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

CROSS FUSED ECTOPIA

IVU study 20 minutes fim..

reveals absence of nephrogram on the right side...

two collecting systems are seen on the left side in the area of left kidney...double moeity.

another nephrogram is seen below the duplex system of left side which appears to be fused with the left kidney...

ureter arising from the left kidney is seen crossing the left iliac bone...

whereas the ureter of lower kidney is seen croosing the lumbar vertebra to reach the iliac bone on right side..then descendind down as a right ureter..

this apperaed to be a case of duplex collecting sysytem on left side and cross fused ectopia ..where right kidney was ectopically present on left side

HISTIOCYTOSIS

CT scan axial section..

bone window reveals lytic lesions in the skull bone involving noth the inner and outer tables of skull.

lesion in the occipital bone(shown here) shows sharp bevelled margins.

no extension into the brain was seen

no associated soft tissue thicking seen.

ventricular system was normal..

possibility of histiocytosis could not be excluded

ABSCESS in BRAIN

CT scan axial sections of brain with contrast

multiple marginally enhancing well defined hypodense lesions are seeen involving the right temporal and parietal lobes...

keeping in view the history of chronic ear duscharge on right side..possibility of ear infection ascending into the brain could not be excluded...

the ear infection led to the formation of multiple abscesses in the brain parenchyma

POST TRAUMATIC BRAIN..HEMATOMA

CT scan axial sections of brain

a marginally calcified extra dural hematoma is seen in the left frontal region

low attenuation area is seen in left temporofrontal and parietal region

there is mass effect on the ibsilateral lateral ventricle and midline shift...

possibility of extra dural hematoma with infarct of above mentioned areas could not be excluded

KARTAGENER'S SYNDROME...

CT scan axial sections of chest..both lung and mediastinal windows were taken..

lung window reveals consolidation and collapse of right upper lobe

area of bronchiectasis is seen involving the middle lobe and basilar segments of right lower lobe..

mediastinal window reveals an obvious mediastinal shift to the right side

lower cuts reveal liver's presence on the right side....

a soft tissue density lesion is seen in the right upper lobe which on lung window confirmed to be collapse of upper lobe on right side with an air bronchogram

all above mentioned findings are summed up as...

situs inversus with bronchiectatic changes and element of collapse involving the right lung...

possibility of kartagener's syndrome could not be excluded....

Patients with primary ciliary dyskinesia as seen in kartagener's syndrome exhibit a wide range of defects in ciliary ultrastructure and motility, which ultimately impairs ciliary beating and mucociliary clearance

Kartagener syndrome is characterized by the clinical triad of chronic sinusitis, bronchiectasis, and situs inversus..infertility is also an outcome of immotile cilia.

sometimes...kartagener's is sometimes diagnosed when patient comes for infertility workup...

EMPYEMA

CT chest axial cuts. a well defined marginally enhancing isodense lesion is seen involving the right pleural cavity.

there is thickening of adjacent pleura.

note is made of some pericardial thickening

---possibility of empyema of right pleural cavity can not be excluded

EAR infection extending into the cranial cavity

CT brain axial cuts

there is sclerosis of right sided mastoid air cells.

a small lytic lesion is seen in small cuts involving the right mastoid.

a well defined marginally enhancing hypodense lesion is seen occupying the right CP angle.The lesion is compressing the fourth ventricle resulting in hydrocephalic changes....temporal horns are dilated

---possibility of cholesteatoma with an abcess can not be excluded