RADIOLOGY CASE OF THE WEEK....
This segment is designed to describe various features of the field of Radiology. Each week, a new Radiology case will be shown and discussed. Initially, an image will be shown (Plain Film, CT, MRI, Mammogram, Ultrasound etc.,). A brief patient history will be given. The pertinent observations will be described and a brief discussion of the abnormality will follow. In the near future, cases will be shown and viewers can try to identify the abnormality. I plan to provide a platform where questions may be asked and answered. These are Teaching Cases only and the discussions will be general. Personal medical advice will not be supported. If you have questions or want to discuss these cases, please feel free to contact me at:
CASE # 1 PATIENT WITH ABDOMINAL PAIN Can you see the abnormal finding?
Discussion: This a Chest Radiograph (X-Ray). The grey object in the center of the chest is the HEART. The dark areas which surround the heart are the lungs. At the bottom of the chest, you will notice the diaphragm. This is the muscle which contracts in order to allow fresh air to fill the lungs. Under the right side of the diaphragm, you will notice the dark area which is situated above the soft tissue density which represents the liver. This dark area represents FREE INTRA-PERITONEAL AIR. Normally, air and gas are contained within the gastrointestinal tract. Specifically, the GI tract includes the ESOPHAGUS, STOMACH, SMALL BOWEL AND LARGE BOWEL (COLON). Sometimes, air and gas can leak out of the bowel and collect in the upper portion of the abdomen. PERFORATION is a condition in which a tear or hole allows air or gas to escape from the bowel. This is dangerous because the BACTERIA which normally live in the GI tract can leak out and cause an INFECTION. The causes of a RUPTURED VISCUS include abnormal distention (swelling of the bowel), traumatic injury (such as a knife or gunshot wound) a perforated ulcer in the stomach (gastric acid burns a hole in the lining of the stomach), Diverticulitis (small out-pouchings which are attached to the colon which become infected and may rupture) and an appendix which becomes inflamed and ruptures. In many instances, the location of the leak must be determined by surgical intervention.
Case # 2 Patient with shortness of breath What is the abnormal finding?
This is a CT Exam of the Pulmonary Arteries in the Chest
Blood Clots can form in the vessels in the body. Blood clots that form in the legs are referred to as DEEP VENOUS THROMBOSIS. A blood clot that doesn't move is referred to as a THROMBUS. A blood clot that moves to another location is referred to as an EMBOLUS. These COMPUTED TOMOGRAPHY (CT) images reveal the presence of a large blood clot situated in the right pulmonary artery (see the large , dark material within the white blood vessel) The blood vessel appears to be white because it is filled with contrast material which contains IODINE. This is a dense material which makes it easy to see the normal blood vessels which contain flowing blood. When there is a clot this large, the ability of the right lung to add oxygenated blood is compromised because the blood can't get to the capillaries where the oxygen is added. Also, the right side of the heart has to pump harder in order to overcome this pressure gradient. Right heart strain may occur. This large PULMONARY EMBOLUS may need to be removed mechanically. On the left side you can see the small, linear filling defect in a branch of the left pulmonary artery. Small clots are usually treated with an anticoagulant. This is a drug that prevents the production of more clot. The body's circulatory system produces substances that break down the clot that is present.
I know that this may be confusing, but, in general, arteries carry oxygenated blood and in books, they are colored RED. Veins carry blood that has a lower level of oxygen and are colored BLUE. In the HEART, this is reversed. The pulmonary artery is carrying blood that has provided the body with oxygen. The oxygen is added in the capillary bed and returns to the left side of the heart through the PULMONARY VEIN.
Dr. Rade E. Ology