This document summarizes various pathologies of the adrenal glands that can be seen on imaging. It describes pheochromocytomas, Conn's adenomas, Cushing's adenomas, adrenal carcinomas, adrenal metastases, and other rare conditions. Radiographic features are provided for each condition, including characteristics seen on CT such as enhancement patterns, size, and presence of necrosis. MRI features such as T1 and T2 signal are also summarized. Differential diagnoses and clinical associations are discussed. Images are included to illustrate key radiologic findings.
The document summarizes the anatomy, physiology, and imaging features of adrenal gland masses. It discusses incidental adrenal masses and describes the radiographic appearance of functioning tumors like pheochromocytoma and Conn's adenoma. It also covers malignant tumors such as metastases, adrenal carcinoma, and lymphoma. Pheochromocytomas appear large and heterogeneous with contrast enhancement on CT and MRI. Metastases are often bilateral, irregular, and heterogeneous. Adrenal carcinoma typically presents as a large mass with necrosis, calcifications, and heterogeneous enhancement.
This document discusses pulmonary tumors, including:
1. It categorizes pulmonary tumors into malignant tumors, low-grade malignancies, and benign tumors. The main malignant tumors discussed are bronchogenic carcinoma, bronchoalveolar carcinoma, lymphoma, metastases, and rare sarcomas.
2. Bronchogenic carcinoma is further broken down by classification, risk factors, location, and radiographic findings. The classifications include adenocarcinoma, squamous cell carcinoma, small cell carcinoma, large cell carcinoma, and adenosquamous tumor. Cavitation and air bronchograms are among the key radiographic findings.
3. Pancoast tumors, a type of superior sulcus tumor, are defined as tumors located
1. The document discusses various pathologies that can present as soft tissue masses in the perinephric space, including nephroblastomosis, retroperitoneal fibrosis, Erdheim-Chester disease, extramedullary hematopoiesis, lymphoma, metastases, and focal solid lesions.
2. It also describes fatty lesions such as angiomyolipoma, liposarcoma, and myelolipoma that can occur in the perinephric space.
3. Cystic lesions including lymphangiomas are also mentioned.
4. Abscesses and infections like acute bacterial pyelonephritis and xanthogranulomatous pyelonephritis are noted as
This document provides an overview of renal tumors, including:
1. It classifies renal tumors into 4 categories: renal parenchymal tumors, mesenchymal tumors, renal pelvis tumors, and secondary tumors.
2. Details are given for common renal parenchymal tumors like renal cell carcinoma (RCC), oncocytoma, Wilms tumor, and others. Radiographic features and diagnostic criteria are described.
3. Uncommon tumors are also briefly discussed, such as mesoblastic nephroma, clear cell sarcoma, and reninoma.
4. Imaging findings on modalities like ultrasound, CT, MRI, and angiography are summarized for many of the tumor
The document discusses imaging of adrenal masses. It provides details on the anatomy and histology of the adrenal glands. Computed tomography (CT) is described as the primary imaging modality for evaluating adrenal gland morphology and masses. CT characteristics such as density measurements on non-contrast scans, enhancement patterns on contrast scans, and washout percentages are used to differentiate benign and malignant adrenal lesions. Magnetic resonance imaging (MRI) techniques such as chemical shift imaging can also help in characterization. The document outlines approaches for characterizing incidentally detected adrenal masses and differentiating functional from non-functional lesions.
This document discusses malignant liver lesions. It describes the different types of primary and secondary malignant tumors that can occur in the liver. The most common are metastatic deposits from other primary cancers, and hepatocellular carcinoma (HCC). HCC is described in detail, including risk factors, pathogenesis, imaging appearance on ultrasound, CT and MRI, staging systems, treatment surveillance, and diagnostic criteria. Other liver cancers such as cholangiocarcinoma are also briefly mentioned.
This document discusses masses that can occur in the pineal region. It describes benign cysts as common incidental findings, seen more often in younger women. Germ cell tumors are another common type and include germinomas, teratomas and others. Imaging can help differentiate these. Rarer parenchymal cell tumors include pineocytomas and pineoblastomas. Extrinsic masses such as gliomas, vein of Galen aneurysms, meningiomas and lipomas are also discussed along with their characteristic imaging features.
The document summarizes the anatomy, physiology, and imaging features of adrenal gland masses. It discusses incidental adrenal masses and describes the radiographic appearance of functioning tumors like pheochromocytoma and Conn's adenoma. It also covers malignant tumors such as metastases, adrenal carcinoma, and lymphoma. Pheochromocytomas appear large and heterogeneous with contrast enhancement on CT and MRI. Metastases are often bilateral, irregular, and heterogeneous. Adrenal carcinoma typically presents as a large mass with necrosis, calcifications, and heterogeneous enhancement.
This document discusses pulmonary tumors, including:
1. It categorizes pulmonary tumors into malignant tumors, low-grade malignancies, and benign tumors. The main malignant tumors discussed are bronchogenic carcinoma, bronchoalveolar carcinoma, lymphoma, metastases, and rare sarcomas.
2. Bronchogenic carcinoma is further broken down by classification, risk factors, location, and radiographic findings. The classifications include adenocarcinoma, squamous cell carcinoma, small cell carcinoma, large cell carcinoma, and adenosquamous tumor. Cavitation and air bronchograms are among the key radiographic findings.
3. Pancoast tumors, a type of superior sulcus tumor, are defined as tumors located
1. The document discusses various pathologies that can present as soft tissue masses in the perinephric space, including nephroblastomosis, retroperitoneal fibrosis, Erdheim-Chester disease, extramedullary hematopoiesis, lymphoma, metastases, and focal solid lesions.
2. It also describes fatty lesions such as angiomyolipoma, liposarcoma, and myelolipoma that can occur in the perinephric space.
