This document discusses paediatric abdominal masses. Ultrasound is generally the initial imaging test which can differentiate cystic from solid masses and indicate organ of origin. CT or MRI may be needed for large or complex masses. Specific masses discussed include renal masses like Wilms tumour, adrenal masses like neuroblastoma, hepatic masses like hepatoblastoma, pancreatic masses, splenic masses, gastrointestinal masses, and pelvic masses like rhabdomyosarcoma. Imaging findings, staging, and treatment options are provided for some of the most common paediatric abdominal masses.
Approach to a Child with an Abdominal Mass and tumours.pptxJwan AlSofi
Clinically oriented approach to a child with abdominal mass.
Discussion about Neuroblastoma
Discussion about Wilms tumor
Discussion about Hepatic tumors
Case discussions
Approach to a Child with an Abdominal Mass and tumours.pptxJwan AlSofi
Clinically oriented approach to a child with abdominal mass.
Discussion about Neuroblastoma
Discussion about Wilms tumor
Discussion about Hepatic tumors
Case discussions
A Practical Approach to differential diagnosis.
This presentation offers a practical approach in differential diagnosis in head and neck masses in children and it is based on the article by Dr. Bernadette L. Koch published on Statdx.com .
Neck Masses need to be divided in Cystic and Solid and according the location.
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
A Practical Approach to differential diagnosis.
This presentation offers a practical approach in differential diagnosis in head and neck masses in children and it is based on the article by Dr. Bernadette L. Koch published on Statdx.com .
Neck Masses need to be divided in Cystic and Solid and according the location.
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
TESTICULAR TUMOURS
PREVALANCE
99% of testicular tumours are malignant.
Life time prevalence of getting testicular tumour is 0.2%.
Very common in Scandinavia; least common inAfrica andAsia.
4 times common in whites than blacks.
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
3. Imaging plays an important role in the diagnosis and
management.
Plain radiographs provide clues to the location of the
mass,organomegaly and the presence of calcifications.
Ultrasound is generally the most valuable procedure for
the initial evaluation.
Ultrasound differentiates cystic from solid masses,
indicates the organ of origin, and suggests the diagnosis,
also about the vascular compromise and intraluminal
thrombosis.
CT or MR needed when the mass is large, poorly defined,
for staging or when obscured by bowel gas.
Radionuclide for specific applications
7. Imaging
• On ultrasound Wilms tumor characteristically is a
well-defined, predominantly solid mass Appears as
echogenic, heterogeneous with cystic areas. Wilms
tumor has a propensity to extend into the renal vein,
inferior vena cava, and right atrium
• On CT Wilms tumours are heterogeneous soft-
tissue density masses, rarely calcifications and
enhancement is patchy.
• On MRI, tumor tends to have decreased signal on T1
and increased on T2
• The lung is commonest site for metastases.
8.
9.
10.
11.
12. Tumor staging
Determined by imaging and surgical findings.
• Stage 1:Encapsulated tumor completely excised.
• Stage 2:Extends beyond the kidney, completely excised
• Stage 3:Residual tumor confined to abdomen and nodes
• Stage 4:Haemetogenous metastasis
• Stage 5:Bilateral tumours at diagnosis
5 year survival exceeds 90% in those with early stage and
favorable histology.
A tumor biopsy is not typically performed due to the
chance of upstaging the cancer and seeding the abdomen
with malignant cells.
13. Treatment
• The main types of treatment that can be used for
Wilm's tumor are:
• Surgery
• Chemotherapy
• Radiation therapy
Nephrectomy followed by chemotherapy
• Postoperative radiation therapy for stage II and
IV lesions
14. • Renal cell carcinoma is very rare in young
children but sometimes occurs in older children
and adolescents
• The imaging characteristics of renal cell
carcinoma are indistinguishable from those of
Wilm's tumor.
