2 INCIDENTALOMAS The definition Tumor (-oma)/lesion found by coincidence (incidental) without clinical symptoms or suspicion.
3 Worry gives a small thing a big shadow
4 OBJECTIVES OF THIS TALK To appreciate the magnitude of the incidentalomas To help differentiate between benign lesions from those that are significant. Identify the ideal imaging modalities / most cost effective workup for lesions needing further evaluation. To discuss the benign incidentalomas commonly encountered on imaging.
5 Incidentalomas Incidence A recent study stated 37% of patients receiving whole body CT scan may have abnormal findings that need further evaluation. Incidence of the incidentalomas is increasing correlating with increase in health screening programs and unnecessary imaging used in low risk patients especially in the ER
6 Consequences of detection
7 Issue facing us? NOT SIMPLE For clinicians : Provoked in part by fear of lawsuits, additional tests are performed. All too often, these tests do not result in diagnostic certainty.. For radiologists : Caught in the same bind, are inclined to suggest additional tests and to dictate in their reports "Cannot exclude..., and"clinical correlation required," implying that a sinister cause of the finding might be discovered. For patients: Heightens worry and yet offers little insight into the appropriate level of concern.
8 Commonly encountered incidentalomas Organ of origin and significance Liver Renal Adrenal Lymph nodes
9 CT TECHNIQUE Regular contrast enhanced CT exam: Portal venous phase ( 70 sec post iv contrast) Hepatic protocol: Triphasic exam including non contrast, arterial (15 20 sec ), portal venous phase (70 sec post iv contrast). Renal protocol: Triphasic exam includes non contrast, cortico medullary (20 30 sec) and nephrographic phase ( sec post iv contrast).
10 Liver Incidentalomas UDO ( Unidentified dark objects) Benign or Significant Simple Cysts, Biliary Hamartomas, Focal Fat, TSTC ( too small to characterize) Significant Multiple TSTC in a patient with known cancer UBO ( Unidentified bright objects) UTBO ( Unidentified transient bright objects) Hemangiomas, Focal Nodular Hyperplasia THAD/THID (Transient hepatic attenuation differences/ intensity differences) Adenomas ( > 5 cm) THAD/THID associated with mass Maarten van Leeuwen for the Dutch Radiology Society
11 Simple Liver Cysts Congenital in origin 5% incidence. Fluid within the cyst has composition mimicking plasma.
13 Simple Liver cysts CT Rounded, thin walled, well defined, low attenuation (0-10HU), No contrast enhancement
14 Simple Liver Cyst MRI T1 weighted Post Gad T1 weighted T2 weighted Rounded, thin walled, well defined, high SI on T2 and no contrast enhancement
15 Significant hepatic cysts Echinococcal/Hydatid cystsparasite Echinococcus granulosus. At risk population: sheep and cattle farmers. T2 - WI Cysts have an outer layer of inflammatory tissue and an inner germinal membrane that produces daughter cysts. T2 WI (MRCP) T 1- WI
16 Echinococcal cyst : Imaging Collapsed parasitic membranes appear as twisted linear structures within the cyst Floating membrane sign. Rupture into biliary T1 tract - WI or peritoneum may T2 also - WI be visualized Iván Pedrosa, MD, Antonio Saíz, MD et al Hydatid Disease: Radiologic and Pathologic Features and Complications Radiographics. 2000;20: T2 - WI
