Term
|
Definition
1. intracapsular rupture
2. extracapsular rupture
3. radial fold
1. gel bleed
2. herniation |
|
|
Term
|
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
|
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
|
Definition
1. intraductal papilloma
2. intracystic papillary carcinoma
3. ductal carcinoma in situ
1. dilated duct with debris |
|
|
Term
|
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
|
Definition
1. gynecomastia
2. breast cancer
3. lipoma
1. hematoma
2. abscess
3. metastatic disease |
|
|
Term
|
Definition
1. invasive ductal carcinoma NOS
2. mucinous carcinoma
3. medullary carcinoma
1. papillary carcinoma
2. ductal carcinoma in situ |
|
|
Term
|
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
|
Definition
1. sebacesous cyst
2. epidermal inclusion cyst
3. focal infection
1. breast carcinoma
2. lymphoma
3. steatocystoma multiplex |
|
|
Term
|
Definition
1. phyllodes tumor
2. fibroadenoma
2. circumscribed breast carcinoma
1. hematoma
2. abscess |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. atherosclerosis
2. fibromuscular dysplasia (mc variant medial fibroplasia "string of beads")
3. dissection
----
1. iatrogenic |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. renal osteodystrophy
2. osteopetrosis
3. Paget disease
1. metastatic disease
2. myelofibrosis |
|
|
Term
|
Definition
1. AS
2. IBD (inflammatory bowel disease)
3. RA
1. psoriatic or reactive arthropathy
2. osteoarthritis
3. septic arthritis |
|
|
Term
|
Definition
1. rheumatoid arthritis
2. crystalline arthropathy (CPPD, gout)
3. collagen vascular disease (SLE)
1. hemochromatosis
2. infection |
|
|
Term
|
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
|
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
|
Definition
1. idiopathic wormian bones
2. osteogenesis imperfecta
3. cleidocranial dysostosis
1. down syndrome
2. metabolic disease (rickets, hypothyroidism) |
|
|
Term
|
Definition
1. idiopathic Madelung deformity
2. Turner syndrome
3. Skeletal dysplasia (multiple epiphyseal dysplasia, dyschondrosteosis)
1. trauma
2. infection/septic arthritis |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
1. hemangioma
2. lymphangioma
3. meningioma
4. mets
5. lymphoma |
|
|
Term
|
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
|
Definition
1. partoid tumor (pleomorphic adenoma, Warthin tumor, mucoepidermoid carcinoma, adenocystic carcinoma)
2. lymphoma
3. mets
---------
4. branchial cleft cyst (type I) |
|
|
Term
|
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
|
Definition
1. mets
2. chordoma
3. chondrosarcoma
4. invasive pituitary macroadenoma
5. plasmacytoma |
|
|
Term
|
Definition
1. dissection.
2. pseudoaneurysm
3. AVF
4. thrombosis |
|
|
Term
|
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
|
Definition
1. acquired cholesteatoma
2. facial nerve schwannoma
3. glomus tympanicum
4. normal variant vasculature
5. cholesterol granuloma |
|
|
Term
|
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
|
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
|
Definition
1. congenital cyst
2. abscess
3. cystic lymph node
4. lymphatic malformation
5. cystic nerve sheath tumor |
|
|
Term
|
Definition
1. meningioma
2. schwannoma
3. paraganglioma
4. mets
5. dehiscent jugular bulb |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
1. glioblastoma multiforme
2. lymphoma
3. demyelinating disease
4. diffuse axonal injury
5. marchiafava bignami disease |
|
|
Term
|
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
|
Definition
1. meningioma
2. choroid plexus papilloma/carcinoma
3. central neurocytoma
4. ependymoma/ subependymoma
5. colloid cyst
6. subependymal giant cell astrocytoma |
|
|
Term
|
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
|
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
|
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
|
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
|
|
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
|
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
|
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
|
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
|
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
|
Definition
1. achondroplasia
2. thanatophoric dysplasia
3. Jeune syndrome
----
4. Ellis van Creveld syndrome
5. chondrodysplasia punctata |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
charms
1. congenital infection (rubella, syphilis)
2. hypophosphatemia (vitamin D resistant rickets)
3. achondroplasia
4. rickets
5. metaphyseal dysostosis
6. scurvy |
|
|
Term
|
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
|
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. |
|
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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. |
|
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Term
|
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 |
|
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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 |
|
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Term
|
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 |
|
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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. |
|
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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 |
|
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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 |
|
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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 |
|
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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 |
|
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Term
|
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. |
|
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Term
|
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. |
|
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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. |
|
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Term
|
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 |
|
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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 |
|
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Term
|
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. |
|
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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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
|
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
|
Definition
|
|
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
|
Definition
|
|
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
|
|
Term
| UIP vs NSIP: 2 other possible characteristics |
|
Definition
1. reticulations
2. traction bronchiectasis |
|
|
Term
| UIP vs NSIP: less associated findings |
|
Definition
|
|
Term
| UIP vs NSIP: subpleural region involved? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| UIP vs NSIP: upper or lower lobes |
|
Definition
|
|
Term
|
Definition
RB: respiratory bronchiolitis. less severe.
DIP: desquamative interstitital pneumonia. more severe. |
|
|
Term
|
Definition
|
|
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
|
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
|
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
|
Definition
|
|
Term
| How can you differentiate silicosis from sarcoid? |
|
Definition
|
|
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
|
Definition
| dilatation and impaction of centrilobular bronchioles |
|
|
Term
| When you see tree in bud, think of |
|
Definition
|
|
Term
|
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
|
Definition
Langerhans: irregular
LAM:round |
|
|
Term
|
Definition
Langerhans: thick
LAM: thin |
|
|
Term
| What kind of pleural effusion can LAM have? |
|
Definition
|
|
Term
|
Definition
LAM: many lung cysts
LIP: less than 12 lung cysts |
|
|
Term
|
Definition
| Lymphocytic interstitial pna |
|
|
Term
|
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
|
Definition
|
|
Term
| if interatrial septum is thickened and fat attenuation |
|
Definition
| lipomatous hypertrophy of the interatrial septum |
|
|
Term
|
Definition
| A left to right shunt that turns into a right to left shunt. |
|
|
Term
|
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
|
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
|
|
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
|
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
|
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
|
|
Term
| when do you call an aneurysm of the thoracic aorta? |
|
Definition
|
|
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
|
|
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
|
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
|
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
|
|
Term
|
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
|
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
|
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
|
Definition
1. elevated estrogen levels
2. marijuana
3. liver disease |
|
|
Term
| What causes of a mass is not commonly found in men? |
|
Definition
|
|
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
|
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
|
|
Term
| if round calcifications under 0.5 mm then call it |
|
Definition
|
|
Term
if punctate, clustered round calcs
1. not #2 below
2. new, increasing in #, linear or segmental, adjacent to known cancer |
|
Definition
|
|
Term
| suspicious calcifications: (old term: intermediate risk) |
|
Definition
1. amorphous / indistinct
2. coarse heterogeneous |
|
|
Term
| size of coarse hetergeneous calcifications |
|
Definition
|
|
Term
if amorphous / indistinct and
1. diffuse/scattered
2. regional, grouped/clustered, linear, segmental |
|
Definition
1. usually b9
2. may warrant bx |
|
|
Term
|
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
|
|
Term
| suspicious calcifications: higher risk |
|
Definition
1. fine pleomorphic
2. fine linear or fine linear branching |
|
|
Term
|
Definition
1. varying in size and shape
2. higher risk of malignancy |
|
|
Term
|
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
|
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
|
|
Term
| What breast carcinoma is likely to present as a well circumscribed mass? |
|
Definition
|
|
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
|
Definition
| amorphous/indistinct distribution pattern |
|
|
Term
|
Definition
| grouped/clustered distribution pattern |
|
|
Term
|
Definition
| fine linear branching pattern |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
lobule aka
terminal ductal lobular unit (tdlu)
1. terminal ducts: intraductal calcifications. suspicious for malignancy
2. acini: lobular calcifications. almost always benign |
|
|
Term
|
Definition
| disruption of normal anatomic planes |
|
|
Term
| can fibroadenoma enhance on mri? |
|
Definition
|
|
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
|
|
Term
| variant that can be mistaken for a mass |
|
Definition
|
|
Term
| can sternalis muscle be unilateral? |
|
Definition
|
|
Term
|
Definition
| superficial thrombophlebitis aka Mondor's disease |
|
|
Term
| superficial thrombophlebitis aka |
|
Definition
|
|
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
|
|
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
|
|
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
|
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
|
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
|
|
Term
autosomal dominant
multiple oil cysts |
|
Definition
|
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
|
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
|
|
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
|
Definition
comedo
cribiform
solid
micropapillary |
|
|
Term
| radiodensity in saline vs silicone implants on mmg |
|
Definition
| saline is less dense (blacker) than silicone (whiter) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
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
|
|
Term
| where does motion artifact most often occur? on what view? |
|
Definition
|
|
Term
| weight loss can make the breast appear |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| when you see a 1st finding on mmg then |
|
Definition
|
|
Term
| multiple defects on ductogram |
|
Definition
|
|
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
|
|
Term
| do saline implants have intra and extracapsular rupture? |
|
Definition
|
|
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
|
Definition
|
|
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
|
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
|
Definition
1. Interrupted peripheral nodular enhancement on arterial phase
2. Centripetal enhancement on delayed phase |
|
|
Term
|
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
|
Definition
Serous ovarian cancer
Mucin producing colorectal cancer |
|
|
Term
|
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
|
|
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
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| What is Budd Chiari syndrome? |
|
Definition
|
|
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
|
|
Term
|
Definition
| Transient Hepatic Attenuation Difference |
|
|
Term
|
Definition
| When the portal vein supply decreases, the hepatic artery supply increases |
|
|
Term
|
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
|
|
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
|
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
|
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
|
Definition
1. hyperdense liver
2. hyperdense lung infiltrates
3. interstitial lung disease |
|
|
Term
|
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
|
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
|
Definition
|
|
Term
| what phase best to diagnose cholangiocarcinoma |
|
Definition
|
|
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
|
Definition
1. achalasia (smooth tapering "bird's beak")
2. scleroderma: patulous GE junction
3. gastric/esophageal cancer (irregular tapering, "shouldering" mass effect) |
|
|
Term
|
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
|
Definition
1. esophagitis (reflux, drug-induced, caustic)
2. viral esophagitis (herpes has small ulcers and CMV/HIV have large ulcers)
3. esophageal carcinoma |
|
|
Term
