Category: Emergency cases

Emergency #21 – Long case

~ EDiR Holders ~ 2 Comments

A 21-year-old male:
* Collapse twice
* Loss of strength of right arm
* Trouble finding words
* Headache

What are the CT Findings?

CT Findings

* 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 are the MRI findings?

MRI findings

* 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?

Diganosis

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
* Vasculitis
* Connective tissue diseases

Viral inflammatory cause for symptoms was confirmed with lumbar puncture and patient was treated with IV anti-viral treatment.

Emergency #20 – Flashcard

~ EDiR Holders ~ Leave a comment

14-year-old boy:
– Actue pain left hemiscrotum

What is the most likely diagnosis?

Click here to see the answer

Acute torsion testis

– Less/no vascularisation – flow with color Doppler-affected testicle
– Lower echogenicity or heterogeneous aspect testicle, if too late already hypoechoic infarcts
– Testicle displaced cranially in the scrotum
– Twisted spermatic cord “like a knot”
– Reactive hydrocele

Below you can see images from a companion case:

Emergency #19 – Flash card

~ EDiR Holders ~ 1 Comment

34-year-old female with acute onset pelvic pain for the past 3 days.

Pelvic ultrasound revealed the following findings:

What is the diagnosis?

Ovarian torsion

Differential diagnosis includes:

– Polycystic ovarian syndrome
– Massive ovarian edema
– Pelvic inflammatory syndrome

More information

The findings of unilateral enlarged ovary without (or little) arterial and venous flow are said to be diagnostic of torsion. The finding of little or no venous flow is more common than no arterial flow, so persistent flow does not exclude the diagnosis. Ancillary findings include free pelvic fluid, unusual midline location of the ovary or a twisted vascular pedicle (giving the whirlpool sign). Most cases of ovarian torsion are caused by an adnexal mass (including dermoid or other cysts), with some occurring due to ovarian hypermobility. Treatment is based on early recognition and surgery, which aims to prevent necrosis and infection. Its findings should be reported urgently to the surgeons for further care, and the radiologist has an important role in this scenario.

Emergency #17 – Flashcard

~ EDiR Holders ~ 1 Comment

40-year-old male:
* 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?

Click here to see the images

Right shoulder for comparison

Additional trauma chest X-ray was done.

Differential diagnosis includes:

* AC-luxation
* CC-luxation
* Left pneumothorax
* No rib #

Emergency #16 – Long case

~ EDiR Holders ~ Leave a comment

21-year-old male:

* Collapse twice
* Loss of strength of right arm
* Trouble finding words
* Headache

What findings do you see on the CT?

CT Findings

* 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?

An MRI is performed.

What findings do you see on the MRI?

MRI Findings

* 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
> Vasculitis
> Connective tissue diseases

Viral inflammatory cause for symptoms was confirmed with lumbar puncture and patient was treated with IV anti-viral treatment

Emergency #15 – Flashcard

~ EDiR Holders ~ 2 Comments

62-year-old female.

* Sudden collapse
* Headache
* Paresis of mouth left-sided
* Pupil difference L>R

What is the most likely diagnosis? What should be the next diagnostic step?

Diagnosis: PCOM aneurysm subarachnoid bleed (with subdural hematoma, intraventricular bleed, midline shift, hydrocephalus)
Next step:CTA (you already see aneurysm on NECT)

Emergency #14 – Flashcard

~ EDiR Holders ~ 3 Comments

18-years-old male:
* 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

Emergency #12 – Flashcard

~ EDiR Holders ~ 1 Comment

31-year-old male:
* 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