Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
174 Cards in this Set
- Front
- Back
- 3rd side (hint)
Congenital Heart Disease
|
1. Acyanotic & inc Pulm flow: ASD, VSD, PDA, ECD (Down's)
2. Acyanotic & nl/dec pulm flow: AS, Ao coarctation, Pulm Stenosis 3. Cyanotic & inc Pulm flow: TGA (common), Truncus, TAPVC, Tri atresia, Tingle ventricle 4. Cyanotic & nl/dec Pulm flow: Tetrallogy, Ebstein, Tri atresia, Pulm atresia |
Four groups based on skin color and pulm vascularity.
|
|
DDx of "Honeycombing" on HRCT
|
UIP (IPF)
Scleroderma/ RA Asbesteosis Chronic hypersensitivity pneumonitis Sarcoidosis Silicosis EG Drug/Toxin (e.g., Bleomycin) |
|
|
DDx of " Tree in Bud" appearance on HRCT
|
EG
M.Tb Bronchopneumonia Fungal Asian panbronchiolitis Viral PNA Bronchiolitis CF Kartagener's ABPA Lymphangitis carcinomatosis |
|
|
DDx of endobronchial mass
|
Tumors: SCC, Adenoid cystic, Mucoepidermoid, Oat cell, Carcinoid, Mets (RCC, melanoma, breast, colon thyroid)
Hamartoma Hemangioma M.Tb Mucous plug F.B. |
|
|
DDx of Bronchiectasis
|
1. Post infectious: TB, aspiration, ABPA (central), pertusis, radiation
2. Bronchial obstr: Neoplasm, F.B. 3. Congenital: CF, Bronchial cartilage def., Kartagener's |
|
|
DDx of "Pleural based mass"
|
Mesothelioma
Fibrous tumor of the pleura Malignant Thymoma Lymphoma Mets (Breast, lung, prost, thyr, RCC) Extrapleural tumors |
|
|
DDx of "Calcified pleural plaques"
|
M.Tb
Asbestosis Fluid (empyema/hemotx --> fibrothorax) Talc |
|
|
Anterior mediastinal mass
|
1. Thymus: cyst, thymolipoma, thymoma (common), CA, thymic carcinoid, lymphoma
2. Teratoma / germ cell tumors (Embyonal cell, seminoma, choriocarcinoma) 3. T-cell lymphoma 4. Thyroid lesions |
4 T's
|
|
DDx of superior mediastinal mass
|
Thyroid CA
Adenopathy (Head & neck CA) Lyhpatic cyst / cystic hygroma Oat cell CA Lymphoma Aneurysm |
|
|
DDx of middle mediastinal mass
|
1. Adenopathy: sarcoid, TB, fungal, beryllium, neoplasm, lymphoma
2. Congenital: Bronchogenic cyst (subcarinal/pretracheal), pericardial cyst 3. Aneurysm 4. Esophageal: Hiatal hernia, esoph divertic or CA, achalasia, hematoma, vx |
|
|
DDx of hilar adenopathy
|
1. Low attenuation: TB, fungal, AIDs, mets, lymphoma
2. Enhancing: Castleman's (giant benign nodal hyperplasia, vasculat mets (RCC, thyroid, oat cell, melanoma) 3. Calcified: TB, Histo, fungus, sarcoid, silicosis, post XRT |
|
|
DDx of posterior mediastinal mass
|
1. Neurogenic (90%): schwanoma, neurofibroma (45%), ganglioneuroma, neuroblastoma, pheo, paraganglionoma, lateral meningomyeolocele
2. T-spine: EMH, hematoma, neoplasm 3. Aneurysm |
|
|
DDx of densely enhancing mediastinal mass
|
1. Vascular: aneurysm, AVM, esoph vx
2. Tumor: paraganglioma, vascular met (RCC, thyroid) 3. Goiter 4. Castleman's dz |
|
|
DDx of Hilar LN eggshell calcification
|
Silicosis
CWP Treated lymphoma Histoplasmosis (more commonly diffuse ca+) Sarcoid (rare and late) |
|
|
DDx of pulmonary artery ectasia
|
Pirmary pulm HTN (rare, young, female)
Secondary pulm HTN (COPD) PA stenosis Takayasu's AVM (Osler Webber Rendu) |
|
|
Conditions Associated with Right Aortic Arch
|
Truncus arteriosus (35%)
Tetralogy (30%) TGA Tricuspid atresia Asplenia |
Five
|
|
DDx of rib notching
|
1. Superior: HyperPTH (common), idiopathic, polio, RA, SLE, local pressure, osteogenesis imperfecta, Marfans
2. Inferior: Coarctation, Blalock Taussig shunt, Takayasu's (unilat), SVC obstruction, AVM, Intercostal neuroma |
|
|
Associated findings in Down's syndrome
|
ASD
VSD ECD Hypersegmented manubrium 11 pairs of ribs |
|
|
Findings in acute cholecystitis
|
Sonographic murphy's (most specific)
Visualized gallstones GB wall thickening > 3mm Pericholecystic fluid |
|
|
DDx of scoliosis
|
1. Idiopathic 70%
2. Congenital: hemivert, butterfly vert 3. VACTER 4. other: NF, CP, muscular dystrophy, myelomenigocele, polio, spinomuscular atrophy, paralytic scoliosis 2/2 cord injury All have increased COBB ANGLE. |
|
|
Adrenal myelolipoma
|
Adrenal hamartoma with erythroid, myeloid, and fatty elements. Fat content (<0 HU) is virtually diagnostic and often distiguishes this entity from adrenal adenomas.
|
|
|
Incidentaloma
|
A nonfunctioning adrenal adenoma discovered serendipitously. These occur in 8% of the population and are more common in older, fat diabetic, hypertensive patients (sydrome X). Must be d/dx from met in pts with h/o malignancy --> look for presence of fat to avoid Bx if possible (<10 HU).
