MED IMAGING EXAM 2 ALL

US does not penetrate:

bone or air (air may interfere w/ study)

Second choice for abdominal abscess is:

US (but cannot pick up bowel lesions)

Acute abdominal series

PA CXR, flat plate, upright abdominal film

What is the imaging study of choice for a patient with appendicitis, pancreatitis, diverticulitis, small bowel obstruction, abscess or tumor, or trauma?

CT

Mesenteric lymph nodes are ususally:

benign

Prostate calcification are often secondary to:

BPH

Feeding tube placement

in distal duodenum or jejunum (used for enteric feeding)

Best way to evaluate esophagus:

endoscopy

pain w/ swallowing (often due to infection or esophagitis)

odynophagia

What do you need for severe dysphagia?

EGD (barium swallow maybe done first)

Worry for ______________ w/ chronic GERD

Barrett's esophagus (cells in esophagus look like cells that line the stomach)

What do you use to visualize strictures?

EGD or dilation

sphincter does not relax and esophagus becomes dilated and loses elasticity

achlasia

What looks similar to achlasia

Chaga's dz

collagen vascular disease that effects smooth muscle (esophagus dilates)

scleroderma

Candida esophagitis can be seen in:

HIV or immunocompromised pts

what is used for dx and tx of Mallory-Weiss tear

EGD

out-pouching of cervical esophagus (resulting from weakness in muscular wall)

Zenker's diverticulum (causing dysphagia)

Most common FB in children? Most common FB in adults?

Study of choice for FB?

coins; meat

EGD

What is used to visualize stomach or duodenum

UGI or EDG

CT is not a good scan for:

stomach or intestinal dz (when you are trying to look at inside linings - will not show ulcers)

____________ can detect 90% of duodenal ulcers

Contrast barium

Most common metastatic tumor of liver

colon CA

Dx of hepatitis

clinical/lab (imaging is used for seeing complications)

What is used for abscesses?

CT w/ IV and GI contrast

What can differentiate between jaundice from liver disease and obstruction of the common bile duct?

US

Which scan is preferred over barium enema but more uncomfortable

air contrast barium enema

_________ should be suspected if transverse colon is the most dilated region

Ileus

No appetite, nausea, abdominal pain, constipation, think:

appendicitis

**will often have appendicolith

Method for polyp removal

electrocautery during colonoscopy

___________ must be stopped for 48 hours after IV contrast administration

Metformin (can have lactic acidosis)

Non-invasive option for look at kidneys it pt cannot tolerate contrast

Renal US

first line evaluation after major trauma or for obstructive stone disease when IVP is contraindicated

CT

What should be ordered if there is visible hematuria w/ known trauma

CT scan

Abnormalities of the kidney

horseshoe shape
pelvic kidney

_______ is good for following benign appearing cysts

US

What is indicated if cyst has septa or internal echoes to r/o CA

CT

Renal stones can occasionally be ___________ within the parenchyma

radiolucent (which is why dye is helpful)

Stag-horn calculi

fill up entire renal pelvis

Intense one sided flank pain and hematuria - what tests are useful?

CT or IVP

**renal stone dz

IVP dye can cause:

worsening renal function

When would you get imaging on a pt w/ pyelonephritis (fever, flank pain, nausea, dysuria, pyuria)?

abscess is suspected or pt is diabetic

Rib fracture of 12th rib, - suspect:

kidney trauma

Most common cancer of kidneys? Study of choice?

renal cell carcinoma; CT scan

**blood in urine and flank pain; can have cysts

Best way to evaluate hydronephrosis

1. US

**due to obstruction at junction between collection system and ureter

dilatation of the distal ureter (cobra head deformity)

Ureterocele

Initial study for suspected bladder cancer

cystoscopy

In patient w/ pelvic fracture - must think _____________ as well

bladder rupture

Bladder elevated centrally is due to:

bilateral bladder hematomas

Study of choice for bladder trauma

CT scan w/ cystogram

Rupture of bladder can be:

extraperitoneal or intraperitoneal (which will outline loops of bowel)

Recurrent bladder infection (cystitis) - do:

IVP

Emphysematous cystitis (gas in the wall or lumen of bladder) is common in:

diabetic pts

Most bladder tumors

transitional cell carcinoma (male smokers)

