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Legionnaires' disease in chest x-ray

It is acute gram-negative bacterial pneumonia that occurs in local outbreaks or as sporadic cases and may cause a fulminant, often fatal, pneumonia. Small pleural effusions are common, whereas cavitation and hilar adenopathy are unusual. Most patients respond well to erythromycin, though the radiographic resolution often lags behind the clinical response.

Imaging Findings:
Patchy or fluffy alveolar infiltrate that rapidly progresses to involve adjacent lobes and the contralateral side.

Breast Cancer in Male Imaging

On mammography , male breast cancer is subareolar or somewhat eccentric to the nipple, with well-defined, ill-defined, or spiculated margins. Calcifications are observed less commonly than in female breast cancer and, when found, are coarser in appearance. Calcifications can also be seen in fat necrosis. Axillary adenopathy may be observed as well.

Mammography is highly sensitive and specific for breast cancer in men, but it should be used to complement the clinical examination. At present, not enough clinical data are available to determine whether the combination of imaging and clinical findings can replace biopsy for the diagnosis of palpable breast abnormalities in men. Ultimately, biopsy should be considered to diagnose male breast cancer because the findings of inflammation, gynecomastia, and fat necrosis can be similar.

False Positives/Negatives

Inflammation, gynecomastia, and fat necrosis may appear similar on mammograms; therefore, these condition can cause false-positive findings. Cases of carcinoma have been found by ultrasonography after they were obscured on previous mammograms by gynecomastia.
A partially circumscribed retroareolar mass in a male with suspicious microcalcifications; this is known breast cancer.

Findings on Ultrasonography:
A hypoechoic mass with irregular, ill-defined, or circumscribed margins may be observed on ultrasonography. With color flow imaging, vascular flow within the mass may be demonstrated.

Similar sonographic findings may be observed in gynecomastia or inflammation; therefore, ultrasonography alone is not a reliable method to distinguish male breast cancer from other etiologies.

Medical Careers : How to Become a Radiologist

To become a radiologist, a science-related bachelor's degree is required, followed by four years of medical school and a residency in radiology. Consider becoming a radiologist with tips from a practice administrator in this free video on career information.

3D Radiological Cross-Sectional Anatomy with Multidetector CT

An exciting new resource for anyone using cross sectional anatomy or involved in the interpretation of radiological scans. Thousands of clear and accurate images, in an intuitive digital format, provide the user with an invaluable aid to cross section anatomy, CT and MRI interpretation and a stunning 3D anatomy image library.

Radiologic Findings of Achondroplasia

Image shows inverted femoral physes (inverted V configuration), which contributes to a waddling gait.

Enlarged calvaria. Note the enlarged mandible.

Achondroplasia: Sagittal section of the cervical spine T2-weighted MRI showing narrowing of the foramen magnum at C1 canal, effacement of the subarachnoid spaces at the cervicomedullary junction, abnormal intrinsic cord signal intensity in this 6-year-old patient who presented with a neurologic deficit.

Ottawa knee rule

A knee x-ray is only required for knee injury patients with any of these findings:

  • age 55 or over
  • isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
  • tenderness at the head of the fibula
  • inability to flex to 90 degrees
  • inability to weight bear both immediately and in the casualty department (4 steps - unable to transfer weight twice onto each lower limb regardless of limping)

Chest radiograph: mnemonics checklist to examine

"Pamela Found Our Rotation Particularly Exciting; Very Highly Commended Mainly 'Cus She Arouses":
  • Patient details
  • Film details
  • Objects (eg. lines, electrodes)
  • Rotation
  • Penetration
  • Expansion
  • Vessels
  • Hila
  • Costophrenic angles
  • Mediastinum
  • Cardiothoracic Ratio
  • Soft tissues and bones
  • Air (diaphragm, pneumothorax, subcut. emphysema)

Large Prolactinoma on MRI imaging

A 32-year-old man presented with a 6-month history of severe headaches, hemiparesis on the left side, and impaired hearing in the left ear. His medical history was otherwise unremarkable.
Magnetic resonance imaging(MRI) with gadolinium revealed a large mass (5.6 cm by 6.9 cm) invading the base of his skull (Panels A and B, arrows). To evaluate the patient for the presence of what was most likely a pituitary macroadenoma, the serum level of prolactin was measured and reported as 7.3 μg per liter (normal range, 4.1 to 18.4).

