Abdominal #17

Known patient with recently diagnosed poorly differentiated vaginal carcinoma with staging FDG PET/CT study. What is the study showing?

What do you see?

– 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

Abdominal #16

What do you see on the following images?

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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)

Abdominal #11

Clinical Information

– 53-year-old male
– Left adrenal nodule was incidentally found on a CT scan
– MRI was performed for better characterization

What are the Imaging Findings

– Left adrenal nodule with loss of signal intensity on out-of-phase image

What is the most likely diagnosis?

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.

Emergency #35

61-year-old female:
– Trauma
– Fracture? What do you see?

Showing the supine AP and lateral view, due to the inability to stand on the right leg.

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Diagnosis: Lipohemarthrosis (fat-blood level) indicating intra-articular #
Comminutive though non-displaced tibia plateau fracture Avulsion fracture proximal fibula (Segond fracture – 100% association with ACL injury)
CT: Schatzker type VI

Schatzker tibia plateau classification

Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, having less than 4 mm of depression or displacement
Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component
Schatzker III: pure depression of the lateral tibial plateau; divided into two subtypes:
Schatzker IIIa: with lateral depression
Schatzker IIIb: with central depression
Schatzker IV:  medial tibial plateau fracture with a split or depressed component
Schatzker V: wedge fracture of both lateral and medial tibial plateau
Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibial plateau fracture (metaphyseal-diaphyseal discontinuity)

Abdominal #10

82-yearold patient:
– Presenting with hematuria

What is the most likely diagnosis?

Enhancing mass in the left renal pelvis, most likely TCC

What is the treatment?

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.

Teaching Points

Teaching points

– 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)