Abnormally thickened endometrium on imaging may occur for a number of reasons which may be categorized based on whether or not they are related to pregnancy. Etiologies 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.
Abnormal testicular Doppler flow (arterial, venous, or both) can be a differential challenge. Always remember that the patient's presenting history helps quite a bit in narrowing the differential.
partial testicular torsion (<360 degrees)
venous outflow is obstructed first, resul...
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 set by the American Board of Radiology, and 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 PGY4 of radiology residency training.
The exam is computer-based and occur...
Abrodil (marketed as Skiodan in the US) was a water-based iodinated contrast medium introduced for clinical use in 1930 3. It was developed by Bronner, Hecht and Schueller in Germany. Chemically, Abrodil is the sodium salt of monoiodomethanesulfonic acid.
It was initially employed for intraveno...
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 abscopal effect is a term used in oncology which refers to a phenomenon in which a locoregional therapy for a tumor leads to systemic anti-tumor effects, such as shrinkage of distant (non-target) tumors.
While the precise mechanism(s) of action are not fully understood, there is a growing a...
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 no...
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...
Non-visualization of the fetal stomach on ultrasound can occur with various physiological as well as pathological processes. It becomes a significant sonographic observation >14 weeks of gestation (about the time the fetus begins to swallow).
physiological emptying: transient
An absent infrarenal inferior vena cava can be congenital, due to the failure of development of the posterior cardinal and supracardinal veins, or acquired, as a result of intrauterine or perinatal inferior vena cava thrombosis.
It is an extremely rare anomaly.
In a fetal sonographic assessment, an absent nasal bone is a feature that can sometimes be used as a surrogate marker for fetal aneuploidy.
It is assessed on a midline sagittal view. In this section, the nasal bone is often seen as a bright echogen...
An absent patella is a rare finding and can be found with an equally rare set of associations:
surgical removal of patella (patellectomy)
nail patella syndrome 2
popliteal pterygium syndrome
proximal focal femoral deficiency (PFFD)
Meier-Gorlin syndrome 3
The absent posterior limb sign is one of the main MRI findings of prognostic significance in term neonates with suspected hypoxic-ischemic brain injury. An absent posterior limb sign is defined as loss of the normally distinct hyperintensity on T1-weighted images in the posterior part of the pos...
Absent pulmonary valve syndrome (APVS) also known as congenital absence of pulmonary valve or pulmonary valve agenesis is a rare cardiac outflow tract anomaly.
It is characterized by completely absent or rudimentary pulmonary valve. It can be associated with aneurysmal dilatation of...
An absent septum pellucidum may rarely be an isolated finding, or more commonly be seen in association with a variety of conditions.
The septum pellucidum is partly or entirely absent in 2 or 3 individuals per 100,000 in the general population.
An absent septum pelluc...
An absent thumb can have many associations. They include:
Fanconi anemia (pancytopenia-dysmelia syndrome)
phocomelia (e.g. thalidomide embryopathy)
Poland syndrome (pectoral muscle aplasia and syndactyly)
Seckel syndrome ...
Absent end-diastolic flow (AEDF) in an umbilical artery Doppler assessment is a useful feature which indicates underlying fetal vascular stress if detected in mid or late pregnancy. It is often classified as Class II in severity in abnormal umbilical arterial Dopplers 9.
Absence of the yolk sac in the presence of an embryo on a transvaginal ultrasound is considered abnormal, and in general is associated with subsequent embryonic death.
Absorbed dose is a measure of the energy deposited in a medium by ionizing radiation. It is equal to the energy deposited per unit mass of a medium, and so has the unit joules (J) per kilogram (kg), with the adopted name of gray (Gy) where 1 Gy = 1 J.kg-1.
The absorbed dose is not a good indica...
In ultrasound, absorption is the reduction in intensity of the sound waves as it passes through tissue. Most of the energy lost is in the form of heat.
Abusive head trauma is a term that is used for inflicted head injury that has occurred by either shaking, impact head trauma, or both, as part of the spectrum of non-accidental injury (NAI).
Subdural hemorrhage in a child should be viewed with suspicion. Most o...
