Ine! oe RadioGyan Radiology Made Easy!RadioGyan.com 1 Radiology Made Easy! 1. A burst fracture of the C1 ring? Jefferson fracture. 2. Any break in the bony ring of a vertebra that occurs ona slice that shows the isa spondylolysis until proved otherwise? basivertebral plexus. 3. Helps distinguish myositis ossificans from parosteal osteosarcoma? Parosteal sarcoma demonstrates central clumps of calcification and myositis ossificans has peripheral ossification/calcification. 4. Define disk bulge, sequestered or free fragment? Disk bulges can be diffuse, broad based, or focal but are attached to the disk. Sequestered or free_ fragments occur when disk material migrate from parent disk. 5. Distinguishing a free fragment from a Tarlov cyst or conjoined nerve root? A free fragment js hyper-dense to thecal sac and Tarlov cyts & conjoined nerve roots are iso-dense to thecal sac. 6. Lateral disk protrusion affects what nerve root? Anerve rooth that has already exited the neuroforamen at a more cephalad level. 7. Congenital causes of spinal stenosis? Achondroplasia, Morquio's disease, idiopathic spinal stenosis 8. Acquired spinal stenosis causes? Degenerative disk disease, post-traumatic stenosis, postsurgical stenosis, Paget's disease, calcification of posterior longitudinal ligament. 9. Anatomic classification of spinal stenosis? Central canal stenosis, neuroforaminal stenosis, lateral recess stenosis. 10. Most useful CT criteria for diagnosing central canal stenosis? Obliteration of epidural fat, flattening of thecal sac. 11. Pars interarticularis defect? Spondylolysis. 12. Anterior displacement of a cephalad vertebral body with respect to a caudad Spondylolisthesis. [Grade | (<25%), Grade Il (25-50%), Grade Ill (50-75%), Grade IV (75-100%)].RadioGyan.com 3 Radiology Made Easy! vertebral body? 13. Most common site for Calcaneonavicular joint. 14. Fi greatest concern for metastatic bone disease or multiple myeloma involvement? A permeative process. 15. Spinal hemangioma CT features? Vertical trabecular thickening, may contain fat, may see phleboliths. 16. Schmorl's node? Herniation of disk material through end plate of vertebral body. 17. Tarlov cysts? Nerve sheath dilatations of fluid density at CT, when large enough can cause bone erosion, particulary within the sacrum. 18. Paget's disease on CT? Purely lytic or sclerotic or mixed. Bone overgrowth, Cortical thickening, disorganized trabecular thickening, in pelvis-thickenign of iliopectineal or ilioischial lines. 19. Fibrous dysplasia? Congenital disorder of bone, fibrous tissue, chondral tissue, and even cysts within bone. Non-aggressive appearance 20. Common right-sided anomalous pulmonary venous return insertions? SVC azygos vein, IVC, Right atrium. 21. Common left-sided anomalous pulmonary venous return insertions? Left brachiocephalic vein, persistent left SVC, Coronary sinus. 22. CT features that suggest lung cancer? Irregular or spiculated margine, Lobulated contour, Air bronchograms or cysts within nodule, Nodular cavitation, > 2 cm. 23. Lung hamartoma CT features? Fat 60% Fat and calcification 30% Diffuse calcification 10%-- Smooth, rounded, or lobulated contour. "popcorn" 24. 4 findings of rounded 1. Ipsilateral pleural thickening or effusion. 2. ContactRadioGyan.com 4 Radiology Made Easy! atelectasis? between lung lesion & pleural surface. 3. "Comet tail” sign. 4. Volume loss of lobe involved. 25. Air-crescent sign? Lung mass capped by a crescent of air. Most typical of mycetoma (fungus ball). Fungus ball (Aspergillus) forms in preexisting cyst or cavity. 26. Lung abscess CT features? Necrosis or cavitation within area of pneumonia or dense consolidation. 27. Satellite nodules & galaxy sign? Granulomatous lesions with smaller nearby nodules > satellite sign. in sarcoidosis, galaxy sign is a larger nodule with nearby grouped smaller nodules. 28. Benign pulmonary nodule calcification patterns? Diffuse (granuloma), Central "bullseye" (histoplasmosis), Popcorn (hamartoma), Concentric "target" (histoplasmosis). 29. Benign pulmonary nodule doubling times? <1 month, or > 16 months. 30. What increase in diameter equals a doubling of volume? 26% increase (10 mm to 12.6 mm) 31. DDx of multiple large pulmonary nodules? Metastases, Lymphoma, Bronchogenic carcinoma Bacterial, fungal, and sometimes viral infections Granulomatous disease, Sarcoidosis, Wegener's granulomatosis, Rheumatoid lung Amyloidosis Septic emboli 32. Pulmonary metastasis characteristics? Typically round and well-defined. Cavitation & calcification can be seen. 33. Signet ring sign? Bronchiectasis. Cross section of pulmonary artery branch adjacent to dilated ring-shaped bronchus. Bronchus diameter exceeds adjacent artery's 34. Bronchiectasis patterns in cystic fibrosis (CF) & allergic bronchopulmonary aspergillosis? CF >bilateral, upper lobes, most severe at para-hilar lungs. ABPA~ central bronchiectasis. 35. Causes of interlobular septal thickening as predominant finding at HRCT 1. Lymphatic spread of carcinoma. 2. Interstitial pulmonary edema. 3. Alveolar proteinosis. 4, Sarcoidosis.RadioGyan.com 5 Radiology Made Easy! 36. Common causes of fibrosis & honeycombing as predominant HRCT findings? IPF 65%, Collage vascular diseases (RA, scleroderma), Drug-related fibrosis, Asbestosis, End-stage hypersensitivity pneumonitis, End-stage sarcoidosis. 37. 3 distributions of pulmonary nodules at HRCT? Perilymphatic nodules (pleural surface, large vessels, and bronchi, interlobular septa, centrilobular regions), Random nodules (miliary TB, hematogenous metastases), Centrilobular nodules (tree-in-bud--endobronchial TB, MAC/MAI, CF, bronchiectasis, bronchopneumonia). 38. CT features of pulmonary lymphangitic spread of carcinoma? Interlobular septal thickening, Peribronchial interstitial thickening, Thickening of fissures, Lymph node enlargement, Patchy distribution. 39. CT features of pulmonary hematogenous spread of tumor? Random distribution, Fissures and pleural surface involvement, Bilateral, Large nodules. 40. CT features of IPF pathic pulmonary fibrosis-UIP is histology pattern)? Intralobular interstitial thickening, Honeycombing, Traction bronchiectasis and bronchiolectasis, Subpleural, posterior, and basal lungs, Ground-glass opacity. 41. Non-spet interstitial Pneumonia (NIP, collagen vascular disease) CT features? Ground-glass opacity, Posterior basal lungs-sparing immediate subpleural lung, Reticulation, traction bronchiectasis and bronchiolectasis, Honeycombing- rare. 42. Active sarcoidosis CT features? Perilymphatic nodules, Patchy, upper lobe predominance, Hilar, mediastinal node enlargement, Ground-glass opacity (small granulomas). 43. HRCT findings in end- stage sarcoidosis? Irregular septal thickening, Architectural distortion, Parahilar conglomerate masses, Honeycombing, Hilar and mediastinal node enlargement. 44. Pulmonary lymphangitic spread of carcinoma? Interlobular septal thickening, Peribronchial interstitial thickening Patchy or unilteral distribution Lymph node enlargement. 45. Pulmonary hematogenous spread of Random distribution, Involvement of fissures & pleural surfaces, Bilateral distribution, Large nodules.RadioGyan.com 6 Radiology Made Easy! tumor? 46. Idiopathic pulmonary fibrosis (IPF) CT features? Intralobular thickening, Honeycombing, Traction bronchiectasis and bronchiolectasis, Predominant subpleural, posterior, basal lung regions, Ground- glass opacity. 47. Non-specific interstitial Pneumonia CT features? Ground-glass opacity, Predominant posterior & basal lung, sparing the immediate subpleural lung, Reticulation, traction bronchiectasis & bonchiolectasis, Honeycombing. 48. Collagen vascular disease as lung disease? Rheumatoid lung, scleroderma, and other collagen disease (UIP, NSIP, BOOP) 49. Active pulmonary sarcoidosis, CT features? Perilymphatic nodules, Patchy, Upper lobe predominance, Hilar, mediastinal nodes, Ground- glass opacity, small granulomas. 50. End-stage sarcoidosis? Irregular septal thickening, Architetural distortion, Parahilar conglomerate, honeycombing, Hilar, mediastinal nodes. 51. Silicosis and Coal Worker's pneumoconiosis? Perilymphatic nodules, Symmetric distribution, Posterior lung predominance, Upper lobe predominance, Conglomerate masses, Hilar, mediastinal nodes (egg-shell calcification). 52. Pulmonary TB, CT features? Endobronchial spread (centrilobular nodules, tree-in- bud, focal areas of consolidation, bronchial wall thickening or bronchiectasis, pathcy or focal), Miliary spread (random nodules, 1-5 mm, Usually diffuse). 53. Pulmonary alveolar proteinosis? Filling of alveolar spaces with lipid-rich proteinaceous material, Patchy or geographic ground-glass opacity, smooth, interlobular septal thickening in ground- glass>"crazy paving". 54. Hypersensitivity pneumonitis, subacute stage CT features? Patchy or geographic ground-glass opacity, Poorly defined centrilobular nodules or ground-glass opacity, Mosaic perfusion, Air trapping. 55. Bronchiolitis obliterans organizing pneumonia, Idiopathic, infections, toxicexposures, drug reactions, autoimmune disease.RadioGyan.com 7 Radiology Made Easy! causes? 56. HRCT features of bronchiolitis obliterans organizing pneumonia? Patchy or nodular consolidation, Patchy or nodular ground-glass opacity, Peripheral and peribronchial distribution. 57. Chronic eosinophilic pneumonia? Filling of alveoli by mixed inflammatory infiltrate (eosinophils), similar to BOOP--patchy consolidation or ground-glass, peripheral distribution. 58. Histiocytosis (aka Langerhans histiocytosis or eosinophilic granuloma)? Centrilobular nodules (may cavitate), Thin-welled, irregular lung cysts, Normal appearing intervening lung, Upper lobe predominance, Spares costophrenic angles. 59. Lymphangiomyomatosis? Women of child bearing age, can occur in Tuberous sclerosis, too, Thin-walled, round lung cysts, Normal-appearing intervening lung, Lymph node enlargement, Diffuse distribution without sparing lung bases. 60. List 4 types of emphysema? Centrilobular (upper lobes, smokers, most common form), Panlobular (less common, alpha1-antitrypsin, most severe at lung bases), Paraseptal (subpleural lung, adjacent to chest wall and mediastinum), Bullous (Large bullae, young men). 61. Split pleura sign? Thickened visceral and parietal pleural layers are split apart and surround an empyema. 62. Extension of an empyema to involve the chest wall is termed? Empyema necessitatis. 63. Lung abscess versus empyema CT characteristics? ‘Abscess (poorly defined, irregular wall, spherical, multiple cavities, acute angles, vessels not displaced), Empyema (well defined, smooth, uniform wall, elliptical, split pleura, acute or obtus angles, vessels displaced). 64. CT features of a malignant effusion? Nodular pleural thickening, pleural thickness > 1.cm, concentrically involves the pleura, encasing the lung, thickening of mediastinal pleura. 65. CT findings for chest wall Extensive contact between tumor & chest wall (> 3cmRadioGyan.com 8 Radiology Made Easy! invasion? or ratio > 0.7), Obtuse angles, Chest wall mass, Bone destruction 66. What passes through the aortic hiatus? Aorta, azygos, hemiazygos, thoracic duct, intercostal arteries, splanchnic nerves. 67. What passes through the esophageal hiatus? Esophagus, vagus nerve, small blood vessels. 68. Anterior mediastinal node groups? Internal mammary LNs, Paracardiac LNs, Prevascular LNs. 69. Middle mediastinal node groups? Pretracheal or paratracheal LNs, Aortopulmonary LNs, Subcarinal LNs, Peribronchial LNs. 70. Posterior mediastinal node groups? Paraesophageal LNs, Inferior pulmonary ligament LNs, Paravertebral LNs. 71. Upper limits of normal for subcarinal lymph node diameter? 1.5 cm. 72. Egg-shell calcified mediastinal LN, DDx? Silicosis, Coal worker's pneumoconiosis, Sarcoidosis, 1B. 73. Calcified mediastinal LNs, DDx? Prior granulomatous disease (TB, histo, fungal, sarcoidosis), Silicosis, Coal worker's pneumoconiosis, treated Hodgkin's disease, Metastasis 74. Mediastinal lymph node enhancement? Castleman's disease, Angioimmunoblastic lymphadenopathy, Vascular metastases, TB, Sometimes sarcoidosis. 75. Left upper lobe cancers involve what mediastinal LN group? ‘Aortopulmonary window LNs 76. Lower lobe lung cancers involve what mediastinal lymph node group? Subcarinal LNs. 77. Resectability non-small cell lung cancer stages? Stage IIlb-IV, contralateral LNs are N3, unresectable 78. Sarcoidosis thoracic Symmetric hilar adenopathy, Lymphoma is typically adenopathy features? asymmetrical. 79. Prevascular space 4Ts: thymoma, teratoma, thyroid tumor, terrible tumors? lymphoma. Other germ-cell tumors, parathyroidRadioGyan.com 9 Radiology Made Easy! masses, lymphangioma 80. Castleman's disease [aka angiofollicular lymph node hyperplasia] > Focal form (Enhancing hilar or mediastinal LNs), jiffuse form (Enhancing mediastinal, hilar, axillary, abdominal, & inguinal LNs) 81. CT features of thymoma? Prevascular or paracardiac location, Typically unilateral, Calcification or cystic degeneration can be present 82. Thymic masses? Thymoma, thymic carcinoma, thymic carcinoid tumor, thymolipoma, thymic cyst, thymic hyperplasia & rebound (after cessation of chemotherapy) 83. 3 main categories of germ-cell tumors? ‘LTeratoma & dermoid cyst, 2. Seminoma (radiosensitive), 3. Non-seminomatous germ-cell tumors (poor prognosis: choriocarcinoma, endodermal sinus tumor, mixed tumors). 84. Teratoma vs dermoid cyst? Teratoma > contains ecto-, meso-, & endodermal origins (can be cystic, contain fat, have fat-fluid level, or calcify). Can be mature or immature (malignant). Dermoid cyst > primarily from epidermal tissue. 85. Lymphangioma types? Simple > small, thin-walled with connective tissue. Cavernous > dilated lymphatic channels. Cystic > hygromas, single or multiple cystic masses filled with serous or milky fluid. 86. Saber-sheath trachea features? Narrowed lateral dimension of intra-thoracic trachea. COPD, repeated trauma from coughing 87. Concentric tracheal narrowing causes? Intubation, Polychondritis, Wegener's granulomatosis, Amyloidosis, Tracheobronchopathia osteochondroplastica. 88. Bronchogenic & esophageal duplication cyst features? ‘Anomalous budding of foregut. Most commonly within subcarinal space. Esophageal duplication cyst indistinguishable from bronchogenic, except they always contact the esophagus 89. Paravertebral neurogenic tumor divisions? 1, Peripheral nerve or nerve sheath (neurofibroma, neurilemmoma--young adults). 2. Sympathetic ganglia (ganglioneuroma, neuroblastoma--children).RadioGyan.com 10 Radiology Made Easy! 3. Paraganglionic cells (pheochromocytoma, chemodectoma). 90. Most common cause of posterior mediastinal mass in patients with neurofibromatosis? Meningocele 91. Granulomatous mediastinitis causes? Histoplasmosis, TB, Sarcoidosis, Chronic mediastinal LN enlargement with fibrosis. Calcification of LNs common 92. Sclerosing mediastinitis vs granulomatous mediastinitis Similar but no calcification with sclerosing mediastinitis. 93. Pericardial cyst features? 60% anterior right cardiophrenic angle, 30% left cardiophrenic angle, 10% occur higher in mediastinum. 94. Morgagni hernia features? Anteromedial diphragmatic foramen of Morgagni. Cardiophrenic angle mass, 90% occur on right. Usually contains liver or omentum. 95. Right upper lung lobe segments? Apical, Posterior, Anterior. 96. Left upper lung lobe segments? Apicoposterior, Anterior, Superior lingual, Inferior lingual. 97. Right middle lung lobe segments? Medial, Lateral. 98. Right lower lung lobe segments? Superior, Anterior, Medial, Lateral, Posterior. 99. Left lower lung lobe segments? Superior, Anteromedial, Lateral, Posterior. 100. Egg-shell calcification of thoracic lymph nodes? Silicosis, Sarcoidosis, TB. 101. Pulmonary agenesis versus pulmonary aplasia? Aplasia has rudimentary bronchus. 102. Pulmonary arteriovenous fistula features? Single dilated vascular sac or tangle of dilatated tortuous vessels. Mostly subpleural, Rapid enhancement and rapid washout.RadioGyan.com 1 Radiology Made Easy! 103. Pulmonary sequestration features? Cystic or solid, Majority left posteromedial lung. All have anomalous systemic arterial supply. 104. Intralobar sequestration vs Extralobar sequestration? Intralobar: diagnosed in adults, recurrent or chronic infection, region of hyperlucent lung, cystic or multicystic structure with air-fluid levels, consolidated or collapsed lung. Extralobar: diagnosed in infants or children, almost always solid mass that rarely contains air. Venous drainage usually via systemic veins. 105. Hypogenic lung sydrome (scimitar Syndrome)? Almost always on right side, hypoplasia of lung, hypoplasia of ipsilateral pulmonary artery, Anomalous pulmonary venous return (scimitar vein) to vena cava or right atrium. Anomalous systemic arterial supply to portion of hypoplastic lung. 106. Extraperitoneal space communicates with? Retroperitoneal space, continuous with posterior pararenal space and extraperitoneal fat of abdominal wall. retropubic space of Retzius 107. Perineum Lies below pelvic diaphragm, includes ischiorectal fossa. 108. Normal fertile ovary dimensions? 2x3x4cm. 109. Bladder carcinoma CT features? Focal thickening of bladder wall, Weakly enhancing mural nodule, Calcifications 5%, Perivesical fat spread, Pelvic LNs> 10 mm 110. Uterine leiomyoma CT features? 40% of women > 30 yo, homogeneous, heterogeneous masses, hypodense,isodense, or hyperdense, dystrophic, mottled calcifications, cystic degeneration 111. Carcinoma of cervic features? SCC 85%, ADCA 15%, hypo or iso-dense to normal cervix, Pelvic fluid collections, Direct extension (thick irregular tissue strands), Enlarged LNs> 10 mm. 112. Endometrial malignancy features? hypodense mass within endometrial cavity, surgical staging method of choice, Enlarged pelvic LNs > 1. cm 113. Ovarian cancer features? Cystic 66%, bilateral 25%, Non-functional 85%, cystic with thick, irregular walls & internal septations.RadioGyan.com 12 Radiology Made Easy! Peritoneal implants, Ascites, Omental cake (irregular, thick greater omentum), follow gonadal lymphatics 114. Normal ovarian follicle size? <3.cm. 115. Functional ovarian cyst features? Benign follicular or corpus luteum cysts, well- defined, thin walled, <3cm. 116. PID CT features? Thickening of fallopian tubes (early) Enlargement & abnormal enhancement of ovaries, Dilated fallopian tubes filled with high-density fluid (advanced- pyosalpinx), Complex adnexal fluid collections (abscess). 117. Adnexal torsion, CT features? Most cases involve mass (benign cystic teratoma, hydrosalpinx, functional cyst), Thickening fallopian tube wall, ascites, deviation of uterus to affected side 118. Testicular cancer LNs involvement? Gonadal lymphatics (testicular veins and renal hilar nodes), external iliac chains to para-aortic LNs. Inguinal LNs involved only when scotrum invaded. 119. Aberrant Rt. subclavian artery? Left arch, last branch (diverticulum of Kommerell), courses behind esophagus. 120. 2 types of right aortic arch? Right arch with aberrant left subclavian, Mirror image right arch (almost always associated with congenital heart disease) 121. Double aortic arch? Vascular ring with dysphagia, no innominate artery (subclavians and carotids come off separately). 122. Ascending aortic aneurysm causes? ‘Atherosclerosis, Marfan's syndrome, cystic medial necrossi, syphilis, aortic valvular disease. 123. 3 common locations for aortic trauma? Aortic root level of ligamentum arteriosum diaphragm and aortic hiatus 124. Stanford aortic dissection types? Type A involves ascending aorta (treated surgically: possibility of retrograde dissection & rupture within pericardium or occlusion of coronary or carotid arteries), Type B > Do not involve arch, arise distal to left subclavian artery (treated medically). 125. DeBakey's aortic dissection types? Type! > entire aorta, Type Il > ascending aorta only, Type ill -> descending aorta only.RadioGyan.com 13 Radiology Made Easy! 126. 3 mediastinum compartments? Supra-aortic mediastinum, subaortic mediastinum, paracardiac mediastinum 127. Mediastinal spaces and recesses? Pretracheal space, Prevascular space, Superior pericardial recess, Azygoesophageal recess, Subcarinal space 128. Persistent left superior vena cava features? Failure of cardinal vein to regress, Lateral to left common carotid artery, enters coronary sinus posterior to left atrium 129. Azygos or hemiazygos continuation of IVC? Hemiazygos (polysplenia), Azygos (asplenia), dilated azygos, hemiazygos systems, Diaphragmatic IVC drains hepatic veins only. 130. Causes of SVC syndrome? ‘Most commonly bronchogenic carcinoma, sarcoidosis, fibrosing mediastinitis, TB, mediastinal radiation. 131. Pulmonary artery diameter in pulmonary HTN? 33 cm, or > ascending aorta. 132. Difference in pulmonary dilatation in pulmonary HTN and pulmonic stenosis? Pulmonic stenosis > main & left pulmonary arteries dilated. Pulmonary HTN > main, left, & right pulmonary arteries dilated. 133. Acute PE vs chronic PE at CT? Acute PE > clot centered in lumen, outlined by contrast [doughnut sign (cross section) & rail-road track sign (same plane)], Chronic PE > clot adherent to wall, located peripherally. 134. Acute pancreatitis CT findings? Enlargement, decrease in density, blurring of margins peripancreatic stranding, blurring of fat planes thickening of retroperitoneal fascia. 135. Com pancreatitis? Fluid collections, Pseudocysts, Necrosis (lack of enhancement), Phlegmon (mass of edema & inflammation), Abscess, Hemorrhage Pseudo- aneurysms, Thrombosis (splenic vein), ascites. 