In cases of large prolactinomas, the initial prolactin level may be erroneously read as normal. After serial dilution of the patient's blood sample to 1:1000, the measured prolactin level was 122,260 μg per liter. Laboratory testing also revealed central hypogonadism. Immunohistochemical staining of a transnasal-biopsy specimen of the mass showed a lactotropic adenoma with tumor cells that were positive for prolactin. Four days after the initiation of treatment with cabergoline, the prolactin level declined to 10,823 μg per liter.
By the time of the 3-week follow-up visit, the prolactin level had further declined, to 772 μg per liter, and the patient's neurologic symptoms had resolved. After 40 months, the prolactin level was maintained at 25 μg per liter and the tumor had regressed substantially (Panels C and D, arrows). The central hypogonadism persisted.

Head and Shoulder Model - Muscles of Mastication

Adenomyomatosis of gall bladder-Segmental type

Adenomyomatosis :a benign condition described as hyperplastic changes of unknown cause involving the wall of gallbladder and causing overgrowth of the mucosa, thickening of the muscular wall, and formation of intramural diverticula or sinus tracts termed Rokitansky-Aschoff sinuses .
Adenomyomatosis is a common tumorlike lesion of the gallbladder with no malignant potential and may involve the gallbladder in a focal, segmental, or diffuse form.

This patient underwent routine sonography of the abdomen. Ultrasound images of the gall bladder reveal thickening and constriction of the mid segment dividing the lumen into a fundic area and another part towards the neck. There is also evidence of small calculi in the fundic segment of the gall bladder.
These ultrasound images suggest segmental adenomyomatosis of the gall bladder. Adenomyomatosis of the gall bladder may be segmental, diffuse or fundal. Images taken using Toshiba Powervision ultrasound and color doppler machine.

Anatomy In CT abdomen

The video will describe anatomical structures as seen on a CT Scan.

Monod sign on Chest - CT scan

Chest radiograph: mnemonics checklist to examine

"Pamela Found Our Rotation Particularly Exciting; Very Highly Commended Mainly 'Cus She Arouses":
  • Patient details
  • Film details
  • Objects (eg. lines, electrodes)
  • Rotation
  • Penetration
  • Expansion
  • Vessels
  • Hila
  • Costophrenic angles
  • Mediastinum
  • Cardiothoracic Ratio
  • Soft tissues and bones
  • Air (diaphragm, pneumothorax, subcut. emphysema)

Mitral Valve Prolapse and Mitral Regurgitation

Mitral valve prolapse and consequent mitral valve regurgitation is seen during TEE examination in a patient undergoing mitral valve repair. The P2 scallop of the posterior mitral leaflet is seen as prolapsed with a flail chord. Color Doppler shows a mitral regurgitant jet.

Evaluation of Collateral Ligament Injury

No validated rules have been formulated for the use of radiography in patients with suspected ligament injuries, but a decision tree can be used as a guide (Figure below).
Although plain radiographs may be useful in the initial diagnosis of these injuries, magnetic resonance imaging (MRI) is becoming the preferred diagnostic method and is rapidly replacing other techniques as the study of choice for the evaluation of knee injuries. However, the routine use of MRI has been questioned because of its significant cost ($600 to $1,200) and the high accuracy of clinical examination in diagnosing some injuries.

Gastric Volvulus and X-Ray

Gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180°, creating a closed loop obstruction that can result in incarceration and strangulation.

Type 1

* This type comprises 2/3 of cases and is presumably due to abnormal laxity of the gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments. This allows approximation of the cardia and pylorus when the stomach is full, predisposing to volvulus.
* This type is more common in adults but has been reported in children.

