| Hydropneumothorax verses Simple Pneumothorax |
Aug 2010 |
5 pages |
| Authors:
Aaron Reed; Michael Dent; Steve Lewis; Paul Shogan; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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 | Three cases are presented to compare and contrast the radiographic findings in hydropneumothorax versus simple pleural effusion. The first case is of a 72-year-old man with metastatic colon cancer presenting with worsening shortness of breath. Post-thoracentesis chest radiographs (Fig 1) and CT (Fig 2) demonstrate a hydropneumothorax. The second case is of a 67 year-old male with non-small cell lung carcinoma who developed a hydropneumothorax following percutaneous drain placement (Fig ... |
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| Solitary Pulmonary Nodule |
May 2010 |
4 pages |
| Authors:
Rebecca Johnson; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
|
| Over 150,000 solitary pulmonary nodules are found each year on chest imaging. The major concern of the patient is whether or not the nodule is cancerous. This can typically be difficult to distinguish from a benign cause on imaging studies alone. Characteristics of the mass seen on imaging studies can help to determine the likelihood that a mass is benign or malignant. These include size, border, density, growth over time, ... |
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| Mycobacterium Xenopi Found Incidentally on MRI of the Cervical Spine |
Jan 2010 |
5 pages |
| Authors:
Chris Walker; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD F EDWARD HEBERT SCHOOL OF MEDICINE
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| The authors present a case of a 44 year old healthy pregnant (with twins) female diagnosed with Mycobacterium xenopi in her lung. A mass was incidentally noted in the right upper apex on an MRI ordered to evaluate a subluxation seen in her cervical spine appreciated on plain radiography. Mycobacterium xenopi is uncommon, especially in immunocompetent patients. The patient did have a fractured ankle while pregnant. This case highlights importance ... |
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| Gun Shot to Thorax Resulting in Localized Hemothorax and Lung Contusion |
Dec 2009 |
5 pages |
| Authors:
Les Folio; Duane Robinson; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
|
| The authors present a case that highlights some important basic points about Chest X-Ray (CXR) interpretation. In addition, CT findings of a gunshot wound (GSW) to the thorax are highlighted to illustrate these findings to help drive home the teaching points. The chest x-ray is the most commonly ordered imaging study in combat hospitals; not dissimilar to civilian emergency rooms. In addition, this case highlights use of the CT scout ... |
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| Mild Traumatic Brain Injury and Conduction Aphasia from a Close Proximity Blast Resulting in Arcuate Fasciculus Damage Diagnosed on DTI Tractography |
Nov 2009 |
5 pages |
| Authors:
J Wesson Ashford; Allyson Rosen; Yu Zhang; Wang Han; Arlene Kasprisin; Stephanie Martinson; Jauhtai Cheng; Michael Weiner; Jerome A Yesavage; Les Folio; VETERANS ADMINISTRATION HOSPITAL PALO ALTO CA
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| The authors present a case demonstrating that a blast injury was associated with both conduction aphasia and an abnormality in the left Arcuate Fasciculus (AF) on MR DTI (Diffusion Tensor Imaging). In addition, this study showed the presence of conduction aprosodia in the setting of damage to the homologous area in the right hemisphere (hereafter referred to as the right homologue of the AF). In prior research, diffusion tensor images ... |
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| Venous Fragment Embolism to the Pulmonary Artery: A Rare Occurrence - Case Report and Literature Review of Venous Fragment Embolization to the Pulmonary Artery |
Sep 2009 |
8 pages |
| Authors:
Christopher M Andrews; Krintine E Andrews; Roger Boodoo; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| Despite the large number of gunshot wounds treated in civilian and military practice, embolization of missiles to the pulmonary artery is relatively uncommon. In a review of 7,500 medical reports from casualties from the Vietnam Vascular Registry, only 22 patients with known vascular trauma had missile emboli (0.3%), and of those, only 4 (.0005%) were to the pulmonary artery. Causative agents of missile embolism are numerous and are often a ... |
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| Bilateral Patellar Tendon Rupture |
Jul 2009 |
4 pages |
| Authors:
Ramon A Riojas; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| A 42-year-old active duty male jumped to exit his truck wearing full body armor and weapons and felt a pop in his left knee. He then tried to hop on the other leg to the aid station and felt a similar pop in the opposite leg. The soldier was unable to walk, however, he tried crawling to obtain medical attention. Eventually friendly forces saw him in distress and took him ... |
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| Gun Shot Wound to the Chest of a Military Working Dog |
Jun 2009 |
6 pages |
