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 Hello Glias ! Acute lower abdominal pain in a reproductive-age woman often triggers suspicion of appendicitis. But sometimes, the real pathology lies within the ovaries — and can closely  mimic gastrointestinal emergencies . Here’s a recent case that emphasizes the importance of radiologic precision and multimodality imaging in diagnosing  ruptured endometriotic cysts . A woman presented with: Severe  lower abdominal tenderness Pain radiating to the  right lower rib Guarding and rebound suggesting  acute abdomen Her ultrasound was challenging: Appendix not visualized Pelvic free fluid  detected No tubo-ovarian abscess (TOA)  appearance Previous history of  hemorrhagic cyst  under resolution Differentials included: ✅ Ruptured hemorrhagic ovarian cyst ✅ Peritonitis from ruptured appendicitis Given diagnostic uncertainty →  Cross-sectional imaging warranted. CT & MRI — Key Turning Point in Diagnosis CT demonstrated: Marked omental...

 Hello Glias ! Venous tumor thrombus arising from thyroid cancer is an  extremely uncommon  and often overlooked presentation. Most thyroid carcinomas spread via  lymphatic pathways , leading to cervical nodal metastases at diagnosis. Direct venous invasion, particularly of the  internal jugular vein (IJV) , is a sign of  aggressive disease  and traditionally associated with  poor prognosis . Yet, not every case follows the rulebook. Recently in clinical practice, I encountered a  unique case : A thyroid mass infiltrating the IJV with an  intraluminal enhancing tumor thrombus , but  no lymph node metastasis  on imaging. This prompted a deeper look into the rare pattern of venous invasion in thyroid cancers. Why This Finding Matters Venous invasion: Signals  advanced loco-regional disease , classified under  T4  in TNM staging  Increases risk of  embolization  to lung or even heart Alters operative ...

   Hello Glias !! Vicarious excretion refers to the elimination of contrast media through an alternate organ when the primary pathway (usually kidneys) is impaired or overloaded. When the gallbladder shows opacification after intravenous iodinated contrast, it indicates that the  liver and biliary system  are partially taking over the role of excreting contrast. Why does it happen? Typically seen when: •  Renal function is compromised  (AKI, CKD) •  High contrast load  is administered •  Delayed imaging  after contrast injection •  Hypotension or hemodynamic instability  reduces renal clearance The contrast is taken up by hepatocytes and excreted into bile, causing visible density in: • Intrahepatic bile ducts • Common bile duct • Gallbladder lumen CT Findings • Hyperdense bile within gallbladder on delayed or follow-up scans • Densities can mimic stones or sludge • No associated wall thickening or obstruction typically Clinica...

Hello Glias ! Detection of calcified encrustations within the renal pelvis on CT is more than just spotting stones. It often reflects an underlying infectious or metabolic problem that demands timely diagnosis and multidisciplinary care. Recognizing imaging clues and knowing the clinical contexts can guide correct management. What is Renal encrustation? Encrustation refers to calcific deposits lining the renal pelvis, calyces, or urinary tract mucosa. These occur when urine becomes supersaturated with minerals or when urease-producing organisms change the urinary environment to favor crystal deposition. Common Causes of Renal Pelvic Encrustation 1.  Infection-related encrustations • Often caused by urease-producing bacteria such as  Corynebacterium urealyticum ,  Proteus ,  Klebsiella • Leads to struvite (magnesium ammonium phosphate) deposition • Seen in  encrusted pyelitis or cystitis • Typically in patients with: Chronic catheterization Immunosuppression Prio...

Hello Glias !  The anterior mediastinum is home to some of the most commonly encountered masses on chest imaging. Thymic cysts are benign, fluid-filled lesions but can easily be mistaken for neoplastic processes like thymoma, germ cell tumors, or lymphoma. Accurate differentiation avoids unnecessary surgeries and anxiety. What Are Thymic Cysts • Benign lesions arising in the thymus or thymopharyngeal tract • Uni- or multilocular • Can be congenital or acquired (infection, radiation, autoimmune disease) They frequently appear during an evaluation for unrelated symptoms or cancer staging. CT Clues On CT, a thymic cyst typically shows  fluid attenuation , meaning it appears near water density. Some cysts may look slightly denser if they contain protein or blood products, but they still lack soft tissue nodularity. A true cyst shows  no internal enhancement . At most, you may see a very thin enhancing rim corresponding to the capsule. If any mural nodularity or solid enhancin...

Pericardial recesses are small “nooks” of normal pericardial fluid that become visible on modern thin-slice MDCT. They are completely normal, yet they frequently imitate mediastinal lymph nodes or cystic lesions. Mislabeling them can create unnecessary concern and even affect oncologic staging. Every radiology resident should feel comfortable identifying these fluid spaces confidently. Why These Recesses Fool Us • They lie close to major vascular and mediastinal structures • They can appear as discrete pockets of fluid • They may be imaged in only one or two slices if thicker cuts are used Given the stakes in oncology imaging, distinguishing recesses from disease matters. The Major Recesses to Know Understanding the organization of the pericardial space is the first step. Two serosal reflections create several recognizable compartments. Transverse sinus Located between the aorta, pulmonary artery, and left atrium. Contains: • Superior aortic recess • Inferior aortic recess • Right and ...