Radiology Case of the Month: TB or Not TB That is the Question.

45-year-old female presenting initially with fever, nonproductive cough, night sweats, pleuritic chest pain, fatigue and weight loss over the past month.

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.

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 OF THE MONTH: Pulmonary Langerhans Cell Histiocytosis (PLCH).

PURPOSE: Obtaining a tissue sample diagnostic of pulmonary Langerhans cell histiocytosis (PLCH) by transbronchial biopsy is notoriously difficult. The condition's appearance on computed tomography is well described and singularly characteristic, perhaps adequate for definitive diagnosis. We propose an approach to diagnosis of these patients. METHODS: Radiology case report of PLCH in a middle-aged female smoker with two week history of nonproductive cough, low grade fevers, and fatigue. RESULTS: Computed tomography (CT) provided the diagnosis of PLCH. Transbronchial biopsies failed to provide a definitive diagnosis. CONCLUSIONS: Utility of transbronchial biopsy in diagnosis of PLCH is limited. Patients who present with signs, symptoms and high resolution computed tomography typical of PLCH do not require a correlation by tissue diagnosis. If cancer is suspected, a wedge biopsy should be performed for tissue diagnosis.

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.

Radiology case of the month. Abnormally dilated arteries in an asymptomatic male. RADIOLOGIC DIAGNOSIS: Aortic coarctation. There is narrowing in the region of the aortic isthmus (arrows, Figures 2 and 4). The extent of collateral arterial dilation (arrows, Figures 1 and 3) suggests this to be a hemodynamically significant finding.

A 61-year-old male with a past medical history of chronic, uncontrolled hypertension received a non-contrasted computed tomogram (CT) of the chest and abdomen to investigate for possible Conn syndrome. This noncontrast study showed some areas of nodularity around the vertebral bodies bilaterally and extending into the posterior mediastinal region. A CT of the chest with intravenous contrast, and 3D reconstruction were then obtained.

MRS findings in a patient with juvenile-onset Alexander's leukodystrophy.

Alexander's leukodystrophy is a rare cerebral white matter disorder with an onset that can be infantile, juvenile, or occur in the adult years. It is thought to be demyelinative, but the pathogenesis is ill-defined. We report a 24-year-old woman with juvenile-onset Alexander disease, of 12 years duration, who underwent magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) serially as part of her care. The patient's latest MRI showed periventricular-increased signal intensity on T2 and fluid attenuation and inversion recovery sequences, which appeared stable when compared to her first study seven years ago. MRS revealed an elevated choline/creatine ratio with relative suppression of the n-acetyl aspartate peak, also similar to her previous MRS findings. MRS also showed elevation of myoinositol levels, best demonstrated with the short echo-time spectra. These findings support the primarily demyelinative characteristics of this leukodystrophy and may provide a surrogate marker of disease progression, as well as a potential response to therapeutic intervention when this becomes available.