1 / 74

cases

cases. Dr Payal Damor R1 Radiodiagnosis S.S.G.H BARODA. CASE 1. A 23-year-old man presented to casualty dept with 8–10 episodes per day of diarrhoea with intermixed blood & mucus. By day 9 of hospitalization, the frequency of episodes of diarrhoea had increased to 12 times per day.

daryla
Download Presentation

cases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. cases Dr Payal Damor R1 Radiodiagnosis S.S.G.H BARODA

  2. CASE 1

  3. A 23-year-old man presented to casualty dept with 8–10 episodes per day of diarrhoea with intermixed blood & mucus. By day 9 of hospitalization, the frequency of episodes of diarrhoea had increased to 12 times per day. He underwent CT abdomen & pelvis.

  4. Supine topogram obtained at abdominal CT demonstrates dilated loops of large and small intestine in a pattern suggestive of adynamic ileus. The transverse colon appears ahaustral, contains pseudopolyps (arrow), and has a diameter of 8 cm.

  5. Coronal reformatted CT image of the abdomen and pelvis shows pseudopolyps (arrow) that extend into the lumen of the transverse colon. Coronal reformatted CT image of the abdomen and pelvis shows wall thickening and marked irregularity of the remaining mucosa in the ascending and descending colon (arrows).

  6. Axial CT image shows mural stratification and a target sign (arrow) in the ascending colon. Gas bubbles adjacent to the caecal wall are suggestive of pneumatosis (arrowhead). The small intestine is mildly dilated, but its wall is normal in thickness. Ascites also is present.

  7. Axial CT image obtained at the level of the upper pelvis shows dilatation of the perisigmoid vasculature (arrow), hyperattenuation of adjacent fat, and ascites

  8. ULCERATIVE COLITS

  9. DISCUSSION • Common idiopathic inflammatory bowel disease with continuous concentric + symmetric colonic involvement • Etiology: hypersensitivity/autoimmune • Age peak:20-40 years & 60-70 years; • M:F= 1:1 • Alternating periods of remission + exacerbation

  10. C/F: Bloody diarrhea,electrolyte depletion, fever, systemic toxicity,abdominal cramps Extra colonic manifestations: •  Fatty infiltration of the liver •  Gallstones (28-34%) •  Sclerosing cholangitis •  Bile duct carcinoma •  Amyloidosis •  Urolithiasis: oxalate/uric acid stones •  Migratory arthritis •  Sacroiliitis and ankylosing spondylitis • Erythema nodosum and uveitis

  11. Location: Begins in rectum with proximal progression , relatively uniform symmetric involvement of bowel Plain film: • Diffuse dilatation with loss of haustral markings • Hyperplastic mucosa,polypoidal mucosa,deep ulcers • Toxic megacolon • Free intraperitoneal gas • Complete absence of fecal residue (due to inflammation)

  12. Plain abdominal radiograph on a patient with known ulcerative colitis who presented with an acute exacerbation of his symptoms. Image shows thumb-printing in the region of the splenic flexure of the colon.

  13. longitudinal image of the colon showing circumferential continuous thickening of the colon wall. Cross-section of the transverse colon with stratification .mucosa, sub mucosa & muscle layers are visible.

  14. Ulcerativecolitis in a 27-year-old man. Contrast-enhanced CT scan shows minimal diffuse thickening of the sigmoid colon with minimal inflammatory stranding. CT scan of a patient with long-standing ulcerativecolitis shows a submucosal halo of fat within the rectum (arrow). There is also perirectal fibrofatty proliferation (*).

  15. ULCERATIVE COLITIS – BARIUM FINDINGS

  16. Double-contrast barium enema studies show granular mucosa

  17. Single-contrast enema study in a patient with known ulcerative colitis in remission shows a benign stricture of the sigmoid colon.

  18. Ulceration with Polypoid changes Postinflammatory polyposis

  19. Barium enema examination demonstrates loss of haustral folds in the entire descendingcolon with small ulcerations suggested. The colon has a "lead-pipe" appearance. The distribution and appearance are suggestive of ulcerative colitis.

  20. Instant enema shows that total involvement with a granular mucosa,complete absence of haustration & narrowing of the bowel.The terminal ileum is dilated & featureless secondary to reflux ileitis.

