Image of the Day 2: mediastinal mass
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This document summarizes the case of a 46-year-old man who presented with chest pain and cough. His chest examination and X-ray showed an enlarged mediastinum. Differential diagnoses for the cause of the mediastinal mass include Hodgkin's lymphoma, non-Hodgkin's lymphoma, thyroid mass, teratoma, and tumors of the thymus. Advanced imaging such as CT scan or MRI would help differentiate the origin of the mass and diagnostic radiological intervention such as biopsy may be needed.
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![In Image of the Day 1, [Link] i put a case of Dissecting aortic aneurysm with
haemothorax secondary to the leaking. Today’s image would broaden up our mind to think
about non vascular cause of enlarged mediastinal mass. The differential diagnosis would be
Hodgkin’s lymphoma, non hodgkin’s lymphoma, Thyroid mass, Teratoma and Tumors of the
thymus (cyst or thymoma).
Other rarer cases of widened mediastinum reported in case studies include venous aneurysm,
mediastinal lipomatosis, descending necrotizing mediastinitis, spontaneous rupture of
common carotid artery, malignant fibrous histiocytoma, traumatic extravasation of
cerebrospinal fluid and others.
Lateral chest film may help to differentiate the origin of the mass. However, with the advance
of radiological modalities, CT scan and MRI are found to be more superior than plain
radiograph. Radiological intervention would alse very helpful for diagnostic purpose
especially in doing biopsy.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Carpen ini ditulis khas buat peserta misi kemanusiaan anjuran Kelas Peradaban Nabawi USMKK, Medical Student Relief Team (MERIT) dan juga Medical Student Awareness Team (MESAT). Semoga kita semua terus konsisten dengan usaha dakwah melalui program kesihatan. insyaALLAH suatu hari nanti Islam pasti akan tersebar ke serata dunia kerana “Islam itu Mudah dan Fitrah”
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This document discusses the evidence-based approach for managing asthma in pregnancy. It notes that asthma prevalence may reach up to 8% during pregnancy. Pregnancy causes physiological immunosuppression and a shift to a Th2-dominated immune state using regulatory T cells to maintain tolerance to the fetus. For many women, asthma improves during pregnancy, but it may also worsen or stay the same depending on pre-pregnancy severity and other risk factors like smoking. Proper asthma management is important to prevent exacerbations and reduce risks to both mother and fetus. A variety of asthma medications are reviewed for safety and efficacy during pregnancy.
3. rifampicin urine
This document discusses different causes of urine discoloration, distinguishing between hematuria (blood in urine) and non-hematuria causes. It emphasizes the importance of determining whether urine discoloration stems from hematuria, which can indicate serious systemic or renal issues, or non-hematuria causes like concentrated urine, myoglobin release, diet, drugs, and dyes. The document specifically examines a case where a patient taking the antibiotic rifampicin for TB treatment experienced orange urine discoloration, as rifampicin is known to sometimes cause this side effect.
Image of the day 6
A cholangiogram image showed a hypodense lesion in a patient's common hepatic duct after gallbladder removal, which was initially thought to be a stone but was actually an air bubble formed during contrast injection that later disappeared. The doctor posted the image along with an illustration of the biliary tree to help remember the simple anatomy, hoping others with similar memory issues could also benefit.
4. left hip ant dislocation
This x-ray image shows a left anterior hip dislocation, identified by a prominent lesser trochanter, abducted hip position, femoral head below the acetabulum, and disrupted Shenton's line. Anterior hip dislocations are rare, accounting for 5-10% of dislocations. Unlike posterior dislocations, they usually occur without fracture. The injury mechanism typically involves hyperextension of the abducted leg levering the femoral head from the acetabulum. Without treatment, a neglected dislocation can lead to early osteoarthritis requiring total hip replacement.
