Daniel Souza @danatsouza Twitter profile

Last Seen Profiles

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@cln_alicia

Daniel Souza

@danatsouza

3 years

@danabaraki She has a good eye and great future as diagnostic radiologist! 😉

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Daniel Souza

@danatsouza

1 year

Seems like yesterday (but only 20 years ago)... as an R2 back at my dear @ufrj looking at CT films and (shocker): actually WRITING a report... and USING a REAL PEN! @futureradres you will miss these days! I would do this all over again! @BrighamRad

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Daniel Souza

@danatsouza

3 years

4550 days, 4 fellowships, two 8-year-old twin girls, one 6-year-old boy, and a one-year-old puppy later… i have become an US citizen! So grateful for all the opportunities and everything this country has provided to us. Thank you friends for making this an unforgettable journey!

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Daniel Souza

@danatsouza

1 year

So THIS is why I don't say 'gallbladder is normal' in my CT reports... not its thing! Are you able to tell me how many gallstones were missed? Sure, DECT can help but really? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

In addition to antibiotics, percutaneous catheter drainage should be considered for treatment of pyogenic liver abscesses... how many catheters? Well... some argue every cavity deserves one! @BrighamRad @AURtweet @futureradres @FOAMrad @SAR_RFS @HarvardMacy @CBRadiologia @SIRRFS

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Daniel Souza

@danatsouza

1 year

Rare manifestation... what a 'pearl' - pun intended (careful, Dad-iology joke): innumerable punctate calcifications corresponding to peritoneal nodules/granulomas - peritoneal sarcoidosis! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

66-year-old female patient, asymptomatic, incidental finding. Diagnosis? Answer with a GIF! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia @ABR_Radiology #MedEd

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Daniel Souza

@danatsouza

1 year

Middle-age female patient with incidental finding in the kidneys. History withheld. What is the patient's diagnosis? Answer with GIFs only! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

5 months

What is the name of this finding (yellow arrow)? Often misinterpreted as pancreatic mass, or lymphadenopathy... @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Large, heterogeneous pancreatic mass (no upstream ductal dilatation or atrophy) + thickened gastric folds and ulcers = gastrinoma causing Zollinger Ellison syndrome. 2nd most common "functioning" neuroendocrine tumor of the pancreas (after insulinoma), majority malignant.

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Daniel Souza

@danatsouza

1 year

Welcome to my world: yet another one of my many @AIUMultrasound 'pet peeves' @futureradres @BWHRadEdu @ACOREdu @SAR_RFS thanks Dr. Munn from @TuftsMedicalCtr for this highly referenced (at least by me) article! #MedTwitter 'The Earth has north and south poles. It has no mid-pole'

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Daniel Souza

@danatsouza

2 years

This is ALSO rare (and another one of my favorites!). Cystic dilatation of the distal bile duct aka choledochocele = Todani type III choledochal cyst! These are cute but predispose to cholangiocarcinoma and should be followed. @BrighamRad @SocAbdRadiology @sar_pdar

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Daniel Souza

@danatsouza

2 years

Small encapsulated fat density (negative HU) mass abutting the posterior right lobe, detached/degenerated epiploic appendage that 'stuck' to the liver surface... 'benign' pseudolipoma of the Glisson capsule! @BrighamRad @AURtweet @futureradres @SAR_RFS @CBRadiologia @HarvardMacy

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Daniel Souza

@danatsouza

1 year

Another great call by @ShannaMatalonMD : extensive small bowel thickening +submucosal edema in patient taking tyrosine kinase inhibitor pazopanib... small intestinal lymphangiectasia! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Benign pancreatic cystic mass with lobulated contour and "honeycomb" appearance, or multiple (>6) and small (<2 cm) cysts, thin (hypervascular) septations, central scar (+/- calcifications) in an elderly female patient = serous microcystic cystadenoma aka "grandmother" tumor!

