Brockenbrough-Braunwald sign

Brockenbrough-Braunwald sign

Q1.Brockenbrough-Braunwald sign noted during cardiac catheterization is seen in

a.aortic  stenosis

b.hypertrophic obstructive cardiomyopathy

c.mitral stenosis

d.pericarditis

ANS.-----b====Brockenbrough-Braunwald sign noted during cardiac catheterization is seen in hypertrophic obstructive cardiomyopathy

• Upon cardiac catheterization, catheters can be placed in the left ventricle and the ascending aorta, to measure the pressure difference between these structures.
•  In normal individuals, during ventricular systole, the pressure in the ascending aorta and the left ventricle will equalize, and the aortic valve is open. 
• In individuals with aortic stenosis or with HCM with an outflow tract gradient, there will be a pressure gradient (difference) between the left ventricle and the aorta, with the left ventricular pressure higher than the aortic pressure. This gradient represents the degree of obstruction that has to be overcome in order to eject blood from the left ventricle.
• The Brockenbrough–Braunwald–Morrow sign is observed in individuals with HCM with outflow tract gradient. This sign can be used to differentiate HCM from aortic stenosis.
•  In individuals with aortic stenosis, after a premature ventricular contraction (PVC), the following ventricular contraction will be more forceful, and the pressure generated in the left ventricle will be higher. Because of the fixed obstruction that the stenotic aortic valve represents, the post-PVC ascending aortic pressure will increase as well. 
• In individuals with HCM, however, the degree of obstruction will increase more than the force of contraction will increase in the post-PVC beat. The result of this is that the left ventricular pressure increases and the ascending aortic pressuredecreases, with an increase in the LVOT gradient.
• While the Brockenbrough–Braunwald–Morrow sign is most dramatically demonstrated using simultaneous intra-cardiac and intra-aortic catheters, it can be seen on routine physical examination as a decrease in the pulse pressure in the post-PVC beat in individuals with HCM.

Ollier’s disease

Ollier’s disease/Maffuci’syndrome/Beckwith- Widerman’s syndrome /Klippel-trenaunay-Weber  syndrome

Q1.Enchondrma and heamangioma is found in

a.Ollier’s disease

b.Maffuci’syndrome

c.Beckwith- Widerman’s syndrome

d.Klippel-trenaunay –Weber  syndrome

ANS. b===MAFFUSI SYNDROME------ Maffucci syndrome is a congenital non hereditary mesodermal dysplasia  characterised by multiple enchondromas with soft  tissue cavernous haemangiomas. 

www.msdlatinamerica.com

• Ollier disease ( enchondromatosis) is a non-hereditary, sporadic, skeletal disorder characterised by multiple enchondromas that are principally located in the metaphyseal regions.

• Beckwith–Wiedemann syndrome  is an overgrowth disorder usually (but not always) present at birth characterized by an increased risk of childhood cancer and certain congenital features.
•  Five common features used to define the syndrome are: macroglossia, macrosomia (birth weight and length greater than the 90th percentile), midline abdominal wall defects (omphalocele/exomphalos, umbilical hernia, diastasis recti), ear creases or ear pits, and neonatalhypoglycemia (low blood sugar after birth).

• Klippel–Trénaunay–Weber syndrome is a rare congenital medical condition in which blood vessels and/or lymph vessels fail to form properly. 
• The three main features are nevus flammeus (port-wine   stain), venous and lymphatic malformations, and soft-tissue hypertrophy of the affected limb.

FRCR MCQ ---MRI (Inversion recovery)

MRI (Inversion recovery)

Q1. The MRI technique used to null signal from fluids is
a.FLAIR
b.STIR
c.GRE
d.HASTE

Q2.The MRI technique used to null signal from fat is
a.FLAIR
b.STIR
c.GRE
d.RARE

ANS.Q1===a----The MRI technique used to null signal from fluids                              is FLAIR(fluid attenuated inversion recovery )
        Q2===b---- The MRI technique used to null signal from fat is                               STIR(short-tau inversion recovery)

Inversion recovery

• In this sequence type, the magnetization is ‘prepared’ before the initial 90-degree excitation pulse by the addition of an 180-degree ‘inversion’ pulse. 
• The signal obtained will be influenced by the relative degree of recovery experienced by the spins along the z-axis. 
• The inversion time (TI) is the time allotted for this recovery process to evolve between the 180-degree inversion and 90-degree excitation pulses. The inversion pulse introduces heavy T1 weighting into this sequence.

Specific forms of the technique -



www.mriworld.org

• A== fluid attenuated inversion recovery (FLAIR) where the TI is chosen so that the magnetization from fluids is nulled (≈2200 ms) in the detection (x–y) plane and TE is long (80–100 ms), introducing a lot of T2 as well as T1 weighting. Thecombination  of fluid nulling with T2 weighting is particularly useful in assessing lesions with prolonged T2 adjacent to fluid structures (e.g. periventricular demyelination).

•  B====In short-tau inversion recovery (STIR), T1 is kept short, and is typically used to null signal from fat. An example of its use in this context is in the delineation of breast lesions and orbital pathology.