11-13 week antenatal scan is considered a routine investigation advised for the fetal well being as well as for early screening in pregnancy (see antenatal screening).
It includes multiple components and is highly dependant on the operator. Traditionally three factors are used to calculate the ...
≤11 ribs is associated with a number of congenital abnormalities and skeletal dysplasias, including:
asphyxiating thoracic dysplasia (Jeune syndrome)
short rib polydactyly syndromes
chromosome 1q21.1 deletion syndrome
14-3-3 protein is found in the cerebrospinal fluid (CSF), and is currently used to help identify patients with sporadic Creutzfeldt-Jakob disease (sCJD).
In diagnosing sCJD, the sensitivity of 14-3-3 protein is 92% and its specificity is 80% 1. A negative 14-3-3 assay may be helpful in reducin...
Comparing 1.5T vs 3T MRI systems identifies a number of differences; a 3T system has
increased signal to noise ratio (SNR)
increased spatial resolution
increased temporal resolution
increased specific absorption rate (SAR)
increased acoustic noise
Signal to noise ratio
18q syndrome is a rare chromosomal anomaly where there is a deletion of part of the long arm of chromosome 18. Associated symptoms and findings vary widely, as does their severity. Characteristic features include short stature, mental retardation and hypotonia, facial and distal skeletal abnorma...
1p19q codeletion stands for the combined loss of the short arm chromosome 1 (i.e. 1p) and the long arm of chromosome 19 (19q) and is recognised as a genetic marker predictive of therapeutic response to both chemotherapy and combined chemoradiotherapy and overall longer survival in patients with ...
1p36 deletion syndrome, or monosomy 1p36, is a chromosomal abnormality characterised most commonly by a deletion in the distal segment of the short arm of chromosome one 1.
The 1p36 deletion syndrome is present in approximately 1 in 5000 live births. It is the most common terminal...
The 2001 World Health Organization (WHO) classification of hepatic hydatid cysts is used to assess the stage of hepatic hydatid cyst on ultrasound and is useful in deciding the appropriate management for it depending on the stage of the cyst. This classification was proposed by WHO in 2001 and a...
The 2005 WHO histological classification of odontogenic tumours lays out a classification system for neoplasms and other tumours related to the odontogenic apparatus. At the time of writing (2016), it is still the most widely used classification system.
The 2008 WHO classification of tumours of haematopoietic and lymphoid tissues is at the time of writing (mid 2016) the most widely used classification system.
nodular lymphocyte predominance
classical Hodgkin lymphoma
Endometrial stromal tumours (EST) constitute <2% of all uterine tumours and <10% of uterine mesenchymal neoplasms 1.
Over the past four decades, EST classification has gone through various modifications, starting from the earliest study by Norris and Taylor 2. This was primarily due to the rar...
20° oblique projection is a troubleshooting projection used in mammography, especially in young women and in follow-up patients.
The C-arm is turned approximately 20° for a superomedial-inferolateral oblique. With the patient's feet pointing towards the unit and her torso turned slig...
The 22q11.2 deletion syndrome, also known as the DiGeorge syndrome or velocardiofacial syndrome, is a syndrome where a small portion of the chromosome 22 is lost and results in a variable but a recognisable pattern of physical and behavioural features.
The estimated incidence is a...
2-hydroxyglutarate is a metabolite that accumulates in the brains of patients with IDH-1 mutated (IDH-1 positive) brain tumours, particularly diffuse low-grade gliomas. Although not in widespread clinical use, it is likely that 2-hydroxyglutarate, which resonates at 2.25 ppm, will be able to be ...
Three-dimensional (3D) ultrasound is a technique that converts standard 2D grayscale ultrasound images into a volumetric dataset. The 3D image can then be reviewed retrospectively. The technique was developed for problem-solving (particularly in obstetric/gynecologic exams) and to potentially re...
4D syndrome is a term given to syndromic glucagonomas, a type of pancreatic endocrine tumour.
D: dermatitis (necrolytic migratory erythema, often involving the groin)
D: deep vein thrombosis
The 5-F rule refers to risk factors for the development of cholelithiasis in the event of upper abdominal pain:
fair: more prevalent in the Caucasian population 1
fat: BMI >30
fertile: one or more children
forty: age ≥40
cholelithiasis can occur in young patients with a positive fam...
