Diagram of Anterior anatomical relations of both kidneys

The kidneys are retroperitoneal organs that are located in the perirenal retroperitoneal space with a longitudinal diameter of 10–12 cm and a latero-lateral diameter of 3–5 cm and a weight of 250–270 g.
In the supine position, the medial border of the normal kidney is much more anterior than the lateral border, The upper pole of each kidney is situated more posteriorly than the lower pole.
The right kidney,  anteriorly :
has a relation with the inferior surface of the liver with peritoneal interposition,and with the second portion of the duodenum without any peritoneal interposition since the second portion of the duodenum is retroperitoneal .
The left kidney, anteriorly :
has a relation with the pancreatic tail, the spleen, the stomach, the ligament of Treitz and small bowel, and with the left colic lexure and left colon . Over the left kidney, there are two important peritoneal relections, one vertical corresponding to the spleno-renal ligament (connected to
the gastro-diaphragmatic and gastrosplenic ligaments) and one horizontal corresponding to the transverse mesocolon.

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2 The Upper Limb
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5 The Hip, Pelvis and Sacro-iliac Joints
6 The Vertebral Column
7 The Thorax and Upper Airways
8 The Skull
9 The Facial Bones and Sinuses
10 Dental Radiography
11 The Abdomen and Pelvic Cavity
12 Ward Radiography
13 Theatre Radiography
14 Paediatric Radiography
15 Mammography

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What is the most appropriate interpretation of this CT Scan?

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a. Ependymome
b. Medulloblastoma
c. Subependymoma, Medulloblastoma with obstr hydrocephalus


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Causes of Bilateral diminished concentration of contrast material in the pelvocalyceal system

1- Overhydration/ inadequate dehydration :
Causes dilution of the contrast material (Note that the kidneys may be entirely normal).

2- Polyuria :
Excretion of large volumes of hypotonic urine due to diuretic therapy, diabetes insipidus (lack of antidiuretic hormone ADH secreted by the posterior lobe of the pituitary gland), diabetes mellitus, and intrinsic renal diseases.

3- Renal failure (uremia) :
Severely decreased renal function due to a variety of underlying causes.

4- Nephrosclerosis :
Long-standing hypertension causes narrowing of extraand intrarenal arteries with prolonged intrarenal circulation time and decreased excretion of contrast material.
Malignant nephrosclerosis. Nephrotomogram obtained 5 minutes after the injection of contrast material shows minimum opacification of small, smooth kidneys.

5- Technical :
Injection of an inadequate dose of contrast material.

Causes of Bilateral diminished concentration of contrast material in the pelvocalyceal system

X-ray of Gallstone ileus

Imaging Findings :

Classic triad of
  1. jejunal or ileal filling defect
  2. gas or barium in the biliary tree
  3. small bowel obstruction.

Gallstone ileus is caused by a large gallstone entering the small bowel via a fistula from the gallbladder or the common bile duct to the duodenum. Usually occurs in elderly women.

Gallstone ileus. Upper gastrointestinal series demonstrates the obstructing stone (white arrows) and barium in the biliary tree (black arrow).

 Localized osteoporosis due to Burn, Frostbite and Electric shock

The bone demineralization is most marked where softtissue damage was greatest, is an early radiographic finding that may persist for a prolonged period.

Electrical injury. This X-ray shows comminuted fracture of the head and shaft of the humerus associated with mottled decalcification of the humeral head.
The cortex of the humerus is thin, and the medullary cavity is widened. Discrete areas of rarefaction can be seen in the shaft and distal metaphyseal region.

Disuse osteoporosis follows prolonged immobilization

To maintain osteoblastic activity at normal levels, bones must be subjected to a normal amount of stress and muscular activity. Within a few weeks after the fracture of a bone, localized osteoporosis becomes detectable, especially distal to the site of injury.

The cortical margin of an involved bone never completely disappears (unlike bone destruction due to disease). Similar disuse atrophy due to immobilization follows neural or muscular paralysis.

Disuse osteoporosis. (A) Severe periarticular demineralization follows prolonged immobilization of the extremity.

(B) In a patient with a fractured patella, there is pronounced subcortical demineralization in the distal femur. The cortical margin (arrows) remains intact.

A brief introduction to Extradural haematoma in CT

Extradural haematoma arises between the inner table of the skull and the dura of the brain. They usually develop from injury to the middle meningeal artery or one of its branches,So it is usually temporoparietal in location.
A temporal bone fracture is often the cause, but is not essential. The expanding haematoma separates the dura from the skull; this attachment is quite strong such that the haematoma is confined, giving rise to its characteristic biconvex shape, with a well defined margin.

It may present as primary depressed consciousness or following a lucid interval. The bleeding is usually acute and so of high attenuation. There is often significant mass effect with compression of the ipslateral lateral ventricle and dilatation of the opposite lateral ventricle due to obstruction of the foramen of Munro. The basal cisterns may be effaced.

This is the typical appearance and location of an acute extradural haematoma. Note the high density of the haematoma and slight midline shift .

A Pancreatic mass or just papillary process of the caudate lobe of liver

This patient presented with abdominal discomfort and underwent sonography of the abdomen. Ultrasound images show a rounded mass in the region of the pancreatic head and isthmus. It shows the same echogenicity as the liver (photos 1 and 2). This suggested the possibility of a pancreatic mass, possibly malignant.
However, images 3 and 4, reveal a different diagnosis- the possible "mass" appears to be an extension of the caudate lobe of the liver. These ultrasound images are diagnostic of "papillary process of the caudate lobe of liver."This normal variant may thus mimic pancreatic or preaortic lymph node masses.
Images courtesy of Dr. Ravi Kadasne, UAE.