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
Plumber Vincent DIGS a hole for the iron pipe
Dysphagia from esophageal webs
Iron deficiency anemia
Glossitis
Squamous cell cancer |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
|
|
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
|
|
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
|
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
|
Definition
| dilated biliary duct surrounds hepatic A and portal vein. Caroli's disease |
|
|
Term
|
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
|
|
Term
| milk of calcium bile occurs in the setting of |
|
Definition
|
|
Term
| due to clonorchis sinensis and ascaris lumbricoides |
|
Definition
| recurrent pyogenic cholangitis |
|
|
Term
|
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
|
Definition
| tx for klatskin tumor: resection, stent, transplant |
|
|
Term
|
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
|
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
|
Definition
dd: SOS
scleroderma, sprue, obstruction |
|
|
Term
| ovarian dermoid cyst should have been called |
|
Definition
|
|
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
|
|
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
|
|
Term
|
Definition
|
|
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
|
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
|
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
|
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
|
Definition
| high T2 in the region of the cervix compared to the uterus. |
|
|
Term
|
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
|
|
Term
|
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
|
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
|
Definition
| teratoma with > 50% thyroid tissue |
|
|
Term
|
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
|
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
|
|
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
|
|
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
|
Definition
|
|
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
|
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
|
Definition
| arterialized flow of the adjacent vein |
|
|
Term
|
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
|
Definition
| multiple coronoary aneurysms |
|
|
Term
| If you see focal stenosis in an unusual location, think of |
|
Definition
|
|
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
|
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
|
Definition
|
|
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
|
|
Term
|
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
|
|
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
|
Definition
| 10% larger than normal unaffected vessel |
|
|
Term
|
Definition
| not more than 1 cm more on either side of lesion |
|
|
Term
| tx for symptomatic FMD in renal A |
|
Definition
|
|
Term
| tx for atherosclerosis in renal A |
|
Definition
|
|
Term
|
Definition
IA: proximal
IB: distal
II: collaterals
III: defect in graft
IV: thru graft fabric due to porosity |
|
|
Term
|
Definition
|
|
Term
| fibrinolytic agent and dose |
|
Definition
|
|
Term
| another name for fibrinolytic |
|
Definition
|
|
Term
| what do you monitor with tPA therapy |
|
Definition
|
|
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
|
|
Term
|
Definition
|
|
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
|
|
Term
| supplies: jejunum, ileum, asc and prox 2/3 of transverse colon |
|
Definition
|
|
Term
| supplies: distal 1/3 transverse colon, desc colon and sigmoid and upper rectum |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| portosystemic gradient in TIPS: target |
|
Definition
|
|
Term
| portosystemic gradient in TIPS: how calculate |
|
Definition
| portal pressure minus right atrial pressure |
|
|
Term
|
Definition
| distal to the left subclavian artery at the site of the attachment of the ligamentum arteriosum |
|
|
Term
|
Definition
|
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
SMA:
1. inferior pancreaticoduodenal A
2. jejunal and ileal branches
3. ileocolic A
4. right colic A
5. middle colic A |
|
|
Term
|
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
|
Definition
| systemic necrotizing vasculitis esp of the lungs (pulmonary necrotizing vasculitis) |
|
|
Term
|
Definition
|
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
|
|
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
|
Definition
tace (transarterial chemoembolization)
1. lesions < 3 cm
2. diffuse liver lesions
as per Dr. Egeibor |
|
|
Term
| look at these slides for review |
|
Definition
|
|
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
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Is enchondroma hereditary? |
|
Definition
|
|
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
|
Definition
|
|
Term
| exostosis can transform into |
|
Definition
|
|
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
|
|
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
|
|
Term
| predisposes to osteosarcoma, chondrosarcoma and MFH |
|
Definition
1. Paget's
2. bone infarct
3. radiation |
|
|
Term
|
Definition
|
|
Term
| non - ossifying fibroma aka |
|
Definition
|
|
Term
|
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
|
Definition
1. cortical thickening
2. bony expansion
3. trabecular thickening |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
critoe
capitellum
radial head
internal (medial epicondyle)
trochlea
olecranon
external (lateral epicondyle) |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
|
Term
| rheumatoid negative arthropathy |
|
Definition
| AS, IBD, Reactive arthritis, psoriatic arthritis, erosive OA |
|
|
Term
|
Definition
|
|
Term
|
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
|
Definition
1. destruction
2. increased density
3. debris
4. disorganization
5. dislocation |
|
|
Term
|
Definition
|
|
Term
|
Definition
1. ABC
2. telangiectatic osteosarcoma |
|
|
Term
|
Definition
|
|
Term
|
Definition
1. sonk: older people. insufficiency. medial condyle
2. ocd: younger people. fatigue e.g. microtrauma. lateral aspect of medial condyle |
|
|
Term
|
Definition
1. cortical thickening
2. bony expansion
3. trabecular thickening |
|
|
Term
|
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
|
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
|
Definition
| liposclerosing myxoid fibrous tumor |
|
|
Term
|
Definition
| prominence of posterior superior margin of calcaneus, which can cause pre Achilles or retro achilles bursitis |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
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
|
|
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
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
1. enchondroma
2. bone infarct
3. chondrosarcoma |
|
|
Term
| largest sesamoid bone in the body |
|
Definition
|
|
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
|
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
|
Definition
1. ulnar capping
2. ulnar translocation
3. swan neck and boutonniere deformities
4. Hitchhiker's thumb |
|
|
Term
|
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
|
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
|
|
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
|
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
|
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
|
Definition
| increased signal in the ulnar nerve |
|
|
Term
|
Definition
|
|
Term
|
Definition
| distraction of posterior portion of the vertebral body |
|
|
Term
|
Definition
1. posterior ankle impingement
2. os trigonum gets pinched in space posterior to ankle |
|
|
Term
|
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
|
|
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
|
Definition
1. radial styloid
2. scaphoid
3. capitate
4. hamate
5. triquetral
6. ulnar styloid |
|
|
Term
|
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
|
|
Term
|
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
|
Definition
| thoracic outlet obstruction |
|
|
Term
|
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
|
Definition
| anterior cervical decompression and fusion |
|
|
Term
| if clay shoveler's, need to |
|
Definition
| check CT for extension into lamina |
|
|
Term
|
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
|
Definition
|
|
Term
| atlanto axial distance should be |
|
Definition
< 5 mm kids
< 2.5 mm adults |
|
|
Term
| flexion teardrop can cause |
|
Definition
|
|
Term
|
Definition
| odontoid process goes thru foramen magnum |
|
|
Term
| pars interarticularis defect |
|
Definition
1. stress fx
2. gymnasts
3. can do bone scan |
|
|
Term
|
Definition
| usually anterior and superior |
|
|
Term
| mc coalition in the wrist |
|
Definition
|
|
Term
|
Definition
| herbert screw (hollow screw threaded over wire) |
|
|
Term
|
Definition
| dorsal intercalated segmental instability |
|
|
Term
| joints that have a volar plate |
|
Definition
|
|
Term
| what type of bone is the pisiform? |
|
Definition
|
|
Term
|
Definition
|
|
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
|
|
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
|
|
Term
|
Definition
1. posterior to lower pole of patella
2. anterior to femur |
|
|
Term
| tibial plafond (french for ceiling) fx aka |
|
Definition
|
|
Term
|
Definition
1. medial cord: flexor digitorum brevis
2. lateral cord: abductor digiti minimi |
|
|
Term
|
Definition
1. calcaneus
2. cuboid
3. talus
4. navicular |
|
|
Term
| quadriceps tendon rupture associated with |
|
Definition
| medial or lateral retinaculum tears |
|
|
Term
|
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
|
Definition
fegnomashic
fibrous dysplasia
eg, enchondroma
gct
nof
osteoblastoma
mets, mm
abc
sbc
hyperparathyroidism
infection
chondroblastoma, cmf |
|
|
Term
|
Definition
| march fx (distal 2nd or 3rd metatarsal stress fx) |
|
|
Term
|
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
|
|
Term
| mutilating psoriasis looks like |
|
Definition
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
1. osseous
2. cartilaginous
3. fibrous |
|
|
Term
| what it is between tibia and fibula that calcifies |
|
Definition
|
|
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
|
Definition
1. STT joint
2. !st MCM
3. 1st MCP
4. DIPs |
|
|
Term
|
Definition
1. not true neoplasm
2. due to AV malformation or vascular injury
3. can arise from tumors like GCT, chondroblastoma, osteoblastoma, osteosarcoma |
|
|
Term
|
Definition
1. fluid fluid level (serum-blood
2. septation |
|
|
Term
|
Definition
1. abc
2. gct
3. telangiectatic osteosarcoma |
|
|
Term
|
Definition
remove nidus via
1. surgery
2. radiofrequency ablation |
|
|
Term
|
Definition
| no, can lead to wrong dx of cancer |
|
|
Term
|
Definition
1. head
2. neck: subcapital, transcervical, basicervical
3. intertrochanteric
4. subtrochanteric |
|
|
Term
|
Definition
| removal of vertebral body |
|
|
Term
| if dens not fused to rest of the C2 |
|
Definition
|
|
Term
|
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
|
Definition
1. acetabular component
2. femoral component
3. stem goes into the femur |
|
|
Term
|
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
|
|
Term
| causes of bone marrow reconversion |
|
Definition
1. hypoxia like high altitude
2. possible menstruation |
|
|
Term
| only time you would fat sat T1 |
|
Definition
|
|
Term
|
Definition
1. fullness and decreased ROM
2. tx surgery |
|
|
Term
|
Definition
|
|
Term
| dd distal phalangeal erosions |
|
Definition
1. psoriasis
2. erosive oa
3. scleroderma |
|
|
Term
|
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
|
Definition
LIMP
1. treated lymphoma
2. infection
3. mets
4. paget's |
|
|
Term
| can AS cause spondylolysis or spondylolithesis |
|
Definition
|
|
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
|
|
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
|
|
Term
| is the greater trochanter epiphyseal? |
|
Definition
|
|
Term
| ovoid lucent lesion in femoral neck |
|
Definition
|
|
Term
|
Definition
|
|
Term
| sclerosis in intertrochanteric femur |
|
Definition
| liposclerosing myxofibrous tumor |
|
|
Term
|
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
|
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
|
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
|
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
|
|
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
|
|
Term
| 60 yo with lytic lesion in vertebral body |
|
Definition
| mets, myeloma (plasmacytoma), lymphoma, chordoma, |
|
|
Term
|
Definition
| peroneus brevis splits due to impingement between fibula (esp if convex) and peroneus longus |
|
|
Term
| ankle trauma classification system |
|
Definition
|
|
Term
| lateral collateral ligaments of the ankle |
|
Definition
| 1. anterior talofibular: if intact, others prob intact |
|
|
Term
|
Definition
1. syndesmosis sprains
2. anterior and posterior distal ftibiofibular |
|
|
Term
|
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
|
Definition
|
|
Term
|
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
|
|
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
|
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
|
|
Term
| the central spinal canal should be at least ___ of vertebral body width |
|
Definition
|
|
Term
|
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
|
|
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
|
Definition
|
|
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
|
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
|
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
|
|
Term
|
Definition
|
|
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
|
|
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
|
Definition
|
|
Term
| #subtalar and talonavicular joint dislocation |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
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
|
|
Term
|
Definition
|
|
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
|
|
Term
|
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
|
|
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
|
Definition
1. mets
2. multiple myeloma
3. lymphoma
4. infection
5. chordoma |
|
|
Term
|
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
|
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
|
|
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
|
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
|
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
|
