Neurogenic neoplasm in X-rays

Posterior mediastinal mass that sharply circumscribed, round or oval homogeneous mass that is usually unilateral and paravertebral.

Primarily neurofibromas and neurolemmomas in adults, ganglioneuromas and neuroblastomas in children. Chemodectomas (any mediastinal compartment) and pheochromocytomas are extremely rare. There may be associated rib or vertebral erosion, calcification, and a dumbbell appearance (part of the tumor is inside and part outside the spinal canal).

Neurogenic tumor. (A) Frontal and (B) lateral views of the chest demonstrate a large right posterior mediastinal mass.

ultrasound in gallbladder evaluation

Hemangioma in vertebral body X-ray

Benign, slow-growing tumor composed of vascular channels. Usually asymptomatic and identified in middle-aged patients. The coarse vertical trabecular pattern may extend into the pedicles and laminae. Soft-tissue and intraspinal extension of the tumor or secondary hemorrhage can produce a paraspinal mass.

It is one of these lytic lesions that appeares in X-ray of vertebral body and shows demineralized and occasionally expanded vertebral body with characteristic multiple coarse linear striations running vertically.

 Hemangioma of a vertebral body. Multiple coarse, linear striations run vertically in the demineralized vertebral body.

Pseudocyst formation in Acute Pancreatitis

Sonographic Findings in Acute Pancreatitis:

In the early stages of acute pancreatitis, the gland may not show swelling. But when swelling does occur, the gland is hypoechoic to anechoic due to increased edema within the lobulations of the gland and the congestion of the vessels.
The borders may be somewhat indistinct but usually remain regular with smooth lobulations. On the longitudinal scan, the swollen head of the pancreas may compress the inferior vena cava.
There are some secondary effects and complications to Pancreatitis as the pancreatic duct may be enlarged secondary to inflammation, spasm, edema, swelling of the papilla, or pseudocyst formation.

Pseudocyst of the Pancreatic Tail:

Longitudinal scan of the left upper quadrant demonstrates a pseudocyst formation near the tail of the pancreas. The mass is anterior to the left kidney and contains debris located near the posterior of the pseudocyst. A smaller daughter cyst is seen anterior to the larger pseudocyst.

Aortic Coarctation....The most common cause of rib notching

By far the most common cause of rib notching. Usually involves the posterior 4th - 8th ribs and rarely develops before age 6. Aortic narrowing typically occurs at or just distal to the level of the ductus arteriosus.
Characteristic double bulge in the region of the aortic knob represents prestenotic and poststenotic dilatation. Collateral flow bypassing the aortic constriction to reach the abdomen and lower extremities comes almost entirely from the two subclavian arteries via the thyrocervical, costocervical, and internal mammary arteries and their subdivisions to the posterior intercostals and then into the descending aorta.

Explanation :

The large volume of blood traversing this route causes dilatation, tortuosity, and increased pulsation of the intercostal arteries, which result in gradual erosion of the adjacent bones.  

Unilateral rib notching in coarctation occasionally occurs on the left side when the constriction is located proximal to an anomalous right subclavian artery and on the right side when the coarctation occurs proximal to the left subclavian artery (only the subclavian artery that arises proximal to the aortic obstruction transmits the collateral blood to the intercostals). Notching of the first two ribs does not occur because the first two intercostal arteries, arising from the supreme intercostals, do not convey blood directly to the postcoarctation segment of the aorta. The last three intercostal arteries conduct blood away from the postcoarctation aortic segment and thus do not greatly enlarge or cause rib notching.

Coarctation of the aorta. Notching of the posterior fourth through eighth ribs (arrows).

CT Sign of Tree-In-Bud Appearance

The tree-in-bud sign is seen on thin-section CT images of the lung . Peripheral "within approximately 3–5 mm of the pleural surface", small "from 2–4 mm in diameter", centrilobular, and well-defined nodules of soft-tissue attenuation are connected to linear, branching opacities that have more than one contiguous branching site, thus resembling a tree in bud.

This thin-section computed tomography scan obtained in a 29y old man with acute myeloid leukemia after bone marrow transplantation. The patient had a history of fever and cough. Image shows multiple, small, centrilobular nodules of soft-tissue attenuation connected to linear branching opacities (arrows). Note the morphologic similarities to the photograph of the tree in bud . At serologic examination, an infection with Mycoplasma pneumoniae was confirmed.

