Radiology Grand Rounds-III

Welcome to the Third Edition of the monthly summary of the best in the Radiology Blogsosphere known as “ Radiology Grand Rounds”. Grand Rounds is an old tradition that doctors have. Once a week, they get together and talk about one case in detail. Keeping up with this tradition this Carnival of Medical Imaging has been named “Radiology Grand Rounds”. Every physician would agree that Subspecializtion is the need of the hour in medical field, hence the concept of a specialized Radiology Grand Rounds. Radiology Grand Rounds will be hosted on last Sunday of each month, the schedule and archive will be available at- Radiology Grand Rounds. I would like to thank all the contributors for this edition of Radiology Grand Rounds.

Theme For this weeks’ Radiology Grand Rounds is a Magazine, all of us medical men are used to the Scientific Radiology Periodicals so I thought "Radiology Grand Rounds" would be more entertaining if featured like a Magazine.

CASE FILES

Col(Retd) MGK Murthy from Department of Radiology, NIMHNAS Delhi has sent a very interesting MR image.

"17 yr old boy with severe headache for some weeks duration. A solitary hyperintense structure in frontoparietal region right side probably vein of tolard is noted. This is suggestive of cortical venous thrombosis and it may or may not be bright on diffusion depending on the duration. Superior Sagittal sinus is normal. No haemorrhage is seen. It needs hypercoagulable state work up and anticoagulants. It is expected to clear in about 6 weeks post treatment MRI. Any feedback about this case is welcome here- drmgkmurthy@gmail.com"

Bhavin in his site Spot Diagnosis features a Radiological Sign “The Fallen Fragment Sign”

“One of the complications of a simple bone cyst is fracture. The fracture is often transverse and one sign that is touted is the "fallen fragment sign", due to fragments of bone that are seen in the dependent portion on erect images usually in the inferior aspect of the cyst.”


Scan Man presents describes two cases of ectopic pregnancy with detailed account of their sonographic findings.Medline Plus, the online medical encyclopedia defines an ectopic pregnancy as one that occurs when a fertilized egg implants in tissue outside of the uterus, and the placenta and fetus begin to develop there. The most common site is within a fallopian tube. In a typical ectopic pregnancy, the fertilized ovum (embryo) implants in the lining of the fallopian tube. As it grows, it stretches the fallopian tube and causes pain. If it is not detected early and treated, the growing gestational sac bursts through the fallopian tube causing massive internal bleeding and hypovolemic shock. This makes ruptured ectopic the leading cause of maternal death in the first trimester of pregnancy. Ultrasound Findings- On the abdominal ultrasound, I found what looked like an organized blood clot in the rectovaginal pouch. This was confirmed on transvaginal ultrasound. There was approximately 250 to 300 cc of clotted blood in the rectovaginal pouch. Additionally, the left adnexa showed an irregular ectopic gestational sac of about 6 weeks size with a yolk sac inside.

THOUGHT PROVOKING POSTS

Sumer’s Radiology Site points to newspaper reports on harmful effects of Ultrasound on mice brain and asks-Is Medical Imaging entirely safe?

This is somehing i read in the newspaper today morning!! I hope Tom Cruise read this too, although ultrasound is a very safe investigation too much of everything can be harmful...This study should discourage recreational ultrasound use...Ultrasound affects brain in foetus
"Ultrasound disrupts the brain development of unborn mice, researchers said in a study published on Monday that adds to growing evidence that too many ultrasound scans could also affect human foetuses. Prolonged ultrasound scans of the brains of fetal mice interfered with a process known as neuronal migration in which neurons move from one place to another, the team at Yale University in Connecticut reported.


Tales from The womb points to an article in Last week's New England Journal had a very fine manuscript demonstrating that MRI is now the best method of predicting neurodevelopmental insult in premature infants. Neonatal MRI to Predict Neurodevelopmental Outcomes in Preterm Infants.
“Fortunately or unfortunately, this has the possibility of replacing cranial ultrasound overnight as the discharge screen of choice for determining the type of developmental follow up premature infants need. Ultrasounds cost hundreds of dollars; MRIs cost triple to quadruple as much. On the one hand, if it allows us to focus diminishing out-patient resources on the ones who need it most - fantastic. On the other, if we are paying out more to screen all these infants (and remember that one in every eight infants is born premature) then just what kind of cost savings do we think we'll get out of this (versus sending a few more patients to out patient followup visits and doing serial developmental exams)?”