| Authors:
Meghan Galer; Donna Magid; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
|
| This Military Working Dog (MWD) was shot in the chest during combat operations in Iraq. Military Working Dogs are critical to the safety and well-being of deployed troops in combat operations and, as such, they are triaged and treated in our combat hospitals just like any other soldier; their speciation is not a factor in their triage status. This case familiarizes military physicians with the basic canine anatomy, positioning, and ... |
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| Progressive Atelectasis Secondary to GSW to Airway |
May 2009 |
5 pages |
| Authors:
James Cassleman; Mike Zakaroff; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| Radiographic interpretation of atelectasis bears particular importance in the setting of aspiration, which involves added dangers of infection, inflammation and interstitial edema. While the consequences of pulmonary aspiration are ultimately a function of the type, volume and acidity of aspirated material, the overall result is often diminished gas exchange and loss of lung volume. Regardless of the mechanism, this loss of lung volume frequently occurs in a predictable manner that ... |
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| Cavitary Lung Disease in an HIV-Positive Patient |
Apr 2009 |
5 pages |
| Authors:
Massimo Federico; Bridget Cunningham; Angelo Paredes; Dara Lee; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| We present the case of an HIV-positive patient who presents with radiographic and computed tomography findings of cavitary lung disease. There exists a broad differential diagnosis for pulmonary cavitary lesions in immunocompromised individuals. Key factors in narrowing down the differential include clinical setting, CD4 levels, and radiographic findings. Through awareness of the CT appearance of various entities, radiologists aid clinicians in distinguishing between benign and malignant lesions and in some ... |
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| Gymnast Wrist |
Mar 2009 |
4 pages |
| Authors:
Amit Sanghi; Tylan Muncy; Scott Greenwald; Matthew Monson; Les Folio; TELECOMMUNICATION RESEARCH AND DEVELOPMENT DIV BERN (SWITZERLAND)
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| We present a case of bilateral wrist pain in an adolescent female who is active in competitive sports. Multiple imaging modalities demonstrate a case of gymnast wrist. A discussion of gymnast wrist and differential diagnosis are presented. A young adolescent female presents with complaint of bilateral wrist pain for almost one year. She is otherwise healthy with no other complaints. She has been competitive in sports such as gymnastics and ... |
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| Facial Blast Injury Resulting in Sand Aspiration |
Jan 2009 |
4 pages |
| Authors:
Brett Searcey; Aaron Jackson; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
|
| Sand aspiration has been previously associated with drowning, cave in, and accidental burial. It can be a fatal complication due to obstruction of the airway and subsequent anoxic death. However, to the authors knowledge, it has not previously been associated with blast injuries. We discuss a recent case of a blast-injury survivor in Iraq with findings consistent with sand aspiration on computed tomography (CT) and review presentation, imaging findings, bronchoscopy ... |
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| Keyhole Fracture of the Skull |
Dec 2008 |
5 pages |
| Authors:
Aaron M Jackson; Brett K Searcey; James G Smirniotopoulos; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| The authors present the case of a soldier wounded in Iraq with a gunshot wound to the skull exhibiting a characteristic keyhole fracture pattern on CT scan. Tangential gunshot wounds to the skull were termed keyhole fractures by Spitz in 1980 and the mechanics involved in the creation of the defect were later described by Dixon in 1982 (1,2). Keyhole fractures exhibit entrance and exit wound defects resulting from a ... |
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| Traumatic Brain Injury: Imaging Spectrum from Mild to Severe Closed Head Injury |
Nov 2008 |
8 pages |
| Authors:
Sean Meagher; Alexander Galifianakis; David Jannotta; Pavel Krapiva; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| The authors present a case of a Diffuse Axonal Injury (DAI) that is evident on MRI, though not on CT. In this full-text version we present two more cases of parenchymal injury in increasing severity. There is a continual clinical and imaging spectrum of severity of head trauma: from seemingly trivial falls or car accidents to blast exposure at various distances, to high velocity penetrating and perforating ballistics. Mild Traumatic ... |
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| Pneumocystis Jiroveci Pneumonia |
Oct 2008 |
4 pages |
| Authors:
