1
Q
Good saying… From REW
“MRI of the left knee demonstrates tricompartmental osteoarthritis, severe in the medial tibiofemoral and patellofemoral compartments, with early lateral tibiofemoral compartment arthritis. “
A
Good saying… From REW
“MRI of the left knee demonstrates tricompartmental osteoarthritis, severe in the medial tibiofemoral and patellofemoral compartments, with early lateral tibiofemoral compartment arthritis. “
2
Q
Good saying… from REW:
Suspected chronic full-thickness radial tear of the posterior horn of the medial meniscus extending to the root insertion, with medial meniscal degeneration and extrusion. Although a tear such as this can predispose to medial compartment osteoarthritis secondary to meniscal dysfunction from disruption of the longitudinally orientated fibers responsible for meniscal “hoop strength”, maceration and tearing of the medial meniscus is not unexpected given the severity of the osteoarthritis.
A
Good saying… from REW:
Suspected chronic full-thickness radial tear of the posterior horn of the medial meniscus extending to the root insertion, with medial meniscal degeneration and extrusion. Although a tear such as this can predispose to medial compartment osteoarthritis secondary to meniscal dysfunction from disruption of the longitudinally orientated fibers responsible for meniscal “hoop strength”, maceration and tearing of the medial meniscus is not unexpected given the severity of the osteoarthritis.
3
Q
“A smaller triangular shaped segmental fragment”
A
“A smaller triangular shaped segmental fragment”
4
Q
Knee Joint Effusion…
A
Knee Joint Effusion…
- behind the quadriceps tendon, b/t 2 fat planes
- if the soft tissue/fluid density measures < 5mm, no significant joint effusion
- if > 5mm, + joint effusion
- if > 10mm, large joint effusion
5
Q
Typical appearance of DCIS
A
Typical appearance of DCIS
- Mammo: fine, linear branching pattern; in a linear or segmental distribution
- U/S: nonspecific; may see hypoechoic region +/- calcs
- MR: non-masslike, linear or segmental enhancement
6
Q
Normal upper limits for plantar fascia thickness?
A
Normal upper limits for plantar fascia thickness?
5mm!!!
7
Q
DDx for intraventricular masses
Primary tumors:
- Ependymomas: Fourth ventricle
- Central neurocytoma: Lateral ventricle
- Subependymoma: Frontal horn or fourth
- Ventricle
Intraventricular meningiomas: Left atrium
- Choroid plexus papilloma
- Child: Left atrium
- Adult: Fourth ventricle
Metatastasis:
- Most common are renal and lung carcinoma.
- Lymphoma
Infection: Tuberculoma and neurocysticercosis
A
8
Q
Supralateral hoffa’s fat pad impingement syndrome is associated with
patella alta
A
Supralateral hoffa’s fat pad impingement syndrome is associated with
patella alta
9
Q
Finding of hemophilia in the knee
- hyperdense knee effusion - hemorrhage and/or hemosiderin
- widened intercondylar notch
- squared inferior margin of the patella
- bulbous femoral condyles
- flattened condylar surfaces
A
Findings of hemophilia in the elbow
- hyperdense elbow joint effusion
- radial head overgrowth
- widening of trochlear notch
10
Q
Lateral discoid meniscus >>> medial meniscus
A
11
Q
Cartwheel
A
12
Q
A cartwheel is a sideways rotary movement of the body. It is performed by bringing the hands to the floor one at a time while the body inverts. When both hands are on the floor, the legs travel over the body and feet return to the floor one at a time, ending with the performer standing upright.
A
13
Q
Causes of anterior compression of the cord at the cervicomedullary junction?
- synovial cyst
- rheumatoid pannus
- epidural abscess/hematoma
- clival tumor
- vertebral artery dolichoectasia
A
Causes of anterior compression of the cord at the cervicomedullary junction?
