SKELETAL RADIOLOGY DIFFERENTIALS

VERTEBRA PLANA "fetish"
Fracture
EG
Tumor
Infection
Steroids
Hemangioma

MULTIPLE WORMIAN BONES "pork chps"
Pyknodysostosis
Osteogenesis Imperfecta
Rickets - hypophosphatasia
Kinky Hair Syn
Cliedocranial Dysostosis
Hypothyroid
Primary Acro-Osteolysis (Hadju-Cheney)
Syndromes - Down's

FUSED CERVICAL VERTABRA 5
Infection - fuzy fusion
Ankylosing Spondylitis
Juvenile Rheumatoid Arthritis - posterior elements
Klipel-feil - anterior elements
Dialysis Spondyloarthropathy

ACROOSTEOLYSIS 5
Scleroderma
Thermal Injury - frost bite, burn, epiphysis most sensitive in child
Hadju-Cheney - look for wormian bones
Hyperparathyroidism
Snake Bite

SCOLIOSIS 6
Idiopathic - usually convex to right
Osteoid Osteoma
NF-1 - look for ribbon ribs, upper thoracic
TB
Marfan's
Wilm's - post radiation
STIPPLED EPIPHYSIS 8
Normal
AVN
Cretin
Warfarin Embryopathy
Morquio's
Fetal Alchohol Syn
Down's
Multiple Epiphyseal Dysplasia - mild dwarfism, late onset
Trevor Dz - eccentric overgrowth

DELAYED SKELETAL MATURATION 5
Poor Health
Cretin
Steroid
Down's
Skeletal Dysplasia

SOFT TISSUE CALCIFICATION 6
Vascular - atherosclerosis, hemangioma
Connective Tissue Disorders - scleroderma, dermatomyositis, SLE
Endocrine - HPT, renal,
Trauma - myositis ossificans
Infection - parasites, leporsy
Neoplasm

EXPANSILE LESIONS IN THE RIBS 4
Fibrous Dysplasia
Pagets
Chronic Anemia
Muccopolysaccarhidosis

BULLET SHAPED VERTEBRAL BODIES 3
Hyperparathyroidism
Morquio's - Hurler more inf beak
Achondroplasia

DENSE VERTEBRAL BODY 5
Paget's
Osteopetrosis
Mastocytosis
Lymphoma
Mets
SCALLOPED POSTERIOR VERTEBRAL BODY 6
Hydrocephalus
Hurlers
Ankylosing Spondylitis
Achondroplasia
Acromegaly
NF-1

LATERAL CLAVICLE ERROSION 4
Hyperparathyroidism
Rheumatoid Arthritis
Post-Traumatic Osteolytis
Ankylosing Spondylitis

PERIOSTITIS IN ADULT 5
Hypertrophic Osteoarthropathy
Familial Pachydermoperiostitis
Thyroid Acropachy
Venous Stasis
Sarcoid

PERIOSTITIS IN CHILD 8
Idiopathic
Caffey's Dz - involves mandible
Hypervitaminosis A
Prostiglandin
Syphilis
Leukemia
Scurvy
Ricketts

LYTIC EPIPHYSEAL LESION 3
Chondroblastoma - usually punctate calc
Giant Cell
Infection

LYTIC FINGER LESION 4
Infection - sporotrichosis
Enchondroma - usually sclerotic except in fingers
Epidermoid Inclusion
Glomus Tumor
OSTEOPENIA IN AN ADULT 5
Osteoperosis - thinning of trabecula, aging, steroids
Osteomalacia - Vit D defect, unmineralized osteoid
Hyperparathyroidism - I' & II' types
Renal Osteodystrophy - Vit D & Ca+ probs
Mets & Myeloma

OSTEOPENIA IN A CHILD 7
Renal Osteodystrophy
Liver Dz
Chronic Anemia
Leukemia
Scurvy
Ricket's
Osteogenesis Imperfecta

CALCIFYING METASTASES "bottom"
Breast
Osteosarcoma
Thyroid
Testicular
Ovarian
Mucinous Adenocarcinoma

EXUBERANT CALLUS FORMATION 4
Steroids
Infection
Osteogenesis Imperfecta
Poor Fixation - excess motion

ERROSIVE ARTHROPATHY WITH PROLIFERATIVE CHANGES 4
Seroneg Spondyloarthropathies - ank spond, inflam bowel, psoriasis, rieter
Septic Joint
Errosive Osteoarthritis
Gout

SHORT 4th METACARPAL 3
Turners
CPPD
Hypoparathyroidism
AVASCULAR NECROSIS 6+
Idiopathic - Legg-Perthe
Infection
Trauma
Steroids
SLE
Sickle Cell
etc....

