RSNA2018：Tuesday Case of the Day（Unknown Cases）

RSNA2018每日病例挑战（3）

Tuesday Case of the Day

Breast Imaging

Ramapriya Ganti MD, PhD, Lindsay Compton MD, Jessica H. Porembka, MD

University of Texas Southwestern Medical Center, Dallas, TX

History: 67 year old woman with a rapidly enlarging palpable concern in the right breast for 2 months.

Figure 1: MLO (A) and magnification (B) views of the right breast from diagnostic mammogram. Metallic marker indicates palpable area of concern. (C) Ultrasound at the site of the palpable lump. (D) CT of the chest through the level of the right breast. (E) Nuclear medicine whole body bone scan.

Tuesday Case of the Day

Cardiac

Authors: Carlos S. Restrepo M.D., Ameya Baxi M.D., Sachin S Saboo, M.D.

University of Texas Health Science Center, San Antonio, TX

History: 42 y/o Caucasian woman from Texas with progressive dyspnea. PMH of congenital aortic stenosis (AS) with surgery at 3 years of age (Ross procedure) & recurrent AS with aortic valve replacement twice (St Jude). H/o single vessel CABG to RCA. Echo reveals severe right ventricular outflow obstruction, pulmonic valve stenosis and normal ventricular systolic function. Normal WBC count. CTA and MRI done to better define cardiac anatomy and myocardial viability.

SAX- LGE

Short Axis CTA

4 Ch- LGE

Axial CTA

Tuesday Case of the Day

CHEST

Authors: Lauren K. Groner DO, Daniel B. Green MD

Weill Cornell Medicine, New York, NY

History: 66 year-old man from Uruguay with granulomatosis with polyangiitis(formerly known as Wegener’s granulomatosis) presents with hemoptysis.

Figure 1: Non-contrast chest CT; three axial images (a-c) and one coronal image (d)

Tuesday Case of the Day

Category: ER

Authors: Prasaanthan Gopee-Ramanan, HBSc, RTR, MD1, Vincent M. Mellnick, MD2, Douglas S. Katz, MD, FACR, FSAR, FASER3, Michael N. Patlas, MD, FRCPC, FSAR1

1Department of Radiology, McMaster University, Hamilton, ON, Canada

2Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

3Department of Radiology, NYU Winthrop Hospital, Mineola, NY, USA

History:  37 year-old-man with a single stab injury to the right upper quadrant. Which abnormality requires an urgent surgical consultation?

Figure 1. Axial CECT on admission.

Tuesday Case of the Day

Gastrointestinal

Authors:

Richard Tsai MD, Maria Zulfiqar MD, Anup Shetty MD

Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis MO

History: 72-year-old woman with history of renal cell carcinoma presenting with epigastric and left upper quadrant pain.

Axial (a,b,c) and coronal (d) contrast-enhanced CT images through the abdomen.

Genitourinary Tuesday Case of the Day

Peter Hoang, MD; Mark D. Sugi, MD; Akira Kawashima, MD 

Melanie Caserta, MD; Christine (Cooky) Menias, MD

Mayo Clinic, Scottsdale, AZ

Clinical History: 46-year-old male with right epididymal pain.

Axial T2 TSE with Fat Saturation

Coronal T2 HASTE

Tuesday Case of the Day

Vascular and Interventional

Authors: Resmi Charalel MD*, Sailen G. Naidu  MD, Ji Buethe MD, Dan Scher MD and Robert Liddell MD

*Weill Cornell Medical College, New York, New York

History: 73 year old female with episodes of loss of consciousness.

Figure 1: Celiac digital subtraction angiography (DSA) arterial phase

Figure 2: Celiac digital subtraction angiography (DSA) late phase (venous phase)

Tuesday Case of the Day: Molecular Imaging

Authors: Andrew Kozlov MD1, David A. Mankoff MD PhD1, Amy S. Clark MD2, Austin R. Pantel MD 1

1Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Hospital of the University of Pennsylvania

2Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania

History: 62-year-old woman with chronic lymphocytic leukemia and left breast invasive ductal carcinoma is evaluated with an investigational estrogen receptor radiotracer (A) and restaging FDG PET (B). 