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Daniel Souza

@danatsouza

3 years

Innumerable nonenhancing subcentimeter cystic lesions throughout the liver giving it a "starry sky appearance" = benign biliary hamartomas (or von Meyenburg complexes if you're old like me)

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Daniel Souza

@danatsouza

1 year

Renal agenesis + ipsilateral SV cyst + ejaculatory duct obstruction (arrows) = Zinner syndrome! (Wolffian duct anomaly). May present with perineal pain, recurrent prostatitis, hematospermia, painful ejaculation, and infertility @AURtweet @FOAMrad @SAR_RFS @futureradres #MedEd

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Daniel Souza

@danatsouza

2 years

I know many rads that do not believe this is real but classic: severe weight loss > decreased aortomesenteric angle (<22 degrees/8 mm) > duodenal compression (arrow) = SMA syndrome in 21yoF! @BrighamRad @AURtweet @futureradres @FOAMrad @SAR_RFS @HarvardMacy @CBRadiologia

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Daniel Souza

@danatsouza

2 years

30-year-old male patient with abdominal pain. No additional history provided. Diagnosis? Answer with a GIF! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia @RadioGraphics @ABR_Radiology #MedEd

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Daniel Souza

@danatsouza

10 months

Kinda cute and fatty but not what is looks like: this is metastatic immature teratoma to the liver! Look at the peritoneal disease in the pelvis - @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Multiple T2 bright, T1 dark, peripherally enhancing liver lesions = hepatic hemangiomas? Nope! GIST metastases to the liver. They can be cystic! History is key - don't ASSUME. We all know what happens. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Subcapsular liver lesion in the background of fat deposition/overload... T2 bright, restricted diffusion, T1 hypointense, early peripheral enhancement, progressive fill-in... delayed washout... diagnosis? Later today! @BrighamRad @AURtweet @FOAMrad @futureradres @SAR_RFS #MedEd

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Daniel Souza

@danatsouza

2 years

Welcome @BWHRadiology Abdominal Imaging and Intervention fellows! Looking forward to working with each one of you soon!

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Daniel Souza

@danatsouza

2 years

What is missing? Genetic autosomal recessive disease + complete replacement of the pancreas by fat leading to exocrine and endocrine insufficiency = cystic fibrosis (CF)! Other abdominal manifestations include cirrhosis (as seen) and pancreatic (retention) cysts (not seen here)

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Daniel Souza

@danatsouza

2 years

Rare, autosomal dominant disease leading to innumerable pancreatic cysts of variable size + serous cystadenomas (SCA) + neuroendocrine tumors (NET) + cystic ccRCCs + adrenal pheochromocytomas = von Hippel-Lindau (VHL). Classic @ABR_Radiology Boards question! @BrighamRad @SAR_RFS

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Daniel Souza

@danatsouza

1 year

Gooorgeous double-contrast esophagram aka barium swallow study (if you like it simple) done by @BrighamRad fellow @sameerhanfi at @BrighamWomens . Diagnosis please? Answer with GIFs only! @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Yup, I've made this mistake... T2 bright, T1 FS dark, does not enhance... but not a cyst! Fat (neg) density by CT, no OOP signal drop BUT 'india ink' artifact at interface... benign renal AML! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Be careful: T1 hypo/T2 hyper liver lesion, progressive enhancement, but NOT hemangioma! This is breast cancer met, restricted diffusion, early peripheral 'targetoid' enhancement, NOT nodular discontinuous! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

24-year-old male with heterogeneous testicular teratomas on CT and MRI: masses with cystic components, calcification, and fibrosis. Unlike ovarian teratomas, often aggressive behavior! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Scrotal pearls for @futureradres : testicular microlithiasis (>5 nonshadowing echogenic <3 mm foci per US image) a/w increased incidence of testicular cancer. In this case, with RP LN metastasis! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

5 months

46-year-old male patient with elevated creatinine, history of nephrolithiasis, mildly atrophic right kidney, without hydronephrosis. Noncontrast CT is performed. Can you make two additional relevant additional findings?