The 5th metacarpal pit refers to the normal exaggeration of the pit-like depression in the head of fifth metacarpal.
It should not be mistaken for a fracture (old or new) or an erosion.
The 5-tier ACR system was a previously used system for classification of radiologic breast findings, proposed by the American College of Radiologists (ACR). It is no longer in widespread use, having been gradually superseded by the new 6-tier BIRADS classification system first published in 1992....
Aarskog syndrome or Aarskog–Scott syndrome (also known as the facio-digito-genital syndrome) is a rare anomaly characterized by short stature in association with a variety of structural anomalies involving mainly the face, distal extremities, and external genitalia.
Aase-Smith syndrome (or Aase syndrome) is an extremely rare congenital disorder.
congenital hypoplastic anaemia - fetal anaemia
cleft lip, cleft palate
hydrocephalus (due to Dandy-Walker anomaly)
The American Association for the Surgery of Trauma (AAST) injury scoring scales are the most widely accepted and used system of classifying and categorising traumatic injuries. Injury grade reflects severity, guides management, and aids in prognosis. At the time of writing (mid 2016), 32 differe...
The American Association for the Surgery of Trauma (AAST) renal injury scale 3-4 is the most widely used grading system for renal trauma at the time of writing (late 2016). Severity is assessed according to the depth of renal parenchymal damage and involvement of the urinary collecting system a...
The 1994 revision of the AAST (American Association for the Surgery of Trauma) liver injury scale is the most widely used liver injury grading system at the time of writing (late 2016).
haematoma: subcapsular, <10% surface area
laceration: capsular tear, <1 cm parenc...
The 1994 revision of the American Association for the Surgery of Trauma (AAST) splenic injury scale is the most widely used grading system for splenic trauma at the time of writing (late 2016).
subcapsular haematoma <10% of surface area
capsular laceration <1 cm depth...
ABC/2 is a fast and simple method for estimating the volume of intracerebral haemorrhage (or any other ellipsoid lesion for that matter) which does not require volumetric 3D analysis or software. Intracerebral haemorrhage volume is an important predictor of morbidity and mortality (and thus tria...
AP supine radiograph can be performed as a standalone projection or as part of an acute abdominal series, depending on the clinical question posed, local protocol and the availability of other imaging modalities.
the patient is supine, lying on their back, either on the X-ray ...
The dorsal decubitus view is a supplementary projection often replacing the lateral decubitus view in the context of an unstable patient who is unable to roll nor stand. Used to identify free intraperitoneal gas (pneumoperitoneum). It can be performed when the patient is unable to be transferred...
The lateral decubitus abdominal radiograph is used to identify free intraperitoneal gas (pneumoperitoneum). It can be performed when the patient is unable to be transferred to, or other imaging modalities (e.g. CT) are not available. The most useful position for detecting free intraperitoneal ai...
AP oblique supine radiograph is normally performed when localising foreign bodies or lines within the abdominal cavity. Additionally, the oblique abdominal series can be utilised in the assessment of the upper intestinal tract during barium studies.
the patient is laying 30 de...
The PA erect abdominal radiograph is often obtained in conjunction with the AP supine abdominal view in the acute abdominal series of radiographs. When used together it is a valuable projection in assessing air fluid levels, and free air in the abdominal cavity.
The erect abdominal radiograph h...
PA prone radiograph is rarely performed, often utilised when a patient is unable to lay supine. The projection is adequate for the examination of the abdominal cavities, however, not as practical for the renal structures due to magnification.
the patient is prone, either on th...
Abdominal adhesions are bands of scar tissue (ﬁbrous or ﬁbrous fatty), most often occurring as a complication of previous abdominal surgery.
Adhesions often occur with
multiple abdominal operations or previous postoperative intra-abdominal complications
history of intra-abdominal i...
Abdominal and pelvic anatomy encompasses the anatomy of all structures of the abdominal and pelvic cavities.
The abdominal aorta is the main blood vessel in the abdominal cavity that transmits oxygenated blood from the thoracic cavity to the organs within the abdomen and to the lower limbs.
origin: continuation of descending thoracic aorta at T12
course: descends anterior and slightly to th...
Abdominal aortic aneurysms (AAA) are focal dilatations of the abdominal aorta that are 50% greater than the proximal normal segment or >3 cm in maximum diameter.