Hadiah termahal dari allah
Teks tersebut menceritakan pertemuan dan diskusi antara Ricky, seorang mahasiswa Muslim, dengan Cindy, seorang mahasiswi non-Muslim yang ingin mengetahui lebih dalam tentang Islam. Mereka membahas berbagai konsep tentang Islam seperti konsep Ketuhanan, konsep neraka, dan persepsi terhadap hak-hak wanita dalam agama tersebut. Cindy mengungkapkan beberapa kesalahpahaman yang dimilikinya, dan Ricky berusaha unt
Bilateral pleural effusion
A lady with underlying chronic renal disease presented with shortness of breath. Chest x-ray findings included blunting of the right and left costophrenic angles with no tracheal shift and opacity in the right lung field, consistent with bilateral pleural effusion. The provisional diagnosis was bilateral pleural effusion secondary to fluid overload. Differential diagnoses included heart, liver or kidney problems, infection, trauma, malignancy or autoimmune conditions.
Monoclonal gammopathy with pathological fracture
This 40-year-old woman presented with a right thigh fracture following a minor fall at home. Examination revealed tenderness and swelling of the right thigh. Imaging showed reduced bone density and a subtrochanteric fracture. Laboratory tests found hypercalcemia. Skeletal survey found multiple lytic bone lesions. She was diagnosed with monoclonal gammopathy, an overproduction of a particular immunoglobulin protein by a single clone of B cells, which caused the pathological fracture and reduced bone density. Treatment involved surgery to fix the fracture, addressing the hypercalcemia, and chemotherapy or stem cell transplant for the underlying plasma cell disorder.
Distal third left femoral shaft fracture with arterial injury
A 35-year-old woman was in a palm oil lorry accident that caused her left femoral shaft fracture and arterial injury. She presented with a cold, painful left leg with absent pulses. Exploration revealed an oblique femoral shaft fracture with partial femoral artery injury. The bone was plated and artery repaired with end-to-end anastomosis. Post-operatively, pulses returned and she showed great improvement. The case highlights that vascular injury can occur with femoral fractures and should be monitored for even in closed fractures.
Early preparation for professional iii
This document provides advice and recommendations for preparing for the Professional III M.D. exam, specifically focusing on the clinical exam components. It discusses strategies for practicing short cases and long cases, including forming study groups to practice examinations on real patients and with examiner roles. Recommendations include starting preparation early, practicing frequently, learning common medical conditions, managing cases based on ministry guidelines, and getting feedback on performances from colleagues. While acknowledging a lack of perfect preparation, the author hopes to provide some useful tips based on their experience to help students pass this important exam.
Emergency procedures summary
1) The document outlines several emergency procedures including rapid sequence intubation, chest tube insertion, femoral line insertion, CVP line insertion, and peritoneal tap.
2) It provides detailed steps for each procedure including necessary equipment, patient positioning, anesthesia, insertion technique, and post-procedure care.
3) The procedures are commonly assessed in OSCE exams and require careful preparation, sterile technique, knowledge of anatomy, and verification of correct placement.
Thrombocytopenia summary
This document discusses various causes of thrombocytopenia including bone marrow disorders, increased platelet consumption, and hypersplenism. It specifically describes idiopathic thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). ITP is characterized by autoantibodies against platelets that cause their premature destruction. It commonly presents with purpura and mucosal bleeding. Treatment involves corticosteroids, IVIG, or splenectomy. TTP is a thrombotic microangiopathy associated with a deficiency in a protease that breaks down fibrin. It presents with a pentad of thrombocytopenia, microangiopathic hemolytic an
Brain Resuscitation
A 44-year-old woman collapsed at work and received bystander CPR and defibrillation. She was intubated by EMS and taken to the ED with a pulse but exhibiting seizure activity and a minimally responsive neurological exam. The document then discusses therapeutic hypothermia for cardiac arrest survivors including how to induce and maintain cooling, potential complications, and prognostic factors.
Short case examination pelvic mass-ovarian mass
1) The physician examined a 45-year-old woman with an abdominal mass. On examination, a 15x10 cm firm, mobile mass was found in the right lower quadrant.
2) The mass is likely ovarian based on its location, mobility, and the physician being able to get below it. Differential diagnoses include fibroids and masses from other pelvic organs.
