Core Radiology 11-15-2007

Front 1

differences between benign and malignant ulcers: (7)

Back 1

1) PROJECTION (outside vs inside lumen); 2) BORDER (smooth vs irregular); 3) LOCATION relative to edema (central vs eccentric); 4) RADIATING FOLDS (start close to vs far from crater edge); 5) RADIATING FOLD THICKNESS (uniform vs clubbed); 6) hampton's line vs carmen kirklin complex; 7) HEALING (complete vs incomplete)

Front 2

contraindications to contrast (6)

Back 2

1) PREGNANCY; 2) ALLERGY to IV contrast; 3) RENAL INSUFFICIENCY; 4) MULTIPLE MYELOMA; 5) CHF; 6) GOUT

Front 3

sequence of findings with untreated bowel ischemia

Back 3

aperistaltic loop (sentinal loop) --> thumbprinting --> pneumatosis coli --> perf or portal venous gas

Front 4

causes of loss of abdominal organ outlines (2)

Back 4

1) decreased retroperitoneal fat (eg cachexia, anorexia); 2) ascites

Front 5

common radiographic findings in inflammatory bowel disease

Back 5

1) calcium oxalate renal/gall stones; 2) ahaustral narrow colon; 3) sacroiliitis

Front 6

when not to use gastrograffin?

Back 6

can cause pulmonary edema --> contraindicated if aspiration risk

Front 7

esophageal anatomy on barium swallow: 3 segments, 2 lines

Back 7

SEGMENTS: tubular (majority), vestibular (bulb like area near GEJ), and submerged segments (leads to GEJ); LINES: A line (b/w tubular and vestibular portions); Z line / B ring: between vestibular and submerged segments, represents squamocolumnar junction

Front 8

types of peristalsis (3)

Back 8

1) PRIMARY: stripping wave init by swallowing; 2) SECONDARY: stripping wave follows primary, gets remaining food; 3) TERTIARY (nonstripping, disordered)

Front 9

what 3 conditions cause absent esophageal peristalsis?

Back 9

1) LATE achalasia; 2) Scleroderma; 3) Neuropathy (DM, EtOH)

Front 10

Types of hiatal hernias (3)

Back 10

TYPE 1: Sliding (95%); TYPE 2: Paraesophageal (5%); Type 3: Combination (rare)

Front 11

what's seen with sliding hiatus hernia on CXR?

Back 11

retrocardiac density

Front 12

what is boerhaave's syndrome

Back 12

RUPTURE OF ESOPHAGUS: linear tear across GEJ 2/2 vomiting across closed glottis (often in drunk/passed out); similar to mallory-weiss, but goes THROUGH the wall, not just mucosal tear ==> no hematemesis, but aberrent air seen on cxr

Front 13

stomach visualization in UGI with prone vs supine positions

Back 13

SUPINE: fundus and antrum are posterior --> fill with contrast; PRONE: body is anterior, so fills with contrast

Front 14

what can a pancreatic pseudocyst do to duodenum?

Back 14

cause c-loop widening (sweep abnormality)

Front 15

3 stages of reading a IVU

Back 15

1) SCOUT FILM: radio opacities/lucencies; 2) NEPHROGRAM PHASE (renal fxn, parenchymal morphology); 3) PYELOGRAM PHASE (timing, tubular evaluation -- polyps, fistulas, etc)

Front 16

stone vs polyp in ureter

Back 16

stone causes spasm --> stenosis; polyp, TCC causes Bergman's sign (uretral dilatation distal to obstruction on retrograde pyelogram)

Front 17

what does pyelonephritis look like on CT?

