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 ?



ANSWER

Blount's disease
Xray Findings
  • Bilateral depression and deformity of medial aspect of proximal tibial epiphysis and metaphysis
  • Beaking of proximal tibial metaphysis bilaterally


Differential Diagnosis:
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


Diagnosis
Xray Features
  • 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.

Boy with Dyspnoea and Angina

Tuesday, April 20, 2010 42 comments

This is a PA chest Xray of 16 years old boy who came to the cardiology unit complaining of  shortness of breath which was aggravated on exertion and mild chest pain.And he also had frequent faints.
On examination he was found to have jerky pulse and systolic murmur which was best heard at the left lower sternal edge.


What is your diagnosis?
What are the ECG changes that you would expect in this condition?

Lady with Bilateral Ptosis

Thursday, April 15, 2010 13 comments

This is the  Chest CT  of a  33 year old woman who came to the  neurology unit complaining of  drooping  of her eye lids and generalized fatigability  which is worsen when she is in the middle of some work and comes to  the normal  by the rest.Drooping  of her eye lid which was bilateral and  more prominent on the left  side.In addition to that she also complained that she had recent onset chestpain along with dry cough.On examination Pemberton's sign was elicited.


Identify this CT?
What are the causes of positive Pemberton's sign?
How  would you link all her clinical features?


Baby presented with tachypnoea

Wednesday, April 7, 2010 22 comments

This is a Supine  Xray of a This 2 month old male baby presented with tachypnoea who was brought  to the paediatric ward by  his parents.On examination it was found to have that the child was cyanotic.


Identify this Xray??

ANSWER

ANSWER - RIGHT SIDED CONGENITAL DIAPHRAGMATIC HERNIA with Mediastinal shift


It is a congenital malformation of the diaphragm. The most common type of CDH is a Bochdalek hernia; other types include Morgagni's hernia, diaphragm eventration and central tendon defects of the diaphragm. Malformation of the diaphragm allows the abdominal organs to push into the chest thereby impeding proper lung formation.


CDH is a life-threatening pathology in infants, and a major cause of death due to two complications: pulmonary hypoplasia and pulmonary hypertension.


Newborns with CDH often have severe respiratory distress which can be life-threatening unless treated appropriately.


Congenital diaphragmatic hernia occurs 1 in 2200 births.


It occurs more commonly on the left than the right (5:1).

Clinical Presentation
The affected baby, if not diagnosed prenatally, usually presents with respiratory distress between 12 and 24 hours after birth. Other classical signs include:
A scaphoid abdomen
Hyperexpanded chest
Cyanosis
Mediastinal shift to the opposite side


Diagnosis
The majority of diaphragmatic hernia are detected antenatally
Postnatally the diagnosis is confirmed by chest radiology, which shows loops of bowel, or other abdominal viscerae, in the thorax.
Delayed X-ray following administration of contrast via the nasogastric tube shows loops of bowel in the hemithorax, confirming the congenital diaphragmatic hernia


DDx - cystic adenomatoid malformation of the lung


Treatment
Stabilization before surgery- nasogastric aspiration, ventilation and bicarbonate infusion to correct acid-base and blood gas abnormalities


Reduction of abdominal contents and repair of the residual diaphragm with non-absorbable sutures


Postoperative ventilation and early oral feeding are recommended


Prognosis
The overall mortality is 50 to 60%
A good prognostic indicator is the position of the stomach; if it remains in the abdomen the prognosis is good; if it is in the chest the prognosis is poor.
Death is secondary to pulmonary hypoplasia.

This is a Contrast-enhanced CT scan of the Abdomen of a 44 year old woman admitted to the ward complaining of episodic headache, palpitation and excessive sweating that have been occurring about four times for a day which was lasting for about 2-3 minutes.


Identify this  CT Scan??

This is a PA  Chest Xray of a  16 years old boy who was complaining  of having chronic cough associated with  foul  smelling copious amount of sputum who had  been treating  for recurrent  upper respiratory tract infections and recurrent otitis media in his childhood.



What are the abnormalities seen in this Xray?
What is the Diagnosis?


ANSWER

Kartagener’s syndrome
X-ray Chest PA view in Kartagener’s syndrome showing dextrocardia and features of bronchiectasis, more on the left side. Left dome of diaphragm is higher and the fundal gas bubble is seen on the right side, indicating situs inversus.


Kartagener Syndrome , also known as immotile ciliary syndrome or Primary ciliary dyskinesia, is a rare, ciliopathic, autosomal recessive genetic disorder that causes a defect in the action of the cilia lining the respiratory tract , sinuses, Eustachian tube, middle ear and fallopian tube.
Kartagener Syndrome = combination of situs inversus, chronic sinusitis, and bronchiectasis


It is thought that the molecular defect is in the dynein component of cilial apparatus.


CLINICAL FREATURES
Chronic recurrent respiratory infections, including sinusitis, bronchitis, pneumonia and bronchiectasis
Chronic suppurative otitis media
Infertility is common, due to defective ciliary action in the fallopian tube in affected females or diminished sperm motility in affected males
Occationally hydrocephalus


In the ECG there are inverted P waves in lead I abd there is reversed R-wave progression.

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