3. Cystic lesions including lymphangiomas are also mentioned.
4. Abscesses and infections like acute bacterial pyelonephritis and xanthogranulomatous pyelonephritis are noted as
This document provides an overview of renal tumors, including:
1. It classifies renal tumors into 4 categories: renal parenchymal tumors, mesenchymal tumors, renal pelvis tumors, and secondary tumors.
2. Details are given for common renal parenchymal tumors like renal cell carcinoma (RCC), oncocytoma, Wilms tumor, and others. Radiographic features and diagnostic criteria are described.
3. Uncommon tumors are also briefly discussed, such as mesoblastic nephroma, clear cell sarcoma, and reninoma.
4. Imaging findings on modalities like ultrasound, CT, MRI, and angiography are summarized for many of the tumor
The document discusses imaging of adrenal masses. It provides details on the anatomy and histology of the adrenal glands. Computed tomography (CT) is described as the primary imaging modality for evaluating adrenal gland morphology and masses. CT characteristics such as density measurements on non-contrast scans, enhancement patterns on contrast scans, and washout percentages are used to differentiate benign and malignant adrenal lesions. Magnetic resonance imaging (MRI) techniques such as chemical shift imaging can also help in characterization. The document outlines approaches for characterizing incidentally detected adrenal masses and differentiating functional from non-functional lesions.
This document discusses malignant liver lesions. It describes the different types of primary and secondary malignant tumors that can occur in the liver. The most common are metastatic deposits from other primary cancers, and hepatocellular carcinoma (HCC). HCC is described in detail, including risk factors, pathogenesis, imaging appearance on ultrasound, CT and MRI, staging systems, treatment surveillance, and diagnostic criteria. Other liver cancers such as cholangiocarcinoma are also briefly mentioned.
This document discusses masses that can occur in the pineal region. It describes benign cysts as common incidental findings, seen more often in younger women. Germ cell tumors are another common type and include germinomas, teratomas and others. Imaging can help differentiate these. Rarer parenchymal cell tumors include pineocytomas and pineoblastomas. Extrinsic masses such as gliomas, vein of Galen aneurysms, meningiomas and lipomas are also discussed along with their characteristic imaging features.
This document discusses various pleural lesions seen on chest imaging. It describes pleural effusions such as transudative versus exudative effusions, empyema, hemothorax and chylothorax. It also discusses pleural tumors including primary tumors like mesothelioma and metastases. Specific radiographic features of these conditions are provided along with examples of imaging findings.
This document discusses mediastinal masses, beginning with an overview of the mediastinum and its divisions. It then focuses on anterior mediastinal masses, describing various pathologies that can occur including thymoma, thymolipoma, thymic hyperplasia, and thymic cysts. For each pathology, it discusses incidence, associations, pathology, and radiographic features visible on plain radiographs and CT scans. Key signs on imaging include mass location and characteristics, presence of cystic or fatty components, calcification, and effects on surrounding structures.
This document discusses various diseases of the pericardium, heart, and thoracic aorta as assessed through non-invasive imaging techniques. It covers conditions such as pericarditis, pericardial cysts, cardiac tumors including myxomas, angiosarcomas and lymphomas. Diseases of the thoracic aorta explored are aortic dissection, aneurysms, and rupture. Key imaging modalities discussed are echocardiography, CT, MRI, nuclear medicine scans.
1. The document discusses various imaging techniques for examining the liver, bile duct, pancreas and spleen including CT, MRI, angiography, and cholangiography.
2. It provides details on normal anatomy and imaging appearances of common benign and malignant tumors of the liver including hemangiomas, cysts, abscesses, and hepatocellular carcinoma.
3. Imaging findings of gallstones, cholecystitis, pancreatitis, and cholangiocarcinoma are also summarized.
This document discusses hematologic malignancies that involve the liver. Key points include:
1. Hematologic malignancies such as lymphoma are an increasingly common cause of liver lesions. Biopsy may be needed for accurate diagnosis over fine needle aspiration.
2. Primary treatment for hematologic malignancies of the liver is often chemotherapy and/or radiation rather than surgery. Imaging can help differentiate primary from secondary hepatic involvement which impacts treatment.
3. Lymphoma manifestations in the liver include discrete masses, diffuse infiltrating disease, or a mass at the hepatic hilum. Features on imaging can suggest a hematologic origin over other cancers.
This document discusses mediastinal germ cell tumors (GCTs), including their anatomy, classification, pathologic features, diagnosis, and management. It notes that GCTs mainly affect young men and can be benign or malignant. Diagnosis involves imaging such as CT scans and tumor marker tests. Management depends on tumor type but commonly involves chemotherapy, surgery, and monitoring for recurrence. The document provides detailed information on diagnostic criteria and treatment approaches for specific GCT subtypes such as teratomas, seminomas, and non-seminomas.
Diagnostic Imaging of Salivary, Parathyroid and Thyroid GlandsMohamed M.A. Zaitoun
This document provides an overview of salivary gland, parathyroid gland, and thyroid gland diseases. It discusses several common salivary gland conditions including sialolithiasis, sialosis, sialoadenitis, Sjogren's disease, and cystic lesions. For each condition, it describes the incidence, etiology, location, and radiographic features as seen on imaging like CT, MRI, ultrasound, and sialography. It provides examples of images showing the characteristic findings of each disease. In summary, the document is a radiologist's guide to recognizing and differentiating various head and neck gland diseases based on their imaging appearance.
Presentation1.pptx, radiological imaging of cholangiocarcinoma.Abdellah Nazeer
This document discusses radiological imaging techniques for cholangiocarcinoma (bile duct cancer). It provides details on:
- Ultrasound, CT, MRI, MRCP, and ERCP are discussed for imaging bile duct cancer. Each modality has benefits for assessing tumor location and extent.
- Peripheral, hilar, and intrahepatic cholangiocarcinoma are described along with the Bismuth-Corlette classification system for hilar tumors.
