class: center, middle, title-slide # Noon Case Conference ### Howard Mann, M.D. ### University of Utah | Department of Radiology and Imaging Sciences ### October 8th,2024 --- class: center, middle  --- class: inverse name: case panelset Case 1 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ Blunt Chest Trauma] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] </br> <img src="images/01.jpg" width="100%" /> ] <!--end of panel--> .panel[.panel-name[Computed Tomography] .small[After left pleural drain placement] <div style="text-align:center;"> <iframe class="pacsbin" id="case1" src="https://www.pacsbin.com/c/W1lFIP0OC8?s=60674905b224852f2731b1b9&i=60674905b224852f2731b1ba&ww=620&wc=58&an=false&header=false&notes=false&overlay=false" style="width: 475px; height: 475px; border: 0;"></iframe> </div> ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 2 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ Presentation: Blunt Abdominopelvic trauma] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] .small[What interesting finding is present?] <img src="images/APChest.jpg" width="65%" /> ] <!--end of panel--> .panel[.panel-name[Computed Tomography] .small[Do you see the reason for it?] <div style="text-align:center;"> <iframe class="pacsbin" id="case2" src="https://www.pacsbin.com/c/ZJ7M9wJYC8?s=606762bab224852f2731b5b6&i=606762bab224852f2731b5b7&ww=400&wc=40&an=false&header=false&notes=false&overlay=false" style="width: 475px; height: 475px; border: 0;"></iframe> </div> ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 3 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ The CXR was obtained to assess PICC placement in a patient being treated for lumbar infectious diskitis. ] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] .small[Something needs to be done next. Can you determine why and what ?] <img src="images/APPICC.jpg" width="50%" /> ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 4 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ Presentation: This patient underwent uneventful resection of a large adrenal mass]  ] <!--end of panel--> .panel[.panel-name[Chest Radiography] .small[This was performed on the first post-operative day. What is the Impression of your report? ] <img src="images/PostOpPALat.jpg" width="80%" /> ] <!--end of panel--> .panel[.panel-name[Computed Tomography] .left-column[What's your diagnosis?] .right-column[ <div style="text-align:center;"> <iframe class="pacsbin" id="case4" src="https://www.pacsbin.com/c/Wk-tNHgFRU?s=6067782d25ee0c3888a7aa99&i=6067782d25ee0c3888a7aab3&ww=400&wc=40&an=false&header=false&notes=false&overlay=false" style="width: 500px; height: 500px; border: 0;"></iframe> </div> ] ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 5 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ Presentation: A patient with chest pain and respiratory distress.] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] .small[Where is the abnormality located ? Hint: A classic radiology sign is present. ] <img src="images/APMedMass.jpg" width="45%" /> ] <!--end of panel--> .panel[.panel-name[Computed Tomography] .small[Additional information: Serum AFP is markedly elevated. What's the diagnosis ?] <div style="text-align:center;"> <iframe class="pacsbin" id="case5" src="https://www.pacsbin.com/c/-kEHDKftA8?s=6067b2de1b4e713d763c41e8&i=6067b2de1b4e713d763c4206&ww=719&wc=122&an=false&header=false&notes=false&overlay=false" style="width: 450px; height: 450px; border: 0;"></iframe> </div> ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 6 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ Presentation: A perplexed cardiologist needs help with this image. What single historical item do you want to know ?] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] <img src="images/pneumocon.jpg" width="100%" /> ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 7 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ A patient with chronic, progressive exertional dyspnea.] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] .small[Hint: analysis of vessels is important. ] <img src="images/phPALAT.jpg" width="70%" /> ] <!--end of panel--> .panel[.panel-name[Perfusion scan] <img src="images/qscan.jpg" width="50%" /> ] <!--end of panel--> .panel[.panel-name[Axial CT] <div style="text-align:center;"> <iframe class="pacsbin" id="casex" src="https://www.pacsbin.com/c/b1RW7lNYCI?s=6067d49a1b4e713d763c4250&i=6067d49a1b4e713d763c4251&ww=1500&wc=-500&an=false&header=false&notes=false&overlay=false" style="width: 450px; height: 450px; border: 0;"></iframe> </div> ] <!--end of panel--> .panel[.panel-name[Axial MIP CT] <div style="text-align:center;"> <iframe class="pacsbin" id="casexy" src="https://www.pacsbin.com/c/WJXI8xVYRU?s=6067d78a1b4e713d763c42a7&i=6067d78a1b4e713d763c42a8&ww=1771&wc=-243&an=false&header=false&notes=false&overlay=false" style="width: 450px; height: 450px; border: 0;"></iframe> </div> What's your provisional diagnosis ? ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 8 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ A patient without respiratory-chest symptoms.] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] <img src="images/morgag.jpg" width="75%" /> ] <!--end of panel--> .panel[.panel-name[Computed Tomography] <div style="text-align:center;"> <iframe class="pacsbin" id="casexxy" src="https://www.pacsbin.com/c/byzshXVKRL?s=6067dd3a1b4e713d763c42ff&i=6067dd3a1b4e713d763c4300&ww=663&wc=66&an=false&header=false&notes=false&overlay=false" style="width: 500px; height: 500px; border: 0;"></iframe> </div> ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 9 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ A patient with findings of pulmonary hypertension on cardiac ultrasound.] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] <img src="images/phpa2lat2.jpg" width="75%" /> ] <!--end of panel--> .panel[.panel-name[Q scan] </br> <img src="images/perfusionscan.jpg" width="85%" /> ] <!--end of panel--> .panel[.panel-name[Computed Tomography] <div style="text-align:center;"> <iframe class="pacsbin" id="case5" src="https://www.pacsbin.com/c/Zyn15LEYCI?s=6067e1d71b4e713d763c43fc&i=6067e1d71b4e713d763c43fd&ww=1515&wc=-498&an=false&header=false&notes=false&overlay=false" style="width: 450px; height: 450px; border: 0;"></iframe> </div> Hmm. The second case of pulmonary hypertension. This is more difficult. Good luck! ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 10 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ A patient being treated for septic embolism. A CTPA was performed. Another tough (perceptual) case. Evaluate the vessels carefully. Are emboli present ?] ] <!--end of panel--> .panel[.panel-name[CTPA] <div style="text-align:center;"> <iframe class="pacsbin" id="case5" src="https://www.pacsbin.com/c/Z1lHnuEFRU?s=6067e5131b4e713d763c44a5&i=6067e5131b4e713d763c44a6&ww=649&wc=116&an=false&header=false&notes=false&overlay=false" style="width: 450px; height: 450px; border: 0;"></iframe> </div> ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 11 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ A patient provides a history of recurrent lung infections over many years.] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] <img src="images/cpam.jpg" width="75%" /> ] <!--end of panel--> .panel[.panel-name[Chest CT] 4 weeks later. </br> <img src="images/CT4weekslater.jpg" width="100%" /> ] <!--end of panel--> .panel[.panel-name[Chest CT 2] Another infection two years later! <img src="images/CT2yearslater.jpg" width="100%" /> ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 12 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ Chest radiography ostensibly shows a right central mass, consistent with a primary lung cancer. ] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] <img src="images/smallcellCa.jpg" width="45%" /> .small[Wait, is there something else too ?] ] <!--end of panel--> .panel[.panel-name[CT] <div style="text-align:center;"> <iframe class="pacsbin" id="case5xlf" src="https://www.pacsbin.com/c/-1WC7xHFCL?s=6067f0481b4e713d763c44fb&i=6067f0481b4e713d763c44fc&ww=413&wc=87&an=false&header=false&notes=false&overlay=false" style="width: 450px; height: 450px; border: 0;"></iframe> </div> Can you explain the peripheral opacity? ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 13 .panelset[ .panel[.panel-name[Clinical Presentation] .left[ An EKG in this breathless patient shows third-degree heart block. ] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] <img src="images/HeartBlock.jpg" width="50%" /> Can you suggest why he may be breathless ? A CTPA was requested. Surprised ? ] <!--end of panel--> .panel[.panel-name[CTPA] <div style="text-align:center;"> <iframe class="pacsbin" id="case5xlf" src="https://www.pacsbin.com/c/WyI8PfBFR8?s=6067f48a20934b4f6f76f4a5&i=6067f48a20934b4f6f76f4a6&ww=975&wc=69&an=false&header=false&notes=false&overlay=false" style="width: 450px; height: 450px; border: 0;"></iframe> </div> What's the explanation for his symptoms ? ] <!--end of panel--> ] <!--end of panelset--> --- class: inverse name: case panelset Case 14 — Last quick one! .panelset[ .panel[.panel-name[Clinical Presentation] .left[ The asymptomatic person was sent over from his dentist's office (at least, that's what I got from Epic). ] ] <!--end of panel--> .panel[.panel-name[Chest Radiography] <img src="images/dentistcase.jpg" width="55%" /> ] <!--end of panel--> ] <!--end of panelset--> <style type="text/css"> .highlight-last-item > ul > li, .highlight-last-item > ol > li { opacity: 0.2; } .highlight-last-item > ul > li:last-of-type, .highlight-last-item > ol > li:last-of-type { opacity: 1; } </style>