1
Q
What to do if you see a syrinx the first time?
A
Give gadolinium contrast
To exclude an underlying mass lesion
2
Q
Causes for Tc-99m MDP uptake in extraosseous tissues
A
Tc-99m MDP uptake in extraosseous tissues
- Factors contributing to increased soft tissue uptake
- focal hyperemia
- extracellular fluid expansion
- increased tissue calcium and phosphate concentration
- alterations in the local chemical milieu
- Benign
- site of injection
- soft tissue infection/inflammation - abscess, DVT, radiation-induced soft tissue injury
- prior trauma - heterotopic calcification, myositis ossificans
- tumoral calcinosis
- scarring from surgery
- infarction
- Malignant
- primary malignancy in adults - calcified and mucin-producing tumors, breast and lung cancer
- primary malignancy in children - neuroblastoma (hot on bone scan 70% of the time, also MIBG hot)
- metastatic disease
3
Q
Ameloblastoma
A
Ameloblastoma
- benign, locally aggressive tumor
- most common location - mandible
- less common - maxilla
- second most common odontogenic tumor
- odontoma most common
- present at 20-30 y/o
- clinical - hard painless mass near the angle of the mandible in the region of 3rd molar tooth
- 20% associated with dentigerous cysts and unerrupted teeth
- xray/CT
- multiloculated
- expansile “soap bubble” like
- well-demarcated borders
- no matrix calcification
- erosion of the adjacent tooth roots - highly specific
- may erode through the cortex into the adjacent soft tissues
- MRI
- mixed solid/cystic components
- thick irregular walls
- papillary solid structures projecting into the lesion
- enhance +++
- Rx - surgical en bloc resection
- DDx
- dentigerous cyst - the relationship between ameloblastomas and dentrigerous cysts is a controversial one: 20% of ameloblastomas thought to arise from pre-existing dentigerous cysts
- odontogenic keratocyst (OKC) - usually unilocular with thin poorly enhancing walls
- odontogenic myxoma - can be almost indistiguishable
- aneurysmal bone cyst (ABC)
- fibrous dysplasia
4
Q
Burkitt Lymphoma
A
Burkitt Lymphoma
- endemic variant
- Africa
- EBV associated
- jaw or other facial bones
- sporadic variant
- outside of Africa
- rarely associated w/ EBV
- ileo-cecal most common location
- immunodeficiency-associated
- HIV
- transplant pts
5
Q
Post thoracic aortic surgery findings
A
- Left ventricle apical venting is sometimes used to maintain a dry surgical field during valvular surgery, as was done in this case during ascending aortic aneurysm repair.
- A pledgeted suture is a suture that is supported by a small piece of cloth, commonly used in cardiothoracic surgery.
- The pledget may mimic a pseudoaneurysm or contrast leak. Precontrast images may be useful to differentiate these entities.
6
Q
Sprain refers to injury of ligaments.
Strain refers to injury of muscles and tendons.
A
Sprain refers to injury of ligaments.
Strain refers to injury of muscles and tendons.
7
Q
Most common cause of acute pancreatitis in pediatric population in US?
Most common cause of chronic pancreatitis in pediatric population OUTSIDE US?
A
Most common cause of acute pancreatitis in pediatric population in US?
- Trauma
Most common cause of chronic pancreatitis in pediatric population OUTSIDE US?
- Tropical pancreatitis
- Tropical pancreatitis is thought to be caused by a combination of malnutrition and ingestion of environmental toxins found, for example, in the cassava plant.
8
Q
Infantile hemangioendothelioma
A
- may develop consumptive coagulopathy - Kasabach-Merritt sequence
- natural history of haemangioendotheliomas in infancy is a rapid, proliferative growth phase in the first 6 months of life, followed by regression and involution.
9
Q
Normal predental space in children vs adults
A
- Children < 5mm
- Adults < 3mm
10
Q
Why does pyloric stenosis usually present?
A
2nd month of life
4-8 weeks old
3mm thick
15 mm long
11
Q
Debris
There is no plural, and the word is always pronounced without the /s/. It is an uncountable noun:
e.g. There is not much debris remaining from the 9/11 attack.
A
Debris
There is no plural, and the word is always pronounced without the /s/.
It is an uncountable noun:
e.g. There is not much debris remaining from the 9/11 attack.
