Through the Eyes of a Radiologist

Lesson : One

See the big picture & Avoid obsessing over distracting detail



This masterpiece was one of a commissioned series representing the seasons of the year.
The other four remaining works are: “the gloomy day,” “hunters in the snow,” and
“the return of the herd” (Kunsthistorisches museum, Vienna);
And “haymaking” (Lobkowicz palace, Prague castle).

This remarkable group of pictures is a watershed in the history of western art.
These large humanistic landscapes are a drastic departure from early religious
renaissance iconic works. Brueghel painted people as they truly are,
unidealized yet treated with a profound compassion and sensitivity.

If one focuses solely on the peasants in the foreground.

One may miss the port in the background, reflecting an integral part of society at large.

Clinical scenario

Fixation on a large cerebral hemorrhage… 


Axial noncontrast CT of 46 y/o female with headache shows large
intraparenchymal hemorrhage with associated subarachnoid components.
There is mild left to right shift with mass effect on the right lateral ventricle.

 …may detract from a more emergent finding

At a lower level, there is complete effacement of the basilar cisterns.


Companion Case




…the massive ruptured aneurysm


3-dimensional reformatted image from a CTA of the circle of Willis reveals a
giant middle cerebral artery bifurcation aneurysm. Observe the subtle avascular
mass effect on the anterior cerebral arteries (large arrow). 
The nipple sign
(small arrow) demarcates the site of aneurysm rupture and origin of the hemorrhage. 

One may forget to consider an aneurysm upon confronting a large
parenchymal bleed, however the subtle presence of subarachnoid
blood in the sulci should raise one’s suspicions.


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