This document discusses several unusual CT manifestations of common abdominal diseases:
1. Solitary rectal ulcer syndrome appears as a solitary linear ulcer on rectosigmoidoscopy in young patients with rectal bleeding.
2. Giant ulcers in the ileum and colon seen on CT in AIDS patients are caused by cytomegalovirus.
3. Ovarian torsion presents on CT as an adnexal mass rotated to the midline and contralateral side with deviation of the uterus and free fluid. The twisted vascular pedicle may also be seen.
4. Chemotherapy-induced pseudocirrhosis appears on CT as diffuse hepatic fibrosis without masses in patients receiving chemotherapy for cancer.
CARCINOMA ESOPHAGUS - DR ZAHID IQBAL MIR
Dr. Zahid Iqbal Mir, MBBS MS (General Surgery), DNB (General Surgery) has done his MBBS and masters in General Surgery from the prestigious Govt Medical College Jammu and DNB in General Surgery from NBEMS New Delhi. He is a passionate surgeon, earlier practising at Government Medical College, Jammu as Registrar in Department of General Surgery. Nowadays working as Senior Resident in Department of General Surgery, Government Medical College & Hospital, Sector 32, Chandigarh and a rising name in field of surgery.
He is an enthusiastic, enigmatic and dedicated teacher as well. He is not just a resolute learner, but also an awe inspiring guiding light for his juniors, which makes him the most loveable and respected senior.
Currently he is running “LOVE FOR SCALPEL” for PGMEE aspirants on most of the social platforms, which is gaining immense popularity among residents, medical graduates and undergraduates.
Il trattamento chirurgico del colangiocarcinoma - Gastrolearning®Gastrolearning
Gastrolearning II modulo/8a lezione
Il trattamento chirurgico del colangiocarcinoma
Prof. Gian Luca Grazi - Hepato-Biliary-Pancreatic Surgery National Cancer Institute Regina Elena, Roma
CARCINOMA ESOPHAGUS - DR ZAHID IQBAL MIR
Dr. Zahid Iqbal Mir, MBBS MS (General Surgery), DNB (General Surgery) has done his MBBS and masters in General Surgery from the prestigious Govt Medical College Jammu and DNB in General Surgery from NBEMS New Delhi. He is a passionate surgeon, earlier practising at Government Medical College, Jammu as Registrar in Department of General Surgery. Nowadays working as Senior Resident in Department of General Surgery, Government Medical College & Hospital, Sector 32, Chandigarh and a rising name in field of surgery.
He is an enthusiastic, enigmatic and dedicated teacher as well. He is not just a resolute learner, but also an awe inspiring guiding light for his juniors, which makes him the most loveable and respected senior.
Currently he is running “LOVE FOR SCALPEL” for PGMEE aspirants on most of the social platforms, which is gaining immense popularity among residents, medical graduates and undergraduates.
Il trattamento chirurgico del colangiocarcinoma - Gastrolearning®Gastrolearning
Gastrolearning II modulo/8a lezione
Il trattamento chirurgico del colangiocarcinoma
Prof. Gian Luca Grazi - Hepato-Biliary-Pancreatic Surgery National Cancer Institute Regina Elena, Roma
Cholangiocarcinoma: Pathology, diagnosis and treatment.Marco Castillo
A brief description with many abdominal imaging of the Cholangiocarcinoma.
Includes definition, epidemiology, pathology, classification, clinical presentation, diagnosis, staging and treatment.
Pancreatic carcinoma is the most dreaded cancer with very dismal prognosis. It is characterized by obstructive jaundice, high colored urine and clay colored stool.
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Gastric Cancer - Deifinition , epidemiology , histological types and molecular genetics and WHO update
Reference - WHO Classificiation of tumors of Digestive system
Rosai and Ackermann
Cholangiocarcinoma: Pathology, diagnosis and treatment.Marco Castillo
A brief description with many abdominal imaging of the Cholangiocarcinoma.
Includes definition, epidemiology, pathology, classification, clinical presentation, diagnosis, staging and treatment.
Pancreatic carcinoma is the most dreaded cancer with very dismal prognosis. It is characterized by obstructive jaundice, high colored urine and clay colored stool.
