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Congenital cystic adenomatoid malformation
Findings: Multilocular low attn lesion in the RLL with thin enhancing septa ddx: Pulmonary abscess
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Adrenal adenoma Findings: Large right adrenal lesion
Isointense to liver on in-phase scan Hypointense to liver (signal loss) on out-of-phase scan ddx: NONE! This is an Aunt Minnie!
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Pancreatic pseudocysts
Findings: Multiple large pancreatic cystic lesions ddx: Von-Hippel Lindau Cystic pancreatic neoplasm
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Pulmonary hamartoma Findings:
Solitary pulmonary fat-containing nodule in the RML May exhibit “popcorn” calcification ddx: NONE! This is an Aunt Minnie!
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Adrenal macronodular hyperplasia
Findings: Bilateral lobular enlargement of the adrenal glands. ddx: Cushing’s syndrome Metastases Infection Tuberculosis Histoplasmosis
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Von-Hippel Lindau Findings: Numerous bilateral renal cyst
Solid enhancing right renal mass = RCC ddx: NONE! This is an Aunt Minnie!
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SVC obstruction Findings:
Contrast-enhanced CT shows intense enhancement of the medial segment of the left lobe = “liver hot spot” sign Collateral vessels seen anteriorly in the soft tissues ddx: NONE! This is an Aunt Minnie!
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Adrenal metastasis Findings: Large heterogeneous adrenal mass
Size alone makes it a surgical lesion ddx: Adenoma Adenocarcinoma Adrenal cortical carcinoma
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Splenic infarct Findings:
Large spleen containing a low attenuation geographic lesion extending from the hilus to the periphery ddx: NONE! This is an Aunt Minnie!
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Malignant mesothelioma
Findings: Encasement and compression of left lung by enhancing soft tissue mass Invasion of the posterolateral chest wall and mediastinum ddx: Metastases Breast Thymus
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ADPKD Findings: Enlarged bilateral kidneys containing innumerable cysts May also see hepatic cysts Cysts complicated by hemorrhage or infection NO increase risk of RCC ddx: NONE! This is an Aunt Minnie!
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Splenic hemangioma Findings: Low attenuation splenic lesion
Most common solid lesion of the spleen Imaging and enhancement characteristics often unlike hepatic hemangiomas ddx: NONE! This is an Aunt Minnie!
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Nutmeg liver due to heart failure
Findings: CT scan shows ascites and paradoxical enhancement of the liver during the arterial phase ddx: Hepatitis Cirrhosis Budd-Chiari
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Appendix mucocele Findings:
Smooth round filling defect at the cecal base CT shows dilated tubular structure filled with low density material ddx: Mucinous adenocarcinoma of the appendix ? Tubo-ovarian abscess
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Calcified splenic cyst
Findings: Large low density splenic lesion Thick calcified wall ddx: Posttraumatic (false) Epidermoid (true) Chronic hydatid disease
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Pneumacystis pneumonia
Findings: Bilateral ground glass opacity emanating from the hila Normal underlying parenchyma ddx: Hypersensitivity pneumonitis Usual interstitial pneumonia Cryptogenic organizing pneumonia Hemorrhage
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Focal nodular hyperplasia
Findings: Intensely enhancing lesion in the hepatic dome in the arterial phase Quick washout in the portal-venous phase ddx: Hypervascular tumor Metastasis
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Non-calcified splenic cyst
Findings: Large homogeneous low density splenic lesion No calcified wall ddx: Epidermoid cyst (true) Pancreatic pseudocyst Hydatid disease Abscess
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Right heart dysfunction
Findings: Opacification of the hepatic veins during the arterial phase Hepatic parenchyma unremarkable ddx: NONE! This is an Aunt Minnie!
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Cystic renal mass Findings:
Low density renal mass with numerous thin septations Partially exophytic, partially extending to the sinus ddx: Cystic RCC Multilocular cystic nephroma Abscess Xanthogranulomatous pyelonephritis (focal)
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Splenic arter aneurysm
Findings: Dense round lesion medial to the splenic hilum Same density as the aorta Causes Portal hypertension Pancreatitis FMD ddx: Hypervascular mass of stomach or pancreas
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Thymic cyst Findings: Large cystic mass in the anterior mediastinum
High attenuation along the periphery = calcification or rim enhancement ddx: Cystic teratoma
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Emphysematous cholecystitis
Findings: Distended gallbladder with gas within the wall Increased risk in pts. with DM Surgical emergency ddx: NONE! This is an Aunt Minnie!
