1
Q
Inverted Napolean Hat Sign
A
Spondylilosthesis Grade IV
2
Q
Scoliosis
A
Abnormal side-side deviation of spine with rotational involvment
3
Q
Segment most laterally deviated?
A
Apex
4
Q
Deformity of what * is considered standard for scoliosis?
A
20*
5
Q
Lateral Convexity
A
scoliotic curves less than 20*
6
Q
A
Scoliosis
7
Q
Hunter-Volkman Law:
A
The Hueter-Volkmann Law describes how uneven mechanical forces affect spinal growth.
Bone growth slows down when it’s under pressure, and speeds up when pressure is reduced or there’s tension.
8
Q
A
Antalgia
9
Q
A
Congenital Spondy
10
Q
A
Degenerative Spondy L2
11
Q
A
Isthmic Spondy 2A
12
Q
A
Isthmic Spony 2A
13
Q
A
Lateral Listhesis
14
Q
A
Scoliosis with Artefact Clips
15
Q
A
Good Explanatory Card
16
Q
Wolff’s Law
A
bone remodels in response to mechanical stimuli, which contributes to structural curve
17
Q
Which side experiences more degernerative changes & and decreased disc height?
A
Concave Side
18
Q
How do you assess spinal rotation?
A
Use pedicle shadows, grade 0 - 4
19
Q
What is Cobb Angle & how do you find it?
A
measurement of spinal curve
20
Q
What does Flexability Assessment predict
A
mobility, correctability & progression
21
Q
Lack of flexability in the spine reduces likelihood of succcessful spinal ___________?
A
fusion
21
Q
How do you radiographically assess spine flexability in a scoliotic patint?
A
Pt supine, flexes laterally to each side as much as possible. Evaluation taken when pt flexes toward convexity, cob method applied, degree of correction induced is a measure of flexability.
22
Q
How can you ascertain skeletal maturity in the upper body?
A
Vertebral ring apophyses at upper & lower margin of body. Fusion = cessation of spinal growth
23
Q
What does fusion of the left hand & wrist indicate?
A
Distal radial epiphysis closes same time as vertebral ring aphysis
24
Risser Sign
Grades state of ossification & fusion of iliac crest apophysis, used to grade skeletal maturity, fusion indicates near completion of vertebral growth Ossifies L - M.
25
How do you grade a Risser Sign?
0 - 5, 5 = fusion to Ilium & skeletal maturity
26
Scoliosis + Hemivertebrae
27
Why would you use nuclear medicine for scoliosis?
Helpful for localising bone abnormality (hardware failure, infection, discitis etc)
28
2 Types of Scoliosis
Functional + Structural
29
Features of Structural Scoliosis
- generally progressive
- rotational deformity
- major curve
- failure to correct on lateral bending
30
Types of Structural Scoliosis
Idiopathic, Congenital, Developmental, Neuromuscular, Post-traumatic, inflammatory
31
Features of Functional Sciolosis?
- non-progressive
- milder curves
- no rotation or structural alteration
- correction on lateral bending
- Causes: postural, hysterical, nerve root irritation, inflammatory
32
Do 30% of people with idiopathic scoliosis have a family member with it also?
Yes
33
Give 2 features of idiopathic scoliosis?
- unknown aetiology
- most common Scol
34
3 Types of Idiopathic Scoliosis?
Infantile, Juveline, Adolescence
35
What side does infantile scol. bend to?
Left thoracic curve
36
What side does juvenile idiopathic scol. bend to?
Right Thoracic Curve
37
Adolescent scoliosis is the ____________ common overall & idiopathically?
Most
38
What type of curve is most common in Idiopathic Adolescent Scoliosis?
Right Thoracic Curve
39
Features of Adolescent Idiopathic Scol?
- hereditary association
- MC in females
- critical progression between 12 - 16 yrs
40
How does Adolescent Idiotpathic Scol. progress?
- 70% >30* continue after skeletal maturity
- if progress, 1-2*/yr & 5-8*/yr with pregnancy
- 10x increased incidence of congenital defects with curves 20+*
41
Reasons for Congenital Scol?
1. Failure of formation (hemivertebrae)
2. Failure of segmentation (block vertebrae)
3. Mixed congenital syndromes
4. Abnormal bony/neural development
42
What type of scoliosis is this and why?
Congenital - hemivertebrae
43
4 main types of Developmental scoliosis?
- mesenchymal disorders
- neurofibromatosis
- metabolic disorders
- osteochondrodysteophies
44
what type of scoliosis is this?
developmental
45
Causes of Neuromuscular scoliosis?
- UMN lesion (spinal cord tumur, polio)
- LMN lesion (cerebral palsy)
- Myopathic (muscular dystrophy)
46
What shape is neuromuscular scoliosis?
- long, c-shaped curved from cervcal-sacrum
- convex side toward affected muscle groups
- occuring before 11 is suspiscious
47
Why is a left sided thoracic curve a red flag?
Often associated with neuromuscular scol.
48
What is this?
Neuromuscular Scol.
49
What is this?
Post-traumatic Scoliosis
50
Causes of Post Traumatic scoliosis?
- vertebral fx
- radiation
- surgery
- micro-trauma
- degeneration
- extraspinal contractures
51
What are the inflamatory, neoplastic & bone softening diseases that cause scoliosis?
- TB
- Pyogeneic infection
- vertebral column tumours (osteoblastoma, osteoid osteoma)
52
what is this?
Inflammatory/Bone Softening or Neoplastic Scol
53
Spondylolisthesis/Anterolisthesis
- anterior displacement of vertebreal body in relation to segments immediately below
54
What is this?
Anterolisthesis
55
Retrolisthesis
posterior displacement of vertebral body relative to segment below
56
What is this?
Retrolisthesis
57
Spondylolysis
- separation defect of pars
58
What is this?
Spondylolysis (pars defect)
59
Spondyloptosis
- far anterior translation of L5 to reside anterior/inferior to sacrum
60
Dysplastic Spondylolisthesis
- developmental insufficiencny of facets or disc complex resulting in defect/elongation of pars
61
Features of dysplastic spondylolisthesis?
- elongated pedicles
- more prone to recurrent symptoms & clinical deformity
- higher incidence of nerve root pressure due to intact lamina pulled against dural sac
62
What is this?