- synovial cyst
- rheumatoid pannus
- epidural abscess/hematoma
- clival tumor
- vertebral artery dolichoectasia
14
Q
normal volar tilt of radius
A
0-22 degrees
15
Q
Sinus of valsalva aneurysm
- M:F= 4:1
- associated with ventricular septal defects, aortic insufficiency, and bicuspid aortic valve
- congenital form - most often involving the right coronary sinus
- secondary form - most often involving the left coronary sinus (endocarditis, trauma, syphilis, TB)
- complications
- right coronary sinus - rupture into RV - aortocardiac shunt
- left - rupture into the RA
- other - heart block, aortic regurg, MI, etc
A
16
Q
Rhizotomy
A
A rhizotomy (/raɪˈzɒtɵmi/ ry-ZOT-ə-mee) is a term chiefly referring to a neurosurgical procedure that selectively destroys problematic nerve roots in the spinal cord, most often to relieve the symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy.
17
Q
Segments of the ICA
A
- cervical
- petrous
- caroticotympanic artery
- vidian artery
- lacerum
- cavernous
- meningohypophyseal artery
- inferolateral artery
- clinoid
- ophthalmic
- ophthalmic artery
- superior hypophyseal artery
- communicating
- posterior communicating artery
- anterior choroidal artery
- ACA
- MCA
18
Q
What to do with a trauma cervical spine when:
- there is a lot of degenerative changes
- no acute fracture?
A
Suggest MR cervical spine if there is cervical myelopathy
19
Q
How do you tell the difference b/t medial vs lateral femoral condyle
on a lateral xray of the knee???
A
Lateral femoral condyle’s sulcus terminalis involves the weight bearing area
Medial femoral condyle’s sulcus terminalis is usually more anterior
20
Q
If there is absolutely no residual ACL fiber remaining
A
It is likely a CHRONIC ACL tear
21
Q
Elbow ligament and tendon insertion/attachment sites
- biceps
- brachialis
- lateral collateral ligament
- annular ligament
- lateral ulnar collateral ligament
- ulnar collateral ligament
A
Elbow ligament/tendon insertion/attachment sites
- biceps - radial tuberosity
- brachialis - coronoid process of ulna
- lateral collateral ligament - lateral radial head
- annular ligament - volar and dorsal aspects of the sigmoid notch of the ulna
- lateral ulnar collateral ligament - supinator crest of the ulna
- ulnar collateral ligament - sublime tubercle of ulna (medial aspect of the coronoid process)
22
Q
most common histologic type of RCC
A
clear cell RCC is most common
80%
23
Q
Timing of …
- corticomedullary phase
- nephrographic phase
- delayed phase
A
Timing of …
- corticomedullary phase
- 70 sec
- corticomedullary phase of the kidneys = portal venous phase
- nephrographic phase
- 100-120 sec
- delayed phase
- > 5 min
24
Q
What size criteria of RCC changes management / staging?
A
- < 3cm, can be done with RFA or cryo
- < 7cm, stage 1
- > 7cm, stage 2
25
Ostitis
Ostitis
## Footnote
= general term to describe any inflammatory condition of the bone
= "osteitis" NOT equal to "osteomyelitis" - osteomyelitis means infection
26
When assessing OCD, describing "no in-situ fragment"
in-situ fragment means an OC fragment that is about to come loose
27
Good saying... from TL
"to further elucidate..."
Good saying... from TL
"to further elucidate..."
28
DDx for ostitis with cortical thickening
DDx for ostitis with cortical thickening
* osteoid osteoma
* chronic cortical osteomyelitis
* stress fracture/reaction
29
Good short DDx for soft tissue sarcomas
Good short DDx for soft tissue sarcomas
* MFH / malignant fibrous histiocytoma
* fibrosarcoma
* liposarcoma
* synovial sarcoma
* extra-skeletal osteosarcoma/chondrosarcoma
* rhabdosarcoma
30
DDx for iliac wing lesions
DDx for iliac wing lesions
* aneurysmal bone cyst
* fibrous dysplasia
* intraosseous lipoma
* subperiosteal hematoma
31
What extra-axial CSF space is that???