17 Significant hepatic cysts Adult polycystic liver disease (AD PCLD) usually associated with ADPKD.
18 Biliary hamartoma aka von Meyenburg complex Benign liver malformations that histologically contain cystic dilated bile ducts within 10 mm dm surrounded by abundant fibrous stroma Imaging: Typically multiple round or irregular focal lesions of nearly uniform size (up to 15 mm) scattered throughout the liver oct hypodense, similar to cysts ousg hypoechoic or hyperechoic foci, they may have a comet tail artifact omri hypointense on T1 and hyperintense on T2 weighted images. No contrast enhancement. Sonographic Features of Biliary Hamartomas With Histopathologic Correlation J Ultrasound Med :1631
19 BiliaryHamartoma: Imaging T2 - WI T1 - WI Post Gad T1 - WI
20 TSTC too small to characterize lesions <1 cm Large series of 1500 patients who had an abdominal CT examination. TSTC lesions were found in 17% of patients. 45 pts without a known malignancy, all lesions were benign 209 pts with a known malignancy 86 had 1 TSTC: 5% malignant 74 had 2-4 TSTCs: 19% malignant 49 with >5 TSTCs: 76% malignant. Another study of 2978 pts known malignancy TSTCs in 12% 88% benign 12% metastases (1.4% of all patients) The frequency and significance of small ( less than or equal to 15mm) hepatic lesions detected by CT AJR: 158,
21 TSTC (cont.) Conclusion In a patient without a known malignancy, these small hypodense lesions, as a rule, should be considered as benign In a patient with a known malignancy Single TSTC lesion can also be assumed to be benign Multiple TSTCs in these patients are also mostly benign, especially when they are small, sharply defined and hypodense. When to worry: Known malignancy, multiple TSTCs which appear heterogenous and with soft tissue attenuation The primary tumor is breast cancer Prevalence and Importance of Small Hepatic Lesions Found at CT in Patients with Cancer. Radiology. 1999;210:71-74 Small 'indeterminate' lesions on CT of the liver: a follow-up study of stability P J Robinson,, P Arnold, and D Wilson, British Journal of Radiology (2003) 76,
22 Focal Fat Sparing/Infiltration Related to regional differences or disturbances in hepatic blood flow Usual locations: adjacent to gallbladder bed fissure of the ligamentum teres medial segment of the left lobe ventral to the bifurcation of the main branch of the portal vein the subcapsular location.
23 Fatty liver USG
24 Fatty Liver CT
25 Fatty liver MR T1- WI in phase T1- WI out of phase
26 Focal Fat sparing USG Differentiate from space occupying lesions does not cause any mass effect or contour deformation of the organ. Following iv contrast intrahepatic vessels follow their normal course through the lesion without deformity. Typical location of the anomaly.
27 Focal Fat sparing USG
28 Focal Fat Sparing CT
29 Focal Fat infiltration CT
30 UBO Incidental bright/hypervascular lesions Incidence Autopsy incidence of 20 % hemangioma, 3% FNH and 1% adenoma. Introduction of MDCT and MRI Increased detection due to multiple reasons including faster scanning, improved spatial and temporal resolution, less respiratory misregistration, better contrast bolus capture and timing of arterial and venous phases, and volumetric acquisition of the entire data set in single breath hold.
31 Hemangioma Most common benign liver lesion Slowly perfused vascular space. Incidence : 5 20% of the population
33 Hemangioma CT Non- contrast Arterial Venous > 1cm peripheral, discontinuous, intense nodular enhancement during the arterial phase with progressive centripetal fill in on delayed phases
34 Giant Hemangioma CT Arterial Venous
35 Hemangioma MRI Shows the same enhancement characteristics. Advantage of MR over CT is its higher sensitivity to contrast < 1 cm demonstrate immediate homogenous enhancement, isodense to the aorta (flash hemangioma). T2 - WI Arterial Venous
36 Focal Nodular Hyperplasia Incidence : 2 5% population Nonencapsulated firm nodule of normal hepatocytes with a distinct central scar and thin radiating fibrous septa containing Kupffer's cells and primitive bile ductules. Arterial T2- WI Arterial Delayed Difficult to delineate in the portal venous phase. Delayed phase often shows hyperattenuation of the central scar. No calcifications, inhomogeneity or capsule should be seen in FNH
38 Hepatic Adenoma Uncommon benign epithelial liver tumors Young women (20 to 44 yr) Typically solitary Frequently in the right hepatic lobe Multiple lesions with prolonged oral contraceptive use, glycogen storage diseases and hepatic adenomatosis. Complications: malignant transformation, spontaneous hemorrhage, and rupture
39 Non-contrast Portal Arterial Well circumscribed lesion that may display low attenuation because of the presence of fat, old hemorrhage, or necrosis. Recent hemorrhage display high attenuation. Calcification is present in 5 10% of cases. Early enhancement during the arterial phase.
