Today’s cases: March 12, 2016

  1. 54 yo female, mamoplasty, check for problems

Below: CT image showing collapsed ruptured right-sided silicon prosthesis with ”Linguine sign” which are folded in wavy multidirectional lines within the silicon gel. Note the normal prosthesis on left side.


2. 81 yo male, atherosclerosis, PCA, FLAIR image, old infarction, gliosis shown high intensity is white (gliosis), old cerebral vascular disorder, infarction/hemorrhage leads to gliosis, low intensity FLAIR = same as CSF, defect or cerebral gliosis disappears and only CSF remains, shrunk brain b/c SULCUS enlarges, lateral ventricle enlarged (3rd ventricle)

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.

Below: Evidence of old left MCA territory infarct with encephalomalacia and surrounding gliosis. There is ex vacuo dilatation of the left lateral ventricle.  Ventricular size and sulcal pattern is stable.  Further periventricular hypodensities most likely reflect sequelae of chronic small vessel ischaemia. Focal hypodensity in the region of the right external capsule is again noted.   (CT)

Below: CT scans without contrast show enlargement of lateral and third ventricles, but not the fourth ventricle, due to aqueductal stenosis.

Hydrocephalus (I just wanted to show the third ventricle)

What is LBD?

Dementia with Lewy bodies (DLB), also known under a variety of other names including Lewy body dementia (LBD), diffuse Lewy bodydisease, cortical Lewy body disease, and senile dementia of Lewy type, is a type of dementia closely associated with Parkinson’s disease.

Below: Lewi body dementia: normal hippocampus


3. 78 yo female, Alzheimer’s, frontal lobe atrophy, A1 portion of ACA – aneurysm, hemodialysis, CLIP or IVR? Clip is open and cheaper, IVR involves coiling with platinum which is safer but costs as much as a Mercedes Benz!



4. 84 yo male, gait disturbance, shrunken disks, L1,2, bulging disks, compressed dural sac, narrowing of lumbar nerves – will need laminectomy

Below : L4 herniation, but a good example


Laminectomy is surgery that creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves.




5. 22 yo female, rt leg numbness, look at brain, no paralysis, no problems on contralateral side, so OK

6. 70 yo F, sepsis, hazy shadow in lungs, ground glass appearance, pleural effusion, stent in common iliac artery, total hip replacement – saw artifact on CT, osteopenia/porosis, bones looked dark

Below: Stent in a male


Below: artifact due to Total hip replacement


7. 78 yo male, dizzyness, old infarction, after gliosis (when neurons disappear, glial cells fill in the space)

Encephalomalacia is the softening or loss of brain tissue after cerebral infarction, cerebral ischemia, infection, craniocerebral trauma, or other injury.

Below: Encephalomalacia due to old MCA infarct

This case shows the end result of a large middle cerebral artery territory infarct. Over time, the necrotic brain undergoes liquefaction and becomes progressively lower density on CT and progressively higher signal intensity on T2-weighted MRI. The image on the left here is a T2-weighted MR and shows the large area of encephalomalacia (arrows). On the right is a FLAIR image (which suppresses the signal from CSF) and shows that the signal in the infarcted area tracks that of the CSF in the ventricles and sulci. Another feature of encephalomalacia is that the associated volume loss often results in compensatory dilatation of the adjacent lateral ventricle, as in this example (LLV= left lateral ventricle). Differentiating new from old infarcts is usually relatively straightforward on MRI (especially if we look at the diffusion-weighted sequence – have a look at the MRI section if you need to recap your knowledge of MR sequences), but it’s worth knowing that recent infarcts will be hyperintense on FLAIR and will be associated with mass effect rather than volume loss, resulting in compression of the adjacent lateral ventricle.


8. 51 yo male, bulging disks C3, C4, C5, C6 – logitudinal thickening, OPLL, compressing the nerve, Lusckka joint spur

Ossification of the posterior longitudinal ligament (OPLL) is typically an entity seen in patients of Asian descent, although it is seen in all ethnicity. It is characterised by, as the name suggests, ossification of the posterior longitudinal ligament.


9. 69 yo male, prostate cancer, contrast media



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