Thursday, August 27, 2009

Radiology teaching files for iPhone

Readers who have an iPhone or iTouch, might like to know that the first Radiopaedia Radiology Teaching File is now available for download (free) from the itunes app store. 50 CNS cases comprising 170 images, questions and detailed text. Just search for radiology and you should find it easily enough.

Monday, August 24, 2009

Giant Arachnoid granulation

In the differential diagnosis of masses within the dural sinus it is important to consider dural sinus thrombosis which is potentially dangerous and needs immediate management. Thrombosis usually involves an entire segment of a sinus or multiple sinuses and can extend to cortical veins, whereas arachnoid granulations produce focal, well-defined nodular defects in the sinuses. The key features of giant arachnoid granulations are non-enhancing granules with central linear enhancement and surrounding enhancing flowing blood on contrast-enhanced MR . Refered for second opinion- Teleradiology Providers

Ecchordosis Physaliphora-MRI & CT

Ecchordosis physaliphora is a rare congenital, benign, hamartomatous, retroclival mass derived from notochordal tissue that is typically located intradurally in the prepontine cistern. Ecchordosis physaliphora is usually asymptomatic. In rare cases, ecchordosis physaliphora can be symptomatic due to tumor expansion and compression of the surrounding structures and
extratumoral hemorrhage. Only one previous case of such a lesion with associated bleed is described in Turkish Neurosurgery 2009, Vol: 19, No: 3, 293-296. The differential diagnosis of EP also includes chordoma, dermoid, epidermoid, arachnoid cysts and partially thrombosed vertebrobasilar aneurysm. When a retroclival mass is established on MRI, any associated osseous stalk should be evaluated on thin-section CT as in our case which is classical for the diagnosis of Ecchordosis Physaliphora. This is 30 year old female with T1 and T2 hyperintense lesion in prepontine and retroclival region on MRI with no significant enhancement
Reported by Teleradiology Providers

Thursday, August 20, 2009

Paraspinal Tuberculosis-MRI

Note the collection in the left paraspinal region with involvement of the facet joint, with extension via the neural canal into the epidural space.

Tuesday, August 18, 2009

Spontaneous lumbar epidural hematoma-MRI

These are sagittal MRI T1 and T2 weighted images of lumbar spine revealing posterior epidural hematoma which was surgically confirmed and drained. This old patient presented with sudden onset paraparesis. Appearance was isointense to hypointense on Ti weighted image and hyperintense with hypointense areas on T2-weighted images which are highly suspicious for the diagnosis.

Friday, August 14, 2009

Isolated posterior element Potts spine -MRI

Spinal tuberculosis is more common in the eastern countries than in the western world. Recently, there has been a renewed interest in tuberculosis in the west because of its re-emergence, especially in immunocompromised patients (e.g., HIV). The classic radiologic picture of "two vertebral disease with the destruction of the intervertebral disc" is easily recognized and readily treated, but its atypical forms are often misdiagnosed and mistreated. In tuberculosis of the posterior element of the spine, MRI is extremely useful in evaluating the extent of involvement and response to therapy of isolated tuberculosis of posterior elements. Involvement of posterior elements due to tuberculosis is not so uncommon.

Further reading--Isolated tuberculosis of posterior elements of spine: magnetic resonance imaging findings in 33 patients. Spine (Phila Pa 1976). 2002 Feb 1;27(3):275-81

Thursday, August 13, 2009

Pancreatic Divisum-MRCP

Gallbladder is distended and there is no evidence of any filling defects within the lumen. Wall thickness is normal. There is no evidence of dilatation of the intrahepatic biliary radicles. Confluence of the right and left hepatic duct is patent. CBD is of normal caliber and no filling defect or calculus is seen within CBD. Dorsal pancreatic duct appears to open cranial to the opening of the CBD along with a small ventral pancreatic duct opening with the CBD in the region of major papilla. This may indicate a diagnosis of pancreatic divisum, further in view of history of recurrent pancreatitis. There is some beading in the pancreatic duct in pancreatic tail region. ERCP is suggested. Reported by Teleradiology Providers

Wednesday, August 12, 2009


Note the low lying tethered cord along with dysraphic posterior elements. Along with neural placode in relation to lipomatous tissue.

