Spotters 12
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CM3 BEAKED TECTUM
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STRANGULATED FEMORAL HERNIA
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Epithelioid hemangioendothelioma. Unenhanced CT image (A) shows two peripheral hypoattenuating liver masses (M). The large right lobe mass represents coalescence of several smaller lesions that were present on prior examinations. Arterial (B), portal venous (C), and equilibrium phase (D) images demonstrate peripheral enhancement with gradual centripetal progression. Note the capsular retraction (arrows) associated with the masses and hypertrophy of the remaining normal hepatic parenchyma.
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Hematobilia. CT demonstrates high attenuation clot throughout the biliary system after a liver biopsy
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Shifting granuloma sign. (A) Pre and (B) post right lower lobe collapse.
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Primary sclerosing cholangitis. Endoscopic retrograde cholangiopancreatography shows multifocal strictures (arrows) involving the intrahepatic and extrahepatic biliary ducts.
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Ependymoma of the fourth ventricle. Sagittal gadolinium-enhanced T1W (A) and axial T2W (B) MRI. A heterogeneously enhancing mass (arrow) fills the lower half of the fourth ventricle and extends through the foramina of Lushka (arrowhead) and Magendie to lie posterior to the medulla oblongata and upper cervical spinal cord, which are compressed from behind. There is obstructive hydrocephalus.
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CYSTIC PERITONEAL IMPLANTS FROM PSEUDOMYXOMA PERITONEI..WITH CALCIFIED PERISPLENIC IMPLANTS..
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Thrombosed internal jugular vein. On the enhanced computed tomography image, the left internal jugular vein (arrow) fails to fill with contrast. The lumen is hypodense. Surrounding soft tissue planes are preserved, indicating a lack of radiologically evident inflammation. The tubular configuration of the lesion, established with several contiguous slices, confirms the diagnosis. Internal carotid arteries (C), right internal jugular vein (J).
Slide 5
Hematobilia. CT demonstrates high attenuation clot throughout the biliary system after a liver biopsy
Slide 6
Shifting granuloma sign. (A) Pre and (B) post right lower lobe collapse.
Slide 7
Primary sclerosing cholangitis. Endoscopic retrograde cholangiopancreatography shows multifocal strictures (arrows) involving the intrahepatic and extrahepatic biliary ducts.
Slide 8
Ependymoma of the fourth ventricle. Sagittal gadolinium-enhanced T1W (A) and axial T2W (B) MRI. A heterogeneously enhancing mass (arrow) fills the lower half of the fourth ventricle and extends through the foramina of Lushka (arrowhead) and Magendie to lie posterior to the medulla oblongata and upper cervical spinal cord, which are compressed from behind. There is obstructive hydrocephalus.
Slide 9
CYSTIC PERITONEAL IMPLANTS FROM PSEUDOMYXOMA PERITONEI..WITH CALCIFIED PERISPLENIC IMPLANTS..
Slide 10
Thrombosed internal jugular vein. On the enhanced computed tomography image, the left internal jugular vein (arrow) fails to fill with contrast. The lumen is hypodense. Surrounding soft tissue planes are preserved, indicating a lack of radiologically evident inflammation. The tubular configuration of the lesion, established with several contiguous slices, confirms the diagnosis. Internal carotid arteries (C), right internal jugular vein (J).
Slide 11
(A) Bennett's fracture-dislocation of the base of the thumb. Note that the oblique fracture extends into the joint. Note also the radial and proximal displacement of the metacarpal shaft, due to contraction of the abductor pollicis longus. Extra-articular fracture (arrow, B) generally does not require surgical fixation
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Fetal origin of the posterior cerebral artery. A 3D TOF MRA of the circle of Willis shows a fetal origin of the left posterior cerebral artery (arrow), which arises from the left internal carotid artery and is associated with hypoplasia of the left P1 segment.
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Scimitar syndrome. A, B: Lung window images at the bases demonstrating the right lower lobe pulmonary vein (arrows) draining caudally into an enlarged subdiaphragmatic inferior vena cava (C) on image. C: Note right ventricular (RV) volume overload.
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Cerebellar pilocytic astrocytoma. Axial T1W post-gadolinium MRI. There is a cystic lesion in the cerebellum with a small, enhancing mural nodule but otherwise nonenhancing cyst wall. The fourth ventricle is compressed causing hydrocephalus (note enlargement of the temporal horns). The differential diagnosis of this lesion is a cerebellar haemangioblastoma.
