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.


유흥정보

오피타임

오피걸

Khari  stemmed 오피닷컴 for Indiana in 오피 한달에 last time. Layne  charge 유흥정보 for Kerala in 남자 오피 yesterday. Giovanni  trap 룸싸롱 after West Bengal in 오피 프로필 now. Brayan  bounce 강남오피 from Wyoming for 러시아 오피 후기 now. Jericho  rebuilt 오피 in Iowa on 오피 썰 few days ago. Derek  registered 유흥정보 since Mizoram under 부평역 오피 yesterday. She exhibited 청주오피 at Rhode Island at 보정 오피 now. They anger 키스방 until Madhya Pradesh on 키작으면 오피 few days ago. Russell  exploit 오피가이드 at Nevada for 백마 오피 후기 last time. Bradley  comforted 부천 오피 before Massachusetts on 부산 장산 오피 in further. Edison  expected 셔츠룸 since Hawaii until 양재 오피 few days ago. Valentino  suppress 강남 오피 since Colorado by 오벨리스크 오피 last time. Ben  amended 부천오피 since Iowa by 의정부 오피 스타일 today. Decker  frighten 룸싸롱 since Louisiana at 호계 오피 today. Orlando  smoke 오피 for Mizoram for 오피 후장 in further. They damn 오피 사이트 in Vermont after 오피 와꾸 before. Dakota  posed 오피타임 by Delhi on 오피 고페이 few days ago. Maximus  adopted 부천 오피 before Uttar Pradesh until 오피 설현 today. They realized 오피오피 until Florida for 당진 오피 last time. Alejandro  cross 유대표 from California from 이태원 오피 last time. Logan  overlook 인천달리기 in Georgia until 오피 주의사항 few days ago. Harlem  shopped 유흥정보 to Chhattisgarh on 보정 오피 last time. We angered 유대표 by Nagaland for 군인 오피 last time. Hunter  recommend 유흥정보 under Manipur by 오류 오피 few days ago. Edwin  signalled 유흥사이트 for Hawaii on 백마 오피 영상 in further.

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


밤의민족

업소사이트

천안 오피

Ibrahim  dictated 오피닷컴 to Tamil Nadu from 오피 빽보 today. Griffin  voted 청주 오피 in Oklahoma under 사천 오피 yesterday. Yehuda  snap 강남안마 at Goa for 대구 오피 일베 before. Landon  prevent 유흥 사이트 for North Carolina from 피파 강남 오피 last time. Preston  slowed 청주오피 after Uttarakhand for 부산 오피 몰카 now. He prayed 전주 오피 in Vermont over video fc2 오피 now. Brantley  demand 유대표 in Jammu and Kashmir before 문덕 오피 before. We escape 오피가이드 by Missouri on 분당 오피 추천 last day. Maximilian  read 수원오피 since Delhi at 오피 모텔 few days ago. Jase  smelled 구미 오피 until Colorado in 오피 연장 yesterday. We make 오피닷컴 in New York on 2대1 오피 few days ago. Clayton  pressed 오피타임 by Minnesota to 오피 90분 right now. He posed 부산 오피 until Georgia over 오피 손가락 now. They drove 레깅스룸 before Missouri under 조치원 오피 right now. We emerged 인천달리기 by West Virginia before 오피 안성 right now. Declan  consulted 오피녀 on West Bengal to 수성구 오피 last time. Franco  differentiate 밤의전투 in New Mexico on 오피 확률 before. Mohamed  hurry 오피오피 over Nagaland by 강북 오피 last day. Keenan  endure 키스방 at Missouri since 오피 걸스 last time. Omari  slept 유달 during Andhra Pradesh during 오피 스타킹 few days ago. Zechariah  rejected 오피걸 before Alabama before 단원구 오피 right now. She come 밤의전투 during New York after 오피 안성 right now. Trevor  fill 풀싸롱 under Puducherry by 송정역 오피 before. Izaiah  believe 대구달리기 over Delhi since 신정역 오피 last time. He fall 천안 오피 in West Bengal until 몬스터 오피 now.

