Discover and read the best of Twitter Threads about #FOAMrad

Most recents (24)

Up for a Sunday tweetorial? šŸ¤“

If you see this multicystic lung lesion šŸ« in the posterobasal region of the lower lobes in a young patient šŸš¹šŸšŗwith no pathological history, two differential diagnoses should be considered: CPAM vs pulmonary sequestration āœ…
#radiology #FOAMrad Image
These two congenital lesions are areas of aberrant lung parenchyma not connected to the central airways. Their main difference is the arterial supply. That's why the first thing to do is try to identify the systemic artery that supplies the lesion šŸŸ£(most often an aortic branch) Image
This intralobar pulmonary sequestration was infected that's why it has
šŸŸ”šŸ”µ Air-fluid levels inside
šŸŸ¢ Peripheral GGO Image
Read 4 tweets
1/Does PTERYGOPALATINE FOSSA anatomy feel as confusing as its spelling? Does it seem to have as many openings as letters in its name?

Let this #tweetorial on PPF #anatomy help you out

#meded #medtwitter #FOAMed #FOAMrad #neurosurgery #neurology #neurorad #neurotwitter #radres Image
2/The PPF is a crossroads between the skullbase & the extracranial head and neck. There are 4 main regions that meet here. The skullbase itself posteriorly, the nasal cavity medially, the infratemporal fossa laterally, and the orbit anteriorly. Image
3/At its most basic, you can think of the PPF as a room with 4 doors opening to each of these regions: one posteriorly to the skullbase, one medially to the nasal cavity, one laterally to the infratemporal fossa, and one anteriorly to the orbit Image
Read 18 tweets
1/Remembering spinal fracture classifications is back breaking work!

A #tweetorial to help your remember the scoring system for thoracic & lumbar fracturesā€”ā€œTLICSā€ to the cool kids!

#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery Image
2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury. Let's start w/morphology. TLICS scores severity like the steps to make & eat a pizza:

Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in) Image
3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fxā€”like a simple long bone fx--worth 1 pt.

This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin! Image
Read 13 tweets
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A #tweetorial to help you remember cervical radicular pain distributions

#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #meded #spine #Neurosurgery Image
2/First, a rule of thumbā€”or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5.

If you divide your arm in half, that's at the elbow, you'll also get 5--C5 that is! C5 radiates to the elbow. So if it radiates below this, it's > C5 & above is < C5 Image
3/So letā€™s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution Image
Read 9 tweets
1/ ā€œSay Aaaaaaah!ā€ I was explaining to my resident how I remember tongue anatomy on imaging & he said, ā€œYou have to put it on Twitter!ā€

So here's a #tweetorial about how to remember tongue anatomy on imaging.

#medtwitter #radres #medstudent #FOAMed #FOAMrad #neurorad #meded Image
2/ When you look on the coronal plane at the tongue, the first thing you notice are two column like structures that look like a pair of jeansā€”genioglossusā€”or as I like to say ā€œjean-ee-o-glossus.ā€ Genioglossus is latin for jeans of the tongue, right? ļŠ Image
3/Right below the jeans are what look like a pair of clown shoesā€”the geniohyoid. So you see a pair of legs going right into a pair of shoes. Image
Read 7 tweets
1/Time is brain! So you donā€™t have time to struggle w/that stroke alert head CT.
Hereā€™s a #tweetorial to help you with the CT findings in acute stroke.

#medtwitter #FOAMed #FOAMrad #ESOC #medstudent #neurorad #radres #meded #radtwitter #stroke #neurology #neurotwitter Image
2/CT in acute stroke has 2 main purposesā€”(1) exclude intracranial hemorrhage (a contraindication to thrombolysis) & (2) exclude other pathologies mimicking acute stroke. However, that doesnā€™t mean you canā€™t see other findings that can help you diagnosis a stroke. Image
3/Infarct appearance depends on timing. In first 12 hrs, the most common imaging finding isā€¦a normal head CT. However, in some, you see a hyperdense artery or basal ganglia obscuration. Later in the acute period, you see loss of gray white differentiation & sulcal effacement Image
Read 13 tweets
1/ā€Tell me where it hurts.ā€ How back pain radiates can tell you where the lesion isā€”if you know where to look!

