Spotters Set 54 – Learning Radiology Cases 2

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Learning Radiology Cases 2

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  1. Post-traumatic pseudomeningocele
  2. Chondrosarcoma of the left iliac bone: Rings and arcs of classification are typical for chondrosarcoma. Here is the CT of the same patient: CT chondrosarcoma iliac bone.
  3. Right vestibular schwannoma
    • Typical ice-cream cone appearance due to the small intra-canalicular portion (cone) and a large portion in the cerebellopontine (CP) angle (the ice cream).
    • Vestibular schwannoma is the preferred term rather than acoustic schwannoma
    • The differentials for a CP angle tumor are:
      • Schwannoma (85-90% of cases)
      • Meningioma
      • Epidermoid
      • Arachnoid cyst
      • Metastasis
  4. Double duct sign – periampullary carcinoma. The primary lesion at the ampulla may not be seen on imaging. ERCP is the next best step.
  5. Pigmented villonodular synovitis (PVNS)
  6. Lipohemarthrosis secondary to trauma – fat blood interface.
  7. Ileo-ileal intussusception due to ileal lipoma as a lead point. The long segment intussusceptum is also causing mesenteric volvulus. Here is a video showing the volvulus: Axial and Coronal CT showing an Ileo-ileal intussusception due to ileal lipoma and resultant mesenteric volvulus
  8. Liposarcoma
  9. Necrotizing pneumonia
  10. Cyst with a mural nodule – Posterior fossa hemangioblastoma. Here are the differentials for this appearance:
    • Infratentorial
      • Pilocytic astrocytoma: Younger age group, Cyst wall may enhance.
      • Hemangioblastoma: Older age group, Cyst wall rarely enhances, cyst contents can be T1 hyperintense due to protein. Solid component is highly vascular, hence there may be flow voids along the periphery of the lesion. Associated with von-Hippel Lindau (vHL) syndrome. Screening of the spine is a must as in all posterior fossa tumors.
    • Supratentorial
      • Pleomorphic xanthoastrocytoma: Cortical lesion, often associated with meningeal enhancement / dural tail
      • Ganglioglioma: Cortical based mass with calcification.
      • Desmoplastic infantile ganglioglioma: Large cyst with cortical based solid component and thickening/enhancement of adjacent meninges.

Further reading and references:

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