Figure 1: MIP PET images of an investigational estrogen radiotracer. 

Figure 2:  MIP FDG PET images

What is the most appropriate diagnosis based on the presented images

Tuesday Case of the Day

MSK

John S. Symanski, MD and Sujan Fernando, MD

Medical College of Wisconsin

History: 32-year-old man with waxing and waning knee pain for one year

Figure 1: AP Radiograph

Figure 2: Lateral Radiograph

Figure 3: Coronal T2 FS

Figure 4: Axial T1

Tuesday Case of the Day

Neuroradiolgy

Authors: Hilary LP Orlowski, MD; Rami Eldaya, MD; Matthew S. Parsons, MD

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO

History: 7-year-old girl with progressive hearing loss for two months. 

Figure 1:  Axial T2-weighted image (A). Axial Diffusion-weighted image (B). Sagittal T1-weighted post-contrast image (C). Axial non-contrast CT image (D).

Tuesday Case of the Day

Category Nuclear Medicine

Authors: Tarun Jindal, MD; Monica Gerst, MD; Yashesh Shah, MD; Andrew Kaiser, MD; Eric Hu, MD; Levi Sokol, MD; Richard K.J. Brown, MD FACR

University of Michigan

History: 58 year old female with renal failure and joint pain. Evaluate for     inflammatory arthritis.

Figure #1: MDP Bone Scan with SPECT-CT

Tuesday Case of the Day

Obstetrical imaging

Authors: Jonathan Revels, DO; Theodore Dubinsky MD, FSAR, FSRU Mariam Moshiri, MD, FSAR, FSRU 

University of Washington, Seattle, WA

History: *28 year old female G1P2 with previous cesarean section, and 20 week 6 day intrauterine gestation evaluated for routine anatomy.

Figure 1: 

a) Sagittal B-mode US cine sweep through the lower uterine segment, 

b) color Doppler image of lower uterine segment，

C-e) T2WI MR images in axial, sagittal, coronal projection cine loops. 

Tuesday Case of the Day

Pediatric

Arnold C. Merrow, MD1, David Dansie, MD2, Ting Y. Tao, MD, PhD3, Alisa Kanfi, MD4, Michael Aquino, MD, MS5, Luke L. Linscott, MD2

1Cincinnati Children’s Hospital Medical Center, 2Primary Children’s Hospital, 3Cardinal Glennon Children’s Hospital, 4University of Cincinnati Medical Center, 5Toronto Hospital for Sick Children

History: 3-year-old with painless knee mass.

Figure 1: Axial T1W MRI

Figure 2: Sagittal STIR MRI

Figure 3: Sagittal T1W C+ FS MRI

Tuesday Case of the Day

Physics

Authors: Ryan Griesbach, MD and Lori Mankowski Gettle, MD, MBA

Authors affiliation: UW Hospitals and Clinics, Madison WI

History:

Multiphase gadolinium enhanced MRI of the kidneys was performed. Delayed imaging shows a dark area within the right renal collecting system on T1 and T2 weighted images. No corresponding dark focus was seen on the pre-contrast images. Likewise no corresponding abnormality was present on recent prior CT. What is the source of the dark area?

A. Punctate renal stone.

B. Signal void due to T2 shortening at higher gadolinium concentrations.

C. Aliasing of high signal from gadolinium T1 shortening.

D. Inhomogeneity within the main magnetic field.

Tuesday Case of the Day

Category Ultrasound

Authors: David P. Burrowes MD2 and Aya Kamaya MD1

Department of Radiology, Stanford University, Stanford, CA1Department of Radiology, University of Calgary, Calgary, AB2

History: 30 year old female with chronic, recurrent right upper quadrant pain.  Diagnosis?

Figure 1: Sagittal grayscale ultrasound cine view of the right kidney with Valsalva and relaxation in the supine position

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FROM：http://archive.rsna.org/2018/Final%20Unknown%20Cases%2011.12.18.pdf