136. Chronic pancre: features? Causes (alcohol, autoimmune, tropical pancreatitis) Calcifications 50%, Atrophic Duct strictured & dilated segments, "beaded", Pseudocysts. 137. CT features of pancreatic adenocarcinoma? hypodense mass 96%, head > body > tail.RadioGyan.com 14 Radiology Made Easy! 138. Signs of pancreatic Isolated pancreatic mass, Double duct sign without adenocarcinoma mass. resectability? 139. Signs of pancreatic Involvement of major arteries or veins. Extension of adenocarcinoma tumor beyond margins of pancreas, invasion of unresectability? adjacent organs, Ascites (presumtive peritoneal carcinomatosis) 140. Appendicitis CT features? Distended appendix > 6 mm, enhancing thickened walls, appendicolith within phlegmon or abscess. 141. Differential of RLQ pain without abnormal appendix or appendicolith? Crohn's disease, cecal diverticulitis, perforated cecal carcinoma, mesenteric adenitis, PID. 142. Complications associated with perforated appendicitis? Phlegmon (periappendiceal soft-tissue mass), abscess (> 3cm surgical or catheter drainage) 143. Mucocele of appendix? Distended, mucus-filled appendix without inflammation. >2 cm, usually caused by mucinous neoplasm. 144. Diverticulitis CT features? ‘Small, round collections of air, feces, or contrast, wall thickening, hyperemic enhancement, sinus tract or fistual formation, Abscess formation. 145. Colitides? Ulcerative colitis, Crohn's colitis, Pseudomembranous colitis, Typhlitis, Ischemic colitis (splenic flexure, rectosigmoid) Radiation colitis, Infectious colitis, Toxic megacolon 146. CT features of islet cell tumors? Small tumors (<4 cm) enhance. Large tumors heterogeneous with calcification, cysts, necrosis, vascular invasion, tumor extension (generally nonfunctioning). 147. Functioning islet cell tumors' malignant potential? 80% glucagonoma, 60% gastrinoma 10% insulinoma. 148. CT features of pancreatic lymphoma? Focal tumor, homogeneous and weakly enhancing. Diffuse infiltrative tumor resembles pancreatitis. Peripancreatic lymphadenopathy. No or minimal dilatation of pancreatic duct. LymphadenopathyRadioGyan.com 15 Radiology Made Easy! below renal veins in lymphoma but not in pancreatic adenocarcinoma? 149- Metastases to pancreas CT features? Round or ovoid Most heterogeneous, can be diffuse, solitary, or multiple nodules 150. Intra-ductal papillary mucinous neoplasm CT features? Diffuse or segmental dilation of pancreatic duct, atrophy of pancreas, cystic ectasia of branch ducts "punch of grapes", intraductal papillary solid mass, multicystic mass. 151. Pseudocyst CT features? Most common cystic lesion in and around pancreas, low-density collections of fluid, debris, or blood, Distinct walls with occasional calcifications, Generally unilocular, Signs of pancreatitis usually present. 152. Pancreatic mucinous cystic neoplasm CT features? Middle-aged women, Multiloculated cysts, 6 or less cysts > 2 cm are typical, May have calcifications, Most common in tail, pancreatic duct. Do not communicate with 153. Pancreatic serous cystadenoma CT features? Benign, well-circumscribed mass of innumerable small cysts. May have central stellate scar with central calcification. With larger cysts may have honeycomb appearance, Unilocular form indistinguishable from mucinous cystic neoplasms. 154. Splenic cysts? Posttraumatic cyst (most common), Congenital epidermoid cyst, Echinococcal cysts, Pancreatic pseudocyst. 155. Splenic microabscesses CT features? Multiple low-density lesions, differential: lymphoma, kaposi's sarcoma, sarcoidosis, metastases. 156. Most common Hemangioma neoplasm of spleen? 157. Rare primary ‘Angiosarcoma malignancy of spleen? 158. Multiple small focal splenic calcifications? Histoplasmosis or TB. 159. Features of esophageal lack of serosa, early spread, poor prognosis. 90%RadioGyan.com 16 Radiology Made Easy! carcinoma? SCC 10% ADCA (Barrett's) Irregular wall thickening >3mm_Intraluminal polypoid mass Eccentric narrowing of lumen Proximal dilatation Metastases to lymph nodes and liver 160. Esophageal leiomyoma features? Smooth, well-defined mass. Eccentric wall thickening, Leiomyosarcoma (heterogeneous, ulcerate) 161. Esophageal varices, CT features? Well-defined, enhancing nodular and tubular densities adjacent to esophagus 162. Esophagitis causes? Candida, herpes simplex, cytomegalovirus, TB 163. Paraesophageal hernia? Gastric cardia and gastroesophageal junction below esophageal hiatus, adjacent to distal esophagus Fundus of stomach above hiatus, 164. Gastric hernia rotations? Organoaxial (long axis rotation). _Mesenteroaxial (upside down stomach) 165. Gastric varcies without esophageal varices? hallmark findikng of splenic vein thrombosis. 166. Small bowel malignant tumors? Lymphoma (masses, nodular wall thickening), Hematogenous metastases (melanoma, breast lung, RCC), Carcinoid (appendix, mesenteric small bowel, fibrosing reaction) Adenocarcinoma (duodenum) Leiomyosarcoma (large, exophytic, necrosis) 167. Crohn's disease CT features? Terminal ileum 80%, Circumferential thickening (target and double halo), Marked wall enhancement, "comb sign" hyperemic vasa recta, Segmental strictures, Skip areas, Fistulas and sinus tracts, abscesses. 168. Complete mechanical SBO? Dilatation of SB > 2,5 cm, distinct transition zone 167. Paralytic ileus? Dilatation of distal and proximal SB without transition zone 168. Partial mechanical SBO? Transition zone less distinct, small bowel feces 169. Sclerosing mesenteritis features? Inflammatory disorder of unknown cause, chronic inflammation, fat necrosis, fibrosis, misty mesenteryRadioGyan.com 17 Radiology Made Easy! 170. Cystic mesenteric masses? Cystic lymphangiomas, Cystic mesothelioma (rare, benign tumor) cystic teratomas (fat, calcification) 171. Mesenteric neoplasms? Lymphoma (most common), Metastases (more common than primary tumors), Mesenteric fibromatosis (desmoid tumor), GISTs (large, hemorthage, necrosis) Sarcomas (leiomyosarcoma, fibrosarcoma, malignant fibrous histiocytoma liposarcoma) 172. Colon volvulus types? Sigmoid volvulus (most common, mesenteric whirl), Cecal volvulus, Cecal bascule (folding rather than twisting of cecum) 173. Fibrolammelar Carcinoma CT features? Large mass in healthy liver Enhances prominently and heterogeneously Central scar Difficult to distinguish from FNH 174. Liver lymphoma CT features? Diffuse infiltration, Well-defined, homogeneous low- density nodules, Numerous small nodules resembling microabscesses 175. Hepatic adenoma CT features? Young women on oral contraceptives. Menon anabolic steroids. Glycogen storage disease (multiple). Surgical removal for fear of rupture or malignant transformatoin. Unenhanced, isodense to liver. Arterial phase, early homogeneous enhancement. Few Kupffer cells, no sulfur colloid uptake 176. FNH CT features? Mini liver central stellate scar and fibrous bands. Unenhanced, isodense to liver. Arterial phase, immediate intense homogeneous enhancement. May have delayed enhancement of scar. Positive sulfur colloid uptake 177. Cavernous Hemangioma CT features? Unenhanced, hypodense mass. Arterial phase, peripheral nodules of contrast. Venous phase, progressive filling-in from periphery. Delayed, prolonged enhancement. Small hemangiomas, immediate homogeneous enhancement. 178. Cystic liver masses? Hepatic cysts Pyogenic abscess Amebic abscessRadioGyan.com 18 Radiology Made Easy! Hydatid cyst 179. Normal bile duct measurements? Intrahepatic ducts 2 mm in central liver. Common duct < 6mm. Give 1 mm per decade in elderly 180. CT findings of biliary obstruction? Dilated intrahepatic biliary ducts, Dilatation of common duct > 7mm, Gallbladder diameter > 5 cm 181. Precursors of choriocarcinoma? Choledochal cyst. Primary sclerosing cholangitis Caroli's disease intrahepatic stone disease Clonorchiasis 182. Cholangiocarcinoma CT features? Intrahepatic mass-forming, homogeneous tumor with itreguler borders. Periductal infiltrating lesions grow along bile ducts. Intraductal tumors, polypoid or sessile. Extrahepatic cholangiocarcinoma, duct obstructing tumor 183. CT features of primary sclerosing cholangitis? Multiple segmental strictures (beaded appearance) with thickening of bile duct. Complications: obstruction, cholestasis, biliary cirrhosis, cholangiocarcinoma. 184. Choledochal cyst types? Type | cystic dilation of CBD. Typell, CBD diverticulum. Type ll, choledochocele, protrudes into duodenal lumen. Type IVa, intrahepatic saccular dilatations. IVb, extrahepatic multiple cystic dilatations. Type V, Caroli's disease. 185. CT findings of acute cholecystitis? Gallstones in gallbladder 75%, GB distension > 5 cm, GB wall thickening > 3mm, Early-phese enhanced GB fossa, Pericholecystic stranding, Air in GB wall (emphysematous) 186. Gallbladder carcinoma CT features? Polypoid soft-tissue mass, Focal or diffuse wall thickening, Mass containing stones replaces GB and invades liver. 187. CT features of lymphoma in abdomen? Multiple enlarged nodes, Coalescence of enlarged nodes to form multinodular masses which may encase vessels, Conglomerate nodal masses 188. CT features of AIDS in abdomen? lymphadenopathy (MAI, lymphoma, Kaposi's), Focal, small low-density liver lesions (TB, Histo, lymphoma, Kaposi) Focal, small low density spleenRadioGyan.com 19 Radiology Made Easy! lesions (MAI,Cocci, candida, PCP, lymphoma) Splenic or LN calcifications (PCP) Nephromegely with striated nephrogram (HIV nephropathy) Kaposi's sarcoma (adenopathy, hepatosplenomegaly) AIDS- related lymphoma (any solid mass) 189. Surgical indications for splenic trauma? Active bleeding, Large nonperfused portions Pseudoaneurysm formation 190. Cortical rim sign? Delayed finding. Faint enhancement of kidney periphery in renal infarction. Renal capsule supplied by separate arteries 191. Complications of pancreatic trauma? Pseudocyst formation hemorrhagic pancreatitis Abscess Fistula 192. Shock bowel? Severe hypotension and hypoperfusion of bowel. Diffuse dilation of small bowel with wall thickening and increased wall enhancement 192. Extra-peritoneal bladder rupture? Contrast leakage into retropubic space, along abdominal wall, scrotum, thigh, and retroperitoneum. 193. Intra-peritoneal bladder rupture? Contrast in paracolic gutters and surrounding bowel 194. Which adrenal gland more susceptible to traumatic injury? Right adrenal gland. Compression of gland between liver and spine 195. Liver segment I? Caudate lobe, Ligamentum venosum and IVC separate it from liver 196. Liver segments II and III? Lateral division of left lobe. _I!-superior. II!-inferior. 197. Liver segments IV? Medial division of left lobe. |Va-superior. IVb- inferior. 198. Liver segments V & VIII? Anterior segments of right lobe. Vill-superior. V- inferior. 199. Liver segments VI & VI? Posterior segments of right lobe. Vil-superior. VI- inferior. 200. Third inflow? ‘Areas of liver supplied by aberrant systemic veins. Porta hepatis, adjacent to gallbladder, adjacent to fissure of ligamentum teres.RadioGyan.com 20 Radiology Made Easy! 201. Increased liver ‘Amiodarone Hemochromatosis (secondary form- attenuation? hemosiderosis, blood transfusions) 202. Liver nodules in Regenerative nodules Dysplastic nodules Small HCC cirrhosis? nodules Metastatic disease Hemangiomas 203. CT features of portal Portosystemic collateral vessels Enlarged portal hypertension? vein, >13 mm. Splenomegaly Ascites 204. CT features of Budd- Enlarged caudate lobe. Central liver enhances early and peripheral liver enhances late. lesions? Metastases Hepatoma Hepatic adenoma 206. Metastases to liver features on CT? Most common liver malignancy. Most commonly from colon. Target appearance. Hypervascular (carcinoid, choriocarcinoma, pheochromocytoma, RCC, thyroid cancer). Some cystic/nectrotic, calcification 207. HCC CT features? 50% solitary tumor 30% infiltrative 20% multinodular Small tumors, < 3cm bright homogeneous enhancement Necrosis and calcification common Invasion of hepatic and portal veins 208. How much musta renal mass enhance in Hounsfield units before it is considered enhanced? 10-15H 209. Metastatic LN size in RCC? > 2 cm nearly alwasy metastatic, 1-2 cm indeterminate 210. Most common sites for RCC metastases? lungs mediastinum bone liver contralateral kidney adrenal gland brain 211. Bosniak cystic renal mass categories? Category I Benign simple cyst. Category 2 Benign Complicated Category 3 Indeterminate cystic lesions Category 4 Malignant cystic tumors (enhancing soft tissue) 212. VHL & TS CNS involvement differences? VHL-cerebellar, spinal cord, and retinal hemangioblastomas. TS--retinal and cerebral hamartomasRadioGyan.com 21 Radiology Made Easy! 213. Emphysematous pyelonephritis versus emphysematous pyelitis? Emphysematous pyelonephritis: diabetes, urinary obstruction, gas in renal parynchema, nephrectomy. Emphysematous pyelitis: gas in pelvis and calyces (trauma, iatragenic, infection), not a surgical urgency. 214. Renal stone not seen at CT? Crystallin stones related to indinavir (protease inhbitor HIV Rx) 215. What size renal stones can pass on their own? <4mm nearly always pass. > 8 mm rarely pass. 216. Tissue rim sign? Halo of soft tissue that surrounds ureter stone. 217. Absence of white pyramids? Subtle sign of urinary obstruction on affected side. 218. Phlebolith distinguishers? tail sign (vein), central lucency, round 219. Adrenocortical carcinoma features? large >5 cm Necrosis and calcification Delayed contrast washout 220. Adrenal calcification causes? Children (neuroblastoma, gnaglioneuroma) Adult (adrenal carcinoma, pheochromocytoma, glanglioneuroma, metastases) Wolman's disease (autosomal recessive, enlarged calcified adrenal glands, hepatosplenomegaly) 221. In adrenal hyperplasia, adrenal limb thickness exceeds? 10mm 222. Organ of Zuckerkandl? Common location for extra-adrenal pheochromoctyomz. Near origin of IMA. 223. Common metastases to adrenal glands? Lung Breast Melanoma 224. Li ich adrenal adenoma Hounsfield units? <10H 225. Lipid-poor adrenal adenoma features? Non-contrast H > 10 Enhancement washout > 50% 15 minute post-contrast H< 35 226. Serous ascites attenuation value in H? -10 to #15 227. Hemoperitoneum attenuation value in H? >35, averaging 45 HRadioGyan.com 22 Radiology Made Easy! 228. With absence of intrahepatic segment of IVC, how does lower body venous blood reach the heart? Drainage to SVC via azygos system? 229. Aneurysmal diameters of abdominal aorta and iliac arteries? AAA>3cm Iliac aneurysm > 1.5 cm 230. Hyper-attenuating crescent sign? Crescent area of high attenuation (dissecting contrast) within wall or intraluminal thrombus of AAA, impending rupture 231. Beak sign in distinguishing true lumen from false lumen in aortic dissection? Intimal flap and false lumen wall create an acute angle: beak sign 232. Dilatation of vein at site of DVT means acute or chronic? Acute 233. Abdominal & retrocrural LN pathologic size cutoff? Abdominal LN > 10 mm. Retrocrural LN >6 mmRadioGyan.com 23 Radiology Made Easy! 1. Patients with Sjogren syndrome are at increased risk for developing what diffuse lung diseases Lymphocytic interstitial pneumonitis (LIP). Non- Hodgkin pulmonary lymphoma. 2. Ankylosing spondylitis lung involvement Young to middle-aged man with spine changes (kyphosis, spinal ankylosis). Increased lung volumes. Upper lobe fibrobullous disease. Simulates postprimary fibrocavitary Tb or mycetoma formation. 3. These histologic terms provide the most precise method of classi idiopathic interstitial UIP. Acute interstitial pneumonia (AIP). COP. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). DIP. Nonspecific interstitial pneumonia (NSIP). pneumonias 4. Usual Interstitial Most common of the idiopathic interstitial Pneumonia pneumonias. Most cases are sporadic. 30% of cases associated with collagen vascular or immunologic disorder. Findings: Irregular septal or subpleural thickening. Intralobular lines. Honeycombing. Traction bronchiectasis. Typically most severe in peripheral and basal lungs. 4. Acute Interstitial Pneumonia Diffuse ground-glass opacity and consolidation with air bronchograms. Linear opacities, honeycombing, and traction bronchiectasis are uncommon. 5. Conditions associated with BOOP, organizing pneumonia. Viral infection (influenza, adenovirus, measles). Toxic fume inhalation (sulfur dioxide, chlorine). Collagen vascular disease (rheumatoid arthritis and SLE). Organ transplantation (bone marrow, lung, and heart-lung). Drug reactions. Chronic aspiration 6. Cryptogenic Organizing Pneumonia Idiopathic form of organizing pneumonia. Most common finding: Patchy consolidation or ground- glass opacity with subpleural or peribronchial distribution. Scattered nodular opacities may be present. 7. Respiratory Bronchiolitis- Associated Interstitial Lung Disease Typically young, heavy smokers. Scattered ground- glass opacities. Small centrilobular nodules with upper lobe predominance. 8. Desquamative Interstitial Pneumonia 95% are cigarette smokers. Cannot be radiologically distinguished from UIP. Bibasilar reticular opacities.RadioGyan.com 24 Radiology Made Easy! Normal or midly decreased lung volumes. May have ground-glass opacities. Honeycombing is rare. 9. Neurofibromatosis ILD Generally asymmetric upper lung bullae. Generally symmetric lower lung interstitial fibrosis. 10. Tuberous Sclerosis (TS) ILD Indistinguishable from LAM. Symmetric bilateral reticular or reticulonodular opacities. Scattered lung cysts. Normal to increased lung volumes. Pneumothorax is common 11. Lymphangioleiomyomatosis Exclusively in women. Lung cysts separated by interlacing bundles of smooth muscle. May obstruct lymphatics causing chylothorax. Poor prognosis. 12. Alveolar Septal Simulates silicosis or lung sarcoidosis. Upper lung pneumoconioses Amyloidosis reticulonodular opacities. 13. Chronic Aspiration Irregular reticular interstitial opacities. Pneumonia 14. 3 major Asbestosis. Silicosis. CWP. 15. Asbestosis Pleura: Parietal pleural plaques. Pleural effusion. Localized visceral pleural fibrosis. Diffuse pleural fibrosis. Mesothelioma. Lung parenchyma: Interlobular septal thickening. Interstitial fibrosis (asbestosis). Rounded atelectasis. Bronchogenic carcinoma. Lower lung predominance. 16. Silicosis Mining, ceramic work, and sandblasting. Upper lobe and parahilar nodules. Nodule calcification may occur. Egg shell calcification of hilar lymph nodes. Silicoproteinosis like alveolar proteinosis has increased susceptibility to TB. 17. Coal Worker's Pneumoconiosis Predominantly upper lung reticulonodular or small nodular opacities, 18. Rare Pneumoconioses Berylliosis, Aluminum. Hard metal (cobalt, tungsten). 19. Hypersens' Pneumonitis Inhaled antigenic organic dusts: Farmer's lung (moldy hay). Humidifier lung (thermophilic bacteria). Bird- fancier's lung (avian proteins). Acute and chronic forms. Chronic disease findings: Interlobular and intralobular interstitial thickening. Honeycombing, Traction bronchiectasis. May spare costophrenic angles.RadioGyan.com 25 Radiology Made Easy! 20. Lung Sarcoidosis staging? O Normal chest radiograph. 1 Bilateral hilar Iymph node enlargement. 2 Bilateral hilar lymph node enlargement and parenchymal disease 3. Parenchymal disease only. 4 Pulmonary fibrosis. 21. Sarcoidosis ILD Common findings: Symmetric hilar adenopathy allows distinction from malignancy and TB. Symmetric mid and upper lung reticulonodular opacities. Perilymphatic interstitial nodules, 3 to 10 mm. 22. Langerhans Cell Histiocytosis of Lung Very high association with cigarette smoking. Mid and upper lung centrilobular small nodules. In late stages may develop cysts or bullae. Risk of pneumothorax. Nodule-cyst evolution: Nodule to Cavitated nodule to Thick-walled cyst to Thin-walled cyst. 23. Wegener Granulomatosis Necrotizing granulomatous vasculitis involving upper and lower respiratory tracts and kidneys. Discrete nodules or masses with central necrosis and cavitation. May mimic Goodpasture syndrome and idiopathic pulmonary hemorrhage. Tracheal or bronchial lesions may be present. c-ANCA positive. 24. Chronic Eosinophilic Pneumonia ‘Symptoms and radiographic abnormalities last longer than 1 month. Predilection for women. Responds to corticosteroid therapy, improving within 4 to 7 days. Peripheral, homogeneous, ill-defined areas of consolidation that may parallel the chest wall 25. Hypereosinophilic syndrome Male predominance. Blood eosinophilia Cardiomegaly. Pulmonary edema. Pleural effusions. Pulmonary parenchymal infiltration with eosinophils may produce interstitial or airspace opacities. 26. Eosinophilic Lung Disease Associated With Autoimmune Diseases Wegener granulomatosis. Sarcoidosis. Rheumatoid lung disease. Polyarteritis nodosa. Allergic angiitis and granulomatosis. 27. Eosinophilic Lung Disease of Identifiable Etiology Drugs (Nitrofurantoin and Penicillins). Parasites (Ascaris lumbricoides, Strongyloides stercoralis) 28. Pulmonary alveolar proteinosis Lipoproteinaceous material deposits within alveoli. Predilection for males in their 20s to 40s. Bilateral symmetric perihilar airspace opacification. Crezy paving CT finding: Geographic ground-glass opacitiesRadioGyan.com 26 Radiology Made Easy! with thickened interlobular and intralobular septa. Prone to superinfection with Nocardia, Aspergillus, Cryptococcus, and atypical mycobacteria. 29. Alveolar microlithiasis Deposition of minute calculi within alveolar spaces. Confluent bilateral dense micronodular opacities. So- called black pleura sign. Apical bullous disease is common. 