The Final FRCR

Complete Revision Notes

Vincent Helyar, Aidan Shaw

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781351645317
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This is a vital revision aid for postgraduate radiology students taking the Fellowship of the Royal College of Radiology (FRCR) Part 2 final exams. Part 2 comprises two elements: 2a includes a series of six multiple choice exams covering the major body systems, and 2b contains a written exam and an oral viva typically taken at the beginning of the fourth year of specialty training.

chapter 1

Cardiothoracic and Vascular

Cardiovascular

Aberrant left pulmonary artery

Occurs due to the failure of formation of the sixth aortic arch. Blood to the left lung arises from an aberrant left pulmonary artery that arises from the right pulmonary artery. The vessel passes between the trachea and oesophagus and causes narrowing of the trachea in a caudal direction. Associated with other anomalies (e.g. patent ductus arteriosus).

Plain film

●Bronchial obstruction causes lung emphysema (right lung, middle lobe, lower lobes, left upper lobe)

Barium swallow

●Anterior indentation on the oesophagus, just above the level of the carina

Aortic aneurysm

Considered either true (aneurysm bound by all three walls of the vessel) or false (i.e. pseudoaneurysm, part of the wall of the aneurysm is formed by surrounding soft tissue). Aneurysms are described as being saccular or fusiform.

●Saccular aneurysms are eccentric in shape, the aneurysm only forming from part of the circumference of the vessel wall. Associated with mycotic aneurysms (Figure 1.1).

●Fusiform aneurysms involve the full vessel circumference and feature cylindrical dilatation. More commonly seen with atherosclerotic aneurysms (Figure 1.2).

Figure 1.1 Saccular aneurysm. CT angiogram demonstrating a saccular aneurysm arising from the abdominal aorta.

Figure 1.2 Fusiform aneurysm. CT angiogram demonstrating a fusiform abdominal aortic aneurysm.

CT

●Thoracic aortic aneurysms are mostly atherosclerotic and calcified in 75%. Other causes include cystic medial necrosis (a disorder of the large arteries with formation of cyst-like lesions in the media, associated with e.g. Marfan and Ehlers–Danlos syndromes) and syphilis (expect extensive calcification).

●Abdominal aortic aneurysms (AAAs)—mostly atherosclerotic.

●Popliteal aneurysms, associated with an AAA in 30%–50%.

Intervention

●Advised when diameter >5.5 cm (the risk of rupture is greatly increased over this).

●Endovascular stents are generally oversized by 10%. The presence of perigraft air is a common finding in the immediate post-operative period; however, if present >1 week after surgery, suspect infection.

●Endoleak is defined as the continued perfusion of the aneurysm despite placement of a stent graft (Table 1.1).

Table 1.1 The classification of endovascular stent graft endoleaks

Type of endoleak	Site
Type 1	Leak from the stent/graft attachment due to an inadequate seal
1a	Proximal
1b	Distal
Type 2 (most common, 80%)	Filling of the sac from retrograde flow through aortic branches (e.g. lumbar arteries, inferior mesenteric)
Type 3	Structural failure of the stent graft/leak from mid-g...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Foreword
• Acknowledgements
• Introduction
• Authors
• 1. Cardiothoracic and Vascular
• 2. Musculoskeletal
• 3. Gastrointestinal
• 4. Genitourinary, Adrenal, Obstetrics and Gynaecology and Breast
• 5. Paediatrics
• 6. Central Nervous System, Head and Neck
• Index