This is a lateral neck Xray of a Woman came to the ENT clinic complaining of  High fever, Odynophagia(pain during swallowing) and neck pain for 4 days duration.Further questioning on that woman doctor was able to reveal that she  had removed fish bone stuck in her throat about 3weeks ago.
Comment on this Xray?




ANSWER

Answer - Retropharyngeal abscess
ARetropharyngeal abscess is usually seen in infants or young children.
The retropharyngeal space is posterior to the pharynx, bound by the buccopharyngeal fascia anteriorly, the prevertebral fascia posteriorly.
It is a potentially life-threatening medical condition.
The abscess is limited to one side of the midline.This is because of the intervening median raphe of the bucco-pharyngeal fascia which is firmly attached to the pre-vertebral fascia.
Causes
* Upper respiratory tract infection
* Oral infections
* Pharyngeal trauma from endotracheal intubation,endoscopy, foreign body ingestion

CLINICAL FEATURES

Symptoms
  • Breathing difficulty
  • Difficulty swallowing(Dysphagia)
  • Painfull swallowing (Odynophagia)
  • Drooling of saliva
  • High fever
  • Stridor
  • Intercostal retractions
  • Sore throat
Signs
  • Posterior pharyngeal edema
  • Nuchal rigidity
  • Cervical adenopathy
  • Stridor

INVESTIGATIONS

* Full Blood Count
* Blood cultures
* C-reactive protein
* Lateral Neck Xray


Widening of the retropharyngeal soft tissues
Widening of the prevertebral space
Gas in the tissues
Straightening of cervical vertebrae


* Contrast CT scan of the neck - Retropharyngeal abscess appears as a hypodense lesion in the retropharyngeal space with peripheral ring enhancement.
* Chest XRAY - To exclude aspirational pneumonia and mediastinitis

COMPLICATIONS

Possible Complications


1. Airway obstruction
2. Aspiration pneumonia
3. Mediastinitis
4. Osteomyelitis
5. Epidural abscess
6. Jugular venous thrombosis
7. Necrotizing fasciitis
8. Sepsis

TREATMENT

1. Airway management if upper airway obstruction is present
2. Surgery is needed to drain the infected area
3. IV Antibiotics - Gram-positive organisms , gram-negative organisms, and anaerobes must be covered
4. Corticosteroids are sometimes given to reduce airway swelling




Lady With Joint Stiffness

Thursday, January 28, 2010 9 comments

This is X-ray of  hands of a 53 years old woman who has been having joint stiffness which was lasting for about 1 hour particularly in the morning since she was 25 years.What are the Abnormalities that you can see in this Xray and What is the Diagnosis?
How would you treat this patient?



This is a Chest Xray Of a 55 year old male who came to a gastroenterologist, complaining of burning of pain in the epigastric region , usually getting  after meals and was made worse by stooping or lying down.He has got Omeprazole  from a general Practitioner for several times but his symptom  was not settled fully.What is the abnormality seen in this Xray? 

 

This is a Chest Xray of a  man who came to the GP complaining of pain in the neck and the shoulder region and numbness along the inner aspect of his left hand which have been having for years. But he did not pay any attention to that.He had noticed that his symptoms  were getting worsened in the recent past.On examination of his left hand,  trophic skin changes,impaired sensation on the ulnar forearm and  wasting of the hypothenar muscles of the left hand  were noticed.
What are the differential diagnosis in this patient?
What is the abnormality you can identify in this Xray?


Boy Who Undergone Splenectomy

Saturday, January 23, 2010 4 comments

This is the Skull Xray of 10 Years old boy who has been aneamic and undergone splenectomy at the age of 6 years.Identify the Characteristic pattern finding of this Skull X-ray?
What are important points that you have to ask in the history of this patient?






This is a Chest  Xray Of a 36 year old Woman who was previously well  admitted to the hospital complaining of left sided pleuritic type chest pain  associated with shortness of breath for 6 hours.Comment on her Chest Xray?

These are the two Xrays  taken from the 65 year old male complaining of pain in the lower limbs and progressively deviating his limbs away from the midline.And he also noticed that his hat was quite tight for his head which was not previously noticed.Comment on the Xray and What is the Diagnosis?





This is a MRI of a brain of a 10 year old girl who admitted to the hospital who attended  puberty 2months before,now complaining of dull and diffuse type headache associated with visual impairement.And growth retardation also noted in this Child.
What is the probable diagnosis in this girl?
What are the complications and possible outcome of this ?

This is a Chest Xray of a 43 year woman who came to the hospital complaining of High fever ( not documented at home) associated with rigors and  productive and painful cough.
Comment on her Xray?
What are important Chest examination findings that are likely to find in this lady?






These are the Three X-rays taken from the boy who was previously Diagnosed to have Achondroplasia.This time the child was admitted to the Paediatric ward because he was having Ataxia and Obstructive Sleep Apnoea which were appeared 2weeks back.

Describe the characteristic Radiological findings in these X ray?
What  would be the most probable reason for his new developing features?