Aceruloplasminemia is an autosomal recessive type of neurodegeneration with brain iron accumulation and disorder of iron metabolism caused by a mutation in the ceruloplasmin (CP) gene resulting in the production of dysfunctional ceruloplasmin.
Aceruloplasminemia is a very rare dis...
Acalculia (or acquired dyscalculia) represents the acquired loss of the ability to perform simple arithmetic tasks secondary to CNS pathology. It is not to be confused with developmental dyscalculia, which is a different entity and represents developmental disturbance of computational ability.
An acardiac twin, also known a recipient twin, refers to the haemodynamically disadvantaged twin of a twin-pair in the setting of twin reversed arterial perfusion (TRAP) sequence. The acardiac twin undergoes secondary atrophy and is non-viable.
Acardiac twinning is thought to affe...
Acardius acormus is a morphologic subtype of an acardiac twin in a twin reversed arterial perfusion (TRAP) sequence. This entity is the least common of the four subtypes, comprising of cephalic structures only. It is seen in approximately 5% of cases.
Acardius amorphus is a morphologic subtype of the acardiac twin in a twin reversed arterial perfusion (TRAP) sequence. This entity is the least well differentiated of the four subtypes, comprising of an amorphus mass with no recognizable structures. It is seen in approximately 20% of cases.
Acardius anceps is a morphologic subtype of the acardiac twin in a twin reversed arterial perfusion (TRAP) sequence. This entity is the most well differentiated of the four subtypes, with a partly formed head, thorax, and abdomen. It is seen in approximately 10% of cases.
Acardius anephus is a morphologic subtype of an acardiac twin in the twin reversed arterial perfusion (TRAP) sequence. In this entity, no cephalic or structures are present, but the lower limbs are preserved. This is the most common subtype, seen in 60-75% of cases1.
ACC/AHA classification of coronary lesions is a system use to classify coronary arterial calcific plaque burden. It is classified as
discrete (<10 mm)
nonangulated segment <45º
little or no calcification
less than totally occlusive
not ostial in location...
There are a number of accepted abbreviations that we use on Radiopaedia.org. We would like the site to be as standardized as possible and we have therefore chosen our accepted abbreviations and would ask that where possible these are used:
a.k.a. not aka (short for "also known as")
cf. not c.f...
An accessory abductor digiti minimi (ADM) muscle is the commonest accessory muscle of the hypothenar eminence, found in 24% individuals. When present it is one of the intrinsic muscles of the hand.
antebrachial fascia passing anteriorly to Guyon canal
occasionally arises from...
The accessory anterior inferior tibiofibular ligament (accessory AITFL), also known as Bassett's ligament, is an anatomical variant present in many ankles. Pathological thickening of the accessory ligament is seen in the setting of inversion injury that causing the pain due to mild anterior inst...
The accessory appendicular artery, also known as the artery of Seshachalam, is a branch of the posterior cecal artery. It arises from the ileocolic artery, and runs in the mesoappendix.
The exact prevalence of this accessory artery and its impact upon the risk of appendicitis varies among studi...
Accessory breast tissue is a relatively common congenital condition in which abnormal accessory breast tissue is seen in addition to the presence of normal breast tissue. This normal variant can present as a mass anywhere along the course of the embryologic mammary streak (axilla to the inguinal...
Accessory fissures of the lung usually occur at the borders of bronchopulmonary segments. They are common normal variants but are less commonly seen on imaging.
Some of the more common accessory fissure include 1:
azygos fissure: most commonly seen accessory fissure
inferior accessory fissur...
The accessory flexor digitorum longus muscle is an accessory muscle in the deep posterior compartment of the leg with a reported prevalence of 6-8%. Unilateral muscles are more common although bilateral cases have been reported.
origin: variable; either the medial margin of the tibia a...
Accessory gallbladders are a rare anatomical variant occurring in 0.03% of cases (approximately 1 in 3000 people). They can arise from either the left or right hepatic ducts or both. Accessory gallbladders arise from a bifid diverticulum of the hepatic duct in the 5th or 6th week of development ...
The accessory (or superior) hemiazygos vein forms part of the azygos system and along with the hemiazygos vein, it is partially analogous to the right-sided azygos vein. It drains the left superior hemithorax.
Spelling it "hemiazygous" when referring to the vein is incorrect, rega...