NEONATAL LUNG DZ 9
Hyaline Membrane Dz
Bronchopulmonary Dysplasia
Meconium Aspiration
Neonatal Pnuemonia - strep B, HSV, CMV
Premi Acclerated Lung Maturation - stress, glucocorticoids
Transient Tachypnea of the Newborn
Congenital Lobar Emphysema
Pulmonary Interstitial Emphysema
Pulmonary Lymphangiectasia

DIFFERENTIAL Dx FOR NEONATAL LUNG DZ 4
Decreased Lung Vol - HMD
Plueral Effusion - pneumonia, mec aspiration, TTN
Pneumothorax - HMD, mec aspiration
Normal Heart Size w edema - TAPVR III, TTN, pulmonary lymphagiectasia

CHEST WALL DENSITY 5
Skin Ditsel - nipple, mole
Soft Tisssue Noplasm - lipoma, neural, askin
Bone Neoplasm - myeloma, chondrosarc, ewings
Trauma - hematoma, fx
Infection - actinomycosis, TB

PLUERAL DENSITIES 5
Loculated Effusion - CHF, infection
Mets - #1 multiple, thymoma
Mesothelioma - benign has pedicle, malig no plaques assoc
Lipoma
Splenosis - assoc w trauma

PNEUMOTHORAX 7
Trauma
Ventilator
Eosinophilic Granuloma
Lymphangiomyomatosis
Alveolar Protienosis
Pneumocystis Carini
Osteosarcoma Mets
PLEURAL EFFUSIONS 9
CHF
PE
Pneumonia - TB
Trauma - chylous, boerhaave's, aorta
Neoplasm - meig's
Pericarditis - dressler's, post-pericardotomy
Abdominal Pathology - pancreatitis, post-surg
Collagen Vascular Dz - rheumatoid, SLE, wegener's
Low Colloid Pressure

RIGHT SIDE EFFUSION LEFT SIDE EFFUSION
CHF Ruptured Esophagus
Pancreatitis - 68% Ruptured Aorta
Proximal Thoracic Duct Distal Thoracic Duct
GI Neoplasm

DIAPHRAGM ELEVATION 5
Subpulmonic
Pulmonary Volume Loss - atelectasis, venolobar
Nerve Paralysis - phrenic, ALS, myasthenia
Diaphragmatic Abnormality - hernia, eventration
Abdominal Process - abscess, chiliditi

WIDE MEDIASTINUM 8
Technique
Vascular - ectasia, dissection, coarctation, left SVC
Trauma
Neoplasm
Pneumomediastinum
Mediastinitis - histo
Lipomatosis
Achalasia - look for AF levels

SHIFT OF THE MEDIASTINUM
Decreased Lung Volume
Increased Lung Volume - FB, bronchogenic cyst, CAM, swyer-james
Plueral Space Abnormality - effusion, pneumo, diaphragmatic hernia
Partial Absent Pericardium
ANTERIOR MEDIASTINAL MASS 6
Thymus
Germ Cell - teratoma, seminoma, choriocarcinoma
Thyroid
Lymphoma
Cardiovascular - aneurysm, pericardial cyst, epicardial fat pad
Cystic Hygroma


MIDDLE MEDIASTINAL MASS 5
Lymphadenopathy - met, castleman's
Neoplasm
Vascular
Achalasia
Duplications - bronchogenic cyst, sequestration

POSTERIOR MEDIASTINAL MASS 5
Neural - nerve root tumors, gangliomas, paragangliomas, lat meningocele
Duplication - enteric, neurenteric cysts
Inflammation - paraspinous abcess, sarcoid
Hematoma - trauma
Extramedullary Hematopoesis

HILAR ENLARGEMENT 6
Bronchogenic Carcinoma
Lymphoma
Sarcoid
TB
Histo
Pneumoconiosis

TRACHEAL MASSES 7
Squamous Cell
Adenoid Cystic - cylindroma
Carcinoid - "iceberg"
Chondroma
Fibroma
Papilloma - aquired at birth
Hemangioma - kids only
TRACHEAL NARROWING 5
Saber Sheath
Postintubation Stenosis
Relapsing Polychondritis
Amyloidosis
Tracheobronchopathia Osteochondroplastica - benign calc nodules

