Lambda sign and T sign

 

Contrast induced nephropathy

 

Egg shell calcification

Following are the cases in which we get eggshell calcification of lympho nodes on radiography. 

Mnemonic:

SSRI Love Hitting BAT

(Lame? I know!) 

S-Silicosis

S-Sarcoidosis

R- After Radiotherapy

I L- Post irradiation lymphoma

H- Histoplasmosis

A- Amyloidosis

T- Tuberculosis

That's it ! 

- Demotional bloke

Radiologic features seen in pulmonary emphysema mnemonic

Hi!

Radiologic features seen in a case of pulmonary emphysema (Chest X-ray PA view):

mnemonic: PSTR-ANTR

Mnemonic to remember colors in Doppler echocardiography

Short post :)

The mnemonic is BART:

Think before you order a test: High resolution CT scan (HRCT)

Hello, 

Let's talk about HRCT today!

HRCT is the use of thin-section CT images (0.625-mm to 1.5-mm slice thickness) with a high spatial frequency reconstruction algorithm, to detect and characterize diseases that affect the pulmonary parenchyma and small airways.

HRCT cuts THIN slices.

Awesome, isn't it? Why not use an HD camera for every photograph?

Because it comes with a price!

Imaging Findings in PMR

Imaging —

As discussed above, there are characteristic features of periarticular structures (eg, bursitis and tenosynovitis) that can be seen on ultrasonography, magnetic resonance imaging (MRI), and positron emission tomography (PET) . Routine radiographs do not show abnormalities in patients with PMR.

Ultrasound (US) and MRI can demonstrate synovitis of the glenohumeral and hip joints and frequent involvement of extraarticular structures, especially the subacromial/subdeltoid bursa, long head of the biceps, and trochanteric bursa. While subdeltoid/subacromial bursitis is a characteristic imaging feature of PMR, it is not specific and is seen in patients with rheumatoid arthritis (RA) and other shoulder pathology .

Bhopalwala. H

Grading of Sacroiliitis on Imaging

Plain radiographs of the sacroiliac (SI) joints can be semiquantitatively graded based upon the presence of the characteristic radiographic findings :

●Grade 0: Normal .

●Grade 1: Suspicious changes .

●Grade 2: Minimal abnormality – Small localized areas with erosions or sclerosis, without alteration in the joint width . Erosions usually first appear on the iliac side.

●Grade 3: Unequivocal abnormality – Moderate or advanced sacroiliitis with erosions, evidence of sclerosis, widening, narrowing, or partial ankylosis .

●Grade 4: Severe abnormality – Total ankylosis

Bhopalwala. H

Peculiar pattern of pulmonary edema

Usually, left-sided cardiac pathology causes bilateral pulmonary edema but still, the unilateral pattern is seen in a fair number of cases, usually involving right lung parenchyma.

Likely mechanisms include:

1) Lymphatic drainage on the right side is via low caliber right bronchomediastinal trunk as opposed to the more robust thoracic duct on the left side.

2) Numerous conditions ranging from hypertension to valvular pathology can cause enlargement of the left side of the heart.

This will preferentially impinge on the left pulmonary artery causing reduced capillary perfusion and ultimately congestion of left lung parenchyma.

3) In cases of mitral regurgitation jet of regurgitating can preferentially impact either of the right or left pulmonary veins, hence explaining more profound edema on either side.

So, if according to the patient's history and clinical examination suspicion of cardiac failure remains high, then immediate intervention with diuretics and nitrates is warranted in spite of a unilateral pattern of pulmonary edema.

Kirtan Patolia

Radiology series #1 X-rays 1.0

Hello awesomites!

Today I am starting a new series of posts on radiology. Here I will be mostly dealing with the theory and technical part of radiology which as an undergraduate student we rarely read. Starting off with x-rays in this post and CT, USG, MRI to follow in the consecutive ones!

X-rays

A little bit of history,

X-rays were discovered by W. C. Roentgen in Germany on 8^th nov 1895 and for which he received a Nobel Prize in 1901.

First let us know a few technical terms, collectively known as the ‘exposure factors: 

     1) kVP: kilovolt peak

     It determines the penetration of the x-ray beam through the body. High kVP implies more penetration of the body tissues

     2) mAS: milliampere second

     It determines the amount of blackening of the film. A high mAS will cause more blackening of the film for the same amount of x-rays hitting it.

