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41 Cards in this Set
- Front
- Back
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signs of paget's disease on cxr
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increased bone size, increased bone density, coarsened bone trabeculae
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hepatomegaly on CXR
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difficult to assess -- on CXR, only see posterior edge (outlined by fat), while on palpation, feel only anterior edge
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what main cause of hepatomegaly? What 7 subgroups?
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INFILTRATION: 1) CELLS; 2) BLOOD; 3) FLUID/edema; 4) FAT; 5) CARBS; 6) IRON; 7) AMYLOID
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3 main categories of splenomegaly
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1) PORTAL HTN (60%); 2) MYELOPROLIFERATIVE DISEASES; 3) ID (mono, AIDS)
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what film findings in ascites (depending on severity)
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MILD: loss of liver edge; MODERATE: pelvic density, bladder ears (mickey mouse); MARKED: ground glass abdomen, bulging flanks, widened paracolic gutters, centralized bowel loops
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causes of loss of abdominal organ outlines (2)
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1) decreased retroperitoneal fat (eg cachexia, anorexia); 2) ascites
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dependent areas in supine position
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morrison's pouch (subhepatic space), pericolic gutters, pelvis (esp pouch of douglas)
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3 global sources of aberrent air?
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1) from the OUTSIDE (trauma, surgery); 2) from the INSIDE (perf GI); 3) from gas forming organisms (emphysematous peritonitis)
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best type of film for detecting aberrent abdominal air
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upright cxr!
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what makes kidney stone opaque on CXR?
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calcium or phosphate (eg calcium phosphate, calcium oxalate, struvite -- triple phosphate, calcified uric acid)
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MCC of pelvic mass in male
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huge bladder 2/2 obstructing BPH or prostate CA
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MCC of pelvic mass in female
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mucinous tumor of ovary, noncalcified fibroid, recent delivery
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approach to reading abdominal plain films (7 steps)
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1) QUALITY CONTROL (std views, ROI, exposure); 2) LUNG bases + BONES; 3) SOFT TISSUE + ORGANS outlines; 4) BOWEL GAS pattern (stomach, small bowel, colon); 5) CHECKPOINTS (aberrent air, calcification, paucity of gas)
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rule of 3s for small bowel
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3cm lumen, 3mm bowel wall, 3 air fluid levels
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what film findings suggest functional rather than mechanical obstruction?
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mild to moderate dilatation, no transition point
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causes of mechanical obstruction of bowel (3 main ones)
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1) IN THE LUMEN (thrombus, foreign body, stone); 2) IN THE WALL (benign: polyp, adenoma, lipma; malignant: adenocarcinoma, met, lymphoma); 3) EXTRINSIC (adhesions, hernia, mass, volvulus, lymphoma)
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causes of functional bowel obstruction
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idiopathic, postop ileus, drugs (opiates), metabolic (HoK, HoGlyc, HCa), endocrine (DM, hypoTh, hypoPTH), infectious (peritonitis, gastroenteritis)
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causes of sentinal loop
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localized infection (eg appendicitis, pancreatitis, cholecysitis, pyelonephritis, abscess)
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causes of ahaustral colon (5)
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UC, chronic laxative abuse, chronic obstruction, s/p ischemia, s/p radiation
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MCC pneumatosis coli
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ischemia; (= air in the bowel wall)
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approach to evaluating abdominal gas patterns (5 main steps)
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1) IDENTIFY stomach, small bowel, colon; 2) LUMEN DIAMETER (?dilated); 3) AIR FLUID LEVELS (>3 = worrisome, a lot = ?diarrhea); 4) LUMEN CONTOUR (look for ahaustral or thumbprints); 5) BOWEL WALL (look for pneumatosis coli and Rigler's sign)
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causes of portal venous gas (3)
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OUTSIDE (umbilical vein cath); INSIDE (bowel infarction *MCC); 3) INFECTION (emphysematous cholecystitis
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causes of biliary tract air
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OUTSIDE (external biliary stent); INSIDE (tubular GI tract / biliary fistula *MCC); INFECTION (emphysematous cholecystitis)
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causes of air in the bladder lumen (3)
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foley, fistula, infectious (emphysematous cystitis)
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causes of atypical calcifications
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TTII: Tumor, Trauma, Infection, Infarction
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what shape of calcification with prostatic calcification/
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"cauliflower calcification" -- benign
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what does vas deferens calcification look like? What causes it?
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"v"-shaped tubular calcification, often seen with DM
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what does paucity of gas suggest? (2)
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1) mass; 2) proximal obstruction
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classic radiographic triad of gallstone ileus
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biliary tract air, low SBO, calcified RLQ stone
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common radiographic findings in inflammatory bowel disease
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1) calcium oxalate renal/gall stones; 2) ahaustral narrow colon; 3) sacroiliitis
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how to detect pneumoperitoneum on supine film?
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rigler's sign (bowel wall with air on both sides)
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segments of left and right liver lobes
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LEFT: lateral and medial (divided by left hepatic vein superiorily, ligamentum teres inferiorily); RIGHT: anterior and posterior (divided by right hepatic vein)
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what is caroli's disease?
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multiple saccular dilatations of the intrahepatic biliary ducts
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what are most gallstones made of?
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cholesterol (75% of stones); 25% are pigment stones, a/w chronic hemolytic conditions
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what do cholesterol stones look like on CT?
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isodense with bile -- difficult to detect
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radioopaque-ness of gall/kidney stones
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15% of gallstones, 85% of kidneystones are radioopaque -- rest can't be seen with plain film
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us findings in cholecystitis (5)
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1) DILATED gallbladder; 2) GALLSTONES; 3) GB wall THICKENING >2mm +/- edema; 4) PERICHOLECYSTIC FLUID; 5) sonographic MURPHY'S SIGN
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HIDA SCAN: findings in normal, acute cholecystitis, and chronic cholecystitis
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radiotracer given IV; NORMAL: GB and small bowel visualized in 30-60min; ACUTE CHOLECYSTITIS: no GB vis in 90 min; CHRONIC CHOLECYSTITIS: no GB for 60 mins --> morphine --> GB seen at 90min
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linear echogenicities in gallbladder US
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air!
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AIDS cholangitis vs PSC
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PSC involves both intra and extrahepatic ducts; AIDS cholangitis only involves INTRAhepatic ducts; both can cause "beading" with intermittent strictures; the differentiating feature is the CBD: dilated in AIDS cholangitis, intermittent strictures in PSC
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what is adenomyomatosis?
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benign hyperplasia of gallbladder muscle, can be confused radiographically with malignant cancer
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