Case conference aug 24 2017
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Chest radiology, ABR, American Board of Radiology, Indian Radiology, Indian board of radiology, Indian Radiology MD
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Congenital venous anomalies of the Chest
This document discusses congenital venous anomalies in the chest that can be identified through imaging such as CT and MRI. It provides examples of different types of anomalies including an enlarged azygos vein, duplicated superior vena cava, partial anomalous pulmonary venous return, and bronchopulmonary sequestration. Recognizing these thoracic venous anomalies on imaging is important for developing treatment plans and monitoring outcomes. The document demonstrates several cases of anomalies through medical illustrations.
A case of giant mediastinal liposarcoma of thymic origin a rare clinical entity
Abstract
Thymoliposarcoma is an exceedingly rare tumor of thymus with a very few
cases reported till date. This case study presents a 45-year male with rare type
of thymoma. On the contrast-enhanced CT images, there was a large mass lesion
of predominantly fat attenuation in the pre-vascular compartment of the
mediastinum insinuating on both sides of the visceral compartment of the
mediastinum, and extending upto the bilateral cardio phrenic and anterior
costophrenic angles, anterior to the right ventricle with loss of fat plane with
the pericardium, with few sub-centimetric lymph nodes in the right paratracheal
and AP window and a calcified right hilar lymph node, suggestive of
well-differentiated liposarcoma/thymoliposarcoma. Initial CT guided tru-cut
tissue biopsy was inconclusive, and the repeat biopsy revealed as fibro-
collagenous tissue with area of necrosis, focal myxoid changes in the
background with presence of cells which are spindle to oval in shape with
mild nuclear pleomorphism and negative for S100, Cytokeratin, CD34, desmin.
The entire tumor was resected en masse after meticulous dissection
without the support of cardiopulmonary bypass (CPB) with an intact pericardium.
Final histopathology report of the surgical biopsy specimens is consistent
with dedifferentiated thymoliposarcoma with focal ganglionic cell differentiation.
Postoperative follow-up CECT of thorax revealed no evidence of
residual mass in the pre-vascular compartment. The patient is disease-free
and asymptomatic after 6-month and he is under routine follow-up under
Radiotherapy department since he received 30 Gy of postoperative radiotherapy
(PORT).
8 Techniques in Thoracic Imaging Dr. Muhammad Bin Zulfiqar Grainger and Allison
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2) There are different types of endovascular revascularization approaches that can be taken, including complete revascularization targeting all arteries, angiosome-guided targeting the artery directly feeding the problem area, and wound-related targeting the artery directly feeding the wound region.
3) For well-demarcated lesions, angiosome-guided or wound-related revascularization appears to provide good results, while complete revascularization is recommended for large wounds, deep infections, or when aggressive surgical treatment is planned
April 2014: Case of the Month, SIR-RFS
This case report describes a 67-year-old man who presented with recurrent right knee hemarthrosis and swelling. Imaging showed severe osteoarthritis and hypertrophic synovium in the knee. The patient's bleeding was found to be caused by hypertrophic vascular synovium, likely related to his osteoarthritis, and was successfully treated with transarterial embolization of the feeding arteries to the synovium.
Case report 范例2
A 57-year-old woman was admitted after ingesting a fish bone. Chest CT scans showed a pseudoaneurysm of the aortic arch caused by penetration of the fish bone. The images showed a characteristic location and appearance of the pseudoaneurysm of the aortic arch, as well as mediastinal infection and esophagitis. The patient was operated on and pathology confirmed the diagnosis of pseudoaneurysm.
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1) The number of comet-tail images correlated positively with EVLW, wedge pressure, radiographic lung water score.
2) A negative comet test result accurately detected EVLW < 500 mL, while a positive test accurately detected EVLW > 500 mL.
3) Ul
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Congenital venous anomalies of the Chest
This document discusses congenital venous anomalies in the chest that can be identified through imaging such as CT and MRI. It provides examples of different types of anomalies including an enlarged azygos vein, duplicated superior vena cava, partial anomalous pulmonary venous return, and bronchopulmonary sequestration. Recognizing these thoracic venous anomalies on imaging is important for developing treatment plans and monitoring outcomes. The document demonstrates several cases of anomalies through medical illustrations.
A case of giant mediastinal liposarcoma of thymic origin a rare clinical entity
Abstract
Thymoliposarcoma is an exceedingly rare tumor of thymus with a very few
cases reported till date. This case study presents a 45-year male with rare type
of thymoma. On the contrast-enhanced CT images, there was a large mass lesion
of predominantly fat attenuation in the pre-vascular compartment of the
mediastinum insinuating on both sides of the visceral compartment of the
mediastinum, and extending upto the bilateral cardio phrenic and anterior
costophrenic angles, anterior to the right ventricle with loss of fat plane with
the pericardium, with few sub-centimetric lymph nodes in the right paratracheal
and AP window and a calcified right hilar lymph node, suggestive of
well-differentiated liposarcoma/thymoliposarcoma. Initial CT guided tru-cut
tissue biopsy was inconclusive, and the repeat biopsy revealed as fibro-
collagenous tissue with area of necrosis, focal myxoid changes in the
background with presence of cells which are spindle to oval in shape with
mild nuclear pleomorphism and negative for S100, Cytokeratin, CD34, desmin.
The entire tumor was resected en masse after meticulous dissection
without the support of cardiopulmonary bypass (CPB) with an intact pericardium.
