Cardiothoracics & Vascular Flashcards by Tonia Forjoe

What is used to define the right ventricle?

The moderator band

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The following describes which Cardiac MR view?
* LV and LA
* Wall motion and global LV function, Mitral valve issues

2 Chamber view

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The following describes which Cardiac MR view?
LV, LA, RV, RA
Assessment of mitral & tricuspid valves, and AV canal defect

4 Chamber Cardiac view

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Which valves are on the right side of the heart?

Tricuspid valve + Pulmonary valve

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Which valves are on the left side of the heart?

Mitral valve + Aortic valve

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The following describes which Cardiac MR view?
LV, LA, RV, LVOT + Aorta
Visualisation of the LVOT and identify aortic regurgitation/stenosis

3 Chamber cardiac view

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What do the following suggest?
- Shifting of right heart border >3cm to right
Enlarged globular heart

Right atrial enlargement

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What does the following suggest?
Cardiac apex tilted up and out
Rounded left heart border

Right ventricle enlargement

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What does the following suggest?
Cardiac apex tilted down and out
Rounding of cardiac apex

Left ventricle enlargement

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What is the following describing?
Widening of the carinal angle
Elevation of the left main bronchus
Posterior displacement of left mainstem bronchus
Double density sign - superimposed contour on right heart

Left atrial enlargement

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What is the following describing?
Echogenic focus in the left ventricle

Calcified papillary muscle

Normal on pre-natal US, and usually disappears in 3rd trimester

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What is a calcified papillary muscle associated with?

Downs syndrome

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What is the following describing?
Dumbell (Bilobed) fat density >2cm in the atrial septum spares fossa ovalis
Older patient
Can cause SVT

Lipomatous hypertrophy of the inter-atrial septum

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What is the following describing?
Encapsulated
Does not spare the fossa ovalis
T1 bright, drop out on fat sat
Not associated with arrhythmia

Lipoma

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What are the normal coronary cusps?

Right coronary cusp
Left coronary
Non-coronary (Posterior) cusp

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What commonly perfuses the SA and AV Nodes?

RCA

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The following are branches of which coronary artery?
Conus + Nodal branch
Acute marginal
Posterior descending branch

Right main coronary artery

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The following are branches of which coronary artery?
Left anterior descending artery
Circumflex
Diagonal
Obtuse marginal artery

Left main coronary artery

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Which coronary artery supplies the interventricular septum?

LAD

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How is coronary artery dominance determined by?

Which vessel gives rise to the posterior descending artery and posterior left ventricular branches

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What is the following describing?
LCA from the right coronary sinus - courses between aorta and pulmonary artery

Malignant origin

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Which malignant origin is repaired?

LCA from right cusp

RCA from left cusp only if symptomatic

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What is the following describing?
Reversed flow in the LCA as pressure decreases in pulmonary circulation

Anomalous left coronary artery from pulmonary artery

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What is the following describing?
Intramyocardial course of coronary artery (Usually LAD)
Asymptomatic
Plaque normally in segment proximal to the abnormality

Myocardial bridging

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What is the following describing? What are the causes of coronary artery aneurysm in adults/children?

Adults = Atherosclerosis Child = Kawasaki disease

What is the following describing? Connection between coronary artery and cardiac chamber/great vessels Usually RCA into right cardiac chambers

Coronary fistula

What does the following describe? R-R interval is used to trigger data acquisition Reduced radiation Sensitive to HR variability Axial

Prospective cardiac gated CT

What is the following describing? Scan the whole time, review and calculate Functional imaging Less sensitive to HR variability High radiation dose Helical

Retrospective cardiac gated CT scan

What cardiac imaging is best for valvular imaging?

Retrospective cardiac gated ct scan - required to evaluate mitral & tricuspid valves

What drugs are given for coronary CT?

Beta blockers (Control HR) Nitroglycerine (Dilate coronaries)

Which heart valves are being described here: Most superior Most anterior

Most superior = Pulmonic Most anterior = Tricuspid

What is the best imaging modality to look at the heart valves?

ECHO

What is the relevance of supravalvular aortic stenosis?

Williams syndrome

What is the relevance of bicuspid aortic valve and coarctation?

Turner syndrome

What is the most common aortic valve disease?

Bicuspid aortic valve OR Ventricular septal defect

How does mitral stenosis present?

Left atrial enlargement - double density sign, splaying of carina, posterior oesophageal displacement

What is the following describing? Hoarseness caused by compression of the left recurrent laryngeal nerve by enlarged left atrium

Ortners syndrome

What are the most common causes of mitral regurgitation?

Endocarditis Papillary muscle rupture post MI

What is isolated right upper lobe pulmonary oedema associated with?

Mitral regurgitation

What are the following associated with: Supravalvular pulmonary stenosis Valvular pulmonary stenosis Subvalvular pulmonary stenosis

Supravalvular = Williams syndrome Valvular = Noonans syndrome Subvalvular = TOF

What is the most common type of pulmonary stenosis?

Valvular - can lead to ventricular hypertrophy

What does TOF repair involve?

Patch repair of the VSD Relief of the RV outlet obstruction In order to fix the RV outlet obstruction the pulmonary valve integrity must be disrupted

What is a common complication of TOF repair?

Eventual failure of the pulmonary valve (Regurgitation)

When is repair of the pulmonary valve made post TOF surgery?

Repair should be made before the RV is severely dilated 150ml EDV for good outcomes

The following cause what? Endocarditis Carcinoid syndrome Pulmonary arterial HTN (Adults)

Tricuspid regurgitation

What is the following describing? Hypoplastic tricuspid valve Posterior leaf of tricuspid valve is displaced apically (Down) Enlarged RA Decreased RV Tricuspid regurgitation Box shaped heart on CXR

Ebstein anomaly

What is the following describing? RV Hypoplasia ASD or PFO Associated with asplenia

Tricuspid atresia

What is the significance of pulmonary stenosis in tricuspid atresia?

If there is PS = Decreased vascularity No PS = increased vascularity

What is the following describing? Tricuspid and pulmonic valves involved Enhancing tumour with mets to liver

Carcinoid syndrome

What could cause left sided carcinoid syndrome?

Primary bronchial carcinoid Right to left shunt

What is the most common vascular arch variant?

Bovine arch - Brachiocephalic artery and left common carotid artery arise from a common origin

What is the following describing? Brachiocephalic artery + LCCA arise from common origin

Bovine arch

How is a left or right arch determined?

Based on the aortic arch's relationship to the trachea

What is the following describing? Right arch Left subclavian originates from the front of the arch

Right arch with Mirror image - associated with congenital heart abnormalities

What is the following describing? Right arch Left subclavian originates from the back of the arch

Right arch with Aberrant left subclavian

What are right arch with mirror branching most strongly associated with?

Congenital heart disease TOF Truncus

Why is a right arch with aberrant left subclavian a vascular ring?

Because the ligamentum arteriosum completes the ring and encircles the trachea

What is the following describing? Dysphagia lusoria R subclavian passes posterior to oesophagus

Left arch Aberrant right subclavian - most common

What is the most common vascular ring?

Double aortic arch

What is the following describing? Symptoms at birth - tracheal compression + dysphagia Posterior and anterior tracheal indentation

Double aortic arch

What is the following describing? Stenosis/occlusion of the proximal subclavian with retrograde flow in the ipsilateral vertebral artery

Subclavian steal phenomenon

What is the following describing? Stenosis and/or occlusion of the proximal subclavian artery with retrograde flow in the ipsilateral vertebral artery & cerebral ischaemic symptoms

Subclavian steal syndrome

Where is the occlusion in subclavian steal?

Proximal to the vertebral in the subclavian artery, leading to retrograde flow from the vertebral artery

What are the causes of subclavian steal? Child Adult

Child = Takayasu Adult = Atherosclerosis

What is the following describing? Egg on a string

Transposition of the great arteries

What is the following describing on CXR? Snow man heart

Supracardiac Total anomalous pulmonary venous return (TAPVR)

What is the following describing? Boot shaped heart

Tetralogy of Fallot

What is the following describing on CXR? Figure of 3

Aortic coarctation

What is the following describing on CXR? Box shaped heart

Ebsteins Anomaly

What is the following describing on CXR? Scimitar sword

PAPVR with hypoplasia

What are the non-cardiac causes of high output cardiac failure?

