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

4. C/o halitosis, regurgitation while swallowing.

5. Preterm baby, Usg Head.

6. 50 year male, chronic dyspnoea

7. 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.

8. 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

9. 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

11. “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. 

14. 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

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

16. 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).

17. Preterm baby, Usg Head.

18. 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.

19. SPOT 15:50 year male, chronic dyspnoea

20. 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

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

22. THANKS