This document contains descriptions of various medical imaging findings and cases. Some key points summarized: - Spot 1 describes shiny corner signs seen in ankylosing spondylitis on x-ray. Spot 2 shows bone changes in the hands seen in sarcoidosis. Spot 3 shows periosteal bone formation associated with hypertrophic pulmonary osteoarthropathy. - Several spots name common imaging signs and their associated diagnoses, such as the corkscrew sign seen in midgut volvulus in Spot 10. - Case 2 describes a immunocompromised patient with altered mental status, showing findings of toxoplasmosis. Case 6 shows imaging and diagnosis of Moyamoya disease in a

1. SPOTTERS
Dr Mohit Goel
JRII
30 Dec. 2013

2. SPOT 1

4. Shiny corner sign
The shiny corner sign, also known as a
Romanus lesion, is an early spinal finding in
ankylosing spondylitis.
These represent small erosions at the
superior and inferior endplates (corners on
lateral radiograph) of the vertebral bodies,
with surrounding reactive sclerosis.
Eventually the vertebral bodies become
squared

5. SPOT 2

7. Anteroposterior view of the hand in this patient with sarcoid
demonstrates classic changes of bony involvement with this
granulomatous process.
Note the lacelike pattern of destruction, which is seen most
prominently in the proximal phalanges and in the distal third
phalanx.
Soft tissue swelling and some areas of severe bony dissolution
are also noted, which occur in more advanced patterns of
sarcoid.
These changes are typically limited to the hands but can rarely
occur in other parts of the skeleton.
Sarcoid.

8. SPOT 3

10. Patient was known to have long-standing
bronchiectasis shows extensive lamellar
periosteal new bone formation around the
shafts of the distal radius, ulna, metacarpals,
and proximal phalanges.
Hypertrophic osteoarthropathy is
characterised by a proliferative periostisis
involving the long bones. When associated
with a lung condition it is also termed
hypertrophic pulmonary osteoarthropaty
(HPOA). It is usually painful and associated
with clubbing

11. SPOT 4

12. 38-year-old man

13. Von Hippel-Lindau disease (VHL)

14. SPOT 5

15. CT MRI

16. Endolymphatic sac tumors (ELSTs)

19. SPOT 6

20. K/C/O AML on treatment

21. HRCT chest reveals bilateral diffuse GGO with air space consolidation and
subpleural sparing and a few air cysts classical of Pneumocystis jiroveci
pneumonia
Pneumocystis jiroveci pneumonia (PCP)

22. SPOT 7

24. Band heterotopia

25. SPOT 8

27. 4th ventricle ependymoma

28. SPOT 9

31. SPOT 10

32. NAME THE SIGN & DIAGNOSIS

33. Corkscrew sign - midgut volvulus

34. SPOT 11

35. NAME THE SIGN & DIAGNOSIS

36. Holly leaf sign - Asbestosis

37. SPOT 12

38. A 40-year-old woman with progressive abnormal movements of the limbs
for 4 years.

40. SPOT 13

42. Cavum velum interpositum

43. SPOT 14

44. seven-year-old male patient with pulsatile tinnitus

45. Aberrant internal carotid artery
Some authors suggest that the reason could be the absence of the
hypotympanic bony plate because of a congenital failure of ossification.
With age, as the artery elongates and becomes tortuous, it protrudes
through the defect into the tympanic cavity.
Others suggest that the cervical ICA never develops and an aberrant carotid
artery forms when the inferior tympanic artery (a branch of the ascending
pharyngeal artery) enlarges to supply the territory of a cervical carotid
artery. The inferior tympanic artery runs through the middle ear and then
joins the horizontal petrous carotid artery. The so-called aberrant carotid
artery is, in fact, the markedly hypertrophied inferior tympanic artery.

46. SPOT 15

48. Prominent solid periosteal reaction affecting phalanges and distal of radius and ulna.
There is also evidence of soft tissue swelling.
Thyroid acropachy is an uncommon manifestation of autoimmune thyroid disease
which presented with digital clubbing, swelling of digits and toes, and periosteal
reaction of extremity bones (The term acropachy is a Greek word for thickening of the
extremities). It is almost always associated with thyroid ophthalmopathy and
dermopathy.
Thyroid acropachy

49. SPOT 16

52. SPOT 17

54. Intraorbital Lymphatic Malformation
There is an intraconal multilobulated mass with a fluid-fluid level and mild
right globe proptosis.
Vascular lesions account for 5-20% of all orbital masses, and the two most
common orbital vascular lesions are venous malformations (formerly
known as cavernous hemangiomas) and lymphatic malformations (LM) (
formerly known as lymphangiomas).

55. Intraorbital venous-lymphatic malformations are present at birth, but tend not to be
discovered clinically until early childhood when they enlarge as a result of either
intralesional hemorrhage or lymphoid hyperplasia and result in acute proptosis.
Radiologic imaging of intraorbital LMs demonstrates unencapsulated, irregular,
lobulated, and multicompartmental masses.
These lesions can have cystic as well as more solid components. The cystic elements
of these masses commonly exhibit fluid-fluid levels as a result of intralesional
hemorrhage
Ultrasound images of LMs demonstrate heterogeneous, ill-defined lesions with
anechoic cystic portions and extraconal extension.
On CT, these masses exhibit ill-defined borders, irregular attenuations, and variable
enhancement with peripheral rim enhancement in cystic regions. Additionally,
calcified phleboliths can be seen on CT in venous portions of these lesions.
MR imaging -
LMs demonstrate iso- to slightly high signal intensities on T1-weighted images and
very high signal intensities on T2-weighted images.

56. SPOT 18

58. CT reveals a well corticated skull mass with
coarse internal trabeculation in a "starburst"
arrangement.
Intraosseous Hemangioma of skull

59. SPOT 19

62. SPOT 20

63. A 45-year-old woman with painful swelling in the right lower
neck
T1WI T2WI POST CONTRAST
USG

64. Levator Scapulae Cysticerosis

65. Levator Scapulae Cysticerosis

66. CASE 1

67. 57-year-old patient

70. CASE 2

71. 44 yrs. female – immunocompromised with altered mental status

75. CASE 3

76. 34 yrs female with headache

80. CASE 4

81. 80 yr female with history of headache

84. A staphyloma is the term given to an eye whose sclero-uveal coats are
stretched (also known as ectasia). This most commonly occurs
posteriorly, although anterior staphyloma also is recognised. As opposed
to coloboma, staphyloma defect is located off-center from the optic disc,
typically temporal to the disc.
A coloboma is collective term encompassing any focal discontinuity in
the structure of eye, and should not be confused with staphylomas which
are due to choroidal thinning.

85. CASE 5

86. 12 yr male

88. CASE 6

89. A 7-year-old boy presents with repeated transient ischemic attacks.

90. Moyamoya Disease

91. Moyamoya Disease

92. THANK YOU