Splenic Infarct

SPLENIC INFARCT

34 year old male presented with pain left hypochondrium. CECT abdomen showed multiple enlarged lymphnodes in abdomen (perigastric, peripancreatic, pre & para aortic, mesentric regions). Lymphnodes in peripancreatic region (denoted by arrow) were causing compression of splenic artery which lead to multiple infarts in spleen as seen by peripheral wedge shaped hypodense areas with broad base towards capsule. Patient also had hepatosplenomegaly and diagnosed as a case of Grade IV lymphoma.

Polydactyly

PRE-AXIAL POLYDACTYLY

4 year old female child presented with large left foot with polydactyly (7 digits). CT angiography of patient was done to know the blood supply of the extradigits before the patient was taken up for surgery.

Swirl Sign

SWIRL SIGN 

5 years old male child presented with acute onset headache for 1 day. There was no history of trauma. However, he is k/c/o factor IX deficiency. NCCT head revealed large crescent shaped extra-axial collection in Rt fronto-parieto-temporal lobe (-- s/o extradural hematoma) with central hypodense areas -- s/o swirl sign which indicate active bleed within the hematoma. There is also marked midline shift towards left side.

Pine Cone Appearance in Neurogenic Bladder

PINE CONE BLADDER

45 year old female presented with past history of trauma to spine and complain of difficulty in micturition. MCU was performed which showed presence of pine cone bladder and B/l Grade V reflux. DIAGNOSIS -- NEUROGENIC BLADDER.

A pine cone bladder or christmas tree bladder is a cystogram appearance in which the bladder is elongated and pointed with thickened trabeculated wall. It is typically seen in severe neurogenic bladder with increased sphincter tone (detrusor sphincter dyssynergia) due to suprasacral lesions (above S2-S4) or epiconal lesions (in and around S2-S4).

It is however not pathognomonic of a neurogenic bladder and can be seen in patients with lesions anywhere along the sacral reflex arc leading to poor detrusor compliance. Occasionally it is also seen in bladder neck obstruction of a non-neurogenic cause.

Gastric Carcinoma on Barium

  Barium Meal in Gastric Carcinoma showing characteristic  shouldering with filling defect along the greater curvature and causing luminal compromise of antro-pyloric region.

Pyloric canal and duodenal bulb appears normal.

Achalasia Cardia

BIRD BEAK SIGN

HOLD UP OF CONTRAST

Achalasia Cardia essentially refers to a failure of organised esophageal peristalsis with impaired relaxation at the level of lower oesophageal sphincter (LOS) resulting in often marked dilatation of the oesophagus and food stasis.

A barium swallow is able to not only confirm that the oesophagus is dilated but is also able to assess for mucosal abnormalities. Findings include:

• failure of normal peristalsis to clear the oesophagus of barium when the patient is in the recumbent position, with no primary waves identified
• uncoordinated, non-propulsive, tertiary contractions
• oesophageal body dilatation, which is typically maximal in the distal esophagus
• pooling or stasis of barium in the oesophagus when the oesophagus has become atonic or non contractile (late feature in the disease)
• when barium column is high enough (patient standing) the hydrostatic pressure can overcome the LOS pressure allowing passage of oesophageal content
• incomplete LOS relaxation that is not coordinated with oesophageal contraction
• BIRD BEAK SIGN.