Slide 15
Porcelain gallbladder. A: Contrast-enhanced computed tomography (CT) shows extensive calcification in the wall of a contracted gallbladder. When it is this diffuse, the wall calcification may be difficult to differentiate from cholelithiasis. B: CT image of another patient demonstrates discontinuous mural calcification.
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Central neurocytoma. Axial proton density (A) and coronal T1W post-gadolinium (B) MRI. A partly cystic, multi-septated, enhancing mass, which is related to the septum pellucidum, fills the bodies of both lateral ventricles and causes hydrocephalus with dilatation of the left temporal horn
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Secondary hemochromatosis. Iron deposition in the reticuloendothelial system has caused loss of signal in both liver and spleen on this T1-weighted magnetic resonance image (repetition time, 140 ms; echo time, 4 ms; flip angle, 80 degrees).
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Subfrontal meningioma. CT before (A) and after (B) IV contrast medium, and lateral projection of common carotid arteriogram (C). There is a large circumscribed mass in the anterior cranial fossa that is isodense to normal grey matter, contains foci of calcification centrally and enhances homogeneously. There is oedema in the white matter of both frontal lobes and posterior displacement and splaying of the frontal horns of the lateral ventricles. On the arteriogram (C) the mass is delineated by a tumour blush and there is posterior displacement of the anterior cerebral arteries (arrowhead), mirroring the mass effect seen on CT. The ophthalmic artery is enlarged as its ethmoidal branches supply the tumour (arrow).
Slide 19
Autoimmune pancreatitis in a 27-year-old woman with autoimmune hepatitis. A: Pre-intravenous contrast 5-mm image demonstrates global enlargement of the pancreas. B: Portal venous phase 5-mm computed tomography image demonstrates homogeneous enhancement with several large vascular channels seen in the grossly enlarged pancreas. C: Diffuse enlargement included the pancreatic head, which is smooth in contour, normal and homogeneous in attenuation, and without evidence of ductal dilatation. No low attenuation peripheral capsule is seen, as has been reported in some patients with autoimmune pancreatitis. Note incidental jejunal intussusception (*).
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TOF
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Cystic vestibular schawannoma. T2W image reveals a large right cerebellopontine angle tumour with a medial cystic component. The mass extends into and expands the internal auditory meatus and distorts the right middle cerebellar peduncle.
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A 31-year-old patient with Kartagener syndrome. A: Note situs inversus totalis, extensive bronchiectatic changes (black arrow) in right lower lobe as well as a bronchiolectasis (white arrows) in the left base on B.
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Suprasellar dermoid tumours. CT (A). There is a midline, fat density tumour (arrowheads) occupying the suprsasellar region. (B) Coronal T1W MRI of a different patient with a ruptured dermoid tumour. There is a lobulated high signal mass in the chiasmatic cistern compressing and displacing the optic chiasm to the left (arrow). Fat globules, which have spilled into the subarachnoid space, are seen as high signal foci in the left Sylvian fissure. The patient has had previous surgery via a right temporal approach, causing right temporal atrophy and enlargement of the right temporal horn.
Slide 24
Post pancreatitis splenic artery pseudoaneurysm. A: Well-circumscribed, ovoid, 4 × 2 cm structure is seen anterior to the body of the pancreas on precontrast computed tomography (CT). The curvilinear high density within the right aspect of the lesion represents fresh clot. B: Contrast-enhanced CT through the same level demonstrates enhancement of blood within the lumen of the pseudoaneurysm, surrounded by clot.
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Right aortic arch with aberrant left subclavian artery (arrow) is depicted on this magnetic resonance angiographic image.
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Clivus chordoma. Axial T2W (A), coronal T1W (B) and sagittal T1W post-gadolinium (C) MRI. A large mass has destroyed the clivus and extends superiorly compressing the midbrain and hypothalamus. It invades the right cavernous sinus, encasing the internal carotid artery, and extends into the nasopharyngeal soft tissues, posterior ethmoid air cells and optic canals. Tumour also projects into the pontine cistern but appears restrained by dura. The mass returns mixed signal and there is irregular enhancement following contrast injection.
