Abdominal Radiology -Case conference September 6, 2017
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This radiology case conference document discusses multiple cases involving abdominal calcifications: - Case 1 involves gallstones, gall bladder and renal calculi, and a diagnosis of chronic calcific pancreatitis. - Case 2 shows seminal vesicle/vas deferens calcification in a patient undergoing pre-transplant evaluation who had failed bilateral renal transplants. - Other cases discussed include prostatic calcification, left adrenal calcification from old trauma, and fecoliths before and after treatment.
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Wilms tumor, or nephroblastoma, is the most common malignant renal tumor in children under 15. It arises from malignant cells and occurs slightly more often in the left kidney. Diagnosis involves physical exam, imaging tests, and hematologic studies to check for signs of cancer like weight loss. Staging determines if the tumor is localized or metastatic. Treatment includes surgery to remove the tumor along with chemotherapy and sometimes radiation. Nursing care focuses on preparing the child for surgery, monitoring them closely after surgery, and educating parents on follow up care and continuing treatment.
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This document discusses anesthesia for fetal surgeries and intrauterine procedures. It begins with an introduction to fetal surgeries and guidelines for performing them. It then categorizes fetal surgical interventions and discusses specific fetal conditions treated and interventions used. Some risks and benefits of fetal surgery are outlined. The document then focuses on anesthetic management for various procedures, including effects of anesthesia on the fetus and fetal monitoring. It provides details on anesthesia for minimally invasive procedures, open fetal surgery, and fetal response and analgesia. In summary, it is a comprehensive overview of fetal surgeries, conditions treated, and considerations for anesthetic management.
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This document provides an overview of laryngeal carcinoma. It notes that there are approximately 11,000 new cases per year in the US, accounting for 25% of head and neck cancers. Risk factors include tobacco and alcohol use. Presentation is often hoarseness. Diagnosis involves biopsy. Treatment options depend on staging and include surgery such as total laryngectomy or organ preservation approaches combining chemotherapy and radiation. Prognosis remains challenging with many recurrences within the first two years.
Ostomytalk10 12
This document summarizes bladder cancer epidemiology, diagnosis, staging, treatment options including radical cystectomy, and the history and evolution of radical cystectomy and urinary diversion techniques. It discusses how radical cystectomy was first performed in the late 19th century but had high mortality rates until antibiotics were introduced. It outlines key developments like the ileal conduit procedure in the 1950s and robotic cystectomy in the 2000s. The future may involve tissue engineered bladder replacements.
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This document discusses the lasting lung effects of legalizing marijuana and what radiologists need to know. It finds that marijuana smoke deposits tar and chemicals at similar or higher levels than tobacco. Marijuana smoking can cause bronchitis, cough, wheezing and recurrent infections. It also increases the risk of lung cancer. Imaging may show micronodularity, infections like pneumonia, and sequelae of emphysema like pneumothorax. Radiologists should inquire about marijuana use in young patients with extensive unspecified lung findings to help make the diagnosis.
Non-malignant cardiac findings on FDG PET CT
This document discusses non-malignant cardiac findings that can present on FDG PET-CT scans. It presents 5 case examples of focal cardiac FDG uptake and describes the diagnostic approach and differential diagnosis in each case. Common non-malignant etiologies that can cause increased cardiac FDG uptake include physiologic variants, inflammation from conditions like sarcoidosis, infection from endocarditis, and anatomical variants like lipomatous hypertrophy of the interatrial septum. Differentiating malignant from non-malignant cardiac FDG uptake is important to avoid unnecessary diagnostic steps or treatment.
WHITEOUT LEFT HEMITHORAX: WHAT DO YOU THINK IS GOING ON HERE?
Hepatic hydrothorax (HH) is a rare cause of unilateral pleural effusion generally seen in patients withcirrhosis who do not have other reasons to explain their effusion.1 Most commonly HH presents in patients with ascites andtypically results in right sided pleural effusion; however, we detail a unique case below of left sided HH seen in the absence of ascites.
