Short cases MD..pptx

1. MD Sort Cases.
Dr/ Abd Allah Nazeer. MD.

37. 1- AP radiograph of the ankle shows a tremendous amount of swelling of the lateral malleolus with the apex of the swelling
centered on the distal fibular physis. There is a small bony fragment near the physis as well thought to be from an avulsion
injury. Salter-Harris I Fracture.
2-A 20-year-old non-BME (bone marrow edema) osteitis condensans ilii (OCI) patient with intermittent lower back pain for 4
years. (a) Pelvis radiograph demonstrates classic bilateral triangle bone sclerosis beneath the auricular surface of iliac bone
without sacroiliac joint (SIJ) space or surface changes. Same slice of SIJ oblique axial T1-weighted image (b) and short tau
inversion recovery magnetic resonance image (c) show symmetric sclerosis of iliac subchondral bone as very dark signal
intensity in both sequences without BME. Note bilateral SIJ spaces and surfaces are normal.
3-There is lateral displacement of the lesser metatarsals with respect to the first metatarsal with widening of the space between
the 1st and 2nd metatarsal baHomolateral Lisfranc fracture dislocation. se, with an intra-articular fracture from the medial
margin of the base of the 2nd metatarsal.
4- Sagittal (Left, Middle) and coronal (Right) reformatted computed tomography (CT) images of the spinal column revealed
osteopenia, calcifications, and height loss of intervertebral discs associated with kyphoscoliosis. Alkaptonuria and ochronotic
spondyloarthropathy.
5- Axial T2 Flair WI MR. Several in corticosubcortical junction intra-axial hyperintense lesions (tubers sclerosis) are observed.
6- Chiari Malformation Type I: (Left) T2-weighted sagittal MRI; (Right) T2-weighted axial MRI. Note that in Chiari malformation
type I the brainstem and cerebellar tonsils descend below the foramen magnum. In this case, the cerebellar tonsils and caudal
brainstem descended 17 mm below the foramen magnum.
7- Inverted papilloma with secondary sinusitis. Enhancing mass in the left side nasal cavity with destruction of the bony nasal
septum, left lateral nasal wall, erosion of lamina papyracea and the base of skull along the anterior cranial fossa with
secondary sinusitis in the maxillary sinus, left frontal and the sphenoid sinus.
8-Paget disease.
9-Madlung deformity.
10- Membranous right choanal atresia

38. 11- Axial CT without contrast of the temporal bones shows the left internal auditory canal (right) is smoothly
expanded and much larger than the right internal auditory canal (left). This enlargement of the left internal auditory
canal corresponded to the location of an enhancing mass within it on an MRI of the brain performed with contrast
from an outside institution. The diagnosis was left acoustic neuroma.
12- Sagittal T1 MRI without contrast of the brain (above left) shows a large mass expanding the entire brainstem.
Axial T2 (above right) and axial FLAIR (below left) MRI show the mass to be somewhat heterogenous and the mass has
multiple foci of enhancement on the axial T1 MRI with contrast (below right). The diagnosis was brainstem glioma.
13- CXR AP and lateral (above) show a large right sided chest mass whose obtuse angles with the chest wall suggest it
is extrapleural in origin. Axial CT without contrast of the chest (below) shows the mass to be arising from a rib and to
be causing periosteal reaction. The diagnosis was Ewing sarcoma of the rib (Askin tumor).
14- CXR (above left) shows a mass in the left hemithorax. Coronal (above right), axial (below left) and sagittal (below
right) CT with contrast of the chest show a large mass of soft tissue and fat density in the anterior mediastinum that
compresses the left lung posteriorly and causes mediastinal shift to the right.
The diagnosis was mediastinal teratoma.
15- Coronal (above) and axial (below) CT with contrast of the abdomen shows multiple peripheral wedge-shaped
areas of low density in the upper and middle left kidney. The right kidney is noted to be significantly smaller in size
than the left kidney. The diagnosis was acute pyelonephritis of the left kidney and chronic pyelonephritis of the right
kidney.
16- Sagittal US of the pelvis (above left) shows an enlarged right ovary with multiple peripheral follicles. Axial CT with
contrast of the abdomen (above right) shows the right ovary to be enlarged with multiple peripheral follicles and to be
malpositioned in the midline of the pelvis while the coronal CT (below) shows the right ovary to be in a position in the
midline above the bladder. The diagnosis was ovarian torsion.

