tag:blogger.com,1999:blog-306428602024-03-12T18:20:49.608-07:00General Radiology: a few notesThis blog contains a few practically important notes in general radiology. This blog definitely will not have everything related to Radiology. I have also uploaded images.Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.comBlogger47125tag:blogger.com,1999:blog-30642860.post-81661043459289170412011-12-23T08:07:00.000-08:002011-12-23T08:07:49.681-08:00Mesial temporal sclerosis<u><b>MRI:</b></u> <br />
Small volume hippocampus on coronal volumeteric T1<br />
Increased signal on coronal FLAIR<br />
Small mamillary body<br />
Small fornix<br />
Temporal lobe atrophy<br />
Ipsilateral white matter atrophy<br />
Increased signal/ loss of volume of anterior thalamic nucleus<br />
Increased signal/ loss of volume of amygdala<br />
Loss of volume of sibiculum<br />
Loss of grey-white in the anterior temporal lobe<br />
Higher signal on ADC (but may have restricted diffusion following seizure)<br />
Temporal horn dilatation - least sensitive sign<br />
Ipsilateral cerebral hypertrophy<br />
Contralateral cerebellar atrophy<br />
<br />
Rememeber:<br />
10% are bilateral, hence comparison with other side is not always useful<br />
<br />
<u><b>MRS:</b></u><br />
Decreased NAA<br />
Decreased NAA / Cho ratio<br />
Decreased NAA / Cr ratio<br />
Decreased MI<br />
Increased lipid and lactate soon after as seizureKeshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-73993347871559632902011-12-23T05:36:00.000-08:002011-12-23T05:36:11.833-08:00protocol: CT angiography for GI bleedNo oral contrast<br />
<br />
Section thickness 1 mm<br />
Reconstruction interval 0.8 mm<br />
<br />
Unenhanced low dose CT (to show pre-existing intraluminal hyperattenuation)<br />
<br />
100–125 mL I.V contrast 4 mL/sec, followed by 50 mL of saline solution at 4 mL/sec<br />
<br />
Arterial phase - triggering at proximal abdominal aorta (150 HU)<br />
<br />
Portal venous phase at 70 seconds<br />
<br />
<u><b>Reference:</b></u><br />
<a href="http://radiology.rsna.org/content/262/1/109.abstract">Marti M et al. Acute Lower Intestinal Bleeding: Feasibility and Diagnostic Performance of CT Angiography, January 2012 Radiology, 262, 109-116. </a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-13148182886077989552011-11-09T04:17:00.000-08:002011-11-09T04:17:14.742-08:00Understanding Intestinal rotation, non-rotation and malrotation<div class="topbullet">
<u><b>Nonrotation: </b></u> </div>
<div class="topbullet">
Prone for midgut volvulus </div>
<div class="topbullet">
Duodenojejunal junction does
not lie inferior and left of SMA</div>
<div class="topbullet">
Cecum does not lie
in the right lower quadrant. </div>
<div class="topbullet">
</div>
<div class="topbullet">
<b><u>Incomplete
rotation:</u> </b> </div>
<div class="topbullet">
Prone for duodenal obstruction, midgut volvulus, internal herniation (right mesocolic i.e. paraduodenal hernia.) </div>
<div class="topbullet">
Peritoneal bands
from misplaced cecum to mesentery compress D3.</div>
<div class="topbullet">
<br /></div>
<div class="topbullet">
<u><b>Incomplete
fixation:</b></u> </div>
<div class="topbullet">
Mesentery of right and left colon and duodenum do not get fixed
retroperitoneally</div>
<div class="topbullet">
If descending mesocolon (between IMV & posterior parietal attachment) remains unfixed, small intestine migrates to left upper quadrant = left mesocolic
hernia </div>
<div class="topbullet">
If the
cecum remains unfixed, it may lead to volulus of terminal ileum, cecum, or proximal ascending colon </div>
<div class="topbullet">
</div>
<div class="topbullet">
<u><b>CT:</b></u></div>
<div class="topbullet">
Large bowel predominantly on left side and small bowel predominantly on right side</div>
<div class="topbullet">
SMA on right and SMV on left, or SMV anterior to SMA </div>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-17361976029178265012011-09-30T06:22:00.001-07:002011-09-30T06:22:13.862-07:00Radiology reporting<a href="http://radiographics.blogspot.com/2011/09/how-is-format-of-my-radiology-report.html">My reporting format</a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-67861981101693867372011-09-30T05:41:00.000-07:002011-09-30T05:42:05.735-07:00How is the format of my radiology report and why?My radiology report slightly deviates from suggested guidelines, and I will try explain it<br />
<br />
<u><b>Radiology 'standard' report format:</b></u> <br />
<ol>
<li>Title of examination </li>
<li>History/indication </li>
<li>Technique </li>
<li>Comparison </li>
<li>Findings </li>
<li>Conclusion </li>
</ol>
The electronic system, which I use, automatically generates the type of
examination, date and time of the exam, clinical details given by the
clinicians, and the time of signing of the report.<br />
<br />
<b>1. </b><u><b>Title of the examination:</b></u> <br />
I do start with the title of the examination, not because of habit or guidelines. Many a times, the details generated by the system is inadequate.<br />
<br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example 1: </span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">The system generates 'right wrist radiograph', but is not clear whether it is AP and lateral radiograph, or scaphoid views, or views for foreign bodies. So, I start my report with title of the examination, such as 'Right wrist: AP and lateral views'.</span></div>
<div style="background-color: white;">