An accessory left atrial appendage is a frequent fortuitous finding in cardiac imaging, encountered in ~10% of patients. They are more often seen as a small diverticular structure projecting from the right upper side of the left atrial wall.
it must not be confused with ...
Accessory maxillary ostia are a common anatomic variant, and are usually found incidentally on CT scans of the paranasal sinuses. Accessory ostia of the maxillary sinus are common, occurring in up to 40% patients 1. No significant association has been found between the presence of accessory osti...
The accessory meningeal artery is a branch of the maxillary artery but can also branch from the middle meningeal artery.
The artery passes upwards through the foramen ovale to supply the trigeminal ganglion and the dura mater of Meckel cave and the middle cranial fossa. It also usually supplies...
The accessory middle cerebral artery is a variant of the middle cerebral artery (MCA) that arises from the anterior cerebral artery (ACA). It is different from a duplicated middle cerebral artery, in which the duplicated vessel originates also from the distal end of the internal carotid artery (...
Accessory muscles are a form of anatomic variation that refers to supplementary discrete muscles that are found alongside the normal expected musculature. They have been described in the neck, pelvis, upper and lower limbs.
An accessory navicular is a large accessory ossicle that can be present adjacent to the medial side of the navicular bone. The tibialis posterior tendon often inserts with a broad attachment into the ossicle. Most cases are asymptomatic but in a small proportion it may cause painful tendinosis d...
Accessory navicular syndrome occurs when a type II accessory navicular becomes painful due to movement across the pseudo-joint between the ossicle and the navicular bone.
It can be inferred on musculoskeletal ultrasound if a patient's pain is located at a type...
The accessory ossicle of the anterior arch of the atlas is a normal variant and is best appreciated on a lateral cervical/sagittal study. It is observed as a circular and corticated osseous density that articulates with the inferior aspect of the anterior arch of the atlas.
It is not associate...
Accessory ossicles are secondary ossification centers that remain separate from the adjacent bone. They are usually round or ovoid in shape, occur in typical locations and have well defined smooth cortical margins on all sides.
In most cases, they are congenital in origin, although they may occ...
Accessory ossicles of the feet are common developmental variants with almost 40 having been described. Some of the more common include 1-4:
os tibiale externum (accessory navicular)
os calcaneus secundaris
There are numerous named and unnamed accessory ossicles of the lower limb. These include:
ossicles of the hip
ossicles of the knee
ossicles of the foot
os tibiale externum
os calcaneus secundaris
Accessory ossicles of the wrist are commonly seen on plain radiographs of the wrist and associated cross-sectional imaging. Over 20 were originally described 2, although the more common include 1:
lunula: between TFCC and triquetrum
os styloideum (carpal boss): on dorsal surface of 2nd or 3rd ...
The accessory ossicles of the wrist can be easily recalled with the mnemonics:
O: os styloideum (carpal boss)
T: (os) triangulare
T: (os) trapezium secondarium
E: (os) epilunate
O: os hamuli proprium
H: (os) hamuli proprium
O: os tri...
Accessory parotid glands are a normal variant and represent ectopic salivary tissue separate from, but usually in close proximity to, the main parotid glands.
Accessory parotid glands are commonly picked up incidentally on ultrasound; seen in ~20% of the general population 2.
Accessory peroneal muscles are a group of accessory muscles that can occur in the foot region as a normal variant in some individuals. The peroneal compartment is known as the lateral compartment of the leg.
Peroneus quartus muscle
Originally, several accessory muscles were distinguished in th...
The accessory phrenic nerve is an anatomical variant seen in a little over one third of patients (36%). It most commonly arises from the ansa cervicalis, or slightly less commonly, the subclavian nerve. It is unknown as to how much the accessory phrenic nerve contributes to diaphragmatic functio...
Accessory renal arteries are a common variant and are present in ~25% (range 20-30%) and are bilateral in ~10% of the population 1. Their proper identification is of utmost importance for surgical planning prior to live donor transplantation 2,3 and renal artery embolization for various reasons ...
An accessory right inferior hepatic vein is the most common variation of the hepatic veins. It is present in up to 48% of the population and drains the posterior part of the right lobe (mainly segments 6 and 7) directly into the inferior vena cava (IVC).
