Body Ct

Front 1

Patients with Sjogren syndrome are at increased risk for developing what diffuse lung diseases

Back 1

Lymphocytic interstitial pneumonitis (LIP). Non-Hodgkin pulmonary lymphoma.

Front 2

Ankylosing spondylitis lung involvement

Back 2

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.

Front 3

These histologic terms provide the most precise method of classifying the idiopathic interstitial pneumonias

Back 3

UIP. Acute interstitial pneumonia (AIP). COP. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). DIP. Nonspecific interstitial pneumonia (NSIP).

Front 4

Usual Interstitial Pneumonia

Back 4

Most common of the idiopathic interstitial 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.

Front 5

Acute Interstitial Pneumonia

Back 5

Diffuse ground-glass opacity and consolidation with air bronchograms. Linear opacities, honeycombing, and traction bronchiectasis are uncommon.

Front 6

Conditions associated with BOOP, organizing pneumonia.

Back 6

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.

Front 7

Cryptogenic Organizing Pneumonia

Back 7

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.

Front 8

Respiratory Bronchiolitis-Associated Interstitial Lung Disease

Back 8

Typically young, heavy smokers. Scattered ground-glass opacities. Small centrilobular nodules with upper lobe predominance.

Front 9

Desquamative Interstitial Pneumonia

Back 9

95% are cigarette smokers. Cannot be radiologically distinguished from UIP. Bibasilar reticular opacities. Normal or midly decreased lung volumes. May have ground-glass opacities. Honeycombing is rare.

Front 10

Neurofibromatosis ILD

Back 10

Generally asymmetric upper lung bullae. Generally symmetric lower lung interstitial fibrosis.

Front 11

Tuberous Sclerosis (TS) ILD

Back 11

Indistinguishable from LAM. Symmetric bilateral reticular or reticulonodular opacities. Scattered lung cysts. Normal to increased lung volumes. Pneumothorax is common

Front 12

Lymphangioleiomyomatosis

Back 12

Exclusively in women. Lung cysts separated by interlacing bundles of smooth muscle. May obstruct lymphatics causing chylothorax. Poor prognosis.

Front 13

Alveolar Septal Amyloidosis

Back 13

Simulates silicosis or lung sarcoidosis. Upper lung reticulonodular opacities.

Front 14

Chronic Aspiration Pneumonia

Back 14

Irregular reticular interstitial opacities.

Front 15

3 major pneumoconioses

Back 15

Asbestosis. Silicosis. CWP.

Front 16

Asbestosis

Back 16

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.

Front 17

Silicosis

Back 17

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.

Front 18

Coal Worker's Pneumoconiosis

Back 18

Predominantly upper lung reticulonodular or small nodular opacities.

Front 19

Rare Pneumoconioses

Back 19

Berylliosis. Aluminum. Hard metal (cobalt, tungsten).

Front 20

Hypersensitivity Pneumonitis

Back 20

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.

Front 21

Lung Sarcoidosis staging

Back 21

0 Normal chest radiograph. 1 Bilateral hilar lymph node enlargement. 2 Bilateral hilar lymph node enlargement and parenchymal disease 3. Parenchymal disease only. 4 Pulmonary fibrosis.

Front 22

Sarcoidosis ILD

Back 22

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.

Front 23

Langerhans Cell Histiocytosis of Lung

Back 23

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.

Front 24

Wegener Granulomatosis

Back 24

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.

Front 25

Chronic Eosinophilic Pneumonia

Back 25

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

Front 26

Hypereosinophilic syndrome

Back 26

Male predominance. Blood eosinophilia. Cardiomegaly. Pulmonary edema. Pleural effusions. Pulmonary parenchymal infiltration with eosinophils may produce interstitial or airspace opacities.

Front 27

Eosinophilic Lung Disease Associated With Autoimmune Diseases

Back 27

Wegener granulomatosis. Sarcoidosis. Rheumatoid lung disease. Polyarteritis nodosa. Allergic angiitis and granulomatosis.

Front 28

Eosinophilic Lung Disease of Identifiable Etiology

Back 28

Drugs (Nitrofurantoin and Penicillins). Parasites (Ascaris lumbricoides, Strongyloides stercoralis).

Front 29

Pulmonary alveolar proteinosis

Back 29

Lipoproteinaceous material deposits within alveoli. Predilection for males in their 20s to 40s. Bilateral symmetric perihilar airspace opacification. Crazy paving CT finding: Geographic ground-glass opacities with thickened interlobular and intralobular septa. Prone to superinfection with Nocardia, Aspergillus, Cryptococcus, and atypical mycobacteria.

Front 30

Alveolar microlithiasis

Back 30

Deposition of minute calculi within alveolar spaces. Confluent bilateral dense micronodular opacities. So-called black pleura sign. Apical bullous disease is common.

Front 31

Diffuse pulmonary ossification

Back 31

Formation of bone within lung parenchyma. Associations: Mitral stenosis. UIP. Amyloidosis.

Front 32

Tracheocele

Back 32

Paratracheal air cysts. True diverticula. Occur at weakened posterior membrane of cervical trachea.

Front 33

Tracheal bronchus

Back 33

Bronchus suis. Accessory bronchus to all or a 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.

Front 34

Primary neoplasms of trachea

Back 34

Malignant: Squamous cell carcinoma. Adenoid cystic carcinoma (cylindroma). Benign: Chondroma. Fibroma. Squamous cell papilloma. Hemangioma.

Front 35

Tracheal Narrowing

Back 35

Saber-sheath trachea. Amyloidosis. Tracheobronchopathia osteochondroplastica. Relapsing polychondritis. Wegener granulomatosis. Tracheal scleroma.

Front 36

Tracheal dilation

Back 36

Tracheobronchomegaly (Mounier-Kuhn syndrome). Tracheomalacia. Interstitial pulmonary fibrosis.

Front 37

Saber-sheath trachea

Back 37

Coronal diameter is less than two thirds of sagittal diameter. Affects older men with chronic obstructive pulmonary disease (COPD).

Front 38

Tracheobronchopathia osteochondroplastica

Back 38

Multiple submucosal osseous and cartilaginous deposits within trachea and central bronchi of elderly men. Spares membranous posterior wall of trachea.

Front 39

Relapsing polychondritis

Back 39

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.

Front 40

Tracheobronchomegaly (Mounier-Kuhn syndrome)

Back 40

Congenital. Associated with Ehlers-Danlos syndrome. Men under age 50. Trachea and central bronchi measure greater than 3.0 cm and 2.5 cm.

Front 41

Tracheobronchomalacia

Back 41

Diffuse tracheal and central bronchial dilation. Congenital or acquired (COPD, Chronic bronchitis, Cystic fibrosis, Relapsing polychondritis).

Front 42

Fallen lung sign

Back 42

Subtended lung remains collapsed against lateral chest wall. Secondary to bronchial injury. Responds poorly to chest tube evacuation.

Front 43

Broncholithiasis

Back 43

Calcified material within bronchus. Usually from eroding calcified lymph nodes (Histoplasmosis or TB).

Front 44

Asthma

Back 44

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.

Front 45

Chronic bronchitis

Back 45

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.

Front 46

Bronchiectasis

Back 46

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.

Front 47

Cystic fibrosis

Back 47

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.

Front 48

Dysmotile cilia syndrome

Back 48

May result in Rhinitis. Sinusitis. Bronchiectasis. Dysmotile spermatozoa and sterility. Situs inversus. Dextrocardia.

Front 49

Kartagener syndrome triad

Back 49

Sinusitis. Situs inversus.. Bronchiectasis.

Front 50

Allergic bronchopulmonary aspergillosis

Back 50

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.

Front 51

Emphysema

Back 51

Permanent enlargement of airspaces distal to terminal bronchiole. Destruction of alveolar walls without obvious fibrosis.

Front 52

Centrilobular emphysema

Back 52

Airspace distention in central portion of lobule. Spares distal portions of the lobule. Upper lobe predominance. Associated with cigarette smoking.

Front 53

Panlobular emphysema

Back 53

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.

Front 54

Paraseptal emphysema

Back 54

Distention of peripheral airspaces adjacent to interlobular septa. Spares centrilobular region. Generally involves subpleural regions of upper lobes.

Front 55

Paracicatricial or irregular emphysema

Back 55

Lung destruction associated with fibrosis. No consistent relationship to a given portion of the lobule. Commonly associated with old granulomatous inflammation.

Front 56

Emphysema findings

Back 56

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.

Front 57

Arterial deficiency emphysema versus increased markings emphysema.

Back 57

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.

Front 58

Bulla defined

Back 58

Thin-walled cystic space > 1 cm in diameter. Found within lung parenchyma.

Front 59

Bullae may be seen in diseases that cause chronic upper lobe fibrosis, such as

Back 59

Sarcoidosis. Pulmonary Langerhans cell histiocytosis. Ankylosing spondylitis.

Front 60

Primary bullous disease

Back 60

Isolated bullae without intervening emphysema or interstitial lung disease. Associated with: Marfan or Ehlers-Danlos syndromes. Intravenous drug use. HIV infection. Vanishing lung syndrome.

Front 61

CT findings and associations of infectious bronchiolitis

Back 61

Tree-in-bud opacities. Generally due to infection: Viral. Atypical. Mycobacterial.

Front 62

CT findings of diffuse panbronchiolitis

Back 62

Tree-in-bud opacities. Bronchial dilation and thickening.

Front 63

CT findings and associations of Respiratory bronchiolitis–associated interstitial lung disease

Back 63

Centrilobular and geographic ground-glass opacities. Cigarette smoking.

Front 64

CT findings and associations of Hypersensitivity pneumonitis (subacute)

Back 64

Centrilobular ground-glass nodules. Air trapping on expiratory scans. Inhaled organic antigen.

Front 65

CT findings and associations of Follicular bronchiolitis

Back 65

Centrilobular ground-glass nodules. Rheumatoid arthritis. Sjögren syndrome.

Front 66

CT findings and associations of Constrictive bronchiolitis

Back 66

Mosaic attenuation with air trapping on expiratory scans. Bronchial dilation (late). Transplant patients. Drug reactions. Inhalation injury.

Front 67

Transudative pleural effusion lab values

Back 67

Pleural/serum protein ratio less than 0.5. Pleural/serum LDH ratio less than 0.6. Pleural LDH less than 200 IU/L.

Front 68

Infectious causes of pleural effusion?

Back 68

Bacterial/mycobacterial. Viral. Fungal. Parasitic.

Front 69

Cardiovascular causes of pleural effusion?

Back 69

Heart failure. Pericarditis. Superior vena cava obstruction. Postcardiac surgery. Myocardial infarction. Pulmonary embolism.

Front 70

Neoplastic causes of pleural effusion?

Back 70

Bronchogenic carcinoma. Metastases. Lymphoma. Pleural or chest wall neoplasms (mesothelioma).

Front 71

Immunologic causes of pleural effusion?

Back 71

Systemic lupus erythematosus. Rheumatoid arthritis. Sarcoidosis (rare). Wegener granulomatosis.

Front 72

Inhalational cause of pleural effusion?

Back 72

Asbestosis.

Front 73

Trauma causes of pleural effusion?

Back 73

Blunt or penetrating chest trauma.

Front 74

Abdominal disease causes of pleural effusion?

Back 74

Cirrhosis (hepatic hydrothorax). Pancreatitis. Subphrenic abscess. Acute pyelonephritis. Ascites (from any cause). Splenic vein thrombosis.

Front 75

Miscellaneous causes of pleural effusion?

Back 75

Drugs. Myxedema. Ovarian tumor.

Front 76

Pleural effusion from congestive heart failure features

Back 76

Transudative. Bilateral, right larger than left. Isolated right effusion twice as common as isolated left effusion.

Front 77

Findings on CT that are fairly specific for the presence of an exudative pleural effusion

Back 77

Thickening and enhancement of parietal pleura. Loculations. Soft tissue lesions along parietal pleura outlined by pleural fluid.

Front 78

Tumors most commonly associated with pleural effusion are, in order of frequency,

Back 78

Lung carcinoma. Breast carcinoma. Pelvic tumors (ovarian fibroma = Meigs syndrome). Gastric carcinoma. Lymphoma.

Front 79

Lung abscess versus empyema?

Back 79

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.

Front 80

Most common intrathoracic manifestation of rheumatoid arthritis

Back 80

Pleural effusion.

Front 81

Most common causes of chylothorax are

Back 81

Malignancy. Iatrogenic trauma. TB

Front 82

Left chylothorax versus right chylothorax?

Back 82

Left chylothorax: Injury to upper duct. Right chylothorax: Injury to lower duct.

Front 83

Bronchopleural Fistula

Back 83

Communication between lung and pleural space. If bronchus involved, may result in empyema. If peripheral airspace (bronchiole) involved, may result in intractable pneumothorax.

Front 84

Primary spontaneous pneumothorax

Back 84

Often occurs in young or middle-aged men. Predilection of taller individuals. Results from bleb or bulla rupture, usually within upper lungs.

Front 85

Secondary Spontaneous Pneumothorax

Back 85

COPD. Asthma. Valsalva (cocaine, marijuana, labor). Sarcoidosis. Langerhans cell histiocytosis. Lymphangioleiomyomatosis. Necrotizing pneumonia. Abscess. Mechanically ventilated patients.

Front 86

Catamenial pneumothorax

Back 86

Rare recurrent pneumothoraces. Occurs with menses. Pleural endometrial implants. Treated with OCPs.

Front 87

Most common cause of tension pneumothorax

Back 87

Iatragenic trauma in mechanically ventilated patients.

Front 88

Causes of pleural thickening

Back 88

Pneumonia. Pulmonary infarct. Trauma. Asbestos exposure (bilateral).

Front 89

Causes of pleural calcification

Back 89

Visceral pleura: Hemothorax, Empyema (tuberculosis). Parietal pleura:  Asbestos exposure (bilateral).

Front 90

Causes of pleural/extrapleural masses

Back 90

Benign: Fibroma. Lipoma. Neurofibroma. Malignant: Metastases (usually multiple).  Mesothelioma (usually diffuse pleural thickening). Other: Loculated pleural effusion/empyema. Hematoma.

Front 91

Fluid within calcified pleural layers seen on CT suggests

Back 91

Active empyema. Most commonly within patients with prior TB.

Front 92

Fibrothorax

Back 92

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 Hemothorax. Pleurectomy (decortication) may be necessary to restore function.

Front 93

Malignant pleural disease is most often caused by one of four conditions:

Back 93

Metastatic adenocarcinoma (lung, breast, ovary, kidney, GI tract). Invasive thymoma or thymic carcinoma. Mesothelioma. Rarely non-Hodgkin lymphoma.

Front 94

Benign and malignant Asbestos-Related Pleural Diseases

Back 94

Benign: Pleural plaques. Pleural effusions. Diffuse pleural fibrosis. Malignant: Mesothelioma.

Front 95

When viewed en face, calcified pleural plaques appear as

Back 95

Geographic opacities. Llikened to a holly leaf.

Front 96

Poland syndrome

Back 96

Autosomal recessive disorder. Unilateral absence of sternocostal head of pectoralis major. Ipsilateral syndactyly. Rib anomalies.

Front 97

Most common benign neoplasm of chest wall

Back 97

Lipoma

Front 98

Most common malignant soft tissue neoplasms of the chest wall in adults.

Back 98

Fibrosarcomas. Liposarcomas.

Front 99

A rare malignant neoplasm arising from the chest wall of children and young adults

Back 99

Askin tumor. Arises from primitive neuroectodermal rests. Very aggressive with a poor prognosis.

Front 100

Benign chest wall lesions

Back 100

Abscess. Hematoma. Lipoma. Hemangioma. Desmoid tumor.

Front 101

Inferior rib notching causes

Back 101

Coarctation of aorta. Aortic thrombus. Takayasu arteritis. SVC syndrome. Neurofibromatosis.

Front 102

Suprior rib notching cause

Back 102

Paralysis.

Front 103

Benign rib neoplasms, most common first

Back 103

Osteochondroma. Enchondroma. Osteoblastoma.

Front 104

Most common primary rib malignancy

Back 104

Chondrosarcoma.

Front 105

Rib malignancies

Back 105

Most common: Myeloma. Metastatic carcinoma. Primary malignancies: Chondrosarcoma. Osteogenic sarcoma. Fibrosarcoma.

Front 106

Most common metastatic lesions to ribs

Back 106

Breast cancer. Lung cancer.

Front 107

Expansile lytic rib metastases are seen most commonly from

Back 107

Renal cell carcinoma. Thyroid carcinoma.

Front 108

Sclerotic rib metastases are most commonly seen in

Back 108

Breast cancer. Prostate cancer.

Front 109

Pleuropulmonary infections that may traverse the pleural space and produce a chest wall infection include

Back 109

TB. Actinomycosis. Nocardiosis.

Front 110

Sprengel deformity

Back 110

Congenital hypoplastic and elevated scapula.

Front 111

Klippel-Feil syndrome.

Back 111

Sprengel deformity (hypoplastic, elevated scapula). Omovertebral bone. Fused cervical vertebrae. Hemivertebrae. Kyphoscoliosis. Rib anomalies.

Front 112

Erosion of the distal clavicles

Back 112

Rheumatoid arthritis: Well-defined pointed distal clavicle. Hyperparathyroidism: Irregular and wide distal clavicle.

Front 113

H-shaped or Lincoln log vertebrae on lateral chest radiographs

Back 113

Sickle cell anemia.

Front 114

Rugger jersey appearance to thoracic spine on lateral chest radiographs

Back 114

Renal osteosclerosis.

Front 115

Pectus excavatum is commonly associated with congenital connective tissue disorders, such as

Back 115

Marfan syndrome. Poland syndrome. Osteogenesis imperfecta. Congenital scoliosis.

Front 116

Pectus carinatum

Back 116

Outward bowing of sternum. May be congenital or acquired.

Front 117

Eventration of the diaphragm

Back 117

Congenital absence or underdevelopment of diaphragmatic musculature. Localized elevation of anteromedial hemidiaphragm in older individuals.

Front 118

Unilateral diaphragmatic paralysis is usually caused by

Back 118

Surgical injury or neoplastic involvement of phrenic nerve.

Front 119

Bilateral Diaphragmatic Elevation that is not effort related may be caused by

Back 119

Neuromuscular disturbance. Intrathoracic or intra-abdominal disease.

Front 120

Bochdalek Hernia

Back 120

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).

Front 121

Morgagni Hernia

Back 121

Parasternal diaphragm defect. Invariably right sided. Asymptomatic cardiophrenic angle mass.

