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Sllavko K. Kallfa





Prmbledhje Artikujsh nga
Radiopaedia.org
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insects and bugs
reptiles
mythical creatures
X-ray signs


insects and bugs
butterfly fracture.....................f.34
butterfly glioma.........................f.3
reptiles
cobra head sign.........................f.11
mythical creatures
cyclops lesion.............................f.21
medusa head..............................f.28

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Butterfly glioma
Dr Frank Gaillard et al.
A butterfly glioma refers to a high grade astrocytoma, usually a GBM (WHO grade IV), which
crosses the midline via the corpus callosum. Other white matter commissures are also
occasionally involved. The term butterfly refers to the symmetric wing like extensions across the
midline.
Most frequently butterfly gliomas occur in the frontal lobes, crossing via the genu of the corpus
callosum, however posterior butterflies are also encountered.
Like all high grade gliomas the prognosis is dismal, and usually no attempt at 'curative' resection
is made.
Differential diagnosis
primary CNS lymphoma - especially in AIDS patients
cerebral toxoplasmosis - especially in AIDS patients
tumefactive demyelination
cerebral metastases (rare)
occasionally a leptomeningeal process which fills the quadrigeminal and ambient cisterns
can cause confusion

References
1. Lee HJ, Williams R, Kalnin A et-al. Toxoplasmosis of the corpus callosum: another
butterfly. AJR Am J Roentgenol. 1996;166 (6): 1280-1. AJR Am J Roentgenol (citation)
- Pubmed citation
2. Rees JH, Smirniotopoulos JG, Jones RV et-al. Glioblastoma multiforme: radiologic-
pathologic correlation. Radiographics. 1996;16 (6): 1413-38. Radiographics (abstract) -
Pubmed citation
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Synonyms & Alternative Spellings
Synonyms or Alternative Spelling
Include in
Listings?
Butterfly gliomas
GBM butterfly
glioma Yep, this is what a butterfly looks like. Wikipedia source image here Photograph by
Dirk van der Made - for more photos see here.

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From the case:
Butterfly glioma
Modality: MRI
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From the case:
Butterfly glioma
Modality: MRI
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From the case: Butterfly glioblastoma (gross pathology)
Modality: Gross pathology
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Butterfly glioma
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From the
case: Butterfly glioma
Modality: MRI
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From the case:
Butterfly glioma
Modality: MRI



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Cobra head sign
Dr Ian Bickle and Radswiki et al.
The cobra head sign (or spring onion sign) refers to dilatation of the distal ureter, surrounded
by a thin lucent line, which is seen in patients with an adult-type ureterocoele. The presence of
this cobra head appearance is an indicator of uncomplicated ureterocele.
The lucent hood represents the combined thickness of the ureteral wall and prolapsed bladder
mucosa, outlined by contrast material within the bladder lumen.
This lucent line should be thin and well defined. Any thickening, irregularity, or loss of
definition of the cobras hood should raise concern for the presence of a pseudoureterocoele.

References
1. Dyer RB, Chen MY, Zagoria RJ. Classic signs in uroradiology. Radiographics.
2004;24 Suppl 1 : S247-80. doi:10.1148/rg.24si045509 - Pubmed citation
2. Chavhan GB. The cobra head sign. Radiology. 2002;225 (3): 781-2. Radiology (full
text) - doi:10.1148/radiol.2253011206 - Pubmed citation
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Adder head sign
Cobra-head sign
Adder's head sign
Spring onion sign
Cobra's head sign

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From the case: Ureterocoele
Modality: X-ray
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From the case: Ureterocoele
Modality: X-ray
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Ureterocele
From the case: Ureterocele
Modality: Fluoroscopy
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Ureterocele Post
intravenous diureteric 30 mins film shows complete wash out of contrastFrom the case: Ureterocele
Modality: Fluoroscopy
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From the
case: Ureterocoele
Modality: Fluoroscopy
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From the case:
Ureterocoele
Modality: Fluoroscopy



