Category: Podcasts

Case of the Week: Ovarian Mucinous Cystadenocarcinoma (Ultrasound & MRI)

In this radiology lecture, we reveal the imaging appearance of mucinous cystadenocarcinoma of the ovary and explain differentiating features from serous cystadenocarcinoma.

Key points include:

  • A rare type of malignant ovarian epithelial tumor.
  • Often large at presentation, may be enormous.
  • Almost always multilocular.
  • Mucinous, proteinaceous and hemorrhagic material within loculi.
  • US: Scattered low-level echoes.
  • MRI: “Stained glass” appearance = Variable T1/T2 signal. Thick mucin = T1/T2 hyperintense.
  • Irregular, thick septations and solid components with internal vascularity and enhancement allow differentiation from mucinous cystadenoma.

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

Ultrasound of Complete Molar Pregnancy

In this radiology lecture, the ultrasound appearance of complete molar pregnancy is revealed.

Key points include:

  • AKA hydatiform mole = Most common form of gestational trophoblastic disease.
  • Gestational trophoblastic neoplasia (GTN) less common = Invasive mole and choriocarcinoma.
  • Approximately 1/1,000 pregnancies is a molar pregnancy.
  • Most common in females under age 20 and over age 35.
  • Two types of molar pregnancy: Complete (most common) and partial.
  • Complete: Diploid (paternal DNA only), no fetus, more likely to be complicated by GTN.
  • Partial: Triploid (maternal and paternal DNA), abnormal fetus or fetal parts, harder to diagnose.
  • Complete hydatiform mole presentation: Vaginal bleeding, enlarged uterus inconsistent with dates, hyperemesis. Markedly elevated β-hCG level (variable for partial molar pregnancies).
  • Large theca lutein cysts due to ovarian stimulation from elevated β-hCG, but uncommon.
  • US: Heterogeneous, echogenic mass (“snowstorm” appearance), small anechoic cystic spaces (“cluster of grapes”) = hydropic chorionic villi.
  • Treatment: Dilation & curettage. β-hCG levels monitored until no longer detectable to confirm no residual disease.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit:   https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

Case of the Week: Wandering Spleen (CT)

In this radiology lecture, we discuss the CT appearance of wandering spleen!

Key points include:

  • Extremely rare, usually between 20-40 years of age, more common in females.
  • Splenic mobility due to congenital or acquired abnormality of the normal peritoneal attachments/suspensory ligaments.
  • Splenic migration to lower abdomen/pelvis, may develop long vascular pedicle.
  • Twisting of pedicle can lead to splenic ischemia and infarction if not promptly treated.
  • Variable clinical presentation, patients often become symptomatic if torsion of pedicle occurs: Intermittent colicky pain, vague abdominal discomfort, abdominal mass, acute abdomen.
  • Treatment: Surgical detorsion and fixation of spleen (splenopexy), splenectomy may be required in setting of infarction.

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

5 Cases in 5 Minutes: Musculoskeletal #4

Quiz yourself with this week’s interactive video lecture as we present a total of 5 interesting musculoskeletal radiology cases followed by a diagnosis reveal and key teaching points after each case, all in just a few minutes!

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

Case of the Week: Septate Uterus (MRI)

In this radiology lecture, we discuss the MRI appearance of septate uterus, and explain how to differentiate from other uterine anomalies.

Key points include:

  • Most common müllerian duct anomaly (55%): Septal reabsorption abnormality.
  • Ultrasound and MRI provide assessment of external uterine contour and presence of renal anomalies.
  • Hysterosalpingogram of limited value, cannot reliably differentiate between subtypes.
  • On MRI, uterine fundus is typically convex or minimally indented: Fundal cleft less than 1 cm.
  • Midline septum of variable length, may be muscular or fibrous.
  • Important to differentiate type of septum as may alter surgical approach.
  • Compared to bicornuate uterus, higher incidence of reproductive complications (miscarriage).
  • Treatment: Resection of septum if recurrent fetal loss.

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

Ultrasound of Ovarian Dermoid Cyst

In this radiology lecture, we discuss the ultrasound appearance of ovarian dermoid cyst, including the rarely seen but highly specific “floating sphere” sign!

