Tag: EDiR

Abdominal #25

~ EDiR Holders ~ Leave a comment

57-year-old patient:
With recently diagnosed poorly differentiated vaginal carcinoma underwent FDG PET CT for staging

What do you see?

What do you see?

FDG PET/CT study showing:
-A hypermetabolic lower vaginal lesion representing the known vaginal neoplasm associated with a larger hypermetabolic uterine body neoplastic lesion suggesting synchronous malignant process
-Multiple hypermetabolic enumerable bilateral lung deposits associated with a single right lower para-tracheal nodal deposit representing metastatic disease

Emergency #41

~ EDiR Holders ~ 1 Comment

38-year-old-male:
– Presented with cough
– Previous history of asthma
– The patient was noted to have elevated IgE levels and a mildly raised eosinophil count
– Expectorated sputum demonstrated fungal hyphae on microscopy

What do you see?

What do you see?

Allergic Bronchopulmonary Aspergillosis (ABPA)

Finger in glove sign can be seen.

Cardiac #2

~ EDiR Holders ~ 1 Comment

Clinical Data: Young adult with chest pain.

What do you see?

What do you see?

Intra-arterial course of the right coronary artery (RCA). RCA arises from left coronary sinus (not depicted) and passes between aorta and pulmonary trunk.

List at least three other potentially life-threatening congenital coronary artery defects.

List at least three other potentially life-threatening congenital coronary artery defects.

-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)

Discussion:

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.

References and further reading:

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.

Neuroradiology #37

~ EDiR Holders ~ 1 Comment

Clinical Data

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

What do you see?

What do you see?

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).

What is the most likely diagnosis?

What is the most likely diagnosis?

Ruptured suprasellar dermoid cyst.

Ruptured intracranial 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.

References

https://radiopaedia.org/articles/intracranial-dermoid-cyst-1

Head and Neck #15

~ EDiR Holders ~ Leave a comment

What do you see in the following images?

Click here to see the answer

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.

More information

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.

Abdominal #22

~ EDiR Holders ~ Leave a comment

45-year-old female patient:

* Generally unwell with abdominal pain and palpable cervical lymph nodes

Clinical information:

– 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

What do you see?

Diagnosis:

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

Treatment:

Ileocaecal resection, tuberculostatic medication, and HAART

Teaching points:

– 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

Abdominal #21

~ EDiR Holders ~ Leave a comment

86-year-old patient:

– With sudden collapse

Clinical information:

– Patient known with infrarenal aortic aneurysm
– Sudden collapse at home
– Transfer to the hospital with ambulance

Axial and coronal slices of an abdominal CT in 2019 show a tortuous abdominal aorta with aneurysmal dilatations and eccentric thrombus. There is a thrombosed saccular component at the level of the aortic bifurcation (arrow)

CT at presentation:

What is the diagnosis?

Diagnosis:

– Ruptured aortic aneurysm
* known infrarenal aortic aneurysm
* massive retroperitoneal hematoma extending into the posterior pararenal and perirenal compartments
* active contrast extravasation
– Point of weakness: saccular aneurysmal component

Teaching points:

– This case did not show a classic sign of pending rupture; however, a clear point of weakness was retrospectively identified (the saccular aneurysmal component at the aortic bifurcation)
– Radiological signs of pending rupture:
* !! High attenuating crescent (= acute haematoma within the mural thrombus or aneurysmal wall)
* Focal discontinuity of intimal calcification and ‘tangential calcium sign’
* ‘Draped aorta sign’, present when
* The posterior aortic wall is unidentifiable as a distinct line
* The posterior aorta follows the contour of the spine on one or both sides
– Reference: CT signs of pending aortic aneurysm rupture, J.P. Heiken, radiologyassistant.nl
https://radiologyassistant.nl/abdomen/aorta/aneurysm-rupture

Head and Neck #14

~ EDiR Holders ~ Leave a comment

What do you see in the following images?

Click here to see the answer

Nasolabial cyst
Right nasolabial lesion with remodeling of the maxillary alveolus bone. On MRI it shows high signal intensity on both T1- and T2-weighted images with no signal suppression on the T2 FLAIR with Fat saturation sequence.
Differential Diagnosis:
Nasolabial cyst with hemorrhage
Epidermal inclusion cyst
Dermoid cyst
Dentigerous cyst

Abdominal #20

~ EDiR Holders ~ Leave a comment

61-year-old female:
– With elevated ALT, AST, and bilirubin

What do you see?

What do you see?

Wall thickening and enhancement of the gallbladder wall
Mild common bile and intrahepatic duct dilatation
Filling defect within the distal common bile duct

Diagnosis:

Choledocholithiasis