Type 2

* This type is found in 1/3 of patients and is usually associated with congenital or acquired abnormalities that result in abnormal mobility of the stomach.
* Congenital defects as:
-Diaphragmatic defects - 43%
-Gastric ligaments - 32%
-Abnormal attachments, adhesions, or bands - 9%
-Asplenism - 5%
-Small and large bowel malformations - 4%
-Pyloric stenosis - 2%
-Colonic distension - 1%
-Rectal atresia - 1%
The most common causes of gastric volvulus in adults are diaphragmatic defects. In cases of paraesophageal hernias, the gastroesophageal junction remains in the abdomen, while the stomach ascends adjacent to the esophagus, resulting in an upside-down stomach. Gastric volvulus is the most common complication of paraesophageal hernias.

Imaging findings

* Massively dilated stomach in LUQ(left upper quadrant) possibly extending into chest
* Inability of barium to pass into stomach (when obstructed)

Frontal radiograph from an upper GI examination shows the stomach
located in the lower chest in a large hiatal hernia. The greater curvature
of the stomach lies superior to the lesser curvature in an organoaxial twist.
Note that the stomach is not obstructed.

Organoaxial and Mesenteroaxial types:
#Organoaxial type:Twist occurs along a line connecting the cardia and the pylorus--the luminal (long) axis of the stomach.

#Mesenteroaxial type:Twist occurs around a plane perpendicular to the luminal (long) axis of the stomach from lesser to greater curvature.

CT scan of chest, Ground-glass opacification

The video will shed some light on Ground-glass opacification and Crazy paving pattern.

Evaluation of Collateral Ligament Injury

No validated rules have been formulated for the use of radiography in patients with suspected ligament injuries, but a decision tree can be used as a guide (Figure below).
Although plain radiographs may be useful in the initial diagnosis of these injuries, magnetic resonance imaging (MRI) is becoming the preferred diagnostic method and is rapidly replacing other techniques as the study of choice for the evaluation of knee injuries. However, the routine use of MRI has been questioned because of its significant cost ($600 to $1,200) and the high accuracy of clinical examination in diagnosing some injuries.

CT of Acute Pyelonephritis

* Inflammation of the renal parenchyma and renal pelvis due to an infectious source

* Most often secondary to an ascending lower urinary tract infection from gram-negative bacteria
- E. coli
- Klebsiella
- Proteus
- Pseudomonas.

* Exception is S. aureus, which is spread hematogenously

Pathologic Causes:
o Vesicoureteral reflux
o Obstruction in the collecting system usually due to a calculus

Signs and symptoms:
- Fever
- Chills
- Flank pain
- Dysuria
- Increased frequency of urination.
- On exam, costovertebral angle tenderness may be present.

Clinical Findings:

1- CBC
- Elevated white blood cell count.

2- Urinalysis
- Bacteriuria
- Pyuria
- White blood cell casts

3- Acute pyelonephritis is clinical diagnosis,
- Radiographic imaging is used to evaluate underlying pathology
- Rule out any complications as:
-Emphysematous pyelonephritis.....Most often occurs in diabetics Can produce gas in the collecting system and renal parenchyma.

Right kidney is markedly enlarged and has a wedge-shaped area of low attenuation

Radiographic Imaging Findings:
$ Enlarged kidneys (U/S and CT)
$ Hydronephrosis (U/S and CT)
$ Wedge shaped areas of low attenuation secondary to decreased perfusion (CT)
$ Loss of the ability to distinguish the corticomedullary border (CT)
$ Perinephric stranding (CT)


o Antibiotics for non-complicated pyelonephritis.
o Radical nephrectomy for emphysematous pyelonephritis.
o Percutaneous drainage of abscesses

Imaging findings in Bladder Rupture

-Diagnostic evaluation of bladder rupture includes voiding cystourethrography (VCUG) or CT scan

o Voiding cystourethrography historically been preferred contrast enhanced
study for diagnosis of bladder rupture
o Bladder needs to be fully distended and evaluation of a post-voiding
film essential
* Plain film:
o "Pear-shaped" bladder
o Paralytic ileus
o Upward displacement of ileal loops
o Flame-shaped contrast extravasation into perivesical fat
+ Best seen on postvoid films
+ May extend into thigh / anterior abdominal wall
One image from an IVU shows a flame-shaped density adjacent to
right lateral wall of bladder representing extra-peritoneal contrast from a bladder rupture