TRACHEAL DILATION 3
Mounier-Kuhn Syn
Tracheobronchomalacia
Ehler's-Danlos Syn

ATELECTASIS 5
Obstructive - bronchial neoplasm, inflammatory, FB
Passive - plueral process
Compressive - intraparenchymal mass, air trapping
Adhesive - PE, hyaline membrane Dz
Cicatrization

AIRSPACE CONSOLIDATION 5
Blood - trauma, DIC, PE, vasculitis, hemosiderosis
Pus - bacteria, PCP, fungus, TB
Fluid - CHF, renal failure, toxic inhalation, ARDS
Cells - bronchoalveolar Ca, lymphoma
Protien - alveolar portienosis, mucus plug

SEGMENTAL CONSOLIDATION 9
Lobar Pneumonia
Bronchopneumonia
Interstitial Pneumonia - viral, mycoplasm
Aspiration
TB & Atypical Mycobacterium
Trauma
Pulmonary Embolism
Obstructing Neoplasm
Mitral Regurgitation

ADULT RESPIRATORY DISTRESS SYNDROME 5
Event
White Out
Loss of Compliance
Refractory Hypoxemia
Shunt - precapillary
PULMONARY VASCULITIS 4
Infectious - RM spotted fever, mucormycosis
Wegener's - diffuse, cavitate, nasal, 40+yrs, 2:1 male
Goodpasture's - perihilar, hemoptysis, 25yrs, 7:1 male
SLE

PATTERNS OF INTERSTITIAL DISEASE 6
Septal Lines - CHF, lyphangitic Ca
Reticular (irregular lines) - UIP, sarcoid, asbestos, drug
Air Cysts (round) - UIP, PCP, LAM, EG, bronchiectasis
Nodules - sarcoid, silicosis, EG, EAA (extrinsic allergic alveolitis)
Ground Glass Opacities - DIP, PCP, EAA, alveolar proteinosis
Hyperinflation - LAM, EG, CF, or any w COPD

LOWER LOBE INTERSTITIAL DZ (badd lass rf)
Bronchiectasis
Aspiration
DIP - desquamative interstitial pneumonitis
Dermatomyositis
Lymphangitic spread
Asbestosis
Scleroderma
Sarcoid
Rheumatoid Lung
Furadantin

UPPER LOBE INTERSTITIAL DZ (casset)
Cystic Fibrosis
Ankylosing Spondylitis
Silicosis
Sarcoid
Eosinophilic Granuloma
TB

BRONCHIECTASIS 5 (saccular & cylindrical types)
Infectious - aspergilla, TB, Sweyer-James
Congenital - cystic fibrosis, Kartagner syn, agammaglobulinemia
Obstructive - neoplasm, nodes
Chemical - aspiration, inhalation
Fibrotic - COPD
SOLITARY PULMONARY NODULE 5
Bronchogenic Ca
Hamartoma
Granuloma
AVM
Abcess

CAVITATING PULMONARY NODULES 6
Infection - staph, klebsiella, TB, coccidiomycosis, septic emboli, PCP
Neoplasm - squamous cell ca, osteosarcoma
Vasculitis - wegener's, rheumatoid
Trauma - pneumatoceles
Bronchogenic Cyst
Pulmonary Embolism

PULMONARY CALCIFICATION 8
TB
Histo
Silicosis
Alveolar Microlithiasis
Hyperparathyroidism
Chronic Venous Congestion - mitral stenosis
Treated Lymphoma
Idiopathic Pulmonary Osteopathy

UNILATERAL HYPERLUCENT LUNG 5
Chest wall defect - mastectomy, absent pectoralis
PE - westmarks sign
FB - obstuctive emphysema
Pulmonary hypoplasia
Sweyer-James


AORTIC ANEURYSMS 4
Atherosclerosis - abd
Marfan's
Vasculitis - Syphilis, Takayasu, Kawasaki, fungal, TB, polyarteritis nodosa
Aortic Valve Stenosis - asc dilation

CAUSES OF RIB NOTCHING 4
Coarctation
Aortic Thrombosis
Subclavian Obs - Blalock shunt for tricuspid atresia
Pulmonary Oligemia - any cause of dec flow
CARDIOMEGALY 4
Highoutput Failure - vein of Galen aneurysm, AVM etc
Outflow Obstruction Failure
Cardiomyopathy
Pericardial Effusion - always rule out

