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Spotters Set 55 – Interesting Radiology Cases 5

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Interesting Radiology Cases 5

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  1. Retroperitoneal lymphangioma. A differential would be an exophytic renal cyst but the lesion is separate from the kidney and just abutting it.
  2. Congenital cytomegalovirus CMV (TORCH group of infections)
    • TORCH group includes Toxoplasmosis, rubella, cytomegalovirus, and herpes. If syphilis is included, it is termed as TORCH(S).
    • Newer organisms included in the group are: Zika virus, Lymphocytic choriomeningitis virus (LCMV), human Parvovirus B19, human parechovirus, hepatitis B, VZV, tuberculosis, HIV, and the toxocariasis
    • The location and distribution of the calcifications may strongly suggest the specific infectious agent:
      • CMV: Periventricular calcifications, cysts, cortical clefts, polymicrogyria (PMG), schizencephaly, and white matter injury.
      • Zika virus: Severe microcephaly and calcifications at the gray matter-white matter junction.
      • Rubella and HSV: Lobar destruction, cystic encephalomalacia, and nonpatterned calcifications.
      • Congenital syphilis: Basilar meningitis, arterial strokes, and scattered dystrophic calcifications.
      • Congenital HIV: Basal ganglia calcification, atrophy, and aneurysmal arteriopathy
  3. Dandy-Walker malformation with hydrocephalus
  4. Intra-diploic meningocele.
    • Most common in the occipital bone.
    • Usually post-trauma.
    • Often asymptomatic.
    • Strong muscles around the occipital bone and the thickness of the bone prevent the development of a growing skull fracture
    • The main differential is an intra-diploic arachnoid cyst
  5. High-grade glioma/glioblastoma multiforme (GBM):
    • There has been a lot of research in the field of Glioma genomics to characterize tumors with individual mutations.
    • GBMs have now been divided into two types
      • GBM – IDH wild type
        • Arise de novo / primary GBM
        • Most common type.
        • Syndromes associated with GBM: Neurofibromatosis type 1 (NF1), Li-Fraumeni, and Turcot syndrome
        • Imaging: Thick, irregular, enhancing “rind” of tumor surrounding a necrotic core. Hemorrhage is common while calcification is rare.
        • Poorer prognosis.
      • GBM – IDH mutant type.
        • Develop from lower-grade astrocytomas hence, “Secondary” GBM
        • 5% of GBMs
        • Prediliction for frontal lobes
        • Necrosis is less common and there are often significant non-enhancing areas.
        • Better prognosis.
  6. Intra-bronchial (nail) foreign body with post-obstructive changes in the left lower lobe.
  7. Hemichorea- hemiballismus syndrome – Click to watch how these patient present
  8. Gastrointestinal stromal tumor (GIST). Observe that the lesion is closely associated with the bowel loops.
  9. Cerebral abscesses
  10.  Scleroderma (progressive systemic sclerosis)- Dilated esophagus with interstitial lung disease(ILD)
    • ILD is the leading cause of death in scleroderma patients.
    • Imaging features resemble non-specific interstitial pneumonia (NSIP) pattern: Ground glass opacities with superimposed fine reticulations and traction bronchiectasis.
    • Findings are peripheral, subpleural and affect lower lobes more.
    • Coronal luminal diameter of the esophagus can range from 12-40 mm (mean – 23mm) and can be used to differentiate from other diffuse lung diseases.

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