83-year-old female:
– Acute loss of function right arm and leg
– Bleeding? Ischemia?
Dense left medial cerebral artery with subtle obscuring of grey-white matter interface temporal operculum of insula; early ischemia.
CTA: Occlusion M1 Patient received IV thrombolysis and her symptoms improved
53-year-old male:
– Hemodialysis patient
– Presents with a very large scrotum, size of a football
– Patient is not sick, no fever
– Laboratory results are normal
– US: Incarcerated inguinal hernia? Hydrocele? Malignancy?
Diagnosis: Extensive scrotal lymphoedema
– Extensive scrotal wall thickening associated with diffuse lymphoedema extending to the base of penis not involving the penile corpora
– No extension into the deep subcutaneous tissue planes, inguinal canal, or muscles
– No extension to the groin or lower abdomen
– No inguinal adenopathy
– Both testicles are morphologically normal with no associated hydroceles
– There is no associated soft-tissue mass
A 6-year-old boy presenting to emergency department with headache, nausea, and vomiting
Intra-axial cystic lesion with mass effect shows CSF signal intensity on all sequences, without enhancement and perilesional edema
Differential diagnosis include
* Parasitic diseases (hydatid cyst) spheric
* Neuroglial cyst may have surrounding gliosis
* Porencephalic cyst surrounding gliosis, communicates with ventricle
Same cystic lesion in superior lobe of left lung
Hydatid cyst disease
Both lesions were treated by surgery
Elbow pain after a fall. What do you see?
Large joint effusion with the displacement of the anterior fat pad. Mild posterior soft tissue swelling over the olecranon. Fracture line along the lateral aspect of the radial neck. Radial head and articular surface are normal
Nondisplaced radial head fracture
– Check not only the bones and joints but also the soft tissues
– Search and interpret the findings in two different positions
– Pain always withholds a story behind
Left side of the neck.
Multiple enlarged neck clustered lymph nodes, with some of them showing necrosis.
Infectious lymphadenitis: such as TB or pyogenic lymphadenitis.
Metastasis: particularly from head and neck malignancies.
Treated lymphoma or lymphoma in immune compromised patient.
TB lymphadenitis
A 30-year-old female with right shoulder pain.
4 images of the right shoulder were obtained (axillar, Y-view, internal rotation, external rotation)
Right shoulder: There is a nondisplaced fracture involving the inferior aspect of the glenoid, with involvement of the articular surface. Glenohumeral joint shows normal alignment. Acromioclavicular joint is normal. No soft-tissue calcification. No fracture or dislocation
The most likely diagnosis is Hill-Sachs lesion
Hill-Sachs lesions are a posterolateral humeral head compression fracture. Typically occurs secondary to recurrent anterior shoulder dislocations. It is often associated with a Bankart lesion of the glenoid
These lesions are best seen following relocation of the joint. It appears as a sclerotic line running vertically from the top of the humeral head towards the shaft. A wedge defect may be evident in large lesions. The lesions are better appreciated on internal rotation views
57-year-old man with left iliac fossa pain:
What do you see?
* Infiltration/haziness around colon descendens with central fat density
* No or only moderate (secondary) inflammation of colonic wall
Epiploic appendagitis
* Diverticulitis mimic, but self-limiting
* No-touch-lesion!
89-year-old female patient with aplastic anemia. Showing CT images without contrast media. What do you see?
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)
43-year-old healthy patient:
– with fibromyalgia
– No other relevant medical history
What do you see on the following images?
Multiple focal sclerotic bone lesions clustered around joints in both knees and sacroiliac joints
Osteopoikilosis
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
What do you see on the following images?
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.
