Dear Friends,
Muppet is feeling very guilty about the difficulty of case 100. To regain your sympathy, he has selected an easy case: radiographs belong to a 53-year-old woman with moderate pain in the right hemithorax for the last six months. Where is the lesion?
1. Lung
2. Mediastinum
3. Pleura/chest wall
4. Can’t tell
Check the images below, leave your thoughts in the comments sectiona and come back on Friday for the answer.
A short preview of lecture A-158 ‘Connectomics in brain pathology’, from the session NH 7 ‘The human connectome: a comprehensive map of brain connections’ at ECR 2014, given by M.P. van den Heuvel from Utrecht, Netherlands.
Watch the whole lecture and many more at http://ipp.myESR.org
Direct link: http://bit.ly/The_human_connectome
Abstract:
Healthy brain function depends on efficient functional communication within a complex network of structural neural connections, a network known as the connectome. Conversely, damage to the brain’s network, disrupting local neuronal processes and/or global communication between remote functional systems may lead to brain dysfunction. In the last few years, emerging evidence from a wide variety of studies suggests that connectome abnormalities may indeed play an important role in the aetiology of several brain disorders. In my talk, I will discuss the results of recent studies suggesting an important role for affected connectome organization in a number of neurological and psychiatric disorders. In particular, I will highlight the findings of affected functional and structural brain network in neurodegenerative disorders such as Alzheimers and ALS, as well as discuss how the application of network science and connectomics may aid our understanding of the biological basis of psychiatric disorders such as autism and schizophrenia.
The ESR spoke with Donna Walsh, executive director of the European Federation of Neurological Associations (EFNA) about how her organisation supports patients with brain disorders and how well patients are informed about the role of radiology in neurology.
European Society of Radiology: What is the overall aim of your organisation and what exactly do you do to achieve this goal?
Donna Walsh: The European Federation of Neurological Associations (EFNA) is an umbrella group representing pan-European neurology patient groups. Our slogan, ‘empowering patient neurology groups,’ encapsulates our goals as an association. We strive to add capacity to our members, allowing them to be the most effective advocates possible in their own disease-specific areas. EFNA embraces the concept of partnership for progress: working at a high level with relevant stakeholders from the fields of policy, medical, scientific/research, industry, patient partners and other key opinion leaders.
Donna Walsh, executive director of the European Federation of Neurological Associations
ESR: How many patient organisations do you represent? How many members do you have? Who are they?
DW: EFNA is an umbrella organisation comprising 19 predominantly pan-European disease-specific neurology patient organisations. These are Dystonia Europe, Euro-Ataxia, European Alliance for Restless Legs Syndrome (EARLS), European Alliance of Neuromuscular Disorders Associations (EAMDA), European Headache Alliance (EHA), European Huntington’s Federation (EHF), European Multiple Sclerosis Platform (EMSP), European Myasthenia Gravis Association (EuMGA), European Network for Research in Alternating Hemiplegia in Childhood (ENRAH), European Polio Union, European Sexual Health Alliance (ESHA), Guillain-Barre & Associated Inflammatory Neuropathies (GAIN), International Brain Tumour Alliance (IBTA), International Bureau for Epilepsy (IBE), Motor Neurone Disease Association (MND) – Europe, Pain Alliance Europe (PAE), Progressive Supranuclear Palsy Association – Europe (PSP-Europe), Stroke Alliance for Europe (SAFE) , Trigeminal Neuralgia Association UK. As you can see, there are also some national organisations who are associate members and some international groups, in the absence of a pan-European association.
ESR: What are the most common brain diseases in Europe?
DW: Brain disorders are very common and will affect one in three of us during our lifetime. They range from very prevalent disorders such as migraine (affecting up to 15% of the population) to very rare disorders. Most people will have heard of multiple sclerosis, dementia, Parkinson’s disease, epilepsy, stroke, etc. But people often forget that sleep, mood, anxiety, addiction and eating disorders are also disorders of the brain. So brain disorders range from the genetic to the degenerative to the muscular and beyond!
Dear Friends,
Today I am presenting the case of a 43-year-old man with lymphoma, admitted with fever and left pleural effusion. Radiographs were taken after pleural fluid drainage. Check the images below, leave me your diagnosis in the comments section and come back on Friday for the answer.
Diagnosis:
1. Pneumonia
2. LLL collapse
3. Pleural fluid
4. None of the above
Dear Friends,
Muppet and I are very happy to have reached one hundred cases. We hope you enjoyed them as much as we did. Radiographs of this case belong to a 52-year-old man with vague chest complaints. He was operated on for testicular tumour fifteen years earlier.
Check the images below, leave your thoughts and diagnosis in the comments section, and come back on Friday to find out the answer.
Diagnosis:
1. Duplication cyst
2. Lymphangioma
3. Metastasis from testicular tumour
4. None of the above
A short preview of lecture A-585 ‘C. Tumours and tumour-like lesions’, from the session RC 1910 ‘The hand and wrist’ at ECR 2014, given by E. Llopis from Valencia, Spain.
Watch the whole lecture and many more at http://ipp.myESR.org
Direct link: http://bit.ly/The_hand_and_wrist
Abstract:
Radiological study of the wrist and hand is challenging due to its complex anatomy with many small structures and the number of normal bone and soft tissue variants that might mimic injuries. Moreover, many findings can be asymptomatic. Their knowledge is important to avoid misdiagnosis. During this lecture we will also review the role of the different imaging modalities, such as plain films for wrist alignment and bone structures as well as the important role of US and MR in differentiating tumour from tumour-like conditions. We will become familiar with some specific radiological findings that allow us to make accurate diagnoses of soft tissue and bone lesions.