Key points include

  • AKA mature cystic teratoma.
  • Most common ovarian neoplasm.
  • Benign, mean age 30.
  • 10% bilateral.
  • Mature tissue from ≥2 embryonic germ cell layers: Sebaceous material, hair follicles, skin derivatives, fat, muscle, bone, and other tissues lined by squamous epithelium.
  • Specificity of US diagnosis 94-100%.
  • MRI for changing morphology on f/u and for postmenopausal patients.
  • Ultrasound findings: Floating echogenic spherical structures = “Floating sphere” sign (uncommon but pathognomonic), hyperechoic component with acoustic shadowing (Rokitanksy nodule), hyperechoic lines and dots, fat-fluid levels, diffuse or regional bright echoes.
  • Most common complication: Ovarian torsion.
  • Rare complications: Rupture, infection, malignant transformation, hormone secretion, anti-NMDA receptor encephalitis.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

Case of the Week: Retroperitoneal Fibrosis (Ultrasound & CT)

In this radiology lecture, we discuss the ultrasound and CT appearance of retroperitoneal fibrosis.

Key points include:

  • Most cases (70%) are idiopathic = Ormond disease.
  • Nonspecific symptoms depending on involved structures: Malaise, weight loss, low-grade fever.
  • Ureteral entrapment: Obstructive uropathy or renal failure, may see medial deviation of middle third of ureters with hydronephrosis.
  • Venous entrapment: Lower extremity edema, deep venous thrombosis.
  • CT: Soft tissue mass anterolateral to aorta with posterior sparing.
  • DDx: Retroperitoneal Lymphoma will Lift the aorta.
  • MRI: Low T1/T2 signal when inactive, T2 bright with early enhancement when active inflammation.
  • PET/CT: Avid when metabolically active, may aid in identifying appropriate biopsy sites.

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

Case of the Week: Perihilar Cholangiocarcinoma/Klatskin Tumor (CT & MRI)

In this radiology lecture, we discuss the CT and MRI appearance of perihilar cholangiocarcinoma.

Key points include:

  • Perihilar cholangiocarcinoma (AKA Klatskin tumor) occurs at bifurcation of the hepatic duct.
  • Cholangiocarcinoma (CC) is a primary malignant tumor of bile duct epithelium, usually adenocarcinoma.
  • CC is the most common primary hepatic malignancy after hepatocellular carcinoma (HCC), and most are extrahepatic (as opposed to intrahepatic).
  • Appearance of CC is based on growth pattern: Mass-forming, periductal infiltrating, and intraductal growing.
  • Risk factors: Parasite infection, choledochal cyst, primary sclerosing cholangitis, recurrent pyogenic cholangitis, and inflammatory bowel disease (ulcerative colitis).
  • Patients are usually 65 or older.
  • On CT and MRI, perihilar CC appears as a biliary stricture with shouldering/abrupt tapering.
  • If a mass is visible, will typically have rimlike enhancement with gradual centripetal enhancement on delayed images, be T2 bright (but not as homogeneous or as bright as hemangioma), and may have a targetlike appearance on DWI (favors CC over HCC).

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

 

Podcast: Play in new window | Download

Subscribe: Email

Case of the Week: Medullary Sponge Kidney (Ultrasound & CT)

Join me in this radiology lecture revealing the ultrasound and CT appearance of medullary sponge kidney (MSK).

Key points include:

  • MSK is a developmental ectasia with cystic dilatation of the collecting tubules in the pyramids leading to medullary nephrocalcinosis.
  • DDx medullary nephrocalcinosis: Hyperparathyroidism (most common cause in adults), renal tubular acidosis (type 1), MSK, hypervitaminosis D, other causes of hypercalcemia, sarcoidosis.
  • MSK associations: Beckwith-Wiedemann syndrome, congenital hemihypertrophy, Caroli disease, Ehlers-Danlos syndrome.
  • US: Echogenic medullary pyramids.
  • CT: Renal calculi, striated nephrogram, excretory phase “paintbrush” appearance or “growing calculus” sign.
  • Often asymptomatic but may present due to renal stones.

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

Case of the Week: Amebic Liver Abscess (Ultrasound & CT)

In this radiology lecture, we discuss the ultrasound and CT appearance of amebic liver abscess.

Key points include:

  • Entamoeba histolytica infection.
  • Endemic in Africa, Southeast Asia, and Central & South America.
  • More common in males.
  • Presents as right upper quadrant pain, fever and hepatomegaly.
  • Both amebic and pyogenic (bacterial) abscesses can have a layered wall with the “double target” or “double rim” sign.
  • Amebic more likely to be unilocular (septations present in 30%) without “cluster” sign typical of multiloculated pyogenic abscess.
  • Amebic more likely solitary, pyogenic more likely multiple.
  • Can be treated medically (metronidazole), but if diagnosis uncertain, if there is failed response to medical therapy, or if large abscess at risk for rupture = aspiration.

Bächler P, Baladron MJ, Menias C, et al. Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls. RadioGraphics 2016 36:4, 1001-1023.

Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

Instagram: https://www.instagram.com/radiologistHQ/
Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ

Podcast: Play in new window | Download

Subscribe: Email

1 2 3 4 5 … 7