15. Adrenal Masses
Adrenal Hemorrhage
Commonest cause of adrenal mass
May be unilateral or bilateral
Predisposing factors include large babies, obstetric
trauma, neonatal sepsis, and hypoxia
Ultrasound: demonstrate an avascular heterogeneous
adrenal mass that has becomes cystic and smaller over the
following weeks as clot retractions occur.
Serial ultrasound to document the typical course of cystic
changes and resolution, usually evolves from hyper echoic
to iso-echoic to hypo-echoic.
16.
17.
18. Neuroblastoma
• Malignant tumor of neural crest cells
• Commonest extracranial solid malignant tumor
• Approximately 70% originate in the abdomen of
which 2/3rd arise in adrenal,20% in the chest
and 10% in the head and neck
19. • May present as palpable abdominal mass or non
specific symptoms
• 50 to 60% of all neuroblastoma cases present
with metastases
20. Radiological imaging
• Ultrasound demonstrates a hyperechoic mass in the
adrenal or central retroperitonuem often with flecks of
calcification. Doppler for flow in encased vessels
• CT confirms the calcification with low attenuation mass.
• The most characteristic imaging feature is the
encasement of adjacent vessels
• 99m Tc MDP scintigraphy is useful for detection of bone
metastasis.
• mIBG scan
21.
22.
23.
24.
25. Staging
Involve the radiological, surgical and bone marrow
aspirate:
• Stage 1:confined to organ of origin
• Stage 2: extending beyond the organ of origin, unilateral
nodal disease
• Stage 3:extending across the midline, bilateral nodal
disease
• Stage 4: distant metastases
• Stage 4s: age<1year,localized primary(stage 1 or 2
metastases to liver, skin and/or bone marrow)
26. • Treatment options for neuroblastoma largely
depend on the location and size of the tumor and
usually involve multimodal therapy
• 1.Surgery
• 2.Radiation therapy
• 3.Chemotherapy
• Immunotherapy
• Bone marrow transplant
27. Hepatobiliary masses
• Accounts for 6% of abdominal masses
• 2/3rd are malignant and 1/3rd are benign.
Hepatoblastoma
Most common malignant hepatic tumor
• Majority present under 2 years
• No association with cirrhosis
• Increased risk with beckwith wiedemann syndrome,
affected siblings, familial polyposis coli and trisomy 18.
usually present with an abdominal mass
28. Imaging
• On ultrasound single or multiple hyperechoic
masses with distortion of the adjacent vascular
architecture,hepatoblastomas usually are highly
vascular
• On CT heterogeneous low attenuation lesion are
seen with areas of necrosis and hemorrhage and
often containing coarse calcification
• Vascular and tumor thrombus strongly suggest
malignancy
• Lung is the most frequent site of metastases
32. Liver metastases
• Metastases to the liver are more common than
primary hepatic tumours and most frequently
associated with the neuroblastoma, Wilm's
tumour, lymphoma and leukemia
33. Ultrasound of liver metastases can have a variety
of appearances
• hypoechoic: most common ~ 65%
• Hyperechoic
• peripheral halo
• Calcified
• Cystic
• poorly defined (infiltrative)
37. Imaging
• Infantile haemangioendotheliomas have a variable
sonographic appearance and may be either
hypoechoic or hyperechoic or may have mixed
echogenicity
• Colour Doppler sonographic evaluation will show
increased flow.
• On CT enhancement is typical
• On MRI lesions are low signal on T1 and high on T2
with large vascular signal voids
38.
39.
40. Choledochal Cysts
Congenital dilatations of the biliary tree
• Most cause symptoms in childhood and adult life.
There are four types:
• Type 1A: Fusiform dilatation of the CBD below the cystic duct
• Type 1B: Fusiform dilation of the common hepatic duct and
CBD
• Type 2: Eccentric diverticulum off the CBD
• Type 3: Choledococele-Dilatation of the distal intramural
portion of the CBD
• Type 4: Caroli’s disease-saccular dilations of the hepatic bile
ducts
41.
