RadiologySpirit

Friday, July 9, 2010

cause of vesico-ureteric reflux

Excretory urogram demonstrates the classic cobra-head appearance of a ureterocele.

http://emedicine.medscape.com/article/414836-overview

cause of vesico-ureteric reflux

Voiding cystourethrogram (VCUG) demonstrates a large, smooth, central filling defect peripherally outlined by contrast material. The catheter is deviated to the patient's right. This finding is consistent with a large ureterocele.

http:// emedicine.medscape.com/article/414836-overview

cause of vesico-ureteric reflux

Sonogram of a large, obstructing ureterocele in a patient with vesicoureteral reflux. The thin rim of the ureterocele is best noted on the inferior most aspect of the bladder. This ureterocele measured 4 cm in greatest dimension . Note the dilated, left-sided refluxing ureter.

http://emedicine.medscape.com/article/414836-overview

cause of vesico-ureteric reflux

Transverse gray-scale sonogram demonstrates a small left ureterocele in a patient with a low-grade vesicoureteral reflux. Ultrasonography may be the most helpful means to evaluate a patient for a ureterocele, as this is often difficult to visualize on early filling of the bladder during voiding cystourethrography. Patients with gross anatomic abnormalities of the urinary tract are not likely to improve without corrective surgery. In this case, the ureterocele measured less than 1 cm in all dimensions and appeared intermittently throughout the examination.

emedicine.medscape.com/article/414836-overview

Tuesday, July 6, 2010

MRI T1, precontrast showing solitary myeloma involving the second cervical vertebra,notice the T1 hypointensity.
D.D.:
Spinal metastases.

Mnemonic = FOGMACHINES
Differential Diagnosis of Solitary Lucent Bone Lesions
1- Fibrous Dysplasia
2-Osteoblastoma
3-Giant Cell Tumor
4-Metastasis / Myeloma
5-Aneurysmal Bone Cyst
6-Chondroblastoma / Chondromyxoid Fibroma
7- Hyperparathyroidism (brown tumors) / Hemangioma
8-Infection
9-Non-ossifyingFibroma
10-Eosinophilic Granuloma / Enchondroma
11- Solitary Bone Cyst
This is a fairly long differential diagnosis. However, it is one that you must learn.
I still run through it every time I see one of these lesions, just to make sure that I consider all of the important possibilities.
The discussion that follows will dwell almost totally on the plain radiographic findings of these lesions.
CT and MRI are wonderful tools for tumor workups, but they are fairly non-specific. Their place in the workup is to tell us where the lesion is: what its extent is; whether there are any metastases (either in the same bone or elsewhere); and whether an adjacent joint, nerve or blood vessel is involved. However, to tell us what a lesion is, the plain radiograph is still supreme. We've been looking at the darned things for almost a century now, and the plain film findings of most bone tumors are fairly well known. Plain films are not terribly sensitive, but they do have a decent specificity. Therefore, any workup of a bone tumor should start with a good set of plain films

http://www.google.com.eg/imgres?imgurl=http://www.rad.washington.edu/staticpix/mskbook/Location.gif&imgrefurl=http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/online-musculoskeletal-radiology-book/lucent-lesions-of-bone&usg=__wP6FfqdHC_x5-14iuBiS46jwruQ=&h=320&w=300&sz=13&hl=en&start=1&itbs=1&tbnid=_RhbW5cUuf-JqM:&tbnh=118&tbnw=111&prev=/images%3Fq%3Dbone%2Blesions%26hl%3Den%26gbv%3D2%26tbs%3Disch:1

causes of pneumomediastinum

Pneumomediastinum
1. Ruptured esophagus
2. Ruptured trachea/bronchus
3. Iatrogenic
4. Asthma
5. Pneumoperitoneum

rupture esophagus

Blue arrow points to "continuous diaphragm sign." The entire diaphragm is visualized from one side to the other because air in the mediastinum outlines the central portion which is usually obscured by the heart and mediastinal soft tissue structures that are in contact with the diaphragm. The red arrow points to the air beneath and posterior to the heart

http://www.learningradiology.com/archives05/COW%20132-Pneumomediastinum/pneumomedcorrect.htm

rupture trachea

19-year-old man with blunt tracheal rupture. Anteroposterior chest radiograph shows large right-sided pneumothorax, pneumomediastinum, subcutaneous emphysema, and chest wall injuries (arrowheads).