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Gastric Cancer - Deifinition , epidemiology , histological types and molecular genetics and WHO update
Reference - WHO Classificiation of tumors of Digestive system
Rosai and Ackermann
Pancreatitis -a detailed study ( medical information )martinshaji
Pancreatitis is the Inflammation of the pancreatic parenchyma. Acute condition of diffuse pancreatic inflammation & auto digestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood &urine. this is a detailed study pancreatitis describing factors such as definition , epidemiology , etiology , pathophysiology , treatment , prevention , imaging techniques , diagnosis , lab investigations , images , drugs , control etc
please comment
thank u
All you need to know about peri-ampullary cancer
Periampullary cancer is a common diagnosis with patient with progressive jaundice in northern part of India
Timely diagnosis and proper treatment in a way towards cure
Choledochal cysts should be considered in the differential diagnosis in all patients with a history of biliary colic, recurrent cholangitis or pancreatitis with associated dilatation of bile duct, particularly if they are <40 years of age. Delay in the diagnosis increases the incidence of associated biliary pathology and suboptimal surgical therapy
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
4. Solitary rectal ulcer Syndrome:
• occurring mainly in young patients who experience rectal
bleeding
Giant ulcers in ileum and colon by citomegalovirus :
• in AIDS patients
• Feczko PJ et al. AJR 1980
• Balthazar EJ. AJR 1996
- Carcinoma
11. At surgery and pathologic analysis, the ovary was hemorrhagic and necrotic
12. - Ovarian torsion is the twisting of an ovary on its ligamentous supports
- Concomitant ovarian and tubal torsion (adnexal torsion) occur in up to 67% of
cases
- It is generally considered an acute condition (subacute…)
- All ages
- Reproductive years (pregnancy: 5-fold – first trim.)- highest prevalence
Predisposing Conditions
- Large (>5 cm) cysts and cystic neoplasms (benign mature cystic teratomas….)
- Ovarian hyper- stimulation syndrome
- Normal ovaries (usually right ovary) in adolescent or teenagers
- Non-specific symptoms and laboratory tests. DD: PID, appendicitis…..
- Imaging plays a central diagnostic role (ovary-sparing)
Ovarian torsion
. Chang HC et al. RadioGraphics 2008
. Appelbaum HL et al. AJR 2007
. Rha SE et al. RadioGraphics 2002
13. Ovarian torsion Imaging findings
US
Color Doppler
- Complex adnexal mass
- Unilateral enlarged ovary (>4 cm)
- String of pearls sign: Multiple peripheral cysts
- Free pelvic fluid (8%)
- Decrease or absence of venous flow (93%)
- Absence of arterial flow (60-73%)
- Ovaries without flow in the vascular pedicle
- Twisted vascular pedicle: (circular vessels: “whirlpool sign“)
14. Ovarian torsion Imaging findings
CT
- Adnexal mass in the midline, rotated towards the contralateral side of the pelvis
- Deviation of the uterus to the side of the affected ovary
- Free fluid
- Necrosis seems to be the cause of a cystic appearance on CT
15. T2 FSTIRT2
Ovarian torsion Imaging findings
MR - Pregnant women, young girl
- MR imaging is recommended to help detect the twisted vascular pedicle
(“whirlpool sign“) or in patients with a suspected ovarian mass.
16. Take home message: Ovarian torsion in
a “women in their reproductive years”,
without an underlying mass
17. 49 y-old woman, breast cancer
Liver and bone metastasis (IV)
CHT induction and consolidation
No hepatic masses
Chemotherapy-induced pseudocirrhosis
Control: 20 weeks later
20. radiology.rsna.org n Radiology: Volume258:Number1—January2011
normally instruct the cell to grow and
divide. Hence, it acts as a tyrosine kinase
inhibitor. Important to notice is a recent
discovery that cetuximab is active only
in tumors that are wild type for KRAS
(3). The exact mechanism of action is
unclear, as cetuximab recently demon-
strated antitumor activity in patients
with colorectal cancer whose disease
g. Peripheral nerves
, cisplatin, taxanes),
n and gemcitabine),
n), heart (eg, anthra-
tral nervous system
hotrexate, 5-FU) are
s (Table 3).
apies have developed
proved knowledge of
ey target cell surface
case of monoclonal
ous signaling mole-
of kinase inhibitors).
ents affect multiple
ore, have the poten-
cules that are critical
hways, causing toxic-
n previously observed
the toxicities of the
molecularly targeted
here is concern that
Publishedonline
10.1148/radiol.10092129 Content Code:
Radiology2011; 258:41–56
Abbreviations:
EGFR= epidermal growthfactor receptor
5-FU= fluorouracil
TKI= tyrosinekinaseinhibitor
VEGF= vascular endothelial growthfactor
L.H.S. hasdisclosedfinancial relationshipswith
AstraZenecaandNovartis.