Dysplastic Spondylolisthesis
63
Type A Isthmic Spondylolisthesis?
- lytic or fatigue fx of pars
- MC L5
64
Type B Isthmic Spondylolisthesis?
Elongation but intact pars due to initial & repeated stress fx that heals as body moves very gradually anteriorly elongated by pars
65
Type 2C Spondy
rare acute fx of pars
66
What is the difference between Type A & Type B isthmic spondylolisthesis?
Type A: a break in the pars causes the slip
Type B: the pars get stretched out rather than broken
67
Features of isthmic spondylolisthesis?
- higher incidence in athletes
- aetiology unclear
- 90% of all spondy happen at L5
68
Degenerative Spondylolisthesis
- secondary to long standing degenerative changes of both facets & discs
- no pars disruption
- no more than 25% anterior diplacement
- MC L4
69
What is this?
Degenerative Spondylolisthesis
70
Traumatic Spondylolisthesis
- secondary to fxs in area of neural arch other than pars
- common at C2 (hangmans fx)
71
What is this?
Traumatic Spondylolisthesis (Hangmans fx)
72
What is this?
Traumatic Spondy
73
Patholigcal Spondylilosthesis
- occurs in conjunction with bone disease
- Padget's disease, mestastic bone disease etc
74
What is this?
Pathological spondylolisthesis
75
Progression of displacement seldom occurs after ____yrs, with most displacement occuring before ____yrs
18yrs, 10yrs
76
Spondylolisthesis clinical findings:
- prominent heart-shaped buttocks
- hyperlordosis
- palpable "step defect" (in non-lytic)
- prominent spinous process (in lytic)
- symmetric transverse skin furrow above illiac crest
- clicking sensation may be felt in trunk flx or slr
- hamstring tightness
77
What do you do when seeing a spondy on radiograph?
- look for cause (pars defect, disc degen., lesion etc.)
- a radiolucent defect in pars (lateral lumbar - scotty dog)
- buttressing phenomunon (anterior osteophyte formation at anterior sacral base)
78
What is this?
Anterior osteophyte formed in an attempt to stabilise at sacral base
79
What is a grade 5 spondy called?
spondyloptosis
80
What grades of spondy are these?
1 & 2
81
What grades of spondy are these?
3 & 4
82
What is this and what does it mean?
A bowline of brailford & inverted napoleon hat sign are features of an advanced grade 3/4/5 spondy
83
Wilkinson Syndrome
- unilateral pars defect often create compensatory stress hypertrophy of the contralteral pars & pedicle region
- as the congenital absence of a pedicle, a disease process must be ruled out
- the combination of unilateral pars & contralateral stress causes sclerotic pedicle
84
What is this?
Wilkinson's syndrome
85
What is this?
Wilkinson's Syndrome
86
Cervical spondy
- rare
- MC C6
- pars defect most commonly bilateral
- 50% associated with SBO
87
What is this?
Cervical spondylolisthesis
88
What is this?
Cervical Spondylolisthesis
89
Instability
- excessive mobility of spondylolisthetic segment
- evaluate with lateral lumbar flex/ext views
- if movement of >4mm translation > unstable
- alternate method is lateral lumbar with axial traction/compression
90
treatment for spondy?
- advise stop causative activity for 6-8 weeks
- bed rest
- stretching hamstrings & strengthening abdominal/back muscles
- use of non-narcotic analgesics
- boston brace
- surgery
91
What is this?
Osteosarcoma - osteoid matrix
92
What is this?
Osteosarcoma - osteoid matrix
93
What is this?
Osteoblastic Lesion
94
What is this?
Osteolytic - enchondroma
95
What is this?
Osteolytic - enchondroma
96
What is this?
Chondroblastoma
97
What is this?
Chondrosarcoma
98
What is this?
Fibrous Dysplasia Lesion
99
What is this?
Fibrous Dysplasia Lesion
100
Are geographic slow growing or fast growing & most aggressive or least aggressive?
slow growing & least aggressive
101
is a moth eatern pattern slow or fast growing & agressive or not aggressive?
fast growing & aggressive
102
is permeative pattern fast or slow growing, and agressive or not aggressive?
rapid growth, most aggressive
103
3 types of tumor matrix?
osteoid, chondroid, fibrous
104
description of osteoid matrix
cumulus, cloud like, blastic
105
description of chondroid matrix
stippled, punctate, flocculent, popcorn, cauliflower, arcs & rings
106
description of fibrous matrix?
ground glass, smoky
107
Describe an osteoma?
1. benign harmartoma
2. MC in skull & facial bones
3. generally asymptomatic
4. treatment not nessassary, may interfere with drainage of sinus
108
gardener's syndrome
- multiple abnormal growths (multiple osteoma's)
- should have colon exam
109
What tumour fits this description:
- benign heamatoma
- asymptomatic
- compact lamella bone
Enostoma
110
What tumour fits this description:
- multiple bony islands
- typically found near joints
osteopoikilosis
111
Which tumour fits this description:
- MC in male, 10yr - 25yr
- have nightpain
- lesion composed of central fibrocasular core of osteoid material
- sorrounding core is reactive bone formation
- MC in long bones
Osteoid Osteoma
112
If intramedullary osteoid osteoma, what features does it display?
- intracapsular
- less sclerosis & less periosteal reaction
- less symptomatic
113
what is the treatment for osteoid osteomas & what are some complications?
1. ablation
2. surgery
- lesion will recur if nidus isn't completely removed & growth may accelerate
114
Which tumour is most fitting to this description:
- MC male, 10yr - 20yr
- similar symptoms to osteoid osteoma but less severe
- typically lucent, expansile lesion with cortical thinning
- effects T/L junction, C/S, long bone
- more common in diaphysis
Osteoblastoma
115
How do you treat osteoblastoma?
- surgical excision for small lesions
- ~5% recurrence rate
116
Malignant meaning?
a tumour having properties of malignancy that can invade & destroy nearby tissue
117
Metastisis meaning?
the process by which cancer spreads from primary tumour to distant body locations
118
sarcoma meaning?
- malignant tumour arises from transformed cells derived from embryonic mesoderm
- ie. malignant tumours made out of cancerose bone, cartilage, fat, muscle & vascular tissue
119
Carcinoma meaning?