PULMONARY ARTERIAL HYPERTENSION 4
Primary
Lung Disease - COPD
Multiple PE
Eisenmienger

EMPHYSEMA TYPES 3
Centrilobular - #1, smoker, upper
Panacinar - alpha-1-antitrypsin, diffuse
Paraseptal - peripheral blebs

ESOPHAGEAL FILLING DEFECTS 8
Squamous Cell Ca
Adenocarcinoma
Lymphoma
Lieomyoma / Lieomyosarcoma
Polyps - hyperplastic, pseudo
Varices
FB
Extrinsic

ESOPHAGEAL ULCERATION 8
Reflux Esophagitis
Glygogenic Acanthosis
Candida - small shaggy ulcers
Herpes - larger ulcers, can sim candida
CMV - large discrete ulcers
Pill Ulcer
Crohn's
Adenocarcinoma

NARROWED STOMACH 8
PUD - ZE
Corrosive
Adenocarcinoma
Lymphoma
Crohn's
TB
Sarcoid
Radiation

DUODENAL FOLD THICKENING 10
Zollinger-Ellison Syn
Brunner's Glands - hyperplasia or fold thickening
Lymphoma
Ectopic Gastric Mucosa
Crohn's
Pancreatitis
Varices
Hematoma - Henoch-Schonlien
Giardia
Whipple's - nodes
SMALL BOWEL OBSTRUCTION 6
Adhesions
Hernia
Volvulus
Intussuseption
Neoplasm
Foriegn Body

DISTENTION WITHOUT OBSTRUCTION 6
Scleroderma
Sprue
Lactose Intolerance
Electrolyte Imbalance
Peritonitis
Vagotomy - assoc w distended GB as well

FILLING DEFECT IN THE SMALL BOWEL 10
Lipoma
Lymphoma
Lieomyosarcoma
Lymphangiectasia
Carcinoid
Adenocarcinoma
Mets - hematogenous, peritoneal seeding
Kaposi's
Endometrioma
Duplication

MECKEL'S RULE OF 6 2'S
2% of Population
2:1 Male
2% Symptomatic
Present before age 2
2ft from iliocecal valve
2in long

FISTULAS 5
Crohns
TB
Radiation
Post-op
Malignancy
FILLING DEFECTS IN THE COLON 5
Polyp
Adenocarcinoma
Lymphoma
Lipoma
Inverted Appendiceal Stump

DIFFUSE COLONIC DISEASE 4
Neoplasm - adenoca, lymphoma
Inflammation - Crohn's, ulcerative colitis
Infection - c. difficile, salmonella, shigella, ameoba, CMV
Ischemia - usually segmental

POLYPOSIS SYNDROMES 7
Familial Polyposis - diffuse, auto dom
Gardeners Syn - mostly colon, osteomas, desmoids
Turcot's Syn - colon only, auto rec, glioblastoma
Puetz-Jegher's Syn - mostly sm bowel, GU anomalies in women
Juvenile Polyposis - mostly colon, hamartomatous
Cronkite-Canada Syn - diffuse, hamartomatous, unknown inheritance
Cowden's Syn - diffuse

TARGET LESIONS 4
Melanoma
Lymphoma
Kaposi's
Mets - breast

PROTIEN LOSING ENTEROPATHIES 3
Whipple's
Menetrier's
Cronkite-Canada Syn

LOW DENSITY RETROPERITONEAL NODES 3
Seminoma
Whipple's
Mycobacterium Avium Intracellulari
SOLID PANCREATIC MASSES 7
Phlegmon
lrcinoma
Lymphoma
Insulinoma - B cell, 10% malig, hypoglycemia
Gastrinoma - G cell, 60% malig, ZE
Glucagonoma - A cell, 80%, diabetes mellitis, necrotizing migratory erythema
VIPoma - diarrhea

CYSTIC PANCREATIC MASSES 5
Pseudocyst
Congenital Cyst
Serous Cystadenoma - microcystic, VHL
Mucinous Cystadenoma
Choledochocele

HEPATIC LESIONS 8
Congenital Cysts - Caroli's
Abcess - bacteria, amoeba, hydatid, candida
Hemangioma
Mets
HCC
FNH
Adenoma
Angiosarcoma

FATTY INFILTRATION OF THE LIVER 6
Alcohol
Obesity
Steroids - Cushings
Diabetes
Hyperal
Malnutrition - short bowel, chemotherapy

