Radiology MRI

Incidental finding on a trauma CT scan showing air in ducts of the right parotid gland. Note also air in the main  parotid duct . This is known as Pneumoparotid . It is caused by periodic increased air pressure in the oral cavity. It can be seen in people playing wind instruments, after dental procedures, coughing and other activities involving forceful exhalation.

Surface renderings of the CT showing Titanium Mesh used in cranioplasty to cover extensive defect in the right temporal bone. Defect was due to craniectomy after intracranial hemorrhage following trauma. Also note old zygomatic bone fractures.

First image shows Acute Lacunar Thalamic Infarct on the right side with corresponding second image showing prior study 11 hours before, that also depicts acute infarction. CTA shows occlusion of the P1 segment of the right Posterior Cerebral Artery (arrows). You can also (with some difficulty) depict a thromb in this segment (arrowheads). Lacunar Thalamic Infarcts are quite common and often accompanied with Posterior Cerebral Artery territory infarcts. In fact PCA infarcts are detected more often. However isolated thalamic infarcts are also seen. The clue here is vascular supply to the thalami. It comes mainly from P1 and P2 segments of the Posterior Cerebral Arteries. Therefore radiologists and neurologists should pay attention to posterior circulation in case of suspected or detected thalamic infarcts. Patients with such infarcts present with specific neurologic findings. Excellent review of vascular supply can be found in the following articles: Jeremy D...

T1 with iv Gadolinium and T2 showing non-enhancing, pathology verified Astrocytoma grade 2 in the medial parts of the left temporal lobe. Note distortion of the brain architecture. However subject of this post concerns Gadolinium Guidelines in attention to Nephrogenic Systemic Fibrosis. Here is the summary: Gadolinium Guidelines - eGFR 60 or greater - OK - eGFR 30-59 - weight-based dose of GBCA (0.2 mL/kg) can be administered with maximal dose of 20 mL allowed within 24 hours - eGFR less than 30 - GBCA cannot be administered except in cases of medical necessity; informed consent required; nephrology consultation required; hemodialysis should be considered According to: Yingbing Wang - Incidence of Nephrogenic Systemic Fibrosis after Adoption of Restrictive Gadolinium-based Contrast Agent Guidelines