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Uh Ukrainian and Sudanese medical students. Is that right? Correct. Yeah. Excellent. Ok. Look, I'm really sorry to hear of the predicament in Sudan. And um, uh, the, the Ukrainian teaching has been going for about a year now and I'm hoping that whatever we deliver is really useful to you and we'll do everything we can to keep you guys on board and educated in the best way we can. So, what I'm going to do is I'm going to give you a PDF, which I'm just going to show you here. You should all get this PDF. And if you click on a link, um, case number one is a patient who's got left chest pain and dyspnea. Okay. Patient number two is a patient who has got spontaneous chest pain. And so, uh there's a lot to get through and I probably won't get through it all this morning. But I'm going to let you have a look at them at your leisure. And if you want me to give another talk to go over the rest of the cases, I'd be very happy to do that. So what you do is you click on the link and it opens in safari and, and so uh this uh then um opens that case there and if you look in the right hand corner, you can see a light blue tab. If you press on that, it gives you the history, left chest pain and dis near. Okay. So, um is there everyone able to open those cases, by the way? I'm hoping so, I've tried it through my computer and it works perfectly correct and I'm seeing yes. Is in the comments so quite lovely. Excellent. Excellent. Ok. That's great. So what I'm going to do is I'm going to give a Power Point presentation to give you the answers. But you at home on your computers can have a look through the cases in real, real time. Yeah. And uh people who are joining later probably needs the that need the link resending. So I'm going to do that for you. But if the moderator could do it from now on, that'd be, that'd be great. Lovely. I'll just resend it whenever there's new comments. Yeah. Brilliant. OK, guys. So away we go. Case number one is a patient who has got uh left chest pain and dis nail and we can see here that they've got a pneumothorax, okay. And if you look at my cursor, you can see the lung edge here and you can see an absence of lung markings. So this is an a prickle pneumothorax. Now, an april pneumothorax occurs in the apex because the patient is in the erect position. And so this is where the pneumothorax collects. Now, if the patient is in a supine position, you tend to get the pneumothorax collecting uh around the CP angle. And so what I've done is I've just drawn a diagram to demonstrate that. So this is the a prickle pneumothorax. And if the patient is in a supine position, when the X rays done, the pneumothorax tends to collect in the base, uh so called deep sulka sign. And so the costophrenic angle on the right is lower than it is on the left in this schematic diagram. And this is because the patient's got a pneumothorax in the supine position. And so this is another example of a super pneumothorax. It's a CT and this is the scout film of a CT which effectively is a Supine film. And you can see the deep costophrenic sulcus on the right hand side, there's the deep costophrenic circus on the right hand side and the patient's already got a tube going in and this lucency reflects the pneumothorax. Okay. So the deep costophrenic sulcus compared to the left hand side denotes the fact that this patient has got uh a pneumothorax in a supine position. And you can actually see the surgical emphysema in the soft tissues here. Everyone happy with that is everyone able to open that link and have a look at for themselves. Yes, sir. Okay. Number two this patient has got chest pain. Now, this is quite a subtle abnormality because the patient's chest pain is due to what we call a pneumomediastinum and that's gas in the mediastinum. Now, ordinarily, we wouldn't expect medical students or even foundation doctors to pick that up on the chest X ray, but I'm just showing it to you um to demonstrate what's a possible cause for chest pain. So this is the varietal pleura stripped off the mediastinum. And you can actually uh see this white line and the white line here. And that's a pneumomediastinum. Sometimes the pneumomediastinum uh goes between the heart and the diaphragm and it gives you what's called a so called continuous diaphragm sign. Uh And this is such a case. So this patient has got a pneumomediastinum and they've got the so called continuous star from sign and there's the continuous start from sun. Okay. So that's a sign of new memory test on um Okay. Um Somebody is having trouble opening the link. Um is that, is that everyone's experience or is it, is it just some of you are having difficulty opening the link, the majority