30. Diffuse pulmonary ossification Formation of bone within lung parenchyma. Associations: Mitral stenosis. UIP. Amyloidosis. 31. Tracheocele Paratracheal air cysts. True diverticula. Occur at weakened posterior membrane of cervical trachea. 32. Tracheal bronchus Bronchus suis. Accessory bronchus to all ora portion of right upper lobe. Arises from right lateral tracheal wall within 2 cm of tracheal carina. Associated with congenital tracheal stenosis and aberrant left pulmonary artery. 33. Primary neoplasms of trachea Malignant: Squamous cell carcinoma. Adenoid cystic carcinoma (cylindroma). Benign: Chondroma. Fibroma. Squamous cell papilloma. Hemangioma. 34. Tracheal Narrowing ‘Saber-sheath trachea. Amyloidosis. Tracheobronchopathia osteochondroplastica. Relapsing polychondritis. Wegener granulomatosis. Tracheal scleroma. 35. Tracheal dilation Tracheobronchomegaly (Mounier-Kuhn syndrome). Tracheomalacia. Interstitial pulmonary fibrosis. 36. Saber-sheath trachea Coronal diameter is less than two thirds of sagittal diameter. Affects older men with chronic obstructive pulmonary disease (COPD) 37. Tracheobronchopathia osteochondroplastica Multiple submucosal osseous and cartilaginous deposits within trachea and central bronchi of elderly men. Spares membranous posterior wall of trachea 38. Relapsing polychondritis Systemic autoimmune disorder. Affects cartilage of earlobes, nose, larynx, tracheobronchial tree, joints, and large elastic arteries. Diffuse smooth wall thickening of the wall of trachea and central bronchi with luminal narrowing. 39. Tracheobronchomegaly (Mounier-Kuhn syndrome) Congenital. Associated with Ehlers-Danlos syndrome. Men under age 50. Trachea and central bronchi measure greater than 3.0 cm and 2.5 cm.RadioGyan.com 27 Radiology Made Easy! 40. Tracheobronchomalacia Diffuse tracheal and central bronchial dilation. Congenital or acquired (COPD, Chronic bronchitis, Cystic fibrosis, Relapsing polychondritis). 41. Fallen lung sign Subtended lung remains collapsed against lateral chest wall. Secondary to bronchial injury. Responds poorly to chest tube evacuation. 42. Broncholithiasis Calcified material within bronchus. Usually from eroding calcified lymph nodes (Histoplasmosis or TB). 43. Asthma Transient bronchial narrowing. Peribronchial cuffing and tram tracking. Air trapping: Hyperinflation, Flattening or inversion of diaphragm, Attenuation of peripheral vascular markings. Prominence of the retrosternal airspace. Complications: Pneumomediastinum. Pneumothorax, Subpleural blebs from expiratory air dissection. 44. Chronic bronchitis. Excess production of sputum on most days for at least 3 months in 2 consecutive years. 50% have normal chest radiographs. Some patients show peribronchial cuffing or tram tracks. 45. Bronchiectasis. Permanent dilation of bronchi. Cylindric bronchiectasis: mild diffuse dilation. Varicose bronchiectasis: cystic dilation interrupted by focal areas of narrowing. Cystic bronchiectasis: localized saccular dilation. Caused by chronic inflammation with cartilage damage and dilation. Localized bronchiectasis is most commonly a result of prior TB. Generalized bronchiectasis is seen in cystic fibrosis. Central bronchiectasis: Allergic bronchopulmonary aspergillosis. Cystic fibrosis. Bronchial atresia. Acquired central bronchial obstruction. Production of abnormally thick, tenacious mucus. Recurrent infection commonly with Pseudomonas aeruginosa or Staphylococcus aureus. Severe bronchiectasis. Hyperinflation with predominantly upper lobe bronchiectasis and mucus plugging. 47. Dysmotile cilia syndrome. May result in Rhinitis. Sinusitis. Bronchiectasis. Dysmotile spermatozoa and sterility. Situs inversus. Dextrocardia. 48. Kartagener syndrome triad. Sinusitis. Situs inversus.. Bronchiectasis.RadioGyan.com 28 Radiology Made Easy! 49. Allergic bronchopulmonary aspergillosis. Hypersensitivity reaction to Aspergillus. Asthma, blood eosinophilia, bronchiectasis with mucus plugging, and circulating antibodies to Aspergillus antigen. Proximal upper lobe bronchiectasis with mucoid impaction. Finger in glove appearance. 50. Emphysema. Permanent enlargement of airspaces distal to. terminal bronchiole. Destruction of alveolar walls without obvious fibrosis. 51. Centrilobular emphysema. Airspace distention in central portion of lobule. Spares distal portions of the lobule. Upper lobe predominance. Associated with cigarette smoking. 52. Panlobular emphysema. Distention of airspaces throughout lobule. Destruction of central respiratory bronchioles and peripheral alveolar sacs and alveoli. Predilection of lower lobes. Associated with alpha-1 antitrypsin deficiency. 53. Paraseptal emphysema. Distention of peripheral airspaces adjacent to interlobular septe. Spares centrilobular region. Generally involves subpleural regions of upper lobes. 54. Paracicatricial or irregular emphysema. Lung destruction associated with fibrosis. No consistent relationship to a given portion of the lobule. Commonly associated with old granulomatous inflammation. 55. Emphysema findings. Diffuse hyperlucency (panlobular). Flattening and depression of hemidiaphragms. Increased retrosternal airspace (panlobular > centrilobular). Bulla. Enlarged central pulmonary arteries. Right heart enlargement (centrilobular). Loss of pulmonary capillary bed. 56. Arterial deficiency emphysema versus increased markings emphysema. Arterial deficiency: Predominantly panlobular emphysema. Hyperinflated lungs with peripheral vascular attenuation and bullae. Pink Puffers. Increased markings: Increased linear parenchymal markings. Small airways thickening of chronic bronchitis. Bullae uncommon. Blue Bloaters. 57. Bulla defined. Thin-walled cystic space > 1 cm in diameter. Found within lung parenchyma. 58. Bullae may be seen in diseases that cause chronic ‘Sarcoidosis. Pulmonary Langerhans cell histiocytosis. Ankylosing spondylitis.RadioGyan.com 29 Radiology Made Easy! upper lobe fibrosis, such as: 59. Primary bullous disease. Isolated bullae without intervening emphysema or interstitial lung disease. Associated with: Marfan or Ehlers-Danlos syndromes. Intravenous drug use. HIV infection. Vanishing lung syndrome. 60. CT findings & associations of infectious bronchiolitis. Tree-in-bud opacities. Generally due to infection: Viral. Atypical. Mycobacterial. 61. CT findings of diffuse panbronchiolitis? Tree-in-bud opacities. Bronchial dilation and thickening. 62. CT findings & associations of Respiratory bronchiolitis—associated interstitial lung disease (RB- ILD). Centrilobular and geographic ground-glass opacities. Cigarette smoking. 63. CT findings & associations of Hypersen: pneumonitis (sub-acute)? Centrilobular ground-glass nodules. Air trapping on expiratory scans. Inhaled organic antigen. 64. CT findings and associations of Follicular bronchiolitis? Centrilobular ground-glass nodules. Rheumatoid arthritis. Sjogren syndrome. 65. CT findings and associations of Constrictive bronchiolitis? Mosaic attenuation with air trapping on expiratory scans. Bronchial dilation (late). Transplant patients. Drug reactions. inhalation injury. 66. Transudative pleural effusion lab values Pleural/serum protein ratio less than 0.5. Pleural/serum LDH ratio less than 0.6. Pleural LDH less than 200 IU/L. 67. Infectious causes of pleural effusion? Bacterial/mycobacterial. Viral. Fungal. Parasitic. 68. Cardiovascular causes of pleural effusion? Heart failure. Pericarditis. Superior vena cava obstruction. Postcardiac surgery. Myocardial infarction. Pulmonary embolism. 69. Neoplastic causes of pleural effusion? Bronchogenic carcinoma. Metastases. Lymphoma. Pleural or chest wall neoplasms (mesothelioma). 70. Immunologic causes of Systemic lupus erythematosus. Rheumatoid arthritis.RadioGyan.com 30 Radiology Made Easy! pleural effusion? Sarcoidosis (rare). Wegener granulomatosis. 71. Inhalational cause of pleural effusion? Asbestosis. 72. Trauma causes of pleural effusion? Blunt or penetrating chest trauma. 73. Abdominal disease causes of pleural effusion? Cirrhosis (hepatic hydrothorax). Pancreatitis. ‘Subphrenic abscess. Acute pyelonephritis. Ascites (from any cause). Splenic vein thrombosis. 74. Miscellaneous causes of pleural effusion? Drugs. Myxedema. Ovarian tumor. 75. Pleural effusion from congestive heart failure features? Transudative. Bilateral, right larger than left. Isolated right effusion twice as common as isolated left effusion. 76. Findings on CT that are fairly specific for the presence of an exudative pleural effusion? Thickening and enhancement of parietal pleura. Loculations. Soft tissue lesions along parietal pleura outlined by pleural fluid. 77. Tumors most commonly associated with pleural effusion are, in order of frequency, Lung carcinoma. Breast carcinoma. Pelvic tumors (ovarian fibroma = Meigs syndrome). Gastric carcinoma. Lymphoma. 78. Lung abscess versus empyema? Empyema: Oval. Oriented longitudinally. Thin. ‘Smooth (split pleura sign). Obtuse chest wall angle. Compresses lung. Requires drainage. Abscess: Round. Thick and irregular wall. Acute chest wall angle. Consumes lung. Antibiotics and postural drainage to treat. 79. Most common intra- thoracic manifestation of rheumatoid arthritis? Pleural effusion. 80. Most common causes of Malignancy. latrogenic trauma. TB chylothorax are? 81. Left chylothorax vs right | Left chylothorax: Injury to upper duct. chylothorax? Right chylothorax: Injury to lower duct. 82. Bronchopleural Fistula ‘Communication between lung & pleural space. If bronchus involved, may result in empyema.RadioGyan.com 31 Radiology Made Easy! If peripheral airspace (bronchiole) involved, may result in intractable pneumothorax. 83. Primary spontaneous pneumothorax. Often occurs in young or middle-aged men Predilection of taller individuals. Results from bleb or bulla rupture, usually within upper lungs. 84. Secondary Spontaneous Pneumothorax. COPD. Asthma. Valsalva (cocaine, marijuana, labor). Sarcoidosis. Langerhans cell histiocytosis. Lymphangioleiomyomatosis. Necrotizing pneumonia. Abscess. Mechanically ventilated patients. 85. Catamenial pneumothorax. Rare recurrent pneumothoraces. Occurs with menses. Pleural endometrial implants. Treated with OCPs. 86. Most common cause of tension pneumothorax. latragenic trauma in mechanically ventilated patients. 87. Causes of pleural thickening? Pneumonia. Pulmonary infarct. Trauma. Asbestos exposure (bilateral). 88. Causes of pleural calcification? Visceral pleura: Hemothorax, Empyema (TB). Parietal pleura: Asbestos exposure (bilateral). 89. Causes of pleural /extra-pleural masses? Benign: Fibroma. Lipoma. Neurofibroma. Malignant: Metastases (usually multiple). Mesothelioma (usually diffuse pleural thickening). Other: Loculated pleural effusion /empyema. Hematoma. 90. Fluid within calcified pleural layers seen on CT suggests? Active empyema. Most commonly within patients with prior TB. 91. Fibrothorax. Pleural thickening extending over more than one fourth of the costal pleural surface. Commonly results from resolution of an exudative pleural effusion (including asbestos-related effusions), Empyema, or Hemothorex. Pleurectomy (decortication) may be necessary to restore function. 92. Malignant pleural disease is most often caused by 1 of 4 conditions: Metastatic adenocarcinoma (lung, breast, ovary, kidney, GI tract). Invasive thymoma or thymic carcinoma. Mesothelioma. Rarely non-Hodgkin lymphoma. 93. Benign & malignant Benign: Pleural plaques. Pleural effusions. DiffuseRadioGyan.com 32 Radiology Made Easy! asbestos - related pleural Diseases? pleural fibrosis. Malignant: Mesothelioma. 94. When viewed en face, calcified pleural plaques appear as? Geographic opacities. Likened to a holly leaf. 95. Poland syndrome ‘Autosomal recessive disorder. Unilateral absence of sternocostal head of pectoralis major. Ipsilateral syndactyly. Rib anomalies. 96. Most common benign neoplasm of chest wall? lipoma 97. Most common malignant soft tissue neoplasms of the chest wall in adults. Fibrosarcomas. Liposarcomas. 98. A rare malignant neoplasm arising from the chest wall of children and young adults Askin tumor. Arises from primitive neuroectodermal rests. Very aggressive with a poor prognosis. 99. Benign chest wall lesions? Abscess. Hematoma. Lipoma. Hemangioma. Desmoid tumor. 100. Inferior rib notching causes? Coarctation of aorta. Aortic thrombus. Takayasu arteritis. SVC syndrome. Neurofibromatosis. 101. Superior rib notching cause? Paralysis. 102. Benign rib neoplasms, most common first? Osteochondroma. Enchondroma. Osteoblastoma. 103. Most common primary rib malignancy? Chondrosarcoma. 104, Rib malignancies Most common: Myeloma. Metastatic carcinoma. ary malignancies: Chondrosarcoma. Osteogenic sercoma. Fibrosarcoma. 105. Most common metastatic lesions to ribs? Breast cancer. Lung cancer. 106. Expansile lytic rib metastases are seen most Renal cell carcinoma. Thyroid carcinoma.RadioGyan.com 33 Radiology Made Easy! commonly from? 107. Sclerotic rib metastases are most commonly seen in? Breast cancer. Prostate cancer. 108. Pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include? TB. Actinomycosis. Nocardiosis. 109. Sprengel deformity Congenital hypoplastic and elevated scapula. 110. Klippel-Feil syndrome. Sprengel deformity (hypoplastic, elevated scapula). Omovertebral bone. Fused cervical vertebrae. Hemivertebrae. Kyphoscoliosis. Rib anomalies. 111. Erosion of the distal clavicles. Rheumatoid arthritis: Well-defined pointed distal clavicle. Hyperparathyroidism: Irregular and wide distal clavicle. 112. H-shaped or Lincoln log vertebrae on lateral chest radiographs? Sickle cell anemia. 113. Rugger jersey appearance to thoracic spine on lateral chest radiographs? Renal osteosclerasis. 114, Pectus excavatum is commonly associated with congenital connective tissue disorders, such as Marfan syndrome. Poland syndrome. Osteogenesis imperfecta. Congenital scoliosis. 115. Pectus carinatum Outward bowing of sternum. May be congenital or acquired. 116. Eventration of the diaphragm Congenital absence or underdevelopment of diaphragmatic musculature. Localized elevation of anteromedial hemidiaphragm in older individuals, 117. Unilateral diaphragmatic paralysis is usually caused by? Surgical injury or neoplastic involvement of phrenic nerve. 118. Bilateral Neuromuscular disturbance. Intra-thoracic or intra-RadioGyan.com 34 Radiology Made Easy! Diaphragmatic Elevation that is not effort related may be caused by? abdominal disease. 119. Bochdalek Hernia Herniation through embryonic pleuroperitoneal canal. Neonates present with large hernias with lung hypoplasia and respiratory distress. Adults present with small hernias, mostly on the left side (liver thought to be protective). 120. Morgagni Hernia. Parasternal diaphragm defect. Invariably right sided Asymptomatic cardiophrenic angle mass. 121. Primary diaphragmatic tumors. Benign: Lipomas. Fibromas. Schwannomas Neurofibromas. Leiomyomas. Echinococcal cysts & extra-lobar sequestrations may be found within the diaphragm. Metastatic invasion more common > 1.ry malignancy (Fibrosarcoma): Lower lobe bronchogenic carcinoma. Mesothelioma. 122. Cystic adenomatoid malformation (CAM). Usually seen in infancy. One or several large cysts lined with respiratory epithelium with scattered mucous glands, smooth muscle & elastic tissue. Round, air-filled masses that compress adjacent lung and mediastinum. 123. Bronchial atresia presentation? Central bronchial mucocele with peripheral hyper- lucency in 2 young, asymptomatic patient. 124, Intra-lobar & extra- lobar sequestration blood supply & drainage? Intralobar sequestration: Single large artery from infra-diaphragmatic aorta. Pulmonary vein drainage. Extralobar sequestration: Small branches systemic arteries and occasionally pulmonary arteries. Systemic venous drainage (IVC, azygos, or hemiazygos veins). 125. Hypogenetic lung- scimitar syndrome? Variant of hypoplastic lung with abnormal venous drainage to the IVC just above or below right hemi- diaphragm. Small Rt. hemithorax with diaphragmatic elevation or eventration. Dextroposition of heart. Herniation of Lt. lung anteriorly into Rt. hemithorax. 126. Three radiographic patterns of aspiration pneumonitis? Extensive bilateral airspace opacification. Diffuse but discrete airspace nodular opacities. Irregular parenchymal opacities that are not obviously airspace.RadioGyan.com 35 Radiology Made Easy! 127. Exogenous lipoid pneumonia. Older patients with swallowing disorders or gastroesophageal reflux. Use mineral oil as a laxative or inhale oily nose drops. Fat density opacity. 128. Drug that cause drug induced chest diseases Lupus-like syndrome (procainamide, isoniazid, hydralazine). Nitrofurantoin. Bleomycin. Methotrexate. Amiodarone. 129. Aconfident diagnosis of hamartoma can be made when HRCT shows? Nodule < 2.5 cm with a smooth or lobulated border & containing focal fat. May have popcorn calcification. 130. Benign neoplasm arising from neural elements in central airways or lung parenchyma. The skin is the most common site for these tumors. Granular cell myoblastoma 131. Bronchogenic adenocarcinoma features? Most common type of lung cancer (nonsmokers, too). Arise from bronchiolar or alveolar epithelium. Irregular or spiculated appearance. Occur in the lung periphery. 132. Bronchioloalveolar cell | Grows along bronchiolar and alveolar walls (lepidic carcinoma (BAC) growth). May appear as: Solitary nodule. Focal ground-glass opacity. May mimic pneumonia or bilateral nodular airpsace processes. 133. Squamous cell carcinoma features? Arises centrally within lobar or segmental bronchi. Central necrosis with cavitation may be seen. Generally presents as hilar mass & atelectasis. 134. Small cell carcinoma features? Arises centrally within main or lobar bronchi from bronchial neuroendocrine (Kulchitsky) cells. Hematogenous dissemination. Hilar/mediastinal mass 135. Large cell bronchogenic carcinoma radiographic feature? Large peripheral mass. 136. In addition to cigarette smoke, well-recognized risk factors for development of bronchogenic carcinoma? Asbestos exposure. Previous Hodgkin lymphoma. Radon exposure. Viral infection, Diffuse interstitial or localized lung fibrosis.RadioGyan.com 36 Radiology Made Easy! 137. Most common radiographic findings from endo-bronchial tumor obstruction Resorptive atelectasis. Obstructive pneumonitis. 138. Majority of pancoast tumors, histology type? SCC. Adenocarcinoma. 139, Pancoast tumor symptoms? ‘Arm pain & muscular atrophy due to brachial plexus involvement. Horner syndrome (ptosis, anhydrosis, miosis) from involvement of sympathetic chain. Shoulder pain from chest wall invasion. 140. CT angiogram sign & BAC? Filling of airspaces with mucoid material produced by malignant cells creates low-density airspace opacification surrounding enhanced pulmonary arteries. 141. Typical radiologic findings of lymphangitic carcinomatosis? Linear and reticulonodular opacities. Peribronchial cuffing. Sub-pleural edema or pleural effusion. 142. Helps distinguish lymphangitic carcinomatosis due to lung cancer from other metastases Unilateral or asymmetric involvement of lungs suggests lung cancer rather than an extra-pulmonary site. 143. 2 patient groups of small cell lung cancer? Disease limited to one hemithorax > limited disease. Contralateral lung or extra-thoracic spread > extensive disease. 144, 2 most common 1L.ry tracheal malignancies? SCC > Adenoid cystic carcinoma. 145. Tracheal mass size & malignancy Masses > 2 cmare likely to be malignant. Masses < 2 cm are more likely benign. 146. Other, less common ry tracheal malignancies? Mucoepidermoid carcinoma. Carcinoid tumor. Adenocarcinoma. Lymphoma. Small cell carcinoma. Leiomyosarcoma. Fibrosarcoma. Chondrosarcoma. 147. L.ry malignant neoplasms of central bronchi? ‘Squamous cell carcinoma. Small cell carcinoma. Carcinoid tumor. Bronchial gland tumors (adenoid cystic carcinoma, mucoepidermoid carcinoma). 148. Carcinoid radiologic features? Prefers Rt. upper & middle lobes. Well-defined smooth or lobulated nodules or masses. Iceberg tumor: small intra-bronchial & large extra~RadioGyan.com 37 Radiology Made Easy! luminal soft tissue component. 149. A benign neoplasm comprised of disorganized epithelial & mesenchymal elements normally found in the bronchus or lung. Pulmonary hamartoma. 150. A feature that helps distinguish lymphangitic carcinomatosis from interstitial fibrosis, Thickened septal lines of lymphangiti carcinomatosis do not distort the pulmonary lobule. 151. Lymphocytic interstitial pneumonitis (LIP). Infiltration of pulmonary interstitium by mature lymphocytes. CT findings: Diffuse ground-glass opacity. Poorly defined centrilobular nodules. Thin-walled cysts. Associations: Sjogren syndrome. Hypo-gamma- globulinemia. Multicentric Castleman disease. AIDS. 152. Post-transplant lymphoproliferative disorder (PTLD) ‘Spectrum of entities > Ranging from benign polyclonal lymphoid proliferation to aggressive non- Hodgkin lymphoma. 153. Pulmonary blastoma Rare malignant tumor affecting children & young adults. Histology simulates fetal lung at 10 to 16 weeks’ gestation. Tend to be extremely large at presentation. 154. Lobar pneumonia features? Typical of pneumococcal pulmonary infection. Inflammatory process spreads via pores of Kohn and canals of Lambert to produce non-segmental consolidation. Air bronchograms are common 155. Bronchopneumonia features? Most common pattern of pneumonia. Typical of staphylococcal pneumonia. Inflammation centered around lobular bronchi. Multifocal opacities produce patchwork quilt of scattered normal and diseased lobules. No air bronchograms due to exudate within bronchi. 