Stick 'Em Up Cute Kitten!

How funny is this? The other night I had a dream that I was robbing a bank.... But when I entered the bank, all the tellers were cute little kittens.... And then, I realized that I had forgotten my gun, so I had to tickle them.... Then I found this video....

Sturge-Weber syndrome

Findings

Gyriform calcifications are observed over the left occipital lobe in the CT exam. The MRI demonstrates atrophy of the left cerebral hemisphere. There is enlargement of the left choroid plexus which demonstrates homogeneous enhancement post contrast. There is also gyriform enhancement post contrast most significantly on the left occipital lobe. There is diffuse enhancement of the subcutaneous tissues over the left eye.


Diagnosis: Sturge-Weber syndrome.


Key points

Classically the patients have a facial port-wine stain, ipsilateral intracranial abnormalities, contralateral hemiparesis, hemiatrophy, mental retardation, and homonymous hemianopia. The severity of these features varies widely patient to patient. Commonly the patients will have glaucoma on the affected side. Seizures are also very common.
Only 8% of patients with port-wine stains have Sturge-Weber Syndrome. 13% of Sturge-Weber syndrome patients do not have a facial angioma.
There is no clear genetic link at this time. There is no sex or race Predilection and it is very seldom seen more than once in the same family. Several different chromosomal abnormalities have been implicated.
Radiographically one can see "tram track calcifications" which are leptomeningeal calcifications like those seen on the CT image.
MRI can demonstrate the angiomatous abnormalities. In this case the cutaneous capillary angioma (port-wine stain) is well demonstrated as is the meningeal angiomatosis over the left occipital lobe. Cerebral hemiatrophy is well demonstrated by MRI as is the choroidal angiomatosis.
Multiple therapies are employed in these patients. The port-wine stains can be "removed" with laser treatments. Seizures can be treated with anticonvulsants. Refractory seizures can be treated surgically. The surgeries can be as extensive as a hemispherectomy.

Christmas Season in Manila Downtown (2)

Manila Downtown is the place to go for the ultimate bargain hunting experience in the Philippines. In the Avenida-Carriedo-Quiapo area, hundreds of makeshift stalls compete with numerous established bazaars and shops of odds and ends. You can find everything here for your convenience. But shop with caution as any crowded place is a favorite hunting place of pickpockets and thieves, and Manila downtown is no exception. During this photo shoot, I have observed a strong police presence, the city government's laudable effort to mitigate petty crimes. But then again it is always a good measure to exercise prudence: always keep an eye on your pocket and belongings. I am still fortunate that in my frequent foray in in this motley crowded place, I have not experienced a single incident of my pocket being picked, except when my cellphone was stolen during the Senyor Nazareno procession last January 9, 2009, and that I blame for my carelessness. Lastly, downtown Manila can be a desensitizing experience to a tourist or a first-timer, but once you have adjusted accordingly to the culture shock, you cannot fail to come again and again to this endlessly fascinatingly crowded place.

Traffic at Plaza Goiti, corner of Carriedo and Avenida Rizal, Manila















Calendar 2010 and ampaw seller in Avenida Rizal. Ampaw is the small red envelope that people use to enclose a cash gift.

Empty Sella and CSF Rhinorrhea-MRI & CT

Spontaneous cerebrospinal rhinorrhea is a rare clinical condition. More commonly it develops due to cerebral tumors or hydrocephalus; it is seldom seen in association with empty sella syndrome. This is a 40 yr old female with spontaneous CSF leak. MRI images reveal a flattened thinned out pituitary gland and defect in the sellar floor on coronal CT scan images. Contrast MRI images are provided.

Second opinion by- Teleradiology Providers

Can You Guess This TV Theme? #24 - Answer

Two weeks in a row, two shows about odd couple adoptions.... I thought this theme was especially difficult to guess.....

Emmanuel Lewis is 'Webster', a young child adopted by Katherine and George Papadapolis, played by Susan Clark and Alex Karras.

Webster was orphaned after his parents, a former NFL teammate of George Papadapolis and his wife, were in a tragic car crash.... Webster is adopted soon after the loss of his parents, and everybody quickly learns lessons about love, life and laughter....

Again.... There's not too many interesting tidbits about 'Webster' floating around....

Did you know that Susan Clark and Alex Karras were married in real life? Or that Corin Nemec, who went on to play Parker Lewis in 'Parker Lewis Can't Lose', played young Nicky Papadapolis?

My favorite.... A little known comedian, he goes by the name of Jerry Seinfeld, was fired as a writer for 'Webster' after only a few episodes.

Barack Obama Could Be A Wide Receiver

This commercial that aired during the Detroit Lions and Green Bay Packers game on Thanksgiving for the United We Serve program, NFL and the United States proved something..... Barack Obama can't throw a baseball, but he sure can catch a football.... Wait a second, that was totally a forward lateral Mr. President....

