radiology spotters mixed bag

Spotters – Mixed bagDR. ANISH CHOUDHARY02.05.16DEPT. OF RADIODIAGNOSIS, BVDUMC, PUNE-43

1. SIGN ?

2.

3. h/o RTA. Sign?

4.

5.

6.One-hour-old newborn with abnormal prenatal ultrasound

7.

One-hour-old newborn with abnormal prenatal ultrasound

1.

8. 35 yr/F with a slowly enlarging skull mass

9.

10. Epiphrenic Diverticulum

11. sign/dx?

12. Sign ?

13. Sign ?

14. A 30-year-old Paraguayan man with a 3-month history of dizziness, fever, weight loss, and behavioral and sleep-wake cycle alterations but no other personal background of interest

15.An 8-year-old boy with fever, neck pain, and diarrhea that began 2 weeks ago, associated with intermittent double vision, blurred vision, and emesis in the last 2 days. Cerebellum biopsy showed only macrophages.

16.

A 62-year-old man with headaches, vomiting, and vision loss, status post VP shunt, who later developed left sided hearing loss, confusion, gait instability, and worsening depression

17.

18. A 28-year-old man with congenital anosmia, delayed puberty, and infertility

19.

A previously healthy 30-year-old man with 1-week history of fever with chills, altered mental status, petechial skin rashes, and purpuric rash on the buttocks

20.

A 25-year-old man with oculocutaneous albinism presented to the emergency department with multiple exophytic head and neck masses that had been developing for years.

21.A 27-year-old woman with amenorrhea and history of thalassemia

22. A 5-month-old boy brought by his parents to the clinic for evaluation of bilateral leukokoria. Examination revealed bilateral retrolental masses. His elder brother was also blind by birth and developed hearing loss at the age of 12 years. His 2 elder sisters were completely normal

23.

24.

25.

1. SIGN ?

1.

2.

Congenital aqueductal web

aqueductal pathology are common causes of obstructive non communicating hydrocephalus characterized by supratentorial ventricular dilatation and normal size 4th ventricle. Aqueductal stenosis is the commonest pathology while diaphragm/web are rare.

3. h/o RTA. Sign?

21. White cerebellum signWhite cerebellum sign, also called reversal sign or dense cerebellum sign, is encountered when there is a diffuse decrease in density of the supratentorial brain parenchyma, with relatively increased attenuation of the thalami, brainstem and cerebellum. This sign indicates irreversible brain damage and has a destitute prognosis

severe head traumabirth asphyxiadrowningstatus epilepticusbacterial meningitisencephalitispost-cardiac arrest hypoxiaPathology

There are different theories proposed for this sign:

raised intracranial pressure causes partial venous obstruction resulting in distension of deep medullary veinspreferential flow to posterior circulationtranstentorial herniation partially relieving the increased intracranial pressure and thus increase perfusion of central structures

4.

4. Pneumoperitoneum

Foot ball sign- A large amount of free intraperitoneal gas on a supine radiograph of the abdomen is manifested by an oval radiolucency in the epigastrium, reminiscent of an American football.

Aunt Minnie's PearlsThe football sign, seen on a supine abdominal radiograph,is indicative of a massive pneumoperitoneum.

5.

5. Meconium peritonitis

Meconium peritonitis is the result of in utero perforation and prenatal leak of meconium into the peritoneal cavity. The underlying etiology varies but includes obstruction or malformation, although obstructive lesions are identified in only 5O% of the cases.

results in intraperitoneal caldftcation that ma be focal or scattered, diffuse or punctuate, or may outline the walls of a pseudocyst, which contains meconium.

Aunt Minnie's PearlScattered or focal, punctuate peritoneal calcifications

or a calcified pseudocyst in a newbom = shape in utero

bowel perforation and meconium peritonitis.

6.One-hour-old newborn with abnormal prenatal ultrasound

6. Omphalocele

Omphalocele is a congenital ventral abdominal defect in which abdominal contents, primarily bowel and sometimes liver, are herniated outside the abdominal wall and are covered by a sac.

The defect is in the midline and invariably the umbilical cord inserts into the omphalocele sac as this anomaly is the result of failure of bowel to return to the abdomen after its normal developmental herniation into the umbilical cord during gestation from 6th to 10th weeks

7.

One-hour-old newborn with abnormal prenatal ultrasound

7. Gastroschisis Gastroschisis is a defect in the anterior abdominal wall typically

located to the right of a normal umbilicus consisting of variable amounts of eviscerated bowel that is not contained within a sac or membrane.

Gastroschisis is a defect in the abdominal wall typically to the right of a normal umbilicus consisting of variable amounts of herniated bowel.

1.

8. 35 yr/F with a slowly enlarging skull mass

CT reveals a well corticated skull mass with coarse internal trabeculation in a "starburst" arrangement.

Intraosseous Hemangioma of skull 8.

9.

4th ventricle ependymoma

10. Epiphrenic Diverticulum

10. Epiphrenic Diverticulum

Epiphrenic diverticula are pulsion diverticula of the distal oesophagus arising just above the LES, more frequently on the right side.

They are less frequent than traction mid oesophageal diverticula, but may have more clinical relevance.

Fluoroscopy : Barium swallow is the best imaging method is a contrast oesophagogram , including prone oblique views of the distal oesophagus. One should look for evidence of oesophageal motility disorders and hiatus hernia.

Plain film

On chest X-ray, they may appear as a retrocardiac soft tissue mass with or without an air fluid level, mimicking a hiatus hernia.

11. Sandwich Sign / Hamburger Sign – Mesenteric lymphoma

Sandwich Sign / Hamburger Sign

The enhancing, encased vascular structures represent the sandwich filling while the soft-tissue attenuation, mesenteric lymphadenopathy comprises the bun .