156. Interstitial ppeumonia features? Viral and mycoplasma infection. Inflammatory thickening of bronchial and bronchiolar walls and pulmonary interstitium Peribronchial cuffing & reticulonodular opacities. 157. Pneumatoceles may Thin walls. Rapid change in size.RadioGyan.com 38 Radiology Made Easy! be distinguished from abscesses by? Generally develop during late phase of infection. 158. Ranke complex? Calcified parenchymal focus (Ghon lesion) & LN calcification. Primary TB. 159. Post-primary TB? Reactivation occurs in apical and posterior segments of upper lobes and superior segments of lower lobes lll-defined patchy and nodular opacities. Cavitation usually indicates active & transmissible disease. 160. Rasmussen aneurysm Erosion of cavitary focus into pulmonary artery branch can produce an aneurysm. 161. Miliary TB. May complicate 1.ry or reactivation disease. Hematogenous dissemination. Diffuse bilateral 2- to 3-mm pulmonary nodules. 162. Opportunistic fungal lung pathogens? Aspergillus. Candida. Cryptococcus. 163. Aspergillus lung involvement? Aspergilloma / mycetoma within preexisting cavities. Semi-invasive (chronic necrotizing) aspergillosis in mildly impaired immunity. Invasive pulmonary aspergillosis in neutropenia. Allergic bronchopulmonary aspergillosis in hyper- immunity. 164, Pulmonary echinococcal cysts are composed of 3 layers: Inside out: Endocyst > produces daughter cysts. Exocyst (chitinous layer) > protective membrane. Pericyst > surrounding compressed, fibrotic lung. 165. CT halo sign. Decreased attenuation surrounding a dense, mass- like opacity. Relatively specific for invasive aspergillosis in a neutropenic patient. 166. Most common AIDS- g Opportunistic infection? PCP. 167. Interlobular (Septal) Lines Thin, short, 1-to 2-cm lines oriented perpendicular to and intersecting costal pleura. 168. Interlobular (septal) lines DDx:- Interstitial edema. Lymphangitic carcinomatosis. Sarcoidosis. Idiopathic pulmonary fibrosis (IPF) (other forms of usual interstitial pneumonia UIP).RadioGyan.com 39 Radiology Made Easy! 169. Intra-lobular lines ILD, DDx? IPF (UIP). Asbestosis. Alveolar proteinosis. Hypersensitivity pneumonitis. 170. Thickened fissures ILD, DDx? Pulmonary edema. Sarcoidosis. Lymphangitic carcinomatosis. 171. Peribronchovascular interstitial thickening, DDx? Pulmonary edema (smooth). Sarcoidosis (nodular). Lymphangitic carcinomatosis (smooth or nodular). 172. Centrilobular nodules ILD, DDx? Hypersensitivity pneumonitis. Bronchiolitis obliterans with organizing pneumonia (BOOP)/cryptogenic organizing pneumonia (COP). Respiratory bronchiolitis-associated ILD (RB-ILD). 173. Sub-pleural lines ILD DDx? Asbestosis. IPF (UIP). 174. Parenchymal bands ILD DDx? Asbestosis. IPF (UIP). Sarcoidosis. 175. Honeycombing, DDx? IPF (UIP). Asbestosis. Hypersensitivity pneumonitis (chronic). Sarcoidosis. 176. Thin-walled cysts ILD DDx? Eosinophilic granuloma (EG). Lymphangioleiomyomatosis. Tuberous sclerosis. Neurofibromatosis (pneumatocele). (emphysema). 177. Micronodules, random distribution ILD DDx? Miliary TB or histoplasmosis. Hematogenous metastases. Silicosis / CWP. EG. 178. Micronodules, peri- lymphatic distribution ILD DDx? Sarcoidosis. Lymphangitic carcinomatosis. Silicosis/CWP. 179. Ground-glass opacities ILD DDx? Desquamative interstitial pneumonia (DIP). Acute interstitial pneumonia (AIP). Hypersensitivity pneumonitis. BOOP/COP. RB-ILD. Hemorrhage. PCP. CMV pneumonia. Alveolar proteinosis. 180. Traction bronchiectasis ILD DDx? Sarcoidosis. Silicosis / CWP. 181. Conglomerate mass ILD DDx? Sarcoidosis. Silicosis. CWP. Radiation fibrosis. 182. Sub-pleural Lines? 5-10 cm long curvilinear opacities are found within 1 cm of pleura & parallel the chest wall. Most often seen in patients with asbestosis & less commonly, IPF.RadioGyan.com 40 Radiology Made Easy! 183. Parenchymal bands. Non-tapering linear opacities, 2 to 5 cm in length. Extend from lung to contact pleural surface. Asbestosis. IPF. Sarcoidosis. 184, Honeycombing. ‘Small (6to 10 mm) cystic spaces with thick (1 to 3 mm) walls. Usually have shared walls. Usually in posterior subpleural regions. End-stage pulmonary fibrosis: IPF (UIP). Chronic hypersensitivity pneumonitis. Occasionally sarcoidosis. 185. Thin-walled cysts. Slightly larger in diameter (10 mm) than honeycomb cysts. Uniform in size. Thinner walls. Do not share walls with adjacent cysts. Cysts of LCH and LAM are usually evenly distributed from central to peripheral portions of upper lobes 186. Micronodules. 1- to 3-mm. Sharply marginated. Round opacities seen on HRCT. Represent conglomerates of granulomas or tumor cells within the interstitium. 187. Ground-Glass or Hazy Increased Density Granular appearance with maintained visibility of pulmonary vessels. Absence of air bronchograms. Desquamative interstitial pneumonia (DIP). Pneumocystis jiroveci (formerly P carinii) pneumonia (PCP). Acute hypersensitivity pneumonitis. Non- specific interstitial pneumonia (NSIP). Interstitial pulmonary edema 188. Traction Fibrosis causes traction on the walls of bronchi, bronchiectasis resulting in irregular dilation. 189. ILDs Upper zone TB (post-primary). Chronic fungal infection distribution? (Histoplasmosis, Coccidioidomycosis}. Sarcoidosis. Eosinophilic granuloma. Silicosis. Ankylosing spondylitis. Hypersensitivity pneumonitis (chronic). Radiation fibrosis from ttt of head & neck malignancy 190. ILDs Lower zone distribution? IPF, Asbestosis, Rheumatoid lung (RTD-Lung) . Scleroderma. Neurofibromatosis. Dermatomyositis / polymyositis. Chronic aspiration. 191. ILDs normal or increased lung volumes? Sarcoidosis. Eosinophilic granuloma (EG). LAM. TS. ILD superimposed on emphysema 192. ILDs Honeycombing? IPF. Sarcoidosis. EG. RTD-lung Scleroderma. Pneumoconiosis. Hypersensitivity pneumonitis. Chronic aspiration. Radiation fibrosis. 193. ILDs miliary nodules? TB. Fungi,(Histoplasmosis, Coccidioidomycosis, CryptRadioGyan.com 41 Radiology Made Easy! ococcosis). Silicosis. Metastases (Thyroid carcinoma, RCC, Bronchogenic/carcinoma, Melanoma, Choriocarc inoma). Sarcoidosis. EG. 194, Hilar / mediastinal LNs enlargement? Sarcoidosis. Lymphangitic carcinomatosis . Lymphoma. Hematogenous metastases. TB. Fungal infection. Silicosis. 195. ILDs Pleural disease? Asbestosis (plaques). Lymphangitic carcinomatosis (effusion). RTD-lung disease (effusion / thickening) _ LAM (chylous effusion). 196. Manifestations of Rheumatoid Lung Disease (RTD-Lung Disease)? Pleural effusion. Pleural thickening. Pericarditis. Pericardial effusion. Pulmonary fibrosis (basilar predominance). Necrobiotic nodules (peripheral cavitating nodules, Caplan syndrome). Bronchiolitis obliterans (Hyperinflation) Pulmonary arteritis. Pulmonary arterial HTN. Right heart enlargement. Pulmonary hemorrhage 197. Caplan syndrome? Thick walled cavitating lung nodules. Rheumatoid arthritis patients with hypersensitivity to inhaled dust particles (coal, silica, asbestos). 198. Scleroderma ILD Inter-lobular septal thickening. GGO, Honeycombing. findings? Lower lung predominance. Patulous esophagus. 199. Interstitial pulmonary | intrapulmonary vascular shadows. Peribronchial edema CXR findings? cuffing. Tram tracking. 200. Kerley A & B lines? Kerley A lines > thickening of central connective tissue septa. Kerley B lines > thickening of peripheral interlobular septa. 201. Alveolar pulmonary edema localized to Rt upper lung may be seen in patients with? Severe mitral regurgitation. 202. Causes of Pulmonary Venous HTN & Pulmonary Edema? LV failure. Mitral valve disease (Mitral stenosis, Mitral insufficiency). LA myxoma. Cor triatriatum. Obstruction of central pulmonary veins (fibrosing mediastinitis, pulmonary vein stenosis, pulmonary venous thrombosis). Obstruction of intra-pulmonary veins (pulmonary veno-occlusive disease). 203. Radiographic findings Enlargement of pulmonary veins (progressive dilation of horizontally oriented pulmonary veins).RadioGyan.com 42 Radiology Made Easy! of pulmonary venous HTN are? Redistribution of pulmonary blood flow to upper lungs. 204. ARDS. Respiratory failure due to increased capillary permeability edema. Associated with increased lung stiffness (non-compliance) 205. Common causes of ARDS? Shock. Severe trauma. Burns. Sepsis. Narcotic overdose. Pancreatitis. 206. ARDS radiographic findings? Patchy peripheral airspace opacities (12-24 hrs). Confiuent bilateral airspace opacities with air bronchograms (days). Coarse reticulo-nodular pattern (week) that may resolve. 207. Causes of neurogenic pulmonary edema? Head trauma. Seizure. Increased intracranial pressure. 208, Hemorrhage or hemorrhagic edema of the lung can result from? Trauma. Bleeding diathesis. Infections (invasive aspergillosis, mucormycosis, Pseudomonas, influenza). Drugs (penicillamine). Pulmonary embolism (PE). Fat embolism. ARDS. Autoimmune diseases (Goodpasture syndrome, idiopathic pulmonary hemorrhage, Wegener granulomatosis (WG), SLE, rheumatoid arthritis, & poly-arteritis nodosa). 209. Goodpasture syndrome? Damage to alveolar & renal glomerular basement membranes by cytotoxic antibody. 210. Idiopathic Pulmonary Hemorrhage (IPH)? Indistinguishable from Goodpasture syndrome. Pulmonary hemorrhage (Hge)& anemia in patient with normal renal function & urinalysis. No anti- glomerular basement membrane antibodies. 211. Vasculitides that can cause pulmonary Hge? WG. SLE. Rheumatoid arthritis. Polyarteritis nodosa. 212. D-dimer. Sensitive, but not specific marker of venous thrombosis. 213. Most common radiographic findings in PE without infarction are? Localized peripheral oligemia with or without distended proximal vessels (Westermark sign) Peripheral airspace opacification. Linear atelectasis. 214, Radiographic features that suggest infarction in PE? ‘mail pleural effusion & pleura-based wedge-shaped opacity (Hampton hump).RadioGyan.com 43 Radiology Made Easy! 215. Non-thrombotic PE causes? Air embolism. Macroscopic fat embolism. Methylmethacrlate embolization from vertebroplasty. Radioactive seed embolization from prostate brachytherapy. 216. PAH is defined as a systolic pressure in pulmonary artery exceeding? 30 mm Hg. 217. Typical radiographic findings of PAH are? Enlarged main & hilar pulmonary arteries that taper, rapidly toward lung periphery. RV enlargement. 218. PAH measurements of proximal inter-lobar pulmonary artery (CXR) & main pulmonary artery (CT) Inter-lobar pulmonary artery > 16 mm. Main pulmonary artery > 28.6 mm. 219. In addition to PAH, enlargement of the central pulmonary arteries may be seen in? High cardiac output (anemia, thyrotoxicosis). Left-to-right shunts (ASD, VSD, PDA, PAPVR). 220. Shunt vascularity on chest radiographs? Enlargement of both central and peripheral pulmonary arteries. 221. Disorders of the pulmonary arteries that produce PAH include? Chronic PEs. Vasculitis. Pulmonary arteriopathy resulting from long-standing increased pulmonary blood flow from left-to-right shunt. 222. Multiple pulmonary nodules of similar size and appearance are almost always Metastases. Granulomas. 223. Pulmonary nodule is defined as Round or oval opacity 4 to 30 mm in diameter. 224, Pulmonary mass is defined as Round opacity > 3 cm. 225. DDx in patient < 35 ys, non-smoker with no history of malignancy? Granuloma. Hamartoma, Inflammatory lesion. 226. An SPN in patient > 35 Benign pattern of calcification. Presence of intra- lesional fatRadioGyan.com 44 ys should never be followed radiographically without tissue confirmation unless the lesion contains? 227. Studies have shown that bronchogenic carcinoma has a doubling time of? Between 1 month & 2 years. 228. Presence of small satellite nodules around the periphery of a dominant pulmonary nodule is strongly suggestive of? Benign disease, particularly granulomatous infection. 229. Presence of a halo of GGO encircling an SPN in an immunocompromised, neutropenic patient should suggest the diagnosis of? Invasive pulmonary aspergillosis. 230. Comet tail of bronchi & vessels entering hilar aspect of a mass & associated with lobar volume loss is characteristic of? Round atelectasis. 231. Complete or central calcification within an SPN is specific for? Healed granuloma from TB or histoplasmosis. 232. Concentric or laminated calcification of an SPN? Granuloma & allows confident exclusion of neoplasm. 233. Popcorn calcification within a pulmonary nodule is diagnostic of: Pulmonary hamartoma. 234. Fat within an SPN is Pulmonary hamartoma. Radiology Made Easy!RadioGyan.com 45 Radiology Made Easy! diagnostic of a? 235. Enhancement of malignant SPNs? 15H. 236. Most common thoracic inlet masses? Thyroid masses. lymphomatous nodes. Lymphangiomas. 237. Intra-thoracic thyroid Well-defined margins. Continuity of mass with cervical thyroid. Coarse calcifications. Cystic or necrotic areas. Baseline high CT attenuation (intrinsic iodine content). Intense enhancement (225 H). 238. Lymphangioma? Tumor of dilated lymphatic channels. Cystic or cavernous form (cystic hygroma) is commonly discovered in infancy and is often associated with: Turner syndrome and trisomies 13, 18, and 21. 239. Anterior mediastinal masses? Thymic neoplasms. lymphoma. Germ cell neoplasms. Primary mesenchymal tumors. 240. Thymoma vs thymic carcinoma? Thymomas > may be encapsulated (non-invasive) or invasive. Thymic carcinomas > epithelial component shows signs of frank malignancy. 241. Thymoma-associated autoimmune diseases? Myasthenia gravis. Pure red cell aplasia. Graves" disease. Sjogren syndrome. Hypogammaglobulinemia. 242. Thymic cysts. Congenital: Remnants of thymopharyngeal duct. Contain thin or gelatinous fluid. Acquired: Post-inflammatory. Associations: AIDS, Prior radiation or surgery, Autoimmune conditions (sjégren syndrome, Myasthenia gravis, Aplastic anemia) 243. Thymic masses? Thymoma. Thymic cyst. Thymolipoma. Thymic hyperplasia. Thymic neuroendocrine tumors. Thymic carcinoma. Thymic lymphoma. 244. Germ cell neoplasms Teratoma (benign & malignant). Seminoma. Embryonal cell carcinoma. Endodermal sinus tumor. Choriocarcinoma 245. Mesenchymal anterior mediastinal tumors? Lipoma. Hemangioma. Leiomyoma. Liposarcoma. Angiosarcoma. 246. __ is the most frequent site of a localized nodal mass in patients with Anterior mediastinum.RadioGyan.com 46 Radiology Made Easy! Hodgkin disease? 247. Akey in distinguishing Lry from metastatic mediastinal germ cell neoplasm is the presence of? Retroperitoneal LN involvement in metastatic gonadal tumors. 248. Benign & malignant teratoma features on CT? in > round or oval and smooth in contour. Malignant > irregular, lobulated or ill-defined margin 249. Middle mediastinal masses? Foregut & mesothelial cysts. Tracheal & central bronchial neoplasms. Diaphragmatic hernias. Vascular lesions. 250. DDx for central calcification of mediastinal /hilar LNs on CT? Mycobacteria. Fungus. 251. DD for peripheral (eggshell) calcification of mediastinal/hilar LNs on CT Silicosis. Sarcoidosis. 252. DDx for hyper-vascular mediastinal/hilar LN on CT? Carcinoid tumor/small cell carcinoma. Kaposi sarcoma. Metastases (RCC. Thyroid carcinoma), Castleman disease. 253. DDx for necrotic mediastinal/hilar LN on CT? Mycobacteria. Fungus. Metastases (SCC. Seminoma. Lymphoma). 254. Differences in LNs of sarcoidosis & lymphoma / metastases? Sarcoidosis > Lobular LNs that do not coalesce. Lymphoma/mets > May form conglomerate enlarged nodal masses. 255. Castleman disease also known as? Angiofollicular LN hyperplasia. 256. Pericardial cysts most commonly arise in the: Anterior cardiophrenic angles. Rt-sided lesions being twice as common as Lt-sided lesions 257. 3 groups of neurogenic tumors of the posterior mediastinum. Intercostal nerves > Neurofibroma. Schwannoma. Sympathetic ganglia > Ganglioneuroma. Ganglioneuroblastoma. Neuroblastoma. Paraganglionic cells -> Chemodectoma. Pheochromocytoma. 258. Most common posterior mediastinal neurogenic tumors ina child? Neuroblastoma. Ganglioneuroma.RadioGyan.com 47 Radiology Made Easy! 259. Most common posterior mediastinal neurogenic tumors in adult? Neurofibroma. Schwannoma. 260. Multiple lesions in the mediastinum, particularly bilateral apicoposterior masses are virtually diagnostic of? Neurofibromatosis. 261. Posterior mediastinal masses? Esophageal lesions. Foregut cysts. Vertebral lesion. Lateral thoracic meningocele. Pancreatic pseudocyst. 262. Causes of chronic sclerosing (fibrosing) mediastinitis? Histoplasmosis (most common). TB. Radiation therapy. Drugs (methysergide). Idiopathic (autoimmune). 263. SVC syndrome manifestations: Headache. Epistaxis. Cyanosis. Jugular venous distention. Edema. 264. Ludwig angina describes? ‘Sub-sternal chest pain caused by intra-mediastinal extension of infection. 265. Causes of unilateral pulmonary artery enlargement include? Post-stenotic dilation from valvular or post-valvular pulmonic stenosis. Pulmonary artery aneurysms. Distension of pulmonary artery by thrombus / tumor. 266. Rare vasculitides that may present with pulmonary a. aneurysms? Behcet disease & Hughes-Stovins syndrome 267. Sarcoidosis 1-2-3 sign? ‘1, Rt paratracheal. 2. Rt hilar. 3. Lt hilar LNs enlargement. 268. Coronary calcification is detected at angiography in___% of patients with 50% diameter stenosi 75% 269.A___% diameter narrowing is the physiologic point at which flow is restricted enough to result in ischemia under stress conditions. 50% diameter narrowing. Roughly predicts a 75% cross-sectional area reduction. 270. Cardiac MR uses? Define location and size of previous myocardialRadioGyan.com 48 Radiology Made Easy! infarctions. Demonstrate complications of previous infarctions. Establish presence of viable myocardium for possible revascularization. Differentiate acute versus chronic myocardial infarction. Evaluate regional myocardial wall motion and systolic wall thickening. Demonstrate global myocardial function with right ventricular and left ventricular ejection fractions. Demonstrate regional myocardial perfusion. Evaluate papillary muscle and valvular abnormalities. 271, Myocardial rupture may occur __ days after infarction. 3 to 14 days. 272. Dressler syndrome? Onset is typically 1 week to 3 months post-injury. Fever, chest pain, pericarditis, pericardial effusion, & pleuritis with pleural effusion usually more prominent on the left. Dressler syndrome responds well to anti- inflammatory medications. 273. Hibernating myocardium vs stunned myocardium? Hibernating > High-grade stenosis resulting in chronically ischemic myocardium. May act like post- infarction scar. Improved function with revascularization. At risk for acute infarction. Stunned myocardium > Post-ischemic, dysfunctional myocardium without complete necrosis. Potentially salvageable. 274. Causes of dilated cardiomyopathies? Ischemic cardiomyopathy (most common cause): Chronic ischemia. Prior infarction. Anomalous coronary arteries. Long-term sequelae of myocarditis: Coxsackie virus. Toxins: Ethanol, Adriamycin, Doxorubicin. Metabolic conditions: Mucolipidosis. Mucopolysaccharidosis. Glycogen storage disease. Nutritional deficiencies: Thiamin. Selenium). Infants of diabetic mothers. Muscular dystrophies. 275. Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of dilated cardiomyopathy? LV thin. LV dilated. Decreased contractility. Normal to decreased compliance. 276. Ventricular Wall. Ventricular Cavity. LY thick. LV normal to decreased. Increased contractility. Decreased compliance.RadioGyan.com 49 Radiology Made Easy! Contractility. Compliance features of hypertrophic cardiomyopathy? 277. Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of restrictive cardiomyopathy? Normal LV wall. Normal LV cavity. Normal to decreased contractility. Severely decreased compliance. 278. Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of Uhl anomaly? RV thin. RV dilated. Decreased contractility. Normal to decreased compliance. 279. Hypertrophic cardiomyopathies are divided into 2 basic types? Concentric hypertrophy: may be diffuse, mid- ventricular, or apical in distribution. Asymmetrical septal hypertrophy (ASH) > also known as idiopathic hypertrophic sub-aortic stenosis (IHSs). 280. Hypertrophic cardiomyopathy causes? May be familial (60%). Autosomal dominant with variable penetrance. Associated with neurofibromatosis and Noonan syndrome. Secondary to pressure overload. 281, Features of ASH (asymmetric septal hypertrophy)? Hypertrophy of the inter-ventricular septum (>12-13 mm). Abnormal ratio of thickness of inter-ventricular septum to Lt. ventricular posterior wall (>1.3:1). Narrowing of Lt. ventricular outflow tract during systole. 282. Restrictive cardiomyopathy causes? Infiltrative disorders: Amyloid. Glycogen storage disease. Mucopolysaccharidosis. Hemochromatosis. Sarcoidosis. Myocardial tumor infiltration. 283. What other disease should be ruled out when considering restrictive cardiomyopathy? Constrictive pericarditis. 284. MR finding in restrictive cardiomyopathy caused by amyloidosis or sarcoidosis? High signal in the myocardium onT2WIs.RadioGyan.com 50 Radiology Made Easy! 285. Defined as right ventricular failure secondary to pulmonary parenchymal or pulmonary arterial disease. Cor pulmonale. 286. Etiologies of cor pulmonale include Destructive pulmonary disease (pulmonary fibrosis and chronic obstructive pulmonary disease). Hypoxic pulmonary vasoconstriction resulting from chronic bronchitis, asthma, CNS hypoxia, upper airway obstruction. Acute and chronic pulmonary embolism. Idiopathic pulmonary hypertension. Extrapulmonary diseases affecting pulmonary mechanics such as chest deformities, morbid obesity (pickwickian syndrome), neuromuscular diseases. 