http://www.ajronline.org/cgi/content-nw/full/180/6/1670/FIG1

iatrogenic pneumomediastinum

This chest radiograph shows pneumomediastinum (radiolucency noted around the left heart border) in this patient who had a respiratory and circulatory arrest in the ED after experiencing multiple episodes of vomiting and a rigid abdomen. The patient was taken immediately to the operating room, where a large rupture of the esophagus was repaired.

http://emedicine.medscape.com/article/808162-media

bronchial asthma

Posteroanterior chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Mediastinal air is noted adjacent to the anteroposterior window and airtrapping extends to the neck, especially on the right side.

emedicine.medscape.com/article/353436-overview

Monday, July 5, 2010

Sunday, July 4, 2010

anteror mediastinal masses could be remembered by nemonic
4 T's and 2 L
4 T's are Thymoma,Terrible lymphoma,Thyroid masses and Teratoma
while 2 L are
2 L are Lipoma,Lipomatosis and
Lymphangioma

CT scan of chest showing an anterior mediastinal mass (thymoma) in a patient with myasthenia gravis.

emedicine.medscape.com/article/1171206-diagnosis

2-Mediastinal teratoma: Enhanced CT scan of the chest shows large, septated anterior

mediastinal mass containing fat and bony elements

3-Substernal thyroid. Axial contrast-enhanced CT scan reveals an enlarged thyroid gland extending inferiorly to the level of, and posterior to, the sternum (arrow). There is mass effect on the trachea, which is compressed and displaced toward the right.

http://www.google.com.eg/imgres?imgurl=http://download.imaging.consult.com/ic/images/S1933033207755118/gr2-midi.jpg&imgrefurl=http://imaging.consult.com/image/topic/dx/Head%2520and%2520Neck%3Ftitle%3DTrachea,%2520Tumor-like%2520Conditions%26image%3Dfig2%26locator%3Dgr2%26pii%3DS1933-0332(07)75511-8&usg=__uLfFVRE3__7U0tMAo_b468-jhbc=&h=152&w=200&sz=5&hl=en&start=3&itbs=1&tbnid=jHnWESUzdpIIyM:&tbnh=79&tbnw=104&prev=/images%3Fq%3Dsub%2Bsternal%2Bthyroid,ct%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1

4-Mediastinal lymphoma: Esophageal involvement by mediastinal lymphoma. CT scan in a patient with large cell lymphoma of the mediastinum shows extensive mediastinal adenopathy compressing the esophagus (arrowhead) and superior vena cava (arrow).

http://www.google.com.eg/imgres?imgurl=http://download.imaging.consult.com/ic/images/S1933033206705420/gr11-midi.jpg&imgrefurl=http://imaging.consult.com/image/topic/dx/Gastrointestinal%3Ftitle%3DEsophagus,%2520Other%2520Malignant%2520Tumors%26image%3Dfig11%26locator%3Dgr11%26pii%3DS1933-0332(06)70542-0&usg=__uTZTDQZoEVoHH4U-pWmSd-gqSmo=&h=194&w=200&sz=6&hl=en&start=13&itbs=1&tbnid=krD-8l90xPz2yM:&tbnh=101&tbnw=104&prev=/images%3Fq%3Dmediastinal%2Blymphoma%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1

Acute Alveolar infiltrate
1. Pulmonary edema
2. Pneumonia
3. Aspiration
4. Hemorrhage
this means presence of fluid inside alveoli which could be water as in pulmonary edema,exudate in pneumonia,blood in hemorrhage or any kind of aspiration materials.

