Thursday, January 29, 2009

Rotator Interval Tear-MRI

There is evidence of fluid collection in the subscapularis and subcoracoid bursa, in relation to the coracobrachialis and biceps tendon, in relation to anterior spect of the supraspinatus tendon and superior aspect of subscapularis tendon. . There is altered signal intensity in the region of rotator interval in relation to the anterosuperior aspect of the glenohumeral joint. Minimal fluid in identified in relation to the glenoid cavity. These finding can be consistent with rotator interval partial tear/injury. These tears are sometimes not accurately demonstrable by MRI arthroscopic correlation is suggested.

Wednesday, January 28, 2009

Radiology Case Discussion-Musculoskeletal Radiology

There is evidence of significant synovial collection in relation to the knee joint distending the supra-patellar bursa & medial / lateral recess. Synovium appears thickened & irregular. Fluid collection with septae is noted in relation to lateral aspect of femur with areas of signal suppression on GRE suggestive of haemosiderin staining. Areas of altered signal intensity appearing hyperintense on T2 fat sat images noted in patellar articular surface, medial condyle of femur & tibial plateau may indicate erosive process as disease history in chronic. Degenerative changes are seen in tibio-femoral & patello-femoral articulation in form of marginal osteophytes and articular cartilage thinning. On post gadolinium scans there is evidence of synovial thickening & enhancement. Nodular enhancement is noted in area noted in relation to lateral femoral condyle.
IMPRESSION: 32 yrs old female with synovial collection with synovial thickening & collection with septae in relation to lateral femoral condyle with haemosiderin staining, contrast enhancement and erosive process in patella, medial femoral condylar & tibial plateau, early degenerative changes. D/ D Includes synovial process like tuberculosis / RA / pigmented villo-nodular synovitis. ESR / RA factor is suggested. In view of haemosiderin staining PVNS is suggested as first differential. On follow up ESR and mantoux were done and were found to be negative.
Your comments and discussions are recommended.

Friday, January 23, 2009

Intrabiliary rupture of hydatid cyst-MRCP

Hydatid cysts of the liver exert pressure on the surrounding parenchyma, and in approximately one-fourth of the cases, due to higher pressure in the cyst, the cysts eventually leak into small bile ducts or perforate into large ones. Thus the most common complication of hydatid cyst of the liver is spontaneous rupture into the biliary tract. Intrabiliary rupture occurs into the right duct in 55–60% of cases, into the left duct in 25–30% and rarely into the confluence or gall bladder.
This is a case of a hydatid cyst of the left lobe with MRCP images which ruptured spontaneously into the left hepatic duct. Thick slab and Thin Slab images are shown, with communication with hydatid cyst and left hepatic duct and intraluminal linear filling defects.

Wednesday, January 21, 2009

Case Discussion-Neuroradiology

This is 22 year old male with weakness of the both hands and on clinical examination it was C8/T1 distribution. MRI done outside was reported as unremarkable except for early discovertebral changes. Referred to us for a repeat study, we noticed cord atrophy and signal alteration at C4-C6 levels, which couldn’t be explained with disc disease. There was no history of trauma. No AVM was evident. Vascular cause was suspected. Hirayama disease is one of the differentials in such an appearance and it is mandatory to do a flexion study in cases like this. On flexion the diagnosis was clinched by anterior movement of posterior dura and engorged epidural veins seen as prominent flow voids. Your views are welcome. We encourage readers to discuss their doubts.

Keep checking for more such teasers!

Discussion-Hirayama Disease-On myelograms and flexion-extension MR images, forward migration of the posterior wall of the dura mater is observed. The posterior epidural space becomes enlarged with flexion and is seen as a crescent of high signal intensity on T1-
and T2-weighted MR images, with or without epidural flow voids. Compressive flattening of the spinal cord accompanies the forward shifting of the posterior dura. The changes are often greatest at the C6 vertebral level . In the majority of cases, spinal cord flattening is asymmetric. In later stages of the disease, spinal cord atrophy ensues and is generally limited to the anterior horn cells region. Morphologic changes on MR images correlate with clinical and electromyographic data
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Tuesday, January 20, 2009

Twitter for Healthcare

For those who don't know Twitter, it is a free social networking and micro-blogging service that allows its users to send and read other users' updates (otherwise known as tweets), which are text-based posts of up to 140 characters in length. (Wikipedia).
Read Full Article here-

Monday, January 19, 2009

Discussion Case- Gastroinstinal Radiology

53 yr ol lady being treated for mediatinal Lymphnodal TB at premier hospital in Delhi, has no change in finding over 2 yrs We would like comments and they will be displayed here Please support diagnosis with relevant literature. If we recieve a good rersponse to this case we will post more such teasers.