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Islet cell tumor Findings:
Enhancing mass in the pancreatic tail = gastrinoma Pancreatic cysts Associations: Z-E syndrome VHL MEN I ddx: Hypervascular metastasis
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Neuroblastoma Findings:
Large retroperitoneal mass encases the aorta and extends to the renal hilum Peripheral enhancement and several foci of high density (? Ca2+) ddx: Lymphoma Metastatic LAN
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Focal nodular hyperplasia
Findings: Isointense T1 and T2 hepatic mass = “stealth” lesion Intense enhancement in the arterial phase ddx: NONE! This is an Aunt Minnie!
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Lymphoma Findings: Innumerable low density lesions of the liver and one in the spleen ddx: Metastatic disease Fungal abscesses
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Dissecting pancreatic pseudocyst
Findings: Lobular low density subcapsular lesion of the posterior spleen ddx: Lymphoma Abscess
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Hepatosplenic sarcoidosis
Findings: Hepatosplenomegaly Diffuse infiltration by innumerable tiny low density lesions ddx: Microabscesses TB, histo, CMV, PCP Bacterial microabscesses Metastatic disease Kaposi’s sarcoma
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Moire spleen Findings:
Normal swirling enhancement pattern of the spleen during the arterial phase ddx: NONE! This is an Aunt Minnie!
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Adenomyosis of the gallbladder
Findings: Diffuse gallbladder wall thickening “ring down” artifact from the non-dependent wall Abnl thickening of the smooth muscle layer May be focal or diffuse No long term consequence ddx: NONE! This is an Aunt Minnie!
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Focal nodular hyperplasia of the liver
Findings: Single mass in the lateral segment of the left lobe Intense arterial enhancement EXCEPT for a central “scar” ddx: NONE! This is an Aunt Minnie!
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Osteitis condensans Findings:
Focal increased bone density of the medial head of the left clavicle No periosteal reaction or soft tissue mass Rare idiopathic disorder ddx: Sclerotic metastasis Radiation necrosis Osteomyelitis
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Atrophy of the teres minor
Findings: High T1 signal at the attachment of the teres minor = fatty muscular atrophy Axillary nerve impingement in the quadralateral space ddx: NONE! This is an Aunt Minnie! S I S T
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Achalasia Findings: Dilated and debris-filled esophagus ddx:
Pseudoachalasia Obstructing tumor Benign or malignant stricture Chaga’s disease Posterior mediastinal abscess
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Bladder TCC Findings: Diffuse wall thickening of the bladder ddx:
Underdistension Muscular hypertrophy from outlet obstruction Cystitis
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Cervical carcinoma Findings: Fluid-filled endometrial cavity
Suggestion of soft tissue fullness in LUS Incidental left rectus sheath hematoma ddx: Normal menses Cervical stenosis Obstructing metastasis
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Cholangiocarcinoma Findings:
ERCP shows diffuse irregular narrowing of the CBD and intrahepatic biliary tree ddx: Scerlosing cholangitis Ascending cholangitis AIDS cholangiopathy
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Thyroid opthalmopathy
Findings: Bilateral enlargement of the extraoccular muscles except the lateral rectus = “I ’ M S L ow” Sparing of the tendon Usually NO eye pain ddx: Pseudotumor Involves tendons Pts have eye pain
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Closed loop SBO Findings:
Dilated fluid-filled small bowel loops localized in the RUQ Medial displacement of the colon ddx: Internal hernia Small bowel volvulus
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Endometrial carcinoma
Findings: Irregular enhancing mass extending from the endomentrial cavity to the myometrium ddx: Leiomyosarcoma Metastasis Gestational trophoblastic disease (if pt pregnant)
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Pulmonary alveolar proteinosis
Findings: Diffuse ground glass opacities of the secondary pulmonary lobules = “crazy paving” Scatter thickening of the interlobular septa Increased risk of Nocardia infection Rx: BAL ddx: NONE! This is an Aunt Minnie!
