Case Summary

A 56-year-old female presented with abdominal/pelvic pain and fullness. Her history is significant for a large fibroid uterus treated with a hysterectomy and bilateral salpingo oophorectomy (BSO) approximately 10 years previous.

Imaging Findings

A noncontrast CT scan was ordered and revealed a large lobulated mass filling much of the pelvis and extending into the abdomen. Separate from the large mass were some smaller nodular masses that were initially thought to represent lymphadenopathy. No evidence of omental caking, hepatic metastasis, or ascites was demonstrated.

An MRI of the abdomen and pelvis was then performed with and without gadolinium that demonstrated a large, […]

By |January 18th, 2018|Case Studies, News|0 Comments

Case Study – Chronic Noninfectious Osteomyelitis (CNO)

By Josh Gottlieb, OMS IV, NYIT-COM and Roy Gottlieb, D.O.



X-ray demonstrated marked wavy solid cortical thickening along the posterior cortex of the tibia (Figures 1 and 2). The periosteal reaction was thought to be non-aggressive in type without evidence of a Codman’s triangle or “onion-skin” appearance.

On MRI, there is marrow edema in the thickened posterior cortex with mild adjacent soft tissue edema (figures 3 and 4). Linear vascular grooves are demonstrated in the cortex without radiation to a focal osteoid osteoma nidus.

A CT demonstrated marked […]

By |January 19th, 2017|Case Studies|0 Comments

Case Study – Everything is Backwards (CCTGA)

By Joshua I. Gottlieb, OMSII; Roy Gottlieb, D.O. FSCCT



Both CT and MR demonstrate atrioventricular discordance and ventriculoarterial discordance diagnostic of CCTGA. Both images also demonstrate situs inversus totalis. In addition, MR offered the benefit of evaluating the severity of the VSD shunt using phase contrast MR imaging with Q-flow analysis taken above the pulmonary and aortic valves. The Vp/Vq ratio measured 2:1. The severities of the valve abnormalities were also better evaluated using MR, which demonstrated moderate tricuspid insufficiency, mild aortic and pulmonic valve insufficiency, moderate subpulmonic, and mild […]

By |February 29th, 2016|Case Studies|0 Comments

Case Study – OHVIRA Syndrome

By Joshua I. Gottlieb, OMSII; Roy Gottlieb, D.O. FSCCT; Karie McMurray, M.D.



MRI Findings were crucial in determining the correct diagnosis in this patient with a complex congenital anomaly consisting of uterine didelphys, obstructed right hemivagina (atresia) with hematocolpus, ipsilateral agenesis of right kidney, and non-obstructed left hemivagina.

FINAL DIAGNOSIS – OHVIRA SYNDROME (Obstructed Hemivagina with Ipsilateral Renal Anomaly)

OHVIRA syndrome (previously known as Herlyn-Werner-Wunderlich syndrome) was first reported in 1950 [1] and is a rare congenital anomaly of the Müllerian (paramesonephric) ducts and Wolffian (mesonephric) structures consisting of the following triad: […]

By |February 29th, 2016|Case Studies|2 Comments

Case Study – Sinus Venosus ASD Associated With Partial Anomolous Pulmonary Venous Return

By Joshua I. Gottlieb, OMSII; Roy Gottlieb, D.O. FSCCT



The CTA study performed for pre-pulmonary ablation therapy revealed an enlarged anomalous right superior pulmonary vein draining into the superior vena cava as demonstrated on the coronal, 3D image (figure 1), and axial (figure 2) images. This anomaly is associated with a sinus venosus type atrial septal defect (SVASD) well demonstrated on this reconstructed four-chamber view of the heart (figure 3). The sinus venosus atrial septal defect (SVASD) and the partial anomalous pulmonary venous return (PAPVR) contribute to a left-right […]

By |June 25th, 2015|Case Studies|0 Comments

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