2. chest wall
Definition
1. mediastinal masses
a. esophageal duplication cyst
b. bronchogenic cyst
c. neuroenteric cyst
d. hemangioma
e. lymphangioma
f. germ cell tumor
g. thymus
h. aortic, pulmonary, ductus aneurysm
2. chest wall
a. mesenchymoma
b. lymphangioma
c. hemangioma
Term
anterior, middle and posterior mediastinal masses
Definition
1. anterior: thymic lesion (thymoma, thymolipoma, thymic cyst, thymic ca), teratoma, thyroid enlargement, lymphoma
2. middle:
a. mediastinal: lymphadenopathy
b. vasculature: aortic/pulmonary/ductus aneurysm
c. bronchus: bronchogenic cyst, lung cancer
d. esophagus: esophageal duplication cyst, esophageal cancer, hernia, esophageal diverticulum
3. posterior:
a. neurogenic:
1) ganglion: neuroblastoma, pheochromocytoma, paraganglioma, ganglioneuroblastoma, ganglioneuroma
2) nerve sheath tumor
3) myelomeningocele
b. neuroenteric cyst
c. spinal:
1) extramedullary hematopoiesis
2) infection
3) trauma
d. vascular
1) aneurysm of the descending aorta
2) azygous continuation of the IVC
e. GI: Bochdalek hernia
Term
dd anterior vertebral body beaking (bullet shaped vertebral bodies)
Definition
1.mucopolysaccharidosis
a. Hurler: anterior inferior beaking
b. Morquio's: anterior mid-vertebral body beaking
2. achondroplasia
3. hypothyroidism
--
4. Down's syndrome
5. Neuromuscular disease
Term
dd wormian bones
Definition
pork chops
pyknodysostosis
oi
rickets in healing
kinky hair syndrome
cleidocranial dysplasia
hypothyroidism
otopalatodigitial syndrome
pachydermoperiostosis
syndrome of downs
Term
dd
1. coxa vara:
2. coxa valga:
Definition
1. coxa vara:
a. proximal focal femoral deficiency
b. bone softening disorders: metabolic or congenital dysplasia (OI, FD, cleidocranial dysplasia)
2. coxa valga: neuromuscular disorders (not bearing enough weight to develop normal femoral neck)
Term
dd for periosteal reaction in children
Definition
SLAAMPOCC
1. syphilis
2. leukemia
3. Hypervitaminosis A
4. abuse
5. mets, neuroblastoma
6. physiologic
7. oi
8. caffey's disease (infantile cortical hyperostosis)
9. vitamin C deficiency (scurvy)
Term
248
dd dense metaphyseal bands
Definition
1. normal variant
2. lead
3. other heavy metals
4. treated rickets
5. treated leukemia
6. torch infections (e.g. toxo, rubella, cmv, herpes)http://radiology.rsna.org/content/211/3/773.full
Term
249
dd lytic lesion in posterior elements
Definition
mo ape
mets
osteoblastoma, osteoid osteoma
abc
plasmacytoma
eg
Term
dd diaphyseal lesion
1. < 30 years
2. > 30 years
Definition
1. < 30 years: eg, leukemia, Ewing's (diaphyseal), osteosarcoma (diaphyseal or metadiaphyseal), infection
2. > 30 years: mets, lymphoma, multiple myeloma, infection
Term
dd frayed metaphysis
Definition
charms
1. congenital infection (rubella, syphilis)
2. hypophosphatemia (vitamin D resistant rickets)
3. achondroplasia
4. rickets
5. metaphyseal dysostosis
6. scurvy
Term
dd multiple renal masses
Definition
1. nephroblastomatosis
2. mets
3. lymphoma
4. pyelonephritis
5. infarcts
Term
dd bilateral enlarged kidneys (some)
Definition
1. HIV
2. lymphoma/leukemia
3. bilateral renal vein thrombosis (like from dehydration in neonate)
4. bilateral pyelonephritis
5. autosomal recessive polycystic kidney disease
6. nephroblastomatosis
7. bilateral Wilms, Beckwith Wiedemann (macroglossia, polyhydramnios, hepatomegaly, large kidneys, omphalocele, hemihypertrophy)
8. bilateral RCC. Von Hippel Lindau (renal cysts, rcc, pancreatic cysts, pheochromocytoma, islet cell tumors, liver cysts)
Term
dd filling defect in bladder
Definition
1. rhabdomyosarcoma (sarcoma botyroides is subtype of rhabdomyosarcoma and looks like a bunch of grapes)
2. tcc
3. stone (uric acid, xanthine, indinivir)
4. fungus ball
5. hematoma
6. ureterocele
etc. S Alabama #287
Term
255
globe lesion in a child dd
1. retinoblastoma
2. PHPV
3. Coats disease
4. retinopathy of prematurity
5. toxocariasis
Definition
globe lesion in a child dd
1. retinoblastoma: +calcs. normal size globe.
a. trilateral retinoblastoma: bilateral retinoblastoma and pineal tumor
b. quadrilateral retinoblastoma: bilateral retinoblastoma, pineal lesion and suprasellar tumor.
2. persistent hyperplastic primary vitreous (PHPV) : no calcs. small globe. retrolental soft tissue and stalk "Martini glass".
3. Coats disease: no calcs. normal size globe. retinal telangiectasias. V shaped retinal detachment.
4. retinopathy of prematurity: bilateral micro-ophthalmos with h/o prematurity due to prolonged oxygen therapy.
5. toxocariasis: no calcs. normal size globe. enhancing lesion in posterior aspect of globe due to granulomatous reaction. history of contact with cats/dogs
Term
dd pediatric cerebral calcifications and mc
Definition
TORCH infections
1. toxoplasmosis
2. other: syphilis (Wimberger's sign: erosion along proximal and medial tibia)
3. rubella (celery stick appearance)
4. cmv (calcs) and mc
5. herpes
Term
dd chf in newborn
Definition
1. shunt: hemangioma, hemangioendothelioma, vein of Galen malformation
2. left sided obstruction: AS, Mitral stenosis, Pulmonary stenosis
3. volume overload: mitral, tricuspid insufficiency, asd
AND MORE
Term
enlarged ovary
1. ovarian torsion
a. characteristic: US grayscale and color/spectral flow
b. if you see flow, does that rule out ovarian torsion?
c. predisposing factors to ovarian torsion
d. what can you find in intermittent or incomplete torsion?
2. ovarian neoplasm
3. tubo-ovarian abscess
4. hemorrhagic cyst
a. characteristic
Definition
1. ovarian torsion
a. characteristic: enlarged ovary, peripheral cysts, +/- cyst/tumor. decreased flow (1st: decreased venous flow then 2nd: decreased arterial flow)
b. if you see flow, you don't rule out ovarian torsion because there could be intermittent, incomplete torsion
c. predisposing factors to ovarian torsion: ovarian mass/cyst in adult or normal adnexal mobility in child
d. what can you find in intermittent or incomplete torsion? hyperemia
2. ovarian neoplasm
3. tubo ovarian abscess
4. hemorrhagic cyst
a. characteristic: lace like pattern and no flow
Term
enlarged ovary wtih multiple peripheral follicles
1. ovarian torsion:
a. US characteristic
b. US flow characteristic
c. predisposing factors to ovarian torsion:
1) adult
2) child
d. if you see flow, can you rule out torsion?
e. what can you see in intermittent or incomplete torsion?
2. polycystic ovarian disease:
a. aka
b. clinical picture
c. US characteristic
3. ovarian hyperstimulation syndrome
a. characteristics
b. other characteristics
c. life threatening due to
Definition
1. ovarian torsion
a. enlarged ovary, peripheral follicles, +/- ovarian cyst/mass.
b. decreased flow (first affects venous outflow then arterial inflow)
c. predisposing factors to ovarian torsion
1) adult: mass or cyst
2) child: normal adnexal mobility
d. if you see flow, can you rule out torsion? no, the torsion could be intermittent or incomplete
e. what can you see in intermittent or incomplete torsion? hyperemia
2. polycystic ovarian syndrome
a. aka Stein Leventhal syndrome
b. clinical picture: obesity, hirsuitism, irregular menses/ infertility
c. US: "string of pearls" configuration (10 or more < 5 mm peripheral follicles)
3. ovarian hyperstimulation syndrome (ohs)
a. characteristics: enlarged ovary with multiple peripheral follicles
b. other characteristics: pleural effusions, ascites
c. life threatening due to electrolyte and fluid imbalances
Term
hyperechoic liver mass
1. hemangioma:
a. common appearance:
b. common atypical appearance
c. vascularity?
d. MR
2. focal fatty infiltration
a. most often due to
b. usually located
3. hcc:
a. on MR?
4. mets
a. mc
b. characteristic appearance
5. focal nodular hyperplasia
a. characteristic pattern
b. characteristic flow pattern
6. hepatic adenoma
a. appearance
Definition
1. hemangioma
a. common appearance US: hyperechoic.
b. common atypical appearance US: reverse "target" appearance (hypoechoic mass with peripheral hyperechoic rim)
c. vascularity in hemangioma on US? no
d. MR:
1) T2: high intensity
2) T1 post contrast: peripheral puddling with centripetal fill-in
2. focal fatty infiltration
a. most often due to obesity
b. usually along the falciform ligament and portal confluence
b. usually occurs adjacent to the falciform ligament and
3. hepatocellular carcinoma
a. on MR: high on T2
4. metastatic disease
a. mc:colon
b. characteristic appearance: target appearance (central hyperechoic with peripheral hypoechoic rim)
5. focal nodular hyperplasia
a. characteristic appearance; central scar
b. "spoke wheel" pattern of flow
c. has hepatocytes so positive sulfur colloid
6. hepatic adenoma
a. appearance: varied, but hypoechoic and might have areas of hyperechoic because can contain fat.
Term
A. complex extra testicular fluid collection
1. varicocele
a. defn
b. more common on
c. if on right
d. tx
2. hematocele
a. appearances
3. pyocele
a. look for
B. layers surrounding the testicle from inner to outer
Definition
A. complex extratesticular fluid collection
1. varicocele
a. varicocele is abnormal dilatation of the spermatic cord veins (pampiniform plexus) > 2mm
b. more common on left due to drainage into left renal vein (longer left testicular vein, angled entrance into the left renal vein)
c. if varicocele is on right, should search for retroperitoneal mass
d. tx: coiling of the spermatic vein
2. hematocele:
a. can appear cystic, fluid-fluid levels or low level echoes
3. pyocele
a. look for ring down artifact indicating gas indicating possible necrotizing fasciitis, aka Fournier's gangrene.
B. layers surrounding the testicle from inner to outer
a. tunica albuginea: if discontinuous, then testicular rupture.
b. visceral layer of tunica vaginalis: hydrocele etc. is between the layers of the tunica vaginalis.
c. parietal layer of tunica vaginalis
Term
hyperechoic renal mass
1. angiomyolipoma
a. has a propensity to _____ if > 4 cm.
b. associated with
c. on ultrasound
2. renal cell carcinoma
3. complex cyst
a. can mimic
a. associated with
Definition
1. angiomyolipoma
a. angiomyolipoma has a propensity to bleed if > 4 cm
b. angiomyolipoma associated with tuberous sclerosis (cortical tubers, angiomyolipomas, LAM, renal cysts, subependymal giant cell astrocytoma)
c. hyperechoic and posterior shadowing
2. renal cell carcinoma
a. associated with VHL (renal cysts, rcc, pancreatic cysts, islet cell tumors, pheochromocytoma, liver cysts)
3. complex cyst
a. can mimic a solid mass
Term
complex cystic adnexal mass with positive HCG
1. ectopic pregnancy
a. characteristics
2. corpus luteal cyst
a. characteristics
3. hemorrhagic cyst
a. US appearance
b. can also have
Definition
1. ectopic pregnancy:
a. characteristics: lack of intrauterine pregnancy, adnexal mass (separate from ovary) with "ring of fire" pattern. can have hemoperitoneum and pseudogestational sac.
2. corpus luteal cyst
a. characteristics: arises from ovary
3. hemorrhagic cyst:
a. US appearance: lacelike internal echoes
b. can also have thick echogenic rim and hemoperitoneum
3. hemorrhagic cyst
Term
heterogeneous uterus
1. diffuse leiomyomas
a. on US
b. on T2
c. location
d. can be ___ which can mimic___
e. fibroid vs. adenomyosis
f. parts of the uterus on T2 MR
2. adenomyosis
a. can be
b. what is adenomyosis?
3. endometrial cancer:
a. what is considered abnormal endometrial stripe for postmenopausal woman
Definition
1. diffuse leiomyomas
a. US: hypoechoic uterine mass
b. MR: Low intensity on T2
c. location: subserosal (near abdominal cavity, intramural, submucosal (near uterine cavity)
d. can be infiltrative which can mimic adenomyosis
e. fibroid has mass effect; adenomyosis does not have mass effect.
f. parts of the uterus on T2 MR
1) bright: endometrium
2) dark: junctional zone (if > 10 mm then think of adenomyosis)
3) intermediate: myometrium
2. adenomyosis
a. can be focal or diffuse
b. adenomyosis is the endometrium going toward the myometrium
3. endometrial carcinoma
a. > 5 mm (bright area on T2) is considered abnormal for post menopausal woman
Term
A. thickened endometrial stripe
1. endometrial hyperplasia
a. can be due to
b. US can show
2. endometrial polyps
a. what is a helpful finding?
b. what kind of study can be done?
3. endometrial carcinoma
a. endometrial stripe should be ___in postmenopausal woman
b. endometrial stripe should be ___ in postmenopausal woman on hormone replacement therapy or tamoxifen
c. endometrial stripe should be ___ in premenopausal women
d. how to measure endometrial stripe:
4. submucosal fibroids
a. appearance on US
5. if positive hcg
a. retained products of conception
1) flow?
b. gestational trophoblastic disease
1) ranges from ___ to____
2) can be associated with
b. gestational trophoblastic disease
B. thin endometrial stripe: mc cause
Definition
1. endometrial hyperplasia
a. can be due to tamoxifen
2. endometrial polyps
b. US can show small cystic spaces
a. a helpful finding suggesting endometrial polyps is a vascular stalk
b. sonohysterogram (US of uterus after instillation of sterile water)
3. endometrial carcinoma
a. es <= 5 mm in post menopausal woman
b. es <= 8 mm in post menopausal woman on hrt/tamoxifen
c. es <= 20 mm in pre menopausal women
d. how to measure endometrial stripe:
1) in secretory phase: measure the whole hyperechoic area.
2) in later proliferative phase: multilayer appearance. measure hyperechoic line to hyperechoic line.
4. submucosal fibroids
a. submucosal fibroids are hypoechoic on US
5. if positive hcg
a. retained products of conception
1) rpoc may or may not have flow. flow is suggestive of rpoc
b. gestational trophoblastic disease
1) ranges from benign mole to choriocarcinoma
2) can be associated with theca lutein cysts
B. mc cause of thin endometrial stripe: endometrial atrophy
Term
266
A. uterine anomaly
B. if hematometrocolpos
1. dd
2. what do you call blood in uterus? vagina? uterus and vagina?
Definition
A.
1. bicornuate uterus:
a. can be unicollis or bicollis (one or two cervices)
b. midline uterine dimple > 1 cm
c. tx: metroplasty
2. septated uterus
a. midline uterine dimple < 1 cm
b. tx: hysteroscopic resection of septum
3. didelphus uterus
a. two cervices. two uteri, two vaginas
b. usually no problem with fertility
4. need to check for GU anomalies also
4. arcuate uterus
B. hematometrocolpos
1. dd
a. neonate or girl at puberty: imperforate hymen, vaginal septum (add vaginal atresia if neonate)
b. adult: cervical or vaginal stenosis due to radiation tx for cervical or colorectal cancer
2.
a. blood in uterus: hematometra
b. blood in vagina: hematocolpos
c. blood in uterus and vagina: hematometrocolpos
Term
"starry sky" liver
1. acute hepatitis
a. appearance is due to
b. does chronic hepatitis give rise to the "starry sky" liver?
2. hepatic congestion
a. can be due to
3. infiltrating neoplasm
a. like
4. toxic shock syndrome
a. what is toxic shock syndrome?
5. biliary or portal venous gas:
a. gas vs. "starry sky" appearance
Definition
1. acute hepatitis
a. appearance of acute hepatitis is due to increased echogenicity of the portal triad (portal vein, hepatic artery, bile duct) and decreased echogenicity of the liver parenchyma due to edema
b. chronic hepatitis does not give rise to the "starry sky" appearance. in chronic hepatitis, the portal triad is not clearly visualized and the liver parenchyma is coarsened.
2. hepatic congestion
a. hepatic congestion can be due to
1) right heart failure: demonstrates pulsatile flow in the portal and hepatic veins
2) IVC occlusion
3) SVC occlusion: Budd Chiari syndrome
3. infiltrating neoplasm (HCC, diffuse metastatic disease including lymphoma, leukemia) can mimic the "starry sky" appearance by decreasing the echogenicity of the liver parenchyma.
4. toxic shock syndrome
a. tss is a toxin mediated disease most commonly caused by Staph aureus.
5. biliary or portal venous gas:
a. gas vs. "starry sky" appearance: gas is mobile.
Term
268
A. "target" lesions in the liver:
1. how does a target lesion appear?
2. what is a reverse target lesion?
B. dd for "target" lesions in the liver
Definition
A. "target" lesion in the liver
1. target lesion: hyperechoic in center with hypoechoic rim. mets
2. reverse target lesion: hypoechoic in center and hyperechoic rim. atypical hemangioma (a typical hemangioma is just hyperechoic)
B. dd target lesions in liver
1. hepatocellular carcinoma
a. predisposing factors to hcc: etoh, hep bc, aflatoxins
2. metastatic disease
a. like breast, lung, colon
3. lymphoma
a. what type? non-Hodgkins (Hodgkin's is more common in the chest)
4. hepatic abscesses
Term
portal vein thrombosis
1. tumor thrombus
a. can be from
b. tumor thrombus vs bland thrombus
1) flow?
2) expansion of the portal vein
2. bland thrombus
a. predisposing factors
3. hepatic cirrhosis with portal htn can mimic thrombus
Definition
1. tumor thrombus
a. can be from hcc, metastatic disease, cholangiocarcinoma, gallbladder carcinoma (90% adenocarcinoma), pancreatic carcinoma, gastric carcinoma
b.
1) tumor thrombus has flow. bland thrombus does not have flow
2) portal vein expansion favors tumor thrombus over bland thrombus.
2. bland thrombus
a. predisposing factors
1) hypercoagulable conditions like protein C and S deficiency, factor V leiden
2) infectious/inflammatory conditions: hepatitis, pancreatitis, cholangitis, occasionally appendicitis
3) trauma/iatrogenic
Term
cystic adnexal mass with negative HCG
1. ovarian neoplasm
a. characteristic
b. flow?
2. hemorrhagic cyst
a. characteristic
b. flow?
3. toa
a. why would toa look like cystic mass?
b. how to help distinguish toa from cystic mass
4. endometrioma:
a. US appearance
b. MR appearance
Definition
1. ovarian neoplasm
a. characteristics of neoplasm: papillary projections, thick septations
b. +flow
2. hemorrhagic cyst
a. characteristic
1) reticular lacelike appearance
2) can also have fluid fluid level
3) hyperechoic retracted clot can mimic papillary projections or thick septations
b. no flow in clot
3. tubo ovarian abscess
a. toa can look like cystic mass due to dilated and redundant fallopian tubes
b. help distinguish toa from cystic mass by history
4. endometrioma
a. US appearance:
1) homogeneous low level echos
2) through transmission
b. MR appearance
1) T2 shading (low T2)
Term
multiple hypoechoic liver masses
1. hcc or mets
a. typical appearance for hcc or mets
b. other appearance of hcc or mets
c. what entity would you include under mets?
d. what is the typical appearance of lymphoma on US
e. what can lymphoma mimic?
2. multifocal abscess
3. candidiasis
a. usual presentation
b. if not usual presentation and large, has a ____ appearance
4.hematoma
a. can be
b. later can appear
5. diffuse focal fatty infiltration with focal fatty sparing
a. normal liver echogenicity
b. focal fatty sparing occurs usually
Definition
1. neoplasm (multifocal HCC, metastatic disease, lymphoma)
2. multifocal abscesses
3. candidiasis
a. usual presentation: microabscesses
b. if not usual presentation and large, can have a TARGET appearance
4. hematoma
a. can appear isoechoic to liver
b. later can appear cystic
5. diffuse fatty infiltration with focal fatty sparing
a. normal liver echogenicity is only slightly more echogenic than renal cortex
b. focal fatty sparing usually occurs along
1) gallbladder fossa
2) along falciform ligament
3) porta hepatis
Term
hypoechoic renal mass
1. simple or complex renal cyst
2. lymphoma
a. does the kidney have native lymph tissue?
b. Hodgkins or non Hodgkins lymphoma in kidneys?
c. if lymphoma of the kidneys usually unilateral or bilateral?
d. what can lymphoma mimic?
3. renal abscess
4. renal cell carcinoma
a. usually -echoic
b. but can be -echoic
5. metastatic disease
a. from?
b. usually unilateral or bilateral?
Definition
1. simple or complex renal cyst
2. lymphoma
a. the kidney does not have native lymph tissue so lymphoma of the kidneys is usually due to systemic disease or immunocompromise
b. kidneys usually have non Hodgkin's lymphoma
c. lymphoma of the kidneys is usually bilateral
d. lymphoma can mimic cysts, but has lack of through transmission.
3. renal abscess
4. renal cell carcinoma
a. rcc is usually hyperechoic
b. but rcc can be iso or hypoechoic
2. metastatic disease
a. liver, breast, colon, melanoma
b. metastatic disease is usually bilateral
Term
hyperechoic foci in gallbladder wall
Definition
1. porcelain gallbladder:
a. higher risk for gallbladder carcinoma
b. if see porcelain gallbladder then look for gallbladder mass, liver mets, lymphadenopathy
c. porcelain gallbladder vs gallbladder filled with stones: if sound penetrates near wall then can see back wall in porcelain gb. if gallbladder filled with stones, won't see back wall.
2. Gallbladder filled with gallstones
a. wall echo shadow complex: wall (looks hyperechoic then hypoechoic), echo (hyperechoic), shadow (hypoechoic)
b. gallbladder filled with gallstones vs porcelain gallbladder: would see back wall with porcelain gallbladder if sound penetrated front wall. would not see back wall in gallbladder filled with stones.
2. emphysematous cholecystitis
a. air is very bright and mobile
b. causes dirty shadowing
c. can cause comet tail artifact (reverberation artifact due to bright reflectors)
3. adenomyomatosis (type of hyperplastic cholecystosis)
a. gallbladder wall thickening
b. comet tail artifact: crystals (bright reflectors) deposit in Rokitansky Aschoff sinuses causing reverberation artifact.
c. how do you distinguish emphysematous cholecystitis vs adenomyomatosis: pt with ec are sick appearing clinically. pt with adenomyomatosis are not sick appearing clinically.
4. cholesterolosis (type of hyperplastic cholecystosis): echogenic foci with comet tail artifact
5. cholesterol polyp: vascular, nonmobile, < 1cm, nonshadowing, usually multiple (take out if > 1 cm to r/o malignancy.)
6. gb adenoma: usually single and < 1cm. (take out if > 1 cm to r/o malignancy)
Term
enlarged painful testicle
Definition
1. testicular torsion
a. setting: bell clapper deformity where the tunica vaginalis completely surrounds the testis, epididymis and part of the spermatic cord and the testis is not attached to the posterior scrotal wall.
b. need surgery within 6 h to increase chance of salvaging the testicle.
c. can mimic orchitis if detorses and becomes hyperemic.
d. vascularity: decreased.
2. epididymo-orchitis:
a. vascularity: decreased
b. in severe orchitis, there may be ischemia and this can mimic torsion.
3. testicular trauma
a. hematoma: abnormal echogenicity of testicle (one article showed mainly hypoechoic regions)
b. fracture: linear region of abnormal echogenicity of testicle
c. rupture:
1) tunica albuginea (hyperechoic) is discontinuous.
2) need surgery within 72 h for testicular rupture in order to salvage the testicle.
d. hematocele: hyperechoic fluid
Term
gallbladder wall thickening
A. diffuse
B. focal
Definition
A. Diffuse
1. acute cholecystitis:
a. gallbladder wall should be < = 3 mm
b. if HIV, could be due to cmv or cryptosporidium
2. gallbladder wall thickening could be from
a. could be from edema via CHF, hypoproteinemia, ascites due to liver disease (via cirrhosis and portal htn) or renal failure.
b. could be from secondary inflammation from hepatitis, pancreatitis, pyelonephritis.
3. adenomyomatosis:
a. can be diffuse or focal
b. gallbladder wall thickening
c. comet tail artifact from reverberation artifact due to crystals being deposited in Rokitansky-Aschoff sinuses.
B. Focal
1. gallbladder carcinoma
a. gallbladder carcinoma is associated with porcelain gallbladder
2. gallbladder polyp
a. features of gb polyp: < 1 cm, non-shadowing lesions attached to gb wall
b. if > 1 cm, need to be remove to r/o malignancy
3. adenomyomatosis:
a. can be focal or diffuse
b. gallbladder wall thickening
c. comet tail artifact due to reverberation artifact from crystals deposited in the Rokitansky Aschoff sinuses.
Term
right lower quadrant mass in a child
Definition
1. appendicitis
a. measure outer wall to outer wall
b. normal appendix should be less than 6 mm
c. blind ending tubular structure
d. non-compressible
2. intussusception
a. lead point can be: meckel's diverticulum (has ectopic gastric mucosa), lymhoma, inspissated feces in cystic fibrosis, bowel wall hemorrhage in Henoch Schonlein purpura (small vessel vasculitis)
3. enteric duplication cyst: ileum is most common site
4. adnexal mass in a female: toa, hemorrhagic cyst, endometrioma, ovarian cyst, ectopic pregnancy, torsion with or without a mass.
5. Meckel diverticulum: ectopic gastric mucosa
6. mesenteric adenitis:
a. multiple enlarged lymph nodes usually anterior to the right psoas muscle
b. no appendicitis
c. can have some inflammation of the TI and cecum.
Term
thyroid mass
Definition
1. benign thyroid nodule
a. types: hyperplastic (mc), adenoma, colloid cysts
b. characteristic of benign thyroid lesion:
1) eggshell calcifications; cystic; thin hypoechoic halo, hyperechoic or isoechoic; no LN; comet tail artifact is usually due to inspissated colloid.
2. thyroid malignancy
a. types: papillary (mc), follicular (Hurtle cell is a variant of follicular), medullary (associated with MEN II and III), anaplastic, mixed. also lymphoma and mets.
b. characteristics of malignant thyroid lesions: microcalcifications; solid; hypoechoic; microcalcs don't have comet tail artifact; LN (can be cystic or calcified)
3. parathyroid adenoma: usually posterior to thyroid gland, hypoechoic, ovoid and highly vascular
1. thyroglossal duct cyst:
a. what is it? cystic lesion that can located from the foramen cecum at the base of the tongue to the thyroid bed.
b. tx: sistrunk procedure: remove middle 1/3 of hyoid bone and the thyroglossal duct cyst
Term
multiple splenic hypoechoic foci
Definition
1. fungal abscess: candidiasis, aspergillus, cryptococcus (cac)
2. diffuse lymphoma
3. granulomatous disease:
a. histoplasmosis.
b. if HIV, TB or pneumocystis jiroveci.
4. metastatic disease: mc melanoma
Term
periventricular cysts
Definition
1. periventricular leukomalacia
a. < 32 weeks
b. may be hyperechoic, hypoechoic then cystic then volume loss
2. subependymal cysts:
a. congenital
b. acquired: can be due to germinal matrix hemorrhage.
3. infection
a. TORCH infections have a variety of findings like microcephaly, hydranencephaly, porencephalic cysts, periventricular calcifications
b. cysts which may calcify: neurocystercercosis
4. porencephaly: cystic space that usually communicates with ventricle due to encephalomalacia from any destructive process (hemorrhage, infarct, infection)
5. choroid plexus cyst: associated with trisomy 18 (edwards); clenched hands with overlapping digits and choroid plexus cysts.
Term
280
periventricular hyperechoic foci
Definition
1. preterm < 32 w
a. germinal matrix hemorrhage:
1) types: I (germinal matrix), II (intraventricular), III (intraventricular with hydrocephalus), IV (parenchymal hemorrhage due to venous hemorrhagic infarct)
2) poor prognosis: types III and IV
b. early periventricular leukomalacia: initially presents with increased echogenicity then progresses to cyst formation and then volume loss
2. term
a. intraventricular/intraparenchymal hemorrhage: initially can be hyperechoic then hypoechoic then cystic. due to trauma, coagulopathy, heparin for ecmo (extracorporal membrane oxygenation), venous infarction.
b. hypoxic-ischemia brain injury: pulmonary dz, cyanotic heart dz, trauma. subcortical region or basal ganglia.
3. infection: the calcifications are hyperechoic
a. periventricular: CMV
b. scattered: toxoplasmosis
c. basal ganglia: HIV
d. cystic lesions that may calcify: neurocystercercosis
Term
common bile duct dilatation
Definition
the common bile duct should be < 6 mm under 70 years old. if 70 years, can be 7 mm and so on.
1. non-obstructive causes: choledochal anomalies
2. obstructive:
a. intrahepatic:
1) intrahepatic cholangiocarcinoma
2) primary sclerosing cholangitis, recurrent pyogenic cholangitis (from clonorchis sinensis or ascaris lumbricoides), AIDS cholangiopathy (CMV and cryptosporidium)
b. extrahepatic
1) extrahepatic cholangiocarcinoma
2) pancreatic cancer:"double duct sign" (both cbd and pancreatic duct are dilated)
3) fibrosis from chronic pancreatitis
4) extrinsic lymph node compression
Term
enlarged painless testicle
Definition
1. testicular neoplasm
a. most common pure gct: seminoma
b. types of germ cell tumor
1) seminomatous:
2) non-seminomatous: embryonal cell carcinoma, yolk sac tumor (high afp), choriocarcinoma (high bhcg), teratoma (3 layers, a little calc, a little fat), mixed germ cell tumor
c. associated with microlithiasis (controversial: some say to fu in q 6 m, others say no fu necessary)
d. retroperitoneal adenopathy suggestive of retroperitoneal extension
e. Azzopardi tumor: burnt out germ cell tumor of the testis with mets
2. lymphoma/leukemia
a. lymphoma: older men
b. leukemia: children
c. why see recurrence in testicle? chemotherapy is hindered by the blood testis barrier.
3. testicular cysts
a. testicular
1) usually located near mediastinum testis
2) may originate from dilated rete testis (tubular ectasia of the rete testis) [~aside the rete testis makes up part of the mediastinum testis. tubular ectasia of the rete testis is associated with testicular and epididymal cysts and spermatoceles. tubular ectasia of the rete testis is low on T1 and high on T2]
b. tunica albuginea cysts: peripherally located
4. aside: cystic lesions in the epididymis
a. epididymal cysts: can occur anywhere in the epididymus
b. spermatocele:
1) occurs in the head of the epididymus
2) may see spermatozoa.
Term
283
A. nuchal translucency
1. defn and when measure:
2. dd
B. nuchal thickness
1. defn and when measure
2. dd
Definition
A. nuchal translucency
1. defn: > 3mm at 11-14 w
2. dd:
a. trisomy 13 (patau):
1) hyperechoic enlarged kidneys
2) post axial polydactyly
3) holoprosencephaly with craniofacial anomalies
4) echogenic intracardiac
5) defn of Meckel Gruber (not in dd of increased nuchal translucency, but has dysplastic cystic kidneys, postaxial polydactyly, encephlocele and other cns problems like holoprosencephaly]
b. trisomy 18 (edwards): clenched fists with overlapping digits, choroid plexus cysts, cardiac problems, strawberry skull, low afp, bhcg, estriol
c. trisomy 21 (downs)
B. Nuchal thickness
1. > 6mm at 18-22w
2. dd: trisomy, 13, 18, 21, turner's
Term
284
sacral mass
A. dd
B. sacrococcygeal teratoma
1. types
2. type that has the worst prognosis
3. what features make the prognosis worse? why? how can the teratoma affect the fetus, mother?
C. explain open and closed neural tube defects
D. myelomeningocele associated with?
Definition
A. dd
1. sacrococcygeal teratoma
2. myelomeningocele, myelocele, meningocele
3. rhabdomyosarcoma
4. duplication cyst
B. sacrococcygeal teratoma
1. types of sacrococcygeal teratoma: I-IV. I is external and IV is intrapelvic.
2. type that has the worst prognosis: type IV (intrapelvic)
3. if large and solid (as opposed to small and cystic), can get AV shunting
a. fetus: hydrops fetalis
b. mother: "mirror" syndrome: mother has edema
C. neural tube defects
1. closed:
a. myelomeningocele: placode beyond skin surface
b. myelocele: placode flush with skin surface
c. meningocele: csf filled sac
2. closed: sub q fat extension into spinal cord
a lipomyelomeningocele: placode-lipoma interface outside of spinal canal
b. lipomyelocele: placode-lipoma interface within spinal canal
D. myelomeningocele associated with Chiari II malformation
Term
285
posterior fossa malformation
dd and characteristics
Definition
1. Chiari malformation: cerebellar tonsils greater than 5 mm below the foramen magnum. both can have hydrocephalus though hydrocephalus more associated with chiari II malfn.
a. Chiari I malformation: associated with syrinx 25% of the time
b. Chiari I malformation: associated with myelomeningocele almost 100% of the time. other characteristics
1) tectal beaking
2) enlarged massa intermedia
3) elongated cerebellar tonsils
4) elongated 4th ventricle
5) clival scalloping
6) absent corpus callosum
7) luckenschadel skull (lacunar skull)
8) cervical medullary kinking
9) myelomeningocele.
10) cerebellum is towering through the incisura
11) US findings:
a) lemon sign: indentation of the frontal bones (nonspecific)
b) banana sign: cerebellar tonsils wrapped around brainstem

2. Dandy Walker malformation
a. enlarged posterior fossa cyst with communication with the 4th ventricle
b. aplasia or hypoplasia or the cerebellar vermis: cause of problem
c. enlargement of the posterior fossa
d. torcular-lambdoid (torcula is the confluence of the superior sagittal, transverse, straight and occipital sinus; lambdoid refers to lambdoid suture) inversion
e. Dandy Walker variant looks like Dandy Walker malformation except that variant has normal sized posterior fossa

3. Joubert Syndrome
a. aplasia or hypoplasia of the cerebellar vermis
b. elongation of superior cerebellar peduncles
c. increased depth of the interpeduncular fossa
d. signs:
1) molar tooth sign: from elongation of the superior cerebellar peduncles and increased depth of the interpenducular fossa
2) batwing sign: batwing shape to the 4th ventricle
Term
286 Hyperechoic thoracic mass
Definition
1. congenital pulmonary airway malformation
a. types
1) I: cysts > 2 cm
2) II: cysts < 2 cm
3) III: microscopic cysts (appears solid)
b. prognosis of CPAM: may enlarge or decrease in size in 3rd trimester

2. sequestration
a. types of sequestration: systemic arterial supply (look for systemic feeding artery). usually no communication with tracheobronchial tree.
1) intralobar: doesn't have own pleural covering. drains through pulmonary venous circulation. not associated with extra anomalies. less common.
2) extralobar: own pleural covering. drains through systemic venous circulation. associated with other anomalies. more common.

3. congenital lobar emphysema:
a. associated with bronchial atresia
b. ball valve phenomenon in bronchus.
c. appearance:
1) opacified with fetal lung fluid at birth
2) becomes more lucent with air later

4. congenital diaphragmatic hernia
a. congenital diaphragmatic hernia most commonly on left side
Term
287
types of twins
Definition
1. dichorionic/diamnionic twin pregnancy:
a. 2 chorions, 2 amnions, 1 or 2 placentas
b. membrane separating the twin fetuses => 2 mm
c. signs: lambda sign or twin peaks sign
d. most common type of twin pregnancy is dichorionic diamnionic (80%)

2. monochorionic/diamnionic twin pregnancy. 1 chorion. 2 amnions. 1 placenta.
a. membrane separating the twins < 2mm
b. risk of
1) twin twin transfusion syndrome: 20% difference in estimated fetal weight.
a) recipient twin is large for dates, polyhydramnios and large cord.
b) donor twin is small for dates, oligohydramnios and small cord (may be stuck twin).
c) TTTS can be associated with twin embolization syndrome (the surviving twin has anomalies likely due to hypoperfusion not embolization)
2) twin reversed arterial perfusion (TRAP): pump twin pumps its deoxygenated blood to the acardiac twin via the acardiac twin's umbilical artery (not correct direction)
a) pump twin can die from high output state and then hydrops.
b) acardiac twin: selective perfusion of lower extremities

c. physiology in fetus
1) umbilical artery goes around the fetal bladder: carries deoxygenated blood away from fetus.
2) umbilical vein carries oxygenated blood to the fetus.
3. monochorionic/monoamnionic twin pregnancy: 1 chorion, 1 amnion. 1 placenta. membrane between fetuses < 2mm. risk of cord entanglement. 40% survival rate.
Term
asymmetric fetal size
Definition
1. twin twin transfusion syndrome
2. fetal demise: absolute signs are lack of cardiac activity and absence of movement.
3. normal variation: there can normal variation between fraternal and identical twins
Term
enlarged bladder (megacystis)
A. defn megacystis
B. should see bladder by
C. dd
Definition
A. defn megacystis:
2nd trimester bladder > 3 cm
3rd trimester bladder > 6 cm

B. should see bladder by 9-10 wks

C. dd

1. posterior urethral valves. in males.

2. prune belly syndrome. in males.
a. abdominal wall defect
b. GU anomalies
c. cryptoorchidism (undescended testes)

3. megacystis microcolon-intestinal hypoperistalsis syndrome: form of neuropathy or myopathy. more in females.

4. marked vesicoureteral reflux. can have megacystis. more in females.
Term
umbilical cord abnormality
Definition
1. two vessel cord: associated with fetal anomalies and growth restriction. if there is 3 vessels near fetus then it is considered normal.
2. cord hematoma: anywhere. may be iatrogenic, associated with 50% risk of fetal demise.
3. cord hemangioma: near placenta. can cause hemorrhage and jeopardize fetal blood flow.
a. a chorioangioma is a hemangioma occurring within villi
b. most chorioangiomas cause no fetal problems, but can be associated with high output cardiac failure in the fetus due to AV anastomosis.
4. umbilical cord varix: anywhere. focal dilatation of the umbilical vein. (possibly cause a vascular steal phenomenon). can thrombose and cause fetal demise.
5. Wharton jelly cyst: thickening of wharton's jelly near fetus. associated with omphaloceles.
Term
"double "bubble" sign
Definition
1. congenital duodenal obstruction (duodenal atresia/stenosis) due to failure of recanalization of bowel (in contrast jejunal and ileal atresia is due to vascular insult). associated with down's syndrome.

2. annular pancreas: pancreatic tissue surrounds the 2nd portion of the duodenum.

3. intestinal malrotation with volvulus
Term
292
hyperechoic intracardiac focus
Definition
1. trisomy 13 and 21
1. echogenic intracardiac focus/papillary muscle calcification: calcification of the papillary muscle usually in the left ventricle. associated with trisomy 13 (patau) and 21 (down's)

2. teratoma: 3 layers.

3. hemangioma: most likely in the RA.

4. rhabdomyoma. interventricular septum. associated with tuberous sclerosis.

5. myxoma: likely location attached to septum in the left atrium

6. fibroma: low T2. arise in septum or left ventricular free wall
Term
293
CNS ventriculomegaly
Definition
1. ventriculomegaly
a. defn: lateral ventricle > 10 mm at the level of the atria
b. can be idiopathic.
c. measure with "cross" not "x" calipers
2. congenital aqueductal stenosis
a. can be due to web/septations, infection, hemorrhage
b. cerebral aqueduct is between 3rd and 4th ventricles.
3. Arnold Chiari malformation: cerebellar tonsils greater than 5 mm below the foramen magnum. both can have hydrocephalus through hydrocephalus more associated with chiari II malfn.
a. Chiari I malformation: associated with syrinx 25% of the time.
b. Chiari II malformation: associated with myelomeningocele almost 100% of the time. other characteristics
1) tectal beaking
2) enlarged massa intermedia
3) elongated cerebellar tonsils
4) elongated 4th ventricle
5) clival scalloping
6) absent corpus callosum
7) luckenschadel skull (lacunar skull)
8) cervical medullary kinking
9) myelomeningocele.
10) cerebellum towering through the widened incisura
11) US findings:
a) lemon sign: indentation of the frontal bones (nonspecific)
b) banana sign: cerebellar tonsils wrapped around medulla
10) hydrocephalus can be seen also
4. other dx that can be associated with hydrocephalus
a. agenesis of the corpus callosum
b. Dandy Walker malformation
1) enlarged posterior fossa cyst with communication with the 4th ventricle
2) aplasia or hypoplasia or the cerebellar vermis
3) enlargement of the posterior fossa
4) torcular-lambdoid (torcula is the confluence of the superior sagittal, transverse, straight and occipital sinus; lambdoid refers to lambdoid suture) inversion
5) Walker variant looks like Dandy Walker malformation except that variant has normal sized posterior fossa.
6. holoprosencephaly can look like hydrocephalus
a. alobar: thalami are fused. monoventricle.
b. semilobar: thalami are fused or partially fused.
c. lobar: thalami are not fused. falx present.
7. communicating hydrocephalus e.g. prior hemorrhage.
Term
Cardiac outflow anomalies
Definition
1. transposition of the great arteries
a. types
1) D type: more common. aorta is right and anterior to pulmonary trunk. ventriculoarterial discordance.
2) L type: less common. aorta is left and anterior to the pulmonary trunk. both ventriculoarterial and atrioventricular discordance.
b. tx: arterial switch procedures.
2. truncus arteriosus
a. types:
I: common trunk
II: pulmonary arteries coming off trunk posteriorly
III: pulmonary arteries coming off trunk laterally
IV: pseudotruncus: collateral systemic vessels from supply the lungs esp from the descending aorta.
b. associated with right aortic arch, vsd, DiGeorge's syndrome (absent thymus and parathyroid glands)
3. tetralogy of fallot:
a. rvh, overriding aorta, pulmonary stenosis, vsd.
b. pentology of fallot: tetrology and asd.
4. double outlet right ventricle
5. hypoplastic left heart syndrome
Term
cystic posterior neck mass
Definition
1. cystic hygroma: associated with Turner's syndrome and 13(patau), 18 (edwards), 21 (downs)
2. occipital encephalocele (brain)/cervical myelomeningoele
[review:
a. closed spinal dysraphism
1) meningocele: csf filled sac
2) myelomeningocele: protrudes beyond skin surface
3) myelocele: flush with skin surface
d. open spinal dysraphism
1) lipomyelomeningoele: outside of spinal canal
2) lipomyelocele: within spinal canal.]
3. cystic teratoma: 3 germ cell layers
Term
A. enlarged hyperechoic kidneys in fetus
1. autosomal recessive polycystic kidney disease
a. the cysts are ___ so appear ___
b. associated with _____ in an ____ manner
c. US appearance
1) usual appearance
2) other US appearance
2. trisomy 13
a. associated with
b. aka
3. Meckel Gruber syndrome
a. what is the triad?
b. how dx?
4. autosomal dominant polycystic kidney dz (adpkd)
a. associated with
b. US characteristics they can have
B. dd for cystic kidneys in adult
Definition
A.
1. autosomal recessive polycystic kidney disease
a. the cysts in ARPKD are small so appear solid
b. ARPKD are associated with liver fibrosis in an inverse manner (the more the kidney is affected the less the liver is affected)
c. US appearance of ARPKD:
1) usual appearance of ARPKD: enlarged hyperechoic kidneys
2) other US appearance: sometimes the medullary pyramids are hyperechoic and the renal cortex is hypoechoic
2. trisomy 13:
a. trisomy 13 associated with
1) hyperechoic enlarged kidneys
2) post axial polydactyly (extra digits beyond the 5th digit)
3) holoprosencephaly
4) cardiac defects especially intracardiac echogenic focus
b. aka Patau syndrome
3. meckel gruber syndrome
a. triad
1) dysplastic cystic kidneys (cysts can be small and look solid or large and appear cystic)
2) post axial polydactyly
3) encephalocele or other CNS abnormality like holoprosencephaly
b. if 2/3 of the Meckel Gruber triad then diagnostic of Meckel Gruber syndrome
4. autosomal dominant polycystic kidney disease
a. 1)ADPKD is associated with 2) htn 3)liver cysts, 4) pancreatic cysts, 5) berry aneurysms, 6) colonic diverticulosis, 7)mitral valve prolapse)
b. ADPKD can also have
1) solid clot within a cyst
2) ring down artifact from precipitated crystals
B. dd for cystic kidneys in adult
1. ADPKD
2. ARPKD
3. multiple renal cysts
4. acquired cystic kidney disease
5. VHL (renal cysts, RCC, pancreatic cysts, pheochromocytoma, islet cell tumors, liver cysts, hemangioblastomas of the retina and cerebellum)
Term
oligohydramnios: defn, causes ____, manifests after ___wks
Definition
Defn of oligohydramnios: < 5 cm amniotic fluid index and maximum vertical pocket of 1-2 cm. causes hypoplasia of the lungs, manifests after 16 w. mneumonic DRIPP (demise, renal anomalies, iugr, prom, post dates)
1. bilateral renal failure/outlet obstruction
2. intrauterine growth restriction due to decreased perfusion which also decreases perfusion of the kidneys and thus decreased urine output
3. fetal demise causes decrease in size of gestational sac as no amniotic fluid is produced
4. premature rupture of membranes
5. post dates
Term
polyhydramnios: defn
Definition
Defn of polyhydramnio: > 25 cm amniotic fluid index or maximum vertical pocket of > 8 cm.
1. fetal gi anomalies usually proximal to colon where water absorption occurs (esophageal atresia, duodenal atresia, jejunal and ileal atresia).
2. fetal cns anomalies due to decreased swallowing
3.maternal diabetes due to hyperglycemia
4. idiopathic polyhydramnios: in non diabetic mother, should be closely followed. considered benign condition if other causes are ruled out.
5. fetal hydrops:
a. 2 cavities are affected (placenta, body wall edema, pleural effusions, pericardial effusions, ascites)
b. can also have polyhydramnios
c. due to
1) non immune hydrops: chromosomal anomalies, cardiac anomalies, infection
2) immune hydrops: Rh- mother and Rh+ fetus due to immune incompatibility.
Term
299
placental location abnormality
Definition
1. placenta previa
a. complete: completely covering the internal os
b. partial: partially covering the internal os
c. marginal: at the margin of the internal os
d. low lying: within 2 cm of the internal os

2. placenta accreta/increta/percreta: if have placenta previa, check for placenta accreta/increta/percreta (association)
a. normal myometrium on MR, middle iso intense layer with two thin low intensity layers on either side.
a. on us, normal myometrium is hypo-echoic. if thinning of myometrium (appeared hyperechoic instead of hypoechoic region in one statdx image), vascularity extending into myometrium, lacunae (irregularly shaped vascular spaces) in placenta, lacunae with turbulent flow then may have placenta accreta.
a. accreta: adherent to the myometrium
b. increta: within the myometrium, but not involving serosa
c. percreta: invasion through myometrium involving the serosa

3. velamentous insertion of the cord: cord inserts on fetal membranes. if the fetal vessels cross cervix before inserting on placenta then it is called vasa previa.

4. marginal insertion of the cord: cord insertion onto placenta within 2 cm of placental edge. likely not associated with IUGR.
Term
300
abdominal wall defect
Definition
1. omphalocele: midline, has covering, associated with other anomalies, umbilical cord arises from omphalocele. mortality higher than those with gastrochisis.

a. OEIS: omphalocele, bladder extrophy, imperforate anus, spinal anomalies.
b. Beckwith-Wiedemann syndrome: macroglossia, polyhydramnios, hemihypertrophy, hepatomegaly, nephromegaly, omphalocele.
c. Pentology of Cantrell: supraumbilical midline abdominal wall defect (with omphalocele), defect in the inferior sternum, defect in the diaphragmatic pericardium, anterior diaphagmatic hernia, cardiac anomalies.

2. gastroschisis: usually right of midline, no covering, not associated with other anomalies, umbilical cord arises separate from gastrochisis, lower mortality than omphalocele.

3. limb-body wall complex: short umbilical cord, herniated abdominal viscera (omphalocele), scoliosis, craniofacial defect, limb anomalies

4. Bladder extrophy: extrophy of bladder through abdominal wall defect

5. cloacal exstrophy: extrophy of bladder and bowel through abdominal wall defect
Term
301
cranial/calvarial defect
Definition
1. anencephaly: associated with elevated alpha fetoprotein, can have angiomatous stroma (tissue located above the orbits). diagnose after 11 wks when normal cranial ossification should be present.
a. anencephaly: always has acalvaria (skull not present, but skull base present)
b. exencephaly: early manifestation of anencephaly
c. acalvaria: skull absent
d. acrania: skull and skull base absent
2. amniotic band syndrome: asymmetric calvarial defects
3. encephalocele: occipital in western hemiphere (southeast asians get frontal-ethmoidal)
4. myelomeningocele: can be cervical. lumbosacral is most common and associated with chiari II. malfn)
Term
diaphragm abnormality
Definition
1. congenital diaphragmatic hernia
a. Bochdalek: left and posterior
b. Morgagni: right and anterior
a. can cause lung hypoplasia
2. congenital pulmonary airway malformation
a. type I: > 2 cm
b. type II: < 2 cm
c. type III: microscopic cysts. appear solid.
3. diaphragmatic eventration: can look like congenital diaphragmatic hernia on certain cuts. hypoplasia of the diaphragm (usually right anterior).
4. sequestration: listed with this dd, but doesn't have cysts. systemic arterial supply
a. intralobar: pulmonary venous drainage. doesn't have own covering. not associated with extra anomalies.
b. extralobar. systemic venous drainage. has own covering. associated with extra anomalies.
Term
fetal hydrops
Definition
A. fetal hydrops
1. defn: need two components to diagnose fetal hydrops. placental enlargement, anasarca (body wall edema), pericardial effusion, pleural effusion, ascites. can cause "mirror" syndrome, which is pre-eclampsia/edema in mother.

A. non immune

1. cardiovascular anomalies: structural anomalies, arrhythmias, high output cardiac failure
2. chromosomal abnormalities
a. trisomy 13 (patau): bilateral echogenic nephromegaly, post axial polydactyly, holoprosencephaly with craniofacial anomalies, echogenic cardiac focus (down's also has echogenic cardiac focus).
b. trisomy 18 (edward's): choroid plexus cysts, clenched hands with overlapping digits)
c. trisomy 21 (downs): endocardial cushion defect, VSD, echogenic cardiac focus (patau also has this), duodenal atresia, esophageal atresia, omphalocele, echogenic bowel, renal pelviectasis
3. infection: bacterial, viral, parasitic (esp toxoplasmosis, syphyllis, cmv, parvovirus B19)

B. immune hydrops
1. Rh- mother. Rh+fetus. Rh incompatibility
Term
linear echoes wtihin amniotic fluid
Definition
1. amniotic band syndrome: only use "syndrome" if associated with congenital anomalies like limb constriction.
2. synechiae: due to uterine adhesions. may cause abnormal fetal lie.
3. chorioamniotic separation: normal prior to 16 weeks. if small, usually no effect on pregnancy.
4. hemorrhage: fibrin strands appear irregular (chorioamniotic separation appears more smooth as per me)
Term
placental abnromality/mass
Definition
1. placental hematoma: types
a. subchorionic: between uterine wall and chorion. if at the margin, called marginal subchorionic hemorrhage. if small, physiologic.
b. retroplacental: between placenta and uterine wall. if > 20 w and separation of placenta from uterine wall, placenta abruption.
c. subamniotic: between placenta and amnion.
d. preplacental: above placenta on side of umbilical cord.
2. placental venous lakes: hypoechoic lesions in the placenta. not associated with increased morbidity or mortality.
3. succenturiate lobe: mass of placental tissue located away from main placental tissue. associated with perinatal mortality. succenturiate means accessory.
4. circumvallate placenta: thickened chorioamniotic membranes at periphery of placenta. associated with perinatal mortality. vallate means ridge.
Term
choroid plexus cyst
Definition
1. incidental finding if normal triple screen and no other anomalies found
2. trisomy 18 (edwards): associated with choroid plexus cysts and clenched fists with overlapping digits.
3. trisomy 21 (downs): used to think that there was an association with downs, but actually no association between down's and choroid plexus cysts. (downs has echogenic bowel, esophageal atresia, duodenal atresia, omphalocele, endocardial cushion defect, vsd, echogenic cardiac focus (trisomy 13 also has echogenic cardiac focus), renal pelviectasis)
Term
ventricular septal defect
Definition
at minimum, should get 4 chamber view and view of ventricular outflow tracts. best time to image would be 18-22 weeks.
1. vsd. left to right shunt after birth.
2. endocardial cushion defect: associated with down's
3. normal foramen ovale allows the bypass of the lungs so that more oxygenated blood can get to the organs including the brain. (umbilical vein carried oxygenated blood to fetus and umbilical artery carries deoxygenated blood to the placenta)
Term
dd IUGR
Definition
IUGR
1 Symmetric: insult early in pregnancy. head and body equally affected. ~baby causes (chromosomal abnormalities in fetus, infection, drug toxicity). 10% of IUGR.
2. Asymmetric: insult later in pregnancy. body affected more than head. ~maternal and placental causes (smoking, htn, collagen vascular disease, dm, placenta previa, placental infarction), 90% of IUGR.
Term
dd ascites
Definition
1. fetal hydrops
2. GI: meconium peritonitis, volvulus, atresia, hepatitis, liver fibrosis, biliary atresia
3. GU: nephrotic syndrome, obstruction, ovarian cyst with torsion
Term
dd calcification in the mid abdomen
Definition
1. meconium peritonitis
2. liver calcifications, concerning and needs additional workup.
3. gallstones, rare
Term
pancreatic cancer classic appearance
Definition
1. dilated cbd and pancreatic duct
2. hypoechoic mass at head of the pancreas
Term
dd for retroperitoneal nodes
Definition
1. location: pericaval and periaortic
2. causes: lymphoma, testicular, renal, cervical, prostate ca
Term
cystic lesion in/near the pancreas
Definition
1. pseudocyst
2. serous (microcystic) or mucinous (macrocystic) neoplasm
3. pancreatic cysts associated with: ADPKD, VHL, cystic fibrosis
4. splenic A aneurysms
Term
dd cystic lesion in liver
Definition
1. liver cysts
2. liver cysts associated with ADPKD
3. Caroli's disease
4. von meyenburg complexes
5. cystic mets
6. cystic hcc
7. hydatid cysts from echinococcal infection (cyst with daughter cysts at periphery)
8. amebiasis
9. pyogenic cyst
10. and more
Term
315
Secondary pulmonary lobule
1. central:
2. peripheral
Definition
1. Central: pulmonary A, bronchiole
2. Peripheral: pulmonary V, lymphatics, connective tissue
Term
Causes of interlobular septal thickening
Definition
1. pulmonary edema
2. Lymphatic spread of tumor
Term
What is the XR correlate of interlobular thickening?
Definition
Kerley B lines
Term
If unilateral interlobular septal thickening, then think of
Definition
lymphangitic spread of tumor
Term
List of (idiopathic) Interstitial pna
Definition
1. UIP/IPF (usual interstitial pna/idiopathic pulmonary fibrosis): subpleural honeycombing in lower lobes. dt collagen vascular dz, drugs, asbestosis, hypersensitivity pneumonitis
2. NSIP (non specific interstitial pna). ggo sparing subpleural region in lower lobes. dt collagen vascular dz, drugs, idiopathic.
3. OP (organizing Pna) aka BOOP, COP. Peribronchial and subpleural ggo/consolidation in lower lobes. "Reverse halo sign" or "Atoll sign" (eosinophilic pna has reverse batwing sign and also has chronic ggo or consolidation in upper lobes)
4. DIP (desquamative interstitial PNA-lower lobes and more severe) and RB ILD (respiratory bronchiolitis interstitial lung dz-upper lobes and less severe): ggo, which involves the subpleural region. related to smoking.
5. LIP (Lymphoid interstitial pna)
6. AIP (acute interstitial PNA)
Term
UIP: main CT characteristic and other two characteristics
Definition
1. subpleural honeycombing
2. Traction bronchiectasis
3. Reticulations
Term
Is UIP upper or lower lobe predominant?
Definition
Lower lobe predominant esp basal posterior segment
Term
mc cause of UIP
Definition
IPF
Term
Increased or decreased lung volumes in UIP
Definition
Decreased lung volumes in UIP
Term
A. Other causes of UIP (aka non-idiopathic causes of usual interstitial lung dz)
B. causes of NSIP
Definition
A.
1. collagen vascular disease: RA, scleroderma, sle
2. exposures: abestosis (esp if calcified pleural plaques), drug related fibrosis, hypersensitivity pneumonitis
B. causes of NSIP
a. collagen vascular disease: RA, scleroderma, SLE
b. drug reaction
c. idiopathic
Term
Prognosis of IPF
Definition
Poor
Term
Do you have to bx to dx IPF
Definition
No bx necessary if no other dz. If you suspect IPF on imaging then it is IPF
Term
UIP vs NSIP: Primary CT characteristic
Definition
U: honeycombing
N: ggo
Term
UIP vs NSIP: 2 other possible characteristics
Definition
1. reticulations
2. traction bronchiectasis
Term
UIP vs NSIP: less associated findings
Definition
U: ggo
N: honeycombing
Term
UIP vs NSIP: subpleural region involved?
Definition
U: yes
N: no
Term
UIP vs NSIP: prognosis?
Definition
U: poor
N: good
Term
UIP vs NSIP: upper or lower lobes
Definition
both lower lobes
Term
RB and DIP: stand for
Definition
RB: respiratory bronchiolitis. less severe.
DIP: desquamative interstitital pneumonia. more severe.
Term
RB and DIP: related to
Definition
smoking
Term
RB and DIP: spectrum of dz and upper/lower lobes
Definition
RB less severe than DIP
a. RB: upper lobes
b. DIP: lower lobes
Term
RB and DIP: CT findings
Definition
ggo with no subpleural sparing. (if there is subpleural sparing then think of NSIP)
Term
2 types of lung opacities
Definition
1. consolidation: obscures vessels
2. ggo: doesn't obscure vessels
Term
acute causes of consolidation and ggo
Definition
1. pneumonia (ggo may be caused by atypical pna e.g. viral and pcp)
2. edema
3. hemorrhage
4. diffuse alveolar damage e.g. ARDS
Term
Chronic causes of lung consolidation
Definition
1. organizing pneumonia (OP): atoll sign or reverse halo sign. lower lobes. peribronchial and subpleural.
2. eosinophilic pna: reverse batwing appearance. upper lobes. spares the subpleural region
3. broncho alveolar carcinoma (adenocarcinoma in situ)
Term
Chronic causes of lung ggo
Definition
1. organizing pneumonia (OP)
2. eosinophilic pna
3. broncho alveolar carcinoma (adenocarcinoma in situ)
4. protein alveolar proteinosis, lipoid pna (both rare)
5. hypersensitivity pneumonitis
Term
Characteristic sign of OP and eosinophilic pna
Definition
1. OP: Reverse halo sign or "Atoll" sign: ggo surrounded by consolidation. lower lobes. affects peribronchial and subpleural region.
2. chronic eosinophilic pna: Reverse batwing appearance. upper lobes. spares the subpleural region.
Term
Characteristic location of OP and Eosinophilic pna
Definition
Central and peripheral consolidation aka peribronchial and subpleural
Term
What does the halo sign represent?
Definition
1. consolidation centrally and ggo peripherally.
2. can mean invasive pulonary aspergillosis, but non-specific
Term
Organizing pna in upper or lower lobes?
Chronic eosinophilic pna in upper or lower lobes?
Definition
1. organizing pna: lower lobes
2. chronic eosinophilic pna: upper lobes
Term
What is crazy paving?
Definition
interlobular thickening and ggo
Term
What does crazy paving mean?
Definition
Protein alveolar proteinosis (non-specific)
Term
Mosaic attenuation pattern
Definition
heterogeneous pattern of lung attenuation
Term
What sign is associated with hypersensitivity pneumonitis?
Definition
Head cheese sign (mosaic perfusion, ggo, normal lung and air trapping)
Term
Pulmonary nodule distribution patterns
Definition
1. perilymphatic: subpleural and non-uniform. silicosis, sarcoid, lymphangitis spread of tumor.
2. random: uniform. miliary TB, miliary fungal, mets.
3. centrilobular: sparing the pleural and uniform. infection (bronchiolitis, bronchopna), endobronchial spread of tumor/infection, hypersensitivity pneumonitis and vasculitis
Term
dd for perilymphatic distribution
Definition
sarcoid
silicosis
lymphagitic spread of tumor
Term
dd for random distribution
Definition
miliary TB
Miliary fungal
mets
Term
dd for centrilobular distribution
Definition
1. bronchiolitis
2. bronchopna
3. endobronchial spread of tumor e.g. BAC
4. endobronchial spread of infection e.g. TB or MAC
5. hypersensitivity pneumonitis
6. vasculitis
Term
2 signs related to sarcoid
Definition
1. 1-2-3-4 sign: R paratracheal, R hilar, L hilar, L aortopulmonary window nodes
2. Galaxy sign:upper lobe masses with surrrounding satellite nodules
Term
Silicosis looks like
Definition
Sarcoid
Term
How can you differentiate silicosis from sarcoid?
Definition
by history
Term
What do you call complicated silicosis?
Definition
Progressive massive fibrosis`
Term
dd of eggshell calcifications of LN
Definition
Sarcoid, pneumoconiosis (silicosis, coal worker's pneumoconiosis), TB
Term
What is tree in bud?
Definition
dilatation and impaction of centrilobular bronchioles
Term
When you see tree in bud, think of
Definition
infection
Term
Types of emphysema:
Definition
1. centrilobular
2. paraseptal
3. panlobular
Term
Types of emphysema: upper or lower lobes?
Definition
1. centrilobular: upper
2. paraseptal: upper
3. Panlobular: homogeneous or lower
Term
Types of emphysema: cause
Definition
1. centrilobular: smoking
2. paraseptal: smoking
3. panlobular: smoking or alpha 1 antitrypsin deficiency
Term
Types of emphysema: characteristics
Definition
1. centrilobular: no walls
2. paraseptal: no walls
3. panlobular: lungs are too big, too black and vessels too small
Term
EG vs LAM: associated with:
Definition
Langerhans: smoker
LAM: women of childbearing age and tuberous sclerosis
Term
Langerhans vs LAM: lobe affected
Definition
Langerhans histiocytosis:upper
LAM: upper and lower
Term
EG vs LAM: shape
Definition
Langerhans: irregular
LAM:round
Term
EG vs LAM: wall
Definition
Langerhans: thick
LAM: thin
Term
What kind of pleural effusion can LAM have?
Definition
chylous
Term
LAM vs LIP
Definition
LAM: many lung cysts
LIP: less than 12 lung cysts
Term
LIP stands for
Definition
Lymphocytic interstitial pna
Term
LIP can occur in
Definition
1. Young people with AIDS
2. Sjogren's syndrome
Term
aortic ectasia vs aneurysm
Definition
3.5 for aortic ectasia and 4.5 cm for aneurysm
Term
pulmonary htn
Definition
>= 3.0 cm
Term
if interatrial septum is thickened and fat attenuation
Definition
lipomatous hypertrophy of the interatrial septum
Term
Eisenmenger's physiology
Definition
A left to right shunt that turns into a right to left shunt.
Term
cor pulmonale
Definition
pulmonary hypertension secondary to chronic lung disease
Term
what is the most reliable imaging finding to differentiate a aneurysm from a pseudoaneurysm of the left ventricle
Definition
pseudo aneurysm will have a narrow neck/mouth
Term
pulmonary artery hypertension vs. pulmonary stenosis
Definition
1. pah: main and bilateral pulmonary arteries dilated
2. pulmonary stenosis: main and left pulmonary artery dilated.
Term
types of bronchiectasis
Definition
cvs
1. cylindrical: uniform. least severe.
2. varicose: "string of pearls"
3. saccular or cystic. marked dilatation. most severe.
Term
1. subpleural honeycombing. lower lobes
2. ggo which spares the periphery. lower lobes.
3. ggo. smoking related
4. chronic ggo or consolidation.
Definition
1. uip/ipf
2. nsip
3. rb (less severe-upper lobe, centrilobular) or dip (more severe-lower lobe, can extend into periphery)
4. op (lower lobes), chronic eosinophilic pna (upper lobes), bronchoalveolar carcinoma
Term
distribution
1. perilymphatic:
2. random
3. centrilobular
Definition
1. perilymphatic: sarcoid, silicosis, perilymphatic spread of tumor
2. random: miliary fungal, miliary tb, mets
3. centrilobular: bronchiolitis (like tb or MAI), endobronchial spread of tumor, hypersensitivity pneumonitis, vasculitis
Term
lung neoplasms and location
Definition
1. central: squamous cell carcinoma
2. peripheral: adenocarcinoma
Term
round pneumonia
1. age
2. because
Definition
1. age: < 8 years old
2. pores of Kohn and canals of Lambert
Term
pulmonary nodule with macroscopic fat and popcorn calcifications
Definition
hamartoma
Term
1. multiple AVMs
2. aka
3. tx
Definition
1. Osler Weber Rendu syndrome
2. hereditary hemorrhagic telangiectasias
3. tx: coils or detachable balloons
Term
dd multiple pulmonary nodules
Definition
1. mets
2. fungal/tb
3. septic emboli
4. Wegener's granulomatosis
5. rheumatoid nodules
Term
Wegener's granulomatosis:
1. what is it?
2. abnl lab value
3. affects
Definition
1. vasculitis
2. C-ANCA
3. sinus, lungs, kidneys
Term
cavitating pulmonary mass
Definition
1. tb
2. fungal disease
3. squamous cell cancer
4. septic emboli
5. Wegener disease
6. rheumatoid arthritis
Term
miliary pulmonary nodules
Definition
1. TB
2. fungal
3. mets
4. pneumoconiosis (silicosis and coal worker's pneumoconiosis-upper lobe)
5. healed varicella
Term
what is an advanced complication of silicosis
Definition
progressive massive fibrosis
Term
upper lobe dz:
lower lobe dz:
Definition
casset (cystic fibrosis, ankylosing spondylitis, silicosis, sarcoid, eg, tb)
badass (bronchiectasis, asbestosis, desquamative interstitial pneumonia/drugs/dermatomyositis, alpha 1 antitrypsin deficiency, sickle cell dz, scleroderma)
Term
dd cystic lung disease
Definition
1. emphysema
2. lymphangioleiomyomatosis (LAM)
3. pulmonary langerhans cell histiocytosis (eg)
4. pneumocystis pneumonia
5. lymhocytic interstitial pneumonitis (LIP)
Term
asbestosis vs asbestos related diseases
Definition
1. asbestosis: is an asbestos related disease with pulmonary fibrosis.
2. asbestos related diseases: round atelectasis is a common finding
Term
TB
1. primary
2. post primary
Definition
1. primary: usually lower lobe
2. post primary: usually upper lobe
Term
hyperlucent lung
Definition
1. chest wall abnormality like Poland syndrome (asymmetry of breast, hypoplasia/aplasia of pectoralis major muscle and associated with syndactyly)
2. Swyer James syndrome: developing lung is injured and abnormal airways remain open.
3. asthma
4. foreign body
5. pe if supine
6. ptx if supine
Term
hodgkins or non-hodgkins more common in thorax?
Definition
Hodgkins more common in thorax
Term
anterior, middle and posterior mediastinal mass
Definition
1. anterior: thymoma, thyroid lesion, teratoma (just say germ cell tumor) lymphoma
2. middle: lymph node, aortic vascular lesion, bronchogenic cyst, pericardial cyst, hiatal hernia.
3. posterior: neurogenic tumor (schwannoma, neurofibroma, neuroblastoma, ganglioneuroma), neuroenteric cyst, extramedullary hematopoiesis
Term
Do nodes enhance with sarcoid, Castleman's, TB?
Definition
yes
Term
when do you call an aneurysm of the thoracic aorta?
Definition
4 cm
Term
how can you tell if something is in the posterior mediastinum?
Definition
1. splaying of the ribs.
2. if above the clavicle , then probably in the posterior mediastinum or neck (cervicothoracic sign)
Term
if posterior mediastinal mass expands the neuroforamen
Definition
dumbbell shaped
Term
chronic air space disease
Definition
1. organizing pneumonia
2. chronic eosinophilic granuloma
3. bronchoalveolar carcinoma
Term
1. usually lower lobe and spares the subpleural space
2. usually upper lobe and reverse batwing appearance
Definition
1. organizing pna
2. chronic eosinophilic pna
Term
acute and chronic causes of ggo/consolidation
Definition
1. acute: pna, edema, hemorrhage, ARDS
2. chronic: organizing pneumonia, eosinophilic pna, bronchoalveolar carcinoma
Term
thoracic lymphoma
1. usually involves
2. calcifies?
3. Hodgkin's or non-Hodgkin's
Definition
1. usually involves the superior mediastinal nodes.
2. only calcifies after tx
3. Hodgkin's
Term
dd calcified pleural disease
Definition
1. asbestos related disease
2. fibrothorax:sequelae of pyothorax, hemothorax or pleural effusion.
3. talc pleurodesis: tx for recurrent pleural effusion and ptx
Term
dd bronchiectasis
Definition
1. infectious e.g. MAI (if in rml and lingula, think Lady Windermere's)
2. cystic fibrosis
3. allergic bronchopulmonary pna (ABPA)
4. endobronchial problem (mass, mucous)
5. Kartagener's syndrome (ciliary dyskinesia, sinusitis, bronchiectasis, infertility, situs inversus)
Term
allergic bronchopulmonary pneumonia
1. occurs more often in people with
2. appearance
Definition
1. asthma
2. finger in glove appearance (from mucous plugging). (can also be seen in bronchial atresia and cystic fibrosis among other things)
Term
Kartagener's syndrome
Definition
1. sinusitis
2. bronchiectasis
3. infertility
4. situs inversus
Term
Lady Windermere's syndrome
Definition
bronchiectasis in the rml and lingula
Term
What else can give a perilymphatic distribution besides sarcoid, silicosis (and coal worker's pneumoconiosis) and lymphangitic spread
Definition
lymphoproliferative disorder (lymphoma, post transplant lymphoproliferative disorder, LIP-lymphoid interstitial pneumonitis)
Term
what does asbestos related disease predispose to?
Definition
mesothelioma
Term
dd pleural based mass
Definition
1. metastasis
2. empyema
3. mesothelioma
4. solitary fibrous tumor of the pleural (hypoglycemia and hypertrophic arthropathy)
5. fibrothorax
Term
true vs false ventricular aneurysm
Definition
1. true: all 3 layers, medical mgt. wall is the LV.
2. false: not all 3 layers. surgery. wall if scar or pericardium.
Term
dd cardiac mass
Definition
1. thrombus
2. metastasis
3. benign (myxoma) or malignant tumor (sarcoma)
Term
mri
thrombus vs tumor/mets
Definition
thrombus doesn't enhance
tumor/met enhance
Term
1. mc location for myxoma
2. type of myxoma in kids
3. if multiple myxomas in kids
Definition
1. in left atrium attached to the interatrial septum.
2. type of myxoma in kids: rhabdomyoma
3. if multiple rhabdomyoma, tuberous sclerosis (tubers, angiomyolipoma, LAM, rhabdomyomas, subependymal giant cell astrocytoma)
Term
mc primary cardiac tumor
1. mc benign cardiac tumor
2. mc malignant cardiac tumor
Definition
1. benign: myxoma
2. malignant: sarcoma
Term
dd delayed myocardial enhancement
Definition
1. infarction: vascular distribution (subendocardial or transmural)
2. myocarditis: not a vascular distribution (midportion of the myocardium)
3. infiltrative disease: amyloidosis, sarcoid, lymphoma, glycogen storage disease
Term
cardiac wall fat dd
Definition
1. lipoma
2. lipomatous hypertrophy of the intra-atrial septum
3. arrhythmogenic right ventricular dysplasia:fibrofatty infiltration of the right ventricular myocardium
Term
stages of sarcoid (based on cxr not ct)
Definition
I. adenopathy
II. adenopathy and parenchymal disease
III. parenchymal disease only
IV. fibrosis
Term
MR viability study
A. measure at
B. when is myocardium considered viable?
C. which phase? high and low intensity means?
Definition
A. measure at end diastole
B. myocardium is viable (benefit from reperfusion) if
1. if myocardial wall (black) >= 5.5 cm
2. if myocardial wall (black)/total wall (black and white) > 50%
C. MR occurs delayed phase
1. high intensity (white): scar
2. low intensity (black): myocardial wall.
Term
lung cancer staging: 4 stages
1. surgery vs no surgery
2. What are the criteria for no surgery?
Definition
1. tx
a. surgery for stages I and II
b. no surgery for stages III and IV
2. criteria for no surgery: T3, N3 (these make it at least stage III)
a. tumor extending into chest wall, diaphragm, mediastinal fat, pericardium. T3
b. whole lung atelectasis. T3
c. < 2 cm from carina. T3
d. contralateral mediastinal lymph nodes. N3
e. ipsilateral scalene or supraclavicular LN. N3
Term
causes of gynecomastia
Definition
1. elevated estrogen levels
2. marijuana
3. liver disease
Term
What causes of a mass is not commonly found in men?
Definition
1. fibroadenoma
2. cyst
Term
Can a man with a palpable mass get assigned birads 3 on mammogram?
Definition
no, men don't get cysts or fibroadenomas so if they have a palpable mass, they need an ultrasound so that is a birads 0
Term
benign tumor more common in men than women
Definition
1. myofibroblastoma
2. granular cell tumor
Term
cc view
1. superior on film:
2. inferior on film:
Definition
1. superior on film: outer
2. inferior on film: inner
Term
birads category and likelihood of malignancy
http://www.ncbi.nlm.nih.gov/pubmed/19787181
Definition
1: 0%
2: 0%
3: 2%
4A: 2-10%
4B: 10-50%
4C: 50-95%
5: 95%
6: 100%
Term
typically benign calcifications
Definition
1. egg shell / rim: fat necrosis, lipid cyst or cyst
2. round, benign if diffuse / scattered
3. dystrophic
4. sutural
5. dermal or skin calcifications: spherical or polygonal with lucent center
6. coarse "popcorn-like": fibroadenoma
7. vascular: railroad track
8. milk of calcium
9. large rod like: secretory disease
Term
egg shell or rim calcification can be due to
Definition
1. cysts
2. oil cysts or lipid cysts
3. fat necrosis
Term
dystrophic calcifications
1. result from:
2. can be
Definition
1. prior surgery or radiation
2. bizarre
Term
what is milk of calcium cysts
Definition
calcium that sediments in the dependent portion of cysts
1. smudgy on CC
2. curvilinear on MLO
Term
secretory disease aka
Definition
1. plasma cell mastitis
2. mastitis obliterans
3. periductal mastiits
(calcification of inspissated material in benign duct ectasia)
Term
how to confirm calcification is in the dermis
Definition
tangential view
Term
if round calcifications under 0.5 mm then call it
Definition
punctate
Term
if punctate, clustered round calcs
1. not #2 below
2. new, increasing in #, linear or segmental, adjacent to known cancer
Definition
1. birads 3
2. birads 4A
Term
suspicious calcifications: (old term: intermediate risk)
Definition
1. amorphous / indistinct
2. coarse heterogeneous
Term
size of coarse hetergeneous calcifications
Definition
0.5-1 mm
Term
if amorphous / indistinct and
1. diffuse/scattered
2. regional, grouped/clustered, linear, segmental
Definition
1. usually b9
2. may warrant bx
Term
distribution modifiers
Definition
1. Diffuse or scattered: b9. throughout whole breast and maybe bilateral.
2. Regional: b9. in greater than 2cc of breast, but not in ductal distribution
3. grouped / clustered: can b benign or malignant. 5 calcs in 1 cm.
4. linear: malignant. in a line.
5. segmental: malignant. in ducts and branches
Term
What does grouped / clustered mean?
Definition
5 calcifications within 1 cm distance
Term
grouped / clustered can be
Definition
benign or malignant
Term
suspicious calcifications: higher risk
Definition
1. fine pleomorphic
2. fine linear or fine linear branching
Term
pleomorphic
Definition
1. varying in size and shape
2. higher risk of malignancy
Term
mass
Definition
1. seen on 2 projections.
2. convex outward
3. denser in center than periphery.
Term
mass and types of asymmetry, birads
Definition
1. mass: 2 views. convex outward
2. asymmetry: only on 1 projection. may be projectional. birads 1
3. focal: 2 projections. concave outward. less than 1 quadrant. birads 3.
4. global: 2 projections. concave outward, 1 quadrant or more. birads 2.
5. developing asymmetry: a focal asymmetry which is new, larger or more conspicuous. birads 4

http://radiographics.rsna.org/content/29/1/e33.long
Term
ultrasound descriptors
Definition
1. shape: oval (including macrolobulated-3 or less lobulations), round, irregular
2. orientation: parallel to skin (wider than tall) or not parallel to skin (taller than wide)
3. margins: circumscribed or not well-circumscribed (indistinct, microlobulated (more than 3 lobulations), angular, spiculated)
4. echo pattern (anechoic, hyperechoic, hypoechoic)
5. posterior acoustic features (none, enhancement, shadowing, combined)
6. calcifications: none or present
a. macrocalcifications
b. microcalcifications: in or outside of mass
Term
tissue composition on ultrasound
Definition
1. homogeneous:
a. mostly hypoechoic fat and hyperechoic connective tissue arcs (Cooper's ligaments)
b. mostly hyperechoic (fibroglandular) connective tissue and a thin layer of subcutaneous hypoechoic fat
2. heterogeneous
Term
another name for
1. parallel:
2. not parallel:
Definition
1. parallel: wider than tall. horizontal
2. not parallel:taller than wide. vertical
Term
is the round shape considered parallel or not parallel
Definition
not parallel
Term
What breast carcinoma is likely to present as a well circumscribed mass?
Definition
papillary carcinoma
Term
Which breast carcinoma usually has good prognosis
Definition
pure tubular carcinoma (the more the tubular components of the tubular carcinoma, the better the prognosis)
Term
breast mri enhancement patterns
A. initial
B. delayed
Definition
A: initial: slow, medium or fast (cancers usually have fast initial phase)
B. delayed:
type 1. persistent: benign. continuous increase
type 2. plateau: indeterminant. initial increase then flattening
type 3. washout: malignant. initial increased then decrease.
CANCER: fast on initial phase and washout on delayed phase.
Term
[image]
Definition
amorphous/indistinct distribution pattern
Term
[image]
Definition
grouped/clustered distribution pattern
Term
[image]
Definition
fine linear branching pattern
Term
[image]
Definition
pleomorphic
Term
[image]
Definition
segmental
Term
basic unit of the breast
Definition
lobule aka
terminal ductal lobular unit (tdlu)
1. terminal ducts: intraductal calcifications. suspicious for malignancy
2. acini: lobular calcifications. almost always benign
Term
architectural distortion
Definition
disruption of normal anatomic planes
Term
can fibroadenoma enhance on mri?
Definition
yes
Term
dd of fat containing masses on mammogram
Definition
1. hamartoma
2. galactocele
3. lymph node
4. lipoma
5. oil cyst or lipid cyst
6. fat necrosis.
Term
another name for hamartoma
Definition
fibroadenolipoma (FAL)
Term
variant that can be mistaken for a mass
Definition
sternalis muscle
Term
can sternalis muscle be unilateral?
Definition
yes
Term
ropelike density on mmg
Definition
superficial thrombophlebitis aka Mondor's disease
Term
superficial thrombophlebitis aka
Definition
Mondor's disease
Term
fat necrosis:
1. can fat necrosis enhance on mr?
2. what does fat necrosis typically look like on us
Definition
1. yes, fat necrosis can enhance on mr
2. fat necrosis is typically hyperechoic on us, but can be hypoechoic if inflammatory state
Term
what does duct ectasia look like on mr (t1 and t2)
Definition
both bright due to inspissated material
Term
dd for
1. unilateral skin thickening
2. bilateral skin thickening
Definition
1. unilateral: inflammatory breast cancer, chf, mastitis, radiation tx
2. bilateral:
a. chf
b. superior vena cava obstruction
c. bilateral lymphedema
d. psoriasis
e. renal failure and volume overload
Term
can chf affect the breast unilaterally?
Definition
yes
Term
A. implant rupture
1. intracapsular
2. extracapsular
B. radial fold
Definition
A. implant rupture can be intra or extracapsular depending on whether it is inside or outside the body's fibrous capsule.
a. intracapsular rupture: slicone still within body's fibrous capsule. silicone on both sides of the radial fold. linguini sign, noose sign, keyhole sign, teardrop sign, notch sign
b. extracapsular rupture: silicone outside of body's fibrous capsule.
B. radial fold is normal. it is just an infolding of the wall of the capsule encasing the silicone
Term
What does free silicone look like on us?
Definition
Hyperechoic margin with posterior echogenic noise ("snowstorm" pattern)
Term
1. curvilinear bands coursing across the inferior portions of both breasts
2. reduced glandular tissue
3. glandular tissue in the lower inner quadrant instead of the usual upper outer quadrants.
3. dystrophic calcifications
Definition
reduction mammoplasty
Term
1. can lymph node enhance on mri?
2. how can you distinguish pathologic from reactive lymph node
Definition
pathologic lymph has obliteration of fatty hilum.
Term
when is pectoralis muscle invasion suggested?
Definition
with enhancement of the muscle (not tenting)
Term
peau d'orange
Definition
inflammatory breast cancer
Term
what is inflammatory breast cancer
Definition
tumor emboli in the dermal lymphatics
Term
post radiation changes max post tx when?
Definition
6 months so do baseline post tx mmg at 6 m.
Term
hyperacute vs chronic clot on us
Definition
1. hyperacute: anechoic
2. chronic: hyperechoic
Term
tx for papilloma
Definition
excision cuz difficult to differentiate from papillary carcinoma
Term
radial scar
1. from trauma or surgery?
2. due to?
3. looks like
4. aka
5. benign or malignant?
6. palpable?
7. associated with
7. associated with atypia or malignancy?
Definition
1. not from trauma or surgery
2. due to slow infarction
3. black star on white background
4. aka complex sclerosing lesion
5. benign
6. usually not palpable
7. associated with atypia and malignancy (tubular carcinoma)
Term
pash
1. stands for
2. due to
Definition
1. pseudo angiomatous stromal hyperplasia
2. estrogen therapy
Term
1. breast asymmetry
2. aplasia or hypoplasia of the pectoralis major muscle
3. associated with syndactyly
Definition
Poland syndrome
Term
autosomal dominant
multiple oil cysts
Definition
steatocystoma multiplex
Term
how to evaluate positioning using posterior nipple line
Definition
the posterior nipple line on the MLO view should not be 1 cm more than the posterior nipple line on the CC view.
Term
how do you evaluate positioning on the mlo view?
Definition
posterior nipple line should intersect the pectoral muscle
Term
types of breast composition
Definition
1. Almost entirely fat (<25% glandular)
2. Scattered fibroglandular densities (25-50% glandular)
3. Heterogeneously dense (50-75% glandular)
4. Extremely dense (>75% glandular)
Term
How do you describe a mass?
Definition
1. Shape: round, oval, macrolobulated (3 or less lobulations), irregular
2. Margins: circumscribed, microlobulated (more than 3 lobulations), obscured, indistinct, spiculated
3. Density: High, equal, low, radiolucent (fat containing) compared to fibroglandular tissue
Asymmetry: asymmetry, focal, global, developing
Term
calcifications from fibrocystic changes can be
Definition
benign appearing or indeterminant
Term
"breast within a breast" appearance
Definition
hamartoma or fibroadenolipoma (FAL)
Term
does a lipoma calcify?
Definition
no
Term
oil cyst
Definition
focal fat necrosis
Term
what is fat necrosis?
Definition
intracellular fat escapes the damaged cells
body reacts by forming granulation tissue
Term
what cancer can kind of look like a cyst on ultrasound?
Definition
medullary carcinoma (hypoechoic with posterior shadowing)
Term
what breast lesion can be intraductal, intracystic or solid mass?
Definition
papilloma (need to excise because cannot distinguish from papillary carcinoma
Term
inflammatory breast cancer
1. etiology:
2. type of cancer:
3. usual tx:
4. presentation
Definition
1. etiololgy: invasion of the dermal lymphatics
2. type of cancer: can be ductal or lobular
3. usually tx with chemotx as usually advanced
4. presentation: peau d'orange
Term
Paget disease of the nipple
1. etiology
2. presentation
Definition
1. malignant cells travel to epidermis via the lactiferous ducts
2. ezcematoid skin changes of the nipple
Term
breast cancer:
1. well-circumscribed mass:
2. good prognosis:
3. can look like cyst (hypoechoic with posterior enhancement)
4. another name for colloid carcinoma:
4.5: high on T2
5. intraductal or intracystic or solid:
6. disproportionately represented in developing asymmetry
7. "shrinking breast" due to
8. can look like small spiculated mass, radial scar or architectural distortion
9. bilaterality highest with
Definition
1. well-circumscribed mass: papillary, medullary, mucinous/colloid, invasive ductal or dcis (mc), lymphoma, mets, [phylloides tumor (benign or malignant), sarcoma]
2. good prognosis: tubular cancer
3. can look like cyst: medullary cancer
4. another name for colloid carcinoma: mucinous carcinoma
4.5: high on T2: colloid/mucinous carcinoma
5. papillary carcinoma (cannot distinguish from papilloma)
6. invasive lobular carcinoma "single file" growth pattern
7. "shrinking" breast due to invasive lobular carcinoma
8. tubular carcinoma
9. bilaterality highest with invasive lobular cancer
Term
normal skin overlying breast should not be more than __mm
Definition
2 mm
Term
1. what % of breast cancers are in males?
2. what type of breast cancer occur in males?
Definition
1. 1%
2. ductal (no lobular cuz men don't have lobular (acini) differentiation)
Term
on an mlo and true lateral view, how can you tell if something is medial or lateral?
Definition
muffins rise and lead falls
1. if medial, the lesion will rise on the true lateral view
2. if lateral, the lesion will fall on the true lateral view
You can also use the same technique (rolled views) to check if something is superior or inferior on the mlo views.
Term
A. multifocal vs multicentric and tx
B. synchronous vs metachronous and bilaterality highest with what type of cancer?
Definition
A.
1. multifocal: in more than 1 quadrant. can't do lumpectomy.
2. multicentric: in only 1 quadrant. can do lumpectomy.
B. bilateral breast cancer. bilaterality highest with invasive lobular ca
1. synchronous: detected at same time
2. metachronous: detected at different times
Term
subtypes of dcis
Definition
comedo
cribiform
solid
micropapillary
Term
radiodensity in saline vs silicone implants on mmg
Definition
saline is less dense (blacker) than silicone (whiter)
Term
mc met to breast
Definition
melanoma
Term
% synchronous breast ca
Definition
1-2%
Term
daily
weekly
monthly
quarterly
Definition
daily: processor quality control
weekly: phantom images
monthly: visual checklist to assure xr equipment is optimal
quarterly: repeat analysis (determine cause of repeat exams) and analysis of fixer retention on film
semiannually: darkroom fog, screen-film contact, compression
Term
how often do you clean the screen?
Definition
weekly
Term
where does motion artifact most often occur? on what view?
Definition
inferior on MLO views
Term
weight loss can make the breast appear
Definition
denser
Term
what views can be used to evaluate a focal asymmetry
Definition
1. spot compression
2. rolled cc views
3. true lateral
Term
What can diabetics have that can mimic a neoplasm
Definition
diabetic mastopathy
Term
dd palpable solid mass in lactating female
Definition
1. fibroadenoma
2. lactating adenoma
3. galactocele
4. tubular adenoma (looks like fibroadenoma)
5. focal mastitis
6. normal breast tissue
7. cancer
Term
hypoechoic mass with thin neck that extends to the skin
Definition
benign sebaceous cyst
Term
treatment for phylloides tumor
1. surgery? margins? lymph node dissection?
2. radiation?
3. chemo?
Definition
1. wide excision with > 1 cm margins. don't need lymph node dissection
2. radiation may help.
3. chemo doesn't help.
Term
fibroadenoma vs complex fibroadenoma
1. risk of malignancy
2. tx
Definition
1. complex fibroadenoma has higher risk of malignancy than fibroadenoma.
2. However, complex fibroadenoma doesn't definitely need to be removed.
Term
what medication can result in fibroadenomas
Definition
cyclosporin A therapy for renal transplant
Term
dd for axillary lymph node
Definition
1. metastatic disease
2. lymphoma
3. granulomatous infection (e.g. sarcoid, TB)
4. collagen vascular disease (e.g. rheumatoid)
5. hyperplasia
6. infection
Term
If lymph node bx shows breast cancer and mmg negative then can do
Definition
mri
Term
1.mmg: focal asymmetry of mixed density
2.us: hyperechoic tracking along Cooper's ligaments
Definition
1. hematoma (should follow to resolution)
2. if doesn't go away then maybe cancer
Term
dd
bilateral breast masses
Definition
1. mets
2. lymphoma
3. fibroadenoma and papillomas can be multiple and bilateral
4. others that may simulate bilateral breast masses:
a. injection granulomas
b. neurofibromatosis
Term
if h/o trauma and you think something might be a hematoma as it has decreased in size
1. when follow up?
2. how long do you follow?
Definition
1. follow up 6-8 weeks
2. follow until resolution
Term
tiny opacities in the lymph nodes
Definition
1. granulomatous disease
2. gold therapy for rheumatoid arthritis
3. silicone from injections or implants
Term
which density masses are benign?
Definition
fat density and mixed density masses
Term
if you see density in the center of fat necrosis, it could be
Definition
hematoma
Term
if focal asymmetry
1. you should perform
2. if wu
a. negative
b. mass
3. compared to prior
a. if stable
b. if increasing in size
Definition
1. spot compression and US
2. if wu
a. negative: prob benign: birads 3
b. mass: birads 4
3. compared to prior
a. if stable, birads 2
b. if increasing in size, birads 4
Term
if core needle bx show atypia, then need
Definition
surgical excision
Term
what should the positive biopsy rate be for screening mammogram? (% of cancer out of all the screening biopsies)
Definition
30% of biopsies should be positive for cancer in a screening population.
Term
what is more likely to be benign on US
a. hypoechogenicity or
b. hyperechogenicity
Definition
hyperechogenicity
Term
in breast US
1. hyperechoic
2. hypoechoic
Definition
1. hyperechoic: tiny calcs not able to be seen on mmg
2. hypoechoic: fat
Term
what cuff is sometimes left in a patient after chemotx
Definition
Hickman catheter cuff
Term
when you see a 1st finding on mmg then
Definition
search for 2nd finding
Term
multiple defects on ductogram
Definition
papillomatosis
Term
definition circumscribed on US
1. has to be
2. not have
Definition
1. circumscribed at least 75% the way around
2. not microlobulated, obscured, indistinct or spiculated.
Term
giant fibroadenoma
1. defn
2. aka
3. tx
Definition
1. 500 g or just disproportionately large compared to breast.
2. juvenile fibroadenoma
3. excision
Term
what views do you use to check for milk of calcium
Definition
cc and lateral
Term
do saline implants have intra and extracapsular rupture?
Definition
no
Term
implants
1. saline
2. silicone
Definition
1. saline: whitish
2. silicone: white
Term
lactating adenoma
1. aka
2. looks like
3. hx
Definition
1. tubular adenoma
2. looks like fibroadenoma
3. lactating
Term
asymmetric breast tissue vs. focal asymmetry
Definition
1. asymmetric breast tissue: density that after workup, you are certain, it is normal breast tissue.
2. focal asymmetry: it persists on spot compression and if US is negative then it is birads 3.
Term
positioning for stereotactic biopsy
Definition
1. if anterior: upright
2. if posterior: prone
Term
eklund views
Definition
for breast with implants
Term
1. do u give contrast for breast mr
2. after surgery, what birads if everything looks normal.
3. what lesions do you have to re-biopsy (usually by surgical excision)?
Definition
1. you do give contrast for breast mri except in cases with silicone
2. after surgery, if everything looks normal, give birads 3 for 3-5 years (q 6 months for 1st year)
3. re-biopsy indicated for
a. atypical lesion
b.Papilloma > 1 cm or away from nipple
c. Radial scar (minority viewpoint: some say that if 11 g or less needle used and dx radial scar, don't need a re-bx)
d. Discordance: noncongruent imaging/pathology findings
Term
macrolobulated vs microlobulated
Definition
macrolobulated: large lobulations
microlobulated: each lobulation < 2 mm
Term
Benign liver lesions
Definition
1. Hemangioma
2. FNH
3. Adenoma
Term
What liver lesions have a central scar?
Definition
1. FNH: central scar is made up of vascular channels and ductules so high T2
2. FIbrolamellar HCC: central scar is low on T2
3. Large hemangioma: central scar can be fibrous or cystic. usually hemangioma high on T2
Term
Hemangioma
Definition
1. Interrupted peripheral nodular enhancement on arterial phase
2. Centripetal enhancement on delayed phase
Term
FNH vs Adenoma: Age
Definition
FNH: Young female
Adenoma: female on ocp and male on steroids or glycogen storage disease
Term
FNH vs Adenoma: enhancement
Definition
FNH: homogenous enhancement with central scar
Adenoma: variable enhancement dt fat and hemorrhage
Term
FNH vs adenoma: central scar
Definition
FNH: +central scar
Adenoma: no central scar
Term
Which is positive on sulfur colloid scan: fnh or adenoma or both?
Definition
55% of fnh are positive on sulfur colloid scan because of kuppfer cells
Term
Why do you want to differentiate FNH from adenoma?
Definition
Adenoma can hemorrhage and has malignant potential
Term
What are some cystic liver mets?
Definition
1. neuroendocrine tumors (islet cell tumors, carcinoid, pheochromocytoma)
2. adenocarcinoma from pancreas, colon or ovaries
Term
What are some cystic mets in M/F
Definition
male: head and neck
female: cervical
Term
Calcified mets
Definition
Serous ovarian cancer
Mucin producing colorectal cancer
Term
Hypervascular mets
Definition
CT MRIS
choriocarcinoma
thyroid
melanoma
renal cell
islet cell tumor and other neuroendocrine tumors like carcinoid, pheochromocytoma
sarcoma
Term
Suspect HCC in the setting of
Definition
1. Lesion > 2 cm
2. cirrhosis
3. Hep B infection
Term
Characteristics of HCC
on T2, vascularity, enhancement
Definition
1. High T2
2. hypervascular
3. enhance on arterial phase with quick washout
Term
Bland thrombus vs tumor thrombus
Definition
Bland thrombus: thrombus
Tumor thrombus: thrombus due to tumor
Term
Cholangiocarcinoma characteristic
Definition
1. infiltrative
2. tends to cause scarring: capsular retraction, biliary ductal dilatation, delayed enhancement
Term
What can predispose to cholangiocarcinoma?
Definition
1. Primary sclerosing cholangitis (PSC). Ulcerative colitis predisposes to PSC. PSC can lead to biliary cirrhosis. (primary biliary cirrhosis has increased antibody levels)
2. parasite (clonorchis sinensis)
3. Caroli's disease
Term
Cholangiocarcinoma that involves the hilum
Definition
Klatskin's tumor
Term
Cirrhosis usually affects
Definition
1. R hepatic lobe
2. Medial segment of the left hepatic lobe
Term
Cirrhosis with compensatory hypertrophy occurs in
Definition
1. Lateral segment of the left hepatic lobe
2. Caudate
Term
Regenerating nodules aka
Definition
siderotic nodules
Term
Regenerating nodules on ____MR sequence_____ due to _____artifact
Definition
gradient, blooms, susceptibility
Term
1. regenerating nodules on T2
2. Dysplastic nodules on T1
3. hcc and mets on t2
4. fibrosis on T2
Definition
1. regenerating nodules; Dark on T2 (iso or any on T1)
2. dysplastic nodules. usually not visualized on mr or ct (high on t1)
3. hcc and mets: bright on t2 (variable t1)
4. fibrosis bright on t2 (low t1)
http://www.ajronline.org/content/183/6/1595.full
Term
Can dysplastic nodules have cellular atypia?
Definition
y
Term
Causes of hepatic steatosis
Definition
1. obesity
2. pregnancy
3. etoh
4. tpn
Term
advanced liver fibrosis: T1 and T2
Definition
T1: low
T2: high

http://radiographics.rsna.org/content/29/6/1615.full
Term
1. How to diagnose hepatic steatosis on non con CT
2. How to diagnose hepatic steatosis on post con CT
3. How do you diagnose liver steatosis on MR?
Definition
1. > 10 HU reduction in the liver compared to the spleen
2. if liver enhances less than spinal muscles then steatosis
3. Signal loss on out of phase imaging
Term
Primary vs secondary hemochromatosis: etiology
Definition
P: hereditary; autosomal recessive
S: not hereditary; dt transfusions, dyserythropoesis
Term
Primary vs secondary hemochromatosis: physiology
Definition
P: too much absorption from GI tract
S: dietary Fe overload
Term
Primary vs secondary hemochromatosis: deposits in
Definition
p: liver hepatocytes, pancreas and skin (bronze diabetes), heart, musculoskeletal system
s: liver kupffer cells, spleen, BM
Term
Primary vs secondary hemochromatosis: toxicity
Definition
P: more toxic
S: less toxic
Term
dx of liver hemochromatosis on non contrast CT
Definition
HU > 80
Term
Causes of increased liver attenuation: dd
Definition
GI WATT
Gold therapy (for RA), Iron, Wilson's disease, amiodarone, thoratrast, Type IV glycogen storage disease
Term
How do you diagnose hemochromatosis?
Definition
biochemically
Term
What is Budd Chiari syndrome?
Definition
Hepatic vein thrombosis
Term
What are the findings of Budd Chiari syndrome due to
Definition
severe hepatic congestion
Term
What do you see in Budd chiari syndrome?
1. Portal venous phase:
2. Delayed phase:
Definition
1. Portal venous phase: central liver enh
2. Delayed: Peripheral liver enhancement
Term
What do you call collaterals in chronic portal vein thrombosis?
Definition
Cavernous transformation
Term
THAD stands for
Definition
Transient Hepatic Attenuation Difference
Term
What is THAD?
Definition
When the portal vein supply decreases, the hepatic artery supply increases
Term
What can THAD be due to?
Definition
1. portal vein thrombus
2. HCC
Term
What is the physiology of nutmeg liver
Definition
hepatic venous congestion
Term
What are the causes of nutmeg liver
Definition
1. Budd Chiari syndrome
2. R heart failure
3. constrictive pericarditis
Term
What enhances when there is Budd Chiari syndrome?
Definition
the caudate enhances normally because it has a separate draining vein
Term
Is hepatic infarction common?
Definition
No, hepatic infarction is rare
Term
What is the usual shape of hepatic infarction?
Definition
Wedge shaped, but changes in shape and size with time
Term
What is the usual etiology of hepatic infarction?
Definition
iatrogenic
Term
fibrolamellar carcinoma vs. fnh on mri T2
Definition
central scar on T2
1. fnh: high cuz vascular channels
2. fibrolamellar: low cuz fibrous?
Term
types of volvulus
Definition
1. organo-axial: axis of rotation around the gastro esophageal junction and pylorus
2. mesentero axial:axis of rotation around the gastrohepatic ligament
Term
Mirizzi syndrome
Definition
mass in cystic duct causes mass effect on the common hepatic duct
Term
medial vs lateral deviations of the ureters
Definition
1. medial: retroperitoneal fibrosis
2. lateral: lymphadenopathy/lymphoma, aortic aneurysm, retroperitoneal hematoma, pelvic mass
Term
Robson classification of renal cell carcinoma
Definition
I: confined by renal capsule
II: extends thru renal capsule. confined by Gerota's fascia. can involve ipsilateral adrenal gland, which is within Gerota's fascia
IIIA: renal vein or IVC
IIIB: regional lymph nodes > 1 cm
IIIC: both IIIA and IIIB
IVA: direct invasion of adjacent organs/structures
IVB: distant mets
Term
mucinous vs serous cystadenoma
Definition
1. mucinous: large size. smaller number (mother)
2. serous: small size. larger number. (small, serous benign) (grandmother)
Term
cystic lesions of the pancreas
1. if h/o pancreatitis
2. grandmother
3. mother
4. daughter
5. grandfather
6. pancreatic tumors with cystic degeneration
Definition
1. pseudocyst
2. serous cystic neoplasm: central calcs. small and many cysts. b9. can observe. in head. assoc with VHL (retinal and cerebellar hemangioblastomas, renal cysts, rcc, pancreatic cysts, pancreatic islet cell tumors, pheochromcytoma, liver cysts)
3. mucinous cystic neoplasm: peripheral calcs. larger and less number of cysts. malignant and malignant potential. need surgery. in tail
4. SAPEN (solid and papillary epithileal neoplasm): large. in tail. need surgery.
5. intraductal papillary mucinous neoplasm (males=female): main duct type (pancreatic duct is dilated), side branch type (bunch of grapes connected to pancreatic duct), mixed. malignant potential
6. pancreatic tumors with cystic degeneration: adenocarcinoma or neuroendocrine tumor
Term
amiodarone can cause
Definition
1. hyperdense liver
2. hyperdense lung infiltrates
3. interstitial lung disease
Term
nodular liver contour dd
Definition
1. cirrhosis: can have regenerating nodules (low T2) and primary/mets (high T2)
a. micronodular: alcohol
b. macronodular: hepatitis
2. treated mets: looks like macronodular cirrhosis. (pseudocirrhosis)
3. Budd Chiari syndrome: regenerating nodules
Term
dd for linitis plastica
Definition
1. gastric tumor
2. mets like from breast or lung
3. lymphoma
Term
esophageal diverticulum dd
Definition
1. Zenker's: midline, above the cricopharyngeus muscle (upper esophageal sphincter). in Killian's dehiscence
2. Killian James diverticulum: lateral. at the level of the cricopharyngeus muscle. in cervical esophagus.
3. Epiphrenic diverticulum: pulsion. distal esophagus
4. traction diverticulum. traction. mid esophagus
5. pseudodiverticulosis: dilatation of submucosal glands due to inflammation.
Term
hepatic abscess can be due to
Definition
1. bacteria (pyogenic abscess)
2. amoeba (amebic cyst)
3. echinococcal infection (hydatid cyst): can have daughter cysts
4. fungal infection (mycotic abscess)
Term
HU of liver cyst
Definition
-20 to +20
Term
what phase best to diagnose cholangiocarcinoma
Definition
delayed
Term
RUOQ cystic mass in child
Definition
1. choledochal cyst: types (I: mc. fusiform; II: diverticulum; III: choledochocele; IV: extrahepatic ductal dilatation; V: intrahepatic ductal dilatation or Caroli's disease.
2. GI duplication cyst
3. pancreatic pseudocyst
Term
todani classification of choledochal cysts
Definition
I. extrahepatic. single. fusiform dilatation. mc
II. extrahepatic. single. diverticulum.
III. extrahepatic. single. cholechocele
IV. extrahepatic. multiple (and also multiple intra and extrahepatic)
V. intrahepatic. multiple (or single). Caroli's disease
Term
dd esophageal submucosal masses/thickened folds
Definition
1. varices: changes with positioning. types:
a. uphill: distal esophagus. portal htn.
b. downhill: proximal esophagus. svc obstruction
2. reflux esophagitis
3. esophageal carcinoma
4. lymphoma
Term
esophageal dilatation
Definition
1. achalasia (smooth tapering "bird's beak")
2. scleroderma: patulous GE junction
3. gastric/esophageal cancer (irregular tapering, "shouldering" mass effect)
Term
achalasia caused by
Definition
1. Chagas disease
2. fungal infection
3. vagotomy
Term
dd esophageal pseudodiverticulosis
Definition
1. esophagitis (reflux, drug-induced)
2. candida infection
3. carcinoma (superficial spreading squamous cell carcinoma)
Term
esophageal ulcers
Definition
1. esophagitis (reflux, drug-induced, caustic)
2. viral esophagitis (herpes has small ulcers and CMV/HIV have large ulcers)
3. esophageal carcinoma
Term
solid pancreatic mass
Definition
1. adenocarcinoma: hypovascular
2. islet cell tumor: hypervascular
3. solid and papillary epithileal neoplasm (SPEN)
4. lymphoma
5. mets
Term
Zollinger Ellison syndrome associated with
Definition
gastrinoma
Term
MEN
Definition
I: pituitary tumor, parathyroid tumor, pancreatic islet cell tumor
IIA: medullary thyroid cancer, pheochromocytoma, parathyroid tumor
IIB: medullary thyroid, pheochromocytoma, neuroma
Term
A. 5 parts of the stomach
B. 4 parts of the duodenum
Definition
A.
1. cardia (near ge junction)
2. fundus (upper)
3. body (mid)
4. antrum (lower)
5. pylorus (near gastroduodenal junction)
c fb ap
B.
1st: duodenal bulb
2nd: descending
3rd: horizontal
4th: ascending
Term
dd gastric ulcer
Definition
1. peptic ulcer: extend beyond expected wall of esophagus. antrum.
2. gastric cancer ulcer does not extent beyond expected location of esophagus. antrum.
3. Zollinger Ellison syndrome: gastrinoma. ulcers beyond duodenal bulb.
4. lymphoma
5. mets
Term
dd gastric fold thickening
Definition
1. gastritis
2. gastric cancer
3. gastric metastasis
4. lymphoma
5. Menetrier's disease: hyperplastic hypersecretory gastropathy of uncertain etiology with increased risk of gastric cancer.
Term
Menetrier's disease
1. what is it?
2. cause?
3. risk of cancer?
Definition
1. hyperplastic hypersecretory gastropathy
2. uncertain etiology
3. increased risk of cancer
Term
RLQ mass dd
Definition
1. appendicitis
2. mucocele. if ruptures, can lead to pseudomyxoma peritonei
3. appendiceal/cecal carcinoma
4. lymphoma
5. adnexal mass
Term
pseudomyxoma peritonei
1. what is it?
2. common cause?
Definition
1. intraperitoneal gelatinous ascites
2. ruptured appendix mucocele
Term
mesenteric mass dd
Definition
1. metastatic disease
2. carcinoid (high activity on octreoscan)
3A. desmoid tumor: seen in those with Gardner's syndrome (familial adenomatous polyposis, cranial osteomas and desmoid tumor)
3B. fibrosing mesenteritis: pts don't have Gardner's syndrome, but has something that looks like desmoid tumor
4. lymph nodes: those with low attenuation lymph nodes (TB, MAI, Whipple's) or lymphoma
5. abdominal mesothelioma
Term
Gardner syndrome
Definition
1. familial adenomatous polyposis
2. desmoid tumors
3. cranial osteomas
Term
dd terminal ileal wall thickening
Definition
1. Crohn's disease (narrowing of terminal ileum)
2. "backwash" ileitis with UC (dilatation of the terminal ileum)
3. infection
a. like cambylobacter, salmonella, yersenia, TB (t syc)
b. if HIV, CMV or cryptosporidium
4. lymphoma
5. mets
6. ischemia (ileocecal branch of SMA)
Term
dd colonic wall thickening
Definition
1. diverticulitis
2. colon cancer
3. inflammatory bowel disease: UC or Crohn's
4. ischemia
Term
dd small bowel wall thickening
Definition
1. Crohn's disease
2. small bowel hemorrhage
3. lymphoma/mets
4. amyloidosis (can deposit amyloid in GI tract)
5. Whipple's disease (has low attenuation lymph nodes like in TB, MAI, Whipple's disease,)
Term
esophageal stricture dd
A. focal
B. diffuse
Definition
focal
1. reflux esophagitis
2. drug induced esophagitis
3. esophageal cancer
a. scc: mc. risk factors (smoking, alcohol, achalasia, caustic ingestion, plummer vinson syndrome)
b. adenocarcinoma from barrett's esophagus
B. Diffuse
5. NG tube
6. caustic esophagitis (usually alkaline substance)
7. radiation changes
Term
Risk factors for esophageal cancer (SCC)
Definition
1. smoking
2. alcohol
3. achalasia
4. caustic ingestion
5. Plummer Vinson syndrome
Term
Plummer Vinson syndrome
Definition
Plumber Vincent DIGS a hole for the iron pipe
Dysphagia from esophageal webs
Iron deficiency anemia
Glossitis
Squamous cell cancer
Term
Barrett's esophagus
Definition
Metaplasia
can lead to adenocarcinoma
Term
small bowel dilatation dd
Definition
1. small bowel obstruction (small bowel dilatation due to mechanical obstruction)
2. ileus (small bowel dilatation due to lack of peristalsis)
3. celiac sprue: improves on gluten free diet. "reversal of jejunal and ileal fold patterns". normally the jejunum is feathery (lots of folds). now the ileum is feathery
4. scleroderma: small bowel dilatation due to fibrosis in walls of small bowel. "hidebound bowel"
Term
multiple splenic nodules dd
Definition
1. mets/lymphoma
2. splenic abscesses
a. candida in immunocompromised
b. granulomatous disease (fungal, TB, sarcoid)
3. splenic infarcts
Term
remember to include in every dd if applicable
Definition
1. primary, mets, lymphoma
2. ischemia
3. crohn's or UC
Term
intrahepatic biliary strictures dd
Definition
1. primary sclerosing cholangitis
2. ascending cholangitis due to infection
3. AIDS cholangiopathy (caused by cryptosporidium or CMV)
4. cholangiocarcinoma or mets
5. post transplant arterial ischemia
Term
1. primary sclerosing cholangitis
2. primary biliary cirrhosis
Definition
1 primary sclerosing cholangitis: occurs more often in ulcerative colitis. can lead to cholangiocarcinoma.
2. primary biliary cirrhosis: bile duct destruction causes liver cirrhosis. AMA positive. Primary sclerosing cholangitis can lead to biliary cirrhosis.
Term
dd for liver HU > 80
Definition
GI WATT
gold therapy
iron deposition
wilson's disease
amiodarone
thoratrast
type I and IV glycogen storage disease (high T1) [Iron deposition has low T1 and low T2]
Term
esophagus lesions
1. esophagitis
a. reflux esophagitis
b. Barrett esophagus
c. Medication induced esophagitis
d. Crohn esophagitis
2. Strictures
a. benign:
1) reflux stricture
2) Barrett stricture
3) caustic stricture
4) radiation stricture
5) achalasia
6) blistering skin disorders
a. malignant
1) annular carcinoma
2) pseudoachalasia
3) lymphoma (extrinsic compression by adenopathy)
1. Diverticula
a. pharyngeal
a. Zenker
a. Killian-Jamieson
a. Mid-esophageal
a. epiphrenic
a. pseudodiverticulosis
1. filling defects
a. benign tumors
1) GIST
2) adenoma
3) inflammatory esophagogastric polyp
4) fibrovascular polyp
a. malignant tumors
1) carcinoma
2) mets
3) lymphoma
4) malignant GIST
5) spindle cell carcinoma
a. non neoplastic filling defects:
1) varices
2) esophageal duplication cyst
3) ectopic gastric mucosa
4) foreign body
Definition
esophagus lesions
1. esophagitis
a. reflux esophagitis: thickened folds, can cause benign appearing stricture (smooth) above GE jn
b. Barrett esophagus: leads to adenocarcinoma. can cause benign appearing stricture in mid esophagus.
c. Medication induced esophagitis: usually at arch or distal esophagus (where tablet gets stuck)
d. Crohn esophagitis: ulcers can occur.
e. infectious esophagitis:
1. candidiasis: plaquelike filling defects.
2. herpes: small
3. CMV and HIV: large


