What is your diagnosis?
Arteriovenous Malformation are lesions of the cerebral vasculature development such that blood flows directly from the arterial system to the venous system without passing through a capillary system.
The direct AV connection exposes the venous system to abnormally high pressures. This results in a system of enlarged feeding vessels, the tangled nidus of the AVM itself, and enlarged draining venous structures.
AVMs are considered congenital lesions.
Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) are thought to be responsible for the development of AVM
- Hemorrhage (ICH,SDH,IVH)
- Progressive neurologic deficit - May be caused by mass effect or ischemia resulting from local vascular steal phenomenon
- If blocks the CSF pathway - Hydrocephalus
Hemorrhage is more likely to be caused by small lesions, while seizures are more likely to be caused by large lesions.
- CT scan to exclude Intracranial haemorrhages
- CT angiography better vascular detail than magnetic resonance angiography
- Cerebral angiography provides definitive diagnosis. It allows grading of the AVM via the following Spetzler and Martin criteria.
- Advantages: immediate and permanent recovery after complete resection by craniotomy
- Disadvantages: Intraoperative bleeding, damage to adjacent neural tissue, and ischemic stroke
- Benefit of invasive treatment for unruptured AVMs has never been proven
- Occlusion of blood vessels with coils or particles or glue introduced by a radiographically guided catheter
- An invasive procedure
- Use it as adjuvant therapy prior to craniotomy to decrease intraoperative bleeding and reduce the size of AVM
- Is Curative in lesions <1 cm in diameter that are fed by a single artery
- Can access all anatomic locations of the brain
- It can only treat smaller lesions
- Takes 2 or more years for a full destructive effect
Also known as osteonecrosis, aseptic necrosis, ischemic bone necrosis
Resulting from the temporary or permanent loss of the blood supply to an area of bone
Some regions of the human skeleton have a much higher tendency to develop ischaemia
- neck of femur
- proximal pole of the scaphoid bone
- body of the talus
- Fracture of the neck of femur
- Complication of osteo- and rheumatoid arthritis
- Neuropathic joint
- Typically middle aged men
- Affects hips and knees
High levels of steroids:
- Cushing's syndrome
- Sickle cell anaemia
- Infective endocarditis
- Chronic liver disease
- Caisson disease
- Gaucher's disease
- Diabetes mellitus
- Polycythaemia rubra vera
Avascular necrosis usually affects people between 30 and 50 years of age
Onset may be insidious but often there is a dramatic onset of pain.
Early stage of the disease x-ray images usually appear normal so Bone scans is useful
Hip resurfacing or metal on metal (MOM) resurfacing in younger patients and Realignment osteotomy
Bisphosphonates- reduces the rate of bone breakdown by osteoclasts, thus preventing collapse
Identify the Xray?
What is the possible complication of this condition that she may be having in future?
(calcifying cholecystitis, or cholecystopathia chronica calcarea)
Porcelain gallbladder means the wall of the gallbladder has been calcified to a hard and bluish white texture resembling porcelain ceramic.
It is predominantly found in overweight female patients of middle age.(male-to-female ratio is 1:5)
Gallstones are present in 90% of patients with porcelain gallbladder
Low-grade chronic inflammation(chronic cholecystitis)t intramural hemorrhage and an imbalance in calcium metabolism are implicated for the condition
Occurrence of gallbladder carcinoma(commonly adeno carcinoma) is remarkably high in patient with porcelain gallbladder and patients with gallbladder carcinoma usually have a poor prognosis
- Abdominal pain (especially after eating)
- Palpable mass may occasionally be found
- Plain abdominal Xray-galllbladder is seen as having semi radiolucent appearance
- Non-functioning gallbladder on oral cholecystogram
- Ultrasound Scan
- CT Scan
This is a PA chest Xray of a 43 year old woman who was presented with Shortness of Breath on exertion(Dyspnoea), Cough and Chest pain.Other than the pulmonary symptoms she also complains of milld fever and loss of appetite.
Respiratory Examination was normal other than bilateral crackles.
What are the Differntial Diagnosis?
This is abdominal Xray of a 73 years old male who came to the surgery casualty ward complaining of severe colicky type abdominal pain particularly in the left lower quadrant,gross abdominal distension and not passing stools and flatus for 1 day .This patient was on long term use of laxatives for chronic constipation.On examination of his abdomen, It was tympanic and palpable mass found in the Abdomen.
What is the Diagnosis?