Hello Dr Chail, Please Look At Ct Again With Special

Posted on Fri, 27 Dec 2019

Question: Hello Dr Chail, please look at ct again with special attention to the spine.It looks to me like Logan's spine is some what twisted and compressed.You pointed out the end plate lesions but I think he has compression of his spine as well.Thank you Sir

Follow up: Dr. Vivek Chail (0 minute later)

Hello Dr Chail, please look at ct again with special attention to the spine.It looks to me like Logan's spine is some what twisted and compressed.You pointed out the end plate lesions but I think he has compression of his spine as well.Thank you Sir

Answered by Dr. Vivek Chail (44 minutes later)

Brief Answer:
There is Schmorls a node and end plate changes in the lower end plate of T11 vertebral level

Detailed Answer:
Hi,
Thanks for writing in to us.

There is a Schmorls node and end plate changes in the lower end plate of T11 vertebra.

Please find the image in the link below

https://ibb.co/T86MbVz

This is not of serious concern.

Regards,

Above answer was peer-reviewed by : Dr. Yogesh D

Answered by Dr. Vivek Chail (0 minute later)

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Vivek Chail (6 hours later)

Thank you for letting me know there is no concern with those lesions.

The other question we have is, is it polyps, diverticula or the tiny impn cyst in the body of the pancreas, causing the descending colon to look so odd?
It looks as if it is twisted or something and matches pictures with problems at the spleen peduncle that state torsion is causing the problems.
Logan's feces is just larger than the size of a pencil and does not matter if he is taking laxatives or not.

Thanks

Follow up: Dr. Vivek Chail (0 minute later)

Answered by Dr. Vivek Chail (32 hours later)

Brief Answer:
No cysts visualised in the pancreas

Detailed Answer:
Hi,
Thanks for writing in to us.

There is a bit of crowding of the bowel in the peri splenic area. The pancreas is not showing any cysts and is otherwise normal.

We cannot comment about any diverticula in the large bowel as there is no rectal contrast. There are fecal contents in the transverse colon near the splenic flexure area.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Answered by Dr. Vivek Chail (0 minute later)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (15 days later)

Hi Dr Chail, I am emailing pictures from the endoscopy just done on XXXXXXX There is a lot of bile in the stomach and his stomach is huge according to gastro surgeon who looked at scans and did endoscopy.Do you think the endoscopy pictures show sma and if it is intermittent sma symptoms; does that mean at times the duodenum is more open than others?Please, what do you recommend .Thank You

Follow up: Dr. Vivek Chail (0 minute later)

Follow up: Dr. Vivek Chail (11 minutes later)

Images uploaded

Follow up: Dr. Vivek Chail (0 minute later)

Images uploaded

Answered by Dr. Vivek Chail (13 hours later)

Brief Answer:
Cannot adequately make a diagnosis of SMA or intermittent SMA syndrome

Detailed Answer:
Hi,
Thanks for writing in to us.

The endoscopy images are showing bile and acid in the stomach lumen. It will help to know if he was in fasting state for few hours before to endoscopy and if there was increased secretions in the stomach. SMA or intermittent SMA syndrome cannot be adequately diagnosed if there is only bile and acid in the stomach and this is in fluid state and should be able to pass through most strictures.

Regards,

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Vivek Chail (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Vivek Chail (7 hours later)

He fasted for 8 hours before the test.I do not understand the statement,

"SMA syndrome cannot be adequately diagnosed if there is only bile and acid in the stomach and this is in fluid state and should be able to pass through most strictures.

Are you saying sma can not be diagnosed with endoscopy or, is there a different type of endoscopy that should be done?

Please clarify.
Thank you

Thank You

Follow up: Dr. Vivek Chail (0 minute later)

Answered by Dr. Vivek Chail (17 hours later)

Brief Answer:
There is linear endoscopy ultrasound for viewing SMA syndrome

Detailed Answer:
Hi,
Thanks for writing in to us.

SMA syndrome is due to mechanical obstruction of the duodenum from an angulation of the superior mesentric artery. This causes obstruction to the movement of contents from the stomach and duodenum to the distal part.

If we see food particles in the stomach during endoscopy even after fasting then there is a possible obstruction to movement at the gastric outlet or duodenum. In case of XXXXXXX he was fasting for 8 hours and we only find collection of bile and acid in the stomach lumen. This shows that the food taken 8 hours previously has most likely passed through the duodenum.

I mean to say that SMA syndrome will not always show on usual endoscopy.

There is a special procedure called Linear endoscopic ultrasound that can show the SMA with endoscopy.

Regards,

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Answered by Dr. Vivek Chail (0 minute later)