Author: Brent Weinberg, MD

Board Review Cases – Brain

Posted on by Brent Weinberg, MD

Board Review Cases – Brain

This playlist is a collection of only the brain imaging board review cases on this site. These cases are geared towards preparation for the radiology resident ABR core exam, although similar material is used for the ABR certifying exam general and neuroradiology sections as well as neuroradiology CAQ.

The format of this playlist is case-based. Each case consists of a series of images followed by 1 or 2 questions. The first question is usually to name the diagnosis, while the second is a multiple choice question to test deeper understanding of the specific condition. Try to get the diagnosis before you see the second questions.

If you prefer, check out the full “Neuroradiology board review cases – Brain” playlist on YouTube.

 

Board Review Cases – Pediatrics

Posted on by Brent Weinberg, MD

Board Review Cases – Pediatrics

This playlist is a collection of only the pediatric board review cases on this site. These cases are geared towards preparation for the radiology resident ABR core exam, although similar material is used for the ABR certifying exam general and neuroradiology sections as well as neuroradiology CAQ.

The format of this playlist is case-based. Each case consists of a series of images followed by 1 or 2 questions. The first question is usually to name the diagnosis, while the second is a multiple choice question to test deeper understanding of the specific condition. Try to get the diagnosis before you see the second questions.

If you prefer, check out the full “Neuroradiology board review cases – Pediatrics” playlist on YouTube.

 

Board Review 2 – Case 12

Posted on by Brent Weinberg, MD

Board Review 2 – Case 12

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows multiple images throughout the body, with initial emphasis on the lumbar spine, where there is destruction of a lumbar vertebral body and surrounding abscess and inflammatory changes of the adjacent disc. There is relative sparing of the lumbar discs.

There is also disease elsewhere in the body, including an osseous lesion in a left-sided rib, ground glass and tree-in-bud nodules in the lungs, and nodular enhancing lesions in the brain. This makes you think about some sort of systemic process.

The diagnosis is: spinal tuberculosis

Spinal tuberculosis is a serious disease which can cause a discitis-osteomyelitis. The classic teaching, although it may not be true, is that the disease will spare the intervertebral discs. Other things to consider in the differential are metastatic disease and other infections.

   Full Playlist on Youtube

Board Review 2 – Case 11

Posted on by Brent Weinberg, MD

Board Review 2 – Case 11

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows MRI imaging from a relatively normal study of the lumbar spine. However, upon closer inspection, it is clear that there is a heterogenous mass in the right kidney.

The diagnosis is: renal cell carcinoma

Masses in the kidney can be a missed source of pain, and it is important to look for incidental findings. Plus, your board exam will not necessarily tell you which topic you are dealing with. Radiologists are most commonly sued because of failure to diagnose, so be careful.

   Full Playlist on Youtube

CT (computed tomography) face radiology search pattern

Posted on by Brent Weinberg, MD

CT (computed tomography) face radiology search pattern

When you start taking call as a radiology resident, a common test you are going to encounter is a maxillofacial CT, or face CT. This is especially true if you are taking call at a level 1 or level 2 trauma center. A lot of times, this is done in conjunction with a head and/or cervical spine CT. This is an extremely common test in the setting of trauma, including assault and car accidents (MVA or MVC). The key in these settings is to rule out a significant fracture or soft tissue injury to the face.

Because there are a lot of structures, it is important to have a useful search pattern. Reconstructions, especially the coronal reconstruction, are key when interpreting CT of the face. These allow you to see key structures that are parallel to the slice plane on axial images. Symmetry is extremely helpful, as the left should match the right. Additionally, making sure all the fat and fascia planes are clean is very useful.

This video will walk you through a step-by-step approach to evaluating a CT of the face. I recommend a pattern where you start with the coronals at the cranial (top) part of the image, and then work your way down. In this way, you can look at the brain, orbits, sinuses, palate, mandible, and so forth, minimizing the risk of missing a significant finding. Then you can repeat the pattern with the axial images. Finally, the sagittal images are a nice troubleshooting tool, especially for the mandible and cervical spine. As you practice, you will find you can move more quickly through your search without necessarily focusing on each individual element for too long.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may be involved with patients with facial injuries and other abnormalities.

 

See this and other videos on our Youtube channel.

Board Review 2 – Case 10

Posted on by Brent Weinberg, MD

Board Review 2 – Case 10

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a relatively homogeneous mass of the cervical spine replacing several vertebral bodies. There is involvement of the adjacent soft tissues, epidural space, and posterior elements.

The differential diagnosis for this mass is lymphoma, myeloma, and metastatic disease. Given young age of the patient, myeloma and metastatic disease are less likely, although possible.

The diagnosis is: lymphoma.

   Full Playlist on Youtube

Board Review 2 – Case 9

Posted on by Brent Weinberg, MD

Board Review 2 – Case 9

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows narrowing of the thecal sac in the lower lumbar spine due to a cystic lesion that is in the dorsal epidural space just to the left of the midline. There is minimal surrounding abnormal enhancement.

The diagnosis is: synovial cyst

Synovial cysts, along with bursal cysts from the spinous processes, are cystic lesions which can cause canal narrowing. These can be treated with minimally invasive rupture versus surgical resection.

   Full Playlist on Youtube

Board Review 2 – Case 8

Posted on by Brent Weinberg, MD

Board Review 2 – Case 8

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This patient is a young patient with seizures. Imaging shows a small and somewhat cystic mass in the right temporal lobe. There is minimal surrounding FLAIR abnormality, with minimal enhancement on post-contrast imaging.

There is a differential for low grade appearing masses in the temporal lobe which includes ganglioglioma, dysembryoplastic neuroepithelial tumor (DNET), and pleomorphic xanthoastrocytoma (PXA). You will not always be able to tell the difference. Gangliogliomas are said to be more likely to enhance than DNET, but this is frequently not the case (as in this case).

The diagnosis is: ganglioglioma.

Ganglioglioma is the most common neoplastic cause of seizures, and are commonly found in younger patients and in the temporal lobes.

   Full Playlist on Youtube

Board Review 2 – Case 7

Posted on by Brent Weinberg, MD

Board Review 2 – Case 7

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a suprasellar mixed solid and cystic mass. There is relative preservation of the normal pituitary, which makes adenoma less likely. There is mass effect on the optic chiasm, which probably accounts for the patients visual symptoms.

The diagnosis is: craniopharyngioma. There are two major types of craniopharygioma, adamantinous and papillary. Adamantinous are more common in younger patients and more likely to have calcification.

   Full Playlist on Youtube

Board Review 2 – Case 6

Posted on by Brent Weinberg, MD

Board Review 2 – Case 6

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a CT with hyperdense blood tracking in the left basal ganglia and thalamus. Although the patient is relatively young, the location is strongly suspicious for hypertensive hemorrhage. Further evaluation for underlying causes, such as a vascular malformation or tumor, is warranted with vascular imaging (such as CTA) and MRI.

The diagnosis is: hypertensive hemorrhage

   Full Playlist on Youtube