Front 122

Primary diaphragmatic tumors

Back 122

Benign: Lipomas. Fibromas. Schwannomas. Neurofibromas. Leiomyomas. Echinococcal cysts and extralobar sequestrations may be found within the diaphragm. Metastatic invasion more common than primary malignancy (Fibrosarcoma): Lower lobe bronchogenic carcinoma. Mesothelioma.

Front 123

Cystic adenomatoid malformation

Back 123

Usually seen in infancy. One or several large cysts lined with respiratory epithelium with scattered mucous glands, smooth muscle, and elastic tissue. Round, air-filled masses that compress adjacent lung and mediastinum.

Front 124

Bronchial atresia presentation

Back 124

Central bronchial mucocele with peripheral hyperlucency in a young, asymptomatic patient.

Front 125

Intralobar and extralobar sequestration blood supply and drainage

Back 125

Intralobar sequestration: Single large artery from infradiaphragmatic aorta. Pulmonary vein drainage. Extralobar sequestration: Small branches systemic arteries and occasionally pulmonary arteries. Systemic venous drainage (inferior vena cava, azygos, or hemiazygos veins).

Front 126

Hypogenetic lung-scimitar syndrome

Back 126

Variant of hypoplastic lung with abnormal venous drainage to the IVC just above or below right hemidiaphragm. Small right hemithorax with diaphragmatic elevation or eventration. Dextroposition of heart. Herniation of left lung anteriorly into right hemithorax.

Front 127

Three radiographic patterns of aspiration pneumonitis

Back 127

Extensive bilateral airspace opacification. Diffuse but discrete airspace nodular opacities. Irregular parenchymal opacities that are not obviously airspace.

Front 128

Exogenous lipoid pneumonia

Back 128

Older patients with swallowing disorders or gastroesophageal reflux. Use mineral oil as a laxative or inhale oily nose drops. Fat density opacity.

Front 129

Drug that cause drug induced chest diseases

Back 129

Lupus-like syndrome (procainamide, isoniazid, hydralazine). Nitrofurantoin. Bleomycin. Methotrexate. Amiodarone.

Front 130

A confident diagnosis of hamartoma can be made when HRCT shows

Back 130

Nodule less than 2.5 cm with a smooth or lobulated border and containing focal fat. May have popcorn calcification.

Front 131

Benign neoplasm arising from neural elements in the central airways or lung parenchyma. The skin is the most common site for these tumors.

Back 131

Granular cell myoblastoma.

Front 132

Bronchogenic adenocarcinoma features

Back 132

Most common type of lung cancer (nonsmokers, too). Arise from bronchiolar or alveolar epithelium. Irregular or spiculated appearance. ccur in the lung periphery.

Front 133

Bronchioloalveolar cell carcinoma (BAC)

Back 133

Grows along bronchiolar and alveolar walls (lepidic growth). May appear as: Solitary nodule. Focal ground-glass opacity. May mimic pneumonia or bilateral nodular airpsace processes.

Front 134

Squamous cell carcinoma features

Back 134

Arises centrally within lobar or segmental bronchi. Central necrosis with cavitation may be seen. Generally presents as hilar mass and atelectasis.

Front 135

Small cell carcinoma features

Back 135

Arises centrally within main or lobar bronchi from bronchial neuroendocrine (Kulchitsky) cells. Hematogenous dissemination. Hilar/mediastinal mass.

Front 136

Large cell bronchogenic carcinoma radiographic feature

Back 136

Large peripheral mass.

Front 137

In addition to cigarette smoke, well-recognized risk factors for the development of bronchogenic carcinoma include

Back 137

Asbestos exposure. Previous Hodgkin lymphoma. Radon exposure. Viral infection. Diffuse interstitial or localized lung fibrosis.

Front 138

Most common radiographic findings from endobronchial tumor obstruction.

Back 138

Resorptive atelectasis. Obstructive pneumonitis.

Front 139

Majority of pancoast tumors, histology type

Back 139

SCC. Adenocarcinoma.

Front 140

Pancoast tumor symptoms

Back 140

Arm pain and muscular atrophy due to brachial plexus involvement. Horner syndrome (ptosis, anhydrosis, miosis) from involvement of sympathetic chain. Shoulder pain from chest wall invasion.

Front 141

CT angiogram sign and BAC

Back 141

Filling of airspaces with mucoid material produced by malignant cells creates low-density airspace opacification surrounding enhanced pulmonary arteries.

Front 142

Typical radiologic findings of lymphangitic carcinomatosis

Back 142

Linear and reticulonodular opacities. Peribronchial cuffing. Subpleural edema or pleural effusion.

Front 143

Helps distinguish lymphangitic carcinomatosis due to lung cancer from other metastases

Back 143

Unilateral or asymmetric involvement of lungs suggests lung cancer rather than an extrapulmonary site.

Front 144

Two patient groups of small cell lung cancer

Back 144

Disease limited to one hemithorax (limited disease). Contralateral lung or extrathoracic spread (extensive disease).

Front 145

Two most common primary tracheal malignancies

Back 145

SCC > Adenoid cystic carcinoma

Front 146

Tracheal mass size and malignancy

Back 146

Masses > 2 cm are likely to be malignant. Less than 2 cm are more likely benign.

Front 147

Other, less common primary tracheal malignancies

Back 147

Mucoepidermoid carcinoma. Carcinoid tumor. Adenocarcinoma. Lymphoma. Small cell carcinoma. Leiomyosarcoma. Fibrosarcoma. Chondrosarcoma.

Front 148

Primary malignant neoplasms of the central bronchi include

Back 148

Squamous cell carcinoma. Small cell carcinoma. Carcinoid tumor. Bronchial gland tumors (adenoid cystic carcinoma, mucoepidermoid carcinoma).

Front 149

Carcinoid radiologic features

Back 149

Prefers right upper and middle lobes. Well-defined smooth or lobulated nodules or masses. Iceberg tumor: small intrabronchial and large extraluminal soft tissue component.

Front 150

A benign neoplasm comprised of disorganized epithelial and mesenchymal elements normally found in the bronchus or lung.

Back 150

Pulmonary hamartoma.

Front 151

A feature that helps distinguish lymphangitic carcinomatosis from interstitial fibrosis,

Back 151

Thickened septal lines of lymphangiti carcinomatosis do not distort the pulmonary lobule.

Front 152

Lymphocytic interstitial pneumonitis

Back 152

Infiltration of pulmonary interstitium by mature lymphocytes. CT findings: Diffuse ground-glass opacity. Poorly defined centrilobular nodules. Thin-walled cysts. Associations: Sjogren syndrome. Hypogammaglobulinemia. Multicentric Castleman disease. AIDS.

Front 153

Posttransplant lymphoproliferative disorder (PTLD)

Back 153

Spectrum of entities. Ranging from benign polyclonal lymphoid proliferation to aggressive non-Hodgkin lymphoma.

Front 154

Pulmonary blastoma

Back 154

Rare malignant tumor affecting children and young adults. Histology simulates fetal lung at 10 to 16 weeks’ gestation. Tend to be extremely large at presentation.

Front 155

Lobar pneumonia features

Back 155

Typical of pneumococcal pulmonary infection. Inflammatory process spreads via pores of Kohn and canals of Lambert to produce nonsegmental consolidation. Air bronchograms are common.

Front 156

Bronchopneumonia features

Back 156

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.

Front 157

Interstitial pneumonia features

Back 157

Viral and mycoplasma infection. Inflammatory thickening of bronchial and bronchiolar walls and pulmonary interstitium. Peribronchial cuffing and reticulonodular opacities.

Front 158

Pneumatoceles may be distinguished from abscesses by

Back 158

Thin walls. Rapid change in size. Generally develop during late phase of infection.

Front 159

Ranke complex

Back 159

Calcified parenchymal focus (Ghon lesion) and lymph nodel calcification. Primary TB.

Front 160

Postprimary TB

Back 160

Reactivation occurs in apical and posterior segments of upper lobes and superior segments of lower lobes. Ill-defined patchy and nodular opacities. Cavitation usually indicates active and transmissible disease.

Front 161

Rasmussen aneurysm

Back 161

Erosion of cavitary focus into pulmonary artery branch can produce an aneurysm.

Front 162

Miliary TB

Back 162

May complicate primary or reactivation disease. Hematogenous dissemination. Diffuse bilateral 2- to 3-mm pulmonary nodules.

Front 163

Opportunistic fungal lung pathogens

Back 163

Aspergillus. Candida. Cryptococcus.

Front 164

Aspergillus lung involvement

Back 164

Aspergilloma or mycetoma within preexisting cavities. Semi-invasive (chronic necrotizing) aspergillosis in mildly impaired immunity. Invasive pulmonary aspergillosis in neutropenia. Allergic bronchopulmonary aspergillosis in hyperimmunity.

Front 165

Pulmonary echinococcal cysts are composed of three layers:

Back 165

Inside out: Endocyst, produces daughter cyts. Exocyst (chitinous layer), protective membrane. Pericyst, surrounding compressed, fibrotic lung.

Front 166

CT halo sign

Back 166

Decreased attenuation surrounding a dense, mass-like opacity. Relatively specific for invasive aspergillosis in a neutropenic patient.

Front 167

Most common AIDS-defining opportunistic infection.

Back 167

PCP

Front 168

Interlobular (Septal) Lines

Back 168

Thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting costal pleura.

Front 169

Interlobular (septal) lines DDx:

Back 169

Interstitial edema.   Lymphangitic carcinomatosis.   Sarcoidosis.   Idiopathic pulmonary fibrosis (IPF) (other forms of usual interstitial pneumonia UIP).

Front 170

Intralobular lines ILD DDx

Back 170

IPF (UIP). Asbestosis. Alveolar proteinosis. Hypersensitivity pneumonitis.

Front 171

Thickened fissures ILD DDx

Back 171

Pulmonary edema.   Sarcoidosis.   Lymphangitic carcinomatosis.

Front 172

Peribronchovascular interstitial thickening

Back 172

Pulmonary edema (smooth).   Sarcoidosis (nodular).   Lymphangitic carcinomatosis (smooth or nodular).

Front 173

Centrilobular nodules ILD DDx

Back 173

Hypersensitivity pneumonitis.  Bronchiolitis obliterans with organizing pneumonia (BOOP)/cryptogenic organizing pneumonia (COP).  Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD).

Front 174

Subpleural lines ILD DDx

Back 174

Asbestosis.   IPF (UIP).

Front 175

Parenchymal bands ILD DDx

Back 175

Asbestosis.   IPF (UIP).   Sarcoidosis.

Front 176

Honeycombing

Back 176

IPF (UIP).   Asbestosis.  Hypersensitivity pneumonitis (chronic).  Sarcoidosis.

Front 177

Thin-walled cysts ILD DDx

Back 177

Eosinophilic granuloma (EG). Lymphangioleiomyomatosis.  Tuberous sclerosis.  Neurofibromatosis (pneumatocele). (emphysema).

Front 178

Micronodules, random distribution ILD DDx

Back 178

Miliary tuberculosis or histoplasmosis.  Hematogenous metastases.  Silicosis/coal worker's pneumoconiosis (CWP).  EG.

Front 179

Micronodules, perilymphatic distribution ILD DDx

Back 179

Sarcoidosis.   Lymphangitic carcinomatosis.  Silicosis/CWP.

Front 180

Ground-glass opacities ILD DDx

Back 180

Desquamative interstitial pneumonia.  Acute interstitial pneumonia (AIP).  Hypersensitivity pneumonitis. BOOP/COP.  RB-ILD.  Hemorrhage.  Pneumocystis jiroveci pneumonia.  Cytomegalovirus pneumonia.  Alveolar proteinosis.

Front 181

Traction bronchiectasis ILD DDx

Back 181

Sarcoidosis.   Silicosis/CWP.

Front 182

Conglomerate mass ILD DDx

Back 182

Sarcoidosis.  Silicosis.  CWP.  Radiation fibrosis.

Front 183

Subpleural Lines

Back 183

5- to 10-cm-long curvilinear opacities are found within 1 cm of the pleura and parallel the chest wall. Most often seen in patients with asbestosis and, less commonly, IPF.

Front 184

Parenchymal bands

Back 184

Nontapering linear opacities, 2 to 5 cm in length. Extend from lung to contact pleural surface. Asbestosis. IPF. Sarcoidosis.

Front 185

Honeycombing

Back 185

Small (6 to 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.

Front 186

Thin-walled cysts

Back 186

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

Front 187

Micronodules

Back 187

1- to 3-mm. Sharply marginated. Round opacities seen on HRCT. Represent conglomerates of granulomas or tumor cells within the interstitium.

Front 188

Ground-Glass or Hazy Increased Density

Back 188

Granular appearance with maintained visibility of pulmonary vessels. Absence of air bronchograms. Desquamative interstitial pneumonia (DIP). Pneumocystis jiroveci (formerly P carinii) pneumonia. Acute hypersensitivity pneumonitis. Nonspecific interstitial pneumonia (NSIP). Interstitial pulmonary edema.

Front 189

Traction bronchiectasis

Back 189

Fibrosis causes traction on the walls of bronchi, resulting in irregular dilation.

Front 190

ILDs Upper zone distribution

Back 190

Tuberculosis (postprimary). Chronic fungal infection (Histoplasmosis, Coccidioidomycosis).  Sarcoidosis.  Eosinophilic granuloma.  Silicosis.  Ankylosing spondylitis.  Hypersensitivity pneumonitis (chronic). Radiation fibrosis from treatment of head and neck malignancy.

Front 191

ILDs Lower zone distribution

Back 191

Idiopathic pulmonary fibrosis.  Asbestosis.  Rheumatoid lung.  Scleroderma.  Neurofibromatosis.  Dermatomyositis/polymyositis.  Chronic aspiration.

Front 192

ILDs normal or increased lung volumes

Back 192

Sarcoidosis.  Eosinophilic granuloma.  Lymphangioleiomyomatosis.  Tuberous sclerosis.  Interstitial disease superimposed on emphysema.

Front 193

ILDs Honeycombing

Back 193

Idiopathic pulmonary fibrosis.  Sarcoidosis.  Eosinophilic granuloma.  Rheumatoid lung.  Scleroderma.  Pneumoconiosis.  Hypersensitivity pneumonitis.  Chronic aspiration.  Radiation fibrosis.

Front 194

ILDs miliary nodules

Back 194

Tuberculosis.  Fungi (Histoplasmosis, Coccidioidomycosis, Cryptococcosis). Silicosis.  Metastases (Thyroid carcinoma, Renal cell carcinoma, Bronchogenic carcinoma, Melanoma, Choriocarcinoma).  Sarcoidosis.  Eosinophilic granuloma.

Front 195

Hilar/mediastinal lymph node enlargement

Back 195

Sarcoidosis.  Lymphangitic carcinomatosis.  Lymphoma.  Hematogenous metastases.  Tuberculosis. Fungal infection.  Silicosis.

Front 196

ILDs Pleural disease

Back 196

Asbestosis (plaques).  Lymphangitic carcinomatosis (effusion).  Rheumatoid lung disease (effusion/thickening).  Lymphangioleiomyomatosis (chylous effusion).

Front 197

Manifestations of Rheumatoid Lung Disease

Back 197

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 hypertension. Right heart enlargement. Pulmonary hemorrhage

Front 198

Caplan syndrome

Back 198

Thick walled cavitating lung nodules. Rheumatoid arthritis patients with hypersensitivity to inhaled dust particles (coal, silica, asbestos).

Front 199

Scleroderma ILD findings

Back 199

Interlobular septal thickening. Ground-glass opacities. Honeycombing. Lower lung predominance. Patulous esophagus.

Front 200

Interstitial pulmonary edema CXR findings?

Back 200

Intrapulmonary vascular shadows. Peribronchial cuffing. Tram tracking.

Front 201

Kerley A and B lines?

Back 201

Kerley A lines thickening of central connective tissue septa. Kerley B lines thickening of peripheral interlobular septa.

Front 202

Alveolar pulmonary edema localized to the right upper lung may be seen in patients with

Back 202

Severe mitral regurgitation.

Front 203

Causes of Pulmonary Venous Hypertension and Pulmonary Edema

Back 203

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 intrapulmonary veins (pulmonary venoocclusive disease).

Front 204

Radiographic findings of pulmonary venous hypertension are

Back 204

Enlargement of pulmonary veins (progressive dilation of horizontally oriented pulmonary veins). Redistribution of pulmonary blood flow to upper lungs.

Front 205

ARDS

Back 205

Respiratory failure due to increased capillary permeability edema. Associated with increased lung stiffness (noncompliance).

Front 206

Common causes of ARDS

Back 206

Shock. Severe trauma. Burns. Sepsis. Narcotic overdose. Pancreatitis.

Front 207

ARDS radiographic findings

Back 207

Patchy peripheral airspace opacities (12-24 hrs). Confluent bilateral airspace opacities with air bronchograms (days). Coarse reticulonodular pattern (week) that may resolve.

Front 208

Causes of neurogenic pulmonary edema

Back 208

Head trauma. Seizure. Increased intracranial pressure.

Front 209

Hemorrhage or hemorrhagic edema of the lung can result from

Back 209

Trauma. Bleeding diathesis. Infections (invasive aspergillosis, mucormycosis, Pseudomonas, influenza). Drugs (penicillamine). Pulmonary embolism. Fat embolism. ARDS. Autoimmune diseases (Goodpasture syndrome, idiopathic pulmonary hemorrhage, Wegener granulomatosis, systemic lupus erythematosus, rheumatoid arthritis, and polyarteritis nodosa).

Front 210

Goodpasture syndrome

Back 210

Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody.

Front 211

Idiopathic Pulmonary Hemorrhage

Back 211

Indistinguishable from Goodpasture syndrome. Pulmonary hemorrhage and anemia in patient with normal renal function and urinalysis. No antiglomerular basement membrane antibodies.

Front 212

Vasculitides that can cause pulmonary hemorrhage

Back 212

Wegener granulomatosis. Systemic lupus erythematosus. Rheumatoid arthritis. Polyarteritis nodosa.

Front 213

D-dimer

Back 213

Sensitive, but not specific marker of venous thrombosis.

Front 214

Most common radiographic findings in PE without infarction are

Back 214

Localized peripheral oligemia with or without distended proximal vessels (Westermark sign). Peripheral airspace opacification. Linear atelectasis.

Front 215

Radiographic features that suggest infarction in PE

Back 215

Small pleural effusion and pleura-based wedge-shaped opacity (Hampton hump).

Front 216

Nonthrombotic pulmonary embolism causes

Back 216

Air embolism. Macroscopic fat embolism. Methylmethacrlate embolization from vertebroplasty. Radioactive seed embolization from prostate brachytherapy.

