Blogs

Fate’s Triple Whammy
January 24, 2020
This is an alert 86-years old man who has been treated successfully earlier for carcinoma colon and prostate. He had weight loss and a repeat PET shows liver lesions and a lesion in the left iliac bone. The question was which tumor spread did these lesions represent, colon (most likely) or prostate (less likely) or both.A CT guided biopsy of the left iliac lesion was done, which to everyone’s surprise showed that this was a metastatic lesion from a liver primary, essentially...
Try and Try Till You Succeed - A Lymphoma Story
January 24, 2020
This is a 77-years old man who presented with progressive increase in size of nodes and skeletal lesions, seen well on the PET. The left para-aortic retroperitoneal node was easy to access. The biopsy however showed only lymphoid tissue with microgranulomas, essentially non-diagnostic. This didn’t make sense, so I pushed and managed to convince the patient and his treating doctor to let me biopsy the right sacral ala lesion. The PET showed marked uptake with some rarefaction...
Adult Tetralogy of Fallot
January 14, 2020
This is a 38-years old man who presented for the first time with breathlessness. The echo showed a perimembranous ventricular septal defect (VSD) and pulmonary arterial hypertension (PH). The MRI shows the perimembranous VSD, the aorta subtending the RV & LV and infundibular hypertrophy with resultant RVoT obstruction. To find a tetralogy of Fallot morphology presenting for the first time at this age is highly unusual. #adulttcongenital #congenitalheartdisease #ToF #tetra...
DOTA-PET - How it Changes the Game
January 13, 2020
This is a 64-years old man who presented with cough. There was a mass occluding the left lower lobe bronchus with post-obstructive changes in the subjacent lower lobe. The minIP shows this well. A PET/CT done prior to the biopsy showed mild uptake with no other lesion in the body. A biopsy showed carcinoid. A DOTA-PET was then performed, which to our surprise showed extensive skeletal metastatic disease.DOTA-PET is more sensitive than FDG-PET when it comes to neuroendocrine ...
Occipital Condylar TB - One More Unusual Site
January 10, 2020
This is a 22-years old lady who presented with neck pain with painful movements. An MRI showed an osteolytic lesion involving the right occipital condyle (axial T2) and the adjacent occipito-atlantal joint (sagittal T2). She was sent for a biopsy. We did a contrast CT to understand the anatomy of the lesion and found that there was easy access with the vertebral artery inferior to the lesion and not in the path of the needle. Frank pus was aspirated that was PCR positive for...
Endobronchial TB - The Power of MinIPs
January 10, 2020
This is a 64-years old lady with chronic cough. She had an earlier CT in 2008 showing calcified mediastinal nodes. The current CT shows that the subcarinal node is calcified and causes narrowing of the intermediate bronchus. The minIP image in the coronal plane shows it the best and makes it very easy to appreciate and understand the pathology. Bronchoscopy showed endobronchial nodules, positive for active tuberculosis. #tuberculosis #endobronchialTB #minIP ...
The Lost Art of Plain Radiograph Interpretation
January 7, 2020
This 56 years old man was referred for a CT guided biopsy on the basis of an MRI report of an osteolytic lesion at D10 with abnormal soft tissue.The MRI showed a fracture extending from the anterior to the posterior elements. I then looked at the radiographs, which showed frank ankylosing spondylitis.This has never been picked up. The patient effectively had a fracture through D10, essentially a pseudarthrosis / Andersson lesion and he did not need a biopsy.  ...
Congenital Lobar Emphysema (CLE)
January 3, 2020
This 3 years old boy came with sudden breathlessness. A simulated radiograph from the CT scan images shows increased lucency of the left upper and mid-zones, which on the axial CT scan is seen a left upper lobe overinflation due to a high-grade stenosis of the left upper lobe bronchus (arrow). The minIP image shows this well (arrow). The operated overinflated lung is seen in the last panel.  ...
GIST
January 3, 2020
This 74-years old man came with a retro-gastric mass picked up on USG. He had some non-specific complaints. The CT scan shows a mass with a typical “target” appearance. The MRI shows a variegated appearance that is typical of a gastro-intestinal stromal tumor (GIST). A CT guided biopsy confirmed the diagnosis. ...
Portal Nodal Tuberculosis
January 1, 2020
This 24-years old man had fever every night starting April 2019, when a CT scan showed necrotic portal nodes. A biopsy could not be done at the time and he was not put on any treatment. He came in the 3rd week of Dec, with an increase in the size of the nodes. A trans hepatic CT guided biopsy yielded pus and the PCR (GeneXpert) on the same day was positive for TB, with rifampicin resistance. ...
Head-Cheese Sign
December 31, 2019
This has nothing to do with cheese, but represents a mish-mash of meat made from the head of a calf or pig. This variegated appearance when seen in a patient with interstitial lung disease (ILD), suggests fibrotic hypersensitivity pneumonitis as mentioned. The blue arrow points to the ground-glass, the green to the area of air-trapping and the red to a normal spared lung lobule. ...
Mounier-Kuhn disease
December 30, 2019
60-years old man with treated for asthma. CT chest shows bronchiectasis. The trachea and bronchi show diverticular disease, which is beautifully captured in the minIP images. MinIP is an excellent tool for depiction of tracheo-bronchial disorders like these. ...
Not all spine infection is tuberculosis
December 27, 2019
56-years old lady presented with backache. MRI shows infectious spondylitis at L5/S1. The CT scan shows similar findings. While in India, tuberculosis is commonest infection to present in this manner, other infections can also behave similarly. Hence they need to be biopsied.Her culture showed Burkholderia infection.Always biopsy!!! ...
Superadded tumors in ILDs are not uncommon
December 26, 2019
55-years old with chronic hypersensitivity pneumonitis. Her routine CT scan in September 2018 showed a focal lesion in the lingula, either infection or tumor. She was not worked up and a follow-up scan 15 months later showed increase in the size of this lesion with irregular margins and air-bronchiolograms. A biopsy showed adenocarcinoma with a lepidic pattern of growth. #ILD #interstitial lung diseases #Ctscan #adenocarcinoma #lungcancer #hypersensitivitypneumonitis ...
Lungs of stone
December 25, 2019
19-years old boy with gradually progressive breathlessness. Pulmonary alveolar microlithiasis (PAM) is one of those rare situations, where the radiograph is a spot diagnosis compared to the CT scan. The CT scans show the “black pleura” sign along with subtle subpleural and peri-lymphatic calcification / ossification. The soft tissue windows show the calcification / ossification better. Septal thickening in the lower lobes is a common manifestation. #alveolarmicrolithias...
Always do a CT in patients with unexplained marrow edema
December 24, 2019
20-years old girl with back pain since Feb 2019. MRI of Apr 2019 showed right L4 pedicle marrow edema. Nothing was done. Her pain continued and a repeat MRI of October 2019 showed the same marrow edema. She had typical pain that was more at night and responded to anti-inflammatory drugs. She was sent for a biopsy. We did a CT scan that showed a classic osteoid osteoma at the tip of the superior articular facet of the L4 vertebra, that we subsequently did an RFA for.#osteoido...