Infantile haemangioendothelioma Vein of Galen malformation

The following present with either cyanosis or acyanosis? TOF TAPVR Transposition GA Truncus Tricuspid atresia

Cyanotic

What cardiac condition is being described here: Cyanotic Right sided Arch Increased pulmonary vasculature

Truncus

What cardiac condition is being described here: Cyanotic Right sided arch Normal pulmonary vasculature

TOF

What cardiac condition is being described here: Cyanotic Left sided arch Cardiomegaly

Ebsteins anomaly OR Pulmonary atresia without VSD

What cardiac condition is being described here: Cyanotic Left sided arch Normal heart size Increased pulmonary blood flow

TAPVR D-Transposition Single ventricle

What cardiac condition is being described here: Cyanotic Left sided arch Decreased/normal pulmonary blood flow

TOF Ebsteins Tricuspid atresia

What are the non-cyanotic congenital cardiac disorders?

ASD VSD PDA PAPVR Aortic coarctation - post ductal

Are the following cyanotic or acyanotic? ASD VSD PDA PAPVR Aortic coarctation - post ductal

Acyanotic

Are the following cyanotic or acyanotic? TOF TAPVR Transposition GA Truncus Tricuspid atresia

Cyanotic

What are the differentials for a small heart (Congenital cardiac)?

Adrenal insufficiency (Addisons) Cachexia Constrictive pericarditis

What are the causes of CHF in the newborn?

TAPVR*** Congenital aortic or mitral stenosis Left sided hypoplastic heart Cor triatriatum Infantile pre-ductal coarctation

What is being described here? Most common congenital heart disease Cardiomegaly Increased vasculature Small aortic knob Splaying of carina - big left atrium

VSD

What is the most common type of VSD?

Membranous - below the aortic valve

What is being described here? Premature Maternal rubella Cyanosis Cardiomegaly, increased pulmonary vasculature, large aortic arch

PDA

When does a PDA usually close?

24hrs post birth functionally Anatomically around 1 month

What is the most common type of ASD? Which is most likely to be symptomatic?

Most common = Secundum, can close without treatment Symptomatic = Primum, due to ECD

What are the following associated with? Hand/thumb defects + ASD Ostium primum ASD/ECD Sinus venosus ASD Unroofed coronary sinus

Hand/thumb defects + ASD = Holt Oram Ostium primum ASD/ECD = Downs syndrome Sinus venosus ASD = PAPVR Unroofed coronary sinus = Persistent left SVC

What is being described here? Happen secondary to deficient development of a portion of the atrial septum, inter ventricular septum and AV Valves

Endocardial cushion defect/AV Canal defect

What is being described here? Secondary to a fenestrated or unroofed coronary sinus Can lead to paradoxical emboli and chronic right heart volume overload Allows for two way flow from L-R

Coronary sinus ASD

Which parts of the septum are affected by these ASDs? Ostium secundum Primum Sinus venosus

Ostium secundum = Mid septum Primum = Lower septum Venosus = Upper septum

What is being described here? One or more of the 4 pulmonary veins draining into the right atrium Mild or asymptomatic

PAPVR

What are the following PAPVRs associate with? Right sided Right sided + Pulmonary hypoplasia

Right sided PAPVR = Sinus venous ASD Right sided PAPVR + Pulmonary hypoplasia = Scimitar syndrome

What is being described here? All of the pulmonary venous system drains into the right side of the heart

TAPVR (Total anomalous pulmonary venous return)

What is required for survival in TAPVR?

Large PFO

What is being described here? All of the pulmonary venous system drains into the right side of the heart Veins drain above the heart Snowman appearance

Supracardiac TAPVR (Most common)

What is being described here? All of the pulmonary venous system drains into the right side of the heart Veins drain below the diaphragm (IVC/Hepatic veins) Obstruction leads to pulmonary oedema

Infracardiac TAPVR

What is the most common cause of cyanosis in the first 24 hrs?

Transposition of the great arteries

What is being described here? Aorta arises from the right ventricle Pulmonary trunk arises from the left ventricle Survival depends on ASD/VSD/PDA

Transposition of the great arteries

What is being described here? Egg on a string RV to aorta (Anterior and to right of PA) LV to PA PDA may be the only connection between the two systems. If separate this would not be compatible with life

D Transposition TGA

What is being described here? Atrium hooks up with the wrong ventricle and ventricle is connected to the wrong vessel LA to RV to Aorta RA to LV to PA Inversion of ventricles Aorta is anterior and to the left of the PA

L Transposition TGA

What is being described here? PA draped overtop the aorta

Corrected D-transposition TGA

What is being described here? VSD RVOT obstruction Overriding aorta RV hypertrophy

Tetralogy of Fallot

What is being described here? Cyanosis Single trunk supplying both the pulmonary and systemic circulation No separate aorta and pulmonary trunk VSD present Associated with right arch

Truncus arteriosus

What is being described here? Heart failure in first week of life Narrowing before the left subclavian artery (Pre-ductal) Hypoplastic aortic arch

Infantile coarctation of the aorta

What is being described here? Leg claudication, BP differential Distal to the left subclavian artery (Post ductal) Normal diameter aortic arch Collateral formation likely

Adult coarctation of the aorta

What is aortic coarctation strongly associated with?

Turners syndrome and Bicuspid aortic valve is the most common associated defect

What is being described here? Figure of 3 sign 4-8th rib notching 1st + 2nd avoided (Costocervical trunk supply)

Aortic coarctation

What is being described here? Left ventricle and aorta are hypoplastic Pulmonary oedema ASD/Large PFO

Hypolastic left heart

What is being described here? Abnormal pulmonary vein draining into the left atrium Fibromuscular membrane causes subdivision of the LA Appears as triple atrium heart Causes pulmonary HTN + Pulmonary oedema

Cor triatriatum sinistrum

How does the wave front of necrosis start in ischaemic heart disease?

SubENDOcardial to subEPIcardium Also affects blood vessels, meaning contrast does not enhance these areas - Dark signal in ocean of delayed enhancement

What is the significance of microvascular obstruction? Affects blood vessels, meaning contrast does not enhance these areas - Dark signal in ocean of delayed enhancement

Independent predictor or death and adverse LV remodelling

What is the following describing? Post acute injury Myocardial dysfunction post revascularisation Perfusion study normal (Sestamibi) Wall motion is abnormal

Stunned myocardium

What is the following describing? Chronic Areas of decreased perfusion and contractility, even at rest FDG PET tissue takes up tracer more than normal myocardium Redistribution of thallium Reversible with revascularisation Wall motion abnormal

Hibernating myocardium

What is the following describing? Wall motion abnormal Abnormal fixed perfusion Will not redistribute thallium, no FDG PET uptake Cannot be revascularised

Infarct/Scar (Dead myocardium)

What imaging is used to assess: Diastolic function Systolic function

Diastolic = Echo Systolic = Cardiac MRI

Why is stress imaging done?

Because coronary arteries can auto-regulate, so demand is increased by exercise or drugs to make stenosis significant Dobutamine - used for wall motion Adenosine - perfusion analysis

What is the following describing? Zone of enhancement extending from subendocardium to epicardium in vascular distribution

Acute MI on MR

How does injured myocardium appear on MR in the 1st week?

Increased T2 signal (Salvageable tissue)

What is the following describing in terms of cardiac ischaemic disease? Delayed enhancement Normal thickness myocardium T2 signal from oedema Microvascular obstruction - islands of dark signal in enhanced tissue

Acute MI

What is the following describing? Delayed enhancement Thinned myocardium T2 dark tissue No microvascular obstruction

Chronic MI

What is the following describing? Myocardium intact Mouth wider than body Anterior-lateral wall of myocardium

True ventricular aneurysm

What is the following describing? Mouth narrow compared to body Myocardium not intact (Pericardial adhesions contain it) Posterior-lateral wall

False ventricular aneurysm Has higher risk of rupture

What imaging is used to assess myocardial viability?

T1 post contrast IR GE

What is the following describing? Cardiac dilatation + End diastolic diameter >55mm Decreased EF No enhancement/linear mid-myocardial enhancement

Dilated cardiomyopathy

What is the most common cause of restrictive cardiomyopathy?

Amyloid

What is the following describing? Biatrial enlargement Concentric thickening of the left ventricle Reduced systolic ventricular function Late Gd enhancement of subendocardial circumference Difficult to suppress myocardium

Amyloid cardiopathy

What is the following describing? Bilateral ventricular thrombus

Eosinophilic cardiomyopathy

What is the following describing? Thickened pericardium > 4mm Calcified pericardium Septal bounce - ventricular septum moves toward the LV in wave pattern in diastole No late Gd myocardial enhancement

Constrictive pericarditis

What are the causes of constrictive pericarditis?