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Daniel Souza

@danatsouza

1 year

Have u ever made this diagnosis? Well-defined, round, thick-walled, cavitated uterine mass, blood products, adenomyosis change = accessory cavitated uterine malformation (ACUM)! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd @SARpelvicDFPs

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Daniel Souza

@danatsouza

1 year

Have you seen this before? It is becoming increasingly common: endoscopic metallic anchors post POSE procedure for morbid obesity! Less invasive alternative to sleeve gastrectomy and RYGB. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

2/2 - MRI shows homogeneous solid mass, mildly/moderately T2 hyper, nearly T1 iso, nearly isoenhancing to spleen, no iron contents, 'spleen within spleen' appearance = benign splenic hamartoma! @BrighamRad @AURtweet @futureradres @FOAMrad @SAR_RFS @HarvardMacy @CBRadiologia

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Daniel Souza

@danatsouza

1 year

[1/2] 34-year-old female patient without underlying malignancy or symptoms. Likelihood of malignancy? Diagnosis? What would you recommend as next step? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Looks like intrahepatic cholangiocarcinoma (iCCA) but even rarer, low grade malignancy: coalescent, peripheral, target appearing masses + capsular retraction + rim-like enhancement = epithelioid hemangioendothelioma, path-proven. @BrighamRad @futureradres @CBRadiologia @SAR_RFS

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Daniel Souza

@danatsouza

1 year

Homogeneously hyperechoic liver mass but NOT a hepatic hemangioma... fat-containing by CT: hepatic adenoma (steatotic type or HNF-1A mutated). Low risk of bleeding or malignant transformation. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

5 months

24-year-old woman with infertility. HSG shows no intraperitoneal spill and small round filling defect at the left fundus, likely small endometrial polyp or submucosal fibroid. Any additional findings? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

2/2. April Fool's Day! Always rule out vascular etiology prior to performing biopsy to avoid catastrophic bleeding - in this case, presacral varices mimicking soft tissue mass on noncontrast! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

High-grade small bowel obstruction with transition point at distal ileal mass = very rare adenocarcinoma within Meckel diverticulum! It contains all layers, remember rule of 2s - @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

I call this avidly enhancing mesenchymal tumor heterogeneously homogeneous (or homogeneously heterogeneous): solitary fibrous tumor (SFT)! I was concerned with biopsy bleeding but it went OK! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Large heterogeneous pelvic mass in 59-year-old male patient. Differential diagnosis wide... it could have been sarcoma, GIST... This one was biopsy-proven: solitary fibrous tumor (SFT)! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

80-year-old female with pneumobilia (blue) + SBO (red) + large obstructing gallstone in the distal ileum (yellow) = Rigler's triad in gallstone ileus! Another Abdominal Radiology favorite! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

[1/2] Discrete non-masslike subcapsular hypodensity in segment IVB, adjacent to falciform ligament, not displacing vessels, benign or malignant? Perfusional? Next step? Answer later today! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

3/3: Gorgeous multiseptated cyst with daughter cysts, usually right lobe, can simulate malignancy, mural calcifications indicate no active infection: hepatic hydatid cyst! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd @ShannaMatalonMD

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Daniel Souza

@danatsouza

1 year

Failed renal transplantation with extensive calcifications likely due to elevated calcium phosphate product, severe secondary hyperparathyroidism, aluminum toxicity and longstanding dialysis. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Lobulated 'honeycomb' appearing pancreatic cystic mass = innumerable small cysts + enhancing thin septa + central scar = benign serous (microcystic) cystadenoma! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Classic!... heterogeneous mildly T2 hyperintense, progressive enhancement + biliary ductal dilatation, often with capsular retraction: intrahepatic cholangiocarcinoma (ICCa)! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