- malignant tumour originating from epitheal cells (breats, lung, colon)
120
what tumour fits this description:
- 2nd MC malignancy of bone
- MC 10yr - 25yr Male
- MC location > 1. Femur, 2. Tib/Fib, 3. Humerus
- Metaphysis
- Painful swelling at lesion & decreased ROM
Osteosarcoma
121
What tumour fits the following radiographic appearance:
- long zone of transition
- cortical disruption
- soft tissue extension
- periosteal new bone is irregular
- soft tissue mass
osteosarcoma
122
what is the metastasis of osetosarcoma?
- common to lungs (causes cannoball metastases)
- 50% to bone, 12% to kidney
123
treatment of osteosarcoma?
- amputation
124
what tumour fits this description?
- MC everyone, 10yr - 20yr
- typicaly asymptomatic
- MC in short bones, then long bones
- arises from residual islands of cartilage left in the metaphysis as physis grows away
- short bones> geographic lucency, mildly expanside, no periosteal reaction
- long bones> flocculent CA++
Enchondroma
125
what tumour fits this description?
- multiple version of echondroma
Ollier's Disease
126
what is enchondromatosis + hemangiomas?
Maffucci's Syndrome - soft tissue vascular tumours
127
What tumour fits this description:
- Males <20yrs, open growth plates
- asymptomatic, palpable mass
- occurs in any bone in metaphysis or cortical
- formed from displaced cartialge from physis
- MC benign tumour of bone
osteochondroma
128
epiphyseal version of osetochondroma?
trevor's disease
129
treatment of osteochondroma?
- usually leave alone
- surgery if symptomatic
- prognosis good
130
malignancy is suspected when:
1. lesion enlarges rapidly
2. patient complains of pain with no trauma
3. MRI shows cartilage cap is 2cm+
131
What tumour fits this description?
- epyphyseal
- MC 10yrs - 20yrs
- oval, lobulated
- 50% have CA++
Chondroblastoma
132
What tumour fits this description?
- 10yrs - 30yrs, female & male
- slowly evolving pain & occasional swelling
- MC in tibia
- 1cm - 10cm radiolucent lesion
- eccentric, round or oval geographic lesion
- endosteal scalloping
Chondromyxoid Fibroma
133
What type of tumour:
- MC males 40yr - 60yr
- possible pain or soft tissue prominence with 1-2yrs of symptoms
- ill-defined destructive lesion
- long zone of transition
- cortical destruction
- periosteal reaction
- large soft tissue mass
- malignant
- 3rd MC primary malignancy of bone
conventional chondrosarcoma
134
Treatment for conventional chondrosarcoma?
- amputation
- 10yr survival rate between 30% - 70%
135
What tumour best fits the description:
- slightly expansile
- geographic lytic destruction
- matric CA++
- cortical thinning
- needs surgical excision
- low-grade tumour
- good prognosis
Clear Cell Chondrosarcoma
136
What type of tumour fits this description:
- benign fibrous lesion of bone
- highly cellular, composed of fibroblasts
- MC 4yr - 20yr Males
- most lesions asymptomatic (larger ones may not be)
- spontaneous regression is the usual outcome
- lucent +/- ground glass appearance
- geographic +/- sorrounding sclerosis
- round, oval
- cortical expansion & thinning
- metaphyseal eccentric
- femur, tib
Fibroxanthoma
137
Management for fibroxanthoma?
small lesions - don't touch
large lesions - excision
138
What tumour best fits this description?
- MC 30yr - 50yr
- huge soft tissue component
- 50% occur in knee
- local pain/swelling
- 33% have pathologic fx
- non-specific, lytic destruction of any 3 types
- very little to no sclerosis
- cortical destruction
- usually no tumour matrix
Fibrosarcoma
Any tumur which appears malignant in tibia or femur and is not mets, prime consideration should be given to fibrosarcoma
139
What type of tumour?
- 80% - 95% are benign
- MC 20yr - 40yr, males & females
- females more benign, males more malignant
- intermittent achy nature
- localised swelling & tenderness
- restricted ROM of adjacent joint
- occaionally grows larger & is clinically silent
- MC metaphyseal of long bone
- lytic/soap bubble appearance
- sharply defined ZOT
- growth can involve entire width of bone
GCT
140
Treatment for GCT?
- nitrogen freezing
- bone packing
- curettage
141
What type of tumour fits this description?
- lesion containing thin-walled cystic cavities
- non-neoplastic
- trauma plays a role
- MC 5yrs - 20yrs, female
- 80% in long bones & spine
- sharp decarmacted but thin subperiosteal shell
- multiple fine septae
- loss of cortex
- aggressive appearance
ABC
142
Treatment for ABC?
- curettage with bone chip replacement
- steroid injection
143
What tumour fits this description:
- MC white males, 10yr - 25yr
- non-specific pain with swelling, palpable soft tissue mass
- may mimic infection
- MC longbones, diahphysis/metaphysis
- aggressive, primarily mixed or lytic destruction
- moth eaten/permiative
- cortical disruption
- long zone of transition
- soft tissue extension
- laminate periosteal reaction
- metastisis early to lungs & bone
- periosteal reaction
Ewing's Sarcoma
144
Treatment for Ewing's Sarcoma?
chemo, resection & radiation
145
What tumour fits this description:
- MC 40yr+
- may be asymptomatic
- unexplained weightloss
- pain/pathologic fx
- wakes patient
- lytic, blastic or mixed
- seldom see periosteal reaction or soft tissue mass
Osseous Mestatasis
146
Describe Osseous Mestatasis in the spine?
1. Pedicle destruction
2. Vertebral collapse
3. Ivory Vertebrae
147
What tumour fits the description:
- uncontrolled plasma cell & antibody destruction
- plasma cells originate in red bone marrow
- MC males 50yrs - 70yrs
- calcium elevation
- renal disease
- anemia
- bone pain
- osteopenia
- multiple punched out lesions
- rain drop skull
Multiple Myeloma
148
What is the solitary form of multiple myeloma called?
Plasmacytoma
149
What tumour fits the following description?
- MC everyone, >40yrs
- asymptomatic, neuro deficits
- spine 50%, frontal skull 20%
- Spine > corduroy cloth, polka dot
- Skull > spoked-wheel, sunburst
Hemangioma
150
What is the treatment for hemangioma?
