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Clin Dx Review For Radiology per Abby

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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

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