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Prepare trainees to be on call for the emergency department with this specialized training series.
Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 1 min.
19 topics, 1 hr. 35 min.
Clinical Scenario 1 - Orbital Trauma/Inflammation - Introduction Video
2 m.Case 1 - Anterior Segment Ocular Injury
9 m.Case 1 - Ocular Injury/Globe Anatomy
6 m.Case 2 - Choroidal Detachment, Retinal Detachment, Vitrious Hemorrhage, Orbital Floor Fracture
9 m.Case 2 - Orbit: Foreign Body
8 m.Case 2 - Orbit: Non-accidental Trauma
3 m.Case 2 - Early Ocular Intervention
6 m.Case 2 - Non-Ocular Orbital Trauma
3 m.Case 2 - Orbital Wall Fracture
8 m.Case 2 - Orbital Medial Wall Fracture
8 m.Case 2 - Orbital Apex and Roof Fracture
5 m.Case 2 - Orbital Blow Out Fractures
6 m.Case 2 - Orbital Trauma
5 m.Case 2 - Indications for Surgery
4 m.Case 3 - Orbital Cellulitis, Periorbital Abscess
6 m.Case 3 - Orbital Inflammation
5 m.Case 4 - Pediatric Subperiosteal Abscess
4 m.Case 4 - Orbital Pseudotumor
7 m.Orbital Trauma/Inflammation Lesson Reinforcement Quiz
29 topics, 1 hr. 34 min.
Clinical Scenario 2 - Facial/Neck Trauma - Video Introduction
6 m.Case 5 - Cominuted Nasal Bone Fracture
2 m.Case 5 - Multiple Fractures in Nasal Bones
3 m.Case 5 - Nasal Bone Fracture Summary
3 m.Case 5 - Mandibular Fractures
6 m.Case 5 - Displaced Mandible Fracture At the Angle
3 m.Case 5 - Midface Butresses
3 m.Case 5 - Naso-orbito-ethmoid Fractures
5 m.Case 5 - NOE Fracture
3 m.Case 5 - Midface NOE Fracture
3 m.Case 5 - Le Fort Fractures
7 m.Case 5 - Bilateral Le Fort 1 & 2 Fractures
4 m.Case 5 - Bilateral Le Fort 1, Unilateral Le Fort 2 & 3
4 m.Case 5 - Le Fort Summary
1 m.Case 5 - Zygomaticomaxillary Complex (Tripod) Fracture
5 m.Case 5 - Tripod Fracture
3 m.Case 5 - ZMC Summary
2 m.Case 5 - Capo de Tutti Fractures
5 m.Case 6 - Bilateral Temporal Bone Fractures
9 m.Case 6 - Temporal Bone Fractures
2 m.Case 7 - Complications of Temporal Bone Injury
3 m.Case 8 - Temporal Bone Fracture Summary
3 m.Case 9 - Transverse Sinus Injury
3 m.Case 10 - Dissection, pseudo aneurysm
5 m.Case 11 - Bilateral Dissection
4 m.Case 12 - Horner's Syndrome, MS, Dissection
5 m.Case 12 - Horner's Syndrome
5 m.Case 12- Airway Injury
4 m.Facial/Neck Trauma Lesson Reinforcement Quiz
12 topics, 46 min.
Clinical Scenario 3 - Sore Throat Pain and Fever - Video Introduction
1 m.Case 13 - Tonsillitis
6 m.Case 13 - Peritonsillar Abscess
5 m.Case 14 - Phlegmon
6 m.Case 15 - Epiglotitis, Super Glotitis, Air Way Compromise
7 m.Case 16 - Periodontal Disease
9 m.Case 16 - Ludwig's Angina
3 m.Case 16 - Summary: Ludwig's Angina
3 m.Case 17 - Ludwig's Angina, Sialadinitis
4 m.Case 17 - Lemierre's Syndrome
2 m.Case 17 - Malignant Otitis Externa
6 m.Sore Throat Pain and Fever Lesson Reinforcement Quiz
12 topics, 42 min.
Clinical Scenario 4 - Mass in the Neck - Video Introduction
4 m.Case 18 - T Cell Lymphoma, lymphadenopathy
4 m.Case 18 - Retropharyngeal Space
3 m.Case 19 - Retropharyngeal Abscess
4 m.Case 20 - Retropharyngeal Phlegmon
3 m.Case 20 - Retropharyngeal Space Collections
4 m.Case 20 - Afebrile
7 m.Case 21 - 2nd Branchial Cleft Cyst
4 m.Case 22 - Thyroglossal Duct Cyst
5 m.Case 22 - Sarcoma in the Levator Scapuli
2 m.Case 22 - Thyroid Nodules
9 m.Mass in the Neck Lesson Reinforcement Quiz
27 topics, 1 hr. 42 min.
