CASE BASED RADIO-GRAPHIC DISCUSSIONS

hi everyone this is Dr Sati team MDS conquer so now I'm going to discuss the case based radiographic diagnosis so here with I've presented little clinical scenario of the cases so wherein the patient will give you the chief complaint there are some symptoms and also a clinical presentation will be there along with it there is a radiograph okay so based on the clinical presentation and based on the findings that we get in a radiograph that is given for that particular case we have to arrive at that diagnosis okay so that is nothing but the case based radiographic discussion so which we are going to do now so coming to the first one so here a patient has presented to a clinic and on routine radiographic examination the patient had mixed ropic radiolucent lesion which was involving more than one quadrant okay and the very important point to be noted is the teeth were vital so there was no problem with the teeth the associated teeth were vital so what is your diagnosis so now let's look at the radiograph so if you see here the teeth are vital and you can see some lesions which are present involving the quadrants so there's no clinical symptom which is being given by the patient this was seen as a radiographic finding only because the teeth are vital and there are no symptoms related to the teeth or any problem with the teeth then you have to go for a cement oous displasia so this cement oous displasia either it occur can occur as periapically so if it is present only with one single tooth it is called as periapical C OES displasia and if you can see it in one or more areas then you can go for focal cement OES displasia and if it is involving more than one or two quadrants then you have to go for fluid cement oous displasia so here you can see more L of lesion so you can go for flid cement oous displasia and it can occur at three stages so first one it will be simple radiolucency next is a mixed radioopaque radiolucent lesion and at times it can be completely radioopaque also okay so this is regarding the cement toes displasia so since it's just a radiographic finding and the teeth are vital you can go for cement oous displasia okay now coming to the next case so here there's an young adult patient who has developed swelling and he has also noticed a symmetry in his mailla 4 years back okay so underline there is a symmetry of the phase and it is since 4 years so he has noticed that since 4 years okay so it's been a long time and it is young adult patient even that you have to underline next the swelling was very firm in consistency and it is painless so it is actually painless and it was firm in consistency now let's see the radaph so a radaph was taken so it's a Advanced Imaging technique the CT was taken and if you see there is a radio opes lesion with expansion of the maxilla right so there is involvement of the sinus and also there is expansion which goes in favor of a fibro oous leion which is nothing but fibrous displasia Okay so so here if you see there is expansion and based on the symptoms that is given by the patient that it is a symmetry was observed and it is not much painful it is painless and it was very firm inconsistency and on a radiographic examination you can also see that it's clearly evident when you compare with the other side it's clearly evident that it is involving the sinus as well and there is an expansion then you have to go for a fibrosus legion which is nothing but the fibrous dysplasia okay so this is our second case now coming to the third one so here a patient has developed a swelling from the past 3 months so there's only swelling since past 3 months and he had pain in the associated teeth for which he had to undergo extractions of the offending teeth so very important Point already given in the question that is onion peel or onion skin appearance so quite simple diagnosis I think it is already roaming in your mind so here it is orogenic origin because the teeth were painful and he had to undergo extraction and there was a swelling which the patient has observed the radiographic examination has shown the onion peel appearance so this is an axile section which has shown the onion peel appearance clearly right so that goes in favor of Osteo myus the GES or the proliferative Osteo myus gives this peculiar onion skin or onion peel appearance okay so B besides the Osteo myus the proliferative osto myus there's one more condition or one more disease which also shows this onion skin appearance which is nothing but eving saroma okay even in eving saroma you can find out this onion peel or onion skin appearance but it commonly eving saroma occurs in children and very young gettles and the patient will most probably complain a pain in the bone okay bone pain will be there and obviously it will not have such similar symptoms right so orogenic symptoms will not be there right so you have to go for eving saroma if the case is given otherwise like if it is a young patient or a child is given and pain in the bone then you have to go for eving saroma because it's not orogenic right so both these cases have the similar aerographic presentation of having onion skin and Oran peel appearance but the clinical findings will be different So based on that you have to arrive at the diagnosis okay next coming to the other case so here the patient has discolored teeth and you can see on examinations there's some translucent Hue that can be seen on examination so the radiographic findings are as follows so coming to the diagnosis so underlining point is a translucent Hue okay so if you see now there's a translucent Hue and