- embolisation
- vertbroplasty
- DONT radiate (turns malignant)
151
What lesion fits the following description?
- MC males, 40yrs - 70yrs
- causes bowl & bladder dysfunction, motor weakness, headaches, blurred vision, cranial nerve neuropathy
- sacrum > lytic destruction, indistinct sacral borders, loss of acurate lines, anterior displacement of bowel gas
- skull > lytic destruction, loss of definition of sella turcia
- malignant
Chordoma
152
What tumour fits the following description:
- chronic, tumour like process causing bone enlargment & softening
- Stage 1 > lytic
- Stage 2 > Mixed
- Staged 3 > Sclerotic
- Stage 4 > Malignant Degeneration
- pathologic fxs
Padget's Disease
153
What tumour fits the following description?
- non-inherited bone forming developmental anomoly
- normal marrow & cancellous bone are replaced by immature woven bone & dense fibrous tissue
- most asymptomatic
- skin signs (dark patches)
- can be monostotic or polystotic
- monostotic > radiolucent, trabeculated, ground-glass, well demarcated, thick sceloritc border, endoteal thinning
- polystotic > femur, skull, humerus, tibia
Fibrous Dysplasia
154
2 types of osteonecrosis?
- Medullary Infarct > doesn't involve joint surface
- AVN > involves bone near & in joint
155
5 stages of Osteonecrosis
1. Pre-collapse > normal or mild osteopenia
2. Repair Phases > mottled, patchy sclerosis +/- internal lucency
3. Collapse of subarticular surface > subchondral crescent sign
4. Frank Articular Collapse > epiphysis becomes flattened or step defect
5. Post collapse > fragmentation
155
Causes of Osteonecrosis
Pancreatitis
Lupus
Alchoholism
Steroid therapy
Trauma
Idiopathic
Caisson's disease
Radiation
RA
Amyloid
Gaucher's disease
Sickel Cell Diease
156
Decribe this condition:
- MC in non-black, males, 4yrs - 8yrs
- 90% unilateral
- obliteration of lateral arterial group of arteries
- Early > joint effusion, symmetrical femoral head size, radiolucency of proximal metaphysis
- Later > fragmentation, flattening, deformity, OA
Legge-Calve-Perthes Disease
157
What is the necrosis of the scaphoid called?
Preiser's Disease
158
What is necrosis of the lunate called?
Keinblock's Disease
159
What is freiberg's infarction?
necrosis of the 2nd & 3rd metatarsal heads
160
What is a dense, fragmented tarsal navicular called?
Kohler's Disease (not true necrosis)
161
What is AVN of navicular called? (comma shaped deformity)
Muller Weis Syndrome
162
What is AVN of the humeral head called?
Haas Disease
163
What is a delayed collapse of the vertebral body due to avascularity called?
Kummel Disease
164
What disease do the following features fit:
- when under low pressure, RBC distort & become sickle shaped
Sickle cell anemia
165
What disease do the following clinical and radiographic findings represent:
- weakness & pallor
- jaundice
- acute bone pain
- salmonella infection
- osteopenia
- growth disturbance
- diffuse scelrosis
- hair on end appearance
- spinal H shaped vertebrae
Sickle Cell Anemia
166
What disease do the following symptoms show in?
- hereditary disorder of hemoglobin synthesis
- MC in mediterraen descent
- delayed growth
- overgrowth of maxillary bone
- forward teeth
- wide eyes
- marrow hyperplasia
- AVN, chondrocalcinosis, hemochomatosis, hepatospenmegaly
Cooley's Anemia
167
What disease meets the following characteristics:
- coagulation disorder by deficiency of clotting factors
- females carry, manifests in men
- bleeding tendence
- hemorrhage in all body tissues, cavities, bone & joints
- Intraosseious hemmorahage that results in destructive & expansile lesions
- Articular hemmorahage produces acute & chronic hemarthrosis
- soft tissue swelling
- osteoporosis
- expansile lesions
- joint efusions
- accelerated growth at epiphysis
Haemophilia
168
What disease fits this description?
- etiology is unknown
- congenital endplate weakness
- begins before 8yrs old, discovered in teens
- MC in males
- back pain
- increased kyphosis
- anterior vertebral body wedging
- fragmentation of vertebral endplates
Schevermann’s Kyphosis
169
What disease fits the following description:
- autosomal dominant trait that causes inadequate bone formation
- short limbs contrast normal trunk length
- anteior wedged - bullet nosed vertebrae at T/L junction
- stenotic spinal canal
Achondroplasia
170
What is a congenital fusion of cervical vertebrae called?
Kippel-Feil Syndrome
171
What disease do the following symptoms fit:
- multisystem connective tissue disease
- defective collagen production
- excess joint laxity cause recurrent dislocations
- severe scoliosis & kyphosis
- heart wall hole
Marfan's Syndrome
172
Describe the radiographic changes of Down Syndrome?
- Ossification of manubrium
- Aplasia of 12th rib
- High lumbar vertebral bodies
- Changes in skeletal maturation
- Atlantoaxial instability
173
Diagnose the following condition:
- osteoporosis
- abnormal detenition
- premature osteoscleoris resulting in deafness
- diffuse decrease in bone density with pencil thin cortices & multiple fxs
- shepards crook deformity
- codfish vertebrae
- intramedullary rods
Osteogenesis Imperfecta
174
Diagnose the following condition:
- hereditary disorder that results from defective osteoclasts
- bones are abnormally dense & disorganised
- generalised osteosclerosis with enchroachment on marrow cavities
- long bones > club shaped osteosclerotic metaphysis, bone-within-bone appearance
- spine > sandwhich vertebrae with dense endplates
Osteopetrosis
175
Explain how CT works
uses x-rays to build cross sectional images of the body as the x-ray rotates around patient
176
What are indications for CT?
- fractures
- trauma (chest, abdomen, head)
- spine (cord impingment)
- neoplasms
- post traumatic calcified soft tissue lesion
- vascular conditions
177
Views of CT:
- sagittal (spinous process, facets)
- coronal (facets, vertebral body heights, TVP, sacrum & SI joints)
- axial (posteior ribs, VB - pedicles, SP, sacrum, SI joint)
- soft tissue window (spinal canal, disc, organ, soft tissue calcifications)
178
Advantages of MRI
- non-invasive
- no radiation
- soft tissue contrast
- multiplanar capabilities
- can visualise active parts of brain
179
Disadvantages of MRI
- expensive
- longer to aquire
- not safe for metal implants
180
What is a T1 weighted image?