Subarachnoid hemorrhage unmasks aortic coarctation in a young man
A 20-year-old man presented with a severe headache and confusion and was found to have a subarachnoid hemorrhage from a ruptured basilar tip aneurysm. He was also found to have long-standing hypertension. Further cardiac imaging revealed an aortic coarctation, which had gone undiagnosed and likely caused his hypertension. Cardiac MRI and MRA clearly showed the coarctation and extensive collateral vessels that had formed. A cardiac catheterization further demonstrated a significant pressure gradient across the coarctation, confirming it as the cause of his hypertension. The patient subsequently underwent stent placement in the coarcted segment.
Aortic Arches A REVIEW E POSTER
This document discusses aortic arch anomalies. It begins by describing normal aortic arch development. It then defines vascular rings as vessels that encircle the trachea and esophagus, causing symptoms. It classifies the main types of vascular rings as complete rings (double aortic arch with right/left/balanced dominance, right aortic arch with left ductus arteriosus) and incomplete rings (innominate artery compression, pulmonary artery sling, left aortic arch with aberrant right subclavian). Each type of ring is described in detail with examples and images provided.
Subaortic membrane
A 43-year-old male presented with chest trauma after a fall. A trans-thoracic echocardiogram revealed a 1 cm mass protruding into the left ventricular outflow tract. Cardiac MRI was obtained for better tissue characterization. The MRI showed the mass had a non-enhancing morphology. Based on the echocardiogram and MRI findings, the mass was determined to be a sub-aortic membrane. The patient was discharged with regular follow up since he did not have a significant gradient across the membrane or aortic regurgitation.
ALCAPA AND TAKEUCHI PROCEDURE
A 29-year-old female with a history of ALCAPA and Takeuchi procedure as a child presented with palpitations. Her recent echocardiogram showed worsening pulmonic stenosis and her holter monitor detected non-sustained ventricular tachycardia. She was ordered for a cardiac MRI to assess for left ventricular scar that could explain her arrhythmia and to evaluate her coronary anatomy before potential angiogram or hemodynamic study. CMR is useful for delineating coronary anatomy and detecting characteristic sub-endocardial late gadolinium enhancement in the basal anterolateral wall seen in ALCAPA patients. CMR may avoid the need for invasive procedures by clearly defining the postoperative anatomy in adults who
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This document discusses chest tubes and complications that can arise from procedures like needle thoracocentesis and tube thoracostomy placement. It notes that needle thoracocentesis can result in false positives or negatives if the needle is not correctly placed in the pleural space. Tube thoracostomy placement can also have complications if the tube is placed incorrectly, such as being extrapleural, intrapulmonary, or penetrating mediastinal structures. Correct placement of chest tubes and procedures is important to avoid failure to decompress the intended body spaces and potential fatal outcomes.
Alveolar sarcoid
A 37-year-old woman presented with a 1-month history of daily cough and 30 lb unintentional weight loss. She was diagnosed with alveolar sarcoidosis based on radiographic findings of reticulonodular opacities. Alveolar sarcoidosis is a rare manifestation of pulmonary sarcoidosis characterized by interstitial granulomas compressing airways and mimicking airspace disease. The patient recovered with steroid treatment and follow-up imaging showed interstitial fibrotic changes, consistent with Stage 1 sarcoidosis.
Discitis and osteomyelitis in Sickle cell disease
1. A 14-year-old male with sickle cell disease presented with low back pain radiating up his spine that was worsened with movement. MRI showed chronic bone marrow changes and compression deformities consistent with his condition.
2. CT-guided biopsy of vertebrae showed preliminary positive cultures, with a presumptive diagnosis of vertebral osteomyelitis/discitis.
3. Vertebral osteomyelitis/discitis can result from hematogenous spread, direct inoculation, or contiguous spread. Treatment involves pathogen-directed antimicrobial therapy and drainage of abscesses if present.