Final histopathology report of the surgical biopsy specimens is consistent
with dedifferentiated thymoliposarcoma with focal ganglionic cell differentiation.
Postoperative follow-up CECT of thorax revealed no evidence of
residual mass in the pre-vascular compartment. The patient is disease-free
and asymptomatic after 6-month and he is under routine follow-up under
Radiotherapy department since he received 30 Gy of postoperative radiotherapy
(PORT).
8 Techniques in Thoracic Imaging Dr. Muhammad Bin Zulfiqar Grainger and Allison
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manzi how much does the angiosome concept really matter?
1) The document discusses the concept of angiosomes, which are the three-dimensional blocks of tissue fed by source arteries. It explores how well understanding angiosome territories can guide revascularization approaches.
2) There are different types of endovascular revascularization approaches that can be taken, including complete revascularization targeting all arteries, angiosome-guided targeting the artery directly feeding the problem area, and wound-related targeting the artery directly feeding the wound region.
3) For well-demarcated lesions, angiosome-guided or wound-related revascularization appears to provide good results, while complete revascularization is recommended for large wounds, deep infections, or when aggressive surgical treatment is planned
April 2014: Case of the Month, SIR-RFS
This case report describes a 67-year-old man who presented with recurrent right knee hemarthrosis and swelling. Imaging showed severe osteoarthritis and hypertrophic synovium in the knee. The patient's bleeding was found to be caused by hypertrophic vascular synovium, likely related to his osteoarthritis, and was successfully treated with transarterial embolization of the feeding arteries to the synovium.
Case report 范例2
A 57-year-old woman was admitted after ingesting a fish bone. Chest CT scans showed a pseudoaneurysm of the aortic arch caused by penetration of the fish bone. The images showed a characteristic location and appearance of the pseudoaneurysm of the aortic arch, as well as mediastinal infection and esophagitis. The patient was operated on and pathology confirmed the diagnosis of pseudoaneurysm.
CHEST Ultrasound Comel - Tail Images
Ultrasonography of the lungs can detect "comet-tail images" originating from water-thickened interlobular septa, which may indicate pulmonary edema. This study assessed the diagnostic accuracy of lung comet-tail images compared to chest radiography, pulmonary wedge pressure, and extravascular lung water (EVLW) measured by transpulmonary thermodilution. In 60 patients studied before and after cardiac surgery:
1) The number of comet-tail images correlated positively with EVLW, wedge pressure, radiographic lung water score.
2) A negative comet test result accurately detected EVLW < 500 mL, while a positive test accurately detected EVLW > 500 mL.
3) Ul
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2. Testicular torsion presents with signs of vascular compromise like absent or decreased intratesticular blood flow. Other vascular etiologies like varicocele are detected with Doppler ultrasound.
3. Infections like epididymitis appear as enlarged, hypoechoic organs with increased vascularity. Complications include abscess or infarction.
4. Trauma often causes hematomas, hematoceles or ruptures visible on ultrasound with associated blood flow loss. Malignancies usually appear as heterogeneous masses.
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This document provides an overview of congenital central nervous system diseases, including:
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2. Disorders of diverticulation and cleavage involving abnormalities such as dysgenesis of the corpus callosum. Dysgenesis can be complete or partial absence and is commonly associated with other CNS anomalies.
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BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007
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Aorta, the major conductance vessel of the body, can be affected by a variety of pathologic processes leading to aneurysm, dissection, or ischemic syndromes. There has been a drastic increase in the incidence of aortic aneurysm making it the 18th most common cause for death.
When ignored, the patients’ condition might worsen leading to death due to rupture and hemorrhage. Here we report a case of ascending aortic aneurysm affecting the aortic root and proximal part of ascending aorta. Conscious awareness of this pathological process augments a great deal to radiologists and sonographers during various imaging techniques and rescues the patient from aneurysm-related deaths.
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2. It provides details on the indications, patient preparation, techniques, and interpretation of CT and MRI for brain imaging. CT is useful for emergencies while MRI provides better soft tissue contrast for identifying most lesions.
3. The advantages of MRI over CT include not using ionizing radiation and providing better visualization of some areas like the posterior fossa. Disadvantages include longer scan time and inability to image patients with pacemakers or certain implants.
Metastatic malignant bilateral cbt case report 2015
This case report describes a rare case of a 45-year-old man with metastatic malignant bilateral carotid body tumors. He presented with a long-standing left neck swelling and was found to have bilateral carotid body tumors, with the largest on the left side measuring 5.1 x 3.8 cm and classified as Shamblin class III, and the smallest on the right side measuring 1.6 x 1.4 cm and classified as Shamblin class I. Imaging also revealed solitary soft tissue masses in the liver, right suprarenal gland, and left paravertebral region suspicious for metastases. Treatment for bilateral carotid body tumors is debated, but excision of the largest tumor first followed by individualized management of remaining
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A 58-year-old male presented with pain and swelling in his left leg for years. Imaging showed a giant pseudoaneurysm of the left femoral artery measuring 9.46x9.52x5.29 cm, diagnosed 25 years after a war injury and surgery to his left femur. The pseudoaneurysm was likely caused by the initial injury or contact with fixation hardware. The pseudoaneurysm was successfully treated with open surgery using resection and a vascular graft. The patient recovered well after surgery. Giant pseudoaneurysms after trauma can present delayed and may require open surgery rather than endovascular approaches.