- Imaging features of peripheral, hilar, intrahepatic cholangiocarcinoma are shown including enhancement patterns and involvement of bile ducts.
This document discusses C.N.S. vascular malformations, specifically arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVF). It covers the definition, types, clinical presentation, radiographic features, grading systems, complications and treatment options for each condition. Key points include that AVMs are congenital lesions with direct connections between arteries and veins, while DAVFs are acquired lesions resulting from damage to venous structures. Presentations can include hemorrhage, seizures, and neurological deficits. Diagnosis is made through CT, MRI, and catheter angiography. Management depends on the size, location, and severity of the lesion.
This document discusses pulmonary thromboembolism (PE), including:
- The anatomy of the pulmonary vasculature and definitions of acute PE.
- Risk factors for PE include inherited or acquired hypercoagulability states.
- Presentation is often nonspecific but may include dyspnea, chest pain, or syncope. Diagnosis is made using D-dimer, CTA, or V/Q scan.
- CTA directly visualizes intraluminal thrombi and allows assessment of right heart strain. Chronic thromboembolism involves organized thrombi causing pulmonary hypertension.
CT evaluation and staging of lung cancer can determine prognosis and treatment. There are two main types: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is staged using the TNM system to describe tumor size (T), lymph node involvement (N), and metastases (M). Higher TNM stages indicate less favorable prognoses. SCLC is generally staged as limited disease, confined to one lung, or extensive disease with distant metastases. Accurate staging helps guide treatment decisions.
1. The document describes the five deep neck spaces: anterior visceral space, carotid space, retropharyngeal space, posterior cervical space, and perivertebral space.
2. Each space is defined by its anatomical boundaries and contents, which can include viscera, blood vessels, nerves, lymph nodes, and pathologies such as tumors, infections, cysts.
3. CT and MRI images are presented to illustrate normal anatomy as well as various diseases found within the deep neck spaces, such as abscesses, aneurysms, lymphadenopathy, tumors.
1) Radiological evaluation plays an important role in staging and characterizing lung cancer. Imaging modalities like CT, MRI, and PET are used to determine the size, location, involvement of surrounding structures, and presence of metastases.
2) Key features examined on imaging include the side, lobe, level and number of primary tumors, invasion characteristics, and characteristics of involved lymph nodes.
3) Accurately determining the TNM stage guides treatment decisions between surgical, medical, and radiation oncologists. PET imaging can help differentiate tumor from atelectasis and detect occult metastases not seen on CT.
1. Orbital cellulitis and abscesses can result from sinus infections spreading through the orbital septum. On imaging, preseptal cellulitis appears as soft tissue swelling while postseptal infections involve retrobulbar fat stranding and proptosis. Abscesses also form subperiosteal collections.
2. Lymphoma is the most common orbital tumor and often presents as an asymptomatic mass in the superolateral orbit. On CT it appears homogeneous and mildly enhancing while MRI shows restricted diffusion. Metastases can also occur from primary cancers.
3. Dermoids and teratomas are common in children and have fat attenuation on CT with bone changes. Lymphangiomas
This document summarizes the anatomy and imaging features of various adrenal gland lesions. It describes the typical appearance of the adrenal glands on CT and MRI. Common adrenal tumors like adenomas, carcinomas, pheochromocytomas, and metastases are discussed. Adenomas often appear lipid-rich on CT and demonstrate signal loss on opposed-phase MRI. Carcinomas usually appear large, inhomogeneous, and demonstrate central necrosis. Pheochromocytomas tend to be large and heterogeneous with areas of necrosis. Neuroblastomas often insinuate around vessels in children. Myelolipomas contain detectable fat. Distinguishing features between tumor types are highlighted.
This document discusses various radiological techniques for examining the cardiovascular system, including fluoroscopy, roentgenography, fluorography, tomography, angiography, computed tomography, ultrasonography, and magnetic resonance imaging. It describes how to evaluate the heart shape and position using these techniques. Common cardiovascular abnormalities are outlined, including mitral valve disease, aortic valve disease, diffuse myocardial disease, and limited vascular abnormalities. The document also discusses analyzing coronary arteries, congenital heart diseases, and evaluating cardiac function and plaque types using multidetector computed tomography.
The patient presented with neck pain and left arm weakness. Imaging showed an intramedullary mass in the cervical spinal cord. Further imaging found additional masses in the cerebellum and eye. Biopsy of the spinal cord mass revealed a hemangioblastoma. The patient was diagnosed with von Hippel-Lindau syndrome based on multiple hemangioblastomas and cysts in the pancreas. The patient underwent surgery to remove the spinal cord mass and experienced post-operative weakness but subsequent improvement.
Radiological diagnostics of Cardiovascular SystemEneutron
This document discusses various radiological techniques for examining the cardiovascular system, including fluoroscopy, roentgenography, fluorography, tomography, angiography, computed tomography, ultrasonography, and magnetic resonance imaging. It provides details on evaluating heart size and shape, positioning, cardiac contours and arcs seen in different views. Common cardiovascular abnormalities are described based on their radiological presentations, such as mitral and aortic heart shapes. Congenital heart diseases are categorized into three groups based on blood flow abnormalities. Methods for examining coronary arteries both invasively and non-invasively are also outlined.
This document discusses various pleural lesions seen on chest imaging. It describes pleural effusions such as transudative versus exudative effusions, empyema, hemothorax and chylothorax. It also discusses pleural tumors including primary tumors like mesothelioma and metastases. Specific radiographic features of these conditions are provided along with examples of imaging findings.
This document discusses mediastinal masses, beginning with an overview of the mediastinum and its divisions. It then focuses on anterior mediastinal masses, describing various pathologies that can occur including thymoma, thymolipoma, thymic hyperplasia, and thymic cysts. For each pathology, it discusses incidence, associations, pathology, and radiographic features visible on plain radiographs and CT scans. Key signs on imaging include mass location and characteristics, presence of cystic or fatty components, calcification, and effects on surrounding structures.
