Apple core lesion

Various Appearance of Portal Hypertension ~ To be continued

Spenoadrenorenal shunt

MRI feature of white matter disease

Brain atrophy
Involved symmetericity
Myelin abnormality
Brainstem & cerebellar involvement
Contrast enhancement
Malformation
Dynamic imaging pattern

Pseudomyxoma peritonei

Ruptured mucocele with foreign body peritonitis
Male: cystadenocarcinoma of appendix
Female: cystadenocarcinoma of ovary

*Thickening of peritoneal + omental sufaces
*Omental cake
*Posterior fixation of bowel loops and mesentery
*Voluminous septated/loculated pseudoascites
*Several thin-walled cystic masses of different size throughout abdominal cavity
*Scalloped contour of liver and splenic margins
Annular / semicircular calcifications

GIST

Esophageal GIST

Gastric GIST

Hiatal hernia

Sliding hernia (axial type): 95%
- GEJ is aboe the diaphragm
- Reflux is more likely with larger hernias
- May be reducible in erect position
Paraesophageal hernia
- GEJ is in its normal position
- Part of the fundus is herniated above the diaphragm through esophageal hiatus and lies to the side of the esophagus
- Not reflux
- More prone to mechanical complications
- Usually nonreducible

*Gastric folds aboe diaphragm
*B line above diaphragm
*Schatzki's ring above diaphragm

%Esophagitis
%Duodenal ulcers

Sign of Intraperitoneal Free Air

Rigler's sign
Triangle sign
Falciform ligament sign
Inverted V sign
Urachus sign
Hyperlucent liver sign
Hepatic age som
Doge cape sign
Anterior superior oal sign
Foot ball sign
Dolphin sign

The pathway of ascites flow over lower abdomen

a. The pelvic cavity, especially the pouch of Douglas
Pouch of Douglas - The most caudal and posterior part of the peritoneal cavity
Upper 4th sarcal segment
Fixation of the peritoneum to Denonvillier's fascia
b. The right lower quadrant at the termination of the small bowel mesentery
c. The superior aspect of the sigmoid mesocolon
d. The right paracolic gutter

Gastric Volvulus

Gastric volvulus
- Mesenteroaxial type: from lesser to greater curve
- Organoaxial type: from cardia to pylorus
Cause
- Diaphragmatic defect
- Intestinal malrotation
- Wandering spleen
-Absence of gastrophrenic ligament and gastrosplenic ligament
Resolve spontaneously sometimes.

*Organoaxial vovulus*

Juxtapapillary diverticula

Rotator Cuff

Muscle Origin on scapula Attachment on humerus Function
Supraspinatus muscle supraspinous fossa greater tubercle abducts the arm
Infraspinatus muscle infraspinous fossa greater tubercle laterally rotates the arm
Teres minor muscle lateral border greater tubercle laterally rotates the arm
Subscapularis muscle subscapular fossa lesser tubercle medially rotates the humerus

Major Upper Abdominal Peritoneal Reflection

Falciform ligament - Right coronary ligament - Left triangular ligament
Lesser omentum
Gastrohepatic ligament
- Glisson's capsule
- Left gastric artery
- Coronary vein
- Left gastric nodal chain
Hepatoduodenal ligament
- Free edge of gastrohepatic ligament
- Portal triad
- Portacaval region

Gastrocolic ligament
- Gastroepiploic vessels
- superior mesenteric vein ate the level of uncinate process of pancreas
- Transverse mesocolon
- Taenia mesocolica
Duodenocolic ligament
- descending duodenum
- posterior hepatic flexure
Gastrosplenic ligament
- Gastrocolic ligament and extended from the greater curvature of the stomach to the spleen.
Phrenicocolic ligament
- From the anatomic splenic flexure of the colon to the diaphragm at the level of 11th rib and serves to support the spleen in the left upper quadrant
Small bowel mesentery
- Extended from the left side of the second lumbar vertebra downward to the right. across the aorta and inferior vena cava, to the right sarcoiliac joint, about 15cm.

Complication of subtotal gastrectomy

Esophageal Symptoms

Delayed Gastric Emptying

Recurrent Ulcers

Carcinoma

Afferent Loop Syndrome

Diarrhea

Weight Loss and Malabsorption

Anemia

Cholelithiasis

Dumping syndrome : early and late

Typical aging change of pancreas

ICH in MRI appearance

T1WI
Hyperacute (intracellular oxy-Hgb): Isointense
Acute (intracelluar deoxy-Hgb): Isointense
Subacute-early (intracellular met-Hgb): Hyperintense
Subacute-late (extracelluar met-Hgb): Hyperintense
Chronic-early (extraelluar met-Hgb & ferritin/hemosiderin wall): Hyperintense
Chronic-late (hemosiderin): Isointense
T2WI
Hyperacute (intracellular oxy-Hgb): Hyperintense with/without hypointense rim
Acute (intracelluar deoxy-Hgb): Hypointense
Subacute-early (intracellular met-Hgb): Hypointense
Subacute-late (extracelluar met-Hgb): HyperHyperintense
Chronic-early (extraelluar met-Hgb & ferritin/hemosiderin wall): Hyperintense with pronounced low signal rim
Chronic-late (hemosiderin): Hypointense
T2*GRE
All hypointense, senseitive to some lesions
DWI
Findings parallel that of convential T2WI
Significant correlation between lesion volume and degree of ADC elevation in perihematoma edema
T1WI with contrast
Ring enhancement appearance in subacute phase