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This document discusses MRI for prostate cancer detection and the PI-RADS classification system. It provides details on:
1. Multiparametric MRI which combines T2-weighted, diffusion, and dynamic contrast-enhanced imaging to accurately detect clinically significant prostate cancer.
2. The PI-RADS classification system standardized prostate MRI acquisition, interpretation, and reporting. It describes PIRADS scores from 1 to 5 based on lesion appearance and characteristics on different MRI sequences.
3. Examples of MRI findings for different PIRADS scores, such as restricted diffusion and early enhancement indicating a higher grade tumor warranting biopsy.
some personal surgical cases
A man aged 50 years presented with subarachnoid hemorrhage from a complex left internal carotid artery aneurysm that was clipped during surgery. He recovered without deficits. A woman aged 29 years previously had an aneurysm clipped that later recurred, requiring another clipping. A woman aged 44 years had two bleedings from an anterior communicating artery aneurysm that was ultimately clipped after two coiling attempts.
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associated complications. Resection of these hypervascular tumors is necessary for local tumor control, reduction
in patient-reported pain, improved neurological functioning, and spinal stability. This adjunctive procedure has
been associated with improved surgical outcomes and easier facilitation of surgical resection. As such, we provide a review of the current literature examining the employment of this technique
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1. Ultrasound is the primary imaging method for evaluating acute male genitourinary pathology due to its availability, lack of radiation, and ability to detect blood flow changes.
2. Testicular torsion presents with signs of vascular compromise like absent or decreased intratesticular blood flow. Other vascular etiologies like varicocele are detected with Doppler ultrasound.
3. Infections like epididymitis appear as enlarged, hypoechoic organs with increased vascularity. Complications include abscess or infarction.
4. Trauma often causes hematomas, hematoceles or ruptures visible on ultrasound with associated blood flow loss. Malignancies usually appear as heterogeneous masses.
Acs0616 Repair Of Femoral And Popliteal Artery Aneurysms
Femoral and popliteal artery aneurysms are the most common type of peripheral aneurysms. While rarely rupturing, they can cause limb-threatening complications like embolization and thrombosis if left untreated. The optimal treatment is elective repair and reconstruction, rather than emergency repair after complications occur. Factors like symptoms, aneurysm size, and extent of disease help determine the appropriate treatment approach. Preoperative evaluation involves imaging to characterize the aneurysm and assess inflow and outflow vessels. The goals of surgical repair are to eliminate embolic risk, prevent rupture, relieve mass effect if present, restore distal limb perfusion, and achieve durable reconstruction.
Presentation1, radiological imaging of aicardi syndrome.
This document summarizes key features of Aicardi syndrome based on a review of radiological findings. Aicardi syndrome is a rare X-linked genetic disorder that is typically fatal in males. It involves characteristic malformations of the brain, eyes, and spine. Radiological findings include agenesis of the corpus callosum, polymicrogyria, choroid plexus papillomas, interhemispheric cysts, colpocephaly, cerebellar hypoplasia, tectal enlargement, and chorioretinal lacunae. The document presents several MRI and CT images demonstrating these hallmark radiological features of Aicardi syndrome.
Carotid Blowout Syndrome
Carotid blowout syndrome (CBS) is an uncommon but dreaded complication that occurs in patients treated for head and neck cancer. CBS is the result of necrosis of the arterial wall, which can occur following resection, after reirradiation for a recurrent or second primary tumor, by direct tumor invasion of the carotid artery wall or by a combination of these factors.
Carotid blow out syndrome
discuss a patient presenting with impending carotid blow out with emphasize on management implications
ECMO thoracic surgery (poster ESTS 2013)
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This document provides an overview of congenital central nervous system diseases, including:
1. Neural tube closure defects such as anencephaly, Chiari malformations, and cephaloceles. Anencephaly is the most common neural tube defect and presents as absent brain tissue above the orbits.
2. Disorders of diverticulation and cleavage involving abnormalities such as dysgenesis of the corpus callosum. Dysgenesis can be complete or partial absence and is commonly associated with other CNS anomalies.
3. Posterior fossa malformations including Chiari malformations. Chiari I involves tonsillar herniation while Chiari II presents with herniation of brainstem and cerebell
BELL BOTTOM Perugia 2001 Phoenix 2003 Phoenix 2007
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ABOUT BELL BOTTOM TECHNIQUE-Presentation of the first custom made flared graft and our experience using Bell Bottom tecnique in abdominal aortic aneurysm with ectatic common iliac artery
PRESENTAZIONI UFFICIALI SULLA TECNICA BELL BOTTOM
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(Chirurgia Vascolare-ULSS 15 Alta Padovana)
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Aorta, the major conductance vessel of the body, can be affected by a variety of pathologic processes leading to aneurysm, dissection, or ischemic syndromes. There has been a drastic increase in the incidence of aortic aneurysm making it the 18th most common cause for death.
When ignored, the patients’ condition might worsen leading to death due to rupture and hemorrhage. Here we report a case of ascending aortic aneurysm affecting the aortic root and proximal part of ascending aorta. Conscious awareness of this pathological process augments a great deal to radiologists and sonographers during various imaging techniques and rescues the patient from aneurysm-related deaths.