The prevalence of AAAs increases with age. Males are much more commonly affected than females, with a ratio of 4:1. The...
Abdominal aortic aneurysm (AAA) rupture is a feared complication of abdominal aortic aneurysm and is a surgical emergency. It is part of the acute aortic syndrome spectrum.
Abdominal aortic aneurysms are common and affect ~7.5% of patients aged over 65 years 6.
Abdominal aortic aneurysms (AAA) are focal dilatations of the abdominal aorta that are 50% greater than the proximal normal segment or >3 cm in maximum diameter.
This is a summary article; read more in our article on abdominal aortic aneurysm.
Abdominal aortic injuries are a very rare form of traumatic aortic injury and are much less common than thoracic aortic injury.
Aortic injury occurs in <1% of blunt trauma patients, with abdominal aortic injury representing only ~5% of all aortic injuries 1. Males are more freque...
The abdominal cavity is divided into two major compartments, the peritoneum and retroperitoneum, early in fetal development.
The parietal peritoneum is reflected over the peritoneal organs to form a series of supporting peritoneal ligaments, mesenteries and omenta. The peritoneal reflections ca...
Abdominal ectopic pregnancies are an extremely rare type of ectopic pregnancy.
They are thought to represent ~1% of all ectopic pregnancies 6 with an estimated incidence of 1:1000-10,000 births.
It is often thought that they most frequently result from a tubal rupture ...
Abdominal hernias (herniae also used) may be congenital or acquired and come with varying eponyms. They are distinguished primarily based on location and content. 75-80% of all hernias are inguinal.
Content of the hernia is variable, and may include:
small bowel loops
mobile colon segments (s...
The lateral view abdominal radiograph is a useful problem-solving view that can complement frontal views of the abdomen, often utilised in the context of forging dies or to better visualise lines such as a shunt. It is different than the lateral decubitus view of the abdomen and looks more like ...
An opacity projecting over the abdomen has a broad differential. Possibilities to consider include:
ingested, e.g. coins, batteries, bones, etc
artifacts, e.g. object attached to the cloth of the patient like a safety pin or button
iatrogenic, e.g. haemostatic clips, gastric b...
This mnemonic helps to remember the relative echogenicity of abdominal organs on ultrasound:
Darling Parents So Love Kids
From most to least echogenic:
K: kidneys (cortex)
Abdominal paracentesis, more commonly referred to as an ascitic tap, is a procedure that can be performed to collect peritoneal fluid for analysis or as a therapeutic intervention.
diagnostic: especially for newly diagnosed ascites
determine aetiology of ascites
assess for bacter...
AP supine radiograph for neonates is a mobile examination performed on the neonatal unit. It can be taken as a standalone projection or as part of a series including a left lateral decubitus x-ray in cases of suspected perforation.
the patient is supine, lying on their back i...
Abdominal radiography can be useful in many settings. Before the advent of computed tomography (CT) imaging, it was a primary means of investigating gastrointestinal pathology and often allowed indirect evaluation of other abdominal viscera.
Although abdominal radiography has lower...
Abdominal radiology conditions are a broad group of heterogeneous conditions that are split into:
true pathology (e.g. colonic carcinoma)
the underlying process (e.g. large bowel obstruction)
It is important to have an overview of these conditions and understand what imaging is useful in thei...
Abdominal radiology curriculum for medical students is broadly split into content that refers to imaging (the test and findings) and conditions that are considered key for this stage of training.
Some non-abdominal conditions are included in this portion of the curriculum, including breast dise...
Imaging in general surgery is vital to ensure timely and accurate diagnosis for patients.
You need to know the gamut of tests that are available when to use the correct test, some important findings that commonly occur and (for some investigations) how to approach looking at the images that ar...
Abdominal radiology interpretation is a key component of how to make the most of diagnostic imaging. You need to know how to look at the commonly performed radiology tests and how to make common diagnoses.
Abdominal radiology key findings are a group of imaging findings that are really important in imaging of the abdomen. They point to disease processes and help to narrow the differential diagnosis. It is important to know these and recognise them on imaging.
Abdominal radiology presentations are a relatively distinct group of presentations that precipitate assessment medical and surgical teams.
Abdominal radiology tests and when to use them are a set of articles that help to outline the common tests that may be used in radiology and what they are useful for.