<br /></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;"><b>Example 2: </b></span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">The system generates, 'MRI craniofacial', when in fact, TMJ MRI is performed. I have to write my title as 'MRI TMJs'</span></div>
<br />
<b>2. </b><u><b>History/ indication:</b></u><br />
I usually do not write this in my report as this is electronically generated. However, I do occasionally write history, if there are further details available (either from clinic letters or conversation with the referring team) which would add to my radiological conclusion.<br />
<br />
<div style="background-color: #a2c4c9;">
<span><span style="background-color: white;"></span></span><b><span style="font-size: x-small;">Example: </span></b></div>
<div style="background-color: #a2c4c9;">
<span style="background-color: #a2c4c9; font-size: x-small;">I would write, 'Further clinical details: I note the patient was diagnosed with carcinoma breast 10 years ago for which she was treated with chemoradiation.'</span></div>
<br />
<b>3. </b><u><b>Technique:</b></u><br />
I do not write details of the technique in plain radiograph, fluoroscopy and ultrasound.<br />
<br />
<b>In CT, </b>I write a brief technical detail. <br />
<br />
<br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example: </span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">In 'CT abdomen and pelvis', I write, non-enhanced CT KUB followed by split dose CT IVU - standard departmental protocol.</span></div>
<br />
<b>In MR, </b>I write all the sequences used. I also mention what sequences were not used, but would have added to the radiological diagnosis.<br />
<br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example: </span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">In 'MRI brain', I write, 'axial PD and T2 supplemented by sagittal FLAIR and coronal T1 sequences. Please note DWI and ADC mapping was not performed.</span></div>
<br />
If the radiographers have a difficulty in getting the scans right or are unable to perform all sequences, they usually write the details on the request form for the radiologist's attention. I always write 'radiographer's note' soon after the technique, if there is one. This will assist the clinician and reviewing radiologist not to start a blame game.<br />
<br />
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;"></span></div>
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example:</span></b></div>
<div style="background-color: #a2c4c9;">
<span style="background-color: #a2c4c9; font-size: x-small;">'Radiographer's note': Too large patient. Used body coils. Unable to perfom coronal STIR because patient started moving.</span></div>
<br />
4. <u><b>Comparison</b></u><br />I do not put this as a 'heading'. I usually start my 'Report' with comparison, if available.<br />
<br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example:</span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">'Comparison is made with the CT dated 1/1/11 and MRI dated 2/2/11' at the beginning of the report.</span></div>
<br />
5. <u><b>Findings: </b></u><br />
I give heading of 'Report' for 'Findings' section.<br />
<br />
When I was a radiology resident and registrar, the teaching was to keep radiology description separate from pathological terms. The 'findings' contained clear descriptive radiology terms and signs, avoiding clinical or pathological 'impressions' until one reached the heading of 'conclusion' or 'impression'. This holds good when you are learning the grammer and language of radiology and trying to correlate them clinically.<br />
<br />
As we gain more experience, the 'Findings' part of the report will be filled with more of 'impressions' rather than 'radiological discriptions or signs'.<br />
<br />
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;"><b>Example 1:</b></span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">I am yet to see a radiologist who reports, 'A few, thin, band like, linear, nearly horizontal opacities are shown in the both lower zones of the lungs, close to the diaphragms' in 'Findings', and writes, 'Minor atelectasis in both lung bases' in 'Conclusion'. it would be simple to write, 'bibasal atelectasis is noted', not to cause any unnecessary alarm to the clinician.</span></div>
<span style="font-size: x-small;"><br /></span><br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example 2:</span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">I would not write the following paragraph to keep my 'Findings' to be 'radiologically descriptive' and to avoid 'clinical conclusion'. </span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">'A large area of homogeneous hyperdensity, measuring 4 x 3 cm, is seen in the right basal ganglion, with mean attenuation of 54 HU. A small area of low attenuation is seen around the hyperdensity. Similar hyperdesnity is seen in the occipital horn of the right lateral ventricle with further hyperdensities in the third and fourth ventricles. The right sylvian fissure is effaced. Overlying gyri and sulci are also effaced. Midline shift is seen, measuring 3 mm to the left. Mild dilatation of the left lateral ventricle is seen' </span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">I would rather write, 'Acute hemorrhage is shown in the right basal ganglia with intraventricular extension, leading to mild dilatation of the left lateral ventricle'. </span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">I think this makes sense to the referring tea.</span></div>
<br />
<br />