12
Q
Differences in pediatric kidneys vs adult kidneys
on ultrasound?
A
Pediatric kidneys:
- prominent hypoechoic pyramids
- renal cortex may be echogenic (in neonates)
- no renal sinus fat
13
Q
Benign enlargment of subarachnoid space in infancy
BESS of infancy
A
Benign enlargement of subarachnoid space in infancy (BESS)
- male predominant
- majority associated with familial macrocephaly
- transient accumulation of CSF in the frontal region
- thought to be due to delayed development or delayed function of arachnoid villi at the sagittal sinus
- US
- widening of bifrontal and anterior interhemispheric CSF spaces (>5mm)
- no flattening of adjacent gyri
- normal posterior sulci
- normal ventricular size
- key feature differentiating subarachnoid and subdural spaces - cortical veins traversing the subarachnoid spaces
- spontaneous resolution by 2 y/o
14
Q
A
Dilated duct due to intraductal papilloma
- Solitary papillomas are usually located centrally in a major duct in the subareolar breast, often within 1 cm of the nipple.
- Multiple papillomas, in contrast, are usually located in the periphery of the breast and are associated with a higher risk of subsequent breast cancer compared to central papillomas.
- Intraductal papillomas are part of a spectrum of papillary lesions, which also includes atypical papillomas and intraductal papillary carcinoma.
- Histologic categorization of papillary lesions can be difficult due to their heterogeneity, and distinguishing a malignant from a benign papillary lesion may be challenging for the pathologist, particularly if only a portion of the lesion is available for review.
- Some studies have shown a significant upgrade rate with surgical excision, while others suggest imaging followup
15
Q
What to look for in a neonate with an arterial infarct
A
- Cardiac causes
- Hemoglobinopathy, such as sickle cell dz
16
Q
In a supine baby, if he/she aspirates, where does it go?
A
RUL!!!
17
Q
NG vs NJ tubes?
A
NG tubes often cause reflux and aspiration, esp in babies
To prevent aspiration, use NJ tube!!!
18
Q
Cortical pseudolaminar necrosis
A
Cortical pseudolaminar necrosis, also known as cortical laminar necrosis and simply laminar necrosis, is the (uncontrolled) death of cells in the (cerebral) cortex of the brain in a band-like pattern with a relative preservation of cells immediately adjacent to the meninges.
It is seen in the context of cerebral hypoxic-ischemic insults, i.e. strokes.
Hyperintense on both T1 and T2!!!
19
Q
What is the normal carinal angle?
A
70 degrees +/- 10 degrees in adults
if splayed
- subcarinal mass
- LA enlargement
20
Q
A
21
Q
A
Seen as a small soft-tissue density adjacent to the lateral border of the aortic knob on a frontal radiograph in up to 10% of normal patients
Normally the left superior intercostal vein drains the left 2nd, 3rd, and 4th posterior intercostal veins and connects the left brachiocephalic vein and the accessory hemiazygous vein
As such, the left superior intercostal vein provides a collateral path of blood back to the heart
The size of the left superior intercostal vein is inversely related to the size of the accessory hemiazygous vein: the smaller (or absent) the accessory hemiazygous, the larger will be the left superior intercostal vein
The accessory hemiazygous vein (orange arrow below) drains the posterior intercostal veins from 3-4 intercostal spaces between the left superior intercostal vein (green arrow below) and the uppermost branch of the hemiazygous vein (blue arrow below)
22
Q
Glabella
A
the smooth part of the forehead above and between the eyebrows.
23
Q
Most common lung findings of Wegener’s granulomatosis in children?
Most common airway findings in Wegener’s granulomatosis in children?
A
Most common lung findings of Wegener’s granulomatosis in children?
- nodules
Most common airway findings in Wegener’s granulomatosis in children?
- stenosis (often subglottic)
24
Q
Paraneoplastic syndrome associated with
mature cystic teratomas?
A
Paraneoplastic syndrome associated with mature cystic teratomas?