287. Uhl anomaly? Acquired disorder in infants or adults. Also called arrhythmogenic Rt. ventricular dysplasia. Dilation of RV with marked thinning of anterior right ventricular wall. MR may show fatty infiltration of anterior RV free wall. Premature death from early congestive failure or arrhythmias. 288. Enlargement of pulmonary outflow tract causes? Left-to-right shunts. Post-stenotic dilation 2.ry to pulmonary stenosis. Pulmonary arterial HTN. Marfan syndrome. Takayasu arteritis. Idiopathic dilation of pulmonary artery. 289. DDx for pulmonary arterial HTN includes? Long-standing pulmonary venous HTN (mitral stenosis). Eisenmenger physiology (long-standing left- to-right shunts). Pulmonary emboli. Vasculitides (rheumatoid arthritis or polyarteritis nodosa). 1.ry pulmonary HTN. 290. Increased pulmonary blood flow is caused by? Lt-to-Rt. shunts. High output states: Volume loading. Pregnancy. Peripheral shunt lesions (arteri-ovenous malformations). Hyperthyroidism. Anemia. Leukemia. 291. Decreased pulmonary blood flow with a small heart is caused by? Chronic obstructive pulmonary disease. Hypovolemia. Malnourishment. Addison disease. 292. Mitral stenosis in the adult is usually caused by? Rheumatic heart disease. 293. Causes of Pulmonary Ltventricular failure. Mitral stenosis. Mitral regurge.RadioGyan.com 51 Radiology Made Easy! Venous HTN? Aortic stenosis. Aortic regurgitation. Pulmonary veno- occlusive disease. Congenital heart disease. 294. Lt atrial enlargement, Lt ventricular enlargement, & bulging of the atrial septum to the right. Mitral regurgitation. 295. Cardiac thrombus features? Intra-atrial thrombi are usually associated with atrial fibrillation, often secondary to rheumatic heart disease. Commonly occurs along posterior wall of LA. Left ventricular thrombi are usually secondary to recent infarction or ventricular aneurysm. Clots typically have low MR GRE signal, whereas tumors have intermediate signal. Clots will not enhance. 296. Intra-cardiac lipomas or lipomatous hypertrophy features? High T1 signal and fat suppression. Second most common benign cardiac tumor. 297. Atrial myxoma features? 50% of primary cardiac tumors. Most common primary benign cardiac tumor. Most (75% to 80%) are in LA. May mimic rheumatic valvular disease clinically. 298, Benign cardiac tumors? Atrial myxoma. Lipoma. Rhabdomyoma (50% to 85% of tuberous sclerosis). Fibromas (12% may calcify). Rare teratoma. 299. Metastatic cardiac tumor features? 10 to 20 times more common than primary cardiac tumors. Breast. Lung, Melanoma. Lymphoma. 300. L.ry malignant cardiac tumors? ‘Angiosarcoma (most common). Rhabdosarcoma. Liposarcoma. Other sarcomas. 301. Constrictive pericardial disease features? Fibrous or calcific thickening of pericardium. Compromises ventricular filling through restriction of cardiac motion. Most common cause is post- pericardiotomy. Other causes: Coxsackie B. TB. Chronic renal failure. Rheumatoid arthritis. Neoplastic involvement. Radiation pericarditis. 302. DDx for a cardio- phrenic angle mass includes Pericardial cyst. Fat pad. Lipoma. Enlarged LNs. Diaphragmatic hernia. Ventricular aneurysm. 303. Congenital absence of pericardium features? ‘Complete Lt-sided absence (55%). Foraminal defects (35%). Total absence (10%). M> F. Complete absence: Heart is shifted toward the Lt, with prominent bulge of Rt ventricular outflow tract,RadioGyan.com 52 Radiology Made Easy! main pulmonary artery & Lt atrial appendage. Partial absence of pericardium risks strangulation of cardiac structures. Surgical closure of partial defects is usually recommended. 304, Non-infectious causes of miliary pattern? Pneumoconioises (silicosis). EG. Sarcoidosis. Metastases (Thyroid. Melanoma.) 305. Minimal pl. effusion volume visible on frontal, lateral & decubitus CXR? Frontal (200 mL). Lateral (75 mL). Decubitus (5 mL) 306. Which junction line, anterior or posterior, extends above clavicles? Posterior junction line. 307. Define pulmonary cavity? Refers to a lucency located wtihin a nodule, mass, or focus of consolidation. 308. Order of the Lt lower lobe basilar segments (from lateral to medial) ona frontal CXR? Anteromedial, Lateral, Posterior (ALP). 309. DDx of sub-carinal mass on radiograph? LN enlargement. Bronchogenic cyst. Left atrial enlargement. 310. Classic 1.ry TB chest radiograph findings? Parenchymal consolidation with mediastinal & hilar LNs enlargement. 311. Ranke complex? Combination of calcified lung nodule & calcified LNs. 312. Ghon lesion? Lung nodule that is a residum of 1.ry TB Usually is calcified. 313. At what pulmonary venous wedge pressures do Kerley lines, effusions, and airspace opacities occur? Normal 12 mm Hg. Kerley lines 17 mm Hg. Effusion 20 mm Hg. Airspace opacity 25 mm Hg. 314, Complications of bronchiectasis? Recurrent infections. Hemoptysis. Mucoid impaction. Atelectasis. 315. Hereditary hagic telangiectasia (Osler- Weber-Rendu disease). Telangiectasias. AVMs. Aneurysms in multiple orgen systems (Pulmonary. Gl. Cutaneous. CNS) 316, Parenchymal findings Wedge-shaped peripheral foci of consolidation. Linear bands.RadioGyan.com 53 Radiology Made Easy! associated with acute PE? 317. Focal areas of chroni consolidation may be seen in Lipoid pneumonia. Bronchoalveolar cell carcinoma Lymphoma 318. Diffuse chronic consolidation can be seen in? Bronchoalveolar cell carcinoma. Alveolar proteinosis. Sarcoid. Lipoid pneumonia. 319. Kartagener's syndrome (dyskinetic cilia syndrome) triad? Situs invertus. Bronchiectasis. Sinusitis. 320. W. granulomatosis lung findings? Multiple lung nodules or masses. Cavitation occurs 50%. Local or diffuse consolidation due to Hge. 321. Help distinguish LCH from LAM? LCH: Usually associated with nodules & variable appearing cysts. Spares costophrenic angles. 322. PCP findings? Extensive GGOs in a patchy or geographic pattern. 1/3 have upper lobe predominant cysts of varying sizes & wall thicknesses. 323. Bronchopleural fistula, post-pneumonectomy should be considered if? Pneumonectomy space fails to fill with fluid. Abrupt decrease in air-fluid level in the pneumonectomy space. New collection of air in previously opacified pneumectomy space. Contralateral mediastinal shift. 324, Superior sulcus tumor symptoms? Shoulder pain. Horner's syndrome (ptosis, miosis, anhidrosis), Weakness & atrophy of hand muscles. 325, Deems a superior sulcus tumor unresectable? Any involvement of vertebral body, brachial plexus, subclavian artery. 326, Satellite nodules? ‘Smaller nodules adjacent to a lung mass. Suggests an infectious etiology. 327. Mediastinal lipomatosis causes? Cushing's syndrome. Steroid therapy. Obesity. 328. Rounded atelectasis Form of peripheral lobar atelectasis that develops with pleural disease (commonly asbestosis). Volume loss. Comet tail (whorled bronchovascular structures). 329. Diameter of ascending aorta aneurysm: 4-cm. 6 cm significant risk of rupture. 330. Bulla vs bleb? Bulla, sharply demarcated area of emphysema > 1 cm Bleb, gas-containing space within visceral pleura. 331. CXR finding in healed Diffuse discrete pulmonary calcifications.RadioGyan.com 54 Radiology Made Easy! varicella pneumonia? 332. Nodal status & stage in NSCLC? ): No metastatic LNs. Metastatic ipsilateral hilar LNs. N2: Metastatic ipsilateral mediastinal&subcarinal LNs N3: Metastatic contralateral mediastinal or hilar LNs 333. Causes of SVC syndrome? Neoplastic > Lung cancer (especially small cell carcinoma). Lymphoma. Metastatic carcinoma. Benign > Long-term IV devices (catheters. pacemakers). Fibrosing mediastinitis (Histoplasmosis). 334. Neoplastic & non- neoplastic causes of hypertrophic pulmonary osteoarthropathy? 90% Malignant lung neoplasms. Non-neoplastic > Cystic fibrosis. IPF. Localized fibrous lesions of the pleura 335. Epicardial fat pad sign? Double lucency sign. Displacement (> 4 mm) of anterior & posterior (epicardial) pericardial fat by pericardial fluid. 336. What obvious structures should be avoided while planning a TTNB (transthoracic needle biopsy)? Inter-lobar fissures. Pulmonary vessels. Bullae. Areas of severe emphysema. 337. Peripheral consolidation (photographic negative of pulmonary edema) Chronic eosinophilic pneumonia. 338. Sloughed lung within a cavity? Pulmonary gangrene. Closely associated with Klebsiella 339. Mosaic lung attenuation causes? Small airways disease. Chronic PE. 340. Distinguishes small airways disease of chronic PE in setting of mosaic attenuation? Expiratory images demonstrate air-trapping in small airways disease. 341. Congenital tracheobronchomegaly? Mounier-Kuhn syndrome. 342. Allergic broncho- Central bronchiectasis. Mucous plugging (finger-in-RadioGyan.com 55 Radiology Made Easy! pulmonary aspergillosis (ABPA) CXR findings? glove). Atelectasis. Patchy migratory foci of consolidation. 343. Pulmonary alveolar proteinosis (PAP) susceptible infections? Nocardia. Aspergillus. Mucormycetes. 344. Localized fibrous tumor of the pleura enhancement pattern? Intense & homogeneous contrast enhancement. 345. Calcified fine lung nodules DDx? Healed varicella. Healed histoplasmosis. Silicosis. Calcified metastases. 346. CT findings of Swyer- James syndrome? Areas of decreased lung attenuation with associated reducing in number & size of vessels. Bronchiectasis. Air trapping on expiratory images. 347. Cardiac bronchus. Blind-ending diverticulum arising from medial wall of bronchus intermedius. Rarely presents with recurrent infections, hemoptysis, cough, and or dyspnea. 348. Bronchioliti obliterans organizing pneumonia CT findings? Patchy bilateral airspace consolidation with peripheral, sub-pleural distribution. Poorly defined lung nodules in a peribronchiolar distribution. 349. Triad of pulmonary veno-occlusive disease? Severe pulmonary artery HTN. Evidence of pulmonary edema. Normal wedge pressure. 350, Water lily sign? Echinococcus cysts > Endocyst ruptures its contents within the ectocyst, floating on top of debris, like a water lily. 351. DDx for wall-to-wall heart? Tricuspid regurgitation. Pericardial effusion. Dilated cardiomyopathy. 352. Common predisposing factors for aortic dissection? HTN. Annuloaortic ectasia: Marfan or Ehlers-Danlos syndrome. Bicuspid aortic valve. Aortic aneurysm. Arteritis. 353. Anatomic structure separating Type A from Type B (Stanford) aortic dissections? Left subclavian artery. Distal type B. Proximal type A. 354, Chest bone findings associated with Marfan syndrome? Pectus excavatum. ScoliosisRadioGyan.com 56 Radiology Made Easy! 355. Pectus excavatum associations? Marfan syndrome. Ehlers-Danlos syndrome. Mitral valve prolapse. Homocystinuria. Hunter-Hurler syndromes. 356. 4 life threatening complications of type A aortic dissection? Coronary artery dissection (myocardial infarction). Carotid a. dissection (stroke). Pericardial Hge (tamponade). Aortic valve rupture (aortic regurgitation) 357. Helps distinguish ventricle true aneurysms from pseudo-aneurysms? Pseudo-aneurysm ~> Inferoposterior location. Narrow neck (< 50%). Aneurysm > Anteroapical location. Wide neck. 358. Which aberrant subclavian artery (Rt or Lt) is a vascular ring? Right aortic arch with aberrant left subclavian artery. Left-sided ligamentum arteriosum completes the ring. 359. Causes of SVC syndrome? Neoplastic: Bron.genic carcinoma. Mets.Lymphoma. Infectious: Fungal infection (histoplasmosis, fibrosing mediastinitis). 360. Persistent Lt SVC associations? ‘ASD. Tetralogy of Fallot. P(T)APVR. 361. Tetralogy of Fallot. 4 primary lesions? Overriding aorta. VSD. Pulmonar infundibular stenosis. Right ventricular hypertrophy. 362. Thoracic vessels. Takayasu arteritis involvement? Aorta. Right common carotid artery. Subclavian arteries. Pulmonary arteries. 363. Causes of constritive pericarditis? Cardiac surgery. Radiation therapy. Uremic pericarditis. Viral pericarditis (coxsackie).. TB pericarditis. 364. TTT of intramural hematoma of aorta? Similar to aorta dissections: Type A (surgically). Type B (medically). 365. Sinus of valsalva aneurysm vs aortic root dilation? Sinus of valsalva aneurysm is focal dilation of one sinus of Valsalva, not entire root. 366. TAPVR types? Type |: Supra-cardiac drainage. Snowman heart. Type Il: Cardiac. Coronary sinus or Rt atrium drainage. Type Ill: Infra-cardiac. Portal vein, hepatic vein, or ductus venosus drainage (pul. edema dt obstruction).RadioGyan.com 57 Radiology Made Easy! 367. Aortic pseudo- aneurysm causes? Atherosclerosis (penetrating ulcer). Infection. Trauma. latrogenic. 368, Mirror-image right aortic arch congenital heart disease associations? Tetralogy of Fallot. Truncus arteriosus. 369. 4 components of scimitar syndrome? Rt. lung hypoplasia. Hypoplestic Rt. pulmonary artery. Rt. lower lobe systemic arterial supply. PAPVR from Rt. lung. 370. Partial congenital absence of the pericardium findings: Leftward deviation of the heart without deviation of mediastinum. Prominent Lt. atrial appendage. Lung located between aorta & pulmonary artery confirms diagnosis. 371. Heterotaxy syndrome associated with interruption of IVC with Azygous continuation? Bilateral left-sidedness/polysplenia syndrome. 372. Features that suggest a primary malignant cardiac tumor? Invasiveness. Extension outside of heart. Involvement of more than one chamber. Central necrosis or cavitation. Large pericardial effusion. 373. Pulmonary sling aberrant course? Left pulmonary artery arises from right pulmonary artery and courses between esophagus and trachea.RadioGyan.com 58 Radiology Made Easy! Un-resectable pancreatic cancer factors? Vascular encasement (SMA). Direct invasion of adjacent organs. Liver metastasis. Adenopathy. Ascites (peritoneal spread). Para-neoplastic condition in pancreatic adenocarcinoma? Trousseau's sign (spontaneous venous thrombosis). Normal size of duodenal papilla? Less than 1.5 cm. Perivaterian neoplasms? Carcinoma. Polyps. Leiomyoma. (Familial polyposis syndrome and associated Gardner's syndrome) 2 types of gastric volvulus? Organoaxial. Mesenteroaxial. Small bowel folds in Celiac disease & Scleroderma? Celiac: Jejunum decreased folds, ileum increased folds. Scleroderma: Increased folds throughout. 5 folds per inch is normal. lleocecal valve upper limits of normal size? 3.cm, certainly abnormal if > 4 cm. Most common cause of enlarged ileocecal valve? Lipomatous infiltration. Diseases that can enlarge the ileo- cecal valve? Lipoma. Crohn's disease. Lymphoma. Prolapsing ileal neoplasms. 2 conditions can cause eccentric sacculations of small bowel? Crohn's disease. Scleroderma. What vitamin deficiency may occur with small bowel diverticula? Vitamin B12 from bacterial overgrowth. Causes of toxic megacolon? Ulcerative colitis. Crohn disease. Infectious colitis (especially in AIDS). Ischemia. Pseudomembranous coli Which colon segment is most commonly involved in toxic mega- colon? Transverse colon (most non-dependent). What causes the colonic dilation in toxic mega-colon? Transmural infiamation with destruction of ganglion cells (myenteric plexus). 3 causes of intramural tracking? Diverticulitis. Crohn's disease. Malignancy. Disorders cause wide-mouth diverticula (pseudo-sacculations) in the colon? Scleroderma. Crohn's disease. Ischemia. In what patient population does right-sided diverticulitis occur? Young adults. Asians. Main differential feature of diffuse Diffuse esophageal spasm presents with chest pain. Presbyesophagus is asymptomaticRadioGyan.com 59 Radiology Made Easy! esophageal spasms & presbyesophagus Does emphysematous cholecystitis result in air in biliary system outside of the gallbladder? No, because the cystic duct is obstructed. What tumors of the appendix can product pseudomyxoma peritonei? Mucocele. Mucinous cystadenoma. Myoglobulosis. What are the two categories of cecal volvulus? ‘Axial torsion. Bascule (folding of cecum on right colon without significant twisting). What underlying condition do patients with emphysematous cholecystitis most likely have? Diabetes. What conditions can lead to superior mesenteric artery syndrome? Rapid weight loss. Immobilization. Wearing a body cast. Decreased peristalsis. Drugs. What's the Bourne test? In suspected enterovesical fistula, urine is collected, spun, and radiographed for dectection of barium. What's the difference between a fistula and a sinus tract? Fistula tract connects two mucosal lined structures. Sinus tract ends blindly or in a cavity without normal mucosa. What drug is associated with pneumatosis of the bowel? Steroids. What pulmonary and collagen vascular diseases can cause pneumatosis of the bowel? Scleroderma. SLE. Dermatomyositis. Asthma. COPD. CF. Factors that distinguish a pancreatic abscess from pseudocyst? Abscess (forms earlier after pancreatitis, days to weeks, high HU 20-50, may contain air). Gallstone ileus triad? Air in biliary system. Radiopaque stone. Bowel obstruction. All 3 present probably only 30% of the time. Causes of nodular filling defects in duodenal bulb and proximal duodenum? Heterotopic gastric mucosa. Benign lymphoid hyperplasia. Brunner's gland hyperplasia (large nodules). What conditions may result in loss of haustral folds? Most types of colitis. Laxative abuse. Scleroderma. Most common location in stomach for a malignant ulcer? Antrum (most common area for benign ulcers, too). Fundus ulcers, though uncommon, are more likely to be malignant. What liver lesion exhibitis cetripetal Hemangioma, peripheral to central enhancement over time.RadioGyan.com 60 Radiology Made Easy! opacification? Spigelian, Richter's, and Littre's hernias? Spigelian: lower quadrant through semilunar line. Richter's: only one wall of bowel involved. Littre's: Meckel's diverticulum hernia. Disorder that causes thyroid and breast abnormalities, hyperkeratosis, and harmartomas of the small bowel? Cowden disease. Features of Cronkhite-Canada syndrome? Weight loss. Anorexia. Alopecia. Multiple intestinal hamartomas. Cutaneous masses and small bowel tumors? Neurofibromatosis. What conditions may cause focal strictures of the small bowel? Crohn's disease. Certain infections. Radiation therapy. Ischemia What neoplasms of the stomach grow exophytically? Spindle cell tumors (GISTs, leiomyoma, leiomyosarcoma, leiomyoblastoma). Neurofibromas. Lymphomas. Bony abnormalities in patients with adenomatous polyposis syndrome? Osteomas. Cortical hyperostosis. Possible extraintestinal neoplasms of FAPS? Osteomas. Glioblastomas. Medulloblastomas. Thyroid carcinoma. Congenital condition that may cause diffuse bowel edema? Lymphangiectasia. Complications of Caroli's disease (Type V Choledochal Cyst or communicating cavernous ectasia of the bile ducts)? Cholangitis. Fibrosis. Portal hypertension. Cholangiocarcinoma. Most common cause of portal hypertension and varices worldwide (parasite)? Shistosomiasis. Unusual variant of esophageal carcinoma that spreads submucosally producing thickened folds? Varicoid carcinoma of the esophagus. Most common internal hernia? Paraduodenal hernia. Aleft paraduodenal herniaextends | Landzert. through the fossa of? Aright paraduodenal hernia etends _| Waldeyer.RadioGyan.com 61 Radiology Made Easy! through the fossa of? Paraduodenal hernia is due to a congenital defect in the? Transverse mesocolon. Causes of rectal varices (not internal hemorrhoids)? Portal hypertension. IVC obstruction. Severe abdominal adhesions. Amyloidosis most commonly affects what part of the Gl tract? Small intestine, with valvulae thickening and mucosal granularity. Causes of Booerrhaave's syndrome? Endoscopy. Seizures. Coughing. Asthma. Childbirth. Severe straining. Blunt trauma. Pancreatic phlegmon (massive enlargement of the pancreas by inflammation tissue) complications? Necrosis. Hemorrhage. Infection. CREST? Subcutaneous Calcinosis. Raynaud's phenomenon. Esophageal dysfunction. Sclerodactyly. Telangiectasia. Crowding of the valvulae by fibrosis (scleroderma) term? Hidebound. What age groups are symptomatic in annulary pancreas? 50% present as children. 50% present as adults. Annular pancreas complications? Duodenal obstruction. Increased susceptibility to pancreaatitis. The substance secreted by this tumor causes an intense desmoplastic response, producing mesentery fibrosis, with tethering and kinging of small bowel? Carcinoid tumor secreting serotonin. Insulinoma facts? 90% benign. smalll less than 2 cm. Most difficult to detect on imaging Gastrinoma facts? Major cause of Zollinger-Ellison syndrome. MEN-1 syndrome. 60% Malignant. Ectopic locations outside pancreas. Glucagonoma facts? Secrete glucagon. Produce Diabetes Mellitus. 80% Malignant. viPoma facts? Secrete vasoactive intestinal peptide. WOHA (Watery Diarrhea, Hypokalemia, Achlorhydria).. Variable malignancy. Somatostatinoma facts? Rare. Cause diarrhea. Nonfunctioning islet cell tumor facts? 