Ischaemic colitis Clinical and Radiological findings

Clinical characteristics
• Ischaemic colitis is caused by interruption to the colonic blood supply that include thrombosis , bowel obstruction and trauma.
• Some Predisposing factors included as age,oral contraceptives,sickle cell disease and surgical ligation of the inferior mesenteric artery.
• Presents with acute lower abdominal pain and tenderness,usually out of proportion to the clinical signs.There may be rectal bleeding or diarrhoea.
• Most commonly affects the left side of the colon, especially at the splenic flexure where there is a watershed between the territories of the superior and inferior mesenteric arteries.The rectum is usually spared.
• May be a transient condition with spontaneous resolution over a few months. May lead to incomplete healing with smooth stricture formation. Severe disease can lead to colonic infarction,with a high associated mortality.

Radiological features
• AXR : plain film is often normal;however,gas within the colon may out line the characteristic thumb printing of thickened, oedematous folds seen in this condition.
• Barium enema : single-contrast instant enema may demonstrate thumb printing and ulceration associated with this condition.Adoublecontrast enema shows these findings more reliably but should be used with caution in anacutely ill patient.A smooth stricture maybe demonstrated on a delayed study.
Late-stage ischaemic colitis. Single-contrast barium enema demonstrates a clear zone of transition between normal and abnormal colon at the junction of the middle and distal thirds of the transverse colon.The proximal colon has normal mucosa and haustral pattern while the distal
segment is featureless and abnormally narrowed.
• CT :contrast-enhanced spiral CT is the usual first-line investigation for suspected ischaemic colitis.Adual phase scan,performed in the arterial and portal phases,may demonstrate thrombus in both the mesenteric arterial or venous systems.The affected colon may appear abnormally circumferentially thickened and demonstrate poor contrast enhancement.There may be a sharp cut off between normal and abnormal colon at the boundary of vascular territories.Mural gas may be seen in more advanced disease and,in severe cases,portal gas may be identified. The latter is a poor prognostic factor.
Superior mesenteric artery (SMA) thrombosis. Normal enhancement of the aorta (arrowhead). No enhancement seen in the SMA (arrow).
• Angiography :a more limited role in the era of multislice spiral CT but may demonstrate attenuated arterial flow or the presence of a thrombus.

Ischaemic colitis Clinical and Radiological findings

CT Images of Heart in abdominal

Regardless of bad pt. positioning or quality, notice the heart ♥️ in the abdomen! That's a presentation of a rare congenital malformation in which the heart is abnormally located either partially or totally outside of the thorax.

CXR: absence of heart
CT: heart in abdomen


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Right kidney
Left kidney
Renal cortex
Renal columns
Renal pelvis

Adrenal gland
Fundus of stomach
Body of stomach
Antrum of stomach
Duodenal bulb
Small bowel
Right colic flexure
Left colic flexure
Opening of ureter
Seminal vesicle
Right ovary
Left ovary
Spinal column
Symphysis pubis
Acoustic shadow
Psoas muscle
Pelvic bone
Thyroid gland
Sternohyoid muscle
Sternothyroid muscle
Sternocleidomastoid muscle
Omohyoid muscle
Internal jugular vein
Common carotid artery
Tracheal cartilage

Radiological features of Bezoar

Bezoar is an intestinal mass caused by the accumulation of ingested
material which Can lead to obstruction or ulceration.
Bezoar Types :
A phytobezoar is formed from poorly digested plant fibre.
A trichobezoar is formed from ingested hair, almost always in females.

Trichobezoar. Large ‘hair ball’ mass completely filling the stomach (arrow).

Radiological features :
• A mass may be seen within the stomach.
• May demonstrate bowel obstruction.
 Barium studies:
• May demonstrate an intraluminal filling defect that does not have a fixed site of attachment to the bowel wall.
• Barium may flow into crevices within thebezoar.
• This may demonstrate a low-density mass containing pockets of air.
• As on barium studies, oral contrast may intersperse with the mass
though gaps between the ingested materials.

Trichobezoar (same patient) in coronal CT reformat.Oral contrast is seen outlining the huge trichobezoar.

Syphilitic Aortitis in Chest X-ray

Syphilitic Aortitis in Chest X-ray appears as a dilatation of the ascending aorta, frequently with mural calcification

It may cause inflammation of the aortic valvular ring that results in aortic insufficiency. Approximately one-third of patients develop narrowing of the coronary ostia that may lead to symptoms of ischemic heart disease.

Syphilitic aortitis. Aneurysmal dilatation of the ascending aorta with extensive linear calcification of the wall (arrows). Some calcification is also seen in the distal aortic arch.

What is Ultrasound Gain–correct, over, under (with photos)

Gain refers to the control sonologists use to adjust the brightness with which returning sound waves are displayed by the ultrasound machine. When an echo returns from body tissue, it does so within an amplitude range.
The ultrasound device translates that amplitude range to a brightness, which it displays on the monitor. The overall gain allows the sonologist to adjust the brightness of all returning echoes. Decreasing the gain makes the overall image less bright, while increasing the gain makes the image more bright .

These figure shows the types of gain:

(A) (Correct) This image is correctly gained

(B) (Over) The image has too much gain applied to the image. Compared with image A, echoes are found where there should be none.

(C) (Under) The image is undergained. The image is too dark, potentially making it difficult for accurate diagnosis.

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