- Limbic encephalitis
- Cushing syndrome
25
Grading for chondromalacia
•grade I
focal areas of hyperintensity with normal contour
◦arthroscopically : softening or swelling of cartilage
•grade II
blister-like swelling/ fraying of articular cartilage extending to surface
◦arthroscopically : fragmentation and fissuring within soft areas of articular cartilage
•grade III
◦partial thickness cartilage loss with focal ulceration
◦arthroscopically : partial thickness cartilage loss with fibrillation (crab-meat appearance)
•grade IV
◦full thickness cartilage loss with underlying bone reactive changes
◦arthroscopically : cartilage destruction with exposed subchondral bone
26
What malignancy is most commonly associated with leptomeningeal carcinomatosis?
What malignancy is most commonly associated with leptomeningeal carcinomatosis?
* breast
* lung
* lymphoma
* leukemia
* melanoma
27
How to measure for Chiari I malformation
* anterior - basion
* posterior - opisthion
* need to measure from cortical bone to cortical bone (not just the fatty marrow part)
28
In children, it is common to have prominent perivascular spaces
In children, it is common to have prominent perivascular spaces
29
Triad of prune belly syndrome
* underdevelopment of anterior abdo wall muscle
* ureteric distention
* bilateral cryptorchidism
30
Fetal and neonatal tumors are most often supratentorial in location, in comparison to tumors in older children, which are often infratentorial.
Fetal and neonatal tumors are most often supratentorial in location, in comparison to tumors in older children, which are often infratentorial.
31
3 most prominent features of craniopharyngioma
* mixed solid and cystic
* calcification (\>90%)
* enhancement (\>90%)
peds craniopharyngioma - often solid/cystic
adult craniopharyngioma - often purely solid
32
DDx for pituitary stalk lesions
* neoplastic
* germinoma
* hypothalamic glioma
* CNS lymphoma
* pituicytoma
* granular cell tumor
* metastasis
* infectious
* CNS TB
* sequelae of meningitis
* infiltrative
* LCH
* sarcoidosis
* lymphocytic hypophysitis
33
DDx for pineal tumor in kids
* pineoblastoma
* germ cell tumor
* retinoblastoma (also ocular inovlvement)
* astrocytoma - but more precisely arises from the tectal plate/midbrain
34
Pineoblastoma
* highly malignant (WHO IV)
* PNET
* highly cellular
* 30% have CSF dissemination
* most present w/ hydrocephalus
* many have localized invasion
* average age of Dx - 3 y/o
35
Germinoma
* supersellar - 20%
* pineal - 80%
* M:F = 10/1
* in the supersellar region - "hugs" the ventricles
* very chemo/rad sensitive, good 5 year survival
36
37
Brainstem glioma
* astrocytoma
* low grade usually
* low attenuation on CT
* "engulfs" the basilar artery
38
Arc of Buhler
Arc of Buhler
* persistent embryonic connection b/t the celiac artery and SMA
* independent of other collateral pathways b/t celiac and SMA
* GDA
* dorsal pancreatic artery
* travels vertically
* ventral to abdominal aorta
* 1-4% of individuals
39
Arc of Riolan
Aarc of Riolan
* aka "meandering mesenteric artery"
* meander: to follow a winding and turning course
* connects proximal SMA (or one of its primary branches) to the proximal IMA
* important artery for either proximal SMA or IMA occlusion
* in distal abdominal arotic occlusion, it provides collateral flow from SMA to IMA to iliac vessels (via superior rectal artery) and to lower (via external iliac artery)
40
Marginal artery of Drummond
Marginal artery of Drummond
* anastomosis of the terminal branches of ileocolic, right colic, and middle colic arteries of the SMA, and of the left colic and sigmoid branches of the IMA, to form a continuous arterial circle and arcade along the inner border of the colon
* important connection b/t SMA and IMA
* junction of SMA and IMA territories is splenic flexure
41
Neuroblastoma
vs
Wilm's tumor
Neuroblastoma
* younger age \< 2y/o
* metastases - liver and bone
* 3/4 show calcifications
* surrounds and engulfs vessels
* no renal vein/IVC invasion
Wilm's
* older age = approx. 3y/o
* metastases - lungs
* no calcifications
* displaces vessels
* invade renal vein/IVC
42
Choriocarcinoma
* results from
* normal pregnancy
* ectopic
* molar pregnancy
* metastases go to
* lungs
* brain
Choriocarcinoma
* Results from
* normal pregnancy
* ectopic pregnancy
* molar pregnancy
* metastases go to
* lungs
* brain
43
Penumbra sign in Brodie abscess
Penumbra sign in Brodie abscess - highly specific for Brodie abscess (vs tumor):
Highly vascularized granulation tissue at the periphery of the abscess, high in signal intensity on T1 images (both noncontrast and contrast-enhanced sequences) and typically indistinguishable from the hyperintense signal of the fluid collection on T2 imaging.