|
|
|
DDx of Cushings Syndrome
|
Cushing's Dz (#1 cause): pituitary adenoma --> smooth bilateral nodular thickening
Adrenal adenoma: focal low density round mass with normal or atrophic contralateral gland Adrenal carcinoma: large with central necrosis and irregular margins. 30% calcify Ectopic ACTH: oat cell CA of lung |
|
|
Neuroblastoma
|
Malignant tumor of adrenal gland or sympathetic ganglion. Aggressive cousin of pheo. Occure in children. Large lobular with stippled calcification. T2 bright. Presence of bone mets indicated poor Px.
|
|
|
Pheochromocytoma
|
Malignant neoplasm of adrenal medulla. Present w/ paroxsymal HA, diaphoresism pals, and HTN. Ruel of 10's: 10% bilat, extraadrenal, malig, familial (MEN II)
Extraadrenal locations: sympathetic chain, Zuckerkandl). Well circumscribed > 3cm Very bright on T2 (light bulb lesion) |
|
|
Renal Cell CA
|
Malignant tumor of distal tubules. Highly vascular with tendancy towards bleeding. May have cystic components that resemble simple renal cyst. Often metastasizes to lungs and bone (lytic). Stage III (renal vein/IVC), stage IV (distal mets or local invasion). Most are sporadic, but risk factors are VHL and chronic HD. Major DDx is w/ Oncocytoma - benign renal tumor with same imaging characteristics except that most are hypovascular and hve spoke wheel appearance.
|
|
|
Schistosomiasis
|
Middle eastern patient
Hematuria and bladder mass --> SCC Bladder wall calcification |
|
|
Angiomyolipoma
|
Benign solitary renal mass.
Middle aged female. Mixture of smooth muscle, fat, and vessels. Presence of fat (<0 HU) is diagnostic. Usually asymptomatic, but can enlarge. May be multiple and bilateral in patients with tuberous sclerosis (skin lesion, low IQ, and multiple hamartomas). |
|
|
Adult Polycystic Kidney Dz.
|
Autosomal dominant.
Large polycystic nonfunctioning kidneys Pancreatic and hepatic cysts 15% have intracranial aneurysms (check MRA). |
|
|
DDX of Medullary nephrocalcinosis
|
1. HyperPTH
2. Medullary sponge kidney: asymp dilation of collecting tubules in renal medulla. can have stones/infxn (bouquet of flowers on IVP), ass'd with Caroli's dz and hepatic fibrosis. 3. RTA |
|
|
Intracerebral Hematoma
|
Traumatic brain injury (i.e. cortical contusion)
HTN (BG and pons) AVM (supratentorial) Amyloidosis (GW jxn of occip and parietal) Mets from RCC or Melanoma GBM or other primary CNS tumor |
|
|
Subdural hematoma
|
Elderly after head trauma
Shearing of bridging veins Crescentic extraaxial blood collection crosses suture lines, but respects dural reflections (falx, tentorium) Acute --> high attenuation Chronic --> low attenuation |
|
|
Eosinophilic Granuloma/ Langerhans Histiocytosis
|
Multiple cysts and nodule with upper lobe predominance and peribronchovascular distribution.
Occurs in young smokers. Nodules-->cavitary nodule --> interstitial fibrosis with cysts (late) Pts may present with recurrent spontaneous PTX CXR show normal lung volumes with sparing of CPA Tx is to stop smoking Px is variable with 1/3 progressing to ESLD |
|
|
Pulmonary Alveolar Proteinosis
|
Accumulation of PAS+ material in distal airspaces with little underlying inflamation.
30-50 yr, M>F Progressive SOB, nonproductive cough Opportunistic infxn with nocardia/TB/fungi 2/2 macrophage dysfunction. CXR shows large bilateral symmetric central/lower lung zone opacity (i.e. Batwing) HRCT shows GG opacity with thickening of interlobular septa ("crazy paving") Tx with pulm levage if symptomatic. Steroids no helpfull. |
|
|
BOOP/ COP
|
Excessive prolif of granulation tissue in small airways.
50-60 yrs, M>F S/Sx suggestive of CAP CXR with bilateral diffuse / pathcy alveolar infiltrate with normal lung volumes. Recurrent / migratory opacity. HRCT with patch ASD, GG opacity, bronchial wall thickening Tx with steroids Px is usually good. |
|
|
LIP
|
Benign polyclonal prolif of B cells in lungs
mono/polyclonal gamopathy on SPEP 50's, F>M Progressive cough x several month --> honeycombing (late) Variable Px (1/3,...) |
|
|
UIP / IPF
|
50-60's M>F
Progressive SOB and cough CXR with diff interstitial opacity and decr lung volumes HRCT with subpleural and basilar opacity (reticulonodular)--> honeycombing with traction bronchiectasis (late). Px is poor with progression to ESLD and death in 5-10 yrs. Etiology likely 2/2 abnormally increased fibrogenesis rather than inflamation. |
|
|
DIP
|
40-50's
Exclusively in smokers Alveolar spaces filled with macropages (smokers histiocytes) rather than desquamated pneumocytes) HRCT with patchy peripheral GG opacity and some cystic changes. Tx steroids. Px is good. > 10 years mean survival. |
|
|
Respiratory bronchiloitis
|
Like DIP
BUT smokers histicytes fill respiratory bronchioles instead of alveoli. Good Px. |
|
|
AIP / Hammon Rich Syndrome
|
Explosive onset and progressive course.
Poor Px - like ARDS Extensive interstitial fibroblast proliferation No clear insiting event. |
|
|
NSIP
|
Uniform cellular infiltrate with varriable degrees of fibrosis
M=F Subacute onset HRCT with GG opacity and consolidation Better Px than UIP. |
|
|
Lymphangiomyomatosis
|
Thin walled cysts with normal intervening lung.