The sandwich sign is specific for mesenteric lymphomas. Although many disease processes may cause mesenteric lymphadenopathy, only lymphoma results in the large, bulky lymphadenopathy that results in the sandwich sign.

CT appearance of mesenteric fat and vessels "sandwiched" between two nodular layers of mesenteric lymphadenopathy

Also seen on ultrasound. Highly suggestive of mesenteric lymphoma . Usually non-

Hodgkin's variety (NHL) Mesenteric masses occur in 30-50% of patients with NHL Frequently associated with retroperitoneal adenopathy as well. Sandwich sign may also be seen in patients with post-

transplantation lymphoproliferative disorder (PTLD).

12. Sign ?

12. Colon cut off sign

Colon cut-off sign describes gaseous distension seen in proximal colon associated with with narrowing of the splenic flexure in cases of acute pancreatitis. Though originally described in abdominal radiographs, this sign has also been demonstrated in contrast enemas and CT.

This appearance results from inflammatory process extending from the pancreas into the phrenicocolic ligament via the transverse mesocolon .

Differential diagnosis ::The colon cut off sign can also be seen in : Carcinoma of colon Inflammatory bowel disease Mesenteric ischaemia

13. Sign ?

The whirlpool sign (also known as the whirl sign) is seen when structures twist on itself. It is most commonly described in the abdomen bowel rotates around its mesentery, with mesenteric vessels creating the whirls but is also seen in ovarian torsion.

Whirlpool sign - mesenteric

It is seen in a number of settings: malrotation complicated by midgut volvulus caecal volvulus sigmoid volvulus closed loop bowel obstruction enteritis: similar pattern, but in the opposite direction has been described on ultrasound Malrotation and midgut volvulus

It represents the swirling appearance of the mesentery and superior mesenteric vein around the superior mesenteric artery. The direction of swirl is clockwise on ultrasound (viewed from above so-to-speak) and counter-clockwise on CT (as if viewed from below).

It is the corollary of the corkscrew sign seen on barium studies.

13. Whirlpool sign - Intussusception

14. A 30-year-old Paraguayan man with a 3-month history of dizziness, fever, weight loss, and behavioral and sleep-wake cycle alterations but no other personal background of interest

14. Cerebral Chagas Disease (Chagoma) in a Patient with Previously Unknown AIDS

Chagas disease is the result of an infection caused by the parasite Trypanosoma cruzi that is endemic to Latin America.

Involvement of the CNS is rare, and most of the cases are due to reactivation of chronic disease (after 10–20 years) in inmunosupressed patients, manifesting as a necrotizing meningoencephalitis and development of cerebral masses

15.An 8-year-old boy with fever, neck pain, and diarrhea that began 2 weeks ago, associated with intermittent double vision, blurred vision, and emesis in the last 2 days. Cerebellum biopsy showed only macrophages.

15. Whipple disease It is a systemic disorder caused by a gram-positive bacillus

Tropheryma whippelii, often affecting the small bowel and inducing a malabsorption syndrome. Other systems such as the osteoarticular, cardiac, and CNS can also be involved.

Isolated CNS syndrome is rare.

16.

A 62-year-old man with headaches, vomiting, and vision loss, status post VP shunt, who later developed left sided hearing loss, confusion, gait instability, and worsening depression

16.Postcontrast coronal T1WI (A) shows diffuse leptomeningeal enhancement including CNVIII at the pontocerebellar angles. Noncontrast T1WI (B) shows hyperintense signal around the fourth ventricle, near the pontocerebellar angle. Postcontrast T1WI (C) shows leptomeningeal enhancement, nodular in nature, in the right sylvian fissure. T2WI (D) lacks clear lesion correlation. Figure E shows a large heterogeneous hyperintense intradural L2–3 lesion, with contrast enhancement in Figure F. There is some artifact along the right posterolateral VP shunt tract in images B and D

16. Diffuse Leptomeningeal Melanocytosis It is a rare condition characterized by proliferation of

melanocytes in the leptomeninges (pia and arachnoid mater) anywhere in the central nervous system.

more commonly seen in children under 10 years old but can occur in any age group.

17.

Pneumobilia, also known as aerobilia, is accumulation of air in the biliary tree. It is important to distinguish pneumobilia from portal venous gas, the other type of branching hepatic gas.

Differentiating between biliary and PV gas is usually achievable especially when intravenous contrast is used. Gas within the biliary tree tends to be more central, whereas gas within the portal venous system tends to be peripheral (pushed along by the blood). Also, biliary gas is ante-dependent, and typically fills the left lobe of the liver.

Ultrasound

Ultrasound is very sensitive in detecting gas within the liver as it causes artifact, specifically regions of high echogenicity with prominent shadowing or reverberation. The liver has been described as having a 'striped appearance'.

CT

Branching hepatic gas is easily appreciable on CT as branching air-density regions within the liver.

17. Pneumobilia

18. A 28-year-old man with congenital anosmia, delayed puberty, and infertility

18.

18.

19.

A previously healthy 30-year-old man with 1-week history of fever with chills, altered mental status, petechial skin rashes, and purpuric rash on the buttocks

19.

20.

A 25-year-old man with oculocutaneous albinism presented to the emergency department with multiple exophytic head and neck masses that had been developing for years.

20.

20.

21.A 27-year-old woman with amenorrhea and history of thalassemia

21.

21.

22. A 5-month-old boy brought by his parents to the clinic for evaluation of bilateral leukokoria. Examination revealed bilateral retrolental masses. His elder brother was also blind by birth and developed hearing loss at the age of 12 years. His 2 elder sisters were completely normal

22.

22.

23.

23. Pancoast Tumor

23. Pancoast tumour

24.

24.

24. Twiddler’s syndrome

25.

25.

25. Pelvic digit

Thank you