Elie Goulding, M.D.

Take a look at this CTA -- what's your diagnosis?

Case submitted by Elie Goulding, M.D., via

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 Large partially thrombosed pseudoaneurysm is identified in the region of graft and surgery related to CABG along ascending aorta.

 Pseudoaneurysms can arise proximally or distally along grafts most commonly at the anastomotic sites. CTA can evaluate extent of any partial thrombosis. If there is continued increase in size or if it is large enough, it would require surgical correction. 

Pseudoaneurysms are associated with infection or leak. Coil occlusion or covered stents are common interventions to treat, as well, especially in high-risk patients.

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What is this seen post bypass surgery along the aorta?

Image IQ Quiz: What's the Diagnosis of Post-Bypass CTA?

Enlarged right kidney with striated nephrogram is consistent with pyelonephritis. In pyelonephritis, the kidneys often appear normal with kidneys that could be enlarged due to edema. There may be lower attenuation of the affected kidney. Perinephric stranding is also a finding that may be present. Post contrast, as visualized in this image, one can see focal or wedge-like areas of hypodensity (striated nephrogram) if in excretory phase.

What is your diagnosis in this case with a patient presenting with a fever and abdominal pain?

Image IQ Quiz: Patient Presents with Fever and Abdominal Pain

Case submitted by Elie Goulding, M.D., radiologist, to

A young child presents with shortness of breath and distress. The chest X-Ray (CXR) demonstrates large left-sided lucency relative to right hemithorax. Deep sulcus sign is also demonstrated on the left side. There is also slight rightward mediastinal shift. Splaying of ribs is not definite, but there is suggestion of possible splaying at certain levels.

Evaluation for tension pneumothorax would be critical which would include mediastinal shift, splaying of ribs, for instance. Serial imaging would also be important to assess if the pneumothorax is worsening.

What is your diagnosis of a young child who presents with shortness of breath and distress? 

Elie Goulding, M.D.

Articles

Image IQ Quiz: What's the Diagnosis of Post-Bypass CTA?

Image IQ Quiz: Patient Presents with Fever and Abdominal Pain

Image IQ Quiz: Patient Presents with Shortness of Breath and Distress