TeleFast Rad (2025)

13/07/2025

☢️ Neonatal hip ultasround☢️

Neonatal hip ultrasound is a non-invasive imaging technique used to evaluate the hips of newborns and infants, primarily to detect developmental dysplasia of the hip (DDH) — a condition where the hip joint is not properly formed.

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✅ Why It’s Done
• Screening for DDH in:
• Breech babies
• Girls (higher risk)
• First-born children
• Babies with a family history of DDH
• Babies with clinical signs (e.g., hip click, limited abduction)
• To monitor hip development over time in infants at risk

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🖥️ Technique

Performed with the baby in a lateral decubitus position (on the side), using a high-frequency linear transducer (7.5–12 MHz).

Two views are essential:
1. Coronal view in the neutral position
• Visualizes the relationship between the femoral head and acetabulum.
• Used to measure:
• Alpha angle (bony coverage): should be >60°
• Beta angle (cartilaginous roof)
2. Transverse view with flexion (dynamic view)
• Assesses femoral head movement in/out of acetabulum.
• Useful for detecting subluxation or dislocation during stress maneuvers (Barlow/Ortolani).

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📊 Graf Classification System (most common)

Used to categorize the hips based on alpha and beta angles (check the firstly uploaded image)

🧒 When to Perform
• Routine screening: 4–6 weeks of age
• At-risk infants: As early as 2 weeks, with follow-up

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🩺 Clinical Relevance

Early diagnosis and treatment of DDH are crucial to:
• Avoid long-term complications (limb length discrepancy, limp, arthritis)
• Reduce the need for surgery

Neonatal hip ultrasound is most commonly used for evaluating developmental dysplasia of the hip (DDH), but it has other clinical applications as well. Here are the key additional uses:

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✅ Other uses than DDH assesment !

🔹 1. Septic Arthritis or Osteomyelitis
• Detects joint effusion, which may indicate infection.
• Helps guide aspiration or drainage.
• May show adjacent bone involvement or soft tissue edema.

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🔹 2. Hip Effusion (Non-infectious)
• Differentiates between transient synovitis and infectious arthritis.
• Useful in infants with fever and limping or refusal to move the limb.

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🔹 3. Trauma Assessment
• Evaluate for:
• Joint effusion
• Fracture-related soft tissue changes
• Hemarthrosis
• Especially useful when X-rays are inconclusive in infants due to non-ossified bones.

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🔹 4. Guided Procedures
• Aspiration or injection under ultrasound guidance (e.g., in septic arthritis or hemarthrosis).

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🔹 5. Neonatal Tumors or Masses
• Identifies soft tissue or bony masses (e.g., teratomas, hemangiomas).
• Differentiates solid from cystic lesions.

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🔹 6. Vascular Abnormalities
• Assesses femoral artery and vein flow.
• Identifies vascular malformations or thrombosis, especially in infants with femoral catheterization.

09/07/2025

☢️ What is O-RADS ?

✅O‑RADS stands for Ovarian‑Adnexal Reporting and Data System, a standardized framework developed by the American College of Radiology (ACR) in 2018. It’s used by radiologists to consistently classify lesions on the ovaries and adnexa (including fallopian tubes and surrounding tissues) found during ultrasound or MRI examinations .

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🔍 Key Components

1. Dual Imaging Approach
• O‑RADS US (Ultrasound):
• Assigns categories from 0 to 5, indicating increasing risk of malignancy:
• 0 – Incomplete assessment
• 1 – Normal
• 2 – Almost certainly benign (

17/06/2025

☢️Bucket handle tear & its MRI features☢️

✅ A bucket handle tear is a specific type of meniscal tear in the knee, commonly involving the medial meniscus. It is a longitudinal, displaced tear where a central fragment of the meniscus is torn and flipped centrally into the intercondylar notch, resembling the handle of a bucket.

