Hangman's Fracture

A hangman's fracture is unique in that it can only occur in one place in our bodies, the axis or C-2 vertebrae. A hangman's fracture occurs when the arch of C-2, most commonly involving both pedicles or pars interarticularis. This is most commonly the result after execution by hanging or anytime the neck is severely hyperextended such as in a car accident. Oddly enough, when a person uses hanging as a means of suicide, the victim most often dies from lack of oxygen, not a hangman's fracture because there is not enough force exerted on the neck. Sublaxation of C-2 on C-3 commonly occurs along with a Hangman's Fracture.

The most frequent sign of a Hangman's fracture is some type of motor function most often due to a compressed cervical nerve or more seriously, compression of the spinal cord. Unfortunately, if the spinal cord is cut, the patient will most likely not survive.

The most common treatment for a hangman's fracture is some type of immobilization. Whether with a stiff C-Collar in the case of stable fractures or with a halo in the case of unstable fractures.

Surgical repair is also sometimes necessary to relieve pressure from the spinal cord and ensure proper alignment. Whether the patient has a stable or unstable fracture, many weeks of bed rest are in their future. The patient recovering from a Hangman's Fracture should consider themselves very lucky to be alive.

I found my picture at imaging.consult.com and my information about Hangman's Fractures on wikipedia.org and in the book Radiographic Pathology for Technologists by Mace and Kowalczyk.

Goiter

For pathology of the neck I decided to research goiters. I have never actually seen one while working in CT but thought it might be interesting to find out more about them. While doing my research, I had a hard time finding any radiologic images but did actually find a LOT of regular pictures of people with goiters. I never realized how big they could get!!

The CT image above shows a large goiter that is actually compressing this patient's trachea and making breathing very difficult.

The two most common causes of a goiter are a lack of iodine in the diet or more frequently for people here in the United States, an overproduction of thyroid stimulating hormone or TSH.

Goiters can cause several types of complications including compression or the esophagus and trachea which could mean difficulty swallowing or breathing. Other problems can include a cough that won't go away or changes in the pitch of a person's voice.

Treatments for goiter can be as simple as medication to control TSH production or even surgery to remove the goiter. The problem with using medication as a treatment is that it usually will not shrink the goiter, but instead prevent it from growing any larger. In this case, surgery would be the treatment option of choice.

I found the information for this blog on endocrineweb.com.

AVM

For this week's pathology blog I decided to talk about arteriovenous malformations or AVM. In the image seen, this patient's AVM, which was not previously known about, ruptured, causing an acute bleed and was subsequently treated with surgery. During this surgery, the patient's AVM was discovered and also surgcially treated.

An AVM is a defect where the arteries and veins of the brain are not connected properly. The arteries and veins pretty much become a big jumble of vessels and of course can't function properly. This causes increased blood flow and subsequently higher blood pressure in the area of the AVM. Unlike an aneurysm, there are no set "risk factors" for an AVM. They are considered to be congenital as most people who suffer from an AVM are born with them.

The most common symptom of an AVM is an acute brain bleed. Other symptoms may include seizures, loss of motor functions, loss of senses, mass effect seen on a CT scan, severe head or facial pain. These types of symptoms are often confused with those of a stroke therefore proper screening is very important!!

Treatment for AVM's vary and depend greatly upon several factors including the age of the patient, the location of the AVM, the size of the AVM, and whether or not the patient is at risk for an acute bleed. Treatments may include surgery, radiation, embolization, or a combination of these.

I found my information at www.brain-aneurysm.com

Facial Bone Fractures

Fractures of the bones of the face are most often the result of some type of trauma including motor vehicle accidents, falls, or altercations. The images to the right show fractures of the right maxilla, zygoma and orbital rim.

Most facial fractures are easily diagnosed but some symptoms may include pain, swelling, bruising, facial deformity, facial tenderness or bleeding from the nose. Fractures of the nasal bones, the zygoma, and the mandible are the most common, but others can occur depending upon the location of the blow to the face. In fact, if a person is hit hard enough in the nose, it can cause fractures of the ethmoid bone!

The most common imaging method for the diagnosis of facial fractures is a non contrast CT exam. Both bone and soft tissue algorithms are used in order to determine the extent of the damage.