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Ovarian cystadenocarcinoma
Findings: Large multilocular cystic lesion with fine septa in the right hemipelvis ddx: Ovarian cystadenoma Tubo-ovarian abscess Mucocele of the appendix
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Normal head US Findings:
Sagittal images through the anterior fontanel show normal appearance of the caudo-thalamic groove Normal choroid plexus in the lateral ventricle
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Diffuse bronchiectasis
Findings: Thick-walled tubular structures extending from the hila to the periphery Accompanying pulmonary artery = “signet ring” sign ddx: Immotile ciliary syndrome Chronic infections (immune deficiency)
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Early necrotizing enterocolitis
Findings: Mildly distended bowel loops with “soap bubble” appearance in the RLQ No evidence of pneumatosis or perforation Rx: bowel rest; surgery if free gas ddx: NONE! This is an Aunt Minnie!
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Intussusception Findings:
Low density intraluminal mass within a small bowel loop Contrast surrounding this mass produced the “coil spring” appearance Associated with a lead point in adults: Lipoma Carcinoma lymphoma Meckel’s diverticulum
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Gaucher spleen Findings:
Enlarged spleen containing numerous low density lesions with mild peripheral enhancement ddx: Lymphoma Metastases Abscesses
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Klippel Trauneny Webber syndrome
Findings: Unilateral muscular and soft tissues enlargement Numerous vessels within the soft tissues ddx: NONE! This is an Aunt Minnie!
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Metastatic ovarian carcinoma
Findings: Numerous low density round lesions within the anterior spleen and within the gastrosplenic ligament ddx: Dissecting pancreatic pseudocyst
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Sickle cell spleen Findings: Small, densely calcified spleen ddx:
NONE! This is an Aunt Minnie!
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Splenic tuberculosis & retrocrural LAN
Findings: Several punctate low density lesions within an otherwise unremarkable spleen Large enhancing lymph nodes surrouding the aorta in the retrocrural space ddx: Lymphoma MAI
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Splenic microabscesses
Findings: Enlarged spleen contains innumerable low density lesions ddx: Fungal Bacterial Metastases Lymphoma Kaposi’s sarcoma Gamma-Gandy bodies (portal hypertension) Sarcoidosis
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Allergic bronchopulmonary aspergillosis
Findings: Tubular branching opacities of the left upper lobe emanating from the hilum = “finger-in-glove” appearance ddx: Pulmonary AVM Rule out malignancy!
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Thrombocytopenia-absent radius syndrome
Findings: Absent bilateral radii and left thumb Prone to bleeding due to thrombocytopenia ddx: Many other causes of radial dysplasia Holt Oram VATER Fanconi syndrome
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Swyer-James syndrome Findings: Hyperlucent left lung
Diminished pulmonary parenchymal and vascular markings Expiration view shows air trapping ddx: Endobronhial foreign body Pneumothorax Congenital lobar emphysema Pulomary artery hypoplasia
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RUL collapse Findings: Wedge-shaped opacity of the right apex
Upper displacement of the minor fissure Right sided mediastinal shift Elevation of the right hemidiaphragm ddx: NONE! This is an Aunt Minnie!
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Cystic hygroma Findings:
2nd trimester fetal US shows a large cystic structure along the posterior neck Recommend amnio Causes: Isoloated (nl karyotype) Generalized hydrops = lymphagiectasia (fatal) Turner’s / Noonan’s Trisomy 21, 18, 13
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Langerhan’s cell histiocytosis
Findings: Single geographic lytic lesion of the skull involving inner and outer table No sclerotic margin but surrounding sclerotic reaction ddx: Metastasis Osteomyelitis Multiple myeloma (multiple) Epidermoid (sclerotic rim)
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Laryngotracheobronchitis
Findings: Narrowing of the subglottic airway = “steeple sign” a.k.a. Croup viral infxn (parainfluenza) but may be bacterial (S. aureus) Check lateral film for acute epiglottitis (25% have subglottic narrowing) ddx: epiglotitis membranous croup
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Pulmonary sling Findings:
Soft tissue opacity between the trachea and esophagus Normal appearance on the frontal radiograph Pt. may present with wheezing ddx: Lymphadenopathy Esophageal mass
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