In contrast, tumors generally have a collagenous lining that has relatively little vascularity and show low T1 signal.
44
New name for Wegener's granulomatosis?
Granulomatosis with polyangiitis
45
Subungual exostosis
46
Prominent external occipital protuberance
A normal variant
47
For an OCD lesion, what is the best MR sequence to look at for stability - i.e., overlying cartilage integrity?
T2\* GRE
cartilage will be bright
bones are dark
48
Intramedullary spinal cord neoplasms are relatively rare
4-10% of all CNS neoplasms
Most common intramedullary spinal cord neoplasms
* in children - astrocytoma
* eccentric location in the cord, ill-defined borders, and heterogeneous, patchy enhancement
* in adults - ependymoma
* central location in the cord, a well-defined cleavage plane, and intense, homogenous enhancement
49
Congenital tracheal stenosis
Congenital tracheal stenosis
* due to presence of complete or near-complete cartilaginous tracheal rings
* often associated with
* pulmonary sling - LPA arises from the RPA
* pulmonary hypoplasia
50
2 types of ependymoma
* cellular (intra-medullary)
* arise from ependymal cells lining the central canal of the spinal cord
* myxopapillary (filum terminale)
* arise from cell rests along the filum
51
Patients receiving systemic chemotherapy for cancer metastatic to the liver can develop a radiologic mimic of cirrhosis known as pseudocirrhosis.
The most frequently reported cause of pseudocirrhosis is breast cancer that has metastasized to the liver.
Morphologic changes that occur in pseudocirrhosis include lobular hepatic contour due to capsular retraction, segmental volume loss, and enlargement of the caudate lobe. The absence of septal fibrosis in pseudocirrhosis distinguishes it from true cirrhosis.
Patients receiving systemic chemotherapy for cancer metastatic to the liver can develop a radiologic mimic of cirrhosis known as pseudocirrhosis.
The most frequently reported cause of pseudocirrhosis is breast cancer that has metastasized to the liver.
Morphologic changes that occur in pseudocirrhosis include lobular hepatic contour due to capsular retraction, segmental volume loss, and enlargement of the caudate lobe. The absence of septal fibrosis in pseudocirrhosis distinguishes it from true cirrhosis.
52
Necrobiotic lung nodules
Necrobiotic lung nodules
* RA
* IBD
* Caplan syndrome
53
Causes of intravertebral air
Causes of intravertebral air
* Intravertebral air may be seen in degenerative joint disease, osteomyelitis (pyogenic infections, NOT TB), osteonecrosis, penetrating trauma, in the postoperative period, and idiopathic.
* It is commonly seen in the sacrum and ilium adjacent to the sacroiliac joint and in the cervical vertebral bodies.
54
Onus
refer to something that is one's duty or responsibility
55
far-flung
distant, remote
56
Bungling
Bungling
## Footnote
carry out (a task) clumsily or incompetently, leading to failure or an unsatisfactory outcome
57
DDx for basal ganglia calcification
DDx for basal ganglia calcification
* ischemic stroke
* hypoxic ischemic injury - chronic sequela
* infectious encephalitis - HIV, TORCH
* endocrinologic disorders - hypo/hyper-parathyroidism
* Fahr disease - familial cerebrovascular ferrocalcinosis, is a rare autosomal dominant neurodegenerative disorder that can present with neuropsychiatric or extrapyramidal symptoms
58
Mallory-Weiss tear
vs
Boerhaave syndrome
Mallory-Weiss tear is a mucosal esophageal tear as a result of forceful vomiting or retching.
A Mallory-Weiss tear is a partial thickness esophageal tear as opposed to Boerhaave syndrome, which involves a transmural tear.
