Radio Practicals Reviewer

SURGERY BLOCK: RADIOLOGY PRACTICALS REVIEWER 2024
INTRO TO RADIO (DONE)
FIVE BASIC RADIOGRAPHIC DENSITIES Air is the most radiolucent (blackest)

and Metal is the most radiopaque (whitest).
X-RAY. RADIOPAQUE WHITE
RADIOLLICENT BLACK
PA VS AP VIEW
Ribs curve Ribs Horizontal Posterior-to-anterior (PA): Exactly as it

Scapula away Scapula obstructing
Heart normal Heart magnified sounds, a PA view entails X-rays penetrating
PA view, the scapula is protracted outward. through the posterior/dorsal surface of a
patient and being recorded on the opposite
AP view, the scapula is obstructing the lung side. This is the preferred imaging
fields, and there is orientation, however bed-ridden patients may
not be able to allow for this type of X-ray to be
It is important to realize that the LEFT side of taken.
the image (for both AP and PA films) Anterior-to-posterior (AP): The opposite of a
represents the RIGHT side of the patient. PA. this orientation is commonly taken with
portable X-rays with patients who are
X-RAY. bed-ridden and laying on their back. The
anatomy of the heart can appear artificially
larger due to this image orientation. In most
circumstances PA orientations are preferred.
Lateral views (right/left) Left lateral decubitus position (LLDP)

Pediatric Population patients are radiographed when laying on
Examining Pulmonary Densities their left side. This can be done for logistical
reasons (patient is unable to stand for an
X-RAY upright lateral X-ray) or can be done to
evaluate for the e ect of gravity on
pathological findings (i.e. to assess for layering
of a pleural e usion).
1
MRI INITENSITY
Excelllent for SOFT TISSUE
uses a magnetic field and computer-generated
radio waves to create detailed images of the
organs and tissues in your body. (Signal
Intensity)
W/OUT RADIATION
Uses Gadolinium Contrast.
(-) Contrast / (+) Contrast

Hypointensity Hyperintensity
= “Darker” = Pic enhanced
CT-SCAN DENSITY / ATENCIATION High density tissue (such as bone) absorbs

Attenuation/Density the radiation to a greater degree, and a
Excellent Bony Details reduced amount is detected by the scanner on
the opposite side of the body. (hyperdense)
Low density tissue (such as the lungs),

absorbs the radiation to a lesser degree, and
there is a greater signal detected by the
scanner. (hypodense)
Hypodensity = Darker
Hyperdensity = Lighter
2
ULTRASOUND ECHOIC
Echogenicity
No Radiation
FLUID is always BLACK and TISSUE is GRAY.

The denser the tissue, is the brighter white it
will appear in ultrasound the brightest white
being bone.
Hypoechoic = whiter image

Hypoechoic = Gray image
Anechoic = Gray
3
PULMO (DONE)
Pulmonary tuberculosis TREE IN A BUD SIGN-CT-SCAN

CT - Scan only
Tree in Bud Sign
4
Pneumonia
● CT-SCAN
● There is consolidation of alveolar
patern. Airways are filled of Fluid
making it appear as Solid
PLEURAL EFFUSION
● “175 ML” 150 ML
● OPACITY (WHITE)
● SHARPNESS OF COSTROPHRENIC
ANGLE DISAPPEARS → BLUNT
● Pleural Meniscus sign (+)
● Passive Atelectasis
● BEST ASSESSED BY ULTRASOUND
5
PNEUMOTHORAX
● Deep Sulcus Sign
● Double Diaphragm sign
● Visualization of PLEURAL LINE
EMPHYSEMA
● Di use Hyperlucency
● Lung is Hyperaerated
● Flattened Diaphragm (located below
10th rib)
● Increased Peripheral Vascular Markings
● RIGHT HEART ENLARGEMENT
6
ADENOCARCINOMA
● Most Common Type of Lung CA
● NON-SMOKERS
● SPICULATED NODULES
SQUAMOUS CELL CARCINOMA

● 2ND MOST COMMON LUNG CA
● ARISES CENTRALLY IN LOBAR AND
SEGMENTAL BRONCHUS
7
SMALL CELL CARCINOMA

● Arises centrally within lobar and
segmental bronchus
● Hilar or mediastinal mass
● (+) Lymph node Metastasis
● Displacement of mediastinal structures
LARGE CELL CARCINOMA

● Arises peripherally
● Solitary Mass
● Often Large at time of Presentation
PULMONARY METASTASIS
● Cannon Ball Appearance (X-ray)
● Feeding Vessel Sign (Vessels directly
leading to a nodule)
8
CONGENITAL PULMONARY AIRWAY

MALFORMATIONS
● Hyperintense cystic lesion (multiocular)
● Solid Lesion with multiple tiny cyst
CARDIAC IMAGING done
Enlargement of the heart shadow

May be contribute to large cardiac
shadow
• Dilatation of the cardiac chambers
• Pericardial fluid
• Pericardial e usion
• Oreo cookie sign
Right Ventricular Enlargement

Frontal radiograph
Displacement of
cardiac apex in leftward and superiorly
direction
Elevation of
Lateral radiograph
cardiac apex
Opacification Of the retrosternal clear space
9
Right atrial enlargement

• Convex Right margin > 3 cm from
Right lateral vertebral border
• ↑ Height of Right atrium (most
reliable)
Left ventricular enlargement

• Frontal radiograph
• Prominent left heart border with
rounding
• Inferolateral shift of apex
Left atrial enlargement

• Frontal
• Double density sign—enlarged left
elevation of
atrium visualized through the right LMB
Atrium
• Frontal
• Third mogul sign
Pulmonary
Aortic Knob
L Atrium
L Ventricle
10
Pericardial
fat pad
Left atrial enlargement Imaging

• Lateral Seen in lateral view ONLY ! • Barium study
• Indentation of the esophagus
• Walking man sign—Elevate the left (earliest)
upper lobe bronchus (earliest sign in
radiography
Pulmonary edema
• Bat wing appearance
Atrial septal defect

• Usually presents in later childhood or
early adulthood
•F>M
• Imaging
• Enlarged right atrium
• Enlarged left ventricle
11
Ventricular septal defect

• Imaging
• Enlarged left atrium I
Patent ductus arteriosus

• Imaging
x
• Enlarged aorta and main pulmonary x
artery
Tetralogy of Fallot
• Most common cyanotic heart disease
8
• Components
1. Right ventricular outflow tract
obstruction
2. Right ventricular hypertrophy
3. VSD
4. Overriding aorta
• Imaging “BOOT - SHAPED HEART”

• “boot-shaped heart”
• 25% have right-sided aortic arch
12
Ebstein anomaly
• apical displacement of the septal and
posterior tricuspid valve leaflets →
W
atrialization of the right ventricle
• Imaging
• “box-shaped heart” “BOX - SHAPED HEART”
• Enlarged right atrium
• Small right ventricle
Transposition of great arteries

• Most common cause of cyanotic
heart disease in neonates
• Imaging
• “Egg on a string”
• Narrow mediastinal waist—Aorta
anterior to the heart
O
• Right aortic arch in 5%
“EGG ON STRING”
Truncus arteriosus
• Single great artery
• Imaging
• Cardiomegaly with narrow
mediastinum
• Right-sided aorta arch 21-36%
“BOOT - SHAPED HEART”
13
Total anomalous pulmonary venous • Imaging

return • Snowman sign or figure-of-8 sign
• Types
• Supracardiac
8
• Most common
• Drainage: Common confluent of
pulmonary veins → vertical vein →
innominate vein
• Cardiac
• Drainage: Coronary sinus or right atrium
• Infracardiac
• Drainage: hepatic IVC, hepatic vein, portal
venous system
• All pulmonary veins connect anomalously to the systemic
venous circulation
SNOWMAN / FIGURE OF 8 SIGN
Coarctation of the aorta • Imaging

“3 SIGN” / RIB NOTCHING
• Associated with Turner syndrome • “3 sign”
• Rib notching
• Hx and PE
• Upper extremity hypertension
• “radiofemoral delay”
• Congenital focal narrowing of the C
-
aorta
~
I
14
Myocardial infarction
• Imaging
• Normal
• Pulmonary edema
Isolated right upper lobe

edema due to papillary muscle rupture
True left ventricular aneurysm • Imaging

• Abnormal contour along the mid portion of the left cardiac
• All layers of the muscular wall border near the apex
a ected • May calcify
• Anterior or anterolateral wall—most
common location
• Treatment
• medical
Left ventricular pseudoaneurysm • Imaging

• Contained rupture • Retrocardiac density
• Posterior wall—most common • Abnormal posterior contour on lateral
location radiograph
15
Mitral regurgitation • Imaging
• Imaging • Associated with mitral annular

calcification
• Cardiomegaly
• Enlarged left atrium
Mitral stenosis
• Imaging
• Normal sized heart
• Enlarged left atrium
Aortic regurgitation
• Imaging
• Cardiomegaly
• Enlarged of the left ventricle
• Enlargement of the ascending aorta
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Aortic stenosis
• Imaging
• Normal heart size
• Enlarged of the left ventricle
• Enlarged ascending aorta
Pericardial e usion • Imaging

• Imaging • Oreo cookie sign
• Represent parallel lucent epicardial and
• Water/flask bottle sign
pericardial fat stripes and radiopaque
• the fluid causes the pericardium to sag, pericardial e usion
mimicking an old-fashioned water bottle
Pericardial calcification
• Associated with constrictive
Pericarditis
17
URORAD 1 and 2 (DONE)
Plain KUB X-ray Serial Images w/ contrast

