An anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion is similar to a Bankart lesion, in that it too is usually due to anterior shoulder dislocation and involves the anterior inferior labrum.
Unlike the Bankart lesion in which the labrum and glenoid periosteum is avulsed from ...
The anterior lacrimal crest is a bony projection on the frontal process of the maxilla continuous with the orbital rim which creates the lateral margin of the lacrimal sac fossa. The medial palpebral ligament is attached to anterior lacrimal crest.
Immediately anterior to the anterior lacrimal ...
The anterior lateral malleolar artery is the counterpart to the anterior medial malleolar artery, supplies the lateral aspect of the ankle.
Origin and course
branch of anterior tibial artery
runs posterior to the tendons of extensor digitorum longus and fibularis tertius to th...
The anterior longitudinal ligament (ALL) arises from the anteroinferior basilar portion of occipital bone, traverses the entire length of the spine, and ends on the anteriosuperior portion of the sacrum.
The ALL runs along the anterior surface of the vertebral bodies (firmly united to the perio...
Anterior medial malleolar artery is the counterpart to the anterior lateral malleolar artery, and supplies the medial aspect of the ankle.
Origin and course
branch of anterior tibial artery
arises approximately 5 cm proximal to the ankle
passes posterior to the tendons of exte...
Germ cell tumours are one of the causes of anterior mediastinal mass, and any of the germ cell histologies may be identified. They can therefore be divided histologically into:
non-seminomatous germ cell tumours (NSGCT)
embryonal cell carcinoma
yolk sac tumour
Getting a film with an anterior mediastinal mass in the exam is one of the many exam set-pieces that can be prepared for.
The film goes up and after a couple of seconds pause, you need to start talking:
There is a left sided mediastinal mass that makes obtuse angles with the mediastinal c...
The anterior mediastinum is the portion of the mediastinum anterior to the pericardium and below the thoracic plane.
It forms the anterior part of the inferior mediastinum, and contains the thymus, lymph nodes, and may contain the portions of a retrosternal thyroid.
The anterior nares (or nostrils) form the entrance to the nose. Each naris is formed by a ring of structures:
medially the columella (soft tissue anteroinferior portion of the nasal septum)
laterally and superiorly the ala
inferiorly the nasal sill
The anterior pararenal space is the portion of the retroperitoneum that lies between the posterior surface of the parietal peritoneum and the anterior reflection of the perirenal fascia.
It contains the duodenum, pancreas and retroperitoneal segments of the ascending and descendi...
The anterior perforated substance, or substantia perforata anterior, is an area in the basal forebrain that plays an important role with regards to the blood supply of deep grey matter structures of the brain.
Located within the basal forebrain, the anterior perforated substance...
The anterior pituitary (or adenohypophysis) is by far the largest part of the pituitary gland, and is responsible for synthesis and release of most pituitary hormones (with the exception of oxytocin and antidiuretic hormone (ADH) which are released by the posterior pituitary).
It consists of 3 ...
The anterior ramus of the lateral sulcus, is located at the very anterior end of the lateral sulcus (sylvian fissure), just anterior to the ascending ramus, and passes superiorly into the inferior frontal gyrus separating the pars orbitalis form the pars triangularis of the frontal operculum.
Anterior sacral meningocoele is a congenital defect seen in the anterior aspect of the spine. It is defined as a meningeal cyst that occurs in the presacral space secondary to agenesis of a portion of the anterior sacrum.
In approximately 50% of cases, associated malfo...
The anterior capsular insertion, unlike the posterior aspect of the shoulder joint capsule which has a constant scapular attachment along the margins of the glenoid labrum, inserts a variable distance from the labrum.
The capsular insertions are classified as follows:
type I: at or very near t...
Anterior shoulder dislocation is by far the commonest type of dislocation and usually results from forced abduction, external rotation and extension 1.
Broadly speaking, anterior shoulder dislocations occur in a bimodal age distribution. The first, and by far the more prevalent a...
The anterior spinal artery supplies the anterior portion of the spinal cord and arises from the vertebral artery in the region of the medulla oblongata. The two vertebral arteries (one of which is usually bigger than the other) anastamose in the midline to form a single anterior spinal artery at...
The anterior spinothalamic tract, also known as the ventral spinothalamic fasciculus, is an ascending pathway located anteriorly within the spinal cord, primarily responsible for transmitting coarse touch and pressure.
The lateral spinothalamic tract (discussed separately), in contrast, primar...
Anterior subluxation of cervical spine (also known as hyperflexion sprain) is a ligamentous injury to the cervical spine.
