Dx Imaging 3 Final Compiled by Casey Foster

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Dx Imaging 3 FinalCompiled by Casey Foster
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Neuroradiology

• Diff Dx
• Extradural
• Intradural Extramedullary
• Intradural Intramedullary

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Extradural

• Mass outside the dura compressing from out to in
• Diff Dx
• DJD changes (osteophytes, herniations)
• Trauma (bone fragment, hematoma)
• Iatrogenic (post surgical complication)
• Infection (abscess)
• Tumor (mets, myeloma)

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DJD changes

• Osteophytes
• Herniations

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Trauma

• Bone fragment

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Iatrogenic

• Iatrogenic hematoma

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Infection

• Abscess
• Stenosis Normal

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Tumor

• Diff Dx
• Mets, Primary bone tumor, Neurofibromatosis

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Intradural Extramedullary

• Between the Dura and the cord/brain
• Diff Dx
• Meningitis
• Meningioma, Schwannoma
• Mets

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Meningitis

• Arachnoiditis most common
• Findings thickened and clumped nerve roots

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Meningioma/Schwannoma

• Meningioma (CNS) Schwannoma (PNS/CN 8)

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Meningioma/Schwannoma

• Which is this?
• We dont know could be either

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Metastasis

• Could be from anywhere
• Cant find specific pictures

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Intradural Intramedullary

• Inside the dura and the cord/brain itself
• Diff Dx
• Blood (subdural hematoma)
• Inflammation (transverse myelitis)
• Cells (ependymoma, astrocytoma, mets)
• MS (demyelination of nervous tissue)
• Syringomyelia (CSF pocket within cord)

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Blood

• Intraspinal hematoma

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Inflammation

• Transverse Myelitis
• Characterized with local enlargement of the
  spinal cord and increased signal intensity on T2
  images.
• Typically the high signal intensity extends over
  several spinal segments

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Tumors

• Ependymoma Astrocytoma
• (1 inAdults) (1 in Kids)

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Multiple Sclerosis

• Focal but progressive demyelination disorder

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Syringomyelia

• Collection of CSF fluid within the cord parenchyma

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Skull series

• Lateral
  AP (Towne)
• PA (Caldwell)

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Skull series

• Physiologic calcifications
• Pineal gland Hyperostosis
  Frontalis
• Choroid plexus (normal
  variant)
• Flax cerebri
• Tentorium cerebelli
• Pathological calcifications
• Tumors
• Mets

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Skull series (misc)

• Normally brain has 3 mm cortex
• Thinning of cortexloss of Fx
• Parietal bone is most commonly fracture
• Enlarging ventriclesmaking up for brain loss

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Sinus Series

• PA Waters (PA
  tilt)
• Lateral of paranasal sinuses
• Ffrontal
• EEthomoid
• SpSphenoid
• MMaxillary

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Osseous lesions-Lytic

• Multiple Myeloma-1 primary malignancy of
  skeleton
• Pagets (expands bone and sclerosing/softening)
• Lytic-gtmixed-gtblastic-gtmalignant (rarely reached)
• Osteomyelitis

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Osseous lesions-Blastic

• Osteoma (asymptomatic, benign)
• Osteoblastic mets

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Multiple Sclerosis

• 20-40 females gt males
• Demyelination of idiopathic origin
• Visual disturbance, sensory and muscle probs
• Intermittent and relapsing

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Dementia

• Dementiaslow and progressive decline in mental
  Fx (progressive cognitive decline)
• Alzheimer's and small infarcts are top 2 causes
• Imaging findings
• Generalized atrophy of cerebral cortex

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Stroke

• Death of brain tissue due to vascular compromise
  (hypoperfusion)
• Risksatherosclerosis hypertension
• MCAmost common site
• Types
• Ischemic
• Reduced flow from plaque (atherosclerosis) or
  other obstruction (embolus-FIND SOURCE!)
• Hemorrhagic
• Vessel burst/damage
• Blood leak into vault
• More deaths

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Stroke continued

• Dx
• History and physical
• Confirm with CT/MRI
• Symptoms depend on part of brain hit

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AP Chest radiology

• Search pattern basics
• Soft tissues
• Bone
• Central shadow
• Hilum
• Lung

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AP Search pattern Soft tissues

• Paraspinal
• Neck
• Axilla
• Breast
• Diaphragm shape/height
• Subdiaphragm
• Liver
• Spleen

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AP Search pattern Bone

• Vertebral column
• Body
• Pedicles
• Shoulder
• Humerus
• Scapula
• AC/SC joints
• Ribs
• Back
• Front
• Clavicle

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AP Search pattern Central shadow

