Today’s cases: March 5th, 2016

  1. 55 yo female, wrist pain, synovium thickening for all bones in wrist, indicative of Rheumatoid Arthritis, RS (3Pe Remitting seronegative symmetrical synovitis with pitting edema)below:

Well-defined bony erosions in the carpal bones and metacarpal bases in a patient with rheumatoid arthritis of the hands.


2. 56 yo male, no other information given, ENT doc referring so we looked at that region, all looked ok, but saw reticular shadow in the chest – but almost normal

 A reticulonodular interstitial pattern is produced by either, overlap of reticular shadows, or by the presence of reticular shadowing and pulmonary nodules. While this is a relatively common appearance on a chest radiograph, very few diseases are confirmed to show this pattern pathologically.



3. 63 yo Female, no other information from referring doc, submandibular mass seen, normal gland compressed by tumor, liver cysts, can see pleural junction

Below: Contrast-enhanced axial CT image shows hypodense, enlarged right submandibular gland with calculus (thick white arrow) and thickening of adjacent fascia (thin white arrow)

Figure 12: Contrast-enhanced axial CT image shows hypodense, enlarged right submandibular gland with calculus (thick white arrow) and thickening of adjacent fascia (thin white arrow)


4. 61 yo male, Blue toe syndrome, peripheral areas atheroscelotic possibly due to HTN, hyperlipedemia etc, lung bulla

Blue toe syndrome, also known as Trash Foot or Purple Toe Syndrome, is caused by a blockage of the small blood vessels in the foot that reduces the flow of blood and oxygen to the tissues.


Pulmonary bullae are focal regions of emphysema with no discenible wall which measure more than 1cm in diameter 1-2.

Below: Apical Bulla in rt lung


5. 67 yo male, post op rectal cancer, Bullae seen, COPD -emphysema, thickening in apex of lung – inflammation, checked lymph nodes:

Less than 1cm diameter = normal
If not, check with tomor marker to confirm

Below: Axial contrast-enhanced T1-weighted MRI study delineates nonspecific pleural thickening in the posterior right upper lung (orange arrow).

6. Emergency case, DWI to Dx acute Brain infarct, high intensity FLAIR, new infarct seen, but suggest due to shrinkage or edema, ON FLAIR: CSF is BLACK, Hemorrhage is white-old infarction (so don’t diagnose it wrong or your pt will get TPA which will cause more hemorrhage!)


7. 57 yo male, no info, he looked ok


8. 44 yo female, myoma in uterus, probably adenomyosis – same spectrum of Dx as with pts with Endometrial cysts – commonly seen (if you see bleeding in the ovary), over menstruation (Menorrhagia)

Adenomyosis (ad-uh-no-my-O-sis) occurs when endometrial tissue, which normally lines the uterus, exists within and grows into the muscular wall of the uterus.



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