SPONDYLOSIS

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Spondylosis is a condition of degenerative changes in the spine. Spondylosis can progress into spondylolisthesis. Spondylolisthesis is the slippage of one vertebra over another vertebra. This can occur in three different ways: forward (anterolistheis), backward (retrolistheis), or sideways (laterlistheis). Symptoms of spondylosis and spondylistotheisis are back pain, sciatica, numbness, difficulty walking, and burning sensations.

Spondylosis is most commonly caused by degenerative disc disease. It can also occur due to weakened ligaments in the lower part of the spine. The most common area for spondylolisthesis is L4-L5. Laminectomy, a surgical procedure to remove part of the lamina, is preformed to help relieve nerve impingement.

CLAY SHOVELER'S FRACTURE

A Clay Shoveler fracture is an uncommon avulsion fracture of the spinous processes, usually of c-7 or t-1. This fracture is caused by a sudden load on a flexed spine when the arms are extended. Shoveling heavy loads in rapid succession places the body in the perfect position for this to occur.

Clay Shoveler’s fracture causes a burning “knife” like pain in the upper back between the shoulder blades. The severity of the fracture determines treatment course. Often times no treatment is required and the fracture heals on its own. Pain medications and physical therapy are most common when treatment is necessary. In severe cases surgery is preformed to remove the tips of the spinous processes of the affect vertebra.

Jefferson Fracture

A Jefferson fracture is a burst fracture of the ring of the first cervical vertebra into multiple pieces with protrusion of pieces into the spinal canal. It is named Jefferson from Sir Geoffrey Jefferson, a neurologist and neurosurgeon, whom discovered it in 1920. Jefferson fractures are usually caused by a hyperextension of neck the or hard impact to the back of head and neck area. A diving accident in shallow water, high fall, or roll over motor vehicle accidents are the most common causes of c-1 fractures. Over one third of victims of a Jefferson fracture also have a related c-2 atlas fracture.

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c-1 fx

Plain radiographs, CT, and MRI are all used in the diagnosis of Jefferson fractures. They can affect anyone of any age but are rare in children. Neck pain is the number one complaint of patients. The extent of fracture damage determines the course of treatment. Treatment can range from wearing a soft or hard collar to surgery depending on the extent of impairment of the patient.

CT image Jefferson Fracture

Carotid body tumors

Carotid body tumors are very uncommon. The tumor usually appears just lateral to top of hyoid bone at the upper part of the neck where the common carotids branch into the internal and external carotids. Carotid body tumors are also called chemodectomas or paragagliomas. They are slow growing tumor which is usually benign.

Carotid body tumors usually present with hoarseness and difficulty swallowing, but are mostly painless. They usually affect women over the age of 50. There are numerous modalities to detect carotid body tumors: CTA, MRA, US, and carotid angiography. The size of the tumor determines the course of treatment. Embolization is preformed on tumors greater than 4 cm with radiation and chemotherapy.

Salivary Gland Calculus/Obstruction

Salivary glands produce saliva when we eat to help aid in chewing and digestion. Chemicals contained in saliva can crystallize to form a calculi or stone and block the ducts of the salivary glands. When a duct is clogged by calculi, this inhibits saliva from being able to exit the duct therefore causing pain and inflammation of the gland. The most common salivary glands to be affected by calculus are the submandibular glands, although any salivary gland can develop stones.

sublingual salivary gland

1 out of every 30,000 persons can be affected by salivary gland calculi. To determine if there is a stone or where it is located there are different modalities to choose from: CT, MRI, NM, and US.

stone

Usually the stone is crushed or removed via endoscopic procedure depending on the size and shape of calculi.

Salivary Gland Stone

VEIN OF GALEN MALFORMATION

Vein of Galen malformation is a rare arterial venous malformation that develops between six and eleven weeks in utero. This causes an abnormal communication between the arteries and veins. Vein of Galen malformation typically occurs in new born babies with severe congestive heart failure, hydrocephalus, loud intracranial bruit, and seizure. An older child with a vein of Galen malformation will usually have an abnormally large head, developmental delays, learning disabilities, and strokes.

CT, MRI, and Angiography are all tools used to diagnosis vein of Galen Malformation. To repair this vessel, an embolization is preformed instead of traditional surgery. If this vessel is not repaired, it can lead to brain damage, stroke, or death.

Angiofibroma

Angiofibromas are benign tumors of the fibrous connective tissue within the nasopharynx. They are invasive and aggressive. Angiofibromas are genetic and primary affect adolescent males. Angiofibromas are known to cause tubercous sclerosis, which is caused by an abundance of endothelium in the lined vascular spaces. Angiofibromas can cause nasal obstruction, abnormal speech, and difficulty swallowing.If left untreated, it can develop into ear canal obstruction. Angiofibormas are visualized with either CT or MRI. There are used to determine the size of the tumor and if there is any encroachment into other structures.
Angiofibroma - Angiofibromas are treated with surgery. Embolization of the tumor is preformed before the tumor is excised. If the tumor is not able to be removed, radiation may be utilized in an attempt to shrink the tumor’s size.