Racemose form of neurocysticercosis in the
left MCA cistern!!!
32
The most common location for intraventricular neurocysticercosis?
The most common location for intraventricular neurocysticercosis is the fourth ventricle. It can cause obstructive hydrocephalus and ventriculitis.
33
Stages of neurocysticercosis
Stages of neurocysticercosis
* vesicular
* lava viable, no inflammation
* colloid vesicular
* scolex begins to degenerate
* hyperdense on CT
* T1 and T2 hyper on MR
* perilesional edema and enhancement
* granular nodular
* scolex dead, mineralize
* calcified nodular
* calcified nodules
34
What are the two KEY questions to ask when approaching
an abnormal CXR?
What are the 2 KEY questions to ask when approaching an abnormal CXR?
- acute vs chronic (ask for priors)
- patient's immune status
35
What to always think about when approaching a trauma patient with abnormal CXR?
Aspiration
36
Insertion sites of the rectus femoris muscle?
Insertion of rectus femoris muscle
* direct head - AIIS
* indirect head - posterosuperior aspect of acetabulum
37
Pencil-in-cup deformity can be seen in...?
Pencil-in-cup deformity can be seen in...
* psoriatic arthritis (mainly in hands)
* reactive arthritis (mainly in feet)
38
"Ivory phalanx" is seen in...
"Ivory phalanx" is seen in...
psoriatic arthritis
39
DDx for distal clavicular resportion??
DDx for distal clavicular resorption? - SHIRT
* Scleroderma
* Hyperparathyroidism
* Infection
* RA
* Trauma (weightlifters)
40
What is the bone lesion that you always forget
so that it is important to always keep in mind???
Enchondroma
41
Hyperparathyroidism leads to what changes in hands
besides subperiosteal resorption of the radial aspects of the middle phalanges of the 2nd and 3rd digits?
Acro-osteolysis
42
Which part of the bone does GCT arise from??
Metaphyseal side of the physeal plate
43
What is the longitudinal split of peroneus brevis tendon associated with?
Boomerang shape of the peroneus brevis tendon
Longitudinal split of the peroneus brevis tendon is associated with:
* ankle inversion injury (when the peroneus brevis tendon is entrapped b/t the peroneus longus tendon and the lateral malleous)
* associated with ATFL tear
44
Anatomy of the amygdala vs hippocampus
45
Lowest rate of lower GI bleed to be detected by
NM scan vs angiograhy?
NM for LGIB - 0.05-0.1 cc/min
CT angio for LGIB - 0.5-1.0 cc/min
46
Subtypes of RCC
Subtypes of RCC
* clear cell - most common 80%
* papillary - second most common, less enhancing
* medullary - sickle cell trait patients
47
parosteal lipoma
* 40-70y/o males
* long bones
* consists mostly of fat and has an associated bony component
* not contiguous with adjacent medullary cavity - distinguishes it from an osteochondroma
48
Cryptogenic organizing pneumonia
COP
=
Bronchiolitis obliterans organizing pneumonia
BOOP
histologically, it is called bronchiolitis obliterans organizing pneumonia / BOOP
when BOOP cause is unknown - idiopathic BOOP
= cryptogenic organizing pneumonia / COP
49
Causes of panlobular emphysema
Causes of panlobular emphysema
* alpha-1 antitrypsin deficiency
* smoking
* IV Ritalin abuse
50
ROUND pneumonia
ROUND atelectasis
51
Primary malignancies that can cause
miliary pulmonary nodular metastases?
Primary malignancies that can cause miliary metastases?
TB-MP
* thyroid
* breast
* melanoma
* pancreatic
52
What to ask when faced with an abnormal CXR?
