Liver Abscess

A pt presented with high fever and abdominal pain. He had elevated transaminases and bilirubin.
CT abdomen revealed lesions in the liver

Same lesion shown in different views

Liver Abscess. Coronal View

Liver Abscess Sagittal View

Liver Abscess Axial View

Aspiration was performed under CT guidance.

Cultures grew Strep Anginosus , sensitive to ceftriaxone. He was treated with ceftriaoxone for several weeks follow by oral therapy. Repeat imaging showed resolution of lesions.

Extensive Dental Caries

A 48 year old man presented with fever. Blood cultures were positive for streptococcus. An echocardiogram revealed a vegetation on mitral valve. Source of initial infection was not clear. He was noted to have poor oral hygiene.
Panorex was ordered which is shown below

Panorex showing Extensive Dental Caries

Panorex showed dental caries as shown by the arrows.

It was concluded that the most likely source of introduction of streptococcus infection is his mouth.

Follow up with his dentist was recommended post discharge.

A case of pulmonary mass

53 year old gentleman had chest X ray for as part of some routine workup, which is shown below

The chest X ray showed a calcified well circumscribed mass of about 3 cm in size, as pointed by the arrow.

Differential Diagnosis include

Malignancy which could be primary lung or metastatic

Tuberculosis

Fungal infections

CT chest was ordered and shown below

CT scan confirmed the findings and showed well circumscribed, calcified mass with clear borders and Golf Ball like appearance. 

Biopsy showed spindle shaped cells and yeast forms, confirming the diagnosis of histoplasma. The well circumscribed golf ball like mass is known as histoplasmoma. 

Since this pt was asymptomatic, No treatments interventions were performed

Opacification and Sclerosis of Sphenoid Sinus

Image below shoes thickening and sclerosis of sphenoid sinus wall (as shown by arrow). This shows long standing inflammatory process. Differential include chronic bacterial or fungal sinusitis

Intra Abdominal Abscess

Intrabdominal Abscess as shown by arrows. Its in the sub-hepatic space and going down the right para-colic gutter. Pt had partial right sided colonic resection for a benign lesion and developed poly-microbial abscess as a complication of surgery.

Acute Colitis due to Clostridium Difficile

60 year old patient presented with diarrhea and sepsis. CT scan abdomen showed acute colitis. See the images below

CT abdomen with contrast demonstrates
1 &2)Edema of sigmoid colon wall
     3) Diverticula
4&5) Fat stranding, which is another sign of inflammation
Down below, same patient after 5 days of treatment with oral vancomycin showing significant improvement in colitis.

Brain Abscess

Multiple MRI views showing multi-loculate intracerebral and subdural fluid collections with ring enhancing cerebral lesions and dural enhancement. There is associated vasogenic edema and localized mass effect. 
This elderly gentleman presented with altered mental status which was on going on for a month. Other medical problems included Diabetes and End Stage Renal Disease needing hemodialysis