42. Complications include cholangitis, biliary calculi,
pancreatitis and biliary cirrhosis.
• On ultrasound or CT the biliary tree dilatation or
cyst can be seen.
• 99mTc-HIDA scinitraphy will show accumulation
of tracer within the cyst.
• Percutanous or endoscopic cholangiography and
MRCP are helpful in preoperative planning.
43.
44. Pancreatic masses
• Pancreatic pseudocysts occurring as the sequelae
of previous pancreatitis or trauma
• True epithelial line congenital pancreatic cysts are
less common
• Primary pancreatic tumours are rare in childhood
including the pancreticoblastoma,papillary
epithelial neoplasm and endocrine adenomas
48. • Asplenia and polysplenia occurs as part of heterotaxy
syndrome.(Situs ambiguus)
• Asplenia is associated with right
isomerism,malrotation and severe congenital cardiac
defects with majority of infants dying in the first year
of life
• Polysplenia in which multiple well defined masses
are found in the left upper quadrant.
• Wandering spleen is ectopic location outside the
left upper quadrant
52. Focal splenic lesions
• Splenic cysts may be congenital or acquired
secondary to trauma, infarction or hydatid
disease.
• Benign focal splenic masses include
haemangiomas,lymphangiomas, AVM and
hamartomas
53. Gastrointestinal Masses
• Duplication cysts and mesenteric/omental cysts
• Commonest malignancy is Burkitt’s non
Hodgkin’s lymphoma
▫ Ill defined mass of adherent bowel loops with
infiltration of the adjacent mesentery and with
lymphadenopathy
56. Rhabdomyosarcoma
• Commonest pediatric soft tissue sarcoma
• Pelvis most frequent site of origin
• In boys mostly arises from the prostate or
bladder base
• In girls from the urinary bladder, uterus or
vagina
57. • These are aggressive tumors
• Invasion of adjacent viscera and pelvic wall
• Distant spread to lymph nodes, lung and bone
58. Ultrasound
• shows heterogeneous well-defined irregular
mass of low to medium echogenicity
CT
• soft tissue density
• some enhancement with contrast
• adjacent bony destruction seen in over 20% of
cases
59.
60.
61. Ovarian tumors
• 65% are benign and 35% are malignant
• Ovarian teratomas usually present at puberty
and 90% are benign
• The majority of ovarian malignancies are germ
cell tumour
• Most are large >15cm at presentation
62. Serology
• CA-125 levels - elevated in most ovarian
malignancies (~ 80% in general)
• AFP levels - elevated particularly with immature
ovarian teratomas (~ 50% of cases) and ovarian
yolk sac tumours
63. Imaging
• On ultrasound solid and cystic component can
be demonstrated
• CT can demonstrate the solid-cystic mass with
fat and calcific components
• It is not possible to determine whether a mass is
benign or malignant unless local invasion or
distant metastasis is present on imaging
64.
65.
66.
67. Adnexal torsion
• Can occur at any age but is most frequent in the first
two decades of life. The affected ovary may be
normal or containing a cyst or tumour.
• Patients present with acute lower abdominal pain
and vomiting.
• Ultrasound demonstrate an enlarged swollen ovary
with peripheral cysts and free fluid in the pouch of
Douglas
• Doppler signal is usually absent.
68.