The above two examples to justify me why I do not use the heading of 'Findings'. 'Findings' heading will contain my clinical impressions also. So I call this 'Findings' heading as 'Report'.<br />
<br />
In 'Report', I use descriptive radiology terms only if this has differentials; otherwise, I use clinical/ pathological terms.<br />
<br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example: </span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">In an elderly person, I would write, 'multiple typical simple cysts are shown in the kidneys', rather than, 'mutliple, rounded, low attenuation lesions of varying sizes are shown in both kidneys with mean attenuation of 3 HU with hardly measurable thin margins'. and then in 'Conclusion', write them again as 'most likely simple cysts'.</span></div>
<br />
I always use present tense, although there are few exceptions during ultrasound and interventions. I start with the most important finding first, write relevant positive findings and then important negative findings. <br />
<br />
I give measurement only if it makes sense clinically.<br />
<br />
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">Example:</span></div>
<div style="background-color: #a2c4c9;">
<span style="background-color: #a2c4c9; font-size: x-small;">I would definitely measure the lung cancer, but will not bother to measure renal cysts in the same patient. </span></div>
<br />
I do mention all incidental findings in my report. But I will under play them.<br />
<br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example 1:</span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">Incidental note is made of a few typical simple cysts in the kidneys.</span></div>
<br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Example 2:</span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">Note is made of mucosal thickening in the left maxillary sinus.</span></div>
<br />
I try my best to keep my language simple, to use correct medial terminology, and to avoid abbreviations.<br />
<br />
<br />
<b>6. </b><u><b>Conclusion: </b></u><br />
I use the heading of 'Comments' for 'Conclusion'. I use 'comment', instead of 'conclusion', because I want the referring clinician to <b>read</b> my 'Report'. Unless he/she reads the report, my 'Comment' section will not make any sense to the referring clinician. I try to keep my 'Report' section as breif as possible and as clinically relevent as possible.<br />
<br />
Most of my plain film and ultrasound reports do not have 'Comment' heading. Many of my CT/MR brains, CT of paranasal sinuses, CT petrous, MRI lumbosacral spine and MRI extremities also do not have 'Comment' section.<br />
<br />
<div style="background-color: #a2c4c9;">
<b><span style="font-size: x-small;">Examples where I use 'Comment' section: </span></b></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">To answer the clinical question if not done in my 'report', </span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">When my report is too long and contains too many clinically relevant findings.</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">When I need to combine more than one finding to arrive to a single diagnosis</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">When I need to advise the clinician regarding further tests</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">When I need to discuss with the clinician for further clinical details and previous imaging</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">When I want the case to be reviewed and discussed in the MDT</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">When I could not arrive to a single diagnosis and want to discuss the differentials in order</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">When the findings are equivocal or indeterminate, I try to give my reasoning for my clinical conclusion</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">When the radiological finding does not correlate with the clinical suspicion or diagnosis</span></div>
<br />
I also use 'Comment' section to record my communication with the referring team.<br />
<br />
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">Example:</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">'The report was faxed to concerned GP surgery'</span></div>
<div style="background-color: #a2c4c9;">
<span style="font-size: x-small;">'I discussed the findings with the on-call surgical registrar'. </span></div>
<br />
Useful links from my blogs:<br />
<a href="http://www.iradix.in/component/myblog/blogger/keshrad/">My other blogs</a><br />
<br />Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com2tag:blogger.com,1999:blog-30642860.post-47252133649597439872010-03-24T06:58:00.000-07:002010-03-24T06:58:33.014-07:00Diffusion MRI of the brain: Simplified<u><b>Basics:</b></u> <br />
Bright signal on DWI (B=1000) means restricted diffusion and/or T2 effect.<br />
On ADC, low signal in the same region means restricted diffusion, and bright or isointense signal means T2 shine through effect.<br />
On T2, the same area may appear bright or isointense.<br />
<br />
<u><b>Pathologies with restricted diffusion:</b></u><br />
Acute stroke, acute stroke, acute stroke... (repeat this 10 times before proceeding to next)<br />
Infection: Herpes encephalitis, Pyogenic infection, CJD, meningoencephalitis <br />
Epidermoid (ADC usually cannot be calculated)<br />
<br />
Diffuse axonal injury<br />
Oxyhemoglobin (intracellular and hyperacute) (extracellular methHb shows increased signal on both DWI and ADC!)<br />
