موقع د. كمال سيد الدراوي طبي_ اكاديمي _ ثقافي _ تعليمي _ _ استشارات طبية_فيديو طبي |
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د.كمال سيد Admin
عدد المساهمات : 2471 نقاط : 4259 السٌّمعَة : 9 الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950 تاريخ التسجيل : 30/07/2012 العمر : 74 الموقع : السودان - سنار العمل/الترفيه : طبيب عمومى وموجات صوتية الساعة الان : دعائي :
| موضوع: Facebook Radiology الثلاثاء أبريل 30, 2019 9:55 pm | |
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| | | د.كمال سيد Admin
عدد المساهمات : 2471 نقاط : 4259 السٌّمعَة : 9 الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950 تاريخ التسجيل : 30/07/2012 العمر : 74 الموقع : السودان - سنار العمل/الترفيه : طبيب عمومى وموجات صوتية الساعة الان : دعائي :
| موضوع: رد: Facebook Radiology الثلاثاء أبريل 30, 2019 9:57 pm | |
| [rtl][/rtl]
What is the most likely diagnosis?
23year-old male with stabbing pain after being stabbed
Pulmonary Contusion Tension Pneumothorax Laceration of the Lung Eosinophilic Granuloma Simple Pneumothorax
Answer:
2. Tension Pneumothorax
Pneumothorax Tension Pneumothorax
Presence of air in the pleural space
The above film shows a right sided tension pneumothorax with right sided lucency and leftward mediastinal shift. This is a medical emergency. Failure to place a right chest tube immediately could allow venous return to diminish and lead to possible death. [rtl]https://www.med-ed.virginia.edu/courses ... chest.html[/rtl]
Anatomy
Visceral pleura is adherent to lung surface There is no air in the pleural space normally The introduction of air into the pleural space separates the visceral from the parietal pleura In contradistinction, the visceral and parietal pleura usually do not separate from each other in obstructive atelectasis
Pathophysiology
Either from disruption of visceral pleura Or, trauma to parietal pleura
Clinical findings
Acute onset of Pleuritic chest pain (Dyspnea (in 80-90% Cough Back or shoulder pain
Etiologies
Penetrating trauma Blunt trauma May be due to rib fracture May be caused by increased intrathoracic pressure May lead to bronchial rupture “Fallen lung sign” (ptotic lung sign) -- hilum of lung is below expected level within chest cavity Persistent pneumothorax with functioning chest tube Iatrogenic Tracheostomy Central venous catheter attempt or insertion Mechanical ventilation May occur in up to 25% of patients maintained on PEEP May be bilateral or under tension Thoracic irradiation
************ A pneumothorax is defined as air inside the thoracic cavity but outside the lung. A spontaneous pneumothorax (PTX) is one that occurs without an obvious inciting incident. Some causes of spontaneous PTX are; idiopathic, asthma, COPD, pulmonary infection, neoplasm, Marfan's syndrome, and smoking cocaine. However, most pneumothoraces are iatrogenic and caused by a physician during surgery or central line placement. Trauma, such as a motor vehicle accident is another important cause. : A tension PTX is a type of PTX in which air@ enters the pleural cavity and is @ trapped during expiration usually by some type of ball valve-like mechanism. This leads to a @ buildup of air increasing intrathoracic pressure. Eventually the pressure buildup is large enough to @ collapse the lung and @ shift the mediastinum away from the tension PTX. If it continues, it can @ compromise venous filling of the heart and even death.
