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Question

Lesser sac

Answer 1

* space b/t stomach and pancreas * communicates with the greater sac (the rest of the peritoneal cavity) through foramen of Winslow

Answer 2

* Serous ascites -10 to +15 HU * Hemoperiteoneum \>30-45 HU

Answer 3

* most common cause - mucocele of the appendix/appendiceal mucocele * other rare causes * mucinous tumors of colon, rectum, stomach, pancreas or urachal tumors * mucinous cystadenocarcinoma * imaging findings * loculated mucinous fluid causes liver scalloping * septations * mottled densities * calcifications

Answer 4

* loculated ascites * abscess * pancreatic pseudocyst * ovarian cyst/cystic tumor * lymphocele (post surgery/trauma) * cystic lymphangioma (congenital) * mesenteric cyst - cystic lymphangiomas of the mesentery * enteric duplication cyst * cystic teratoma

Answer 5

* abdominal aorta bifurcates at the level of iliac crest * common iliac vessels bifurcate at the level of pelvic brim - sacral promontory * external iliac artery * internal iliac artery = hypogastric vessels

Answer 6

* duplicated IVC * drains into the Ieft renal vein * retroaortic or curcumaortic left renal vein * absent intrahepatic segment of IVC * azygos continuation of IVC drains blood into the SVC

Answer 7

* a crescent-shaped area of high attenuation within the wall or within the intraluminal thrombus of AAA * indicative of impending rupture of AAA * similar to intramural hematoma * it is caused by acute blood dissecting into the intraluminal thrombus and dissecting to the outer weak wall of the aneurysm

Answer 8

* a subtype of aortic dissection * hemorrhage within the vasa vasorum, which weakens the media, but does not tear the intima * hyperdense blood within the wall of the aorta on unehanced CT * may progress or resolve

Answer 9

* true IVC thrombus will * associated IVC dilatation (acute) * enhancing IVC wall - provided by the vasa vasorum!

Answer 10

It consists of removal of the distal half of the stomach (antrectomy), the gall bladder and its cystic duct (cholecystectomy), the common bile duct (choledochectomy), the head of the pancreas, duodenum, proximal jejunum, and regional lymph nodes. Reconstruction consists of attaching the pancreas to the jejunum (pancreaticojejunostomy) and attaching the hepatic duct to the jejunum (hepaticojejunostomy) to allow digestive juices and bile respectively to flow into the gastrointestinal tract and attaching the stomach to the jejunum (gastrojejunostomy) to allow food to pass through. Whipple originally used the sequence: bile duct, pancreas and stomach, whereas presently the popular method of reconstruction is pancreas, bile duct and stomach, also known as Child's operation.

Answer 11

* most common in thoracic spine * anterior and lateral bridging/flowing osteophytes * right \> left due to pulsation of the thoracic aorta * Cspine - flowing anterior osteophytes * Lspine - RARELY have bridging osteophytes but commonly have anterior vertebral body osteophytes * Have to be more than \>4 vertebrae

Answer 12

* anterior abdo wall muscles * rectus abdominis within the rectus sheath * flanks * external oblique * internal oblique * transversus abdominis * posterior abdo wall muscles * latissimus dorsi * quadratus lumborum * paraspinal muscles

Answer 13

* incisional hernia * inguinial hernias * direct hernia - medial to inferior epigastric vessels, acquired * indirect hernia - lateral to inferior epigastric vessels, congenital * femoral hernia * paraumbilical hernia * midline * through the linea alba * spigelian hernia * lateral edege of the rectus abdominis * through the linea semilunaris

Answer 14

* benign tumor * skeletally immature patient 10-25y/o * based in epiphysis * most common location - proximal humerus \> prox tibia \> proximal femur * path - nodules of relatively mature cartilaginous tissue surrounded by highly cellular tissue * chromosomal abn - 5 and 8 * imaging appearance * epiphyseal lesion * lytic geographic lesion with central calcifiation - chondroid matrix * MR - low T1, heterogenous T2 (low T2 due to calcifications; high T2 due to non-calcification chondroid matrix); +++ associated reactive marrow edema * may have malignant degeneration * look for associated soft tissue mass * pathologic fracture * Rx * small lesion - RFA * large lesion - surgical curettage and bone graft

Answer 15

Chondroblastoma T2 * heteogeneous T2 signal - calcified and non-calcified chondroid matrix * reactive bone marrow edema