40 Significant Lesion: Adenoma 5cm. Arterial Portal Tendency for spontanous hemorrhage and rupture esp. if predominantly exophytic
41 THED Transient hepatic enhancement differences An area of bright contrast enhancement on the arterial phase images that returns to isoattenuation on the portal venous phase. DOES NOT CORRESPOND TO MASS Causes: increase in the primary arterial inflow, indirectly by means of portal hypoperfusion, flow diversion caused by an arterioportal shunt, aberrant venous drainage THAD/THID associated with a focal lesion THAD/THID without a focal lesion
42 THAD without mass: Imaging Arterial
43 THAD without mass: Imaging Arterial Portal
44 THAD with mass: Imaging
45 THAD with mass: Imaging
46 Characterization of hepatic lesion Preferred modality to characterize incidentalomas is MRI Better for lesion characterization (multiple sequences) Minimize radiation burden.
47 Part 2 Renal incidentalomas
48 Renal lesions Insignificant Significant Low attenuation High attenuation Simple cyst, TSTC, Small AML Hemorrhagic cyst Large AML (> 4 cm) Renal cell carcinoma
49 The Simple Renal Cyst Fifty per cent of individuals over 50 years of age have single or multiple cysts. Homogeneity, water content, and a sharp interface with adjacent renal parenchyma, with no wall thickening, calcification, or enhancement.
51 T1- WI T2 - WI
52 Renal cysts and ADPKD The Big Question Diagnosis of ADPKD < 30 yrs 2 cysts (unilateral or bilateral), yrs > 5 cysts > 60 yrs > 8 cysts bilaterally Positive family history and association with liver cysts Recommended that screening for intracranial aneurysms patients with a personal or family history of intracranial hemorrhage. Patient with ADPKD has a 5% chance of getting brain aneurysms. Renal cystic disease (ADPKD and ARPKD) Nephrol Dial Transplant (2002) 17:
53 Acquired renal cystic disease
54 The Bosniak system of renal cysts Type I simple cysts. Type II minimally complicated cysts. Thin (< 1mm) septations (few). Hyperdense cysts. Fine calcification in wall/septae. IGNORE Type II F Multiple thin septa, mild thickening of wall/septa without enhancement. FOLLOW Type III indeterminate may show uniform wall thickening, nodularity with enhancement, thick or irregular peripheral calcification, or a multilocular nature with multiple enhancing septa. (80 90% malignant) EXCISE Type IV nonuniform or enhancing thick wall, enhancing or large nodules in the wall, or clearly solid components in the cystic lesion. Practical approach to cystic renal mass : David S. Hartman, MD, Peter L. Choyke, MD and Matthew S. Hartman, MD How I do it: Evaluating Renal masses. Gary M. Israel, MD and Morton A. Bosniak, MD
55 Bosniak Type I
56 Non-contrast Arterial Bosniak Type II Portal
57 Hemorrhagic Non-contrast renal cyst (Bosniak Type II) Acquired cystic renal disease or autosomal dominant polycystic renal disease Criteria described by Bosniak small (with a diameter of 3 cm or less) round, well marginated homogeneously hyperattenuating should not enhance.
58 T1- WI Post Gad T1-WI T2-WI Arterial Hemorrhagic Cyst Imaging
59 Bosniak Type IIF
60 Bosniak Type III
61 Bosniak Type IV
62 The Bosniak system of renal cysts Type I simple cysts. Type II minimally complicated cysts. Thin (< 1mm) septations (few). Hyperdense cysts. Fine calcification in wall/septae. IGNORE Type II F Multiple thin septa, mild thickening of wall/septa without enhancement. FOLLOW Type III indeterminate may show uniform wall thickening, nodularity with enhancement, thick or irregular peripheral calcification, or a multilocular nature with multiple enhancing septa. (80 90% malignant) EXCISE Type IV nonuniform or enhancing thick wall, enhancing or large nodules in the wall, or clearly solid components in the cystic lesion. Practical approach to cystic renal mass : David S. Hartman, MD, Peter L. Choyke, MD and Matthew S. Hartman, MD How I do it: Evaluating Renal masses. Gary M. Israel, MD and Morton A. Bosniak, MD
63 Angiomyolipoma Benign neoplasm composed of fat, vascular and smooth muscle elements Incidence %, Male: female: 1: 4 Symptomatic : palpable abdominal mass, hematuria or flank pain.