• Central
• Trachea
• Descending aorta
• Right border
• Right Ventricle
• Left border
• Aortic knob
• Left pulmonary artery
• Left ventricle

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AP Search pattern Hilum

• Right and left hilum
• A calcified mass here is bronchogenic carcinoma
  until proven otherwise
• Anything suspect in this region gets a CT scan
• Can also be pulmonary hypertension (COPD,
  Scoliosis)

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AP Search pattern lung

• Only thing that should be in lung on normal film
  is blood vessels

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Search pattern lung

• Opaque
• Nodule-soft tissue density lt 3 cm
• Mass-soft tissue density gt 3 cm
• Consolidation-pneumonia/tumor
• Atelectasis-air is reabsorbed
• Lucent
• Hyperinflation-COPD
• Pneumothorax-spontaneous
• Cavitary lesions-hollow center
• Others
• Nodular Masses
• Reticular patterns Vascular alterations

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Lateral Search pattern

• Posterior skin and bones
• Vertebra get lucent lower
• Lucent stuff (normal)
• Trachea
• Bronchi
• Retrosternal space
• Retrocardiac space
• Opaque stuff (normal)
• Heart
• Aorta
• Pulmonary arteries
• Anterior skin and bones
• Diaphragm arc

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Chest Overview heart

• Cardiothoracic ratio should be approx 12 (heart
  should take up lt55 of thorax)
• Cardiomegaly if above 60
• Right border should be visible on right side of
  vertebral column
• Deviation of heart to left may be due to
• Atelectasis
• Pectus excavatum

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Chest Overview mediastinum

• Contents
• Heart
• Aorta
• Pulmonary arteries
• Esophagus
• Lymph

• Divisions
• Anterior
• Middle
• posterior

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Anterior mediastinum

• From sternal to front of pericardium
• Diff Dx (5ts)
• Thymoma
• Thyroid
• Teratoma
• Terrible lymphoma
• Terrible aneurysm

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Middle mediastinum

• From the pericardium to the anterior 1/3 of
  vertebral body
• Diff Dx
• Bronchogenic carcinoma
• Lymphoma

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Posterior mediastinum

• From posterior 2/3 of vertebral body to back of
  ribs
• Diff Dx
• Neuronal tumors
• Aneurysm
• Paraspinal masses

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Chest overview hilum

• Pulmonary arteries seen as radiopaque (white)
  lines on lateral chest
• Left pulmonary artery higher than right
• If any other masses are seen high likelihood of
  lung cancer presence
• Pulmonary arteries enlarge in hypertension (COPD)

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AP Lordotic view

• Allows for better imaging of lung apicies
• Brachiocephalic artery better visualized as well
• 1st rib easily viewed

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Chest CT

• Chest CT is done with different levels
• Two contrast levels shows different things
• Lung window Mediastinum window

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Chest CT heart

• Cross section showing parts of the heart
• aL ventricle
• bR ventricle
• cR atrium
• dL atrium
• ethoracic
• aorta

e
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Chest CT levels

• Aortic arch
• Trachea
• Right Ventricle
• Pulmonary arteries
• Right ventricle
• Left ventricle

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Anatomy of the Chest

• Trachea
• Divides at carina into right and left primary
  bronchus
• Aortic arch
• Brachiocephalic trunk
• Left common carotid
• Left subclavian

• 2 lungs
• Right has 3 lobes
• Left has 2
• Heart shifted to left
• 4 ventricles
• 4 valves
• Aorta
• Ascending and descending

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Lung diseases

• Solitary pulmonary nodule Diff Dx
• Aka coin lesion
• Typically in people under 70
• Granulomatous disease (99 of time) if calcified
• Tumor (bronchogenic or mets)
• TB
• Fibrotic repair
• Sarcoidosis
• 1,2,3 signparatracheal mass and mass in each
  hilum

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Lung diseases

• Granulomatous disease
• 99 from Histoplasmosis (central US)
• Almost all calcify
• Findings
• Hilar adenopathy

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Lung diseases

• Tuberculosis
• Organism gets walled off (granuloma formation)
  and may calcify
• Typically in poor areas/countries that are
  densely populated (India)
• Typically infects the hilum first then may go to
  lung apicies (Horners syndrome)
• May infect the spine producing Potts vertebra
• May be dormant for years on end

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Lung diseases

• Bronchogenic carcinoma
• Typically people over 70
• Solitary pulmonary nodule larger than 3 cm (not
  likely to be found if less than 6 cm though)
• Higher incidence in smokers or those with
  occupational hazards
• If metastatic it likely came from another lung
  cancer