Mallory-Weiss tear - conservative management
Boerhaave syndrome - surgical treatment
59
Scapholunate ligament disruption with
intercarpal communication from the midcarpal to the radiocarpal compartments
Scapholunate ligament disruption with
intercarpal communication from the midcarpal to the radiocarpal compartments
* normal scapholunate interval - 2-3mm
* wrist joint is divided into 3 compartments
* midcarpal joint
* radiocarpal joint
* distal radioulnar joint
* disruption of the scapholunate ligament --\> abnormal intercommunication b/t midcarpal and radiocarpal compartments
* disruption of the triangular fibrocartilage (TFCC) --\> abnormal intercommunication b/t midcarpal and distal radioulnar compartments
60
Adult vs pediatric
testicular germ cell tumors
Seminomas are more common in the adult population,
with nonseminomatous germ cell tumors more common in the pediatric population.
* most common - yolk sac tumor
61
Diffuse idiopathic skeletal hyperostosis (DISH)
* R\>L (left side is inhibited by pulsation of the aorta)
* most common in thoracic spine
* can also been seen at SI joints
* DISH itself is often incidental, but may produce spinal stiffness and limitaiton of ROM
* associated with ossification of the posterior longitudinal ligament (OPLL) --\> neurological symptoms due to nerve or spinal cord displacement or impingement
* in truma may mimic "carrot-stick"/"chalk-stick" fracture in AS
Diffuse idiopathic skeletal hyperostosis (DISH)
* R\>L (left side is inhibited by pulsation of the aorta)
* most common in thoracic spine
* can also been seen at SI joints
* DISH itself is often incidental, but may produce spinal stiffness and limitaiton of ROMassociated with ossification of the posterior longitudinal ligament (OPLL) --\> neurological symptoms due to nerve or spinal cord displacement or impingement
62
3 diagnostic criteria for DISH
3 diagnostic criteria for DISH
* flowing ossification along the anterolateral aspect of at least 4 contiguous vertebral bodies
* primarily due to ossification of the anterior longitudinal ligament
* intervertebral disc heights are preserved with minimal degenerative disc disease
* no evidence of apophyseal or costovertebral fusion
63
Most common cardiac tumors
* most common - metastatic cardiac tumors
* secondary
* benign
* 1st - myxoma
* 2nd - rhabdomyoma (peds)
* 3rd - fibroma
* malignnat
* angiosarcoma
64
Beam hardening
* occurs with polyenergetic beams
* preferential attenuation of lower energy photons (due to photoelectric effect)
* as the beam passes through an absorbing medium, the average energy of the beam increases as lower energy photons are attenuated with higher probability
Beam hardening
* aluminum or copper filters can be placed in the path of an X-ray beam to intentionally remove some low energy X-rays from the beam
* without the filtration process, these low energy photons with little penetrating power would be totally absorbed superficially in the patient, dramatically increasing the patient dose without providing any signal for the image receptor
* CT - petrous temporal bone or metal
* beam hardening artifact = streak artifacts
65
CT renal mass protocol
* unenhanced
* corticomedullary - best for cortical-medullary differentiation, and preoperative vascular mapping
* nephrographic - homogeneous renal parenchymal enhancement, most sensitive in detecting renal mass
* excretory - collecting system
CT renal mass protocol
* unenhanced - calcifications, stones
* corticomedullary - best for cortical-medullary differentiation, and preoperative vascular mapping
* nephrographic - homogeneous renal parenchymal enhancement, most sensitive in detecting renal mass
* excretory - collecting system
66
Any renal mass with enhancing solid component
- RCC until proven otherwise
Any renal mass with enhancing solid component
- RCC until proven otherwise
67
Scamp
Scamp
A person, especially a child, who is mischievous in a likable or amusing way.