Radiological Techniques of brain Space occupying lesion
1. The document discusses various imaging modalities used to evaluate space occupying lesions in the brain including plain x-rays, CT, MRI, carotid angiography, ultrasound, thermography, cysternography, and isotope scanning.
2. It provides details on the indications, patient preparation, techniques, and interpretation of CT and MRI for brain imaging. CT is useful for emergencies while MRI provides better soft tissue contrast for identifying most lesions.
3. The advantages of MRI over CT include not using ionizing radiation and providing better visualization of some areas like the posterior fossa. Disadvantages include longer scan time and inability to image patients with pacemakers or certain implants.
Metastatic malignant bilateral cbt case report 2015
This case report describes a rare case of a 45-year-old man with metastatic malignant bilateral carotid body tumors. He presented with a long-standing left neck swelling and was found to have bilateral carotid body tumors, with the largest on the left side measuring 5.1 x 3.8 cm and classified as Shamblin class III, and the smallest on the right side measuring 1.6 x 1.4 cm and classified as Shamblin class I. Imaging also revealed solitary soft tissue masses in the liver, right suprarenal gland, and left paravertebral region suspicious for metastases. Treatment for bilateral carotid body tumors is debated, but excision of the largest tumor first followed by individualized management of remaining
Advanced Journal of Vascular Medicine
A 58-year-old male presented with pain and swelling in his left leg for years. Imaging showed a giant pseudoaneurysm of the left femoral artery measuring 9.46x9.52x5.29 cm, diagnosed 25 years after a war injury and surgery to his left femur. The pseudoaneurysm was likely caused by the initial injury or contact with fixation hardware. The pseudoaneurysm was successfully treated with open surgery using resection and a vascular graft. The patient recovered well after surgery. Giant pseudoaneurysms after trauma can present delayed and may require open surgery rather than endovascular approaches.
23204931
The document describes a case of a 3-week-old infant referred for tachypnea. Chest x-ray showed cardiomegaly and normal pulmonary vascularity. Aortogram showed normal aorta but retrograde filling of the left coronary artery from collaterals, with the proximal left coronary draining into the pulmonary artery rather than the aorta. The most likely diagnosis is Bland-White-Garland Syndrome, a rare condition where one coronary artery, usually the left, originates from the pulmonary artery rather than the aorta.
Presentation1, mri imaging of the prostate
This document discusses MRI for prostate cancer detection and the PI-RADS classification system. It provides details on:
1. Multiparametric MRI which combines T2-weighted, diffusion, and dynamic contrast-enhanced imaging to accurately detect clinically significant prostate cancer.
2. The PI-RADS classification system standardized prostate MRI acquisition, interpretation, and reporting. It describes PIRADS scores from 1 to 5 based on lesion appearance and characteristics on different MRI sequences.
3. Examples of MRI findings for different PIRADS scores, such as restricted diffusion and early enhancement indicating a higher grade tumor warranting biopsy.
some personal surgical cases
A man aged 50 years presented with subarachnoid hemorrhage from a complex left internal carotid artery aneurysm that was clipped during surgery. He recovered without deficits. A woman aged 29 years previously had an aneurysm clipped that later recurred, requiring another clipping. A woman aged 44 years had two bleedings from an anterior communicating artery aneurysm that was ultimately clipped after two coiling attempts.
Endomyocardial biopsy
Endomyocardial biopsy is a technique where heart tissue is sampled from patients with suspected cardiac disorders. Historically, open surgical biopsies were performed in the 1950s, followed by needle biopsies using modified biopsy tools. The first transvenous biopsy tool was developed in Japan in 1962. Endomyocardial biopsy is now commonly performed via the internal jugular or femoral vein to obtain tissue samples from the right ventricle for microscopic examination. Potential indications include evaluating unexplained cardiomyopathy, diagnosing myocarditis, investigating transplant rejection, and assessing drug toxicity. Complications can include perforation, arrhythmias, pneumothorax, and hemopericardium. The biopsy tissue allows for diagnosis and monitoring of various
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http://yassermetwally.com
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This document describes a surgical technique called the "ascending aortic slide" for repairing interrupted aortic arch (IAA) in cases where the gap between the proximal and distal aortic portions is too wide for a direct anastomosis. The technique involves splitting the ascending aorta longitudinally and sliding the flap posteriorly to connect to the distal arch, creating a native tissue bridge. It was used successfully in 5 patients with IAA. Benefits are that it provides a tension-free connection using native tissue with potential for growth, and a scaffold for patch augmentation. Complications were minimal. The technique is concluded to be a safe and effective option for difficult IAA repairs where other methods may not allow for tension-free reconstruction
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Radiological Techniques of brain Space occupying lesion
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Metastatic malignant bilateral cbt case report 2015
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Recurrence of Klippel-Trenaunay syndrome symptoms after surgery: a single cas...
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Spinal Cord Magnetic Resonance Angiography - Spinal MRA
Spinal Cord Magnetic Resonance Angiography - Spinal MRA
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Spinal tumor embolization: benefit for surgical resection
The embolization of hypervascular spinal tumors preoperatively has shown to be a worthwhile adjunctive procedure to minimize the elevated risks associated with surgical resection, such as intraoperative blood loss and its
associated complications. Resection of these hypervascular tumors is necessary for local tumor control, reduction
in patient-reported pain, improved neurological functioning, and spinal stability. This adjunctive procedure has
been associated with improved surgical outcomes and easier facilitation of surgical resection. As such, we provide a review of the current literature examining the employment of this technique
Harbor UCLA Neuro-Radiology Case 7
The patient presented with neck pain and left arm weakness. Imaging showed an intramedullary mass in the cervical spinal cord. Further imaging found additional masses in the cerebellum and eye. Biopsy of the spinal cord mass revealed a hemangioblastoma. The patient was diagnosed with von Hippel-Lindau syndrome based on multiple hemangioblastomas and cysts in the pancreas. The patient underwent surgery to remove the spinal cord mass and experienced post-operative weakness but subsequent improvement.