3rd most common islet cell tumor. GenerallyRadioGyan.com 62 Radiology Made Easy! malignant. Larger. Necrotic on imaging studies. Causes of ischemic bowel? Low flow states (shock, major surgery, cardiac abnormality). Atherosclerosis (chronic). Embolism (acute). Venous occlusion (mesenteric venous occlusive disease) Major inflammatory processes that affect the terminal ileum? Crohn's disease. Tuberculosis. Yersiniosis. Crohn's disease and Yersiniosis? Yersiniosis: lacks lumen narrowing, lacks deep ulceration, short, self-limited course, heals without scarring. Benign splenic tumors and CT characteristics? Hemangioma and lymphangioma (hypodense to splenic tissue, may calcify). Hamartoma (isodense to splenic tissue). Syndrome of generalized angiomatosis? Klippel-Trenaunay-Weber syndrome. Define pseudopolyp, cobblestoning, and post-inflammatory polyp? Pseudopolyp: island of normal or edematous mucosa surrounded by ulcerated or denuded mocusa. Cobblestoning: normal mucosa surrounded by linear ulceration (Crohn's disease). Postinflammatory polyp: regenerating normal mucosa. FAPS (Gardner's type) effect on the mesentery? Mesenteric fibromatosis. When mesenteric fibromatosis occurs in a round shape this is called? Desmoid. Causes of portal venous gas? infarcted bowel. Ulcers. Acute bowel dilation. Endoscopy. Necrotizing enterocolitis. Through what does a Zenker's diverticulum protrude? Killian's dehisence. What are lateral diverticula of the pharyngoesophageal junction termed? Killian-Jamieson diverticula. Colon watershed regions? Splenic fleXure (SMA, IMA junction). Rectosigmoid. Appearance of the liver with enhancing lobules of hepatocytes and areas of edema that do not enhance? Nutmeg liver (can be seen in patients with passive venous congestion of liver and early stages of Budd- Chiari syndrome). 3 types of anal canal malignant Adenocarcinoma. Squamous cell carcinoma. Cloacogenic carcinoma (women, worse prognosis).RadioGyan.com 63 Radiology Made Easy! neoplasms? Storage disease associated with splenomegaly? Gaucher's disease. Amyloidosis. Hemochromatosis. Niemann-Pick disease. Pancreatic cystic neoplasm associated with von-Hippel Lindau disease? Microcystic adenoma What liver malignancies may calcify? Fibrolamellar HCC. Hepatoblastoma. Intrahepatic cholangiocarcinoma. Metastases. Nuclear scanning distinction of FNH from fibrolamellar HCC? FNH is hot (has Kupffer cells). Fibrolamellar HCC is cold (No Kupffer cells). Pathognomonic finding for cavernous | Phleboliths. hemangiomas of the colon? What is the most common location _| Distal ileum. of Burkitt's lymphoma in North America? Longitudinal dimension of the spleen | 12 - 14 cm should not eceed? Heterogeneous spleen in early Moire spleen. arterial phase? Congenital splenic cysts which contain an epithelial lining? Epidermoid cysts. Accessory spleen versus splenosis? ‘Accessory (supernumerary) splenic tissue at hilum not post-traumatic (splenosis). Granulomatous disease of the spleen, major finding and common causes? Multiple punctate calcifications. Histoplasmosis Tuberculosis. Sarcoidosis. Fungal infections of the spleen, most common finding? Microabscesses, multiple small low densities. Benign splenic neoplasms (2)? Lymphangioma. Hemangioma. Malignant splenic neoplasms? Hemangiosarcoma. Angiosarcoma (thorotrast 1950s). Kaposi sarcoma. Lymphoma (AIDS and non- AIDS). Leukemia. Normal splenic finding may mimic a splenic laceration? Splenic cleft. Splenic artery aneurysm demographics?. Women (medial dysplasia) rupture risk at pregnancy. Men (atherosclerosis). Sicke cell disease's eventual effect on Autosplenectomy, smalll, densely calcified splenicRadioGyan.com 64 Radiology Made Easy! spleen? remnant. Longitudinal dimension of the spleen | 12 - 14 cm. should not exceed? Maximal size of pancreatic duct in adults and elderly? 3mmand 5mm. Common sites of ectopic pancreatic tissue? walls of stomach, duodenum, and Meckel diverticulum. Fatty replacement of the pancreas is common in? diabetes. obesity. elderly. Cystic fibrosis. Pancreatitis complications? Necrotizing pancreatitis. Hemorrhagic pancreatitis. Thrombosis (splenic, portal, mesenteric veins). Pseudoaneurysms. Pseudocysts. Ascites. Abscess. Pancreatic endocrine neoplasms? Insulinomas. Gastrinomas. VIPomas. Somatostatinomas. Glucagonomas. Pancreatic exocrine neoplasms? ‘Adenocarcinoma. Cystic pancreatic neoplasms {microcystic adenoma, mucinous cystic neoplasms). Cystic teratomas. Low attenuation pancreatic mass ViPoma with dilated loops of bowel? Interposition of the hepatic fleure Chilaiditi sign. between the dome of the liver and the right hemidiaphragm? Extracolonic sequelae of ulcerative colitis? Hepatitis. Sclerosing cholangitis. Cholangiocarcinoma. Sacroili spondylitis. Neutropenic colitis (pericecal]? Typhii Gardner syndrome? Intestinal adenomatous polyps with osteomas of the skull or long bones. Epidermoid cysts. Fibromatosis. Turcot syndrome? Medulloblastoma. Glioblastoma multiforme. Family polyposis. Most common appendiceal tumor? Carcinoid tumor. Pneumatosis cystoides coli? ‘Asymptomatic, large round air collections in colon wall (iatrogenic mucosal injury). Pneumato: testinalis causes? Infectious colitis. Necrotizing colitis. Bowel infarction. Typhlitis. Toxic megacolon. Most common site for intussusception in colon? lleocecal. Rare condition with mucinous cysts Colitis cystica profunda.RadioGyan.com 65 Radiology Made Easy! in colon wall? Term for sensation of alump in the __| Globus. throat? Nasopharyngeal reflux is prevented by the soft palate apposing the posterior pharyngeal wall, known as the? Passavant cushion or pad. Functional abnormalities of the pharynx in barium swallows? Nasopharyngeal reflux. Laryngeal penetration. Tracheal aspiration. Cricopharyngeal achalasia. Cricopharyngeal hypertrophy. Major structural abnormalities of the pharynx on barium swallow? Strictures. Webs. Diverticula (Zenker [pharygoesophageall). Lateral pharyngeal pouches. Lateral pharyngeal diverticula For an esophagram, if esophageal rupture is suspected what contrast should be used? Water-soluble contrast. For an esophagram, if aspiration or a tracheo-esophageal fistula is suspected what contrast should be used? Barium. water-soluble contrast should be avoided for it can cause pulmonary edema. What does the Z-line represent? Zigzagging transition zone between squamous epithilium to columnar. Describe proximal escape in esophagography? Occurs when a primary contraction wave pushes barium caudally but at the mid third of the esophagus it breaks with regression of the bolus proximally Tertiary contraction waves? Nonpropulsive contractions of muscularis propria seen as indentations at the margins of the esophagus which occur locally or over large segments. Feline esophagus differential? Normal variant. Scleroderma. GER. Incomplete relaxation of the LES because of neuronal degeneration? Achalasia. Diffuse esophageal spasm characteristics? Severe tertiary contractions following 30% of swallows. Corckscrew appearance at -ray. Primary versus secondary achalasia? Primary, no known source. Secondary, known source (neoplasm, Chagas disease). Chagas disease? ‘South American Trypanosoma cruzi destroys myenteric plexus of esophagus and colon. CausesRadioGyan.com 66 Radiology Made Easy! myocarditis and cardiac aneurysms. Progressive systemic sclerosis’ effect on esophagus? Muscular atrophy and collagen deposition of distal 2/3 of esophagus resulting in reflux. VACTERL congenital anomaly mnemonic? Vertebral. Anal atresia. Cardiac. Tracheoesaphageal fistula/esophageal atresia. Renal agenesis/dysplasia. Limb. 2 most common vascular rings to effect to the esophagus? Double aortic arch. Aberrant left subclavian artery. Describe course of aberrant left subclavian artery? Last branch of right aortic arch that usually passes behind the esophagus to ascend on the left. Describe course of aberrant right subclavian artery? Last branch of left aortic arch that usually passes behind the esophagus to ascend on the right. Describe course of pulmonary sling? Left pulmonary artery arises from right pulmonary artery and courses between the trachea and esophagus. 2 types of hiatal hernias? Sliding hiatal hernia (GE j moves). Paraesophageal hernia (GE j stable, cardia moves). A-ring? Muscular/contractile ring at the tubulovestibular junction B-ring? Mucosal ring, ridge of tissue at the squamosal- columnar junction of the distal esophagus. Schatzki ring? Pathologic B-ring that can result in dysphagia (inflamed B-ring from reflux). Barrett esophagus? Metaplastic replacement of squamous epithelium with columnar above normal Z-line secondary to longstanding reflux. Common esophagitides? Esophageal candidiasis (shaggy mucosa). Herpes esophagitis (discrete ulcers). Cytomegalovirus esophagitis (larger ulcers). HIV esophagitis (largest ulcers). Benign esophageal neoplasms? Leiomyoma. Fibrovascular polyp. Squamous papilloma. Malignant esophageal neoplasms? SCC. Adenocarcinoma. Lymphoma. Kaposi sarcoma. Spindle-cell carcinoma. Leiomyosarcoma. Metastases. Common location for Booerhave esophagus perforation? Left posterior lateral wall of distal esophagus just proximal to the gastroesophageal junction. Esophageal bypass surgical techniques? Gastric pull-through (esophagogastrectomy). Colonic interposition.RadioGyan.com 67 Radiology Made Easy! Structural abnormalities of the small intestine? Atresia (jejunum, ileum > duodenum). Jejunoileal stenosis. Enteric duplication cyst. Malrotation. Meckel diverticula. Diverticula. Small bowel obstruction. Small bowel hernias. Adhesions. Adynamic ileus. Common causes of small bowel obstruction? ‘Adhesions. Hernias. Neoplasms. Intussusception. Volvulus. Foreign bodies. Inflammatory process. Prestenotic phase of Crohn disease, findings? Blunting, flattening, distortion, straightening, and thickening of mucosal folds. Other prestenotic changes of Crohn disease? Apthous erosions. Cobblestoning. Inflammatory pseudopolyps. Postinflammatory polyps. Skip lesions. Pseudodiverticula. Small bowel infection that can mimick appendicitis clinically and Crohn disease radiographically? Yersiniosis at terminal ileum. Small bowel infection of middle aged men with malabsorption, fever, weight loss, chronic uvei endocardiits, arthralgia, lymphadenpathy, and skin pigmentation? Whipple disease. Diffuse intestinal disease? Menetrier disease. Intestinal lymphangiectasia. Mastocytosis. Radiation enteritis. Progressive systemic sclerosis. Celiac disease. Graft-versus-host disease. Ischemic enteritis. Benign small bowel neoplasms? Adenomas. Leimyomas. Lipoma. Peutz-Jeghers syndrome. Cowden disease. Familial polyposis. Malignant small bowel neoplasms? Carcinoid tumors. Adenocarcinoma. Lymphoma. Kaposi sarcoma. Leiomyosarcoma. Metastases. Sharp angulation in the lesser curvature that demarcates the junction of the body and antrum? Angular notch. Two common causes of gastroparesis? Diabetes. Progressive systemic sclerosis. Focal loss of superficial epithelium? Erosion. Middle-aged men, enlargement of gastric rugal folds? Menetrier disease (protein-losing enteropathy) Benign gastric neoplasms? Hyperplastic polyp (sessile, less than 1cm).RadioGyan.com 68 Radiology Made Easy! Adenomatous polyps (>4cm). Leiomyoma. Malignant gastric neoplasms? Gastric adenocarcinoma. Gastric lymphoma. Kaposi sarcoma. Billroth | versus Billroth II? |: partial gastrectomy with gastroduodenoscopy. II: partial gastrectomy with gastrojejunoscopy.RadioGyan.com 69 Radiology Made Easy! Mural bladder wall calcification? Bladder stone. TCC. Cystitis. Foreign body encrustation. Amyloidosis. Extrinsic displacement of bladder? Pelvic hematoma & urinoma. Pelvic mass. Bladder diverticulum. Lymphadenopathy. Pelvic lipomatosis. liopsoas hypertrophy. Intra-peritoneal bladder rupture, CT characteristics? Lateral pelvic recess (lateral paravesical recesses superior to bladder). Midline pouch of Douglas (posterior to bladder & anterior to rectosigmoid) Extra-peritoneal bladder rupture, CT characteristics? Perivesical space (extends anterior & superior to bladder to level of umbilicus). Retrorectal or pre- sacral space. Heal loop complications? Early (obstruction or extravasation at ureteroileal anastomosis). Late (chronic pyelonephritis, nephrolithiasis, obstruction). Filling defects in urethra? Calculus. Polyp. Carcinoma. Condylomata acuminata. Polypoid urethritis. Malacoplakia. Urethritis cystica. Metastases. Amyloidosis. Para-urethral out-pouchings or tracts? (Pseudo) diverticulum. Fistula. Cowper's duct or gland. Glands of Littre. Mullerian remnants (utricle or Mullerian cyst). Ovarian neoplasms, types & frequency? Epithelial 65%. Germ cell 25%. Sex cord-stroma 5%. Secondary or metastatic 5%. Gonadoblastoma rare Epithelial ovarian tumors? Serous. Mucinous. Endometrioid. Clear-cell. Brenn (rare). Serous or Papillary epithelial ovarian tumors? 75% benign (large unilocular cyst). Malignant (solid masses, nodular walls, contrast enhancement). Mucinous epithelial ovarian tumors? 95% benign (large multilocular cystic mass). Pseudomyxoma peritonei. Ovarian dermoid cyst (mature cystic teratoma) Primordial germ cell. Common in girls less than 15 yo. 15% bilateral. Torsion, trauma, infection, rupture. Sebaceous plug or tooth. Metastases to ovary Krukenberg tumors: Signet ring cells, mucinous ADCA from stomach or colon. Breast cancer. Lymphoma Nonseminomatous germ cell tumors? Embryonal cancer. Yolk sac cancer. Choriocarcinoma. Teratoma. Bilateral, Entire ureteral dilatation without ureteral obstruction? Bladder outlet obstruction. Prune-belly. Diabetes insipidus. Polydypsia. Primary megaureter.RadioGyan.com 70 Radiology Made Easy! Unilateral, entire ureteral dilatation without ureteral obstruction? Vesicoureteral reflex (grades II-IV). Ectopic ureter inserting below bladder. Bacterial infection. Ureteral dilatation of distal segment only without ureteral obstruction? Primary megaureter. Vesicoureteral reflux (grade ). Ureteral dilatation of proximal segment only without ureteral obstruction? Retrocaval or retroiliac ureter. Enlarged urterus. Postpartum ectasia. Malignant causes of ureteral narrowing? Urothelial neoplasm. Local extension of extrinsic tumor. Distant metastasis. Lymphoma. Infectious causes of ureteral narrowing? TB. Schistosomiasis. Inflammatory bowel disease causes of ureteral narrowing? Regional enteritis. Diverticulitis. Appendicitis. Gynecologic causes of ureteral narrowing? Endometriosis. Traumatic causes of ureteral narrowing? Stone passage. latrogenic. Mechanical stone extraction. Ureterolithotomy. Radiation therapy. TCC features? 2/3 papillary. 85% of urothelial neoplasms. 20% multifocal. Associations: aniline dyes, tobacco, analgesics, Balkan nephropathy. Uncommon associations with retroperitoneal fibrosis, RPF? Aortic aneurysm. Aortic graft. Retroperitoneal hge. Urinoma. Abscess. Mets. Drugs. Bowel Disease. CT signs of ureteral stone? Homogeneous density in ureter lumen. Unilateral hydronephrosis. Hydroureter. Perirenal stranding. Nephromegaly. Loss of white renal pyramids. Kidney stones. Intraluminal ureteral filling defects Calculi. Blood clots. Sloughed papilla. Fungus ball Mucopus. Air bubbles. Mucosal ureteral filling defects? Neoplasm. Edema. Leukoplakia. Mural ureteral filling defect? Ureteritis cystica. Hemorrhage. Malacoplakia. Endometreiosis. Schistosomiasis. Common causes of focal filling defects of the bladder wall? Neoplasm. Stone. Blood clot. Enlarged prostate. Malignant bladder neoplasms? TCC. SCC. Adenocarcinoma. Benign bladder neoplasms? Leiomyoma. Fibroepithelial polyp. Hemangioma. Pheochromocytoma. Adenoma. Outpouchings of bladder wall? Diverticulum and saccule (<5 mm). Cystocele. Herniation of bladder. Urachal diverticulum. Bladder diverticula features? Result from bladder neck or urethral obstruction. Congenital (Hutch diverticulum). Can causeRadioGyan.com 71 Radiology Made Easy! ureteral obstruction or reflux. Urinary stasis may lead to stones or cystitis. 2% have carcinomas. Features of xanthogranulomatous pyelonephritis, XGPN? Female predominance. History of UTIs. Nephrolithiasis. Renal enlargement. Renal hypofunction. Fractured calculus. Renal cysts. Extrarenal extension common. Features of renal infarcts? Wedge-shaped. Cortical rim sign. Usually multifocal. Progressive atrophy over time. CT findings of pyelonephritis? Renal enlargement. Multifocal wedge-shaped hetergeneous areas. Parenchymal striations. DDx of small scarred kidneys? Unilateral: Reflux nephropathy. Previous renal surgery. Bilateral: Normal calyces (renal infarcts). Abnormal calyces (bilateral reflux nephropathy or analgesic nephropathy) In reflux nephropathy scarring first develops? At renal poles. DDx of unilateral small smooth kidney? Normal calyces: Renal artery stenosis. Chronic renal vein thrombosis. Renal hypoplasia. Subcapsular hematoma. Radiation therapy. Abnormal calyces: Postobstructive atrophy. Urographic signs of renal artery stenosis (RAS)? Small smooth kidney. Delayed nephrogram. Delayed pyelogram. Hyperdense pyelogram. Ureteral notching. Causes of unilateral reniform enlargement? Ureteral obstruction. Duplication anomalies and hypertophy. Parenchymal infiltration (pyelonephritis, XGP, contusion, infiltrating neoplasm). Edema (acute renal vein occlusion, acute arterial occlusion/arteritis). Causes of striated nephrogram? Common: Acute ureteral obstruction. Pyelonephritis. Uncommon: ARPKD. Acute renal vein thrombosis. Renal contusion. Rare: Radiation nephritis. Common and uncommon causes of bilateral renal enlargement with masses? Common: ADPCKD. Uncommon: Acquired renal cystic disease. Simple cysts. Lymphoma. Metastases. Wilm's tumor. Causes of medullary nephrocalcinosis? Common: Medullary sponge kidney. Hyper- calcemia. RTA. Uncommon: Papillary necrosis. TB. Hyperoxaluria. Chronic furosemide use. Causes of cortical nephrocalcinosis? Common: Chronic glumerulonephritis. Acute cortical necrosis. Uncommon: Hyperoxaluria. Rare: Alport's syndrome. Chronic transplant rejection.RadioGyan.com 72 Radiology Made Easy! General causes of renal failure? Prerenal: Underperfusion. Renal: Diffuse parenchymal disease. Postrenal: Bladder outlet obstruction, Bilateral ureteral obstruction. Enlarged hyperechoic kidneys? HIV nephropathy. 2 types of renal sinus fat proliferation? Renal sinus lipomatosis: increased fat with little mass effect. Replacement lipomatosis: renal atrophy, massive fat. Renal sinus cysts? Peripelvic: multiple, small, insinuating. Parapelvic: typical simple renal cyst. Uriniferous: urine extravasation. Renal sinus neoplasms. Renal: RCC, AML, MLCN. Sinus: AML, teratoma, Lipoma/sarcoma, fibroma/sarcoma, neuroma / sarcoma, leiomyoma /sarcoma, malignant histiocytoma, Normal ureter course measurements & landmarks? < 1. cm lateral to transverse process. Not medial to vertebral pedicle. Ureters separated by > 5 cm Rt adrenal gland is located posterior to the? Inferior vena cava (IVC) at the level where the IVC enters the liver. Radiographic abnormalities of Horseshoe kidney? Renal nonrotation. Lower pole fusion. Low retroperitoneal position. Renal vascular anomalies Other urinary tract abnormalities associated with horseshoe kidney? UPJ obstruction. Duplication anomalies. Stone formation. Pyeloureteritis cystica. Infection-based stone formation. Crossed fused ectopia? One kidney crosses midline and fuses with the other. Ureters insert in the bladder in their normal position (crossed kidney's ureter crosses midline). Radiographic findings of pel nfundibular MDK (Multicystic dysplastic kidney)? Randomly distributed cysts. Noncommunicating cysts. Absent renal function. Atretic ureter. Radiographic findings of hydronephrotic MDK? Dominant cyst in region of renal pelvis. Radially arrayed cysts may communicate. Minimal renal function possible. Ureter occluded at UPJ (ureteropelvic junction). Abnormalities with ARPKD (autosomal recessive polycystic kidney disease)? Oligohydramnios. Nephromegaly. Hyperechoic kidneys. Renal failure inversely proportional to. hepatic failure. MSK (Medullary sponge kidney associations? Renal tubular ectasia. Nephrolithiasis. Medullary nephrocalcinosis. Caroli's disease. Ehler's-Danlos $. Multilocular cystic nephroma (IMLCN) Benign cystic neoplasm. Young boys (1st decade). Adult women (3rd and 4th decades). Herniation ofRadioGyan.com 73 Radiology Made Easy! associations? parenchymal mass into renal pelvis, Bosniak CT classification of cystic renal masses? Class |; simple cysts, non-operative. Class Il: septated, minimal calcium, non-enhancing high-density cyst, infected cyst, non-operative. Class Ill: multiloculated, hemorrhagic, dense calcium, non-enhancing solid component, renal- sparing surgery. Class IV: marginal irregularity, enhancing solid component, radical nephrectomy. RCC: IVU features? Expansile mass. calyceal displacement, compression. Ureteral notching. Diminished function, if renal vein occluded. RCC: CT, MR features? Approximately spherical shape. Fails criteria for simple cyst. Lacks internal fat (AML). Enhances. Other abnormalities that present with renal agenesis? Absent ipsilateral ureter. Absent ipsilateral hemitrigone. Absent ipsilateral vas deferens. Ipsilateral seminal vesicle cyst. Unicornuate uterus. Abnormal bowel gas pattern. Non-rotated verus mal-rotated kidney? Non-rotated: anterior positioned UPJ (Ureteropelvic junction). Mal-rotated (over-rotated): posterior positioned UPJ. Calyceal diverticulum, details? Intra-parenchymal cavity lined with transitional epithelium that communicates with collecting system. Type 1: communicates with minor calyx. Type 2: communicates with infundibulum. Type 3: communicates with renal pelvis. Mesoblastic nephroma, details? Benign neoplasm. Hamartoma of the kidney. Diagnosed in children < 2 years. Mimic malignant neoplasms (Wilm's) Nephroblastomatosis associations? Increased risk of Wilm's tumor (multiple & bilateral). Young patients with renal enlargement and multiple sub-capsular masses.. Primitive renal tissue that persists beyond 36 wks gestation. Organs within anterior pararenal space of retroperitoneum? Pancreas. Retroperitoneal colon (right & left). Duodenum. Organs within posterior pararenal space of retroperitoneum? None. Organs within perirenal space of Kidney. Adrenal gland. Collecting system. Renal & perirenal vasculature. Renal & perirenal lymphaticsRadioGyan.com 74 Radiology Made Easy! retroperitoneum? Solitary expansile renal masses? Common: Cyst, RCC. Uncommon: AML, abscess, mets. Rare: Oncocytoma, MLCN, Localized renal cystic dz, Focal XGPN. Other areas of interest in abdominal imaging in RCC? Contralateral kidney. Renal vein. Vena cava. Regional LNs. Ipsilateral adrenal gland. Adjacent organs. Liver. Skeleton. Features of oncocytoma? Male 6th or 7th decade. Solid expansile mass. Iso- heteroechoic at US. Homogeneous enhancement CT. Pseudocapsule. Central scar in larger lesions. Spoke wheel angiographic pattern. Features of multilocular cystic nephroma, MLCN? 50% males, <3 ys. 50% females > 40 ys. Expansile, multiloculated cystic renal mass. Herniation into collecting system. Enhancing septa at CT. Absent hemorrhage. Hypo-or avascular at angiography. Features of renal abscess? Evidence of infection. Hypoechoic with less through transmission than cyst. Thick wall, rim enhancement CT. Perinephrich inflammatory changes. Neovascularity in wall on angiogram. Features of XGPN? Middle-aged females with UTIs. Focal hypo- functioning renal mass. Infection-based stones. Features of renal lymphoma? Usually with systemic lymphoma, Usually bilateral. Multifocal, diffuse, or focal. Hypoechoic without through-transmission. Often with massive lymphadenopathy. Features of angiomyolipoma, AML? 80% in adults (females). 