65-year-old woman with cholecystitis:
* Fell off bike at 40 km/h
* Pain left shoulder
> What views of the shoulder in trauma setting should be done?
> Is this in endo- or exorotation?
> Do you need right shoulder to compare with?
* Collapse twice
* Loss of strength of right arm
* Trouble finding words
What findings do you see on the CT?
* No abnormalities were seen
* No bleeding
* No signs of recent ischemia
Patient develops fever. Cannot bend his neck properly. When asked, he has been traveling recently to Thailand.
What further imaging could help us?
What findings do you see on the MRI?
* Two areas left frontal and left parietal with T2/FLAIR hyperintense swelling/edema of cortex and subcortical white matter, with diffusion restriction and patchy, gyriform cortical enhancement
* Diffusely leptomeningeal enhancement
* No ring-enhancing lesions. No white matter vasogenic or cytotoxic edema
What is the most likely diagnosis?
Cerebritis (precursor of abscess) and meningitis. Not yet an abscess
Note: Encephalitis means inflammation of PARENCHYMA
Differential diagnosis of meningitis:
> Leptomeningeal carcinomatosis
> Sarcoidosis and other granulomatous diseases
> Connective tissue diseases
Viral inflammatory cause for symptoms was confirmed with lumbar puncture and patient was treated with IV anti-viral treatment
* Sudden collapse
* Paresis of mouth left-sided
* Pupil difference L>R
* Rigid abdomen and generalised tenderness
* Pain lower abdomen
* CRP 250
What do you see? Perforated appendicitis? What is your diagnosis?
Diagnosis Perforated sigmoid diverticulitis (Hinchey 3 or 4, peritonitis)
> Mesenterial fatty infiltration, free air bubbled outside bowel lumen.
> Also subdiaphragmal free air and free fluid.
> Notice enlarged reactive lymph nodes and peritoneal thickening and enhancement, indicative of peritonitis.
> Patient was operated, free faeces was found in the abdomen.
Hinchey classification of acute diverticulitis:
* Stage 1a: phlegmon
* Stage 1b: diverticulitis with pericolic or mesenteric abscess
* Stage 2: diverticulitis with walled off pelvic abscess
* Stage 3: diverticulitis with generalised purulent peritonitis
* Stage 4: diverticulitis with generalised faecal peritonitis
* With flank pain
* Increased inflammatory parameters
* Decreased kidney function
Why is the right kidney less dense than the left?
Click here to see the answer
Obstructive kidney stone in the right proximal ureter (arrow) with secondary hydronephrosis
The increased pressure in the collecting system slows the ultrafiltration of urine and causes a slower enhancement of the right kidney in comparison with the left kidney, reflecting the impaired kidney function