Penetrating Atherosclerotic Ulcer
Penetrating atherosclerotic ulcer (PAU) is an ulcerating atherosclerotic lesion that penetrates the aortic wall. CT is often used to evaluate PAU, showing features like a focal outpouching with adjacent hematoma. While some cases progress slowly, PAU carries a risk of complications like rupture. Treatment depends on factors like symptoms, expansion rate, and surgical risk. Careful monitoring is important due to variable prognosis.
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May Cases
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
Pneumonia
Lung Masses
Pulmonary Nodules
Hilar Lymphadenopathy
Aorto-enteric Fistula
Diaphragmatic Hernia
Intra-aortic Balloon Pump
Pacemaker
Impella
diagnostic workup of the the thoracic surgery patient
This document discusses the diagnostic workup and various imaging modalities used for thoracic surgery patients, including chest radiographs, computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), and ultrasound. CT is often the primary imaging method and can evaluate lungs, mediastinum, chest wall and vasculature. PET/CT provides functional and anatomical data for staging cancers. MRI is also useful for soft tissue contrast while ultrasound effectively images pleural effusions. Accurate staging of thoracic neoplasms with these imaging tools is important for determining appropriate therapy.
Harbor UCLA Neuro-Radiology — Case 4
A 43-year-old female presented with headaches and involuntary limb movements. Brain MRI showed a lobulated, enhancing extra-axial mass in the left parietal lobe with surrounding edema. Cerebral angiography revealed the tumor was primarily fed by the posterior division of the left middle meningeal artery. The patient underwent embolization followed by surgical resection of the mass. Pathology found features consistent with a hemangiopericytoma, a mesenchymal tumor that can recur and metastasize unlike meningiomas.
Hybrid atrial fibrillation ablation
In this ppt, i am going to discuss a new innovative procedure for the treatment of atrial fibrillation.
Dr Anil:AIIMS Patna, Primary leiomyosarcoma of IVC.
- A 60-year-old female presented with vague right loin pain, weight loss, and weakness. Imaging revealed a 6-7 cm retroperitoneal mass adjacent to the renal portion of the IVC, which was compressing the luminal space.
- The patient underwent surgery involving a right nephrectomy and resection of the tumor along with the involved portion of the IVC. A Dacron graft was implanted to reconstruct the IVC.
- Pathology identified the tumor as a leiomyosarcoma arising from the smooth muscle of the IVC, which is an extremely rare malignancy. Complete surgical resection offers the best chance of survival when the tumor is resectable.
primary leiomyosarcoma of IVC: CCR Presented by Dr Anil Kumar.Senior Resident...
Clinical Combined Round presentation By Dr Anil on rare Case :Primary Leiomyosarcoma of Juxtarenal IVC:
Percutaneous coronary intervention
PCI involves placing a balloon or stent into the coronary arteries via catheter to mechanically reopen blocked vessels and improve blood flow to the heart. It has evolved from early experiments in the 1940s-50s to become a common procedure today for treating conditions like heart attacks and angina. The presentation provides historical context on PCI and describes the equipment, techniques, indications, and anatomy involved.
Anevrisme suprarenale
This document describes the surgical technique for repairing type IV thoracoabdominal aortic aneurysms and suprarenal abdominal aortic aneurysms. The technique involves a retroperitoneal approach with suprarenal or supravisceral aortic clamping. Renal and intestinal arteries are continuously perfused using a passive shunt from the right axillary artery to protect these organs from ischemia during the procedure. The proximal anastomosis is beveled with the tip at the level of the celiac trunk. Patch insertion of visceral artery origins allows implantation into the graft. Renal protection techniques aim to limit ischemia time to less than 45-50 minutes to prevent renal failure, and may include cold perfusion, prostagland
A Complex Case Of Polianeurysmatic Disease
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
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The Value of Multimedia-Enhanced Radiology Reporting
Statistics from the American College of Radiology study,“Traditional Text-Only Versus Multimedia-Enhanced Radiology Reporting: Referring Physicians’ Perceptions of Value," explains how valuable referring physicians believe multimedia radiology report to be.
Carotid artery disease
The document describes the anatomy of the carotid arteries and their branches, evaluation and imaging of carotid artery disease, and treatment strategies including lifestyle modifications to reduce risk factors, carotid endarterectomy to remove plaques from significantly stenotic arteries, and outcomes data from clinical trials on endarterectomy for symptomatic and asymptomatic carotid stenosis. Imaging modalities like carotid duplex ultrasound, CTA, and MRA are described for evaluating the degree of carotid stenosis. The benefits of carotid endarterectomy are greater for symptomatic high-grade stenosis while more moderate for asymptomatic disease.
Minimal invasive cardiothoracic surgery2
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique used for procedures in the chest. Some key points:
- VATS was first developed in the early 20th century but saw rapid development and increased use from 1990 onward.