2. Strictures
a. benign: smooth, tapered margin
1) reflux stricture: just above GE junction. Zollinger Ellison syndrome (gastrinoma) can cause stricture)
2) Barrett stricture: mid esophagus
3) caustic stricture: usually long and narrow. can be due to prolonged NGT
4) radiation stricture: h/o radiation tx
5) achalasia: stricture opens transiently (pseudoachalasia has a fixed stricture). complication of achalasia: scc and candida infection
6) blistering skin disorders: can be due to epidermolysis bullosa dystrophica or benign mucous membrane pemphigoid
a. malignant stricture: irregular, abrupt margin
1) carcinoma: Shouldered margin
2) pseudoachalasia: looks like achalasia, but the stricture is fixed (in achalasia, the stricture will open)
3) lymphoma (extrinsic compression by adenopathy)

1. filling defects
a. benign tumors: smooth surface
1) GIST: submucosal/intramural. obtuse margins. dd: neuroma, fibroma, neurofibroma, lipoma, hemangioma. esophageal duplication cyst can have similar appearance (water attenuation on CT)
2) adenoma: resemble polyp
3) inflammatory esophago-gastric polyp: due to esophagitis
4) fibrovascular polyp: in cervical esophagus with thin stalk
a. malignant tumors: polypoid, irregular
1) carcinoma: scc is more proximal. Barrett is more distal. most adenocarcinomas are from Barrett
2) mets
3) lymphoma: may be primary or secondary in the esophagus
4) malignant GIST
5) spindle cell carcinoma: this is a carcinosarcoma
a. non neoplastic filling defects:
1) varices: serpentine. shape changes. dd: varicoid carcinoma.
2) ectopic gastric mucosa: 2 small filling defects in cervical esophagus.
3) foreign body
4) bronchopulmonary foregut malformation: esophageal duplication cyst, bronchogenic cyst, neuroenteric cyst (vertebral body anomalies)

1. Diverticula
a. pharyngeal: called pharnygeal pouches. usually lateral.
a. Zenker: posterior and above cricopharyngeus muscle. in killian triangle or killian's dehiscence.
a. Killian-Jamieson: lateral and below the cricopharyngeus muscle. in Killian Jamieson space.
a. Mid-esophageal: traction (granulomatous dz like TB) or pulsion (due to motor abnormalities)
a. epiphrenic: distal esophagus.
a. pseudodiverticulosis: usually due to chronic reflux. candida often cultured, but not causative factor.
Term
misc esophageal lesions
Definition
A. feline esophagus:
1. transient transverse fine folds
2. dd: normal or esophagitis.
B. rings
1. A ring: muscular. transient.
2. B ring (LES): Schatzki ring is a symptomatic narrowing of the B ring. if B ring < 10 mm, then pt likely to be symptomatic.
3. C ring: diaphramatic impression
4. between A and B ring: vestibule
5. between B and C ring: hiatal hernia
C. Aberrant R subclavain A: posterior to esophagus
D. scleroderma: aperistalsis of distal 2/3 of esophagus.
E. Glycogen acanthosis: elevated nodules in elderly pts
F. hiatal hernia: GE junction in thorax. 2 types: sliding and short (due to chronic reflux esophagitis).
G. paraesophageal hernia: GE junction in normal position. high incidence of incarceration so surgically fixed.
H. esophageal perforation: Iatrogenic (usually cervical) and Boerhaeve syndrome (from vomiting usually distal esophagus)
Term
esophagus
Definition
esophageal masses
1. intraluminal/mucosal: acute angles. filling defect. dd: papilloma, polyp (adenomatous, postinflammatory, giant fibrovascular), carcinoma
2. intramural/submucosal: obtuse angles. maintains mucosal pattern. leiomyoma, fibroma, lipoma, lymphoma, mets, GIST
3. extraluminal: obtuse angles, mass effect
Term
risk factors for esophageal cancer
Definition
risk factors for esophageal cancer: reflux, alcohol, caustics, achalasia, head and neck cancers
90% SCC and 10! adenocarcinoma (associated with Barrett's)
Term
pseudodiverticulosis: risk of
Definition
increased risk of candida and malignancy
Term
benign vs malignant gastric ulcers
Definition
1. benign: Hampton's line
2. malignant: Carman meniscus
Term
dd gastric fold thickening
Definition
ZE syndrome
Menetrier's disease
cancer, lymphoma, mets
etc.
Term
1. colonic interposition
2. thoratrast can cause
3. hemochromatosis
4. gallstones vs air
5. fnh vs fibrolamellar ca
6. hemangioma
7. multiple hemangiomas
8. pancreatic divisum
9. IPMN
10. psc: surveil
11. pancreatitis on MR
12. criteria for chemoembo of liver mets
Definition
1. colonic interposition: when you replace part of the esophagus with colon
2. thoratrast can cause: small spleen and angiosarcoma
3. hemochromatosis:
a. what sequences do you want to see? T1, T2, gradient
b. what do you compare the liver to? if liver less intense than the paraspinal muscle then possible hemochromatosis.
c. how do you quantify hemochromatosis? use gradient echo and spin echo sequences. measure signal intensity of liver compared to paraspinal muscle.
d. do you need to surveil hemochromatosis? yes, there is risk of hcc
4. what is dark on T2 in gallbladder? stones, air (?blooms on gradient and is non dependent). if what you think is air doesn't bloom then can do US.
5. fnh vs fibrolamellar ca: fnh is a stealth lesion (can't see well sometimes) and central scar is high on T2
6. hemangioma: peripheral nodular enhancement is like intensity of aorta
7. syndromes with multiple hemangiomas: Kasabach Merritt syndrome (hemangioma and thrombocytopenia), blue rubber bleb nevus syndrome (multiple GI hemangiomas)
8. pancreatic divisum: associated with recurrent pancreatitis or pancreatic stones
9. IPMN does not have calcs
10 Primary sclerosing cholangitis has risk for cholangiocarcinoma so should surveil.
11. pancreatitis on MR: pancreas becomes low T1 (don't see high T1 fat), flip flop enhancement (no arterial enhancement, only portal venous phase enhancement; normal pancreas will have arterial enhancement)
12. criteria for chemoembolization of liver mets (TACE-transcatheter arterial chemo embolization): ?1 lesions under 5 cm or 3 lesions = or < 3 cm.???
Term
diverticulosis vs. pseudodiverticuli
Definition
1. diverticulosis: mesenteric border
2. pseudodiverticuli/sacculations: antimesenteric border. can be from chronic inflammatory disease with fibrosis e.g. Crohn's and muscle atrophy e.g. scleroderma
Term
midgut vovulus
Definition
1. corkscrew pattern of jejunum in right or mid upper abdomen
1. SMV wraps around SMA in a clockwise fashion
Term
sb dilatation with normal folds
Definition
1. celiac sprue
2. scleroderma
3. obstruction
4. ileus
Term
what do you put in dd of crohn's?
Definition
TB
Term
ribbon bowel
Definition
graft vs host disease
Term
dd multiple colonic filling defects
Definition
multiple adenomas
polyposis
multiple adenocarcinomas
mets
lymphoma
ibd
pneumatosis (pneumatosis cystoides coli. can be dt ischemia)
lymphoid hyperplasia
infectious colitis: amebiasis, schistosomiasis
Term
1. pseudomyxoma peritonei
1. mesenteric tumors
1. toxic megacolon
Definition
1. pseudomyxoma peritonei: could be due to ruptured mucocele or mucinous tumor (appendix, ovary, pancreas)
1. mesenteric tumors: desmoid, carcinoid, lymphoma, mesothelioma, fibrosing mesenteritis (can look like tumor)
1. toxic megacolon: acute enlargement of colon. most common cause of toxic megacolon is ulcerative colitis
Term
mc cause of life threatening viral infection in HIV
Definition
CMV colitis
Term
dd colonic bowel wall thickening
Definition
1. colitis:
a. pseudomembranous colitis: "accordion sign". tx: abx
b. inflammatory: diverticulitis
1. tumor: primary, lymphoma, mets
1. ischemia
1. hemorrhage
Term
thumbprinting
Definition
marked submucosal edema. similar dd to colonic bowel wall thickening.
Term
cecal vs sigmoid volvulus
Definition
1. cecal: midline LUQ. younger pt
1. sigmoid: RUQ. coffee bean. older pt
tx: surgery
I still basically cannot tell the difference
Term
if see calcifications on abd xr, may be __
Definition
if see calcifications on xr, may be calcific mets (colorectal, stomach, ovarian, breast)
Term
retrorectal space should be
Definition
retrorectal space should be < 1 cm.
dd rectorectal space widening: tumor, duplication cyst, pelvic lipomatosis, and more
Term
1. premalignant tumor of biliary tract
2. can turn into
3. tx
4. appearance
Definition
1. biliary cystadenoma
2. biliary cystadenoma can turn into cystadenocarcinoma
3. tx: surgery
4. papillary projections and mural calcification
Term
if on angiogram, you are trying to see the portal vein, but instead see a collection of collateral vessels
Definition
portal vein thrombosis with cavernous transformation
Term
central dot sign
Definition
dilated biliary duct surrounds hepatic A and portal vein. Caroli's disease
Term
choledochol cyst
Definition
1. tx: resection
1. types:
I: fusiform dilatation. mc
II: diverticulum
III: choledochocele:
IVA: intra and extrahepatic cysts
IVB: extrahepatic cysts
V: intrahepatic cysts
Term
biliary strictures
1. benign
2. malignant
Definition
biliary strictures
1. benign: tapered narrowing. posttraumatic, inflammatory, hepatic artery embolization
2. malignant: abrupt narrowing. irregular margins. cholangiocarcinoma, pancreatic cancer, duodenual ampullary carcinoma, lymphoma, mets
Term
hyperplastic cholecystosis: benign non-inflammatory hyperplasia of gallbladder/bile duct wall. both types have thickened gallbladder walls
Definition
1. adenomyomatosis: hyperechoic foci with comet tail (aka ring down) artifact. Rokitansky Aschoff sinuses has crystals.
2. cholesterolosis: 2 types
a. planar: strawberry gallbladder (not seen on imaging)
b. cholesterol polyps: non dependent polyps. no shadowing. no comet tail artifact.
1) if < 10 mm follow up
2) if > 10 mm and suspicious features, can do CT or go straight to surgery.
Term
if gallbladder wall thickening, irregularity of wall then
Definition
gangrenous cholecystitis
Term
milk of calcium bile occurs in the setting of
Definition
chronic cholecystitis
Term
due to clonorchis sinensis and ascaris lumbricoides
Definition
recurrent pyogenic cholangitis
Term
gallstone ileus
Definition
Rigler triad
1. biliary air
2. ectopic gallstone usually at the terminal ileum
3. obstruction (ileus is misnomer)
Term
primary sclerosing cholangitis
1. tx
2. appearance on ercp
Definition
psc
1. palliative until transplant
2. tree in winter
Term
tx for klatskin tumor
Definition
tx for klatskin tumor: resection, stent, transplant
Term
tx for bile leak/biloma
Definition
abx, drainage, surgery for reconnecting anastomosis
Term
when give abx for procedures
Definition
biliary, renal, gyne drainage needs abx
Term
pyogenic cholangitis
1. due to
2. tx
Definition
1. due to gram negatives
2. tx: abx and decompression
Term
air in gallstone
Definition
mercedes benz sign (on xr: black mercedes sign in gallstone)
Term
1. criteria for liver chemoembo
2. air vs gallstones on T1
Definition
1. can do tace (trans arterial chemo embo) if no portal vein tumor thrombus, lesions < 3 cm or diffuse lesions
1. both air and gallstones are dark on T1 (if gallstones is calcific then dark on T1, but can be brighter on T1 if more cholesterol) and T2. air is nondependent and blooms on gradient. (air is dark on everything)
Term
sb dilatation
Definition
dd: SOS
scleroderma, sprue, obstruction
Term
ovarian dermoid cyst should have been called
Definition
mature cystic teratoma
Term
mature cystic teratoma layers
Definition
1. contains all 3 layers (endoderm, mesoderm, ectoderm)
2. a real dermoid only contains the epidermis (but the dermoid in the pelvis is really a teratoma cuz the pelvic dermoid has all 3 layers)
Term
Robson staging of renal cell carcinoma
Definition
I: confined to kidney
II: confined to gerota's fascia (confined to perinephric fat or involves ipsilateral adrenal gland)
III:
A. venous invasion (renal vein or IVC)
B. lymph nodes
C. both
IV:
A: direct extension into adjacent organs outside of Gerota's fascia
B. distant Mets
http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/RenalCellCarcinomaStaging.pdf
Term
What is the complication of angiomyolipoma?
Definition
hemorrhage
Term
What syndrome is associated with angiomyolipoma?
Definition
tuberous sclerosis (cardiac myxomas, cortical tubers, angiomyolipomas, lam, renal cysts, subependymal giant cell astrocytoma)
Term
Renal atrophy due to renal subcapsular hematoma
Definition
Page kidney
Term
Page kidney can cause
Definition
HTN
Term
nephrocalcinosis: cortex or medulla. dd?
Definition
1. cortical: acute tubular necrosis or chronic glomerulonephritis
2. medulla: medullary sponge kidney, RTA, type I, hyperparathyroidism, lasix in kids
Term
causes of papillary necrosis
Definition
postcard is mnemonic
pyelonephritis
obstruction
sickle cell dz
tb
cirrhosis
analgesics
renal vein thrombosis
diabetes
Term
mullerian duct anomalies
A. types
B. association with
Definition
A.
1. unicornuate
2. septate: < 1 cm uterine cleft. septation
3. bicornuate: > 1 cm uterine cleft. can have one (unicollis) or two cervices (bicollis). communication between uterine cavities.
4. didelphus: two cervices. no communication between uterine cavities
B. GU anomalies
Term
3 phases of enhancement in kidney
Definition
1. corticomedullary: (25-70 sec), cortex bright.
2. nephrographic (80-180 sec). contrast is in medulla. (best phase for detecting masses)
3. excretory: (> 3 min)
Term
if there is fat, is the signal loss on in phase or out of phase (opposed phase) imaging
Definition
out of phase (or opposed phase) imaging (te will be around 2 and you will see india ink)
Term
work up of adrenal lesion
Definition
1. if obvious fat: myelolipoma
2. if HU < 10: lipid rich adrenal adenoma
3. calculate relative washout: (enhanced-delayed)/enhanced
a. if > 40% then lipid poor adenoma
b. if < 40% then can do mr
3. in and out of phase imaging
a. if dropped signal on out of phase (or opposed phase) imaging then not tumor
b. if no dropped signal on out of phase imaging then tumor
Term
ureteral filling defects
Definition
1. transitional cell carcinoma: risk increases with smoking, aniline dyes, cyclophosamide.
2. malakoplakia (soft plaques due to infection with E coli in immunocompromised host).
3. pyeloureteritis cystica: due to chronic infection. no malignant potential.
4. radiolucent stones: uric acid, xanthine and indinavir
4. clot
5. fungal infection
6. mets
Term
1. low renal cortical intensity on T2
2. what does it look like on T1?
3. cause
Definition
1. paroxysmal nocturnal hemoglobinuria (dark colored urine in the morning due to hemoglobin)
2. low on T1
3. cause: predisposition of the red cell to hemolysis
Term
teratoma, endometrioma, vs hemorrhagic cyst
Definition
1. teratoma: high T1, fat sats out
2. endometrioma: high T1, does not fat sat out. enhances. has T2 shading. US: diffuse low level echoes. still present after 6-8 w.
3. hemorrhagic cyst: high T1, does not fat sat out. doesn't enhance. does not necessarily have T2 shading. US: lacelike appearance. disappears in 6-8w.
Term
adenomyosis
Definition
1. junctional zone >= 10 mm on T2 (dark area on T2)
2. hyperintense T2 foci on T2 in junctional zone
Term
A. Where would you see testicular tumors drain?
B. What is a burnt out germ cell tumor?
Definition
A. The lymphatic drainage follows the testicular veins
1. right: interaortocaval chain where right testicular vein enters the ivc.
2. left: left para aortic nodes inferior to the left renal hilum where the left testicular vein enters the left renal vein.
B. burnt out germ cell tumor: a germ cell tumor of the testicles that metastatsized (like to lymph node) and then regressed. you still have to biopsy the mets to figure out what it is.
Term
parts of the urethra from posterior to anterior
Definition
pm bp
1. prostate
2. membranous
3. bulbous
4. pendulous
Term
tx of renal angiomyolipoma
Definition
1. < 4 cm conservative mgt
2. > 4cm
a. if not bleeding: partial nephrectomy
b. if bleeding, coiling then partial nephrectomy when stable
Term
grading of vesico ureteral reflux
Definition
I: reflux to ureters
II: reflux to renal pelvis
III: mild blunting of the calyces.
IV: less dilated and tortuous
V: more dilated and tortuous
Term
hypervascular mets
Definition
ct mri
choriocarcinoma
thyroid
melanoma
renal
islet cell tumor
Term
extracorporal shock wave lithotripsy, best results with
Definition
1. calcium oxalate and uric acid stones < 2.5 cm.
Term
bosniak classifications of cysts
Definition
I: simple cyst
II: thin septa, fine calc, high attenuation uniform cysts
IIF: appears benign, but need fu
III: enhancing septa or walls
IV: enhancing solid component
Term
cervical cancer
Definition
high T2 in the region of the cervix compared to the uterus.
Term
hypoperfusion complex
Definition
1. enhancement and thickening of bowel walls
2. enhancement of adrenal glands and kidneys
3. small caliber ivc and aorta
Term
persistent nephrogram following prior contrast administration
Definition
acute tubular necrosis due to hypoperfusion (e.g. shock from contrast reaction or any other cause of hypoperfusion)
Term
brachytherapy (radiation seed placement) for prostate cancer
Definition
alternative to external beam radiation therapy or prostatectomy
Term
diverticula-like outpouchings in fallopian tubes
Definition
1. salpingitis isthmica nodosa
2. cause: unknown
3. usually h/o PID
4. usually associated with infertility, ectopic pregnancy
Term
incomplete development of a kidney (smaller kidney with fewer papillae and calyces, but normal function)
Definition
hypoplastic right kidney
Term
Renal TB
Definition
1. "putty kidney"
2. can have calcifications
Term
types of urachal anomalies
Definition
1. patent
2. sinus: near umbilicus
3. diverticulum: near bladder
4. cyst: in central portion of urachus
Term
cancer of the GU system
Definition
1. renal cell carcinoma
2. transitional cell carcinoma
3. scc: related to chronic infection/inflammation
4. adenocarcinoma: from urachal remnants. 70% associated with calcifications.
Term
hydrosalpinx
1. defn
2. appearance on US
3. causes
Definition
hydrosalpinx
1. defn: dilated fluid filled fallopian tubes > 4 mm
2. tubular structure with incomplete septations
3. due to obstruction due to PID, endometriosis (and tumor according to south alabama)
Term
struma ovarii
Definition
teratoma with > 50% thyroid tissue
Term
testicular tumors
Definition
1. germ cell tumor
a. seminomatous
b. non-seminomatous
1) choriocarcinoma: high bhcg
2) yolk sac tumor: high afp
3) embryonal cell tumor
4) teratoma: all 3 germ cell layers (dermoid in the ovary (aka mature teratoma) has more calc, more fat, teeth, hair. dermoid can have fat fluid level)
2. sex cord tumor: Sertoli cell tumor. Leydig cell tumor.
3. mets: kidney, prostate, lymphoma (mc > 60 y), leukemia
Term
intratesticular vs extratesticular masses
Definition
intratesticular masses are more likely to be malignant.
Term
hutch diverticulum
Definition
peri-ureteral diverticulum of the bladder
Term
1. multiple outpouchings in ureter. dx?
2. due to?
Definition
1. ureteral pseudodiverticulosis
2. probably due to hyperplastic response to stone, obstruction, inflammation, tcc
Term
1. staghorn calculi predispose to
2. tx for answer to #1
Definition
1. xgp (xanthogranulomatous pyelonephritis)
2. tx: partial or total nephrectomy
Term
1. outpouching of calyx into corticomedullary region
2. imaging
Definition
1. calyceal diverticululm
2. imaging may show filling on delayed imaging
Term
persistent connection of the scrotum to the peritoneum
Definition
patent processus vaginalis
Term
necrotizing fasciitis of the male perineum
Definition
Fournier's gangrene
Term
theca lutein cysts due to
Definition
theca lutein cysts due to
1. elevated b hcg
2. associated with hydatid mole, infertility treatment, multiple gestation, triploid fetus, immune hydrops
Term
malignant form of gestational trophoblastic disease
Definition
choriocarcinoma
Term
seminal vesicle cyst associated with
Definition
ipsilateral renal agenesis
Term
1 intrauterine synechiae or adhesions
2. T shaped uterine cavity: in utero DES exposure.
3. blood in the uterus and vagina
4. cystic lesions
a. perineum
b. vaginal wall
c. cervix
Definition
1. intrauterine synechiae: Asherman's syndrome
2. T shaped uterine cavity: in utero DES exposure. increased risk of clear cell carcinoma of the vagina
3. blood in the uterus and vagina: hematometrocolpos
4. cystic lesions
a. perineum: Bartholin's gland cyst
b. vaginal wall: Gartner's duct cyst
c. cervix: Nabothian's cysts
Term
two big dd for ureteral stricture
Definition
tb
schistosomiasis (eggs laid in bladder wall)
Term
acute hematoma
Definition
> 40 HU
Term
anatomy of the kidney and ureters
Definition
1. renal cortex
2. renal medulla (medullary pyramids)
3. renal papilla
4. calyces
5. renal pelvis
6. ureter
Term
branches of the renal artery
Definition
segmental, interlobar, arcuate (around renal medulla)
Term
pre medication for those "at risk" for anaphylatoid rxn
Definition
1. prednisone 50 mg 13, 7, 1 h prior to contrast
2. benadryl 50 mg IV, IM or PO 1h prior to contrast
Term
procedure for metformin and contrast
Definition
1. hold metformin before iodinated contrast
2. restart metformin after 48 hours if renal fn nl
Term
A. tx for contrast rxn
1. if minor
2. if extensive or increasing rxn
3. if severe rxn
B. tx bradycardia
Definition
A. tx for contrast rxn
1. if minor, benadryl
2. if extensive or increasing rxn, epinephrine 1:1,000 SQ (0.01 cc/kg)
3. if severe, epinephrine 1:10,000 IV (0.1 cc/kg), O2, IVF, corticosteroids, albuteral inhaler if bronchospasm
B. Atropine 0.02 mg/kg
Term
should use barium unless
Definition
1. suspected or potential bowel perforation
2. before surgical or endoscopic procedures
3. confirmation of percutaneously placed bowel catheters
Term
cervical cancer staging
1. amenable to surgery
2. not amenable to surgery
Definition
look on T2. cervical cancer is high on T2, normal cervix and vagina is low on T2. (on CT, cervical cancer is iso or hypoattenuating to normal cervix)
1. amenable to surgery:
IB: confined to cervix
IIA: extends to upper 2/3 of vagina
2. not amenable to surgery: IIB-IVB, if beyond cervix and extends to lower 1/3 of vagina.
Term
Pseudoaneurysm signs on us
Definition
1 yin yang
2 "to and fro" appearance. goes up then down.
Term
AVF on US sign
Definition
arterialized flow of the adjacent vein
Term
tx for pseudoaneurysm
Definition
1. US guided compression
2. US guided injection of thrombin
3. embolotherapy with coils only if narrow neck
4. stent if need to preserve flow
5. surgery as last resort
statdx
Term
Who are candidates for endovascular carotid stent placement (3 criteria)
Definition
1. greater than or = 70% stenosis
2. symptomatic
3. high risk surgical candidates for carotid endarterectomy (the surgical procedure)
Term
1. Who gets Fibromuscular dysplasia (FMD)?
2. mc subtype
3. classic appearance of this subtype
4. arteries most commonly involved and sequelae
5. tx
Definition
1. Young women
2. medial fibroplasia
3. string of beads
4.
a. renal: htn
b. carotid: cva
5. angioplasty
Term
Blue toes syndrome:
1. What is this?
2. angiogram is?
Definition
1. Distal embolization of small emboli e.g. cholesterol
2. normal
Term
Intimal hyperplasia:
1. What is this?
2. Can this occur in a stent?
Definition
1. Healing process continues past 3 m
2. yes
Term
AV fistula:
1. What is this?
2. US findings?
3. history?
Definition
1. Single communication between artery and vein
2. arterialization of the adjacent vein
3. trauma
Term
Kawasaki's disease
Definition
multiple coronoary aneurysms
Term
If you see focal stenosis in an unusual location, think of
Definition
radiation arteritis
Term
Polyarteritis nodosa:
A. What do you see?
B. where?
C. tendency to?
D. due to
Definition
A. multiple aneurysms
B. liver, pancreas, kidneys
C. bleed
D. ICLASH: idiopathic, cryoglobinemia, leukemia, rA (rheumatoid arthritis), Sjogren syndrome, hepatitis B
Term
Temporal arteritis:
1. aka
2. you see
3. where
4. how dx
Definition
1. Giant cell arteritis
2. stenosis or occlusion
3. arch vessels or temporal artery
4. bx
Term
Takayasu's arteritis:
1. u see?
2. where?
3. what syndrome can you see?
4. aka
Definition
1. stenosis or occlusion
2. arch vessels, aorta or pulmonary A
3. midaortic syndrome (midaortic stenosis and renal A stenosis)
4. pulseless dz
Term
Buerger's dz:
A. What see?
B. smokers?
C. where?
Definition
A.
1. Normal vessels
2. Occlusions
3. Corkscrew collaterals
B. yes
C. peripheral vasculature
Term
Popliteal artery entrapment:
1. What see?
2. if see entrapment, look at
Definition
1. compression of the popliteal A when plantar flex due to abnormal relationship to the medial head of the gastrocnemius or popliteus
2. other side, it may be bilateral
Term
thoracic outlet compression: what is this?
Definition
compression of the contents of the thoracic outlet e.g. arteries, veins, nerves
Term
thoracic outlet compression: have pt do what to do maneuver?
Definition
Can raise arm during the CT or MR exam
http://radiographics.rsna.org/content/26/6/1735.full.pdf+html
Term
thoracic outlet compression: may also see
Definition
aneurysm wtih distal emboli in addition to the compression
Term
What is median arcuate ligament compression?
Definition
Median arcuate ligament compresses the celiac trunk
Term
AVM: characteristics
Definition
1. large feeding vessel
2. Tangle of vessels
3. Early draining vein
Term
AVM:
1. mc location
2. if multiple
3. upper or lower lobe?
Definition
1. lungs
2. osler weber rendu syndrome
3. lower
Term
Vascular neoplasms
1. benign:
2. malignant:
Definition
1. benign: hemangioma
2. malignant: hemangiopericytoma, hemangiosarcoma
Term
If see aortic dissection think:
Definition
1. Marfan syndrome
2. Ehlers-Danlos syndrome
Term
Homocystinuria can have
Definition
thromboembolic disease
Term
Marfan vs homocystinuria: can have
Definition
bilateral lens dislocation
Term
Marfan vs homocystinuria: type of dilocation
Definition
Marfan: superior
Homocystinuria: inferior
Term
Leriche syndrome: What is occluded?
Definition
Aorta or iliac artery
Term
Leriche syndrome: sxs
Definition
1. absent femoral pulses
2. bilateral claudication
3. impotence
Term
acute thrombo-embolism has
Definition
1. abrupt occlusion
2. meniscus
3. no collaterals
Term
characteristics of mycotic aneurysm
Definition
irregular wall and atypical location
Term
drugs which can induce vasospasm
Definition
1. cocaine
2. vasopressin
3. ergotamine
Term
defn of
1. Inflow:
2. Outflow:
3. Distal:
Definition
1. Inflow: aorto-iliac arteries
2. Outflow: fem-pop A
3. Distal: tib/pedal A
Term
"tibial" refers to lesions in the
Definition
1. anterior tibial
2. posterior tibial
3. peroneal (aka fibular)
Term
50% stenosis by diameter corresponds to ___% stenosis by cross sectional area
Definition
75%
Term
What systolic pressure gradient is considered hemodynamically significant
1. at rest:
2. after vasodilator like ntg:
Definition
1. at rest: 10%
2. after vasodilator like ntg: 20%
Term
Optimal balloon diameter
Definition
10% larger than normal unaffected vessel
Term
Optimal balloon length
Definition
not more than 1 cm more on either side of lesion
Term
tx for symptomatic FMD in renal A
Definition
angioplasty
Term
tx for atherosclerosis in renal A
Definition
primary stent placement
Term
types of endoleak
Definition
IA: proximal
IB: distal
II: collaterals
III: defect in graft
IV: thru graft fabric due to porosity
Term
mc type of endoleak
Definition
type II
Term
fibrinolytic agent and dose
Definition
tPA 1mg/hr
Term
another name for fibrinolytic
Definition
thrombolytic
Term
what do you monitor with tPA therapy
Definition
fibrinogen level
Term
tPA therapy: when do you stop? reduce dose?
Definition
stop if < 100
reduce does if 100-150
Term
tPA therapy: How long is the trial?
Definition
48h
Term
embolic agents
Definition
1. particulate
2. coil
Term
types of particulates and if temporary or permanent
Definition
1. gelfoam: temporary
2. polyvinylchloride (PVA): perm
3. embospheres: perm
Term
supplies: stomach, duodenum
Definition
celiac
Term
supplies: jejunum, ileum, asc and prox 2/3 of transverse colon
Definition
SMA
Term
supplies: distal 1/3 transverse colon, desc colon and sigmoid and upper rectum
Definition
IMA
Term
Where is the SMA?
Definition
L1
Term
Where is the IMA?
Definition
L3
Term
portosystemic gradient in TIPS: target
Definition
= or < 12 mm Hg
Term
portosystemic gradient in TIPS: how calculate
Definition
portal pressure minus right atrial pressure
Term
where is the isthmus
Definition
distal to the left subclavian artery at the site of the attachment of the ligamentum arteriosum
Term
widening of mediastinum
Definition
> 8 cm at arch
Term
aortic dissection 3 groups
Definition
1. intramural hematoma
2. classic aortic dissection with intimal tear
3. penetrating atherosclerotic ulcer
Term
Stanford A vs B dissection
Definition
A: ascending aorta, proximal to L subclavian A
B. distal to L subclavian A
Term
ascending aorta aneurysm
Definition
> 4 cm
Term
common iliac aneurysm
Definition
> 12mm
Term
SVC syndrome
Definition
SVC drains through collaterals into IVC and returns back to right atrium
Term
if pulsatile flow in vein then
Definition
right heart failure / tricuspid regurgitation
Term
branches of celiac, sma, ima
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum (anastomosis with the right gastric)
b. splenic: dorsal pancreatic A, short gastric A, left gastroepiploic artery
c. common hepatic: proper hepatic A, gastroduodenal A (right gastroepiploic and superior pancreaticoduodenal A are branches of gastroduodenal), r gastric A

SMA: inferior pancreatico-duodenal A, jejunal and ileal branches, ileocolic A, right colic A, middle colic A

IMA: left colic, sigmoid, superior rectum
Term
anastamotic
1.celiac and sma
2. sma and ima
Definition
1. celiac and sma: arc of buehler
2. sma and ima: marginal artery of drummond, Arc of Riolan
Term
failing renal transplant with abnormal doppler examination
Definition
1. ATN: resistive index > 0.9. recovery of function
2. renal artery stenosis: turbulent flow, peak systolic velocity < 250 cm/s, parvus et tardus waveform
3. urinary obstruction: hydronephrosis
4. transplant rejection: looks like ATN
5. renal vein thrombosis (diastolic flow in a "to and fro" pattern
6. cyclosporine toxicity: renal plasma flow reduced
Term
Branches of the celiac, sma, and ima
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)

SMA: inferior pancreatico-duodenal A, jejunal and ileal branches, ileocolic A, right colic A, middle colic A

IMA: left colic, sigmoid, superior rectum
Term
[image]
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)
Term
[image]
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)
Term
[image]
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)
Term
[image]
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)
Term
[image]
Definition
SMA:
1. inferior pancreaticoduodenal A
2. jejunal and ileal branches
3. ileocolic A
4. right colic A
5. middle colic A
Term
[image]
Definition
IMA
1. left colic
2. sigmoid A
3. superior rectal A
Term
thoracic outlet syndrome
1. types:
2. some causes:
3. compresses:
4. tx if arterial or venous:
4. what position for best evaluation?
5. some imaging findings?
a. arterial
b. venous
Definition
1. types: arterial, venous, neurogenic
2. some causes: cervical rib, supernumerary muscles, repetitive upper extremity motion etc.
3. compresses: nerve, axillary/subclavian artery or axillary/subclavian vein
4.
a. arterial: possible percutaneous tx, definitive tx = surgery
b. venous: thrombolysis, anticoagulation, definitive tx = surgery
4. arm abducted and externally rotated
5.
a. arterial: axillary/subclavian artery stenosis/occlusion or aneurysm/pseudoaneurysm with distal emboli
b. venous: filling defect in axillary/subclavian vein
Term
hypothenar hammer syndrome
Definition
1. pseudoaneurysm or occlusion at the hypothenar eminence
2. emboli to the digital arteries
Term
Paget - Schroetter syndrome
1. aka
2. what is it?
3. cause
4. dd for causes
5. tx:
Definition
1. effort thrombosis
2. axillary/subclavian vein thrombosis at the thoracic inlet [thoracic inlet (anatomic)=thoracic outlet (clinical)]
3. cause: repetitive upper extremity exercise
4. dd: axillary/subclavian vein thrombus due to prior instrumentation/catheter placement, hypercoagulable state
5. tx: thrombolysis, anticoagulation then definitive tx with surgery
Term
Giant cell arteritis vs Takayasu's arteritis
1. population
2. tx
Definition
1.
a. GCT: old caucasian adies
b. Takayasu: young asian ladies
2. tx; steroids, but can be treated like atherosclerotic disease if in the fibrotic phase (when esr has normalized)
Term
Churg Strauss syndrome
Definition
systemic necrotizing vasculitis esp of the lungs (pulmonary necrotizing vasculitis)
Term
aneurysm caused by TB
Definition
Rasmussen aneurysm
Term
Osler Weber Rendu syndrome
1. what is it?
2. aka
Definition
1. multiple AVM and telangiectasias
2. aka hemorrhagic hereditary telangiectasias
Term
cystic adventitial disease
Definition
mucoid cysts in the adventitia which leads to compression of the artery
Term
varicocele
1. which side more common?
2. tx:
3. mm of vein
Definition
1. left gonadal vein drains into left renal vein. right gonadal vein drains into IVC. if varicocele on right, then look for retroperitoneal mass
2. tx: can do coiling
3. > 2mm
Term
IVC abnormalities and IVC filter placement
A. Circumaortic/retroaortic left renal vein
B. Megacava
C. duplicated IVC
D. Inferior vena cava thrombosis extending from just below the renal veins (leaving no room for IVC filter between thrombus and renal veins), in renal veins or above the level of the renal veins,
Definition
A. place filter below the left circumaortic or left retroaortic vein.
1. circumaortic left renal vein: normal left renal vein goes anterior to the aorta to drain into the IVC. the circumaortic left renal vein goes posterior to the aorta at the level of L2/L3 to drain into the IVC.
2. retroaortic left renal vein: No normal left renal vein going anterior to the aorta to drain into the IVC. the retroaortic left renal vein goes posterior to the aorta at the level of L2/L3 to drain into the IVC.
B. Megacava: > 2.8 cm. need to place bird nest's filter (fits up to 4.2 cm) or two filters in the common iliac arteries.
C. duplicated IVC: left common iliac vein drains into the smaller left IVC which typically drains into the left renal vein. need to place a filter in each of the IVCs.
D. need to place suprarenal IVC filter
Term
A. how to perform percutaneous nephrostomy and when is it emergent?
B. risk factors for TCC
C. causes of papillary necrosis
Definition
A.
1. check for anticoagulation profile
2. give abx
3. posterolateral approach
4. aim for middle calyx
5. advance wire when urine return
6. dilate
7. place drain
8. emergent placement needed if infection
B.
a. aromatic amines
b. cyclophosphamide
C. POSTCARD: pyelonephritis, obstruction, sickle cell disease, TB, cirrhosis, analgesics, renal vein thrombosis, diabetes
Term
tips
1. stands for
2. pathway
3. what do you do tips for
4. need to do venogram if on doppler, you find...
5. how often monitor ultrasound
6. portal vein flow should be
7. contra-indications:
8. complications:
Definition
1. transjugular intrahepatic portosystemic shunt
2. R IJ, right hepatic vein, right portal vein, main portal vein
3. keep porto systemic gradient < = 10 mmHg
4. if
a. portal venous velocity < 50 cm/s
b. stent velocity < 50 cm/s or > 150 cm/s
c. change in velocity from baseline (increase or decrease) > 50 cm/s
(top 3 diff)
5. baseline, 1, 3, 6, 12 months then yearly
6. hepatofugal (towards TIPS)
7. contraindications: severe liver disease, severe hepatic encephalopathy, polycystic liver disease, large hypervascular liver tumor, severe right sided heart failure, infection, portal vein thrombus
8. complications: right sided failure, thrombus/stenosis of the stent, bleeding, hepatic encephalopathy, renal failure
Term
mgt of aortic dissection and intramural hematoma
Definition
1. if type A: surgery. proximal to left subclavian A.
2. if type B: medical mgt. distal to left subclavian A.
However, emerging data suggests that endovascular stents good for type B and maybe type A also.
Term
biliary duct obstruction
1. cholangiocarcinoma at the hilum
2. double duct sign
3. primary sclerosing cholangitis is associated with and can lead to...
4. parasites that can block the common bile duct
Definition
1. Klatskin tumor
2. pancreatic cancer causing dilatation of the common bile duct and pancreatic duct
3. associated with UC, can lead to primary biliary cirrhosis and cholangiocarcinoma
4. clonorchis and ascaris (clonorchis can predispose to cholangiocarcinoma)
Term
how can you treat GI bleeding
Definition
1. intra-arterial vasopressin: 0.4 units/min if 6-12h or 0.2 u/min if 12-24h of tx.
2. transcatheter embolization with gelfoam and peripherally placed microcoils. (must turn off intra arterial vasopressin for 30 min prior to doing embolization)
Term
A. tx of
1. pulmonary AVM
2. bleeding from bronchial arteries
B. causes of bleeding from bronchial A
Definition
A.
1. pulmonary AVM: coils
2. bronchial A: pva so that u can go back again for rebleed
B. causes of bleeding: aspergillosis, bronchogenic carcinoma, cystic fibrosis, bronchiectasis, TB
Term
A. vessels of the heart
B. tx
Definition
A.
1. L main: LAD (septal, diagonal), left circumflex A (obtuse marginal)
2. RCA: posterior descending A
B. tx: angioplasty and possible stenting
Term
scimitar syndrome
Definition
1. partial anomalous pulmonary venous return
2. can see lung hypoplasia
a. anomalous pulmonary vein draining into IVC or portal vein (scimitar).
b. hypoplastic lung supplied by aorta.
Term
1. acyanotic heart with increased vascularity
2. acyanotic heart with normal vascularity
3. cyanotic heart with increased vascularity
4. cyanotic heart with decreased vascularity
Definition
1. acyanotic/increased: vsd, asd, pda
2. acyanotic/normal: aortic stenosis, coarctation of the aorta, interrupted aortic arch, pulmonary stenosis
3. cyanotic/increased: total anomalous pulmonary venous return, truncus arteriosus, transposition of the great vessels, tricuspid atresia, (t)single ventricle [double outlet right ventricle, Eisenmenger physiology-left to right shunt turning into right to left shunt]
4. cyanotic/decreased-normal: tetrology of Fallot (pulmonary stenosis, overriding aorta, vsd, rvh), pulmonary atresia, tricuspid atresia/stenosis, Ebstein anomaly (atrialization of the RV), [DORV with pulmonary stenosis]
Term
TAPR (total anomalous pulmonary venous return)
A. types
B. sign
Definition
A. types: supracardiac (left vertical vein or azygous vein), cardiac (RA or coronary sinus), infracardiac (vein below diaphragm-IVC, portal vein), mixed
B. snowman appearance in supracardiac type. body is heart. left head: vertical vein, top head: innominate vein, right head: svc
Term
types of aortic stenosis
Definition
1. valvular: mc. degenerative, bicuspid aortic valve, rheumatoid
2. subvalvular
3. supravalvular: rare. coronary arteries are dilated.
Term
A. thoracic aorta
1. dilatation
2. aneurysmal
B. abdominal aorta
C. common iliac artery
D. pulmonary hypertension
Definition
A. thoracic aorta
1. dilatation: > 3.5 cm
2. aneurysmal > 4.5 cm
B. abdominal aorta > 3 cm
C. common iliac artery > 1.5 cm
D. pulmonary htn > 3.5 cm
Term
LV aneurysm
1. types
2. wall
3. location
Definition
1. true: wall is LV. anterior wall and apex
2. false: rupture of LA and "wall" is scar tissue or pericardium. posterolateral wall and diaphagmatic.
Term
transposition of the great arteries: types
Definition
1. types
a. D type: incompatible with life unless asd, vsd, pda. "egg on a string"
b. L type: congenitally corrected.
Term
azygous continuation of the IVC
1. you don't see
2. you do see
3. associated with
Definition
1. don't see IVC
2. see enlarged azygous or hemiazygous vein
3. polysplenia
Term
transposition of the great arteries: types
Definition
1. types
a. D type: incompatible with life unless asd, vsd, pda. "egg on a string"
b. L type: congenitally corrected.
Term
A. aortic arch variants
1. bovine aortic arch
2. left vertebral artery origin off the arch
3. left arch and aberrant right subclavian A
a. what is it?
b. esophagram
4. right arch and aberrant left subclavian A
a. what is it?
b. where does the left subclavian A come off of?
c. esophagram?
d. associated with?
5. double aortic arch:
a. which side larger and higher?
b. what is the 4 vessel sign?
c. esophagram?
6. pulmonary sling:
a. what is it?
b. associated with?
c. esophagram?
B. which ones need surgery?
Definition
A.
1. bovine aortic arch: left carotid artery comes off the innominate artery
2. left vertebral artery comes off the arch between the left common carotid and left subclavian A (usually the vertebral comes off the subclavian A)
3. left arch and aberrant right subclavian A
a. aberrant right subclavian A comes off posterior to the left subclavian A and passes to contralateral side posterior to the esophagus.
b. posterior indentation of the esophagus.
4. right arch and aberrant left subclavian A
a. aberrant left subclavian comes off as last branch of arch from diverticulum of Kommerell and passes to contralateral side posterior to the esophagus
b. aberrant left subclavian A comes from diverticulum of Kommerell
c. esophagram: posterior indentation of the esophagus
c. associated with congenital heart dz (10%)
5. double aortic arch:
a. the double aortic arch surrounds the trachea and esophagus. r arch usually larger and higher.
b. usually two carotid A and two subclavian A (4 vessel sign)
c. esophagram:
1) posterior and lateral indentation of the esophagus.
2) narrowing of the trachea
3) trachea appears midline
6. pulmonary sling: left pulmonary A comes off the right pulmonary A and passes to left side between the trachea and esophagus.
b. associated with complete tracheal rings
c. esophagram: anterior indentation of the esophagus
B. complete vascular rings and pulmonary sling need surgery:
1. double aortic arch: complete vascular ring
2. right arch with aberrant left subclavian and symptomatic ductus arteriosum/ligamentum arteriosum. complete vascular ring.
3. pulmonary sling
Term
persistent left sided IVC
Definition
left sided IVC drains into coronary sinus then RA or just straight into RA.
Term
Buerger's disease
1. what is it?
2. demographics
3. aka
4. characteristic
Definition
1. non necrotizing vasculitis of peripheral vessels
2. male smokers
3. thomboangitis obliterans
4. corkscrew collaterals
Term
internal and external iliac artery vessels
Definition
1. internal:
a. posterior: iliolumbar, lateral sacral, superior gluteal A
b. anterior: inferior gluteal, middle rectal, inferior vesical, uterine A and more
2. external:
Term
1. replaced vs accessory right hepatic A
2. where from?
Definition
1.
a. replaced: the whole liver supplied by aberrant hepatic A
b. accessory: part of liver is supplied by aberrant hepatic A
2. aberrant hepatic artery can be from
a. left gastric A
b. SMA
Term
subclavian A stenosis
1. can have
2. tx
Definition
1. can have
a. distal emboli
b. vertebrobasilar insufficiency due to subclavian steel phenomenon
2. tx: surgical correction. don't use endovascular repair cuz thrombus might embolize
Term
May Thurner syndrome
1. what is it?
2. tx
Definition
1. compression of the left common iliac vein by the right common iliac artery resulting in venous thrombus.
2. stent placement
Term
coarctation of the aorta
1. signs
2. associated with
3. category
Definition
1. signs:
a. figure of 3 sign of the aorta.
b. inferior rib notching due to dilatation of intercostal collaterals.
c. left ventricular hypertrophy.
2. associated with
a. bicuspid aortic valve
b. Turner's syndrome
3. acyanotic, normal vascularity (see card #92)
Term
cardiac valves:
1. cranial to caudal
2. lateral
3. frontal
Definition
1. pulmonary, aortic, mitral, tricuspid
pamt
2. lateral
a. anterior: tricuspid
b. posterior cranial: aortic
c. posterior caudal: mitral
3. frontal:
a. cranial: aortic
b. right caudal: tricuspid
c. left caudal: mitral
Term
types of pacemakers
Definition
1. single chamber: RA or RV
2. dual chamber: RV and LV (via the coronary sinus vein)
3. biventricular: RA, RV and LV (via the coronary sinus vein)

http://my.clevelandclinic.org/heart/services/tests/procedures/pacemaker.aspx
Term
where should central venous catheters end?
Definition
in SVC below anterior 1st rib.
Term
artery of adamkiewicz
1. arises from
2. if embolized
3. embolization is complication of ...
Definition
1. arises from left side of the aorta or left intercostal A
2. if embolized, spinal cord ischemia
3. complication of bronchial A embolization (bronchial A also comes off descending aorta)
Term
A. lower extremity arteries
B. upper extremity arteries
Definition
A. common iliac, external iliac, common femoral, superficial femoral, popliteal, (anterior and posterior tibial, peroneal (aka fibular) A and V
B. subclavian, axillary, brachial, (radial and ulnar), superfical and deep palmar arch, digital A
Term
carotid doppler numbers
1. cm/s
2. intima/media measurement should be
Definition
1.
a. 125-230 cm/s: 50-69% stenosis
b. > 230 cm/s: > 70 % stenosis
2. 1 mm
Term
common IR cases
Definition
1. hands: hypothenar hammer syndrome, emboli, Buerger's
2. wrist to elbow: possibly dialysis related AV fistula or AV graft-usually not shown
3. elbow to shoulder: pseudoaneurysm, AV fistula due to trauma and iatrogenic
4. shoulder to mediastinum:
a. axillary pseudoaneurysm from crutches
b. thoracic outlet syndrome (venous-tx is thrombolysis, anticoagulation, surgical decompression with resection of cervical rib, scalenectomy or combination) (aka Paget von Schroetter syndrome)
c. thoracic outlet syndrome (arterial-tx is surgical reconstruction as usually due to extrinsic compression)
d. subclavian steal syndrome
e. vasculitis
1) if < 40 years: Takayasu's
2) if > 40 years: Giant cell arteritis
5. mediastinum
a. SVC syndrome. can treat with thrombolysis prior to stenting, angioplasty, surgery as per statdx (need to confirm)
1) benign like fibrosing mediastinitis-don't treat benign unless stridor or cerebral hypertension
2) malignant
3) catheter related
b. persistent left SVC (associated with asplenia)
6.thoracic aorta: Marfan's (look for dissection flap), traumatic aortic injury (TAI at isthmus), Takayasu's, systemic supply for sequestration, bronchial angiogram (TB, cystic fibrosis, tumor, asperigillosis, sarcoid; make sure you also look at the ipsilateral subclavian artery to see if a branch needs to be embolized)
7. pulmonary: catheter fragment (talk about retrieval), pulmonary AVM (solitary vs Osler Weber Rendu; tx is coil or detachable balloon), CT for PE
8. abdominal aorta: aneurysms atherosclerotic and mycotic), dissection, stent grafts (discuss endoleaks)
9. celiac: anatomy, hepatic (trauma, tumors, chemo embolization), GDA (pseudoaneurysm from pancreatitis or ulcer), splenic (trauma), left gastric (gastritis, Mallory Weiss tear)
10. SMA: GI bleed (tics and angiodysplasia), shock bowel/low cardiac output, venous phase to see portal vein (in order to discuss TIPS)
11. IMA: rare GI bleed from left colic
12. renal: ostial stenosis (proximal), FMD, trauma PAN (polyarteritis nodosa)
13. Biliary drain and nephrostomy: indications, contraindications and technique
14. IVC: filters-anatomy and placement, size of cava (options for larger than 28 mm), retrievable vs permanent
15. iliacs: atherosclerotic stenosis/occlusions, plasty, stents, lytic therapy, pelvic fractures with embolization
16. femorals: trauma (including post puncture pseudoaneurysm and thrombin injection), lytic therapy, stents
17. popliteal: occlusion (trauma, atherosclerotic, embolic, popliteal entrapment aneurysm, cystic adventitial disease)
18. below knee: nothing shown to my knowledge
19. ABI: 0.4 and below-rest pain/tissue loss, 0.4-0.8 claudication, above 0.8 normal
20. drugs: TPA, heparin, ntg, thrombin, papaverine, aspiring, plavix, antibiotics, vasopressin
21. CT guided: drainages and biopsies: know routes, some people do abscessogram before pulling drainage catheters.
Term
1. if hemorrhage or pseudoaneurysm in GI system, what technique can you use?
2. how do you treat gi bleed from tics or angiodysplasia in gi tract?
3. components of polyarteritis nodosa?
4. if you have ascites and need biliary drain, should
5. retrievable vs permanent filters
6. if you see non subtracted angiogram, look for
7. what is your gradient that you want to achieve after angioplasty or stenting?
8. what do you want to do before putting in biliary drain, nephrostomy tube, ivc filter
9. how do you treat pseudoaneurysm of artery
a. with end vessels that can be sacrificed
b. with end vessels that can not be sacrificed
10. if you have a pseudoaneurysm in the liver, can you take out the hepatic A?
11. defn massive hemoptysis?
12. causes of hemoptysis
13. how do you describe the bronchial artery angiogram if bleeding
14. tx for bleeding
15. after tx of bronchial A for bleeding, now what?
16. complication of tx of pulmonary bleeding with particles?
Definition
1. hemorrhage or pseudoaneurysm in GI system: you can use sandwich technique (coiling on both sides and gelfoam in the middle)
2. gi bleed from tics or angiodysplasia: coil or gelfoam
3. PAN: systemic small to medium vessels vasculitis causing microaneurysms, occlusions and hemorrhage of the kidney and many others (liver, spleen, pancreas, gi tract, cns, cardiac)
4. if have ascites and need biliary drain then should drain ascites first
5. a retrievable filter can be permanent, it is just retrievable. you can use retrievable in young patients with trauma, advanced cancer pt
6. if you see non subtracted angiogram, look for fractures
7. you would like to look for a gradient < 10 mmHg after angioplasty or stenting
8. make sure you look at prior studies before putting in biliary drain, nephrostomy tube, ivc filter.
9. pseudoaneurysm of peripheral artery tx
a. with end vessels that can be sacrificed: coiling
b. with end vessels that cannot be sacrificed: stenting
10. if you have a pseudoaneurysm in the liver, you can take out the hepatic A distal to the cystic artery (so that the gallbladder won't necrose)
11. massive hemoptysis: 300 cc (100cc-1000cc as per statdx and writers of statdx say 500cc, but Dr. Dunne uses 300 cc)
12. causes of hemoptysis: TB, cystic fibrosis, sarcoid, aspergillus infection, lung cancer
13. bronchial artery angiogram:
a. hypertrophy of the bronchial A
b. neovascularity
c. AV shunting
14. tx for pulmonary bleeding: particles. don't use gelfoam cuz only lasts 5-10 d, don't use coiling cuz pt will probably rebleed and you can't get past coil
15. after treating all bleeding from bronchial A, you should check the ipsilateral subclavian A for any bleeding
16. potential complication of tx of bleeding with particles: embolization of the artery of adamkiewitz and anterior spinal artery; looks like shepard's crook; going to anterior spinal cord. bronchial A (bronchial artery from descending aorta)
Term
coarctation of the aorta
Definition
1. seen in Turner's (they also have cystic hygroma and horseshoe kidney) and bicuspid aortic valve
2. 3 sign on cxr
3. reverse 3 sign on esophagram
4. rib notching
a. most often involves 4th-8th ribs
b. can involve 3-8th ribs
c. doesn't involve 1st and 2nd ribs because these supplied by intercostal A from thyrocervical trunk from subclavian A
Term
avm tx
1. peripheral vessels
2. brain
3. lungs
Definition
1. avm in peripheral vessels: alcohol
2. avm in brain: glue
3. avm in lungs: coil (avm in lungs is like avf)
Term
when see sfa intimal injury
1. say
2. tx
Definition
1. say no evidence of AVF or contrast extravasation
2. surgery or stent for sfa intimal injury
Term
tx for GI bleed
Definition
coiling proximally
Term
(need to double check this slide)
tx for aneurysm
1. ascending aorta
2. thoracic descending aorta
3. abdominal aorta
tx for thoracic dissection
1. ascending aorta
2. descending aorta
Definition
tx aneurysm:
1. ascending aortic aneurysm: surgery if > 5.5 cm
2. descending aortic aneurysm: can stent if > 6.5 cm
3. abdominal aortic aneurysm: can stent graft if > 5 cm or > 1 cm growth per year
tx dissection
1. ascending aortic dissection: surgery
2. descending thoracic aortic dissection and abdominal aortic dissection: medical mgt. surgery or stent if > 5 cm or growth of > 1 cm/year, in presence of aneurysm or other complication.
Term
if you cannot select the artery that you want to coil and the patient is "crashing" you can
Definition
You can take out the entire artery where you are if the patient is crashing.
Term
TIPS (transjugular intrahepatic portosystemic shunt)
1. indications:
2. absolute contra indications to TIPS:
3. relative contraindications to TIPS:
4. what type of stent?
5. what is the pathway?
6. what is normal portosystemic gradient?
7. goal of TIPS portosystemic gradient?
8. if after TIPS, the portosystemic gradient is still high then can
Definition
TIPS
1. indications: variceal bleeding refractory to medical treatment, intractable ascites due to cirrhosis/portal htn, pre liver treatment as a temporizing measure.
2. contraindications to TIPS: Right sided heart failure, polycystic liver disease, severe liver failure
3. relative contra indications to TIPS: active intrahepatic or systemic infection, severe hepatic encephalopathy, portal vein thrombosis
4. use a covered stent
5. R IJ, svc, RA (shouldn't have LBBB), IVC, R hepatic V, go anterior to the R portal vein
6. normal portosystemic gradient is 5 mmHg
7. goal of TIPS portosystemic gradient is 12 mmHg
8. if after TIPS, the portosystemic gradient is still high
a. further stent dilatation
b. can coil varices if present
c. can put in parallel TIPS
Term
traumatic aortic injury
1. what is widened mediastinum
2. what are some radiographic signs of traumatic aortic injury?
3. what is the angiographic view of the aorta?
4. tx
Definition
traumatic aortic injury
1. widened mediastinum defn: > 8 cm at T4 (take off of Left subclavian A)
2. signs of traumatic aortic injury: indistinct aorta outline, right paratracheal soft tissue density, esophageal/NGT deviation to the R, tracheal deviation to the right, inferior displacement of the left mainstem bronchus, apical pleural cap, 1st or 2nd rib fx
3. LAO: lay aorta out
4. tx: (need to double check)
a. ascending aorta: surgery
b. descending aorta: endovascular stent graft
Term
vascular subclavian steel syndrome
1. what is this?
2. tx
Definition
subclavian steel syndrome
1. stenosis or occlusion of the subclavian A proximal to the takeoff of the vertebral A so that you have reversal of flow in the vertebral A (need to double check details)
2. tx of vascular subclavian steel
a. if due to occlusion: lysis and stenting
b. if due to stenosis: angioplasty
c. if refractory to endovascular tx then can do by pass surgery.
Term
tx aneurysm
1. renal artery
2. pulmonary artery
Definition
tx aneurysm
1. renal artery: if narrow neck, coiling.
2. pulmonary artery: if narrow neck, coiling
Term
tx for liver metastasis
Definition
tace (transarterial chemoembolization)
1. lesions < 3 cm
2. diffuse liver lesions
as per Dr. Egeibor
Term
look at these slides for review
Definition
292, 293, 321, 347
Term
Lytic lesion in posterior elements of spine
Definition
GO APE
GCT
Osteoblastoma
ABC
Plasmacytoma
EG
Term
Mc Cune Albright syndrome
Definition
1. FD
2. precocious puberty
3. cafe au lait spots (coast of Maine)
Term
Coast of california cafe au lait spots
Definition
NF
Term
enchondroma aka
Definition
chondroma
Term
if multiple enchondroma
Definition
1. Ollier's
2. Maffucci's
Term
Mafucci's has
Definition
hemangiomas
Term
Is enchondroma hereditary?
Definition
no
Term
malignant potential for multiple enchondromas
Definition
25% (Mafucci's has more malignant potential than Ollier's, but both about 25%)
Term
How do you distinguish enchondroma from chondrosarcoma?
Definition
chondrosarcoma if:
1. pain
2. growth after skeletal maturity
3. rapid growth over short period of time
Term
exostosis aka
Definition
osteochondroma
Term
exostosis can transform into
Definition
chondrosarcoma
Term
if multiple exostosis, called
Definition
multiple hereditary exostosis
Term
if multiple hereditary exostosis, hereditary?
Definition
yes, (only I would need to make a card for this)
Term
malignant potential of exostosis
Definition
10%
Term
how to distinguish exostosis from chondrosarcoma
Definition
1. do MRI and check cartilaginous cap (if > 1 cm then chondrsarcoma or
2. if pain, growth after skeletal maturity, rapid growth over short interval
Term
bubbly eccentric lesion in tibial midshaft
Definition
adamantinoma
Term
predisposes to osteosarcoma, chondrosarcoma and MFH
Definition
1. Paget's
2. bone infarct
3. radiation
Term
mc bone lesion
Definition
non ossifying fibroma
Term
non - ossifying fibroma aka
Definition
fibroxanthoma
Term
fibrous dysplasia
Definition
1. cherubism
2. lion like
3. shepard's crook
Term
fibrous dysplasia characteristics
Definition
1. ground glass
2. long lesion in a long bone
Term
paget's
Definition
1. cortical thickening
2. bony expansion
3. trabecular thickening
Term
case: GCT
Definition
1. early adulthood 20-30 when close growth plate
2. too old for ABC (usually under 20 y)
3. too old for EG and chrondroblastoma (<20y)
4. too young for mets
5. big lesion, need to cement cuz prone to fx
Term
synovial osteochondromatosis
Definition
1. located in baker's cyst bursa
2. cause: synovial metaplasia, grows and breaks off
3. tx synovectomy
4. pt also had bipartite patella
Term
paget dz of left iliac spine:
Definition
1. dd: mets or tx'd lymphoma
2 can check alk phos (elevated in paget's) or psa (elevated in prostate ca)
3. can do bone scan. if only one hot then paget's. if many hot then mets
4. can also bx
Term
xr ap tibia #4271700
Definition
1. cortical thickening and intramedullary sclerosis
2. non-agressive appearing
3. dd: could be some sort of sclerosing dysplasia like melorheostosis "dripping candle wax appearance"
4. mets unlikely but cannot exclude mets
5. could be some sort of sclerosing dysplasia
Term
nof (non-ossifying fibroma) aka
Definition
1. fibroxanthoma
2. fibrous cortical defect
Term
osteoid osteoma
Definition
sclerotic center and lucent periphery
Term
osteoid osteoma vs osteoblastoma
Definition
1.5 cm and more is osteoblastoma
Term
1. suprascapular N
2. axillary N
3. subscapular N
Definition
1. suprascapular nerve innervates supraspinatus, infraspinatus
a. suprascapular notch lesion affects supraspinatus and infraspinatus
b. spinoglenoid notch lesion affects only the infraspinatus
2. axillary nerve innervates teres minor and deltoid M. axillary nerve runs through the quadrilateral space which is bordered by teres minor-superior, teres major-inferior, long head of the triceps-medial, humerus-lateral.
3. subscapular N: subscapularis M
Term
malignant transformation
1. Ollier's
2. Mafucci's
3. Multiple hereditary exostosis
risk of malignant transformation greatest with:
Definition
1. enchondromatosis 25%
2. enchondromatosis with hemangiomas 25%. (greatest risk)
3. multiple exostosis 10%
Term
fibrous dysplasia with
1. precocious puberty, cafe au lait spots (coast of maine)
2. intramuscular myxomas
Definition
1. McCune Albright Syndrome
2. Mazabrauds syndrome
Term
Parosteal vs conventional osteosarcoma
1. age
2. better prognosis
Definition
parosteal osteosarcoma older age and better prognosis.
Term
maisonnueve fx
Definition
medial malleolar fx
proximal fibular fx
Term
AVN
1. lunate
2. apophyseal rings of vertebral bodies
3. navicular
4. 2nd metatarsal head
Definition
1. lunate: Keinbocks
2. apophyseal rings of vertebral bodies: Scheuerrmann
3. navicular: Kohler
4. 2nd metatarsal head: Freiberg infraction
Term
risk factors for AVN
Definition
1. alcohol
2. steroids
3. trauma
4. Caisson dz (decompression sickness from deep sea diving)
5. vasculitis (RA, SLE)
6. radiation and chemotherapy
7. Gaucher's disease: lysosomal storage disease
8. sickle cell dz
9. pancreatitis
10. fat embolism
Term
1. Is ACL medial or lateral to PCL
2. Double PCL sign for
3. What can be mistaken for double PCL sign
Definition
1. ACL is lateral to PCL
2. meniscal tear (usually medial)
3. meniscofemoral ligament of humphrey (this is anterior. meniscofemoral ligament of Wrisberg is posterior to PCL)
Term
1. overtubulation
2. undertubulation
Definition
1. overtubulation: gracile. nimrod. neuromuscular dz/neurofibromatosis, immobility, Marfan, juvenile RA, oi, dysplasia.
2. undertubulation: short and squat-erlenmeyer flask deformity. tongs. tumor like lesions (fibrous dysplasia, Paget's, Multiple hereditary exostosis), Osteopetrosis, nieman pick dz, gaucher's, sickle cell dz
Term
dense bones
Definition
3m profs
myelofibrosis
mastocytosis
mets
paget's
renal osteodystrophy
osteopetrosis
fluorosis
scd
Term
Segond's
1. what does it look like?
2. what is it?
3. what is it associated with?
4. what is Pelligrini Stieda lesion and where is it?
Definition
1. linear calcification lateral to the proximal tibia
2. avulsion of the lateral capsular ligament
3. acl tear and meniscal tear (usually medial)
4. Pelligrini Stieda lesion: avulsion injury of medial collateral ligament so medial to distal femoral epicondyle
Term
Particle dz
1. what is it?
2. sx?
3. normal lucency at cement bone interface
4. if normal lucency is increased, what could it be?
5. tx?
Definition
1. granulomatous response to shed submicron portions of prosthesis. polyethylene and/or methymethacrylate cement
2. sx: pain, decreased ROM, limb shortening
3. 2mm
4. particle disease, infection, mechanical loosening or all 3
5. tx: revision
Term
idiopathic transient osteoporosis of the hip occurs in
A. what population?
B. what region?
Definition
A.
1. women pregnant in their 3rd trimesters
2. middle aged men
B. femoral head and neck
Term
1-6. muscle attachments: asis, aiis, greater and lesser trochanter, ischial tuberosity, inferior pubic ramus
7. quadriceps
8. greater and lesser tubercle
Definition
ss ir mm is ha
1. asis: sartorius
2. aiis: rectus femoris
3. greater trochanter: gluteus medius, gluteus minimum
4. lesser trochanter: iliopsoas
5. ischial spine: hamstrings (biceps femoris, semitendinosis, semimembranosis)
6. inferior pubic ramus (adductor magnus, longus, brevis)
7. quadriceps: rectus femoris, vastus lateralis, vastus medialus, vastus intermedius
8.
greater tubercle: supraspinatus, infraspinatus, teres minor
lesser tubercle: subscapularis
Term
order of ossification
Definition
critoe
capitellum
radial head
internal (medial epicondyle)
trochlea
olecranon
external (lateral epicondyle)
Term
acro osteolysis dd
Definition
pinch fo
psoriasis
injury (heat, frostbite)
neuropathy (leprosy, DM)
collagen vascular disease (scleroderma, raynaud's)
hyperparathyroidism
familial (Hadju Cheney syndrome)
other (polyvinyl chloride exposure, progeria)
Term
1. Jefferson's fx
2. Hangman's fx
Definition
1. Jefferson's: C1 compression fracture
2. Hangman's: C2 bilateral pars fx
Term
1. atlantoaxial laxity
2. distal clavicle erosions
3. ivory vertebral body
4. lytic lesion in posterior elements of spine
5. dense bones
6. epiphyseal lesion
7. overtubulation
8. undertubulation
9. vertebra plana
10. wormian bones
Definition
1. atlanto axial laxity: DRASTIC. diabetes, ra, as, sle, trauma, infection, congenital
2. distal clavicle erosions: SHIRT. scleroderma, hyperparathyroidism, infection, RA, trauma
3. ivory vertebral body: LIMP. lymphoma, infection, mets, Paget's
4. lytic lesion in posterior elements of spine: GO APE. gct, osteoblastoma, abc, plasmacytoma, eg
5. dense bones: 3M PROFS. myelofibrosis, mastocytosis, mets, paget's, renal osteodystrophy, osteopetrosis, fluorosis
6. epiphyseal lesion: MICE GAS. mets, infection, chondroblastoma, eg, gct, abc, subchondral cyst.
7. overtubulation. NIMROD. neurofibromatosis/neuromuscular disorder, immobility, marfans, jra, oi, dysplasia
8. undertubulation. TONGS. tumor like lesions (FD, Paget's, multiple hereditary exostosis), osteopetrosis, Nieman Pick dz, Gaucher's dz, SCD
9. vertebra plana. FETISH. fx, eg, tumor, infection, steroids, hemangioma
10. womian bones. (mc: OI, healing rickets, downs) PORKCHOPS. pyknodysostosis, OI, Rickets, Kinky hair syndrome, cleidocranial dysostosis, hypothyroidism/hypophosphatasia, otopalatodigital syndrome, pachydermoperiostosis/primary acro osteolysis (Hadju Cheney syndrome), syndrome of
Downs
Term
specific injuries for child abuse
Definition
1. sternum
2. spinous process
3. scapula
4. posterior ribs
5. metaphyseal corner fracture, bucket handle fx
Term
components of carpal tunnel
Definition
1. median nerve
2. flexor policis longus
3. flexor digitorum superficialis
4. flexor digitorum profundus
Term
dens fx
Definition
I: tip
II: base
III: extends into vertebral body
Term
flexion and extension teardrop location
Definition
1. flexion: C5-C7
2. extension: C2-C3
Term
bipartite patella vs fracture
Definition
1. bipartite patella: usually superolateral. doesn't fit together like puzzle piece
2. fracture: usually horizontal. fits together like puzzle piece.
Term
Osgood Schlatter vs. Sinding Larson Johanson dz
Definition
1. Osgood Schlatter dz: partial avulsion of the tibial tubercle
2. Sinding Larson Johanson dz: osteochondrosis of inferior pole of patella
Term
tarsal coalition
1. mc
2. 2nd mc
3. % bilateral
Definition
1. calcaneonavicular: mc
2. talocalcaneal (subtalar): 2nd mc
3. 25% bilateral
Term
bone marrow reconversion
1. red to yellow or yellow to red?
2. starts where?
3. why?
4. how diagnose?
Definition
bone marrow reconversion
1. yellow to red
2. starts in proximal metaphysis
3. why? hypoxia (lung dz, high altitude, marathon runners) and chronic anemia (menstruation, sickle cell dz, thalassemia)
4. how diagnose? low T1
Term
salter harris
Definition
I: widening
II: physis and metaphysis
III: physis and epiphysis
IV: physis, metaphysis and epiphysis
V: crush injury of physis
Term
eponyms
1. Galleazi
2. Monteggia
3. Essex-Lopresti
4. Colles
5. Smiths
6. Barton
7. Reverse Barton
8. chauffer's or Hutchinson's
9. March fx
10. Jones/pseudojones
11. Jumper's knee
12. Bennett's/Rolando's:
13. Gamekeeper's thumb:
14. Housemaid's/Clergyman's knee
15. Little leaguer's elbow
16. nursemaid's elbow
17. Tillaux
18. Triplane
19. Pilon
20. Lisfranc
Definition
1. Galleazi: GRD. radial fracture and distal radio ulnar dislocation
2. Monteggia: MUP. ulnar fracture and proximal radial head dislocation
3. Essex-Lopresti: EPRD. proximal radial fx and distal radio ulnar dislocation
4. Colles: distal radial fx with dorsal angulation of distal fragment
5. Smiths: "" with volar angulation of distal fragment
6. Barton: intraarticular distal radial fx with dorsal angulation of distal fragment
7. Reverse Barton: "" with volar angulation of distal fragment
8. chauffer's or Hutchinson's: radial styloid fx
9. March fx: stress fx of metatarsal head
10. Jones (> 1.5 cm)/pseudo Jones (< 1.5 cm): base of 5th metatarsal fx
11. Jumper's knee: high signal in proximal patellar tendon
12. Bennett's/Rolando's: 1st metacarpal. Bennett's (not comminuted), Rolando's (comminuted)
13. Gamekeeper's, skier's: avulsion of the ulnar collateral ligament.
14. housemaid's: prepatellar swelling. clergyman's: pre infrapatellar swelling
15. little leaguer's elbow: sclerosis at medial epicondyle
16. nursemaid's elbow: the radial head slips out of the annular ligament
17. Tillaux: distal tibia SH III fx
18. Triplane: distal tibia SH IV fx
19. Pilon: distal tibial fx due to axial loading
20. Lisfranc: homolateral and divergent
Term
pes anserine
Definition
sartorius
gracilis
semitendinosis
Term
dd intra articular calcifications
Definition
1. hyperparathyroidism
2. scleroderma or mixed connective tissue disease
3. gout with renal failure (not regular gout)
4. idiopathic tumoral calcinosis
Term
age of blood
Definition
key: age, T1, T2, name, Hg
1. < 24h, It, Be, hyperacute, oxyHg
2. 1-3 d, Id, Dy, acute, deoxy Hg
3. 4-7d, Bi Dy, early subacute, met Hg intracellular
4. 1-2w, Ba By, late subacute, met Hg extracellular
5. >2w, Do Do, chronic, hemosiderin
Term
Rotator cuff tears
A. types
B. if see ___, worry about labral tears
C. location of lesion and nerve affected
D. Labral injuries
Definition
A. types:
1. partial: bursal (superior), articular (inferior), intrasubstance. can be partial or full thickness
2. complete
B. paralabral cysts indicate that there may be a paralabral tear
C.
1. suprascapular notch: affects suprascapular nerve which innervates supraspinatus and infraspinatus.
2. spinoglenoid notch: affects branch of suprascapular nerve which innervates infraspinatus
3. quadrilateral space (aka quadrangular space): axillary nerve which innervates deltoid and axillary nerve. bordered by teres minor-superior, teres major-inferior, long head of triceps-medial, humerus-lateral
D. Labral injuries
1. Bankart and Bankhart type lesions: affects anterior inferior labrum: Bankart, Perthes, GLAD (glenolabral articular disruption), ALPSA (anterior labral periosteal sleeve avulsion-is a medially moved GLAD),
2. SLAP: affects superior labrum. superior labral anterior posterior
Term
Parsonage Turner syndrome
1. what is it?
2. due to?
Definition
1. idiopathic neuropathy of the suprascapular nerve
2. possibly post viral
Term
dd sheet like calcifications
Definition
1. dematomyositis/polymyositis
2. scleroderma
3. hyperparathyroidism
Term
modic changes
Definition
1. fluid: low T1 and high T2
2. fat: high T1 and T2
3. fibrosis. low T1 and T2
Term
intra osseous disc herniation
Definition
Schmorl's node
Term
rheumatoid negative arthropathy
Definition
AS, IBD, Reactive arthritis, psoriatic arthritis, erosive OA
Term
SLE
Definition
reversible deformity
Term
Gout and pseudogout
Definition
1. Gout: uric acid
2. pseudogout: calcium pyrophosphate crystals.
a. pseudogout: clinical presentation of calcium pyrophosphate deposition
b. chondrocalcinosis: CPPD in cartilage. many causes
c. pyrophosphate arthropathy
Term
anatomy of the ankle
A. posterior
B. anterior
Definition
A: posterior: from medial to lateral. tom, dick and harry. posterior tibial, flexor digitorum longus, flexor hallucis longus
B. anterior: from medial to lateral. tom hates dick with a passion. anterior tibial, extensor hallucis longus, extensor digitorum longus, peroneus brevis (near bone) and peroneus longus.
Term
dd osteoarthropathy adult
Definition
1. primary hypertrophic osteoarthropathy= pachydermoperiostosis
2. secondary hypertrophic osteoarthropathy:
a. lung cancer. get cxr
b. venous stasis
Term
dd periostitis child
A. under 6m
B. over 6m
Definition
always think of trauma: accidental and non-accidental
A. under 6 m: physiologic, infection, prostaglandin therapy, Caffey disease
B. over 6 m: juvenile idiopathic arthritis, scurvy, hypervitaminosis A, sickle cell dactylitis
Term
neuropathic joint
Definition
1. destruction
2. increased density
3. debris
4. disorganization
5. dislocation
Term
limbus vertebra usually
Definition
anterior superior
Term
dd for abc on mr
Definition
1. ABC
2. telangiectatic osteosarcoma
Term
normal bohler's angle
Definition
28-48 degrees
Term
sonk vs ocd
Definition
1. sonk: older people. insufficiency. medial condyle
2. ocd: younger people. fatigue e.g. microtrauma. lateral aspect of medial condyle
Term
Paget's dz
Definition
1. cortical thickening
2. bony expansion
3. trabecular thickening
Term
ulnar variance
Definition
1. positive ulnar variance: ulnar moves distally to TFC (triangular fibrocartilage). ulnar impaction syndrome
2. negative ulnar variance: ulnar moves proximally. unlar impingement syndrome. assoc with Keinboch's (AVN of the lunate)
Term
dd distal phalanx erosions
Definition
1. psoriasis
2. erosive OA
3. scleroderma
Term
A. cortically based lesion
B. other lesions
Definition
A.
1. FD
2. osteoid osteoma
3. non ossifying fibroma aka fibroxanthoma
B.
1. enchondroma
2. bone infarct
3. if pain, think chondrosarcoma
Term
dd for fluffy periostitis
Definition
1. Psoriatic arthritis
2. Reactive arthritis
3. AS
4. possibly IBD
5. hyperparathyroidism
Term
dd PVNS
Definition
1. PVNS
2. fibrous tissue
3. hematoma
4. calcifications (look at plain film to see if have calcs)
Term
dd for parosteal osteosarcoma
Definition
1. myositis ossificans (calcifies from outside to inside)
2. parosteal osteosarcoma (calcifies from inside to outside)
Term
lesion in femoral neck
Definition
liposclerosing myxoid fibrous tumor
Term
Haglund's deformity
Definition
prominence of posterior superior margin of calcaneus, which can cause pre Achilles or retro achilles bursitis
Term
dd intra articular tumor
Definition
1. PVNS
2. synovial cell sarcoma
3. abscess
Term
Milwaukee shoulder syndrome
Definition
1. elderly women
2. complete tear of rotator cuff
3. OA
4. calcium hydroxyapatite and calcium pyrophosphate dihydrate crystals
Term
dd for anything
Definition
TIC MTV
trauma, infection, congenital, metabolic, tumor ,vascular, arthritis
Term
erosions
A. central
B. marginal
Definition
A. central: RA, 4 seroneg (AS, IBD, PA, Reactive arthritis), pseudogout
B. marginal:gout, infection
Term
Weber classification
Definition
A: distal. not surgical
B; extends from joint. may or may not be surgical
C: proximal. surgical
Term
case that will be on boards
1. ballooned patella
2 gracile bones
what is dd if male /female
Definition
1. male: hemophilia
2. female: JRA
go thru NIMROD: nf, immobility, marfans, jRa, OI, dysplasia
Term
Legg Calve Perthes
Definition
AVN of femoral head in 5-6 year old
Term
1. what is coxa magna
2. what causes coxa magna
Definition
1. mushroom shaped femoral head
2. AVN, Legg Calves Perthes dz
Term
HU
Definition
+1000: bone
+100: soft tissue
0: fluid
-100: fat
-1000: air
Term
femoral acetabular impingement types
Definition
1. CAM on femoral side
2. Pincer on acetabular side
Term
particle disease
1. due to
2. sx
3. normal lucency at bone-cement interface
4. if normal lucency too great then could be due to
Definition
1. granulmatous response to shed submicron polyethylene particles
2. pain, decreased ROM, limb shortening
3. normal lucency < 2mm
4.
a. particle disease
b. mechanical loosening
c. infection
d. or all 3
Term
another name for Hangman's fx
Definition
c2 b pars fx
Term
posterior fat pad
Definition
1. in child: supracondylar fracture
2. in adult
a. h/o trauma: occult radial head fx
b. no h/o trauma: joint effusion
Term
gamekeeper's thumb
1. what is it?
2. what is the stener lesion?
3. why is the stener lesion important?
Definition
1. ulnar collateral ligament tear
2. adductor aponeurosis is between the complete tear of the UCL
3. stener lesion make this surgical
Term
usual location of the
1. flexion teardrop
2. extension teardrop
Definition
1. flexion teardrop: C5-C7
2. extension teardrop: C2-C3
Term
non ossifying fibroma aka
Definition
fibroxanthoma
Term
Some characteristics of fibrous dysplasia
Definition
1. cherubism
2. shepard's crook deformity
3. lion like face
4. ground glass
5. long lesion in a long bone.
Term
pes anserine muscles
Definition
1. sartorius
2. gracilis
3. semitendinosis
sgt
Term
virtually pathonomonic for non accidental trauma
Definition
1. metphyseal corner fracture
2. bucket handle fx
3. fx of posterior rib at junction of the transverse process
Term
rickets
Definition
1. vitamin D deficiency
2. widening of the physis
3. cupping and fraying of the metaphysis
4. cupping and fraying of the costochondral junction
(Rachitic rosary)
Term
SCFE
1. % bilateral
2. salter harris fx
3. tx
4. characteristic of SCFE
5. primary direction of slippage of the epiphysis
6. complications of SCFE
Definition
1. 25% bilateral
2. SH I fx
3. tx: pinned as is to prevent further slippage
4.
a. widening of the physis
b. metaphyseal irregularity
c. regional osteopenia
d. Klein's line (line along lateral femoral neck) should normal bisect at least 1/6 of the epiphysis
5. slippage of the epiphysis is medial and posterior
6. complications of SCFE:
a. AVN
b. varus deformity and femoral neck shortening
c. early OA
d. chondrolysis
Term
PVNS
1. stands for
2. dd
Definition
1. pigmented villonodular synovitis
2. dd: hematoma and maybe others
Term
calcific bursitis and tendonitis
1. is due to
2. tx
Definition
1. calcium hydroxyapatite crystals
2. put in needle and breaking up the calcium and then aspirating it
Term
surgical tx of rotator cuff impingement
Definition
1. acromioplasty
2. coracoacromial ligament si released at its attachment to the acromion
Term
rotator cuff tear
Definition
1. tendonitis, tendinopathy, tendinosis
2. partial:
a. bursal: near suacromial bursa (superior)
b. articular: near humerus (inferior)
c. intrasubstance
3. full thickness tear: high T2 from bursal to articular surface. an injection that results in fluid in subacromial bursa means that there is a full thickness tear.
4. complete tear:
a. if retraction is proximal to glenoid then tx is not surgery
b. if retraction is distal to glenoid then tx is surgery.
Term
if biceps tendon is out of bicipital groove then
Definition
tear of the transverse ligament (made up of the coracohumeral ligament and subscapularis tendon)
Term
dd for lesion that looks like abscess
Definition
1. chronic infection
a. brodie's abscess
b. sinus tract: more serpiginous
c. cloaca: more like gap
d. involucrum: periosteal new bone surrounding sequestrum
e. sequestrum: dead bone
2. osteoid osteoma
3. NOF: usually asymptomatic
4. can mention metastatic disease
Term
psoriasis
A. characteristics
B. dd
Definition
A. characteristics
1. distal central erosions (RA, seroneg, pseudogout have central erosions. marginal erosions occur in gout and infection)
2. pencil in cup
3. sausage digit
4. ivory phalanx
5. periostitis
B. erosive OA, scleroderma
Term
dd calcs adjacent to 4th metacarpal
Definition
1. infection
2. myositis ossificans
3. chondroma
Term
migration of femoral head
1. OA
2. RA
Definition
1. OA: superior migration of femoral head
2. RA: medial (axial) migration of femoral head
Term
basketball foot
Definition
1. subtalar joint dislocation
2. someone steps on foot and the body keeps on going
Term
dd sheet like soft tissue calcifications
Definition
1. dermatomyositis/polymyositis
2. scleroderma
3. hyperparathyroidism
Term
dd diffuse periosteal thickening
Definition
1. pachydermoperiostosis: primary hypertrophic osteoarthropathy
2. secondary hypertrophic osteoarthropathy
a. bronchogenic ca
b. pleural mesothelioma
c. solitary fibrous tumor of the pleura
d. IBD and many other things
3. venous stasis
Term
TFC
1. stands for
2. complication
3. location of calcs
Definition
1. triangular fibrocartilage tear
2. complication: SLAC wrist
3. between scaphoid and lunate
Term
if something looks like small metal upside down tulip
Definition
suture anchor
Term
dd for enchondroma
Definition
1. enchondroma
2. bone infarct
3. chondrosarcoma
Term
largest sesamoid bone in the body
Definition
patella
Term
sustentaculum tali
1. articulates with
2. what runs under it?
3. #facets?
4. # articulations
Definition
1. articulates with middle facet
2. flexor hallucis longus runs under it
3. 3 facet (anterior, middle and posterior)
4. 2 articulations (anterior and posterior)
Term
dd distal erosions
Definition
1. psoriasis
2. erosive OA
3. scleroderma
Term
segond fx
1. location
2. associated with
3. % chance of seeing an ACL tear
Definition
1. along lateral aspect of proximal tibia
2. associated with acl tear, mcl tear, tear through the meniscii esp medial
3. if see segond fx, almost 100% chance of seeing acl tear
Term
RA
Definition
1. ulnar capping
2. ulnar translocation
3. swan neck and boutonniere deformities
4. Hitchhiker's thumb
Term
oa
Definition
1. affects 1st CMC, STT joint, DIPs
2. subchrondral cysts
3. superior migration of the femoral head (axial or medial migration would indicate more RA)
4. calcar buttressing
5. OA and RA can both produce protrusio acetabuli
6. OA is a synovial disease so affects facets, not disks which are not synovial joints
7. oa only affects inferior portionso f the SI joints which are synovial and thus vulnerable to OA
Term
modic changes
I
II
III
Definition
I: water: low T1, high T2
II: fat: high T1 and T2
III: fibrosis: low T1 and T2
Term
intra osseous disk herniation thru a weakened endplate
Definition
Schmorl's node
Term
DISH vs OPPL
a. full names
b. location
c. risk for
Definition
a. diffuse idiopathic skeletal hyperostosis vs ossification fo the posterior longitudinal ligament
b. dish is thoracic. oppl is more cervical
c. risk for fx, neurologic injury, (dysphagia with DISH)
Term
AS
1. HLA B27 positive
2. where is si joint erosive disease?
Definition
1. 90%
2. lower si joints which are synovial
3. "shiny corners" which is osteitis
4. squared vertebral bodies
5. syndesmophytes: ossification in the annulus fibrosis
6. bamboo spine
7. prone to fx and paralysis
Term
connective tissue disorders
1. list
2. all have what in common?
Definition
1. scleroderma, sle, dermatomyositis/polymyositis
2. all have vasculitis
Term
gout
Definition
1. sodium urate crystals
2. marginated erosions
3. overhanging edge
4. gouty tophus enhances on MR
5. mc joint: 1st metatarsal phalangeal joint
Term
pseudogout
Definition
1. calcium pyrophosphate deposition disease
2. pseudogout is clinical presentation of calcium pyrophosphate deposition disease
3. chondrocalcinosis can be caused by calcium pyrophosphate in cartilage among many other causes
4. characteristic finding: chondrocalcinosis in TFC (triangular fibrocartilage), in knee meniscii and patellofemoral compartment narrowing
Term
epicondylitis
1. medial:
2. lateral:
Definition
1. medial: tennis elbow
2. lateral: may seen in association with Little Leaguer's elbow
Term
cubital tunnel syndrome
Definition
increased signal in the ulnar nerve
Term
nightstick fx
Definition
ulnar shaft fx
Term
chance fx
Definition
distraction of posterior portion of the vertebral body
Term
os trigonum can cause
Definition
1. posterior ankle impingement
2. os trigonum gets pinched in space posterior to ankle
Term
bones of the ankle
Definition
1. talus (medial)
2. calcaneus with sustentaculum tali (bulk lateral)
3. navicular (medial with talus)
4. cuboid (lateral with calcaneus)
5. medial, lateral and middle cuneiform (all more medial)
Term
1. where is achilles prone to tear?
2. kagar triangle=
3. who gets achilles tendon rupture
Definition
1. watershed area 2-6 cm proximal to the Achilles insertion
2. pre-achilles fat pad = kagar triangle
3. weekend warriors
Term
type of os trigonum that predisposes to posterior ankle impingement syndrome
Definition
large
Term
1. absolute contra indications to MR
2. relative contra indications to MR
Definition
1. absolute:
a. defibrillators/pacemakers
b. metallic foreign body in eye, spine, maybe ear
c. ferromagnetic clips in the CNS
d. electronically magnetically mechanically activated implants e.g. cochlear implants
2. relative
a. cochlear implant
b. infusion pump
c. neurostimulators
d. prosthetic heart valve
e. body hemostatic clips
f. obesity
g. pregnancy
Term
what muscles attach to the coracoid
Definition
1. coracobrachialis
2. short head of the biceps
3. pec minor
Term
causes of diffuse periostitis
Definition
1. primary hypertrophic osteoarthropathy: pchydermoperiostosis
2. secondary:
a. lung cancer, get chest xr
b. mesothelioma
c. solitary fibrous tumor of the pleura
d. inflammatory bowel disease
e. venous stasis
f. leukemia
g. Caffey's dz: infantile cortical hyperostosis
h. trauma, non accidental trauma
i. infection
Term
tx
1. colles
2. smith's
3. bartons and reverse bartons
Definition
1. colles: casting
2. smith: surgery
3. barton and reverse barton (dislocation is predominant finding): surgery
Term
greater arc injuries
Definition
1. radial styloid
2. scaphoid
3. capitate
4. hamate
5. triquetral
6. ulnar styloid
Term
causes of osteitis pubis
Definition
1. trauma
2. pregnancy/childbirth
3. psoriasis
4. high level of athletic activity
5. gu/gyne surgery
Term
segond vs pelligrini stieda lesion
Definition
1. segond: lateral to proximal tibia. avulsion of the lateral capsular ligament
2. pelligrini stieda lesion. medial to distal femur. ossification of mcl or avulsion injury of mcl
Term
when do you most certainly know that you have a weber C fx
posterior or medial malleolar fx?
Definition
ans: posterior malleolar
Term
enthesophyte: occurs
Definition
at attachment site of tendon or ligament on bone due to "pull" at attachment site
Term
internal vs external rotation
Definition
1. internal: ice cream cone appearance
Term
if suspect AC joint separation
Definition
1. can do side by side comparison of both AC joints with weights
2. should not be more than a 50% difference
Term
cervical rib can cause
Definition
thoracic outlet obstruction
Term
rotary subluxation
Definition
< 10% normal
> 45% clinically correlate
< 45% prob dislocated
Term
pavlov's ratio for cervical spine stenosis
Definition
pavlov's ratio.
spinal canal width/vertebral body width should be > 0.8 in people without spinal canal stenosis
Term
ACDF stands for
Definition
anterior cervical decompression and fusion
Term
if clay shoveler's, need to
Definition
check CT for extension into lamina
Term
jefferson's fracture
Definition
aka traumatic spondylolithesis
effendi classification
Term
subtalar joint
# facets, # articulations?
Definition
between talus and calcaneus
3 facets: anterior, middle, posterior
2 articulations: anterior and posterior
Term
acl medial or lateral
Definition
acl is lateral
Term
atlanto axial distance should be
Definition
< 5 mm kids
< 2.5 mm adults
Term
flexion teardrop can cause
Definition
anterior cord syndrome
Term
cranial settling
Definition
odontoid process goes thru foramen magnum
Term
pars interarticularis defect
Definition
1. stress fx
2. gymnasts
3. can do bone scan
Term
limbus vertebrae
Definition
usually anterior and superior
Term
mc coalition in the wrist
Definition
lunate triquetral
Term
how to fix scaphoid fx
Definition
herbert screw (hollow screw threaded over wire)
Term
disi
Definition
dorsal intercalated segmental instability
Term
joints that have a volar plate
Definition
mcp and pip (not dip)
Term
what type of bone is the pisiform?
Definition
sesamoid
Term
normal bohler's angle
Definition
28-48 degrees
Term
greater and lesser arc injuries
Definition
1. greater arc: trans scaphoid perilunate fx dislocation associated with greater arc fx
2. lesser arc: pure lunate dislocation without fx
Term
if fx of tibial plateau may have
Definition
fat fluid level
Term
sacral insufficiency fx may be due to
Definition
1. osteoporosis
2. radiation tx
Term
complication of hip dislocation if not relocated in 24h
Definition
AVN
Term
Hoffa's fat pad
Definition
1. posterior to lower pole of patella
2. anterior to femur
Term
tibial plafond (french for ceiling) fx aka
Definition
pilon fx
Term
plantar fascia
Definition
1. medial cord: flexor digitorum brevis
2. lateral cord: abductor digiti minimi
Term
chopart's joint
Definition
1. calcaneus
2. cuboid
3. talus
4. navicular
Term
quadriceps tendon rupture associated with
Definition
medial or lateral retinaculum tears
Term
sonk vs ocd
Definition
1. sonk: older, medial , insufficiency
2. ocd: younger, lateral, stress e.g. microtrauma
Term
mc benign bone tumor
1. names
2. malignant transformtion if single or multiple
Definition
1. exostosis (osteochondroma)
2. 1% malignant transformation to chondrosarcoma (if not multiple)
2. 10% chance of malignant transformation if multiple (25% chance of malignant transformation with Mafucci's and Ollier's-multiple enchondromas/chondroma)
Term
biceps brachii
1. long and short head origin
2. insertion
3. which (proximal or distal) more likely to rupture?
Definition
1. origin:
a. short head: coracoid
b. long head: glenoid via the bicipital groove
2. insertion: radial tuberosity
3. which is more commonly ruptured? proximal
Term
os acromiale
1. can cause
2. should fuse by
Definition
1. can cause impingement symptoms
2. should fuse by 25 years
Term
morton neuroma
1. what it is not
2. what it is
Definition
1. not a nerve tumor
2. perineural fibrosis along plantar N
Term
lytic lesion mneumonic
Definition
fegnomashic
fibrous dysplasia
eg, enchondroma
gct
nof
osteoblastoma
mets, mm
abc
sbc
hyperparathyroidism
infection
chondroblastoma, cmf
Term
mc stress fx
Definition
march fx (distal 2nd or 3rd metatarsal stress fx)
Term
high heels can cause
Definition
Freiburg infarction (avn of the 2nd or 3rd metatarsal head)
Term
order of bone marrow conversion
Definition
red to yellow
1. proximal epiphysis
2. distal epiphysis
3. diaphysis
4. distal metaphysis
5. proximal metaphysis
-reconversion starts with proximal metaphysis
Term
in and out of phase imaging
1. te
2. tr
Definition
te: 2 and 4
tr: the same
Term
mutilating psoriasis looks like
Definition
RA
Term
lipoma vs liposarcoma
Definition
liposarcoma has thick septa and enhancing soft tissue nodules
Term
calcaneal lipoma vs bone cyst
Definition
1. lipoma: calcs
2. cyst: no calcs
Term
mc tarsal coalition
Definition
calcaneonavicular
Term
types of coalition
Definition
1. osseous
2. cartilaginous
3. fibrous
Term
what it is between tibia and fibula that calcifies
Definition
interosseous membrane
Term
neuroforamina at cch. if head turned to right then looking at which neuroforamina
Definition
1. if head turned to the right then looking at left neuroforamina
Term
ulnar variance
1. positive
2. negative
Definition
1. positive: ulnar moves distally to TFC (triangular fibrocartilage). ulnar impaction syndrome
2. negative: ulnar moves proximally. keinbochs (avn of the lunate). ulnar impingement syndrome
Term
oa affects
Definition
1. STT joint
2. !st MCM
3. 1st MCP
4. DIPs
Term
cause of ABC
Definition
1. not true neoplasm
2. due to AV malformation or vascular injury
3. can arise from tumors like GCT, chondroblastoma, osteoblastoma, osteosarcoma
Term
abc on MR
Definition
1. fluid fluid level (serum-blood
2. septation
Term
dd for abc on mr
Definition
1. abc
2. gct
3. telangiectatic osteosarcoma
Term
tx osteoid osteoma
Definition
remove nidus via
1. surgery
2. radiofrequency ablation
Term
bx stress fx?
Definition
no, can lead to wrong dx of cancer
Term
types of femoral fx
Definition
1. head
2. neck: subcapital, transcervical, basicervical
3. intertrochanteric
4. subtrochanteric
Term
corpectomy
Definition
removal of vertebral body
Term
if dens not fused to rest of the C2
Definition
os odontoideum
Term
segond fx
Definition
avulsion of the lateral capsular ligament
Term
synovial cell sarcoma
1. in joint?
2. why that name?
Definition
1. not within joint
2. called synovial cell sarcoma because of the synovial cells
Term
total hip arthroplasty
1. if new,
2. if not new
Definition
1. if new, prosthesis
2. if not new: revision
Term
parts of the prosthesis
Definition
1. acetabular component
2. femoral component
3. stem goes into the femur
Term
types of arthroplasty
Definition
1. unipolar hemiarthroplasty
2. bipolar hemiarthroplasty
3. total hip arthroplasty
Term
bone lesions review
A. aggressive-appearing
B. benign-appearing
Definition
A. aggressive
1. benign things that appear aggressive: osteomyelitis, abc, langerhans
2. mets
3. primary tumor:
a. mm, plasmacytoma
b. lymphoma
c. leukemia
d. ewing's sarcoma
4.locaton
a. gct: epiphyseal
b. adamantinoma: tibia
c. chordoma: spine
B. benign-appearing
1. infection
2. matrix
a. osteoid: bone island, osteoma, osteoid osteoma, osteoblastoma (like osteoid osteoma, but > 2 cm
b. chondroid: chondroblastoma, enchondroma (ollier's, mafucci's), exostosis, juxtacortical chondroma (aka periosteal or parosteal chondroma), chondromyxoid fibroma
c. fibrous: fibrous dysplasia, benign fibrous histiocytoma
3. cysts: abc, sbc
4. location
a. spine: hemangioma
b. epiphyseal: gct
c. under nail: glomus tumor
5. nof
6. eg
Term
how to stage osteosarcoma
Definition
1. mri to proximal distal joint sto look for skip lesions
2. ct chest to look for mets
3. +/-bone scan
Term
does mm light up on bone scan
Definition
no
Term
causes of bone marrow reconversion
Definition
1. hypoxia like high altitude
2. possible menstruation
Term
only time you would fat sat T1
Definition
post gad
Term
sx of acl cyst and tx
Definition
1. fullness and decreased ROM
2. tx surgery
Term
if fat containing lesion
Definition
lipoma
liposarcoma
Term
dd distal phalangeal erosions
Definition
1. psoriasis
2. erosive oa
3. scleroderma
Term
cortically based lesions
Definition
1. fd
2. nof (aka fibroxanthoma)
3. osteoid osteoma (if > 2 cm then osteoblastoma)
Term
dd erosions around insertion of achilles tendon
Definition
1. ra and the seronegative (reactive, psoriatic arthritis, IBD, AS)
2. hyperparathyroidism
3. infection
4. Haglund's triad [pump bump (aka haglund's deformity), insertional tendonopathy and preachilles bursitis]
Term
1. what is hemangoma made of?
2. if large hemangioma, what is it at risk for?
Definition
1. made of fat
2. at risk for pathologic fracture
Term
ivory vertebral body
Definition
LIMP
1. treated lymphoma
2. infection
3. mets
4. paget's
Term
can AS cause spondylolysis or spondylolithesis
Definition
yes
Term
dd for fluffy periostitis
Definition
seroneg arthropathies (Psoriatic arthritis, AS, IBD, reactive arthritis)
Term
lucent lesion that is not epiphyseal
Definition
abc
fd
not gct cuz not going to epiphysis
Term
1. lack of overlap between glenoid and humeral head
2. cause
3. concurrent findings
Definition
1. possible posterior shoulder dislocation
2. sz, electric shock
3. reverse bankart, reverse hill sachs, lesser tuberosity
Term
why does a tillaux fracture usually go through the lateral epiphysis
Definition
SH III
cuz medial fuses first
Term
if low T1 and T2 with intra-articular component: dd
Definition
pvns, fibrous tissue, hematoma, calcs (look on plain film to look for calcs)
Term
% meniscal tears with bucket handle
Definition
10%
Term
1. what is the cause of ballooning
2. what if ballooning and widening of the intercondylar notch?
Definition
1. hyperemia
2. hemophilia or JRA
3. hemophilia
Term
where is the free surface of the meniscus?
Definition
superior or inferior articular surface (not anterior or posterior)
Term
myositis ossificans (aka) vs parosteal osteosarcoma:
calcification
Definition
myositis ossificans (aka heterotopic bone) calcified from outside in and parosteal osteosarcoma calcifies from inside out
Term
spondylolysis vs spondylolithesis
Definition
1. spondylolysis: fx
2. spondylolithesis: fx and movement
Term
bone within bone appearance
Definition
stophh
sickle cell
thoratrast
osteopetrosis
paget's
hypervitaminosis D
heavy metal
Term
mallet or baseball finger
Definition
avulsion at base of DIP
Term
is the greater trochanter epiphyseal?
Definition
yes
Term
ovoid lucent lesion in femoral neck
Definition
synovial herniation pit
Term
does RA have ankylosis
Definition
no
Term
sclerosis in intertrochanteric femur
Definition
liposclerosing myxofibrous tumor
Term
complications of OPPL
Definition
1. decreased ROM
2. stenosis
3. pseudoarthrosis
Term
osteochondral defect
1. if fluid around fragment then
2. if overlying cartilage is not intact then can
Definition
osteochondreal defect
1. if fluid around fragment then surgical
2. if overlying cartilage is not intact then can patch cartilage
Term
ocd vs sonk
Definition
1. ocd:lateral aspect of medial condyle, younger, chronic microtrauma (due to fatigue)
2. sonk: weight bearing surface, insufficiency fx, older
Term
stress fx usually occurs in
Definition
1. proximal tibia
2. distal fibula
Term
complication of DISH
Definition
1. fusion, fx, pseudoarthrosis, OPPL
Term
how do you r/o infection at the SI joint?
Definition
1. aspirate joint
2. prone with posterior approach
Term
sign of AVN
Definition
1. sclerosis
2. flattening of the femoral head
3. crescent sign (stepoff) and crescent sign indicates subchondral fx
Term
what is monteggia fx at risk for?
Definition
neurovascular injury
Term
1. spares disc
2. involves disc
Definition
1. spares disc
a. chronic infection like TB and fungal
b. mets
2. involves disc: acute disciitis
Term
jones vs pseudo jones
1. what does better
2. what is pseudojones
3. difference
Definition
1. pseudo jones does better
2. pseudo jones is avulsion of the peroneus brevis tendon
3. difference: jones is distal to 1.5 cm from base of 5th metacarpal
Term
lucent lesion in 8 year old in neck femur
Definition
1. more likely: infection, fd, sbc
2. less likely: eg, abc
(remember gct is epiphyseal)
Term
sclerosis of the ilium adjacent to the SI joint
Definition
osteitis condensa ilii
Term
60 yo with lytic lesion in vertebral body
Definition
mets, myeloma (plasmacytoma), lymphoma, chordoma,
Term
split peroneus syndrome
Definition
peroneus brevis splits due to impingement between fibula (esp if convex) and peroneus longus
Term
ankle trauma classification system
Definition
Lauge Hansen
Term
lateral collateral ligaments of the ankle
Definition
1. anterior talofibular: if intact, others prob intact
Term
high ankle sprain
Definition
1. syndesmosis sprains
2. anterior and posterior distal ftibiofibular
Term
tarsal tunnel syndrome
Definition
1. pressure on medial and lateral plantar nerves in tarsal tunnel
2. flexors are in tarsal tunnel
3. space occupying lesions like ganglion cysts can cause sensory symptoms in sole and medial toes
Term
deep to superfical in region of achilles
Definition
1. soleus
2. plantaris
3. gastrocnemius
Term
soft tissue mass with calcs: dd
Definition
1. myositis ossificans
2. parosteal osteosarcoma
3. juxtacortical chondroma that degenerated into a chondrosarcoma
Term
chondrosarcoma can arise from
Definition
1. chondroma
2. enchondroma (aka chondroma). if multiple,
a. Ollier's 25% risk of malignant transformation
b. Mafucci's 25% risk of malignant transformation (more risk than Olliers)
3. exostosis (osteochondroma)
a. if single: 1% risk of malignant transformation
b. if multiple: 10% risk of malignant transformation
Term
1, dd of chondrocalcinosis
2. type of calcium
Definition
2. calcium pyrophosphate crystals
1. dd
a. pseudogout (clinical presentation)
b. degenerative OA
c. RA or any of the other seroneg (AS, IBD, Reactive arthritis, PsA)
d. hyperparathyroidism
e. trauma
f. septic arthritis
g. hemochromatosis etc.
c. septic
Term
dd for lytic lesion around sclerotic nidus
Definition
1. sequestrum
2. osteoid osteoma
Term
gct location
Definition
goes to epiphysis
Term
anatomy of disc
Definition
1. central
2. paracentral
3. neuroforaminal
4. lateral recess
Term
avulsion fracture through lesser trochanter
Definition
1. in adult: worry about pathologic fx
2. in child: don't worry about pathologic fx
iliopsoas
Term
lytic lesion in older adult
Definition
1. infection
2. mm
3. lymphoma/plasmacytoma
4. mets
Term
lytic lesion in non-epiphyseal region in child
Definition
1. sbc
2. fd
3. eg
Term
what type of femoral fx do the elderly get?
at most risk for avn?
Definition
-both subcapital
-types through the neck: subcapital, transcervical, basicervical
Term
calcific density lateral to humeral head
Definition
1. heterotopic bone
2. calcific tendonitis
3. fx
Term
synovial osteochondromatosis
1. location
2. tx
Definition
1. popliteal bursa
2. tx: synovectomy
Term
which one doesn't have volar plate?
Definition
distal interphalangeal joint doesn't have volar plate
Term
6 yo with permeative pattern in metadiaphyseal portion of distal femur and soft tissue mass
Definition
1. ewings
2. infection
3. osteosarcoma
4. leukemia/lymphoma
Term
lymphoma
1. NHL
2. HL
Definition
1. NHL: increases with age. prognosis not as good as HL
2. HL: bimodal peak at 20-29 year and > 55 years. usually curable.
Term
how to differentiate osteopoikilosis vs mets
Definition
at most, osteopoikilosis will be warm on bone scan
Term
is pisiform a volar or dorsal structure?
is hook of hamate a volar or dorsal structure
Definition
pisiform: volar
hook of hamate: volar
Term
anterior humeral line should be
Definition
mid 1/3 of capitellum
otherwise, possible supracondylar fx
Term
#cortical thickening of cranium at occipital bone and clivus: dd
Definition
pagets, fd, mets
Term
the central spinal canal should be at least ___ of vertebral body width
Definition
50%
Term
#intra-articular tumor
Definition
1. pvns
2. hematoma
3. fibrous material
4. calcifications (check xr to see if calcs)
5. synovial cell sarcoma
6. abscess
Term
milwaukee shoulder syndrome
Definition
1. elderly woman
2. OA
3. complete rotator cuff tear
4. calcium hydroxyapatite and calcium pyrophosphate crystals
Term
if fx through pedicle and lamina
Definition
pedico-laminar fx
Term
#soft tissue density (not fat) near proximal 5th digit
Definition
giant cell tumor of the tendon sheath
Term
do you think avulsion fx at the greater trochanter in an adult is pathologic?
Definition
no. gluteus medius and minimus
Term
1. what are screws between fragments?
2. what are screws
Definition
1. interfragmentary screws
2. tibiofibular syndesmotic screw
Term
when do you worry about chondrosarcoma
Definition
1. pain
2. growth after skeletal maturity
3. rapid growth over short period of time
4. cartilaginous cap > 1cm
5. any aggressive features
Term
heel spurs
Definition
1. posterior
2. plantar
Term
mr
1. image contrast
a. T1
b. fluid sensitive
2. pulse sequence
a. spin echo
b. gradient echo
c. inversion recovery
3. PD
a. if fat sat:
b. if not fat sat
Definition
1. image contrast
a. T1
b. fluid sensitive
1) T2
2) T2* (this can be T1 or PD fat sat using gradient echos)
3) STIR: homogeneous fat sat over large FOV
4) FLAIR
2. pulse sequence
a. spin echo
1) types
a) CSE (echo train length = 1)
b) FSE (echo train length >1, usually 16, 32 etc.0
c) DSE
d) single shot (good for MRCP) or echo planar
2) can be
a) T1: low TR, low TE
b) T2: high TR, high TE
c) PD: high TR, low TE
b. gradient
1) e.g. SPOILED and more
2) TE < 25, TR < 700
c. IR: high TR, variable TE
1) STIR: homogeneous fat sat over large area
2) FLAIR: see pathologic fluid in brain
3. PD
a. if fat sat, looks fluid sensitive
b. if not fat sat, looks like T1
Term
aggressive appearing
1. benign things
2. mets
3. round cell tumor
4. location specific
Definition
things that can look aggressive
1. benign things
a. infection
b. ABC
c. EG
2. mets
3. round cell tumor
a. Ewing's sarcoma
b. multiple myeloma (plasmacytoma)
c. lymphoma
d. leukemia: kids
4. location specific
a. epiphysis: GCT
b. anterior tibial cortex: adamantinoma
c. spine, sacrum, clivus: chordoma
Term
what do you see for AVN
1. xr
2. mr
Definition
1. XR: crescent sgn
2. MR: double ling sign/rim sign
Term
renal osteodystrophy
Definition
1. osteomalacia
2. osteopenia
3. osteosclerosis
4. soft tissue calcifications
5. secondary hyperparathryoidism
a. bone resorption
b. brown tumor
c. possible chondrocalcinosis (more common with primary hyperparathyroidism)
Term
abc due to
Definition
1. local circulatory disturbance
2. development of dilated vascular channels
Term
# points to os naviculare (medial to navicular bone)
1. what attaches?
2. what is the significance?
Definition
1. posterior tibial tendon attaches to os naviculare
2. posterior tibial tendon may be unstable if attached to an os naviculare
Term
does sustentaculum tali project medially or laterally
Definition
medially
Term
gct is located
Definition
epiphyseal
Term
scoliosis
1. look at
2. tx
a. < 20 degrees
b. 20-40 degrees
c. > 40 degrees
Definition
1. look at Cobb angle
2. tx
a. < 20 degrees: no tx
b. 20-40 degrees: back brace
c. > 40 degrees: surgery
Term
#physis appears widened medially along proximal left tibia
Definition
dx stress fx
Term
pisiform
1. dorsal or volar
2. sesamoid bone of
Definition
pisiform
1. volar (hook of hamate is also volar)
2. sesamoid bone of flexor carpi ulnaris
Term
tx for scapholunate ligament tear
Definition
surgery to re-attach the ligaments
Term
tx for SLAC wrist
Definition
arthrodesis
Term
#subtalar and talonavicular joint dislocation
Definition
basketball foot
Term
#right hip is normal and left hip has
a. dysplastic acetabulum
b. erosion of femoral head
Definition
dx: infection. it is not hip dysplasia because erosion of femoral head
Term
# 15 yo with peri articular osteopenia, fusion of carpal bones
Definition
JRA
Term
#aggressive sclerotic lesion in acetabulum dd
Definition
1. mets like from prostate
2. paget's dz
3. osteosarcoma
dx: tx'd prostate mets with rad tx, which caused osteosarcoma
Term
#xr pelvis
1. erosions of the pubic symphysis
2. (left hip also pinned and there's OA)
Definition
dd:
1. RA and seronegatives (AS, IBD, PsA, Rxtive A)
2. infection
3. chronic microtrauma
Term
#chondrocalcinosis in the knee and patellofemoral joint narrowing
1. what is this?
2. if aspirate joint, what do you see?
Definition
1. this might be pseudo gout, which is a clinical dz
2. might be calcium pyrophosphate crystals if aspirate joint.
Term
ossification vs calcification
Definition
ossification: bone by itself
calcification
Term
#almost looks like extra bone near inferior pubic ramus
Definition
1. myositis ossificans (aka heterotopic bone)
Term
what % of pars defect is symptomatic
Definition
50%
Term
#lateral thumb xr
avulsion fx of extensor policis longus
1. mechanism
2. aka
Definition
1. mechanism: forced flexion
2. aka: baseball or mallet finger
Term
1. what are the hyperdense areas in gouty arthritis due to?
2. dd
Definition
1. calcium urate crystals
2. gout, infection esp TB, RA (if lesions are proximal), RSD?
Term
What are the two things that you want to look at if looking at soft tissue mass?
Definition
1. density: is it fat density?
2. bone involvement
Term
how long does it take for osteomyelitis to appear on plain film
Definition
10-14 d
Term
1. ACL screws are called
2. what do you use to repair the ACL
3. complications of ACL graft
Definition
1. interference screws
2. patellar tendon, cadaveric graft (patellar tendon or hamstring)
3. complications of ACL graft: re-tear, cyclops lesion, infection, graft vs host disease, secondary OA
Term
ligament so humphrey and wrisberg
Definition
1. meniscofemoral ligaments
2. goes from posterior horn of lateral meniscus to medial femoral condyle
3. 2 types
a. humphrey: anterior to pcl
b. posterior of pcl
Term
central vs marginal erosions
1. central erosions
2. marginal erosions
Definition
1. central erosions:
a. RA
b. 4 seronegatives (Rxtive A, PsA, IBD, AS)
c. erosive OA
d. pseudogout
2. marginal erosions
a. infection
b. gout
Term
epiphyseal lesions
Definition
MICE GAS
mets
infection (Brodie's abscess)
chondroblastoma
EG
GCT (epiphyseal)
ABC (not normally epiphyseal, but can cross to epiphysis when physis fuses)
subchondral cyst
Term
#aggressive lesion in the right cervical facet dd
Definition
1. osteosarcoma
2. chondrosarcoma
3. Ewing's sarcoma
4. infection
5. lymphoma
dx: chondromyxofibroma
Term
#41 yo expansile lesion in proximal fibula
Definition
1. dx: gct. not ABC because pt is 41 years old. ABC usually occurs in younger patients. if 70 year old and this lesion, should include some mets like renal or thyroid, which can be bubbly
Term
Freiberg's infraction
1. associated with
2. is
3. dd
Definition
1. associated with high heeled shoes
2. is AVN of the 2nd or 3rd metatarsal head
3. dd: infection
Term
Segond vs Pelligrini stieda phenomenon
Definition
1. Segond: lateral proximal tibia: lateral capsular ligament
2. Pelligrini stieda phenomenon: medial distal femur. medial collateral ligament from the medial femoral condyle.
Term
mechanism of Jefferson's?
what is it?
Definition
C1 fx
axial loading
Term
Y view is to see
Definition
fx through the coracoid
Term
1. bone marrow should be
2. if not, it could be
Definition
1. bone marrow should be darker than disc space or muscle
2. if not darker then disc space of muscle then could be bone marrow reconversion
Term
risk of chondrosarcoma goes up wtih
Definition
1. endosteal scalloping
2. axial location
3. larger lesions
Term
what else can look like double PCL sign
Definition
ligament of Humphrey (meniscofemoral ligament) from posterior horn of lateral meniscus to medial femoral condyle
Term
Weber classification and tx
A. distal fibula
B extends from joint
C. proximal fibula
Definition
A: not surgical
B: might be surgical
C. surgical
Term
1. tx for scapholunate or TFC tear
2. what are complications of scapholunate tear?
Definition
1. ans: surgery
2. OA and SLAC wrist
Term
24 yo with forearm xr. soft tissue mass adjacent to the ulnar causing erosions and saucerization
1. dd
2 if fluid fluid levels on MR
Definition
1. dd (differentiate by hx)
a. parosteal osteosarcoma
b. infection
c. chondroma
d. hematoma
2. if fluid fluid level on MR
a. ABC
b. telangiectatic osteosarcoma
Term
another name for watershed zone
Definition
musculotendinous junction
Term
DISH
1. mc location
2. sx DISH
3. what other entities big big osteophytes
Definition
1. mc location: thoracic spine
2. decreased ROM
3. PsA and Rxtive A
Term
#will be on boards
1. 35 yo f with
1. ballooned patella
2. gracile bone
3 dd if female or if male
Definition
1. ballooning in patella shows hyperemia, which may be accompanied by intercondylar notch widening. this may represent hemophilia in male or JRA in female.
2. gracile bone: NIMROD (overtubulated, long thin):
Neurofibromatosis/neuromuscular dz
immobility
marfans
JRA
OI
dysplasia
3. dx
if male: hemophilia
if female: JRA
(aside: TONGS for undertubulated bone, tumor like lesions (paget, FD, multiple hereditary exostosis, osteopetrosis, niemann picks, gauchers, sickle cell dz)
Term
#gout hand
1. if distal: dd
2. if proximal: dd
Definition
1. if distal: gout
2. if proximal: gout or RA
Term
#mri s/p surgery of L spine, give contrast
1. if doesn't enhance
2. if enhances
Definition
1. if doesn't enhance: disc
2. if enhances: scar tissue
Term
#MR meniscal tear
1. types of tear
2. types of cyst
3. tx
Definition
1. types of tear:
a. horizontal: degenerative
b. vertical: traumatic
2. types of cyst. if see meniscal cyst then makes meniscal tear more likely
a. parameniscal: next to meniscus
b. intrameniscal: within meniscus
3. tx
a. if peripheral: stitch: can heal cuz has good blood supply
b. if central: meniscectomy (cannot heal well so don't use stitch)
Term
#26 yo with epiphyseal lesion
Definition
1. abc
2. gct
3. eg
4. chondroblastoma
Term
polyp vs mucous retention cyst on MR
Definition
1. polyp: enhances
2. mucous retention cyst: doesn't enhance
Term
why wouldn't you give contrast on T2?
Definition
because contrast would be dark on T2
Term
what are the two ways of classifying ankle injuries
Definition
1. Weber: classified by radiograph
2. Lauge Hansen: classified by mechanism
Term
#5 causes of sclerotic lesion that appears indeterminate
Definition
1. mets
2. infection
3. multiple myeloma
4. lymphoma
5. one more
Term
# xr pelvis with sclerosis only on sacral side
1. dx
2. occurs in
Definition
1. osteitis condensa ilii
2. happens in multiparous women
Term
laminar fx vs clay shoveler's fx
Definition
1. laminar fx: higher
2. clay shoveler's fx: lower
Term
1. B9 lesions
2. malignant
Definition
Benign lesions
1. osteoid lesions
a. osteoid osteoma < 2cm/osteoblastoma > 2 cm
b. osteoma
c. bone island
d. liposclerosing myxofibrous tumor LSMFT
2. chondroid
a. enchondroma (chondroma)
b. exostosis (osteochondroma)
c. chondroblastoma (low T2, epiphysea, young adultsl)
d. chondroid myxoid fibrous tumor (metaphyseal, young adults)
3. fibrous
a. non ossifying fibroma (fibroxanthoma)
b. benign histiocytoma fibroma (looks like NOF, but with expansion)
c. fibrous dysplasia
4. cystic: ABC, SBC
5. misc: hemangioma, hyperparathyroidism (brown tumor), gct, eg, lipoma (calcaneous)
malignant
1. osteosarcoma
a. conventional: intramedullary cloud like
b. telangiectatic: looks like ABC
c. juxtacortical
1) parosteal: more common. arises from outer layer of periosteum. cauliflower. prognosis better than conventional osteosarcoma. older presentation than conventional osteosarcoma.
2) periosteal. less common. arises from inner layer of periosteam. saucerization
2. chondrosarcoma: intramedullary type is on boards
a. age older
b. metaphyseal
c. basu has case of rib chondrosarcoma
Term
what is the ligament affected in atlanto axial instability
Definition
transverse ligament
Term
in jefferson fx
Definition
anterior C1 goes anteriorly and posterior C1 goes posteriorly
Term
#35 yo male with lesion in distal femur (not epiphyseal) demonstrating endosteal scalloping. CT shows geographic lesion. HU 30. dd?
Definition
1. dd: fd, benign fibrohistiocytoma (aka benign histiocytoma fibroma)
2. pt too old for osteoblastoma or ABC
Term
#lateral skull xr
1. hyperplstic frontal sinus (if small called hypoplastic)
2. calvarial thickening posteriorly
3. macrognathia (big jaw)
Definition
dx: acromegaly
Term
#xr of patella.
cortically based sclerotic lesion posterior distal aspect of femur
1. dd
2. is nof a tumor?
3. what if nof?
4. when is NOF usually gone by?
5. if multiple nof, think of
Definition
1. dd: nof, fd
2. NOF is not a tumor
3. NOF is a defect in growth plate
4. NOF is usually gone by 40 year
5. if multiple NOF, think of neurofibromatosis
Term
13yo f with left hip dysplasia in frog leg view. there are pins projecting over the left acetabulum
dd?
Definition
-dd:
1. hip dysplasia, infection, legg calve perthes with secondary OA, SCFE with secondary OA
-dx: hip dysplasia
Term
#lytic L4 vertebral body
Definition
1. mets
2. multiple myeloma
3. lymphoma
4. infection
5. chordoma
Term
distal radius xr
Definition
1. one side: buckle/torus fracture
2. other side: greenstick
Term
lateral collateral ligamentous complex
Definition
1. lateral collateral ligament
2. IT band
3. biceps femoris
4. popliteus
5. and more
Term
STIR stands for
Definition
short tau inversion recovery
Term
#multiple lytic and sclerotic mixed lesion in thoracolumbar spine
Definition
1. mm/plasmacytoma
2. lymphoma
3. mets
4. infection
Term
#erosions at talonavicular joint
Definition
1. dx: RA
2. dd: PsA, Rxtive A, infection
Term
dense metaphyseal bnads in 13 month old
1. dd
2. how to differentiate dd
Definition
1. dd: pb poisoning, tx'd rickets or physiologic
2.
a. if dense metaphyseal bands not seen in fibula then, physiologic
b. if dense metaphyseal bands seen in fibula then likely lead poisoning
Term
Lis franc
1. tx
2. complication
Definition
1. tx: surgery
2. complication: OA
Term
what is the mechanism of medial malleolar fx?
1. inversion (distal foot points medially) or
2. eversion (distal foot points laterally)
Definition
medial malleolar fx caused by inversion
Term
#foot with periostitis. dx?
Definition
dx: bronchogenic lung ca
Term
mushroom shaped femoral head and normal acetabulum
1. called
2. dd
Definition
1. mushroom shaped femoral head called coxa magna
2. dd: AVN or Legg Calves Perthes disease (5 years old usually, SCFE is usually 10-15 years old)
Term
AC joint separation
Definition
1. can do AC joints bilaterally with weights
2. if > 50% difference then can have dx of AC joint separation
Term
appearance of hemangioma is due to
Definition
1. vertical trabeculations which are preserved.
2. corduroy appearance on sagittal and polka dot appearance on axials
Term
HU
1. linear or exponential
2. examples
Definition
1. exponential
2. examples:
+1000 bone
+100 soft tissue
0 water
-100 fat
-1000 air
Term
HAV
1. stands for
2. aka
3. tx
Definition
1. hallux valgus
2. aka bunion
3. tx: bunionectomy
Term
upper vs lower lobes
Definition
upper: cystic fibrosis, AS, silicosis, sarcoidosis, eg, tb
lower: bronchiectasis, asbestosis, desquamative interstitial pna, alpha one antitrypsin deficiency, scleroderma, sickle cell disease.

