11) Women, Men, and Children Flashcards
Women’s imaging
- Mammography and the female breast
- Gynecological conditions
- Obstetrical conditions
Breast cancer
- Leading cause of non-preventable cancer death in women
- 180,000 cases per year; 46,000 deaths
Risk of breast cancer increases with
- Age, especially after 40
Mammography can detect
- Presence of early breast cancer at the non-palpable stage
Mammography cannot rule out breast cancer in a patient with
- Palpable mass or other abnormality on clinical examination
- Basically it can rule in cancer, but it cannot rule it out
Screening mammography
- Performed on asymptomatic women to detect unsuspecting cancer at an early age
Diagnostic mammography
- Problem-solving mammography
- Performed to evaluate abnormal clinical findings
There is general agreement that all women over the age of 50 should have
- Annual screening mammograms (some sources say over 40)
A mammogram consists of two views of each breast
- Mediolateral oblique (MLO)
- Craniocaudad (CC) view
The augmented breast poses problems with mammography
- Implant can obscure up to 85% of the tissue
- MRI can be done in these patients
- Ultrasound can be performed to evaluate implant leakage
Risk factors for breast cancer
- Maternal relative with breast cancer
- Longer reproductive span
- Obesity
- Nulliparity
- Later age at pregnancy
- Atypical hyperplasia
- Previous breast or uterine cancer
Breast Imaging Reporting and Data System (BIRADS) defines five type of margins
- Circumscribed
- Obscured
- Micro-lobulated
- Ill-defined
- Spiculated
Circumscribed margins
- Well defined
- Sharply demarcated with an abrupt transition between the lesion and the surrounding tissue
Microlobulated margins
- Small undulating circles along the edge of the mass.
Obscured margins
- Hidden by superimposed or adjacent normal tissue
Ill-defined margins
- Poorly defined and scattered
Spiculated margins
- Marked by radiating thin lines
BIRADS assessment categories
- Category 0-5
Category 0
- Need additional imaging evaluation
Category 1
- Negative
Category 2
- Benign finding
Category 3
- Probably benign finding
- Short interval follow up suggested
Category 4
- Suspicious abnormality
- Biopsy should be considered
Category 5
- Highly suggestive of malignancy
- Appropriate action should be taken
A spiculated, dense mass especially when not palpated is almost always
- Carcinoma
Skin calcifications
- Typical lucent center
- Polygonal shape
- Not in the breast parenchyma, but may project as such on a mammogram
Vascular calficifications
- Seen as parallel tracks or linear tubular calcifications that run along a blood vessel
Coarse or popcorn-like calcifications
- Typically found in involuting fibroadenomas
- Fibroadenomas usually regress with menopause and microcalcifications will develop into coarse macrocacifications
Rod-shaped calcifications
- Typical of secretory disease but not of breast cancer
- Usually >1mm, occasionally branching, and may have lucent centers
- Form in debris that collects in the duct lumen or cause an inflammatory reaction around a duct
Round calcifications/smooth round calcifications
- Associated with a benign process
- May vary in size in a cluster
- When <1mm they are often found in the acini of lobules
- When <0.5mm the term punctate is used
Spherical or lucent-centered calcifications
- Can range from <1mm to >1cm
- May be found as debris collected in a duct, in areas of fat necrosis and fibroadenomas
Risks associated with mammography
- Radiation dose
- False positive (increases with age)
- Implant interference
- False negative
- High rate of litigation
Primary imaging method for the female pelvis
- Ultrasound
Transabdominal pelvic ultrasound
- Performed using the patient’s full bladder as an acoustic window
Transvaginal pelvic ultrasound
- Uses a specially designed transducer that is placed inside the patient’s vagina for scanning
- Helps to improve visualization of small structures
Transvaginal pelvic ultrasound is especially valuable in
- Obstetrical imaging to depict first trimester development and diagnose ectopic pregnancy
CT and MRI can also produce excellent images of the female pelvis, and are helpful in
- Staging of pelvic malignancies
Hysterosalpingogram (HSG)
- Water soluble contrast material injected into the uterus to image the female organs
- Normal examination will show contrast flowing into the uterine tubes and the peritoneal cavity
Gynecological conditions that can be diagnosed using ultrasound
- Ovarian cysts
- Pelvic inflammatory disease
- Endometriosis
- Benign tumors of the uterus and ovaries
- Ovarian masses may be cyctic, solid, or complex
Benign tumors of the uterus
- Leiomyomas
Benign tumors of the ovaries
- Cystadenomas
- Cystic teratomas
Ultrasound during pregnancy
- Accurately date the pregnancy