Acute vs chronic? ask for priors!!!
Ask for immune status!!!
53
Rx / embolization criteria for pulmonary AVM
Embolization criteria for pulmonary AVM
- AVM size \> 2cm
- feeding artery size \> 3mm
54
3 different types of ASD
* septum primum
* septum secundum (most common)
* sinus venosus
55
56
What's the most reliable way in telling whether a ventricle
is the LV?
LV: fibrous continuity of the AV and semilunar valves
57
Natural course of LV rhabdomyoma
usually involute with time
may become T1 hyperintense, almost like fat
58
LA myxoma is seen in which syndrome?
Carney complex\*\*\*
* AKA - LAMB syndrome
* autosomal dominant
* cardiac and skin myxomas
* hyperpigmentation of skin
* endocrine activity
NOTE: Carney complex is distinct from Carney triad
* Carney triad (CT) is a multiple endocrine neoplasia (MEN) syndrome, characterized by the coexistence of three types of neoplasms, mainly in young women
* gastric gastrointestinal stromal tumor
* pulmonary chondroma
* extra-adrenal paraganglioma
59
Cor triatriatum
Cor triatriatum
* 2 types
* classical cor triatriatum (cor atriatum sinistrum): commoner
* cor triatriatum dexter
* In the classical type, there is abnormal incorporation of pulmonary venous structures into the left atrium with an unnecessary fibromuscular membraneous sub division through the atrial chamber. - cause of pulmonary hypertension in children
* With cor atriatum dexter a similar scenario is seen through the right atrium. Sometimes (favourably) fenestrations within the membrane may allow some passage of blood flow.
60
Utility of MCA Doppler
Utility of MCA Doppler
* MCA velocity
* test for fetal anemia
* in the setting of e.g., maternal antibodies
* if the fetus is anemic, the blood will be thinner and the MCA velocity will be higher
* higher MCA velocity is abnormal
* MCA PI
* in the setting of IUGR
* esp with the presence of increased UA PI
* if there is IUGR, UA PI will increase
* fetus will compensate by reducing MCA PI to preserve and redistribute blood flow to the brain
* therefore, reduced MCA PI is an indication of IUGR
* if untreated, eventually the fetus will decompensate and MCA PI will increase --\> demise
61
If a woman has a bicornuate or didelphyic uterus and
one horn gets a pregnancy
The other horn will also demonstrate decidual reaction b/c of the hormonal changes...
62
peroneal nerve anatomy and etc
peroneal nerve
* sciatic nerve runs along the thigh to the knee
* sciatic nerve divides into tibial and common peroneal nerves at the popliteal fossa
* common peroneal nerve runs along the posterolateral margin of the fibular neck and enters the fibular canal
* common peroneal nerve trifurcates at or distal to the fibular neck
* deep peroneal nerve
* superficial peroneal nerve
* recurrent or articular branch
* causes of peroneal nerve compression
* trauma
* extrinsic compression, e.g., extrinsic ganglion cyst
* intrinsic compression, e.g., intraneural ganglia
* result in
* denervation injury in the *_anterior_* compartment
63
hibernating myocardium
vs
stunned myocardium
stunned myocardium
* dysfunctional, dyskinetic myocardium
* due to repeated episodes of acute ischemia
* but shows normal or near-normal perfusion
* revascularization is not usually needed
hibernating myocardium
* dysfunctional, dyskinetic myocardium
* from chronic ischemia
* shows "fixed" perfusion defect on Th or mibi scan (just like fixed myocardial infarct/scar)
* but actually still metabolic active, but has switched from normal free fatty acid metabolism to anaerobic glucose metabolism given the chronic ischemia
* will show perfusion on F-18-FDG PET/CT --\> the gold standard for myocardial viability study!!!
