 share screen. Okay, here we go, share. Yes, we got it. Okay. Okay, here we go. Okay, so unfortunately, I can't call on you, which is good for some of you, you don't want to be called on. But I'm going to show a case with a few slides. And then I'll just ask you for the answer. So I don't know how you want to do it. You want people to type it in? Yeah, so we'll ask people to type in the chat box. And usually the fastest finger wins the fastest finger first, something like that. And we keep track of who's winning. I'll let you run the chat box. Okay. All right. These are routine cases Linda and I see every day. Okay. Patient presents 50-ish year old male presents with FUO. I'll share a couple images. I think one of the things I'll just speak over it is look at the spleen. What's going on? There was no calcifications in the spleen on the non-contrast scan. There's the spine. Here's some of the 3D showing of the spleen, the extensive ascites. And here's the venous phase. So we're getting answers coming in, sir. Should I read it up to you? Yeah, so we got angiosarcoma spleen and splenic hemangema, hypervascular myths, angiosarcoma lymphoma, hematoma. Right. I think that's very good. If you go back, first of all, you see the sclerotic bone lesions, then you have this vascular lesion in the spleen. You can get hemangiomas can be vascular, but this is diffusely vascular. You have ascites and you have widespread ballistic bone lesions. And as somebody suggested, that was an angiosarcoma. Very good. Believe it or not, we've had three cases of angiosarcoma in the last four or five months. We hardly see them, but we have been seeing them lately. They were exceedingly rare. They can cause splenic rupture, but it's rare. You can see this one article here with 12 cases in radiology. So a pretty uncommon. The lesions may exhibit substantial enhancement. And again, you can think about hemangioma, but just the pattern does not really look like hemangioma. Hemangiomas are better defined. Okay. Very good. Okay. In this case, patient presents 50-ish year old acute abdomen, ER, rule out the section. That's why we did the study. So you can see the impressive spleen. Okay. And you can see that high density zone, big spleen. We've got answers from Raghuram saying splenic rupture, then the splenic hematoma, and AML rupture. Right. So I guess it's good to say the splenic rupture, but patient was not a trauma patient. I guess the second answer would be why the patient has acute bleeding and splenic rupture. I mean, obviously trauma is the most common reason for splenic rupture and splenic bleed, but there was no trauma. So the spleen looks enlarged, some of that is the blood. It's sort of a modeled enhancement pattern as well. Looks like something's infiltrating, perhaps. Here it is on the cinematic with this infiltration of the splenic tissue, the blood, the act of bleeding and diagnosis. CLL, presenting with acute bleed. So kind of a great case. Okay. Okay. Another patient left up a quadrant pain. This is something you may see more frequently than we do, but maybe not. So nice. And look at the bone is a good hint. Now I'm going to keep going down. There's in the pelvis. You can see the big spleen. What's happening in the pre-sacral space as well. So if you have answers coming through, she can fast actually. So picture frame, vertebra, sickle cell from Poonam, Lino-Megale, Hepatospina, Thalassemia, Lymphoma. These are the answers before. Right. So someone got it right. I mean, sort of the thing over here, the stuff in the pre-spinal region, what is that? So a big spleen, sclerotic bone lesions, almost like a bone and bone, but the soft tissue density is really the critical question. What is this? You could say, maybe it's adenopathy, but that's a classic appearance for extramedulary hematopoiesis. And this was a classic case of Thalassemia with extramedulary hematopoiesis. Very good. Okay. Another patient looks similar, but not the same. Back pain. Back pain in a 60-year-old. So the answer is Cordoma from most of them. Okay, good. Right. A very classic location for Cordoma infiltrating. I showed this compared to the last case, which was extramedulary hematopoiesis. Here it's a much more aggressive soft tissue mass and a much different appearance to the bone. Here it is nicely on cinematic as well. You can see that infiltration of the bone really nicely shown. And this was a Cordoma. Okay. Very good. And again, Cordoma, the lowest cervical spine, but the pre-sacral region is really where we typically like to see it. Okay. So a very, very nice, nice appearance there. And again, not an uncommon diagnosis, but so something good to be able to recognize. Okay. What about this case? This is a 30- a-year-old female with abdominal pain. Again, more than 95%. Desmoid once is endometriosis. Damn, you guys are good. You must have been watching my, you know, his masses in the rectus muscle enhancing, masses down here. All right. You follow it down, abdominal pain with multiple masses that are enhancing. You know, masses in the abdominal wall, I like to think about desmoid tumors or possibility. You can think about sarcomas, but endometriosis is one of the things that gives you enhancing lesions. Typically, it's patients who've had prior C-sections or prior surgeries. There's a wide differential for abdominal wall masses, but one of them is endometriosis. Very good. So I won't go through those slides in order to save some time. Very good. And it's just a differential diagnosis, but it's good to think about endometriosis because you can make a, it's a great diagnosis. Okay, good. Patient with weight loss. The next few are going to be bowel, and I'm going to give you this duana lipoma. Okay, weight loss and GI bleeding. So I guess you see a nice measurement there. Here it is cinematic. So what are we thinking about? What a mixed bag actually. There's liposacoma, Crohn's ulcerative colitis, ideal mass carcinoma, Crohn's lymphoma. Right, very good. So yeah, that's a differential. It's focal. This ended up being adenocarcinoma, but