upper: tb, lower: fungal as per Dr. erickson's notes
Term
causes of BM reconversion
Definition
chronic hypoxia: marathon runners, high altitudes, menstruation, SCD, thalassemia
Term
1. os trigonum
2. os navicularae
Definition
1. os trigonum: located posterior to talus. can cause posterior ankle impingement syndrome
2. os naviculare: located medial to navicular bone. can cause instability as posterior tibial tendon inserts here
Term
cuneiform means
hamate means
Definition
cuneiform means wedge shaped
hamate means hook shaped
Term
#moth eaten appearance in distal tib and fib to metatarsals
dd
Definition
1. infection
2. osteopenia (better)/osteoporosis (worse)
3. reflex sympathetic dystrophy
Term
bursas around the shoulder from medial to lateral
Definition
1. subcoracoid
2. subacromial
3. subdeltoid
Term
what is bright on T1?
Definition
1. fat
2. proteinaceous material
3. blood
4. dilute calcium
Term
#lucent lesion in femoral head with pathologic fx in skeletally immature pt. dd
Definition
1. main dd: fd, infection
2. other dd: eg, ubc/sbc
3. abc vs gct
a. abc: starts metaphyseal when younger than 12 years old and then epiphyseal
b. gct: starts metaphysealwhen around 12 year old and then epiphyseal
Term
xr foot with soft tissue with faint calcs
1. dd
2. calcs disappear on bone windows so dd
Definition
1. gout, hemangioma, hematoma
2. if calcs disappear on bone windows then dx is gout (hemangioma and hematoma have bulkier calcs that don't disappear on bone windows)
Term
xr femur with calc in soft tissue. dd
Definition
1. heterotopic bone
2. avulsion fx from the lesser trochanter (iliopsoas) (dx)
Term
#lytic lesion in the femoral head and neck: dd
Definition
1. FD
2. not NOF cuz not cortically based
Term
femoral acetabular impingement
1. types
2. a cause
3. tx
Definition
1. CAM: femur and Pincer: acetabulum
2. cause: OA
3. tx: surgery
Term
# lateral radiograph of the knee with normal variant
Definition
trochlear shelf
Term
sclerotic lesion with some areas of lucency of left hip (rod and screw also in place)
1. dx
2. malignant degeneration
3. why not osteoma
Definition
1. liposclerosing myxofibrous tumor
2. 10% chance of malignant degeneration
3. not osteoma because of areas of lucency
Term
#11 mo xr radius and ulna
1. fx thru ulnar
2. periostitis
dx?
Definition
subacute fx
Term
complications of ACL tear (if see interference screws on xr then ask for MR to check for complications)
Definition
1. ACL re-tear
2. cyclops lesion (fibrosis anterior to the distal insertion of the interference screw)
Term
#foot xr with
pencil in cup at MTP joint, erosions fluffy periostitis (aka enthesopathy)
dd?
Definition
1. not RA cuz RA doesn't cause fluffy periostitis (enthesopathy). fluffy periostitis is productive change
2. not neuropathic joint because not much debris
3. dd: seroneg (Rxtive A, PsA, IBD, AS)
4.
Term
causes of loosening
Definition
1. mechanical loosening
2. infection
3. particle disease
4. acute fx
Term
1. what innervates the hamstrings?
2. obturator nerve goes through
3. innervates the adductors
4. innervates the quadriceps?
5. origin vs insertion
Definition
1. hamstrings innervated by sciatic nerve
2. obturator foramen
3. obturator nerve innervates the adductors
4. quadriceps innervated by the femoral N
5. origin is proximal insertion is distal
Term
what is this wire thing called that is encircling the femur in a pt with hip replacement?
Definition
cerclage
Term
#if pt is female, can she have AS
Definition
a female can have AS, but AS is more common in males
Term
#
1. cloud-like lesion adjacent to the distal femur.
on CT,
2. intramedullary cavity involvement on CT
Definition
dx: conventional osteosarcoma. this is not parosteal or periosteal osteosarcoma because there is too much intramedullary cavity involvement
Term
# tib/fib xr
vertical cortical sclerosis around tibia and fibula
#4271700
Definition
dx: sclerosing dysplasia
Term
#xr cervical spine
f: posterior part of C2 goes posteriorly
dd?
Definition
1. dd: hangman's fx (traumatic spondylolithesis) or dens fx
2. dx on CT: dens fx
Term
mr acl cyst. sx?
Definition
1. feeling of fullness
2. decreased ROM
3. pain
Term
#CT of facial bones
F: left maxillary bone lesion
dd?
Definition
dd: osteosarcoma, infection
Term
main sclerosing dysplasias
1. melorheostosis
a. symptomatic?
b. tx?
c. affect many bones?
2. osteopoikilosis
a. bone scan?
b. symmetric?
3. osteopathia striata: appearance?
4. osteopetrosis
a. appearance
b. complication
5. pyknodysostosis: rare?
6. intramedullary osteosclerosis
Definition
1. melorheostosis
a. can be symptomatic
b. no real tx
c. can affect many bones, but usually in a dermatomal pattern
2. osteopoikilosis
a. look warm on bone scan and can use this to distinguish from mets (hot on bone scan)
b. yes, symmetric
3. osteopathia striata: thin sclerotic vertical lines
4. osteopetrosis
a. bone within bone appearance
b. complication: fx
5. pyknodysostosis: rare
6. intramedullary osteosclerosis: rare. affects the intramedullary cavity
Term
multicentric reticulo histiocytosis looks like
Definition
sarcoid
Term
#hand xr with bilateral acroosteolysis with calcs at tips of fingers. dd?
Definition
1. scleroderma
2. frostbite
3. psoriasis
dx: scleroderma
Term
dd for posterior scalloping
Definition
1. dural ectasia: marfans, erlos danlos, AS, NF
2. small spinal canal: achondroplasia
3. mucopolysaccharidoses
a. Hurler: anterior inferior vertebral body beaking
b. Morquio: anterior mid vertebral body beaking
4. neoplasm
a. in child: astrocytoma
b. in adult: ependymoma
Term
dd for vertebra plana
Definition
fx
eg
tumor (mm, lymphoma, leukemia)
infection
steroids
hemangioma
Term
wormian bones
Definition
porkchops
pyknodysostosis
oi
rickets, healing
kinky hair syndrome
cleidocranial dysostosis
hypothyroidism, hypophosphatasia
otopalatodigital syndrome
pachydermoperiostosis, progeria, primary acro-osteolysis (Hadju cheney syndrome)
syndrome of downs
idiopathic
Term
dd periosteal reaction children
Definition
slaampocc
1. syphillis
2. leukemia
3. hypervitaminosis A
4. abuse
5. mets
6. physiologic
7. oi
8. caffey's disease (infantile cortical hyperostosis)
9. vitamin C deficiency (scurvy)
Term
discoid meniscus
1. prone to
2. dx
Definition
discoid meniscus
1. prone to tears
2. see central portion of disc on 3 or more slices (aka > 14 mm)
Term
baker's cyst located between
Definition
1. semimembranosis
2. medial head of the gastrocnemius
Term
types of meniscal tears
1. classified by direction
2. defn of complex tear
Definition
1. horizontal
2. radial
3. vertical
if more than one plane then complex tear
Term
fatty proliferation of the synovium
Definition
lipoma arborescens
Term
how common is a bucket handle tear?
when do you suspect bucket handle tears
Definition
1. 10% of meniscal tears are bucket handle tears
2. suspect bucket handle tears when meniscus is diminutive or truncated.
Term
dd for double pcl sign
Definition
1. bucket handle tear of the medial meniscus
2. acl tear
3. meniscofemoral ligament of Humphrey
Term
1. can synovial osteochondromatosis be in bursa?
2. particle disease is a reaction against?
3. signs of coalition
4. appearance of thalassemia in skull
5. chronic osteomyelitis can develop into
6. infarct can transform into
7. characteristics of RA of the knee
8. periosteal reaction that looks like hair on end (but not in the skull) is called
9. word used to describe meniscus that does have bone next to it.
Definition
1. yes, synovial osteochondromatosis can be in bursa
2. particle disease submicron particles like polyethylene or metal or any other submicron particle
3. signs of coalition
a. talar beaking: nonspecific, but due to the coalition
b. anteater's nose sign: calcaneonavicular coalition
c. C sign: subtalar coalition (aka talocalcaneal coalition)
4. appearance of thalassemia in skull: hair on end
5. chronic osteomyelitis can develop into squamous cell cancer (Marjolin's ulcer)
6. infarct can transform into MFH (malignant fibrous histiocytosis)
7. RA of the knee has marked joint space narrowing bilaterally, but not much productive change
8. periosteal reaction that looks like hair on end (but not in the skull) is called sunburst
9. meniscus is "uncovered" if doesn't have bone next to it.
Term
fractures that children can get
Definition
1. buckle: bulges in or out
2. torus fracture: bulges out
2. greenstick fracture: fracture does not extend to the other side.
3. plastic bowing fracture: bowing without visible fracture
Term
1. when describing subluxation, describe the movement of the ____ bone
2. epiphyseal lesions
3. what is the etiology of Keinboch's
4. tenosynovitis vs. tendinopathy
5. Blount's disease associated with and due to
Definition
1. when describing subluxation, describe the movement of the distal bone e.g. anterior translation of the tibia (in relation to the femur). also consider the possibility of dislocation with subsequent relocation.
2. epiphyseal lesions: mice gas (mets, infection, chondroblastoma-benign appearing, eg, gct, abc, subchondral cyst AND telangiectactic osteosarcoma.
3. Keinbochs is avn from chronic microtrauma
4. tenosynovitis (fluid around tendon) and tendinopathy (tendon thickened and/or high signal within tendon)
5. Blount's disease associated with early weight bearing and due to infection/trauma. not AVN.
Term
chondrosarcoma
1. characteristics on plain film suspicious for chondrosarcoma
2. if ____, cannot follow up in 6 months
Definition
chondrosarcoma:
1. characteristic
a. endosteal scalloping
b. axial location (not appendicular)
c. large
d. painful
2. large or painful
Term
A. dd for HOA (hypertrophic osteoarthropathy)
B. how to differentiate HOA from venous stasis?
Definition
A.
1. venous stasis
2. primary HOA: pachydermoperiostitis (hereditary)
3. secondary HOA: thyroid acropachy, IBD, biliary disease, cirrhosis
4. HPOA: lung cancer, solitary fibrous tumor of the pleura, chronic inflammatory or infectious process in the lungs, mesothelioma
B. venous stasis is usuallly not painful (presents with swelling) and HOA is likely painful. venous stasis can have ulcers, phleboliths, associated varicosities.
Term
dd sclerotic diaphyseal lesion, cortically based
Definition
1. NOF
2. FD
3. osteoma
4. osteoid osteoma, maybe.
Term
dd for calcifications in soft tissue
Definition
1. polymyositis/dermatomyositis: sheet like
2. scleroderma: can be sheet like, but if see sheet like, choose polymyositis/dermatomyositis first.
3. hyperparathyroidism
Term
1. the higher the te, the more ___ weighting
2. if the vertebral body is replaced with fat, this could be due to
3. abc
a. is abc only epiphyseal?
b. abc has what characteristic?
c. dd
4. in and out of phase imaging
a. if tr is the same and te is 2
b. if tr is the same and te is 4
5. patellofemoral narrowing, ballooning in the patella:
a. dx
b. main dd
c. other dd
6. osteosarcoma
a. conventional
b. periosteal
c. parosteal
Definition
1. the higher the te, the more t2 weighting
2. if the vertebral body is replaced with fat, this could be due to radiation tx
3. abc
a. abc is not only epiphyseal, it could occur secondary to other things so it can be anywhere.
b. abc has fluid fluid levels
c. dd: telangiectactic osteosarcoma also has fluid fluid levels
4. in and out of phase imaging
a. tr is the same and te is 2, out of phase imaging with india ink. if fat, will drop out on out of phase imaging.
b. tr is the same and te is 4, in phase imaging. no india ink.
5. patellofemoral narrowing and ballooning in patella
a. dx: hemophilia
b. main dd: jRA (or JIA now)
c. other dd: RA or any of the seronegatives
6. osteosarcoma
a. conventional: more involvement of medullary cavity
b. periosteal: calcs, but not as much as parosteal
c. parosteal: more calcs outside of medullary cavity.
(parosteal older and better prognosis than conventional. periosteal also has better prognosis than conventional, but not as good as parosteal)
Term
1. renal osteodystrophy
2. what can look like DISH if there is bulky anterior osteophytes?
3. What are some other epiphyseal equivalents?
4. 3 things that can have a fluid fluid level
5. dd: epiphyseal lesion in 24 yo
a. if intermediate aggressiveness:
b. if more aggressive appearing:
c. if well circumscribed:
Definition
1. renal osteodystrophy is osteomalacia and secondary hyperparathyroidism
2. Psoriatic arthritis and reactive arthritis can look like DISH if DISH has bulky osteophytes
3. The tarsal bones, greater/lesser tuberosity or greater/lesser trochanter are epiphyseal equivalents
4. 3 things that can have fluid fluid level: abc, gct, telangiectatic osteosarcoma
5.dd: gct, abc
a. if intermediate aggressiveness: gct, abc, infection
b. if more aggressive appearing: telangiectatic osteosarcoma
c. if well circumscribed: chondroblastoma
Term
Describing tumors
Definition
Describing tumors
1. matrix: lucent, sclerotic, fibroid
2. location: epiphyseal, metaphyseal, diaphyseal
3. location: central, eccentric, cortically based, periosteal
4. aggressiveness:
a. narrow or wide zone of transition
b. sclerotic border vs no sclerotic border
c. geographic vs permeative
d. erosions
e. soft tissue component
f. periostitis
Term
lucent lesion neck of femur. young person
Definition
1. eg
2. fd
3. sbc
4. brodie's abscess
Term
1. what is giant cell tumor of the tendon sheath?
2. giant cell tumor of the tendon sheath is the same pathological entity as?
Definition
1. soft tissue that is low T1 and T2. can cause changes (like sclerosis) of the adjacent bone, but it is not a bone lesion
2. pvns
Term
1. if you cannot tell if something is fluid sensitive because there is no fluid to be seen and it is fat sat, it may be___
2. usually if there is fluid around a tendon, then it is ___ unless
3. time to inversion
a. STIR
b. FLAIR
Definition
1. if you cannot tell if something is fluid sensitive because there is no fluid to be seen and it is fat sat, it may be T2 because most places will fat sat their T2
2. usually if there is fluid around a tendon, then it is tenosynovitis unless it is the biceps tendon or flexor hallucis longus (these may have some fluid around them because continuous with joint space.
3. TI
a. STIR, TI around 150
b. FLAIR TI around 2500
Term
fu of lesions
Definition
1. if definitely benign: no fu
2. if prob benign: 6 m fu (most ~99% of b9 appearing lesions fall into this category)
3. if fx, pain, large then refer to ortho
Term
sclerotic on iliac side of sacro iliac joint only.
Definition
osteitis condensas illi
Term
DeQuervain's tenosynovitis
Definition
fluid around the abductor policis longus and extensor policis brevis
Term
Morel Lavallee lesion
Definition
-closed degloving injury
-may see fluid fluid levels and globules of fat.
Term
msk sequences that Dr. Egeibor does
Definition
T1, T2, PD, gradient
Term
1. ABER view used for
2. SLAP vs. sublabral recess
3. Hill sachs vs normal humerus
Definition
1. ABER (abduction external rotation) view used to assess the anterior inferior labrum
2. SLAP vs sublabral recess:
a. if < 3 mm then sublabral recess
b. if > 3 mm then SLAP
3. Hill Sachs vs normal humerus
a. if defect at coracoid or above then Hill sachs
b. if "defect" below coracoid then normal humerus.
4.
Term
aggressive bone lesion
Definition
lemon
lymphoma, eg/ewing's sarcoma, multiple myeloma/mets, osteomyelitis, neuroblastoma mets
Term
dd for high T2 in globus pallidus
Definition
1. Wilson disease
2. Japanese encephalitis
3. Leigh's dz
4. Cruetzfeldt Jacob dz
5. Carbon monoxide poisoning
Term
types of herniation
Definition
1. subfalcine: under the falx
2. uncal:
3. transtentorial(up)
4. tonsillar (down)
Term
types of vascular malformations
Definition
1. cavernous angioma (cavernoma)
2. developmental venous anomaly
3. AVM
4. Capillary telangiectasia
Term
Common locations of capillary telangiectasias
Definition
1. spine
2. cerebellum
3. pons
Term
dd for focal increased density on CTA
Definition
1. aneurysm
2. pseudoaneurysm
3. AVM
4. non accidental trauma
Term
What is high on T1?
Definition
1. met Hg:
2. melanin:
3. minerals:
4. Lipid:
5. proteinaceous material:
6. Other:
Term
What is high on T1? met Hg
Definition
1. hemorrhage
2. amyloid angiopathy
Term
What is high on T1? melanin:
Definition
melanoma mets
Term
What is high on T1? minerals:
Definition
1. Wilson
2. hyperalimentation, hypermagnesiumia, hepatic encephalopathy
3. Fahr dz (hypoparathyroidism, pseudohypoparathyroidism, pseudopseudohypoparathyroidism)
4. Fabry disease
Term
What is high on T1? Lipid:
Definition
lipoma, dermoid, teratoma
Term
What is high on T1? Proteinaceous material
Definition
colloid cyst, rathke's cleft cyst, ectopic posterior pituitary gland
Term
What is high on T1? Other
Definition
NF1, cholesterol granuloma
Term
Spectroscopy
Definition
3: choline (the bad) and creatine. if choline high then maybe neoplasm
2: NAA (the good): if low NAA then maybe neoplasm
1: Lactate and lipid (the ugly): if high then more for infection
Term
globe hemorrhage: types
Definition
1. vitreous
2. choroidal
3. retinal
Term
globe hemorrhage: vitreous
Definition
in vitreous humor
Term
globe hemorrhage: choroidal
Definition
U shaped
Term
globe hemorrhage: retinal
Definition
V shaped
Term
dd cholesterol granuloma
Definition
1. mucocele
2. mets
Term
cholesterol granuloma: T1 and T2
Definition
both T1 and T2 high
Term
cholesterol granuloma: location
Definition
petrous apex
Term
cholesterol granuloma: why high T1?
Definition
blood products
Term
Posterior vertebral scalloping: due to
Definition
1. Increased intraspinal pressure
2. Dural ectasia
3. Think of achondroplasia if has small spinal canal
4. congenital skeletal d/o
Term
Posterior vertebral scalloping: dural ectasia
Definition
1. Marfan
2. Erlos danlos
3. NF1
4. Ank Spond
Term
Posterior vertebral scalloping and small spinal canal, think of
Definition
achondroplasia
Term
Posterior vertebral scalloping: congenital d/o
Definition
Morquio and Hurler
Morquio: central beaking anteriorly
Hurler: inferior beaking anteriorly
Term
causes of thrombus in dural venous sinus
Definition
dm spot
1. dehydration
2. meningitis
3. sickle cell dz
4. pregnancy
5. ocp
6. trauma
Term
when do you see in the empty delta sign?
Definition
superior sagittal sinus thrombosis
Term
physiologic vascular hyperdensity
Definition
1. hemoconcentration: dehydration and polycythemia vera
2. neonate
Term
salivary gland tumors:
1. benign
2. malignant
Definition
1. benign: pleomorphic adenoma, warthin's tumor
2. malignant: Muco-epidermoid ca, adenocystic ca
Term
mc benign salivary gland tumor
Definition
pleomorphic adenoma
Term
mc malignant salivary gland tumor
Definition
Muco-epidermoid ca
Term
mc benign in male vs female
Definition
1. male: warthin's
2. female: pleomorphic adenoma
Term
mc benign unilateral vs bilateral
Definition
uni: pleomorphic adenoma
bi: 10% of Warthin's are bilateral
Term
Salivary gland tumor that likes perineural spread
Definition
Adenocystic ca along CN VII
Term
Do malignant salivary gland tumors occur more often in the parotid or non-parotid gland?
Definition
Non-parotid glands
Term
Cystic lesions in posterior fossa in adult
Definition
1. hemangioblastoma
2. cystic mets
Term
Cystic lesions in posterior fossa in child
Definition
1. pilocytic astrocytoma
2. ganglioglioma
3. pleomorphic xantho astrocytoma
Term
intraventricular neoplasms (6)
Definition
1. colloid cyst
2. choroid plexus papilloma
3. choroid plexus carcinoma
4. mets
5. subependymoma
6. meningioma
7. central neurocytoma
Term
Where are intraventricular meningiomas?
Definition
in the atria (between the temporal and lateral horns)
Term
dd for cortically based cystic mass with enhancing component:
Definition
do gp
1. dysembryoplastic neuroepithilieal tumor (DNET)
2. oligodendroglioma
3. ganglioglioma
4. pleomorphic xanthoastrocytoma
Term
tx for thyroglossal duct cyst
Definition
Sistrunk procedure (resection of mid 1/3 of hyoid bone and thyroglossal duct cyst)
Term
thyroglossal duct cyst may become
Definition
papillary carcinoma (mc thyroid cancer)
Term
superficial siderosis: on____, gives____
Definition
gradient, blooming artifact
Term
superficial siderosis: dd
Definition
1. brain surface vessels
2. meningoangiomatosis
Term
superficial siderosis: presents with
Definition
hearing loss
Term
superficial siderosis: prior CT may show
Definition
subarachnoid hemorrhage
Term
tumors thru the foramina of lushka
Definition
1. choroid plexus papilloma
2. choroid plexus carcinoma
3. schwannoma
4. meningioma
5. medulloblastoma (kids)
6. ependymoma
Term
Lipoma: common locations
Definition
1. interhemipheric
2. tectal
3. suprasellar
Term
Lipoma: T1 and T2
Definition
high on both
Term
Lipoma:dd
Definition
hemorrhage
dermoid
teratoma
Term
Colloid cyst: location
Definition
anterior aspect of the 3rd ventricle
Term
Colloid cyst: can cause
Definition
obstructive hydrocephalus
Term
Colloid cyst: benign?
Definition
yes
Term
Colloid cyst: on mr
Definition
variable
Term
Colloid cyst: on non con CT
Definition
high density
Term
Colloid cyst: tx
Definition
1. surgery
2. aspiration
3. shunting
Term
intramedullary tumors
Definition
1. astrocytoma
2. ependymoma
3. hemangioblastoma
4. mets
Term
demyelinating d/o
Definition
1. ms
2. transverse myelitis:
a. infection eg. herpes
b. post infectious ADEM
c. vasculitis
Term
intradural extramedullary
Definition
1. meningioma
2. nerve sheath tumor (schwannoma, NF))
3. leptomeningeal carcinomatosis
4. sarcoid
5. infection
Term
common causes of leptomeningeal carcinomatosis: primary in adults
Definition
gbm, astrocytoma, ependymoma
Term
common causes of leptomeningeal carcinomatosis: primary in kids
Definition
ependymoma, medulloblastoma, choroid plexus papilloma/ca, gct (germ cell tumor), Dr. P adds PNET
Term
common causes of leptomeningeal carcinomatosis: secondary
Definition
lung, breast, melanoma, lymphoma
Term
common causes of leptomeningeal carcinomatosis: aka
Definition
zuckerguss
Term
What is the tPA window for CVA?
1. intravenous:
2. Intra-arterial:
Definition
1. intravenous: 3h
2. Intra-arterial: 6 h
Term
if greater than 1/3 of MCA territory affected, can you still give tPA?
Definition
no
Term
If kyphosis of the thoracic spine and multilevel end plate irregularity, you have
Definition
Scheuermann Dz
Term
What is the tx for Scheuermann Dz?
Definition
conservative
Term
types of diastematomyelia
I:
II:
Definition
I: divided by bony or fibrous spur
II: not divided by bony or fibrous spur (but spinal cord is divided)
Term
cochlear aplasia: usually bilateral?
Definition
yes
Term
cochlear aplasia: don't see
Definition
cochlea
Term
cochlear aplasia: can see
Definition
IAC, vestibule, semicircular canals
Term
cochlear aplasia: can you get cochlear implant?
Definition
no
Term
What is it called when you have less than 2.5 turns of the cochlea?
Definition
Mondini malfn
Term
Can people with Mondini malfn get cochlear implants?
Definition
yes (remember those with cochlear aplasia cannot get cochlear implants)
Term
dd for parapharyngeal space mass
Definition
1. salivary gland tumor like pleomorphic adenoma, adenocystic ca
2. nerve sheath tumor: schwannoma and NF
3. SCC via perineural spread
Term
If have multiple nerve sheath tumors (schwannomas and NF), what syndrome?
Definition
NF2
Term
If something is in the parapharyngeal space and nerve sheath tumor, what nerve is involved?
Definition
CN V
Term
What gives restricted diffusion?
Definition
1. acute infarct
2. acute MS
3. herpes encephalitis
4. abscess
5. medulloblastoma
6. meningioma
7. pineoblastoma
8. PNET
9. lymphoma
10. mucinous adenoca mets
11. epidermoid cyst
Term
What are the sutures?
Definition
metopic, sagittal, coronal, lambdoid
Term
Craniosynostosis: sagittal
Definition
scaphocephaly or dolichocephaly
Term
Craniosynostosis: metopic
Definition
trigonocephaly
Term
Craniosynostosis: coronal
Definition
brachycephaly
Term
Craniosynostosis: what is plagiocephaly
Definition
1 or more craniosynostosis. asymmetric
Term
Craniosynostosis: all (coronal, lambdoid and sagittal)
Definition
Cloverleaf or
kleeblattschädel deformity
Term
Aneurysmal subarachnoid hemorrhage: more common in anterior or posterior circulation?
Definition
anterior
Term
Aneurysmal subarachnoid hemorrhage: mortality?
Definition
50%
Term
Aneurysmal subarachnoid hemorrhage: rebleed?
Definition
25%
Term
Aneurysmal subarachnoid hemorrhage: vasospasm in what time period?
Definition
1-3 w
Term
Aneurysmal subarachnoid hemorrhage: tx:
Definition
coiling or surgical clipping
Term
Aneurysmal subarachnoid hemorrhage: dd
Definition
pseudosubarachnoid hemorrrhage
Term
pseudosubarachnoid hemorrhage can be due to:
Definition
1. pyogenic leptomeningitis
2. diffuse cerebral edema like from hypoxia
Term
Scalp hematomas from deep to superficial
Definition
1. cephalohematoma:
2. subgaleal heamtoma:
3. caput succedaneum:
Term
Which scalp hematomas cannot cross the suture line?
Definition
1. cephalohematoma: can cross
2. subgaleal heamtoma: can cross
3. caput succedaneum: cannot cross suture lines
Term
What is the subgaleal hematoma deep to?
Definition
aponeurosis
Term
molar tooth sign: what is it?
Definition
dysplastic cerebellar vermis
Term
molar tooth sign: what syndrome is it associated with?
Definition
Joubert syndrome
Term
molar tooth sign: what does the 4th ventricle look like?
Definition
batwing
Term
If hemangioma extends into the spinal cord, it is called?
Definition
compressive or aggressive hemangioma
Term
dd for compressive or aggressive hemangioma
Definition
1. mets
2. plasmacytoma
3. GCT
Term
chordoma: what is it?
Definition
notocord remnant
Term
chordoma: mc location?
Definition
sacral
Term
chordoma: tx?
Definition
surgery and radiation
Term
dd pediatric 4th ventricle tumor
Definition
1. medulloblastoma (roof)
2. ependymoma (calcs and hemorrhage)
3. Other unconfirmed: pilocytic astrocytoma, atypical rhabdoid/teratoid tumor
Term
dd for MS
Definition
1. ADEM
2. Lyme dz
Term
dd for recurrent cerebral hemorrhage
Definition
1. HTN
2. amyloid angiopathy
3. hemorrhagic transformation of stroke
Term
amyloid angiopathy clinical picture
Definition
1. non-HTN
2. demented
Term
EG: aka
Definition
Langerhans cell histiocytosis
Term
EG: what is it?
Definition
1. proliferation of Langerhans cells histiocytosis
2. granulomatous lesions
Term
EG: dd of EG in the spine
Definition
compression fx
Term
dd for serpinginous structure along spinal cord
Definition
1, dural AVF
2. AVM
3. venous collaterals`
Term
tx for most dural AVF
Definition
endovascular embolization
Term
dural AVF can cause
Definition
venous HTN with secondary ischemia
Term
AVM: dd
Definition
dural AVF
Term
AVM: grading system
Definition
Spezler Martin
Term
AVM: grading system based on
Definition
1. size of nidus
2. eloquent vs non-eloquent region
3. deep or superficial vein
Term
AVM: tx
Definition
1. embolization
2. surgery
3. radiation (gamma knife)
Term
AVM: complication
Definition
1. bleeding
2. ischemia from steel phenomenon
Term
thalamic mass dd
Definition
1. astrocytoma
2. lymphoma
3. mets
Term
dd for periventricular high FLAIR signal
Definition
1. chronic small vessel ischemia
2. demyelinating dz
3. transependymal CSF flow (associated with acute hydrocephalus)
Term
ideal ventriculostomy position
Definition
ipsilateral frontal horn anterior to foramen of Monro
Term
posterior CC and splenium lesion
Definition
1. CNS lymphoma
2. GBM
3. mets
4. MS
5. DAI (diffuse axonal injury)
6. status epilepticus
Term
4 stages of neurocystercerosis
Definition
1. vesicular: cyst
2. colloidal: cyst with ring enhancement
3. granular: enhancing nodule
4. nodular calcified: calcified nodule
Term
Which stages are active/not active: neurocystercercosis
Definition
1 and 2 are not active
3 and 4 are active
Term
if intraventricular lesion attached to the septum pellucidum near foramen of Monro (2 dd)
Definition
1. central neurocytoma
2. subependymoma
Term
Does parenchymal involvement occur with central neurocytoma?
Definition
rare, but it can be seen with aggressive variants of central neurocytoma
Term
Mucopolysaccharidoses: prototype
Definition
Hurler's
Term
Mucopolysaccharidoses: physiology
Definition
cannot break down glycoaminoglycans (GAG) so GAG accumulate in the peri-vascular spaces (Virchow-Robin spaces)
Term
Mucopolysaccharidoses: MR findings
Definition
tubular CSF intensity structures coursing through CC and white matter (mostly parietal and occipital)
Term
dd for Hurler's
Definition
1.macrocephaly with dilated perivascular spaces/virchow robin spaces
2. normal virchow robin spaces
3. perinatal hypoxic ischemic encephalopathy
4. velocardiofacial syndrome and hypomelanosis of Ito
Term
Hurler's vs Morquio syndrome: anterior beaking
Definition
Hurler: inferior
Morquio: Mid portion
Term
Hurler's vs Morquio syndrome: CNS involved?
Definition
Hurler: yes
Morquio: No
Term
tx for Hurler
Definition
BM transplant
Term
Stapes sit on round or oval window?
Definition
oval window
Term
What is pachymeningeal enhancement?
Definition
enh of dura
Term
dd for pachymeningeal enhancement
Definition
1. pachymeningitis
2. subdural hemorrhage
3. intracranial hypotension
4. mets
5. sarcoid, fungal, TB
Term
findings in intracranial hypotension
Definition
1. pachymeningeal enh
2. caudal displacement of cerebellar tonsils
Term
What is leptomeningeal enh?
Definition
enh of pia and arachnoid
Term
dd for leptomeningeal enh
Definition
1. meningitis
2. prior subarachnoid hemorrhage
3. subacute infarction
4. leptomeningeal carcinomatosis
5. neurosarcoid, fungal, tb
Term
dd meningioma (2)
Definition
1. hemangiopericytoma
2. solitary fibrous tumor if low on T2
Term
what mimics GBM or lymphoma?
Definition
tumefactive demyelinating d/o
Term
when see something that looks like brain tumor, think of
Definition
1. tumefactive demyelinating d/o
2. subacute CVA
3. subacute hematoma
4. infection like TB
Term
if you see bitemporal lobe mass and h/o nasopharyngeal ca or chordoma
Definition
radiation necrosis
Term
dd meningioma (2)
Definition
1. hemangiopericytoma
2. solitary fibrous tumor if low on T2
Term
what mimics GBM or lymphoma?
Definition
tumefactive demyelinating d/o
Term
when see something that looks like brain tumor, think of
Definition
1. tumefactive demyelinating d/o
2. subacute CVA
3. subacute hematoma
4. infection like TB
Term
if you see bitemporal lobe mass and h/o nasopharyngeal ca or chordoma
Definition
radiation necrosis
Term
Ependymoma
1. if supratentorial:
2. if infratentorial:
Definition
1. if supratentorial: intraparenchymal
2. if infratentorial: intraventricular
Term
if tongue of tissue going out of 4th ventricle tract, it is more likely to be __1__ than__2__
Definition
1. ependymoma
2. medulloblastoma
Term
mc location of meningioma
Definition
atria of lateral ventricle
Term
does chondrosarcoma in brain have calcs?
Definition
no
Term
chrondrosarcoma vs. chordoma, which one if midline/off midline?
Definition
midline: chordoma
off midline: chondrosarcom
Term
dd GBM
Definition
lymphoma
Term
attaches to septum pellucidum (2)
Definition
1. central neurocytoma: enhances. vascular.
2. subependymoma: usually doesn't enhance. not as vascular
Term
attaches to septum pellucidum (2) and enhancemnt
Definition
1. central neurocytoma: enhances. vascular.
2. subependymoma: usually doesn't enhance. not as vascular
Term
craniopharyngioma: location
Definition
suprasellar
Term
craniopharyngioma: characteristics (2)
Definition
1. calcs
2. cysts
Term
craniopharyngioma:age
Definition
young
Term
dd for enhancing orbital mass
Definition
1. hemangioma
2. lymphangioma
3. meningioma
4. mets
5. lymphoma
Term
mc intra orbital tumor
Definition
hemangioma
Term
charac of intra orbital hemangioma
Definition
intense enhancement
Term
meningioma: associated with
Definition
NF 2
Term
meningioma:
1. if extra conal
2. if intra contal
Definition
1. extraconal:
a. sphenoid wing meningioma
b. cavernous sinus meningioma
2. intraconal: optic nerve sheath meningioma
Term
if bilateral enhancing orbital masses
Definition
1. mets
2. lymphoma
Term
tripod fx through
Definition
1. zygomatic arch
2. inferior orbital wall
3. lateral orbital wall
Term
le fort fx involves
Definition
pterygoid plates
Term
type of Le Fort fx
Definition
I: maxillary bone
II: nasal bone
III: orbital bone (most severe)
Term
cavernous sinus mass/enhancement 3 dd and 3 more
Definition
1. meningioma
2. schwannoma
3. carotid-cavernous fistula
4. Tolosa-Hunt syndrome
5. sarcoid
6. perineural spread of tumor
Term
if meningioma in cavernous sinus called
Definition
cavernous sinus meningioma
Term
schwannoma in cavernous sinus usually arise from
Definition
CN V
Term
carotid cavernous fistula (CCF): types
Definition
direct:
indirect:
Term
carotid cavernous fistula: etiology
Definition
direct: trauma
indirect: spontaneous
Term
carotid cavernous fistula:
Definition
direct: young men
indirect: older women
Term
carotid cavernous fistula: cavernous sinus connects to
Definition
direct: carotid A
indirect: branch of carotid A
Term
clue that CCF exists
Definition
dilation of the cavernous sinus, superior ophthalmic V and proptosis
Term
CCF tx
Definition
embolization
Term
orbital pseudo tumor involving the cavernous sinus is called
Definition
Tolosa Hunt Syndrome
Term
MR appearance of orbital pseudo tumor:
T1:
T2:
enh:
Definition
T1: iso to low
T2: iso to low
enh: positive enh
Term
what can spread peri-neurally thru cavernous sinus?
Definition
1. sinonasal ca
2. head and neck ca
Term
aggressive sinus dz wtih bony destruction and two more
Definition
1. invasive fungal sinusitis
2. Wegener's granulomatosis
3. sinonasal carcinoma e.g. SCC
4. Lymphoma
5. cocaine nose
Term
Invasive fungal sinusitis:
1. causes (2):
2. CT:
3. MR T1 and T2:
Definition
1. causes (2): aspergillus and mucormycosis
2. CT: fungal secretions are hyperdense
3. MR T1 and T2: low on both
Term
Wegener's granulomatosis:
1. What is it?
2. Where is it?
3. T1, T2, enh
Definition
1. vasculitis
2. sinus, lungs, kidneys
3. Low T1 and T2, enh
Term
Sinonasal ca
1. mc
2. if pterygopalatine fossa involved can go to tw places
Definition
1. scc
2. orbital, middle cranial fossa
Term
Lymphoma of paranasal sinus can involve
Definition
Waldeyer tonsillar ring
Term
What does Waldeyer tonsillar ring involve?
Definition
1. adenoids (nasopharyngeal tonsils)
2. palatine tonsils
3. lingual tonsils
4. tubal tonsils
Term
cocaine nose
Definition
1. v constriction
2. ischemia
3. necrosis
Term
dd of unilateral parotid mass and 2 more
Definition
1. pleomorphic adenoma
2. Warthin tumor
3. parotid carcinoma like mucoepidermoid ca or adenoid cystic ca
4. lymphadenopathy form lymphoma or mets
5. branchial cleft cyst
Term
pleomorphic adenoma vs warthin tumor: gender
Definition
Pleomorphic adenoma: female
Warthin tumor: male
Term
pleomorphic adenoma vs warthin tumor: uni or bilateral
Definition
Pleomorphic adenoma: uni
Warthin tumor: can be bilateral
Term
pleomorphic adenoma vs warthin tumor: appearance
Definition
Pleomorphic adenoma: heterogeneous
Warthin tumor: cystic and solid
Term
salivary gland ca: mc
Definition
muco-epidermoid ca
Term
salivary gland ca: perineural spread
Definition
adeno cystic ca
Term
salivary gland ca: more common location of salivary gland ca
Definition
non-parotid gland
Term
lymphadenopathy in parotid gland due to
Definition
1. lymphoma
2. mets from:
a. head and neck scc
b. skin ca: scc or melanoma
Term
type of branchial cleft cyst in parotid gland
Definition
I
Term
dd of bilateral parotid masses 2
Definition
1. lympho epithielial cysts.
2. Sjogrens syndrome
3. Warthin tumors
4. lymphadenopathy
5. Sarcoidosis
Term
lympho epithelial lesions occur in pts with
Definition
AIDS
Term
Sjogren syndrome
Definition
1. parotid gland enlargment
2. dry eyes
3. dry mouth
Term
sarcoidosis: enlargement of two things
Definition
1. parotid gland
2. lacrimal gland
Term
sarcoidosis: serum level of ___ is elevated
Definition
ace
Term
sarcoidosis: gallium 67 scan shows
Definition
Panda sign
Term
orbital muscle enlargement dd 2
Definition
1. thyroid associated orbitopathy
2. orbital pseudo tumor
3. lymphoma
4. sarcoidosis
5. infectious myositis
Term
thyroid associated orbitopathy: aka
Definition
graves ophthalmopathy
Term
thyroid associated orbitopathy: involves or spares the myotendinous junctions
Definition
spares (orbital pseudotumor involves the myotendinous junction)
Term
thyroid associated orbitopathy: order or EOM involvement
Definition
I'M SLOW
IR, MR, SR, LR, superior oblique
Term
orbital pseudo tumor: involves or spares the myotendinous junctions
Definition
involves. (thyroid orbitopathy spares the myotendinous junction)
Term
orbital pseudo tumor: if involves the cavernous sinus called
Definition
Tolosa Hunt syndrome
Term
dd of pharyngeal mucosal mass 2
Definition
1. SCC
2. lymphoma
3. infection/abscess
4. minor salivary gland tumor
5. Tornwalt cyst
Term
nasopharyngeal SCC arises from
Definition
fossa of Rosenmuller
Term
ring enhancing lesions
Definition
a magic dr
aids (lymphoma)
mets
abscess (infection)
glioma
infarction
contusion
demyelinating dz
resolving hematoma
Term
mets to bone: T1 and T2
Definition
T1: low
T2: high
Term
what type of stent can be used to treat dissection of the carotid?
Definition
coronary stent
Term
parts of the ica
Definition
C1, cervical;
C2, petrous;
C3, lacerum;
C4 cavernous;
C5, clinoid;
C6, ophthalmic;
C7, communicating
Term
teratoma vs dermoid: enh
Definition
teratoma enhances more than dermoid (according to south alabama)
Term
hemangioblastoma: location
Definition
intramedullary or extramedullary intradural
Term
hemangioblastoma: characteristics
Definition
syrinx and feeding vessels
Term
thallium: which is hot? lymphoma vs GBM
Definition
lymphoma
Term
thallium: which is hot? lymphoma vs. toxo
Definition
lymphoma
Term
if see filum terminale lipoma, look for
Definition
tethered cord
Term
dx of tethered cord if below:
Definition
L2-L3 interspace
Term
normal filum terminale size
Definition
< 1 mm
Term
pachymeningeal enhancement dd
Definition
~straight
pachymeningitis
intracranial hypotension
subdural hemorrhage
mets
sarcoid, fungal, TB
Term
leptomeningeal enhancement dd
Definition
~curvy
leptomeningitis
subacute infarct
prior subarachnoid hemorrhage
carcinomatous meningitis
neurosarcoid, tb, fungal
Term
sellar/suprasellar lesion
Definition
satchmo
sarcoid, sellar tumor (adenoma)
aneurysm
teratoma, dermoid, epidermoid
craniopharyngioma
hypothalamic glioma, histiocytoma
mets/meningioma
optic nerve glioma
Term
rule of 90% craniopharyngioma: 90% have 3 things
Definition
1. cyst
2. calc
3. enhancing Component
Term
Cystic suprasellar lesions
Definition
Rathke's cleft cyst
Arachnoid cyst
empty sella
Term
dd fibrous dysplasia
Definition
1. Paget's
2. mets
Term
FD and precocious puberty
Definition
Mc Cune albright syndrome
Term
hemangioma: T1 and T2
Definition
T1 high maybe cuz of fat
T2 high maybe cuz of vasculature
Term
ependymoma vs subependymoma
1. both
2. one
Definition
1. both come from ependymal cells
2. think of subependymoma as more intraventricular (not confirmed by online search)
Term
mucocele vs mucous retention cyst
Definition
mucocele causes bony expansion
Term
subarachnoid hemorrhage and aneurysm: interhemipheric fissure
Definition
A comm
Term
subarachnoid hemorrhage and aneurysm: ipsilateral basal cistern (higher than the level of the pons and posteriorly at level of 3rd ventricle, not confirmed)
Definition
p comm
Term
subarachnoid hemorrhage and aneurysm: sylvian fissure
Definition
mca trifucation
Term
subarachnoid hemorrhage and aneurysm:interpenduncular fossa (like anterior midbrain?), or intraventricular
Definition
basilar tip
Term
subarachnoid hemorrhage and aneurysm: posterior fossa cistern, intraventricular
Definition
PICA
Term
pineal gland tumors and dd
Definition
1. pineocytoma, pineoblastoma, pineal cyst
2. Germ cell tumor
3. mets
4. Retinoblastoma
Term
Trilateral retinoblastoma
Definition
bilateral orbital retinoblastoma and pineal gland tumor
Term
quadrilateral retinoblastoma
Definition
bilateral orbital retinoblastoma and pineal gland tumor and suprasellar cistern tumor
Term
How does gu infection get to spine?
Definition
Plexus of batson
Term
VHL
Definition
pancreatic cyst, pheo, renal cyst, rcc, liver cyst. Hemangioblastoma retinal and cerebellar
Term
dd for clival chordoma
Definition
(from radiographics and top 3 dd)
1. chondrosarcoma
2. plasmacytoma/lymphoma/mets
3. pituitary adenoma
4. meningioma
5. nasopharyngeal malignancy like SCC
Term
dd for sacral chordoma
Definition
1. chondrosarcoma
2. mets/plasmacytoma/lymphoma
3. GCT
4. myxopapillary ependymoma
http://www.ajronline.org/content/174/2/417.long
Term
What lines do you look it to determine if basilar invagination?http://www.urmc.rochester.edu/smd/rad/neurocases/Neurocase382.htm
Definition
1. Chamberlain's line
2. McGregor's line
3. McRae's line
Term
Chamberlin's line
Definition
1. Line from posterior hard palate to posterior aspect of the foramen magnum.
2. tip of dens should be not more than 5mm above this line
3. ~mid
Term
McGregor's line
Definition
1. Line from posterior hard palate to lowest point of the occiput.
2. tip of dens should be not more than 7 mm above this line
3. ~lower
Term
McRae's line
Definition
1. Line from anterior and posterior foramen magnum
2. tip of dens should be not above this line
3. ~upper
Term
MEN I
Definition
1. pituitary tumors
2. parathyroid tumors
3. pancreatic islet cell tumors
Term
MEN II
Definition
1. parathyroid hyperplasia
2. pheochromocytoma
3. medullary thyroid cancer
Term
paraganglioma: common carotid artery bifurcation
Definition
carotid body tumor
Term
paraganglioma: jugular foramen
Definition
glomus jugulare
Term
paraganglioma: vagus nerve
Definition
glomus vagale
Term
paraganglioma: middle ear
Definition
glomus tympanicum
Term
paraganglioma: adrenal gland
Definition
pheochomocytoma
Term
dd for epidural spinal mass
Definition
1. disk extrusion
2. epidural hematoma
3. epidural abscess
4. mets
5. epidural lipomatosis
6. synovial cyst
Term
epidural lipomatosis can be associated with (2)
Definition
1. steroids
2. obesity
Term
synovial cyst due to
Definition
degenerative facet disease
Term
dd for masticator space mass
Definition
1. infection
2. sarcoma
3. venolymphatic malfn
4. nerve sheath tumor
Term
Infection in masticator space usually arises from
Definition
tooth
Term
types of sarcoma in masticator space
Definition
1. sarcoma (can be osteosarcoma, chrondosarcoma, Ewing sarcoma
2. rhabdomyosarcoma esp in kids
Term
venolymphatic malformation in the masticator space
Definition
1. hemangioma
2. lymphangioma
Term
nerve sheath tumor in masticator space
Definition
1. schwannoma
2. neurofibroma
Term
how to distinguish schwannoma from neurofibroma
Definition
neurofibroma more homogeneous
Term
lytic skull lesion
Definition
mets
osteomyelitis
EG
hemangioma
hyperparathyrodsm
epidermoid/dermoid
Term
sellar/suprasellar mass in a child (dd130)
Definition
1. craniopharyngioma
2. germ cell tumor
3. rathke's cleft cyst
4. optic nerve/hypothalamic glioma
5. hypothalamic hamartoma
Term
craniopharyngioma
Definition
1. calcs
2. cysts
3. enh component
Term
germ cell tumor: mc subtype
Definition
germinoma
Term
germ cell tumor with fat
Definition
1. teratoma
2. dermoid
Term
hypothalamic hamartoma vs glioma
Definition
glioma enhances
Term
clinical presentation of hypothalamic hamartoma
Definition
1. gelastic sz
2. precocious puberty
Term
sellar/suprasellar lesions
Definition
satchmo
sarcoid, sellar tumor (adenoma)
aneurysm
teratoma, dermoid, epidermoid
craniopharyngioma
hypothalamic glioma, histiocytoma
mets/meningioma
optic nerve glioma
Term
PRES stands for
Definition
Posterior reversible encephalopathy syndrome
Term
What predisposes to PRES?
Definition
1. Pre-eclampsia
2. chemotherapy
3. uremic encephalopathy
statdx
Term
What do you see on MRI with PRES T2/FLAIR and where?
Definition
parietal and occipital high T2/FLAIR in 95%
statdx
Term
Vein of Galen aneurysmal malformation: tx
Definition
endovascular embolization
http://www.ajnr.org/content/23/10/1717.long
Term
Vein of Galen aneurysmal malformation: can cause
Definition
CHF
Term
Anatomy of cerebral veins
1. superior sagittal sinus, inferior sagittal sinus, straight sinus, transverse sinus, sigmoid sinus, internal jugular vein
2. anterior from staight sinus: vein of Galen
2. superior branch from vein of Galen: internal cerebral vein, thalamostriate vein, septal veins
3. inferior branch from vein of Galen: basal vein of Rosenthal
Definition
[image]
Term
cerebellar atrophy
Definition
1. alcohol abuse: Wernicke's encephalopathy, Marchiafava Bignami syndrome
2. dilantin therapy
3. paraneoplastic syndrome
other rare:
1. sporadic olivopontocerebellar atrophy
2. cerebello olivary degeneration
3. Friedreich ataxia
Term
What do you see on MR in Wernicke's encephalopathy?
Definition
High T2 in
1. peri aqueductal gray matter
2. mammillary bodies
3. thalamus
4. hypothalamus
Term
What do you see on MR in Marchiafava bignami?
Definition
High T2 in corpus callosum
Term
What usually presents first: cerebellar atrophy or primary tumor in paraneoplastic syndrome?
Definition
cerebellar atrophy
Term
dd for tonsillar herniation (case 135, page 281)
Definition
1. Chiari malformation
2. ependymoma (can mimic tonsillar herniation)
3. posterior fossa mass
4. intracranial hypotension
Term
Both type I and II Chiari malformation have
Definition
1. Low lying tonsils
2. small posterior fossa
Term
how do you diagnose low lying tonsils?
Definition
cerebellar tonsils are >= 5mm below the basion-opisthion line (foramen magnum)
Term
Chiari I malformation has
Definition
syrinx
Term
Chiari II malformation has:
Definition
1. Luckenschadel "lacunar" skull
2. dysgenesis of the corpus callosum
3. beaked tectum
4. enlarged massa intermedia (between thalami)
5. "towering" cerebellum protruding thru the incisura
6. low lying torcula
7. compressed and elongated 4th ventricle
8. cervico-medullary kinking
9. posterior C1 arch anomalities
10. myelomeningocele
Term
enhancing intramedullary spinal mass
Definition
1. ependymoma
2. astrocytoma
3. hemangioblastoma
4. mets
5. demyelinating disease
Term
ependymoma vs astrocytoma: adult vs children
Definition
ependymoma: adult
astrocytoma: children
Term
ependymoma vs astrocytoma: characteristics
Definition
ependymoma: more cysts and hemorrhage
astrocytoma:
Term
hemangioblastoma characteristic
Definition
vascular
Term
hemagioblastoma associated with
Definition
VHL
Term
demyelinating disease in the spine does not respect the
Definition
gray white boundary
Term
demylinating disease in the spine is ___shaped
Definition
flame shaped
Term
optic nerve enlargement and enhancement
Definition
1. optic nerve glioma
2. optic neuritis
3. optic nerve sheath meningioma
4. leukemia/lymphoma
5. sarcoidosis
Term
if bilateral optic nerve gliomas, think of
Definition
NF 1
Term
If tram track enhancement of optic nerve sheath on axial imaging, think of
Definition
optic nerve sheath meningioma
Term
enhancing orbital mass dd
Definition
1. hemangioma
2. lymphangioma
3. meningioma
4. mets
5. lymphoma
Term
mc orbital tumor
Definition
hemangioma
Term
if enhancing orbital mass and fluid fluid levels, think
Definition
lymphangioma
Term
meningiomas associated with
Definition
hyperostosis
Term
dd for basilar invagination
Definition
PF ROACH
paget's
FD
RA, rickets
OI, O-malacia
achondroplasia
chiari I malfn, cleidocranial dysostosis
hyperparathyroidism, Hurler syndrome
Klippel-Feil anomaly
http://www.urmc.rochester.edu/smd/Rad/neurocases/Neurocase382.htm
Term
venous angioma =
Definition
developmental venous anomaly
Term
carotid space mass dd
Definition
1. paraganglioma
2. nerve sheath tumor
3. vascular abnormalities
4. lymphadenopathy
Term
appearance of paraganglioma on MR
Definition
"salt and pepper" appearance
Term
what is a vascular abnormality in the carotid space that can mimic a mass?
Definition
venous thrombus
Term
if see multiple paragangliomas, think of
Definition
1. familial paragangliomas
2. VHL
3. NF 1
4. MEN II
http://www.hccpjournal.com/content/4/4/169
Term
familial paragangliomas
Definition
multiple paragangliomas
Term
familial paraganglioma are associated with
Definition
pheochromocytomas (paraganglioma in adrenal gland)
Term
grading of neonatal intracranial hemorrhage
Definition
I: germinal matrix
II: intraventricular without hydrocephalus
III: intraventricular with hydrocephalus
IV: parenchymal
Term
If see periventricular hyperechoic areas then cystic areas later then called
Definition
periventricular leukomalacia
Term
[image]
Definition
T2 demonstrates bifrontal, bitemporal subdural empyema


http://www.casesjournal.com/content/2/1/6335
Term
ring enhancing lesion: dd
Definition
aids (lymphoma, toxo)
mets
abscess (infection)
glioma
infarction
contusion
demyelinating dz
resolving hematoma
Term
if aids patient, think of :
Definition
1. lymphoma (ring enh)
2. toxo (ring enh)
3. crypto (not ring enh)
Term
confluent white matter lesions in an adult
Definition
1. demyelinating disease
2. neoplasm like gliomatosis cerebri
3. progressive multifocal leukoencephalopathy (PML)
4. microvascular ischemic disease
5. auto immune mediated vasculitis
Term
confluent white matter lesions in child
Definition
1. acute disseminating encephalomyelitis (ADEM)
2. multiple sclerosis
3. dysmyelinating disease (leukodystrophy)
4. progressive multifocal leukoencephlopathy)
Term
dysmyelinating disease (leukodystrophy)
Definition
1. Metachromatic
2. adrenoleukodystrophy
3. Alexander disease
4. Canavan
Term
leukodystrophy: mc
Definition
metachromatic leukodystrophy
Term
leukodystrophy: frontal lobes
Definition
Alexander disease
Term
leukodystrophy: occipital lobes
Definition
metachromatic leukodystrophy
Term
leukodystrophy: adrenal glands
Definition
Adrenoleukodystrophy
Term
leukodystrophy: x linked
Definition
Adrenoleukodystrophy
Term
leukodystrophy: increased NAA
Definition
Canavan disease
Term
dd for massive supratentorial cerebrospinal fluid collection in a newborn
Definition
1. massive hydrocephalus
2. hydranencephaly
3. alobar holoprosencephaly
4. agenesis of the cc with midline interhemispheric cyst
5. bilateral open lip schizencephaly
Term
hydranencephaly is due to:
Definition
1. occlusion of the ICA
2. necrosis of the brain parenchyma in the anterior circulation
Term
types of holoprosencephaly
Definition
1. alobar
2. semilobar
3. lobar
Term
2 characteristics of alobar holoprosencephaly
Definition
fusion of the thalami
monoventricle
Term
schizencephaly associated with
Definition
septo-optic dysplasia
Term
schizencephaly vs porencephaly
Definition
schizencephaly has gray matter lines clefts
Term
jugular foramen mass dd
Definition
1. meningioma
2. schwannoma
3. paraganglioma
4. mets
5. high jugular bulb
Term
high jugular bulb (jb) aka
Definition
high riding jugular bulb
Term
high jugular bulb defn
Definition
jb extends above floor of IAC with no connection to middle ear
Term
if high jb has connection to middle ear, called
Definition
dehiscent jugular bulb
Term
[image]
Definition
white arrow: high jugular bulb
curved arrow: IAC
Term
treatment for intracranial lipoma? surgery?
Definition
no place for surgical mgt
Term
if you see abscess in globe e.g. from ethmoidal air cells, call it
Definition
subperiosteal abscess
Term
if high high T2 in the pons centrally with sparing of the periphery
Definition
osmotic demyelination syndrome
Term
old name for osmotic demyelination syndrome
Definition
central pontine myelinolysis
Term
central pontine myelinolysis: classic setting
Definition
rapid hyponatremia correction
Term
dd for osmotic demyelination syndrome
Definition
1. ischemia
2. MS
3. glioma
Term
1. acute pharyngitis causing
2. IJ thrombophlebitis
Definition
Lemierre's syndrome
Term
Gradenigo syndrome
Definition
1. petrous apicitis
2. deep facial pain (CN V)
3. lateral rectus palsy (CN VI)
Term
dd for arachnoid cyst
Definition
1. epidermoid cyst
2. subdural hygroma
3. porencephalic cyst
4. neuro epithileal cyst
Term
favourite locations of the arachnoid and epidermoid cysts
Definition
1. arachnoid: middle cranial fossa
2. epidermoid: posterior cranial fossa
Term
dd for fibromuscular dysplasia in the neck
Definition
Takeyasu's arteritis
Term
[image]
Definition
glomus tympanicum
see glomus tumor (white arrow) on cochlear promontory
open arrow: malleus
Term
middle ear mass dd
Definition
1. acquired cholesteatoma
2. facial nerve schwannoma
3. glomus tympanicum
4. normal variant vasculature
5. cholesterol granuloma
Term
[image]
Definition
cholesteatoma (white arrow)
sigmoid plate partially dehisced (open arrow)
Term
Where is the cholesteatoma located?
Definition
Prussak space (lateral attic)
Term
What can get eroded by the cholesteatoma?
Definition
1. scutum (get blunting of the scutum)
2. ossicles
Term
[image]
Definition
aberrant ica (white arrow)
cochlea (black arrow)
Term
high T1 and T2 in middle ear
Definition
cholesterol granuloma
Term
high T1 in basal ganglia
Definition
1. met Hg (blood, amyloid angiopathy)
2. melanoma mets
3. hepatic encephalopathy, Wilson's
4. calcifications
Term
dd inner ear congenital malfn
Definition
1. large vestibular aqueduct syndrome
2. cystic cochleovestibular anomaly
3. cystic common cavity
4. cochlear aplasia
5. laryrinthine ossificans
Term
1. large vestibular aqueduct syndrome
Definition
enlargement of the vestibular aqueducts measuring > 1.5 mm
Term
2. cystic cochleovestibular anomaly
Definition
dilatation of the cochlea and vestibule: "figure 8" appearance
Term
3. cystic common cavity
Definition
cystic cavity in place of the normal inner ear structures (cochlea, vestibule and commonly the semicicular canals)
Term
complete labyrinthine aplasia
Definition
complete absence of labyrinth (cochlea, vestibule, semicircular canals)
Term
complete labyrinthine aplasia aka
Definition
Michel anomaly
Term
4. cochlea aplasia
Definition
complete absence of cochlea (vestibule and semicircular canals are present)
Term
mondini malfn
Definition
less than 2.5 turns of cochlea
Term
5. labyrinthine ossificans
Definition
ossification of the membranous labyrinth
Term
labyrinthine ossificans due to
Definition
prior insult
Term
location of cochlea, vestibule and semicircular canals
Definition
cochlea: medial
semicircular canals: lateral
Term
aggressive sinus disease dd
Definition
1. invasive fungal sinusitis
2. Wegener granulomatosis
3. sinonasal carcinoma
4. lymphoma
5. cocaine nose
Term
Wegener granulomatosis is a
Definition
vasculitis
Term
Wegener granulomatosis affects
Definition
1. sinus
2. lungs
3. kidneys
Term
Wegener granulomatosis T1, T2, post contrast
Definition
low on T1 and T2, enhances
Term
Increased T2 signal in basal ganglia/thalami in child: dd
Definition
1. Wilson disease (copper deposition)
2. Mitochondrial d/o like Leigh syndrome
3. CO poisoning
4. ischemia
5. osmotic demyelination
6. kernicterus (unconjugated bilirubin)
Term
Branches of the external carotid artery
Definition
Some Attendings Like Freaking Out Potential Medical Students."
1. superior thyroid
2. ascending pharyngeal
3. lingual
4. facial
5. occipital
6. posterior auricular
7. maxillary
8. superficial temporal
Term
diffuse temporal lobe mass dd
Definition
1. herpes encephalitis
2. ischemia/infarction
3. gliomatosis cerebri
4. limbic encephalitis
5. status epilecpticus
Term
if gyriform enhancement in temporal lobes
Definition
herpes encephalitis
Term
looks like herpes encephalitis
Definition
limbic encephalitis
Term
limbic encephalitis due to
Definition
paraneoplastic syndrome (a primary tumor causes the encephalitis somehow)
Term
dd subependymal nodules
Definition
1. tuberous sclerosis
2. heterotopic gray matter
3. TORCH infection
4. mets
Term
tuberous sclerosis
Definition
C TALRS
cardiac rhabdomyomas
tubers
angiomyolipoma
lam
renal cyst
subependymal giant cell astrocytoma
Term
torch infection
Definition
toxoplasmosis
rubella
cmv
herpes
Term
most likely torch to have subependymal and periventricular calcs
Definition
CMV
Term
globe lesion in a child dd
Definition
1. retinoblastoma
2. persistent hyperplastic primary vitreous (PHPV)
3. Coats disease
4. retinopathy of prematurity
5. toxocariasis
Term
retinoblastoma vs persistent hyperplastic primary vitreous (PHPV) vs coats dz: calcs
Definition
retinoblastoma: +calc
PHPV: -calcs
coats: -calcs
Term
retinoblastoma vs PHPV vs coats: globe size
Definition
retinoblastoma: normal
PHPV: small
coats: normal
Term
If bilateral micro-ophthalmia with a history of prematurity, think of
Definition
retinopathy of prematurity
Term
retinopathy of prematurity is due to
Definition
prolonged oxygen therapy
Term
normal size globe and lack of calcs (like coats dz) but h/o contact with cat/dogs
Definition
toxocariasis
Term
temporal bone fracture types
Definition
1. longitudinal temporal bone fx
2. transverse temporal bone fx
Term
mc type of temporal bone fx
Definition
longitudinal
Term
longitudinal and transverse fx:type of hearing loss
Definition
longitudinal: conductive
transverse: sensorineural
Term
longitudinal and transverse fx: involvement of facial nerve
Definition
longitudinal: less common
transverse: more common
Term
longitudinal and transverse fx: structures more affected
Definition
longitudinal: ossicular dislocation
transverse: inner ear abnormality
Term
cystic neck mass dd
Definition
1. congenital cyst like thyroglossal duct cyst or 2nd branchial cleft cyst
2. abscess
3. cystic lymph node
4. lymphatic malformation
5. cystic nerve sheath tumor
Term
some congenital cysts (2)
Definition
1. thyroglossal duct cyst
2. 2nd branchial cleft cyst
Term
thyroglossal duct cyst location
Definition
1. midline
2. usually infrahyoid
Term
2nd branchial cleft cyst usually location
Definition
angle of mandible
Term
cystic mets
Definition
1. scc
2. papillary thyroid ca
Term
most common lymphatic malformation
Definition
cystic hygroma
Term
usual location of cystic hygroma
Definition
posterior neck
Term
cystic hygroma associated with
Definition
Turner and Down syndromes
Term
Name a cystic nerve sheath tumor
Definition
cystic schwannoma
Term
posterior fossa cyst dd
Definition
1. mega cisterna magna
2. arachnoid cyst
3. Dandy Walker malformation
4. Joubert syndrome (vermian hypoplasia)
Term
Mega cisterna magna vs arachnoid cyst: mass effect
Definition
Mega cisterna magna: - mass effect
arachnoid cyst: + mass effect
Term
Mega cisterna magna vs arachnoid cyst: vessels
Definition
Mega cisterna magna: + vessels in it
arachnoid cyst: displaces vessels
Term
Dandy Walker malformation
Definition
1. enlarged posterior fossa
2. partial or complete absence of cerebellar vermis
3. hypoplasia of the cerebellar hemispheres
4. dilated 4th ventricle that connects to a posterior CSF fluid collection
5. torcula above the lambdoid sutures (torcular-lambdoid inversion)
Term
Joubert syndrome is:
Definition
vermian hypoplasia
Term
Joubert syndrome: appearance
Definition
1. "molar tooth" appearance of the midbrain
2. "bat wing" appearance of the 4th ventricle
Term
schizencephaly: type I and II
Definition
type I: closed lip
type II: open lip
Term
Schizencencephaly vs porencephaly: lining
Definition
schizencephaly: lined by gray matter
porencephaly: lined by dysplastic white matter
Term
porencephaly aka
Definition
porencephalic cyst
Term
dd for intraparenchymal hemorrhage
Definition
1. vascular malfn
2. hemorrhagic infarct
3. hemorrhagic neoplasm
4. contusion
5. cerebral amyloid disease
Term
hypervascular mets
Definition
1. lung
2. renal cell
3. thyroid
4. melanoma
Term
corpus callosal lesion
Definition
1. glioblastoma multiforme
2. lymphoma
3. demyelinating disease
4. diffuse axonal injury
5. marchiafava-bignami disease
Term
diffuse axonal injury affects:
Definition
punctate hemorrhages at the gray-white matter junction
Term
marchiafava bignami disease
Definition
lesion esp in splenium of cc
Term
wernicke's lesion in
Definition
1. periaqueductal gray matter
2. mammillary body
Term
cortically based neoplasm dd
Definition
1. dysembryonoplastic neuroepithileal tumor (DNET)
2. oligodendroglioma
3. ganglioglioma
4. pleomorphic xanthoastrocytoma
Term
oligodendroglioma usually in
Definition
frontal lobe
Term
oligodendroglioma commonly
Definition
calcify
Term
cortically based and cystic with enhancing nodule
Definition
1. pleomorphic xanthoastrocytoma
2. ganglioglioma
Term
Wedge shaped corically based pseudocystic mass
Definition
DNET (dysembryonoplastic neuroepithileal tumor)
Term
normally the posterior pituitary
Definition
is high on T1 due to the neurosecretory granules (which go from the hypothalamus to the pituitary gland)
Term
characteristic finding of ectopic posterior pituitary
Definition
high T1 in the midline
Term
if agenesis of the corpus callosum, can see on coronal
Definition
Viking horn appearance to the lateral ventricles
Term
cephalocele: statdx definitions
Definition
1. meningoencephalocele (encephalocele): brain, meninges, csf
2. encephalocele: meninges, csf
Term
menigoencephalocele: aka
Definition
encephalocele
Term
sturge weber syndrome
Definition
1. serpinginous calcs
2. gyral enhancement
3. gyral atrophy
Term
dyke davidoff mason syndrome
Definition
thickening of the calvarium associated with cerebral hemiatrophy
Term
if looks like MS, but no involvement of CC, think of
Definition
CADSIL
https://my.statdx.com/#edxExpandedContent;multiple_brain_hyperintensities_t2flair__rare_but__expert-ddx
Term
[image]
Definition
periventricular leukomalacia:
T2 demonstrates loss of periventricular white matter and dilatation of the lateral ventricle
Term
Extra-axial mass that follows CSF intensity and herniates through a prior fx
Definition
leptomeningeal cyst
Term
other names for cavernous angioma
Definition
1. cavernoma
2. cavernous malfn
3. cavernous hemangioma
Term
If high T2 in basal ganglia, thalami and cerebral cortex
Definition
CJD (statdx)
Term
pathognomonic for CJD
Definition
high DWI of the cerebral cortex (aunt minnie)
Term
mesial temporal sclerosis
Definition
1. high T2/FLAIR of the hippocampus
2. volume loss in the hippocampus
Term
tx for Werinicke's
Definition
thiamine
Term
pyriform aperture stenosis vs choanal atresia
Definition
1. pyriform aperture stenosis: anterior. narrowing of nasal inlet
2. choanal atresia; posterior. narrowing of posterior opening from the nasal vault to the nasopharynx
Term
laryngocele: types and difference
Definition
1. internal: does not extend through the thyrohyoid membrane
2. external: extends through the thyrohyoid membrane
Term
another name for external laryngocele
Definition
mixed
Term
[image]
Definition
1. oval window atresia: thick white bone at oval window (white open arrow)
2. tympanic segment of facial N is deviated medially (white arrow)
3. (the facial nerve should be under the lateral aspect of the beak of the duck in the coronal plane)
Term
external auditory canal atresia: unilateral vs bilateral
Definition
bilateral: associated with syndrome
unilateral: not associated with syndrome
Term
image down to what to evaluated the right and left recurrent laryngeal nerve
Definition
right: image down to right subclavian A
Left: image down to aortic arch
Term
dd for ivory vertebral body
Definition
LIMP
lymphoma
infection
mets
paget's
Term
[image]
Definition
1. Guillain Barre syndrome
2. enhancement of cauda equina (esp ventral roots) and conus medullaris
3. white arrows: enhancement of ventral roots of the cauda equina
statdx
Term
chance fracture mechanism
Definition
hyperflexion
1. anterior compression
2. posterior distraction
Term
chance fracture associated with
Definition
abdominal injury
Term
if ependymoma in filum terminale called
Definition
myxopapillary ependymoma
Term
dd for myxopapillary ependymoma
Definition
1. astrocytoma
2. mets
3. paraganglioma
Term
cavernous angioma in spine:
1. T1
2. T2
3. angio
Definition
1. T1 heterogeneous
2. T2: heterogeneous with ring of low intensity on t2
3. normal angio
Term
[image]
Definition
1. dx: Kummell's disease
2. due to: post-traumatic osteonecrosis of a vertebral body
3. what do you see: horizontal cleft of air within a collapsed vertebral body
Term
grades of glioma
Definition
I: no enh
II: slight peripheral enh
III: enh
IV: necrosis
Term
modic changes
Definition
I: fluid: low T1 and high T2
II: fat: high T1 and t2
III: fibrosis. low T1 and T2
Term
bone marrow reconversion
Definition
low on T1
Term
segments of the mca
Definition
M1: horizontal
M2: sylvian
M3: cortical
Term
craniotomy vs craniectomy
Definition
craniotomy: bone flap put back
crantiectomy: bone flap not put back
Term
flair (csf dark with high something) looks like:
Definition
t1 post contrast
Term
stir (csf bright) looks like:
Definition
t2 fat sat
Term
flair: te and tr
Definition
both high
Term
what is high te and tr
Definition
te > 70
tr > 700
Term
[image]
Definition
Tarlov cyst:
1. well circumscribed csf intensity masses extending through bilateral neuroforamen
2. there appears to be widening of the right neuroforamen.
Term
Tarlov cyst aka
Definition
perineural cyst
Term
Tarlov cyst usually at
Definition
S2 or S3
Term
Tarlov cyst location: intamedullary, extramedullary, intradural or extradural
Definition
extradural
Term
DISH aka
Definition
Forestier's disease
Term
Extension of disc material beyond the vertebral end plates
1. > 50%:
2. 25-50%:
3. < 25 %:
Definition
1. > 50%: bulge
2. 25-50%: broad based
3. < 25 %: focal
Term
disc protrusion vs extrusion
Definition
protrusion: wide margin of attachment at base
extrusion: narrow margin of attachment at base
Term
post op recurrent or residual disc herniation vs scar tissue
Definition
scar tissue enhances
Term
if see ankylosis in a child, think about
Definition
Juvenile Idiopathic arthritis (JIA)
Term
Still's disease
Definition
systemic JIA
Term
JIA aka
Definition
Juvenile rheumatoid arthritis
Juvenile chronic arthritis
Term
spinal dysraphism
Definition
1. closed: lipomyelocele, lipomyelomeningocele
2. open: meningocele, myelocele, myelomeningocele
Term
lipomyelocele and lipomeningomyelocele
1. both:
2. one:
Definition
1. both have sub q fat extension into spinal canal
2. lipomeningomyelocele has has #1 above and neural placode outside of spinal canal
Term
1. meningocele
2. myelocele
3. myelomeningocele
Definition
1. meningocele: dura and arachnoid, no neural elements
2. myelocele: neural elements flush with skin
3. myelomeningocele: neural elements protrudes above skin surface with expansion of subarachnoid space posterior to placode
Term
Are lipomyelomeningoceles associated with Chiari II malfn?
Definition
no
Term
Caudal regression syndrome
Definition
conus medullaris can appear truncated
Term
caudal regression syndrome associated with what other syndromes?
Definition
1. VACTERL
2. OEIS
3. Currarino triad
Term
VACTERL
Definition
vertebral anomalies
anal imperforation
cardiac malfn
te fistula
renal abnormalities
limb abnormalities
Term
OEIS syndrome
Definition
omphalocele
extrophy of the bladder
imperforate anus
spinal anomalies
Term
Currarino triad
Definition
1. partial sacral agenesis
2. anorectal malformation
3. presacral mass
Term
sirenomyelia aka
Definition
mermaid syndrome
Term
sirenomyelia
Definition
1. fused lower extremities
2. on spectrum of caudal regression
Term
many pts with caudal regression are
Definition
offspring of diabetic mothers
Term
NF1
Definition
LOSSS
1. lisch nodules
2. optic nerve gliomas
3. sphenoid wing dysplasia
4. skeletal abnormalities
5. spinal abnormalities
Term
NF 1: skeletal abnormalities
Definition
"ribbon" deformity of the ribs due to multiple neurofibromas of the intercostal nerves
Term
NF 1: spinal abnormalities
Definition
1. scoliosis
2. scalloping of the posterior vertebral bodies (dural ectasia and lateral meningoceles)
Term
Some people think that _______is pathognomonic for NF1
Definition
plexiform neurofibromas
Term
What pattern do the neurofibromas cause intraforaminally
Definition
"dumbbell" pattern
1. widening the neural foramen
2. expanding outside the canal
Term
What do should you worry about when evaluating neurofibromas?
Definition
degeneration into malignant nerve sheath tumors
Term
If vertebral body anomalies and cystic intraspinal masses, think
Definition
neuroenteric cysts
Term
[image]
Definition
epidural lipomatosis: sagittal T2
Term
defn epidural lipomatosis
Definition
epidural fat wider than 6 mm
Term
What do V2 and V3 go thru?
Definition
round max is an ovale man
1. maxillary division of CN V goes thru foramen rotundum
2. mandibular division of CN V goes thru foramen ovale
Term
sellar lesions can also be (Dr. P's lecture)
Definition
1. lymphoma, mets, granulomatous disease
2. rathke's cleft cyst (can be like cyst or high on T1 due to proteinaceous material)
3. craniopharyngioma (cyst and calcs)
4. schwannoma (usuallly parasellar), meningioma (usually dural tail)
5. aneurysm
6. pituitary micro or macroadenoma or invasive macroadenoma (if >2/3 of cavernous carotid periphery is involved)
7. macroadenoma can also have hemorrhage.
8. cystic adenoma
9. sheehan's syndrome (pituitary necrosis due to postpartum hypotension)
10. hypothalamic glioma (may not enhance much as low grade), hypothalamic hamartoma (can be of the tuber cinereum)
11. arachnoid cyst or racemose neurocystercosis (low DWI), epidermoid cyst (high DWI).
12. dermoid (can rupture and cause chemical meningitis)
13. chordoma
14. extension of other cancer like squamous cell carcinoma or nasopharyngeal carcinoma.
Term
pituitary apoplexy
Definition
hemorrhage or infarct in the pituitary gland (may have also a macroadenoma)
Term
1. looks like meningioma, but low on T2
2 dd for meningioma
Definition
1. solitary fibrous tumor (aka hemangiopericytoma)
2. meningioma, solitary fibrous tumor / hemangiopericytoma
Term
other things to think about when trying to diagnose a brain mass
Definition
1. demyelinating disease
2. subacute hematoma
3 subacute stroke
4. infection like TB
Term
if see a mass, also look for
Definition
herniation
hemorrhage
hydrocephalus
Term
cyst and nodule
Definition
1. juvenile pilocytic astrocytoma
2. ganglioglioma
3. pleomorphic xanthoastrocytoma
4. hemangioblastoma if in posterior fossa (usually more edema. #1-3 above don't have much edema)
Term
if multiple lesions
Definition
1. multiple emboli (doesn't enhance, but #2-5 enhance)
2. multiple abscesses
3. TB
4. mets
5. demyelinating disease
Term
restricted diffusion, high DWI/low ADC, ~low T2 compared to CSF, high nuclear to cytoplasmic ratio, cellular tumors (it's something like this)
Definition
1. abscess
2. epidermoid
3. lymphoma
4. medulloblastoma
5. meningioma
6. PNET (primitive neuroectodermal tumor)
--------------------
6. pineoblastoma (solid portion frequently restricts)
7. mucinous adenocarcinoma met
and others
Term
5 parts of the pharynx
Definition
1. nasopharynx
2. oropharynx
3. oral cavity
4. hypopharynx (hyoid bone to esophagus)
5. larynx (hyoid bone to trachea)
Term
spaces
1. anterior
2. posterior
Definition
Anterior
1. pharyngeal mucosal space
2. masticator space
3. parotid space.
4. carotid space
5. parapharyngeal space