NARROWED BILIARY DUCTS 5
Inflammation - pancreatitis #1 overall
Postsurgical
Sclerosing Cholangitis - ascending assoc
Cholangiocarcinoma
Biliary Atresia
THICKENING OF THE GALLBLADDER 6
Infection - bacterial, hepatitis, AIDS
Edema - CHF, hypoprotienemia (anasarka), portal venous obs (ascites)
Adenomyomatosis
Adenocarcinoma
Amyloid
Lymphatic Obstruction

VASCULAR METS TO LIVER "ercp"
Endocrine
Renal
Carcinoid
Pancreatic

SPLENOMEGALY 6
Lymphoma / Luekemia - chronic myeloid leukemia
Infection - EBV, malaria
Venous Obstruction
Extramedullary Hematopoeisis
Glycogen Storage Dz
Amyloid

SPLENIC LESIONS 7
Traumatic Cyst - follows hematoma
Epidermoid Cyst
Hydatid
Lymphoma
Hemangioma
Abcess
Infarct

BENIGN RENAL TUMORS 5
Angiomyolipoma
Adenoma - oncocytoma
Multilocular Cystic Nephroma
Hemangiopericytoma - juxtaglomerular
Mesoblastic Nephroma

CYSTIC ADENEXAL MASS 7
Hemmorhagic Cyst - observe if in a mensturating female
Tuboovarian abcess
Hyperstimulated ovaries
Ovarian Torsion
Cystadenocarcinoma
Dermoid or Teratoma etc
Endometrioma

ADRENAL MASS 7
Adenoma - <4cm, check for Cushing's or Conn's
Carcinoma or Met - >4cm
Pheochromocytoma
Neuroblastoma
Myelolipoma
TB
Hemorrhage

PHEOCHROMOCYTMA'S RULE OF 5 10's
10% Extradrenal
10% Malignant
10% Assoc w MEN II
10% Bilateral
10% in Child

PAPILLARY NECROSIS - "postcard"
Pyelonephritis
Obstruction
Sickle Cell Anemia
TB
Cirrhosis
ASA
Renal Vien Thrombosis
Diabetes - must be assoc w severe infection, used to be #1
NEPHROCALCINOSIS "marchin"
Medullary Sponge Kidney - medullary
Alkali Excess - medullary
Renal Tubular Acidosis - medullary
Chronic Glomerulonephritis - cortical
Hypercalcemia - HPT, osseous mets, medullary
Inflammation - TB, sarcoid
Necrosis - medullary or cortical

LARGE KIDNEYS 7
Acute Medical Renal Dz
Acute Tubular Necrosis
Obstruction
Renal Vein Thrombosis
Polycystic Kidney Dz
Lymphoma
Amyloid

RENAL TRANSPLANT COMPLICATIONS 6
Acute Tubular Necrosis
Rejection - hyperacute, acute or chronic
Renal Artery Thrombosis
Lymphocele - #1 cause of fluid collection
Urinoma
Cyclosporin Toxicity

STRIATED NEPHROGRAM 4
Acute Collecting System Obstruction
Pyelonephritis
Contusion
Infantile Polycystic Kidney Dz

URETERAL DEFECTS 7
Ureteritis Cystica
Edema
TCC
Vascular Collarteral Impressons
Subepithelial Hemorrhage - usually in pelvis
Pseudodiverticuli
Diverticuli - usually partial duplication

ECHOGENIC KIDNEY 6
Glomerlonephritis
Lupus Nephritis
Hypertensive Nephrosclerosis
Diabetic Nephrosclerosis
Amyloid
Rejection

ACUTE CONTRAST REACTIONS
Uticaria - watch, benedryl, zantac
Facial Edema - O2, monitor, Epi 1:1000 .1ml SQ
Bronchospasm - Epi SQ first, then Epi 1:10,000 1ml IV, CODE if sat <90
Hypotention w Tachy - Trendelenberg, O2, LR, Epi, Epi
Hypotention w Brady - Trendelenber, O2, LR, Atropine 1mg IV X 2
never give <.5 of atropine IV, it may have a reverse effect
Hypertention - Hydralazine 5mg IV
Pheochromocytoma Contrast Rxn - Phentolamine 5mg IV
Seizure - Valium 5mg IV
Edema - Lasix 40mg IV, Morphine 2mg IV

