Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for September 2008

Infectious Esophagitis

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  • Candidiasis – plaquelike, shaggy
  • Herpes – multiple discrete ulcers
  • CMV – large, flat, solitary ulcer
  • HIV – indistinguishable from CMV

Written by lmwong

September 25, 2008 at 1:39 am

Peptic and Inflammatory Esophagitis

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  • mild reflux – thickened folds only
  • mod reflux – thickened folds and tiny ulcers
  • severe reflux – folds and moderate to large ulcers
  • chronic reflux – stricture above GEJ, scarring deformity, transverse folds
  • Barrett esophagus – stricture at high location, transition zone, reticulated mucosal pattern
  • Medication-induced – ulcer with edema, level or arch or distal
  • Crohn esophagitis – aphthous ulcers, confluent

Written by lmwong

September 25, 2008 at 1:34 am

Hemangioblastoma

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  • benign
  • most common primary cerebellar neoplasm in adults
  • multiple vs solitary
  • multiple, supratentorial ~ von Hippel-Lindau disease
  • spinal cord, medulla, cerebral hemispheres
  • always superficial location; pia matter blood supply
  • CT = well-defined cystic lesion, intensely enhances; 40% solid nonspecific findings; rarely calcify
  • MRI = low T1, high T2, enhances, flow voids
  • DDx: posterior fossa tumors
  • Link

Written by lmwong

September 24, 2008 at 4:18 am

Posted in cystic, neuro, tumor

Brain Stem Glioma

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  • majority are astrocytoma, mostly WHO Grade I and II
  • exophytic growth into adjacent cisternal spaces
  • enlarged pons, extending beyond anterior margin of basilar artery
  • abnormal fourth ventricle contour
  • bright on T2
  • enhancement is variable: avid to none
  • 80% occur in childhood
  • 15% of posterior fossa tumors in kids
  • DDx: posterior fossa tumors
  • link

Written by lmwong

September 24, 2008 at 3:54 am

Posted in neuro, pediatrics, tumor

Ependymoma

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  • posterior fossa tumor in children
  • from ependymal cell lining ventricular system
  • intraventricular or spinal cord mass
  • 70% in 4th ventricle
  • WHO grade II

CT

  • isodense
  • mixture of calcification, cystic changes, hemorrhage; heterogenous appearance

MRI

  • iso to gray matter on T1
  • hyper to gray matter on T2
  • heterogenous enhancement

DDX: posterior fossa tumors

link

Written by lmwong

September 24, 2008 at 3:42 am

Posted in neuro, pediatrics, tumor

Lines of the hip, pediatrics

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Congenital Hip Dysplasia
  • Yellow = Hilgenrenier’s line
  • Blue = Acetabular line
  • Red = Perkin’s line
  • Green = Shenton’s arc
  • Pink = proximal epiphysis lies outside of lower quadrant = CHD

Written by lmwong

September 23, 2008 at 2:41 pm

Posted in msk, pediatrics

Liver Infections

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Pyogenic Abscess

  • seeding from appendicitis, diverticulitis, cholecystitis, cholangitis, endocarditis
  • complex fluid collections
  • pic

Fungal Abscess

  • immunocompromised patients
  • Candida
  • “wheel within a wheel” appearance, target lesion
  • pic

Granulomatous Disease

  • Pneumocystits carinii in AIDS patients, MAI, CMV
  • multiple echogenic foci throughout the liver

Parasite

  • Echinococcal hydatid cyst
  • Amebic
  • Schistosomiasis
  • variable cystic appearances, daughter cysts, calcifications
  • pic

Written by lmwong

September 20, 2008 at 3:05 am

Posted in cystic, differential, gi, liver

Hepatocellular Carcinoma (HCC)

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  • most common malignant primary tumor of liver
  • associated with Hep B, Hep C, and cirrhosis
  • ETOH, Wilson’s disease, Type 1 glycogen storage disease, aflotoxin ingestion (Africa)
  • solitary, multifocal, diffuse, or infiltrating
  • typically large dominant lesion with scattered smaller satellite lesions
  • strong association with venous invasion; portal vein >> hepatic veins
  • hypervascular; hyperattenuated on delayed imaging compared to liver

http://brighamrad.harvard.edu/Cases/bwh/hcache/335/full.html

Written by lmwong

September 19, 2008 at 11:27 pm

Posted in cancer, gi, liver, tumor

Hepatic Adenoma

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  • hepatocytes with few Kupffer cells and no bile ductules
  • associated with birth control pills, anabolic steroids
  • risk of bleeding; surgical treatment
  • multiple = hepatic adenomatosis (type I glycogen storage disease)
  • U/S = nonspecific.
  • low but real risk of malignant degeneration

