Sumer's Radiology Site

Primary Bone Lymphoma

2008-07-06T16:06:00.001+05:30

This is case which was previously MRI to be infective, ATT started and no response was noted and lesions increased subesequently. It was not thought to be AVN as head has not collapsed. Acetabulum is normal. There is fluid along with soft tissue invasion and no periosteal response. All point to primary bone lymphoma -femur common site

Primary bone lymphoma is defined as a tumor involving a single focus with unequivocal evidence of lymphoma in the bone lesion. It is rare. Most cases are of the diffuse large B-cell category. The age distribution is bimodal with peaks in the second to third decade, and a second peak in the fifth to sixth decade with women more commonly affected in the older age group. There is a wide pattern of bone involvement with the spine forming the most frequent site of axial lesions, and the femur is the most common site overall.

Further reading
Appl Radiol 33(3):36-44, 2004.

Case by Dr MGK Murthy, Sr Consultant Radiologist

Dr.Sumer K Sethi, MD, Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Osteogenesis Imperfecta

2008-07-06T14:57:00.000+05:30

At times a picture speaks louder than words...

Acute Pyelonephritis

2008-07-05T16:13:00.000+05:30

This a a young female presented with symptoms of urinary tract infection with CT shwoing bulky right kidney with inhomogenous striated nephrogram, likely acute pyelonephritis.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Central Pontine Myelinolysis

2008-07-05T16:08:00.000+05:30

This is 19-month old girl with severe diahorrhea, MRI brain showing altered signal intensity in the central pons. Rarely reported in this age group but can be central pontine myelinolysis.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Myositis Ossificans

2008-07-05T16:06:00.000+05:30

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

This is a post head injury follow up case shwoing myositis ossificans surrounding the hip joint.

Chronic Pancreatitis-CT

2008-07-02T15:55:00.000+05:30

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Colloid Cyst-MRI

2008-07-02T15:54:00.001+05:30

Here is classical image of colloid cyst located in relation to the foramen of monro appearing hyperintense on T1 WI and hypointense on T2 WI.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Agenesis of the corpus callosum

2008-07-01T16:32:00.001+05:30

A case of seizure disorder with partial agenesis (hypoplasia), the anterior portion (posterior genu and anterior body) is formed, but the posterior portion (posterior body and splenium) is not formed. The rostrum and the anterior/inferior genu are also not formed. Note the colpocephaly.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Lymphocytic Hypophysitis-MRI

2008-07-01T15:58:00.000+05:30

This is a case of histopathologically proved case of lymphocytic hypophysitis. MRI revealed enlargement of the pituitary gland and fossa, with traingular-dumbell shaped mass with significant heterogenous post contrast enhancement. There is suprasellar extension and alteration of the optic chiasm. Pituitary stalk cannot be identified.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Hypoxic Brain Injury-MRI

2008-07-01T15:54:00.000+05:30

This is patient who had a cardiorespiratory arrest and MRI was done which revealed hypoxic injury. T2/FLAIR and diffusion images are provided, and show symmetrical hyperintensity in the bilateral thalami, basal ganglia and brainstem.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Radiology Grand Rounds-XXV

2008-06-30T19:19:00.000+05:30

Here is a case of Renal Hydatid for the Radiology Grand Rounds submitted by Dr MGK Murthy and Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds

Echinococcosis is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. Adult worm lives in the proximal small bowel of the definitive host, attached by hooklets to the mucosa. Eggs are released into the host's intestine and excreted in the feces. Humans may become intermediate hosts through contact with a definitive host (usually a domesticated dog) or ingestion of contaminated water or vegetables. The ovum loses its protective layer as it is digested in the duodenum. Once the parasitic embryo passes through the intestinal wall to reach the portal venous system or lymphatic system, the liver acts as the first line of defense and is therefore the most frequently involved organ. Renal hydatid is rare accounting for 2% usually. There are no clincal symptoms except cystic rupture into the collecting system, which leads to acute renal colic and hydatiduria .

Imaging findings in hydatid disease depend on the stage of cyst growth (ie, whether the cyst is unilocular, contains daughter cysts, or is partially or completely calcified [dead]) . A difference in attenuation and signal intensity between the fluid in the central portion of the cyst and that in the peripheral cysts is a typical finding in echinococcosis due to a difference in content .Daughter vesicles (brood capsules) are small spheres that are formed from rests of the germinal layer and appear as cysts within a cyst. They contain the scolices and hooklets, along with sodium chloride, proteins, glucose, ions, lipids, and polysaccharides . When daughter cysts are separated by the hydatid matrix, they demonstrate a "wheel spoke" pattern .

