Lytic Distal Femur Lesion (GCT)

Good case of an uncommon solitary lytic bone lesion.

 

This has the 4 hallmarks elaborated in Brandt and Helms:

  1. occurs only with a closed growth plate
  2. abuts articular surface: 84-99% come within 1 cm of the articular surface 1
  3. well defined with non-sclerotic margin (though < 5% may show some sclerosis 8)
  4. eccentric

 

As with most bone tumors, this is not a slam dunk as there are always mimics ranging from fibrous dysplasia to metastatic disease.

 

Advertisements

CSF Leak After Diastematomyelia Operation

I’ll be frank, I don’t have all the details on this but the findings are clear on this animated gif.  If you watch carefully, you can see the pulsation artifact at the site of leak.  There is a rent in the dura and pseudomeningocele in the dorsal soft tissues.

 

ezgif.com-gif-maker.gif

I’m guessing this was a laminectomy for a bony septum producing symptoms.  I have seen these on myelography where the dye pours out as soon as it’s injected.

Portal Vein Thrombosis on Noncontrast CT

I have seen PVT enough to know that it is:

    • Frequently missed
    • Can have bad consequences of portal venous hypertension
    • Management is a bit of a conundrum for clincians and rads.
      • Who to consult?
        • Vascular surgery
        • Heme/onc
        • GI
      • When to follow-up if at all?
        • Additional studies
          • Is an abdominal doppler needed?
      • Treatment
        • Anticoagulation
          • Fraught with difficulty because of the commonly associated cirrhosis and bleeding potential due to PVH/Varices.

 


One of my former colleagues and fellowship trained body imager missed this diagnosis leading to bad sequela of PVH a year later in a young patient.  Perhaps he was spending too much time preening his soul patch instead of fulfilling his primary responsibility to the patient-making the correct diagnosis.

In the images below, I have windowed the CT narrowly to show the contrast between the normal attenuation arterial system and the thrombosed portal venous system.  This makes it hard to see the fat and some of the secondary findings of PVH.  The coronal images below show a more normal window, but are harder to make sense of.

axial nc pvt

I’m presuming this patient has some hypercoagulable state since the patient already has an IVC filter.

cor nc pvt (2)