my few case reports and interesting signs in radiology

1. Dr Santhosh .k
MBBS MDRD
Specialist Radiologist
THDC university city.

2.  KIMS CASE
CAME FOR EVALUATION OF UPPER ABDOMEN
PAIN.
WEIGHT LOSS
FEMALE /48.

6.  GB MASS
 FAT PLANE LOST /LOCAL INVASION.
 VERT METS/WINKING OWL SIGN /ABSENT
PEDICLES. IN AP VIEW

8.  Case # 2/ KMC MANIPAL .
 Case of renal transplant on immuno
supressive therapy.
 58 YR MALE/diabeteic/CRF.

RIGHT HYPOCHONDRIAC PAIN , TOXIC.

12.  Any abnormality?
 ? Differentials
 Teaching point is: There should be no lucency over liver, on plain xray .
 if its there then 4 possibilities Pneumobilia, portal vein gas, chilaiditi or
abscess.

In this renal transplant case abdomen xray showed this small irregular
LUCENCY over liver shadow,
 USG showed dirty shadowing with absent hepatic artery flow
 CT showed Biliary necrosis with abscess..!!!

Soft tissue opacity in xray in RIF is transplanted right kidney.
 Take home msg: There should be no lucency over liver shadow.....!!

13.  KIMS CASE
 YOUNG MALE CAUCASIAN – FITNESS FREAK- GYM
enthusiast …
 WITH SUDDEN ONSET OF RIGHT ARM PAIN AND
SWELLING .
 HAD UNDERGONE SEVERE FITNESS REGIM LAST
THREE MONTHS.

16.  Upper-extremity deep venous thrombosis (UEDVT) is an increasingly important
clinical problem in children. These events are classified as primary or secondary,
with the latter being the most common and usually associated with the presence of
a central venous line. Among primary UEDVT, the so-called Paget-Schroetter
syndrome, effort-related or exercise-induced upper-extremity thrombotic event
represents an extremely rare finding that has never been described in a pediatric
series. The objective of the second part of this two-part article is to report the first
pediatric series in a group of adolescents with this condition from a single center,
describing their clinical features, management, and outcome. A retrospective chart
review of 6 patients seen between December 2003 and April 2005 was conducted,
with a median follow-up of 9 months (range 2-17). Four females and two males, all
Caucasian, were enrolled with a median age of 16 years (range 14-17). In all cases,
strenuous exercise was present in the month preceding diagnosis and mild trauma
was present in only one case (weight lifting). At presentation, all patients had
objective swelling of the affected limb for a median of 4 days (range 2-14), and 4
patients had UEDVT of the dominant arm. Thrombophilia investigation revealed that
50% had a combined prothrombotic state at presentation, and all patients were/are
being treated with anticoagulation for 6 months (low-molecular-weight heparin
followed by warfarin). Continuation of the initial symptoms was present in all cases
but one at the 3-month clinic follow-up (last case has yet to reach 3 months of
follow-up), and residual moderate to severe postthrombotic syndrome was present
in all 3 cases followed for more than 12 months. Of those 3 patients followed for
more than 1 year, 2 patients recurred despite having complete resolution of the
thrombus after 6 months of anticoagulation, and the third patient underwent
surgery with clinical improvement. Adolescents with UEDVT treated only with
anticoagulation seem to have a poor outcome.
 American journal of radiology . 2005,

17.  ARAB
 40 YRS
 Direct case ,
 severe abdomen pain followed by bleeding
PR.

20.  DIVERTICULITIS

21.  6M BABY
 LACK HEAD CONTROL /MISSING MILE STONES.
 CAME FOR NEUROSONOGRAM.
 OUT SIDE REFERENCE .

25.  VOGM.
 . In the neonatal and infantile age groups,
the most common type of AVS is the vein of
Galen aneurysmal malformation (VGAM),
 which has a male-to-female ratio of 3:1.

27.  Lemon sign.
Head US image obtained in a 24-week-old fetus shows the cranial
vault with an abnormal shape and flattening of the frontal bones,
creating a lemon-shaped appearance. The baby was delivered at
term and had a Meningo myelomA
Banana sign.
 On a US image obtained in the same patient as in ,Figure 4, the
cerebellum (arrows) has a banana-like appearance because it is
wrapped around the brainstem and obliterates the cisterna
magna due to downward traction by the spinal cord.eningocele.

28.  MENINGO MYELOCELE
 ARM.

30.  POSTERIOR FOSSA CYSTIC LESION
 DANDY WALKER
 Dandy Walker malformation consists of a group of
anomalies where there is a posterior fossa
cyst communicates with the fourth ventricle, as well as
abnormal development of the cerebellar vermis.
 In its classical presentation consists of the triad of:
 Hypoplasia of the vermis and cephalad rotation of the
vermian remnant
 Cystic dilatation of the fourth ventricle extending
posteriorly. Usually the cerebellar hemispheres are
displaced anterolaterally, but with a normal size and
morphology
 Enlarged posterior fossa with torcular-lambdoid inversion