64 Angiomyolipoma Imaging
65 Angiomyolipoma : Significant
66 Part 3 : Adrenal incidentalomas
67 Adrenal Incidentalomas Prevalence ranges from 1.4% to 8.7%, increasing with age Most of these masses are benign, even in patients with a known malignancy. Most common tumor in the adrenal gland is the adenoma. A recent study <3 cm nononcologic patient 99% benign <3 cm oncologic patient 67% benign
68 Imaging of Adenoma: CT Generally small (< 3cm) Density <10 HU on a non contrast CT sensitivity of 70% and a high specificity of 98% for the diagnosis of an adenoma.
69 Imaging of Adenoma: CT Non-contrast Mean: 3 HU
70 Imaging of Adenoma: CT
71 Imaging of Adenoma: CT 30% of adrenal adenomas do not contain enough intracellular lipid to have a density of less than 10 HU called lipid poor. CT washout study: Attenuation values are measured on unenhanced, initial Non-contrast Portal enhanced (at 60 sec) and delayed CT (at 15 min). Absolute & relative wash out is calculated. Delayed
72 Imaging of Adenoma: MRI T1-WI in phase T1-WI out phase Loss of signal on out of phase imaging
73 Myelolipoma Benign neoplasm composed of mature adipose tissue and a variable amount of hematopoietic elements. Incidence varies from % at autopsy. Most are unilateral Large amounts of fat often are seen interspersed with higher attenuation myeloid tissue. May contain calcification in as many as 20% of patients which may be due to previous hemorrhage.
74 Myelolipoma : USG and CT Imaging Key to diagnosis is to find a true focal fat collection in the adrenal mass.
76 A Last Note: Lymph nodes
77 Lymph Nodes : Size criteria Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology 1991;
79 Pathological Lymphadenopathy
80 Conclusions Abdominal Incidentalomas are very common on imaging with an increasing incidence. Most incidentalomas can be diagnosed with certainty on imaging Clinical history may be instrumental for correct diagnosis.
81 Diagnosis is not the end, but the beginning of practice. ~ Martin H. Fischer
Focal Liver Lesions: Characterization with MDCT Jorge A. Soto, M.D. CT: Principle Ability to detect a liver lesion depends upon: Relationship between size and section thickness Background organ attenuation:
Radiology Caveats and Pearls in Liver Tumors Greg de Prisco, M.D. Staff Radiologist Baylor University Medical Center firstname.lastname@example.org Liver anatomy 101 Fundamentals of CT & MRI Focal Liver Lesions
Management of Abdominal Incidentalomas Found on Cross-sectional Imaging: Management Strategies Michael Nipper, M.D. Q1: What Percentage of the Time Does My Radiology Group Give Specific Follow-up Recommendations
WHAT IS THE BEST WAY TO EVALUATE THE LIVER MASS? Mitchell L Shiffman, MD Chief, Hepatology Section Virginia Commonwealth University Medical Center Richmond, VA LIVER MASSES DISCOVERY AND SIGNIFICANCE Incidental
MRI of benign and focal liver lesions Dr Nick Woodward Royal Free London Introduction Focal liver lesions Benign Characterisation of lesions seen on other modalities Characterisation of benign hepatocellular
Renal Cysts What should I do now? Dr Edmund Chiong Asst. Professor & Consultant Department of Urology National University Hospital What are renal cysts? Fluid-filled structures in the kidney that are not
Why Liver Tumors Appear As They Do?: Imaging-Pathologic Correlation Pablo R. Ros, MD, MPH University Hospitals of Cleveland Case Western Reserve University Cleveland, Ohio USA XLIV Curso Anual Sociedad
Characterization of small renal lesions: Problem solving with MRI Gary Israel, MD With the widespread use of cross-sectional imaging, many renal masses are incidentally found. These need to be accurately
Work up of the focal liver lesion Milan Kinkhabwala, MD Professor of Surgery Chief, Division of Transplantation Montefiore Einstein Center for Transplantation 2 Incidental findings are common with increasing
