Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for December 2009

Bronchial Isomerism

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  • bilateral symmetry of bronchi and pulmonary lobes
  • ~CHD
  • bilateral RS ~ asplenia
  • bilateral LS ~ polysplenia

Written by lmwong

December 22, 2009 at 10:44 am

Posted in chest, lung

Congenital Cystic Adenomatoid Malformation

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  • Type 1
    • big cysts (2-10 cm)
  • Type 2
    • multiple small cysts
    • renal and cardiac anomalies
  • Type 3
    • solid
  • any lobe
  • alveoli replaced by adenomatoid
  • surgical resection
  • 70% present during 1st week of life
  • 10% diagnosed after 1st year
  • supplied by pulmonary artery; systemic supply rare
  • can involve entire lobe
  • prenatal diagnosis
    • polyhydramnios
    • fetal hydrops
    • solid or cystic mass in fetal thorax
  • excise affected lobe

Written by lmwong

December 22, 2009 at 10:42 am

Posted in chest, lung, pediatrics

Achalasia

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  • dysphagia, regurgitation, aspiration PNA
  • aperistalsis of the distal 2/3 and failure of the LES to relax
  • single contrast UGI = bird-beak narrowing and column of contrast opacifying dilated esophagus.
  • recommend Manometry
  • Rx: balloon dilatation and Heller myotomy (surgical incision)
  • DDx: Chagas disease, pseudoachalasia (carcinoma of the GE junction)
  • Eventual LES relaxation with continued drinking, distinguishes this from pseduoachalasia
  • Complications: Candida from stasis and Carcioma in upper/mid esophagus (20 years).

Written by lmwong

December 19, 2009 at 2:21 am

Posted in esophagus, gi

Acalculous Cholecystitis CT criteria

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2 major or 1 major + 2 minor

Major criteria:

  • Gallbladder wall thickening greater than 3 mm
  • Subserosal halo (ie, gallbladder wall edema)
  • Pericholecystic fatty inflammation
  • Pericholecystic fluid (without ascites or hypoalbuminemia)
  • Mucosal sloughing
  • Intramural gas

Minor criteria:

  • Gallbladder distention (>5 cm transverse)
  • High-attenuation bile (sludge)

Written by lmwong

December 19, 2009 at 2:18 am

Posted in abdomen, ct, gallbladder, gi

Abnormal Renal Vasculature

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  • multiple renal arties is common, 25% of population
  • second, diminutive artery supplying lower pole
  • supernumerary veins, less common than arteries
  • left is retroaortic
  • significant for preop planning

Written by lmwong

December 19, 2009 at 2:15 am

Posted in gi, renal

Aberrant tracheal bronchus

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  • RUL or segment of, originates from trachea
  • no clinical consequence
  • if intubated, may block origin and cause atelectasis

Written by lmwong

December 19, 2009 at 2:13 am

Posted in chest, lung, pulmonary

Abdominal walls and spaces

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Walls

  • falciform ligament
  • lesser omentum
  • greater omentum
  • anterior and posterior renal fascia

Spaces

  • peritoneal space
  • left subphrenic space
  • right subphrenic space
  • Morrion’s pouch
  • lesser sac
  • retroperitoneal space
  • anterior pararenal
  • perirenal
  • pelvis
  • pouch of Douglas (cel-de-sac)
  • retrovesical
  • extraperitoneal space

Written by lmwong

December 19, 2009 at 2:12 am

Posted in abdomen, gi

3 Remnants of Notocord

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  • Chordoma
  • Thornwaldt’s cyst
  • Schmorls node/limbus vertebra

Written by lmwong

December 19, 2009 at 2:09 am

Posted in bone, msk, Phalen, spine

Presacral Widening

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  • >1.5 cm
  • Inflammatory Disease (UC, Crohn’s, or other)
  • Rectal Carcinoma
  • Dermoid Cyst
  • Rectal Duplications
  • Osteomyelitis of sacrum
  • Mets
  • Chordomas
  • Pelvic Abscesses

Written by lmwong

December 17, 2009 at 10:57 pm

Posted in differential, msk

Disease and Nuclear Medicine Agent

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CNS

  • Brain death = Tc-99m labelled pertechnetate and DTPA, (sometimes HMPAO, ECD)
  • SPECT brain perfusion = Tc-99m lab. HMPAO and ECD
  • CSF (normal pressure hydrocephalus) = In-111 lab. DTPA

Neck

  • Thyroid = I-123 and 131
  • Parathyroid = Tc-99m lab. sestamibi
  • Salivary Gland = Tc-99m pertechnetate

Cardiovascular

  • Myocardial perfusion = Tc-99m Sestamibi, Thallium-201, Tc-99m Tetrofosmin

Pulmonary

  • PE = Tc-99m MAA perfusion, Xe-133 ventilation

Liver

  • Normal tissue = Tc-99m sulfur colloid
  • Hemangioma = Tc-99m RBC
  • HCC = Gal-67

GI

  • GI bleed = Tc-99m RBC, (Tc-99m colloid)
  • Meckel’s diverticulum = Tc-99m pertechnetate
  • Hepatobiliary/GB = Tc-99m IDA (or HIDA)
  • Gastric or Esophageal motility = Tc-99m colloid
  • Vit B12 malabsorption (Schilling test) = Co-57 Vit B12
  • Carcinoid = Octreotide scan
  • Focal Nodular Hyperplasia = Sulfur Colloid Normal
  • Fibrolamellar Hepatocarcinoma = Sulfur Colloid Cold

MSK

  • Bone Scan = Tc-99m MDP, F-18
  • Osteomyelitis = Tc-99m diphosphoate (3 phase bone scan), Ga-67 citrate, In-111 or Tc-99m lab. WBC.

