Today’s cases: February 6th, 2016

  1. Acute cholecystitis, cyst, gallstones – Adenomyomatosis, MRCP – white/water area can be seen.

Magnetic resonance cholangiopancreatography or MRCP uses a powerful magnetic field, radio waves and a computer to evaluate the liver, gallbladder, bile ducts, pancreas and pancreatic duct for disease. It is noninvasive and does not use ionizing radiation.

LINK

Adenomyomatosis of the gallbladder is a hyperplastic cholecystosis of thegallbladder wall. It is a relatively common and benign cause of diffuse or focal gallbladder wall thickening. It is most easily seen on ultrasound and MRI.

Axial

Axial T2

Coronal T2


 

2. 45 yo male, gall bladder polyps, is there a stone? —- check the common bile duct..jaundiced eyes, incr bilirubin, OVAL mass? if kidney cyst – benign

Gallbladder polyps are growths or lesions resembling growths (polypoid lesions) in the wall of the gallbladder. True polyps are abnormal accumulations of mucous membrane tissue that would normally be shed by the body.


 

3. 73 yo male, energy imbalance, post surgery for IPMN, sudden pain liver function damage, intra hepatic bile duct DILATED, b/c stenosis? / in hepatic hilum? Looked at saggital view, T1 ERCP tube

Intraductal papillary mucinous neoplasm (IPMN) is a type of tumor (neoplasm) that grows within the pancreatic ducts (intraductal) and is characterized by the production of thick fluid by the tumor cells (mucinous).

 

Below: Abdominal ultrasound revealed marked intrahepatic biliary duct dilation and an intrahepatic bile duct stone in the left lobe of the liver with posterior acoustic shadowing (arrowhead).


4. Headaches, discomfort, left side of face, Cavum vergae (aysmptomatic), extrernal carotid artery OK, MRA if white OK, if dark – stenosis, sinusitis maxillary sinus

The cavum vergae (CV), along with the cavum septum pellucidum (CSP) is a persistence of the embryological fluid-filled space between the leaflets of the septum pellucidum and is a common anatomical variant. The CV is sometimes referred to as the 6th ventricle 3.

 


 

5. 40 yo male, acoustic tumor, SAGITAL VIEW: internal acoustic meatus, internal auditory canal, sinusitis

Below: internal acoustic meatus

Sinusitis


 

6. 40 yo male, Submandibular gland cancer, bone metastasis to Thoracic 1-3, 5-9,  PET CT, Gadolinium enhanced MRI, lesion is colored, Tx radiation therapy (compression of spinal cord leads to paralysis)

Below: Images are of a 38-year-old woman with a left submandibular gland tumor. A maximum intensity projection image (A) and fused PET/CT image (B) were obtained. Early-phase SUVmax, delayed-phase SUVmax, and retention index for the tumor were 17.4, 23.1, and 32.8%, respectively. The tumor was diagnosed as pleomorphic adenoma. Images courtesy of AJR.

PET/CT of submandibular gland tumor

Figure 8: Non-contrast T2W axial & coronal images (top row) and T1W axial and coronal images showing parotid (thick white arrows) and submandibular glands (thin white arrow)

Below: Figure 2: MRI : Sagittal short tau inversion recovery (STIR). Axial T2 weighted images (T2WI). Sagittal and axial postcontrast T1 weighted images (T1WI): lesion involving the vertebral body and posterior elements of the fourth lumbar vertebra, hypointense on T1WI and hyperintense on T2 and STIR, with strong enhancement after administration of gadolinium. Presence of prevertebral and right epidural soft tissue masses. Intervertebral disc spared.

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7. Emergency case: 76 yo male, post op DCM, Short of breath, pleural effusion, referring MD things heart failure or pneumonia? CRP evaluation, thickness seen in bronchial wall, no lung fluid elevation, so probably infection

Dilated cardiomyopathy (DCM) is a condition in which the heart’s ability to pump blood is decreased because the heart’s main pumping chamber, the left ventricle, is enlarged and weakened. In some cases, it prevents the heart from relaxing and filling with blood as it should.

Chest radiograph shows a large heart. Image does n

Chest radiograph shows a large heart. Image does not provide any clue to the etiology of the dilated cardiomyopathy; however, the healing rib fractures and right lower lobe pneumonia (aspiration pneumonia) suggest alcoholic cardiomyopathy as the cause.

Magnified right chest radiograph shows an area of right lower lobe aspiration pneumonia in a patient with dilated cardiomyopathy (same patient as in the previous image).


8. Emergency case: 95 yo female, unconscious, lacunar infarction in pons, cerebral peduncle, crus cerebri, no internal hemorrhage, MRI showed deep cerebral infarcton in deep cerebral white matter, black area – old hemmorage, T2 micro bleeding in pons/thalamus? cervical MRA – ICA not well visualized, stomach herniation, enlarged gall bladder


 

 

 

 

 

 

 

 

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