of opened the link? But I just see one person here that got that problem. So hopefully we can solve it soon as possible. Okay. Keep on trying and uh I'll make some accommodation for those people who can't see the link. So this is pneumomediastinum and the most important question that we need to ask in somebody with the pneumomediastinum. Can anyone tell me what, what question we need to ask if it's a spontaneous pneumomediastinum? Any thoughts? Can anyone put their answer in the chat? Maybe we should have, could they breathe? Like if, can they breathe or there's the pain while breathing? Yes, they certainly get pain. But whenever I see it as a radiologist, the thing I'm most worried about is a spontaneous esophageal rupture. Um So I look for any history of vomiting which might proceed esophageal rupture. But other causes are things like asthma. You can get it with barrow trauma, secondary to um endotracheal intubation and ventilation. But this is a new memory test on um and it's distinct from a pneumothorax, they can often coexist but, but it is distinct notice. Also you can see some surgical emphysema in the left supraclavicular fossa and this is the so called continuous diaphragm sign. Ok. Case number three. Uh this patient has clearly got consolidation and where is that consolidation? It's in the right lower lobe. And the reason why it's in the right lower lobe is because I can't see the die from, but I can see the right heart border. So this increased density, this consolidation anatomically must be in the right lower lobe. And if it's in the right lower lobe, you you are probably dealing with a pneumococcal pneumonia. Okay. Now, on the chest X ray, the normal chest X ray, the right lower lobe goes over this area here. But it's also you see a little bit of the lung below the diaphragm. Now, it's not below the diaphragm. It's just projected below the diaphragm because the diaphragm is dome shaped. So some of that right, lower lobe goes below the diaphragm or projected below the diaphragm. And it, it's of interest to note that on the lateral film, you can only see the left hemi diaphragm because the right hemi diaphragm has the same density as this consolidation. And therefore, you don't see it either on the um frontal or the lateral projection. So this is a patient who's got right lower lobe pneumonia. It's a low bar pneumonia and the patient is likely to have pneumococcal pneumonia. Now, here's an interesting uh fact, if you have a right lower lobe pneumonia, sometimes you're able to see the diaphragm. And the reason why you are able to see the diaphragm in some patient's is that the consolidation occurs behind the point of contact of the X ray beam with the dome of the diaphragm. So at this point here, there's a rated lung above the diaphragm. And so you can see the diaphragm and that's because the consolidation is behind that point. Now, but if the consolidation involves the point of contact of the X ray beam and the diaphragm, you're going to lose the diaphragm. Does everyone understand that that's the concept of the silhouette sign? Yes, everyone is everyone happy with that concept. But the, the real um important thing here is that the right heart border is seen and therefore, it's not the middle lobe that's causing the problem, it's the lower lobe. So I'm going to explain this again because it's really, really quite a useful thing. The reason why we can see the heart is that the heart has a different radiographic density to the lung. The reason we can see the diaphragm interface is because the interface of the diaphragm with the lung, the diaphragm muscle has a different radiographic density to the lung. Okay. And if the consolidation is away from the point of contact of the X ray beam and the diaphragm, the diaphragm is visible because of this ray here, which is tangential to the diaphragm. Okay. And it's got aerated long above it. So the gas in the lung above it has a different radiographic density to the diaphragm. And therefore you see the diaphragm, therefore, you see the diaphragm, but the consolidation is behind this point of contact. And that's why in this particular case, you've got the consolidation and the consolidation is in the lung at the point of contact of the X ray and the diaphragm. Does that, does that make it any clearer? Yes, sir. Ok. Thank you. OK. Case number three A we've got a patient who's got a dry cough, a fever and breathlessness. And so this patient has got Pneumocystis, Jiroveci pneumonia. Now, we used to call this Pneumocystis Corini a pneumonia, but it's now been renamed Pneumocystis Jiroveci pneumonia. So, this patient is immunocompromised and he's got bilateral perry hila airspace, shadowing, it's mid and upper zone