Appearance of lye strictures in X-ray

-What is the most likely diagnosis in the patient shown below?

a. Esophageal varices
b. Esophageal carcinoma
c. Reflux esophagitis
d. Lye stricture
e. Fibrovascular polyp


THE RIGHT ANSEWR : .d

There is very long segment of smoothly narrowed esophagus from just below the level of the clavicles to the EG junction. This appearance is characteristic of a stricture caused by the ingestion of a caustic material such as lye. Lye, which became component of some drain cleaners in the late ?60s, is so highly toxic that only a few drops can cause this full-thickness liquefaction necrosis of the esophagus. The acute ulcerative phase is invariably followed in several weeks by this fibrotic stage. There is a significantly higher incidence of carcinoma of the esophagus in patients with lye strictures than in the normal population.

Increased Anterior Posterior Diameter

Increased Anterior Posterior Diameter:
Barrel chested appearance resulting from air trapping
that sometimes occurs with advanced COPD. Xray on the right also demonstrates the increased
A-P diameter along with flattening of the diaphragms.

Ileocecal Intussusception

A 45-year-old man with no notable medical or surgical history presented with a 24-hour history of intense pain in the right side of the abdomen with associated nausea and vomiting. He reported having had similar but much less severe episodes during the previous 6 months. Results of initial laboratory tests were unrevealing.
Physical examination showed moderate abdominal distention. Computed tomographic scans of his abdomen revealed an ileocecal intussusception (Panel A, arrow) with a pathologic mass, 2.5 cm in diameter, at the apex, also known as the lead point (Panel B, arrow). Diagnostic laparoscopy was performed, and the diagnosis of intussusception was confirmed.

Laparoscopically assisted ileocecal resection with primary anastomosis was performed. Gross inspection of the specimen showed a pedunculated lipoma within the terminal ileum. The patient had a rapid recovery, with complete resolution of his symptoms.

Large urinary bladder calculus (by Pie Scanner 100 Falco system)

This 50 yr. old male patient complained of hematuria. Sonography reveals a large echogenic,oval object of 4.4 cms. in the urinary bladder. As the ultrasound images reveal, it is freely mobile with change in position, occupying the dependent part of the bladder. Diagnosis: large stone in the urinary bladder. Urinary bladder calculi are usually formed by migration of stones from the kidney or ureter. It may also be caused due to stasis of urine in the bladder, due to bladder outlet obstruction. Ultrasound images taken using Pie Scanner 100 Falco system.

64 MDCT/CTA/3D Evaluation of Pancreatic Masses

Pneumococcal pneumonia in chest X-ray

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.

Imaging Findings:

It appears as Homogeneous consolidation that almost invariably abuts against a visceral pleural surface and almost always contains an air bronchogram.

Pneumococcal pneumonia. Homogeneous consolidation of the right upper lobe and the medial and posterior segments of the right lower lobe. Note the associated air bronchograms (arrows).

3- D ultrasound image WOW !!

These 3 dimensional ultrasound images show various pathologies of the urinary bladder, providing a whole new "dimension" to sonographic imaging.

3- D ultrasound image of ureterocele:
The Rt. ureterocele is seen as a small sac bulging in from the posterior wall of the bladder.


3-D ultrasound image of bladder diverticulum:
A small right sided vesical diverticulum. (UB= urinary bladder)



Vesical calculus:
This 3-D ultrasound image of a vesical calculus shows that 3-D imaging must be used in conjunction with 2-D B-mode imaging to identify pathology. This bladder calculus is difficult to distinguish from (see topmost image) ureterocele purely on 3-D ultrasound. Perhaps a cross sectional image would show the internal structure better. (All images courtesy of Ravi Kadasne, MD, UAE).

Acromegaly X-ray & Imaging Studies

This is a lateral view of a pituitary adenoma. Please note the expanded sella turcica (between the orbit on the left and the radio-dense mastoid on the right).