Patient presents with neck pain. There may be symptoms due to spinal cord oedema.
It results from ligamentous injury, however, there may b...
The anterior superior alveolar canal courses through the anterior wall of the maxillary sinus, and contains the anterior superior alveolar nerve, artery and vein. Usually, it shares a common channel with the infraorbital canal but when seen separately should not be confused for a fracture.
The anterior superior alveolar nerve, also known as the anterior superior dental nerve, is the third branch of the infra-orbital nerve, from the maxillary division of the trigeminal nerve. It is the largest of the superior alveolar nerves and contributes to the superior dental plexus.
The anterior superior iliac spine is an important bony surface landmark and is the prominence is the most anterior part of the ilium. It can be palpated at the lateral end of the inguinal fold. Attachments include the inguinal ligament, tensor fasciae latae and sartorius.
Clinically, as an easi...
Anterior superior iliac spine (ASIS) avulsion injuries typically occur in athletes during forceful muscular contraction. ASIS is the site of attachment for sartorius and tensor fascia latae muscles.
ASIS avulsion, like other pelvic avulsion injuries, is a stable fracture.
The anterior talofibular ligament (ATFL) is part of the lateral collateral ligament complex of the ankle. Its role is to stabilise the talus. It is also the weakest of the lateral collateral ankle ligaments.
The ATFL is an intra-capsular flat two-banded ligament that arises from...
Anterior talofibular ligament (ATFL) injury is the most common of the ligament injuries that can occur as part of the lateral ligament complex injuries 2. The injuries can comprise either soft tissue tears, avulsion fractures or both.
ATFL injuries typically occur with an inversion i...
The anterior temporal artery is usually a branch of the M1 segment of the middle cerebral artery (MCA) that curves out of the Sylvian fissure and runs over the temporal lobe to supply the anterior third of the superior, middle and inferior temporal gyri.
The temporopolar arter...
Anterior temporal lobe perivascular spaces are recently recognised special variants of tumefactive perivascular spaces, which can mimic cystic tumours with surrounding oedema.
A predilection for women has been reported 1. Age range is wide, from 24 to 86 years old reported 1.
The anterior tibial artery is the main arterial supply of the anterior compartment of the leg.
The anterior tibial artery arises from the popliteal artery in the popliteal fossa and continues distally as the dorsalis pedis artery.
The popliteal artery usually divides at...
The anterior tibial translocation sign or anterior drawer sign (a.k.a. anterior translation of tibia) is seen in cases of complete rupture of the anterior cruciate ligament, and refers to anterior translocation (anterior tibial subluxation) of the tibia relative to the femur of more than 7 mm 1.
The anterior tibial veins, continuations of the venae comitantes of the dorsalis pedis artery, leave the anterior compartment between the tibia and fibula and pass through the proximal end of the interosseous membrane. They unite with the posterior tibial veins to form the popliteal vein at the ...
The anterior triangle forms the anterior compartment of the neck and is separated from the posterior triangle by the sternocleidomastoid muscle. The triangles of the neck are surgically focussed, first described from early dissection-based anatomical studies which predated cross-sectional anatom...
The anterior ulnar recurrent artery is a recurrent branch of the proximal ulnar artery that ascends in the anterior medial aspect of the elbow, anterior to the medial epicondyle of the humerus to anastomose with the inferior ulnar collateral artery (from the brachial artery) and contribute to th...
Anterior vertebral body beaking occurs in a number of conditions and may eminate from the central portion or the lower third of the vertebral body.
Morquio syndrome 1 (middle for Morquio)
Hurler syndrome 2
The anterolateral ligament of the knee (ALL) is a ligament that is thought to aid with rotational stability of the knee joint. Some think that its presence (or reconstruction) may result in better outcomes from ACL stabilisation surgery 2. The ligament has also been implied in Segond fractures 3...
The term anterolisthesis refers to anterior displacement (forward slip) of vertebral body relative to one below.
The common causes of an anterosuperior mediastinal mass can be remembered by using the mnemonic:
T: thoracic aorta
T: terrible lymphoma
T: teratoma and germ cell tumours - see mediastinal germ cell tumours
Testicular cancer metastasis can represent a si...
Anti-GQ1b IgG antibody syndrome refers to a number of conditions which share autoantibodies to the ganglioside complex GQ1b, and have overlapping clinical spectrums.