predominant. The other thing to note is that this patient does not have any plural effusions and does not have any lymphadenopathy. And that's very, very typical of PCP or PJP as we call it. And this patient was actually HIV positive and that's why they had PJP or PCP. So on the CT, you can see that it causes a ground glass appearance in the mid and upper zones and relative spurring of the lung basis. Now, there could be a situation where the patient presents with exactly the same symptoms, but the chest X ray is normal and in that situation, it's sometimes worth doing the CT scan because the CT scan is more sensitive at sharing these subtle areas of ground glass change. And if it shows the subtle areas of ground glass change, you're then dealing with uh Pneumocystis, Jiroveci pneumonia. Okay. Now, if the patient wakes up in the middle of the night, gasping for breath, they're not immunocompromised and they've got plural effusions, this could be pulmonary edema. So consolidation and ground glass change can look very similar in different pathologies. Um What we need to know is we need to know what the presenting clinical information is. So the next case case number four, we've got a patient who's got uh bilateral pleural effusions who've got these curly be lines and they've got this Batwing, Harry Harlot alveolar pulmonary edema, okay. And a batwing is supposed to look like that and there's the pleural effusion. And so after treatment, you can see that the pleural effusion will go and the peri hilar earth space shadowing will get better. So this is the same patient after treatment, but you can still see the curly be lines. Can you all see those? Can everyone see the curly be lines? Curly be lines are very small to pursue inner mattress? Yeah, I'll show you a better example in the next case. But a curly beeline just means you've got fluid in the interlobular septum and that interlobular septum is the gap between the secondary pulmonary lobules and I'll show you on the next case. So before you get bilateral alveolar pulmonary edema in heart failure, you get interstitial pulmonary edema and that manifests as interlobular septal thickening or so called curly be lines. So here are curly be lines. Can you see them here? Yeah. Yeah. Yeah, curly be lines and curly be lines due to pulmonary venous hypertension and you get fluid oozing out of the pulmonary veins. And because the pulmonary veins uh anatomically exist in these sector, this causes the interlobular sector to be thickened with fluid and they are then the curly be lines. Now, if you ever see curly be lines on a chest X ray, this is very, very strong evidence that you've got heart failure. So it's a very powerful thing in radiology. And the other thing just to let you know is that this patient has got an ET tube, which is a bit low in position. So it's just about to intubate the right main bronchus. And that needs to be withdrawn by about two centimeters. So, always look at the ET tube and make sure it's in the correct position. So they're the curly be lines and just to recap a bit of anatomy for you, hopefully, you will all know this or remember this from your early anatomical days. But the secondary pulmonary lobule consists of a bronchial and a pulmonary artery. And they are always side by side which leads to Alfio lie. And I've put the pulmonary artery in blue because it's deoxygenated hemoglobin and the pulmonary vein goes in the sector. So it goes in the, the, the gap between this pulmonary lobule and this pulmonary lobule. And the other thing that runs in the pulmonary lobules are the lymphatics. So whenever you get hungry, venous hypertension fluid oozes out of the vein. And then you get these so called curly be lines. And the other cause of curly be lines is when you get a condition called lymphangitis. And that's because the lymph vessels who's lymph fluid into the same space when they get obstructed by carcinoma or a island malignancy. So this anatomical drawing is really quite important for the radiologist and, and if you can understand this, it will help you understand better why these patient's get curly be lines. So here's the CT scan showing uh pulmonary edema. So this is interstitial pulmonary edema and you can see all these curly be lines. And the reason being is that the pulmonary veins just who's fluid in the sector which are at right angles to the chest wall. Okay. Um while uh talking, so we're about 25 minutes in. Um Do you like the format where you can scroll through the images? Yes, sir. Yeah, everyone, everyone like that. Or would you prefer a standard Power Point lecture? Great stuff? OK. Super. Okay. So uh number five, we've got a patient who's got a left lower lobe collapse and the left lower