spotters Guide Dr Anand Hatgaonkar Associate Professor, Dept of Radiodiagnosis Presenter Dr. Ashok Sharma JR-2, Dept of Radiodiagnosis

C/o halitosis, regurgitation while swallowing.

Preterm baby, Usg Head.

50 year male, chronic dyspnoea

Caroticocavernous fistula Abnormal communication between the carotid circulation and the cavernous sinus. Axial maximum-intensity projection slab from a CT cerebral angiogram shows dilatation of both superior ophthalmic veins and engorgement of the cavernous sinuses.

CT proptosis enlarged superior ophthalmic veins extraocular muscles may be enlarged orbital oedema may show SAH/ICH from a ruptured cortical vein Angiography (DSA) rapid shunting from ICA to CS enlarged draining veins retrograde flow from CS, most commonly into the ophthalmic veins Ultrasound arterialised ophthalmic veins may be seen on Doppler study

Caroticocavernous fistulas Classification It can be broadly classified into two main types: Direct: direct communication between intracavernous ICA and cavernous sinus Indirect: communication exists via branches of the carotid circulation (ICA or ECA) Another method is to classify according to four main types: Type A: direct connection between the intracavernous ICA and CS Type B: dural shunt between intracavernous branches of the ICA and CS Type C: dural shunts between meningeal branches of the ECA and CS Type D: B + C

“Lyre sign”- Carotid body tumour  Refers to the splaying of the internal and external carotid by a carotid body tumour. Classically described on angiography   Chemodectoma or carotid body paraganglioma, is a highly vascular glomus tumour that arises from the paraganglion cells of the carotid body.  It is located at the carotid bifurcation with characteristic splaying of the ICA and ECA. 

Differential diagnosis vagal schwannoma: tends to displace both vessels together rather than splaying them vagal neurofibroma: tends to displace both vessels together rather than splaying them lymph node mass: may look similar if hypervascular glomus vagale tumour: same pathology but located more rostrally carotid bulb ectasia

SPOT 10 : C/o halitosis, regurgitation while swallowing.

Zenker's diverticulum Zenker's diverticulum (posterior hypopharyngeal diverticulum) is an acquired mucosal herniation through an area of anatomic weakness in the region of the cricopharyngeus muscle (Killian's dehiscence).

Preterm baby, Usg Head.

Peri Ventricular Leukomalacia (PVL) It is a white matter disease that affects the periventricular zones. In prematures -is a watershed zone between deep and superficial vessels. PVL occurs most commonly in premature infants born at less than 33 weeks gestation (38% PVL) and less than 1500 g birth weight (45% PVL). Detection of PVL is important because a significant percentage of surviving premature infants with PVL develop cerebral palsy, intellectual impairment or visual disturbances.

SPOT 15:50 year male, chronic dyspnoea

Pulmonary alveolar microlithiasis  Widespread intra-alveolar deposition of spherical calcium phosphate microliths (calcospherites).  Often discovered incidentally on a chest radiograph. The radiographic features are frequently out of proportion to clinical symptoms . Due to a mutation that causes inactivation of a sodium-dependent phosphate cotransporter, which itself is found mainly in alveolar type ii cells. This cotransporter normally clears phosphate from degraded surfactant, and when inactivated there is accumulation of phosphate in the alveolus, and calcium phosphate microliths are then thought to form .  Usually, there is no abnormal calcium metabolism.  Associations Testicular microlithiasis

FINDINGS: Sandstorm" of diffuse pulmonary microcalcification in a peripheral distribution "Lucent mediastinum" sign "Black pleura" sign

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