Patient's Prefer- More Speed

In this month American Journal of Roentgenology AJR 2011; 196:605-610 An article by Pat A. Basu et al titled  Creating a Patient-Centered Imaging Service: Determining What Patients Want, according to  author's survey responses,"results needed to be communicated within a few hours for an "acceptable" rating from 95% of patients. Further is concluded by the authors that patients want their results communicated much sooner than is currently practiced. "

Radiology teaching files for iPhone

Readers who have an iPhone or iTouch, might like to know that the first Radiopaedia Radiology Teaching File is now available for download (free) from the itunes app store. 50 CNS cases comprising 170 images, questions and detailed text. Just search for radiology and you should find it easily enough.

Calcified Baker's Cyst

Note the calcified baker's cyst on plain skiagram.

Lateral Patellar Tilt

The role of patellofemoral malalignment in anterior knee pain has been shown by many investigators. Detection of lateral displacement was the sole purpose of earlier studies until Laurin et al. introduced the concept of patellar tilt as a form of malalignment. This tilt could be observed even with the patella completely reduced in the femoral groove, and was therefore independent of the mediolateral position of the patella.

Reported bt Teleradiology Providers

Paraduodenal Hernia-CT

Intestinal obstruction is a common clinical condition that is usually suspected on the basis of clinical signs and patient history. Internal hernias are rare cause for intestinal obstruction. Para duodenal hernias constitute approximately 53% of all internal hernias

Cervical Dermal Sinus-MRI

Congenital dermal sinuses are epithelium-lined tracts that extend from an opening in the skin through deeper tissues. Most dorsal congenital dermal sinuses are located in the lumbosacral area; a cervical location is unusual. This is a 13 year old girl patient.
Reported by Teleradiology Providers

Haglund's Syndrome

Haglund syndrome is a common cause of posterior heel pain, characterized clinically by a painful soft-tissue swelling at the level of the Achilles tendon insertion. On the lateral heel radiograph the syndrome is characterized by a prominent calcaneal bursal projection, retrocalcaneal bursitis, thickening of the Achilles tendon, and a convexity of the superficial soft tissues at the level of the Achilles tendon insertion, a “pump-bump.

Reported by- Teleradiology Providers

Retinoblastoma-CT

Note the soft tissue lesion with calcification in the left globe.

Teleradiology Providers

Spontaneous rupture of arachnoid cyst into subdural space

I was asked for opinion when i was just walking by the OPD of hospital, couldn't resist clicking the image with my mobile phone. Hence the poor quality of image but the finding is well seen. Arachnoid cysts are known to present as spontaneous subdural hygroma. Also noted a snap shot of my Teleradiology centre in Delhi.

Teleradiology Providers

Appearance of TB Hip following treatment

Findings-There is evidence of erosive osseous destruction involving the acetabulum & medial articular surface of left femoral head. There is synovial collection in relation to the left hip Minimal marrow edema is identified to erosive lesions in relation to the left hip along with area of patchy sclerosis. Fluid is identified in the left ilio psoas bursa.
Opinion- On treatment follow up case of TB left hip reveals:- Erosions involving the acetabulum & femoral head with minimal marrow edema and patchy sclerosis in left hip with synovial collection & fluid signal in ilio psoas bursa. Findings are consistent with partially treated tubercular hip.

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)

Tuberculosis of Hip-Osteoarticular Involvement

Findings-There is evidence of osseous destruction and altered marrow signal intensity involving the left hip, acetabulum & femoral head / neck appearing hypointense on T1WI and heterogeneously hyperintense on T2 / fat sat T2WI, there is evidence of synovial collection in relation to the left hip. Left hip joint space is reduced.

Opinion- Osseous destruction & marrow edema involving the bones forming the left hip articulation along with synovial collection & reduced joint space. Findings are consistent with infective etiology, likely tuberculosis. Clinical & laboratory collection is advised.

