0:00

Next patient 16 is

0:03

looking at the time. Okay, we have some good good amount of time left 68

0:06

year old female elevated liver function tests. We love

0:09

that history right get that all the time.

0:12

So so an MRI.

0:17

Some example Doppler features identify fmd. So,

0:20

you know with the areas of renal with the areas of narrowing you're

0:23

going to see evidence of renal arteries stenosis of elevated velocities.

0:26

There may be a little bit of tardis Harvest waveforms more distally and

0:29

if you're lucky on both the color and the grace called maybe

0:32

you see that lumpy bumpy appearance typically with renal artery stenosis. So

0:35

you'll see it in approximal portion. So if you see evidence of that

0:38

but in the mid portion in a young patient and and particularly

0:41

young female patient, you may bring up

0:44

the possibility of fmd and usually that's it and they'll get a CT or

0:47

an MRI has the next Imaging step.

0:50

Okay, so let's look at some cases this case

0:53

here elevator lft 60 atrial female.

0:56

T2 weighted image

1:08

it's always a lot to look at these abdomen cases, but

1:12

We have elevated lft's history. Perhaps they can narrow.

1:16

What you want to look at look at the coronal t2s as well?

1:29

So people are starting to chime in the chat box. I'll have a look at that in a

1:32

second while I go through this case for the group.

1:35

What a group to 252 participants right

1:38

now my goodness.

1:41

253 we just got a new one. That's awesome. So let's look at

1:44

the let's get teach you fats at I suppose that's always useful

1:47

thing to look at.

1:48

Maybe that helps you.

1:51

Maybe you already know the answer.

1:54

Maybe a T1 and let's just look at one of the post

1:57

contrast sequences a lot of people in the chat box. So I got a sense people know the

2:00

answer here.

2:01

That's good.

2:03

You know my goal here is is never to stump the group. It's

2:06

just to share some interesting cases. And so what I like it when

2:09

everyone gets the right answer.

2:15

Okay, let's scroll through enough sequences for now.

2:18

and let me just

2:21

look at the chat box. Okay, here we go. Let's go. Oh my goodness.

2:24

Everyone's saying the same thing, huh?

2:26

So CBD strictures, so I think that's a

2:29

good thought because you all the doctoral dilatation and some people have said the

2:33

same thing.

2:34

over and over and over

2:38

Yeah at spelling is tough though. I gotta look up the spelling every

2:41

single time. I do it. That's hopefully this belt I

2:44

have in my PowerPoint is correct that you

2:47

guys are that that's someone someone took back their answer. Now this

2:50

referred to me. Okay, I'll buy that in the interest of time. And so

2:53

this is yeah, if anyone you know

2:56

has trained alongside me with me

2:59

will know that for some

3:02

reason I really like this because I like the name Richie. It's a

3:05

nice little name a couple of Z's in there. And so here we have a big

3:09

Stone really impacted in that gallbladder neck, but what's

3:12

amazing is that look what it's doing to it's in certain, you know, right at

3:15

that insertion of the cystic duct in the common hepatic type

3:18

is really having the Mass Effect here in almost and quite a

3:21

bit of upstream bilary reductal dilatation. And what's

3:24

interesting is well in this case I think is that you know,

3:27

if you looked at it patient happens to have colathysis more

3:30

distally so happens to actually have a CBD Stone but that

3:33

seems to be reasonably okay causing maybe

3:37

a little bit of prominence really bulk of

3:40

this is happening by this really massive stone at the gallbladder neck

3:43

causing common a paddock obstruction is

3:46

a bunch of gallstones in there as well. There's a bunch of other findings in the liver

3:49

and sweet that

3:53

and let's

3:56

see the chat box. Yep. Perfect. And so let's look at let's

3:59

learn a little bit about this. This is I anticipated

4:02

a quicker case.

4:05

And you guys nailed it?

4:08

So, you know, it's an impacted Stone either in

4:11

the cystic doctor, you know, maybe I should read write that

4:14

really the gallbladder neck area as well and causes extrinsic Mass Effect

4:17

on the common hepatic duct result in

4:20

dilatation of the intrapatic duct. So right there, is that key image in this

4:23

here as well showing the intraumatic double rotation. I wish our MRCP showed

4:26

this in one image. It doesn't quite do that which is

4:29

why I didn't show you that image, but

4:31

Turns out that your group didn't need it.

4:34

And segment 6 actually that was a Hemangioma. And

4:37

so this right over here incidentally and the

4:40

reason you know, if you look at the t2 signals not quite as

4:43

bright as CSF, but it's relatively benign T2 signal

4:46

and as I go

4:49

Back here. I can just show you and to be fair. I didn't

4:52

really show you a lot of the post contrast sequences. You can see it's sort of has that peripheral

4:55

discontinuous nodule or enhancement fills in

4:58

so that's going to be a Hemangioma there.