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
|
|
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
|
|
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
|
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
|
|
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
|
|
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
|
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
|
|
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
|
Definition
fx
eg
tumor (mm, lymphoma, leukemia)
infection
steroids
hemangioma |
|
|
Term
|
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
|
|
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
|
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
|
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
|
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
|
|
Term
| DeQuervain's tenosynovitis |
|
Definition
| fluid around the abductor policis longus and extensor policis brevis |
|
|
Term
|
Definition
-closed degloving injury
-may see fluid fluid levels and globules of fat. |
|
|
Term
| msk sequences that Dr. Egeibor does |
|
Definition
|
|
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
|
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
|
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
|
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
|
|
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
|
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
|
Definition
1. vitreous
2. choroidal
3. retinal |
|
|
Term
| globe hemorrhage: vitreous |
|
Definition
|
|
Term
| globe hemorrhage: choroidal |
|
Definition
|
|
Term
| globe hemorrhage: retinal |
|
Definition
|
|
Term
|
Definition
|
|
Term
| cholesterol granuloma: T1 and T2 |
|
Definition
|
|
Term
| cholesterol granuloma: location |
|
Definition
|
|
Term
| cholesterol granuloma: why high T1? |
|
Definition
|
|
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
|
|
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
|
|
Term
| mc malignant salivary gland tumor |
|
Definition
|
|
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
|
|
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
|
|
Term
| superficial siderosis: prior CT may show |
|
Definition
|
|
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
|
Definition
1. interhemipheric
2. tectal
3. suprasellar |
|
|
Term
|
Definition
|
|
Term
|
Definition
hemorrhage
dermoid
teratoma |
|
|
Term
|
Definition
| anterior aspect of the 3rd ventricle |
|
|
Term
|
Definition
| obstructive hydrocephalus |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Colloid cyst: on non con CT |
|
Definition
|
|
Term
|
Definition
1. surgery
2. aspiration
3. shunting |
|
|
Term
|
Definition
1. astrocytoma
2. ependymoma
3. hemangioblastoma
4. mets |
|
|
Term
|
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
|
|
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
|
|
Term
| If kyphosis of the thoracic spine and multilevel end plate irregularity, you have |
|
Definition
|
|
Term
| What is the tx for Scheuermann Dz? |
|
Definition
|
|
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
|
|
Term
| cochlear aplasia: don't see |
|
Definition
|
|
Term
| cochlear aplasia: can see |
|
Definition
| IAC, vestibule, semicircular canals |
|
|
Term
| cochlear aplasia: can you get cochlear implant? |
|
Definition
|
|
Term
| What is it called when you have less than 2.5 turns of the cochlea? |
|
Definition
|
|
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
|
|
Term
| If something is in the parapharyngeal space and nerve sheath tumor, what nerve is involved? |
|
Definition
|
|
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
|
Definition
| metopic, sagittal, coronal, lambdoid |
|
|
Term
| Craniosynostosis: sagittal |
|
Definition
| scaphocephaly or dolichocephaly |
|
|
Term
| Craniosynostosis: metopic |
|
Definition
|
|
Term
| Craniosynostosis: coronal |
|
Definition
|
|
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
|
|
Term
| Aneurysmal subarachnoid hemorrhage: mortality? |
|
Definition
|
|
Term
| Aneurysmal subarachnoid hemorrhage: rebleed? |
|
Definition
|
|
Term
| Aneurysmal subarachnoid hemorrhage: vasospasm in what time period? |
|
Definition
|
|
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
|
|
Term
| molar tooth sign: what is it? |
|
Definition
| dysplastic cerebellar vermis |
|
|
Term
| molar tooth sign: what syndrome is it associated with? |
|
Definition
|
|
Term
| molar tooth sign: what does the 4th ventricle look like? |
|
Definition
|
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
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
|
Definition
|
|
Term
| dd for recurrent cerebral hemorrhage |
|
Definition
1. HTN
2. amyloid angiopathy
3. hemorrhagic transformation of stroke |
|
|
Term
| amyloid angiopathy clinical picture |
|
Definition
|
|
Term
|
Definition
| Langerhans cell histiocytosis |
|
|
Term
|
Definition
1. proliferation of Langerhans cells histiocytosis
2. granulomatous lesions |
|
|
Term
| EG: dd of EG in the spine |
|
Definition
|
|
Term
| dd for serpinginous structure along spinal cord |
|
Definition
1, dural AVF
2. AVM
3. venous collaterals` |
|
|
Term
|
Definition
| endovascular embolization |
|
|
Term
|
Definition
| venous HTN with secondary ischemia |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| AVM: grading system based on |
|
Definition
1. size of nidus
2. eloquent vs non-eloquent region
3. deep or superficial vein |
|
|
Term
|
Definition
1. embolization
2. surgery
3. radiation (gamma knife) |
|
|
Term
|
Definition
1. bleeding
2. ischemia from steel phenomenon |
|
|
Term
|
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
|
|
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
|
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
|
|
Term
|
Definition
|
|
Term
| Stapes sit on round or oval window? |
|
Definition
|
|
Term
| What is pachymeningeal enhancement? |
|
Definition
|
|
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
|
|
Term
| dd for leptomeningeal enh |
|
Definition
1. meningitis
2. prior subarachnoid hemorrhage
3. subacute infarction
4. leptomeningeal carcinomatosis
5. neurosarcoid, fungal, tb |
|
|
Term
|
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
|
|
Term
|
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
|
|
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
|
|
Term
| chrondrosarcoma vs. chordoma, which one if midline/off midline? |
|
Definition
midline: chordoma
off midline: chondrosarcom |
|
|
Term
|
Definition
|
|
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
|
|
Term
| craniopharyngioma: characteristics (2) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| dd for enhancing orbital mass |
|
Definition
1. hemangioma
2. lymphangioma
3. meningioma
4. mets
5. lymphoma |
|
|
Term
|
Definition
|
|
Term
| charac of intra orbital hemangioma |
|
Definition
|
|
Term
| meningioma: associated with |
|
Definition
|
|
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
|
|
Term
|
Definition
1. zygomatic arch
2. inferior orbital wall
3. lateral orbital wall |
|
|
Term
|
Definition
|
|
Term
|
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
|
|
Term
| carotid cavernous fistula (CCF): types |
|
Definition
|
|
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
|
Definition
| dilation of the cavernous sinus, superior ophthalmic V and proptosis |
|
|
Term
|
Definition
|
|
Term
| orbital pseudo tumor involving the cavernous sinus is called |
|
Definition
|
|
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
|
|
Term
| What does Waldeyer tonsillar ring involve? |
|
Definition
1. adenoids (nasopharyngeal tonsils)
2. palatine tonsils
3. lingual tonsils
4. tubal tonsils |
|
|
Term
|
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
|
Definition
|
|
Term
| salivary gland ca: perineural spread |
|
Definition
|
|
Term
| salivary gland ca: more common location of salivary gland ca |
|
Definition
|
|
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
|
|
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
|
|
Term
|
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
|
|
Term
| sarcoidosis: gallium 67 scan shows |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
|
Definition
a magic dr
aids (lymphoma)
mets
abscess (infection)
glioma
infarction
contusion
demyelinating dz
resolving hematoma |
|
|
Term
|
Definition
|
|
Term
| what type of stent can be used to treat dissection of the carotid? |
|
Definition
|
|
Term
|
Definition
C1, cervical;
C2, petrous;
C3, lacerum;
C4 cavernous;
C5, clinoid;
C6, ophthalmic;
C7, communicating |
|
|
Term
|
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
|
|
Term
| thallium: which is hot? lymphoma vs. toxo |
|
Definition
|
|
Term
| if see filum terminale lipoma, look for |
|
Definition
|
|
Term
| dx of tethered cord if below: |
|
Definition
|
|
Term
| normal filum terminale size |
|
Definition
|
|
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
|
Definition
|
|
Term
| FD and precocious puberty |
|
Definition
| Mc Cune albright syndrome |
|
|
Term
|
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
|
|
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
|
|
Term
| subarachnoid hemorrhage and aneurysm: sylvian fissure |
|
Definition
|
|
Term
| subarachnoid hemorrhage and aneurysm:interpenduncular fossa (like anterior midbrain?), or intraventricular |
|
Definition
|
|
Term
| subarachnoid hemorrhage and aneurysm: posterior fossa cistern, intraventricular |
|
Definition
|
|
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
|
|
Term
|
Definition
| pancreatic cyst, pheo, renal cyst, rcc, liver cyst. Hemangioblastoma retinal and cerebellar |
|
|
Term
|
Definition
(from radiographics and top 3 dd)
1. chondrosarcoma
2. plasmacytoma/lymphoma/mets
3. pituitary adenoma
4. meningioma
5. nasopharyngeal malignancy like SCC |
|
|
Term
|
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
|
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
|
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
|
Definition
1. Line from anterior and posterior foramen magnum
2. tip of dens should be not above this line
3. ~upper |
|
|
Term
|
Definition
1. pituitary tumors
2. parathyroid tumors
3. pancreatic islet cell tumors |
|
|
Term
|
Definition
1. parathyroid hyperplasia
2. pheochromocytoma
3. medullary thyroid cancer |
|
|
Term
| paraganglioma: common carotid artery bifurcation |
|
Definition
|
|
Term
| paraganglioma: jugular foramen |
|
Definition
|
|
Term
| paraganglioma: vagus nerve |
|
Definition
|
|
Term
| paraganglioma: middle ear |
|
Definition
|
|
Term
| paraganglioma: adrenal gland |
|
Definition
|
|
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
|
|
Term
|
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
|
|
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
|
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
|
Definition
1. calcs
2. cysts
3. enh component |
|
|
Term
| germ cell tumor: mc subtype |
|
Definition
|
|
Term
|
Definition
|
|
Term
| hypothalamic hamartoma vs glioma |
|
Definition
|
|
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
|
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
|
|
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
|
|
Term
|
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
|
|
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
|
|
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
|
|
Term
| hemagioblastoma associated with |
|
Definition
|
|
Term
| demyelinating disease in the spine does not respect the |
|
Definition
|
|
Term
| demylinating disease in the spine is ___shaped |
|
Definition
|
|
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
|
|
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
|
Definition
|
|
Term
| if enhancing orbital mass and fluid fluid levels, think |
|
Definition
|
|
Term
| meningiomas associated with |
|
Definition
|
|
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
|
Definition
| developmental venous anomaly |
|
|
Term
|
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
|
|
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
|
Definition
|
|
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
|
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
|
Definition
| metachromatic leukodystrophy |
|
|
Term
| leukodystrophy: frontal lobes |
|
Definition
|
|
Term
| leukodystrophy: occipital lobes |
|
Definition
| metachromatic leukodystrophy |
|
|
Term
| leukodystrophy: adrenal glands |
|
Definition
|
|
Term
|
Definition
|
|
Term
| leukodystrophy: increased NAA |
|
Definition
|
|
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
|
|
Term
| schizencephaly vs porencephaly |
|
Definition
| schizencephaly has gray matter lines clefts |
|
|
Term
|
Definition
1. meningioma
2. schwannoma
3. paraganglioma
4. mets
5. high jugular bulb |
|
|
Term
| high jugular bulb (jb) aka |
|
Definition
|
|
Term
|
Definition
| jb extends above floor of IAC with no connection to middle ear |
|
|
Term
| if high jb has connection to middle ear, called |
|
Definition
|
|
Term
|
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
|
|
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
|
|
Term
|
Definition
1. petrous apicitis
2. deep facial pain (CN V)
3. lateral rectus palsy (CN VI) |
|
|
Term
|
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
|
|
Term
|
Definition
glomus tympanicum
see glomus tumor (white arrow) on cochlear promontory
open arrow: malleus |
|
|
Term
|
Definition
1. acquired cholesteatoma
2. facial nerve schwannoma
3. glomus tympanicum
4. normal variant vasculature
5. cholesterol granuloma |
|
|
Term
|
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
|
Definition
aberrant ica (white arrow)
cochlea (black arrow) |
|
|
Term
| high T1 and T2 in middle ear |
|
Definition
|
|
Term
|
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
|
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
|
|
Term
|
Definition
| complete absence of cochlea (vestibule and semicircular canals are present) |
|
|
Term
|
Definition
| less than 2.5 turns of cochlea |
|
|
Term
| 5. labyrinthine ossificans |
|
Definition
| ossification of the membranous labyrinth |
|
|
Term
| labyrinthine ossificans due to |
|
Definition
|
|
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
|
|
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
|
|
Term
| looks like herpes encephalitis |
|
Definition
|
|
Term
| limbic encephalitis due to |
|
Definition
| paraneoplastic syndrome (a primary tumor causes the encephalitis somehow) |
|
|
Term
|
Definition
1. tuberous sclerosis