Front 217

PAH is defined as a systolic pressure in the pulmonary artery exceeding

Back 217

30 mm Hg.

Front 218

Typical radiographic findings of PAH are

Back 218

Enlarged main and hilar pulmonary arteries that taper rapidly toward lung periphery. RV enlargement.

Front 219

PAH measurements of proximal interlobar pulmonary artery (CXR) and main pulmonary artery (CT)

Back 219

Interlobar pulmonary artery > 16 mm. Main pulmonary artery > 28.6 mm.

Front 220

In addition to PAH, enlargement of the central pulmonary arteries may be seen in

Back 220

High cardiac output (anemia, thyrotoxicosis). Left-to-right shunts (ASD, VSD, PDA, PAPVR).

Front 221

Shunt vascularity on chest radiographs

Back 221

Enlargement of both central and peripheral pulmonary arteries.

Front 222

Disorders of the pulmonary arteries that produce PAH include

Back 222

Chronic PEs. Vasculitis. Pulmonary arteriopathy resulting from long-standing increased pulmonary blood flow from left-to-right shunt.

Front 223

Multiple pulmonary nodules of similar size and appearance are almost always

Back 223

Metastases. Granulomas.

Front 224

Pulmonary nodule is defined as

Back 224

Round or oval opacity 4 to 30 mm in diameter.

Front 225

Pulmonary mass is defined as

Back 225

Round opacity greater than 3 cm.

Front 226

Differential in a patient under the age of 35, particularly a nonsmoker without a history of malignancy,

Back 226

Granuloma. Hamartoma, Inflammatory lesion.

Front 227

An SPN in a patient over 35 years of age should never be followed radiographically without tissue confirmation unless the lesion contains

Back 227

Benign pattern of calcification. Presence of intralesional fat.

Front 228

Studies have shown that bronchogenic carcinoma has a doubling time of

Back 228

Between 1 month and 2 years.

Front 229

Presence of small satellite nodules around the periphery of a dominant pulmonary nodule is strongly suggestive of

Back 229

Benign disease, particularly granulomatous infection.

Front 230

Presence of a halo of ground-glass opacity encircling an SPN in an immunocompromised, neutropenic patient should suggest the diagnosis of

Back 230

Invasive pulmonary aspergillosis.

Front 231

Comet tail of bronchi and vessels entering the hilar aspect of the mass, and associated with lobar volume loss is characteristic of

Back 231

Round atelectasis.

Front 232

Complete or central calcification within an SPN is specific for

Back 232

Healed granuloma from tuberculosis or histoplasmosis.

Front 233

Concentric or laminated calcification of an SPN

Back 233

Granuloma and allows confident exclusion of neoplasm.

Front 234

Popcorn calcification within a pulmonary nodule is diagnostic of

Back 234

Pulmonary hamartoma.

Front 235

Fat within an SPN is diagnostic of a

Back 235

Pulmonary hamartoma.

Front 236

Enhancement of malignant SPNs

Back 236

15 H.

Front 237

Most common thoracic inlet masses?

Back 237

Thyroid masses. Lymphomatous nodes. Lymphangiomas.

Front 238

Intrathoracic thyroid goiter CT findings?

Back 238

Well-defined margins. Continuity of mass with cervical thyroid. Coarse calcifications. Cystic or necrotic areas. Baseline high CT attenuation (intrinsic iodine content). Intense enhancement (>25 H).

Front 239

Lymphangioma?

Back 239

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.

Front 240

Anterior mediastinal masses?

Back 240

Thymic neoplasms. Lymphoma. Germ cell neoplasms. Primary mesenchymal tumors.

Front 241

Thymoma versus thymic carcinoma

Back 241

Thymomas may be encapsulated (noninvasive) or invasive. Thymic carcinomas, epithelial component shows signs of frank malignancy.

Front 242

Thymoma-associated autoimmune diseases

Back 242

Myasthenia gravis. Pure red cell aplasia. Graves disease. Sjogren syndrome. Hypogammaglobulinemia.

Front 243

Thymic cysts

Back 243

Congenital: Remnants of thymopharyngeal duct. Contain thin or gelatinous fluid. Acquired: Postinflammatory. Associations: AIDS, Prior radiation or surgery, Autoimmune conditions (Sjögren syndrome, Myasthenia gravis, Aplastic anemia).

Front 244

Thymic masses

Back 244

Thymoma. Thymic cyst. Thymolipoma. Thymic hyperplasia. Thymic neuroendocrine tumors. Thymic carcinoma. Thymic lymphoma.

Front 245

Germ cell neoplasms

Back 245

Teratoma (benign and malignant). Seminoma. Embryonal cell carcinoma. Endodermal sinus tumor. Choriocarcinoma.

Front 246

Mesenchymal anterior mediastinal tumors

Back 246

Lipoma. Hemangioma. Leiomyoma. Liposarcoma. Angiosarcoma.

Front 247

_________ is the most frequent site of a localized nodal mass in patients with Hodgkin disease.

Back 247

Anterior mediastinum.

Front 248

A key in distinguishing primary from metastatic mediastinal germ cell neoplasm is the presence of

Back 248

Retroperitoneal lymph node involvement in metastatic gonadal tumors.

Front 249

Benign and malignant teratoma features on CT

Back 249

Benign: round or oval and smooth in contour. Malignant: irregular, lobulated, or ill-defined margin.

Front 250

Middle mediastinal masses

Back 250

Foregut and mesothelial cysts. Tracheal and central bronchial neoplasms. Diaphragmatic hernias. Vascular lesions.

Front 251

Differential for central calcification of mediastinal/hilar lymph nodes on CT?

Back 251

Mycobacteria. Fungus.

Front 252

Differential for peripheral (eggshell)l calcification of mediastinal/hilar lymph nodes on CT?

Back 252

Silicosis. Sarcoidosis.

Front 253

Differential for hypervascular mediastinal/hilar lymph nodes on CT?

Back 253

Carcinoid tumor/small cell carcinoma. Kaposi sarcoma. Metastases (RCC. Thyroid carcinoma). Castleman disease.

Front 254

Differential for necrotic mediastinal/hilar lymph nodes on CT?

Back 254

Mycobacteria. Fungus. Metastases (SCC. Seminoma. Lymphoma).

Front 255

Differences in lymph nodes of sarcoidosis and lymphoma/metastases?

Back 255

Sarcoidosis: Lobular lymph nodes that do not coalesce. Lymphoma/mets: May form conglomerate enlarged nodal masses.

Front 256

Castleman disease also known as

Back 256

Angiofollicular lymph node hyperplasia.

Front 257

Pericardial cysts most commonly arise in the

Back 257

Anterior cardiophrenic angles. Right-sided lesions being twice as common as left-sided lesions.

Front 258

Three groups of neurogenic tumors of the posterior mediastinum.

Back 258

Intercostal nerves: Neurofibroma. Schwannoma. Sympathetic ganglia: Ganglioneuroma. Ganglioneuroblastoma. Neuroblastoma. Paraganglionic cells: Chemodectoma. Pheochromocytoma.

Front 259

Most common posterior mediastinal neurogenic tumors in children

Back 259

Neuroblastoma. Ganglioneuroma.

Front 260

Most common posterior mediastinal neurogenic tumors in adults

Back 260

Neurofibroma. Schwannoma.

Front 261

Multiple lesions in the mediastinum, particularly bilateral apicoposterior masses, are virtually diagnostic of

Back 261

Neurofibromatosis.

Front 262

Posterior mediastinal masses

Back 262

Esophageal lesions. Foregut cysts. Vertebral lesion. Lateral thoracic meningocele. Pancreatic pseudocyst.

Front 263

Causes of chronic sclerosing (fibrosing) mediastinitis

Back 263

Histoplasmosis (most common). TB. Radiation therapy. Drugs (methysergide). Idiopathic (autoimmune).

Front 264

SVC syndrome manifestations

Back 264

Headache. Epistaxis. Cyanosis. Jugular venous distention. Edema.

Front 265

Ludwig angina describes

Back 265

Substernal chest pain caused by intramediastinal extension of infection.

Front 266

Causes of unilateral pulmonary artery enlargement incluce

Back 266

Poststenotic dilation from valvular or postvalvular pulmonic stenosis. Pulmonary artery aneurysms. Distension of pulmonary artery by thrombus or tumor.

Front 267

Rare vasculitides that may present with pulmonary artery aneurysms

Back 267

Behçet disease and Hughes-Stovins syndrome

Front 268

Sarcoidosis 1-2-3 sign

Back 268

1: Right paratracheal. 2. Right hilar. 3. Left hilar lymph node enlargement

Front 269

Coronary calcification is detected at angiography in ____% of patients with 50% diameter stenosis.

Back 269

75%

Front 270

A_____% diameter narrowing is the physiologic point at which flow is restricted enough to result in ischemia under stress conditions.

Back 270

50% diameter narrowing. Roughly predicts a 75% cross-sectional area reduction.

Front 271

Cardiac MR uses?

Back 271

Define location and size of previous myocardial 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.

Front 272

Myocardial rupture (may occur ______ days after infarction.

Back 272

3 to 14 days.

Front 273

Dressler syndrome

Back 273

Onset is typically 1 week to 3 months postinjury. Fever, chest pain, pericarditis, pericardial effusion, and pleuritis, with pleural effusion usually more prominent on the left. Dressler syndrome responds well to anti-inflammatory medications.

Front 274

Hibernating myocardium versus stunned myocardium?

Back 274

Hibernating: High-grade stenosis resulting in chronically ischemic myocardium. May act like postinfarction scar. Improved function with revascularization. At risk for acute infarction. Stunned myocardium: Postischemic, dysfunctional myocardium without complete necrosis. Potentially salvageable.

Front 275

Causes of dilated cardiomyopathies

Back 275

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.

Front 276

Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of dilated cardiomyopathy?

Back 276

LV thin. LV dilated. Decreased contractility. Normal to decreased compliance.

Front 277

Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of hypertrophic cardiomyopathy?

Back 277

LV thick. LV normal to decreased. Increased contractility. Decreased compliance.

Front 278

Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of restrivice cardiomyopathy?

Back 278

Normal LV wall. Normal LV cavity. Normal to decreased contractility. Severely decreased compliance.

Front 279

Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of Uhl anomaly?

Back 279

RV thin. RV dilated. Decreased contractility. Normal to decreased compliance.

Front 280

Hypertrophic cardiomyopathies are divided into two basic types:

Back 280

Concentric hypertrophy: may be diffuse, midventricular, or apical in distribution. Asymmetrical septal hypertrophy (ASH), also known as idiopathic hypertrophic subaortic stenosis (IHSS).

Front 281

Hypertrophic cardiomyopathy causes?

Back 281

May be familial (60%). Autosomal dominant with variable penetrance. Associated with neurofibromatosis and Noonan syndrome. Secondary to pressure overload.

Front 282

Features of ASH (asymmetric septal hypertrophy)?

Back 282

Hypertrophy of the interventricular septum (>12 to 13 mm). Abnormal ratio of thickness of interventricular septum to left ventricular posterior wall (>1.3:1). Narrowing of left ventricular outflow tract during systole.

Front 283

Restrictive cardiomyopathy causes

Back 283

Infiltrative disorders: Amyloid. Glycogen storage disease. Mucopolysaccharidosis. Hemochromatosis. Sarcoidosis. Myocardial tumor infiltration.

Front 284

What other disease should be ruled out when considering restrictive cardiomyopathy?

Back 284

Constrictive pericarditis.

Front 285

MR finding in restrictive cardiomyopathy caused by amyloidosis or sarcoidosis?

Back 285

high signal in the myocardium on T2WIs.

Front 286

Defined as right ventricular failure secondary to pulmonary parenchymal or pulmonary arterial disease.

Back 286

Cor pulmonale.

Front 287

Etiologies of cor pulmonale include

Back 287

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.

Front 288

Uhl anomaly

Back 288

Acquired disorder in infants or adults. Also called arrhythmogenic right 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.

Front 289

Enlargement of pulmonary outflow tract causes

Back 289

Left-to-right shunts. Poststenotic dilation secondary to pulmonary stenosis. Pulmonary arterial hypertension. Marfan syndrome. Takayasu arteritis. Idiopathic dilation of pulmonary artery.

Front 290

Differential diagnosis for pulmonary arterial hypertension includes

Back 290

Long-standing pulmonary venous hypertension (mitral stenosis). Eisenmenger physiology (long-standing left-to-right shunts). Pulmonary emboli. Vasculitides (rheumatoid arthritis or polyarteritis nodosa). Primary pulmonary hypertension.

Front 291

Increased pulmonary blood flow is caused by

Back 291

Left-to-right shunts. High output states: Volume loading. Pregnancy. Peripheral shunt lesions (arteriovenous malformations). Hyperthyroidism. Anemia. Leukemia.

Front 292

Decreased pulmonary blood flow with a small heart is caused by

Back 292

Chronic obstructive pulmonary disease. Hypovolemia. Malnourishment. Addison disease.

Front 293

Mitral stenosis in the adult is usually caused by

Back 293

Rheumatic heart disease.

Front 294

Causes of Pulmonary Venous Hypertension

Back 294

Left ventricular failure. Mitral stenosis. Mitral regurgitation. Aortic stenosis. Aortic regurgitation. Pulmonary veno-occlusive disease. Congenital heart disease.

Front 295

Left atrial enlargement, left ventricular enlargement, and bulging of the atrial septum to the right.

Back 295

Mitral regurgitation.

Front 296

Cardiac thrombus features

Back 296

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.

Front 297

Intracardiac lipomas or lipomatous hypertrophy features

Back 297

High T1 signal and fat suppression. Second most common benign cardiac tumor.

Front 298

Atrial myxoma features

Back 298

50% of primary cardiac tumors. Most common primary benign cardiac tumor. Most (75% to 80%) are in LA. May mimic rheumatic valvular disease clinically.

Front 299

Benign cardiac tumors

Back 299

Atrial myxoma. Lipoma. Rhabdomyoma (50% to 85% of tuberous sclerosis). Fibromas (12% may calcify). Rare teratoma.

Front 300

Metastatic cardiac tumor features

Back 300

10 to 20 times more common than primary cardiac tumors. Breast. Lung. Melanoma. Lymphoma.

Front 301

Primary malignant cardiac tumors

Back 301

Angiosarcoma (most common). Rhabdosarcoma. Liposarcoma. Other sarcomas.

Front 302

Constrictive pericardial disease features

Back 302

Fibrous or calcific thickening of pericardium. Compromises ventricular filling through restriction of cardiac motion. Most common cause is postpericardiotomy. Other causes: Coxsackie B. Tuberculosis. Chronic renal failure. Rheumatoid arthritis. Neoplastic involvement. Radiation pericarditis.

Front 303

Differential diagnosis for a cardiophrenic angle mass includes

Back 303

Pericardial cyst. Fat pad. Lipoma. Enlarged lymph nodes. Diaphragmatic hernia. Ventricular aneurysm.

Front 304

Congenital absence of pericardium features

Back 304

Complete left-sided absence (55%). Foraminal defects (35%). Total absence (10%). M > F. Complete absence: Heart is shifted toward the left, with prominent bulge of right ventricular outflow tract, main pulmonary artery, and left atrial appendage. Partial absence of the pericardium risks strangulation of cardiac structures. Surgical closure of partial defects is usually recommended.

Front 305

Noninfectious causes of miliary pattern

Back 305

Pneumoconioises (silicosis). Eosinophilic granuloma. Sarcoidosis. Metastases (Thyroid. Melanoma.)

Front 306

Minimal pleural effusion volume visible on frontal, lateral, and decubitus chest radiographs

Back 306

Frontal (200 mL). Lateral (75 mL). Decubitus (5 mL)

Front 307

Which junction line, anterior or posterior, extends above the clavicles

Back 307

Posterior junction line.

Front 308

Define pulmonary cavity

Back 308

Refers to a lucency located wtihin a nodule, mass, or focus of consolidation.

Front 309

Order of the left lower lobe basilar segments (from lateral to medial) on a frontal radiograph

Back 309

Anteromedial, Lateral, Posterior (ALP).

Front 310

DDx of subcarinal mass on radiograph

Back 310

Lymph node enlargement. Bronchogenic cyst. Left atrial enlargement.

Front 311

Classic primary TB chest radiograph findings

Back 311

Parenchymal consolidation with mediastinal and hilar lymph node enlargement.

Front 312

Ranke complex

Back 312

Combination of calcified lung nodule and calcified lymph nodes.

Front 313

Ghon lesion

Back 313

Lung nodule that is a residum of primary TB. Usually is calcified.

Front 314

At what pulmonary venous wedge pressures do Kerley lines, effusions, and airspace opacities occur?

Back 314

Normal 12 mm Hg. Kerley lines 17 mm Hg. Effusion 20 mm Hg. Airspace opacity 25 mm Hg.

Front 315

Complications of bronchiectasis

Back 315

Recurrent infections. Hemoptysis. Mucoid impaction. Atelectasis.

Front 316

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease)

Back 316

Telangiectasias. AVMs. Aneurysms in multiple organ systems (Pulmonary. GI. Cutaneous. CNS)

Front 317

Parenchymal findings associated with acute PE

Back 317

Wedge-shaped peripheral foci of consolidation. Linear bands.

Front 318

Focal areas of chronic consolidation may be seen in

Back 318

Lipoid pneumonia. Bronchoalveolar cell carcinoma. Lymphoma.

Front 319

Diffuse chronic consolidation can be seen in

Back 319

Bronchoalveolar cell carcinoma. Alveolar proteinosis. Sarcoid. Lipoid pneumonia.

Front 320

Kartagener's syndrome (dyskinetic cilia syndrome) triad

Back 320

Situs invertus. Bronchiectasis. Sinusitis.

Front 321

Wegener's granulomatosis lung findings

Back 321

Multiple lung nodules or masses. Cavitation occurs 50%. Local or diffuse consolidation due to hemorrhage.

Front 322

Help distinguish LCH from LAM

Back 322

LCH: Usually associated with nodules and variable appearing cysts. Spares costophrenic angles.

Front 323

PCP findings

Back 323

Extensive ground glass opacities in a patchy or geographic pattern. 1/3 have upper lobe predominant cysts of varying sizes and wall thicknesses

Front 324

Bronchopleural fistula, postpneumonectomy should be considered if

Back 324

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.

Front 325

Superior sulcus tumor symptoms

Back 325

Shoulder pain. Horner's syndrome (ptosis, miosis, anhidrosis). Weakness and atrophy of hand muscles.