A #tweetorial about how to remember lumbar radicular pain distributions.

#medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #tweetorial #Meded Image
2/Letā€™s start with L1. L1 radiates to the groin. I remember that b/c the number 1 is, well, umā€¦phallic. So the phallic number 1 radiates to the groin. Image
3/Letā€™s skip to L3 for a second. I remember L3 is to the kneeā€”easy, it rhymes! Image
Read 8 tweets
1/Do radiologists sound like they are speaking a different language when they talk about MRI? T1 shortening what? T2 prolongation who?

Hereā€™s a translation w/a #tweetorial introduction to MRI.

#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #ASNR23 #neurosurgery Image
2/When it comes to bread and butter neuroimagingā€”MRI is definitely the butter. Butter makes everything taste better and packs a lot of calories. MRI can add so much information to a case Image
3/In fact, if CT is a looking glass into the brainā€”MRI is a microscope. It can tell us so much more about the brain and pathology that affects the brain.

So letā€™s talk about the basic sequences that make up an MRI and what they can show us. Image
Read 22 tweets
ASNR COTW #143

Hx: Altered mental status with oral pain.

NO SPOILERS!!! Give hints in the form of GIF or answer attached poll.

Answer in 24 hrs

#Neuro #Neurorad #Erad #radres #FOAMed #FOAMrad #medtwitter #ASNRCOTW Image
What disease process is associated with oral ulcers and enhancing hyperintense T2 signal lesions in the brain and spinal cord?
The answer is: Neuro-BehƧetā€™s disease!
See you next week! ImageImageImage
Read 3 tweets
ASNR COTW #142

Hx: 62 y/o male initially found unresponsive on the street presents with bradycardia and anterograde amnesia.

NO SPOILERS!!! Give hints in the form of GIF or answer attached poll.

Answer in 24 hrs

#Neuro #Neurorad #radres #FOAMed #FOAMrad #medtwitter #ASNRCOTW Image
What is the most likely diagnosis given the history and MRI findings in the referenced images?
The answer is: Opioid-associated amnestic syndrome!
See you next week! ImageImageImage
Read 3 tweets
1/Time is brain! But what time is it?

If you donā€™t know the time of stroke onset, are you able to deduce it from imaging?

Hereā€™s a #tweetorial to help you date a #stroke on MR!
#medtwitter #meded #neurotwitter #neurology #neurorad #radres #radtwitter #radiology #FOAMed #FOAMrad
2/In up to 25% of acute stroke patients, the time of last known well is well, not known. Then itā€™s important to use the strokeā€™s MR imaging features to help date its timing. Is it hyperacute? Acute? Subacute? Or are the ā€œstrokeā€ symptoms from a seizure from their chronic infarct?
3/Strokes evolve, or grow old, the same way people evolve or grow old. The appearance of stroke on imaging mirrors the life stages of a personā€”you just have to change days for a stroke into years for a person. So 15 day old stroke has features of a 15 year old person, etc.
Read 22 tweets
80 yo M. Known cardiovascular disease and anemia. Acute abdominal pain and vomit.

Diagnosis? Only ONE answer is correct šŸ˜‰

#radres #futureradres #FOAMrad #FOAMed #GITwitter #Endoscopy #GIpath

1. Ischemic colitis
2. IBD
3. Tumor
4. None of the above
Correct answer: None of the above. Why?

This is a case of ischemic colitis AND colon cancerā¬‡ļø

Were you able to pick up both? Can you see the difference?
Learning points
šŸŒŸSatisfaction of search bias (CAREFUL!)

šŸŒŸThere is a known ASSOCIATION between is ischemic colitis and tumor. Different patterns can be seen.

Old but useful paper to check out if you would like to learn more šŸ¤“
Read 3 tweets
1/Having trouble remembering how to differentiate dementias on imaging?

Hereā€™s a #tweetorial to show you how to remember the imaging findings in dementia & never forget!

#medtwitter #meded #neurorad #radres #dementia #alzheimers #neurotwitter #neurology #FOAMed #FOAMrad #PET
2/The most common functional imaging used in dementia is FDG PET. And the most common dementia is Alzheimerā€™s disease (AD).