* US
o "Bladder within a bladder" = bladder surrounded by fluid collect

Anatomy of aorta and appearance on x-ray

female reproductive system anatomy

more targeted therapy for psoriatic and rheumatoid arthritis by contrast-enhanced MRI

In the past the treatment for patients with psoriatic arthritis was based on the treatment for those with rheumatoid arthritis
According to a new study ,contrast-enhanced magnetic resonance imaging (MRI) could help to differentiate between psoriatic and rheumatoid arthritis in hands and wrists. the results of the study might lead to a more targeted therapy unique to each condition.

This study
that was done at the University Hospital of Tubingen imaged using contrast-enhanced magnetic resonance imaging 31 patients with rheumatoid arthritis and 14 with psoriatic arthritis. The contrast media in rheumatoid and psoriatic arthritis is presumed to be different and the difference can only be seen 15 minutes after the contrast material is given.
“Our study revealed a significant difference in perfusion between those patients with rheumatoid arthritis and psoriatic arthritis after 15 minutes. However, since it was a small group of patients and there was an overlap in perfusion values between both types of arthritis, a diagnosis could not be led by contrast-enhanced MRI alone. Our results are nonetheless promising though,” said Nina Schwenzer, lead author of the study.

Pulmonary Stenosis X-Ray

Imaging Findings:
There is Enlargement of the right atrium and right ventricle with decreas of pulmonary vascularity.

The enlargement of Right atrium is secondary to enlargement of the right ventricle.

Pulmonary atresia: Marked right atrial enlargement associated with decreased pulmonary vascularity.

Anencephaly:First congenital anomaly to identify

Imaging Findings:
unable to identify normal brain tissue cephalad to the bony orbits or brainstem along with symmetric absence of the bony calvarium.

Anencephaly. Long-axis image of a 14-week fetus demonstrates a poorly developed, small head (arrows) visualized in continuity with the fetal spine (arrowhead).

NOTE THAT: It is First congenital anomaly to identify in utero with ultrasound. The diagnosis can be made as early as the 12th week of gestation and is typically made at the time of an attempted biparietal diameter determination for fetal age.

MRI of Temporomandibular joint effusion

A temporomandibular joint (TMJ) effusion is unusual in asymptomatic patients, and thus should trigger a careful search for underlying pathology. It usually precedes osteoarthritis of the TMJ. Effusions are seen in:

  • TMJ dysfunction
  • septic arthritis
  • rheumatoid arthritis

“Small TMJ joint effusion.”

“Mild TMJ effusion”
“large TMJ effusion. ”

Radiographic features

On PD / T2 weighted sequences, both synovial proliferation and effusions can be high on signal. If necessary they two can be distinguished by administering gadolinium.

Answer this case

Look at the following case. Why is this an emergency? The patient has:

a. A tension pneumothorax.
b. An acute pneumonia of the right lung.
c. Had a pulmonary embolism.
d. A simple pneumothorax.
e. Been shot.

Lunate bone Dislocation

*Most severe of carpal instabilities

*Most commonly associated with a trans-scaphoid fracture

*Involves all the intercarpal joints and disruption of most of the major carpal ligaments

*Produces volar dislocation and forward rotation of lunate
Concave distal surface of lunate comes to face anteriorly

*Capitate drops into space vacated by lunate

*Capitate and all other carpal bones lie posterior to lunate on lateral radiograph

*Triangular appearance of lunate on frontal projection

Pagets Disease

The photos show Pagets of the tibia - lower leg - bowing - clinical and Xray

Pagets Disease
is a metabolic bone disease that involves bone destruction and regrowth that results in deformity. The patient is frequently entirely assymptomatic and the condition can be discovered after routine Xrays, requested for other reasons. However of those people who become symptomatic, the commonest features are:

Deformity of bone
Manifestations of complications.
Detail of the thickened and irregular bone structure

In pagets disease
, the remodelling process(by osteoclast and osteoblast) is disordered, with large abnormal osteoclasts working at a much greater turnover than normal, followed by the irregular laying down of bone

Gone are the days where pain killers and antiinflammatories were the only approach. The mainstay of therapy at the current state of the art is that of bisphosphonates, either oral or intravenous pulse. Such preperations include - alendronate(oral), risedronate (oral) and pamidronate (intravenous) . Such therapy results in a reduction in the alkaline phosphatase, and reduction in pain.

