Body Flashcards
What are the diagnostic criteria for PCOS?
“>12 follicles (per 1 image!)
Enlarged ovaries”
UPJ obstruction
“A ureteropelvic junction obstruction (UPJ) is the most common form of urinary tract obstruction in pediatrics.
There are variable degrees of obstruction to urine flow at the level of the ureteropelvic junction. Patients may be diagnosed antenatally with sonography or present with urinary tract infection (UTI), intermittent abdominal pain, vomiting, or hematuria.”
What rate of bleeding can you target for 1)CT, 2) transcatheter embolization and 3)Tagged RBC?
“RBC: 0.1ml/min
angiogram: 1ml/min
CT: need 5ml/min?
angiogram: need 1mg/min
transcatheter embolization of the bleeding source arising from the left colic artery should be possible, as long as the rate of bleeding continues at > 0.5 mL/min.
2) CT: 0.3
(conventional angiography=1; CT is 0.3ml/min; tagged RBC is 0.1ml/min)”
What is the most accurate means in assessing adenopathy in endometrial carcinoma
FDG-PET/CT is the most accurate means of assessing adenopathy. The first-echelon nodes for endometrial cancer include either pelvic or paraaortic nodal stations. Imaging the pelvis only could result in missed paraaortic nodal metastases and inadequate treatment.
What is the most specific imaging appearance for endometrioma on ultrasound?
The appearance of an endometrioma often overlaps with other adnexal masses. Tiny echogenic foci in the cyst wall , which represent cholesterol deposits, is a specific finding for an endometrioma in the setting of cystic ovarian lesion with diffuse internal low-level echoes.
What are the common US appearances of Pheos?
“Pheochromocytomas have a variable sonographic appearance: purely solid (68%), complex (16%), and cystic (16%). They may present as a small (< 2 cm) or larger mass.
- Smaller tumors are usually solid and round with uniform echogenicity. Larger tumors may be heterogeneous due to necrosis.
- Extra-adrenal pheochromocytomas are more difficult to detect due to overlying bowel gas. However, the bladder wall, renal hilum, and organ of Zuckerkandl at the origin of the inferior mesenteric artery should always be evaluated.
- Pheochromocytomas are very vascular lesions, typically with large feeding arteries and significant intratumoral vascularity. There may be compression or invasion of the inferior vena cava and/or the renal vein.
The rule of 10s: 10% are bilateral, 10% are extra-adrenal, 10% are malignant, 10% are pediatric, 10% are silent, 10% are autosomal dominant, and 10% have calcifications.”
Gastroparesis
“Treatment of gastroparesis is primarily medical and begins with diet modification. Metoclopramide (Reglan) and low-dose erythromycin can stimulate gastric emptying. Endoscopic Botox injection has been done to relax the pylorus, although studies regarding efficacy are conflicting. Gastric electrical stimulation, gastric bypass surgery, jejunostomy, and parenteral nutrition are alternatives in severe cases.
- Think whne you see 1) gastric distension AND 2) severe vascular calcification”
Candida esophagitis
”- Candida esophagitis is a common cause of odynophagia in immunocompromised patients (can occur in immunocompetent as well). It is usually associated with oral thrush.
- There is a shaggy esophageal surface in Candida esophagitis, as well as raised plaques and shallow ulcers.
- Most patients who have Candida (monilial) esophagitis will also have oral thrush and most have some immune deficiency, though it may be otherwise silent, as in some patients with diabetes or alcoholism. Due to increased awareness among clinicians, Candida esophagitis is usually diagnosed on clinical exam without reliance on radiographic studies, particularly in patients with AIDS.
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Hepatic adenoma
“The hepatic mass is heterogeneously hypervascular on the axial arterial phase image (Fig. 1) and remains hyperdense to the liver on the axial venous phase images (Figs. 2-3)(i.e. NO WASHOUT). The liver does not appear to be cirrhotic.
- A large, lentiform subcapsular hematoma compresses the lateral surface of the liver. These are classic features of hepatic adenoma. Neither focal nodular hyperplasia (FNH) nor hemangiomas are prone to spontaneous hemorrhage.
- While hepatocellular carcinoma (HCC) can also present with hemorrhage, it would typically show ““washout”” (i.e., hypodensity relative to the liver on the venous phase images), and usually arises in a cirrhotic liver, not present here. Hemorrhage from a ruptured adenoma was confirmed at surgery in this case.”
Cystic renal masses
While the appearance of this mass is consistent with a multilocular cystic nephroma (a benign lesion), it must also be considered worrisome for a cystic renal cell carcinoma (RCC). At nephrectomy, a cystic clear cell RCC was confirmed. I.e CAN”T differentiate multilocular cystic nephroma from Clear cell RCC
autoimmune pancreatitis
The loss of fatty lobulation and relatively mild stricturing of the pancreatic and common bile duct in this case are compatible with autoimmune pancreatitis, which relies on biopsy, elevated serum levels of IgG4, &/or prompt resolution with steroid therapy for confirmation.