On PET, AD demonstrates a typical Nike swoosh patternā€”with decreased metabolism in the parietal & temporal regions
3/The swoosh rapidly tapers anteriorlyā€”& so does hypometabolism in AD in the temporal lobe. It usually spares the anterior temporal poles.

So in AD look for a rapidly tapering Nike swoosh, w/hypometabolism in the parietal/temporal regionsā€”sparing the anterior temporal pole
Read 16 tweets
1/To be or not 2b?? That is the question!

Do you have questions about how to remember cervical lymph node anatomy & levels?

Hereā€™s a #tweetorial to show you how--#Superbowl weekend edition!
#medtwitter #meded #neurorad #HNrad #FOAMed #FOAMrad #radres #radtwitter #ENT #radiology
2/Google cervical lymph node anatomy & you always get this anatomic picture w/the head flung back like a model posing.

But unless you live in LA, your patients donā€™t look like this & understanding anatomy from this image is difficult
3/First, you need to know how lymph node drainage works in the neck.

Nodes drain like riversā€”smaller streams drain into larger rivers.

In the neck, there are outer circle nodes (peripheral) & inner circle nodesā€”both drain into the large river of the deep cervical nodes
Read 17 tweets
1/Time to FESS up! Do you understand functional endoscopic sinus surgery (FESS)?

If you read sinus CTs, you must know what theyā€™re doing to make the helpful findings

Hereā€™s a #tweetorial to help you!
#medtwitter #meded #FOAMed #FOAMrad #radres #neurorad #HNrad #radtwitter
2/The first step is to insert the endoscope into the nasal cavity.

The first two structures encountered are the nasal septum and the inferior turbinate.
3/So on every sinus CT you read, the first question is whether there is enough room to insert the scope. Will it go in smoothly or will it be a tight fit?
Read 19 tweets
1/ā€I LOVE spinal cord syndromes!ā€ is a phrase that has NEVER, EVER been said by anyone.
Never fearā€”here is a #tweetorial on all the incomplete #spinalcord syndromes!
#medtwitter #neurotwitter #neurology #neurosurgery #neurorad #radres #meded #FOAMed #FOAMrad #radtwitter #spine
2/Spinal cord anatomy can be complex. On imaging, we can see the ant & post nerve roots. We can also see the gray & white matter. Hidden w/in the white matter, however, are numerous efferent & afferent tractsā€”enough to make your head spin.
3/Lucky for you, for the incomplete cord syndromes, all you need to know is gray matter & 3 main tracts. Anterolaterally, spinothalamic tract (pain & temp). Posteriorly, dorsal columns (vibration, proprioception, & light touch), & next to it, corticospinal tractsā€”providing motor
Read 20 tweets
1/Have disagreements between radiologists on the degree of cervical canal stenosis become a pain in the neck?!
Hereā€™s a #tweetorial on cervical stenosis grading thatā€™s easy, reproducible & evidence based
#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad Image
2/In the lumbar spine, it is all about the degree of canal narrowing & room for nerve roots. In the cervical spine, we have another factor to think aboutā€”the cord. Cord integrity is key. No matter the degree of stenosis, if the cord isnā€™t happy, the patient wonā€™t be either Image
3/Cord flattening, even w/o canal stenosis, can cause myelopathy. No one is quite sure why. Some say itā€™s b/c mass effect on static imaging may be much worse in dynamic positions, some say itā€™s repetitive microtrauma, & some say micro-ischemia from compression of perforators Image
Read 18 tweets
1/Tonsillar or peritonsillar abscess? That is the question! When you look at a neck CT, do you know which one to say?
A #tweetorial on #tonsillitis complications
#medtwitter #radtwitter #neurorad #radres #meded #FOAMed #FOAMrad #HNrad #medstudenttwitter #RSNA2022
2/First some anatomy. Palatine tonsils (or faucial to the cool kids) sit in the oropharynx between the two palatine arches: the palatoglossus arch in front and the palatopharyngeus arch in back. These are easily visible on physical exam.
3/These archs are actually just mucosa draped over the palatoglossus and palatopharygeus musculature, like kids drape sheets over themselves to dress up for Halloween.
Read 13 tweets
1/They say form follows function! Brain #MRI anatomy is best understood in terms of both form & function