A few acute MS lesions<br />
Post-ictal<br />
Susceptibility artefact: in inferior frontal and temporal regions should not be mistaken for restricted diffusion<br />
<br />
<u><b>Non-restricted diffusion:</b></u><br />
Infection: HIV encepahlopathy<br />
Tumor: primary or secondary, arachnoid cyst<br />
Inflammation: most acute MS lesions<br />
Chronic lesions: chronic stroke, gliosis, neuronal loss<br />
Others: hypertensive encephalopathy, clyclosporin toxicity, hyperperfusion after endartertectomyKeshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com2tag:blogger.com,1999:blog-30642860.post-62301552311521754222007-10-17T08:53:00.000-07:002007-12-20T03:17:08.814-08:00Sinus thrombosis<strong><u>NECT:</u></strong><br />Dense Delta sign = dense clot sign - commonly seen in SSS, can be seen in other sinuses too.<br />Non-arterial infarcts<br />Dense cortical veins = cord sign<br />Often a/w hemorrhage<br />Infarction of basal ganglia and thalami is typical of CVT (this is not a feature of arterial infarct)<br />Temporal lobe infarct - vein of Labbe thrombosis<br /><strong>Pitfalls:</strong><br />Hyperdense sign can be normal in infants and neonates, in patients with increased hematocrit (dehydration, polycythemia)<br />Subdural hemorrhage can mimic CVT and vice versa<br /><br /><strong><u>CECT:</u></strong><br />Empty delta sign, commonly seen in SSS, can be seen in other sinuses too.<br />Enhancement of falx and tent<br /><strong>Pitfalls:</strong><br />Intrasinus septa can mimic empty delta sign<br /><br /><strong><u>MR:</u></strong><br />GE images for hemorrhage<br />Acute: iso on T1, low on T2<br />Subacute: high on T1 and T2<br />Chronic: iso on T1 and T2<br />TOF - short imaging time, beware of artefacts, more false positives, false negative due to methHb<br />Phase contrast - artefacts due to movements and turbulent flow, no false negative due to methHb<br />Post-Gd venogram - less false positives, false negative due to methHb or enhancing chronic thrombus<br /><strong>Pitfalls:</strong><br />Intrasinus septa can mimic CVT<br />Slow flow may mimic loss of flow void<br />MethHb may show increased signal on TOF<br /><br /><strong><u>References:</u></strong><br /><a href="http://www.ajronline.org/cgi/content/abstract/189/6_Supplement/S76">Poon CS et al. Radiologic Diagnosis of Cerebral Venous Thrombosis. AJR 2007; 189:S76-S78</a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-3385879123463240722007-10-16T01:54:00.001-07:002007-10-16T02:01:58.717-07:00Pancreatitis: what every radiolgosit should know<strong><u>Balthazar severity index:</u></strong><br /><strong>CT appearance:</strong><br />Normal - 0 points<br />Large pancreas - 1 point<br />Pancreatic/ peripancreatic inflammation - 2<br />1 fluid collection - 3<br /><u>> </u>2 fluid collection - 4<br /><strong>% necrosis:</strong><br />0 - 0<br /><> 50% - 6<br /><strong>Score of 0 - no mortality, score 7to10 - 17% mortality</strong><br /><strong></strong><br /><strong></strong>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-72087082014237568842007-10-16T01:54:00.000-07:002007-10-16T02:00:36.637-07:00Pancreatitis: what every radiolgosit should know<strong><u>Balthazar severity index:</u></strong><br /><strong>CT appearance:</strong><br />Normal - 0 points<br />Large pancreas - 1 point<br />Pancreatic/ peripancreatic inflammation - 2<br />1 fluid collection - 3<br /><u>> </u>2 fluid collection - 4<br /><strong>% necrosis:</strong><br />0 - 0<br /><> 50% - 6<br /><strong>Score of 0 - no mortality, score 7to10 - 17% mortality</strong><br /><strong></strong><br /><strong></strong>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-86012658846624605022007-08-09T15:52:00.000-07:002007-08-09T16:11:18.927-07:00Hypothalamic lesions<ol><li>Cranipharyngioma - solid and cystic, bimodal, enhance </li><li>Germinoma - upper part of infundibulum, solid, enhance, a/w pineal germinoma </li><li>Hypothalamic hamartoma - tuber cinerium, solid with cysts, no enhancement, no calcium </li><li>Osteolipoma (lipoma) - tuber cinerium, fat and osteoid </li><li>Dermoid cyst - midline, fat, no enhancement </li><li>Epidermoid cyst - parasellar, CSF signal but high signal on FLAIR, no enhancement </li><li>Arachnoid cyst - typical </li><li>Rathke's cleft cyst - variable signal, no enhancement, no calcium </li><li>Colloid cyst - variable signal, rim may enhance, no calcium </li><li>Hypothalamic chiasmatic glioma - solid, enhance </li><li>Ganglioglioma - solid with cystic component, nodular or solid enhancement </li><li>Choristoma (low grade glioma) - infundibulum, isointense, variable enhancement </li><li>Perisellar meningioma - typical </li><li>Hemangioblastoma - cyst with enhancing mural nodule, a.w VHL syndrome </li><li>Cavernoma - typical </li><li>Metastasis - intense enhancement, bone destruction, no sellar enlargement </li><li>Lymphoma </li><li>Leukemia </li><li>Langercells histiocytosis - paediatric, stalk > 3mm, intense enhancement </li><li>Hymphocytic infundibuloneurohypophysitis </li><li>Sarcoidosis - stalk, a/w leptomeningeal enhancement </li><li>Wegener's granulomatosis </li><li>Tuberculosis </li><li>Syphilis </li><li>Encephalitis </li><li>Suprasellar pituitary tumour - enhance </li><li>Ectopic posterior pituitary </li><li>Aneurysm - blood products<br /><br /><strong><u>Reference: </u></strong><br /><a href="http://radiographics.rsnajnls.org/cgi/content/abstract/27/4/1087">Saleem SN et al. Lesions of the Hypothalamus: MR Imaging Diagnostic Features. RadioGraphics 