Learn it all ~ MED IMAGING
What are some things that CT can see on bone?
- bone tumors - articular surfaces - comminuted fractures - tibial plateau fractures
Ventilation
- inhale gas with radioactive particles (PE does not affect ventilation)
Perfusion
- inject radioactive particles IV; trapped in capillary bed of lungs (PE affects perfusion)
Cerebellar Hemangioblastoma MRI of brain shows a cystic lesion in the cerebellum with an enhancing nodule (post-Gadolinium)
...
pulmonary embolism
46 year old male: recent diagnosis of pancreatic cancer. sudden onset chest pain and shortness of breath
Left subphrenic abscess
48 year old male: Recent hemicolectomy for colorectal carcinoma. Severe left upper abdominal pain and fever
Difficulty swallowing -video esophagram / swallowing study -modified barium swallow Impacted food or foreign body Persistent heartburn / reflux disease (GERD) Chest pain
ESOPHAGRAM (Barium Swallow) indications
igns of ectopic pregnancy on TVUS include:
Empty uterus • Free fluid in the pelvis • Direct visualization of the ectopic gestation as a complex adnexal mass (Fig. 6.2) • On rare occasions, fetal cardiac activity may be seen within the adnexal mass.
is the most common gynaecological malignancy.
Endometrial carcinoma
Upper GIT bleeding
Endoscopy
Dysphagia
Endoscopy where malignancy suspected Barium swallow for other indications
Stent-graft placement
Endovascular Abdominal Aortic Aneurysm Repair
Double contrast technique Long nasogastric tube placed Barium and methyl cellulose infused
Enteroclysis
AP
Portable chest x-rays are almost always done
gross hematuria, flank pain and palpable mass
RENAL TUMOR - MALIGNANT RENAL CELL CARCINOMA (RCC) classic triad of
solid
RENAL TUMOR - MALIGNANT RENAL CELL CARCINOMA (RCC) most are
cystic
RENAL TUMOR - MALIGNANT RENAL CELL CARCINOMA (RCC) small percentage are
local lymph nodes, lung and bone
RENAL TUMOR - MALIGNANT RENAL CELL CARCINOMA (RCC) spreads (metastasizes) to
film exposed
RETROGRADE PYELOGRAM contrast injected as
a cystoscope procedure
RETROGRADE PYELOGRAM done during a
ureter and intrarenal collecting system
RETROGRADE PYELOGRAM shows
distal ureter
RETROGRADE PYELOGRAM small catheter placed into
Prostate CA Breast CA Gastric CA Carcinoid tumor
SCLEROTIC LESION Typical for metastatic disease from
making new bone
SCLEROTIC LESIONS lower destruction of bone; allows body to respond by
Epididymo-orchitis
SCROTAL US infection
Surgical emergency Loss of blood flow
SCROTAL US torsion
testis
SCROTAL US tumor usually within the
Single contrast small bowel exam Small bowel follow-through Enteroclysis
SMALL BOWEL STUDIES
Suspected obstruction / paralytic ileus Hematoschezia (blood in stools) Suspected malabsorption Unintended weight loss Suspected Crohn's disease
SMALL BOWEL STUDIES indications
Findings often subjective or difficult to appreciate on plain films Usually assessed with echocardiography as next test Sometimes need MR or other imaging
SPECIFIC CHAMBER OR VESSEL ABNORMALITIES
Coins, bone, food, plastic
SWALLOWED (INGESTED) FOREIGN BODY examples
Thoracic inlet Aortic arch level Just above diaphragm
SWALLOWED (INGESTED) FOREIGN BODY stick at
What is the system stating?
Salter harris 1 --> epiphyseal plate cartilage fracture salter harris 2 -->fracture of metaphysis salter harris 3 -->fracture of epipyhysis only salter harris 4 --> fracture of metaphysis and epiphysis salter harris 5--> compaction and compression of epiphyseal plate
Fractures around the epiphysis of bones (growth spots) are normally classified as ____?
Salter-harris system
tumor infection torsion hematoma
Scrotal US for
s the commonest type of ovarian malignancy. These are usually large (>15 cm) and seen on US as multiloculated cystic masses with thick, irregular septations and soft tissue masses
Serous cystadenocarcinoma
plain films
Slipped capital femoral epiphysis (SCFE) diagnosed with
low yield
Small bowel studies are generally
Which fracture of the wrist ocurs when you fall and your wrist is FLEXED?
Smith
fracture of transverse processes
T1 weighted- fat saturated sagittal contrast enhanced MRI of the lumbar spine
burst fracture
T2 weighted sagittal MRI of the lumbar spine
Transjugular intrahepatic portosystemic stent
TIPSS
Abnormal connection between the trachea and esophagus
TRACHEO-ESOPHAGEAL (TE) FISTULA
of tip or do esophagram
TRACHEO-ESOPHAGEAL (TE) FISTULA look for position
other congenital defects VATER
TRACHEO-ESOPHAGEAL (TE) FISTULA may have
NG tube and do a lateral film
TRACHEO-ESOPHAGEAL (TE) FISTULA put in
For all other patients with suspected ectopic pregnancy,
TVUS
should be performed to measure endometrial thickness. The ideal time for TVUS is on days 4-6 of the menstrual cycle, when the endometrial echo should be at its thinnest. The likelihood of endometrial hyperplasia is low if the endometrial thickness measured with TVUS is <12 mm.
Transvaginal US
haemorrhagic ovarian cyst
Transvaginal US with color doppler. 30 year old female sudden onset of acute pelvic pain
Most prostate carcinomas are now diagnosed through
creening. Screening methods include digital rectal examination (DRE) and prostate specific antigen (PSA) blood assay. PSA screening is controversial for a number of reasons:
not imaged
cystitis is usually
portable AP films obesity pregnant ascites straight back syndrome pectus excavatum
extracardiac causes of cardiac enlargement where CTR is more than 50% but heart is normal
penetration
factors to evaluate the quality of chest X-rays are
The majority of solid masses that arise from the uterus are
fibroids. Fibroids are often multiple. Fibroids are usually seen on US as masses of variable echogenicity in the smooth muscle wall of the uterus (myometrium).
Causes of a solid ovarian mass include
fibroma and Brenner tumour. A pedunculated fibroma may extend into the adnexa and mimic a solid ovarian mass.
Painless haematuria may be classified clinically as
macroscopic or microscopic. Initial clinical tests in the patient with haematuria consist of urine culture to exclude infection, examination of urine for protein and red cell casts, and measurement of blood pressure.
bowel obstruction
many different causes
conceptual age (menstrual age used)
menstrual age is 2 weeks greater than
The most common indication for renal mass biopsy is for management of a
small mass (<3 cm), where a positive biopsy result would indicate a non-operative approach.
What are the 4 characterisitcs of rheumatoid arthritis?
soft tissue swelling bone erosion reduced bone density abnormalities of joint alignment
What are some characteristics of inflammatory polyarthyopathy?
soft tissue swelling pain gets worse when walking morning stiffness
Ultrasound in the skeletal system is used to look at?
soft tissues (tendons, ligaments, muscles) *can tell tears in any of these very easily
What is another name for these fractures?
spiral, transverse or oblique
19-21 weeks' gestation Most major fetal malformations are able to be diagnosed on US at this
stage of pregnancy
Calculi
stones
What is another fracture that is common in athletes due to repetative trauma to a normal bone? Where is it mostly located?
stress fracture metatarsals
What are the 3 locations in which femoral neck fractures are classified as?
subcapital basilar transcervical
Which muscle is mostly teared during the rotator cuff tear and the calcific tenonisis?
suprasinatus
Humeral fractures are common among the elderly and are seen in mostly which parts of the humerous bone?
surgical neck anatomical neck lesser tuberosity greater tuberosity
What part of the femur is usually fractured? What is this common in?
surgical neck osteoporosis
Seminoma is usually seen as a localized hypoechoic mass outlined by
surrounding hyperechoic testicular tissue
what may be helpful in threatened abortion, when bleeding and pain are mild and the cervix is closed
transvaginal US
Most fractures in the metatarsals are _____?
transverse
buckle fracture
type of distal radius fracture shown
greenstick fracture
type of distal radius fracture shown
impacted, comminuted fracture
type of distal radius fracture shown
avulsion
type of fracture shown
comminuted fracture
type of fracture shown
compound fracture
type of fracture shown
pathological fracture
type of fracture shown
stress fracture
type of fracture shown
what is gout caused by?
uric acid and deposition in soft tissue
The primary imaging investigation in the assessment of prostatism is
urinary tract US. Urinary tract US includes assessment of prostate, bladder and upper urinary tracts.
Pelvic ring fractures have a high rate of association with _____?
urinary tract injuries
the tip is in the right main bronchus
you are sent to check on the position of a dobbhoff feeding tube that was just inserted before feeding the patient you say:
Perthes disease
(avascular necrosis of the femoral epiphysis)
acute cholecystitis
43 year old female: acute right upper quadrant pain
angiomyolipoma
43 year old female: incidental finding on CT
urinary tract obstruction due to ureteric calculus
43 year old male. Acute right upper quadrant pain and fever
hepatocellular carcinoma
46 year old male: Hepatitis-B positive. Recent deterioration of liver function
SVC thrombosis
69 year old female: swelling of arms and face. Recent removal of central venous catheter
Width of heart Width of chest Ratio should be less than .55 (or about 50% or less)
CARDIOTHORACIC RATIO
physiology as well as anatomy
CAROTID DUPLEX ULTRASOUND (US) images
carotid bifurcation
CAROTID DUPLEX ULTRASOUND (US) useful to assess the
initial process (HMD/RDS) improves
CHRONIC LUNG DISEASE BRONCHOPULMONARY DYSPLASIA (BPD) develops as
round and linear densities
CHRONIC LUNG DISEASE BRONCHOPULMONARY DYSPLASIA (BPD) diffuse
cystic changes
CHRONIC LUNG DISEASE BRONCHOPULMONARY DYSPLASIA (BPD) progresses to
a respirator
CHRONIC LUNG DISEASE BRONCHOPULMONARY DYSPLASIA (BPD) usually on
fat, muscle and vessel tissue
RENAL TUMOR - BENIGN ANGIOMYOLIPOMA (AML) contains
large
RENAL TUMOR - BENIGN ANGIOMYOLIPOMA (AML) may bleed, if
Don't bother Almost always negative High gonadal dose Even if it's fractured Will you put the butt in a cast?
COCCYX
Which fracture of the wrist occurs when you fall and your wrist is EXTENDED?
COLLE
incidentally
RENAL TUMOR - BENIGN ANGIOMYOLIPOMA (AML) often found
CT
RENAL TUMOR - MALIGNANT RENAL CELL CARCINOMA (RCC) _____ is most sensitive
growth plate
SALTER-HARRIS PEDIATRIC FRACTURE CLASSIFICATION SYSTEM involvement of the
What are another name for these?
buckle torus greenstick plastic
Ionizing radiation 1, 4, 8,16, 64 or more "rows"
COMPUTED TOMOGRAPHY (CT) image formation
fusion of sagittal suture
***couldn't download entire photo newborn male abnormal head shape
Trauma Abdominal pain Suspected mass Suspected inflammatory process
COMPUTED TOMOGRAPHY (CT) indications
NPO (sometimes not)
COMPUTED TOMOGRAPHY (CT) patient prepartion
valve function and chamber appearance
ECHOCARDIOGRAPHY (CARDIAC ULTRASOUND) also allows assessment of
abnormal wall motion
ECHOCARDIOGRAPHY (CARDIAC ULTRASOUND) areas with decreased blood flow will show
wall motion in real time
ECHOCARDIOGRAPHY (CARDIAC ULTRASOUND) noninvasive shows
pain or vaginal bleeding
ECTOPIC PREGNANCY may or may not cause
bleeding within the pelvis
ECTOPIC PREGNANCY may rupture and/or cause
What is shown in the following picture?
*CT coronary calcium scoring*: Note calcification in the left anterior descending artery (arrow) in a middle-aged male with atherosclerosis of the coronary arteries.
What condition is pictured?
"water bag" or "carpet bag" heart - indicative of Pericardial effusion
What is shown in the following picture?
*Calculation of ejection fraction: echocardiography.* b) measurement of left ventricular volume at end of diastole c) measurement of left ventricular volume at end of systole
What is shown in the following picture?