🦴☢️MRI features of a bucket handle meniscal tear
🛑Absent bow tie sign: On sagittal images, the normal meniscus body (seen on 2+ slices) disappears or appears on only 1 slice.
🛑Double PCL sign: A displaced meniscal fragment lies anterior to the posterior cruciate ligament, mimicking a second PCL.
🛑Intercondylar notch sign: The torn meniscal fragment is seen lying within the intercondylar notch.
🛑Flipped meniscus sign: The torn piece is displaced anteriorly and appears in front of the ACL.
🛑Double anterior horn sign: Both anterior and displaced posterior horns appear in the anterior compartment.
🛑Truncated meniscus: The expected normal crescent-shaped meniscus is missing from its location.
🛑Enlarged anterior horn: The anterior horn looks bulkier than normal due to displacement of the torn fragment

05/06/2025

Eid Adha Mubarak

02/06/2025

☢️ Sinus pericranii & its radiological features …

✅ Sinus pericranii (SP) is a rare vascular anomaly characterized by an abnormal communication between the intracranial dural venous sinuses (typically the superior sagittal sinus) and extracranial venous structures through dilated emissary veins. It usually presents as a soft, compressible, non-pulsatile scalp mass that may enlarge with maneuvers that increase intracranial pressure (like Valsalva maneuver or crying in children).

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✅ Key Features
• Location: Most often over the midline scalp, particularly the parietal or frontal region.
• Appearance: A soft, bluish, non-tender mass that can change in size with posture or straining.
• Communication: Between intracranial dural venous sinuses and extracranial veins via dilated diploic and emissary veins.
• Congenital or acquired: Most are congenital, but it can also be acquired following trauma or surgery.

☢️ Radiological features ..

Radiological features of sinus pericranii (SP) are key to diagnosis and treatment planning. Here’s a breakdown of the imaging modalities used and the characteristic findings seen in each:

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🧠 1. MRI & MR Venography (MRV)

MRI Brain:
• T1-weighted images: Lesion may appear isointense or slightly hypointense.
• T2-weighted images: Shows a hyperintense or flow void lesion, depending on blood flow.
• FLAIR: Typically no signal abnormality unless associated pathology exists.
• Post-contrast T1: Shows enhancement of the venous structure.
• Dynamic imaging (e.g., MRV): Confirms venous flow and communication with dural venous sinuses.

MRV:
• Direct visualization of the connection between extracranial venous structures and intracranial dural sinuses (especially the superior sagittal sinus).
• Venous channels traversing the diploic space and calvarial defect.

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🦴 2. CT & CT Venography (CTV)

Non-contrast CT Head:
• May show a calvarial defect or thinning at the point of communication.
• Well-defined scalp lesion, iso- or hypoattenuating depending on venous content.

CTV:
• Enhances venous structures.
• Shows transosseous venous channels connecting extracranial veins to intracranial venous sinuses.
• Bony remodeling or scalloping around the transosseous tract is often visible.

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🩻 3. Digital Subtraction Angiography (DSA)
• Gold standard, though often reserved for preoperative planning.
• Demonstrates delayed venous filling of the extracranial component during the venous phase.
• Dynamic assessment of venous flow direction.
• Identifies any abnormal shunts or high-flow features (rare in SP but relevant for differential diagnosis).

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🧪 4. Doppler Ultrasound (especially in children)
• Compressible, hypoechoic or anechoic lesion.
• Venous waveform on Doppler.
• Size increases with Valsalva or crying.
• Confirms vascular nature and compressibility.

24/05/2025

🧠 Hemorrhagic Infarction in the Brain

A hemorrhagic infarction in the brain refers to a cerebral ischemic stroke that becomes secondarily hemorrhagic, meaning bleeding occurs into the previously infarcted (dead or dying) brain tissue.

🔹 Why It Happens
• After a clot blocks a cerebral artery, brain tissue downstream is deprived of oxygen and dies (ischemic infarct).
• If blood flow is restored (either spontaneously or via treatment like thrombolytics or thrombectomy), the damaged blood vessels in the infarcted area may rupture and leak blood.
• This causes hemorrhage into the infarcted area, leading to a hemorrhagic transformation of an ischemic stroke.