Back 17

ACUTE: wedge-shaped area of low attenuation; CHRONIC: wedge-shaped DEFECT (missing tissue)

Front 18

differentiating b/w CHRONIC pyelonephritis and CHRONIC infarct on CT

Back 18

both show wedged-shaped DEFECT of PARENCHYMA, but pyelo --> apex of defect is TOWARD CLUBBED calyx, while infarct --> apex BETWEEN NORMAL calyces

Front 19

3 MCC papillary necrosis

Back 19

1) ANALGESIC ABUSE; 2) DM; 3) SICKLE CELL DISEASE

Front 20

findings in 2' hyperPTH (3)

Back 20

distal resorption of b/l clavicles; widening of SI joints and pubic symphysis; horizontal linear lucency through centers of multiple vertebral bodies ("rugger jersey spine")

Front 21

three types of benign primary liver tumors

Back 21

focal nodular hyperplasia (hepatocellular), simple hepatic cyst (biliary epithelium), hemangioma (mesenchymal)

Front 22

what liver pathology causes diffuse decreased echogenicity?

Back 22

hepatitis, amyloid

Front 23

most common benign tumor of the liver

Back 23

hemangioma

Front 24

which is more common, liver mets or primary liver tumors?

Back 24

liver mets 20x as common, unless cirrhosis or hemochromatosis --> HCC more common than mets

Front 25

radiologic test of choice for HCC

Back 25

triple-phase CT: C- low attenuation; C+: ARTERIAL phase: hyperdense; PORTAL phase: hypodense; EQUILIBRIUM phase: hypodense with hyperdense pseudocapsule [because HCC receives blood from hepatic artery, while liver only receives 20% from hepatic a.]

Front 26

radiologic findings with cirrhosis

Back 26

early: hepatomegaly +/- fatty infiltration; late: shrunken, nodular liver with portal HTN, hypertrophied caudate lobe and sometimes left lobe (dual blood supply),

Front 27

diff between hemochromatosis and hemosiderosis

Back 27

hemochromatosis: Fe in parenchyma (not RES) --> liver and panc with end-organ dystruction, no spleen involvement; HEMOSIDEROSIS: Fe in RES only --> liver and SPLEEN, pancreas spared, no end-organ dysfunction

Front 28

how to dx iron deposition in the liver (imaging)

Back 28

MRI: T1 --> dark out of phase, even darker in phase (opposite of fat)

Front 29

what risk increased with pancreas divisum? What is it?

Back 29

most commong congenital variant -- failure to fuse of dorsal and ventral pancreatic heads --> 2 openings into duodenum --> INCREASED risk of PANCREATITIS, perhaps b/c second opening too small --> backup of enzymes

Front 30

what is the "renal halo sign"

Back 30

seen with pancreatitis: fluid collection develops in anterior pararenal space, makes perirenal fat more promient, looks like a halo around the kidneys

Front 31

what does pancreatic necrosis look like on CT?

Back 31

no enhancement on C+ CT

Front 32

"double duct sign"

Back 32

both CBD and pancreatic duct dilated -- often seen with pancreatic cancer (other causes: ampullary carcinoma, cholangiocarcinoma, stones)

Front 33

MCC mechanical SBO (2)

Back 33

adhesions and hernias

Front 34

displacement of loops in which IBD?

Back 34

Crohn's -- transmural inflammation --> inflammation of mesenteric "creeping" fat --> displacement

Front 35

radiologic findings with crohn's

Back 35

STRICTURES with increased surrounding MESENTERIC fat, ulcers, SKIP LESIONS; STRING SIGN, COMB SIGN (increased visualization of mesenteric vessels due to fat hypertrophy), PSEUDODIVERTICULAE

Front 36

differential for ahaustral colon (5)

Back 36

1) LAXATIVE abuse; 2) UC; 3) ISCHEMIA; 4) chronic CONSTIPATION; 5) s/p RADIATION

Front 37

what is thumbprinting?

Back 37

thickened mucosal wall (usu 2/2 ischemia --> scalloped mural indents --> bowel air with sharp angles

Front 38

what does sigmoid volvulus look like on radiology?

Back 38

"coffee bean sign:" central white line separating lumens

Front 39

whats the dx? CT with thickened bowel wall with trapped air

Back 39

diverticulitis

Front 40

infectious etiologies of multilobar consolidation

Back 40

legionella, G-, aspiration, aspergillus (in I/C); NOT pneumococcus

Front 41

what does air-crescent suggest?

Back 41

invasive aspergillus

Front 42

most specific finding for alveolar process

Back 42

air bronchograms

Front 43

what pathogens produce diffuse interstitial pattern in PNA?