Answer 16

* follow up HCCs --\> always biphasic liver, use early arterial phase to bring out HCC * unknown/indeterminate hepatic lesions --\> always triphasic liver - need to do unenhanced phase to exlude calcifications

Answer 17

may be complicated by * acute diverticulitis * bacterial overgrowth - B12 deficiency

Answer 18

* Vasculitis of the kidneys * necrotizing granulomatous angiitis of medium sized vessels * striated nephrogram

Answer 19

* 2nd most common cause of colonic bleeding - most common cause is diverticulosis * most commonly on the right * cluster of dialted thin walled vessels in the mucosa * imaging * cluster of thin walled arteries during arterial phase * along *_anti-mesenteric_* border of the colon * progressive enhancement during PV and delayed phases * early draining vein, persisting into late venous phase

Answer 20

* right hepatic vein drains into IVC separately * middle and left hepatic veins often form a common trunk * caudate lobe - separate drainage directly into the IVC * via *_short hepatic veins_*

Answer 21

Right portal vein obliquely and Left portal vein transversely

Answer 22

* anterior to caudate lobe - fissure of the ligamentum enosum (remnant of ductus venosus) * posterior to the caudate lobe - IVC * arterial supply - both R and L hepatic arteries * venous drainage - small hepatic veins directly into the IVC * papillary process * a proces of the caudate lobe * may extend towards the lesser sac * may appear separate from the rest of the caudate lobe and simulate a mass or lymph node

Answer 23

Segment IV

Answer 24

* Falciform ligament * contains ligament teres (remnant of umbilical vein) * separates into coronary ligaments - define "bare area" of the liver * separates segments II/III from IVa/IVb * Ligamentum venosum * contains remnant of ductus venosus; in fetal life shunts blood from umbilical vein to IVC * separates caudate lobe from left lobe * Lesser omentum * suspends the lesser curvature of the stomach & duodenal bulb from the inferior surface of the liver, attaching within the fissure of ligamentum venosum * made of * gastrohepatic ligament * heatoduodenal ligament * gastrohepatic ligament * contains gastric artery, coronary vein (portal HTN) * hepatoduodenal ligament * contains portal vein, hepatic artery, and CBD * anterior border of foramen of Winslow opens to lesser sac * Greater omentum * made of * gastrocolic ligament * gastrosplenic ligament * gastrophrenic ligament

Answer 25

* HCC * carcinoid mets * FNH

Answer 26

* arterial - 20-25sec * portal venous - 60-70sec * delayed phase - 10-20 min

Answer 27

* delayed contrast fill-in of a hemangioma * fibrotic tumors such as a cholangiocarcinoma

Answer 28

* Increased hepatic arterial inflow and decreased portal venous inflow for whatever reason * 3rd inflow from systemic vein * portal vein thrombosis * etc * hyperenhancement during arterial phase * normalizes during portal venous phase

Answer 29

* dissemination of neoplasm into the subarachnoid space --\> beneath the arachnoid and pia mater * direct extension - e.g., primary brain tumor * hematogenous dissemination - e.g., leukemia * most common cancers that cause leptomeningeal spread * breast * lung * melanoma

Answer 30

* The most common lesion of the spermatic cord = varicocele * The most common solid tumor of the spermatic cord = lipoma

Answer 31

* MRI features can be variable - solid, solid/cystic, and cystic * T2 susceptibility - due to presence of hemosiderin - therefore called "brown tumor" * very few osteolytic tumors result in T2 shortening * diagnostic of brown tumor

Answer 32

* usually solitary (80%) * multiple PAVMs high associated with HHT * hereditary hemorrhagic telangiectasia/Osler Weber Rendu Syndrome * autosomoal dominant * M=F * epistaxis, telangiectasias, family member with syndrome * treatment criteria * treat \> 2cm to avoid CNS or heart failure * treat any feeding artery \> 3mm * screen family members

Answer 33

* Craniosynostosis (from cranio, cranium; + syn, together; + ostosis relating to bone) is a condition in which one or more of the fibrous sutures in an infant skull prematurely fuses by turning into bone (ossification), thereby changing the growth pattern of the skull * Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures * Craniosynostosis can occur as part of a syndrome or as an isolated defect. Nonsyndromic craniosynostosis is more common and often idiopathic. * Complications associated with craniosynostosis can be severe and include increased intracranial pressure, impaired cerebral blood flow, and inhibition of brain growth. * Moderate to severe cases of craniosynostosis are treated surgically. Techniques include cranial vault reshaping, distraction osteogenesis, and endoscopic craniectomy.

