Clin Dx Review For Radiology per Abby
Terms
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- Why use the lordotic view?
- Shows the lung markings
- Absorb x-rays well, inc density
- radiopaque
- Absorb X-rays poorly, dec densityu
- radiolucent
- Solid organs are ______ for US.
- Echogenic
- Fluid is _____ for US.
- Echolucent
- Why get a CXR?
- Pneumonia, CHF, trauma, ICU
- Why get an Abd XR?
- Acute abd pain, check tube placement
- How you quantify brightness on a CT?
- HU
- Why get non-contrast head CT?
- AMS, anything due to cranial bleed
- Why get a contrast head CT?
- Immunocompromised CNS infx, tumors
- Why get a chest CT?
- trauma, PE, hemoptysis
- Why get an Abd/Pelvic CT?
- PLQ pain, LLQ pain, N/V/distention, trauma
- Why get an abd US?
- RUQ pain, cirrhosis, abn LTF
- Why get a renal US?
- dec urinary output, cysts, transplant with inc Cr
- Why get a brain MRI?
- Chronic h/a, unilat weakness, difficulty with speech and balance, MS, pituitary adenoma, CNS infx
- Why get a spinal MRI?
- back and neck pain with neuro sxs
- Abd MRI?
- evaluate a mass, dx difficult CT cases, MRCP, MRA of vessels
- bone scan?
- newly dx Ca, chronic back pain, DM
- T1, MRI
- gray is gray and white is white
- T2 MRI
- CSF and water are bright
- Flair MRI
- variation of T2, CSF= gray abnl= white
- Diffusion wt MRI
- ischemia is bright
- Acute Radiation Syndrome
- Bone marrow suppression, GI sxs, Neurovascular Sx
- Acute blood on CT
- <3days, hyperdense
- Subacute blood on CT
- 3-14 days, isodense
- Chronic blood on CT
- >14days, hypodense
- Types of extra-axial ICH
- subarachnoid, epidural, subdural
- causes of subarachnoid ICH
- aneurysm, trauma
- CT of subarachnoid ICH
- hyperdense, CSF in fissures
- causes of epidural hematoma
- skull fx, MMA tear
- CT of epidural hematoma
- lens-shaped can cross falx, does not cross suture lines
- causes of subdural hematoma
- tearing of veins, abuse, NOT skull fx
- CT of subdural hematoma
- crescent shaped, do not cross falx
- Hct level of subdural hematoma
- rebleed
- types of intra-axial ICH
- cortical contusions, intraventricular, DAI
- causes of cortical contusions
- brain hitting bone
- CT of cortical contusion
- circumscribed, hyperdense, anterior or middle fossa
- causes of intraventricular
- tearing of veins
- CT of intraventricular
- hyperdense, in the ventricles
- cause of DAI
- MVCs, shearing forces
- What is a watershed infarct?
- dec'd BP during surgery, bilateral sxs, "man in Barrel"
- SXS of left MCA tear
-
anterior- motor aphasia
posterior- receptive aphasia - SXS of right MCA tear
- visuospatial dysfx
- SXS of ACA tear
- leg weakness
- SXS of PCA tear
- hemianopsia
- CT of petichial hemmorhage
- creeping blook in gyriform pattern, hyperdense
- CT of acture stroke (non-contrast)
- insular ribbon sn, hyperdense MCA sn, hypodense edema
- What is insular ribbon sn?
- Blurring of gray-white layers of insular cortex
- Suprasellar masses
- SATCHMO
- Ring enhancing lesions
- MAGICDR
- T1 bright lesions
- hemorrhage, melanin, fat, inc'd protein, Gadolinium, Ca++
- 3-6-9 Rule of GI
-
SB<3
TC<6
C<9 - Rule of 3s of GI
- walls and folds<3mm, diameter <3mm, only 3 air fluid levels
- Adynamic ileus
- dilation of both large and small bowels
- SNS of free air
- subdiaphragmatic gas outlining the falciform ligamnet, gas on both sides of bowel (Riglers)
- Portal venous gas
- thin-branched lucencies that extend to liver periph.
- Pneumobilia
- centrally located branched lucencies that do NOT extend to liver periph
- Sigmoid Volvulus
- coffee bean sn, brids beak sn
- Double contrast UGI
- U and L abd pain, N/V, prior ulcer, prior GI surgery, heme + stools
- Benign Gastric Ulcer
- folds to the crater, crater penetration beyond NL margin, hampton's line, ulcer collar
- What is Hampton's line?
- thin line across ulcer neck
- UGI with SBFT
- U and L abd pain, N/V, h/o Crohn's, prior GI surgery, anemia
- Look of Crohn's
- Folds thicken, aphthous ulcer, fistulas, skip lesions, creeping fat, cobblestone look
- Need double contrast BE?
