Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for January 2010

Congenital Diaphragmatic Hernia

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  • MC is Bochdalek hernia
  • MC left side
  • diagnosed at prenatal US, follow with MRI
  • up to 50% mortality
  • 50% have CHD
  • most have malrotation

read more

Written by lmwong

January 30, 2010 at 9:47 am

Apical Cap or Mass

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  • normal
  • extrapleural fat
  • inflammatory disease (TB)
  • superior sulcus carcinoma
  • neural tumor or other posterior mediastinal mass
  • mesothelioma
  • mediastinal hemorrhage
  • radiation fibrosis
  • peripheral upper lobe collapse

Written by lmwong

January 30, 2010 at 9:43 am

Posted in chest, differential

Single Well Circumscribed Breast Lesion

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Benign

  • nipple
  • skin lesion
  • cyst
  • inflammatory lymph node
  • fibroadenoma
  • papilloma
  • hamartoma

Malignant

  • Phyllodes tumor
  • mets
  • medulary carcinoma
  • mucoid carcinoma
  • colloid carcinoma

Written by lmwong

January 30, 2010 at 9:37 am

Multiple Well Circumscribed Breast Lesions

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Benign

  • Skin lesions
  • Inflammatory nodes
  • cysts
  • fibroadenomas

Malignant

  • Mets

Written by lmwong

January 30, 2010 at 9:35 am

Ill-defined irregular breast opacities

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Benign

  • fat necrosis
  • previous surgery
  • radial scar/CSL
  • Hamartoma
  • breast abscess
  • composite opacity

Malignant

  • Carcinoma

Written by lmwong

January 30, 2010 at 9:33 am

Breast Microcalcifications Differential

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Benign

  • Sclerosing adenosis
  • fibrocystic change
  • vascular
  • skin lesion

Malignant

  • DCIS
  • Invasive cancer

Written by lmwong

January 30, 2010 at 9:32 am

Edematous Breast Differential

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Benign

  • breast abscess
  • medical – heart failure
  • fluid overload, etc.
  • radiotherapy
  • recent surgery

Malignant

  • Inflammatory carcinoma

Written by lmwong

January 30, 2010 at 9:30 am

Multiple Small Bowel Lesions Differential

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  • lymphoma
  • polyposis syndrome
  • hemangiomas
  • neurofibromas
  • metastases

Written by lmwong

January 28, 2010 at 4:15 pm

BIRADS

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0__ Incomplete: Your mammogram or ultrasound didn’t give the radiologist enough information to make a clear diagnosis; follow-up imaging is necessary

1__ Negative: There is nothing to comment on; routine screening recommended

2__ Benign: A definite benign finding; routine screening recommended

3__ Probably Benign: Findings that have a high probability of being benign (>98%); six-month short interval follow-up

4__ Suspicious Abnormality: Not characteristic of breast cancer, but reasonable probability of being malignant (3 to 94%); biopsy should be considered

5__ Highly Suspicious of Malignancy: Lesion that has a high probability of being malignant (>= 95%); take appropriate action

6__ Known Biopsy Proven Malignancy: Lesions known to be malignant that are being imaged prior to definitive treatment; assure that treatment is completed

Written by lmwong

January 28, 2010 at 4:12 pm

Ventricular Draining System

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Written by lmwong

January 26, 2010 at 11:48 am

Posted in neuro

Corpus Callosum Mass

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  • GBM
  • lymphoma

Written by lmwong

January 26, 2010 at 11:46 am

Posted in differential, neuro

Cysticercosis

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  • ring-enhancing lesions
  • most common parasite infection of CNS
  • pork tape worm (t solium) larvae ingested in pork, develop as tape worm in small intesting, release eggs in stool
  • parenchymal, intraventricular, subarachnoid pattern
  • stages
    • small foci of edema
    • cyst formation with small central focus –> symptoms
    • collapse and calcify

Written by lmwong

January 26, 2010 at 9:27 am

Posted in neuro

Reading V/Q scans

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Normal

  • perfusion and ventilation is uniform in both lungs
  • hila, aorta, fissues appear as defects
  • wash out in 2-3 minutes ventilation

Bilateral perfusion defects

  • PE
  • Extrinsic compression of pulmonary artery
  • Physiologic response from decreased or absent ventilation
  • pleural effusion

