Sunday, October 28, 2007

Radiology Grand Rounds XVII

Here is a case of Pediatric Aneurysm for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

The incidence of congenital aneurysms in the general population is about 1-2%. Clinically, a ruptured aneurysm presents as sudden onset of severe headache. In cases of subarachnoid hemorrhages, the most common aneurysms are posterior communicating, 38%; anterior communicating, 36%; middle cerebral, 21%. These three locations account for 95% of all ruptured aneurysms. The basilar artery accounts for only 2.8% and posterior fossa aneurysms are even less common. Posterior fossa aneurysms are as such uncommon. PICA (Posterior inferior cerebellar artery) aneurysms are extremely rare. In this child we can see that aneurysm producing mass effect and no leak has occurred. The speciality of paediatric aneurysms are increased incidence in posterior fossa and a higher incidence of giant aneurysms (more than 2.5 cm diameter) and there is diversity of type and these are more often located in peripheral location . In this case of a eleven year old boy congenital saccular variety is possible.

Childhood intracranial aneurysms are exceedingly uncommon. Diagnosis of intracranial aneurysms in childhood may be difficult because of their infrequency and confusing clinical presentation. The first report of an aneurysmal SAH in a child was published in 1871 in the German pathology literature, when Eppinger detailed the case of a 15-year-old boy, a gymnast who collapsed while exercising. Postmortem analysis revealed an intracerebral hemorrhage associated with an aneurysm as well as a stenosis of the aorta. The development of contemporary neuroimaging has contributed greatly to the study, understanding, diagnosis, and treatment of pediatric intracerebral aneurysms. The emergence of CT and MR imaging studies obtained with contrast agents has allowed noninvasive, detailed characterization of aneurysms and the structures surrounding them.

Take Home Message-- Aneurysms unequivocally occur in children and cause SAH. Giant aneurysms and lesions in the posterior fossa are relatively more common in children than in adults. The termination of the CA and the ACA are disproportionately common sites of aneurysm formation in the anterior circulation of children. Traumatic and infectious aneurysms occur more frequently in children than in adults, but this may reflect a relative paucity of spontaneous aneurysms in children. Vasospasm occurs in children but appears to be better tolerated. Surgical outcomes in children appear to be moderately better than in adults.
Reference- Medscape ( Registration required). Intracranial Aneurysms

Also, the pioneering experience of Teleradiology Providers for an Indian Village settings has been accepted as a letter to editor in Radiology. Read the full text here-

I hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Sunday, October 21, 2007

Radiology Outsourcing Discussion Group

Here is a link to newly formed Radiology Outsourcing Discussion forum. Do participate if interested in the topic.

Radiology Outsourcing hosted by sumer.sethi.

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Chat about what's on your mind. More about public chats.

Friday, October 19, 2007

Coarctation Of Aorta-Interesting Case Report

Coarctation of the aorta (CoA) is a relatively common defect that accounts for 5-8% of all congenital heart defects. CoA may occur as an isolated defect or in association with various other lesions, most commonly bicuspid aortic valve and ventricular septal defect (VSD). The diagnosis of CoA may be missed unless an index of suspicion is maintained, and diagnosis is often delayed until the patient develops congestive heart failure (CHF), which is common in infants, or hypertension, which is common in older children. Note the narrowed segment on the black blood image and the MIP. In the axial section note the discrepancy between ascending and descending aorta. Also note the scapular & intercostal collaterals. Case by- Dr MGK Murthy & Dr Sumer Sethi of Teleradiology Providers

Wednesday, October 17, 2007

Spinal Dermoid-MRI

A case of low back acke with right leg pain for 2 months. Radiology- T1 and Fat suppressed T2 weighted images.

Diagnosis-Spinal Dermoid Cyst

There is equal male and female preponderance. The most frequent site of these tumors begin in an extramedullary location; a few may lie in the substance of the cord itself. Complications of the cyst include secondary infection, particularly when associated witha dermal sinus. Rarely these lead to chemical meningitis from the cholesterol-laden keratin released in the subarachnoid space from a ruptured cyst leading to a foreign body type of reaction.

Saturday, October 13, 2007

Quote of the Month--Where do we stand in Medicine now?

2000 B.C. - Here, eat this root.
1000 A.D. - That root is heathen. Here, say this prayer.
1850 A.D. - That prayer is superstition. Here, drink this potion.
1940 A.D. - That potion is snake oil. Here, swallow this pill.
1985 A.D. - That pill is ineffective. Here, take this antibiotic.
2000 A.D. - That antibiotic is unhealthy. Here, eat this root.

Read this somewhere i don't remember but surely makes a lot of sense.

Tuesday, October 09, 2007

Locations of Misidentified Intracranial Hemorrhage

"In an article by W.M. Strub et al in American Journal of Neuroradiology 28:1679-1682 did an interesting review on the patterns of error of radiology residents in the detection of intracranial hemorrhage on head CT examinations while on call. Radiology residents prospectively interpreted 22,590 head CT examinations out of which there were a total of 1037 discrepancies identified, of which 141 were due to intracranial hemorrhage. The most common types of intracranial hemorrhage that were missed were subdural and subarachnoid hemorrhage. The most common location for missed subdural hemorrhage was either parafalcine or frontal. The most common location of missed subarachnoid hemorrhage was in the interpeduncular cistern. "

Thursday, October 04, 2007

Glomus Jugulare-MRI

"Contrast-enhanced MRI demonstrates enhancing soft-tissue masses at characteristic locations; these findings are important for diagnosis. Nonenhanced MRI can demonstrate glomus tumors, but the demonstration of a strongly enhancing mass is typical in the diagnosis of a glomus tumor. Contrast-enhanced imaging can show intense tumor enhancement, which again, is a key finding in the diagnosis. In addition, a salt-and-pepper fine vascular pattern can be seen in the tumors; this finding is suggestive of intrinsic tumor neovascularity and is particularly well demonstrated on T2-weighted images. Direct coronal imaging can show tumoral relationships to adjacent structures such as the brainstem and skull base, and deep cervical soft-tissue structures extraordinarily well depicted."

Case by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers

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