lobe collapse gives you a sail shape behind the heart. You've got volume loss and the remaining left upper lobe has got a little bit more lucency because of course, it's had to expand to occupy the space that's been vacated by the left lower lobe. Okay. And you can see that in the CT over here. So it just looks a little bit blacker than the lung on the other side. And I'm just going to play a movie and you'll see how this left lower lobe collapse looks like. So the lobe collapses towards the spine and towards the posterior part of the chest. And that's why you get this sale shape, shadow behind the heart. So this is left upper lobe and this is the solid collapsed, left lower lobe. Now, in the UK, the vast majority of patient's who present with a low bar collapse tend to have a cast member of the Broncos. So it's a very important diagnosis in this country. Now, I'm not sure whether that's the same in Sudan. It probably is the same in Ukraine. But we tend to think about endobronchial cancers. If it's not due to an endobronchial cancer, it could be due to a foreign body or a mucus plug in somebody who's got asthma. Okay. So this is a nice example of a left lower lobe collapse. And you can see that the patient has also got a little bit of consolidation in the over inflated left upper lobe. So this turned out to be a left lower lobe collapse. Uh not due to a malignancy. I think this was due to a mucus plug. Uh This is I think is an old rib fracture just there and the left lower lobe collapses by going towards the midline and towards the posterior thorax. Case five A is a patient who's got a left upper lobe collapse and it looks completely different. So it looks quite dense. You can see the aortic knuckle, but you can't see an interface because you're looking at it uh face on or on fuss. Whereas on the left lower lobe collapse example, you were looking at the profile of the collapse. Now don't get um I don't want to get too technical about why things look the way they do. But um on a pa film or a frontal film, a left upper lobe collapse will give you this hazy shadow and on a pa film, a left lower lobe collapse will give you this sale shape behind the heart. Okay. So let me play the movie and you can see that the left upper lobe collapse is going towards the mediastinum towards the anterior chest wall. And you don't really get an interface uh which is tangential to the X ray beam. Therefore, you just see increased density. Uh This patient has got a lymph node on the other side. So if you look carefully, when you come to scroll through the images, you can see that there is an enlarged lymph node on that right hand side, just the uh so this patient has got a left upper lobe collapse due to a left hilar tumor just here. And they've got a contralateral uh right Hyler lymph node and that's how the left up a load collapses. So again, just to, just to uh reiterate in the United Kingdom, these patient's who present uh spontaneously with a low bar collapse, tend in general to have a an endobronchial tumor. Now, the exception is that this is a middle lobe collapse and I know it's a middle lobe collapse because the right heart border has become invisible and then we've got increased density projected over the right mid zone. And this is because we have a collapse of the middle lobe and a collapse of the middle lobe. Although that can be due to an endobronchial tumor because it's a small bronchus, it's more susceptible to be obstructed by mucus plugs. Okay. So, uh so this is, this is very important to remember. OK. Case number six, we've got a patient who has got a continuous star from sign. Remember this, what's that sign of anyone? What's the continuous diaphragm? A sign of ghastly hilum. It's pneumomediastinum. Yeah. So we've got gas between the diaphragm and the heart and you've got this continuous diaphragm sign and you can actually see the pneumomediastinum tracking ERP into the neck and marked surgical emphysema. Now, the patient has also got a chest drain on the right hand side, uh open the second intercostal space. A chest rain in the egg zillah and another chest rain on the left hand side. So the patient's got bilateral pneumothorax, sees, they've had a tracheostomy and the positive pressure ventilation for that patient has led to bilateral pneumothorax, sees and a pneumomediastinum. And what's this tube here? That's the drainage uh new, it's a nasogastric tube. But where is it? Where is that? Nasogastric tube? It's going through tricky in. Yeah. So it's going in the trachea in the right main bronchus and then the right lower lobe broncos. So what would you do if you saw that if you saw that nasogastric tube, take it out, take it as it's not, it's out. Yeah. Take it