Free floating particles in Liqor amnii


This was a 38 week old pregnancy showing multiple echogenic particles in the amniotic fluid (liqor amnii) on ultrasound/ Color Doppler imaging. Such freely mobile particles in the amniotic fluid are called free floating particles and are commonly seen in the 3rd trimester. Sometimes, particulate debris, when abundant, can be confused with normal umbilical cord floating in the amniotic fluid, on grey scale B-mode ultrasound. However, Color Doppler easily distinguishes between the two (see Doppler images above). Studies show some direct correlation between the size and number of free floating particles and levels of Maternal serum alpha feto-protein (MSAFP). These particles are presumed to be the result of vernix caseosa shed from the fetal skin. However, free floating particles may be visualized on ultrasound imaging even during the 2nd trimester (when vernix is not present).

Radiographic anatomy of Paediatric Shoulder

This page contains normal radiographic anatomy of the paediatric shoulder

Images on this page :
* AP
* Lateral
* SI

Paediatric Shoulder - AP

Paediatric Shoulder - Lateral

Paediatric Shoulder - Superiorinferior view (SI)


Source :www.wikiradiography.com

Molar pregnancy....snow white appearance on ultrasound

Molar pregnancies are an uncommon and very frightening complication of pregnancy and occurs due to an abnormal fertilization process.The formal medical term for a molar pregnancy is "hydatidiform mole."

The diagnosis of molar pregnancy can nearly always be made by ultrasound, because the chorionic villi of a typical complete mole proliferate with vacuolar swelling and produce a characteristic vesicular sonographic pattern.
• Previously when the diagnosis was made at a later stage, the classical ‘snowstorm’ pattern of the uterus was described; however this is not commonly seen now.
Scan of the uterus shows the classical bunch-of-grapes appearance or snow-storm appearance in the uterine cavity is noted. This is the typical appearance of a gestational trophoblastic disease.
• Benson et al reported that the majority of first trimester complete moles demonstrated a typical
sonographic appearance of a complex and echogenic intrauterine mass containing many small
cystic spaces {which correspond to the hydropic villi on gross pathology}.

Blunt trauma to pancreas

• Blunt trauma to pancreas is usually caused by compression against the vertebral column; the best and most common example is seat belt compression injuries. Blunt trauma to pancreas is Usually associated with upper abdominal visceral injury.
• Graded from minor contusion and capsular haematoma (grade I) to severe devascularising crush injury (grade IV).
• Pancreatic trauma is usually damage occurs at most vulnerable segment of pancreas: the junction of the body and tail.
Radiological features
- CECT:
•Laceration–area of intrapancreatic low attenuation, often difficult to see.
•Direct evidence of haemorrhage – fluid around superior mesenteric artery and pancreas.
•Indirect evidence – thickening of anterior pararenal fascia.
- Often requires delayed scans to exclude/monitor complications of pancreatitis and devascularised pancreas.
Complications of Blunt trauma to pancreas
• Post-traumatic pancreatitis, with:
  1.  peripancreatic fat stranding
  2.  diffuse or focal pancreatic enlargement
  3.  irregular pancreatic contour.
• Splenic vessel fistula or arterial pseudoaneurysm.
• Pancreatic abscess.
• Pancreatic pseudocyst.

Pancreatic trauma. Laceration of the pancreas within the proximal body (arrow heads).

hysterosalpingography

Hysterosalpingography, also called uterosalpingography, is an x-ray examination of a woman's uterus and fallopian tubes that uses a special form of x-ray called fluoroscopy and a contrast material. An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions.
Preparation for the procedure
The exam should take place on days 7-10 after the beginning of your last menstrual bleeding.
Please arrive 15 minutes before the scheduled exam time.
You will be given a contrast screening form to complete.
The technologist will verify your identification and exam requested.
There will be an opportunity for you to talk to the radiologist about the plan for the procedure and give your consent.
During the procedure
The duration of the procedure will vary, but the average is about 45 minutes.
The technologist will position you on the exam table.
The technologist and radiologist will be available to answer any questions.
After the procedure
The patient may experience vaginal spotting (bleeding) and pelvic cramps for 1 day after the procedure.
Tylenol may be taken as indicated after the procedure for pain relief.
If you experience increased pain, fever, or heavy bleeding after the exam, contact your doctor immediately.


Benefits of Schüller view on showing Mastoid bone

Schüller's view (Runstrom) is a lateral view of the mastoid obtained with the sagittal
plane of the skull parallel to the film and with a 30° cephalocaudal angulation of the x-ray beam.

These 30° in Schüller's view displaces the arcuate eminence of the petrous bone downward and shows the antrum and the upper part of the attic.