64
typical radiotracer normal organ uptake
* gallium
* thallium
* octreotide
* MIBG
* Technetium
radiotracer normal organ uptake
* gallium
* lacrimal glands\*\*\* (look like eyes)
* nasopharynx
* liver, bowel, skeleton
* thallium
* heart
* octreotide
* spleen, kidneys
* MIBG
* parotid gland\*\*\*
* heart
* thyroid
* liver, bowel
* Tc
* salivary gland
* thyroid
* stomach
65
special use of
gallium
vs
thallium
* gallium --\> lymphoma / HCC / vertebral osteomyelitis-disciitis/ PCP lung infection / sarcoidosis
* thallium --\> kaposi sarcoma / lymphoma
66
cancers that are NOT FDG-avid (not good for PET)
cancers that are not FDG-avid, not good for PET/CT
* prostate cancer
* RCC
* bladder cancer
* carcinoid
* mucinous cancers
67
"to the left of..."
"to the right of..."
"to the left of..."
"to the right of..."
68
Compaction of embolization coils for cerebral aneurysm
* The coils placed in intracranial aneurysms can compact, leading to recurrence of the aneurysm. Pulsatile blood flow creates a water hammer effect on the coil mass, leading to compaction of the mass followed by reopening of the aneurysm lumen.
* This complication usually occurs in the first 6 months after coil placement. Follow-up imaging demonstrates compaction of the embolization coils (decrease in volume of the coil mass) and increased or recurrent filling of the aneurysm compared with the immediate post-embolization studies.
* Factors that contribute to a cerebral aneurysm recurrence from coil compaction include *_large aneurysm size*_, _*presence of thrombus*_, and _*low coil-packing density_*.
* the thrombus can eventually dissolve and lead to free space where blood can reaccumulate
69
Hydrocarbon aspiration pneumonia
| (fire-eater lung)
* History is essential to make the diagnosis of hydrocarbon aspiration since initial chest radiographs are often normal or nonspecific.
* Evolution to *_cavitation*_ and _*pleural effusion_* is common. Patients are often only mildly symptomatic and do not require exhaustive workup or intervention.
* Despite the graphic early imaging findings, long-term sequelae such as pulmonary fibrosis are uncommon.
* When aspirated, these substances dissolve surfactant and activate macrophages leading to a prolonged inflammatory reaction. This has been confirmed by bronchoalveolar lavage and electron microscopy, which demonstrates macrophages with lipoid inclusions and a paucity of microorganisms.
70
ductal carcinoma - tubular subtype
usually small but spiculated in appearance
but very slow growing, can be stable for years
ductal carcinoma - tubular subtype
usually small but spiculated in appearance
but very slow growing, can be stable for years
71
Phyllodes tumor
* like a large fibroadenoma
* 25% malignant; 20% of these metastasize - to lung and bone
* well-circumscribed masses; can have T2 hyperintense cystic spaces
Phyllodes tumor
* like a large fibroadenoma
* 25% malignant; 20% of these metastasize - to lung and bone
* well-circumscribed masses; can have T2 hyperintense cystic spaces
72
DDx for solid but very hypoechoic breast masses
without much spiculations/desmoplastic reactions?
DDx for solid, very hypoechoic breast masses on U/S
without much spiculations or desmoplastic reactions?
* medullary/mucinous subtype of ductal carcinoma
* ductal carcinoma NOS but high grade
* lymphoma
73
Expression:
"in-and-of-itself"...
Expression:
"in-and-of-itself"...
74
Subcoracoid impingement
* Subcoracoid impingement is an uncommon, nevertheless important cause of anterior shoulder pain and chronic impingement syndrome, which can be idiopathic, traumatic, or iatrogenic in etiology. Diagnosis is mainly clinical; however, it can be suggested on MRI.
* A coracohumeral interval of less than *_6.8 mm_* on axial MRI may suggest, but not establish, the radiological diagnosis of subcoracoid impingement.
* shortest distance between the lesser tuberosity and the coracoid process (coracohumeral interval).