Front 326

Deems a superior sulcus tumor unresectable

Back 326

Any involvement of vertebral body, brachial plexus, subclavian artery.

Front 327

Satellite nodules

Back 327

Smaller nodules adjacent to a lung mass. Suggests an infectious etiology.

Front 328

Mediastinal lipomatosis causes

Back 328

Cushing's syndrome. Steroid therapy. Obesity.

Front 329

Rounded atelectasis

Back 329

Form of peripheral lobar atelectasis that develops with pleural disease (commonly asbestosis). Volume loss. Comet tail (whorled bronchovascular structures).

Front 330

Diameter of ascending aorta aneurysm

Back 330

4 cm. 6 cm significant risk of rupture.

Front 331

Bulla versus bleb

Back 331

Bulla, sharply demarcated area of emphysema greater than 1 cm. Bleb, gas-containing space within visceral pleura.

Front 332

Chest radiograph finding in healed varicella pneumonia

Back 332

Diffuse discrete pulmonary calcifications.

Front 333

Nodal status and stage in NSCLC

Back 333

N0, No metastatic lymph nodes. N1, Metastatic ipsilateral hilar lymph nodes. N2, Metastatic ipsilateral mediastinal and subcarinal lymph nodes. N3, Metastatic contralateral mediastinal or hilar lymph nodes.

Front 334

Causes of SVC syndrome

Back 334

Neoplastic: Lung cancer (especially small cell carcinoma). Lymphoma. Metastatic carcinoma. Benign: Long-term IV devices (catheters. pacemakers). Fibrosing mediastinitis (Histoplasmosis).

Front 335

Neoplastic and nonneoplastic causes of hypertrophic pulmonary osteoarthropathy

Back 335

90% Malignant lung neoplasms. Nonneoplastic: Cystic fibrosis. IPF. Localized fibrous lesions of the pleura

Front 336

Epicardial fat pad sign

Back 336

Double lucency sign. Displacement (>4 mm) of anterior and posterior (epicardial) pericardial fat by pericardial fluid.

Front 337

What obvious structures should be avoided while planning a TTNB (transthoracic needle biopsy)

Back 337

Interlobar fissures. Pulmonary vessels. Bullae. Areas of severe emphysema.

Front 338

Peripheral consolidation (photographic negative of pulmonary edema)

Back 338

Chronic eosinophilic pneumonia.

Front 339

Sloughed lung within a cavity

Back 339

Pulmonary gangrene. Closely associated with Klebsiella.

Front 340

Mosaic lung attenuation causes

Back 340

Small airways disease. Chronic pulmonary embolism.

Front 341

Distinguishes small airways disease of chronic PE in setting of mosaic attenuation

Back 341

Expiratory images demonstrate air-trapping in small airways disease.

Front 342

Congenital tracheobronchomegaly

Back 342

Mounier-Kuhn syndrome.

Front 343

Allergic bronchopulmonary aspergillosis radiographic findings

Back 343

Central bronchiectasis. Mucous plugging (finger-in-glove). Atelectasis. Patchy migratory foci of consolidation.

Front 344

Pulmonary alveolar proteinosis susceptible infections

Back 344

Nocardia. Aspergillus. Mucormycetes.

Front 345

Localized fibrous tumor of the pleura enhancement pattern

Back 345

Intense and homogeneous contrast enhancement.

Front 346

Calcified fine lung nodules differential

Back 346

Healed varicella. Healed histoplasmosis. Silicosis. Calcified metastases.

Front 347

CT findings of Swyer-James syndrome

Back 347

Areas of decreased lung attenuation with associated reducting in number and size of vessels. Bronchiectasis. Air trapping on expiratory images.

Front 348

Cardiac bronchus

Back 348

Blind-ending diverticulum arising from medial wall of bronchus intermedius. Rarely presents with recurrent infections, hemoptysis, cough, and or dyspnea.

Front 349

Bronchiolitis obliterans organizing pneumonia CT findings

Back 349

Patchy bilateral airspace consolidation with peripheral, subpleural distribution. Poorly defined lung nodules in a peribronchiolar distribution.

Front 350

Triad of pulmonary veno-occlusive disease

Back 350

Severe pulmonary artery hypertension. Evidence of pulmonary edema. Normal wedge pressure.

Front 351

Water lily sign

Back 351

Echinococcus cysts: Endocyst ruptures its contents within the ectocyst, floating on top of debris, like a water lily.

Front 352

Differential diagnosis for wall-to-wall heart?

Back 352

Tricuspid regurgitation. Pericardial effusion. Dilated cardiomyopathy.

Front 353

Common predisposing factors for aortic dissection

Back 353

Hypertension. Annuloaortic ectasia: Marfan or Ehlers-Danlos syndrome. Bicuspid aortic valve. Aortic aneurysm. Arteritis.

Front 354

Anatomic structure separating Type A from Type B (Stanford) aortic dissections

Back 354

Left subclavian artery. Distal type B. Proximal type A.

Front 355

Chest bone findings associated with Marfan syndrome

Back 355

Pectus excavatum. Scoliosis.

Front 356

Pectus excavatum associations

Back 356

Marfan syndrome. Ehlers-Danlos syndrome. Mitral valve prolapse. Homocystinuria. Hunter-Hurler syndromes.

Front 357

4 life threatening complications of type A aortic dissection

Back 357

Coronary artery dissection (myocardial infarction). Carotid artery dissection (stroke). Pericardial hemorrhage (tamponade). Aortic valve rupture (aortic regurgitation).

Front 358

Helps distinguish ventricle true aneurysms from pseudoaneurysms

Back 358

Pseudoaneurysm: Inferoposterior location. Narrow neck (less than 50%). Aneurysm: Anteroapical location. Wide neck.

Front 359

Which aberrant subclavian artery (right or left) is a vascular ring

Back 359

Right aortic arch with aberrant left subclavian artery. Left-sided ligamentum arteriosum completes the ring.

Front 360

Causes of SVC syndrome

Back 360

Neoplastic: Bronchogenic carcinoma. Metastases. Lymphoma. Infectious: Fungal infection (histoplasmosis, fibrosing mediastinitis).

Front 361

Persistent left superior vena cava associations

Back 361

ASD. Tetralogy of Fallot. P(T)APVR.

Front 362

Tetralogy of Fallot. 4 primary lesions

Back 362

Overriding aorta. VSD. Pulmonar infundibular stenosis. Right ventricular hypertrophy.

Front 363

Thoracic vessels. Takayasu arteritis involvement

Back 363

Aorta. Right common carotid.Subclavian arteries. Pulmonary arteries.

Front 364

Causes of constritive pericarditis

Back 364

Cardiac surgery. Radiation therapy. Uremic pericarditis. Viral pericarditis (coxsackie). Tuberculous pericarditis.

Front 365

Treatment of intramural hematoma of aorta

Back 365

Similar to aorta dissections: type A (surgically) type B (medically).

Front 366

Sinus of valsalva aneurysm versus aortic root dilation

Back 366

Sinus of valsalva aneurysm is focal dilation of one sinus of Valsalva, not entire root.

Front 367

TAPVR types

Back 367

Type I: Supracardiac drainage. Snowman heart. Type II: Cardiac. Coronary sinus or right atrium drainage. Type III: Infracardiac. Portal vein, hepatic vein, or ductus venosus drainage (pulmonary edema due to obstruction).

Front 368

Aortic pseudoaneurysm causes

Back 368

Atherosclerosis (penetrating ulcer). Infection. Trauma. Iatrogenic.

Front 369

Mirror-image right aortic arch congential heart disease associations

Back 369

Tetralogy of Fallot. Truncus arteriosus.

Front 370

4 components of scimitar syndrome

Back 370

Right lung hypoplasia. Hypoplastic right pulmonary artery. Right lower lobe systemic arterial supply. PAPVR from right lung.

Front 371

Partial congenital absence of the pericardium findings:

Back 371

Leftward deviation of the heart without deviation of mediastinum. Prominent left atrial appendage. Lung located between aorta and pulmonary artery confirms diagnosis.

Front 372

Heterotaxy syndrome associated with interruption of IVC with Azygous continuation

Back 372

Bilateral left-sidedness/polysplenia syndrome.

Front 373

Features that suggest a primary malignant cardiac tumor

Back 373

Invasiveness. Extension outside of heart. Involvement of more than one chamber. Central necrosis or cavitation. Large pericardial effusion.

Front 374

Pulmonary sling aberrant course

Back 374

Left pulmonary artery arises from right pulmonary artery and courses between esophagus and trachea.

Front 375

question

Back 375

answer

Front 376

Disk protrusion terminology

Back 376

Bulge: Broad-based disk bulge. Usually bulging annulus fibrosus. Protrusion: Focal disk bulge. Usually herniated nucleus pulposus.

Front 377

Intervertebral disk high intensity zone (HIZ)

Back 377

High T2 signal of annulus indicating annular tear.

Front 378

Disk free fragment mimickers

Back 378

Conjoined root: Normal variant of two roots exiting thecal sac together. Same density of thecal sac. Tarlov cyst: Normal variant of dilated nerve root sleeve. Same density of thecal sac.

Front 379

Lateral Disks

Back 379

May cause nerve root impingement causing symptoms of a superior level. Nerve root has already exited central canal.

Front 380

Common causes of Central Canal Stenosis

Back 380

Facet joint degenerative change (most common). Lligamentum flavum hypertrophy.

Front 381

Most common cause of neuroforaminal stenosis

Back 381

Facet joint degenerative change with bony encroachment.

Front 382

Lateral recess

Back 382

Lumbar spine bony canals where nerve roots lie after exiting thecal sac and before entering neuroforamen. Hypertrophy of superior articular facet is most common cause of encroachment.

Front 383

Spondylolysis identified on axial images

Back 383

Break in bony ring of the lamina (pars interarticularis) at the mid vertebral body level.

Front 384

Spondylolisthesis occurs from either

Back 384

Bilateral spondylolysis. Facet joint degenerative change.

Front 385

Distinguishes postop scar from disk material

Back 385

Scar tissue enhances. Disk material has only minimal peripheral enhancement.

Front 386

Differentiates disk infection fromdegenerative disk disease at MR

Back 386

Type 2 degenerative disk disease: Low T1 disk and high T2 parallel endplate bands. Disk space infection: High T2 disk.

Front 387

Myelopathy neurologic signs

Back 387

Ataxia. Bowel and bladder incontinence. Babinski sign.

Front 388

Radiculopathy neurologic signs

Back 388

Muscle weakness. Decreased reflexes. Dermatomal sensory deficits.

Front 389

Urgency for imaging acute myelopathy

Back 389

Poor prognosis if left untreated for greater than 24 hours.

Front 390

Common causes of myelopathy

Back 390

Extramedullary: Epidural mass cord compression. Cervical spine stenosis. Intramedullary: Tumor. Inflammation, Arteriovenous malformation (AVM). Spinal dural arteriovenous fistula (SPAVF).

Front 391

Definition of Intramedullary spinal canal lesion

Back 391

Usually confined to spinal cord. May be exophytic.

Front 392

Definition of extramedullary spinal canal lesion

Back 392

Outside of spinal cord. May be intradural or extradural.

Front 393

Intradural intramedullary lesions

Back 393

Ependymoma. Astrocytoma. Hemangioblastoma. Lipoma/(Epi)dermoid. Syringohydromyelia. Intramedullary AVM. Met/abscess (rare).

Front 394

Intradural extramedullary lesions (includes subarachnoid space)

Back 394

Meningioma. Schwannoma/neurinoma. Neurofibroma. Hemangiopericytoma. Lipoma/(Epi)dermoid. Arachnoid cyst/adhesion. Drop/leptomeningeal metastasis. Veins (extramedullary AVM).

Front 395

Extradural extramedullary lesions

Back 395

Degenerative: Herniated disc. Synovial cyst. Osteophyte. Rheumatoid pannus. Nondegenerative: Metastasis. Abscess. Hematoma. Primary tumor expansion or invasion. Epidural lipomatosis

Front 396

Most common intramedullary lesion at MRI

Back 396

Multiple sclerosis

Front 397

Lupus Erythematosus spinal cord involvement

Back 397

Areas of high T2 signal with cord swelling. May involve 4 or 5 vertebral segments. Have less well-defined margins than MS plaques.

Front 398

Atlantoaxial instability and rheumatoid arthritis

Back 398

Inflammatory changes (pannus) destroy transverse ligament of C1. Dens may slide posteriorly and intermittently compress cord causing myelomalacia. 5% of RA patients frank atlantoaxial instability.

Front 399

Vertebral body and disc infection findings

Back 399

Adjacent vertebral bodies and disc usually involved. Destruction greatest at endplates. Posterior elements usually spared. Low T1 and high T2 marrow signal with normal diffusion. If pyogenic disk enhances, granulation tissue extends above and below affected vertebrae.

Front 400

Vertebral body neoplasm findings

Back 400

Isolated or noncontiguous involvement. Pedicles typically affected. Low T1 and high T2 signal with restricted diffusion. Disk typically spared (except prostate cancer). Enhancement may obscure metastases within fatty marrow.

Front 401

Vertebral body osteoporosis findings

Back 401

Several vertebral bodies with height loss. Anterior weding with posterior elements spared. Normal T1 and T2 unless fracture. Disk spared.

Front 402

TB of the spine, or Pott disease

Back 402

Causes slow collapse of one or more vertebral bodies. Gibbus deformity, acute kyphosis. Infection spreads underneath longitudinal ligaments. Can lead to cord compression. May spare disks.

Front 403

Most common neoplasm of the spine

Back 403

Metastases

Front 404

Two most common primary intramedullary tumors

Back 404

Astrocytoma. Ependymoma.

Front 405

Spinal cord astrocytoma and ependymoma shared features

Back 405

Expansile. Low T1 and high T2 signal with variable enhancement. Increased incidence in neurofibromatosis.

Front 406

Spinal cord Ependymoma features

Back 406

Most common spinal cord tumor in adults. Divided into cellular (intramedullary) and myxopapillary (filum terminale) types. Peak incidence inf ourth decade. Male predominance. These slow-growing neoplasms arise from ependymal cells lining the central canal of the cord or cell rests along the filum. Expansile. Low T1 and high T2 signal with variable enhancement. Increased incidence in neurofibromatosis.

Front 407

Spinal cord Astrocytoma features

Back 407

Most (75%) occur in cervical and upper to midthoracic cord. Fusiform cord widening. High T2 signal. Contrast enhancement over several vertebral body segments.

Front 408

Hemangioblastoma features

Back 408

Occur in spinal cord and posterior fossa. High association with Von Hippel-Lindau syndrome. Densely enhancing nidus with related cyst and or cord expansion. May be extramedullary and multiple. May be mistaken for arteriovenous malformation (AVM).

Front 409

Syrinx

Back 409

Shorter term for syringohydromyelia. Hydromyelia, dilation of central canal and lined by ependyma. Syringomyelia, cavity outside central canal lined by glial cells. Suspect tumor as a cause of unexplained syrinx.

Front 410

Most common intradural tumor in thoracic region

Back 410

Meningioma

Front 411

Spinal meningioma features

Back 411

Most (80%) occur in women. Average age of 45. Multiple meningiomas suspicious for neurofibromatosis. Usually extramedullary/intradural. Can have extradural component. Dense calcification can occur. Dense homogenous enhancement. Broad dural tails.

Front 412

Most common intraspinal mass

Back 412

Schwannoma

Front 413

Spinal schwannoma features

Back 413

Neuroforaminal extension and expansion are common in cervical and thoracic spine with intra and extraspinal components, dumbbell shape. In lumbar spine, tend to remain within dural sac.

Front 414

Common intrathecal drop metastases

Back 414

Subarachnoid seeding of primary CNS tumors: Posterior fossa medulloblastomas. Ependymomas. Pineal region neoplasms.

Front 415

Most common spine extradural neoplasm

Back 415

Metastatses: Breast, Lung, Prostate carcinoma.

Front 416

Very low T1 and T2 marrow signal

Back 416

Myelofibrosis

Front 417

Spinal AVM features

Back 417

May be intramedullary or extramedullary. Intramedullary AVMs have a nidus of abnormal vessels that may cause hemorrhage or ischemia. Extramedullary AVMs generally are arteriovenous fistulas. Spinal dural arteriovenous fistulas (SDAVFs) cause symptoms through venous hypertension and congestion of the cord with edema.

Front 418

Tethered Cord features

Back 418

Low-lying conus medullaris. In a newborn conus normally at L2. Typically ascends one to two vertebral segments as child grows. May form a taut mass in posterior lumbar canal, obscuring conus/cauda junction.

Front 419

Caudal Regression Syndrome

Back 419

Hypoplastic or absent distal spine and sacrum. Blunted conus.

Front 420

Spinal Arachnoid cysts and epidermoids

Back 420

Similar to brain arachnoid cysts and epidermoids. Arachnoid cysts follow CSFsignal. Epidermoids restrict diffusion, bright on DWIs.

Front 421

Spinal Epidural Hematoma

Back 421

Ventral epidural space contains plexus of veins. These can tear in trauma, resulting in epidural hematoma.

Front 422

Nerve Root Avulsion

Back 422

Most commonly occur in cervical spine. Typically involve roots of brachial plexus and upper extremities. Birth trauma from shoulder traction is common example.

Front 423

Acute versus chronic sinusitis findings

Back 423

Acute sinusitis: Air-fluid levels and foamy secretions. Typically caused by viral URI. Chronic sinusitis: Mucoperiosteal thickening. Thickening of bony sinus walls.

Front 424

Disease limited to the infundibulum of the maxillary ostium will result in

Back 424

Isolated obstruction of maxillary sinus.

Front 425

Lesion located at hiatus semilunaris (middle meatus) results in

Back 425

Obstruction of ipsilateral maxillary sinus, anterior and middle ethmoid air cells, and frontal sinus. Described as ostiomeatal pattern of obstruction.

Front 426

Sphenoid sinusitis is of great clinical concern as it may

Back 426

Extend intracranially due to presence of valveless veins.

Front 427

Sinus mucous retention cyst versus mucocele

Back 427

Mucous retention cyst: Obstructed mucous glands within mucosal lining. Usually round. 1 to several cm in diameter. Mucocele: Entire sinus is obstructed. Expansion of sinus. Sinus wall bony thinning and remodeling. Mass may be present obstrucing draining ostium.

Front 428

Inverting Papilloma

Back 428

Neoplastic epithelium inverts and grows into underlying mucosa of lateral nasal wall. Surgically resected due to association with squamous cell carcinoma.