- It is used for diagnostic and therapeutic procedures like biopsy, resection of lung masses or cysts, and treatment of spontaneous pneumothorax.
- Advantages over open thoracotomy include less pain, blood loss, faster recovery, and shorter hospital stays.
- While limitations exist for some procedures or patient conditions, VATS has become very popular worldwide for many chest surgeries, with adoption rates over 75% in some
Mixed intraosseous haemangioma of rib a rare entity
A 25-year-old female presented with upper back pain and shortness of breath. Imaging showed an osteolytic lesion involving the left second rib. The lesion showed heterogeneous enhancement on CT with peripheral calcification. Angiography demonstrated a vascular tumor. The rib lesion was excised and found to be a mixed capillary and cavernous hemangioma, a rare entity. Hemangiomas rarely involve the ribs and can be misdiagnosed due to variable imaging appearances. Complete resection is often curative for symptomatic rib hemangiomas.
A Sinister Cause for Recurrent Syncope: Metastatic Parapharyngeal Space Tumor
This case report describes a 68-year-old male who presented with recurrent syncope. Investigations revealed a large mass in his left parapharyngeal space compressing the carotid artery. Biopsy of the mass showed metastatic squamous cell carcinoma. Parapharyngeal space tumors can rarely cause syncope by compressing the carotid artery. Management is challenging in advanced cases. The patient was deemed unsuitable for treatment and received palliative care. This case highlights that in patients with recurrent syncope, parapharyngeal space tumors should be considered as a rare cause of compression of the carotid artery.
Coronary Aneurysms: What Every Radiologist Should Know
1) Coronary artery aneurysms can be caused by atherosclerosis, Kawasaki disease, connective tissue diseases, cocaine use, trauma, and infections.
2) Imaging such as coronary CTA or angiography is important to establish the diagnosis and characterize the aneurysms.
3) Treatment depends on the underlying cause but may include anticoagulation, antiplatelet drugs, surgery such as bypass or stenting, to prevent complications like thrombosis.
Diethrich Sweden
1. Endovascular techniques are increasingly being used to treat aortic pathologies like aneurysms and dissections as they can reduce mortality and morbidity compared to open surgery.
2. However, many challenging cases involve the ascending aorta and aortic arch, which are still difficult to treat using endovascular methods alone due to anatomical constraints.
3. Hybrid procedures combining endovascular and open surgical techniques show promise for expanding the applications of endovascular therapy in complex cases, with extra-anatomic bypass grafts and branches helping to create adequate landing zones for endografts.
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Spinal tumor embolization: benefit for surgical resection
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Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May Cases
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Dr Anil:AIIMS Patna, Primary leiomyosarcoma of IVC.
Dr Anil:AIIMS Patna, Primary leiomyosarcoma of IVC.
primary leiomyosarcoma of IVC: CCR Presented by Dr Anil Kumar.Senior Resident...
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Mixed intraosseous haemangioma of rib a rare entity
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A Sinister Cause for Recurrent Syncope: Metastatic Parapharyngeal Space Tumor
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Coronary Aneurysms: What Every Radiologist Should Know
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Marijuana rsna presentation (final)
This document discusses the lasting lung effects of legalizing marijuana and what radiologists need to know. It finds that marijuana smoke deposits tar and chemicals at similar or higher levels than tobacco. Marijuana smoking can cause bronchitis, cough, wheezing and recurrent infections. It also increases the risk of lung cancer. Imaging may show micronodularity, infections like pneumonia, and sequelae of emphysema like pneumothorax. Radiologists should inquire about marijuana use in young patients with extensive unspecified lung findings to help make the diagnosis.
Non-malignant cardiac findings on FDG PET CT
This document discusses non-malignant cardiac findings that can present on FDG PET-CT scans. It presents 5 case examples of focal cardiac FDG uptake and describes the diagnostic approach and differential diagnosis in each case. Common non-malignant etiologies that can cause increased cardiac FDG uptake include physiologic variants, inflammation from conditions like sarcoidosis, infection from endocarditis, and anatomical variants like lipomatous hypertrophy of the interatrial septum. Differentiating malignant from non-malignant cardiac FDG uptake is important to avoid unnecessary diagnostic steps or treatment.
WHITEOUT LEFT HEMITHORAX: WHAT DO YOU THINK IS GOING ON HERE?
Hepatic hydrothorax (HH) is a rare cause of unilateral pleural effusion generally seen in patients withcirrhosis who do not have other reasons to explain their effusion.1 Most commonly HH presents in patients with ascites andtypically results in right sided pleural effusion; however, we detail a unique case below of left sided HH seen in the absence of ascites.
Subarachnoid hemorrhage unmasks aortic coarctation in a young man
A 20-year-old man presented with a severe headache and confusion and was found to have a subarachnoid hemorrhage from a ruptured basilar tip aneurysm. He was also found to have long-standing hypertension. Further cardiac imaging revealed an aortic coarctation, which had gone undiagnosed and likely caused his hypertension. Cardiac MRI and MRA clearly showed the coarctation and extensive collateral vessels that had formed. A cardiac catheterization further demonstrated a significant pressure gradient across the coarctation, confirming it as the cause of his hypertension. The patient subsequently underwent stent placement in the coarcted segment.