● This doesn’t have a contrast yet. • Pyelogram phase
● Evaluate and look for calcifications, • There is decreasing in enhancement in the parenchyma
abdominal mass, and bone fractures. of the kidney Collecting structures
because it goes to collecting structures – renal pelvis,
ureter, and
urinary bladder.
• A pyelogram phase scan at 3 to 5 minutes shows
contrast filling of
the collecting system and ureters.
Nephrogram Phase (1-2 mins)

d
• After giving IC contrast → 1-2 mins → take x-ray again.
• At approximately 1-2 mins following the onset of
contrast injection, the renal parenchyma will be Full bladder and Postvoid
enhanced.
Left picture. Full bladder
• If the patient has an abnormal kidney (e.g. chronic
kidney disease) Right picture. Postvoid
→ delay of enhancement or the procedure can’t be done • Here the patient was instructed to urinate. Sometimes,
due to contraindications. there are
residual such in cases of enlarged prostate.
• Eyeballing of the radiologists if the residue is significant
• If there are suspicious stones, there will be a filling
defect.
Homogenous: Produce smooth filling defect - “buo at
itim na itim”
Heterogenous:Produce irregular filling defect- “may part
na hindi buong buo yung itim. Usually a mass”.
Retrograde Ileal Conduit (Loopogram)
18
The ureter was attached to the bowel segment. Then the

stoma of the bowel segment is placed onto the surface of
the abdomen
CT Stonogram
Ideal imaging modality for stones
o Check for stones (location, thickness, HU, extent of
obstruction)
Gold standard for kidney stones
CT Urogram • Unenhanced – no contrast

• Nephrographic – the contrast is in the parenchyma of
• Precontrast scans
the kidney
o Obtained from the kidneys through the bladder to
• Pyelographic – Enhanced collecting structures
detect
urinary stones and calcifications
• Nephrogram phase
o At 120 seconds after contrast injection
o Renal parenchyma is uniformly enhanced • Pyelogram
phase scan
o At 3-5 mins
o Contrast filling of the collecting system and ureters •
“Parang KUB IVP pero CT Scan”
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Abnormal Renal Rotation/ Malrotated

Kidney
Congenital Anomaly
• Left picture. KUB IVP. Shows the renal hilum facing
laterally. Normally, it should face medially.
• CT scans show the collecting structures facing anteriorly
→ abnormal renal rotation.
• Prone to stasis of urine → renal calculi
Renal Agenesis
Congenital Anomaly
• CT stonogram shows absent right kidney
• Not all renal agenesis loses adrenals.
• 90% cases of renal agenesis has complete adrenals.
Horse-shoe Kidney
Congenital Anomaly
• Fusion of the inferior aspects of kidney
• Prone to stasis of urine → renal calculi
• Prone to malignancy
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Ectopic Kidney
Congenital Anomaly
• KUB IVP. Showing you a normal right kidney.
• Ideally, the left kidney is higher than the right but in the
left picture,
the left kidney is located in the pelvic region. 8
• Right picture. CT Scan. The left kidney is ectopic.
o One normal and one pelvic kidney – 1 in 3,000 – most C

common
o Crossed renal ectopia – 1 in 7,000 – 2nd most common
Acute pyelonephritis
RENAL INFECTIONS
V
• Is usually the result of ascending urinary tract infection
caused by a gram-negative organism, especially E. Coli.
• Imaging evaluation is indicated in patients who fail to
respond to treatment or are severely ill.
• CT is more sensitive than US in demonstrating the subtle
changes in the renal parenchyma associated with
uncomplicated pyelonephritis. Complications are well
demonstrated by CT or US.
• Contrast enhancement reveals streaks and wedges of
Striated nephrogram
low attenuation extending to the renal capsule (the
“striated nephrogram”).
8
• In contrast study, there is the presence of multiple
hypodense wedge-shaped areas.
• With a striated nephrogram, the capsule is not
enhanced.
Complications of Pyelonephritis
• Rim enhancing fluid collection → abscess
• Demonstrates multiple air foci within the collection –
aerobic bacteria
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Emphysematous pyelonephritis
RENAL INFECTIONS
• Is a form of acute pyelonephritis with air in the renal
parenchyma. Most cases occur in patients with diabetes,
obstruction, or immunocompromised.
• The condition is rapidly progressive and often life
threatening.
• Mixed flora infection with gram-negative organism is
most common.
KUB X-ray. There is air in the left kidney.
• CT stonogram. Shows air foci involving the bilateral

kidney.
• Emphysematous pyelitis – air in the collecting structures
Xanthogranulomatous pyelonephritis
Rare destructive granulomatous process
• An obstructing stone, often a staghorn calculus, is
usually present.
• The kidney is chronically infected, most commonly with
Proteus mirabilis, and does not function in the a ected
areas.
• Renal parenchyma is destroyed and replaced by
xanthoma cells, which are lipid-laden macrophages.
• CT and US demonstrate focal or di use hydronephrosis
and a complex mass with areas of high and low density.
• Staghorn calculi –calculi that conform the shape of the
Inflammatory changes extend into perinephric fat. renal pelvis
• Initially presents as chronic pyelonephritis.
• There is a lysis of medulla destroying the parenchyma
22
There is parenchymal thinning.

• Demonstrates a bear paw sign.
Renal tuberculosis
• May follow primary pulmonary tuberculosis by as much
as 10-15 years
• The urinary tract is the most frequent site of
extrapulmonary tuberculosis.
Hallmarks of renal tuberculosis

always “Unilateral”
• Papillary necrosis
• Parenchymal destruction
• Cavity formation leading to uneven caliectasis
• Fibrosis and scarring of the collecting system and the
renal parenchyma Putty kidney – Progressive Stage
• Parenchymal masses owing to granuloma formation • KUB IVP X-ray
• The right kidney is atrophic and completely replaced by
• Strictures of the collecting system and ureters
dystrophic
• Widely variant patterns of calcification calcification indicative of a putty kidney.
• The left collecting structures show an uneven caliectasia
STAGES with multifocal strictures in the proximal ureter.
• Early
o Papillary necrosis (single or multiple) resulting in
uneven caliectasis – “may hydronephrosis pero hindi
uneven”
• Progressive
o Multifocal strictures and hydronephrosis
o Mural thickening and enhancement (on cross-sectional
imaging)
• End-stage
o Progressive hydronephrosis and parenchymal thinning
o Dystrophic calcification or “putty kidney”
• CT Scan
• Atrophic right kidney with dystrophic calcification. This
kidney doesn’t function anymore. Candidate for renal
transplant.
23
Renal cell carcinoma

• Are primary malignant adenocarcinomas derived from
the renal tubular epithelium and are the most common
malignant renal tumor.
RISK FACTORS
• Cigarette smoking
• Dialysis-related cystic disease • Obesity
• Treatment with cyclophosphamide (chemotherapy
agent)
• Example of RCC in CT urogram on pyelogram phase
• The left kidney shows an exophytic nodule with areas of
necrosis
(arrow)
• Exophytic cystic nodule. RCC because the plural wall

and cyst were enhanced using contrast. Presence of
stranding densities.
Radiographic features
Ultrasound • Exophytic cystic mass showing mural enhancement.
• It may appear solid or partially cystic, and may be Wall and septations are enhanced.
hyper, iso, or hypoechogenic to the surrounding renal
parenchyma.
CT
• MDCT without and with intravenous contrast
administration is the tumor evaluation and staging
24
method of choice.
• Diagnosis depends on the demonstration of tumor
enhancement.
• Even with enhancement, most tumors are
heterogeneously lower in attenuation than enhanced
renal parenchyma
MRI
o Hyperintensity on T1WI usually reflects tumoral
hemorrhage
o Most RCCs are heterogenous on T2WI, reflecting areas
of tumor necrosis, hemorrhage, and hemosiderin.
• Aside from the pattern of nodules, mass, and cysts, we
o T1C+ (Gd): often shows a prompt arterial enhancement.
have tumor thrombus formation. The left kidney
o MRI is also useful for imaging renal vein and IVC tumor demonstrates a hypo- enhancing mass which appears to
thrombus occupy the entire length kidney.
• Tumor Thrombus in Renal Vein and Inferior Vena Cava.

• Coronal plane image from an MR angiogram shows an
irregularly enhancing mass (arrow) replacing the upper
pole of the right kidney. Enhancing tumor thrombus
(arrowhead) extends continuously from the renal mass
through the renal vein and into the lumen of the inferior
vena cava. Enhancement di erentiates tumor thrombus
from bland thrombus. The right renal artery (curved
arrow) is well shown
25
Renal cell carcinomas (RCC)

Main metastatic sites
• The most common sites of metastasis are, in order: RCC
o Lungs
o Bones
o Lymph nodes
o Liver
o Adrenals
o Brain
• Renal cell carcinoma is one of the more common causes
of cannonball metastases to the lung.
• Multiple nodule masses with varying sizes are scattered

Cannonball Metastases in the lungs suggestive of cannonball metastases
• It refers to a large, multiple, well circumscribed, round
pulmonary metastases that appear well like cannonballs.
• Metastases with such an appearance are classically
secondary to:
o Renal cell carcinoma
o Choriocarcinoma
• Or less common primary tumors:
o Prostate carcinoma
o Synovial sarcoma
o Endometrial carcinoma
Renal Lymphoma
• Most cases are non-Hodgkin lymphoma.
• Patterns of renal involvement include di use disease
enlarging the kidney, multiple bilateral solid renal
masses, solitary bulky tumor, perirenal tumor
surrounding the kidney, and tumor invasion from the
retroperitoneum into the renal sinus.
• CT shows lymphoma as homogenous and poorly
enhancing. Extensive retroperitoneal adenopathy
favors the diagnosis.
• Non–Hodgkin lymphoma (arrows) infiltrates the

perirenal space partially surrounding both kidneys. Note
the impaired contrast enhancement of the right kidney
caused by lymphomatous involvement of the right renal
blood vessels (arrowhead). The tumor infiltrates the sinus
and parenchyma of the right kidney.
26
Metastases
The kidneys are a frequent site of hematogenous
metastases; however, most are detected late in the
course of malignancy.
• Most metastases appear small, irregular infiltrative
renal masses. Some are large, solitary, and not
distinguishable from RCC.
• Common primary tumors include lung, breast, colon
carcinoma, and melanoma.
• Metastases to the Kidney. In a patient with lung cancer,
the ill- defined low attenuation lesions (arrows) in the
renal parenchyma of both kidneys represent metastatic
disease. Metastases are typically infiltrative and poorly
defined.
CYSTIC RENAL MASSES

