Alexandria Radiology

GI & GU Case 20

anne — Wed, 30 Dec 2009 14:27:36 +0000

Gonadal vein thrombosis (GVT) is mostly observed in females. It can occur at any age but is classically found in the post partum period. In about 90 percent of the cases, it occurs on the right side. It is potentially fatal if it extends into the IVC and renal veins resulting in pulmonary embolism. GVT can clinically mimic other pathologies such as pyelonephritis and cholecystitis.

On CT the involved vein is enlarged with a central low attenuation area consistent with thrombus. US frequently is limited because of overlying bowel gas. Mild perivascular stranding may be encountered. Anticoagulant and intravenous (IV) antibiotic therapy is the treatment of choice.

Chest Case 15

anne — Tue, 17 Nov 2009 16:24:15 +0000

Chest radiographs are normal in more than half of patients with H1N1. The typical pattern when present is one of bilateral alveolar disease with lower and central lung preponderance. Small pleural effusions have also been described. Follow up radiographs usually show waxing and waning of alveolar disease. Agarwal et al. have recently shown that CT was more sensitive than plain radiographs (AJR oct 2009). The CT scans showed a combination of ground glass opacities and consolidation in most patients. The distribution was diffuse without zonal predominance in seven patients.

Pulmonary emboli were also identified on CT but determined not to be related to H1N1.

AAR participates in Walk to Fight Breast Cancer

anne — Tue, 27 Oct 2009 13:22:38 +0000

AAA is proud to have supported the Alexandria Walk to Fight Breast Cancer which provides mammograms to uninsured women or those in financial need.

Musculoskeltal Case 23

anne — Thu, 15 Oct 2009 15:44:07 +0000

Giant cell tumors of the tendon sheath are the second most common tumors of the hand, after the ganglion cyst. There is controversy regarding the underlying nature of this lesion, specifically whether it is a neoplastic or nonneoplastic. They do not always arise from the tendon sheath but may arise from the synovium. They have a predilection for the flexor surfaces of the hand. Clinically, they are usually painless masses. They can occur at any age, but are most commonly diagnosed between ages 30 and 50. They commonly occur in the hands but have been identified in the foot as well. Most lesions were inhomogeneous due to low-signal-intensity areas and enhanced following gadolinium administration.

On plain radiographs, a small number of the lesion (about 20 percent) will show smooth bony erosions.

On MRI, the lesion is typically hypointense to intermediate on T1 WI and inhomogenous mixed to intermediate and/or high signal on T2 WI with internal low signal septations. Intense and homogenous enhancement is seen after contrast administration.

On ultrasound, they typically appear as solid, homogeneous hypoechoic masses with detectable internal vascularity that are associated with the flexor tendons of the fingers.

Treatment is usually with surgicalexcision.

Musculoskeletal Case 22

anne — Wed, 30 Sep 2009 17:04:16 +0000

Osteoid osteoma (OO) is a benign skeletal neoplasm. They account for approximately 10 percent of benign bone tumors. Osteo osteoma occurs most frequently in the second decade. About 80 percent of OO cases are cortical. The rest are intramedullary. The proximal femur is the most common location followed by the tibia, posterior elements of the spine, and the humerus.

The classic radiological appearance is a radiolucent nidus surrounded by a reactive sclerosis in the cortex of the bone usually less than 2 cm in long axis. The tumors may regress spontaneously.

Chest Case 14

anne — Tue, 01 Sep 2009 11:48:05 +0000

Lymphangioleiomyomatosis (LAM) is a rare disorder resulting from proliferation of smooth muscle cells along lymphatics in lung, thorax and abdomen. The etiology of the disease is unknown. The disorder affects young patients with female predominance. It presents with spontaneous pneumothorax, chylothorax, hemoptysis, and slowly progressive dyspnea. Similar lesions may be seen in tuberous sclerosis (Some suggest LAM is a forme frust of tuberous sclerosis). Extrapulmonary LAM is rare.

Radiographically presents with numerous thin walled cysts, 90 percent with size of cysts < 5-10 mm. Recurrent pneumothotax, 70 percent. Chylous pleural effusions, 25 percent.

Head & Neck Case 22

anne — Thu, 27 Aug 2009 14:31:43 +0000

The tripod fracture consists of a set of three fractures. The first involves anterior and postero-lateral maxillary walls as well as the orbital floor. The second portion involves the zygomatic arch. The third involves the lateral orbital wall, or the fronto-zygomatic suture. The tripod fracture is usually secondary to a direct blow to the malar eminence.

Keith M Sterling MD discusses Uterine Fibroid Embolization

anne — Mon, 27 Jul 2009 14:35:16 +0000

Keith M Sterling, MD discusses Uterine Fibroid Embolization on WJLA Channel 7.
Follow-up on-line discussion.

Nitan Kumar, MD discusses Inova Alexandria Hospital MRI reaccreditation

anne — Tue, 14 Jul 2009 18:37:14 +0000

Nitan Kumar, MD discusses Inova Alexandria Hospital MRI services, among the first in the region to earn accreditation in cardiac imaging.

Neuro Case 31

anne — Tue, 14 Jul 2009 17:28:30 +0000

Fetal cystic hygromas are congenital malformations of the lymphatic system appearing as single or multiloculated fluid-filled cavities. Approximately 75–80 percent of all cystic hygromas involve the neck and the lower portion of the face. They tend to be infiltrative without respect to fascial planes. They often progress to hydrops and cause fetal death. The majority (about 80–90 percent) are detected by the time the patient is 2 years old. Approximately half of these fetuses have monosomy X (Turner syndrome), while 10-15 percent of cases have trisomy 18, 21 or 13. Cystic hygromas are midline, posterior, septated, cystic masses without associated bone defects. They frequently contain a characteristic appearing midline nuchal ligament.

The differential considerations include: encephalocele, meningomyelocele, and teratoma. Teratomas are typically solid in nature. Encephaloceles have associated calvarial abnormalities and may contain brain tissue. Meningomyeloceles are most of the time encountered in the lumbar region.