Pheochromocytoma radiology
A 67-year-old female presented with right upper quadrant abdominal pain following meals and diarrhea for two weeks. Imaging studies including CT, MRI, and MIBG scan revealed bilateral adrenal masses consistent with pheochromocytoma. Laboratory tests showed markedly elevated urine and plasma metanephrines levels confirming the diagnosis. Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. It is usually benign but can be malignant in 10% of cases.
Hemithorax white out (1)
A 28-year-old female with diabetes, chronic pancreatitis, and substance abuse presented with cough, chills, and nausea for 3 days. Imaging showed complete white-out of the left lung with an air bronchogram sign. The differential diagnosis for hemithorax white-out included pulmonary edema, consolidation, or a chest wall/pleural mass. Given the trachea was midline and presence of an air bronchogram sign, consolidation from pneumonia was suspected. The patient was treated with antibiotics.
Case conference abdomen November 1, 2017
1. The document discusses several abdominal radiology cases presented at a case conference, including a slipped lap band, C. difficile colitis, levamisole-induced vasculitis, inflammatory bowel diseases, and images in mixed inflammatory bowel disease.
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Severe Hyponatremia, SIADH, and Pericardiac Effusion as Initial Presenting Fe...
A 56-year-old female presented with headache, dysarthria, and unsteady gait. Imaging revealed a moderate to large pericardial effusion. Labs showed hyponatremia consistent with SIADH. A pericardial window drained fluid and symptoms improved. Further imaging found metastatic non-Hodgkin's lymphoma to the pericardium and lung, explaining the presentation. The patient's citalopram use and pericardial effusion both likely contributed to her SIADH. Management included fluid restriction, hypertonic saline, and pericardial drainage.
Empyema as a complication of lung abscess drainage
This document describes the case of a 66-year-old male admitted for management of a cavitary lung lesion. He underwent CT-guided drainage of a lung abscess, but subsequently developed an empyema, likely due to contamination during drainage. He required a VATS procedure with debridement and decortication. Key learning points included that lung abscesses usually resolve with antibiotics, but drainage or resection may be needed for complicated cases, and percutaneous drainage carries risks of empyema or fistula formation from contamination.
Splenic rupture
Pt 1 is a 45-year-old man who presented with flank and chest pain due to a large splenic abscess and rupture secondary to illicit drug use including methamphetamines and heroin. Imaging showed a large fluid collection replacing the spleen. Pt 2 is a 27-year-old woman who presented with abdominal and pelvic pain due to an extracapsular splenic hemorrhage from illicit drug use. Both patients underwent splenic artery embolization and splenectomies. Illicit drug use such as cocaine can cause splenic infarction and subsequent rupture from vasospasms.
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A 50-year-old female presented with an incidental 2x3 cm paraesophageal mass found on CT during a hematuria workup. FDG PET showed intense focal uptake in the mass concerning for metastatic lymph node or esophageal cancer. Biopsies were nondiagnostic. VATS showed necrotizing granuloma suggestive of fungal infection, likely histoplasmosis. Treatment with itraconazole led to a significant decrease in FDG avidity on follow-up PET-CT, indicating histoplasmosis rather than cancer. This case demonstrates that focal FDG uptake can be caused by fungal infection, which should be considered in the differential diagnosis of possible esophageal cancer.
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This document discusses several cases of atypical chest neoplasms:
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2. It also discusses lymphangitic carcinomatosis, a tumor spread through the lungs' lymphatics most commonly seen with adenocarcinoma. On imaging, it demonstrates interlobular septal thickening, thickening of the bronchovascular interstitium, and often has a "dot in box" appearance
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This document describes a patient who was initially diagnosed with Klebsiella pneumonia based on imaging signs seen two years ago. More recently, imaging showed new signs and a lung biopsy was positive for Cryptococcus neoformans, while blood cultures detected Cryptococcus. The patient also has cavitary lung lesions caused by Mycobacterium avium-intracellulare superimposed on the initial infection.
Airways lecture final 2017
A 30-year-old previously healthy man presented with worsening shortness of breath over two days. He had been working in a corn silo filled with nitrous oxide the day before and inhaled some of the gas. Laboratory results showed elevated white blood cells. Imaging showed diffuse lung inflammation and injury consistent with acute hypersensitivity pneumonitis from inhaling the gas. He required ventilator support but was successfully treated with steroids and diuretics and showed improvement over the next few days.