Front 429

Juvenile nasopharyngeal angiofibromas

Back 429

Male adolescents with epistaxis. Benign tumor but can be locally aggressive. Fills nasopharynx and bows posterior wall of maxillary sinus forward. Retromaxillary pterygopalatine fossa location is a hallmark feature. Avidly enhance.

Front 430

Malignancies of paranasal sinuses and nasal cavity.

Back 430

Squamous cell carcinoma. Lymphoma. Minor salivary tumors.

Front 431

Most common salivary malignancies include

Back 431

Adenoid cystic carcinoma. Adenocarcinoma. Mucoepidermoid carcinoma.

Front 432

Esthesioneuroblastoma

Back 432

Arises from neurosensory receptor cells of olfactory nerve and mucosa. Occurs anywhere from cribriform plate to turbinates. Often quite destructive by time of diagnosis. Usually found high within nasal vault.

Front 433

Three most common primary (mets by far more common) skull base malignant tumors

Back 433

Chordoma (destructive midline mass). Chondrosarcoma. Osteogenic sarcoma (from radiation or Paget's degeneration).

Front 434

Cholesteatoma

Back 434

Soft tissue mass (epidermoid cyst of desquamating stratified squamous epithelium) within middle ear cavity. Typically associated with bone erosion. Superior tympanic membrane (pars flaccida) is the most common site. CT images extent of disease.

Front 435

Opacified petrous apex differential

Back 435

Retained fluid secretions: Dark T1, bright T2, no enhancement. Petrous apicitis: Dark T1, bright T2, and ring enhancement. Nonaerated petrous apex: Bone marrow, bright T1, dark T2, and no enhancement. Cholesterol granuloma: Hemorrhagic component, bright T1 and T2.

Front 436

Cholesterol granuloma

Back 436

Granulation tissue within partially obsructed petrous air cells. Have cholesterol and hemorrhagic component (high T1 and T2 signal).

Front 437

Deep anatomy of the head and neck is subdivided by layers of deep cervical fascia into the following spaces:

Back 437

(1) Superficial mucosal. (2) Parapharyngeal. (3) Carotid. (4) Parotid. (5) Masticator. (6) Retropharyngeal. (7) Prevertebral.

Front 438

Mucosal head and neck compartment contents

Back 438

Squamous mucosa. Lymphoid tissue (adenoids, lingual tonsils). Minor salivary glands.

Front 439

Mucosal head and neck compartment pathology

Back 439

Nasopharyngeal carcinoma. Squamous cell carcinoma. Lymphoma. Minor salivary gland tumors. Juvenile angiofibroma. Rhabdomyosarcoma.

Front 440

Parapharyngeal head and neck compartment contents

Back 440

Fat. Trigeminal nerve (V3). Internal maxillary artery. Ascending pharyngeal artery.

Front 441

Parapharyngeal head and neck compartment pathology

Back 441

Minor salivary gland tumor. Lipoma. Cellulitis/abscess. Schwannoma.

Front 442

Parotid head and neck compartment contents

Back 442

Parotid gland. Intraparotid lymph nodes. Facial nerve (VII). External carotid artery. Retromandibular vein.

Front 443

Parotid head and neck compartment pathology

Back 443

Salivary gland tumors. Metastatic adenopathy. Lymphoma. Parotid cysts.

Front 444

Carotid head and neck compartment contents

Back 444

Cranial nerves IX–XII. Sympathetic nerves. Jugular chain nodes. Carotid artery. Jugular vein.

Front 445

Carotid head and neck compartment pathology

Back 445

Schwannoma. Neurofibroma. Paraganglionoma. Metastatic adenopathy. Lymphoma. Cellulitis/abscess. Meningioma.

Front 446

Masticator head and neck compartment contents

Back 446

Muscles of mastication. Ramus and body of mandible. Inferior alveolar nerve.

Front 447

Masticator head and neck compartment pathology

Back 447

Odontogenic abscess. Osteomyelitis. Direct spread of squamous cell carcinoma. Lymphoma. Minor salivary tumor. Sarcoma of muscle or bone.

Front 448

Retropharyngeal head and neck compartment contents

Back 448

Lymph nodes (lateral and medial retropharyngeal). Fat.

Front 449

Retropharyngeal head and neck compartment pathology

Back 449

Metastatic adenopathy. Lymphoma.

Front 450

Prevertebral head and neck compartment contents

Back 450

Cervical vertebrae. Prevertebral muscles. Paraspinal muscles. Phrenic nerve.

Front 451

Prevertebral head and neck compartment pathology

Back 451

Osseous metastases. Chordoma. Osteomyelitis. Cellulitis. Abscess.

Front 452

Tornwaldt cysts

Back 452

Benign midline nasopharynx lesion of high T2 signal. Believed to be remnant of notochordal tissue (benign).

Front 453

Most common minor salivary gland malignancy and has propensity for perineural spread

Back 453

Adenoid cystic carcinoma

Front 454

The parapharyngeal space is surrounded by what spaces

Back 454

the carotid space posteriorly, the parotid space laterally, the masticator space anteriorly, and the superficial mucosal space medially. Therefore, the parapharyngeal space will be compressed on its medial surface by masses originating from the mucosal surface, displaced anteriorly by carotid sheath masses, displaced medially by parotid masses, and displaced posteriorly and medially by masses within the masticator space.

Front 455

Triad of nasopharyngeal malignancy

Back 455

1) Mucosal mass of lateral nasopharynx (fossa of Rosenmuller). (2) Lateral retropharyngeal nodes. (3) Mastoid opacification (eustachian tube dysfunction)

Front 456

Head and neck paragangliomas

Back 456

Vascular tumors arising from neural crest cell derivatives. Names given according to location: Carotid body tumor (at carotid bifurcation). Glomus vagale tumor (vagus nerve). Glomus jugulare tumor (jugular ganglion of vagus nerve). Glomus tympanicum tumor (Arnold and Jacobson nerves of middle ear).

Front 457

Salivary gland tumors

Back 457

Benign: Pleomorphic adenoma. Warthin tumor. Malignant: Adenocystic carcinoma. Adenocarcinoma. SCC. Mucoepidermoid carcinoma.

Front 458

Head and neck trans-spatial disease categories

Back 458

Lymphatic masses (lymphangioma). Neural masses (neurofibroma, schwannoma, perineural spread of tumor). Vascular masses (hemangioma).

Front 459

Head and neck diseases that demonstrate perineural spread

Back 459

Fungal infections. Squamous cell carcinoma. Adenoid cystic carcinoma.

Front 460

This lymph node chain serves as the final common afferent pathway for lymphatic drainage of the entire head and neck.

Back 460

Internal jugular nodal chain

Front 461

Pathologic size of head and neck lymph nodes

Back 461

Jugulodigastric and submandibular nodes may normally measure up to 1.5 cm. All other nodes up to 1.0 cm.

Front 462

Common optic nerve sheath complex tumors

Back 462

Optic nerve glioma. Optic sheath meningioma.

Front 463

Optic nerve glioma

Back 463

Low grade pilocytic astrocytoma. Most common tumor of optic nerve. Typically occurs during first decade of life. High association with neurofibromatosis type 1. Enlarged sheath complex may be tubular, fusiform, or eccentric with kinking. Rarely calcify.

Front 464

Arachnoidal hyperplasia or gliomatosis

Back 464

Thickening of perioptic meninges associated with optic nerve gliomas. Reflects peritumoral reactive meningeal change.

Front 465

Optic sheath meningiomas

Back 465

Grow in a linear fashion along optic nerve. Tram track pattern of linear enhancement. May invade through dura. May be extensively calcified.

Front 466

Orbital vascular lesions and age groups

Back 466

Capillary hemangiomas, infants (younger than 1 year). Diagnosed within first weeks of life. Lymphangiomas, older group of children (3 to 15 years). Propensity to bleed. Often contain blood degradation products. Cavernous hemangiomas, adults. Sharply circumscribed and round. Venous varix, generally in adults. Dilated vein. Changes with Valsalva maneuver.

Front 467

Superior ophthalmic vein pathology

Back 467

Thrombosis often occurs with cavernous sinus thrombosis. Loss of normal flow void. Enlargement occurs with cavernous carotid fistulas.

Front 468

Most common cause of intraorbital mass in an adult

Back 468

Idiopathic inflammatory pseudotumor. Inflammatory lymphocytic infiltrate. Involves tendinous attachments to the globe. Often rapidly develops presenting with painful proptosis, chemosis, and ophthalmoplegia.Lymphoma tends to present with painless proptosis.

Front 469

3 common adult intraorbital masses

Back 469

Idiopathic inflammatory pseudotumor. Cavernous hemangioma. Lymphoma.

Front 470

Enlargement of extraocular muscles with sparing of tendinous attachments to the globe

Back 470

Thyroid ophthalmopathy (Graves disease). Causes unilateral or bilateral proptosis in adults. Muscles involved, in decreasing order: I'M SLow. Inferior rectus. Medial rectus. Superior rectus. Lateral retus.

Front 471

Lesions of the lacrimal gland

Back 471

Inflammatory: Sarcoidosis. Sjogren syndrome. Neoplastic: Salivary gland (mixed-cell tumor or adenoid cystic carcinoma). Lymphoma. Pseudotumor. Dermoid (fat-fluid level).

Front 472

Retinoblastoma features

Back 472

Most common primary ocular malignancy. Leukocoria. Calcified ocular mass.

Front 473

Thyroglossal duct

Back 473

Epithelium-lined tract along which primordial thyroid gland migrates. Extends from foramen cecum (tongue base) to anterior of thyrohyoid membrane and strap muscles to ends at thyroid isthmus. Normally involutes by 8 to 10 weeks of gestation. May give rise to cyst, sinus tract, or ectopic thyroid tissue.

Front 474

The usual clinical presentation is that of a painless neck mass along the anterior border of the sternocleidomastoid muscle, presenting during the first to third decade.

Back 474

Second branchial cleft cyst. Anterior to mid sternocleidomastoid muscle. Lateral to internal jugular vein at the level of carotid bifurcation.

Front 475

Lymphangiomas

Back 475

Congenital malformations of lymphatic channels. Benign and nonencapsulated. Classified as capillary, cavernous, or cystic. Most present at birth or during infancy.

Front 476

Subgaleal hematoma

Back 476

Soft tissue swelling of the scalp located beneath subcutaneous fibrofatty tissue and above temporalis muscle.

Front 477

Intracranial air, pneumocephalus, may be seen with what fractures

Back 477

Compound skull fractures. Fractures involving paranasal sinuses.

Front 478

Epidural hematoma generalities

Back 478

Usually arterial in origin. Often result from skull fracture disrupting middle meningeal artery.Strips dura from inner table of the skull. Forms an ovoid mass. Generally does not cross suture lines.

Front 479

Venous epidural hematomas

Back 479

Less common than arterial epidurals. Tend to occur at the vertex, posterior fossa, or anterior aspect of middle cranial fossa. Usually result from disrupted dural venous sinuses. Vertex epidurals can cross sagittal suture.

Front 480

Subdural hematomas

Back 480

Typically result from tearing of cortical veins that traverse the subdural space. Will not cross falx cerebri or tentorium. Can cross sutural margins. Frequently layer along hemispheric convexity from anterior falx to posterior falx. Crescent-shaped in axial plane. Biconvex in coronal plane.

Front 481

Subarachnoid hemorrhage

Back 481

Result from disruption of small subarachnoid vessels, aneurysm, or direct extension by a contusion or hematoma. Hyperdense linear areas within cisterns and sulci. May lead to subsequent hydrocephalus by impaired CSF resorption at the arachnoid villi.

Front 482

Intraventricular hemorrhage

Back 482

May result from tearing of subependymal veins, direct extension of parenchymal hematoma, retrograde flow of subarachnoid hemorrhage. Risk of hydrocephalus by obstruction of the aqueduct or arachnoid villi. Hyperdense material layering within ventricular system.

Front 483

Diffuse axonal injury (DAI)

Back 483

Widespread disruption of axons due to acceleration or deceleration injury. Small, petechial hemorrhages at gray-white junction of cerebral hemispheres and or corpus callosum.

Front 484

T2 shinethrough

Back 484

T2 and DW bright and ADC dark.

Front 485

Cortical contusions

Back 485

Focal brain injury involving superficial gray matter. Occur near bony protuberances: Temporal lobes above petrous bone or posterior to greater sphenoid wing. Frontal lobes above cribriform plate, planum sphenoidale, and lesser sphenoid wing.

Front 486

Traumatic Intracerebral Hematoma

Back 486

Rupture of small intraparenchymal blood vessels. Tend to have less surrounding edema than cortical contusions. Most are located in the frontotemporal white matter.

Front 487

Traumatic subcortical gray matter injury

Back 487

Uncommon manifestation of primary intra-axial injury. Multiple petechial hemorrhages primarily affecting basal ganglia and thalamus.

Front 488

Von Hippel-Lindau syndrome imaging manifestations

Back 488

Visceral: Renal cell carcinomas. Pheochromocytomas. Pancreatic islet cell tumors. Pancreatic, hepatic, renal, and splenic cysts. CNS: Retinal capillary hemangiomas. Spinal cord and posterior fossa hemangioblastomas. Endolymphatic sac adenocarcinomas.

Front 489

Distinguishing epidermoids from arachnoid cysts on MR imaging.

Back 489

Both follow CSF T1 and T2 signal. Epidermoids restrict diffusion, are bright at DWI. Arachnoid cysts do not restrict diffusion. Epidermoids are composed of epithelial cells that grow in layers. Arachnoid cysts contains CSF.

Front 490

Pachymeningeal versus leptomeningeal enhancement findings unfinished.

Back 490

Pachymeningeal enhancement is characteristically thick, smooth, and uninterrupted.

Front 491

Rare cystic lesion classically located at the anterior roof of the third ventricle at the foramen of Monro.

Back 491

Colloid cyst. Generally are hyperdense to brain parenchyma. Do not enhance.

Front 492

Carotid cavernous fistula (CCF)

Back 492

Communication between cavernous portion of internal carotid artery and surrounding venous plexus. Typically follows a full-thickness arterial injury. Results in venous engorgement of cavernous sinus, ipsilateral superior ophthalmic vein, inferior petrosal sinus.

Front 493

Diffuse cerebral edema CT imaging findings

Back 493

Decreased cerebral density. Loss of gray-white differentiation. Usually spares cerebellum and brainstem, which appear relatively hyperdense.. Falx and cerebral vessels may appear dense, mimicking acute subarachnoid hemorrhage.

Front 494

Subfalcial herniation

Back 494

Most common form of brain herniation. Cingulate gyrus is displaced across midline under the falx. May compress adjacent lateral ventricle. May enlarge contralateral ventricle (obstruction of the foramen of Monro). Both anterior cerebral arteries may be displaced to contralateral side.

Front 495

Uncal herniation

Back 495

Medially displaced medial temporal lobe over free margin of tentorium. Focal effacement of ambient cistern and lateral suprasellar cistern. Rarely compresses contralateral cerebral peduncle (Kernohan's notch) against tentorial margin.

Front 496

Transtentorial Herniation

Back 496

Descending transtentorial herniation: Effacement of suprasellar and perimesencephalic cisterns. Pineal calcification is displaced inferiorly. Ascending transtentorial herniation: May involve vermis and parts of cerebellar hemispheres. Large posterior fossa hematomas

Front 497

Leptomeningeal cyst

Back 497

Known as a growing fracture. Caused by traumatic tear of the dura. Outpouching of arachnoid at site of suture or skull fracture.

Front 498

Duret hemorrhage

Back 498

Midline hematoma within tegmentum of rostral pons and midbrai. Associated with descending transtentorial herniation. Due to stretching or tearing of penetrating arteries.

Front 499

Nonaccidental trauma head findings

Back 499

Skull fractures. Subdural hematomas. Diffuse brain swelling.

Front 500

Moya moya disease

Back 500

Rare leptomeningeal vascular collaterals that form due to stenosis or occlusion of Circle of Willis arteries. Puff of smoke appearance at angiography. Associations: Sickle cell disease. Neurofibromatosis type I. Down's syndrome. Fibromuscular dysplasia.

Front 501

Differential diagnosis of supratentorial partially cystic, partially solid mass in a child:

Back 501

Pilocytic astrocytoma. PNET (primitive neuroectodermal tumor). Hemorrhage.

Front 502

Le Fort I

Back 502

Floating palate. Horizontal fracture through maxillary sinuses, nasal septum, and inferior ptyergoid plates.

Front 503

Le Fort II

Back 503

Pyramidal fracture through bridge of nose, medial orbits, lateral and posterior maxillary walls, nasal septum, inferior orbital rim (infraorbital nerve injury), and midportion of ptyergoid plates.

Front 504

Le Fort III

Back 504

Craniofacial dysjunction. Horizontal fracture through orbits. Begins near nasofrontal suture and extends posteriorly through nasal septum, medial and lateral orbit walls, zygomatic arch, and base (superior aspect) of pterygoid plates.

Front 505

CT scans done within 6 hours of MCA occlusion will commonly exhibit

Back 505

Insular ribbon sign: Subtle blurring of gray-white layers of insula. Caused by early edema. Lentiform nucleus edema sign: Hypodense putamen.

Front 506

Ischemic penumbra

Back 506

ischemic but not infarcted (salvageable) tissue. Peri-infarct tissue.

Front 507

Diffusion-Weighted MR in Acute Ischemia

Back 507

Brain water diffusion rates fall rapidly during acute ischemia. Bright signal on DWIs.

Front 508

Apparent diffusion coefficient (ADC).

Back 508

Reflects pure diffusion behavior. Free of underlying T2 contributions (shine through or dark through).

Front 509

Fluid-Attenuated Inversion Recovery (FLAIR) in Ischemia

Back 509

Suppresses free water CSF signal but allows T2 weighting of parenchyma. Increases conspicuity of T2 changes in ischemia. May help detect small cortical lesions and acute subarachnoid hemorrhage.

Front 510

Fogging effect

Back 510

CT finding occuring during 2nd week after infarction. Cerebral edema and mass effect subside while proteins accumulate from cell lysis. Injurred brain morphology and density appear normal at CT.

Front 511

Hemorrhagic Transformation of Infarction

Back 511

Seen 1 to 2 weeks postinfarction. Hemorrhage of reperfused capillaries. Serpiginous line of petechial blood following gyral contours of infarcted cortex.

Front 512

Time course of CT-detected enhancement of infarcted brain

Back 512

Begins at about 1 week. Peaks at 7 to 14 days. Often assumes a gyral pattern. As gliosis ensues and blood-brain barrier is repaired, enhancement fades and resolves by 3 months.