Females of childbearing age. Presents with SOB and spontaneous PTX Chylous pleural effusions offten seen. |
|
|
Parotid gland tumors
|
1. Benign (80%): Pleomorphic adenoma, Warthin's tumor
2. Malignant (20%): Adenocarcinoma, Adenocystic, Squamous cell, Mucoepidermoid |
|
|
Thyroid Tumors
|
1. Benign: Thyroid adenoma
2. Malignant: Follicilar, Papillary, Anaplastic Carcinomas Risk factor is h/o prior radiation exposure. |
|
|
Epidural hematoma
|
Extraaxial blood collection
Lenticular shaped Crosses dural reflections, but respects suture lines 95% are associated with overlying skull fx. Often 2/2 laceration of middle meningeal artery. |
|
|
DDx of middle ear soft tissue mass
|
Cholesteatoma
Chronic OM Granulation tissue Cholesterol granuloma Glomus tympanicum tumor |
|
|
DDx of Jugular fossa mass
|
Glomus jugular tumor (#1, highly vascular)
Neurofibroma (#2) Schwannoma Chonrosarcoma Mets |
|
|
DDx of tram track enhancement of ooptic nerve
|
Optic nerve meningioma
Optic neuritis Pseudotumor Sarcoidosis Leukemia/lymphoma Normal varriant |
|
|
DDx of orbital mass
|
1. Adult: Hemangioma, schwannoma, melanoma, menigioma, lymphoma, peudotumor (painful proptosis, occular muscle enlargement, steroid responsive), carotid-cavernous fistula, mucocele
2. Kids: Retinoblastoma, Rhabdomyosacr, optic nerve glioma, lymphoma, hemangioma, dermoid cyst, neuroblastoma |
|
|
DDx of cystic neck mass
|
Thyroid: colloid cyst, cystic degeneration, papillary CA, cystic mets
Extrathyroid: Branchial cleft cyst (lateral to carotid), thyroglossal duct cyst (midline mass), Ranula (retention cyst of sublingual gland), Cystic hygroma (kids) |
|
|
DDx of Solid Neck mass
|
SCC
Lymphadenopathy Parotid tumors neurilemoma/NF/Glomus TB (scrofula) Fungal Abcess Sarcoid Ectopic thyoid |
|
|
DDx of extraxial mass
|
1. Hemispheric: Menignioma, mets, lymphoma, arachnoid cyst, dermoid/epidermoid, ICH
2. CPA: acoustic neuroman, facial neuroma, meningioma, epidermoid, paraganglioma, petrous apex cholest. cyst, aneurysm, mets 3. Clivus/prepontine cystern: mets, menignioma, chordoma, chondroma, chondrosarcoma |
|
|
DDx of Inraaxial mass
|
1. Hemespheric: Astrocytoma, GBM, oligodendroglioma, lymphoma, met, PNET, ganglioma, gangliocytoma
2. Sella: Adenoma, craniopharyngeoma, rathke's cleft cyst, met, abcess, sarcoid, EG stalk 3. Pineal: Germ cell tumor, pineal parenchymal cell 4. Cerebellum: Astrocytoma, meduloblastoma, hemangioblastoma, met, ependymoma, chorid plexus papilloma/CA 5. Brainstem: astrocytoma, GBM |
|
|
DDx of suprasellar mass
|
Pituitary microadenoma (#1 for adults)
Craniopharyngeoma (#1 for kids) Sarcoid - sellar lesion with SS extension Aneurysm Arachnoid cyst Germ cell tumors Eppidermoid/dermoid Hypothalamic glioma Mets MEningioma Optic glioma EG |
|
|
DDx of ring enhancing lesion
|
Primary CNS tumor
Met Lymphoma (AIDS) Abcess Granuloma MS Toxo Cysticercosis Old hematoma Infarct Vasculitis AVM |
|
|
DDx of Basal Ganglion Ca++
|
Physiologic (#1)
HypoPTH HyperPTH TORCH, AIDS Post inflammatory (TB, Toxo) Cystercosis |
|
|
Danny Walker MAlformation
|
1. Vermian hypoplasia/aplasia
2. Large psterior fossa Must be d/dx from mega cisterna magna and Chiari IV (complete abcess of cerebellum) |
|
|
Syringohydromyelia
|
Cystic space within spinal cord secondary to dilation of central canal.
Must r/o Chiari malformation, spinal dysraphism, DW malformation, diastematomyelia, astrocytoma, ependymoma and trauma.. |
|
|
Astrocytoma
|
80% of gliomas
Hemispheric in adults Brainstem (pilocytic) in kids Low grade I->II->Anaplastic (III)-_ GBM (IV) Multicentric glioma must be DDx from mets Tectal gliomas have good Px - no need for Bx, just follow. |
|
|
Oligodendroglioma
|
Uncommon primary CNS tumor of adults.
Slow growing Present as large hemispheric mass (usually frontal lobes). Hypodense with cysts 805 have calcification Can cause pressure erosion on skull. |
|
|
Ependymal tumors
|
Ependymoma: slow growing into 4th ventricle. Children, NF2, extrudes through Luschka into CPA and CM which helpos ddx from mebulloblastoma. 50% have fine calcification and or cystic regions.
Subependymoma: Asymptomatic 4th ventricle tumor seen in elderly males. often multiple. |
|
|
Choroid plexus papilloma/ carcinoma
|
Rare tumor or lateral ventricles.
Age < 5yr. 90% benign papilloma Can occur in 4th ventricle or CPA in adults Often with drop mets to spinal canal Hydrocephalus Strongly enhancing. 25% calcify |
|
|
Meningioma
|
Cell of origin is the arachnoid cap cell.
