CT Head breakdown: how to identify and deal with multiple space occupying lesions скачать в хорошем качестве

CT Head breakdown: how to identify and deal with multiple space occupying lesions

A female aged 50 has a non contrast brain CT after an episode of confusion. What does it show? ———————————————————————- BRAIN METASTASES 👨🏽‍💻This case is all about being able to tell the difference between cytotoxic and vasogenic oedema. Let’s look at each in turn: VASOGENIC OEDEMA ▫️blood-brain barrier disrupted ▫️mainly affects white matter giving finger like pattern ▫️seen predominantly with space occupying lesions such as tumour or abscess CYTOTOXIC OEDEMA ▫️blood-brain barrier intact ▫️Na+/K+ pumps fail to operate ▫️Na+ accumulation within cells leading to water being drawn in ▫️leads to ionic oedema with extracellular water accumulation seen as low attenuation within both grey and white matter on CT ▫️loss of grey-white matter differentiation on CT ▫️seen with ischaemic stroke 👨🏽‍💻In this case we can see diffuse low density affecting just the white matter - diffuse vasogenic oedema. This should then alert you to the possibility of space occupying lesions which you just make out without IV contrast. Once we give the contrast we can then see multiple ring enhancing lesions 👨🏽‍💻Malignancy and infection make up the vast majority of peripherally enhancing brain lesions and diffusion weighted MRI is really helpful in trying to tell the difference between abscess and cancer. Abscesses usually light up on DWI given that pus restricts the movement of water molecules whereas this is less the case with malignancy 👨🏽‍💻In this case there was a background of breast cancer and the metastases all resolved on giving chemotherapy with remission maintained several years down the line 🔻@theradiologistpage ✅Patient consent obtained ——- #theradiologist #radiology #radiologist #physician #physicianassistant #medicine #medstudent #medicalstudent #medschool #medicalschool #radtech #whitecoat #mri #medical #radiography #radiologystudent #doctor #medicalstudents #interventionalradiology #surgeon #medic #frcr #anatomy #usmle #medlife #exams #brainct