Viva segment 1

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Viva segment 1

  1. 1. VIVA CASES
  2. 2. CASE ONE New born with bilious vomiting
  3. 3. 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
  4. 4. 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 )
  5. 5. CASE TWO – H/O progressive head enlargement
  6. 6. 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
  7. 7. 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
  8. 8. CASE THREE Q. What are the findings of X ray ? Reduction in L5 height, tear drop fracture antero-inferior body
  9. 9. CASE THREE
  10. 10. CASE THREE Q. 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 <ul><li>Further Suggested Reading </li></ul><ul><li>Classification of spinal injuries </li></ul><ul><li>T and Z scores </li></ul>
  11. 11. CASE FOUR - 45 days old infant with microcephaly and seizure
  12. 12. CASE FOUR <ul><li>NCCT Head: </li></ul><ul><li>Bilateral basal ganglionic and periventricular calcification </li></ul><ul><li>Hourglass configuration of brain with pachygyria </li></ul>What are the findings ? Congenital CMV infection What is the diagnosis ?
  13. 13. CASE FOUR What are the differentials ? <ul><li>Causes of bilateral ganglionic calcification </li></ul><ul><li>Causes of normal intracranial calcification </li></ul><ul><li>Congenital toxoplasmosis – calcification more haphazard </li></ul><ul><li>Chronic lymphocystic choriomeningitis – macrocephaly commoner than microcephaly. May be indistinguishable </li></ul>Related topics :
  14. 14. CASE FIVE - Chronic smoker with Haemoptysis
  15. 15. CASE FIVE What are the findings? <ul><li>Multiple thin wall cysts of varying sizes b/l , relative sparing of lower zones. </li></ul><ul><li>Non-cavitating centrilobular nodules in right zone. </li></ul><ul><li>Prominent Main pulmonary artery </li></ul><ul><li>Bronchial artery tortuous </li></ul><ul><li>- Chronic lung disease with plexogenic arteriopathy </li></ul>What are the differentials? centrilobular nodules, perceptible walls Basal sparing, nodule Basal sparing Chronic smoker, cystic pattern, centrilobular Nodules chronic smoker, cystic lung disease, relative sparing of base <ul><li>- LCH </li></ul><ul><li>Centriacinar empysema </li></ul><ul><li>LAM </li></ul><ul><li>IPF </li></ul>Against For Differential

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