Our Opinion-when a lesion remains static with no change we need to get on with other structures in the nighbourhood The lesion is likely to represent oesophageal duplication cyst with a d/d of leiomyoma . Unfortunately in both the conditions endoscopy does not score. We tried oral contrast and it does not go there that does not exclude the possiblility These are uncommon and constitute only 0.5 - 2.5 % of all esophageal tumors . Of duplication cysts, 60% are located in the lower esophagus. mid third shows 20%, can be paraoesophageal or intramural in location.
Result from developmental errors occurring at the fifth to eight week of life and are believed to represent a failure of complete vacuolation of the originally solid esophagus to produce a hollow tube. They are lined by nonkeratinizing squamous or ciliated columnar epithelium: a double layer of smooth muscle in their walls and absence of cartilage are necessary findings to exclude a diagnosis of bronchial cyst radiologically it shows up as smooth appx 5 cm diameter hypodense mass nonenhancing after i v contrast. d/d includes abscess, old hematoma, neurofibroma, lipoma, leiomyoma, or other foregut duplications

Ref; 1.Weiss L, Fragelman D, Warhit JM. CT demonstration of an esophageal duplication cyst. J Comput Assist Tomogr 1983; 7: 716-718.regs

Case submitted by-
Dr MGK Murthy, Sr Consultant Radiologist

Thursday, January 15, 2009

Duplication of Gall Bladder

26 yr old male has reported for routine health preemplyoment checkup. Sonography shows two well defined transonic structures in gallbladder fossa region Inview of the location and appearence, duplicatin of gall bladder is suggested.Duplication is reported to be 1 in 12000 cholecytograms or 1 in 4000 autopsiesit is known to be associated with choledochal or duodenal duplication. It is asociated with high incidence of cholelithiasis and intermittent cystic duct obstructionGB arises from caudal aspect of hepatic diverticulum around 7 wks of intrauterine life.starts as solid structure and canalizes by 12 th week and is usually sonologically identified by 14 th has doubtful value in foetal life.

Case by- Dr MGK Murthy, Sr Consultant Radiologist
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Wednesday, January 14, 2009

Progressive Multifocal leucoencephalopathy (PML)-MRI

This is a case of known case of AIDS (46yr old male) on Antiretroviral therapy, who developed right sided weakness and memory loss. MRI reveals T2/FLAIR left parietal hyperintensity with diffusion restriction on DWI. There is involvement of splenium of corpus callosum. No post gadolinium enhancement was seen. There was subtle mass effect. Diagnosis of Progressive Multifocal leucoencephalopathy was made (PML). Relative lack of mass effect, non enhancing nature and classical location are points in favor of the diagnosis.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Monday, January 12, 2009


Intracranial ependymomas are typically isodense on unenhanced CT scans with minimal to moderate enhancement upon contrast administration. Calcification can be noted on unenhanced CT scans in approximately one half of cases. Cyst formation is common in these tumors, and foraminal spread can be observed in posterior fossa lesions through the foramina of Luschka and Magendie. On precontrast and postcontrast MRI, tumors often appear heterogeneous secondary to necrosis, hemorrhage, and calcification. Variable signal intensity is noted on T1- and T2-weighted images although intracranial ependymomas are usually hypointense to isointense on T1-weighted images and hyperintense compared with gray matter, on T2-weighted images.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

Saturday, January 10, 2009

Viral encephalitis-MRI

The images show symmetrical bilateral putaminal vasogenic oedema with mild restriction on diffusion and no bleed.

The possibilities are
1.Methanol intoxication- should show bleed and opitc nerves involvement
2. Wilson disease- usually shows calcium to some extent apart from other basal ganglia ivolvement
3.Hypoxic ischaemic insults – should involve caudate and other graymatter nuclei
4. Leighs syndrome
5.Kearns-sayrnes syndrome
6. Striatal degeneration ass with lebers optic atrophy
7.Certain types of metabolic disorders
8.Carbonmonoxide poisoning-specially involves globus pallidus as well
9. Near drowning hypoxic anoxic injury

In our 4 yr old girl child, as the CSF is negative and she has staus epilepticus and other regions are not involved, slow viral disease causing encephalitis is possible. However classical SSPE should show starting from occipital cortex, then partietal and then other regions including basal ganglia, brainstem and post fossa white matter necrosis Imaging can be normal as well in SSPE. rpes encephalitis involves Temporal regions. Dengue, and Japanese B encephalitis usually involve thalami.
Case by Dr MGK Murthy, Sr Consultant Radiologist

Friday, January 09, 2009

Suspected Arachnoid cyst of the velum interpositum

The velum interpositum is the potential subarachnoid space between the fornix and its attached choroid above and the choroid forming the roof of the 3rd ventricle inferiorly, and is an anterior extension of the quadrigeminal plate cistern just located superior to the pineal gland. If this potential space is simply prominent, it is known as cavum velum interpositum. However, if there is mass effect such as inferior displacement of the internal cerebral veins or the pineal gland, arachnoid cyst is the most likely explanation.
Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Amyotrophic Lateral Sclerosis-MRI

Note the high signal in the corticspinal tracts bilaterally inh the cervical spine

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

Monday, January 05, 2009

Contrast agent for blood flow approved by FDA

"The U.S. Food and Drug Administration today approved Vasovist Injection (gadofosveset trisodium), the first contrast imaging agent for use in patients undergoing magnetic resonance angiography, or MRA, a minimally invasive test for examining blood vessels."
FDA Approves First Imaging Agent To Enhance Scans Of Blood Flow - Helps Detect Possible Blood Vessel Problems. Medical News Today

Cancer risk from cardiac CT

"Scientists have found evidence that the risk of cancer from exposure to radiation during computed tomography for cardiovascular disease has been overstated. Radiology and cardiovascular researchers from the Medical University of South Carolina in Charleston, S.C., also said that the new estimates are several times lower than previously published conclusions. In earlier studies, many scientists claimed that the risk of cancer from radiation exposure during CT for cardiovascular disease was approximately 1 in 114, but the new study suggests that the risk is 1 in 1000."
The findings of the study were presented at the annual meeting of the Radiological Society of North America in Chicago.

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