LANDMARKS IN GESTATIONAL AGE
Transabdominal
20mm gest sac - yolk sac seen
25mm gest sac - embryo seen
9mm embryo - heart activity, 6.9wks
1800iu BhCG - gest sac visualized
Transvaginal
10mm gest sac - yolk sac seen
15mm gest sac - embryo seen
6mm embryo - heart activity, 6.3wks
1000iu BhCG - gest sac visualized, earliest poss at 500iu
Heart Rate < 85bpm at < 10wks gest = demise
Age in days = sac diameter in mm + 30
Age in wks = CRL in cm + 6
AFP - between .4 - 2.5 MOM, depends on age & # of gestations

BIOPHYSICAL PROFILE 4
Breathing
Motion - assoc inc heart rate part of "nonstress" test
Tone
Fluid Volume

POLYHYDRAMNIOS 3
Maternal Factors - diabetes, erthroblastosis fetalis
Placental Factors - chorioangioma
Fetal Factors - 20%, neural tube defect, prox GI obs, nonimmune hydrops

OLIGOHYDRAMNIOS 4
Renal Anomalies
Fetal Demise
IUGR - usually asymetric, assoc w placental insuff
Post Dates

MULTICYSTIC MASSES IN THE FETUS
Congenital Adenomatoid Formation
Bowel Dilation - atresia, meconium ileus, hernia in chest
Cystic Hygroma
Pulmonary Sequestration
Bronchogenic Cyst
Multicystic Dysplastic Syndrome
Hydronephrosis - look for valves
Stimulated Ovaries

SALIVARY LESIONS 6
Cysts - lymphoepithelial, branchial
Sialadenitis
Pleomorphic Adenoma
Warthins Tumor
Adenoid Cystic - cylindroma
Mucoepidermoid

SINSUS LESIONS 8
Aplasia or Hypoplasia - should be seen by 6, adult by 15
Mucocele
Inverting Papilloma
Squamous Cell Ca
Juvenile Angiofibroma
Ameleoblastoma
Infection - Sinusitus, mucormycosis
Wegeners - septal erosion

SKULL LESIONS "help me"
Hemangioma
EG
Leptomeningeal Cyst
Pagets
Mets & Myeloma
Epidermoid

RETROPHARYNGEAL THICKENING 5
R/O redundancy - image in extention
Abcess
Cystic Hygroma
Rhabdomyosarcoma
Trauma

LACRIMAL GLAND LESIONS 6
Pleomorphic Adeoma
Adenoidcystic Ca
Lymphoma
Pseudotumor
Dermoid
Mets
OCULAR LESIONS 8
Retinoblastoma
Persistent Hyperplastic Primary Vitreous - embryonic vasc hyaloid
Coat's Dz - lipoprotienacious flued behind retina
Retrolental Fibrosis - oxygen toxicity, calc can sim retinoblastoma
Melanoma
Drusen - hyaline & calc of optic disk
Detachment
Infection - toxacara canis

CONAL LESIONS 8
Graves - bilat, painless
Pseudotumor - unilat, painful
Lymphoma
Mets
Glioma
Meningioma
Infection - surgical
Varix

RING ENHANCEING LESION - "magic dr"
Mets
Abcess
Glioma
Infarct
Contusion
Demyelinating Dz
Resolving Hematoma

ABCESS vs METS 3
Daughter Lesions
Sharper Inner Margin
Thicker Towards Cortex

CONGENITAL INFECTIONS 5
CMV - central calc
Toxoplasmosis - peripheral calc
Ruebella - both
Herpes - none
Varicella
H. flu - subdural hygroma
AIDS RELATED CNS DZ 4
Toxoplasmosis
HIV Encephalopathy
Progressive Multifocal Leukoencephalopathy - papova virus
I' CNS Lymphoma

DEMYELINATING DISEASES 6
Multiple Sclerosis
Aquired Disseminated Encephalomyelitis
Progressive Multifocal Leukoencephalopathy - papova virus
Toxic - Etoh, Wernicke's, osmotic myelinosis
Trauma
Vascular - PVL, necrotizing leukoencephalopathy, Binswanger's, SLE

DYSMYELINATION DISORDERS 6
Metachromatic Leukodystrophy - lysosomal, deep confluent, hypo thalami
Krabbe Dz - lysosomal, deep confluent, hyper thalami, rapid
Adrenoleukodystrophy - post to ant
Alexander's Dz - inclusions, ant to post
Canavan's Dz - spongy degen, U fibers 1st
Amino Acid Deficiency - phenylketonuria, maple syrup urine, homocystinuria