1) Pulmonary Alveolar Edema. There is extensive, bilateral airspaces disease with fluid in the minor fissure (blue arrow) and bilateral pleural effusions (ref arrows). Although the heart is not enlarged, the cause was still on a cardiogenic basis.
http://www.google.com.eg/imgres?imgurl=http://www.learningradiology.com/caseofweek/caseoftheweekpix2007-1/cow267arr.jpg&imgrefurl=http://www.learningradiology.com/archives2007/COW%2520267-Pulmonary%2520edema-CHF/pulmedemacorrect.html&usg=__YRtgi0C8v73xQys3usyMs9_3_Vw=&h=443&w=500&sz=38&hl=en&start=8&sig2=GWET39uAxZAeo7LW_hF9VQ&itbs=1&tbnid=DIXYRi9W8kwI2M:&tbnh=115&tbnw=130&prev=/images%3Fq%3Dpulmonary%2Bedema%2Bx%2Bray%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1&ei=nHMwTNOmOMuTjAfIjbHDBQ

2) pneumonia

http://gardenrain.wordpress.com/2010/01/page/4/

3) aspiration pneumonia:Ninety percent of unilateral diffuse lung opacities are accounted for by just five conditions: pneumonia; aspiration; pulmonary oedema; lymphangitis; and radiation pneumonitis.

4)pulmonary hemorrhage:chest radiographs demonstrate extensive bilateral diffuse pulmonary consolidation with sparing of the periphery of the lungs, creating the window frame effect that is suggestive of pulmonary hemorrhage.

Hysterosalpingogram in 40-year-old woman shows medium-sized cesarean section scar defect arising from left lower uterine cavity wall (arrow).

http://www.ajronline.org/cgi/content/full/190/4/870/FIG1

Hysterosalpingogram in 37-year-old woman shows linear cesarean section scar defect at uterine isthmus (arrows).

Tubal polyp. Spot radiograph shows a small filling defect (arrow) in the proximal left fallopian tube, a finding that typically represents a tubal polyp.

http://radiographics.rsna.org/content/26/2/419.figures-only

. Irreversible tubal occlusion with a microinsert. (a) Scout radiograph obtained prior to the instillation of contrast material shows a microinsert that has been placed hysteroscopically into the proximal fallopian tube. (b) Radiograph obtained after instillation shows no contrast material filling of the fallopian tube beyond the microinsert, a finding that helps document tubal occlusion.

http://radiographics.rsna.org/content/26/2/419.figures-only

Peritubal adhesions. Spot radiograph demonstrates a round collection of contrast material adjacent to the left fallopian tube, a finding that suggests peritubal adhesions. Note the free contrast material spillage on the right side.

http://radiographics.rsna.org/content/26/2/419.figures-only

Hydrosalpinx. (a) Steep right oblique spot radiograph shows dilatation of the ampullary portion of the right fallopian tube (arrow). The left fallopian tube is normal in caliber. Mucosal folds are visible in the ampullary portions of both fallopian tubes, a finding that helps confirm the presence of contrast material within the tubes. (b) Spot radiograph shows dilatation of the ampullary portion of the left fallopian tube, a finding that is consistent with a hydrosalpinx. No contrast material spillage is seen on the left side. The right fallopian tube is abruptly cut off, a finding that is consistent with previous tubal ligation.

http://radiographics.rsna.org/content/26/2/419.figures-only

Tubal occlusion. (a) Spot radiograph demonstrates abrupt cutoff of the left fallopian tube. (b) Spot radiograph demonstrates cutoff of contrast material in the isthmic portions of both fallopian tubes, with bulbous dilatation of the distal aspects of the opacified portions. These findings can be seen with postsurgical occlusion (eg, following tubal ligation).

http://radiographics.rsna.org/content/26/2/419.figures-only

Cornual spasm. (a) On an HSG spot radiograph obtained during the early filling stage of the uterus, the right fallopian tube does not opacify beyond the cornual portion (arrow), whereas the left fallopian tube opacifies to the ampullary portion. Arrowheads indicate amorphous calcifications on the right side of the pelvis. These calcifications were also present on the scout image (not shown). (b) On a spot radiograph obtained after the instillation of additional contrast material, the right fallopian tube opacifies to the ampullary portion. Right-sided SIN and a left-sided hydrosalpinx are also noted. Amorphous calcifications (arrowheads) are again seen on the right side of the pelvis.

http://radiographics.rsna.org/content/26/2/419.figures-only

SIN. Spot radiograph demonstrates SIN as small outpouchings or diverticula from the isthmic portion of the fallopian tubes. SIN can be either unilateral or (as in this case) bilateral.