* coracohumeral interval = shortest distance b/t lesser tuberosity and coracoid process.
* Physical exam findings, response to lidocaine, secondary signs on MRI (cystic changes, tendinopathy and/or tear, bone marrow edema) are paramount in establishing the diagnosis.
* Pain can be elicited by flexion, adduction, and internal rotation.
75
What are the components of the "biceps pulley"?
Components of the biceps pulley
* coracohumeral ligament
* superior glenohumeral ligament
* anterior aspect of the supraspinatus tendon, and
* superior aspect of the subscapularis tendon.
76
bisphosphates related insufficiency fractures
most common proximal 1/3 femoral diaphysis
*_lateral_* cortical thickening first!!!
can be unilateral or bilateral
therefore, always order contralateral xray
77
Most common locations of Ewing sarcoma
1. femur
2. pelvis
78
Dr. JHM chest tip:
## Footnote
when you see clearly airway changes on CXR, such as
- bronchiectasis
- bronchial wall thickening
States that!!
Because airways changes such as bronchiectasis narrows your DDx down by so much so you won't be faked out by the "intersitital markings" and go down the path of interstitial lung disease...
Dr. JHM chest tip:
when you see clearly airway changes on CXR, such as
- bronchiectasis
- bronchial wall thickening
States that!!
Because airways changes such as bronchiectasis narrows your DDx down by so much so you won't be faked out by the "intersitital markings" and go down the path of interstitial lung disease...
79
Coalescent mastoiditis refers to acute mastoiditis with erosion of the mastoid septae and resulting coalescence of the mastoid air cells.
A Bezold abscess occurs when infection spreads into the neck soft tissues following erosion of the mastoid tip.
Coalescent mastoiditis refers to acute mastoiditis with erosion of the mastoid septae and resulting coalescence of the mastoid air cells.
A Bezold abscess occurs when infection spreads into the neck soft tissues following erosion of the mastoid tip.
80
Rigler's triad
Rigler's triad
## Footnote
- pneumobilia
- ectopic gallstone
- small bowel obstruction
81
What is the most basic AUTOMATIC you are supposed to say when you encounter ANY imaging case???
What is the most basic AUTOMATIC you are supposed to say when you encounter ANY imaging case???
Compare with PRIORS!!!!!!!
82
Special names for leukemic infiltrates into solid organs?
chloroma
extramedullary myeloblastoma
granulocytic sarcoma
=
extramedullary solid tumors composed of granulocytic precursor cells
83
84
What is considered significant post void residual volume?
\> 50cc
85
What is considered significantly enlarged prostate volume?
\> 40cc
86
2 recesses in the inferior and anterior aspect of the 3rd ventricle
- supra-optic recess
- infundibular recess
2 recesses in the inferior and anterior aspect of the 3rd ventricle
- supra-optic recess
- infundibular recess
87
Early OB ultrasound, when do you need to change dates?
Early OB ultrasound, when do you need to change dates?
* 9-20 weeks on U/S - discrepancy \> 6 days
* \> 20 weeks on U/S - discrepancy \> 11 days
88
Ovary size on ultrasound
measurements?
upper limites of ovarian volume?
* Ovary size = 0.523 x A x B x C
* rough rule of thumb = 4 x 3 x 2cm
* Upper limits for volume = 10cc
89
PCOS
The revised ASRM/ESHRE *_Rotterdam consensus*_ criteria 4 devised in 2003 require _*2 of the following 3 criteria_* for the diagnosis:
* oligo- or anovulation
* hyperandrogenism (clinical or biochemical) and
* polycystic ovaries: on imaging
Imaging of PCOS
May show sonographic features of polycystic ovaries = bilateral enlarged ovaries with multiple small follicles: 50%
* increased ovarian size (\>10 cc)
* 12 or more follicles measuring 2-9 mm
* follicles of similar size
* peripheral location of follicles: which can give a string of pearl appearance
* hyperechoic central stroma
* the ovarian outline may be slightly irregular ref
Hypo-echoic ovary without individual cysts: 25%
Normal ovaries: 25%
90
Acute subdural bleeds have a high mortality rate, higher even than epidural hematomas and diffuse brain injuries, because the force (acceleration/deceleration) required to cause them causes other severe injuries as well.