2. heterotopic gray matter
3. TORCH infection
4. mets |
|
|
Term
|
Definition
C TALRS
cardiac rhabdomyomas
tubers
angiomyolipoma
lam
renal cyst
subependymal giant cell astrocytoma |
|
|
Term
|
Definition
toxoplasmosis
rubella
cmv
herpes |
|
|
Term
| most likely torch to have subependymal and periventricular calcs |
|
Definition
|
|
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
|
|
Term
| normal size globe and lack of calcs (like coats dz) but h/o contact with cat/dogs |
|
Definition
|
|
Term
| temporal bone fracture types |
|
Definition
1. longitudinal temporal bone fx
2. transverse temporal bone fx |
|
|
Term
| mc type of temporal bone fx |
|
Definition
|
|
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
|
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
|
|
Term
|
Definition
1. scc
2. papillary thyroid ca |
|
|
Term
| most common lymphatic malformation |
|
Definition
|
|
Term
| usual location of cystic hygroma |
|
Definition
|
|
Term
| cystic hygroma associated with |
|
Definition
| Turner and Down syndromes |
|
|
Term
| Name a cystic nerve sheath tumor |
|
Definition
|
|
Term
|
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
|
Definition
|
|
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
|
Definition
|
|
Term
| dd for intraparenchymal hemorrhage |
|
Definition
1. vascular malfn
2. hemorrhagic infarct
3. hemorrhagic neoplasm
4. contusion
5. cerebral amyloid disease |
|
|
Term
|
Definition
1. lung
2. renal cell
3. thyroid
4. melanoma |
|
|
Term
|
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
|
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
|
|
Term
| oligodendroglioma commonly |
|
Definition
|
|
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
|
|
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
|
Definition
|
|
Term
|
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
|
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
|
|
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
|
|
Term
|
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
|
Definition
|
|
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
|
|
Term
|
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
|
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
|
|
Term
| if ependymoma in filum terminale called |
|
Definition
|
|
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
|
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
|
Definition
I: no enh
II: slight peripheral enh
III: enh
IV: necrosis |
|
|
Term
|
Definition
I: fluid: low T1 and high T2
II: fat: high T1 and t2
III: fibrosis. low T1 and T2 |
|
|
Term
|
Definition
|
|
Term
|
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
|
|
Term
| stir (csf bright) looks like: |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Tarlov cyst:
1. well circumscribed csf intensity masses extending through bilateral neuroforamen
2. there appears to be widening of the right neuroforamen. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Tarlov cyst location: intamedullary, extramedullary, intradural or extradural |
|
Definition
|
|
Term
|
Definition
|
|
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
|
|
Term
| if see ankylosis in a child, think about |
|
Definition
| Juvenile Idiopathic arthritis (JIA) |
|
|
Term
|
Definition
|
|
Term
|
Definition
Juvenile rheumatoid arthritis
Juvenile chronic arthritis |
|
|
Term
|
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
|
|
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 |
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Term
|
Definition
vertebral anomalies
anal imperforation
cardiac malfn
te fistula
renal abnormalities
limb abnormalities |
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Term
|
Definition
omphalocele
extrophy of the bladder
imperforate anus
spinal anomalies |
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Term
|
Definition
1. partial sacral agenesis
2. anorectal malformation
3. presacral mass |
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Term
|
Definition
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Term
|
Definition
1. fused lower extremities
2. on spectrum of caudal regression |
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Term
| many pts with caudal regression are |
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Definition
| offspring of diabetic mothers |
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Term
|
Definition
LOSSS
1. lisch nodules
2. optic nerve gliomas
3. sphenoid wing dysplasia
4. skeletal abnormalities
5. spinal abnormalities |
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Term
| NF 1: skeletal abnormalities |
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Definition
| "ribbon" deformity of the ribs due to multiple neurofibromas of the intercostal nerves |
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Term
| NF 1: spinal abnormalities |
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Definition
1. scoliosis
2. scalloping of the posterior vertebral bodies (dural ectasia and lateral meningoceles) |
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Term
| Some people think that _______is pathognomonic for NF1 |
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Definition
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Term
| What pattern do the neurofibromas cause intraforaminally |
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Definition
"dumbbell" pattern
1. widening the neural foramen
2. expanding outside the canal |
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Term
| What do should you worry about when evaluating neurofibromas? |
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Definition
| degeneration into malignant nerve sheath tumors |
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Term
| If vertebral body anomalies and cystic intraspinal masses, think |
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Definition
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Term
|
Definition
| epidural lipomatosis: sagittal T2 |
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Term
| defn epidural lipomatosis |
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Definition
| epidural fat wider than 6 mm |
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Term
| What do V2 and V3 go thru? |
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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 |
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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. |
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Term
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Definition
| hemorrhage or infarct in the pituitary gland (may have also a macroadenoma) |
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Term
1. looks like meningioma, but low on T2
2 dd for meningioma |
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Definition
1. solitary fibrous tumor (aka hemangiopericytoma)
2. meningioma, solitary fibrous tumor / hemangiopericytoma |
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Term
| other things to think about when trying to diagnose a brain mass |
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Definition
1. demyelinating disease
2. subacute hematoma
3 subacute stroke
4. infection like TB |
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Term
| if see a mass, also look for |
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Definition
herniation
hemorrhage
hydrocephalus |
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Term
|
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) |
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Term
|
Definition
1. multiple emboli (doesn't enhance, but #2-5 enhance)
2. multiple abscesses
3. TB
4. mets
5. demyelinating disease |
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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 |
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Term
|
Definition
1. nasopharynx
2. oropharynx
3. oral cavity
4. hypopharynx (hyoid bone to esophagus)
5. larynx (hyoid bone to trachea) |
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Term
spaces
1. anterior
2. posterior |
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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 |
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Term
enhancement
1. dural:
2. leptomeningeal: |
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Definition
1. pachymeningeal (dural): intracranial hypotension, csf leak, shunt catheter
2. leptomeningeal (pia and arachnoid): sarcoid, tb, carcinomatosis, shunt infection |
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Term
| arachnoid cyst vs epidermoid cyst |
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Definition
both low t1 and high t2
1. arachnoid cyst: low dwi. no restricted diffusion.
2. epidermoid cyst: high dwi. restricted diffusion. |
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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 |
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Term
| multiple heterotopias vs tuberous sclerosis on MR |
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Definition
1. multiple heterotopias don't enhance
2. TS enhances and sometimes low T2 signal due to calcium |
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Term
dd white matter dz
1. adults
2. children |
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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) |
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Term
|
Definition
| paralysis of upward gaze due to lesion in region of pineal gland |
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Term
|
Definition
1. Capillary: common in infancy and naturally regress
2. Cavernous: can enlarge, composed of vascular channels. Can have phleboliths |
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Term
| anterior vs posterior nasal obstruction |
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Definition
1. anterior: pyriform aperture stenosis
2. posterior: choanal atresia |
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Term
| dwi and adc with hemangioblastoma |
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Definition
|
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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 |
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Term
|
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] |
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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? |
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Definition
1. lactate and lipid
2. choline: cell membrane. NAA neuron
3. mr: 48 h. pet 6 m |
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Term
|
Definition
AMEN
1. arachnoid cyst
2. meningioma, mets
3. epidermoid cyst
4. nerve sheath tumor |
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Term
|
Definition
1. infarct: in reperfusion or healing phase
2. lymphoma
3. encephalitis |
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Term
|
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 |
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|
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.) |
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Term
|
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 |
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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 |
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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 |
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|
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 |
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|
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 |
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Term
|
Definition
|
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Term
|
Definition
dimethyl: HIDA
disofenin: DISHIDA
Mebrofenin: BRIDA |
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Term
| HIDA-child biliary atresia vs neonatal hepatitis |
|
Definition
1 mCi IV
dynamic and delayed 24h |
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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 |
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Term
|
Definition
Give slow infusion of CCK at 0.02 ug/kg over 30 min
Dynamic imaging to get EF using ROI over GB |
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Term
|
Definition
5 mCi
IV
48 h
(Usually 1-3 days later, but can be 4 or more days later) |
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Term
|
Definition
nasal, lacrimal
liver
bowel (so not good for abd processes)
no spleen (so good for splenic abscess) |
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Term
| gallium 67 citrate good for |
|
Definition
chronic infection
spine osteomyelitis
chest: pcp, sarcoid
splenic abscess |
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Term
| What tells you that it is a gallium scan? |
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Definition
| nasal mucosa and lacrimal glands, liver, intestines, not spleen |
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Term
| Indium 111 labelled wbc: dose |
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Definition
1. 500 uCi IV at 1d
2. there is also tc labeled rbc 10 mCi at 2h |
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Term
|
Definition
|
|
Term
| indium 111 labelled wbc: good for |
|
Definition
acute
non-spine osteomyelitis
abdomen pelvis pathology (no bowel activity)
not good for splenic abscess |
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|
Term
| What tells you it is an indium scan? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Thallium can detect what kind of chest tumor? |
|
Definition
thallium 201 chloride
3 mCi IV
3h |
|
|
Term
|
Definition
| thyroid, heart and salivary glands (and kidneys) |
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Term
|
Definition
10-20 mCi (remember 20 mCi cuz easier)
image at 20 min, 2h (2-4 hours) |
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|
Term
| 99m tc sestamibi where does it go? |
|
Definition
| salivary gland, thyroid (gone by 2 hours), overactive parathyroid tissue, heart, liver |
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Term
| 99m tc pertechnetate vs I123: thyroid biology |
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Definition
1. 99m Tc pertechnetate: just trapped.