21. Peripheral edema
Weight increase
Pleural and Pericardial
effusions
Ascites
Capillary protein leak syndrome
Ascites alone, should not be mistaken for disease progression
22. Peritoneal carcinomatosis from ovarian tumor
Failed available standard CHT
“Double blind” Trial : Placebo / Antiangiogenic
CT, basal CT, 9 weeks
23.
24. A- Intestinal obstruction and perforation
B- Partial response with gastric metastases
C-Partial response with peritoneal carcinomatosis
D- Partial response and GI perforation
25. Oral contrast media extravasation
GI perforation secondary to
the Antiangiogenic agent
26. 160 patients
The pathogenesis of bowel perforation is unknown, but
suggested mechanisms include ischemia with
thrombosis of intestinal mesenteric vessels
27. Acute B-L Leukemia
CHT: Since day +35 coincident with medullary recovery:
Fever and facial rash and oedema . Cultures: (-)
Fever and facial rash and oedema disappeared with
high doses of steroids
28. • Pneumatosis Coli
• Pneumoperitoneum
Rutinary follow-up
• Minimal abdominal pain and
distension
• No peritoneal signs, fever, or
leukocytosis
30. “ Pneumoperitoneum usually
denotes a perforation of an
intra-abdominal viscus, but in
about 10% of patients, a
nonsurgical source is responsible
for free air in the peritoneum”.
31. • Mularski RA. et al. Crit Care Med 2000
• Mularski RA. et al. West JMed 1999
32. • Heng Y et al. Am J Gastro 1995
• Liu DM. Can J Emerg Med 2003
Pneumatosis
Type
Characterization Asociation Surgical
treatment
Microvesicular
pneumatosis
Small collections of air within
the lamina propria
Associated with invasive
procedures
-
Cystic
Pneumatosis
Macroscopic submucosal
cysts
(mm-cm)
- Pneumoperitoneum
. 10% of patients with small
bowel pneumatosis
. 2% of those with large
bowel pneumatosis
• COPD
• Immunosupression
therapy (haematologic)
• Bevacizumab
• Immunocompromise
• Steroid usage
• Inflammatory bowel
disease
• Post bone marrow
transplantation
-
Linear
Pneumatosis
Represent the tracking of gas
through compromised
submucosa
. Bowel ischemia or infarction +
34. • Take home message
• To be aware of possible
CHT toxicity manifestations
We should look for, not only
on images but in the clinical
history to help distinguish
new-onset toxicity from
disease progression.
• Reporting CHT toxicity
findings to the oncologist is
important, in order to choose
to discontinue therapy
39. CT characteristics Exophytic renal
angiomyolipoma
Well-differentiated liposarcoma
Defect in the Renal Parenchyma + -
Vessels in the Lesion +
(enlarged internal vessels with
aneurysm formation)
-
Additional Angiomyolipomas + +/-
Size Usually larger
40. • Careful evaluation enables accurate
differentiation of large exophytic
angiomyolipomas and well-differentiated
retroperitoneal liposarcomas
Take home message:
41. Arthrosis for several years treated with NSIDs
Neutropenia. Medulary biopsy: normal
Hepatomegaly, abnormal liver function test and jaundice
(total bilirrubin: 14 mg)
GP: requested an abdominal CT
42.
43. A- HCC
B- Hipervascular Metastasis
C- Vasculitis
D- A-V shunt
We recomended a hepatic biopsy and antibodies determination in
order to diagnose any reumatoid disease.