2007;27:1087-1108<br /></li></ol></a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-86976909863671842382007-08-01T03:20:00.000-07:002007-08-01T03:29:27.202-07:00Virchow Robin spcaesVR spaces should have identical signal to CSF on all pulse sequences<br /><br /><strong>3 characteristic locations:<br /></strong>1. <strong>Basal ganglia: </strong>Along lenticulostriate arteries entering basal ganglia through anterior perforated substance<br />2. <strong>Cerebral white matter: </strong>Along the path of perforating medullary arteries as they enter cortical gray matter over the high convexities and extend into the white matter<br />3. <strong>Midbrain: </strong><br /><strong></strong><br />They can be very large, may cause mass effect,<br /><br /><strong>Differentials:<br /></strong>Lacunar infarct: Deep and non-cortical<br />PVL: Premature infants<br />MS<br />Crytococcus<br />MPS<br />Cystic neoplasms<br />Cysticercosis<br />Arachnoid cyst<br />Neuroepithelial cyst<br /><br /><strong><u>References:</u></strong><br /><a href="http://radiographics.rsnajnls.org/cgi/content/abstract/27/4/1071">Kwee RM et al. Virchow-Robin Spaces at MR Imaging. RadioGraphics 2007;27:1071-1086</a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1165365648656896552006-12-05T16:33:00.000-08:002006-12-05T16:40:49.170-08:00Trauma<strong><u>Young person with severe RTA: </u></strong><br /><strong><u>CXR AP supine:</u></strong><br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k245/keshblog/CXR/Trauma/pneumothoraxsupinesmall.jpg" border="0" /></a><br /><br /><strong><u>Findings:</u></strong><br />It is easy to notice rib fractures and ETT in place.<br />Did you notice difference in the lucency in the lung bases? Which lung base is more lucent? That may be the only sign of pneumothorax!<br /><br /><strong><u>CT correlation: </u></strong><br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k245/keshblog/CXR/Trauma/pneumothoraxsupineCTcorrelation.jpg" border="0" /></a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com1tag:blogger.com,1999:blog-30642860.post-1161992266402310122006-10-27T16:33:00.000-07:002006-10-27T16:37:46.850-07:00Colonic carcinoma<strong><u>Dukes staging:</u></strong><br /><br />A - Tumour confined to bowel wall<br />B - Tumor penetrates bowel wall<br />C - Regional lymphnode involved<br />D - Distant metastasis<br /><br /><strong><u>TNM:</u></strong><br /><br />T1 - Submucosal involvement<br />T2 - Muscularis propria involvement<br />T3 - Beyond muscularis propria<br />T4 - Peritoneal surface involvement<br /><br />N1 - up to 3 perirectal/ colic nodes<br />N2 - 4 or more perirectal/ colic nodesKeshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1159202718553311012006-09-25T09:43:00.000-07:002006-09-25T09:45:18.666-07:00Azygous fissureImages:<br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20CXR/normals/azygousfissurecxr.jpg" border="0" /></a><br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20CXR/normals/azygousfissureCT.jpg" border="0" /></a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1158519646806464272006-09-17T12:00:00.000-07:002006-09-25T09:46:29.263-07:00Image Gallary<strong><u>Chest imaging: </u></strong><br /><a href="http://radiographics.blogspot.com/2006/09/azygous-fissure.html">Azygous fissure</a><br /><br /><a href="http://musculoskeletal-radiology.blogspot.com/2006/09/image-gallary.html"><strong>Musculoskeletal Imaging</strong></a><strong> </strong>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1158514394066545712006-09-17T09:45:00.000-07:002006-09-17T10:42:33.453-07:00Sarcoidosis<strong><u>History: </u></strong><br />35 year old CT chest with suspected TB<br /><br /><strong><u>Mediastinal windows:<br /></u></strong><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20HRCT%20CHEST/sarcoidosis/sarcoidnodularCT1.jpg" border="0" /></a><br /><strong><u>Lung windows:<br /></u></strong><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20HRCT%20CHEST/sarcoidosis/sarcoidnodularCT2.jpg" border="0" /></a><br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20HRCT%20CHEST/sarcoidosis/sarcoidnodularCT3.jpg" border="0" /></a><br /><strong><u>Findings: </u></strong><br />Multiple mediastinal nodes in the right paratracheal region. Numerous uniform shaped small lung nodules, deistributed predominantly in the upper and mid zones in the perihilar region with preivascular distribution. No fissural beeding.<br /><strong><u></u></strong><br /><strong><u>Diagnosis: </u></strong><br />Sarcoidosis<br /><br /><strong><u>Discussion:</u></strong><br />Differenitals for nodular lung lesions include sarcoidosis, eosinophilic granuloma, miliary tuberculosis and metastasis. Distribution of multiple small nodules in perivascular distribution with irregular thickening of bronchovascular bundles and interlobular septa in upper lobes and associated mediastinal lymphadenopathy strongly indicate sarcoidosis.<br />The present case is slightly unusual, because there is no fissural beeding and the mediastinal lymphnodes are not large.<br /><br /><strong><u>References: </u></strong><br /><a href="http://radiographics.rsnajnls.org/cgi/content/full/24/1/87">Koyama T et al. Radiologic Manifestations of Sarcoidosis in Various Organs. RadioGraphics 2004; 24: 87</a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1158510523341450832006-09-17T09:28:00.000-07:002011-11-09T04:19:05.539-08:00GI imaging<b><u>Inflammatory bowel disease:</u></b><br />
<a href="http://radiographics.blogspot.com/2006/09/crohns-disease.html">Crohns disease</a><br />