*Covered stent for aortic aneurysm.* AXR shows the position of the stent graft (arrows).
What is shown in the following picture?
*Abdominal aortic aneurysm*: A reconstructed image from a CT angiogram shows the following structures: • aorta (Ao) • left and right renal arteries (LRA, RRA) • left and right kidneys (LK, RK) • left and right common iliac arteries (LCIA, RCIA)
What is shown in the following picture?
*Aortic dissection*: CT scan. Note the thin intimal flap in the ascending aorta (arrow). In the descending aorta the flap is seen separating the true lumen (TL) from the false lumen (FL).
What is shown in the following picture? (Part a)
*Aortic dissection*: CXR show intimal calcification (arrow) displaced centrally by blood in the false lumen.
What is shown in the following picture? (Part b)
*Aortic dissection*: Coronal contrast-enhanced CT in the same patient as previous slide shows true lumen and false lumen separated by intimal flap. The intimal flap contains calcification (arrow), which is displaced on previous slide of CXR.
What is shown in the following picture?
*Covered stent for aortic aneurysm.* CT with intravenous contrast injection shows the stent graft (G) within the aortic aneurysm. Note the presence of contrast enhancement in the aneurysm sac anterior to the graft indicating an endoleak (arrow).
What is shown in the following picture?
*CT angiogram of the coronary arteries - normal anatomy* • aorta (A) • pulmonary artery (PA) • pulmonary vein (PV) • left atrium (LA) • left main coronary artery (LCA) • left anterior descending artery (LAD) • circumflex artery (CIR)
What is shown in the following picture?
*Deep vein thrombosis (DVT)*: thrombus is seen as echogenic material (arrow) projecting into the common femoral vein (CFV).
What is indicated within the yellow box?
*Kerley B Lines* Progress up the sides of the lungs that go further up as it gets worse. Lymphatics get congested with chronic failure (lymphatic vascular congestion) When you see these on the right or left it means CHRONIC heart failure.
What is shown in the following picture?
*Leaking abdominal aortic aneurysm*: CT obtained in a patient with acute onset of abdominal pain shows an aortic aneurysm (A) and a large left retroperitoneal hematoma (H).
What is shown in the following picture?
*Left atrial enlargement and mitral annular calcification.* Heart is enlarged with prominence of the left atrial appendage producing a bulge of the upper left cardiac border (white arrow). Curvilinear calcification in the mitral valve annulus (black arrow).
What is shown in the following picture?
*Left ventricular aneurysm*: Transverse MRI scan showing a four chamber view of the heart. The apex of the left ventricle has a markedly thinned wall and is dilated (arrows). Note that 'P' stands for pericardial effusion.
What is shown in the following picture?
*Myocardial ischemia: thallium scintigraphy*: Top 3 images are of the left ventricle after exercise; below these are corresponding images after a rest period. Note the presence of a region of reduced myocardial uptake of thallium with exercise (arrows). There is normal distribution of activity at rest, indicating reversible ischemia rather than established infarction
What is shown in the following picture?
*Normal deep veins*: duplex Ultrasound. US images obtained just below the inguinal ligament in the transverse plane showing the common femoral artery (FA) and vein (FV). The common femoral vein is able to be compressed with gentle pressure (arrow), excluding the presence of deep vein thrombosis (DVT)
What is shown in the following picture?
*Percutaneous transluminal angioplasty (PTA)*. a) Catheter angiography shows a stenosis of the superficial femoral artery in the upper thigh (arrow). b) Following PTA the stenosis is no longer seen.
What is shown in the following picture?
*Pulmonary arterial hypertension*: Dilated main pulmonary artery produces a bulge of the upper left cardiac border (arrow), higher than the left atrial appendage. Prominent hila due to enlarged right and left pulmonary arteries. Rapid tapering of calibre of pulmonary arteries as they extend through the lungs.
What is shown in the following picture?
*Pulmonary embolism*: CT pulmonary angiogram. Pulmonary embolus seen as a low density filling defect in the right pulmonary artery (arrow). • ascending aorta (A) • descending aorta (D) • main pulmonary artery (PA)
What is shown in the following picture?
*Renal trauma and embolization*: b) Catheter angiogram shows extravasation of contrast material (arrow). c) Post-embolization angiogram shows embolic material (arrow) with cessation of bleeding.
What is shown in the following picture?
*Renal trauma*. CT post-trauma shows a lacerated left kidney surrounded by a large hematoma. Small pools of extravasated contrast material indicate active bleeding (arrows).
What is shown in the following picture?
*Situs inversus*: Orientation of visible organs is a 'mirror image' of normal, with heart and stomach to the right, and liver to the left.
What is shown in the following picture?
*Stenosis of left common iliac artery (arrow)*. CT angiogram
What is shown in the following picture?
*Tunnelled central venous port.* The tip of the catheter is well positioned at the junction of the superior vena cava and right atrium (arrow).
What is pictured in the following PAL CXR?
*congestive heart failure (CHF)* • Heart is enlarged. • Bilateral pleural effusions (bilateral blunted costophrenic angles) • The left atrium is double the normal density (this means atrial enlargement) • Left bronchus is elevated from L atrial enlargement • Cephilization: vessels in upper part are congested • No clear spino-phrenic angle on the lateral view
What is shown in the following picture?
*coronary stenosis (arrow)* on CT angiogram of coronary arteries
Fahr's Disease Unenhanced CT reveals dense calcifications within the basal ganglia, subcortical white matter of the posterior parietal lobes, and the dentate nuclei of the cerebellum.
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Fun fact:
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Most ovarian tumours are well seen with US (see above). CT of abdomen and pelvis is the investigation of choice for pretreatment staging of ovarian cancer. CT is used to search for signs of peritoneal spread, such as ascites and peritoneal masses, liver metastases, and lymphadenopathy (Fig. 6.13). Chest CT/CXR are also performed to detect pulmonary metastases and pleural effusion.
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NORMAL SACRUM
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The most common cause of IUGR is placental insufficiency.
...
Pheochromocytoma
10 % are malignant Can cause HTN
A gestational sac should become visible on TVUS at a β-hCG level of
1000 mlU/ml
Nuchal thickness US at
11-14 weeks gestation
slipped upper femoral epiphysis
13 year old female left hip pain
avulsion anterior superior iliac spine: sartorius origin
14 year old male acute right hip region pain while playing soccer
osteochondritis dissecans medial femoral condyle
15 year old male recurrent knee pain and locking
right urinary tract obstruction
15 year old male: History of recurrent left flank pain. MAG3 scintigraphy (Series of sequential images of the kidneys. The numbers on the image represent minutes following injection of MAG3. Note the orientation on the first image in the top left corner.
grade 2 VUR, reflux into lower moiety of duplex collecting system
18 month old female. Micturating cystourethrogram to investigate recurrent urinary tract infection
Fetal morphology scan at
19-21 weeks gestation
bstetric US scan for assessment of fetal morphology is best performed at
19-21 weeks' gestation
a minimal requirement for trauma is that ___ views need to be taken on the radiograph?
2 (lateral view) (frontal view AP)
Tumour is graded histologically using the Gleason scale from
2 (well differentiated) to 10 (anaplastic, highly aggressive).
mediastinal mass
2 year old female mild shortness of breath and cough for a few days
Toddler's fracture
2 year old male acute presentation with a limp
placenta praevia
26 year old female us for 3rd trimester bleed image is longitudinal pelvic
For suspected ankle trauma ____ views are needed?
3 (lateral, oblique, AP)
Grade 4 VUR
3 month old male micturating cystourethrogram to investigate recurrent urinary tract infection
round pneumonia
3 year old male cough and fever
left lower lobe collapse
3 year old male known asthma, acute presentation
Which of the following is the least likely cause of RUQ pain? 1. Cholecystitis 2. Acute Hepatitis 3. Aortic Dissection 4. Duodenal Ulcer
3. Aortic Dissection
benign cystic teratoma (ovarian dermoid)
30 year old female mild intermittent pelvic pian transvaginal US
orchitis
30 year old male acute scrotal pain
testicular tumour
30 year old male acute scrotal pain
multicystic dysplastic kidney
34 year old female 3rd trimester obstretric US for follow up of foetal anomaly
acute pyelonephritis
34 year old female. Acute right upper quadrant pain and fever
acute pancreatitis
38 year old male: acute, severe epigastric pain
ankylosing spondylitis • Vertically orientated bony spurs arising from vertebral bodies (syndesmophytes) • Fusion or ankylosis of the spine giving the 'bamboo spine' appearance • Sacroiliac joint changes including erosions producing an irregular joint margin • Sclerosis and fusion of sacroiliac joints later in the disease process.
38 year old male: chronic back pain and stiffness
malrotation
4 month old female upper gastrointestinal tract barium study to investigate bile stained vomiting
empyema
4 year old male severe respiratory distress, cough, and fever
Acute appendicitis
40 year old female: acute right iliac fossa pain
chronic gouty arthropathy
52 year old male: chronic foot pain
reversed (hepatofugal) portal vein flow
53 year old male: history of hepatic cirrhosis
severe coronary artery stenosis
54 year old male: several episodes of central chest pain
stricture bulbous urethra
55 year old male poor urinary stream with micturition
rheumatoid arthritis
56 year old female: severe chronic foot pain and deformity
acute diverticulitis
57 year old male: acute left iliac fossa pain
endotracheal tube misplaced in right main bronchus left pulmonary collapse
6 month old female. severe bronchiolitis requiring respiratory support
cystic fibrosis
6 year old male chronic respiratory disease with recent deterioration
A PE
60% of patients dying the hospital have had
mucinous cystadenocarcina of the ovary
67 year old female pelvic swelling transvaginal US image including color power doppler
small bowel obstruction
67 year old female: acute abdominal pain and distension
adenocarcinoma of the pancreas
67 year old female: chronic, severe epigastric pain
thoracic aortic aneurysm
68 year old female: vague central chest pain
osteoarthritis
69 year old female: chronic left hip pain
aortic dissection
76 year old male: acute onset of intrascapular chest pain
metastases from adenocarcinoma of the prostate
78 year old male: Sclerotic lesions on Xray of pelvis
aortic aneurysm: ruptured
78 year old male: acute abdominal pain
paget disease
78 year old male: chronic bilateral hip pain
perthes disease
8 year old male left hip pain
Yolk sac should become visible when the average diameter of the gestational sac is _____; an embryo should be visible at _____.
8mm 16 mm
of little help
90% of low back pain cases resolve in 4-6 weeks plain films are
Fun fact: did you know sloths can turn their heads in a 270 degree angle around their bodies..
:)
No hemodynamically significant stenosis
< 10 mmHg pressure drop across stenosis
Hemodynamically significant stenosis
> 10 mmHg pressure drop across stenosis
Stomach 2 hours after birth Small bowel 6 hours after birth Rectum 24 hours after birth
Air in bowel (in a neonate)
RUQ liver uptake gallbladder and bile ducts bowel activity
HEPATOBILIARY EXAM images obtained over the
Therefore, if you look on pg. 173 in the book at the two pictures you can figure out the difference on which one is a fracture and which one is normal?
A) fracture B) normal pg 173
Suspected Obstruction / Perforation Foreign Bodies Tube / Line Positions (Trauma) (Pain) (Suspected Mass) (Suspected Inflammatory Process)
ABDOMINAL PLAIN FILMS EXAM INDICATIONS
US, CT, MR, angiogram
AORTA can be imaged with
45-70
AORTIC DISSECTION - common in ____ yrs of age
false channel channel dissects a variable distance
AORTIC DISSECTION Blood begins to flow through a wall defect, into a
Marfan syndrome, coarctation of aorta, bicuspid aortic valve Aortic atherosclerosis and hypertension
AORTIC DISSECTION for
Perforation of GIT
AXR
small bowel obstruction
AXR CT in doubtful cases, or to define location and cause
CT in doubtful cases, or to define location and cause
AXR Contrast enema to localize level of obstruction
Intussusception
AXR and US Imaging-guided reduction unless contraindicated
Stress fracture
Abnormal stresses on normal bone Common at the metatarsals
VESICOURETERAL REFLUX (VUR)
Abnormal ureter at its junction with the bladder
dense enough to see on plain films
About 85% of urinary tract calculi are
NPO
HEPATOBILIARY EXAM patient preparation
Indications for renal cortical scintigraphy with 99mTc-DMSA:
Acute pyelonephritis in infants and young children 115 116 • Renal scars complicating urinary tract infection in children
is usually unilateral, and is defined as sudden, painful scrotal swelling The main differential diagnosis in this situation is torsion versus acute epididymo-orchitis.