Unilateral perfusion defects

  • mucus plug
  • compression of pulmonary artery by tumor
  • fibrosing mediastinitis
  • PE
  • massive effusion
  • pneumonitectomy

Ventilation abnormalities

  • Chronic lung disease
  • mucus plug
  • airspace disease

Matched Defect

  • COPD
  • airspace disease
  • tumors and other mass lesions
  • asthma
  • pleural effusion
  • lung infarction

Mismatched defect

  • PE
  • Pulmonary artery compression
  • radiation therapy
  • vasculitis

Reverse mismatched defect

  • pneumonia
  • alveolar pulmonary edema
  • mucus plug

Interpretation and Probability

Modified PIOPED criteria link

Written by lmwong

January 26, 2010 at 9:13 am

Cystic Intraaxial Supratentorial Brain Lesions

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  • astrocytoma
  • ganglioglioma and ganglioneuroma
  • pleomorphic xanthoastrocytoma
  • DNET
  • sinus mucocele that invaded through cranium
  • congenital

Written by lmwong

January 25, 2010 at 11:41 am

Pituitary Adenoma

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  • >10 mm = macroadenoma
  • <10 mm = microadenoma
  • 75% hormonally active = prolactinoma (MC), growth hormone (acromegaly)
  • from anterior lobe of gland
  • pseudocapsule demarcates from normal gland
  • bromocriptine – high incidence of adenoma hermorrhage

Written by lmwong

January 25, 2010 at 11:31 am

Posted in neuro, tumor

Craniosynostosis

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  • premature fusion of cranial suture
  • sagittal > coronal > metopic >>> lambdoid
  • “reverse Klingon sign” = Sagittal synostosis
    • elongated AP = dolichocephaly,¬†scaphocephalic
  • Coronal synostosis
    • unilateral: plagiocephaly,¬†“harlequin” appearance of orgit
    • bilateral: brachycephaly
  • Metopic synostosis
    • triagular head configuration = trigonocephaly
  • Apert’s syndrome
    • Klebblattschadel =¬†closure of coronal, lambdoid, and sagittal sutures = “clover-leaf” deformity of the skull
  • Crouzon’s disease = craniofacial dysostosis
  • Tracher Collins syndrome = mandibulofacial dysostosis

Written by lmwong

January 25, 2010 at 11:17 am

Posted in bone, msk, neuro, pediatrics

Child Abuse Nonaccidental Trauma

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  • skull fractures: depressed, bilateral, healing
  • intracranial hemorrhage: subdural hematoms, other
  • cerebral infarction, anoxic brain injury
  • retinal hemorrhages
  • metaphyseal corner fractures
  • posterior rib fractures
  • scapular fractures
  • spiral fractures of long bones

Written by lmwong

January 25, 2010 at 11:07 am

Posted in bone, msk, neuro, pediatrics, trauma

Thyroid Ophthalmopathy

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  • most common cause of proptosis
  • 90% bilateral
  • inferior rectus and medial rectus muscle body enlargement with sparing of tendon insertions
  • hyper or euthyroid
  • become fibrotic and fatty change
  • DDx:
    • myositis
    • pseudotumor
    • vascular: fistula, thrombosis, AVM

Written by lmwong

January 25, 2010 at 11:01 am

Posted in eye, neuro, orbit, thyroid

Sellar and Suprasellar Masses

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S A T C H M O

  • Pituitary adenoma (micro/macro)
  • Craniopharyngioma (from pars tuberalis, large)
  • Rathke cleft cyst (from pars intermedia, small)

S ella (pituitary) tumors, sarcoid

A neurysm, arachnoid cyst

T eratoma

C raniopharyngioma

H ypothalamic glioma, hamartoma, histiocytosis

M eningioma

O ptic nerve glioma

Written by lmwong

January 25, 2010 at 10:40 am

Posted in differential, neuro

Congenital Lobar Emphysema

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  • over expansion of alveoli
  • ball-valve air trapping
  • neontal period to 6 months
  • LUL (MC) > RML > RLL
  • initially, soft tissue density due to retained fluid –> over expansion and hyperlucency
  • thinning of pulmonary vasculature

Written by lmwong

January 24, 2010 at 5:08 pm

Posted in chest, pediatrics, pulmonary