These are the Two Xrays (One is Xray KUB and Other one is Xray of the Pelvis) taken from a woman was complaining of Lower back and Loin pain for 3 weeks duration.Along with that she also had lassitude and dyspepsia.Comment on these two Xrays?And What are the Biochemical tests that you would like to do on this situation?







This is the CT of the Brain of a 68 year old man who was admitted to the Neurosurgery ward at around 10.00 pm in the night after a history of falling in his house.At the time he was brought to the Hospital he was confused.Comment On this CT Brain and How would you Manage this Patient?

ANSWER - ACUTE SDH IN THE LEFT FRONTO PARIETAL REGION OF THE BRAIN 


Acute subdural hemorrhage  is a type of hematoma, a form of traumatic brain injury in which blood collects within the subdural space in between the inner meningeal layer of the dura matter and the arachnoid matter.It results from rupture of cortical bridging veins that connect the venous system of the brain to the large intradural venous sinuses.Acute subdural hematoma has a very high mortality rate.

Predisposing factors
  • Violently shakes an infant or small child- classical finding in Shaken baby syndrome or Battered Baby Syndrome
  • cerebral atrophy, e.g. elderly
  • Low CSF pressure after shunting
  • Alcoholism
  • Coagulation disorder or anticoagulation therapy

CLINICAL FEATURES
  1. Loss of consciousness or fluctuating levels of consciousness
  2. Focal neurological signs
  3. Signs of increased ICP
  4. At the End stage, signs of Brain Stem herniation

INVESTIGATIONS
  • CT scan is mandatory
CT scan, subdural hematomas are classically crescent-shaped, with a concave surface away from the skull
Initially it is become hyperdense and  after 10-20 days, the subdural hematoma becomes isodense with brain. Later it becomes relatively hypodense
Mid line Shifting with compressed ipsilateral ventricle and dialated contralateral ventricle due to obstruction at the foramen of Munro
  • Skull X-ray 

MANAGEMENT
  • Large or symptomatic hematomas require a craniotomy
  • Evacuate hematoma through 2-3 burr holes, and irrigate cavity with saline
  • In infants,evacuate haematoma through the anterior fontanelle
  • Identifies and controls sites of bleeding
  • Conservative management - steroid treatment over several weeks if it is small.
Postoperative complications include increased ICP, brain edema, infections,seizure and rebleeding

This is a X-ray showing the part of the vertebral column and the pelvis of a 32 years old man who came to the hospital complaining of insidious onset of lower back pain  for more than 2 months period.He complained that back pain persisted, even at rest.And The back pain is associated with spinal stiffness in the morning.
What is the Diagnosis?
What are important Xray signs that can be elicited in Xray spine?



This is a Barium Swallow of a 24 year young girl who was complaining of difficulty in swallowing Solid food as well as Liquids recently.Difficulty in swallowing is more prominent when she was taking solid foods. she also has experienced a retrosternal chest pain while she was  eating.Recently her weight has been reduced by 4.3kg.Comment on her Ba Swallow?



Krish 5 Year old boy brought  to the hospital by his mother because she has noticed that her child did not have appropriate height for his age and having Mild limb deformity.This child has a previous Hx  of  Right tibial fracture  when the child was 3years old.What is the most likely Diagnosis?

This is a PA Chest Xray of 48 years old man who was a heavy Smoker for more than 15 years, came to the hospital complaining of drooping of his Right eye lid and pain and numbness in his right arm for 1 month duration.On Examination he was found to have Right sided Ptosis, Miosis(constriction of the pupils and wasting of the small muscles of the Right arm.Comment on this X ray and What is the most probable Diagnosis in this patient?



Man with lost his consciousness

Thursday, January 7, 2010 15 comments

This is a non contrast CT of the Brain of 28 year old computer engineer who has been undergone RTA previous night at about 9.30 pm.At that time he was not under alcohol consumption and Soon after the attack he lost his consciousness for about 2mins and then recovered fully.
Comment on his CT-Brain???
What is Lucid Period; What is the pathophysiology behind it???


This is a non contrast CT of the brain of Mr.Alex 28 year old Previously Diagnosed to have Ventricular Septal Defect, was presented with Left Sided Headache which was worsened especially in the morning,Vomiting and  Fever for 2 weeks Duration.He  has also developed right sided focal seizure 2days back.Comment on this CT?

 

This is an Axial T2 Weighted MRI of the brain of 61 year old male patient who has been having severe cognitive impaitement over last 8 months.And His relatives has noticed that he was having mood disturbances personality changes also.Comment on this MRI?


This is a double-contrast barium enema obtained 18-year-old woman who was complaining of insidious onset progressive type abdominal pain and Diarrhoea.Identify the changes that you can see & what is the Dx?




3 month old baby was admitted to the peaediatric ward by his parents because of their child was excessively crying over past 2 weeks.He was found to have Icteric and Right upper quandrial abdominal mass on examination.
Comment on this child Xray?



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