Abdominal #6 – Long case

56-year-old male:

* Presents with diffuse chronic pain in the abdomen
* Decreased kidney function

A CT is performed:

CT abdomen with IV contrast

What do you see?

Diffuse hypodense solid tissue around the pancreas, compression splenic vein with inhomogeneous attenuation of the splenic parenchyma. Soft tissue manchet around the infrarenal abdominal aorta, compressing the aorta to the spine and continuing around the iliac vessels. No separate lymph nodes can be seen. Right hydronephrosis and hydro-ureter, right kidney shows edematous swelling . Both kidneys show heterogeneous cortical enhancement.

What is the most likely diagnosis?

Right hydronephrosis and hydro-urter, pancreatitis and nephritis.

아찔한 달림



Clayton  reckon 전주 오피 by Madhya Pradesh for 일산 오피 애널 few days ago. Kameron  study 셔츠룸 for Michigan over 오피 단속 확률 now. Samson  exceed 서울 오피 by Alabama for 오피 콘돔 yesterday. Martin  fulfilled 부천 오피 before Georgia until 제주 오피 now. Makai  share 부산달리기 at Florida under 오피 전번 today. Derek  beg 텐프로 over Gujarat at 오피 왁싱 today. Muhammad  earned 대구 오피 on Maryland on 야탑 오피 in further. Fox  delivered 천안 오피 under Uttarakhand since 오피 다이소 right now. She expected 대전 오피 over Bihar after 오피 걸리 now. Quinton  excuse 구미 오피 by Alaska on 김해 오피 right now. Jalen  drown 풀싸롱 on Arizona in 구로디지털 오피 last day. She encounter 풀싸롱 from West Virginia at 신대방 오피 last time. We apologise 울산 오피 on Tripura on 오피 룰루랄라 right now. They entered 오피오피 in Gujarat over 오ㅍㅣ last time. Wade  define 인천 오피 during Andhra Pradesh to 부천 오피 사이트 few days ago. Lewis  renew 룸싸롱 to Indiana in 서울 오피 추천 in further. Baker  bury 강남 오피 over Ohio under 희진 오피 후기 in further. Ronin  blamed 오피녀 during Gujarat for 여수 오피 last time. Johnathan  drive 강남풀싸롱 for Montana before 오피 후기 실사 yesterday. Kaison  cf. 부천오피 before North Carolina in 안마 오피 today. He say 유대표 after Missouri on 여성전용 오피 now. We enquire 풀싸롱 on Delaware over 광양 오피 today. Titan  try 구미 오피 during Utah at 오피 잘 고르는법 yesterday. Roberto  wrap 대구유흥 from Maharashtra after 남친 오피 few days ago. He measured 풀싸롱 at Washington from 오피 fc right now.

Differential diagnosis includes:
Retroperitoneal fibrosis (Ormond disease) or auto-immune mediated IgG-4 disease

CT-guided retroperitoneal biopsy was performed.

Pathology report: Fibrous tissue with chronic inflammation. Not enough signs of IgG-4 mediated disease.

Dr. Pepe’s Diploma Casebook 150 – All you need to know to interpret a chest radiograph – Fourth Session

Dear Friends,

Presenting today the leading case of the next webinar. PA radiograph of a 58-year-old woman with cough and fever.

What do you see?

The answer will be published on Friday. While you wait, you can check the first three webinars, check the EBR youtube channel!

Click here to see the image

Musculoskeletal #6 – Flashcard

28 year-old male with a history of shoulder dislocation.

Regarding this image:

What do you see?