      3) Contrast: It is the contrast shadow that is produced on the film i.e. white for bone and black for soft tissues. It is influenced mainly by the penetration of the x-rays i.e. the kVP and partly by mAS.

A low kVP (low penetration) means high contrast.

Contrast is proportional to 1/kVP

But,

A low mAS (less blackening) means low contrast.

Contrast is directly proportional to mAS

Let us take up an example,

In obese and heavily built patients, more penetrance is needed so we need to increase the kVP but if we do so by increasing the kVP we are reducing the contrast which is not good.

So to achieve both high contrast and good penetrance, kVP is increased as well as mAS is increased.Increased kVP will take care of the required penetrance while high mAS will ensure good contrast.

The general protocol to increase the contrast is first by reducing the kVP and then if necessary increasing the mAS to desired levels.

That’s all for now, more about the actual working of the x-ray machine and different settings in the next post. Hope you liked it !

Until then,

Keep calm and keep studying

Stay awesome!

-          Ashish G. Gokhale

MCQ mnemonics series: Mnemonic for a condition causing lower abdominal pain

A 60-year-old male is admitted with a two day history of lower abdominal pain and marked vomiting. On examination he has abdominal swelling, guarding and numerous audible bowel sounds. What is the diagnosis?

1) Gallstone ileus
2) Ischaemic colitis
3) Large bowel obstruction
4) Sigmoid volvulus

Answer given below:

Pulmonary Embolism Picmonic

Hey guys!!

Pulmonary embolism is a diagnosis of exclusion. I am sure this illustration will help you to make a diagnosis of PE after you have ruled out the other differentials.

Thank you Subasini for this wonderful illustration! Inspired! :*

Diagnostic features in the X-ray and probable pathology in the Sinus

Hello :)

1. Haziness of sinuses only :- Sinusitis
2. Bony expansion without erosion :- Benign tumefaction e.g Polyposis
3. Decreased air shadow in nasal cavity without bony expansion :- Hypertrophic rhinitis
4. Bony erosion with expansion :- Malignancy
5. Bony defect without expansion of haziness :- Surgically induced (Iatrogenic) or fracture
6. Fluid level in maxillary sinus :- Sinusitis with pus signifying acute bacterial maxillary sinusitis

This question was asked to me by my friend and it was fun to find the answer.
(Source :-Otolaryngology at the eleventh hour By Anupam Mishra)

That's all for today.
-Upasana Y. :)

Image Based MCQ on Twin Pregnancy

Hello awesomites! 

Yesterday we posted an Image based MCQ on Twin Pregnancy. Here's the answer for it. 

#Radiology
#Obs_Gynae
Q. What is the diagnosis of the given USG image? 

A. Polyhydramnios 

B. Diamniotic Monochorionic twins 

C. Diamniotic dichorionic twins

D. Monoamniotic Monochorionic twins. 

The correct answer is C. Diamniotic dichorionic twins. 

The twin peak sign (also known as the lambda (λ) sign) is a triangular appearance of the chorion insinuating between the layers of the inter twin membrane  and strongly suggests a dichorionic pregnancy.  It is best seen in the first trimester (between 10-14 weeks). While the presence of a twin peak sign is a useful indicator of dichorionicity its absence, however, is not that useful in confidently excluding it.

It should be noted that the 'twin' in 'twin-peak' refers not to the presence of two peaks, but that it relates to twins. In pregnancies with more than two fetuses, the chorionicity and amnionicity of the each fetus may be different, and therefore this sign only aids in determining chorionicity of adjacent twins.

That's all! 

Thank you 

MD Mobarak Hussain (Maahii) 

Image Based MCQ on Fracture

Hello awesomites!
Yesterday we posted an Image based MCQ on Fracture of forearm bones and here's the answer for it.
Q. The X-ray of forearm in AP and Lateral views as shown in the image is diagnostic of

A. Galeazzi fracture-dislocation
B. Barton fracture
C. Monteggia fracture-dislocation
D. Colles fracture

Ans: c) Monteggia fracture-dislocation

Monteggia fracture-dislocations is defined as fracture of the ulnar shaft along with concomitant dislocation of the radial head.

