1	NEERS October, 2009 (Answers)
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7	Os centrale carpi Rare accessory carpal bone in humans(<0.3%) between scaphoid, capitate and trapezoid Normal bone in primates with the exception of humans and some African apes Ossification center appears at 6 weeks and fuses with scaphoid at 8 weeks Can be seen as part of congenital syndromes-Holt Oram, hand foot uterus, Larsen’s and otopalatodigital syndrome. Three patterns- well marginated independent bone incompletely separated bone with smooth contours empty space with synovial tissue
8	Os centrale Carpi: Avascular Necrosis May appear sclerotic and fragmented on radiographs MRI is essential ? trauma may interrupt the vascular supply Treatment: Surgical excision
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11	AORTIC WALL THICKENING Intraumural hematoma Hemorrhage due to rupture of vasa vasorum within aortic media, resulting in non communicating dissection with typical absence of intimal tear Infectious aortitis Autoimmune aortitis Fibrosis Post traumatic fibrosis (less common)
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13	AORTITIS Infection Neisseria, Tuberculosis, Rickettsia, Spirochetes, Fungi and Viruses Non infection Takayasu, Giant cell, polyarteritis nodosa, Bechet, Sarcoidosis, Spondyloarthropathy, SLE, drug induced etc Paraneoplastic vasculitis ??
14	HERPETIC AORTITIS Patient responded well to Acyclovir with dramatic resolution of aortic wall thickening on follow up chest CT
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17	Lipoleiomyoma, large right parametrial parasitic degenerated fibroid and endometrial cancer
18	Uterine Leiomyoma Benign tumors of uterine smooth muscle 20-30% of women above age 35 Intramural, submucosal and subserosal Lipoleiomyoma: Rare, postmenopausal, associated with other fibroids Parastitic Fibroid: Rarest, a subserosal fibroid detached from uterus and receiving blood supply from other organs eg tube, bowel, mesentery (the uterine stalk gradually degenerates)
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23	Longus Colli Acute Calcific Tendinitis Deposition of calcium hydroxyapatite in the superior oblique tendon fibers of the longus colli muscles Acute inflammation may result in prevertebral serous effusions, mimicking abscess Fluid smoothly expands the retropharyngeal space in all directions absence of enhancing wall absence of associated suppurative retropharyngeal lymph nodes characterisitic tendinous calcifications
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26	Right main stem bronchus avulsion
27	Tracheobronchial tear Persistent or progressive pneumothorax/pneumomediastinum despite thoracostomy tube drainage Most within 2.5cm of tracheal carina due to shearing or direct compression between spine and sternum Fallen lung sign: Lung falls away from hilum into dependent position Delayed diagnosis leads to bronchostenosis Rx: Primary repair of right main stem bronchus with reinforcement using an intercostal flap
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30	AAA rupture with aortocaval fistula 1% of patients with AAA develop aortocaval fistula Simultaneous isodense opacification of IVC with adjacent aorta Loss of normal anatomical space between aorta and IVC Direct visualization of abnormal communication between the two vessels Rx: Open surgical repair with direct closure of caval defect from inside the aortic lumen and surgical reconstruction of AAA with prosthetic graft.
31	Thank you