Orbital Cellulitis

Orbital Cellulitis

Orbital cellulitis is an acute infection of the eye caused by a bacteria or fungus. It is sometimes a byproduct of injury, a sty, ethmoid sinusitis, or an insect bite. Orbital cellulitis usually affects only one eye. It can affect the globe of the eye, the upper cheek, the eyebrow, or even the eyelid. Most patients present with swelling or redness around the eye, high fever, and/or painful eye movement.

Time is very critical in the treatment of orbital cellulitis. If left untreated, it can lead to blindness, brain abscesses, or meningitis. When a patient presents with eye swelling, and fever, usually a CBC and blood cultures are drawn. A sinus x-ray and a contrasted CT are preformed in order to assist in the diagnosis.

Axial contrast-enhanced CT image of the orbit shows soft tissue thickening of the right preseptal region (between arrows). The retroorbital fat is normal (arrowheads).

The severity of the infection determines the treatment course. Generally, the patient is admitted to the hospital to receive IV antibiotics. If the IV antibiotics prove to be ineffective, sometimes it is necessary to go in and surgically decompress the infection.

Prolactioma

Prolactinomas are benign tumors of the pituitary gland. They are the most common type of pituitary gland tumors. Prolactinomas can cause an increase or decrease the amount of the hormone prolactin. Changes in prolactin levels affect women and men differently. Prolactinomas are more common in women than in men and rarely affect children. Women may experience milk production (galacotorrhea), missed menses (amenorrhea) or irregular menses, and reduced sex drive (libido). Men may develop enlarged breasts (gynecomastia), low libido, vision loss, and headaches.

Blood tests are preformed to check for high levels of prolactin. MRI is the best imaging modality to determine if a tumor is a prolactinoma. Prolactinomas are usually too small to be visualized on CT.

Prolactinoma.		Prolactinomas

Prolactinomas are usually treated with medications that mimic Dopamine. Dostinex is on drug that is used in treatment of prolactinomas because of its dopamine like effect on the pituitary. Dopamine controls the amount of prolactin the pituitary gland produces. Medications usually control symptoms and patients are able to live a normal life. If the tumor has not shrunk or symptoms are not controlled by medication within six months of starting them, surgery or stereostatic radiation is recommended.

Glomus Tympanicum Tumors

Glomus tympanicum tumors are benign neoplasms that involve the tympanic membrane. The glomus tumors affect the glomobody of the middle ear. The glomobodies are tiny structures that regulate oxygen pressure in the ear and the mastoids.

Glomus tympanicum tumors usually affect one ear. They present with hearing loss and tinnitus. They can also cause headaches, bloody ear discharge, and palpations. Glomus tumors cause severe pain on the affected ear when they come in contact with cold air or water. The tumors have either a reddish or bluish discoloration behind the tympanic membrane when the ear canal is visualized.

Normal Ear Drum	Glomus Tympanicum

Females are almost three times more likely to have glomus tympanicum tumors than males. Adults between the ages of 40-60 are most likely to develop glomus tympanicum tumors.

Visualization of the tympanic membrane is performed using an otoscope. Hearing tests are also utilized to determine the amount of hearing loss. CT scans are done to determine the size of the tumor. Glomus tympanicum tumors appear as thickness on CT images.

Glomus jugulare tumor.
CT scan demonstrates a permeative destructive skull-base mass with involvement of the mastoid air cells

The best treatment is surgery. If the tumor is small, it is removed via a small incision in the ear canal. If the tumor is large, it is removed via an incision behind the ear. If the tumor is excessively large, the tumor may be subjected to radiation.

Glioblastomas Multiforme

Glioblastomas are the most common and aggressive forms of brain tumors. Nearly 23% of all brain tumors are glioblastomas. They affect the glial cells which surround and support the main component of the brain: nerve cells. There are two categories of glioblastomas: giant cell and gliosacroma. Glioblastomas spread easily to other surrounding brain tissues.

Glioblastomas often present with seizures, nausea, vomiting, headaches, and hemi paresis. With progression of the size of the brain tumor, it can cause memory loss, personality deficits, and neurological deficits. Glioblastomas can be detected with either CT or MRI. A sterotatic biopsy is the preferred procedure to confirm the tumor type.

Axial CT head

T-2 weighted MRI Sagittal

Glioblastomas are treated with anticonvulsants to prevent or reduce seizures. Corticosteroids may be administered to help with brain edema and inflammation. Chemotherapy and radiation can be used to shrink the tumor. Surgery is the best treatment to remove the tumors. Recurrence of glioblastomas is very high even when the entire tumor is removed. Mortality is very common, especially when the entire tumor can not be removed.

Glioblastoma is the type of brain tumor that killed Senator Ted Kennedy.

Let me Introduce Myself

Hello! My name is Joanna Howard. I have been an X-ray tech for 13 years and a CT tech for 12 years. I have wanted to get my Bachelors degree for almost 10 years. I am a mother of two girls; 8 and 2.