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
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!
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
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!
And now you'll never have guess about asparagus!
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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!
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.
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
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!
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!
3/Let’s start with L1. L1 radiates to the groin.
I remember that b/c the number 1 is, well, um…phallic.
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!
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?
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.