Young male patent:
– Presented with elbow pain post-fall of bicycle
Olecranon process fracture
Elevated posterior fat pad projecting posterior to the distal humerus indicative of the presence of an intracapsular effusion in the elbow
25-year-old female:
Presented with RIGHT-SIDED ILIAC FOSSA PAIN
Appendicitis
Infracecal epiploic appendigitis
Appendicular mucocele
Cecal diverticulitis
Clinical Data: A 53-year-old patient with myocardial infarction (STEMI) and cardiac decompensation (Pulmonary-to-systemic flow ratio Qp:Qs of 3.9)
Post-myocardial infarction ventricular septal defect/rupture (VSD/VSR).
Ventricular septal defect/rupture is a rare but life-threatening complication after myocardial infarction. Generally, patients with VSR present with a transmural infarction. The defect results in left-to-right shunting and right ventricular pressure and volume overload. The rupture site can expand abruptly, resulting in sudden hemodynamic collapse in previously stable patients. Surgical closure is the definitive treatment for post-infarction VSD; however, the optimal timing of surgery remains controversial. Percutaneous closure devices have also been applied with success.
– Crenshaw BS, Granger CB, Birnbaum Y, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 2000;101:27-32.
– Menon V, Webb JG, Hillis LD, et al. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am Coll Cardiol 2000;36:1110-6.
– O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA,
Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-e140. doi: 10.1016/j.jacc.2012.11.019. Epub 2012 Dec 17. PMID: 23256914.
Clinical Data: 70-year-old male, asymptomatic, incidental finding on chest X-ray
Enlargement of the left coronary artery (LAD) and right coronary artery (RCA) with peripheral thrombus
within both vessels diagnostic of coronary artery aneurysms.
Coronary artery aneurysm:
Definition: coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient’s largest coronary vessel by 1.5 times
Etiology: Atherosclerosis, genetic, autoimmune/inflammatory, infectious
Clinical Presentation: mostly clinically silent
Complications: local thrombosis > distal embolization and myocardial infarction; aneurysm rupture > cardiac tamponade; myocardial stenosis
Treatment: percutaneous or surgical
Clinical Data: 44-year-old patient with stomach pain and belching
Showing USG of the upper abdomen (stomach)
Showing Upper GI contrast study
Showing Abdomen CT:
US: Small capacity partially distensible stomach with appreciable wall thickening
Fluoroscopy:
·The stomach is not distended adequately
·A narrow lumen identified
·The normal mucosal fold pattern is distorted, thickened, and nodular
CT Scan:
·Small calcification in spleen
·No diverticulae
·No lymph nodes
·No ascites
(1) Neoplastic
·Gastric adenocarcinoma (scirrhous)
·Metastases
(2) Lymphoma
(3) Diffuse gastric diverticula (rare)
(4) Inflammatory
·Radiotherapy
·Granulomatous disease
(5) Scarring (e.g., Ingestion of corrosives)
(6) Gastric amyloidosis
Linitis plastica
Linitis plastica is the term attributed to the specific appearances of the stomach.
The stomach is small, non-distensible with a diffusely thickened wall, the appearance referred to as like a traditional water bottle.
The underlying cause is almost always a scirrhous adenocarcinoma with diffuse submucosal infiltration, which contributes to the thickening and rigidity to the stomach wall observed on CT or endoscopy.
Gastric lymphoma
Clinical Data: Young adult with chest pain.
Intra-arterial course of the right coronary artery (RCA). RCA arises from left coronary sinus (not depicted) and passes between aorta and pulmonary trunk.
-Anomalous aortic origin of coronary artery (AAOCA)
-Anomalous origin of the left coronary artery originating from the pulmonary artery (ALCAPA)
-Anomalous origin of the right coronary artery originating from the pulmonary artery (ARCAPA)
-Single coronary artery
-Hypoplastic right coronary artery
-Congenital coronary artery ostial stenosis or atresia
-Anomalous circumflex coronary artery arising from the right pulmonary artery (ACARPA)
Congenital coronary artery anomalies (CAAs) are often incidental findings. They can be classified as CAAs of origin, course, and of termination. Although they are rare and most of them are benign variants, some are associated with an increased risk of myocardial ischemia, so recognizing and reporting them is substantial.
1. Gentile F, Castiglione V, De Caterina R. Coronary Artery Anomalies. Circulation. 2021 Sep 21;144(12):983-996. doi: 10.1161/CIRCULATIONAHA.121.055347. Epub 2021 Sep 20. PMID: 34543069.
2. Waterbury TM, Tarantini G, Vogel B, Mehran R, Gersh BJ, Gulati R. Non-atherosclerotic causes of acute coronary syndromes. Nat Rev Cardiol. 2020 Apr;17(4):229-241. doi: 10.1038/s41569-019-0273-3. Epub 2019 Oct 3. PMID: 31582839.