This document discusses various diseases of the pericardium, heart, and thoracic aorta as assessed through non-invasive imaging techniques. It covers conditions such as pericarditis, pericardial cysts, cardiac tumors including myxomas, angiosarcomas and lymphomas. Diseases of the thoracic aorta explored are aortic dissection, aneurysms, and rupture. Key imaging modalities discussed are echocardiography, CT, MRI, nuclear medicine scans.
1. The document discusses various imaging techniques for examining the liver, bile duct, pancreas and spleen including CT, MRI, angiography, and cholangiography.
2. It provides details on normal anatomy and imaging appearances of common benign and malignant tumors of the liver including hemangiomas, cysts, abscesses, and hepatocellular carcinoma.
3. Imaging findings of gallstones, cholecystitis, pancreatitis, and cholangiocarcinoma are also summarized.
This document discusses hematologic malignancies that involve the liver. Key points include:
1. Hematologic malignancies such as lymphoma are an increasingly common cause of liver lesions. Biopsy may be needed for accurate diagnosis over fine needle aspiration.
2. Primary treatment for hematologic malignancies of the liver is often chemotherapy and/or radiation rather than surgery. Imaging can help differentiate primary from secondary hepatic involvement which impacts treatment.
3. Lymphoma manifestations in the liver include discrete masses, diffuse infiltrating disease, or a mass at the hepatic hilum. Features on imaging can suggest a hematologic origin over other cancers.
This document discusses mediastinal germ cell tumors (GCTs), including their anatomy, classification, pathologic features, diagnosis, and management. It notes that GCTs mainly affect young men and can be benign or malignant. Diagnosis involves imaging such as CT scans and tumor marker tests. Management depends on tumor type but commonly involves chemotherapy, surgery, and monitoring for recurrence. The document provides detailed information on diagnostic criteria and treatment approaches for specific GCT subtypes such as teratomas, seminomas, and non-seminomas.
Diagnostic Imaging of Salivary, Parathyroid and Thyroid GlandsMohamed M.A. Zaitoun
This document provides an overview of salivary gland, parathyroid gland, and thyroid gland diseases. It discusses several common salivary gland conditions including sialolithiasis, sialosis, sialoadenitis, Sjogren's disease, and cystic lesions. For each condition, it describes the incidence, etiology, location, and radiographic features as seen on imaging like CT, MRI, ultrasound, and sialography. It provides examples of images showing the characteristic findings of each disease. In summary, the document is a radiologist's guide to recognizing and differentiating various head and neck gland diseases based on their imaging appearance.
Presentation1.pptx, radiological imaging of cholangiocarcinoma.Abdellah Nazeer
This document discusses radiological imaging techniques for cholangiocarcinoma (bile duct cancer). It provides details on:
- Ultrasound, CT, MRI, MRCP, and ERCP are discussed for imaging bile duct cancer. Each modality has benefits for assessing tumor location and extent.
- Peripheral, hilar, and intrahepatic cholangiocarcinoma are described along with the Bismuth-Corlette classification system for hilar tumors.
- Imaging features of peripheral, hilar, intrahepatic cholangiocarcinoma are shown including enhancement patterns and involvement of bile ducts.
This document discusses C.N.S. vascular malformations, specifically arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVF). It covers the definition, types, clinical presentation, radiographic features, grading systems, complications and treatment options for each condition. Key points include that AVMs are congenital lesions with direct connections between arteries and veins, while DAVFs are acquired lesions resulting from damage to venous structures. Presentations can include hemorrhage, seizures, and neurological deficits. Diagnosis is made through CT, MRI, and catheter angiography. Management depends on the size, location, and severity of the lesion.
This document discusses pulmonary thromboembolism (PE), including:
- The anatomy of the pulmonary vasculature and definitions of acute PE.
- Risk factors for PE include inherited or acquired hypercoagulability states.
- Presentation is often nonspecific but may include dyspnea, chest pain, or syncope. Diagnosis is made using D-dimer, CTA, or V/Q scan.
- CTA directly visualizes intraluminal thrombi and allows assessment of right heart strain. Chronic thromboembolism involves organized thrombi causing pulmonary hypertension.
CT evaluation and staging of lung cancer can determine prognosis and treatment. There are two main types: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is staged using the TNM system to describe tumor size (T), lymph node involvement (N), and metastases (M). Higher TNM stages indicate less favorable prognoses. SCLC is generally staged as limited disease, confined to one lung, or extensive disease with distant metastases. Accurate staging helps guide treatment decisions.
1. The document describes the five deep neck spaces: anterior visceral space, carotid space, retropharyngeal space, posterior cervical space, and perivertebral space.
2. Each space is defined by its anatomical boundaries and contents, which can include viscera, blood vessels, nerves, lymph nodes, and pathologies such as tumors, infections, cysts.
3. CT and MRI images are presented to illustrate normal anatomy as well as various diseases found within the deep neck spaces, such as abscesses, aneurysms, lymphadenopathy, tumors.
1) Radiological evaluation plays an important role in staging and characterizing lung cancer. Imaging modalities like CT, MRI, and PET are used to determine the size, location, involvement of surrounding structures, and presence of metastases.
2) Key features examined on imaging include the side, lobe, level and number of primary tumors, invasion characteristics, and characteristics of involved lymph nodes.
3) Accurately determining the TNM stage guides treatment decisions between surgical, medical, and radiation oncologists. PET imaging can help differentiate tumor from atelectasis and detect occult metastases not seen on CT.
1. Orbital cellulitis and abscesses can result from sinus infections spreading through the orbital septum. On imaging, preseptal cellulitis appears as soft tissue swelling while postseptal infections involve retrobulbar fat stranding and proptosis. Abscesses also form subperiosteal collections.