<a href="http://radiographics.blogspot.com/2011/11/understanding-intestinal-rotation-non.html">Understangin intestinal malrotation</a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1158510413411892512006-09-17T09:08:00.000-07:002006-09-17T09:26:54.176-07:00Crohn's disease<strong><u>History: </u></strong><br />25 year old immegrant with chronic GI symptoms referred from GP for ultrasound<br /><br /><strong><u>Ultrasound:<br /></u></strong><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20GI/Crohns%20disease/crohnsusg.jpg" border="0" /></a><br /><strong>Findings:<br /></strong>Multiple thick walled small bowel loops in the left upper abdomen, suggestive of inflammatory bowel disease<br /><br /><strong><u>Barium follow through:<br /></u></strong><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20GI/Crohns%20disease/crohnsfollowthru.jpg" border="0" /></a><br /><strong>Findings:<br /></strong>Loong segment narrowing of the jejunal loops with loss of mucosal pattern and bowel wall thickening<br /><br /><strong><u>Diagnosis: </u></strong><br />Crohn's disease<br /><br /><strong><u>Discussion: </u></strong><br />Normal bowel appears as 5 concentric alternate hypo and hyperechoic rings (gut signatue). The average thickness is 2-5mm.<br />Bowel wall thickening, inflammation of mesenteric fat, mesenteric lymphadenopathy, strictures and fistulas can be seen on US. Bowel wall thickening is usually symmetric with partial or total loss of normal bowel morphology or a 'pseudokidney' sign may be seen. Absence of peristalsis may be observed. The bowel is usually rigid and non-compressible. Angulation may be appreciated. Inflammation of mesentery is seen as echogenic mass (creeping fat). On Doppler, increased blood may be seen, suggestive of active disease. Strictures may be seen as luminal narrowing. Fistula is seen as hypoechoic linear tract with gas bubbles. Transvaginal ultrasound may be used in the diagnosis of rectovaginal and enterovesical fistulas. Inflammatory masses, abscesses are easily demonstrated on ultrasound. Involvement of the urinary bladder is better demonstrated on ultrasound. Presence of free air and bowel obstruction may also be diagnosed on ultrasound.<br />Ultrasound is 87% sensitive in the diagnosis of crohns disease.<br /><br /><strong><u>References: </u></strong><br />1. <a href="http://radiographics.rsnajnls.org/cgi/content/full/19/suppl_1/S179">Damini N et al. Nongynecologic Applications of Transvaginal US. Radiographics. 1999;19:S179-S200</a><br />2. <a href="http://radiographics.rsnajnls.org/cgi/reprint/16/3/499">J Sarrazin and SR Wilson. Manifestations of Crohn disease at US. RadioGraphics 1996; 16: 499</a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com1tag:blogger.com,1999:blog-30642860.post-1158507196713665802006-09-17T08:07:00.000-07:002006-09-17T08:33:37.266-07:00Chonalgiocarcinoma<strong><u>History:<br /></u></strong>75 year old lady with features of obstructive jaundice<br /><br /><strong><u>Unenhanced CT abdomen: </u></strong><br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20HEPATOBILIARY/cholangiocarcinoma/1CT1unenhanced.jpg" border="0" /></a><br /><br /><strong><u>Enhanced CT abdomen:<br /></u></strong><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20HEPATOBILIARY/cholangiocarcinoma/1CT2enhanced.jpg" border="0" /></a><br /><br /><strong><u>Findings:<br /></u></strong>Marked intrahepatic biliary dilatation. A small area of calficiation and surrouding small area of low attenuation in the liver close to the caudate lobe. No extrahepatic biliary dilatation. No other abnormality. Unenhanced CT showed the findings better than the enhanced CT<br /><br /><strong><u>ERCP:<br /></u></strong><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20HEPATOBILIARY/cholangiocarcinoma/2ERCP.jpg" border="0" /></a><br /><strong>Findings:<br /></strong>Marked intrahepatic biliary dilataion. A focal area of irregular filling defect in the distal intrahepatic biliary segment<br /><br /><strong><u>AXR: </u></strong>post percutaneous stenting<br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20HEPATOBILIARY/cholangiocarcinoma/3AXR.jpg" border="0" /></a><br /><br /><strong><u>Diagnosis:<br /></u></strong>Intrahepatic cholangiocarcinoma<br /><br /><strong><u>Discussion:<br /></u></strong>Calcification in intrahepatic cholangiocarcinoma is usally illdefined, mostly occurs in the periphery of the tumour and is seen in about 20% of patients. Calcifications may also be seen in in biliary cystadenocarcinomas. However, the most common cause of calcified hepatic lesions is inflammatory lesion like granulomatous diseases (TB). Hydatid cysts produce curvilinear or ring calcification. Large hemangiomas may show large central coarse calcffications. Hepatic adenoma may show solitary or multiple calcifications usually eccentric in location. Fibrolamellar carcinoma show calcifications in approximately 20% of cases . Calcfied hepatic metastases are most commonly due to mucin-producing neoplasms (colon carcinoma).<br />The likely causes for the calcifications in intrahepatic cholangiocarcinomas include central necrosis, mucinous type of cholangiocarcinoma. it is not known if the calcification can predict the prognosis of the disease.<br />Most of the cholangiocarcinomas are inoperable at the time of presentation and are treated with either ERCP or percutaneous stenting.