Slide 27
Ruptured hepatocellular adenoma. Precontrast CT image (A) shows a large heterogeneous mass (arrows) near the dome of the liver. Central areas of hyperintensity represent hemorrhage. Note the high attenuation perihepatic blood (arrowheads). Contrast-enhanced image (B) shows enhancement of the peripheral intact portion of the mass (open arrows). The hemorrhagic portion of the mass does not enhance. Note loss of integrity of the liver capsule anterolaterally. Coronal volume-rendered image (C) shows the peripherally enhancing mass, ruptured liver capsule, and perihepatic blood (arrowheads).
Slide 28
Glomus jugulare tumour. An axial CT (A) demonstrates expansion of the right jugular foramen and bone destruction in the adjacent petrous bone by a mass that is markedly enhancing on axial T1W post-contrast images (B). The mass contains areas of flow voids, corresponding to the dilated tumour vessels seen on the right external carotid artery angiogram (C).
Slide 29
Pituitary apoplexy due to haemorrhage into a pituitary macroadenoma. Coronal (A) and sagittal (B) T1W images demonstrate a hyperintense area at the superior aspect of the tumour that contains a fluid level and it is consistent with a recent intratumoural haemorrhage. The optic chiasm is stretched across the apex of the mass.
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Benign teratoma. A large, well-circumscribed, heterogeneous mass containing low-density fluid, calcifications, and fat occupies most of the left hemithorax. The mass displaces but does not invade vascular structures. Pathologic examination showed a benign cystic teratoma, which contained sebaceous fluid, a small amount of fat, and embryonic teeth.
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Hepatic angiomyolipoma. Contrast-enhanced CT image shows a heterogeneously enhancing hepatic mass that contains foci of macroscopic fat (arrow).
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Craniopharyngioma. CT following IV contrast medium. There is a partly calcified, partly cystic lesion in the suprasellar region. There is inhomogenous enhancement of the solid tumour components.
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Pulmonary alveolar proteinosis, 15-year-old girl with shortness of breath. High-resolution computed tomography through the lung bases shows extensive ground-glass opacity and interstitial thickening, creating a “crazy paving†appearance
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Hepatocellular carcinoma. Arterial phase CT image (A) shows a well-defined hyperattenuating mass (arrow) in segment VII of the liver. On the portal venous phase image (B) the mass has become isoattenuating and is no longer identified.
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Suprasellar meningioma. Sagittal T1W post-gadolinium MRI. A lobulated, enhancing suprasellar mass arises from the region of the tuberculum sellae and extends down into the pituitary fossa displacing the pituitary stalk posteriorly. Enhancing dural ‘tails’ (arrowheads) can be seen extending over the planum sphenoidale and clivus.
Suprasellar meningioma. Sagittal T1W post-gadolinium MRI. A lobulated, enhancing suprasellar mass arises from the region of the tuberculum sellae and extends down into the pituitary fossa displacing the pituitary stalk posteriorly. Enhancing dural ‘tails’ (arrowheads) can be seen extending over the planum sphenoidale and clivus.
Slide 36
Azygos continuation of inferior vena cava. A: Computed tomography scan at the level of the distal aorta (A) shows a markedly dilated azygos vein (arrow). B: A dilated azygos vein (arrow) is noted at the level of the liver. The inferior vena cava is absent.
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PERTHES DISEASE
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Sylvian ‘dot’ sign. (A) CT shows dense MCA branch due to occlusive acute thrombus (short arrow). There is very subtle loss of grey-white differentiation between the insular cortex and lateral border of putamen posteriorly (arrowhead), whereas more anteriorly it is preserved (long arrow). (B) DWI confirms a small acute cortical infarct adjacent to the thrombosed vessel.
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Congenital lobar emphysema, 6-month-old boy. Computed tomography through the upper thorax shows a hyperinflated left upper lobe with attenuated vascularity.
Slide 40
Top of the basilar’ syndrome. T2-weighted MRI shows multiple infarcts in the basilar and posterior cerebral artery territories including the left thalamus (A), both occipital lobes (B), and cerebellar hemispheres (C). Note the absence of flow void in the distal basilar artery in B (arrow).
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Multilocular cystic nephroma in a 4-year-old boy. Contrast-enhanced computed tomography scan shows a low-attenuation mass containing several enhancing septations in the upper pole of the left kidney.