Explanation of the tree-in-bud sign

The tree-in-bud pattern represents bronchiolar luminal impaction with mucus, pus, or fluid, which demarcates the normally invisible branching course of the peripheral airways . In addition, dilated and thickened walls of the peripheral airways and peribronchiolar inflammation can contribute to the visibility of affected bronchioles . In histopathologic studies, the tree-in-bud appearance correlates well with the presence of plugging of the small airways with mucus, pus, or fluid; dilated bronchioles; bronchiolar wall thickening; and peribronchiolar inflammation .

Ultrasound Training of the Female Reproductive Organs

Describe and demonstrate the protocol for sonographic scanning of the female pelvis, including transabdominal and endovaginal scanning. Identify and explain the anatomy and physiology of the female pelvis on diagrams and sonograms. Describe and demonstrate Doppler evaluation of the female pelvis, including uterus and ovaries. Identify on images, common abnormalities and pathologies of the uterus and adnexa, including fallopian tubes, ovaries, and the appearance and locations of the various types of intrauterine contraceptive devices. Describe the sonographic evaluation and follow-up of the infertile patient. Describe the interventional and post-operative uses of ultrasound. Differentiate the sonographic appearances of the female reproductive organs in relation to the menstrual cycle, the use of contraceptives and hormone replacement, and following chemotherapy.

CT scan of chest, Ground-glass opacification

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

Central dislocation of Hip joint

The central dislocation of hip joint is a fracture-dislocation, shown in the image below, where the femoral head lies medial to a fractured acetabulum. This is caused by a lateral force against an adducted femur seen in side impact MVCs "motor vehicle collisions".

Fracture-dislocation of the right hip. The bony fragments are likely part of the acetabulum.

CT Coronary agniogram by Multidetector CT scanner

How To Read CT Sinus Scans Like An Expert

Calcification changes in Dermatomyositis

Dermatomyositis is one of these diseases that show CALCIFICATION ABOUT THE FINGERTIPS ; like Scleroderma and Calcinosis universalis.
Calcification of the fingertips with associated terminal phalangeal erosion is one manifestation. More commonly, there is extensive calcification in muscles and subcutaneous tissue underlying the associated skin lesions.

Irregular calcific deposits involve all the fingers.

Avulsion Injury to Pelvis Ischial tuberosity

Most commonly, pelvic site. Usually occurs before closure of the apophysis secondary to extreme active hamstring contractions, as in sprinting by runners or sudden and excessive passive lengthening in cheerleaders or dancers. Patients typically present with pain in the buttock region, an antalgic gate, or inability to walk.

Imaging Findings :

Insertion of the hamstring muscle group. During the healing stage, the avulsion can have an aggressive appearance, including lysis and destruction. Chronic avulsions frequently result in prominent bone formation.

Ischial tuberosity. Bilateral chronic avulsions. Note the protuberant bone (closed arrows) and a large, smooth fragment (open arrows).

Malrotation of the kidney

It is Unilateral or bilateral anomaly. When the renal pelvis is situated in an anterior or lateral position, the upper part of the ureter often appears to be displaced laterally, suggesting an extrinsic mass. The elongated pelvis of a malrotated kidney may mimic obstructive dilatation.

Findings :

Often bizarre appearance of the renal parenchyma, calyces, and pelvis that may suggest a pathologic condition in an otherwise normal kidney.

Malrotation of the left kidney. Note the apparent lateral displacement of the upper ureter and the elongation of the pelvis.

Chest x-ray --Air Crescent Sign

This video will shed some light on air crescent sign seen on Chest x-rays and CT scan chest.

Silhouette Sign in Chest x-ray

How to recognise Right side and Left in Chest X-RAY

You can identify the right and left sides of the chest X-ray by getting some land marks in the film in front of you; let`s start :

1- Heart is the 1st clear object to know as it is predominates to the left.
2- Rhight hemidiaphram is higher than the left one.
3- Gastric fundal air shadow on the left.
4- Left hilum normally higher than right.
5- Aortic knuckle must be at the left ( some patients have a right-sided arch,but you can find it by checking).
6- Horizontal fissure on the right.

STANDARD LATERAL CHEST RADIOGRAPH

left side of the chest against filmholder (cassette); beam from right at a distance of six feet; lesion located behind the left side of the heart or in the base of the lung are often invisible on the PA view because the heart or diaphragm shadow hides it; the left lateral will generally show such lesions; the left lateral is thus the customary lateral view as it is the best view to visualize lesions in the left thorax. Also, the heart is less magnified when it is closer to the film.

• Good for viewing area behind heart (retrosternal airspace — between the heart and sternum).

• Marked with a "R" or "L" according to whether the right or the left side of the patient was against the film — left lateral or right lateral.

To visualize a lesion in the left thorax, it is better to get a left lateral view.