F>M, age 40-60 yr. 20% of all CNS tumors 90% supratentorial Extraaxial, strongly enhanging (key feature) 20% calcify Dural tail, slow growth, round shape Spoke wheel appearance on angio with persistent tumor blush Similar MR signal as falx (T2 dark, with strong enhancement). |
|
|
Hemangioblastoma
|
Benign neoplasm of endotherlial cell origin.
Most common primary cerebellar tumor in adults with VHL. Characteristically is cystic lesion with enhancing mural (pial) nodule (80%) |
|
|
Ganglioneuroma
|
Benign tumor of kids and adolescents
Contains glial and neural elements Slow growing Pt presents with seizures. Cortical lesion of temporal lobes Suspect if in young patients with long h/o sz s/o and temporal lobe cortical mass. |
|
|
Meduloblastoma
|
Aggressive infratentorial PNET of children
Roof of 4th ventricle (midline cerebellar) Associated with Turcot's syndrome Intense homogenoues enhancement (key feature) Dense cell packing (hyperintese on noncontrast CT). |
|
|
Schwanoma
|
Nerve sheath tumor (benign)
Associated with NF2 90% are in CPA from VIII CPA mass, > 2 mm diff b/w R and L IAC, IAC > 8mm Icecream cone appearance T2 bright, enhancing |
|
|
Pineal Tumors
|
Kids and adolescents
Parinauds syndrome (no upward gaze)/hydrocephalus Germ cell tumors (>50%): Germinoma (#1 like seminoma), teratoma, embryonal cell (+HCG+AFP), choricoCA (+HCG-AFP), yolk sac tumor (-HCG,+AFP) Pineal cell tumors (25%): Pineocytoma (beign), Pinealoblastoma (malignant PNET in pts with Rb, exploded calcification). |
|
|
CNS lymphoma
|
AIDS
B cell NHL Located deep (BG and periventricular WM) 2 lymphoma --> leptomeningeal eeding Diffusely infiltrative with little mass effect Dense cell packing Ring or homogenous enhancement Elevated Choline peak on MRSI Radiosensitive May resolve with short course of steroids. DDx from Toxo (multiple cortical lesions with increased lipid/lactate on MRSI). |
|
|
Arachnoid cyst
|
Arises from splitting of arachnoid membrane.
75% are in kids Middel cranial fossa, SS and quadrageminal cistern, CPA and CM Extraaxial mass with CSF signal. Can cause mass effec and pressure erosion of skull by slow enlargment. |
|
|
Colloid cyst of 3rd ventricle
|
Interventricular foramen of Monro
Adults Intermittent HA, ataxia from obstructive hydrocephalus T2 hypointense (incr paramagnetic content) CT hyperintense |
|
|
Gout
|
Arthritis 2/2 urici acid crystals
Risk factors are uric acid 1. overproduction: EtOH, ChemoTx, lymphoma, Liesch Nihan Synd, or 2. underexcretion: HCTZ, renal failure, EtOH, hyper or hypoPTH LE>UE, small>large joints Marginal erosions Overhanging edges Preserved joint space Juxtaarticular ST deposits (tophi) olecranon bursitis Chondrocalcinosis |
|
|
Carcinoid tumor
|
Most common benign 1 lung tumor
Central mass (often with endobronchial component) or peripheral nodule. Occasionally with benign appearing calcifications Rarely have carcinoid syndrome (flushing, tachy, hypotesion, wheezing, secretory diarrhea, tricuspid valve abnl). |
|
|
PCP
|
AIDS
CD4<200 Bilateral symmetric perihilar opacities Bilateral upper lobe cysts 2/2 prior prophylaxis with aerosolized pentamidine. |
|
|
DDx of consolidation
|
Pneumonia
Pneumonitis Neoplasm (bronchioalveolar) Aspiration Pulmonary contusion/hemorrage Alveolar proteinosis Lipoid Pneumonia Sarcoid Pulmonary edema |
|
|
DDx of posterio mediastinal mass
|
1. Neurogenic: schwanoma, NF, ganglioneuroma (fusiform with vertically oriented long axis)
2. T-spine fx with paraspinal hematoma 3. EMH in pts with hemolytic anemias |
|
|
IV contrast premedication
|
Prednisone 50mg PO 13h, 7h,1h prior
Benadryl 50 mg PO 1h prior Incidence of contrast rxn 5-12% HOCM, 1-3% LOCM Acute Tx: Epi 1:1,000 0.1-0.3 ml SC q15min x3 --> 1:10,000 1-3 ml IV |
|
|
T1 wieghted image
|
Low TE = 20 ms
Low TR = 600 ms Fat is high signal Water is low signal Subacute blood (methemaglobin), pus, melanin, gadolinium are all high signal. |
|
|
T2 weighted image
|
High TE = 80 ms
High TR = 3000 ms Water/ fluid is high signal Calcium, gas, old blood (hemosiderin), fibrous tissue are all low signal |
|
|
Proton density
|
Low TE = 20 ms
High TR = 3000 ms Combined T1 and T2 properties |
|
|
Pleural effusion
|
PA view detects > 200 cc fluid
Decubitus films can detect less fluid Trasudate: Pleural/Serum protein <0.5, Pleural/Serum LDH<0.6, Pleural LDH < 200 Subpulmonic effusion: hard to Dx as there is no blunting of CPA. Look for lack of visible bronchovascular structure behind hemidiaphram |
|
|
Pulmonary Hamartoma
|
Benign
Well circumscribed Pulmonary nodule Popcorn calcification often present + fat on CT |
|
|
Acute appendicitis
|
U/S findings: Diameter>6mm, noncompressible
CT findings: >6mm, enhancing wall, appendicolith, fat stranding cecal effacement, periapendiceal fluid, lack of filling, abcess |
|
|
Diverticulitis
|
10-20% risk if diverticulosis is present.
