Radiology short cases

🚩Malposition of central line into azygos vein:

Abrupt bend at the tip of the left central venous catheter.
It was in the azygos vein

🚩Misplaced endotracheal tube:

Esophageal intubation

🚩Reversible Splenial Lesion:

♦️Findings:

Axial FLAIR, axial T1 post contrast, sagittal T2, and axial diffusion weighted imaging demonstrates a well defined, symmetric, non-expansile, nonenhancing signal abnormality at midline involving the corpus callosum splenium. The splenium lesion demonstrates restricted diffusion.

♦️Discussion/Differential Diagnosis:

The reversible splenial lesion is also known as MERS (mild encephalitis/encephalopathy with a reversible isolated SCC lesion), and is typically asymptomatic in isolation as opposed to other causes of corpus callosum lesions that will cause symptoms of hermispheric disconnection.
These are classically associated with stopping or changing antiepileptic drugs, after a single seizure, after focal status epilepticus, but may also be seen with electrolyte imbalance, hypoglycemia, and uremia.

The reversible splenial lesion is nearly always perfectly symmetric involving the central fibers, nonenhancing, and with DWI restriction.

If the lesion does not fulfill these criteria, the wide range of other processes that may affect the corpus callosum should be considered such as MS/ADEM, PRES, DAI, Marchiafave Bignami disease, and neoplasm.

The MERS lesion resolves within 1 month, most by 1 week.

🚩Straight sinus/Vein of galen thrombosis with bilateral thalamic infarction:

Findings:

Axial T1 and T2 weighted images show extensive abnormal signal with mass effect in the thalami, right internal capsule, and right basal ganglia.
The sagittal images show abnormal signal in the straight sinus/vein of galen region consistent with thrombosis.
Lack of flow signal in these areas is confirmed by phase contrast MIP image.

♦️Differential diagnosis:
Bilateral signal abnormalities should raise the possibility of dural sinus/deep venous thrombosis. Other etiologies of bilateral abnormal thalamic signal abnormalities include "top of the basilar" syndrome (occlusion of a large thalamoperforator that supplies both thalami), glioma, metastatic disease, and less likely encephalitis.

🚩Intracranial neurenteric cyst:

A well-defined round mass with smooth margins, located anterior to the brainstem is the characteristic presentation of intracranial neurenteric cysts.

Wide range of signal intensity on T1 and T2 weighted images is attributed to its variable protein content

🚩Right inferior lumbar hernia (Petit hernia):

There is a bowel protruding as content, defect measuring 4.8 cm.

🚩Superior lumbar hernia:

Herniation of abdominal and perinephric fat through a defect in superior lumbar triangle

♦️A Grynfeltt-Lesshaft hernia (or superior lumbar hernia) is a type of lumbar hernia, with herniation occurring through the superior lumbar triangle (of Grynfeltt-Lesshaft.

🚩Stroke

🚩Fredericson MRI classification of medial stress syndrome:

The Fredericson MTSS classification follows a progression related to the extent of injury. This begins with periosteal edema (grade 1), followed by progressive marrow involvement (grades 2 and 3), and eventually cortical stress fracture (grades 4a and 4b).

🚩Medial tibial stress syndrome:

Selected MRI images demonstrate periosteal and subjacent marrow edema along the anteromedial border of the tibial diaphysis, in keeping with medial tibial stress syndrome (shin splints)