Written by lmwong

September 19, 2008 at 11:17 pm

Posted in gi, liver

Cystic Neck Masses in Pediatrics

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  1. Brachial Cleft Cyst: Type 2 most common (1-4)
  2. Ranula: impacted salivary gland
  3. Thyroglossal Duct Cyst: abarrent migration of thyroid tissue from tongue
  4. Venolymphatic Malformation: Fluid fluid levels, posterior to SCM
  5. Odontogenic Keratocyst: associated with teeth

Written by lmwong

September 11, 2008 at 5:54 pm

Posted in cystic, ent, neck, pediatrics

Hirschsprung’s Disease, BE findings

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  • Transition zone (often subtle during first week of life)
  • Abnormal, irregular contractions of aganglionic segment (rare)
  • Thickening and nodularity of colonic mucosa proximal to transition zone; cobblestone (rare)
  • Delayed evacuation of barium
  • Mixed barium-stool pattern on delayed radiographs
  • Distended bowel loops on plain radiographs that almost fill after contrast enema
  • Question mark–shaped colon in total colonic aganglionosis

Written by lmwong

September 9, 2008 at 6:56 pm

Posted in abdomen, gi, pediatrics

Neuroblastoma

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  • most common extracranial solid tumor in kids
  • from neural crest tissue, sympathetic nervous system
  • 50% fatal; 2/3 have mets at diagnosis
  • ages 2-4 yo, 90% diagnosed at 5 yo; younger diagnosed, better outcome
  • 65% abdominal, 2/3 of which are adrenal; remainder in neck
  • fever, malaise, bone pain, racoon eyes (periordbital ecchymosis and proptosis), blueberry muffin baby (skin mets)
  • associated syndromes: myoclonic encephalopathy of infancy (MEI), watery diarrhea, heterochromia and Horner’s syndrome
  • mets to lymph nodes, liver, bone, cns, skin (blueberry muffin)
  • prognosis: age, state, histology, site of primary
  • NM MIBG: increased uptake in tissue, photpenia in bone mets, hot on bone scan
  • X-ray: calcifications, moth-eaten bony mets
  • CT: calcification, necrosis, LAD, mets, IVC thrombus, encases mesenteric vessels

Staging

1: tumor localized, resected
2A: tumor localized, non-resectable
2B: tumor unilateral, ipsilateral nodes
3: tumor crosses midline, +/- nodes
4: tumor crosses midline, + nodes, distant mets
4S: mets to skin, liver, bone marrow

Written by lmwong

September 9, 2008 at 1:24 pm

Posted in abdomen, gi, pediatrics, tumor

Vesicoureteral Reflux (VUR) Classification

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Grade I – reflux into non-dilated ureter
Grade II – reflux into the renal pelvis and calyces without dilatation
Grade III – mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices
Grade IV – dilation of the renal pelvis and calyces with moderate ureteral tortuosity
Grade V – gross dilatation of the ureter, pelvis and calyces; ureteral tortuosity; papillary impressions

Written by lmwong

September 8, 2008 at 12:04 am

Uretheral Injury Classification

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The classification system of Goldman et al (6) is as follows:

Type I injury: The posterior urethra is stretched and elongated but intact. The prostate and bladder apex are displaced superiorly due to disruption of the puboprostatic ligaments and resulting hematoma.

Type II injury: Disruption of the urethra occurs above the urogenital diaphragm (UGD) in the prostatic segment. The membranous urethra is intact.

Type III injury: The membranous urethra is disrupted with extension of injury to the proximal bulbous urethra and/or disruption of the UGD.

Type IV injury: Bladder neck injury with extension into the proximal urethra.

Type IVA injury: Injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury.

Type V injury: Partial or complete pure anterior urethral injury.

Source: http://radiographics.rsnajnls.org/cgi/content/full/23/4/951

Written by lmwong

September 8, 2008 at 12:00 am

Posted in classification, GU, trauma

Pediatric Lung Mass Differential

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  1. Sequestration
  2. CCAM
  3. Congenital Lobar Emphysema
  4. Duplication cysts (esophageal, neuroenteric)
  5. Congenital Diagphragmatic hernia
  6. Neoplasm/Lymphoma
  7. Pneumonia/pneumonitis

Written by lmwong

September 4, 2008 at 1:35 pm

Support Lines & Device Placement

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  • ET tube tip – 5-7 cm above carina; b/w T5-7
  • Chest tube tip and side port – pleural space
  • Nasogastric Tube side hole – distal to GE junction
  • Dobhoff tube – second portion of duodenum
  • Transvenous Pacemaker lead – RV apex
  • Central line tip – RA and SVC junction
  • Swan Ganz catheter tip – proximal R or L PA
  • IABP marker – distal to L subclavian artery
  • UAC tip – T5-T8
  • UVC – RA and IVC junction
  • pH probe marker – T8 or 5 cm above GEJ

Written by lmwong

September 2, 2008 at 3:47 pm

Posted in x-ray