2. I 123: trapped and organified |
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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) |
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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) |
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Term
|
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) |
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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 |
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Term
|
Definition
4h: 5-15% (5%)
24h: 3-35% (24%) |
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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 |
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|
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. |
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|
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 |
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|
Term
| How is this 99m Tc mertiatide done? aka? |
|
Definition
10 mCi IV 20 min
aka 99m Tc MAG 3 |
|
|
Term
|
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 |
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|
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) |
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|
Term
| What are the parts of the ventilation portion? |
|
Definition
Single breath
Equilibrium
washout |
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Term
|
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 |
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|
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
|
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
|
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
|
|
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
|
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
|
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
|
Definition
I 123: 10 mCi.
I 131: 1 mCi
both 2d
p. 110 requisites and online article |
|
|
Term
|
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
|
Definition
| decreased uptake in the parietal and temporal lobes |
|
|
Term
| Lingual thyroid: thyroid status |
|
Definition
|
|
Term
|
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
|
Definition
|
|
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
|
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
|
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
|
|
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
|
|
Term
| What is the acceptable level of Mo 99 |
|
Definition
|
|
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
|
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
|
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
|
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
|
|
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
|
|
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
|
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
|
|
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
|
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
|
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
|
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
|
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
|
Definition
SMA:
1. inferior pancreaticoduodenal A
2. jejunal and ileal branches
3. ileocolic A
4. right colic A
5. middle colic A |
|
|
Term
|
Definition
IMA
1. left colic
2. sigmoid A
3. superior rectal A |
|
|
Term
|
Definition
IMA
1. left colic
2. sigmoid A
3. superior rectal A |
|
|
Term
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
|
Definition
1. High energy source (I 131)
2. low or medium energy collimator |
|
|
Term
|
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
|
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
|
|
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
|
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
|
Definition
|
|
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
|
Definition
1. between lateral ventricles
a. superiorly: corpus callosum
b. inferiorly: septum pellucidum
2. more inferiorly: 3rd ventricle |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
|
|
Term
|
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
|
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
|
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
|
|
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
|
Definition
| two histologically different tumors in the adrenal gland. |
|
|
Term
|
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
|
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
|
Definition
|
|
Term
|
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
|
|
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
|
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
|
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
|
Definition
|
|
Term
|
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
|
Definition
|
|
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
|
Definition
1. fibrous dysplasia
2. unicameral bone cyst
etc.? |
|
|
Term
|
Definition
1. patella
2. calcaneus
3. most apophysis like iliac crest, ischial tuberosity, greater/lesser trochanter |
|
|
Term
|
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
|
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
|
Definition
1. cxr: widened mediastinum
2. causes: obesity, endogenous production of steroids (Cushing's syndrome), exogenous steroids for asthma, COPD etc. |
|
|
Term
|
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
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. trauma
2. iatrogenic
3. idiopathic
4. asthma
5. LAM (also has chylous effusions and ptx) |
|
|
Term
|
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
|
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
|
Definition
dwi: csf is low intensity
adc: looks like black holes everywhere. |
|
|
Term
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
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) |
|
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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 |
|
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Term
|
Definition
1. usually upper lobe
2. classic finding: perihilar density (can be round or tubular) surrounded by hyperinflation |
|
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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. |
|
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Term
|
Definition
1. intrinsic: usually iatrogenic from ETT or tracheostomy
2. extrinsic: usually from external compression from thyroid gland (multinodular goiter, thyroid carcinoma) or lymphoma |
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Term
|
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 |
|
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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 |
|
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Term
|
Definition
1. oligodendroglioma
2. ganglioglioma
3. dnet (dysembronoplastic neuroepithieal tumor
4. pleomorphic xanthoastrocytoma |
|
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Term
| ectopic posterior pituitary differential |
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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 |
|
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Term
| PRES and Creutzfeld Jakob disease |
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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) |
|
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Term
|
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. |
|
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Term
|
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 |
|
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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 |
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Term
|
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) |
|
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Term
|
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] |
|
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Term
|
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 |
|
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Term
|
Definition
1. pectus carinatum: sternum protrudes anteriorly
2. pectus excavatum: sternum depressed. |
|
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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 |
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Definition
1. ascending aorta: false lumen is anterolateral
2. descending aorta: false lumen is posterolateral |
|
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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) |
|
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Term
|
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 |
|
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Term
|
Definition
LV aneurysm usually due to MI
1. true LV aneurysm: usually apical or anterolateral
2. false LV aneurysm: usually diaphragmatic or posterolateral. |
|
|
Term
|
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) |
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Term
|
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 |
|
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Term
|
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. |
|
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Term
|
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
|
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 |
|
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Term
|
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 |
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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 |
|
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Term
|
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. |
|
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Term
|
Definition
1. close with indomethacin or ligation
2. keep open with prostaglandins |
|
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Term
|
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
|
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 |
|
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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
|
|
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
|
Definition
1. spastic: upper motor neuron. "christmas" tree or "pinecone" pattern. pseudodiverticula.
2. atonic: lower motor neuron. large bladder. |
|
|
Term
|
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
|
|
Term
|
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. |
|
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Term
|
Definition
| Legg Calve Perthes disease |
|
|
Term
|
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
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
1. acetabular component
2. femoral component
3. stem goes into the femur |
|
|
Term
|
Definition
Weber A: no surgery
Weber B: may or may not be surgial
Weber C: surgical |
|
|
Term
|
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
|
|
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
|
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
|
Definition
1. hemifacial microsomia
2. ear anomalies
3. cleft palate
4. vertebral segmentation errors. |
|
|
Term
| grapelike mass in bladder of child |
|
Definition
|
|
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
|
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
|
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
|
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
|
Definition
1. neuroenteric
2. bronchogenic cyst
3. enteric cyst |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
4 fibers
3 speck groups
3 masses
Done weekly |
|
|
Term
|
Definition
1. mmg: fan shaped, retroareolar density
2. US: hypoechoic, retroareolar lesion with extension into fat |
|
|
Term
|
Definition
| 7 - 14 days after 1st day of menstrual period. |
|
|
Term
|
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
|
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
|
Definition
|
|
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
|
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
|
Definition
| astrocytoma,ependymoma, hemangioblastoma mets, demyelinating disease |
|
|
Term
|
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
|
Definition
1. metastatic disease
2. hyperparathyroidism (lung, stomach)
3. renal osteodystrophy (prominent ribs end activity aka rachitic rosary bed) |
|
|
Term
|
Definition
1. dd testicular torsion: abscess
1. dose for scrotal scintigraphy: Tc pertechnetate 10 mCi |
|
|
Term
|
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
|
|
Term
|
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
|
Definition
|
|
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
|
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
|
Definition
1. hiatal: behind heart
2. paraesophageal: a little left of midline
3. Bochdalek's: left posterior
4. Morgagni: right anterior |
|
|
Term
|
Definition
1. nifedipine sublingual
1. nitroglycerin intra arterially 100 ug at site |
|
|
Term
|
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
|
Definition
polyneuropathy
organomegaly
endocrinopathy
m protein (monoclonal plasma cell proliferative disorder)
skin changes |
|
|
Term
|
Definition
|
|
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
|
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
|
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
|
|
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
|
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
|
Definition
caudate
putamen, globus pallidus (lenticular nucleus)
substantia nigra |
|
|
Term
| high T1 and T2 in region of pituitary |
|
Definition
|
|
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
|
Definition
1. gray white matter junction
2. corpus callosum especially splenium
3. brainstem
4. deep white matter |
|
|
Term
|
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
|
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
|
Definition
1. cervical
2. petrous
3. lacerum
4. cavernous
5. clinoid
6. ophthalmic
7. communicating |
|
|
Term
|
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
|
Definition
1. subacute sclerosing panencephalitis
2 prior measles infection
3. subcortical and periventricular white matter disease |
|
|
Term
|
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
|
Definition
1. absent septum pellucidum
1. small optic chiasm or nerves
1. associated with ectopic posterior pituitary and holoprosencephaly |
|
|
Term
|
Definition
1. v2: maxillary. foramen rotundum (two U's so 2nd division of cnV)
2. v3: mandibular. foramen ovale. |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
| think tetrology of fallot, truncus arteriosus, tricuspid atresia |
|
|
Term
|
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
|
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
|
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
|
|
Term
| dd for somewhat worrisome mass breast mass |
|
Definition
|
|
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
|
|
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
|
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
|
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
|
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
|
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
|
Definition
|
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
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
|
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
|
|
Term
|
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
|
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
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
|
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
|
Definition
1. tx of liver adenoma: surgery
2. malignant potenial and bleeding
3. adenoma can have fat and hemorrhage |
|
|
Term
|
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
|
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
|
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
|
Definition
|
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
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
|
Definition
looser zones
1. dx: osteomalacia or rickets
1. type of insufficiency fracture |
|
|
Term
| % malignant transformation of paget's |
|
Definition
|
|
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
|
|
Term
| growth disturbance of osseous structures and atrophic muscle |
|
Definition
| neuromuscular d/o like polio |
|
|
Term
|
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
|
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
|
|
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
|
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
|
Definition
|
|
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
|
|
Term
|
Definition
| langherhan's cell histiocytosis |
|
|
Term
| type of lethal osteogenesis imperfecta |
|
Definition
| type II osteogenesis imperfecta is lethal |
|
|
Term
|
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
|
Definition
1. typhlitis ("typhl-" means "blind sac"): seen in transplant patients.
2. pseudomembranous colitis
3. diverticulitis |
|
|
Term
|
Definition
| pancreas and mesentary hematoma |
|
|
Term
|
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
|
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
|
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
|
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
|
|
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
|
Definition
nutcracker syndrome
1. left renal vein is compressed between sma and aorta. can have renal varices and hematuria.
