Slideshow: Imaging of Facial Trauma

Slideshow: Imaging of Non-traumatic Intracranial Hemorrhages

Imaging of Non-traumatic Intracranial Hemorrhage from Rathachai Kaewlai

Prepare for AOCR 2014

This year, the largest radiology meeting in Asia will be held in Kobe, Japan!

Many big names in radiology from around the world will be joining as invited speakers including JKT Lee, AR Margulis, M Prokop, D Resnick and H Hricak.

Scientific programs include all radiology subspecialties with interesting additions of IT, Radiation Safety and Emergency Radiology.

Kobe is an international port city with a long historical importance. The city is famous for European bakeries, Kobe beef, and fresh seafood. Sightseeing spots like Kyoto, Osaka, Nara and Hiroshima are reachable by day trips. During this time of the year, Kobe temperature ranges between 21 and 29 degrees Celsius. 

Details and registration information can be found at this LINK.

Enhanced Intervertebral Disc in Post-discectomy Patients

Sagittal, fat-suppressed T1W MR images of the spine without (above) and with (below) IV contrast show two band enhancement of L4/5 disc (arrows), which parallel to the endplates of an asymptomatic post remote-discectomy patient. 

 Facts: Imaging of Postoperative Lumbar Discectomy

• Intervertebral disc enhancement, annular enhancement and vertebral body enhancement are generally suggestive signs of disc space infection in post-discectomy patients
• However, some patients without clinical signs/symptoms of infection may have abnormal enhancement of disc/endplate and annulus. 
• In a study of 94 patients without clinical infection, post-operative MRI (3-6 months after surgery) shows anular enhancement in almost all cases and 20% of patients have disc enhancement that are not present on preoperative MRI
• Suggestive pattern of "incidental" enhancement: linear enhancement within the disc (two thin bands paralleling the end plates). Authors postulate that this could be due to accelerated degenerative disc change, unrelated to infection

Reference:

Ross JS, Zepp R, Modic MT. The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk. AJNR Am J Neuroradiol 1996;17:323-331.

Tracheal Bronchus

Axial and coronal-reformatted CT images in a patient with tuberculosis of the right upper lobe (stars) show a tracheal bronchus (arrows) arising from the right lateral wall of the trachea, within 2 cm of the carina. Note a normal-appearing right upper lobe bronchus (arrowhead). 

Facts

• Abnormal bronchus arising directly from the lateral wall of the trachea (on either side, but right side is more common), supplying the upper lobes
• 0.1% - 2% incidence
• Most cases are found incidentally on bronchoscopy or CT
• Associated with other anomalies such as ribs, vertebrae

Types

• Two types: displaced, or supernumerary
• "Displaced" type = RUL bronchus or any of its segmental bronchus in cephalad location than normal. If the entire RUL bronchus arises from tracheal wall, it is called "bronchus suis"
• "Supernumerary" type = normal RUL bronchus and its segmental bronchi but there is extra bronchus arising directly off the lateral wall of the trachea

Clinical implications

• In children, it is associated with recurrent infections, stridor, respiratory distress and thoracic masses
• In adults, it can complicate endotracheal intubation (occlusion or accidental intubation of a tracheal bronchus can cause atelectasis)

Our case: supernumerary bronchus arising from the right lateral wall of the trachea. The patient presented with TB of the right upper lobe. 

Reference:

Aoun NY, et al. Tracheal bronchus. Respir Care 2004;49:1056-8.