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Diagnostic Imaging > Spine and Thorax cards brainscape > Flashcards

Spine and Thorax cards brainscape Flashcards

1
Q

What does routine routine radiologic eval of C-Spine include?

A

3-5 projections, of AP open-mouth, AP lower C-Spine, Lateral, & sometimes R & L obliques

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2
Q

Which view demonstrates the Atlanto-Axial Joint (C1-C2)?

A

AP open mouth

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3
Q

Which view shows 5 lowest Cervical vertebrae?

A

AP lower C-Spine

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4
Q

Which view shows normal alignment of all 7 cervical vertebrae and facet joints?

A

Lateral

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5
Q

Which view shows 1-side IVF?

A

R & L obliques

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6
Q

What 3 lines in Lat view tell you if Cervical alignment is normal?

A

Ant borders of Vert bodies, Post borders of vert bodies, Juntion of laminae/SPs

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7
Q

What are the borders of basic CT scan & MRI of C-Spine?

A

Base of skull –> T2

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8
Q

When might you limit size of C-Spine CT?

A

Pediatric population, to minimize radiation exposure

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9
Q

ABCDs of C-Spine

A

Alignment/Anatomy, Bone Density/Signal, Canal space/CNS, Disc integrity, & Soft tissues

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10
Q

In severe trauma, ______ is used because (1)______, (2)_______, & (3)_______.

A

CT, because (1) it’s fast, (2) minimal moving of pt, & (3) head/neck imaged at same time as spine

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11
Q

Which view screens for Fx/dislocation of C-Spine in trauma?

A

Cross-table lateral.

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12
Q

What 3 things suggest trauma in PFs?

A

ABN soft tissues, abn vert alignment, abn joint relationships

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13
Q

How do you decide if C-Spine injury is stable or unstable?

A

Is there a threat to spine cord, now or in the future?

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14
Q

What imaging mode decribes injury to ST, nerves, disk, and neuro deficits?

A

MRI

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15
Q

What 2 Fx types are characteristic in C-Spine?

A

Avulsion, Compression

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16
Q

Which C-Spine injury is most unstable/life threatening?

A

Fx-dislocations

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17
Q

What causes isolated unilateral facet joint dislocations?

A

Flexion-rotation force

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18
Q

What causes isolated B facet joint dislocation?

A

Hyperflexion force

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19
Q

______ dislocations are stable injuries.

A

Unilateral dislocatons without anterior translation

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20
Q

______ or _______ dislocations are unstable injuries.

A

Bilateral, or unilateral with anterior translation

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21
Q

______ sprains injure the posterior ligaments & ST.

A

Hyperflexion sprains

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22
Q

______ sprains injure the anterior ligaments & ST.

A

Hyperextension sprains.

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23
Q

What is worst case for cervical sprain?

A

Ligamentous tearing, w/transient joint sublux and compression Fx.

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24
Q

Since acute disc hernations aren’t Dx’d with PFs, how do we catch them?

A

Myelography, or MRI

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25
Q

What view is best for DDD, and what do you look for?

A

Lateral view. Look for decr disk space height.

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26
Q

What techique best shows disk dehydration and degeneration?

A

MRI

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27
Q

What will you see in Lateral views for DJD?

A

Decr facet joint space, sclerosis, osteophytes

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28
Q

Age when most people have some DJD

A

> 60 y/o

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29
Q

What will Cervical DDD cause at vertebral endplates?

A

C-Spine Spondylosis, spurring

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30
Q

Ouch, I have spurring on my Ant/Ant-Lat vertebral bodies & annulus? What’s it called?

A

Spondylosis Deformans. At least your disc height won’t shrink!

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31
Q

Ossification flowing along anterior borders of ≥4 adjacent vertebra

A

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

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32
Q

Will you have DDD or DJD with DISH?

A

No

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33
Q

How often will you see Ossification of Post Long Lig with DISH?

A

50% of the time

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34
Q

Which vertebrae will usually have anomolies?

A

Transitional vertebrae between sections (cerv, thor, lumb, etc.)

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35
Q

What anomoly of upper C-Spine could lead to instability?

A

Diminutive Dens

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36
Q

What 2 views are used for T-Spine?

A

Anteroposterior, Lateral

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37
Q

What does Anteroposterior show you?

A

All 12 vertebrae

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38
Q

What does Lateral show you?

