Name the syndrome or the effect.
Tuesday, January 8, 2019
Case 13
The case last time demonstrates a great example of a comet-tail artifact, which is a special type of reverberation artifact, related to micro-calicific or highly reflective objects interrogated by the ultrasound beam. In the case of the gallbladder, this is consistent with Adenomyomatosis, which is a common cause of focal or diffuse gallbladder wall thickening, due to cholesterol deposition and formation of Rokitansky-Aschoff Sinuses (intramural diverticula lined by mucosal epithelium) penetrating into the muscularis layer of the gallbladder wall. Generally, this is an asymptomatic, incidental finding and is not necessarily premalignant, but can be found in the setting of chronic gallbladder inflammation, which has a higher risk of gallbladder cancer.
There are three characteristic appearances on imaging of the related gallbladder wall thickening, which are fundal (focal), segmental (annular) , and generalized (diffuse), of which, fundal seems to be the most common. Radiopedia also has a nice example of the MRCP appearance of adenomyomatosis, as can be seen below.
Case courtesy of Dr Erik Ranschaert, Radiopaedia.org. From the case rID: 12339
The case last time demonstrates a great example of a comet-tail artifact, which is a special type of reverberation artifact, related to micro-calicific or highly reflective objects interrogated by the ultrasound beam. In the case of the gallbladder, this is consistent with Adenomyomatosis, which is a common cause of focal or diffuse gallbladder wall thickening, due to cholesterol deposition and formation of Rokitansky-Aschoff Sinuses (intramural diverticula lined by mucosal epithelium) penetrating into the muscularis layer of the gallbladder wall. Generally, this is an asymptomatic, incidental finding and is not necessarily premalignant, but can be found in the setting of chronic gallbladder inflammation, which has a higher risk of gallbladder cancer.
There are three characteristic appearances on imaging of the related gallbladder wall thickening, which are fundal (focal), segmental (annular) , and generalized (diffuse), of which, fundal seems to be the most common. Radiopedia also has a nice example of the MRCP appearance of adenomyomatosis, as can be seen below.
Case courtesy of Dr Erik Ranschaert, Radiopaedia.org. From the case rID: 12339
Monday, November 19, 2018
Case 12 - Triquetral Fracture
Triquetral fractures are the second most common carpal bone fracture, often occurring along the dorsal aspect of the carpal bones. While there are multiple mechanisms for the method of injury, the most common method is impaction from the ulnar styloid, which acts as a chisel, along the dorsal cortex of the triquetrum. Dorsal avulsion injuries are best visualized on the lateral radiograph, as seen in this case, as a result of the strong dorsal ligaments avulsing off the dorsal cortex.
One of my favorite signs in all of radiology is the "Pooping Duck Sign," which is present on the lateral radiograph. The duck is the composed of the superimposition of the Scaphoid and the Lunate bones, while the 'poop' is the avulsed bony fragment of the triquetrum.
Here is a normal lateral radiograph of the wrist with the Pooping Duck sign below.
Nearly all of these fractures are treated non operatively; rarely is any surgery required. As an aside, the skeletal anatomy website by Dr. Richardson is extremely helpful and one I recommend to add to your armamentarium as a quick resource for bony anatomy you might need throughout training.
References:
Case courtesy of Dr Matt Skalski, https://radiopaedia.org/. From the case: https://radiopaedia.org/cases/57109
Radiographic Skeletal Anatomy by Michael L. Richardson, M.D. at the University of Washington:
http://uwmsk.org/RadAnatomy.html
Radiology Tips:
http://radiologytips.com
Triquetral fractures are the second most common carpal bone fracture, often occurring along the dorsal aspect of the carpal bones. While there are multiple mechanisms for the method of injury, the most common method is impaction from the ulnar styloid, which acts as a chisel, along the dorsal cortex of the triquetrum. Dorsal avulsion injuries are best visualized on the lateral radiograph, as seen in this case, as a result of the strong dorsal ligaments avulsing off the dorsal cortex.
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| Case courtesy of Dr. Matt Skalski |
Here is a normal lateral radiograph of the wrist with the Pooping Duck sign below.
 |
| Courtesy of Dr. Michael L. Richardson, M.D. |
 |
| Courtesy of Dr. Michael L. Richardson, M.D. |
 |
| Image Courtesy of Radiology Tips (http://radiologytips.com/modality/radiography/pooping-duck/) |
Nearly all of these fractures are treated non operatively; rarely is any surgery required. As an aside, the skeletal anatomy website by Dr. Richardson is extremely helpful and one I recommend to add to your armamentarium as a quick resource for bony anatomy you might need throughout training.
References:
Case courtesy of Dr Matt Skalski, https://radiopaedia.org/. From the case: https://radiopaedia.org/cases/57109
Radiographic Skeletal Anatomy by Michael L. Richardson, M.D. at the University of Washington:
http://uwmsk.org/RadAnatomy.html
Radiology Tips:
http://radiologytips.com
Monday, November 5, 2018
Case 11 - Trauma, MVC
In most significant trauma, both blunt and penetrating, there will often be multiple findings and you don't want to let satisfaction of search get you. This case demonstrates a minuscule right pneumothorax, with air noted in the anterior costophrenic recess. Subpleural groudglass in the lingula is also present, representing a pulmonary contusion. Additionally, there is a SUBTLE sternal body fracture. This patient also had a couple of subtle, non-displaced rib fractures, but I didn't include those as some of the images on purpose. The things I've seen folks miss the most on trauma are small pneumothoraces, non-displaced rib, sternal, and vertebral body/transverse process fractures, and small mediastinal hematomas. Be sure to always look in these regions for abnormalities. In trauma, I always look at three things on the sagittal series - the sternum, vertebral bodies, and diaphragms looking for injury. If I see a sternal fracture, I will also look at the retrosternal space searching for a hematoma, which can be very small. Reexamining the vessels is also important to assess for underlying vascular injury. I will also run the spine on the axial and coronals looking for transverse process fractures. I've included a link to a good radiographics article for blunt thoracic trauma.
In most significant trauma, both blunt and penetrating, there will often be multiple findings and you don't want to let satisfaction of search get you. This case demonstrates a minuscule right pneumothorax, with air noted in the anterior costophrenic recess. Subpleural groudglass in the lingula is also present, representing a pulmonary contusion. Additionally, there is a SUBTLE sternal body fracture. This patient also had a couple of subtle, non-displaced rib fractures, but I didn't include those as some of the images on purpose. The things I've seen folks miss the most on trauma are small pneumothoraces, non-displaced rib, sternal, and vertebral body/transverse process fractures, and small mediastinal hematomas. Be sure to always look in these regions for abnormalities. In trauma, I always look at three things on the sagittal series - the sternum, vertebral bodies, and diaphragms looking for injury. If I see a sternal fracture, I will also look at the retrosternal space searching for a hematoma, which can be very small. Reexamining the vessels is also important to assess for underlying vascular injury. I will also run the spine on the axial and coronals looking for transverse process fractures. I've included a link to a good radiographics article for blunt thoracic trauma.
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