Simple Renal Cyst
• Most common renal mass
• Small cysts are asymptomatic. Large cysts (4cm)
occasionally cause obstruction, pain, hematuria, or
hypertension/
• Cysts are commonly multiple and bilateral
• US, CT, and MR can each make a definitive diagnosis.
Complicated Cyst
• Simple renal cysts may become complicates by
hemorrhage or infection.
• The resulting change in imaging characteristics may • Bosniak 1-2F is not cancerous
make di erentiation from cystic renal tumors di cult. • Bosniak 3-4 enhances hence, cancerous.
• Bosniak 1 – fat arrow

• Bosniak 2 – arrowhead
• Significant enhancement measure +15HU
27
Medullary sponge kidney

• Refers to dysplastic dilatation of the collecting tubules
in the papilla. The dilatation is cylindrical or saccular in
configuration. The condition causes urinary stasis in the
papilla, which results in stone formation and occasionally
infection.
• Stones in the papilla cause increased echogenicity in
the medulla on US.
• KUB X-RAY. Showing medullary sponge with kidney

calcifications.
Renal Failure
• In patients with renal failure, US is usually requested to
exclude hydronephrosis, assess renal size, and identify
renal parenchyma disease.
• Sonographic signs of renal parenchymal disease include
a di use increase in parenchymal echogenicity often
associated with loss of corticomedullary di erentiation.
C
• KUB Ultrasound
• Showing a small kidney with:
o 8.3 cm – “kapal ng buong kidney” o 2.6 cm –
parenchymal thickness o 0.4 cm – (normal size is 1-2.7cm)
• Cortex and medulla is not appreciated.
• Kidney is whiter than liver. Ideally, the should be
isoechoic.
28
Nephrocalcinosis
• Nephrocalcinosis is a broad term that refers to the
pathologic deposition of calcium in the renal
parenchyma. Nephrocalcinosis is usually bilateral and the
results of systemic disorders.
BILATERAL
Medullary nephrocalcinosis
P
• Ultrasound
• Left. An example of medullary nephrocalcinosis. Renal
medulla is calcified.
• Right. Nephrolithiasis → hydronephrosis
Parts of Male Urethra
Voiding cystourethrography in males

• The penile urethra (PU) extends from the urethral
meatus to the suspensory ligament of the penis
(straight arrow) at the penoscrotal
junction.
• The bulbous urethra (BU) extends from the
penoscrotal junction to
the urogenital diaphragm (curved arrow) • The
posterior urethra consists of the membranous urethra
and the prostatic urethra.
• The membranous urethra (curved arrow) is only 1 cm
in length and is entirely within the muscle of the
urogenital diaphragm.
29
The verumontanum (arrowhead) is a nodular structure

that produces a [normal] filling defect on the
urethrograms by bulging into the prostatic urethra.
• The prostatic urethra extends from the inferior aspect
of the verumontanum to the base of the bladder (B)
Plain abdominal X-ray in Supine Position
• A plain film should be done first before introducing a

contrast → evaluate for the presence of calcifications,
mass, pathologies, and bone structures. After then, a
contrast can be introduced
Prostate Ultrasound Transrectal

Transabdominal
⑬ " Mr
The bladder should be full to evaluate the
prostate gland. • Evaluation is done with an empty bladder.
• Usually done to measure the prostate • Endocavitary probe is inserted in the rectum
gland. Not suitable for diagnosing lesions. MRI is better of the patient.
for evaluating lesions and nodules due to higher • The rectum is just below the prostate.
sensitivity. • Rectum – green oval
• Prostate – red oval
30
Scrotal Sonography
*C
Usually done by Radiologists → not usually done by Rad
techs due to complicated evaluation
• Common misdiagnosis between testicular torsion and
orchitis due to the same clinical presentation
• Also used in assessing undescended testis → usually
located inguinal
• If the undescended testis is not removed → high risk for
CA
I
Congenital Anomalies
Ureteral Duplication/Double collecting
system
• A kidney has two ureters draining the kidney.

• The two ureters may either drain the kidney into the
bladder independently of one another or as a single
ureter into the bladder.
• Reflux nephropathy of the lower pole system may be
evident. Cystic dilatation of the upper pole system is
usually associated with marked parenchymal thinning.
• The upper pole ureter is commonly tortuous and dilated.
The ectopic ureterocele and its associated dilated ureter
may simulate a multiseptated cystic mass in the pelvis.
• Drooping Lily Sign
31
• The upper ureter is the one that is obstructed because

its connection with the bladder is a ureterocele or no
opening at all → ureterohydronephrosis.
• The lower ureter is usually normal
Postcaval ureter / Retrocaval ureter

• Retrocaval ureter is a developmental variant in which
the right ureter passes behind the inferior vena cava at
the level of L3 or L4 vertebra.
• The ureter exits anteriorly between the cava and the
aorta to return to its normal position. The condition is
associated with varying degrees of urinary stasis and
proximal pyeloureterectasis.
• The anomaly is due to faulty embryogenesis of the
inferior vena cava, with abnormal persistence of the right
subcardinal vein anterior to the ureter instead of the
right supracardinal vein posterior to the ureter.
Simple Ureterocele
• Simple ureterocele is a cystic dilatation of the
intravesicular segment of the ureter caused by a
congenital prolapse of the distal ureter into the bladder
lumen at the normal insertion site of the
ureter into the trigone.
• Contrast studies demonstrate a rounded filling defect in
the bladder at the ureteral insertion. j
• A radiolucent halo is produced by the wall of the ureter
outlined both inside and outside by contrast.
• US demonstrate a cystic mass at the ureteral orifice.
Peristalsis of the ureter causing alternate filling and Demonstrates “spring onion” sign or “cobra head” sign
emptying of the ureterocele is seen on real-time US.
32
• The distal wall of the ureter herniates to the bladder

(lucent appearance).
• Conventional radiograph from an excretory urogram

demonstrates mild dilation of the right ureter associated
with a simple ureterocele (u) that protrudes into the
lumen of the bladder (B).
• The radiolucent wall of the ureterocele (arrowhead) is
outlined by contrast within the ureterocele and contrast
within the bladder lumen. The wall of the ureterocele is
made up of the wall of the ureter and the bladder
mucosa.
Urachus
• In the absence of complete obliteration, the urachus
persists in a number of configurations depending on the
location and degree of obliteration.
Patent urachus
• Communication between bladder and umbilicus through
a urachus that has not involuted.
Urachal cyst
• Imaging shows a fluid-filled cyst in the midline
abdominal wall usually in the lower third region of the
urachus.
Umbilical urachal cyst and sinus

• Imaging shows a tubular structure in the midline • An example of a fluoroscopy. Recurrent umbilical
infection. A
abdominal wall extending caudally from the umbilicus.
cystogram that shows a tract from the urinary bladder to
• “Parang malalim yung pusod” the umbilicus.
Vesicourachal diverticulum
Is an outpouching of the bladder in the anterior midline
location of the urachus. This is s een in adults with
bladder outlet obstruction as a fluid-filled sac extending
cranially from the bladder in midline abdominal wall.
33
Posterior urethral valve

• Present recurrent UTI in pediatric males.
• A thick valve-like membrane extends obliquely across
the urethral lumen from the verumontanum to the distal
prostatic urethra obstructing the flow of urine.
• Findings of bladder outlet obstruction are present with
bladder wall hypertrophy and usually bilateral
hydronephrosis.
• Characteristically the membrane flattens to allow
passage of a catheter into the bladder, but it balloons
and obstruct urine flow with voiding. • Left picture. A normal voiding cystourethrogram.
• Usually discovered on pre-natal US. • Right picture. Shows a cystic structure below the urinary
bladder.
• Gold standard for diagnosing Posterior urethral

valve: Voiding cystography
• Classic finding: Key-hole sign
Vesicoureteral Reflux Cystogram

• Is a common cause of hydronephrosis in children.
• The basic defect is an abnormal ureteral tunnel at the
UVJ and associated urinary tract infection allowing
infected urine from the bladder to reflux up the ureter.
NORMAL
34
ABNORMAL
• Demonstrates residual in the urinary bladder.
• The contrast was extended up to the left kidney
showing reflux from urinary bladder → ureter → calyces
Hydronephrosis
• Hydronephrosis is not synonymous with obstruction but
has a number of causes that are reviewed in this section.
• US is an excellent screening modality for determining
O
the presence of urinary tract dilation.
• Dilation of the upper urinary tract – proximal ureter,

renal pelvis, major and minor calyces.
• Right picture. An example of KUB IVP showing a left

sided hydronephrosis. SFU Grade 4
• Left picture. CT Urogram. SFU Grade 4.
35
Urolithiasis
• In order to di erentiate di erent types of stones, check

for Hounsfield units.
• Use the CT Appearance as a reference for getting the
HU.
O
⑥ S
• Findings of ureteral obstruction include:
o Mild dilatation of the pelvicalyceal system and ureter
(3mm) proximal to the stone
o Slight decrease in attenuation of the a ected kidney
caused by edema
o Perinephric soft tissue stranding representing edema in O 8
the perinephric and periureteral fat.
• Stones less than 6mm in size are likely to pass An example of ureterovesical junction stone.
spontaneously through the ureter within 6 weeks →
managed medically.
o Exception: if the stones are located in the
inferior calyces
• Stone larger that 6mm are more likely to retain lodged
O
in the ureter and require intervention for removal. Calculi
are most likely to befound at the three points of ureteral
narrowing.
An example of inferior nephrolithiasis.
36
+SHADOWING = Stones
- SHADOWING = Calcifications
#
p.
• An ultrasound of nephrolithiasis.
• Hyperechoic lithiasis showing posterior acoustic
shadowing.
Ureteral Mass
Transitional Cell Carcinoma
Second most common primary renal malignancy
These lesions cause a distinct filling defect in the
collecting system or the ureter. Most TCC occurs in men
(4:1) aged 60 and older.
• The tumor metastasize most commonly to regional
lymph nodes, liver, lung, and bone.
• KUB IVP. Demonstrates heterogenous filling defect.
• Goblet sign or champagne glass sign refers to the

appearance of the ureter when it is focally dilated by an
intraluminal mass.
37
Neurogenic bladder
• Is a term applies to a dysfunctional urinary bladder that
results from an injury to the central or peripheral nerves
that control and regulate urination
• Most neurogenic bladder eventually become
trabeculated, thick- walled, and reduced in capacity.
Christmas Tree Sign
• Demonstrates a Christmas tree appearance of pine

cone bladder.
Cystitis
• CT shows bladder wall thickening and perivesical
&
edema.
• MR demonstrates mucosal edema and inflammation as
high signal intensity on T2WI, easily di erentiated from
normal low-signal bladder wall.
+ Thickening of wall
- Gas
• Measurement of normally distended bladder wall: 3mm

