Your SlideShare is downloading. ×
NERRS Abd Rad Answers 2012
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

NERRS Abd Rad Answers 2012

496

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
496
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Unknown histogenesis, progesterone receptors
  • Transcript

    • 1. NERRS Case 145-year-old man with chronic low grade fevers and right upper quadrant pain Paul B. Shyn, MD
    • 2. NERRS Case 1 HEPATIC FASCIOLIASIS zoonotic disease (liver fluke Fasciola Hepatica) end host sheep or cattle, int host freshwater snail found in humans “by chance” who have ingested contaminated watercress or water 2 stages: the hepatic (acute, invasive) stage and the biliary (chronic, obstructive) stage serologic confirmation or eggs in stool is mandatory for a final diagnosis Diagnostic imaging in the study of human hepatobiliary fascioliasis. Cantisani V, Cantisani C, Mortelé K, et al. Radiol Med. 2010;115(1):83-92.
    • 3. NERRS Case 1 HEPATIC FASCIOLIASISSonography  non-specific, hypoechoic subcapsular areasCT  single or multiple hypodense nodular areas or tunnel-like branching or tortuous peripheral hypodensities (penetration of parasite through Glisson’s capsule) + capsular enhancement Diagnostic imaging in the study of human hepatobiliary fascioliasis. Cantisani V, Cantisani C, Mortelé K, et al. Radiol Med. 2010;115(1):83-92.
    • 4. NERRS Case 1 HEPATIC FASCIOLIASISMRI  capsular hyperintensity on T2 weighted images  multiple peripheral lesions, hyperintense on T2 and peripheral prgressive enhancementDD schistosomiasis, echinococcosis, toxocara cholangitis, liver abscesses Diagnostic imaging in the study of human hepatobiliary fascioliasis. Cantisani V, Cantisani C, Mortelé K, et al. Radiol Med. 2010;115(1):83-92.
    • 5. NERRS Case 229-year-old female with left upper quadrant discomfort Christina LeBedis, MD
    • 6. NERRS Case 2 DIAGNOSIS & DISCUSSION• Diagnosis solid pseudopapillary tumor solid & papillary epithelial neoplasm (SPEN) “DAUGHTER”• Clinicodemographic Features benign (85%) or low grade malignant young women (85%, age 25y) no race & location predilection
    • 7. NERRS Case 2 IMAGING FEATURES• Classic Appearance solitary large (mean 9.3 cm) well demarcated capsule solid & cystic areas hemorrhage calcifications (30%)
    • 8. NERRS Case 2 IMAGING FEATURES• Solid pseudopapillary carcinoma (15%) size lesion (> 5 cm ?) and age not different male gender duct obstruction vascular invasion metastatic disease  5-year survival 96%
    • 9. NERRS Case 2 DIFFERENTIAL DIAGNOSIS• Encapsulated Pancreas Lesions Mucinous Cystic Neoplasm Pancreatic Endocrine Tumor Pancreatic Pseudocyst Sugar Tumor (PEComa)
    • 10. Rare Cystic Tumors ENDOCRINE TUMORS body and tail, middle age 75% sporadic, 25% MEN-1 most tumors “functioning” “hyperfunctioning”, “functional”, or “syndromic” cystic endocrine tumors 56/133 (42%) cystic or areas of necrosis larger than solid lesions (8.4 cm vs 2.9 cm) especially non-syndromic (36/56)
    • 11. NERRS Case 334-year-old female with recurrent right upper quadrant pain Kathleen McCarten, MD
    • 12. NERRS Case 3 CAROLI DISEASE What ?  congenital ductal plate abnormality  saccular dilatation of the bile ducts  communicating with biliary tree  segmental (>) or diffuse  associated abnormalities medullary sponge kidney renal tubular ectasia congenital hepatic fibrosis (Caroli Syndrome)
    • 13. NERRS Case 3 CAROLI DISEASEMRIductal dilationintrahepatic onlycommunicatingsaccular bile ducts« eye of the tiger »« central dot »
    • 14. NERRS Case 3 OTHER CHOLEDOCHAL CYSTS congenital cystic dilatations of ducts > anomalous common channel pancreatic juice reflux prevalence much higher in Japan (1/1,000) versus US (1/130,000) 8:1 female predominance 60% present before age 10 De Wilde VG, et al. Choledochal cysts in the adult. Endoscopy (1991) 23:4-7
    • 15. NERRS Case 3CHOLEDOCHAL CYSTS - TODANI • Type I - solitary fusiform extrahepatic • Type II - extrahepatic supraduodenal diverticulum • Type III - choledochocele • Type IV - multiple extrahepatic cyts or intra + extrahepatic • Type V - Caroli’s disease
    • 16. NERRS Case 447-year-old female with abdominal pain and fever Suzie Yi Huang, MD
    • 17. NERRS Case 4 ECTOPIC PANCREAS usually 0.5 cm - 2 cm [rarely up to 5 cm] incidence varies location (> submucosa [50%])  most commonly stomach (26- 38%), duodenum, jejunum (16%), Meckel diverticulum or ileum  rare in colon, esophagus, gallbladder, bile ducts, liver, spleen, umbilicus, mesentery, mesocolon, omentum usually asymptomatic stenosis, ulceration, bleeding, invagination, ca
    • 18. NERRS Case 543-year-old female with pelvic pain and rectal bleeding Frank Scholtz, MD
    • 19. NERRS Case 5 SIGMOID ENDOMETRIOSIS 6-10% of female population; retrograde menstruation 10% GI involvement (deep endometriosis) extensive fibrosis, little endometrial-like cells iso-intense to muscle on T1- and T2-WI “mushroom cap” sign on T2-weighted images rarely progressive, rarely recurrent DD: adenoca – treatment: hormonal or surgery Evaluation of colonic involvement in endometriosis: double- contrast barium enema vs. magnetic resonance imaging. Faccioli N, Foti G, Manfredi R, et al. Abdom Imaging 2010;35(4):414-21.

    ×