Fat enhancing image used for anatomy & contrast
181
What is a T2 weighted image?
Water enhancing image with some fat enhancement that makes discs & inflammation brighter
182
Contraindications for MRI
- patient over 130kgs
- claustrophobia
- aneurysn clips
- foreign bodies
- shrapenel
- implants
- early pregnancy
183
Indications for MRI
- congenital abnormalities (scoliosis, tethered cord syndrome etc.)
- trauma (retropulsed fragment, spinal cord injury etc.)
- Infection (osteomylitis, discitis etc.)
- osseous vertebral tumours
- spinal cord tumours
- discs
- DJD
- Spinal & lateral recess stenosis
- postoperative spine
- hip pathology
- knee pathology
- shoulder pathology
184
What does the ABCDEF stand for when examing chest x-rays?
Airways
Bones
Cardiac
Diaphram
Effusions
Fields
185
What factors affect technical quality?
- rotation
- inadequate inspiration
- suboptimal penetration
186
Describe how rotation can affect a patient?
- crooked patient can mean costophrenic angles are not visible
- gastric bubble may not be visible
- should be able to see top of lung apex abov clavicle
- should be able to see each spinous process closer to clavicle on side that is rotated forward
187
How can inspiration affect an x-ray?
- on full inspiration 9-10 posteior ribs visible or 6-7 anteiorly
- inadequate inspiration makes
> lung volumes appear falsely low
> lung markings appear falsely prominent
> false appearance of pulmonary edema
> cardiac silhouette & mediastinum may appear falsely enlarged
188
How can suboptimal penetration affect x-ray?
- exposure if considered good when outlines of vertebral bodies are barely visible
189
What abnormalities deviate the trachea to the affected side vs away from the affected side?
Away: pneumothorax, pleural effusion, large mass
To: collapsed lung, pneumectomy, pleural fibrosis, pulmonary fibrosis
190
What is the following condition called?
- focal deformation
- superior surface
> osteogenesis imperfect
> connective tissue disease
> local pressure
> hyperparathyroidism
- inferior surface
> cortication of the aorta
> subclavian or SVC obstruction
Rib Notching
191
What causes air within the subcutaneous tissue?
Pneumothorax, penetrating chest wall trauma, gas gangrene
192
What is cardiomegaly?
abnormally large heart if cardiothoracic ration 50% on PA caused by any sided heart failure
193
What are the signs and cause of right ventricular enlargements?
- filling of retrosternal space on lateral view
- causes> pulmonary hypertension or pulmonary valve disease
193
What are the signs & cause of left atrial enlargment?
- splaying of carinal angle >90*
- double density sign
- cause left sided heart failure
194
what are the cause & findings of pericardial effusion?
- enlarged cardiac silhouette, watter bottle sign, oreo cookie sign
- Acute > trauma, viral pericarditis, latrogenic
- Chronic > malignancy, renal failure, hypothyroidism, TB
195
What is it called when the heart faces the wrong way?
Dextrocardia
196
What are the abnormalities of the mediastinum?
- widened
- masses
197
what causes hilar enlargment?
- primary lung disease
- lymphoma
- mets
- TB
- viruses
- silicosis
- pulmonary hypertension
198
what is a pneumothorax?
- air in the pleurall space sorrounding the lung
- size of PNT is based on thickness of rim of air around the lung <2cm = small, >2cm = large
199
what is a pleural effusion?
- fluid in pleural space
- characteristics - unilateral vs. bilateral, size, free flowing vs. loculated
- seen on L before PA
200
what is subpulmonic effusion?
- fluid accumulation between lung base & the diaphram which doesn't track up to the pleura & doesn't blunt costophrenic angle
201
what does a subpulmonic effusion look like on radiograph?
- diaphragm appears to peak more lateral & horizontal than normal
- on left: abnormally large distance between gastric bubble & lung base
- on right: abnormally high horiztonal fissure
202
what is a pseudotumour?
- fluid colleciton trapped within a fissure which looks like lung mass
- suspiscion is due to location of fissure & smooth contour
203
causes of pleural effusions:
- heart failure
- hepatic hydrothorax
- pneumonia
- malignancy
- pleural TB
- pancreatitis
- sarcoidosis
204
what causes pleural plaques?
prior asbestos exposure
205
what causes diffuse pleural thickening?
- prior infection
- prior hemothorax
- asbestos or silica exposure
- radiation
- malignancy
206
what causes pleural malignancies?
- metastic disease
- mesothelioma (asbestos exposure)
207
What causes an elevated hemidiaphragm?
- dimished lung volume
- phrenic nerve paralysis
- eventration of diaphragm
- subphrenic abscess
- hepatomegaly
208
What causes pneumoperitoneum and what is it?
- the presence of free air or gas within the peritoneal cavity (life threatening)
- perforated viscus
- post-operative
- trauma
- peritoneal dialysis
209
what is a hiatal hernia?
- occurs when the upper part of the stomach pushes up through a small opening (hiatus) in the diaphragm, the muscle separating the chest and abdomen
210
what is pneumonmediastinum & what causes it?
- a rare condition defined by the presence of free air within the mediastinum (the chest cavity between the lungs), often caused by air leaking from the lungs, airways, or esophagus
- trauma, vomiting, asthma, post neck or chest surgery, barotrauma, esophageal rupture
211
what is pneumopericardium & what causes it?
- a rare, potentially life-threatening condition defined by the presence of air or gas within the pericardial sac (the sac surrounding the heart)
- trauma
- bacterial pericarditis
- post-cardiac surgery
- fistula between pericardium & either lung, stomach or esophagus
212
What is chilaiditi's sign?
- gas seen between liver & diaphragm
- presence of haustral folds suggesting gas at intrcolonic & not pneumoperitoneum
213
what is chilaiditi's syndrome?
- condition of abdominal pain or other symptoms caused by interposed colon
214
What causes reduced lung volumes?
- poor inspirtatory effort
- suboptimally timed exposure
- restrictive lung disease
- subpulmonic effusions
215
What is hyperinflation & what causes it?
