DR Flashcards
Most common malignancies that mets to the lungs
“BReTh Lung” - breast, renal, thyroid, lung, melanoma and sarcoma
Smoking related lung diseases
RB (respiratory bronchiolitis), RB-ILD, DIP (desquamative interstitial pneumonia), PLCH (pulmonary langerhans cell histiocytosis), emphysema
Branches of the external iliac arteries
Inferior epigastric and deep circumflex iliac arteries
Branches of the posterior internal iliac artery
Iliolumbar artery, lateral sacral artery, superior gluteal artery
“I L S”
Most common cardiac mass
Thrombus (pseudotumor)
Most primary cardiac tumor
Myxoma
Often in the left atrium
Most common primary pediatric cardiac tumors
Rhabdomyoma
Associated with tuberous sclerosis
Majority of malignant cardiac tumors in adults vs peds
Angiosarcoma in adults
Rhabdomyosarcoma in children
Most common cardiac tumor
Metastasis
Most common malignant cardiac tumor
Sarcoma (specifically angiosarcoma)
gas in a vertebral body compression fracture representing osteonecrosis
Kummell disease
What is DISH and what it is associated with
DISH - diffuse idiopathic skeletal hyperostosis; bridging anterior osteophyte formation spanning at least 4 vertebral bodies.
Associated with OPLL (ossification of the posterior longitudinal ligament)
Atlanto-dental interval that indicates Anterior atlantoaxial subluxation is present
ADI >2.5 mm in adults, >5mm in children
What is this finding and what is it associated with?
Symmetric sacroiliitis; IBD and ankylosing spondylitis
Other clinical symptoms ankylosing spondylitis is associated with
Pulmonary fibrosis (upper lobe predominant), aortitis and cardiac conduction defects
What is acro-osteolysis
Resorption of distal portion of the distal phalanges
The four ligaments that make up the lateral collateral ligament
Popliteus tendon
Fibular collateral tendon
Ilitotibial band
Biceps femoris tendon
What sign is this image representing and what injury does it indicate
Double PCL sign - displaced meniscal fragment flips centrally into the intercondylar notch from bucket handle tear of the medial meniscus
What sign is this and what does it indicate
Double delta sign - anteriorly flipped displaced bucket handle fragment of lateral meniscus tear
O’donoghue’s triad
ACL injury with meniscal and MCL tear
What is this lesion called
Pellegrini-stieda lesion - post-traumaic calcification medial to the medial femoral condyle, which may be secondary to MCL avulsion injury
What sign is this image depicting
Boomerang sign is a boomerang-shaped region of cytotoxic edema in the splenium of the corpus callosum typically seen in cytotoxic lesions of the corpus callosum (CLOCCs)
What is the syndrome called when you have difficulty swallowing secondary to compression from aberrant (retroesophageal) right subclavian artery
Dysphagia Lusoria
Fold thickening and “reticulated mucosal pattern” of the esophagus
Esophagitis
Hiatal hernia + high stricture
Barrett’s esophagus
Multiple small esophageal ulcers with edema
Herpes ulcers (herpes has ‘halos’)
Large, flat ulcers with bird-beak stricture stricture at the GE junction
CMV/AIDS
Achalasia + NSIP changes of the lung
Scleroderma
NSIP: non-specific interstitial pneumonia
What is this sign called and what is it associated with
Carman meniscus sign - describes the lenticular shape of barium in cases of large and flat gastric ulcers, in which the inner margin is convex toward the lumen. It usually indicates a MALIGNANT ulcerated neoplasm; in cases of benign gastric ulcers, the inner margin is usually concave toward the lumen
Carney’s triad
rare syndrome defined by the coexistence of three tumors:
- extra-adrenal paraganglioma
- gastric gastrointestinal stromal tumor (GIST)
- pulmonary chondroma (rare benign tumor of the lung)
What is this picture depicting and what is the cause?
Linitis plastica - type of adenocarcinoma with diffuse submucosal infiltration, leading to thickening and rigidity to the stomach wall
Equation for adrenal washout if you have all phases (non-con, portal venous and delayed) vs only portal venous and delayed.
Absolute washout (all phases):
[(HU portal venous phase) - HU delayed)] / [(HU portal venous phase - HU non-enhanced)] x100
>60% washout is suggestive of adrenal adenoma.
Relative washout (only portal venous and delayed):
[(HU portal venous phase) - (HU delayed)] / (HU portal venous phase) x 100
>40% is suggestive of adrenal adenoma.
