Interesting Cases
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Interesting Interesting Cases Cases Dr. WALEED AL HAJJI Dr. WALEED AL HAJJI
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Interesting Cases. Dr. WALEED AL HAJJI. History. Thirty years old male patient who is experiencing left extensive femoro-popliteal DVT. Hospitalized One day later he developed chest pain and shortness of breath Chest X-ray was obtained. CT angiography of the pulmonary arteries was done. - PowerPoint PPT Presentation
Transcript of Interesting Cases
Interesting CasesInteresting Cases
Dr. WALEED AL HAJJIDr. WALEED AL HAJJI
HistoryHistory
Thirty years old male patient who is experiencing left extensive femoro-popliteal DVT.
HospitalizedOne day later he developed chest pain and
shortness of breathChest X-ray was obtained
CT angiography of the pulmonary arteries was done
Case was diagnosed as pulmonary embolism; IVC filter was inserted to guard against further PE
The patient survived that attack of PE, with follow up CT angiography of the pulmonary artery revealing complete resolution of the embolization of the right pulmonary artery.
Two days later, the patient experienced similar attack of chest pain, that found to be due to another attack of PE.
That was inspite of the IVC filter inserted in place!!!
CT of the chest and abdomen was performed
A
B
Diagnosis Diagnosis
Double IVCDouble IVC
Duplication of the IVC results from persistence of both supracardinal
veins. The prevalence is 0.2%–3%
A double IVC can be associated with A double IVC can be associated with other conditions, such as a horseshoe other conditions, such as a horseshoe kidney, a circumaortic renal vein, a kidney, a circumaortic renal vein, a retroaortic left renal vein, and a retroaortic left renal vein, and a retroaortic right renal vein with retroaortic right renal vein with hemiazygos continuation of the IVChemiazygos continuation of the IVC
Case 2Case 2
Diagnosis
Fenestration of the septum pellucidum.
This is one of the findings in chronic obstructive hydrocephalus. Also known as non-communicating hydrocephalus is simply hydrocephalus due to obstruction of CSF flow out of the ventricles. Frequent causes of obstructive hydrocephalus include:-aqueduct stenosis -meningitis
Features of long standing obstructive hydrocephalus are:
-Marked dilatation of the lateral and third ventricles.
-Thinned and elevated corpus callosum.
-Depression of the fornices.
-Rounding of the infundibular, optic and pineal recesses.
-Ballooning of the suprapineal recess.
-Fenestration of the septum pellucidum.
Case 3Case 3
This is an incidental finding during an angiography procedure
Case 4Case 4
History: Upper chest discomfort.
Diagnosis:
Carcinoma of the gastric fundus (pseudoachalasia presentation) with direct invasion of the GEJ.
Differential Diagnosis for Pseudoachalasia:
Carcinoma of the gastric cardia or fundus with direct invasion of the GEJ or distal esophagus.
Hematogenous metastases from breast, lung, or pancreatic cancer.
Lymphoma.
Chagas.
Malignancy-induced secondary achalasia is an uncommon condition, accounting for only 2 to 4% of patient with findings of achalasia at manometry.
Most patients with primary achalasia are between 20 and 50 years of age and have symptoms of dysphagia for an average of 4 to 6 years. Whereas, most patients with secondary achalasia are older than 50 years and have symptoms, on average, less than 6 months.
Case 5Case 5
28 years old male patientAdmitted to the casualty with a stab
injury to the left popliteal fossaNo much bleeding was noted on
admission!!
Traumatic (stab) pseudoaneurysm Pop. A
Case 6Case 6
A 76-year-old woman presented with:– Vague abdominal pain (persistent for over
two years)– Recent (over the previous three months),
unwanted 8 kg weight loss
Differential Diagnosis Differential Diagnosis
Gallbladder carcinomaAdenomyomatosisChronic inflammationMetastastic disease (metastatic
melanoma)And less likely, multiple polyps
Diagnosis Diagnosis
Adenocarcinoma of the gallbladder
DiscussionDiscussion
Pathology DiscussionPathology Discussion
CholecystectomyCholecystectomyDDiffuse iffuse
thickening of the thickening of the wall but no wall but no obvious focal obvious focal lesionlesion.
Diffuse papillary projections of epithelium
Diffuse, adenomatous epithelial change
In some areas, dysplastic changes consistent with adenocarcinoma in situ
The tumor focally invades into muscularis propria only superficially
Radiology Discussion:Radiology Discussion: GB carcinoma, a highly lethal condition Sixth most common gastrointestinal
malignancy (after colon, pancreas, stomach, liver, and esophagus)
Because symptoms are often vague, this carcinoma is frequently detected late; in fact, detection is typically related to invasion of adjacent organs
Risk factorsRisk factors
Post-menopausal statusCigarette smokingGallstones (seen in 85% of cases of
gallbladder carcinoma)
The presence of a choledochal cystcholedochal cyst, anomalous junction of the anomalous junction of the pancreaticobiliary ductspancreaticobiliary ducts, and low low insertion of the cystic ductinsertion of the cystic duct are also associated with higher incidence. It is thought, in these cases, that gallbladder carcinoma may develop in response to chronic biliary reflux of pancreatic chronic biliary reflux of pancreatic secretionssecretions
Imaging appearancesImaging appearances MMass replacing the gallbladderass replacing the gallbladder (55%) most
common (DD hepatocellular carcinoma, cholangiocarcinoma, and metastatic disease of the gallbladder fossa)
FFocal or diffuse wall thickeningocal or diffuse wall thickening (25%) (DD congestive heart disease, hypoalbuminemia, cirrhosis, hepatitis, cholecystitis, and adenomyomatosis)
PPolypoid massolypoid mass (DD polyps (adenomatous, hyperplastic, or cholesterol), carcinoid tumor, melanoma metastasis, and hematoma)
References References
Levy AD, Murakata LA, Rohrmann CA. AFIP Archives. Gallbladder Carcinoma: Radiologic-Pathologic Correlation. Radiographics 2001; 21: 295-314.
Bang Huu Huynh, MD - Case Coordinator Amy Ho Huang, MD - Radiology Discussion Jian Shen, MD, PhD - Pathology Discussion Steven E Seltzer, MD - Attending Radiologist
May 12, 2003
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