DX: Esophageal calcification after corrosive injury

Sorry for the delay. This couple of months have been quite diffucult but we are still making some noise. Anyways here is the conclusion of this case.

We inquire if patient had a history of caustic ingestion (sodium hydroxide) and he did a couple of months ago. He accidentally swallowed this corrosive but induced himself vomiting shortly after ingestion.

Relevant findings are as described:

There was no adenopathy or infiltration to surrounding tissues.

Primary DD is Leiomyoma.

The course of corrosive damage to the intestinal tract can be divided in three phases:

1) 1.4 days after ingestion, acute necrosis with intensive inflamatory reaction in surrounding tissue occurs,.
2) 3-5 days after ingestion, in wich sloughing of necrotic tissue occurs and repair begins with fibroblastic activity.

3) 3-4 weeks after ingestion, when the fibrous tissue begins to contract and the inflammatory reaction subsides. Contraction and adhesion between granulating areas in the lumen lead to stricture formation.

Stricture formation is the leading radiological feature of the chronic phase of corrosive esophageal injury with prestenotic dilation of the esophagus as in this case. Stricture has benign characteristics with smooth, concentric tapering of the esophageal wall at the margins. Calcifications are unusual.Here is an article that explains this unusual characteristic:

http://www.springerlink.com/content/h071q457134h1311/


Thank you for your FB comments, be sure to check my homepage at FB..

Blessings..

CASE 19: 56 y/o man with progressive dysphagia

Patient came with history of dysphagia associated with weight loss but unremarkable at first as dysphagia can produce anorexia. No history of trauma or foreign body ingestion.

We recommended a barium swallow and further neck CT:

Findings and possible DD..

DX: Choroidal Melanoma

Here is the conlusion of the case. It was obvious the asymmetry of orbits corresponding to changes in posterior chamber of right eye.

It was hyperintense in T1/ hypo in T2, so hemorraghic changes are considered. It had no classical signs of retinal or choroidal detachment, instead there was an intraocular globular amorphus mass. Post gad images revealed mass enhancement and no peripheral involvement.

Here's a descriptive T2 snd T1 slice:

Red arrow shows the posterior chamber involvement and on the right it shows the globular appeareance of the mass.  Blue arrow shows an incidental sellar arachnoidocele.

Here is the "mushroom like" appeareance of Choroidal Melanoma. Photo Courtesy of AFIP Atlas of Tumor Pathology.

Choroidal melanoma is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma in the body. It is nevertheless an infrequently found tumor.

Is a subtype of uveal melanoma. Uveal melanomas can be divided into 2 categories: (1) anterior uveal melanomas, in which the tumor arises in the iris, and (2) posterior uveal melanomas, in which the tumor arises in either the choroid or the ciliary body. Intraocular melanomas simultaneously can involve more than 1 uveal structure.

The ocular tissue where these tumors arise, the uvea, is a densely pigmented layer that forms part of the wall of the eye. The uvea is subdivided into the iris, the ciliary body, and the choroid. The choroid underlies the retina and its pigment epithelium throughout the ocular fundus. The main function of the uvea is to provide oxygen and other nourishment to the highly metabolically demanding retinal photoreceptors. It is primarily a vascular tissue, with fenestrated capillaries and stroma containing melanocytes.

Incidence of primary choroidal melanoma is about 6 cases per 1 million population. Perhaps because of increased sunlight exposure, there appears to be a higher incidence of uveal melanoma in the southern latitudes of the United States. Alternatively, this might be the effect of a tendency of older Americans to retire in the South.

Choroidal melanomas remain asymptomatic for prolonged periods of time; they may be found incidentally during ophthalmoscopy. In general, the more anterior their origin, the longer the delay of any symptoms.


Thank you and see you next time..

CASE 18: 54 y/o woman with right eye pain and visual impairment

Sorry the delay from the past case. Some issues had to be arranged. Ok here it goes..

Patient had this symptoms since 6 months from now, but at this time right visual impairment is more persistent and she noticed some changes in esclera's color.

Here are the images, click to enlarge:

T1WI AXIAL

 T2WI CORONAL

T2WI SAGITAL 

T2WI AXIAL

T1WI POST GAD

Findings and possible Dx..