RADIOLOGY CASE OF THE WEEK presented by Dr. Rade E. Ology


Signal Intensity!

While screening mammography is recommended for most female  patients, there are situations when MRI may be of better diagnostic value. For example, women with dense breast tissue may benefit from an MRI exam because the dense breast tissue makes it difficult to see some cancers. Also, women who are at higher risk of developing breast cancer (ie., positive family history of breast cancer) may benefit. Many different MRI sequences as well as administration of gadolinium (contrast material) facilitate the search for breast cancers and other lesions.



A person whose sex assigned at birth was male but whose gender identity is female.

This mammogram has the appearance of a female patient's breast. Although the patient was born a male, she has developed prominent breast tissue because of years of taking estrogen which stimulates the growth of breast tissue. Although the breast tissue resembles a female breast mammographically, the ducts do not produce milk. In other words, this person could not breastfeed a baby. Male patients may develop tenderness and a lump beneath the nipple. The classic "flame shaped" area of increased density in this region is referred to as gynecomastia. Certain medications may cause gynecomastia, which may be symmetric or asymmetric.


Very Marked Enlargement of the Spleen

MYELOFIBROSIS (MF) is a rare and advanced myeloproliferative neoplasm that disrupts the body's normal production of blood cells. With this disease, there is scarring/fibrosis of the bone marrow. EXTRAMEDULLARY HEMATOPOIESIS is the production of blood elements outside of the bone marrow. One of the major sites of extramedullary hematopoiesis occurs in the spleen. In this case, the spleen measures 25 cm in length (normal is around 10 cm). The patient's liver is normal in size (16 cm).



This patient lost his balance and fell and hit his head.  In most cases, the most  important finding is an intracranial bleed. This is when the blood vessels in the brain itself are torn or there may be disruption of blood vessels around the brain. Because the intracranial space  is so compact, blood and fluid is incompressible and it pushes on or displaces the brain. This can cause difficulty in breathing if the brianstem is involved. Speech and vision can be affected if other parts of the brain are involved. This is a fracture of the upper part of the cervical spine. This was the very first image of the brain and was actually  below the level that brain CT exams usually begin. This observation prompted a formal CT exam of the cervical spine. These first few images revealed a fracture of the right side of the posterior arch of C-1 (shown) and a fracture of the lateral aspect of the  right facet of the second vertebral body.


Kidney Cancer

Look at the appearance of the kidneys. The right kidney exhibits a normal shape (RENIFORM). The left kidney, however, is lumpy bumby in shape. Also, because of the presence of the mass/ tumor, it is ENLARGED. Normal kidney cells can become cancerous. This will likely compromise kidney function. Because it is MALIGNANT, the tumor may invade the blood supply of the kidney and go to other areas in the body. This is referred to METASTATIC  disease. It spreads through a process called HEMATOGENOUS DISSEMINATION. The usual treatment may be removal of the entire kidney (NEPHRECTOMY). For smaller tumors, only a portion of the kidney may be surgically removed  (PARTIAL NEPHRECTOMY). For even smaller tumors, an ABLATION procedure may be performed. This is a procedure that basically VAPORISES the tumor.



Patient History: Headaches

Notice the large mass on the right side. Is it a brain tumor? Perhaps, but it may be a tumor of the covering of the brain ( ie., a MENINGIOMA. A meningioma is a benign tumor which originates from the covering of the brain. This is called the DURA. Notice the mass effect that pushes the brain towards the left. Notice how the mass and associated swelling press in on the right lateral ventricle. The dark area around this mass is called VASOGENIC EDEMA. Although this tumor is histologically benign, it presents in a malignant fashion. Surgical removal is likely the method of treatment.  A BRAIN TUMOR is a tumor of the brain itself. This type of tumor usually has surrounding edema  (swelling) as well. There was one finding which leaned me toward meningioma as I came up with my DIFFERENTIAL DIAGNOSIS. On the bone window settings (images that show  the bone detail of the skull), there was irregularity of the inner table (inside surface) of the skull right where the mass is. A tumor of the brain (INTRA-AXIAL lesion) would likely not cause such bony destruction.


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