Acute scrotum
of the prostate is the second most common malignancy in males, its incidence increasing steadily with age.
Adenocarcinoma
Normal Adenoma Metastasis Pheochromocytoma
Adrenal glands can be
Small bowel follow-through
Also single contrast Done immediately after an UGI
"added up" to give a numeric score
Amount of calcium seen in coronary arteries
the presence of CAD
Amount of calcium seen in coronary arteries "added up" to give a numeric score The score correlates with the probability of
uterus and ovaries look normal
An ectopic pregnancy may be present even if the
from those that may cause local invasion and metastases.
An increasing PSA level If either DRE or PSA are abnormal, prostate biopsy is performed. This is done under transrectal ultrasound (TRUS) guidance (Fig. 5.11). Less commonly, biopsies may be performed using a US-guided transperineal approach under general anaesthetic.
is the commonest cause of a benign solid renal mass in adults. Eighty per cent occur sporadically, and are usually small and asymptomatic.
Angiomyolipoma (AML) AMLs contain fat, giving them a characteristic appearance on US and CT; visible fat in a renal mass usually implies a benign aetiology.
What is shown in the following picture?
Apical four chamber view of the heart using echocardiography
types of aortic dissection
Ascending (Type A) Descending (Type B)
Hematoschezia Constipation Suspected diverticulitis Weight loss / anemia of unknown cause
BARIUM ENEMA (BE) lower gastrointestinal exam (LGI) indications
Placement of rectal tube Barium instilled by gravity Air pumped in
BARIUM ENEMA (BE) lower gastrointestinal exam (LGI) procedure
proximal and distal
BARIUM EXAMS How to Review a Barium Study look for ______and_____ segments
normal, dilated, or narrowed
BARIUM EXAMS How to Review a Barium Study structure caliber
normal or displaced
BARIUM EXAMS How to Review a Barium Study structure position
See through structure
BARIUM EXAMS (GI STUDIES) Double contrast (air contrast)
aspiration
BARIUM EXAMS (GI STUDIES) Gastrografin contraindicated for
suspected perforation
BARIUM EXAMS (GI STUDIES) Gastrografin for
NPO; "bowel prep" for barium enema
BARIUM EXAMS (GI STUDIES) Patient preparation
structure with a solid column
BARIUM EXAMS (GI STUDIES) Single contrast Outlines
smoot, innie or outie
BARIUM EXAMS How to Review a Barium Study mucosal surface/margin
DO NOT PLACE A CATHETER Call urologist Ascending urethrogram
BLADDER TRAUMA - RUPTURE If there is blood at the tip of the penis after a trauma -
intraperitoneal or extraperitoneal
BLADDER TRAUMA - RUPTURE may be
DEXA (Dual Energy X-ray Absorptiometry) Measures bone mineral density (BMD) at hip and lumbar spine Measured against young normals
BONE MINERAL DENSITY ASSESSMENT
T-SCORE ABOVE -1.0
BONE MINERAL DENSITY ASSESSMENT NORMAL
consolidation round pneumonia more common 2-3 years
Bacterial pneumonias usually have
Percutaneous transluminal angioplasty (PTA) is a procedure that can open up a blocked blood vessel using a small, flexible plastic tube, or catheter, with a "balloon" at the end of it. When the tube is in place, it inflates to open the blood vessel, or artery, so that normal blood flow is restored.
Balloon dilatation, stent, thrombolysis
tuberous sclerosis
Base on the accompanying CT appearances, what is the most likely underlying syndrome in this patient?
Adenoma
Benign mass May need MR to diagnose
US may also be used as a guide for various procedures including:
Biopsy of solid lesions or complicated cysts • Cyst aspiration for diagnostic and therapeutic purposes • Cyst ablation by injection of ethanol • Radiofrequency ablation of small tumours.
Fractures of the calcaneous can be measure using ____ angle?
Boehlers (normal measurement is 25-40 degrees)
Vertebral metastases
Bone scintigraphy
small bowel and colon look similar in neonates
Bowel obstruction
level of abnormality
Bowel obstruction try to assess
Normal No hemodynamically significant stenosis Hemodynamically significant stenosis Critical stenosis Completely occluded vessel
CAROTID DUPLEX levels
Horseshoe kidney Duplication of ureter Ectopia In general there can be errors in number, size, form, fusion, position Often associated with genital tract anomalies
CONGENITAL ANOMALIES
pulmonary veins
CONGESTIVE HEART FAILURE (CHF) Blood "backs up" into the
pump enough blood
CONGESTIVE HEART FAILURE (CHF) Left sided heart chambers cannot
be enlarged cardiomegaly
CONGESTIVE HEART FAILURE (CHF) heart MAY
bat-wing shaped
CONGESTIVE HEART FAILURE (CHF) lung pattern may appear
interstitial edema to avelolar edema
CONGESTIVE HEART FAILURE (CHF) progression from plump vessels (cephalization) to _____ to ____
From mild to severe to death
CONTRAST RISKS Allergic Reaction
Contrast gets out of the vein and into the tissues May cause pain / tissue loss
CONTRAST RISKS Extravasation
Contrast can decrease renal function Usually avoided if known renal disease
CONTRAST RISKS renal function
to aortic root, and into a coronary artery Contrast injected (intra-arterial)
CORONARY ANGIOGRAM (CARDIAC CATHETERIZATION) is a catheter at femoral artery threaded up to
asymptomatic patients only
CORONARY ARTERY DISEASE CT CALCIUM SCREENING for what kind of patients?
LLQ Diverticulitis
CT
LUQ Splenic
CT
Midepigastric/back Panc / Aorta
CT
RLQ Appendicitis
CT
aortic dissection
CT
Left lower quadrant pain
CT US in children and women of childbearing age
Right lower quadrant pain
CT US in children and women of childbearing age
Acute pancreatitis
CT US to search for gallstones
...
CT CONTRAST When and which kind? for GI tract assessment Not usually given for trauma
Intravenous (IV)
CT CONTRAST When and which kind? for solid organ assessment Vascular structures Allergies, nephrotoxicity
Staging of adenocarcinoma of prostate
CT abdomen and pelvis Bone scintigraphy MRI prostate
Diagnostic Imaging for Midepigastric / Back Pain
CT best for most indications
IV oral rectal
CT contrast types
is usually also performed to search for retroperitoneal lymphadenopathy, liver metastases and lung metastases.
CT of abdomen and chest
Complex cysts or solid renal masses found with US usually require further assessment with
CT or MRI.
Simple renal cysts are extremely common in adults. They are usually small and asymptomatic, discovered incidentally on ________
CT or US examinations of the abdomen. Simple cysts have thin walls and clear fluid contents.
pulmonary embolism
CT pulmonary angiogram V/Q scintigraphy in selected cases. e.g allergy to iodinated contrast material
investigation of choice for painless haematuria.
CT urography CT urography is a term used to describe a contrast-enhanced CT technique designed to provide excellent delineation of the renal collecting systems, ureters and bladder, as well as cross-sectional images of the kidneys and adjacent structures. Although the precise method may vary, CT urography usually consists of a multiphase examination including scans performed with sufficient delay after contrast material injection to allow opacification of the collecting systems and ureters
Painless haematuria
CT urography and cystoscopy US for further definition in selected cases
splenic evulation
CT with IV
Renal colic/flank pain
CT without contrast enhancement is the imaging test of choice for acute flank pain. AXR/KUB if ureteric calculus seen on CT Radiograph of kidneys, ureters and bladder (KUB) refers to a supine AXR done to diagnose and follow up renal or ureteric calculi
Cystic fibrosis
CXR
Pulmonary infection
CXR
pneumonia
CXR
Congestive cardiac failure
CXR echocardiography
Oesophageal atresia and tracheo-oesophageal fistula
CXR and AXR
A valve
Can be normally functioning Can be stenotic (too tight) Can be regurgitant or insufficient (too loose) Can have vegetations (growths)
What is shown in the following image?
Cardiomegaly. CT ratio greater than 50%. Also, costophrenic angles are blunted, indicating pleural effusion.
Acute mesenteric ischaemia
Catheter angiogram Interventional radiology
affected as well
Chamber or vessel "behind" is often
are poor
Clinical exams for PE and DVT
radiolucent, including fish bones
Coins, bone, food, plastic Most (except coins) are
Crohn disease
Colonoscopy CT or MR enterography AXR in acute presentation
Ulcerative colitis
Colonoscopy AXR in acute presentation
HYDRONEPHROSIS
Congenital obstruction from duplex system Congenital UPJ obstruction
Characterization of complex renal cyst found on ultrasound
Contrast enhanced CT (CT urography)
is used for further characterization of a solid lesion or complex cyst found on US.
Contrast-enhanced CT CT is more accurate than US for characterization of internal contents of a mass, in particular to show areas of fat confirming the diagnosis of AML
heart muscle Primarily the left ventricle
Coronary arteries feed the
claudication
Crampy type pain in lower extremity
the gold standard investigation for tumours of the lower urinary tract.
Cystoscopy accompanied by ureteroscopy Retrograde pyelography may also be performed at the time of cystoscopy where upper urinary tract tumour is suspected.
TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)
Delayed resorption of pulmonary amniotic fluid Increased lung volumes Linear densities Small pleural effusions Clears in 1-2 days
edema, pain and redness
DEEP VENOUS THROMBOSIS (DVT) causes
US (or venogram)
DEEP VENOUS THROMBOSIS (DVT) diagnosed with
veins
DEEP VENOUS THROMBOSIS (DVT) forms in
Thickening of the nuchal translucency may be associated with
Down syndrome and other types of fetal aneuploidy.
US and plain films
Developmental dysplasia of the hip (DDH) diagnosed with
Twin pregnancy, when recognized on US examination, may be classified as follows:
Dichorionic diamniotic • May be dizygotic or monozygotic May be dizygotic or monozygotic • Dizygotic may be different sex; monozygotic are same sex • Separating membrane seen between the fetuses • Separate placentas may be identified • Mortality rate 9 per cent Monochorionic diamniotic • Monozygotic, therefore same sex • Separating membrane between the fetuses may be seen • Single placenta • Mortality rate 26 per cent Monochorionic monoamniotic • Monozygotic, therefore same sex • No separating membrane • Single placenta • Mortality rate 44 per cent.
Atherosclerosis
Dilated, tortuous, plaque
The most likely diagnosis in this patient with LLQ pain is..
Diverticulitis
Liver mass: characterization
Dynamic contrast enhanced imaging: CT, MRI, CEUS
Screening for CAD
Exercise stress test: ECG echocardiography perfusion scintigraphy CT coronary angiography catheter coronary angiogrpahy CT calcium score
face, scalp
External carotid artery (ECA) to
Radiopaque
FOREIGN BODIES such as Metal, gravel, glass seen on on plain films as
CEUS, contrast-enhanced ultrasound; ERCP, endoscopic retrograde cholangiopancreatography; KUB, radiograph of kidneys, ureters and bladder; MRCP, magnetic resonance cholangiopancreatography; PTC, percutaneous transhepatic cholangiography; RBC, red blood cells.
FYI
may project into the endometrial cavity or, alternately, may lie on the surface of the uterus or may even be attached by a stalk of tissue (pedunculated). Pedunculated fibroids may lie in the pelvis lateral to the uterus (adnexa) and may be difficult to distinguish from a solid ovarian tumour.
Fibroids
HYPERTROPHIC PYLORIC STENOSIS
First-born male 2-6 weeks old Nonbilious vomiting Thickened pyloric muscle -Palpable "olive
acute Pyelonephritis
Flank pain, fever, pus in urine (pyuria) May progress to renal abscess usually to imaged
minor or major
Fluid in the fissures can be
Kerley B lines
Fluid in the interstitium
PERICARDIAL EFFUSION
Fluid in the pericardial space
What is pericardial effusion?