Posterior
1. Perivertebral space
2. Retropharyngeal space
3. Posterior cervical space
Term
enhancement
1. dural:
2. leptomeningeal:
Definition
1. pachymeningeal (dural): intracranial hypotension, csf leak, shunt catheter
2. leptomeningeal (pia and arachnoid): sarcoid, tb, carcinomatosis, shunt infection
Term
arachnoid cyst vs epidermoid cyst
Definition
both low t1 and high t2
1. arachnoid cyst: low dwi. no restricted diffusion.
2. epidermoid cyst: high dwi. restricted diffusion.
Term
hemorrhagic pattern and location of aneurysm
1. diffuse subarachnoid hemorrhage in the basal cisterns:
2. diffuse subarachnoid hemorrhage in the basal cisterns with extension into the temporal lobe:
3. subarachnoid hemorrhage predominantly around the medulla with intraventricular hemorrhage:
4. interhemispheric hemorrhage and parechymal frontal hemorrhage:
Definition
(radkat question 42 2012)
1. diffuse subarachnoid hemorrhage in the basal cisterns: posterior communicating and basilar tip aneurysm
2. diffuse subarachnoid hemorrhage in the basal cisterns with extension into the temporal lobe: posterior communicating or middle cerebral artery aneurysm
3. subarachnoid hemorrhage predominantly around the medulla with intraventricular hemorrhage: pica or vertebral artery aneurysm
4. interhemispheric hemorrhage and parechymal frontal hemorrhage: anterior communicating artery
Term
multiple heterotopias vs tuberous sclerosis on MR
Definition
1. multiple heterotopias don't enhance
2. TS enhances and sometimes low T2 signal due to calcium
Term
dd white matter dz
1. adults
2. children
Definition
1. adult: progressive multifocal leukoencephalopathy, demyelinating disorders (ms, adem, lyme dz), glioma/lymphoma
2. child: progresive multifocal leukoencephalopathy, demyelinating disorders (ms, adem, lyme dz), leukodystrophy (metachromatic (occipital lobes), alexander (frontal lobes), adrenoleukodystrophy (affects adrenals), canavan (high NAA)
Term
Parinaud's syndrome
Definition
paralysis of upward gaze due to lesion in region of pineal gland
Term
hemangiomas
Definition
1. Capillary: common in infancy and naturally regress
2. Cavernous: can enlarge, composed of vascular channels. Can have phleboliths
Term
anterior vs posterior nasal obstruction
Definition
1. anterior: pyriform aperture stenosis
2. posterior: choanal atresia
Term
dwi and adc with hemangioblastoma
Definition
1. low dwi
2. high adc
Term
words to remember
1. osler weber rendu syndrome
2. hiv white matter disease
3. child with white matter injury
Definition
1. hereditary hemorrhagic telangiectasia
2. progressive multifocal leukoencephalopathy
3. periventricular leukomalacia
Term
spinal cord tumors
Definition
1. intramedullary:
a. astrocytoma: more common in kids
b. ependymoma: more common in adults
c. paraganglioma: vascular
d. hemangioblastoma: vascular
e. mets
2. extramedullary, intradural:
a. nerve sheath tumor: schwannoma, neurofibroma
b. meningioma
c. mets
3. extradural:
a. giant cell tumor
b. multiple myeloma
c. osteoblastoma, osteosarcoma, chondrosarcoma
d. mets and others
[aside: lytic lesions in posterior elements: GO APE: gct, osteoblastoma, abc, plasmacytoma, eg]
Term
1. What is very high on spectroscopy with lymphoma?
2. What is choline and NAA for?
3. When do you look for tumor recurrence with MR, PET?
Definition
1. lactate and lipid
2. choline: cell membrane. NAA neuron
3. mr: 48 h. pet 6 m
Term
CP angle tumor
Definition
AMEN
1. arachnoid cyst
2. meningioma, mets
3. epidermoid cyst
4. nerve sheath tumor
Term
gyriform enhancement
Definition
1. infarct: in reperfusion or healing phase
2. lymphoma
3. encephalitis
Term
nf1 criteria
Definition
1. 2 or more neurofibromas or a plexiform neurofibroma
2. 2 or more lisch nodules (iris hamartomas)
3. 6 or more cafe au lait spots (like coast of california)
4. axillary and inguinal freckling
5. optic nerve glioma
6. bone dysplasia
7. 1st degree relative with nf1
Term
1. does orbital rhabdomyosarcoma arise from the eom?
2. sarcoid can mimic
3. dd for orbital pseudotumor
4. if skin is involved in orbital lesion, think of
5. what types of tumor can occur in lacrimal glands
Definition
1. orbital rhabdomyosarcoma does not arise from the eom, it arises from the fat
2. sarcoid can mimic meningioma or glioma
3. thyroid orbitopathy, lymphoma, Wegener's granulomatosis.
4. skin can be involved in basal cell carcinoma or scc
5. lacrimal glands can have the same tumors as those in the salivary glands (pleomorphic adenoma etc.)
Term
pineal region tumors
Definition
pineal region tumors:
1. pineoblastoma
2. pineocytoma
3. germ cell tumors
a. germinoma: - hcg, - afp
b. yolk sac tumor: -hcg, +afp
c. choriocarcinoma: + hcg, -afp
d. embryonal: + hcg, +afp
e. teratoma: +/- hcg, +/- afp
Term
Indium 111 DTPA cisternography
Definition
500 uCi 4, 24, 48 hours
intrathecal
250-500 mCi (remember 500 mCi easier)
-also can be used to detect CSF leak
Term
What agents can be used for cisternography?
Definition
1. Indium 111 DTPA 500 uCi 4.5, 24, 48 h
2. 99m Tc DTPA 20 mCi < 24 h
Term
What can you use for cerebral perfusional imaging?
Definition
1. 20 mCi at 20 min: Tc HMPAO or Tc ECD
2. FDG PET 10 mCi at 45-60 min
Term
99m Tc MDP
1. regular
2. triple phase
Definition
1. 20 mCi
3h
2. flow: first minute, blood pool: next few minutes, delayed 3h
Term
IDA stands for
Definition
iminodiacetic acid
Term
3 types of IDA
Definition
dimethyl: HIDA
disofenin: DISHIDA
Mebrofenin: BRIDA
Term
HIDA-child biliary atresia vs neonatal hepatitis
Definition
1 mCi IV
dynamic and delayed 24h
Term
HIDA-adult for acute cholecystitis
Definition
5 mCi IV
wait 1h then morphine (0.04 mg/kg as per req) if see the activity in sb and then wait 30 min more
Term
HIDA for EF
Definition
Give slow infusion of CCK at 0.02 ug/kg over 30 min
Dynamic imaging to get EF using ROI over GB
Term
gallium 67 dose
Definition
5 mCi
IV
48 h
(Usually 1-3 days later, but can be 4 or more days later)
Term
gallium goes to
Definition
nasal, lacrimal
liver
bowel (so not good for abd processes)
no spleen (so good for splenic abscess)
Term
gallium 67 citrate good for
Definition
chronic infection
spine osteomyelitis
chest: pcp, sarcoid
splenic abscess
Term
What tells you that it is a gallium scan?
Definition
nasal mucosa and lacrimal glands, liver, intestines, not spleen
Term
Indium 111 labelled wbc: dose
Definition
1. 500 uCi IV at 1d
2. there is also tc labeled rbc 10 mCi at 2h
Term
indium goes to
Definition
liver
spleen
no bowel
Term
indium 111 labelled wbc: good for
Definition
acute
non-spine osteomyelitis
abdomen pelvis pathology (no bowel activity)
not good for splenic abscess
Term
What tells you it is an indium scan?
Definition
hot spleen
Term
pet scan look for
Definition
hot brain and heart
Term
Thallium can detect what kind of chest tumor?
Definition
thallium 201 chloride
3 mCi IV
3h
Term
thallium goes to
Definition
thyroid, heart and salivary glands (and kidneys)
Term
99m Tc sestamibi:dose
Definition
10-20 mCi (remember 20 mCi cuz easier)
image at 20 min, 2h (2-4 hours)
Term
99m tc sestamibi where does it go?
Definition
salivary gland, thyroid (gone by 2 hours), overactive parathyroid tissue, heart, liver
Term
99m tc pertechnetate vs I123: thyroid biology
Definition
1. 99m Tc pertechnetate: just trapped.
2. I 123: trapped and organified
Term
How to visualize the thyroid?
Definition
1. Tc pertechnetate: 5 mCi at 20 min
(20-30 min)
2. I 123 400 uCi at 4h (count 1,2,3,4) (200-400 uCi)
Term
How to visualize the thyroid?
Definition
1. Tc pertechnetate: 5 mCi at 20 min
(20-30 min)
2. I 123 400 uCi at 4h (count 1,2,3,4) (200-400 uCi)
Term
I 131 doses
Definition
1. Thyroid carcinoma diagnostic fu: 2-5 mCi (2 mCi)
2. Thyroid carcinoma ablation: 100-200 mCi
3. Grave’s dz treatment: 80-150 uCi/g of thyroid tissue (100uCi/g of thyroid tissue)
Term
What agents can be used to calculate RAIU?
Definition
I 123: 200-400 uCi (400 uCi in 4h)
I 131: 7 uCi
http://www.sh.lsuhsc.edu/raddept/pdf/sec18/Rad%20Proc%2018.8.1.3.pdf
Term
What is the normal RAIU?
Definition
4h: 5-15% (5%)
24h: 3-35% (24%)
Term
Causes of high and low RAIU
Definition
High RAIU: Grave’s dz or TSH secreting pituitary adenoma
Low RAIU:
1. acute thyroiditis
2. subacute thyroiditis (dequervain's thyroiditis)
3. exogenous iodine like contrast, kelp
4. thyroid hormone abuse
5. PTU
Term
I 131 tx:
Thyroid carcinoma diagnostic fu:
Thyroid carcinoma ablation:
Grave’s dz treatment:
Definition
Thyroid carcinoma diagnostic fu: 2-5 mCi (2 mCi)
Thyroid carcinoma ablation: 100-200 mCi
Grave’s dz treatment: 80-150 uCi/g of thyroid tissue (remember 100 Uci/g of thyroid tissue). about 10 mCi.
Term
What are the renal agents and doses?
Definition
1. tubular: 99m Tc MAG 3: 10mCi. 20 min dynamic imaging. (10 mCi)
2. tubular: OIH (Hippuran labeled with I 131) 400 uCi
3. glomerular: 99m Tc DTPA: 10-20 mCi. 20 min dynamic imaging. (10 mCi)
4. cortical agent: 99m Tc DMSA: 3 mCi 3 h (5 mCi max)
http://www.auntminnie.com/index.asp?sec=ref&sub=ncm&pag=get&itemid=55315#MAG3
Term
How is this 99m Tc mertiatide done? aka?
Definition
10 mCi IV 20 min
aka 99m Tc MAG 3
Term
VQ scan
Definition
if not on vent:
1st: Xe 133 20 mCi
2nd: Tc MAA 5 mCi.
b. if on vent:
1st: Tc MAA 5 mCi
2nd Tc DTPA 30 mCi
Term
# particles for perfusion
Definition
Normal: 500,000
Pulmonary HTN, known right to left shunts or pregnancy:100,000
Neonates: 10,000-50,000 (50,000)
Term
What are the parts of the ventilation portion?
Definition
Single breath
Equilibrium
washout
Term
Modified Pioped criteria
Definition
Large (> 75% of a segment), moderate (25-75% of a segment), small (< 25 % of a segment).
1 large = 2 mod= 4 small
1. High prob: 2 large, 1 large and 2 mod, 4 mod. (or anything that has perfusional defect with a smaller cxr defect)
2. Intermediate prob: 1 mod. Nl cxr. (or anything that doesn’t fall into the high or low probability category)
3. Low: 3 small defects. Normal cxr (or any perfusional defect with larger cxr abnormality)
Normal/very low: no perfusional defects
Term
Cardiac perfusional imaging dose:
Definition
1. 99mTc sestamibi and 99mTc tetrofosmin: 10 mCi at rest (image 20 min after injection) and 30 mCi with stress (image 40 min after injection). [tc sestamibi can also be used for parathyroid 20 mCi at 20 min and 2h, breast 20 mCi starting at 5 min)
2. 201 Tl chloride: 3 mCi at maximum exercise, image within 10 min, then image at rest after 3-4 hours. If clear cut normal or reversible ischemia then stop. If fixed perfusional defect, can give another 1-1.5 mCi and recheck to see if real perfusional defect
3. Rubidium 82 chloride stress and rest 40-60 mCi.
http://www.auntminnie.com/index.asp?sec=ref&sub=ncm&pag=car&itemid=55276#Technique
also requisites
Term
Cardiac imaging dose: Viability studies
Definition
1. 201 Tl chloride: 3 mCi image then wait 3-4 hours then reimage. If defect, do again in 24 h to prove that this is scar not hibernating myocardium
2. FDG-18 PET: glucose loading and can give insulin. 10 mCi of FDG. image 60 min after glucose. You compare the FDG with NH3
Term
When is viability imaging better than pefusional imaging
Definition
Mild or moderate fixed perfusional defects
Term
Anatomy of heart?
Definition
Stress on top of rest images
Short axis: apex to base
Top: anterior
Bottom: inferior
My left: septal
My right: lateral
Horizontal axis: inferior (posterior) to anterior
Vertical axis: Septum to lateral wall
Term
Attenuation defects
female:
male:
Definition
Female: anteroseptal
Male: inferior wall (subdiaphragmatic)
Term
How can the stress be produced and contra-i
Definition
1. Dipyridamole: 2nd or 3rd degree AV block or sinus node dysfn. COPD/asthma, xanthines (caffeine/theophylline/aminophylline)
2, Adenosine: : 2nd or 3rd degree AV block or sinus node dysfn. COPD/asthma, xanthine (caffeine/theophylline/aminophylline)
3. Dobutamine: no beta blockers or ccbd x 24 h prior to exam, v tach, afib, LBBB, severe AS, hypertrophic cardiomyopathy, uncontrolled heart failure
Term
How can these stress agents be reversed?
Definition
1. Dipyridamole (persantine): aminophylline 1-2mg/kg IV infusion slowly
2. Adenosine: aminophylline as above, but fast acting so just turn off.
3. Dobutamine: esmolol IV (beta blocker)

Aunt minnie online
Term
What side is more commonly dominant and how tell?
Definition
Right dominant (90%) is more common than left (10%)
Right dominant: RCA supplies the PDA (posterior descending)
Left dominant: Circumflex supplies the PDA (posterior descending)
Term
Blood supply: short axis?
Definition
Septum: lad
Anterior: lad
Lateral: left circumflex
Inferior: rca
Term
Blood supply: vertical long axis?
Definition
Apex: LAD or RCA
Anterior: LAD
Inferior: RCA
Term
Blood supply: horizontal long axis?
Definition
septum: LAD
Apex: LAD or RCA
Lateral: L Cx
Term
Prep for PET myocardial viability protocol?
1. Fasting for:
2. Starting glucose should be less than:
3. Give glucose load of ___ and wait ___
4. If glucose over ___ then cancel test
5. If glucose between ___ and __ then can give ___
6. Inject ____mCi
7. Image after ___
8. compare to___
Definition
1. Fasting for: 6h
2. Glucose should be less than: 130
3. Glucose load 50-75 g, wait 45-60 min
4. Cancel if glc > 200
5. 130-200, insulin
6. 10 mCi
7. 1h
8. Nitrogen 13 Ammonia 10-20 mCi
Term
How is 99m Tc labelled rbc done?
Definition
Give 20 mCi of 99m Tc labelled rbc
Dynamic imaging for 60-90 min then can do delayed 24h.
Term
What detects lower bleeding rates?
Definition
99mTc labeled rbc scan: detects 0.1 cc/min
Angiography detects 1 cc/min
But remember sulfur colloid can detect 0.05-0.1 cc/min
Term
How can the rbc be labeled?
Definition
1. In vitro: take 3cc of patient’s blood and place in vial with SnPYP. Add sodium hypochlorite. Add 20 mCi of 99mTc. Add anticoagulant. pertechnetate. Put back in pt
2. Modified in vivo or “in viVtro”: SnPYP is given IV. After 10-30 min, 5-10 cc of blood is withdrawn. Add 20 mCi of 99mTc pertechnetate. Incubate at least 20 min. Add anticoagulant. Then re-inject.
3. In vivo:10-15 mg/kg stannous pyrophosphate is injected into a vein. 15-30 min later inject 99mTc pertechnetate. There is free pertechnetate.
Term
How is this Meckel study done?
Definition
10 mCi 99m Tc pertechnetate IV
Dynamic imaging (this study showed to 30 min)
(if Tc for thyroid then give 5 mCi and image at 20 min, if for scrotal perfusion then 15 mCi and dynamic)
Term
How does one prepare for 99mTc pertechnetate scan to evaluate for Meckel's diverticulum?
Definition
NPO for 4 hours
1. Pentagastrin: enhances radiotracer up take by ectopic mucosa
2. Cimetidine: blocks release of radiotracer by ectopic mucosa
3. Glucagon: decreases small bowel peristalsis
Term
What is the dd for a cold nodule on 99mTc pertechnetate or I 123
Definition
Colloid cyst (40%)
Adenoma (mc 40%)
Thyroiditis
Carcinoma (20%)
Hematoma

Lymphoma or lymph node
Abscess
Metastasis (breast kidney)
Parathyroid lesion
Term
Types of thyroid cancer?
Definition
Papillary: mc
Follicular: 2nd mc
Medullary: elevated calcitonin levels from C cells (medullary cancer arises from C cells)
MEN II (medullary thyroid cancer, pheochromocytoma, parathyroid)
MEN III (medullary thyroid cancer, pheochromocytoma, neuroma)
{MEN I: pituitary, pancreas, parathyroid}
Anaplastic (poor prognosis)
Term
What nuc studies do you use to detect recurrent disease?
Definition
I 131 scan: Papillary and follicular thyroid cancer
PET scan: Medullary and anaplastic thyroid cancer
Term
How do you prepare for thyroid whole body imaging and why?
Definition
Low iodine diet for 2 weeks
Try to increase TSH by
2-4 weeks of no thyroid hormone therapy or
Giving recombinant TSH
The higher TSH makes the body want to take up the radioactive 131I if there is a cancer that wants it.
Prevents false negative studies
Term
What is the treatment for localized thyroid cancer? (prob don't need to memorize this)
Definition
Stage IA: If less than 1.5 cm then subtotal thyroidectomy without I 131.
Stage IB: if follicular, multiple papillary or older than >45 and male then near total thyroidectomy and 30 mCi of I 131
Stage II: 1.5-4.4 cm or multiple tumors or cervical mets: total thyroidectomy, +/- neck dissection and I 131 (30 or 100-150 mCi)
Stage III > 4.5 cm or local tumor invasion: same as above and I 131 (150-200mCi)
Stage IV: distant mets. Same as above and I 131 > 200 mCi
Term
What is the dose used after surgery?
Definition
Residual thyroid tissue: 100 mCi (stat dx)
Local cervical lymph nodes: 100 mCi
Distant metastases (mediastinal, pulmonary and osseous): 200 mCi
Term
Where do colloid cysts usually originate from?
Definition
Cystic degeneration of thyroid adenomas
Term
How to tell difference between 99m Tc pertechnetate and I 123 ?
Definition
99m Tc pertechnetate has more background activity, salivary secretions (and thus esophagus from swallowing), thyroid, stomach, kidney, bladder
Term
Another name for toxic multinodular goiter?
Definition
Plummer’s disease
Term
What is the tx for:
1. toxic multinodular goiter/toxic adenoma
2. grave's dz
Definition
1. Toxic multinodular goiter or toxic adenoma: 30 mCi (higher dose) 1 131. More resistant to ablation therapy
2. Graves disease: ~10 mCi (lower dose) 1 131 (100 uCi/g). Less resistant to ablation therapy.
Dose 100 uCi/g (from aunt minnie online and requisites)
Term
Where do you see free pertechnetate?
Definition
Salivary glands
Background
Stomach, thyroid
Kidneys and bladder
Term
When do you have to decreased the number of particles and to what?
Definition
1. Neonate/Children (10,000-50,000)
2. Pregnant woman (decrease particles to decrease radiation dose to fetus), Pulmonary hypertension, Right to left shunt
100,000 particles
3. normal: 500,000 particles
Term
What is a medical event?
Definition
Patient whole body dose > 5 rem (50 mSv)
Single organ dose > 50 rem (500 mSv)
1 rem=10 mSv
Requires verbal and written notification of the nuclear regulatory commission (NRC)
Term
Dd of superscan?
Definition
1. If more axial than appendicular skeleton: Widespread metastasis especially prostate and breast. Also lung and lymphoma
2. If increased in both axial and appendicular skeleton:
Renal osteodystrophy with secondary hyperparathyroidism (prominent activity along the costochondral junctions)
Osteomalacia
Hyperthyroidism
3. Paget’s disease
Term
How do you differentiate stress fx from shin splints?
Definition
Stress fx: focal regions of increased uptake on all three phases of bone scan
Shin splint: Generalized region of increased uptake on delayed phase imaging
Term
How is an Indium 111 pentreotide (Octreoscan) performed?
Definition
6 mCi Indium 111 pentreotide (Octreoscan) given and then images taken 4, 24 hours later
Term
What are some tumors with somatostatin R?
Definition
Islet cell tumors
Gastrinoma
Glucagonoma
Insulinoma
VIPoma
Carcinoid
Pheochromocytoma (more commonly imaged with MIBG)
Neuroblastoma (more commonly imaged with MIBG)
Term
Where is normal radiotracer found in the Indium 111 Octreoscan?
Definition
spleen and kidneys: very hot
Liver
Gallbladder
Spleen
Kidneys
Bladder
Blood pool
Intestines
Faint thyroid
Term
How is MIBG study done?
Definition
I 123: 10 mCi.
I 131: 1 mCi
both 2d
p. 110 requisites and online article
Term
MIBG goes to
Definition
Liver, heart
adrenal medulla (adrenal medulla not really seen)
Term
What do you use to block iodine uptake into the thyroid?
Definition
1. Lugol’s solution
2. Supersaturated potassium iodide (SSKI)
Give 1 day prior to study and 6 days following administration of tracer
Term
if have 99m Tc MDP, there may be faint liver uptake due to
Definition
technical artifact of colloid formation by the MDP
Term
what agents do you use to image brain?
Definition
1. FDG PET. 10 mCi
2. SPECT brain study: 99m Tc HMPAO or 99m Tc ECD. 20 mCi at 20 min
if for sz:
a. FDG PET: 10 mCi inter-ictal. look for decreased activity.
b. SPECT: 20 mCi Tc HMPAO. ictal. look for increased activity.
Term
Can you tell the FDG PET from the SPECT study when imaging the brain?
Definition
Not really according to UCSF video nuc (#7 self assessment, time: 34:45)
Term
1. nuclear imaging for sz
2. nuclear imaging for dementia
Definition
1. sz
a. FDG PET: inter-ictal. look for decreased activity.
b. SPECT: 20 mCi Tc HMPAO or ECD at 20 min. ictal. look for increased activity.
2a. SPECT cerebral perfusion 20 mCi at 20 min. same as above.
-Tc HMPAO (ceretec)
-Tc ECD (neurolite)
2b. PET imaging: 10mCi of FDG, image after 45-60 min
Term
Alzheimer's disease:
Definition
decreased uptake in the parietal and temporal lobes
Term
Lingual thyroid: thyroid status
Definition
hypothyroid
Term
Lewy body disease
Definition
decreased activity in the temporal, parietal and occipital lobes
Term
1. Pick's disease:
2. Parkinson's dz:
3. Huntington's dz:
Definition
1. aka frontotemporal dementia. decreased activity in the frontotemporal lobes
2. putamen
3. caudate
Term
if sulfur colloid scan hot:
1. just hot in some places:
2. Caudate lobe:
3. Quadrate lobe:
Definition
1. just hot in some places: regenerating nodular cirrhosis
2. Caudate lobe: Budd-Chiari syndrome
3. Quadrate lobe: SVC syndrome
Term
Dd for photopenic region on Tc99m SC scan
Definition
HCC
Fibrolamellar HCC
Metastases
Hepatic adenoma
Hemangiomas
Abscesses
Term
Liver lesions with central scar
Definition
1. fibrolamellar HCC
2. giant hemangioma
3. FNH
Term
1. hot on sulfur colloid, central scar
2. cold on sulfur colloid, calcs and hemorrhage
3. cold on sulfur colloid, increasing activity on 99m Tc rbc study
Definition
1. FNH
2. hepatic adenoma
3. hemangioma
Term
How are the Tc sulfur colloid study done?
Definition
99m Tc sulfur colloid scan
3-4 mCi (remember 3 mCi)
Image 10-15 min after injection (remember 10 min)
(if study is for bleeding then give 10 mCi and image at 3 min and if study is for bone marrow give 10 mCi and image at 2h; if study is for lymphoscintigraphy then 100 uCi in each of the 4-6 0.1 cc syringes; if for reflux then 1 mCi in (age +2) x 30 cc)
Term
if see hot spleen, what study and dose?
Definition
1. Indium 111 oxine labelled wbc: 500 uCi in1d
2. 99m Tc HMPAO labelled wbc: 10 mCi in 2h
Term
67Ga citrate dose?
Definition
5 mCi in 2d
Term
1. bones:
2. bones and hot liver:
3. bones and hot spleen:
4. lacrimal, nasal mucosa, liver, intestine, not spleen
5. liver, heart, adrenal medulla and looks blurry
6. adrenal cortex
7. stomach and thyroid
8. parathyroid
9. I 131 tx: diagnostic, ablative, grave's, adenoma
10. blood
11. hepatobiliary scintigraphy for cholecystitis
12. prostate
13. kidneys and spleen
14. brain perfusion: sz and brain death
15. renal scintigraphy
16. renal cortical imaging
17. VQ scan: two ways
18. muga
19. biliary atresia
20. cholecystitis
21. gallbladder ejection fraction
22. thyroid imaging
23. nuclear imaging for sz
24. nuclear imaging for dementia
Definition
1. bones: Tc MDP, 20 mCi, 3h
2. bones and hot liver: Tc sulfur colloid (3 mCi at 10 min for liver-spleen study, 10 mCi at 3 min for bleeding study and at 2h for bone marrow study, 100 uCi in each of the 4-6 tuberculin syringes for lymphoscintigraphy, 1 mCi in (age+2) x 30 cc for reflux)
3. bones and hot spleen: Indium 111 labeled wbc (500 uCi 24h) or Tc labelled wbc (10 mCi 2h).
4. gallium 67 citrate: 5 mCi, 48 h.
5. MIBG (I 123 10 mCi, I 131 1 mCi, both 2d):
6. I 131 NP 59 1mCi, 5d
7. Tc pertechnetate: 10 mCi for Meckel's in adults dynamic, 5 mCi for thyroid 20 min, scrotal scintigraphy 15 mCi flow and blood pool.
8. Tc sestamibi: for parathyroid 20 mCi 20 min and 2h. for cardiac 10 mCi at rest and 30 mCi at stress. can also image parathyroid 3 other ways (1. tc sestamibi 20 mCi at 20 min minus I 123 (400 uCi at 4h) or Tc pertechnetate (5 mCi at 20 min) or thallium minus tc pertechnetate (5 mCi at 20 min)
9. I 131: 2 mCi diagnostic or 100-200 mCi ablative therapy. 2d. grave's 100 uCi/g or 10 mCi, adenoma 30 mCi.
10. Tc labelled rbc 20 mCi, dynamic
11. 5 mCi Tc mebrofenin. wait 1h and can give morphine (0.04 mg/kg like around 2mg) then wait 30 min more
12. 5 mCi of Indium 111 cabromab pendetide (prostascint) 4d (need to give 2 mCi of Tc labeled rbc b4 scan)
13. octreoscan 6 mCi 4h and 24h
14.
1. sz
a. FDG PET:10 mCi. inter-ictal. look for decreased activity.
b. SPECT: 20 mCi Tc HMPAO or ECD. ictal. look for increased activity.
2. SPECT cerebral perfusion imaging: 20 mCi at 20 min
a. Tc HMPAO (ceretec) or Tc ECD (neurolite)
b. PET imaging: 10mCi of FDG, image after 45-60 min
15. Tc MAG 3 10 mCi or I 131 OIH (hippuran) 400 uCi and Tc DTPA 10 mCi, dynamic
16. Tc DMSA 3 mCi in 3h
17.
a. if not on vent:
1st: Xe 133 20 mCi then 2nd: Tc MAA 5 mCi.
b. if on vent:
1st: Tc MAA 5 mCi then 2nd Tc DTPA 30 mCi
18. tc rbc 25 mCi
19. 1 mCi Tc mebrofenin: dynamic and delayed
20. 5 mCi Tc mebrofenin: wait 1h, give morphine (0.04 mg/kg or about 2 mg) and wait 30 min more
21. cck 0.02 ug/kg over 30 min then get EF
22. Tc pertechnetate 5mCi at 20 min or I 123 400 uCi at 4 h
23.
a. FDG PET: inter-ictal. look for decreased activity.
b. SPECT: 20 mCi Tc HMPAO or ECD. ictal. look for increased activity.
24.
a. SPECT cerebral perfusion imaging: 20 mCi of "see below". Image 15 min-3h later ( 20 min)
-Tc HMPAO (ceretec)
-Tc ECD (neurolite)
b. PET imaging: 10mCi of FDG, image after 45-60 min
Term
dosage of I 131 for
1. diagnostic exam:
2. tx for thyroid ca:
3. tx for grave's dz:
4. tx for toxic multinodular goiter or toxic adenoma
Definition
1. diagnostic exam: 2 mCi
2. tx for thyroid ca: 100-200 mCi (100 uCi for post surgery ablation and 200 mCi for metastatic dz)
3. tx for grave's dz: 100 uCi/g. approximately 10 mCi
4. 30 mCi I 131
Term
major spill vs minor spill for I 131 and others
Definition
I 131: 1 mCi or more is major
Tc 99m, Tl-201, Ga 67: 100 mCi or more is major
Term
photopeaks (KeV)
1. tc:
2. FDG:
3 I 123:
4. I131:
5. indium:
6. thallium
7. gallium
Definition
1. tc: 140
2. FDG: 511
3 I 123: 159 (~150)
4. I131: 364, 637 (~300, 600)
5. indium: 173, 247 (~100, 200)
6. thallium 201: 70, 167 (~100, 200)
7. gallium 67: 93, 185, 300 (~100, 200, 300)
Term
How to differentiate Xe 133 and Tc DTPA ventilation study?
Definition
1. Xe 133: not on vent. wash in and wash out phase.
2. Tc DTPA: on vent. no wash in and wash out phase.
Term
how to differentiate perfusion from ventilation study
Definition
ventilation study has activity in the trachea
Term
How do you evaluate a VP shunt?
Definition
Tc DTPA 1 mCi (in about 1 cc) into shunt reservoir. should see in abdomen if normal study.
Can also use Tc DTPA 20 mCi in cisternography if imaging under 24h
Term
Scrotal scintigraphy
Definition
Tc pertechnetate 15 mCi flow and blood pool
remember: Tc pertechnetate can be used for
1. thyroid: 5 mCi at 20 min
2. meckel's: 10 mCi dynamic
3. testicle: 15 mCi dynamic
Term
lymphoscintigraphy
Definition
1. Tc sulfur colloid: 4-6 injections of 100 uCi in 0.1 cc each with tuberculin syringe. dynamic and delayed imaging
2. also used for:
a. liver spleen: 3 mCi at 10 min
b. bleeding: 10 mCi at 3 min and bone marrow: 10 mCi at 2h
c. reflux: 1 mCi in (age + 2) x 30 cc
Term
lymphoscintigraphy used for
Definition
1. melanoma
2. breast ca
Term
how to evaluate for vesico ureteral reflux with nuclear medicine study and how much less radiation compared to contrast vcug
Definition
Tc sulfur colloid 1 mCi in volume
Volume = (age + 2) x 30 cc
Less radiation by 1/100th the radiation of contrast vcug
2. also used for:
a. liver spleen: 3 mCi at 10 min
b. bleeding: 10 mCi at 3 min and bone marrow: 10mCi at 2h
c. lymphscintigraphy: 100 uCi 4-6 in tuberlin syringe.
Term
How do you check for radiochemical impurity?
Definition
thin layer chromatography
Term
How does free pertechnetate degrade images
Definition
1. thyroid, stomach
2. background, salivary glands
3. kidneys, bladder
Term
What is the acceptable level of aluminum concentration?
Definition
< 10 ugm per ml
Term
What is the acceptable level of Mo 99
Definition
0.15 uCi /mCi of Tc 99
Term
how to calculate ejection fraction with muga
Definition
1. (end diastolic volume - end systolic volume)/(end diastolic volume-background).
2. Tc rbc 25 mCi
Term
What are the tubular and glomerular renal agents?
Definition
1. tubular: Tc MAG 3 (10 mCi) and OIH (hippuran, labeled with I 131) (400 uCi)
2. glomerular: Tc DTPA 10 mCi
Term
short dd for superscan
Definition
1. prostate ca
2. primary hyperparathyroidism
3. renal osteodystrophy with secondary hyperparathyroidism
Term
if bone scan (may look like superscan) with soft tissue, lungs, gi tract, and/or some others), then think
Definition
renal osteodystrophy with secondary hyperparathyroidism
Term
dd for hot spot in spine on Tc mdp bone scan
Definition
20 mCi of Tc mdp:
1. unilateral: osteoid osteoma, fx, wilkinson syndrome (unilateral pars defect and other side sclerotic)
2. bilateral: bilateral pars defect
Term
What can be used to detect infection?
Definition
1. Tc MDP bone scan: 20 mCi at 3h
2. Gallium 67 citrate: 5 mCi at 2d
3. Indium 111 labeled wbc 500 uCi at 1d
4. Tc labelled wbc 10 mCi 2h.
Term
differential for cold lesions on bone scan
Definition
1. highly vascular tumors: renal cell ca, thyroid ca
2. other tumors: lung ca, anaplastic tumors
2. slow growing tumors: bone cysts
1. multiple myeloma
Term
seizure nuclear studies
Definition
1.
a. FDG PET: inter-ictal. look for decreased activity. 45-60 min
b. SPECT: 20 mCi Tc HMPAO. ictal. look for increased activity. 20 min
2a. SPECT cerebral perfusion imaging: 20 mCi of "see below". Image 15 min-3h later (20 min)
-Tc HMPAO (ceretec)
-Tc ECD (neurolite)
2b. PET imaging: 10mCi of FDG, image after 45-60 min
Term
what is the pathway of the csf?
Definition
1. produced by choroid plexus in lateral ventricles
2. foramen of monro, 3rd ventricle, cerebral aqueduct, 4th ventricle
3. through foramen of Magendie (1 midline) and foramina of Lushka (2 lateral)
4. subarachnoid space to bath spinal cord and brain
5. arachnoid villi to venous system
5. absorbed through arachnoid granulations.
Term
how to detect csf leak
Definition
500 uCi Indium 111 DTPA at 4h, 24, 48h
also can be used for
cisternography to check for normal pressure hydrocephalus
Term
1. what is the dose of lasix given?
2. cck?
3. morphine
Definition
1. lasix: 40 mg IV
2. 0.02 ug/kg over 30 min
3. morphine 0.04 mg/kg. about 2 mg
Term
what is normal, borderline and abnormal response to lasix?
Definition
< 10 min: normal
10-20 min: borderline
> 20 min: abnormal
Term
dd of hot femoral head on Tc MDP bone scan
Definition
1. AVN
2. mets
3. fx
4. osteoarthritis
5. osteomyelitis
Term
What is the dose for cardiac stress testing and reversal agent
1. dipyridamole (persantine):
2. adenosine:
3. dobutamine:
Definition
1. dipyridamole: 0.56 mg/kg for 4 min. aminophylline.
2. adenosine: 0.14 mg/kg/min fo r4 min. just stop.
3. dobutamine:begins with 5 ug/kg/min then increases. esmolol
(from requisites p. 465 (prob don't need to know doses)
Term
if cardiac imaging and pt overweight, can do ___ imaging
Definition
planar instead of spect imaging
Term
morphine dose for hepatobiliary scintigraphy augmentation
Definition
0.04 mg/kg. about 2 mg
Term
FDG PET to look for mets
1. fasting for
2. cancel if
3. insulin?
Definition
1. fasting for 6h
2. cancel if glc > 200
3. no insulin within 2h of of FDG injection. you don't really want insulin because it can push FDG into muscles.
Term
parodoxical bulging of LV during systole
1. called:
2. sign of:
3. may be associated with
Definition
1. dyskinesis
2. scar or infarct
3. aneurysm formation
Term
if you have clumping of Tc MAA then the number of particles available
Definition
decrease
Term
if patient is hyperthyroid and
1. high RAIU
2. low RAIU on Tc pertechnetate thyroid scan
Definition
high RAIU: Grave's dz, TSH secreting tumor
low RAIU
1. acute thyroiditis (if painful)
2. subacute thyroiditis ( if not painful) aka DeQuervain's thyroiditis
3. exogenous thyroid
4. exogenous iodine from
a. contrast (within last 6 wks)
b. kelp
5. antithyroid medications like PTU
Term
fibrofatty replacement of the right ventricular wall
Definition
arrhythmogenic right ventricular dysplasia
Term
Modified Pioped criteria
Definition
Modified Pioped criteria "Large (> 75% of a segment), moderate (25-75% of a segment), small (< 25 % of a segment). 1 large = 2 mod= 4 small

1. High prob: 2 large, 1 large and 2 mod, 4 mod. (or anything that has perfusional defect with a smaller cxr defect)

2. Intermediate prob: 1 mod. Nl cxr. (or anything that doesn't fall into the high or low probability category)

3. Low: 3 small defects. Normal cxr (or any perfusional defect with larger cxr abnormality)

4. Normal/very low: no perfusional defects
Term
alk phos: paget's vs prostate ca
Definition
alk phos elevated in paget's disease
Term
paget's disease: % with sarcomatous degeneration
Definition
1%
Term
reason for stopping exercise stress testing
Definition
1. reach target heart rate
2. fatigue
3. arrhythmia
4. 3-4 mm ST depression
Term
What are the ways you can image the parathyroid?
Definition
1. Tc sestamibi 20 mCi at 20 min (thyroid and parathyroid) and 2h (parathyroid only)
2. Tc sestamibi 20 mCi at 20 min (thyroid and parathyroid) and subtract out the thyroid with Tc pertechnetate (5 mCi). can do sestamibi or pertechnetate first.
3. Tc sestamibi 20 mCi at 20 min (thyroid and parathyroid) and subtract out the thyroid with I 123 (can do both at same time (I 123 is 400 uCi in 4h; 140 KeV for Tc and 159 KeV for I 123)
4. Thallium (thyroid and parathyroid) minus pertechnetate (5 mCi in 20 min thyroid): not really done much anymore
Term
How do we do attenuation correction for PET/CT?
Definition
Ans: CT attenuation correction (this is the "new" way of doing the correction. I'm assuming that this is the way it is being done here.
Term
1. Perfusional imaging done with:
2. Viability imaging done with:
Definition
1.
1a. Tc sestamibi or tetrofosmin. 10 mCi rest then 30 mCi stress
1b. Thallium. 3 mCi stress then 1mCi rest
1c. Rubidium 82 stress and rest. 50 mCi (can be 40-60 mCi)
2.
2a. Thallium 3 mCi then 1 mCi
2b. FDG 18 compared to nitrogen 13 ammonia (10-20 mCi-remember 10 mCi easier)
Term
1. If matched defect then_____ probability
2. If triple match then ____ probability
3. if stripe sign then __probability
Definition
1. matched means V and Q defect. low probability
2. triple match means defect on V,Q and cxr. low prob
3. stripe sign is a perfusional defect surrounded by good perfusion. low prob.
Term
Branches of the celiac, sma, and ima
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)

SMA: inferior pancreatico-duodenal A, jejunal and ileal branches, ileocolic A, right colic A, middle colic A

IMA: left colic, sigmoid, superior rectum
Term
[image]
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)
Term
[image]
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)
Term
[image]
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)
Term
[image]
Definition
1. celiac:
a. left gastric: esophageal branch, to lesser omentum, anastomosis with the right gastric
b. splenic: pancreatic A, short gastric A, splenic A (left gastroepiploic artery)
c. common hepatic: proper hepatic A (R gastric, R and L hepatic), gastroduodenal A (right gastro-epiploic and superior pancreaticoduodenal A)
Term
[image]
Definition
SMA:
1. inferior pancreaticoduodenal A
2. jejunal and ileal branches
3. ileocolic A
4. right colic A
5. middle colic A
Term
[image]
Definition
IMA
1. left colic
2. sigmoid A
3. superior rectal A
Term
[image]
Definition
IMA
1. left colic
2. sigmoid A
3. superior rectal A
Term
[image]
Definition
IMA
1. left colic
2. sigmoid A
3. superior rectal A
Term
when you look at bone scan, make sure you also look to see what organs?
Definition
kidneys and bladder
Term
what do you call it when the kidneys are fused and both on one side
Definition
crossed fused renal ectopia
Term
Complications of renal transplant
Definition
1. hematoma, urinoma (< 30 d), lymphocele (> 30d for lymphocele)
2. poor renal function
a. ATN (if early) or cyclosporine toxicity (if later). good perfusion
b. rejection: poor perfusion.
3. renal infarction (either arterial or venous)
4. obstruction
Term
If poor renal function and renal transplant, could be due to
1. if good perfusion:
2. if poor perfusion:
Definition
1. if good perfusion: ATN if early or cyclosporine toxicity if later
2. if poor perfusion: rejection
Term
if bone scan with hot spleen, think
Definition
sickle cell disease
Term
How do you differentiate infarction from infection of bone?
Definition
1. osteomyelitis and infarct will be hot on bone scan
2. osteomyelitis will be hot on gallium (for spine)/wbc study (appendicular skeleton) and infarct will be cold.
3.Tc sulfur colloid scan will be normal for osteomyelitis, but infarct will be cold.
1. bone scan (20 mCi Tc MDP 3h)
2. Tc sulfur colloid (10 mCi Tc sulfur colloid at 3 min for bleeding. other Tc SC 3 mCi at 10 min-liver spleen or 2h for bone marrow, 2. 10 mCi at 3min-bleeding, 3. 1 mCi in (age +2) x 30 cc for vesicourethral reflux 4. 100 uCi in each of the 4-6 syringes for lymphoscintigraphy)
3. wbc labeled study (Tc HMPAO wbc 10 mCi in 2h or Indium 111 wbc 500 uCi in 1d)
Term
Tc sestamibi can be used for:
Definition
1. parathyroid: 20 mCi at 20 min and 2h
2. cardiac: 10 mCi at rest and 30 mCi at stress
3. breast 20 mCi starting at 5 min
Term
differential for transient ischemic dilatation (TID)
Definition
1. multi-vessel coronary disease
2. subendocardial ischemia
3. systolic dysfunction
Term
How to differentiate Tc labeled rbc and Tc labeled sulfur colloid for bleeding
1. by image
2. what can one do and the other can't
Definition
1. you can see bone marrow with tc labeled sulfur colloid
2. You can image over a longer period of time with Tc labeled rbc.
http://njms2.umdnj.edu/zuckier/documents/14625841_000.pdf
Term
what renal agent can be used in renal failure?
Definition
Tc labeled MAG 3 (tubular agent)
(not sure if Tc DTPA can be used, couldn't really find answer)
Term
study for evaluation of acute pyelonephritis in children and cortical scarring imaging
Definition
Tc 99m DMSA 3 mCi at 3h
Term
if increased flow to the testicle,
1. think of:
2. study:
3. other studies using the same agent
Definition
1.think of: epididymitis
2. study: Tc 99 pertechnetate 15 mCi dynamic
3. other studies using Tc pertechnetate
a. 5 mCi at 20 min for thyroid
b. 10 mCi dynamic for meckel's
c. 15 mCi dynamic for scrotal scintigraphy
Term
Bone and gallium scan
1. both hot in same place:
2. hot in different places (discordance):
Definition
1. both hot in same place: infection
2. hot in different places: possible loosening
Term
Differential for bilateral renal artery stenosis on renal scan
Definition
1. dehydration
2. hypoperfusion
3. obstruction
4. chronic calcium channel blockers
Term
Can Tc 99 DTPA be used to evaluate for cerebral perfusion?
Definition
No, Tc DTPA does not cross the blood brain barrier. If it is accidentally used for the brain perfusional study, you will get a false positive.
Term
I 131 physiologic uptake in:
Definition
1. salivary secretion and then in pharynx and larynx (may need to drink water to clear)
2. stomach and intestines
3. kidney and bladder
4. diffuse liver
p. 559 top 3 diff
Term
What can happen if you give a larger I 131 dose (> 5mCi) for a diagnostic scan?
Definition
"stunning" of the thyroid gland prior to I 131 therapy
Term
causes of focal hot spot on Tc sulfur colloid liver spleen scan
Definition
1. fnh (focal nodular hyperplasia)
2. regenerating nodular cirrhosis (hepatocytes surrounded by fibrosis)
3. if in caudate: Budd Chiari syndrome
4. if in quadrate: SVC syndrome
Term
Can wbc labeled exams demonstrate GI bleeding?
Definition
yes, active GI bleeding (has wbc in addition to rbc)
1. Indium 111 oxine labeled wbc 500 uCi in 1d
2. Tc HMPAO 10 mCi in 2h
Term
Problems with QC images
1. round white:
2. branching white:
3. decreased activity:
4. varied:
Definition
1. round white: photomultiplier tube defect
2. branching white: cracked crystal
3. decreased activity: collimator defect
4. varied: electronic artifact
Term
QC
1. daily:
2. weekly:
3. monthly:
Definition
1. daily: field uniformity. extrinsic flood with collimator.
2. weekly: spatial resolution/linearity with bar phantom.
3. monthly: field uniformity. intrinsic flood without collimator.
Term
1. Stress fracture vs. shin splints
2. types of stress fracture
3. osteomyelitis vs cellulitis
Definition
1.
a. stress fx hot on flow, blood pool and delayed.
b. shin splints only hot on delayed
2.
a. fatigue: abnormal stress on normal bone
b. insufficiency: normal stress on abnormal bone
3.
a. osteomyelitis: hot on flow, blood pool and delayed
b. cellulitis: hot on flow and blood pool
Term
malignancies cold on bone scan
Definition
1. multiple myeloma
2. renal cell ca
3. thyroid ca
Term
dd for positive FDG pet scan
Definition
1. malignancy
2. infection/inflammation
3. granulomatous disease (sarcoid, fungal, TB)
Term
What types of cancer can give false negative on Pet CT?
Definition
1. broncho-alveolar carcinoma
2. mucinous mets e.g. ovarian, colon
Term
how do you prep a patient for biliary scintigraphy
Definition
phenobarbital 5 mg/kg/day for 5d
Term
What determines thallium scan viability?
Definition
24 hour scan. if perfusional defect doesn't fill in by 24 hour imaging then scar (not hibernating myocardium)
Term
dd for meckel's diverticulum
Definition
1. appendicitis
2. inflammatory bowel disease
3. intussusceptioin
4. AVM
5. tumor
Term
What is evidence of a right to left shunt?
Definition
radioactivity in the brain and extremities (thyroid, stomach and renal only may just be due to free pertechnetate and not right to left shunt)
Term
What is the energy of cobalt 57?
Definition
122 keV
Term
dd for septal penetrance
Definition
1. High energy source (I 131)
2. low or medium energy collimator
Term
TSH from?
Definition
TSH is from the anterior pituitary
TRH is from the hypothalamuc
Term
1. how can you tell the difference between thallium and sestamibi scan?
2. what else do you look for on the thallium and sestamibi scan?
Definition
1 thallium is a little more grainy and sestamibi goes to the gallbladder and bowel
2. make sure that you also look at the chest to make sure there is not a hot lung cancer, which can light up on thallium or sestamibi.
Term
omphalocele vs gastrochisis
Definition
1. omphalocele: midline. has covering.
2. gastrochisis: off midline. no covering.
Term
surfactant deficiency
1. when occur?
2. complications
3. pleural effusions?
Definition
1. before 34 weeks
2. complications:
a. immediate: pneumothorax, pneumomediastinum
b. pie (pulmonary interstitial pneumonia)-week 1
c. later: bpd (bronchopulmonary dysplasia)-week 4
(if it looks like BPD and no h/o intubation then could be Wilson Mikity syndrome)
3. usually no pleural effusions (beta hemolytic strep pna can have effusions)
Term
surfactant deficiency vs beta hemolytic strep pneumonia
Definition
pleural effusion occurs with beta hemolytic strep pna not surfactant deficiency
Term
1. causes of pulmonary hypoplasia
2. What is Potter syndrome?
Definition
1. oligohydramnios, thoracic dysplasia, intrathoracic herniation of abdominal viscera
2. Potter syndrome: renal agenesis, oligohydramnios, pulmonary hypoplasia
Term
neonatal lung disease with increased lung volumes
1. transient tachypnea of the newborn
a. occurs in
b. resolves by
2. meconium aspiration
a. occurs in
b. complication
c. pathophysiology
3. pneumonia
a. can be caused by
b. not caused by
4. congenital heart disease
a. acyanotic normal vascularity
b. acyanotic increased vascularity
c. cyanotic normal vascularity
d. cyanotic decreased vascularity
Definition
1. transient tachypnea of the newborn (TTN)
a. occurs in term infants born by C section
b. resolves by 3 d
2. meconium aspiration
a. occurs in post term infants with amniotic fluid stained with meconium, which can cause a chemical pneumonitis
b. air block complication like pneumothorax
c. meconium causes a chemical pneumonitis
3. pneumonia
a. listeria, e coli, klebsiella
b. not caused by beta hemolytic strep pneumonia
4. congenital heart disease
a. acyanotic normal vascularity: Aortic stenosis, coarctation of the aorta, interrupted aortic arch, pulmonary stenosis.
b. acyanotic increased vascularity: asd, vsd, pda
c. cyanotic decreased vascularity: tetrology of fallot (pulmonary stenosis, overriding aorta, vsd, rvh), tricuspid atresia/stenosis, pulmonary atresia, Ebstein's anomaly (atrialization of the RV), double outlet right ventricle with pulmonary stenosis
d. cyanotic increased vascularity: transposition of the great vessels, total anomalous pulmonary venous return, truncus arteriosus, single ventricle, tricuspid atresia, atrioventricular septal defect, double outlet right ventricle, eisenmenger physiology (left to right shunt turning into a right to left shunt)
Term
cyanotic infant with increased pulmonary vascularity
1. transposition of the great arteries:
a. types
b. appearance
c. treatment for D type
2. truncus arteriosus
a. types:
b. associated with
3. total anomalous pulmonary venous return
a. types:
b. appearance
Definition
1. tga
a. types
1) D type: not congenitally corrected. atrioventricular concordance and ventriculo-arterial discordance.
2) L type: congenitally corrected. atrioventricular discordance and ventriculoarterial discordance.
b. appearance: egg on a string
c. tx for D type TGA: Jatene or Mustard-Senning procedure (intra-atrial baffle)
2. truncus arteriosus
a. types:
type 1) aorta and main pulmonary A arise from common trunk
type 2) pulmonary A originates from posterior truncus
type 3) pulmonary A originates from lateral truncus
type 4) "pseudotruncus". pulmonary arterial supply from collaterals from descending aorta
b, associated with right aortic arch
3. total anomalous pulmonary venous return
a. types:
1) supracardiac: "snowman" appearance with vertical vein being left side of head. top of head is
{left} innominate vein and right side of head is svc
2) others: cardiac (coronary sinus or RA), infracardiac (below diaphragm into ivc or portal vein) and mixed
b. appearance: "snowman" for supracardiac type
4. tricuspid atresia
5. single ventricle
6. double outlet right ventricle
7. eisenmenger physiology (left to right shunt turning into right to left shunt)
Term
A acyanotic increased pulmonary vascularity
1. vsd:
a. left atrium?
b. types
c. mc type
d. presents
2. asd:
a. left atrium?
b. types
c. mc type
d. presents
3. pda
a. close with
b. keep open with
4. av septal defect:
a. aka
b. associated with
B. acyanotic with normal pulmonary vascularity
1. AS
a. types and mc type
b. associated with
c. characteristic
2. coarctation of the aorta
a. xr signs
b. esophagram signs
c. associated with
d. types
e. what is pseudocoarctation?
3. interruption of the aortic arch
4. PS
a. types and mc type
b. characteristic
c. PS vs pulmonary htn
Definition
A. acyanotic with increased pulmonary vascularity
1. vsd:
a. left atrium enlarged
b. types: membranous (mc), muscular, inlet, outlet
c. membranous is mc
d. presents younger
2. asd:
a. left atrium not enlarged
b. ostium primum, ostium secundum, sinus venosus, coronary sinus
c. mc asd: ostium secundum
d. presents older
3. pda:
a. close with indomethacin
b. keep open with prostaglandins
4. AV septal defect:
a. aka endocardial cushion defect
b. down's syndrome
B. acyanotic with normal pulmonary vascularity
1. AS
a. types: supravalvular, valvular (mc), subvalvular
b. associated with bicuspid aortic valve
c. dilatation of ascending aorta (from post stenotic jet spray)
2. coarctation of the aorta
a. xr signs:
1) figure of 3 sign
2) rib notching
b. esophagram signs: reverse 3 sign
c. associated with bicuspid aortic valve and Turner's syndrome
d. types: preductal (infantile), juxtaductal, postductal (adult)
e. pseudocoarctation: kinking of the aorta at the ligamentum arteriosum (but no pressure gradient so no collaterals)
3. interruption of the aortic arch
4. PS
a. types: supravalvular, valvular (mc), subvalvular
b. characteristic: dilatation of the post stenotic pulmonary artery
c. PS vs pulmonary htn: in PS, post stenotic jet hits main and left pulmonary A so both dilated. in pulmonary htn, central pulmonary arteries are dilated. pulmonary htn if pulmonary trunk >=29 mm
Term
solid pulmonary mass dd
1. round pna:
a. age
b. why?
2. congenital pulmonary airway malformation (C PAM)
a. types
b. tx
3. sequestration:
a. types and characteristics
b. commonly affects
4. AVM enhances like
5. bronchogenic cyst usual location
6. bronchial atresia appearance
Definition
1. round pneumonia
a. under age 8
b. collateral air circulation (pores of Kohn, channels of Lambert) not well developed)
2. C PAM
a. types: I (> 2 cm), II (< 2 cm), III (microcysts, appears solid)
b. tx: surgery
3. sequestration: usually affects left lower lobe. systemic arterial supply
a. intralobar: pulmonary venous drainage. no own pleural covering, not associated with other anomalies, presents later.
b. extralobar: systemic venous drainage. own pleural covering, associated with other anomalies, presents earlier
4. AVM: enhances like vessel
5. bronchogenic cyst: usually mediastinal
6. bronchial atresia: finger in glove appearance
7. congenital diaphragmatic hernia appears solid at birth or on right (usually more likely to have liver than bowel on right).
Term
liver mass in infant
1. hepatoblastoma
a. afp?
b. calcifications
2. hemangioendothelioma
a. can cause
b. calcification
c. associated with
3. mesenchymal hamartoma characteristics
4. metastatic disease: mc and characteristics
5. abscess:
6. hematoma:
Definition
1. hemangioblastoma
a. elevated afp
b. "chunky" calcifications
2. hemangioendothelioma
a. vascular shunting can cause high output cardiac failure
b. coarse or fine calcifications
c. can be associated with
1) cutaneous hemangiomas
2) Kasabach Merritt syndrome: thrombocytopenia with vascular tumor like hemangiomas, hemangioendothelioma etc.
3. mesenchymal hamartoma: multilocular and cystic
4. mets
a. neuroblastoma mets: calcs and hemorrhage
b. wilms mets: hypodense on CT
5. abscess
6. hematoma
Term
1. neuroblastoma:
a. can arise from
b. lab values
2. organ of zuckerlandl
a. what is it?
b. where is it?
c. what pathological process can be there?
Definition
1. neuroblastoma
a. can arise from adrenal glands and sympathetic chain (which includes the organ of zuckerlandl)
b. elevated urine catecholamines
2. organ of zuckerlandl
a. chromaffin cells
b. along the aorta from the cranial to the SMA to the bifurcation of the aorta into the iliacs
c. paraganglioma (more common) or neuroblastoma (rare)
Term
suprarenal mass in child
1. neuroblastoma
a. neuroblastoma vs Wilm's tumor
b. neuroblastoma vs adrenal hemorrhage
c. nuclear medicine study
d. staging
e. stage with best prognosis
f. age
2. extralobar sequestration
a. extralobar vs intralobar sequestration
b. most common lobe affected
3. pheochromocytoma
a. syndrome
b. nuclear study
4. adrenal hyperplasia: bilateral?
5. adrenal cortical carcinoma:
a. size?
b. characteristics:
Definition
1. neuroblastoma
a. neuroblastoma vs. Wilm's tumor
1) neuroblastoma: +calcs, surrounds vessels, displaces the kidney, no renal vein or ivc invasion.
2) Wilm's tumor: no calcs, displaces vessels, "claw sign", +renal vein or ivc invasion.
b. neuroblastoma vs adrenal hemorrhage
1) neuroblastoma: gets larger, vascular
2) adrenal hemorrhage: should decrease in size, avascular
c. nuclear medicine study: MIBG
d. staging of neuroblastoma
I. confined to organ of origin
II. not confined to organ of origin, but doesn't cross midline
III. crosses midline
IV: distant mets
IV S: age under 1 year and stage I or II with mets to skin, liver, bone marrow only
e. best prognosis: stage IV S
f. age around 2 years
2. extralobar sequestration
a. extralobar vs intralobar sequestration. both supplied by systemic arterial system
1) extralobar: separate pleural covering, drained by systemic venous system, associated with other anomalies. presents early.
2) intralobar: no separate pleural covering, drained by pulmonary venous system, not associated with other anomalies. presents later
b. most common lobe affected: left lower lobe
3. pheochromocytoma
a. syndromes
1)
-MEN IIA: medullary thyroid, pheochromocytoma, parathyroid tumor
-MEN IIB: medullary thyroid, pheochromocytoma, neuroma
(MEN I: pituitary, parathyroid tumors, pancreatic islet cell tumors)
2) von Hippel Lindau: renal cysts, rcc, pancreatic cysts, islet cell tumors, pheochromocytoma, liver cysts, retinal and cerebellar hemangioblastomas
b. nuclear study: MIBG
4. adrenal hyperplasia classically bilateral
5. adrenal cortical carcinoma
a. typically large (> 5 cm)
b. necrosis and calcs
Term
solid renal mass
1. Wilms tumor
a. age
b. syndromes:
c. Wilm's tumor vs. neuroblastoma
2. mesoblastic nephroma
a. age
b. what is it?
c. distinguishable from Wilm's?
3. nephroblastomatosis:
a. what is it?
b. bilateral?
c. malignant degeneration to?
d. surveillance?
4. lymphoma
5. RCC: syndrome?
Definition
solid renal mass
1. Wilm's tumor
a. age 3 years
b. syndromes
1) WAGR syndrome: Wilms tumor, aniridia, Genital anomalies, mental Retardation
2) Beckwith Wiedemann: macroglossia, polyhydramnios (from macroglossia preventing swallowing), omphalocele, large kidneys, hepatomegaly, hemihypertrophy
c. Wilm's tumor vs. neuroblastoma
1) Wilm's tumor: "claw sign", displaces vessels, extension into renal vein/IVC. No calcs
2) neuroblastoma: displaces kidney, surrounds vessels, no extension into renal vein/IVC. +calcs.
2. mesoblastic nephroma
a. age: newborn
b. hamartoma
c. not distinguishable from Wilms tumor
3. nephroblastomatosis
a. persistent nephrogenic rests
b. usually bilateral
c. malignant degeneration into Wilms tumor
d. recommend annual surveillance to exclude malignant degeneration into Wilms tumor. nephroblastomatosis will not enhance and Wilms tumor will enhance.
4. lymphoma
5. RCC syndrome: VHL (renal cysts, RCC, pancreatic cysts, pheochromocytoma (MEN IIA and IIB), islet cell tumors (MEN I), liver cysts, retinal and cerebellar hemangioblastomas)
Term
renal cystic lesion
1. hydronephrosis
2. multicystic dysplastic kidney
a. charactertistic
b. look at___ for___
c. how to distinguish from other cystic renal diseases
3. multilocular cystic nephroma
a. population
b. tx and why?
c. characteristic
4. autosomal dominant polycystic kidney disease
a. characteristics
b. risk for
5. cystic Wilms
a. syndromes
b. Wilms vs neuroblastoma
5. cystic RCC: syndrome
6. Abscess
Definition
1. hydronephrosis: cystic lesions that communicate
2. multicystic dysplastic kidney:
a. cystic lesions that do not communicate
b. look at contralateral side for UPJ obstruction
c. distinguish from other cystic causes as mcdk doesn't have activity on nm studies (other cystic causes do have activity)
3. multilocular cystic nephroma
a. young boys < 4 years and older women > 40 years
b. tx: surgical resection because cannot distinguish from cystic Wilms or cystic RCC
c. characteristic: multilocular cysts
4. ADPCKD
a. liver and pancreatic cysts
b. berry aneurysms which can rupture
5. cystic Wilms
a. syndromes
1) WAGR: Wilms tumor, aniridia, genital anomalies, mental Retardation
2) Beckwith Wiedemann syndrome: macroglossia, polyhydramnios, hepatomegaly, large kidneys, omphalocele, hemihypertrophy.
b. Wilms tumor vs neuroblastoma
1) Wilms tumor: no calcs, can extend into renal vein/IVC, displaces vessels, "claw sign"
2) neuroblastoma: +calcs, doesn't extend into renal vein/IVC, surrounds vessels. displaces the kidney
5. cystic RCC: VHL (renal cysts, RCC, pancreatic cysts, pheochromocytoma (MEN IIA and IIB), islet cell tumor (MEN I), liver cysts, retinal and cerebellar hemangioblastomas)
6. abscess
Term
subglottic airway narrowing
1. croup (laryngotracheobronchitis)
a. characteristics
b. age
c. aka
2. epiglottitis
a. characteristic
b. can co-exist with
3. retropharyngeal abscess:
a. what is the difference between a retropharyngeal abscess and parapharyngeal abscess?
b. how can you rule out physiologic pseudothickening
4. foreign body
5. bacterial tracheitis
a. age
b. characteristic
6. hemangioma:symmetric or asymmetric narrowing?
Definition
1. croup
a. characteristics
1) "steeple" sign.
2) loss of the normal shouldering
3) overdistention of the hypopharynx
b) 1 year old
c) laryngotracheobronchitis
2. epiglottitis
a. characteristics
1) "thumb" sign
2) thickening of the aryepiglottic folds
b. can co-exist with croup
3. retropharyngeal abscess
a. retropharyngeal is behind the pharynx and parapharyngeal is lateral to the pharynx
b. r/o pseudothickening by retaking xr with extension and inspiration.
4. foreign body: the foreign body is on the side that is expanded on expiratory views.
5. bacterial tracheitis:
a. age: 8 years
b. characteristic: plaques
6. hemangioma: asymmetric narrowing
Term
1. parts of the tonsils
2. parts of the pharynx
Definition
1. parts of the tonsils: adenoids (posterior nasopharynx), palatine tonsils (posterior oral cavity), lingual tonsils (posterior and inferior to the tongue)
2. parts of the pharynx: nasopharynx, oropharyx, oral cavity, hypopharynx (posterior), larynx.
Term
distal bowel obstruction pattern in neonate
1. Meconium plug syndrome
a. aka
b. type of patient
c. prognosis
2. Hirshsprung's
a. occurs at
b. measurement
c. rare variant
d. due to
e. dx by
f. associated with
3. ileal atresia/stenosis:
a. microcolon?
b. terminal ileum
c. due to
4. meconium ileus
a. microcolon?
b. terminal ileum
c. occurs in
Definition
1. Meconium plug syndrome
a. aka: functional immaturity of the colon or small left colon
b. children of diabetic mothers, mother's treated with magnesium or opiates, prematurity
c. stooling becomes normal after contrast enema and passage of meconium
2. Hirshsprung's
a. usually occurs at rectosigmoid junction
b. measurement: abnormal rectosigmoid ratio (sigmoid larger than rectum)
c. rare variant affects the entire colon (the whole colon is small because no ganglion cells around to make the colon relax)
d. due to lack of ganglion cells
e. dx by biopsy distal to the transition zone
f. associated with Down's syndrome
3. ileal atresia/stenosis:
a. +microcolon
b. terminal ileum collapsed
c. due to in utero focal ischemic injury
4. meconium ileus
a. +microcolon
b. distended and bubbly stool pattern in RLQ
c. cystic fibrosis
Term
distal bowel obstruction pattern in neonate
1. Meconium plug syndrome
a. aka
b. type of patient
c. prognosis
d. characteristic
2. Hirshsprung's
a. occurs at
b. measurement
c. rare variant
d. due to
e. dx by
f. associated with
g. characteristic
h. tx:
3. ileal atresia/stenosis:
a. microcolon?
b. due to
c. terminal ileum
4. meconium ileus
a. microcolon?
b. terminal ileum
c. occurs in
Definition
1. Meconium plug syndrome
a. aka: functional immaturity of the colon or small left colon
b. children of diabetic mothers, mother's treated with magnesium or opiates, prematurity
c. stooling becomes normal after contrast enema and passage of meconium
d. small caliber left colon. multiple filling defects
2. Hirshsprung's
a. usually occurs at rectosigmoid junction
b. measurement: abnormal rectosigmoid ratio (sigmoid larger than rectum); normally rectum larger than sigmoid)
c. rare variant affects the entire colon (the whole colon is small because no ganglion cells around to make the colon relax)
d. due to lack of ganglion cells in the myenteric plexus
e. dx by biopsy distal to the transition zone
f. associated with Down's syndrome
g. characteristic: dilated proximal portion and narrowed aganglionic distal portion
h. tx: resection of aganglionic segment
3. ileal atresia/stenosis:
a. +microcolon
b. due to in utero focal ischemic injury
c. terminal ileum collapsed.
4. meconium ileus
a. +microcolon
b. filling defects in the RLQ
c. cystic fibrosis
Term
can you distinguish small and large bowel in the newborn?
Definition
not really
Term
bowel wall thickening in immunocompromised child
1. pseudomembranous colitis
a. due to
b. appearance
c. usually affects
2. typhlitis
a. aka
b. affects
3. graft vs host disease
a. affects
b. appearance
4. post transplant lymphoproliferative disorder
due to
5. shock bowel: appears similar to
Definition
1. pseudomembranous colitis
a. due to C difficile overgrowth
b. "accordion sign"
c. usually affects long segment of colon: "pancolitis"
2. typhlitis
a. neutropenic colitis
b. usually affects right colon
3. graft vs host disease
a. usually affects entire small and large bowel (mucosa looks very bright as per me)
b. "ribbonlike" appearance on small bowel follow through.
4. post transplant lymphoproliferative disorder due to reactivation of Epstein Barr virus
5. shock bowel appears similar to graft vs host disease, but shock bowel usually spares the colon.
Term
skeletal dysplasia
1. achondroplasia
a. mc
b. characteristics
c. -melia
2. thanatophoric dysplasia
a. mc
b. characteristics
c. -melia
3. Jeune syndrome
a. characteristics
b. -melia
4. Ellis Van Creveld syndrome
a. clinical characteristics
b. -melia
5. Chondrodysplasia punctata
a. characteristic
b. -melia
Definition
1. achondroplasia
a. mc nonlethal skeletal dysplasia
b. characteristics
1) trident hand (thumb, fingers 2/3, fingers 4/5)
2) decreased interpedicular distance in the lower lumbar spine
3) tombstone iliac bones
4) champagne glass inner pelvic contour
5) spinal stenosis
6) posterior vertebral body scalloping
c. rhizomelic
2. thanatophoroic dysplasia
a. mc lethal skeletal dysplasia
b. characteristics
1) telephone receiver femurs
2) platyspondyly (Jeune syndrome has nl vertebral bodies)
3) cloverleaf skull (variable)
c. rhizomelia
3. Jeune's asphyxating thoracic dystrophy
a. characteristics
1) bell shaped thorax
2) upside down trident acetabula
3) handle bar clavicles
4) normal vertebral bodies: Thanatophoric dysplasia has platyspondyly.
b. acromelia
4. ellis van creveld syndrome
a. nail, hair, teeth abnormalities
b. acromelia
5. chondrodysplasia punctata:
a, characteristic: stippled epiphysis
b. type of epiphyseal dysplasia
c. rhizomelia
Term
-melia
1. rhizomelia
2. mesomelia
3. acromelia
4. micromelia
Definition
1. rhizomelia: "root" proximal e.g. humerus
2. mesomelia: middle e.g. radius, ulnar
3. acromelia: distal e.g. phalanges
4. micromelia: the whole limb is shortened
Term
"double bubble sign
1. malrotation with midgut volvulus
a. upper gi with small bowel follow thru findings
b. CT/US findings
2. duodenal atresia/stenosis
a. associated with?
b. due to
c. not due to___ like in ____
3. annular pancreas often coexists with
4. duodenal web appearance
Definition
1. malrotation with midgut volvulus
a. upper gi with small bowel follow through findings: ligament of treitz (between duodenum and jejunum) should be to the left of the spine and at the level of or superior to the duodenal bulb
b. ct/us findings: sma is on right and smv on left (opposite of normal relationship). can see whirlpool sign where the smv wraps around the sma in a clockwise direction.
2. duodenal atresia/stenosis
a. associated with down's syndrome
b. due to failure of recanalization
c. duodenal atresia is not due to ischemic event like in jejunal or ileal atresia.
3. annular pancreas often coexists with duodenal atresia/stenosis
4. duodenal web has windsock appearance
Term
defn
1. malrotation
2. midgut volvulus
Definition
1. malrotation: abnormal fixation of small bowel mesentery that results in short mesenteric base
2. midgut volvulus: abnormal twisting of small bowel around SMA
Term
posterior vertebral body scalloping
Definition
1. increased intraspinal pressure from
a. in child: astrocytoma
b. in adult: ependymoma
2. dural ectasia
a. connective tissue disorder: Marfan's or Erlos Danlos
b. neurofibromatosis I from plexiform neurofibromas and meningoceles (LOS lisch nodules, optic gliomas, sphenoid wing dysplasia). coast of california cafe au lait spots (remember coast of main cafe au lait spots are for mc cune albright syndrome which also has fibrous dysplasia and precocious puberty)
3. achondroplasia: rhizomelia, trident hand, decreased interpedicular distance in the lumbar spine, tombstone iliac bones, champagne glass pelvic inlet, spinal canal stenosis, posterior vertebral body scalloping)
4. mucopolysaccharidosis: anterior vertebral body beaking
a. Hurler's: inferior anterior vertebral body beaking
b. Morquio's: mid anterior vertebral body beaking
-----------
5. can normal variant if exclude all other causes
Term
germ cell tumor
classificationhttp://radiographics.rsna.info/content/24/2/387.full#sec-16
Definition
germ cell tumor
1. teratoma: 3 germ cell layers
a. mature aka dermoid cyst: teeth, hair, lots of fat
b. immature: mostly solid, has scattered calcs and fat
2. seminoma
a. location
1) in pineal or suprasellar region: germinoma
2) in ovary: dysgerminoma
b. appearance: solid
3. non seminomatous germ cell tumor
a. e.g. yolk sac tumor (high afp), choriocarcinoma (high beta hcg), embryonal carcinoma
b. appearance: hemorrhage, calcs
4. mixed
Term
presacral mass
1. germ cell tumor like sacrococcygeal teratoma
2. meningocele
3. rectal duplication cyst
4. lymphangioma
5. ovarian cyst: risk of torsion if
Definition
1. germ cell tumor like sacrococcygeal teratoma
a. part of currarino triad (scimitar sacrum, presacral mass, anorectal malformations)
2. meningocele: can be part of
a. currarino triad: scimitar sacrum, presacral mass, anorectal malformations) or neurofibromatosis I (plexiform neurofibromas, meningoceles, lisch nodules, optic nerve gliomas, sphenoid wing dysplasia)
3. Rectal duplication cyst
4. lymphangioma
5. ovarian cyst risk of torsion if > 6 cm
Term
long bone aggressive lesion
1. osteosarcoma
a. where?
b. age
c. evaluate for local "skip" lesions with
d. evaluation for metastatic disease with
2. Ewing's sarcoma
a. location
b. age
3. osteomyelitis: include in dd when?
4. Langerhans cell histiocytosis: include in dd when?
5. metastatic disease: which ones?
Definition
1. osteosarcoma
a. metaphyseal
b. 10-20 years
2. Ewing's sarcoma
a. metadiaphyseal
b. 10-15 years
3. osteomyelitis: include in almost all dd
4. Langerhans cell histiocytosis: age < 30 years
5. metastasis: leukemia, lymphoma, neuroblastoma
Term
endobronchial lesion in a child
1. foreign body
a. mc
b. how to check radiographically for fb
2. papilloma
a. if multiple called
b. associated with
3. carcinoid: appearance on CT
4. inflammatory polyp: goes away when...
4. salivary gland tumor like
Definition
1. foreign body
a. most common: nuts
b. check with
1) inspiratory and expiratory views: if on expiratory views, the lung doesn't collapse then fb could be on that side.
2) bilateral decubitus views: the side closer to the ground should collapse. if it doesn't, there might be a fb on that side.
3) fluoroscopy
4) CT
2. papillomas
a. if multiple called papillomatosis
b. associated with HPV 6 and 11
3. carcinoid: hypervascular on CT
4. inflammatory polyp: goes away when causative factor removed (infection, foreign body, inhaled toxin)
5. salivary gland tumor: like mucoepidermoid cancer and adenoid cystic cancer
Term
1. erlenmeyer flask deformity dd
2. gracile bone dd
Definition
1. undertubulated bone. short and squat bone. erlenmeyer flask deformity. tongs
a. tumor like lesions:
1) fibrous dysplasia:
a) ground glass opacities
b) syndromes
-Mc Cune Albright syndrome: fd, precocious puberty, cafe au lait spots (coast of maine)
-Mazabraud syndrome: fd, intramuscular myxomas
2) Pagets: elevated alk phos. bony expansion, cortical thickening, coarse trabeculations
3) multiple hereditary exostosis:
b. osteopetrosis: rugger jersey spine (also seen in hyperparathyroidism)
c. Niemann Pick disease: lysosomal storage disease
d. gaucher disease: lysosomal storage disease
e. sickle cell disease
2. overtubulated bone. gracile bone. long and thin. nimrod
a. neurofibromatosis/neuromuscular disease
b. immobility
c. Marfans
d. jRa
e. oi
f. dysplasias
Term
lytic skull lesion in child
1. Langerhans histiocytosis
a. old name
b. appearances
2. infection: appearance
3. epidermoid cyst
4. leptomeningeal cyst due to?
5. mets, which ones?
Definition
1. Langerhans histiocytosis
a. old name: EG
b. appearances: beveled edge, button sequestrum
2. infection: button sequestrum.
3. epidermoid cyst
4. leptomeningeal cyst: growing fracture due to dural tear exposing the fracture to CSF pulsations
5. mets (neuroblastoma, leukemia)
Term
A. appearance of AVN of the femoral head
1. Legg Calve Perthes disease
a. age
b. more common in boys or girls
c. %bilateral
2. SCFE
a. age
b. boys or girls more common?
c. % bilateral
b. can result in
3. steroids
4. trauma
5. Gaucher's disease: what type of disease?
6. sickle cell disease
7. Meyer dysplasia
a. age
b. male or female
c. uni or bilateral
d. symptomatic?
B. appearance of AVN
Definition
1. Legg Calves Perthes disease:
a. age 5 years
b. more common in boys
c. 25% bilateral
2. SCFE (slipped capital epiphysis)
a. age 10-15 years
b. more common boys
c. 25% bilateral
b. AVN can be complication of SCFE
3. steroids
4. trauma
5. gaucher disease is lysosomal storage disease
6. sickle cell disease
7. Meyer dysplasia
a. age: 2-4 years
b. male
c. often bilateral
d. asymptomatic
B. appearance of AVN
1. xr
a. femoral head flattening and sclerosis
b. crescent sign (subchondral fracture)
2. mr:
a. double line sign (on T2: bright inner line is hyperemic granulation tissue and dark outer line is sclerotic bone)
b. rim sign: high T2 surrounded by low T1 which represents fluid between borders of an osteochondral fragment and implies instabiity (may not be important to memorize)
Term
A. aortic arch variants
1. bovine aortic arch
2. left vertebral artery origin off the arch
3. left arch and aberrant right subclavian A
a. what is it?
b. esophagram
4. right arch and aberrant left subclavian A
a. what is it?
b. where does the left subclavian A come off of?
c. esophagram?
d. associated with?
5. double aortic arch:
a. which side larger and higher?
b. what is the 4 vessel sign?
c. esophagram?
6. pulmonary sling:
a. what is it?
b. associated with?
c. esophagram?
B. which ones need surgery?
Definition
A.
1. bovine aortic arch: left carotid artery comes off the innominate artery
2. left vertebral artery comes off the arch between the left common carotid and left subclavian A (usually the vertebral comes off the subclavian A)
3. left arch and aberrant right subclavian A
a. aberrant right subclavian A comes off posterior to the left subclavian A and passes to contralateral side posterior to the esophagus.
b. posterior indentation of the esophagus.
4. right arch and aberrant left subclavian A
a. aberrant left subclavian comes off as last branch of arch from diverticulum of Kommerell and passes to contralateral side posterior to the esophagus
b. aberrant left subclavian A comes from diverticulum of Kommerell
c. esophagram: posterior indentation of the esophagus
c. associated with congenital heart dz (10%)
5. double aortic arch:
a. the double aortic arch surrounds the trachea and esophagus. r arch usually larger and higher.
b. usually two carotid A and two subclavian A (4 vessel sign)
c. esophagram:
1) posterior and lateral indentation of the esophagus.
2) narrowing of the trachea
3) trachea appears midline
6. pulmonary sling: left pulmonary A comes off the right pulmonary A and passes to left side between the trachea and esophagus.
b. associated with complete tracheal rings
c. esophagram: anterior indentation of the esophagus
B. complete vascular rings and pulmonary sling need surgery:
1. double aortic arch: complete vascular ring
2. right arch with aberrant left subclavian and symptomatic ductus arteriosum/ligamentum arteriosum. complete vascular ring.
3. pulmonary sling
Term
cystic pulmonary mass
1. congenital lobar emphysema:
a. what is it?
b. where does it usually occur?
2. congenital pulmonary airway malformation
a. what is it?
b. types
3. congenital diaphragmatic hernia
a. which side more common?
b. Bochdalek
c. Morgagni
4. necrotizing pneumonia: prognosis
5. pneumatoceles
Definition
1. congenital lobar emphysema
a. progressive expansion of pulmonary lobe due to bronchial obstruction
b. affects LUL > RML > RUL (aside: sequestration usually affects LLL)
2. congenital pulmonary airway malformation
a. hamartomatous proliferation of terminal bronchioles. ~hamartomas
b. types:
1) I: >= 2 cm cysts
2) II: < 2 cm cysts
3) III: solid appearing due to very small cysts
3. congenital diaphragmatic hernia: can look solid at birth or if on right (liver often herniated on right instead of bowel). looks more cystic later and on left.
a. more common on left
b. Bochdalek: left back (Back and Bochdalek)
c. Morgagni: right anterior
4. necrotizing pneumonia: usually good prognosis in otherwise healthy children
5. pneumatoceles
Term
esophageal obstruction in neonate
1. tef/ea
a. most common type
b. types
c. association with
d. if E/H type fistula suspected then do
2. foreign body likely to get stuck where?
3. esophageal duplication cyst
a. right or left side usually?
b. communication with esophagus?
4. vascular ring
a. can cause
b. esophagram shows
c. types
Definition
1. tracheo esophageal fistula/esophageal atresia:
a. most common type: C type
b. types:
type A: Esophageal atresia only
type B: EA with proximal TEF
type C: EA with distal TEF
type D: EA with proximal and distal TEF
type E: TEF without EA. aka type H
c. association with VACTERL: vertebral body anomaly, anal atresia, cardiac anomalies, TE fistula, esophageal atresia, renal, radial ray Limb anomalies
d. if E/H type fistula suspected then do upper GI with water soluble contrast
2. foreign body:
a. likely to get stuck at thoracic inlet, level of aortic arch and GE junction
3. esophageal duplication cyst
a. usually right sided
b. usually not in communication with the esophagus
4. vascular ring:
a. complete vascular ring can cause dysphagia.
b. esophagram shows posterior and bilateral lateral indentations
c. types
1) double aortic arch
2) right arch with aberrant left subclavian A (with ductus/ligamentum arteriosum)
Term
Wilson Mikity syndrome
Definition
1. looks like BPD (occurs at around 4 wks)
2. but no h/o intubation
Term
how to tell term vs pre term baby
Definition
if you see humeral epiphysis then term (> 37 weeks)
Term
normal inspiration is
Definition
8 ribs according to south alabama
Term
1. white dots on a black background
2. black dots on a white background
Definition
1. white dots on a black background:
a. hypoinflated lungs: surfactant deficiency, GBS, lung hypoplasia
b. hyperinflated lungs: meconium aspiration, pna (klebsiella, e coli legionella), congenital heart disease
2. black dots on a white background:
1st week: pulmonary interstitial emphysema
2nd-3rd week: Wilson Mikity syndrome (looks like bronchopulmonary dysplasia, but no h/o intubation)
4th week: Wilson MIkity syndrome or bronchopulmonary dysplasia (4 wks), Wilson Mikity syndrome (looks like bronchopulmonary dysplasia, but no h/o intubation)
Term
high frequency ventilation
1. for
2. what is it? (bonus)
Definition
1. high frequency ventilation is for anything with high risk of ptx like surfactant deficiency or PIE (pulmonary interstial emphysema)
2. high frequency ventilation (900 breathes per minute, tidal volume of 2cc/kg)
Term
dd bell shaped thorax
Definition
1. lung hypoplasia
a. oligohydramnios: like from Potter disease (bilateral renal agenesis, oligohydramnios, lung hypoplasia)
b. thoracic dysplasia like Jeune asphyxiating thoracic dystrophy (bicycle handle bar clavicles, bell shaped thorax, upside down trident acetabula)
c. nervous system abnormality like trisomy 21 (hypotonia), pharmacologic paralysis, structural brain anomalies

c.
Term
1. pathway of
a. UVC
b. UAC
2. ideal placement
a. UVC and UAC
b. ETT and how does ETT move when head goes up/down
c. OG tube
d. PICC line
Definition
1. pathway of
a. UVC: umbilical V, left portal vein, ductus venosus, hepatic vein, IVC (in and up)
b. UAC: umbilical A, iliac A, aorta (in, down, 180 degree turn up)
2. ideal placement
a. UVC and UAC: T8-T10 or below L3 (away from celiac, SMA, IMA)
b. ETT: should be at level of clavicles. if chin moves up, the ETT moves up. if the chin move down, the ETT moves down.
c. OG tube should be below GE junction
Term
complication of neonatal pneumonia and prematurity of the lungs
Definition
hemorrhage
(south alabama)
Term
lobes affected
1. sequestration
2. cle
3. bronchial atresia
4. hypogenetic lung syndrome
Definition
1. sequestration: LLL < RLL
2. congenital lobar emphysema LUL > RML > RUL
3. bronchial atresia: LUL > LLL > RML
4. hypogenetic lung syndrome (aka scimitar syndrome or partial anomalous pulmonary venous return): RLL
Term
Swyer James syndrome is due to
Definition
infectious insult during lung development
Term
Hypogenetic lung syndrome
1. aka
2. usually occurs in RLL
Definition
1. scimitar syndrome, partial anomalous pulmonary venous return
2. hypogenetic lung syndrome usually occurs in RLL
Term
cystic hygroma
1. due to
2. associated with
Definition
1. congenital blockage of lymphatic drainage
2. Turner's syndrome, Downs syndrome.(just remember Turners and Downs)
others: Turners syndrome, Trisomy 13 (Patau), 18 (Edwards), 21 (Down's), Noonan's, Fetal alcohol syndrome
Term
Mucopolysaccharidosis
Definition
-deficiency of lysosomal enzymes. bullet shaped metacarpals
1. Hurlers: mental retardation. gargoyle face. oar shaped ribs. anterior inferior vertebral body beaking
2. Morquio's: no mental retardation. anterior mid-vertebral body beaking.
3. Hunter's: X linked. all others are autosomal recessive.
Term
Cleidocranial dysplasia
A. used to be called
B. characteristics
Definition
A. cleidocranial dysplasia used to be called cleidocranial dysostosis
B.
1. wormian bones and delayed closure of sutures
2. clavicular abnormalities
3. supernumerary teeth (statdx)
------
Term
TORCH infections
1. sign for rubella
2. sign for syphilis
Definition
toxo, other (syphilis), rubella, cmv, herpes
1. rubella: celery stalk appearance
2. syphilis: Wimberger's sign (proximal medial tibial erosion)
Term
dd septic hip
Definition
1. septic hip: bacterial infection
2. toxic synovitis: viral infection
3. trauma
4. chronic synovial arthritis
5. Legg Calve Perthes
Term
specific fractures for child abuse
Definition
1. scapula
2. sternum
3. spinous process
4. posterior ribs
5. metaphyseal corner fracture (aka bucket handle tear)
Term
fractures that children can get
Definition
1. buckle: bulges in or out
2. torus fracture: bulges out
2. greenstick fracture: fracture does not extend to the other side.
3. plastic bowing fracture: bowing without visible fracture
Term
developmental dysplasia of the hip
1. plain film done at? acetabular angle should be?
2. US: age done? alpha angle: ?
Definition
developmental dysplasia of the hip
1. plain film > 6 months old. after proximal femoral epiphysis ossification.
a. Hilgenreiner's line
b. Perkin's line
c. Shelton's line
d. acetabular angle should be 30 degrees at birth and decreases with time.
2. US: < 6 months old. before proximal femoral epiphysis ossification.
a. alpha angle: should be greater than 60 degrees
b. beta angle
Term
neuropathic joint and pathophysiology
1. shoulder
2. spine and lower extremity
3. feet
Definition
neuropathic joint
1. shoulder: syrinx
2. spine and lower extremities: tabes dorsalis (syphilis)
3. feet: diabetes, alcoholism
Term
1. the -oceles
2. myelo goes before meningo so myelomeningo-
Definition
the -oceles
lipomyelomeningocele
lipomyelocele
lipomeningocele (?found not in reputable journals)
myelomeningocele
myelocele
meningocele
Term
dd lucent diaphyseal lesion
1. < 30 years:
2. > 30 years:
Definition
1. < 30 years: infection, eg, leukemia, Ewing's (diaphyseal)/osteosarcoma (metaphyseal or metadiaphyseal)
2. > 30 years: infection, lymphoma, multiple myeloma, metastasis.
Term
birth trauma to the sternocleidomastoid muscle
Definition
1. torticollis
2. aka fibromatosis coli
Term
Apert's syndrome
Definition
1. craniofacial abnormalities
2. syndactyly
Term
1. what type of contrast do you use if you are worried about obstruction or aspiration?
2. what do you use for suspected bowel perforation?
3. what do you use for possible aspiration?
Definition
1. use iso-osmolar contrast if worried about obstruction or aspiration
2. use gastrograffin (water soluble contrast) for suspected bowel perforation (barium can cause peritonitis)
3. use barium for possible aspiration (gastrograffin can cause pneumonitis)
Term
hypertrophic pyloric stenosis
1. width of muscle
2. length of muscle
3. how is this done
Definition
1. width of muscle: > 3 mm
2. length of muscle: > 14 mm
3.
a. baby fasting for 4h
b. use 6-10 MHz linear array
c. have baby drink water (best as hypoechoic) or milk (echogenic). if breastfeeding and don't want to deviate from breastfeeding, feed then scan.
d. do a scan while supine to look for any gross pathology
e. scan while baby is drinking with left side slightly elevated.
http://www.ultrasoundpaedia.com/normal-pylorus/
Term
necrotizing enterocolitis
1. occurs in
2. radiographic signs
3. tx
4. etiology:
Definition
necrotizing enterocolitis
1. occurs in premature infants
2. radiographic signs: portal venous gas, pneumatosis intestinalis, Rigler's sign (gas on both sides of the walls), football sign, unchanging bowel gas pattern over serial films
3. tx
a. bowel rest, abx
b. if free air, surgery
4. etiology: infection, ischemia
Term
meconium peritonitis
1. dd
2. can extend into ____ due to ______
3. if contained, called _____
Definition
meconium peritonitis
1. dd: teratoma, gallstones, liver calcifications
2. can extend into scrotum due to patent processus vaginalis
3. if contained, called meconium pseudocyst.
Term
intussusception
1. lead point: adult vs children
2. how do you perform reduction?
3. clinical presentation
4. radiographic appearance
a. axial
b. longitudinal
Definition
intussusception
1. lead point: children usually don't have lead points
2. performing a reduction
a. can use water soluble contrast or air
b. have surgery standing by
c. no more than 3 attempts
d. maintain fluid level no more than 3 feet above pt
e. maintain the pressure for no more than 3 minutes against non-moving loop intussusception
3. presents with currant jelly stool
4. radiographic appearance
a. axial: target sign or bull's eye sign
b. longitudinal: pseudokidney appearance
Term
meconium peritonitis
1. dd
2. can extend into ____ due to ______
3. if contained, called _____
Definition
meconium peritonitis
1. dd: teratoma, gallstones, liver calcifications
2. can extend into scrotum due to patent processus vaginalis
3. if contained, called meconium pseudocyst.
Term
autosomal recessive polycystic kidney disease
1. appearance
2. also has ____
Definition
autosomal recessive polycystic kidney disease
1. appearance: bilateral enlarged kidneys
2. also has hepatic fibrosis. the more the liver is affected, the less the kidney is affected.
Term
vesicoureteral reflux
1. types
2. tx
Definition
vesicoureteral reflux
1. grades:
I: reflux into ureter
II: reflux into pelvis/calyces without hydronephrosis
III: reflux with mild hydronephrosis
IV: reflux with moderate hydronephrosis
V: reflux with severe hydronephrosis
2. tx:
a. prophylactic abx to prevent scarring (DMSA scan 3 mCi at 3h; if low radiotracer activity then scar.) prior to expected resolution at 6 years old
b. surgical reimplantation if persistent infection, not resolved by 6 years old or with significant scarring
Term
Weigert Meyer rule
Definition
1. upper pole: inserts ectopically (inferior and medial). obstructed. ureterocele
2. lower pole: inserts normally. reflux.
Term
prune belly syndrome
A. triad
B. prune belly syndrome vs posterior urethral valves
Definition
A. prune belly syndrome triad
1. urinary tract dilatation
2. deficient abdominal wall muscles
3. cryptorchidism (undescended testes)
B. prune belly syndrome (no dilated posterior urethra) vs posterior urethral valve (has dilated posterior urethra)
Term
primary megaureter
1. what is it?
2. characteristic
Definition
1. functional obstruction due to absent peristalsis
2. may appear like concentric tapering to normal sized distal ureter
Term
type of cancer, sickle cell trait or disease is higher risk for
Definition
renal medullary cancer
Term
Robson classification of RCC
Definition
Robson staging of renal cell carcinoma
I: confined to kidney
II: confined to gerota's fascia (confined to perinephric fat or involves ipsilateral adrenal gland)
III:
A. venous invasion (renal vein or IVC)
B. lymph nodes
C. both
IV:
A: direct extension into adjacent organs outside of Gerota's fascia
B. distant mets
Term
A. neuroblastoma vs Wilms tumor
B. origin of neuroblastoma
Definition
A.
1. neuroblastoma: elevated the aorta. calcifications. crosses midline. 2 years old.
2. Wilms tumor: invades the renal vein/ivc. no calcs, doesn't cross midline. 3 years old.
B. origin of neuroblastoma
1. adrenal gland
2. sympathetic chain which includes the organ of Zuckerlandl (near aorta from above SMA to iliac bifurcation)
Term
adrenal hemorrhage progression on US
Definition
1. hyperechoic
2. hypoechoic
3. multiseptated pseudocyst, calcification or complete resolution
Remember no flow in adrenal hemorrhage
Term
renal trauma
1. if low density in kidney
a. round
b. wedge shaped
2. whole kidney is low density except for rim of enhancement then
Definition
1. if low density
a. round: contusion
b. wedge shaped: infarct
2. arterial pedicle injury
Term
Complications of renal transplant
Definition
A. fluid collection
1. hematoma (< 30 d). cold on renogram
2. urinoma (< 30 d). hot on renogram
3. lymphocele (> 30d). cold on renogram
4. abscess. cold on renogram. hot on wbc labeled or gallium scan.
B. high resistive index (>0.9). poor renal function
a. good perfusion
1) ATN (early)
2) cyclosporine toxicity (later).
b. poor perfusion: rejection
C. renal infarction
a. arterial:
1) parvus tardus waveform
2) high velocity
b. venous:
1) reversal of diastolic flow
2) no collaterals
D. obstruction
Term
types of gray matter heterotopias
1. cause
2. clinical presentation
3. types
4. mc type:
Definition
gray matter heterotopia
1. etiology: genetic or acquired (toxins or infection) causing abnormal migration from germinal matrix to cortex
2. types
a. agyria/pachygyria spectrum
1) agyria
2) pachygyria
3) lissencephaly
4) polymicrogyria
b. band heterotopia
c. subependymal heterotopia (mc)
4. mc type : subependymal heterotopia
Term
suprasellar mass
Definition
satchmo
sarcoid, sellar tumor (adenoma)
aneurysm, arachnoid cyst
teratoma, dermoid, epidermoid
craniopharyngioma
hypothalamic glioma, hypothalamic hamartoma/hamartoma or tuber cinereum
mets/meningioma
optic nerve glioma
eg of pituitary stalk
Term
1. Sturge Weber syndrome
a. characteristics
b. dd:
c. usually affects
d. aka
2. Von Hippel Lindau
3. Tuberous sclerosis
4. neurofibromatosis I
5. neurofibromatosis II
6. Chiari I malformation
7. Chiari II malformation
8. Dandy Walker malformation
Definition
1. Sturge Weber syndrome:
a. serpiginous calcification, gyral enhancement and gyral atrophy
b. dd
1) Dyke Davidoff Mason syndrome aka cerebral hemiatrophy: normal side is the larger side.
2) hemimeganencephaly: normal side is the smaller.
c. usually affects V1
d. encephalotrigeminal angiomatosis
2. Von Hippel Lindau: renal cysts, rcc, pancreatic cysts, pheochromocytoma, islet cell tumors, liver cysts, hemangioblastomas of the retina and cerebellum
3. TS: TALRS. cortical Tubers, angiomyolipomas, LAM, renal cysts, subependymal giant cell astrocytoma
4. NF1: Lisch nodules (iris hamartomas), optic nerve gliomas, sphenoid wing dysplasia, plexiform neurofibromas with ribbon ribs
5. NF2: multiple hereditary schwannomas, meningiomas, ependymomas
6. Chiari I: downward herniation of cerebellar tonsils => 5 mm below foramen magnum. +syrinx. no supratentorial abnormalities.
7: Chiari II: downward herniation of cerebellar tonsils => 5 mm below foramen magnum. +myelomeningocele. other abnormalities (luckenschadel/lacunar skull, large massa intermedia, tectal beaking, kinking at the cervicomedullary junction, small posterior fossa)
8. Dandy Walker malformation: large posterior fossa, large cyst communicating with the 4th ventricle, vermian hypoplasia/agenesis, torcular-lambdoid inversion
Term
jna
1. involves
2. can pre-operatively treat with
3. supplied by
Definition
juvenile nasopharyngeal angiofibroma
1. involves:pterygopalatine fossa (posterior to maxillary sinus)
2. can pre operatively treat with embolization
3. supplied by branches of the EC or occasionally the IC
Term
branches of the eca
Definition
Branches of the external carotid artery
"Some Attendings Like Freaking Out Potential Medical Students."
1. superior thyroid
2. ascending pharyngeal
3. lingual
4. facial
5. occipital
6. posterior auricular
7. maxillary
8. superficial temporal
Term
epispadias vs hypospadias
Definition
epispadias: urethral opening in on "top"/dorsum of penis
hypospadias: urethral opening no "bottom"/ventrum of penis
Term
tethered cord
1. defn
2. -oceles
3. associated with myelomeningocele
Definition
1. conus below L2-L3 disc space
2. -oceles
a. meningocele: herniation of CSF filled sac
b. open spinal dysraphism:
1) myelomeningocele: neural placode is beyond skin surface. 98%
2) myelocele: neural placode is flush with skin surface
c. closed spinal dysraphism with fatty mass above intergluteal crease
1) lipomyelomeningocele: placode-lipoma interface is beyond spinal canal
2) lipomyelocele: placode-lipoma interface is within spinal canal
3. associated with myelomeningocele
Term
holoprosencephaly
A. subtypes
B. associated with
C. normal formation of the corpus callosum
D. normal myelination of the corpus callosum
Definition
1. alobar: one cerebrum, one thalamus, monoventricle
2. semilobar: posterior falx
3. lobar: posterior and partial anterior falx
B. associated with anterior dysgenesis of corpus callosum (other things are usually associated with posterior dysgenesis) and absent septum pellucidum
C. normal formation of the corpus callosum: genu, body, splenium/posterior, rostrum/anterior (~anterior to posterior)
D. normal myelination of the corpus callosum (~posterior to anterior)
Term
vein of galen malformation
1.is
2. tx
Definition
vein of galen malformation
1. is an AVF of the median prosencephalic vein of Markowski (vein of galen malformation is a misnomer because this AVF prevents the formation of the vein of Galen)
2. tx: endovascular embolization with coils or acrylic glue
Term
1. Dandy Walker malformation
2. Dandy Walker variant
3. Mega Cisterna Magna
4. Arachnoid cyst
Definition
1. Dandy Walker malformation: Enlarged posterior fossa cyst, which communicates with the 4th ventricle. hypoplastic or agenesis of the cerebellar vermis, torcular-lambdoid inversion. Enlarged posterior fossa. (small posterior fossa chiari 2 malfn)
2. Dandy Walker variant: normal size posterior fossa
3. Mega Cisterna magna: no mass effect.
4. arachnoid cyst: mass effect.
Term
1. acyanotic heart with increased vascularity
2. acyanotic heart with normal vascularity
3. cyanotic heart with increased vascularity
4. cyanotic heart with decreased vascularity
Definition
1. acyanotic/increased: vsd, asd, pda
2. acyanotic/normal: aortic stenosis, coarctation of the aorta, interrupted aortic arch, pulmonary stenosis
3. cyanotic/increased: total anomalous pulmonary venous return, truncus arteriosus, transposition of the great vessels, tricuspid atresia, (t)single ventricle [double outlet right ventricle, Eisenmenger physiology-left to right shunt turning into right to left shunt]
4. cyanotic/decreased-normal: tetrology of Fallot (pulmonary stenosis, overriding aorta, vsd, rvh), pulmonary atresia, tricuspid atresia/stenosis, Ebstein anomaly (atrialization of the RV), [DORV with pulmonary stenosis]
Term
TAPR (total anomalous pulmonary venous return)
A. types
B. sign
Definition
A. types: supracardiac (left vertical vein or azygous vein), cardiac (RA or coronary sinus), infracardiac (vein below diaphragm-IVC, portal vein), mixed
B. snowman appearance in supracardiac type. body is heart. left head: vertical vein, top head: innominate vein, right head: svc
Term
types of aortic stenosis
Definition
1. valvular: mc. degenerative, bicuspid aortic valve, rheumatoid
2. subvalvular
3. supravalvular: rare. coronary arteries are dilated.
Term
A. thoracic aorta
1. dilatation
2. aneurysmal
B. abdominal aorta
C. common iliac artery
D. pulmonary hypertension
Definition
A. thoracic aorta
1. dilatation: > 3.5 cm
2. aneurysmal > 4.5 cm
B. abdominal aorta > 3 cm
C. common iliac artery > 1.5 cm
D. pulmonary htn > 3.5 cm
Term
LV aneurysm
1. types
2. wall
3. location
Definition
1. true: wall is LV. anterior wall and apex
2. false: rupture of LA and "wall" is scar tissue or pericardium. posterolateral wall and diaphagmatic.
Term
transposition of the great arteries: types
Definition
1. types
a. D type: incompatible with life unless asd, vsd, pda. "egg on a string"
b. L type: congenitally corrected.
Term
azygous continuation of the IVC
1. you don't see
2. you do see
3. associated with
Definition
1. don't see IVC
2. see enlarged azygous or hemiazygous vein
3. polysplenia
Term
transposition of the great arteries:
A. normal
B. types
Definition
A. normal: aorta is posterior and to the right of the pulmonary trunk
B. types
a. D type: incompatible with life unless asd, vsd, pda. "egg on a string". aorta is anterior and to the right of the pulmonary trunk.
b. L type: congenitally corrected. aorta is anterior and to the left of the pulmonary trunk.
Term
A. aortic arch variants
1. bovine aortic arch
2. left vertebral artery origin off the arch
3. left arch and aberrant right subclavian A
a. what is it?
b. esophagram
4. right arch and aberrant left subclavian A
a. what is it?
b. where does the left subclavian A come off of?
c. esophagram?
d. associated with?
5. double aortic arch:
a. which side larger and higher?
b. what is the 4 vessel sign?
c. esophagram?
6. pulmonary sling:
a. what is it?
b. associated with?
c. esophagram?
B. which ones need surgery?
Definition
A.
1. bovine aortic arch: left carotid artery comes off the innominate artery
2. left vertebral artery comes off the arch between the left common carotid and left subclavian A (usually the vertebral comes off the subclavian A)
3. left arch and aberrant right subclavian A
a. aberrant right subclavian A comes off posterior to the left subclavian A and passes to contralateral side posterior to the esophagus.
b. posterior indentation of the esophagus.
4. right arch and aberrant left subclavian A
a. aberrant left subclavian comes off as last branch of arch from diverticulum of Kommerell and passes to contralateral side posterior to the esophagus
b. aberrant left subclavian A comes from diverticulum of Kommerell
c. esophagram: posterior indentation of the esophagus
c. associated with congenital heart dz (10%)
5. double aortic arch:
a. the double aortic arch surrounds the trachea and esophagus. r arch usually larger and higher (so right indentation higher).
b. usually two carotid A and two subclavian A (4 vessel sign)
c. esophagram:
1) posterior and lateral indentation of the esophagus.
2) narrowing of the trachea
3) trachea appears midline
6. pulmonary sling: left pulmonary A comes off the right pulmonary A and passes to left side between the trachea and esophagus.
b. associated with complete tracheal rings
c. esophagram: anterior indentation of the esophagus
B. complete vascular rings and pulmonary sling need surgery:
1. double aortic arch: complete vascular ring
2. right arch with aberrant left subclavian and symptomatic ductus arteriosum/ligamentum arteriosum. complete vascular ring.
3. pulmonary sling
Term
persistent left sided IVC
Definition
left sided IVC drains into coronary sinus then RA or just straight into RA.
Term
coarctation of the aorta
1. signs
2. associated with
3. category
Definition
1. signs:
a. figure of 3 sign of the aorta.
b. inferior rib notching due to dilatation of intercostal collaterals.
c. left ventricular hypertrophy.
2. associated with
a. bicuspid aortic valve
b. Turner's syndrome
3. acyanotic, normal vascularity (see card #92)
Term
1. situs solitus
2. situs inversus
a. what is it?
b. syndrome?
3. situs ambiguous
a. aka (2 other names)
b. defn
c. types
4. dextrocardia and levocardia
5. high risk of cardiac disease if
Definition
1. situs solitus: left arch, left gastric bubble
2. situs inversus:
a. right arch, right gastric bubble
b. Kartagener's: situs inversus with dextrocardia (so lower risk of chd), bronchiectasis, sinusitis
3. situs ambiguous
a. aka heterotaxy syndromes aka Ivemark syndrome
b. situs ambiguous: arch and gastric bubble on opposite sides
c. types:
1) asplenia syndrome: bilateral right sidedness. bilateral trilobed lungs, no spleen, more severe chd, bilateral svc, epiarterial bronchus (bronchus is posterior to pulmonary A), right isomerism of atria (two right atria).
2) polysplenia syndrome: bilateral left sidedness.bilateral bilobed lungs. polysplenia, malrotation/volvulus (less severe chd), azygous continuation of svc, hyparterial bronchus (bronchus is below and anterior to pulmonary artery), left isomerism of the atria (two left atria).
4. dextrocardia and levocardia (heart on right and left)
5. high risk of cardiac disease if heart and stomach bubble on opposite sides.
Term
4 groups of congenital heart disease
ucsf video
Definition
1. -cyanotic. increased pulm flow. dd: asd, papvc, vsd, pda. LAE? (double right heart contour on PA and posterior displacement of the esophagus on lateral view)
a. -LAE: ASD, PAPVC
b. +LAE: VSD, PDA. Aortic arch enlargement (look at ascedning aorta)?
1) -aortic arch enlargement. vsd
2) +aortic arch enlargement. pda
2. +cyanotic. nl to decreased vascularity. dd: tof, ebstein's anomaly (atrialization of the RV), tricuspid atresia with restricted ASD, pulmonary stenosis with intact ventricular septum, tricuspid atresia of the newborn (transitory condition). heart enlarged?
a. no heart enlargement: TOF (pulmonary stenosis-decreased pulmonary arterial contour, RVH-boot shaped heart, but no cardiomegaly, overriding aorta-right aortic arch (r aortic arch 25% of the time, vsd)
b. +heart enlargement (R heart problems): Ebstein's anomaly, tricuspid atresia with restricted asd, pulmonary stenosis with intact ventricular septum, tricuspid atresia of the newborn (transitory)
3. +cyanotic. increased pulmonary flow. superior mediastinum enlarged? TGA, truncus, TAPVC, tricuspid atresia, "Tingle" ventricle (variants: DORV, DOLV)
a. narrowed superior mediastinum: TGA
b. widened superior mediastinum: supracardiac TAPVC
4. +cyanotic. pulmonary edema. infradiaphragmatic TAPVC, reversible heart stress (severe anemia, asphyxia, hypocalcemia, hypoglycemia, arrhythmia, hypervolemia, myocarditis), severe coarctation of the aorta (at 1-3 weeks)
Term
omphalocele associated with what syndromes?
Definition
1. OEIS: omphalocele, bladder extrophy, imperforate anus, spinal anomalies
2. Beckwith Wiedemann syndrome: hemihypertrophy, macroglossia, polyhydramnios, hepatomegaly, large kidneys, omphalocele
3. Pentaology of Cantrell: supra-umbilical midline abdominal wall defect, lower sternal wall defect, anterior diaphragmatic hernia, defect of diaphragmatic pericardium, cardiac anomalies
Term
1. tetrology of fallot
2. pentology of fallot
Definition
1. tetrology of fallot: rvh, overriding aorta, pulmonary stenosis, vsd
2. pentology of fallot: add asd
Term
diagnosing nf 1
Definition
If you have 2/6 of the following then you have NF 1
1. 6 or more café au lait spots > 5 mm (coast of California)
2. axillary or inguinal freckling
3. 2 or more neurofibromas or a plexiform neurofibroma
4. optic nerve glioma
5. one family member with nf1
6. Distinctive bone lesion
Term
1. celery stalk metaphysis
2. rickets
3. dense metaphyseal lines
4. syphilis
Definition
1. celery stalk metaphysis: the "orc" of torch. syphyilis, rubella, cmv.
2. rickets: rachitic rosary, metaphyseal cupping, fraying and splaying
3. dense metaphyseal lines: physiologic, treated rickets, treated leukemia, lead
4. syphilis: stippled epiphysis, Wimberger's sign (destruction of proximal medial tibia), periosteal reaction, celery stalk metaphysis.
Term
post transplant perinephric fluid collections
1. immediate post op
2. early post op
3. 4-8 w post op
4. other
Definition
1. hematoma, seroma
2. urinoma
3. lymphocele
4. abscess
Term
diminshed renal function post renal transplant
1. what do you look at?
2. dd
3. usually differentiate #2 by
4. other vascular causes
Definition
1. RI > 0.8
2. ATN, cyclosporine toxicity, rejection
3. US guided biopsy
4.
a. renal artery stenosis: peak systolic velocity > 250 cm/s. parvus tardus
b. renal vein thrombosis: to and fro flow. reversal of diastolic flow.
Term
1. what divides the right and left hepatic lobes?
2. what divides the left hepatic lobe?
3. what is the ligamentum teres
4. what does the ligamentum venosum divide?
5. what is the ligamentum venosum?
Definition
1. the middle hepatic vein divides the right and left hepatic lobes
2. the ligamentum teres divides the left hepatic lobe into medial and lateral segments
3. the ligamentum teres is the obliterated umbilical vein
4. the ligamentum venosum divides the lateral segment of the left hepatic lobe from the caudate lobe
5. the ligamentum venosus is the obliterated ductus venosus
Term
how thick can the thyroid isthmus be?
Definition
3 mm
Term
molar pregnancy, can see
Definition
theca lutein cysts
Term
endometrioma
1. appearance on US
2. on MR
3. how to distinguish endometrioma from dermoid
Definition
endometrioma
1. appearance on US: diffuse homogeneous internal low level echoes with posterior enhancement
2. appearance on MR: high T1 and low T2 due to iron (can have shading sign on T2 due to protein and iron content)
3. both endometrioma and dermoid can be high on T1. endometrioma doesn't have fat. dermoid has fat, which sats out.
Term
US measurements:
Definition
transvaginal:
1. 10 mm mean sac diameter: yolk sac
2. 18 mm mean sac diameter: fetus
3. 5 mm crown rump length should see fetal heart beat
4. should see gestational sac transvaginally at beta hcg of 1,500 IU/L.
5. normal AFI (amniotic fluid index): 5-25 cm
6. normal S/D ratio: ~4 at 16 w and ~2 at term.
7. bowel should return to abdomen by 12 w.
8. omphalocele and gastrochisis have elevated maternal alpha fetoprotein.
Term
clubfoot vs rockerbottom foot
Definition
1. clubfoot: associated with trisomy 18 (Edwards), oligohydramnios, twinning. foot inverted at ankle.
2. rockerbottom feet: associated with trisomy 18. downward portion of foot is convex. "Persian slipper" appearance.
Term
blighted ovum
1. defn
2. aka
Definition
1. msd > 18 mm transvaginally and no embryo
2. aka anembryonic pregnancy
Term
in pregnancy, should see
1. normally
2. abnormally
Definition
1. normal: double decidua sign
2. abnormal: pseudogestational sac (fluid in otherwise empty uterine cavity)
(slide 71 south alabama us fetus)
Term
cervical incompetence
1. cervical length should be
2. stages
Definition
1. > 3 cm. otherwise, there is cervical incompetence.
2. Trust Your Vaginal US. When U shaped then bulging membranes with or without fetal parts.
Term
fibroids
1. US
2. MRI T2
3. types
Definition
1. US: hypoechoic to myometrium
2. T2 MR: low intensity
3. subserosal, submucosal, intramural
Term
Are calcifications in the placenta normal?
Definition
yes, calcifications in the placenta can be normal.
Term
calcification in abdomen
Definition
meconium peritonitis
Term
cystic hygroma associated with
Definition
-mostly associated with turner's syndrome, but cystic hygroma is also associated with trisomy 13, 18, 21
-turner's is associated with cystic hygroma and coarctation of aorta.
Term
[image]
Definition
1. between lateral ventricles
a. superiorly: corpus callosum
b. inferiorly: septum pellucidum
2. more inferiorly: 3rd ventricle
Term
[image]
Definition
1. from cranial to caudal:
a. lateral ventricle
b. caudothalamic groove
c. caudate nucleus
d. thalamus
2. posteriorly: germinal matrix and cerebellum
Term
why can there be hydrocephalus with hemorrhage?
Definition
a. acutely: blocking of the arachnoid villi with particulate blood clot
b. chronically: obliterative fibrosing arachnoiditis
Term
small triangular region in uterine cavity next to pregnancy
Definition
-implantation bleed or subchorionic hematoma.
-it is where chorion insert on endometrium
-must be followed to r/o propagation.
Term
lithium is associated with
Definition
-Ebstein's anomaly: atrialization of the RV (downward displacement of the tricuspid valve)
-Category: cyanotic. not increased vascularity. large heart.
Term
if echogenic LV, think about
Definition
Myocardial fibroelastosis especially in a patient with hypoplastic left heart syndrome
Term
renal artery stenosis
Definition
1. parvus et tardus waveform distal to stenosis. slowed systolic upstroke and delayed time to peak systolic velocity
2. velocity > 200 cm/s distal to stenosis.
Term
Hashimoto's thyroiditis
Definition
1. hypothyroid
2. at risk for non-Hodgkin's lymphoma
3. US of Hashimoto's thyroiditis: heterogeneous, very vascular when patient is hypothyroid
4. nuclear scan: Tc pertechnetate or I 123
a. early: look like Grave's disease (uniform increased activity)
b. late: look like multinodular goiter (patchy activity)
Term
A. prostate cancer
B. zones of the prostate
Definition
A. prostate cancer
1. prostate cancer is usually hypoechoic
2. usually arises from the peripheral zone
B. zones of the prostate from outer to inner
1. peripheral: prostate cancer
2. transitional: bph
3. central
Term
subclavian steel syndrome
Definition
1. partial: retrograde flow (going down) at peak systole
2. complete: retrograde flow (going down) during systole and diastole
3. what can you do to bring out subclavian steel syndrome? upper extremity exercise
Term
ovarian dermoid
Definition
1. tip of iceberg sign
2. fluid fluid level (due to fat). the other dd that could have a F/F level is a endometrioma.
Term
Murphy's sign vs sonographic Murphy's sign
Definition
1. +Murphy's sign: ruoq is palpated. pt takes an inspiration and stops when gallbladder hits hand because the gallbladder is inflamed.
2. +sonographic Murphy's sign: the pt hurts more over the gallbladder than any other region.
Term
ICA stenosis
Definition
1. velocity and % stenosis
a. 125-230 cm/s: 50-69% stenosis
b. > 230 cm/s: > 70% stenosis
2. signs
a. string sign: ICA is narrow
b. spectral broadening (~more velocities are seen; there is more fill in under the curve; slide 148 south alabama US)
3. ICA vs ECA
a. ICA is posterolateral to ECA
b. ECA has branches
c. ECA will be affected when you do the "temporal tap"
Term
1. mets that can calcify
2. candidate for metastatectomy has
Definition
1. COBS: colon, ovarian, breast, stomach
2. candidate for metastatectomy has 4 or less lesions
Term
defn hypertrophic pyloric stenosis
Definition
1. single wall thickness: > 3 mm
2. length of channel: > 15 mm
Term
1. Is DVT excluded if no echogenic thrombus is seen?
2. lack of augmentation means
Definition
1. DVT is not excluded if no echogenic thrombus is seen.
2. lack of augmentation means occlusion in non-visualized segment
Term
1. radio opaque stones
2. non radio opaque stones
Definition
1. radio opaque stones: calcium oxalate, calcium phosphate
2. non-radio opaque stones: C SMUXI, cystine, struvite, matrix (protein), urate, xanthine, indinavir
Term
mgt of simple ovarian cysts
1. pre menopausal
2. post menopausal
Definition
1. pre menopausal:
a. 5 cm or less: no fu
b. > 5 and =< 7 cm: yearly fu
c. > 7 cm: MR or surgical consultation
2. post menopausal:
a. 1 cm or less: no fu
b. > 1 and < = 7 cm: yearly fu
c. > 7 cm: MR imaging or surgical consultation
(remember the numbers 1,5,7)
Term
causes of portal htn
Definition
1. prehepatic: portal vein thrombosis, compression of portal vein by tumor
2. intrahepatic:
a. pre sinusoidal: fibrosis
b. sinusoidal: hepatitis
c. post sinusoidal: alcohol
3. posthepatic: Budd Chiari, CHF, constrictive pericarditis
Term
hyperechoic kidneys in adult
Definition
1. enlarged: HIV > 11 cm
2. normal size: acute glomerulonephritis, lupus, Goodpasture's syndrome, Diabetes
3. small: medical renal disease < 9 cm
Term
pancreatic findings
1. small, echogenic pancreas
2. large pancreas isoechoic to the liver
3. pancreas should be ____to the liver
Definition
1. small echogenic pancreas: cystic fibrosis. CT shows fibrofatty (mainly fatty) pancreas
2. large pancreas isoechoic to the liver: acute pancreatitis. 3. pancreas should be hyperechoic to the liver.
Term
etiology of periventricular leukomalacia
Definition
1. ischemia
2. infection
3. inflammation
Term
von meyenberg complexes
Definition
biliary hamartomas
benign
no tx necessary
possible risk of malignant transformation
Term
1. dermoid plug
2. kasabach Merritt syndrome
3. tx for adenomyomatosis
4. complication of dermoid
5. what kind of transducer do you use to measure the appendix?
6. which type of cpam has the worst prognosis?
7. does omphalocele, gastrochisis, anencephaly have elevated afp?
8. when can you start diagnosing anencephaly?
9. when does the lemon sign disappear?
Definition
1. dermoid plug: solid echogenic ovarian in a dermoid (mature cystic teratoma), which represents fat, calcium (e.g. teeth), hair etc.
2. kasabach Merritt syndrome: hemangioma with thrombocytopenia.
3. tx for adenomyomatosis: cholecystectomy if symptomatic
4. complication of dermoid: torsion, rupture and chemical peritonitis, malignant degeneration, most commonly squamous cell carcinoma (from squamous lining of cyst)
5. appendix on US: is measured with 7-15 MHx high resolution probe. dx appendicitis if
a. outer wall to outer wall > 6 mm
b. one wall measures < 3 mm
c. non-compressible
6. CPAM (congenital pulmonary airway malformation)
a. type I: > 2 cm
b. type II: < 2 cm
c. type III: microcysts. solid appearing (worse prognosis)
7. elevated afp
a. omphalocele: if membrane not intact then elevated afp
b. gastrochisis: 95% have elevated afp
c. anencephaly: elevated afp
8. anencephaly only diagnosed after 14 w.
9. lemon sign disappears by 3rd trimester
Term
1. when treat pseudocyst
2. complications of pseudocyst
3. risk factors for portal vein thrombus
Definition
1. tx pseudocyst
a. if symptomatic
b. asymptomatic and hasn't resolved after 6 wks
2. complications of pseudocyst: rupture, infection, hemorrhage, compression of stomach/duodenum, cbd, large vessels.
3. risk factors for portal vein thrombus: hypercoagulable states, stasis in portal vein from cirrhosis, pancreatitis, seeding of portal vein with infected material from appendicitis, intraperitoneal abscess, inflammatory bowel disease)
Term
1. how large should the thyroid isthmus be?
2. dd for enlarged thyroid
Definition
1. isthmus of thyroid should be < 3 mm
2. dd enlarged thyroid: goiter, grave's, hashimoto's thyroiditis, thyroiditis
Term
cause of periventricular leukomalacia
Definition
inflammation and ischemia
Term
dilated rete testis associated with
Definition
spermatocele
epididymal cyst
intratesticular cyst
Term
dilated rete testis associated with
Definition
spermatocele
epididymal cyst
intratesticular cyst
Term
tx gastrochisis
Definition
post natal surgery
Term
christmas tree bladder
Definition
christmas tree bladder may indicate neurogenic bladder. two types:
1. spastic: small, trabeculations. upper motor neuron problem.
2. atonic: big. lower motor neuron problem.
Term
Why is active menstrual bleeding a relative contraindication to hsg?
Definition
relative contraindication to hsg: risk of intravasation (lymphatic or vascular) may occur during active mentsrual bleeding (however lymphatic or vascular intravasation is not dangerous; intravasation may make interpretation difficult)
Term
ureteral pseudodiverticulosis
Definition
1. due to hyperplastic ureteral epithelium
2. associated with chronic infection or inflammation
3. increased risk of TCC so need periodic surveillance with urine cytology or imaging studies like intravenous pyelograms
Term
subchorionic cyst
Definition
1. mc type of placental surface cyst (other type: amniotic epithelial inclusion cyst)
2. can compress the vessels leading to adverse fetal outcome.
Term
criteria for % stenosis of the ICA using PSV (peak systolic velocity=cm/s) and PSV ICA/CCA
Definition
SRU (Society of Radiologists in Ultrasound) consensus panel (not NASCET criteria)
1. PSV < 125 cm/s or ICA/CCA ratio < 2 then < 50% stenosis.
2. PSV 125-230 cm/s or ICA/CCA ratio 2-4 then 50-69% stenosis.
3. PSV > 230 cm/s or ICA/CCA ratio > 4 then > 70% stenosis.
Term
Nuclear medicine study for testicular torsion
Definition
1. Tc 99m pertechnetate 15 mCi flow and blood pool and delayed imaging
2. signs:
a. nubbin sign: increased activity in the pudendal artery just above the testicle.
b. ring or bull's eye sign: photopenic testicle surrounded by high activity in the dartos muscle, which is supplied by the pudendal A
Term
Treatment of contrast reaction
ACR guidelines for adults and children
a. urticaria
b. facial or laryngeal edema
c. bronchospasm
d. hypotension with tachycardia
e. hypotension with bradycardia (vagal rxn)
f. severe hypertension
g. seizures
h. pulmonary edema
Definition
A. general overview
1. Assess the patient
2. airway, breathing, pulse
3. vital signs
4. O2 6-10 L face mask, ekg, monitor vital signs, call cardiopulmonary resuscitation team if necessary.
5. if hypotensive, elevate legs 60 degrees (preferred) or trendelenberg position. give IVF (ringer's lactate or normal saline).
6. if facial/laryngeal edema, bronchospasm, hypotension (without bradycardia), can give epinephrine 1:1000 0.1-0.3 mg SQ/IM or epinephrine 1:10,000 0.1-0.3 mg IV up to 1mg.
7. special situations
a. urticaria: benadryal 50 mg IM/IV/PO
b. hypotension with bradycardia (vagal rxn): atropine 1 mg IV slow push up to 3 mg.
c. hypertension: NTG 0.4 mg SL. may repeat x 3.
d. seizure: valium 5 mg IV. may repeat if necessary.
e. pulmonary edema: lasix 20-40 mg IV, slow push.