Schüller's view also gives an excellent view of the extent of the pneumatization of the mastoid,the distribution and the degree of aeration of the air cells, the status of the trabecular pattern, and the position of the vertical portion of the lateral sinus.
Schüller view: Well-developed normally pneumatized mastoidal air cells can be observed in the picture on the left side (double arrow). In the picture on the right side, the mastoid cells (arrow) are obscured, and not air-containing, due to chronic otitis media.

Scaphoid fractures overview

A Scaphoid fracture is the most common type of wrist fracture which is almost always caused by a fall on the outstretched hand..Scaphoid fractures usually cause pain and swelling at the base of the thumb. The pain may be severe when you move the thumb or wrist, or when the patient try to grip something.
Anatomic snuffbox tenderness is a highly sensitive test for scaphoid fracture, whereas scaphoid compression pain and tenderness of the scaphoid tubercle tend to be more specific. Initial radiographs in patients suspected of having a scaphoid fracture should include anteroposterior, lateral, oblique, and scaphoid wrist views..........

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Indications of Thumbprint sign in Chest & Abdominal X-ray

the thumbprint sign is a finding on a lateral C-spine radiograph that suggests the diagnosis of epiglottitis. The sign is caused by a thickened free edge of the epiglottis, which causes it to appear more radiopaque than normal, resembling the distal thumb.

Thumb’ like epiglottitis. Note the swollen epiglottitis like a thumbprint
" enlarged epiglottis in epiglottitis which, instead of its usual thin fingerlike projection, is stubby, like the thumb "In an abdominal x-ray, the "thumb print sign" has similar appearance of thumbs protruding into the intestinal lumen, but are in fact caused by thickened edematous mucosal folds. Abdominal thumbprinting a sign of intestinal ischemia.

Thumbprinting-indentation in contrast or air-filled bowel lumen caused by submucosal infiltration and resembling a thumbprint; eg ischemia

Congenital aortic stenosis in X-ray

In Supravalvular aortic stenosis you can see Aortic knob is often small due to underdevelopment and stenosis of the supravalvular portion of the aorta. Different from the poststenotic aortic dilation that occurs with valvular aortic stenosis.

Congenital aortic stenosis. Small aortic arch with moderate enlargement of the left ventricle.

Hallux varus in X-ray

Hallux varus is a deformity of the great toe joint where the hallux is deviated medially (towards the midline of the body) away from the first metatarsal bone. The hallux usually moves in the transverse plane.
The condition has various degrees ..............





X-ray Osgood-Schlatter disease

Osgood Schlatters disease is a very common cause of knee pain in children and young athletes usually between the ages of 10 and 15. It occurs due to a period of rapid growth, combined with a high level of sporting activity.

Imaging Findings

* Normal x-ray findings do not exclude the disease, which is diagnosed clinically
* Radiographs have Limited role "Clinical diagnosis"...............



 Lateral radiograph of the knee demonstrating fragmentation of the tibial tubercle with overlying soft tissue swelling.

Characteristic black pleura‌ sign in Alveolar microlithiasis in chest X-ray

Alveolar microlithiasis is a rare disease of unknown etiology characterized by the presence of a myriad of very fine micronodules of calcific density in the alveoli of the lungs of a usually asymptomatic person. Characteristic black pleura‌ sign (due to contrast between the extreme density of the lung parenchyma on one side of the pleura and the ribs on the other side).

Alveolar microlithiasis appears in Chest X-ray as diffuse, very fine micronodules of calcific density that are usually asymptomatic. Characteristic black pleura sign (it is due to contrast between the extreme density of the lung parenchyma on one side of the pleura and the ribs on the other side).



Alveolar microlithiasis. Nearly uniform distribution of typical fine, sandlike mottling in the lungs. The tangential shadow of the pleura is displayed along the lateral wall of the chest as a dark lucent strip (arrows).

Journal Effects of Dual-Energy Technique on Radiation Exposure and Image Quality in Pediatric Body CT.

Effects of Dual-Energy Technique on Radiation Exposure and Image Quality in Pediatric Body CT.

AJR Am J Roentgenol. 2016 Aug 4:1-10. [Epub ahead of print]
Siegel MJ1, Curtis WA1, Ramirez-Giraldo JC2.
Abstract

OBJECTIVE: The purpose of this study was to assess the effects of dual-energy CT (DECT) on radiation exposure and image quality in pediatric body CT.

MATERIALS AND METHODS: This retrospective study included 79 children (median age, 10.1 years; range, 12 days-18 years) who underwent thoracic or abdominal-pelvic CT or CT angiography with dual-energy technique between October 2014 and March 2015. The delivered volume CT dose index (CTDIvol) from DECT was recorded and compared with the estimated CTDIvol had the patient undergone scanning with a standard single-energy CT (SECT) protocol. Size-specific dose estimates were calculated for both DECT and SECT. Image quality was subjectively scored (scale, 1-4). For 16 of 79 patients who underwent both DECT and SECT, image contrast and noise were measured and contrast-to-noise ratio calculated. Parametric and nonparametric testing of independent and paired samples was performed.