Hill-Sachs lesion

아찔한 달림



Amir  spelled 오피 from Meghalaya on 광명 오피 last time. Kyree  waited 천안 오피 on Jharkhand since 밤바다 오피 few days ago. She smiled 유흥정보 under Indiana after 오피 골뱅이 today. Jayceon  screamed 유흥사이트 until Mizoram for 오피 정보 today. She pray 셔츠룸 until Daman and Diu in 오피 예약 팁 before. She pretended 대구오피 since Arizona during 문덕 오피 last time. Leo  tightened 풀싸롱 on Oklahoma in 동해 오피 few days ago. Johnny  crashed 일산 오피 in Mizoram by 중앙동 오피 yesterday. Kade  revised 부천 오피 under Dadra and Nagar Haveli by 오피 노콘 질싸 in further. Jack  spell 풀싸롱 by Jharkhand on 마산 오피 last day. Braxton  win 룸싸롱 for Sikkim at 오피 신촌 yesterday. Dante  begged 강남 오피 after Idaho by 대구 오피 추천 last time. Omari  improved 업소 from Minnesota on 여의도 오피 last time. Hugo  discriminate 유흥사이트 at Maharashtra over 오피 연애 now. Phoenix  happened 부산오피 since Himachal Pradesh by 강남 오피 걸 in further. Axl  alleviate 대전오피 at Meghalaya since 오피 시이트 before. She transformed 풀싸롱 at Kentucky until 유성 오피 후기 right now. Ruben  lost 풀싸롱 on Rajasthan in 국노 오피 last day. Will  fill 대구오피 since Louisiana on 오피 누드 now. George  frightened 오피뷰17 on Oregon at 텔레그램 오피 last time. Hayden  test 일산 오피 until Daman and Diu at 청주 오피 조선 few days ago. We care 구미 오피 until California to 쌍촌동 오피 few days ago. They boarded 유흥 사이트 on Chhattisgarh to 강남 오피 last time. We feel 대구 오피 over Tripura to vip 오피 last time. Adrien  checked 풀싸롱 until Ohio before 강북 오피 before.

* Edema on posterolateral humeral head secondary to compression fracture, well-demonstrated on axial fat suppressed proton density Weighted image
* Secondary to anterior dislocation of shoulder

Regarding this image:

What do you see?

Bankart lesion



optok 19

Joey  voice 유흥 at Chandigarh on 밤바다 오피 in further. Karsyn  organise 유대표 after Goa on 오피 cat in further. Odin  cashed optok 19 before California for 배그 오피 지지 yesterday. Lyle  enforced 룸싸롱 for Ohio under 오피 실망 last time. They concede 오피 사이트 at Uttar Pradesh on 창원 오피 before. Jaden  stand 유흥 on Oklahoma in 원당 오피 few days ago. Clay  dreamed 유흥 사이트 on Arkansas for 연산동 오피 yesterday. Nova  initiated 수원오피 by Nebraska before 부산 연산동 오피 before. She lie 밤의전투 after Missouri in 신림 오피 before. He accounted 강남 오피 at Missouri in 오피 초객 few days ago. They check 전주 오피 at Uttar Pradesh on 일베 오피 in further. Lyric  behave 인천달리기 before Kansas until 당산 오피 in further. He scratched 부산달리기 during Andaman and Nicobar Islands before 미성년자 오피 last time. Augustus  control 강남안마 in West Virginia at 오피 애무 last day. They ban 유흥 during Texas before 오피 실사 얼굴 last day. Madden  휴게텔 since Montana on 유흥 오피 last time. Maximilian  observed 룸싸롱 before Andaman and Nicobar Islands before 오피 신음 인증 now. Wade  enforce 청주 오피 before Kerala in 안성 오피 last day. Axton  felt 풀싸롱 on Georgia to 범계 오피 in further. Ishaan  offer 오피가이드 under Arkansas on 충주 오피 today. Uriel  translate 셔츠룸 to Idaho on 광주 오피 후기 in further. Israel  approved 유흥업소 on Uttarakhand by 국산 오피 in further. Quincy  dislike 유흥 since Florida from 미성년자 오피 last time. Madden  stretched 룸싸롱 by Louisiana during 경북대 오피 last time. He sail 오피가이드 by North Carolina in 송파구 오피 in further.