- subjective impression that total lung capacity is increased based on number of ribs seen, flattening of diaphragm & increased lucency of lungs
- causes > COPD, asthma
216
What causes aveolar opacities?
- due to fluid accumulation within aveoli & terminal bronchioles
- fluid may be oedema, pus or blood
- opacities are hazy with poorly defined margins but respect lobar boundaries
217
What causes cardiogenic pulmonary edema?
- any cause of congestive heart failure
218
what causes non-cardiogenic pulmonary edema?
- acute lung injury
- acute respiratory distress syndrome
219
How do you differentiate cardiogenic from non-cardiogenic oedema?
- air bronchograms
- peribranchial cuffing
- kerley lines
- bat wing's pattern
220
What is an air bronchogram?
- bronchi are not usually visible on x-ray
- opacification of alveoli adjacent to bronchi results in dark air-filled bronchi becoming identifiable
221
what is peribranchial cuffing?
- bronchi are not usually visible on x-ray
- oedema can accumulate around bronchi making bronchial walls thick
- appears like a ring when seen in cross section, and like tram tracks when seen longitundinally
222
what are Kerley A & B lines?
A - diagonal unbranching lines, 2cm-6cm long extening from hilum
- represent channels between peripheral & central lymphatics
B - faint, thin horizontal lines, 1-2cm at the lung periphery, usually at the bases
- represent interlobular septa
223
What is cephalisation?
- increased visibility of pulmorary vassels at lung apices compared to bases
- suggest increased left atrial
224
What is bat wings pattern and what is it seen in?
- bilateral perihilar concentration of opacification
- seen in cardiogenic pulmonary oedema & pneumonia
225
Features of Cardiogenic Pulmonary Edema?
- cardiac size enlarged
- regional distribution of opacities relatively homogenous
- air bronchograms uncommon
- peribronchial cuffing common
- concurrent pleural effusions & kerley B lines
226
Features of non-cardiogenic pulmonary edema?
- cardiac size normal
- regional distribution of opacities relatively normal
- air bronchograms common
- peribronchial cuffing uncommon
- concurrent pleural lines & kerley B lines uncommon
227
Types of Intersitial opacities?
- reticular (too many lines)
- nodular (too many dots)
- reticulonodular (too many lines & dots)
228
compare alveolar opacities to intersitial opacities:
Alveolar:
- lobar or segmental distribution (unless diffuse or batwing)
- hazy margin
- air bronchograms
- rapidly changing
- fluffy, cloudlike
Interstitial:
- do not respect lobar or segmental boundaries
- sharp margin
- no air bronchograms
- changes slowly
- reticular, nodular, reticulonodular
229
What is a silhouette sign?
- loss of normally visible border of the intrathoracic structure caused by an adjacent pulmonary density
230
Causes of focal opacities?
- infections
- malignancy
- pulmonary infarction
- pulmonary hemorrhage
- vasculitis
- eosinophilic pneumonia
231
What is a spine sign?
an abnormal increase in opacification overlying the spine while moving S - I on laterla view, suggestive of lower lobe opacities
232
Radiographic features of lobar pneumonia:
- homogenous consolidation
- air bronchograms
- sharp borders corresponding to fissures
233
Radiographic features of segmental pneumonia:
- patchy opacification
- air bronchobrams uncommon
- vague borders
- frequently bilateral
234
Radiographic features of interstitial pneumonia:
- reticular pattern
- no air bronchogram
- often develops airspace disease
235
Radiographic features of round pneumonia:
- spherical opacification
- easily mistaken for tumor or lung mass
- much more common in children than adults
236
Radiographic features of cavitary pneumonia:
- distinguished by cavities
- may or may not have air-fluid level
237
what are solitary pulmonary nodules:
- defined, well circumscribed, generally round, smaller than 3cm in diameter
- comparison to prior x-ray
- DDX: malignancy
238
What causes multiple pulmonary nodules:
- pulmonary mets
- lyphoma
- fungal pneumonia
- parasites & bacteria
239
How do you spot a pulmonary embolism:
- most PE have no x-ray changes
- if large can see hampton's hump or westermark sign
240
What are the cavitating lung lesions:
- pneumonia
- lung abcess
- TB
- pulmonary mets
- septic pulmonary emboli
- granutamoatosis with polyanitis
- RA
- pneumatocele
241
what is aspergilloma?
- arises when pre-existing lung cavities become colonised with aspergillus
- asymptomatic + cough
242
What is atelectasis?
- loss of lung volume due to collapse of lung tissue
243
Classification of Atelectasis?
1. Obstructive
> airway obstruction followed by gas resorption within non-ventilated alveoli
> tumour, mucus plug, foreign body aspiration
2. Non-obstructive
> Passive: disruption of normal contact between visceral & parietal pleura allows elastic recoil of lung to pull itself inwards (pleural effusion, pneumothorax)
> Compressive: space occupying lesion in thorax physically compresses adjacent lung (tumour, elevated diaphram)
>Adhesive: diminished surfacant results in higher suface tension in the fluid lining alveoli (respiratory distress syndrome, radiation pneuomonitis)
>Critical: severe parenchymal scarring (TB, idiopathic pulmonary fibrosis)
244
what is lobar atelectasis?
- lobar collapse is exteeme form of atelectasis (usually from airway obstruction)
- caused by lung cancer, foreign body aspiration, mucus plugging, external airway compression
245
What should we see on a liver radiograph?
- located RUQ
- interior angle is far lateral & pointed
- should be no gas/air seperation between liver & right hemidiaphragm
246
What do we see with hepatomegaly?
- inferior angle of liver becomes blunt & medial border extends towards midline
- will displace hepatic flexure downward & medial
247
What do we look for with kidneys on x-ray?
- kidney length should be no more than 3.5 vertebral bodies
- dromedary hump > seen on left kidney caused by spleen pushing into side
248
Where do we find adrenal glands on x-ray?
bilateral, above kidneys
249
What do we see with the gallbladder on x-ray?
Not visible unless contains calcifications
250
What is the flank stripe and what does it show?
- fat stripe
- outlines margin of abdomen lateral to ascending & descending colon
- line is often obliterated in inflammatory conditions of abdomen
251
What do we look for with the spleen on x-ray
- only lower pole casts shadow
- vertical height 8cm - 12cm
- when spleen enlarges it will travel anterior & inferior
252
What do we look for bladder on x-ray?