Clinical Scenario 5 - Cervical Spine Trauma - Video Introduction
7 m.Case 23 - Occipital Condyle Fracture
2 m.Case 24 - Anterior Arch C1 Fracture
6 m.Case 25 - Odontoid Fracture
4 m.Case 25 - How to Diagnose Alanto-odontoid Distraction
5 m.Case 25 - Odontoid Fractures: Summary
5 m.Case 26 - Jefferson Fracture, vertebral dissection
4 m.Case 27 - Jefferson Fracture on MRI
7 m.Case 27 - Jefferson's Burst Fracture: Summary
4 m.Case 27 - Fixed Rotatory Subluxation
4 m.Case 28 - Bilateral Jumped Facet
9 m.Case 28 - Unilateral Facet Dislocation, Carotid Dissection
4 m.Case 28 - Hyperextension Injury
4 m.Case 28 - Cervical Spine Flexion Injury
6 m.Case 29 - Transverse process fracture
3 m.Case 30 - Unstable Fracture, Two Column Injury
6 m.Case 30 - Epidural Hematoma Summary
7 m.Case 31 - Facet Fracture, Vertebral Artery Occlusion
4 m.Case 31 - Spinal Cord Injury Without Radiographic Abnormalities
4 m.Case 31 - Thoracolumbar AO Spine Injury Score
2 m.Case 32 - Chance Fracture
2 m.Case 32 - Axial Loading Fractures
5 m.Case 33 - Lumbar Transverse Process Fracture
2 m.Case 33 - Transverse Process Fractures and Visceral Injury
3 m.Case 34 - Compression Fracture
4 m.Case 34 - Compression Fracture & Stress Injury
3 m.Cervical Spine Trauma Lesson Reinforcement Quiz
9 topics, 28 min.
Clinical Scenario 6 - Fever, Back Pain - Video Introduction
2 m.Case 35 - Discitis, Osteomyelitis
5 m.Case 35 - Diskitis: Summary
6 m.Case 36 - Tuberculous Spondylitis with Psoas Abscess
4 m.Case 37 - Spinal Cord Infarct
5 m.Case 38 - Spinal Cord Astrocytoma
2 m.Case 39 - Guillain-Barré Syndrome
2 m.Case 39 - Grisel Syndrome, Calcific Tendonitis of Longus Coli,
6 m.Fever, Back Pain Lesson Reinforcement Quiz
13 topics, 37 min.
Head and Neck Emergencies - Video Introduction
8 m.Case 40 - Fungus Ball
2 m.Case 40 - Fungal Sinusitis
2 m.Case 40 - Allergic Fungal Rhinosinusitis
7 m.Case 41 - Invasive Fungal Sinusitis
4 m.Case 41 - Invasive Fungal Sinusitis Imaging Signs
4 m.Case 42 - Necrotizing Fasciitis
4 m.Case 42 - Necrotizing Fasciitis: Summary
2 m.Case 43 - Allergic Fungal Sinusitis with Mucocele
2 m.Case 43 - Epidural Abscess from Sinusitis
3 m.Case 44 - Otomastoiditis with Bezold abscess
2 m.Case 45 - Frontal Lobe Abscess, Sinusitis
3 m.Head and Neck Emergencies Lesson Reinforcement Quiz
0:01
Let's take a quick look at this case.
0:03
Here we have the common carotid arteries coming up. In a patient
0:08
who had strangely a bilateral Horner syndrome, actually going
0:13
downward. But let's go back up and if we watch the left side,
0:18
we see the carotid bifurcation and we see a little
0:22
bit of irregularity to the internal carotid artery.
0:25
Is there a flap already here across the carotid?
0:29
Here we see just irregular blood vessel without pouching, that
0:35
should not be the normal lumen of the internal carotid artery.
0:38
Here we can see a nicely demonstrated flap on the left
0:41
side. And then we continue up into the petrous portion.
0:45
But even here, the vessel is all irregular, showing
0:49
areas of narrowing and internal arch-
0:53
Here's another area of dissection.