<br /><br /><strong><u>References: </u></strong><br />1. <a href="http://radiographics.rsnajnls.org/cgi/content/full/21/suppl_1/S97">Lee WJ et al. Radiologic Spectrum of Cholangiocarcinoma: Emphasis on Unusual Manifestations and Differential Diagnoses. RadioGraphics 2001; 21: 97</a><br />2. <a href="http://radiographics.rsnajnls.org/cgi/reprint/18/3/675">Stoupis C et al. The Rocky liver: radiologic-pathologic correlation of calcified hepatic masses.<br />RadioGraphics 1998; 18: 675</a>Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com1tag:blogger.com,1999:blog-30642860.post-1158504555524514362006-09-17T07:33:00.000-07:002006-09-17T07:49:30.483-07:00Omental herniation following penetrating abdominal injury<strong><u>History: </u></strong><br />35 year old, penetrating abdominal injury<br /><br /><strong><u>CT:<br /></u></strong><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/penetrating%20abdominal%20injury/penetratingabdominalinjuryCT1.jpg" border="0" /></a><br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/penetrating%20abdominal%20injury/penetratingabdominalinjuryCT2.jpg" border="0" /></a><br /><strong><u>Findings:</u></strong><br />The site of penetrating wound is seen. There is a small pneumoperitoneum. No abdominal organ is injured.<br /><br /><strong><u>Follow-up:<br /></u></strong>Managed conservatively in view of no injury to abdominal organs. He presented a month later with persistant pain abdomen<br /><br /><strong><u>Ultrasound:<br /></u></strong><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/penetrating%20abdominal%20injury/penetratingabdominalinjuryUS.jpg" border="0" /></a><br /><strong><u>Findings:<br /></u></strong>The panoramic view shows the site of penetrating injury. In addition, there is omental herniation into the abdominal musculature.<br /><br /><strong><u>Discussion:<br /></u></strong>Complications of penetrating abdominal injury without associated abdominal visceral injury include wound infection, wound dehiscence, herniation, necrotizing fasciitis and intrabdominal infection. The incidence of omental herniation after penetrating trauma is not documented in the literature, may be because it is not a seriour complication. Interestingly, omentum may be placed to close the penetrating wound, especially in thin individuals and the radiologists should be aware of this while reporting. Abdominal wall herniation are documented even after blunt injuries.Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1158163272729089702006-09-13T08:53:00.000-07:002006-09-13T09:01:14.780-07:0035 year old lady with endometrial carcinoma<strong><u>History: </u></strong><br />35 year old lady with endometrial carcinoma with back pain- ? bone metastasis<br /><br /><strong><u>LS spine AP and lateral views:<br /></u></strong><a href="http://s90.photobucket.com/albums/k280/keshrad/endoemtrial" target="_blank" action="'view¤t="><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/endoemtrial%20ca%20lung%20mets/1.jpg" border="0" /></a><br /><a href="http://s90.photobucket.com/albums/k280/keshrad/endoemtrial" target="_blank" action="'view&current="><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/endoemtrial%20ca%20lung%20mets/2.jpg" border="0" /></a><br /><br /><strong><u>Findings:<br /></u></strong>LS spine is normal. Did you notice right basal lung metastasis and surgical clips in the pelvis?<br /><br /><strong><u>Lesson:<br /></u></strong>It is important to look at 4 corners of a radiograph.<br />In all known malignancies look for lunug bases for any metastasisKeshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1158162717526324652006-09-13T08:48:00.000-07:002006-09-13T08:51:59.246-07:0080 year old lady with weight loss and pain abdomen<strong><u>AXR: </u></strong><br /><a href="http://s90.photobucket.com/albums/k280/keshrad/Pagets/?action=view¤t=plainfilm.jpg" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/Pagets/plainfilm.jpg" border="0" /></a><br />Reported as 'scoliosis with lumbosacral degeneration'<br /><br />One year later, the lady underwent bone scan for backache<br /><a href="http://s90.photobucket.com/albums/k280/keshrad/Pagets/?action=view&current=nuclearscan.jpg" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/Pagets/nuclearscan.jpg" border="0" /></a><br /><br /><strong><u>Diagnosis:</u></strong><br />Paget's disease.<br /><br /><strong><u>Lesson:</u></strong><br />Look at bones carefully in all abdomen radiographs<br />Paget's is one of the common diseases missed in its early stage on radiograph; apparantly, in most radiographs are the first ones to suggest Paget's diseaseKeshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com1tag:blogger.com,1999:blog-30642860.post-1158078960017438252006-09-12T09:35:00.000-07:002006-09-25T09:36:06.400-07:00ADPKD<strong><u>History: </u></strong><br />65 year old gentleman with known ADPKD presented with increasing right lumbar pain<br /><br /><strong><u>Image gallary:<br /></u></strong><a href="http://s90.photobucket.com/albums/k280/keshrad/ADPKD/?action=view¤t=CT1.jpg" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/ADPKD/CT1.jpg" border="0" /></a><br /><a href="http://s90.photobucket.com/albums/k280/keshrad/ADPKD/?action=view&current=CT2.jpg" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/ADPKD/CT2.jpg" border="0" /></a><br /><a href="http://s90.photobucket.com/albums/k280/keshrad/ADPKD/?action=view¤t=CT3.jpg" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/ADPKD/CT3.jpg" border="0" /></a><br /><br /><strong><u>Findings: </u></strong><br />ADPKD with hemorrhaic cyst in the right kidney<br />Did you notice the IVC filter with thrombus at the tip of the IVC filter also?