Mechanism: Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH).

Classification: The Bado classification is used to subdivide the Fracture dislocation into four types.

Type I: anterior dislocation of radial head (Most common)
Type II: posterior dislocation of radial head
Type III: lateral dislocation of radial head
Type IV: anterior radial head dislocation as well as proximal third ulnar and radial shaft fractures

That's all!
Thanks for your active participation.

MD Mobarak Hussain (Maahii)

Subpleural opacities and Ground Glass Opacities

Hey guys!

I saw a patient today, a 37 year old female patient with chief complaints of cough and shortness of breath. She has a history of allergic rhinitis and migraine. She is also obese with an BMI of 31.

As you must have guessed already she was diagnosed with Bronchial asthma. On the spirometry report done 4 months back,  there was an obstructive pattern and after giving bronchodilators her FEV1 increased by 22% (>12%) and FEV1 vol increased by 300ml (>200ml). These findings also strongly support the diagnosis of asthma.

She was started on Albuterol as needed and Salmeterol-fluticasone MDI. She didn't show good response in the first 4 weeks, so she was also started on Montelukast and Tiotropium inhaler.

Now after 4 months, she still had cough and shortness of breath. She had bilateral polyphonic wheezes. A chest X Ray was done which came out to be normal. On pulse oximetry, SaO2 was 97% while breathing ambient air. On chest CT we found two attributes:
Subpleural opacities and Ground glass opacities.

So based on the CT scan findings, differential diagnosis:

Subpleural opacities:
1. Eosinophilic granulomatosis with polyangiitis( previously called Churg Strauss).

2. Organizing pneumonia

3. Pulmonary embolism with resultant subpleural pulmonary infarction

4. Allergic bronchopulmonary aspergillosis ( well, not really, actually in this case, there is peripheral air space opacification which looks identical to subpleural opacities)

Now Ground glass opacities:

1. Atypical pneumonia

2. Hypersensitivity pneumonia

3. Several ILDs

4. Sarcoidosis

5. Pulm Edema

6. Pulm Haemorrhage

That's all!

-VM

Flexion Tear Drop Fracture

Hello guys!

Here's a short description on Flexion Tear Drop Fracture and its radiological findings.

It typically occurs from severe flexion and compression forces, most commonly at C5-C6 (diving head first, motor vehicle collision deceleration).

Radiographic features -

1. Sagittal fracture through the vertebral body.
2. Fracture of the anteroinferior vertebral body (Tear Drop Sign)
3. Loss of anterior height of the vertebral body -Cervical kyphosis.
4. Posterior cervical displacement above the level of injury.
5. Widening of interspinous processes.
6. Intervertebral disc space narrowing.
7. Disruption of the spinolaminar line.
8. Vertebral body rotation with an AP diameter that appears smaller than on other levels.
9. Anterior dislocation of the facet joints.

That's all! 

Thank you.

MD Mobarak Hussain (Maahii) 

Fact of the day : Reduced white matter due to depression

Hey Awesomites

People ( or patients ) suffering from depression have reduced integrity of white matter substance. This means the neuronal circuit loses its connections with other parts of brain due to miscommunication between the brain cells.

A recent study mapped the internal structures of brain using diffusion tensor imaging ( DTI ) technology, that is a specialised MRI scan that creates a 3D map as it follows the diffusion of water in brain tissue.
( Source )


- Jaskunwar Singh

Ultrasonography in Acute Appendicitis

Hey Awesomites

Ultrasonography ( graded compression technique ) is the investigation of choice in cases of acute appendicitis.

Mnemonico diagnostico: Opacities that may be confused with renal calculus

Hey Awesomites

Mnemonic for opacities on a plain abdominal radiograph that may be confused with renal calculus:
TOP GAME

Tubercular calcified lesions in the kidney
Ossified tip of 12th rib
Phleboliths (calcifications in the wall of pelvic veins)

Gall stones
Appendicular/ Adrenal gland concretions
Mesenteric lymph node calcifications
External (foreign) bodies in alimentary canal (ex., cyclopenthiazide)


Thats all
- Jaskunwar Singh