- Detect multiple pregnancies
- Monitor fetal growth
- Assess fetal well-being
- Real-time motion images let you observe fetal cardiac motion and fetal movements
Ectopic pregnancy is one of the leading causes of
- Maternal death during pregnancy
- Occurs in 1-2% of all pregnancies
- Accounts for 15% of maternal deaths
The incidence of ectopic pregnancy has been steadily increasing because
- More women are contracting pelvic inflammatory disease or undergoing in vitro fertilization
- Both increase the likelihood of ectopic implant
Placenta previa
- A condition in which the placenta covers the internal os of the cervix
Symptoms of placenta previa
- Painless bleeding in the third trimester
- Should have an ultrasound to determine the position of the internal os in relation to the placenta
One of the most common placental complications
- Hemorrhages (because the placenta contains many blood vessels)
Placental abruption
- When the hemorrhage is retroplacental (between the placenta and the uterine wall), placental abruption may occur, separating the placenta from the uterus
Placental abruption can produce
- Pain, vaginal bleeding, and hypovolemic shock
- Ultrasound examination will show an echogenic collection of blood in the retroplacenteal area
Placental abruption is a major cause of
- Fetal mortality
- Accounts for up to 15-20% of perinatal deaths
- Maternal morbidity and mortality may also occur with this condition
Method of choice for scrotal imaging
- Ultrasound
- Can identify testicular tumors, testicular torsion, testicular trauma, and many other conditions
The prostate can be evaluated using
- IVP
- Ultrasound
- CT
The male urethra is usually evaluated using
- RUG
- Imaging by injection of a water soluble contrast agent via a small catheter
- VCUG-films are taken while patient urinates on the fluoroscopy table
The male bladder can be evaluated using
- Cystogram
Goal of pediatric imaging
- Obtain high quality images with the least amount of radiation
- Patients from 1 day old to 1 year old don’t move very much
Patients over 4 years old
- Usually cooperative
- 1 to 3 years usually need to be restrained for plain films or sedated for MRI, nuclear medicine, and CT
Patients 1-3 years old
- Usually need to be restrained for plain films
- Sedated for MRI, nuclear medicine, and CT
- May not cooperate for barium studies necessitating the placement of an NG tube
Most common pediatric chest conditions
- Croup and epiglottitis
- Viral pneumonia
- Bronchitis
- Cystic fibrosis
Croup
- Causes acute airway obstruction
- Caused by influenza and parainfluenza viruses
Peak incidence of croup
- Between 6 months and 3 years
Critical side for croup
- Immediately below the larynx, where edema narrows the subglottic trachea
- Area has an inverted “V” appearance of the airway on AP neck radiograph
Epiglottitis
- Caused by Hemophilus influenza
- Life-threatening and much more dangerous condition than croup
Epiglottitis imaging
- Film must be taken upright
- A lateral soft tissue neck film will show marked enlargement of the epiglottis, and thickening of the surrounding tissues
- “Thumb sign” on lateral neck radiograph
Pneumonia imaging in children
- Chest films show thickening of the bronchial wall, hyperaeration, and increased lung markings
- Bronchiolitis occurs in infants less than 1 year old, bronchitis older infants and children
Cystic fibrosis imaging in children and young infants
- Chest film may be entirely normal
- Diagnosis of cystic fibrosis made clinically
Clinical manifestations of cystic fibrosis
- Chronic cough
- Recurrent pulmonary infections
- Obstructive pulmonary disease
Cystic fibrosis films in older children may show
- Hyperaeration
- Peribronchial cuffing
- Increased lung markings
- Dilated bronchi (bronchectasis)
Other pulmonary complications seen in older children with cystic fibrosis
- Pneumonia
- Lung abscess
- Pneumothorax
- Atelectasis
Almost half of the abdominal masses in children are
- Renal in origin
- Most are benign and have an excellent prognosis
Hydronephrosis is the single most common cause of
- Neonatal abdominal mass
In older infants and children, the majority of abdominal masses are
- Also renal in origin
- 22% are a Wilms’ tumor (malignant tumor of embryologic elements)
- Hydronephrosis accounts for another 20% in this age group
Recommended initial imaging examination for pediatric abdominal masses
- Ultrasound
Salter-Harris (epiphyseal plate fractures) stages
- I) Fracture along the growth plate
- II) Fracture extends above the growth plate
- III) Fracture extends below the growth plate
- IV) Fracture extends through the growth plate
- V) Impaction of the growth plate
Thurston-Holland sign
- A triangular metaphyseal fragment seen in Salter-Harris type II fractures
Types of fractures commonly seen in pediatric patients
- Tarus
- Greenstick