🧠☢️ Radiological Features of Hemorrhagic Infarction

📌 1. Non-Contrast CT (NCCT)
• Hyperdense areas within a region of low attenuation (ischemic area), indicating blood in the infarcted tissue.
• Appears as:
• Patchy or confluent hyperdensities
• Often follows vascular territories (e.g., MCA distribution)
• May have mass effect if bleeding is significant
• Hemorrhagic transformation is typically seen 24–48 hours after the ischemic event.

Types on CT (based on ECASS classification):
• HI-1 (Hemorrhagic infarction 1): Small petechiae, no mass effect
• HI-2: More confluent petechiae, still no mass effect
• PH-1 (Parenchymal hematoma 1): Less than 30% of infarcted area with some mass effect
• PH-2: Dense hematoma >30% of infarcted area with significant mass effect

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📌 2. MRI (Especially Gradient Echo or SWI sequences)
• T2/GRE or SWI*: Blooming artifacts (signal voids) caused by susceptibility from blood breakdown products (like hemosiderin).
• T1 and T2: Signal changes vary with age of hemorrhage:
• Hyperacute (

18/05/2025

☢️ Organ of Zuckerkandl Paraganglioma ☢️

✅The Organ of Zuckerkandl is a small collection of chromaffin cells (neuroendocrine cells derived from the neural crest) located near the aortic bifurcation or along the abdominal aorta. It is a site where extra-adrenal paragangliomas can develop.

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🔬 What is a Zuckerkandl Paraganglioma?

A Zuckerkandl paraganglioma is a paraganglioma (a type of neuroendocrine tumor) that arises from the Organ of Zuckerkandl. It is an extra-adrenal pheochromocytoma, meaning it can produce catecholamines (norepinephrine, epinephrine, and dopamine) like adrenal pheochromocytomas but occurs outside the adrenal gland.

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📍 Location of the Organ of Zuckerkandl
• Near the inferior mesenteric artery to the aortic bifurcation (L2–L4 levels).
• Adjacent to the sympathetic chain.

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📸 Radiological Features of Zuckerkandl Paraganglioma

1. CT Scan
• Well-defined, hypervascular mass near the aortic bifurcation.
• Enhances intensely with contrast due to rich vascularity.
• May show central necrosis or hemorrhage in large tumors.
• Sometimes calcifications are seen.

2. MRI
• T1-weighted: Low to intermediate signal intensity.
• T2-weighted: Bright (hyperintense) signal – classic “light bulb” sign.
• Post-contrast: Strong enhancement.
• May demonstrate the classic “salt-and-pepper” appearance due to hemorrhage (pepper) and slow-flow vessels (salt).

3. Functional Imaging
• 123I-MIBG Scintigraphy: Uptake if tumor is functional.
• 68Ga-DOTATATE PET/CT or 18F-FDOPA PET/CT: Highly sensitive for detecting paragangliomas, especially in hereditary syndromes.
• 18F-FDG PET/CT: Useful in metastatic or aggressive tumors.

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🧬 Clinical Context
• May be functional (secreting catecholamines), causing:
• Hypertension
• Palpitations
• Headaches
• Sweating
• Often associated with hereditary syndromes like:
• SDHx mutations (e.g., SDHB, SDHD)
• MEN2
• VHL
• NF1

16/05/2025

☢️ The “4th ring of Valvassori” sign …!

The “4th ring of Valvassori” sign is a radiologic sign seen on high-resolution CT of the temporal bone, and it is associated with enlarged vestibular aqueduct syndrome (EVAS) or other inner ear malformations.

✅What it refers to:
• Normally, on axial CT images of the inner ear, the three semicircular canals appear as three ring-like structures: lateral, superior, and posterior semicircular canals.
• In some patients with vestibular aqueduct enlargement, an additional ring-like structure becomes visible, which is the dilated vestibular aqueduct.
• This fourth “ring” is not a true semicircular canal, but it mimics one in appearance — hence the term “4th ring”.

✅Clinical Relevance:
• Seen in Pendred syndrome or non-syndromic sensorineural hearing loss.
• Suggests the presence of inner ear dysplasia, especially enlarged vestibular aqueduct — a common cause of progressive or fluctuating hearing loss in children.