out. Absolutely. The reason being is if somebody isn't very good that looking at chest x rays comes along and has a look at that, they may think that that's in the stomach. Now, you and I know that that's not in the stomach but somebody who isn't very good at looking at chest x rays or very experienced might on the basis of seeing that uh start feeding the patient via the NG tube, which would be a disaster. So it's got to come out and it, it came out and it was re cited over here and that's in the normal position that goes into the esophagus and into the through the gastro esophageal sphincter and then into the stomach. And you can see that the patient has still got this continuous star from sign. Okay. All happy about that. Any questions on the misplaced nasogastric tube. The patient has also got a yards uh adult respiratory distress syndrome. Uh and that's just manifesting as quite dense and global consolidation in both lungs. OK. Case six A, we've got another pneumothorax just here and the patient's got an intercostal tube in situ and this patient has gotten much bigger pneumothorax than the first case I showed you. And they've actually got a collapse of that left lower lobe. And see here this sale shape. And that's because of the pneumothorax, not because of an endobronchial lesion. And the left upper lobe is also deflating because of the pneumothorax. Now, this patient has got a pneumothorax. But can you see that the intercostal drain is not in the right place, the side hole is out here and then what's going to happen is the pressure from the gas in the pleural space goes through the tube and out through the side holes giving you this, um, surgical emphysema. Okay. So what, what do you think people need to do in order to correct that tube placement? What would you do can certainly remove it because then it could make a one day entry. We have to, we might have been readjusted. Yeah, you can readjust it. So, um depending on your experience, you could put a guidewire in and then just run it over the guidewire. Or you could ask a radiologist, would they mind helping you readjust it? But it should be able to be done at the bedside quite safely. Uh Putting the guidewire in it means that you're less likely to cause any, any trauma to any vital structures. Okay. This is a patient who had an assault. So she was assaulted. What you can't see here is that she's got a rib fracture, there's the rib fracture on the CT and she's got this very large opacity now because of the history of trauma. This is obviously a hemothorax and it's under tension because you might be able to see on the ct image that I've given you the link for the ct that there's some depression of the diaphragm and there's medicine I'll shift. And one of the things we look for in radiology, when we see blurred, we try and see a blood clot and that blood clot is called a sentinel clot. Uh and it tells you that that's worthy bleeding is likely to be coming from. And in fact, this patient had lacerated an intercourse lottery. Okay. Now, if you have a massive hemothorax and you put a chest drain in, what do you think is going to happen? It's a possible of rupturing again. So, yeah. So what's going to happen is the the increased pressure from the hemothorax, tamponade is the blood vessel and stops it to bleed. But if you start start putting a chest drain in relieving the pressure, this thing might bleed again. So, what you do need to do is you need to ask a surgeon or an interventional radiologist to consider embolize ing or ligating the intercostal artery that's bleeding. Ok. So just draining a hemothorax could be dangerous because you get a reduction in pressure in that hemi thorax and then that starts bleeding more. Okay. So that's, that's called the sentinel closs hemothorax. Now, if I didn't have the history of trauma, I could think, well, is this due to a malignancy? So it's really important that the radiologist gets a full history of what's going on so we can give you the right answer. So always make sure that your uh, radiology request forms have as much information as, as at all possible. Okay. Uh Case number eight, what have we got here? Can everyone see that we've got lung diaphragm, undersurface, the diaphragm. And then we've got this double diaphragm sign because we've got gas under the diaphragm, okay. And gas under the diaphragm equals pneumoperitoneum. And it means that you've got a perforated viscous. Now, in the UK, the commonest cause of pneumoperitoneum is a perforated Judean or ulcer. Okay. So perforated duodenal ulcer, uh the next communist cause will be a perforated sigmoid colon. So seeing both sides of the diaphragm mean that you can see that there's gas above and gas below the diaphragm. Therefore, there