Tuesday, September 28, 2010

Long standing Portal hypertension-CT

Shrunken liver with nodular outline and relative enlargement of the caudate lobe. These are consistent with chronic liver disease. GB is contracted with thickened, possibly edematous walls. IHBR dilatation in this possibly indicates associated portal biliopathy.  Calcification in relation to anatomical site of the main portal vein, porta hepatis and spleinc vein. Spleen is enlarged. Calcification is also noted in the splenic parenchyma which is seen extend along the vascular branches. Calcification in the portal venous system is known to occur in the long standing portal hypertension. Collateral/tortousity noted in perisplenic region and lienorenal region.  Collaterals are alos noted along the body wall. Gross ascites.  Wall thickening in the GE junction which may indicate varices. Stomach wall is also thickened.

Monday, September 27, 2010

Tuber cinereum hamartoma-MRI

A hypothalamic or tuber cinereum hamartoma is benign non neoplastic heterotrophic lesion in the brain that typically occurs about the hypothalamus. The tuber cinereum is a part of the hypothalamus located between the mamillary bodies and the optic chiasm. Thought to arise from anomalous neural migration between 35 and 40 days in utero (time of hypothalamic formation). This is isointense to gray matter on T1 weighted images and hyperintense on T2 and FLAIR images. There was no post gadolinium enhacement. This is 28year old male.



Friday, September 24, 2010

Radiology Residency


Road versus destination.This possibly happens to all of us sometime or the other. I always cross DND to reach my hospital from home and am usually late, never really noticed the beautiful river below and what all you could see while on the road and my main concern was to avoid getting late and honking. Today with the common wealth causing this crazy jam at the ashram crossing, realised that there is nothing i could do about it and started to see around and saw the our river yamuna with these rains is actually looking amazingly beautiful and that you can see the lotus temple at the distance from the middle of the road and huge building of barakambha at the distance.  May be this is true for our residencies as well, most of us while doing our post graduation are more concerned about the destination, that we fail to enjoy the time we have at that time to learn without actually thinking of the returns and ways to increase business. Residency is one of the best times of our education as although there are pressures of exam, on call duties and struggle to understand more and more things which apparently appear simple to the seniors around, still we are at the peak of our knowledge quest and skill acquistion.

Tuesday, September 21, 2010

Telestroke

According  Steven R. Levine and Mark Gorman, MD  From the Center for Stroke Research & Henry Ford Stroke Program in Stroke. 1999;30:464-469; Time is of the essence for effective intervention in acute ischemic stroke.  They emphasize that computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.


Further reading and reference

"Telestroke" The Application of Telemedicine for Stroke

Hypertrophic cranial pachymeningitis-MRI

Hypertrophic cranial pachymeningitis is a rare chronic fibrosing inflammatory disease characterized by marked diffuse thickening of the cranial dura mater that causes progressive neurological deficits. Chronic headache and cranial neuropathy are the common clinical manifestations of patients with hypertrophic cranial pachymeningitis.  Gadolinium enhanced T1WI, coronal sequence, reveals markedly thickened and enhancing falx and tentorium cerebelli. This is a 35yr old female with chronic headache.

Saturday, September 18, 2010

Hematometra with hematosalpinx-MRI

This is 13 year old who had abdominal pain and had not yet achieved menarche. MRI revealed blood distended in the uterine cavity and bilateral hematosalpinx. Right sided rudimentary horn was also suspected.


Friday, September 17, 2010

LV Contrast for R/O Thrombus

This one is shared from the youtube and for all the residents this is how ultrasound contrast agent work for cardiovascular imaging.

Does the choice of MRI machine matter?

"This is about an article on Kevin MD  in which a patient underwent MRI cervical spine for neck pain and was reported normal. Imaging was substandard and physician wanted another repeat MRI. However, insurance company refused as MRI was just done a week back. Patient was admitted and repeat study revealed cervical herniated disk."

  • My question in India in lot of places MRI are done in permanent magnet at about 0.3T strength and pathologies are often missed. Are they justified?
  • As a Reporting Radiologist will you write on such reports suboptimal for reporting?
  • What is the way out, for radiologists as if you are on payroll, you cannot possibly write suboptimal on each study and get paid for it as well. What if the patient sues the first radiologist for missed diagnosis, does he have the defense opf suboptimal machine and for that matter how do you define a suboptimal machine?