Plain films (erect chest and supine abdomen), as well as ultrasound and CT abdomen, will be the bread and butter of the imaging ...
The abdomen, when looking from in front, is divided into nine regions by imaginary planes (two vertical and two horizontal) forming abdominal surface anatomy. The nine regions are of clinical importance when examining and describing pathologies related to the abdomen. The horizontal planes are o...
Abdominal trauma is usually divided into blunt and penetrating trauma.
Findings of abdominal trauma
splenic trauma: most common
gastrointestinal tract (bowel) trauma:
proximal jejunum is most commonly affected by blunt trauma,...
Abdominal x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using ABDO X is a helpful and systematic method for abdominal x-ray review:
A: air - where it should and shouldn't be
B: bowel - position, size and wall thickness
D: dense st...
Abdominal x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using ABDO X is a helpful and systematic method for abdominal x-ray review, where A refers to the assessment of the presence and location of air.
This is a s...
Abdominal radiographs can be challenging examinations to look at. It is always best to approach radiographs in a systematic way.
Bowel gas pattern
Gas within the bowel forms a natural contrast with surrounding tissues since it has a very low density. Bowel can only be seen if it contains air/g...
Abdominal x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using ABDO X is a helpful and systematic method for abdominal x-ray review, where X refers to the assessment of external objects and artifacts.
This is a sum...
Abdominal x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using ABDO X is a helpful and systematic method for abdominal x-ray review, where B refers to the assessment of the bowel loops.
This is a summary article; w...
Abdominal x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using ABDO X is a helpful and systematic method for abdominal x-ray review, where D refers to the assessment of dense structures such as the bones and areas of calcification.
Abdominal x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using ABDO X is a helpful and systematic method for abdominal x-ray review, where O refers to the assessment of the intra-abdominal organs and soft tissues.
Abdominal radiographs can be a useful examination, but you need to think about the question you are asking before getting the test. Before the advent of computerised tomography (CT) imaging, it was a primary means of investigating gastrointestinal pathology (and often allowed indirect evaluation...
Abdominoschisis refers to a split or in the abdominal wall. Some authors use the term synonymously with a gastroschisis. When the defect continues into the thoracic region it is termed a thoraco-abdominoschisis. A large abdominoschisis is considered part of the limb body wall complex 2.
The abducens nerve is the sixth cranial nerve. It courses from its nucleus located in the dorsal pons to its innervation of the lateral rectus muscle and can be divided into four parts:
nucleus and intraparenchymal portion
cavernous sinus portion
The abductor digiti minimi muscle is on the lateral side of the foot and contributes to the large lateral plantar eminence on the sole.
origin: lateral and medial processes of calcaneal tuberosity, and band of connective tissue connecting calcaneus with base of metatarsal V
The abductor digiti minimi muscle overlies the opponens digiti minimi.
origin: pisiform, the pisohamate ligament, and tendon of flexor carpi ulnaris
insertion: 5th proximal phalanx
action: abducts 5th finger at metacarpophalangeal joint
arterial supply: ulnar artery
The abductor hallucis muscle forms the medial margin of the foot and contributes to a soft tissue bulge on the medial side of the sole.
origin: medial process of calcaneal tuberosity
insertion: medial side of base of proximal phalanx of great toe
action: abducts and flexes great toe ...
The abductor pollicis brevis is a thin subcutaneous muscle located laterally in the thenar eminence of the hand.
origin: mainly from the flexor retinaculum
few fibres originate from the tubercles of scaphoid and trapezium and tendon of abductor pollicis longus
accessory slips may ori...
The abductor pollicis longus (APL) is a muscle found in the deep layer of the posterior compartment of the forearm. As it descends, it becomes superficial and passes under the extensor retinaculum and through the 1st extensor compartment of the wrist before attaching distally.
Abernethy malformations are rare vascular anomalies of the splanchnic venous system. They consist of congenital portosystemic shunts and result from persistence of the embryonic vessels.
Type I malformations are thought to occur only in females, while type II have a male predomin...
The ABER position relates to MR arthrography of the shoulder joint and is a mnemonic for ABduction and External Rotation.
In this position, labral tears are made conspicuous by tightening the inferior glenohumeral labroligamentous complex (which are also the most important glenohumeral ligament...