✅What the Image below shows:
• Axial CT Scan: This high-resolution axial CT image of the temporal bone reveals a hypodense (lucent) halo encircling the cochlea, highlighted by the arrows.
• 4th Ring Appearance: This lucent halo represents the “4th ring of Valvassori”, indicative of pericochlear otospongiosis (a form of otosclerosis).
🛑• Clinical Significance:
The presence of this sign correlates with retrofenestral otosclerosis, which can lead to sensorineural or mixed hearing loss due to the involvement of the cochlear capsule.

12/05/2025

☢️Budd-Chiari syndrome and its radiological features☢️

✅Budd-Chiari Syndrome (BCS) is a rare condition caused by obstruction of the hepatic venous outflow, which can lead to liver congestion, hepatomegaly, ascites, and eventually liver failure.

✅Causes

The obstruction can be due to:
• Thrombosis (most common cause)
• Membranous webs or strictures in hepatic veins or inferior vena cava
• Hypercoagulable states (e.g., polycythemia vera, antiphospholipid syndrome, factor V Leiden mutation)
• Malignancies (e.g., hepatocellular carcinoma)
• Infections or trauma

✅ Radiological features:

The radiological features of Budd-Chiari Syndrome (BCS) reflect hepatic venous outflow obstruction and the liver’s compensatory changes. Imaging is critical for diagnosis, with the key modalities being ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI).

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1. Doppler Ultrasound
• Absent, reduced, or reversed flow in hepatic veins.
• Intraluminal thrombus in hepatic veins or inferior vena cava (IVC).
• Hepatic vein narrowing or non-visualization.
• Enlarged caudate lobe (has its own drainage pathway).
• Collateral veins (venovenous collaterals bypassing obstructed veins).
• Ascites.

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2. CT Scan (contrast-enhanced)
• Non-opacified hepatic veins (especially during the venous phase).
• Caudate lobe hypertrophy (drains directly into the IVC).
• Heterogeneous hepatic enhancement: “Mosaic” or “nutmeg liver” appearance due to varying perfusion.
• IVC narrowing or thrombosis.
• Collateral venous pathways, particularly intrahepatic collaterals.
• Ascites and splenomegaly in chronic cases.

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3. MRI
• Better tissue characterization and visualization of thrombosis.
• Absent flow or thrombus in hepatic veins or IVC.
• Regenerative nodules (hyperintense on T1-weighted imaging).
• Mosaic enhancement pattern.
• Enlarged caudate lobe and liver surface irregularity in chronic stages.

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4. Venography (Hepatic/IVC) – Gold Standard (Invasive)
• Direct visualization of hepatic vein obstruction or occlusion.
• “Spider web” appearance of intrahepatic collaterals.
• Used when noninvasive imaging is inconclusive or before intervention.

09/05/2025

☢️ Mirror Image Artifact in Ultrasound:

✅Mirror image artifact occurs when the ultrasound beam reflects off a strong reflector (like the diaphragm or pleura) and is redirected back into the tissue. The machine assumes all echoes travel in a straight line and at a constant speed, so it misplaces the reflected structure, showing a duplicate (mirror image) on the other side of the reflector.

🛑Example:
• A common example is liver or spleen appearing to have a duplicate image above the diaphragm, within the lung field.

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✅Other Common Ultrasound Artifacts:
1. Reverberation Artifact:
• Caused by sound bouncing back and forth between two strong reflectors (e.g., between the probe and a metallic object).
• Appears as multiple, equally spaced lines.
2. Comet Tail Artifact:
• A form of reverberation, often due to small structures (e.g., surgical clips, cholesterol crystals).
• Appears as a dense tapering trail behind a reflector.
3. Ring-Down Artifact:
• Caused by resonance of gas bubbles.
• Similar to comet tail but longer and continuous.
4. Acoustic Shadowing:
• Occurs when sound hits a very dense object (e.g., bone or stone).
• Appears as a dark shadow behind the object.
5. Enhancement (Posterior Acoustic Enhancement):
• Seen behind fluid-filled structures (like cysts or bladder).
• Appears as an increased brightness due to low attenuation.
6. Edge Shadowing (Refraction Shadow):
• Caused by bending of the ultrasound beam at curved edges (like cysts or vessels).
• Produces dark streaks extending from the edge.
7. Side Lobe Artifact:
• Occurs when off-axis beams produce echoes that are misinterpreted as coming from the main beam path.
• Can produce false echoes near anechoic structures like cysts.
8. Speed Displacement Artifact:
• When ultrasound travels through tissues with speeds different from 1540 m/s.
• Structures appear at incorrect depths.