68
Epilation
removal of hair by the roots
Epilation
removal of hair by the roots
69
Cellular sensitivity to radiation based on cell cycle
* most radiosensitive - M
* more radiosensitive - late G2
* least radiosensitive - S
Cellular radiosensitivity based on cell cycle
* most radiosensitive - M (mitosis)
* more radiosensitive - late G2 phase
* least radiosensitive - S (synthesis)
70
Acute radiation syndrome based on dose
* bone marrow syndrome - 2 Gy
* GI syndrome - 8 Gy
* CNS syndrome - 20 Gy
Acute radiation syndrome based on dose
* bone marrow syndrome - 2 Gy
* GI syndrome - 8 Gy
* CNS syndrome - 20 Gy
71
Radiation effects
Probabilistic (stochastic)
vs
Deterministic (non-stochastic)
Radiation effects
Probabilistic (stochastic) --\> DNA encoding changes
* effects more likely to occur with increasing dose
* probability of incurring events is proportional to dose
* NO minimal threshold
* severity of effect not related to dose
* e.g., genetic effects and cancer
vs
Deterministic (non-stochastic) --\> cell death
* have a dose threshold above which the effect will occur, below which the effect will not occur
* thresholds may vary depending on individual biologic differences in radiation sensitivity
* severity of effect increases with dose
* e.g., damage to skin, lens, and acute radiation syndrome
* NOTE: no deterministic effects from radiation exposure if dose \< 0.1 Gy (higher than most single diagnostic radiology exam)
72
Current ICRP dose threshold for lens cataract
0.5 Gy
for both acute and chronic exposure
with latent period inversely proportional to dose
73
Genetic effects
There is no direct evidence at any dose level that exposure of parents to radiation leads to excess genetic disease in offspring.
Genetic effects
There is no direct evidence at any dose level that exposure of parents to radiation leads to excess genetic disease in offspring.
74
Accessory navicular bone
aka
Os naviculare
* most common: asymptomatic adolescent female
* often associated with pes planus, thought to be from abnormal insertion of the tibialis posterior tendon onto the accessory navicular bone leading to loss of function and plantar arch support
* 3 types
* Type 1: Also known as “os tibiale externum"; a 2–3 mm sesamoid bone embedded within the distal posterior tibial tendon near its navicular insertion that is usually asymptomatic.
* Type 2: A secondary navicular ossification center with a fibrocartilaginous articulation with the navicular bone that may evolve into bony fusion.
* Type 3: A prominent navicular tuberosity, also known as a cornuate navicular, thought to be a fused type 2.
Accessory navicular bone
aka
Os naviculare
most common: asymptomatic adolescent female
often associated with pes planus, thought to be from abnormal insertion of the tibialis posterior tendon onto the accessory navicular bone leading to loss of function and plantar arch support
3 types --
Type 1: Also known as “os tibiale externum"; a 2–3 mm sesamoid bone embedded within the distal posterior tibial tendon near its navicular insertion that is usually asymptomatic.
Type 2: A secondary navicular ossification center with a fibrocartilaginous articulation with the navicular bone that may evolve into bony fusion.
Type 3: A prominent navicular tuberosity, also known as a cornuate navicular, thought to be a fused type 2.
75
Pharmaceutical monograph
Pharmaceutical Monograph
76
Carpal boss
The condition may represent either or a combination of:
* degenerative osteophyte formation
* os styloideum (an accessory ossicle of the wrist)
* bony prominence at the base of the second or third metacarpals
Pain may be the result of a ganglion, inflamed bursa or extensor tendon slipping over the boney prominence.
77
A cavitating lung lesion with what...findings would
move pulmonary TB up the list?
If you see a cavitating lesion with:
* peri-lesional bronchial wall thickening
* peripheral satellite lesions
==\> move TB up the DDx list
78
Hawkins Sign
Hawkins Sign
* subchrondral radiolucent band
* seen 6-8 weeks following fracture
* increase in bone resorption related fracture healing
* actually a good sign
79
Ankle injuries that are related Maisonneuve fracture
* medial malleolus
* posterior malleolus
* antior talofibular ligament
* etc...
80
Melorheostosis
Melorheostosis
* abnormality of a sensory nerve ...
* can have pain, swelling etc
* cortical thickening - candle wax appearance
* on NM bone scan - intensely hot!!!
* associated with soft tissue tumors
* myxomas!
81
Plantar fibromatosis
a.k.a. Ledderhose disease
Plantar fibromatosis
* benign fibroblastic proliferation of the plantar fascia
* a type of superficial fibromatosis
* M:F=2:1
* clinical
* palpable nodules and masses
* middle to medial aspect of the plantar arch
* ultrasound
* hypo to mixed echogenicity
* discrete, fusiform, multinodular thickening of the plantar fascia
* separate from the calcaneal insertion
* MRI
* T1 - iso to low signal compared to muscle
* T2 - low to intermediate signal compared to muscle
* T1 post gad - various contrast enhancement
* Rx - local excision with wide margins
82
HME
HME
Hereditary multiple exostosis
malignant common site of malignant transormation
* pelvic exostosis
83
Cerebral vasospasm occurs most frequently 4–10 days after aneurysmal SAH and can last for a prolonged period.