[rtl]https://www.med-ed.virginia.edu/courses ... chest.html[/rtl] | |
| | | د.كمال سيد Admin
عدد المساهمات : 2471 نقاط : 4259 السٌّمعَة : 9 الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950 تاريخ التسجيل : 30/07/2012 العمر : 74 الموقع : السودان - سنار العمل/الترفيه : طبيب عمومى وموجات صوتية الساعة الان : دعائي :
| موضوع: رد: Facebook Radiology الثلاثاء أبريل 30, 2019 9:57 pm | |
| [rtl][/rtl]
Spontaneous pneumothorax
Most common etiology is Rupture of subpleural blebs in apical region of lung Age 20-40 years Left is a supine view of a PTX, note the medial position of the air. Right is an image demonstrating the deep sulcus sign (letter D in the image) in supine views of a PTX. M:F = 8:1 Especially in patients who are tall and thin Smokers
Left is a supine view of a PTX, note the medial position of the air. Right is an image demonstrating the deep sulcus sign (letter D in the image) in supine views of a PTX. Red arrows point to thin white visceral pleural line which is the single best sign for a pneumothorax
Prognosis
Recurrence in 30% on same side Recurrence in 10% on contralateral side
Treatment
(Simple aspiration (success in >50% (Tube thoracostomy (effective in 90%
Other causes of a pneumothorax
Neonatal disease Meconium aspiration Respirator therapy for hyaline membrane disease Malignancy Primary lung cancer Lung metastases, especially from osteosarcoma Also pancreas, adrenal, Wilms tumor Pulmonary infections Tuberculosis Necrotizing pneumonia Coccidioidomycosis Hydatid disease Pertussis Acute bacterial pneumonia Staphylococcal septicemia (AIDS (Pneumocystis carinii, Mycobacterium tuberculosis, atypical mycobacteria Complication of pulmonary fibrosis Histiocytosis X Idiopathic Cystic fibrosis Sarcoidosis Scleroderma Eosinophilic granuloma Interstitial pneumonitis Rheumatoid lung Idiopathic pulmonary hemosiderosis Pulmonary alveolar proteinosis Biliary cirrhosis Asthma or emphysema Produce a second peak incidence of pneumothorax from 45-65 years of age Due to rupture of peripheral emphysematous areas “Catamenial pneumothorax” is a recurrent spontaneous pneumothorax that occurs during menstruation and is associated with endometriosis of the diaphragm R >> L Marfan’s syndrome Ehlers-Danlos syndrome Pulmonary infarction Lymphangiomyomatosis and tuberous sclerosis
On CXR, a PTX appears as air without lung markings in the least dependant part of the chest. Generally, the air is found peripheral to the white line of the pleura. In an upright film this is most likely seen in the apices. A PTX is best demonstrated by an expiration film. It can be difficult to see when the patient is in a supine position. In this position, air rises to the medial aspect of the lung and may be seen as a lucency along the mediastinum. It may also collect in the inferior sulci causing a deep sulcus sign.
يتبع | |
| | | د.كمال سيد Admin
عدد المساهمات : 2471 نقاط : 4259 السٌّمعَة : 9 الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950 تاريخ التسجيل : 30/07/2012 العمر : 74 الموقع : السودان - سنار العمل/الترفيه : طبيب عمومى وموجات صوتية الساعة الان : دعائي :
| موضوع: رد: Facebook Radiology الثلاثاء أبريل 30, 2019 10:00 pm | |
| Types of pneumothorax 1- Closed pneumothorax = intact thoracic cage Open pneumothorax = "sucking" chest wound - 2Tension pneumothorax - 3Accumulation of air within pleural space due to free ingress and limited egress of airPathophysiology:Intrapleural pressure exceeds atmospheric pressure in lung during expiration (check-valve mechanism)FrequencyIn 3-5% of patients with spontaneous pneumothorax(Higher in barotrauma (mechanical ventilation Imaging findings in pneumothoraxMust see the visceral pleural white lineVery thin white line that differs from a skin fold by its thicknessAbsence of lung markings distal or peripheral to the visceral pleural white lineNot