LUMBAR MYELOGRAPHY

these are captured views of a recent presentation i gave in our department ..

the topic was myelography..it covered the procedure of lumbar myelography and cerviacal myelography,the findings, and different modalities for spinal cord examination.

basically conventional myelography is...

žInvasive test with associated risks
žHas been largely replaced by MR, which is non-invasive and therefore safer.

but still in cases where MRI is contraindicated and in some units where surgeons prefer conventional myelograohy..it is being done.

Water-soluble non-ionic contrast media, which are licensed for intrathecal use (e.g. lohexol), are virtually non-neurotoxic, do not cause epileptic fits and are apparently devoid of arachnoid toxicity.

CT myelography is usually done after conventional myelography which is done under fluorocopic control.

CTM is
žPerformed after intrathecal injection
žCan be performed at any level of vertebral column
žMultiple slices taken (1.5 – 3mm)
›Gantry is tilted
žWindowing allows for density and contrast changes

žCan obtain images with small amounts of contrast
›Can be done 4 hours after initial injection of contrast

MR myelography is noninvasive and...
›Allows direct visualization of spinal cord, nerve roots, and surrounding CSF
›Can be done in various planes

Aid in diagnosis and treatment of neurodisorders

ABDOMENAL LYMPHADENOPATHY

CT scan abdomen with contrast.

multiple marginally enhancing enlarged lymph nodes are seen in the para aortic region and pre aortic regions along the vessels..

?tuberculous lymphadenopathy

HEMATOMA brain

CT brain

a hyperdense lesion is seen involving the left thalamic area with some inter ventricular component--hemmorhage/hematoma

there is calcification of bilateral basal ganglia.

a low attenuation area is seen in occipital region without any mass effect --old infarct.

BRONCHIECTASIS

CT scan axial sections of lungs.

bronciectatic chanes are seen involving the posteromedial segments of both lower lobes

???pneumoconiosis

HRCT lungs.

patient had a history of long term intake of steroids..

thickening of both interlobular and interlobar interstitial tissue septa is seen involving lower lobes bilaterally.

there were small pinpoint nodules involving both upper lobes--miliary nodules

keeping in view the above findings...possibilities are:

?pneumoconiosis--silicosis

?miliary tuberculosis

SPHENOID WING MENINGIOMA WITH EXTENSION INTO THE RIGHT ORBIT

MRI brain

a well defined iso to hyperintense lesion is seen involving the right temporal lobe evident on T2 WI and iso intense on T1WI.

the lesion is extra axial and shows mass effect and mild midline shift.

post contrast sequences reveal homogenous enhancement of the lesion with some nodularity on its posterior aspect.

the lesion is extending into the right orbit into the extraconal compartment and resulting in right non axial proptosis by pushing the eyeball outwards.

the lesion shows local extension into the covering soft tissues of the right temporal area

the above findings suggest possibilty of sphenoid wing meningioma with extension into the right orbit.

CA CONJUNCTIVA ---RECURRENCE

CT brain axial and coronal cuts

a soft tissue density lesion is seen involving the right maxillary, temporal and orbital areas.

the lesion measured about 2.5cm in the medial wall of the right orbit.

the lesion is elevating the roof of right orbit and is pushing and infiltrating the lamina papyracea medially.

the lesion is involving the right cheek and soft tissues of right temporal area.

there is involvement of the right maxiallry, ethmoidal and frontal sinuses.

right eyeball not visualized--history of surgery...

right optic nerve not visualized..?iinfiltrated by the mass lesion

patient was a known case of CA conjunctiva.

recurrence of tumour was the most probable diagnosis

?? pneumocystis carinii

CT scan axial section of lungs

multiple areas of consolidation, acinar shadowing, ground glass haze and cavitation are seen involving both lungs

some bronchiectatic changes also visible...

possibility of infect by pneumocystis carinii could not be excluded