Jennifer R. Tynan

Metastatic craniopharyngioma: case report and literature review

BackgroundDistant spread of craniopharyngioma is a rare but important complication. Most cases are a result of spread along the surgical path. We describe a rare case of metastatic leptomeningeal craniopharyngioma as a result of dissemination along CSF pathways in a child. A review of previously described cases is provided.Case presentationA 14-year-old male was diagnosed with metastatic craniopharyngioma on routine follow-up imaging after multiple surgeries and radiation for locally recurrent craniopharyngioma. The lesion was erosive through the right parietal bone, but had remained clinically silent. The lesion was distant from previous surgical paths. The patient underwent right parietal craniotomy and resection of the lesion. Duraplasty and cranioplasty were necessary for closure. Histopathology confirmed adamantinomatous craniopharyngioma. One-year follow-up demonstrated no recurrence.DiscussionA review of reported cases suggests that leptomeningeal implantation may be an important step in metastases of craniopharyngioma, although the mechanism is poorly understood. Attention to tumor spillage at the time of surgery may be important in preventing distant recurrences.

Reduction of Adult Fingers Visualized on Pediatric Intensive Care Unit (PICU) Chest Radiographs After Radiation Technologist and PICU Staff Radiation Safety Education

Purpose A recent publication from our centre revealed a disturbing finding of a significant incidence of adult fingers seen on the pediatric intensive care unit (PICU) chest radiographs. This is inappropriate occupational exposure to diagnostic radiation. We hypothesized that the incidence of adult fingers on PICU chest radiographs would decline after radiation safety educational seminars were given to the medical radiation technologists and PICU staff. Methods The present studys objectives were addressed by using a pretest-posttest design. Two cross-sectional PICU chest radiograph samples, taken before and after the administration of radiation safety education for our medical radiation technologists and PICU staff, were compared by using a χ2 test. Results There was a 61.2% and 76.9% reduction in extraneous adult fingers, directly exposed to the x-ray beam and those seen in the coned regions of the film, respectively, on PICU chest radiographs (66.7% reduction overall). This reduction was statistically significant (χ2 = 20.613, P < .001). Conclusions Limiting unnecessary occupational radiation exposure is a critical issue in radiology. There was a statistically and clinically significant association between radiation safety education and the decreased number of adult fingers seen on PICU chest radiographs. This study provides preliminary evidence in favour of the benefit of radiation safety seminars.

Adult Fingers Visualized on Neonatal Intensive Care Unit Chest Radiographs: What You Don’t See

Purpose In a previous publication, it was revealed that a disturbingly high incidence of adult fingers were seen on pediatric intensive care unit radiographs, an example of inappropriate occupational exposure to diagnostic radiation. The present study examined adult fingers seen on neonatal intensive care unit (NICU) radiographs to assess the frequency of this occupational radiation exposure. During this study, we encountered an unexpected issue. The inappropriately exposed fingers appeared on the raw images but were sometimes cropped during technologist image processing before being sent to the picture archiving and communication system (PACS) for interpretation. Our audit describes the frequency of cropping adult fingers from images before display on PACS, with the intent of unmasking this source of occupational radiation exposure, of which quality assurance personnel may not be aware. Methods At the x-ray workstation, the raw NICU source x-ray images were analysed for the visibility of adult fingers and then were compared with the final processed images sent to PACS by the x-ray technologist. Results Of 230 radiographs audited, 30 (13%) contained fingers directly in the x-ray beam that remained visible on PACS, 22 (10%) contained fingers in the direct beam that were cropped before being sent to PACS for analysis, and 44 (19%) contained fingers in the coned area. Conclusions A significant number of adult fingers are being exposed to radiation during the acquisition of NICU radiographs. Cropping NICU radiographs before sending them to PACS can conceal a significant source of occupational radiation exposure.

Answer to Case of the Month #161: Internal Hernia Through the Foramen of Winslow

A 77-year-old woman presented with a 1-week history of intermittent right upper quadrant pain. She had no nausea, vomiting, jaundice, or temporal relationship of the pain to eating. Her surgical history included a hysterectomy and appendectomy. On physical examination, her right upper quadrant was tender to palpation and percussion, but there was no guarding, rebound tenderness, or flank pain. Laboratory tests were normal. A supine abdominal radiograph (Figure 1) and computed tomographic imaging (Figures 2, 3) was obtained.

