PhilipsKay Vydareny Imaging Interpretation Competition Finals

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Philips/Kay Vydareny Imaging Interpretation
CompetitionFinals

• Saturday April 28, 2007

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Case 1

• 5 year old female with bilateral lower extremity
  weakness after being thrown by a donkey.

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Everything is Bigger and Better in Texas

• Rodeo is the official state sport of Texas.
• The Houston Livestock Show and Rodeo is the
  largest rodeo in the world with 20 nights of
  rodeo events and concerts.

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Case 2

• 16 year old male with jerking movements and
  hyperaesthesia.

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Case 3

• 3 year old male with scrotal swelling and pain.

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No flow was detected on Doppler interrogation.
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Everything is Bigger and Better in Texas

• Texas Medical Center
• Largest medical center in the world
• 5.3 million patient visits per year
• 13 Hospitals
• 2 Medical Schools
• 4000 physicians
• 1 Billion in current building projects under
  construction

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Case 4

• 62 year old female who has undergone a mastectomy
  and completed radiation therapy for breast cancer
  three months earlier. She now has shortness of
  breath.

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Case 5

• 39 year old male with vertigo.

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Trivia 1

• Dr. Michael E. DeBakey
• Former Chairman of Surgery at Baylor College of
  Medicine
• Well known for his pioneering work in
  cardiovascular surgery

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Trivia 1

• Dr. Michael E. DeBakey
• Spent his early career as a physician in the Army
  during World War II

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Trivia 1

• What was Dr. DeBakeys most famous contribution
  to military medicine?

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Case 6

• 17 year old female with a history of pelvic
  ganglioneuroblastoma treated 15 years earlier.
  She presents to the emergency department with
  constipation.

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Case 7

• 27 year old man with arrhythmias and a left
  ventricular ejection fraction of 42.

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End Diastole
End Systole
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End Diastole
End Systole
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Everything is Bigger and Better in Texas

• The King Ranch in Texas is bigger than the state
  of Rhode Island.

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Case 8

• 40 year old man with multiple myeloma.

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Case 9

• 52 year old man with newly diagnosed
  pheochromocytoma.

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Everything is Bigger and Better in Texas

• In 1860 Longhorn cattle outnumbered people 9 to 1
  in Texas.

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Case 10

• 12 year old girl with recurrent pelvic pain

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Case 11

• 35 year old male presents to the Emergency
  Department after a motor vehicle collision.
• He complains of mild headache.

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Trivia 2

• On July 20, 1969, the human race first set foot
  on the moon during the Apollo 11 mission.

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Trivia 2

• What was the first word spoken from the surface
  of the moon by the astronauts in the Lunar Module?

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• Review

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Case 1

• 5 year old female with bilateral lower extremity
  weakness after being thrown by a donkey.

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Case 2

• 16 year old male with jerking movements and
  hyperaesthesia.

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(No Transcript)
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(No Transcript)
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Case 3

• 3 year old male with scrotal swelling and pain.

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(No Transcript)
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No flow was detected on Doppler interrogation.
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Case 4

• 62 year old female who has undergone a mastectomy
  and completed radiation therapy for breast cancer
  three months earlier. She now has shortness of
  breath.

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(No Transcript)
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Case 5

• 39 year old male with vertigo.

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Trivia 1

• What was Dr. DeBakeys most famous contribution
  to military medicine?

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Case 6

• 17 year old female with a history of pelvic
  ganglioneuroblastoma treated 15 years earlier.
  She presents to the emergency department with
  constipation.

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Case 7

• 27 year old man with arrhythmias and a left
  ventricular ejection fraction of 42.

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End Diastole
End Systole
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End Diastole
End Systole
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Case 8

• 40 year old man with multiple myeloma.

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Case 9

• 52 year old man with newly diagnosed
  pheochromocytoma.

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Case 10

• 12 year old girl with recurrent pelvic pain.

