Lea Alhilali, MD Profile picture
Jul 1, 2022 5 tweets 4 min read Read on X
1/Hungry for a good case?! Radiologists love imaging findings that look like food—this case takes it to the next level
A🧵about an interesting case that really brought the phrase “watching what you eat” home #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #radiology #HNrad Image
2/Pt was eating dinner, suddenly started coughing & was in respiratory distress. A tubular object was seen in the trachea on CT—I jokingly asked if he had aspirated a worm! It looked almost like a curly straw—but it would be hard to aspirate that! Image
3/Our initial thought was that it was pasta—there are many types of pasta that are tubular, and pasta can look very dense on CT. We each took turns guessing the type of pasta—there were guesses of ziti, penne, rigatoni and macaroni Image
4/But as my mom once said, it’s not easy eating greens! This was asparagus. And we were actually able to find a paper on asparagus CT imaging. Asparagus has different appearances depending its fibrous content. Not surprisingly—the one aspirated was max fibrous! Image
And now you'll never have guess about asparagus!

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More from @teachplaygrub

Sep 26
1/Ready to seize the day w/epilepsy imaging?

Everyone knows mesial temporal sclerosis (MTS)!

But did you know there are different KINDS of MTS??

Read on for this month's @theAJNR SCANtastic on what YOU need to know in the latest in epilepsy imaging!

ajnr.org/content/45/9/1…
Image
2/The name of the “hippocampus” comes from its shape on gross anatomy.

Early anatomists thought it looked like an upside down seahorse—w/its curved tail resembling the tail of a seahorse.

Hippocampus literally means seahorse. Image
3/In cross section, it has a spiral appearance, leading to its other name, Cornu Ammonis, translated Ammon’s Horn.

Ammon was an Egyptian god w/spiraling rams horns. Image
Read 14 tweets
Sep 24
1/Have MULTIPLE questions about the new criteria for MULTIPLE sclerosis?

ECTRIMS 2024 just came out w/proposed new changes to the McDonald criteria for multiple sclerosis.

The changes are complex, but here is a thread w/the basics that you NEED to know! Image
2/The 2017 criteria were complex as well, but the basic theme was that they required dissemination in both time & space.

So you needed lesions in multiple locations and of multiple different ages. Image
3/Proposed new criteria bring a paradigm shift from relying on a combination of dissemination in both space in time, to relying on other factors that can replace dissemination in time

It also proposes that new imaging features specific to MS can be used in diagnosis as well Image
Read 15 tweets
Sep 20
1/“Tell me where it hurts.”

How back pain radiates can tell you where the lesion is—if you know where to look!

Do YOU know where to look?

Here’s how to remember the lumbar radicular pain distributions! Image
2/Why is it important to know the radicular pain distributions?

Most times patients have many POSSIBLE sources of pain--and when you are looking at an MRI, it's your job to decide which finding is the most LIKELY source of pain

These pain distributions can help you do that! Image
3/Let’s start with L1. L1 radiates to the groin.

I remember that b/c the number 1 is, well, um…phallic.

So the phallic number 1 radiates to the groin. Image
Read 9 tweets
Sep 16
Having trouble visualizing the location of the visual cortex?

Wish you knew where to look for where you see?

Let me open your eyes w/a quick & easy way to find the visual cortex on imaging so that you’re never caught looking! Image
2/Coronal plane is actually the easiest plane to find the visual cortex because it is directly perpendicular to the Calcarine fissure. Image
3/On the coronal, the calcarine fissure is relatively shallow relatively other sulci, so it looks like two evil eyes staring at you!

Remember: Eyes = vision, so eyes staring at you = visual cortex! Image
Read 8 tweets
Sep 13
1/Hate it when one radiologist called the stenosis mild, the next one said moderate--but it was unchanged?!

How do you grade it?

Do you estimate? Measure? Guess???

Here’s a thread about a lumbar grading system that’s easy, reproducible & evidence-based! Image
2/Lumbar stenosis has always been controversial.

In 2012, they tried to survey spine experts to get a consensus as to what are the most important criteria for canal & foraminal stenosis.  

And the consensus was…that there was no consensus

So what should you use to call it? Image
3/Well, you don’t want just gestalt it—that is a recipe for inconsistency & disagreement

But you don’t want to measure everything either—measurements are not only cumbersome, they introduce reader variability & absolute measurements don’t mean the same thing in every patient. Image
Read 15 tweets
Sep 9
1/Nothing is more CENTRAL to reading an MRI than finding the CENTRAL sulcus?

How do YOU find it?

Are you just using gestalt when you say “frontal” or “parietal”? 

Time to recenter your search pattern with this thread on how to find the central sulcus on a brain MRI! Image
2/On axial images, at the very top of the brain, the superior frontal gyrus & precentral gyrus combine to look like a bent knee

You can remember that bc precentral is the motor strip & you move by bending your knee! Image
3/Hand motor region is here as well.

You can remember this bc superior frontal gyrus & precentral gyrus together look like a letter L.

And you make the L loser L sign w/your hand! Image
Read 12 tweets

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