A

All but top 2-3 vertebrae, which are covered by shoulder.

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39
Q

What views are used for the Sternum?

A

Posterior oblique, Lateral

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40
Q

What does posterior oblique show you about the Sternum?

A

Shows the sternum, without the spine getting in the way.

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41
Q

What does Lateral show you about the Sternum?

A

Shows entire sternum in profile

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42
Q

Which are the above diaphragm ribs?

A

T1-T9

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43
Q

Which are the below diaphragm ribs?

A

T8-T12

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44
Q

What does AP or PA show you in the rib department?

A

Posterior or anterior ribs

45
Q

What does Ant-Obl or Post-Obl show, for ribs?

A

Shows axillary ribs

46
Q

What does PA chest view show?

A

Screens for rib-Fx complications, like Pneumothorax or hemothorax.

47
Q

Which injury is most commonly seen on PFs in T-Spine?

A

Anterior vert body compression Fx.

48
Q

What are PF signs of Vert body compression Fx?

A

Step defect -Wedge deformity -Linear zone of impaction -displaced endplates -loss of disk height -paraspinal edema -abdominal ileus

49
Q

Step defect

A

Superior enplate displaced forward, visible on lateral view

50
Q

Wedge deformity

A

Ant vert body collapsed, giving it triangular or trapezoidal appearance from lateral view.

51
Q

Linear zone of impaction

A

White line below superior endplate, shows increased density from acute compression Fx, and later shows callus formation.

52
Q

What does Abdominal Illeus show, and why is it important?

A

It shows excess gases in intestines in AP view. Suggests injury to paraspinal autonomic nerves/ganglia, 2º Fx.

53
Q

What causes T-Spine Fx-dislocation injuries?

A

High-energy hyperflexion forces, such as MVA or falls from great height.

54
Q

When is potential for instability greatest in T-Spine Fx-dislocation?

A

When 2-3 columns are involved.

55
Q

How often is their neuro involvement in Thoracolumbar Fx’s?

A

15-20% of the time.

56
Q

How can you catch rib Fx on subsequent PFs?

A

Callus formation, or displacement of fragments from breathing.

57
Q

What will you see with osteoporotic compression Fx’s?

A

Incr radiolucency, thinning of cortical margins, altered trabecular patterns, wedge deformity, biconcave deformity, vertebra plana deformity, endplate deformity, Schmorl’s nodes

58
Q

Biconcave deformity

A

“Fish” deformity, from gradual endplate depression

59
Q

Vertebra Plana deformity

A

Vertebra becomes flat-shaped

60
Q

Endplate deformity

A

Smooth indentations seen at central enplates

61
Q

Schmorl’s nodes

A

Nucleus materal leaks into fissures in vertebral bodies, and appear as radiolucent “nodes”

62
Q

2 methods used to measure Scoliosis

A

Cobb method, Pedicle method

63
Q

How do we measure skeletal maturity from PF?

A

Compare PF of L hand/wrist to general population. Stage of ossification of vertebral ring apophyses to vert bodies. Risser’s sign: compare iliac apophyses to ileum.

64
Q

How do you spot Tuberculous Osteomyelitis (Pott’s Disease)?

A

Lytic destruction of vertebral bodies, usually under the longitudinal ligaments.

65
Q

S/Sx of Scheuermann’s Disease

A

Common in adolescence. Back aches, thoracic kyphosis, from osteochondrosis in spine.

66
Q

A kid has Scheuermann’s Disease. What will his Lateral PF show?

A

In ≥ 3 adjacent vertebra, irregular bone growth in anterior epiphysis. Also Schmorl’s nodes.

67
Q

Why is CXR done first in CP assessment?

A

1 it separates CV from Pulmonary disease 2 Tells you enough info about pathologies to start Tx 3 It narrows D/Dx enough to direct further imaging studies

68
Q

What does PA view of CXR show you?

A

Lung fields, mediastinum, & bony thorax

69
Q

What stuff can we examine in Mediastinum in PA CXR?

A

Trachea, heart, great vessels, esophagus

70
Q

What does L Lateral CXR show us?

A

Heart, L lung, retrosternal space, Ant & Post Mediastinum, & Thoracic Space

71
Q

What is Cardiothoracic Ratio? What should it be in an adult?

A

Estimate of heart size in PA CXR. Should be < half width of chest.