Radiographic features of abnormalities of the hand and wrist in a female patient aged 48 yr with an estimated disease duration of 8–10 yr. At the hand, note at terminal phalanges the enlargement of tuft and bases. At metacarpophalangeal joints, it is worth noting the widening of some articular spaces, whereas at the proximal interphalangeal joints there is narrowing of others. Note the width of some proximal phalanges resembling the presence of "beak-like" osteophytes at the level of distal interphalangeal joints and at proximal interphalangeal joints. Periarticular calcific deposits are also present. At the wrist, note the enlargement of distal radius and ulna as well as at ulnar styloid. Lateral to the radius, some "beak-like" osteophytes can be appreciated.

Radiographic features of bone proliferation at sites of tendon and ligament attachment to bone (enthesopathy) in a female patient aged 48 yr with an estimated disease duration of 8–10 yr. Note the proliferation along the posterior margin of the calcaneus. This is a proliferative enthesopathy different from the common enthesopathy occurring in other rheumatic diseases. This latter spondyloarthopathy is characterized by a primary erosive, due to local release of cytokines, and a secondary proliferative process.



Sagittal spin-echo T1-weighted MR image (420/15, 90° flip angle) of a sparsely granulated GH-producing adenoma in a 61-year-old woman. The height of the adenoma is 23 mm. The adenoma has grown in an infrasellar direction (arrows). No suprasellar component is noted.

Coronal fast spin-echo T2-weighted MR image (3,710/108, 90° flip angle) of a sparsely granulated GH-producing adenoma (large solid arrows) in a 45-year-old woman. This massive adenoma is hyperintense. Invasion of the right side of the cavernous sinus is seen with the displaced right internal carotid artery (open arrow) and the lateral wall of right side of the cavernous sinus (small solid arrows).

Ultrasound of Amoebic Liver Abscess

Amoebic liver abscess is usually single but can be multiple. Typically located in the right lobe of liver subcapsular close to the diaphragm and posterolateral, though it can be situated in any location. It`s size may vary from few centimeters to a large size occupying almost entire right lobe of liver.

Very early stage :

In the initial stage, cell death occurs but entire dissolution and liquefaction is not complete as the contents are not liquid. This may be termed as solid abscess. On ultrasound these lesions are usually small and probably are the most challenging as compared to the other stages of the liver abscesses. The margins of the abscess may be ill defined, the abscess is hypoechoic as compared to the surrounding liver. However, there is no true liquefaction at this stage and therefore there is poor or no posterior acoustic enhancement. The demarcation between the abscess and the surrounding liver is also poor.

At this stage, the differential diagnosis of fat spared area in a fatty liver or an early neoplastic lesion have to be considered.

Recently formed amoebic abscesses :

An abscess of recent onset has a distinct central liquified area. This is seen on ultrasound as a sonolucent or an hypoechoic area usually with fine internal echoes. Because of the liquefaction, there is associated posterior acoustic enhancement. The cavity may be round, oval or branching. The walls of the abscess at this stage are usually not very thick and sometimes the demarcation between the wall and the surrounding tissue can be poor. Sometimes the walls may be thicker and these may be seen as shaggy, ill-defined echogenic areas along the walls (see Picture). It is at this stage of the abscess that aspiration may be required. Small amount of air in the abscess because of secondary infection or following an aspiration is seen as highly reflective dots.

It is at this stage of the abscess that differential diagnosis of a cyst in the liver, a cyst with haemorrhage, cystic metastatic deposit or sometimes a hydatid cyst and haematoma are to be considered.

Abscesses of some duration :

The basic difference between an acute abscess and an abscess of some duration is that; in the latter the body has had time to wall up the lesion by producing a layer of fibrous tissue around it. On sonography an abscess shows thick walls which may vary from a few mm to 1.5 cm in thickness. The echogenicity of the abscess also varies, abscesses generally become more sonolucent at this stage, some abscesses become more echogenic because of organisation of fluid.

Healing Stage :

The abscess heals, the liquid contents dry up, which has been described as putty appearance. On ultrasound it is seen again as a lesion with thick walls fairly echogenic as compared to surrounding organs. This shadow can be seen on ultrasound for a long time, even years. It is usually at this stage that the differential diagnosis of a neoplasm, haemangioma or granuloma in liver come into picture.

