Today’s cases: January 23rd, 2016

1. Emergency case: 74 yo male, vomiting, low sat O2, lacunar infacrtion – ischemic change, sometimes asymptomatic or can lead to Hemiparesthesia

Hemiparesthesia means numbness or other abnormal or impaired sensation that is experienced on only one side of the body.

Lacunar stroke or lacunar infarct (LACI) is a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain’s deep structures.


A lacunar infarct is a type of silent stroke, which means it may not produce any outside symptoms. In many cases, patients are unaware when they suffer a lacunar stroke. Despite not causing any symptoms, this type of stroke still damages the brain and puts the patient at risk of major stroke attacks in future.

2. Aspiration pneumonia, Lung infiltration, ground glass appearance, (if both sides of lung = heart related), if not, then probably pneumonia b/c thickening bronchus – broad thickening, bronchial dilation

Aspiration pneumonia is an inflammation (usually due to an infection) of your lungs and bronchial tubes that occurs after you inhale foreign matter. It’s also known as anaerobic pneumonia. This condition is caused by inhaling materials such as vomitus, food, or liquid.


3. 49 yo female, pancreatic tumor/fat infiltration? Looked at non-contrast enhanced CT, inconclusive, too deep to take biopsy of pancreas (my question)??

Pancreatic lipomatosis?

Pancreatic lipomatosis refers to fatty replacement of pancreatic parenchyma. This finding is most often associated with obesity and aging. 

What is fatty infiltration of the pancreas?

In and off it self, fatty infiltration of the pancreas is a benign condition; it simply means that fat tissue has been laid down inside the pancreas. This fat tissue does not inhibit the other pancreatic tissue, and it does not in and of itself predispose to cancer or other serious complications. Although most cases of fatty infiltration of the pancreas are probably just normal variants, they may be more prevalent in obesity, where fat gets laid down in all of the internal organs.

4. 77 yo female, atherosclerosis of brain? – MRA, DWI, no acute infarction, MCA (M1) – focal stenosis, M2 portion visualized so anastomosis was probably formed = not complete stenosis, also noticed gliosis, infiltrating edema (T2 white area), lacuna infarct, ischemic change

Inline image 2

Gliosis is a nonspecific reactive change of glial cells in response to damage to the central nervous system (CNS). In most cases, gliosis involves the proliferation or hypertrophy of several different types of glial cells, including astrocytes, microglia, and oligodendrocytes. In its most extreme form, the proliferation associated with gliosis leads to the formation of a glial scar.

And likely has shortage of normal cells –

Tx: I asked about IVR, but MCA is difficult to get to, so control HTN and hyperlipidemia


– Diagnosis Gliosis, Location(s) Cerebral hemispheres, with gamuts Hypodense intracerebral lesion on noncontrast CT – See more at:

Gliosis, Cerebral hemispheres, CT

5. 38 yo male, from a whole body check, we noticed a bulla in the lung.

Bulla (defect in ara of normal alveolar cells)

Bulla is a pathological entity caused by the confluence of two or more of the terminal elements of the bronchial tree. They may be found subsequent to any condition that interferes with normal respiratory mechanism that produces increased intra-alveolar pressure. A single bulla is a rarity: they vary in size from that of a large vesicle to that of a large grape fruit. There are two views as to the formation of bullae: both believe bullae to be the result of the increased intra-alveolar pressure that is present. The distinction between bullae and blebs has been stressed. Bullae are by no means innocuous. There is no clinical sign or symptom characteristic of bullae. Diagnosis is nearly always made by means of x-rays and the differential points have been discussed. There is no known treatment of the condition.

Below: Chest x-ray of a large bulla with true infection; after the appropriate medical treatment fever, hemptysis and fluid level persisted and the bulla was resected

Sometimes bullae can calcify and become granulomas. ??? Not sure if this is correct???

6. 46 yo male, follow-up on pancreatic cystic mass, IPMN, cystic lesion, used MRCP, saw stent, if cyst has a septum, or MURAL NODULE = malignant change

Intraductal papillary mucinous neoplasm (IPMN) is a type of tumor (neoplasm) that grows within the pancreatic ducts (intraductal) and is characterized by the production of thick fluid by the tumor cells (mucinous).

A mural nodule is a small nubbin (lump) of solid tissue on the inner wall of a cyst.
It is another component of a complex cyst (where is it?). Complex as opposed to simple cysts are at a higher risk for harboring malignancy and so usually require further evaluation

Source: HealthTap,

Magnetic resonance cholangiopancreatography (MRCP) is a medical imaging technique that uses magnetic resonance imaging to visualize the biliary and pancreatic ducts in a non-invasive manner.[1] This procedure can be used to determine if gallstones are lodged in any of the ducts surrounding the gallbladder.

Below: MRCP image showing stones in the distal common bile duct: (a) Gallbladder with stones (b) Stone in bile duct (c) Pancreatic duct (d) Duodenum.

MRCP Choledocholithiasis.jpg


7. 74 yo male, COPD, lung cancer? Lung is darker than normal, over inflated, dead space of air, no transfer of O2/CO2.

8. 51 yo female, hip joint MRI, left side pain

Ex MRI Hip case:


9. 44 yo female, cystitis, enlarged bladder, checked for fistula of bladder/intestine? Found nothing.

A bladder fistula is when an opening forms between the bladder and some other organ or the skin. Most often the bladder opens to the bowel (“enterovesical fistula”) or the vagina (“vesicovaginal fistula”).

Bladder with two diverticula


10. 51 yo male, lower abdominal pain

  1. Check for acute appendicitis – ileocecal bulb
    6mm = normal
    7mm = abnormal

2. Diverticulitis of AAA?  –

Diverticulitis – fat density elevated (dirty fat sign)

脂肪組織(腸間膜および大網内)などのへの病変の波及に伴う網状影をdirty fat signという。

inflammation of a diverticulum, especially in the colon, causing pain and disturbance of bowel function.



Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s