- Guaniac + stool, incomplete colonoscopy, abd pain, colon Ca screen
- IVP
-
NL calyx= cupped, dilated calyx= clubbed
ureters<7mm
bladder has smooth outline - Location of stones
- UPJ, UVJ, where ureter crosses the iliac
- classification of fx
- extent, direction, displacement, # of Fx lines, rotation, angulation
- Complete Fx
- discontinuity btw 2 or more fragments
- Incomplete Fx
- portion of the cortex remains intact, AKA greenstick
- Closed Fx
- overlying skin intact
- Open Fx
- AKA compound fx, overlying skin is open
- Transverse Fx
- R angle to axis of the bone
- Oblique Fx
- 45 degree angle to long bone
- Comminuted Fx
- more than 2 fragments
- Butterfly fragment
- triangular fragment is detached from other 2 fragments
- Segmental Fx
- segment is detached both proximally and distally
- Lipohemarthrosis
- fx that allows fat and blood into joint space
- Compression fx
- compaction of bone which dec length
- depressed fx
- portions driven inward
- Stress Fx
- in response to repeated stress
- Pathologic fx
- occurs in area of weakness from disease
- Torus Fx
- AKA buckle, cortex is intact with buckling of the opposite
- Bowing fx
- plastic deformation caused by stress
- displacement
- separation of fragments (sideways)
- Angulation
- angular deformity
- Distraction
- separation of fragments (wide)
- Dislocation
- disruption of articulation
- Subluxation
- partial loss of articualtion
- Colle's fx
- transverse fx of distal radius with dorsal angulation
- Boxer's fx
- transverse fx of the neck of 5th metacarpal with 5th metacarpal volar angualtion
- Monteggia fx
- fracture of shaft of ulna with anterior dislocation of radius at elbow
- Galeazzi fx
- fx of shaft of radius and dorsal dislocation of ulna at wrist
- Jones Fx
- tranverse fx of base of 5th metatarsal
- SH type 1
- through epiphyseal plate
- SH type 2
- through metaphysis, plate and epiphysis
- SH type 3
- through epiphysis, not metaphisis, then plate
- SH type 4
- through metaphysis, plate and epiphysis
- SH type 5
- compression
- anterior column of spine
- vertebral bodies, discs, ant and post long. Ligaments
- Posterior column
- facets, aposyseal jts, pedicles, lamina, ligaments
- Jefferson Fx
- comminuted fx of atlas (ring breaks)
- Hangman's fx
- hyperextension of head, break arch of C2 with anterior subluxation of C2 on C3
- Clay Shoveler's fx
- avulsion of spinous process in L C-spine or U C-spine
- Seatbelt fx
- transverse fx of lumbar vertebra with visceral injury
- Spondylosis
- Cleft btw sup and inf articular process of vertebra
- Spondylolithesis
- displacement after spondylolysis
- Radiographic osteoporosis
- cortical thinning with irregularity and resorption of endosteal surfaces, compression of T-spine, spotty skull
- Radiographic Osteomalacia
- loss of bone density, indistinct cortical borders, bowling deformities, protrusionacetabuli
- What is protrusion acetabuli?
- Inward bending of the sideways with deepening of acetabular cavities
- Radiographic Rickets
- inc'd distance btw epiphysis and end of shaft, metaphyseal lines disappear, bowing rachitic rosary, kyphosis
- What is rachitic rosary?
- beading of sternal ends of ribs
- Radiographic Paget's?
- Radiolucent skull, cottonwool appearance of cortex, enlarged vertebral bodies
- Radiographic gout?
- jt effusion, periarticular swelling, punchout defects in hand and foot, overhanging edges, jt space narrowing, tophi
- Osteochondroma
- benign projection of bone with cartilaginous cap in children (usually knees)
- Endochondroma
- benign cartilaginous tumor from medullary canal in children (usually hand bones)
- Giant Cell Tumor
- distal end of femur or proximal tib
- Osteoid Osteoma
- round with lucent center with cortical thickening, pain worse at night
- Osteoma
- from outer skull, sinuses, manible, <2cm lesion
- Bone Cyst
- fluid filled with fibrous wall
- Aneurysmal cyst
- has AV communications, expansile
- Bone Island
- defined, dense compact bone
- Osteogenic Sarcoma
-
"sunburst pattern"
"codman's triangle" - Chondrosarcoma
- bone destruction which may punctuate with cartilaginous matrix
- Ewing's Sarcoma
- in bone marrow, fusiform layers with periosteal rxn, mimics osteomyelitis
- Multiple Myeloma
- flat bones and red marrow effected, osteolytic
- Osteolytic Lesions
- breast, kidney, thyroid
- Osteoblastic Lesions
- prostate, breast
- RA
- in hands and feet, symmetric involvement with multiple joints
- Ankylosing spondylitis
- bilat, symmetric, in SI jt, bamboo spine
- Reiter's Syndrome
- post infx, SI jts, toes, asymmetric and bilat
- Psoriatic Arthritis
- DIP vs PIP, asymmetric, bony ankylosis
- OA
- loss of cartilage, in wt bearing jt, narrowing of jt space, osteophytes, Heberden's nodes
- Infx Arthritis
- red, hot, swollen, sequestra, kissing sequestra
- Osteomyelitis
- metaphyses of long bones, vertebra, ragged-moth-eaten appearance
- Frequenr herniated discs
- L4-5, L5-S1, C5-6, C6-7
- Fibrous dysplasia
- single or multiple bones, radiolucent with bands of sclerosis
- What is the best dx tool for hemothorax and PTX?
- PA CXR
- What is the best dx tool for sinusitis?
- CT fo sinuses
- What is the best dx tool for TMJ?
- MRI
- What is the best dx tool for M.M. or metastatic dz?
- Bone Survey
- What is the best dx tool for Scoliosis?
- Erect AP, LAT of Whole Spine
- What is the best dx tool for ICH?
-
Noncontrast CT
Blood is bright - Osteoporosis Circumscripta
-
sharply demarcated radiolucency in skull
destructive phase of Pagets - Reparative Phase of Pagets
- irregular islands of sclerosis and cortical thickening- Cotton woool appearance
- 1st sn of Ichemic Necrosis of Bone
- radiolucent crescent sn in subcortical locations--> may progress to fragmentation and compression
- What is the best dx tool for ischemic necrosis of bone?
- MRI and Bone scan
- Where does ischemic necrosis of bone usually occur?
- femoral head
- What is the cause of a lacunar infarct?
- uncontrolled HTN