Today’s cases: November 11th, 2015

  1. A one-year-old, external ear trauma, however, everything looked good on the CT, radiology tech was asked to do a visual check, but he had already gone home – So, as there is nothing remarkable to discuss in this case, I will present two common temporal bone pathologies – see this website for original.
    Below: 14 y.o. (M), The eardrum is thickened. A small amount of soft tissue (arrow) is visible between the scutum and the ossicular chain but no erosion is present. This favors the diagnosis of chronic otitis media.

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Below: Cholesteatoma is believed to arise in retraction pockets of the eardrum. It gradually enlarges over time due to exfoliation and encapsulation of the tissue. Most cholesteatomas are acquired, but some are congenital. The ENT surgeon often states that cholesteatoma is a clinical diagnosis. Scraps of cholesteatoma are visible in the external auditory canal.

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2. Older male (did not check age), BPH – Benign prostatic hyperplasia, confirmed with DWI – diffusion weighted image, shows the tumor as white, hypervascularity, with dynamic study one can diagnose BPH

Benign prostatic hyperplasia (BPH) is an extremely common condition in elderly men and is a major cause of bladder outflow obstruction. Although the term prostatomegaly is often used interchangeably, strictly speaking prostatomegaly may refer to any cause of prostatic enlargement.

The radiologist will check the peripheral zone –

Below: Prostatomegaly

Below: example of DWI – T2-weighted imaging (left) of a man with extensive Gleason 3+4 tumor shows low signal thoughout the peripheral zone corresponding to tumor. Very high b-valued high-resolution DWI (right) image shows restricted diffusion in the same tumor compared to normal prostate.

T2-weighted imaging of a man with extensive Gleason score 3+4=7 tumor shows low signal thoughout the peripheral zone corresponding to tumor. Very high B-valued high-resolution DWI (right) image shows restricted diffusion in the same tumor compared to normal prosatate.


3. 44 y.o., (F), tongue cancer study after chemoradiotherapy, previous study comparison showed mass worsening, this was an ACC (adenoid cystic carcinoma) – very rare.
Chemoradiotherapy (CRT, CRTx) is the combination of chemotherapy and radiotherapy to treat cancer.[1] Synonyms include radiochemotherapy (RCTx, RT-CT) and chemoradiation. Chemoradiotherapy as neoadjuvant therapy before surgery has been shown to be effective in various cancers.

There was deformity but no mass. However – there was:

– Pleural dissemination, so we checked the lymph nodes for metastasis and found ROUND lymph nodes (should be OVAL) and size over 1 cm.
– Metastasis in pleural wall…(chemotherapy regimen will probably be changed)

Below: Pleural effusion


4. 68 y.o.(M), calcification at bifurcation of both common carotid arteries, pt has both hard plugs and soft plugs, we looked at a CT, and 3D CT

Hard plug – calcification                                                                                                             Soft plug –  atheroma, (this can cause hemmorhage)

An atheroma is an accumulation of degenerative material in the tunica intima (inner layer) of artery walls. The material consists of (mostly) macrophage cells, or debris, containing lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.  

Below: Surface-rendered 3-dimensional volume CT angiogram demonstrates a complete occlusion of the right common carotid artery (CCA).

Below: CT and CT angiography in a patient with a load left neck bruit and symptoms of a transient ischemic attack. A, CT scan demonstrates that the left jugular vein (LJV) is superimposed on the left common carotid artery (LCCA). B, After electronic removal of the superficial left jugular vein, a high-grade stenosis of the origin of the left external carotid artery (LECA) is demonstrated clearly. Dense calcifications are seen (red arrows) near the origins of both the left external carotid artery and the carotid bulb. The left internal carotid artery is not significantly stenotic.

CT and CT angiography in a patient with a load lef

 Case below: A man in his 70s is referred to CT for follow-up of a stenosis of the right internal carotid.       

Below: Volume rendered image of the pure arterial enhancement, from aortic arch to Circle of Willis

Below: Maximum Intensity Projection (MIP) highlights calcified bilateral carotid artery plaques (arrow)


5. 88 y.o. (F), acute infarction of rt PCA due to stenosis, upon inspection rt PCA looked narrowed, brain perfusion is very important – PCA occlusion causes big problems, looked at FLAIR image, infarction involved the thalamus

Below: Infarction, posterior cerebral artery

Below: Figure 2: Left PCA occlusion. (a) Unenhanced CT scan shows hypodensity in left PCA territory. (b) DWI image shows acute left PCA territory infarct. (c) SWI images show susceptibility sign in proximal PCA (arrow). (d) Reconstructed volume-rendered images from contrast-enhanced MRA show left PCA occlusion after the origin (arrow)

6. 71 y.o. (M), infarction of paramedian artery, we see infarction in pons, looked at microangiogram, basilar arteries, vertebral arteries, thalamus, noticed gliosis, looked and DWI image, FLAIR image

Below: Axial T1: hypointensity signal in right thalamus

Below: Axial T1: slight hypointense signal in right paramedian pons

7. 79 y.o. (F), ascites (inflammation and fluid  in the perititoneal cavity), swelling in stomach wall, intrahepatic bile duct enlarged or bileoma (Bilomas refer to extrabiliary collections of bile), an abcess can cause infection and visa versa, passive atelectasis (passive atelectasis is caused by simple pneumothorax), resected mass taken out of liver

Below: Axial CT shows severe bilateral pleural effusion with passive atelectasis in lower lobes of both lungs.

Below: Ascites. Axial CT scan of the abdomen shows low density ascitic fluid surrounding the liver, spleen and stomach. – See more at: http://learningradiology.com/archives06/COW%20193-Ascites/ascitescorrect.htm#sthash.L9bafCEr.dpuf

Ascites

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