44. Cronic hepatitis with severe
inflammatory activity
Necrotic Arteritis in medium
size hepatic artery
Autoimmune Hepatitis, Aneurism
Outcome: normalization of all
parameters after appropriate treatment
Liver Aneurysm
ANA(+)/ ENA(+)/ antiSSA(+)
LES
45. —58-year-old man with polyarteritis nodosa.
Tarhan N C et al. AJR 2003;180:1617-1619
46. HEPATIC
INVOLVEMENT
- Hepatomegaly is seen in 39% to 40%
- Steatosis due to glucocorticoid therapy or to SLE itself
- Arteritis (21%) of SLE
- Nodular regenerative hyperplasia of the liver, is a rare but important
complication of SLE associated with noncirrhotic portal
hypertension.
- Autoinmune hepatitis. The most common one, is the classic
“lupoid hepatitis” with chronic active hepatitis
• Up to 4,7% of patients with SLE have chronic active hepatitis
• Up to 10% of patients with Autoinmune hepatitis have SLE
47. INTESTINAL VASCULITIS
GASTRIC INVOLVEMENT
COLON AND SMALL BOWEL
INVOLVEMENT
INTESTINAL
PSEUDOOBSTRUCTION
PANCREATIC AND
GALLBLADDER INVOLVEMENT
PERITONITIS AND ASCITES
MALABSORPTION AND
PROTEIN-LOSING
ENTEROPATHY
- In 53% in those with active SLE and abdominal pain. Involves small arteries
- CT: shows ischemic bowel disease
- Opportunistic infections (eg. Mucormycosis) may mimic GI vasculitis and should
be suspected in these immunocompromised patients with not active LES
- Perforation from peptic ulcer disease ( 6% to 8%)
- Pernicious anemia
- Pneumatosis cystoides intestinalis (benign pneumoperitoneum)
- Necrotizing enterocolitis
- CMV enteritis, prone to salmonella infection
- Intestinal obstruction without a mechanical cause. Initial manifestation of lupus (
41% to 50% .
- Associated urinary tract involvement with ureterohydronephrosis, suggesting a
smooth muscle dysmotilityand secondary vesiculoureteric reflux or to fibrosis of the
ureterovesicular junction. One- third of patients have interstitial cystitis
- Recurrent pancreatitis occurs in 43% of patients. Chronic pancreatitis in 14%
- Primary sclerosing cholangitis and autoimmune cholangiopathy.
- Acute pancreatitis is a rare. Associated with thrombosis and cutaneous vasculitis.
- Ascites from infection, bowel infarction, perforation, pancreatitis, mesenteric
vasculitis, or serositis.
- Chronic ascites lupus can be due to nephrotic syndrome, heart failure, protein-
losing enteropathy, constrictive pericarditis, lupus peritonitis, or indolent infections
such as tuberculosis.
48. ‘‘Hepatic disease may be more common in SLE than is usually thought
and we should be aware of it ”
* Abraham S. Ann Rheum Dis 2004
** Ebert EC. J Clin Gastroenterol 2011
Patients with liver disease should be treated as soon as possible,
especially those patients with jaundice or persistent increase of liver
enzymes values”
Take home message:
49. CASE 8: 65 year-old woman
Left lumbar pain, fever, leukocyturia and WCC rise, … suggesting acute Pyelonephritis
Fecaluria and pneumaturia
• History: pelvic surgery, radiotherapy and chemotherapy
Dec-2007
50. CT 6 months before, Post-surgery, RT and CHT April-2007
52. A- Bladder tumor and ureteral infiltration
B- Colon cancer
C- Ovarian cancer
D- Ureteral tumor and colonic invasion
The patient has an acute pyelonephritis secundary to an ureteral fistula
56. Fistulas in Malignant Gynecologic Disease
- As a result of a primary or recurrent tumor
- As a consequence of:
Surgery (particularly if the surgical procedure is radical and complex or
if the surgical field includes previously irradiated tissue)
Radiation therapy (eg, cervical, colorectal, endometrial cancer)
Types:
- Vesicovaginal and enterovaginal fistulas (more frequent)
- Ureterovaginal, enterovesical, enterocutaneous, and uretero-alimentary
tract
. Narayanan P et al. RadioGraphics 2009
. Yu NC et al. RadioGraphics 2004
59. - Ureterocolic fistulas are most common and can be caused by urinary
calculi, iatrogenic trauma, diverticulitis, radiation therapy, transitional cell
carcinoma, and tuberculosis
• Symptoms: flank pain, hematuria, recurrent urinary tract infections,
pneumaturia, fecaluria, and diarrhea
