Role of imaging (images) in my practice. Dr P Senthur Nambi Consultant Infectious Diseases

Transcription

1 Role of imaging (images) in my practice Dr P Senthur Nambi Consultant Infectious Diseases

2

3 Medical images: My thoughts Images are just images Subject to the intellect of the interpreter View it in conjuction with history & clinical exam Disease evolves, so images evolve too Discuss with the radiologist

4 45 yrs male, fever with cough, sputum - 5 days Is it Bronchitis or Pneumonia?

5 Chest Xray in Pulmonary TB Reasonably sensitive but lacks specificity PPV around 60% & results in overtreatment May miss Mediastinal nodes Retrocardiac infiltrates Pulmonary vascular disease Miliary TB

6 X-ray based evaluation causes over diagnosis of TB Overdiagnosis Diagnosed by X- ray alone Actual cases NTI, Ind J Tuberc, 1974

7 THICK WALLED CAVITY IN LEFT MIDZONE..POOR RESPONSE TO ATT..

8 Fungal cultures..

9 Pneumonia with air bronchogram sign

10 Tree in bud appearance

11 Air fluid level

12 CT chest in FUO when? FUO with no localisation Patient has cough, SOB But normal chest x ray No sputum avl or unable to expectorate

13 Miliary TB

14 Necrotic mediastinal nodes Pericardial effusion

15 Lobar pneumonia Continues to have fever on appropriate therapy

16 20 years male, cough with dyspnoea - 1 month, 3kg weight loss

17 HRCT Thorax

18 CKD host on dialysis; cough with sputum 10 days

19 Unequivocal Halo sign surrounding a nodule Halo Small vessel angio invasion

20 Young male admitted with dengue..developed IV site phlebitis

21 US abdomen Liver or splenic enlargement or abscess Abdominal nodes Abdominal abscess Clarifies etiology of deranged LFT Renal abnormalities

22 USG Abdomen

23

24 Emphysematous cystitis Prostatic abscess

25 Loculated abscess collections (black arrows) posterior to the uterus (U)

26 Infected peritoneal fluid collection (A) with abnormal enhancement and thickening of the peritoneum (arrow).

27 Bilateral adrenal masses

28 CT abdomen When? Patient with pyelonephritis has fever on appropriate therapy FUO with no localisation & normal chest imaging Post intraabdominal surgery with complications

29 Meningitis Axial contrast-enhanced T1W MR image in a child with acute pyogenic meningitis reveals enhancing leptomeningeal exudates over bilateral cerebral convexities (arrows)

30 Meningitis - Acute complications Hydrocephalus Subdural effusion or empyema Stroke Abscess Dural sinus thrombophlebitis

31 Abscess Well defined Thick border Surrounding oedema

32 Etiology MRI Finding Herpes simplex Japanese B encephalitis West Nile virus Chandipura virus medial temporal lobe, cingulate gyrus, orbital surface of frontal lobes thalami (87-94%), substantia nigra, basal ganglia deep gray matter and brainstem (50%); white matter lesions mimicking demyelination; meningeal involvement on contrast enhanced images Normal EV 71 dorsal pons, medulla, midbrain, and dentate nuclei of the cerebellum; anterior horn cells of spinal cord in patients with acute flaccid paralysis

33 Herpes Encephalitis MR image shows high signal in the temporal lobes including hippocampal formations and parahippogampal gyrae, insulae, and right inferior frontal gyrus.

34 Chronic Meningoencephalitis (TB) Normal Enhancement in the basal cistern and meninges, with dilatation of the ventricles Tuberculous abscess in the left parietal region. Note the enhancing thick-walled abscess. 34

35 Tuberculoma Contrast MRI, showing multiple tuberculomas

36 Arachnoiditis Severe Arachnoiditis. A T2- weighted sagittal image reveals thickened nerve roots (arrows), intradural cysts (arrowheads) and pseudotethering

37 Poorly controlled diabetic..

38 PET CT Final frontier?

39 PET-CT scan Not a routine procedure in the workup of FUO due to high cost & limited availability Should eliminate the need for many unnecessary invasive & noninvasive diagnostic tests Important role as a second-line procedure in the management of nearly 50% of patients with FUO

40 Role of PET - CT Localisation of abnormal foci to guide the etiological diagnosis in FUO Diagnosis of infections in suspected chronic infections of bone & joints, painful hip prosthesis vascular prosthesis diabetes with suspicion of charcot s neuroarthropathy fever in AIDS

41 Role of PET-CT Detection of extent of inflammation in Sarcoidosis Inflammatory bowel disease Vasculitis involving the great vessels RA, Polymyalgia rheumatica Asses response to therapy

42 Imaging Final thoughts Important role in localising the site of problem & to analyse the extent of involvement Helps in predicting the etiology to some extent Great value in Immunecompromised host, HIV+ individuals Cost, commercial considerations Radiation exposure Special considerations (MRI, pregnancy)

43 Thanks..