Most common presentation of primary renal lymphoma?
“Q) most common presentation of primary renal lymphoma? A) multiple bilateral renal mass
- Most cases are seen in the setting of widespread disease, usually hematogenous spread by direct invasion.
- The most common is bilateral hypoechoic masses. A large autopsy series showed multiple renal masses in 61% of cases.”
splenic trauma
“Splenic injuries are characterized by the size of subcapsular &/or intraparenchymal hematomas and lacerations as well as by the degree of fragmentation and findings of vascular injury (such as devascularization, active arterial extravasation, and pseudoaneurysm formation). Do not forget to look carefully at other abdominal viscera, particularly adjacent organs.
- Remember that splenic injuries may also occur with relatively minor trauma when the spleen is enlarged (such as in the setting of mononucleosis).”
Renal replacement lipomatosis
“Renal replacement lipomatosis: Usually associated with XGP (or chronic inflammation). THink of it like fatty infiltration (ass with chronic inflammaitno from XGP)
Unilateral process; severe parenchymal atrophy
Fibrofatty proliferation in sinus and perirenal space
Centrally located calculus (often staghorn) in 70%
Fat proliferation within the renal sinus, mild cortical thinning, and a staghorn calculus are features characteristic of replacement lipomatosis. Fat proliferation is likely due to chronic inflammation (a process similar to the fibrofatty mesenteric proliferation seen in cases of Crohn disease). Lack of low attenuation within the renal parenchyma argues against xanthogranulomatous pyelonephritis.”
Treatment options of SMA pathology
”- Angioplasty and stent placement are the most appropriate treatment options for chronic mesenteric ischemia and proximal superior mesenteric artery stenosis.
- Acute thrombosis, either arterial or venous, is best treated with systemic anticoagulation. Surgical embolectomy, angiography with transcatheter lytic therapy, or suction embolectomy could be considered for acute arterial thrombus depending on local expertise.
- Median arcuate artery syndrome is best treated with surgical median arcuate ligament release.”
Midline pelvis mass in patient with primary amenorrhea
“The ultrasound and MR image demonstrate a large, elongated mass within the pelvis anterior to the rectum and posterior to the urinary bladder. The mass contains complex fluid and a large amount of dependently layering debris.
On the MR, the uterus is seen projecting anteriorly off the superior aspect of the mass.
- These findings are consistent with a vaginal obstruction causing massive dilation of the vagina (and a lesser degree of endometrial cavity dilation) by accumulated blood products (hematometrocolpos). Such patients will usually have a history of lack of menstruation.
- Main differential is imperforate hymen”
Myelolipomas on US
On ultrasound, myelolipoma appears as a well-defined, homogeneously echogenic adrenal mass due to its predominant fat content. In masses > 4 cm, there is apparent diaphragm disruption due to reduced sound velocity as it passes through a fatty mass.
What are the three Four common esophageal diverticuli found on upper GI studies?
“1) killian jamiesons: smooth-walled outpouching from the pharyngoesophageal junction that projects inferiorly and laterally,
2) as opposed to posteriorly, as would be typical of a Zenker diverticulum.
3) Traction diverticula usually occur at the level of the carina due to granulomatous infection of adjacent hilar nodes.
4) Epiphrenic diverticula typically arise near the gastroesophageal junction and are most often associated with esophageal dysmotility.”
bilomas as a complication of liver transplantation
Bilomas are bile-containing fluid collections and a potential complication in liver transplants. Although hematomas are the most common fluid collection post liver transplant, the time frame from date of transplant, intrahepatic location, and presence of gas in the collection suggest biloma in this case. A HIDA scan may be helpful in identifying biliary excretion into the collection, which would be diagnostic for a biloma. Alternatively, aspiration yielding biliary fluid is also diagnostic. Treatment usually involves percutaneous drainage, as bilomas are often infected. If left untreated and the biliary leak continues, bile peritonitis may ensue.
What is the normal size of the pancreas? ANd what do you see in acute pancreatitis
“The pancreatic head, body, and tail are considered enlarged when equal or greater than 3.0, 2.5, and 2.0 cm respectively.
- The pancreatic echogenicity should be greater than that of the liver.
- This rule of thumb cannot be used in the setting of hepatic steatosis, which causes increased hepatic echogenicity. The sonographic appearance of the pancreas is often normal in mild cases of pancreatitis, and a negative exam does not exclude the diagnosis.
- Potential complications of pancreatitis should be excluded, including pseudocyst and abscess formation, necrosis, pancreatic ascites, pleural effusion (usually left-sided), pseudoaneurysm formation, as well as thrombosis of the splenic, superior mesenteric and portal veins. Obstructing, intraductal stones should also be excluded as a potential cause of pancreatitis.”
What are the 2 most common malignancies assocaited with peritoneal carcinomaosis?
“The most common associated primary malignancies are gastrointestinal (stomach, colon) and ovarian carcinomas.