Electrotherapy in Physiotherapy

Chest X-rays of the Kyphotic Patient

The radiographer has, by force of habit, angled the X-ray tube caudally for the AP sitting projection. This is a positioning trap in bedside radiography of kyphotic patients. The result is extreme foreshortening of the chest. Even the use of a horizontal ray would have resulted in significant foreshortening of the lung fields (see the lateral image).

This is a lateral chest image taken on a patient with a moderately severe thoracic kyphosis. A triangular positioning sponge has been placed behind the patient. Note that the patient's chest is angled forward considerably and this position is associated with the patient's thoracic kyphosis.

Allman and Tossy classification for Acromioclavicular joint injury

Normal acromioclavicular joint.

There are several classification systems for acromioclavicular joint injury grading,

Allman and Tossy classification

* grade I

•  mild sprain
•  normal plain film findings
•  increased T2 signal on MRI

* grade II

•  moderate sprain
•  subluxation by less than 50 % of clavicular height on plain film
•  fluid outside joint capsule on MRI

* grade III

•  complete disruption
•  widening of joint, more than 50% subluxation on plain film
•  MRI usually not required                                                                                                                

Acromioclavicular joint Grade 3 disruption - “Acromioclavicular joint injury, grade 3 ”

Watch an Angiogram Procedure

In this video, Dr. Mark A. Turco, Director of the Center for Cardiac and Vascular Research at Washington Adventist Hospital (Takoma Park, Maryland), performs an angiogram on a female patient with a history of heart disease in her family. Her stress test had indicated that she might have blockages in the blood vessels that carry blood to and from her heart. In his cath lab at Washington Adventist Hospital, Dr. Turco is able to see whether there are blockages and, if so, begin developing a treatment plan for her.

Berry aneurysm

A berry aneurysm refers to an intracranial aneurysm with a characteristic shape which accounts for the vast majority of intracranial aneurysms as well as non-traumatic subarachnoid haemorrhages. They occur at branch points, usually of sizable vessels, but sometimes at the origin of small perforators which may not be seen on imaging.

This photo on the right is Photo of a Norwegian blueberry.

Pathology

The aneurysmal pouch is composed of thickened hyalinised        intima with the muscular wall & internal elastic lamina being absent.

Comments required on a radiology report:

* size : ideally 3 axis maximum size meansurements
* neck : maximal width of the neck of the aneurysm
* shape and lobulations
* orientation : the direction in which the aneurysm points is often important in both endovascular and surgical planning

This small berry aneurysm projecting inferiorly from the ACOM had pushed into the optic chiasm causing a bitemporal hemianopia, similar to that seen in pituitary lesions.

SAH angiogram

Carpal bones mnemonic

Some Lovers Try Positions That They Can't Handle

• S - Scaphoid
• L - Lunate
• T - Triquetral
• P - Pisiform
• T - Trapezium
• T - Trapezoid
• C - Capitate
• H - Hamate

Proximal: A=Scaphoid, B=Lunate, C=Triquetral, D=Pisiform
Distal: E=Trapezium, F=Trapezoid, G=Capitate, H=Hamate

CT Scan Physics - Basics Part 2

CT Scan Physics - Basics Part1

Pearl necklace sign

Adenomyomatosis of the gallbladder is a hyperplastic cholesterolosis of the gallbladder wall which is common and benign.
Adenomyomatosis presents usually asymptomatic, however in most cases It is associated with chronic biliary inflammation, most commonly gallstones in 25 - 75% but also seen in cholesterolosis in 33% and pancreatitis.

The pearl necklace sign is seen in patients with adenomyomatosis of the gallbladder, on both oral cholecystograms and MRCP. It represents the contrast / fluid filled intramural mucosal diverticula (Rokitansky-Aschoff sinuses) which line up reminiscent of pearls on a necklace.

MRI images demonstrate adenomyomatosis at the gallbladder fundus This case was donated to Radiopaedia.org by Radswiki.net

It is said to be highly specific (92%) for the diagnosis of adenomyomatosis, however is frequently not seen, only present in ~70% of cases.