*caviat: if the adrenal HU is negative on non-contrast, you can forego the calculations and call it adenoma.
What is the most common noncontrast CT finding of a brainstem glioma?
Expansion of the pons (can be subtle on CT, most frequently shows generalized expansion of the pons. Can see mild effacement of CSF spaces surrounding the pons and basilar artery)
MR sequence most sensitive to showing hypoxic ischemic event?
DWI (most sensitive and 1st sequence to be positive within hours of the event)
Most common primary intracranial CNS neoplasm in an adult?
Meningioma.
Glioblastoma multiforme is most common primary neuroepithelial tumor.
Vestibular schwannoma is most common cerebellopontine angle tumor and second most common extraaxial neoplasm in adults.
Pituitary adenoma is most common sellar and parasellar neoplasm.
What is this showing
Spigelian (ventral) hernia - defect in aponeurosis of internal oblique and transverse abdominal muscles
Posterolateral = bochdalek
Anterior = morgagni
Non-smoking young patient with chronic cough and findings of obstructive lobar atelectasis - what is the likely cause?
Endobronchial tumor - most prevalent etiology of benign intraluminal mass is a carcinoid (neuroendocrine tumor)
What are the sentinel nodes that are affected in metastatic disease from the:
1) right testis
2) left testis
1) right testis - aortocaval chain at the level of 2nd lumbar vertebral body
2) left testis - left paraaortic nodal group just below left renal vein
What is vicarious excretion
Contrast excretion from non-renal source such as such as hepatobiliary (liver and gallbladder). If you see gallbladder opacification on radiograph, it usually indicates renal failure.
5 yo pt presenting with HA, ataxia and dizziness for 3 weeks.
Likely diagnosis based on image?
Brainstem glioma- this is pontine glioma which is typically slow growing and have short clinical prodrome prior to diagnosis.
What sign is this and what does it indicate?
Where is the pathology?
Focal hepatic hot spot sign - indicates increased contrast accumulation in the medial segment of the left hepatic lobe caused by superior vena cava obstruction (chest pathology). It signifies diversion of contrast into collaterals through the internal thoracic, superior epigastric, and inferior epigastric veins that communicate with paraumbilical veins around the umbilicus. The superior and inferior veins of Sappey are the chief paraumbilical veins that carry blood to the left lobe of the liver.
What is May Thurner syndrome
chronic compression of the left common iliac vein (CIV) against the lumbar vertebrae by the overlying right common iliac artery (CIA), with or without deep venous thrombosis
What does cavernous transformation of the portal vein mean
Replacement of normal single channel portal vein with numerous tortuous venous channels- this is sequela of portal vein thrombosis.
CT demonstrates: numerous vascular structures in the region of the portal vein, which is not seen. These vessels enhance during portal venous phase but not during arterial phase. What are you worried about?
Cavernous transformation of the portal vein due to portal vein thrombosis
What is May-Thurner syndrome
Chronic compression of left common iliac vein against the lumbar vertebra by the overlying RIGHT common iliac artery (with OR without deep venous thrombosis)
If you see tortuous cardiac vessels, what two pathologies should you think about?
Coronary artery fistula and ALCAPA (anomalous left coronary artery from pulmonary artery)
What does DIPNECH stand for and what is it?
(Findings include peripheral bronchial tumor-lets)
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary disorder that is characterized by diffuse hyperplasia of bronchiolar and bronchial pulmonary neuroendocrine cells.
What is the aortic nipple?
It’s seen in about 10% of PA chest x-rays on the lateral surface of the aortic arch/aortic knob. It represents the left superior intercostal vein.
Most common lung pathology with peribronchovascular cysts and nodules in ppl with Sjõgren’s disease?
Lymphocytic Interstitial Pneumonitis (LIP) (features of autoimmune dz, common airway involvement, CT features of bronchovascular soft tissue thickening, GGO, nodules and cysts)
Is anterior or posterior sternoclavicular joint dislocation more common and which is more serious?
Anterior is more common, posterior is more serious
What is atoll pattern associated with?
Organizing pneumonia, septic emboli, mucormycosis.
angioinvasive aspergillosis has HALO sign: ground glass opacity surrounding a pulmonary nodule or mass representing hemorrhage
What are some of the differentials for the image finding(s)?
