Moderate proptosis of the left orbital enlarged globe associated with thickened sclera.

Evidence of broad based left sphenoid wing hypoplasia.

A small well defined left temporal lobe arachnoid cyst associated with intra orbital herniation of the
middle cranial fossa through the sphenoid defect.
An infiltrating soft tissue enhancing mass seen trans-spatial at the lateral, pre septal, temporal fossa
and skull base. It shows multiple small areas of cystic changes.
Thickened tubular optic nerve associated with widening of the optic foramen.
Operative fixation of the roof and lateral wall of the left orbit by plates and appearing bone graft.
OPINION:

CT findings are consistent with Neurofibromatosis type I (NF1) Von Recklinghausen disease with the
following features.
Recurrent infiltrating Plexiform Neurofibroma.
Sphenoid hypoplasia.
Buphthalmous.
Apparent optic nerve glioma.
Post operative fixation of the roof and lateral

The liver is of average size with regular contour with moderate dilated
intra hepatic biliary radicles on both lobes more at left one and an ill
defined small iso dense focal hilar mass lesion. It is associated with
thickening of the conflu...ence of left and right hepatic ducts. It shows
minimal patchy contrast enhancement. No detected portal vein or hepatic
artery invasion. it is associated with wall thickening of the gall bladder
with no detected definite intervening fat plane .
Patent portal vein.
Normal diameter of common bile duct. No ductal stones.
Normal appearance of the pancreas. No dilatation of the pancreatic duct.
Opinion:
Extra hepatic biliary obstruction at level of confluence of right and left
hepatic ducts and distal to cystic duct ( gall bladder not distended) by ill
defined hilar heterogeneous mass.suggestive of hilar
cholangiocarcinoma (klatskin tumor) with possible gall bladder infiltration
in 83 old female.ERCP with adjuvant biliary stenting is recommended.

Diffuse thickening of the supra and infra tentorial leptomeninges, basal cisterns and subarachnoid CSF spaces
associated with abnormal high SI on FLAIR sequances and T1 WIs. They shows nodular (at right parietal lobe sub
arachnoid CSF space) and smooth diffuse enhancement in post contrast study (dirty CSF).
Diffuse thickening and enhancement of the pia of folia, floor and posterior surface of the 4th ventricle.
Mild enhancement of the cranial nerves at the both CPAs.
Abnormal SI linear areas seen at the posterior limb of both internal capsules. They display low SI on T1 WIs and
high SI on T2 and FLAIR images. No detected contrast enhancement.
Elongated finger-shaped CSF SI on all pulse sequence cavum septum pelluicidum and cavum vergae associated
with bowing the leaves of the septum pelluicidum. They are seen between the frontal horns and extend
posteriorly between fornices of body of lateral ventricles. It measured about 1.2 cm in diameter.
No detected localized intra axial SOL at the posterior fossa.
Mild infra and supra tentorial ventricular system with evidence of right side shunt tube with its tip at right lateral
ventricle.
No gross vascular abnormality.
Normal brain stem.
Opinion:

Diffuse leptomeningeal and sub arachnoid carcinomatosis (metastases)..CSF seeding from previous surgically
removed Medulloblastoma (posterior fossa PNET).
Ependymal spread of metastasis along the floor and posterior wall of 4th ventricle.
No detected recurrent or residual posterior fossa enhanced localized SOLs.
Cavum septum pelluicidum and cavum verge (normal variant).
Arrested hydrocephalic changes with shunt tube seen at the occipital horn of the right lateral ventricle.
Gliotic changes of the posterior limb of both internal capsules

Multiple small intra medullary SOL seen involving the entire cervical and
dorsal cord. The displays low SI on T1 WIs and high SI on T2 WIs. They
show mild heterogeneous contrast enhancement.
Dirty sub arachnoid CSF with increased intensity (ground glass
appearance). They shows marked contrast enhancement along the spinal
cord with characteristic sugar coating appearance.
Marked enhancement of the spinal cord lining and nerve roots.
Normal diameters of the bony spinal canal.
Preserved height and T2 signal brightness of the lumbar intervertebral
discs.
No evidence of disc herniations or significant bulges.
Normal marrow signal of the imaged vertebrae.
Opinion:
Multiple drop intra medullary metastases.
Diffuse leptomeningeal tumor spread CSF disseminated metastases from
the previous operated Medulloblastoma (posterior fossa PNET).