– 200mL
• Normal measurement of not distended bladder wall:
5mm – 70mL
Emphysematous cystitis
• Is a form of bladder inflammation with gas within the
bladder wall.
• Gas within the bladder lumen is seen in emphysematous
cystitis, instrumentation, and vesicocolic fistula.
+ Thickening of wall
+Gas
38
Transitional Cell Carcinoma

• Transitional cell carcinoma of the bladder is the most
common urinary tract neoplasm.
• The hallmark of TCC is multiplicity and reoccurrence.
• Top Left. CT urogram image demonstrates a flat

mucosal lesion (arrow) arising from the right lateral wall
of the bladder (B). Contrast enhancement of the lesion is
slightly greater than that of the bladder wall revealing
the extent of the tumor. This is a T1 lesion, confined to the
• MRI. T2 Sequence. bladder wall. The bladder wall is thickened (between
arrowheads) and irregular because of muscle
hypertrophy induced by the chronic obstruction of an
enlarged prostate. On this early phase CT image, the
bladder is distended with low-attenuation urine.
• Top Right. Coronal plane delayed image from CT
urogram reveals the papillary growth pattern of a
transitional cell carcinoma (arrow) well outlined by
contrast-opacified urine.
• Bottom Left. Early post-contrast image from a CT
urogram shows enhancement of the tumor (arrow) and
distinct enhancing nodules (arrowhead) of soft tissue in
the perivesical fat. This is strong CT evidence of spread
of tumor through the bladder wall, making this a pT3b
stage lesion.
• Bottom Right. Early phase post-contrast CT urogram
image shows an enhancing tumor (arrow) involving the
right ureterovesical junction (arrowhead). This is a stage
T2 lesion. S, seminal vesicles.
39
Cystolithiasis / Bladder stones

• Bladder stones may migrate from the kidney or form
primarily within the bladder because of urinary stasis or
a foreign body. Solitary stones are most common
Bladder Diverticulum
• Bladder diverticula are herniations of the bladder
mucosa between interlacing muscle bundles. Most are
located posterolaterally near the UVJ. Diverticula may
contain stones or tumor and occasionally do not fill on
cystograms.
• Complications of bladder diverticula include urinary
stasis, infection, stone formation, vesicoureteral reflux,
and bladder outlet obstruction.
o
Diverticula on ultrasound
40
Bladder Trauma Intraperitoneal Bladder Rupture

Extraperitoneal Bladder Rupture • Results from blunt trauma applied to a
distended bladder. The sudden rise in intravesical
• Results from puncture of the bladder by a
pressure results in rupture of the bladder dome and
spicule of bone from a pelvic fracture extravasation into the peritoneal space.
o Contrast extravasates into o Contrast in paracolic gutters and between loops of
extraperitoneal compartments small bowel.
o Extraluminal contrast into perivesical
space
o Extension of extraluminal contrast to
the thigh, scrotum, or perineum.
Urethral Strictures
• Gonorrhea – most common cause
• Urethral strictures are abnormal narrowings of the
urethra resulting
from fibrous scar tissue. They may involve the entire
urethra or only a small portion.
41
Straddle injury
• Straddle injury is when trauma occurs to the groin area
between the thighs. It can happen from straddling a hard
object, or accidents such as falling onto a bicycle
crossbar.
Prostate Carcinoma
• Theoretically, normal measurement is <30 grams.
• US findings associated with prostate cancer include
distinct hypoechoic nodule, poorly marginated
hypoechoic area in the peripheral zone, mass e ect on
surrounding tissues, asymmetric enlargement of the
prostate, deformation of prostatic contour, heterogenous
area in the homogenous gland, and focal increased Normal: Homogenous
vascularity in the peripheral zone with color flow US. Ca: Heterogenous
• On MR2TWI, cancers appear as areas of low signal
within the high- signal peripheral zone.
• Prostate MRI, T2 Sequence. Lesions are easier to

identify using this imaging
Transrectal prostate US. Bottom picture is hypoechoic
Hyperechoic
42
Benign Prostatic Hyperplasia

• Is a nodular hypertrophy of the glandular tissue of the
transitional zone.• Is a nodular hypertrophy of the
glandular tissue of the transitional zone.
• A radiograph from an excretory urogram shows marked

uplifting of the bladder base because of massive
enlargement of the prostate (P, between red
arrowheads). The trigone (blue arrowhead) and ureteral
orifices are markedly elevated, resulting in a J- shaped
appearance to the distal ureters (u). The bladder wall is
Transrectal US. Small peripheral zone. Big Transitional
thickened (between arrows) and the bladder (B) mucosal
zone
pattern is prominent.
MRI. Thin peripheral zone but doesn’t have lesion. Big

transitional zone
GIT and HBT (Done)
Pneumoperitoneum
Rigler Sign
● an abdominal radiograph when gas is
outlining both sides of bowel wall A
Air in the peritoneum

can ONLY be seen in X-ray PA view
Erect Chest X-ray
43
Ascites
An accumulation of fluid in the peritoneal

cavity
Necrotizing enterocolitis
Seen on preterm infants

Distended Abdomen
Imaging:
Initial → Fixed distention
Later:
● Pneumatosis intestinalis (air within the
bowel wall)
● Portal venous gas
● Pneumoperitoneum
Hypertrophic Pyloric Stenosis
P.E: Olive shaped mass

Ultrasound: wall thickness >4mm; length of
By
>16mm
X-ray:
Caterpillar sign
appears as a single air pocket with peristaltic
contractions, suggesting a gastric outlet
obstruction with hyperperistalsis.
44
Acute appendicitis
Ultrasound:
aperistaltic, non-compressible, dilated
#
appendix (>6 mm outer diameter). appears
round when compression is applied
+Fecalith
Intussusception
Classically, intussusception manifests in the

transverse orientation as a 'target sign' or
'donut sign'
representing layers of intestine within the
intestine.
In the longitudinal orientation, the layers of

intestine appear as a 'pitchfork' or
'submarine sandwich' (Figure 2).
Esophageal atresia
(EA) and trachea- esophageal fistula
(TEF)
A,B= Gasless
C,D,E= Not Gasless
45
Pyloric atresia
Single Bubble Sign
Congenital obstruction distal to the

Stomach
Non-bilious vomiting
Duodenal atresia
Imaging
● Absent distal bowel gas
● Double Bubble Sign
Dilation of PROXIMAL DUODENUM and

STOMACH
Jejunal atresia
Imaging:
● Triple bubble sign 1
3
● Dilation of the: Stomach, Duodenum
and Jejunum
2
46
Meconium Ileus
Associated with cystic fibrosis
Imaging
● Contrast enema
○ Microcolon
○ Distended ileum with rounded
filling defects in the distal
ileum
● Perforation → Meconium peritonitis

Abdominal and scrotal calcifications
“MICROCOLON”
Hirschsprung disease
Imaging
● Radiograph - Distal bowel obstruction
r
pattern
● Contrast enema - Cone-shaped
(tapering) transition zone at the junction
of the spastic, narrowed distal colon,
and dilated proximal colon Rectum
smaller than sigmoid (rectum sigmoid
ratio of <1)
aka “TOXIC MEGACOLON”
47
Indirect inguinal
Hernia
Bowel loops in scrotal area
Imaging
● Small bowel obstruction
● Bowel loops in the hemiscrotum
Imperforate anus
Imaging
● Invertogram
● M line of Cremin Drawn perpendicular
to the long axis of the ischium on the
lateral view
● Passes through the junction of the
middle and lower third of the bone
● High type: Pouch ends above the line

● Low type: Pouch ends below the line
48
Hepatic Steatosis
The echogenicity of the liver is
greater, it’s hyperechoic
relative to the right kidney
In CT SCAN DARKER LIVER> SPLEEN
CB S
A
S
RK LK
Hypodense = CT Scan
Hyperechoic = Ultrasound
Hepatic Abscess
Ring enhancing mass in CT scan
MRI;Central hyperintensity on T2W with an

irregular wall that
enhances late
Cirrhosis
Lobulated Liver Contour

Small lobulated liver GO
Cholelithiasis Plain Film = Mercedez Benz Sign
Ultrasound = Imaging of choice; Echogenic

with posterior acoustic
shadowing
49
#H
MRI; Filling Defects
Porcelain Gallbladder
Gallbladder demonstrates echoes and

posterior dense shadowing, with usually poor
delineation of the gallbladder wall itself.
+ Cancer
Gallstone Ileus
Classic findings (Rigler Triad)
● Gallstone in the RLQ – gallstone
moved from RUQ → RLQ (stone is now
located in the ileocecal junction).
● SBO (ileus)
● Pneumobilia – air went in to the
biliary tree when the stones went out
from it.
50
Pancreatic divisum
MRCP is the gold standard
- Majority of the pancreatic gland drains

into the minor papilla via the duct of
Santorini
- The posterior head and uncinated
process drain into the major papilla via
duct of Wirsung with the CBD.
Annular pancreas
Ring of pancreatic tissue surrounds the

descending duodenum
Annular pancreatic duct
usually communicates with
the main pancreatic duct
Acute Pancreatitis
Initial evaluation: UTZ

• Hypoechoic due to edema
CT scan with intravenous contrast’ Imaging of

choice
Ill-defined pancreatic planes with loss of
Lobulations (edematous pancreas)
Nonenhancement of the pancreas (necrotic
pancreatic tissue)
Chronic Pancreatitis
- Pancreatic calcification is
pathognomonic
- Small, irregular atrophic pancreas with
altered parenchymal pattern
O
51
Pancreatic Cancer Double duct sign – (can be seen in MRCP)