- Less commonly, peritoneal carcinomatosis may occur with lung, breast, and renal cell carcinoma, sarcomas, and lymphoma. Frequently, it is accompanied by malignant ascites.”
What extra-hepatic and extra-biliary complication can occur after liver transplant?
“Adrenal hematomas are a known potential complication of liver transplant where the right adrenal vein can be injured during surgery or thrombosed.
- Other causes of adrenal hemorrhage include trauma (most commonly affecting the right adrenal gland) and severe stress, such as in sepsis, burns, or multiorgan failure.
- Bilateral adrenal hemorrhages can result in adrenal crisis, a potentially fatal condition if not discovered and treated appropriately.”
WHat is Mönckeberg medial arterial calcification.? what condition is it associated with?
The supine radiographs show extensive calcification of all the medium-sized arteries of the abdomen and pelvis, having a continuous, “tram-track” pattern of calcification, characteristic of Mönckeberg medial arterial calcification. This is strongly associated with insulin-dependent diabetes, subsequently confirmed in this patient. The films also show massive distention of the stomach with fluid and gas , typical of gastroparesis, which is also common in severe diabetes. This was confirmed with a dual-phase radionuclide gastric emptying study (not shown).
How would you differentiate adrenal myelolipoma vs liposarcoma?
“This is a typical appearance of an adrenal myelolipoma, although some of these benign neoplasms have more soft tissue components and/or calcification.
- The remote possibility of this representing a retroperitoneal liposarcoma would be best evaluated by a follow-up CT scan in about 6 months.”
What is the cause of hydrosalpinx?
“Hydrosalpinx is due to obstruction of the ampullary segment of the fallopian tube.
This is most commonly due to adhesions related to prior episodes of pelvic inflammatory disease, but endometriosis. Tubal carcinoma.
- other etiologies include tubal ligation, hysterectomy without salpingo-oophorectomy, endometriosis, and tubal carcinoma.”
Ddx for starry sky appearance of the liver?
“The ““starry sky”” appearance of the liver is characterized by decreased hepatic parenchymal echogenicity resulting in increased echogenicity of the portal triads , usually in the setting of hepatomegaly.
- The ““starry sky”” appearance has been described in acute hepatitis, leukemia, Burkitt lymphoma, toxic shock syndrome, the fasting liver, and right heart failure but is most commonly described in the setting of acute hepatitis.”
what AML size is usually indicated for embolization?
“The figures show large bilateral renal angiomyolipoma (AML) with a large amount of perinephric hematoma on the right.
- Angioembolization is usually the first-line therapy for renal angiomyolipoma.
- Regrowth and repeated hemorrhage after embolization can occur; laparoscopic partial nephrectomy is the definitive and minimally invasive treatment alternative.
- Large ( > 4 cm) symptomatic AMLs are generally treated with embolization or surgery because of the risks of hemorrhage. Conservative management of AMLs can be considered to preserve renal function in patients with tuberous sclerosis who are at high risk of end-stage renal disease.”
What is the most common bladder mlaignancy associated with paraplegis patient?
“With the provided history of paraplegia and indwelling catheter, squamous cell carcinoma (SCC) should be high on the differential diagnosis list. Although urothelial (transitional cell) carcinoma is the most common bladder malignancy overall (accounting for 90-95% of bladder cancers),
- SCC is the most common bladder malignancy in paraplegic patients.
- Squamous cell carcinoma represents approximately 5% of all bladder cancers and is usually accompanied by a history of chronic bladder irritation, bladder calculi, indwelling catheters, or history of cyclophosphamide treatment.”
“What is the most common:
1) extra-testicular tumor?
2) epidydimal tumor?
3) Spermatic cord tumor?
3) Extra-testicular
4) malignant tumor?
5) Tumor associated with VHL?”
” 1) lipoma (involving the spermatic cord)
2) adenomatoid tumor
3) lipoma (these usually involve the spermatic cord (not epidydimus)
4) rhabdomyosarcoma
5) cystadenoma”
What are some non-traumatic causes of bilateral adrenal hemorrhage?
“This represents spontaneous bilateral adrenal hemorrhage, possibly on the basis of infection (e.g., meningococcemia; Waterhouse-Frederickson syndrome) or vasculitis.
- Vasculitis is more likely in this patient with lupus. In the setting of acute hypotension this patient likely has acute adrenal insufficiency, a medical emergency that must be treated with supplemental adrenal corticosteroid medication.
- Patients who are receiving chronic corticosteroid medication often require supplementation at times of stress (e.g., acute infection; general surgery).”
How do you differentiate immature vs mature teratoma?
”- more soft tissue, larger, ill defined boarders, different calcificaiton.
- Only mature and immature teratomas have macroscopic fat. Fat in an immature teratoma presents as smaller foci dispersed within a large soft tissue mass compared with large collections in mature cystic teratoma. Immature teratomas are often larger with less well-defined borders. Also, the calcifications in an immature teratoma are morphologically different from those in a mature cystic teratoma; they are irregular and amorphous rather than coarse and tooth-like.”