Risk of vasospasm is greatest at days 7–8 after initial bleed and can start as early as day 3.
Cerebral vasospasm occurs most frequently 4–10 days after aneurysmal SAH and can last for a prolonged period.
Risk of vasospasm is greatest at days 7–8 after initial bleed and can start as early as day 3.
84
After SAH from rupture of an aneurysm there is risk of the following:
* Rebleed, particularly within the first 24 hours prior to definitive therapy with endovascular coiling or clipping
* Acute hydrocephalus
* Vasospasm and resulting infarction
After SAH from rupture of an aneurysm there is risk of the following:
* Rebleed, particularly within the first 24 hours prior to definitive therapy with endovascular coiling or clipping
* Acute hydrocephalus
* Vasospasm and resulting infarction
85
Treatment of vasospasm includes the following:
* Hypervolemia
* Hemodilution
* Hypertension
* If a patient continues to worsen with declining neurological status or with considerable elevation of transcranial Doppler velocities, a calcium channel blocker (eg, Nicardipine or Verapamil) can be injected intra-arterially to induce vascular relaxation.
Treatment of vasospasm includes the following:
* Hypervolemia
* Hemodilution
* Hypertension
* If a patient continues to worsen with declining neurological status or with considerable elevation of transcranial Doppler velocities, a calcium channel blocker (eg, Nicardipine or Verapamil) can be injected intra-arterially to induce vascular relaxation.
86
Kaposi Sarcoma
* endothelial neoplasm - spindle-shaped cells with abnormal endothelial lining of vascular channels and slit like spaces of extravasated red cells
* HHV-8 related
* multi-centric involvement
* lung
* skin
* GI tract
* lymph nodes
* AIDS-related - most common AIDS-related neoplasm
* can also occur in non-AIDS but immunosuppressed patients (e.g., transplant patients)
* CXR - bilateral perihilar opacities
* CT
* perihilar opacities
* "flame-shaped" consolidations
* bronchovascular bundle thickening
* basilar predominance
* enhancing lymphadenopathy
* NM
* Gallium-Thallium imaging\*\*\*\*\*\*\*
* Gallium-negative
* Thallium-positive
* Rx
* HAART
* chemotherapy and radiation therapy
* cryotherapy for skin lesions
Kaposi Sarcoma
* endothelial neoplasm - spindle-shaped cells with abnormal endothelial lining of vascular channels and slit like spaces of extravasated red cells
* HHV-8
* multi-centric involvement
* lung
* skin
* GI tract
* lymph nodes
* AIDS-related - most common AIDS-related neoplasm
* can also occur in non-AIDS but immunosuppressed patients (e.g., transplant patients)
* CXR - bilateral perihilar opacities
* CT
* perihilar opacities
* "flame-shaped" consolidations
* bronchovascular bundle thickening
* basilar predominance
* enhancing lymphadenopathy
* NM
* Gallium-Thallium imaging\*\*\*\*\*\*\*
* Gallium-negative
* Thallium-positive
* Rx
* HAART
* chemotherapy and radiation therapy
* cryotherapy for skin lesions
87
What's the difference between a wet and a dry cappuccino?
As if all the various espresso drinks weren't confusing enough. A typical cappuccino has 1/3 steamed milk, 1/3 foamed milk, and 1/3 espresso.
The differences between a wet and dry cappuccino aren't exactly carved in stone. A wet cappuccino has more steamed milk than frothed milk, whereas a dry cap has less steamed milk.
88
Neuroblastic tumors such as ganglioneuroblastoma should be considered in the differential diagnosis for retroperitoneal tumors, especially in children and young adults.
Neuroblastic tumors can arise in any location along the sympathetic nervous system chain, from the neck to the pelvis. The most common location is the adrenal gland.
Ganglioneuroblastomas often appear heterogeneous on MRI with variable enhancement and high signal intensity on T2-weighted imaging. Some may be hemorrhagic and thus hyperintense on T1-weighted images.