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Case 11

• 35 year old male presents to the Emergency
  Department after a motor vehicle collision.
• He complains of mild headache.

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Trivia 2

• What was the first word spoken from the surface
  of the moon by the astronauts in the Lunar Module?

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Answers
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Case 1

• 5 year old female with bilateral lower extremity
  weakness after being thrown by a donkey.

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Case 1

• Traumatic disruption of the infrarenal abdominal
  aorta

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Traumatic Disruption of the Aorta

• Vesalius credited with first identifying
  traumatic aortic disruption in 16th century in a
  man who had fallen from a horse
• Usually associated with seat-belt injuries and
  Chance fractures

Choit et al J Pediatr Surg 2006411184-1190
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Case 2

• 16 year old male with jerking movements and
  hyperaesthesia.

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Hyperintensity in basal ganglia and cortex on T2
and FLAIR
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Restricted diffusion on DWI and ADC
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Case 2

• Rabies

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Rabies

• Bats, skunks, raccoons, foxes, and coyotes most
  common reservoirs in the U.S.
• Virus replicates in muscle and spreads to CNS,
  where it becomes sequestered.
• Virus then spreads centrifugally via PNS.
• Symptomatic rabies manifests as furious form or
  less common paralytic form.

Mani and Murray Pediatrics in Review
200627129-136
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Case 3

• 3 year old male with scrotal swelling and pain.

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No flow was detected on Doppler interrogation.
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Case 3

• Torsion of the paradidymis

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Paratesticular Appendages
Rolnick J Urol 1968100755-756
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Torsion of the Paradidymis

• Paradidymis, or Giraldes organ
• Composed of remnants of the mesonephric duct
• Located near the lower spermatic cord above the
  epididymal head
• Rarely found, even at autopsy
• Can become symptomatic by encysting and enlarging
  or torsing

Oraxi et al J Clin Ultrasound 198917598-601
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Case 4

• 62 year old female who has undergone a mastectomy
  and completed radiation therapy for breast cancer
  three months earlier. She now has shortness of
  breath.

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Case 4

• Post-radiation BOOP

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Post-radiation BOOP
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Post-radiation BOOP

• Post radiation therapy changes
• Radiation pneumonitis
• Within irradiated field
• BOOP
• Within and outside irradiated field
• Arises months after XRT
• Chronic eosinophilic pneumonia
• Lymphangitis
• Infection (TB)

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Case 5

• 39 year old male with vertigo.

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Case 5

• CN VII schwannoma arising from the greater
  superficial petrosal nerve

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CN VII Schwannoma

• Schwannomas account for 6-8 of intracranial
  neoplasms.
• Most common CN affected is CN VIII, followed by
  V, then VII
• The GSPN is the motor root of the pterygopalatine
  ganglion.
• The GSPN is rarely involved in nerve sheath
  tumors and perineural spread of tumor.

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Trivia 1

• What was Dr. DeBakeys most famous contribution
  to military medicine?

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MASH

• Dr. DeBakey invented the Mobile Army Surgical
  Hospital (MASH) unit, which was first used during
  the Korean War.
• MASH units provided early medical care to wounded
  soldiers and greatly improved their chance of
  survival.

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Case 6

• 17 year old female with a history of pelvic
  ganglioneuroblastoma treated 15 years earlier.
  She presents to the emergency department with
  constipation.

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Case 6

• Radiation-induced osteosarcoma of the left
  superior pubic ramus seen on a background of
  radiation-induced growth arrest of the pelvis.

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Radiation-induced osteosarcoma

• Radiation-induced OS is seen in 0.2-4 of exposed
  patients (6-22 of 2 OS).
• Risk is related to exposure dose, which is
  typically gt 1,000 cGy.
• Other causes of secondary OS include Paget
  disease (67-90 of secondary OS), chronic
  infection, osteonecrosis, fibrous dysplasia, and
  osteogenesis imperfecta.

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Case 7

• 27 year old man with arrhythmias and a left
  ventricular ejection fraction of 42.