RESULTS: For all 79 studies, actual median CTDIvol and size-specific dose estimate were 3.7 and 5.9 mGy for DECT versus prescanning estimates of 4.4 and 7.7 mGy for SECT, resulting in 12.5% and 11.2% radiation exposure reduction (p < 0.01). Diagnostic image quality was achieved in all patients. In the 16-patient subset, the median CTDIvol values of DECT and SECT were 3.1 and 3.4 mGy (p < 0.05). Median noise was greater with DECT than with SECT (p < 0.01), but the mean contrast-to-noise ratios for the liver and portal vein were similar (liver, p = 0.32; portal vein, p = 0.21).

CONCLUSION: In pediatric body CT, the use of DECT results in radiation exposures comparable to or less than those of SECT while maintaining contrast and contrast-to-noise ratio.

Journal Criteria Low Back Pain

ACR Appropriateness Criteria Low Back Pain.

J Am Coll Radiol. 2016 Sep;13(9):1069-78. doi: 10.1016/j.jacr.2016.06.008. Epub 2016 Aug 3.
Patel ND1, Broderick DF2, Burns J3, Deshmukh TK4, Fries IB5, Harvey HB6, Holly L7, Hunt CH8, Jagadeesan BD9, Kennedy TA10, O'Toole JE11, Perlmutter JS12, Policeni B13, Rosenow JM14, Schroeder JW15, Whitehead MT16, Cornelius RS17, Corey AS18.
Abstract

Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI.

The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Sumerdoc go on play store For android

One well-known blog in india now can be installed on android, can be downloaded on google play store
sumerdoc merupak radiological most active blogs provide information about radiology.
many people subscribe to new articles on a weekly basis. review case studies and seminars and events surrounding the radiology always update.

Apps CTisus for android Mobile

CTisus there is now a mobile version for Android, aimed to ease users about updating the info ctisus, you can directly download for free in the play store. may be useful.
klick here for see the apps mobile 

CT Cancer Pediatric

CT Cancer Pediatric

Clinical history of CT Canser pediatric

This 17 year-old cancer patient was referred to Phoenix Children's Hospital for a follow-up CT abdominal scan on the iCT system. The technologist used IMR knowledge-based reconstruction to perform the exam.

with parameters, Image scan parameters

  • 120 kVp
  • 52 mAs/slice
  • 26.4 cms
  • 2.6 second scan time
  • 4.2 mGy CTDIvol
  • 188 mGy x cm DLP
    Left image: iDose<sup>4</sup> reconstruction; Right image: IMR <br />

    Left image: iDose<sup>4</sup> reconstruction; Right image: IMR <br />

    Left image: iDose<sup>4</sup> reconstruction; Right image: IMR

    Source Content from netforum philips.

    Apk for android Interpretation of Emergency Head CT

    Acute stroke , Subdural haematoma (SDH) , Extradural haematoma , Subarachnoid haemorrhage , Cerebral venous sinus thrombosis , Contusions , Skull fractures , Meningitis , Raised intracranial pressure , Hydrocephalus , Abscesses , Arteriovenous malformation , Solitary lesions , Multiple lesions , Self-assessment section , Self Assessment – Answers 
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    CT POSITIONING IN PLY STORE

    The aplication for android can you instal in your android, this apk the explain abaout ct positioning, i have download very fast, the apk as below :
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    abnormal mri brain in meningitis case

    This abnormal mri brain in meningitis case, infection of the meninges, may be suppurative or granulomatous.

    Untitled

    abnormal mri brain images of meningitis with mri, visible in arrow.

    Aseptic Meningitis :

    —All non-bacterial causes of meningitis, Typically less ill appearing than bacterial meningitis, Most common cause is viral, HSV,  type II, Enterovirus (coxsackie, echovirus), Affects all ages, Generally self-limited illness, Other Viral, HIV, Lymphocytic choriomeningitis virus, Arbovirus, Mumps, CMV, EBV, VZV, Adenovirus, Measles, Rubella, Rotavirus, Influenza and parainfluenza, Other infectious, Borrelia burgdorferi, Mycobacterium tuberculosis, Treponema pallidum, Mycoplasma pneumoniae, Rickettsia, erlichia, brucella, Chlamydia, Fungal, Cryptococcus, Coccidiodes, Histoplasmosis, Parasitic, Angiostrongylus, Toxoplamosis,  Medication, NSAID’s , Bactrim, Pyridium, Malignancy, Lymphoma and leukemia, Malignancy, Lymphoma and leukemia, Metastatic carcinoma, Autoimmune, Sarcoid, Behcet’s, SLE

    abnormal mri brain meningitis

    abnormal mri brain meningitis 2

    abnormal mri brain in meningitis case.