The conditions believed to represents various clinical manifestations of a common immunological disorder include 1:
Anti N-methyl-D-aspartic acid (NMDA) receptor encephalitis is an autoimmune encephalitis with antibodies against the NMDA receptors. It is sometimes considered a form of autoimmune limbic encephalitis. It usually affects young patients particularly young females, in about 60% of whom ovarian ter...
Anti-neutrophil cytoplasmic antibody-associated vasculitides refer to a group of heterogeneous autoimmune diseases characterized by necrotising vasculitides and positive anti-neutrophil antibody titres. They are reactive to either proteinase-3 (PR3-ANCA) - cANCA or myeloperoxidase (MPO-ANCA) - p...
Anti-synthetase syndrome (ASS) is a systemic, inflammatory, autoimmune disease that is characterised by inflammatory myositis, polyarthritis associated with interstitial lung disease (ILD) and anti-synthetase autoantibodies.
ASS can result from autoantibodies to eight of the aminoacy...
Implanted antibiotic beads are a form of microbiological treatment inserted during orthopaedic procedures to aid with the treatment of chronic infection. They are also used as a local treatment for osteomyelitis.
The beads are radiopaque, thus lending themselves to visualisation on all imaging ...
Antibiotic-associated diarrhoea can be broadly divided into two groups:
Clostridium difficile colitis
The former is a life-threatening condition, requiring prompt diagnosis and treatment whereas the later is milder and self-limiting.
Both result from changes in the bo...
Antimuscarinics decrease bowel movements in pelvic MRI, and may be used for better image acquisition.
Usually, 20mg of hyoscine butylbromide IM/IV is administered prior to examination.
Benign prostatic hyperplasia
Antiphospholipid syndrome is a systemic autoimmune disorder. It is usually defined as the clinical complex of vascular occlusion and ischaemic events occurring in patients who have circulating antiphospholipid antibodies.
Patients have circulating antiphospholipid antibodies cross-re...
Pulmonary involvement in antiphospholipid syndrome is one of the most frequent arterial complications of antiphospholipid syndrome.
It is essentially related to pulmonary arterial microthrombosis and may cause a wide spectrum of conditions, which include 3-5:
Antithrombin (AT) III deficiency (now simply called antithrombin deficiency) refers to a congenital lack of the endogenous anticoagulant antithrombin.
Antithrombin deficiency is considered the least common of the three main anticoagulant deficiencies (the other two being protein C...
Antopol-Goldman lesions are very rare presentations of subepithelial haemorrhage in the renal pelvis, presenting as discrete mass-like haematomas.
The cause of these lesions is uncertain, although non-steroidal anti-inflammatory drug (NSAID) overuse, trauma, and amyloidosis have been...
Antral follicle count (AFC) or basal antral follicle count is a test performed to check a female individual's ovarian reserve.
A female is born with a lifetime supply of eggs and as she enters puberty these eggs develop. During and after puberty these follicles develop and are relea...
The antral nipple sign refers to redundant pyloric mucosa protruding into the gastric antrum and is seen in pyloric stenosis.
cervix sign of pyloric stenosis
target sign of pyloric stenosis
shoulder sign of pyloric stenosis
The antral pad sign is a feature seen on a spot radiograph of the upper gastrointestinal tract obtained with orally-administered contrast material. It refers to the extrinsic impression or indentation on the posteroinferior aspect of the antrum. The impression is generally arcuate and smooth, an...
Antrochoanal polyps (ACP) are solitary sinonasal polyps that arise within the maxillary sinus. They pass to the nasopharynx through the sinus ostium and posterior nasal cavity, enlarging the latter two.
Similar, less common, polyps can arise in the sphenoid sinus extending into the nasopharynx:...
An antrolith is a calcified mass within the maxillary sinus. The origin of the nidus of calcification may be extrinsic (foreign body in sinus) or intrinsic (stagnant mucus, fungal ball).
Most antroliths are small and asympotomatic. Larger ones may present as sinusitis with symptoms like pain a...
The AO classification of proximal humeral fractures, along with the Neer classification, is one of the most frequently used systems for classifying proximal humeral fractures.
The AO classification divides proximal humeral fractures into three groups, A, B and C, each with subgroups, and place...
The aorta, the great artery, is the largest artery of the human body and carries oxygenated blood ejected from the left ventricle to the systemic circulation. It is divided into:
It has branches from each section a...
The broad term aortic aneurysm is usually reserved for pathology discussion. More specific anatomic and radiologic discussion is based on the location of the aneurysm:
thoracic aortic aneurysm
abdominal aortic aneurysm
The aortic annulus is a fibrous ring at the aortic orifice to the front and right of the atrioventricular aortic valve and is considered the transition point between the left ventricle and aortic root. The annulus is part of the fibrous skeleton of the heart. It is at the level of the sinus of V...
