Acute traumatic abdominal aortic intramural hematoma

Post MVA.  Infra renal abdominal aortic injury classified as intramural hematoma.  Associated L4 fracture involving superior endplate and posterior elements.

CTA Atriopulmonary Fontan

Young adult male born with a single ventricle.  Underwent sucessful atriopulmonary Fontan procedure. This the original Fontan procedure which has largly been replaced by the Fontan baffle and the direct Caval conduit to the pulmonary arteries.  In this case an ASD and the tricuspid valve are surgically closed and the right auricle is used as a conduit the pulmonary artery.  Image on the bottom is an STL model suitable for 3D printing. Model was created on a Samsung Galaxy Tab S3 using DroidRender (available in Play Store)

Update 6/17

Have not posted in a while but hopefully that will change. We are going through a more formal affiliation with Promedica in Toledo.  This will lead to a deeper connection of our residency program to Toledo Hospital.  A good thing. If you are a medical student interested in our program and would like more information about this affiliation and our program please contact me at terrence.lewis@utoledo.edu.

Cardiac Sarcoid

figure: Delayed myocardial enhancement in the lateral wall of the left ventricle.

The patient has a history of sarcoid with pulmonary involvement.  MRI shows enhancement on DME short axis images in the lateral wall of the LV, at mid myocardial depth. Infarct would be more linear in a subendocardial distribution.

Posterior Cerebral Venous Circulation

Get out your 3d glasses.  This is just a quick anaglyph I extracted from an MR to demonstrate the anatomy of the posterior cerebral venous circulation and practice using Slicer, a nice open source visualization tool available at www.slicer.org. As always, select the image for a larger view.

Update: All is well at UTMC.  We are interviewing residency candidates now and they are all top notch.  The department has undergone a nice renovation.

Dural AVM

CTA: posterior fossa vascular malformation. Prominant subarchnoid venous varices near the torculum (red) and menigeal arterial branches (blue)

A dural arteriovenous malformation is an abnormal connection between a meningeal artery and a meningeal vein or dural venous sinus.


Type I dural arteriovenous malformation are suppied by meningeal arteries and drain into a meningeal vein or dural venous sinus. The flow within the draining vein or venous sinus is anterograde.


The high pressure within a Type II dural AV malformation causes blood to flow in a retrograde fashion into subarachnoid veins which normally drain into the sinus. Typically this is because the sinus has outflow obstruction. Such draining veins form venous varices or aneurysms which can bleed. Type II  malformation need to be treated to prevent hemorrhage. The treatment may involve embolization of the draining sinus as well as clipping or embolization of the draining veins.


Type III dural AV  malformation  drain directly into subarachnoid veins. These veins can form aneurysms and bleed. Type III dural malformation need to be treated to prevent hemorrhage. Treatment can be as simple as clipping the draining vein at the site of the dural sinus. If treatment involves embolization, it will only typically be effective if the glue traverses the actual fistula and enters, at least slightly, the draining vein.

Perthe's Lesion

MR Arthrogram:  Avulsed anterosuperior cartilagenous labrum with periosteal stalk still attached to glenoid

A variation of the Bankart lesion, the Perthes lesion occurs when the scapular periosteum remains intact but is stripped medially, and the anterior labrum is avulsed

from the glenoid but remains partially attached to the scapula by the intact periosteum. Sometimes the laburm settles into its normal position but is detached and unstable.  This type of Perthes lesion may be difficult to diagnose.  This example is displaced and easier to identify.