1 Hypothalamic hamartoma - PowerPoint Presentation

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Hypothalamic

hamartoma

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gbs

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Intracranial Hypotension

Etiology: reduced CSF pressure is precipitated by

Surgery ( CSF over shunting) or trauma ( including trivial fall).

Vigorous exercise or violent coughing.

Diagnostic lumbar puncture.

Spontaneous dural tear, ruptured arachnoid diverticulum.

Severe dehydration.

Disc herniation or osteophytes (rare).

Classic Imaging features:

Downward displacement of brain through

incisura

( slumping midbrain).

Diffuse

dural

thickening/ enhancement.

Veins,

dural

sinuses distended.

Subdural

hygromas

/ hematomas.

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Name

artefact

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Phase wrap/aliasing

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Epidermoid

Epidermoid cysts comprise 0.2%–1.8% of primary intracranial

The most common location for epidermoid cysts is the cerebellopontine angle cistern (40%–50%), Epidermoid cysts also occur in the fourth ventricle (17%) and the sellar and/or parasellar regions (10%–15%).

CSF-like mass that insinuates within cisterns, encasing adjacent nerves and vessels.

On CT scans, most epidermoid cysts are well-defined hypoattenuated masses that resemble CSF and do not enhance. Calcification is present in 10%–25% of cases.

Isointense or slightly hyperintense to CSF on both T1- and T2-weighted MR images ,do not suppress completely on FLAIR images and restrict on diffusion-weighted images. Do not enhance, although some minimal rim enhancement occurs in approximately 25% of cases.

Rare “white epidermoids” have high protein content and may appear hyperattenuated on CT scans

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A.CYST

EPIDERMOID

The major differential consideration for the epidermoid cyst is an arachnoid cyst. Arachnoid cysts are isointense to CSF at all sequences, including FLAIR. They displace rather than invade structures such as the epidermoid. Finally, arachnoid cysts do not restrict on diffusion-weighted images

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A

sbestosis

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Orbital blowout fractures

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METASTATIC THYMIC CARCINOID

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METASTATIC THYMIC CARCINOID

most common histologic type for a neuroendocrine tumour of the thymus.

ranges in differentiation and 

behavior

from typical carcinoid to atypical carcinoid to small cell carcinoma.

50% of are functionally active -patients have Cushing syndrome as a result  of

adrenocorticotropic

hormone secretion by the  tumour -

ADRENAL HYPERPLASIA

carcinoid syndrome is uncommonLarge masses -propensity for local invasion. Focal areas of necrosis and punctate calcification may be present

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MYOSITIS OSSIFICANS

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50 yr old female c/o progressive jaundice since 2 months

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CHOLANGIOCARCINOMA

Cholangiocarcinoma is an adenocarcinoma that arises from the bile duct epithelium. It is the second most prevalent liver cancer after hepatocellular carcinoma

These three types of cholangiocarcinoma—extrahepatic, peripheral intrahepatic, and hilar intrahepatic

CT, -irregular mass with markedly low attenuation, minimal peripheral enhancement, and focal dilatation of intrahepatic ducts around the tumor. Thin, incomplete rim enhancement during both the arterial and portal venous phases.

The central part of the tumor does not enhance during these phases, whereas there may be prolonged enhancement at delayed-phase CT.

ancillary findings in peripheral cholangiocarcinoma include capsular retraction and dilatation ,Atrophy and thickening of the peripheral intrahepatic ducts

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RETINOBLASTOMA

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5yr old with failure to thrive,

neurodevelopmental

delay,

pigmentary

retinopathy,

neurosensory

hearing loss, dental caries.

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Cockyane

syndrome

rare autosomal recessive

dysmyelinating

disease. 

Cinical

features include failure to thrive, developmental delay,

cutaneous

photosensitivity, pigmentary retinopathy, neurosensory hearing loss, dental caries, and

cachectic dwarfism. The diagnosis is considered very likely if the first 2 clinical criteria and at least 3 of the other criteria mentioned above are present.major brain atrophycalcifications in the basal ganglia (one of the causes of basal ganglial

calcifications in a child). Calcification may also occur in cerebellar and cerebral cortical region

lack of

myelination

of the white matter

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MRI

There is atrophy which predominantly involves the

supratentorial

 

white matter, the cerebellum, the corpus callosum, and the brain

 

stem

.T2:

calcfication may be seen as low signal in putaminal, dentate nuclear and corticial regions The combination of

demyelination

and basal ganglia calcification may therefore be helpful in the imaging of this entity.

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Mycotic aneurysm of aorta

Infected aneurysm (or mycotic aneurysm) is defined as an infectious break in the wall of an artery with formation of a blind, saccular out-pouching that is contiguous with the arterial lumen

Infected aneurysms are uncommon but can affect any artery The aorta, peripheral arteries, cerebral arteries, and visceral arteries are involved in descending order of frequency

Staphylococcus

and

Streptococcus

species are the most common causes of infected aneurysms

Infected aneurysms can develop from

(a)

hematogenous spread (b) infection of a preexisting intimal defect (c) contiguous involvement or (d)

direct infectious inoculation of the vessel

Early changes of aortitis preceding aneurysm formation include an irregular arterial wall, periaortic edema, a periaortic soft-tissue mass, and periaortic gas

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MUCOPOLYSACHROIDOSIS

Macrocephaly

Delayed myelination

Dilated VR spaces

Hydrocephalous

White matter hyperintensities

J shaped sella

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Congenital cystic

adenomatoid malformation

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SINUS PERICRANII

Fluctuant scalp swelling

Communicating with underlying venous sinus through defect in skull

associated anomalies of deep venous system may be present

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DIAGNOSIS

BASAL CELL NEVUS SYNDROME – GORLIN SYNDROME

Hereditary condition characterized by multiple basal cell carcinomas ,

Odontogenic keratocysts ,palmoplantar pits ,dural calcification ,medulloblastoma

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RADIOLOGIC FEATURES

Odontogenic keratocysts in 80-90%,more common in mandible Calcification of falx in 100% ,calcified tentorium,dura and basal ganglia

Ventriculomegaly

Desmoplastic medulloblastoma

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SARCOIDOSIS

The most common manifestation is bilateral hilar and mediastinal nodal enlargement, which is seen at some stage during the illness in over three quarters of patients . Classically the distribution is of bilateral hilar and right paratracheal nodal enlargement, which is known as the 1-2-3 SIGN or Garland triad

stage 0

 : normal chest radiograph

5 - 10% of patients at presentation

stage I

 : hilar or mediastinal nodal enlargement only

45 - 65% of patients at presentation

60% go onto complete resolution

stage II : nodal enlargement and parenchymal disease 25 - 30% of patients at presentation

stage III

 : parenchymal disease only

15% of patients at presentation

stage IV

 : end-stage lung (pulmonary fibrosis)

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Parenchymal features are varied depending on the individual patient and the stage of disease

reticulonodular opacities most common : 75 - 90% of stage II and III cases .middle and upper zone distribution

bilateral and symmetric

nodularity may be prominent

airspace-like opacities (alveolar sarcoidosis )usually ill-defined and peripheral ,may appear mass-like actually represent interstitial rather than intra-alveolar process

coalescence of multiple ill-defined nodules

end-stage fibrosis occurs in approximately 20% of patients ,permanent coarse linear opacities ,typically radiating laterally from the hilum into the adjacent upper and middle zones ,upward and outward elevation of hila ,distortion of normal distribution of vessels and fissures

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Organoaxial

volvulus

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22 y old male presented with neck mass

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Plunging

ranula