Variations in hepatic vascular anatomy ...
Accessory sacroiliac joints are a common finding, present on ~15% (range 13-17.5%) of CT studies, and may be unilateral or bilateral. They are an articulation between the medial aspect of the posterior superior iliac spine and the sacrum just lateral to the second dorsal sacral foramen. They may...
The accessory semimembranosus muscle is a rare accessory muscle of the posterior compartment of the thigh. It arises from the distal aspect of the semimembranosus muscle belly and courses through the popliteal fossa between it and the semitendinosus muscle medially and the biceps femoris lateral...
The accessory soleus muscle is an anatomical variant characterized by an additional distinct muscle encountered along a normal soleus muscle. It is uncommon with a prevalence of ~3% (range 0.7-5.5%).
origin: fibula, soleal line of the tibia, or the anterior surface of the soleus muscle...
An accessory superior acetabular notch is a normal variant of the acetabulum, which can be seen on radiographs. It may lead to diagnostic confusion, especially in younger patients.
appear as bilateral symmetric fluid-filled pits in the roof of the acetabulum with sh...
The parietal and occipital bones in particular are common regions for accessory sutures because of their multiple ossification centers.
It is important to know these anatomic variations, mainly on the head trauma image studies in children, where it could be difficult to differentiate non-depres...
The accordion sign (also known as concertina sign) is seen on CT examinations of the abdomen and refers to the similarity between the thickened edematous wall of pseudomembranous colitis and the folds of an accordion. This appearance is the result of hyperemic enhancing mucosa stretched over mar...
Ace-of-spades sign refers to the pathognomonic configuration of the left ventricle as seen in apical hypertrophic cardiomyopathy 1-3.
It consists of marked ventricular wall thickening at the apex resulting in cavity narrowing at the apex with a relatively normal appearance of the mid-ventricula...
The acetabular angle is a radiographic measurement used when evaluating potential developmental dysplasia of the hip (DDH). It is most useful in patients who have started to ossify the epiphysis since ossification diminishes the usefulness of ultrasound.
The angle is formed by a horizontal lin...
Acetabular dysplasia is referred to as a shallow acetabulum, not being able to provide sufficient coverage for the femoral head and thus leading to instability of the hip joint.
Acetabular dysplasia is a form of developmental dysplasia of the hip (DDH) often referred to in the adol...
The acetabular foramen is formed by the bony margins of the acetabular notch and completed by the transverse ligament of the hip. From its margins (both transverse ligament and acetabular notch) arises the ligamentum teres. Through it pass nutrient vessels to the femoral head epiphysis.
The acetabular fossa, also known as the cotyloid fossa, is the central aspect of the medial wall of the acetabulum that hosts the ligamentum teres and the fibrofatty pulvinar. It is the nonarticular portion inside the U-shaped labrum that extends to the acetabular notch 1. The acetabular fossa i...
Acetabular fractures are a type of pelvic fracture, which may also involve the ilium, ischium or pubis depending on fracture configuration.
Acetabular fractures are uncommon. The reported incidence is approximately 3 per 100,000 per year. This study reported a 63% to 37% male to f...
The acetabular index also called acetabular roof angle or Tönnis angle is a radiographic measurement of femoral head bony coverage by the acetabulum. It is useful in assessing for developmental dysplasia of the hip (DDH) as well as pincer morphology in femoroacetabular impingement (FAI).
Acetabular labral calcification in the hip can be a finding detected on imaging studies. It has an association with osteoarthritis of the hip and may account for higher pain levels in individuals with a high degree of calcification independent of age and histological degeneration 2.
An acetabular labral sulcus is type of normal variant seen as cleft like appearance on imaging. It forms where the labrum meets the adjacent articular cartilage. Several sulci can be identified which include
several sublabral sulci
posterosuperior ~ 48%
anterosuperior ~ 44%
anteroinferior ~ ...
Acetabular labral tear, as the name implies, is a tear involving the acetabular labrum of the hip. It is defined as a defect in the labral surface, intralabral surface or chondrolabral junction 10.
With the increasing use of hip arthroscopy in orthopedic surgery since the 1970s pathologies of t...