Front 513

Intravascular MR enhancement of infarcted brain

Back 513

Commonly seen in infarct during the first week. May be due to slow flow or vasodilation in arteries and veins. May be detected within minutes of vessel occlusion. Seen in a majority of cortical infarcts at 1 to 3 days. Resolves by 10 days.

Front 514

Maximal brain swelling post brain infarction occurs at what days

Back 514

3 to 7 days postinfarction.

Front 515

Encephalomalacia post brain infarction occurs when

Back 515

30 to 90 days (1 to 3 months) postinfarction.

Front 516

ACA (anterior cerebral artery) three subgroups:

Back 516

Medial lenticulostriate branches: Rostral portions of basal ganglia. Pericallosal branches: Corpus callosum. Hemispheric branches: Medial frontal and parietal lobes.

Front 517

Two main branch groups of MCA (middle cerebral artery)

Back 517

Lateral lenticulostriate branches: Supply most of basal ganglia. Hemispheric branches: Lateral cerebral surface.

Front 518

Major branches of PCA (posterior cerebral artery)

Back 518

Midbrain and thalamic perforating branches. Posterior choroidal arteries. Cortical branches to medial temporal and occipital lobes.

Front 519

(Deficit/Syndrome : Cerebral artery/branch/side affected), Leg weakness :

Back 519

ACA/Hemispheric branch/either side

Front 520

(Deficit/Syndrome : Cerebral artery/branch/side affected), Incontinence, akinetic mutism :

Back 520

ACA/Hemispheric branch/both sides

Front 521

(Deficit/Syndrome : Cerebral artery/branch/side affected), Facial weakness :

Back 521

ACA/Medial lenticulostriates/either side

Front 522

(Deficit/Syndrome : Cerebral artery/branch/side affected), Dysarthria with or without motor aphasia :

Back 522

ACA/Medial lenticulostriates/Left

Front 523

(Deficit/Syndrome : Cerebral artery/branch/side affected), Face and arm weakness > leg weakness :

Back 523

MCA/Hemispheric branch/either side

Front 524

(Deficit/Syndrome : Cerebral artery/branch/side affected), Motor aphasia (anterior lesion) :

Back 524

MCA/Hemispheric branch/Left

Front 525

(Deficit/Syndrome : Cerebral artery/branch/side affected), Receptive aphasia (posterior lesion) :

Back 525

MCA/Hemispheric branch/Left

Front 526

(Deficit/Syndrome : Cerebral artery/branch/side affected), Global aphasia :

Back 526

MCA/Hemispheric branch (total)/Left

Front 527

(Deficit/Syndrome : Cerebral artery/branch/side affected), Neglect syndromes :

Back 527

MCA/Hemispheric branch/Left

Front 528

(Deficit/Syndrome : Cerebral artery/branch/side affected), Visulospatial dysfunction :

Back 528

MCA/Hemispheric branch/Right

Front 529

(Deficit/Syndrome : Cerebral artery/branch/side affected), Variable lacunar syndromes :

Back 529

MCA/Lateral lenticulostriate branches/Either

Front 530

(Deficit/Syndrome : Cerebral artery/branch/side affected), Hemianopsia :

Back 530

PCA/Hemispheric branch/Either

Front 531

(Deficit/Syndrome : Cerebral artery/branch/side affected), Cortical blindness :

Back 531

PCA/Hemispheric branch/Both

Front 532

(Deficit/Syndrome : Cerebral artery/branch/side affected), Memory deficits :

Back 532

PCA/Hemispheric branch/Both

Front 533

(Deficit/Syndrome : Cerebral artery/branch/side affected), Somnolence :

Back 533

PCA/Thalamoperforators/Either

Front 534

(Deficit/Syndrome : Cerebral artery/branch/side affected), Sensory disturbances :

Back 534

PCA/Thalamoperforators/Either

Front 535

(Deficit/Syndrome : Cerebral artery/branch/side affected), Ataxia, vertigo, vomiting :

Back 535

Cerebellar/PICA, AICA, or SCA/ Either

Front 536

(Deficit/Syndrome : Cerebral artery/branch/side affected), Coma if mass effect :

Back 536

Cerebellar/PICA, AICA, or SCA/ Either

Front 537

(Deficit/Syndrome : Cerebral artery/branch/side affected), ± brainstem deficits :

Back 537

Cerebellar/PICA, AICA, or SCA/ Either

Front 538

(Deficit/Syndrome : Cerebral artery/branch/side affected), Man-in-a-barrel syndrome :

Back 538

Watershed/ACA,MCA,PCA/Either

Front 539

(Deficit/Syndrome : Cerebral artery/branch/side affected), Severe memory problems :

Back 539

Watershed/ACA,MCA,PCA/Bilateral

Front 540

Order of cerebellar branches going from top to bottom can be remembered using the acronym

Back 540

SAP: Superior cerebellar artery. Anterior inferior cerebellar artery. Posterior inferior cerebellar artery.

Front 541

SCA territory

Back 541

Superior vermis. Middle and superior cerebellar peduncles. Superolateral aspects of cerebellar hemispheres.

Front 542

Anterior Inferior Cerebellar Arteries (AICA) arise from

Back 542

Proximal basilar artery.

Front 543

Posterior Inferior Cerebellar Arteries (PICA) arise from

Back 543

Distal vertebral artery, 1 to 2 cm below basilar origin.

Front 544

Involvement of the medulla in PICA infarction adds elements of Wallenberg syndrome, which include

Back 544

Ataxia. Facial numbness. Horner syndrome. Dysphagia. Dysarthria.

Front 545

Lacunes

Back 545

Small subcortical infarcts. May occur in any territory. Characteristic locations: Lenticular nucleus (37%). Pons (16%). Thalamus (14%). Caudate (10%). Internal capsule/corona radiata (10%).

Front 546

Beginning at the genu and working back, the internal capsule carries somatotopically organized fibers

Back 546

Corticobulbar fibers. HAL: Head fibers. Arm fibers. Leg fibers.

Front 547

Perivascular spaces

Back 547

Virchow-Robin spaces. May simulate lacunes. Follow CSF signal. No mass effect. Occur along path of a penetrating vessel.

Front 548

Small-Vessel Ischemic Changes

Back 548

Small foci of T2 hyperintensity scattered throughout brains of older patients. May or may not have clinical symptoms. Commonly associated with patchy or diffuse T2 hyperintensity in the centrum semiovale.

Front 549

Some cerebral vasculitides

Back 549

Autoimmune disorders. Drug exposure (heroin, amphetamines). Polyarteritis nodosa. Idiopathic processes (giant cell arteritis).

Front 550

Venous sinus thrombosis predisposing factors include

Back 550

Hypercoagulable states. Pregnancy. Infection (spread from contiguous scalp, face, middle ear, or sinus). Dehydration. Meningitis. Direct invasion by tumor.

Front 551

Empty delta sign

Back 551

Filling defect within sagittal sinus on postcontrast CT. Indicates venous sinus thrombosis.

Front 552

Superficial hemosiderosis (or superficial siderosis)

Back 552

Diffuse hemosiderin deposition on brain surface. Due to large or recurrent subarachnoid hemorrhages.

Front 553

MR oxyhemoglobin per time, RBC, and T1 and T2 signal

Back 553

Less than 1 day. RBC intact. T1 iso/dark. T2 bright.

Front 554

MR deoxyhemoglobin per time, RBC, and T1 and T2 signal

Back 554

0-2 days. RBC intact. T1 iso/dark. T2 dark.

Front 555

MR methemoglobin (intracellular) per time, RBC, and T1 and T2 signal

Back 555

2-14 days. RBC intact. T1 bright. T2 dark.

Front 556

MR methemoglobin (extracellular) per time, RBC, and T1 and T2 signal

Back 556

10-21 days. RBC lysed. T1 bright. T2 bright.

Front 557

MR hemosiderin/ferritin per time, RBC, and T1 and T2 signal

Back 557

> 21 days. RBC lysed. T1 dark. T2 dark.

Front 558

Most sensitive areas for detecting SAH

Back 558

Dependent parts of occipital horns. Interpeduncular fossa.

Front 559

Main finding in patients whose condition continues to deteriorate after the initial SAH

Back 559

Infarcts from post SAH increased intracranial pressure or arterial vasospasm.

Front 560

Congenital berry aneursym

Back 560

May be due to congenital absence of arterial media. Those larger than 3 to 5 mm are at increased risk for rupture. Often occur near branch points of circle of Willis.

Front 561

Distal branch cerebral aneurysms are seen in what conditions

Back 561

Prior trauma. Systemic infection (bacterial endocarditis with mycotic aneurysm).

Front 562

Besides berry aneursyms, list other causes of cerebral aneurysms

Back 562

Atherosclerosis. Fibromuscular disease. Polycystic kidney disease. Mycotic. Post-traumatic.

Front 563

Main differential considerations for cerebral parenchymal hemorrhage

Back 563

Hypertensive hemorrhage. Vascular malformations. Drug effects. Amyloid angiopathy. Bloody tumors.

Front 564

Common locations for intracranial hypertensive hemorrhages

Back 564

Putamen (35% to 50%). Subcortical white matter (30%). Cerebellum (15%). Thalamus (10% to 15%). Pons (5% to 10%).

Front 565

Intracranial hemorrhage cause in young patients, less common than hypertension

Back 565

Vascular malformations: AVMs. Cavernous malformations. Telangiectasias. Venous malformations.

Front 566

Arteriovenous malformations

Back 566

Most common type of brain vascular malformation. Abnormal tangle of arteries directly connected to veins without intervening capillaries. Most present with hemorrhage or seizures. 2% to 3% annual risk of bleeding,

Front 567

Cavernous malformations

Back 567

Thin-walled sinusoidal vessels (neither arteries nor veins). May present with seizures or small parenchymal hemorrhages.

Front 568

Venous malformations

Back 568

Anomalous veins that drain normal brain. Occur in 1% to 2% of patients. Enlarged enhancing stellate venous complex that extends to ventricular or cortical surface.

Front 569

Amyloid angiopathy cerebral hemorrhage

Back 569

Can cause intracranial, frequently lobar, hemorrhage. Amyloid deposits within media and adventitia of medium size and small cortical arteries. Not associated with systemic vascular amyloidosis. Affects elderly.

Front 570

Hemorrhagic cerebral neoplasm

Back 570

Primary: Glioblastomas. Metastatses: Bronchogenic carcinoma. Thyroid. Melanoma. Choriocarcinoma. Renal cell carcinoma.

Front 571

Features of Benign Versus Malignant Intracranial Hemorrhage

Back 571

Benign: Complete hemosiderin rim. Mild edema. Minimal acute enhancement (unless AVM). Blood products evolve from periphery to center. Malignant: Delayed or incomplete hemosiderin ring. Moderate surrounding edema. Moderate to severe acute enhancement. Irregular or complex blood product evolution.

Front 572

Glial cell intracranial neoplasms (gliomas)

Back 572

Astrocytoma. Oligodendroglioma. Ependymoma. Choroid plexus tumor.

Front 573

Nerve sheath intracranial neoplasms

Back 573

Schwannoma, Neurofibroma.

Front 574

Extra-axial tumors

Back 574

Tumors occuring along brain meninges or within the ventricles. Most nonglial tumors.

Front 575

Significant general midline shift, if shift is greater than

Back 575

3 mm.

Front 576

Hallmarks of uncal herniation?

Back 576

Effacement of ambient cistern. Contralateral hydrocephalus. May compromise ipsilateral oculomotor (III) nerve (pupillary dilation).

Front 577

Differentiating a small neoplasm from a small infarct may be very difficult. When can followup imaging be obtained to help distinguish between the two.

Back 577

Virtually all infarcts will be smaller in size by 3 weeks. If lesion is same size or larger at 3 weeks, a neoplasm should be favored.

Front 578

Extra-axial mass refers to

Back 578

Everything outside the brain: Arachnoid. Meninges. Dural sinuses. Skull. Ventricles.

Front 579

White matter buckling?

Back 579

Extra-axial lesions may buckle white matter. Inward compression of white matter (thinning of fronds). Preserved gray-white matter differentiation.

Front 580

Tumors of high cellular density

Back 580

Usually small cell tumors (high nucleus:cytoplasm ratio, hyperdense and T2 hypointense): Lymphoma. Pineoblastoma. Neuroblastoma. Medulloblastom. Metastases: Melanoma. Lung carcinoma. Colon carcinoma. Breast carcinoma.

Front 581

Some specialized areas of the brain have no blood-brain barrier and will normally enhance

Back 581

Choroid plexus. Pituitary glands. Pineal glands. Tuber cinereum. Area postrema.

Front 582

Tumor enhancement generally means

Back 582

Aggressive, high-grade neoplasms tend to have fenestrated capillaries (blood-brain barrier breakdown) allowing for enhancement.

Front 583

Postop granulation tumor versus residual tumor?

Back 583

Granulation tissue generally forms 72 hours after surgery. Early (less than 72 hours) postop enhancement likely reflects residual tumor rather than granulation tumor.

Front 584

Diffuse white matter radiation injury

Back 584

Unenhancing geographic white matter T2 hyperintensity conforming to radiation ports. Develops 6 months postradiation therapy.

Front 585

Radiation necrosis

Back 585

Indistinguishable from recurrent tumor on conventional imaging. May demonstrate mass effect and enhancement. Radiation necrosis may have elevated lactate peak (necrosis) on MRS. Recurrent tumor may have elevated choline peak and depressed n-acetyl aspartate (NAA) peak.

Front 586

Astrocytoma grades and types

Back 586

Grade I (pilocytic astrocytoma, subependymal giant cell astrocytoma). Grade II (lack necrosis and endothelial proliferation). Grade III (anaplastic astrocytoma). Grade IV (necrosis and endothelial proliferation, Glioblastoma multiforme).

Front 587

Female predominant brain tumors

Back 587

Meningioma (4:1). Neurofibroma. Pineocytoma. Pituitary tumor.

Front 588

Male predominant brain tumors

Back 588

Pineal germinoma (10:1). Pineal parenchymal tumor (4-7:1). Medulloblastoma (3:1). Glioblastoma multiforme (3:2). Choroid plexus papilloma (2:1). CNS lymphoma. Hamartoma of tuber cinereum.

Front 589

Two neoplasms that may exhibit bihemispheric spread through the corpus callosum.

Back 589

Glioblastoma multiforme. CNS lymphoma.

Front 590

Intra-axial Lesions With Marked Surrounding Edema

Back 590

Metastases. Abscess. Glioblastoma multiforme. Radiation necrosis. Hematoma (mild).

Front 591

Hemorrhagic Brain Tumors

Back 591

Primary: Glioblastoma multiforme (most common overall). Oligodendroglioma. Metastasis: RCC. Thyroid carcinoma. Choriocarcinoma. Melanoma.

Front 592

Cerebral Ring-Enhancing Lesions

Back 592

MAGIC DR. Metastasis. Abscess. Glioblastoma multiforme. Infarct. Contusion. Demyelinating disease. Resolving hematoma. radiation necrosis.

Front 593

This MR sequence may help distinguish acute infarct from low-grade neoplasm.

Back 593

DWI. Infarct exhibitis restricted diffusion.

Front 594

Gliomatosis cerebri

Back 594

Rare neoplastic infiltration of at least three lobes of the brain. Poor prognosis. Diffuse involvement of cerebral white matter with or without a mass.

Front 595

In an adult with a heterogeneous calcified mass within the periphery of a frontal lobe with calvarial erosion and relative absence of edema should suggest the diagnosis of

Back 595

Oligodendroglioma.

Front 596

Oligodendroglioma features

Back 596

Grade II tumor. Commonly located in the frontal lobes. Often extends to cortex and may erode calvarium. 70% calcify.

Front 597

Calcified Glial Tumors in Order of Frequency

Back 597

Old Elephants Age Gracefully: Oligodendroglioma. Ependymoma. Astrocytoma. Glioblastoma multiforme.

Front 598

CNS lymphoma imaging characteristics

Back 598

Hyperdense and T1 hypointensity on T2WIs with surrounding vasogenic edema. Subependymal spread is common. Bihemispheric involvement via corpus callosum may be seen.

Front 599

Ganglioglioma and Gangliocytoma

Back 599

Ganglioglioma contains glial cells and differentiated neurons. Most common tumor seen with chronic temporal lobe epilepsy. Gangliocytoma and ganglioneuroma are pure neuronal tumors without glial components. Floor of third ventricle is the most common location for gangliocytoma.

Front 600

Desmoplastic Infantile Ganglioglioma

Back 600

Rare variant of ganglioglioma seen in the first year of life. Very large heterogeneous mass with intense enhancement.

Front 601

Most common tumor associated with medically refractory partial complex seizures

Back 601

Dysembryoplastic neuroepithelial tumor. Always involves cortical gray matter. May have “soap bubble” appearance with exophytic extension beyond cortical gray matter margin.

Front 602

Congenital Brain Tumors in Infants Younger Than 60 Days Old

Back 602

Teratoma (most common): Two thirds are supratentorial. Primitive neuroectodermal tumors: Curvilinear, sparse calcification. Astrocytoma. Choroid plexus papilloma. Ependymoma. Medulloepithelioma. Germinoma. Angioblastic meningioma. Ganglioglioma.

Front 603

Most (80% to 85%) metastatic lesions occur supratentorially, with the exception of ___________, which has a predilection for the posterior fossa.

Back 603

Renal cell carcinoma.

Front 604

Most Common Intra-axial Metastases to the CNS

Back 604

Lung. Breast. Melanoma. Colon cancer.

Front 605

Most Common Extra-axial Metastases to the CNS

Back 605

Breast. Prostate. Lung. Neuroblastoma.

Front 606

Most Common Hemorrhagic Metastases to the CNS

Back 606

Melanoma. Renal. Thyroid. Choriocarcinoma.

Front 607

Leptomeningeal carcinomatosis

Back 607

Malignant invasion of leptomeninges. May mimic meningitis. Commonly involves basal cisterns. May present with cranial nerve palsies. Common malignancies: Breast. Lung. Lymphoma. Leukemia. Primary CNS malignancies.

Front 608

Most common primary cerebellar neoplasm in adult population.

Back 608

Hemangioblastoma.

Front 609

Most reliable way to differentiate a medulloblastoma from an astrocytoma on cross-sectional imaging studies is

Back 609

Noncontrast CT scan. Astrocytoma will usually be hypodense. Medulloblastoma will almost never be hypodense.