2. Lymphoma is the most common orbital tumor and often presents as an asymptomatic mass in the superolateral orbit. On CT it appears homogeneous and mildly enhancing while MRI shows restricted diffusion. Metastases can also occur from primary cancers.
3. Dermoids and teratomas are common in children and have fat attenuation on CT with bone changes. Lymphangiomas
This document summarizes the anatomy and imaging features of various adrenal gland lesions. It describes the typical appearance of the adrenal glands on CT and MRI. Common adrenal tumors like adenomas, carcinomas, pheochromocytomas, and metastases are discussed. Adenomas often appear lipid-rich on CT and demonstrate signal loss on opposed-phase MRI. Carcinomas usually appear large, inhomogeneous, and demonstrate central necrosis. Pheochromocytomas tend to be large and heterogeneous with areas of necrosis. Neuroblastomas often insinuate around vessels in children. Myelolipomas contain detectable fat. Distinguishing features between tumor types are highlighted.
This document discusses various radiological techniques for examining the cardiovascular system, including fluoroscopy, roentgenography, fluorography, tomography, angiography, computed tomography, ultrasonography, and magnetic resonance imaging. It describes how to evaluate the heart shape and position using these techniques. Common cardiovascular abnormalities are outlined, including mitral valve disease, aortic valve disease, diffuse myocardial disease, and limited vascular abnormalities. The document also discusses analyzing coronary arteries, congenital heart diseases, and evaluating cardiac function and plaque types using multidetector computed tomography.
The patient presented with neck pain and left arm weakness. Imaging showed an intramedullary mass in the cervical spinal cord. Further imaging found additional masses in the cerebellum and eye. Biopsy of the spinal cord mass revealed a hemangioblastoma. The patient was diagnosed with von Hippel-Lindau syndrome based on multiple hemangioblastomas and cysts in the pancreas. The patient underwent surgery to remove the spinal cord mass and experienced post-operative weakness but subsequent improvement.
Radiological diagnostics of Cardiovascular SystemEneutron
This document discusses various radiological techniques for examining the cardiovascular system, including fluoroscopy, roentgenography, fluorography, tomography, angiography, computed tomography, ultrasonography, and magnetic resonance imaging. It provides details on evaluating heart size and shape, positioning, cardiac contours and arcs seen in different views. Common cardiovascular abnormalities are described based on their radiological presentations, such as mitral and aortic heart shapes. Congenital heart diseases are categorized into three groups based on blood flow abnormalities. Methods for examining coronary arteries both invasively and non-invasively are also outlined.
Navigating the World of Topsoil: A Guide to the Right Choice for Your Gardennerissacampuzano
Are you looking to improve your garden's health but unsure about which topsoil to choose? This PPT provides insights into selecting the right topsoil for your gardening needs. From understanding various types of topsoil to evaluating their benefits, this resource equips you with the essential knowledge to make an informed decision. Explore to learn more.
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MISS RAIPUR 2024 - WINNER POONAM BHARTI.DK PAGEANT
Poonam Bharti, a guide of ability and diligence, has been chosen as the champ from Raipur for Mrs. India 2024, Pride of India, from the DK Show. Her journey to this prestigious title is a confirmation of her commitment, difficult work, and multifaceted gifts. At fair 23 a long time ago, Poonam has as of now made noteworthy strides in both her proficient and individual lives, encapsulating the soul of present-day Indian ladies who adjust different parts with beauty and competence. This article dives into Poonam Bharti’s foundation, achievements, and qualities that separated her as a meriting champion of this award.
4. Anatomy of the Adrenal
Gland
a) Arterial Supply :
-Superior adrenal artery: branch of inferior phrenic
artery
-Middle adrenal artery: branch of the aorta
-Inferior adrenal artery: branch of the renal artery
5.
6. b) Venous Drainage :
-Each gland is drained by a single vein that
enters into the :
Inferior vena cava on the right
Renal vein on the left
7. c) Physiology :
-Cortex divided into 3 zones :
Zona glomerulosa (aldosterone)
Zona fasciculata (ACTH dependent)
Zona reticularis (sex hormones)
-Medulla (epinephrine, norepinephrine)
8. d) Imaging Appearance :
-Y configuration : each adrenal gland consists of an
anteromedial ridge (body) and two posterior limbs best
seen by CT/MR
-Posterior limbs are close together superiorly but spread
out inferiorly
-Right adrenal lies adjacent to IVC throughout its extent
-Left adrenal lies adjacent to splenic vessels at its cephalad
margin
-Size :
Limbs: 3 to 6 mm thick
Length of entire adrenal: 4 to 6 cm
Width of entire adrenal: <1 cm
Weight: 4 to 5 g/gland
16. 1-Incidence :
-Is an uncommon tumor of the adrenal gland
-The tumors are said to follow a 10% rule :
10% are extra-adrenal
10% are bilateral
10% are malignant
10% are found in children
10% are familial
10 % are not associated with hypertension
17. 2-Associations :
-The majority of cases are sporadic
-In 5-10% of cases , a pheochromocytoma is a
manifestation of an underlying condition including :
a) MEN II (both MEN IIa and MEN IIb) :
-MEN IIa : medullary thyroid carcinoma ,
pheochromocytoma & parathyroid adenoma
-MEN IIb : medullary thyroid carcinoma ,
pheochromocytoma , oral ganglioneuromas & other soft
tissue tumors
b) VHL
c) Sturge-Weber Syndrome
d) TS
18. 3-Radiographic Features :
-Usually large > 5 cm with marked contrast