Frostberg inverted 3 sign - CBD and PD dilated
d
E acement and distortion of the mucosal
pattern on the medial
wall of the second part of the duodenum
NEURO RAD (DONE)
ACUTE ISCHEMIC STROKE

Hyperacute signs correspond to the first 0-6
hours stage of Acute Brain Ischemia.
On MRI, we have Loss of Flow Void. That is

because there is obstruction.
*Hyperdense in CT
*Lacunar Stroke
*Acute Ischemic Stroke is more worst than Chronic HYPERDENSE ARTERY SIGNS (seen on CT)
LOSS OF FLOW VOID (seen on MRI)
52
ACUTE MCA ISCHEMIA
INSULAR RIBBON SIGN

• Within 6 hours post occlusion
• Represents early edema
LENTIFORM NUCLEUS EDEMA SIGN

• Lentiform nucleus = putamen + globus
pallidus
• Proximal middle artery occlusion INSULAR RIBBON SIGN
• Within 6 hours post occlusion
DIFFUSION WEIGHTED IMAGING (DWI)

• Most sensitive imaging sequence for
detection of brain ischemia
• Within minutes after infarction begins
• Lightbulb sign – precedes T2 hyperintensity
(6-12 hours post ictus)
LENTIFORM NUCLEUS EDEMA SIGN
BRAIN INFARCTION
Edema
SUBACUTE PHASE (1 week to 3 weeks)

Midline Shift
- Edema leads to Mass E ect Slight sulcal
e acement Marked midline shift with
brain herniation (subfalcine herniation)
CHRONIC PHASE (> 3 weeks)
- Macrophages remove dead tissues –
gliotic scar, and encephalomalacia
- Wallerian Degeneration – atrophy of the
cortisospinal tract –shrunken SUBACUTE PHASE (1 week to 3 weeks)
appearance of the cerebral peduncle
- Widening and ex-vacuo dilatation of the
ventricles
53
CHRONIC PHASE (> 3 weeks)
CHIARI I
abnormal low position of the cerebellar
tonsils relative to the foramen magnum.
Symp: Headache, CN Abnormalities

*assoc. w/ syrinx (Syringomyelia) 8
*Evaluate the spine
*MOST COMMON
CHIARI II
The posterior fossa is small and the cerebellar
tonsils and medulla appear to be squeezed out
into the upper cervical canal. The cerebellum
appears to tower through the tentorial incisura
*Assoc. w/ MYELOMENINGOCOELE
*Small posterior fossa
*Squeezed cerebellar tonsils & medulla Beaked appearance(A.);callosal malformations
(white arrow in A) and hydrocephalus (*) are
frequent
Cerebellar Tonsils; low lying;dysplastic, syrinx
cavity, (B),
medial gyri (red arrows in C) may appear to be

interdigitated due to an associated
dysplasia of the falx.
54
Spinal dysraphism (myelomeningocele)(D.)
CHIARI III
• Considered a high cervical myelocystocele
formed a cyst.
RARE
LIPOMYELOMENINGOCELE
- On MRI, you’ll see the protrusion, as well
as the presence of this high signal
intensity.
- subarachnoid space is dilated, causing
the placode to bulge posteriorly.
O
COCKAYNE’S SYNDROME
● Bilateral Calcification on CT
MRI:
● atrophy which predominantly involves
the supratentorial white matter, the
cerebellum, the corpus callosum, and
the brainstem
● T2: calcification may be seen as low
signal in the putaminal, dentate nuclear,
and cortical regions
55
DANDY-WALKER MALFORMATION
enlarged posterior fossa, high position of the
torcula, and huge cystic enlargement of the
fourth ventricle The vermis and cerebellar
hemispheres are markedly hypoplastic and the
falx cerebelli are typically absent.
*Opposite of Chiari
*Hypoplastic vermis & cerebellar hemispheres
dilated third ventricle and bowing of the

corpus callosum (arrow)
LISSENCEPHALY Malformation of cortical

development
Type 1: complete form;
*Severe form: arrest of
classic neuronal migrattion
o Smooth brain or agyric with an hourglass
shape Lissen = “smooth”
o Markedly thickened cortex
COMPLETE CALLOSAL AGENESIS

• Racing car sign on CT
CT: Racing Car

MRI: Moosehead sign
Total loss of corpus callosum • MRI is the modality of choice

*”Racing Car sign” o Moosehead sign, or Viking Helmet Sign
56
Alzheimer’s Disease
• MRI is the modality of choice Widened Sulcations
•Most Common cerebral amyloid deposition + Thinning of Gyri
disease
Neuritic plaques &

Neurofibrillary angles -
progressive loss of
neurons
BRAIN ATROPHY: CT
• Medial Temporal Lobe Atrophy (hippocampus

and entorhinal
cortex)
• Temporoparietal cortical Atrophy
PICK DISEASE
- ex vacuo dilatation of the ventricles

seen on the abnormal brain.
- The white structures are the ventricles, –
T2 sequence.
- Tauopathies characterized by the
accumulation of Pick Bodies
FABRY DISEASE
- T2 hyperintensities in the white matter
of the frontal and parietal lobes
- Decreased or absent expression of
hydrolase alpha galactosidase A,
ultimately resulting in abnormal
accumulation of globotriaosylceramide
(Gb3) in various organ systems
T2 hyperintensities (bright)
57
CEREBRAL ARTERIOVENOUS
MALFORMATIONS
“Nidus” = Nest
• Focus of serpiginous hyperdense area
relative to the adjacent brain
• Bag of worms appearance
CT: Bag of worms Angiography Gold Standard

Angiography: Nidus
MRI: Flow voids
On MRI, you’ll see these flow voids – which are

the normal appearance of
the circulating blood. (absence of flow void:
ischemic stroke)
EPIDURAL HEMATOMA
• Biconvex or lentiform in shape *Collection of blood bet.
• Hyperdense inner surface of the skull &
• Sharply demarcated outer layer of dura
• Mass e ect (+) *Assoc. w/ skull fracture
*Torn MMA
• Swirl sign
*Biconvex
*Limited by cranial sutures
*95% supratentorial
SUBDURAL HEMORRHAGE
• Crescent-shaped *Accumulation of blood w/n
• Homogenous subdural space
*Stretching & tearing of bridging
• Hyperdense extra-axial collection
cortical veins
*Extensive than EDH
*Limited by dural reflections
(Falx cerebri, Tentorium
Cerebelli & Falx Cerebelli)
58
SUBARACHNOID HEMORRHAGE
• Hyperattenuating material filling the *Presence of blood w/n the
subarachnoid space subarachnoid space
*Trauma & ruptured
• Most common location: Circle of Willis and
aneurysm
Sylvian Fissure
• MRI is sensitive to subarachnoid blood, and is FLAIR - Fluid attenuated inversion
able to visualize it recovery
well in the first 12 hours, typically as a
hyperintensity in the “Worst Headache of my life”
subarachnoid space on FLAIR.
MSK
MUSCULOSKELETAL IMAGING
● Needs 2 or more view Tibia
○ AP Fibula
○ Lateral
HIP FRACTURE (Right)

● (+) discontinuity on the Shenton’s line
(yellow)->proximal femoral neck to
--
pelvic bone
LYTIC LESION (Old X-ray)

● Source of METASTASIS FROM
PRIMARY MALIGNANCY (Old X-ray)
● led to COMPLETE OBLIQUE
DISPLACED FRACTURE of PROXIMAL
FEMUR (Current X-ray)
59
BOWING DEFORMITY
● No visible fracture but there is
curvature of the bone
Lateral view - best imaging position
TORUS / BUCKLE FRACTURE

● loading side on the ipsilateral side
● (+) deformity of the bone
GREENSTICK FRACTURE
● loading side on contralateral side
● May lead to progression and
displacement
Transverse fracture but not complete

Children
60
JEFFERSON FRACTURE
● Type of vertebral fracture
HANGMAN FRACTURE
● Type of vertebral fracture
PERIOSTEAL REACTIONS
I
SOLID
● Seen in osteomyelitis
● Osteomyelitis: mnemonic: POE
○ Periosteal thickening solid;
Codman’s triangle
○ Osteopenia (regional) &
osteolysis
○ Endosteal scalloping
LAMELLATED Osteosarcoma
● Unilamellated are seen in osteomyelitis
● Multilamellated are seen in Ewing’s
sarcoma
CODMAN’S TRIANGLE
● Seen in osteomyelitis and osteosarcoma
61
CODMAN’S TRIANGLE
● may be seen with aggressive lesions:
○ Osteosarcoma
○ Ewing sarcoma
○ OSTEOMYELITIS
○ Active aneurysmal bone cyst
○ Giant cell tumor
○ Metastasis
○ Chondrosarcoma (especially
juxtacortical chondrosarcoma)
○ Malignant fibrous histiocytoma
OSTEOPENIA
● decrease in bone density
OSTEOLYSIS
● “nalusaw”, lytic formation
metastatic in origin
62
ENDOSTEAL SCALLOPING
● Arises in medulla
NON HEALED FRACTURE OF THE DISTAL

END OF THE TIBIA WITH CORTICAL
DESTRUCTION AND LOSS OF
TRABECULATIONS
OSTEOMYELITIS
● with bone destruction
● With solid periosteal thickening
● With adjacent soft tissue swelling
63
COMPLICATIONS OF OSTEOMYELITIS
● SEQUESTRUM
○ Devitalized bone
○ Bone fragment in infection
○ Delineated by rim of lucency
○ CANNOT be penetrated by any
antibiotics
○ Mgt: Surgery
● CLOACA
○ formation of tract from within the
bone up to soft tissues
○ Sinus tract: if outside soft tissues
● INVOLUCRUM
○ periosteal reaction to adjacent
sequestrum
○ thickens
OSTEOMYELITIS
● Location: proximal humerus
64
BRODIE ABSCESS
● an intraosseous abscess related to a
focus of subacute pyogenic
osteomyelitis.
● Etiology
○ S. aureus (most common);
cultures often negative
● Location
○ predilection for ends
(metaphysis) of tubular bones:
■ Proximal/distal tibial
metaphysis (most
common)
■ Carpal and tarsal bones
● Location: proximal tibia

