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| Oesophago-gastro-duodenal barium study |
A 27-month-old girl was referred to our hospital because of growth retardation. She was small for her age. Her weight and height were under 3rd percentile. She was vocalising well and her motor development was normal. She had strabismus and there was no other focal neurological signs. She was born through normal vaginal delivery at 28th gestational week and weighed 900 grams. Pregnancy and neonatal period were normal. There was no family history of congenital central nervous system (CNS) disorders. There were no neuroradiological findings of inborn errors of metabolism, leukodystrophy, exposure to hypoxia or inflammatory CNS disease.
Magnetic resonance imaging (MRI) were given here.
Female with acute onset of severe right-sided abdominal pain associated with nausea, vomiting and diarrhoea
52 years old female patient presented with acute onset of severe right-sided abdominal pain associated with nausea, vomiting and one episode of diarrhoea. This was preceded by similar episodes of pain over a 3-week period. On examination the patient had a palpable right iliac fossa mass. Plain film of the abdomen showed a paucity of bowel gas in the right side of the abdomen with an impression of a soft tissue mass in this area.
Abdominal USS and Contrast enhanced CT scan of the abdomen were performed.
Female with severe occipital headache with vomiting, dizziness and blurred vision
What is the most likely diagnosis?
ANSWER
The un-enhanced CT(upper image) demonstrates increased attenuation within the straight sinus, vein of Galen.
Lower Image demonstrates the filling defects within the vein of Galen,straight sinus and superior sagittal sinus on a CT venogram sagittal reconstruction.
This patient was female, had just finished steroid treatment after a chest infection and was on the combined oral contraceptive pill, all risk factors for venous sinus thrombosis.
The appearance of venous sinus thrombosis on un-enhanced CT is high attenuation secondary to thrombus formation, with corresponding filling defects on CT venogram as demonstrated in this case.
A differential for hyper-attenuation of the un-enhanced venous sinuses is elevated levels of haematocrit (Eg:secondary to polycythaemia ). Children also have higher haematocrit levels and a lower brain density often causing a hyper-dense appearance of the sinuses.Another differential is partial volume effects due to the proximity of the cerebral venous sinuses to bony structures. For both of these differentials, there should not be a corresponding filling defect on a CT venogram.
The venous sinuses can be separated into the deep cerebral veins comprising the straight sinus, internal cerebral veins and the vein of Galen, and the cerebral venous sinuses comprising the sigmoid, transverse and superior sagittal sinuses. High attenuation in the deep cerebral veins on un-enhanced CT has been shown to be 100% sensitive and 99.4% specific for deep venous sinus thrombosis.
73-year-old diabetic male patient who was admitted to our hospital with severe left flank pain and high fever. Physical examination revealed a left flank palpable mass.
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| Contrast-enhanced CT |
What is the diagnosis?
6 years old boy presented with pain in the left hip and limping. Plain radiographs of the pelvis, AP and frog lateral views, were performed. Follow-up films were performed after 3 months. Follow-up films showed good healing of the left femoral epiphysis with a mild coxa magna deformity of the femoral neck.
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| Pelvic X-ray - frog lateral view |
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| follow up Pelvic Xray AP view |
ANSWER
The initial radiographs showed fragmentation of the left femoral epiphysis, which appears dense as compared with the right.
The aetiology of Perthes disease is idiopathic. It represents multiple vascular occlusive episodes that involve the femoral head, causing changes of avascular necrosis. It is a long ongoing process of vascular change and repair and is different from avascular necrosis secondary to trauma. It usually affects Caucasian boys (4-5 times more often than females), in the age group of 3-12 years, occurring bilaterally in 15% of cases and when bilateral is usually asymmetrical. When symmetric involvement is seen, hyporthyroidism and epiphyseal dysplasia should be excluded. The onset is earlier in females and the prognosis worse. There is increased incidence of associated congenital anomalies, congenital heart disease, pyloric stenosis and undescended testes.
Female with diffuse pustulous skin lesions and polyarthralgias
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| CT AXIAL PELVIS |
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| CT AXIAL CLAVICLE |
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| CT CORONAL LOWER LUMBAR |
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| Tc-99m methylene diphosphonate bone scintigraphy |
ANSWER
The main findings in the CT study were sclerosis, irregularities, and hyperostosis of the manubrium and medial ends of both clavicles; asymmetric sacroiliitis (Fig. 2) and sclerosis and erosion of the superior-lateral corner of L4 vertebral body .
Bone scintingraphy revealed intense radiotracer uptake in both clavicle medial ends and sternoclavicular joints. There was also radiotracer uptake in the sacroiliac joints (more pronounced on the right).
SAPHO is an acronym that refers to an uncommon syndrome, composed of the combination of synovitis, acne, pustulosis, hyperostosis and osteitis. It affects more often young adults, with a female preponderance.
The causes are unknown, although some authors support its integration in seronegative spondyloarthtropaties which is supported by the increasead prevalence of the HLA B27 allele, occasional presence of sacroiliitis, inflammatory bowel disease and psoriasis.The most common dermatologic manifestations are palmoplantar pustulosis, severe acne, and psoriasis.
Characteristic radiographic findings include hyperostosis, which includes endosteal and periosteal proliferation and enthesopatic ossification. In association there are mixed areas of osteolysis. Adjacent joints show manifestations of arthritis, namely erosions and joint space narrowing. CT can depict these alterations in greater detail.
An 11-year-old boy was referred with acute paraplegia and local tenderness over the left costovertebral angle. He had also history of left side insidious back pain, low grade fever and malaise. Chest X-ray also showed a calcified focus probably a calcified lymph node at the left hilar region however no evidence of parenchymal infiltration was found.Helical abdominal CT was performed after taking the Plain radiograph of the thoracolumbar region.
Image of Helical abdominal CT was given here.
Identify the lesion and what is the most likely diagnosis?
ANSWER
Transverse T2-weighted image. Tube thickening (arrow) is detected as an amorphous solid masslike structure. A small amount of fluid (long arrow) in the Douglas space is seen.
Sagittal T2-weighted image depicts a few small cystic structures (small arrows) in the periphery of the enlarged adnexa, probably related to transudation of fluid into the ovarian follicles due to ovarian congestion.
Imaging findings were strongly suggestive of hemorrhagic necrosis of the adnexa following torsion and were confirmed surgically.
Adnexal torsion is a rare cause of lower abdominal pain, often presenting as a diagnostic problem due to the nonspecific clinical, laboratory and sonographic findings, as it was seen also in this patient.It is associated with an ipsilateral ovarian tumour or cyst in 50-81% of cases, which is almost always benign.
The sonographic findings of adnexal torsion are usually nonspecific and include the presence of a cystic, solid or complex adnexal mass, as it was seen in this patient.Free intraperitoneal fluid is found in one to two thirds of patients. CT and MR imaging is usually recommended in subacute or chronic cases to confirm the diagnosis of adnexal torsion and to differentiate haemorrhagic from nonhaemorrhagic infarction.Common CT and MR imaging findings of adnexal torsion include fallopian tube thickening, ascites and uterus deviation to the twisted side.Imaging findings suggestive of haemorrhagic infarction include eccentric smooth wall thickening exceeding 10 mm in a cystic ovarian mass, lack of contrast enhancement of the internal solid component or the thickened wall of a twisted adnexal mass, haemorrhage within the tube or adnexal mass, or haemoperitoneum.
Female with Hypostenia and hypoestesia localized at lower limbs
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| axial T1-weighted post-Gadolinium image |
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| sagittal image T1-weighted post-Gadolinium |
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| sagittal T2-weighted image |
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| sagittal PD-weighted image |