B. clinical situations: more detail
a. urticaria:
1) if mild, no tx needed in most cases
2) if moderate, diphenhydramine (benadryl)50 mg PO/IM/IV
3) if severe, epinephrine (1:1,000) SC 0.1 mg if no cardiac contraindications
b. facial or laryngeal edema:
1) O2 6-10 L via face mask.
2) epinephrine SC/IM 1:1,000 0.1-0.3 mg or epinephrine IV 1:10,000 0.1-0.3 mg. Repeat up to a maximum of epinephrine 1 mg.
3) call cardiopulmonary arrest team.
c. bronchospasm
1) O2 6-10 L via mask. monitor ekg, O2 sat and vitals.
2) Albuterol 2-3 puffs prn
3) if not responsive to albuterol especially if hypotensive, then epinephrine. epinephrine (1:1,000) 0.1-0.3 mg SC/IM or epinephrine (1:10,000) 0.1-0.3 mg IV up to 1 mg.
4) call for cariopulmonary arrest team if necessary.
d. hypotension with tachycardia
1) elevate legs 60 degrees (preferred) or more or Trendelenburg position. monitor ekg, pulse ox and blood pressure.
2) give 6-10 L O2 via mask.
3) IV ringer's lactate or normal saline.
4) if poorly responsive, can give epinephrine 1:10,000 0.1-0.3 mg IV. can repeat up to 1 mg.
5) if still not responsive, call cardiopulmonary arrest team
e. hypotension with bradycardia (vagal rxn)
1) secure airway
2) O2 6-10 L mask. monitor vital signs.
3) elevate legs 60 degrees or more (preferred) or trendelenburg position.
4) IV: Ringer's lactate or normal saline
5) atropine 1 mg IV slowly (repeat up to 3 mg)
6) ensure complete resolution of hypotension and bradycardia prior to discharge.
f. severe hypertension:
1) O2 6-10 L/min via face mask
2) ekg, pOx, BP
3) ntg 0.4 mg SL (may repeat x 3) or topical ntg 2% 1 inch
4) if no response, consider labetolol 20 mg IV q 10 min up to 300 mg
5) transfer to ICU or ER
6) for pheochromocytoma, phentolamine 5mg IV may be used. can use labetolol if phentolamine if not available.
g. seizures
1) O2 6-10 L/min via face mask
2) consider diazepam (valium) 5 mg or mor eas needed.
3) if longer affect necessary, consider phenytoin (dilantin) infusion.
4) monitor vital signs esp. pOx because respiratory depression can occur with benzodiazepine.
5) consider calling cardiopulmonary resuscitation team if intubation needed.
h. pulmonary edema
1) O2 6-10 L/min face mask
2) elevate torso
3) furosemide (lasix) 20-40 mg IV, slow push
4) consider giving morphine 1-3 mg IV)
5) transfer to ICU or ER.
Term
follow up
1. hemorrhagic cyst
2. endometrioma
3. dermoid
4. simple cysts
Definition
1. hemorrhagic cyst:
a. if reproductive age
< = 5 cm: no fu needed
> 5 cm: fu 6-12 w to ensure resolution
b. if early post menopausal: fu until resolution.
c. if late post menopausal: consider surgical evaluation.
2. endometrioma: fu 6-12 w. if not surgically removed, follow up yearly due to malignant potential.
3. dermoid: if not surgically removed, follow up yearly due to malignant potential
4. simple cyst
a. premenopausal:
1) <= 5 cm: no fu needed
2) > 5 and <=7 cm: yearly fu
3) > 7 cm: MRI or surgical consultation
b. post menopausal
1) < =1 cm. no fu
2) > 1 and < = 7 cm: yearly fu
3) > 7 cm: MRI or surgical consultation.
Term
nephroblastomatosis
Definition
1. can transform into Wilm's tumor
2. if increase in size or new heterogeneous appearance then may have transformed into Wilm's tumor
3. screen q 3 months with ultrasound up to age 7 years to check for Wilm's tumor
4. biopsy doesn't help in distinguishing nephroblastomatosis from Wilm's
Term
malakoplakia vs leukoplakia
Definition
1. malakoplakia: soft plaque. no malignant potential. from granulomatous reaction to chronic UTI.
2. leukoplakia: white plaque. malignant potential. due to cornified squamous epithelium from chronic irritation (infection/stones)
3. dd: tcc, mets, blood clot, fungus ball, pyeloureteritis cystica (no malignant potential. cystic degeneration of Brunn cell nests), radiolucent stones (ic smux-indinavir, cystine (can be faintly opaque), struvite, matrix, urate, xanthine)
Term
retroperitoneal fibrosis: T1 and T2
Definition
low on T1 and T2
Term
causes of persistent nephrogram
Definition
1. Acute tubular necrosis
2. obstruction
3. renal A stenosis
4. renal V thrombus
5. hypotension
6. pyelonephritis
7. contrast induced nephropathy (CIN)
8. papillary necrosis
and more
Term
adrenal collision tumor
Definition
two histologically different tumors in the adrenal gland.
Term
rim sign kidney
Definition
1. no perfusion in kidney due to renal artery compromise
2. rim of peripheral sub-capsular enhancement due to supply by capsular perforating vessels
Term
polyposis syndromes
Definition
1. familial adenomatous polyposis:
a. Gardner's: desmoid tumors, osteomas, papillary thyroid cancer
a. Turcot's: CNS tumors
2. Lynch syndrome: hereditary adenomatous nonpolyposis colon cancer. multiple cancers.
3. Peutz-Jeghers syndrome: sb hamartomas. gi malignancy and gyne tumors
4. Cowden disease: hamartomas. tumors of the thyroid and breast
5. Cronkhite Canada syndrome: hamartomas. skin, hair, nail changes
6. juvenile polyps: hamartomas in the rectum and sigmoid
Term
renal cortical low T1 and T2
Definition
hemolysis due to
1. paroxysmal nocturnal hemoglobinuria
2. hemolysis from malfunctioning cardiac mechanical valves.
3. sickle cell disease
Term
cervical incompetence.
Definition
length of cervix < 3 cm
Term
if intussusception
Definition
1. image guided pressure reduction can be done if no pneumoperitoneum or peritonitis.
2. IV access, surgery consultation
3. fluid is placed no more than 3 feet above radiography table. no more than 3 attempts. < 3 min duration.
Term
placenta previa
A. types
B. if dx'd in 2nd trimester
Definition
A. types
1. complete
2. partial
3. marginal: within 2 cm
4. low lying
B. if diagnose placenta previa in 2nd trimester, then should fu because 90% resolve by term.
Term
tips (transjugular intrahepatic portal venous shunt) velocity
Definition
1. measure at proximal, mid and distal regions of the TIPS
2. peak velocity should be >50-90 and < 190 cm /s (stat dx) (remember should be 90-190 cm/s)
3. the peak velocities should be within 50 cm/s of post procedure baseline
Term
filling defect in bladder
Definition
1. tcc
2. if urachus, adenocarcinoma
Term
fu gallbladder cholesterol polyp
Definition
< 10 mm and no suspicious features (single, vascularity, sessile) serial follow up
> 10 mm and/or suspicious features: CT or surgery to r/o malignancy.
Term
sludge can have what artifact?
Definition
twinkle
Term
complete absence of mullerian ducts (~no uterus and upper 2/3 of vagina)
Definition
Mayer-Rokitansky-kuster hauser syndrome
Term
recurrent pyogenic cholangitis
1. other name
2. cause
3. appearance
Definition
recurrent pyogenic cholangitis
1. other name of recurrent pyogenic cholangitis: oriental cholangitis
2. cause: clonorchis sinensis, ascaris lumbricoides
3. intra and extra hepatic biliary stones without gallbladder stones.
Term
dd placental mass
Definition
1. placental hematoma e.g. placental abruption or subchorionic hemorhage. no flow
2. venous lake: no flow
3. chorioangioma: flow
Term
renal artery stenosis
US numbers
1. peak velocity
2. renal/aortic velocity ratio
3. acceleration to peak systole
Definition
1. peak velocity > 200 cm/s
2. renal/aortic velocity ratio > 3.5
3. acceleration to peak systolic > 0.07 sec
Do CTA to confirm RAS
Term
dd for extratesticular mass
Definition
1. lipoma
2. adenomatoid tumors (usually affecting epididymis)
3. TB, sarcoid, lymphoma, mets
4. if VHL, papillary cystadenoma
5. leiomyoma
Term
Iliotibial band syndrome
Definition
1. edema between the iliotibial band and the distal lateral femoral condyle.
(2. aside: insertion of iliotibial tract is on Gerdy's tubercle on the lateral tibial.)
Term
how to evaluate for pyloric stenosis
Definition
1. pt has right side down to pool fluid in antrum
2. give small amounts of glucose water, formula or breast milk
3. look at pylorus.
a. pyloric channel length should not be > 16 mm
b. single wall thickness of pylorus should not be > 3 mm
(stat dx)
Term
osteoid osteoma age
Definition
< 30 years
Term
mets to bone
Definition
low T1 and high T2 with enhancement on T1 post contrast
Term
dd for acetabuli protrusio
Definition
OA
RA
Ankylosing spondylitis
JIA (juvenile idiopathic arthritis)
crystalline arthropathy
trauma
Paget's
renal osteodystrophy and more
Term
Ewing's include up to
Definition
30 years old
Term
dd lesion with cortical scalloping
Definition
1. periosteal osteosarcoma
2. periosteal chondroma
3. periosteal chondrosarcoma
Term
complications of ACL repair
Definition
1. cyclops lesion: low T1 and T2 anterior to ACL graft.
2. graft rupture
3. improper graft placement
and more
Term
metaphyseal lesion
Definition
1. fibrous dysplasia
2. unicameral bone cyst
etc.?
Term
epiphyseal equivalents
Definition
1. patella
2. calcaneus
3. most apophysis like iliac crest, ischial tuberosity, greater/lesser trochanter
Term
chf
Definition
1. cardiomegaly
2. central venous congestion
3. cephalization. upper lobe vessels >= lower lobe vessels 15-20 mmHg
4. increased interstitial markings: e.g. Kerley B lines (thickening of the interlobular septa) 20-25 mmHg
5. alveolar edema e.g. batwing appearance > 25 mmHg.
6. pleural effusions:
Term
Pancoast tumor
Definition
1. tumor of the lung apex or superior sulcus (not anatomic structure, but just close to nerves and vessels)
2. can be accompanied by arm/shoulder pain and horner's syndrome from involvement of sympathetic chain and stellate ganglion.
Term
mediastinal lipomatosis
Definition
1. cxr: widened mediastinum
2. causes: obesity, endogenous production of steroids (Cushing's syndrome), exogenous steroids for asthma, COPD etc.
Term
sarcoid stages
Definition
0: normal cxr
1: lymph nodes
2: lymph nodes and parenchymal disease
3: parenchymal disease
4: fibrosis
Term
if unilateral interstitial dz, think
Definition
lymphangitic carcinomatosis
Term
TB
1. ghon focus:
2. ghon/ranke complex:
Definition
TB
1. ghon focus: calcified caseating parenchymal granuloma from primary infection (tuberculoma)
2. ghon/ranke complex: ghon focus and ipsilateral calcified hilar lymph node.
Term
thoracic aortic aneurysms
Definition
1. defn thoracic aneurysm is aorta > 4 cm
2. repair if symptomatic or growth rate >= 1 cm/yr or
a. if ascending aorta aneurysm > 5.5 cm then surgical repair
b. if descending aortic aneurysm > 6.5 cm then endovascular repair
Term
dd for multiple calcified pulmonary nodules
Definition
1. TB
2. fungal infection like histoplastmosis
3. pneumoconiosus like silicosis and coal worker's pneumoconiosus
4. sarcoidosis
5. healed varicella
Term
pneumopericardium dd
Definition
1. trauma
2. surgery
3. fistula with air containing organ like esophagus or stomach
4. infectious pericarditis with air producing organism
from radiopaedia
Term
solitary pulmonary nodule
Definition
< 3 cm
Term
lung carcinoma staging
Definition
1. tx:
a. surgery for stages I and II
b. no surgery for stages III and IV
2. criteria for no surgery: T4, N3 (these make it at least stage III)
a. tumor extending into esophagus, trachea/carina, heart/great vessels, vertebral body, mediastinum or tumor nodules within the ipsilateral lung, but different lobe as the primary mass. T4
b. malignant pleural effusion. T4
c. contralateral hilar or mediastinal lymph nodes. N3
e. ipsilateral scalene or supraclavicular LN. N3
Term
what makes a pulmonary nodule benign?
Definition
1. benign pattern of calcification: diffuse, central, laminated, popcorn. otherwise, all other patterns are not considered benign.
2. stability for 2 years
3. contrast enhancement less than 15 HU
4. if fat and/or popcorn calcification: hamartoma (hamartoma can grow)
Term
segments of the lungs
Definition
1. RUL: apical, anterior, posterio
2. RML: medial, lateral
3. RLL: superior, APML basal
4. LUL:
a. apico-posterior
b. anterior
c. superior lingula
d. inferior lingula
5. LLL: superior, APML basal
Term
dd pleural based mass
Definition
1. mesothelioma: occurs 30-40 years after exposure (brant and helms)
2. lymphoma
3. mets
4. empyema
5. fibrothorax
6. solitary fibrous tumor of the pleura
Term
transient radiographic infiltrates
Definition
1. transient radiographic infiltrates: Loeffler syndrome
2. Loeffler syndrome:
a. type of pulmonary eosinophilia (other types are chronic eosinophilic pna and eosinophilic vasculitis (Churg Strauss syndrome) and more)
b. peripheral blood has elevated eosinophilic count
Term
types of bronchiectasis
Definition
1. cylindrical: can have signet ring appearance (pulmonary A next to dilated bronchus)
2. varicose: beaded appearance
3. saccular: cystic appearance (also called cystic)
Term
on lateral decubitus views, what would you see on normal study.
Definition
on lateral decubitus views, the side closer to the ground should collapse. if still inflated, then maybe foreign body on that side.
Term
1. pulmonary hypertension vs lymph node enlargement
2. defn pulmonary hypertension
3. types of pulmonary hypertension
4. pulmonary htn vs pulmonary stenosis
Definition
1. my own deduction: on lateral view, the radiopaque region appears like a semicircle anterior and posterior to the trachea
2. defn pulmonary htn: pulmonary trunk > 3 cm or pulmonary A = or > aorta
3. types of pulmonary htn
a. precapillary: primary pulmonary htn, Pulmonary embolism
b. parenchymal: COPD, chronic interstitial lung disease
c. post capillary: CHF, pulmonary venous occlusive disease
4. pulmonary htn vs pulmonary stenosis:
a. in pulmonary htn, the main and bilateral pulmonary A are dilated.
b. pulmonary stenosis: main and left pulmonary A are dilated.
Term
pulmonary edema causes
Definition
1. cardiogenic: large heart. CHF, arrhythmia, coronary artery disease, valvular disease, myocarditis, cardiomyopathy, fluid overload from renal failure.
2. non-cardiogenic: normal size heart. smoke inhalation, head trauma, sepsis, hypovolemic shock, near drowning, high altitude pulmonary edema, heroin overdose, DIC (dissseminated intravascular coagulopathy).
Term
1. signs of RUL and LUL collapse
2. dd for endobronchial lesions
a. child
b. adult
Definition
1. signs
a. RUL collapse: Golden S sign. elevation of the right minor fissure.
b. LUL collapse: Luftsichel sign. lucent superior segment of the LLL.
2. dd for endobronchial lesions:
a. child: foreign body, inflammatory polyp, carcinoid, salivary gland tumor, papilloma
b. adult: squamous cell disease, lymphoma, carcinoid, salivary gland tumor, papilloma
Term
mitral valve stenosis
Definition
1. cardiomegaly, left atrial enlargement, prominent atrial appendage, enlarged pulmonary artery
2. "doming" or hockey stick configuration to the anterior leaflet of the mitral valve during diastole. thickened mitral valve
Term
unilateral hyperlucent lung
Definition
unilateral hyperlucent lung
1. faulty technique: patient rotated
2. absent soft tissue (Poland syndrome, mastectomy)
3. airway obstruction (FB, endobronchial lesion, bronchial compression)
4. emphysema (bullae, congenital lobar emphysema, unilateral transplant)
5. Swyer James syndrome
6. PE
7. ptx
8. compensatory overinflation
9. pulmonary artery hypoplasia
Term
right aortic arch types
Definition
right aortic arch
1. right aortic arch with aberrant left subclavian: small increase in congenital heart disease. 4 vessels (left cca, r cca, r subclavian A, L subclavian A-goes behind esophagus)
2. right aortic arch with mirror image branching: usually associated with congenital heart disease. 3 vessels (left innominate, right cca, right subclavian A-anterior to trachea).
Term
horner's syndrome
Definition
miosis (constricted pupil), anhydrosis (loss of facial sweating), ptosis
Term
acute and chronic ggo and consolidation
Definition
1. acute: blood, pus, water (edema), ARDS
2. chronic
a. organizing pna: upper lobes, peribronchial and subpleural, atoll sign (ggo surrounded by consolidation)
b. chronic eosinophilic pna: lower lobes. can be peripheral, but heals from outside to inside so sometimes subpleural region can be spared. reverse batwing sign.
c. bronchoalveolar carcinoma.
d. causes of chronic ggo: protein alveolar proteinosis, lipoid pna, hypersensitivity pneumonitis
Term
coarctation of aorta
Definition
1. rib notching 3-8th ribs. not 1st and 2nd because these supplied by intercostal A from thyrocervical trunk.
2. figure of 3 sign
3. associated with Turner's syndrome and bicuspid aortic valve.
4. pseudo-coarctation: redundancy of the aorta at the isthmus (distal to the takeoff of the left subclavian A)
Term
causes of pneumothorax
Definition
1. trauma
2. iatrogenic
3. idiopathic
4. asthma
5. LAM (also has chylous effusions and ptx)
Term
sequestration
Definition
sequestration will have an arterial supply. venous return supplied by
1. intralobar: pulmonary vein. visceral pleural covering.
2. extralobar: systemic vein. own pleural covering.
Term
achondroplasia
Definition
achondroplasia
a. mc nonlethal skeletal dysplasia
b. characteristics
1) trident hand: 2nd-4th fingers are around the same length
2) decreased interpedicular distance in the lower lumbar spine
3) tombstone iliac bones
4) champagne glass inner pelvic contour
5) spinal stenosis
6) posterior vertebral body scalloping
7) chevron shape of the distal femoral physis
8) posterior scalloping of vertebral body
9) metaphyseal flaring
10) bullet shaped metacarpals
c. rhizomelia
Term
dwi and adc
Definition
dwi: csf is low intensity
adc: looks like black holes everywhere.
Term
bronchogenic carcinoma
Definition
1. small cell:
2. non-small cell:
a. squamous cell carcinoma: central. mc cause of pancoast tumor (can get horner's syndrome miosis, ptosis and anhydrosis)
b. adenocarcinoma: peripheral
c. large cell: large peripheral mass
Term
non small cel tnm staging
Definition
not surgical if T4, N3
T4: involvement of the trachea/carina, heart/vessels, esophagus, vertebral bodies, malignant pleural effusion, involvement of lungs in other segments besides main mass
N3: ipsilateral supraclavicular and ipsilateral scalene. contralateral hilar or mediastinal.
Term
complications of lung biopsy
Definition
ptx
hemoptysis
Term
aspergillosis
Definition
aspergillosis
1. fungal infection caused by the genus aspergillus
2. types
a. non-invasive: aspergilloma or mycetoma. develop in pre-existing cavities.
b. semi-invasive
c. invasive: halo sign (ggo usually due to hemorrhage surrounding consolidation) (fyi: reverse halo is for organizing pna). in setting of immunocompromise.
d. abpa: allergic bronchopulmonary aspergillosis: finger in glove appearance and central bronchiectasis especially in upper lobes. a h/o asthma or cystic fibrosis. (fyi: finger in glove also in bronchial atresia)
Term
constrictive pericarditis
Definition
1. pericardium > 2 mm
2. 50% associated with calcification
3. causes: TB, viral, uremia, neoplasm, traumatic, idiopathic
Term
Post pneumonectomy
1. normal
2. abnormal
Definition
Post pneumonectomy
1. normal: normally, post pneumonectomy, serosanguinous fluid fills the site 2 ribs a day and then there is shift of the mediastinum toward the side of the pneumonectomy.
2. abnormal:
a. abnormal, post pneumonectomy, air filling the side of the pneumonectomy (bronchopleural fistula or empyema).
b. abnormal is also shift of mediastinum away from the site of pneumonectomy (hemorrhage or chylothorax)
c. post pneumonectomy syndrome: mediastinal shift of the post pneumonectomy patient causes compression of the trachea and left main bronchus (usually occurs after right pneumonectomy in children/adolescents).
Term
dd for cavitating pulmonary mass
Definition
cavity
C: cancer (bronchogenic ca or mets esp scc)
A: autoimmune (Wegener's granulomatosis or rheumatoid nodules)
V: vascular. bland or septic emboli
I: infection due to bacteria or fungal abscess
T: trauma causing pneumatoceles
Y: Youth: CPAM, sequestration, bronchogenic cyst
Term
Goodpasture's syndrome
Definition
autoimmune d/o
1. renal failure
2. pulmonary hemorrhage
Term
if bilateral ptx in child, suspect
Definition
mets from
osteosarcoma (especially osteosarcoma)

http://www.learningradiology.com/archives04/COW%20122-PTX-Deep%20Sulcus/deepsulcuscorrect.htmpancreas
Wilm's tumor
adrenals
Term
partial or complete absence of pericardium
Definition
1. heart is shifted to the left: "snoopy nose" sign
2. air between aortic arch and main pulmonary with prominent left atrial appendage: "snoopy's ear"
4. air between left hemidiaphragm and inferior heart border
Term
normal positioning of
1. ETT
2. NGT
3. feeding tube
4. Swan Ganz catheter
Definition
normal positioning of
1. ETT: 5-7 cm (remember 5 cm) above carina. the ett can move 2 cm up (head extended) or down (head flexed)
2. NGT: tip below diaphragm in the fundus (upper) of the stomach (parts of the stomach: cardia, fundus, body, antrum, pylorus)
3. feeding tube: 2nd or 3rd portion of duodenum (however, most are in the stomach)
4. Swan Ganz catheter: right pulmonary artery
Term
ebstein's anomaly
Definition
1. cardiomegaly with normal vascularity (fyi: other cause of cardiomegaly with normal vascularity cyanotic is tetrology of fallot)
2. atrialization of the RV
3. phase map demonstrates regurgitation (black) into RA (other techniques called black blood or white blood technique)
4. dd: pericardial effusion
Term
diffuse ill defined pulmonary opacities
Definition
1. sarcoid
2. fungal
3. lymphoma
4. lymphangitic carcinoma
5. kaposi's if HIV
Term
cardiac masses
Definition
cardiac mass

1. thrombus: doesn't enhance
2. metastatic disease: variable appearance. mc.
3. benign cardiac neoplasm
a. atrial myxoma: LA attached to interatrial septum. hypointense on gradient. iso to cardiac muscle on T1 and heterogeneously enhances.
b. rhabdomyoma: attached to interventricular septum. associated with tuberous sclerosis
4. malignant cardiac neoplasm
a. sarcoma
b. primary cardiac lymphoma
Term
Left sided SVC
Definition
persistence of the left cardinal vein
1. located anterolateral to aortic arch
2. passes anterior to the left pulmonary artery
3. drains into coronary sinus
Term
A. respiratory bronchiolitis and desquamative interstitial pneumonia
B. organizing pneumonia and chronic eosinophilic pneumonia
Definition
A. RB vs. DIP
1. respiratory bronchiolitis: ggo upper lobes. centrilobular
2. dip: ggo lower lobes. peripheral
B. OP vs. eosinophilic pneumonitis
1. OP: ggo in lower lobes. reverse atoll sign (ggo with peripheral consolidation), peribronchial and subpleural
2. chronic eosinophilic pneumonia: ggo in upper lobes. reverse batwing appearance. subpleural region heals first so sometimes not involved.
(fyi: atoll sign is in ABPA and batwing sign is in CHF)
Term
possible causes of crazy paving pattern (many)
Definition
1. acute: edema, HEMORRHAGE, bacterial pneumonia, acute respiratory distress syndrome (ARDS)
2. chronic: organizing pna, eosinophilic pneumonitis, bronchoalveolar carcinoma (BAC), protein alveolar proteinosis (PAP), lipoid pneumonia (LIPOID PNA)
3. radiographics listing of extra listing of causes of crazy paving pattern: Pneumocystis carinii pneumonia (PCP), SARCOID
Term
bronchial atresia
Definition
1. usually upper lobe
2. classic finding: perihilar density (can be round or tubular) surrounded by hyperinflation
Term
dd gas filled mass in the neck
Definition
1. apical lung hernia
2. laryngocele
3. lateral pharyngeal diverticulum
4. tracheal diverticulum
5. Killian Jamieson Diverticulum: lateral and inferior to the cricopharyngeus muscle. in the killian jamieson space.
6. Zenker's diverticulum: posterior and superior to the cricopharyngeus muscle. in killian's triangle or dehiscence.
Term
tracheal stenosis
Definition
1. intrinsic: usually iatrogenic from ETT or tracheostomy
2. extrinsic: usually from external compression from thyroid gland (multinodular goiter, thyroid carcinoma) or lymphoma
Term
heart dz child
Definition
1. -cyanotic. increased pulm flow. dd: asd, papvc, vsd, pda. LAE? (double right heart contour on PA and posterior displacement of the esophagus on lateral view) (prob should put endocardial cushion defect here)
a. -LAE: ASD, PAPVC
b. +LAE: VSD, PDA. Aortic arch enlargement (look at ascending aorta)
1) -aortic arch enlargement. vsd
2) +aortic arch enlargement. pda

2. -cyanotic. normal vascularity: AS, PS

3. +cyanotic. nl to decreased vascularity. dd: tof, ebstein's anomaly (atrialization of the RV), tricuspid atresia with restricted ASD, pulmonary stenosis with intact ventricular septum, tricuspid atresia of the newborn (transitory condition). heart enlarged?
a. no heart enlargement: TOF (pulmonary stenosis-decreased pulmonary arterial contour, RVH-boot shaped heart, but no cardiomegaly, overriding aorta-right aortic arch (r aortic arch 25% of the time, vsd)
b. +heart enlargement (R heart problems): Ebstein's anomaly, tricuspid atresia with restricted asd, pulmonary stenosis with intact ventricular septum, tricuspid atresia of the newborn (transitory)

4. +cyanotic. increased pulmonary flow. superior mediastinum enlarged? TGA, truncus, TAPVC, tricuspid atresia, ""Tingle"" ventricle (variants: DORV, DOLV)
a. narrowed superior mediastinum: TGA
b. widened superior mediastinum: supracardiac TAPVC

5. +cyanotic. pulmonary edema. (CHF in newborn)
a. extracardiac shunt: hemangioma or hemangioendothelioma (can be Kasabach merritt syndrome), vein of galen malformation.
b. systemic: reversible heart stress (severe anemia, asphyxia, hypocalcemia, hypoglycemia, arrhythmia, hypervolemia, sepsis
c. left sided obstruction: severe coarctation of the aorta (at 1-3 weeks), myocarditis, (infradiaphragmatic TAPVC?)
d. volume overload: ASD. tricuspid or mitral insufficiency
Term
dd for
1. perilymphatic distribution
2. random distribution
3. centrilobular distribution
Definition
1. dd for perilymphatic distribution: sarcoid silicosis lymphagitic spread of tumor
2. dd for random distribution: miliary TB, Miliary fungal mets
3. dd for centrilobular distribution
1. bronchiolitis
2. bronchopna
3. endobronchial spread of tumor e.g. BAC
4. endobronchial spread of infection e.g. TB or MAC
5. hypersensitivity pneumonitis
6. vasculitis
Term
cortically based tumors
Definition
1. oligodendroglioma
2. ganglioglioma
3. dnet (dysembronoplastic neuroepithieal tumor
4. pleomorphic xanthoastrocytoma
Term
ectopic posterior pituitary differential
Definition
1. to have ectopic posterior pituitary, should not see high T1 signal in normal region of the pituitary gland
2. dd for high T1: hemorrhage, fat, melanin
Term
PRES and Creutzfeld Jakob disease
Definition
A. posterior reversible encephalopathy syndrome
1. high T2/FLAIR in the cortical and subcortical parietal and occipital lobes
2. can also affect the frontal lobes, temporal lobes, cerebellum and basal ganglia
3. usually normal dwi, but can have high ADC due to vasogenic edema
4. causes: eclampsia/pre eclampsia, septic shock, autoimmune disease like lupus, cancer chemotherapy, transplantation, hypertension
5. dd: acute cerebral infarct, hypoglycemia, gliomatosis cerebri, progressive multifocal leukoencephalopathy
B. Creutzfeld Jakob disease:
1. high FLAIR in the basal ganglia, thalami and cortex
2. can show high DWI also
Term
1. dd for rathke's cleft cyst
2. compare brain intensity to what?
3. if see hemorrhage superior posterior to clivus:
Definition
1. dd for rathke's cleft cyst: arachnoid cyst
2. compare brain intensity to gray matter
3. if you see hemorrhage superior posterior to clivus: retroclival hematoma
Term
1. cephalohematoma
2. subgaleal hematoma
3. caput succedaneum
Definition
1. deep to superficial:
a. cephalohematoma: hemorrhage beneath periosteum so doesn't cross suture lines
b. subgaleal hematoma: crosses suture lines. under the aponeurosis of the scalp.
c caput succedaneum (means substitute): crosses suture lines. above the aponeurosis of the scalp
Term
dd perfusional deficits in kidney on CT
Definition
1. lymphoma
2. infarct
3. emboli
4. acute pyelonephritis
Term
does reversal of diastolic flow mean renal vein thrombosis in a native kidney or transplant kidney
Definition
reversal of diastolic flow is only a sign for renal vein thrombosis in transplant kidney (no venous collaterals in transplant kidney)
Term
cervical incompetence
Definition
1. if length of cervix is < 3 cm then cervical incompetence.
2. may be presentation of placental abruption.
3. not associated with placenta previa.
Term
renal TB
1. early
2. late
Definition
renal TB
1. early:
a. infundibular strictures: "purse-string" appearance
b. "moth eaten" papillae due to inflammation and necrosis
b. "pipestem" ureter if straight rigid ureter
c. "beaded" ureter if narrowing
d. "thimble" bladder if small calcified bladder
2. late: "putty" kidney (small calcified kidney) associated with "autonephrectomy"
Term
A. renal arteries
B. anatomy of the kidneys
Definition
A. renal arteries
1. interlobar or segmental A: both side of the pyramids
2. arcuate arteries: connect the segmental A around the peripheral portion of the pyramids
B. anatomy of the kidneys
1. renal cortex
2. renal medulla (pyramids and columns of bertin)
3. renal papilla (~tip of pyramid), calyx, pelvis, ureter
Term
multicystic dysplastic kidney
Definition
multicystic dysplastic kidney
1. evaluate other kidney for ureteropelvic junction obstruction and multicystic dysplastic kidney
2. follow up
a. before birth: if bilateral mcdk, some offer termination
b. after birth: monitor US until involution. if complications like recurrent infections, htn, Wilm's tumor then nephrectomy
Term
tx for pseudoaneurysm
Definition
tx for pseudoaneurysm
1. US guided compression
2. US guided injection of thrombin:
a. get thrombin 1,000U/ml soln
b. dilute to thrombin 100 U/ml with sterile saline
c. use 25 gauge needle
d. inject 1 cc/10 seconds (100 U) and observe for 10 sec
e. injection stopped when no flow in pseudoaneurysm
f. occlude neck of pseudoaneurym with probe or manually during injection
g. monitor distal pulses before, during and after procedure
h. fu US immediately after procedure and 24 hour later
i. bedrest for 24 h after tx
3. embolotherapy with coils only if narrow neck
4. stent if need to preserve flow
5. surgery as last resort
Term
thyroid
1. enlargement of thyroid if
2. dominant nodule if
3. suspicious nodule if
4. dd of enlarged thyroid gland
Definition
thyroid
1. enlargement of thyroid if > 2 cm in AP or transverse direction
2. dominant nodule if > 1.5 cm
3. suspicious nodule if microcalcifications
4. dd of enlarged thyroid gland: multinodular goiter, Hashimoto's thyroiditis, grave's disease, subacute thyroiditis, DeQuervain's thyroiditis
a. if hypothyroid: Hashimoto's thyroiditis
b. if hyperthyroid: do RAIU
1) if hyperthyroid and high RAIU: Grave's disease
2) if hyperthyroid and low RAIU: Subacute thyroiditis (painless) or DeQuervain's thyroiditis (painful)
Term
situs
Definition
1. situs solitus: left arch and left gastric bubble
2. situs inversus: right arch and right gastric bubble
a. situs inversus with dextrocardia: e.g. Kartagener's syndrome (sinusitis, bronchiectasis, infertility). low risk of congenital heart disease
b. situs inversus with levocardia: high risk of congenital heart defects.
c. situs ambiguous aka heterotaxy syndromes aka Ivermark syndrome: arch and stomach bubble on opposite sides
1) asplenia syndrome: bilateral right sidedness. bilateral trilobed lungs, no spleen, more severe chd, bilateral svc, eparterial bronchus (bronchus is posterior to pulmonary A), right isomerism of atria (two right atria).
2) polysplenia syndrome: bilateral left sidedness.bilateral bilobed lungs. polysplenia, malrotation/volvulus (less severe chd), azygous continuation of svc, hyparterial bronchus (bronchus is below and anterior to pulmonary artery), left isomerism of the atria (two left atria).
[fyi: rul bronchus is higher than lul bronchus on lateral view]
Term
causes of UIP and NSIP
Definition
1. UIP: idiopathic, collagen vascular disease (scleroderma, RA), drug reaction, chronic hypersensitivity pneumonitis ("head cheese" sign), asbestosis, sarcoid (usually upper lobes, but may look like UIP)
2. NSIP: idiopathic, collagen vascular disease (scleroderma, RA), drug reaction, hypersensitivity pneumonia
Term
pectus deformity
Definition
1. pectus carinatum: sternum protrudes anteriorly
2. pectus excavatum: sternum depressed.
Term
aortic aneurysm and dissection tx
Definition
1. aneurysm:
a. ascending aorta: fix with surgery if > 5.5 cm
b. descending thoracic aorta: fix with stent if > 6.5 cm
c. abdominal aorta aneurysm: fix with stent if > 5 cm, symptomatic or increasing > 1 cm/yr.
2. aortic dissection
a. ascending aorta dissection: surgery
b. descending thoracic aorta and abdominal aorta dissection: medical management or stent. if involves regions with branch vessels, can do fenestration (poke hole in the distal intimal flap)
Term
true vs false lumen in aortic dissection
Definition
1. ascending aorta: false lumen is anterolateral
2. descending aorta: false lumen is posterolateral
Term
total anomalous pulmonary venous return
Definition
types:
1. supracardiac (left vertical vein or azygous vein)
2. cardiac (RA or coronary sinus)
3. infracardiac (vein below diaphragm- IVC, portal vein),
4. mixed
(obstructed forms cause pulmonary edema)
Term
aortic stenosis types
Definition
1. supravalvular: Williams syndrome or rubella. will see dilated coronary arteries
2. valvular: degenerative
3. subvalvular: IHSS (idiopathic hypertrophic subaortic stenosis)
Term
defn thoracic, abdominal aortic and iliac aneurysm
Definition
1. thoracic aortic aneurysm: tx if > ~ 6cm (5.5 cm for ascending and 6.5 for descending aorta)
2. abdominal aortic aneurysm: > 3 cm
3. common iliac aneurysm > 1.5 cm
Term
LV aneurysm
Definition
LV aneurysm usually due to MI
1. true LV aneurysm: usually apical or anterolateral
2. false LV aneurysm: usually diaphragmatic or posterolateral.
Term
normal vs bovine arch
Definition
Normal arch: from right to left. 3 vessels from arch (listed below)
1. innominate goes to right (R cc and R subclavian A)
2. L CC A
3. L subclavian A

Bovine arch: LCCA comes off the innominate (brachiocephalic A) going to the R. 2 vessels from arch (innominate and left subclavian)
Term
aberrant R subclavian A
Definition
4 vessels from aortic arch: anterior to posterior
1. R CCA
2. L CCA
3. L subclavian A
4. aberrant R subclavian A (crosses posterior to the esophagus)
a. arises from the diverticulum of kommerell (dilatation of the proximal aberrant vessel at its origin)
b. can cause dysphagia lusoria (lusoria means freak or aberrant)
Term
emergencies for radiation tx
Definition
1. cord compression
2. svc syndrome
Term
muga scan
Definition
muga scan (multiple gated acquisition)
1. done with Tc labelled rbc
2. ejection fraction: (end diastolic volume) - (end systolic volume)/(end diastolic volume) - (background)
Term
if obese pt and need cardiac imaging
1. which agent?
2. if doesn't fit on spect
3. common areas for attenuation defect (male and female)
Definition
if obese pt and need cardiac imaging
1. can use Tc 99 sestamibi (140 kev) instead of thallium (80 kev) because less soft tissue attenuation with higher photon energy
2. if doesn't fit on spect machine, can do planar imaging
3. attenuation defect
a. female: anteroseptal
b. male: infradiaphragmatic
Term
defn
1. hypokinesis
2. akinesis
3. dyskinesis
Definition
1. hypokinesis: decreased contractility
2. akinesis: no contractility
3. dyskinesis: paradoxical dilatation during systole (should be contracting during systole): may represent infarct or scarring. may also be associated with aneurysm formation.
Term
arvd
Definition
arrhythmogenic right ventricular dysplasia: ~ fatty infiltration of the right ventricle
Term
when doing viability cardiac study, compare fdg pet with ___
Definition
when doing viability cardiac study, compare fdg pet with 13N-NH3
Term
cardiac angiogram
Definition
1. inject left main:
a. LAD: diagonals
b. L Cx: obtuse marginal
2. RCA by itself. didn't see pda on the angiogram
Term
1. signs of LAE and RAE
2. valves from cranial to caudal
a. PA
b. lateral
3. RVH and LVH
4. if right aortic arch, think of
Definition
1a. signs of LAE:
a. splaying of the carina greater than 90 degrees
b. extra right atrial border more than 1/3 into the right thorax
1b. signs of RAE: extension of R heart border
2. valves from cranial to caudal
a. PA: PAMT
b. lateral: better view to deduce valves than PA. draw line from carina to apex and then line horizontal to the floor.
1) superior posterior: pulmonary valve
2) superior anterior: aortic valve
3) inferior posterior: mitral valve
4) inferior anterior: tricuspid valve
3. ventricles
a. RVH: apex points up. loss of retrosternal space
b. LVH: apex points down. loss of retrocardiac space
4. if R aortic arch (trachea deviated to the midline or left), think of
a. TOF:
b. tricuspid atresia:
c. double aortic arch
d. supracardiac total anomalous pulmonary venous return
Term
asd and vsd types
Definition
1. asd: ostium primum, ostium secundum (mc), sinus venosus, coronary sinus
2. vsd: membranous (mc), muscular, inlet, outlet
Term
collateral pathway from aorta to lower extremities
Definition
1. anterior (Winslow) pathway: subclavian A, internal mammary A, superior epigastric A, inferior epigastric A, external iliac A.
2. middle (visceral) pathway: SMA to IMA via the marginal artery of drummond and arc of Riolan, hemorrhoidal A, external iliac A
3a: posterior pathway: intercostal, subcostal, lumbar A to the internal iliac A then external iliac A
3b: posterior pathway: intercostal, subcostal, lumbar A to the external iliac A
Term
arterial vs venous flow:
Definition
1. arterial flow: central
2. venous flow: cephalization
Term
clockwise rotation of heart
Definition
clockwise rotation is a sign right sided . sign of asd.
Term
pda
Definition
1. close with indomethacin or ligation
2. keep open with prostaglandins
Term
pseudocoarctation
Definition
1. elongation of the aorta
2. kinking of the aorta at the ligamentum arteriosum
3. no pressure gradient so no collaterals
Term
if right sided aortic arch
Definition
1. boot shaped heart: TOF
2. tricuspid atresia
2. prominent and cranial position of the main pulmonary artery: truncus arteriosus (type I has these pulmonary A features)
3. double aortic arch
Term
calcifications in lungs
Definition
1. granulomatous disease like TB, fungal infections
2. mets like osteosarcoma
3. "metastatic pulmonary calcifications" from abnormal calcium metabolism
Term
signs of invasive aspergillosis
Definition
1. halo sign: consolidations surrounded by ggo
2. air crescent sign: can be a sign
Term
complication of strep pneumonia in child
Definition
delayed onset of right diaphragmatic hernia
Term
tx of congenital diaphragmatic hernia
Definition
1. in utero repair
2. post uterine ecmo (extracorporal membrane oxygenation)
Term
hourglass configuration of the esophagus
Definition
double aortic arch
Term
Menetrier's disease
1. adults
2. children
Definition
Menetrier's disease: thickened gastric rugal folds
1. adults: chronic. may have increased risk of gastric cancer
2. children: self limited. associated with CMV or campylobacter pylori infection
Term
1. predispose to gallstones
2. complication of gallstones
Definition
1. predispose to gallstones: hemolytic anemia like sickle cell disease, cystic fibrosis, parenteral nutrition, malabsorption
2. complication of gallstones: obstruction and infection (cholecystitis, cholangitis, pancreatitis)
Term
neurogenic bladder
Definition
1. spastic: upper motor neuron. "christmas" tree or "pinecone" pattern. pseudodiverticula.
2. atonic: lower motor neuron. large bladder.
Term
congenital hip dysplasia
Definition
1. when done?
a. delay US to 2-4 weeks after birth.
b. < 6 m: US
c. > 6m: xr
(proximal femoral epiphysis develops at 3months)

2. lines
a. Hilgenreiner's line: horizontal. superior aspect of the triradiate cartilages.
b. Perkin's line: perpendicular. lateral aspect of the acetabular roof
c. femoral head should be in the inner lower quadrant of the intersection of the Hilgenreiner and Perkin's line.

3. alpha angle (more medial) should be > 60 degrees

4. the humeral head should be covered by at least 50% of the acetabulum.
Term
spiral fracture of the tibia
Definition
toddler's fracture
Term
NOF aka
Definition
fibroxanthoma
fibrous cortical defect
Term
# of ossification centers in wrist
Definition
# of ossification centers in the wrist = age + 1. should see 2 ossification centers at 6 months old.

if less than the expected number of ossification centers then possibly have hypothyroidism
Term
if dense metaphyseal bands
Definition
1. dd:
a. physiologic
b. lead poisoning
c. treated rickets
2. to differentiate physiologic and lead poisoning/treated rickets, check the fibula
a. if fibula normal then could be lead poisoning or treated rickets.
b. if fibula affected by dense metaphyseal lines then could be physiologic. (lead poisoning and treated rickets like to preferentially affect the tibia)
Term
severe hypoxic/ischemic injury in child:
reversal sign and white cerebellum sign
Definition
cerebral edema
1. reversal sign: white matter has higher attenuation than gray matter on CT (normally the white matter has higher attenuation than gray matter)
2. white cerebellum sign: diffuse edema of the cerebral hemispheres with sparing of the cerebellum so that the cerebellum has high attenuation.
Term
avn in 4-8 year old
Definition
Legg Calve Perthes disease
Term
dd for rickets
Definition
A. dd for rickets
1. rickets: osteomalacia in the pediatric population. can be due to low vitamin D among other things. high alkaline phosphatase.
2. hypophosphatasia can lead to rickets: low or absent alkaline phosphatase.
3. metaphyseal dysplasia
B. appearance of rickets and hypophosphatasia:
1. metaphyseal fraying, flaring, cupping.
2. zone of provisional calcification is poorly defined
Term
multicystic dysplastic kidney follow up
Definition
1. serial ultrasound to monitor
2. nephrectomy if enlargement (potential Wilm's tumor), recurrent infections, mass effect, or hypertension (seems like they used to do surgery on everyone, but now surgery more conservative)
Term
if proximal femur is congenitallly absent
Definition
proximal femoral focal deficiency
Term
ecmo
Definition
extracorporal membrane oxygenation (normal to see white out of lungs with ecmo)
1. two types
a. veno-arterial (most common): two cannulas in the R IJ and R cc
b. veno-venous: single lumen dual catheter draining right atrium
2. complication: hemorrhage due to anticoagulation
3. when do you stop ecmo? grade III intracranial hemorrhage (as per Dr. A)
Term
1. proximal humeral epiphysis
2. distal femoral epiphysis
3. proximal femoral epiphysis
4. 1 molar
5. 2 molars
Definition
1. proximal humeral epiphysis: 36 wks
2. distal femoral epiphysis: at birth
3. proximal femoral epiphysis: 3 m (if see proximal femoral epiphysis at birth then think trisomy 13, 18, 21.
4. 1 molar: 33 wks
5. 1 molars: 36 wks
Term
physiologic periosteal reaction
Definition
1. bilateral, symmetric, diffuse
2. spares the metaphysis
3. commonly involves the femur, tibia, humerus
Term
buckle fracture =
Definition
torus fracture
Term
mc salter harris
Definition
SH II
Term
epiphyseal equivalent
Definition
1. greater/lesser tuberosity, greater/lesser trochanter, patella, calcaneus, tarsal bones (as per Dr. Erickson)

1. most apophysis: iliac crest, ASIS, AIIS, ischial tuberosity
Term
scfe
Definition
1. slipped capital femoral epiphysis (scfe)
2. 25% bilateral. can do prophylactic bilateral pinning
3. pistol grip deformity occurs when scfe leads to oa (now grouped under the term femoral acetabular impingement syndrome)
Term
ghost triad
Definition
1. used for diagnosing biliary atresia
2. ghost triad (you don't see the bile ducts)
a. gallbladder < 1.9 cm
b. irregular wall
c. indistinct mucosal lining (normal gallbladder mucosa is echogenic)
Term
continuous diaphragm sign
Definition
pneumomediastinum
Term
pediatric lung white out
Definition
1. lung agenesis (no short ending bronchus): problem side is white.
2. lung aplasia (has short ending bronchus)
2. lung hypoplasia
3. hypogenetic lung syndrome (scimitar syndrome-lung hypoplasia and subdiaphragmatic partial anomalous pulmonary venous return)
4. unilateral absence of pulmonary artery:the side that has the absence is white.
5. pulmonary artery hypoplasia
Term
normal lung expansion
1. adults
2. kids
Definition
normal lung expansion
1. adults: 9 posterior
2. kids: 8 posterior
Term
posterior urethral valve on vcug
Definition
1. dilatation and elongation of the posterior urethra (equivalent to the keyhole sign on US)
2. trabeculated bladder with pseudodiverticula
3. VUR (seen in 50% of pts with PUV)
Term
vertebral anomalies
Definition
1. failure of formation: hemivertebra e.g. dorsal (wedge) vertebra, butterfly vertebra]
2. failure of segmentation: e.g. block vertebra
3. vertebral anomalies associated with VACTERL (vertebral anomalies, anal atresia, cardiac anomalies, TE fistula, esophageal atresia, renal anomalies, radial ray anomalies, limb anomalies)
Term
mosaic perfusion pattern
Definition
1. small airway disease e.g. asthma (reversible), bronchiolitis obliterans, hypersensitivity pneumonitis. air trapping on expiratory phase. +air trapping (the hypodense regions do not become hyperdense on expiratory phase). vessels are smaller in hypodense areas.
2. vascular lung disease: e.g. chronic pulmonary embolism. no air trapping on expiratory phase. vessels are smaller in hypodense areas.
3. infiltrative disease: e.g. pneumocystis pna and more. no air trapping on expiratory phase. vessels are approximately the same size in the hypodense and hyperdense areas.
Term
elbow dislocation
Definition
1. complications
a. neurovascular compromise
b. avulsion fracture and incarceration of the medial epicondyle (most common)
2. need to take post reduction xrays.
Term
osteoid osteoma
Definition
1. if < 2 cm then osteoid osteoma. if greater than 2 cm then osteoblastoma.
2. tx: surgery or ablation with radiofrequency, thermal or laser
3. dd: Brodie's abscess, osteoblastoma, stress fracture, (also osteoma)
Term
1. yolk sac
2. fetal pole
3. heart beat
Definition
1. yolk sac: msd 8 mm
2. fetal pole: msd 16 mm
3. heart beat: crown rump length 5 mm "alive at 5"
Term
Paget's disease
Definition
1. bony expansion, trabecular coarsening, cortical thickening, "speckled" appearance on T1 and T2
2. blade of grass appearance, picture frame appearance of vertebral bodies
3. skull: osteoporosis circumscription, cotton wool spots, widening of the diploic space.
4. bones become "fatty" on MRI
5. malignant degeneration into osteosarcoma
6. high alk phos (mets from prostate ca would have low alk phos and high psa)
7. remember what a large vertebral body looks like
Term
big bone island: hot or cold on bone scan
Definition
a big bone island can be hot on bone scan.
Term
3 things that can have fluid fluid levels
Definition
gct, abc, telangiectatic osteosarcoma
Term
fibrous dysplasia vs mets
Definition
fibrous dysplasia tends to be unilateral
Term
lesion of carpal bone (lunate): low T1 and high T2 dd
Definition
1. keinboch's: avn of the lunate. if keinboch's advanced, then need surgery. related to repetitive microtrauma. associated with negative ulnar variance (ulnar impingement syndrome)
2. trauma
3. infection
Term
supraspinatus tear
Definition
1. partial tear: bursal (superior), intrasubstance, articular (inferior)
2. full thickness tear: if you see fluid in the subacromial bursa after intra-articular gadolinium then full thickness tear
3. complete tear:
a. if retraction is proximal to glenoid then not surgical
b. if retraction is distal to glenoid then surgical
Term
giant cell tumor of the tendon sheath
Definition
1. giant cell tumor of the tendon sheath is pvns
2. low t1 and low t2
3. blooms on gradient
4. intense enhancement on t1 post contrast
Term
biceps tendon dislocation and tear
Definition
1. if out of bicipital groove then dislocation
a. intra-articular dislocation if tear of subscapularis tendon
b. extra-articular dislocation if no tear of subscapularis tendon
2. biceps tendon tear
a. intra-articular tear if tear located in horizontal portion
b. inter tubercular tear if tear located in vertical portion
3. usually if there is tear of biceps tendon, it is clinically diagnosed. however, if the biceps is not retracted due to the biceps aponeurosis and the biceps tear is suspected then can do an MR to look for biceps tear.
Term
if see sclerotic lesion, may want to further evaluate with
Definition
ct (however, with most cases, want to further evaluate with MR)
Term
os odontoideum
1. etiology
2. evaluate stability with
Definition
1. etiology: controversial
a. congenital
b. sequelae of prior fracture
2. evaluate stability with flexion and extension views.
Term
bone infarct can malignantly transform into
Definition
mfh
Term
parts of the prosthesis
Definition
1. acetabular component
2. femoral component
3. stem goes into the femur
Term
tx of Weber fx
Definition
Weber A: no surgery
Weber B: may or may not be surgial
Weber C: surgical
Term
loosening
Definition
1. granulomatous response to shed submicron portions of prosthesis. polyethylene and/or methymethacrylate cement
2. sx: pain, decreased ROM, limb shortening
3. 2mm
4. particle disease, infection, mechanical loosening or all 3
5. tx: revision
Term
1. what is the cause of ballooning
2. what if ballooning and widening of the intercondylar notch
3. if male or female?
Definition
1. hyperemia
2. hemophilia or JRA (now JIA, juvenile idiopathic arthritis)
3.
a. male: hemophilia
b. female: JIA
Term
1. lytic lesion in posterior elements of spine
2. how to distinguish?
Definition
1. lytic lesion in posterior elements of spine: GO APE. gct, osteoblastoma, abc, plasmacytoma, eg
2. abc has fluid fluid levels
Term
pathway of the
a. uvc
b. uac
Definition
1. pathway of the uvc and uac
a. UVC: umbilical V, left portal vein, ductus venosus, left or middle hepatic vein, IVC (in and up). at hemidiaphragm (~T8)
b. UAC: umbilical A, iliac A, aorta (in, down, 180 degree turn up) (T8-T10 or below L3 away from takeoffs of vessels)
Term
VP shunt
1. how to evaluate VP shunt with nuclear study
2. complications of overshunting
Definition
VP shunts
1. Tc DTPA 1 mCi (in about 1 cc) into shunt reservoir (can also use Indium 111 DTPA). should see in abdomen if normal study.
2. complications of overshunting: craniosynostosis, subdural hemorrhage
Term
what rbc labeling do we use?
Definition
ultratag, which is in vitro
1. take out 1-3 cc of patient's blood with anticoagulant (heparin or ADC)
2. add to vial, which already has stannous ion.
3. follow direction on the ultratag kit.
a. add syringe I and II
b. add 20 mCi of Tc 99

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=81111
Term
how long do you wait after sestamibi injection before imaging?
Definition
15-30 min
Term
1. DWI and ADC hyperintense
2. DWI hyperintense and ADC hypointense
Definition
1. DWI and ADC hyperintense: vasogenic edema. T2 shine through.
2. DWI hyperintense and ADC hypointense: cytotoxic edema.
Term
high on t2 in brainstem in child
Definition
1. brainstem glioma
2. infarct
3. ADEM
4. UBO (unidentified bright objects) in neurofibromatosis
Term
posterior reversible encephalopathy syndrome vs Creutzfeldt Jakob disease
Definition
1. PRES: low T1 and high T2 in cortical and subcortical white matter. likely normal. can have high dwi/low adc if infarct. can have high ADC due to vasogenic edema
2. Creutzfeldt-Jakob: iso T1 and high T2 in cortex and basal ganglia. can have high DWI.
Term
hypoxic-ischemic injury
Definition
1. premature infant: injury to periventricular white matter affected
2. term infant: injury to basal ganglia and thalami (watershed regions)
-both high lactate (anaerobic metabolism)
Term
Goldenhar syndrome
Definition
1. hemifacial microsomia
2. ear anomalies
3. cleft palate
4. vertebral segmentation errors.
Term
grapelike mass in bladder of child
Definition
botryoid rhadomyosarcoma
Term
mibg vs indium 111 octreoscan
Definition
1. mibg: liver and heart hot. I123 10mCi at 2 d. neuroblastoma and pheochromocytoma.
2. indium 111 octreoscan: spleen and kidney hot. 6 mCi at 4 and 24 hours. neuroblastoma and pheo and more.
Term
pleuropulmonary blastoma
Definition
1. can have entirely solid, cystic or mixed.
2. dd: CPAM, sequestration, congenital lobar emphysema, PNET, rhabdomyosarcoma, bronchogenic cyst, cystic hamartoma
Term
sequestration
1. mc
2. tx
3. may co-exist with
Definition
sequestration
1. intralobar
2. tx: surgery in the US
3. sequestration may co-exist with CPAM
Term
newborn opacities
Definition
1. premature:
a. low lung volumes: surfactant deficiency syndrome
b. pneumonia
2. term
a. high lung volumes: meconium aspiration.
b. mild high lung volumes: transient tachypnea of the newborn
c. pneumonia
Term
types of teratoma and tx
Definition
1. mature (like dermoid): surgery
2. immature (small amount of fat and calc): surgery with likely chemoradiation
3. teratoma with malignant components: surgery with chemoradiation
Term
1. which type of CPAM is associated with other anomalies?
2. do you use contrast CT in evaluating CPAM?
3. tx for CPAM?
Definition
1. which type of CPAM is associated with other anomalies? type II (< 2 cm cysts)
2. do you use contrast CT in evaluating CPAM? yes, you want to look for a component of sequestration (look for systemic arterial supply)
3. tx for CPAM? surgery for symptomatic and likely asymptomatic because risk of infection and small risk of malignant degeneration (rhabdomyosarcoma)
Term
foregut duplication cyst
Definition
1. neuroenteric
2. bronchogenic cyst
3. enteric cyst
Term
biliary atresia
Definition
1. triangular cord sign: hyperechoic remnant of cbd paralleling the portal vein

2. ghost triad:
a. gallbladder < 1.9 cm
b. irregular wall
c. indistinct mucosal lining (normal gallbladder mucosa is echogenic)
Term
parts of the duodenum
Definition
1st: duodenal bulb
2nd: descending
3rd: horizontal
4th: ascending
Term
1. what contrast do you use for suspected meconium ileus
2. contrast if suspect perforation in adult
3. contrast if worried about aspiration
Definition
1. if suspecting meconium ileus, use dilute gastrograffin (it is hypertonic even if somewhat diluted and this can increase small bowel secretions)

2. use gastrograffin (water soluble contrast) for suspected bowel perforation (barium can cause peritonitis)

3. use barium for possible aspiration (gastrograffin can cause pneumonitis)
Term
omphlalocele and gastrochisis
Definition
1. omphalocele (malrotation and increased risk of volvulus). elevated afp. doesn't need to be fixed right away since there is covering.
2. gastrochisis (nonrotated bowel). elevated afp. risk of motility disorders.
Term
what determines intensity on T2 of acoustic neuroma?
Definition
Acoustic neurona (schwannoma) on T2:
1. if more Antoni A cells: hypointense on T2
2. if more Antoni B cells: hyperintense on T2
Term
arachnoid vs epidermoid cyst
Definition
1. arachnoid cyst: follows csf on al sequences. no restricted diffusion. looks like csf on flair.
2. epidermoid cyst: restricted diffusion. higher signal on flair compared to csf.
Term
meningioma vs. schwannoma
Definition
meningioma will not expand the iac, schwannoma will expand the iac.
Term
when looking at tumor, think of
Definition
1. demyelinating disorder
2. subacute infarct
3. subacute hemorrhage
5. infection like TB
5. thrombosed aneurysm (will have pulsation artifact), don't say biopsy
Term
predispose to pancreatitis in kids
Definition
1. trauma
2. HIV
3. cystic fibrosis
4. pancreas divisum: the ventral duct (Wirsung) and dorsal duct (Santorini) do not fuse. the smaller one (Santorini) has to drain the majority of the pancreas. secretin mr cholangiopancreatography (MRCP) can help identify pancreas divisum.
5. annular pancreas: the pancreas encircles the 2nd portion of the duodenum
Term
intussusception
Definition
1. usually ileocecal
2. usually due to lymphoid hyperplasia. can be due to Meckel diverticulum, polyps, lymphoma, bowel wall hemorrhage.
3. pseudokidney sign and bullseye appearance
4. procedure for air insufflation: make sure there is no peritonitis or free air, place pt in lateral decubitus position, insufflate up to 120 mmHg up with up to 3 tries. if doesn't reduce or peritonitis/free air then surgery.
Term
breast composition
Definition
1. Mostly Fat Density: 0-25% densities
2. Scattered Fibroglandular Tissue: 25-50% densities
3. Heterogenous Breast Density: 50-75% densities
4. Extremely Dense Breasts: 75-100% densities
Term
calcifications mmg
Definition
CIA FF

A. Intermediate suspicious (interval change and distribution)
1. Coarse Heterogeneous (0.5-1mm).
2. Amorphous/indistinct

B. Highly suggestive of
1. Fine pleomorphic
2. Fine, linear and fine linear branching
Term
distribution of calcifications
Definition
1. Diffuse/scattered
2. Regional- does not conform to a ductal distribution: more than 2 cc
3. Grouped or clustered: 5 calcs within 1 cm
4. Linear
5. Segmental- triangular pattern extending to the nipple
Term
description of masses by mmg
Definition
A. Shape
1. Round
2. Oval
3. Macrolobulated (not going to be used anymore)
4. Irregular (if not above)

B. Margins
1. Circumscribed (at least 75% of the circumference)
2. Microlobulated (each lobulation < 2mm) (not going to be used anymore)
3. Obscured (hidden by adjacent tissue)
4. Indistinct (suggests infiltration)
5. Spiculated
Term
circumscribed malignant breast masses
Definition
peanut m and m

Papillary carcinoma
Medullary carcinoma
Mucinous/colloid carcinoma
Term
How do you perform a ductogram?
Definition
1. Use galactography canula
2. Canulate the discharging duct (20-30 openings)
3. Take preliminary mammogram
5. Inject 0.5 cc of a mixture of Omnipaque 300 and sterile water (1:1 ratio). make sure no air bubbles are injected.
6. Take post injection mammogram mag views in at least 2 projections (CC and MLO with magnification)
Term
asymmetry
Definition
1. Asymmetry: 1 projection
2. Global asymmetry: 2 projections. 1 or more quadrants
3. Focal asymmetry: 2 projections. Less than 1 quadrant.
4. Developing asymmetry: focal asymmetry that is new, increasing or denser
Term
breast edema dd
Definition
1. hormonal therapy
2. inflammatory carcinoma
3. radiation therapy
4. mastitits
5. lymphatic/venous obstruction: svc syndrome, chf, renal failure
Term
need breast re-biopsy, usually excisional.
Definition
1. Any atypical findings
2. Papilloma > 1 cm or away from nipple
3. Radial scar
4. LCIS
5. Discordance: noncongruent imaging/pathology findings
Term
post lumpectomy calcifications
Definition
1. if within 6 months of lumpectomy, likely benign
2. if > 6 months of lumpectomy, may not be benign
Look at morphology of calcifications.
Term
terms for mmg
1. stereotactic bx
2. needle localization
3. bracketing
4. spot mag and spot compression.
5. views
a. eklund:
b. cleopatra
c. cleavage
d. tangential
Definition
1. stereotactic biopsy or US guided bx
2. needle localization: can be done for mass or calcifications.
a. talk to patient and explain risks and benefits
b. ask patient if she is on any anticoagulation or has had a reaction to lidocaine.
c. look for shortest distance to lesion. if shortest distance is on CC view then put the grid on the lateral view (don't use MLO for stereotactic)
d. look at where the lesion is (e.g A3) and push needle all the way in
e. take the perpendicular image and pull out needle if needed.
f. place hook 1 cm distal to the distal end of the lesion.
g. mark skin with bb.
h. take cc and true lateral views for the surgeon

3. can do bracketing for calcifications

4. spot views
a. if calcs: do spot mag
b. if mass: do spot compression
5. views
a. eklund for implants
b. cleopatra: exaggerated lateral CC
c. cleavage: exaggerated medial CC
d. tangential: for dermal calcifications
Term
ACR phantom
Definition
4 fibers
3 speck groups
3 masses

Done weekly
Term
gynecomastia
Definition
1. mmg: fan shaped, retroareolar density
2. US: hypoechoic, retroareolar lesion with extension into fat
Term
When do breast mri?
Definition
7 - 14 days after 1st day of menstrual period.
Term
wipe test
Definition
1. use Geiger Muller counter for wipe test
2. should perform wipe test weekly
Term
if see outline of muscles on bone scan
Definition
1. rhabdomyolysis
2. elevated creatine kinase
Term
dose calibrator
Definition
Must check 4 things
should be within 10%
1. accuracy: annually. you have a source with known radioactivity. does the dose calibrator get it right, which it is decaying?
2. constancy: daily. you have a cobalt source with known radioactivity. does the dose calibrator get it right?
3. linearity: quarterly. measure low and high radioactivity and see if the dose calibrator gets it right
4. geometry: during installation and after repair or relocation. is the dose calibrator able to measure radioactivity in different containers like pill, syringe, vial.
Term
1. lemierre's syndrome
2. gradenigo syndrome
3. lhermitte-duclos syndrome
Definition
1. lemierre's syndrome: acute pharyngitis causing IJ thrombophlebitis
2. gradenigo syndrome: petrous apicitis, pain in the distribution of CN V, CN VI palsy,
3. cerebellar mass (usually vermis and usually unilateral): best diagnostic clue: widened cerebellar folia
Term
1. positive predictive value for mmg?
2. pressure to breasts
according to Dr. S
Definition
1. 1/3 biopsies should be positive for cancer.?
2. 15 lbs pressure to breasts
Term
transportation labels: nuclear medicine
Definition
transportation labels. if over these amounts then cannot receive.
1: < 0.5 mrem/hr. yellow
2. < 50 mrem/hr. yellow
3. < 200 mrem/hr. yellow
Term
doses summary
1. bones:
2. bones and hot liver:
3. bones and hot spleen:
4. lacrimal, nasal mucosa, liver, intestine, not spleen
5. liver, heart, adrenal medulla and looks blurry
6. adrenal cortex
7. stomach and thyroid
8. parathyroid
9. I 131 tx: diagnostic, ablative, grave's, adenoma
10. blood
11. hepatobiliary scintigraphy for cholecystitis
12. prostate
13. kidneys and spleen
14. brain perfusion: sz and brain death
15. renal scintigraphy
16. renal cortical imaging
17. VQ scan: two ways
18. muga
19. biliary atresia
20. cholecystitis
21. gallbladder ejection fraction
22. thyroid imaging
23. nuclear imaging for sz
24. nuclear imaging for dementia
Definition
***
1. bones: Tc MDP, 20 mCi, 3h

2. bones and hot liver:
a. Tc sulfur colloid (3 mCi at 10 min for liver-spleen study,
b. Tc sulfur colloid 10 mCi at 3 min for bleeding study and at 2h for bone marrow study,
c. Tc sulfur colloid 100 uCi in each of the 4-6 tuberculin syringes for lymphoscintigraphy
d. 1 mCi in (age+2) x 30 cc for reflux)
e. Tc 99 sulfur colloid can also be used for gastric emptying study.1 mCi.

3. bones and hot spleen: Indium 111 labeled wbc (500 uCi 24h) or Tc labelled wbc (10 mCi 2h).

4. gallium 67 citrate: 5 mCi, 48 h.

5. MIBG (I 123 10 mCi at 2 d (don't really use I 131 1 mCi 2d cuz too expensive)

6. I 131 NP 59 1mCi, 5d

7. Tc pertechnetate:
a. 5 mCi for thyroid 20 min
b. 10 mCi for Meckel's in adults dynamic
c. scrotal scintigraphy 10 mCi flow and blood pool.

8. Tc sestamibi:
a. for parathyroid 20 mCi 20 min and 2h.
b. for cardiac 10 mCi at rest and 30 mCi at stress. can also image parathyroid 3 other ways
1) tc sestamibi 20 mCi at 20 min minus I 123 (400 uCi at 4h) [or minus Tc pertechnetate (5 mCi at 20 min). Tc pertechnetate not used much, but can be used if pt does not want to stop synthroid and RAIU calculation not needed]

9. I 131:
a. 2 mCi diagnostic
b. 100-200 mCi ablative therapy.
c. grave's 10 mCi (100 uCi/g)
d. toxic adenoma 30 mCi.

10. Tc labelled rbc 20 mCi, dynamic

11. 5 mCi Tc mebrofenin. wait 1h and can give morphine (0.04 mg/kg like around 2mg) then wait 30 min more

12. 5 mCi of Indium 111 cabromab pendetide (prostascint) 4d (need to give 2 mCi of Tc labeled rbc b4 scan)

13. octreoscan 6 mCi 4h and 24h

14.
1. sz
a. FDG PET:10 mCi. inter-ictal. look for decreased activity.
b. SPECT: 20 mCi Tc HMPAO or ECD. ictal. look for increased activity.
2. SPECT cerebral perfusion imaging:
a. Tc HMPAO (ceretec) or Tc ECD (neurolite) 20 mCi at 20 min
b. PET imaging: 10 mCi of FDG, image after 45-60 min

15. Tc MAG 3 (tubular) agent 10 mCi or I 131 OIH (hippuran) 400 uCi, dynamic (don't use Tc DTPA 10 mCi, which is GFR agent and only used for to calculate GFR)

16. Tc DMSA 3 mCi in 3h

17.
a. if not on vent: 1st: Xe 133 20 mCi then 2nd: Tc MAA 5 mCi.
b. if on vent: 1st: Tc MAA 5 mCi then 2nd Tc DTPA 30 mCi

18. tc rbc 25 mCi

19. 1 mCi Tc mebrofenin: dynamic and delayed

20. 5 mCi Tc mebrofenin: wait 1h, give morphine (0.04 mg/kg or about 2 mg) and wait 30 min more

21. cck 0.02 ug/kg over 30 min then get EF

22. Tc pertechnetate 5 mCi at 20 min or I 123 400 uCi at 4 h

23.
a. FDG PET: inter-ictal. look for decreased activity.
b. SPECT: 20 mCi Tc HMPAO or ECD. ictal. look for increased activity.

24.
a. SPECT cerebral perfusion imaging: 20 mCi. Image 15 min-3h later ( 20 min)
-Tc HMPAO (ceretec)
-Tc ECD (neurolite)
b. PET imaging: 10mCi of FDG, image after 45-60 min
Term
1. if high t1, ask for
2. if no contrast, ask for
Definition
1. if high t1, ask for fat sat
2. if no contrast, ask for post contrast
Term
solid and cystic cerebral mass
Definition
1. pilocytic astrocytoma
1. hemangioblastoma
1. pleomorphic xanthoastrocytoma (children, young adults)
1. ganglioglioma (children, young adults)
Term
if choline higher than NAA
Definition
tumor or ischemia
(normally NAA is higher than choline)
Term
oligodendroglioma
Definition
has calcifications
Term
bilateral basal ganglia calcifcification
Definition
1. hiv, toxoplasmosis (multifocal), cmv (periventricular)
2. fahr disease
3. hyperparathyroidism, hypoparathyroidism, pseudohypoparathryroidism, pseudopseudohypoparathyroidism
4. neurocystercercosis, hypoxic ischemic injury
Term
restricted diffusion
Definition
-infarct, gbm, lymphoma, abscess, epidermoid cyst, Creutzfeldt-Jacob disease, active MS

-meningioma sometimes
Term
hydrocephalus and periventricular high T2 and FLAIR
Definition
transependymal flow of csf
Term
intramedullarly tumors
Definition
astrocytoma,ependymoma, hemangioblastoma mets, demyelinating disease
Term
fnh vs fibrolamellar hcc
Definition
1. central scar of fnh:
a. high central scar t2.
b. scar fills in with delayed
2. central scar of fibrolamellar hcc:
a. low central scar on T2.
b. scar doesn't enhance
Term
1. renal artery stenosis is in the kidney that has ____

2. if DMSA defect, the dd is ?

3. if there is a cold nodule on Tc 99m pertechnetate thyroid (Tc 99m pertechnetate not used much) then can confirm with ?

4. amiodarone can cause ?

5. % of hot nodules with malignancy is ??
Definition
1. renal artery stenosis is in the one kidney that has retention on MAG 3 scan

2. if DMSA defect, the dd is scar or pyelonephritis. treat with antibiotics. if the defect improves, it was pyelonephritis. if the defect does not improve, it is scar.

3. if there is a cold nodule on Tc 99m pertechnetate (Tc 99m pertechnetate not used much) then can confirm with I123 study.

4. amiodarone can cause thyroiditis

5. % of hot nodules with malignancy is < 1%
Term
1. alara:

2. nrc: nuclear regulatory commission:

3. illinois is an agreement state?

4. occupational dose limits
a. general public:
b. fetus in declared pregnancy:
c. occupational adult:
Definition
1. alara: as low as reasonably achievable

2. nrc: nuclear regulatory commission: regulates nuclear material including its transport.

3. illinois is an agreement state

4. occupational dose limits
a. general public: 1 mSv/yr
b. fetus in declared pregnancy: 5 mSv/yr
c. occupational adult: 50 mSv/yr
Term
dd bone scan and hot spleen
Definition
dd bone scan and hot spleen: sickle cell disease with splenic infarcts, prior splenic trauma, prior liver spleen scan.
Term
high and low resistance waveform
Definition
1. high resistance waveform: diastole is at or below line. no forward flow during diastole due to distal high pressure. capillaries are not open to receive blood during diastole. e.g. eca, femoral A

2. low resistance waveform: diastole is above line. forward flow during diastole due to distal low pressure. capillaries remain open to receive blood during diastole. e.g. ica and renal A (very metabolic organs)

3. veins
a. further from the heart: continuous with normal respiratory variation e.g. femoral vein, portal vein
b. closer to heart: pulsatile flow. e.g. subclavian vein and hepatic vein
Term
1. dark on T2, call it a
2. dd Creutzfeldt jacob disease:
3. if something looks like mass in brain, look for ?
4. giant aneurysm:
5. dd and disposition posterior reversible encephalopathy syndrome:
6. dd meningioma:
Definition
1. dark on T2: flow void
2. dd Creutzfeldt jacob disease: hypoxic ischemic encephalopathy
3. if something looks like mass in brain, look for pulsation artifact
4. giant aneurysm: > 2.5 cm
5. dd and disposition posterior reversible encephalopathy syndrome: dd is acute ischemia/infarct (restricted diffusion). should follow up as PRES (no restricted diffusion) is usually reversible.
6. dd meningioma: hemangiopericytoma
Term
1. terms to use when describing lesion:
2. male breast: pectoralis muscle is ? in male. if palpable mass or breast enlargement
3. core needle biopsy: about ? samples is good.
4. describe calcifications on what views?
1. if pregnant or lactating and mass
1. dd mass pregnancy:
Definition
1. terms to use when describing lesion: use only mass vs. asymmetry: don't say density. recommend clinical follow up.
2. male breast: pectoralis muscle thick in male.
a. if male c/o palpable mass: us
b. if male c/o breast enlargement, may not need to do breast ultrasound. recommend clinical follow up.
3. core needle biopsy: 14 gauge needle in spring loaded device. go parallel to the chest wall to avoid pneumothorax. about 3 samples is good.
4. describe calcifications on: mag views, not standard views.
1. if pregnant or lactating, start with ultrasound.
1. dd mass pregnancy: galactocele, lactating adenoma, fibroadenoma, breast cancer. can fna or core biopsy during pregnancy vs. short term follow up and close clinical observation.
Term
1. images needed for core biopsy:
1. type of biopsy for lymph node:
1. architectural distortion: do ?
1. if non mass enhancement, worry about ?
Definition
1. images needed for core biopsy: picture going through the lesion.
1. type of biopsy for lymph node: usually use fna as there are large vessels in the axilla (can do core biopsy, but not usually done). aim for cortex (not fatty hilum). 25 gauge needle. cortex is definitely enlarged if 4 mm or more.
1. architectural distortion: do spot compression view and then US.
1. if non mass enhancement, worry about dcis
Term
1. posterior to nipple:
1. US descriptors:
a. bad:
a. good:
1. if something is discordant then
Definition
1. posterior to nipple: posterior nipple line
1. US descriptors:
a. bad: irregular (or round) shape and indistinct (or angular, spiculated) margins
a. good: oval shape
1. if something is discordant then re-biopsy or surgical excision.
Term
1. if can see calcs under US then ...
1. if mass already look suspcious on screening, can ...
1. do US of axilla only if ...
1. shrinking breast:
1. can a person get another lumpectomy?
1. definition unifocal, multifocal, multicentric
1. stereotactice biopsy:
Definition
1. if can see calcs under US then can do under us if definitely sure that the calcs seen correlate with the suspicious ones on mmg
1. if mass already looks suspcious on screening, can skip spot views and do US
1. do US of axilla only if palpable problem or complaining of axillary problem.
1. shrinking breast: lobular carcinoma
1. can a person get another lumpectomy? No because cannot re-irradiate on same side. after lumpectomy, pt needs mastectomy.
1. definition unifocal, multifocal, multicentric
a. Unifocal process.
b. multifocal: one quadrant (a "focus")
c. multicentric: more than one quadrant ("multiple centers")
1. stereotactice biopsy:
a. vacuum device. 8 gauge mammotome. take 10 samples. don't want to take all calcs out cuz can't find them again. need to put clip in. do specimen radiograph. with clip, take mmg to show that clip is in place.
Term
dd superscan
Definition
1. metastatic disease
2. hyperparathyroidism (lung, stomach)
3. renal osteodystrophy (prominent ribs end activity aka rachitic rosary bed)
Term
dd testicular torsion
Definition
1. dd testicular torsion: abscess
1. dose for scrotal scintigraphy: Tc pertechnetate 10 mCi
Term
meckel's preparation
Definition
1. Pentagastrin (not available in US): enhances radiotracer up take by ectopic mucosa
2. Cimetidine: blocks release of radiotracer by ectopic mucosa
3. Glucagon: decreases small bowel peristalsis
Term
if tc scan and uptake in thyroid and stomach then
Definition
free pertechnetate.
Term
tumoral calcinosis dd
Definition
1. tumoral calcinosis: peri articular soft tissue calcification. can have sedimentation level
2. parosteal osteosarcoma if involving the bone
3. myositis ossificans:
Term
dd hot spot on sulfur colloid
Definition
1. fnh
2. regenerative nodules
3. if caudrate: budd chiari
3. if quadrate: svc syndrome (only will see this pattern on upper extremity injection, not lower extremity injection)

cold
1. mets, hcc, hemangioma, big cyst, abscess

1. damanged (with heat) rbc for or sulfur colloid spleen for splenules
Term
interventional radiology treatment
Definition
****
1. tx brain avm: glue
1. tx pulmonary avm: coil
1. tx peripheral avm: alcohol. need to put tourniquet to prevent alcohol from going to lungs and causing flash pulmonary edema and can also cause skin necrosis.
a. percutaneous
a. endovascular
1. tx angiodysplasia (angiodysplasia=avm) in the bowel: can coil, but should resect the bowel.
1. tx aneurysm, pseudoaneurysm in vessel that you cannot sacrifice: stent (however, you should not place stent in place of motion so may have to coil places of motion)
1. tx aneurysm, pseudoaneurysm in vessel that you can sacrifice: coil
1. bronchial A bleeding: particles
1. tx of vessel narrowing
a. if diffuse narrowing: stent
a. if focal narrowing: thrombolysis. check cbc, inr. look at prior imaging. if motor deficits (like cannot dorsi or plantar flex), then may not be candidate for thrombolysis. make sure there is no contraindication (stroke < 3 months ago, head trauma < 3 m ago, active bleeding, brain tumor or AVM). embed tip of catheter within clot. give 0.5 tPa 0.5 mg/hr. can also give heparin 500u/hour to prevent pericatheter thrombosis. if fibrinogen < 150 then can turn down tpa (also want to know if patient is bleeding or not bleeding). repeat angiogram late in day if started earlier that day or the next day. stop tpa if get pulse. trial lasts a max of 48 hours. look for underlying focal stenosis (especially if athertosclerotic disease) that can be angioplastied.
1. nephrostomy: give abx. posterior approach below ribs. aim for posterior calyx (if not sure if posterior, can add air and if air in the calyx then posterior because air rises). if bloody, occlude stop cock, check vitals, wait 15 min and see if stopped bleeding. if frank pus then don't do pyelogram because could have sepsis.
1. cholangiogram: give abx prior to procedure. check cbc, inr, prior imaging. use ultrasound guidance and go thru the left hepatic lobe from the subxiphoid region. if benign stenosis then don't stent. if malignant stenosis then can stent.
1. stenosis in renal A
a. ostial (near aorta): due to atherosclerotic disease or Takayasu's. stent
b. mid renal A: due to fibromuscular dysplasia. angioplasty
Term
instead of saying ivp, should say
Definition
ivu (intravenous urogram)
Term
rabbit/bunny ears on cxr
Definition
avm
Term
1. does Left bundle branch block prevent you from going through the right side of the heart?
1. symptoms of pulmonary avm
1. cannot do pulmonary angiogram if pulmonary hypertension is
1. if using crutches can have:
1. if aortic aneurysm:
1. device using to take out catheter in pulmonary A:
Definition
1. does Left bundle branch block prevent you from going through the right side of the heart? no, you can just use a transcutaneous pacer
1. what are some symptoms with pulmonary avm? hemoptysis, hypoxia, paradoxical cerebral embolism/abscess
1. cannot do pulmonary angiogram if pulmonary hypertension is > 70 mmHg (normal pulmonary artery pressure < 20 mmHg)
1. if using crutches can have: axillary A aneurysm
1. if aortic aneurysm: atherosclerotic disease, mycotic aneurysm, syphilis, erlos danlos, marfan (especially aortic root)
1. device using to take out catheter in pulmonary A: amplatz gooseneck snare. enter via the femoral vein. pull the catheter into sheath before coming out.
Term
TIPS (transjugular intrahepatic portosystemic shunt)
1. indications:
2. absolute contra indications to TIPS:
3. relative contraindications to TIPS:
4. what type of stent?
5. what is the pathway?
6. what is normal portosystemic gradient?
7. goal of TIPS portosystemic gradient?
8. if after TIPS, the portosystemic gradient is still high then can
9. tips ultrasound follow up
Definition
TIPS
1. indications: variceal bleeding refractory to medical treatment, intractable ascites due to cirrhosis/portal htn, pre liver treatment as a temporizing measure.
2. contraindications to TIPS: Right sided heart failure, polycystic liver disease, severe liver failure
3. relative contra indications to TIPS: active intrahepatic or systemic infection, severe hepatic encephalopathy, portal vein thrombosis
4. use a covered stent
5. if ascites, can remove ascites prior to procedure. R IJ, svc, RA (shouldn't have LBBB, if have LBBB can do trancutaneous pacing), IVC, R hepatic V, go anterior to the R portal vein
6. normal portosystemic gradient is 5 mmHg
7. goal of TIPS portosystemic gradient is 12 mmHg
8. if after TIPS, the portosystemic gradient is still high
a. further stent dilatation
b. can coil varices if present
c. can put in parallel TIPS (connect L portal vein to left or middle hepatic artery)
9. tips US follow up: baseline, 1m, 3m, 6m, 12m
a. measure velocity proximal, middle and distal tips stent: should be between 90-190 cm/s and not more 50 cm/s from each other or baseline.
Term
when can you angioplasty vs stent and how do you declare success
Definition
1. tx
a. angioplasty if focal, concentric, noncalcified
a. stent if diffuse, eccentric, calcified
2. declare success if
a. move from one abi group to another (though remember diabetics have falsely elevated abi and may need to use toes in place of ankle pressures)
1) rest pain (< 0.4 abi)
1) claudication (0.4-0.8 abi)
1) asymptomatic (> 0.8 abi)
a. gradient becomes < 10 mmHg
a. stenosis is < 30% when measuring from film
Term
left sided ivc
Definition
drains into coronary sinus then RA
Term
1. multiple pulmonary aneurysms:
1. multiple pulmonary avm:
1. ivc filter size:
a. regular ivc filter
a. bird's nest filter
1. should see signs of pregnancy endovaginally when bhcg
Definition
1. multiple pulmonary aneurysms: Behcet's
1. multiple pulmonary avm: multiple hereditary telangiectasias (osler weber rendu)
1. ivc filter size:
a. up to 28 mm for regular ivc filter
a. up to 40 mm for bird's nest filter
1. should see signs of pregnancy endovaginally when bhcg > 2,000
Term
hernias
Definition
1. hiatal: behind heart
2. paraesophageal: a little left of midline
3. Bochdalek's: left posterior
4. Morgagni: right anterior
Term
prevent vasospasm with
Definition
1. nifedipine sublingual
1. nitroglycerin intra arterially 100 ug at site
Term
popliteal artery disease
Definition
1. atherosclerotic
2. cystic adventitial disease
3. popliteal artery entrapment syndrome: look at other side
4. popliteal artery aneurysm:
5. emboli
6. trauma
Term
poems syndrome
Definition
polyneuropathy
organomegaly
endocrinopathy
m protein (monoclonal plasma cell proliferative disorder)
skin changes
Term
flat waist sign
Definition
LLL collapse
Term
scalloping of bone posterior and medial to distal femur
Definition
1. cortical desmoid
1. don't confuse with
a. juxtacortical (can also call this periosteal) chrondroma
a. periosteal osteosarcoma: larger than those with juxtacortical chondroma and in older age group)
Term
split pleura sign
Definition
1. empyema: +split pleura sign (enhance of the inner visceral and outer parietal pleura)
2. effusion from other etiology like chf: no split pleura sign.
Term
hemorrhage in lungs and affects kidneys
Definition
1. microscopic polyangitis
2. goodpasture's
3. Wegener's granulomatosis.
Term
liver and renal masses
Definition
A. liver mass
1. hcc
1. hemangioblastoma: like hcc. high afp. newborn
1. hemangioendothelioma: kasabach merritt syndrome
1. mesenchymal hamartoma: solid and cystic
B. renal mass
1. rcc or Wilm's tumor:
1. mesoblastic nephroma: newborns
1. nephroblastomatosis: can degenerate into wilm's tumor
1. multilocular cystic nephroma
Term
glioma arising from the ependymal cells of the conus medullaris, filum terminale, cauda equina
Definition
myxopapillary ependymoma
Term
cavum septum pellucidum
cavum vergae
Definition
cavum septum pellucidum: anterior
cavum vergae: posterior
Term
sinus lesion: mucous retention cyst, mucocele vs tumor
Definition
1. mucous retention cyst doesn't fill in the entire sinus
2. mucocele: usually low T1 and high T2 with mass effect. peripheral enhancement
3. inverted papilloma or sinonasal carcinoma: homogenous enhancement
Term
aqueductal stenosis
Definition
1. narrowing at the aqueduct of sylvius (between 3rd and 4th ventricles.
-aside: foramen of monro between lateral and 3rd ventricles
Term
Low density on CT, high T2 in bilateral globus pallidus
Definition
1. carbon monoxide poisoning
2. manganese with hyperalimentation
3. cyanide
Term
corpus callosum on axial
1. anterior
2. posterior
Definition
corpus callosum on axial
1. anterior: genu
2. posterior: splenium
Term
basal ganglia
Definition
caudate
putamen, globus pallidus (lenticular nucleus)
substantia nigra
Term
high T1 and T2 in region of pituitary
Definition
rathke's cleft cyst
Term
white matter
1. centrum semiovale
2. corona radiata
Definition
1. centrum semiovale: don't see ventricles. more superior
2. corona radiata: see the lateral ventricles. more inferior
Term
white matter disease in adult and child
Definition
1. adult: progressive multifocal leukoencephalopathy. associated with HIV
2. child: periventricular leukomalacia
Term
diffuse axonal injury
Definition
1. gray white matter junction
2. corpus callosum especially splenium
3. brainstem
4. deep white matter
Term
herpes encephalitis
Definition
1. high T2/FLAIR bilateral medial temporal lobes
2. gyriform enhancement
3. restricted diffusion (high dwi and low adc)
Term
subependymal heterotopia, cortical tubers, mets
Definition
1. subependymal heterotopia: follows gray matter enhancement.
2. cortical tubers: doesn't always follow gray matter. may have low t2 from calcs
3. mets: enhances
Term
herniation
Definition
1. subfalcine: across the falx
2. transtentorial
a. descending (uncal): from cerebral lesion. kernohan's notch (contralateral to the duret hemorrhage), duret hemorrhage (midbrain hemorrhage), effacement of the suprasellar cistern
b. ascending: from cerebellar lesion
3. tonsillar: 5 mm below
Term
dd high T1 in basal ganglia
Definition
1. chronic liver failure
1. hyperalimentation
1. hyperparathyroidism, hypoparathyroidism, pseudohypoparathyroidism, pseudopseudoparathyroidism
1. neurofibromatosis type I: has UBOs (unidentified bright objects)

dd for high T1:

1. met Hg (hemorrhage, amyloid angiopathy)

1. melanin (melanoma mets)

1. lipid (lipoma, dermoid, teratoma)

1. proteinaceous material (colloid cyst, rathke's cleft cyst, ectopic posterior pituitary)

1. minerals (Wilsons disease, hyperalimentation, hepatic encephalopathy, hyperparathyroidism, hypoparathyroidism, pseudohypoparathyroidism, pseudopseudohypoparathyroidism)

1. nf 1 (unidentified bright objects)