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Abdominal Radiology -Case conference September 6, 2017
- 1. RADIOLOGY CASE CONFERENCE SEPTEMBER 6, 2017. DR. JAYANTH H. KESHAVAMURTHY. M.D.
- 2. THEME : ABDOMINAL CALCIFICATIONS
- 10. GB AND RIGHT RENAL CALCULI.
- 12. DIAGNOSIS
- 21. GALL BLADDER WALL CALCIFICATION AND CHOLANGIOCARCINOMA
- 23. WHAT DISEASE? WHICH IS ABNORMAL ORGAN?
- 24. SICKLE CELL DISEASE AND SPLEEN CALCIFIED FROM AUTO SPLENECTOMY
- 29. Thorotrast is a radioactive radiographic contrast agent containing thorium dioxide first produced in Germany in 1928 and was in use until the 1950s. It was used primarily for cerebral angiography, and 90% of the estimated 50,000-100,000 patients who received it were studied for this purpose.
- 32. • Large rim calcified cyst in the spleen, likely benign. This could be secondary to previous trauma.
- 36. CYSTIC RENAL DISEASE LUPUS CALCIFIED SPLENIC GRANULOMAS
- 40. • Other than granuloma think of other causes for liver and spleen calcifications. • Evaluate chart for any treated lymphoma as in this case here.
- 44. • Multiple pelvic phleboliths. • Small well-defined round osseous lesions in the left side of the abdomen, adjacent to midline represent calcified lymph node in the para-aortic and left common iliac groups, also visualized on the corresponding CT.
- 61. CASE 2
- 63. • Failed kidney transplant • Seminal vesicle / vas deferens calcification
- 66. FAILED BILATERAL RENAL TRANSPLANTS
- 75. Gall stone Calcific pancreatiits Penile calcification
- 78. ?
- 80. LEFT ADRENAL CALCIFICATION LIKELY FROM OLD TRAUMA
- 83. FECOLITH BEFORE AND AFTER TREATMENT
- 86. PRE RENAL TRANSPLANT EVALUATION. WHAT ARE THE
- 91. Active extravasation from the left gastric artery which was successfully treated with coil embolization.
- 95. RIGHT RENAL ARTERY ANEURYSM
- 99. RUPTURED MYCOTIC ANEURYSM FROM BRUCELLOSIS
- 105. Bladder exstrophy or ectopia vesicae is characterized by deficient lower anterior abdominal wall along with anterior walls of urinary bladder. The severity of these defects is widely variable. There may be rudimentary posterior wall of urinary bladder. The estimated incidence of bladder exstrophy is 1:10,000-50,000 live births. There is a recognized male predilection with a male to female ratio of 3:1 . Most cases are sporadic. Associated bony findings include widely separated pubic bones with absent symphysis pubis leading to characteristic " waddling gait". This appearance on AP plain radiograph of the pelvis has been likened to a manta ray swimming towards you (manta ray sign).
- 106. Bladder exstrophy is caused by a developmental defect of the cloacal membrane. Associated defects in males include cryptorchidism, inguinal hernia and epispadia. Associated defects in females include vaginal duplication and clitoral cleft. This is associated prenatally with elevated maternal alpha feto protein levels. Common complications include urinary incontinence, infertility, urinary infections and increased risk of bladder malignancy in the extruded bladder. Treatment is with surgical intervention (primary closure/excision with urinary diversion) and prognosis is generally good.
- 115. SEVERELY DILATED URINARY BLADDER WITH DIVERTICULAE AND CALCULI
Editor's Notes
- Chronic calcific pancreatitis
- Milk of calcium
- Spleen from SCD
- spleen
- Splenic granulomas
- Treated lymphoma
- Renal and fibroid
- Failed kidney transplant Seminal vesicle / vas deferens calcification
- Prostatic calcification
- Gall stone Calcific pancreatiits Penile calcification