31.  OBSERVE THESE TWO SLIDES
 GIVE COMMENTS.

34.  FIRST - IVP - RT PUJ OBSTRN
 SECOND – PLAIN KUB- EPN+ EC,
 UNCONTROLLED DIABETEIC

36.  38 YR OLD MALE WITH PAIN ABDOMEN
 CAME FOR USG
 KIMS PT
 STILL CONTACTS ME

39.  RECTO SIGMOID MASS
 2 SIGNS
 PSEUDO KIDNEY APPEARANCE ON USG
 DOUGHNUT SIGN – CT SCAN

40.  ALCOHALIC SEVERE ABDOMENAL PAN
RADIATING TO BACK

42.  RECENT SAMNAN CLINIC CASE CAME FOR USG
 8 YR OLD GIRL WITH RECURRENT UTI/FEVER

45.  CASE 10
 CASE CAME FOR USG ABD
 – ABDOMINAL PAIN
 HISTORY OF BODY ACHE
 RECURRENT UROLITHIASIS
 STONES MOANS GROANS…

48.  HYPOECHOIC LESION POSTERO INFERIOR TO
RIGHT THYROID LOBE ,
 FNAC DONE UNDER USG GUIDANCE
 HPE/- PTH ADENOMA
 FB

49.  50 YR OLD MALE
 HEMATURIA
 MASS PER ABDOMEN .
 LOSS OF WEIGHT
 ABDOMENAL DISTENSION .

50.  USG
 LARGE RENAL MASS
 RENAL VEIN /IVC DOPPLER ALSO DONE

54.  RIGHT RCC
 HUGE TUMOUR THROMBUS INVADING RT
RENAL VEIN AND IVC,RIGHT ATRIUM
 CAUSING SECONDARY BUDD CHIARI
SYNDROME

55.  C/O RECURRENT ABORTION .

57.  BICORNUATE
 D/D SEPTATE UTERUS
 3D USG /MRI ADVISED

58. 40 YR OLD INDIAN MALE
EVENING FEVER
L,O,W T
ABDOMEN DISTENSION
CAME FOR USG ABD

62.  DIAGNOSIS
 USG GUIDED ABDOMENAL TAPPING
 GRAM STAINING DONE .
 WET TYPE OF ABDOMENAL TB

63.  Radiology signs

68.  14 YR OLD BOY WITH SIGNS OF MENENGITIS
 PRIOR H/O VIRAL FEVER

70.  HERPES ENCEPHALITIS

73.  ICECREAM CONE SIGN
 MRI
 ACOUSTIC NEUROMA.
 DD MENINGIOMA

75.  TRAM TRACK SIGN
 BIL AVN

77.  SANDWITCH SIGN ‘
 LYMPHOMA
 TESTICULAR TUMOUR METS

79.  ACUTE ON CHRONIC BILATERAL SDH

81.  MOUNT FUJI SIGN
 TENSION PNEUMO CEPHALUS.

93.  Vertebral scalloping in a patient with back pain.
 1)Lateral radiograph of the lumbar spine shows
anterior scalloping of the vertebral bodies of L3 and
L4 and an indistinct L3-4 space. Vague curvilinear
calcifications anterior to the spine (arrow) are
related to an abdominal aortic aneurysm.
 2) Axial CT scan of the abdomen shows an abdominal
aortic aneurysm that has eroded the vertebral body.
There has been hemorrhage into the left side of the
retroperitoneum with loss of outline of the left psoas
muscle. Note also the “draped aorta sign”: an
unidentifiable posterior aortic wall and a posterior
aspect of the aorta that follows the vertebral
contour. The draped aorta sign is highly indicative of
aortic wall deficiency and a contained leak (,20).

94.  FINDINGS PLEASE …

98.  HOLY LEAF SIGN .
 ASBESTOSIS

100.  1)Dilated main pulmonary artery produces a
bulge of the upper leftcardiac border,
 higher than the left atrial appendage.
 2)Prominent hila due to enlarged right and
left pulmonary arteries.
 3) Rapid tapering of calibre of pulmonary
arteries as they extend through the lungs.
 4) BRONCHIECTASIS - CORPULMONALE -
PAH

102.  FELINE ESOPHAGUS

103.  CANDIDA ESOPHAGITIS
==========================
Candida oesophagitis is usually identifi ed on
barium studies as discrete, linear, or irregular
plaque-like lesions separated by segments of
normal intervening mucosa – mainly in the upper
half of the oesophagus. In more advanced
disease, coalescent plaques may produce a
‘cobblestone’ appearance or, in severe cases
(usually in patients with AIDS), a grossly irregular
or shaggy oesophagus caused by extensive
plaque, pseudomembrane formation, intramural
haemorrhage and
ulcerations. In some cases, the disease can
present with mycetoma formation, which may
simulate an intramural neoplasm.

104.  RIGLER SIGN
 CONTINUOUS DIAPHRAGM SIGN

106.  123 SIGN

107.  X.rays chest frontal projections which shows
both hila are enlarge and lobulated and
widening of superior mediastaniam giving the
typical picture of garland triad rest of scan is
normal findings could be sarcoidosis and
other differential could be tuberclosis...
 ct scan chest with contrast is suggested for
further evalution
 D/D SARCOIDOSIS /LYMPHOMA/TB