Mukesh Harisinghani
@mharisinghani
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Professor of Radiology, Harvard Medical School, @mghimaging Mass General Hospital; #radiology ; Cases are ancient; Opinions are my own
Boston, MA
Joined March 2009
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Cobblestone appearance of candidiasis of esophagus
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HIV positive patient with CD4 count of 18: Kaposi's sarcoma involving inguinal nodes
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Intracardiac and subcutaneous metastases from melanoma
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When the spleen says I just don't like staying the LUQ
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Lead pipe colon appearance in long standing ulcerative colitis; loss of normal haustral folds
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Don't let your eyes fool you; history of breast primary; no that is not a metastasis; it is a liver cyst that appears dense because the liver has very low attenuation due to fat; always measure the density; this was 9 HU
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The fearless don't worry about obstacles and carve their own path; transcaval biopsy of RP node; yielding positive diagnosis of metastases;
@ajgunnmd
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Soft tissue surrounding aorta and kidneys in a patient with bone pain; there is a differential; this was Erdheim Chester disease
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Focal well-circumscribed lesion outside the bladder but in close proximity extrinsically compressing; not something common; this was PECOMA
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Going through the differential of perinephric soft tissue stranding; primary RP fibrosis; IgG4 disease; lymphoma; Erdheim Chester or the disease that this patient had; Rosai Dorfman disease
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This is what happens when you stop by McDonalds have your fries and then show up for your CT scan
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No, this patient has not received any contrast; this is cortical nephrocalcinosis; much less common than medullary but you have to know causes; in this case, it was chronic glomerulonephritis
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Called an AML; calcification should give you pause; was a liposarcoma
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Fournier's gangrene severe enough to be seen on plain radiograph
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Li-Fraumeni syndrome (LFS) is a cancer predisposition disorder that is commonly associated with germline mutations of the p53 tumor suppressor gene; when u see multiple tumors think of it; breast and leiomyosarcoma in this instance
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Patient with splenic trauma years ago and splenectomy; came with arterially enhancing liver lesions; case of intrahepatic splenosis; biopsy proven
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Young female with liver lesions; shows what looks like peripheral discontinuous enhancement; look like hemangiomas but are not; tissue sampling showed metastatic choriocarcinoma
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Post colonoscopy free air under the right hemidiaphragm
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Young patient with enlarged spleen and perisplenic bleed; in absence of obvious trauma think of mononucleosis
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Perinephric vascular lesion; rare diagnosis; angiosarcoma
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What structure is this; medial to the left adrenal; can be rounded, can be FDG avid and is often mistakenly called a lymph node; remember this location; it is celiac ganglion and is usually better seen on left
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Liver hemangioma with classic mirror image artifact on US
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A patient presenting with hematuria; rupture of AAA into the renal vein
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Is this c diff infection; but no diarrhea; spleen enlarged, ascites this is marked portal hypertensive colopathy; common on right side
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When one coronal reformat says it all; cecal volvulus
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When evaluating pancreas, always look at T1 fat sat pre gadolinium; here is there a sharp cutoff from normal high signal with no ductal dilatation; igG4 pancreatitis
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80 year old with dysphagia; classic corkscrew esophagus
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CT in a patient complaining of abdominal pain; ulcerated GIST nicely seen with positive contrast
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adrenal insufficiency; bilateral adrenal calcifications from histoplasmosis
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What is large, contains fat, is in retroperitoneum and likes to push things away; liposarcoma
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And we know the cause of bilateral renal infarcts here
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Mirizzi syndrome: common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder
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Nice depiction of anal sphincter anatomy on coronal T2 image; useful when evaluating patients with anorectal fistulas and also when staging low rectal cancer patients
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Ventral hernia with primary epiploic appendagitis
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When you have intussusception and multiple polypoid filling defects in bowel; Peutz Jeghers syndrome
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Male patient on anabolic steroids; bleeding adenoma in liver
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Is that the left kidney; history of congenitally absent left kidney; this is pseudo kidney sign from intussusception in someone with bowel metastases from melanoma
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Insulin dependent diabetes mellitus can lead to focal subcapsular fat deposition in liver, which can mimic focal lesions
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Good example of Riglers sign of pneumoperitoneum
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Fatty replacement of pancreas and small bowel feces sign; diagnosis is .......... Cystic fibrosis
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Testicular seminoma against a backdrop of microlithiaisis
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Bilateral psoas metastases from primary renal cell carcinoma
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Young patient with sclerosing encapsulating peritonitis; Also known as abdominal cocoon.