1. cholesterol granuloma
Term
dd for high T2 in basal ganglia
Definition
1. hypoxic ischemic encephalopathy, PRES
1. gliomatosis cerebri
1. ADEM
1. neurofibromatosis I: unidentified bright objects (also high T1)
1. Wilson disease, Japanese encephalitis, Leigh disease, Creutzfeldt Jakob disease, carbon monoxide poisoning.
Term
ica angiogram
Definition
1. cervical
2. petrous
3. lacerum
4. cavernous
5. clinoid
6. ophthalmic
7. communicating
Term
cholesterol granuloma
Definition
1. high t1 and t2 in petrous apex
2. =epidermoid
2. dd mucocele
Term
posterior cerebral circulation
Definition
1. vertebral A
a. pica (posterior inferior cerebellar A)
1. basilcar A
a. aica (anterior inferior cerebellar A)
a. superior cerebellar A (CN III between superior cerebellar A and posterior cerebral A)
a. posterior cerebral A
Term
sspe
Definition
1. subacute sclerosing panencephalitis
2 prior measles infection
3. subcortical and periventricular white matter disease
Term
basilar invagination
Definition
1. Chamberlain's line: draw a line from the posterior hard palate to the posterior aspect of the foramen magnum. if the tip of the dens is > 5 mm above this line then there is basilar invagination
2. McGregor's line: another line that can be used to determine basilar invagination.
(platyspondyly is flattening of the skull base, which is different from basilar invagination)
Term
septo-optic dysplasia
Definition
1. absent septum pellucidum
1. small optic chiasm or nerves
1. associated with ectopic posterior pituitary and holoprosencephaly
Term
v2 and v3
Definition
1. v2: maxillary. foramen rotundum (two U's so 2nd division of cnV)
2. v3: mandibular. foramen ovale.
Term
melas
Definition
1. mitochondrial myopathy, encephalopathy, lactic acidosis, and, strokes
2. appearance, disappearance and re appearance of strokes in a non-vascular territory.
1. lactate doublet
1. confirm with muscle biopsy.
Term
olivopontocerebellar degeneration
Definition
1. alcohol
2. phenytoin
3. paraneoplastic syndrome (due to presence of cancer in body)
4. chemotherapy
Term
mitral valve regurgitation
Definition
1. can have LAE
2. due to papillary muscle rupture due to myocardial infarction, rheumatic heart disease, endocarditis, trauma
Term
pulmonary edema
Definition
1. cephalization 12-18 mmHg
2. Kerley B lines < 18 mmHg (increased interstitial markings)
3. alveolar edema > 25 mmHg
Term
mitral regurgitation, mitral stenosis
aortic regurgitation, aortic stenosis
Definition
1. left atrial enlargement
a. +cardiomegaly: mitral regurgitation
a. -cardiomegaly: mitral stenosis
1. aortic enlargement
a. +cardiomegaly: aortic regurgitation
a. -cardiomegaly: aortic stenosis
Term
risk factors for aortic dissection
Definition
1. hypertension
1. annulo aortic ectasia (marfan's, erlos danlos)
1. bicuspid aortic valve
1. aortic aneurysm
1. arteritis
Term
risk factors for aortic dissection
Definition
1. hypertension
1. annulo aortic ectasia ( due to cystic medial necrosis, which is idiopathic or due to Marfan's or Erlos Danlos)
1. bicuspid aortic valve
1. aortic aneurysm
1. arteritis
Term
gainesville heart review
Definition
1. increased arterial flow (left to right shunt)
a. no lae: asd, papvc/scimitar
a. lae: (the lecturer says that difficult to tell these apart)
+aortic knob enlargement: pda
-aortic knob enlargment: vsd
1. decreased arterial flow: right sided obstructions
a. tetralogy of fallot: normal sized heart
a. ebstein's anomaly: large heart
1. venous obstruction: left sided lesion. fuzzy vessels.
a. coarctation of the aorta: mc
a. aortic stenosis
a. IHSS. now called hocm (hypertrophic obstructive cardiomyopathy)
a. cor triatriatum (2 chamber left atrium)
a. hypoplastic left heart syndrome
a. TAPVR below the diaphragm
Term
qp:qs
Definition
ratio of pulmonary blood flow (in main pulmonary A) to systemic blood flow (in ascending aorta)
Term
if ecd or av canal, look for
Definition
down's syndrome. down's syndrome associated with
1. 11 pairs of ribs
2. increased number of ossification centers in the sternal manubrium
Term
if right aortic arch
Definition
think tetrology of fallot, truncus arteriosus, tricuspid atresia
Term
tof
Definition
1. vsd: left to right shunt. +LAE
1. ps (infundibular): decreased arterial flow
1. over riding aorta
1. rvh
-if predominant PS: present early. decreased pulmonary flow.
-if predominant vsd: present later. lae.
Term
concordance vs discordance
Definition
A. concordance
1. situs solitus: left aortic arch, left heart apex, left stomach bubble
1. situs inversus: right aortic arch, right heart apex, right stomach
B. discordance
a. situs solitus with dextroversion: left arch, right ventricular, left stomach
a. situs inversus with levoversion (remember perversion): right arch, left ventricular apex, right stomach bubble
-situs solitus/inversus is for below diaphragm.
-dextroversion/levoversion is for heart
Term
surgical procedures for congenital heart disease
Definition
1. blalock taussig shunt: connect subclavian A to pulmonary A for tof
1. modified blalock Taussig: gore tex graft connects subclavian A to pulmonary A
1. rashkind: atrial balloon septostomy for transposition
1. mustard and senning: atrial septectomy and baffle for transposition
1. Rastelli connect RV to Pulmonary artery for transposition
1. fontan: connect RA to pulmonary A for tricuspid atresia
1. arterial switch (jatene): for transpositions
1. norwood: 3 stages for hypoplastic left heart.
Term
where do the outer/middle ear structures meet the inner ear?
Definition
outer/middle ear structures meet inner ear at the oval window
Term
anatomy of temporal bone
Definition
1. eac:
1. scutum divides eac and middle ear
a. medial to scutum: epitympanum (prussak's space is the lateral aspect of the epitympanum)
1. tympanic membrane
a. pars tensa lower 2/3
a. pars flacida upper 1/3
1. middle ear cavity: divided into
a. epitympanum (malleus head, incus): above eac (external auditory canal)
a. mesotypanum: at eac (adjacent to the tympanic membrane)
a. hypotympanum. below eac. doesn't have ossicles
1. aditus ad antrum: connects to mastoid air cells (no bony septations)
1. stapes sits on oval window.
1. oval window: at neck of goose on coronal.
1. round window: receives mssg (seen on same image of oval window)
1. glomus tympanicum: at the cochlear promontory.
1. cochlea is anterior. cochlea should have 2.5 turns. basal turn is the most prominent.
1. lower jaw of the gator on coronal: tympanic segment of the facial nerve.
1. crista falciforme: eroded if lesion in IAC (near head of the goose)
1. IAC: 7 up coke down.
a. anterior superior: CN 7
a. anterior inferior: cochlear N
a. posterior superior: superior vestibular N
a. posterior inferior: superior vestibular N
a. Bill's bar: separates CN 7 and superior vestibular N
a. crista falciforme (aka falciform crest, aka transverse crest) separates posterior superior and posterior inferior
1. haller cells: along inferior medial margin of the orbit and can obstruct osteomeatal unit.
Term
optic nerve sheath complex
Definition
optic nerve sheath complex: optic nerve and perioptic nerve sheath
Term
if lymph node superficial to sternocleidomastoid muscle, look for primary in
Definition
if lymph node superficial to sternocleidomastoid muscle, look for primary in skin or parotid, not deeper
Term
dd for breast calcifications
Definition
1. infiltrating ductal carcinoma
2. dcis
Term
dd of spiculated breast mass
Definition
1. infiltrating ductal carcinoma
2. radial scar
3. fat necrosis
4. scar
(fibroadenoma should not be spiculated)
Term
if large group of worrisome calcifications
Definition
consider infiltrating ductal carcinoma in addition to dcis.
Term
skin thickening breast
Definition
1. mastitis
2. inflammatory breast cancer."p'eau dorange"
Term
quadrant that can be missed on breast and what to do
Definition
1. quadrant that can be missed: upper inner quadrant
2. do cleavage views to visualize the upper inner breast
Term
breast mri: chest wall invasion if
Definition
if enhancement extends into chest wall
Term
birads of developing fat necrosis
Definition
birads 2 or 3
Term
dd for somewhat worrisome mass breast mass
Definition
1. idc
2. fibroadenoma
Term
papilloma
1. how perform ductogram
2. what if not seen on mmg and ultrasound, but only seen on ductogram?
Definition
1. ductogram: 0.1-0.2 cc with 31 gauge needle on tuberculin syringe (this is the way she does it)
1. how to localize if only seen on ductogram
a. surgeon would put in blue dye in and try to remove area of blue dye
a galactogram with contrast to make sure in correct area and blue dye for surgeon
a. wire localization after ductogram
Term
if mmg and us negative. if mri postive, can do
Definition
2nd look ultrasound
Term
views to look for layering of milk of calcium
Definition
do cc and lateral view (not mlo)
Term
dd for axillary lymph node calcifications
Definition
1. old granulomatous disease
1. gold therapy for rheumatoid arthritis
1. silicone from implants or injections
Term
when mmg a pregnant woman who needs breast work up
Definition
1. perform US first
1. if need mmg, discuss radiation and possibility of milk fistula if biopsy late in pregnancy
Term
shrinking breast
Definition
invasive lobular carcinoma
Term
intralobar vs extralobar sequestration
Definition
1. extralobar has own covering. presents earlier.
2. intralobar presents with infection. presents later.
Term
anterior mediastinal mass.
1. if calc and absence of fat
2. if calc and fat
Definition
1. if calc and absence of fat: thymoma
1. if calc and fat: teratoma
Term
hilar convergence vs hilar overlay sign
Definition
1. hilar convergence: if see vessels converge to pulmonary A and not mass then mass in hilum.
2. hilar overlay sign: if mass superimposes on vessels then mass is in hilum and is not a large pulmonary A
Term
multiple pulmonary halo sign
Definition
1. invasive aspergillosis
2. hemorrhagic met
3. vasculitis like Wegener's (now called C ANCA positive vasculitis
Term
mucoid impaction dd
Definition
1. asthma
2. allergic bronchopulmonary aspergillosis
3. cystic fibrosis
Term
lipomatous hypertrophy of the interatrial septum: brown or yellow fat on pet?
Definition
1. lipomatous hypertrophy of the interatrial septum is brown fat so it has high activity on pet
2. don't confuse lipomatous hypertrophy of the interatrial septum with mets.
Term
dd of crazy paving pattern
Definition
1. protein alveolar proteinosis
2. lipoid pneumonia
Term
endobronchial lesion dd
Definition
1. adults: carcinoid (enhances a lot), salivary gland tumor, papilloma, squamous cell carcinoma, lymphoma
2. child: carcinoid, salivary gland tumor, papilloma, foreign body, inflammatory polyp

other dd: hamartoma (-10 HU, low attenuation
Term
pleural thickening: mesothelioma vs mets
Definition
fissural and medial involvement indicate mesothelioma (not mets)
Term
cardiac myxoma
Definition
1. myxoma more likely in LA
1. calcified myxoma more common in the RA
1, usually attached to interatrial septum at fossa ovalis
Term
another name for BAC
Definition
in situ adenocarcinoma
Term
parital vs complete absence of pericardium: which is more common?
Definition
partial absence of percardium is more common, but more dangerous because risk of herniation
Term
extramedullary hematopoiesis can have what density
Definition
fat density
Term
bronchiectasis dd
Definition
1. abpa (allergic bronchopulmonary pneumonia)
2. cystic fibrosis
3. mai (lady windermere's)
4. kartagener's syndrome
5. endobronchial problem (mass, mucous)
Term
large lesion near heart. s/p cardiac bypass
Definition
saphenous vein bypass graft aneurysm
Term
dd mosaic attenuation
Definition
1.+air trapping (hypodense regions do not increase in density on expiratory phase): small vessel disease like asthma, hypersensitivity pneumonitis, bronchiolitis obliterans
2. no air trapping (the hypodense areas become more dense on expiratory phase): vascular disease like chronic PE.
Term
constrictive pericarditis
Definition
1. constrictive pericarditis:
a. large svc and larve ivc.
a. thick pericardium measuring >= 4 mm (normal < 4 mm)
a. tx: surgical pericardial stripping. large svc, ivc

2. restrictive cardiomyopathy:
a. thickened myocardium
a. due to sarcoid, amyloid, hemochromatosis, glycogen storage disease, lymphoma
a. tx: medical management for underlying disorder. heart transplant for those refractory to medical management.
Term
elevated peak systolic in ica: dd
Definition
1. ipsilateral proximal stenosis to site of interrogation
2. contralateral stenosis.
Term
bilateral enlarged echogenic kidneys
Definition
1. aids nephropathy
1. acute tubular necrosis
1. autosomal recessive polycystic kidney disease in infants
1. leukemia
1. amyloid/multiple myeloma
--------
1. acute glomerulonephritis/interstitial nephritis
Term
follow up of microlithiasis testicular
Definition
can be clinical or with ultrasound (no consensus)
Term
signs of carotid stenosis
Definition
1. > 70% stenosis if
a. peak systolic velocity is > 230 cm/s
a. ICA/CCA ratio > 4
2. spectral broadening
3. turbulance
Term
If ECA has low resistance waveform, stenosis is in?
Definition
1. high resistance waveform: diastole at or below baseline. e.g. ECA
2. low resistance waveform: diastole above baseline. e.g. ICA.
-if ECA has low resistance waveform (should have high resistance waveform) then there is internalization of the eca and there is stenosis of the ica.
Term
post transplant fluid collection
Definition
2d: hematoma/seroma
2w: urinoma
2m: lymphocele
anytime: abscess
Term
follow up of molar pregnancy
Definition
need to follow b hcg after evacuation of molar pregnancy
Term
retroperitoneal soft tissue (~thickening around aorta): dd
Definition
1. retroperitoneal fibrosis
1. lymphadenopathy or lymphoma (elevates aorta from spine aka moves aorta anteriorly)
1. hematoma (look for abdominal aortic aneurysm
--------------)
1. horseshoe kidney
Term
cystic changes in the mediastinum testis
Definition
1. tubular ectasia of the rete testis
Term
arterialization of the vein
Definition
1. arterialization of a vein: AVF
2. you want to distinguish an AVF (arterialization of the vein) from a pseudoaneurysm (yin yang appearance) because you don't want to inject thrombin in an AVF.
Term
intussusception
Definition
prior to reduction, do lateral decubitus to look for free air (free air is contraindication to reduction)
Term
bilateral enlarged cystic ovaries
Definition
bilateral enlarged cystic ovaries (theca lutein cysts)
hyperstimulation syndrome
Term
cervical cancer:
1. if hydronephrosis:
2. if extension to lower 1/3 of vagina
Definition
cervical cancer: not surgical candidate if stage III. FIGO classification.
1. IIIA: extension to lower 1/3 of vagina
2. IIIB: hydronephrosis
Term
intratesticular tumor with onion skin pattern
Definition
1. epidermoid cyst
a. onion skin pattern
a. can have peripheral calcifications
2. dd for epidermoid cyst: teratoma
3. tx epidermoid cyst: surgical excision because US appearance is not pathognomonic.
Term
branching hyperechoic regions with shadowing in liver: dd
Definition
1. venous gas: microbubbles, which move on real time imaging
2. biliary gas
3. stones in bile ducts
4. hepatic A calcifications (less common)
Term
endometrial thickening (hyperechoic endometrium is thickened): dd
Definition
1. endometriral ca
2. endometrial hyperplasia
3. polyp: can see with sonohysterography
4. endometritis
5. pregnancy
6. gestational trophoblastic disease
Term
hypo-echoic region in myometrium: dd
Definition
dd for hypoechoic area in myometrium
1. fibroid
1. adenomyosis
Term
what keeps pda open/closed?
Definition
1. prostaglandin keeps pda open (P and P)
2. indomethacin closes pda
Term
radiation can cause
Definition
radiation can cause sarcomas
Term
how to distinguish jia from hemophilia?
Definition
mri:
1. jia: no blood products
2. hemophilia: shows blood products. if low t1 and t2 then have hemosiderin.
Term
amorphous calcification near shoulder (this case was near medial proximal diaphyseal femur)
Definition
1. hydroxyapatite deposition disease
1. can inject anesthetic and corticosteroid.
Term
renal osteodystrophy
Definition
1. osteoporosis/osteomalacia:
1. hyperparathyroidism: widened SI joint and symphysis pubic, brown tumors
1. metastatic calcification around 5th PIP joint
1. osteosclerosis: rugger jersey spine
Term
wegener's granulomatosis now called
Definition
c anca positive vasculitis
Term
tx of avulsion of medial epicondyle with fragment within the joint
Definition
surgery
Term
dd foot problem in child
Definition
1. rockerbottom foot (congenital vertical talus): dorsal dislocation of the navicular (not yet ossified) on the head of the talus. talus and calcaneus are not parallel. causes flatfoot.
2. clubfoot (talipes equinovarus): talus and calcaneus are parallel. causes persistant cavus deformity.
Term
metastatic vs osteoporotic compression fx
Definition
nitrogen gas is in osteoporotic compression fx not mets
Term
deep sulcus sign
Definition
1. deep sulcus sign on lateral knee radiograph: abnormal depression in the lateral distal femoral condyle (lateral condyle should not be deeper than the medial condyle)
2. deep sulcus sign is worrisome for acl tear
Term
dd scalloping of posterior aspect of distal femur
Definition
1. juxtacortical chondroma
2. periosteal osteosarcoma
3. periosteal chondrosarcoma
4. cortical desmoid (typically medial posterior region of distal femur)
Term
thymus displace laterally by medial air
Definition
pneumomediastinum
Term
r aortic arch
Definition
right aortic arch
1. tetrology of fallot
2. truncus arteriosus
3. tricuspid atresia
4. vsd
Term
if imperforate anus, think about
Definition
if imperforate anus, do ultrasound of spine to look for tethered cord (as part of currrarino triad-this examiner put it with curraino triad).
1. vacterl: vertebral anomalies, anal atresia, te fistula, esophageal atresia, radial, renal, limb anomalies
2. currarino triad: partial sacral agenesis (like scimitar sacrum), presacral mass (like teratoma, meningocele), anorectal anomaly (like imperforate anus)
Term
if venous infarction then look for hypercoagulable states
Definition
hypercoagulable states
1. dehydration
1. protein C deficiency
1. protein S deficiency
1. antithrombin III deficiency
1. antiphospholipid syndrome
etc.
Term
density in lungs surrounded by air trapping
Definition
bronchial atresia: density in lungs surrounded by air trapping
Term
caterpillar stomach
Definition
hypertrophic pyloric stenosis
Term
hyperechoic pancreas on US
Definition
dd fatty pancreas
1. cystic fibrosis
1. schwachman diamond syndrome
1. pearson syndrome
Term
if necrotizing enterocolitis, look for signs of free air
Definition
1. rigler's sign (air on both sides of bowel)
1. football sign (soccer ball in center of abdomen)
1. gas outlining the falciform ligament or liver edge
Term
if multiple dialted bowel loops in 40 day old
Definition
1. intussusception
1. stricture from prior nec
1. adhesions from prior surgery
Term
incomplete fractures
Definition
incomplete fractures
1. plastic bowing fracture: a smooth bend in the shaft of the bone
1. torus(aka buckle) fracture: compression side bulges out.
1. greenstick: fracture on tension side which does not extend to other side.
Term
lytic lesion in skull of child
Definition
1. langerhan's cell histiocytosis
1. epidermoid cyst
1. hemangioma
1. metastasis
Term
opacity within trachea: dd
Definition
1. membranous croup (aka bacteral tracheitis) due to staph or strep
1. foreign body in trachea
Term
intussusception reduction
Definition
1. check for free air or peritonitis because this is a contra indication to radiographic reduction. IV, surgery consult, 3 tries, 3 minutes each. if no reduction then surgery.
1. contrast reduction: don't use barium. 3 feet above patient.
1. air insufflation: place pt in lateral decubitus position, insufflate up to 120 mmHg.
Term
mri
1. black blood
2. bright blood
Definition
1. black blood: spin echo
2. bright blood: gradient echo
Term
if lung between aorta and pulmonary artery
Definition
1. if lung between aorta and pulmonary A: absence of the percardium
2. partial absence is more common than complete absence
3. if partial absence is more dangerous because can lead to herniation and strangulation of left atrial appendage.
Term
osler weber rendu syndrome
Definition
1. osler weber rendu syndrome (aka hereditary hemorrhagic telangiectasia)
1. symptoms:
a. parodoxical emboli: stroke and abscess
a. hemoptysis
a. shortness of breath
Term
if you see a 3D MRI image, just say
Definition
post processing image
Term
alcapa
Definition
1. alcapa: anomalous left coronary artery off pulmonary A
2. can cause cardiomyopathy
Term
delayed cardiac enhancement
Definition
1. infarct:
a. subendocardial or transmural
a. vascular pattern
1. amyloid
a. subendocardial
a. diffuse
1. myocarditis
a. subepicardial
a. diffuse
1. sarcoid
a. patchy nodular (amyloid and myocarditis can also be patchy)
1. cardiac noncompaction: this is not enhancement, but can look like enhancement. it is lack of compaction of the subendocardial myocardium. can cause arrhythmia, heart failure and thrombus leading to death. if more than 2/3 is not compacted then you have non compaction.
Term
how to perform aortogram
Definition
1. access femoral A
2. place tip of catheter at aortic root
3. perform at least two views including LAO
Term
ductus diverticulum (aka ductus bump)
Definition
ductus diverticulum/bump
1. anterior medial descending aorta
1. smooth and small
1. at aortic isthmus (site of obliterated ductus arteriosus)
Term
causes of aortic dissection
Definition
1. hypertension
1. traumatic
1. atherosclerosis e.g. penetrating ulcer
1. marfan's or erlos danlos
Term
precaution to be taken when coiling pulmonary avm
Definition
when coiling pulmonary avm: you need to have a person at the head of the table compressing the carotid to prevent any coils from going to the brain
Term
sma to ima connections
Definition
arc of riolan is more medial than marginal artery of drummond (along left colon)
Term
if focal stenosis in iliac A
Definition
1. evaluate distal peripheral flow to make sure that improvement in stenosis would help flow to foot.
2. can give 100 ugram of ntg to see if there is improvement in the gradient.
3. access the contralateral limb so that there is access to both iliac A (e.g. in case an enlargement in the iliac A causes a problem in the other iliac A)
Term
tx of left subclavian A stenosis (with subclavian steel)
Definition
ballloon expandable stent not self expanding stent
Term
endoleak classification
Definition
IA and IB: proximal and distal attachment site
II: fills from collaterals (IMA or lumbar)
III: defect in graft
IV: graft porosity
V: endotension
Term
proper hepatic vein with corkscrew pattern of branches
Definition
1. cirrhosis: proper hepatic vein with corkscrew pattern
2. causes of cirrhosis: alcohol, hepatitis BC,
3. complications of cirrhosis:
a. portal htn
a. hcc (has hepatic A blood flow so can treat with chemoembolization).
a. mets are harder to treat because their main blood supply is from the portal vein.
Term
tx splenic A aneurysm
Definition
-place coils pre and post aneurysm to prevent back bleed (fills from the other direction).
-symtomatic lesions lesions and lesions in women of childbearing age should be treated.
-asymptomatic lesions < 60 years and > 2-3 cm should be treated.
Term
mesenteric mass: dd
Definition
mesenteric mass dd
1. metastatic disease
2. carcinoid (high activity on octreoscan)
3A. desmoid tumor: seen in those with Gardner's syndrome (familial adenomatous polyposis, cranial osteomas and desmoid tumor)
3B. fibrosing mesenteritis: pts don't have Gardner's syndrome, but has something that looks like desmoid tumor
4. lymph nodes: those with low attenuation lymph nodes (TB, MAI, Whipple's) or lymphoma
5. abdominal mesothelioma
Term
if classic ct findings of hcc and elevated afp, biopsy?
Definition
don't need to bioipsy
Term
hcc vs regenerating nodules on mri
Definition
1. hcc washes out on portal venous phase to less than normal liver. high T2 (mets also have high T2)
1. regenerating nodules washes out on portal venous phase to normal liver. low T2
Term
tx of liver adenoma
Definition
1. tx of liver adenoma: surgery
2. malignant potenial and bleeding
3. adenoma can have fat and hemorrhage
Term
dd cystic liver lesions
Definition
1. cystadenoma or cystadenocarcinoma
2. hydatid cyst/echinococcus: daughter cysts (cyst within cyst appearance)
3. hepatic cyst
4. abscess
Term
type of colitis in
1. HIV: cmv
2. immunocompromised:
Definition
colitis
1. HIV: cmv colitis
2. immunocompromised: pseudomembranous colitis
Term
1. coffee bean shape
2. LUQ
Definition
1. sigmoid volvulus: coffee bean shape (one line). dilated distal bowel.
2. cecal volvulus: points to LUQ. no cecum visualized. only diagnosis if > 10 cm. no dilated distal bowel.
Term
fnh
Definition
1. can use eovist to help characterize focal liver lesions on mri
2. fnh: homogeneously enhances
3. high central scar t2
4. fnh hold onto contrast
Term
linnitus plastica
Definition
1. breast or lung
2. lymphoma
Term
if multiple liver masses with peripheral enhancement
Definition
1. hypervascular mets
2. ct mri: choriocarcinoma, thyroid, melanoma, renal, islet cell tumor
Term
radiotracer in lungs on bone scan
Definition
1. pulmonary microlithiasis
2. metastatic calcification
a. hypercalcemic states like hyperparathyroidism
a. rta, type II
a. hypervitaminosis D
a. milk alkali syndrome
a. sarcoid
a. diffuse tumors especially myeloma
Term
if hyperthyroid and high RAIU then dd
Definition
hyperthyroid and high RAIU
1. graves
1. rebound phase of subacute thyroiditis (painless) or rebound phase of Dequervain's subacute thyroiditis (painful)
1. iodine deficiency
1. congenital organification defect (detect congenital organification defect with perchlorate washout test)
Term
tc sestamibi
Definition
10 rest and 30 stress
Term
1. what test is performed daily in nuclear medicine?
2. cardiac blood supply
3. if hot in
a. quadrate
a.
Definition
1. daily uniformity

2. cardiac blood supply:
a. septal, anterior, apex: left anterior descending A
a. lateral: L circumflex A
a. inferior: right coronary A
3. if hot in
a. quadrate: svc syndrome
a. thyroid and abdominal organs (liver, spleen, kidneys): right to left shunt
a. thyroid and stomach: free pertechnetate
Term
if see brain on nucs
Definition
1. call it brain perfusion or metabolism scan
2. areas affected
a. parietotemporal: Alzheimer's disease. Amyvid targets beta amyloid plaque in brain.
a. frontal: Pick's disease
a. Lewy body disease: occipital lobes
Term
if cardiac fixed defect beats
Definition
1. cannot be infarct.
2. then look at source images.
3. dd
a. hot liver defect
a. attenuation defect
Term
1. cluster of small bowel loops (cocooning) with distorted mesenteric vessels:
1. Ulcerative colitis
1. dilated small bowel:
1. mr spectroscopy
1. pyelonephritis vs scar on dmsa scan
1. cocooning
Definition
1. cluster of small bowel loops with distorted mesenteric vessels: internal hernia
1. UC has fibrofatty proliferation
1. dilated small bowel:
a. dynamic: stair step fluid fluid levels
a. adynamic: ileus.
1. mr spectroscopy
a. NAA: marker of neuronal health
a. choline: cell marker (can be compared to creatine)
a. lactate and lipid: cell destruction
b. good (NAA) in middle at around 2, the bad (choline) at around 3, the ugly (lactate, lipid) at around 1.
b. high grade tumor: the bad and ugly
b. low grade tumor: the bad
b. radiation necrosis or stroke: the ugly
b. ms: low good
1. pyelonephritis vs scar on dmsa scan
a. wedge shaped: pyelonephritis
a. scar is not necessarily wedge shaped
1. cocooning dd: TB peritonitis, meconium peritonitis (neonates), sclerosing peritonitis, calcified peritoneal carcinomatosis, pseudomyxoma peritonei, peritoneal mesothelioma
Term
evaluation of pediatric patient with uti
Definition
1. can evaluate initially with vcug then fu with dmsa
1. prophylactic antibiotics are out of vogue now. if no damage seen on dmsa, reflux exams are now being discouraged.
Term
rim sign
1. morphine?
2. significance.
Definition
rim sign
1. do not give morphine to rim sign
2. rim sign means may be gangrenous cholecystitis. call surgeon.
Term
multiple small defects on perfusional study. cxr normal. no ventilation defects. dd?
Definition
fat emboli, tumor emboli, amniotic emboli
Term
octreoscan and mibg for
Definition
A. octreoscan 6 mCi at 4 and 24h. kidney and spleen hot.
1. islet cell tumor especially: carcinoid gastrinoma
2. carcinoid
B. mibg. 10 mCi at 2d. liver and heart hot.
1. pheochromocytoma
2. neuroblastoma
Term
colon hot on bone scan: dd
Definition
1. prior imaging study like cardiac (mibi) done the day before
2. vesicocolonic fistula (rare)
3. coincidental GI bleed at time of injection (rare)
Term
tx for grave's disease
Definition
1. I 131 10 mCi is treatment of choice in Grave's disease.
1. 90% efffective with just one dose. can tx again in 3 months.
1. you may be hypothyroid and need synthroid the rest of your life.
1. other treatments: can have ptu or surgery, but treatment of choice is I 131.
1. I 131 doesn't cause cancer. can have children. doesn't affect health of future children.
1. go over precautions.
a. careful with urine and stool for 1 week (flush twice, wash hands well)
a. careful with saliva for about 1 week. (no kissing, use condoms, use plastic utensils/cups/plates)
a. careful with eating utensils for about a week
a. distance rule
Term
A. tc vs indium labelled wbc
B. defn: laceration, fracture, shattered
Definition
A. tc vs indium labelled wbc
1. if see bladder then tc labelled wbc
2. if don't see bladder then indium labelled wbc.
B. definition
1. laceration
1. fracture: goes to other side
1. shattered: multiple fractures
Term
gastric emptyng
Definition
1. there is a "national standard" for gastric study
1. University of florida uses normal gastric emptying > 40% at 4h for semisolids. (we use 80% liquids at 4 hours. this is substandard procedure)
Term
cardiac fdg pet viability study
Definition
cardiac fdg pet
1. flow markers: nh3 and rubidium
1. compare to fdg
1. if cold defect on flow and radiotracer on fdg then hibernating myocardium.
1. if cold defect on flow and fdg then scar.

aside:
1. feed heart. give glucose
2. starve cancer
Term
lytic lesions on ct with normal on bone scan dd
Definition
1. multiple myeloma / plasmacytoma (in older patient
2. langerhans cell histiocytosis (in young patient)
3. other (not confirmed): lymphoma (small round blue cell tumor) and renal / thyroid mets
Term
radiotracer in soft tissues on bone scan: dd
Definition
1. myositis ossificans of paraplegia
1. tumoral calcinosis
Term
How can palliate metastatic pheochromocytoma?
Definition
palliation metastic pheochromocytoma. can tx with I 131 90 mCi (not confirmed)
Term
radiation dosimetry report and radiation exposure limits
Definition
1. occupational:
a. total effective dose equivalent: 5 rem/yr
a. skin/extremity: 50 rem/yr
a. lens: 15 rem/yr
1. non radiation workers: 0.100 rem/yr.
1. how do you know what the dose to nonradiation workers is? badge the room.
Term
vq scan
Definition
whole lobe, whole lung, not likely PE.
perfusional defect that matches with cxr: intermediate
vq match: low
triple match: vq and cxr match: low
stripe sign: low
Term
biliary atresia
Definition
biliary atresia
1. tx: kasai procedure before 3 months old.
1. can't diagnose biliary atresia in premature pt.
Term
within what period of seizure do you have to give radiotracer to evaluate intra ictal.
Definition
30 seconds within time of seizure
Term
tumor that can retain radiotracer on bone scan
Definition
neuroblastoma (can have calcifications)
Term
technique for spill
Definition
A. swim:
1. secure area
1. warn others
1. identify the spill/agent (I 131 major cuz volatile (can breathe in) call rso)
1. maintain the area until help arrives.
B. patient: keep patient with spill. give patient booties, gown to put on. bring patient to hot lab for survey and decontamination. check clothing and strip if needed. keep clothing for I 131 10 half lives, which is 3 months). patient can shower if necessary. check RAI to see how much of the dose is still in patient and if need to retreat.
C. spill: put on mask, booties, gown. map out area of contamination with survey meter.
1. if I 131 then need to scrub.
2. if Tc then cover with "chucks" and limit contact for 8 half lives.
Term
1. what do you use to find splenule
2. if bone scan with heart and liver hot
3. if bone scan hot especially in sphenoid bone and other areas:
4. if bone scan with bony expansion and very hot areas:
Definition
1. splenules: heat damaged red cells
2. if bone scan with heart and liver hot then amyloid
3. if bone scan hot especially in sphenoid bone and other areas: polyostotic fibrous dysplasia.
4. if bone scan with bony expansion and very hot areas: Paget's (Mickey mouse in spine diagnostic)
Term
epiphysis open vs closed. abc vs gct
Definition
1. if epiphysis open: abc. when say abc, can also say osteoblastoma. can also say brown tumor
2. if epiphysis closed gct
Term
low t1 and high t2 of hip
Definition
1. early avn, rsd, osteomyelitis, neoplasm, osteoid osteoma in young patient.
1. transient osteoporosis of the hip if plain films show osteopenia of femoral head.
Term
enhancing mass in region of plantar fascia
Definition
plantar fibromatosis
Term
madelung deformity
Definition
madelung deformity
1. bowing of radius
1. associated with many syndromes
Term
1. multiple enchondromas
2. with multiple phleboliths that appear to be in soft tissues
Definition
1. ollier's
2. mafucci's
-25% chance of malignant transformation into chondrosarcoma (more malignant potential in mafucci's compared to ollier's)
Term
looser zones
Definition
looser zones
1. dx: osteomalacia or rickets
1. type of insufficiency fracture
Term
% malignant transformation of paget's
Definition
<1%
Term
if bone has lower signal intensity than muscle on t1
Definition
-if bone has lower signal intensity than muscle then diffuse bone marrow infiltration
1. bone marrow reconversion (if has this pattern, but other listed below are the actual dd)
2. diffuse metastasis
3. severe chronic anemia like thalassemia
4. AIDS
Term
bone infarct and erlenmeyer flask deformity
Definition
1. gaucher's
2. severe chronic anemias like sickle cell disease or thalassemia
(gainesville notes also list metaphyseal dysplasia (Pyle's disease) and fibrous dysplasia
Term
axial migration with ring osteophytes in hip
Definition
1. axial (medial) migration
a. RA
b. if ring osteophytes:
1) AS (axial migration with ring osteophytes is characteristic of AS)
2) burnt out RA with OA
3) old septic joint with OA
2. superior migration is OA
Term
compression fx vertebral body: pathologic?
Definition
1. if see completely normal marrow then it is non-pathologic
1. if see any abnormal marrow (bone lower than muscle on T1) then pathologic fracture e.g. due to multiple myeloma.
Term
dd lucent metaphyseal bands
Definition
1. syphilis
1. rickets
1. scurvy
1. leukemia
1. neuroblastoma mets
-if see osteopenia in child, think of leukemia.
Term
if infection in joint then
Definition
joint space narrowing
Term
growth disturbance of osseous structures and atrophic muscle
Definition
neuromuscular d/o like polio
Term
low t1 and t2
Definition
1. polyarticular: gout, pvns, hemophilia, amyloid
2. monoarticular: synovial osteochondromatosis (same as synovial chondromatosis)
Term
10 signs of RA in the cervical spine
Definition
1. odontoid erosion
1. atlantoaxial subluxation
1. basilar invagination
1. disc narrowing lacking significant osteophytes
1. endplate irregularity at multiple levels
1. endplate sclerosis
1. subluxation at multiple levels
1. erosion and narrowing of facet joints
1. spinous process erosion
1. osteoporosis
Term
synovial sarcoma
Definition
1. soft tissue mass near joint.
1. may have cystic portions with enhancing solid portions.
1. does not arise from synovium
dd: nerve sheath tumor, complicated ganglion
Term
pattern of syndesmophytes (ossification of the annulus fibrosis) on vertebral bodies
Definition
1. asymmetric: PsA, Reactive arthritis, (infection is unilateral)
2. symmetric (as, ibd, hyperparathyroidism)
Term
if septic joint and aspiration negative
Definition
tb
Term
dd for lamdoid defect in neurofibromatosis
Definition
epidermoid cyst, leptomeningeal cyst.
Term
dd for testicular torsion
Definition
1. trauma
1. missed torsion
1. orchitis
1. torsion of appendix testis
-----
1. acute epididymitis,
Term
necrotizing enterocolitis
1. tx
2. look for
Definition
nec
1. bowel rest and abx
2. free air
Term
cystic fibrosis
Definition
1. pancreatitis
1. diabetes
1. gallstones
1. chronic pulmonary infections
1. bronchiectasis
1. infertility
1. osteoporosis
1. electrolyte imbalances
Term
cause of perventricular leukomalacia
Definition
brain injury prior to 33 weeks
from ischemia (however infection, inflammation also probably plays a role)
Term
pulmonary edema in child: dd
Definition
coarcation of aorta, double aortic arch, congenital aortic stenosis, hypertrophic obstructive cardiomyopathy (hocm), alcapa (aberrant left coronary artery from the pulmonary artery), glycogen storage (Pompe), cardiomyopathy, congenital mitral stenosis, left atrial myxoma, pulmonary vein obstruction
Term
caudothalamic groove
Definition
germinal matrix
Term
if absent and distortion of zone of provisional calcification
Definition
rickets
dd: hypophosphatemia
Term
if have problem with kidney (also skin, liver, gi tract) then can have
Definition
rickets
Term
eg now called
Definition
langherhan's cell histiocytosis
Term
type of lethal osteogenesis imperfecta
Definition
type II osteogenesis imperfecta is lethal
Term
sacral dysgenesis
Definition
1. sacral dysgenesis is a form of caudal regression complex
1. associated with insulin dependent.
1. look for ectopic or imperforate anus
1. gu abnormalities
Term
metaphyseal lucency dd by age
Definition
1. 1d: syphilis and other torch infections
2. 1y: rickets, scurvy
3. 2y: neuroblastoma
4. 6y: leukemia
Term
dd for typhlitis
Definition
1. typhlitis ("typhl-" means "blind sac"): seen in transplant patients.
2. pseudomembranous colitis
3. diverticulitis
Term
dd duodenal hematoma
Definition
pancreas and mesentary hematoma
Term
renal hemosiderosis dd
Definition
sickle cell disease
thalassemia
paroxysmal nocturnal hemoglobinuria
mechanical valves causing chronic hemolysis
Term
1. medullary nephrocalcinosis
2. cortical nephrocalcinosis
3. cause of both cortical and medullary nephrocalcinosis
Definition
1. medullary nephrocalcinosis: hypercalcemic states like hyperparathyroidism, medullary sponge kidney, rta (type I), lasix in kids, hypervitaminosis D, milk-alkali syndrome, nephrotoxic drugs
2. cortical nephrocalcinosis: chronic glomerulonephritis, acute cortical necrosis, Alport's syndrome, rejected renal transplant
3. both cortical and medullary nephrocalcinosis: oxalosis
Term
1. outpouching in the fallopian tubes
2. when perform hsg
Definition
1. salpingitis isthmicia nodosa
2. day 7-10d, consent them, use hsg catheter.
Term
cystocele and rectocele
Definition
cystocele, rectocele below pubococcygeal line
Term
most important for ovarian torsion
Definition
large ovary (still suspect even if flow)
Term
fat containing mass in region of adrenal gland
Definition
myelolipoma
angiomyolipoma
liposarcoma
Term
omental caking dd
Definition
1. metastasis (ovarian, GI, pancreas, GB)
2. lymphoma
3. tb
4. mesothelioma
Term
cyst and small kidneys: dx?
Definition
cyst and small kidneys: dx?
1. answer: acquired renal cystic disease (90% get this after 5-10 years of dialysis)
2. acquired renal cystic disease has risk of rcc so need follow up.
Term
adenomyosis
Definition
thickening of junctional zone > 12 mm
Term
cystic mass renal that classically herniates into renal pelvis
Definition
multilocular cystic nephroma
Term
1. both kidneys fused and on one side.
2. enlarged ovaries with large cysts, pleural effusion, ascites
3. if gfr < 30 and mri with contrast ordered
Definition
1. cross fused ectopia
2. ovarian hyperstimulation syndrome
3. consider alternative exam that does not need contrast like US or CT, use lowest amount of contrast necessary, avoid group 1 GBCAs (gadolinium based contrast agents), inform referring physician and patient of risks and proceed only if both agree to risks. risk fo nsf (nephrogenic systemic fibrosis)
Term
filling defect in uterus on hsg
Definition
blood, fibroid, polyp, asherman (synechiae)
Term
retroperitoneal fibrosis vs lymphoma
Definition
1. lymphoma pushes the aorta anteriorly
2. causes of retroperitoneal fibrosis
a. idiopathic (Ormond's disease)
a. medications like methysergide, ergotamine)
a. radiation therapy
a. retroperitoneal blood, infection ,urine
a. peri aneurysmal fibrosis from AAA
a. malignancy
Term
if hu 40-50 on noncontrast CT
Definition
blood
Term
stretch of the urethra and trauma
Definition
1. stage I urethral injury. tx bladder catheter
1. anatomy of the urethra: distal to proximal
a. penile urethra. anterior urethra.
a. penoscrotal junction
a. bulbous urethra. anterior urethra.
a. membranous (narrowed) at urogenital diaphragm. posterior urethra.
a. prostatic (has verumontanum). posterior urethra
Term
if bilateral adrenal lesions
Definition
1. mets: look at chest for tumor
1. pheochromocytoma 10% bilateral
1. lymphoma
1. hemorrhage
Term
cervical cancer and hydronephrosis
Definition
cervical cancer stage IIIb
Term
mri with contrast in person with gfr 35
Definition
1. consider alternative exam that does not need contrast like US or CT
1. use lowest amount of contrast necessary
1. avoid group 1 GBCAs like omniscan (gadolinium based contrast agents)
1. inform referring physician and patient of risks and proceed only if both agree to risks.
1. risk fo nsf (nephrogenic systemic fibrosis)
Term
bx of kidney. what should send for?
Definition
if suspect lymphoma need to send for flow cytology.
Term
bilateral solid ovarian masses with blood flow
Definition
fibromas
thecomas
fibrothecomas
krukenburg
lymphoma
endometrioma (this doesn't have flow)
Term
nutcracker syndrome
Definition
nutcracker syndrome
1. left renal vein is compressed between sma and aorta. can have renal varices and hematuria.
2. tx: stent
Term
glomus tympanicum
Definition
1. glomus tympanicum is on cochlear promontory
1. dd: aberrant carotid A. if you think that it is glomus tympanicum, look at carotid A lateral wall to make sure that it is intact.
Term
non aggressive lesion in petrous apex
Definition
1. know it is not in cerebellopontine angle because doesn't deform pons.
1. cholesterol granuloma (high on T1 and T2)
1. mucocele (low on T1 and high on T2)
1. congenital cholesteatoma/epidermoid tumors
1. petrous apicitis

--------------------
1. aneurysm of petrous portion of ICA
1. chondrosarcoma, osteosarcoma
1. meningioma
1. lymphoma, leukemia, plasmacytoma, mets
1. non aerated petrous apex mimicking a lesion
Term
dd sinus mass
Definition
1. mucocele (entirely fills the sinus, no air bubbles)
1. inverted papilloma (usuallly in maxillary sinus and cerebriform pattern). tx: wide resection. has malignant potential
1. polyposis (usually many sinuses affected)
1. antrochoanal polyp
1. sinonasal carcinoma: aggressive
Term
globe lesions dd
Definition
globe lesion in a child dd

1. retinoblastoma: +calcs. normal size globe.
a. trilateral retinoblastoma: bilateral retinoblastoma and pineal tumor
b. quadrilateral retinoblastoma: bilateral retinoblastoma, pineal lesion and suprasellar tumor.
2. persistent hyperplastic primary vitreous (PHPV) : no calcs. small globe. retrolental soft tissue and stalk "Martini glass".

3. Coats disease: no calcs. normal size globe. retinal telangiectasias. V shaped retinal detachment.

4. retinopathy of prematurity: bilateral micro-ophthalmos with h/o prematurity due to prolonged oxygen therapy.

5. toxocariasis: no calcs. normal size globe. enhancing lesion in posterior aspect of globe due to granulomatous reaction. history of contact with cats/dogs
Term
dd benign lymphoepithelial cysts
Definition
1. Associated with AIDS (adenoid hypertrophy shows young person in this case)
2. collagen vascular disease like Sjogren's (smaller cysts)
Term
if lost, look at the temporal bone in an organized manner
Definition
1. external ear: auricle, external auditory canal
1. middle ear:
a. epitympanum (attic): scutum (divides eac and middle ear), prussak's space is lateral attic.
a. mesotympanum: tympanic membrane (between eac and mesotympanum), malleus, incus, stapes (sits on oval window)
a. hypotympanum:
3. inner ear:
a. cochlea (2.5 turns)
a. vestibule (between cochlea and semicircular canals),
a. semicircular canals (superior, posterior, lateral): posterior and superior join at the common crus.
a. facial nerve canal:
-----------------
a. round window is for pressure relief.
Term
chronic sjogren's syndrome
Definition
chronic Sjogren's syndrome has atrophy and fatty replacement of parotid glands and lacrimal glands
Term
optic nerve sheath complex
Definition
optic n should look like brain. nerve sheath should look like csf
Term
dd for mass in frontal lobe and nasal cavity
Definition
1. esthesioneuroblastoma (if see mass between globes, say if extends into nasal cavity, may be esthesioneuroblastoma)
1. mets
1. lymphoma
1. aggressive meningioma (not this case)
Term
temporal bone fracture
Definition
1. longitudinal: conductive hearing loss. less common to involve the facial nerve (recoverable). ossicular dislocation.
1. transverse: sensorineural hearing loss. more common to involve the facial nerve (non-recoverable). inner ear abnormality.
Term
if fluid in mastoid air cells
Definition
1. water: can be csf
2. pus: look for complications like abscess. coalescent type of mastoiditis.
3. blood: look for fx
Term
carotid body tumor vs glomus jugulare
Definition
1. carotid body tumor: splays eca and ica. cannot say nerve sheath tumor in differential
2. glomus jugulare: both ica and eca go anteriorly. add nerve sheath tumor in differential
Term
cystic lesion in the mandible
Definition
1. dentigerous cyst: cyst surrounds crown of impacted tooth.
1. ameloblastoma: enhancing mural nodule. soap bubble pattern. cyst can surround crown of impacted tooth.
1. odontogenic cyst. no enhancing mural nodule.
1. abc
1. gct
Term
mucous retention cyst
Definition
mucous retention cyst: usually high on t2
Term
looks like abscess in the region of the IJ
Definition
1. IJ thrombophlebitis
1. look for tonsillar abscess, septic emboli
Term
dd clival lesion
Definition
1. metastasis, multiple myeloma, lymphoma.
1. chordoma: midline. high T2.
1. chondrosarcoma: off midline. high T2.
1. fibrous dysplasia: variable appearance. can mimic almost any of the skull lesions.
and more.
Term
fibrous dysplasia
Definition
low t1, low t2, may enhance. correlated with CT
Term
dd for enlarged superior ophthalmic veins
Definition
1. cc fistula
1. cavernous sinus thrombosis
or maybe
1. varix
Term
how diagnose pituitary apoplexy
Definition
pituitary apoplexy
1. hemorrhage
a. hematocrit level
a. high T1
a. high density on CT
1. infarct without hemorrhage
a. edematous pituitary with rim enhancement
a. restricted diffusion on dwi
Term
say ___ before listing differential
Definition
say aggressive or non-aggressive lesion before saying differential
Term
fetal hydrops
Definition
2 or more fluid cavities
1. placental enlargement
1. anasarca (body wall edema)
1. pericardial effusion
1. pleural effusion
1. ascites
Term
cystic lesion in nasopharynx
1. anterior
2. posterior
Definition
1. anterior: thyroglossal duct cyst (resect with sistrunk procedure remove mid 1/3 of hyoid bone). risk of papillary carcinoma.
2. posterior: tornwaldt cyst. between longus colli muscles. no treatment necessary.
Term
can diagnose omphalocele after
Definition
10 w
Term
gastrochisis defect usually on
Definition
right side
Term
if reversal of diastolic flow in umbilical cord
Definition
if reversal of diastolic flow then placental insufficiency which can cause iugr
Term
hypoplastic left heart syndrome
Definition
1. LV and ascending aorta: hypoplastic
2. pulmonary A and ductus are dilated (the right heart is carrying most of the cardiac output)
Term
hypoechoic material contiguous with placenta, but covering the cervix
Definition
placental abruption
Term
single umbilical artery
Definition
single umbilical artery
1. umbilical artery should go on both sides of bladder. if only on one side, think single umbilical artery
1. associated with other malformations including aneuploidy and trisomy 18
1. increased rate of IUGR and prematurity.
Term
hyperechoic bowel in fetus
Definition
hyperechoic bowel in fetus
1. usually normal variant
1. CMV infection
1. cystic fibrosis
1. trisomy 21
1. bowel ischemia
1. swallowed pigmented amniotic fluid from abruption
Term
dd sacrococcygeal teratoma
Definition
myelomeningocele (more cystic)
Term
signs of down's syndrome
Definition
A. 2nd trimester
1. hypoplastic nasal bone
1. nuchal thickness (18-22 w) greater than 6 mm

B. soft signs
1. pelviectasis
1. echogenic bowel
1. echogenic intracardiac focus
1. short humerus and femur
Term
placenta percreta tx
Definition
c-section and total abdominal hysterectomy after delivery for placenta percreta
Term
swims
Definition
1. stop the spill:
a. if liquid, put on gloves and drop absorbent paper
a. if dry, put on gloves and dampen (can use water or oil, but make sure that adding would no spread contamination or make it airborne.)
a. if major spill: switch off all fans. do not attempt to clean up.
1. warn others: if danger to life, call 911.
1. isolate the area
1. monitor yourself carefully and completely for contaminated gloves, clothing, shoes.
1. stay in or near area until help arrives. notify your supervisor.

a. major vs. minor spill. call rso
1) major: people are at risk. usually > 100 mCi or I131 (potential for airborne contamination)
1) minor: people not at risk call the rso

identify
a. don booties, gloves, mask, goggles
a. get the survey meter (gm counter)
a. swipe and use well counter. if 364 value I 131 and then major spill cuz volatile.
Term
if ring artifact on tc sestamibi spect
Definition
center of rotation error or non uniform gamma camera
Term
f cannot see parathryoid lesion on sestamibi
Definition
can to spect
Term
inflammatory bowel disease
Definition
1. indium labelled wbc: do dynamic in first hour if looking for inflammatory bowel disease. (this case just had one image at 1 hr instead of dynamic)
2. better and easier to use fdg to look at inflammatory bowel disease.
Term
Radioactive iodine administration
1. what do you call this? (points to a metal container)
2. who supervises?
3. what is the paperwork?
Definition
radioactive iodine administration
1. pig
2. nrc for I 131 administration.
3. written directive should exist. written directive is a paper required if 30 mCi or more of iodine. must be signed by an approved user.
Term
2 yo with radiotracer in tibia: dd
Definition
1. toddler fx
2. acute or chronic osteomyelitis
3. langherhans
4. fd
5. osteoid osteoma
Term
1. what category is nuclear medicine in?
2. how to receive a package?
Definition
1. category II
2. how to receive a package
a. survey meter
a. wipe test
1) < 200 dpm: background
1) < 22,000 dpm: decontaminate
1) > 22,000 dpm: call rso
a. perform no later than 3 hours during normal business hours. No later than 18 hours on non working hours.
Term
crmo
Definition
1. chronic recurrent multifocal osteomyelitis (not infectious, it is inflammatory and treated with antibiotics).
1. multiple hot regions on bone scan
1. related to SAPHO (synovitis, arthritis, pustulosis, hyperostosis, osteitis). some lump crmo and sapho together.
Term
legg calve perthes vs scfe
Definition
1. legg calve perthes. age 8-10 years. race white
2. scfe (slipped capital femoral epiphysis). older. race black.
Term
mdp goes to soft tissue if
Definition
1. cell death: tumor under treatment, polymyositis, electric injury, frostbite etc.
2. calcification: metastatic calcification (hyperparathyroidism, rta type II, milk alkali syndrome, hypervitaminosis D), nephrogenic systemic fibrosis, actively calcifying tumors like mucinous adeno ca of pancreas, ovary etc.
3. ossification: osteosarcoma mets, myositis ossificans
Term
unilateral loss of perfusion
Definition
a. nl vent
1. large pulmonary mass, probably hilar
3. pulmonary A agenesis
3. pe rare
b. abnormal ventilation: Swyer james syndrome due to air trapping
Term
spine
1. bilateral hot spots
1. unilateral hot spots
Definition
1. bilateral pars defect (spondylolysis)
2. unilateral pars defect (spondylolysis)
note: if planar normal then ask for spect
Term
liver calcs on bone scan
Definition
1. mucinous mets (not likely osteosarcoma because osteosarcoma likes to go to lungs)
2. acute cellular death: peaks 2-6 days after chemotherapy.
Term
if switch to battery and high levels
Definition
high energy storage in battery
Term
weekly wipe test map
Definition
1. wipe test weekly. (daily survey meter)
1. date of map.
1. which well counter was used.
1. someone needs to sign.
1. need to wipe 5 spots in each room. each spot is wiped at least 5 times.
Term
daily survey meter
Definition
1. daily survey meter to survey every room that uses radiation.
1. they showed a video of person running through rooms. this doesn't meet law because need to stop and write down reading.
Term
superscan mdp with radiotracer in skin
Definition
A. calcification
1. nephrogenic systemic fibrosis
1. calcifiphylaxis (vascular calcifications, thrombosis and skin necrosis)
1. metastatic calcification (hyperparathyroidism, rta (type II), hypervitaminosis D, milk alkali syndrome)
A. cellular death
1. tumors under treatment
1. infarcts
1. polymyositis, dermatomyositis
1. electric injury/frostbite
A. ossification
1. osteosarcoma mets
1. myositis ossificans
Term
if something looks funny, look at
Definition
raw images
Term
if dont' see or cannot localize on bone scan, ask for
Definition
spect images
Term
what tumors take up gallium?
Definition
A. tumors that take up gallium: "omas"
1. hepatoma (hcc)
1. sarcoma
1. lymphoma
1. melanoma
B. doses: image at 3 d
1. dose for tumor: 12 mCi
1. dose for infection: 6 mCi
Term
decreased right foot uptake on bone scan
Definition
rsd
tx rsd: acupuncture.
Term
if muscle uptake on pet
Definition
1. insulin if muscle uptake all over
2. exercise if muscle uptake focal
Term
fluid collection s/p renal transplant
Definition
A. fluid collections
2d: hematoma/seroma
2w: urinoma
2m: lymphocele
anytime: abscess
2. leak vs urinoma
a. leak: occurs immediately. not contained.
a. urinoma: occurs at 2w. contained.
Term
hot mets: flare phenomenon vs. progressing mets
Definition
1. if patient treated then cannot distinguish flare phenomenon and progressing metastasis. can do fdg pet to distinguish flare phenomenon and progressing mets. (fdg pet has decreased activity in treated mets)
1. if patient not treated then probably progressing mets.
Term
thyroid with mets
Definition
1. tx thyroid cancer with I 131 . 600 mCi max.
1. side effect of I 131 treatment: idiopathic pulmonary fibrosis
1. if maxed out on treatment and patient still has mets then give synthroid to keep patient's TSH low.
1. if bad images then think thyroid scan
1. to look for mets:
a. 5 mCi and examine 3d later.
a. always do post therapy scan to find more tumor.
Term
csf leak
Definition
1. use indium 111 DTPA
1. place 3 pledglets on each side after radiotracer goes to basal cisterns
1. pre and post weight of pledglets. measure serum sample.
1. check radioactivity in the pledglets.
Term
donut sign in distal femur in 24 yo. no trauma
Definition
gct
Term
if matched defects on cxr and perfusion scan. normal ventiliation
Definition
1. ans: indeterminant.
1. mets on cxr may be causing perfusional defect. PE could also be causing the perfusional defects.
Term
recurrent tumor vs radionecrosis
Definition
fdg pet
1. recurrent tumor: hot on pet
2. radionecrosis: cold on pet
Term
if left ventricular ejection fraction under ____ then stop chemotherapy
Definition
if left ventricular ejection fraction under 45% then stop chemotherapy
Term
1. tx for toxic multinodular goiter or toxic adenoma
2. xenon trap:
Definition
1. tx for toxic multinodular goiter (plummer's) or toxic adenoma): 29.9 mCi I 131
2. xenon trap: traps xenon in charcoal filter
Term
1. how do you rule out PE in pregnant woman
2. medical event
Definition
1. rule out PE in pregnant woman with VQ scan. VQ scan has increased dose to fetus and breast compared to CTA, but increased blood volume of pregnancy makes high incidence of mistimed bolus. give 1 mCi perfusion only study. get shielded chest radiograph.
2. medical event: dose in the wrong organ: >=5 rem total body or >= 50 rem body part/organ. notify NRC or state equivalent in 24 hours. Notify patient and referring physician within 24 hours.
Term
1. ionization chamber
2. hyperthyroid. low RAIU.
3. diamox cerebral perfusion study
Definition
1. ionization chamber: can measure activity. cannot measure energy. need to perform accuracy and precision daily and linearity yearly.
2. low RAIU:
a. toxic:
1) don't feel goiter: prescribed dose of synthroid is too high.
2) feel goiter: acute phase of subacute thyroiditis.
a. not toxic
1) recent iodine load e.g. contrast
2) suppressed with PTU or tapazole.
3. diamox cerebral perfusion study: after diamox, the cerebral perfusion should increase, if it stays the same then that area has cerebral insufficiency
Term
1. technologist injected Tc DTPA instead of Tc MDP. what is this called?
2. if dose in wrong organ

cryptococcus on mri
Definition
1. medical incident. Injection of wrong radiotracer: medical incident (not event). all diagnostic doses are incidents now. report it in the quarterly ALARA report. (incident < 5 rem total body and < 50 rem to body part)
2. medical event: dose in wrong organ. > 5 rem whole body or > 50 rem body part/organ. notify NRC or state equivalent and doctor and patient within 24 h
Term
1. dd extra axial mass
2. gelatinous pseudocysts
Definition
1. dd extra axial mass: nerve sheath tumor, meningioma, lymphoma
2. gelatinous pseudocysts: cryptococcus. other dd: TB (tuberculoma can be low T2), toxoplasmosis (ring enhancing lesions), lymphoma (low T2)
Term
dd white matter disease in child
Definition
1. anterior: Alexander
2. posterior: adrenoleukodystrophy (X linked)
3. diffuse, spares U fibers: metachromatic (tigroid appearance on T2)
4. diffuse, starts at U fibers: Canavan's (high NAA)
Term
cc lesions: dd
Definition
lymphoma
gbm
demyelinating dz (but not mass like)
Term
tumefactive ms
Definition
horseshoe pattern of ring enhancement
Term
A. cortically based tumor: dd
B. cyst and nodule
Definition
A. cortically based tumors
oligodendroglioma
dnet (dysembryonal plastic neuroepithelial tumor)
cerebritis
infarct
(ganglioglioma, pleomorphic xanthoastrocytoma)
B. cyst and nodule: ganglioglioma, pleomorphic xanthoastrocytoma, pilocytic astrocytoma, hemangioblastoma
Term
A. dd osmotic demyelination syndrome
B. dd intraventricular tumor
C. dd craniopharyngioma
D. leptomeningeal enhancement
E. pachymeningeal enhancement
F. ring enhancing lesions
G. demyelinating lesion
H. infant with cyst and nodule
I. dd for ADEM
J. dd extra axial skull based lesions
K. High T2 in basal ganglia
L. High T1 in basal ganglia
M. high T1:
Definition
A. dd osmotic demyelination syndrome
1. encephalitis
2. NF 1

B. dd intraventricular tumor
1. central neurocytoma
2. ependymoma
3. meningioma
4. mets

C. dd craniopharyngioma: hypothalamic/chiasmic glioma, adenoma with hemorrhage, teratoma, exclude aneurysm.

D. leptomeningeal enhancement: fungal, TB, leptomeningeal carcinomatosis, lymphoma/leukemia, sarcoid

E. pachymeningeal enhancement: intracranial hypotension, post op shunt, dural mets (prostate or breast)

F. ring enhancing lesions
1. glioblastoma multiforme: irregular rim
1. primary central nervous system lymphoma in immunocompromised host (periventricular)
1. abscess: smooth rim. restricted diffusion
1. tumefactive MS: incomplete ring
--------
1. subacute infarct
1. resolving hematoma

G. demyelinating lesion
1. MS
1. ADEM (acute disseminated encephalomyelitis)
1. gliomatosis cerebri
1. subacute sclerosing panencephalitis (measles mediated encephalitis)
1. HIV encephalitis

H. infant with cyst and nodule
1. DIG (desmoplastic infantile ganglioglioma): large cortically based
1. supratentorial ependymoma (calcifies)
1. PNET (hyperdense)
1. pilocytic astrocytoma

I: dd for ADEM: MS, PMH (progressive multifocal leukoencephalopathy), gliomatosis cerebri, subacute sclerosing panencephalitis, HIV encephalitis.

J. skull base extra axial masses: meningioma, hemangiopericytoma, mets, lymphoma, multiple myeloma/plasmacytoma

K. High T2 in basal ganglia: Wilson disease (usually low on T1, but can be high due to copper), Japanese encephalitis, Creutz feldt Jacob disease, hypoxic event, carbon monoxide poisoning, NF1

L. High T1 basal ganglia: TPN, liver disease, NF1

M. high T1: fat, melanin, methemoglobin (subacute), proteinaceous material, manganese
Term
dd of intra-axial hemorrhage
Definition
1. htn: basal ganglia, thalamus, cerebellum
2. vascular malformation especially avm, cavernoma
3. tumor hemorrhage (primary and mets): CT MRI (choriocarcinoma, thyroid, melanoma, renal, islet cell tumor). don't forget lung and breast.
4. amyloid angiopathy
5. trauma
Term
vascular malformations that cannot see on angio
Definition
cavernoma and capillary telangiectasia
Term
superficial siderosis
Definition
superficial siderosis
1. low T2 and gradient
2. if no h/o bleed, then look for tumor in spine.
Term
1. Wernicke's encephalopathy
2. Marchiafava Bignami disease
Definition
1. Wernicke's encephalopathy: high T2, contrast enhancement and restricted diffusion in the mamillary bodies, thalamus, peri-aqueductal gray matter.
2. Marchiafava Bignami disease; low T1 in the mid corpus callosum with thinning of corpus callosum.
Term
"black dot differential" multiple areas of low signal intensity on swi: dd
Definition
multiple low intensity on SWI: dai, mets, amyloid angiopathy, cavernoma
Term
tumors that restrict diffusion
Definition
restricted diffusion: highly cellular tumors like lymphoma, small cell carcinoma
Term
venous thrombus.
Definition
1. high density on CT
2. early venous thrombus: iso T1 and low T2
3. late venous thrombus: high T1 and high T2
4. T1 post contrast: filling defect early
4. low intensity on gradient
Term
colloid cyst dd
Definition
colloid cyst dd
1. colloid cyst
1. aneurysm
1. subependymoma
1. neurocystercercosis
1. csf flow void artifact
Term
if on t2, the vessel is bright
Definition
if on t2, the vessel is bright (vessels should be dark on T2), then dx is dissection (carotid)
Term
if shown post contrast MR study
Definition
1. if shown post contrast MR study, ask for pre contrast.
1. precontrast
a. if precontrast high on T1 then may be hemorrhage (neurosurgical emergency).
a. if precontrast is low then only say presumably enhancing
Term
hemangiopericytoma
Definition
"meningioma" with atypical features like frank bone erosion and multiple flow voids
Term
dd endometrioma
Definition
1. endometrioma (has T2 shading)
2. hemorrhagic cyst (doesn't have t2 shading)
Term
adenoma
Definition
1. if functional signs of adenoma: do adrenal gland sampling to see if side of adenoma is the side of high cortisol etc.
2. if no functional signs: no follow up


a. if obvious fat (HU -90 to -30) then adrenal myelolipoma (macroscopic fat). surgery not needed if dx certain.

b. if no obvious fat, but < 10 HU on CT then myelolipoma or lipid rich adenoma.
1) if fat sats out on MR then myelolipoma.
2) if doesn't fat sat out, but drop signal on out of phase imaging (the one with india ink) then lipid rich (microscopic/intracellular fat) adenoma.
3) if doesn't fat sat out and doesn't drop signal on out of phase imaging then lipid poor adenoma or mets. may need bx to differentiate lipid poor adenoma vs mets.
c. if trying to figure out lipid poor adenoma vs mets.
1) if post contrast CT < 35 HU and relative washout > 50% then lipid poor adenoma.
2) relative washout: post contrast HU - delayed HU/post contrast HU. if relative washout > 50%, then benign adenoma. e.g. post contrast 50 HU, delayed 30 HU. relative washout is (50-30)/50=20/50=40% so this < 50% washout and less likely to be adenoma. benign adenomas washout quickly.
3) absolute washout: (enhanced-delayed)/(enhanced-unenhanced). if washout > 50% then benign adenoma.
Term
two kidneys that didn't divide
Definition
partial duplication of kidney
Term
hairpin turn in ureter
Definition
retrocaval right ureter.
Term
dd and fu for calyceal diverticulum
Definition
calyceal diverticulum vs megacalyx with stone. gu will not do anything for this.
Term
pear shaped bladder or reverse tear drop bladder
Definition
1. pelvic hematoma
a. look for pelvic fracture and pubic diastasis
2. lymphadenopathy: a. lymphoma b. mets c. primaries e.g. uterine, cervix, prostate ca

3. pelvic lipomatosis: a. overweight middle aged AAM b. proliferation of unencapsulated fat c. mass effect on bladder and rectum d. associated with cystitis glandularis [aside: chronic inflammation from infection, stones, tumor can cause cystitis glandularis (mucin producing goblet cells) or cystitis cystica (fluid filled cysts)]
4. psoas hypertrophy: more common in athlete's with narrow bony pelvis
5. iliac artery aneurysm can cause a pear shaped bladder if bilateral and large.
Term
IIF. bosniak.
Definition
q6 m then q yr for 5 years. (we do this at county)
Term
ivc tumor
Definition
1. leiomyosarcoma
1. mets: rcc, hcc
1. endometrial tumor
-bx endovascularly.
Term
if septate uterus
Definition
septate uterus:
1. fibrous (low T2) septum: can have hysteroscopic septoplasty
1. muscular (iso T2) septum: may require metroplasty (which may be done hysteroscopically)
Term
on ct, compare density to...
Definition
1. if lower density than psoas then may be fluid like urine.
2. if higher density in the psoas then may be hemorrhage.
Term
soft tissue rim sign
Definition
soft tissue all around the stone so stone in ureter
Term
perinephric fluid
Definition
1. if perinephric fluid is lower density than psoas then might be urine.
1. can have fornix rupture from relieving hydrophrosis.
1. tx: ureteral stent. abx
Term
cyst prostate
Definition
1. mullerian duct cyst: midline. rarely communicates with urethra. large
2. prostatic utricle: communicates with urethra. small.
Term
trauma to abdominal organs and treatment
Definition
laceration: one side
fracture: two sides of liver
shattered: more than one fracture
tx: if hemodynamically unstable or pancreatic duct transected then surgery.
Term
A. dd dilated small bowel
B. regularly thickened small bowel loops
C. irregularly thickened small bowel loops
Definition
SOS HEI GM WALE
A. dilated small bowel: scleroderma, obstruction (dynamic)/ileus (adynamic), sprue. SOS
B. regularly thickened: hemorrhage, edema, inflammation/ischemia. HEI
C. irregularly thickened: GM WALE. giardia, mastocytosis, Whipple, Amyloid, lymphoma, eosinophilic enteritis
Term
dd gastric mass
Definition
1. single filling defect: lipoma, gist, carcinoma, single mets, adenoca, lymphoma
1. multiple filling defects: mets, lymphoma, .
Term
sprue vs scleroderma
Definition
1. sprue: reversal of fold pattern (decreased jejunal folds and increased ileal folds), flocculation (granular appearance of barium precipitate), moulage sign (blunted or absent valvulae)
2. scleroderma: hidebound (closely spaced thin folds), antimesenteric sacculations
Term
dd for cocooning
Definition
1. metastatic peritoneal carcinomatosis (ovary, colon, stomach, pancreas)
2. primary peritoneal carcinoma or mesothelioma
3. Peritonitis like from TB
4. pseudomyxoma peritonei
Term
carcinoid syndrome
Definition
1. carcinoid secreting substances that cause flushing diarrhea, bronchospasm.
2. dd: carcinoid, desmoid, peritoneal mets, lymphoma, mesothelioma
Term
benign vs malignant appearing ulcer
Definition
1. benign: round or oval crater, regular thickened folds equidistant from crater. projects beyond expected lumen.
2. malignant: irregular crater, bizarre folds ending at variable distance from ulcer. does not project beyond expected lumen.
Term
A. gastric polyps
B. gastric volvulus
Definition
A. gastric polyps: hyperplastic, hamartomatous, adenomatous. syndromes (Gardner's, Peutz Jegher)
B. gastric volvulus
1. mesentero axial: less common more lethal. twist on vascular pedicle
1. organo axial: more common. less lethal. twist on the long axis.
Term
what type of stent to use for tips
Definition
covered viotorr stent for tips
Term
ir: recanalization of the umbilical vein
Definition
left portal vein continues as umbilical vein
gastric vein (my case)
not confirmed
Term
if see venogram of smv say,
Definition
venous phase of sma injection
Term
causes of stenosis
Definition
1. atherosclerosis
1. fibromuscular dysplasia
1. vasculitis
1. extrinsic compression: compression syndromes or tumor "encasement"
1. spasm
1. radiation
Term
mae thurner syndrome
Definition
1. dvt more common in left leg.
1. mae thurner syndrome: left iliac vein trapped between spine and right iliac artery.
1. can put stent after lysing.
Term
dvt lysing with tpa
Definition
1. tx of vessel narrowing
a. if diffuse narrowing: stent
a. if focal narrowing: thrombolysis. check cbc, inr. look at prior imaging. if motor deficits (like cannot dorsi or plantar flex), then may not be candidate for thrombolysis. make sure there is no contraindication (stroke < 3 months ago, head trauma < 3 m ago, active bleeding, brain tumor or AVM). embed tip of multi side hole catheter within clot. give 0.5 tPa 0.5 mg/hr. can also give heparin 500u/hour to prevent pericatheter thrombosis. if fibrinogen < 150 then can turn down tpa (also want to know if patient is bleeding or not bleeding). repeat angiogram late in day if started earlier that day or the next day. stop tpa if get pulse. trial lasts a max of 48 hours. look for underlying focal stenosis (especially if atherosclerotic disease) that can be angioplastied.
Term
av fistula
Definition
1. check arterial inflow
1. check venous outflow
1. follow flow back to svc
1. stenosis usually at venous outflow
1. stenosis can cause pseudoaneurysm
1. when angioplasty, measure size of vessels and start small.
1. types: av fistula vs interposition graft (indirect A to V)
Term
ivc filter
Definition
consent patient. do cavogram to look for variant anatomy. measure size of ivc.

A. place filter below the left circumaortic or left retroaortic vein. if no room below the circumaortic or retroaortic vein then can place filter above renal veins.
1. circumaortic left renal vein: normal left renal vein goes anterior to the aorta to drain into the IVC. the circumaortic left renal vein goes posterior to the aorta at the level of L2/L3 to drain into the IVC.
2. retroaortic left renal vein: No normal left renal vein going anterior to the aorta to drain into the IVC. the retroaortic left renal vein goes posterior to the aorta at the level of L2/L3 to drain into the IVC.

B. Megacava: > 28 mm. need to place bird nest's filter (fits up to 40 mm) or if ivc too big for bird's nest filter, you can place two filters (fits up to 28 mm) in the common iliac arteries.

C. duplicated IVC: left common iliac vein drains into the smaller left IVC which typically drains into the left renal vein. need to place a filter in each of the IVCs or suprarenal filter

D. can place suprarenal IVC filter if
1. no room infrarenally due to clot or extrinsic compression. need 3 cm to land filter
1. clot in renal vein or gonadal vein
1. duplicated IVC
1. pregnant or likely to become pregnant.
1. failed ivc filter

E. if has hook, then retrievable. can leave retrievable in as permanent. can use retrievable in young person with trauma or advanced cancer patient.
Term
if gonadal vein valves incompetent
1. female
2. male: spermatic vein (aka testicular vein)
Definition
1. female: pelvic congestion
2. male: varicocele. left more common. if see right then look for malignancy.
tx: embolize entire length of gonadal vein
Term
tx for gi bleed
Definition
GI bleed
1. want to use coil (come back 1-2 branch orders to place coil to slow flow down)
1. don't want to use particles or gelfoam cuz they may cut off other blood supply.
1. do post embolization angiogram
Term
vasopressin?
Definition
hasn't seen anyone use vassopressin in 15 years
Term
splenic A aneurysm tx
Definition
-use sandwich technique (this case in celiac) need to check from other end.
Term
tx angiomyelolipoma
Definition
-devascularize by embolizing with etoh and methiodol to sclerose the vessels. (subselect)
-if bleedng, can use coil
Term
tx bronchial A hemoptysis
Definition
1. use particles, not gelfoam (doesn't last) or coiling (you want to be able to go back)
1. look for abnormal blood vessels, may not see active bleeding.
1. due to bronchiectasis, tb, cystic fibrosis, aspergillosis, cancer
1. use particles greater than 250 microns because A of Adamkiewicz (supplies spinal cord and can arise from aorta) is 200 microns. use polyvinyl chloride particles about 350 microns.
1. contraindications: diffuse disease,
Term
thrombin is for treatment of pseudoaneurysm is contraindicated if
Definition
1. av fistula
2. tx for pseudoaneurysm: check pulses. dilute thrombin (usually 1000u/cc) to 100u/cc. use 25 gauge needle and occlude neck while injecting. inject 1 cc over 10 seconds. wait 10 seconds to see if occluded. check pulses and US post procedure. bedrest for 24 hours. check pulses and US again.
Term
if ectopic, look for
Definition
cornual or cervical pregnancy
Term
dd reversal of renal artery flow
Definition
renal vein thrombosis, rejection
Term
ovarian tumors pathology
Definition
1. epithelial origin: 85%
2. germ cell
3. sex cord stromal tumors
Term
if turbulence in renal transplant, could be
Definition
1. avf: arterialization of vein.
2. pseudo aneurysm: yin yang appearance. to and fro flow.
Term
if portal vein pulsatile
Definition
if portal vein is phasic then chf. (portal vein should not be pulsatile)
Term
what are some signs of suspicious thyroid nodule
Definition
suspicious thyroid nodule if
1. microcalcifications
2. hypoechoic
3. ill defined
4. taller than wide
5. hypervascular
Term
A. birads descriptors for masses
B. dd for malignant masses
C. dd for benign
D. dd for spiculated mass
Definition
A. birads descriptors for masses. ROI, CIS
1. shape (ROIL) round, oval, irregular, lobulated (not used for US).
2. margins: circumscribed (> 75%), indistinct, spiculated, microlobulated, obscured (mammo only), angulated (US only)
B. dd malignant masses: infiltrating ductal carcinoma, DCIS,
C. dd benign masses: fibroadenoma, fat necrosis
D. dd spiculated mass: IDC (including tubular carcinoma), radial scar, fat necrosis, post trauma especially post surgical scar, sclerosing adenosis.
Term
unilateral breast swelling
Definition
inflammatory breast cancer, mastititis, chf, venous or lymphatic obstruction like svc syndrome, radiation tx
Term
if see calcs after surgery
Definition
residual disease, recurrent disease, fat necrosis
Term
galactocele on mmg
Definition
lucency cuz of fat
Term
solid breast mass
Definition
1. if there is through transmission, but not anechoic: solid breast mass.
2. if cannot see flow, it could just be that the flow is too low.
Term
if one breast larger than the other
Definition
surgery vs invasive lobular carcinoma
Term
follow up options
Definition
1. I would want to scan the patient myself
1. I would talk to patient.
1. if palpable, I would offer biopsy.
1. stay away from birads 3 on boards.
1. I would recommend surgery consult.
Term
US of breast: hyperechoic with shadowing
Definition
extracapsular rupture
Term
dcis can present as mass what percentage of time?
Definition
10% of time
Term
dd idc
Definition
1. idc
2. scar
3. fat necrosis
Term
malignancy in breast with peripheral calc
Definition
primary or secondary osteosarcoma
Term
bilateral and unilateral lymph nodes
Definition
1. bilateral: met, lymphoma, hiv, sarcoid, ra, lupus
2. unilateral: cat scratch, breast cancer (even if mmg negative, call birads 4 if unilateral).
Term
how do tangential view
Definition
use alphanumeric grid to get tangenital iew.
Term
long segment intramedullary lesion
Definition
1. adem or devic 's disease (optic neuritis and spinal cord involvement)
1. astrocytoma
1. ependymoma: can hemorrhage. central location cuz arises from ependymal lining cells from central canal of cord.
1. lymphoma
1. sarcoid
Term
tx astrocytoma and ependymoma
Definition
1. astrocytoma: chemo and radiation tx.
1. ependymoma (central): microsurgical dissection can be done.
Term
terminal ventricle
Definition
1. mild cystic dilatation of distal spinal cord
2. aka ventriculus terminalis
3. dd: syrinx
Term
diffuse bone marrow replacement
Definition
1. diffuse bone marrow replacement if vertebral body darker than disc on T1.
2. dd: lymphoma, extramedullary hematopoiesis
Term
intradural, extramedullary csf filled lesion
Definition
1. dx: arachnoid cyst
2. epidermoid don't go to thoracic spine.
3. usually don't do dwi in spine.
Term
snake eye appearance in cord
Definition
1. Compression of cord (e.g from disc) causes ischemia and the snake eye appearance (high intensity eyes on fluid sensitive sequences)
1. need to report the snake eye appearance because surgery for the disc will not help all neuro symptoms.
Term
high T2 signal in posterior columns
Definition
1. subacute combined degeneration: due to low B12 levels
Term
dd myxopapillary ependymoma
Definition
paraganglioma
nerve sheath tumor
meningioma
intradural metastasis
Term
expansion of right neuroforamen: schwannoma vs neurofibroma
Definition
schwannomas are higher on T2 because have cystic areas
Term
epidural lipomatosis
Definition
epidural lipomatosis
1. idiopathic
2. long term steroids
3. obesity
Term
fluid fluid level in bone: dd
Definition
1. abc,
2. can have abc in them: osteoblastoma, gct
Term
demyelinating disease: long vs short segment.
Definition
1. long segment: ADEM, Devic's
2. short segment: MS
Term
paraspinal flow voids
Definition
paraspinal flow voids
1. spinal dural arterio-venous fistula: need tx with glue embolization or surgery.
2. spinal cord arteriovenous malformation
3. collateral venous flow from IVC occlusion
1. spinal cord neoplasm with increased vascular flow like hemangioblastoma (also paraganglioma)
Term
posterior to disk: low t1 and high t2 (with peripheral low t2).
Definition
synovial cyst with hemorrhage (don't call herniation). will not show classic herniation on boards
Term
etiology of os odontoideum
Definition
1. never fused
2. separated in childhood and never fused.
Term
when see ankylosing spondylitis, look for
Definition
when see ankylosing spondylitis, look for fx, which needs casting cuz fragment or osteophyte can retropulse into spinal canal
Term
sclerotic limbus vertebra due to
Definition
herniation of disc preventing fusion.
Term
extradural extramedullary (epidural) mass
Definition
1. disc
1. blood
1. abscess
1. lymphoma
1. mets
Term
regenerative nodules vs hcc
Definition
1. regenerative nodules: low on T2. blooms on gradient. if iron deposition then siderotic. washes out to normal liver on portal venous phase.
2. hcc: high on T2. washes out to lower intensity than normal liver on portal venous phase.
Term
fnh scar vs fibrolamellar scar
Definition
1. fnh central scar follows blood pool. (used to think high on t2 in fnh)
2. scar in fibrolammelar will not follow blood pool
Term
A. hygrography
B. grape like cysts in cervix
Definition
A. MR hygrography: MRCP (cholangiopancreatography), MRU (urography)
B. adenoma malignum (subtype of mucinous adenocarcinoma):grapelike cysts in cervix
Term
tx for multiple splenic varices due to splenic vein thrombus
Definition
1. need to tx with splenectomy
1. if multiple splenic varices due to splenic vein thrombus then cannot tx with tips.
Term
cystic lesion in uterine wall
Definition
fibroid, interstitial pregnancy, obstructed horn of bicornuate system, endometriosis, adenomyoma (not leiomyoma, adenomyoma is endometrioma in myometrium)
Term
meig's syndrome
Definition
fibromas, pleural effusions and ascites
Term
kruckenberg tumor
Definition
stomach (typically), colon, breast, lung, contralateral ovary
Term
stones in liver cyst (not gallbladder): dd
Definition
1. choledochal cyst
2. duplicated
3. ectopic gallbladder.
Term
if spleen blooms on gradient
Definition
1. gamna gandy bodies: splenic hemorrhage
2. associated with portal hypertension, sickle cell disease among other entities
Term
1. Gardner's
1. Turcots
1. Lynch syndrome
1. Peutz Jeghers syndrome
1. Cowden disease
1. Chronkhite Canada syndrome
1. Juvenile polyps
Definition
1. familial adenomatous polyposis:
a. Gardner's: desmoid tumors, osteomas, papillary thyroid cancer
a. Turcot's: CNS tumors

2. Lynch syndrome: hereditary adenomatous nonpolyposis colon cancer. multiple cancers.

3. Peutz-Jeghers syndrome: sb hamartomas. gi malignancy and gyne tumors

4. Cowden disease: hamartomas. tumors of the thyroid and breast
5. Cronkhite Canada syndrome: hamartomas. skin, hair, nail changes

6. juvenile polyps: hamartomas in the rectum and sigmoid
Term
sb narrowing and thickening.
Definition
sb narrowing: crohn's, TB
sb dilation: lymphoma
(list may not be complete)
Term
submucosal stomach tumor
Definition
leiomyoma, gist, sarcoma, mets, lymphoma
Term
two types of volvulus
Definition
1. sigmoid volvulus: coffee bean shape (one line). dilated distal bowel.

2. cecal volvulus: points to LUQ. no cecum visualized. only diagnosis if > 10 cm. no dilated distal bowel.
Term
if say crohn's,
Definition
say lymphoma too
Term
if see fistula or extravasation of contrast
Definition
diverticultis (dd: cancer, crohn's)
Term
surgery for cancer and ulcer disease of the stomach
Definition
Billroth I: part of stomach removed and stomach attached to duodenum.
Billroth II: part of stomach is removed and stomach attached to jejunum.

Complications of billroth II:
-bile reflux gastritis.
-marginal ulcer
-long term risk of cancer.
Term
what type of polyps do patients with ulcerative colitis get?
Definition
inflammatory pseudopolyps (can also get adenomatous polyps and adenocarcinoma, but if asking this question, they probably want the inflammatory pseudopolyp answer).
Term
ducts with multiple stones.
Definition
recurrent pyogenic cholangitis
Term
tethered folds on gi exam
Definition
carcinoid
adhesions
mets
-----
mesothelioma
desmoid
TB
Term
tx for sigmoid and cecal volvulus
Definition
1. colonoscopic decompression
1. can also treat with surgery.
1. can check with water soluble contrast barium enema
Term
low denisty mass in liver
Definition
abscess (pyogenic, amebiasis, hydatid disease (echinococcus)), hematoma, biloma, tumor
Term
small calcified spleen
Definition
sickle cell from infarcted spleen
Term
sentinal loop
Definition
sentinel loop is focal ileus due to nearby inflammation like from pancreatitis
Term
mucocele dd
Definition
dd for mucocele
1. enteric duplication cyst
1. mesenteric cyst (rare)
Term
new name for arvd
Definition
arrhythmogenic right ventricular cardiomyopathy
Term
fishmouth deformity aortic valve
Definition
bicuspid aortic valve.
Term
mr stress perfusional study. if black on stress and not on rest then defect
Definition
reversible ischemia.
Term
mr thrombus: tx
Definition
anticoagulation
Term
hocm
Definition
hypertrophic obstructive cardiomyopathy
-LV hypertrophy not explained by obvious etiology
-abnl systolic anterior motion of the anterior leaflet of mitral valve.
Term
ivc tumor
Definition
leiomyosarcoma
angiosarcoma
rcc, hcc
endometrial tumor
Term
if dextroversion (not dextrocardia)
Definition
-if dextroversion (apex still points left, but heart moved to right ), then think of papvc (scimitar syndrome)
-also associated with right lung hypoplasia
Term
papillomatosis at risk for
Definition
papillomatosis at risk for squamous cell cancer
Term
if young person with increased lung volumes, think
Definition
LAM
Term
chest wall infection
Definition
1. nocardia in immunocompromised.
1. actinomycosis in those with poor dentition and aspirate.
1. TB.
Term
aortic injury cxr
Definition
1. ill defined aortic knob
1. apical cap
1. depressed L mainstem bronchus
1. displaced trachea
1. displaced NG tube
Term
how to detect congenital organization defect
Definition
congenital organification defect: perchlorite washout test
Term
pentology of fallot
Definition
tetrology of fallot with asd
Term
tx transposition of the great vessels
Definition
1. jantene procedure
2. arterial switch procedure
3. make sure that you give prostaglandin to keep pda open prior to surgery.
Term
normal cardiac size and pulmonary edema in newborn
Definition
type III total anomalous pulmonary venous return.
Term
cxr in down's syndrome
Definition
11 or 13 ribs
more than one ossification center in manubrium
Term
coarctation of the aorta
Definition
1. preductal: child
2. post ductal adult
3. tx can be endovascular stent or surgical correction
1. can see rib notching (ribs 3-8) starting at age 6 years
Term
double aortic arch
Definition
1. not associated with other heart problems
2. can have stridor and difficulty swalling with double aortic arch.
Term
dd pulmonary sling on esophagram
Definition
bronchogenic cyst
Term
vsd, asd, pda with eisenmenger complex: tx
Definition
don't close! pt will die. can do transplantation.
Term
close pda
Definition
1. indomethacin
2. coiling
3. surgery
(pda can open on day 7)
Term
cor triatriatum
Definition
LA is divided into two chambers.
Term
very large heart dd
Definition
tricuspid atresia
ebstein's anomaly
Term
Definition
asplenia: cyanotic heart disease
polysplenia: acyanotic heart disease
Term
1. PRES
2. Creutzfeldt Jacob
3. osmotic demyelination syndrome
Definition
1. PRES (posterior reversible encephalopathy syndrome): high FLAIR in parieto occipital lobes. no restricted diffusion. related to htn.
2. Creutzfeldt Jacob disease: high T2 in basal ganglia, thalamus and cortex. can have high DWI.
3. osmotic demyelination syndrome: high central T2 in the pons with sparing of the periphery and corticospinal tracts. Also can involve basal ganglia and white matter.
Term
hemorrhage in brain: dd
Definition
1. hypertensive hemorrhage: usually in basal ganglia, thalamus, cerebellum
1. cerebral amyloid angiopathy: lobar hemorrhage and multiple cortical and subcortical (gray white matter interface) small black dots on T2*
1. hemorrhagic mets: at gray white junction like amyloid angiopathy
1. capillary telangiectasias in brainstem.
1. cavernous malformation: peripheral low intensity on T2
---------
1. venous thrombus: can be lobar
1. deep cerebral venous thrombosis: look for hypodense thalami
Term
abdomen mr at stroger
Definition
1. T1 in and out of phase
1. T2
1. T1 post contrast dynamic imaging
Term
shown map of room
Definition
1. do survey meter daily
2. do wipe test weekly (at least 5 wipes per room)
Term
where would you find low activity in the following
1. Alzheimer's
2. Pick's disease
3. Lewy body disease
Definition
a. Alzheimer's disease: parietotemporal lobes. Amyvid targets beta amyloid plaque in brain.
a. Pick's disease: frontal lobes
a. Lewy body disease: occipital lobes
Term
1. mibg vs gallium
2. indium vs sulfur colloid
Definition
1. mibg (liver, heart and parotid) and gallium (lacrimal)
2. indium 111 (whole body) and sulfur colloid (just show liver and spleen)
Term
if left vocal cord doesn't light up then
Definition
left vocal cord paralysis so look for tumor
Term
persistent uptake in both kidneys on mag 3
Definition
acute tubular necrosis. follow with MAG 3 in 1-2 weeks
Term
grainy and radiotracer in bowel (especially stomach), bladder, and salivary glands
Definition
I 131 or I 123 (looks better than I 131)
Term
cervical, axillary, hilar, mediastinal on pet/ct
Definition
1. can be brown fat or lymphoma (correlate with CT)
2. brown fat is never below diphragm (inguinal, retroperitoneal) so worry about lylmhoma below diaphragm
Term
dose calibrator:
Definition
1. daily: constancy or precision with cobalt 57
2. annually: accuracy
Term
papillary and follicular thyroid cancer tx'd with I 131. if follow up is negative, but positive on pet/ct
Definition
then dedifferentiated into non-I 131 avid thyroid cancer.
Term
1. gallium:
2. octreoscan:
Definition
1. gallium: 6 mCi (sarcoid) or 12 mCi (tumors) at 3 d
2. octreoscan: 4 mCi at 4 and 24 h
Term
stop breastfeeding
Definition
1. F18 FDG: 1d.
2. gallium: stop forever
3. I 131: stop forever
4. Tc 99m: 12 hours
5. tc 99m pertechnetate: 4 h
6. mibg I 123: 3 d
Term
1. NRC and ALARA
2. dd for non visualization of gallbladder
Definition
NRC: nuclear regulatory commission
alara: as low as reasonably achievable
2. acute cholecystitis, chronic cholecystitis, long period of fasting > 24h. if fasting can give cck.
Term
transportation labels
Definition
I: < 0.5 mR/h
II 0.5-50 mR/h and < 1 mR/hr at 1 m
III: 50-200 mR/h and 1-10 mR/h at 1 m
Term
1. well counter and thyroid scan picture
1. bone uptake on pet/ct
1. cold on I 131
Definition
1. well counter and thyroid scan
2. bone uptake on pet/ct: mets (patchy) vs. g csf (diffuse) treatment
3. dd cold on I 131: non functioning adenoma, colloid cyst, thyroid cancer (< 10% chance of cancer in cold nodule and < 1 % chance of cancer in hot thyroid nodule)
Term
radiotracer in kidney on bone scan only on posterior view
Definition
renal failure
Term
tx for paget schroetter syndrome
Definition
1. tx: surgery
2. don't put stent because it will be compressed.
Term
Adson's manuever
Definition
like combing the back of head.
Term
tx cystic adventitial disease causing vessel narrowing
Definition
surgical bypass
Term
pseudoaneurysm tx
Definition
1. compression of pseudoaneurysm: for 20 mins
2. thrombin: 21 gauge needle. 1,000u/cc. inject 0.2-0.3 cc (200-400 u of thrombin). inject with color doppler on (the pseudoaneurysm wil fill quickly). direct needle away from neck of aneurysm. (face the case way)
Term
tx of angiomyolipoma
Definition
tx if > 4 cm or symptomatic
1. if bleeding, coiling
2. if not bleeding, particles
3. if refractory to embolization then surgery.
Term
tx hcc (5.5 cm)
Definition
1. surgery (if peripheral)
1. needle ablation: can be done if less than 3 cm and away from ivc.
1. endovascular: bland particles or chemotherapy (particles with chemo or drug eluting beads). tumor < 8 cm and not involving more then 50% of the liver.
1. radioembolization: take microcatheter to region and tx with Yttrium 90
Term
popliteal artery aneurysm
Definition
1. 10% bilateral and may have abdominal aortic aneurysm so check aorta for aneurysm.
1. tx: surgery of popliteal aneurysm (can't stent because bend leg)
Term
angiodysplasia vs. diverticulum bleed
Definition
take microcatheter to site and coil.
1. angiodysplasia: see vein
2. diverticulum bleed: don't see vein.
Term
rasmussen aneurysm
Definition
1. TB and pulmonary A aneurysm
1. proximal coil and sacrifice the area.
1. pulmonary A angiogram: check if LBBB (external pacer can be used if LBBB) or pulmonary HTN (relative contraindication just limit the amount of contrast). go through femoral vein or IJ, RA, RV, main pulmonary trunk and then superselect right and left pulmonary A.
1. dd: necrotizing pna etc.
Term
how to do uterine artery embolization
Definition
1. fibroid should enhance on MR (if doesn't then UAE won't work)
1. go through internal iliac A (anterior division), select uterine A and inject particles. both sides.
1. avoid the ovarian A (cause menopause) and cervicovaginal A (cause post surgical pain)
1. if fibroid still enhancing after 6 months, could have feeders through ovarian A (aka gonadal artery) (consider particle embolization of ovarian A, but can cause menopause)
1. if pedunculated fibroid and narrow stalk less than 1 cm in size then say don't do uae on boards (in real life, some people still do these)
Term
thickening of the wall of the bypass graft
Definition
1. q 6m follow up
2. ok to see air around up to 1 month after bypass
1. fuzzy margin and adjacent air suggests infection
1. if adjacent air and loop of bowel with some high density consider a aorto enteric fistula
Term
aortic transection tx
Definition
surgery
Term
sma syndrome
Definition
sma syndrome
1. sma compressing the 3rd portion of duodenum
1. can be due to sudden weight loss
1. tx; surgery
Term
tx for compression fracture
Definition
1. vertebroplasty (single transpedicular approach) or kyphoplasty (two transpedicular approaches, inflate balloon)
1. can tx osteoporotic and pathologic compression fracture. (used to not be able to treat pathologic compression fracture)
1. use fluoroscopy. pt is prone. transpedicular or parapedicular approach. 11 or 13 g needle. cement in center of vertebral body. make sure there is no arterial extravasation (venous is kind of ok)
1. risk of other adjacent vertebral bodies.
Term
embolization material
Definition
1. trauma: gelfoam (not permanent)
1. permanent:
a. coil: focal active extravasation. not going back. e.g. GI bleed, sandwich technique for splenic A aneurysm
a. particles: bronchial A, angiomyolipoma (might go back)
a. liquids
1. tpa 1 mg/hr for 12-24 h (max 48 h). aim fibrinogen more than 150. 500 u/hr heparin through sheath.
Term
supply of hemoptysis in cystic fibrosis and tb
Definition
1. cf: bronchial A (particles)
1. tb (rasmussen's aneurysm): pulmonary A (coil) or bronchial A (particles)
Term
Definition
medications used in IR
1. vasodilator: nitro 100 mcg IA
1. heparin: 5000 u prior to PTA or stent; aim for ACT > 250. sheath always flushed with heparinzed saline
1. platelet inhibitors: plavix 75 mg daily and asa 81 mg daily for patients treated with stents.
Term
joubert syndrome
Definition
1. molar tooth pattern: midbrain
2. elongation of the superior cerebellar peduncles
2. batwing appearance to the 4th ventricle
4. dysplastic cerebellar vermis.
Term
rcc tnm staging
Definition
I: < 7 cm
II: > 7 cm
IIIa: perinephric fat
IIIb: renal vein and/or infra diaphragmatic ivc
IIIc: supradiaphragmatic ivc
IV: beyond gerota's fascia

