Tag: flashcard

Abdominal #22

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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

Head and Neck #14

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What do you see in the following images?

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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 #18

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75-year-old female:
– Day 4 post Whipple procedure
– Ongoing abdominal pain with increased inflammatory markers and slightly increased lactate levels

What do you see?

– Post-operative changes following partial pancreatectomy and duodenojejunostomy (partially shown)
– Prominent mesenteric nodes
– Partially occlusive thrombus of the superior mesenteric vein (best seen on axial slice) extending to a large jejunal branch (seen on coronal slice)

What is the most likely diagnosis?

Partial SMV occlusion as a complication to recent Whipple procedure

Neuroradiology #35

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What do you see in the following images?

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Polymicrogyria
Bilateral cortical thickening with numerous small gyri with signal characteristics similar to normal grey matter.
Dilated bilateral perivascular spaces in the subjacent white matter.

Abdominal #17

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Known patient with recently diagnosed poorly differentiated vaginal carcinoma with staging FDG PET/CT study. What is the study showing?

What do you see?

– 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

Head and Neck #13

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What do you see?

Labyrinthitis Ossificans

Ossification of the membranous labyrinth, high-density bone deposition involving all the cochlear turns.

This usually occurs as a complication of suppurative labyrinthitis, either due to otomastoiditis or meningitis. Other causes include trauma, autoimmune diseases, and surgery.

Abdominal #16

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What do you see on the following images?

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TB cervical lymphadenitis

Mild progression in size of multiple necrotic lymph nodes in bilateral supraclavicular, axillary regions, at all anterior and posterior cervical chain (more prominent at right side lower anterior cervical chain)

Musculoskeletal #29

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30-year-old male:

· Persistent pain in his right ankle, for a year long, a synovial mass was demonstrated on ultrasound. · Ankle MRI was performed

What do you see?

Pigmented villonodular synovitis (diffuse articular form)

* Benign proliferative condition affecting the synovial membrane. Most commonly monoarticular
* MRI: Mass-like synovial proliferation with lobulated margins and articular erosions
– Signal -> T1: low-intermediate ; DPFS/STIR: heterogeneous with areas of high signal ; GE: blooming artifact ; T1GD: variable enhancement.

What is the differential diagnosis?

Differential diagnosis includes:
* Scarring – capsulitis
* Siderotic synovitis
* Synovial sarcoma

Musculoskeletal #26

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Describe the abnormality

Bilateral sacroiliac joint space narrowing, subchondral erosions, subchondral sclerosis, and subchondral fatty marrow infiltration.

What is the differential diagnosis?

Bilateral symmetrical:
Ankylosing spondylitis
Inflammatory bowel disease. 

Bilateral asymmetrical:
Psoriasis
Reactive arthritis (Reiter syndrome) 

What is the most likely diagnosis?

Ankylosing spondylitis

What are the markers of active inflammation?

Erosions with high signal intensity on STIR or T2- weighted images, subchondral edema, and enhancement within or adjacent to the sacroiliac joint.

What are the markers of chronic disease?

Low signal intensity on T1- and T2- weighted images, subchondral sclerosis, narrowing of the joint spaces, bone bridging, and ankylosis.