4th-Sth decade. 20% in tuberous sclerosis. Well-defined hyperechoic mass. Fat, even small amounts, diagnostic with CT. Neovascularity with aneurysm on angiography. Unlikely to bleed if < 4 cm Von Hippel-Lindau disease, (VHL dz)? 40% RCC. 75% simple renal cysts Hemangioblastomas CNS. Retinal angiomas. Pancreatic cysts. Pancreatic neoplasms. 50-80% Pheochromocytomas (multiple, bilateral, extra- adrenal). Tuberous sclerosis, TS features? Renal cystic dz. 80% AMLs. Cerebral hamartomas. Cardiac rhabdomyomas (sarcomas). Skeletel osteomas. Pulmonary lymphangioleiomyomatosis. Infiltrative renal neoplasms? TCC. SCC. infiltrative RCC. Renal medullary carcinoma. Renal lymphoma.RadioGyan.com 75 Radiology Made Easy! Distinctions of GU SCC versus TCC? SCC more aggressive. Fast-growing. 50% SCC have coexistent renal calculus. Renal medullary carcinoma Patients < 40 ys. Sickle cell trait > disease. Poor prognosis, < 4 months. Weigert-Meyer rule? Duplication anomaly. Upper moiety ureter inserts inferior & medial to normal (lower moiety) bladder insertion. Medial deviation of upper ureter? Lower-pole renal mass. Lateral retroperitoneal mass. Psoas hypertrophy. RPF. Retrocaval ureter. Medial deviation of lower ureter? Lymphadenopathy. Pelvic lipomatosis. lliopsoas hypertrophy. Pelvis mass/fluid collection. lliac vessel ectasia. Abdominopelvic resection. Cystocele. Lateral deviation of upper ureter? Malrotated or horseshoe kidney. Lymphadenopathy. Psoas hypertrophy. AAA. Retro -peritoneal mass/fluid. Ureter mobilization surgery. Lower ureter lateral deviation? Central pelvic mass/fluid collection. Sciatic ureteral hernia Retrocaval ureter: urography findings? Right ureter. Abrupt medial deviation. Course medial to pedicle. Fish-hook shape. Hydronephrosis. Pelvic lipomatosis features? Young African male. Bilateral hydronephrosis. Extrinsic bladder compression. tear-drop bladder .RadioGyan.com 76 Radiology Made Easy! Most common arch anomaly 2 congenital aorta arch anomalies seen in an adult vascular radiology practice: Diverticulum of Kommerell? Pseudo-coarctation (aortic kink)? Evidence of mediastinal hemorrhage (hge) includes Direct signs of aortic injury include Keys to ig ing a ductus bump| from a contour abnormality at the aortic isthmus? ‘Ascending aortic aneurysm causes: ‘Aneurysms of the arch and descending aorta, causes: Posttraumatic thoracic aortic aneurysms most often occur at Left arch with aberrant right subclavian artery. 2% of population. Left-sided (normal) arch with aberrant right subclavian artery. Pseudocoarctation (aortic kink) of thoracic aorta. Dilation at origin of aberrant Rt. subclavian artery. May impress esophagus, resulting in dysphagia. Mild form of coarctation, hemodynamically insignificant stenosis. Infolding occurs near ligamentum arteriosum. Pressure gradient across the kink < 10 mmHg. roximal ascending aorta. Just beyond Lt subclavian {aortic isthmus). Just above level of the diaphragm. Poorly defined fat planes. Mediastinal hge. Peri vascular hematoma. Periaortic hematoma. Contrast extravasation. ‘Abnormal contour of aorta. Change in caliber. Intraluminal irregularity (intimal flap). Ductus bump is very smooth and convex without acute margins. Aortic tear has acute margins and irregularly shaped. May have associated Luminal narrowing. Persistence of contrast in the outpouching. Double densities. Intimal flap. Cystic medial necrosis. Marfan syndrome. Ehlers- Danlos syndrome. Syphilis. Atherosclerosis. Aortic isthmus. Major complications of thoracic aortic aneurysms Takayasu arteritis Aortic infection is usually divided into 2 types based on the causative microorganism: Rupture. Acute dissection. Granulomatous (giant cell) inflammation of media and adventitia of large elastic arteries. [Asian women. Female-to-male ratio of 10:1. Most often affects thoracic aorta and its proximal branches and pulmonary arterie: (nonsyphiRadioGyan.com 77 Radiology Made Easy! Mycotic nonsyphilitic aortitis, the most common organisms are: Very large aneurysmal aortic root with sinotubular ectasia (tulip-bulb Stanford classification for aortic dissection? Diagnosis of chronic PE by pulmonary angiography is based on the identification of Most common complaint in symptomatic patients with PAVM PAVMs categories Indications for transcatheter embolotherapy of PAVMs include PAVMs are usually treated when the Most common indication for bronchial arteriography Common anatomic variants of peripheral arterial system. In general, a normal ABI should be greater than An ABI between and ignifies intermittent to severe claudication. Staphylococci. Streptococci. Salmonella. Marfan syndrome. appearance) Type A involves ascending aorta. Type B does not involve ascending aorta. DDx of aortic dissection? Intramural hematoma. Penetrating aortic ulcer. [Together these constitute the acute aortic Syndrome ‘Webs. Luminal irregularities. Abrupt vessel narrowing and /or obstruction. Dilated central pulmonary arteries. Epistaxis from hereditary hemorrhagic telangiectasia. imple: One artery to one vein. Comple: feeding arteries and/or draining veins. Exercise intolerance. Prevention of neurologic complications. Prevention of lung hemorrhage (hemoptysis). 3mm Multiple feeding artery is at least Hemoptysis. ‘Absence of anterior or posterior tibial arteries (5% of individuals). High origin of radial artery from the axillary or brachial artery (17% of patients). Persistent sciatic artery (normal fetal branch of internal iliac artery that continues into lower etremity). 1 0.95 & 0.5 The angiographic appearance of diabetic vascular disease differs Vascular calcification involving arteries of all sizes. Disease involvement is more distal, often sparring large proximal vessels.RadioGyan.com 78 Radiology Made Easy! from typical atherosclerosis in 2 main ways: Most common site for upper- extremity atherosclerotic involvement is the In acute peripheral thrombosis or embolism, what clinical findings steer toward an endovascular Exclusive of Takayasu arteritis, what two main vasculitides occur in the Giant cell arteritis typically involves the Angiographic hallmark of Buerger disease is approach versus open surgery. peripheral arterial system? segment narrowing. Proximal left subclavian artery. Can result in subclavian steal. In general, patients with pain and pallor are embolic candidates. Sensory and motor deficits are treated surgically Giant cell arteritis. Buerger disease. ‘Medium to large blood vessels supplying head (Temporal arteries), neck (Carotid arteries), and arms (Axillary and brachial arteries). Most common in women greater than 60 years. Smooth, long Corkscrew appearance of arteries. Collaterals around areas of occlusion (most often at wrists and| ankles). Absence of atherosclerotic findings. Buerger disease (thromboangiitis obliterans) Range of angiographic findings of trauma include Hypothenar hammer Which peripheral arteries can be sacrificed (embolized) without consequence? Fibromuscular disease (FMD) has been described in what arteries Thoracic outlet syndrome ‘Acute inflammation and thrombosis of arteries and veins. Primarily affects hands and feet. Typically young heaving smoking males Vasospasm. intimal irregularity. Pseudoaneurysm. Extravasation. Arteriovenous fistula. Repetitive palmar trauma. Injury of ulnar artery adjacent to hook of hamate. Ulnar artery can be aneurysm, thrombosed, or send emboli to digital arteries. Branches of internal iliac. Branches of profunda femoris. Geniculate branches. Subclavian/axillary/brachial artery branches (except vertebral). pper extremity: Subclavian a. Axillary a. Brachial a ower extremity: Iliac a. Femoral a. Popliteal a. Compression syndrome of upper limb neurovascular bundle at the level of scalene muscles and first rib. 70% with arterial injury have a cervical rib.RadioGyan.com 79 Radiology Made Easy! Popliteal entrapment Adventitial cystic disease Popliteal artery & or vein deviate around medial head of gastrocnemius. Mucin collects in adventitial layer. May lead to narrowing or obstruction. Most commonly in popliteal artery. Arteriomegaly Elective repair of an asymptomatic AAA is when the diameter exceeds Endo-leaks are categorized into 4 types? Commonest pathogen of mycotic aneurysms or pseudoaneurysms of abdominal aorta? Leriche syndrome Aortoiliac occlusive disease can be caused by inflammatory diseases, in particular Hypoplastic aortic syndrome There are a number of etiologies for renal artery occlusive disease, including Neurofibromatosis causes renal artery stenosis by Hypertension secondary to Renal artery aneurysms, outside of trauma, are basically of 2 types: Unusual manifestation of aneurysmal disease. Diffuse generalized dilation of aortoiliac & femoral vessel: 5.0 cm. Type 1: Leak at superior or inferior attachment site. Type 2: Patent side branch filling grafted aneurysm sac (Lumbar or Inferior mesenteric artery). Type 3: Loss of stent graft integrity. Type 4: Leak through porous graft mate! Salmonella species, up to 74%. Bilateral buttock claudication, impotence, and absent femoral pulses. Aortic occlusion. Takayasu arteritis. Long segment, smooth narrowing of abdominal aorta. May extend into branch vessels Congenital long segment narrowing of aorta. Usually seen in young females. Two most common: Atherosclerosis. Fibromuscular dysplasia (FMD). Others: Dissection. Vasospasm. Vasculitis. Coarctation syndromes. Neurofibromatosi: Extrinsic compression of renal artery by neurofibromata. Disorganized intimal and medial proliferation at renal artery orifice or proximal renal arte! Children. Extrarenal: Atherosclerosis. FMD. intrarenal: Polyarteritis nodosa (small & multiple).RadioGyan.com 80 Radiology Made Easy! PAN is a rare necrotizing vasculitis that affects small & medium-sized arteries of multiple organs, most DDx of microaneurysms includes? Most common aneurysm outside of aorta and iliac arteries. commonly Kidney (85%). Liver (65%). Multiple, small, saccular microaneurysms, occlusions, and irregular stenoses| throughout abdominal viscera. PAN. Wegener granulomatosis. Systemic lupus erythematosus. Rheumatoid vasculitis. Drug abuse. Splenic artery aneurysm. Hepatic neoplasms (mets included), which are responsive to embolization? Hepatocellular carcinoma. Neuroendocrine tumors. Melanoma. Sarcoma. Colorectal metastases. Tumor replacement of greater than % of normal liver isa contraindication to embolization. three collateral communications of mesenteric arteries. Causes of acute mesenteric ischemia. A left SVC occurs in 0.3% of the population & descends through Lt. mediastinum anteriorly to join the ito the R. Azygos continuation of the IV caused by? Retroaortic left renal vein, circumaortic left renal vein? The femoral vein is a continuation of the popliteal vein at the which dri 50% to 75%. ‘Marginal artery of Drummond: Anastomosis between right colic, right and left branches of middle colic and left colic arteries. Found along mesenteric border of colon. Important collateral supply in IMA occlusions. Arc of Riolan: Variable communication between SMA and IMA. Located more centrally than marginal artery. Arc of Buehler: Short, ventral artery between main celiac and SMA. Persistent fetal communication. ‘Arterial embolism and thrombosis. Nonocclusive hemia. Mesenteric venous thrombosis. coronary sinus ‘Absence of intrahepatic portion of the IVC. Failure of right subcardinal vein to anastomose with hepatic veins. Hepatic veins drain into RA. Renal and iliac veins drain via azygos and hemiazygos veins into SVC. Retroaortic left renal vein (2%) crosses behind aorta. Both retroaortic and preaortic renal veins form the circumaortic left renal vein (8%). Adductor hiatusRadioGyan.com 81 Radiology Made Easy! Contraindications for peripheral thrombolysis: Complications of venous thrombolysis include: Phlegmasia cerulea dolens Paget-von Schrétter syndrome SVC syndrome is caused by May-Thurner syndrome Budd-Chiari syndrome Coronary vein porto-systemic shunt pathway dications to TIPS? Contre resistance resulting in ischemia. Internal bleeding. Stroke within past 6 months. Cranial or spinal surgery within past 2 months. Intracranial neoplasm. Bleeding diathesis. Uncontrolled hypertension. Contraindication to anticoagulation. Pulmonary embolus. Bleeding: Ataccess site. Hemorrhagic stroke. GI bleeding. Retroperitoneal hematoma. Limb arterial compromise caused by massive acute venous thrombosis. Thrombosis involves both main and collateral venous drainage. Causes swelling and severe elevations in vascular Compression of subclavian vein by a cervical rib, soft tissue anomaly, or scar tissue after clavicle fracture. Results in thrombosis and arm swelling. SVC stenosis and or thrombosis. Extrinsic compression: Bronchogenic carcinoma (up to 82%). Granulomas (histoplasmosis and tuberculosis). Lymphoma. Intrinsic: Intravascular foreign bodies (pacemaker leads, central venous catheters), Venous stenoses caused by chronic dialysis and venous hypertension. Compression of left iliac vein by crossing right iliac artery. This is normal anatomy. Arterial pressure on vein results in wall thickening, narrowing, and thrombosis. Occlusion of hepatic veins. Result of hepatic venous or IVC outflow obstruction. Communicates with azygos system in submucosa of distal esophagus and gastric cardia. Hepatic failure. Severe right heart failure.RadioGyan.com 82 Radiology Made Easy! Mammographic signs of malignancy Definition of breast mass Spiculated mass. Pleomorphic micro-calcifications. (40% of breast cancers) Space occupying lesion seen in 2 different projections. Convex borders. Distorts normal architecture. Increased central density. Definition of breast focal asymmetry Defi n of breast asymmetry Descriptors of breast mass (5) Descriptors of breast shapes (4) Descriptors of breast margins (5) Confined asymmetry with similar shape on two views. Lacks borders conspicuity of a true mass. Space occupying lesion seen in only one view. ‘Size. Morphology. Associated calcifications. Associated findings. Location. Round. Oval. Lobular. Irregular. Circumscribed (>75%). Microlobulated (undulated).| Obscured. indistinct (ill-defined). Spiculated. Definition of circumscribed breast mass. >75% of mass is circumscribed (well-defined). Definition of obscured breast mass. Border is likely circumscribed but hidden by normal tissue. Descriptors of breast density (4). DDx for breast mass with spiculated margins & or architectural distortion (4). Definition of Radial Scar/Complex Sclerosing Lesion. DDx for well-defined mass (6). DDx for multiple bilateral masses (5). High. Equal. Fat-containing radiolucency. Non-fat- containing radiolucency. Breast cancer. Fat necrosis. Scar. Radial Scar. Central sclerosis with varying degrees of epithelial proliferation (precancerous). Cyst. Fibrosis. Fibroadenomas. Breast cancer. Lymphoma. Metestases. Cysts. Fibroadenomas. Multiple Papillomas. Metastises. Multifocal breast cancer. DDx for ill-defined breast mass (3). DDx for fat-containing radiolucent breast mass (5). Description of a breast fibroadenoma? Descriptors of calcifications (4). Breast cancer. Abscess (usually subareolar in lactating women). Spontaneous Hematomas (coagulopathy, Oil cyst (result of trauma). Lipoma. Galactocele. Hamartoma. Fibroadenolipoma. Most common well-defined homogeneous solid mass. Large, coarse and irregular calcifications. Morphology (shape). Distribution. Associated findings. Location.RadioGyan.com 83 Radiology Made Easy! Benign breast calcifications (10). Milk of calcium? Skin/lucent center. Vascular. Coarse /Popcorn. Large/Rod-like. Round (small < 1 mm, punctuate < 0.5 mm). Eggshell/Rim. Milk of Ca. Suture. Dystrophic. Sedimented calcifications in macro/micro-cysts. Amorphous on cranial caudal view. Semilunar, crescent, tea-cup shaped on medial lateral oblique view. Large rod-like calcifications. Lucent centered calcification. Coarse popcorn calcifications. Tnvoluting fibroadenoma Ductal ectasia and/or secretory calcifications. Fat necrosis or calcified debris in ducts. Eggshell/rim calcifications. Fat necrosis. Calcifications within wall of cysts Dystrophic calcifications Dot-dash or casting calcifications Intermediate concern breast High probability breast calcifications (2) Calcification distribution modifiers (5) Definition of regional distribution ion of grouped/clustered distribution Definition of segmental distribution Post trauma. Radiation changes. Comedocarcinoma type of intraductal carcinoma. “Amorphous/Indistinct. Coarse heterogeneous (>0.5| calcifications (2) mm but not the size of dystrophic calcifications). Fine pleomorphic (varying in size and shapes, less than 0.5 mm). Linear or branching (suggests filling of involved duct) iffuse/Scattered. Regional. Grouped/Clustered. Linear. Segmental. Scattered in large volume (>2cc) of Breast tissue. Does not conform to duct distribution. Less likely to be malignant. At least 5 calcifications occupy small volume (<1 cc). Calcifications distributed in ductal distribution. Worrisome for malignancy. Definition of architectural distortion Significance of asymmetric tubular structure/solitary dilated duct Distorted architecture without definite mass. Suspicious for malignancy or radial scar, if no prior trauma or surgery. Little as Tong as no other findings. Intra-mammary LN? Typically reniform with radiolucent notch. Typically within upper outer breastsRadioGyan.com 84 Radiology Made Easy! Definition of global asymmetry. Associated breast findings (6). tors of mammography location (3) & depth (3). Descriptors of Breast compo: (4) BIRADS Classification: BIRADS-3 Imaging decisionin patient < 30 years) with palpable abnormality Breast US, background echotexture descriptors (3) Breast US, Mass Shapes (3) Breast US, Orientation descriptors (2) Breast US, Margin descriptors (5) Breast US, Lesion boundary descriptors (2) Echo Patterns (5) Posterior Acoustic Features (4) Greater volume of Breast tissue in one breast relative to the other. No mass, distorted architecture or associated suspicious calcifications. Skin retraction, Skin lesion, Skin thickening (>2 mm], Nipple retraction, Trabecular thickening, Axillary adenopathy (> 2cm, non-fatty replaced are worrisome) ‘Subareolar, Central, Axillary tail. Anterior, Middle, Posterior. ‘Almost entirely fat (less than 25% glandular). Scattered fibroglandular densities (25-50%). Heterogeneously dense (51-75%). Extremely dense (275%). ADS-0 > Incomplete. BIRADS-1 > Negative. BIRADS-2 > Benign Findings BIRADS-3 > Probably Benign (3-94%). BIRADS-4 > Suspicious abnormality (A, B, C). BIRADS-5 > Highly suggestive (>95%). BIRADS-6 > Proven malignancy. Probably Benign. Less than 2% chance of malignancy. Low grade cancer if present. Ast: US. 2nd: Single oblique view (only if necessary). Homogeneous: fibroglandular or fat. Heterogeneous: typically occurs in younger patients. Oval. Round. Irregular. Parallel (wider than tall). Not Parallel, umscribed. Indistinct. Micro-lobulated. ngular. Spiculated. ‘Abrupt. Echogenic: no sharp demarcation between mass and surrounding tissue. ‘Anechoic. Hyperechoic. Complex. Hypoechoic. Isoechoic. None. Enhancement (echogenic deep to mass).RadioGyan.com 85 Radiology Made Easy! Breast US, Clustered Micro-cysts (2) Shadowing (echopenic deep to mass). Combined. Fibrocystic changes. Apocrine metaplasia: Tiny anechoic foci (< 2 to 3 mm) with thin (< 0.5 mm) septations. DDx for mass in or on skin (6) Breast US, Normal LN appearance? Sebaceous or epidermal inclusion cysts. Keloids. Moles. Neurofibromas. Accessory nipples. Reniform (hypoechoic cortex and echogenic fatty hilus). Axillary LN typically < 2 cm. DDx for abnormal LNs (7). Breast US, BIRADS 3 Breast MR, Focus versus Foci Breast MR, Non-mass-like enhancement descriptors (7) Breast MR, Focal area definition Breast MR, Difference between linear & ductal enhancement Breast MR, Difference between segmental & regional enhancement Breast MR, Internal MR enhancement patterns (5) Breast MR, Kinetic Curve? Breast MR, Screening population selection criteria Metastatic disease. Infectious. Connective tissue disorder (RA, Sarcoidosis). lymphoma. Leukemia. Granulomatous disease (calcifications). Solid mass with circumscribed margins, oval shape & parallel orientation. Likely fibroadenoma, non- palpable complicated cysts, or cluster of microcysts Small (less than 5 mm) isolated spot(s) of enhancement. Not seen on precontrast images. Focal area. Linear. Ductal. Segmental. Regional. Diffuse. Multiple areas of enhancement. Internal enhancement. Non-mass like. Occupies < 25% of breast quadrant. Ductal: resembles a line on 2 views, points towards| nipple Linear: resembles a sheet rather than a line. ‘Segmental: triangular enhancement with apex towards nipple, suggests ductal morphology. Regional: geographic enhancement, not conforming to a duct. Homogeneous. Heterogeneous. Stippled/Punctate. Clumped. Reticular/Dendritic. Initial phase: Slow, Medium, Rapid. Delayed phase: Washout (malignant), Plateau (either), Persistent (benign). >25% risk, based on family history, PIIH, etc.RadioGyan.com 86 Radiology Made Easy! Risk factors for Breast cancer (6) Expected outcomes in group of 1000 asymptomatic women Personal History. Age. Mother, Sister, Daughter with breast cancer. Atypical or precancerous lesions on biopsy. Nulliparity or 1.st child at or > 30 years. 