Descending necrotizing mediastinitis secondary to retropharyngeal abscess.

We report a case of descending necrotizing mediastinitis (DNM) in a 68-year-old male who presented in acute respiratory distress accompanied with anterior cervical neck swelling and pain with swallowing. Contrast enhanced computed tomography (CECT) of the neck demonstrated a large, peripherally enhancing retropharyngeal fluid and air collection that appeared to communicate with a fluid and air collection within the mediastinum. CECT of the chest demonstrated punctate foci of air and fat stranding along the anterior and superior mediastinum. Radiological evidence and the presence of necrosis on surgical debridement of the retropharyngeal abscess established the diagnosis of DNM. This case emphasizes the role of computed tomography (CT) in the diagnosis of DNM and demonstrates the utility of chest imaging in a high-risk patient who presents with a retropharyngeal abscess.

Rare primary mucosal melanoma of the larynx.

Few cases of primary mucosal melanoma of the larynx have been documented in the literature, so only a limited amount of data exists regarding its diagnosis and treatment. The prognosis is poor, as patients often present at a late stage with regional or distant metastases. We describe the case of a 66-year-old man who presented with hoarseness and dysphagia. Laryngoscopy identified a dark discoloration of the supraglottic larynx and incomplete mobility of the right vocal fold; an excisional biopsy confirmed the diagnosis. We discuss the epidemiology, clinical features, diagnosis, interpretation of imaging findings, and management of this rare malignant melanoma.

Radiology Case Of The Month: Brain Magnetic Resonance Imaging with Bilateral Hyperintensities in the Globus Pallidi.

An MRI of the brain and spine of an 11-year-old male revealed the following abnormality which is consistent with his chronic condition.

"What Program Directors Think" III: Results of the 2014/2015 Annual Surveys of the Association of Program Directors in Radiology (APDR).

RATIONALE AND OBJECTIVES: The Association of Program Directors in Radiology regularly surveys its members regarding issues of importance to support radiology residency programs and their directors. MATERIALS AND METHODS: This is an observational cross-sectional study using two Web-based surveys posed to the Association of Program Directors in Radiology membership in the fall of 2014 (49 items) and the spring of 2015 (46 items) on the subjects of importance to the members, including the Accreditation Council on Graduate Medical Education Milestones, the Non-Interpretative Skills Curriculum, the American Board of Radiology Core Examination, the effect of the new resident testing and program accreditation paradigms on training outcomes, the 2015 Residency Match, the Interventional Radiology/Diagnostic Radiology (IR/DR) Residency, and Program Director (PD)/Program Coordinator resources. RESULTS: Responses were collected electronically, results were tallied using SurveyMonkey software, and qualitative responses were tabulated or summarized as comments. Findings were reported during the 63rd annual meeting of the Association of University Radiologists. The maximal response rate was 33% in the fall of 2014 and 36% in the spring of 2015. CONCLUSIONS: PDs believed that the radiology Milestones, now largely implemented, did not affect overall resident evaluation, was not reflective of resident experience, and actually made evaluation of residents more difficult. PDs also felt that although the American Board of Radiology oral examination had been a better test for clinical practice preparedness, their new residents knew at least as much as before. There was little evidence of recall reemergence. The radiology training community saw a drop in residency applicant quality as demonstrated by the United States Medical Licensing Examination scores and clinical rotation grades. Because the new IR/DR Residency positions were to be funded at the expense of the traditional DR positions, the majority of PDs expected a negative effect of the impending IR/DR match on their DR recruitment. PDs were in favor of a unified clinical radiology curriculum similar to the Radiological Society of North America online physics modules.

RADIOLOGY OF THE MONTH: Vocal Cord Dysfunction with Multiple Cranial Neuropathies.

A 67-year-old female presented to our institution with a progressive history of hoarseness for the past six months. The patient also referred shoulder weakness and cough during the same period of time. She denied weight loss and tobacco use. Past medical history was negative for squamous cell carcinoma of the head and neck region. Physical examination demonstrated asymmetry of the sternocleidomastoid and trapezius muscles. Flexible laryngoscopy was performed and revealed complete unilateral vocal cord paralysis on the right. Magnetic Resonance (MR) of the brain with intravenous contrast (Figure 1) and computer tomography (CT) of soft tissue of the neck with contrast (Figure 2) were performed for further evaluation.

Radiology Case of the Month: A Case with Relapsing Episodes of Weakness and Seizures.

A 23-year-old man presented to the clinic with a oneweek history of left upper and lower extremity numbness, starting in his left hand and progressing to his left foot. He then experienced intermittent difficulty walking and left-sided drooling. The patient also reported having a left arm abscess one week earlier, for which he received penicillin and oxycodone and acetaminophen. He denied any weakness, seizure, headache, fever, nausea, vomiting, or focal neurological deficit, as well as any recent history of immunization or upper respiratory infection symptoms. During the initial visit, magnetic resonance images were obtained. Over the course of the next year, the patient presented to the hospital six times for additional symptoms including weakness, slurred speech, and seizures. During this period, brain biopsy, serology tests, and MR spectroscopy were performed confirming the initial diagnosis. Moreover, multiple MR images were performed showing progression and relapsing. RADIOLOGICAL DIAGNOSIS: Multiphasic Acute Disseminated Encephalomyelitis.

Intracranial pyogenic abscess: imaging diagnosis utilizing recent advances in computed tomography and magnetic resonance imaging.

Intracranial abscesses are life-threatening medical emergencies with pyogenic debris accumulating in the brain. Delay in the diagnosis can result in significant morbidity and mortality. Computed tomography and magnetic resonance imaging play an important role in the diagnosis of brain abscesses. However, the classic ring-enhancing appearance of an intracranial abscess can be mimicked by several other entities, most notably a necrotic tumor. This paper reviews new advances in CT and MR for imaging patients with suspected brain abscess. The role of computed tomography (CT) perfusion and new magnetic resonance sequences including DWI sequences, ADC map, MR spectroscopy, FLAIR and post-contrast enhanced T1 weighted images will also be discussed.

Magnetic resonance imaging and proton magnetic resonance spectroscopy of intracranial epidermoid tumors.

Intracranial epidermoid tumors or cysts are considered benign lesions. Differentiation of epidermoid tumors from arachnoid cysts is important for appropriate patient care because the treatment is different for each lesion. Arachnoid cysts can appear very similar to epidermoid tumors on computed tomography (CT). Epidermoid tumors can grow in the cerebellopontine angle (CPA) cistern, the most common location of these lesions, resulting in trigeminal neuralgia and facial paralysis. Treatment for epidermoid tumors is exclusively surgery. Arachnoid cyst, on the other hand, is a benign condition that rarely produces symptoms. Recent advances in magnetic resonance imaging (MRI) have allowed more accurate imaging diagnosis of epidermoid tumors. This article reviews the recent advances in MRI using conventional T1W, post-contrast T1W, T2W, steady-state free precession imaging, fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and proton magnetic resonance spectroscopy (MRS) in the imaging diagnosis of epidermoid tumors.