Best Prank Ever!

Why are the Japanese so awesome? I'm all for pulling pranks, but I am small time compared to the Japanese. I'm a 'cockroach under the bagel' kind of guy....

This is a video of a Japanese television show, where a couple of guy are set up in a meeting where the men they're meeting with are shot and killed by sniper fire. The men who are set up proceed to scurry and hide, until a 'police officer' runs into the room to protect help protect them. The 'police officer' eventually reveals that the whole thing was a prank and everyone has a good laugh and a change of pants....

Endolymphatic Sac Tumor

Findings

CT images showing an erosive lesion of the right petrous bone, centered at the right vestibular aqueduct opening (endolymphatic sac). The lesion is eroding the posteriolateral wall of the jugular fossa. There is also erosion of the posterior wall of the right IAC, however the right IAC itself is still intact. There are scattered bony spicules seen within the lesion.
Axial T1 and axial T2 precontrast images, respectively, at the level of cerebellopontine angle. There is a hyperintense multilobulated lesion occupying the right endolymphatic sac space. There is also a central area of low signal intensity which enhances post-gadolinium.
T1-weighted post-gadolinium axial and coronal images, respectively. There is a central area of enhancement indicating hypervascularity. Low-signal intensities within the lesion represent intratumoral bony spicules.

Differential Diagnosis:
- Paraganglioma (glomus jugulare)
- Cystic and papillary adenocarcinoma
- Chondroid lesions
- Cholesterol granuloma
- Metastasis
- Cystic schwannoma


Diagnosis: Endolymphatic Sac Tumor (Papillary Adenomatous Tumor of the Temporal Bone)


The endolymphatic sac is part of the membranous labyrinth derived from the neuroectoderm and located within the petrous portion of the temporal bone where it also contacts the dura. Endolymphatic sac tumors (ELST) were described in 1989 by Heffner as a unique pathologic entity originating from the epithelium of the endolymphatic sac, specifically the rugose or middle portion of the sac. ELST histology is benign and exhibits two patterns; mixed type and papillary adenomatous type. The former is generally confined while the latter demonstrates a more aggressive nature by locally invading the temporal bone. Patients most often present with sensorineural hearing loss and may also present with tinnitus, facial nerve palsy or vestibular dysfunction. ELST is a rare skull base lesion and most lesions are sporadic. However, there is an increased incidence seen in patients with von Hippel-Lindau disease (vHL), 7% of whom are diagnosed with this lesion. If ELST is seen bilaterally, vHL becomes a likely diagnosis.

ELST is a slow growing lesion which erodes the temporal bone and often presents with intratumoral bony spicules. In addition, due to the tumor’s slow growth, the petrous bone cortex expands and surrounds the lesion with a thin shell of reactive bone. The lesion may also exhibit hypervascularization, usually from a branch of the external carotid artery.

CT may show a soft tissue mass in the endolymphatic sac between the sigmoid sinus and internal auditory meatus. On MR imaging, this lesion exhibits a hyperintense focus on T1WI with an inhomogeneous signal on T2WI. Focal low signal intensities within the lesion represent bony fragments. Tumor foci may enhance on T1WI with gadolinium due to hypervascularity. Advanced lesions may spread far, making it difficult to identify the origin of the tumor and expanding the differential. Treatment is surgical resection.

The Golden Age

Nobody knew a better Halloween song, huh? I was guessing somebody might have mentioned 'Monster Mash'. They would've been wrong, but I thought it might have been thrown into the mix....

Anyway, I'll be the first one to admit that having a new baby (a second child) has left me a little strapped for time lately, and I'm a little late to the game with this video, but I'm really impressed by mashup videos people make.... And this video is pure radness.... I can only imagine this person spent his entire life making this video.... How did they find the 50 to 75 video clips that fit perfectly to make an entire song? I sure wish I was creative.

Antrochoanal polyp

Findings

Noncontrast axial CT image in bone window demonstrating a low density mass opacifying the left maxillary sinus extending to the posterior choana. No bony destruction is present.
Noncontrast coronal CT image in soft tissue window better demonstrating the lesion extending through the middle meatus. Contralateral maxillary antral mucosal thickening is present.


Diagnosis: Antrochoanal polyp


Antralchoanal polyps present as mucoid masses originating at the maxillary antrum extending through a sinus ostium to the choana.
Antralchoanal polyps demonstrate non aggressive features with only peripheral enhancement.
Treatment is complete surgical resection.
Originally described by Killian in 1906, antrochoanal polyps result from edematous hyperplasia of respiratory epithelium that herniates through the maxillary infundibulum or the ostium of the maxillary sinus to the level of the posterior choanal (boundary of the nasal cavity and nasopharynx). They commonly arise from the maxillary antrum, hence antrochoanal; however nasochoanal, sphenochoanal, and ethmochoanal polyps have been reported. They comprise 4-6% of all sinonasal polyps and are frequently associated with bilateral maxillary sinusitis. Younger males with a mean age approximately 10 years, presenting with unilateral nasal obstruction is the typical clinical scenario.