72
Q

What PA CXR sign ID’s watery lesions in specific lung lobes? How does it appear?

A

Silhouette Sign. Loss of normal heart or diaphragm border with water in adjacent lobe.

73
Q

Which sign in CXR shows ABN fluid in airspaces? How does it work?

A

Air Bronchogram Sign. Airways normally invisible, but they become brigt when they have fluid in them.

74
Q

Why might lung fields be ABN white?

A

Pneumonia, Atelectasis, Pleural Effusion

75
Q

Why might lung fields be ABN black?

A

Pneumothorax, COPD

76
Q

Why might mediastinum be ABN wide?

A

Aortic dissection, Lymphadenopathy

77
Q

Why might heart be ABN shaped?

A

CHF, Mitral valve stenosis

78
Q

What can ECG of heart show us?

A

Blood Flow, Cardiac Output, EF, Valve Fxn, Heart wall motion, & Pericardium

79
Q

What does Ventilation/Perfusion (V/Q) Scan tell us about?

A

Flow of air and blood to all segments of the lungs

80
Q

What does a “Mismatch” in segment in V/Q Scan indicate?

A

Pulmonary Embolism

81
Q

Nuclear Perfusion Studies tell us about _______ during _____ & ____.

A

Perfusion of blood into heart muscle during rest and exercise.

82
Q

Which study can be made into a movie to eval ventricles & EF?

A

Multigated Acquisition (MUGA) Scan

83
Q

What is the best study for PE?

A

CT Pulmonary Angiography

84
Q

What is a non-invasive scan for whole-body vascular evaluation?

A

Magnetic Resonance Angiography (MRA)

85
Q

Which PF view shows all 5 lumbar vert bodies?

A

AP view

86
Q

Which PF view shows alignment of lumbar vertebrae and IV disk spaces?

A

Lateral view

87
Q

Which PF view shows detail of lumbosacral junction?

A

Lateral L5-S1 spot film

88
Q

Which PF view shows lumbar facet joints and the “Scottie Dog” image?

A

R & L obliques

89
Q

Which PF view shows B SI joints at same time?

A

AP Axial

90
Q

Which PF view shows each SI joint individually?

A

R & L obliques

91
Q

_____ is a common injury in the Thoracolumbar area.

A

Compression Fx

92
Q

What is the collar on the Scottie Dog?

A

Bright streak on Pars Interarticularis, on Oblique view. Dx of Spondylolysis

93
Q

How do we tell Fx Spondylolisthesis from Degenerative Spondylolisthesis?

A

Spinous Process Sign

94
Q

3 regions of possible spinal stenosis

A

Central Canal, IVF, Lateral or Subarticular Recess

95
Q

What suggests stenosis on PF?

A

Location of degenerative changes

96
Q

Which technique is best for showing stenosis’ canal encroachment and thecal sac constriction.

A

MRI

97
Q

How does Ant Herniation cause Spondylosis Deformans?

A

Ant Long Lig is elevated, causing growth of osteophytes at anterior & lateral margins.

98
Q

What are 3 directions of IV disk herniations?

A

Anterior, Intravertebral, & Intervertebral

99
Q

Why don’t we image for LBP before 4-6 weeks of onset?

A

Because most pt’s will improve in that time with conservative Tx.

100
Q

Is X-Ray any good for disk herniation?

A

Nope! MRI is good, also Discography

101
Q

At what age is SI PF useful? Why not earlier?

A

Not until age 15-18. because Sacrum not yet fully ossified, so ABN wide joint space is expected.

102
Q

Which side of SI joints do PF’s typically image, and why?

A

Lower halves, because they are synovial.

103
Q

How does Ankylosing Spondylitis appear in early PFs?

A

ABN narrowing of upper SI joints, & squaring off of ant borders of vert bodies.

104
Q

How does Ankylosing Spondylitis appear in later stage PFs?

A

Syndesmophytes bridge vert bodies, appearing as “bamboo spine”

105
Q

Are abnormalities in L-Spine PF’s always cause for concern?

A

No, they are often not clinically signnificant

106
Q

Most common L-Spine abnormality

A

Sacralization of L5

107
Q

Other common abnormalities

A

Spina Bifida Occulta, Facet Tropism

108
Q

Facet Tropism

A

dissimilar facing and/or size of a vertebra’s zygapophyseal joints.

Diagnostic Imaging (6 decks)

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