Can You Guess This TV Theme? #24

Good morning everybody! I trust you all had a wonderful Thanksgiving. Here it is again..... Can you guess this TV theme?

Intraosseous cavernous hemangioma of the left maxillary bone

Findings

Noncontrast orbital CT demonstrates a mass arising from the left maxillary bone with internal bony trabeculations in a “honeycomb,” “sunburst,” or “spokewheel” pattern typical for an intraosseous cavernous hemangioma.
This pattern of trabeculation on CT translates into a network of linear hypointense T1 and T2 signal with interspersed areas of enhancement on the T1 post gadolinium images characteristic of this entity.


Diagnosis: Intraosseous cavernous hemangioma of the left maxillary bone


Intraosseous cavernous hemangiomas are benign neoplasms which comprise only up to 1% of all osseous tumors and 7-10% of skull tumors. These are most frequently seen in the frontal and parietal bones with the orbital and maxillofacial bones infrequently involved. These tumors are slow growing and are generally asymptomatic unless they cause mass effect on sensitive structures such as within the intraorbital compartment. In symptomatic cases, en bloc resection is generally the treatment of choice. Preoperative angiography with potential embolization may be helpful as these tumors can bleed profusely.

Clinical differential diagnosis includes fibrous dysplasia, osteoma, dermoid cyst, meningioma, eosinophilic granuloma, Lagerhan cell histiocytosis, and metastatic disease. On imaging, these tumors are well-defined and have characteristic internal trabeculations and enhancement features described as a “honeycomb,” “sunburst,” or “spokewheel” pattern. Malignant degeneration is rare.

Significance of DWI hyperintensity in splenium

This is a case of 38 yr old female who presented to us with a history of convulsions. MR imaging brain was performed and a small focus of splenium hyperintensity is noted on diffusion weighted and slightly hyperintense on FLAIR images.
Discussion
Focal splenial hyperintensity has been reported in patients with clinically mild encephalitis/encephalopathy, epilepsy, in association with antiepileptic drug, acute cerebellitis, and stroke-like episodes. In a study by Bulakbasi et al, AJNR 27: 1983-86, transient lesion of splenium of corpus callosum (SCC) is a significant but nonspecific finding. It is probably due to inflammatory changes of the splenium and may be only detectable change in patients with good prognosis, indicating a clinically mild form of encephalitis/encephalopathy. Clinically all patients recover on days 4-9.

HEMORRHAGIC INTRACRANIAL SECONDARIES

The incidence of hemorrhage in metastatic neoplasms is highest in melanoma, hypernephroma, bronchogenic carcinoma, and choriocarcinoma. Other metastatic tumours that bleed are breast and thyroid metastasis. Of the primary intracranial neoplasms, hemorrhage occurs most frequently in relation to pituitary neoplasms. Other primary tumors that have been reported to bleed include glioblastoma multiforme, lower-grade gliomas, ependymomas, choroid plexus papillomas, sarcomas, and meningiomas.
Our patient is 55 yr old male and shows large ring enhancing, slightly hyperintense lesions in parietal and frontal region. Lesions are hyperintense on both T1 and T2 weighted images and show ring enhancement on contrast study. This appearance is very suggestive of secondaries from renal cell carcinoma.

Second Opinion by -Teleradiology Providers

Happy Thanksgiving!

I just watched the movie 'Food, Inc.', and I'm horrified by the condition and treatment of the animals kept for our consumption.

Don't get me wrong, I'm still going to demolish the turkey today.... Because it is delicious.....

Anyway, here's the PETA commercial that was banned from the major networks this Thanksgiving....

Christmas Season in Manila Downtown

This is the time of the year when we usually say that the spirit of Christmas is just around the corner. We all know it would come along, but all too sudden it's here and everywhere, the unmistakable signs of the Yuletide season: the cool breeze of gentle winds, Christmas carols in the air, and the pervading colors of red and green decors all around. It is said that the Filipinos have the longest Yuletide season in the world and we are proud of it. Starting as early as the arrival of the "Ber" months, we hear radio stations start playing the ever nostalgic"Ang Pasko ay Sumapit", and some homes begin putting displays of the Infant Jesus in the belen, a Christmas tree, the traditional parol, and the all too familiar glittery letterings we all use to hang on our walls: "Maligayang Pasko at Manigong Bagong Taon".

Yesterday, I made a round of downtown Manila's Avenida-Carriedo-Quiapo area and took some photos of the happenings around. Despite the harrowing setbacks that the Philippines has experienced this year, the general mood in Manila is one of excitement and optimism, and the familiar sights are all here: a vendor who offers his wares to the coming pedestrians, a shopper who haggles for a discount, people wanting to be photographed, street boys playing mechanical toys, pedestrians scouting for a gift to purchase, and the usual rowdy crowd of Manila downtown. Everyone seemed happy and relaxed, and no one seemed in too much of a hurry, despite the so-called Christmas rush.