Aortic Arches A REVIEW E POSTER
This document discusses aortic arch anomalies. It begins by describing normal aortic arch development. It then defines vascular rings as vessels that encircle the trachea and esophagus, causing symptoms. It classifies the main types of vascular rings as complete rings (double aortic arch with right/left/balanced dominance, right aortic arch with left ductus arteriosus) and incomplete rings (innominate artery compression, pulmonary artery sling, left aortic arch with aberrant right subclavian). Each type of ring is described in detail with examples and images provided.
Subaortic membrane
A 43-year-old male presented with chest trauma after a fall. A trans-thoracic echocardiogram revealed a 1 cm mass protruding into the left ventricular outflow tract. Cardiac MRI was obtained for better tissue characterization. The MRI showed the mass had a non-enhancing morphology. Based on the echocardiogram and MRI findings, the mass was determined to be a sub-aortic membrane. The patient was discharged with regular follow up since he did not have a significant gradient across the membrane or aortic regurgitation.
ALCAPA AND TAKEUCHI PROCEDURE
A 29-year-old female with a history of ALCAPA and Takeuchi procedure as a child presented with palpitations. Her recent echocardiogram showed worsening pulmonic stenosis and her holter monitor detected non-sustained ventricular tachycardia. She was ordered for a cardiac MRI to assess for left ventricular scar that could explain her arrhythmia and to evaluate her coronary anatomy before potential angiogram or hemodynamic study. CMR is useful for delineating coronary anatomy and detecting characteristic sub-endocardial late gadolinium enhancement in the basal anterolateral wall seen in ALCAPA patients. CMR may avoid the need for invasive procedures by clearly defining the postoperative anatomy in adults who
Chest tubes - what one needs to know?
This document discusses chest tubes and complications that can arise from procedures like needle thoracocentesis and tube thoracostomy placement. It notes that needle thoracocentesis can result in false positives or negatives if the needle is not correctly placed in the pleural space. Tube thoracostomy placement can also have complications if the tube is placed incorrectly, such as being extrapleural, intrapulmonary, or penetrating mediastinal structures. Correct placement of chest tubes and procedures is important to avoid failure to decompress the intended body spaces and potential fatal outcomes.
Alveolar sarcoid
A 37-year-old woman presented with a 1-month history of daily cough and 30 lb unintentional weight loss. She was diagnosed with alveolar sarcoidosis based on radiographic findings of reticulonodular opacities. Alveolar sarcoidosis is a rare manifestation of pulmonary sarcoidosis characterized by interstitial granulomas compressing airways and mimicking airspace disease. The patient recovered with steroid treatment and follow-up imaging showed interstitial fibrotic changes, consistent with Stage 1 sarcoidosis.
Discitis and osteomyelitis in Sickle cell disease
1. A 14-year-old male with sickle cell disease presented with low back pain radiating up his spine that was worsened with movement. MRI showed chronic bone marrow changes and compression deformities consistent with his condition.
2. CT-guided biopsy of vertebrae showed preliminary positive cultures, with a presumptive diagnosis of vertebral osteomyelitis/discitis.
3. Vertebral osteomyelitis/discitis can result from hematogenous spread, direct inoculation, or contiguous spread. Treatment involves pathogen-directed antimicrobial therapy and drainage of abscesses if present.
Pheochromocytoma radiology
A 67-year-old female presented with right upper quadrant abdominal pain following meals and diarrhea for two weeks. Imaging studies including CT, MRI, and MIBG scan revealed bilateral adrenal masses consistent with pheochromocytoma. Laboratory tests showed markedly elevated urine and plasma metanephrines levels confirming the diagnosis. Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. It is usually benign but can be malignant in 10% of cases.
Hemithorax white out (1)
A 28-year-old female with diabetes, chronic pancreatitis, and substance abuse presented with cough, chills, and nausea for 3 days. Imaging showed complete white-out of the left lung with an air bronchogram sign. The differential diagnosis for hemithorax white-out included pulmonary edema, consolidation, or a chest wall/pleural mass. Given the trachea was midline and presence of an air bronchogram sign, consolidation from pneumonia was suspected. The patient was treated with antibiotics.
Case conference abdomen November 1, 2017
1. The document discusses several abdominal radiology cases presented at a case conference, including a slipped lap band, C. difficile colitis, levamisole-induced vasculitis, inflammatory bowel diseases, and images in mixed inflammatory bowel disease.
2. Key findings are described from a CT scan showing pneumatosis intestinalis and mesenteric vein gas in a patient with abdominal distension and vomiting being evaluated for ileus.
3. Another case discusses findings from a CT consistent with acute sigmoid volvulus without evidence of bowel perforation or other complications. Emergent surgical consultation is recommended.
Severe Hyponatremia, SIADH, and Pericardiac Effusion as Initial Presenting Fe...
A 56-year-old female presented with headache, dysarthria, and unsteady gait. Imaging revealed a moderate to large pericardial effusion. Labs showed hyponatremia consistent with SIADH. A pericardial window drained fluid and symptoms improved. Further imaging found metastatic non-Hodgkin's lymphoma to the pericardium and lung, explaining the presentation. The patient's citalopram use and pericardial effusion both likely contributed to her SIADH. Management included fluid restriction, hypertonic saline, and pericardial drainage.