Full: dome shaped water density
Empty: concavity
253
What should the retrorectal space be in cm:
1.5cm - 2cm
254
How wide should the large bowel & small bowel be?
LB: 6cm
SB: 3cm
255
Pathologic patterns seen on contrast studies:
1. polypoid lesion
2. mucosal masses
3. ulceration
4. diverticula
5. extrinsic compression
256
What are conduit calcifications:
- conduit channels or tubular structures through which fluids are conducted
- confined only to tubular walls
- flecks or streak like calcifications
257
Describe Abdominal Aorta Atherosclerosis:
- occurs due to smoking, diabetes, hypertension
- more common below renal arteries
- distribution of calcination is irregular & patchy
258
Describe abdominal aortic aneurysm:
- caused by atherosclerosis
- MC males 60yr - 80yr
- Asymptomatic, pain in low back or back of leg, abdominal mass or pain
o 3cm – 3.5cm = dilation
o 3.5cm – 4.5cm = aneurysm
o 4.5cm – 6cm = surgical consultation
o Over 7cm = immediate consultation
259
Describe calcification of iliac arteries:
- 2nd MC site for AAC
- well defined paralell lines of radiodensity
260
Describe condiut wall calficiations:
- vas deferns
- MC in diabetics
- bilateral, curved and paralleling pubic rami
261
What is a concretion:
- stone or calculus
- calcified mass formed in tubular or hollow structure
- sharp, clearly defined external margin
262
What are appendicoliths:
- concretions frequently associated with appendicitis in children
- RLQ
263
What are cholethisasis?
- Stones blocking bile duct or cystic duct
- MC in elderly, obese & women
- RUQ
264
What are pancreatic calculi?
- chronic pancreatitis due to alcholism
- multiple tiny dense discrete opacities that cross midline
265
What are phleboliths:
- stones common in pelvis
- can confuse with urinary tract stone
266
Where are prostatic calculi stones located?
- multiple & clustered behind pubic symphysis
- often asymptomatic
267
What is an injection granuloma?
- results from subcutaneous fat necrosis secondary to injection of pharmaceuticals
- frequently seen in ST around hip
268
What is a cystic calcification:
- calcium deposition in the wall of abnormal fluid filled structure
- smooth, curvilinear rim of opacity
- MC > porcelian gallbladder, echinococcal cysts, aneurysms
269
What are echinococcal cysts?
- hydatid cysts
- mother cyst generally has complete oval calcification with multiple daughter cysts
270
What should you do if you see an ovarian cyst?
- refer to specialist as any cystic calcification in this area must be treated as malignancy until proven otherwise
271
What is a leiomyoma?
- uterine fibroids are MC calcified mass of female genital tract
- mottled, nodular, stippled
- occasionally extends out of pelvis
272
What is a cystic teratoma?
- MC ovarian mass
- benign
- teeth like calcification
273
What is functional ileus?
- 1+ loops of bowel lose their ability to propogate the peristaltic waves of bowel
274
What is localised ileus?
- 1 or 2 persistently dialated loops of small bowel
- adjacent organ inflammation
- irritation causes these loops to lose their normal function
- some air can pass through
275
What is generalised adynamic ileus?
- entire bowel is apweistaltic (air filled & dialted)
- swallowed air fills lumen
- caused by operation or electrolyte imbalance
276
Describe a mechanical obstruction:
- organic & obstruction lesion preventing passage of content past point in either small or large bowel
- bowel dilates proximally to point of obstruction from swallowed air & digestive
- air & content forward of the point may be completely elimated so that no air remains in rectum
277
Causes of Small and Large Bowel Obstruction:
SBO:
> postsurgical adhesions
> hernia
> intussusception
> IBD
> malignancy
> gallstone ileus
LBO:
> tumour
> hernia
> volvulus
> diverticulitis
> intussusception
278
Findings of SBO:
- air density over inguinal region
- more loops = more distal the obstruction
279
Findings of LBO:
- colon loops disproportionately dilated compared to SB
- coffee bean sign
280
What is pneumoperitoneum?
- due to perforated gas-filled viscus (ulcer, recent surgery)
- usually seen under diaphragm
281
3 types of interstial opacities - reticular, nodular and reticulonodular
282
abdominal aortic aneurysm
283
abdominal aortic aneurysm
284
abdominal aortic aneurysm
285
abdominal aortic aneurysm
286
ABC
287
ABC
288
ABC
289
Abdominal Aorta Atherosclerosis
290
Achondroplasia
291
Achondroplasia
292
Achondroplasia
293
air bronchogram
294
air bronchogram
295
Air within subcutanous tissue
296
alveolar opacities
297
ASD closure device
298
aspergilloma
299
Bat wings pattern
300
Biventricular pacemaker
301
bladder stones or urinary tract calculi
302
bladder
303
bowel gas displacement
304
bowel gas displacement
305
breast implants
306
bronchopneumonia
307
cardiomegaly
308
cephalisation
309
chest tube
310
chilatiditi's sign
311
cholethisasis
312
chondroblastoma
313
chondroblastoma
314
Chondromyxoid Fibroma
315
Chondromyxoid Fibroma
316
chordoma
317
chordoma
318
chordoma
319
chordoma
320
clear cell chondrosarcoma
321
clear cell chondrosarcoma
322
concretion
323
Conduit wall calcifications
324
Conduit wall calcifications
325
Conduit wall calcifications
326
conventional central line (jugular)
327
conventional chondrosarcoma
328
conventional chondrosarcoma
329
Cooley's Anaemia
330
Cooley's Anaemia
331
cystic calcification
332
cystic teratoma
333
deep brain stimulator
334
deep sulcus sign - pneumothorax
335
diffuse pleural thickening - pleural carcinomatosis
336
diffuse pleural thickening - pleural TB
337
elevated hemidiaphragm
338
endotracheal tube
339
enostoma
340
enostoma
341
ewing sarcoma
342
ewing sarcoma