Global south = TB Global north = Idiopathic/Virus

What is the following describing? Late Gd enhancement in non-vascular distribution lateral free wall Epicardial or mid wall (Not subendocardial)

Myocarditis

What is the following describing? Signal in both T2 and Early Gd will be increased Late Gd pattern is middle and epicardial in non-coronary distribution Focal wall thickening from oedema Involves the septum

Sarcoidosis

What is the following describing? Transient akinesia or dyskinesia of the left ventricular apex without coronary stenosis Ballooning of the left ventricular apex No delayed enhancement

Takotsubo Cardiomyopathy

What does the following LGE pattern suggest: Subendocardial Transmural Subendocardial circumferential

Subendocardial = Infarct Transmural = Infarct Subendocardial circumferential = Amyloidosis

What does the following LGE pattern suggest: Midwall Epicardial Thick and midwall

Midwall = Myocarditis, Idiopathic dilated CM, Sarcoidosis Epicardial = Myocarditis, Sarcoidosis Thick and midwall = HCM

What do the following findings suggest? Fibrofatty degeneration of the RV myocardium Dilated RV with reduced function Normal LV

Arrhythmogenic right ventricular cardiomyopathy

What do the following findings suggest? Abnormal hypertrophy of myocardium compromising diastole Patchy mid wall delayed enhancement of the hypertrophied muscle

Hypertrophic cardiomyopathy Delayed enhancement is also an independent risk factor for sudden death

What do the following findings suggest? Loosely packed myocardium, left ventricle has spongy appearance Increased ventricular trabeculations and deep intertrabecular recesses No myocardial thickening

Left ventricular noncompaction

What do the following findings suggest? Biventricular replacement of myocardium with connective tissue and fat Delayed Gd enhancement in midwall Dilated cardiomyopathy

Muscular dystrophy (Becker - mild, Duchenne - severe)

What is the most common met to the heart? Which cancer has a higher percentage of cardiac involvement?

Lung cancer Melanoma

What is the most common malignant tumour of the heart in adults?

Angiosarcoma

What do the following findings suggest? RA pericardial lesion Cause RHF and/or tamponade Bulky/heterogenous Sun ray - enhancement as it grows along perivascular spaces associated with epicardial vessels

Angiosarcoma

What is the most common primary cardiac tumour in adults?

Left atrial myxoma

What do the following findings suggest? Interatrial septum attachment - ball with stalk Calcified May prolapse through mitral valve Enhancement with Gd

Left Atrial myxoma

What do the following findings suggest? Mass within the heart Favours left atrial appendage No enhancement

Cardiac thrombus

What is the most common fetal cardiac tumour?

Hamartoma (Rhabdomyoma)

What do the following findings suggest? Left ventricle myocardium T2 bright Cardiac tumour Associated with tuberous sclerosis

Rhabdomyoma

What do the following findings suggest? IV septum location Mass Dark on T1/T2 Enhance brightly on perfusion and late Gd

Cardiac fibroma

What do the following findings suggest? 2nd most common primary cardiac tumour Involves heart valves (Aortic/Mitral) Highly mobile Systemic emboli are common

Fibroelastoma

How do you differentiate a fibroeslastoma from vegetations?

Vegetations tend to involve the valve free edges Fibroelastoma does not do that

What do the following findings suggest? Primary tumour Pericardial nodularity and effusion Pericardium is favoured

Metastatic disease

What do the following findings suggest? Normal heart on previous Cardiomegaly now Water bottle heart Oreo cookie sign on lateral - 2 lucent lines epicardial/pericardial fat and central opaque line (fluid)

Pericardial effusion

What do the following findings suggest? Pericardial effusion Flattening or inversion of IV septum towards LV Reflux of contrast into IVC/Azygous

Cardiac tamponade

What do the following findings suggest? Right cardiophrenic sulcus No communication with pericardium ROI measuring water density

Pericardial cyst

What is the most likely site for pericardial absence?

Partial absence of the pericardium over the left atrium and adjacent pulmonary artery Heart shifts toward the left

What do the following findings suggest? Heart contacting the left chest wall

Infer partial absence of the pericardium

The following describes what? If 2 things are similar in density and touching, they will appear as one If heart touches the left hemidiaphragm then the border will disappear

Silhoutte sign

What is the following describing in relation to the diaphragm on CXR? More posterior Gastric bubble under it

Left hemidiaphragm

What is the following describing in relation to the diaphragm on CXR? More anterior Has the highest point

Right hemidiaphragm

On a lateral radiograph what structure appears as a dark hole?

Left upper lobe bronchus

What is the significance of an opacity in the raider triangle (Dark triangle behind trachea on lateral chest radiograph)?

Aberrant right subclavian artery

What does the following describe? S sign - Minor fissure shape May have elevation of the hilum

Right upper lobe collapse

What does the following describe? Increased density at right heart border and loss of border Lateral - anterior density over the heart

Right middle lobe collapse

Chronic RML collapse - Loss of right heart border Small nodules Bronchiectasis Involvement of lingula

Lady Windermere syndrome - MAI infection

What does the following describe? Increased density at right heart border, no loss of right heart border Hyperexpansion of RML May have pulling of mediastinal vessels to right - triangle opacity to right of trachea

Right lower lobe collapse

What does the following describe? Loss of visualisation of the right hemidiaphragm & right heart border

Right lower lobe + Right middle lobe collapse

What does the following describe? Dense wedge shaped opacity in Left lung Increased density in medial left upper zone Juxtraphrenic peak - upward traction of diaphragm

Left upper lobe collapse

What does the following describe? Retrocardiac opacity Lateral - Posteriorly directed triangle opacity Flattened contours of hilum and heart border

Left lower lobe collapse

Re: the hilum sign, what does this mean? If the vessels of the hilum are obscured then a soft tissue mass is touching them

The mass is in the hilum

Re the hilum overlay sign: what does this mean? If the vessels of the hilum can still be seen then the mass isn't touching them

Mass is anterior or posterior to the hilum

If a mass extends above the clavicles, where is it located?

Not in the anterior mediastinum

What is the location of the following mass if: - It has an incomplete/hazy border - It has a crisp circumferential border

Incomplete = Pleural based Crisp circumferential border = Pulmonary

What does the following describe? Pneumonia with bulging fissure

Klebsiella

What does the following describe? Airspace opacification in peripheral lower lobes Rib osteomyelitis/invasion of adjacent chest wall

Actinomycosis

What does the following describe? Fine reticular pattern Patchy airspace opacity with tree-in bud

Mycoplasma

The following post bone marrow transplant pulmonary findings are seen at which stage? Pulmonary oedema Haemorrhage Invasive aspergillosis

Early neutropenic (0-30 days)

The following post bone marrow transplant changes are seen at which stage? Bronchiolitis Obliterans COP

Late >90 days

The following post bone marrow transplant pulmonary findings are seen at which stage? PCP CMV

Early 30-90 days

What does the following describe? Post bone marrow transplant Bronchiolitis obliterans (Air trapping - mosaic attenuation)

Graft v Host disease

What does the following describe? AIDS GGO bilaterally + perihilar regions, sparing of lung periphery Thin walled cysts

PCP

What does the following describe? AIDS Flame shaped opacity

Kaposi sarcoma

What does the following describe? Ghon focus - granuloma Ranke complex - Nodal expansion which calcifies May have pleural effusions

Primary TB

What does the following describe? Local progression of parenchymal disease to cavitation Happens to immunocompromised people

Primary progressive TB

What does the following describe? Positive PPD Negative CXR No symptoms

Latent TB

What does the following describe? Endogenous reactivation of latent infection Apical and Posterior UL or Superior LL location Cavitation

Post primary TB

What is a Rasmussen aneurysm?