With what I have observed, I guess Manilans are hardly the people who can face natural and man-made disasters with long gloomy faces, and we can choose to smile despite everything that had happened. But as the saying goes, the proof of the pudding is in the eating so here's some happy pictures for you who may not believe it. And while we're on it let me have the honor to greet you a first Maligayang Pasko at Manigong Bagong Taon!

(This is the first of my series on the Christmas Season in Manila Downtown 2009)

Meri Krismas, hihihihih

SACROCOCCYGEAL TERATOMA

Sacrococcygeal teratoma is the most common tumour of the fetus and neonate, with a reported incidence of 1 in 35,000-40,000. This neoplasm is composed of tissues from all three germ layers. The extent of sacrococcygeal teratoma was classified according to the American Academy of Pediatrics.
Type 1 – Primarily external and has only a mimimal presacral component.
Type 2 – Primarily external but has a significant intrapelvic portion.
Type 3 – Partially external but is predominantly intrapelvic with abdominal extension.
Type 4 – Located entirely within the pelvis and abdomen.
Associated complications :
· Intrapelvic mass effect- bladder displacement, hydronephrosis, large tortuous ureters and urinary ascites.
· Dysplastic changes in kidney.
· Severe oligohydoamnios.
· Congenital hip dislocation.
On MRI the content of teratomas can be well assessed. They may be solid, cystic or mixed with areas of necrosis, haemorrhage, and calcification. Predominantly solid masses have a poorer prognosis than cystic avascular masses.

Case Submitted by Dr Sangeeta Aneja, MD, Associate Professor & Head, Department of Radiodiagnosis, L.L.R.M. Medical College, Meerut.

Bank Robber Eats Evidence In Front Of Police

A suspected bank robber, John Ford, was caught soon after he allegedly committed his crime. A bank teller had reported that the robber presented a 'hold-up' note, but did not produce a gun. Twinsburg police found cash and a gun in Ford's car, however, they did not find the note!

Police were baffled, until they saw the dashboard camera footage of officers searching the suspect for weapons. As the officers are emptying the suspect's pockets, they put a folded note on the hood of the car, and the suspect proceeds to eat the note. Now, the police can only wonder if the piece of paper contained the 'hold-up' note.

Petrous apex chondrosarcoma

Findings

The head CT (bone windows) demonstrates a region of bony destruction extending from the right petro-occipital fissure into the carotid canal. The axial T2 images demonstrate a hyper intense, extra-axial, right petrous apex mass that extends from the petro-occipital fissure to the cavernous sinus. The margins of the mass are lobulated, and it encases the cavernous internal carotid artery. The axial T1 contrast-enhanced images demonstrate intense enhancement of the mass.


Diagnosis: Petrous apex chondrosarcoma


Key points

Classic MR imaging appearance of petrous apex chondrosarcoma is a mass located at the petro-occipital fissure with high T2 signal intensity that heterogeneously enhances.
The CT shows chondroid mineralization in 50%.
Invasive bone changes at the petro-occipital fissure strongly favors the diagnosis. Greater than 50% will have associated bone destruction.
2/3 located at the petro-occipital fissure, 1/3 located at the anterior basis sphenoid
Usually has lobulated margins
High T2 signal, low to intermediate T1 signal
Heterogeneous enhancement with contrast; whorls of enhancement within tumor matrix are often seen
Often displaces or encases the ICA
Classic presentation is a CN 6 nerve palsy. Other CN palsies can occur less commonly (3, 5, 7, 8—3, 4, and 6 are possible with cavernous sinus invasion)


Differential diagnosis
- Metastatic tumor
- Chondrosarcoma
- Plasmacytoma
- Nasopharyngeal cancer
- Chordoma
- Cholesteatoma
- Calcified meningioma
- Chondromyxoid fibroma

Distinguishing characteristics from other entities in the differential:
- Metastatic tumor – Can have a similar appearance; breast cancer and prostate cancer are two of the most common tumors to metastasize to the petrous apex
- Plasmacytoma - Usually intermediate T1 and T2 signal; usually more midline
- Chordoma - Similar appearance to chondrosarcoma but often see tumor "thumb" indenting the anterior pons; often midline
- Cholesteatoma - Does not enhance but has an otherwise similar appearance
- Calcified meningioma – Not typically destructive; low to intermediate T2 signal
- Chondromyxoid fibroma - Similar MR appearance to chondrosarcoma; areas of ground glass density can be seen on CT

Don't Tread On Me

Here's another hilarious/scary video from NewLeftMedia.com.... Again, two guys, Chase Whiteside (interviews) and Erick Stoll (Camera), interviewed 'real Americans' who were out at the Tea Party protests in Washington D.C.