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Cyclops lesion
Dr Frank Gaillard et al.
A cyclops lesion, (also known as localised anterior arthrofibrosis) , is usually found as a
complication of ACL repairs.
Epidemiology
Cyclops lesions occur with an estimated frequency of 1 - 9.8% of patients following anterior
cruciate ligament reconstruction. They are rarely encountered in patients who have not had ACL
reconstruction, but have nonetheless sustained ACL injuries
3
.
Clinical presentation
When symptomatic the knee has difficulty fulling extending and is painful when attempts are
made, with an eventual audible and palpable clunk. It typically presents 8 to 32 weeks (16
weeks on average) after ACL repair
3
.
Pathophysiology
The exact aetiology is uncertain, and may be related to gradual fraying and bunching up of ACL
or graft fibres, excessive fibrosis, or alternatively due to uplifting of fibrocartilaginous tissue
during drilling of the tibia for anterior cruciate ligament reconstruction serves as a nidus for
fibrous tissue deposition.
The end result, regardless of cause, is a rounded fibrous ball sitting in the intercondylar
notch. Pathologically, the lesion consists of central granulation tissue surrounded by dense
fibrous tissue.
Radiographic features
MRI
As with other internal derangements of the knee, MRI is the modality of choice for assessing the
post operative knee.
At MR imaging, a soft-tissue mass is seen anteriorly or anterolaterally in the intercondylar notch
near the tibial insertion of the reconstructed anterior cruciate ligament.
Because of its fibrous content, a cyclops lesion typically has intermediate to low signal intensity
with all pulse sequences.
Treatment and prognosis
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Treatment is arthroscopic excision.
Etymology
The lesion was so named because of its bulbous appearance and characteristic focal areas of
reddish-blue discoloration (from venous channels) that resemble an eye at arthroscopy.

References
1. Mccauley TR. MR imaging evaluation of the postoperative knee. Radiology. 2005;234
(1): 53-61. doi:10.1148/radiol.2341031302 - Pubmed citation
2. Sheldon PJ, Forrester DM, Learch TJ. Imaging of intraarticular masses. Radiographics.
25 (1): 105-19. doi:10.1148/rg.251045050 - Pubmed citation
3. Runyan BR, Bancroft LW, Peterson JJ et-al. Cyclops lesions that occur in the absence
of prior anterior ligament reconstruction. Radiographics. 27 (6): e26. doi:10.1148/rg.e26 -
Pubmed citation
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Localised anterior arthrofibrosis

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cyclops lesion Original wikipedia file here
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From the case: Cyclops
lesion
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cyclops lesion
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From the case: Cyclops lesion
Modality: MRI
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From the case: Cyclops lesion
Modality: MRI


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Caput medusae sign - developmental venous
anomalies
Dr Jeremy Jones and Dr Frank Gaillard et al.
The caput medusae sign, refers to developmental venous anomalies of the brain, where a
number of veins drain centrally towards a single drain vein. The appearance is reminiscent of
Medusa, a gorgon of Greek mythology, who was encountered and defeated by Perseus.
The sign is seen on both CT and MRI when contrast is administered. Angiographically the caput
medusa appearance is seen only in the venous phase.
The caput medusae sign, also known as a palm tree sign , I suppose if there are
associated cavernous haemangiomas (making it a mixed vascular malformation) then these could
represent dates?
See also
Caput medusae sign - portal hypertension

References
1. Boukobza M, Enjolras O, Guichard JP et-al. Cerebral developmental venous anomalies
associated with head and neck venous malformations. AJNR Am J Neuroradiol. 1996;17
(5): 987-94. AJNR Am J Neuroradiol (abstract) [pubmed citation]
2. Saba PR. The caput medusae sign. Radiology. 1998;207 (3): 599-600. Radiology
(citation) [pubmed citation]
3. Caput medusae from Wikipedia, the free encyclopedia. Caput medusae
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Medusa_head_sign
Medusa head
Medusa head sign
Caput medusa
Caput medusae
Caput medusa sign
Palm tree sign of developmental venous anomalies

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Medusa By Carvaggio Author:
Michelangelo Merisi da Caravaggio or Caravaggio (1573(1573)1610(1610))Original file:
http://commons.wikimedia.org/wiki/File:Medusa_by_Carvaggio.jpgModifications: background and
dropshadowLicense: This image (or other media file) is in the public domain because its copyright has
expired.This applies to the United States, Australia, the European Union and those countries with a
copyright term of life of the author plus 70 years.
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From the case: Developmental venous anomaly
Modality: MRI
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From the
case: Venous angioma
Modality: CT
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From the case:
Venous angioma
Modality: CT

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Butterfly Fracture
Butterfly Fracture
A fracture in which the centre fragment is triangular shaped.
Butterfly Fracture
No particular mechanism is associated with butterfly fractures

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In In this
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example, there is a comminuted fracture of the mid and distal diaphysis of the tibia with a butterfly
fragment (A).this example, there is a comminuted fracture of the mid and distal diaphysis of the tibia
with a butterfly fragment (A).
A comminuted fracture has multiple fracture lines that communicate to a single point or plane. The
large fragments are generally referred to as "butterfly" fragments. In this example, there is a
comminuted fracture of the mid and distal diaphysis of the tibia with a butterfly fragment (A).