Good case of an uncommon solitary lytic bone lesion.
This has the 4 hallmarks elaborated in Brandt and Helms:
- occurs only with a closed growth plate
- abuts articular surface: 84-99% come within 1 cm of the articular surface 1
- well defined with non-sclerotic margin (though < 5% may show some sclerosis 8)
As with most bone tumors, this is not a slam dunk as there are always mimics ranging from fibrous dysplasia to metastatic disease.
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.
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.
That’s a lot of adenopathy. So much so that it might be a 50/50 mix of normal organs to LAN. There is also an acute segmental PE in the RLL. You have to look hard on the GIF to find it.
I can’t remember ever seeing axillary adenopathy this severe.
Big and kinda scary looking at first glance. The important thing is to follow the blood pool (aorta) and watch what the mass does. Here we see centripetal filling on a 4 phase liver study.
Another extreme case. Biggest and most asymmetric alveolar ridge maxillary tori I’ve seen.
Don’t think I’ve ever seen one quite this large and without a displaced fracture. Impressive.
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
- When to follow-up if at all?
- Additional studies
- Is an abdominal doppler needed?
- 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.
I’m presuming this patient has some hypercoagulable state since the patient already has an IVC filter.