Fat-containing lesions of the liver: What do we need to know about them? C. Santos Montón, S. del Carmen Martínez, M. Martin Izquierdo, D. C. Cuellar, A. Herrero Hernandez, J. F. Ojeda Esparza; Salamanca/ES
MRI of Benign Liver Lesions and Metastatic Disease Characterization with Gadoxetate Disodium Rocky C. Saenz, D.O. Department of Diagnostic Radiology, Botsford Hospital, Farmington Hills, MI Introduction
Liver Imaging Patricia Lipford Abbitt,, MD Professor and Chief - Body Imaging Section Department of Radiology College of Medicine University of Florida Liver Imaging/Cirrhosis Number of patients with hepatitis
Renal Cancer: Symptoms, diagnosis, pathology & prognosis Mark Johnson Consultant Urological Surgeon Newcastle upon Tyne Hospitals NHS Foundation Trust Plan for today: How renal tumours present What investigations
Middle-aged Woman With a Focal Liver Lesion on Imaging Bilal Hameed, MD University of California, San Francisco Objectives Common liver lesions seen in women on imaging Describe key findings on imaging
Kidney Cancer OVERVIEW Kidney cancer is the third most common genitourinary cancer in adults. There are approximately 54,000 new cancer cases each year in the United States, and the incidence of kidney
Classical behavior of liver metastases (LM) How to differentiate benign liver lesions Frederik Vandenbroucke Radiologie en Medische Beeldvorming Universitair Ziekenhuis Brussel Erasmus Abdominal and Urogenital
Incidental Focal Liver Lesions FLLs and Incidentalomas Gopal A. Ramaraju, MD Associate Professor Gastroenterology and Hepatology University of Rochester Medical School/ Strong Memorial Hospital Disclosure
Liver Imaging: A Guide for Medical SpRs D.E. Malone St. Vincent s University Hospital, Dublin, Ireland Core Curriculum in Hepatology SVUH 2013 Acknowledgements Ronan Ryan Sinead McEvoy Lisa Lavelle Anne
Differential Diagnosis in Ultrasound A Teaching Atlas von Günter Schmidt 1. Auflage Thieme 2005 Verlag C.H. Beck im Internet: www.beck.de ISBN 978 3 13 131891 6 schnell und portofrei erhältlich bei beck-shop.de
Case Studies  July 22, 2014 By Danielle DeMulder, MD  and Erini Makariou, MD  Case History: 54-year-old male presents with palpable right retroareolar abnormality. Case History: 54-year-old male
October 25-November 19, 2004 Breast Ultrasound: Benign vs. Malignant Lesions Jill Steinkeler,, Tufts University School of Medicine IV Breast Anatomy Case Presentation-Patient 1 62 year old woman with a
Contrast-Enhanced Ultrasound (CEUS) Odd Helge Gilja, MD, PhD Professor Department of Medicine Haukeland University Hospital Bergen, Norway The Micro-Bubble Contrast Agents - World View IEEE Transactions
Breast Imaging: Ultrasound Evaluation of Breast Masses Jennifer Kohr, MD Radiologist Virginia Mason Medical Center I have no disclosures 1 Case 1: Additional views of baseline screening mammogram finding
Chest Radiography Interpretation: Reading Chest Films Lisa Chen, M.D. Assistant Clinical Professor Pulmonary and Critical Care Division Department of Medicine San Francisco General Hospital Michael Gotway,
BREAST ULTRASOUND INDICATIONS Indications Technique and Normal Anatomy Annina N. Wilkes MD Thomas Jefferson University Hospital Evaluation of palpable mass Evaluation of mass on mammogram Initial imaging
Ultrasound of Benign Pathology Reni Butler, M.D. Department of Radiology and Biomedical Imaging Yale School of Medicine Ultrasound of Benign Pathology Cyst Intramammary Lymph Node Lipoma Fibroadenolipoma
Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Version History Version Date Summary of Change/Process 0.1 09.01.11
WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS This is a patient information booklet providing specific practical information about gall bladder polyps in brief. Its aim is to provide the patient
Assessment of Thyroid Nodules (AACE.com for Guidelines) March, 2007 Prevalence: palpable 3-7% (6.4% of women and 1.5% of men); ultrasound ~50% More common in elderly and those with iodine deficiency or