    abnormal mri brain

    abnormal mri brain Neonatal meningitis

    —Leading cause of newborn meningitis in developed countries

    —Best diagnostic clue: Meningoencephalitis in anewborn

    abnormal mri brain meningitis 2

    the images of abnormal mri brain.

    abnormal mri brain neonatal.

    abnormal mri brain meningitis 2

    abnormal mri brain meningitis 2

    abnormal mri brain IN MENINGITIS CASE.

    abnormal mri brain Intracranial Empyema

    Abnormal mri brain Subdural empyema l

    Ø collection of pus between dura and leptomeninges

    Øas a complication of meningitis, paranasal sinusitis, otitis media, osteomyelitis, or a penetrating wound of the skull

    Ø Frontal sinusitis is the most common cause

    Ø Route: retrograde fashion through a dural sinus or through bridging veins

    Ø even when small, usually cause focal neurologic deficits

    Ø considered a neuro-surgical emergency because of its progressive clinical course.

    ØDespite recent improvement in surgical technique and antibiotics, mortality remains high (25% to 40%).

    ØComplications :venous thrombosis and infarction

    abnormal mri brain meningitis 2

    hypodense or isodense crescentic or lenticular area adjacent to the inner table of the skull CECT and enhancement of the medial rim may be seen

    abnormal mri brain meningitis 2

    abnormal mri brain, Enhancement of the margin of the empyema is characteristic better visualized with MRI than with CT

    Abnormal mri brain of the empyema

    abnormal mri brain Herpes encephalitis

    Herpes simplex encephalitis

    —most common endemic encephalitis in the USA (2 per million) and causes 10-20% of all viral encephalitis.

    —Early diagnosis is important because AV therapy can decrease mortality and morbidity.

    —HSV1 causes 95% of HSE. Most commonly occurs due to virus reactivation. HSV2 causes 80-90% of neonatal encephalitis

    Source: Panagaria A. Neurol In. 49:360; 2001.

    §Definitive diagnosis: PCR, intrathecal antibodies, brain biopsy – take time and may be false negative in early disease [1].

    §Imaging helps in establishing an early diagnosis.

    source > Akyldz BN Paeditr Emerg Care 24;377 :2008.

    — Usually bilateral

    — Hemorrhage and enhancement seen

    — Basal ganglia tend to be spared or involved in contiguity with the TL.

    — Pons may be involved [Tien AJR:161,1993]

    MR is more sensitive and shows lesions earlier than CT or SPECT,

    abnormal mri brain

    abnormal mri brain

    abnormal mri brain

    Abnormal mri brain Of Herphes

    abnormal mri brain

    abnormal mri brain Epidural Empyema

    —collection of pus between the dura and calvaria,

    — complication of otitis media, mastoiditis, sinusitis, or osteomyelitis of the skull.

    — not as toxic as that with subdural empyema.

    —Displacement of the falx and dural sinuses away from the inner table of the skull, an important and useful sign indicating the epidural location of a collection

    image

    > T2-weighted MR images , A hypointense rim, representing inflamed dura, in an epidural, but not a subdural, empyema

    >, epidural empyema may extend into the subgaleal space through emissary veins or adjacent

    > Epidural empyema, like epidural hematoma, can across the midline but is limited by the sutures

    >  In contrast, a subdural collection of any kind cannot cross the midline but is not limited by the sutures

    abnormal mri brain

    abnormal mri brain EPIDURAL EMPYEMA

    abnormal mri brain HSV

    — Both HSV1 and 2 are commonly prevalent in Indian population. (Mixed=83%, HSV1=10%, HSV2=1%) [1]

    — HSV2 along with TORCH agents are major causes of neonatal encephalitis.

    — Infections result from maternal birth canal or transplacental spread

    — Unlike HSV1, HSV2 infection in neonates is diffuse.

    HSV 2:

    — Imaging findings are nonspecific.

    — CT scans in early disease may be negative or show subtle areas of low density

    — Conventional MR and DWI show lesions better.

    — Lesions may be multifocal involving almost any area of brain or limited to temporal lobes brainstem and cerebellum.

    — Watershed infarcts may be seen

    —  In-utero infections can result in microcephaly, encephalomalacia or calcification.

    sOURCE )Vossough.2008. Neuroradiol 50:355

    abnormal mri brain

    Axial T1WI MR shows diffuse cystic encephalomalacia and prominent CSF-containing spaces

     

    abnormal mri brain

    Axial T2WI MR shows areas of high signal in frontal lobes WM due to acute H5V-2

    abnormal mri brain

    abnormal mri brain HSV 1 AND HSV2

    Chest X Ray Imaging