2. tx: stent |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
|
Term
| gastrochisis defect usually on |
|
Definition
|
|
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
|
|
Term
|
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
|
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
|
Definition
| c-section and total abdominal hysterectomy after delivery for placenta percreta |
|
|
Term
|
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
|
|
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
|
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
|
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
|
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
|
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
|
|
Term
| if dont' see or cannot localize on bone scan, ask for |
|
Definition
|
|
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
|
|
Term
|
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
|
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
|
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
|
|
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
|
Definition
lymphoma
gbm
demyelinating dz (but not mass like) |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
| "meningioma" with atypical features like frank bone erosion and multiple flow voids |
|
|
Term
|
Definition
1. endometrioma (has T2 shading)
2. hemorrhagic cyst (doesn't have t2 shading) |
|
|
Term
|
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
|
Definition
|
|
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
|
Definition
| q6 m then q yr for 5 years. (we do this at county) |
|
|
Term
|
Definition
1. leiomyosarcoma
1. mets: rcc, hcc
1. endometrial tumor
-bx endovascularly. |
|
|
Term
|
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
|
Definition
| soft tissue all around the stone so stone in ureter |
|
|
Term
|
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
|
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
|
Definition
1. single filling defect: lipoma, gist, carcinoma, single mets, adenoca, lymphoma
1. multiple filling defects: mets, lymphoma, . |
|
|
Term
|
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
|
Definition
1. metastatic peritoneal carcinomatosis (ovary, colon, stomach, pancreas)
2. primary peritoneal carcinoma or mesothelioma
3. Peritonitis like from TB
4. pseudomyxoma peritonei |
|
|
Term
|
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
|
Definition
1. atherosclerosis
1. fibromuscular dysplasia
1. vasculitis
1. extrinsic compression: compression syndromes or tumor "encasement"
1. spasm
1. radiation |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
| hasn't seen anyone use vassopressin in 15 years |
|
|
Term
|
Definition
| -use sandwich technique (this case in celiac) need to check from other end. |
|
|
Term
|
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
|
Definition
| cornual or cervical pregnancy |
|
|
Term
| dd reversal of renal artery flow |
|
Definition
| renal vein thrombosis, rejection |
|
|
Term
|
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
|
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
|
Definition
|
|
Term
|
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
|
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
|
|
Term
| dcis can present as mass what percentage of time? |
|
Definition
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
| fibromas, pleural effusions and ascites |
|
|
Term
|
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
|
Definition
| leiomyoma, gist, sarcoma, mets, lymphoma |
|
|
Term
|
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
|
Definition
|
|
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
|
Definition
| sickle cell from infarcted spleen |
|
|
Term
|
Definition
| sentinel loop is focal ileus due to nearby inflammation like from pancreatitis |
|
|
Term
|
Definition
dd for mucocele
1. enteric duplication cyst
1. mesenteric cyst (rare) |
|
|
Term
|
Definition
| arrhythmogenic right ventricular cardiomyopathy |
|
|
Term
| fishmouth deformity aortic valve |
|
Definition
|
|
Term
| mr stress perfusional study. if black on stress and not on rest then defect |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
hypertrophic obstructive cardiomyopathy
-LV hypertrophy not explained by obvious etiology
-abnl systolic anterior motion of the anterior leaflet of mitral valve. |
|
|
Term
|
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
|
|
Term
|
Definition
1. nocardia in immunocompromised.
1. actinomycosis in those with poor dentition and aspirate.
1. TB. |
|
|
Term
|
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
|
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
|
Definition
11 or 13 ribs
more than one ossification center in manubrium |
|
|
Term
|
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
|
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
|
|
Term
| vsd, asd, pda with eisenmenger complex: tx |
|
Definition
| don't close! pt will die. can do transplantation. |
|
|
Term
|
Definition
1. indomethacin
2. coiling
3. surgery
(pda can open on day 7) |
|
|
Term
|
Definition
| LA is divided into two chambers. |
|
|
Term
|
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
|
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
|
Definition
1. T1 in and out of phase
1. T2
1. T1 post contrast dynamic imaging |
|
|
Term
|
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
|
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
|
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
|
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
|
|
Term
| tx for paget schroetter syndrome |
|
Definition
1. tx: surgery
2. don't put stent because it will be compressed. |
|
|
Term
|
Definition
| like combing the back of head. |
|
|
Term
| tx cystic adventitial disease causing vessel narrowing |
|
Definition
|
|
Term
|
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
|
Definition
tx if > 4 cm or symptomatic
1. if bleeding, coiling
2. if not bleeding, particles
3. if refractory to embolization then surgery. |
|
|
Term
|
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
|
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
|
Definition
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
| if dermoid > 5 cm then at risk for torsion |
|
|
Term
|
Definition
1. usually no flow
2. can disappear with respiration. |
|
|
Term
|
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
|
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
|
Definition
1. prior pericarditis: TB, uremic pericarditis, idiopathic
2. prior hemopericardium: surgery, trauma, malignancy
3. radiation treatment. |
|
|
Term
|
Definition
|
|
Term
| timing of delayed hyperenhancement cardiac study |
|
Definition
|
|
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
|
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
|
|
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
|
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
|
|
Term
| achondroplasia inheritance |
|
Definition
|
|
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
|
Definition
|
|
Term
|
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
|
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
|
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
|
|
Term
|
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
|
|
Term
| atlanto occipital dissociation |
|
Definition
powers ratio:
basion-posterior arch/opisthion-anterior arch> 1 then atlanto occipital dissociation |
|
|
Term
|
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
|
Definition
| 1. arises from calcitonin producing parafollicular cells. |
|
|
Term
|
Definition
|
|
Term
| distal compared to proximal bone |
|
Definition
| e.g. posterior translation of the tibia in relation to the femur. |
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
Definition
venatech (not retrievable)
meridian (retrievable) |
|
|
Term
|
Definition
| mean elevated pulmonary pressure > 25 mmHg at rest |
|
|
Term
|
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
|
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
|
|
Term
| medullary nephrocalcinosis |
|
Definition
| change transducer to check for parathyroid adenoma |
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
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
|
Definition
I 123: 200 uCi. 160 keV
I 131: 20 uCi. 360 keV
Tc pertechnetate 5 mCi |
|
|
Term
|
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
|
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
|
Definition
1. hospital: > 200 mCi. need to check with survey meter to see drops below certain value.
2. not in hospital: < 200 mCi |
|
|
Term
|
Definition
1. diffuse: gcsf. stop gcsf beforehand. erthyropoietin can do the same thing
2. not diffuse: mets |
|
|
Term
|
Definition
| 8 mCi, photopeaks (100,200, 300), 3d |
|
|
Term
|
Definition
|
|
Term
| pet ct can be negative if |
|
Definition
adenocarcinoma in situ (BAC)
mantle cell lymphoma
lung carcinoid |
|
|
Term
|
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
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
|
|
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
|
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
|
Definition
|
|
Term
|
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
|
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
|
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
|
Definition
1. endometrial cancer
1. submucosal fibroid
1. polyp
1. adenomyosis |
|
|
Term
|
Definition
| ill defined areas of heterogeneity in myometrium |
|
|
Term
|
Definition
1. trisomy 18
2. cardiac anomalies
3. increased mortality associated with trisomy 18 and cardiac anomalies
face the case |
|
|
Term
|
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
|
Definition
| patient should be made aware of importance of fetal movements. |
|
|
Term
|
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
|
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
|
Definition
acl tear
mcl tear
meniscal tear (especially medial)
posterolateral corner injury (global descriptor) |
|
|
Term
|
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
|
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
|
|
Term
| alpha 1 antitrypsin deficiency |
|
Definition
| associated with liver disease (and wegener's granulomatosis and necrotizing panniculitis.) |
|
|
Term
|
Definition
|
|
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
|
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
|
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
|
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
|
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
|
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
|
|
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
|
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
|
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
|
|
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
|
|
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
|
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
|
Definition
1. perforation
1. retropharyngeal abscess
1. pneumomediastinum |
|
|
Term
|
Definition
|
|
Term
|
Definition
| produces csf so hydrocephalus for this. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
1. cyst which is periparotid
2. cyst near sternocleidomastoid |
|
Definition
1. periparotid: type I
2. near sternocleidomastoid: type II |
|
|
Term
|
Definition
| low occipital/high cervical encephalocele |
|
|
Term
|
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
|
Definition
|
|
Term
|
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
|
Definition
1. coarctation of the aorta
1. right sided aortic arch
1. fracture
1. pneumothorax
1. pneumomediastinum |
|
|
Term
|
Definition
|
|
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
|
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
|
Definition
|
|
Term
| absent radius. relatively normal thumb |
|
Definition
| thrombocytopenia absent radius (TAR syndrome) |
|
|
Term
| sclerotic proximal cuboid |
|
Definition
|
|
Term
|
Definition
hyperechoic mucosa
hypoechoic muscle |
|
|
Term
|
Definition
mesenteric cyst
choledochal cyst |
|
|
Term
| before cross sectional imaging |
|
Definition
1. say would consider US.
1. concerned about radiation |
|
|
Term
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
> 6 cm
associated with ulcerative colitis |
|
|
Term
|
Definition
1. < 3 cm: antibiotics
1. > 3 cm and well defined: percutaneous drainage
1. not well defined or multiloculated: surgery |
|
|
Term
|
Definition
| tumecfactive MS: leading edge of enhancement (horseshoe open toward the cortex) |
|
|
Term
|
Definition
1. adem doesn't enhance (Dr. Eg said can enhance a little peripherally)
1. adem involves the brain stem |
|
|
Term
|
Definition
1. HIV encephalopathy: symmetric
1. pml: asymmetric |
|
|
Term
|
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
|
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
|
Definition
|
|
Term
| scalloping of inner cortex |
|
Definition
1. enchondroma
1. fibrous dysplasia
1. other tumors |
|
|
Term
|
Definition
| Wilson's or hemochromatosis |
|
|
Term
|
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
|
|
Term
| meckel diverticulum arises from |
|
Definition
|
|
Term
|
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
|
Definition
|
|
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
|
Definition
1. hemangioma
1. lymphoma
1. angiosarcoma |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
> 4 cm
can result in thrombocytopenia or consumptive coagulopathy (kasabach merritt syndrome) |
|
|
Term
|
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
|
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
|
|
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
|
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
|
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
|
Definition
1. high attenuation in liver, spleen, lymph nodes
1. increased risk of hcc, cholangiocarcinoma, angiosarcoma |
|
|
Term
|
Definition
1. due to ligamentous laxity
1. tx: splenopexy: fixation of spleen
1. risk of torsion |
|
|
Term
|
Definition
1. due to rupture of appendiceal mucocele or mucinous adenocarcinoma of the appendix, ovary, colon, pancreas
1. often calcification in mucinous ascites |
|
|
Term
|
Definition
1. peritoneal mesothelioma
1. presents about 30-40 years after asbestos exposure
1. tx: surgery, chemo and radiation |
|
|
Term
|
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
|
|
Term
| mc fibromuscular dysplasia |
|
Definition
| medial fibroplasia (beaded appearance) |
|
|
Term
|
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
|
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
|
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
|
|
Term
|
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
|
Definition
|
|
Term
| attacks of headache, palpitations, sweating during micturition |
|
Definition
1. paraganglioma in the bladder
1. high T2
1. MIBG scan |
|
|
Term
|
Definition
| usually due to radiation tx or chemotherapy like cyclophosphamide |
|
|
Term
|
Definition
due to subcapsular hematoma
manifests as hypertension |
|
|
Term
|
Definition
| 40-60 HU on noncontrast CT |
|
|
Term
|
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
|
Definition
1. if asymptomatic, no tx
1. if symptomatic with pain, hematuria, infection then possible surgery
(calyceal diverticulum typically fills with excreted contrast) |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
1. intracapsular: capital, subcapital (risk of avn and non union), transcervical, basicervical
1. intertrochanteric:
1. subtrochanteric: |
|
|
Term
|
Definition
| tabes dorsalis (syphilis) |
|
|
Term
|
Definition
1. density: increased or normal
1. disorganization
1. dislocation
1. debris
1. distention (effusion) |
|
|
Term
|
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
|
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
|
Definition
1. epiphyseal: shoulder, hip, knee. can involve the spine, patella, pelvis
1. skeletally immature
1. can be associated with abc |
|
|
Term
|
Definition
1. metadiaphyseal lytic lesion usually proximal tibia
1. average age 18 years according to statdx |
|
|
Term
|
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
|
Definition
|
|
Term
|
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
|
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
|
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
|
|
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
|
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
|
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
|
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
|
|
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
|
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
|
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
|
Definition
| T2* mapping (tells how much iron in liver) |
|
|
Term
|
Definition
|
|
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
|
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
|
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
|
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
|
|
Term
| hocm (hypertrophic obstructive cardiomyopathy) and delayed enhancement |
|
Definition
|
|
Term
| causes of popliteal artery entrapment |
|
Definition
1. muscle hypertrophy
1. extra muscles |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
V2: rotundum
V3: ovale
reverse alphabetical |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
peri: lymphatic drainage.