Pseudoanuerysm in a TB cavity

What does the following describe? Aspergilloma in a pre-existing cavity Positional change

Aspergillus

What does the following describe? Immunocompromised Halo sign - consolidation with GG halo (Invasive component) Air Crescent sign - thin crescent of air within consolidate mass (Post treatment)

Invasive aspergillus

What does the following describe? Asthma/CF Upper lobe central saccular bronchiectasis with mucoid impaction (Finger in glove)

ABPA - Allergic Bronchopulmonary Aspergillosis

What does the following describe? Immunocompromised patients Invasion of mediastinum, pleura and chest wall

Mucormycosis

What does the following describe? Multiple GG or consolidative nodules Immunosuppressed or post bone marrow transplant

CMV

What does the following describe? Multifocal GGO with small nodular opacities Skin lesions before or after

Measles

What does the following describe? Multiple peripheral nodular opacities Small round calcific lung nodules when healed

Varicella

What does the following describe? Bilateral, peripheral subpleural GGO Bronchovascular thickening - favours Lower lobes Lower zone multifocal opacities

COVID 19

What does the following describe? Multiple round opacities +/- cavitation Lower lobe predominant Peripheral nodular densities with wedge shaped densities Feeding vessel sign - nodule with big vessel going into it

Septic Emboli

What does the following describe? Jugular vein thrombosis with septic emboli Previous or current oropharyngeal infection/Recent ENT surgery

Lemierre Syndrome

the following cause what change in the lung? Cancer - Squamous cell cancer Auto-immune - Wegeners, RA, Caplan Vascular - Septic emboli Infection - TB Trauma - Pneumatoceles Young - CCAM/Sequestration

Cavitation

What does the following describe? Round/Oval lesion <3 cm diameter in lung Surrounded by normal lung parenchyma

Solitary pulmonary nodule

Are the following patterns of calcification considered benign or suspicious? Solid/Diffuse Laminated (Concentric) Central Popcorn

Benign

Are the following patterns of calcification considered benign or suspicious? Eccentric Small flecks

Suspicious

The following signs in a lung nodule are suggestive of benign or malignant pathology? Presence of fat Rapid doubling time <1 month Slow doubling time >16 months

Benign

The following signs in a lung nodule are suggestive of benign or malignant pathology? Spiculated margins Air bronchogram through the nodules Partially solid lesions with GG component

Malignant

What do the following findings suggest: Solid nodule >1 cm in size HOT on PET Cold on PET

HOT = Cancer Cold = Not Cancer

What do the following findings suggest: GG Nodule Hot on PET Cold on PET

Hot = Infection Cold = Cancer

What do the following lung findings suggest: Nodule - lentiform/triangular with a fissural attachment

Benign perifissural lymph node

What do the following lung findings suggest: Nodule spherical shaped Perifissural Growth through the fissure not spreading around it

Atypical perifissural nodule, less likely to be a lymph node

What is the significance of multiple pulmonary nodules? >5

Makes malignancy statistically less likely

What do the following findings suggest: Smoking association Cavitation May have paraneoplastic syndrome e.g. ectopic PTH Central

Squamous cell carcinoma

What do the following findings suggest: Peripheral Large >4cm

Non-Small cell Large cell cancer

What do the following findings suggest: Peripheral Most common Upper lobe Can present in non-smoker and as SPN

Non small cell - Adenocarcinoma

What do the following findings suggest: Central Smoking Central lymphadenopathy Can present with SVCO + Paraneoplastic syndromes

Small cell lung cancer

What lung cancer stage would the following features suggest? Chest wall invasion Pericardium invasion Phrenic nerve invasion Satellite nodule in the same lung lobe

What lung cancer stage would the following features suggest? Mediastinal or great vessel invasion Invasion of the diaphragm Invasion of the carina >1 satellite nodule in another lobe in the same lung

What is considered metastases in lung cancer?

Two masses/nodules in different lungs

The following are contraindications to what: Growth of tumour through fissure Invasion of pulmonary vasculature Invasion of main bronchus Invasion of upper/lower lobe bronchi Malignant pleural effusion

Contraindications to lobectomy/resection of lung cancer

What do the following lung findings suggest? Post pneumonectomy Fluid filled space with air on the post pneumonectomy side

Bronchopleural fistula

What do the following lung findings suggest? Macroscopic fat Popcord calcifications Mass in the lungs

Pulmonary hamartoma

What do the following lung findings suggest? AIDS patient Flame shaped opacities Bloody pleural effusion is common Thalium positive, Galium negative

Kaposi Sarcoma

What do the following lung findings suggest? Nodular thickening of the interlobular septa Subpleural interstitiel No distortion of the pulmonary lobule

Lymphangitis carcinomatosis

What do the following lung findings suggest? Post solid organ or stem cell transplant Within 1 yr of transplant Well defined pulmonary nodules Mass, patchy airspace consolidation, halo sign, interlobular septal thickening

Post transplant lymphoproliferative disorder - B cell lymphoma

What do the following lung findings suggest? AIDS patient Multiple peripheral nodules 1-5cm Lung nodules Pleural effusion Lymphadenopathy

AIDS related pulmonary lymphoma

What do the following lung findings suggest? Unilateral absence of pectoral muscle Unilateral hyper-lucent chest Limb issues

Poland syndrome

What do the following lung findings suggest? Hyper lucent region Decreased vascularity Mucoid impaction in blind ending bronchus - finger in glove <25HU

Bronchial atresia

What do the following lung findings suggest? Fusion of the posterior basilar segments of the lower lobes behind the heart Associated with Scimitar syndrome

Horseshoe lung

What do the following lung findings suggest? Smoker and young Centrilobular nodules + Upper lobe predominance Nodules cavitate to thin walled, which then become thick walled and bizarre shapes Spares costophrenic angles

Pulmonary Langerhans cell Histiocytosis

What do the following lung findings suggest? Female child bearing age Thin walled round cysts Uniform/diffuse distribution

Lymphangiomyomatosis (LAM)

What is LAM associated with?

Tuberous sclerosis Chylothorax

What do the following lung findings suggest? Bilateral oncocytomas Chromophobe RCC Thin walled floppy oval cysts Lower zone and paramediastinal regions Fibrofolliculoma - Skin disease

Birt Hogge Dubbe

What do the following lung findings suggest? Associated with autoimmune diseases/HIV Cystic lung disease - thin walled (Perivascular - vessels along cysts) Ground glass

Lymphocytic interstitial pneumonitis (LIP)

What do the following lung findings suggest? AIDS Ground glass appearance Hilar and mid zones Pneumatoceles Bilateral thin walled upper lung predominant cysts

Pneumocystis Pneumonia

What do the following lung findings suggest? Bullous disease occupying at least 1/3 of hemithorax

Vanishing lung syndrome

What is the following pattern of emphysema? Apical basal gradient Favours upper zones of each lobe Focal lucencies, centrally within secondary pulmonary lobule Central dot sign

Centrilobular emphysema

What is the following pattern of emphysema? Favours lower lobes Uniform distribution across secondary pulmonary lobule

Panlobular emphysema

What is the following pattern of emphysema being described? Adjacent to pleura and septal lines Peripheral distribution within SPL Small focal lucencies <3 bubbles thick

Paraseptal emphysema

What do the following lung findings suggest? Holy leaf pleural plaques with calcifications Plaques spare apices and costophrenic angles

Benign asbestosis related changes

What do the following lung findings suggest? Atelectasis next to pleural thickening/scarring Comet tail convergence of local bronchovascular structures

Round atelectasis

What do the following lung findings suggest? Miners/Quarry workers Multiple nodular opacities favouring upper lobes Egg shell calcifications of hilar nodes Perilymphatic nodules

Silicosis

What do the following lung findings suggest? Large masses in upper lobes Radiating strands T2 dark

Progressive massive fibrosis Complication of silicosis/pneumoconiosis

What should be considered if you see cavitation in the setting of silicosis?

What do the following lung findings suggest? Nodular opacities Calcifications with central nodular dot Perilymphatic distribution

CWP (Coal workers pneumoconiosis)

What goes around the periphery of the secondary pulmonary lobule?

Pulmonary veins Lymphatics

The following lung diseases have nodules in which pattern? Sarcoid Lymphangitic spread of Ca Silicosis

Perilymphatic

The following lung diseases have nodules in which pattern? Miliary TB Mets Fungal

Random

The following lung diseases have nodules in which pattern? Infection RB-ILD Hypersensitivity pneumonitis

Centrilobular

What do the following lung findings suggest? One row of bubbles in the sub pleural region

Paraseptal emphysema

What do the following lung findings suggest? 3 rows of bubbles in the sub pleural region

Honeycombing

What do the following lung findings suggest? CXR - Lung volume reduced Reticular pattern in posterior costophrenic angle

Usual interstitial pneumonia

What do the following lung findings suggest? Apical to basal gradient (Worse in lower lobes) Traction bronchiectasis Honeycombing Subpleural basal predominant distribution

Definite UIP

What is UIP v IPF?