Fluid in the pericardial space
Aneurysm
Focal bulge in one or more areas
25% due to Carcinoma (CA) 25% due to Infection 15% due to calculi (stones) Cystoscope (sometimes with retrograde pyelogram) usually needed along with imaging
For Non-traumatic hematuria:
US
For most female genital system assessment, ___ is the first exam
total knee replacement: complicated by fracture
From the accompanying images of a patient that has undergone jt replacements, please choose the most likely diagnosis from the list below
Signs of a failed pregnancy on TVUS include:
Gestational sac >20 mm with no fetal pole identified Fetal pole >5 mm with no fetal heartbeat identified.
CT without contrast
Great for calculi, doesn't show much else
Macroscopic (visible) or Microscopic Traumatic or Non-traumatic
HEMATURIA can be
radiopharmaceutical -morphine/cck
HEPATOBILIARY EXAM _____ GIVEN IV
HIDA SCAN
HEPATOBILIARY EXAM aka
Surfactant deficiency -AKA respiratory distress syndrome (RDS) -prematurity Low lung volumes Patchy, granular densities in the lungs Air bronchograms Shows up 4-6 hours after birth
HYALINE MEMBRANE DISEASE (HMD)
obstruction
HYDRONEPHROSIS
US (IVP) Nuclear medicine renogram and renal scan with Lasix
HYDRONEPHROSIS may do
US (or UGI)
HYPERTROPHIC PYLORIC STENOSIS diagnosed by
From kidney, ureter, bladder, urethra
Hematuria from
the heart touches the lateral chest wall, it's enlarged
How can you tell if the heart is enlarged on an AP (usually portable) film
C - Upper lobe collapse and consolidation
How is the abnormality of the right lung best described? A - Pneumothorax B - Hyperexpansion C - Upper lobe collapse and consolidation D - Lower lobe collapse
Plain Films Barium Studies Nuclear Medicine Ultrasound (US) Computed Tomography (CT) Magnetic Resonance (MR)
IMAGING MODALITIES
Plain films series Then straight to the highest yield test Gallbladder/bile ducts: US or HIDA GI tract except for small bowel Endoscopy (versus barium studies) Small bowel: barium studies or CT Specialty exams for certain instances JUST ABOUT EVERYTHING ELSE: CT
IN THE REAL WORLD...
pyelonephritis cystitis
INFECTION can be
not very sensitive
INFECTIONS Plain films are ________ for these conditions, especially early osteomyelitis
If it completely obstructs the bronchus -Atelectasis -Volume loss Ball-valve (partial) obstruction -Air-trapping Peanut in RT main bronchus (more vertical) -Common from 9 months - 3 years of age Inspiration / expiration Bilateral decubitus films
INHALED (ASPIRATED) FOREIGN BODY
air trapping
INHALED (ASPIRATED) FOREIGN BODY Ball-valve (partial) obstruction
Atelectasis Volume loss
INHALED (ASPIRATED) FOREIGN BODY If it completely obstructs the bronchus Atelectasis Volume loss
pneumonia can develop
INHALED (ASPIRATED) FOREIGN BODY If undetected,
Biopsy - Angiography TIPSS Biliary drainage / stent placement
INTERVENTIONAL TECHNIQUES
venous access PTA IVC filter placement vascular embolization endovascular abdominal aoritc aneurysm repair
INTERVENTIONAL TECHNIQUES IN THE PERIPHERAL VASCULAR SYSTEM
Pain, vomiting, palpable abdominal mass, rectal bleeding
INTUSSUSCEPTION can cause
Currant-jelly
INTUSSUSCEPTION can cause _____ stools
barium enema, except with shock or perforation
INTUSSUSCEPTION may be reduced by
telescopes into the next part
INTUSSUSCEPTION one part of bowel
Order an MR hip (CT hip)
If a fracture is suspected, but the films look normal
Back pain
Imaging not indicated in most cases Radiography MRI/CT for radiculopathy/myelopathy Imaging indicated in neck and back pain for chronic, relapsing or unremitting pain, or in the presence of clinical 'red flags' (see above)
Neck pain
Imaging not indicated in most cases Radiography MRI/CT for radiculopathy/myelopathy Imaging indicated in neck and back pain for chronic, relapsing or unremitting pain, or in the presence of clinical 'red flags' (see above)
Pigg-o-stat
Immobilizes child Artifacts
heart is farther from the film and is more magnified
In an AP film, the heart is ____ from the film and is ____
First, do a thorough history and careful physical exam Next, obtain relevant blood work Then obtain relevant plain films Only then should a barium study or cross-sectional study be considered
In the ideal world...
brain
Internal carotid artery (ICA) to
Malignancies of the female reproductive system are staged by the
International Federation of Gynaecology and Obstetrics (FIGO) These classification systems are also converted into the TNM system and published by the American Joint Committee on Cancer (AJCC).
Percutaneous Nephrostomy (PCN) Ureteral Stent -Antegrade or retrograde Shock Wave Lithotripsy (ESWL) Percutaneous Nephrolithotomy Renal Artery Embolization
Interventional Techniques
is also known as intravenous urogram (IVU).
Intravenous pyelogram (IVP)
What is shown in the following picture?
Intravenous vena cava filter (arrow)
What is the cardiothoracic ratio (CT ratio), and what is the normal value?
It is the width of the heart compared to the width of the chest, and a normal value is ~50% or less.
Ectopia
Kidney in wrong spot
Lung CA Renal CA Breast CA Multiple myeloma
LYTIC LESION Typical for metastatic disease from
may invade beyond the bladder wall and cause hydronephrosis due to obstruction of the distal ureters
Large or advanced bladder tumors It follows from the above that the imaging assessment of painless haematuria requires visualization of the renal parenchyma to exclude a renal mass, plus visualization of the urothelium. This includes imaging of the collecting system, renal pelvis, ureters and bladder.
solid organ well
MAGNETIC RESONANCE IMAGING (MRI) Assesses ______ well
gadolinium
MAGNETIC RESONANCE IMAGING (MRI) ______ contrast often used
A very strong magnetic field Radiofrequency energy
MAGNETIC RESONANCE IMAGING (MRI) forms images by the interaction of:
for problem-solving in the abdomen
MAGNETIC RESONANCE IMAGING (MRI) mainly for
Chest radiography (PAL CXR) Ultrasound Nuclear Medicine / SPECT Computed Tomography (CT / CTA / CTV) Magnetic Resonance (MR / MRA / MRV) Contrast Angiography
MODALITIES
Intravenous Pyelogram (IVP) / Urogram (IVU) Cystogram / urethrogram Retrograde / antegrade pyelogram Hysterosalpingogram (HSG) Ultrasound CT Nuclear Medicine MR Angiography / interventional
MODALITIES
Radiculopathy New or worse neurological deficit
MR spine recommended for:
Radiographs are mostly used for arthopathy but you can also use ____for better synovial views?
MRI
increasingly used as a problem-solving modality in the characterization of renal and adrenal masses, and in the staging of prostatic carcinoma.
MRI
is the investigation of choice for early stage disease as it is more accurate than US in the assessment of depth of myometrial invasion and invasion of the cervix
MRI
is the investigation of choice for measuring tumour size and assessing depth of uterine invasion and local tumour extension in the pelvis.
MRI
may be used for the diagnosis of uterine disorders including adenomyosis and endometriosis. is also used for staging of gynaecological malignancies.
MRI
Sciatica
MRI CT where MRI is unavailable
is the imaging investigation of choice for local staging of prostate carcinoma.
MRI T2-weighted scans are able to display the architecture of the prostate including differentiation of central and peripheral zones. Carcinoma is usually seen as a low signal mass in the peripheral zone.
In some centers,_____ is used in preference to CT for the investigation and characterization of renal masses.
MRI The most common indication for renal mass biopsy is for management of a MRI generally gives similar information to CT in the detection, classification and staging of renal cysts and tumours.
acute crush fracture
MRI: saggittal STIR of the lumbar spine
pseudoaneurysm/tear
MVA motor vehicle accident likely to cause
at rest after IV injection of radioactive tracer Heart is imaged at rest after IV injection of radioactive tracer Patient exercises on treadmill Re-injection of tracer Heart is re-imaged Looking for differences between rest and stress images
MYOCARDIAL PERFUSION SPECT STRESS TEST Heart is imaged
NEPHROSTOMY
Method to relieve obstruction
CT with contrast
More complete picture Ionizing radiation, contrast risk
Rest pain
More severe, may lead to tissue loss
in women are ovarian in origin. Other possible causes of an adnexal mass would include bowel tumour, abscess or postoperative fluid collection.
Most adnexal masses
Properly positioned Thickened epiglottis (looks like a thumb)
NECK IMAGING Lateral soft tissue neck film
2 to 7 years old Severe sore throat and fever Difficult inspiration Patient may be drooling
NECK IMAGING Epiglottitis
drain to the outside
NEPHROSTOMY allows urine to
renal pelvis
NEPHROSTOMY need passed through to the
position the tip in the renal pelvis
NEPHROSTOMY wire and catheter use dot
neural crest
NEUROBLASTOMA has __ origin
adrenal glands
NEUROBLASTOMA often in
in posterior mediastinum or along sympathetic chain system
NEUROBLASTOMA sometimes
Uncomplicated febrile seizure -6 months to 4 years -generalized Uncomplicated asthma -Known asthmatics, simple attack Uncomplicated gastroenteritis -Acute onset of diarrhea +/or vomiting
NO IMAGING NEEDED
Fractures inconsistent with the history Fractures in different stages of healing Fractures at unusual sites -sternum or scapula Be aware of disease mimics -Vitamin D deficiency; -osteogenesis imperfecta Refer to pediatric radiologist
NON-ACCIDENTAL INJURY (CHILD ABUSE)
pediatric radiologist
NON-ACCIDENTAL INJURY (CHILD ABUSE) refer to
Menstrual age is 2 weeks greater than conceptual age (menstrual age used) Visible by about 5 weeks EGA (estimated gestational age - menstrual age) Shows the gestational sac within the uterus May see embryo, heartbeat, yolk sac
NORMAL 1ST TRIMESTER GESTATION
5 Weeks EGA (estimated gestational age - menstrual age)
NORMAL 1ST TRIMESTER GESTATION Visible by about
embryo, heartbeat, yolk sac
NORMAL 1ST TRIMESTER GESTATION may see
uterus
NORMAL 1ST TRIMESTER GESTATION shows the gestational sac within the
Routine OB US is not necessary -Often done to see fetal sex Allows measurement of fetus to determine if growth is normal Shows development of fetal anatomy Shows cervix, placenta and amniotic fluid Usually done at 18-22 weeks May be repeated as necessary
NORMAL 2ND / 3RD TRIMESTER GESTATION
if growth is normal
NORMAL 2ND / 3RD TRIMESTER GESTATION allows measurement of fetus to determine
not necessary Often done to see fetal sex
NORMAL 2ND / 3RD TRIMESTER GESTATION routine OB US is
cervix, placenta, and amniotic fluid
NORMAL 2ND / 3RD TRIMESTER GESTATION shows
of fetal anatomy
NORMAL 2ND / 3RD TRIMESTER GESTATION shows development
18-22 weeks
NORMAL 2ND / 3RD TRIMESTER GESTATION usually done at
Normal inspiration -Posterior 8th rib -Anterior 6th rib Normal thymus -Sail sign -Up to 2-3 years old "Babygram" Pigg-o-stat -Immobilizes child -Artifacts
NORMAL CHEST X-RAY
Check for stones -phleboliths Check gas pattern Assess patient for contrast reaction
NORMAL IVP - SCOUT check and assess for
Reflux (gastro-esophageal or GERD) exam Gastric emptying exam GI Bleeding scan Labeled white blood cell exam Liver-spleen scan Hepatobiliary scan Meckel's scan
NUCLEAR MEDICINE STUDIES
interventional techniques (stent, angioplasty)
Narrowing may be re-opened by
Laryngotracheobronchitis (LTB) 6 months to 3 years old "Brassy cough": barking seal Ballooning of pharynx / hypopharynx on lateral film Steeple sign on AP X-ray signs are not specific
Neck imaging Croup
IVP
No longer a common first test Ionizing radiation, contrast risk
Ultrasound
Noninvasive, but doesn't show ureters well
Posterior 8th rib Anterior 6th rib
Normal inspiration
vertebral body disk space pedicle posterior spinous process
Normal lumbar spine label Red lines from top to bottom
A chamber or vessel can be
Normal size Dilated (too big) Restricted (too small) Or it can have a thickened or thinned wall
Insufficiency fracture
Normal stresses on abnormal bone Common at the sacrum
Sail sign Up to 2-3 years old
Normal thymus
UPJ: ureteropelvic junction UVJ: ureterovesicular junction Where the ureter crosses over the pelvis margin
OBSTRUCTION (HYDRONEPHROSIS) common levels
decrease
OBSTRUCTION (HYDRONEPHROSIS) if long duration, renal function may
CT w/o contrast (stone protocol exam)
OBSTRUCTION (HYDRONEPHROSIS) protocol should be
Calculi (stones) Tumor Stricture (scarring)
OBSTRUCTION (HYDRONEPHROSIS) several causes, most often due to
Duodenal obstruction Atresia Hirschsprung disease Meconium ileus Meconium plug syndrome Malrotation Midgut volvulus
OTHER GI TRACT ABNORMALITIES
May be cystic, complex or solid May be benign or malignant
OVARIAN MASS may be
Metastasis
Often from lung CA
-1.0 and -2.5
Osteopenia: T-score between
below -2.5 Higher risk for fracture
Osteoporosis: T-score
removed
Ovarian mass often need to be
many indeterminate studies
PE Nuclear Medicine ventilation/perfusion (V/Q) lung scan:
CT pulmonary angiogram
PE most common method used currently
Developmental dysplasia of the hip (DDH) Perthes disease Slipped capital femoral epiphysis (SCFE)
PEDIATRIC HIP PROBLEMS
"water bag" configuration
PERICARDIAL EFFUSION described as a
Pressure waveform studies MRA, CTA, contrast angiogram
PERIPHERAL ARTERIAL DISEASE (PAD) Assessed with
the muscles of the affected limb due to vessel stenosis
PERIPHERAL ARTERIAL DISEASE (PAD) Decreased blood flow to
venous access
PICC line, tunnelled catheter, implanted port
Look at the lung bases and CP angles Follow the gas pattern (hollow organs) Look at the solid organs / positions Look at the psoas muscle margins Look at the skeleton Assess any calcifications Is everything where it should be?
