Musculoskeletal #12 – Flashcard

43-year-old healthy patient:
– with fibromyalgia
– No other relevant medical history

What do you see on the following images?

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IMAGING FINDINGS:

Multiple focal sclerotic bone lesions clustered around joints in both knees and sacroiliac joints

DIAGNOSIS:

Osteopoikilosis

TEACHING POINTS:

Sclerosing bony dysplasia characterized by multiple enostoses
Typically clustered around joints, aligned parallel to trabeculae. Usually 1-3 mm, they can reach up to 20 mm
Rare condition; inherited; asymptomatic; incidental
Important to avoid misdiagnosis with other relevant pathologies such as metastasis

Neuroradiology #22 – Flashcard

What do you see on these images?

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Oligodendroglioma

CT scan shows a large calcified lesion. MRI shows a large cortical-based high T2 lesion with cystic component and dark T2 foci corresponding to the calcifications. Post-contrast images show patchy enhancing areas.  

Differential Diagnosis

DNET (usually may calcify) ganglioglioma (cystic areas, enhancing solid component, may calcify).

Emergency #22 – Long case

81-year-old male:

* Severe pain abdomen
* Tender abdomen
* Clinical ileus

What do you see?

Diagnosis

Mechanical ileus with caliber change in ileum. Distended stomach with air in the major curvature of the wall, with air bubble outside lumen, suspect for pneumatosis intestinalis. Extended air in left portal vein branches and in central portal vein (portal venous gas peripheral, gas in bile ducts central).

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What additional findings do you see?

1. Contained rupture AAA with slowly progressive lytic destruction and remodeling of lumbar spine
2. Gall stones

Musculoskeletal #11

68-year-old male:
* Presents with a mass around knee which has been present for seven years and has been enlarging since then

What do you see?

A sclerotic ill-defined soft tissue mass around the knee was present on radiographs.
The mass is located in the soft tissue around the knee with no apparent bone destruction.

Coronal fat-suppressed T2 WI (a) shows a hyperintense lobulated mass which was hypointense on T1 WI (b) and has peripheral heterogeneous enhancement on postcontrast T1 WI (c); cortical bone is preserved.

The mass encircles a pedunculated lesion which continues with cortical and medullary bone (arrows), consistent with an osteochondroma.
Histopathologic diagnosis of the mass is chondrosarcoma.

Osteochondromas

* Osteochondromas are developmental lesions rather than true neoplasms and are often referred to as an osteocartilaginous exostosis (or simply exostosis).
* An osteochondroma is composed of cortical and medullary bone protruding from and continuous with the underlying bone; cortical and medullary continuity between the osteochondroma and parent bone is well depicted on MRI.
* Malignant transformation, almost invariably due to chondrosarcoma arising in the cartilage cap of the lesion, occurs in approximately 1% of solitary osteochondromas.
* Lesions that grow or cause pain after skeletal maturity should be suspected of malignant transformation since osteochondromas only rarely enlarge after this time.

Head and Neck – Flashcard #2

What do you see on the following images?

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Dehiscent jugular bulb

The jugular bulb bulges into the left middle ear cavity with absence of the sigmoid plate separating the jugular bulb from the middle ear in keeping with dehiscent jugular bulb.

It is one of the causes of pulsatile tinnitus, patients can also present with conductive hearing loss if the jugular vein contacts the tympanic membrane.

Emergency #21 – Long case

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.

Abdominal #9 – Flashcard

31-year-old male with:

* Right upper quadrant & epigastric pain
* History of gastric bypass surgery

What aquatic sign is used for the finding in the red circle?

Whirlpool sign

What is shown at the blue arrow?

The transition point from dilated small bowel (with the “small bowel feces sign”) to non-dilated small bowel at the site of internal herniation through a mesenteric defect.