Answer 34

Posterior acetabulum is steeper!

Answer 35

* most common location - Morison's pouch and lower pelvis * may become symptomatic days even years after surgery * asymptomatic dropped stones can be left alone * always have high index of suspicion for radiolucent stones when dealing with recurrent peri-hepatic abscesses in a post-op patient * when symptomatic (e.g., recurrent abscesses), dropped stones must be removed to allow complete recovery

Answer 36

* dropped surgical clips * dropped appendicoliths or gallstones * calcified epiploic appendages * auto-amputated ovary from prior remote ovarian torsion * calcified peritoneal carcinomatosis * calcified lymph nodes

Answer 37

Biliary obstruction * obstruction without dilatation - early / low grade obstruction * dilatation without obstruction - prior obstruction, post-decompression

Answer 38

* with associated mass * HCC * cholangiocarcinoma * metastatic disease * without associated mass * PSC * recurrent pyogenic cholangitis * biliary injury (iatrogenic) * ischemia (post surgical anastamotic ischemia) * HIV cholangiopathy

Answer 39

* most common - lymphoma or GI tract * less common - breast/lung/RCC/HCC

Answer 40

* INTRA-hepatic saccular biliary dilatation * associated with PCKD * "central dot sign" - portal triad structures seen within the saccular dilatation * post gad T1 - enhancing * T2 - flow voids

Answer 41

* I - fusiform dilatation of extrahepatic CBD (most common) * II - true saccular diverticulum of intra- and extra- hepatic biliary ducts * III - choledochocele - focal protrusion of dilated segment of CBD into the duodenum * IV - * V - Caroli disease - cystic/saccular dilatation of intrahepatic biliary ducts

Answer 42

* internal mammary nodes * Rotter's nodes * interpectoral nodes * between the pec major and pec minor muscles * supraclavicular nodes

Answer 43

* rapidly fluctuating mixture of red and blue color * Doppler signals behind a strong specular reflector and may be seen behind coarse calcifications or biopsy clips * e.g. * surgical clips * coarse calcifications * kidney stones

Answer 44

* margins * spiculated * angular * ductal extension * branch pattern * microlobulation * echo-pattern * marked hypoechogenicity * shadowing\*\* * calcification * shape * tall \> wide * architectural distortion * skin thickening

Answer 45

MOST breast cancers are very *_HYPOechoic, but with posterior acoustic shadowing_*!!! Most echogenic masses are benign * lipoma * focal fibrosis * angiolipoma

Answer 46

* glycogen hepatopathy in children * hepatomegaly * hyperattenuation of the liver parenchyma * type I DM

Answer 47

MISME * multiple intracranial schwannomas * meningiomas * ependymomas

Answer 48

Retroperitoneal fibrosis bland soft tissue density encasing...

Answer 49

Coronal projection

Answer 50

* adrenal adenoma (esp lipid-rich adenoma) drop out on FS images * but not all adrenal adenoma (esp lipid-poor adenoma) demonstrate dropout * can be further assessed with CT adrenal protocol to exam its washout

Answer 51

* In-and-Out Phase Images * + dropout --\> microscopic fat * India Ink Artifact * + India Ink --\> macroscopic fat * must have water/fat interface

Answer 52

Laundry Hamper

Answer 53

* breast carcinoma * fat necrosis * surgical scar * radial scar/complex sclerosing lesion

Answer 54

* cysts * fibroadenomas * multiple papillomas * metastases

Answer 55

* calcinosis cutis * elevated lab values * adolase * transaminases * CPK * LDH * heliotrope rash - purple discoloration of the upper eyelids * Gottron papules - scaly plaques erupt over the knucles * proximal muscle inflammation and edema - high signal intensity on T2 and STIR

Answer 56

* pleomorphic, often branching * high grade - camedonecrosis * linear * dot-dash * low grade - cribriform and micropapillary * punctate * granular

Answer 57

Occurrence and development of events by chance in a happy or beneficial way

Answer 58

* screening in high risk patient * life time risk \> 20% * BRCA-1/-2 positive * other genetic syndromes, such as p53 mutations, etc * chest radiation in 10-30y/o * staging * extent of local disease * multifocality of lesions * post treatment followup * e.g., differentiate post lumpectomy changes vs recurrent cancer * axillary metastatic LAD with unknown origin * breast implant evaluation