PLAIN FILMS How to Review an Abdomen Film
medially or at lung base
PNEUMOTHORAX (PTX) look for lucency
difficult to detect
PNEUMOTHORAX (PTX) patient often supine, _______
claudication
PRESSURE WAVEFORM STUDY ANKLE-BRACHIAL INDEX (ABI) 0.5 to 1.0
rest pain
PRESSURE WAVEFORM STUDY ANKLE-BRACHIAL INDEX (ABI) < 0.5
Normal
PRESSURE WAVEFORM STUDY ANKLE-BRACHIAL INDEX (ABI) About 1.0 or greater
both arms and ankles
PRESSURE WAVEFORM STUDY ANKLE-BRACHIAL INDEX (ABI) blood pressures at
is non-specific and may be elevated in nodular hyperplasia and chronic prostatitis, as well as prostatic carcinoma.
PSA
if ruptured
PSEUDOANEURYSM / TEAR high mortality if
contained or ruptured
PSEUDOANEURYSM / TEAR may be
arch, just past origin of LT subclavian artery
PSEUDOANEURYSM / TEAR typically at
Percutaneous transluminal coronary angioplasty used in a coronary angiogram
PTCA stands for what? & used in ______?
IVC, right side of heart and then the pulmonary artery, where it plugs a vessel (embolizes)
PULMONARY EMBOLISM - PE Part of a clot (deep venous thrombus - DVT) from a leg or pelvic vein breaks loose and goes to the
Pneumothorax Pneumomediastinum Pneumopericardium
PULMONARY INTERSTITIAL EMPHYSEMA (PIE) can lead to
the periphery
PULMONARY INTERSTITIAL EMPHYSEMA (PIE) irregular radiolucencies extending towards
Cervical cancer is the third most common gynaecological malignancy. Mortality from cervical cancer has decreased over the last 40 years due to widespread use of the
Papanicolaou (pap) smear.
is usually performed under general anaesthetic. A retrograde ureteric catheter is inserted via cystoscopy to opacify the renal collecting system with contrast material and to prevent calculus fragments passing down the ureter. The renal collecting system is then punctured with a needle followed by passage of a guidewire. A tract into the collecting system is made with a series of dilators and the renal stone extracted.
Percutaneous nephrolithotomy
to plaque rupture (ACS)
Plaque buildup (atherosclerosis) narrows the vessel; may lead
enlargement of left atrium
Please choose the dominant finding relevant to cardiovascular disease with reference to the attached CXR
TORCH
Pneumonia ________ in neonates
viral, may be bacterial in orgin
Pneumonia often
ECTOPIC PREGNANCY
Pregnancy that develops outside the uterine cavity (tubal pregnancy)
refers to obstructive voiding symptoms due to prostatic enlargement
Prostatism
70% of cases
Pulmonany embolism diagnosis has been missed in up to
non specific
Pulmonary embolism CXR
acute chronic diabetics
Pyelonephritis can be
Lower GIT bleeding
RBC scintigraphy CT angiography Treat bleeding with interventional radiology or surgery
medications
RENAL ARTERY STENOSIS (RAS) HTN not controlled with
Atherosclerosis Fibromuscular dysplasia (FMD) common in young women
RENAL ARTERY STENOSIS (RAS) can cause
<5% o f HTN
RENAL ARTERY STENOSIS (RAS) causes
MRA (or Nuclear medicine captopril renogram or RA US or angiogram) Intervention
RENAL ARTERY STENOSIS (RAS) diagnosed with
CT
RENAL TRAUMA usually do ____ for gross (macroscopic) hematuria
CT easy to measure fat
RENAL TUMOR - BENIGN ANGIOMYOLIPOMA (AML) ____ is often diagnostic
Fibrous dysplasia
Radiography CT for complex areas, e.g. craniofacial
Trauma: suspected fracture or dislocation
Radiography CT in selected cases for further definition of anatomy MRI in selected cases for detection of subtle fractures not shown on radiographs, e.g. scaphoid
Spondylolysis and spondylolisthesis
Radiography SPECT-CT MRI if sciatica is the dominant symptom
Non-accidental injury
Radiography (skeletal survey)
LYTIC LESION
Relatively rapid destruction of bone Leaves a "black hole" with irregular edges
is used to assess renal function and urodynamics, including calculation of the percentage of total renal function contributed by each kidney. is used in renal transplant to assess transplant perfusion and function, diagnose rejection or acute tubular necrosis, and detect urinary leak or outflow obstruction.
Renal scintigraphy
Angiotensin-converting enzyme (ACE) inhibitor renogram Indication: screening test for renal artery stenosis in suspected renovascular hypertension.
Renal scintigraphy with injection of captopril
Diuresis renogram Indication: differentiation of mechanical urinary tract obstruction from non-obstructive hydronephrosis
Renal scintigraphy with injection of furosemide
muscular HYPERTROPHY OR WALL THICKENING
Response to increased PRESSURE (HTN or valvular stenosis) is usually
CHAMBER ENLARGEMENT OR DILATATION
Response to increased VOLUME (valvular regurgitation / insufficiency or fluid overload) is usually
is usually performed in the operating theatre, in conjunction with formal cystoscopy.
Retrograde pyelogram (RPG)
The most common clinical presentation of endometrial carcinoma is postmenopausal bleeding. Fifteen per cent of women with postmenopausal bleeding will have endometrial carcinoma. The FIGO staging system for endometrial carcinoma is as follows: The most common clinical presentation of endometrial carcinoma is postmenopausal bleeding. Fifteen per cent of women with postmenopausal bleeding will have endometrial carcinoma. The FIGO staging system for endometrial carcinoma is as follows:
Stage 0: carcinoma in situ • Stage I: tumour limited to the uterus • Stage IA: tumour limited to the endometrium • Stage IB: invasion of less than 50 per cent of the myometrium • Stage IC: invasion of more than 50 per cent of the myometrium • Stage II: invasion of the cervix with no extrauterine extension • Stage III: extension beyond the uterus, but not outside the pelvis • Stage IV: invasion of bladder or rectum, or distant metastases.
RCC tumour up to 7 cm confined to kidney
Stage I
tumour >7 cm confined to kidney RCC
Stage II
RCC invasion of adrenal gland, perinephric fat or IVC, and/or involvement of one regional lymph node
Stage III
RCC local invasion beyond Gerota's fascia; spread to more than one lymph node; distant metastasis.
Stage IV
Hemodynamically significant stenosis
System unable to compensate
D - Bones A pacemaker is in place but the heart is not enlarged. There is minor shadowing of the right lung base adjacent to the pleural effusion. Elsewhere, detail of the lungs is reduced by the abnormal bones which are abnormally dense.
There is a small right pleural effusion. Which other structures are most strikingly abnormal? A - Heart chambers B - Lungs C - Soft tissues D - Bones
D - Left mastectomy
There is evidence of which previous operation? A - Thyroidectomy B - Mitral valve replacement C - Right pneumonectomy D - Left mastectomy
Pathological fracture
Through a point of weakness due to a bone abnormality or lesion
peptic ulcer disease
UGI
Suspected cholecystitis Abnormal lab values suggesting: -Liver disease -Biliary disease Suspected appendicitis (children) Follow-up
ULTRASOUND (US) indications
Patient size Intervening bowel gas
ULTRASOUND (US) limitations
NPO
ULTRASOUND (US) patient preparation
Liver, gallbladder, bile ducts Spleen, pancreas, appendix
ULTRASOUND (US) structures seen
Arterial access Pressure monitoring Enters umbilicus, curves down to pelvis, ascends to left of spine Tip should be at about: -T8 level OR -L3 level
UMBILICAL ARTERY CATHETER
T8 level OR L3 level
UMBILICAL ARTERY CATHETER Tip should be at about:
umbilicus, curves down to pelvis, ascends to left of spine
UMBILICAL ARTERY CATHETER enters
Venous access Pressure monitoring Enters at umbilicus, goes towards liver, along right side of spine Tip projects at IVC or right atrium level
UMBILICAL VEIN CATHETER
distal esophagus, stomach and duodenum
UPPER GASTROINTESTINAL EXAM (UGI) Usually includes what three structures?
Suspected ulcer Hematemesis Persistent vomiting Weight loss / anemia of unknown cause Abnormal plain films
UPPER GASTROINTESTINAL EXAM (UGI) indications
above or below
URETERAL STENT can be placed from
help urine get past an obstructing stone, tumor, or stricture
URETERAL STENT placed to
ureter renal pelvis cortex/medulla
URINARY TRACT CALCULI may be in
nephrocalcinosis
URINARY TRACT CALCULI may be in the cortex/medulla
nephrolithiasis if large, called a staghorn calculus
URINARY TRACT CALCULI may be in the renal pelvis
obstruction
URINARY TRACT CALCULI may or may not cause
Acute scrotum
US
Hypertrophic pyloric stenosis
US
Prostatism
US
RUQ Cholecystitis
US
Right upper quadrant pain
US
Scrotal mass
US
Second and third trimester complications, such as placental abruption or suspected intrauterine growth retardation,use what?
US
Urinary frequency and nocturia
US
What study should be performed first in a 20 yo female with RLQ pain?
US
Young female pelvic/LQ pain
US
spleen
US
Urinary tract infection
US MAG3 scintigraphy for suspected obstruction MCU ± DMSA in selected cases
Liver mass: detection
US CT or MRI following US
Hydronephrosis
US MAG3 scintigraphy
is the initial investigation of choice for diagnosis of suspected renal mass, followed by CT.
US US will accurately characterize a renal mass as a simple cyst, complex cyst or a solid mass.
For rotator cuff tear ' which is usually wear and tear' which two image modalities are best to be used?
US MRI
Abdominal trauma
US 'FAST' scan CT in haemodynamically stable ___________________________ Interventional radiology for acute bleeding Urethrogram and CT cystogram
the principal imaging investigations used for assessment of the urinary tract in both males and females.
US / CT
Renal mass
US and CT MRI in some centres Biopsy in selected cases
Abdominal mass
US for initial assessment CT/MRI for further characterization and staging
abdominal aortic aneurysm
US for surveillance CT for preoperative planning CT for suspected leak
acute epididymo-orchitis: where imaging is required, what is investigation of choice
US with color Doppler US is quick, non-invasive and highly accurate at differentiating torsion from inflammation.
is the first investigation of choice for a scrotal mass. The primary role is to differentiate intratesticular from extratesticular masses; in most cases, this is sufficient to distinguish malignant and benign lesions.
