Posts

Viral Pneumonia

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This is just a refresher of how lungs look like in cases of a severe viral pneumonia. Findings on both X-ray and CT are nonspecific for COVID-19 but those are the findings we can see. The important factor is progression of the lung changes and diffuse distribution in both lungs. There is some predilection for the peripheral and lower parts of the lungs. Opacities are more diffused of type "ground glass" compared to more dense in bacterial pneumonia. Increased interstitial pattern can be seen. The end result in severe cases is diffuse lung edema or ARDS that leads to death.


85 years old patient with heart failure. Note diffuse, mostly interstitial opacities in both lungs especially in the right upper lobe and apical segment of the left lower lobe.


57 years old patient, shortly on respirator that died with cause of death officially announced as heart failure. Note diffuse predominantly interstitial "ground-glass" opacities most prominent in the left upper lobe.



Same …
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STR COVID-19 Position Statement - March 10, 2020

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STR - Society of Thoracic Radiology just published a video about radiological findings of COVID-19. Here is a link to this video: https://veritastv.org/programs/covid-19
Here are some important points:

Complex RNA virus from SARS family that easily mutates. Causes respiratory distress requiring Intensive Care.

WHO hoping that it will burn out in July like SARS. That's why isolation is important.

 However it is more serious than SARS - data per 2020-03-10.

It plateaus in China but goes up in Europe as for 2020-03-10.















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2 small abscesses

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Immunocompromised patient presents with ring-enhancing subcortical expansivities with perifocal oedema. MRI was performed (not shown) suggesting 2 small abscesses. Patient was set on antibiotics.


Control MRI after one month shows on axial T1 without- and with contrast slightly decreased size of ring enhancing expansivities.



Both small abscesses are still enhancing.


There is still perifocal vasogenic edema seen on axial FLAIR and T2 weighted sequences. Note on T2 a well defined low signal rim of the abscesses.


Diffusion weighted imaging showing central diffusion restriction (high signal on DWI and low on ADC-map).

Numerous pathologic entities show as ring-enhancing lesions therefore it is important to include patient's history in evaluation. Here the biggest clue is restricted diffusion. However hemorrhage can also show restricted diffusion due to high protein content as well as rim of hemosiderin on T2.

You can also check my other cases related to this topic:

Abscess and Subdural …
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101 years old brain

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Yes, as you can see in the title this (female) person is 101 years old. I wanted to show those images as an example of "successful aging". There is some cortical atrophy (GCA 2), some temporal atrophy (MTA 1 right and 2-3 left) as well as some central atrophy and slight atrophy in corpus callosum. Brainstem and cerebellum show no significant signs of atrophy. There is an old lacunar infarction medially in the left thalamus and some ischemic changes in the anterior parts of the left internal capsule but without signs of extensive microvascular disease. By simply looking at the brain I would estimate the age at about 80. BTW. It is known that the atrophy tends to progress in logarithmic and nonlinear fashion - meaning that you see more progression of atrophy in advanced age compared to less change in the younger ages - as a general rule of aging. However of course there are exceptions to this rule.
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Cytotoxic Lesions Of the Corpus Callosum (CLOCCs)

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45 years old patient on antiepileptic (lamotrigine) and antidepressant medication. Presents with unspecific neurological symptoms. MRI without contrast shows diffusely demarcated oval lesion with edema in splenium of corpus callosum.


Diffusion weighted imaging shows restricted diffusion with high signal on DWI and low on ADC corresponding with cytotoxic edema. However location is not specific for infarction. Given the history of treatment together with appearance of the lesion the Cytotoxic Lesions Of the Corpus Callosum (CLOCCs) was presumed to be the most likely diagnosis. CLOCCs do no enhance. Medication was stopped and follow up scan was scheduled.


Control scan 1 month later was performed without and with contrast and as expected no contrast enhancement was seen. The lesion has decreased in size. Patient symptoms have resolved.


Reduction of edema in the lesion is well seen on T2 sequence.

As a side note: the control scan was performed on 1.5T vs 3.0T MRI scanner for initial exam -…
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Calcified Thoracic Disc Herniation

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Large left sided paramedian calcified thoracic disk herniation. Note calcifications also present anteriorly in the annulus fibrosus at this level that has reduced disk height. CT was performed 5 years prior.


Current MR (sag STIR and axial T2) showing mostly unchanged disk herniation with low signal on both sequences, but fortunately without spinal stenosis - visible spinal fluid around medulla. The slightly high signal in medulla on sag is an artifact. Calcified thoracic disk herniations pose problem for surgeons when are causing spinal stenosis and requiring operation. It is common that thoracic disk herniations calcify. Should not be confused with meningioma. Thoracic spine being part of thoracic cage is more rigid and stable than more flexible cervical and lumbar spine - so the herniations tend to progress less than on other spinal levels.
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Sinus Thrombosis - 9 days old neonate - MRI

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9 days old neonate. Mother known with sinus thrombosis during pregnancy. This is T1 without contrast showing high signal of methemoglobine in sinus rectus, superior sagittal sinus and cavernous sinus - representing massive blood clots of sinus thrombosis.


SWI sequence is showing low signal of hemosiderine deposits in central veins. T2 sequence is showing clot filled occipital part of sagittal sinus. ToF MRV (flow based venous angio) shows corresponding flow defects, same on MRV MiP reconstruction.


DWI and ADC-map showing ischemia in the basal ganglia, corpus callosum and corona radiata frontally. Those ischemic changes can be reversible in case of sinus thrombosis (venous infarcts). Major risk are the possible brain hemorrhages - that are fortunately not present in this case.

Teaching point is to look very carefully at non-contrast T1 of neonate for possible high signal changes representing methemoglobine products, not only in dural sinus but also in the subarachnoidal spaces for pos…
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