Aberrant arachnoid granulations (AbAG) are arachnoid granulations that penetrated the dura but failed to migrate normally in the venous sinus. They are most often located in the greater wing of the sphenoid bone. Occasionally, they are seen in the posterior temporal bone wall.
Aberrant internal carotid artery is a variant of the internal carotid artery (ICA) and represents a collateral pathway resulting from involution of the normal cervical portion (first embryonic segment) of the ICA 5.
There is consequent enlargement of the usually small collaterals which course t...
Aberrant left pulmonary artery, also known as pulmonary sling, represents an anatomical variant characterised by the left pulmonary artery arising from the right pulmonary artery and passing above the right main bronchus and in between the trachea and oesophagus to reach the left lung. It may le...
Aberrant right subclavian arteries (ARSA), also known as arteria lusoria, are the commonest of the aortic arch anomalies 2.
The estimated incidence is 0.5-2%.
They are often asymptomatic, but around 10% of people may complain of tracheo-oesophageal symptom...
Aberrations in the Normal Development and Involution of the breast (ANDI) is an all-encompassing term that is used to describe a wide spectrum of the benign breast diseases. As the name suggests, it is based on the theory that most of the encountered benign breast disorders are essentially minor...
Abnormal bowel wall attenuation patterns on CT scan can be grouped under five categories:
water halo sign
fat halo sign
The first three patterns are seen on contrast studies.
It is defined as uniform enhancement of th...
A mnemonic used for abnormal collection of barium anywhere in the body :
Abnormal ductus venosus waveforms can arise in a number of conditions ranging from aneuploidy to vascular malformations and fetal tumours.
Abnormal waveforms in fetal ductus venosus flow assessment can occur in a number of situations:
Down syndrome: around 80...
Abnormal intra-abdominal gas is an important radiologic finding with many potential causes. It may be seen on a chest radiograph, abdominal radiograph, CT or MRI.
abnormally located bowel, e.g. Chilaiditi syndrome (bowel interpose...
An eccentrically-located gestational sac towards the fundus of the uterus is the normal sonographic appearance; however an abnormally eccentric gestational sac on ultrasound may be apparent due to a number of causes
interstitial ectopic pregnancy 1
normally implanted pregnancy in...
An abnormally low sac position can result from several possibilities which include
impending / ongoing miscarriage
cervical ectopic pregnancy
fundal fibroid or other mass compressing the sac downward
Abnormally thickened endometrium on imaging may occur for a number of reasons which may be categorised based on whether or not they are related to pregnancy. Aetiologies may also be classified based on whether the patient is premenopausal or postmenopausal.
Abnormal renal rotation (renal malrotation) refers to an anatomical variation in the position of the kidneys, in particular to anomalous orientation of the renal hilum. It may occur unilaterally or bilaterally. It is almost always an asymptomatic incidental finding.
The OMERACT ultrasound group published a consensus in 2005 of widely accepted definitions of abnormal ultrasound findings in rheumatological diseases:
erosion: an intra-articular discontinuity of the bone surface that is visible in two orthogonal planes
joint effusion: abnormal hypoechoic or a...
The ABR certifying exam is the second of two exams necessary for certification in diagnostic and interventional radiology in the United States of America (the first is the core exam). It is taken 15 months after the end of the PGY 5 year (or three months after a one year PGY 6 fellowship).
The ABR core exam is the first of two exams necessary for certification in diagnostic and interventional radiology in the United States of America. It is taken at the end of the PGY 4 year of radiology residency training.
The exam is computer-based and occurs in two sessions (7.5 hours and 6 ho...
Abscesses are focal confined collections of suppurative inflammatory material and can be thought of as having three components 1:
a central core consisting of necrotic inflammatory cells and local tissue
peripheral halo of viable neutrophils
surrounded by a 'capsule' with dilated blood vessel...
The absent bow tie sign represents the loss of the normal appearance of the menisci on parasagittal MRI images, and is suggestive of meniscal injury.
Normally the medial and lateral menisci appear as low signal bow-tie-shaped structures between the femoral condyles and tibial plateaux. As the n...
Agenesis of the ductus venosus (ADV) is a rare fetal vascular anomaly.
According to the data obtained from the screening tests performed at 11-14 weeks of pregnancy, its incidence is reported to be 1/2500 12.
In a large case series, Acherman et al. 13 defined five drai...