Radiology Grand Rounds XXVIII

Here is a case of Carotid Artery Dissection for the Radiology Grand Rounds submitted by Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds

Carotid artery dissection is a significant cause of ischemic stroke in all age groups. Dissection of the internal carotid artery can occur intracranially or extracranially, with the latter being more frequent. Internal carotid artery dissection can be caused by major or minor trauma, or it can be spontaneous in which case genetic, familial, and/or heritable disorders are likely etiologies. MRA signs of dissection include irregular vessel margins, filling defects, extravasation of contrast, vascular occlusion, and caliber changes of the vessel. The latter sign is important and appreciated on axial views, but 3-dimensional reconstructed views allow study from any angle. This is 11yr old who presented with hemiplegia after head injury, also noted was beaded appearance of external carotids which suggest pre-existing fibromuscular dysplasia.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

Radiology Grand Rounds XX

Here is a case of Tendoachilles Tear for the Radiology Grand Rounds submitted by Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

In Greek mythology, Achilles was a Greek hero of the Trojan War, the central character and greatest warrior of Homer's Iliad which takes for its theme the Wrath of Achilles.Later legends state that Achilles was invulnerable on all of his body except for his heel. These legends state that Achilles was killed in battle by an arrow to the heel, and so an "Achilles' heel" or Achilles' tendon has come to mean a person's principal weakness.

Axial and saggital MRI of the ankle show an abnormal contour and altered signal intensity involving the tendoachilles, On the T2 and fat suppressed image is an area of high signal in the tendon suggesting tear. Clinical signs for complete tear are Thomson's test and inability to tiptoe.

Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Images Courtesy
Teleradiology Providers

Radiology Grand Rounds XIX

Here is a case of Glomus Jugulare for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

Glomus tumours
Synonyms are paragangliomas and chemodectomas
Location is usually jugular bulb, middle ear, carotid body, vagus nerve, periaortic, larynx, ciliary ganglion, mandible, nose and fallopian canal

Origin is embryonic neuroepithelium in close association with autonomic nervous system
4% are functional
4% are metastatic
Mostly benign and hypervascular

Imaging
CT findings-destruction, expansion, involvement of sites as mentioned above no soft tissue component, intense enhancement with salt and pepper appearance.
MRI shows better delineation of characteristics, extent across CV junction, encasement of vessels, involvement of cranial nerves and IAM as well as intracranial extent

Treatment is controversial
For a small lesion may be only radiosurgery
For a bigger lesion combination of surgery with radiation

The Glasscock-Jackson and Fisch classifications of glomus tumors are widely used. The Fisch classification of glomus tumors is based on extension of the tumor to surrounding anatomic structures and is closely related to mortality and morbidity.
Type A tumor - Tumor limited to the middle ear cleft (glomus tympanicum)
Type B tumor - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement
Type C tumor - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the pterous apex
Type C1 tumor - Tumor with limited involvement of the vertical portion of the carotid canal
Type C2 tumor - Tumor invading the vertical portion of the carotid canal
Type C3 tumor - Tumor invasion of the horizontal portion of the carotid canal
Type D1 tumor - Tumor with an intracranial extension less than 2 cm in diameter
Type D2 tumor - Tumor with an intracranial extension greater than 2 cm in diameter

Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Images Courtesy

Teleradiology Providers

Radiology Grand Rounds XVIII

Here is a case of Acetabular fracture for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

This patient had posterior dislocation of hip reduced about 6 months back now he presents with complaint of pain in the left hip.

FAQ (questions to be answered)
(a)Is it unreduced?
NO

(b) Has it developed AVN?
NO

(c) Is there any associated injury which Xray did not pickup?
MRI is silent on it

(d) Can anything else help?
YES CT would help

(e) What does it show?
It shows post wall fracture comminuted with loose fragment in the joint cavity

(f)What are the complications of posterior dislocation hip?
Complications-- include avascular necrosis, osteoarthosis, sciatic nerve injury and heterotrophic ossification.

(g) What are the types of acetabular fractures?
Acetabular fractures are classified according to Judet classification usually.
Walls, Columns and Transverse varieties

Wall fractures
Anterior wall
Posterior wall
Posterior column with posterior wall (also a column fracture)
Transverse with posterior wall (also a transverse fracture)

Column fractures
Anterior column
Posterior column
Both-column
Posterior column with posterior wall (also a wall fracture)
Anterior column with posterior hemitransverse (also a transverse fracture)

Transverse fractures
Transverse
T-shaped
Transverse with posterior wall (also a wall fracture)
Anterior column with posterior hemitransverse (also a column fracture)

Common types (90%)
Both-column
Transverse with posterior wall
Posterior wall
T-shaped
Transverse

Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Radiology Grand Rounds XVII

Here is a case of Pediatric Aneurysm for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

The incidence of congenital aneurysms in the general population is about 1-2%. Clinically, a ruptured aneurysm presents as sudden onset of severe headache. In cases of subarachnoid hemorrhages, the most common aneurysms are posterior communicating, 38%; anterior communicating, 36%; middle cerebral, 21%. These three locations account for 95% of all ruptured aneurysms. The basilar artery accounts for only 2.8% and posterior fossa aneurysms are even less common. Posterior fossa aneurysms are as such uncommon. PICA (Posterior inferior cerebellar artery) aneurysms are extremely rare. In this child we can see that aneurysm producing mass effect and no leak has occurred. The speciality of paediatric aneurysms are increased incidence in posterior fossa and a higher incidence of giant aneurysms (more than 2.5 cm diameter) and there is diversity of type and these are more often located in peripheral location . In this case of a eleven year old boy congenital saccular variety is possible.