UIP is the most common ILD IPF is when UIP is idiopathic

What do the following lung findings suggest? Homogenous inflammation or fibrosis Lower lobe, posterior, peripheral predominance Ground glass opacities Micronodules Sparing of immediate subpleural lung

NSIP

What are the differences in these types of NSIP? Cellular Fibrotic

Cellular = GG alone Reticulation + Traction bronchiectasis = Fibrotic

What do the following lung findings suggest? Smoking history Apical centrilobular ground glass nodules Upper lobe predominant

RB-ILD

What do the following lung findings suggest? Smoking Diffuse ground glass opacification Patchy or subpleural distribution Peripheral lower lobe predominant ground glass with small cystic spaces

DIP

What do the following lung findings suggest? Young person 20-40yrs Hilar/Mediastinal nodes bilateral Perilymphatic nodules Upper lobe predominant Upper lobe mass (Nodal conglomerate) with satellite nodules

Sarcoid lung changes

What do the following lung findings suggest? Bilateral hilar lymph node enlargement Arthritis Erythema Nodosum

Lofgren syndrome (Acute sarcoid)

What do the following lung findings suggest? Post lung transplant Bronchiectasis Bronchial wall thickening Air trapping interlobular septal thickening

Chronic rejection/Bronchiolitis Obliterans

What do the following lung findings suggest? Crazy paving - Interlobular septal thickening with ground glass Smoking Central and symmetric Spares apices and costophrenic angles Elevated LDH

Pulmonary alveolar proteinosis

What are the causes for crazy paving on CT? Intrelobular septal thickening + GGO

COP Cancer (BAC) COVID/ARDS PCP

What do the following lung findings suggest? Low attenuation/fat density in consolidation

Lipoid pneumonia

What do the following lung findings suggest? Granulation tissue deposition in alveolar spaces Patchy airspace consolidation or GGO Peripheral or peri-bronchial distribution Reverse halo - consolidation with GG centre

Cryptogenic organising pneumonia

What do the following lung findings suggest? Peripheral oesinophilia Asthma history Bilateral Non-segmental consolidation Favours peripheral lungs and upper lobes Peripheral GGO or consolidation

Chronic eosinophilic pneumonia

What is the Halo sign and what are the causes of it?

Nodule with GG around it Haemorrhage/invasion into surrounding tissues Causes: Invasive Aspergillosis, Fungal infection, Haemorrhagic mets, BAC, Wegeners

What is the Reverse Halo sign? What causes it?

Central ground glass with rim of consolidation Causes: COP, TB, Pulmonary infarct

What do the following lung findings suggest? Patchy ground glass opacities (Increased attenuation) Ill defined centrilobular GG nodules Mosaic perfusion, air trapping (Decreased attenuation)

Hypersensitivity pneumonitis

What do the following lung findings suggest? UIP Picture + Air trapping

Chronic hypersensitivity pneumonitis

What do the following respiratory findings suggest? Coronal trachea diameter <2/3 sagittal diameter Normal size main bronchi and tracheal wall thickness

Saber Sheath trachea Associated with COPD

What do the following respiratory findings suggest? Spares posterior membrane Diffuse anterior and lateral thickening of the trachea No calcifications Recurrent episodes of pneumonia and inflammation

Relapsing polychondritis

What do the following respiratory findings suggest? Circumferential tracheal thickening Focal or long segment No calcifications Subglottic involvement is common

Wegeners granulomatosis

What do the following respiratory findings suggest? Spares the posterior membrane Cartilaginous and osseous nodules within submucosa of tracheal and bronchial walls

Tracheobronchopathia Osteochondroplastica (TBO)

What do the following respiratory findings suggest? Irregular focal or short segment thickening Can involve posterior membrane Calcifications common

Amyloidosis

Which tracheal diseases spare the posterior membrane?

Relapsing polychondritis Tracheobronchopathia Osteochondrplastica (TBO)

Which tracheal diseases spare the posterior membrane?

Amyloid Post intubation Wegeners

What do the following respiratory findings suggest? <3cm Central location (Tracheal bifurcation) Calcification Contrast enhancement No association with smoking

Typical carcinoid

What do the following respiratory findings suggest? >3cm Peripheral location (Distal to segmental bronchi) Associated with smoking Contrast enhancement

Atypical carcinoid

What do the following respiratory findings suggest? Upper trachea, prefers posterior lateral trachea Thickening, mass or nodule Not associated with smoking Main or lobar bronchus

Adenoid cystic carcinoma

What is the most common tracheal malignancy? Where is it typically found?

Squamous cell carcinoma Lower trachea/proximal bronchus

What are the common malignancies to met to the trachea/bronchus?

Lung Thyroid Oesophagus

What is the most common benign tumour of the trachea?

Squamous cell papilloma

What do the following respiratory findings suggest? Focal subglottic circumferential stenosis with hourglass configuration

Subglottic stenosis (Most commonly due to post intubation) OR if no Hx of intubation - Adult croup

What do the following respiratory findings suggest? Congenital cystic bronchiectasis Deficiency of cartilage in 4th-6th order bronchi

Williams Campbell syndrome

What do the following respiratory findings suggest? Massive dilatation of the trachea >3cm

Mounier-Kuhn

What do the following respiratory findings suggest? Inflammation of the small airways Tree in bud appearance

Bronchiolitis

What do the following respiratory findings suggest? Reticulations with or without honeycombing Consolidate opacities (COP) Lower lobes favoured

Rheumatoid arthritis

What do the following respiratory findings suggest? Upper lobe fibrobullous disease Unilateral then bilateral

Ankylosing spondylitis

What do the following respiratory findings suggest? NSIP Lower lobe predominant findings Dilated fluid filled oesophagus

Scleroderma

What do the following respiratory findings suggest? Pleuritis Pleural/Pericardial effusion Progressive loss of lung volume

SLE

What do the following respiratory findings suggest? Cirrhotic liver SOB on sitting up Subpleural telangectasia - dilated subpleural vessels

Hepatopulmonary syndrome

What do the following respiratory findings suggest? Nodules with cavitation, random distribution GG changes - haemorrhage Nasal septum perforation

Granulomatosis with polyangiitis (Wegener's)

What do the following respiratory findings suggest? Bilateral coalescent airspace opacities that look like oedema (Haemorrhage) Resolve within 2 weeks Pulmonary haemosiderosis - iron deposition as small, ill-defined nodules

Goodpastures syndrome

What do the following respiratory findings suggest? Circumferential pleural thickening extending to medial pleura Pleura thickness >1 cm Extension into the fissure

Mesothelioma

What is the most common cause of lateral pleural thickening?

Trauma/Old rib fractures

How is mesothelioma staged?

MRI with contrast - evaluate local chest wall, diaphragm, pericardial invasion PET CT = Mets

What do the following respiratory findings suggest? Not associated with asbestos or smoking Large solitary visceral pleural tumour

Solitary fibrous tumour of the pleura (Benign)

What do the following respiratory findings suggest? Asymmetric pleural effusion Enhancement of pleura Septations or gas

Empyema

What do the following respiratory findings suggest? Round Claw sign - acute angle with pleura

Pulmonary abscess

What do the following respiratory findings suggest? Left sided Posterior Diaphragmatic hernia

Bochdalek

What do the following respiratory findings suggest? Anterior Small Right sided diaphragmatic hernia

Morgagni

What do the following respiratory findings suggest? Mediastinal location Cystic appearance Fat Calcifications and teeth

Mediastinal teratoma

What do the following respiratory findings suggest? Mediastinal location Right anterior cardiophrenic angle

Pericardial cyst

What do the following respiratory findings suggest? Soft tissue mass with calcifications that infiltrates the normal fat planes of the mediastinum

Fibrosing mediastinitis

What is PAPVR?

When one or more of the pulmonary veins (4) drains into the RA/SVC rather than the left atrium

What do the following respiratory findings suggest? Dilated right inferior pulmonary vein draining into the IVC

Scimitar sign

What is TAPVR?

Cyanotic heart disease where all the pulmonary venous system drains into the right side of the heart

What do the following respiratory findings suggest? Anomalous course of the pulmonary vein to then connect to the left atrium

Meandering pulmonary vein No left to right shunt

The following suggests what kind of PE - chronic or acute? Central clot Venous dilatation Perivenous soft tissue oedema

Acute

The following suggests what kind of PE - acute or chronic? Peripheral clot Web like Shrunken veins with collateral vessels Calcifications within thrombus Mosaic attenuation in lungs Pulmonary HTN

Chronic PE

What do the following respiratory findings suggest? RV > LV Leftward bowing of IV septum Contrast reflux into hepatic veins

Chronic PE

What do the following respiratory findings suggest? Variant of pulmonary HTN Normal capillary wedge pressure Enlarged mediastinal lymph nodes

Pulmonary veno-occlusive disease

What are the causes of pulmonary artery pseudoaneurysm?

Iatrogenic from swan ganz catheter Behcets Chronic PE

What do the following respiratory findings suggest? PA bigger than aorta Segmental artery to adjacent bronchus ratio is increased RV dilatation/hypertrophy

Pulmonary HTN

What is the following describing? Air extends above the great vessels Air does not extend above the great vessels

Pneumomediastinum = Air extends above the great vessels Pneumopericardium = Air does not extend above the great vessels

What is a flail chest?