Silicosis

Asbestosis: a problem of industerial exposure

Pathophysiology, clinical data and radiology

Marjolin Ulcer-MRI

Malignant degeneration of untreated chronic wounds is a well-known complication. These rare, aggressive tumors that originate in chronically nonhealing wounds are called Marjolin’s ulcer. This is a 15 year old boy with long standing burn scar on the forearm.

Radiation Exposure

Abdominal CT versus X-Ray
Organ doses of radiation from CT scanning are considerably larger than those from corresponding conventional radiography. A conventional anterior-posterior abdominal x-ray examination results in a dose to the stomach of approximately 0.25 mGy, which is at least 50 times smaller than the corresponding stomach dose from an abdominal CT scan. A posterior-anterior chest x-ray would result in a radiation dose to the lungs of 0.01 mGy and a lateral chest x-ray, of a radiation dose of 0.15 mGy to the lungs.
Morning Report Questions

Q: Why are more children undergoing diagnostic testing with CT scanning?
A: The major growth area in CT use for children has been for the presurgical diagnosis of appendicitis, for which CT appears to be both accurate and cost-effective — though usually no more so than ultrasonography. A considerable literature questions the use of CT, particularly as a primary diagnostic tool for acute appendicitis in children. A poll of pediatric radiologists (Slovis, Pediatr Radiol, 2002) suggested that perhaps one third of all CT studies could be replaced by alternative approaches or not performed at all.

Q: What is a gray (Gy) — the unit used to describe the radiation dose delivered by a CT scan?
A: Various measures are used to describe the radiation delivered by CT scanning, the most relevant being absorbed dose, effective dose, and CT dose index. The absorbed dose is the energy absorbed per unit of mass and is measured in grays (Gy). One gray equals 1 joule of radiation energy absorbed per kilogram.

CT & Sonography of Pancreatic Serous Cystadenoma

Cystic lesions of the pancreas are common, and 80-90% of these lesions are pseudocysts or retention cysts. Cystic neoplasms of the pancreas are less common, accounting for about 10-15% of all cystic pancreatic lesions. True cysts of the pancreas are rare.

The two most common cystic neoplasms of the pancreas are serous cystadenoma (which is benign )and mucinous cystic neoplasms.Serous cystadenoma is more common than mucinous cystic neoplasm, with a ratio of about 2:1. Intraductal papillary mucinous tumor (IPMT) is a more recently discovered cystic neoplasm that may be a variant of the mucinous cystic neoplasm (biologic behavior of mucinous cystic neoplasm and IPMT ranges from benign to malignant).

Radiography:

No radiographic abnormalities are associated with serous cystadenoma except those related to a mass that is large enough to displace or obstruct the bowel or those related to a prominent central calcification.
The main mimics of this tumor are pseudocysts and mucinous cystic tumors.

C.T. : Classically, these lesions have a mean diameter of 5-8 cm (range, 4-20 cm) and a lobulated external contour. They are composed of a grapelike cluster or honeycomb pattern of 6 or more uniformly sized cysts that are 2 cm or smaller. They tend to occur in the head or neck of the gland, although biliary obstruction is present in only about 15% of the cases.

In about 30% of the cases, a central, stellate, late-enhancing scar is present with calcification. Small septa and internal debris may be seen in individual cysts. Because the capsule of these tumors is poorly developed, there is often poor distinction of the tumor from the surrounding pancreatic parenchyma. No communication occurs with the pancreatic duct, except in rare cases.

Serous cystadenoma on a contrast-enhanced CT scan. Note the Swiss cheese–like enhancement and gentle external lobulation.

Serous cystadenoma on a nonenhanced CT scan. Note the central calcification, attenuation similar to that of water, and external lobulation.

Ultrasonography:

The cluster-of-grapes pattern and external lobulation may be seen. However, when the cysts are small, the mass can be echogenic (because of the large number of acoustic interfaces), and they can appear solid (see the image below). This finding can suggest the presence of an adenocarcinoma. The presence of increased through transmission, even if the mass is fairly echogenic, should suggest the diagnosis.