US with colour Doppler
Jaundice
US, MRCP Other imaging/intervention as indicated: ERCP, PTC
Varicocele consists of dilated veins of the pampiniform plexus producing a tortuous nest of veins well seen on
US. The vascular nature of the mass is confirmed with colour Doppler. Most varicoceles occur on the left and present with a clinically obvious mass or with infertility. Small asymptomatic varicoceles are common incidental findings on scrotal US. Varicoceles are caused by venous incompetence in most cases. Large varicoceles associated with infertility or discomfort may be amenable to therapeutic embolization of the testicular vein.
very
UTERINE MASS - FIBROID (LEIOMYOMA) is how common?
asymptomatic
UTERINE MASS - FIBROID (LEIOMYOMA) may be
vaginal bleeding
UTERINE MASS - FIBROID (LEIOMYOMA) may cause
menses or hormones
UTERINE MASS - FIBROID (LEIOMYOMA) may influence or be influenced by
Cardiac (Echocardiography / TEE) Vascular (Duplex / Color Doppler)
Ultrasound
Antegrade insertion is performed where the lower ureter is occluded making retrograde insertion impossible:
Under imaging guidance, the renal collecting system is punctured with a needle and a guidewire passed through the needle down the ureter and into the bladder. • The stent is then passed over the guide wire and pushed into position. • The upper pigtail of the stent should lie in the renal pelvis or upper pole calyx. • The lower pigtail should lie in the bladder (Fig. 5.13).
subcutaneous tissue
VENTRICULOPERITONEAL (VP) SHUNT CATHETER runs in the
tip is in the ventricle, and the tube brings excess CSF to the abdomen - peritoneum (or vascular system)
VENTRICULOPERITONEAL (VP) SHUNT CATHETER tip is in the
patients with hydrocephalus
VENTRICULOPERITONEAL (VP) SHUNT CATHETER used in
lead to recurrent infections
VESICOURETERAL REFLUX (VUR) if left untreated it can
cystourethrogram or nuclear medicine cystogram
VESICOURETERAL REFLUX (VUR) voiding
Greyscale Spectral Doppler Color / Power Doppler
Various modes of CAROTID DUPLEX ULTRASOUND (US)
OVARIAN CYST
Very common May have more than one Change with menstrual cycle
normal or near normal, CXR interstitial pattern common up to 2 years
Viral pneumonias often have
10%
WILM'S TUMOR (NEPHROBLASTOMA) ______ bilateral
US Or CT
WILM'S TUMOR (NEPHROBLASTOMA) diagnosed by
1-5 years
WILM'S TUMOR (NEPHROBLASTOMA) presents at
Magnetic resonance cholangiopancreatography (MRCP) is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic duct.
What is Magnetic Resonance Cholangiopancreatography (MRCP)?
B - Pneumoperitoneum Free gas under the diaphragm forms crescents of low density (black) under each hemidiaphragm. In the setting of acute abdominal pain this is a sign of bowel perforation.
What is the life threatening abnormality? A - Tension pneumothorax B - Pneumoperitoneum C - Pneumobilia D - Pulmonary oedema
A - Lung cancer Compare the meniscus sign with increased density beneath (effusion) with the normal right hemidiaphragm. When you see a pleural effusion don't forget to think of the causes. Sometimes the cause is visible, as on this image
What is the likely cause of the pleural effusion in this smoker with finger clubbing? A - Lung cancer B - Heart failure C - Sarcoidosis D - Systemic lupus erythematosus
A - Sarcoidosis Sarcoidosis is characterised by bilateral hilar adenopathy (arrowheads) and certain clinical features such as erythema nodosum (shin rash).
What is the likely diagnosis in this patient with a rash on the shins? A - Sarcoidosis B - Lung cancer C - HIV D - Asbestosis
autosomal dominant
What is the most likely mode of inheritance of the condition shown on the accompanying CT?
B - Extensive surgical emphysema
What is the striking abnormality? A - Poor quality image B - Extensive surgical emphysema C - Cardiomegaly D - Pneumoperitoneum
A - Lung fibrosis This patient has had a spontaneous pneumothorax secondary to underlying lung fibrosis. There is an extensive reticular pattern seen throughout both lungs.
What is the underlying cause of the right pneumothorax? A - Lung fibrosis B - Metastatic disease C - Emphysema D - Trauma
normal supine abdomen phleboliths
What position is this? what is arrow pointing to?
one of the pedicles is missing
What's missing is the key-1? this close up frontal view of the lower thoracic spine. Can you tell how the radiologist looked at this radiograph and wondered if the patient had lung cancer?
a metallic filling in the distal esophagus
Where did I put that tooth? the patient's physician ordered a barium swallow. This is a view of the esophagogastric junction. It shows
A - Azygos fissure
Which anatomical variant is visible? A - Azygos fissure B - Cervical rib C - Dextrocardia D - Pectus excavatum
B - Air bronchogram
Which radiological sign is beautifully demonstrated in the left lung? A - Air pneumogram B - Air bronchogram C - Air radiogram D - Air tomogram
CTA, MRA or angiogram
With Coronary Artery Disease we can image the narrowing with
flow laser, atherectomy, stent
With coronary angiogram lots of gadgets used to re-establish _____. What are some examples of gadgets?
Nonradiopaque: not seen on plain films May be able to see with US
Wood, plastic, pencil lead:
What is the choice for imagining for dislocations and fractures?
X-Rays (radiographs)
diabetics Pyelonephritis
Xanthogranulomatous pyelonephritis Emphysematous pyelonephritis
heavy alcohol ingestion pancreas (; most often from alcoholism
You look at this radiograph and say the patient's pain probably comes from
hyperinflated
______ lungs in CHRONIC LUNG DISEASE BRONCHOPULMONARY DYSPLASIA (BPD)
How will metastasis look like on a xray?
a less dense spot through the bone (gray)
small percentage of benign cysts have more complex features and are classified as complex cysts. Causes of a complex cyst include
a simple cyst complicated by haemorrhage or infection, benign cyst containing septations or calcifications, or a cystic tumou
Transvaginal US (TVUS) utilizes a
a transvaginal probe and provides better anatomical detail of the uterus and ovaries.
burst fracture
accompanying transverse CT of the lumbar spine
PULMONARY INTERSTITIAL EMPHYSEMA (PIE)
air in the interstitial space
A chromosomal abnormality can only be confirmed by
amniocentesis or chorionic villous sampling (CVS).
In first trimester the most important factors to establish on US are the presence and appearance of
an intrauterine gestational sac.
Hydrocele is seen on US as
anechoic fluid surrounding the testicle. Hydrocele may be congenital, idiopathic, or secondary to inflammation, torsion, trauma or tumour.
GI bleeding
angiography for
clavicle over 3rd rib
angulation
What does colles fracture consists of?
angulation of the bone and a transverse fracture
What is a seconday ossification center that arises from growing bone (forms from a protrussion of growing bone)?
apopyhsis
What are MRI and CT use for in the musculoskeltal system?
assessing specific problems
The most common ovarian tumour in premenopausal women is
benign cystic teratoma or 'dermoid cyst'. Dermoid cysts contain fat, hair and sometimes teeth, and are bilateral in 10 per cent of cases. Dermoid cysts are seen on US as complex cystic or solid lesions with markedly hyperechoic areas due to fat content
hematuria
blood in the urine
any primary tumor can metastases into ____?
bone
What is another name for scintigraphy in muscloskeltal?
bone scan
What are complete fractures?
bone that break all the way through
What does non-union mean?
bone will never unite unless there is some intervention
What are incomplete fractures?
bones that do not break all the way through
What are two rotator cuff disorders?
calcific tendonisis degenerative tendonosis of the rotator cuff tear
calcification of the stylohyoid ligament
calcification in the neck the blue arrows point to
Costal (rib) cartilages Gallstone (cholelithiasis) Kidney stone (nephrolithiasis) Appendicolith Phlebolith Arterial calcifications - aortoiliac, splenic Calcified uterine fibroid (leiomyoma) Calcified lymph nodes Prostate calcifications
calcifications examples
Pericardial effusion somewhat mimics ___________.
cardiomegaly
Internal carotid artery (ICA) External carotid artery (ECA)
carotid bifurcation consist of
____ is not seen on radiograph? Which modality is it seen best with?
cartilage (HYALINE) MRI
Where do you see most incomplete fractures?
children
investigation of choice for CAD depends on what factors
clinical presentations cardiac risk factors local expertise and availabilyt
angiography (For GI BLEEDING)
coils or vasopressin
What is a very popular distal radius fracture?
colles fracture
multiple pregnancy Risks to the fetuses include an increased incidence of
congenital anomalies, intrauterine growth retardation and low birthweight, and premature labour.
What disease do the following indicate? 1. left-sided heart chambers cannot pump enough blood 2. blood "backs up" into the pulmonary veins 3. heart *MAY* be enlarged 4. possible "bat wing" lung pattern 5. progression from "plump" vessels (cephalization), followed by interstitial edema, then alveolar edema (pulmonary congestion)
congestive heart failure (CHF)
Bone bruises are also seen which are?
contusions in the trabeculae due to compression
cardiac catherization
coronary angiogram aka
What is the two parts of the bone? and which one appears white on the xray and which one appears less dense?
cortex --> white medulla --> less dense
At_______ , the ureteric orifice is identified and a catheter passed into the ureter Contrast material is then injected via this catheter to outline the collecting system and ureter.
cystoscopy
Ureteric stent insertion may be either retrograde or antegrade. Retrograde insertion is done via
cystoscopy
longitudinal
direction of fracture line
oblique
direction of fracture line
spiral
direction of fracture line
transverse
direction of fracture line
emergency surgery
dissection type A of aorta treated by
medication
dissection type B of aorta treated by
_____ are the most common radius fractures?
distal radius
Fetal MRI may be useful in second and third trimester pregnancy for sorting out complex fetal anomalies. MRI is used increasingly in gynaecology for
diverse indications including suspected endometriosis, diagnosis of uterine pathology such as adenomyosis, and staging of gynaecological malignancies
high
does aortic dissection have high or low mortality
Sigmoid volvulus
dominant finding relevant to gastrointestinal disease for attached AXR
caecal volvulus
dominant finding relevant to gastrointestinal disease for attached AXR
distal large bowel obstruction due to colorectal carcinoma
dominant finding relevant to gastrointestinal disease for attached AXR
perforated gastric ulcer
dominant finding relevant to gastrointestinal disease for attached AXR
small bowel obstruction due to adhesions
dominant finding relevant to gastrointestinal disease for attached AXR
aortic dissection
dominant finding with reference to the accompanying chest CT
interstitial oedema
dominant finding with reference to the accompanying chest CT
pericardial calcification
dominant finding with reference to the accompanying chest CT
pulmonary arterial hypertension
dominant finding with reference to the accompanying chest CT
Deep venous thrombosis
duplex US
hypertension: suspected renal artery stenosis
duplex US
venous incompetence
duplex US
f a gestational sac cannot be identified in the uterus with TVUS despite a β-hCG level of 1000 mIU/mL or more,
ectopic pregnancy should be considered.
In non-pregnant premenopausal womenIf hormonal therapy does not control the bleeding, endometrial hyperplasia (precursor for endometrial carcinoma)
endometrial polyp are the primary diagnoses
he diagnostic sign of endometrial carcinoma on US is
endometrial thickening. An endometrial thickness of more than 5 mm in a postmenopausal woman is an indication for further assessment with hysteroscopy and endometrial sampling.