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)

Hemophilic Arthropathy- MRI

Known case of hemophilia.
Findings-There is evidence of significant synovial collection involving the knee joint distending the suprapatellar bursa with inhomogeneous appearance with septae & areas of haemosiderin deposition seen as signal suppression on GRE. There is evidence of erosive destruction involving the tibio-femoral & patello-femoral articulation. Secondary degenerative changes noted in the tibio-femoral & patello-femoral articulation with reduction in joint space. Areas of marrow edema noted in knees in relation to bones forming the knee joint appearing hyperintense on T2 fat sat images. Anterior cruciate ligament is not well seen. Posterior cruciate ligament is stretched but intact. Internal architecture of the knee is distorted with haemosiderin deposition in relation to synovium.
Opinion-Significant synovial collection involving the knee joint & suprapatellar bursa with extensive haemosiderin deposition, erosive arthropathy involving tibiofemoral & patellofemoral articulation with marrow edema involving the bones surrounding knee joint, distorted internal architecture of knee. Likely suggestive of sequelae of long standing hemarthrosis. Patient is a known case of hemophilia. Consistent with hemophilic arthropathy.

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)

Duplication of Gall Bladder

26 yr old male has reported for routine health preemplyoment checkup. Sonography shows two well defined transonic structures in gallbladder fossa region Inview of the location and appearence, duplicatin of gall bladder is suggested.Duplication is reported to be 1 in 12000 cholecytograms or 1 in 4000 autopsiesit is known to be associated with choledochal or duodenal duplication. It is asociated with high incidence of cholelithiasis and intermittent cystic duct obstructionGB arises from caudal aspect of hepatic diverticulum around 7 wks of intrauterine life.starts as solid structure and canalizes by 12 th week and is usually sonologically identified by 14 th week.it has doubtful value in foetal life.

Case by- Dr MGK Murthy, Sr Consultant Radiologist
Teleradiology Providers

Ependymoma-MRI

Intracranial ependymomas are typically isodense on unenhanced CT scans with minimal to moderate enhancement upon contrast administration. Calcification can be noted on unenhanced CT scans in approximately one half of cases. Cyst formation is common in these tumors, and foraminal spread can be observed in posterior fossa lesions through the foramina of Luschka and Magendie. On precontrast and postcontrast MRI, tumors often appear heterogeneous secondary to necrosis, hemorrhage, and calcification. Variable signal intensity is noted on T1- and T2-weighted images although intracranial ependymomas are usually hypointense to isointense on T1-weighted images and hyperintense compared with gray matter, on T2-weighted images.

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)

Contrast agent for blood flow approved by FDA

"The U.S. Food and Drug Administration today approved Vasovist Injection (gadofosveset trisodium), the first contrast imaging agent for use in patients undergoing magnetic resonance angiography, or MRA, a minimally invasive test for examining blood vessels."

Reference-

FDA Approves First Imaging Agent To Enhance Scans Of Blood Flow - Helps Detect Possible Blood Vessel Problems. Medical News Today

Primary Choledocholithiasis-MRCP

"Up to 85% of CBD stones are secondary from GB. Primary CBD stones are caused by conditions leading to bile stasis and chronic bactibilia. Up to 90% of patients with brown pigment CBD stones have bile culture results positive for bacteria. Primary duct stones are usually brown pigment stones. Brown stones differ from black pigment stones by having a higher content of cholesterol . In Western population Biliary stasis is secondary to factors such as sphincter of Oddi dysfunction, benign biliary strictures, sclerosing cholangitis, and cystic dilatation of the bile ducts. Bile stasis promotes growth of bacteria, which produce phospholipase A1, thus releasing fatty acids from biliary phospholipids. The duct epithelium and/or bacteria (eg, Escherichia coli) produce beta-glucuronidase in amounts sufficient to deconjugate bilirubin diglucuronide. The presence of free fatty acids, deconjugated bilirubin, and bile acids leads to the formation of insoluble calcium bilirubinate particles. With the loss of bile acids, cholesterol becomes insoluble, resulting in the formation of biliary sludge. The sludge also contains mucin and bacterial cytoskeletons, which further aid in stone formation. In Asian populations, infestation with A lumbricoides and C sinensis may promote stasis by either blocking the biliary ducts or by damaging the duct walls, resulting in stricture formation. Bactibilia is also common in these instances, probably secondary to episodic portal bacteremia. Some authors have suggested that the stones are formed because of the bactibilia alone and that the parasites' presence is just a coincidence. "