it could be lymphoma. If it was Crohn's, I would have worried about Crohn's developing a carcinoma because the wall thickness. Okay, good. So now I'll show you again following that differential. Here's another patient, abdominal pain. So similar but different. We're getting gist and lymphoma as the answer. Right, this was B cell lymphoma. It's much bulkier. I think that's one of the helpful things with lymphoma. Often you see nodes, but not always, but the bulkiness. Okay, small bowel lymphoma. Very good. What about this patient? Abdominal pain and gerombin and a lohamatocrit. Okay, so I'm going to look. Looks like some nodes also. So what about this one? What do people think? Yeah, so this angio-dysplasia, AML, adenociae, intrususception, colonic carcinoma, sequel masses intrususception, so there's a differential. Right, it's good differential. I mean, so something's involving the colon and the small bowel. Whenever I see a colon and small bowel, although we know adenocarsinoma can grow into the cecum and cecum, adenocarsinoma can grow into bowel, with those extra nodes present, I always like to think about lymphoma. And this was B cell lymphoma of the cecum. Okay. All right, with that, let me show you another one. Fever and right-level quadrant pain. Answers are coming from appendicular mass, gist, lymphoma, appendicular lymphoma, appendicitis mass. Right, bulky tumor. I just put this one in with the other one. Nice pet positive. This was B cell lymphoma of the cecum. Kind of interesting the difference between the prior study, which showed a smaller mass and this larger mass present here. And then getting away from the cecum, patient presents with abdominal pain and weight loss. Here's a, looks very similar, right? Except it's not, looks like it's more the stomach, right? And answer. So again, we're getting maybe gist, actually. And small bowel lymphoma. Yeah, I think gist is a good thought, you know, but then when you realize it's really a big ulceration in the stomach, but gist often ulcerate, bulky. This was gastric lymphoma. My first thought would have been gist too, that it's an ulceration. Gist commonly ulcerate, they're very large, but gastric lymphoma can be very bulky. And this was a really, really nice example of gastric lymphoma. Okay, I'm near the end. I'll just left lower quadrant pain. So what do you think? I'll go back there. Again, question. Answers are like carcinoid, diverticulitis, paniculitis. Right, but this is coming off, this is coming off the small bowel, right? It looks like diverticulitis. And in fact, it is, but it's not your typical colonic diverticulitis. It's small bowel diverticulitis, specifically jejunal diverticulitis, which is far less common, often looks like a perforation. It's pretty rare. Patients are treated typically conservatively. So it's an important diagnosis to make. We wrote this article like a lifetime ago, but we see cases every once in a while. And what about this case? I think I have two cases left. This may be the last, next last one. Patient presents with GI bleed. I'm just, and then here it is, or it's rule out GI bleed. It has a history of GI bleeding. Okay, and here's the MIP imaging, which I really like for looking for sources of bleeding. The patient has no positive oral contrast. So I'm still say colon diverticulitis and angiotysplasia, sigmoid diverticulitis, ulcerative colitis. These are the differences. And 100% agree. What's interesting here is you have bleeding in multiple sites. Now most of the time we do GI bleeding CT is 95% accurate, but usually it's one side of bleeding. And if I only saw this, I would say diverticulitis, probably is the cause. This patient has multiple sites of bleeding. It ends up when you get the full history. This patient I think had leukemia and was on checkpoint inhibitors. So I show this case to make the point that patients who are on immune therapy can present with GI bleeding and often it's multiple areas of GI bleeding. And that's what happens with immune checkpoint inhibitors. We're seeing that used a lot. I'm sure it's being used a lot in India as well for a range of tumors very successfully. But there are a lot of complications with checkpoint inhibitors, including a colonic bleeding and multifocal sites of GI bleeding as in this case. So it's something good to think about. And I won't go through those slides. Okay. And then we're going to end with this case. This is suspected GI bleed in a patient with ALL. Okay. And I'm showing this case because I made some really good cinematics the other day. So pseudo-membranous colitis, ulcerative colitis, Crohn's disease, shock bowel, pan colitis, neutropinic state, radiation entritus, neutropinic colitis. These are the answers we're getting. Those are all great thoughts. This patient had a bone marrow transplant previously. So right. It has a nice target sign. It could be ischemia. It could be inflammatory. It could be infectious. Very impressive looking ileum. Very impressive vasorecta. And in patients with bone marrow transplants, graft versus host disease is one of the things that can occur. Fortunately these days, graft versus host is less common because of different therapies that are given, but it can't occur. And this is a case of graft versus host disease. Okay. So I'll stop there. And I will thank everybody for their attention. And I especially would like to thank the organizers for the invite. Gave me something to do on Sunday morning, just joking. But it's an honor for us to be invited. And Linda, I'll put Linda back too as well. Yeah. I mean, thank you. It's been great. Thank you for this opportunity. And hopefully we'll be invited back in person because I would love to visit India sometime. We should plan that next year. It's been wonderful. The squeeze has been really terrific. So thank you both, Dr. Linda as well as Dr. Fishman for consenting for this event. And it's great to have you on our CT bus program. Thank you. And we hopefully do this again next year. Thank you, everyone. And goodbye from all of us. Great evening. Bye.