DIFFUSE AXONAL INJURY
Corticomedullary Junction - frontal, temporal
Corpus Callosum - post body & spenium
Pons & Dorsal Midbrain

VASCULAR COLLATERALS 3
Circle of Willis
Ophthalmic
Meningeal

MRI STAGES OF HEMORRHAGE 5
T1 T2
Hyperacute <6hrs iso Bright Oxyhemoglobin
Acute 7-72hrs iso Dark Deoxyhemoglobin
Early Subacute 3-7d Bright Dark Methemoglobin still in RBC
Late Subacute 1-4wks Bright Bright Methemoglobin diluted extracellular
Chronic >4wks Dark Dark Hemosiderin
CT STAGES OF HEMORRHAGE 4
Hyperacute - 2-3hrs, isodense
Acute - 3hrs to 2wks, hyperdense (60-100HU, dec by 1.5HU/d)
Subacute - 2-4wks, isodense
Chronic - >4wks, hypodense

PARENCHYMAL HEMATOMA 8
Trauma
Hypertention
Infarct
Aneurysm
AVM
Tumor
Bleeding Diathesis
Amyloid

SKULL BASE LESIONS 7
Chordoma
Chondrosarcoma
Squamous Cell
Schwannoma
Meningioma
Mets
Glomus

POSTERIOR FOSSA MASS IN A CHILD 4
Medulloblastoma - hyperdense, no calc
Ependymoma - plastic, calc
Pilocytic Astrocytoma - cyst & nodule
Brainstem Glioma

POSTERIOR FOSSA MASS IN AN ADULT 5
Mets
Hemangioblastoma - 20% w VHL
Subependymoma
Infarct/Hemorrhage
Abcess

CEREBELLOPONTINE ANGLE MASS 4
Schwannoma - 7/8, vest of VIII 75%, facial 4%
Epidermoid
Arachnoid Cyst
Meningioma
CEREBELLAR DYSPLASIA'S 6
Cebellar atrophy
Chiari IV Malformation
Joubert's Syndrome - split vermis
Rhomboencephalosynapsis - absent vermis
Tectocerebellar Dysraphia - hypoplastic vermis, cb rotated ant lat to stem
Lhermitte-Duclos Dz - gangliocytoma

PINEAL TUMORS 7
Germinoma - 60%, dense, placental alk phos
Teratoma - both
Choriocarcinoma - B-hcg
Endodermal Sinus Tumor - alpha-fetoprotien
Embryonal Cell Carcinoma - both
Pineocytoma
Pineoblastoma

SELLAR REGION MASS 6
Aneurysm
Adenoma
Craniopharyngioma
Chordoma
Meningioma
Hamartoma

INTRAVENTRICULAR MASS 6
Ependymoma
Meningioma - trigone, encysted temporal horn
Choroid Plexus Papilloma
Giant Cell Astrocytoma - TS
Colloid Cyst
Epidermoid Cyst

COATING OF SPINAL CORD 3
Drop Mets
Lymphoma
Sarcoid
EXTRADURAL SPINAL CORD LESIONS 8
Osteoid Osteoma
ABC
EG
Chondrosarcoma
Chordoma
L Mets & Myeloma
Vascular

INTRADURAL EXTRAMEDULLARY CORD LESIONS 5
Neurofibroma
Meningioma
Dermoid
Arachnoid Cyst
Mets

INTRAMEDULLARY CORD LESIONS 5
Ependymoma - myxopapillary
Astrocytoma
Hemangioblastoma
Infection
Infarct

BASAL GANGLIA & THALMUS LESIONS - bilat & sym
Methanol - putamen very sensitive
Carbon Monoxide - globus pallidus
Hypertention - Hematoma, must be long standing
Glioma
Cushing's Reflex - any mass will cause HTN acutely

NF-2 "mis me"
Multiple
Inherited
Schwannoma
Meningioma
Ependymoma


LARGE FLUID FILLED HEAD 3
Hydrocephalus - macrocephaly
Hydrancephaly - normocephaly
Holoprosencephaly - microcephaly
CONGENITAL GRAY MATTER NEURODEGENERATIION 3
Lipodoses - Tay-Sach's
Mucopolysaccaroidosis - Morquio's, Hurler's
Glycogen Storage Dz - Pompe's