There are many different treatment options for those who have facial fractures. Fractures of the nose can sometimes be left to heal on their own, depending upon the severity of the damage and whether or not the fractures interferes with breathing. Surgery for the treatment of orbital rim fractures is often only necessary if the patient experiences persistent double vision or if the patient's eye begins to recede into the eye socket. Fractures of the maxillae, mandible, and zygoma almost always require surgery.

I found the information for this blog at emedicinehealth.com.

Blowout Fracture

This week, I decided to find out some more information on blowout fractures of the orbit. A blowout fracture often results when there is some type of trauma to the medial wall or floor of the orbit. This often causes an increase in intraorbital pressure. Blowout fractures most often occur as a result of a motor vehicle accident or an altercation.

Most of the time when a person experiences a blowout fracture of the medial wall of the orbit, they will have some other type of facial fracture, either of the nose or cheekbone. A "pure" orbital blowout fracture is most often a fracture of only the floor of the orbit.

While the fracture itself is a problem, the most worrisome complications of a blowout fracture occur when the soft tissues of the eye herniate down into the maxillary sinuses or when air becomes trapped in the orbit leading to an increase in intraorbital pressure. This increase in pressure can cause the inferior rectus muscle to become compressed reducing motion of the eye. The person may also suffer from a "black eye", double vision, enophthalmos (a condition where the eyeball is drawn back into the orbital cavity), and nosebleeds along with many other complications.

The modality of choice for imaging an orbital blowout fracture is CT. Both bone and soft tissue windows should be used to see the fracture itself and to see the resulting soft tissue complications. The most common treatment of a blowout fracture is surgical repair.

I found the information for this posting on e-radiography.net, wikipedia.com, emedicine.com, and from our lecture notes.

Prolactinoma

A prolactinoma is a disorder of the endocrine system and is the result of the pituitary gland producing too much of the hormone prolactin. This can cause a decrease in a woman's estrogen levels and a man's testosterone levels which often causes infertility. While prolactinomas are benign tumors, they, like many pathologies of the pituitary gland, they can lead to visual disturbances due to compression of the surrounding tissues.

Overproduction of prolactin can be contributed to many different factors:

-The use of medication to treat hypertension, nausea, and GERD.

-Under active thyroid

-Other tumors of the pituitary

-Breast feeding

An interesting fact about prolactinomas is that women are much more likely to develop them than men and they most often occur in people under 40.

Blood tests and vision tests can help detect prolactinomas but CT and MRI allow us to actually visualize the size, shape, and location of the tumor. MRI is usually the preferred method of diagnosis over a CT scan.

Most prolactinomas can be treated with medication but in some cases, surgery to remove the tumor may be necessary. If left untreated a prolactinoma can lead to vision loss, hypopituitarism, osteoporosis, and complications with pregnancies.

For this blog I obtained all of my information from mayoclinic.com.

Mastoiditis

This week for my pathology blog I decided to write about mastoiditis. Mastoiditis occurs when the epithelial tissues that lines the tiny air cavities of the temporal bones become inflamed.

Mastoiditis is most often caused by an ear infection when a person's eustachian tubes become blocked causing a buildup of bacteria and other fluids to back up into the mastoids.

Some symptoms of mastoiditis can include inflammation, tenderness, and swelling behind the ear in the regions of the mastoids. Fever and headache along with these other symptoms may also be a sign of mastoiditis. Diarrhea, irritability and pulling the the ears in infants may also be early signs of an acute mastoiditis infection. Fluid draining from the ear may also be a sign of serious mastoiditis infection. Cholesteotomas, another pathology we discussed this week can also cause mastoiditis.

In order to diagnose mastoiditis an MRI or CT of the IAC's are the exams of choice. X-rays may also be performed but give physicians far less information on the extent of the infection. MRI and CT which confirm mastoiditis will often show bone destruction or fluid buildup in the mastoids.

Mastoiditis was once the leading cause of mortality in young children. But with the advent of antibiotics, mastoiditis is pretty rare. Nowadays, antibiotics are usually prescribed at the first sign of an ear infection preventing it from spreading to the mastoids. Though if left untreated or not diagnosed soon enough, mastoiditis can lead to destruction of the mastoids and temporal bones. In the case of destruction of the mastoids as shown in the picture above, the infection is free to spread to the brain possibly leading to a brain abscess.

I found my information about mastoiditis on two different websites; wikipedia.com and emedicine.com.