CT findings: colonic wall thickening, diverticulae, abcess, fat stranding, localized extraluminal or free intraperitoneal air. Must be DDx from colonic CA that has perforated. |
|
|
CPPD
|
Chondrocalcinosis
Arthropathy similar to OA Knee (petelofemoral) Associated with hyperPTH, Gout, Hemachromatosis |
|
|
Pigmented Villonodular Synovitis
|
Adults with synovial hypertrophy and hemosiderin deposits
Diffuse or focal Knee>hip>elbow Errosive (large cystic cavities) Joint space narrowing late |
|
|
Bone tumor matrix
|
Osteoid: OO, osteoblastoma, osteochondroma, bone island, osteosarcoma
Chondroid: Enchondroma, osteochondroma, chrondroblastoma, chondromyxoid fibroma, chondrocsarcoma Intermed: Fibrous dysplasia, osteoblastoma, osteosarc Cellular: Fibrous tumors, round cell tumors |
|
|
Osteoid osteoma
|
Clinical hallmark is noctural pain relieved by ASA
Young males Tx percutaneous RF ablation intracortical lesion with lucent nidus < 2cm Limb overgrowth in kids Sclerotic rim surround nidus Hot on bone scan |
|
|
Osteoblastoma
|
Histologically like osteoid osteoma
Less common Rapid expansile lytic growth well circumscribed (like ABC) Varriable sclerosis (>2cm with sclerosis is giant osteoid osteoma) Spine and long bones If malignant, can have ST component like osteocarcoma |
|
|
Osteosarcoma
|
2nd most common primary bone tumor (after MM)
Long bones (femur, tib, humerus) ill-defined, intramedullary, with s.t. mass Marked periosteal reaction (codman, sunburst) Telangiectatic varriant has no matric or periosteal rxn but is more malignant (lytic) and can mimic and ABC. |
|
|
Enchondroma
|
Benign centrally located (medullary) cartilagenous tumor
Predilection for phalanges Usually asymptomatic but can have path fx Lytic with rings and arcs calcification Endosteal scalloping and cortical expasion No ST mass of periosteal rxn Can rarely undergo malignant transformation Oillers dz (enchondromatosis) = multiple unilateral enchondromas of hands and feet that stabilized at puberty, inc risk of chondrosarc. Maffucci's synd = Oiller's dz & multiple S.T. hemagiomas. |
|
|
Osteochondroma
|
Cartilage cpped benign bony projection from metaphysis.
Common Has growth plate which fuses at puberty Always grows away from joint Painless. M>F MOCE = auto dominant, sessile lesions, severe growth abnl, and rarely malignant transformation. |
|
|
Chondromyxoid fibroma
|
Rare benign tumor
Geographic, lytic appearance, eccentric location about knee Cartilagenous matrix rarely seen Tx req curettage |
|
|
Chondrosarcoma
|
Malignant cartillagenous tumor
Usually low grade, asymptomatic, incidentally found Usually metaphyseal Lytic +/- chondroid matirx Medullary or exostotic Can degenerate into fibosarcoma, MFH, or OSA in 10% |
|
|
Chondroblastoma
|
Rare benign tumor
Exclusively found in epiphysis of immature skeleton Knee or proximal humerus Tx is currettage |
|
|
Fibrous Cortical Defect
|
Cortically based lesion of whorled conective tissue bundles
Histologically identical to NOF No medullary involvement (unlike NOF) 1-4 cm (smaller than NOF) Asymptomatic (no risk for Fx) Lucent cortical lesion with nl or sclerotic border. 90% are in tib/Fib metaphyseal location |
|
|
Nonossifying fibroma
|
Histologically same as FCD
Larger tha FCD (1-7cm) May cause pain if path Fx (Tx with currettage if symptomatic) Involves medulla Metaphyseal location (90%) Tib/Fib |
|
|
Unicameral Bone Cyst
|
Benign centrally located, commmon
Fluid filled lesion Kids 10-20 yr Usually present with path Fx and pain Long bones (prox humerus or femur) Does not cross physis Expansile (fluid/fluid levels) Fallen fragment sign 2/2 path fx is pathognomonic! No periosteal reaction Resolves with puberty |
|
|
Aneurysmal Bone Cyst
|
Expansile thin walled blood filled cystic cavity
Rapid progression (2-6 mo) with increasing pain Eccentric location Posterio spine, long bone metaphyses, Pelvis No periosteal reaction Fluid/fluid levels |
|
|
Gian cell tumor
|
Rare tumor of osteoclast origin
Characteristically occurs in epiphysis with metaphyseal extension Usually @ knee 10% malignant lytic, expansile, locally aggressive Can invade joint |
|
|
DDx of peripheral artery aneurysm
|
Atheroscerosis
Inectious/Mycotic - staph, syphilis, salmonella Inflamatory - Takayasu (pulseless dz), GCA, PAN Congenital - Marfan, honocysteinuria, Ehlers-Danlos Fibromuscular dysplasia Neurofibromatosis Pseudoxanthoma elasticum |
|
|
Contrast induced nephrotoxicity
|
Persistent nephrogram >24-48h
Vicarious ecretion of contrast wia liver/biliary (e.g. galbladder opacification) |
|
|
Dermatomyositis arthropathy
|
Widespread S.T. Calcification is hallmark finding.
|
|
|
SLE arthropathy
|
Nonerosive
Distribution like RA (symmetric) Prominent subluxation of MCP joints (reducible) S.T. swelling |
|
|
Rheumatoid Arthiis
|
Clinical Dx (7/11 classic, 5/11 definite, 3/11 probable).