Front 610

Posterior Fossa Masses in Children: Medulloblastoma

Back 610

Most common pediatric CNS malignancy. Majority (85%) arise from cerebellar vermis. Commonly extends into fourth ventricle causing hydrocephalus. Highly malignant neoplasm (WHO grade IV). Hyperdense on CT. Hypointense on T1WIs. Variable on T2WIs.

Front 611

Posterior Fossa Masses in Children: Pilocytic astrocytoma

Back 611

Location: Cerebellar vermis. Hemisphere. Cystic with enhancing nodule.

Front 612

Posterior Fossa Masses in Children: Ependymoma

Back 612

Location: 4th ventricle. Appearance: Foraminal extension. Heterogeneous on CT and MR. Intense but heterogeneous enhancement.

Front 613

Posterior Fossa Masses in Children: Brainstem glioma

Back 613

Location: Brainstem. Appearance: Expansile brainstem. Isodense to hypodense on CT. Hypointense on T1WIs. Hyperintense on T2WIs.

Front 614

Most common brain tumor seen in neurofibromatosis type 1 (NF1)

Back 614

Pilocytic astrocytoma.

Front 615

Cystic cerebellar mass with an enhancing mural nodule suggests two possible diagnoses, and the best discriminator between the two is

Back 615

Age. Pilocytic astrocytoma, peak age of birth to 9 years. Hemangioblastoma, peak age of 35 years.

Front 616

Capillary hemangioblastomas

Back 616

Benign neoplasms of endothelial origin. Most common primary cerebellar neoplasm in adults. 4% to 20% occur as part of von Hippel-Lindau syndrome. Occur most often in cerebellar hemispheres and spinal cord. Well-defined cystic mass with an intensely enhancing mural nodule.

Front 617

Dysplastic Cerebellar Gangliocytoma (Lhermitte-Duclos Disease)

Back 617

Likely a hamartoma. Half of patients have Cowden disease (phacomatosis, colonic polyps, cutaneous tumors, meningioma, glioma, thyroid, breast neoplasms). CT often is normal. Striated cerebellar mass on T1and T2 WIs.

Front 618

Meningioma

Back 618

Most common extra-axial neoplasm of adults. Peak age of 50 to 60 years. Occur more commonly within women. Multiple tumors are associated with neurofibromatosis. Common locations: Parasagittal or convexity locations (50%). Sphenoid wing (20%). Olfactory groove/planum sphenoidale (10%). Parasellar region (10%). Hyerdense, hyperenhancing mass with variable surrounding edema. Calcification occurs in 10% to 20% of cases. Angiographically, early dense tumor blush that persists well into venous phase,

Front 619

Cerebral Intraventricular Masses

Back 619

Choroid plexus papilloma (24%). Choroid plexus carcinoma (2%). Ependymoma (18%). Subependymoma (11%). Central neurocytoma (10%). Subependymal giant cell astrocytoma (6%). All other astrocytomas (9%). Meningioma (6%). Colloid cyst (4%). Metastasis (2%).

Front 620

Most Common Lateral Ventricle Masses, by Location and Age: 0 - 10 yo, Ventricle Body

Back 620

PNET (Primitive neuroectodermal tumor). Teratoma. Choroid plexus papilloma.

Front 621

Most Common Lateral Ventricle Masses, by Location and Age: 0 - 40 yo, Ventricle Trigone

Back 621

Choroid plexus papilloma.

Front 622

Most Common Lateral Ventricle Masses, by Location and Age: 10 - 40 yo, Foramen of Monro

Back 622

Subependymal giant cell astrocytoma. Pilocytic astrocytoma.

Front 623

Most Common Lateral Ventricle Masses, by Location and Age: 10 - 40 yo, Ventricle Body

Back 623

Ependymoma. Pilocytic astrocytoma. Central neurocytoma.

Front 624

Most Common Lateral Ventricle Masses, by Location and Age: > 40 yo, Ventricle Body

Back 624

Subependymoma.

Front 625

Most Common Lateral Ventricle Masses, by Location and Age: > 40 yo, Ventricle Trigone

Back 625

Meningioma. Metastasis.

Front 626

Choroid Plexus Papilloma

Back 626

Most commonly occurs in lateral ventricle, especially in children. Increased intracranial pressure and hydrocephalus due to: Increased tumor production of CSF. Impaired CSF resorption (tumoral hemorrhage). CSF obstruction (mass effect). WHO grade I. May engulf glomus of choroid plexus. Choroid plexus calcification in first decade of life suggests choroid plexus papilloma.

Front 627

Central neurocytoma

Back 627

Arises from septum pellucidum or ventricular wall. 50% occur in lateral ventricle near foramen of Monro. May be bilateral. Most patients (75%) are between 20 and 40 years. Well-circumscribed lobulated mass within lateral or third ventricles. Hyperdense at CT. Cystic elements (Swiss cheese) and calcification are common.

Front 628

Subependymoma

Back 628

WHO grade I. Most are asymptomatic. Well-circumscribed lobulated intraventricular mass. Isodense to hypodense at CT. Frequent calcification (33%) and cystic degeneration (20%). Low T1 and high T2 signal. Hypointensity on T1WIs and hyperintensity on T2WIs are seen on MR. Enhancement not as diffuse as in central neurocytoma.

Front 629

Subependymal giant cell astrocytoma

Back 629

Seen in 10% of patients with tuberous sclerosis (look for subependymal and cortical hamartomas). WHO grade I. Commonly calcifies. and slow-growing, with calcification a common feature. Almost always produces some degree of hydrocephalus.

Front 630

Colloid cyst

Back 630

Occurs in anterosuperior portion of third ventricle near foramen of Monro. Can cause acute hydrocephalus. Almost all are hyperdense. Variable T1 and T2 signal.

Front 631

Masses of the Anterosuperior Third Ventricle

Back 631

Colloid cyst. Meningioma. Choroid plexus papilloma. Hamartoma. Glioma. Vascular lesion. Granulomatous disease.

Front 632

Most common neoplasm of pineal region

Back 632

Germ cell tumors

Front 633

Calcified pineal mass in a female is more likely to be

Back 633

Pineocytoma. In a male more likely to be a germinoma.

Front 634

When calcification in the pineal region exceeds ____ in size, a pathologic pineal process should be suspected.

Back 634

1 cm.

Front 635

Cerebral Germ cell tumors

Back 635

Well-defined, usually midline masses. 65% occur in pineal region (male more than female). 60% of all pineal masses. 35% are suprasellar (male = female). Germinoma is by far the most common. Commonly seen in children and young adults.

Front 636

Pineal region masses

Back 636

Germ Cell Tumors (60%): Germinoma. Teratoma. Embryonal carcinoma. Endodermal sinus tumor. Choriocarcinoma. Pineal Parenchymal Tumors (14%): Pineocytoma. Pineoblastoma. Other: Pineal cyst, glioma, tentorial meningioma, vein of galen malformation, arachnoid cyst, lipoma.

Front 637

Pineoblastoma

Back 637

Similar to medulloblastoma, part of PNET spectrum. Majority occur in young children. Well-circumscribed, often lobular. Local invasion and frequent calcification. WHO grade IV. Rarely may occur with bilateral retinoblastomas, the so-called trilateral retinoblastoma.

Front 638

Pineocytoma

Back 638

Most commonly seen in adults (women more than men). Usually well demarcated, noninvasive, and slow growing. Often calcified. Rarely metastasizes. At imaging, can't be differentiated from pineal germinoma or pineoblastoma.

Front 639

Pineal cysts

Back 639

Are common. Signal similar to or slightly higher than CSF, likely due to lack of CSF puslation. No enhancement.

Front 640

Pituitary adenomas

Back 640

Most common sellar masses. Microadenomas (10 mm or smaller). Macroadenomas (>10 mm). 75% are hormonally active, most of which are microadenomas. Lateral gland generally contains prolactin and growth hormone secreting adenomas. Central gland generally contains ACTH, TSH, FSH secreting adenomas. Microadenomas best detected on coronal T1WIs: Focal hypointensity (on noncontrast studies).

Front 641

Craniopharyngioma

Back 641

Arise from squamous epithelial remnants of anterior lobe of pituitary gland. Commonly are symptomatic due to large size. Most common suprasellar mass in children. Peak incidence between 5 and 10 years of age and 50 and 60 years. Solid and cystic components are typical. Large cystlike sellar/suprasellar mass with enhancing rim and some calcification. T1 (liquid crystal) and T2 hyperintense cyst.

Front 642

Rathke cleft cyst

Back 642

Arise from squamous epithelial remnants of anterior lobe of pituitary gland. Usually asymptomatic. Cyst may contain mucus, serous fluid, or cellular debris. Variable signal intensities. May mimic craniopharyngioma.

Front 643

Schwannoma

Back 643

Arises from Schwann cells. Commonly affects vestibulocochlear (VIII) and trigeminal (V) nerves. Cystic degeneration is common, especially in larger lesions. T1 hypointense to gray matter and T2 hyperintense to gray matter. Intense enhancement.

Front 644

Most helpful imaging feature in distinguishing vestibular schwannomas

Back 644

Extension of enhancement along course of seventh and eighth nerves.

Front 645

Suprasellar Masses

Back 645

SATCHMO Sella (pituitary) tumor. Sarcoid. Aneurysm. Arachnoid cyst. Teratoma. Craniopharyngioma. Hypothalamic glioma. Hamartoma of tuber cinereum. Histiocytosis. Meningioma. Optic nerve glioma.

Front 646

Cerebellopontine Masses

Back 646

AMEN Acoustic (vestibular) schwannoma. Meningioma. Ependymoma. Neuroepithelial cyst (arachnoid, epidermoid).

Front 647

Epidermoid versus Dermoid

Back 647

Epidermoid: Common. 40 to 50 yo. Ectoderm. Off midline (cerebellopontine cistern, parasellar, posterior fossa). Follows CSF, except hyperintense on DWI. Lobulated with peripheral enhancement. Dermoid: Uncommon. 20 to 30 yo. Ectoderm and mesoderm. Midline (pericerebellar, suprasellar). Typical fat attenuation or signal.

Front 648

Intracranial lipomas

Back 648

Occur within all age groups. Most common locations: Interhemispheric falx (often associated with agenesis of corpus callosum). Quadrigeminal plate. Suprasellar regions. Chemical shift artifact or fat suppression. Presence of flow void or traversing cranial nerve favors lipoma and excludes dermoid.

Front 649

Arachnoid cysts

Back 649

Are intra-arachnoidal. 50% occur in middle cranial fossa. Other sites: Frontal convexity. Suprasellar and quadrigeminal cisterns. Posterior fossa. Follow CSF signal and density. May remodel adjacent bone. Do not restrict diffusion. Enlarged cisterna magna fills immediately at cisternography; whereas, arachnoid cyst may not fill or slowly fill.

Front 650

Hamartoma of tuber cinereum

Back 650

Rare congenital hamartoma. More common in boys. Precocious puberty, gelastic seizures, developmental delay, and hyperactivity. Well-circumscribed, round or oval mass centered at the tuber cinereum (base of infundibulum). Does not calcify or hemorrhage. Stalk connecting mass with tuber cinereum or mamillary bodies cinches diagnosis.

Front 651

Intracranial tuberculoma

Back 651

Granuloma with central caseous necrosis. Isodense or slightly hyperdense nodules or small mass lesions.

Front 652

Brain Coccidioidomycosis

Back 652

Occurs in southwestern United States. Focal parenchymal granulomas are rare. Hydrocephalus is common from complicating meningitis.

Front 653

Brain Blastomycosis

Back 653

Occurs in Ohio and Mississippi River valleys. Frequently presents with meningitis with parenchymal abscesses and granulomas less likely. Epidural granulomas and abscesses also occur usually from direct extension from bone infection.

Front 654

Brain Histoplasmosis

Back 654

Occurs in Midwest and southern United States. Meningitis is most common. Multiple or solitary granulomas may occur.

Front 655

CNS Aspergillosis

Back 655

Parenchymal disease usually takes the form of an abscess. Granulomas are unusual. Abscesses are often multiple with irregular ring enhancement. Subcortical or cortical infarcts and hemorrhage from blood vessel invasion may occur.

Front 656

CNS Mucormycosis

Back 656

Invades brain usually by direct extension from sinuses, nose, or oral cavity. Almost all patients are diabetic or immunocompromised. Tends to invade blood vessels. Lesions are often in the base of the brain, adjacent to diseased sinuses. Infarcts, intra-axial or extra-axial hemorrhage, and meningeal enhancement can be seen with CT or MR.

Front 657

CNS Candidiasis

Back 657

Usually causes meningitis. Granulomas and small abscesses may occur. Meningeal enhancement or multiple small enhancing granulomas or microabscesses are usually seen.

Front 658

Most frequently reported CNS fungal infection.

Back 658

Cryptococcosis.

Front 659

CNS Cryptococcosis

Back 659

50% occur in immunocompetent patients. Common infection in patients with AIDS. Usually presents as meningitis. Granulomas can occur and are usually multiple. Abscesses are less common. CT scans can be normal. Cryptococcomas are small, usually multiple, solid-enhancing, peripheral parenchymal nodules. Gelatinous pseudocysts can be seen.

Front 660

Gelatinous pseudocyst

Back 660

Cystic lesion usually in basal ganglia. Perivascular spaces filled with cryptococcal organisms. Usually found only in immunocompromised.

Front 661

Cysticercosis

Back 661

Caused by larvae of pork tapeworm Taenia solium. Ingested eggs hatch in intestine and larvae are hematogenously distributed, forming cysticerci. 3 stages of CNS disease: Early phase, edema and/or nodular enhancement. Later, peripheral viable cysts. Scolex may be seen as small mural nodule. Late phase, peripheral calcifications without edema or enhancement.

Front 662

Echinococcosis

Back 662

Caused by dog tapeworm. More commonly involves liver and lungs, but brain can rarely be involved. Cysts are usually solitary, unilocular, large, round, and smoothly marginated. Most often supratentorial, in the middle cerebral artery territory.

Front 663

Congenital CNS toxoplasmosis

Back 663

Atrophy, dilated ventricles, and calcifications. Periventricular white matter, basal ganglia and cerebral hemisphere calcifications. In CMV, calcifications are usually periventricular only.

Front 664

Amebic meningoencephalitis

Back 664

Amebae enter nasal cavity of patients swimming in infested water. Direct extension through cribriform plate to the brain. Severe meningoencephalitis results and is usually fatal. Early in infection, meninges and gray matter may enhance. Later, diffuse cerebral edema ensues.

Front 665

Neurosyphilis

Back 665

Symptomatic patients may have aseptic meningitis, tabes dorsalis, general paresis, or meningovascular disease. Imaging is usually normal in tabes dorsalis, rarely gummas are found: small enhancing nodules on brain surface with adjacent meningeal enhancement. Meningovascular syphilis thickening of meninges and medium to large vessel arteritis.

Front 666

CNS Lyme disease

Back 666

2 Forms. Cranial neuritis: Thick, enhancing nerves. CNs III to VIII may be involved (CN VII most common). Parenchymal form: Multiple small white matter lesions. Similar to multiple sclerosis. Lesions may have nodular or ring enhancement. Meninges may enhance.

Front 667

Cytomegalovirus, congenital CNS infection

Back 667

Most common CT findings: Periventricular calcification. No calcifications of basal ganglia or cortices as seen congenital toxoplasmosis.

Front 668

Neonatal herpes simplex encephalitis

Back 668

Early in course: Diffuse brain swelling or bilateral patchy areas of decreased density (hypoechoic, too) in cerebral white matter and cortex. Sparing of basal ganglia, thalami, and posterior fossa structures. Multicystic encephalomalacia is the end result.

Front 669

Adult herpes simplex CNS infection

Back 669

May cause encephalitis or cranial neuritis. 70% mortality rate in untreated patients. Ill-defined hypodensities within one or both temporal lobes. Virus is usually latent within gasserian ganglion. Frontal lobes may be involved. Insular cortex is often involved, but adjacent putamen is spared. Usually swelling with mass effect. Streaky enhancement is variable. The CT findings are not usually seen before the fifth day of symptoms. Increased FLAIR and T2 signal within temporal and/or frontal lobe(s) with sparing of putamen. Middle cerebral artery infarct (often involves putamen, unlike herpes).

Front 670

Ramsay Hunt syndrome

Back 670

Herpes zoster facial neuritis. Ear pain, facial paralysis, vesicular eruption about the ear. MR may reveal increased enhancement of facial nerve.

Front 671

Acute disseminated encephalomyelitis (ADEM)

Back 671

May occur after viral infection, following a vaccination, or spontaneously. When treated early with steroids, most patients make a full recovery. Increased T2 and FLAIR signal within white matter of brainstem, cerebellum, and basal ganglia. Optic neuritis is also common.

Front 672

Subacute sclerosing panencephalitis

Back 672

caused by variant of measles virus. Occurs in children and young adults who had measles before age 2, after a 6- to 10-year asymptomatic period. Causes progressive dementia, seizures, and paralysis, leading to death. Initially may have focal lesions in gray matter and subcortical white matter. Later, periventricular white matter lesions may enhance. Late stages usually is profound cortical atrophy.

Front 673

Progressive multifocal leukoencephalopathy (PML)

Back 673

Demyelinating disease caused by a papova virus. Occurs only in immunosuppressed patients, especially in AIDS.

Front 674

Creutzfeldt-Jakob disease

Back 674

Caused by a prion. Rapidly progressive dementia, ataxia, and myoclonus, leading to death. Early stage, high DWI signal within cerebral cortex and basal ganglia. Later stage, atrophy and increased T2 and FLAIR signal within cortex and basal ganglia.

Front 675

Meningitis forms causing thick meningeal enhancement (pachymeningeal)

Back 675

Tuberculous meningitis. Fungal meningitis. Racemose cysticercosis. Sarcoidosis.

Front 676

Most common AIDS CNS infections

Back 676

HIV encephalopathy. Toxoplasmosis. Cryptococcosis. Other fungal infections. CMV and Herpes meningoencephalitis. Mycobacterial infection. PML. Meningovascular syphilis.

Front 677

Most common CNS AIDS tumor

Back 677

Primary CNS lymphoma.

Front 678

HIV Encephalopathy

Back 678

Diffuse atrophy is most common manifestation. White matter lesions are seen with AIDS dementia complex. Diffuse pattern of increased T2 signal in deep white matter or multiple small punctate white matter lesions.

Front 679

Most common opportunistic CNS infection in AIDS

Back 679

Toxoplasmosis.

Front 680

Toxoplasmosis

Back 680

Multiple high T2 signal and enhancing mass lesions (1-4 cm) with surrounding vasogenic edema. Larger lesions usually exhibit ring enhancement. Unlike bacterial abscesses, toxoplasmosis lesions are not high in signal on DWI. Preferred sites: Basal ganglia. White matter. Cortex. Main differential consideration is primary CNS lymphoma.