Funnel chest (pectus excavatum)-CT

Funnel chest (pectus excavatum), the sternum is depressed so that the ribs on each side protrude anteriorly more than the sternum itself. Posteroanterior radiography also depicts parasternal soft tissues of the anterior chest wall as an area of increased density in the inferomedial portion of the right hemithorax. The severity of the deformity is best quantified with CT.
The “pectus index” can be derived by dividing the transverse diameter of the chest by the anteroposterior diameter. Normal value of this index to be 2.56 (±0.35 SD) and suggested that a pectus index greater than 3.25 necessitated surgical correction.

Thursday, September 16, 2010

Solitary Fibrous Tumour of the Orbit-CT

SFT might be included in the differential diagnosis of soft tissue masses in the orbit, if one sees a markedly enhancing mass showing the similar characteristics to those of the internal carotid artery on postcontrast CT or MR images.  Since the first report by Klemperer and Rabin1 in 1931 as a primary spindle-cell tumor of the pleura, solitary fibrous tumor (SFT) has been recognized as a distinctive, though rare, pathologic entity that most commonly arises from the pleura and peritoneum.

Wednesday, September 15, 2010

Papillary cystic and solid tumour of the pancreas-CT

The Papillary cystic and solid tumour of the pancreas (PCSTP) is an unusual low-malignant epithelial tumour, which mostly affects young females with a mean age 25 years.  It has also been referred to as a solid-cystic epithelial tumour, solid-pseudopapillary tumour or papillary-cystic tumour. Typically, on CT scan PCSTP tumours appear as sharply circumscribed, well-encapsulated, heterogeneous and hypodense lesions. This is a 37 year female with histologically proven case of PCSTP.

Monday, September 13, 2010

iPad for Radiology-Potential Applications

Sam Friedman, MD in his article entitled "The iPad--Radiology's Sharper Image?" talks about iPad and its potential for radiology. Accrding to him "It may still be a work in progress, but Apple's tablet device could herald a new computing age that extends to the radiology suite."

He further says "Even though the iPad looks like an iPhone built for the supersize inhabitants of Pandora, its ambitions are as much about shrinking our laptops as about stretching our smartphones."

Sam Friedman, MD, is chief technical officer (CTO) and medical director of nuclear medicine at Pitts Radiology, Columbia, S.C., and a radiology blogger (www.doctordalai.com).

Friday, September 10, 2010

Urachal Carcinoma-CT

The urachus is a remnant of the intraembryonic portion of the allantois. The urachus is an extraperitoneal structure located in the space of Retzius (which is bounded by the transversalis fascia ventrally and the parietal peritoneum dorsally). If the urachus persists beyond birth, it can give rise to a number of congenital and acquired disorders. Congenital disorders include a patent urachus, urachal sinus, vesicourachal diverticulum, urachal cyst, and umbilical-urachal sinus. Acquired conditions relating to these congenital anomalies include infection, which is the most common complication, as well as benign and malignant neoplasms. This is a 32 year old male with umblical mass.


Thursday, September 09, 2010

Radiology Journal Watch

New edition of following open access journals are available online.

Internet Journal of Radiology.
This peer reviewed open access journal has been around for some time now and now we are offering rapid turn around time by online submission and processing.
Current Issue.

Journal of Surgical Radiology.
Just a few months ago, its inaugural July issue introduced an innovative concept of a free, web-based publication accessible to readers across the globe through modern media such as iPods and PDA. This was also annouced on our blog.

Current Issue.

Wednesday, September 08, 2010

Computer which can read your mind- This is not science fiction

The world’s first patient-ready and commercially available brain computer interface just arrived at CeBIT 2010. The Intendix from Guger Technologies (g*tec) is a system that uses an EEG cap to measure brain activity in order to let you type with your thoughts. Meant to work with those with locked-in syndrome, or other disabilities, Intendix is simple enough to use after just 10 minutes of training.


Reference and further reading-
Intendix, The Brain Computer Interface Goes Commercial

Radiological signs of Papillary necrosis

The named signs of papillary necrosis-- ball-on-tee, lobster claw, and signet ring refer to the radiographic patterns of papillary excavation seen with papillary necrosis.

Causes are -
Nonsteroidal anti-inflammatory drugs; Sickle cell anemia; Analgesic nephropathy; Infection, especially tuberculosis; and Diabetes mellitus (the memory aid NSAID)

Hemorrhage in metastatic neoplasms-CT

Multifocal haemorrhagic ring lesions  with vasogenic edema, possibly haemorrhagic mitotic etiology (likely secondaries).  Note- The incidence of hemorrhage in metastatic neoplasms is highest in melanoma, hypernephroma, bronchogenic carcinoma, and choriocarcinoma. Other metastatic tumours that bleed are breast and thyroid metastasis


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