• Diagnosis: Retrograde pyelography, and contrast-enhanced CT: Gas in the
ureter
Barium studies of the intestinal tract often will not reveal the
fistula
Uretero–Alimentary Tract Fistula
60. - Right ureter: terminal ileum, cecum, appendix,
and ascending colon and their mesenteries
- Left ureter: descending colon and sigmoid
colon and their mesenteries
- Either ureter may be injured during surgery, or
radiation performed on these structures, or
engulfed in an adjacent mass
. Avritscher R et al. RadioGraphics 2004
I would add: The ovary
Take home message:
61. CASE 9 : 24 year-old man. Down Syndrome
No abdominal complaints
Abdominal mass (at manual exploration)
Right mass effect that displaces right
abdominal structures
69. Down Syndrome Cancer Incidence in DS
Leukemia
Testicular cancer
Other cancers
- Acute lymphocytic
- Acute non-lymphocytic
- 19-fold higher
- Seminomatous (gonadal and extragonadal)
- 50-fold higher (0.5% compared with an expected incidence of 0.087%
in the general population)
- Non-Hodgkin lymphoma, stomach, colon, small intestine, breast,
endometrial, brain, kidney, liver cancers…
* Hill DA et al. Arch Intern Med. 2003 … N: 4872 (DS)
** Goldacre MJ et al. Arch Dis Child 2004 ....N: 1453 (DS)--- 460 000(NDS)
*** Rima d et al. European Journal of Medical Genetics 2006
**** Cools M et al. Human Pathology 2006
70. • Because of improvement in medical care, a higher proportion of children
with DS are now surviving beyond adolescence
• Therefore, more patients reach the predisposition age range when
testicular cancer is most prevalent (35 years)
• Testicular palpation in this population should be considered a
component of routine physical examination
Take home message:
Ocasionally takes a subacute or intermittent chronic course. Understanding the imaging appearance of ovarian torsion will lead to conservative, ovary-sparing treatment.
Ascites alone should not be mistaken for disease progression.
The incidence of bevacizumab- associated gastrointestinal perforation is slightly higher in cases of ovarian cancer. than in those of colon cancer (5.4% vs 1.7%)
surgicalemergency
Pneumatosiscystoidesintestinalis is characterized by multiple intramural gas-filled cysts that may be throughout the gastrointestinal tract but are most commonly found at the terminal ileum. The condition is generally benign and asymptomatic .Pneumatosiscystoidesintestinalis is generally found in conjunction with other primary disease processes,
chronic obstructive pulmonary disease (COPD).Reporting this finding to the oncologist is important, because he or she may choose to discontinue therapy.
May grow to be large and bulky, extending into the perinephric space (exophytic or extrarenalWell-differenciated subtype (perinephric space)
Liposarcoma and exophytic renal angiomyolipoma. On occasion, their appearances may be so similar that they can be confused on imaging and even sometimes at histologic examination. However, their differentiation is important because the prognosis and treatment are different. For liposarcomas, surgical resection—usually with the adjacent kidney—is necessary. Angiomyolipomas, may hemorrhage and require emergent treatment (embolization or surgery) if life-threatening bleeding occurs, but they do not necessarily require surgery.
NonsteroidalAntiinflammatory Drugs (NSAIDs)
Residual mass
Ovarian carcinoma (Transitional Type. GIII, PT1c. FIGO I). At surgery the tumor was confined to the ovary. There was neither ureteral nor bowel infiltration
Ovarian carcinoma (Transitional Type. GIII, PT1c. FIGO I). At surgery the tumor was confined to the ovary. There was neither ureteral nor bowel infiltration
Fistulas may occur Radiation therapy may precipitate fistula formation by inducing progressive Endarteritisobliterans, whichmayresult in necrosis and breakdown of mucosalsurfaces.and these fistulas mayoccur up to 30 Fistulas also may develop as a complication
CT cistography
Right ureter is related to the
19-fold higher (95% CI. 10.4 to 31.5) than the rate in the comparison cohort. For other cancers combined,