Urine catecholamines and metanephrines may be elevated.
Neuroblastic tumors such as ganglioneuroblastoma should be considered in the differential diagnosis for retroperitoneal tumors, especially in children and young adults.
Neuroblastic tumors can arise in any location along the sympathetic nervous system chain, from the neck to the pelvis. The most common location is the adrenal gland.
Ganglioneuroblastomas often appear heterogeneous on MRI with variable enhancement and high signal intensity on T2-weighted imaging. Some may be hemorrhagic and thus hyperintense on T1-weighted images.
Urine catecholamines and metanephrines may be elevated.
89
Classification of neurogenic tumors - based on cell origin
* nerve sheath tumor
* ganglion cell tumors ( = neuroblastic tumors) - 3 subtypes based on histology and malignancy potential:
* neuroblastoma - malignnat
* ganglioneuroblastoma (intermediate/mixed)
* ganglioneuroma (benign)
* paraganglion cell tumors
Classification of neurogenic tumors - based on cell origin
* nerve sheath tumor
* ganglion cell tumors ( = neuroblastic tumors) - 3 subtypes based on histology and malignancy potential:
* neuroblastoma - malignnat
* ganglioneuroblastoma (intermediate/mixed)
* ganglioneuroma (benign)
* paraganglion cell tumors
90
Mazabraud syndrome
Mazabraud syndrome
* polyostotic fibrous dysplasia
* soft tissue/intramuscular myxomas
91
* polyostotic fibrous dysplasias
* soft tissue / intramuscular myxomas
what syndrome?
Mazabraud syndrome
92
Tack
93
Felt-tip pen
94
Cowden syndrome
Cowden syndrome
aka "multiple hamartoma syndrome"
* mucocutaneous lesions
* GI tract/bowel hamartomatous polyps
* thyroid abnormalities
* fibrocystic changes of breasts
* INCREASED RISK FOR
* tyroid cancer - 5%
* breast cancer - 30-50%
* Lhermitte-Duclos disease (LDD)
- dysplastic cerebellar gangliocytoma
95
Gorlin syndrome
aka "basal cell nevus syndrome"
is a phakomatosis
Gorlin syndrome = basal cell nevus syndrome
* basal cell cancer
* odontogenic keratocyst
* falcine calcifications - bilamellar calcification
* rib anomalies - bifid rib, fused, splayed
* palmar pits \> 3
* first degree relative with Gorlin syndrome
96
Hyperdense testes in the setting of trauma
Need prior for comparison
DDX: hemorrhagic contusion vs neoplasm
97
testicular adrenal rest tumors
CAH is an autosomal recessive disorder with enzyme defect, usually 21-hydroxylase, that presents in the neonatal or infantile period with resulting impaired production of aldosterone and cortisol. There is resultant increase in pituitary ACTH production which leads to hyperplasia of the adrenal tissue. This leads to the common enlarged cerebriform appearance of the adrenal glands in these patients. During embryologic development, the adrenal glands are in close proximity to the undifferentiated gonad, and part of the adrenal cells may be included within it, leading to adrenal tissue within the testis. With increased ACTH, there is also hyperplasia of this aberrant adrenal tissue, leading to testicular adrenal rest tumors (TART).
TART have no malignant tendencies. However, their common location is the mediastinum testis, which leads to compression of the seminiferous tubules with resultant damage to the adjacent testicular tissue and obstructive azoospermia, and infertility. TART is seen in up to 94% of males with CAH. They are typically not palpable and are identified only with ultrasound or MR evaluation.
The radiologist should be aware of TART as a possible intratesticular lesion entity, possibly saving the patient from surgical intervention. Additionally, an incidental finding of enhancing testicles in the presence of hyperplastic adrenal glands should prompt the radiologist to consider the possibility of increased ACTH levels and TART and to recommend further evaluation of the testes with ultrasound or MR.
98
LR+ = sensitivity / (1-specificity)
LR- = (1-sensitivity) / specificity
LR+ = sensitivity / (1-specificity)
LR- = (1-sensitivity) / specificity
99
cholecystomy tube - you have to make sure cystic duct is patent -- contrast HAS to transit through the small bowel!!!
cholecystomy tube - you have to make sure cystic duct is patent -- contrast HAS to transit through the small bowel!!!
100
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