39. 17- Coronal (left) and axial (above right) CT with contrast of the abdomen show a large low density
faintly calcified mass arising from the right adrenal gland. Axial image of the pelvis in bone windows
(below) shows multiple lytic bone lesions throughout the iliac wings and sacrum. The diagnosis was
neuroblastoma with diffuse bone metastases.
18- AXR (above) shows an extremely distended stomach with peristaltic waves (caterpillar sign).
Sagittal (below left) and transverse (below right) US of the pylorus shows the pylorus muscle to be
thickened and elongated in length, measuring 3.9 mm thick and 20 mm in length. The diagnosis was
hypertrophic pyloric stenosis.
19- Axial CT with contrast of the abdomen (above left) shows a large, inhomogenous multifocal
mass on the right side of the abdomen that enhances less than the liver and that did not appear to
arise from the right adrenal gland or right kidney. Axial T2 (above right) and axial (below left) and
coronal (below right) T1 MRI with contrast of the abdomen show the mass arising from and
involving nearly the entire liver and encasing the portal veins. The diagnosis was hepatoblastoma.
20- Coronal (left) and axial (right) CT with contrast of the abdomen shows wall thickening and
mucosal hyperenhancement of the terminal ileum with separation of the bowel loops due to
mesenteric infiltration of fat and prominent vasa recta (comb sign). The diagnosis was Chron
disease.

40. 21- Radiograph of the lower extremities shows an absent right femur and a deformity
of the left femur. The diagnosis was bilateral proximal focal femoral deficiency.
22- Radiograph of the feet shows varus angulation of the left forefoot. There is a dysplastic
appearing medial cuneiform bone with associated widening at the first tarsal-metatarsal joint.
The diagnosis was club foot.
23- Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the
abdomen show a round, avidly enhancing soft tissue mass arising from the subcutaneous
tissues to the left of midline. The diagnosis was fibromatosis.
24- AP radiograph of the pelvis shows delayed ossification of the femoral heads, with multiple
femoral head ossification centers present along with delayed ossification of the pubic bones.
The diagnosis was spondyloepiphyseal dysplasia.
25- AP radiograph of the spine (left) shows thoracic scoliosis convex left (levoscoliosis) with a
compensatory lumbar scoliosis convex right, thus this is an atypical scoliosis curve for
adolescent idiopathic scoliosis. Sagittal T1 MRI without contrast of the cervical spine (above
right) shows the tip of the cerebellar tonsils over 10 mm beneath the foramen magnum. Sagittal
and axial T2 MRI of the thoracic spine (below right) show a large syrinx in the center of the
thoracic spinal cord. The diagnosis was abnormal adolescent idiopathic scoliosis due to a Chiari
I malformation causing a syrinx of the spinal cord.

41. 26- There is complete osseous fusion of the lunate and triquetrum.
27- Hemangiolipoma - ischioanal fossa,
28- Pott puffy tumor with the formation of an epidural abscess. The
initial concern for a superior sagittal sinus thrombosis on the CTV
was thought to be secondary to compression/mass effect from
the adjacent epidural abscess.
29-Barium swallow reveals fixed narrowing of the esophagus at
the level of the aortic arch without mucosal abnormality. The
narrowing runs obliquely from the inferior left to the superior
right and involves the posterior aspect of the esophagus. This
is consistent with extrinsic compression by a retro-esophageal
aberrant right subclavian artery resulting in dysphagia lusoria.

42. 30- MRI features most consistent wit quadrigeminal cistern lipoma (incidental finding).
31- There is an aberrant left pulmonary artery arising from the right pulmonary artery
and coursing behind the trachea at the level of the carina and anterior to the thoracic
esophagus.
32- Robert's uterus is a rare form of Müllerian duct anomaly and a subtype of the
asymmetric septated uterus that has a blind hemicavity with unilateral hematometra
due to obstruction by the septum and contralateral uterine cavity connecting to the
cervix with normal external uterine fundus contour and may be associated with
ipsilateral hematosalpinx and or endometrioma.
33- CT features of a duodenal diverticulum arising from the medial aspect of second
part of duodenum compressing the distal CBD most consistent with Lemmel syndrome.
Lemmel syndrome is defined as obstructive jaundice caused by a periampullary duodenal
diverticulum compressing the intrapancreatic common bile duct with resultant bile duct
dilatation.
34- MRI features of a well-defined cortical lesion with a "bubbly appearance" on the T2
sequence, most consistent with dysembryoplastic neuroepithelial tumor (DNET).

43. THANK YOU.