para: no lymphatic drainage |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
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
|
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
|
|
Term
|
Definition
1. subendocardial enhancement, not in a vascular distribution
1. can have clots also |
|
|
Term
|
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
|
Definition
| worry about compression of bilateral aca and aca infarcts |
|
|
Term
| extensive sub arachnoid hemorrhage. mc region |
|
Definition
|
|
Term
| attached to septum pellucidum |
|
Definition
1. central neurocytoma
1. choroid plexus papilloma
1. subependymoma/ependymoma
1. intraventricular metastasis |
|
|
Term
|
Definition
1. choroid plexus papilloma/carcinoma (kids: atria, adults: 4th ventricle)
1. cenral neurocytoma, meningioma, astorcytoma, mets |
|
|
Term
|
Definition
1. germinoma
1. mets
1. etc. |
|
|
Term
|
Definition
|
|
Term
|
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
|
Definition
1. medulloblastoma in adult
1. mets
1. hemangioblastoma
1. pilocytic astrocytoma |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. manipulation should be minimized in those with suppurative cholangitis.
1. give abx
1. contraindication: uncorrrectable coagulaoathy, massive ascites. |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
|
|
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
|
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
|
Definition
blue: persistent. good
yellow: plateau. baddish
red: washout. bad |
|
|
Term
| if two breast masses: index is |
|
Definition
|
|
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
|
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
|
Definition
1. anechoic
1. posterior enhancement
1. edge shadowing |
|
|
Term
|
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
|
|
Term
|
Definition
1. mags: cc and true lateral
1 spot: cc and mlo |
|
|
Term
|
Definition
| RUOQ (if in other quadrants, work up for malignancy) |
|
|
Term
|
Definition
|
|
Term
| tubular cancer looks like |
|
Definition
|
|
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
|
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
|
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
|
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
|
Definition
1. adenoma, fnh, hemangioma
1. hcc, mets |
|
|
Term
|
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
|
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
|
Definition
1. coil (preferred method)
1. covered stent
1. surgery (if indicated) |
|
|
Term
|
Definition
1. put air into stomach. aim for body of stomach
1. indications: proximal or distal obstruction, reflux, dementia |
|
|
Term
|
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
|
Definition
| can treat with radiofrequency ablation as probably < 3 cm. (osteoblastoma is > 1.5 cm) |
|
|
Term
|
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
|
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
|
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
|
Definition
|
|
Term
|
Definition
1. yin yang
1. to and fro waveform
1. dampened waveform (Arterial and venous waveform together) |
|
|
Term
|
Definition
1. only type II is treated with coiling of feeding vessels
1. other types are surgical
"graftogram" |
|
|
Term
|
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
|
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
|
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
|
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
|
|
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
|
Definition
1. polyarteritis nodosa (kidneys, liver, pancreas)
1. necrotizing angiitis from speed (e.g. speed kidney)
1. mycotic aneurysm |
|
|
Term
|
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
|
|
Term
| what causes the calcification in sturge weber? |
|
Definition
calcification in sturge weber due to
ans: dystrophic calcs |
|
|
Term
|
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
|
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
|
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
|
Definition
1. spares disc: tb/fungal infection. mets
1. involves disc: acute disciitis. |
|
|
Term
|
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
|
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
|
Definition
right: azygous
left: hemiazygous |
|
|
Term
|
Definition
|
|
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
|
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
|
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
|
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
|
|
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
|
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
|
Definition
1. ABPA: treat with steroids
1. mycetoma: saprophytic form. if hemoptysis, consider embolization
1. invasive
1. semi invasive |
|
|
Term
|
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
|
Definition
1. at least 3 ribs involved
1. inspiration the chest collapses: parodoxical motion
1. need elective intubation |
|
|
Term
|
Definition
-opacity near pleura and whirl pattern in adjacent lung parenchyma
-don't biopsy. not lung mass. |
|
|
Term
|
Definition
adenocarcinoma pleural mets
invasive thymoma |
|
|
Term
|
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
|
Definition
normal pcwp < 12 mmHg
> 15 mmHg: cephalization
> 20 mmHg: pulmonary interstitial edema
> 25 mmHg: pulmonary alveolar edema (batwing) |
|
|
Term
|
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
|
Definition
| from beginning of injection |
|
|
Term
|
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
|
Definition
1. nodularity
1. right lobe hypertrophy
1. widening of the fissures
1. ascites
1. splenomegaly |
|
|
Term
|
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
|
|
Term
| timing of adrenal lesion washout |
|
Definition
| pre, enhanced (60 s), delayed (10 min. 15 min delayed is classic teaching) |
|
|
Term
|
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
|
Definition
| > 180 HU in the main pulmonary artery |
|
|
Term
|
Definition
1. can give water to drink
1. can also give lasix 20 mg |
|
|
Term
|
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
|
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
|
|
Term
|
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
|
Definition
1. lung abscess: same measurements on PA and lateral radiographs
2. empyema: different measurements on PA and lateral radiographs |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
1. daily qc: battery, background, constancy
1. types of survey meters
1. cutie pie
1. gm counters |
|
|
Term
|
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
|
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
|
Definition
1. balloon fenestration especially if false lumen supplying renal A, celiac, sma.
1. stent
1. surgery |
|
|
Term
|
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
|
Definition
benign: angioplasty
malignant: stent |
|
|
Term
| coarctation of the aorta: types |
|
Definition
| two types: preductal (infantile), juxtaductal/postductal (adult) |
|
|
Term
|
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
|
Definition
1. no endovascular repair
1. tx: surgical |
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
Definition
| usually just medical management |
|
|
Term
|
Definition
|
|
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
|
Definition
|
|
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
|
Definition
1. aspergillus
1. mucormycosis
1. vasculitis
1. hemorrhage |
|
|
Term
|
Definition
1. TB
1. atypical mycobacteria
1. fungal
1. metastatic disease |
|
|
Term
|
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
|
|
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
|
Definition
1. esophageal rupture due to vomiting
1. pneumomediastinum and pneumothorax
1. usually left sided. |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. almost entirely fat
1. scattered fibroglandular densities
1. heterogeneously dense
1. extremely dense |
|
|
Term
|
Definition
| breast imaging reporting and data systems |
|
|
Term
|
Definition
| aka posterior nipple line |
|
|
Term
|
Definition
1. anterior, middle and posterior 1/3 for depth
1. say anterior depth, middle depth, posterior depth. |
|
|
Term
|
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
|
|
Term
|
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
|
Definition
| look for h/o surgery or trauma |
|
|
Term
| popcorn calcs in breast mass |
|
Definition
| fibroadenoma (involuting) |
|
|
Term
|
Definition
| don't use taller than wide (antiparallel) or wider than tall (parallel) |
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
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
|
Definition
1. idiopathic wormian bones
2. osteogenesis imperfecta
3. cleidocranial dysostosis
1. down syndrome
2. metabolic disease (rickets, hypothryoidism) |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
| can preferentially affect one pulmonary (right) |
|
|
Term
|
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
|
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
|
Definition
| bicuspid aortic valve (fish mouth appearance on MR) |
|
|
Term
| scimitar syndrome associated with |
|
Definition
|
|
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
|
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
|
Definition
1. associated with asd, vsd, pulmonary stenosis
1. radial dysplasia/aplasia |
|
|
Term
|
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
|
Definition
| lam high lung volumes and looks almost normal. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| vs lipoma. compress esophagus. lipomatosis more diffuse. |
|
|
Term
|
Definition
|
|
Term
| extramedullalry hematoposise and extra medullary hematopo osteopetrosis |
|
Definition
|
|
Term
| pneumomediastinum from bleomycin |
|
Definition
|
|
Term
|
Definition
|
|
Term
| cystic thymoma wiht mural nodules |
|
Definition
|
|
Term
|
Definition
|
|
Term
| ssc, mucoepidermoid in trachea. |
|
Definition
|
|
Term
| sarcoid ,silicossis and can cavitate. |
|
Definition
|
|
Term
| asymptomatic and high attenuation |
|
Definition
|
|
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
|
Definition
| silicosis, amiodarone, ?amyloidosis? |
|
|
Term
|
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
|
Definition
1 seminal vesicle cyst
1. ipsilateral renal agenesis
1. ejaculatory duct obstruction |
|
|
Term
|
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
|
Definition
1. large ovary
1. peripheral follicles
1. decreased enhancement |
|
|
Term
| salpingitis isthmica nodosa |
|
Definition
| diverticuli from the fallopian tube. |
|
|
Term
|
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
|
|
Term
| paintbrush appearance of the pyramids |
|
Definition
|
|
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
|
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
|
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
|
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
|
|
Term
|
Definition
aliasing
1. increase the prf,
1. cannot detect true peak velocity due to low doppler sampling rate. |
|
|
Term
|
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
|
Definition
1. small: medical renal disease:
1. large:
a. HIV
a. diabetes |
|
|
Term
|
Definition
< 3 cm is abnormal
funneling (V shaped) is bad
tx: cerclage |
|
|
Term
|
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
|
Definition
1. ask for us of the adrenals, kidneys and liver
1. hcc
1. rcc, wilms
1. adrenal cortical carcinoma |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
1. Budd Chiari syndrome: can evaluate with Ultrasound
1. Right heart failure
1. constrictive pericarditis |
|
|
Term
|
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
|
Definition
| endoscopic ultrasound guided biopsy |
|
|
Term
|
Definition
| crest syndrome (calcinosis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia) |
|
|
Term
|
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
|
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
|
Definition
| obtain surgical consult to determine feasibility of removing stone |
|
|
Term
|
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
|
Definition
| appendicitis, crohn's disease, tb |
|
|
Term
| if inflammation around small bowel |
|
Definition
| dd: sb diverticulitis (can have abscess), crohn's disease |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. ballooning of hypopharynx
1. thumb sign anteriorly of epiglottis |
|
|
Term
|
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
|
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
|
|