X-ray Appearance
1. Typically, diffuse ground-glass or finely granular
appearance
2. Bilateral and symmetrical distribution
3. Air bronchograms are common
-Especially extending peripherally
4. Hypoaeration in non-ventilated lungs
-Hyperinflation excludes HMD
5. Granularity is the interplay of
1. Air-distended bronchioles & ducts
2. Background of atelectasis of alveoli
6. May change from film-to-film if there is
1. Expiration (air disappears)
2. Better aeration (small bubble formation

THE SAME CASE IN CONTINUATION WITH

MARKS: WE GAVE TUBERCULOUS LESION AS
DIAGNOSIS...PATIENT WAS ON AKT AND AFTER
SEEING ALL THESE RESPONSE ON FACEBOOK I
HAVE CALLED THE PATIENT AGAIN AND SHE
HAS IMPROVED..SO WILL DO HER FOLLOW UP
MRI AGAIN (FREE OF COURSE.. FOR THE
FACEBOOK) AND WILL UPLOAD THAT NEW
IMAGES ALSO AGAIN.

On flair coronal you can see there is two

components of the lesion, one is hyperintense
and other is hypointense but clearly seprate
from the compressed temporal horn of
ventriclebut that hypointense nealy fluid
density part of the lesion is getting merge with
the temporal horn to give a false impression
of enlarged temporal horn on T2which is not
enlarged

CT: Axial and coronal images (Fig. 1-2) show a

calcified mass in the glenoid fossa, bulging into
the epitympanum and abutting to middle cranial
fossa floor.
MRI: The mass has low signal intensity in T2w
sequences (Fig. 3-5) and intermediate signal
intensity in T1w sequences (Fig. 6).
Inhomogeneous enhancement is seen in post
contrast T1w images (Fig. 7-9). Not only the mass,
but surrounding soft tissues and dural lining show
enhancement. No bony changes, neither
enhancement of the condyle is detected

CHONDROCALCINOSES

A relatively flat extra-axial mass lesion is seen

along the left temporo-occipital cerebral
convexity, which is indenting and mildly
compressing the adjacent cerebral
parenchyma. Mild perilesional oedema is also
noted.

Focal calvarial hypertrophy is well visualized

on the left side. Note the difference in the
calvarial thickness on either side of midline.

Extensive soft tissue calcification is seen

around the pelvis and proximal femora.
Bilateral avascular necrosis that has resulted
from steroid therapy has warranted total hip
replacement.

Diffuse, multiple or generalised soft tissue

calcification may be seen in:hyperparathyroidism and renal osteodystrophy
other disorders of calcium and phosphate
metabolism eg. hypoparathyroidism, chronic
haemodialysis, milk-alkali syndrome, etc.
scleroderma dermatomyositis polyarteritis
nodosa Raynauds syndrome rheumatoid arthritis
systemic lupus erythematosus sarcoidosis gout
ochronosis Ehlers-Danlos syndrome Werners
syndrome (adult progeria)

Intravenous contrast injection was performed

in the upper limb). The urinary bladder
contained an air fluid level and extensive
intramural air suggesting a diagnosis of
Emphysematous Cystitis (Fig 1-3). The
patient was treated with antibiotics and Creactive protein improved from 67 mg/L to
normal levels. Escherichia coli was isolated in
urine samples. The patient was discharged
shortly afterwards.

1) Fracture of the left femoral neck.

2) Left hemipelvis is sclerotic with a coarse
pattern, cortical thickening and expansion.
This is pagets disease.
3) Calcification in fibroids

A large well defined enhanced soft tissue density mass seen

centered on the right maxilla at both buccal and lingual
sides. It is associated with marked bone destruction of the
related maxilla. Medially, it is seen extending to the nasal
cavity with subsequent destruction of the pyriform
aperature. Laterally, it invades the buccal space. Superiorly,
it partially fills the right maxillary antrum and reach the
floor of the orbit with subsequent bony wall destruction.
Inferiorly, it is seen extending to the lingual space and
invades the hard palate. Anteriorly, it is seen reaching the
skin and subcutaneous tissue. Posteriorly, it invades the
posterior maxillary wall and retro maxillary fat plane (infra
temporal fossa), but intact pterygoid plates..
.


No evidence of new sclerotic bone formation.
No detected vascular invasion.
No detected separable enlarged lymph nodes.
No air density could be seen.
Patent left osteomeatal units and
sphenoethmoidal recesses.
Clear nasopharynx and oropharynx

OPINION:
CT findings are consistent with large soft tissue
mass centered on right maxilla with marked bone
destruction and above described
extensionsSuggestive of malignant process
rather than infectious process corresponding the
given history..Mostly squamous cell
carcinoma/adenocarcinoma.Biopsy is highly
recommended