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Lung diseases

• Coccidioidomycosis
• San Jauquin Valley fever (SW US) fungal infection
• Findings
• Multiple pulmonary nodules
• Mostly in lung bases
• Mostly with cavitation

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Lung diseases

• Pneumonia
• Effects immunocompromised
• Bacterial
• Lobal (focal airspace loss)
• TB-thick walled (miliary, re-infected)
• Fungal-thick walled
• Histoplasmosis, Coccidiomycosis, Cryptococcus,
  Aspergillus, Pneumocystis
• Viral
• Influenza, CMV, Varciella

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Lung disorders

• Pleural effusion
• Thickening of liquid between pleural space
• Gravity dependent
• Produces pleural friction rub
• Types
• Transudate-CHF or neoplasm (from plasma)
• Exudate (from plasma)
• Empyema-infection (from organisms)
• Hemothorax-bleed (pure blood)
• Chylothorax-trauma or neoplasm (lymph duct
  rupture)

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Lung disorders

• Atelectasis
• Defined as incomplete inflation of the lung
• Multiple etiologies
• Cicatrization (lung pulled by scar tissue)
• Obstruction (bronchogenic carcinoma)
• Resorption of air from alveoli
• Indirect signs
• Displaced mediastinum, tracheal deviation, hilum
  deviation, diaphragmatic elevation, intercostal
  narrowing
• Direct signfissure displacement

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Lung disorders

• COPD (Chronic Obstructive Lung Disease)
• 1 cause is Emphysema
• Cystic fibrosis
• Chronic asthma
• Chronic bronchitis
• Bronchiectasis
• Patterns
• Pink puffer
• Blue bloater

• Findings
• Barrel chest
• Low diaphragm
• Vertical, small heart
• Hyper lucent lungs
• Large retrosternal space
• Dilated central pulmonary artery

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Lung disorders

• Cystic fibrosis
• 1 autosomal carried disorder
• Fibrotic repair of the lungs due to chronic
  pneumonia
• Chronic pneumonia due to plugged air passages due
  to thickened mucous secretions
• Bronchiectasis
• Abnormal widening of bronchial tubes
• Due to recurrent infections

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Heart disorders

• Cor Pulmonale
• Right ventricular hypertrophy due to pulmonary
  hypertension
• Typically caused by COPD
• Congestive heart failure
• Left ventricle hypertrophy
• Caused by systemic hypertension

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Diaphragm disorders

• Elevation of the diaphragm (should be at 10th
  rib)
• Atelectasis
• Paresis of diaphragm (phrenic nerve compressed in
  mediastinum)
• Push from abdominal contents
• Eventrationcongenital anomaly
• Referral to neck and shoulders
• Air underneathperitonitis

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Rib disorders

• Lytic destruction
• Mets
• Commonly from the lung
• Myeloma
• Raindrop pattern
• Positive lab tests
• Blastic building
• Primary tumor
• Prostate mets
• Get bone scan if hot in many areas then mets

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Mediastinal disorders

• Aortic
• Tortuositytwisting of aorta due to hypertension
• Aneurysm
• Dissection (tearing)
• Lymph
• Lymphadenopathy (widening of mediastinum)
• Mets to lymph nodes (widening of mediastinum)

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Aortic aneurysm

• Bulging or swelling of circumference of a blood
  vessel (aorta)
• Causes True
  aneurysm
• Atherosclerosis Involves all layers
• Aortitis (due to syphilis) Saccular or
  fusiform
• Vasculitis False aneurysm
• Cystic necrosis Involves media and
• Trauma adventitia
• Marfans syndrome Has false lumen

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Abdominal disorders

• Peritonitis will cause air under the right
  hemidiaphragm due to rupture of a hollow organ
• Multiple air fluid levels
• Indicates small bowel obstruction

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Head and neck disorders

• Horners syndrome
• Meiosis, ptosis, anhydrosis
• Caused by compression of cervical chain
  sympathetics by apical lung tumor
• Pancoast syndrome
• Horners plus arm pain and tingling
• Caused by compression of brachial plexus by
  malignant tumor

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Vertebral disorders

• Scoliosis
• After 55 curvature noted the risk of pulmonary
  hypertension increases-gtCor Pulmonale

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Congenital anomalies

• Tetrology of Fallot
• Pulmonary stenosis
• Inter-ventricular defect
• Dextroposed (right sided) aorta getting blood
  from both ventricles
• Right ventricle hypertrophy
• Findings
• Pulmonary oligemia (less vessels in lungs)
• Boot shaped heart

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Congenital anomalies

• Tricuspid atresia
• Anomalous tricuspid valve
• Atrial septal defect
• Left ventricle hypertrophies due to increased
  load (does work of right and left ventricles)