interesting cases march 2015
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MR, 15 MARCHYasser Asiri, R1
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1) MR Number :1289022 Hx:
77 year-old saudi female known case of congestive heart failure, HCV +ve and old treated TB. She presented with symptom of shortness of breath.
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X-rays
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DDx Bronchogenic carcinoma penumonia. Round atelactasis Abscess. Intrapulmonary sequestration. Hydated cyst. Localized fibrous tumor of the chest wall.
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Dx: Round Atelectasis
Always associated with chronic diseases and adjacent pleural disease.
Represents infolding of the viscreal pleura as isolated area*.
Collapsed lung floating on pleural effusion. Development of fibrous adhesions
suspending the rounded atelectasis area in elevated and tilited position.
Usually the mass 2.5cm to 5 cm in diameter.
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The vessels leading to the mass are crowded, and they tend to diverge and arc as they reach the mass giving the appearance of “comet tail sign”.
-May slowly resolved or remain unchanged on serial CXR or CT scans.
may have air bronchogram.
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To confidently suggest the diagnosis of “Round Atelectasis”: Three criteria must be met:
1. Contiguity with chronic pleural effusion/thickening.
2. Typical appearance of crowded vessels and bronchi sweep into the base of the atelectatic lung.
3. Volume loss in the affected lobe.
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2) 618104 Hx:71 year-old Saudi male presented to the
hospital with intestinal obstruction and hematemesis.
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DDx Hiatal hernia. Forgut duplication cyst. Diaphramatic rupture. Retrocardiac lung abcess.
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Diaphramatic Hernia Congenital defect:o Bochdalek hernia.o Morgangi hernia.
Aquired defect:o Trumatic diaphragmatic rupture.o Hiatus hernia.
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Hiatal hernia Protrusion of portion of the stomach into the
thorax.
There are two types: Sliding type : Most common 95% , GEJ is above the
diaphragm.
Paraesophageal type: 5% , GEJ in normal position below the
diaphragm.
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Part of the fundus herniated above the diaphragm through the hiatus and lies along side of the esophagus.
More prone to complications.
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Imaging features: Gastric folds above the diaphragm. Concentric indentation (B-lines) above
the diaphragm.
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Phrenic ampulla: no gastric mucosa. A-ring: (for Above) indentation at the upper boundary of the ampulla.B-ring: (for Below) indentation at the lower boundary of the ampulla.Z-line: ( Zigzag line) squamoculominal junction between the stomach and esophagus.
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Association: Esophagitis 25%. Doudenal ulcers 20%
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Complication Gartic volvuls. Strangulation and obstruction. Ischemia and infarction.
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Thank You