Bone Island

A bone island, also known as an enostosis, is a focus of compact bone located in cancellous bone. This is a benign entity that is usually found incidentally on imaging studies; however, the bone island may mimic a more sinister process, such as an osteoblastic metastasis.
In CT: a round nodule without extension outside the cancellous bone and does not cause bony destruction

Intestinal intussusception

Acute segmental infarction of kidney

Staging of colon cancer

Modified Duke Staging System
Modified Duke A
The tumor penetrates into the mucosa of the bowel wall but no further.
Modified Duke B
B1: tumor penetrates into, but not through the muscularis propria (the muscular layer) of the bowel wall.
B2: tumor penetrates into and through the muscularis propria of the bowel wall.
Modified Duke C
C1: tumor penetrates into, but not through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes.
C2: tumor penetrates into and through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes.
Modified Duke D
The tumor, which has spread beyond the confines of the lymph nodes (to organs such as the liver, lung or bone).
TNM Staging System (Tumor, Node, Metastisis)
Tumor
T1: Tumor invades submucosa.
T2: Tumor invades muscularis propria.
T3: Tumor invades through the muscularis propria into the subserosa, or into the pericolic or perirectal tissues.
T4: Tumor directly invades other organs or structures, and/or perforates.
Node
N0: No regional lymph node metastasis.
N1: Metastasis in 1 to 3 regional lymph nodes.
N2: Metastasis in 4 or more regional lymph nodes.
Metastasis
M0: No distant metastasis.
M1: Distant metastasis present.

Pharynx, anatomy and disease

Lateral pharyngeal pouch: At the level of valleculae
Superior - hyoid bone, middle constrictor muscle
Posterior - stylopharyngeus muscle, superior cornu of the thyroid cartilage
Anterior - thyrohyoid muscle and membrane
5% aspiration
Lateral pharyngeal diverticula: from tonsillar fossa or region of the thyrohyoid membrane
Persistent pouches or saccular collections of the region of the thyrohyoid membrane
Zenker's Diverticulum
Killian-Jamieson Pouches and Diverticula
Webs
Inflammatory disorder
Benign tumor
Malignant tumor

Von Hippel-Lindau Disorder

•Autosomal dominant disorder (Chroosome 3) with 1/35000-1/40000 incidence in America
•Most attacked in 2nd to 3rd decades
•M:F is about 1:1
Diagnostic Criteria
•> 1 hemangioblastoma of CNS
•1 hemangioblastoma + visceral manifestation
•1 manifestation + family history

Subclassification by NIH

•Type I: Renal + pancreatic cysts, high risk for RCC, no pheochromocytoma
•Type IIA: Pheochromocytoma, pancreatic islet cell tumor
•Type IIB: Pheochromocytoma + renal + pancreatic disease

Angiomatous lesions

- Retinal hemangioblastomas -> Von Hippel tumor
- CNS hemangioblastomas -> Lindau tumor
- Endolymphatic sac tumors
- Renal cell carcinoma - Pancreatic cysts and tumors
- Pheochromocytomas
- Epididymal cystadenomas

Groove pancreatitis

a form of segmental pancreatitis affecting the head of the pancreas, is localized within the "groove" between pancreas head, duodenum, and common bile duct. Differentiation between groove pancreatitis and pancreatic head carcinoma is often difficult.

Impact of protein plug over Santorini's duct may be the cause of groove pancreatitis

Image: a mass was detected in the head of the pancreas that involved the duodenum. Dynamic CT demonstrated a poorly enhancing lesion extending between the pancreatic head and the duodenum.

Bowler Hat Sign

For differienation of polyp and diverticulm of colon.
Bowler hat pointing toward center of cup showed a polyp and pointing away from center of cup showed a diverticulum
When the bowler hat is nearly parallel to long axis of bowel, it is impossible to determine whether it is a polyp or a diverticulum

Metastasis with hepatoduodenal ligament extension

Gastric cancer with hepatic hilum invasion and common hepatic artery encased.

The spreading from hepatoduodenal ligament can be domostrated from this image

Squamous cell carcinoma

30% of lung cancer
Related to smoking
65% found in main, lobar, or segmental bronchi
Endobronchial mass
Bronchial obstruction
Infiltration of bronchial wall
Local invasion
Hilar mass
Atelectasis and consolidation common
30% solitary nodule or mass
Central necrosis and cavitation relatively common
Metastasis late
Relatively good prognosis

Right middle lobe syndrome

Most in child
Chronic inflammation
Congential heart disease
Asthma
Cystic fibrosis
Bronchopulmonary dysplasia
Obstructive lesion

Cause repeated pneumonia

Atelectasis

cause: tumor (most SCC), TB, sarcoidosis, Post operative atelectasis. Large left atrium.
Types:
Resorption - Obstruction
Relaxation - Passive, Pleural effusion, pneumothroax
Adhesive - ARDS (decrease in surfatant production)
Cicatricial - Lung fibrosis
ex. right middle lobe syndrome
Discoid atelectasis: Emoblus, Penumonia, Inadequate inspiration Carcinoma
Segmental atelectasis
Sign
Double lesion sign - RUL and RML collapse
Shifting granuloma sign
Golden's S sign - RUL
Juxtaphrenic peak - UL
Luftsichel sign - LUL - Apical cap
Falt waist sign - LLL
Comet-tail sign - Rounded
Rounded atelectasis - Posterior lower lobe. often free pleural effusion with inflammation

Overture

It's said the author of "Radiology Review Manual" wrote this book when he was a resident according his note for examination. Therefore, in the era of Web 2.0, maybe I can record my study and my idea in this blog. It is a start and it is a record of my work.