Acetabular labrum acts to deepen the acetabulum and increase contact between the pelvis and the femoral head. Its exact biomechanical role remains to be fully elucidated.
The acetabular labrum is a C-shaped fibrocartilaginous structure with an opening anteroinferiorly at the site...
The acetabular notch is a depression in the margin of the acetabulum located anteroinferiorly. It is bridged by the transverse ligament, and thus forms the acetabular foramen. The ligamentum teres has part of its origin from the acetabular notch.
Acetabular protrusion, also known as protrusio acetabuli, is intrapelvic displacement of the acetabulum and femoral head, so that the femoral head projects medial to the ilioischial line. It should be differentiated from coxa profunda.
Acetabular protrusion is divided into primary an...
Acetabular retroversion denotes an abnormal posterior angulation of the superolateral acetabular rim, resulting in excessive coverage of the femoral head and metaphysis along the anterior border 1,2.
Acetabular retroversion is a common abnormality affecting 5 to 20% of the genera...
The acetabular sector angles are a set of angles, comprising the anterior acetabular sector angle (AASA), the posterior acetabular sector angle (PASA) and horizontal acetabular sector angle (HASA) and are used on cross-sectional imaging, especially pelvic CT, for the evaluation of acetabular cov...
The acetabular sourcil is a radiographic feature seen on plain radiographs of the hip and pelvis as well as coronal CT reformats and MR images. It refers to the roof or the weight-bearing area of the acetabulum and is characterized by an increased degree of sclerosis.
Its medial and lateral edg...
The acetabular version angle or acetabular anteversion angle is a measurement used on cross-sectional imaging especially pelvic CT for the assessment of acetabular morphology.
The acetabular version angle is influenced by pelvic obliquity and pelvic tilt, which might lead to measurement ...
The acetabulum (plural: acetabula) is the large cup-shaped cavity on the anterolateral aspect of the pelvis that articulates with the femoral head to form the hip joint.
All three bones of the pelvis (the ilium, ischium, and pubis) together form the acetabulum. The three bones ar...
Achalasia (primary achalasia) is a failure of organized esophageal peristalsis causing impaired relaxation of the lower esophageal sphincter, and resulting in food stasis and often marked dilatation of the esophagus.
Obstruction of the distal esophagus from other non-functional etiologies, not...
Acheiria refers to absence of one or both hands and can occur in a number of situations, including:
amniotic band syndrome: particularly if unilateral
Cornelia de Lange syndrome 1
fetal hydantoin syndrome 2
Rare defect occurring in 1:65 000 live births.
Achievements are a recent feature of your public profile. They are a way of showcasing to the world some of the ways you have contributed to Radiopaedia.
There are 6 achievements currently, two of them representing 'current status' and representing the current level of a specific...
Achilles tendinopathy refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. It can be seen both in athletes and non-athletes. It is hard to differentiate clinically from a paratendinopathy (which is most...
Achilles tendon ossification is an uncommon condition that consists of characteristic bone formation within the substance of the Achilles tendon.
Achilles tendon ossification is more common in males 4.
The etiology is unknown but Achilles tendon ossification is seen ...
Achilles tendon tears are the most common ankle tendon injuries, and are most commonly seen secondary to sports-related injury, especially squash and basketball.
There is strong male over-representation presumably as a result of the predominantly sport related etiology. Patients a...
Achilles tendon thickening can occur for a number of reasons.
The Achilles tendon has an average AP diameter of 6 mm 1. Thickening of the tendon is when it exceeds 8 mm in AP diameter and can result from:
Achilles tendon xanthomata are painless soft tissue masses occurring most commonly at the distal portion of the tendon and are usually bilateral and symmetrical.
Characterized by localized accumulation of lipid-laden macrophages, inflammatory cells and giant cells secondary to choles...
Achondrogenesis refers to a group of rare and extreme skeletal dysplasias.
The estimated incidence is 1:40,000 with no recognized gender predilection.
It is classified as an osteochondrodysplasia, meaning deficiency of both bone and cartilage development.
Achondrogenesis type Ia, also known as the Houston-Harris subtype, is a subtype of achondrogenesis. It is an extremely rare lethal skeletal dysplasia (chondrodysplasia) with a characteristic severe disarrangement of endochondral ossification.
Some of the common clinical f...