enhancement
-It should be noted that in patients with suspected
pheochromocytoma ionic contrast may be
contraindicated as it could precipitate a
hypertensive crisis
a) CT :
-On CT pheochromocytomas are large usually
heterogeneous masses with areas of necrosis
and cystic change with marked contrast
enhancement
19. Pheochromocytomas in a 35-year-old woman with hypokalemia, a family history of
pheochromocytoma, and a new diagnosis of von Hippel–Lindau syndrome, axial
arterial phase (a) and coronal arterial phase volume-rendered (b) CT images,
obtained for evaluation of right upper quadrant pain, show small incidental bilateral
adrenal masses (arrow), the degree of vascularity resulted in a differential diagnosis
of metastatic hypervascular tumor or pheochromocytoma, pathologic analysis
revealed bilateral pheochromocytomas; the lesion on the right measured 2 cm, and
the two masses in the left adrenal gland measured 0.4 cm and 0.6 cm
20. Pheochromocytoma with pathologically proved hemorrhage and necrosis in a 39-year-old
woman, coronal precontrast volume-rendered (a) and axial postcontrast (b) CT
images show a large, well-defined mass with higher attenuation inferiorly that
compresses the liver and right kidney, on the contrast-enhanced image, enhancing
septa and multiple cystic areas are seen. Classically a vascular mass,
pheochromocytoma can also be cystic, particularly when the tumor is large, as in this
case
21. Pheochromocytomas in a 47-year-old woman with a history of neurofibromas
resected from both wrists who presented with abdominal pain, axial (a) and
coronal multiplanar reformation (b) images from contrast-enhanced CT
show bilateral adrenal masses (arrows), which are predominantly cystic on
the left (white arrowheads) and solid with cystic components (black
arrowheads) on the right, fine-needle aspiration performed in one mass
demonstrated a pheochromocytoma
22. Pheochromocytoma with rapid washout, axial portal venous phase (a) and
delayed phase (b) CT images show a small solid mass in the right adrenal
gland, the RPW of the adrenal nodule is 52%, a value that can be seen with
adenoma; however, the portal venous phase attenuation of 164 HU
suggests a pheochromocytoma, such high enhancement levels are not
characteristic of adenoma but are seen with some pheochromocytomas
23. Necrotic pheochromocytoma in a 42-year-old man, coronal arterial
phase (a) and venous phase (b) volume-rendered images from
contrast-enhanced CT show a large (>20 cm) hypervascular right
suprarenal mass, the mass has central necrosis and compresses
the right kidney inferiorly
24. b) MRI :
*T1 :
-Slightly hypointense to the remainder of the
adrenal
*T2 :
-Markedly hyperintense (lightbulb sign) , this is a
helpful feature
*T1+C :
-Heterogenous enhancement
c) Nuclear Medicine : MIBG
-Abnormal uptake
25. Axial T1-weighted in-phase MR image (a), out-of-phase MR image (b), and
three-dimensional GRE contrast-enhanced MR image with VIBE (c) show a
pheochromocytoma (arrow), the pheochromocytoma shows the typical
features of no loss of signal intensity on the out-of-phase image and intense
enhancement on the contrast-enhanced image
27. 1 Incidence :
-Accounts for 70 % of Conn’s syndrome
-30 % of Conn’s syndrome due to
hyperplasia which can be occasionally
nodular and mimic an adenoma
2 Radiographic Features :
-Usually small < 2 cm
-Relatively low dense
29. 1 Incidence :
-Accounts for 20 % of Cushing syndrome
-80 % of Cushing syndrome is due to
excess ACTH from pituitary tumor or
ectopic source (small cell carcinoma ,
pancreatic islet cell , carcinoid medullary
carcinoma of the thyroid & thymoma)
2 Radiographic Features :
-Usually > 2 cm in diameter
30. d) Adrenal Carcinoma :
-50 % are present as functioning tumor
-Cushing's syndrome most common clinical
manifestation
34. 1-Primary sites :
-Lung :
Small cell carcinoma : 90% of adrenal masses
detected by CT screening represent metastases
Non–small cell carcinoma : 60% of adrenal
masses
-Breast
-Kidney
-Bowel
-Ovary
-Melanoma
35. 2-Radiographic Features :
-Adrenal mass usually > 2-3 cm with
irregular margins
-Bilateral adrenal masses
-Heterogeneous enhancement
-In the presence of a known primary
malignant tumor many adrenal masses
are benign (40 % are metastases)
36. Adrenal metastases in a 61-year-old man with hepatocellular carcinoma,
axial (a) and coronal volume-rendered (b) images from contrast-enhanced
CT show primary hepatic carcinoma in the right lobe, along with large
bilateral adrenal masses, the high-attenuation components of the adrenal
lesions probably represent contrast material from prior chemoembolization
or calcifications
37. Metastatic renal cell carcinoma in a 67-year-old woman, coronal arterial
phase (a) and venous phase (b) volume-rendered CT images show
widespread metastatic disease involving the liver, lung, adrenal gland, and
bones, the liver metastases are hyperattenuating and are well seen on the
arterial phase image but become less conspicuous on the venous phase
image
38. Adrenal metastasis in a 61-year-old man with a history of left nephrectomy for
renal cell carcinoma, coronal arterial phase (a) and delayed
phase (b) volume-rendered images from contrast-enhanced CT show a
hypervascular right adrenal mass with central necrosis, a finding consistent
with pheochromocytoma or a metastasis from renal cell carcinoma, the latter
diagnosis was proved at pathologic analysis after resection; however, the
enhancement pattern is similar to that of necrotic pheochromoctyoma
41. 1-Incidence :
-50 % are present as functioning tumor
-Cushing's syndrome most common clinical
manifestation
42. 2-Radiographic Features :
-Mass usually >5 cm at time of diagnosis
-Central area of low attenuation due to
tumor necrosis
-Heterogeneous enhancement because of
areas of necrosis , hemorrhage
-50% have calcifications
-Hepatic , nodal or venous spread