>3 segmental (more than 1 fracture in a rib) OR >5 adjacent rib fractures

What do the following respiratory findings suggest? Persistent pleural fluid collection after pleural drain placement Displaced extrapleural fat

Extraplueral haematoma

What do the following respiratory findings suggest? Non segmental ill defined areas of consolidation Sub pleural sparing Appear within 6hrs of trauma and disappear within 72 hrs

Pulmonary contusion

What do the following respiratory findings suggest? Gas fluid level in an area of pulmonary consolidation Resolves slowly

Pulmonary laceration

What do the following respiratory findings suggest? Long bone fracture 1-2 days post femur fracture GG nodules in lungs No filling defect to suggest PE Resolves in 1-3 weeks

Fat embolus

What is the aortic isthmus?

Segment of aorta between the origin of the left subclavian and ligamentum arteriosum

The following are branches of which main artery? Splenic artery Common hepatic artery Left gastric artery

Coeliac trunk

The following are branches of which artery? Gastroduodenal artery Left & Right hepatic

Common hepatic artery

What do the following findings suggest? Hepatic artery arises from ectopic location

Replaced hepatic artery

What do the following findings suggest? Hepatic artery is duplicated with one vessel from coeliac and another vessel from ectopic location

Accessory hepatic artery

When does the common hepatic artery become the proper hepatic artery?

After it gives off the GDA

The following vessels arise from which artery? Iliolumbar Lateral sacral Superior gluteal Inferior gluteal

Posterior division of Internal iliac artery

What do the following findings suggest? Connection between obturator artery and internal iliac arteries Courses over the superior pubic rim Risk of massive haemorrhage in pelvic fracture

Corona Mortis

What is the course of the subclavian artery compared to the vein?

Subclavian artery runs posterior to the subclavian vein

The following are landmarks for which arteries? Begins at 1st rib Begins at lower border of teres major

1st rib = Axillary artery Lower border of teres major = Brachial artery

Which artery is being described here? Bigger artery in forearm Gives off common interosseous Supplies superficial palmar arch

Ulnar artery

Where does the external iliac become the common femoral?

Once it gives off the inferior epigastric at the inguinal ligament

What are the branches of the common femoral artery?

Deep femoral (Profunda) - Lateral and posterior Superficial femoral artery - Anterior & Medial

What is the most medial artery in the leg?

Posterior tibial (Medial malleolus)

What do the following findings suggest? Cirrhosis Enlarged left renal vein Dilatation of IVC at level of left renal vein

Splenorenal shunt (Collateral between splenic vein and renal vein)

Where does a left sided SVC drain into?

Coronary sinus

What is a duplicated IVC associated with?

Renal associations - horseshoe kidney and crossed fused ectopic kidneys

What do the following findings suggest? Renal vein anterior to aorta (superior) Renal vein posterior to aorta (Inferior)

Circumaortic venous collar

What do the following findings suggest? Hepatic veins drain directly into RA Duplicated IVC usually - left IVC terminates in left renal vein Crosses to join right IVC Polyspenia

Azygous continuation

What do the following findings suggest? Atherosclerosis Gap in aortic intimal calcifications Ulceration of the aortic wall

Penetrating aortic ulcer

What do the following findings suggest? Continuity with undissected portion of aorta Smaller cross sectional area Surrounded by calcifications

True lumen of aortic dissection

What is a type A dissection What is a type B dissection

Type A = Dissection involving ascending aorta and arch proximal to take off of the left subclavian (Surgical) Type B = Distal to take off of left subclavian (Medical)

What do the following findings suggest? Cobweb sign - slender linear areas of low attenuation Larger cross sectional area Beak sign - acute angle at edge of lumen

False lumen of aortic dissection

What do the following findings suggest? Hyperdense crescent sign on non contrast CT T1 bright crescent on MR

Intramural haematoma

What do the following findings suggest? Enlargement of lumen of vessel >1.5x diameter All 3 layers are intact

True aneurysm

What do the following findings suggest? All 3 layers of the vessel are not intact Contained rupture

False aneurysm (Pseudoaneurysm)

What do the following findings suggest? Yin/Yang sign - doppler US Collection

Pseudoaneurysm

What is the most common place for a traumatic aortic pseudoaneurysm?

Aortic isthmus (Tethering from ligamentum arteriosum)

What do the following findings suggest? Ascending aortic calcifications

Takayasu Syphillis

What do the following findings suggest? Cystic medial necrosis of the aorta Leading to aneurysm

Marfans

What do the following findings suggest? Aneurysm of the right aortic sinus Asian man Associated with VSD

Sinus of valsalva aneurysm

What do the following findings suggest? Peri-aortic stranding Rapid aneurysm enlargement Posterior wall of aorta drapes over vertebral column Hyperdense crescent sign

Impending aortic rupture

What do the following findings suggest? Saccular pseudoaneurysm Thoracic or suprarenal aorta Lobular contours Peri-aortic fat stranding/gas

Mycotic aneurysm

What do the following findings suggest? Orificial renal artery stenosis HTN Teenager or child

NF1 - dysplasia of arterial wall

What do the following findings suggest? Annuloaortic ectasia - dilatation of aortic root Aortic valve insufficiency - aortic regurgitation Tulip bulb - ascending aortic aneurysm May have pulmonary artery enlargement

Marfans

What do the following findings suggest? - Hypertelorism (Frog eyes) - Bifid uvula and cleft palate - Aortic aneurysm with tortuisity or ectatic vertebral arteries

Loeys Dietz Syndrome

What do the following findings suggest? Hypermobile joints Bleeding diatheses Aortic aneurysm with tortuisity - aortic root

Ehlers Danlos

What is the risk with Ehlers danlos and vascular intervention?

High risk of arterial dissection

What do the following findings suggest? Saccular asymmetric aortic aneurysm with involvement of aortic root branches Tree bark intimal calcifications Ascending aorta/Arch

Syphlitic aneurysm

What is the most common site of aortoenteric fistula?

D3 + D4

What do the following findings suggest? Asymmetrical thickening of the aorta Sparing of the posterior wall Young patient Periaortic inflammatory changes

Inflammatory aneurysm

What do the following findings suggest? Complete occlusion of the aorta distal to the renal arteries Atherosclerosis Impotence, absent femoral pulses, buttock claudication

Leriche syndrome

What do the following findings suggest? Progressive narrowing of abdominal aorta High and long segment Children/young adults No atherosclerosis HTN, weak or absent femoral pulses, claudication

Mid aortic syndrome

What do the following findings suggest? Young patient Heart failure within 1st week of life Narrowing before left subclavian artery Hypoplastic aortic arch Pulmonary oedema

Infantile aortic coarctation

What do the following findings suggest? Leg claudication, BP differential Post ductal - narrowing distal to left subclavian artery Normal diameter aortic arch

Adult aortic coarctation

The following are associate with which vascular pathology? Turner syndrome Bicuspid aortic valve*** Berry anuerysms

Aortic coarctation

What do the following findings suggest? Figure 3 sign XR Rib notching - 4-8th ribs (Inferior aspect)

Aortic coarctation

Which ribs are spared notching in aortic coarctation and why?

Ribs 1 + 2 These are fed by the costocervical trunk

What do the following findings suggest? Elongation with narrowing and kinking of the aorta No pressure gradient, collaterals or rib notching

Pseudocoarctation

What do the following findings suggest? Anterior scalene muscle causing compression of subclavian vessels and brachial plexus (Nerve**, vein, artery)

Thoracic outlet syndrome

What do the following findings suggest? Anterior scalene muscle compression of subclavian vessels and brachial plexus Thrombus in the subclavian vein

Paget Schroetter (Managed with lysis not stenting)

What are the most common sites for visceral artery aneurysms?

Splenic artery Hepatic artery SMA

What do the following findings suggest? Compression of coeliac artery by median arcuate ligament 20-40yrs Hooked appearance of coeliac trunk

Median arcuate ligament syndrome

What do the following findings suggest? Bowel has thinner wall Non dilated bowel Reduced enhancement Mesentary not hazy until infarct If reperfused then bowel wall is thick, target appearance

Acute arterial mesenteric ischaemia

What do the following findings suggest? Dilatation of bowel wall with thickening Variable enhancement Fat stranding and ascites

Venous mesenteric ischaemia

What do the following findings suggest? Bowel looks normal - but involved segments are thickened at watershed areas Delayed filling of PV Narrow SMA and intramural branches Hypotensive

Non occlusive mesenteric ischaemia

What are the watershed areas of mesenteric perfusion?