the radio graph if you see there are no pulp Chambers the pulp Chambers are obliterated if you can zoom and see you can see that the pulp Chambers are completely obliterated so that's nothing but the shell teeth right so shell teeth and having such translucent Hue it's nothing but very simple I think you must have already come to the answer it is dentinogenesis imperfect right so this is how the questions can be as they can post a clinical picture they can give you the symptoms and they'll post a radiographic picture as well and they'll ask you to come for the diagnosis so it's quite simple the only thing I want to suggest is read word by word Line to Line underline the points and give complete look to the diagram observe the diagram completely okay where exactly the abnormality is and what are the findings that you can get out of the diagram that is given based on that you have to come to your diagnosis don't be in a hurry to come to your diagnosis first note one by one and then give your diagnosis okay now coming to the other case here a patient has developed a swelling in the jaw 6 months back that has gradually increased to the present size and the radiographically there was expansion of the cortical plate with a multilocular lesion very important point to be underlined and there is a swelling okay and there's a expansion of the cortical plate now let's see the radaph very pretty clear the radiograph shows a expansion of the cortical plate multilocular Hazard lesion and also there is resorption of the roots of the associated teeth right so this is nothing but a benign tumor which is showing this presentation which is orogenic origin which is nothing but the emo blastoma Soo blastoma has this cortical expansion the xshell cracking effect right and also knife as resorption of the roots will be there and a multilocular lesion so all these goes in favor of the emo blastoma okay so it's pretty clear if you see the diagram If You observe if you know all the findings of radiographic findings of emo blastoma then you can easily arrive at the diagnosis so number one is first the location right if you see it is posterior mandible number one number two s is the periphery and shape if you see the periphery and shape it is il defined there's expansion of the cortical plate and it's completely involving the it is like shape is also completely IL defined and it's completely involving the entire posterior mandible right so that is a second thing third thing internal structure internal structure if you see it is multilocular right fourth thing effect on the surrounding structures if you see the fourth Point effect on the surrounding structures there is a knife edge resorption of the associated teeth so four steps fifth step formulat your diagnosis go for emo blastoma clear I hope it is clear okay now coming to the next case here a patient has developed a severe bone pain in his limbs okay so there is a bone pain so patient himself complains that the pain is within his bone and he has also observed a mild swelling now the radiograph has shown as given in the picture so your diagnosis so this is an important point to be underlined so let's see the radiograph now now if you see the radio graph there is a elevation of the per periosteum which is giving this triangle appearance which is nothing but the cadman's triangle right if such presentation of a limb of a long bone is given with a elevated periosteum giving this quadman triangle appearance blindly go for osteosarcoma osteosarcoma has the cman triangle appearance of the long bones so directly you can go for Osteo saroma okay coming to the next case so here a patient has presented with pain and swelling which was felt over the salivary gland area so whenever a salivary gland is involved if you think that the patient is having a problem with the salivary gland then always better to do a contrast Imaging so obviously first we'll go for an ultrasound but if we can't find anything out of it always is better to go for a contrast Imaging okay so radiographic presentation is as follows if you see the picture it gives a idea of a hot dog or a sausage string appearance so if you see there's a sausage string appearance which is seen in the radiograph right so here the patient was having a problem with or a pain and swelling related to salivary gland and the radiograph has shown sausage string appearance right so it's nothing but inflammation of the salivary gland duct okay the duct of the salivary gland has been inflamed which has given this hot dog or sausage string appearance which is also called as Silo doiis okay so this is silo doritis clear so the picture the radiographic picture is very very important for you to come or arrive at a good diagnosis okay so there will be options given like jrin syndrome or uh pintis or citis okay so xyo oitis sausage string appearance jrin syndrome cherry blossom appearance cytis leafless tree appearance benign tumor ball in hand appearance so all these appearances is quite important for you to know and if you have to also have the radiographic picture in your brain okay because you know the names of all the appearances but how they look also you need to know so that's the reason I've posted here so it is citis which is nothing but the inflammation of the salivary gland duct which gives this saus string or hot dog appearance okay now next coming to the come directly radiograph so I'll ask the question so here a patient was having a swelling and he has underwent the extraction of the impacted tooth and the radiograph has shown this okay so there is a unilocular radiolucency with a thin got like thin R