0 Not a true diaphragmatic opening

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MCQ 146

Q. Which of the following is not a true opening in diaphragm ?

a. Vena caval hiatus

b. Esophageal hiatus

c. Aortic hiatus

d. All are true apertures

ANSWER:

Answer : C - Aortic hiatus (T12 level)
Aortic hiatus is a gap in between diaphragm and body of T12 vertebra. It is not a true opening within the diaphragm and lies behind it.

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 Open ring sign

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MCQ 145

Q. Open ring contrast enhancement (Open ring sign) is seen in ?

a. Demyelination

b. Cerebral abscess

c. Granuloma

d. Low grade glioma

ANSWER:

Answer : A - Demyelination.
The open ring is towards the grey matter. The enhancement towards the white matter represents the advancing front of demyelination.

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 Boerhaave's syndrome vs Mallory–Weiss syndrome

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Boerhaave's syndrome vs Mallory–Weiss syndrome

Boerhaave's syndrome	Mallory–Weiss syndrome
Site :  Lower thoracic oesophagus	Site: Vertical tear in cardia of stomach , may extend to distal oesophagus.
There is vertical perforation, and all gastric content goes into mediastinum. No history of foreign body. Mackler's triad may be seen : Chest pain,  vomiting and  subcutaneous emphysema	Mucosa and submucosa are involved, NOT a complete perforation. Presentation : Hematemesis (Not pain)
Reason : Vomiting / Retching against closed cricopharynx. i.e barotrauma	Reason : Vomiting , Increased LES (Lower esophageal sphincter)  pressure. –  can cause tear.
Sign : Air in mediastinum Hamman’s Sign  (seen with any cause of pneumomediastinum.) – On auscultation , because of air around heart. Investigation of Choice : Water soluble contrast study ( DO NOT USE BARIUM)	Diagnosis : Upper GI endoscopy.
Treatment : Immediate surgery (via LEFT thoracotomy ) If >24-48 hrs – Let heal with secondary intention , do not suture , Just put a drain.	Treatment : Conservative (95 % cases)

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 Esophageal ring

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Site : Lower oesophagus.

 A-Ring = Lower esophageal muscular ring 

• Mostly asymptomatic.
• Symptoms if present : Dysphagia for both solids and liquids in absence of food impactions.
• Situated few centimeters proximal to Schatzki's location (see below)

 B-Ring = Lower esophageal mucosal ring = Schatzki ring 

• There is fibrous thickening in submucosa, it is symmetrical. Mucosa is normal histopathologically.
• Most patients are asymptomatic.
• Symptoms if present : Dysphagia, more for solids , and food impactions.
• Has association with hiatus hernia
• Seen in Lower oesophagus above diaphragm at Squamocolumner junction
• Treatment : Balloon when needed.

DYSPHAGIA if present is NON-PROGRESSIVE

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel