CA SUPRASTRUCTURE OF LEFT MAXILLARY ANTRUM

MRI brain...

a heterogenous signal intensity mass is seen involving the suprastructure of left maxillary antrum.

the lesion is also involving floor of the orbit and is extending into the orbit resulting in non-axial proptosis of the left eyeball.

post contrast sequences reveal heterogenous enhancement of the lesion.

there is preseptal thickening of the left eye.

note is made of subretinal hemorrhage in the left eyeball.

Retained secretions are seen in both maxillary and ethmoidal sinuses.

possibility of CA SUPRASTRUSTURE OF LEFT MAXIALLRY ANTRUM with involvement of the left orbit cannot be excluded.

GROWING SKULL FRACTURE with LEPTO MENINGEAL CYST

patient presented with history of fall in a well.

MRI brain....

a well defined fluid intensity lesion is seen in the frontoparietal region with perilesion edema, mass effect .

The lesion appears hyperintense on T2W1 and hypointense on T1WI and FLAIR(shown in right image)

the lesion is eroding the inner table of skull and is invading the diploe.

post contrast sequences reveal no enhancement of the lesion(shown in left image).

diagnosis is..

growing skull fracture

CONGENITAL LOBAR EMPHYSEMA/BULLA

CT scan axial cuts lung window of a patient less than 5 yrs of age...

a well defined cavity is seen involving the right middle lobe resulting in mass effect and mediastinal shift to the contralateral side.

keeping in view the history..

possibilty of

congenital lobar emphysema/emphysematous bulla can not be excluded

chest X ray AP view of the same patient

reveals a radiolucency in the the right lung field which is devoid of vascular markings.

possibility is of bulla..

PULMONARY EMBOLISM

CT scan axial cuts of chest..

both lung and meiastinal windows...

a soft tissue density lesion is seen in the lumen of the main pulmonary trunk,both pulmonary vessels...,

the upper and middle division of right pumonary artery.

the lesion appears to be a straddling thrombus invading the vasculature on right side.

there is acinar shadowing with ground glass haze involving the right upper and middle lobes.this appears to be infarct invoving the lung parenvhyma because of the pulmonary thrombus

--------------------------------------> straddling thrombus

POSTERIOR PERINEPHRIC ABSCESS

CT scan axial cut of abdomen

a well defined marginally enhancing hypodense lesion is seen involving the posterior perinephric space...the lesion shows fluid density.

the lesion is pushimg the right kidney anteriorly..the right psoas muscle shows altered densities...

right sided posterior perinephric abscess/psoas abscess

pericardial effusion

CT scan chest axial cut..

there is smooth thickening of the pericardium and pericardial effusion

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