evidence enough to say there is a pneumothorax only if there are no lung markings seenNo lung markings will be seen with bullous diseaseBullae have a concave surface facing the chest wallPneumothorax almost always has a convex surface facing the chest wallDisplacement of mediastinum and/or anterior junction lineDeep sulcus signOn frontal view, larger lateral costodiaphragmatic recess than on opposite sideDiaphragm may be inverted on side with deep sulcusTotal / subtotal lung collapseThis is passive or compressive atelectasisCollapse of SVC or IVC due to decreased systemic venous return and decreased cardiac outputTension hydropneumothoraxSharp delineation of visceral pleural by dense pleural spaceMediastinal shift to opposite sideAir-fluid level in pleural space on erect chest radiographRadiographic signs in upright positionWhite margin of visceral pleura separated from parietal pleuraUsually seen in the apex of the lungAbsence of vascular markings beyond visceral pleural marginMay be accentuated by an expiratory film in which lung volume is reduced while amount of air in pneumothorax remains constant so that relative size of pneumothorax appears to increaseRadiographic signs in supine positionAnteromedial pneumothorax (earliest location)Outline of medial diaphragm under cardiac silhouetteDeep sulcus signDecubitus views of the chest may demonstrate a pneumothorax on the side that is non-dependentLeft lateral decubitus view for right-sided pneumothoraxRight lateral decubitus view for left-sided pneumothoraxيتبع | |
| | | د.كمال سيد Admin
عدد المساهمات : 2471 نقاط : 4259 السٌّمعَة : 9 الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950 تاريخ التسجيل : 30/07/2012 العمر : 74 الموقع : السودان - سنار العمل/الترفيه : طبيب عمومى وموجات صوتية الساعة الان : دعائي :
| موضوع: رد: Facebook Radiology الثلاثاء أبريل 30, 2019 10:05 pm | |
| Newborn with cyanosis. What's the diagnosis?
Ebstein’s Anomaly
Rare
POSTERIOR and SEPTAL cusps of tricuspid valve are displaced into the Right ventricle which makes Right ventricle smaller
o- Combined with tricuspid insufficiency or sometime tricuspid stenosis, the Right Atrial pressure is elevated producing a R to L shunt through the foramen ovale
o- Pulmonary vasculature is usually diminished
o- In those with large atrial septal defects, the pulmonary vasculature may appear prominent
o- There is an atrialized portion of the right ventricle between the AV groove and the tricuspid valve
o- The right ventricle and right atrium dilate
o The right heart border becomes prominent
· Think of Ebstein’s anomaly if:
o Pulmonary flow is decreased
o Cyanosis is present in the neonate
o One of the few conditions to produce cardiomegaly in the first few days of life
learningradiology.com | |
| | | د.كمال سيد Admin
عدد المساهمات : 2471 نقاط : 4259 السٌّمعَة : 9 الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950 تاريخ التسجيل : 30/07/2012 العمر : 74 الموقع : السودان - سنار العمل/الترفيه : طبيب عمومى وموجات صوتية الساعة الان : دعائي :
| موضوع: رد: Facebook Radiology الثلاثاء أبريل 30, 2019 10:15 pm | |
| Hemangioma of the Spine
Case of the Week 587 is a 67 year-old complaining of low back pain who has an incidental finding on a lumbar spine series. Hemangioma of the Spine. (Top) Close-up lateral radiograph of the lower lumbar spine shows the classical coarse linear striation in the body of L4 (white circle). (Bottom) An axial CT scan image of the lower abdomen demonstrates a vertebral body with a very prominent trabecular pattern characteristic of the corduroy or polka-dot appearance of a hemangioma of the spine (yellow circle). The cortex is not thickened and the surrounding soft tissues are normal. For these same photos without the arrows, click here and here For more information, click on the link if you see this icon
What's the diagnosis?