3) To confirm the diagnosis, an abdominal ultrasound would be performed to determine the origin and nature of the mass. Further tests and potential surgery would depend on whether the mass is determined to be benign or malignant.
A&e end posting osce assesment group 7
The document contains sample questions and answers for an OSCE (Objective Structured Clinical Examination) assessment in accident and emergency settings. It includes sample cases and imaging for pediatric resuscitation, medical emergencies, trauma, and orthopedic injuries. For each case, it lists questions to assess indication, diagnosis, management, and complications. The responses provide concise answers addressing the prompts for each case scenario.
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Similar to Image of the Day 2: mediastinal mass
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Dr. Myhammad Bin Zulfiqar PGR IV SIMS/SHL
In this presentation we shall discuss the role of radiologist in the management of leukemia
Crimson Publishers-Cardiac Metastasis in an Asymptomatic Geriatric Female
Cardiac Metastasis in an Asymptomatic Geriatric Female by Taral R Sharma in Gerontology & Geriatrics studies
Multiloculated thymic cyst poster presenation
A 47-year-old male presented with shortness of breath, orthopnea, and dry cough. Imaging revealed a large mediastinal cyst compressing the right lung. The patient underwent a thoracotomy and excision of the cyst. Histopathology determined it was a rare multiloculated thymic cyst. Multiloculated thymic cysts are acquired lesions resulting from inflammation that can be difficult to differentiate from malignant lesions on CT. Complete surgical excision and histopathology are required for accurate diagnosis.
Anwser,s 8
The blood gas results show a respiratory acidosis with a pH of 7.25 and a PCO2 of 7.5 kPa. This is consistent with type I respiratory failure due to an acute process like pneumonia. Bronchopulmonary dysplasia and asthma are chronic conditions unlikely to cause such an acute deterioration. While intubation may be required, the immediate priority should be supportive care and treating the underlying cause rather than intubation alone. Bicarbonate is usually not required to correct a respiratory acidosis as the kidney can compensate.
The best answer is:
B - Blood gases suggest type 1 respiratory failure.
A Case of Pancoast's tumour
This document summarizes a case of a 51-year-old male diagnosed with a Pancoast tumor (lung cancer) in the right upper lobe that invaded the chest wall. The patient presented with chest and shoulder pain and was found to have a heterogeneous contrast-enhancing mass on CT scan. Biopsy confirmed squamous cell carcinoma. Pancoast tumors are a rare type of lung cancer that typically invades structures at the thoracic inlet like nerves and ribs. Treatment may include pre-operative radiation and surgery to remove the tumor and affected structures, followed by post-operative radiation.
Pathology of Myocardial Infarction
The document discusses myocardial infarction (MI) including its pathogenesis, clinical features, complications, pathology findings at different time points, and case studies. It provides details on coronary artery anatomy, atherosclerosis, infarction morphology on gross and microscopic examination over time, and complications of MI such as cardiac rupture and aneurysm formation.
Primary Mediastinal Liposarcoma
1) The document presents a case report of a 32-year old man who presented with superior vena cava syndrome due to a large primary mediastinal liposarcoma.
2) CT scans showed the tumor involved three mediastinal compartments and compressed major blood vessels.
3) The patient underwent surgical debulking but the tumor was not fully resectable. He received chemotherapy but ultimately died from pneumonia.
CARDIAC TUMORS.pptx
Cardiac tumors are abnormal growths that can occur in the heart. They can be either cancerous (malignant) or noncancerous (benign). The most common type of benign cardiac tumor is an intracardiac myxoma, which usually originates in the left atrium. Left atrial myxomas can cause a triad of embolic phenomena, systemic symptoms, and obstructive manifestations as they interfere with the mitral valve. Diagnosis is made through 2D echocardiography and treatment involves surgical resection of the tumor along with the affected part of the atrial septum.
Giant Thoracoabdominal Ganglioneuromma : an unusual mimicker of ruptured Aort...