Axillofemoral bypass graft

This elderly female patient underwent an axillofemoral graft (also called axillofemoral bypass graft) for loss of blood flow in the right femoral artery. The procedure involved connecting the right femoral artery and right axillary artery using an artificial graft tube, which was placed along the subcutaneous plane of the chest and abdomen. This patient underwent Color Doppler imaging to assess the condition and flow in the graft tube. The color Doppler image above shows the artificial axillofemoral graft tube with normal flow through it.
Note the large diameter of the graft tube and location in the subcutaneous plane of the chest wall.

Angiography -- Abdominal aorta

The video will explain abdominal branches and procedure of DSA.

How Klebsiella infection appears on chest X-ray

Imaging Findings :
Homogeneous parenchymal consolidation containing air bronchograms (simulates pneumococcal pneumonia). Primarily involves the right upper lobe. Typically induces a large inflammatory exudate, causing increased volume of the affected lobe and characteristic bulging of an adjacent interlobar fissure.See this figure below:

Small Comment:
Most commonly develops in alcoholics and in elderly patients with chronic pulmonary disease. Unlike acute pneumococcal pneumonia, Klebsiella pneumonia causes frequent and rapid cavitation, and there is a much greater incidence of pleural effusion and empyema.

For Comparison with pneumococcal pneumonia :

Pneumococcus infection on X-ray

Imaging Findings:
Homogeneous consolidation that almost invariably abuts against a visceral pleural surface and almost always contains an air bronchogram.

Note that this infection most commonly occurs in alcoholics and other compromised hosts. Cavitation and pleural reaction are rare.
In children, may produce the so-called round or spherical pneumonia, in which a well-circumscribed spherical consolidation on both frontal and lateral views simulates a pulmonary or mediastinal mass (See the figure below)

Melorheostosis X-ray on Hand

This patient presented by a pain in left index finger after a trivial sport-related injury. AP and lateral views of the left index finger and subsequently an AP view of the left hand were performed.
After initial inspection of these views it was decided to obtain an AP view of the whole of the left hand including the wrist. On examination the patient had full range of movement and no skin abnormalities were seen.

Both the dedicated views of the left index finger and the radiograph of the left hand demonstrated irregular endosteal linear areas of increased density along the major axis of the 2nd and 3rd metacarpals and the 1st, 2nd and 3rd proximal phalanges. These were encroaching on the medulla, but were primarily cortically based. The adjacent epiphyses were also involved to varying degrees. Additionally, there was almost complete sclerosis of the 2nd and 3rd middle and distal phalanges and their epiphyses. There were also irregular areas of sclerosis in the lunate, trapezoid and capitate. Joint fusion, shortening of the involved bones or ossified soft tissue masses were not detected. Unfortunately, no radiographs of the contralateral hand were available for comparison.

The appearances are consistent with melorheostosis.

Irregular endosteal sclerosis along the major axis of the 2nd proximal phalanx and almost complete sclerosis of the middle and distal phalanges, including their epiphyses.

Similar appearances as seen in the index finger are also seen in other bones of the left hand, including irregular areas of sclerosis in the lunate, trapezoid and capitate.

What is melorheostosis ??
Melorheostosis is a non-genetic disease of unknown aetiology. It is usually unilateral, asymmetrical and the most common site is in the diaphyses of the lower limb. Sclerotic linear streaks along the long axis of the affected bone, which are often likened to "dripping candle wax", are seen. The epiphyses may also be affected. Soft tissue calcification and ossification with a periarticular predisposition may occur. Melorheostosis can be asymptomatic but may also present with pain, soft tissue contracture and indurating skin lesions. In this patient the finding may be incidental and her pain attributed to soft tissue injury, or the pain may be due to the melorheostosis. Time will tell!