The correct answer is at: [rtl]http://bit.ly/18ffU0O[/rtl]
General Considerations
Benign
Most often located in lower thoracic, upper lumbar spine Skull is second most common location (spoke-wheel appearance) Mostly asymptomatic More frequent in females Peak incidence in 40’s Multiple in up to 1/3 of cases Most often occur in the medullary cavity of bone Microscopically, there is hamartomatous proliferation of vascular tissue Classified as to cavernous, capillary, arteriovenous and venous Spine hemangiomas are usually capillary type; skull are cavernous
Clinical Findings
Usually asymptomatic Very slow growing No known malignant potential Over 40, patients may present with pain from compression fracture
Imaging Findings
Conventional radiography is usually the first means of imaging hemangiomas Prominent trabecular pattern from resorption of trabeculae by enlarged vascular channels produces Vertical striations Overall density of vertebral body is increased Cortex is not thickened and vertebral body is not increased in size Small hemangiomas will not be visible on conventional radiographs
CT Corduroy (aka accordion, honeycomb, polka-dot) spine from coarse trabeculae seen in cross section Thickened vertebral trabeculae produce a polka-dot appearance Bone destruction and soft tissue extension may be present but are rare
MRI Allows for diagnosis of soft-tissue extension Increased signal intensity on both T1 (high fate content) and T2 (increased vascularity) Nuclear medicine Usually normal uptake on bone scan
Differential Diagnosis
Paget disease Metastases Lymphoma Multiple myeloma
Treatment
Observation Treatment is instituted only if they are symptomatic and may include Vascular embolization prior to surgery Surgical excision Vertebroplasty Ethanol injection
Complications
Pathologic fracture Hemorrhage, when it occurs, is usually iatrogenic Thrombosis Displacement of adjacent nerves producing pain
[url=http://www.learningradiology.com/archives2013/COW 587-Hemangioma Spine/hemangiomacorrect.html][rtl]http://www.learningradiology.com/archiv ... rrect.html[/rtl][/url] | |
| | | د.كمال سيد Admin
عدد المساهمات : 2471 نقاط : 4259 السٌّمعَة : 9 الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950 تاريخ التسجيل : 30/07/2012 العمر : 74 الموقع : السودان - سنار العمل/الترفيه : طبيب عمومى وموجات صوتية الساعة الان : دعائي :
| موضوع: رد: Facebook Radiology الثلاثاء أبريل 30, 2019 10:25 pm | |
| (Young heavy smoker with no leg pulse. Why? (hint: not atherosclerosis تم تحجيم الصورة إلى : 92 % من الحجم الطبيعي لها [ 539 x 595 ]ANSWER: [rtl]http://goo.gl/W61lA5[/rtl]
Buerger disease
Case contributed by: Dr G Balachandran
Presentation: 40 years old male was referred for evaluation of intermittent claudication in left lower limb.He was a chronic,heavy smoker.
Patient Data: Age: 40 Gender: Male Modality: CT
CTA shows total obstruction at left external iliac artery ,femoral.popliteal arteries.
Normal right side lower limb arteries.
Case Discussion:
Buerger disease is an obliterative arteritis found predominantly in heavy smokers. It most commonly affects medium and small vessels of the lower extremities.
VRs allow visualization of complex, overlapping arterial channels without the need for preliminary bone removal, providing an excellent overview of the complex anatomy.
Peripheral CTA provides complete delineation of both the femoropopliteal segment and inflow and outflow arteries, including lesion number, length, stenosis diameter and morphology, adjacent normal arterial caliber, degree of calcification, and status of distal runoff vessels. These findings help in planning the procedure with respect to route of access, balloon selection, and expected long-term patency after femoropopliteal intervention. Compared with catheter angiography, peripheral CTA provides better estimates of the effects of eccentric stenoses on luminal diameter reduction . In addition, collateral vessels can be evaluated with MIP and VR images, and arterial segments distal to long-segment occlusions are well visualized peripheral CTA is more cost effective than digital subtraction angiog-raphy (DSA) for preprocedure evaluation of patients with claudication
[rtl]http://radiopaedia.org/cases/buerger-disease[/rtl] | |
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