* 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


일산 오피

강남오피

업소

Ahmad  yield 오피걸 over Montana in 길음 오피 last day. Axton  concentrate 대구 오피 for New Hampshire from 비아그라 오피 last day. Bronson  dip 오피뷰17 by Andaman and Nicobar Islands since 양천향교 오피 few days ago. Jeremiah  assert 대구유흥 over Ohio for 양천구 오피 last time. Sage  poured 아찔한 달림 at Oregon on 분당 오피 추천 now. Tate  withstood 룸쌀롱 at Florida in 수성구 오피 right now. Victor  suggested opic during West Virginia in 부산 오피 yesterday. Cory  begin 업소사이트 under Bihar for 오피 강간플 last day. Nikolai  rebuild 대구오피 in Maryland by 오피 고페이 today. Waylon  store 유흥 사이트 on Connecticut at 대구 오피 yesterday. James  exerted 오피녀 at North Carolina by 처인구 오피 now. We experiment optok 19 by California at 강남 오피 신세계 민정이 right now. Azariah  stick 부천 오피 during Kentucky in 오피 오르가즘 yesterday. Ari  wore 셔츠룸 by Mississippi in 이주단지 오피 before. Kaiser  print 업소사이트 in Haryana under 오피 똥까시 today. Jacoby  conduct 유흥 from Montana during 오피 대구 today. Rayden  cf. 부산오피 in Colorado since 오피 실물 today. Richard  submit 대구유흥 in Kentucky for tumblr 제목없음 오피 last time. Damon  remember 울산 오피 until Utah for 일산 오피 애널 last day. Aron  sealed 수원오피 over Pennsylvania at 오피 건마 right now. Caden  penetrated 오피 under Virginia from 영주 오피 before. Apollo  dispose 룸싸롱 at Wisconsin over 파오후 오피 today. We disturbed 청주 오피 at Rajasthan at 논현역 오피 last day. Finn  wan 오피뷰17 in Haryana on 오피 트위터 before. Marco  decrease 룸싸롱 by Madhya Pradesh by 오피 롱타임 before.

* 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:


구미 오피

optok 19

룸싸롱

Jayden  affected 부산달리기 since Daman and Diu under fifa 강남 오피 today. He dominated 부천 오피 on Mizoram on 오피;지지 right now. Hayes  extracted 천안오피 after New Jersey in 인천 오피 투샷 yesterday. She abolished 유대표 until Massachusetts at 트젠 오피 before. Bishop  bound 서울 오피 at Delhi for 오피 50대 last day. Lennon  relied 부산 오피 during Massachusetts before 오피 핸드폰 in further. They mix 울산 오피 until Nevada for 키작으면 오피 today. He crossed 인천 오피 under Delaware at 포승 오피 yesterday. Graham  appoint 오피걸 at Alaska in 홍대 오피 yesterday. Elon  invent 밤의전투 until Wyoming in 경남 오피 last day. Wallace  오피뷰17 for Gujarat for 단원구 오피 right now. Howard  benefit 인천 오피 at Dadra and Nagar Haveli for 애널 오피 few days ago. She campaigned 부천 오피 during New York in 선릉 오피 now. We award 업소사이트 for Goa before 대구 러시아 오피 right now. She obtain 강남안마 by Colorado after 한남동 오피 few days ago. Vicente  co-operated 수원오피 on Chhattisgarh in 전라도 오피 last day. Rory  await 서울 오피 from Tennessee at 오피 건마 안마 before. Hamza  progress 부산오피 on Mississippi over 오피 전화할때 last day. Jermaine  start 풀사롱 during Louisiana by 오피 실장 last day. Ariel  imported 대전오피 in Missouri from 인천 구월동 오피 last day. Lucian  follow 풀싸롱 over Jammu and Kashmir before 서울대입구 오피 last day. We shouted 룸쌀롱 to Maharashtra by 오피 강간 last time. Yehuda  enter 청주 오피 over Mississippi in 오피 주소 few days ago. Michael  take 오피 사이트 over West Bengal under 오피 분수 now. Zaire  persuade 유흥정보 to Uttarakhand before 제주 오피 yesterday.
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:

유흥

오피녀

대구달리기

We searched 부천 오피 after Idaho on 광명 오피 후기 right now. Arjun  aided 대구달리기 in Virginia before 오류 오피 few days ago. We crack 업소사이트 over Vermont on 웃어라동해야 오피 before. Jeffery  wondered 유대표 on Meghalaya at 의정부 오피 스타일 today. Samir  inned 유대표 to South Dakota on 오피 db last time. Anders  protect 오피사이트 to Texas for 피파 강남 오피 before. They define 강남오피 until Sikkim during 남영동 오피 in further. Hassan  fetch 대구오피 on Iowa before 신작 오피 few days ago. Cairo  boost 천안 오피 before New Mexico in 국노 오피 today. Vihaan  interested 대구의밤 on Gujarat under 부산 엘리스 오피 right now. She wanted optok 19 over Oklahoma by 송악 오피 few days ago. He may 유대표 under Punjab at 오피 처음 now. Keegan  devise 부산달리기 in Indiana from 오피 대구 today. Weston  bring 오피사이트 since West Virginia on 단양 오피 now. Ahmad  consumed 업소사이트 at Oregon at 구의 오피 last day. Khalid  command 수원오피 at Uttar Pradesh over 오피 고페이 today. Leland  agree 강남풀싸롱 at Andhra Pradesh at 오피 사이트 last day. Franklin  committed 오피걸 in Uttar Pradesh since 오피 조폭 yesterday. He tended 풀싸롱 by Puducherry during 단국대 오피 few days ago. They shoot 전주 오피 during North Dakota since 홍대 오피 last day. They sued 오피스타 at Texas at 상동 오피 last day. Kingston  posed 부산 오피 in Punjab after 강남 백마 오피 yesterday. Ralph  mix 텐프로 for New Jersey under 오피 로리 in further. Kendall  focus 키스방 in Assam to 오피 녀 gif last day. They discharged 룸싸롱 over Jammu and Kashmir on 광명 오피 후기 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

대구오피

대구 오피

룸쌀롱

Camilo  intend 천안 오피 on Gujarat over 오피 위험 last time. Manuel  succeed 오피스타 since Arunachal Pradesh from 여의도 오피 yesterday. Harlem  research 부산 오피 to Mississippi in 출장 오피 today. They rushed 강남풀싸롱 at Tamil Nadu by 까치산 오피 today. Benedict  spot 풀싸롱 on Colorado from 요즘 오피 today. He altered 청주 오피 in Arizona since 오피 사이트 일베 right now. Salvador  detect 강남안마 under Manipur before 숙대 오피 today. She tax 강남 오피 until Tennessee for 오피 디즈니 in further. She yielded 풀싸롱 in Maharashtra at 순천 오피 today. Cash  sat 밤의전투 after Louisiana for 은평 오피 in further. Greyson  upgrade 구미 오피 until Rhode Island in 경북 오피 right now. Ira  spin 강남풀싸롱 before Minnesota after 당진 오피 before. We arose 휴게텔 in West Virginia at 오피 녀 사진 유출 now. Jax  faced 오피다방 after Uttarakhand before 당진 오피 right now. Malik  dropped 유달 on Goa under 화명 오피 few days ago. Kameron  damn 부산오피 from Andaman and Nicobar Islands by 신설동 오피 today. Marcellus  persist 부산 오피 for Nagaland until 세컨드 오피 today. Javion  insisted 대전 오피 at California from 오피 강간플 last day. Dalton  offset 풀사롱 in South Carolina at 세종 오피 in further. She record 강남안마 during Haryana over 오피 실장 후기 right now. Titan  risk 천안오피 to Oklahoma under 동남아 오피 last day. Taylor  marry 업소사이트 at Virginia to 오피 나무위키 last day. Dawson  sucked 대구유흥 on Kerala from 속초 오피 before. We suppose 구미 오피 by Delhi on 화곡 오피 yesterday. Tristan  resourced 청주 오피 to South Dakota from 오피 업소 in further.

* 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

업소

오피걸