Viva segment 1

VIVA CASES

CASE ONE

New born with bilious

vomiting

CASE ONE

What are the findings ?Supine radiograph of the abdomen of an infant shows two prominent gas distended viscus in the upper abdomen c/w dilated stomach and

duodenum. Lack of bowel gas in distal bowel

What is your diagnosis? Duodenal atresia – Double bubble sign with lack of distal bowel gas is diagnostic

What are the differentials ? With a dilated stomach and duodenum and some gas in distal bowel, D/D include stenosis,Ladd’s bands,annular pancreas, duodenal web, malrotation, preduodenal portal vein, duplication cyst

CASE ONE

What are the associations of duodenal atresia ?

Seen in 50-60% - Down’s, CHD, vertebral &rib anomalies, GI anomalies

What are associated findings on an infantogram ?

Eleven pairs of ribs & altered iliac index (Down’s); rib & vertebral anomalies, L- R shunt

( always look for features of Down’s in a pt with double bubble )

CASE TWO – H/O progressive head enlargement

CASE TWO

What are the salient findings ?

Lateral skull radiograph of a child :

- flocculent calcification in the sellar & suprasellar region with sellar enlargement,

- enlarged cranium & sutural diastasis

- pneumoventricle ( post pneumoencephalography)

What is the diagnosis ?

How would you confirm your diagnosis ?

Craniopharnygioma – sellar and suprasellar calcification in a child suggests the diagnosis

MRI Brain / CECT head f/b HPE

CASE TWO

What would you expect to see on CT/ MRI ?

CT - Mixed solid cystic suprasellar mass with calcifications and obstructive hydrocephalus.

MRI – MC hyperintense, MB iso/hypo on T1; hyper on T2, solid components may enhance

Related topics :

D/d sellar/ suprasellar masses in child

Causes of intracranial calcification in child

CASE THREE

Q. What are the findings of X ray ?Reduction in L5 height, tear drop fracture antero-inferior

body

CASE THREE

CASE THREEQ. Do you get any additional information on MRI ?

Two column fracture of L5 . No canal compromise

Q. Would any additional investigations be needed to assess this injury?

Lateral skiagrams of lumbar spine in flexion and extension for assessment of stability +/ - DEXA Hip and spine

Further Suggested Reading•Classification of spinal injuries•T and Z scores

CASE FOUR - 45 days old infant with microcephaly and seizure

CASE FOUR

NCCT Head:

• Bilateral basal ganglionic and periventricular calcification

• Hourglass configuration of brain with pachygyria

What are the findings ?

Congenital CMV infectionWhat is the diagnosis ?

CASE FOUR What are the differentials ?

1. Causes of bilateral ganglionic calcification

2. Causes of normal intracranial calcification

1. Congenital toxoplasmosis – calcification more haphazard

2. Chronic lymphocystic choriomeningitis – macrocephaly commoner than microcephaly. May be indistinguishable

Related topics :

CASE FIVE - Chronic smoker with Haemoptysis

CASE FIVEWhat are the findings?

1. Multiple thin wall cysts of varying sizes b/l , relative sparing of lower zones.

2. Non-cavitating centrilobular nodules in right zone. 3. Prominent Main pulmonary artery 4. Bronchial artery tortuous - Chronic lung disease with plexogenic arteriopathy

What are the differentials?Differential For Against

- LCH

-Centriacinar empysema- LAM- IPF

Chronic smoker, cystic pattern, centrilobular Nodules

chronic smoker, cystic

lung disease, relative sparing of base centrilobular nodules,

perceptible walls Basal sparing, nodule

Basal sparing