Empyema as a complication of lung abscess drainage
This document describes the case of a 66-year-old male admitted for management of a cavitary lung lesion. He underwent CT-guided drainage of a lung abscess, but subsequently developed an empyema, likely due to contamination during drainage. He required a VATS procedure with debridement and decortication. Key learning points included that lung abscesses usually resolve with antibiotics, but drainage or resection may be needed for complicated cases, and percutaneous drainage carries risks of empyema or fistula formation from contamination.
Splenic rupture
Pt 1 is a 45-year-old man who presented with flank and chest pain due to a large splenic abscess and rupture secondary to illicit drug use including methamphetamines and heroin. Imaging showed a large fluid collection replacing the spleen. Pt 2 is a 27-year-old woman who presented with abdominal and pelvic pain due to an extracapsular splenic hemorrhage from illicit drug use. Both patients underwent splenic artery embolization and splenectomies. Illicit drug use such as cocaine can cause splenic infarction and subsequent rupture from vasospasms.
Radiology case conference october 4 2017. pptx
A 50-year-old female presented with an incidental 2x3 cm paraesophageal mass found on CT during a hematuria workup. FDG PET showed intense focal uptake in the mass concerning for metastatic lymph node or esophageal cancer. Biopsies were nondiagnostic. VATS showed necrotizing granuloma suggestive of fungal infection, likely histoplasmosis. Treatment with itraconazole led to a significant decrease in FDG avidity on follow-up PET-CT, indicating histoplasmosis rather than cancer. This case demonstrates that focal FDG uptake can be caused by fungal infection, which should be considered in the differential diagnosis of possible esophageal cancer.
Atypical lung neoplasms1
This document discusses several cases of atypical chest neoplasms:
1. It describes bronchus-associated lymphoid tissue (BALT) lymphoma, a rare subtype of primary non-Hodgkin lymphoma that occurs in the lung. BALT lymphoma has nonspecific imaging findings but usually presents as nodules, masses, consolidation or ground-glass opacity.
2. It also discusses lymphangitic carcinomatosis, a tumor spread through the lungs' lymphatics most commonly seen with adenocarcinoma. On imaging, it demonstrates interlobular septal thickening, thickening of the bronchovascular interstitium, and often has a "dot in box" appearance
Pulmonary infections 1
This document describes a patient who was initially diagnosed with Klebsiella pneumonia based on imaging signs seen two years ago. More recently, imaging showed new signs and a lung biopsy was positive for Cryptococcus neoformans, while blood cultures detected Cryptococcus. The patient also has cavitary lung lesions caused by Mycobacterium avium-intracellulare superimposed on the initial infection.
Airways lecture final 2017
A 30-year-old previously healthy man presented with worsening shortness of breath over two days. He had been working in a corn silo filled with nitrous oxide the day before and inhaled some of the gas. Laboratory results showed elevated white blood cells. Imaging showed diffuse lung inflammation and injury consistent with acute hypersensitivity pneumonitis from inhaling the gas. He required ventilator support but was successfully treated with steroids and diuretics and showed improvement over the next few days.
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Case conference aug 24 2017
- 1. August 24, 2017. Dr. Jayanth H.Keshavamurthy M.D.
- 2.
- 3.
- 4.
- 5. Renal cell cancer with metastasis
- 6.
- 7.
- 8. CSF in pleural space
- 9.
- 10.
- 11.
- 13.
- 14.
- 17.
- 18.
- 20. Pleural lipoma
- 21.
- 22.
- 25.
- 30.
- 31.
- 32.
- 34.
- 35.
- 36.
- 38.
- 39.
- 40.
- 42.
- 43.
- 44. Subendocardial fat attenuation is identified within the lateral wall left ventricle, consistent with sequela of remote myocardial infarction. Diagnosis
- 45.
- 48.
- 51.
- 53.
- 55.
- 56. Case A
- 57. Why bone X ray is shown in chest case conference
- 58.
- 59.
- 60. Case B
- 61.
- 62.
- 63. Case A from Lung cancer and Case B from COPd. Hypertrophic pulmonary Osteoarthropathy
- 64.
- 66. Imaging Perspective: Computed tomography and plain film radiographs can be used to assist in the diagnosis of trapped lung. Trapped lung does not appear larger on expiration than on inspiration in comparison to pneumothorax. The visceral pleural line delineates the scarred lung contour. http://www.eurorad.org/Case 13940 Trapped lung
- 67.
- 68.
- 70. Multiple, large bullae, varying sizes; 1-20cm in diameter; average 2-8cm Bullae predominant in subpleural location; also present in lung parenchyma Usually asymmetric; one lung involved to greater extent than the other Concomitant foci of paraseptal and centrilobular emphysema Giant bullous emphysema also known as “Vanishing lung syndrome” or “Type 1 bullous disease” was first described by Burke in 1937
- 71. Large bullae may be difficult to differentiate from pneumothorax Presence of visceral pleural reflection denotes pneumothorax Cross table lateral or inspiratory/expiratory studies may help distinguish GBE from pneumothorax Caveats
- 72.
- 73.
- 74. See decreased vascular markings in left lung
- 75. Clinical team on chest radiograph thought there was pneumothorax and put chest tubes. Patient died of other causes.
- 76.
- 77.
- 79. Solitary Fibrous Tumour of the Pleura (SFTP) is a benign mesenchymal tumour that arises, usually, from the pleura
Editor's Notes
- RML patial collapse
- Left lung lesion
- T2, T1 and post contrast. . Large posterior subcutaneous atypical lipoma.
- IS there a let pneumothorax, what next?