New Webinar from Prof. Cáceres – SOLVED

Prof. Cáceres is preparing a new webinar about the “Pulmonary fat, my friend”. Join him this Wednesday June 16th at 12:00 CEST. He will discuss the case presented here, among others. Register here.

Dear Friends,

Today’s radiographs belong to two different patients with peripheral opacities of the chest. What would be your diagnosis?

1. A is fat and B solid tissue
2. B is fat and A solid tissue
3. Both are fatty
4. Need a CT

Click here to see the answer

Findings: Radiograph of case A shows an opacity in the left upper lung. Its inner contour is outlined by air (arrow) and the outer border is not visible (asterisk) suggesting an extrapulmonary lesion (incomplete border sign).
CT shows that the opacity represents extrapleural fat (B, arrow).

Radiograph of the second case shows a well-defined rounded opacity (C, arrow), that was interpreted as a peripheral pulmonary nodule. PET-CT was done, and the apparent pulmonary nodule was shown to be extrapleural fat (D, arrow).

 
These two cases are shown to emphasize that fat in or around the lung cannot be distinguished from soft tissues in the plain chest radiograph. To recognize fat, CT is necessary.
 
More information about fatty lesions of the lung is given in the webinar “Mediastinal fat: my friend” that will be published soon on the EBR youtube channel.

Musculoskeletal #21

65-year-old man. Paraplegia after skiing accident. What do you see?

Click here to see the answer

Imaging findings

Complete low dorsal transdiskal and transvertebral fracture with extension to middle and posterior columns on an ankylosed spine.
Sever posterior angulation and displacement of the superior segment cord deformity, compression and myelopathy.

Diagnosis

Severe complete unstable ankylosed spine fracture with cord compression and mielopathy

Teaching points

Ankylosed spine show specific patterns of fracture with: higher tendency to three column involvement, and increased frequency of neurologic complications.

Neuroradiology #29

An 89-year-old female patient with aplastic anemia. What do you see?

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CT images without contrast media: Subacute isodense right subdural hematoma, revealed with narrowing of right cerebral hemispheric sulci and right lateral ventricle and minimal midline shift (red arrows), acute left subdural hematoma (blue arrow)

Musculoskeletal #20

72-year-old alcoholic patient with intractable dorsal pain and legs numbness and weakness.

What do you see?

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IMAGING FINDINGS:

Thoracic spine compression fracture with posterior displacement of the posterior wall of the vertebral body compromising the spinal canal, cord compression and associated myelopathy. T2W image shows fluid and hypointense bubble-like artifact consistent with vacuum cleft in the collapsed anterior vertebral body

DIAGNOSIS:

Kümmel disease (osteonecrosis and collapse of the vertebral body)

TEACHING POINTS:

Intravertebral vacuum cleft and fluid within the collapsed vertebral body is a characteristic feature
Differential diagnosis includes a pathologic (tumoral) fracture, and the presence of air strongly favors osteonecrosis

Would you like to see a complementary case?

Click here


MR T2-weighted and CT images to highlight the characteristic features of Kümmel disease

Intravertebral fluid seen on T2 image and air on CT image

Neuroradiology #28

A 24-year-old female patient with headache. What do you see?

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Multinodular and vacuolating neuronal tumor (MVNT): Cortical ribbon-juxtacortical T2 hyperintense (a-b) round to oval nodular lesions, not suppressed on FLAIR images (c) and usually no enhancement (d) may show fair enhancement rarely, without diffusion restriction (not shown)

Musculoskeletal #19

54-year-old man with dorsolumbar irradiated left leg pain and paresthesias

What are the imaging findings?

CT: Slightly insufflating lytic lesion in the left pedicle, with thickened vertical trabeculae (“polka dot sign”) 
MRI: The lesions show high signal on T2 and STIR sequences, with small foci of T1 hyperintensity within the lesions suggesting fatty component. Soft tissue component with the same characteristics and avidly enhancing. Note the spinal canal secondary stenosis, cord displacement and compression

What is the most likely diagnosis

Aggressive vertebral hemangioma with soft tissue component

Neuroradiology #27

48-year-old male patient, HIV (+); presented to emergency with headache, confusion, N/V.

What do you see?

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T2 hyperintense lesions of left caudate nucleus, left putaminal and right dentate nucleus , with perilesional edema.

Small corticomedullary T2 hyperintense lesions with faint enhancement.

Caudate and putaminal lesions demonstrates faint peripheric contrast enhancement whereas cerebeller lesion has strong peripheric and central nodular enhancement.

Caudate and cerebellar lesion have tiny microhemorrhages on SWI, a clue for diagnosis.

Toxoplasmosis

· Most common opportunistic CNS infection and most common cause of a mass lesion in AIDS
· Basal ganglia, thalamus, corticomedullary junction and cerebellum frequently involved
· Microhemorrhages can be seen on SWI, lesions may have ring or nodular enhancement
· Major ddx is lymphoma:
– Lymphoma is usually solitary whereas solitary lesions are uncommon in toxoplasmosis.
– Microhemorrhages are uncommon in lymphoma