is no more person, name everyone, everyone. Okay with that. Do I need to explain anymore to anyone? I have a question regarding the last slide. Yeah, go ahead. You said regarding this sentinel plot. Uh We need to like it, the ruptured artery. So what we do first, we do the ablation of the ruptured artery first or we drain first or we do both do it together. Okay. So if you put a drain in the pressure inside the thorax will reduce and therefore the pressure that's blocking the artery from um, bleeding will be reduced also and it will just open up the lacerations again so that the patient will just carry on bleeding. So a certain amount of pressure in the thorax is stopping this thing bleeding. So putting the drain in first is not the right thing to do. And what you need to do is you need to stop the bleeding at the source and then put the drain in. Is that, is that clear? Yes. Yes. Ok. Great stuff. So it's new. My purse name, case number nine, we've got a saddle, pulmonary embolus and it's called a saddle because it looks like a saddle. It goes from right to left. And we've got these uh big clocks in the pulmonary artery. And the fact that the right ventricle as a larger diameter than the left ventricle means that you've got right sided heart strain. Now, does anyone know what the ECG equivalent of right sided heart strain is, uh, there's a spike you get right access deviation and you get a so called S one Q three T three. So effectively, what you're seeing here is you're seeing too much right ventricle, it's quite dilated and it's uh it's twisting and so that's called right axis deviation. And it means that the heart is under strain because of this pulmonary embolus. So as radiologists, we always look at the right ventricle and say that this is a cute thrombus in the pulmonary arteries and the heart is under strain and that's really quite a useful bit of information because when the heart is under strain, the morbidity and mortality increases. Okay. So this is uh this is a very, very important radiological sign and you'll notice that there's not very much to see on the chest X ray. And that's, that's quite a standard in pulmonary embolus. You don't see very much on the chest X ray. And so you're waiting for the CT scan to show all the, all the features and this patient had a very large saddle pulmonary embolus. Ok. Case number 10, we've got an aortic dissection. Can you all see the dissection just here? Just uh can everyone see that? That's uh yeah. And the reason why it's called Stanford A is because it's involving the A sending aorta as well as the arch. Okay. So anything that's proximal to the origin of the left subclavian artery is regarded as a Stanford a dissection. And what's the, what's the difference in treatment between a Stanford A and a Stanford? Be, is it one of them? You just give medical treatment and then the other one, you give medical and surgical treatments? Absolutely. Which one gets the surgical treatment? Is it uh be I'm not actually sure. Uh It's Stanford A Stanford A. So, so when you've got a dissection, which is very proximal, okay. So this is involving the part of the AORTA which is proximal to the left subclavian artery which comes off about here. Uh that needs a surgical treatment. And when you see uh in case 10 A, the dissection just distal to the left subclavian artery, but not involving the ascending aorta. You know that it's a Stanford be and that's treated with anti hypertensives. Um So if I just go back to the stump today, you can see here that the dissection has gone right down into the pericardium and this patient has got a hemopericardium. So this, this needs to be treated with surgery pretty quickly. Otherwise, the patient will die. Um And that's a pretty major operation, probably about 10 hour operation usually, but that's what the patient needs. And in patient, uh patient's who have Stanford type be. All you need to do here is put them on anti hypertensive therapy because hypertension is a very, very common cause of aortic dissection. Ok, elbow fusion. How am I convinced that this is elbow fusion, Casey? 