43. Adrenocortical carcinoma in a 62-year-old woman with hypertension, virilization, and an enlarging
abdominal mass, coronal arterial phase (a) and venous phase (b) volume-rendered CT images
show a large left suprarenal mass with hypervascularity and necrosis on the arterial phase image
and some areas of mild enhancement on the venous phase image, the mass abuts the left
hemidiaphragm, with left pleural effusion and left lung atelectasis, and is inseparable from the left
kidney, at surgery, which included left nephrectomy, a portion of the left hemidiaphragm was
resected and the left lower lobe was partially decorticated, pathologic analysis revealed a
malignant adrenocortical neoplasm
44. Primary adrenocortical carcinoma in a 55-year-old woman, coronal volume-
rendered images from contrast-enhanced CT show a nearly 15-cm right
adrenal mass that displaces the right kidney inferolaterally and invades the
inferior vena cava (IVC) medially (arrowheads in a), tumor thrombus
extends into the intrahepatic IVC (arrows in b)
45. 61-year-old woman who presented with left lower quadrant pain, arterial phase
(A), portal venous phase axial (B), and coronal (C) images show well-
encapsulated large 13.5-cm mass lesion arising from left adrenal gland with
internal calcifications but containing no focal fat, pancreas and left kidney
are displaced by mass, but there is no evidence of invasion into adjacent
vascular structures, on resection this mass represented adrenocortical
carcinoma
46. Sagittal T1-weighted three-dimensional contrast-enhanced GRE MR image
obtained with VIBE (a) and coronal T2 obtained with half-Fourier
RARE (b) show a large mass involving the right adrenal gland, the mass
exhibits heterogeneous low signal intensity on the T1 and high signal
intensity with a heterogeneous pattern of contrast enhancement and areas
of necrosis (arrow in b) on the T2
47. c) Lymphoma :
-Lymphoma can involve the adrenal gland
secondarily or arise as a primary adrenal
tumor (uncommon)
-Lymphadenopathy will be seen elsewhere
48. Adrenal lymphoma in a 67-year-old man with an adrenal mass, imaging was
performed for diagnosis and staging, axial arterial phase (a) and coronal
arterial phase volume-rendered (b) CT images show an 11-cm mass in the
left adrenal bed, the mass invades the left hemidiaphragm, encases the
celiac and renal arteries, and displaces the aorta, the mild degree of organ
displacement despite the size of the mass and the infiltrative appearance
are suggestive of lymphoma; the diagnosis was confirmed at core biopsy
49. Axial T1-weighted in-phase (a) and out-of-phase (b) MR images show
bilateral lymphomatous deposits, the deposits have low signal
intensity, and the signal intensity does not decrease on the out-of-
phase compared with the in-phase image
53. Neuroblastoma (a, b) Coronal unenhanced T1 (a) and axial T2
obtained with inversion recovery (b) show a right adrenal tumor, the
tumor is predominantly hypointense on the T1 and has areas of
high-signal-intensity hemorrhage (arrow in a), the tumor is
hyperintense on the T2
55. a) Non-Functioning Adenoma :
-The majority of lesions are not functioning. Although CT
does not allow differentiation of functioning from
nonfunctioning masses, the presence of contralateral
adrenal atrophy suggests that a lesion may be
functioning, because pituitary adrenocorticotropic
hormone secretion is suppressed by elevated cortisol
levels
-The precontrast attenuation varies according to the
presence or absence of lipid, with mean attenuation in
the range of −
2 to 16 HU in lipid-rich adenomas and
higher attenuation (20–25 HU) seen in the setting of
lipid-poor adenomas
-Lipid-poor adenomas represent 10%-40% of adenomas
-Regardless of lipid content, adenomas typically
demonstrate rapid washout, which is defined as an APW
of more than 60% and an RPW of more than 40% on
delayed images
56. -Radiographic Features :
1-CT :
-Mass 1 to 5 cm
-< 0 HU : diagnostic of adenoma (due to fat)
-0 to 10 HU : diagnosis almost certain (follow-up or MRI)
-Calcification rare
-Slight enhancement with IV contrast
-Rarely, an adenoma can hemorrhage, usually in a patient
receiving anticoagulant therapy, the presence of
hemorrhage results in regions of higher attenuation and
heterogeneity, at CT, heterogeneity and regions of
increased attenuation have been shown to correlate with
hemorrhage at pathologic analysis, before liquefaction,
the precontrast attenuation will be higher than 10 HU
57. Adrenal adenomas in a 62-year-old man with incidentally detected bilateral
adrenal nodules, clinical assessment revealed subclinical Cushing
syndrome, coronal contrast material–enhanced multiplanar reformation CT
image shows small (<2 cm) bilateral adrenal nodules, the relative
percentage washout (RPW) was more than 50% for both nodules, a finding
compatible with adenomas, follow-up CT performed 7 months later showed
stability of the lesions
58. 2.1-cm left adrenal mass was discovered incidentally on contrast-
enhanced computed tomography (CT), because the mass could not
be characterized on the contrast-enhanced CT, this unenhanced CT
was performed. It shows that the lesion (arrows) is of low
attenuation (6 HU), which is consistent with a lipid-rich adenoma
59. Lipid-poor adenoma in a 45-year-old woman who underwent CT for characterization of an
adrenal mass, axial precontrast (a), coronal portal venous phase volume-
rendered (b), and coronal delayed phase volume-rendered (c) CT images show a
well-defined left adrenal mass less than 2 cm in diameter, the attenuation
measurements were 22 HU on the precontrast image, 64 HU on the portal venous
phase image, and 26 HU on the delayed phase image, for an absolute percentage
washout (APW) of 90% and an RPW of 59%, the findings were consistent with a lipid-
poor adenoma
60. Adrenocortical adenoma with hemorrhage in a 78-year-old woman with an adrenal mass