The aortic arch represents the direct continuation of the ascending aorta and represents a key area for a review of normal variant anatomy and a wide range of pathological processes that range from congenital anomalies to traumatic injury.
origin: continuation of the ascending aorta at...
A mnemonic to remember the major branches of the aortic arch is:
A: arch of aorta
B: brachiocephalic trunk
C: left common carotid artery
S: left subclavian artery
Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within th...
The aortic hiatus is one the three major apertures through the diaphragm and lies at the level of T12. Strictly speaking, it is not a real aperture in the diaphragm, but an osseoaponeurotic opening between it and the vertebral column.
The hiatus is situated slightly to the left of the midline ...
Aortic intramural haematoma (IMH) is an atypical form of aortic dissection due to haemorrhage into the wall from the vasa vasorum without an intimal tear. It is part of the acute aortic syndrome spectrum.
Typically aortic intramural haematomas are seen in older hypertensive patien...
The aortic isthmus is the part of the aorta just distal to the origin of the left subclavian artery at the site of the ductus arteriosus.
This portion of the aorta is partly constricted in the fetus because of the lack of flow within the aortic sac and ascending aorta. It marks the partial sepa...
An aortic nipple is seen in about 10% of PA chest x-rays on the lateral surface of the aortic arch/aortic knob. It represents the left superior intercostal vein.
When prominent, superior vena cava obstruction should be considered as the left superior intercostal vein serves as a collateral path...
Aortic pseudoaneurysms typically occur as a result of trauma, a subset of traumatic aortic injury. They can be acute or chronic.
Aortic pseudoaneurysms are contained ruptures of the aorta in which the majority of the aortic wall has been breached, and luminal blood is held in only by...
The aortic root is the first part of the aorta and connects the heart to the systemic circulation.
The aortic root lies between the junction of the aortic valve and ascending aorta. It has several subparts 1:
three aortic valve leaflets and leaflet attachments
three aortic sin...
Aortic spindles are an anatomical variant of the proximal descending thoracic aorta. It occurs just distal to the aortic isthmus and has a circumferential smooth bulging appearance.
ductus diverticulum: not circumferential
thoracic aortic aneurysm
The aortic valve is one of the four cardiac valves. It is the semilunar valve that allows blood to exit the left ventricle. It opens during systole and closes during diastole. The valve has left, right and posterior cusps, the bases of which attach around the valve orifice to a fibrous ring or a...
Aortic valve stenosis (also known as aortic stenosis) is the most common type of valvular heart disease that requires valve replacement. It can be classified according to the anatomical location: supravalvular, valvular and subvalvular 1.
There are several causes of aortic valve ...
The aortic-pulmonary stripe is an uncommon feature of frontal chest x-rays and was first described by Keats in 1972 1.
It is formed by the interface of the pleural surface of the anterior segment of the left upper lobe contacting the mediastinal fat that is anterolateral to the pulmonary trunk ...
Aortitis refers to a general descriptor that involves a broad category of infectious and non-infectious conditions where there is inflammation (i.e. vasculitis) of the aortic wall.
The presentation is non-specific with fever, pain and weight loss.
Aorto-left renal vein fistula is an extremely rare complication of abdominal aortic aneurysm rupture. The initial clinical presentation is often non-specific, however, characteristic imaging findings, if recognised early, can lead to prompt diagnosis and assist in surgical planning.
Aortocaval fistula is a rare and devastating complication of abdominal aortic aneurysm (AAA), wherein the aneurysm erodes into the inferior vena cava.
Spontaneous rupture of an abdominal aortic aneurysm into the adjacent inferior vena cava occurs in <1% of all aneurysms and in ~3...
Aortoenteric fistula is an uncommon catastrophic cause of gastrointestinal haemorrhage. Aortic fistulas can be primary (associated with complicated abdominal aortic aneurysm) or secondary (associated with graft repair).
The annual incidence of primary aortoenteric fistulas is thou...
Aortoiliac occlusive disease refers to complete occlusion of the aorta distal to the renal arteries.
When the clinical triad of impotence, pelvis and thigh claudication, and absence of the femoral pulses are present, it may also be called Leriche syndrome, which usually affects you...
Aortopulmonary septal defect (APSD), also known as aortopulmonary window (APW), is a congenital anomaly where there is an abnormal communication between the proximal aorta and the pulmonary trunk in the presence of separate aortic and pulmonary valves.