Transvaginal
exam gives more detailed view
Transabdominal
exam gives overview
What are the 3 technical assessments needed to look at bone on an xray?
fine bony detail --> sharp definition of surfaces soft tissue detail --> fat planes between muscles visible aurticular surfaces (minimal overlap)
What is lipohaemarthosis of the knee?
fluid levels of the knee that are low density
chronic Pyelonephritis
found incidentally, scarred kidney
there is no fracture
fracture or not? - part 2 the patient has pain where the arrow is pointing. After looking at this foot radiograph you say
Bones that are healing are called ____ and form into new bone in what 3 stages?
fracture union inflammatory stage reparative stage remodeling stage
What is a pathological fracture? What is an example?
fractures due to weak points in bones. Langerhans cells histiocytosis
What are communtion fractures?
fractures in multiple segments (fragments)
What are delayed unions?
fractures that do not heal in specific time, this can occur if their is immobilization as well as in the elderly
total hip replacement: dislocated
from the accompanying images of a patient has undergone joint replacements please choose the likely diagnosis
total hip replacement: periprosthetic fracture
from the accompanying images of a patient has undergone joint replacements please choose the likely diagnosis
PSA is unable to differentiate those tumours that may remain small and confined to the prostate from
from those that may cause local invasion and metastases.
fracture of transverse processes
frontal radiography of the lumbar spine
transabdominal US has a wider field of view and requires a
full bladder to visualize the pelvic organs.
Spectroscopy increases the accuracy of tumour detection with MRI, though has not replaced TRUS-guided biopsy.
fyi
What is an example of metabolic anthroplasty?
gout
What are 2 examples of apophysis?
greater trochanter and tibial tuberosity
What are some things you are looking for when looking at a bone xray?
head of bone facets articular surfuces epicondyle condyles tuberosity trochanter foramen processes
Glomerulonephritis is suspected where haematuria is accompanied by
heavy proteinuria and red cell casts. Glomerulonephritis is confirmed with renal biopsy, best done under imaging guidance, usually US. Patients with glomerulonephritis should have a CXR to search for cardiac enlargement and pulmonary oedema, plus a renal US to screen for underlying renal morphological abnormalities.
The most common CT appearance of renal cell carcinoma is a
heterogeneous soft tissue mass that enhances with intravenous contrast material (
w/ angulation anterior structures will be projected (like the clavicles) will be projected
higher on the film than posterior structures
Fractures of the femur are normally called ?
hip fractures
10 posterior ribs
how many posterior ribs visible in an excellent inspiration
Most (90 per cent) extratesticular lesions are benign. The most commonly encountered extratesticular masses are
hydrocele, varicocele and epididymal cyst.
Lymphoma of the testis is
hypoechoic and homogeneous and may be focal or diffuse.
On US, most intratesticular tumours are
hypoechoic. Weaker diffuse reflections produce grey dots
If the patient is infertile (cannot become pregnant), then a _______________ is also often ordered to assess the anatomy of the uterus and Fallopian tubes
hysterosalpingogram (HSG)
apical lordotic view
if the X-ray beam is angled toward the head the film is obtained is called
heart is closer to the film and thus less magnified
in a PA film, the heart is ________ and thus ____
narrowing
in a coronary angiogram images of enhanced vessels show area of
TVUS has a smaller field of view, and is not appropriate for very young or elderly patients. Apart from these constraints, TVUS is more accurate than transabdominal US in
in first trimester pregnancy and in most gynaecological conditions.
< than 50%
in most normal people cardio-thoroacic ratio is
Kerley B lines means there is fluid where?
in the pulmonary interstitium
Myositis
infected / inflamed muscle
Cellulitis
infected / inflamed subcutaneous fat
Osteomyelitis
infected bone / marrow
Septic arthritis
infected joint space
What are the 3 categories that arthopathies can be seperated into?
inflammatory degenerative metabolic
What is a major limitation for radiography when it comes to bones?
insensitivity for bones to change (early adultohood to adolescence)
at least 8-9 posterior ribs
inspiration
what is the fracture called when it is broken between the two trochanters?
intertrochanter fracture
TVUS may be used to guide
interventional procedures, such as biopsy, cyst aspiration, abscess drainage and ovarian harvest.
IVP consists of a series of radiographs performed after
intravenous injection of iodinated contrast material to show the kidneys, renal collecting systems, ureters and bladder.
What are arthopathies?
joint disease
When radiographing long bones what should be included?
joints at each end
Name some common sites of metastases?
kidney breast prostate lung GI thryoid melanoma
Patients with suspected ectopic pregnancy who are haemodynamically unstable should be assessed
laparoscopically
osteoarthritis
lateral radiograph of lumbar spine
hangman's fracture
lateral radiography of the cervical spine
normal cervical spine
lateral radiography of the cervical spine
osteoarthritis
lateral radiography of the cervical spine
anastomosis check post-radial prostatectomy
micturating (voiding) cystourethrogram (MCU/VCU
MCU
micturating cystourethrogram.
What is the name of the fracture that occurs in the anterior upper third? What is the name of the fracture that occurs in the lower third?
monteggia galeazzi
Figure 6.11 Cystadenocarcinoma of the ovary: US. Transvaginal US shows a multicystic ovarian mass with multiple septations and complex fluid contents.
most common cancer
Figure 6.10 Dermoid cyst of the ovary: US. The right ovary (arrows) is enlarged due to the presence of a hyperechoic mass. The mass contains focal calcification (C) casting an acoustic shadow (AS).
most common tumour
US is also usually the investigation of choice for
most gynaecological disorders, including pelvic mass, dysmenorrhoea and postmenopausal bleeding.
US, CT and scintigraphy have replaced IVP for
most indications including renal colic, prostatism, urinary tract infection and renal cell carcinoma.
Gallstones
most likely cause of the abnormal calcifications shown on this AXR
trans-scaphoid perilunate dislocation
most likely classification of the fracture shown in the accompanying wrist radiograph
myocardial viability
myocardial perfusion scintigraphy echocardiography
Which hand fracture is the classic 'punching injury'?
neck of the 5th metacarpal
prominent, normal thymus
neonate; mild transitory respiratory distress, now resolved
mild transitory respiratory distress, now resolved
neonate;radiography performed in expiration
It can be split into two categories, monoarthpathy and polyarpathy
no answer
Late union is when there is ossification of callous around the fracture.
no answer :)
on the skin
nodules but where? this view of the upper abdomen demonstrates multiple soft tissue nodules. these are most likely located where?
acute left flank pain and microhaematuria
non-constrast enhanced CT
Towards the end of the first trimester, a thin hypoechoic layer can be observed in the posterior neck of the fetus, deep to the skin. This is known as
nuchal translucency
s can be seen from this staging system, the most important factor in early endometrial carcinoma is the degree
of local invasion.
Polycystic ovarian syndrome (PCOS) is a common cause of chronic anovulation and infertility. PCOS refers to a spectrum of clinical disorders with the classic triad of
oligomenorrhoea, obesity and hirsutism (Stein-Leventhal syndrome) being the best known.
What is the difference between open and closed bone?
open --> also called compound goes through the skin closed --> no impediment of the skin
splenomegaly
photo wasn't attached to quiz. 11 year old male recurrent abdominal discomfort for about 10 days
As stated above, over 60 per cent of RCCs are diagnosed incidentally. Most of these are small, early-stage tumours (<4 cm) amenable to minimally invasive, nephron-sparing treatment options. Such treatment options include
open or laparoscopic partial nephrectomy and percutaneous tumour ablation. Percutaneous tumour ablation techniques are becoming widely available and include radiofrequency (RF) and cryoablation. Both techniques involve precise intratumoral placement of probes under imaging guidance. Ablation procedures may be performed with local anaesthesia and conscious sedation or general anaesthesia. Choice of imaging guidance technique (US, CT or MRI) depends on multiple factors including size and position of tumour, body habitus of patient, and local expertise and availability. Patient preparation includes: • Bleeding studies • Biopsy: up to 25 per cent of small renal tumours are benign and do not require treatment.
What is the prime example of degenerative arthoplasty? What is the main pathological change in OA?
osteoarthritis loss of articular cartilage
Clavicle fractures occur usually midshaft and which side of this is usually displaced downward?
outer fragment (lateral side)
there if free air
pain after sigmoidoscopy you look at this radiograph and decide
The classic clinical triad of ectopic pregnancy consists of
pain, vaginal bleeding and palpable adnexal mass.
paget's disease
pelvic pain this is a frontal radiograph of the pelvis radiograph of the pelvis in a 79 year old man what is the most likely diagnosis
_____ fractures are extremely common in motor accidents and significant trauma? How many planes do these fractures occur in?
pelvic ring fractures , 2
Avulsion fractures occur most often in ______ near the _____ and are distraction forces of muscles, tendons and ligaments?
pelvis athlets
see spine through the heart
penetration
Percutaneous nephrostomy refers to
percutaneous insertion of a drainage catheter into the renal collecting system.
When you hear the term "water bag" or "carpet bag", what should you think of?
pericardial effusion
What is the difference between a perilunate dislocation and a lunate dislocation?
perilunate --> will articulate with the other bones as well as the carpal bones lunate --> will not articulate with other bones
Claudication: PVD Peripheral vascular disease (PVD), commonly referred to as peripheral artery disease (PAD)
physiological testing and doppler US CTA/MRA ***** catheter angiogrpahy largely replaced by CTA/MRA for diagnosis of PVD
Third trimester US for a variety of indications, e.g
placenta praevia, suspected intrauterine growth retardation, follow-up of fetal anomalies.
Views Available Supine abdomen Upright abdomen Left lateral decubitus abdomen (LLD) Posteroanterior chest x-ray (PA CXR) Two views of the abdomen Three views (three-way) of the abdomen Four views of the abdomen "Obstruction Series"
plain films views available
MRI
please choose the imaging investigation of choice for the following clinical scenario: 35 year old male: severe,debilitating left leg pain in distribution of L5 dermatome
no imaging required
please choose the imaging investigation of choice for the following clinical scenario: 38 year old male acute lower back pain while gardening; afebrile; no leg pain; normal neurological examination
Scintigraphy with 99mTc-MDP (bone scan)
please choose the imaging investigation of choice for the following clinical scenario: 58 year old male: staging of adenocarcinoma of prostate; no back pain or neurological symptoms; exclude skeletal metastases
MRI
please choose the imaging investigation of choice for the following clinical scenario: 65 year old male: low back pain for 1 week; increasing in severity; febrile; sigmoid colectomy 1 month previous for complicated diverticulitis
radiograph of the spine
please choose the imaging investigation of choice for the following clinical scenario: 69 year old female: acute onset severe mechanical low back pain; no trauma; known osteoporosis
ultrasound
please choose the imaging investigation of choice with reference to the following clinical scenario: 18 year old male: acute scrotum
non-constrast enhanced CT
please choose the imaging investigation of choice with reference to the following clinical scenario: 50 year old male: acute left flank pain and microhaematuria
micturating (voiding) cystourethrogram (MCU/VCU
please choose the imaging investigation of choice with reference to the following clinical scenario: 55 year old male: anastomosis check post-radial prostatectomy
Contrast enhanced CT (CT urography)
please choose the imaging investigation of choice with reference to the following clinical scenario: 66 year old female: Characterization of complex renal cyst found on ultrasound
ultrasound
please choose the imaging investigation of choice with reference to the following clinical scenario: 76 year old male: Urinary frequency and nocturia
right-sided, or bilateral
pleural effusion is often
Second or third trimester vaginal bleeding may be due to
premature labour, or placental problems including placenta praevia, placental abruption and placenta accreta.
congestive cardiac failure
premature neonate; respiratory distress
surfactant deficiency syndrome (SDD) and pneumothorax
premature neonate; respiratory distress
Bones have primary and secondary ossification centers, which center is found before birth and where is it located and which is found after birth and where is it located?
primary --> before birth and located in the diaphysis secondary --> after birth and located in the epiphysis
PICC line
procedure shown on the accompanying CXR
aortic valve replacement
procedure shown on the accompanying CXR
mitral valve repair and pacemaker
procedure shown on the accompanying CXR
Contrast pulmonary angiogram
radiology contrast method used for PE
For MCU, the bladder is filled with contrast material via a urethral catheter. Images of the contrast-filled bladder are obtained. The catheter is then
removed and radiographs are taken during micturition.
Fibrous lamellae 3 types: I - connect renal capsule with _____ II - only connected to capsule, circumscribing kidney III - connect ARF to ------
renal fascia PRF
Most solid renal masses are malignant; _______ is the most common type.
renal cell carcinoma Over 60 per cent of RCC are diagnosed incidentally.
The imaging workup of patients with painless haematuria is therefore directed at excluding or diagnosing
renal cell carcinoma and urothelial carcinoma (transitional cell carcinoma or TCC).