N0: no nodes
N1: one lymph node group
N2: more than one lymph node group

M0:no mets
M1: mets beyond gerota's fascia.
Term
cervical cancer non-resectable
Definition
1. extension beyond parametrium (cancer is low intensity on T2. parametrium is high intensity on T2)
1. extension to lower 1/3 of vagina
1. hydronephrosis
Term
prostate cancer
Definition
on T2, peripheral zone and seminal vesicles are bright. tumor is dark on T2. if extracapsular invasion (seminal vesicles, neurovascular bundles involved) then mgt is non surgical (hormonal or radiation)
Term
urethral diverticulum
Definition
1. can have stone or infection
1. increased risk of tcc or adenoca (not really scc which is usually seen in urethra)
Term
urachal cyst increased risk of
Definition
adenocarcinoma
Term
if dermoid > ___ cm then
Definition
if dermoid > 5 cm then at risk for torsion
Term
hemangioma liver
Definition
1. usually no flow
2. can disappear with respiration.
Term
gas in wall
Definition
1. dirty shadowing
2. twinkle artifact
Term
transplant liver with hepatic A stenosis
Definition
1. hepatic a stenosis can cause infarct of biliary tree (look for biliary dilatation).
1. monitor post transplant 12h, then q 24h post transplant
1. tx: stent or surgical tx
Term
renal vein in transplant kidney
Definition
look for renal vein thrombus in renal pelvis
Term
1. focal lissencephaly
1. cortex with multiple small sulci
Definition
1. focal lissencephy: pachygyria
2. polymicrogyria:
Term
which lobe of the pituitary is high on T1
Definition
posterior lobe of the pituitary (anterior lobe of pituitary can be high on T1 in in first 3 months of life and pregnancy.)
Term
how to calculate velocity from gradient
Definition
gradient = 4 v squared (modified bernoulli's equation)
Term
dd primary cardiac tumor
Definition
1. myxoma
2. rhabdomyxoma
3. fibroma
4. angiosarcoma
Term
subendocardial vs transmural infarct.
Definition
1. if delayed imaging, subendocardial infarct: intervention
1. if delayed imaging, transmural infarct: no intervention
Term
calcific pericarditis
Definition
1. prior pericarditis: TB, uremic pericarditis, idiopathic
2. prior hemopericardium: surgery, trauma, malignancy
3. radiation treatment.
Term
normal pericardium size
Definition
< 3 mm
Term
timing of delayed hyperenhancement cardiac study
Definition
10 min
Term
tx pulmonary valve stenosis
Definition
dilatation of stenosis or valve replacement if dilatation doesn't work (can't do this with aorta, tx for aortic stenosis is surgery)
Term
A. double vs triple inversion recovery
Definition
A.
1. double ir: not fat suppressed.
2. triple ir with stir. fat suppressed.
Term
lca aneurysm tx
Definition
1. stent: preferred option
2. surgery
Term
tx of aberrant left coronary artery arises from the right coronary artery and passes between the aortic root and main pulmonary artery (malignant course)
Definition
surgery
Term
focal vs diffuse stenosis in coronary vessel and treatment
Definition
1. focal: angioplasty and stenting
2. diffuse: cabg
Term
diffuse calcification of LV wall
Definition
hypercalcemic states like renal disease
Term
spontaneous dissection of the carotid artery in a young person: dd
Definition
nf1 > fmd
Term
if carotid has 100% stenosis, 99.9% stenosis or bilateral: tx?
Definition
1. if 100% stenosis, don't fix
2. if 99.9% stenosis then can do endovascular repair or surgery
3. fix more stenotic side first if bilateral.
Term
carotid body tumor and juvenile nasopharyngeal carcinoma blood supply
Definition
ascending pharyngeal from eca
Term
tx of endoleak I and II
Definition
type I endoleak: see on arterial phase. fix right away
type II endoleak: see on venous phase. may not need to fix right away.
Term
dd pseudoaneurysm
Definition
1. penetrating aortic ulcer
2. mycotic aneurysm
-tx: stent or surgery.
Term
dd lucent metaphyseal lines
Definition
1. neuroblastoma mets
1. leukemia
1. infection e.g. syphilis
Term
dense metaphyseal lines
Definition
1. lead poisoning
2. treated rickets
3. normal variant (fibula would not be affected if normal variant)
Term
nephroblastomatosis vs wilm's on us and mr
Definition
1. us: wilm's is more spherical and nephroblastomatosis would be more oval
2. mr: wilm's would enhance compared to cortex. nephroblastomatosis would not enhance compared to cortex.
Term
metaphyseal flaring dd
Definition
1. rickets: high alk phos
2. hypophosphatasia: low alk phos
3. metaphyseal dysplasia: normal alk phos
per Dr. Adeniji not confirmed
Term
looks like legg calve perthes disease, but asymptomatic
Definition
meyer dysplasia
Term
diagnose oi with
Definition
skin biopsy
Term
achondroplasia inheritance
Definition
autosomal dominant
Term
complications of cystic fibrosis
Definition
1. pneumothorax
1. recurrent pneumonia
1. bronchiectasis
1. meconium ileus
1. distal intestinal obstruction syndrome
1. gallstones, cirrhosis, portal htn, varices
Term
chest wall mass with rib destruction
Definition
mets, ewing's, askin (pnet), langerhan's
Term
ellis van creveld
Definition
syncarpaly
polydactyly
Term
neurofibromatosis I
Definition
1. ribbon ribs
1. multiple NOFs
1. pseudoarthrosis
1. lambdoid suture calvarial defect
1. widened neuroforamina
1. scoliosis especially high thoracic (high thoracic is almost pathognomonic for nf1)
1. posterior vertebral scalloping
Term
birads
Definition
breast imaging-reporting and data systems
Term
A. cervical cancer staging FIGO
B. renal cell cancer staging
C. lung cancer staging
Definition
A. Surgical at 2B (beyond parametrium, lower 1/3 of vagina, hydronephrosis)
I: cervix
IIA: upper 2/3 of vagina
IIB: invading parametrium
III: lower 1/3 of vagina, pelvic wall, hydronephrosis
IV: bladder, rectum, beyond true pelvis
B. renal cell cancer staging
T1: < 7 cm
T2: > 7 cm
T3A: invades renal vein and/or ipsilateral peripnephric fat
T3B: invades infradiaphragmatic IVC
T3C: invades supradiaphragmatic IVC or wall of IVC
T4: invades ipsilateral adrenal gland or beyond Gerota's fascia
N0: no LN
N1: one regional LN
N2: more than one regional LN
M0: no mets
M1: distant mets
C. lung cancer staging: non surgical if
I: lung cancer
2. criteria for no surgery: T3, N3 (these make it at least stage III)
a. tumor extending into chest wall, diaphragm, mediastinal fat, pericardium. T3
b. whole lung atelectasis. T3
c. < 2 cm from carina. T3
d. contralateral mediastinal lymph nodes. N3
e. ipsilateral scalene or supraclavicular LN. N3
Term
small bowel follow through shows fold thickening
Definition
1. if fold thickening in small bowel follow through, think hemorrhage, edema, inflammation/ischemia.
2. if hemorrhage, hsp (henoch schonlein purpura)
Term
types of bezoar and management
Definition
1. tricobezoar (hair), phytobezoar (plant), lactobezoar (milk), yeast bezoar, hematoma bezoar, gastrolith (mixture)
2. complications: weight loss, hemorrhage, ulcer, perforation, obstruction
3. tx: surgery for tricho bezoar and phyto bezoar. fluids for lactobezoar.
Term
hydrocarbon ingestion can cause
Definition
1. pneumatoceles
1. hydrocarbons: furniture polish, gas, kerosene, charcoal fluid lighter.
Term
if suspect toddler's or cuboid fracture, but xr negative
Definition
get bone scan or follow up radiograph
Term
craniosynostosis due to
Definition
1. sutural sclerosis
1. can be primary (idiopathic) or secondary
1 secondary: metabolic disorder, bone dysplasia, hematologic disorders, external compression, decreased intracranial pressure,
Term
lissencephaly associated with
Definition
cmv infection
Term
Klippel Feil syndrome
Definition
1. cervical fusion
2. associated with sprengel deformity and omovertebral bone
Term
dd for posterior urethral valves
Definition
1. eagle barrett syndrome/prune belly syndrome: crypto orchidism, abdominal wall defect, gu anomalies.
Term
if bilateral distal radial physis are wide and irregular in gymnast
Definition
traumatic osteolysis
Term
atlanto occipital dissociation
Definition
powers ratio:
basion-posterior arch/opisthion-anterior arch> 1 then atlanto occipital dissociation
Term
plakias
Definition
1. malakoplakia: chronic inflammation
2. leukoplakia: pre malignant.
Term
associated with neoplasm?
1. pseudodiverticulosis
2. ureteritis cystica
Definition
1. pseudodiverticulosis: associated with neoplasm
2. ureteritis cystica: not associated with neoplasm
Term
ascending vs descending
1. TB
2. schistosomiasis
Definition
1. TB: descending
2. schistosomiasis: ascending
Term
associated with urethral diverticulum
Definition
1. adenocarcinoma (not scc which is the usual with urethra)
2. endometriosis
Term
if mastoiditis with bony destruction
Definition
coalescent otomastoiditis
Term
dysphagia lusoria caused by
Definition
aberrant right subclavian A
Term
retinal vs choroidal detachment
Definition
1. retinal: v shaped
2. choroidal: u shaped
Term
medullary thyroid cancer
Definition
1. arises from calcitonin producing parafollicular cells.
Term
dd for sequestrum
Definition
lymphoma, eg, ewing's
Term
distal compared to proximal bone
Definition
e.g. posterior translation of the tibia in relation to the femur.
Term
not epiphyseal
Definition
fd, sbc,eg
Term
4 types of aspergillus
Definition
1. mycetoma
2. invasive
3. semi-invasive
4. abpa
Term
types of cholesteatoma (acquired)
Definition
1. pars flaccida: more common. lateral epitympanum
2. pars tensa: less common. medial epitympanum
3. tx: mastoidectomy
a. canal wall up: posterior wall EAC not removed.
a. canal wall down: posterior wall EAC removed.
Term
otospongiosis
Definition
1. aka otosclerosis
2. two types
a. fenestral: starts fenestral. around oval window (stapes sits on oval window)
a. cochlea: progresses from fenestral to cochlea. around cochlea.
Term
somatostatin receptor positive tumors
Definition
octreoscan 4 mCi at 4h and 24h
1. islet cel tumors: insulinoma, gastrinoma, VIPoma, glucagonoma
2. carcinoid
3. medullary thyroid cancer
4. paragangliomas
5. pheochromocytoma, neuroblastoma (better imaged with MIBG(
Term
1. mondini malformation
2. michel anomaly
Definition
1. mondini: less than 2.5 turns of cochlea
2. michel anomaly: inner ear aplasia
Term
ivc filter used
Definition
venatech (not retrievable)
meridian (retrievable)
Term
pulmonary hypertension
Definition
mean elevated pulmonary pressure > 25 mmHg at rest
Term
paraduodenal hernia
Definition
1. left: fossa of Landzert
2. right: fossa of waldeyer
Term
when draining abscess want to avoid
Definition
1. superior and inferior epigastric A
2. bowel
3. different approaches: transgluteal, transrectal, transvaginal
Term
medial and lateral knee
Definition
lateral: lateral collateral ligamentous complex:
1. fibular collateral ligament
3. biceps femoris

medial: pes anserine (sartorius, gracilis, semitendonosis)
Term
relative washout adrenal gland
Definition
1. > 60% then adenoma
1. 70 second and 10 minute scanning post injection
Term
what kills those with pnd (paroxysmal nocturnal hemoglobinuria)
Definition
venous thrombosis
Term
medullary nephrocalcinosis
Definition
change transducer to check for parathyroid adenoma
Term
tx gct
Definition
curretage and graft
Term
fdg pet body
Definition
15 mCi, 511 keV, 60 min following injection. 4 h fasting. cancel if glucose > 200 (don't say give insulin). earplugs, no exercise, no talking, no cell phone, no reading. dark room. no insulin (fast acting) that morning. can use long acting only the day before. turn off the insulin pump during study.
Term
tc mag3
Definition
tc 99 mag 3:
1. flow: see aorta and iliac vessels
1. dynamic imaging (1 image/ min) for 40 min. give lasix at 20 min.
Term
hida scan
Definition
a. 5 mCi Tc99mHIDA. q5-15 min for 2 h then hourly until 4h until see gallbladder. we don't morphine.
a .non visualization of the gb: acute cholecystitis, prolonged fasting, recent meal, pancreatitis, hepatocellular dysfunction
Term
A. need lugol's if
B. I 131 kev, half life. image
Definition
A.
I 123 MIBG- (or I 1131 MIBG-500uCi)
B. I 131 360 kev. half life 8d. image 3 days later.
Term
thyroid scan
Definition
I 123: 200 uCi. 160 keV
I 131: 20 uCi. 360 keV
Tc pertechnetate 5 mCi
Term
triple phase bone scan
Definition
immediate angiogram, 5 min blood pool, 3 h blood pool
Term
when do you see biliary duct and intestine on hida scan
Definition
15 min: biliary duct
30 min: intestine
Term
dd nonvisualization of bowel
Definition
1. hepatic dysfunction
2. biliary atresia
Term
tx of thyroid cancer
Definition
1. 100 mCi without mets
2. 150 mCi lymph node
3. 200 mCi lung mets
4. 250 mCi mets to bone marrow
Term
thyroid scan for post cancer
Definition
1. 3 mCi 6 days.
2. 6 days after treatment.
recheck after 6 months after initial then yearly.
-TSH prior to treatment should be > 40mU/ml before tx with I131
-no iodine or synthroid for 2-4 weeks prior to treatment or can give thyrogen.
-2 days of following directions of flushing twice, no sharing utensils, no animals, away from kids/pregnant, wash clothes separately, no kissing/sex, put garbage separately, no preparing food, sit away from everyone in car, if traveling (doctor can write note)
Term
hospital vs outpatient
Definition
1. hospital: > 200 mCi. need to check with survey meter to see drops below certain value.
2. not in hospital: < 200 mCi
Term
bone on pet scan
Definition
1. diffuse: gcsf. stop gcsf beforehand. erthyropoietin can do the same thing
2. not diffuse: mets
Term
gallium
Definition
8 mCi, photopeaks (100,200, 300), 3d
Term
tc sestamibi
Definition
active transport.
Term
pet ct can be negative if
Definition
adenocarcinoma in situ (BAC)
mantle cell lymphoma
lung carcinoid
Term
intra articular gad
Definition
1. pointing away from the head: tear
2. pointing toward head: no tear
Term
if fracture through distal lateral talus, called
Definition
1. fracture of the lateral talar process
1. need to know if fracture through lateral talar process because surgical.
Term
acl and pcl: medial or lateral?
Definition
LAMP
lateral: ACL
medial: PCL
Term
bipartite patella
Definition
1. superolateral
2. doesn't fit together like puzzle piece
3. complications of bipartite patella: cystic degeneration (maybe erosions at the synchondrosis, sclerosis, quadriceps tendon rupture (one case report only) mentioned by face the case)
Term
femoral acetabular impingement
Definition
CAM
Pincer
Term
baker's cyst
Definition
1. medial head of gastrocnemius and semimembranosis
2. medial side
3. complication: hemorrhage, infection, rupture/leakage with ill-defined edema (face the case)
Term
pericardial fatty mass
Definition
1. pericardial fat pad
2. pericardial lipoma
3. diaphragmatic hernia
4. liposarcoma
Term
causes of pneumomediastinum
Definition
1. lungs: alveolar rupture from asthma or mechanical ventilation, pneumothorax
2. trauma or iatrogenic: rupture of esophagus (like boerhaave's) or trachea
3. abdomen: pneumoperitoneum or pneumoretroperitoneum
Term
skin lesions
Definition
1. will have air around it
2. mole, wart, neurofibroma, melanoma (face the case showed large breast cancer)
Term
fibrous tumor of the pleura: bony destruction?
Definition
fibrous tumor of the pleura: no bony destruction
Term
stages of hypersensitivity pneumonitis
Definition
1. acute
2. subacute
3. chronic
-characteristics: ground glass centrilobular pulmonary nodules, mosaic attenuation pattern
Term
Kaposi's sarcoma in lung
Definition
1. Kaposi's: thickening around the peribronchovascular bundles
1. dd: lymphoma
1. tx: highly active anti Retroviral therapy (HAART) with or without chemotherapy
Term
dd apparent elevation of hemidiaphragm
Definition
1. subpulmonic effusion: can perform decubitus views. subpulmonic effusion will layer out if at least 5 cc.
1. elevation of the hemidiaphragm:
a. may be due to phrenic nerve palsy. can ask patient if had phrenic nerve injury due to trauma or surgery.
a. check under fluoroscopy using the sniff test: patient sniffs and the side with palsy will elevate (instead of depress). if there is positive sniff test then look for mass compressing phrenic nerve with cross sectional imaging
Term
tracheal lesions
Definition
1. benign: papilloma, hamartoma
2. malignant: SCC, adenoid cystic carcinoma
Term
dd mosaic perfusion pattern: air trapping
Definition
1. asthma
1. hypersensitivity pneumonitis
1. bronchiolitis obliterans (this is not BOOP or COP): air trapping. bronchiectasis if post infectious. can be due to many etiologies like post infectious, inhalation injury, drug exposure, transplant, connective tissue disorders, idiopathic.
Term
tarsal tunnel syndrome
Definition
1. entrapment neuropathy of the tibial N in tarsal tunnel
1. location: between flexor digitorum longus and flexor hallucis longus
2. contains tibial nerve, which branches into medial and lateral plantar nerves.
3. if compressing on tibial nerve then can have denervation of the plantar muscles (manifested by edema)
1. can be due to mass, scar, altered osseous morphology
Term
dark T1 and T2
1. inside joint
1. outside joint
Definition
1. inside joint: PVNS
1. outside joint: giant cell tumor of the tendon sheath. (dd of giant cell tumor of tendon sheath=neurofibroma)
Term
labral tear vs. normal
Definition
1. labral tear: points away from head and irregular
2. normal: points to head and smooth
Term
1. how do you inject joint
1. where is subacromial bursa?
Definition
1. inject joint with gadolinium contrast and CT contrast under fluoscopic guidance.
2. alternate way: just use gad. gadolinium can be diluted 1:200. this means 0.1 cc in 20 cc.
1. subacromial bursa: located between acromion and supraspinatus tendon. if fluid goes into subacromial bursa then you know that there is likely tear.
Term
exostosis (osteochondroma)
Definition
look for medullary canal continuation
Term
classification of AC separation
Definition
Rockwood
I: AC sprain
II: AC disrupted
III: AC and CC ligament disrupted
IV-VI; others
-can use weights
Term
hydroxyapatitie deposition disease
Definition
1. commonly in the supraspinatus tendon
1. aka Milwaukee shoulder
1. can have calcific tendonitis and bursitis
1. tx:
a. calcific tendonitis: can break up deposits and aspirate
a. bursitis: can inject steroid with some lidocaine into bursa
Term
US anatomy. abdomen
Definition
1. skin, subcutaneous fat, rectus abdominis muscle, linea alba
1. right lobe of the liver
1. stomach
1. uncinate process, head, neck, body, tail of the pancreas
1. smv, sma,
1. splenic vein and portal vein (portosplenic confluence)
1. ivc (left renal vein), aorta
1. vertebral body
Term
portal triad
Definition
1. common duct
1. portal vein
1. in between: hepatic A (if closer to transducer then could be replaced right hepatic A (right hepatic A from the sma instead of the celiac)). accessory right hepatic artery is in the same spot, but it is in addition to normal right hepatic artery.
Term
how to improve image quality on US
Definition
1. switch transducer to higher frequency for better spatial resolution (but smaller area). good for neonate or child or if small part like thyroid, scrotum (12), remember dvt 7, abdomen 3.5.
2. increase depth if what you want to see is too close to the transducer.
3. focal zone should be in the middle of what you want to see
4. TGC (time gain compensation) curve should be set so that images that are further away (more prone to be dark) should have its gain increased to make the whole image look more uniform (not darker if further away)
Term
normal kidney size
Definition
9-13 cm
Term
if on dialysis and kidneys are small
Definition
1. acquired cystic renal disease
1. increased risk of RCC so there should be surveillance for RCC
Term
echogenic kidneys
1. small
2. large
Definition
echogenic kidneys
1. small: medical renal disease
2. large: HIV or diabetic nephropathy
Term
hypoechoic region with enhancement in axilla with flow
Definition
lymphoma or ?pathologic lymph node
Term
in inguinal region
Definition
1. common femoral vein
2. superficial and deep femoral artery
if can compress the artery, but not the vein then the vein is really non compressible.
Term
temporal tap
Definition
to see the eca
Term
to and fro flow
Definition
and yin yang=pseudo aneurysm
Term
if gallbladder wall thickening look for
Definition
1. pleural effusion, prominent hepatic veins and pulsatility in the portal vein: may be due to chf
2. ascites: may be due to hypoproteinemia
Term
fat vs air on CT
Definition
put on lung windows. air will still be black, fat will not be black anymore.
Term
if you are not sure that you are looking at stomach then can...
Definition
if you are not sure that you are looking at stomach then can give water.
Term
dermoid
Definition
A. appearances
1. plug alone
2. plug in a cyst
3. "starry sky"=hair. mimics endometrioma, but thicker.
B. tip of iceberg sign: hyperechoic area with posterior shadowing.
C. dermoid may not have flow. increased risk of torsion. use clinical symptoms to figure out if patient has torsion.
Term
endometrioma and hemorrhagic cyst vs fibrothecoma
Definition
1 endometrioma and hemorrhagic cyst: no flow
2. fibrothecoma/fibroma/thecoma: has flow and is ovarian mass.
Term
if biopsying an axillary lymph node, aim for
Definition
if biopsying an axillary lymph node, aim for abnormally thickened cortex and preferably some adjacent fat.
Term
how can you tell two vessel umbilical cord?
Definition
1. if two vessel then artery will equal size of vein
2. if 3 vessel cord then artery usually half the size of the vein
Term
dd endometrial mass
Definition
1. endometrial cancer
1. submucosal fibroid
1. polyp
1. adenomyosis
Term
adenomyosis: US
Definition
ill defined areas of heterogeneity in myometrium
Term
two vessel cord
Definition
1. trisomy 18
2. cardiac anomalies
3. increased mortality associated with trisomy 18 and cardiac anomalies
face the case
Term
management of IUD
Definition
in 1st trimester or early 2nd trimester
1. if string is seen in vagina, remove
2. if string is not seen in vagina, but wants to continue pregnancy, then remove under ultrasound guidance.
Term
nuchal cord
Definition
patient should be made aware of importance of fetal movements.
Term
hyperechoic liver lesion
Definition
1. hemangioma
1. adenoma
1. fnh is likely hypoechoic, but can be hyperechoic sometimes. has spoke wheel pattern
1. hcc
1. solitary met
1. focal fatty infiltration
Term
if need MR, but has pacemaker
Definition
1. if have pacemaker, but need MR. as per boards, cannot do MRI. (real answer: need to go to place that can handle this. need cardiologist, electrophysiologist, written confirmation of pacemaker). basically, don't do MRI
1. can do US (good for complete tear, but no partial tear
1. can do fluoroscopic arthrogram
1. can do CT arthrogram (best answer)
Term
paget's disease in pelvis
Definition
1. thickening of iliopectineal lines
1. acetabuli protrusio (can also be caused by OA and RA and many other things)
Term
dd calcifications in soft tissue
Definition
1. hyperparathyroidism
2. dermatomyositis (sheet like calcifications): rash and polymyositis (autoimmune myopathy)
3. scleroderma (can be sheet like also, but if sheet like choose dermatomyositis first)
Term
mri in
Definition
Term
MRI in dermatomyositis/polymyositis
Definition
1. do proximal shoulders, proximal thighs, pelvis
2. look for which muscle is active (edema, high STIR) so that can guide area of biopsy and treatment.
3. can also look for atrophy. if still have muscle mass then can go for more aggressive treatment. if a lot of atrophy, then maybe not aggressive treatment (#3 not confirmed. from face case)
Term
acute vs chronic charcot joint
Definition
1. recent trauma and acute pain in acute charcot joint.
2. acute charcot joint looks clinically like osteomyelitis, but no wbc count.
Term
if suspect lis franc, but don't see on plain film, can do
Definition
weight bearing or stress views
Term
lunate, perilunate or midcarpal dislocation
Definition
1. need immediate reduction. must notify clinician immediately
2. risk of OA and ligamentous injury (instability). face case said AVN also.
Term
if segond, look for
Definition
acl tear
mcl tear
meniscal tear (especially medial)
posterolateral corner injury (global descriptor)
Term
osteoid osteoma
Definition
1. mri may not show nidus
1. ct guided radiofrequency thermal ablation
Term
intramuscular enhancing mass (low T1 and high T2, +enhancement): dd
Definition
1. sarcoma
1. nerve sheath tumor (neurofibroma or schwannoma)
a. split fat sign
a. target sign
a. look for skin neurofibromas, which would increase likelihood of neurofibroma
Term
lung abscess
Definition
1. can do FNA for organisms
1. don't put in chest tube. may cause empyema
1. percutaneous drain only for non resolving abscess or empyema near chest wall.
Term
dedifferentiated liposarcoma
Definition
has fatty component (liposarcoma) and soft tissue component (dedifferentiated component)
Term
if see pleural effusion and/or platelike atelectasis (or another lung abnormality), consider
Definition
pulmonary embolism
Term
alpha 1 antitrypsin deficiency
Definition
associated with liver disease (and wegener's granulomatosis and necrotizing panniculitis.)
Term
boerhaave syndrome
Definition
usually from left side
Term
retroperitoneal neurogenic tumor
Definition
1. nerve sheath tumor: neurofibroma or schwannoma
a. asymptomatic: not necessarily surgery (no one said to do surgery)
a. symptomatic: surgery
1. Other: ganglioneuroblastoma, ganglioneuroma, neuroblastoma
Term
if low attenuation in CT PE study
Definition
1. transient interruption of contrast: low contrast enhancement of the pulmonary A due to taking a deep breathe and increasing lower extremity blood return to the right atrium. solve this problem by having patient take a smaller breath and holding or delaying imaging by 5 seconds after inspiration. (aorta has high HU in images I saw)
2. poor bolus timing
Term
appearance of spine on lateral radiograph
Definition
vertebral bodies should become darker as we go down thoracic spine. if not, maybe a mass.
Term
3 spaces that a mass can be in the thoracic cavity
Definition
1. intraparenchymal: acute margins
1. pleural: obtuse margins
1. extrapleural: may have obtuse margins and may involve f chest wall (bones and soft tissue), extrapleural not completely confirmed.
Term
esophagitis
Definition
1. reflux esophagitis
1. Barrett esophagus: increased risk of adenocarcinoma
1. medication induced
1. Crohn's
1. infectious:
a. candida
a. herpes: small
a. HIV and CMV: large
Term
esophageal strictures
Definition
1. long: radiation, caustic ingestion, reflux from ngt
1. focal:
a. esophageal carcinoma: mucosal lesions have acute angles
a. chronic reflux stricture
a. stricture from Barrett's esophagus
1. extrinsic mass or adenopathy (like from lymphoma): submucosal, obtuse angle
1. achalasia: not fixed
1. pseudoachalasia (just means not achalasia): fixed. has shouldering. worrisome for cancer.
Term
esophageal filling defects
Definition
1. benign: GIST, adenoma, inflammatory esophagogastric polyp, fibrovascular polyp (thin stalk, cervical esophagus, large polyp)
1. malignant: esophageal cancer, lymphoma, mets, malignant GIST, spindle cell carcinoma
Term
dd thickened gastric folds
Definition
1. gastritis: related to H. pylori infection.
1. menetrier's disease: idiopathic hypertrophic gastropathy
1. lymphoma
1. Zollinger Ellison syndrome: gastrinoma. associated with MEN I (parathyroid tumor, pancreatic islet cell tumor, pituitary tumor)
--------
1. varices: from portal hypertension
1. Crohn disease
Term
gastric filling defects
Definition
1. benign: polyp (adenomatous-can be part of familial adenomatous polyposis syndrome, hyperplastic), GIST (gastrointestinal stromal tumor)
1. malignant: malignant GIST, adenocarcinoma, lymphoma, mets
1. other: bezoar (trichobezoar, phytobezoar, lactobezoar)
Term
gastric narrowing
Definition
1. carcinoma like adenocarcinoma
1. lymphoma
1. mets
----
1. granulomatous disease (sarcoid, TB, Crohns, syphilis, eosinophilic gastroenteritis)
1. peptic scarring
1. corrosive ingestion
Term
Post operative stomach
Definition
complications of post operative stomach
1. marginal ulcer
1. afferent loop syndrome: dilated duodenum. (afferent loop is the duodenum and the efferent loop is the jejunum. think alphabetical order)
1. blown duodenal stump
1. jejunogastric intussusception
1. gastric remnant bezoar:
a. phytobezoar
a. tricobezoar
a. yeast bezoar
a. blood clot bezoar
a. lactobezoar (can just give liquids)
1. post gastrectomy carcinoma
1. post reflux gastritis: can cause inflammatory polyp, thickened folds.
Term
on chest xray, make sure you look at
Definition
clavicles
Term
looks like congenital absence of pericardium
Definition
1. pulmonary stenosis
1. pulmonary htn
1. pulmonary aneurysm
1. congenital absence fo pericardium
Term
intusussception reduction:
Definition
intusussception reduction:
1. make sure no free air or peritonitis (contra indication)
1. rectal tube
1. no inflation
1. 18 gauge needle in case tension pneumoperitoneum
1. surgery on standby
1. 3 feet up
1. 3 min each time
1. 3 tries
1. don't use barium
Term
3 moguls
Definition
1. aortic knob
1. main pulmonary A
1. left atrial appendage (prominent in congenital pericardial defect)
Term
ulcerative and inflammatory disease of the duodenum
Definition
1. ulcerative: peptic ulcer, Zollinger Ellison syndrome
2. inflammatory: pancreatitis, Crohn's disease (usually already has ileal disease), adult celiac disease (usually affects jejunum and ileum)
Term
urethral injury
Definition
I: hematoma: normal urethrogram
II: stretch injury
III: partial tear
IV: complete tear
V: complete tear
Term
prostate cancer on ultrasound
Definition
1. usually hypoechoic
2. choline is high in prostate cancer
Term
testicular microlithiasis
Definition
1. q6m for 2 years then yearly. stop only if there are no microlithiasis.
2. also check tumor markers yearly: afp, b hcg,
Term
tx didelphys, septate uterus
Definition
1. didelphys: aka bicornuate bicollis. surgery
1. if muscular septate uterus: can do hysteroscopic removal of septum or surgery
1. if fibrous septum then can do hysteroscopic removal of septum
Term
dd sin (salpingitis isthmica nodosa)
Definition
1. TB
2. endometriosis
Term
polycystic ovarian syndrome
Definition
1. die of 3rd spacing of fluid
1. tx: hormonal. if hormonal doesn't work then can do wedge resection.
Term
iud. what type of infection?
Definition
actinomycosis
Term
benign vs malignant thyroid nodule
Definition
1. benign: eggshell calcifications; cystic; thin hypoechoic halo, hyperechoic or isoechoic; no LN; comet tail artifact is usually due to inspissated colloid.
2. malignant: microcalcifications; solid; hypoechoic; microcalcs don't have comet tail artifact; LN (can be cystic or calcified)
Term
duodenal masses and filling defects
Definition
p. 168 gi book
partial listing
1. malignant: adenocarcinoma, lymphoma, mets, malignant GIST
2. benign: GIST, adenoma, polyps
3. non neoplastic: enteric duplication cyst, annular pancreas, etc.
Term
schistosomiasis
Definition
1. snails are intermediate hosts.
2. live a part of their stage in bladder or intestine of humans
Term
pseudothickening of prevertebral soft tissue
Definition
may be secondary to
1. flexion
2. expiration
-less than 1/2 of vertebral body (AP diameter)
Term
retropharyngel air
Definition
1. perforation
1. retropharyngeal abscess
1. pneumomediastinum
Term
elevation of thymus
Definition
pneumomediastinum
Term
choroid plexus papilloma
Definition
produces csf so hydrocephalus for this.
Term
poorly defined cortex
Definition
premature patient
Term
colloid cyst at risk for
Definition
positional hydrocephalus
Term
1. cyst which is periparotid
2. cyst near sternocleidomastoid
Definition
1. periparotid: type I
2. near sternocleidomastoid: type II
Term
chiari III
Definition
low occipital/high cervical encephalocele
Term
reflux
Definition
I: ureter
II: renal pelvis
III: mild caliceal blunting
IV: caliceal and ureteral dilatation
V: very dilated and tortuosu collecting ystem
Term
normal t 1/2 life on mac 3 scan
Definition
t 1/2 < 10 min normal
t 1/2 10-20 min equivocal
t 1/2 > 20 min obstruction (right side is on right on mag 3 scan
Term
gold standard for evaluation posterior urethral valve
Definition
remove foley and do voiding vcug
Term
wilms staged by
Definition
surgery
Term
dd wilm tumor
Definition
clear cell sarcoma and rhabdoid tumor
Term
1. bright blood
1. dark blood
Definition
1. bright blood: steady state free precession
1. dark blood: T2 double inversion recovery
Term
on cxr, always check for
Definition
1. coarctation of the aorta
1. right sided aortic arch
1. fracture
1. pneumothorax
1. pneumomediastinum
Term
mri myocarditis
Definition
subepicardial
Term
transposition of the great arteries
Definition
distal lead should go anteriorly on two lead pacer.
1. mustard and senning (older than 30 year old) or jatene procedure (30yo or younger) for atrial switch procedure.
1. pulmonary trunk anterior and draped over aorta=pathomneumonic for jatene procedure.
Term
aortic dissection dd in child
Definition
1. loeys dietz syndrome (double uvula): looks like marfans
1. marfans
Term
post surgical repair of pulmonary sling. complication?
Definition
tracheal rings/tracheomalacia
Term
anterior cortex lytic lesion in kids
Definition
1. non painful: NOF
1. painful: chondromyxofibroma
children's
Term
epiphyseal lesion
Definition
1. infection
1. chrondroblastoma
1. eg
Term
blount's vs. physiologic bow legs
Definition
1. blount's involves the proximal tibia
1. physiologic bow legs: involves many parts of the tibia
children's hosp review
Term
congenital foot deformity
Definition
1. descriptors: diagnose with weight bearing images
1) hindfoot
a. equinus: calcaneal plantar flexion
a. calcaneus: calcaneal dorsiflexion
2) forefoot valgus or varus
3) hindfoot valgus or varus
1. clubfoot (talipes equinovarus): parallel talus and calcaneus. hindfoot equinus, hindfoot varus forefoot varus.
1. flat foot (pes planovalgus): talus and calcaneus not parallel. no hindfoot equinus. hindfoot valgus. forefoot valgus. reduces.
1. rockerbottom feet (congenital vertical talus): talus and calcaneus not parallel. hindfoot equinus. hindfoot valgus. forefoot valgus. talus dislocated from navicular. doesn't reduce.
Term
normal bowing in NF1
Definition
anterolateral
Term
absent radius. relatively normal thumb
Definition
thrombocytopenia absent radius (TAR syndrome)
Term
sclerotic proximal cuboid
Definition
stress fracture
Term
bowel on ultrasound
Definition
hyperechoic mucosa
hypoechoic muscle
Term
ruq cyst on ultrasound
Definition
mesenteric cyst
choledochal cyst
Term
before cross sectional imaging
Definition
1. say would consider US.
1. concerned about radiation
Term
microcolon dd
Definition
1. meconium ileus (filling defect and cystic fibrosis)
1. ileal atresia (doesn't reflux into distal ileum)
1. total colonic hirschsprung
1. megacystis microcolon intestinal hypoperistalsis syndrome (rare and probably not on boards)
Term
other forms of neuroblastoma
Definition
1. neuroblastoma: least differentiated. younger. worse prognosis
1. ganglioneuroblastoma
1. ganglioneuroma:most differentiated. older. better prognosis
Term
if double bubble
Definition
say that you will do upper GI (not for pyloric stenosois) to r/o malrotation
Term
duodenal hematoma or any trauma
Definition
r/o non accidental trauma
Term
if see small rectum and displaced anteriorly
Definition
think of presacral mass.
1. teratoma: fat and calcifications
1. rhabdomyosarcoma
1. neuroblastoma
1. chordoma, osteosarcoma, ewing sarcoma if involving bone
Term
if shown non specific peds abdomen xray
Definition
r/o intussusception with US.
Term
Beckwith Wiedemann
Definition
1. hemihypertrophy
1. macroglossia
1. hepatomegaly: hepatoblastoma
1. renal enlargement. nephroblastomatosis. Wilm's tumor
1. pancreatoblastoma
1. neuroblastoma
1. rhabdomyosarcoma
1. omphalocele
1. polyhydramnios
Term
types of rcc
Definition
1. clear cell
1. papillary
1. medullary
1. chromophobe
1. collecting duct
Term
clear cell renal cell carcinoma vs angiomyolipoma
Definition
1. clear cell: microscopic fat. drop on out of phase imaging, but doesn't fat sat
1. angiomyolipoma: macroscopic fat. may or may not drop on out of phase imaging and sats out on fat sat images.
Term
filling defects in small bowel
Definition
1. gist
2. mets
3. lymphoma
short list
Term
1. small bowel dilatation
Definition
1. small bowel dilatation and thin straight folds: SOS.
a. obstruction: ileus or mechanical bowel obstruction
a. sprue (celiac): reversal of the jejunal and ileal fold pattern (normally jejunum has a lot of folds and the ileum has less folds. this is reversed in sprue). flocculation, increased risk of lymphoma. moulage (jejunum is without folds, more tubular)
a. scleroderma: hidebound appearance, antimesenteric sacculations
2. thick straight folds
a. segmental: ischemia, radiation enteritis, hemorrhage, adjacent inflammatory process. (hemorrhage, edema, inflammation/infarct, HEI)
a. diffuse: venous congestion, hypoproteinemia, cirrhosis
3. thick nodular folds
a. segmental: Crohn (can say TB if say Crohn), lymphoma, mets, infection
a. diffuse: GM WALE. giardia, mastocytosis, whipple disease, amyloidosis, lymphoma/mets, eosinophilic gastroenteritis and more
Term
if al small bowel on right and all large bowel on left
Definition
intestinal non rotation
Term
toxic megacolon
Definition
> 6 cm
associated with ulcerative colitis
Term
diverticular abscess tx
Definition
1. < 3 cm: antibiotics
1. > 3 cm and well defined: percutaneous drainage
1. not well defined or multiloculated: surgery
Term
tumefactive MS vs. tumor
Definition
tumecfactive MS: leading edge of enhancement (horseshoe open toward the cortex)
Term
adem vs ms
Definition
1. adem doesn't enhance (Dr. Eg said can enhance a little peripherally)
1. adem involves the brain stem
Term
if HIV and brain issue
Definition
1. HIV encephalopathy: symmetric
1. pml: asymmetric
Term
contrast
Definition
1. 125 mg solumedrol IV and try to wait 4 hours (can do earlier, but not been shown to be effective). 50 mg IM benadryl 1 hour prior and then solumedrol again after CT or MR with contrast
1. prednisone 40 mg 13, 7, 1h prior and 6 hr after PO and benadryl 50 mg PO 1h prior and 6 h after.
1. if multiple myeloma, sickle cell; hydrate and use visipaque.
1. gfr > 30 then can give gad. otherwise, don't give gad
Term
1. doppler angle incidence
1. intima media thickness
Definition
1. doppler angle incidence less than 60 degrees to the direction of flow. long line is parallel to the vessel.
1. intima (hyperechoic )media (hypoechoic) thickness layer should be < 1 mm.
Term
severe stenosis
Definition
1. aliasing
1. turbulence
1. spectral broadening
1. tardus parvus
Term
total vs high grade occlusion of the ICA
Definition
1. total occlusion: medical management
1. high grade occlusion: stenting or carotid end arterectomy
-if may need intervention, can confirm diagnosis with CTA and MRA
-fix worst side first
-don't fix sooner than 6 w after stroke
Term
phase contrast image for subclavian steel
Definition
1. time of flight mra: if saturation band placed superiorly then flow toward saturation band should be high intensity. if no high intensity flow (can't see it) in vertebral A then there is reversal of flow in the vertebral A.
Term
high T2 pons in kids
Definition
adem
astrocytoma
lymphoma
Term
scalloping of inner cortex
Definition
1. enchondroma
1. fibrous dysplasia
1. other tumors
Term
pseudogout dd
Definition
Wilson's or hemochromatosis
Term
birads descriptors
Definition
A. birads descriptors for masses. ROI, CIS
1. shape (ROIL) round, oval, irregular, lobulated (not used for US).
2. margins: circumscribed (> 75%), indistinct, spiculated, microlobulated, obscured (mammo only), angulated (US only)
Term
if internalization of the eca or cca then
Definition
stenosis of the ica
Term
meckel diverticulum arises from
Definition
small bowel not cecum
Term
couinaud classification
Definition
1: caudate
2: superior lateral segment of the left lobe
3: inferior: lateral segment fo the left lobe
4A superior medial segment of the left lobe
4B: inferior medial segment fo the left lobe
5: inferior anterior segment of the right lobe
6: inferior posterior segment of the right lobe
7: superior posterior segment of the right lobe
8: superior anterior segment of the right lobe
superior from inferior: main portal vein
right and left lobe: middle hepatic vein
Term
dd sequestrum in child
Definition
osteomyelitis
eg
lymphoma
Term
how to do arthrocentesis of the
1. si joint
2. shoulder joint
Definition
how to do arthrocentesis: look at prior studies. consent patient. sterile technique. anesthetize locally. send for culture and sensitivity.
1. si joint: place patient prone. CT guidance. angulate the needle tip slightly laterally
2. shoulder joint: place patient supine. use fluoroscopy. aim for the humeral head straight AP. if no aspirate, turn needle 180 degrees. if still no aspirate, pull back a little and aim more medial.
Term
splenic tumors
Definition
1. hemangioma
1. lymphoma
1. angiosarcoma
Term
splenic tumors
Definition
1. hemangioma
1. lymphoma
1. angiosarcoma
Term
gbm vs radiation necrosis
lymphoma vs toxo
Definition
thallium 201
K analog
active transport
81 kev
gbm and lymphoma are hot.
4 mCi at 1/4 hour (15 min) and 4 h.
Term
liver hot on bone scan
Definition
l. liver mets: colon, ovarian,
1.prior study tc sulfur colloid
1. amyloid
Term
posterior mediastinal uptake on bone scan
Definition
1. neuroblastoma
1. osteomyelitis
Term
positive octreoscan
Definition
islet cell tumor, gastrinoma, medullary thyroid, pituitary adenoma, small cell, lung cancer carcinoid, neuroblastoma, pheochromocytoma
4 mCi at 4 and 24 hours
Term
liver spleen scan shows bone uptake and hotter spleen with splenomegaly
Definition
-colloid shift
-cirrhosis, metastatic disease in the liver, budd chiari, anything which damages the liver
Term
calcified hot in chest
Definition
met from colon, ovarian, osteosarcoma, and maybe histoplasmosis (as per Jen)
Term
pick's, alzheimer's, lewy body disease
Definition
1. anterior: pick's disease
2. temporoparietal: alzheimer's. use amyvid to confirm (alzheimer's has high uptake in cortical gray matter)
3. occipital: lewy body. alzheimer's doesn't usually affect occipital lobes until late. use DAT scan to confirm. lewy body will be positive in DAT scan. dat is usually used for parkinson's disease.
Term
diffuse liver disease
Definition
1. cirrhosis: atrophic right lobe. hypertrophic caudate and left lobe
1. fatty infiltration: focal or diffuse. drop on out of phase imaging
1. hemochromatosis: primary. low T2 in liver, pancreas, heart. can have cirrhosis and hcc.
1. hemochromatosis: secondary (aka hemosiderosis). low T2 in liver, spleen, bone marrow. no organ damage.
1 .budd chiari: normal enhancing caudate lobe.
1. dd of high density liver on CT. GI WATT
a. gold therapy
a. iron deposition (hemochromatosis)
a. wilson disease
a. amiodarone (high density in liver and lung)
a. thoratrast
a. glycogen storage disease: can be high or low density. associated with multiple adenomas.
Term
hepatic abscess
Definition
1. pyogenic
1. amebic: low attenuation ring surrounding fluid.
1. hydatid cyst: echinococcus. daughter cysts
1. candidiasis: affects liver and spleen. Bull's eye lesions on US (hyperechoic center and hypoechoic halo)
Term
giant hemangioma
Definition
> 4 cm
can result in thrombocytopenia or consumptive coagulopathy (kasabach merritt syndrome)
Term
benign liver tumors
Definition
1. hemangioma: peripheral nodular enhancement with centripetal fill in. isodense to aorta.
1. fnh: central scar. homogeneously enhancing on arterial phase. iso to liver on porto venous phase with peripheral enhancement. hot on sulfur colloid scan.
1. hepatic adenoma: heterogeneous enhancement. can have fat and hemorrhage. birth control pills, steroids, multiple in glycogen storage disease.
1. biliary cystadenoma or carcinoma: large cystic mass with septattions
1. angiomyolipoma: multiple in tuberous sclerosis
1. cyst
Term
hcc
Definition
1. hyperenhancing
1. rapid washout to less than normal liver
1. high T2
Term
thoratrast (thorium dioxide)
Definition
1. alpha emitter
1. associated with cancer in the liver (hcc, cholangiocarcinoma, angiosarcoma)
Term
if hyperechoic center and hypoechoic halo in liver
Definition
mets, hc, adenoma
Term
hyperavascular mets vs. hemangiomas on us
Definition
both hyperechoic
1. hypervascular mets: posterior shadowing.
1. hemangioma: slight posterior enhancement.
Term
characteristic of reflux nephropathy
Definition
1. cortical thinning
1. calyceal dilatation
Term
dd enlarged bilateral kidneys
Definition
1. HIV nephropathy: echogenic kidneys
1. diabetic nephropathy
1. amyloidosis
1. lupus nephritis
1. acute tubular necrosis
Term
inflammatory diseases of the bile ducts
Definition
1. primary sclerosing cholangitis: beaded appearance. increased risk of cholangiocarcinoma
1. primary biliary sclerosis: involves small bile ducts. autoimmune.
1. aids cholangiopathy: looks like pbc
1. recurrent pyogenic cholangitis: duct dilatation and stones
1. bacterial cholangitis: small abscess cavities that communicate with bile ducts
Term
masses and filling defects of the bile ducts
Definition
1. choledocholithiasis
1. mirizzi syndrome: stone in cystic duct causing inflammatory stricture of common duct
1. cholangiocarcinoma: klatskin tumor at confluence of right and left biliary ducts.
1. sludge balls, blood clots, mucous
and more
Term
todani classification of choledochal cysts
Definition
1. fusiform: mc. extrahepatic.
2. diverticulum: rare. extrahepatic.
3. cholechocele: rare. extrahepatic. near duodenum
4. intra and extrahepatic
5. intrahepatic: caroli's disease
Term
masses and filling defects of gallbladder
Definition
1. gallstones
1. tumefactive sludge: no flow. no shadowing. sludge that looks tumor like
1. gallbladder polyps: usually cholesterol polyps. usually < 1 cm. +flow in larger polyps. no shadowing. nonmobile
1. adenomyomatosis: echogenic foci with ring down artifact. cholesterol crystals in rokitansky aschoff sinuses.
1. gallbladder ca
1. mets: especially melanoma
Term
inflammatory diseases of the pancreas
Definition
1. acute pancreatitis: complications: necrotizing pancreatitis (non enhancement of a region and possibly hemorrhage), portal or splenic vein thrombus. splenic artery pseudoaneurysm,
1. chronic pancreatitis: calcifications. ductal dilatation, atrophy
1. complications of cystic fibrosis:
1. pneumothorax
1. recurrent pneumonia
1. bronchiectasis
1. meconium ileus
1. distal intestinal obstruction syndrome (dios)
1. gallstones, cirrhosis, portal htn, varices
Term
pancreatic tumors
Definition
1. pancreatic adenocarcinoma
a. hypodense on CT
a. hyperechoic on US
a. hypointense on T1 and hyperintense on T2 on MR
1. pancreatic adenocarcinoma is not resectable if
a. arterial invasion: usually sma or celiac
a. extensive venous invasion: if there is a little venous invasion of the smv or portal vein or splenic vein, can still be resectable, but not resectable if extensive venous invasion
a. +lymph nodes
a. mets
1. islet cell tumors
a. hyperdense on post contrast CT
a. hypoechoic on US
a. types: insulinoma, gastrinoma, glucagonoma, VIPoma, somatostatinoma
Term
hyperfunctioning islet cell tumors
Definition
1. insulinoma: hypoglycemia
1. glucagonoma: diabetes, necrolytic erythema migrans
1. gastrinoma: gastric ulcers
1. VIPoma: WDHA. watery diarrhea, hypokalemia, achlorhydria
1. somatostatinoma: steatorrhea
-associated with MEN I (parathyroid, pituitary, pancreatic islet cell tumor)
Term
ductal adenocarcinoma vs islet cell tumors
Definition
1. ductal adenocarcinoma: < 4 cm. hypovascular, hyperechoic on US, no calcs, encase vessels, ductal dilatation
1. islet cell tumor: 0.5-10 cm. hypervascular. hypoechoic on US. +calcs. doesn't usually encase vessels. doesn't usually cause ductal dilatation
Term
more common mets to pancreas
Definition
1. melanoma
1. renal cell carcinoma
Term
pancreatic cystic neoplasms
Definition
1. serous cystadenoma: < 2 cm, >= 6 cysts. if symptomatic then surgery, if not symptomatic then can observe.
1. mucinous cystic neoplasm: > = 2cm. less than 6 cysts. surgery
1. IPMN: intraductal papillary mucinous neoplasm: main duct or side branches.
1. solid and papillary epithelial neoplasm; can be predominantly cystic, solid or both
1. autosomal dominant polycystic renal disease: can have berry aneurysm, liver cysts and pancreatic cysts.
1. von hippel lindau: renal cysts, rcc, pancreatic serous cystadenoma, islet cell tumor, pheochromocytoma, liver cysts, retinal and cerebellar hemangioblastomas
1. cystic islet cell tumor
1. pseudocyst
1. abscess: may have gas.
Term
1. pancreas divisum
1. annular pancreas
Definition
1. pancreas divisum: ventral and dorsal duct do not fuse. predispose to pancreatitis.
a. main papillae: ventral duct of Wirsung. drains head
a. accessory papillae: dorsal duct of Santorini. drains body and tail.
1. annular pancreas: pancreatic tissue or ventral duct encircles the duodenum causing obstruction
Term
inflammatory diseases of the spleen
Definition
1. hyperechoic centrally and hypoechoic peripherally: candidiasis
1. echinococcus. hydatid cyst: daughter cysts. peripheral calcification
1. calcific granulomas: histoplasmosis or sarcoid
1. hypodense splenic lesions: sarcoid
Term
masses of the spleen
Definition
1. hemangioma in the spleen: frequently atypical in appearance in the spleen.
1. inflammatory pseudotumor: hemorrhage and necrosis that looks like tumor
1. siderotic nodules: Gamna Gandy bodies. blooms on gradient due to hemorrhage in spleen from portal hypertension.
1. lymphoma
1. mets: like melanoma
and more p 654 gi book
Term
thoratrast
Definition
1. high attenuation in liver, spleen, lymph nodes
1. increased risk of hcc, cholangiocarcinoma, angiosarcoma
Term
wandering spleen
Definition
1. due to ligamentous laxity
1. tx: splenopexy: fixation of spleen
1. risk of torsion
Term
pseudomyxoma peritonei
Definition
1. due to rupture of appendiceal mucocele or mucinous adenocarcinoma of the appendix, ovary, colon, pancreas
1. often calcification in mucinous ascites
Term
dd peritoneal metastasis
Definition
1. peritoneal mesothelioma
1. presents about 30-40 years after asbestos exposure
1. tx: surgery, chemo and radiation
Term
dd mesenteric mass
Definition
dd mesenteric mass
1. metastatic disease

2. carcinoid (high activity on octreoscan)

3A. desmoid tumor: seen in those with Gardner's syndrome (familial adenomatous polyposis, cranial osteomas and desmoid tumor)

3B. fibrosing mesenteritis: pts don't have Gardner's syndrome, but has something that looks like desmoid tumor

4. lymph nodes: those with low attenuation lymph nodes (TB, MAI, Whipple's, necrotic lymph nodes) or lymphoma

5. abdominal mesothelioma

6. mesenteric GIST
Term
retained surgical sponge with inflammatory reaction
Definition
gossybipoma
Term
mc fibromuscular dysplasia
Definition
medial fibroplasia (beaded appearance)
Term
renal aneurysms
Definition
intraparenchymal renal artery aneurysm

1. vasculitis
a. polyarteritis nodosa (necrotizing vasculitis of the kidneys, liver, pancreas),
b. Takayasu's arteritis (branchess of the aorta, aorta/pulmonary A)
c. Wegener vasculitis (necrotizing granulomatous vasculitis usually involving the sinus, lung, kidneys)
d. Churg-Strauss syndrome (necrotizing vasculitis usually lung)]
e. lupus

2. mycotic/septic emboli causing pseudoaneurysms

3. trauma

4. Ehlers Danlos syndrome
------------
Term
ivc tumor
Definition
1. extension of hcc, rcc, adrenal cortical carcinoma, endometrial tumor
1. primary: leiomyosarcoma, angiosarcoma
Term
renal artery velocity stenotic when
Definition
distal to stenosis
1. > 200 cm/s (stenosis)
1. parvus tardus
1. aliasing (maybe don't say this one)
1. turbulence
1. spectral broadening
Term
avf renal transplant
Definition
1. see aliasing, turbulence
1. arterialization of vein
1. high velocity, low resistance waveform in artery
Term
reversal of diastolic flow in renal vein transplant dd
Definition
1. if with no flow in renal vein then renal vein thrombosis. treatment is thrombectomy
1. if flow then may need biopsy to distinguish
a. acute tubular necrosis (early)
a. cyclosporine toxicity (later)
a. rejection
Term
leukoplakia predisposes to
Definition
scc
Term
pyeloureteritis cystica
Definition
1. pyeloureteritis cystica: no malignant potential. chronic irritation from infection or calculi.
1. malakoplakia: no malignant potential. chronic infection.
1. leukoplakia: risk of SCC. chronic irritation
1. pseudodiverticulosis: risk of urothelial carcinoma (tcc). need monitoring
Term
primary megaureter usually on
Definition
left (2/3 of time on left)
Term
fat stranding, forniceal rupture vs perinephric hematoma
Definition
1. fat stranding: linear
1. forniceal rupture: low density in perinephric space. treat with prophylactic antibiotics
1. perinephric hematoma: high density in perinephric space
Term
urachal cancer
Definition
adenocarcinoma
Term
attacks of headache, palpitations, sweating during micturition
Definition
1. paraganglioma in the bladder
1. high T2
1. MIBG scan
Term
hemorrhagic cystitis
Definition
usually due to radiation tx or chemotherapy like cyclophosphamide
Term
page kidney
Definition
due to subcapsular hematoma
manifests as hypertension
Term
hemorrhage
Definition
40-60 HU on noncontrast CT
Term
trauma to gu system
Definition
1. posterior urethral injury: associated with extraperitoneal hematoma. associated with pelvic fractures
1. extraperitoneal bladder injury: almost always associated with pelvic fractures. tx: foley.
1. intraperitoneal bladder injury: 75% associated with pelvic fractures. tx: surgery
Term
tx calyceal diverticulum
Definition
1. if asymptomatic, no tx
1. if symptomatic with pain, hematuria, infection then possible surgery
(calyceal diverticulum typically fills with excreted contrast)
Term
prostatic cyst dd
Definition
1. mullerian duct cyst: midline. rarely communicates with urethra. large
2. prostatic utricle: midline communicates with urethra. small.
3. seminal vesicle cyst: off midline. associated with renal agenesis.
Term
dilated tubules in the mediastinum testes without flow
Definition
tubular ectasia of the rete testis
1. associated with spermatoceles and epididymal cysts and intratesticular cysts
Term
adrenal adenoma
Definition
1. adrenal adenoma: drops signal on out of phase imaging. can also do subtraction (in phase minus out of phase): if subtraction image bright then adrenal adenoma
1. if doesn't drop signal on out of phase imaging then could be lipid poor adenoma, mets, adrenal cortical carcinoma, pheochromocytoma
Term
adrenal cortical carcinoma
Definition
1. large
1. hemorrhage, necrosis, calcs
Term
retroperitoneum
Definition
retroperitoneum
1. primary tumor: liposarcoma, leiomyosarcoma, leiomyomatosis in the IVC (associated with uterine fibroids)
1. lymphoma
1. mets
1. retroperitoneal fibrosis: soft tissue around aorta. medial deviation of ureters
and more
1.
Term
endometrioma vs hemorrhagic cyst vs dermoid
Definition
all high on T1
1. endometrioma: T2 shading
2. hemorrhagic cyst: may look like endometrioma
3. dermoid: fat sat on T1
Term
cervical cancer
Definition
1. IIB disease is nonsurgical: if extends beyond cervix (parametrial invasion) or extend to lower 1/3 of vagina
1. look on T2. cervical cancer is high on T2 and normal is low on T2. (prostate is opposite. prostate cancer is low on T2 and normal peripheral zone and seminal vesicles are high on T2)
Term
multiple cystic structures in cervix
Definition
1. adenoma malignum (rare variant of cervical adenocarcinoma): may see enhancing component.
1. dd nabothian cysts
Term
vaginal cysts
Definition
1. gartner duct cyst: proximal vagina. anterolateral wall
2. bartholin duct cyst: distal vagina. posterolateral wall
Term
if fluid collection near joint vs away from joint
Definition
1. near joint: meniscal cyst
1. away from joint: synovial cyst or ganglion cyst
Term
types of hip fractures
Definition
1. intracapsular: capital, subcapital (risk of avn and non union), transcervical, basicervical
1. intertrochanteric:
1. subtrochanteric:
Term
charcot spine due to
Definition
tabes dorsalis (syphilis)
Term
neuropathic joint
Definition
1. density: increased or normal
1. disorganization
1. dislocation
1. debris
1. distention (effusion)
Term
achilles tendon tear
Definition
1. partial: surgery or immobilization depending on
a. patient's activity level
a. % of fibers torn (< 50% or > 50%)
1. complete: surgery
a. < 3 cm diastasis: end to end anastomosis
a. > 3 cm diastasis: graft with flexor hallucis longus
-also consider patient's activity level
Term
melorheostosis
Definition
1. dripping candle wax
1. can involve one side of bone
1. sclerotomal pattern
Term
AS and DISH predispose to
Definition
fracture and pseudoarthrosis
Term
H shaped vertebra and splenomegaly
Definition
1. sickle cell disease
1. Gaucher's disease in ashkenazi jew
Term
chondroblastoma
Definition
1. epiphyseal: shoulder, hip, knee. can involve the spine, patella, pelvis
1. skeletally immature
1. can be associated with abc
Term
chondromyxoid fibroma
Definition
1. metadiaphyseal lytic lesion usually proximal tibia
1. average age 18 years according to statdx
Term
pe protocol
Definition
1. 4 cc/s
1. slice thickness 1.25 mm
1. roi triggered when HU 200
Term
pulmonary Artery angiogram
Definition
1. go into IJ or femoral vein to RA, RV then right and left pulmonary A (make sure no LBBB prior to this)
1. check for severe pulmonary hypertension. if > 70 mmHg in pulmonary A then decrease amount of contrast injected (extra contrast and cause right heart failure)
Term
treatment of PE with thrombolectomy when
Definition
cardiopulmonary instability
Term
stents should be changed
Definition
q 6 m
Term
supply to adrenal gland
Definition
1. tumors: adrenal cortical carcinoma or pheochromocytoma
1. blood supply
a. superior adrenal A: from inferior phrenic A
a. middle adrenal A: from aorta above the renal A
a. inferior adrenal A: from proximal renal A
Term
drainage approaches
Definition
1. transabdominal
1. transrectal
1. transvaginal
1. transgluteal: go through sacrospinous ligament. stay near sacrum and away from sciatic nerve and gluteal vessels.
Term
peripheral vascular malformation
Definition
1. hemangioma or AVM
-draining vein occluded by balloon catheter or coils or glue
a. if low flow: percutaneous sclerotherapy with liquid scleroscent (alcohol or glue) in nidus
a. high flow: embolization
this needs to be confirmed. article was confusing.
-short answer: place tourniquet and inject alcohol percutaneously.
Term
persistent sciatic artery
Definition
1. sciatic artery comes off the internal iliac artery and supplies lower extremity
1. can get aneurysm and pseudoaneurysm from sitting on it.
1. treat with surgery not stent.
Term
when remove catheter done for abscess
Definition
1. can do abscessogram to look for fistula before pulling. we don't do that.
1. check and flush to make sure not just obstructed.
1. do imaging to make sure no residual collection
1. less than 15 cc output per 24 h.
Term
which chest nodes could be biopsied?
Definition
1. only prevascular nodes can be biopsied
1. if patient crashes after procedure, may be due to hemopericardium (like from pulmonary A).
1. tx hemopericardium: US guided pericardiocentesis with drain left in place.
Term
if see an cerebral infarct
Definition
1. infarct can be seen with decreased pet or cerebral perfusion.
1. if cerebral infarct, look at contralateral cerebellum to see if decreased perfusion. this is not due to cerebellar infarct, due to cerebellar diaschisis
1. if see cerebellar low perfusion or metabolism, look at contralateral cerebrum for infarct (may be only clue to cerebral CVA)
Term
what can you use to find cerebral ischemia
Definition
-diamox will dilate the normal cerebral vessels, but the abnormal vessels will have decreased perfusion because it is already dilated to its max
Term
how to figure out if the ica can be sacrificed
Definition
1. give diamox
1. occlude ica with ballon
1. ischemia region will have low perfusion
Term
how to check for csf leak
Definition
1. place pledglets in nose or ear
1. give indium 111 dtpa 500 uCi intrathecally
1. measure radioactivity in pledgets compared to blood serum levels. if > 1.5 then leak
1. image for leak at 1 and 3 hours
Term
hot pleural effusion of ascites on bone scan
Definition
malignant pleural effusion or ascites
Term
cerebral perfusion study
Definition
1. 5 sec: carotid
2. 10 sec: aca and mca (trident)
3. 15 sec: sss
-use tc pertechnetate 20 mCi, Tc HMPAO 10 mCi, Tc ecd 10 mCi
Term
bone scan
1. osteomyelitis vs cellulitis
1. stress fracture vs shin splints
Definition
bone scan
1. osteomyelitis vs cellulitis:
a. osteomyelitis: hot on all 3
a. cellulitis: hot on angiographic (aka flow), blood pool, but not delayed.
1. stress fracture vs shin splints
a. stress fracture: hot on all 3
a. shin splints: hot on delayed
1. stress fracture vs shin splints
Term
bone scan
1. oa vs spondylolysis
1. oa vs met
Definition
bone scan: look at spect images.
a. oa facet is more posterior. kind of at level of disc (but can still see vertebral body in some cases)

a. spondylolysis at level of vertebral body. may see bilateral as one side is the spondylolysis and the other side is the reactive

a. mets: involves vertebral bodies and pedicles (just adjacent to vertebral bodies)
------------------
1. facet oa vs spondylolysis

a. oa: at level of disc. facet is posterior
a. spondylolysis: at level of vertebral body
1. facet oa vs met
a. facet oa: at level of disc. facet is posterior
a. met: at level of vertebral body (can also involve pedicle)

-------------------
Term
if bone scan and uptake in kidneys (hotter than spine)
Definition
1. hyperparathyroidism
1. sickle cell disease
1. radiation
1. chemotherapy
1. iron overload
Term
bone scan with uptake in heart, skin, liver, skeletal muscle
Definition
amyloid
Term
if bone scan and uptake in liver
Definition
1. mets from mucinous adenocarcinoma like colon, ovary
1. diffuse hepatic necrosis. hcc. cholangiocarcinoma
1. recent tc sulfur colloid scan
1. amyloid
1. colloid formation (Al)
Term
colloid shift
Definition
1. normal: liver has most of activity then spleen and maybe a little for the bone marrow
1. colloid shift: spleen and bone marrow have more activity than the liver. due to
a. liver cirrhosis (can also have uptake in the lungs)
a. diffuse liver mets
----------------
Term
chest uptake on octreoscan
Definition
1. carcinoid
1. small cell
1. lymphoma
1. islet cell tumor, neuroblastoma or pheochromocytoma mets
1. other octreoscan uptake (not answer to this question): medullary thyroid cancer, pituitary adenoma
Term
hibernating vs infarct on nh3 and fdg pet
Definition
1. hibernating: no flow on nh3. flow on fdg pet
2. infarct: no flow on nh3 or fdg pet.
Term
lymphoma positive on
Definition
thallium
gallium
octreoscan
pet
Term
infant with hypothryoidism
Definition
1. do Tc 99 pertechnetate:
a. if no thyroid: could be absent thyroid
a. if +thyroid
1) in sublingual region then sublingual thyroid
1) if in thyroid bed or sublingual region. do I 123 study
a) if +I 123 study then just hypothyroid
a) if -I 123 study then congenital organification defect. confirm with perchlorite washout test.
Term
LeVeen or Denver shunt
Definition
1. use 1 mCi or Tc MAA or Tc sulfur colloid
1. see radiotracer in peritoneum (if using Tc sulfur colloid, would see normal sulfur colloid scan).
1. this shunt is for ascites and moves it into the ivc with a one way valve.
Term
if high thyroglobulin, but I 131 negative then
Definition
can do pet scan. if pet positive then could be anaplastic (dedifferentiated) or hurthle cell thyroid cancer. cannot treat these with I131. can give chemo or radiation.
Term
if see large bladder on bone scan
Definition
can ask patient to void and repeat scan.
Term
size of normal spleen should be
Definition
< 13 cm
Term
hmpao activity in basal ganglia and brainstem
Definition
1. not brain death
1. may be due to global anoxic injury from hypotension, asphyxiation
Term
urinary diversion on mag 3 scan with bowel activity. h/o nephrectomy and cystectomy.
Definition
1. urinary diversion done with ileal loop urostomy: a piece of ileum is taken from bowel and used to connect the ureter to a RLQ stoma
1. if see bowel activity on mag 3 scan then maybe there is a fistula.
Term
s/p leg amputation, bone scan showed increased activity in the ribs, stump and acetabulum
Definition
1. ribs: linear. likely fracture
1. stump: normal after surgery due to trauma and surgery
1. acetabulum: complex regional pain syndrome, infection, tumor recurrence. correlate with xr
Term
safe for discharge from hospital after I 131 treatment if
Definition
1. safe for discharge from hospital after I 131 treatment if < 7 mCi/hr (2 mrem/hr) at 1 m.
1. no written instructions required at this level.
Term
VQ scan
Definition
1. >2 large (>75% of a segment) mismatched defect (defect on flow, but not ventiliation): high probability. > 80% chance of PE. no further imaging. treat.
1. small (<25% of a segment) mismatched defect: low probability. < 20% chance of PE. no further imaging.
1. triple match (VQ and cxr) in mid to upper lobes: low probability. < 20% chance of PE. no further imaging.
1. matched (VQ): low probability. < 20% of PE. no further imaging.
1. stripe sign (perfusional defect with normal perfusion between the defect and pleura): low probability. < 20%. no further imaging.
1. all others: intermediate or indeterminate. can do bilateral lower extremity dopplers or CTA. 20-80% chance of PE.
1. matched (VQ): low probability
1. all others: intermediate or indeterminate probability
Term
4 bar phantom
Definition
1. checks linearity and spatial resolution.
1. done weekly
1. 4 quadrants with lines.
Term
if unicornuate uterus, consider
Definition
1. mrkh syndrome (mayer rokitansky kuster hauser syndrome)
2. also look for ipsilateral renal agensis
Term
hemochromatosis in and out of phase
Definition
1. in phase: very dark liver (more than out of phase)
2. opposite of fatty liver.
Term
fu hemochromatosis
Definition
T2* mapping (tells how much iron in liver)
Term
mrcp: image is from
Definition
t2
Term
1. bright blood technique: csf bright and vessel bright
2. dark blood technique
Definition
1. bright blood: due to steady state free precession
2. dark blood: T2
Term
delayed post contrast
Definition
1. actually double IR (don't say that because others may do some other tweaking)
1. blood is bright (csf not bright): so not ssfp
Term
breast cancer which is high on T2
Definition
-colloid carcinoma (aka mucinous carcinoma)
-usually T2 would usually mean benign breast tissue
Term
capsular retraction on mmg
Definition
pericapsular infection may be responsible for capsular retraction.
Term
tattoo sign
Definition
skin calcs will not change no matter what view you do.
Term
extra vs intra capsular rupture
Definition
1. extra: snow storm
2. intra: step ladder
Term
hilum convergence and overlay sign
Definition
1. hilum convergence: if not converging on mass: in middle juxtahilar mediastinum (not vascular)
1. hilum overlay: not converging on mass. in anterior or posterior mediastinum, but usually anterior.
Term
ascending dissection
Definition
1. check coronary arteries
1. check pulmonary arteries
1. check involvement of renal A and other takeoffs (celiac, sma, ima)
1. hemopericardium
Term
bronchogenic cyst can turn into
Definition
can turn into cancer
Term
hocm (hypertrophic obstructive cardiomyopathy) and delayed enhancement
Definition
get defibrillator
Term
causes of popliteal artery entrapment
Definition
1. muscle hypertrophy
1. extra muscles
Term
retropelvic space
Definition
1. retropelvic space aka retzius space
2. extraperitoneal
Term
if see medial tentorial artery of bernasconi cassanari
Definition
1. be concerned about dural meningioma and dural avf
1. medial tentorial artery of bernasconi cassinari
Term
looser zones
Definition
osteopenic bone or ricketic bone with fracture along medial surface. transverse. insufficiency fracture
Term
bucket handle tear vs radial tear
Definition
1. bucket handle tear: surgery
1. radial tear: heal on own
Term
ucl tear
Definition
1. ucl (ulnar collateral ligament: distal medial humerus to ulnar) appears more medial to the flexors (distal humerus)
1. treatment: tommy john surgery (tunnel graft)
Term
hair on end
Definition
1. hair on end is widening of the diploic space and periostitis
1. dd: thalassemia, sickle cell anemia, iron deficiency anemia and more
Term
hyperparathyroidism
Definition
1. primary: osteopenia, subperiosteal bone resorption, si joint erosions, brown tumors, subperiosteal erosion in radial (lateral) 2nd and 3rd middle phalanges (pathognomonic for hyperparathyroidism)
2. secondary: usually from renal osteodystrophy. osteosclerosis, rugger jersey spine,
Term
v2 and v3 through
Definition
V2: rotundum
V3: ovale
reverse alphabetical
Term
petrous apex lesion
Definition
1. petrous apicitis
1. cholesterol granuloma (high T1 and high T2) with dd of mucocele
1. bone lesions: chondrosarcoma, plasmacytoma, mets
1. eg, pagets, fibrous dysplasia
1. meningioma, nerve sheath tumor (schwannoma) etc.
Term
lyre sign (pronounced liar)
Definition
carotid body tumor splays the internal and external ica.
Term
dd pres
Definition
ask for mrv to r/o dd for pres
1. venous thrombus.
2. cortical vein thrombosis like with meningitis.
Term
germinoma vs pineal gland tumor
Definition
1. germinoma: engulfs pineal calcifications
1. pineoblastoma: peripheral calcificaions
1. pineocytoma: "explodes" pineal calcifications
Term
developmental dysplasia of the hip
Definition
1. hilgenreiner line: superior aspect of triradiate cartilage
1. perkins line: lateral aspect of acetabulum
1. shenton line: medial aspect of femoral neck to inferior border of pubic ramus. should be a smooth arc.
Term
rice bodies dd
Definition
1. dd rice bodies
a. infection like TB
a. synovitis or bursitis with RA or JIA
1. synovial osteochrondromatosis: difficult to differentiate from rice bodies.
Term
syndromes associated with
1. wilms tumor
1. neuroblastoma
drash syndrome, wagr, beckwith wiedeman
Definition
syndromes associated with
1. wilms tumor: WAGR, drash syndrome (wilms, pseudohermaphroditism, progressive glomerulonephritis), sotos (cerebral giantism), Beckwith Wiedemann
1. neuroblastoma: NF 1, Hirsprung, Beckwith Wiedemann
Term
high density in thalamus or cerebellum
Definition
1. reversal sign or white cerebellar sign
1. normally white matter is higher density than gray matter
1. if gray matter (thalamus or ~cerebellum) higher density than white matter then hypoxic ischemic injury in child
Term
ipmn: types
Definition
1. main branch: pancreatic duct dilated.
1. side branch: pancreatic duct not dilated. can be multicystic
1. combination main and side branch appearance.
Term
peri vs para pelvic cyst
Definition
peri: lymphatic drainage.
para: no lymphatic drainage
Term
rokitansky nodule
Definition
same as dermoid plug
Term
gartner cyst associated
Definition
with gu anomalies.
Term
tx bartholin's and gartner's duct cyst
Definition
1. bartholin's cyst: marsupialization if recurrent disease
1. gartner's duct cyst: marsupialization if symptomatic then marsupialization
Term
what is allowed in each area
Definition
-should be less than 2 times background
I. restricted area: if not less than 2 times background then should wash
II: unrestricted area: should be less than 2 times background
Term
cardiac mr
Definition
1. subendocardial, mesocardial, subepicardial, transmural
1. if > 50% then cannot revascularization
1. if infarct, but some areas not showing delayed enhancement. this may be due to microvascular plugging (no reflow zone)
Term
two sequences used in cardiac MR imaging
Definition
ssfp, delayed enhancement
Term
thick left ventricular wall and hetergeneous enhancement on delayed imaging.
Definition
amyloid
Term
loefler endocarditis
Definition
1. subendocardial enhancement, not in a vascular distribution
1. can have clots also
Term
takotsubo cardiomyopathy
Definition
1. reversible left ventricular akinesis
1. no delayed enhancement
1. no significant coronary artery narrowing angiographically
Term
management fo subsolid pulmonary lesions
Definition
1. < 5mm ggo: no fu needed
1. > 5 mm ggo: fu at 3m then yearly for 3 years.
Term
temporal lobe high T2 and flair in temporal lobe: dd
Definition
1. herpes encephalitis
1. limbic encephalitis: paraneoplastic syndrome especially from small cell cancer
1. gliomatosis cerebri
Term
hiv and ring enhancing lesion dd
Definition
1. high choline: lymphoma
2. lactate doublet: toxoplasmosis
Term
subfalcine herniation
Definition
worry about compression of bilateral aca and aca infarcts
Term
extensive sub arachnoid hemorrhage. mc region
Definition
a comm
Term
attached to septum pellucidum
Definition
1. central neurocytoma
1. choroid plexus papilloma
1. subependymoma/ependymoma
1. intraventricular metastasis
Term
intraventricular lesion
Definition
1. choroid plexus papilloma/carcinoma (kids: atria, adults: 4th ventricle)
1. cenral neurocytoma, meningioma, astorcytoma, mets
Term
dd crangiopharyngioma
Definition
1. germinoma
1. mets
1. etc.
Term
dissection on mr
Definition
t1 fat sat
Term
pres vs. infarct
Definition
pres
1. no restricted (if restricted then worry about infarct)
1. no enhancement (if enhancement, worry about infarct subacute)
1. only involves white matter (if involves gray then maybe infarct)
1. causes: htn, immunosuppressive tx (cyclosporine)
1. if resolves in two weeks then due to pres. if doesn't resolve, maybe due to infarct.
Term
if cc formed posteriorly, but not anteriorly, think about
Definition
semilobar holoprosencaphly
Term
cerebellar mass
Definition
1. medulloblastoma in adult
1. mets
1. hemangioblastoma
1. pilocytic astrocytoma
Term
poorly seen on fdg pet
Definition
1. renal cell carcinoma
1. prostate cancer
1. neuroendocrine tumors
1. low grade glioma
1. bronchoalveolar carcinoma (adenocarcinoma in situ)
Term
1. poorly seen cancers on bone scan
1. cold defects
Definition
1. poorly seen cancers: renal cancer, thyroid cancer, myeloma (because lytic)
1. cold defects: avn, hemangioma, radiation induced fibrosis
Term
bone scan and
1. spleen hot
2. RUOQ hot
Definition
bone scan and
1. spleen hot: sickle cell disease, thalassemia, large subcapsular hematoma, hemosiderosis
1. RUOQ hot: hepatoblastoma, neuroblastoma in child
Term
octreoscan
Definition
1. neuroblastoma
1. pheochromocytoma/paraganglioma
1. carcinoid
1. islet cell tumor
1. small cell cancer, lymphoma, breast cancer
1. pituitary adenoma, medullary thyroid
Term
prep for fdg pet (non cardiac)
Definition
1. fast 4 hours
1. no exercise 24 hours
1. long acting insulin the night before
1. if insulin given in morning then should wait 2 hours until test
Term
can you use a dose calibrator for wipe test?
Definition
You cannot use a dose calibrator for a wipe test. need to use a well counter.
Term
osteomyelitis vs. normal marrow
Definition
1. normal marrow: see both areas on indium labelled wbc and Tc sulfur colloid
1. osteomyelitis: see hot on indium labelled wbc, but not on Tc sulfur colloid
Term
if see defect in mrv, look at
Definition
if see defect on mrv, look for high T1 in veins to confirm thrombus.
Term
birads
ultrasound and mmg lexicon
Definition
ultrasound
1. shape: round, oval, irregular
2. margins: circumscribed, indistinct, spiculated, microlobulated, angular
mmg
1. shape: round, oval, irregular, lobular
2. margins: circumscribed, indistinct, microlobulated, spiculated, ill defined)
both use roi cis: round, oval, irregular, circumscribed, indistinct, spiculated
Term
Nuclear medicine studies
Definition
1. spleen > liver
a. -kidneys: sulfur colloid with colloid shift, wbc labelled study.
a. +kidneys: indium 111 labelled octreoscan (No GI/vascular uptake. spleen and kidneys) and rbc labelled study (+GI/vascular uptake)
1. liver > spleen: sulfur colloid study
1. liver = spleen
a. +bone and bowel. + lacrimal glands: gallium
a. -bone and bowel. + heart and liver: I 123 MIBG
1. no liver. no spleen
a. +salivary glands: Tc pertechnetate
a. +diffuse liver and GU/GI: I 131 or I 123
Term
treat splenic artery aneurysm
Definition
1. coil from distal to proximal across aneurysm
1. treat if symptomatic, > 2.5 cm, enlarging
1. treat if asymptomatic in pregnant women or women who may become pregnant.
Term
anterior tibial, peroneal, posterior tibial artery from lateral to medial
Definition
anterior tibial (dorsalis pedis), peroneal, posterior tibial (medial and lateral plantar A)
Term
emergency premedication
Definition
1. solumedrol 40 mg or hydrocortisone 200 mg IV q 4h until exam.
1. benadryl 50 mg IV prior to exam.
1. steroid have not been shown to be effective < 4 hours prior to contrast injection
Term
how do you size
1. balloon:
1. stent:
Definition
how do you size:
1. balloon: 10% larger than normal adjacent artery
2. stent: 1 mm larger than normal adjacent artery and 1-2 cm longer
Term
angioplasty candidate
Definition
1. concentric
1. noncalcified
1. < 3 cm stensois
Term
if after angioplasty… then can stent
Definition
1. if after angioplasty… then can stent
a. > 30% stenosis
a. pressure gradient > 10 mmHg at rest
a. pressure gradient > 20 mmHg after vasodilator
1. can stent with nitinol stent
1. good for angioplasty if: concentric stenosis, < 3 cm, noncalcified.
Term
median arcuate ligament syndrome
Definition
median arcuate ligament syndrome
1. worsens with expiration
1. tx: surgery
1. celiac can fill via gastroduodenal and pancreaticoduodenal arteries
Term
paget schroetter syndrome
Definition
1. thoracic outlet syndrome
1. do abduction
1. look at other side to see if bilateral
1. associated with well developed musculature, supernumerary muscles, cervical rib, can do rib removal or scalenectomy
1. tx: thrombolysis, anticoagulation, surgery.
1. no angioplasty, no stent.
Term
pulmonary aneurysm
Definition
1. if multiple: HHT (hereditary hemorrhagic telangiectasia). From pulmonary A: tx coiling
1. presentation: paradoxical emboli (abscess and cva)
1. family members should also be checked for aneurysms
Term
mesenteric ischemia
Definition
1. need 2/3 of celiac, sma and ima for mesenteric ischemia
1. symptoms: food fear, post prandial abdominal pain
1. collaterals
a. celiac to sma: gastroduodenal pancreaticoduodenal. arc of buhler
a. sma to ima
1) marginal artery of drummon
1) arc of riolan
a. ima can receive flow from the internal iliac A via the hemorrhoidal A
Term
abdominal aortic aneurysm
Definition
1. repair if > 5 cm. Can use a smaller number in women and those with connective tissue disorders
1. tx: surgery or endovascular stent
Term
internal iliac branch pseudoaneurysm
Definition
1. tx: coil or gelfoam
1. if in midline, can coil both branches from internal iliac
1. if patient unstable, can take out entire internal iliac
1. should look at contralateral internal iliac A and femoral A to look for other trauma.
Term
abscess
Definition
1. approaches: transabdominal, transvaginal, transrectal, transgluteal (through sacrospinous ligament, stay close to sacrum and away from sciatic nerve and vessels)
1. < 15 cc/ 24h and abscess resolved on imaging. abscessogram to look for fistula
1. sample should be sent for culture and sensitivity.
Term
angiodysplasia
Definition
1. usually in the right colon, especially the cecum.
1. tx: embolization has been attempted with variable success. surgery.
1. appearance: tangle of vessels and early draining vein. the parallel artery and vein have a tram track appearance.
Term
cholangiogram
Definition
1. manipulation should be minimized in those with suppurative cholangitis.
1. give abx
1. contraindication: uncorrrectable coagulaoathy, massive ascites.
Term
svc obstruction tx
Definition
1. if malignant: radiation with or without chemotherapy
1. if benign:
a. anticoagulation
a. surgery
a. endovascular stenting
1) if no thrombus: stent
1) if thrombus: thrombolysis and stent.
Term
arteries and veins of upper extremities
Definition
1. arteries, subclavian, axillary, brachial, radial, ulnar. there is also median A and interosseous A
1. veins: subclavian, axillary, cephalic (from subclavian), basilic (from axillary). there is also median V
Term
tips
Definition
1. transjugular intrahepatic portosystemic shunt
1. indications: ascites, varices, hydrothorax refractory to medical management
1. abnormal gradient > 12 mmHg
1. gradient is portal vein pressure (portal vein pressure estimated by hepatic vein wedged pressure) minus RA pressure.
1. hepatic vein branches point to feet. portal vein branches point to head.
Term
normal pressures
1. Right atrium
1. Right ventricle
1. pulmonary artery
Definition
normal pressures
1. Right atrium: 5 mmHg mean
1. Right ventricle: 30/ 5 mmHg
1. pulmonary artery 30/5 mmHg
Term
acute femoral artery embolization
Definition
tx: surgical embolectomy or bypass grafting if limb severely threatened.
Term
thrombolytic therapy in chronic dvt
Definition
1. thrombolytic therapy in chronic dvt less likely to succeed.
1. signs of chronic dvt (> 2w): lack of venous dilatation, presence of collaterals and more
Term
venogram to check for
Definition
1. IVC duplication: left common iliac vein drains into a left sided ivc, which drains into left renal vein
1. left sided IVC: drains into coronary sinus then RA or just into RA
1. retroaortic or circumaortic left renal vein. usually at L2-L3
1. accessory left renal vein
1. supra renal placement if pregnant or may become pregnant, gonadal/renal vein clot, no room below the renal veins (need 3 cm to land a filter), failed ivc filter)
Term
causes of renal artery narrowing
Definition
atherosclerotic disease, fibromuscular dysplasia, dissection, neurofibromatosis
Term
sma embolus tx
Definition
1. surgery is treatment of choice
1. endovascular repair in rare cases if proximal short segment.
Term
bronchial artery bleeding
Definition
1. also check subclavian A/axillary, internal mammary, inferior phrenic A
1. use 350 um pva
1. shunting, hypervascularity, hypertrophy, neovascularity.
Term
jna
Definition
juvenile nasopharyngeal angiofibroma
1. embolize ascending pharyngeal (look for delayed enhancement of orbits; sometimes supply of orbit is from external carotid. if supply of orbit from eca then cannot do embolization cuz might go blind)
1. embolize with particles
Term
hcc
Definition
hcc tx
1. liver transplant
1. if no cirrhosis: resection
1. if cirrhosis:
a. < 3 cm: ablation
a. > 3 cm or not in suitable location for ablation: embolization
Term
tips
Definition
1. covered region of viotorr stent should be intraparenchymal
1. calculate MELD score (based on serum bilirubin, INR, serum creatinine). if < 18 then can have tips. if > 18 and have tips, may get liver failure.
Term
gradient
1. normal
1. goal if varices
1. goal if ascites
Definition
portosystemic gradient (psg)
1. normal < 6 mmHg
1. goal if varices: 12 mmHg
1. goal if ascites: 10 mmHg
Term
to make sure what you are seeing on mmg is what you are biopsying on us
Definition
25 gauge needle in the mass on the mammogram
Term
how to perform stereotactic biopsy
Definition
1. consent: allergy to lidocaine, blood thinners, pregnancy
1. calc in window. 15 degree plus minus (stereo pair) to calculate z.
1. mammotome 10 samples. 8 gauge mammotome vacuum assisted device (14 gauge for US guided. kopan's needle for needle loc)
1. radiograph of specimen to make has calcs
1. leave clip behind in region of biopsy.
1. confirmatory mmg to confirm position (cc and straight lateral). (also do cc and straight lateral for needle loc.)
Term
cortex abnormal if
Definition
> 4 mm
Term
cyst
complicated:
complex:
Definition
cyst
1. complicated: thin septation, hemorrhagic, fluid debris level, debris moving inside. birads 3
1. complex: solid portion. birads 4
Term
dd papilloma
Definition
1. papillary lesion (papilloma, papillary carcinoma), dcis, debris if history of trauma.
(for papilloma: can biopsy then surgery, fna then surgery depending on surgeon)
1. 30-31 gauge needle for ductogram (premedicate like CT if allergy). mix 0.5 cc omnipaque and 0.5 cc saline. until pain or refluxing out.
Term
kinetics breast
Definition
blue: persistent. good
yellow: plateau. baddish
red: washout. bad
Term
if two breast masses: index is
Definition
the bigger one.
Term
on mr, non mass like enhancement
Definition
1. check with US
1. if not seen on US then can do MR guided bx
Term
needle localization
Definition
1. alphanumeric grid (> 7 cm length) or US (< 5cm length)
1. kopan's 21 gauge hookwire system
1. thick portion of wire through lesion on both views (MLO and true lateral)
1. bb is on skin
1. 1 cm deep to the lesion MLO and true lateral view.
1. L on specimen image stands for lateral
Term
simple cyst
Definition
1. anechoic
1. posterior enhancement
1. edge shadowing
Term
if calcs > 2 cm then do
Definition
bracketing (need to know superior inferior and medial lateral cuz dissect all the way back anyway)
Term
if lymphoma or breast mets then
Definition
birads 2
Term
when do mags
Definition
1. mags: cc and true lateral
1 spot: cc and mlo
Term
lymph node likely in
Definition
RUOQ (if in other quadrants, work up for malignancy)
Term
if radial scar
Definition
give birads 5
Term
tubular cancer looks like
Definition
radial scar
Term
mr:
cancer
mucinous
firoadenoma
Definition
cancer: low T2, enhancing:
mucinous cancer: high T2. enhancing
fibroadenoma: high T2. enhancing.
Term
dd for bilateral breast masses
Definition
cysts, fibroadenoma, lymphoma, mets, multicentric breast cancer
Term
breast gauges
Definition
1. 8 g: mammotome for stereotactic. 10 samples
1. 14 g: US guided biopsy.
1. 21 g needle for kopan hookwire system
1. 25 g needle for confirming that US lesion is the same lesion on mmg
1. 30 g needle for ductogram
Term
alternative to TIPS if gastric varices
Definition
1. brto (balloon occluded retrograde transvenous balloon occlusion)
1. occlusion balloon (via left renal vein into splenorenal shunt), put in sclerosing agent.
Term
tips normal pressures
1. main portal vein
1. stent
Definition
tips normal pressures
1. main portal vein: > 30 mmHg = normal
1. stent: 90-190 mmHg = normal
Term
when follow up tips
Definition
1. 2w, 3m, 6m, 12m then yearly or if symptoms
Term
tips
1. indications
1. contraindications
1. problem cm/s
Definition
tips:
1. indications: ascites, varices, hydrothorax refractory to medical management
1. absolute contraindications
a. MELD score (based on serum bilirubin, serum creatinine, INR) > 18
a. polycystic kidney disease
a. severe encephalopathy
a. right sided heart failure
1. relative contraindications
a. pulmonary hypertension
a. tumor in path of the shunt
a. active infection
a. hepatic or portal vein thrombosis
a. hepatopulmonary syndrome (shortness of breath due to liver disease)
1. problem with shunt if
a. main portal vein < 30 cm/s
a. shunt outside the range of 90-190 cm/s
a. temporal change of > 50 cm/s (checked at 2w, 3m, 6, yearly or if problem)
a. he
a.
Term
dd hemoptysis
Definition
1. AVM: coil
1. bronchial A particle > 350 um
1. pulmonary aneurysm from swan ganz catheter or rasmussen aneurysm (if from pulmonary A then coil. if from bronchial A then particles?)
1. pulmonary embolism: thrombolysis with TPA (1 mg/hr)
a. thrombolysis for severely symptomatic patients
a. absolute contraindications: cerebral hemorrhage, cerebral tumor, cerebral trauma, active bleeding
Term
what to measure during tips procedure
Definition
1. pre tips: RA pressure, hepatic wedge pressure (estimates portal vein pressure) and free pressure (estimate RA pressure)
1. post tips: RA pressure, portal vein pressure
1. goal of portal systemic gradient
a. 12 mmHg for varices
a. 10 mmHg for ascites
Term
hypervascular liver mass
Definition
1. adenoma, fnh, hemangioma
1. hcc, mets
Term
splenic artery aneurysm
Definition
1. tx if symptomatic, > 2.5 cm, enlarging
1. tx if asymptomatic and pregnant or may become pregnant.
1. use coils with sandwich technique
1. when coiling aneurysm, worry about splenic infarct so need to give vaccinations: pneumococcal and meningococcal
Term
nephrostomy technique
Definition
1. seldinger technique (not mentioned by Roti)
1. Single (1) stick technique for when there is hydronephrosis or pyonephrosis etc. (can see the renal pelvis easily). under US guidance.
1. double (2) stick technique for stones. 1st aim for stone then place contrast or air to localize the calyces. place chiba needle. discuss with surgeon where they would like the stent (usually stent above the stone is better)
-this info from Roti
Term
if symptomatic from liver cyst and ADPKD
Definition
1. put needle in cyst
1. inject contrast to make sure there is no connection with the biliary tree (may have connection because they are bile duct cysts)
1. if no connection, can inject alcohol
1. check blood alcohol level.
1.
Term
treatment of hepatic artery aneurysm
Definition
coil using sandwich technique
Term
how can you treat fibrous dysplasia
Definition
cementoplasty and kyphoplasty
Term
ankle brachial index from stanford
Definition
< 0.4 pain at rest. vascular referral.
0.4-0.8 claudication. vascular referral.
0.8-0.9 medical management for some arterial disease
> 0.9 -1.0 acceptable
Term
biliary stent tx
1. benign
1. malignant
Definition
biliary stent tx
1. benign: angioplasty
1. malignant: stent either placed by GI or IR
Term
complication of ivc filter
indication for filter
Definition
1. complications: ivc clot, new PE, new DVT, filter migration
1. indication for filter: contra indication to anticoagulate or require major surgery in near future
Term
what vessel can supply lesion at dome of diaphragm
Definition
phrenic A from aorta or celiac
Term
treatment of AVF
Definition
1. coil (preferred method)
1. covered stent
1. surgery (if indicated)
Term
G tube placement
Definition
1. put air into stomach. aim for body of stomach
1. indications: proximal or distal obstruction, reflux, dementia
Term
uterine embolization
Definition
1. on pre op MRI: fibroid should enhance
1. don't treat pedunculated fibroids.
1. need to embolize uterine artery distally (past the cervicovaginal A) bilaterally with particles
1. avoid ovarian A (can cause menopause) and cervicovaginal A
1. for women who don't want to be pregnant.
Term
tx of osteoid osteoma
Definition
can treat with radiofrequency ablation as probably < 3 cm. (osteoblastoma is > 1.5 cm)
Term
fistulogram
Definition
1. native AVF: radial-cephalic, brachiocephalic, brachiobasilic
1. loop graft
1. clinical presentation
a. if cold extremity: problem with artery. cannot angioplasty an artery so refer to surgery. however, if there is thrombus at the arterial side, can use fogarty balloon to pull the thrombus on the arterial side to the venous side to remove.
a. if edema in extremity then likely problem on venous side.
1. fistula lasts longer than grafts.
Term
common variant hepatic anatomy
Definition
1. replaced right hepatic A coming from the sma
1. replaced left hepatic A coming from the left gastric A
Term
nephrostomy
Definition
1. consent patient: bleeding, infection.
1. look at prior imaging
1. give antibiotics
1. place patient prone.
1. prep and drape using sterile technique
1. local anesthesia
1. use US or fluoroscopic guidance (Seldinger, one stick or two stick technique)
1. postero lateral approach through line of Brodell (avascular area of kidney).
Term
sinistral portal hypertension
Definition
1. splenic vein thrombus or obstruction usually due to pancreatitis or pancreatic cancer.
1. causes portal hypertension and gastric varices
1. tx: splenectomy
1. however, if cannot do splenectomy then can try balloon occluded retrograde transvenous occlusion (BRTO)
1. if cannot do splenectomy and low platelets, can embolize spleen.
Term
pneumothorax
Definition
pneumothorax
1. more susceptible to pneumothorax: emphysema, COPD
1. if # of fissures need to cross higher then risk of pneumothorax higher
1. check cxr 1 and 3 h post biopsy
1. if pneumothorax, place chest tube.
1. air leak if patient coughs and see air bubble. if air leak, stay for another 24 h to wall suction. if no air leak then put to water seal for few hours and if still no air leak then discharge.
Term
look at childs pugh score for chemoembolization
Definition
childs pugh is based on
1. bilirubin, inr, albumin, ascites, encephalopathy
(MELD is based on bilirubin, inr, creatinine)
Term
acute vs chronic compression fracture
Definition
1. low T2 chronic: don't treat
1. high T2 acute: treat
Term
if avf in transplant
Definition
coil
Term
pseudoaneurysm
Definition
1. yin yang
1. to and fro waveform
1. dampened waveform (Arterial and venous waveform together)
Term
treatment of endoleak
Definition
1. only type II is treated with coiling of feeding vessels
1. other types are surgical
"graftogram"
Term
bypass graft occlusion
Definition
1. usually due to stenosis at anastomotic sites
1. tx: thrombolysis if acute (< 2w)
Term
uterine artery embolization (uae)
Definition
1. pre op mri: fibroid should enhance. make sure not pedunculated. r/o adenomyosis. look for aberrant uterine artery anatomy, look for supply to fibroids from ovarian A.
1. high T1 signal in fibroids correlated with less shrinkage of fibroid.
Term
treatment of may thurner syndrome
Definition
1. catheter directed thrombolysis and stent.
Term
other supply of bronchial artery
Definition
1. subclavian/axillary A, internal mammary, inferior phrenic
1. pulmonary A, aorta
1. 350 micron particles
1. bronchial arise from aorta at T5-T7.
Term
avoid placing needle ___ rib
Definition
avoid placing needle under rib due to intercostal artery
Term
thrombolysis
Definition
1. 1 mg/hr tpa. fibrinogen should be > 150. if < 100 then stop. if 100-150 then turn down tpa.
1. heparin 5000u bolus then 500u/hr. ACT should be > 250
1. trial max 48h
1. if stent then give plavix 75 mg daily and asa (?81mg)
Term
hemobilia
Definition
1. if due to liver parenchyma or bile duct fistula with portal vein/hepatic vein then may just resolve with conservative management. may need to upsize the biliary drainage catheter
1. if due to bile duct fistula with hepatic artery, do angiogram to look for cause of bleeding. if cannot find cause then remove catheter over wire and repeat study. if find pseudoaneurysm with fistulous connection to bile duct, can put balloon up in area of bleeding while doing coiling of pseudoaneurysm (sandwich technique from distal to proximal)
Term
1. atoll sign or reverse halo sign
1. halo sign
Definition
1. atoll sign or reverse halo sign: organizing pneumonia. ggo surrounded by consolidation.
1. halo sign: ABPA. consolidation surrounded by ggo.
Term
foreign body retrieval
Definition
amplatz nitinol gooseneck snare
Term
pericatheter fibrin sheath
Definition
1. problem when aspirating, but not injecting
1. can treat with low dose thrombolytic agents
1. contrast flows within pericatheter fibrin sheath on imaging.
Term
flow in hepatic cirrhosis
Definition
increased
Term
transjugular biopsy of diffuse liver disease
Definition
1. R IJ, R hepatic V, turn anteriorly (away from liver capsule). use metallic guiding canula to take one or more biopsies.
1. transjugular biopsy of diffuse liver disease can be done in the setting of ascites or impaired coagulation
Term
indications for bare stent placement in abdominal aorta or iliac artery
Definition
1. technical failure of angioplasty (> 30% stenosis, > 10 mmHg systolic gradient, recurrent stenosis), dissection, eccentric, longer, heavily calcified stenosis.
Term
dd renal aneurysm
Definition
1. polyarteritis nodosa (kidneys, liver, pancreas)
1. necrotizing angiitis from speed (e.g. speed kidney)
1. mycotic aneurysm
Term
cortically based lesions
Definition
do gp
-dnet: bubbly lesion (high T2) which points to ventricles.
-oligodendroglioma: calcifications
-ganglioglioma: cyst and nodule in temporal lobe
-pleomorphic xanthoastrocytoma: cyst and nodule in temporal lobe
Term
tx of vein of galen aneurysm
Definition
glue
Term
what causes the calcification in sturge weber?
Definition
calcification in sturge weber due to
ans: dystrophic calcs
Term
optic nerve gliomas
Definition
child: pilocystic astrocytoma
adult: gbm
Term
periventricular leukomalacia
Definition
1. due to hypoxia
1. premature watershed area: periventricular (non premature child and adult watershed area would be between aca, mca, pca).
Term
branchial cleft cyst
Definition
II: posterior to the submandibular gland, lateral to the carotid space, anterior to the sternocleidomastoid muscle
I: near external auditory canal or extending from the external auditory canal
III: posterior to the carotid space. medial to sternocleidomastoid muscle
Term
retropharyngeal vs prevertebral abscess.
Definition
1. retropharyngeal abscess: anterior to longus colli muscles. ENT
1. prevertebral abscess: posterior to longus colli muscles. neurosurgery
Term
dd for myxopapillary ependymoma
Definition
1. nerve sheath tumor
1. epidermoid cyst
1. mets
Term
long vs short segment spinal cord high flair/T2
Definition
< 2 segments: MS
> 2 segments: adem, devic's disease
Term
what has target sign in
Definition
target sign: both nf and schwannomas, but more for nf. post contrast T1 demonstrates peripheral enhancement.
Term
extradural vs extramedullary intradural
Definition
extramedullary intradural has csf both proximally and distally
Term
dd for osteomyelitis in spine
Definition
1. TB: spares disc until late in disease.
1. brucellosis: not common in US
1. fungal: typically spares disc
1. modic 1 changes: low T1, high T2 with enhancement.
Term
spares disc
involves disc
Definition
1. spares disc: tb/fungal infection. mets
1. involves disc: acute disciitis.
Term
post surgical back
Definition
1. scar enhances
1. failed back surgery syndrome (some characteristic from stat dx)
a. recurrent disc: doesn't enhance
a. arachnoiditis
a. stenosis
Term
liver pseudoaneurysm treatment from trauma
Definition
gelfoam or coil (case 94 crs)
Term
pelvic lymphocele treatment
Definition
case 95 ir crs
1. drain
1. if persistent, then can put sclerosing agent (absolute alcohol) 2-3x per week until resolved
Term
popliteal artery aneurysm
Definition
1. commonly bilateral
1. check aorta for aneurysm
1. tx: surgery
Term
acute cholecystitis, gallbladder rupture and pericholecystic abscess
Definition
1. drain abscess
1. place percutaneous cholecystostomy drain. drain removed when
a. surgeon takes out gallbladder or
a. percutaneous removal of all stones, and mature tract is present, no problems when tube is capped.
Term
yttrium 90 microspheres
Definition
1. hcc
1. colorectal cancer mets
-need to check anatomy prior to treatment
-can embolize vessels that you don't want yttrium to go to like gastroduodenal or right gastric arteries
-give 5 mCi of Tc MAA prior to tx to check for any extrahepatic activity (there shouldn't be any) then can give ytttrium
Term
pleural catheter placement
Definition
-if palliative for malignant pleural effusion, can use tunneled catheter placed under fluoroscopic or ultrasound guidance.
-can also use chemical sclerotherapy if persistent effusion
Term
hepatic artery problem in transplant
Definition
1. if hepatic artery stenosis or thrombosis then biliary strictures
1. treatment
a. stenosis: angioplasty or surgery
a. thrombosis: surgery
Term
tx for free floating thrombus in ivc
Definition
1. can do ivc filter placement even if no contraindication to anticoagulation
Term
azygous and hemiazygous
Definition
right: azygous
left: hemiazygous
Term
treatment for biloma
Definition
can drain biloma
Term
renal vein renin sampling
Definition
if one side is > 1.5 times the other side. the side that is higher has the renal artery stenosis
Term
What artery feeds
1. mallory weiss tear
1. duodenal ulcer
Definition
What artery feeds
1. mallory weiss tear: left gastric A
1. duodenal ulcer: gastroduodenal A
Term
saucerization
Definition
periosteal osteosarcoma vs infection vs cortical desmoid (in posterior distal femur).
Term
hypothenar hammer syndrome
Definition
1. ulnar artery prone to aneurysm or thrombosis as it crosses the hook of the hamate bone
Term
endoleak
Definition
1. follow grafts with CT pre, arterial, and delayed imaging
1. type I: needs urgent surgical repair
1. type II: most common. fills from lumbar, sacral, gonadal, accessory renal, ima branhces. can treat with side branch or glue embolization o faneurysm sac or watchful waiting.
Term
treatment of peripheral venous malformation
Definition
direct injection of 100% alcohol sclerosant after injecting contrast (to see how much sclerosant to inject)
Term
mycotic aneurysm
Definition
irregular, saccular, eccentric
don't insert stent or graft
can use native vessels for bypass
tx: surgical resection of aneurysm
Term
tx for takayasu's arterities
Definition
1st choice: steroids
2nd choice if still stenosis: surgical bypass (like carotid to subclavian A aka carotid subclavian bypass)
3rd choice if still stenosis: angioplasty and/or stenting
Term
pancreatic pseudocyst drainage indicated
Definition
1. infected pseudocyst
1. persistent pain 6 wks following initial pancreatitis episode
1. remove drain when < 10 cc/d for 2 days
Term
how to check for portal vein obstruction on angiogram and why
Definition
-check for portal vein obstruction on venous phase of sma injection
-should see smv, main portal vein, right and left portal veins
-if portal vein obstruction may not be able to do chemoembolization in hepatic A (risk of necrosis)
-if portal vein obstruction, may have to remove before TIPS or use a non obstructed portal vein (e.g. left portal vein)
Term
how often do you change ureteral stents
Definition
q 3months
Term
treatment of benign ureteral stricture
Definition
can do ureteroplasty (case 130 crs ir)
Term
treatment of choledocholithiasis
Definition
1. ERCP with sphincterotomy and stone removal
1. biliary drainage to relieve obstruction
Term
oral contrast
Definition
1. 1-2% barium for CT (95% is what we use for barium enema)
1. don't want to use oral contrast when looking for pancreatic mass, biliary stone or gu stone.
Term
aspergillosis forms
Definition
1. ABPA: treat with steroids
1. mycetoma: saprophytic form. if hemoptysis, consider embolization
1. invasive
1. semi invasive
Term
dd pap
Definition
pulmonary hemorrhage
lymphoma/leukemia
Term
protein alveolar proteinosis
Definition
-accumulation of protein rich and lipid rich surfactant material in alveoli.
-types
1) primary: due to increased production by type II pneumocytes or decreased clearance by macrophages. may be immune mediated. Pt may have antibody to GMCSF (granulocyte macrophage colony stimulating factor)
2) secondary: immunodeficiency states, protein intolerance, acute silica exposure
1. tx: broncho alveolar lavage or treat underlying disorder if secondary.
Term
flail chest
Definition
1. at least 3 ribs involved
1. inspiration the chest collapses: parodoxical motion
1. need elective intubation
Term
round atelectasis
Definition
-opacity near pleura and whirl pattern in adjacent lung parenchyma
-don't biopsy. not lung mass.
Term
mesothelioma dd
Definition
adenocarcinoma pleural mets
invasive thymoma
Term
castleman disease
Definition
1. benign lymph node enlargement with uniform enhancement
1. can have calcs
1. -calcs and uniform contrast enhancement of LN
-in mediastinum
-tx:
1) unicentric disease: surgery
2) multicentric disease: steroids, monoclonal antibodies and more
-dd carcinoid
Term
chf and pressures
Definition
normal pcwp < 12 mmHg
> 15 mmHg: cephalization
> 20 mmHg: pulmonary interstitial edema
> 25 mmHg: pulmonary alveolar edema (batwing)
Term
pulmonary nodule
Definition
1. contrast enhancement < 15 prob benign
1. if washout > 60% then probably benign (get pre, enh at 80s and delayed at 10 min)
Term
acute and chronic clot on T1 and T2
Definition
acute clot: iso T1, hypo T2 (can look like normal T2 flow void)
subacute clot: high T1, high T2
chronic: iso T2
Term
when do you start timing
Definition
from beginning of injection
Term
CT liver
Definition
1. arterial (20 s, aorta > portal vein), portovenous (80s, aorta = portal vein), delayed (10 min)
1. look for arterially enhancing lesions
a. hemangioma: nodular peripheral enhancement with centripetal fill in.
a. fnh: fades out to liver on portovenous phase. can confirm with eovist (fnh retains contrast enhancement with eovist)
a. enhances and washes out to lower than liver.
1) if cirrhotic: hcc
1) if not cirrhotic: hypervascular mets, adenoma (has microscopic fat on mr imaging (drops signal on out of phase imaging)).
1. if a lesion is low on portovenous phase, may be hypovascular mets like from colon ca.
Term
signs of cirrhosis
Definition
1. nodularity
1. right lobe hypertrophy
1. widening of the fissures
1. ascites
1. splenomegaly
Term
crescent sign
Definition
stone in cbd surrounded by fluid (crescent shaped fluid)
Term
resectable pancreatic cancer
Definition
unresectable if
1. distant mets
1. portal vein invasion
1. circumferential involvement of the celiac, sma or hepatic A
Term
how to biopsy pancreatic cancer
Definition
US endoscopic bx
Term
timing of adrenal lesion washout
Definition
pre, enhanced (60 s), delayed (10 min. 15 min delayed is classic teaching)
Term
renal protocol
Definition
1. pre, split nephrographic and excretory phases.
1. split would be: be give half dose and wait 7 minutes, give other half of the dose then image at 90 seconds.
Term
when trigger for pe
Definition
> 180 HU in the main pulmonary artery
Term
ct urogram
Definition
1. can give water to drink
1. can also give lasix 20 mg
Term
high resolution chest
Definition
1. no IV contrast
1. edge enhanced bone protocol
1. 1 mm thickness at 15 mm intervals
Term
ctdi (adult head, adult abd, child abd) and dlp
Definition
CTDI: CT dose index mGy
1. adult head 60 mGy
1. adult abd 35 mGy
1. child abd 25 mGy
1. dlp: dose length product mGy-cm
Term
image wisely
Definition
1. match protocol to indication so that one test can answer question
1. minimize image creep. no overlap if chest, abd, pelvis
1. minimize phase creep. don't do extra phases unless necessary
1. use split bolus in CT urography
1. use breast shields
1. report radiation dose
Term
when percutaneous stone removal is planned, what calyx provides easiest access into ureter?
Definition
upper pole calyx
Term
male breast masses
Definition
male breast masses
1. don't get fibroadenoma or lobular carcinoma
1. looks like fibroadenoma: myofibroblastoma
1. can look circumscribed or spiculated: granular cell tumor
Term
white out of one side of lung
Definition
1. pushes: pleural effusion
1. pulls: atelectasis (due to enchobronchial tumors like lung carcinoma, carcinoid, hamartoma, adenocystic carcinoma, mucoepidermoid carcinoma, metastatic tumors
Term
lung abscess vs empyema
Definition
1. lung abscess: same measurements on PA and lateral radiographs
2. empyema: different measurements on PA and lateral radiographs
Term
causes of rib notching
Definition
coarctation of the aorta
neurofibromatosis
Term
thymic mass and gct and lymphoma
Definition
1. thymoma: may have calcs. look for indistinct borders which would suggest invasive thymoma
1. invasive thymoma: look for chest wall invasion. can look like mesothelioma
1. thymic carcinoma: spreads hematogenously
1. thymolipoma: has fat
1. gct: fat and calcs
1. lymphoma: has lymph nodes
Term
dose calibrator with lead shield
Definition
L block shield with dose calibrator
Term
used to block radiation
Definition
lead brick
Term
survey meter
Definition
1. daily qc: battery, background, constancy
1. types of survey meters
1. cutie pie
1. gm counters
Term
blue toe syndrome
Definition
-subacute or chronic microembolization
-can be due to atherosclerotic clot in aorta showering down to the legs.
-tx endovascular or long term anticoag with asa 81 mg, plavix, coumadin (not confirmed elsewhere)
Term
tx for acute pe with right heart strain
Definition
1. catheter directed thrombolysis/thrombectomy or surgical thrombectomy
1. IV tPA only after above.
Term
cholecystostomy
Definition
1. transhepatic route to gallbladder. US guidance. stay below diaphragm.
1. place catheter
1. give abx before like keflex
1. cannot pull before 6 w (need a mature tract)
Term
ascending and descending aorta dissection
Definition
ascending: anterior is false lumen
descending: posterior left lateral is the false lumen
Term
dissection aortic tx
Definition
1. balloon fenestration especially if false lumen supplying renal A, celiac, sma.
1. stent
1. surgery
Term
tx type II endoleak
Definition
-coil collateral vessel. stick sac directly or go from artery below.
Term
uterine artery embolization
Definition
1. fu mri 3 months after ufe
1. particle size for embolization: pva 500 microns. perform bilaterally
1. contraindication: known uterine malignancy or prior radiation for cervical cancer.
1. cannot do pedunculated fibroids.
1. go past cervicovaginal A.
Term
characteristics of bleeding from bronchial A
Definition
-av shunting, hypertrophy, hypervascularity, neovascularity, corkscrewing
-may also be supplied by subclavian, internal mammary, inferior phrenic, intercostals, pulmonary a, aorta
Term
biliary stenosis: tx.
Definition
benign: angioplasty
malignant: stent
Term
coarctation of the aorta: types
Definition
two types: preductal (infantile), juxtaductal/postductal (adult)
Term
popliteal A aneurysm
Definition
1. bilateral 10%
1. aorta also has aneurysm 1/3 of time
1. tx: thrombolysis followed by covered stent or surgery
1. worry about distal embolization
Term
leriche syndrome tx
Definition
1. no endovascular repair
1. tx: surgical
Term
avf in kidney transplant
Definition
coil
Term
transgluteal approach
Definition
-as close to sacrum as possible and ideally below the piriformis muscle
-through the sacrospinous ligament
-away from sciatic nerve and vessels
Term
causes of retroperitoneal fibrosis
Definition
1. idiopathic: Ormond's
1. aortitis
1. drugs like methysergide, beta blocker, hydralazine, ergotamine, lsd
1. diseases that simulate desmoplastic reaction
1. tx: steroids, ureteral stents
Term
hypothenar hammer syndrome
Definition
1. tx: consider anticoagulant, antiplatelet therapy or surgery. if acute clot, maybe thrombolysis.
1. dd: Raynaud's, Buerger's disease, vasculitis, atherosclerotic disease, emboli
Term
treatment of rcc
Definition
can embolize with particles
(embosphere is brand of pva polyvinyl alcohol, which is a particle)
Term
types of liver abscess and treatment
Definition
1. echinococcal: stay away from draining
1. amoebic: can treat with metronidazole (flagyl), but if persistent then can drain.
1. pyogenic:
Term
buerger disease tx
Definition
usually just medical management
Term
if cxr, look for
Definition
right aortic arch
Term
popliteal artery syndrome
Definition
1. medial deviation of the popliteal artery
1. may be due to the medial head of the gastrocnemius
1. can do MRI to see which muscle is deviating the popliteal A medially.
1. tx: surgery
Term
when do we do mri in patient with newly diagnosed breast cancer?
Definition
young women with dense breasts
Term
kinetic curve breast
Definition
60s, 90s, 90s
Term
TB
1. Ranke complex
1. Ghon focus/lesion
Definition
TB
1. Ranke complex: calcified pulmonary nodule and calcified LN
1. Ghon focus/lesion: lung nodule at site of primary TB
Term
characteristics of pulmonary embolism
Definition
1. peripheral wedge shaped opacities
1. feeding vessel
1. central lucencies
Term
halo sign
Definition
1. aspergillus
1. mucormycosis
1. vasculitis
1. hemorrhage
Term
low density lymph nodes
Definition
1. TB
1. atypical mycobacteria
1. fungal
1. metastatic disease
Term
calcified lymph nodes
Definition
1. TB, fungal (histoplasmosis), sarcoid, silicosis
1. treated lymphoma
1. osteosarcoma mets
Term
suspect bronchopleural fistula if
Definition
post pneumonectomy, if there is a decrease in fluid and shift of mediastinum away from pneumonectomy, suspect bronchopleural fistula (normal post pneumonectomy is increased in fluid and shift of mediastinum toward pneumonectomy.)
Term
dd lymphangitic spread of tumor
Definition
1. atypical infection
1. drug toxicity
case 64
Term
if pulmonary nodule enhanced image is > ____HU then is concern for malignant process
Definition
if pulmonary nodule enhanced image is > 15 HU then is concern for malignant process
Term
level elevated in sarcoid
Definition
ace levels
Term
ascending aortic aneurysm
Definition
1. cystic medial necrosis (Marfan's and Ehlers-Danlos syndromes), atherosclerosis, syphilis,
1. annuloaortic ectasia: refers to pear shaped appearance of ascending aorta due to dilated sinuses of Valsalva
1. fix if > 5.5 cm (fix if descending aorta > 6.5 cm)
Term
boerhaave's syndrome
Definition
1. esophageal rupture due to vomiting
1. pneumomediastinum and pneumothorax
1. usually left sided.
Term
Kaposi's
Definition
1. thickening of bronchovascular bundles
1. dd: lymphoma, lymphangitic spread of tumor, sarcoid
1. kaposi's vs lymphoma: lymphoma (not Kaposi's) will be positive on gallium scan
Term
apical cap
Definition
1. superior sulcus tumor
1. lymphoma
1. hematoma
1. abscess
Term
if difference in breast composition
Definition
1. tram flap (in breast that is less dense)
1. inflammatory breast cancer (in breast that is more dense)
Term
tram flap
Definition
transverse rectus abdominus myocutaneous flap
Term
if lesion is medial, what view do you get?
Definition
want lateral medial view to see medial lesion better. receptor closer to medial region on lateral medial view.
Term
US guided biopsy
Definition
-consent patient. ask for history of anticoagulants like asa, plavix, coumadin
-do US (can also scan axilla if breast mass looks worrisome)
-mark entrance site
-prep and drape
-let patient listen to the spring loaded 14g biopsy device
-place 2% lidocaine for superficial and deep tissues
-nick with scalpel
-take 4-5 samples
-make sure take image of biopsy
-compression for 5 min
-place clip and post clip two view mmg
Term
calc in axillary ln: dd
Definition
1. tb, sarcoid, fat necrosis
1. breast mets (if new, then US then bx), ovarian mets, thyroid mets
1. gold deposit for tx of RA, silicone deposition
Term
thrombophlebitis
Definition
1. superficial location
1. tubular or beaded structure
1. mondor's disease
1. tx: supportive care. analgesics for pain, warm compresses. can completely resolve in 6 wks. don't need anticoagulants.
Term
opacity, density, mass, focal asymmetry, asymmetry
Definition
1. never use the words: opacity or density
1. use only: mass, focal asymmetry, asymmetry
Term
densities
Definition
1. almost entirely fat
1. scattered fibroglandular densities
1. heterogeneously dense
1. extremely dense
Term
birads stands for
Definition
breast imaging reporting and data systems
Term
retro areolar plane
Definition
aka posterior nipple line
Term
how describe depth
Definition
1. anterior, middle and posterior 1/3 for depth
1. say anterior depth, middle depth, posterior depth.
Term
phyllodes tumor tx
Definition
-10% of phylloides tumors are malignant
-if get phyllodes tumor, results are concordant, but need to surgically excise.
50% bilateral popliteal aneurysms
Term
popliteal artery aneurysm
Definition
50% bilateral popliteal aneurysm
1/3 associated with aortic aneurysm
Term
if new mass or palpable mass in breast then
Definition
bx
Term
if calcs in medial side:
Definition
1. do spot mag cc and LM.
1. don't say pleomorphic on screening mmg, describe on spot mags
Term
if extensive segmental calcifications , bx
Definition
bx most posterior and anterior extent
Term
adequacy of specimen radiograph
Definition
if calcs right at edge then tell them surgeon that there is calcs at the margin and they have to take more
Term
if see fat necrosis
Definition
look for h/o surgery or trauma
Term
popcorn calcs in breast mass
Definition
fibroadenoma (involuting)
Term
parallel vs antiparallel
Definition
don't use taller than wide (antiparallel) or wider than tall (parallel)
Term
which NF goes to breast
Definition
nf1
Term
markers
Definition
1. round nipple marker
1. linear scar marker
1. round mole marker
1. triangle palpable mass
Term
stereotactic not too easy if:
Definition
1. too posterior near chest wall or too anterior near nipple
1. if less than 2 cm breast when compressed
1. in these circumstances, may need surgical bx excision
Term
implants retro pect or pre pectoral?
Definition
1. prepectoral: over pectoralis muscle
1 retropectoral: under pectoralis muscle.
Term
if abnormal mammogram
Definition
1. compare with old exams.
1. look at blind spots (behind nipple and periphery of breast. 1. look for more than one finding.
Term
systematic approach to every case
Definition
1. say views
1. composition
1. masses (look at blind spots, behind nipple and periphery of breast), focal asymmetry, asymmetry
1. calcifications
1. architectural distortion
1. nipple retraction
1. lymph nodes
Term
1. spot compression for mass
1l spot mag for calcs
Definition
1. spot compression for mass: mlo, lateral and cc.
1l spot mag for calcs: lateral and cc.
-medial lateral view for lesion in lateral aspect
-lateral medial view for lesion in medial aspect
Term
abnormal lymph node cortex
Definition
2mm. can do core bx (no one does fna anymore)
Term
fibromatosis coli:
Definition
-sternocleidomastoid M larger on one side compared to the other
-regresses on own
-do not touch lesion
-may be related to trauma
Term
nasolacrimal duct mucocele
Definition
1. nasolacrimal duct mucocele: start with massage. may need pediatric ENT involvement (stent, surgery)
1. dd: dacrocystocele (acquired lacrimal duct cyst)
Term
types of radial head dislocation
Definition
1. traumatic:
2. congenital: most commonly posterior. often bilateral.
Term
wormian bones
Definition
1. idiopathic wormian bones
2. osteogenesis imperfecta
3. cleidocranial dysostosis
1. down syndrome
2. metabolic disease (rickets, hypothryoidism)
Term
Osteogenesis imperfecta
Definition
fragile bones
blue sclera
abnormal dentition
hearing impairment
wormian bones
imaging findings: multiple fx, osteoporosis, kyphoscoliosis
Term
polyostotis fibrous dysplasia
Definition
1. mccune albright syndrome: precocious puberty with cafe au lait spot (coast of maine)
1. mazabroud: soft tissue myxoma
Term
microcolon dd
Definition
ileal atresia
meconium ileus
total hirschprung
immature colon
Term
dd for posterior urethral valves
Definition
eagle barrett (aka prune belly syndrome): cyptoorchidism, absent anterior wall muscles, gu anomalies
Term
intussusception
Definition
1. consult surgeon
1. have 18 g needle ready in case perforate and need to decompression pneumoperitoneum.
1. 3 attempts, 3 minutes each. 3 feet above patient.. But in reality, more attempts and more time.
1. use water soluble contrast or air insufflation (< 120 mmHg). most places use air insufflation cuz if perf, only air.
1. target sign, pseudokidney sign.
Term
scoliosis
Definition
1. idiopathic: mc. thoracic spine usually curves to right thoracic. lumbar usually curves to left.
1. nf1: usually focal and severe. can have neurofibromas.
1. marfans and erlos danlos can cause scoliosis
1. osteoid osteoma: usually focal like nf, but not severe
1. neuromuscular: long C shaped curves.
1. correct with rods > 40 degrees
Term
hemangioendothelioma
Definition
1. can regress on own
1. if small and accessible, can remove.
1, if cannot remove: can give medications like interferon and vincristine and rapamycin
Term
if 4 yo and looks like jna: might be
Definition
rhabdomyosarcoma
(jna usually causes anterior bowing of posterior wall)
Term
abd cyst with multiple septations
Definition
1. duplication cyst: gut wall signature sign
1. meseneteric syt
1. meconium pseudocyst: calcs
1. renal cyst
1. ovarian cyst: look for normal ovaries
1. choledochal cyst
Term
sequestration
Definition
1. extralobar: infants present with respiratory distress. more common in infants.
1. intralobar: older children present with recurrent infections. mc overall
1. supplied by aora
Term
tracheo esophageal atresia
Definition
mc type: esophageal atresia and distal te fistula
assoc with trisomy 21 and vacterl
Term
image gently
Definition
image gently for kids
1. reduce radiation in children
1. look for alternative like US or MR
1. fluoro.
a. on pulsed fluoroscopy.
a. save image rather than taking another exposure (use last minute hold)
a. only mag when really need to.
1. ct: use special protocols for children
1. take vow to image gently.
Term
hydrocele types
Definition
1. congenital: more common in children.
a. encysted type
a. furnicular: doesn't go around testicle.
1. acquired: goes around testicle.
Term
constrictive pericarditis
Definition
1. calcification of pericardium.
1. thickness of pericardium > 4 mm
1. septal bound during inspiration
Term
myxoma vs mets
Definition
1. both enhance
1. myxoma: attached to interatrial septum. usually LA. can have delayed enhancement. well defined. tx: resection.
1. mets: more aggressive (not usually pedunculated). can be multiple. usually early enhancement as very vascular.
Term
bright blood steady state free precession gradient vs post contrast imaging
Definition
if post contrast then liver or pulmonary artery should be bright.
Term
aneurysm of saphenous vein graft
Definition
-may see area of coronary vessels marked by round markers
-look for thrombosis of the aneuryslm
Term
hypokinesis, akinesis, dyskinesis
Definition
1. hypokinesis: decreased contractility