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Pseudoprostate sign in a female patient; urethral adenocarcinoma arising in a diverticulum
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Hepatosplenic hypodensities; with upper abdominal adenopathy; first thought would be lymphoproliferative disorder or some systemic infection; this was sarcoid
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Large enhancing lesion arising from right kidney; central scar; oncocytoma
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Doesn't get any more classic than this; microcystic serous cystadenoma of pancreas
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So called sandwich sign in mesenteric lymphoma; vessel between 2 nodes
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Fat containing lesion adjacent to the left kidney; was called AML but look closer and make sure is it really arising from the kidney; this was RP liposarcoma
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Large low density lesion; can be tough to tell site of origin; it touches the splenic vein which means it is likely pancreatic in origin; pancreatic lymphangioma
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Diffuse omental nodularity, thickening; peritoneal metastases, TB, lymphoma and don't forget mesothelioma which this was
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Clinical context is everything; history of endometriosis; pain and fever; is this an endometrioma on US; was a tubo-ovarian abscess on surgery
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Patient on anticoagulation and spontaneous intramural small bowel hematoma
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Median arcuate ligament syndrome; median arcuate ligament presses too tightly on the celiac artery and the celiac plexus
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Disease in multiple compartments; in this case peritoneal and retroperitoneal; think lymphoma
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Post-surgical fat necrosis can appear mass like and feel mass like
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Adrenal lesion with calcification; adrenocortical carcinoma; incidentally kidneys showing striated pattern from pyelonephritis
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Lithium toxicity with small cysts in both kidneys
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Complains of hematuria, flank pain; left renal vein thrombosis in someone with nephrotic syndrome; as patients with nephrotic syndrome have a hypercoagulable state
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Multiple splenic lesions; no history of lymphoma; not infection; this turned out to be splenic sarcoidosis
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No RUQ pain, No Sonographic Murphys sign; No gallstones; patient with GB wall thickening due to acute hepatitis
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Pancreatic tail lesion in an young patient; cystic and peripheral calcification; no prior history of pancreatitis; SPEN
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One that is not neoplasm; testicular epidermoid cyst
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String of pearl sign in bowel obstruction on erect radiograph
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Gangrenous cholecystitis with intraluminal hemorrhage
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Always pay close attention to RLQ so as not to miss the mucocele of the appendix
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Patient with NF1 showing plexiform neurofibromas in pelvis
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Am not a chest radiologist but saw this interesting older case with differential that can be applied in abdomen as well; calcified nodes; list of conditions can cause this; this was treated lymphoma
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Not something you see often; aortic stent to esophageal fistula
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Plain radiograph showing bowel pneumatosis and portal venous air
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Fat containing lesion pushing bowel and organs to the contralateral side; liposarcoma
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Very often post renal ablation we see lumbar bulge or herniation presumably from motor nerve injury
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What is the cause of pear shaped bladder; pelvic lipomatosis
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Diffuse nodular lesions in subcutaneous area, retroperitoneum; is this NF1, melanoma metastases; but this was diffuse myeloma
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When looking at hollow viscus if there is dependant asymmetric thickening call attention; this was MALT lymphoma of stomach
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One entity tough to differentiate from hydronephrosis unless you have longitudinal imaging to compare and relevant history; congenital megacalyces due to underdevelopment or maldevelopment of renal pyramids
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Bile ducts are supplied by hepatic artery; biliary ischemia and necrosis post transplant
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Patient on anticoagulation with spontaneous hemorrhagic cholecystitis
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Lumbar Hernia of Grynfellt-Lessart. Can be confused with a lipomatous tumor
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And the diagnosis is
Appendiceal mucinous tumor with pseudomyxoma peritonei
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Floating membranes; no sonographic Murphy's sign; gangrenous cholecystitis on US
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Low-density lesions in the liver in a patient with breast cancer; with vessels coursing through; tumefactive fatty infiltration
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Splenic metastasis can occur in ovarian cancer and appears to be more common in serous cystadenocarcinomas
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We are all familiar with medullary nephrocalcinosis, this is example of cortical nephrocalcinosis in patient with Alports syndrome
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What looks like primary retroperitoneal fibrosis is IgG4 disease; keep that in differential
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