Epidural pneumorrhachis in COVID-19: a rare clinical entity

Pneumorrhachis is an extremely rare clinical entity, involving air entrapment within the spinal canal. We present a unique case of epidural pneumorrhachis accompanying pneumomediastinum and pneumopericardium, in the setting of COVID-19 infection in a 62-year-old woman. Diagnostic testing was remarkable for elevated inflammatory markers, along with mild transaminitis and hyponatremia. CT scan of the chest revealed extensive patchy ground-glass opacities, with no evidence of pulmonary embolism. Intravenous antibiotics and steroids were initiated for management of advanced multifocal bilateral COVID-19 pneumonia. Her hospital course was complicated by rapidly worsening hypoxia accompanied by worsening inflammatory markers. Repeat chest CT showed worsening multifocal opacities, extensive pneumomediastinum, pneumopericardium, and subcutaneous emphysema extending into the lower neck soft tissues, posterior mediastinum, and supraclavicular regions. Neck CT confirmed diffuse subcutaneous emphysema from the mediastinum extending into the retropharyngeal space, neck, and anterior chest wall. Right-sided epidural air in the spinal canal spanning C6-T1 was also noted. She was evaluated by neurosurgery, continued on antibiotics for the epidural air, and transferred to the ICU for frequent monitoring of respiratory and neurological status, which remained stable. Although pneumorrhachis is an extremely rare clinical manifestation, prompt recognition can lead to appropriate early interventions and improved patient outcomes

Evaluation of cardiac anatomy and normal variants on multidetector CT - a pictorial review

Cardiac E-Poster: P504LEARNING OBJECTIVES: (1) To give an overview of recent advances in multi-detector computed tomography (MDCT) that enables evaluation of cardiac anatomy. (2) To provide a spectrum of cardiac anatomy and normal variants using line diagrams and CT images. (3)Highlight the standard anatomical terminologies used when reporting cardiac CT. DESCRIPTION: A thorough knowledge of cardiac anatomy and its variations is paramount when reporting cardiac CT. Traditionally, detailed coronary anatomy was difficult to appreciate on standard CT. With availability of MDCT combined with multiplanar post-processing, volume rendering as well as specific acquisition technologies, excellent depiction of fine structural cardiac anatomy is now possible and has revolutionized cardiac imaging to an extent that it is now an essential tool in routine clinical practice. In this presentation, we will describe anatomy of normal coronary arteries, cardiac chambers, and cardiac valves with the aid of line diagrams and CT images (including MPR, MIP and 3D volume-rendered images). Normal variants including anomalous origins of coronary arteries will also be reviewed. We will examine post-processing techniques, imaging planes and common pitfalls while interpreting cardiac CT. In addition, standard terminologies used while reporting anatomy of cardiac CT will be discussed. CONCLUSION: We hope to have availed the observer with a concise pictorial review of CT cardiac anatomy enabling quick and accurate interpretation. Knowledge of cardiac anatomy is crucial for precise assessment and interpretation of cardiac CT and we believe this presentation will stimulate general radiologists and trainees to develop further interest in cardiac imaging