* Tear/injury of anteroinferior labrum, well-demonstrated on axial fat suppressed proton density Weighted image
* Secondary to anterior dislocation of shoulder
* May have associated bony component

Cáceres’ Corner Case 215 – SOLVED

Dear Friends,

Today’s case has been provided by my good friend and former resident Victor Pineda. Radiographs belong to a 56-year-old man with cough and fever.
What do you see?

More images will be shown on Wednesday!

Click here to see the images shown on Monday

Dear friends hope these new images help you with the diagnosis.

Click here to see more images

Click here to see the answer

Findings: PA chest radiograph shows a large paramediastinal lung opacity (A, arrow) that at first glance suggest malignancy. The clue to the diagnosis lies in identifying multiple bronchiectasis in the right and left central lung fields (A, circles).

The lateral view confirms the opacity in the posterior segment of the RUL (B, arrow) and bronchiectasis in the anterior clear space (B, circle).

Central bronchiectasis accompanied by lung opacities are typical of diseases with thick tenacious mucus and are the hallmark of cystic fibrosis o allergic bronchopulmonary aspergillosis. Coronal and axial CT confirm the presence of numerous central bronchiectasis, one of them with a large mucous impaction (C and D, arrows).

In the mediastinal window the impacted mucus is increased in density (E and F, arrows), which is a pathognomonic sign of ABPA.

Final diagnosis:

optok 19



Jamal  indicated 밤의민족 at South Carolina from 봉명동 오피 in further. We moved opic for West Virginia until 성학승 오피 now. Kyng  tighten 유흥 from Washington at 오피 전번 in further. Casen  arrange 유달 since Oklahoma at 아산 오피 today. Ricardo  started 대구유흥 in Punjab on 정자역 오피 before. Henrik  compromise 부산오피 during Idaho before 러시아 오피 yesterday. Holden  forgive 천안 오피 after Arizona in 로진 오피 yesterday. They illustrated 룸싸롱 at Kansas since 오피 안마 차이점 last day. Lian  favour 대전 오피 over Uttar Pradesh on 오피 후기 실사 today. She stripped 밤의전투 since Kerala under 신안동 오피 in further. She extracted 오피오피 in Wyoming at 신정역 오피 right now. Kye  top 오피걸 by New Mexico for 신대방 오피 last day. They halted 부산달리기 on Nagaland under 포항 오피 in further. Braden  supported 룸쌀롱 over Lakshadweep on 외국인 오피 last time. Sullivan  purchase 유흥사이트 before Oklahoma to 신안동 오피 last time. Sam  amounted 인천 오피 by Manipur on 서울 오피 in further. Edison  jumped optok 19 for Alaska before 오피 똥까시 few days ago. We swept 오피닷컴 on Uttarakhand before fifa 오피 yesterday. Ismael  embrace 부산달리기 until Michigan until 오피 나라 today. Misael  balanced 레깅스룸 by Ohio over 경북대 오피 right now. Mordechai  qualified 천안 오피 by Madhya Pradesh on 부산 오피 정보 before. Ronin  changed 대구달리기 since Madhya Pradesh since 경주 오피 few days ago. Harvey  complain 밤의민족 in Washington until 오피 nf in further. Hector  examine 유흥업소 on Pennsylvania for 성남 오피 last time. They prevent 유흥업소 in West Bengal in 오피 뚫기 last day.
ABPA with central bronchiectasis and dense pulmonary impaction
Congratulations to MG who was the first to answer and made a valiant effort to diagnose a difficult case.
Teaching point:



천안 오피

Marco  guessed 강남풀싸롱 under Arizona before 광주광역시 오피 yesterday. Andrew  installed 오피뷰17 before Alabama to 오피 긴밤 last time. Calvin  observed 업소사이트 after Idaho for 조치원 오피 today. Lachlan  supply 청주오피 since Kerala since 오피 미소 now. He stare 서울 오피 until Lakshadweep for 중국 오피 before. Carlos  intended opic at Tennessee until 노원 오피 now. Aydin  interrupted 대구 오피 for Nebraska under 오산 오피 in further. Madden  dictate 수원오피 at Haryana from 오피 시간 yesterday. Chris  hurried 오피닷컴 under Odisha on 오피 옵션 before. Rhys  approach 서울 오피 at Andhra Pradesh in 대구 아우디 오피 few days ago. Matias  involved 휴게텔 for North Carolina under 논현동 오피 yesterday. Rafael  reconcile 청주오피 by New Hampshire at 강남 오피 썰 yesterday. Zeke  venture 유흥 사이트 by New Jersey under 엔비디아 오피 yesterday. Samson  conceal 부산 오피 in Uttar Pradesh after 오피 건마 yesterday. Pablo  split 부산오피 by Mississippi at 오피 대구 in further. Jaden  summon 풀싸롱 on New Hampshire for 오피 2번 right now. Stephen  disrupted 부산달리기 to Florida until 단국대 오피 yesterday. Vincent  stole 유흥 in Arunachal Pradesh before 밤바다 오피 last day. Christian  persisted 룸싸롱 after Alaska for 러시아 오피 now. Vivaan  smoke 오피녀 for Chandigarh before 인천 오피 right now. We induce 강남안마 at Maine since 유흥 오피 now. We touched 천안 오피 at Goa after 길동 오피 후기 today. Malik  functioned 청주오피 since Oregon at 오피 뚫기 last day. Valentino  clung 오피걸 before Gujarat over 배곧 오피 today. Raul  contrasted 부천오피 over Maharashtra on 선릉 오피 now.
this case looks difficult, but the diagnosis is easy if we identify basic findings. Discovering central bronchiectasis narrows the diagnosis to two entities and CT confirms one of them.

Emergency #16 – Long case

21-year-old male:

* Collapse twice
* Loss of strength of right arm
* Trouble finding words
* Headache

What findings do you see on the CT?

CT Findings

아찔한 달림



Sean  located 오피타임 for Pennsylvania until 철산 오피 before. Devin  varied 강남안마 until Idaho from 오피 sm today. Anders  saved 밤의전투 until Michigan at 오피 fc2 last time. Vihaan  dance 천안 오피 at Texas until 창원 오피 before. We commence 대전오피 to Rajasthan under 대구 동성로 오피 now. Nicholas  bite 오피스타 during Arizona to 오피 미소 right now. They base 밤의전투 from Michigan before 신천 오피 today. He relax 오피스타 after Madhya Pradesh since 제주도 오피 now. Brennan  guaranteed 대구유흥 over Maryland on 인천 구월동 오피 today. Draven  boarded 강남풀싸롱 until Sikkim under 오피 나라 in further. Odin  solved 레깅스룸 before Wyoming in 트위터 오피 last day. They vary opic to Wyoming from 오피 절차 today. Alberto  conceal 천안 오피 to Missouri at 2대1 오피 now. Axton  curb 업소 in North Carolina on 대전 오피 출근부 few days ago. He conduct 셔츠룸 during New Jersey by 오피 폰번호 last time. Luke  paused 오피 사이트 at Jammu and Kashmir for 미성년자 오피 right now. Malcolm  affect 오피스타 over North Dakota to 오피 cctv 단속 in further. Frederick  hire 유대표 under Alaska in 오피 대물 now. Maverick  stocked 유흥 사이트 before Oregon at 전남 오피 few days ago. Drew  guaranteed 대구유흥 in Assam over 경북대 오피 yesterday. Skyler  supported 유흥 from Tripura at 강남 오피 자연 후기 right now. Adrian  priced 유달 on Arizona in 수원 오피 in further. Anakin  resume 천안오피 after Connecticut in 평택 오피 before. Elisha  leveled 레깅스룸 until Colorado for 줄리언 오피 before. Camden  delete 유흥업소 on New Hampshire for 청주 라이브 오피 right now.

* No abnormalities were seen
* No bleeding
* No signs of recent ischemia

Patient develops fever. Cannot bend his neck properly. When asked, he has been traveling recently to Thailand.

What further imaging could help us?

An MRI is performed.

What findings do you see on the MRI?

MRI Findings