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
|
|
Term
|
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
|
|
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
|
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
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. chemotherapy agent and ethiodal (high density) mixed
1. complications: fever, pleural effusion |
|
|
Term
|
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
|
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
|
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
|
Definition
| don't forget fat necrosis or atypical fibroadenoma as per Dr. Adeniji |
|
|
Term
|
Definition
dd: pvns, hemophilia, gout, ra
tx pvns: synovectomy. |
|
|
Term
|
Definition
|
|
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
|
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
|
Definition
1. fluid collection with fat
1. tx: need surgery because will keep re accumulating. |
|
|
Term
|
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
|
Definition
| 1. posterolateral corner (arcuate ligament) |
|
|
Term
|
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
|
Definition
1. can describe as fluid filled cleft
1. labral tear
1. one type: bankhart type (can be bony) |
|
|
Term
|
Definition
| risks of breast biopsy: infection, hemorrhage, syncope, pneumothorax |
|
|
Term
|
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
|
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
|
Definition
|
|
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
|
Definition
1. fusiform dilatation
2. diverticulum
3. choledochocele
4. intra and extra hepatic
5. intrahepatic (Caroli's disease) |
|
|
Term
|
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
|
Definition
|
|
Term
| thoracic outlet syndrome position |
|
Definition
|
|
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
|
|
Term
|
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
|
Definition
| 1. angioplasty if < 3 cm, concentric and noncalcified. |
|
|
Term
|
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
|
Definition
| crutches can cause aneurysm |
|
|
Term
|
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
|
Definition
1. aneurysm
1. glomus vagale
1. nerve sheath tumor
1. IJ thrombus |
|
|
Term
|
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
|
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
|
Definition
1. don't want to reperfuse if motor deficits
1. echo should be obtained after thrombolysis |
|
|
Term
|
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
|
|
Term
|
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
|
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
|
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
|
|
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
|
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
|
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
|
Definition
1. liver cirrhosis
1. splenomegaly
1. some uptake in bone marrow |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
|
Term
10
how to wear ring dosimeter |
|
Definition
|
|
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
|
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
|
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
|
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
|
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
|
Definition
tx endometrioma
1. hormonal treatment with gonadotropin releasing hormone agonist
1. laparoscopic surgery. |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. metaphyseal fraying, cupping, widening
1. loss of provisional zone of calcification |
|
|
Term
|
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
|
Definition
| toxic adenoma: tx 30-60 mCi I 131 |
|
|
Term
|
Definition
brain death study:
tc hmpao and ecd for |
|
|
Term
|
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
|
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
|
Definition
1. breast, lung: usually lytic, but very common met
1. prostate |
|
|
Term
|
Definition
|
|
Term
| normal gastric emptying time |
|
Definition
| 50% emptying at 90 min. if less than 50% then abnormal. face the case. |
|
|
Term
|
Definition
|
|
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
|
Definition
1. if decreased reserve on diamox study. reversible defect. impaired vascular reserve.
face the case. not confirmed. |
|
|
Term
|
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
|
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
|
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
|
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
central: menisectomy
peripheral: suture (good blood supply) |
|
|
Term
|
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
|
Definition
1. Osteosarcoma: bone forming. codman triangle
1. Ewing: not really bone forming and not really codman triangle
-as per egeibor |
|
|
Term
|
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
|
|
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
|
Definition
| 2nd or 3rd intercostal space midclavicular line. |
|
|
Term
|
Definition
1. HIV nephropathy
1. diabetic nephropathy
1. lupus nephritis |
|
|
Term
|
Definition
1. if small, can resolve on own
1. if large, may need percutaneous or surgical drain |
|
|
Term
|
Definition
| percutaneous or surgical drainage |
|
|
Term
| supply of anterolateral wall cardiac |
|
Definition
|
|
Term
| ganglioin cyst appearance |
|
Definition
|
|
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
|
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
|
Definition
1. cmv
1. alcohol/radiation
1. genetic mutation |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
| at risk for squamous cell carcinoma |
|
|
Term
|
Definition
| 1. 8 or smaller foley and inflate a little. then inject non ionic contrast. |
|
|
Term
|
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
|
Definition
1. likely scc
1. if barrett's then adenocarcinoma |
|
|
Term
| cortical nephrocalcinosis |
|
Definition
COAG
acute Cortical necrosis
oxalosis
alport syndrome
chronic Glomerulonephritis |
|
|
Term
|
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
|
Definition
1. Adust kVp for size
1. Adust mA(s) for size
1. Minimize multiphase scanning
1. Minimize overlap
1. Limit coverage |
|
|
Term
|
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
|
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
|
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
|
Definition
|
|
Term
| if septal motion problem, think |
|
Definition
|
|
Term
| portal vein waveform: pulsatile |
|
Definition
| chf, tricuspid regurgitation. should be straight line above baseline. |
|
|
Term
| venetian blind appearance in uterus |
|
Definition
|
|
Term
| tx of intercondylar notch cyst |
|
Definition
1. ct guided aspiration of cyst
1. arthroscopic excision if symptomatic |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
| as low as reasonably achievable |
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
Definition
|
|
Term
31
what cannot be found on wipe test |
|
Definition
|
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
1. medial collateral ligament tear/strain
1. medial meniscal tear
1. acl tear |
|
|
Term
|
Definition
|
|
Term
| transient ischemic dilatation |
|
Definition
|
|
Term
| lymph node cortex should be |
|
Definition
|
|
Term
| cortical nephrocalcinosis |
|
Definition
1. acute cortical necrosis
1. chronic glomerulonephritis
1. oxalosis |
|
|
Term
|
Definition
| 90-190 cm/s. difference of 50 cm/s from base line |
|
|
Term
|
Definition
|
|
Term
|
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
|
Definition
|
|
Term
| osteoid osteoma vs osteoblastoma |
|
Definition
|
|
Term
|
Definition
|
|
Term
| viable myocardium on mri: myocardial scar vs hibernating myocardium on mri |
|
Definition
| if > 50% wall delayed enhancement then not viable. |
|
|
Term
|
Definition
I > 2 cm
II < 2 cm
III microcysts |
|
|
Term
| cardiac: acyanotic and cyanotic |
|
Definition
|
|
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
|
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
|
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
|
|
Term
| cardiac vessels and region supplied |
|
Definition
| lad (diagonals), L circumflex (obtuse marginals), rca, pda, |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
| accreta, increta, percreta |
|
Definition
|
|
Term
|
Definition
|
|
Term
| breast nomenclature: shape, margins, distribution |
|
Definition
|
|
Term
| omphalocele vs gastrochisis, sequestration (types) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
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
|
Definition
1. 2/3 renal.
1. 2/3 carotid
1. 2/3 multivessel
1. renal>carotid |
|
|
Term
|
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
|
|
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
|
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
|
Definition
| acute disseminated encephalomyelitis |
|
|
Term
|
Definition
| cholecystectomy if symptomatic |
|
|
Term
|
Definition
1. lateral to inguinal canal
1. medial to femoral vessels |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
| if dark t1 branching structures in liver |
|
Definition
|
|
Term
|
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
|
Definition
1. subacute combined degeneration.
1. dorsal lateral spinal cord columns |
|
|
Term
|
Definition
1. germinoma: central calc (engulfs central calcified pineal gland)
1 pineoblastoma (pnet): peripheral calc
1. pineocytoma: peripheral calc
1. pineal gland cyst |
|
|
Term
|
Definition
1. craniopharyngioma
1. rathke's cleft cyst
1. dermoid
1. cholesterol cyst
1. blood |
|
|
Term
|
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
|
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
|
|
Term
|
Definition
1. inferior epigastric, contralateral femoral A then external iliac (inferior epigastric) or
1. superior epigastric (from subclavian, internal mammary) |
|
|
Term
|
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
|
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
|
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
|
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
|
|
Term
| amout of allowable free pertechnetate |
|
Definition
|
|
Term
|
Definition
| may have injected tc sulfur colloid too deep. |
|
|
Term
|
Definition
| image joint to joint and non contrast chest CT |
|
|
Term
|
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
|
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
|
Definition
|
|
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
|
|
Term
|
Definition
| major spill with regular dose 15 mCi |
|
|
Term
|
Definition
| if 1 mSv (0.1 rem) in 1 h at 30 cm. |
|
|
Term
|
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
|
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
|
Definition
| 1. look for stricture because 90% of pseudodiverticulosis has stricture |
|
|
Term
|
Definition
1. erosive gastritis (nsaid)
2. aphthous ulcer from early crohns disease. |
|
|
Term
|
Definition
1. inflammatory (aka hyperplastic)
2. adenomatous polyps |
|
|
Term
|
Definition
|
|
Term
|
Definition
| carcinoid, sclerosing mesenteritis, desmoid |
|
|
Term
|
Definition
|
|
Term
| how do you know when lower gi complete |
|
Definition
| appendix, ileocecal valve, terminal ileum |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
| in frequency encode direction |
|
|
Term
|
Definition
1. active transport through norepinephrine transporter and stored in neurosecretory granules.
1. remember give lugol's solution before study. |
|
|
Term
|
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
|
Definition
|
|
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
|
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
|
Definition
1. gangliocytoma
1. area of striated appearance of cerebellum |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
|
|
Term
|
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
|
Definition
1. rathke's cleft cyst
1. craniopharyngioma
1. pituitary adenoma |
|
|
Term
| lytic lesion in posterior spine |
|
Definition
| abc, osteoblastoma, osteoid osteoma |
|
|
Term
|
Definition
| medial: more fat and has sartorius tendon |
|
|
Term
|
Definition
| increase prf (pulse rate frequency) |
|
|
Term
|
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
|
Definition
| renal cell carcinoma. choriocarcinoma |
|
|
Term
|
Definition
| increased risk of wilm's tumor and renal cell carcinoma |
|
|
Term
|
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
|
Definition
| anterior, mid, posterior 1/3 depth |
|
|
Term
|
Definition
| angioplasty, stent, surgery |
|
|
Term
|
Definition
|
|
