A 43-year-old man with inflammation and lower abdominal pain:
What do you see?
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* Inflammatory wall thickening of the sigmoid colon.
* Multiple diverticula, but one enlarged with thickened enhancing wall (arrow).
* Surrounding haziness of the mesosigmoid fat.
* Peritoneal accentuation
Typical image of diverticulitis, in a typical location with typical presentation
Look for signs of perforation or abscess formation
* Severe pain abdomen
* Tender abdomen
* Clinical ileus
What do you see?
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
A 21-year-old male:
* Collapse twice
* Loss of strength of right arm
* Trouble finding words
What are the 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?
* 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.
– 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
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.
What do you see? Perforated appendicitis? What is your diagnosis?
DiagnosisPerforated 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