Hemospermia due to Seminal vesicle calculi

Seminal vesicle calculi are a known cause of passage of blood in semen. This patient had hemospermia. TRUS images show a calculus in right seminal vesicle. Possibly such calculi cause irritation and trauma to the delicate walls of the seminal vesicle resulting in hemorrhage. But surgery may be the final alternative in this case.

Anatomy of Pectoral Girdle Bones

Fantastic Video about Auditory Transduction

This 7-minute video by Brandon Pletsch takes viewers on a step-by-step voyage through the inside of the ear, to the acoustic accompaniment of classical music.

Tear of Medial Cruciate Ligament

These are ultrasound images of the right knee joint following a motorcycle accident. There is a curvilinear echogenic structure within the medial part of the right knee joint cavity. Diagnosis: traumatic rupture of the distal insertion of the medial cruciate ligament, which now floats within the fluid distended (possible hemorrhagic) joint space.

Intraocular foreign body-Trauma to eye

Sonography of the orbits was performed on this patient who sustained injury. Ultrasound images reveal a hyperechoic object in the vitreous cavity within the vitreous humor of the right eyeball. These sonographic findings are diagnostic of intraocular foreign body. Normal left eye is shown for comparison.
Images courtesy of Dr. Jaydeep Gandhi, Radiologist, Mumbai, India.

5 Steps to Chest X-ray Interpretation

Learn some basics of chest x-ray interpretation.

Cancer Treatment Costs Nearly Double (Exceed $48 Billion, Patients' Out-of-Pocket Payments Decrease)

May 10, 2010 -- The cost of treating cancer in the U.S. has nearly doubled in the past 20 years, according to a new analysis.

The analysis also found that outpatient care has become a trend and out-of-pocket costs to patients have declined.

Researchers from the CDC and other institutions looked at data from the 1987 National Medical Care Expenditure Survey and compared the information with data from the 2001 through 2005 Medical Expenditures Panel Survey. The report is published online in the journal Cancer, a journal of the American Cancer Society.

Among the findings:

* The total medical cost of cancer in 1987 was $24.7 billion, expressed in 2007 dollars.
* The total medical cost of cancer increased to $48.1 billion during 2001-2005.
* The increase is the result of new cases in the aging population as well as an increase in the prevalence of cancer.
* As a share of overall medical expenses, cancer costs remained fairly constant, accounting for about 5% each time period.
* Outpatient care became more common, with the expenses for inpatient care for cancer falling from 64.4% to 27.5% of total cancer treatment costs.
* The share of cancer costs paid for by private insurance increased from 42% to 50%, and the share of out-of-pocket costs fell from 17% to 8%. In 1987, Medicare paid for 33% of costs; by 2001-2005, it paid for 34%.

The researchers note limitations of the study, such as the tendency for cancer patients with advanced disease not to participate in surveys, which may translate to an underestimate of costs. The data don't include some information on the "true burden" of cancer, such as the nonmedical costs for child care, travel, caretakers, and lost productivity.

Even so, the data ''enhances our understanding of the burden of cancer on specific payers and how this burden may change as a result of healthcare reform measures or other changes to healthcare financing and delivery,'' the authors write.

MRI showing Pneumocele-Frontal Sinus with Proptosis

Note the expansion of the frontal and ethmoid sinuses with resultant axial proptosis.

Spina bifida in fetus

In this fetus , sonography of the lumbosacral spine shows a major defect in the posterior part of the fetal lumbar and sacral vertebrae due to failure of closure of the dorsal part of the vertebrae (the laminae and spinous processes). The ultrasound image in top , shows 2-D (B-mode) display of the large defect in long section. The image on middle, shows the same appearance in 3-D ultrasound.
The post natal photograph of the area (lower back) shows the open spinal canal. This type of spina bifida is called spina bifida cystica. (Ultrasound images of spina bifida are courtesy of Dr. Martin Horenstein, Argentina).