Splenic flexure Sigmoid rectal junction Ileum/Jejunum

What do the following findings suggest? Closed loop obstruction Mixed arterial and venous picture Congested dilated bowel Lumen is fluid filled

Strangulation

What do the following findings suggest? PR Bleeding Usually right sided Arterial phase shows small arteries in anti mesenteric border Early opacification of dilated draining veins in arterial/venous phase

Colonic angiodysplasia

What do the following findings suggest? Colonic angiodysplasia Aortic stenosis

Heyde syndrome

What do the following findings suggest? Hepatic AVMs Pulmonary AVMs What imaging is required?

HHT CT Lung & Liver + Brain MRA

What do the following findings suggest? Female 30-40s Left renal vein compressed under SMA Abdominal pain, haematuria May have venous collaterals

Nutcracker syndrome

What do the following findings suggest? Narrowing of the renal artery near the ostium/proximal artery Atherosclerosis PSV >180 cm/s

Renal artery stenosis

What do the following findings suggest? Stricturing and beading of the renal artery (Distal artery) HTN

Fibromuscular dysplasia

How is renal artery stenosis treated? How is FMD treated?

RAS = Angioplasty + Stent FMD = Angioplasty

What do the following findings suggest? Narrowing and dilatation of the renal artery Favours the ostium

NF 1

What do the following findings suggest? Multiple aneurysms Multiple splanchnic artery (Coeliac, SMA, IMA) saccular aneurysms, dissections and occlusion Elderly patients

Segmental arterial mediolysis (SAM)

What do the following findings suggest? Pelvic pain Venous obstruction at left renal vein or incompetent ovarian vein valves Multiple dilated parauterine veins

Pelvic congestion syndrome (Managed with ovarian vein embolisation)

What do the following findings suggest? Abnormal dilatation of veins of pampiniform plexus Left side most common

Testicular varicocele

What should be done in the following scenarios: Isolated right varicocele Non-decompressible varicocele

CT Abdomen/Pelvis ?Primary

What do the following findings suggest? Doppler - serpiginous structures in the myometrium with low resistance high velocity patterns

Uterine AVM

What do the following findings suggest? DVT in left common iliac vein Compression of Left common iliac vein by right common iliac artery

May Thurner syndrome Tx: Thrombolysis and stenting

What do the following findings suggest? Compression/Occlusion of the popliteal artery by the medial head of gastrocnemius Medial deviation of the popliteal artery Normal pulses that decrease with plantar flexion

Popliteal entrapment

What do the following findings suggest? Affects the popliteal artery Young men Mucoid filled cysts in outer media/adventitia of vessel May compress artery as they grow

Cystic adventitial disease

What do the following findings suggest? Port wine naevi Bony or soft tissue hypertrophy (Localised gigantism) low flow Venous malformation Persistent sciatic vein Superficial vein in the lateral calf and thigh

Klippel-Trenaunay syndrome

What do the following findings suggest? Intimal thickening due to vessel wall damage

Intimal hyperplasia

What do the following findings suggest? Blunt trauma at hook of hamate May have emboli with obstruction of digits Corkscrew configuration of superficial palmar arch Occlusion of ulnar artery or pseudoaneurysm of ulnar artery

Hypothenar hammer syndrome

What do the following findings suggest? Young women Large vessel vasculitis - usually aorta Wall thickening and wall enhancement May have occlusion of branches or dilatation of aorta

Takayasu arteritis

The following vasculitides affect which vessels? Takayasu GCA

Large vessels

What do the following findings suggest? Old men Aorta and External carotid (Temporal artery) US Temporal artery - thickening of the wall CTA axilla shows wall thickening, occlusions, dilatations

Giant cell arteritis

What do the following findings suggest? Children/Young adults Optic neuritis Uveitis Menieres like symptoms Aortitis

Cogan syndrome

The following vasculitides affect which vessels? PAN Kawasaki

Medium

What do the following findings suggest? Men Renal***, cardiac, GI Microanuerysm formation at branch points Infarcts

Polyarteritis nodosa

What do the following findings suggest? Children Calcified coronary artery aneurysm

Kawasaki disease

The following vasculitides affect which vessels? Wegeners Churg strauss Microscopic polyangiitis HSP Behcets Beurgers

Small vessel disease

What do the following findings suggest? Nasal perforation Cavitary lung lesions Kidneys - vasculitides

Wegeners (Granulomatosis with polyangitis)

What do the following findings suggest? Asthma/Eosinophilia Transient peripheral lung consolidation + GGO Bronchial wall thickening/Septal thickening Systemic vasculitis

Churg Strauss (Eosinophilic granulomatosis with polyangitis)

What do the following findings suggest? Diffuse pulmonary haemorrhage Kidneys

Microscopic polyangiitis

What do the following findings suggest? Children Doughnut sign for intussusception Scrotum with skin oedema Multifocal bowel wall thickening

Henoch Schonlein Purpura (HSP)

What do the following findings suggest? Smokers Small/medium vessels in legs Extensive arterial occlusive disease with development of corkscrew collateral vessels in fingers Ulnar artery normal Auto-amputation

Buergers disease

What do the following findings suggest? Proximal - decreased PSV or low Diastolic flow High velocity jet in middle Distal - Tardus parvus (Slow systolic peak)

Vessel stenosis on US

What is the ideal site of puncture for the CFA?

Middle of the medial 1/3 of the femoral head

What do the following findings suggest? Leak at the top or bottom of the graft, high pressure

Type 1 endo-leak Requires intervention

What do the following findings suggest? Filling of the sac via a feeder artery Most common Most commonly due to IMA or lumbar artery

Type 2 endo-leak May need treatment, may resolve

What do the following findings suggest? Defect/fracture in the graft

Type 3 endo-leak

What do the following findings suggest? Porosity of the graft

Type 4 endoleak

What do the following findings suggest? Endotension Due to pulsation of the graft wall

Type 5 endoleak

What embolisation method would be used in this situation? Large vessel Permanent

Coils Amplatz occluder

What embolisation method would be used in this situation? Large vessel Temporary

Gelfoam Autologous clot

What embolisation method would be used in this situation? Small vessel Permanent

Particles Liquid sclerosants Thrombin Ethiodol

What embolisation method would be used in this situation? Small vessel Temporary

Microspheres Gelfoam

Where would you access if you needed to access a lesion in the iliac vessels?

Ipsilateral CFA or contralateral CFA

Where would you access if you needed to access a lesion in the CFA?

Contralateral CFA

Where would you access if you needed to access a lesion in the SFA?

Ipsilateral CFA

What is meant by the following terms: Antegrade access Retrograde access

Antegrade access = Towards toes Retrograde access = Towards the heart

What is the maximum dose of Lidocaine?

4-5mg/kg 1% Lidocaine = 10mg per 1 mL

The following pathology is typically found in which aspect of the lungs? (Upper/Lower) Coal workers, Silicosis, Progressive massive fibrosis, Cystic fibrosis, RB-ILD, Centrilobular emphysema, Ankylosing Spondylitis, Sarcoid

Upper lobes

The following pathology is typically found in which aspect of the lungs? (Upper/Lower) Asbestosis, Primary cilliary dyskinesia, ILD (UIP/NSIP/DIP), Panlobular emphysema (A1AT), Rheumatoid lung, Scleroderma

Lower lobes

How is a pseudoaneurysm managed?

Direct compression: up to 30mins, no compression if above inguinal ligament Thrombin injection if cavity size >2cm If cavity size <2cm then repeat US in 1 week.

If a patient has the following can they have an EVAR for AAA repair? >10 mm distance from aneurysm to renal arteries Aneurysm neck angle at 120/60º Iliac artery angle <90º Iliac artery length >20 mm Iliac artery diameter >7 mm

Yes

The following describes which pathology? Features lack of enhancement water attenuation round or elliptical shape thin walled, sharply defined and being without internal septa. The most common location is at the right anterior cardiophrenic angles

Pericardial cyst

What is the difference between Churg Strauss (EGPA) v Eosinophillic pneumonia

Churg Strauss is a systemic vasculitis with lung findings of intra-alveolar haemorrhage and vasculitis Eosinophillic pneumonia only affects the lungs - GGO in upper lobes.