CONGENITAL NEURODEGENERATION OF BOTH GRAY & WM 3
Mitochondrial - Leigh's, MERRF, MELAS
Peroxisomal - Zellwenger's
Basal Ganglia - Huntington's, Fahr's, Wilson's

METS THAT HEMORRHAGE (MR, CT)
Melanoma
Renal Cell
Choriocarcinoma
Thyroid

STROKE EVOLUTION
Hyperacute - <12hr, inc T2 at 8hr
Acute - 12-48hrs, sulci efface, meninges enhance
Subacute - 2d-2wks, max mass effect at 5d, parenchymal enhance at 4d, dec T2
Chronic - gliosis & vol loss

ISOTOPES
Tc-99 140keV 6hr Isomeric Transition
I-123 159keV 13.3hr e- capture
I-131 364keV 8d B- decay
Xe-133 82keV 5.2d B- decay
In-111 247 & 173keV 67hr e- capture
Tl-201 71 & 167keV 73hr e- capture
Ga-67 93, 184 & 300keV 78hr e- capture

Tc-99m AGENTS, DOSES & CRITICAL ORGANS
MDP 20mCi Bladder 2rads
HIDA 3mCi Colon 6rads
SC 3mCi Liver 1rad
Ceretec 25mCi Lacrimal
DTPA 20mCi Bladder .5rads
MAG3 10mCi Bladder
DMSA 5mCi Kidney 15rads
Cysto .5mCi Bladder 50mrem
Sestamibi 7-22mCi Colon?
MAA 4mCi Lung 1.5rad

RENAL AGENTS 6
DiethyleneTriamine Pentacetic Acid
DiMercaptoSuccinic Acid
MercaptoAcetylTriglyceride
Iodohippuran
Glucoheptonate

THYROID PATHOLOGY 9
Multinodular Goiter - iodine def
Adenomatous Goiter - Plummer's
Graves Goiter
Hashimoto's Thyroiditis - painless, autoimmune
De Quervain's Thyroiditis - painful, viral
Papillary Ca
Follicular Ca
Anaplastic Ca
Medullary Ca
PAINFUL THYROID ENLARGEMENT 5
De Quervain's Thyroiditis
Acute Suppurative Thyroiditis
Anaplastic Ca
Hemorrhage
Cyst

HIGH T4 WITH LOW UPTAKE 5
Exogenous Iodine - contrast, kelp, meds
Thyroid Hormone Use
Acute Phase Thyroiditis
Metastatic Site of Thyroid Ca
Stuma Ovarii

HIDA PREPARATION 4
Fast 4hrs - cholecystokinin 1mg, if >24hrs
Stop Narcotics - Narcan 2mg
Check Bilirubin - <25mg/dl for DISIDA, add .5mCi for ever inc of 2mg/dl
QA - >90% Tc99m IDA (Immuno Diacetic Acid)

SUPERSCAN 5
Secondary Hyperparathyroidism
Hyperthyroid
Mets - #1
Paget's
Myelofibrosis

SOFT TISSUE UPTAKE OF Tc-99m MDP 6
Hyperparathyroidism
Truama - rhabdomyolysis
Abcess
Malignancy
Sarcoid
Urine - spilled or urinoma

COLLOID SHIFT 4
Cirrhosis
Hepatitis
Hematopoeitic Dz - Inc spleen & marrow metabolism
Macrophage in Lung - from infection
FALSE POSITIVE HIDA SCAN 6
Food - eaten in last 4hrs
Fasting - >24hrs, give CCK
Cystic Duct Cholangiocarcinoma
Pancreatitis
Alcoholism
Liver Dysfxn

FALSE NEGATIVE HIDA SCAN 3
Acalculus Cholecystitis
Duodenal Diverticulum
Accessory Cystic Duct

PROSPECTIVE INVESTIGATION OF PULMONARY EMBOLUS DIAGNOSIS
Normal - 0% probabiltiy of PE
Low - <20% probability of PE
small unmatched perfusion defects regardless of number or CXR
matched VQ defects with normal CXR
perfusion defect smaller than CXR abnormality
VQ defect correlating with a large plueral effusion
triple matched defect in the upper lobes
non-segmental defects (heart, diaph, dildo's etc)
Intermediate - 20-80% probability of PE
1 large or 2 moderate unmatched perfusion defects
VQ defect correlating with a small pleural effusion
triple matched defect in the lower lobes
High - >80% probability of PE
2 large unmatched perfusion defects
Perfusion defect larger than CXR defect