Known patient with recently diagnosed poorly differentiated vaginal carcinoma with staging FDG PET/CT study. What is the study showing?
– A hypermetabolic lower vaginal lesion representing the known vaginal neoplasm associated with a larger hypermetabolic uterine body neoplastic lesion suggesting synchronous malignant process
– Multiple hypermetabolic enumerable bilateral lung deposits associated with a single right lower para-tracheal nodal deposit
What do you see on the following images?
TB cervical lymphadenitis
Mild progression in size of multiple necrotic lymph nodes in bilateral supraclavicular, axillary regions, at all anterior and posterior cervical chain (more prominent at right side lower anterior cervical chain)
What do you see on the following images?
Peritonsillar abscess
What do you see on the following images?
Finger in glove; ABPA
Asthma
Patient with right-sided iliac pain:
Appendicitis
– 53-year-old male
– Left adrenal nodule was incidentally found on a CT scan
– MRI was performed for better characterization
– Left adrenal nodule with loss of signal intensity on out-of-phase image
Adrenal adenoma:
– The most important characteristic feature is the presence of intracellular lipid.
– Chemical shift imaging is the most reliable technique for diagnosing adrenal adenoma: most of them demonstrate a loss of signal intensity on out-of-phase MR images.
82-yearold patient:
– Presenting with hematuria
Enhancing mass in the left renal pelvis, most likely TCC
Left total nephroureterectomy and bladder cuff excision
Microscopy result: Transitional Cell Carcinoma of 2,5 cm in the renal pelvis, low grade.
TNM classification Pyelum-Ureter (8th edition UICC): pTa.
– The vast majority of renal pelvis and ureter tumours are transitional cell carcinoma (> 90%), the remainder of tumours are squamous cell carcinoma (< 10%) and adenocarcinoma (< 1%) Transitional cell carcinoma much more commonly occurs in the bladder than in the renal pelvis or ureter - Synchronous and metachronous tumours are frequent because TCC is caused by toxic exposure through for example cigarette smoking - TCC of the renal pelvis can spread to the kidney and intraluminal seeding to more caudal parts of the ureter and to the bladder is common => always look for other space occupying lesions
– For these reasons, an excretory phase is always useful when a kidney mass is suspected, as TCC’s represent 10 to 15% of renal tumours
– CT scan protocol: non enhanced CT, enhanced CT (70-90 sec), delayed phase (10-15 mins)
31-year-old male with:
* Right upper quadrant & epigastric pain
* History of gastric bypass surgery
Whirlpool sign
The transition point from dilated small bowel (with the “small bowel feces sign”) to non-dilated small bowel at the site of internal herniation through a mesenteric defect.
76-year-old male.
* Presents with acute abdominal pain, enlarged abdomen and no defaecation since a few days.
Abdominal CT scan shows dilated colon loops with a calibre change in the sigmoid. Whirl of mesenterial vessels.
Differential diagnosis is Sigmoid volvulus. This was confirmed on OR.
Sigmoid volvulus is differentiated from a cecal volvulus by its ahaustral wall and the lower end pointing to the pelvis.
Abdominal radiographs will show a large, dilated loop of the colon, often with a few gas-fluid levels. Specific signs include coffee bean sign and absent rectal gas.
CT scan will show large gas-filled loop lacking haustra, forming a closed-loop obstruction. Specific signs include:
– whirl sign: twisting of the mesentery and mesenteric vessels
– bird’s beak sign: if rectal contrast has been administered
– X-marks-the-spot sign: crossing loops of bowel at the site of the transition
– split wall sign: mesenteric fat seen indenting or invaginating the wall of the bowel
Rectal tube insertion for treatment is successful in treating 90% of cases. Occasionally patients suffer from recurrent sigmoid volvulus, for which a surgeon may consider sigmoid colopexy (surgical fixation of the sigmoid colon), or in the surgically unfit, a percutaneous endoscopic colostomy (PEC) might be performed. The mortality rate of sigmoid volvulus is 20-25%. The most serious complication is bowel ischemia, not blow-out perforation as you might expect.
