Board Review

2. Angiomyolipoma
• Findings:
– hypervascular renal mass
– multiple foci of contrast
pooling = aneurysms
– Confirm diagnosis by
detecting fat on CT
• ddx:
– NONE!
– This is an Aunt Minnie!

4. Leriche syndrome
• Findings:
– occlusion of the proximal
left common iliac artery
– reconstitution distally by
multiple collateral
arteries
• causes:
– atherosclerosis
– traumatic
– radiation

6. Splenic vein thrombosis &
portal-portal anastamosis
(arc of Barkow)
• Findings:
– venous phase of splenic
artery injection
– splenic vein thrombosis
– large collateral vessel
from spleen to portal vein
= portal-portal shunt
• causes:
– pancreatitis
– malignancy
– portal hypertension

8. Budd-Chiari
• Findings:
– markedly inhomogeneous
enhancement of liver
parenchyma
– transjugular wedged right
hepatic venogram show a
complex “spider web”
network of tortous
venous collaterals
• ddx:
– NONE!
– This is an Aunt Minnie!

10. Buerger’s disease
• Findings:
– mulitple abrupt segmental
occlusions with “corkscrew
collaterals”
– otherwise normal
background appearance of
vessels
– a.k.a. Thromboangitis
obliterans
– inflammatory arteritis of
unknown etiology
– small and medium sized
artieries of extremities
– young me, cigarette
smokers

12. Celiac axis occlusion &
medial arcuate ligament
• Findings:
– opacification of the celiac
vessels from an SMA
injection
– collateral flow via the
inferior pancreatico-
duodenal arteries via the
GDA
– characteristic appearance
of celiac artery stenosis
• ddx:
– atherosclerosis

14. Great vessel stenoses
TAKAYASU
• Findings:
– Smooth narrowing of the
multiple great vessels
– Aoritc involvement, too
• ddx:
– Takayasu's
– Bechet syndrome
– Giant cell arteritis
– Radiation vasculitis
– Williams syndrome

16. HCC & arterial – portal shunting
• Findings:
– focal increased
vascularity in the left
lobe = vascular tumor
– prominent and early
opacification portal veins
= arterial - portal shuting
– large round filling defect
in main portal ven =
thrombus / tumor invasion
• ddx:
– NONE!
– This is an Aunt Minnie!

18. Hypothenar hammer syndrome
• Findings:
– contour irregularity of
the distal ulnar artery
– multiple distal occlusions
of digital branches
• ddx:
– NONE!
– This is an Aunt Minnie!

20. Klatskin tumor
• Findings:
– percutaneous
cholangiogram shows
dilated intrahepatic
biliary tree
– obstruction likely at the
confluence of the biliary
system
• ddx:
– choledocolithiasis
– other invasive tumor
– portal lymphadenopathy

22. Persistent sciatic artery
• Findings:
– anomalous arteries of the
left leg:
• CFA is normal but
profunda and SFA are
smaller than normal
• large vessel arising
from IIA continues
into the leg
• ddx:
– NONE!
– This is an Aunt Minnie!

24. Posterior knee dislocation &
popliteal artery occlusion
• Findings:
– complete posterior
dislocation of the knee
– angiogram is diagnostic
for popliteal artery injury
• thrombosis
• dissection
• transection
– try to cross with wire --
if unsuccessful -- surgery

26. Right aortic arch &
aberrant left subclavian
• Findings:
– right sided arch with non-
mirror image branching
(four great vessels)
• 1) Lt common carotid
• 2) Rt common carotid
• 3) Rt subclavian
• 4) Lt subclavian
• ddx:
– NONE!
– This is an Aunt Minnie!

29. Splenic artery aneurysm
• Findings:
– KUB shows LUQ
curvilinear signet ring
calcifications
– celiac angiogram is
diagnositc
• causes:
– portal hypertension
– pancreatitis
– pregnancy
– fibromuscular dysplasia
– (NOT hypertension)

31. Takayasu’s dz &
bilateral subclavian steal
• Findings:
– large carotid arteris and
occluded subclavian
arteries
– reconstitution of flow
from vertebral arteries
on delayed image
• other causes:
– atherosclerosis
– trauma
– radiation

33. Venous thoracic
outlet obstructon
• Findings:
– tight stenosis of the left
subclavian vein
– multiple collaterals
reconstitute left
brachiocephaic vein
• causes
– cervical rib
– anomalous muscles
– post-traumatic changes
• Rx:
– surgical (NOT stent)

36. Traumatic aortic injury &
active extravasation
• Findings:
– Widened mediastinum
– Obscuration of the aortic
arch
– Aortagram is diagnostic
• Abrupt caliber change
• Irregular luminal
contour
• Active extravasaton
• ddx:
– NONE!
– This is an Aunt Minnie!

38. Marfan-like syndrome &
Type B aortic dissection
• Findings:
– Angiogram shows widened
aorta and opacification of
two channels
– Lt subclavian and
vertebral arteries have a
beaded, aneurysmal
appearance
• ddx:
– Atherosclerosis
– Hypertension
– Pregnancy
– Ehlers-Danlos syndrome

40. Polyarteritis nodosa
• Findings:
– Selective angiogram of
the right kidney shows
multiple tiny aneurysms
of the parenchymal
arteries
• ddx:
– Mycotic aneurysms

42. Replaced right hepatic artery
• Findings:
– Right hepatic artery
originates from the SMA
– Proper hepatic artery may
also arise from SMA
– Normal variant
– Left hepatic artery may
arise directly from common
hepatic or gastric
• ddx:
– NONE!
– This is an Aunt Minnie!