Opa border around it and the associated roots of the teeth are normal there is no problem with the adjacent teeth right so it's a simple unilocular lesion which is having an anop posterior expansion so that's nothing but OKC OKC has this anop posterior expansion it will not have much of Bol lingual expansion it will have this anop posterior expansion and besides that the associated or the adjacent teeth will not go much of resorption they will be not like like you most commonly it's I'm not saying always most commonly it will not show any resorption of the teeth that is present adjacent to it okay so that goes in favor of okas so there is anop poster expansion which you can clearly see in the picture and the associated the appear to be normal there is no much resorption so that is nothing but the OKC okay OK again either it can occur as unilocular or or multilocular right but here it is a unilocular presentation okay next coming to the this case so here a patient has underwent an implant and few months after the placement of the implant he has developed sever pain and also there was a discharge of pass from his ging sulkus okay when a radiograph is taken there you can see there is a radiolucency which is surrounding that particular implant so if you see there's radi s see here so it's a simple case of a perimplantitis okay so the implantitis where the inflammation occurs around the implant it's nothing but the perimplantitis okay so it's a very simple case now next go for the other case so here if you see a patient has now again I'll ask the question so her patient has presented with a discolored tooth and uh the teeth are when the clinical picture was taken the teeth were like this so you can see here and there there will be a r opaque or more R opacity of the teeth or sorry not R OPAC opacity the the teeth were more white in color okay so the on the clinical presentation here and there the teeth were more white in color and the radio graph it is not that clearly shown here has given a snow capped appearance if I ask you I'll put the clinical presentation if the question is asked so before seeing this picture the patient has presented with discoloration of the teeth okay and there were more opaque or more white areas here and there over the teeth and the radiograph has shown snow capid teeth so what is your diagnosis so wherever you see the snow capid appearance in a OPG then you have to go for hypomaturation type of amelogenesis imp perfector okay hypoplastic type shows picket fence appearance whereas no capid teeth is presented with the hypomaturation type of hemogenesis imperfecta okay so that is regarding this case okay so we are done with almost 10 case presentations now so how the case will be asked what what is interpretation you have to get from your radiograph and what is or what could be your diagnosis okay among the four options more appropriate diagnosis you have to give okay now I'll post some questions for you so I expect you you to give your answers in the comment section below okay you can give your answers as 1 2 and three so what is your answer for number one question what is the answer for number two question and what is the answer for number three question okay after a day or two I will post the answers in the comment session okay so with this you can even get to practice of how to answer these radioraps or the case based discussions right so coming to the first question so here just radiograph okay radiograph was presented and you can see an Arrow showing a little and large surface over the root right so if You observe that what is your radiographic diagnosis and in what all conditions will you find this okay so my question is there is an abnormality here okay along the root the arrow Mark which is showing so what is your diagnosis and in what conditions do you find this radiographic finding okay so there is an abnormality there so what is that abnormality and where all can you see okay so that is your first question coming to the second question so here there are multiple Arrow marks which are being shown here right so the patient has bone pain he has severe pain in the Jaws so a radiograph is taken now if you see there are multiple lesions which are seen as round punched lesions I've already given the hint so what is your diagnosis okay so bone pain and multiple lesions which are small small like a punched out lesions which are involving the Jaws so what is your diagnosis so this is your second question so coming to the third question so here there's a child who has presented with bilateral asymmetric enlargement of the Jaws okay so there is asymmetric enlargement of the Jaws and the Jaws are so bulky as you can see there's choppy cheeks are there and the 3D three Di men image has shown multilocular lesion right so if you see a 3D image this is a three-dimensional image right so and also the teeth appear to be floating here and there right so what could be your diagnosis right so these are the three questions so that's it so I expect you to answer in the comment session below after a day or two after all of you has given your answers I'll post the correct answer answers okay so these are the three questions so if you make yourself habituate to answer such type of case based discussions it will be easy for you in the exam as well because I know you have studied a lot but practice makes you more perfect okay so that's why I expect you to answer okay don't think if you give a wrong answer what will I think okay I'm not going to judge you this is not the exam okay so give your answers whatever you feel so that it makes you perfect okay thank you