Study of choice for bladder tumors

cystoscopy

**follow up w/ CT to see surrounding lymph nodes

study of choice for looking at metastases

bone scan

useful for evaluating suspicious area of prostate (and locating area for biopsy)

transrectal US

first line study for any testicular problem

US

What imaging is used for visualizing testicular torsion

color doppler US

**Torsion is clinical diagnosis (sudden onset of pain)

What is used for staging of testicular CA

CT or CXR

Most common and useful study of female pelvis

US

**Transabdominally or transvaginally

What is used to visualize early or ectopic pregnancy, tubo-ovarian abscess, measurement of endometrial stripe, and ovarian torsion

transvaginal US

Study of choice for pregnancy

US

o Size/date discrepancy
o Vaginal bleeding
o Suspected congenital abnormalities
o Maternal dz
o Suspected fetal demise
o Preterm labor or rupture of membranes

Suspicion for ectopic pregnancy

positive pregnancy test but see nothing in the uterus at 5 weeks or positive pregnancy test and mass on uterus

Most common pelvic tumor of uterus

fibroid (benign)

What type of cancer is difficult to assess by radiological studies (need biopsy)

endometrial CA

_______ is usually detected by PAP smear w/ f/u colposcopy

cervical CA

**further eval w/ CT or MRI

Screening tool for ovarian CA

no effective screening tool right now!

Bloating, weight gain, vaginal bleeding on physical exam

Can do US to recognize mass (CT done to look closely at tumor and look for metastases)

What is used to look at Adrenal glands

CT scan

Most common cancer of adrenal glands

adenoma

**can also have tumors from metastases

What do you get if there is suspected retroperitoneal adenopathy

CT scan

Use oblique views for:

joints, hands, feet

Use CT for:

skull, spine, pelvis

Use MRI for:

muscles, ligaments, spinal cord, cartilage

Use Bone scan for:

metastases, osteomyelitis, occult fractures

Widening of soft tissue line above C3, suspect:

pathology

(4-5 mm at C3 and 10-20mm below C4)

When will you add swimmer's view?

Cannot visualize C7-T1 joint space

Spinal fractures from trauma are most likely from:

MVA

If head CT is indicated, __________ is also done

C-spine CT

Common areas of degenerative changes

C4-C7

Trauma from thoracic spine is usually from:

MVA or osteoporosis

Degenerative changes of thoracic spine

o Spurs
o Calcification of anterior spinal ligament (DISH)
o Calcification of intervertebral disc

Parts of Scotty Dog

o Transverse process - nose
o Pedicle - eye
o Inferior articular facet - front leg
o Superior articular facet - ear
o Pars interarticularis - neck

Lumbar spine degenerative changes

o Loss of disc space
o Hypertrophic spurs (osteophytes)
o Disk calcification
o Herniated/protruding discs

Best study for suspected herniated or protruding disks

MRI

______ is indicated if there is localized pain, elevated ESR, fever, elevated WBC or positive blood culture (indicating a spinal infection)

MRI

Neoplasms in the spine are usually:

metastatic from somewhere else (can be lytic or sclerotic)

**usually arise in bone marrow

Ankylosing Spondylitis is often associated w/:

ulcerative colitis (and patients will usually have HLA antigen)

Primary osteoporosis is mainly caused by:

aging and estrogen deficiency in women

DEXA measures:

bone density

Acute monoarticular joint pain is due to:

Chronic monoarticular joint pain is due to:

Acute: septic arthritis or trauma

Chronic: DJD or aspectic necrosis (get MRI)

Acute polyarticular joint pain is due to:

Chronic polyarticular joint pain is due to:

Acute: viral infection or systemic arthritis

Chronic: osteoarthritic (plain films are good)

thickening of periosteum (white on x-ray)

periosteal reaction

Giant cell tumor is usually in:

long bones

What do you need to get in cases of osteomyelitis?

culture (for diagnosis)

Septic arthritis is usually in the ______. What is used for the diagnosis?

knee

Dx: joint aspiration
**joint films are indicated also

Best true lateral view

axillary view (arm is abducted)

What can be seen in scapular Y view?

coracoid, spine and body of scapula (humeral head should be in center of Y)

3rd most common site for osteogenic sarcoma

humerus

Incomplete fracture due to flexibility of young bones

Greenstick fracture