Am stiff, pain, swelling>1 joint, symetric swelling, SQ nodules, Xray changes, +RF>1:64, poor mucin clot of synovial fluid, hystology. F>M Hands & feet most effected Symmetric ST swelling and joint space narrowing, marginal errosions, periarticular osteopenia, subchondral cysts, errosion of ulnar styloid, triquetrum, and dense with AA dislocation. Felty's = RA, splenomegally, neutropenia and thrombocytopenia Caplan's= RA, peumoconiosis, Rheumatoid lung nodules |
|
|
Scleroderma Arthropathy
|
S.T. calcification
Acroostolysis (2 resorption) Erosive changes of DIP and PIP |
|
|
Inflamatory arthropathies
|
Autoimmune: RA, SLE, Scleroderma, Dermatomyositis
Seronegative: AS, Reiter's, Psoriatic, Enteropathic (UC, chrons, whipples, SSY) Erosive OA |
|
|
Arthritis: General Approach to Dx
|
Alignment - sublux, ulnar dev, disloc (RA, SLE)
Bone - osteoporosis (RA), Erosions (RA, psoriasis), New bone (ostephytes, ankylosis, periosteal) Cartilage - joint space narrowing Distribution - prox (RA, CPPD, AS)v. distal (Peiters, psoriatic), Mono v. Polyarticular S.T. swelling |
|
|
Metabolic arthopathies
|
Crystals: Gout, CPPD, Basic calcium phos
Endocrine: Acromegally Other deposits: Hemochromatosis, Willsons, Alkaptonuria, Amyloidosis, Xanthomatosis, Multicentric reticulohistiocytosis |
|
|
Gradient Echo
|
Low TE = 20 ms
Low TR = 600 ms Blood vessels appear bright Fluid is bright |
|
|
DDx of ring enhancing lesion
|
Brain abcess
Brain met Toxo CNS lymphoma Cysticercosis (look for scolex) primary CNS tumor (glioma) |
|
|
Reiter's syndrome
|
Seronegative
LE distribution: MTP>calcaneous>ankle>knee Errosive M>F, HLA B27 Follows nongonoccocal urethritis or dysentery (SSYCE) MET errosion Enthesopathy (achiles tendon and plantar aponeurosis) Bilateral sacroiliitis (asymetric initially) Bulky asymmetric thoracolumbar bridging osteophytes. |
|
|
Psoriatic arthritis
|
Seronegative spondyloarthropathy
Upper ext polyarticular asym oligoarth) 90% have skin changes, the severity of which correlates with joint dz. 50% have HLA B27 SI joint and spine similar to Reiter's Erosions: pencil in cup, terminal tuft resorption ST swelling: Sausage digits New bone: Mouse ears, ivory phalanx |
|
|
Ankylosing Spndylitis
|
Seronegative
Affects axial skeleton and large prox joints M>F onset in 20s HLA B27 related Associated with IBD, iritis, aortitis, and upper lobe pulm fibrosis Bilateral symetic SI joint erosion->sclerosi->ankylosis Enthesopathy od tuberosities Bamboo spine Ligamentous ossification and Syndesmophytes = calcified outter anulus fibrosus |
|
|
Clay Shoveler's Fracture
|
Avulsion of lower c-spine spinous process (usually C7).
Mechanism of injury is powerful hyperflexion (e.g., shoveling). Obtain swimer's view if needed to see C6-7. |
|
|
Chance Fracture
|
Lap-type seat belt fracture L2-L3 secondary to hyperflexion and distraction injury.
Horizontal split vertebral body with rupture of posterior ligamnets. >50% association with small bowel / colon injury (seat belt syndrome). |
|
|
Galeazzi Fracture
|
1. Distal radial shaft fracture &
2. Distal radioulnar dislocation. |
|
|
Essex-Lopresti Fracture
|
1. Comminuted radial head fracture &
2. Distal radioulnar subluxation/ dislocation. |
|
|
Colles' Fracture
|
Extraarticular fracture of distal radius.
Dorsal displacement and angulation. 2/2 FOOSH injury May be impacted with limb foreshortening. Ulnar styloid fracture found in 50%. Pts often have median or ulnar nerve injury. |
|
|
Smith's Fracture
|
Distal radius fracture
Volar displacement and angulation of distal fragment. Type 1: Hoizontal fx line Type 2: Oblique fx line Type 3: Intraarticular fx (A.K.A. Reverse Barton's) |
|
|
Barton's Fracture
|
Unstable intraarticular fracture of dorsal margin of distal radius.
Carpus follows distal fragment. Requires ORIF. |
|
|
Monteggia Fracture
|
Ulnar shaft fracture with radial head dislocation.
|
|
|
Chauffeur's fracture
|
Intraarticular fracture of the radial styloid.
|
|
|
Rolando Fracture
|
Comminuted intraarticular fracture of 1st MCP joint at the base of the thumb.
Three patterns: Y-, V-, T-shaped fxs. Radial & dorsal dislocation 2/2 pull of APL. |
|
|
Bennett's Fracture
|
Intraarticular fracture at the base of the 1st metacarpal involving the 1st MCP joint.
Dorsal and radial dislocation 2/2 APL Small fragment articulates with trapezium. |
|
|
Gamekeeper's Thumb
|
Rupture of UCL
Often associated with fx at base of proximal phalanx. Angulation >30 degrees with stress is diagnostic |
|
|
Boxer's Fracture
|
Fracture of the 5th metacarpal neck.
Volar angulation and displacement of distal fragment. External rotation of distal fragment. |
|
|
Bucket-handle Fracture
|
Unstable pelvic fracture involving one SI joint and contralateral ischiopubc ramus.
|
|
|
Malgaigne's Fracture
|
Unstable pelvic fracture involving one SI joint and the ipsilateral ischiopubic ramus.