The mortality rate associated with acute subdural hematoma is around 60 to 80%.
Acute subdural bleeds have a high mortality rate, *_higher even than_* epidural hematomas and diffuse brain injuries, because the force (acceleration/deceleration) required to cause them causes other severe injuries as well.
The mortality rate associated with acute subdural hematoma is around 60 to 80%.
91
Chemotherapy agent for treating GCT
monoclonal Ab?
Denosumab
92
Most common location for intraosseous lipoma?
Intertrochanteric region!!!
93
placental venous lake
placental venous lake
* Placental venous lakes refer to a phenomenon of formation of sonolucent cystic spaces centrally within the placenta.
* Finding placental lakes during a second trimester ultrasound scan is *_not_* associated with any utero-placental complication or with an adverse pregnancy outcome.
* They can however be abnormal if very diffuse or if seen very early in pregnancy.
94
placental chorioangioma
placental chorioangioma
* benign vascular tumor
* most common tumor of the placenta
* 1% of all pregnancies
* most often - asymptomatic and incidental finding
* if large (\>4cm) or multiple, may be associated with poor fetal and maternal outcome
* pathology
* arise as a malformation of the primitive angioblastic tissue of the placenta
* perfused by the *_fetal circulation_* --\> may lead to fetal heart failure and platelet sequestration (thrombocytopenia)
* imaging
* often seen as a hypoechoic, rounded mass located near the chorionic plate +/- umbilical cord insertion site.
* It usually contains anechoic 'cystic' areas, and can be seen as distinctly separate to normal surrounding placental tissue
* some heterogeneous areas caused by degenerative processes/ internal haemorrhage can be seen.
chorioangiomas can also rarely appear pedunculated
* Colour Doppler interrogation often demonstrates pulsatile flow within the anechoic 'cystic' areas, which actually represent enlarged vascular channels
* treatment
* usually just expectant management
95
Hypertrophic olivary degeneration
Hypertrophic olivary degeneration
* Disruption along the *_dentatorubro-olivary pathway_* may lead to hypertrophic degeneration of the inferior olivary nucleus.
* The most common clinical presentation is *_palatal tremor or myoclonus_*, which develops 10 to 11 months following the initial insult.
* The inferior olivary nucleus demonstrates *_delayed hypertrophy with abnormal T2 signal*_ on MRI and may _*eventually undergo atrophy_*.
* *_Guillain–Mollaret triangle_* - formed by the red nuclei and dentate nuclei
* Affects *_ipsilateral inferior olivary nucleus*_ and _*contralateral dentate nucleus_*
96
medullary thyroid cancer
medullary thyroid cancer
* neuroendocrine tumor
* avid for MIBG scan
* calcitonin secreting --\> low serum calcium levels
* every medullary thyroid cancer should undergo genetic testing
* 80% sporadic
* 20% syndromes - MEN-2A and MEN-2B
* (NOTE: MEN-2B is MEN-2A with mucousal lesions and marfanoid body habitus)
97
Normal uptake of I131-MIBG scan
I-131 MIBG scan
* need Lugol solution to block thyroid uptake
* normal MIBG uptake
* salivary gland
* heart
* liver
* spleen
* bladder (excreted free iodine)
* colon (20% of cases)
* faintly within normal adrenal medulla (10% of cases)
98
Adrenal washout values
Absolute washout \> 60%
Relative washout \> 40%
99
cobweb =
cobweb = spider web
100
what segment lies in front of the caudate lobe?
Segments 4a and 4b.
101
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