Monday, August 10, 2009

Pancreatic duct calculi-MRCP

Note the dilated MPD and filling defects in distal pancreatic duct consistent with calculi. Patient is a follow up case of chronic pancreatitis. Reported by Teleradiology Providers

Saturday, August 08, 2009

Erosive retro-odontoid soft tissue with DISH-MRI and CT

This is 77 yr old man with walking difficulty and episodes of respiratory arrest. Magnetic resonance imaging (MRI) showed a heterogeneously enhancing soft-tissue mass causing erosion of the dens and the inner surface of the lateral masses of the C1 vertebrae. The soft-tissue mass was predominantly isointense on T1-weighted imaging and hypointense on T2- weighted imaging. There was significant enhancement after gadolinium administration. MRI also showed patches of ossification of the posterior longitudinal ligament at the C2 to C7 levels and anterior marginal osteophytes and bridging osteophytes (syndesmophytes) along the cervical vertebral column, in keeping with DISH. Cervicodorsal syringohydromyelia is noted.

Similar case report was found in Erosive Inflammatory Pseudotumor of the Odontoid Process in Association With Forestier’s Disease (Diffuse Idiopathic Skeletal Hyperostosis). Am J Orthop. 2009;38(2):E41-E44. According to them DISH can be a causative agent for either fracture or pseudotumor of the odontoid process.

Friday, August 07, 2009

Pathology and Radiology's Combined Future Conference

Pathology and Radiology's Combined Future is Nowat KU: How Integrated Breast Cancer Diagnostics are Improving Patient Care
PRESENTERS: Ossama Tawfik, M.D., PhD Director of Anatomic and Surgical Pathology, The University of Kansas Medical CenterMark Redick, M.D., PhD Assistant Professor of Radiology, The University of Kansas Medical CenterSyed Hafeez (Moderator) Administrative Director, Providence Memorial HospitalIn a pioneering effort at The University of Kansas, a radiologist and a pathologist are working side by side to review each other's primary images and issue a single, integrated diagnostic report for breast cancer patients. The big surprise from this groundbreaking collaboration is a measurable improvement in diagnostic accuracy, leading to improved patient outcomes. If you're a pathologist or radiologist, what does this mean for you? More than likely, it means a future of increased collaboration. Instead of separate clinical silos, pathologists and radiologists will work side by side, sharing each other's primary images and producing a single, unified diagnostic report for clinicians.To understand the benefits of a collaborative working relationship between pathologists and radiologists, join us on August 19, 2009 for a special audio conference that features two innovators-pathologist Ossama Tawfik, M.D. and radiologist Mark Redick, M.D.—both from The University of Kansas (KU). Targeting micro-calcifications in breast cancers, you'll learn how, together, their reviews of the radiology and pathology images triggered significant revisions to the original diagnostic reports from each specialist.
DATE: Wednesday, August 19, 2009
TIME: 1 p.m. EDT; 12 p.m. CDT; 11 a.m. MDT; 10 a.m. PDT
PLACE: Your telephone or speakerphoneCOST: $195 per dial-in site (unlimited attendance per site) through 8/7/09; $245 thereafter
TO REGISTER: Click here or call 1-800-560-6363 toll-free

Thursday, August 06, 2009


"GO RAD is a new global outreach program developed by the International Society of Radiology. The purpose is to reach out to and advance radiology education throughout a global radiology community by aggregating current, practical, radiology literature with content targeted and dedicated to developing nations and underserved populations. "
This looks like a great concept by ISR. Good work!

Saturday, August 01, 2009

Cap on junior doctor hours

European rules preventing trainee doctors from working more than 48 hours a week have come into force. Reference-BBC News. Lets hope our Indian laws also make a note of it soon, i have known residents working for 36hours straight at times here!

Giant hiatal hernia-CT

Hiatal hernias may be categorized as paraesophageal or sliding. Paraesophageal hiatal hernias are rare hernias involving migration of the gastric fundus into the thorax while the gastroesophageal junction remains below the diaphragm. Sliding hiatal hernias, by far more common, involve migration of both the gastroesophageal junction and the stomach into the thorax; they place patients at risk for reflux.

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