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Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: January Cases
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. Lauren Ramsey, PA-C works with the Sanger Heart & Vascular Institute. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Atrial Myxoma
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Amol cardiac tumours
Cardiac tumors can be primary tumors originating from the heart or secondary tumors from metastases. Primary tumors are more commonly benign myxomas found in the left atrium of middle aged patients, while secondary tumors are more prevalent. Imaging with echocardiography, CT, and MRI can characterize tumors and determine if they are resectable. MRI provides the best evaluation of tumor extent, involvement of surrounding structures, and differentiation of tumor types.
A case of giant mediastinal liposarcoma of thymic origin a rare clinical entity
Abstract
Thymoliposarcoma is an exceedingly rare tumor of thymus with a very few
cases reported till date. This case study presents a 45-year male with rare type
of thymoma. On the contrast-enhanced CT images, there was a large mass lesion
of predominantly fat attenuation in the pre-vascular compartment of the
mediastinum insinuating on both sides of the visceral compartment of the
mediastinum, and extending upto the bilateral cardio phrenic and anterior
costophrenic angles, anterior to the right ventricle with loss of fat plane with
the pericardium, with few sub-centimetric lymph nodes in the right paratracheal
and AP window and a calcified right hilar lymph node, suggestive of
well-differentiated liposarcoma/thymoliposarcoma. Initial CT guided tru-cut
tissue biopsy was inconclusive, and the repeat biopsy revealed as fibro-
collagenous tissue with area of necrosis, focal myxoid changes in the
background with presence of cells which are spindle to oval in shape with
mild nuclear pleomorphism and negative for S100, Cytokeratin, CD34, desmin.
The entire tumor was resected en masse after meticulous dissection
without the support of cardiopulmonary bypass (CPB) with an intact pericardium.
Final histopathology report of the surgical biopsy specimens is consistent
with dedifferentiated thymoliposarcoma with focal ganglionic cell differentiation.
Postoperative follow-up CECT of thorax revealed no evidence of
residual mass in the pre-vascular compartment. The patient is disease-free
and asymptomatic after 6-month and he is under routine follow-up under
Radiotherapy department since he received 30 Gy of postoperative radiotherapy
(PORT).
CNS Rapid Review of Radiology
Text book, CNS, Neuro imaging, Adult and paediatric, Diagnosis imaging, case and answer , differential diagnosis, pathology base discussion
Benign Thyroid Swellings
This document provides information on benign thyroid swellings. It begins with the surgical anatomy of the thyroid gland including its location, parts, coverings, arterial supply, venous drainage, and nerve supply. It then discusses the physiology of the thyroid gland including hormone production and regulation. Various types of thyroid enlargements are described such as simple goiter, clinically discrete swellings, hyperthyroidism, and thyroiditis. Diagnostic tests and treatments are also summarized.
Abdominal masses in children
It is a powerpoint which describes abdominal masses in children designed for the students of radiology.
Cardiac tumour bv tam duc
This document discusses cardiac tumors. It begins by classifying cardiac tumors as neoplastic or non-neoplastic lesions and further classifying neoplastic lesions as benign or malignant tumors. The document then discusses the incidence, clinical manifestations, diagnostic evaluations, and approaches to different types of cardiac masses and benign tumors specifically, covering myxomas, lipomas, papillary fibroelastomas, and rhabdomyomas.
Case record...Epidural secondary CNS lymphoma
A 32-year-old male presented with a single grand mal seizure. CT scans showed extradural masses in the left parietal and frontal regions, compressing the brain and ventricles. Surgery revealed nodular dural thickening without brain infiltration. Biopsy diagnosed non-Hodgkin B-cell lymphoma. Further staging found extensive extraneural disease, though the CNS manifestations were the initial presentation. The patient was referred for oncology management for epidural secondary CNS lymphoma.
Presentation1.pptx, radiological imaging of the thyroid gland diseases.
