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When Air Is Your Best Barrier

When Air Is Your Best Barrier

This 10-years old girl presented with an osteoid osteoma involving the superior lamina of L2 on the right.
There was some concern about heating of the dura and nerves during the RFA.

We injected air into the epidural space, which likely acted as a barrier to flow of heat. The RFA was successful and her pain disappeared. The RFA images shows the electrode tip (blue arrow) and the air (red arrow). #osteoidosteoma
#RFA
#radiofrequencyablation
#spineosteoidosteoma
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Not all Spine Infections are Tuberculosis

Not all Spine Infections are Tuberculosis

This 64-years old man had fever and backache. An MRI of Oct 2017 showed some osteophytosis centred at the dorsolumbar junction, but no other abnormality.

A PET/CT done on 01 Dec shows uptake along the area of new bone proliferation at this level.

A CT scan done at the time of biopsy shows focal osteolysis with a discovertebral lesion at D10/11. A biopsy was done from the osteolytic lesion and the perivertebral soft tissue.

It shows MSSA – methicillin susceptible staphylococcus aureus

#radiologypicoftheday
#spineinfection
#spine
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Rib involvement by metastasis from squamous cell carcinoma of tongue

Rib involvement by metastasis from squamous cell carcinoma of tongue

This 38-years old man had successfully undergone surgery and adjuvant therapy for carcinoma tongue and adjacent nodes.

Six months later, he presented with chest pain and a left pleural effusion. PET/CT showed uptake along the left 7th and 8th ribs.

The sagittal reconstruction shows the rib involvement well, but so does the unfolded rib view.

A biopsy was performed through the pleural collection and confirmed metastatic spread

#radiologypicoftheday
#carcinomatongue
#metastasis
#rib
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Pic of the Day2

Pic of the Day

Pic of the Day
The Power of CT scan. This 64-years old man with backache has an MRI showing an L3 lesion with osteolysis and abnormal right perivertebral soft tissue.He was referred for a CT guided biopsy. The CT scan itself so beautifully shows the osteolytic lesions and sequestra, signs that are typical of osteomyelitis. A biopsy was also performed and the results are awaited.

#osteomyelitis
#spineinfection
#spineMRi
#mrispine
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Pic of the Day1

Pic of the Day

Pic of the Day
This young man dislocated his elbow. The MRI done after 2 days shows tears of the ulnar and radial collateral ligaments, the lateral ulnar collateral ligament and a tear of the brachial.
Typically when both ligaments are torn, the medial and lateral, it generally is following severe trauma involving dislocation.
#elbowtrauma
#elbowMRI
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Pic Of The Day – CT Myelogram

Pic Of The Day – CT Myelogram

Pic Of The Day – CT Myelogram
This elderly gentleman had a contraindication for MRI.
He presented with acute right sided radiculopathy.
A CT myelogram was performed, which shows a large right posterolateral disc hernia at L4/5 with inferior migration and compression of the right L5 and S1 nerve roots. The migrated fragment is likely sequestered.
While the reasons for doing CT myelogram are highly limited, it is a modality that can help save the day in select patients and specific circumstances.#ctmyelogram
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picoftheday

Pic of The Day

Pic of The Day
This is a young patient who has tuberculosis and suspected mediastinal adenopathy.

The CT scan shows infectious bronchiolitis in the left upper lobe with a left pleural effusion.
What looks like mediastinal nodes are actually loculated collections in the antero-superior and posterior pericardial recesses and the transverse sinus of the pericardium likely due to rupture of one of the nodes.
It is easy to mistake these lesions for adenopathy, if not careful.
#tuberculosis
#pericardium
#pericarditis
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Pic Of The Day – Giant Cell Tumor of The Spine

Pic Of The Day – Giant Cell Tumor of The Spine

Pic Of The Day – Giant Cell Tumor of The Spine

This 25-years old woman presented with radiculopathy and back pain. The MRI shows an expansile T2 low signal lesion involving L1 with canal compromise. There is minimal marrow edema and the discs are not involved.

As with all such lesions in young people, she was labeled to have tuberculosis.
Given that the discs are not involved and that the marrow edema is minimal and that the lesion is expansile, a primary bone neoplasm should be considered. At this age, the most likely T2 low signal lesion would be a giant cell tumor.
The CT scan shows an expansile lesion with well defined margins, but without a sclerotic rim. The biopsy confirmed a giant cell tumor.

#giantcelltumor
#GCTspine
#MRIspine
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Pic Of The Day – Mucinous Invasive Adenocarcinoma with Lepidic Spread

Pic Of The Day – Mucinous Invasive Adenocarcinoma with Lepidic Spread

Pic Of The Day – Mucinous Invasive Adenocarcinoma with Lepidic Spread

This 67-years old woman came with cough and fever and a radiograph showing an opacity in the left upper and mid zones, simulating old tuberculosis.

On the CT, there is a dense lesion in the posterior segment of the left upper lobe towards the apex with focal fibrosis that could perhaps be a post-infectious lesion. However more inferiorly, the lesion is subsolid.

Subsolid lesions like these are worrisome. This lesion is more than 8 mm in diameter and hence can either be excised or can undergo a CT guided biopsy, which we did.

It has been diagnosed to be a mucinous invasive adenocarcinoma with lepidic spread…we would have called this bronchoalveolar carcinoma in the olden days.

Moral: Don’t ignore subsolid lesions, especially the ones larger than 8 mm.
#lungnodule
#subsolidlungnodule
#CTguidedbiopsy
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Pic Of The Day – Acute Enthesopathy in DISH

Pic Of The Day – Acute Enthesopathy in DISH

Pic Of The Day – Acute Enthesopathy in DISH

This 57 years old man had a cervical spine MRI last week with whole spine screening, which showed marrow edema involving the D7 vertebral body anteriorly to the right.

The dedicated MRI shows an osteophyte arising from D7 on the right with marrow and periosseous edema.

It is the CT though that shows the exact status. There is flowing ALL ossification in the lower cervical and upper dorsal spine. At D7 and D8 there are bridging enthesophytes and the D7 enthesophyte shows marrow edema suggesting acute enthesopathy superimposed on a background of DISH (diffuse idiopathic skeletal hyperostosis)

#MRIspine
#DISH
#enthesopathy
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