Week 8

Question 1

Respiratory distress is one of the most common presenting problems of newborns; what does this include?

Answer 1

Transient tachypnea of the newborn (TTN)
Respiratory distress syndrome (RDS)
Meconium aspiration syndrome

Question 2

Respiratory Distress Syndrome:
1) What is it?
2) What causes it? Explain
3) What are the Sxs?

Answer 2

1) Premature infants (<34 wks gestation)
2) Usually due to surfactant deficiency
Alveolar sacs collapse, widespread atelectasis
3) Severe respiratory distress after birth, progressively worsens
Cyanosis, grunting, nasal flaring, inter-/subcostal retractions, tachypnea

Question 3

Respiratory Distress Syndrome: What are the imaging findings?

Answer 3

Ground-glass appearance to lungs
Bilateral and symmetric
Air bronchograms common
Hypoaeration

Question 4

Reactive airway disease/ bronchiolitis:
1) What is it?
2) Imaging findings?

Answer 4

Question 5

Asthma:
1) How is it diagnosed?
2) When can CXR be used?
3) What are 3 complications?

Answer 5

1) Clinical diagnosis (not radiologic)
2) CXR can be used to evaluate cause or complications of asthma episode
3) Atelectasis secondary to mucus plug
Pneumothorax
Pneumomediastinum

Question 6

Pneumonia:
1) Sxs in neonates?
2) Sxs in older infants?

Answer 6

1) Group B strep is most common cause
Sx: commonly only fever
2) Usually viral
Sx: bacterial - fever, chills, tachypnea, cough, chest pain, SOB; viral -cough, wheeze, stridor

Question 7

Pneumonia: Imaging findings?

Answer 7

Bacterial: Lobar consolidation, round pna, pleural effusion,
Viral:patchy areas, infiltrates

Question 8

Tonsils and Adenoids:
1) When are they visible?
2) When do they stop growing? Explain

Answer 8

1) Adenoids not visible until 3-6 months; Grow until 6yo
2) Involute through development
Adults do not have visible adenoids

Question 9

Epiglottitis: Describe this

Answer 9

1) Airway obstruction due to infection and edema of epiglottis
Life-threatening medical emergency
2/2 H. influenza B + other bacteria
Usually 3-6 yo; pt drools own saliva
2) Imaging
Not always necessary
May be false in early stages
Obtained in upright position only
Lateral neck xr
Thumbprint sign
Enlarged epiglottis

Question 10

Laryngotracheobronchitis (croup): Descr the imaging and how to Dx

Answer 10

1) What about steeple sign?
Tapering of upper trachea on frontal view
Not really reliable by itself
2) Croup is typically diagnosed clinically

Question 11

Ingested Foreign Bodies:
1) When do they occur?
2) What are some special hazards? Explain

Answer 11

1) Usually between 6mo and 6 years
80% pass spontaneously
Ex/ toys, coins, fish or chicken bones
2) Perforation, obstruction, stricture formation:
Button batteries = Emergency; can cause severe burns and perforation
Magnets: Multiple magnets can draw bowel loops together

Question 12

Infant Cardiomegaly:
1) What is the normal baby heart size?
2) Descr the Cardiothoracic ratio

Answer 12

1) Heart will normally appear larger relative to thorax than in adults.
2) In adults: 50%
Infants: nl @ 65%
Thymus gland (white arrows) large until 3 yo

Question 13

Thymus Gland: Descr a normal thymus

Answer 13

Contours appear lobular
Appears largest up to 3 yo then begins to involute, but can be seen into the teenage years

Question 14

Salter-Harris Fractures: How do you evaluate these?

Answer 14

Be sure to compare both sides
Typically, accidental fractures in children

Question 15

Descr mammograms

Answer 15

Low-dose x-ray imaging; a device that applies compression to the breast is used to improve image quality by: reducing the thickness of the tissue x-rays must penetrate
1) Decreasing radiation scatter thereby reducing the required radiation dose
2) Holding the breast in place.