7 months

[1/2] What is the name of this sign? GIFs only please! What does it usually associated with? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Surgeons get upset when misdiagnosed... protrusion is medial to the femoral vein and inferior to epigastric vessels: femoral hernia NOT inguinal hernia, tougher surgery, worse prognosis. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Extra-uterine pelvic mass, T2 hypo, well-defined, non restricting, with fairly homogeneous enhancement, central degeneration = biopsy-proven parasitic leiomyoma/fibroid! (post torsion of pedunculated type) @BrighamRad @AURtweet @futureradres @FOAMrad @SAR_RFS @CBRadiologia

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Daniel Souza

@danatsouza

2 years

Small bowel feces sign (feculent material in the small intestine) can be helpful to diagnose small bowel obstruction AND localize the site of obstruction = Crohn's stricture at the terminal ileum in this case! @SAR_RFS @CBRadiologia @futureradres @BrighamRad @FOAMrad #MedEd

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Daniel Souza

@danatsouza

1 year

This is REALLY rare so don't miss out -> largely necrotic mass in the pancreas with internal hemorrhage, atypical for adenocarcinoma: pancreatic angiosarcoma! Very aggressive, poor prognosis. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Beware, as this is a recurring theme: 'undrainable' or 'chronic' pelvic abscess that turns out to be mucinous adenocarcinoma! Typical appearance on T2WI, poor prognosis. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Difference between an ovarian SIMPLE CYST (white arrow) and an ovarian ENDOMETRIOMA (red arrow) on MRI = T2 bright vs dark, T1 dark vs bright, diffusion restriction vs shine through... and both NOT enhancing! @SocAbdRadiology @AIUMultrasound @BrighamRad @HarvardMacy #MedEd

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Daniel Souza

@danatsouza

10 months

[2/2] Eovist/Primovist-enhanced liver MRI performed: heterogeneous mass, restricted diffusion, central scar with septa, no contrast uptake on hepatobiliary phase. Rare but classic! Diagnosis? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

[2/2] Mildly T2 bright, nearly T1 isointense, avid arterial enhancement, 'fading' with surrounding spleen, homogeneous: classic splenic hamartoma aka splenoma ('splenic FNH'), benign! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Sausage-shaped pancreas + diffuse narrowing of main pancreatic duct + PSC-like CBD stricture with duct wall thickening/hyperenhancement = Autoimmune Pancreatitis + Cholangitis (IgG4 Disease)! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Multiple T1 hyperintense (hemorrhagic) ovarian cysts with T2 shading + "kissing" ovaries configuration due to adhesions = pelvic endometriosis @AIUMultrasound @BrighamRad @SocAbdRadiology @sar_pdar #MedEd

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Daniel Souza

@danatsouza

6 months

[2/2] BINGO! A linear-shaped, "pancake" or "lying-down" adrenal is a sign often seen with the absence of the kidney in the renal fossa due to agenesis, ectopia, or horseshoe kidney! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Scattered linear densities at the gastric fundus... residual enteric contrast? Nope... this is POSE procedure (Primary Obesity Surgery Endoluminal) for weight loss... gastric full-thickness anchors/stitches gives the stomach this appearance @BrighamRad @sar_pdar @futureradres

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Daniel Souza

@danatsouza

11 months

Don't be fooled. An adrenal mass with microscopic fat is not always an adenoma, clinical context and 'your bestie' priors are key! This is HCC metastasis, which can also demonstrate washout! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Very common benign "tumor" (harder diagnosis in the spleen > liver, as typical early nodular peripheral discontinuous enhancement often not seen): T2 hyper, T1 hypo, homogeneous, progressive, persistent enhancement, delayed washout = splenic hemangioma! @BrighamRad @SAR_RFS

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Daniel Souza

@danatsouza

3 years

This is rare! Todani type 2 choledochal cyst: diverticulum arising from the extrahepatic bile duct #FOAMrad #radres #futureradres @SocAbdRadiology

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Daniel Souza

@danatsouza

1 year

Fundal cleft with divergent, symmetric uterine horns with normal zonal anatomy ('owl appearance') + duplicated cervix: bicornuate bicollis uterus with obstructed left hemi-vagina (red)! Did you notice the renal agenesis? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres

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Daniel Souza

@danatsouza

1 year

(Rad)iology Joke Warning: Adrenal myelolipoma is the Shrek tumor of the adrenal gland = fatty, often large and ugly, but benign and one my favorites! No imaging follow-up required for this. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Large perinephric fatty mass without major solid components: AML or retroperitoneal liposarcoma? Great thoughts but not the final diagnosis on path... any other thoughts? Answer later today! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

34-year-old female with large heterogeneous solid liver mass with intralesional fat, avid enhancement, and washout in 34-year-old female patient: biopsy-proven inflammatory adenoma! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

3 years

Proud to see our soon graduating @BrighamRad fellows successfully performing liver mass biopsy in subcentimeter liver lesions like this!

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Daniel Souza

@danatsouza

1 year

Prostate MRI without IV contrast performed. What is the diagnosis? Answers with GIFs only! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @SAR_ProstateDFP @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Extensive intramural gas throughout the stomach in a patient with mild upper abdominal discomfort = benign gastric emphysema. Not sure what caused it. Surely I will never know... GIF thoughts? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Just learned this one: diffuse splenic calcifications by CT/MRI in systemic mastocytosis! Most often diffuse bone involvement, generalized mottled osteopenia or marbled sclerosis. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

5 months

27-year-old male patient with hematuria and positive urine cytology. Diagnosis? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Low T2 signal + magnetic susceptibility at renal cortex, more conspicuous on longer TE in-phase dual echo = hemosiderosis! In this case: mechanical hemolysis due to prosthetic cardiac valve. @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

9 months

Difficult diagnosis of (very) rare disease but some clues: intermediate to high T2 signal, marked restriction, area of irregular, ill-defined margin, heterogeneous enhancement, rapid growth can also help: uterine leiomyosarcoma (LMS)! @SAR_RFS @FennessyFiona @BrighamRad

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Daniel Souza

@danatsouza

1 year

Not very common... severe circumferential symmetrical gastric wall thickening with submucosal edema + mucosal hyperenhancement (best on DECT). Biopsy-proven eosinophilic gastritis! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Signs and pearls from @SocietyAbdRad at #SAR23 : how to differentiate ovarian mass from subserosal fibroid: ovarian beak sign, bridging vessels, myometrial claw sign. Thanks @VParoder & Yuliya Lakhman! @BrighamRad @ABR_Radiology @ACOREdu @futureradres @HarvardMacy #MedTwitter

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Daniel Souza

@danatsouza

2 years

MR enterography w normal small bowel gradual tapering and fold pattern: larger with more numerous and thicker folds in jejunum (LUQ, <3 cm, 4-7 per inch) than ileum (RLQ, <2 cm, 2-4 per inch) @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Diagnosis? Answers with GIFs only! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

[1/2] I was asked to review this liver with an incidental and quite unusual appearance: lymphoma? mets? benign? Next step? Answer later today! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

18

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Daniel Souza

@danatsouza

2 years

It is RLQ pain but slow down... this is not acute appendicitis = cecal diverticulitis (another favorite!) @BrighamRad @BrighamBEI @SocAbdRadiology @ASER_ERad @HarvardMacy @KhuranaBharti @SAR_RFS

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12

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Daniel Souza

@danatsouza

2 years

Middle-age female patient with large enhancing thick-walled pancreatic tail cystic mass, associated thick septations +/- solid components, high CEA on fluid analysis, no communication with the main duct = path-proven mucinous cystic neoplasm (MCN) harboring adenocarcinoma

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Daniel Souza

@danatsouza

10 months

43-year-old with extensive pseudomyxoma peritonei due to urachal adenocarcinoma (yellow arrows): late presentation, unfortunately with poor outcome... @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

3

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Daniel Souza

@danatsouza

3 months

Cheers to an amazing #SAR24 met so many inspiring colleagues and idols, saw so many dear friends, fellows, colleagues, looking forward to 2025! @SocietyAbdRad @SAR_RFS @ACOREdu @BWHRadEdu