WILM'S TUMOR (NEPHROBLASTOMA)
renal malignancy
Blunt trauma MVA Penetrating trauma Gunshot, stab wound Laceration, hematoma, avulsion from vascular pedicle
renal trauma
What is an example of inflammatory polyarthyopy? what is the main pathological issue of this?
rheumatoid arthritis synovial inflammation
spinous process between clavicle
rotation
A simple cyst appears on US as a
round anechoic (black) structure with a thin or invisible wall (Fig. 5.4). No further imaging is required for simple renal cysts diagnosed with US.
Where renal cell carcinoma is suspected, US is also used to look for specific findings such as
s invasion of renal vein and inferior vena cava (IVC), lymphadenopathy, and metastases in the liver and contralateral kidney.
pars interarticularis defect (spondyloysis)
sagittal CT of the lumbar spine
What is the most common type of fracture on a wrist?
scaphoid
stricture
scarring
_______ is the main screening of metastasis and tumors?
scintigraphy *BUT CT WITH SCINTIGRAPHY FOR GOOD RESULTS
Imaging for staging of testicular tumours consists of
scrotal US, abdomen CT for retroperitoneal lymphadenopathy, and chest CT for mediastinal lymphadenopathy and pulmonary metastases.
Epididymal cyst, also known as spermatocele, is a common incidental finding on
scrotal US, or may occasionally be large enough to present as a palpable mass. Epididymal cyst appears on US as a well-defined anechoic simple cyst in the head of the epididymis, i.e. posterolaterally at the superior pole of the testis.
Fetal MRI may be useful in what trimester pregnancy for sorting out complex fetal anomalies.?
second third
What are the three common patterns for anterior pelvic injury?
seperation of the pubic symphysis bilateral fractures of the pubic rami unilateral fractures of the pubic rami
uses highly focused sound waves to fragment renal or ureteric stones. is the technique of choice for the management of most renal stones.
shock wave lithotripsy
Ovarian masses may be classified on US as
simple cysts, complex cysts (cyst complicated by soft tissue septations or nodules) or solid.
Renal masses may be classified with imaging into
simple cysts, complex cysts and solid masses.
SPECT-CT
single photon emission CT-CT
CT is also used for staging of renal cell carcinoma. Factors relevant to staging of RCC include
size of tumour, invasion of local structures such as adrenal gland, vascular invasion of renal vein or IVC, lymphadenopathy, and metastases in the liver and skeleton.
What are some things you can see on an xray that would make you know is an arthopathy ?
symmetry or asymmetry small joints or large weight bearing joints erosions joint space narrowing oseophytes
Nodular hyperplasia with enlargement of the central prostate is the commonest cause of
symptomatic prostatic enlargement. Symptoms of prostatism include frequency, nocturia, poor stream, hesitancy and post-void fullness.
Osteochondral fractures of the ankle are most common in which bone?
talus
Most (over 90 per cent) intratesticular masses are malignant. Exceptions include
testicular abscess, TB, sarcoidosis and benign tumour such as Sertoli-Leydig tumour.
SCROTAL US IMAGE __________ ON EACH SIDE
testis and epididymis
normal gas in the joint space
the arrows point to
For ascending urethrogram, a small catheter is passed into
the distal urethra and contrast material injected. Radiographs are obtained in the oblique projection to show the urethra in profile.
calcification of an old tuberculous empyema
the most likely cause of this abnormality in the left hemithorax is
left atrial myxoma
the most likely diagnosis for the following clinical scenario with reference to accompanying image. 35 year old female: mild intermittent chest pain and shortness of breath
salter harris type 2
the most likely salter-harris classification for the accompanying image
salter-harris type 3
the most likely salter-harris classification for the accompanying image
salter-harris type 4
the most likely salter-harris classification for the accompanying image
US
the primary imaging investigation of choice for assessment of gynaecological disorders
PA
the standard chest X-ray is a ___ film
aspirated barium
this is a frontal radiograph of the chest in a patient who just did what
the silhouette sign
this is a radiograph of a hollow rubber ball that has been filled with water using a syringe. that the inside wall of the ball can no longer be seen is an example of
patient has an abdominal aortic aneurysm
this is the lateral lumbar spine radiograph on a 78 year old female with back pain what is the key finding
Based on CT appearances, cystic renal lesions may be classified according
to the Bosniak system
Radial and ulnar fractures usually occur ____?
together
Normal CT
top left - IVC bottom left - right adrenal gland right arrow - stomach
In the absence of compelling evidence of urinary tract infection or glomerulonephritis, painless haematuria should be considered to be due to
urinary tract tumour until proved otherwise.
MR (or bone scan)
usually done for suspected osteomyelitis
Is sctinigraphy sensitive or insensitive?
very sensitive therefore can see very specific things on bones
Micturating cystourethrogram (MCU) is also known as
voiding cystourethrogram (VCU).
lateral supine film
what film often shows the PTX better
Bilateral decubitus films
what films used for INHALED (ASPIRATED) FOREIGN BODY
[type of echocardiogram] A transesophageal echo (TEE) test is a type of echo test in which the ultrasound transducer, positioned on an endoscope, is guided down the patient's throat into the esophagus (the "food pipe" leading from the mouth into the stomach). An endoscope is a long, thin, flexible instrument that is about ½ inch in diameter.The TEE test provides a close look at the heart's valves and chambers, without interference from the ribs or lungs. TEE is often used when the results from standard echo tests are not sufficient, or when your doctor wants a closer look at your heart. TEE may be combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart's valves.
what is a TEE?
Flow: stagnant blood Wall abnormalities Hypercoagulability (thick blood)
what is virchow's triad?
film is under penetrated, you can't see heart through the spine. dEgree of inspiration is probably adequate. rotation can not be evaluated and there is slight amount of angulation. incidentally, there is large bronchogenic ca in the left lung
what is wrong with this photo
patient is rotated considerably toward her own left side notice how the hemidiaphragm appears elevated on the side to which the patient is rotated
what is wrong with this photo
the image is apical lordotic look at the high position of the clavicles. it is also under penetrated. you can't tell if its roared and the degree of inspiration is adequate
what is wrong with this photo
the patient has taken a poor inspiration. Also rotated toward his own right, it is slightly under penetrated and he is not angulated
what is wrong with this photo
normal supine abdomen
what position is this?
normal upright abdomen surgical clips (top arrow) air fluid level (bottom arrow)
what position is this? what are arrows pointing to?
Endoscopy (versus barium studies)
what test should use for GI tract except for small bowel
US or HIDA
what test should use for Gallbladder/bile ducts
CT
what test should use for JUST ABOUT EVERYTHING ELSE:
barium studies or CT
what test should use small bowel
normal lateral lumbar spine vertebral body disk space pedicle posterior spinous process iliac crest
what view is this? label yellow lines from top to bottom
liver, pancreas, spleen, nodes
what you biopsy
echocardiogram, myocardial perfusion SPECT stress test, MR or PET
with CAD the effects of the narrowing seen by
In what two areas in bone overlap unavoidable?
wrist and ankle
A gestational sac is seen as a round fluid-filled structure in the uterus. It contains a
yolk sac (arrow) and a single fetus
Management of placental insufficiency and other factors that may impact on fetal well-being is assisted by assessment of various US parameters including:
• Amniotic fluid volume • Doppler analysis of umbilical artery, umbilical vein, ductus venosus and fetal middle cerebral artery • Fetal breathing movements • Fetal limb movements • Fetal heart rate.
The 'Rotterdam criteria' for the diagnosis of PCOS include:
• Anovulation • Hyperandrogenism • US findings of 12 or more follicles measuring 2-9 mm, and ovarian volumes of more than 10 cc • Exclusion of other possible aetiologies such as Cushing's disease or androgen secreting tumour.
Technique of percutaneous nephrostomy:
• Antibiotic cover • Local anaesthetic and intravenous conscious sedation; general anaesthetic in children • Imaging guidance: US and fluoroscopy, or CT • Renal collecting system punctured with a needle • Passage of a guidewire • Insertion nephrostomy catheter over the guidewire.
Indications for MCU:
• Assessment of urinary tract infection in children (see Chapter 13) • Following radical prostatectomy to check the surgical anastomosis and the integrity of the bladder base • Assess posterior urethral problems in male adults • Stress incontinence in female adults.
The fetal morphology scan provides an assessment of gestational age accurate to ±1 week, based on a number of measurements including:
• Biparietal diameter of the fetal skull • Head circumference • Abdomen circumference • Femur length. placenta position aminiotic fluid volume
US of the urinary tract may supplement CT urography in selected cases. Indications for US include:
• Characterization of complex cysts • Differentiation of complex cysts from solid masses.
First trimester US used for
• Confirmation of live pregnancy • Accurate assessment of dates • Management of complications, e.g. suspected ectopic pregnancy
Goals of imaging a suspected renal mass include:
• Confirmation of presence and site of mass • Classification into simple cyst, complicated cyst or solid mass • Assessment of contents, such as the presence of fat • Differentiation of benign from malignant • Diagnosis of complications such as local invasion, venous invasion, lymphadenopathy and metastases.
US signs of testicular torsion:
• Decreased spermatic cord Doppler signal and lack of blood flow in the testis • Testis may be normal in appearance, or enlarged and hypoechoic.
US signs of acute epididymo-orchitis:
• Enlarged hypoechoic epididymis with increased blood flow • Enlarged hypoechoic testis with increased blood flow • Surrounding fluid/hydrocele.
Indications for ascending urethrogram:
• In the setting of trauma prior to urethral catheterization in a male patient with an anterior pelvic fracture or dislocation, or with blood at the urethral meatus \• Suspected urethral stricture, which may be the result of previous trauma or inflammation.
Limitations of US in this context include:
• Incomplete visualization of the kidneys due to obesity or intestinal gas • Inability to visualize small urothelial tumours.
Staging of testicular tumour incorporates four factors:
• Local growth within the testicle and invasion of adjacent structures including spermatic cord and scrotal skin • Spread to regional lymph nodes • Metastasis to distant lymph nodes or other organs, e.g. lung and brain • Serum tumour marker levels
An accurate risk assessment for fetal aneuploidy is calculated based on:
• Maternal age • Nuchal thickness • Presence or absence of the fetal nasal bone • Maternal levels of β-hCG and pregnancy-associated plasma protein A (PAPP-A).
Postprocedure follow-up includes:
• Observation for immediate complications, such as pain • Imaging with contrast-enhanced CT or MRI to ensure ablation of the tumour and exclude complications such as haemorrhage.
Histologically, most cervical carcinomas are squamous cell carcinoma. The mode of spread is by local invasion plus involvement of lymph nodes. The FIGO staging system for cervical carcinoma is as follows:
• Stage 0: carcinoma in situ • Stage 1: confined to the uterus • Stage 2: local invasion beyond the uterus not involving the lateral pelvic wall or lower third of vagina • Stage 3: more extensive invasion with involvement of pelvic wall or lower vagina or causing hydronephrosis • Stage 4: invasion of bladder or rectal mucosa or distant metastases, including pelvic and retroperitoneal lymph nodes.
The FIGO staging system for ovarian cancer is as follows:
• Stage I: tumour confined to the ovary • Stage II: tumour involving one or both ovaries with pelvic extension • Stage III: intraperitoneal metastases and/or regional lymphadenopathy • Stage IV: distant metastases beyond the peritoneal cavity, e.g. liver metastases or malignant pleural effusion.
Indications for RPG:
• To better define lesions of the upper renal tract identified by other imaging studies such as CT • Haematuria where other imaging studies are normal or equivocal • Guide for various interventional procedures including removal of ureteric calculus and ureteric stent placement.
Over 70 per cent of cases of haematuria have no demonstrable cause. Demonstrable causes of haematuria include:
• Urinary tract infection • Urinary calculi • Tumour of urinary tract • Trauma • Glomerulonephritis
Adenocarcinoma of the prostate may be diagnosed in a number of ways:
• Urinary tract symptoms, e.g. haematuria, obstructive voiding symptoms • Histological examination of tissue chips obtained by transurethral resection (TURP) for presumed benign prostatic enlargement • Bone metastases may be the initial finding due to a specific presentation like bone pain or spinal cord compression • Multiple sclerotic metastases are occasionally picked up as an incidental finding on a radiograph performed for unrelated reasons, e.g. pre-anaesthetic CXR or AXR for abdominal pain.