Question 16

What is the use of ultrasound in breast imaging? Explain

Answer 16

1) Most commonly used in conjunction with diagnostic mammography; determines cystic vs solid masses
2) Screening high-risk patients and patients with dense breasts with ultrasound increases breast cancer detection over mammography alone

Question 17

What is the use of MRI in breast imaging? Explain

Answer 17

1) Screens certain high-risk patients as well as evaluating patients who have received breast implants
2) Most sensitive of all breast imaging modalities and the most expensive

Question 18

Descr breast tissue

Answer 18

Breasts are composed of fat, fibroglandular tissue and connective tissue. Depending on the amount of fat and fibroglandular tissue, the breast will appear less dense (more fat - darker), more dense (less fat - whiter), or a combination of both.

Question 19

What can mammograms tell us?

Answer 19

Masses
Asymmetry
Architectural distortion
Calcifications

Question 20

What can be diagnosed via breast imaging?

Answer 20

Cancer
Cysts
Fibroadenomas
Abscesses
Image guided biopsies (U/S)
RISKS- false positives or overdiagnosis

Question 21

Describe Breast imaging indications

Answer 21

1) Know age recommendations for annual screenings including risk factors
2) Special views recommended by Radiologist
3) Ultrasound for palpable masses, or if Radiologist recommends
4) MRI excellent diagnostic tool but difficult to get approved and for pts to lie still due to positioning

Question 22

Mammography:
1) Descr sensitivity
2) How is imaging viewed?

Answer 22

1) Sensitivity depends on density of breast tissue – as density increases (whiter,) sensitivity decreases
“Polar bear in a snowstorm”
2) images are viewed with the patient’s right on your left and the patient’s left on your right (per usual.)

Question 23

Mass Descriptors: What are some descriptors for:
1) Shape
2) Margins
3) Density

Answer 23

1) Shape-Oval, round, irregular
2) Margins-Circumscribed, obscured, micro-lobulated, indistinct, spiculated
3) Density-High-density, equal density, low-density, fat-containing

Question 24

Descr cysts on mammogram

Answer 24

small oval low-density mass (white circle). Cysts are benign, may be single or multiple, and may change in size over time.

Question 25

Descr Breast Calcifications on mammogram

Answer 25

Calcifications in degenerating fibroadenomas in the same breast. One has coarser calcifications (solid white arrow) than the other (dotted white arrow). Fibroadenomas are common benign tumors.

Question 26

Soft tissue imaging: 1) Describe U/S 2) Describe MRI

Answer 26

1) determines cystic vs solid mass; good for symptomatic pts; more sensitive than mammogram in pts w/dense breasts 2) Some pts can’t tolerate- indications: screening for high-risk pts and those with implants; evaluating pts on chemo or with + nodes and unknown primary site

Question 27

Nipple discharge: Descr this

Answer 27

Most is benign, however Spontaneous Unilateral Clear or bloody Are usually => pathological

Question 28

When should you eval a pt with nipple discharge?

Answer 28

=> 30  mammography Will also usually need U/S May need ductogram (looking for filling defect

Question 29

Descr mastitis

Answer 29

inflammation of the breast infectious vs non-infectious causes Usually treated before imaging- can mimic inflammatory carcinoma of the breast, so if patient does not completely respond to antibiotic treatment, mammogram is necessary; U/S can also distinguish the two.

Question 30

Descr abcesses

Answer 30

Can also be difficult to distinguish on imaging from invasive carcinoma -though both present clinically as masses, breast cancer is not always tender, abscesses are always tender.

Question 31

Breast Trauma: What may mammograms show?

Answer 31

Mammograms may show hematomas and Oil cysts along the path of a seatbelt after an MVA

Question 32

About ___% of the population have dense breast tissue, which makes detecting breast cancers challenging. U/S or MRI can be used in high-risk patients.

Answer 32

50%

Question 33

Post Op breast category includes what?

Answer 33

Includes h/o mammoplasty, augmentation, lumpectomy, and biopsies.

Question 34

Post Op breast: Descr implants

Answer 34

Breast implants (silicone or saline) can rupture and can leak within or outside of the capsule that has formed around them MRI without contrast is the gold standard for assessing integrity of breast implants. The older the implant the more likely the chance of rupture.

Question 35

Post Op breast: What are 3 things it can cause?

Answer 35

Distortion Asymmetry calcifications

Question 36

Descr changes in post op breasts

Answer 36

Post op changes should stabilize by 2 years. Any new changes after that time need to be fully evaluated.