Some Italians have rigged up a Nintendo Wii controller to control their PACS Viewer.  One step closer to the ultimate radiology user interface!

Some observant readers have noticed that capitalization varies between the reports featured in “Case of the Day” and posted in the “Sample Reports” on our website.  Are we inconsistent?  Do different radiologists write reports using different styles?

The answer is:  no, we are actually very consistent!  We consistently produce reports how our customers want them.  If a customer requests reports to be written in ALL CAPS, we will do it.  If a customer requests reports to be written in normal capitalization, we will do it.  Our process ensures that you get reports formatted exactly to your preference.

Furthermore, we are sensitive to the fact that certain ER docs and certain radiologists really hate certain phrases.  Do you cringe every time you see “limited study” or “fecal materials”?  Don’t worry, we can ensure that those words never appear on your reports.  Instead, we’ll use medically equivalent terms that will best satisfy your preferences.

Found this on the radRounds video site.  So true!

24/7 Radiology today unveiled its new online presence.  It’s not all cosmetics though, as our new Client Portal has customized reports just for you.

Visit now at http://www.247rad.com!

As with our patient, when large portions of the cranium have been removed by operation, external injury, or exfoliation, the brain is deprived of its support, and, by the pulsation of its arteries, the dura matter is rubbed against the rough edges of the bone, by which it ulcerates, and the brain then protrudes. This protrusion from the cerebrum is more particularly apt to occur when the dura matter has been wounded by accident or design and it may present  itself under three different forms: It may consist either of disorganized pure cerebral matter, partly of cerebral matter and of coagulated blood; or be an organized mass.

The first generally occurs immediately after the injury, and arises from the substance of the brain being wounded, and a portion of it being separated from the common mass.

The second most commonly takes place some days after the injury, and seems to arise from the rupture of one or more blood vessels a little below the surface of the brain, in consequence of which, a portion of this viscus is mechanically raised through the opening in the dura matter, skull, and integuments. This protrusion is of a dark color and is at first covered by the pia matter, but the internal hemorrhage continuing, the brain is still farther raised. This membrane then gives way. At length, the the brain yields and the blood is effused upon the surface of the tumor.

The third species of protrusion from the brain follows abscess or ulceration of that organ, hence does not appear for many days, and is as completely organized as the fungi springing from other ulcers. The fungus which arises from the brain shoots up with great rapidity, is of a greyish colour, and is generally about the size of a pigeon’s head, but, on some occasions, it is as large as a hen’s egg or a small orange. Its appearance is always preceded by an opening in the dura matter and is always connected with ulceration of the brain.

External herniations, also known as fungus cerbrei, are the rarest of the acquired herniations. They are most frequently caused by post surgical and post traumatic defects that allow swollen or displaced brain to pass through. This type of herniation may be beneficial by relieving intracranial pressure and thereby preventing more devastating complications due to internal herniation; however; external exposure of the brain can result in infections, complications, and many of these patients have a poor prognosis because of  the severity of their underlying illness. Both CT and MR imaging are effective at demonstrating these herniations. MR imaging, however, is clearly superior at defining soft tissue, which can be critical in certain clinical scenarios. Distingushing brain tissue from other tissues such as granulation tissue, cholesteatoma, tumor, or other lesions involving defects of the skull is essential and MR imaging accomplishes this well.

Observation

Clinical History: bleed, follow up

Technique: CT scan of the head without intravenous contrast

Compared with prior study dated January 30, 2010

The presence of streak artifact limits the study. There is interval development of some degree of herniation of the left frontal lobe through the left craniectomy defect with interval development of subdural hygroma in the right frontoparietal convexity and evolution of the previously noted mild left to right subfalcine herniation into a mild degree of right to left subfalcine herniation. There is partial interval improvement of the pneumocephalus in the left frontal and left parietal convexities. There is no significant interval change in the left frontotemporoparietal, parafalcine, and left paratentorial hyperdensities, which may reflect subdural hemorrhage. There is interval development of opacities in some of the ethmoid air cells and sphenoid sinuses.

Impression

INTERVAL DEVELOPMENT OF SOME DEGREE OF HERNIATION OF THE LEFT FRONTAL LOBE THROUGH THE LEFT CRANIECTOMY DEFECT. CONSISTENT WITH DEVELOPMENT OF POST-SURGICAL PSEUDOENCEPHALOCELE (FUNGUS CEREBRI). ASSOCIATED INTERVAL DEVELOPMENT OF RIGHT-SIDED SUBDURAL HYGROMA AND MILD RIGHT TO LEFT SHIFT. NO SIGNIFICANT INTERVAL CHANGE IN THE LEFT FRONTOTEMPOROPARIETAL, PARAFALCINE, AND LEFT PARATENTORIAL HYPERDENSITIES, MAY REFLECT SUBDURAL HEMORRHAGE. INTERVAL DEVELOPMENT OF OPACITIES IN THE ETHMOID AND SPHENOID SINUSES, SUGGESTIVE OF SINUSITIS. PARTIAL INTERVAL IMPROVEMENT OF THE PNEUMOCEPHALUS IN THE LEFT FRONTAL AND LEFT PARIETAL CONVEXITIES.

59 year old male trauma patient has a right shoulder xray taken to rule out fracture. The images show the head of the humerus (upper arm bone) to be in front of and below its expected location. The shoulder joint has been dislocated. No fracture is seen. There may be related injuries to the muscles and ligaments of the shoulder, however these cannot be seen on xrays, a followup MRI would be the examination of choice for such an evaluation.

Observation

Clinical History: R/o fracture

Technique: DX right shoulder

No prior study is available for comparison

The mineralization of the visualized bony structures is well maintained. There is anterior and inferior dislocation of the humerus in relation to the glenoid fossa, with the humeral head in subcoracoid location. No acute displaced fracture is identified. Degenerative changes are seen in the acromioclavicular joint.

Impression

Anterior and inferior dislocation of the humerus. No acute displaced fracture is identified.

Let’s face it:  mixing chemicals is dangerous.  Even if you know what you’re doing, there’s always the risk of something going wrong.  So was the case of today’s John Doe:

Clinical History: Chemical explosion (patient mixing chemicals when it exploded)

Technique: DX right hand, 3 views

There is complete comminuted fracture of the base of the first metacarpal with angulated dorsal displacement and intraarticular extension. There is also minimally displaced corner fracture at the ulnar side of the base of the first proximal phalanx also with intraarticular extension. Possible tuft fracture. There are multiple comminuted/shattered phalangeal fractures from the third to the fifth digit with adjacent skin and soft tissue avulsion with some areas of traumatic amputation. Also seen is undisplaced to a slightly displaced fracture of the base of the fourth and fifth proximal phalanx.

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