Non-contrast CT imaging will usually reveal a large dumbbell shaped, up to 5-6 cm, mucoid density mass occupying the maxillary sinus, exiting via a widened ostium, and into the nasopharyngeal airway. Rarely will antrochoanal polyps extend deep into the nasopharynx or protrude through a nostril. Peripheral enhancement is frequently seen without central enhancement. MR imaging reveals similar findings with hypointense to variable T1 signal. The lesion is hyperintense on T2WI with only peripheral enhancement.

Differential diagnosis includes intranasal glioma, nasoethmoidal encephalocele, juvenile angiofibroma, inverted papilloma, and esthesioneuroblastoma. Intranasal gliomas usually present at birth or the very young as a soft tissue mass centered at the nasal dorsum. Nasoethmoidal encephaloceles present at birth with a frontal, nasal or medial orbital soft tissue mass contiguous with intracranial brain parenchyma extending through a bony defect. Juvenile angiofibromas present in adolescent males as an intensely enhancing mass originating at the sphenopalatine foramen extending into the posterior nasopharynx. Inverted papillomas are usually found in older males as a locally aggressive mass centered at the middle meatus extending into the maxillary sinus and nasal cavity. Esthesioneuroblastomas present in the second and sixth decades as a solid enhancing mass centered within the superior nasal cavity extending into the cribriform plate. Complete surgical resection is the treatment of choice with mean time to recurrence of 45 months.

Posterior reversible encephalopathy syndrome (PRES)

Findings

The head CT demonstrates multiple, bilateral, patchy foci of hypo attenuation within the subcortical white matter with some minimal cortical involvement of the occipital, anterior parietal, and posterior frontal lobes. Axial T2 and FLAIR sequences demonstrate multiple symmetrical, patchy foci of increased signal within the subcortical white matter of the bilateral occipital, anterior parietal, and posterior frontal lobes. No corresponding areas of restricted diffusion were seen on DWI or ADC sequences.

Differential diagnosis
- Posterior reversible encephalopathy syndrome (PRES)
- Acute cerebral ischemia
- Atypical viral encephalitis
- Acute demyelinating disease


Diagnosis: Posterior reversible encephalopathy syndrome (PRES). Also known as reversible posterior leukoencephalophy syndrome (RPLS)


Key points

Consider the diagnosis when you see patchy cortical/subcortical posterior territory lesions in a patient with acute severely elevated BP
95% will have parietal occipital subcortical/cortical lesions that are hyper intense on T2/FLAIR sequences
Additional common locations include the cerebellum, junctions of vascular watershed zones. Can less commonly be seen in the basal ganglia; rarely in the brainstem or deep white matter
Usually bilateral
Extent of findings is highly variable
Usually has a patchy morphology as opposed to a confluent one
Patchy, bilateral hypo dense foci with a predilection for the posterior circulation on CT
The most important differential diagnosis is cerebral ischemia. Acutely, diffusion will be decreased in cerebral ischemia, but increased in PRES. Diffusion, can, however, be increased if PRES is untreated and results in irreversible ischemia.
Usually reverses with control of BP but can occasionally result in death or permanent neurologic disability

Eve of Undas at the Manila North Cemetery

BIRADS SCORE-MAMMOGRAM

Our patient is 73 yr old female presented to us with a solid lump in left breast. Craniocaudal and medio-lateral oblique views of left breast show an asymmetric nodular density in left breast with minimally iregular margins and punctate foci of microcalcifications.Small lymphnodes are seen in left axillary region.

BIRADS Scores

0 Incomplete
Your mammogram or ultrasound didn't give the radiologist enough information to make a clear diagnosis; follow-up imaging is necessary
Need to review prior studies and/or complete additional imaging
1 Negative
There is nothing to comment on; routine screening recommended
Continue routine screening
2 Benign
A definite benign finding; routine screening recommended
Continue routine screening
3 Probably Benign
Findings that have a high probability of being benign (>98%); six-month short interval follow-up
Short-term mammogram follow up at 6 mths, then every 6-12 mths for 1-2 yrs
4 Suspicious Abnormality
Not characteristic of breast cancer, but reasonable probability of being malignant (3 to 94%); biopsy should be considered
Perform biopsy, preferably needle biopsy
5 Highly Suspicious of Malignancy
Lesion that has a high probability of being malignant (>= 95%); take appropriate action
Biopsy and treatment as necessary.
6 Known Biopsy Proven Malignancy
Lesions known to be malignant that are being imaged prior to definitive treatment; assure that treatment is completed