Saturday, February 27, 2010

CO Poisoining-MRI

Bilateral globus pallidus hyperintensity is characterstic of CO poisoning. In this case this was an obscure case clinically and diagnosis of suspected retrospectively after MRI was done.

Reported by- Teleradiology Providers.

Wednesday, February 17, 2010


Schwannomas and neurofibromas are common variants of nerve sheath tumors. Pathologically Schwannomas are lobulated, well-circumscribed round or oval tumours that may show cystic changes, necrosis more often while neurofibromas are unencapsulated, fusiform, less well circumscribed and rarely show necrosis and cystic degeneration. They are most common intradural extramedullary spinal neoplasm, though extradural and dumb-bell masses too share 15% each..

Symptoms are same as of disc herniation i.e pain and radiculopathy. On plain films, widening of neural foramen may be seen along with anterior erosions with paraspinous soft tissue masses with posterior vertebral scalloping.

On MRI, they are mostly iso-intense on T1-weighted images, hyperintense on T2-weighted and enhance on contrast enhanced T1-weighted images.

Differential diagnosis includes : Meningiomas and ependymomas (at conus and filum terminale)

Our patient shows a TYPICAL dumb-bell shaped, lobulated schwannoma with intradural as well as extradural extension. It measures 54X23X52 mm and is iso-intense on T1 and heterogeneously hyperintense on T2 weighted images. Posterior scalloping of D12 vertebrae is well demonstrated in this case.

Submitted by Dr Sangeeta Aneja, MD Head of Dept, LLRM Meerut

Biceps Tendon Tear-MRI

Complete rupture of the distal biceps tendon is often an avulsion from the radial attachment and clinically evident. However, differentiation of complete from partial tears is sometimes difficult clinically, particularly if the bicipital aponeurosis remains intact. Most tears occur 1–2 cm above the radial tuberosity, where there is relative hypovascularity and a histologic structural transition point . Degeneration secondary to hypoxic tendinopathy occurs in this region. In complete rupture of the distal biceps tendon, there is discontinuity with or without retraction. The longitudinal view of the tendon. acquired with FABS imaging often best demonstrates the discontinuity . , FABS imaging (flexed elbow, abducted shoulder, supinated forearm with arm overhead and patient lyinn prone) provides a detailed view of the distal biceps tendon, including the difficult-to-assess region near its insertion on the radial tuberosity and is often helpful in differentiating partial from complete tears.

The proximal tendon is enlarged and demonstrates abnormal signal intensity. If the bicipital aponeurosis is intact, there may be no retraction, and at clinical examination the patient may even appear to retain some flexion and supination capability. The axial view is best for appreciating an intact bicipital aponeurosis. In partial tears, findings include a change (usually an increase) in caliber and abnormal contour of the tendon. Abnormal intratendinous signal intensity is seen at MR imaging. The US equivalent, reduced echogenicity, is often more difficult to confidently assess. Peritendinous fluid (edema, bursitis, or hemorrhage) may also be visible.

In our case , biceps can be traced upto its insertion site at the radial head with enlargement and thickening of proximal tendon. Abnormal intratendinous signal intensity can be appreciated in PD fat suppressed images along with peritendinous fluid signals. The conventional views (as in our case) don’t give a true longitudinal view of the tendon, FABS imaging is advised to differentiate distal biceps tendon partial tear from complete tear.

Friday, February 12, 2010

Extradural Arachnoid Cyst-MRI

Extradural arachnoid cysts in the spine are rare and are seldom a cause of spinal cord compression. They are thought to arise from congenital defects in the dura mater, and they almost always communicate with the intrathecal subarachnoid space through a small defect in the dura.

Submitted by Dr Sangeeta Aneja, MD Head of Dept, LLRM Meerut

Thursday, February 11, 2010

Dural Extension of Intratemporal Cholesteatoma-MRI

Note the the right intratemporal cholesteatoma with extension along the tentorial leaves seen as hyperintense signal on DWI.
Submitted by Dr Sangeeta Aneja, MD Head of Dept, LLRM Meerut.

Tuesday, February 09, 2010

Andersson lesion-Ankylosing Spondylitis

In ankylosing spondylitis Discovertebral lesions are frequently termed Andersson lesions. Many reports have emphasised on destructive abnormalities at discovertebral junction in this disorder. These lesions have been observed in the early and late phases of the disease and occur in traumatic and nontraumatic situations. This is a case of ankylosing spondylitis with history of trauma. This can mimic tuberculosis especially in our country

Second opinion- Teleradiology Providers

Thursday, February 04, 2010

Choroidal Detachment-USG

The suprachoroidal space is normally virtual because the choroid is in close apposition to the sclera. As fluid accumulates, this space becomes real, and the choroid is displaced from its normal position. Serous choroidal detachment involves transudation of serum into the suprachoroidal space. It may be due to increased transmural pressure, most frequently caused by globe hypotony of any etiology or trauma, or exudation of serum, most frequently caused by inflammation. Serous detachment is typically painless, with a variable degree of vision loss

Hemorrhagic choroidal detachment is a hemorrhage in the suprachoroidal space or within the choroid caused by the rupture of choroidal vessels. This can occur spontaneously (rare), as a consequence of ocular trauma, during eye surgery, or after eye surgery. The outcome is generally worse for intraoperative hemorrhages, which often are accompanied by loss of eye contents.Postoperative hemorrhagic detachments are characterized by sudden excruciating throbbing pain with an immediate loss of vision.

B-scan very well depicts the serous as well as hemorrhagic choroidal detachements. They are seen as well defined, dome-shaped, thick , relatively fixed, choroidal membranes from both sides approximating each other (kissing sign). Being a vascular layer, it shows vascularity on Color Doppler. Serous detachments show no or insignificant echoes in suprachoroidal space while thick internal echoes may be seen in hemorrhagic detachments.

Posterior dislocation of an IOL-Ultrasound

Posterior dislocation of an IOL may occur during or shortly after cataract surgery. In these cases, posterior capsular rupture or zonular dialysis usually is present. The IOL rarely dislocates completely onto the retinal surface. It usually lies meshed into the anterior vitreous with one haptic still adherent to the capsule or iris. It may cause a vitreous hemorrhage by mechanical contact with ciliary body vessels. The IOL may be related to retinal detachment or cystoid macular edema secondary to vitreous changes. No age, gender or sex predilection is seen.

This is a case of middle aged male who had a previous history of cataract surgery and now presented with sudden loss of vision. In our patient,lens is very well visualized in pre-retinal space and is relatively fixed. There are thick membranes with internal echoes in vitreous s/o vitreous haemorrhage.

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