I know it's 9 minutes long.... But it's a fantastic view of what people, outside of my little bubble, are thinking.

I love the guy that's holding the 'Joe Wilson For President' sign who ends up telling the interviewer that he's not supporting Joe Wilson for President.... Ooooh, and the lady that's talking about Barack Obama wanting to create a 'citizen army'! Oh, just go watch the video!

These guys have put together six other videos, and all of them are very well done.... The videos about equality in Maine, and John Boenher and health care are particularly well done.... Go check them out!

Sarah Palin Book Signing Brings Out The 'Real Americans'!

Two guys, Chase Whiteside (interviews) and Erick Stoll (Camera), from NewLeftMedia.com, stood outside a 'Borders' book store in Columbus, Ohio to interview customers waiting in line for Sarah Palin to sign their copies of her new book titled 'Going Rogue'. There is quite a disturbing trend.... These people are amazing! Seriously, watch the whole video.... The Steeler's fan is my favorite!

By the way, here's a tip..... If someone asks you to give your views about any item that you support, and you know nothing about that item that you support.... Don't stand there and talk, and talk, and talk, and talk..... I wish he would have tapped each person on the forehead with the microphone after they stopped talking!

These guys have put together six other videos, and all of them are very well done.... Go check them out!

Skateboarding Dog Plays Tony Hawk Game

What's better than a skateboarding dog? A dog that beats a skateboarding video game by riding a wireless skateboard controller.... Tony Hawk's new skateboarding video game, 'RIDE', is played by riding a wireless skateboard..... This bulldog destroys the game.... Watch his spin move!

Cortical Dysplasia-MRI

Focal cortical dysplasia is a common cause of intractable epilepsy in children and is a frequent cause of epilepsy in adults. All forms of focal cortical dysplasia lead to disorganization of the normal structure of the cerebral cortex. This is a 9year old girl presented with refractory complex partial seizures.

Orbital Lymphoma-CT

This is 68 year old man with bilateral propotosis and lymphadenopathy. CT images are characterstic of orbital lymphoma.

Second Opinion- Teleradiology Providers

Tuberous Sclerosis

These are the follow up images done for the case of bilateral Renal angiomyolipoma presented in this blog few days back. CT brain reveals characterstic subependymal nodules and CT chest shows lung cysts. These are classical findings of tuberous sclerosis.

LATEST ISSUE OF INTERNET JOURNAL OF RADIOLOGY

TABLE OF CONTENTS
Original Articles
Radiofrequency denervation of the sacroiliac joint- experiences in a series of 30 patients - J. Gossner & B. Kietzmann
CT Evaluation Of Parapharyngeal Masses: Pictorial Assay - K. Rajagopal, A. Ramesh, S. Sreepathi & C. Shetty
Case Reports
Cranial and Spinal involvement in Neurofibromatosis type 2 - S. Aneja, R. Sangal, M. Murthy & S. Sethi
Periadrenal Bronchogenic Cyst with Intracystic Milk of Calcium - S. Park & S. Hwang
Hypoplastic Vertebral Artery as a predisposing cause for dissection - N. Mahmood, C. Ballal, V. Hegde & H. Suresh
Vein of Galen Malformation - A. Singh, M. D’Alessandro, S. Kao & Y. Sato
Steroid-induced Extensive Bilateral Femoral and Tibial Bone Infarcts in a Patient with Ulcerative Colitis - I. Chernev & K. Yan
Longitudinal stress fracture of tibia – a rare diagnosis - I. Gupta, S. Sethi & J. Shankar
Sunburn appearance on MRI - T. Bartalena, M. Rinaldi, E. Rimondi, G. Rossi & D. Bartalena
Magnetic Resonance Imaging findings in a case of intramedullary teratoma of conus medullaris - G. Chand, V. Chowdhury & S. Singh
Splenic torsion, an unusual cause of acute abdominal pain. - M. Murthy, S. Rajani & K. Bhagheerathi
Pneumatosis intestinalis with superior mesenteric and hepatic portal venous gas in sigmoid colonic cancer: CT findings. - G. Di Salvo, G. Zotto, P. Spillare, G. Schittullo & A. Bruscagnin
Editorial
Healthcare Blogging-A review - S. Sethi

Sumer's Blog now on Medscape-Radiology

Thanks to Lakhs of visitors and readers who benefited from this site over last 5 years now, i am now also blogging with Medscape at my blog called as "Radiology 2.0". Before giving the diagnosis on any film look at the image from a distance, take a bird's eye view and then concentrate on the findings. This is what will make a radiologist's interpretation of films superior to other clinical counterparts.

Hydatid Cyst-CT

Two cases of hydatid cysts in lung and exophytic lesion in the left lobe of liver diagnosed in last two days on CT.