Paul Shogan; Tylan Muncy; Kevin McCarthy; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| We present a case of Pneumocystis jiroveci (formerly P. carinii) Pneumonia (PJP). A 60 year old HIV+ male with a CD4+ count of 144 cells/mm3 complaining of cough, dyspnea, and chest pain was ultimately diagnosed with PJP by lung biopsy after negative bronchoalveolar lavage (BAL). This case demonstrates typical radiographic findings of PJP, with symmetric bilateral lower lobe reticulonodular ground-glass opacities, complicated by spontaneous pneumomediastinum and pneumothorax. |
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| Severe Epistaxis from an Intracranial Vascular Bleed from Grenade Injury |
Sep 2008 |
5 pages |
| Authors:
Thomas J Willson; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| This case demonstrates the importance of trajectory analysis of blast and/or ballistic penetrating head and neck injuries. In particular, this case focuses on an intracranial vascular injury generated by a hand grenade with the diagnosis assisted by trajectory mapping using MDCT (Multi-Detector CT) volumetrically acquired datasets. Further, this case shows the usefulness of reformatted images to analyze projectile wound trajectories and reviews complex anatomic planes for use in triage, treatment, ... |
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| Lung Laceration with Active Bleeding, Contusion and Hemothorax |
Aug 2008 |
5 pages |
| Authors:
Christopher Backus; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| The following case demonstrates the importance of emergent imaging in patients with thoracic gunshot wounds. The AP chest in our case highlights findings that correlate well with follow up CT Angiogram of the chest. A companion case is provided to illustrate wound dynamics in the lung with a variation of extent of intrathoracic bleeding. This case also exemplifies application of complex planes that are now commonplace with modern CT imaging ... |
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| Traumatic Carotid Pseudoaneurysm Post Gun Shot Wound to the Head/Neck |
May 2008 |
5 pages |
| Authors:
Erik A Abrames; Stephen R Chen; Wilmer Jones; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
|
| Pseudoaneurysms have many etiologies that include blunt or penetrating trauma, iatrogenically during vascular procedures or dehiscence of a vascular graft. Pseudoaneurysms can be treated in a variety of ways and treatment decisions often depend on their size and location. In Iraq, a security guard was found to have a carotid pseudoaneurysm after sustaining a gun shot wound to the head and neck. The following discussion looks at causes, imaging modalities, ... |
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| Superior Vena Cava Syndrome: Radiological Diagnosis and Endovascular Treatment |
Mar 2008 |
4 pages |
| Authors:
Gabriel Peterson; Joseph Ronsivalle; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| SVC syndrome results from increased hydrostatic pressure in the venous system distal to the SVC, through which blood flow has been diminished or obstructed. The source for obstruction may be an extrinsic process compressing the SVC or an intraluminal process, such as a venous thrombosis. The diagnosis is most often confirmed with computed tomography or venography. Diagnostic criteria include the demonstration of obstruction as well as the opacification of collateral ... |
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| Case 24: Stress Fracture of the Tibia |
MAR 2008 |
6 pages |
| Authors:
Daniel McKim; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY AND RADIOLOGICAL SCIENCES
|
| Stress fractures, also known as "fatigue fractures", are common overuse injuries. They have been described in almost every bone of the human body though they most commonly occur through the diaphysis of lower extremity weight bearing bones. Most often this micro trauma is found in military recruits and athletes taking part in running activities. A diagnosis can often be made by patient history and radiographic findings. However computed tomography, magnetic ... |
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| Brodie Abscess |
Oct 2007 |
6 pages |
| Authors:
Catherine H McHugh; Lorraine G Shapeero; Les Folio; Mark Murphey; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD DEPT OF RADIOLOGY
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| Brodie abscess is a rare bone lesion that forms as a result of subacute osteomyelitis. Patients typically present with a several month history of non-specific pain and swelling, often lacking an inciting traumatic event and systemic symptoms. While radiographs are the initial diagnostic modality, Magnetic Resonance (MR) imaging can be useful in the further delineation of the disease. We present a typically appearing case, with initial normal radiography before findings ... |
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| Osteoid Osteoma |
May 2007 |
5 pages |
| Authors:
Timothy G Sanders; John P Lichtenberger; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
|
| Osteoid osteoma is a common, osteoid-producing, benign bone neoplasm affecting pediatric and young adult patients. This tumor most often occurs in the cortical bone as a small, fibrovascular nidus with surrounding sclerosis and soft tissue edema. The diagnosis of osteoid osteoma can usually be made on the basis of radiographic findings, however other entities including stress fracture, osteomyelitis and osteoblastoma occasionally present a diagnostic challenge and can influence which imaging ... |