Back 43

if IMMUNOCOMPETENT: viruses (influenza, parainfluenza, adeno), mycoplasma, "walking PNA"; IMMUNOCOMPROMISED: PCP, other viruses (CMV)

Front 44

what lung infections can calficy? What non-infectious processes?

Back 44

TB!!; others: histo, cocci, blasto; ddx: sarcoidosis, silicosis

Front 45

characteristics of reactivation TB

Back 45

apical scarring, cavitations, volume loss, calcifications, usu no adenopathy

Front 46

multiple cystic areas in complicated lung infection -->?

Back 46

bronchiectasis! (makes you worried --> CT?)

Front 47

what 2 signs suggest PTX on supine films

Back 47

"deep sulcus sign" and "medial costophrenic sulcus sign"

Front 48

tx of PTX

Back 48

depends on size; SMALL: obs, O2 (nitrogen diffusion); MEDIUM (20-30%): chest tube; TENSION: emergency chest tube +/- needle decompression; REPEATED: chemical pleurodesis/partial pleurectomy

Front 49

lung collapse vs pleural effusion

Back 49

mediastinal shift: If deviation toward whiteout, collapse; else, effusion (or other space-occupying process)

Front 50

hepatomegaly on CXR

Back 50

difficult to assess -- on CXR, only see posterior edge (outlined by fat), while on palpation, feel only anterior edge

Front 51

what film findings in ascites (depending on severity)

Back 51

MILD: loss of liver edge; MODERATE: pelvic density, bladder ears (mickey mouse); MARKED: ground glass abdomen, bulging flanks, widened paracolic gutters, centralized bowel loops

Front 52

dependent areas in supine position

Back 52

morrison's pouch (subhepatic space), pericolic gutters, pelvis (esp pouch of douglas)

Front 53

MCC of pelvic mass in male

Back 53

huge bladder 2/2 obstructing BPH or prostate CA

Front 54

MCC of pelvic mass in female

Back 54

mucinous tumor of ovary, noncalcified fibroid, recent delivery

Front 55

what do cholesterol stones look like on CT?

Back 55

isodense with bile -- difficult to detect

Front 56

HIDA SCAN: findings in normal, acute cholecystitis, and chronic cholecystitis

Back 56

radiotracer given IV; NORMAL: GB and small bowel visualized in 30-60min; ACUTE CHOLECYSTITIS: no GB vis in 90 min; CHRONIC CHOLECYSTITIS: no GB for 60 mins --> morphine --> GB seen at 90min

Front 57

what is adenomyomatosis?

Back 57

benign hyperplasia of gallbladder muscle, can be confused radiographically with malignant cancer

Front 58

causes of primary esophageal dysmotility

Back 58

achalasia, diffuse esophageal spasm, nutcracker esophagus, others

Front 59

how to dx a small sliding hiatal hernia?

Back 59

B-line > 1cm above hiatus between swallows (during swallows, submerged segment submerges below hiatus)

Front 60

pulsion vs traction esophageal diverticulae

Back 60

PULSION: a/w disordered peristalsis: Zencker's (posterior) and Epiphrenic (lateral); TRACTION: a/w extrinsic abnormalities (eg tuberculous mediastinal node), usu mid-esophageal

Front 61

what are feline folds?

Back 61

fine esophageal folds caused by submucosal contractions 2/2 esophagitis / irritation

Front 62

what does barrett's esophagus look like on barium swallow?

Back 62

mid-esophageal stricture with reticular mucosal pattern, +/- ulcer, +/- hiatal hernia

Front 63

what to do to work up any stricture?

Back 63

biopsy! (r/o cancer)

Front 64

ddx for varicoid lesion on barium swallow? (2)

Back 64

1) Varices; 2) esophageal tumor (carcinosarcoma / lymphoma)

Front 65

what to CMV / HIV esophageal ulcers look like?

Back 65

EITHER multiple diamond-shaped ulcers with halo OR giant ulcer toward GEJ

Front 66

what causes duodenal hematoma?

Back 66

often MVA (esp C3 segment)

Front 67

which renal stones radioopaque on CT?

