Week 15: Hematopoietic and Endocrine System Pathologies

Question 1

Anemia

Answer 1

• a decrease in the oxygen carrying ability of the blood
• affects red blood cells
• many types anemia: iron deficiency, hemolytic, aplastic, etc
• can be short or long term, mild or severe
• causes: iron deficiency, vitamin deficiency, chronic diseases, hemolytic and bone marrow disorders
• symptoms: fatigue, weakness, pale or yellow (if hemolytic anemia) skin, irregular heartbeats, shortness of breath (dyspnea), cold hands and feet, headaches, and chest pain
• diagnosed with blood tests, low RBC count

Question 2

Leukemia

Answer 2

• cancer of the body blood forming tissues including the bone marrow and the lymphatic system
• the bone marrow produces abnormal/immature WBC leaving the patient susceptible to infection
• can be chronic or acute
• acute leukaemia is most common
• WBC count is high but they are damaged
• bleeding tendency due to decreased platelets

Question 3

Leukemia Radiographic Appearance

Answer 3

• x-ray (skeletal) - radiolucent bands at metaphases on long bones after 2 years of age, bone destruction (moth eaten appearance with resulting osteosclerosis), possible pathologic fractures
• x-ray (CXR)- enlarged mediastinal and hilar lymph nodes, bilateral reticular changes; congestive heart failure
• KUB/US- splenomegaly; increased size of liver, kidneys, may cause displacement or obstruction of GI/GU systems
• may see GI infiltration = intra-luminal filling defects

Question 4

Lymphoma

Answer 4

• neoplasms of the lymphoreticular system (lymph nodes, spleen, lymphoid tissues of parenchymal organs (GI tracts, lung, skin))
• being in the lymphocytes
• may be Hodgkins or non-Hodgkins depending on which lymphocyte is affected, lab test needed to determine which one
• Hodgkins has a more predictable progression
• non-Hodgkins is more common and more aggressive with lower survival rates

Question 5

Hodgkins Lymphoma

Answer 5

• cells in the lymphatic system/lymph nodes grow abnormally and may spread beyond it
• affects mainly the neck, chest, armpits, and upper body
• moves form one lymph node to the next
• it begins with infection fighting cell called a lymphocyte, develops a genetic mutation causing many diseased cells that continue to multiply

Question 5

Non-Hodgkins Lymphoma

Answer 5

• very similar to Hodgkins lymphoma
• it will likely be more diffuse through the body, starts everywhere
• may be seen in lymph nodes in same areas as Hodgkins as well as the groin and abdomen

Question 5

Lymphoma Radiographic appearance

Answer 5

• often first seen on a CXR
• mediastinal lymph nodes involvement/swelling (lymphadenopathy) = widening of upper half of mediastinum
• if the later shows the mass anteriorly there is a good change it is a lymphoma
• sclerosis may develop I spine = ivory vertebrae

Question 6

Pituitary Gland

Answer 6

• pituitary gland = master gland because controls most glandular activity
• small, pea sized gland
• sits in sella turcica
• anterior lobe secretes growth hormone, thyroid stimulating hormone (TSH), sex hormones and ACTH
• posterior lobe secretes vasopressin (ADH) and oxytocin
• controlled by hypothalamus

Question 7

Pituitary Adenoma (Tumour)

Answer 7

• generally arise in the anterior lobe
• make up about 10% of intracranial tumours
• usually slow growing and benign
• affects the secretion of hormones

Question 8

Pituitary Adenoma (Tumour) Radiographic Appearance

Answer 8

• MRI is the superior modality for visualization, gamma knife for treatment
  CT:
• tumours will take up contrast homogeneously
• become hyperdense
• may see adjacent bone erosion and tumour extension outside of the sella turcica

Question 9

Cushing’s Disease

Answer 9

• excess of glucocorticoids
• could be exogenous (from administered cortisone/ corticosteroids) or endogenous (from a tumour)
• due to a benign pituitary tumour causing secretion of too much adrenocorticotropic hormone (ACTH) which stimulates the adrenal glands to produce too much cortisol
• due to adrenal gland tumour, malignant or non-malignant
• radiographic appearance: CT or US: Bilateral thickening of adrenal gland wings, x-ray: osteoporosis, widening of mediastinum from fat deposits

Question 10

The Thyroid Gland

Answer 10

• thyroid function controlled by TSH from pituitary gland
• thyroid uses iodine from the bloodstream to synthesize thyroid hormones
• control cellular metabolism
• because of this, nuclear medicine with the administration of radioactive iodine, is the best modality to evaluate the thyroid gland

Question 11

Hyperthyroidism- Graves Disease

Answer 11

• from excess production of thyroid hormone
• speeds up metabolism
• usually presents as Graves disease in which entire gland affected

Question 12

Hypothyroidism Radiographic Appearance:

Answer 12

• children: delayed bone development/ age, thickened skull, small facial sinuses and mastoid air cells
• adults: enlarged heart shadow due to pericardial effusion

Question 13

Hyperthyroidism- Graves Disease Imaging Appearance

Answer 13

• nuclear medicine imaging shows diffuse gland enlargement with increased iodine uptake
• CT will show exophthalmos from thickening of extra-ocular muscles (muscles around eyes)

Question 14

Hypothyroidism

Answer 14

• reduced secretion of thyroid hormone
• slows metabolism
• can be congenital
• can be caused by a pituitary adenoma
• can be autoimmune
• can be related to excessive radiation/ radiation treatment to neck, thyroid or chest