Causes of Osteoporosis

• Vascular – anemic states
• Drugs – steroids, heparin
• Dietary Deficiency – scurvy, malnutrition, ca deficiency
• Idiopathic
• Congenital – Osteogenesis Imperfecta
• Toxic = ETOH, chronic liver disease
• Endocrine/metabolic – senile, postmenopausal, pregnancy, DM, hyperparathyroidism, Cushing’s disease, acromegaly, hypogonadism

Causes of Osteopenia

Adults

• Osteoporosis = most common
• Osteomalacia = looser zones
• Hyperparathyroidism = subperiosteal resorption
• Disseminated Multiple Myeloma = focal lytic lesions

Children

• Renal Osteodystrophy
• Liver Dz
• Chronic Anemia
• Leukemia
• Scurvy
• Ricket’s
• Osteogenesis Imperfecta

Diffuse Sclerosis of bone; Osteosclerosis

• Vascular: sickle cell
  
• Neoplasm: metastatic prostate, breast
• Drugs: vit D, fluroide
• Congenital: osteopetrosis, pyknodysostosis
• Endocrine/Metabolic: hyperparathyroidsm, renal osteodystrophy (MC)

Focal or Multifocal Sclerotic Disease

• Vascular
• Infection
• Neoplasm: 1) Primary – osteoma, osteosarcoma; 2) metastatic – prostate, breast
• Congenital: bone island, osteopoikilosis
• Trauma
• Endocrine/Metabolic: Paget’s disease

Upper GI Bleeding

1. Duodenal ulcer
2. Esophageal varices
3. Gastric ulcer
4. Acute hemorrhagic gastritis
5. Esophagitis
6. Mallory-Weiss tear
7. Neoplasm
8. Vascular malformation
9. Vascular enterofistula

Duodenal Masses

• Metastases
• Duodenal adenocarcinoma
• Lymphoma
• Duodenal adenoma
• GISTs (calcifications, smooth surface)
• Lipoma
• Lymphoid hyperplasia
• Gastric Mucosal Prolapse/Heterotopic Gastric Mucosa
• Brunner Gland Hyperplasia/Adenoma
• Ectopic pancreas
• Extrinsic Mass
• Pancreatic adenocarcinoma: reverse 3 or epsilon sign on UGI

Benign vs Malignant Stomach Ulcers

Benign

• Intact mucosa to edge of ulcer
• Smooth mound with tapering edges
• Collar with overhang
• Projects beyond expected lumen
• Folds extend into crater
• Depth > Width
• Sharp Contour
• Hampton line

Malignant

• Location within lumen of stomach
• Eccentric
• Width > Depth
• Nodular, rolled, irregular, or shouldered edges
• Carmen meniscus sign = crecent on lesser curvature with surrounding nodular tumor

Ulcers can bleed, perforate, obstruct, and form fistulas (w/ pancreas, omentum, biliary, liver, colon)

Multiple Esophageal Mucosal Masses

Nonneoplastic

• Candida Esophagitis
• Reflux Esophagitis
• Glycogenic Acanthosis
• Crohn’s Disease
• Pemphigoid and Epidermolysis Bullosa
• Hairy Esophagus

Neoplastic

• Papillomatosis
• Superficial Spreading Carcinoma
• Cowden’s Syndrome
• Leukoplakia

Intussusception in Adults

• LIPOMA
• malignant tumor
• Meckel diverticulum
• Lymphoma
• Mesenteric nodes
• Foreign body

Hernia Types

• Direct Inguinal: medial to inferior epigastric artery
• Indirect Inguinal: lateral to inferior epigastric artery
• Pantaloon: both direct and indirect
• Femoral
• Cooper’s hernia: femoral hernia with 2 sacs, first in femoral canal, second through defect in superficial fascia
• Epigastric: through linea alba above umbilicus
• Umbilicus
• Littre’s hernia: Meckel’s diverticulum
• Richter’s hernia: strangulated hernia invloving 1 sidewall of bowel
• Hiatal hernia: sliding > nonsliding or paraesophageal, mixed or compound
• Spigelian’s hernia: lateral ventral wall
• Velpeau hernia: hernia in groin in front of femoral blood vessels
• Diastasis Recti: separation of L/R rectus abdominus muscles

Misty Mesentery

• Inflammation
• Mesenteric Edema
• Lymphedema
• Hemorrhage or Trauma
• Non-Hodgkin’s Lymphoma
• Idiopathic