Organisations that represent professionals working in radiological subspeciaties and allied sciences are vital parts of the ESR community. The ESR has its own body – the Subspecialties and Allied Sciences Committee – that is dedicated to discussing and highlighting issues that affect these groups. We spoke to chairperson Dr. Catherine Owens to find out about her role, the committee’s functions and some of the items on its current agenda.
ESR Office: What is the main purpose of the Subspecialties and Allied Sciences Committee (SASC) and how does it operate?
Catherine Owens: The SASC was formed to unite all of the important subspecialties within clinical radiology, and the important allied healthcare professionals. The committee is made up of the presidents of each of the ESR’s Subspecialties and Allied Sciences Member Societies. This provides a forum to highlight the common issues within radiology and to try to empower the individual groups to understand and help find joint solutions. As a united group we are more able to increase our powers to lobby national and EU groups to solve some of the current challenges facing radiologists.
Dr. Catherine Owens, chair of the ESR’s Subspecialties and Allied Sciences Committee
Practically speaking, the committee coordinates initiatives related to pertinent issues within all subspecialties in radiology and allied disciplines, in cooperation with the Education Committee for specific educational issues and with the Quality, Safety and Standards Committee for specific professional issues. In addition, the committee assists the European Congress of Radiology Programme Planning Committee in the preparation of the educational and scientific programme for the annual ECR meetings.
Specific tasks and responsibilities of the group include revising detailed curricula for subspecialty training in liaison with the Education Committee; devising Strategies to support the provision of subspecialist radiology; providing liaison between European subspecialty societies, allied sciences societies and the ESR; and contributing to the overall strategies of the ESR related to professional issues, training harmonisation and research collaboration.
A short preview of lecture A-136 ‘A. Thoracic injuries’, from the session MC 622 ‘Chest emergencies’ at ECR 2014, given by S.E. Mirvis from Baltimore, United States.
Watch the whole lecture and many more at http://ipp.myESR.org
Direct link: http://bit.ly/Chest_emergencies
Abstract:
Chest trauma is directly responsible for 25 % of all trauma deaths and is a major contributor in another 50 % of all trauma mortality. Blunt trauma, accounting for 90 % of chest injuries, is the third most common site of injury in polytrauma patients. Plain radiographs still have a role in recognition of some acute thoracic pathology that requires immediate further management, either diagnostically and/or therapeutically, such as tension pneumothorax, major transdiaphragmatic herniation, large hemothorax or obvious mediastinal hematoma. MDCT of the chest is now typically included in a whole body scan with IV contrast to facilitate rapid diagnosis on polytrauma cases using less radiation than selected segmental scans. MDCT is the well-proven diagnostic gold standard for chest injury evaluation. The major advantages of MDCT over other modalities include identification of active bleeding, direct signs of trachea or esophageal injury, direct evidence of major arterial vascular injury, such as pseudoanurysms, pneumo and hemopericardium, location and extent of lung contusion and laceration, and assessment for thoracic spine, shoulder girdle and rib fractures. Diaphragm injuries are well depicted by MDCT, especially on the left by identifying both the torn diaphragm edges, herniation and constriction of abdominal contents at the level of the torn diaphragm (collar sign), and direct contact of herniated structures with the posterior chest wall (dependent viscera). Tracheal injuries are suggested by diffuse and progressive pneumomediastinum, dilated tracheostomy cuff, ectopic endotracheal tube, and direct connection of mediastinal air with the trachea lumen. CT-angiography eliminates the majority of indications for diagnostic catheter angiography.
Dear Friends,
Today I am showing PA chest and sagittal CT of a 66-year-old woman with a persistent RLL infiltrate and negative bronchoscopy. Check the images below, leave me your thoughts in the comments section, and come back on Friday for the answer.
Diagnosis:
1. Tuberculosis
2. Chronic aspiration pneumonia
3. Carcinoma
4. None of the above
A short preview of lecture E³ 920a’ The treated spine and joints’, from the session A-246 ‘A. Imaging of the postoperative spine’ at ECR 2014, given by P.N.M. Tyrrell from Oswestry, United Kingdom.
Watch the whole lecture and many more at http://ipp.myESR.org
Direct link: http://bit.ly/The_treated_spine_and_joints
Abstract:
Spinal surgery is most frequently performed to decompress (disc herniation, stenosis, malignant infiltration), fuse and stabilise (particularly following trauma or infiltrative destructive processes) and correct deformity. Often, there may be a combination of these procedures at one operation. Surgical instrumentation or bone graft is sometimes employed. Patients may present themselves with symptoms early or late following the procedure. This interactive session seeks to address the variety of surgical procedures undertaken and subsequently imaged post-operatively because of symptoms. The session aims to help one to understand and become familiar with the expected post-operative imaging appearances related to the surgical procedure, learn about abnormal pathological features as a cause of symptoms in the acute and more chronic situation and explore the diagnosis and differential diagnosis. This may include post-operative fibrosis versus recurrent disc herniation versus post-operative infection. Failure of fusion due to failure of instrumentation or inadequate take of bone graft can give rise to pseudoarthrosis. Recurrent stenotic symptoms may relate to an inadequate decompression, recurrent disc herniation, post-operative haematoma, extension of a malignant process or ischaemic damage.
