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