Front 681

Most common AIDS CNS fungal infection

Back 681

Cryptococcosis.

Front 682

Progressive multifocal leukoencephalopathy

Back 682

Infection of immunosuppressed patients (AIDS, transplants, leukemics) caused by reactivation of JC virus. Progressive course to death within months. In non-AIDS patients, has a predilection for occipital lobes. In AIDS patients, any part of brain may be involved. High T2 and low T1 lesions within subcortical and deep white matter. Mass effect and contrast enhancement are almost always absent.

Front 683

Primary CNS lymphoma

Back 683

Most common intracranial tumor in AIDS. Solitary or multiple enhancing mass lesions, centrally located within deep white matter or basal ganglia. Lesions usually are T2 isointense to white matter with homogeneous enhancement. Toxoplasmosis lesions usually are T2 hypointense.

Front 684

Dysmyelination

Back 684

Inherited disorder (leukodystrophy), affecting formation or maintenance of myelin. Generally encountered within pediatric population.

Front 685

Demyelination

Back 685

Acquired disorder that affects normal myelin. Generally encountered within adult population.

Front 686

Multiple sclerosis (MS, Primary Demyelination)

Back 686

Multiple CNS lesions separated in time and space. Typical lesions are high T2 signal and round or ovoid in a periventricular (perpendicular to ventricle) or subcortical location. Enhancement reflects new lesions. Dark T1 lesions are due to acutal neuronal tissue loss. Other sites affected: Cerebellar and cerebral peduncles. Corpus callosum. Medulla. Spinal cord. Conglomerate large lesions may be mistake for a neoplasm (tumefactive).

Front 687

Involvement of callosal-septal interface is quite specific for

Back 687

MS.

Front 688

Nonspecific punctuate white matter lesions (small bright lesions on T2WIs) are more prominent in any patient with

Back 688

Vasculopathy or hypercoagulable state.

Front 689

A classic case presentation is that of a young adult female with prior miscarriages presenting with headaches/migraines and ischemic white matter changes.

Back 689

Antiphospholipid syndrome (phospholipid antibody syndrome). Hypercoagulable state with white matter and ischemic changes.

Front 690

Ependymitis granularis

Back 690

Normal anatomic finding. May mimic pathology. High T2 signal at tips of frontal horns. Due to porous ependyma allowing transependymal flow of CSF.

Front 691

Senescent periventricular hyperintensity

Back 691

Age-related high T2 signal along entire length of lateral ventricles.

Front 692

Prominent perivascular spaces

Back 692

CSF-filled perivascular clefts. Also called Virchow-Robin spaces. Punctate foci of high T2 signal. Typically within centrum semiovale and lower basal ganglia at the level of the anterior commissure, where lenticulostriate arteries enter the brain.

Front 693

MR sequences that help distinguish perivascular spaces from parenchymal lesions

Back 693

Proton-density and FLAIR sequences. PD: CSF has similar signal intensity as white matter. Perivascular space is isointense to brain. Ischemic lesions are bright due to gliosis. FLAIR: Parenchymal lesions with gliosis have abnormal signal.

Front 694

Central pontine myelinolysis (CPM)

Back 694

Demyelination of central pons. Due to electrolyte abnormalities, particularly hyponatremia, that are rapidly corrected. Oligodendroglial cells are most susceptible: Central pons. Thalamus. Globus pallidus. Putamen. Lateral geniculate body.

Front 695

Posterior reversible encephalopathy syndrome (PRE)

Back 695

Symmetric subcortical and cortical vasogenic edema within parietooccipital lobes. Temporary failure of autoregulation of cerebral arteries. Associations: Cyclosporin A or tacrolimus (FK506). Acute renal failure/uremia. Hemolytic uremic syndrome. Eclampsia. Thrombotic thrombocytopenia purpura. Chemotherapy (interferon).

Front 696

Marchiafava-Bignami disease

Back 696

Rare demyelination seen frequently in alcoholics. Involves central fibers (medial zone) of corpus callosum. Anterior and posterior commissures. Centrum semiovale. Mddle cerebral peduncles. Felt to reflect a form of osmotic demyelination

Front 697

Wernicke encephalopathy and Korsakoff syndrome

Back 697

Metabolic disorders caused by thiamine (B1 vitamin) deficiency: alcoholics, hematologic malignancies, hyperemesis gravidarum. Wernicke encephalopathy clinical triad of acute ocular movement abnormalities, ataxia, and confusion. If longterm memory and learning problems result then Korsakoff syndrome. Early stage may reveal T2 hyperintensity or contrast enhancement of mamillary bodies, basal ganglia, thalamus, brainstem, and periaqueductal involvement. Chronic stage may show mamillary body and tegmentum atrophy and dilation of third ventricle.

Front 698

Radiation Leukoencephalitis

Back 698

Occurs 6 to 9 months after treatment in excess of 40 Gy. Confluent high T2 signal within white matter extending to subcortical U fibers.

Front 699

Radiation Necrosis

Back 699

Commonly occurs 6 to 24 months postradiation. Enhancing lesion with mass effect and ring enhancement. Or multiple foci of enhancement, Mimicks recurrent neoplasm. MR spectroscopy (MRS): Elevated lactate and lipids (0.9 to 1.3 ppm). Reduced other major metabolites (choline, creatine, and N-acetylaspartate).

Front 700

Metachromatic leukodystrophy: head size, age of onset, white matter involvement, gray matter involvement

Back 700

Normal head size. Infantile form 1-2 yo. Juvenile form 5-7 yo. Diffuse white matter involvement. No gray matter invovlement. Most common Leukodystrophy. Deficiency of the enzyme arylsulfatase A.

Front 701

Adrenoleukodystrophy leukodystrophy: head size, age of onset, white matter involvement, gray matter involvement

Back 701

Normal head size. 5-10 yo. Symmetric occiptal and splenium of corpus callossom white matter invovlement. No gray matter involvement. Sex-linked recessive condition (peroxisomal enzyme deficiency) occurring only in boys.

Front 702

Leigh disease: head size, age of onset, white matter involvement, gray matter involvement

Back 702

Normal head size. Less than 5 yo. Focal areas of subcortical white matter. Basal ganglia and periaquaductal gray matter involvement. Also called subacute necrotizing encephalomyelopathy. Mitochondrial enzyme defect.

Front 703

Alexander disease: head size, age of onset, white matter involvement, gray matter involvement

Back 703

Normal to large head size. Less than 1 yo. Frontal white matter involvement. No gray matter involvement.

Front 704

Canavan disease: head size, age of onset, white matter involvement, gray matter involvement

Back 704

Normal to large head size. less than 1 yo. Diffuse white matter involvement. Vacuolization of cortical gray matter. deficiency of aspartoacylase, leads to the buildup of NAA (MRS).

Front 705

Transependymal flow of CSF

Back 705

Occurs in acute hydrocephalus. May mimic periventricular white matter disease. Important means of CSF reabsorption during ventricular obstruction.

Front 706

CSF circulation route

Back 706

Produced mainly by choroid plexus of lateral, third, and fourth ventricles. Flows from lateral ventricles through foramina of Monro to third ventricle through cerebral aqueduct to fourth ventricle through lateral and medial fourth foramina (Luschka and Magendie) to basilar cisterns and over hemisphere surfaces. Principal site of absorption is into venous circulation through arachnoid villi.

Front 707

Will commonly demonstrate supratentorial ventriculomegaly, with a fourth ventricle that appears normal.

Back 707

Communicating hydrocephalus. Dilated 4th ventricle can be seen in communicating and non-communicating hydrocephalus.

Front 708

Ex Vacuo Ventriculomegaly

Back 708

Enlarged ventricles due to cerebral atrophy. Prominence of both sulci and ventricles.

Front 709

Normal pressure hydrocephalus

Back 709

Chronic, low-level form of hydrocephalus. Clinical triad: Dementia, gait disturbance, and urinary incontinence. CSF pressure is within normal limits. Slight gradient exists between ventricular system and subarachnoid space due to incomplete subarachnoid CSF block. Commonly results from prior subarachnoid hemorrhage or meningitis. Diffuse ventriculomegaly out of proportion to sulcal prominence. Early entry of radiotracer into lateral ventricles, with persistence at 24 and 48 hours. Delay ascent to parasagittal region.

Front 710

Alzheimer disease (AD)

Back 710

Most common cause of dementia. Prefential atrophy of: Hippocampal formation. Temporal lobes. Parietotemporal cortices. Enlargement of temporal horns, suprasellar cisterns, and sylvian fissures may distinguish from age-related atrophy.

Front 711

Parkinson disease

Back 711

Most common basal ganglia disorder. Deficiency of dopamine specifically within pars compacta of the substantia nigra. MR imaging is relatively insensitive but is useful in excluded other causes of movement disorders (stroke).

Front 712

Huntington disease

Back 712

Progressive hereditary disorder occuring in fourth and fifth decades. Findings: Diffuse cortical atrophy. Caudate nucleus atrophy. Putamen atrophy. Enlargement of frontal horns (heart-shaped).

Front 713

Wilson disease

Back 713

Hepatolenticular degeneration. Inborn error of copper metabolism. Hepatic cirrhosis and degenerative changes of basal ganglia. Diffuse atrophy with signal abnormalities involving deep gray matter nuclei and deep white matter.

Front 714

Bilateral lesions of basal ganglia can be seen in a variety of insults

Back 714

Carbon monoxide exposure (globus pallidus). Methanol toxicity (putaminal). Metabolic conditions (Wilson disease). Hallervorden-Spatz disease (iron deposition within globus pallidus). Mitochondrial disorders (Leigh disease and Kearns-Sayre syndrome).

Front 715

Myelination Landmarks by Age 0 days

Back 715

High T1 signal: Dorsal brainstem. Ventrolateral thalamus. Lentiform nucleus. Central corticospinal tracts. Low T2 signal: Posterior limb internal capsule posterior portion.

Front 716

Myelination Landmarks by Age 3 months

Back 716

High T1 signal: Anterior limb internal capsule. Cerebellar white matter.

Front 717

Myelination Landmarks by Age 6 months

Back 717

High T1 signal: Genu of corpus callosum. Low T2 signal: Splenium of corpus callosum.

Front 718

Myelination Landmarks by Age 11 months

Back 718

Low T2 signal: Anterior limb internal capsule.

Front 719

Myelination Landmarks by Age 18 months

Back 719

Adult appearance except for terminal myelination zones (periatrial and adjacent to frontal horns)

Front 720

Myelination Landmarks by Age 24 months

Back 720

Dark white matter on T2 (some minimal high-signal areas may persist peripherally)

Front 721

Pelizaeus-Merzbacher Disease

Back 721

Rare X-linked leukodystrophy. Arrest of myelin development, usually in neonatal period. Shows lack only of myelin formation, rather than myelin formation followed by destruction.

Front 722

HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE)

Back 722

Damage to brain from hypoxia/ischemia occurring in utero or around time of delivery.

Front 723

Hydranencephaly

Back 723

Ischemic infarction of both cerebral hemispheres. Early compromise of both carotid arteries with preservation of posterior circulation. Mimics severe hydrocephalus (thin rind of cortical gray matter). Complete infarction of supratentorial cerebral tissues with preservation of thalami and cerebellum.

Front 724

Hypoxic ischemic encephalopathy occuring within 1st trimester

Back 724

Cortical irregularity and/or hydranencephaly.

Front 725

Hypoxic ischemic encephalopathy occuring at less than 26 weeks of gestation

Back 725

Periatrial injury. No gliosis. Ex vacuo enlargement.

Front 726

Hypoxic ischemic encephalopathy occuring at greather than 28 weeks

Back 726

Periatrial gliosis: high T2 signal.

Front 727

Hypoxic ischemic encephalopathy occuring at term

Back 727

Watershed infarcts. Ulegyria. Variable deep, superficial white matter gliosis and atrophy. Myelination delay. Injury to hippocampus and pons.

Front 728

Periventricular Leukomalacia (PVL)

Back 728

Occurs in term infants, premature infants greater than 26 weeks of gestation. Periventricular gliosis. Ex vacuo ventriculomegaly. Apposition of sulci to ventricular surface.

Front 729

Gliosis in the periatrial region (seen best on proton-density scans) is caused by injury to the developing brain at ______ gestational age or older.

Back 729

28 weeks .

Front 730

Ex vacuo atrial enlargement without gliosis reflects injury prior to _______ gestational age.

Back 730

26 weeks.

Front 731

Acute imaging findings of Profound Perinatal Hypoxic Ischemic Injury

Back 731

Deep gray matter: Isodense to white matter. Mottled high T1 and low T1 signal. White matter: Normal. May see blurred gray-white junction on protein density images.

Front 732

Subacute imaging findings of Profound Perinatal Hypoxic Ischemic Injury

Back 732

Deep gray matter: Variable T1 and T2 signal. White matter: High T1 and low T2 perirolandic cortex.

Front 733

Chronic imaging findings of Profound Perinatal Hypoxic Ischemic Injury

Back 733

Deep gray matter: High T2 signal. White matter: High T2 perirolandic cortex. Thinned gyri, atrophy.

Front 734

Imaging of Profound Postnatal Hypoxic Ischemic Injury

Back 734

Deep gray (Damage to corpus striatum: high signal on T2WIs Relative sparing of thalami) Cortex (Majority of cortex injured: high signal on T2WIs Relative sparing of perirolandic cortex Thinned gyri)

Front 735

Septo-optic dysplasia (SOD)

Back 735

Congenital disorder with variable hypoplasia of optic nerves and complete or partial absence of septum pellucidum. Squared-off appearance of frontal horns.

Front 736

Alobar holoprosencephaly

Back 736

Poor prognosis. Anterior rind of brain tissue and monoventricle communicating with dorsal cyst. Fused thalami. Absent septum pellucidum, corpus callosum, and falx. Upside-down U-shaped mantle of brain tissue. Ends of U are hippocampal ridges.

Front 737

Semilobar holoprosencephaly

Back 737

Partial fusion of hemispheres. Absent or dysgenic corpus callosum and septum pellucidum. High association with migration anomalies. Posterior portion of interhemispheric fissure and falx are usually formed.

Front 738

Lobar holoprosencephaly

Back 738

Partial absence of frontal interhemispheric fissure. Absent septum pellucidum and relatively normal brain overlap with SOD. Body and splenium of corpus callosum are usually present with genu and rostrum absent (dysgenic corpus callosum).

Front 739

Lipomas of corpus callosum

Back 739

Congenital abnormalities. High T1 signal with fat supression. No mass effect. Vessels course through these lesions. Occur because of persistence of meninx primitiva.

Front 740

Lissencephaly and pachygria/agyria complex

Back 740

Synonyms meaning absence of gyri. Smooth hourglass brain. Thick, multilayered cortex. Classic pattern: Arrested neuronal migration with only four cortical layers. Premature infant's brain can be a mimic.

Front 741

Hemimegalencephaly

Back 741

Asymmetric hemispheric enlarged with polymicrogyric and pachygyric changes. May be associated with neurofibromatosis.

Front 742

Polymicrogyria and pachygria

Back 742

Pachygyria is a incomplete lissencephaly. Broad, thick gyri with shallow sulci. Normal interdigitating fingers of subcortical white matter are absent. Polymicrogyria is a cortical dysplasia. Thick mantle of gray matter with multiple small gyri. Normal interdigitating fingers of subcortical white matter are absent. Underlying white matter gliosis in polymicrogyria can sometimes help differentiate it from pachygyria.

Front 743

Heterotopic Gray Matter

Back 743

Islands of gray matter anywhere between ependymal surface and subcortical white matter. May cause seizures.

Front 744

Schizencephaly

Back 744

Abnormal neuronal migration resulting in gray matter-lined clefts that invaginate brain. Extend from ventricular ependymal surface to pial cortical surface. Polymicrogyric clefts do not extend to ventricle. Open lip or closed lip (apposed walls) forms.

Front 745

Distinguishing porencephaly from open lipped schizencephaly

Back 745

Porencephaly: encephalomalacia that communicates with ventricle. Schizencephalic clefts are lined by gray matter. Porencephalic cysts are lined by a thin layer of white matter.

Front 746

Chiari II malformations

Back 746

Small posterior fossa: Cerebellum is squeezed up against tentorium, down through foramen magnum (tonsillar herniation), and forward around brainstem. Pons and medulla are squeezed inferiorly with cervicomedullary kink. Cord syrinx is present. Nearly all have hydrocephalus. Most have partial or complete agenesis of corpus callosum. Most present with myelomeningocele.

Front 747

Chiari I malformations

Back 747

Cerebellar tonsillar ectopia (tonsils extend > 5 mm below foramen magnum). Patients may be asymptomatic. May give rise to cervical spinal cord syrinx.

Front 748

Dandy-Walker Malformations

Back 748

Large posterior fossa with high tentorial insertion. Dilated cystic 4th ventricle fills posterior fossa. Cerebellar vermis and hemispheres may be hypoplastic or absent.

Front 749

Neurofibromatosis type 1 imaging findings (chromosome 17)

Back 749

Altered signal in white matter and basal ganglia. Dural ectasia. Optic and other gliomas. Sphenoid dysplasia. Thinning long bone cortex (ribbon ribs). Plexiform neurofibromas. Café au lait spots. Iris hamartomas (Lisch nodules). Vascular stenoses.

Front 750

Neurofibromatosis type 2 imaging findings (chromosome 22)

Back 750

Vestibular schwannomas. Meningiomas. Spinal glial tumors. Optic and other gliomas.

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Tuberous sclerosis

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Skin lesions: Adenoma sebaceum. Ash-leaf spots. Brain lesions: Subependymal hamartomas. Cortical tubers. Subependymal giant cell astrocytomas located at foramina of Monro (May lead to hydrocephalus)

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Sturge-Weber Syndrome

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Skin and meningeal angiomatous lesions. Port-wine nevus: skin angioma in ophthalmic division of trigeminal nerve. Pial angiomas may result in chronic ischemia, gliosis, and gyral cortical calcifications. Enlargement of deep and subependymal veins may mimic arteriovenous malformations.

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Von Hippel-Lindau Syndrome

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Inherited disorder consisting of retinal angiomas and cerebellar and spinal hemangioblastomas. Cerebellar hemangioblastomas: well-circumscribed cystic lesion with enhancing mural nodule. Prone to sudden spontaneous hemorrhage. Other associations: renal cell carcinoma, liver and kidney angiomas.