Sonogram of serous cystadenoma. The large mass in the head of the pancreas is externally lobulated, with some cystic-appearing regions, some solid-appearing regions, and increased through transmission. Image courtesy of Arnold C Friedman, MD, FACR.

Avascular Necrosis of Femoral Head and costs of treatment

Avascular necrosis of the femoral head (AVN) is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. Although patients are initially asymptomatic, AVN usually progresses to joint destruction, requiring total hip replacement (THR), usually before the fifth decade. It is estimated that almost 10% of the nearly 500,000 THRs performed each year in the United States are intended to treat AVN; at a cost of more than 1 billion dollars, THRs performed to treat AVN constitute approximately 25% of the total national costs for THR.


Axial CT in a patient without avascular necrosis of the femoral head shows prominent and thickened but normal trabeculae (arrow) within the femoral head. Note the delicate, sclerotic, raylike branchings emanating in a radial fashion from the central dense band. This is the asterisk sign.

Avascular necrosis, femoral head. Anteroposterior view of the pelvis shows flattening of the outer portion of the right femoral head from avascular necrosis (arrow), with adjacent joint space narrowing, juxta-articular sclerosis, and osteophytes representing degenerative joint disease.

Avascular necrosis, femoral head. Coronal T1-weighted MRI in a patient showing hypointense signal within the proximal femoral neck and intertrochanteric regions (arrows) representing hematopoietic marrow. Increased signal is present within the greater trochanters and femoral capital epiphysis representing normal fatty marrow .

diagram showing lymphatic drainage of abdominal and pelvic organs

Financial Help With Diabetes Medicine

In order to obtain financial help with diabetes medicine, it's important to have health insurance or to look into government-regulated programs. Learn about drug companies that will give medication at a discounted price with help from a licensed RN in this free video on diabetes medicine.

Penetrating Aortic Ulcer

 Ulceration of an atherosclerotic plaque which penetrates into the internal elastic lamina
· Hematoma then forms within the media of the aortic wall
· Occurs in the elderly who usually have a history of severe atherosclerosis, hypertension, and hyperlipidemia
· Similar presentation to those with a descending thoracic aortic dissection i.e. acute chest or back pain
· Plaque ulceration usually in the middle to distal third of the descending aorta
· Intramural hematoma accompanies the penetrating ulcer 80% of the time
· Associated with abdominal aortic aneurysm
· Disease progresses from intimal plaque ulceration to media hematoma formation to adventitial saccular pseudoaneurysm formation and finally rupture if there is transmural penetration
· Speculated as the cause of descending or thrombosed type dissections with all three

Imaging findings:
· Focal contrast collection projecting beyond the aortic lumen on CT
* Intramural hematoma is indistinguishable from intraluminal thrombus

Enhanced CT scan through the lower thoracic aorta demonstrates
a focal outpouching of contrast posteriorly representing a penetrating aortic ulcer

· Intimal flap is uncommon
· Intramural wall thickening or thrombus is frequently found
· On angiography, there is aortic wall thickening and the ulcerated plaque seen

· On MRI
* High signal intensity on both T1 and T2 with subacute hematoma

· Can be demonstrated by computed tomography, magnetic resonance, angiography and trans-esophageal echocardiography


· Differential diagnosis:
o Aortic dissection (has an intimal flap)
o Atheroma – has a low signal on both T1 and T2

Treatment:
· Surgical cases are those demonstrating hematoma expansion, impending rupture, inability to control blood pressure
· Patients routinely have co-morbid conditions that make them poor surgical candidates and are treated with transluminal placement of endovascular stent grafts

ULTRASOUND

What is an ultrasound?
Ultrasonography, which is sometimes called sonography, uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood blow through various vessels. Ultrasound procedures are often used to examine many parts of the body such as the abdomen, breasts, female pelvis, prostate, scrotum, thyroid and parathyroid, and the vascular system. During pregnancy, ultrasounds are performed to evaluate the development of the fetus.