Answer 59

* Benign * smooth margins * minimal or no enhancement * non-enhancing internal septations * diffuse patchy enhancement * persistent kientic curve * Malignant * spiculated or irregular borders * peripheral or rim enhancement * regional enhancement * ductal enhancement * *_plateau\*\*_* or washout kinetic curves * NOTE: high intensity of T1 is suggestive of benign etiologies --\> hemorrhagic cyst, complicated cyst, fresh fat necrosis, fatty hilum of an intramammary lymph node

Answer 60

* \<25% glandular tissue * fatty * 25-50% * scattered fibroglandular densities * 50-75% * heterogeneously dense * which may obscure detection of small masses * \> 75% * extremely dense * which lowers the sensitivity of mammography

Answer 61

* BI-RADS3 * probably benign (\>98% benign) * recommendations --\> short term follow up * q6/12 x 2 * then q1yr x 3 * BI-RADS4 * suspicious * recommendations --\> biopsy

Answer 62

Good saying "Given ... and ..., consideration should be given to performing a stereotactic-guided mammotome core biopsy to allow for deinitive histologic assessment."

Answer 63

* pharmacologic elevation of estrogen levels * marijuana use * liver disease

Answer 64

* Chronic cystic dilatation of appendiceal lumen by mucin accumulation * Mean age = 50y/o * F:M = 4:1 * Any obstruction lesion can cause mucocele formation * scarring post appendicitis is most common cause * fecalith * appendiceal or cecal carcinoma * endometrioma * carcinoid * polyp * volvulus * Classification based on histology * Focal or diffuse mucosal hyperplasia (simple or retention mucocele) * Mucinous cystadenoma (benign neoplasm, most common type of mucocele) * Mucinous cystadenocarcinoma (less common than cystadenoma, increased risk of perforation) * Pseudomyxoma peritonei: due to rupture (more common with malignant mucocele), peritoneal cavity filled with mucus seedings * CT findings * Simple mucocele and mucinous cystadenoma: well-defined thin walled RLQ cystic mass, with wall or luminal calcification * Mucinous cystadenocarcinoma: solid and cystic components, large irregular mass, thickened enhancing nodular walls, calcifications in solid component * Pseudomyxoma peritonei: loculated ascites, scalloped surface of liver and spleen * MR findings * Mucocele with increased fluid content is T1 hypo and T2 hyper * Mucocele with increased mucin content is T1 and T2 hyper * Prognosis/treatment * Good prognosis for mucocele and cystadenoma * Poor prognosis for cystadenocarcinoma and pseudomyxoma peritonei * Surgical resection (right hemicolectomy)

Answer 65

Hamartoma fibroadenolipoma "breast within a breast"

Answer 66

When the lesion contains fat density - must be benign

Answer 67

The positive biopsy rate that is published as a general guideline of what is appropriate in standard screening practice is about 30%. Thus, 2 of every 3 biopsies yield benign results. This is for a screening population only.

Answer 68

This patient had known ovarian carcinoma, and the biopsy showed metastatic ovarian carcinoma, but the differential diagnosis included a primary breast cancer. The diffuse calcifications are more typical of the psammomatous calcifications seen with ovarian tumors. In fact, when primary breast tumors are the papillary type and have multiple calcifications, the pathologist may include ovarian metastasis in the differential after core biopsy. These are not the typical pop-corn or coarse calcifications one sees with fibroadenomas. Phylloides tumors do not have typical calcifications. Papillomas do occasionally have diffuse calcifications, so this answer is possible, but less likely. The calcifications really make the mass look echogenic on ultrasound. Hyperechogenicity is a benign ultrasound characteristic. It is important to remember that when a mass is suspicious by mammography, one cannot back away from a biopsy because of a benign ultrasound appearance.

Answer 69

Calcified Hickman catheter cuff. The cuff induces a fibrotic response in the subcutaneous tissues, and often remains behind when the catheter is finally removed after treatment. The cuff usually calcifies, and is often seen on mammography as a calcified tubular structure in the superficial tissue of the upper breast.

Answer 70

This appearance of a complex cystic mass with mural nodules is classic for intracystic papillary carcinoma. With rare exceptions, we do not typically see benign breast disease such as cysts and fibroadenomas in men.

Answer 71

Breast MRI and consultation with surgical oncology and medical oncology are recommended. The standard of care in the United States is to treat DCIS as a cancer. MRI demonstrates the extent of disease better than mammography or ultrasound. Surgery can be either lumpectomy to obtain clean margins followed by radiation therapy OR mastectomy without radiation therapy.

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