SA Medical - General Medicine And Imaging of Disease

Types Of Thalassemia Alpha Thalassemia The alpha thalassemia is caused by a decrease in production of alpha globin chains due to a deletion or mutation of one or more of the four alpha globin genes located on chromosome 16. Alpha gene mapping can be obtained to determine the specific mutation. The alpha thalassemia can be generally categorized as: Silent Carrier Alpha Thalassemia Trait Hemoglobin H disease Hemoglobin H-Constant Spring Alpha Thalassemia major Alpha Thalassemia trait in a parent is often dicovered after the birth of an effective child. Beta Thalassemia Minor/carrier/trait : They appear perfectly healthy, however where two carriers decide a family there is one in four chance that their child could inherit their carrier genes and develop Beta Thalassemia Major, one in four of a child being normal and 50% chance of the child also being a carrier. Thalassemia Intermedia : A clinical expression for a condition between Carrier and Major .They often run a hemoglobin of 7-9 g

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