that enlarged from 3 cm to 4 cm over 4 years, coronal pre-contrast volume-
rendered (a), coronal venous phase volume-rendered (b), and axial delayed
phase (c) CT images show a 3.2 × 3.9-cm inhomogeneous mass in the left adrenal
gland, some regions of fat attenuation are identified on the precontrast and delayed
phase images (−
12 HU in c), there are central areas of higher attenuation that
measured 69 HU on the delayed phase image, with an appearance suggestive of
hemorrhage into the mass, resection revealed an adrenocortical adenoma with
central organized hemorrhage
61. Right adrenal gland shows 1.1-cm lesion measuring 8 HU on
unenhanced (A and B), 40 HU on dynamic phase (C and D), and 18
HU on 10-minute delayed phase images (E and F), these density
and washout properties are consistent with adrenal adenoma
62. 2-MRI :
-Fat-suppression techniques are used to
determine if a given lesion contains fat
(e.g., in phase/out of phase imaging , spin-
echo fat-suppression imaging) , if a lesion
contains fat , it is considered an adenoma
63. Axial in-phase (a) and out-of-phase (b) MR images show an adrenal
adenoma (arrow), which exhibits the typical decrease in signal
intensity on the out-of-phase image
64. Axial T1-weighted out-of-phase MR image shows an adrenal adenoma
(black arrow) with a focal area of high-signal-intensity hemorrhage
(white arrow)
65. **N.B. :
-Chemical shift MRI uses a technique based on
hydrogen and fat protons, which resonate at
different frequencies
-By using different time parameters during the
same MRI examination, it is possible to identify
lipid-rich adenomas
-These adenomas show signal loss on out-of-
phase imaging, as opposed to imaging when the
protons are in phase, in contrast, nonadenomas
do not show signal loss on out-of-phase imaging
66. Magnetic resonance imaging incidentally detects a 2.5-cm adrenal
mass (arrows) on (A) the in-phase image and signal dropout
on (B) the opposed out-of-phase image, these findings are
consistent with a lipid-rich adenoma
67. b) Myelolipoma :
-Very rare
-Area of obvious fat mass (low negative
attenuation)
-May enhance with contrast administration
-Calcification , 20%
68. Myelolipoma in a 40-year-old man with metastatic medullary carcinoma
of the thyroid, coronal multiplanar reformation image from contrast-
enhanced CT shows a 5-cm left adrenal mass predominantly
composed of fat (arrows), an appearance diagnostic of a
myelolipoma
69. Myelolipoma in a 31-year-old woman with an adrenal mass, which was
incidentally noted during work-up for chronic anemia and infertility,
coronal volume-rendered CT image shows a 6.5-cm right adrenal
mass composed of soft tissue and fat, an appearance consistent
with a myelolipoma
70. Myelolipoma in a 59-year-old woman with a history of long-standing hypertension, a
normal urinary metanephrine level, and no clinical evidence of hypercortisolism.
Coronal precontrast (a) and arterial phase (b) multiplanar reformation images from
contrast-enhanced CT show an 8-cm left adrenal mass containing multiple foci of fat
and punctate calcifications; there was mild enhancement on venous phase images,
after resection, pathologic analysis revealed a benign vascular lesion with adipose
tissue, findings consistent with a myelolipoma
71. (a, b) Axial T1-weighted MR images obtained without fat suppression (a) and
with fat suppression (b) show typical MR imaging features of right adrenal
myelolipoma, the fatty component of the myelolipoma (arrow in a) shows a
decrease in signal intensity on the fat-suppressed image
74. d) Cyst :
1 Classification
2 Radiographic Features
75. 1-Classification :
a) Endothelial cyst , 40%
b)Pseudocyst (hemorrhage) , 40% , may
contain calcified rim
c) Epithelial cyst , 10%
d) Parasitic cysts (Echinococcus) , 5%
76. 2-Radiographic Features :
-Well defined water density
-Mural calcification (15%) , especially in
pseudocysts and parasitic cysts
77. (a, b) Coronal T1-weighted in-phase (a) and T2 half-Fourier
RARE (b) MR images show an oval, well-circumscribed, right
adrenal cyst (arrow in b) with a thin wall (arrowhead in b), the cyst
has a typical appearance, showing low signal intensity at T1 and
high signal intensity at T2
78. Axial T2-weighted MR image obtained with inversion recovery shows a
left adrenal pseudocyst, note the soft-tissue component in the wall
and the posteriorly located calcification (arrow)
79. Hemorrhagic complicated adrenal cyst, (a, b) Coronal T2 obtained with
half-Fourier RARE (a) and axial contrast-enhanced VIBE
image (b) show a left adrenal mass with areas of signal intensity
similar to that of blood
81. 1 Incidence :
-More common in neonates than adults
2 Etiology :
a) Hemorrhagic tumors
b) Severe trauma
c) Anticoagulation
d)Severe stress (surgery , sepsis , burns &
hypotension)
82. 3-Radiographic Features :
a) Acute hematoma :
-High CT density (>40 HU)
-Enlarged adrenal gland
b) Old hematoma :
-Liquefaction
-Fluid-fluid level
-May evolve into pseudocyst
83. Axial unenhanced T1-weighted three-dimensional GRE MR image
obtained with VIBE demonstrates a right adrenal gland with a high-
signal-intensity rim (arrows), a finding that is consistent with
subacute hematoma
84. f) Granulomatous Disease :
-Most common causes are TB ,
histoplasmosis , blastomycosis ,
meningococcus and echinococcus
-Present as diffuse enlargement or as
discrete mass
-Can have a central cystic component with
or without calcifications
85.
86. b) Bilateral Adrenal Masses :
1 Metastases , in 15 %
2 Pheochromocytoma , in 10 %
3 Hyperplasia :
-Bilateral adrenal enlargement but usually not seen
on CT
4Spontaneous Adrenal Hemorrhage
5-Lymphoma
6-Granulomatous Disease
87. c) Adrenal Calcification :
1-Pseudocyst , Parasitic cyst
2-Carcinoma
3 Addison Disease :
-If caused by TB , calcification is a common finding
4 Neuroblastoma
5Granulomatous Disease
6-Pheochromocytoma
7-Myelolipoma