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| Echinococcosis of the Liver |
Mar 2007 |
4 pages |
| Authors:
Justin Q Ly; Douglas P Beall; Timothy G Sanders; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
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| Echinococcosis is a parasitic infection that poses a potential health threat to military members and others who travel to endemic regions. While canines are the primary host of the Echinococcus tapeworm, sheep and humans serve as secondary or intermediate hosts. Human infestation begins following accidental ingestion of the Echinococcus ova via a contaminated food source. Following ingestion, the ova enter the blood stream or lymphatic system through the small bowel ... |
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| Schistosomiasis Japonicum Involving the Liver and Colon |
Feb 2007 |
5 pages |
| Authors:
Justin Q Ly; Timothy G Sanders; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
|
| This case report reviews the general characteristics and life cycle, clinical presentation, typical imaging findings, and treatment of Schistosomiasis. Schistosomiasis is a chronic infection caused by parasitic trematode worms that currently affects 200 million people in subtropical and tropical environments and is not an insignificant threat to deployed military members. Schistosomiasis infection in humans begins with cercariae penetration of the skin or buccal mucosal from a contaminated water source. Schistosome ... |
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| The Deep Lateral Femoral Notch: A Sign of Anterior Cruciate Ligament Disruption |
Jan 2007 |
4 pages |
| Authors:
Timothy G Sanders; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
|
| The deep lateral femoral notch sign refers to an osteochondral impaction injury of the lateral femoral condyle that is associated with disruption of the anterior cruciate ligament (ACL). At the time of injury, the tibia translates anteriorly relative to the femur resulting in an impaction injury of the lateral femoral condyle against the posterior tibial plateau. Identification of the deep sulcus on the lateral radiograph of the knee is a ... |
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| Hydroxyapatite Deposition Disease |
Nov 2006 |
|
| Authors:
Justin Q Ly; Stephanie J Upton; Douglas P Beall; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
|
 | Hydroxyapatite deposition disease (HADD), a disease most commonly found in middle-aged individuals, is characterized by deposition of calcium phosphate crystals in periarticular tissues. The deposits frequently occur in tendons near their osseous attachments, most commonly involving the supraspinatus tendon. The etiology of HADD is unclear, but may be related to repetitive trauma or metabolic disease. Characteristic clinical and radiographic findings include acute or recurrent articular pain and homogenous calcified deposits ... |
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| The Superior Labrum, Anterior-to-Posterior 'SLAP' Lesion |
Oct 2006 |
5 pages |
| Authors:
Timothy G Sanders; John D Duerden; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
|
| The Superior Labrum Anterior-to-Posterior (SLAP) lesion is a term that was coined to refer to a tear involving the superior glenoid labrum. These lesions are common among military members and athletes that utilize overhead arm movements. They typically occur as a result of a fall on out stretched hand or following repetitive overhead activity that places traction on the shoulder. SLAP lesions represent a specific pattern of injury that involves ... |
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| Subdural Hematoma |
Jul 2006 |
6 pages |
| Authors:
Justin Q Ly; Timothy G Sanders; James G Smirniotopoulos; Les Folio; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
|
| Subdural hematoma is a common injury in both military active duty and their dependents, including children subject to nonaccidental trauma. The subdural hematoma (SDH) is a potentially devastating, yet curable extraaxial fluid collection classically associated with head trauma including rapid acceleration or deceleration that produces tearing of the bridging veins as they cross from brain to dural sinus. Clinical manifestations may be nonfocal and nonspecific and a careful history taking ... |
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| Emergency Decompressive Craniotomy with Banked Skull Flap in Subcutaneous Pocket |
Jan 2006 |
4 pages |
| Authors:
Les Folio; Steven Craig; Brian Singleton; Brian Adams; UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
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| The abdominal KUB (Kidneys, Ureters, and Bladder, also sometimes referred to as Flat Plate) demonstrates a smooth, large, calcific opacity in the left lower quadrant (see figure 1). An enteric tube is also noted with its tip in stomach; surgical staples are noted peripherally to skull cap. No other abnormalities are present on the KUB. The axial CT of the abdomen localizes the skull cap to the anterior abdominal wall ... |
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