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62

Daniel Souza

@danatsouza

2 years

2/2. Not so fast... MRI was performed to further characterize... T2 signal void, T1 iso to muscle, avidly enhancing and matching blood pool, large internal iliac artery saccular aneurysm! @BrighamRad @AURtweet @futureradres @FOAMrad @SAR_RFS @HarvardMacy @CBRadiologia @SIRRFS 😳

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Daniel Souza

@danatsouza

2 years

Cine volume-rendered reconstruction shows ill-defined hypodense, hypovascular, solid mass, arising from the pancreatic head + upstream ductal dilatation and atrophy = pancreatic ductal adenocarcinoma (PDAC). Watch out for those indirect signs, as lesions are often inconspicuous!

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10

61

Daniel Souza

@danatsouza

1 year

Marked thickened gallbladder with intramural low attenuation vs T2 hyperintense nodules and bands, mimics GB cancer, gross path (pun intended) = xanthogranulomatous cholecystitis (XGC)! @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

3

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Daniel Souza

@danatsouza

2 years

1/2 Exophytic bilobed renal cyst with thick (5 mm) irregular septation by grayscale US, noncontrast MRI shows dark T2, bright T1 contents... Bosniak IIF or III? What would you do next? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

5

16

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Daniel Souza

@danatsouza

3 years

Markedly distended fluid-filled small bowel loops ("balloons on strings" configuration) + "whirl sign" of twisted mesenteric vessels = closed-loop obstruction post RYGB. DECT shows ischemic/necrotic bowel wall... confirmed by surgery. @sar_pdar @BrighamRad @SocAbdRadiology

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Daniel Souza

@danatsouza

2 years

Sirius is the brightest star in Earth's night sky. The name means "glowing" in Greek — pancreas should be the "Sirius" organ in the abdomen on T1-weighted images. If not, think chronic pancreatitis @BrighamRad @SocAbdRadiology @sar_pdar #MedEd @futureradres @HarvardMacy

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Daniel Souza

@danatsouza

2 years

Where is the kidney? Crossed fused renal ectopia first described in 1654 by D Panarolus: a (not uncommon) congenital anomaly characterized by fused kidneys, result of disruption of embryologic migration (ascend from the pelvis) @SocAbdRadiology @JUrology @SAR_RFS @BrighamRad

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Daniel Souza

@danatsouza

1 year

[2/2] Glad you did not let that go... MRI confirms PI-RADS 5 lesion! Glazer, Davenport, et al. Focal nodular prostatic peripheral zone enhancement on CT to predict clinically significant (Gleason 4+3 and higher) prostate cancer. J Clin Oncol. 2014;32(4):173.

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Daniel Souza

@danatsouza

5 months

29-year-old female patient with history of low back pain. Diagnosis? Next step? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

2 years

Rare but described complication after partial nephrectomy due to arterial injury (usually longer procedure times) = renal artery pseudoaneurysm! Endovascular treatment with embolization. @BrighamRad @AURtweet @futureradres @FOAMrad @SAR_RFS @SIRRFS @HarvardMacy @CBRadiologia

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Daniel Souza

@danatsouza

10 months

[1/2] 30-year-old female presenting with infertility. Diagnosis? Any recommendations? (clue: ignore focal lucency/round filling defect, gas bubble) @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

10 months

[1/3] Incidental liver lesion, middle age male patient. No history of malignancy or cirrhosis. Benign or malignant? What would you do next? @BrighamRad @AURtweet @FOAMrad @SAR_RFS @futureradres @HarvardMacy @CBRadiologia #MedEd

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Daniel Souza

@danatsouza

1 year

Diagnosis? Clue: NOT brachytherapy seeds or fiducial markers!... Typical findings post Prostatic Urethral Lift ('UroLift') procedure! Monofilament devices retract enlarged prostate to open urethra. Stainless steel tab along urethra connects to nitinol tab in the outer capsule.