Elevated Hemidiaphragm on Chest X-Ray

Causes of an elevated hemidiaphragm are:

 1) Above the diaphragm – decreased lung volume (atelectasis, collapse, lobectomy, pneumonectomy, pulmonary hypoplasia).

2) Diaphragm – phrenic nerve palsy, diaphragmatic eventration

3) Below the diaphragm – abdominal tumour, subphrenic abscess, distended stomach or colon.

Differential diagnoses which may mimic an elevated hemidiaphragm are subpulmonic effusion, diaphragmatic hernia, diaphragmatic rupture and a tumour of the pleura or diaphragm

White Out Lung on Chest X-Ray

Complete White Out’ on the CXR has a limited number of causes.


The differential diagnosis can be shortened further with one simple observation - the position of the trachea.


Is it central, pulled or pushed from the side of opacification?


Pulled 


-Pneumonectomy(usually associated with a segmental rib defect)
-Total Lung Collapse
-Pulmonary Agenesis


Central:


-Consolidation
-Mesothelioma


Pushed:


-Pleural effusion
-Diaphragmatic hernia

Osteoscerotic Lesions : Mnemonic

'Regular sex makes occasional perversions much more pleasurable and fantastic.'




Mnemonic for osteosclerosis


Renal osteodystrophy
Sickle cell disease
Myelofibrosis
Osteopetrosis
Pyknodysostosis
Metastases
Mastocytosis
Paget disease
Athletes
Fluorosis

BASILAR INVAGINATION

PF ROACH

Paget disease
Fibrous dysplasia
Rickets
Osteogenesis imperfecta, Osteomalacia
Achondroplasia
Cleidocranial dysplasia
Hyperparathyroidism, Hurler syndrome

Shapes of Ventricles

1. Viking horn / Steer Horn / Long-Horn appearance of Lateral Ventricles – 
Agenesis  of Corpus Callosum.


2. Bullet shaped third ventricle – Joubert’s Syndrome.


3. Bat(wing) shaped fourth ventricle – Joubert’s Syndrome.


4. Horshoe shaped monoventricle – Alobar Holoprosencephaly.

Bullet shape in Radiology

1. Bullet shaped Posterior Urethra – in PUV MCU.

2. Bullet shaped Thoraco-lumbar vertebrae in Lateral XR spine in Achondroplasia.

3. Bullet shaped metacarpals - MPS

4. Tumbling bullet sign : is seen in bullet within a post-traumatic bone cyst.

5. Bullet shaped third ventricle  : Joubert Syndrome.

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Silver Bromide Emulsion Types

Silver Bromide Emulsion Types in X-Ray


1. Monochromatic Emulsion - No colour sensitizers added, so emulsion will be sensitive to the blue-violet spectrum of the light.


It usually requires prolonged exposure to red light to produce any Photographic Effect on the film. This is the reason why RED LIGHT is used in dark rooms.


2. Orthochromatic Emulsion - Spectral Resolution extended upto green(570nm), with colour sensitizers added.


3. Panchromatic Emulsion - extended upto Red light.(700nm).

Spotter 6 ?

Notch in the Film

You must have noticed a 'notch' in most of the CT films we use. What is the purpose of this notch in a CT / XR film?


Ans: This so called notch is seen only in a 'single sided' = ' single coated' film, where the emulsion is coated only on one side of the film, and to help identify the emulsion side of the film a notch is given in the top right hand corner. Once the film is kept with notch is on our top-right, the emulsion side is nearer to us. This side should be made in contact with the intensifying screen while mounting into a cassette for XR. 


Of course while mounting films on to the lobby, the notch is usually should be on the top-right hand corner.

Spotter 5

Causes of Smooth Interstitial Thickening in HRCT Lung

Causes of Smooth Interstitial Thickening in HRCT Lung 


          L - Lymphangitis Carcinomatosis
          A – Alveolar proteinosis
          L – Lymphoma
          I – Interstitial Pneumonia

Spotter 4

FLAIR and STIR

We are daily seeing FLAIR and STIR. What are the T1 values of Water and Fat? Is it 2500ms for water and 160ms for fat?


T1 value of water is ~4200ms and for fat it is ~ 230ms. 
After the inversion pulse in FLAIR or STIR, longitudinal magnetization begins to recover according to T1. 
The magnetization of a given tissue passes through zero after a time equal to approximately 69% of the tissue T1 value. 
If the TI is selected to equal this time, no magnetization is available from that tissue at the start of the host sequence, and signal from that tissue is suppressed.


In FLAIR the TI selected is ~2500ms (in our case) and in STIR it is 160ms, when the magnetization equals zero for water and fat respectively.

Further study : An Interactive Taxonomy of MR Imaging Sequences

Kienböck’s Disease

General Considerations


Osteonecrosis of the carpal lunate.
Clinical Features
Males 9:1; 20-40 years of age.
History of acute or chronic trauma.
Worsening pain and disability.

Pathologic Features


Avascular necrosis; resorption, deposition, fragmentation, collapse.
Cause obscure, possibly owing to trauma, vascular vulnerability, and a short ulna.

Radiologic Features
Increased density, lucent areas, articular collapse, decreased size of the lunate.

Spotter 3 - Any Answer ?

Name this condition which usually results in death due to affection of the respiratory system?

See further here : ANSWER

MRS Metabolites

Ref: and for details refer : http://spinwarp.ucsd.edu/neuroweb/Text/mrs-TXT.htm

Ledderhose Disease = Plantar Fibromatosis

XGP Vs Replacement Lipomatosis of Kidney

Xanthogranulomatous pyelonephritis is characterized by microscopic fat infiltration of the renal parenchyma. Fat cells remain outside the atrophied renal parenchyma in replacement lipomatosis.


Reniform shape of the kidney is maintained in both replacement lipomatosis and xanthogranulomatous pyelonephritis.


Both xanthogranulomatous pyelonephritis and replacement lipomatosis are usually unilateral.

DDs for Replacement Lipomatosis 


1.Xanthogranulomatous pyelonephritis (XGP)


Enlarged kidney with preserved shape and decreased function that occurs in the presence of long-standing inflammation and calculi (typically staghorn)


Lipid-laden macrophages actually infiltrate renal parenchyma in contrast to replacement lipomatosis in which fat cells remain outside of the atrophied renal parenchyma


Characterized by renal tissue destruction and replacement with hard, yellow, xanthogranulomatous material


Ultrasound shows hypoechoic areas representing purulent material, as well as medium-amplitude echoes corresponding to the fibrofatty and/or necrotic debris


CT shows hydronephrosis or pyonephrosis along with xanthogranulomatous tissue, which typically has attenuation values close to that of water


XGP and replacement lipomatosis may coexist


2. Lipoma


3. Angiomyolipoma


4. Liposarcoma

Did you know?

Avascular necrosis of Talus secondary to trauma is called as Diaz's disease

Alan Cormack (CT)

Sir Godfrey Hounsfield