Often with forshortening of LE and superior displacement of iliac crest. |
|
|
Duverney's Fracture
|
Stable pelvic fracture through one iliac wing.
Does not interrupt pelvic ring. |
|
|
Straddle fracture
|
Unstable pelvic fracture involving both obturator rings.
|
|
|
Pilon Fracture
|
Supramalleolar fracture of the distal tibia extending into the tibial plafond.
Often associated with fracture of dsital tib/fib syndesmosis. MEchanism of injury is axial load (e.g. jumper) Always intraarticular and comminuted. |
|
|
Tillaux Fracture
|
Avulsion of lateral tibial margin.
Juvenile Tillaux is a Salter Harris III becasue the medial growth plate fuses initially. |
|
|
Triplane fracture
|
Childhood fracture of distal tibia with three planes:
1. vertical intraarticular fx through epiphyseal 2. horizontal fx through physis 3. oblique metaphyseal fracture |
|
|
Wagstaffe-Leforte Fracture
|
Avulsion of medial margin of the fibula @ attachment of anterior tibiofibular ligamnet.
|
|
|
Segond fracture
|
Small avulsion fx of superolateral proximal tibia.
Often associated with tears of lateral capsular ligaments, ACL and menisci. |
|
|
Lover's Fracture
|
Calcaneal fx 2/2 axial loading
Boeler's angle < 20 degrees is diagnostic. Often occur bilaterally Usually intraarticular fracture (subtalar joint) Associated with thoracolumbar burst and pilon fractures. Not to be confused with calcaneal stress fractures which are seen as vertical linear sclerotic regions. |
|
|
AC Separation
|
AC widening > 8mm 2/2 ruptured AC ligament.
CC widening > 13mm 2/2 ruptured CC ligament. Downward displacement of scapula. Rockwood Classification: Grade I: Normal X-Ray Grade II: Wide AC, normal CC Grade III: Wide AC and CC |
|
|
Humeral Head Fractures
|
4 part Neer classification
4 segments: anatomic neck, surgical neck, grreater tuberosity, lesser tuberosity. Displacement = > 1 cm separation, or > 45 degrees of angulation. 1 part (no displacement) -> sling. 2 part (disp of one segment) -> closed reduction. 3 part (2 disp segs) -> closed reduction. 4 part (4 disp segs) -> ORIF |
|
|
Distal Humerus Fractures
|
Supracondylar, extraarticular
Transcondylar, intraarticular Intercondylar, intraarticular (T, Y, V shaped) |
|
|
Radial head fracture
|
Commonly 2/2 FOOSH (e.g. Essex-Lopresti Fx)
Look for anterior or posterior fat pad (sail) sign. >3 mm displacement -> ORIF If comminuted -> excision |
|
|
Wrist dislocation
|
Scapholunate dislocation > 60 degrees
Capitolunate dislocation > 20 degrees VISI (volar tilt of lunate) > DISI (dorsal tilt of lunate) |
|
|
Acetabular fracture
|
Letournel classification
Anterior column fx Posterior column fx Transverse fx Comlex (T-shaped) fx |
|
|
Hip Fractures
|
Intracapsular: Capital, Subcapital (common), Transcervical
Extracapsular: Intertrochanteric (70%), Subtrochanteric (30%) AVN occurs in 10-30% of subcapital fractures 2/2 disruption of femoral circumflex artery. |
|
|
Bumper Fractures
|
Intraarticular fracture of tibial condyle.
Mechanism is usually a valgus force (e.g. clipped laterally from car bumper) resulting in lateral tibial plateau fx (80%). Muller classification: Type I: split (25%) Type II: depression (25%) Type III: split-depression (25%) Type IV: comminuted fx of both tibial condyles. |
|
|
Ankle Fractures
|
Weber classification:
A: stable fx through distal fib, below syndesmosis. B: fx through syndesmosis with partial disruption of tib-fib ligamentous complex. C: unstable fx through proximal fib with vertical tear of interosseous membrane and complete disruption of tib-fib lig complex. Often associated with fractures or avulsions of medial maleolus. Ankle mortis is stable iff 3-4mm space is even. |
|
|
Tibial Stress Fracture
|
Zone of sclerosis with periosteal reaction.
Classically occurs in runners. Thickening of posteromedial aspect of proximal tibia. |
|
|
Discoid meniscus
|
Usually lateral meniscus
Normal variant, though more prone to tears. Bridging of ant + post horns on MRI seen in >=3 consecutive sagital images is diagnostic. |
|
|
Chondrocalcinosis
|
Calcification of the menisci
Associated with various metabolic disorders such as: CPPD, hyperPTH, hemachromatosis, Wilson's, gout, and collagen vascular dz. |
|
|
Jefferson's fracture
|
Ring fractuer of C1 resulting from axial compression injury (e.g. diving.).
Uni of bilateral fx of both anterior and posterior arches of C1. Open mouth view shows > 2mm overhang of lateral masses of C1. CT is best at diagnosing this injury. Treat with halo x 3 months. |
|
|
Hangman's fracture
|
Bilateral fractures through C2 pedicle or pars interarticularis.
Anterior dislocation of C2 vertebral body. Ruptured ALL with avulsion of ant-inf C2. Prevertebral soft-tissue swelling. Mechanism is hyperextention and traction injury (e.g. from hanging). |
|
|
Flexion tear drop fracture
|
Acute cord syndrome 2/2 severe flexion injury.
Highly unstable. Tear drop fragment from anterior vertebral body All five ligaments disrupted Posterior subluxation of vertebral body and bilateral subluxed or dislocated facets lead to severe narrowind of spinal canal. May have associated pinous process fracture. |
|
|
Le Forte Facial fractures
|
I: floating face - nasal septum, max sinus, pterygoid plates
II: floating maxilla: sygomatic arches not broken II: floating face: craniofacial dislocation |
|
|
Zygoma (tripod) fracture
|
1. Inferior orbital rim and lateral max wall
2. posterior zygomatic arch 3. diastasis of zygomaticofrontal suture |
|
|
Orbital blow-out fracture
|
Fracture of floor of orbit 2/2 sudden increase in intraorbital pressure.