Clinical Data: Chest pain
Coronary CT angiography was performed.
9 mm aneurysm arising from left anterior descending (LAD) artery. Contrast blush within pulmonary trunk near abnormal, torturous LAD branch
Coronary artery-to-pulmonary artery fistula with left-to-right shunt. Left coronary artery aneurysm.
Coronary artery-to-pulmonary artery fistula (CPAF) is a type of coronary arteriovenous fistula (CAVF), where there is an abnormal connection (fistula) between a coronary artery and either pulmonary trunk or main pulmonary artery. This condition is associated with coronary artery aneurysms (CAA), pulmonary atresia, and ventricular septal defect (VSD). Patients are usually asymptomatic; the most common clinical manifestation is chest pain and dyspnea, especially on exertion.
1. Hang K, Zhao G, Su W, Bao G, Zhao Q, Jiao Z, Tian Z, Zhang H, Nie L, Luo R, Li L, Huang M, Shi L, Li S. Coronary artery-to-pulmonary artery fistula in adults: evaluation with 320-row detector computed tomography coronary angiography. Ann Transl Med. 2021 Sep;9(18):1434. doi: 10.21037/atm-21-4404. PMID: 34733986; PMCID: PMC8506747.
2. Kim H, Beck KS, Choe YH, Jung JI. Coronary-to-Pulmonary Artery Fistula in Adults: Natural History and Management Strategies. Korean J Radiol. 2019 Nov;20(11):1491-1497. doi: 10.3348/kjr.2019.0331. PMID: 31606954; PMCID: PMC6791815.
40-year-old female presents with acute severe headache at the emergency department.
The neurologist wants to rule out an intracranial haemorrhage and orders a CT brain.
Showing images CT without contrast
More images: MRI
CT shows
* low attenuating suprasellar lesion (fat density) with rim calcification.
* multiple scattered smaller similar subarachnoid lesions supra and infratentorial.
* enlarged supratentorial ventricles.
MRI shows
* the suprasellar lesion shows T1 heterogenous and T2-hyperintense signal,
* multiple scattered T1-hyperintense foci subarachnoid and intraventricular in the left frontal horn (arrows).
* no enhancement.
* no diffusion restriction (not shown).
Ruptured suprasellar dermoid cyst.
Intracranial dermoid cysts are often incidental findings and most do not cause symptoms. Both dermoid and epidermoid cysts are ectodermal in origin and lined by stratified squamous epithelium. In addition, dermoid cysts contain epidermal appendages such as sebaceous glands which secrete sebum, an oily substance.
Symptoms occur due to mass effect or rupture. In case of rupture, dermoid material (sebum droplets) can leak into the subarachnoid space which can lead to chemical meningitis and cause symptoms such as headaches, seizures, and vasospasms.
CT shows
-hypoattenuating primary lesion (fat density due to sebum).
-typically, not exclusively, in midline location.
-sometimes rim calcification of the primary lesion.
-smaller similar hypoattenuating lesions in the subarachnoid space in case of rupture.
MRI shows
-generally T1-hyperintense signal (sebum).
-scattered T1-hyperintense droplets in the subarachnoid space and intraventricular. Fat-fluid level within the ventricles.
-variable T2 signal.
-generally no enhancement of the lesion. Leptomeningeal enhancement in case of chemical meningitis.
https://radiopaedia.org/articles/intracranial-dermoid-cyst-1
What do you see in the following images?
Scalp haemangioma
Right parietal subcutaneous well-defined soft tissue oval lesion. It demonstrates low signal on T1W image, Intermediate signal on T2W image with prominent vascular flow voids, and avid enhancement on the post contrast image. No adjacent osseous or soft tissue abnormality. No intracranial extension.
Infantile hemangiomas are benign vascular tumours, most of these tumours arise in the craniofacial region. Most of them are not present at birth but they increase in size during the first year of life, with a subsequent progressive involution during early childhood.
Differential diagnosis includes: epidermoid cyst, lymphatic malformation, and sinus pericranii.
45-year-old female patient:
* Generally unwell with abdominal pain and palpable cervical lymph nodes
– Newly diagnosed HIV infection with a very low CD4 count of 30 cells/uL
– Generally unwell
– Presents at the emergency department with abdominal pain and palpable cervical lymph nodes
Most likely pulmonary and extrapulmonary tuberculosis in an immunocompromised patient with miliary pulmonary lesions, tuberculous colitis and ileitis, and necrotic extrapulmonary adenopathy (cervical and abdominal adenitis)
Microbiological analysis of an excised abdominal node confirmed the presence of Mycobacterium tuberculosis
Ileocaecal resection, tuberculostatic medication, and HAART
– Be aware of TB in immunocompromised patients
– Cervical nodes are the #1 site of extrapulmonary TB adenopathy and the most common cause of adenopathy worldwide
– Intestinal tuberculosis can mimic inflammatory bowel disease