● (+) lytic lesion
● (+) Lucency with a sclerotic border
POTT’S DISEASE
● No skipping on the involved vertebral
body
C
○ Ex: T8-T10 of the vertebral body
Tuberculosis of the spine
65
TUBERCULOUS SPONDYLITIS
Possible di erentials:
● Bacterial formation not related to TB
○ (+) disk involvement
● Pyogenic spondylitis
● Metastasis
○ (+) skipping of the involved
vertebral body
GIBBUS DEFORMITY
● (+) wedge-shape of the vertebral body
● Silver dollar sign
VERTEBRA PLANA
● (+) flattening of the vertebral body
SPONDYLOSIS
● Osteoarthritis of the spine
● Degenerative
● (+) osteophytes
● (+)Hypertrophic bursts
● (+) joint space narrowing
● Sometimes accompanied with
intervertebral disc narrowing
Spondylitis = break
Spondylolisthesis = Slippage
Spondylosis = degeneration
OSTEOSARCOMA
● Most common malignant primary bone
tumor that occur almost exclusively in
children and young adults (<30 years
old)
● Occurs toward the end of a long bone
(metaphyseal: because highly
vascularized) but may occur anywhere
in the bones
● (+) spiculated; periosteal reaction with
66
Codman’s triangle
● (L) Ill defined sclerotic area a ecting
metaphysis of distal fibula with an
aggressive periosteal reaction (sunburst
type); (R) Codman’s triangle
PERMEATIVE PROCESS
● Cortex is solid; holes in the endosteum
○ <30 y/o
■ Ewing sarcoma
■ Infection
■ Eosinophilic granuloma
○ >30 y/o
■ Multiple myeloma
■ Metastatic carcinomatosis
■ Primary Lymphoma of the
bone
PSEUDO PERMEATIVE PROCESS

○ holes in the cortex; multiple
cortical holes
■ Agressive (disuse
osteoporosis
■ Hemangioma
■ Radiation
EWING SARCOMA
● Permeative (multiple small holes) lesion
in the diaphysis of a long bone in a child
● 2nd most common primary malignant
tumor in children and young adults
● “Onion-skin” type of periostitis
● 11/22 Translocation
MYELOMA
● Most common primary malignancy in
adults
● Arises from red marrow due to
monoclonal proliferation of plasma cells
● Considered in patient older 40y/o
● (+) di use permeative appearance that
mimic Ewing sarcoma or primary
lymphoma of the bone
● Commonly involves->calvarium
L) Multiple cortical holes in the endosteum;
(R) Multiple lucencies in the calvarium
• Langerhans cell histiocytosis – if seen in children
67
LYTIC LESION
8
L: Radiograph shows an osteolytic lesion arising in
the shaft of the femur, with extensive cortical
disruption. Case of lung carcinoma
M: Osteolysis of the left hemi pelvis associated

with loss of acetabular and inward protrusion of
the femoral head in a patient known with cervical
carcinoma.
R: Extensive osteoblastic metastases throughout

the pelvic bones and proximal portions of the
femur
OSTEOARTHRITIS
● Loss of joint space
● Osteophytes
● Subchondral cysts (lucent)
● Subchondral sclerosis
*joint space narrowing- nonspecific; present to

all types of arthritis
EROSION OSTEOARTHRITIS
● (+) gull wing appearance and central
68
erosion
JOINT SEPSIS
● Osteonecrosis is also an important sequela
due to e usion and increase in
intra-articular pressure compromises blood
circulation
MRI
(L) T1; (R) T2 – fluid within the urinary bladder is
white (puT2) + erosion
RHEUMATOID ARTHRITIS
● Soft Tissue Swelling
○ Fusiform and periarticular
○ Earliest finding
● Osteoporosis
● Joint space narrowing
● Marginal erosions
Radiograph
● Spares interphalangeal joints
● More on proximal process
69
BOUTONNIERE DEFORMITY
● Flexion contracture deformity
● Flexion of the proximal interphalangeal
joint (PIJ) with extension of distal
interphalangeal joint (DIJ)
SWAN NECK DEFORMITY

● Hyperextension of the proximal
interphalangeal joint (PIJ) with
compensatory flexion of the distal
interphalangeal joint (DIJ)
HLA-B27 SPONDYLOARTHROPATHIES
● Formerly known as rheumatoid variants
● Now known as the seronegative, human
leukocyte antigen B27 (HLA-B27) -
positive spondyloarthropathies
● linked to the HLA-B27 histocompatibility
● Antigen
● group of diseases:
○ Ankylosing spondylitis
○ Inflammatory bowel diseases (L) Osteophytes (degenerative osseous
(Crohn’s) changes) are
○ Psoriatic arthritis horizontal; (M) Marginal syndesmophytes are
○ Reiter syndrome (or reactive vertical; (R)
arthritis)
Non marginal syndesmophytes
70
ANKYLOSING SPONDYLITIS
● Seronegative spondyloarthropathy
● results in fusion (ankyloses) of the spine
and sacroiliac (SI) jointS
● Although involvement also seen in large
and small joints
● Sacroiliitis – hallmark of ankylosing
spondylitis, (symmetrical erosion of the
sacroiliac joint)
● Di use syndesmophytic ankyloses can
Sacroiliitis:
give a “bamboo spine” appearance
(L) Early stage w subchondral sclerosis;
● Interspinous ligament ossification can
(R) Late stage w erosion, SI joints are fused
give a “dagger spine” appearance on
frontal adiographs
Bamboo spine – symmetrical marginal

syndesmophytes
Dagger spine – thickening and calcification of

the interspinous ligament
71
PSORIATIC ARTHRITIS
● inflammatory arthritis associated with
psoriasis
● Hallmark – combination of erosive
change with bone proliferation, in a
predominantly distal distribution
● Imaging findings:
○ Marginal bone erosion;
“pencil-in-cup” deformities (in
phalanges) are common
○ Joint sublaxation (partial
dislocation) or interphalangeal Pencil-in-cup erosion of distal part of middle
ankyloses phalanx + cupping of distal phalanx
○ Bone proliferation results in an
irregular, “fuzzy” appearance to
the bone around the a ected
joint
○ Sacroiliitis: often asymmetrical
GOUT
● Metabolic disorder that results in
hyperuricemia leads to monosodium
urate crystals being deposited in
various sites in the body, especially
joints
● arthropathy caused by gout is very
characteristic radiographically
● Takes 4-6 years for gout to cause
radiographically evident
● Classic radiographic findings
○ Well-defined erosions with
sclerotic borders and
overhanging edges**
○ Soft tissue nodules that calcify in
the presence of renal failure
○ Random distribution in the hands
without marked osteoporosis
72
PSEUDOGOUT
● “Calcium Pyrophosphate Dihydrate” /
Crystal Deposition Disease
● Classic triad
○ Pain
○ Cartilage calcification
(chondrocalcinosis)
○ Joint destruction
● Most common location of
chondrocalcinosis
○ Knee (medial and lateral
compartments
○ Triangular fibrocartilage of wrist
○ Symphysis pubis
NEUROPATHIC / CHARCOAT JOINT

● Classic triad:
1 ○ Joint destruction (severe)
2 ○ Dislocation
3 ○ Heterotopic new bone
● In the spine, instead of joint space,
there is disc space destruction
● commonly seen is in the foot of a
diabetic
● Typically a ects the first and second
tarsometatarsal joints
RICKETS
● Metabolic osteomalacia in children
● Findings:
○ Fraying – edge of metaphysis
loses its sharp border (becomes
irregular)
○ Cupping – edge of metaphysis
changes from convex or flat
surface to a more concave
surface
○ Splaying – widening of
metaphyseal end of bone
VASCULAR IMAGING (DONE)
73
Aorta
• Segments
• Thoracic
• Aortic root
• Ascending
• Arch Descending thoracic aorta
• Abdominal (descending)
• Suprarenal
• Infrarenal - the most common site of abdominal aortic
Aneurysm
• 3D images only show contrast within the lumen,

but the walls of the vessel can’t be assessed
Aortic root
o Aortic annulus
o Sinus of Valsalva / Aortic sinus (of
Valsalva) - photo
§ Right cusp
§ Left cusp
§ Non-coronary cusp
o Sinotubular junction
AORTIC ARCH AND VARIANT
AORTIC ARCH AND VARIANTS

Usual Configuration - most common
3 Branches
o Innominate artery
o Left common carotid artery
o Left subclavian artery
Common Origin of The Brachiocephalic

Artery and Left Common Carotid Artery
• 2 branches
o Common trunk – gives rise
to brachiocephalic and the LCCa
o LSa
Left Vertebral Origin of Aorta

• Left vertebral artery is the
74
third aortic branch (it arises directly from the arch,

normally it arises from the LSa)
• Significance: i.e. what if ptx has aortic dissection,
(the false lumen usually thrombose) and the LVa
arose in the false lumen à LVa will supply the
(posterior) brain and if occluded à all the other
branches can lead to stroke
Left Vertebral Origin of Aorta

Aberrant Right Subclavian Artery
right subclavian artery arises directly from the
arch distal to the left subclavian artery
Aberrant Right Subclavian Artery
• Barium swallow (lateral view)

o Barium opaque on x-ray
o Can cause posterior indentation of theesophagus
o Indentation can also be seen in congenital vascular anomalies
(i.e. double aorta)
75
Penetrating Atherosclerotic Ulcer

• Defect in the intima
• Ulceration of atheromatous plaque
• Atherosclerosis is the major risk factor
• Imaging
o Contrast ulcerating beyond the expected
contour of the aortic wall
Intramural Hematoma
• Defect in the tunica media
• Intact intima
• Related to hypertension
• Rupture of vasa vasorum (supply the aortic wall)
• Can progress to aortic dissection
• Imaging
o (2nd) Crescent sign – hyper-attenuating crescent within
the aorta (45-50 HU)
o Best seen on non contrast CT
Aortic Dissection
• Defect in the intima extending to the media
• Hypertension – most common risk factor
Classification
o Stanford A
o Most common
o A ects ascending aorta
and arch (w or wo descending)
o Treated surgically – as vessels arising from the
arch supplies the brain to MI or stroke
o Stanford B
o Distal to the left subclavian artery
o If it doesn’t involve the A’s)
o Treated medically (just lower the BP and
monitor the ptx)
76
DeBakey classification
image showing 2 lumen
o Usually do 2 scans – w and wo contrast and W/o

contrast: arteries and clotted blood (hematoma) = dense
With contrast: arteries = opacified
Contrast enhanced image

o Intimal flap
• Beak sign – corresponds to the false lumen

o CXR
— Inward displaced calcification of >1cm
77
Thoracic Aortic Aneurysm

• Ascending aorta diameter of > 4cm
• Descending thoracic aorta diameter of >3 cm
• Most common cause is atherosclerosis
• Indication for repair
o Ascending TAA > 5.5cm
o Descending TAA > 6cm
o Annual growth rate of > 1cm/year
• Imaging
o Measure the diameter of (each segment) the aorta
Abdominal Aortic Aneurysm

• Abdominal aorta diameter of > 3cm
• Most common location is infra-renal
follow-up
o Imaging modality:
§ CT aortogram – initial diagnosis
§ Ultrasound – for follow up evaluation
Marfan Syndrome
• Mutation of the fibrillin gene
• Imaging
o Tulip bulb sign
o Ascending segment is dilated
o Annuloaortic ectasia to aortic valve insu ciency
78
Contained Rupture
• Imaging
o Draped aorta sign
§ Posterior wall of an aortic aneurysm drapes or molds to
the anterior surface of the vertebra
Normal aorta – round
(arrows) ruptured aorta – wall

seem to embrace the vertebral body (VB)
Takayasu Arteritis
• Pulseless disease
• Young and middle-aged women
• Imaging
o Acute—Wall thickening and enhancement
o Chronic—Long smooth stenosis
o Indistinguishable from giant cell arteritis (age is the
di erentiating factor)
Thickened wall of aorta
79
Giant Cell Arteritis

• Temporal arteritis
• Most common vasculitis
• Very similar to Takayasu, main di erence is their
epidemiology
• A ects old men
Coarctation of the Aorta

• Congenital narrowing of the proximal descending
thoracic aorta
Types
o Preductal (infant) - left ventricular obstructive lesion
o Juxtaductal (adult) upper extremity hypertension
Coarctation of the aorta
• Imaging
o 3 sign – double bulge from focal aortic narrowing and
post-stenotic dilatation Rib notching
§ Hard to see, upper segment of the 3 = arch of
the aorta, lower = descending, middle is the
narrowing
o Rib notching – 4th to 8th ribsm
§ Seen in the inferior part of the rib
§ Vessels becomes tortuous because of the
abnormal blood
load à erode lower part of the rib
3 Sign
Left Main Coronary Artery

• Bifurcates into left anterior descending coronary artery
and left circumflex arteries
• A ramus intermedius may be present to form a
trifurcation – 20%
Right Coronary Artery

• Courses within the right atrioventricular groove
Branches
o Conus branch
o SA node branch i.e. arrhythmia – think RCA
involvement as SA and AV branch is supplied by this
o Acute marginal branch
80
o Posterior descending artery (85%) - Most of the time,

direct continuation (distal)
o Posterolateral branch (PLA)
DETERMINATION OF DOMINANCE
• Whichever side supplies the posterior descending
artery (PDA) and posterolateral artery (PLA) is
considered the dominant coronary artery
• Right dominant heart – 85%,RCA supplies the PDA and

PLA
• Left dominant heart – 7%,LCx supplies the PDA and PLA
• Co-dominant heart – 7% - RCA supplying PDA, LCx
supplies PLA
• (L) Right dominant; If Left, LCx must continue
posteriorly and give rise to PDA
• (R) Left sinus of valsalva à gives rise to R & L
coronary arteries; an branching pattern anomaly
Malignant Coronary Artery Anomaly

• Malignant coronary artery anomaly carries
increased risk of sudden death
• Coronary CTA—best modality
• Interarterial course of a coronary artery carries a
high risk of sudden death
ALCAPA
• Congenital
• Anomalous left coronary artery from the
pulmonary artery
• Diminished pulmonary vascular resistance results
in flow reversal in the left coronary artery into the
pulmonary trunk (i.e. coronary steal phenomenon)
81
Pulmonary Embolism
• Most common source – thrombi in the deep veins of the
leg and from the pelvis
• Imaging (classic signs on x-ray)

o Hampton hump – wedge-shaped density
o Westermark sign – oligemia
o CT – for definite diagnosis/gold standard Wedge/Triangle shape density
usually seen at the bases = pulmonary infarct = Hampton
(embolism à infract)
Normal CT;
Branching pattern on left lung, vascular markings on

lower R. lung-medially = Westermark
Pulmonary embolism – filling defects
Subclavian Steal Syndrome

• Arteriosclerotic stenotic plaque at the origin of the
subclavian before the takeo of vertebral artery
Reverse flow in the vertebral artery
• Signs and Symptoms
o Claudication of the arm
o Posterior neurologic signs
• Imaging
o Duplex scanning – shows reversal of flow
o MR Angiography
• Treatment o MR Angiography (photo)
o Bypass surgery § L. arch = L. subclavian; (+) focal narrowing
82
Nutcracker Syndrome
• Compression of the left renal vein
Signs and symptoms
o Renal-venous hypertension - Hematuria – Left kidney
bigger
o Left testicular pain - left varicocele—L. testicular v.
drains to L. renal v.
o Left flank pain
• Imaging
o Renal vein stenosis
o Reduced aortic-SMA angle (the normal angle between
aorta and SMA is approximately 45 degree (38-65degree)
Renal Artery Stenosis

• Atherosclerosis (75%) - Near the ostium
• Fibromuscular dysplasia - 2nd most common
(especially in young)
o Beaded appearance (sparing the ostium)
Leriche Syndrome
• Also known as Aorto-Iliac Syndrome
• Occlusion of the aorta distal the renal arteries
• Triad
o Impotence
o Gluteal claudication
o Absence of femoral pulses
May-Thurner Syndrome
• Compression of the left common iliac vein by the
overlying right common iliac artery
• Signs and symptoms
o Left lower extremity edema and pain,
varicosities, deep vein thrombosis or venous ulcers
83
Radio Practicals Samplex 2021
(24 images lang nakuha me sa samplex po hehe so match na lang description sa trans sana andun
ty:)
Source:
Radio practical reviewer AY 2020-2021
3.1 Radio Pracs Samplex 2021
3.2 Radio Pracs Samplex 2021
Question Modality Diagnosis Notes to

remember/ Arrow
1 Imaging diagnosis for Figure 1. CT Subarachnoid Temporal horn of

hemorrhage the left lateral
(Pwedeng due to ventricle
Trauma/Stroke)
● Subarachnoid Hemorrhage
● Parenchymal Hemorrhage
● Meningitis
● None of the above
With notes:
84
2 Location of pathology in Figure 2. CT Basal Ganglia Caudate nucleus

Hemorrhage right (Yellow
arrow)
● Left Basal Ganglia

● Right Basal Ganglia
● Left Thalamus
● Right Thalamus
With notes:
85
3 Image from Trans CT Acute ischemic (+) Dense artery

stroke (hyperacute) sign
*White cerebellar Yellow arrow -
sign (not sure) Cerebellum
NOT SURE DITO White Arrow -
Midbrain
with hyperdense
MCA sign
ITO SURE
HAHAHAHA
4 (*couldn’t find any image) CT Infarct,Right middle White

cerebral artery arrow:Physiologic
distribution with calcification
Subfalcine herniation (Pineal
Gland)
Yellow arrow:
Physiologic
calcification
(choroid
plexus)
5. Imaging diagnosis for Figure 5. CT Epidural Hematoma Left parietal lobe

a
86
● Epidural hemorrhage
● Subarachnoid hemorrhage
● Intraaxial hemorrhage
● Subdural hemorrhage
5. Intracranial hemorrhage usually

b with accompanying fracture.
Which of the following images is the
most common? Please refer to
PDF images.
● Figure 5
● Figure 6
● Figure 1
● Figure 2
With notes:
6 (*couldn’t find any image) CT Subdural Hematoma Left or fronto

parietal lobe
87
7 Image diagnosis for Figure 7. CT Encephalomalacia White arrow : if

fissure, Sylvian
fissure; IF
parenchyma,insul
a
● Chronic infarct
● Acute infarct
● Subacute infarct
● Lacunar infarct
8 Imaging modality used in Figure 8. MRI Hydrocephalus Yellow arrow:

Dandy walker? Ependymal of the
lateral ventricle
If ventricle: lateral
ventricle ; corona
radiata (?)
● MRI
● CT Scan
● Ultrasound
● X-ray
With notes:
88
9 Image from Trans: MRI Normal sagittal view White arrow:

Normal MRI of the MRI/ Genu of corpus
midline image callosum
10 Image from Trans: MRI Lissencephaly Yellow arrow: 3rd

ventricle? Internal
cerebral
vein(?)
Blue arrow:
Subdural space
11 Radiograph in Figure 11. X-ray Tuberculosis (PTB Yellow : right

.a Apicolordot with cavitation) upper lobe of the
ic lung with cavitary
view
abscess
Blue arrow:
89
Cavitation
● ALV
● PA
● Lateral
● AP
11 Imaging diagnosis for Figure 11.

