Radiology patient cases

Today’s cases: November 15th, 2015

  1. 22 (F). Hemoglobin was 7.7, cause unknown. The radiologist could not find any abnormality.


2. 60 (F) Spondylolisthesis L5-S1 (spondylolysis would be in a younger person), forward displacement of the vertebra, lumbar spinal canal stenosis

Spondylolisthesis is the forward displacement of a vertebra, especially the fifth lumbar vertebra, most commonly occurring after a break or fracture

Below: Grade 1 Spondylolisthesis

Spondylolysis and Spondylolisthesis

The most common cause of low back pain in adolescent athletes that can be seen on X-ray is a stress fracture in one of the bones (vertebrae) that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects the fifth lumbar vertebra in the lower back and, much less commonly, the fourth lumbar vertebra.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis). If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition.

Lumbar spinal canal stenosis

As the lumbar spinal canal narrows, the nerves that go through it are squeezed. This squeezing may cause back pain, leg pain and weakness. Arthritis, falls, accidents, and wear and tear on the spine’s bones and joints can also cause lumbar spinal canal stenosis.


3. 69 (M), dizzyness, looked at brain and found CSF space was expanded which means the brain has shrunk slightly – probably normal for his age? Referring physician asked whether there was a hemorrhage, we looked but did not find hemorrhage – only calcification around the area of the choroid plexus (ventral grouve).

The choroid plexus is a plexus of cells that produces the cerebrospinal fluid in the ventricles of the brain.


4. 40 (M), line in femoral cortex, physician wanted to know whether it was part of the normal structure, or whether there was inflammation/hemorrhage, we looked at a T1 weighted image which would show the hemorrhage with high intensity, there was fluid collection around the muscle, some hemorrhagic fluid (Vastus intermedius muscle, rectus femoris muscle).

S: Sartorius; V: Vastus Intermedius; VM: Vastus medialis; VL: Vastus lateralis; R: Rectus femoris; femoris; AM: Adductor magnus; G: Gracilis; SM: Semimembranosus; ST: Semitendinosus; BF: Biceps femoris. References: Enzo Silvestri 2013

Below: moderate grade injury to rectus femoris muscle

On the left the rectus femoris, which can show a variety of edema patterns depending on where (anatomically) the injury took place. The blue arrow demonstrates the tendon of the indirect head, which comes from the hip, it has a vertical orientation on this axial image. Along the posterior portion of the muscle (yellow arrows), there is a flat area of tendon originating from the knee. When a muscle has different orientations of the tendons it means that there are different patterns of edema possible depending on the tendon injured. Therefore this is a pattern of edema corresponding to an injury arising from the knee.

Below: Axial STIR MRI of the thigh in a professional soccer player. There is a haematoma within the vastus intermedius muscle (black arrow). Note the oedema within the overlying vastus lateralis (curved white arrow).


 

5. 48 (F), uterine myoma, 121mm, myxomatous / myxoid degeneration (mucous degeneration), lei myoma

Uterine leiomyomas (uterine fibroids) are benign tumours of myometrial origin and are the most common solid benign uterine neoplasm. Commonly an incidental finding on imaging, they rarely cause a diagnostic dilemma. There are various medical, surgical and interventional treatment options.

Below: broad ligament leioma http://radiopaedia.org/articles/uterine-leiomyoma

Leimyoma

A leiomyoma (plural leiomyomas or leiomyomata) (leio- + myo- + -oma, “smooth-muscle tumor”) is a benign smooth muscle neoplasm that very rarely becomes cancer (0.1%). They can occur in any organ, but the most common forms occur in the uterus, small bowel, and the esophagus

A myxoid tumor
A connective tissue tumor with a “myxoid” background, composed of clear, mucoid substance.


 

6. F (70), ovarian cancer, pt now receiving chemotherapy, images are after operation, no lymph node metastasis in liver, noticed a gall bladder polyp but it will probably be left as it is, slightly roundish lymph nodes noticed at bifurcation of lilac artery which is not good indicating some metastasis, chemotherapy is not effective and will need to be changed

ovarian cancer imaging


 

7.  53 y.o. (F), middle ear abnormality? mastoid bone abnormality? We found the level of mastoid air cells was not good…

Axial CT scan of the temporal bone shows increased attenuation of the mastoid air cells and erosion of the right petrous apex (arrow) with a well-pneumatized left petrous apex. References: Elida Vazquez, Amparo Castellote, et al. “Imaging of complications of acute mastoiditis in children”. Radiographics 2003;23(2):359-372.


 

 

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