This is the second pregnancy of healthy 27 year old mother. The pregnancy was uneventful until the third trimester, when polyhydramnios and intrauterine growth retardation were detected by antenatal ultrasound. The child was born by uncomplicated delivery at 37 weeks of gestation. Apgar scores were 6 and 8. Birth weight: 1730 g. Ambu-bag resuscitation was necessary. Physical examination showed dysmorphic signs, including: small palpebral fissure and abnormal implantation of the thumb of her left hand, along with respiratory distress syndrome, tachypnoea, cyanosis, copious secretions, and a scaphoid abdomen.
Chest radiography was performed soon after birth.
ANSWERXray shows Nasogastric tube projected onto the proximal oesophagus and absence of gastrointestinal air. There is a widespread pattern of granular increased density in the lungs, with effacement of the cardiac borders, consistent with respiratory distress.
Oesophageal atresia and tracheo-oesophageal fistula is a complex of congenital anomalies characterised by incomplete formation of the tubular oesophagus.
Different types of oesophageal atresia are identified on the basis of the presence (and location) or absence of a tracheo-oesophageal fistula.
- Type A: atresia without fistula (8%)
- Type B: atresia with proximal fistula (1%)
- Type C: atresia with distal fistula (80%)
- Type D: atresia with proximal and distal fistulae (1%)
- Type E: fistula without atresia (4%)
About half the children have other associated malformations and the VACTERL complex (Vertebral disorders, Ano-rectal malformations, Cardiovascular anomalies, Tracheo-oesophageal fistula, Radial/Renal dysplasia, Limb defects) is the best known group of anomalies associated with oesophageal atresia.
Typical clinical findings are failure to successfully pass a catheter into the stomach, regurgitation, inability to swallow saliva or milk, aspiration, respiratory distress, aspiration pneumonia.
Radiologic diagnosis is based on findings at anteroposterior and lateral chest radiography wich reveals a blind pouch of the proximal oesophagus, distended with air. adiographic evaluation should always include the abdomen to asses the presence of air in the gastrointestinal tract (distal fistula). In types A and B there is complete absence of gas in the stomach and intestinal tract; in types C and D, the gastrointestinal tract usually appears distended with air.
The type of oesophageal atresia is confirmed by advancing a radiopaque feeding tube from the nose to the level of the atresia. The tube will curl when it approaches the blind end. Rigid bronchoscopy is performed to confirm the anatomy, to evaluate for a proximal fistula and to control the distal fistula.
During pregnancy, oesophageal atresia may be suggested by the presence of a combination of polyhydramnios.
Answer - Type A Oesophageal atresia : atresia without fistula
65 years old male presented with confusion and irregular small pupils that react to near objects, but not to light.Further neurological examination revealed ataxic wide-based gait and foot slap, areflexia and loss of position.
What is the probable diagnosis?
There is an irregular lytic area in the left frontal bone, which variably involves the whole thickness of the vault. The process seems to have extended down the coronal suture into the anterior part of sphenoid. Compare with normal diploic vessels. Otherwise vault markings are normal without any increase in vascular markings. The dorsum sellae appears intact.
Young adult male motorcyclist with haematuria after recent accident.
Identify these two IVUs?
The left renal angiogram shows normal renal perfusion, but with a laceration of the kidney giving a gap in the perfusion and immediate enhancement of the renal cortex.
Identify this CT scan???
This single cut from a CT series after intravenous contrast (given into a lower limb vein) shows opacification of spinal and pre-vertebral veins (immediately behind the aorta). The density of a renogram shows the site of the left kidney. The inferior vena cava opacification is incomplete, outlining a soft tissue mass in the vein and decreasing the effective lumen by at least 75%.
This is an intravenous urogram of a 27 years old white male with a 3 month history of dysuria and bilateral loin pain.He did not have either haematuria or obstructive lowerurinary tract symptoms.On examination of this patient he had bilateral renal angle tenderness and tenderness over the suprapubic area.
Clinical history is suggestive of pyelonephritis.
The kidneys pelvicalyceal systems and proximal ureters appear grossly normal, renal pelvis and calyces are dialted indicating bilateral mild hydronephrosis, implying the possibility of obstruction.(mild left sided hydronephrosis).Both ureters are normal calibre.The lower ends of the ureters cross the bladder wall towards the trigone, but are dilated at their lower end.(cobra head sign) The contrast in the lower end of the ureter is surrounded by a zone of contrast free space within the density of the bladder.
What would be the possible diagnosis in this infant?
This is a double-contrast barium enema of a 31 year old unmarried woman with lower abdominal pain that seemed to occur monthly.And she also complains of passing altered colored stools associated with lower abdominal pain.
What would be the possible diagnosis?
Correct Answer is the Endometriosis of the Caecum
Arachnoid cysts are benign cystic lesions localized within the arachnoid membrane that usually contain clear, colorless fluid that is most likely normal cerebrospinal fluid; rarely, they contain xanthochromic fluid.Most are developmental anomalies.But it can also be associated with neoplasms,trauma,surgery and neonatal infections.They are most commonly found in the suprasellar region, sylvian fissure, over the convexity of the hemisphere, and more rarely in the cisterna magna of the posterior fossa.Arachnoid cysts also occur within the spinal canal.
Arachnoid cyst expansion most likely occurs when intracranial pulsation pushes CSF through defects and CSF then becomes entrapped in arachnoid locations.
Arachnoid cysts often are an incidental finding on imaging. Usually, arachnoid cysts are asymptomatic; this is true even of cysts that are quite large. The most commonly associated clinical features are headache, calvarial bulging, and seizures; focal neurologic signs occur less frequently.
- MRI is the diagnostic procedure of choice because of its ability to demonstrate the exact location, extent, and relationship of the arachnoid cyst to adjacent brain or spinal cord
- On CT scans, arachnoid cysts are characterized by sharp, nonenhancing borders; they are isodense to CSF
- Plain radiographic findings are nonspecific and have little to offer in the diagnosis of arachnoid cysts
This is the Xray showing both knee joints of a 4 1/2 year old female who was brought to the orthopedic clinic by her mother complaining of a 1 1/2 year history of episodic left knee pain, worsening over the past 6 months, especially when walking.
On examiantion there was Bilateral varus deformity of lower extremities which was more prominent in the left side than the right side.
Identify this Xray ?
- Bilateral depression and deformity of medial aspect of proximal tibial epiphysis and metaphysis
- Beaking of proximal tibial metaphysis bilaterally
1) Mild rickets
2) A physiological bow legs
Blount disease is a growth disorder of the tibia characterized by disordered ossification of the medial aspect of the proximal tibial physis, epiphysis, and metaphysis. This progressive deformity is manifested by varus angulation and internal rotation of the tibia in the proximal metaphyseal region immediately below the knee.
Blount disease most likely is caused by a combination of excessive compressive forces on the proximal medial metaphysis of the tibia and altered endochondral bone formation
Two main types
Infantile Blount disease - tends to be bilateral and occurs in children less than 3 years.The infantile form is generally more common in females and children generally start to walk early, usually when aged 9-10 months.
Juvenile Blount disease - usually unilateral seen in children aged 4-10 years
- The medial epiphyseal line demonstrates irregularity
- Abnormal sloping of the medial tibial epiphysis
- The metaphyseal portion of the plate demonstrates irregular beaking
Treatment: Children can be treated by bracing, epiphyseal stapling, osteotomies, or in extreme cases, by intra-epiphyseal corrective realignment.