APSD should not be confused w...
The aortopulmonary (aortic-pulmonary or AP) window is a radiological mediastinal space seen on frontal chest x-rays.
The term "aortopulmonary window" can also refer to a rare form of congenital heart disease, where there is an opening between the aorta and the pulmonary trunk 4. It...
Aortosternal venous compression refers to compression of the brachiocephalic vein as a result of its position between the sternum and the aorta(or regional arteries). It can occur with normal as well as variant anatomy (aberrant right subclavian artery 1).
It is asymptoma...
Apert syndrome (also known as type I acrocephalosyndactyly) is a syndrome that is predominantly characterised by skull and limb malformations.
The estimated incidence is at 1:65-80,000 pregnancies.
Thought to occur from a defect on the fibroblast growth factor receptor...
Apgar score was originally described by Virginia Apgar (American anaesthesiologist, 1909-1974) in 1952.
Helpfully, her surname is also a useful mnemonic for remembering the 5 factors: each is graded as 0, 1 or 2 with a total possible score of 10. The lower the score the worse the prognosis.
Aphthoid ulcers are shallow ulcers of the gastrointestinal mucosa.
infective inflammatory conditions
noninfective inflammatory conditions
idiopathic granulomatous gastritis
The apical ligament is a small ligament that joins the apex (tip) of the dens of C2 to the anterior margin (basion) of the foramen magnum. It is the weak, fibrous remnant of the notochord and does not contribute significant stability.
The more posterior alar and cruciate ligaments are stronger ...
A handy mnemonic to remember common apical lung diseases is:
SET CARP or CARPETS
E: eosinophilic pneumonia
C: cystic fibrosis
A: ankylosing spondylitis
R: radiation pneumonitis
Apical pleural cap refers to a curved density at the lung apex seen on chest radiograph.
The frequency of apical pleural thickening increases with age 3.
It arises from a number of causes:
idiopathic: chronic ischaemic aetiology is favoure...
The apical zone is one of the four chest radiograph zones and an important location for missed diagnoses when reporting a frontal chest radiograph and makes up one of the "check areas". It is sometimes thought of as a subdivision of the upper zone.
Aplastic anaemia is a rare haematopoietic stem-cell disorder. The condition results in pancytopaenia and hypocellular bone marrow. Most cases are acquired, however there are unusual inherited forms.
Aplastic anaemia manifests as a marked reduction in the number of pluripotent h...
Apocrine carcinoma of the breast is a rare variant of breast cancer. The diagnosis is mainly pathological as it is difficult to differentiate from other forms of breast cancer on imaging.
It accounts for about 4% of all cases. It is seen most often in females in the age group of 5...
Apocrine metaplasia of the breast is a benign breast condition and is sometimes considered part of or associated with fibrocystic change. It is a common finding in the female breast, particularly after the age of 25, and many regard it as a normal component of the breast.
Apophyseal avulsion fractures of the pelvis and hip are relatively common among physically active adolescents and young adults.
Pelvic and hip apophyseal injuries typically occur in the 14 to 25 year age range. Kicking sports, such as soccer, and gymnastics are frequently to blame...
The apophysis (pl: apophyses) is a normal bony outgrowth that arises from a separate ossification centre and fuses with the bone in course of time. The apophysis is a site of tendon or ligament attachment, as compared to the epiphysis which contributes to a joint.
When unfused, they can easily ...
The apophysis of the proximal 5th metatarsal lies laterally and is oriented longitudinally parallel to the shaft.
Apophysis of the fifth metatarsal base appears on plain radiographs at age 12 for boys and 10 for girls. Fusion of the apophysis to the metatarsal base usually occurs within the fol...
Apostrophes are used according to standard English grammar rules. They are used for possessives and to indicate missing letters.
When using a possessive it's usually by adding "'s" at the end, e.g. "the patient's disease". Apostrophes should not be used for pluralisation, e.g. "apostrophes" an...
Apparent diffusion coefficient (ADC) is a measure of the magnitude of diffusion (of water molecules) within tissue, and is commonly clinically calculated using MRI with diffusion weighted imaging (DWI) 1.
Diffusion-weighted imaging (DWI) is widely appreciated as an indispensable tool i...
Appendiceal carcinoids are rare overall but represent the most common tumour of the appendix. The appendix is also one of the most common (but not the most common) locations for gastrointestinal carcinoid tumours.
Appendiceal carcinoids can present as the obstructive cau...