Example for mirror Image artifact was found recently with one of our staff

A child was mis-interpreted as having a urinary bladder stone on Ultrasound, specially the child was very irretable

On CT the Urinary bladder was completely free
This was explained as a mirror image artifact of the symphysis p***s! As shown in enclosed images …

04/05/2025

☢️ What is Joubert Syndrome ?
And what is its radiological features? ☢️

✅ Joubert Syndrome (JS) is a rare, autosomal recessive genetic disorder characterized by a distinctive brain malformation, primarily affecting the cerebellar vermis and brainstem. It is classified as a ciliopathy because it arises from defects in the function of primary cilia. The syndrome can present with varying degrees of developmental delay, hypotonia, abnormal eye movements, irregular breathing patterns, and, in some cases, multi-organ involvement (e.g., liver, kidneys, eyes).

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✅ Radiological Features of Joubert Syndrome

The hallmark radiological finding is the “molar tooth sign (MTS)” on axial brain MRI, seen at the level of the midbrain.

📌Key MRI Features:
1. Molar Tooth Sign: 🦷
• Caused by:
• Hypoplasia or aplasia of the cerebellar vermis.
• Deepened interpeduncular fossa.
• Thickened, elongated, and horizontally oriented superior cerebellar peduncles.
• Appears like a cross-section of a molar tooth.
2. Cerebellar Vermis Hypoplasia or Agenesis:
• Partial or complete absence of the vermis.
3. Fourth Ventricle Abnormalities:
• Can appear enlarged and dysplastic.
• Sometimes has a “bat wing” or “umbrella” appearance due to the vermis hypoplasia.
4. Brainstem Malformations:
• Dysplastic or hypoplastic brainstem structures, especially the pons.
5. Corpus Callosum Abnormalities:
• May be hypoplastic or dysgenic in some patients.
6. Supratentorial Findings:
• Occasionally, ventriculomegaly or cortical malformations (e.g., polymicrogyria) may be seen.
7. Diffusion Tensor Imaging (DTI):
• Shows abnormal orientation of white matter tracts due to vermian and peduncular malformations

01/05/2025

☢️Radial Artery Occlusion after PCI☢️

Radial Artery Occlusion (RAO) is one of the most common complications after transradial PCI.

Though often asymptomatic due to dual blood supply to the hand (radial and ulnar arteries), it has important implications, especially if repeat radial access is needed or if the radial artery is considered for use in coronary artery bypass grafting (CABG) or as an AV fistula.

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✅Role of Radiology in RAO

Radiology plays a crucial role in both diagnosing and monitoring radial artery occlusion:

1. Duplex Ultrasound (DUS)
• Gold standard for non-invasive diagnosis
Assesses:
• Flow in the radial artery (absence or reduction)
• Presence of thrombus or stenosis
• Collateral circulation from the ulnar artery
• Can also assess vessel patency over time, especially for follow-up

2. Doppler Ultrasound
• Detects flow velocity and direction
• Useful in confirming occlusion or partial obstruction

3. CT Angiography or MR Angiography (less commonly used)
• Reserved for complex or ambiguous cases
• Offers anatomical detail but is generally not needed for routine RAO

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Radiologic Interventions (in select cases)
• Thrombolysis or thrombus aspiration (rarely indicated unless symptomatic)
• Balloon angioplasty of the radial artery (experimental or in select high-need patients)

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✅Prevention Strategies (Radiology-Relevant)
• Ultrasound-guided access to reduce trauma and improve first-pass success
• Use of small sheaths (ideally 5F or 6F)
• Patent hemostasis technique: ensure blood flow through the radial artery during compression

TeleFast Rad