Cerebral ring enhancing lesions:
“MAGIC DR” or “MAGICAL DR”
M: metastasis
A: abscess
G: glioblastoma
I: infarct (subacute phase) or inflammatory (neurocysticercosis, tuberculoma)
C: contusion
D: demyelinating disease
R: radiation necrosis or resolving hematoma
magical
A: AIDS-related CNS disease (toxoplasmosis or cryptococcosis)
L: lymphoma (immunocompromised)
Two mechanisms associated with this medial orbit blowout fracture?
Hydraulic mechanism - causes outward fracture of the orbital wall due to increased intraorbital pressure from blow to the eye (more common)
Buckling mechanism - fracture due to direct transmission of impact to the orbital walls.
What sign is being demonstrated on this CT scan and what does it represent?
Empty delta sign - on contrast-enhanced CT or contrast-enhanced T1 MR is due to enhancement of the dura surrounding nonenhancing thrombus .
What is the name of the posterolateral component of the jugular foramen * containing the vagus (CN10) and the spinal accessory (CN11) nerves?
Pars vascularis - The jugular foramen is divided by the jugular spine into a smaller anteromedial component, the pars nervosa (transmits CN9), and a larger posterolateral component, the pars vascularis (transmits CN10 & CN11). The pars vascularis also contains the jugular venous component of the jugular foramen. The term pars vascularis is somewhat of a misnomer in that it contains more nerves than pars nervosa.
50 year old female presents unconscious after cardiac arrest. What is the most likely diagnosis based on these imaging findings?
Hypoxic-ischemic encephalopathy - symmetric involvement of the basal ganglia and cerebral cortex with positive restricted diffusion in a patient with a history of cardiac arrest makes hypoxic-ischemic encephalopathy the correct diagnosis in this case.
Female presents with abdominal pain with normal CT 3 months prior. What is the likely diagnosis?
Small intestinal angioedema - edema into the submucosal space of the bowel wall following protein extravasation from “leaky” vessels. It can affect both the small and large bowel.
Male adult presents with chest pain. What is the diagnosis for these finding?
Pulmonary hypoplasia - hypoplasia of the right lung and decreased diameter of the right pulmonary artery.
What is the underlying etiology for the image findings?
Lithium induced nephropathy - microcalcifications within the microcysts in the renal medulla and cortex but otherwise normal size of the kidneys
Would think of another etiology if the kidneys were atrophic.
Differential for peripheral consolidation or ground glass
- Organizing pneumonia
- Chronic eosinophilic pneumonia (typically upper lobe predominant)
- Pulmonary infarction
1 is a
2 is b
3 is e
4 is d
5 is f
6 is c
What is the sign associated with this image? Typically seen with what diagnosis?
Halo sign - ground glass opacity surrounding a pulmonary nodule or mass
Seen typically with angioinvasive aspergillosis - represents pulmonary infarction surrounding by alveolar hemorrhage
What sign is this image depicting and what diagnosis is it associated with?
Air crescent sign (crescent of air from retraction of infarcted lung) - associated with angioinvasive aspergillosis. Good prognosticator as it indicates patient is in recovery phase.
What is this sign and what does it represent?
Fleishner sign - widening of the pulmonary arteries due to clot.
What sign is this and what structure is it?
Aortic nipple - left superior intercostal vein (LSIV). Can be dilated in setting of obstructed SVC as a collateral vessel.
What sign is this image depicting and what is the associated diagnosis?
“Spoke wheel” sign - focal nodular hyperplasia (FNH)
Depicts internal vascular architecture seen in FNH, with central centrifugal arterial vessels radiating from a central artery toward the periphery of the lesion, resembling a ‘‘spoke wheel’
What sign is this image depicting and what does it represent?
wall-echo-shadow sign ; describes a gallbladder full of multiple stones or one giant stone.
Two parallel echogenic arcs represent gallbladder wall and leading edge of the stone (yellow) with an intervening thin layer of hypoechoic bile (red arrow).
What is this image depicting?
Lymphangitic carcinomatosis - asymmetric, nodular septal thickening of right lung. Represents diffuse spread of neoplasm through the pulmonary lymphatics.
What is this sign and what does it mean
Hampton hump - refers to a dome-shaped, pleural-based opacification in the lung most commonly due to pulmonary embolism and lung infarction
Male with hiv presenting with facial swelling. Diagnosis?
Benign lymphoepithelial lesions (BLL or BLEL)
Patient presenting with facial swelling, diagnosis? Shows heterogeneous enhancement on post con with increased T2 signal
Pleomorphic adenomas of the salivary glands, also known as benign mixed tumors
