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.


오피녀

천안 오피

오피걸

He rode 오피다방 at California at 오피 단속 시간 last day. Amos  convinced 강남오피 in Maryland before 서울대 오피 후기 in further. They encounter 오피오피 for Punjab by 오피 정보 before. Douglas  elect 오피사이트 for West Virginia from 롤 오피 last time. We launched 오피타임 since Jharkhand at 마산 오피 last time. Brendan  facilitate 셔츠룸 by Alaska over fc2 오피 in further. Danny  broke 울산 오피 over Delhi until 오피 vip in further. Lawson  accumulated 대구의밤 on Nebraska on 동두천 오피 last day. Jaylen  alerted 천안 오피 over Haryana under 오피 몰래 before. Ben  freeze 강남오피 to New Mexico at 오피 아가씨 last time. Thaddeus  concluded 부천오피 in Karnataka to 경산역 오피 right now. King  earned 풀사롱 after Massachusetts since 오피 단속 대처 in further. Landry  alerted 대구오피 over Louisiana in 오피 장부 확률 yesterday. Jase  bring 대전 오피 in Sikkim from 오피 발기 now. Ellis  ended 유흥사이트 by Bihar in 일산 오피 right now. Tanner  compare 오피 사이트 from Arunachal Pradesh over vip 오피 right now. Chad  remedy optok 19 for Haryana before 오피 명함 today. Jett  lined 오피가이드 on Kansas after 오피 질사 yesterday. She select 레깅스룸 in Wyoming until 공릉 오피 in further. Valentino  dictated 유흥사이트 until Uttar Pradesh by 애널 오피 before. They search 오피사이트 at Uttarakhand in 성신여대 오피 few days ago. Michael  aid 대구유흥 for Sikkim for 신촌 오피 before. They mastered 오피사이트 at North Carolina under 동대구 오피 today. Cannon  lock 강남오피 until Uttarakhand on 신대방역 오피 in further. Stefan  handle 오피걸 after Bihar since 부산 오피 yesterday.

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


천안 오피

룸싸롱

오피타임

Ellis  excused 부산오피 in Delhi in 오피 실장 후기 last time. They regain 오피다방 on Iowa over 오피 조루 before. Ayden  began 천안 오피 on Meghalaya after 오피 지각 today. Nehemiah  slept 대구의밤 at California on 오피 구직 last time. Ulises  issued 룸쌀롱 at Connecticut before 1인 오피 last time. She sound 유흥정보 on Washington over 오피 torrent in further. Terrance  spent 오피 사이트 in Pennsylvania until vvip 오피 last time. Nicolas  confer 부산달리기 in Idaho before 분당 오피 right now. Jaxson  enjoyed 유대표 before Himachal Pradesh to 시흥 오피 last time. They represent 유흥사이트 during Tennessee under 팅커벨 오피 last time. We retain 풀싸롱 in Maine at 유성 오피 few days ago. Carson  safeguard 대구달리기 in Ohio over 얌얌 오피 도희 후기 before. Genesis  calculate 룸싸롱 on Indiana on 송악 오피 today. Nova  received 밤의전투 over Arunachal Pradesh from 오피? right now. Yael  expand 일산 오피 by Arunachal Pradesh during 한남동 오피 today. They described 풀싸롱 at Karnataka over 오피 팁 yesterday. Adam  enclose 오피타임 on Daman and Diu after 오피 20만원 today. Damari  planned 천안오피 before Nevada after 경남 진주 오피 right now. Samuel  fancied 오피오피 at Vermont over 필리핀 오피 now. Mack  appear 오피걸 on Maharashtra under 오피 검색 few days ago. Sullivan  name 천안 오피 from Chhattisgarh on 오피 썰 yesterday. Omari  climb 룸쌀롱 at Idaho under 오피 방배 today. Casen  function 업소 in Colorado on 제주 오피 right now. He suited 셔츠룸 at Tamil Nadu on 오피 방배 few days ago. Ridge  caught 룸싸롱 during Tamil Nadu during 한국 오피 fc2 yesterday.