Can occasionally have medial wall blowout fx. Usually inferior rectus muscle entrapment with diplopia on upward gaze. Best seen on Caldwell and waters views. X-ray findings: Trap door sign, Opacified maxillary sinus, Orbital emphysema, Opacified ethmoid sinus |
|
|
Atlanto-occipital dislocation
|
Trauma
Complete A-O dislocation is fatal Prevertebral s.t. swelling Basion-axial interval > 12 mm is diagnostic. |
|
|
March fracture
|
Stress fracture of metatarsal neck
|
|
|
Lisfranc's fracture-dislocation
|
Dorsal dislocation of tarsometatarsal joints
Most common dislocation of foot Often 2/2 diabetic neuropathic (Charcot's ) joints. 2 types: Homolateral and divergent. Associated with fx of base of metatarsals and cuneiform bones. |
|
|
Dupuytren's fracture
|
Fracture of fibula above tibiofibular ligament.
|
|
|
Maisonneuves fracture
|
Spiral proximal fibular fracture Associated with ankle injury.
Implies ligamentous ankle injury with disruption of interosseous membrane and syndesmosis (usually Weber C). Often missed as it is remote from the site of injury. May also have medial maleolar fracture. |
|
|
Jone's fracture
|
Fx of proximal shaft of 5th metatarsal.
Not due to peroneous brevis avulsion. High rate of nonunion. |
|
|
Glomus tumor
|
Benign vascular tumor of distal phalanx.
Well circumscribed, lytic, and painful. |
|
|
Alkaptonuria (Ochranosis)
|
Metabolic bone dz caused by absence of homogentistic acid oxidase.
Increased tissue homogentistic acid. Black discoloration of cartilage. Dystrophic calcification of intervertebral disks > cartilage, tendons, ligaments Generalized osteoporosis. |
|
|
Hemophilia related arthropathy
|
Multiple acute hemarthrosis -> chronic synovitis and changes.
Monoarticular (Knee> elbow) Hemarthrosis / joint effusions periarticular osteoporosis subchondral cysts secondary OA Square patella, wide interchonylar notch, enlarged radial head, wide trochlear notch. |
|
|
Hemangioma
|
Asymptomatic unless pathologic fx occurs.
Vertbral body > skull > face Corduroy appearance 2/2 vertical trabecular pattern is diagnostic. |
|
|
Ewing's sarcoma
|
Common childhood malignancy of undifferentiated neuroectodermal origin.
40% 5 year survival Usually LE diaphysis or flat bones Aggressive permeative / moth-eaten cortical erosions May have extraosseous soft tissue mass Medullary location (but only cortical changes seen on radiograph). |
|
|
Malignant Fibrous Histiocytoma
|
Osseous MFH rare despite that MFH is most common S.T. sarcoma in adults.
High local recurrance rate and mets (poor prognosis). Either priamry or secondary (pagets, post XRT, chondrosarc). Permeative / moth-eaten often with large s.t. mass. Clinically and radiographically identical to fibrosarcoma. |
|
|
Ossifying fibroma
|
Histologically similar to fibrous dysplasia, osteofibrous dysplasia nad adamatinoma.
Expansile cortical lesion of anterior tibial diaphysis. Sharp sclerotic border Radiographically identical to adamatinoma Younger age group < 20 yr. |
|
|
Fibrous dysplasia (Lichtenstein-Jafee Dz)
|
Benign developmental anomaly (5-0 yr old).
Medullary cavity obliterated by woven bone/ fibrous material. Does not spread. No malignant transformation. Associated with hyperthyroid, hyperPTH, percocious puberty (McCune-Albright). Lucent expansile medullary lesion with ground glass. Well-defined sclertic margins. Endosteal scalloping. Weak bone -> pathologic fx -> shepard's crook deformities. Monostotic (femur) > polyostotic (unilateral). |
|
|
Multiple Myeloma / Plasmacytoma
|
Most common primary bone tumor.
Age > 40 yr. IgG M protein spike on SPEP. Bence-jone's (light chains) protein on UPEP. Increased number of plasma cells in marrow of axial skeleton on BM Bx. Bone pain and anemia. Multiple lytic puched out lesions. Bone scan unreliable. Use MRI or skeletal survey for staging instead. POEMS syndrome in Japan. Polyneuropathy, Organomegally, Endocrinopathy, M protein, Skin hyperpigmentation. |
|
|
Double Bubble
|
= gas in stomach and duodenal bulb with little or no gas distally.
Implies duodenal obstruction Duodenal atresia (most common) -> Down's. Anular pancreas (#2). |
|
|
Eosinophilic granuloma
|
Centrallt located, usually epiphseal
Skull with well defined lytic bone lesions -> hole within a hole. May coalesce (geographic skull). Vertebra plana (+- scoliosis) Permeative, aggressive cortical destruction in the appendicular skeleton. Involves other RES organs +/- interstitial or alveolar infiltrates. Letterer-Siwe = acute disseminated form (10%) Hand-Schuller-Christian = chronic disseminated form (20%) LAngerhan's histiocytosis (EG) = isolateed bony involvment (70%) |
|
|
DDx of pediatric presacral mass
|
Rectal duplication
Anterior meningocele Neuroblastoma Teratoma |
RANT
|
|
DDx of solid renal mass in kids
|
Wilm's - #1 in kids but rare in newborns.
Mesoblastic nephroma - ONLY solid renal mass seen in newborns < 1 month. Nephroblastomatosis - subcortical masses associaed with will's |
|