343
ewing sarcoma
344
ewing sarcoma
345
fibrosarcoma
346
fibrosarcoma
347
fibrosarcoma
348
fibroxanthoma
349
fibroxanthoma
350
flank stripes
351
free flowing & loculated pleural effusion
352
free flowing & loculated pleural effusion
353
freiberg's infarction
354
gall bladder calcification
355
gardener's syndrome
356
gastric bubble and/or intestinal gas
357
GCT
358
GCT
359
GCT
360
GCT
361
generalised adynamic ileus
362
Granutamoatosis with polyangiitis
363
Haas
364
Haemophellia
365
Haemophellia
366
name areas of heart
367
hemangioma
368
hemangioma
369
hemangioma
370
hemangioma
371
hemangioma
372
hemangioma
373
hemangioma
374
hepatic hydatid cyst
375
Hepatomegaly
376
hiatal hernia
377
hiatal hernia
378
hilar enlargment - pulmonary hypertension
379
hilar enlargment - saccular aortic aneurysm
380
hilar enlargment - sarcoidosis
381
hyperinflation
382
ICD
383
illiac artery calcification
384
implantable loop recorder
385
injection granuloma
386
inspiratory film & expiratory film pneumothorax
387
intramedullary osteoid osteoma
388
intramural gas
389
juxtaphrenic peak - lobar atelectasis
390
Keinblocks disease
391
Kerley A and B lines 2
392
kidneys & renal calculus
393
Kerley A and B lines
394
Kippel Feil Syndrome
395
Kippel Feil Syndrome
396
397
Kummel Disease
398
laminated periosteal response
399
large bowel colon
400
lateral decubitus position
401
Lower Bowel Obstruction
402
Lower Bowel Obstruction
403
Lower Bowel Obstruction
404
LCP disease
405
lead fx
406
Left - massive left pleural effusion Right - total collapse of left lung
407
left atrial enlargment
408
left lobar pneumonia
409
left - normal
right - lower lobe opacity - spine sign
410
left ventricular
411
leiomyoma
412
Linear atelectasis
413
liver
414
LLL collapse
415
lobar anatomy - horizontal fissure top, oblique fissure bottom
416
lobar anatomy - horizontal fissure top, oblique fissure bottom
417
localised ileus
418
localised ileus
419
long bone enchondroma
420
LUL collapse
421
lung abcess
422
lung cancer with hilar node metastasis
423
424
maffucci's syndrome
425
marfan's syndrome
426
marfan's syndrome
427
mechanical obstruction
428
mediastinal masses - aortic aneurysms
429
mediastinal masses - benign thymus tumour
430
mediastinal masses - lymphoma
431
mediastinal masses - multinodular goitre
432
mediastinal masses - pericardial cyst
433
mediastinal masses - schwannoma
434
medistinal masses
435
metastic disease pulmonary nodule
436
Monostotic Fibrous Dysplasia
437
Monostotic Fibrous Dysplasia
438
Muller Weis Syndrome
439
multiple myeloma
440
multiple myeloma
441
multiple myeloma
442
multiple myeloma
443
multiple myeloma
444
multiple pulmonary nodule - amyloidosis
445
multiple pulmonary nodule - echinococcus
446
nasogastric tube
447
necrosis
448
Ollier's disease
449
Osseous Metastasis
450
Osseous Metastasis
451
Osseous Metastasis
452
Osseous Metastasis
453
Osseous Metastasis
454
oreo cookie sign - pericardial effusion
455
osseous metastasis
456
osteoblastoma
457
osteoblastoma
458
osteoblastoma
459
osteochondroma
460
osteochondroma
461
osteochondroma
462
osteochondroma
463
osteochondroma
464
Osteogenesis Imperfecta
465
Osteogenesis Imperfecta
466
Osteogenesis Imperfecta
467
osteoid osteoma
468
osteoid osteoma
469
osteoid osteoma
470
osteoid osteoma
471
osteoid osteoma
472
osteoma
473
osteonecrosis
474
osteopoikilosis
475
osteopoikilosis
476
osteosarcoma
477
osteosarcoma
478
PA catheter
479
Padget's Disease
480
Padget's Disease
481
Padget's Disease
482
Padget's Disease
483
Padget's Disease
484
Padget's Disease
485
pancretic calculi
486
perforation
487
peribranchial cuffing
488
periosteal enchondroma
489
periosteal response
490
phleboliths
491
phleboliths
492
PICC line
493
Plasmacytoma
494
pleural effusion
495
pleural effusion
496
pleural malignancy - mesothelioma
497
pleural plaque - asbestos
498
pleural plaque - asbestos
499
pleural plaque - asbestos
500
Pneumatocele
501
pneumomediastinum
502
Pneumonia
503
pneumopericardiam
504
pneumoperioneum
505
pneumoperitoneum
506
Pneumothorax
507
Polystotic Fibrous Dysplasia
508
Polystotic Fibrous Dysplasia
509
Polystotic Fibrous Dysplasia
510
porcelain gall bladder
511
ports
512
Preiser's Disease
513
prosthetic heart valve
514
prosthetic heart valve
515
pseudotumor
516
PSOAS Shadow
517
Pulmonary Embolism
518
Pulmonary Embolism
519
Pulmonary Embolism
520
pulmonary infarction
521
pulmonary mets
522
pulmonary nodule - invasive aspergillus
523
RA
524
reduced lung volume
525
retrosarcral space
526
rib notching
527
right & left subpulmonic effusion
528
right lobar pneumonia
529
right lower lobe
530
right lung collapse due to pneumothorax
531
right middle lobe
532
right upper lobe
533
right upper lobe
534
right ventricular enlargment
535
RLL collapse
536
RML Collapse
537
round atelectasis
538
round pneumonia
539
RUL collapse
540
small bowel obstruction
541
Sickle Cell Anaemia
542
Sickle Cell Anaemia
543
Schevermann’s Kyphosis
544
Schevermann’s Kyphosis
545
septic pulmonary embolism
546
short bone enchondroma
547
short bone enchondroma
548
silhouette sign
549
single-double chamber pacemaker
550
small bowel
551
soft tissue mass
552
solid periosteal response
553
solitary pulmonary nodules
554
SONK
555
spiculated periosteal response
556
splaying of right & left main bronchi due to mediastinal mass
557
spleen
558
splenic hydatid cyst
559
sternotomy
560
T1 weighted image
561
T2 weighted image
562
TB
563
telemetry electrodes & wires
564
total collapse of left lung due to pneumothorax
565
trachea, left & right bronchus
566
twiddler's syndrome
567
Urinary tract stone
568
water bottle sign of pericardial effusion
DI 2
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