Answer to Case of the Month #163: Acute Lymphoblastic Leukaemia

A 5-year-old girl presented with a 2-week history of progressively worsening lower extremity pain, greater on the right, with an inability to bear weight. She was clinically tender over the distal tibia and fibula bilaterally. Initial laboratory test results demonstrated a slightly decreased platelet count but was otherwise unremarkable. Further blood work showed nonspecific inflammatory markers of erythrocyte sedimentation rate (81 mm/h; reference range, 0e20 mm/h) and hypersensitive C-reactive protein (CRP) (256 mg/L; reference range, 0.9 mg/L) were also increased. Diagnostic workup included pelvic radiograph (Figure 1), Tc bone scan (Figure 2), and magnetic resonance imaging (MRI) (Figure 3) within 4 days of presentation to our hospital.

Canadian Residents' Corner / Coin canadien des residents en radiologie Answer to Case of the Month #163 Acute Lymphoblastic Leukaemia

A 5-year-old girl presented with a 2-week history of progressively worsening lower extremity pain, greater on the right, with an inability to bear weight. She was clinically tender over the distal tibia and fibula bilaterally. Initial laboratory test results demonstrated a slightly decreased platelet count but was otherwise unremarkable. Further blood work showed nonspecific inflammatory markers of erythrocyte sedimentation rate (81 mm/h; reference range, 0e20 mm/h) and hypersensitive C-reactive protein (CRP) (256 mg/L; reference range, 0.9 mg/L) were also increased. Diagnostic workup included pelvic radiograph (Figure 1), Tc bone scan (Figure 2), and magnetic resonance imaging (MRI) (Figure 3) within 4 days of presentation to our hospital.

Case of the Month #163

A 5-year-old girl presented with a 2-week history of progressively worsening lower extremity pain, greater on the right, with an inability to bear weight. She was clinically tender over the distal tibia and fibula bilaterally. Initial laboratory test results demonstrated a slightly decreased platelet count but was otherwise unremarkable. Further blood work showed nonspecific inflammatory markers of erythrocyte sedimentation rate (81 mm/h; reference range, 0e20 mm/h) and hypersensitive C-reactive protein (CRP) (256 mg/ L; reference range, 0.9 mg/L) were also increased. Diagnostic workup included pelvic radiograph (Figure 1), Tc bone scan (Figure 2), and magnetic resonance imaging (MRI) (Figure 3) within 4 days of presentation to our hospital.

Answer to Case of the Month #159. Traumatic pseudoaneurysm diagnosis and treatment.

A 25-year-old man presented to the emergency department after having been stabbed in the left axilla, which resulted in a 3-cm laceration near the posterior axillary line. The patient was hypotensive but otherwise stable. A computerized tomography (CT) of the chest was obtained and did not reveal any arterial trauma. Ten days later, the patient presented with a hematoma in the left axilla and severe pain around the healed laceration. The patient underwent CT angiogram (CTA), which demonstrated a subclavian artery pseudoaneurysm (PA) (Figures 1 and 2). Given these findings, left subclavian angiography was performed (Figure 3), followed by successful coil embolization of the left circumflex scapular artery (Figure 4). Crossing the PA was attempted but was not successful, and it was believed that the vessel was completely transected. Two days later, the patient’s symptoms had improved considerably, and CTA was performed as routine follow-up to the embolization (Figure 5).

Answer to Case of the Month #155: Shock Bowel

An 18-year-old woman was an unrestrained passenger in a single vehicle roll-over. Her Glasgow coma score was 8/15; her blood pressure on admission was 77/34 mm Hg. Initial investigations revealed a flail chest, cervical spine fracture, and bilateral femoral fractures. Computed tomography (CT) imaging was obtained through the chest, abdomen, and pelvis after both intravenous and oral contrast administration (Figures 1 and 2).