GU

  • Glomerular filtration = Tc-99m DTPA
  • Tubular excretion = Tc-99m MAG3
  • Parenchyma = Tc-99m-DMSA
  • Acute Pyelonephritis = DMSA
  • Mass = DMSA
  • Vesicoureteral Reflux = pertechnetate, DTPA, sulfur colloid
  • Transplant eval = DTPA or MAG3
  • Scrotum = DTPA
  • Adrenal Cortical = NP-59
  • Adrenal Medullary (Pheo, neuroblastoma) = MIBG

Infection

  • Ga-67 citrate
  • In-111 oxine WBC
  • Tc-99m HMPAO WBC
  • Tc-99m-fanlesomab

Written by lmwong

December 17, 2009 at 10:56 pm

Posted in nuclear medicine

Causes of AVN

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  • Long term corticosteroid use
  • Excess alcohol
  • SLE
  • Trauma
  • Sickle Cell
  • Gaucher’s
  • Renal transplant
  • Dysbarism (Caisson’s. etc)

Written by lmwong

December 17, 2009 at 10:50 pm

Posted in differential, msk

MSK Buzz Words

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  • Double Denisty NM = Osteoid Osteoma
  • Double stripe or Parallel tract sign on long bone = hypertrophic pulmonary osteoarthropathy
  • central nidus = osteoid osteoma
  • Pie shaped lunate = perilunate dislocation
  • Dripping Candle wax = melorheaostosis
  • Serpiginous tram track bone = bone infarcts
  • H shaped vertebrae (Lincoln logs) = sicke cell disease
  • Subependymal calcfication = tuberous sclerosis
  • Bilateral angiomyolipomas = tuberous sclerosis
  • Splaying of posterior elements = spinal dysraphism
  • Anteater sign = calcaneonavicular coalition
  • Talar beaking = talocalcaneal coalition
  • Fallen fragment = solitary bone cyst with fx
  • Bone pain worse at night, better with asprin = osteiod osteoma
  • Bubbly cystic = enchondroma
  • Terry Thomas sign = scapholunate dislocation (ligament disruption)
  • Ground glass = fibrous dysplasia
  • Anterior tibial bowing = Campanacci syndrome
  • Soap bubble = osteoblastoma
  • Cloud like osteoid matrix, suburst, Codman = intramedullary osteosarcoma
  • Cauliflower = parosteal osteosarcoma
  • Popcorn calcification = osteosarcoma
  • Candy cane bone = NF1
  • double PCL sign = bucket-handle tear of medial meniscus
  • kissing contusion = ACL tear
  • pencil-in-cup deformity = psoriatic arthritis
  • superscan = skeletal metastasis on MDP bone scan
  • beveled-edge skull = EG (Langerhans’ cell histiocytosis)
  • Corduroy lesion = vertebral hemangioma
  • subperiosteal resorption = hyperparathyroidism
  • clover leaf skull = achondroplasia
  • bone-within-bone = osteopetrosis
  • gull wing DIP joint = inflammatory arthritis
  • marginal erosions = gout
  • periarticular osteoporosis = rheumatoid arthtritis
  • 11 rib pairs = Down syndrome
  • rib notching = coarctation
  • spoke wheel = osseous hemangioma (esp. skull)
  • polka-dot pattern = vertebral hemangioma
  • radial aplasia = Fanconi’s Anemia
  • hair on end skull = hemolytic anemias or thalassemia

Written by lmwong

December 17, 2009 at 10:48 pm

Posted in buzz, msk

Epiphyseal Lesions

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  • chondroblastoma
  • chrondrosarcoma
  • giant cell tumor

Epiphyseal Equivalents:

  • Patella
  • Calcaneus
  • Carpal bones
  • Apophyses (i.e. greater and lesser trochanters)

Written by lmwong

December 17, 2009 at 10:46 pm

Posted in bone, differential, msk, Phalen

Diffuse Esophageal Spasm

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  • dysphagia and chest pain
  • nonpropulsive contraction
  • impaired LES relazation
  • increased resting pressures
  • corkscrew, curling, rosary bead, shish kabob
  • nutcracker esophagus
  • >180 mm Hg on manometry

Written by lmwong

December 17, 2009 at 4:24 am

Posted in esophagus, gi

Feline esophagus

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  • multiple thin transverse folds
  • transient (distinguish from chronic reflux esophagitis)
  • cross entire esophageal lumen
  • normal varient

Written by lmwong

December 17, 2009 at 3:28 am

Posted in esophagus, gi

Esophageal Filling Defects

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Benign

  • GIST
  • Adenoma
  • Inflammatory polyp
  • Fibrovascular polyp

Malignant

  • carcinoma
  • mets
  • lymphoma
  • spindle cell carcinoma
  • malignant GIST

Nonneoplastic

  • varices
  • duplication cyst
  • ectopic gastric mucosa
  • foreign body

Written by lmwong

December 17, 2009 at 3:14 am

Posted in differential, esophagus, gi

Esophageal duplication cyst

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  • type of foregut cyst
  • lined with squamous epithelium, smooth muscle wall
  • mass effect
  • anywhere in posterior mediastinum
  • CT shows liquid vs solid (GIST)

Written by lmwong

December 17, 2009 at 3:07 am

Posted in chest, esophagus, gi, mediastinal

Reverse Batwing Pattern

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  • Eosinophilic
  • pna
  • BOOP
  • sarcoidosis
  • Radiation pneumonitis
  • Lung contusion
  • Cancer

Written by lmwong

December 17, 2009 at 2:48 am

Posted in chest, differential