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Giant Hemangioma of Liver-Triple Phase CT

2008-06-26T14:24:00.000+05:30

Cavernous hemangioma is the most common benign hepatic tumor. It typically occurs in women. Lesions measuring more than 4 cm in diameter are known as "giant hemangiomas" and often cause symptoms such as vague abdominal distention and pain. The constellation of giant hemangioma, thrombocytopenia, and localized consumption coagulopathy is known as the Kasabach–Merritt syndrome. This is a case of 40 year old female with giant hemangioma of liver with triple phase CT showing classical centripetal fill-in.

Dr Jaya Shankar, MD and Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

CSF Rhinnorrhea-CT

2008-06-25T17:38:00.000+05:30

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Renal Cell Carcinoma-CT

2008-06-25T17:16:00.000+05:30

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Hydatid Cyst- CT

2008-06-22T15:40:00.000+05:30

Imaging--Separation of the laminated membrane from the penicyst produces a split wall or floating membrane appearance.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Central Neurocytoma-CT Imaging

2008-06-21T15:37:00.002+05:30

Imaging of central neurocytoma is usually characteristic. Most of them occur as an exophytic, well circumscribed, globular mass that protrudes into the ventricles. Calcifications are common. This is a postoperative post shunting case of neurocytomas, note the intraventricular nature of tumour, calcification and operative pneumocephalus. Tumour showed immunoactivity for synaptophysin. Radiological differential diagnoses include oligodendroglioma, ependymoma, subependymal giant cell astrocytoma, and intraventricular meningioma.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Pigmented Villonodular Synovitis of Shoulder

2008-06-20T10:12:00.000+05:30

These are MRI pictures of a case of PVNS. Pigmented villonodular synovitis is well known in knee and shoulder involvement is reported rarely. Note the erosive defects in the humeral head.

Case by Dr MGK Murthy, Sr Consultant Radiologist

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Contrast Induced Nephropathy

2008-06-20T09:57:00.000+05:30

"In Radiology 2008;248:97-105 Shaun A. Nguyen et al compared effects of iso-osmolality contrast with a low-osmolality agent on renal function and concluded Intravenous contrast material application in high-risk patients is unlikely to be associated with permanent adverse outcomes. SCr levels after contrast material administration are lower in iodixanol than iopromide groups."

Sonographic gel put to novel use

2008-06-19T11:58:00.000+05:30

Seung Ho Kim et al used sonography transmission gel as Endorectal Contrast Agent for Tumor Visualization in Rectal Cancer in MRI and concluded that it is an effective and safe endorectal contrast agent for rectal MRI. Published in AJR 2008; 191:186-189

Tethered Spinal Cord

2008-06-18T16:44:00.000+05:30

Here is a case of epidural/intradural lipoma showing signal suprresion on fat sat images and a low lying tethered spinal cord.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Cord Astrocytoma

2008-06-18T16:37:00.001+05:30

This is cervical cord astrocytoma with associated syrinx seen on Gd-MRI scan of a child.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Chiari Malformation-MRI

2008-06-18T11:40:00.001+05:30

MRI images showng lumbosacral myelomeningocele, dorsal syringohydromyelia and tonsillar herniation, classical Chiari II malformation.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Hirayama Disease-Dynamic MRI, a rare diagnosis

2008-06-17T15:49:00.001+05:30

We report the MR findings in a case of Hirayama disease, a kind of cervical myelopathy related to flexion movements of the neck. In flexion MR studies, we can see the striking and pathognomonic picture of anterior shifting of posterior dura at the lower cervical spinal canal and prominent epidural venous plexus. In non-flexion studies, we find that asymmetric cord atrophy, especially at the lower cervical cord, though subtle, is highly suggestive of Hirayama disease. When it is seen, a flexion MR study is warranted to prove this diagnosis.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Calcific Tendonitis of Supraspinatus

2008-06-16T19:19:00.000+05:30

This may or may not be the cause for the shoulder pain, and is a common finding on routine shoulder skiagrams

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Osteochondroma with Bursitis

2008-06-16T17:45:00.000+05:30

Patient has history of rapid enlargement of exostosis and it is due to bursa in lesser trochanter at the cap of the osteochondroma, synovial chondromatosis or chondroid metaplasia in bursa needs to be differentiated. Both CT and MRI are useful imaging techniques to differentiate osteochondroma with large bursa formation from malignant transformation of osteochondroma. The lesser trochanter of the femur is the second most common location of large bursa formation. Cartilage thickness has been measured and appears normal.

Case by Dr MGK Murthy, Sr Consultant Radiologist
&
Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences