Download - Viva segment 1
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VIVA CASES
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CASE ONE
New born with bilious
vomiting
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CASE ONE
What are the findings ?Supine radiograph of the abdomen of an infant shows two prominent gas distended viscus in the upper abdomen c/w dilated stomach and
duodenum. Lack of bowel gas in distal bowel
What is your diagnosis? Duodenal atresia – Double bubble sign with lack of distal bowel gas is diagnostic
What are the differentials ? With a dilated stomach and duodenum and some gas in distal bowel, D/D include stenosis,Ladd’s bands,annular pancreas, duodenal web, malrotation, preduodenal portal vein, duplication cyst
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CASE ONE
What are the associations of duodenal atresia ?
Seen in 50-60% - Down’s, CHD, vertebral &rib anomalies, GI anomalies
What are associated findings on an infantogram ?
Eleven pairs of ribs & altered iliac index (Down’s); rib & vertebral anomalies, L- R shunt
( always look for features of Down’s in a pt with double bubble )
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CASE TWO – H/O progressive head enlargement
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CASE TWO
What are the salient findings ?
Lateral skull radiograph of a child :
- flocculent calcification in the sellar & suprasellar region with sellar enlargement,
- enlarged cranium & sutural diastasis
- pneumoventricle ( post pneumoencephalography)
What is the diagnosis ?
How would you confirm your diagnosis ?
Craniopharnygioma – sellar and suprasellar calcification in a child suggests the diagnosis
MRI Brain / CECT head f/b HPE
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CASE TWO
What would you expect to see on CT/ MRI ?
CT - Mixed solid cystic suprasellar mass with calcifications and obstructive hydrocephalus.
MRI – MC hyperintense, MB iso/hypo on T1; hyper on T2, solid components may enhance
Related topics :
D/d sellar/ suprasellar masses in child
Causes of intracranial calcification in child
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CASE THREE
Q. What are the findings of X ray ?Reduction in L5 height, tear drop fracture antero-inferior
body
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CASE THREE
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CASE THREEQ. Do you get any additional information on MRI ?
Two column fracture of L5 . No canal compromise
Q. Would any additional investigations be needed to assess this injury?
Lateral skiagrams of lumbar spine in flexion and extension for assessment of stability +/ - DEXA Hip and spine
Further Suggested Reading•Classification of spinal injuries•T and Z scores
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CASE FOUR - 45 days old infant with microcephaly and seizure
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CASE FOUR
NCCT Head:
• Bilateral basal ganglionic and periventricular calcification
• Hourglass configuration of brain with pachygyria
What are the findings ?
Congenital CMV infectionWhat is the diagnosis ?
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CASE FOUR What are the differentials ?
1. Causes of bilateral ganglionic calcification
2. Causes of normal intracranial calcification
1. Congenital toxoplasmosis – calcification more haphazard
2. Chronic lymphocystic choriomeningitis – macrocephaly commoner than microcephaly. May be indistinguishable
Related topics :
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CASE FIVE - Chronic smoker with Haemoptysis
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CASE FIVEWhat are the findings?
1. Multiple thin wall cysts of varying sizes b/l , relative sparing of lower zones.
2. Non-cavitating centrilobular nodules in right zone. 3. Prominent Main pulmonary artery 4. Bronchial artery tortuous - Chronic lung disease with plexogenic arteriopathy
What are the differentials?Differential For Against
- LCH
-Centriacinar empysema- LAM- IPF
Chronic smoker, cystic pattern, centrilobular Nodules
chronic smoker, cystic
lung disease, relative sparing of base centrilobular nodules,
perceptible walls Basal sparing, nodule
Basal sparing