How are ultrasounds performed?
Ultrasounds may be done on an outpatient basis, or as part of inpatient care. Although each hospital may have specific protocols in place, generally, an ultrasound procedure follows this process:

1.A gel-like substance is smeared on the area of the body to undergo the ultrasound (the gel acts as a conducer).

2.Using a transducer, a tool that sends ultrasound waves, the ultrasound is sent through the patient's body.

3.The sound from the transducer is reflected off structures inside the body, and the information from the sounds is analyzed by a computer.

4.The computer then creates a picture of these structures on a television screen. The moving pictures can be recorded on film videotape.

5.There are no confirmed adverse biological effects on patients or instrument operators caused by exposures to ultrasound

Deep venous thrombosis

differentiate from gout image : HERE

Several different terms are used for the chronic symptoms that can occur after a deep vein thrombosis:
1. Venous stasis syndrome
2. Postthrombotic syndrome
3. Venous insufficiency syndrome
4. Postphlebitic syndrome

Symptoms:

* chronic leg swelling
* chronic (or waxing) pain
* diffuse aching
* leg heaviness
* leg tiredness
* leg cramping
* dark skin pigmentation (=postthrombotic pigmentation; figure)
* hardening of the skin
* skin dryness
* formation of varicose veins
* skin ulcer (stasis ulcer)

Complications of DVT:
- Pulmonary embolism (the most important) WATCH VIDEO
- Post thrombotic syndrome
- Limb ischaemia

Investigation:
* A blood test called a D-Dimer. This measures a substance which develops when a
blood clot breaks down. If this is negative it's unlikely that you have a DVT.
* A Doppler ultrasound. This is a test that uses sound waves to look at your
blood as it flows through your blood vessels. It's the best test to detect
blood clots above your knee.
* A venogram. In this test, a special dye is injected into your vein, which shows
up the vein on X-ray. This is the best way of showing clots below your knee.


Prevention:
There are a number of things you may be able to do to reduce your risk, such as stopping smoking if you smoke, or losing weight if you're overweight. Regular walking can help to improve the blood circulation in your legs and help to prevent another DVT from developing.

There is no good evidence that taking aspirin reduces your risk of developing DVT.

Treatment of DVT:
The treatment for deep venous thrombosis above the knee is anticoagulation, unless a contraindication exists (recent major surgery or abnormal reactions).Anticoagulation prevents further growth of the blood clot and prevents it from forming an embolus that can travel to the lung.

. Warfarin (Coumadin) is the drug of choice. It is begun immediately, but unfortunately it may take a week or more for the blood to be appropriately thinned. Therefore, low molecular weight heparin [enoxaparin (Lovenox)] is administered at the same time. It thins the blood via a different mechanism and is used as a bridge therapy until the warfarin has reached its therapeutic level.

The dosage of warfarin is monitored by blood tests measuring the prothrombin time or INR (international normalized ratio). For an uncomplicated deep vein thrombosis, the recommended length of therapy with warfarin is three to six months.

Some patients may have contraindications for warfarin therapy, for example a patient with bleeding in the brain, major trauma, or recent significant surgery. An alternative may be to place a filter in the inferior vena cava to prevent emboli from reaching the heart and lungs. These filters may be effective but also may be the source of new clot formation.

Compression stockings
These are also called graduated compression stockings.It eases pain and reduce swelling, and to prevent post-thrombotic syndrome. You may need to wear them for two years or more after having a DVT.

In rare cases, surgery may be needed if medicines do not work. Surgery may involve:

* Placement of a filter in the body's largest vein to prevent blood clots from
traveling to the lungs
* Removal of a large blood clot from the vein or injection of clot-busting
medicines.

Popliteal fossa Mnemonic

Popliteal fossa: muscles arrangement

The two Semi's go together, Semimembranosus and Semitendonosus.
The Membranosus is Medial and since the two semis go together, Semitendonosus is also medial.

Therefore, Biceps Femoris has to be lateral.
Of the semi's, to remember which one is superficial: the Tendonosus is on Top.