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PhilipsKay Vydareny Imaging Interpretation Competition Finals

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Title: PhilipsKay Vydareny Imaging Interpretation Competition Finals


1
Philips/Kay Vydareny Imaging Interpretation
CompetitionFinals
  • Saturday April 28, 2007

2
Case 1
  • 5 year old female with bilateral lower extremity
    weakness after being thrown by a donkey.

3
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4
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5
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.

6
Case 2
  • 16 year old male with jerking movements and
    hyperaesthesia.

7
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8
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9
Case 3
  • 3 year old male with scrotal swelling and pain.

10
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11
No flow was detected on Doppler interrogation.
12
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

13
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.

14
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15
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16
Case 5
  • 39 year old male with vertigo.

17
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18
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19
Trivia 1
  • Dr. Michael E. DeBakey
  • Former Chairman of Surgery at Baylor College of
    Medicine
  • Well known for his pioneering work in
    cardiovascular surgery

20
Trivia 1
  • Dr. Michael E. DeBakey
  • Spent his early career as a physician in the Army
    during World War II

21
Trivia 1
  • What was Dr. DeBakeys most famous contribution
    to military medicine?

22
Case 6
  • 17 year old female with a history of pelvic
    ganglioneuroblastoma treated 15 years earlier.
    She presents to the emergency department with
    constipation.

23
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24
Case 7
  • 27 year old man with arrhythmias and a left
    ventricular ejection fraction of 42.

25
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26
End Diastole
End Systole
27
End Diastole
End Systole
28
Everything is Bigger and Better in Texas
  • The King Ranch in Texas is bigger than the state
    of Rhode Island.

29
Case 8
  • 40 year old man with multiple myeloma.

30
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31
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32
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33
Case 9
  • 52 year old man with newly diagnosed
    pheochromocytoma.

34
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35
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36
Everything is Bigger and Better in Texas
  • In 1860 Longhorn cattle outnumbered people 9 to 1
    in Texas.

37
Case 10
  • 12 year old girl with recurrent pelvic pain

38
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39
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40
Case 11
  • 35 year old male presents to the Emergency
    Department after a motor vehicle collision.
  • He complains of mild headache.

41
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42
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43
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44
Trivia 2
  • On July 20, 1969, the human race first set foot
    on the moon during the Apollo 11 mission.

45
Trivia 2
  • What was the first word spoken from the surface
    of the moon by the astronauts in the Lunar Module?

46
  • Review

47
Case 1
  • 5 year old female with bilateral lower extremity
    weakness after being thrown by a donkey.

48
(No Transcript)
49
(No Transcript)
50
Case 2
  • 16 year old male with jerking movements and
    hyperaesthesia.

51
(No Transcript)
52
(No Transcript)
53
Case 3
  • 3 year old male with scrotal swelling and pain.

54
(No Transcript)
55
No flow was detected on Doppler interrogation.
56
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.

57
(No Transcript)
58
(No Transcript)
59
Case 5
  • 39 year old male with vertigo.

60
(No Transcript)
61
(No Transcript)
62
Trivia 1
  • What was Dr. DeBakeys most famous contribution
    to military medicine?

63
Case 6
  • 17 year old female with a history of pelvic
    ganglioneuroblastoma treated 15 years earlier.
    She presents to the emergency department with
    constipation.

64
(No Transcript)
65
Case 7
  • 27 year old man with arrhythmias and a left
    ventricular ejection fraction of 42.

66
End Diastole
End Systole
67
End Diastole
End Systole
68
Case 8
  • 40 year old man with multiple myeloma.

69
(No Transcript)
70
(No Transcript)
71
(No Transcript)
72
Case 9
  • 52 year old man with newly diagnosed
    pheochromocytoma.

73
(No Transcript)
74
(No Transcript)
75
Case 10
  • 12 year old girl with recurrent pelvic pain.

76
(No Transcript)
77
(No Transcript)
78
Case 11
  • 35 year old male presents to the Emergency
    Department after a motor vehicle collision.
  • He complains of mild headache.

79
(No Transcript)
80
(No Transcript)
81
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82
Trivia 2
  • What was the first word spoken from the surface
    of the moon by the astronauts in the Lunar Module?

83
Answers
84
Case 1
  • 5 year old female with bilateral lower extremity
    weakness after being thrown by a donkey.

85
(No Transcript)
86
(No Transcript)
87
Case 1
  • Traumatic disruption of the infrarenal abdominal
    aorta

88
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
89
Case 2
  • 16 year old male with jerking movements and
    hyperaesthesia.

90
Hyperintensity in basal ganglia and cortex on T2
and FLAIR
91
Restricted diffusion on DWI and ADC
92
Case 2
  • Rabies

93
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
94
Case 3
  • 3 year old male with scrotal swelling and pain.

95
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96
No flow was detected on Doppler interrogation.
97
Case 3
  • Torsion of the paradidymis

98
Paratesticular Appendages
Rolnick J Urol 1968100755-756
99
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
100
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.

101
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102
Case 4
  • Post-radiation BOOP

103
Post-radiation BOOP
104
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)

105
Case 5
  • 39 year old male with vertigo.

106
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107
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108
Case 5
  • CN VII schwannoma arising from the greater
    superficial petrosal nerve

109
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110
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.

111
Trivia 1
  • What was Dr. DeBakeys most famous contribution
    to military medicine?

112
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.

113
Case 6
  • 17 year old female with a history of pelvic
    ganglioneuroblastoma treated 15 years earlier.
    She presents to the emergency department with
    constipation.

114
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115
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116
Case 6
  • Radiation-induced osteosarcoma of the left
    superior pubic ramus seen on a background of
    radiation-induced growth arrest of the pelvis.

117
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.

118
Case 7
  • 27 year old man with arrhythmias and a left
    ventricular ejection fraction of 42.

119
End Diastole
End Systole
120
Case 7
  • Left ventricular noncompaction

121
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.
122
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.
123
Left Ventricular Noncompaction
Abnormal
  • Normal

124
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.
125
Case 8
  • 40 year old man with multiple myeloma.

126
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127
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128
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129
Case 8
  • Diffuse parenchymal amyloidosis of the lung

130
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.

131
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.

132
Case 9
  • 52 year old man with newly diagnosed
    pheochromocytoma.

133
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134
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135
Case 9
  • Retroperitoneal brown fat activated by
    catecholemine release from pheochromocytoma

136
Brown Fat
  • Brown fat is a known source of false positive PET
    scans.
  • Usually seen in supraclavicular regions, neck,
    axillae and mediastinum.

137
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

138
Case 10
  • 12 year old girl with recurrent pelvic pain.

139
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140
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141
Case 10
  • Herlyn-Werner Syndrome

142
Herlyn-Werner Syndrome
  • Triad of Herlyn-Werner syndrome
  • Uterine fusion anomaly
  • Gartners duct cyst
  • Ipsilateral renal agenesis

143
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
144
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
145
Case 11
  • 35 year old male presents to the Emergency
    Department after a motor vehicle collision.

146
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147
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148
Case 11
  • Epithelioid hemangioendothelioma of bone

149
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.

150
Trivia 2
  • What was the first word spoken from the surface
    of the moon by the astronauts in the Lunar Module?

151
Trivia 2
  • Houston
  • Houston, Tranquility Base here. The Eagle has
    landed.

152
  • See you next year in Seattle!
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