69. Beckwith-Wiedemann syndrome (BWS) is a congenital
overgrowth disorder:
• macroglossia - most common clinical finding
• omphalocoele
• localised gigantism / macrosomia
• hemihypertrophy
• cardiac anomalies
• pancreatic islet cell hyperplasia
• organomegalies
• nephromegaly
• hepatosplenomegaly
NephroblastomatosisSmall islands of primitive metanephricblastema, which are precursor of Wilms tumor, commonly exist in the kidneys of the normal newborn infant. These primitive cells usually spontaneously regress by 4 months of age. A diffuse and proliferative form of persistent renal blastoma is referred to as nephroblastomatosis. The abnormal tissue can form as multiple discrete nodules within the renal parenchyma or may completely replace the renal cortex. -Nephroblastomatosis appears on CT or IV pyelogram as bilateral lobulated and enlarged kidneys with marked compression, stretching, and distortion of the pelvicaliceal structures On US, the kidneys are enlarged, lobular, andechogenic, or enlarged with diffuse hypoechoic thickening of the cortex. In such cases, Wilms tumor should be suspected. Nephrogenic rests are more likely to appear cortical, tend to be homogeneous, and are of low echogenicity on US, low attenuation on CT, and low signal intensity on T1WIs . Small, focal nephrogenic rests smaller than 1 cm are difficult to visualize by US and are better evaluated with contrast-enhanced CT or T1WI
Sagittal image of the right kidney A rounded solid appearing mass is seen in the interpolar region of the right kidney. The mass shows no obvious calcifications.
Sagittal image of the right kidney The right kidney appears enlarged and lobulated. The complex right renal mass is appreciated again in this image. The mass exhibits a few scattered areas that are hypoechoic
Contrast enhanced axial CT scan The right renal mass is again identified in this image. The mass is seen to occupy a large portion of the kidney and invades the right renal hilum; however it does not cross the midline.
Wilm's Tumor. Conventional radiograph of abdomen shows a large right upper mass displacingbowel loops into the pelvis and accross the midline (blue arrows). Coronal and sagittal reformatted CTdemonstrate a large, heterogeneous mass arising from the right kidney (white arrows). A smallsliver of functioning right kidney is seen to enhance (yellow arrow).
Adrenal HemorrhageThe infants may present with an abdominal mass, jaundice, hypotension, or anemia, but small hemorrhages may go unnoticed. Hemorrhage occurs more frequently on the right and is occasionally bilateral. Older children develop adrenal hemorrhage as a result of accidental trauma, child abuse, meningococcemia, or anticoagulant therapyHemorrhage enlarges the gland and causes loss of the V shape. Initially, the hematoma resembles a solid, echogenic mass . As the hemorrhage resolves, it becomes increasingly hypoechoic, starting in the central region and progressing peripherally .
hypo-echoic hematoma in the right adrenalAdrenal hemorrhage longitudinalAdrenal hemorrhage without vascularity longitudinal
The etiology of neuroblastoma is not well understood. The great majority of cases are sporadic and non-familial.detect neuroblastoma is the mIBG scan (meta-iodobenzylguanidine), which is taken up by 90 to 95% of all neuroblastomas, often termed "mIBG-avid
Tc-99m MDP (Bone Scan)MIBG scintiscan
A well-defined, rounded, mildly lobulated, hypoechoic mass that is separate from the liver is noted in the right upper quadrant. The mass has areas of calcification and appears to displace the kidney downwards and medially.
They usually present with an abdominal massHepatoblastomas originate from immature liver precursor cells, usually unifocal and affect the right lobe of the liver more often than the left lobe, can metastasize.Surgical resection is the usual manner in which material for pathologic assessment is obtained. Open biopsy is performed when complete surgical resection is not possible. Needle biopsy is not recommended, because hepatoblastomas usually are highly vascular.
Precontrast CT scan pre shows a large mass encompassing both lobes of the liver, which is of lower density than normal liver. CECT demonstrates mass that appears to be multinodular, with heterogeneous enhancement less than that of the surrounding liver
Metastatic DiseaseNeuroblastoma is the most common childhood tumor to metastasize to the liver, followed by lymphoma, leukemia, and Wilms tumor. Metastatic lesions are usually multiple, and their imaging appearance is generally nonspecific
Echogenic nodular lesion in segment 7 of liver in a known case of RCC, represents metastatic nodule.