0:56
And then we get into the petrous portion, which looks
0:58
a little bit more normal. On the right side,
1:02
a funny-looking shape in the petrous portion compared to
1:05
the contralateral, so it's probably not a normal vessel.
1:09
Here we have an outpouching of the internal
1:12
artery just as it enters the petrous portion.
1:15
Here's a nice flap across the enlarged lumen of the right
1:21
internal carotid artery. Here it gets quite narrow, winds out
1:24
again, irregular shape. And here's another area of a flap.
1:28
So as you talk about multiple flaps and
1:30
areas of narrowing and widening,
1:32
it should come to mind the possibility that
1:35
the patient has fibromuscular dysplasia.
1:38
That's pretty typical of areas of luminal narrowing and
1:42
widening associated with patients who have dissection.
1:46
And this sort of kinky look to the internal carotid artery with
1:52
the string of pearls or the accordion look to it, is very
1:56
typical a fibromuscular dysplasia, which has the
1:59
complications of dissection and pseudoaneurysm.
2:02
Look at again these multiple rings of narrowing as well as
2:07
widening associated with the internal carotid artery.
2:11
Let's see whether it's even better seen on the sagittal
2:14
scan here. This is not even the vertebral artery,
2:18
as you can see, has that same serrated area
2:22
look to it, that's associated with fibromuscular dysplasia.
2:28
Really awful looking blood vessel.
2:30
Let's look on the other side.
2:33
Widening, narrowing, widening,
2:36
tortuosity, dissection, vertebral artery, not so bad on this side.
2:43
So if you have the case of bilateral fibromuscular
2:47
dysplasia, particularly in a patient who is non traumatic,
2:51
you may see bilateral dissections,
2:53
bilateral areas of narrowing
2:55
and widening in this
2:58
string of pearls type of appearance.
Interactive Transcript
0:01
Let's take a quick look at this case.
0:03
Here we have the common carotid arteries coming up. In a patient
0:08
who had strangely a bilateral Horner syndrome, actually going
0:13
downward. But let's go back up and if we watch the left side,
0:18
we see the carotid bifurcation and we see a little
0:22
bit of irregularity to the internal carotid artery.
0:25
Is there a flap already here across the carotid?
0:29
Here we see just irregular blood vessel without pouching, that
0:35
should not be the normal lumen of the internal carotid artery.
0:38
Here we can see a nicely demonstrated flap on the left
0:41
side. And then we continue up into the petrous portion.
0:45
But even here, the vessel is all irregular, showing
0:49
areas of narrowing and internal arch-
0:53
Here's another area of dissection.
0:56
And then we get into the petrous portion, which looks
0:58
a little bit more normal. On the right side,
1:02
a funny-looking shape in the petrous portion compared to
1:05
the contralateral, so it's probably not a normal vessel.
1:09
Here we have an outpouching of the internal
1:12
artery just as it enters the petrous portion.
1:15
Here's a nice flap across the enlarged lumen of the right
1:21
internal carotid artery. Here it gets quite narrow, winds out
1:24
again, irregular shape. And here's another area of a flap.
1:28
So as you talk about multiple flaps and
1:30
areas of narrowing and widening,
1:32
it should come to mind the possibility that
1:35
the patient has fibromuscular dysplasia.
1:38
That's pretty typical of areas of luminal narrowing and
1:42
widening associated with patients who have dissection.
1:46
And this sort of kinky look to the internal carotid artery with
1:52
the string of pearls or the accordion look to it, is very
1:56
typical a fibromuscular dysplasia, which has the
1:59
complications of dissection and pseudoaneurysm.
2:02
Look at again these multiple rings of narrowing as well as
2:07
widening associated with the internal carotid artery.
2:11
Let's see whether it's even better seen on the sagittal
2:14
scan here. This is not even the vertebral artery,
2:18
as you can see, has that same serrated area
2:22
look to it, that's associated with fibromuscular dysplasia.
2:28
Really awful looking blood vessel.
2:30
Let's look on the other side.
2:33
Widening, narrowing, widening,
2:36
tortuosity, dissection, vertebral artery, not so bad on this side.
2:43
So if you have the case of bilateral fibromuscular
2:47
dysplasia, particularly in a patient who is non traumatic,
2:51
you may see bilateral dissections,
2:53
bilateral areas of narrowing
2:55
and widening in this
2:58
string of pearls type of appearance.
Report
Faculty
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
Tags
Neuroradiology
Head and Neck
Emergency
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