AVM's

Arteriovenous Malformations, or also known as AVM's, are when an artery and vein connect. There are no known causes for this abnormality, but they are congenital. More often, AVM's occur in the brain, but can happen anywhere. Most of the time people with AVM's have no symptoms, unless the blood vessel leaks causing a hemorrhage. If this happens, patients develop headaches, seizures, possible vision or hearing loss, etc. However, there are other complications that may happen with AVM's such as decreased oxygen level to the brain, weakened blood vessels, or even brain damage! Although AVM's are more common in boys than in girls, pregnancy may cause a patient to start developing symptoms. Patient younger than 50 are also at an increased risk to progress signs of having an AVM.

Even though cerebral arteriography is the preferred imaging modality, MRI and CT imaging may also be used. Contrast may be given to the patient to enhance the vessels in either modality to show where the pathology is. I have uploaded images to show what an AVM looks like. One section is MRI images, the other is CTA images.

Treatment includes surgery, radiation treatment (to actually clot the vessels), or embolization (where a catheter is put into an artery in the leg then to where the AVM is and a substance is injected into the catheter to decrease flow of blood).

References:

http://mayoclinic.com/health/brain-avm

http://stanfordhospital.org/ImageGallery/images

Rhinolith

Rhinolith is literally translated as a "Nose stone". It is a calcification found inside the nasal cavity caused from the accumulation of mineral salt (from tears or nasal drainage) that forms around either a exogenous object, such as a piece of cloth or foreign body, or as an Endogenous object, which could be a blood clot or a lump of mucus. The material hardens and as the mineral salt adds to it, it gets larger causing the patient to have difficulty breathing and some pain. Females are more prone to getting a rhinolith.

Treatment for a rhinolith is simple. The stone is taken out in surgery and if the stone is large enough, it is broken up into pieces and then taken out.

Here are some pictures I found on the websites below. It is amazing to see how big "nose stones" get.

References:

http://www.thefreelibrary.com/Rhinolith-a01073751348

http://www.scielo.br (picture #1)

http://www.ghorayeb.com/Rhinolith.html (picture #2)

Blow out fractures

Blow out fractures are fractures that are caused by a blunt force applied to the orbit. The fracture usually occurs within the orbital floor because it is the thinnest part of the orbital wall. Hemorrhaging of blood into the sinus cavity is evidence of a fracture in the floor of the orbit. Orbital emphysema may also be another side effect of this fracture. It is due to the leakage of air into the sinus cavity (usually occurs within the ethmoid sinuses).

One of the fractures that I find the most interesting is called a tripod fracture or a zygomaticomaxillary fracture. This type of fracture basically separates the zygomatic bone from the frontal and maxillary bone leaving a triangle shape, hence the name. Not only does this fracture sometimes cause facial deformity and the patient must have surgery, it may also cause an impingement on the optic canal. Patients may also complain of difficulty eating or blowing their nose. The diagram on the bottom and the picture on the 3-D image on the top are examples of tripod fractures.

A few years ago a patient got in a fight and was punched in the face several times and came in to the hospital to be evaluated. The ER doctor ordered a general facial bone series, but because plain radiographs were not sufficient enough, he was sent to have a CT scan done. He was given a diagnosis of a left tripod fracture and a fracture of the nasal bone.

References:

http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/online-musculoskeletal-radiology-book/facial-and-mandibular-fractures

Eisenberg, Ronald M.D., J.D., F.A.C.R. & Johnson, Nancy, B.A., RT(R) (CV) (CT) (QM).
3rd Ed. 2003. Nervous System. Woodard, Linda Eds. Comprehensive Radiographic
Pathology. (pp 322-323). Missouri: St. Louis.

radiology.uiowa.edu/downloads/

Prolactinoma

What is prolactinoma?

It is a non cancerous pituitary tumor that causes an overproduction of the hormone prolactin. The prolactin hormone stimulates the production in breast milk and it also is in charge of breast development.

Causes of prolactinoma are unknown, but there are several risk factors including individuals who have hypothyroidism, pregnant women, young women, and older men. Results can range anywhere from loss of vision (due to the tumor compressing on the optic nerve), bone loss, and headaches, to lactating from the breast (from the overproduction of prolactin), hypothyroidism, and decrease in other hormones released by the pituitary gland.

Medications are usually given to help regulate hormone levels, but in some rare cases, the tumor must be excised in surgery. I have included an example of a prolactinoma on a CT coronal image with contrast.

References:

www.radpod.org

www.mayoclinic.com

http://www.medi-fax.com/atlas/braintumours/pituitarytumors/case2.html