Today’s MRI: Posterior Reversible encephalopathy syndrome (PRES)

Posterior reversible encephalopathy syndrome (PRES) (also known as hypertensive encephalopathy) is a neurotoxic state that occurs secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. Hyperperfusion with resultant disruption of the blood brain barrier results in vasogenic oedema, but no infarction, most commonly in the parieto-occipital regions.

It should not be confused with chronic hypertensive encephalopathy (aka hypertensive microangiopathy) which results in microhemorrhages in the basal ganglia, pons and cerebellum.

Learn more at


Imaging Signs – The Continuous Diaphragm Sign

The CXR below shows central sub-diaphragmatic lucency (continuous diaphragm sign) in keeping with pneumoperitoneum.

Continuous Diaphragm Sign

Imaging Sign of the Day – Soft-tissue Rim Sign

Soft-tissue rim sign – helpful in distinguishing a ureteric stone from a phlebolith on CT imaging. Ureteric stones appear as a calcific density with a surrounding rim of soft tissue representing the oedematous ureteric wall (red arrow). Phleboliths on the other hand usually have imperceptible walls and therefore they appear to be surrounded by fat (green arrow). Occasionally phleboliths have a tail of remnant parent vein associated with one edge known as the comet-tail sign.

Soft tissue rim sign

Imaging Sign of the Day: Tree in Bud Sign

Tree in bud sign – describes the CT chest appearance of multiple centrilobular nodules that are connected by branching opacified bronchioles. Although initially described in patients with endobronchial tuberculosis, it is now recognized in a large number of conditions ranging from small airways infections like mycobacterium avium complex, to connective tissue diseases like rheumatoid arthritis, to neoplastic conditions like bronchioloalveolar cell carcinoma.

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Ultrasound: Everyone’s doing it!

Ultrasound is a burgeoning area of internal medicine. It’s just not for radiologists anymore.

Multiple specialties are identifying ways to utilize this minimally invasive imaging tech to improve clinical care.

Here’s a blog post about the topic of Ultrasound curriculum for Internal Medicine


Here’s a really cool resource if you’re interested in Ultrasound

It’s a compilation of small ultrasound snippets of clinical findings



How to Read a Chest X-ray

Below is a brief tutorial on how to read a chest x-ray

Ring-enhancing Lesions

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