To visualize a lesion in the right thorax, it is better to get a right lateral view.

A fundamental rule of roentgenography — Try to get the lesion as close to the film as possible.

Basic Gross anatomy of the human heart

PULMONARY Disease With EOSINOPHILIA due to Drug sensitivity

It appears in x-ray as Patchy nonsegmental, peripheral parenchymal consolidation with blood eosinophilia.

Some known drugs like Sulfonamides, penicillin, isoniazid, and many other medications. Nitrofurantoin causes a diffuse reticular pattern. Withdrawal of the drug results in prompt disappearance of the clinical and radiographic manifestations.

Nitrofurantoin-induced lung disease. Mixed alveolar and interstitial pattern in an elderly woman who presented with progressive cough and dyspnea after the long-term use of nitrofurantoin for recurring urinary tract infections.

Methotrexate-induced lung disease. The diffuse, bilateral, patchy densities were changeable and fleeting during the illness. The radiographic findings cleared completely after steroid therapy.

Ultrasound Training Pancreas

Breakthroughs in Imaging Neurovascular Diseases

Breakthroughs in Imaging Neurovascular Diseases such as Multiple Sclerosis: Technical Aspects, Clinical Ramifications, and Understanding the Etiology of the Disease. Presented by Dr. E. Mark Haacke.

ABSTRACT

Magnetic Resonance Imaging has long been an important diagnostic tool for Multiple Sclerosis. Recent developments linking MS to venous malformations have highlighted the use of advanced techniques for imaging iron deposits and blood flow. We introduce here a number of new technical image acquisition and image processing concepts whose application may well extend into other diseases such as Parkinson's, Alzheimer's, stroke and traumatic brain injury. Finally, the development and data mining of worldwide data in specific diseases will also be discussed.

ABOUT THE AUTHOR

E. Mark Haacke is a world renown MRI researcher at Wayne State University. He won the Gold Medal in Kyoto in 2004 for his work on Susceptibility Weighted Imaging and Education. He is the past president of two MRI societies and has just formed "The International Society for Neurovascular Disease". For the last 30 years, Dr. Haacke has focused on the physics and mathematics associated with the technical development of new imaging methods and their clinical applications.

Ultrasound Training Assessment During First Trimester

Bronchiectasis in High-Resolution CT

Bronchiectasis is defined as localized, irreversible dilatation of part of the bronchial tree. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders, but it usually results from necrotizing bacterial infections, such as infections caused by the Staphylococcus or Klebsiella species or Bordetella pertussis.
Diagnosis of bronchiectasis is based on a clinical history of daily viscid sputum production and characteristic computed tomography (CT) scan findings.

Chest radiography is usually the first imaging examination, but the findings are often nonspecific and the images may appear normal. High-resolution computed tomography (HRCT) scanning has become the imaging modality of choice for demonstrating or ruling out bronchiectasis and its extent.HRCT scanning also helps clinicians to evaluate the status of the surrounding lung tissue and exclude other lesions such as neoplasms.

This is a Transverse high-resolution CT scans obtained in a 40-year-old man with bronchiectasis. (a) Scan shows small-airway disease denoted by centrilobular and tree-in-bud (black arrows) opacities and bronchiolectasis in the left upper lobe. Bronchiectasis in the upper lobe was assigned a grade of 1, with grade 1 (white arrows) bronchial wall thickening. In the apical segments of the lower lobes, grade 2 (arrowheads) bronchial wall thickening also is present. (b) Scan shows a combination of grade 1 (arrows) and 2 (arrowheads) bronchial wall thickening in the basal segments of the lower lobes with an overall bronchial wall thickening score of 1.5. The extent of bronchiectasis was evaluated as grade 3 in the right lower lobe and grade 2 in the left lower lobe. (c) Scan shows mosaic attenuation in both upper lobes. (d) Expiratory scan shows air trapping. The hypoattenuating areas (∗) were confirmed to be caused by air trapping in d.

To know grades of bronchial wall thickening:

Indications for OPG requests

An OPG or "ORTHOPANTOGRAM", gives a panoramic view of the mandible and teeth.
It is performed using a technique called "tomography". The X-ray tube moves around the head, the x-ray film moves in the opposite direction behind your head. This generates an image slice where the mandible and teeth are in focus, and the other structures are blurred.

Why to get it ?

Dental Disease

* Caries - appear as different shaped areas of radiolucency in the crowns or necks of teeth.
* Peridontioiditis - when inflammation extends into the underlying alveolar bone and there is a loss of attachment.
* Peridontal Abscess - Radiolucent area surrounding the roots of the teeth.