What pathology do the following findings suggest in a young child with a haematological disorder ? Alveolar and subpleural consolidation Pleural effusions Mosaic perfusion pattern Chronic changes in the lungs: Interstitial changes with septal thickening Wedge opacities Traction bronchiectasis Infective/micro-occlusive pathology

Sickle cell changes in lungs - Acute/Chronic SCD

What abnormality do the following findings suggest? Decreased blood flow/Smaller vessels leads to low attenuation (Dark) areas Normal areas with preserved perfusion are denser (GG) - differences diminish on expiratory imaging Reduced vascular markings

Perfusion abnormality (Mosaic attenuation)

What abnormality do the following findings suggest? Normal blood flow/vessels leads in low attenuation vessels Reduced density on expiration (Lucent) - air trapping Well ventilated areas are denser on expiratory If attenuation differences persist or worsen on expiration Preserved vascular markings

Ventilation abnormality (Mosaic attenuation) - Air trapping

What do the following findings suggest? Large vessel vasculitis Exact features will depend on the stage. Potential features include: systemic thrombi in the vena cava, cerebral sinuses, or limb veins pulmonary arterial occlusions due to emboli or thrombi one or more segmental pulmonary arterial aneurysms bronchial arterial aneurysms

Hugh Stovin syndrome (No oral/genital ulcers) Similar to Behcets disease

The following are linked with which abnormality in the lungs? Osteosarcoma Wilms tumour Histiocytosis

Pulmonary nodules with pneumothorax

The following pathology cause which infiltrative pattern in the lungs? Eosinophilic pneumonia Resolving pulmonary oedema desquamative interstitial pneumonia Sarcoidosis

Reverse bat wings peripheral infiltrates

The following pathology cause which infiltrative pattern in the lungs? pulmonary oedema proeteinosis sarcoidosis lymphoma Goodpasture’s syndrome Alveolar cell carcinoma

Perihilar bat wings infiltrates

The following gives rise to which kind of rib notching? coarctation lies distal to the brachiocephalic trunk but proximal to the origin of the left subclavian artery

Bilateral rib notching

The following gives rise to which kind of rib notching? Coarctation lies distal to the brachiocephalic trunk but proximal to the origin of the left subclavian artery or right sided aortic arch with aberrant left subclavian artery distal to coarctation

Unilateral right rib notching collaterals cannot form on the left, as the left subclavian is distal to the coarctation

The following give rise to which kind of rib notching? aberrant right subclavian artery arising after the coarctation the coarctation is distal to the origin of the left subclavian artery

Unilateral Left rib notching collaterals form on the left collaterals cannot form on the right, as the aberrant right subclavian artery arises after the coarctation

The following cause which kind of pulmonary metastases? Sarcomas Mucinous carcinoma (Colon, Ovarian, Breast) Thyroid – Medullary GCT

Calcified pulmonary mets

The following cause which kind of pulmonary metastases? M: melanoma R: renal cell carcinoma C: choriocarcinoma T: thyroid carcinoma, teratoma B: bronchogenic carcinoma B: breast carcinoma

Haemorrhagic pulmonary metastases

What should be considered if you have an anterior mediastinal mass with pericardial effusion?

Mature cystic teratoma with rupture causing pericardial effusion

What is the most common extra-nodal location for HL?

Thymus

What is the indication for transarterial embolisation of pulmonary AVM?

Feeding vessel diameter >3mm

What is the most common primary to metastasise to the lung?

Lung Breast Lymphoma Ovarian cancer

What do the following findings suggest? LV Dysfunction, LVH, Systolic Anterior Motion of mitral valve, LV Apical aneurysm Isointense to myocardium on T1 & T2 1st pass enhancement, patchy IV delayed enhancement

Hypertrophic obstructive cardiomyopathy (HOCM)

The following lead to which type of delayed enhancement on MRI? Infarct

Subendocardial

The following lead to which type of delayed enhancement on MRI? Chronic cocaine use amyloidosis systemic sclerosis cardiac transplantation hypereosinophilic syndrome

Circumferential subendocardial

The following lead to which type of delayed enhancement on MRI? Infarct severe myocarditis sarcoidosis

Transmural

The following lead to which type of delayed enhancement on MRI? myocarditis sarcoidosis Chagas disease

Subepicardial

The following lead to which type of delayed enhancement on MRI? dilated cardiomyopathy myocarditis sarcoidosis Chagas disease HOCM

Mesocardial (Middle pericardium)

What condition causes superior rib notching?

NF1 (Rare)

What does the following describe? Lungs Homogenous, well circumscribed Non calcified nodule with serpiginous mass connected to blood vessels

Pulmonary AVM

What do the following findings suggest: VQ Scan No matched or unmatched defects Bilateral renal excretion noted

Right to left shunt (Systemic uptake of the radio tracer)

Which chamber of the heart enlarges with the following intracardiac shunt? Membranous VSD Muscular VSD

Membranous VSD = LA Muscular VSD = RV

Which chamber of the heart enlarges with the following intracardiac shunt? PDA ASD

PDA = LA ASD = RA

What do the following findings suggest: Nondilated LV Concentric LVH Mid wall LGE in the basal lateral wall

Fabrys

What do the following findings suggest? Smooth focal outpouching of the thoracic aorta Anteromedial aspect of aorta at aortic isthmus At site of ligamentum arteriosum Calcification + obtuse angle

Aortic ductus bump/diverticulum

What do the following findings suggest? Sharp marginated bulge at inferior surface of aortic isthmus At site of ductus arteriosus

Aortic pseudoaneurysm

What are the guidelines for aortic aneurysm screening at the following stages? <3 cm 3-4.4 cm

<3 cm: Re-screen at age 65yrs 3-4.4 cm: Repeat US in 12 months time

What are the guidelines for aortic aneurysm screening at the following stages? 4.5 - 5.4 cm >5.5 cm

4.5 - 5.4 cm: Repeat US in 3 months >5.5 cm: Vascular referral + CT Aortogram if for surgery

What is the staging imaging used for lung cancer?

CT Neck, Chest, Abdomen

If a patient requires a liver biopsy and has the following conditions, which approach is used? Severe coagulopathy Infiltrated liver disease Ascites

Transjugular approach as no breach of capsule and bleeding is confined to the liver.

The following are risk factors for what? Cardiac CT - Non-calcified plaque measuring <30 HU - Outer vessel diameter at plaque >1.1 x that of adjacent uninvolved vessel (Patent lumen thick vessel wall) - Plaque with ring of hyperattenuation - Small calcified plaque separately visualised from the lumen

Plaque rupture (Cardiac coronary arteries)

The following are CT findings of what? - Eccentric mural thrombus - Mosaic perfusion - Pulmonary artery webs - Bronchial artery & RV Hypertrophy

Chronic PE

What is the following describing? - Congenital left to right shunt (Overoxygentated blood recirculates through lungs, not reaching tissues) - Incomplete ventricular septum - Plethora - Cardiomegaly (LA +/- RV & RV)

VSD

What is the following describing? - Congenital left to right shunt (Overoxygentated blood recirculates through lungs, not reaching tissues) - Incomplete atrial septum - Pulmonary plethora - Cardiomegaly (RA & RV)

ASD

What is the following describing? - Congenital left to right shunt (Overoxygentated blood recirculates through lungs, not reaching tissues) - Opening from pulmonary trunk to aorta persists post birth - Cardiomegaly (LA + LV) - AP window obscured, Pulmonary oedema

Patent ductus arteriosus

What is the following describing? - Congenital left to right shunt (Overoxygentated blood recirculates through lungs, not reaching tissues) - RV Hypertrophied - Reversal of shunt from right to left due to hypertrophy - PA HTN

Eisenmenger syndrome

What is the following describing? - Congenital right to left shunt (Blood bypass lungs = hypoxemia) - Aorticopulmonary septum fails to separate the RV and LV outflow tracts

Persistent ductus arteriosus

What is the following describing? - Congenital right to left shunt (Blood bypass lungs = hypoxemia) - Right ventricle pumps to aorta - LV pumps to pulmonary trunk - Narrow superior mediastinum (Aortic/pulmonary arterial configuration) - Cardiomegaly

Transposition of the great arteries

What is the following describing? - Congenital right to left shunt (Blood bypass lungs = hypoxemia) - Right AV valve fails to develop - Decreased pulmonary vascularity - Normal/Large heart

Tricuspid atresia

What is the following describing? - Congenital right to left shunt (Blood bypass lungs = hypoxemia) - Pulmonary trunk stenosis - Rightward displaced aorta - VSD (VS fails to develop) - RV Hypertrophy - Decreased pulmonary arterial flow

Tetralogy of Fallot

What is the following describing? - Congenital right to left shunt (Blood bypass lungs = hypoxemia) - Pulmonary veins drain into the right heart (Coronary sinus/SVC/Brachiocephalic)

TAPVR

Cardiothoracics & Vascular Flashcards

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