Diffusion MRI of the Abdomen Robert R. Edelman, M.D. Dept. of Radiology NorthShore University Health System Feinberg School of Medicine, Northwestern University Diffusion Imaging Random motion of molecules
CASE OF THE MONTH AUGUST-2015 DR. GURUDUTT GUPTA HEAD HISTOPATHOLOGY CASE HISTORY 52Y MALE RIGHT RADICAL NEPHERECTOMY Case of right renal mass with IVC thrombus. History of surgery and RT for right occipital
1: US of adrenal glands, KLA Ultrasonography of the Adrenal Glands CVM 6105 Kari L. Anderson, DVM, Diplomate ACVR Associate Clinical Professor of Veterinary Radiology Ultrasound has quickly become an important
Something Old, Something New. Michelle A. Fajardo, D.O. Loma Linda University Medical Center Clinical Presentation 6 year old boy, presented with hematuria Renal mass demonstrated by ultrasound & CT scan
Neuroendocrine Tumors: A Review of CT and MRI Findings Pareen Mehta, MD and Patrick M. Colletti, MD Neuroendocrine tumors, including pancreatic neuroendocrine tumors and carcinoid tumors, are rare neoplasms
GIANT LYMPHANGIOMA OF THE BREAST IN AN ADULT Suresh R. Harbade, Pravinkumar P. Wasadikar, Anagha S. Varudkar. 1. Assistant professor, Department of Surgery, Government Medical College, Aurangabad(MS) 2.
Pediatric Breast Masses Marilyn J. Siegel, M.D. Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis, MO Objectives Review normal breast development Recognize the sonographic
Clinical Analysis of Focal Nodular Hyperplasia of the Liver in 11 Patients Purpose: The purpose of this study was to determine the clinical features of focal nodular hyperplasia (FNH) and investigate its
Breast Disease: Diagnosis and Management Nicole Kounalakis, MD Assistant Professor of Surgery Goal of Breast Evaluation The goal of breast evaluation is to classify findings as: normal physiologic variations
Spleen (Effective February 2007) (1%-5%) Anatomy Normal Intraperitoneal, except hilum Left hypochondrium Left hemidiaphragm superior generally considered to be ovoid, with a convex superior and a concave
CONTRAST-ENHANCED ULTRASOUND OF THE LIVER: ELECTRONIC ATLAS OF NORMAL ANATOMY, COMMON & UNCOMMON PATHOLOGY, & GUIDANCE FOR PROCEDURES Mollie Rashid, MD Corinne Deurdulian, MD Suzanne L. Palmer, MD DISCLOSURES
CT and MRI features of the Pathologic Subtypes of Papillary Renal Cell Carcinoma Melissa Price, MD Aoife Kilcoyne, MD Mukesh G. Harisinghani, MD Disclosures Neither I nor my immediate family members have
August 2009 To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma Christina Ramirez, Harvard Medical School Year III Gillian Lieberman, MD Agenda
HISTOLOGY OF LIVER and BILIARY TRACT LEARNING OBJECTIVES At the end of session the student should be able to; Identify the important landmarks of liver, Know the basic histological architecture of liver,
: Derek DuBay, MD Associate Professor of Surgery Liver Transplant and Hepatobiliary Surgery UAB Department of Surgery Focal Hepatic Lesions More Common 1. Hepatic Cyst 2. Hepatic Hemangiomas 3. Focal Nodular
Abdominal Ultrasound in Children Professor Michael Ditchfield Professor & Head of Paediatric Imaging Monash Children s, Monash Medical Centre Monash University Circular smooth muscle of pyloric sphincter
Sigmoid Stenosis caused by diverticulitis versus carcinoma: Can they be differentiated by ultrasound? T Ripollés, MD; MJ Martínez, MD; C Fernández, MD; J Vizuete, MD; D Gómez, MD; G Martín, MD. Department
Gynecology Abnormal Pelvic Anatomy and Physiology: (Effective February 2007) pediatric, reproductive, and perimenopausal/postmenopausal (24-28 %) Cervix Nabothian cysts result from chronic cervicitis most
A912: Kidney, Renal cell carcinoma General facts of kidney cancer Renal cell carcinoma, a form of kidney cancer that involves cancerous changes in the cells of the renal tubule, is the most common type