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End Diastole
End Systole
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Case 7

• Left ventricular noncompaction

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Left Ventricular Noncompaction

• Caused by arrest of the normal compaction of
  the interwoven fibers of the left ventricle
  during weeks 5 through 8 of embryonic life

Weiford et al., Circulation 2004 1092965-1971.
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Left Ventricular Noncompaction

• MR diagnostic criteria ratio of maximal
  thickness of noncompacted to compacted layers gt2
  in end systole measured in parasternal short axis
  view

Weiford et al., Circulation 2004 1092965-1971.
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Left Ventricular Noncompaction
Abnormal

• Normal

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Left Ventricular Noncompaction

• Caused by arrest of the normal compaction of
  the interwoven fibers of the left ventricle
  during weeks 5 through 8 of embryonic life
• Left ventricular noncompaction may present with
  heart failure, arrhythmias, or embolic events.
• LV dysfunction may range from asymptomatic to
  severe disabling congestive heart failure.

Weiford et al., Circulation 2004 1092965-1971.
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Case 8

• 40 year old man with multiple myeloma.

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Case 8

• Diffuse parenchymal amyloidosis of the lung

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Amyloidosis of the Lung

• Tracheobronchial most common
• Nodular
• Diffuse parenchymal least common
• Graham CM, Stern EJ, Finkbeiner WE, et al.
• AJR 1992 158 265-267.

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Amyloidosis of the Lung

• Can cause respiratory failure.
• Interstitial nodules may become confluent or lead
  to honeycombing.
• DDX IPF, pneumoconioses, miliary Tb, collagen
  vascular diseases, eosinophilic granuloma and
  hypersensitivity pneumonitis.

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Case 9

• 52 year old man with newly diagnosed
  pheochromocytoma.

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Case 9

• Retroperitoneal brown fat activated by
  catecholemine release from pheochromocytoma

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Brown Fat

• Brown fat is a known source of false positive PET
  scans.
• Usually seen in supraclavicular regions, neck,
  axillae and mediastinum.

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Brown Fat

• Both plasma and urinary catecholamines returned
  to normal after surgical excision of the
  pheochromocytoma. The PET scan normalized.
• Ramacciotti C, Schneegans O, Lang H, et al.
• Ann Endocrinol (Paris) 2006 67(1) 14-19

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Case 10

• 12 year old girl with recurrent pelvic pain.

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Case 10

• Herlyn-Werner Syndrome

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Herlyn-Werner Syndrome

• Triad of Herlyn-Werner syndrome
• Uterine fusion anomaly
• Gartners duct cyst
• Ipsilateral renal agenesis

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Herlyn-Werner Syndrome

• Rare malformation of the female genital tract
• Failure of lateral Mullerian duct fusion
• Wolffian duct opens to the urogenital sinus
• Failed ureteric bud sprouting

Gholoum et al J Pediatr Surgery 200641987992
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Herlyn-Werner Syndrome

• Usually asymptomatic until menarche, then
  presents with catamenial pain or a paravaginal
  mass but normal menses
• Prompt diagnosis essential to prevent
  endometriosis and pelvic adhesions

Gholoum et al J Pediatr Surgery 200641987992
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Case 11

• 35 year old male presents to the Emergency
  Department after a motor vehicle collision.

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Case 11

• Epithelioid hemangioendothelioma of bone

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Epithelioid Hemangioendothelioma of Bone

• Rare, well-differentiated tumor with features in
  between hemangioma and angiosarcoma
• Occurs in the calvarium, spine, femur, tibia and
  feet of adults during the third or fourth decade
• More common in males
• Clinically may be asymptomatic or may present
  with pain and swelling of the affected bone.

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Trivia 2

• What was the first word spoken from the surface
  of the moon by the astronauts in the Lunar Module?

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Trivia 2

• Houston
• Houston, Tranquility Base here. The Eagle has
  landed.

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• See you next year in Seattle!