#WetreadCoW Case 15

Hx: Fall. Back Pain

Professionally appropriate gif responses only please. Extra points for not using the obvious answer. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #MSKRad #NeuroRad
Silly Twitter, lets keep it together now 🤣

ER went ahead and ordered the CT CAP. Does this help?😏

Turns out the patients pain was more T/L junction and L-spine. 🤔
#WetreadCoW Case 15 Answer: Butterfly vertebra

Vertebral anomaly from lack of fusion of the 2 sides of a vertebral segment (?due to persistent notochordal tissue) ➡️ bowtie appearance on frontal or 2 wedges connected at their tips.#FOAMed #FOAMrad #Neurorad #MSKRad #radres
Butterfly Vertebra are generally incidental. Key is to NOT dx as a compression fx.

+corticated borders!
+sup and inf endplates involved
+lat borders normal (post wall ~nl)
+V-shaped endplates➡️bowtie appearance vs U shaped endplates➡️H-shape in Sickle-cell vs uniform ht loss
Butterfly Vert:

CT is tricky (as I tried 😁). Axials➡️butterfly or Pac-man appearance. Since the anterior body never formed➡️kyphosis/gibbus deformity (resembling ant compression fx)so you often get some of the adjacent vertebra on your slice(below). 👀 for symmetry& cortication
Butterfly Vert:

Sags➡️BIG-small-BIG w varying degrees of anterior height - again 👀 symmetry!

If only 1 side present = a hemivertebra➡️lat scoliosis

Typically incidental findings in young adults, but can be assoc w: Alagille syndrome and VACTERL (both above my pay grade 😁)

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More from @RyanChristieMD

12 Nov
#WetreadCoW Case 15

Hx: Vaginal bleeding

What is the first question to ask? What are the possible diagnoses? (more images to come of course 😀)

Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #bodyrad
@ER_Rad_Hanna @GayatriJoshiMD @RadioGyan #WetreadCoW Case 15 (cont)

+Urine pregnancy test

Diagnosis(es)? Gifs only please! 😀 FOAMrad #FOAMed #radres #errad #bodyrad
#WetreadCoW Answer: Cervical Ectopic Pregnancy

Imaging is easy!

-⭐️NO IUP(endometrium opposed, no fluid or sac)
-gestation sac w/ fetal pole in cervix

1) cervical ectopic
2) spont abortion

Here: Closed os, no endometrial fluid➡️ectopic
#FOAMrad #bodyrad #errad #obgyn
Read 9 tweets
6 Nov
#WetreadCoW Case 14

Hx: Abominal Pain

Can you identify the source of acute pain and the underlying etiology?

Professionally appropriate gif responses only please. No spoilers! #FOAMrad #FOAMed #radres

A case for everyone 😀 #errad #bodyrad #chestrad #NeuroRad ImageImageImageImage
#WetreadCoW Answer: Tuberous Sclerosis

More specifically - multiple large bilateral renal angiomyolipomas through the kidneys (green) with acute R perinephric hemorrhage (red arrows)

*remember ⬆️size of AMLs = ⬆️ risk of hemorrhage

#FOAMed #FOAMrad #bodyrad #radres Image
Tuberous Sclerosis (aka Bourneville Dz)

-neurocutaneous disorder (phakomatosis)
-numerous benign tumors of ectodermal orgin (skin, eyes, CNS)
-usually sporatic
-Classic: child with Vogt's triad (seizures, intellectual disability, adenoma sebaceum rb.gy/rlkgei
Read 5 tweets
23 Oct
#WetreadCoW Case 13

Hx: 50 yo male with cough

Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #FOAMrad #FOAMed #radres #errad #chestrad Image
@WetreadCoW Case 13 Answer: Mounier-Kuhn syndrome (aka tracheobronchomegaly)

-cystic dilation of trachea&bronchi
-absence/atrophy of elastin fibers&smooth muscle
-?congenital (not agreed upon)
-assoc w Ehlers-Danlos

#FOAMed #FOAMrad #chestrad #radres #thoracicrad Image
Read 4 tweets
9 Oct
#WetreadCoW Case 11

Hx: abdominal distention

Please answer with professionally appropriate gif responses only. No spoilers. #FOAMrad #FOAMed #radres #errad #bodyrad Image
#WetreadCoW Case 11 Answer: Pseudomyxoma Peritonei

-accumulation of mucinous ascites from mucin producing tumor. This case is the classic mucinous appendiceal tumor s/p multiple debulking surgeries! #FOAMed #FOAMrad #Radres #bodyrad

👍 on the gifs everyone! ImageImage
Pseudomyxoma Peritonei

Source: mucinous tumor of appendix (#1), colon, stomach, pancreas, urachus, ovary

Rupture➡️ mucin & neoplastic cells into the peritoneum ➡️ diffuse peritoneal spread of malignancy and increasing abdominal distention
Read 5 tweets
2 Oct
#WetreadCoW Case 10

Hx: trauma survey exam. Fall, pain

Dx? Anything else you may want to consider given the history?

Please answer with professionally appropriate gif responses only. No spoilers. #FOAMrad #FOAMed #radres #errad #orthorad #MSKRad Image
#WetreadCoW Case 10 Answer: Ankylosing Spondylitis

-fused SI jts
-fused pubic symphysis
- interspinous ligament ossification = "dagger spine"
-fused Lspine?

⭐️Need to look for spine fx!

Too easy? or maybe everyone is distracted by #ASER2020
#FOAMed #radres #mskrad #orthorad ImageImage
Ank Spon:

-seroneg spondyloarthropathy (neg Rheum factor) ➡️ fusion of the spine, SI jts, pubic symphsysis, and sometimes other jts
- assoc w HLA B27 gene
-usually presents 3rd-4th decade
-trt: NSAIDS, motion/exercise, TNF-alpha blockers
Read 5 tweets
25 Sep
#WetreadCoW Case 9

Hx: MVA, chest pain

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad ImageImage
#WetreadCoW Case 9 Answer: Diverticulum of Kommerell

Focal outpouching of the distal aortic arch + h/o trauma ➡️ think traumatic PSA⭐️, but lets look a bit closer here

No perioaortic stranding
No wall thickening
location = medial (retroesophageal 🤔)
#FOAMrad #radres #chestrad Image
Kommerrell Diverticulum

-focal outpouching of the distal aortic arch at the origin of an aberrant subclavian artery (here artery is very small)

-can be aberrant L subcl in setting of R aortic arch OR aberrant R subcl in normal L aortic arch (here) #FOAMed #FOAMrad #radres
Read 5 tweets

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