<br /><br /><strong><u>Discussion:</u></strong><br />Flank pain and hematuria may result from cyst hemorrhage or infection, calculi<br />and renal tumor. There is high association between cyst hemorrhage and flank pain. Differentiation among these complications is important for management purposes. CT is very useful tool in differentiating them.<br />High density cyst in ADPKD is relatively common finding seen in up to 68% of patients. The larger the size of ADPKD, more the chances of cyst hemorrhage. The factors leading to cyst hemomrhage are possible minor trauma, tight seat belts and spontaneous, possibly related to unsupported sclerotic vessels in the cyst walls. Subcapsular cysts are more likely to bleed.<br />CT demostrates usually demostrates sharply demarcated homogeneously hyperdense round lesion with smooth margin and no contrast enhancement<br />They are usually treated by analgeniscs and rest. Sometimes cyst hemorrhage may also cause severe hematunia whihc may need blood transfusion, renal artery embolization and/or nephrectomy.<br /><br /><strong><u>Reference: </u></strong><br /><a href="http://radiology.rsnajnls.org/cgi/reprint/154/2/477">Levine E et al. High-density renal cysts in autosomal dominant polycystic kidney disease demonstrated by CT. Radiology 1985; 154: 477</a><br /><br /><strong><u>ANOTHER SIMILAR CASE:</u></strong><br />65 year old gentleman with known chronic renal impariment on long term dialysis presented with left flank pain and frank hematuria<br /><br /><u><strong>Images: </strong><br /></u><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20GU/kidney/cyst%20hemorrhage/cysthemorrhageCT1.jpg" border="0" /></a><br /><a href="http://photobucket.com/" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/00%20GU/kidney/cyst%20hemorrhage/cysthemorrhageCT2.jpg" border="0" /></a><br /><br /><strong><u>Findings and discussion:<br /></u></strong>Left upper pole cyst shows increased attenuation, in keeping with cyst hemorrhage. Both kindeys are shrunken and irregular with muleiple cysts, in keeping with chronic renal impairment with long term dialysis. Note the difference in the apeearance of the kindeys in the above case and the present case, although both cases show multiple cysts in both kidneys. The first case is typical for ADPKD and the present one for long term dialysis.Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1157474836649373762006-09-05T09:47:00.000-07:002006-09-09T12:53:58.906-07:00Left ureteric colic<strong><u>History:<br /></u></strong>58 year old gentleman presented with left ureteric colic. CT KUB was requested to exclude ureteric calculus. CT KUB was performed.<br /><br /><strong><u>Images:<br /></u></strong><a href="http://photobucket.com" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/RPF/CT1.jpg" border="0" /></a><br /><br />The case was reviewed by the reporting radiologist, before the patient was sent back. The reported radiologist asked for IV contrast enhanced study<br /><br /><a href="http://photobucket.com" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/RPF/CT2.jpg" border="0" /></a><br /><br /><strong><u>Findings:</u></strong><br />Mild hydronephrosis of the left kidney with significant perinephric fat stranding. The right renal pelvis and both ureters are also slightly prominant upto the level of the retroperitoneal mass lesion encasing the aorta, IVC and both ureters. No similar masses were found the in the abdomen or pelvis.<br /><br /><strong><u>Diagnosis: </u></strong><br />Retroperitoneal fibrosis<br /><br /><strong><u>Discussion:</u></strong><br />Retroperitoneal fibrosis (RPF) usually presents with a dull aching non-colicky pain in the flank, back, scrotum or lower abdomen. Other symptoms may include fever, ankle edema and DVT. Uncommon presentations include weight loss, nausea, vomiting, anorexia and malaise.<br />Rarely RPF may present with <strong>ureteric colic (as in the present case), </strong>Raynaud phenomenon, hematuria, claudication or urinary frequency.<br /><br />60-70% are idopathic, but can be associated with malignancy, inflammatory processes (Crohn disease, ulcerative colitis, sclerosing cholangitis), trauma, radiation, drugs (methysergide, beta blockers, metyldopa). Steroids are used in the management of the disease.Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com0tag:blogger.com,1999:blog-30642860.post-1157012205547929112006-08-31T01:12:00.000-07:002006-08-31T01:16:45.936-07:00Asbestosis<strong><u>History: </u></strong><br />65 year old gentleman with progressive breathlessness<br /><br /><strong><u>Image gallary:<br /></u></strong><a href="http://photobucket.com" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/asbestosis/CTlungwindow.jpg" border="0" /></a><br /><br /><a href="http://photobucket.com" target="_blank"><img alt="Photobucket - Video and Image Hosting" src="http://i90.photobucket.com/albums/k280/keshrad/asbestosis/CTbonewindow.jpg" border="0" /></a><br /><br /><strong><u>Findings:<br /></u>HRCT lung windows: </strong>Bilateral basal interstitial lung disease - reticulations, fibrosis, architectural distortion, traction bronchiectasis<br /><strong>HRCT bone windows: </strong>Extensive calcified pleural plaques<br /><br /><strong><u>Diagnosis: </u></strong>Diagnostic of asbestosis<br /><br /><strong><u>Additional points to be noted/mentioned:</u> </strong>Is there associated TB, pleural mass (mesothelioma)or lung mass (bronchogenic carcinoma)?Keshav.Kulkarnihttp://www.blogger.com/profile/03695575895247064823noreply@blogger.com1