80 require additional studies. 17 biopsied. 6 cancers. Percent of breast cancer not detected at mammography. Percent of malignancies found biopsy of mammographically suspicious abnormalities Mammography radiation risk Convention labeling of Breast radiographs MLO view 9-16%. 25-35%. Life time risk of breast cancer from 1 mammogram. 40-49 y/o: 2/mil, 50-59 y/o: 1/mil. Risk of dying from Breast cancer, 40-49: 700/mil, 50-59: 1000/mil. Marker (I/r/cc/mlo) always placed by axillary tail/lateral breast. Depicts most tissue. Must visualize posterior nipple| line (perpendicular line from pec through nipple) and inframammary fold. CC view Associated with indeterminate calcifications DDx for increased breast density Intra-capsular vs Extra-capsular implant Rupture Description of Gynecomastia Causes of gynecomastia Pec visualized central on the film (only occurs at 30%) with nipple in profile at 1 cm from image edge. Fibrocystic Change. Fibrosis adenosis. Sclerosing adenosis. Epithelial hyperplasia. Cysts. Apocrine metaplasia. Atypical hyperplasia. Hormone therapy (bilateral). Inflammatory cancer (skin thickening). Radiation therapy (at 6 months). Diffuse mastitis. Lymphatic/venous obstruction. Intravascular: contained. Extravascular: free. Mammography can't detect intra-capsular silicone rupture (MR) Triangular or flame shaped area of subglandular tissue with interspersed fat. Unilateral more common than bilateral Chronic liver disease. Meds (cimetidine, thiazides, digitalis). Marijuana. Testicular, adrenal, or pituitary tumor.RadioGyan.com 87 Radiology Made Easy! 4 features that suggest bone malignancy? Benign periostitis features? ‘Aggressive periostitis features? Zone of transition in bony lesions? Osteosarcoma features? Parosteal osteosarcoma features? May mimic an early parosteal osteosarcoma of the posterior femur near the knee. Ewing sarcoma features? Cassic differential diagnosis for a permeative lesion in a child? 30 years old). Cortical destruction. Periostitis. Orientation or axis of the lesion. Zone of transition. Thick, wavy, uniform, or dense periostitis. Due to low-grade chronic irritation that gives periosteum time to lay down thick new bone. Lamellated (onion-skinned), amorphous, or sunburst-like. Periosteum does not have time to consolidate. Border of lesion with normal bone. Narrow: Well- defined (benign). Wide: Imperceptible (aggressive). Destructive lesions with sclerosis from tumor new bone formation or reactive sclerosis. Occur almost exclusively in children and young adults (less than ‘Arises from periosteum. Grows outside one, often wrapping around diaphysis without breaking cortex. Occurs in older age group than central osteosarcomas. Not as aggressive central osteosarcomas. Posterior distal femur is common location. Cortical desmoid tumor. Myositis ossificans. Permeative (multiple small holes) lesion in long bone diaphysis. May have onion-skin, sun-burst, or amorphous periostitis. ion. EG. Ewing sarcoma. Infe Chondrosarcoma features? Bony or soft tissue mass with amorphous, snowflake calcification in an older patient (>40 years). Can't distinguish between enchondromas and low-grade chondrosarcomas. Benign and malignant giant cell tumors appear lentical. If metastasizes (often to lung) then is malignant. Fibrosarcoma features? Lytic tumor without osteoid or chondroid matrix. May be permeative to a fairly well-defined area of lysis. Tend to predominate in fourth decade. May have a bony sequestrum.RadioGyan.com 88 Radiology Made Easy! Malignant fibrous histiocytoma Desmoid tumor Primary lymphoma of bone (reticulum cell sarcoma) Common soft tissue tumors. In bone, appear identical to fibrosarcomas: Variable lytic lesion. May have bony sequestrum. Half-grade fibrosarcoma. More common in soft tissue than bone. Usually are well defined lytic lesions when in bone. Often have benign periostitis with thick spicules. Similar appearance to Ewing sarcoma (perme: or moth-eaten). Occur in older age group than Ewing sarcoma. Classic differential diagnosis for an expansile, lytic metastasis Renal cell carinoma. Thyroid carinoma. Two most common soft tissue tumors Malignant fibrous histiocytoma. Liposarcoma. Synovial sarcomas or synoviomas features? Synovial osteochondromatosis features? Pigmented features? lonodular synovi Soft tissue Hemangioma features? Often adjacent to joints. Typically homogeneously T2 bright. May mimic fluid collection. leading to multiple calcific cartilaginous loose bodies in a joint. 20% do not calcify. May mimic pigmented villonodular synoviti: Rare chronic inflammatory process causing synovial proliferation. Joint swelling, pain, occasionally joint erosions. No calcifications. Low T1 and 12 synovial signal (hemosiderin deposits). Rare chronic inflammatory process causing synovial proliferation. Phleboliths. Often cause cortical holes (pseudopermeative) in adjacent bone. May mimic permeative or moth-eaten pattern. Predental space should not measure more than? Jefferson fracture features? Rotatory fixation of the atlantoaxial joint? Clay-Shoveler's Fracture (#)? 2.5mm. Blow to top of head. C1 ring fracture, lateral masses of C1 must extend beyond margins of C2 body. ‘Atlantoaxial joint becomes fixed. C1—C2 bodies move en mass, instead of rotating on one another. # of C6 or C7 spinous process, relatively innocuous.RadioGyan.com 89 Radiology Made Easy! Hangman's #? Flexion-Teardrop #? Unilateral Locked Facets Unstable, serious # of posterior elements of C2 usually with C2 anterolisthesis on C3. Caused by hyperextension & distraction (head against dashboard). Disruption of posterior C-spine ligaments with anterior vertebral body compression. Usually associated with spinal cord injur Rupture of facet joint ligaments with dislocation due to severe flexion with some rotation. Facets are locked in an overriding position. Seatbelt spine injury Hyperflexion at the waist (lap belt). Distraction of posterior elements and ligaments with anterior vertebral body compression. Usually involves T12, L, or L2. Spondylolysis Kummel disease Bennett Fracture Rolando fracture Break or defect in pars interarticularis portion of lamina. Further collapse of an acute unprotected wedge compression fracture. Results in severe neurologic deficits. Typically occurs 1 to 2 weeks after initial trauma. fracture at base of thumb extending into carpometacarpal joint. Comminuted fracture of thumb base extending into carpometacarpal joint. Mallet finger or baseball finger ‘Gamekeeper's Thumb Failure to diagnose and treat lunate dislocation can result in? Rotary subluxation of the navicular often associated with Kienbock malacia. ‘Avulsion injury at distal phalanx base where extensor digitorum tendon inserts. Avulsion of thumb ulnar collateral ligament at the ulnar aspect of first metacarpophalangeal joint Permanent median nerve impairment. Nerve can get impinged by volarly displaced lunate. Rupture of scapholunate ligament. Scaphoid (navicular) rotates dorsally. Widened space between scaphoid and lunate. Negative ulnar variance. Positive ulnar variance has an increased incidence of Triangular fibrocartilage tears.RadioGyan.com 90 Radiology Made Easy! Fracture of distal radius and ulna with dorsal angulation of distal forearm and wrist. Monteggia Fracture Galeazzi fracture Bony deformities of anterior shoulder dislocation? Permeative lesion in patient < 30 years? Colles fracture. Facture of ulna with dislocation of proximal radius. Fracture of radius with dislocation of distal ulna. Hill-Sachs deformity: indentation on posterosuperior humeral head. Bankart deformity: Bony irregularity or fragment off inferior glenoid. Ewing sarcoma. Infection. Eosinophilig granuloma. Permeative lesion in patient > 40 years? ‘Multiple myeloma. Metastatic carcinomatosis. Primary lymphoma. Subperiosteal bone resorption sites in hyperparathyroidism? Calcification of the sacrotuberous ligament is characteristic for Differential for periosti along bone without an underlying bony Melorheostosis features? Common Causes of Avascular Necrosis Don't touch lesions? Radiologic appearance of myositis ossificans These injuries can have an aggressive radiographic appearance and are located at ligament and tendon insertion sites Radial aspect of middle phalanges. Medial aspect, of proximal tibia. Sacroiliac joints. Distal clavicle. Fluorosis. Hypertrophic pulmonary osteoarthropathy. Venous| stasis. Thyroid acropachy. Pachydermoperiostosis. Trauma. abnormality Idiopathic thickening of cortical new bone. Accumulates near ends of long bones (dripping candle wax). Can affect several adjacent bones. May be symptomatic. Trauma. Steroids. Aspirin. Collagen vascular diseases. Alcoholism. Idiopathic causes. Myositis ossificans. Avulsion injury. Cortical desmoid. Trauma. Discogenic Vertebral Sclerosis. Fracture. Pseudodislocation of Humerus. Circumferential calcification with a lucent center (malignancy may have calcified or ossific center). ‘Avulsion Injury.RadioGyan.com 91 Radiology Made Easy! Cortical desmoid? Geodes can occur in what conditions? Discogenic Vertebral Sclerosis? Dorsal Defect of the Patella? Pseudocyst of the humerus Os odontoideum? Unicameral bone cysts treatment? Bone infarct features? Achondroplasia features? Occur only on posteromedial epicondyle of femur. May result from avulsion of adductor magnus muscle. Trauma. Calcium pyrophosphate dihydrate crystal disease. Rheumatoid arthritis. Avascular necrosis. Variant of a Schmoral node. Often a sclerotic lesion adjacent to endplate. Associated disk space narrowing and osteophytosis. Lytic defect in upper outer quadrant of patella. May mimic pathologic process ‘Anatomic variant of increased cancellous bone near greater tuberosity. May mimic a lytic pathologic lesion. Unfused dens. Smooth, often well-corticated, inferior dens border. Hypertrophied, densely corticated anterior arch of C1. May move anterior to C2 body with flexion. Can mimic a fractured dens. Curettaged and packed to prevent fracture. Those occuring in the calcaneus, however, should be left alone. May be patchy, mixed lytic-sclerotic or even’ resemble permeative process. Typically occur in metadiaphyses. Multiple bone infarcts consider sickle cell anemia or systemic lupus erythematosus. Failure of endochondral bone formation. Narrowing of caudal interpedicular distances. Short| long bones with normal width. Hypertrophic Pulmonary Osteoarthropathy features? Multiple Hereditary Exosto: Central beak or anterior bony projection off vertebral bodies? Inferior bony projections extending anteriorly off the vertebral bodies? Finger clubbing. Extremity periostitis. Multiple osteochondromas or exostoses. Nearly always involves knees. Undertubulation (widened bone diameter) present at site of exostosis. Morquio Syndrome. Hurler Syndrome.RadioGyan.com 92 Radiology Made Easy! Characteristic finding in all of the mucopolysaccharidoses (Hurler, Hunter, Morquio). Osteoma Osteopathia Striata Osteopoikilosis Pachydermoperiostosis Sarcoidosis bony findings? Transient Osteoporosis of the Hip Benign, bony cystic lesion differential? Benign lytic lesions in patients younger than 30 years? lesions that have no ? Benign lyti pain or periosti Fibrous dysplasia discriminator(s)? Enchondroma inator(s)? Eosinophilic granuloma (EG) discriminator(s)? Notch at base of fifth metacarpal. Painful sclerotic cortical lesion with lucent centered nidus. Occurs in patients younger than 30. Nidus is surgically removed or thermally ablated. May mimic osteomyelitis. Bone scan double-density sign versus photopenic area for osteomyel ‘Aka Voorhoeve disease. Multiple 2- to 3-mm-thick linear sclerotic bands aligned parallel to bone long axis. Usually affects multiple long bones. Generally is asymptomatic. Hereditary, asymptomatic disorder. Multiple small (3 to 10 mm) sclerotic bony densities. Primarily involves ends of long bones and pelvis. May mimic diffuse osteoblastic metastases. Rare, familial disease. Skin thickening of face and extremities, finger clubbing, widespread periostitis Lacelike pattern of cortical bony destruction of multiple phalanges. May affect both hands. May have skin nodules. Painful hip osteoporosis and no other finding. Self limited with full resolution. FEGNOMASHIC. Fibrous dysplasia. Enchondroma, EG. Giant cell tumor. Nonossifying fibroma. Osteoblastoma. Metastases, Myeloma. Aneurysmal bone cyst. Solitary bone cyst. Hyperparathyroidism. Infection. Chondroblastoma, Chondromyxoid. Eosinophilic granuloma. Aneurysmal bone cyst. Nonossifying fibroma. Chrondoblastoma. Solitary bone cyst. Fibrous dysplasia. Enchondroma. Nonossifyuing fibroma. Solitary bone cyst. No periosteal reaction. Calcifications present (except phalanges). Painless (no periostitis) ‘Younger than 30 years.RadioGyan.com 93 Radiology Made Easy! Giant cell tumor (GCT) discriminator(s)? Non-ossifying fibroma (NOF) discriminator(s) Epiphyses closed. Abuts articular surface (long bones). Well defined with nonsclerotic margin (long bones). Eccentric. Rules do not apply to flat bone GCTs Younger than 30 years. Painless (no periostitis). Cortically based. Osteoblastoma discriminator(s)? Metastatic disease & myeloma discriminator(s)? ‘Aneurysmal bone cyst (ABC) discriminator(s)? Solitary bone cyst (SBC) discriminator(s| Hyperparathyroidism (brown tumor) discriminator(s)? Infection discriminator(s)? Chondroblastoma discriminator(s)? Mention with ABC, especially in posterior elements of spin >40 years. Expansile. < 30 years. Central. < 30 years. ‘Must have other evidence of hyperparathyroidism. ‘Always mention. < 30 years. Epiphyseal. Chondromyxoid discriminator(s)? Automatics that are mentioned for benign lytic lesions in patients < 30? Automatics that are mentioned for benign lytic lesions in patients > 40? Benign lytic epiphyseal bone lesions No calcified matrix. Infection. Eosinophilic granuloma. Infection. Metastatic disease. Myeloma. Infection. Giant cell tumor. Chondroblastoma. Geode. Differential for benign lytic rib lesion? Multiple benign bony lytic lesion differential? ‘Age and malignant bone tumor groups? (FAME). Fibrous dysplasia. Aneurysmal bone cyst. Metastatic disease and myeloma. Enchondroma and eosinophilic granulom (FEEMHI). Fibrous dysplasia. Eonsinophilic granuloma. Enchondroma. Metastatic disease and myeloma. Hyperparathyroidism (brown tumors). Infection. 1-30: Ewing sarcoma. Osteogenic sarcoma. 30-40: Giant cell tumor. Parosteal sarcoma. Fibrosarcoma. Malignant fibrous histiocytoma. 1' lymphoma of bone. > 40: Chondrosarcoma. Metastatic disease. Myeloma.RadioGyan.com 94 Radiology Made Easy! Fibrous dysplasia features? No periostitis, unless fracture. May be monostotic or polyostotic. Predilection for pelvis, proximal femur, ribs (Iytic posterior ribs, sclerotic anterior ribs), skull. When in pelvis proximal femur involved. McCune-Albright syndrome: Polyostotic fibrous dysplasia, cafe-au-lait spots, precocious puberty. Adamantinoma: Tibial lesion that resembles fibrous dysplasia. Cherubism: Multiple fibrous dysplasia lesions in the jaw. Enchondroma features? Eosinophilic granuloma features? Nonossifying fibroma features? Contain calcified chondroid matrix, except when in phalanges. May cause endosteal scalloping. No periostitis. Difficult to distinguish from chondrosarcoma. Ollier disease (multiple enchondromas). Maffucci disease (multiple enchondromas with soft-tissue hemangiomas) ‘Any lesion in patient under 30 years. May be polyostotic. May have soft-tissue mass. May have bony sequestrum. Fibrous cortical defect (if less than 2cm). Asymptomatic (no periostitis). Metaphyseal. Emanate from cortex. 75% have thin sclerotic border that is scalloped and slightly expansile. Less than 30 years of age. Heal with sclerosis. Osteoblastoma features? Differential of lytic lesion of posterior elements of spine? Crescent sign? Traumatic hemarthrosis displaces the humeral head on the AP film. What lines should be inspected for a suspected sacral fracture on a plain Rectus femoris avulsion occurs at what bony landmark? Rare. Simulate ABCs. Expansile, soup-bubbly. Commonly occur in posterior elements of spine. Osteoblastoma. ABC. TB. Metastasis. Normal shoulder, humeral head slightly overlaps glenoid. Absence of crescent sign is often seen with posterior shoulder dislocation. Inferolaterally ‘Arcuate lines. Anterior inferior iliac spine. Erosions are ordinarily not seen in DJD, except in certain joints such as? Symphysis pubis. Sacroiliac. Temporomandibular joint. Acromioclavicular joint.RadioGyan.com 95 Radiology Made Easy! Hallmarks of DJD are? Sclerosi a weight-bearing bone that has a horizontal or oblique linear pattern? Cross-table lateral plain film of the knee that shows a fat-fluid layer, indicates? In ruling out Lisfranc fracture, medial border of second metatarsal should line up with? Sclerosis. Joint space narrowing. Osteophytosis. Stress fracture until proved otherwise. Intraarticular fracture with bone marrow within joint. Medial border of second cuneiform. When the Bohler angle becomes less than 20 degrees? Only disorder that will cause osteophytes without sclerosis or joint space narrowing Condition with severe osteoporosis of the hands, as well as erosions. Diseases in Which Geodes Are Found Calcaneal fracture should be considered. Diffuse idiopathic skeletal hyperostosis, DISH. Familial. More common in women. Symmetric and bilateral: DIP and PIP joints, base of thumb involement. Erosive osteoarthrits, aka Kellgren arthritis. Degenerative joint disease. Rheumatoid arthritis. Calcium pyrophosphate dihydrate deposition disease (CPPD). Avascular necrosis. Radiographic hallmarks of Rheumatoid arthritis? With rheumatoid arthritis the femoral head tends to migrate whereas in osteoarthritis, it tends to migrate Seronega HLA-B27-posi spondyloarthropathies? Characterized by bony ankylosis, proliferative formation of new bone, and predominantly axial (spinal) involvement? Soft tissue swelling. Osteoporosis. Joint space narrowing. Marginal erosions. Affects proximal hands symmetrically. ‘Axially (RA). Superolaterally (OA). “Ankylosing spondylitis. Inflammatory bowel disease. Psoriatic arthritis. Reiter syndrome. HLA-B27 spondyloarthropathies.RadioGyan.com 96 Radiology Made Easy! Syndesmophyte is a Causes of High-Riding Shoulder Syndesmophyte features of HLA-B27 spondyloarthropathies? Paravertebral ossificatio. Runs vertically, whereas an osteophyte runs horizontally. Rheumatoid arthritis. Calcium pyrophosphate dihydrate deposition disease (CPPD). Torn rotator cuff. ‘Ankylosing spondylitis: Marginal, symmetric. Psoriatic and Reiter syndrome: Nonmarginal, asymmetric. SI joint involvement of HLA-B27 spondyloarthropathies? Psoriatic arthri hands and feet findings in the Proliferative erosions Reiter syndrome causes identical changes in every respect to psoriatic arthritis, with the exception that As many as % of patients with gout concomitantly have CPPD. Hallmarks of Gout? Pseudogout, classic tri Most Common Location of Chondrocalcinosis in Calcium Pyrophosphate Dihydrate Deposition Disease DJD of CPPD has a proclivity for what joints? Three diseases that have a high degree of association with CPPD. Striking radiographic hand abnormalities in collagen vascular diseases (scleroderma, SLE, dermatomyositis, MCTD)? Ankylosing spondylitis and inflammatory bowel disease: Bilateral, symmetric SI joint disease. Reiter| syndrome and psoriatic arthritis: Unilateral or bilateral SI joint disease. Distal predot nce. Proliferative erosions. Soft tissue swelling. Periostitis. Fuzzy margins with wisps of periostitis emanating from them. Seen in psoriatic arthritis. Reiter syndrome involves the feet more commonly than the hands. interphalangeal joint of great toe is commonly affected. 40% Well-defined erosions (sclerotic margins, overhanging edges). Soft tissue nodules (may calcify in renal failure). Random distribution. No osteoporosis. Pain. Cartilage calcification. Joint destruction. Knee. Triangular fibrocartilage of wrist. Symphysis pubis. Shoulder. Elbow. Radio‘ Metacarpophelangeal joints. Patellofemoral joint. Primary hyperparathyroidism. Gout. Hemochromatosis. Osteoporosis. Soft tissue wasting.