Liver metastases, contrast-enhanced CT. Multiple hypoattenuating lesions of varying sizes are seenin both the left and right lobes of the liver, some with indistinct margins
Hemangioendothelioma is a benign endothelial lined vascular mass of the liver seen in infants. It should be suspected in an infant with a large liver mass and congestive heart failure (CHF) or cutaneous hemangiomas.Clinical ManifestationInfantile hemangioendotheliomas are generally noticed within the first few days to months of life. They typically present with a palpable upper abdominal mass with bruit, abdominal distension, hepatomegaly, and high output CHF secondary to arteriovenous shunting. Fifty percent of infants have cutaneous hemangiomas. Hemangioendothelioma can be detected in utero as early as 16 weeks of gestation and is associated with polyhydramnios.
Axial CT scan post-contrast arterial phase at the level of the kidneys showed diffused hepatic masses with intense peripheral enhancement and central non-enhancing areas, B) Venous phase shows diffused enhancement of the lobulated liver segments. Axial unenhanced T1 weighted MRI image shows diffused nodules with low signal intensity, B) Coronal T2 weighted MRI image shows diffuse high signal intensity nodules occupying almost the entire abdomen.
Choledochal cysts are congenital malformations of the intrahepatic or extrahepatic bile ducts. majority of cysts are associated with an anomalous junction of the common bile duct and pancreatic duct Jaundice, pain, and a right upper quadrant mass comprise the classic triad of findings seen with a choledochal cyst. The most common type of choledochal cyst (type 1) is a localized, fusiform or saccular dilation of the common bile duct below the cystic duct.
These patients also have a normal pancreaticobiliary junction.
Ultrasound images reveal a large cystic collection with thickened and shaggy walls, located anterior to left kidney and in close relation to tail and body of the pancreas. These ultrasound findings suggest a diagnosis of pseudocyst of the pancreas
Splenomegaly is a relatively common cause of a left upper quadrant mass in children.
Situsambiguus, also known as heterotaxy is a rare congenital defect in which the major visceral organs are distributed abnormally within the chest and abdomen.The normal position of the organs is known as situssolitus; situsinversusis a condition in which the usual positions of the organs are reversed from left to right as a mirror image of the normal conditionabsent or defective splenic function is associated with a high risk of fulminant bacterial infections, especially with encapsulated bacteria
Left IVC and multiple spleens polysplenia, azygous continuation of the IVC and retroperitoneal hepatic flexure (note no situsinvertus
15-year-old male with Burkitt's lymphoma. CT with contrast. (A) The bulky heterogeneousmassBurkitt lymphoma in a 4 year-old boy infiltrating both kidneys, liver and spleen. a) Axial contrast enhanced CT reveals a homogeneous hypodense nodular lesion in the left kidney (black arrow) and another one that almost replaces the right kidney (yellow arrow). b) Two months later, after chemotherapy, the left kidney lesion was unapparent and the lesion in the right kidney shrunken significantly
The transverse ultrasound image of the pelvis showed a soft tissue mass deep to the urinary bladder This was a prostatic rhabdomyosarcoma.
Axial and coronal CT images below show a complex soft tissue mass, arising from the prostate gland
Ovarian Teratomacomplex cystic and solid pelvic mass containing two teeth and fat
Contrast-enhanced coronal CT images of the abdomen and pelvis, demonstrate a large predominantly cystic left adnexal mass containing multiple septations almost completely occupying the abdomen (black arrow). The twisted vascular pedicle in the left lower quadrant demonstrates a whirlpool sign (white arrows)
Claw signIt refers to the sharp angles on either side of the mass which the surrounding normal parenchyma forms when the mass has arisen from the parenchyma. As such, normal parenchyma extends some way around the mass. Examples where a claw sign is useful include:meningioma vsintraparenchymal brain tumourWilms tumour vsneuroblastomarenal angiomyolipomavs retroperitoneal liposarcoma