Case By Dr MGK Murthy, Sr Consultant Radiologist

Spinal Arachnoid Cyst-MRI

Spinal arachnoid cysts are relatively uncommon lesions that may be intradural or extradural with the intradural variety being rare . The majority of intradural spinal arachnoid cysts occur in the thoracic region with only 15% in the cervical region and 5% in the lumbar region . Most are dorsal to the spinal cord (80%). Secondary intradural spinal arachnoid cyst formation is uncommon and is known to occur due to various causes such as trauma, surgery, lumbar puncture, intrathecal injections, arachnoiditis and inflammation.
MRI is useful to assess the size, nature and extent of the cystic lesion as well as the mass effect on the cord and associated signs of meningeal inflammation. Increased CSF signal intensity on T1 weighted images leading to loss of CSF–cord interface is strongly suggestive of the arachnoiditis
Differential diagnosis on imaging includes other intradural cystic lesions like dermoids, epidermoids, hydatidosis and cysticercosis. In a rare case reported by Ciftci et al, multiple intradural cysticercosis were found in the basal cistern, cisterna magna, and cervical subarachnoid space which were isointense with cerebrospinal fluid both on T2 and T1 weighted images Dermoid can be diagnosed by presence of fat and midline in location, epidermoid are bright on spinal difusion where available. Hydatids are better diagnosed by exclusion. Inflammatory etiology with TB can be suggested by sepate, flow signal aberrations and leptomeningeal enhancement apart from brain findings.

Case by Dr MGK Murthy, Sr Consultant Radiologist
Teleradiology Providers

Sub-acute combined degeneration-MRI

Sub-acute combined degeneration (SCD) is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication due to vitamin B12 deficiency. This is a case of SCD of the spinal cord in a 40-year-old man. Magnetic resonance imaging (MRI) of the spine showed intramedullary hyperintensity seen on T2-weighted images in the posterior column of the cervico-dorsal spinal cord, and lateral columns. A diagnosis of SCD of the spinal cord was considered and confirmed by a low serum cobalamin. Detection of lateral tracts involvement by the MRI is uncommon.

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)

Pericallosal Lipoma-MRI

This is a rare congenital lesion characterized by the presence of fatty deposits in inappropriate places in the central nervous system The embryological derangement that leads to the formation of lipomas is still debated; lipomas are variously considered to be the result of mesodermal inclusion due to dysraphism, hyperplasia of normal leptomeningeal fat cells, heterotopia of displaced dermal anlage or derivatives from the embryological meninx primitiva(most accepted theory). Common locations are pericallosal, quadrigeminal cistern, hypothalamic suprasellar and cerebellopontine regions usually asymptomatic but can present with seizures, headache and behavioural disturbances. can be associated with callosal abnormalities. Pericallosal lipoma is usually located within the interhemispheric fissure along the corpus callosum , and on the basis of MR imaging findings in adults and children, these lesions are classified as one of two types . The tubulonodular form is round, more than 2 cm in size, and is usually located at the genu area of the corpus callosum. The second form, on the other hand, is curvilinear; thin and elongated, it is less than 1 cm in diameter and is usually found more posterior to the corpus callosum. The former has ben more associated with callosal anomalies association with pericallosal lipomas include midline defects (cleft lip or palate, median cleft nose, hypertelorism, cerebellar vermis defects, frontal lipomas) and dysraphism (myelomeningocele, encephalocele, anomalies of the cervical spine, cranium bifidium, or other calvarial defects).

Case by Dr MGK Murthy, MD
Sr Consultant Radiologist
Teleradiology Providers

Medical Blogs-in context of a connected world

Sumer's Radiology Site is cited by Joanna Lynn Karpinski, MLIS (karpinsj@mail.nih.gov) is Associate Fellow, National Library of Medicine (NLM), in Medical Reference Services Quarterly, Vol. 27(1), Spring 2008 Available online at http://mrsq.haworthpress.com

According to the article, titled Disconnected in a Connected World: Knowledge and Understanding of Web 2.0 Tools at the University of Pennsylvania Medical Center

"Radiology, a medical field that is highly dependent on image-based examples for teaching, is experiencing a growth of blogs. Sumer Sethi, M.D., uses his blog to post interesting cases from his routine practice and abstracts related to his day-to-day work. The site is visited by more than 30,000 visitors each year and is a focal point for queries from his students and patients. The blog features not only a means of commenting on Dr. Sethi’s posts, but also a small section called a “shoutbox,” where users can post messages or questions on any topic for Dr. Sethi and other readers to see. Dr. Sethi can respond using the shoutbox."