11. This is a trauma to the elbow. Oh My, convinced that this is um elbow effusion doesn't, yeah. Go ahead. There is a belt here at the. So here is the anterior fat pad. There's the posterior fat pad. The anterior fat pad should be just visible anterior to the anterior cortex of the disallow humorous, but it's been splayed out like this. Okay. And the posterior fat pad should never ever be visible. And the reason why it is visible is that again, it's been pushed out by a joint effusion and the joint capsule is something like that. And so when you get a joint infusion, it pushes this one more anteriorly and it pushes this one posteriorly from this election on fossa. And so, you know, you're dealing with an elbow fusion and the commonest cause of a traumatic elbow fusion is a fracture of the radial head which you can see just there, okay fracture of the radial head, everyone happy with that. So even if you can't see the fracture, the chances are that the elbow effusion. So if you see the anterior fat pad looking like that, and if you see any posterior fat pad, you know, it's a jointer fusion and you know that it's going to be a radial head fracture. And even if you can't see the fracture, it's likely that there is a fracture there. Okay. That's a really, really important thing in trauma radiology. What's the difference between an extradural and a subdural hematoma? Well, the extradural hematoma is len shaped. So biconvex and it's limited by the coronal suture and the landlord suture, simply because the giraffe it's stuck to the suture. And so any bleed that doesn't cross the suture line must be an extradural hemorrhage, okay. And it's almost always caused by a damage to a branch vessel of the middle meningeal artery. So it's often associated with fracture, but not always. And and this is um this is the so called biconvex or lens shaped, extradural hematoma. And classically, the patient has a lucid phase followed by a phase where they become um disorientated, confused, etcetera. So that's an extra Juul hematoma and that needs to be treated pretty quickly. Okay. Now, a subdural hematoma will look very different to that. I'm just going to, I'm just going to show you a subdural hematoma. Um just bear with me there. It is. Can you see how that differs from the extradural hematoma? This crosses the corona suture, it crosses the landlord suture and it looks somebody said like a banana, which I think is a really good description. Uh And it's called concave convex. Uh This is a subdural hematoma and the one I showed you on the power point presentation is of course, uh an extradural hematoma because it doesn't cross the futures. And the two are really quite different in the anatomy, but both need a neurosurgeon to drain them. Okay. 13. Now, this patient has got a subarachnoid hemorrhage which you can see here, there's blood in the full fed trickle, there's blood in the sylvian fissure and excuse me, there is a thrombosed middle cerebral artery. So the subarachnoid blood here, subarachnoid blood here. This is caused by a rupture of the middle cerebral artery which is aneurysmal. Uh I've called an MC A. So it's a middle syllable artery aneurysm which has caused subarachnoid hemorrhage and a subarachnoid hemorrhage, unlike and extradural receptible hemorrhage. You get blood in between the soul sigh covering the brain and in the interpret uncle er system and it's not unusual for the blood to go into the ventricles and it's called an intraventricular extension. Okay. I'm going to finish on that film there. Uh, we've got another 10 cases to go through or maybe a bit more than 10. Um, so I think I need to give you another talk but that's only if you want me to, um, if you don't want me to, that's fine. But at some other point, I will, I'll go through the rest of the cases. Uh Just a bit of feedback for me. Um Do you like the fact that you can scroll through the images on the links that I've given you? Yes, sir. Is that a really good thing or have you ever ever experienced that before? No, it's a good thing. No. So it's a, it's a new, it's a new concept for you. Um Well, I hope you found that useful. Um I um very happy to go through the rest of the cases at some other uh point. I'll, I'll ask the organizers if you want me to, I'll get another date in the diary and if anyone has any questions or any requests for the next time, um If you can let them know and I will, I will see if I can produce some images for you which will enable you to understand radiology bit better. Is that okay? Great stuff? OK. Well, I'm seeing a lot of positive feedback. Professor. Such an amazing presentation, I have to say, to be honest. Okay. Well, that's very kind. Thank you. Thanks for your attention. I hope you will stay safe. And the most important thing from our point of view is that nobody has forgotten about you. Uh We will teach you anything and everything whilst you're undergoing these terrible conflicts. So, um we haven't forgotten about you and the very fact that we are um you know, teaching you in our small way, it means that you are not forgotten. So, thanks for your attention. Thank you very much. Professor has no questions for the professor today. I thank everyone for joining and I thank you as well for this amazing presentation again, professor. And I do hope you have a lovely day. Thank you e too. Goodbye.