Extraction of teeth (eg. wisdom teeth)

* OPG shows angulation, shape of roots, size and shape of crown, effect on other teeth.

Teeth Abnormalities

* Eg. Developmental, to show size, number, shape and position.

Trauma to teeth and facial skeleton

* Mandible fractures are often bilateral.
* Panoramic view of mandible to view the fracture.
* Determine site and direction of fracture lines.
* Relationship of teeth to fracture lines.
* Alignment of bone fragments after healing.
* Evidence of infection or other complications post intervention.
* Follow up to assess healing.

Transplant workup

* To look for evidence of any underlying dental disease (eg. abscess)
* Patients on steriods after a transplant are immunosuppressed and the mouth is a common site of infection.

Image Fusion for Computer-assisted Bone Tumor Surgery

Idiopathic polyhydramnios

In approximately 60% of cases of polyhydramnios, there are no abnormalities detectable in either the mother or the fetus.

Polyhydramnios. Sonogram of a fetus (F) with excessive amniotic fluid and a floating extremity (arrow). (P, placenta.)

Anencephaly as a 1st congenital anomaly in fetal sonography

It is First congenital anomaly identified 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.

Imaging Findings :

Inability 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).

Prostate ultrasound-guided transrectal biopsy

Under sedation extended transrectal ultrasound-guided biopsy are performed. Twenty biopsy cores are obtained with a 20 G biopty-gun (Bard®) The hypoechoic area corresponds to a prostate adenocarcinoma Gleason 3+4 T2c No Mo.

Important Terminology in Urography

# Urogram

 Visualization of kidney parenchyma, calyces and pelvis resulting from IV injection of contrast

# Pyelogram

 Describes retrograde studies visualizing only the collecting system

- So, IVP is misnomer, should be IVU

# Cystography

Describes visualization of the bladder

# Urethrography

Visualization of urethra

# Cystourethrography

Combined study to visualize bladder and urethra

Three dimensional coronal reconstruction of CT urography image, showing contrast-enhanced renal collecting system, ureters, and bladder. Note duplicated system on left side.

Pneumocephalus

X-ray showing nasal and orbital fractures and pneumocephalus

Pneumocephalus is the presence of air in the cranial vault. It is usually associated with neurosurgery, barotrauma, basilar skull fractures, sinus fractures, nasopharyngeal tumor invasion and meningitis.Headache and altered consciousness are the most common symptoms.
Tension pneumocephalus can occur and is a neurosurgical emergency.Plain X-rays can diagnose pneumocephalus, but CT scan is the diagnostic modality of choice.A classical CT sign of tension pneumocephalus is the “Mount Fuji sign”: the massive accumulation of air that separates and compresses both frontal lobes and mimics the profile of the large volcano in Japan.

Large right pneumocephalus compressing right frontal lobe and widening interhemispheric space. There are also air bubbles in basal cisterns and cerebellar fissures bilaterally

Most cases of pneumocephalus resolve spontaneously, and conservative management should be provided. Nonoperative management involves oxygen therapy, keeping the head of the bed elevated, prophylactic antimicrobial therapy (especially in post-traumatic cases), analgesia, frequent neurologic checks and repeated CT scans.

Supraspinatus Pathology by Ultrasound

This video details the complex structures of the human shoulder and how proper and careful ultrasound scanning techniques can identify tendon and rotator cuff tears, as well as avoid false positive and false negative tear diagnoses.

CALCIFICATIONS in Carcinoma of the breast

Malignant calcifications can be detected mammographically in approximately 50% of cases. About 20% of breast carcinomas present only with calcification. Granular calcifications appear as tiny dotlike or somewhat elongated densities that are irregularly grouped close together in a cluster and resemble a stone crushed by a sledgehammer. Casting calcification refers to that formed in segments of irregular ductal lumen containing necrosis and debris from increased cellular activity.

Imaging Findings:

Calcification is extremely variable in distribution, size, form, density, and number. Malignant calcifications tend to form in clusters and are generally smaller, less dense, and more irregular than typical benign calcifications. In a single cluster, calcifications often vary in size, shape, and density.

Carcinoma of the breast. (A) Numerous tiny calcific particles with linear (arrows), curvilinear (solid arrowhead), and branching (open arrowhead) forms characteristic of malignancy. Note the benign calcification in the wall of an artery, which is easily recognized by its large size and tubular distribution (curved arrow).

(B) Magnification view in another patient shows a retroareolar tumor containing coarse calcifications. One centimeter medial to the tumor is a small cluster of calcifications (arrows) without a tumor shadow.