MR, 15 MARCHYasser Asiri, R1

1) MR Number :1289022 Hx:

77 year-old saudi female known case of congestive heart failure, HCV +ve and old treated TB. She presented with symptom of shortness of breath.

X-rays

DDx Bronchogenic carcinoma penumonia. Round atelactasis Abscess. Intrapulmonary sequestration. Hydated cyst. Localized fibrous tumor of the chest wall.

Dx: Round Atelectasis

Always associated with chronic diseases and adjacent pleural disease.

Represents infolding of the viscreal pleura as isolated area*.

Collapsed lung floating on pleural effusion. Development of fibrous adhesions

suspending the rounded atelectasis area in elevated and tilited position.

Usually the mass 2.5cm to 5 cm in diameter.

The vessels leading to the mass are crowded, and they tend to diverge and arc as they reach the mass giving the appearance of “comet tail sign”.

-May slowly resolved or remain unchanged on serial CXR or CT scans.

may have air bronchogram.

To confidently suggest the diagnosis of “Round Atelectasis”: Three criteria must be met:

1. Contiguity with chronic pleural effusion/thickening.

2. Typical appearance of crowded vessels and bronchi sweep into the base of the atelectatic lung.

3. Volume loss in the affected lobe.

2) 618104 Hx:71 year-old Saudi male presented to the

hospital with intestinal obstruction and hematemesis.

DDx Hiatal hernia. Forgut duplication cyst. Diaphramatic rupture. Retrocardiac lung abcess.

Diaphramatic Hernia Congenital defect:o Bochdalek hernia.o Morgangi hernia.

Aquired defect:o Trumatic diaphragmatic rupture.o Hiatus hernia.

Hiatal hernia Protrusion of portion of the stomach into the

thorax.

There are two types: Sliding type : Most common 95% , GEJ is above the

diaphragm.

Paraesophageal type: 5% , GEJ in normal position below the

diaphragm.

Part of the fundus herniated above the diaphragm through the hiatus and lies along side of the esophagus.

More prone to complications.

Imaging features: Gastric folds above the diaphragm. Concentric indentation (B-lines) above

the diaphragm.

Phrenic ampulla: no gastric mucosa. A-ring: (for Above) indentation at the upper boundary of the ampulla.B-ring: (for Below) indentation at the lower boundary of the ampulla.Z-line: ( Zigzag line) squamoculominal junction between the stomach and esophagus.

Association: Esophagitis 25%. Doudenal ulcers 20%

Complication Gartic volvuls. Strangulation and obstruction. Ischemia and infarction.

Thank You