Saeed Rad, M.D.

Case submitted by Saeed Rad, M.D., radiologist, to

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 Patient presents with a history of excessive alcohol (ETOH) intake with increasing difficulty swallowing (dysphagia).

Esophageal varices are seen in over half of patients with portal hypertension, such as in the case of long standing alcohol intake. This is such a case. It is important to note there are other causes of cirrhosis and portal hypertension beyond alcohol intake, including Chid-Pugh C cirrhosis or other causes of liver disease that result in cirrhosis. 

Esophageal varices are dilated submucosal veins of the esophagus and are portosystemic collaterals. Fluoroscopic evaluation with barium demonstrates longitudinal and curvilinear luminal filling defects, representing varices.

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What is your diagnosis in this patient with long standing excessive alcohol intake and difficulty swallowing?

Image IQ Quiz: Patient Presents with Increasing Difficulty Swallowing

The patient presented with elevated IgE on bloodwork with months of weight loss. MRI shows a large cystic mass with multiple serpiginous linear hypointensities with characteristic appearance of hydatid disease of the abdomen and specifically involving the small bowel.

Hydatid disease is caused by the parasite 

 that is endemic to many South American countries. The small intestine is an unusual site for a hydatid cyst, but it is on the differential diagnosis for abdominal involvement. The mechanism for intestinal mesenteric hydatid cysts could be through systemic or lymphatic spread. Patients often are asymptomatic for many years and become symptomatic only after vague abdominal discomfort.

Can you diagnose this mostly asymptomatic patient but with weight loss and abdominal discomfort?

Image IQ Quiz: Patient Present with Elevated Bloodwork and Weight Loss

Case submitted by Saeed Rad, M.D., radiologist, to 

 A 35-year-old patient presented with weight loss that was unexplained. Large linear filling defects were seen within the GI tract on barium study that was consistent with ascariasis (worms).

 Gastrointestinal ascariasis appears typically as multiple worms seen as longitudinal tubular filling defects on contrast studies. The alimentary tract of the worm could contain contrast which would create a multiple parallel line appearance or could also obscure detection.

Can you diagnose this patient with unexplained weight loss?

Image IQ Quiz: Patient Present with Unexplained Weight Loss

Case submitted by Saeed Rad, radiologist, to 

Patient presented with no acute symptoms. The patient demonstrated a deformed chest wall, as well as a chronic history of gradually increasing shortness of breath.

 CT showed multiple osseous lesions with expansile morphology throughout the chest wall, involving the ribs bilaterally following distribution characteristic of fibrous dysplasia. Fibrous dysplasia was diagnosed.

Fibrous dysplasia is a benign tumor-like congenital abnormality that results in extensive osteoblastic activity. It results in replacement of normal bone with fibrous tissue. Typically, fibrous dysplasia does not require treatment. 

Fibrous dysplasia is largely incidentally discovered. On CT scans, fibrous dysplasia is often found to be expansile demonstrating areas of sclerosis, ground glass appearance, cystic components, and potentially endosteal scalloping.

Can you diagnose this patient with a deformed chest wall and chronic history of gradual shortness of breath?

Saeed Rad, M.D.

Articles

Image IQ Quiz: Patient Presents with Increasing Difficulty Swallowing

Image IQ Quiz: Patient Present with Elevated Bloodwork and Weight Loss

Image IQ Quiz: Patient Present with Unexplained Weight Loss

Image IQ Quiz: Patient Presents with Gradual Shortness of Breath