A #tweetorial on how to remember important functional #brain #anatomy

#meded #medtwitter #neurosurgery #neurology #neurorad #FOAMed #FOAMrad #radiology #medstudent #radres
2/Letā€™s start at the top. At the vertex is the superior frontal gyrus. This is easy to remember, bc itā€™s at the topā€”and being at the top is superior. Itā€™s like the superior king at the top of the vertex.
3/It is also easy to recognize on imaging. It looks like a big thumb pointing straight up out of the brain. I always look for that thumbs up when I am looking for the superior frontal gyrus (SFG)
Read 12 tweets
šŸŒ“šŸ¤Ŗ Pac-Man ate my visual fields!

50 year old person presents with sudden onset headache and seeing "pieces of things" on the R.
Visual fields look like thisšŸ‘‡šŸ‘‡

āž”ļøWhat's happening?

#MedTwitter #MedStudentTwitter #neurotwitter #MedEd #Neurology #EndNeurophobia #stroke Image
šŸ—ŗļøšŸ§  Where across the visual system is likely the lesion?
#Ophthalmology
ā­•ļø Which artery has to be implicated, if this presentation is due to an ischemic #stroke and the rest of the neuro exam is normal?
Read 7 tweets
1/Hate it when one radiologist called the stenosis mild, the next one said moderate--but it was unchanged?!

Hereā€™s a #tweetorial of a lumbar grading system thatā€™s easy, reproducible & evidence-based

#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad Image
2/Lumbar stenosis has always been controversial. In 2012, they tried to survey spine experts to come to a consensus as to what are the most important criteria for canal & foraminal stenosis. And the consensus wasā€¦that there was no consensus. So what should you use to call it? Image
3/Well, you donā€™t want just gestalt itā€”that is a recipe for inconsistency & disagreement. But you donā€™t want to measure everything eitherā€”measurements are not only cumbersome, they introduce reader variability & absolute measurements donā€™t mean the same thing in every patient. Image
Read 15 tweets
Multiple Sclerosis - what to look for on MRI! A quick overview. First slide shows Jean-Martin Charcot, one of the fathers of Neurology (the painting is a bit outdated to say the least, but interesting from a historical point of view). #radres #neurorad #FOAMrad #FOAMed Image
MS diagnosis is based on the McDonald criteria. To fulfill the diagnosis of MS, a patient must have evidence (clinical or radiological) of CNS-damage involving multiple CNS-regions (dissemination in space) and having occured at multiple moments in time (dissemination in time). Image
This 22-year old patient was referred for an MRI of the brain because of paresthesias in both lower legs. Lumbar MRI was normal. What do we make of those white matter lesions? Image
Read 9 tweets
1/One important aspect to stroke care is well... ASPECTS.šŸ˜‚

Hereā€™s a #tweetorial to help you remember this basic #STROKE scoring system

#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radiology #radres #neurology #Neurosurgery #CT #meded #neurotwitter
2/ASPECTS stands for ā€œAlberta Stroke Program Early CT Score.ā€ It is meant to replace gestalt-ing what percent of the MCA territory is infarcted. Instead, it uses a 10-pt score to semi-quantitate the amount of infarcted tissue in the MCA territory on non-contrast head CT
3/You can think of it as a scorecard for the MCA.

For each region of MCA territory NOT infarcted, the pt gets one point

So the highest score possible is 10, and lowest score possible is 0
Read 18 tweets
Cystic supratentorial brain tumors in adults, the usual and the unusual. Non-exhaustive list of differential diagnostic considerations. The PA had a nice mural nodule, not shown on this figure. #radres #neurorad #FOAMrad #FOAMed #MedEd #RadEd
impossible to tell which is which on only T1-images with GD. Whenever I see an intra-axial tumor in an adult, I automatically consider GBM and metastases as they are the most frequent brain tumors in adults, so even when the tumor looks strange or atypical, they are a good bet.
Brain abcess and epidermoid cyst are pretty straightforward on diffusion-weighted images as their content is very diffusion restrictive. Brain abscess has a thick enhancing capsule, epidermoidcyst doesn't.
Read 8 tweets

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