This document discusses radiological imaging modalities for evaluating thyroid diseases such as plain X-ray, ultrasound, isotope uptake scan, CT scan, and MRI. It describes indications for thyroid ultrasound including evaluating neck masses, abnormalities found on other imaging, laboratory abnormalities, thyroid size and location, risk for occult cancer, and follow-up of known nodules. Common thyroid diseases discussed include hypothyroidism, hyperthyroidism, goiter, nodules, cancer, and deficiencies. Specific conditions like Hashimoto's thyroiditis, acute infectious thyroiditis, subacute granulomatous thyroiditis, euthyroid sick syndrome, and Graves' disease are also summarized.
Chest radiology essentials mediastinal masses
This chapter discusses mediastinal masses. It describes the different compartments of the mediastinum and states that 60% of mediastinal masses arise in the anterior compartment. It lists the most common causes of masses in each compartment, known as the "4 Ts" in the anterior compartment: thymoma, thyroid masses, teratomas, and lymphoma. It provides details on imaging features of these masses and others, such as cysts, abscesses, and vascular abnormalities. CT is useful for further characterizing masses and determining if they involve surrounding structures.
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Crimson Publishers-Cardiac Metastasis in an Asymptomatic Geriatric Female
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A case of giant mediastinal liposarcoma of thymic origin a rare clinical entity
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Presentation1.pptx, radiological imaging of the thyroid gland diseases.
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Image of the day 8: Pelvic Fracture
This document discusses an open book pelvic fracture case involving a 40-year-old man who was injured when his tractor fell 3 meters. It highlights that open book fractures often result from high-energy injuries and are associated with injuries to other organs. Stabilization of this patient required a multidisciplinary approach from orthopedics, surgery, medicine, and anesthesiology given his unstable hip dislocation, intra-abdominal injury, and blunt cardiac injury also sustained in the accident. The X-ray and ECG findings related to the case are also briefly described.
Left massive pleural effusion
A 72-year-old Chinese lady presented with shortness of breath. Radiograph shows a homogenous radio opaque left lung field occupying the whole lung, displaced heart to the right side, and contra lateral tracheal shift consistent with massive left pleural effusion. Investigations would include pleural tap, pleural biopsy, CT thorax, and fiberoptic bronchoscopy to determine the underlying cause and guide treatment.
Pleural effusion
A 64-year-old Malay man presented with wheezing, shortness of breath on exertion, chest pain on inspiration, abdominal pain, and low-grade fever for two weeks. Chest X-ray showed a homogeneous radio-opaque area in the right lung extending to the upper zone, with the presence of a meniscus layer. The trachea was shifted to the right and there was mediastinal shift. The diagnosis was a right massive pleural effusion.
9 years old girl with high grade fever and rash
A 9-year-old girl presented with a 5-day history of fever and rash. On examination, she had a temperature of 38°C, pulse of 110 beats/min, capillary refill time over 2 seconds, and cold extremities. Laboratory tests showed a platelet count of 60. The provisional diagnosis was dengue hemorrhagic fever in the critical phase with compensated shock. Management involved fluid resuscitation and close monitoring for worsening of vital signs or bleeding that may require admission to the intensive care unit.
Short case pediatric approach to cerebral palsy
This document provides guidance on approaching a pediatric patient with cerebral palsy by outlining what to inspect including positioning, movements, and abnormalities, defines cerebral palsy as a non-progressive brain lesion causing movement and posture disorders, and discusses the types, causes, and multidisciplinary management of cerebral palsy including physiotherapy, medications, and psychosocial support.
Surgical short case stoma
This document provides guidance on examining a stoma. It lists the key aspects to comment on including the site, type of stoma, condition of surrounding skin, status of any loop, and characteristics of discharge. A sample comment is provided as an example. Additionally, the document defines what a stoma is, describes their functions and common complications, and differentiates between ileostomies and colostomies. Images are also included showing examples of different stoma types.
A mature pseudoprimid with hypertension in pregnancy and history of subinfert...