Back 67

ALL! (except some anti-retroviral- associated stones, eg indinivir)

Front 68

calyceal clubbing seen with what?

Back 68

seen with both papillary necrosis and hydronephrosis; in hydronephrosis, also see pelvicalyceal dilation

Front 69

Focal nodular hyperplasia (FNH) on CT/US/MRI

Back 69

CT: C- hypodense +/- CENTRAL SCAR (30%), C+ early enhancement; US: hypoechoic with inc flow from central feeding vessel; MRI: Gd-BOPTA test of choice, ISOINTENSE with liver on 2 hr delay due to similar excretion into biliary tract

Front 70

causes of high attenuation liver (CT)

Back 70

infiltration: hemosiderosis, hemochromatosis, amiodarone, gold therapy, wilson's disease, glycogen storage disease, thorotrast; (most infiltrative processes besides hepatitis and amyloid)

Front 71

what characteristic radiologic finding on plain film for pancreatitis

Back 71

"splenic cutoff sign:" abrupt tapering in proximal descending colon (due to spasm); also, "sentinal small bowel loop" with air fluid levels

Front 72

most common pancreatic neoplasm

Back 72

ductal adenocarcinoma (75%), usu located in the head

Front 73

CT appearance of pancreatic cancer

Back 73

hypodense -- usu poorly vascular

Front 74

common complications of crohn's seen by radiology

Back 74

abscesses, fistuale --> aberrent air, bowel obstruction, extraintestinal (sacroiliitis, stones, ascending cholangitis, pancreatitis)

Front 75

what is "comb sign"

Back 75

seen with crohn's disease: increased visualization of vessels in mesenteric fat due to fat hypertrophy from transmural inflammation

Front 76

what imaging study contraindicated with toxic megacolon?

Back 76

BE -- mucosa very friable

Front 77

linear / filiform polyposis seen with what dz?

Back 77

"burnt-out" IBD -- regenerative foci

Front 78

what does appendicitis look like on CT?

Back 78

ARROW SIGN: pointed luminal contour of barium contrast

Front 79

what causes gamna-gandy bodies (siderotic nodules)?

Back 79

cirrhosis, AML, sickle cell anemia, hemoglobinopathies

Front 80

what does splenic sarcoid look like?

Back 80

spleen with scalloped nodular border

Front 81

air pockets seen in the spleen with what pathology?

Back 81

abscess

Front 82

PNA + volume loss --> ?

Back 82

rarely with simple PNA -- could be post-obstructive PNA 2/2 tumor --> get CT

Front 83

how to assess volume loss with PNA?

Back 83

look for changes in fissure location / ?tracheal deviation?

Front 84

loculated fluid a/w PNA

Back 84

?empyema --> may need to tap

Front 85

ddx of diffuse pleural thickening (5)

Back 85

TB/other empyema, pleural hemorrhage, mesothelioma, pleural mets, pleural fibrosis

Front 86

best view for ptx

Back 86

bolt upright frontal CXR at full end expiration

Front 87

MCC pneumopericardium

Back 87

IATROGENIC (heart surg, pericardiocentesis, CPR); OTHERS: trauma, fistula, infxn

Front 88

ddx for rounded density with air bronchograms

Back 88

MCC: rounded PNA, but bronchiolar alveolar carcinoma on the differential

Front 89

cause of lobar collapse

Back 89

PERIPHERAL: pneumonia; CENTRAL: 1) LUMEN (foreign body, mucus, blood); 2) WALL: tumors; 3) OUTSIDE: masses, LAD

Front 90

mgmt of total lung collapse w/o tension ptx

Back 90

emergent bronchoscopy

Front 91

what is bochdalek hernia?

Back 91

persistent fetal posterior pleuroperitoneal canals -- > allows herniation of abdominal contents (usu L sided)

Front 92

Balthazar's grading system for pancreatitis (5)

Back 92

A: NORMAL pancreas; B: focal or diffuse pancreatic EDEMA; C: ABNORMAL pancreas + peripancreatic INFLAMMATION; D: small, single FLUID collection; E: >=2 large fluid collections +/- gas