Childhood intracranial aneurysms are exceedingly uncommon. Diagnosis of intracranial aneurysms in childhood may be difficult because of their infrequency and confusing clinical presentation. The first report of an aneurysmal SAH in a child was published in 1871 in the German pathology literature, when Eppinger detailed the case of a 15-year-old boy, a gymnast who collapsed while exercising. Postmortem analysis revealed an intracerebral hemorrhage associated with an aneurysm as well as a stenosis of the aorta. The development of contemporary neuroimaging has contributed greatly to the study, understanding, diagnosis, and treatment of pediatric intracerebral aneurysms. The emergence of CT and MR imaging studies obtained with contrast agents has allowed noninvasive, detailed characterization of aneurysms and the structures surrounding them.

Take Home Message-- Aneurysms unequivocally occur in children and cause SAH. Giant aneurysms and lesions in the posterior fossa are relatively more common in children than in adults. The termination of the CA and the ACA are disproportionately common sites of aneurysm formation in the anterior circulation of children. Traumatic and infectious aneurysms occur more frequently in children than in adults, but this may reflect a relative paucity of spontaneous aneurysms in children. Vasospasm occurs in children but appears to be better tolerated. Surgical outcomes in children appear to be moderately better than in adults.

Reference- Medscape ( Registration required). Intracranial Aneurysms

Also, the pioneering experience of Teleradiology Providers for an Indian Village settings has been accepted as a letter to editor in Radiology. Read the full text here-

Teleradiology: A Rural Indian Center's Pioneering Experience

I hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Radiology Grand Rounds XIV

Here is a case of leaking aneurysm for the Radiology Grand Rounds submitted by Dr MGK Murthy of Teleradiology Providers

Concept of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

Radiology Grand Rounds XII

Here is the the twelth Radiology Grand Rounds, hosted on the last sunday of each month with archives maintained by me here-
Radiology Grand Rounds

We start this radiology Grand rounds with a Radiology Quiz
It goes like-
Radiology Quiz!
"A young lady in her 30s was referred to me for having serous mixed with blood(haemoserous) discharge from her previous abdominal incision. This discharge increased during her menses and with the same consistency. She had an emergency surgery a year ago for a ruptured uterus from pyometra (pus within the uterus) She was found to have a congenital (from birth) anomaly. This is her hysterogram"

Blast from the Past

Here is an interesting write up about the X-ray discovery
""Is it light?""No.""Is it electricity?""Not in any known form.""What is it?""I don't know."And the discoverer of the X rays thus stated as calmly his ignorance of their essence as has everybody else who has written on the phenomena thus far."

Radiology Journal Section

Choosing and using bibliographic software
"I’m sure most of you out there have a collection of articles gathered from many journals, and neatly (or not) filed away in your office. Reading and indexing information from the literature used to mean trips to the library with the photocopy card and sitting down with the highlighter to read them.Starting in the late 90’s, many journals started posting abstracts and full text articles online. Pubmed also became a huge resource for searching the most recent literature for citations. All of these electronic references need to be stored somewhere, and paperless filing is becoming a much more viable option. Hard drives have almost limitless memory, and interfaces for saving references electronically have become much more user friendly. Now you need to decide how to choose bibliographic software, and how you will use it."

Alvaro Fernandez presents Lifelong Learning and New Neurons in Adults posted at Brain Fitness. We will need new imaging methods to see this in action-not even fMRI allows us to see neurogenesis take place.

Somethings to think about

MR/PET hybrid on the way too....

Anatomy Trivia

The Azygos lobe

Radiological Sign

"Heart of Stone" image

That wraps up this month's highlights of the Radiology blogosphere. Hope the readers enjoyed the XII edition of the Radiology Grand Rounds. If you liked any of these blogs, keep visiting them. Please email me at sumerdoc@yahoo.com if you are interested in hosting future Radiology Grand Rounds. Also visit our sister concern Teleradiology Providers. Archive for the Radiology Grand Rounds here-Radiology Grand Rounds. Be sure to tune in Next Month Last Sunday 24th June, when Grand Rounds will be hosted at- NeuroRaziology Blog mail to- eytan.raz@gmail.com or sumerdoc@yahoo.com

Submissions requested for the next Radiology Grand Rounds

Next Radiology Grand Rounds will be hosted on last sunday of this month 25-2-07 at Cochin Blogs by Dr Joe Anthony, so hurry send all your Radiology Related submissions to me at sumerdoc@yahoo.com or to Dr Joe at drjoea@gmail.com. If you are not familiar with the concept of the Radiology Grand Rounds check out the archive and concept here-

Radiology Grand Rounds