.b ● Pulmonary tuberculosis
● Bacterial pneumonia
● Covid pneumonia
● Pulmonary mas
With notes:
12 Image from Trans: X-ray Pneumothorax Blue- Gastric

Pneumothorax Bubble
(Hydropneumothorax Yellow- Bullae?
right) Left
hilum/pulmonary
trunk
90
13 Image from Trans: X-ray NORMAL PA CHEST Arrow : Coracoid

process left
scapula
14 Radiograph view used in Figure 14. Right Pleural Effusion,right Dependent part
lateral of the right
decubitus hemithorax
x-ray
Right lateral
decubitus view
● Lateral decubitus
● Lateral
● AP
● PA
With notes:
Loculated Pleural
Effusion
91
15 Image from Trans: X-ray CanonBall Port-a-cath

Cannonball Metastases Metastases (yellow arrow)
(Probably due to Subclavian
Renal cell central venous
carcinoma vs catheter ***yellow
Choriocarcinoma) arrow
(is it in place?
Yes.Passes
median end of
clavicle
before descent
and END is at
IVC)
16 Image from Trans: X-ray Pleural Effusion White arrow:

General image of Pleural effusion (loculated) aortic knob
17 (*couldn’t find any image) X-ray Pneumoperitoneum Yellow arrow:

pulmonary vein?
18 Imaging diagnosis for Figure 18. X-ray Air in the alveoli was
92
removed-
atelectasis
● Atelectasis
● Pleural effusion
● Pneumonia
With notes
19 Image from Trans: X-ray Pulmonary Edema Yellow arrow:

Endotracheal
tube
93
20 (*couldn’t find any image) X-ray Pleural Effusion? (+)Air fluid level
Atelectasis?
Hydropneumothorax
right
21 (*couldn’t find any image) X-ray Hemothorax (?) Right cardiac

silhouette
Pneumonia right obscured**
middle lobe
22 Image from Trans: X-ray Solitary pulmonary Consider

mass, right upper neoplastic versus
lung, inflammatory in
Large Cell Ca (?) nature
23 Imaging diagnosis for Figure 23. X-ray Chondromalacia? Patellar

Osteoarthritis of the osteophyte (spur)
knee
94
● Osteoarthritis
● Fracture
● Gout
● Osteomyelitis
24 Image from Trans: MRI(T2) Septic Arthritis Joint Effusion
25 Image from Trans: X-Ray Osteosarcoma/ White: Codman’s

Osteosarcoma Ewing's Sarcoma Triangle
Yellow :
Sunburst/calcified
soft tissue mass
26 Image from Trans: X-Ray Multiple myeloma Swiss cheese

Myeloma calvarium
95
27 Image from Trans: X-Ray Rheumatoid arthritis Boutonniere's

Rheumatoid Arthritis Deformity
(Boutonniere’s Deformity)
28 Image from Trans: X-Ray Gout
96
29 (*couldn’t find any image) X-Ray Spondylolisthesis (L4 Arrow: Neural

over L5) foramen
30 Image from Trans: X-ray Greenstick fracture Yellow arrow:

Greenstick fracture (different site) **(Lateral/ Growth plate or
Lumbar epiphysis
Spine)
31 Image from Trans: X-Ray Potts dse? Kyphosis ;

Gibbus
Deformity?
32 Imaging diagnosis for Figure 32. X-Ray Ankylosing Bamboo Spine

spondylitis
(Pwede daw na
meron ito sa IBD)
● Ankylosing spondylitis
97
● Pott’s disease
● Vertebral metastases
With notes:
33 Imaging diagnosis of Figure 33. CT Renal tuberculosis White arrow:

Spleen
Yellow arrow:
Renal pelvis or
artery(?labo ng
arrow e?
● Renal TB
● Nephrolithiasis
● Nephrocalcinosis
With notes:
98
34 Image from Trans: Intravenou (CROSSED) Renal Yellow arrow :

Cross-fused Renal Ectopia s(IV) Ectopia Ureter of right
Renal cell Ca urography/ kidney
IVU
REVAL Asenesis
35 Image from Trans: CT scan Upper pole of kidney yellow arrow:

Cross-fused Renal Ectopia with has a mass** renal artery
Renal cell Ca contrast Renal Cell CA(? Pero stenosis
(Coronal histopath kasi
View) nagsasabi kung
anong klaseng CA)
99
36 Imaging diagnosis of Figure 36. Retrograde Posterior urethral Yellow arrow :

cystourethr valve Urethral valve (?)
ogra Diaphragm of the
m valve(?)
--
Fluoroscop
y
● Posterior urethral valve

● Urinary bladder diverticula
● Cystitis
37 The red arrow in Figure 37 X-ray Red- Aortic Notch

.a represents the? Blue- Left Ventricle
Yellow- Right Atrium
100
● 1st left mogul

● 2nd left mogul
● 1st right mogul
● 2nd right mogul
37 The yellow arrow in Figure 37

.b represents the?
● Right atrium
38 What chamber is enlarged in Figure X-ray Mitral Valve Stenosis; Double Density
38? Left Atrial Sign
Enlargement
101
● Left atrium
● Right atrium
● Right ventricle
● Left ventricle
39 What segment of the aorta is CT Aortic Dissection Double Lumen

affected based on this slice (pointed Sign
by the red arrow in Figure 39)
● Ascending aorta
● Descending thoracic aorta
● Descending abdominal aorta
● All of the above
With notes:
102
40 Tortuosity of this vessel results to X-ray Coarctation of aorta 3 sign; Rib

this imaging finding (pointed by the Notching (RED
red arrow in Figure 40) ARROW)
● Intercostal arteries
● Aorta
● Coronary arteries
● Pulmonary arteries
With notes:
103
41 Identify the vessel pointed by the CT renal Baka anatomy lang Arrows
yellow arrow in Figure 41. angiogram tanong
3D Green-
Abdominal Aorta
/ Celiac trunk
White- SMA
Yellow- Renal
artery
Blue- IMA
● Renal artery
● Celiac artery
● Superior mesenteric artery
● Inferior mesenteric artery
With notes:
104
42 Which of the following best X-ray Ascites Red arrow : Medial

.a describes the image shown in displaced bowel /
Figure 42? (Abdominal distention centralized bowel
based from ppt) loops
Black arrow:
Colonic loops?
Bulging flanks
(yung asa gilid na
arrow)
● Bowel loops are displaced

centrally
● Abnormal lucencies at the
periphery of the abdomen
● Multiple air-fluid levels
● Air within the wall of the
bowel
With notes:
42 The image shows bulging flank

.b stripes in Figure 42. Which of the
following conditions can give this
105
imaging appearance?
● Massive ascites
● Chronic pancreatitis
● Inguinal hernia
● Pneumoperitoneum
43 (*couldn’t find any image) CT Red- Gallbladder

Violet- Liver
Yellow- Right Kidney
Green- Left Kidney
44 (*couldn’t find any image) X-ray Left psoas shadow

(green arrow)
Everything is normal
45 What organ is depicted in Figure UTZ Liver; Yellow : IVC

45?
● Liver
● Kidney
● Spleen
● Pancreas
With notes:
106
46 Image from Trans: X-ray Bladder Rupture Red: extraluminal

Bladder Rupture (intraperitoneal) contrast
(Radiopaedia)
Yellow: Contrast
in the left
paracolic gutter
47 Images from Trans: X-ray Neurogenic bladder Xmas tree or pine

cone bladder
48 Imaging diagnosis for Figure 48. X-ray Pneumonia Ground glass

opacities
107
● Pneumonia
● Pleural effusion
● Pulmonary mass
● Atelectasis
49 Imaging modality used in Figure 49. CT Sclerotic bone mets
Metastasis (sabi ni
mama at ni fellow
na dokki)
If lalake na may back
pain , prostatic
Ca
● CT Scan
● MRI
● Bone scan
50 (*couldn’t find any image) MRI Vertebral Metastases Additional finding

(from breast : compression in
carcinoma?) T8
Arachnoiditis (sabi Naka adhere
nung fellow na posteriorly si
doctor na friend ni cauda equina(?)
mama lol hirap
daw nung exam ?)
108

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SURGERY BLOCK: RADIOLOGY PRACTICALS REVIEWER 2024

INTRO TO RADIO (DONE)

FIVE BASIC RADIOGRAPHIC DENSITIES Air is the most radiolucent (blackest)

X-RAY. RADIOPAQUE WHITE

Ribs curve Ribs Horizontal Posterior-to-anterior (PA): Exactly as it

Lateral views (right/left) Left lateral decubitus position (LLDP)

(-) Contrast / (+) Contrast

CT-SCAN DENSITY / ATENCIATION High density tissue (such as bone) absorbs

Low density tissue (such as the lungs),

FLUID is always BLACK and TISSUE is GRAY.

Hypoechoic = whiter image

Pulmonary tuberculosis TREE IN A BUD SIGN-CT-SCAN

SQUAMOUS CELL CARCINOMA

SMALL CELL CARCINOMA

LARGE CELL CARCINOMA

CONGENITAL PULMONARY AIRWAY

CARDIAC IMAGING done

Enlargement of the heart shadow

Right Ventricular Enlargement

Right atrial enlargement

Left ventricular enlargement

Left atrial enlargement

Left atrial enlargement Imaging

Atrial septal defect

Ventricular septal defect

• Enlarged left ventricle

Patent ductus arteriosus

• Imaging “BOOT - SHAPED HEART”

Transposition of great arteries

“BOOT - SHAPED HEART”

Total anomalous pulmonary venous • Imaging

Coarctation of the aorta • Imaging

Isolated right upper lobe

True left ventricular aneurysm • Imaging

Left ventricular pseudoaneurysm • Imaging

Mitral regurgitation • Imaging

• Imaging • Associated with mitral annular

Pericardial e usion • Imaging

URORAD 1 and 2 (DONE)

Plain KUB X-ray Serial Images w/ contrast

Nephrogram Phase (1-2 mins)

Retrograde Ileal Conduit (Loopogram)

The ureter was attached to the bowel segment. Then the

Gold standard for kidney stones

CT Urogram • Unenhanced – no contrast

Abnormal Renal Rotation/ Malrotated

o One normal and one pelvic kidney – 1 in 3,000 – most C

KUB X-ray. There is air in the left kidney.

• CT stonogram. Shows air foci involving the bilateral

There is parenchymal thinning.

Hallmarks of renal tuberculosis

Renal cell carcinoma

• Exophytic cystic nodule. RCC because the plural wall

• Tumor Thrombus in Renal Vein and Inferior Vena Cava.

Renal cell carcinomas (RCC)

• Multiple nodule masses with varying sizes are scattered

• Non–Hodgkin lymphoma (arrows) inﬁltrates the

CYSTIC RENAL MASSES

• Bosniak 1 – fat arrow

Medullary sponge kidney

• KUB X-RAY. Showing medullary sponge with kidney

Parts of Male Urethra

Voiding cystourethrography in males

The verumontanum (arrowhead) is a nodular structure