http://radiographics.rsna.org/content/26/2/419.figures-only

Cesarean section scar. Spot radiograph shows the uterine incision from a cesarean section (arrows) in the typical location (ie, oriented transverse in the lower uterine segment in the region of the isthmus). At HSG, a cesarean section scar can have a linear appearance (as in this case) or can occasionally manifest as a wedge-shaped outpouching or diverticulum.

http://radiographics.rsna.org/content/26/2/419.figures-only

(a, b) Diffuse adenomyosis. (a) Spot radiograph shows irregularity of the uterine contour with small outpouchings of contrast material, findings that represent diffuse adenomyosis. (b) Sagittal T2-weighted MR image shows thickening of the junctional zone to more than 1 cm, especially in the anterior fundus. (c, d) Focal adenomyosis. (c) Spot radiograph demonstrates an irregular mass-like filling defect in the fundus with small contrast material–filled diverticula, findings that represent focal adenomyosis. (d) Transabdominal US image shows thickening of the posterior uterine fundus with a heterogeneous echotexture in the area of focal adenomyosis (cf c).

Friday, July 2, 2010

Leiomyomas. (a) Spot radiograph obtained during the early filling stage shows a well-defined filling defect (arrow) in the fundus. (b) On a spot radiograph obtained with the uterus more distended with contrast material, the fibroid (arrow) is less apparent. (c) Spot radiograph obtained in a different patient reveals a large leiomyoma distorting the endometrial cavity as it drapes over a mass in the left myometrium. (d) Sonohysterogram obtained in a third patient shows a retroverted uterus with fluid outlining a submucosal mass in the fundus. The balloon of an HSG catheter (arrow) is seen in the lower uterine segment.

http://www.google.com.eg/imgres?imgurl=http://radiographics.rsna.org/content/26/2/419/F12.small.gif&imgrefurl=http://radiographics.rsna.org/content/26/2/419.figures-only&usg=__VpUj1hDYgg3gkRJ5XSe6l8I_dXA=&h=192&w=200&sz=34&hl=en&start=44&itbs=1&tbnid=bQ3pvndRAhzw_M:&tbnh=100&tbnw=104&prev=/images%3Fq%3Dhysterosalpingography%26start%3D40%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1

Endometrial polyp. Sagittal sonohysterogram shows a large, well-defined mass in the fundus arising from the anterior aspect of the endometrium. Note the cystic area in the lower portion of the polyp.

http://www.google.com.eg/imgres?imgurl=http://radiographics.rsna.org/content/26/2/419/F12.small.gif&imgrefurl=http://radiographics.rsna.org/content/26/2/419.figures-only&usg=__VpUj1hDYgg3gkRJ5XSe6l8I_dXA=&h=192&w=200&sz=34&hl=en&start=44&itbs=1&tbnid=bQ3pvndRAhzw_M:&tbnh=100&tbnw=104&prev=/images%3Fq%3Dhysterosalpingography%26start%3D40%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1

Synechiae. (a) Spot radiograph shows a central oval filling defect within the uterus, a finding that represents a synechia. (b) Spot radiograph obtained in a different patient demonstrates a short linear defect (arrow) along the inferior left side near the uterine isthmus.

Uterine folds. HSG spot radiograph demonstrates uterine folds (arrows) as linear filling defects that parallel the longitudinal axis of the uterus. Uterine folds are normal findings that are occasionally seen at HSG.

http://www.google.com.eg/imgres?imgurl=http://radiographics.rsna.org/content/26/2/419/F12.small.gif&imgrefurl=http://radiographics.rsna.org/content/26/2/419.figures-only&usg=__VpUj1hDYgg3gkRJ5XSe6l8I_dXA=&h=192&w=200&sz=34&hl=en&start=44&itbs=1&tbnid=bQ3pvndRAhzw_M:&tbnh=100&tbnw=104&prev=/images%3Fq%3Dhysterosalpingography%26start%3D40%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1

A-

B-

Air bubbles. (a) Spot radiograph shows air bubbles (arrow) in the left side of the uterus. (b) Spot radiograph no longer depicts the air bubbles seen in the left cornua of the uterus in a. Air bubbles are often mobile or transient when they are expelled into the fallopian tubes.