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All Posts Tagged: CT SCAN

Green is Gout – Dual Energy CT (DECT) and Gout

This 58-years old man presented with a painful swelling over the radial aspect of the wrist. The radiograph showed an osteolytic lesion. Because of his pacemaker, a CT scan was done, which showed multiple osteolytic lesions in the distal radius and carpal bones with calcified soft tissue.

A biopsy was done, which showed some form of crystal arthropathy. His serum uric acid levels were elevated.

A dual energy CT of both elbows, wrists, hand and both knees, ankles and feet was performed. All the blobs of “green” reflect the presence of urate crystals, typical of gout. Usually in the Indian setting, florid tophaceous gout like this is not common. But in this patient, it has allowed us to clinch the diagnosis.
#ctscan #dect #gout #dualenergyct from Instagram: http://ift.tt/1Roz1tJ

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The Unfolded Infected Rib – Rib Tuberculosis and CT Scan

This is a 34-years old man with a swelling over the left anterior chest wall. The CT scan shows the collection as well as the osteolytic lesions of the ribs and the sclerosis, typical of an infection like tuberculosis.
The unfolded rib image however puts it all in perspective. The osteolytic lesions and the sequestra with surrounding sclerosis involving 4th – 6th are just so much better appreciated.
#tuberculosis #rib #ctscan #unfoldedrib from Instagram: http://ift.tt/1MJCmOr

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Unfolded / Flattened Rib – Fibrous Dysplasia of the Rib

Fig. 1: A simulated radiograph created from CT scan data shows an expansile lesion of the right 5th rib (arrow).

Fig. 1: A simulated radiograph created from CT scan data shows an expansile lesion of the right 5th rib (arrow).

This 29-years old lady had a chest radiograph for cough and fever. It showed an expansile lesion of the right posterior 5th rib (Fig. 1). This pattern typically occurs with either fibrous dysplasia or enchondroma, though the commonest entity in an asymptomatic individual is fibrous dysplasia (1).

Nevertheless a CT scan was performed. Thick maximum intensity projection (MIP) axial (Fig. 2a) and coronal (Fig. 2b) images show an expansile osteolytic lesion with thickening of the cortical margins at places along with a subtle ground-glass matrix. This again is typical of fibrous dysplasia.

Fig. 2 (A,B): Thick MIP axial (A) and coronal (B) images show the expansile osteolytic lesion well with cortical thickening and thinning with a ground-glass matrix.

Fig. 2 (A,B): Thick MIP axial (A) and coronal (B) images show the expansile osteolytic lesion well with cortical thickening and thinning with a ground-glass matrix.

Fig. 2 (A,B): Thick MIP axial (A) and coronal (B) images show the expansile osteolytic lesion well with cortical thickening and thinning with a ground-glass matrix.

Fig. 2 (A,B): Thick MIP axial (A) and coronal (B) images show the expansile osteolytic lesion well with cortical thickening and thinning with a ground-glass matrix.

The Flattened/Unfolded Rib image (Fig. 4) reconstructed on the new Syngo Via platform (2, 3) with automatic numbering of the ribs shows this lesion extremely well.

Fig. 3. The Flattened/Unfolded Rib image with automatic numbering shows the lesion (arrow) with the expansion, size and dimensions exquisitely demonstrated.

Fig. 3. The Flattened/Unfolded Rib image with automatic numbering shows the lesion (arrow) with the expansion, size and dimensions exquisitely demonstrated.

Since the patient and orthopedic surgeon were still concerned about the diagnosis, a CT guided biopsy (Fig. 4) was performed that confirmed the presence of a fibro-osseous lesion.

Fig. 4: A CT guided biopsy (arrow) was performed that confirmed the diagnosis of a fibro-osseous lesion.

Fig. 4: A CT guided biopsy (arrow) was performed that confirmed the diagnosis of a fibro-osseous lesion.

Because of the curvature of the rib, it can be difficult to visualize rib lesions, especially subtle fracture on routing reading, even with multiplanar reconstructions (MPRs) and MIPs. The new Siemens Syngo Via has a Bone Reading module that automatically flattens out the ribs and spine and allows quick and accurate evaluation of rib pathology, both fractures (3) and tumors (4,5).

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