SA Medical - General Medicine And Imaging of Disease

Intima - prevents thrombosis - most chemically active layer Media - smooth muscle ~ vasoconstriction Adventitia - supportive layer - Arterial wall disease @ vasculitis - wall inflammation @ fibromuscular disease @ connective tissue disease @ trauma @ degeneration (atherosclerosis) - Radiological presentation 1 - weaken and dilated - producing an aneurysm - Can rupture - extravasation; pseudoaneurysm formation; AV fistulae 2 - Thickened by @ growth of vessel layers @ deposition of material - AS plaque - causes vessel to narrow and stenose ~ occlusion 3 - loose ability to prevent coagulation ~ results in thrombosis 4 - proliferation of vessels - results in AV malformation @ ?genetic factors @ ?Aquired factors ~ tumors Angiographic suite has: - patient monitoring devices - radiological equipment @ c-arm fluoroscopy ~ dynamic positioning ~ bolus chasing -

Cerebral aneurysm Cerebral aneurysm ·           Symptoms – history of migraines, persistent headache with several months duration, different from usual headache ·           Imaging o     Computer tomography – CT §    Fast and readily available §    Excellent for detection of acute hemorrhage o     Magnetic resonance imaging - MRI §    Higher soft tissue resolution / contrast §    Multiplanar capability o     Plain film – not indicated ·           Normal Head CT o     Blood, acute §    High attenuation – bright o     Midline – is symmetry preserved o     Ventricles o     Cisterns o     Sulci o     Grey white matter interface o     Soft tissue o     Bones o     Sinuses ·           Precontrast o     Spherical mass, smooth margin, high attenuation, slight mass effect, located just anterior to the circle of Willis. No acute haemorrhage, edema or infarct o     At the level of the midbrain and cerebellum o     Differential diagnosis :

LCH = Langerhans Cell Histiocytosis DDx for bone lesions showing bone sequestrum Taken from ACR case-in-point case dated 17.11.u2010

DDx for CRAZY-PAVING PATTERN seen on HRCT BAC = broncho-alveolar cell carcinoma PCP = pneumocystic carinii pneumonia NSIP = non-specific interstitial pneumonia ARDS = acute respiratory distress syndrome OP = organising pneumonia