Acute Abdomen Differential

• Appendicitis
• Acute cholecystitis
• Acute pancreatitis
• Acute diverticulitis
• Acute ulcerative colitis
• Pseudomembranous colitis
• Amebiasis
• Acute intestinal ischemia
• Peritonitis
• Intraperitoneal abscess
• Retroperitoneal abscess
• Bowel obstruction
• Urinary Tract Infection
• Urinary Tract Obstruction
• Pelvic inflammatory disease

Differential Diagnostic HRCT Features in Interstitial Lung Disease

Interlobular Septal Lines	Interstitial edema Lymphangitis carcinomatosis Sarcoidosis Idiopathic pulmonary fibrosis
Intralobular lines	IPF Asbestosis Alveolar proteinosis Hypersensiticity pneumonitis (chronic)
Thickened fissures	Pulmonary edema Sarcoidosis Lymphangitis carcinomatosis
Peribronchovascular interstitial thickening	Pulmonary edema Sarcoidosis Lymphangitis carcinomatosis
Centrilobular nodules	Hypersensitivity pneumonitis BOOP/COP Respiratory bronchiolitis-associated interstitial lung disease
Subpleural lines	Asbestosis IPF
Parenchymal bands	Asbestosis IPF Sarcoidosis
Honeycombing	IPF Asbestosis Hypersensitivity pneumoitis Sarcoidosis
Thin-walled cysts	Eosinophlic granuloma Lympangioleiomyomatosis Tuberous sclerosis Neurofibromatosis (pneumatocele)
Irregular lung interfaces	Pulmonary edema IPF Sarcoidosis
Micronodules, random	Miliary TB or histoplasmosis Hematogenous metases Silicosis/coal worker’s pneumoconiosis EG
Micronodules, perilymphatic distribution	Sarcoidosis
Ground glass opacities	UIP Desquamatic interstitial pneumonia Acute intersitial pneumonia Hypersensitivity pneumonitis BOOP/COP RB-ILD Hemorrhage Pneumocystis jiroveci pneumonia CMV Alveolar proteinosis
Architectural distortion	IPF/UIP
Traction bronchiectasis	Sarcoidosis SIlicosis/CWP
Conglomerate mass	Sarcoidosis Silicosis CWP Radiation fibrosis
Consolidation	BOOP/COP Sarcoidosis Acute Interstitial Pneumonia UIP

Thin Walled Cysts in the chest

• Eosinophilic granuloma
• Lymphangioleiomyomatosis
• Tuberous sclerosis
  
• Neurofibromatosis

Abscess vs Empyema, Chest

• Abscess: Thick, irregular wall; round shape, narrow contact with chest wall
• Empyema: Thin, uniform wall; lenticular shape, broad contact with chest wall, split pleura sign

Types of Atelectasis

• Obstructive = bronchogenic carcinoma
• Passive = pleural effusion, pneumothorax
• Compressive = bulla
• Cicatricial = post-primary TB, radiation fibrosis
• Adhesive = respiratory distress syndrome of the newborn

Diffuse Confluent Airspace Opacities Differential

• pulmonary edema
• pneumonia
• hemorrhage
• neoplasm
• alveolar proteinosis

ATS Lymph Node Stations

Lymph nodes measured by short axis.

NODE GROUP	STATION	UPPER LIMIT (mm)
Pretracheal	2R (right upper)	7
	2L (left upper)	7
	4R (right lower)	9
	4L (left upper)	9
Aorticopulmonary	5	9
Prevascular	6	8
Subcarinal	7	12
Paraesophageal	8	8
Inferior Pulmonary Ligament	9
Tracheobronchial	10L
Peribronchial	10R
Intrapulmonary	11
Internal Mammary	–
Paracardiac	14
Paravertebral	–

Lymphadenopathy: inflammatory, lymphoma or leukemia, metastasis, Sarcoidosis, Castleman’s Disease

L Spine MRI Dictation

Indication: [x].

Technique: An MRI of the lumbar spine was performed utilizing the following sequences: [x]

Comparison: [x]

Findings: Normal lumbar lordosis is preserved. Lumbar vertebral heights and alignment are maintained. No expansile or destructive osseous lesion is seen. No focal disk herniation, spinal canal or neural foramina stenosis is identified. The conus and cauda equina appear normal; the conus terminates at the [x] level. No epidural mass or collection is seen.

Impression: Normal lumbar spine MRI.

MRA Neck Dictation

Indication: [x].

Technique: An MRA of the neck was performed using 2D and 3D time-of-flight techniques without the use of gadolinium.

Comparison: [x]

Findings: No hemodynamically significant stenosis of the common carotid, carotid bifurcation, or internal carotid arteries is seen. The extracranial portions of the vertebral basilar system are preserved without stenosis. No aneurysmal dilatation or dissection is seen.

Impression: Normal MRA of the neck.