This document summarizes the case of a 38-year-old woman referred for high blood pressure at 38 weeks of pregnancy. She has a history of infertility for 4 years and one prior miscarriage. Her current pregnancy was spontaneous. While her blood pressure normalized during early pregnancy, it is now controlled with medication. The document discusses definitions related to advanced maternal age, nulliparity, hypertension in pregnancy, and infertility. It also reviews risks and management considerations for inducing labor given her age, blood pressure, and advanced gestational age.
Osce ophthalmology npdr
This patient, a 49-year-old Malay man, was experiencing blurred vision and was found to have non-proliferative diabetic retinopathy (NPDR) during his third eye exam over 15 years after being diagnosed with diabetes. NPDR was diagnosed based on findings of microaneurysms, dot and blot hemorrhages, and intraretinal microvascular abnormalities. The blurred vision was likely caused by ischemia reducing blood supply to the macula, macular edema, leakage of fluid and fatty deposits under the retina, or bleeding from new fragile blood vessels. Management includes optimizing blood sugar control, regular monitoring, focal laser treatment for macular edema, controlling hypertension, and follow-up eye exams.
Osce post op management for lscs
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Primary non gestational extra gonadal choriocarcinoma of the lung
This document discusses primary non-gestational extragonadal choriocarcinoma of the lung, a rare type of germ cell tumor. It begins by defining choriocarcinoma and distinguishing between gestational and non-gestational types. It then focuses on primary (non-gestational) choriocarcinoma of the lung, which accounts for less than 30 reported cases. The diagnostic criteria include exclusion of other primary sites and normalization of serum HCG levels after treatment. Histopathological examination shows malignant cells resembling trophoblast or syncytiotrophoblast cells. Prognosis is generally poor with average survival of 5 months.
Approach to history taking in internal medicine posting
This document provides guidance on conducting an effective history taking for internal medicine postings. It outlines the key sections to cover, including identification data, chief complaints, history of present illness, past medical history, social history, and others. For each section, it describes the essential information to obtain, such as relevant symptoms and their progression, past and current medical issues, medication usage, lifestyle and family factors. The document emphasizes a structured yet flexible approach, using open-ended questioning followed by focused questions, to fully understand the patient's condition and identify potential diagnoses.
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Image of the Day 2: mediastinal mass
- 1. Image Of The Day 2: Lymphoma Muhamad Na’im B. Ab Razak (MD USM) This 46 years old gentleman who is a chronic smoker and alcoholic and with underlying history of Ex PTB completed treatment presented with non specific chest pain and cough. Otherwise he denied any history of fever, shortness of breath, constitutional symptoms and no reduce effort tolerance. On clinical examination noted that there are no clubbing, no wasting of small muscle, no resting or intentional tremor, no cynosis, no ptosis and no hyperthyroidism symptoms. However, chest examination reveals trachea shifting to the right, bulging of left mediastinum, reduce left chest wall movement, reduce air entry over left chest and dullness on percussion up to left upper zone. Otherwise, reduce vocal resonance and fremitus. The chest X Ray shows 1) Trachea shifted to the right, 2) Heart shifted to the right, 3) Wide mediastinum with anterior mediastinal mass and hazinnes of the left hemithorax up to the upper zone.
- 2. In Image of the Day 1, [Link] i put a case of Dissecting aortic aneurysm with haemothorax secondary to the leaking. Today’s image would broaden up our mind to think about non vascular cause of enlarged mediastinal mass. The differential diagnosis would be Hodgkin’s lymphoma, non hodgkin’s lymphoma, Thyroid mass, Teratoma and Tumors of the thymus (cyst or thymoma). Other rarer cases of widened mediastinum reported in case studies include venous aneurysm, mediastinal lipomatosis, descending necrotizing mediastinitis, spontaneous rupture of common carotid artery, malignant fibrous histiocytoma, traumatic extravasation of cerebrospinal fluid and others. Lateral chest film may help to differentiate the origin of the mass. However, with the advance of radiological modalities, CT scan and MRI are found to be more superior than plain radiograph. Radiological intervention would alse very helpful for diagnostic purpose especially in doing biopsy.