  21. Cx: Toxic megacolon ± perforation in 5-10% • (DDx: granulomatous/ischemic/amebic colitis) Most common cause of death in ulcerative colitis! Colonic adenocarcinoma (3-5%) • Risk starts after 8-10 years of onset of disease • Higher risk with pancolitis • Onset of disease in <15 years of age • Narrowed segment of 2-6 cm in length with eccentric lumen + irregular contour + flattened rigid tapered margins Colonic strictures (10%) • Smooth contour with fusiform pliable tapering margins, usually short + single stricture; • Commonly in sigmoid/rectum/transverse colon • Usually after minimum of 5 years of disease; rarely cause for obstruction (DDx: colonic carcinoma) Perforation

  22. HOW TO DIFFERENTIATE UC FROM CROHN’S DZ….

  23. Crohn disease in a 41-year-old man. (a) Multi–detector row CT scan shows an enlarged appendix (black arrow), stratified symmetric thickening of the terminal ileum (arrowheads), and adjacent creeping fat (white arrow). (b) Sagittal reformatted multi–detector row CT image demonstrates hypoattenuating symmetric thickening of the cecal wall (arrowheads) and stratified thickening of the terminal ileum (arrows).

  24. Crohn disease in a 33-year-old man. Sagittal oblique reformatted multi–detector row CT image shows a thickened, inflammatory terminal ileum (arrowheads) with a fistula and retroperitoneal abscess posteriorly (arrows).

  25. Aphthoid ulceration

  26. 30-year-old man with Crohn's disease involving colon. Image from double-contrast barium enema reveals aphthoid lesions (arrowheads) in sigmoid colon. 25-year-old woman with Crohn's disease involving colon. Image from double-contrast barium enema reveals longitudinal and perpendicular ulcerations (arrows) in right colon.

  27. Cobble stone appearance typical of crohn’s disease

  28. Fissuring ulceration with thorn-like cuts into the bowel wall is a classic feature of Crohn’s disease.

  29. Case 2

  30. 45-year-old woman who has recently noticed a lump on her head.

  31. Plain Xrays reveal a solitary, predominantly lytic expansile lesion arising from the left parietal bone.

  32. Axial CT scan shows no involvement of the underlying brain. The bone windows from the CT images reveal a truly intraosseous lesion, which is predominantly lytic, but has prominent thick trabeculae.

  33. Axial CT scan shows no involvement of the underlying brain. The bone windows from the CT images reveal a truly intraosseous lesion, which is predominantly lytic, but has prominent thick trabeculae.

  34. Findings Plain Xrays reveal a solitary, predominantly lytic expansile lesion arising from the left parietal bone. Axial CT scan shows no involvement of the underlying brain. The bone windows from the CT images reveal a truly intraosseous lesion, which is predominantly lytic, but has prominent thick trabeculae.

  35. Diagnosis Hemangioma of the skull

  36. Discussion Osseous hemangiomas are usually asymptomatic, incidentally discovered benign lesions. They are more frequently seen in men than women, and are usually found in the 4th and 5th decades. Calvarial hemangiomas comprise 20% of all osseous hemangiomas, and 10% of primary benign skull neoplasms.

  37. They are most frequently found in the frontal and parietal bones, arising in the diploic space. They are slow-growing lesions and the outer table tends to expand more than the inner table, with a resultant assymetric shape, as in this case. On plain films and CT, the hemangioma appears as an expansile lytic lesion with radiating, or spoke-wheel-like, thickened trabeculae.

  38. Pathologicallythis trabecular thickening is due to bone formation adjacent to angiomatous channels that are characteristic of the vascular lesion.  There may be a soft tissue component in association with the bone lesion, which will be best identified with contrast enhancement or MR imaging. The signal intensity on MR can vary but it is classically of high T1 and T2 signal.

  39. Noncontrast axial T1-weighted MR image (A) reveals a well-circumscribed mass, in the right frontal bone with intra- and extracranial extension. The lesion is well defined, and the signal intensity is of mixed intensity with some central hyperintensity and bone destruction.

  40. T2-weighted image shows a lesion of high signal intensity with central areas of hypointensity. The lesion is well demarcated from the galea extracranially (outer uniform dark line) and the underlying dura intracranially (inner dark line). There is no surrounding edema.

  41. After gadopentetate dimeglumine administration strong and homogeneous enhancement of the mass, relative enhancement of the bone marrow, and a dural tail sign are observed. The lesion extends intracranially and appears to compress the underlying brain, but without intraparenchymal extension. On the inner table in the parietal area, the small enhancing nodule corresponds to a vessel.

  42. D/D :

  43. Case 3

  44. A 40 yrs old female presentated with c/o mucopurulent discharge from ear & deafness on left side since 4 months

  45. L SCLEROSIS OF MASTOID AIR CELLS

  46. SOFT TISSUE MIDDLE EAR, EAC

More Related