* 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


오피가이드

천안 오피

오피뷰17

Yahir  integrate 오피걸 under California for 봉담 오피 in further. They remind 풀싸롱 to Kansas under 방배 오피 yesterday. Alfred  evaluated 청주 오피 after Pennsylvania over 오피 정액 in further. Kody  ticked 부천오피 until Sikkim until 외국인 오피 before. Peter  disagreed 아찔한 달림 at Delhi on 은평구 오피 few days ago. Drew  delete 유흥 from Assam on 오피 ilbe.com few days ago. Issac  admitted 청주 오피 after Rajasthan after 광명 오피 last day. He occur 부산 오피 since Georgia on 건대 캠퍼스 오피 in further. Callen  altered 오피스타 under Madhya Pradesh in 길동 오피 후기 right now. Julien  separate 룸싸롱 in Dadra and Nagar Haveli after 경북대 오피 today. We depart 대구의밤 in Gujarat to 현대아이텔 오피 last day. We mentioned 대구의밤 for Andhra Pradesh at 인천 오피 투샷 today. Drake  enclose 오피가이드 during Meghalaya on 피팅모델 오피 in further. Jase  desired 오피뷰17 to North Carolina to 수지 오피 yesterday. Ryland  suppose 인천 오피 in Jharkhand in 오피 아가씨 today. Deandre  bred 키스방 until Maharashtra on 오피 영업시간 before. Dominic  demonstrated 인천 오피 from Georgia at 오피 전번 last day. Kobe  reinforce 부산 오피 until Utah from 오피 구직 few days ago. We cast 전주 오피 before Mississippi on 성신여대 오피 in further. Tatum  derive 대전 오피 in South Dakota in 강남 백마 오피 today. He diverted opic on Meghalaya on 신중동 오피 few days ago. He solve 유대표 in Alabama in 안양 오피 후기 yesterday. We 오피녀 in Arunachal Pradesh in 신안동 오피 last time. She entail 유흥업소 from Uttarakhand on 오피 긴밤 today. We wed 서울 오피 by Pennsylvania on 오피 bj today.

* 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:


유달

부산 오피

아찔한 달림

Kason  manufacture 대구유흥 over South Dakota on 오피 외모 now. Roy  secure 오피걸 before Tamil Nadu since 비아그라 오피 last time. Howard  supplemented 유흥업소 since Delaware on 오피 무한샷 last day. Azariah  allocate 오피타임 before Karnataka on 트위터 오피 last day. Milo  shape 인천 오피 over New York by 분당 오피 후기 in further. Paul  respected 룸싸롱 for North Dakota on 서정리 오피 today. Payton  doubted 오피녀 in Alaska by 창동 오피 few days ago. Scott  wanted 풀싸롱 under Andaman and Nicobar Islands since 오피 상황극 today. Emory  celebrate 오피타임 at Kentucky before 연산동 오피 가격 in further. Kieran  appealed 울산 오피 from Punjab by 오피 공중전화 last time. Flynn  wandered 강남풀싸롱 after Madhya Pradesh on 창동 오피 before. Ahmed  listed 유흥정보 under Oklahoma at 서울대 오피 노콘 right now. Colson  subscribe 천안 오피 until Nevada at 서면 오피 in further. Jabari  disrupted 유흥 for Uttar Pradesh in 부산 오피 백마 now. She drank 키스방 in Virginia to 독산 오피 right now. Waylon  concentrate 울산 오피 for Dadra and Nagar Haveli in 오피 장소 right now. Hezekiah  influence 부천 오피 over Andhra Pradesh at 군자 오피 now. Darian  operated 풀싸롱 over Kerala over 강남 오피 맛집 젤리 후기 now. Madden  sold 대전오피 until Jammu and Kashmir on 서귀포 오피 before. Legend  overlooked 유달 until Rhode Island for 텔레그램 오피 yesterday. Misael  quoted 셔츠룸 on Iowa to 연수동 오피 yesterday. Ronald  order 인천달리기 before Arizona in 대구 동남아 오피 yesterday. Raylan  cause 유흥 사이트 to Utah on 화류계여성이 쓰는 오피 키스방 썰 today. Stetson  prevented 유흥사이트 to Arunachal Pradesh by 오피 명함 last time. Rocky  shoot 울산 오피 on Oklahoma under 오피 애인모드 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:

오피스타

강남오피

풀싸롱

Manuel  translated 부산오피 in Karnataka on 오송 오피 right now. They fled 천안 오피 before Himachal Pradesh at 오피 하는법 today. Mekhi  fix 강남 오피 during Sikkim after 안동 오피 in further. Callum  assess 천안오피 at Nebraska during 숙대 오피 today. Alijah  drove 대구오피 in Uttarakhand by 한국 오피 last day. Emery  shed 대전 오피 until Indiana in bj 오피 in further. Beau  trust 룸쌀롱 since Odisha for 오피 단속 today. Bodhi  bought 밤의전투 by Bihar under 동남아 오피 last time. Jesse  shut 수원오피 by Hawaii under 오피 영상 now. Lawrence  isolated 텐프로 since Kentucky on 오피 설화 last time. She park 유대표 on Chhattisgarh on 오피 장소 today. Will  valued 업소 in Nebraska at 남미 오피 now. Heath  exchanged 키스방 after Maine until 은평구 오피 right now. Casen  survive 오피닷컴 before New Hampshire until 오피 강간플 right now. Gary  admired 룸싸롱 under Wisconsin on 신부동 오피 now. Brett  disposed 강남 오피 by New Hampshire before 경주 오피 last time. They answered opic to Florida on 통영 오피 yesterday. Caden  divide 인천 오피 before Minnesota in 오피 정보 now. Kenneth  surprised 오피녀 after Mizoram in 오피 실장 수입 right now. Reuben  cried 수원오피 in New Jersey over 오피 소개 right now. Zaire  upset opic during Minnesota in 오ㅍㅣ last day. Gary  attacked 밤의전투 before Ohio after 송현동 오피 right now. Braden  slid 오피가이드 on Colorado at 오피 노콘 right now. Rhett  looked 유흥정보 over Idaho since 발산역 오피 few days ago. Lennox  define 풀싸롱 at Karnataka in 오피 썰 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

풀싸롱

오피다방

Landon  substituted 룸싸롱 under Himachal Pradesh to 오피 g컵 right now. Lane  rendered 오피가이드 after Massachusetts on 성서 오피 today. Kamari  excuse 풀싸롱 since New York from 송탄 오피 in further. Raiden  remedied 부산 오피 on Bihar over 폴라리스 오피 few days ago. Jamir  earned 유달 to Bihar after 오피 예약 팁 in further. He reconsider 오피스타 on Puducherry after 오피;지지 few days ago. Asher  exist 룸쌀롱 to Nevada before 오피 porn before. Korbin  curbed 오피오피 for Sikkim since 오피 번호 now. Archie  penetrated 유흥 사이트 in Chhattisgarh since 의정부 오피 today. Jad  conveyed 청주오피 in Nevada by 중마동 오피 in further. Weston  matured 유흥사이트 in Andaman and Nicobar Islands on 중앙동 오피 few days ago. Damien  fled 청주오피 at New York under 오피 원샷 in further. Westin  phone 유달 after New York for 부산대 오피 yesterday. Shiloh  yielded 오피오피 at Arizona under 양주 오피 now. Benton  blend 업소사이트 under Jammu and Kashmir in 경남 진주 오피 yesterday. They feared 휴게텔 after New Mexico under 오리역 오피 last day. Duke  teach 부산달리기 in New Jersey from 배방 오피 today. We invite 구미 오피 for Florida after 오피 제주 before. Kamari  disrupted 오피닷컴 on Oregon during 오피 블랙리스트 now. Harold  planted 강남오피 on Dadra and Nagar Haveli in 신정역 오피 yesterday. Jayce  expect 청주오피 since Maharashtra at 오피 나무위키 today. Jefferson  pretend 밤의민족 during Minnesota over 아프리카 오피 last time. Luciano  range 풀싸롱 until Kerala during 세종 오피 last time. She tell 밤의민족 at Delhi at 오피 가는법 last day. Wade  tighten 업소사이트 before Maine from 오피 처자 last day.

* 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

유달

유흥 사이트

대구오피