2. akinesis: no contractility

3. dyskinesis: paradoxical dilatation during systole (should be contracting during systole): may represent infarct or scarring. may also be associated with aneurysm formation.
Term
views mr of heart
Definition
1. short axis: aka 2 chamber view (LV and RV)
1. vertical long axis: ~sagittal. LA and LV
1. horizontal long axis: aka 4 chamber view. ~axial
1. 3 chamber view: see LA, LV, aorta
Term
hibernating myocardium vs infarct/scar on mri
Definition
1. ~hibernating myocardium: < 50% enhancement on delayed imaging
1. infarct/scar: > 50% enhancement on delayed imaging
Term
1. narrow vascular pedicle due to small aortic arch
1. ra enlargement (convex right heart border)
1. increased pulmonary vascularity due to left to right shunt
1. cardiomegaly
Definition
asd
Term
tof
Definition
can preferentially affect one pulmonary (right)
Term
ebstein's anomaly
Definition
1. atrialization of the RV.
1. downward displacement of septal (and posterior) leaflets of tricuspid.
1. RA and RV enlargement (retrosternal space obliterated. heart should not touch the posterior aspect of the sternum)
1. associated with ASD (secundum type)
Term
mitral stenosis.
Definition
1. lae.
1. l atrial appendage enlargement.
1. RA, RV enlargement
1, interstitial edema
1. associated with rheumatic heart disease.
1. can confirm with echocardiogram
Term
hypertrophic cardiomyopathy
Definition
if enhancement then fibrosis and may need icd (implantable cardioverter defibrillator)
Term
sickle cell disease can get
Definition
1. sickle cell cardiomyopathy: cardiomegaly with chf
1. acute chest syndrome: pulmonary opacity (due to infarct, infection)
1. sickle cell: osteosclerosis, fish mouth vertebral bodies
Term
cause of aortic stenosis
Definition
bicuspid aortic valve (fish mouth appearance on MR)
Term
scimitar syndrome associated with
Definition
sequestration
Term
calcification projecting over heart
Definition
1. calcified thrombus
1. calcified coronary aneurysm from kawasaki (tubular and following vessel lad)
1. calcified myxoma more common in RA
Term
malignant course of anomalous left coronary artery
Definition
1. risk of sudden death
1. between pulmonary artery and aorta
1. tx: coronary bypass or reimplantation of left coronary artery
Term
myocardial bridging
Definition
1. segment of coronary artery takes an intramyocardial course
1. treatment needs to be discusssed as ranges from medical to surgical
Term
mitral stenosis vs mitral regurgitation
Definition
1. mitral regurgitation: LV tends to enlarge
1. mitral stenosis: LV doesn't tend to enlarge.
1. usually mixed
Term
centrilobular ground glass opacities
Definition
1. subacute hypersensitivity pneumonitis
1. respiratory bronchiolitis
1. respiratory bronchiolitis-interstitial lung disease
Term
Holt Oram syndrome
Definition
1. associated with asd, vsd, pulmonary stenosis
1. radial dysplasia/aplasia
Term
gut wall signature sign
Definition
1. echogenic mucosa (3)
1. hypoechoic muscle (2)
1. echogenic on both side and in middle, separated by hypoechoic.
Term
ligamentum teres
ligamentum venosus
Definition
ligamentum teres: obliterated umbilical vein
fissure for ligamentum venosus: ductus venosus
Term
hydatid
1. unilocular
type 2: multiple cysts: failry large
type 3: very small cysts like arpckd and ccam type 3
Definition
Term
lam
Definition
lam high lung volumes and looks almost normal.
Term
tracheo b o
Definition
Term
medisstinal lipomatosis
Definition
vs lipoma. compress esophagus. lipomatosis more diffuse.
Term
mliary
Definition
sarcoid
Term
extramedullalry hematoposise and extra medullary hematopo osteopetrosis
Definition
Term
pneumomediastinum from bleomycin
Definition
Term
clemphysema
Definition
dd swyer james syndrome.
Term
cystic thymoma wiht mural nodules
Definition
dd cystic teratoma
Term
pig bronchus (suis)
Definition
extra bronchus
Term
ssc, mucoepidermoid in trachea.
Definition
Term
sarcoid ,silicossis and can cavitate.
Definition
Term
asymptomatic and high attenuation
Definition
alveolar microlithiasis
Term
pas stain for protein alveolar protein. nocardia.
Definition
Term
bronchovascular markings:
Definition
Term
if multiple cysts through otu lugn: lam
Definition
Term
look at amiodarone in lungs. high attenuating and liver too.
Definition
Term
high density lung
Definition
silicosis, amiodarone, ?amyloidosis?
Term
8mm pet scan
Definition
Term
description of mr breast lesions
Definition
1. focus of enhancement: < 5 mm
1. mass: 3D mass with convex margins
1. non mass: can represent dcis or lobular carcinoma
1. shape: round, oval, irregular, (also lobular)
1. margins: smooth, irregular, spiculated
roil sis
Term
zinner syndrome
Definition
1 seminal vesicle cyst
1. ipsilateral renal agenesis
1. ejaculatory duct obstruction
Term
if septate uterus
Definition
1. want to distinguish fibrous vs muscular septum.
1. muscular septum can bleed a lot so approach is different.
Term
von hippel lindau follow up
Definition
1. abdominal us yearly starting age 11 years
1. CT abdomen q 1-2 years after age 20 years.
1. retinal and cerebellar hemangioblastoma
1. renal cysts, rcc
1. pancreatic cysts, pheochromocytoma, islet cell tumor
1. hepatic cysts
1. epididymal cystadenoma
Term
dd for retroperitoneal fibrosis
Definition
1. retroperitoneal fibrosis: idiopathic (Ormond's disease), due to drugs like methylsergide
1. aortitis
1. lymphoma
1. mets
Term
ovarian torsion on MRI
Definition
1. large ovary
1. peripheral follicles
1. decreased enhancement
Term
salpingitis isthmica nodosa
Definition
diverticuli from the fallopian tube.
Term
ovarian tumors
Definition
1. ovarian epithelial tumors
1. dermoid (fat and calcs)
1. fibroma (can have Meig's syndrome with ascites and pleural effusions)
Term
multiple filling defects in the
1. renal pelvis
1. ureter
1. bladder
1. renal and ureter
Definition
multiple filling defects in the (due to multiple small cysts in the wall)
1. renal pelvis: pyelitis cystica
1. ureter: ureteritis cystica
1. bladder: cystitis cystica
1. renal and ureter: pyeloureteritis cystica
Term
what sequence do you use to detect silicone implant rupture
Definition
1. water suppressed STIR (only silicone is bright)
1. look for linguine sign, keyhole, teardrop, noose signs
Term
what zone do you measure in adenomyosis
Definition
1. junctional zone.
Term
paintbrush appearance of the pyramids
Definition
medullary sponge kidney
Term
extraperitoneal vs intraperitoneal bladder rupture
Definition
1. extraperitoneal bladder rupture: associated with pelvic fractures. flame shaped. molar tooth pattern. pear shaped bladder. conservative treatment.
1. intraperitoneal bladder rupture: blunt trauma in child can result in intraperitoneal bladder rupture since the bladder in a child is more intraperitoneal. outlines small bowel loops. surgical treatment.
Term
ulnar variance
Definition
ulnar variance
1. positive ulnar variance: ulna moves distally to TFC (triangular fibrocartilage). ulnar impaction syndrome (aka ulnolunate abutment)
2. negative ulnar variance: ulnar moves proximally. unlar impingement syndrome. assoc with Keinboch's (AVN of the lunate)
Term
medial vs lateral epicondylitis
Definition
1. medial epicondylitis: golfer's elbow. dd: tear of ulnar collateral ligament
1. lateral epicondylitis: tennis elbow. dd: tear of radial collateral ligament.
Term
differential lung distribution
Definition
1. perilymphatic: sarcoid, pneumoconiosis like silicosis or coal worker's pneumoconiosus, lymphangitic spread of tumor, lymphoma. bronchovascular, subpleural, septal
1. random: TB, fungal, mets, (andrea says sarcoid)
1. centrilobular: bronchiolitis, respiratory bronchiolitis (interstitial lung disease), hypersensitivity pneumonitis, vasculitis, bronchoalveolar carcinoma (adenocarcinoma in situ)
Term
plantaris tendon rupture
Definition
1. plantaris tendon rupture
1. fluid between soleus and gastrocnemius
1. aka tennis leg
Term
dd periosteal reaction child
Definition
1. physiologic < 6m
1. child abuse
1. osteomyelitis
1. Caffey's disease < 6m. infantile cortical hyperostosis
1. hypervitaminosis A
1. scurvy
1. prostaglandin therapy
1. fluorosis
Term
sonk vs ocd
Definition
1. sonk (spontaneous osteonecrosis of the knee): older people. insufficiency. medial condyle
1 ocd (osteochondral defect or osteochondritis dissecans): younger people. fatigue e.g. microtrauma. lateral aspect of medial
Term
what is more superior: portal or hepatic veins?
Definition
hepatic veins
Term
aliasing
Definition
aliasing
1. increase the prf,
1. cannot detect true peak velocity due to low doppler sampling rate.
Term
rcc vs column of bertin
Definition
rcc vs column of bertin. differentiate with mag 3 study
1. rcc: decreased radiotracer uptake
1. column of bertin: will be same as rest of cortex (looks like cortex on US)
Term
multicystic dysplastic kidney
Definition
1. non communicating cysts
1. associated with slight increase in Wilms tumor
1. look for contralateral UPJ obstruction
1. tx:
a. surgery if complicated by infections, Wilms tumor
a. if no surgery then need to follow up with serial US
Term
subclavian steel clinical symptoms
Definition
1. arm exercise can cause vertebral basilar insufficiency
Term
1. renal artery stenosis
1. bypass graft stenosis
1. tips should be
1. carotid
Definition
1. renal artery stenosis: > 200 cm/s
1. bypass graft stenosis: > 300 cm/s
1. tips should be 90-190 cm/s and less than 50 cm/s change from baseline
1. carotid:
a. < 50% stenosis: < 125 cm/s. ica/cca ratio < 2
a. 50-69% stenosis: 125-230 cm/s. ica/cca ratio 2-4
a. > 70% stenosis: > 230 cm/s. ica/cca ratio > 4
Term
echogenic kidneys
Definition
1. small: medical renal disease:
1. large:
a. HIV
a. diabetes
Term
incompetent cervix
Definition
< 3 cm is abnormal
funneling (V shaped) is bad
tx: cerclage
Term
dd arpkd
Definition
1. meckel gruber syndrome: post axial polydactyly. can have hyperechoic kidneys. encephalocele
1. patau (trisomy 13) syndrome: post axial polydactyly. has hyperechoic enlarged kidneys. holoprosencephaly.
Term
tumor thrombus in ivc
Definition
1. ask for us of the adrenals, kidneys and liver
1. hcc
1. rcc, wilms
1. adrenal cortical carcinoma
Term
types of dcis
Definition
dcis
1. non comedo: solid, cribiform, micropapillary
1. comedo
Term
multifocal vs multicentric
Definition
1. multifocal: at least 2 foci in 1 quadrant
1. multicentric: at least 2 foci in 2 or more quadrant or more than 5 cm apart.
Term
if want to check for lymphoma
Definition
need to place in rpmi solution for flow cytometry
Term
fatty liver
Definition
1. fatty liver can be due to etoh, diabetes, obesity, steroid, non alcoholic steatohepatitis (NASH)
1. NASH can lead to cirrhosis
1. with elevated liver enzymes, consider biopsy to r/o NASH
Term
epiploic apendagitis
Definition
epiploic apendagitis
1. fat surrounded by hyperdense ring +/- central dot of increased attenuation (thrombosed vein or hemorrhage)
1. dd omental infarct: fat with surrounding fat stranding. doesn't have the central dot. omental infarct in region of omentum.
Term
focal nodular hyperplasia
Definition
focal nodular hyperplasia
1. if need confirmation of fnh on CT then can do mr with eovist. fnh will be hyperintense on delayed (hepatobiliary) imaging. (colorectal cancer mets will be hypointense on delayed (hepatobiliary) imaging)
1. fnh has weak association with ocp use
1. if the patient is on ocp then stop ocp and repeat mr with eovist in 6-12 m
Term
cavernous hemangioma
Definition
1. types of cavernous hemangioma: capillary (< 2 cm) and giant (>10 cm)
1. if you see something that looks like cavernous hemangioma and if h/o colon cancer then would get mr to make sure not mets
Term
fatty replacement of pancreas
Definition
1. fatty replacement of pancreas dd: cf, dm, chornic pancreatitis.
1. if malabsorption from pancreatic insufficiency, can replace with pancreatic enzyme.
Term
rectus sheath hematoma dd
Definition
rectus sheath desmoid tumor (however, the desmoid tumor doesn't cause acute pain and doesn't have surrounding stranding)
Term
if hyperdense liver
Definition
GI WATT
Gold therapy, iron deposition, wilson's disease, amiodarone (if large ivc, suspect heart dz and can do high resolution CT of the chest), thoratrast, type I and IV glycogen storage disease.
Term
nutmeg liver
Definition
1. Budd Chiari syndrome: can evaluate with Ultrasound
1. Right heart failure
1. constrictive pericarditis
Term
follow up
Definition
follow up
1. scroll through other images to look for other lesions
1. try to stage by looking at lymph nodes and other organs
1. can do PET CT
1. can do biopsy
Term
if multiple cysts in the liver
Definition
1. autosomal dominant polycystic kidney disease (associated with liver cysts and berry aneurysms)
1. hepatic cysts can occur with von hippel lindau (would have renal and pancreatic cysts)
1. polycystic liver disease (associated with polycystic kidney disease). can treat with cyst aspiration or fenestration if symptomatic.
1. biliary cystadenoma
1. echinococcus
Term
if pancreatic mass
Definition
endoscopic ultrasound guided biopsy
Term
if scleroderma, may have
Definition
crest syndrome (calcinosis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia)
Term
biloma dd
Definition
1. dd: biloma (from bile duct injury), seroma, hematoma, abscess.
1. may need aspiration to confirm biloma or r/o infection.
1. can also confirm biloma with hida scan
1. ptc (percutaneous transhepatic cholangiography) or ercp (endoscopic retrograde cholangiopancreatography) may be necessary to find the site of leakage
Term
main duct type ipmn
Definition
main duct ipmn
1. confirm with ercp (if see copious mucinous dc from papilla).
1. treatment: total pancreatectomy (taking age into account) as main duct ipmn is considered pre malignant
Term
cystic lesion in pancreas dd
Definition
cystic lesions in pancreas
1. pseudocyst
1. serous or mucinous neoplasm
1. ipmn
1. cystic islet cell tumor
Term
follow up of cystic lesion in pancreas
Definition
1. more aggressive management if: younger patient, high serum amylase, abdominal pain, diabetes, malabsorption.
1. if < 2 cm then fu with T2 MR in q year. if no change then no further fu needed. if growth or > 2 cm then further characterization with mr to further decide if need more follow up vs surgery.
Term
pancreatic stone tx
Definition
obtain surgical consult to determine feasibility of removing stone
Term
dd high T2 in liver
Definition
high T2 in liver: liver cyst, biliary hamartoma (von meyenburg complex), hemangioma
Term
causes of splenic infarct
Definition
causes of splenic infarct: trauma, splenomegaly in cirrhosis, embolic process
Term
hepatic subcapsular hematoma follow up
Definition
1. ask if prior trauma, hypercoagulable state (due to drugs or disease states)
1. look for associated masses: hcc hepatic adenoma can be associated with hemorrhage
1. need fu to resolution to r/o underlying neoplasm
Term
multiple low densities in spleen dd:
Definition
1. most common: lymphoma, sarcoid (can look at chest for sarcoid)
1. fungal infection (usually will involve liver if spleen involved)
1. mets (rare. usually will involve liver if spleen involved). melanoma can involve the spleen without liver
1. can bx a liver lesion if seen. can do fna of spleen.
Term
if persistent pancreatic pseudocyst,
Definition
1. confirm suspicious of fistula with ercp
1. consider surgical treatment as pseudocyst will not go away without surgery if fistula
Term
tx pseudoaneurysm in liver
Definition
tx pseudoaneurysm in liver: inject thrombin
Term
hyper vascular mets to liver:
Definition
neuroendocrine tumors like pancreatic islet cell tumor and bowel like carcinoid.
Term
psoas m abscess:
Definition
appendicitis, crohn's disease, tb
Term
if inflammation around small bowel
Definition
dd: sb diverticulitis (can have abscess), crohn's disease
Term
pancreatic divisum:
Definition
1. can have recurrent pancreatitis.
1. if symptomatic may need surgery or endoscopy
1. can perform US secretin test to see who might benefit from sphincterotomy. if secretin dilates duct then may benefit from sphincterotomy. (statdx)
Term
mesenteric mass dd
Definition
1. carcinoid (calcs, can do octreoscan. carcinoid will be negative on pet), sclerosing mesenteritis, desmoid (usually after surgery, no calc and with gardners), mets (look for tumors in GI tract. may need pet for staging), lymph nodes (from infection), lymphoma (send in rpmi solution for flow cytology. may need pet for staging), mesothelioma, mesenteric GIST
1. rec bx.
Term
benign appearing submucosal stomach lesion
Definition
gist, neurofibroma, lipoma
Term
s/p bariatric surgery
Definition
1. can see lap band
1. look for complications like ulcer and stomal stenosis
Term
if retroperitoneal ln, check
Definition
if retroperitoneal lymph nodes (not mesenteric), check testicle
Term
dd omental caking:
Definition
1. peritoneal mets from ovarian, colon and breast
1. primary peritoneal carcinoma and mesothelioma (rare)
1. lymphoma
1. TB
1. percutaenous image guided bx
Term
subcapsular (surface) low density in liver
Definition
1. surface hepatic mets (especially from ovarian tumor)
1. suspect infection or abscess if pain
1. hematoma
1. biloma
-look for other lesion in peritoneum
-rec percutaneous bx
Term
fat vs air
Definition
put on lung window. if dark then air. if not dark then fat
Term
if splenic hemangioma on mr.
Definition
no need for further imaging if splenic hemangioma on mr
Term
if bladder and rectum affected,
Definition
if bladder and rectum affected, think pelvic radiation changes
Term
biopsy for liver lesions that look like hcc?
Definition
1. American association for the study of liver disease
1. if cirrhotic liver, hypervascular tumor on arterial and washes out on portovenous or delayed, > 1cm and wash then can say it is hcc without bx.
1. european system takes into account afp.
Term
low density lesions in liver and spleen
Definition
1. if immunocompromised: kaposi, lymphoma, candida
1. if malignancy, can be mets like melanoma
1. sarcoid, histoplasmosis, tb
may need bx if hx doesn't help
Term
dd multiple lytic lesions in skull
Definition
1, leukemia/lymphoma
1. neuroblastoma mets (can have widened sutures)
1. langerhans
Term
sirenomelia
Definition
1. fusion of lower extremities
1. caudal regression spectrum
1. children of diabetic mothers
1. associated with vacterl and currarino triad (scimitar sacrum, presacral mass, anorectal malformations)
Term
dd diffuse platyspondyly
Definition
1. diffuse platypondyly i = multiple levels of vertebra plana
1. dd: cushings disease, on steroids for asthma, leukemia, sickle cell disease, scheuerman's, osteoporosis, multiple myeloma
Term
epiglottitis
Definition
1. ballooning of hypopharynx
1. thumb sign anteriorly of epiglottis
Term
croup
Definition
1. ballooning of hypopharynx
1. steeple sign
1. x ray done to rule out foreign body, wall irregularity, or filling defect. don't need xr to diagnose croup.
Term
cyst in oral cavity: dd
Definition
1. dermoid: has fat. can have "stack of marbles" appearance
1. epidermoid: has fluid
1. plunging ranula
1. lymphatic malformation
Term
thyroglossal duct cyst: usually midline or off midline?
Definition
1. usually off midline
Term
sacrococcyal teratoma types
Definition
I: primarily external: best prognosis
II: external and internal components: 1/2 and 1/2
III: external and internal components: more internal
IV: primarily internal: worst prognosis
tx: resection
Term
agenesis of right pulmonary artery
Definition
left side will be hyperlucent
Term
halo around pulmonary lesion: dd
Definition
candida, invasive aspergillosis
Term
swyer james syndrome:size lung
Definition
smaller lung
Term
cpam
Definition
cpam
1. worse prognosis in type III due to association with cardiac anomalies
1. complication: may have malignant transformation.
1. tx: surgery. however, smaller singular cysts can be observed as alternative to surgery.
Term
chest wall mass dd in child
Definition
chest wall mass dd
1. askin tumor
1. ewing's sarcoma
1. neuroblastoma mets
1. rhabdomyosarcoma (can arise in any area, not necessarily where skeletal muscle is found. doesn't arise from skeletal muscle. just differentiates into tumor with skeletal muscle morphology.)
Term
how to describe where something is in "lung"
Definition
hemithorax
Term
congenital lobar emphysema
Definition
1. congenital lobar emphysema: if has life threatening mass effect then can do lobectomy
1. dd: mucous plug. if mucous plug, can remove mucous plug
Term
ecmo
Definition
1. ecmo (extra corporal membrane oxygenation)
1. 2 types: veno venous (one line in IJ with tip in RA) and venoarterial (right carotid and right ij sacrificed. tip in innominate/brachiocephalic A and ra)
1. expect whiteout of both lungs
1. on heparin so do serial head US to monitor for hemorrhage
(1. do cardiac echo to see if any cardiac anomalies that cannot be fixed and not compatible with life. if so, may not want to do echo? as per egeibor?
Term
how to tell if premature infant
Definition
if see proximal humeral epiphysis (36 wks) then mature infant
Term
bilateral opacities.
Definition
1. LIP: steroids tx
1. dd: tb, fungal infection
Dr. Egeibor case
Term
if infant has surfactant deficiency disease, need to also give
Definition
1. if pt looks like has surfactant deficiency, need to give antibiotics for strep also because strep can look like surfactant deficiency disease
Term
ghon focus and ranke complex
Definition
ghon focus: primary tb
ranke complex: primary tb and lymph node
Term
If HIV and cystic lesions in anterior mediastinum
Definition
dd
1. thymic cysts vs cystic teratoma.
Term
do you give contrast to demonstrate esophageal atresia?
Definition
do you give contrast to demonstrate esophageal atresia?
1. no contrast, put air to demonstrate esophageal atresia
Term
dd for hypertrophic pyloric stenosis
Definition
1. dd for hypertrophic pyloric stenosis: pylorospasm (length long, but < 3 mm width of hypoechoic muscle. fluid still going through)
Term
non bilious vs bilious vomiting
Definition
1. non bilious: r/o hypertrophic pyloric stenosis
1. if bilious then r/o malrotation
Term
staging of necrotizing enterocolitis: modified bell's criteria
Definition
1. ileus: medical
2. pneumatosis and portal venous gas: medical
3a. shock : medical
3b. pneumoperitoneum: medical and surgical
Term
reduction of intussusception:
Definition
1. outcome and recurrence similar in barium vs air reduction
1. if mass lead point, don't reduce, go to surgery.
Term
meconium peritonitis: when do you see calcs?
Definition
can see calcs in 24 h
Term
biliary atresia
Definition
biliary atresia
1. triangular cord sign: hyperechoic remnant of cbd paralleling the portal vein
2. ghost triad: a. gallbladder < 1.9 cm b. irregular wall c. indistinct mucosal lining (normal gallbladder mucosa is echogenic)
Term
dilated esophagus
Definition
1. achalasia: Bird's beak appearance. due to impaired relaxation of the lower esophageal sphincter
b. eventually opens

2. Chagas disease

2. pseudo-achalasia:
a. due to esophageal/gastric carcinoma
b. shouldering

3. scleroderma: patulous GE junction

4. stricture due to esophagitis etc.
Term
lateral view of aorta
Definition
1. median arcuate ligament:
1. sma syndrome: compression of bowel by sma. associated with rapid weight loss.
1. stenosis of sma:
1. non occlusive mesenteric ischemia
Term
nephrostomy
Definition
1. posterior mid pole: preferred
1. if putting in ureteral stent, superior pole may be easier.
Term
mass for embolization Pre op
Definition
particles (could do gelfoam, coil too if need to stop bleeding quickly)
Term
biliary drainage
Definition
1. drain ascites
1. subxyphoid approach (more comfortable for pt, not going through pleura (ptx) or tranhepatic approach
1. internal external drain (open to outside and bowel via the biliary tree)
1. can be due to cholangiocarcinoma or lymph node
1. can put in metallic stent, but prefer non metallic stent (more patency) for malignant tumor
Term
thrombolysis
Definition
1. if have muscle working then can consider thrombolysis.
1. thrombolysis can also be done if thrombus there for a long time.
1. guidewire traversal test: if guide wire goes across the clot then probably able to thrombolyse
Term
to get to pulmonary artery, use
Definition
1. angled pigtail catheter (like to get foreign body out)
Term
chemoembolization
Definition
1. chemotherapy agent and ethiodal (high density) mixed
1. complications: fever, pleural effusion
Term
celiac anatomy
Definition
1. common hepatic (proximal) then proper hepatic
1. left hepatic goes straight up and right hepatic appears like continuation of hepatic.
Term
treatment of svc syndrome
Definition
1. usually treat malignant and very symptomatic (difficulty breathing and edema in face)
1. can stent if malignant
1. if bland thrombus: can macerate or thrombolysis
Term
Ir treatments
Definition
1. gi bleed: coil
1. bronchial A bleeding: particles 350 micron
1. pulmonary avm: coil
1. hepatic pseudoaneurysm: coil sandwich technique
1. splenic pseudoaneurysm: coil sandwich technique
1. uterine artery embolization: particles
1. liver chemoembolization: chemoembolization
Term
celiac, sma, ima connections
Definition
1. buehler: celiac to sma
1. barkow: celiac to sma via omental arteries
1. drummond: sma to ima. runs along left colon
1. riolan: sma and ima. more medial. direct connection
Term
sma branches
Definition
1. 1st right: inferior pancreticoduodenal
1. middle colic: to right, up and to left
1. right colic: straight to right
1. ileocolic: down and toward right
1. jejunal to left near cranial
1. ileal to the left near caudal
Term
dd for breast cancer
Definition
don't forget fat necrosis or atypical fibroadenoma as per Dr. Adeniji
Term
debris in joint
Definition
dd: pvns, hemophilia, gout, ra
tx pvns: synovectomy.
Term
mc discoid meniscus
Definition
lateral meniscus
Term
if lateral spine, think of
Definition
posterior scalloping due to
1. increased intraspinal pressure
2. Dural ectasia: erlos danlos, marfans, nf1, ankylosing spondylitis
3. Think of achondroplasia if has small spinal canal
4. congenital skeletal d/o: Morquio: central beaking anteriorly Hurler: inferior beaking anteriorly
Term
1. lower GI or intussusception
1. upper GI
Definition
1. lower GI or intussusception: omnipaque 300. dilute 1:1
1. upper GI: dilute barium
Term
chemoembolization for liver
Definition
< 3 cm, less than 3 lesions
Term
dd nasal and frontal lobe mass
Definition
esthesioneuroblastoma
lymphoma
mets
meningioma
Term
high T1 and high T2 in basal ganglia
Definition
1. High T2: hypoxic ischemic encephalopathy, carbon monoxide poisoning, japanese encephalitis, leigh, wilson, creutzfeld jacob, nf1
1. High T1: bleeding, chronic liver disease, hyperalimentation, NF1, methanol intoxication, hyper or hypoparathyroidism, japanese encephalitis
Term
dd mass in soft tissue
Definition
1. infection
1. sarcoma
1. if in distal extremity: giant cell tumor of the tendon sheath
Term
dd cortically based lesion
Definition
1. nof: non ossifyng fibroma
1. oo: osteoid osteoma
1. fd fibrous dysplasia
Term
morel lavalee
Definition
1. fluid collection with fat
1. tx: need surgery because will keep re accumulating.
Term
stress fx on mr
Definition
1. the normal bone is low t2
1. within high t2, you see linear low t2 (fracture)
Term
high signal around achilles insertion T2
Definition
1. ra and the seronegative (reactive, psoriatic arthritis, IBD, AS) 2. hyperparathyroidism 3. infection
4. Haglund's triad [pump bump (aka haglund's deformity), insertional tendonopathy and preachilles bursitis]"
Term
acl, look at
Definition
1. posterolateral corner (arcuate ligament)
Term
stages of avn
Definition
0 normal
1 edema on MR
2 osteopenia/sclerosis on xr. geographic defect on MR
3 crescent sign and eventual cortical collapse.
4 secondary osteoarthritis
Term
labrum
Definition
1. can describe as fluid filled cleft
1. labral tear
1. one type: bankhart type (can be bony)
Term
risks of breast biopsy
Definition
risks of breast biopsy: infection, hemorrhage, syncope, pneumothorax
Term
needle localization
Definition
a. talk to patient and explain risks and benefits. risks: infection, hemorrhage, syncope, pneumothorax

b. ask patient if she is on any anticoagulation or has had a reaction to lidocaine.

c. look for shortest distance to lesion. if shortest distance is on CC view then put the fenestrated alphanumeric grid on the lateral view (don't use MLO for stereotactic)

c. betadine skin. can use lidocaine. use 21g kopan needle hookwire system

d. look at where the lesion is (e.g A3) and push needle all the way in with hub always in line with the needle.

e. take the perpendicular image and pull out needle if needed to correct position. hook should be 1 cm distal to lesion

f. mark wire with bb on skin. take cc and lateral views for surgeon.
Term
stereotactic biopsy
Definition
1. talk to patient and explain risks and benefits. risks: infection, hemorrhage, syncope, pneumothorax

1. ask patient if she is on any anticoagulation or has had a reaction to lidocaine.

1. place lesion in center of the aperture in the compression plate.

1. images taken at +15 and -15 degrees. mark the lesion on these images. computer determines depth from these images.

1. after betadine and lidocaine. 8g mammotome needle placed in position. ideal position is about 5 mm short to the center of the lesion. position confirmed with stereotactic views.

1. 10 biopsies are taken. clip left in place.
Term
traumatic aortic injury vs ductus
Definition
1. traumatic aortic injury: acute margins
1. ductus diverticulum: obtuse margins
Term
normal resistive index
Definition
normal < 0.7
Term
dissection vs. penetrating aortic ulcer
Definition
1. dissection
1. penetrating aortic ulcer: more focal.
Term
non occlusive mesenteric ischemia (nomi)
Definition
1. blood shunted to brain and heart
1. vasoconstriction of mesenteric vessels.
1. narrowing of mesenteric arteries like SMA
1. can be due to hypotension
a. cardiac: MI, chf
a. sepsis
a. hypovolemia
1. tx:
a. treat underlying cause
a. if early nomi, if can give direct infusion of papaverine to reverse ischemia.
Term
dd primary sclerosing cholangitis
Definition
1. primary sclerosing cholangitis
1. cholangiocarcioma
1. aids cholangiopathy
1. infectious cholangitis
Term
todani classification
Definition
1. fusiform dilatation
2. diverticulum
3. choledochocele
4. intra and extra hepatic
5. intrahepatic (Caroli's disease)
Term
caroli disease
Definition
1. chain of lakes appearance on CT
1. central dot sign: portal veins are central dot.
1. can have portal htn
1. associated with medullary sponge kidney, renal fibrosis, autosomal dominant and recessive polycystic kidney disease, hepatic fibrosis, hepatic cysts, biliary hamartomas
1. tx:
a. if focal: lobectomy or segmentectomy
a. if diffuse: drain. liver transplant.
Term
may thurner tx
Definition
thrombolysis then stent
Term
thoracic outlet syndrome position
Definition
arms in abduction.
Term
mc cause of clot in axillary vein and tx
Definition
1. catheter
1. paget schroetter: can do thrombolysis then anticoag then surgery.
Term
lab value abnormal for polyarteritis nodosa.
Definition
1. p anca
Term
dd takayasu's
Definition
1. takayasu's < 50 years:.tx angioplasty in quiescent phase. don't stent because can occlude.
1. giant cell arteritis > 50 years.
1. radiation
1. atherosclerotic disease
Term
angioplasty vs stent and
Definition
1. angioplasty if < 3 cm, concentric and noncalcified.
Term
how describe vessel
Definition
1. long, med, short
1. concentric, eccentric
1. smooth, irregular
1. if long, concentric and smooth: due to vasculitis or radiation. like ribbon.
1. if short, eccentric, irregular: due to atherosclerotic disease
Term
crutches can cause
Definition
crutches can cause aneurysm
Term
budd chiari syndrome
Definition
1. spider web pattern of venous collaterals
1. correlate with sulfur colloid (hot in caudate)
1. types of portal hypertension: pre sinusodal, sinusoidal, post sinosoidal.
1. dd: intrinsic webs, mc world wide
Term
dd: hypothenar hammer syndrome
Definition
dd:
1. dd: vasculitis like scleroderma (CREST syndrome), Buerger disease (thromboangiitis obliterans), atherosclerotic disease, emboli
Term
carotid body tumor dd
Definition
1. aneurysm
1. glomus vagale
1. nerve sheath tumor
1. IJ thrombus
Term
tulip bulb appearance
Definition
1. tulip bulb appearance due to annuloaortic ectasia.
1. marfan, erlos danlos, homocystinuria, syphilis, mycotic aneurysm, bicuspid aortic valve, atherosclerotic disease
1. osteogenesis imperfecta, ankylosing spondylitis, reactive arthritis
Term
when interventional stent instead of endarterectomy
Definition
1. carotid endarterectomy if >70% stenosis in symptomatic patients. if not surgical candidate then angioplasty and stent.
1. normal psv of ica is < 100 cm/s.
(1. 125-230 cm/s is stenting and symptomatic (as per Arjun). not confirmed online)
Term
tx nutcracker syndrome
Definition
1. compression of the left renal vein between aorta and sma.
1. thin female young predisposes with new onset left flank pain.
1. another presentation: pediatric patient with hematuria
1. can also present as left varicocele or pelvic congestion.
1. > 5 mmHg indicates significant gradient and increased renal venous pressure
1. can balloon and place stent
1. can also relieve left varicocele.
Term
back door of gastroduodenal A
Definition
inferior pancreaticoduodenal A
Term
pseudoaneurysm of subclavian artery
Definition
1. all go to surgery
1. can coil and stent
1. don't say thrombin
Term
thrombolysis
Definition
1. don't want to reperfuse if motor deficits
1. echo should be obtained after thrombolysis
Term
simple breast cyst
Definition
1. anechoic
1. thin imperceptible wall
1. well defined margins
1. posterior enhancement
Term
dd breast spiculated mass
Definition
1. breast cancer
1. fat necrosis
1. radial scar
1. surgical scar
Term
if only see an asymmetry on mlo, but not cc view
Definition
1. can do triangulation
1. from left to right: lateral, mlo, cc.
1. measure the distance of the lesion from the nipple on the lateral and mlo views.
1. draw a line through the views from left to right and find the lesion on the cc (using the same cm from the nipple)
1. if not on the lateral then probably not there.
1. if medial, do cleavage views. if lateral, do exaggerated lateral views.
Term
if solid component for breast cyst
Definition
can do biopsy of solid component or (prob better answer), surgical excision.
Term
breast skin thickening definition
Definition
breast skin thickening definition > 2 mm
Term
if unilateral breast skin thickening, can do
Definition
skin punch biopsy to rule out dermal infiltration by cancer.
Term
if biopsy comes back sclerosing adenosis and calcs still look suspicious
Definition
still need to biopsy again or excisional biopsy
Term
intramammary lymph nodes should be located in the
Definition
lymph nodes should be in upper outer quadrant.
Term
gynecomastia vs male breast cancer
Definition
1. gynecomastia: subareolar. fans back. bilateral.
1. male breast cancer: eccentric. round. unilateral
Term
dd for calcifications of the breast (suspicious or intermediate)
Definition
1. infiltrating ductal carcinoma
1. dcis
1. may not need to mention: early involuting fibroadenoma.
Term
asymmetry only seen on cc view
Definition
1. can roll the top of breast laterally, if the asymmetry moves laterally then in lateral breast.
1. can roll the top of breast medially, if the asymmetry moves medially then in medial breast.
Term
reason that calcification may not be visualized on specimen
Definition
1. non removal
1. pushed out of specimen by mammotome
1. in paraffin block
1. calcium oxalate (need polarized light to see)
1. milk of calcium
1. can repeat mammogram to see if calcs left in patient
Term
surgical excisional biopsy
Definition
1. infiltrating ductal carcinoma
1. dcis
1. phyllodes tumor
1. atypia
1. radial scar
1. papilloma if > 1 cm and away from nipple
Term
periventricular enhancing lesions
Definition
1. lymphoma
1. mets
Term
creutzfelt jacob disease
Definition
1. high flair and t2 in pulvinar in hockey stick configuration
1. restricted diffusion
1. dd: carbon monoxide, cyanide and methanol poisoning, hypoxic ischemic injury, etc.
1. pres (doesn't involves cortex, but cjd does involve cortex)
Term
clival tumors
Definition
chordoma, chondrosarcoma, mets
Term
enhancing lesion in lower lumbar spine
Definition
1. astrocytoma
1. ependymoma
1. meningioma
1. nerve sheath tumor like neurofibroma
1. mets. look at brain for a primary tumor
1. if something is extradural: consider disc fragment (doesn't enhance)
Term
primary abnormality of dandy walker
Definition
vermian absence or dysgenesis
Term
crosses corpus callosum
Definition
1. gbm
1. lymphoma
1. tumefactive toxoplasmosis (in HIV)
1. mets
Term
classic for tumefactive ms
Definition
1. classic for tumefactive MS: open ring
Term
if abscess in brain, need to
Definition
1. tell if intraventricular extension for the surgeon
1. ependymal enhancement: poor prognosis
Term
enhancement along cisterns
Definition
tb, sarcoid, fungal, leptomeningeal carcinomatosis, lymphoma
Term
mimicker of epidural hematoma
Definition
if bony changes
1. mets
1. plasmacytoma
1. osteomyelitis with abscess
1. lch in young patient
Term
tx cavernous carotid fistula
Definition
1. tx: detachable balloon, stent or surgery
1. can clip ica if anterograde flow can be sacrificed (need balloon occlusion test)
1. need to treat because high pressure in ophthalmic vein can cause blindness
Term
management of aneurysm of left arch and aberrant right subclavian A
Definition
1. stent or surgery
Term
dd for intraventricular neoplasm
Definition
1. subependymoma: usually 4th ventricle>lateral ventricle

1. central neurocytoma (anterior or body of lateral ventricles. bubbly appearance with calcs, attaches to septum pellucidum)

1. ependymoma: supratentorial: intraventricular. under tentorium then intraventricular

1. meningioma: in trigone of lateral ventricles

1. mets

1. choroid plexus papilloma: in children
Term
restricted diffusion
Definition
abscess, acute infarct, lymphoma, medulloblastoma, meningioma, epidermoid cyst, acute ms and others
Term
epidermoid vs arachnoid cyst
Definition
epidermoid restricted diffusion and t1 and t2 kind of not as homogeneous in epidermoid
Term
if extradural non enhancing lesion
Definition
1. extradural non enhancing: disc fragment
1. disc fragment can demonstrate peripheral enhancement
Term
complications of thyroid orbitopathy
Definition
1. can do orbital decompression surgery to decrease pressure on optic nerve (compression on optic nerve can cause blindness)
Term
cavernoma
Definition
1. tx: can resect cavernoma
1. if associated developmental venous anomaly, don't take out dva also
Term
when can do fdg pet after surgery, chemotherapy, radiation
Definition
1. 1m: after surgery or chemotherapy
1. 3m: after radiation
Term
toxoplasmosis vs lymphoma:
Definition
pet ct:
1. toxoplasmosis: less fdg avid
1. lymphoma: more fdg avid
Term
cardiac perfusional imaging
1. fixed defect
1. reversible defect
Definition
1. dd fixed defect: artifact (normal wall motion. worse on rest), scar or hibernating myocardium (poor wall motion)
1. dd reversible defect: stress induced myocardial ischemia
Term
alzheimer's disease vs lewy body disease
Definition
1. alzheimer's disease: doesn't involve occipital
1. lewy body disease: involves occipital
Term
pet vs spect imaging of brain
Definition
1. can't really tell the difference
1. however, if experienced, pet has better resolution of the gyri and sulci than spect
Term
colloid shift findings
Definition
1. liver cirrhosis
1. splenomegaly
1. some uptake in bone marrow
Term
bone marrow rebound
Definition
bone marrow and spleen on fdg pet has increased activity after chemotherapy (not new mets)
Term
if bone on fdg pet, can be due to
Definition
1. gcsf
1. bone marrow rebound if recent chemotherapy
Term
fdg pet:
Definition
1. physiologic uptake: brain, heart, liver, spleen, kidneys/bladder, intestines, bone marrow
1. if higher than blood pool then (even if < 2.5 suv) then could be tumor/mets
1. if in joint and even if suv > 2.5 then not likely tumor/mets
Term
I 123 labelled mibg:
Definition
1. looks like gallium without lacrimal gland. uptake in liver, heart, bowel, salivary glands, thyroid, lungs, uterus/prostate
1. can treat paragangliomas like neuroblastoma, pheochromocytoma and other paragangliomas with I 131 MIBG if I123 MIBG avid.
Term
prostascint:
Definition
1. indium carbromab pendetide
1. physiologic uptake in liver, spleen and bone marrow
1. ab against prostate specific membrane antigen
1. if bone scan negative, ct scan negative, and rising psa, can do prostascint scan
Term
chronic cholecystitis
Definition
1. can give cck
1. > 35% ejection fraction is normal
1. if pain, tx with cholecystectomy
Term
dd fdg pet ascites and increased uptake near liver.
Definition
1. mechanism of glucose (phosphorylated like glucose, but cannot be further metabolized and trapped in cell)
1. malignant ascites and maybe granulomatous disease
Term
prostascint vs indium labeled wbc:
Definition
prostascint has blood pool and more soft tissue uptake than indium wbc.
Term
hepatobiliary scan: if persistant uptake in heart and delayed uptake in gb
Definition
hepatobiliary scan: if persistant uptake in heart and delayed uptake in gb then diagnosis is liver dysfunction which may be due to hepatitis
Term
mag 3 renal scan
1. phases:
1. normal values
1. does of lasix
Definition
1. phases: flow, nephrographic and delayed
1. normal values: < 10 min normal, 10-20 min indeterminant, > 20 min obstruction
1. does of lasix 40 mg IV at 20 min
Term
defect in inferior and inferolateral wall
Definition
rca territory
Term
10
how to wear ring dosimeter
Definition
facing palmar side
Term
11
is the survey meter energy resolving?
Definition
the survey meter is not energy resolving
Term
13
is the thyroid probe energy resolving
Definition
yes, the thyroid probe is energy resolving
Term
renal cell cancer staging
Definition
1. T1 < 7 cm. T2 > 7 cm. T3 (a: renal vein. b: infradiaphragmatic ivc. c: supradiaphragmatic ivc or involving the ivc wall). T4: involving adrenal or beyond gerota's fascia. T1 refers to stage I. T2 is stage 2. T3 is stage 3. T4 is stage 4.

1. N0 no nodes. N1 retroperitoneal nodes. N1 is stage 3

1. M0 no mets. M1 distant mets. M1 is stage 4
Term
dermoid plug aka
Definition
rokitansky plug=dermoid plug
Term
bladder outlet obstruction
Definition
1. hydronephrosis, hydroureter, bladder enlargement, bladder diverticuli
1.dd for bladder outlet obstruction: tcc, benign prostatic hypertrophy, urethral stricture
Term
drain renal abscess when
Definition
drain renal abscess if
1. > 3 cm
1. not responding to antibiotics
Term
1. why would you scan someone prone?
2. what do you ask for when you see an ivu?
Definition
1. why would you scan someone prone? to try to see the mid-distal ureters
2. shout for scout: when you see "contrast" on ivu, ask for scout to make sure not staghorn calculus
Term
how describe kidney on ivu:
Definition
how to describe kidney on ivu
1. orientation: superior pole points medially and inferior pole points laterally
2. size
3. shape: reniform?
4. location:
5. symmetry:
6. psoas shadows bilaterally
Term
infiltrating renal tumors
Definition
infiltrating renal tumors
1 lymphoma
2. transitional cell carcinoma
3. renal cell carcinoma (medullary type in those with sickle cell trait)
Term
1. what should you call power doppler?
2. color doppler
Definition
1. power flow: not power doppler
2. color doppler
Term
if you see testicular us, comment on...
Definition
if testicular us, comment on scrotal skin
Term
testicular tumors
Definition
testicular tumors
1. germ cell tumor: seminomatous and non-seminomatous (teratocarcinoma, choriocarcinoma, yolk sac tumor, embryonal cell carcinoma)
1. non germ cell tumor
Term
another name for burnt out germ cell tumor
Definition
burnt out germ cell tumor = azzopardi tumor
Term
dd for intratesticular calcifications
Definition
dd intratesticular calcifications
1. tb or other granulomatous disease
1. burnt out gct (non-seminomatous germ cell tumor)
1. old calcified hematoma or abscess
Term
low density lymph node
Definition
dd for low density lymph nodes
1. necrotic metastatic disease
1. atypical mycobacteria in HIV
1. whipple's disease
1. cavitating lymph node syndrome in celiac sprue (rare)
Term
how can you tell if a kidney is obstructed?
Definition
signs that a kidney is obstructed
1. pelvic dilatation
1. surrounding fat stranding
1. delayed passage of contrast (still in corticomedullary phase when other kidney is already in nephrographic phase)
Term
appearance of fibroid on mr
Definition
fibroid:
1. if no degeneration, iso t1. low t2
1. whorled appearance.
Term
treatment of urinary bladder cancer
Definition
tx of urinary bladder cancer
1. laser fulguration via cystoscope if no invasion of the muscle.
1. surgery: if invades muscle.
Term
testicular microlithiasis follow up
Definition
microlithiasis:
1. make sure look through images to look for testicular tumor
1. follow up every year.
1. no consensus about don't know when stop though.
Term
tx endometrioma
Definition
tx endometrioma
1. hormonal treatment with gonadotropin releasing hormone agonist
1. laparoscopic surgery.
Term
hemorrhagic cyst: 2010
Definition
1. premenopausal: under 5 cm, no follow up. over 5 cm follow up in 6-12 weeks until resolution
1. post menopausal: follow up until resolution
Term
enhancing tumor in rectus sheath after surgery
c section scar
Definition
1. endometrioma
1. desmoid tumor
Term
dd congenital diaphragmatic hernia
Definition
1. CPAM (congenital pulmonary airway malformation)
1. sequestration
1. congenital diaphragmatic hernia
1. bronchogenic cyst
Term
diaphyseal cortical lesion
Definition
diaphyseal cortical lesion:
ostoid osteoma, brodies's abscess, stress fx
Term
osteoid osteoma
Definition
1. radiofrequency of nidus (lucent area).
1. may or may not have sclerotic focus.
Term
1. how to make iso osmolar solution with omnipaque 300 and visipaque

2. do myelogram with
Definition
1. iso osmolar is about 300 mosm/kg H20

1. osmolality of omnipque 300 is around 600 mosm/kg H20. mix 1/2 omnipaque 300 and 1/2 water to get iso osmolar solution

1. visipaque is iso osmolar (~300 mosm/kg).

2. do myelogram with omnipaque 240 (osmolality 520). don't want to go too high because can get seizure.
Term
why is air insufflation done?
Definition
why is air insufflationdone? can be surgeon preference.
Term
adrenal hemorrhage vs adrenal neuroblastoma: when follow up?
Definition
adrenal hemorrhage vs adrenal neuroblastoma: when follow up? 2w
Term
multicystic dysplastic kidney fu
Definition
multicystic dysplastic kidney
1. monitor q 6m then yearly until involution
1. surgery if complications like hypertension, recurrent infection, Wilm's tumor
Term
nephroblastomatosis
Definition
nephroblastomatosis
1. =persistent nephrgenic rests, which should have disappeared before birth.
1. dd: lymphoma
1. fu q 6m for first 3 y. then yearly until adult to monitor for wilms tumor
Term
wilms tumor dd
Definition
1. RCC, clear cell type
1. rhabdoid tumor
Term
if medullary sponge kidney then
Definition
if medullary sponge kidney, switch to linear probe to check for parathyroid adenoma causing hyperparathyroidism
Term
abc vs gct
Definition
1. if physis not fused: abc
1. if physis fused: gct
Term
bullet shaped vertebral body dd
Definition
1. achondroplasia
1. down syndrome
1. morquio or hurler
1. hypothryoidism
Term
epiphyseal chondroid lesion in child
Definition
1. chondroblastoma
1. langherhans histiocytosis
1. infection
Term
developmental hip dysplasia: alpha angle should be
Definition
alpha should be > 60 degrees
Term
dd of hemophilia arthritis
Definition
dd of hemophilia arthritis
1. hemophilia: can have low T1 and low T2 that blooms on gradient.
1. pvns (pigmented villonodular synovitis): low t1 and low t2, which blooms on gradient. more focal nodular than hemophilia
1. gout: low T1 and low T2. no blooming
1. amyloid:low T1 and low T2. no blooming.
1. jia (juvenile idiopathic arthritis)
1. tb
-hyperemia causes ballooning and widening of intercondylar notch
Term
sprengel klippel feil sydnrome
Definition
1. cervical fusion
1. may have sprengel deformity and/or omovertebral bone
Term
neonate with
Definition
1. caffey disease: infantile cortical hyperostosis
2. child abuse
1. leukemia
1. mets like neuroblastoma
1. prostaglandin
1. torch infection (toxoplasmosis, syphilis, rubella, cmv, herpes, hiv)
1. hypervitaminosis A
1. scurvy (low vitamin C)
Term
rickets
Definition
1. metaphyseal fraying, cupping, widening
1. loss of provisional zone of calcification
Term
osteopetrosis
Definition
1. different forms have different inheritances: autosomal dominant or recessive.
1. tx: bone marrow transplant can cure infantile type of osteopetrosis.
1. bones will look normal after bone marrow transplant.
Term
toxic adenoma tx
Definition
toxic adenoma: tx 30-60 mCi I 131
Term
brain death study
Definition
brain death study:
tc hmpao and ecd for
Term
look for splenules with
Definition
look for splenules with sulfur colloid or damanged rbc
Term
common bile duct obstruction
Definition
common bile duct obstruction: liver scan sign (see liver, but not common bile duct or bowel)
Term
prostascint scan:
Definition
prostascint scan: liver looks really hot.
Term
dose I 131 whole body scan
Definition
5 mCi I 131 for whole body scan 2-3 d later.
Term
treatment for thyroid mets
Definition
met tx thyroid 200 mCi (face the case)
Term
osteoblastic mets:
Definition
1. breast, lung: usually lytic, but very common met
1. prostate
Term
tx for grave's disease
Definition
tx: grave's I 131 10 mCi
Term
normal gastric emptying time
Definition
50% emptying at 90 min. if less than 50% then abnormal. face the case.
Term
de quervain thyroiditis
Definition
painful
Term
transient ischemic dilatation
Definition
subendocardial defect due to 3 vessel disease
Term
if uptake near superior right kidney on mag 3
Definition
if uptake near superior right kidney on mag 3
1. could be gb vicarious excretion.
1. confirm with lateral view
1. could be normal variant.
Term
positive on all 3 phases of bone scan:
Definition
positive on all 3 phases of bone scan:
aseptic loosening, osteomyelitis or post surgical changes
Term
diamox study
Definition
1. if decreased reserve on diamox study. reversible defect. impaired vascular reserve.
face the case. not confirmed.
Term
chemoembolization
Definition
1. inject Tc MAA into hepatic A to check for shunt prior to chemoembolization
1. if shunt > 10% (like to lungs) then may not want to chemoembolization
Term
gangrenous toes
Definition
gangrenous toes: focal cold defect on bone scan on blood pool and delayed phase to toes
Term
generalized bilateral hypometabloism and preserved uptake in the subcortical region dd:
Definition
generalized bilateral hypometabloism and preserved uptake in the subcortical region dd: depression, antipsychotics
Term
tx for toxic adenoma or toxic multinodular goiter (plummer disease)
Definition
1. treatment for toxic adenoma or toxic multinodular goiter: 30-60 mCi I 31.
1. some people also call a single toxic adenoma plummer disease
Term
1. octreotide scan vs indium 111 labeled wbc scan:
1. thyroid I 131 vs mibg:
Definition
1. octreotide scan vs indium 111 labeled wbc scan: octreotide has urinary activity.
1. thyroid I 131 vs mibg: thyroid I 131 has bowel activity.
Term
hepatic waveform
Definition
1. up then down (should be more than 2nd down) and down
1. if 1st down goes up above where the 2nd own is then tricuspid regurgitation

http://radiographics.rsna.org/content/29/7/2081.figures-only
Term
surgery for right heart problem
Definition
gfr: problem with right heart
glenn: pulmonary artery to ivc
fontan: pulmonary artery to RA
rastelli: pulmonary artery to RV
Term
tx D transposition of the great arteries
Definition
1. mustard Senning
1. Jatene
Term
tx hypoplastic left heart syndrome
Definition
Norwood
Term
tx for tetrology of fallot
Definition
Blalock Taussig shunt: pulmonary A to subclavian artery
Term
angiodysplasia and diverticular disease
Definition
1. angiodysplasia: usually has draining vein
1. diverticular disease: doesn't have draining vein. right side more likley to bleed than left sided diverticulum
Term
treatment for pseudoaneurysm
Definition
1. pseudoaneurysm due to trauma: coil or stent
1. pseudoaneurysm from needle: can thrombus
Term
liver chemoemoblization
Definition
1. check portal vein for patency.
1. non-target embolizatoin (coil).
1. mixture of lipiodol and chemotherapy agent.
(1. can do gelfoam to keep in as per Dr. Dunne)
Term
biliary drainage.
Definition
1. causes of biliary obstruction: cholangiocarcinoma, lymph nodes, pancreatic cancer, hcc
1. make sure give antibiotics prior to procedure
Term
treatment for svc syndrome
Definition
1. acute malignant: radiation
1. acute thrombus svc: thrombolysis
1. chronic malignant: stent
1. chronic benign: stent or surgery. if due to multiple catheters from renal dialysis, may want to stay away from stents and do angioplasty.
Term
paget schroetter syndrome location
Definition
paget schroetter syndrome location: 1st rib and clavicle.
Term
popliteal A narrowing
Definition
1. atherosclerotic disease
1. embolic disease
1. popliteal artery entrapment syndrome
1. cystic adventitial disease
1. trauma: posterior dislocation of knee
1. aneurysm
Term
thrombolysis
Definition
1. thrombolysis: guidewire traversal test
1. embed multiside hole catheter into thrombus
1. contra indications: cerebral hemorrhage, cerebral tumor, cerebral trauma, active bleeding
Term
reperfusion syndrome
Definition
1. compartment syndrome
1. hyperkalemia: arrhythmia
3. rhabdomyolysis: serum creatine kinase high. myoglobinuria. renal failure.
Term
posterior shoulder dislocation
Definition
trough sign = anteromedial humeral head compression fracture = reverse hill sachs
Term
hill sachs deformity if at level of
Definition
at level of acromion then hill sachs deformity
Term
tx for meniscal tear
Definition
central: menisectomy
peripheral: suture (good blood supply)
Term
osteochondral defect
Definition
1. if high t2, look for intact overlying cartilage
1. if cartilage not intact, consider mr arthrogram to see if contrast goes around the osteochondral defect.
Term
low t1 and high t2 lesion
Definition
1. no enhance: gangliona cyst
2. enhancement: nerve sheath tumor or giant cell tumor of the tendon sheath
Term
osteosarcoma vs ewing's:
Definition
1. Osteosarcoma: bone forming. codman triangle
1. Ewing: not really bone forming and not really codman triangle
-as per egeibor
Term
bowing/plastic fx: tx
Definition
plastic/bowing fracture: fracture then treat
Term
my easy misses
brain, chest shoulder:, abdomen look for
Definition
1. brain: aneurysm. always look for bleed.
1. chest: right arch, coarctation of the aorta
1. shoulder: posterior dislocation
1. abdomen: hemorrhage
Term
cortically based bone lesion
Definition
1. non ossifying fibroma (aka fibroxanthoma)
1. osteoid osteoma
1. fibrous dysplasia
Term
nascet criteria for carotid stenosis
Definition
1. peak systolic velocity 125-230 cm/s, ratio ica/cca 2-4, end diastolic velocity 40-100 cm/s for 50-69% stenosis.
Term
nascet criteria for carotid stenosis
Definition
1. peak systolic velocity 125-230 cm/s, ratio ica/cca 2-4, end diastolic velocity 40-100 cm/s for 50-69% stenosis.
Term
normal ventilation. hetergeneous perfusion (multiple subsegmental defects)
Definition
fat emboli vs vasculitis
Term
causes of pulmonary hypertension
Definition
1. chronic PE
1. copd
1. sarcoid etc.
1. idiopathic
1. inherited
Term
bicornuate uterus treatment
Definition
strassman procedure (requires abdominal incision)
Term
pneumothorax treatment
Definition
2nd or 3rd intercostal space midclavicular line.
Term
hyperechoic kidneys dd
Definition
1. HIV nephropathy
1. diabetic nephropathy
1. lupus nephritis
Term
urinoma tx
Definition
1. if small, can resolve on own
1. if large, may need percutaneous or surgical drain
Term
biloma treatment
Definition
percutaneous or surgical drainage
Term
supply of anterolateral wall cardiac
Definition
diagnals
Term
ganglioin cyst appearance
Definition
apple jelly
Term
fat containing liver lesions
Definition
1. adenoma, fnh, hcc, mets
1. angiomyolipoma, lipoma, liposarcoma
Term
bowing deformity of tibia and fracture of fibula
Definition
1. osteogenesis imperfecta vs neurofibromatosis 1 (blue sclera and brain lesions LOS)
Term
upper gi
Definition
1. upper gi should be done with barium.
1. If possible perforation use iso osmolar water soluble contrast as hyperosmolar can cause pulmonary edema and severe chemical pneumonitis.

http://www.acr.org/~/media/A77716DEDE5C486EA73F2249D578FD39.pdf
Term
lissencephaly due to
Definition
1. cmv
1. alcohol/radiation
1. genetic mutation
Term
rcc vs angiomyolipoma
Definition
if fat and calc: rcc
if fat and no calc: angiomyolipoma
Term
renal artery stenosis vs. obstruction
Definition
both are small and smooth kidneys
1. renal artery stenosis: normal collecting system
1. obstruction: dilated collecting system
Term
if want to check for lymphoma
Definition
flow cytometry in rpmi solution
Term
what is enhancment?
Definition
15 hu enhancement
Term
urethral diverticulum
Definition
at risk for squamous cell carcinoma
Term
retrograde urethrogram:
Definition
1. 8 or smaller foley and inflate a little. then inject non ionic contrast.
Term
muga
Definition
1. ejection fraction: [(end diastolic volume)-(end systolic volume)]/[(end diastolic volume)- (background)]
1. acceptable standard deviation is 1%
1. doxorubicin (adriamycin) for breast cancer and sometimes lymphoma is offending agent.
1. stop chemotherapy if drop from baseline 20% or drops below 40%.

1. if end diastolic volume wrongly high e.g. if whole heart included then EF high
1. if end systolic volume is wrongly high e.g. if whole heart included then EF low.
1. if background is wrongly high e.g. aorta or spleen included in background then EF if low.
Term
complicated vs complex cyst
Definition
1. complicated cyst: internal echo. septation < 1 mm. birads 3.
1. complex cyst: solid component. septation > 1 mm. birads 4
Term
esophageal tumor
Definition
1. likely scc
1. if barrett's then adenocarcinoma
Term
cortical nephrocalcinosis
Definition
COAG
acute Cortical necrosis
oxalosis
alport syndrome
chronic Glomerulonephritis
Term
peyronie's disease
Definition
tunica albuginea fibrosis and calcifications
Term
valleculae, epiglottis, hyoid bone, true and false cords.
Definition
http://emedicine.medscape.com/article/383230-overview

http://www.pogoe.org/image-library?page=11
Term
tracheobronchopathia osteochrondroplastica (tpo)
Definition
calcified nodular thickening of the anterior and lateral walls of trachea (not posterior because no cartilage)
Term
ct for kids
Definition
1. Adust kVp for size
1. Adust mA(s) for size
1. Minimize multiphase scanning
1. Minimize overlap
1. Limit coverage
Term
hot nose sign
Definition
1. increased intracranial pressure
1. shunts blood to eca and maxillary artery
Term
heterogeneous small perfusion defects
Definition
1. fat, septic emboli, amniotic fluid
1. vasculitis
Term
confirm free pertechnetate with
Definition
tlc paper. thin layer chromatography paper
Term
huntington's
Definition
low radiotracer uptake in the caudate
Term
why no lymph nodes seen on lymphoscintigraphy
Definition
1. pt already had lymph node dissection and now has lymphedema. need to get delayed imaging
(1. ?used unfiltered colloid for injection?)
Term
twinkle artifact
Definition
"flow" artifact posterior to stones. looks like flow, but not flow. use spectral imaging to check if the flow is real or not.
Term
free pertechnetate should be
Definition
< 10% (so labelled rbc should be 90%?)
Term
if free pertechnetate, do you repeat vq scan?
Definition
don't need to repeat if can still interpret scan.
Term
cfv divides into
Definition
sfv and profunda
Term
if septal motion problem, think
Definition
LBBB
Term
portal vein waveform: pulsatile
Definition
chf, tricuspid regurgitation. should be straight line above baseline.
Term
venetian blind appearance in uterus
Definition
adenomyosis
Term
tx of intercondylar notch cyst
Definition
1. ct guided aspiration of cyst
1. arthroscopic excision if symptomatic
Term
quadriceps tendon repair
Definition
1. partial: conservative
1. complete: surgery
Term
tx transitional cell carcinoma
Definition
1. take out kidney and ureter.
Term
1
stop breastfeeding
1. technetium
1. fdg
1. indium
1. thallium
1. I 123
1. I 131
1. gallium
Definition
1. technetium, fdg: 1 d
1. indium, thallium, I 123: 3d (~1 wk)
1. gallium: if pt not willing to cease breastfeeding then stop for 4 wks.
1. I 131 cessation
exactly what requisites say
(1. can resume breast feeding after 4 half lives from face the case)
Term
2
major spill
1. I 131
1. indium
1. gallium
1. I 123
1. thallium
1. technetium
Definition
1. > 1 mCi I 131.
1. > 10 mCi indium, I 123, gallium,
1. > 100 mCi of technetium, thallium
-the only patient doses that make a major spill are gallium, indium, and I 131
-this card has been confirmed with http://mpcphysics.com/documents/RadioactiveSpillWorkbook1007.pdf
Term
3
written directive required if
Definition
1. I 131 does more than 30 mCi
1. must be signed by an authorized user (board certified and minimum hours of training)
1. our written directive: signature to administer
Term
4
how to receive radioactive package
1. category I
1. category II
1. category III
1. wipe test: background, when decontaminate, report to rso?
1. when have to check packages?
Definition
1. put on gloves
1. if damaged, call the radiation safety officer
1. use survey meter at surface then 1 m.
1) category I white: < 0.5 mrem/hr
2) category II yellow: < 50 mrem/hr. at 1 m, < 1 mR/hr
3) category III yellow: < 200 mrem/hr. at 1 m, < 10 mR/hr
-if package substantially different from category then call RSO
1. perform wipe test
a. if > 6600 dpm/300 cm2: call rso
1. open package
1. check that package insert matches the product.
1. check product for damage
1. do wipe test on product if reason to suspect contamination
1. check material to discard for radioactivity using survey meter. if greater than background then place with radioactive waste. if < background then remove labels and place in regular trash.
1. maintain record of receipt.
1. if volatile (liquid I 131) then use fume hood (if on the paper on the inside will point up)
1. check packages
a. work hour: within 3 hours of receipt
a. non work hours: within 3h of start of next business day.
Term
5
how to use survey meter
Definition
1. make sure that battery working
1. switch on before going near source
1. check source cesium on the side
1. place on x 10 or x 100 setting then lower setting if nothing detected (try to detect higher levels first)
1. survey meter should be documented: name of surveyor, survey meter # and serial #, date.
1. should pass within 2 cm of area without getting contaminated.
Term
7
upper limit of Mo99/mCi of Tc
Definition
-0.15 uCi Mo99/mCi Tc
-check the amount of Mo99 by placing the elution into a special lead pig. only Mo99 can be detected through the special lead pig.
Term
8
maximum permissable aluminum
Definition
10 ug/ml max aluminum
test with indicator paper which turns red if too much aluminum
Term
9
what to do if minor spill or major spill
Definition
minor spill
1) Notify persons in the area that a spill has occurred
1) Cover the spill with absorbent paper
3) if clothing contaminated, remove and place in plastic bag
1) if person if contaminated, rinse region with lukewarm water and wash with soap
3) Wearing protective clothing, gloves, lab coat
4) Place the paper towels and anything contaminated in plastic bag that goes into radioactive waste
5) Place the bag into a radioactive waste container
6) Survey the area with a Geiger Muller counter
7) Report the incident to the RSO
-----------------------
major spill.
1) Notify all individuals in the vicinity and clear the area
2) Prevent the spread of the spill with paper towels
3) Shield the source if possible, use lead bricks or the thick acrylic plastic shields
4) Close access to the area. have sign.
5) Notify the RSO IMMEDIATELY and rso directs clean up
6) Decontaminate personnel by removing contaminated clothing and washing contaminated skin
Term
14
dose calibrator
1. what is it?
1. discriminate energy?
1. QC: daily, quarterly, annually and other
Definition
1. ionization chamber
1. cannot discriminate energy
1. QC:
a. daily: constancy (aka precision). cesium 137 should have less than 5 % variance
a. quarterly: linearity. watch the decay of Tc pertechnetate. checks from 10-200 mCi. should be within 10%
a. annually: accuracy. should agree within 10%
a. geometry: at installation and after repairs. compensated measurement due to different containers and dilutions
Term
15
well counter qc daily
Definition
well counter qc daily
1. energy peaking
1. background
1. constancy
Term
16
how to perform vq scan in pregnant patient
Definition
1. give only perfusion dose 1 mCi of Tc MAA
Term
17
when release after I 131 dose and instructions.
radiation to family members should be
Definition
1. if
a. < 30 mCi dose then can discharge after 15 min observation
a. inpatient stay if dose > 30 mCi I 131
a. if > 30 mCi then discharge when exposure rate at 1 m < 2 mrem/hr (our institution so that we don't have to give written instructions).
a. face case says: release without instructions if tede (total effective dose equivalent) < 1 mSv

1. other directions
a. sleep alone 1 week
a. avoid prolonged contact with visitors for 3 d (< 6 feet away)
a. flush toilet twice, don't prepare food, use separate utensils, use own bathroom
a. avoid mucous membrane/ fluid contact
Term
18
travel after dose
1. fdg pet
1. technetium
1. thallium
1. I 131
Definition
1. fdg pet: detectable for 1 d
1. technetium: detectable 3 (or 4) d
1. thallium: detectable 1m
1. I 131: detectable 3m
-can write letter with date, patient's name, dose, when administered, 1/2 life, 24 hour contact
http://www.snm.org/index.cfm?PageID=5660
Term
19
annual nrc dose limit for
1. occupational worker
a. lens
a. skin
a. extremities
1. pregnant occupational worker
1. minor occupational worker
1. member of the public
Definition
1. if pregnant, an extra dosimeter can be worn around the abdomen.
1. if person might get 1/10th of the occupational limit of 5 rem/yr then should wear badge. if secretary is near patients who have been injected then she may need to wear a badge also.
1. nrc dose limit
a. occupational worker 5 rem/year.
1) 15 rem/yr lens
1) 50 rem/yr skin/extremities
a. general public 0.5 rem/yr
a. occupational worker who has declared pregnancy 0.5 rem/pregnancy
a. minor occupational worker: 0.5 rem/year
1. member of the public
a. 0.1 rem/yr
a. < 2 mrem/hr on average
Term
20
radioactive waste disposal
Definition
1. if half life < 120 days then decay in storage
a. separate into containers with half life. when full, mark with date, initials, isotope and exposure rate.
a. store for 10 half lives.
a. discard in regular trash without labels if survey meter show activity < background
1. if half life > 120 d then RSO to manage
Term
21
survey meter
Definition
1. daily qc: battery, background, constancy,

1. survey meter daily
a. unrestricted area should be < 2 mrem/hr
a. restricted area may be > 5 mrem/hr. sign need to be posted about nonrestricted area and warning about pregnant and breastfeeding patients

1. wipe test weekly: wipe 5 areas in each room over 300 cm2.
a. if Tc 99m. < 200 dpm for unrestricted area and < 2,000 dpm for restricted area.
a. if I 131. < 2,000 dpm for unrestricted area and < 20,000 dpm for restricted area.
a. http://books.google.com/books?id=i6z49rvtl3UC&pg=PA318&dq=wipe+test+weekly+nuclear+medicine&hl=en&sa=X&ei=tLiYUcCIDKjTyAGpv4G4Ag&ved=0CEoQ6AEwAw#v=onepage&q=wipe%20test%20weekly%20nuclear%20medicine&f=false
a. if any area is > 6600 dpm/300 cm2 then call rso.http://books.google.com/books?id=NFo28VB5MtsC&pg=PA129&dq=wipe+test+weekly+nuclear+medicine&hl=en&sa=X&ei=tLiYUcCIDKjTyAGpv4G4Ag&ved=0CD8Q6AEwAQ#v=onepage&q=wipe%20test%20weekly%20nuclear%20medicine&f=false
(1. daily: survey meter. restricted and unrestricted areas should be < 2 x background. if restricted area has > 2 x background, decontaminate and repeat again)
Term
22
medical incident vs. medical event
Definition
1. wrong route
1. wrong dose > 20% error (10% illinois)
1. wrong pharmaceutical
1. wrong patient
1. unintended permanent non intentional damage as deemed by physician
and
1. > 5 rem whole body dose or > 50 rem organ specific dose. if > 0.5 rem to fetus/nursing child then reportable.
1. need to notify nrc/state regulatory commission and physician/patient within 24 hours.
1. notify in writing nrc within 15 days
1. maintain records for 10 years
-----------
medical incident:
1. whole body dose adult < 5 rem/yr
1. organ dose < 50 rem/yr
Term
24
alara
Definition
as low as reasonably achievable
Term
25
conversion
Definition
1 R = rad = rem
Term
26
in vitro ultratag kit
Definition
In Vitro (Ultratag) 98% labeling
• Add 1-3 ml of blood (heparin as an anticoagulant) to regent vial (Stannous chloride and Dextrose).
• Allow to react for 5 min.
• Add syringe 1 (Na Hypochlorite) and mix by gently inverting four to five times.
• Add syringe 2 (Citric acid, sodium citrate and dextrose) and mix
• Add 10-100 mCi of Tc99 pertechnetate to vial. Mix and allow to react for 20 min.
Term
27
endpoint stress test
Definition
o Endpoints
• HR 85% max predicted
• SBP > 230 or DBP >130
• Fall BP < 80
• Angina
• St depression > 2mm
• V tach > 5 beats
• SVT or afib
• 2:1 (type II AV block) or complete av block (type III)
Term
28
gamma/spect qc: daily, weekly, quarterly
Definition
1. daily: energy peaking, uniformity
1. weekly: spatial resolution and linearity with 4 bar phantom and center of rotation
1. quarterly: tomographic uniformity and overall system performance (Jaszczak phantom)
Term
30
hot sink allows
Definition
1 Ci per year
Term
31
what cannot be found on wipe test
Definition
xe 133
Term
32
if found out 5 wks pregnant 3 hours after dose
Definition
give iv fluids and frequent voiding
1. giving sski doesn't work to block fetal thyroid as fetal thyroid doesn't take up iodine prior to 10-12 weeks
1. everything absorbed in 1st 1-2 hours so inducing vomiting won't help.
Term
33
contrast extravasation
Definition
1. elevate arm above heart
1. warm or cold compresses
1. observe. release if improving or no other new signs occur. if discharge, instruct patient about getting evaluation if paresthesias.
1. get surgery consult if worried about compartment syndrome like paresthesia, poor capillary refill, skin blistering or ulceration.
Term
34
urticaria
Definition
1. benadryl 50 mg PO/IM/IV
1. if severe or widely disseminated: epinephrine (1:1,000) 0.1 mg (0.1cc) sq
Term
35
facial or laryngeal edema
Definition
1. 10L via mask
1. epinephrine (1:10,000) 0.1 mg (1cc). repeat up to 1 mg.
1. call cardiopulmonary response team
Term
36
bronchospasm
Definition
1. 10L via mark
1. albuterol 2 puffs. repeat as necessary.
1. epinephrine (1:10,000) 0.1 mg (1cc). repeat up to 1 mg
1. call cardiopulmonary response team if needed.
Term
37
hypotension with tachycardia
Definition
1. 10L via mask
1. elevate legs 60 degrees or more (preferred) or trendelenburg position
1. monitor:ekg, pOx, vital signs
1. IV Normal saline
--------
1. if poorly responsive, epinephrine (1:10,000) 0.1 mg (1cc). repeat up to 1 mg.
1. if still poorly responsive, call cardiopulmonary resuscitation.
Term
38
hypotension with bradycardia
Definition
1. 10 L/min via mask
1. elevate legs 60 degrees or more (preferred) or trendelenberg position
1. monitor ekg, pOx, vital signs
1. IV normal saline
-----------
1. give atropine 1 mg slow IV push. repeat up to 3 mg
Term
39
severe hypertension
Definition
1. 10 L/min via mask
1. monitor ekg, pOx, vital signs
---------
1. ntg 0.4 mg SL. may repeat x 3.
1. if no response: consider labetalol 20 mg IV then repeat q 10 min up to 300 mg.
1. can use phentolamine 5 mg IV for pheochromocytoma
1. transfer to ER or ICU
Term
49
seizures
Definition
1. 10 L/min via mask
-----------
1. versed 1 mg IV
1. if longer effect needed, consider dilantin (15 mg/kg) at 50 mg/min
1. monitor for respiratory deprression
1. consider cardiopulmonary response team for intubation if needed.
1. consider using cardiopulmonary arrest team if intubation needed.
Term
41
pulmonary edema
Definition
1. 10 L/min via mask
1. elevate torso
----------
1. give lasix 40 mg IV slow push
1. consider morphine 1mg IV
1. transfer to icu or er
Term
42 common radionuclides, half life and kev
Tc, fdg, I 123, thallium, indium, gallium, I 131
Definition
Tc 140 kev 6h
F18 511 kev 110 min
I 123 ~150 (159) kev, 1/2 day
thallium 3d, ~100, 200 (70, 167) kev
indium 111 3d. 100, 200 (173, 247) kev
gallium 3d, 100, 200, 300 (93, 185, 300) kev
I 131 8d ~ 300 (364) kev
Term
cobalt kev and half life
Definition
co 122 kev. half life 270 days
Term
monitoring packages received
Definition
-3h during work or within 3h of start of business day if not during work hours
-wipe test < 6600 dpm/300 cm2
Term
3740
collimators and when to use them
1. high energy
1. medium energy
1. low energy
1. pinhole
Definition
1. high energy: I 131
1. medium energy: gallium, indium
1. low: technetium, thallium
1. pinhole: thyroid, pediatrics (e.g. hips)
1. resolution depends upon size of the apertures of the collimators among other things as per internet
Term
contrast reaction prophylaxis
Definition
1. PO: prednisone 50 mg 13, 7, 1 hour prior to exam. benadryl 50 mg 1 hour prior
1. IV: hydrocortisone 200 mg IV q 4 hours until exam. benadryl 50 mg IV 1 hour prior to exam
Term
dd for high T2 in basal ganglia
Definition
1. hypertensive hemorrhage
1. hypoxic ischemic injury
1. carbon monoxide poisoning
1. methanol toxicity
1. osmotic demylination syndrome (high signal in central pons)
1. Wilson disease, japanese encephalitis, leigh disease, Creutzfeldt jacob
Term
unhappy triad
Definition
1. medial collateral ligament tear/strain
1. medial meniscal tear
1. acl tear
Term
for drain pull
Definition
less than 10 cc/24h
Term
transient ischemic dilatation
Definition
> 1.3
Term
lymph node cortex should be
Definition
< 2 mm
Term
cortical nephrocalcinosis
Definition
1. acute cortical necrosis
1. chronic glomerulonephritis
1. oxalosis
Term
tips
Definition
90-190 cm/s. difference of 50 cm/s from base line
Term
tpa dose
Definition
1 mg/hr
Term
avulsion fractures
Definition
1. asis: sartorius
2. aiis: rectus femoris
3. greater trochanter: gluteus medius, gluteus minimum
4. lesser trochanter: iliopsoas
5. inferior pubic ramus: adductors
1. fibular avulsion fracture: biceps femoris
Term
endoleak, reflux, todani classification, germinal matrix bleed, lung cancer, cervical cancer, neuroblastoma, rcc staging, nascet criteria, velocities for tips. velocities for renal stenosis, normal resistive index, alpha angle, pregnancy numbers (8, 16, 5 mm)
Definition
Term
cervical incompetence
Definition
if > 3 cm
Term
osteoid osteoma vs osteoblastoma
Definition
> 1.5 cm
Term
jones vs pseudojones
Definition
1.5 cm
Term
viable myocardium on mri: myocardial scar vs hibernating myocardium on mri
Definition
if > 50% wall delayed enhancement then not viable.
Term
cpam classification
Definition
I > 2 cm
II < 2 cm
III microcysts
Term
cardiac: acyanotic and cyanotic
Definition
see page 225
Term
ir criteria for success, goal of tips mmHg, definition of portal hypertension
Definition
Term
ir criteria for IR success
Definition
1. < 30% stenosis
1. < 10 mmHg gradient
1. moving from one category to another (0.4, 0.8)
Term
ivc size criteria
Definition
Term
peds lower gi: no microcolon vs microcolon
Definition
Term
normal time mag 3 obstruction
Definition
< 10 min normal
10-20 min indeterminate
> 20 min
Term
endometrial thickness
Definition
post menopausal 5 mm
post menopausal on hormone therapy 8 mm
premenopausal 15 mm (some say 20 mm)
Term
junctional zone should be under
Definition
10 mm
Term
cardiac vessels and region supplied
Definition
lad (diagonals), L circumflex (obtuse marginals), rca, pda,
Term
gastric emptying: normal
Definition
1. U of Florida: 40% at 4h. semisolid.
1. New York: 50% at 90 min. semisolid?
1. cch: 80% in 4 hours. liquid. (substandard probably shouldn't mention)
Term
us anatomy
Definition
Term
thyroid isthmus
Definition
< 3 mm
Term
accreta, increta, percreta
Definition
Term
lateral ventricles
Definition
should be < 10 mm
Term
breast nomenclature: shape, margins, distribution
Definition
Term
omphalocele vs gastrochisis, sequestration (types)
Definition
Term
mammo needle sizes
Definition
Term
mammo numbers
Definition
1. mri 8 gauge, stereotactic 11g mammotome, 14g US guidance, 20g, kopan hookwire system, 30g ductogram
1. 25g needle for confirming the lesion on US is the same lesion seen on mmg.
1. if mass: 4 biopsies. if calc 10 biopsies.
Term
number of particles for vq scan and when reduce
Definition
Term
alzheimer, lewy body, picks, huntingtons
Definition
Term
fibromuscular dysplasia
Definition
1. 2/3 renal.
1. 2/3 carotid
1. 2/3 multivessel
1. renal>carotid
Term
muga scan
Definition
measure ejection fraction on LAO view. this looks like a short axis view. (frame 8 (end systole) and 16 (end diastole))
Term
fu after grave's treatment
Definition
6m
Term
treatment for grave disease I131
Definition
100 uCi/g I131 (about 10 mCi total)
Term
post surgical cystic lesions in pelvis
Definition
peritoneal inclusion cyst, lymphocele etc.
Term
dark on t1 and t2
Definition
t1 and t2 dark with air, calcium. t2 dark with flow void.
Term
treatment for gastrochisis and omphalocele
Definition
1. C section (controversial)
1. surgery
1. omphalocele needs amniocentesis for karyotyping
Term
adem
Definition
acute disseminated encephalomyelitis
Term
tx for adenomyomatosis
Definition
cholecystectomy if symptomatic
Term
femoral hernia location
Definition
1. lateral to inguinal canal
1. medial to femoral vessels
Term
pseudomyxoma peritonei
Definition
1. from rupture of mucinous tumor of appendix or ovary
1. dd: peritoneal carcinomatosis, primary peritoneal carcinoma.
Term
1. if fundus has barium
1. if fundus has air
Definition
1. lpo: fundus has barium
1. rao: fundus has air
with respect to table
Term
out of phase: if liver darker than vessels
Definition
then dropped signal. microscopic fat (fatty liver)
Term
low density in spleen
Definition
lymphoma sarcoid.
Term
gastrinoma location
Definition
outside of pancreas
Term
if dark t1 branching structures in liver
Definition
biliary dilatation
Term
dd for bone infarct
Definition
1. sickle cell disease
1. steroid use
1. gaucher disease
Term
intra axial supratentorial tumors in child
Definition
tape
astrocytoma, ependymoma, teratoma, pnet
Term
vitamin b12 deficiency
Definition
1. subacute combined degeneration.
1. dorsal lateral spinal cord columns
Term
pineal gland lesions
Definition
1. germinoma: central calc (engulfs central calcified pineal gland)
1 pineoblastoma (pnet): peripheral calc
1. pineocytoma: peripheral calc
1. pineal gland cyst
Term
high T1 and T2 lesions
Definition
1. craniopharyngioma
1. rathke's cleft cyst
1. dermoid
1. cholesterol cyst
1. blood
Term
dural avf vs avm spine
Definition
1. dural avf: insiduous sxs
1. avm: may have acute onset. may be associated with bleed (intramedullary or subarachnoid)
Term
olivopontine cerebellar degeneration
Definition
small inferior olives, pons and cerebellum.
Term
1. simple cyst
1. hemorrhagic cyst
1. endometrioma:
1. dermoid:
Definition
1. simple cyst: pre-menopausal 5-7 cm fu yearly; > 7 cm further evaluation with MR and consider surgery. post menopausal 1-7 cm fu yearly; > 7 cm further evaluation with MR and consider surgery.
1. hemorrhagic cyst: > 5 cm fu 6-12 w.
1. endometrioma: malignant transformation to endometrial carcinoma or clear cell carcinoma. initial fu 6-12 w then yearly if not removed surgically.
1. dermoid: malignant transformation to squamous cell carcinoma. fu yearly if not removed surgically.
Term
rhomboencephalosynapsis
Definition
no vermis. cerebellum is fused.
Term
proximal stent graft endoleark tx: another stent graft or angioplasty
II: mid part. consider fu for 6m. if persist or increase in size then intervention.
I: proximal end. usually.
Definition
can call type II endoleak without actually seeing feeding artery
Term
if chylous effusion from thoracic duct.
Definition
can coil thoracic duct.
Term
rectus bleed:
Definition
1. inferior epigastric, contralateral femoral A then external iliac (inferior epigastric) or
1. superior epigastric (from subclavian, internal mammary)
Term
type I endoleak: tx.
Definition
angioplasty or another stent graft
Term
splenic artery aneurysm tx
Definition
tx if > 2 cm. would measure on source image not 3D reconstruction
Term
adrenal vein sampling
Definition
1. check aldosterone and cortisol from both adrenal veins (from the ivc) and the ivc. if ratio of adrenal vein:ivc>3:1 then may have problem
Term
transjugular liver biopsy:
Definition
1. pathway: ij, svc, ivc, hepatic vein
1. if ascites, high INR, can do transjugular liver biopy
1. take bx through sheath.
1. can take about 4 samples
1. check venogram after procedure to make sure no bleeding.
Term
how to measure portosystemic gradient
Definition
if portosystemic gradient > 5 mmHg then portal htn
checking pressure between free hepatic an RA> 5 mmHg may be venoocclusive disease like budd chiari.
1. check wedge pressure ~ portal vein pressure
1. check hepatic vein pressure
1. check right atrial pressure
1. portosystemic gradient is right atrial pressure minus wedged pressure.
1. check the difference between hepatic pressure and right atrial pressure. if high then might be veno occlusive disease like budd chiari.
Term
1. abnormal portosystemic gradient and goal
Definition
1. abnormal portosystemic gradient > 5 mmHg
1. goal for ascites and varices < 12 mmHg
Term
tx of peripheral AVM
Definition
percutaneous injection of glue (alcohol can be used too, but can cause skin necrosis and flash pulmonary edema). can put tourniquet proximally when doing the procedure.
Term
nephrostomy
Definition
1. nephrostomy: try to go to inferior posterior calyx
1. if want to access the ureteropelvic junction, may need to go mid or upper posterior calyx
Term
nutcracker syndrome: types and tx
Definition
1. anterior nutcracker: left renal vein compressed between aorta and sma
1. posterior nutcracker: retroaortic left renal vein compressed between vertebral body and aorta
1. tx: surgical
Term
tx primary sclerosing cholangitis
Definition
liver transplant. may have cholangioplasty for symptomatic relief.
Term
axillary nerve in quadrilateral space supplies
Definition
axillary nerve in quadrilateral space supplies minor, deltoid.
Term
percentage rbc radio labeling adequate
Definition
90%
Term
amout of allowable free pertechnetate
Definition
5%
Term
cannot see sentinal node
Definition
may have injected tc sulfur colloid too deep.
Term
osteosarcoma workup
Definition
image joint to joint and non contrast chest CT
Term
mosaic perfusion
Definition
1. if on inspiration; parenchymal disease. protein alveolar proteinosis, lipoid neumonia, pneumocystis jiroveci, brochoalveolar carcinoma.
1. if on expiration, due to air trapping. if due to small airway disease like bronchiolitis obliterans, asthma, hypersensitivity pneumonitis, Swyer James, rheumatoid or other connective tissue disorders, drug reaction etc.
1. vascular disease like chronic pulmonary embolism, vasculitis, pulmonary arterial hypertension
Term
dd for biliary atresia
Definition
1. biliary atresia
1. alpha one antitrypsin deficiency
1. hepatitis.
Term
treatment of Normal pressure hydrocephalus
Definition
1. if NPH: can shunt
1. if negative for NPH then shunt may not help.
Term
dd high probability PE
Definition
takayasu's arteritis
Term
after chemotherapy, can have
Definition
thymic rebound (hot on pet also), which looks like tumor recurrence, but
Term
risk of thyroid malignancy in hot nodule, multinodular goiter and cold nodule.
Definition
risk of malignancy
1. hot nodule 1%
1. multinodular goiter 2%
1. cold nodule 20%
Term
can send home up to mCi of I 131
Definition
I 131 254 mCi as per law
Term
fdg pet
Definition
major spill with regular dose 15 mCi
Term
high radiation area
Definition
if 1 mSv (0.1 rem) in 1 h at 30 cm.
Term
anatomy of upper GI
Definition
valleculae (above)
pyriform sinus (below)
Term
case corkscrew appearance of the esophagus and schatzki's ring
Definition
1. corkscrew esophagus (esophageal dysmotility disorder) and schatzki's ring.
1. use 13 mm barium tablet to distinguish if symptoms from dysmotility problem or schatzki's ring.
Term
lpo vs rao
Definition
1. rao: supine. if gi study is to my right of spine. fundus with air.
1. lpo: upright. if gi study is to my left of spine. fundus with barium.
Term
impressions on the esophagus
Definition
pharygoesophageal junction, aortic arch, left main bronchus, left atrium, diaphragm
Term
pseudodiverticulois:
Definition
1. look for stricture because 90% of pseudodiverticulosis has stricture
Term
ulcer dd
Definition
1. erosive gastritis (nsaid)
2. aphthous ulcer from early crohns disease.
Term
types of polyps
Definition
1. inflammatory (aka hyperplastic)
2. adenomatous polyps
Term
infection of jejunum
Definition
giardia
Term
mesenteric mass dd
Definition
carcinoid, sclerosing mesenteritis, desmoid
Term
coil spring appearance
Definition
intussusception
Term
how do you know when lower gi complete
Definition
appendix, ileocecal valve, terminal ileum
Term
if pseudosacculations
Definition
if pseudosacculations with wide neck: scleroderma
Term
lap band phi angle should be
Definition
phi angle should be 4-58 degrees
1. if < 4 degrees then could be stenosois
1. if > 58 degrees then could be slippage.
Term
small bowel fold thickening
Definition
1. diffuse: regular (edema: congestive cardiac failure, cirrhosis, nephrotic) or irregular (whipple, amyloidosis, eosinophilic gastroenteritis, a beta lipoproteinemia)
1. segmental: regular (hemorrhage, ischemia, radiation) or irregular (lymphoma, crohns, infection)
Term
two types of gastric bypass
Definition
1. gastric bypass: connect jejunum to proximal stomach; become roux loop. the distal stomach and other jejunum is the afferent loop.
1. lap band:
Term
kissing stent
Definition
if two stent in each common iliac artery. (not the upside down Y shape)
Term
non alcoholic steatohepatitis (nash)
Definition
may have to liver biopsy to rule out NASH
nash can lead to cirrhosis.
fatty liver can be caused by alcohol, obesity, diabetes
Term
liver hyperechoic centrally and peripheral low echogenicity
Definition
if hyperechoic center and hypoechoic halo in liver: mets, hcc, adenoma
Term
gb polyp < 5mm.
Definition
gb polyp
1. if < 10 mm follow up
1. if > 10 mm remove
Term
testicular and epididymal cysts
Definition
1. epididymal: spermatocele (falling snow sign) and epididymal cyst
1. testicular: tunica albuginea cyst (near tunica albuginea) and testicular cysts (usually near mediastinum testis)
Term
placenta previa
Definition
complete, partial, marginal (at edge of internal os), low lying (within 2 cm of internal os)
Term
benign appearing lymph node
Definition
central vessel, fatty hilum and oblong hilum
Term
cervical and prostate cancer
Definition
T1
1. cervical cancer: high T2 which goes through low T2 stromal ring
1 prostate cancer: low T2 which goes through high T2 peripheral zone.
Term
chemical shift artifact
Definition
in frequency encode direction
Term
mibg mechanism
Definition
1. active transport through norepinephrine transporter and stored in neurosecretory granules.
1. remember give lugol's solution before study.
Term
encephalocele syndromes
Definition
1. chiari III (chiari II with encephalocele)
1. meckel gruber (encephalocele, post axial polydactyly, multicystic dysplastic kidney,
1. trisomy 13 (patau): encephalocele/holoprosencephaly post axial polydactyly, enlarged kidneys, intracardiac increased focus)
Term
bone biopsy
Definition
16g needle
Term
1. shoulder aspiration
1. si joint aspiration
Definition
1. 20gauge needle. supine. mid to lower glenohumeral joint.
1. 20g needle. prone. lateral angulation. under CT guidance.
Term
air crescent sign
Definition
air crescent sign
1. invasive aspergillosis: immunocompromised. (CT halo sign: ggo around consolidation is also for invasive aspergillosis) in correct clinical setting
1. mycetoma: not immunocompromised.
Term
manometric characteristics of achalasia
Definition
1. increased lower esophageal sphincter pressure
1. no relaxation of pressure during swallowing.
Term
absolute and relative adrenal washout
Definition
1. absolute > 60% washout then adenoma
1. relative > 40% washout then adenoma
Term
lhermitte duclos disease
Definition
1. gangliocytoma
1. area of striated appearance of cerebellum
Term
portal hypertension
Definition
1. coronary vein goes superiorly
1. umbilical vein goes inferiorly
Term
how much I 131 to give for grave's
Definition
(100 uCi/g x grams of thyroid)/(24h RAIU)
Term
I 131 treatment thyroid
Definition
High Risk Disease:
Contained to Thyroid - 100 mCi
Positive Lymph Nodes - 150 mCi
Lung Metastasis - 200 mCi
Bone Metastasis - 250 mCi
Term
endometrial stripe normal post menopausal
Definition
1. if bleeding
a. and tamoxifen. abnormal > 8mm
a. without tamoxifen. abnormal > 5mm
1. not bleeding: abnormal > 8 mm
Term
if widened teardrop in child on one side, could be
Definition
joint effusion from septic arthritis, toxic synovitis, hemarthrosis
Term
jaccoud arthropathy
Definition
1. deforming arthropathy
1. ulnar deviation of phlanges with subluxation at the metacarpalphalangeal joints
1. may represent lupus
Term
arthrogram mixture for shoulder
Definition
1. 2 cc of iodinated contrast
1. 0.2 cc of gad in 20 cc saline
anterior approach. use about 10-15 cc.
Term
if only seen on mlo, but not cc view
Definition
can do exaggerated lateral or medial view to find lump
Term
types of pacemakers
Definition
pacemakers:
1. single lead: in right ventricle
1. double lead: one in right atrium and another in right ventricle.
1. biventricular pacemaker: one lead in right ventricle and another in the left ventricle via the coronary sinus

implantable cardioverter defribillator (icd)
1. proximal end; should be in the svc: can be misplaced in the coronary sinus?
1. distal end: RV
two lead pacemaker
1. Right ventricle (anterior left medial)
1. left ventricle via the coronary sinus (posterior left lateral)
Term
esophageal submucosal lesions
Definition
1. leiomyoma
1. GIST
1. hematoma (look for fat stranding in soft tissues and muscles)
Term
gossybipoma
Definition
retained sponge
Term
parts of the urethra
Definition
1. prostatic, membranous, bulbous, penile
1. bulbopenile junction
http://academic.amc.edu/martino/grossanatomy/site/medical/Radiology/Reproduction/urethrogram.htm
1. grades: 1: contusion. normal urethrogram. 2: stretch injury. no extravasation. foley. 3: extravasation, but see bladder. foley. 4: don't see bladder < 2 cm separation. delayed surgery. 5: don't see bladder > 2 cm separation. delayed surgery. http://radiographics.rsna.org/content/28/6/1631/T1.expansion.html
Term
congenital adrenal hyperplasia
Definition
1. congenital: lacking in enzyme to create cortisol. can have virilization due to presence of too much cortisol precursor.
1. cushing's (too much cortisol usually from pituitary tumor) and Conn syndrome (too much aldosterone usually from adrenal adenoma or hyperplasia)
Term
dd sellar cystic mass
Definition
1. rathke's cleft cyst
1. craniopharyngioma
1. pituitary adenoma
Term
lytic lesion in posterior spine
Definition
abc, osteoblastoma, osteoid osteoma
Term
medial vs lateral knee
Definition
medial: more fat and has sartorius tendon
Term
decrease aliasing
Definition
increase prf (pulse rate frequency)
Term
epinephrine dosage
Definition
epinephrine 0.1 mg q 3-5 min to a max of 1 mg.
Term
goldman types of urethral tears
Definition
1. stretch injury
2. urethra above urogenital diaphragm (at membranous urethra)
3. urethra at or below urogenital diaphragm
4. bladder neck
5. anterior urethra only
Term
cannonball mets
Definition
renal cell carcinoma. choriocarcinoma
Term
horseshoe kidney
Definition
increased risk of wilm's tumor and renal cell carcinoma
Term
unhappy triad
Definition
1. medial collateral ligament tear/strain
1. medial meniscal tear
1. acl tear
Term
dd for high T2 in basal ganglia
Definition
1. hypertensive hemorrhage
1. hypoxic ischemic injury
1. carbon monoxide poisoning
1. methanol toxicity
1. osmotic demylination syndrome (high signal in central pons)
1. Wilson disease, japanese encephalitis, leigh disease, Creutzfeldt jacob
Term
mr guidance breast biopsy
Definition
1. pt prone
1. breast in compression
1. scan with contrast
1, localize mass with dynacad
1. pull out patient from bore
1. place lidocaine and nick skin with scalpel
1. place biopsy needle
1. confirm placement of biopsy needle
1. biopsy mass (probably at least 4 times)
1. place post biopsy clip
1. scan again to confirm placement of clip.
Term
gyriform enhancement in infarct
Definition
rule of 2.
2d: enhancement
2w: maximal enhancement
2m: resolution of enhancement.
Term
1. protrusion vs extrusion
1. migration vs sequestration
Definition
1.protrusion (wide neck) vs extrusion (narrow neck)
1. migration (disc displaced from source) vs sequestration (disc not continuous with source)
Term
well circumscribed breast mass which is high on T2
Definition
1. cyst
1. mucinous (colloid) carcinoma. enhances.
Term
breast depth
Definition
anterior, mid, posterior 1/3 depth
Term
tx subclavian steal
Definition
angioplasty, stent, surgery
Term
Ellis Van Creveld
Definition
polydactyly
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