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Dx Imaging 3 Final Compiled by Casey Foster

Dx Imaging 3 Final Compiled by Casey Foster. Neuroradiology. Diff Dx Extradural Intradural Extramedullary Intradural Intramedullary. Extradural. Mass outside the dura compressing from out to in Diff Dx DJD changes (osteophytes, herniations) Trauma (bone fragment, hematoma)

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Dx Imaging 3 Final Compiled by Casey Foster

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  1. Dx Imaging 3 FinalCompiled by Casey Foster

  2. Neuroradiology • Diff Dx • Extradural • Intradural Extramedullary • Intradural Intramedullary

  3. 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)

  4. DJD changes • Osteophytes • Herniations

  5. Trauma • Bone fragment

  6. Iatrogenic • Iatrogenic hematoma

  7. Infection • Abscess Stenosis Normal

  8. Tumor • Diff Dx • Mets, Primary bone tumor, Neurofibromatosis

  9. Intradural Extramedullary • Between the Dura and the cord/brain • Diff Dx • Meningitis • Meningioma, Schwannoma • Mets

  10. Meningitis • Arachnoiditis most common • Findings: thickened and clumped nerve roots

  11. Meningioma/Schwannoma Meningioma (CNS) Schwannoma (PNS/CN 8)

  12. Meningioma/Schwannoma • Which is this? • We don’t know could be either

  13. Metastasis • Could be from anywhere • Can’t find specific pictures

  14. 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)

  15. Blood • Intraspinal hematoma

  16. 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

  17. Tumors • Ependymoma Astrocytoma (#1 inAdults) (#1 in Kids)

  18. Multiple Sclerosis • Focal but progressive demyelination disorder

  19. Syringomyelia • Collection of CSF fluid within the cord parenchyma

  20. Skull series • Lateral AP (Towne) • PA (Caldwell)

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

  22. Skull series (misc) • Normally brain has ~ 3 mm cortex • Thinning of cortex=loss of Fx • Parietal bone is most commonly fracture • Enlarging ventricles=making up for brain loss

  23. Sinus Series • PA Waters (PA tilt) • Lateral of paranasal sinuses F=frontal E=Ethomoid Sp=Sphenoid M=Maxillary

  24. Osseous lesions-Lytic • Multiple Myeloma-#1 primary malignancy of skeleton • Paget’s (expands bone and sclerosing/softening) • Lytic->mixed->blastic->malignant (rarely reached) • Osteomyelitis

  25. Osseous lesions-Blastic • Osteoma (asymptomatic, benign) • Osteoblastic mets

  26. Multiple Sclerosis • 20-40 females > males • Demyelination of idiopathic origin • Visual disturbance, sensory and muscle probs • Intermittent and relapsing

  27. Dementia • Dementia=slow 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

  28. Stroke • Death of brain tissue due to vascular compromise (hypoperfusion) • Risks=atherosclerosis & hypertension • MCA=most 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

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

  30. AP Chest radiology • Search pattern basics • Soft tissues • Bone • Central shadow • Hilum • Lung

  31. AP Search pattern: Soft tissues • Paraspinal • Neck • Axilla • Breast • Diaphragm shape/height • Subdiaphragm • Liver • Spleen

  32. AP Search pattern: Bone • Vertebral column • Body • Pedicles • Shoulder • Humerus • Scapula • AC/SC joints • Ribs • Back • Front • Clavicle

  33. AP Search pattern: Central shadow • Central • Trachea • Descending aorta • Right border • Right Ventricle • Left border • Aortic knob • Left pulmonary artery • Left ventricle

  34. 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)

  35. AP Search pattern: lung • Only thing that should be in lung on normal film is blood vessels

  36. Search pattern: lung • Opaque • Nodule-soft tissue density < 3 cm • Mass-soft tissue density > 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

  37. 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

  38. Chest Overview: heart • Cardiothoracic ratio should be approx 1:2 (heart should take up <55% 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

  39. Chest Overview: mediastinum • Contents • Heart • Aorta • Pulmonary arteries • Esophagus • Lymph • Divisions • Anterior • Middle • posterior

  40. Anterior mediastinum • From sternal to front of pericardium • Diff Dx (5’ts) • Thymoma • Thyroid • Teratoma • Terrible lymphoma • Terrible aneurysm

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

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

  43. 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)

  44. AP Lordotic view • Allows for better imaging of lung apicies • Brachiocephalic artery better visualized as well • 1st rib easily viewed

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

  46. Chest CT: heart • Cross section showing parts of the heart • a=L ventricle • b=R ventricle • c=R atrium • d=L atrium • e=thoracic aorta e

  47. Chest CT: levels • Aortic arch • Trachea • Right Ventricle • Pulmonary arteries • Right ventricle • Left ventricle

  48. 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

  49. 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 sign=paratracheal mass and mass in each hilum

  50. Lung diseases • Granulomatous disease • 99% from Histoplasmosis (central US) • Almost all calcify • Findings • Hilar adenopathy

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