Scan Man Points to an extremely useful article by Dr. John R. Wilcox, M.D., titled ‘The Written Radiology Report‘ in the July edition of Applied Radiology Online. The purpose of the article is to help radiologists improve the quality of their written radiology reports by reviewing the components of a report, addressing grammar and writing style, and considering appropriate standardization.
“Part of the problem with radiology reports arises because we do not really understand how important this document has become to the nonradiologist caregiver. This lapse is more understandable when you realize that most major radiology textbooks do not address the subject of report composition. This would be equivalent to a journalism textbook without a chapter on how to write an article. But journalism and radiology have a lot in common. Both professions require spending a great deal of time gathering “facts” and “data” and then reporting that material in written form for a reader.”

Marian Pop sends us a story on a case of suspected Battered baby. Full story in Romanian is here. English translation-

"Ancuta is 1.3 years old.She is scared and stressed, especially because she doesn't know what'sgoing to happen to her.She's in for a shoulder radiography. And she doesn't want to stay there byherself. And if anyone touches her, she starts crying.Actually her name is not Ancuta. I call her that way because today names doesn't matter.When we have to "make a photo" of a small child the mother or the otherparent enters with her, receive an leaded coat and try to hold the childstill for a second, just enough for us to shoot. Otherwise we'll just irradiate the child and mother for no reason.Ancuta doesn't want to stay. Neither stories nor games won't make her staystill. When she's about to lye down she starts crying and try to get up.The mother can't hold her still.One of the nurses gets into the X-ray room. He's in the early 30's andhe's done this times and again. He ain't scared of 3 more gamma rays. Ihope. He enters and helps the mother to hold the child still. And togetherthey hardly make her stay still.Quick- exposure. And in the exact moment we exposed everyone moves, makingour efforts in vain. We caught just a small part of the humerus and thenurse's hand. We must repeat it, there's no other way. And all this whileAncuta cries her heart out, the mother is already on the edge of breaking"what are you doing to my child...?" and everyone is tensed.30 seconds later we see the image- mistery solved: clavicle fracture, witha humerus dislocation. We stay and look at the monitor with an absentmind.For a while before my eyes pass all the Caffey pages regarding the XTrauma syndrome (or how is it's name). Battered child syndrome. I'm scaredand ashamed to look in mother's eyes. I don't know what to say. Did shefell? Did she hit into something? Is it an too energetic child and someonetried an "correction"?I don't have the time to ask. Ancuta has calmed down, the mother take herout on the corridor and leaves towards the referring physician. We sendthe images thought the internal network. The next patient is alreadyundressed and positioned. In 5 minutes everything will become history..I get up and light a cigarette. I know, they're bad for my health, butthey calm me.I'm still moved by what i just saw. Maybe there will be a socialinvestigation, maybe everything was just in my imagination.I throw the cigarette, I'm already late. The patients are waiting.But, still...., how will Ancuta sleep tonight?"

INFORMATION FILES

Jon Mikel of Unbounded Medicine presents a patient handout of NEC ( Necrotizing enterociloitis) with a classic abdominal plain film. Radiographic findings in NEC-Marked abdominal distention, dilated loops, pneumatosis intestinalis (bubbles of gas in bowel’s wall) and/or free intraabdominal air.


UNUSUAL RADIOLOGY

Mikhail Serebrennik of Filmjacket.com presents an abdominal Radiograph of a 58 y.o. mentally challenged female with abdominal pain.

The Radiographs and CT images are must see, it shows needles, needles and needles everywhere!!



This one is must watch for all, this post by dogscatskidslife showing an usual finding in a Cat’s Ultrasound.
“A 2 1/2 year old neutered male cat was sent to us for an ultrasound a while back. The doctor who sent it said that the cat had FLUTD (feline lower urinary tract disease). He had been treating this cat for many months and didn't feel like any progress was being made. So he was wanting an ultrasound to see if there could be stones in the bladder that were not showing up on radiographs (x-rays).I did a complete ultrasound on the cat which was normal, until I got to the urinary bladder. I had located a foreign body that was linear in appearance. "What is that?"After a few minutes, I had determined that I had found a urinary catheter inside of the cat's bladder.”

RADIOLOGICAL QUIZ

Aleksandr Kavokin MD, PhD of RDoctor Medical Portal presents a RADIOLOGY QUIZ. So, click here to-
Test your knowledge of Radiology.


Mikhail Serebrennik of Filmjacket.com presents a 57 y.o. male, no history provided. Can you make a diagnosis?



That wraps up this month's highlights of the Radiology blogosphere. Hope the readers enjoyed the third edition of the Radiology Grand Rounds. If you liked any of these blogs, keep visiting them. Please email me at sumerdoc@yahoo.com if you are interested in hosting future Radiology Grand Rounds. Archive for the Radiology Grand Rounds here-Radiology Grand Rounds.
For More updates on Radiology Grand Rounds A new discussion Group
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Group name: Radiology Grand Rounds
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Group email address radgrandrounds@googlegroups.comBe sure to tune in Next Month Last Sunday 24th September, when Grand Rounds
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dr.scanman@yahoo.co.in