Spotters Set 56 – Classic Radiology Cases 2

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Classic Radiology Cases 5

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  1. Spinal epidural lipomatosis:  “stellate” or “Y“ sign on axial sections due to fat compressing the nerve roots at lumbar levels. Dura fat ratio can be used for grading:
    • Normal     (Grade 0): Dura/fat ratio: 1.5
    • Mild          (Grade 1):  Dura/fat ratio: 1.0-1.5
    • Moderate (Grade 2): Dura/fat ratio: 0.34-1.0
    • Severe      (Grade 3):  Dura/fat ratio: 0.33 or less
  2. Right frontal oligodendroglioma.
  3. État criblé AKA status cribrosum, diffusely widened symmetrical perivascular spaces (Virchow-Robin spaces) in the basal ganglia. État lacunaire is a term used for multiple lacunar infarcts.
  4. Pontine capillary telangiectasia: Subtle enhancement involving the pons without correlate on non-contrast sequences.
  5. Prostatic abscess
  6. Bartholin’s gland cyst: Associated with labia majora.
    • Gartner ducts cysts are higher up (above pubic symphysis) and are associated with VaGina.
    • Nabothian cysts: Located higher up in the cervix.
    • Skene duct cyst: More anteriorly and closer to the external urethral meatus.
    • Urethral diverticulum: Closer to the urethra and may show communication with it.
  7. Thickened prevertebral soft tissue. Here is the CT of the same patient showing odontoid fracture. Criteria for widened prevertebral space:
  8. Hydatid cyst with peripheral calcification. Also incidental note of azygous lobe. Make sure that you mention ALL findings in a case.
    • WHO classification is ONLY for the classifying liver hydatids.
    • Here are named signs for hydatid disease in lung Ref: Radiology Review Manual - Dahnert:
      • “Meniscus sign”, “double arch sign,” “moon sign,” “crescent sign” =thin radiolucent crescent in the uppermost part of cyst (due to rupture of pericyst with air dissecting between pericyst +laminated membrane)
      • Air-fluid level = rupture of all cyst walls with air entering the endocyst
      • Cumbo sign = air-fluid level inside endocyst+ air between pericyst and endocyst with an “onion peel” appearance
      • Serpent sign= collapsed membranes inside cyst outlined by air (after expectoration of cyst contents)
      • “Water lily sign,” “sign of the camalote” = completely collapsed crumpled cyst membrane floating on the cyst fluid
      • Mass within cavity =crumpled membranes fall to the most dependent portion of cavity after complete expectoration of cyst fluid.
  9. Pseudomyxoma peritonei due to ovarian masses. In male patients and female patients with normal with ovaries, pseudomyxoma peritonei, look for the appendix carefully. It is caused due by mucinous neoplasms so the common causes are mucinous tumors or ovaries and appendix.
  10. Left frontal oligodendroglioma.  (One set can have two cases of the same pathology! ).

Further reading and references:

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