Ovarian Pathology Physiologic cysts: Functional cysts Pathology: A simple cyst is a sac containing fluid or semi-solid material. Physiologic cysts are generic types of hormonally active cysts that result
Benign Ovarian Masses Anthony Hanbidge Learning Objectives Describe technique for assessment of ovarian masses Explain importance of transvaginal scan List the common benign masses Specify distinguishing
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 3/5/2011 Radiology Quiz of the Week # 10 Page 1 CLINICAL PRESENTATION AND RADIOLOGY QUIZ
March 2006 A 69 Year-Old Woman with Abdominal Pain Paul Cremer, Harvard Medical School Year III Patient Presentation HPI: 69 year-old woman with two months (3/05-5/05) of increasing fatigue and acute-on-chronic
Experiences of using a single post-contrast CT scan of the chest after biphasic contrast injection P C Pretorius, FCRad (Diag) SA Drs Visser, Erasmus, Vawda & Partners, Port Elizabeth Corresponding author:
This lecture is drawn from the continuing medical education program Finding Hope: Prevention, Early Detection and Treatment of Pancreatic Cancer, Nov, 2011. Robert P. Jury, MD Cystic Neoplasms of the Pancreas:
MRI problem solving in the liver, pancreas, kidneys, and adrenal glands John R. Leyendecker Associate Professor, Abdominal Imaging Clinical Director, MRI Wake Forest University School of Medicine Disclosures
CHAPTER 11 The Spleen in Sarcoidosis SPLENIC ENLARGEMENT The true incidence of splenic enlargement in sarcoidosis is not known. Asymptomatic, mild enlargement of the spleen is common and requires no treatment.
Thyroid, Parathyroid and neck ultrasound Objectives Review cases of thyroid, parathyroid and neck diseases Imaging pattern based approach Review literature and guidelines for FNA 1 Imaging pattern based
EXTRAHEPATIC BILE DUCT CANCER General Information Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver. A network of
OVARIAN CYSTS Follicular Cyst Ovarian cysts are fluid-filled sacs that form within or on the ovary. The majority of these cysts are functional meaning they usually form during a normal menstrual cycle.
Gallbladder cancer Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder. Gallbladder cancer is a rare disease in which malignant (cancer) cells are found
: Palpable mass Abnormal mammogram with normal physical exam Vague thickening or nodularity Nipple Discharge Breast pain Breast infection or inflammation The physician s goal is to determine whether the
Understanding breast changes UHN For women Read this resource to learn: Parts of your breast Types of breast changes What follow up appointments you may need Breast Imaging Department Princess Margaret
POSTMENOPAUSAL OVARIAN CYSTS:HOW TO ASSESS AND WHAT TO DO Steven R. Goldstein, MD Professor of Obstetrics and Gynecology Director of Gynecologic Ultrasound Co-Director, Bone Densitometry New York University
Breast Imaging Protocol Eastern Radiologists, Inc. Breast Imaging Network Screening Mammography Images: Routine CC and MLO views, XCCL if needed. Implant Patients: CC and MLO in both routine and implant
46 CHAPTER THREE ULTRASOUND 3.0 Goals: Understanding how ultrasound works; its uses, strengths, and weaknesses Objective questions: 3.1 What is ultrasound? 3.2 How does ultrasound work? 3.3 How is an image
February 2012 Hepatocellular Carcinoma: A Guide to Screening and Diagnosis Reid Merryman, Harvard Medical School Year III Agenda Hepatocellular carcinoma (HCC) introduction Index patient: clinical presentation
International Journal of Clinical Medicine, 2011, 2, 264-268 doi:10.4236/ijcm.2011.23042 Published Online July 2011 (http://www.scirp.org/journal/ijcm) Incidence of Incidental Thyroid Nodules on Computed
Liver Cancer And Tumours What causes liver cancer? Many factors may play a role in the development of cancer. Because the liver filters blood from all parts of the body, cancer cells from elsewhere can
Recanalized Umbilical Vein in the Presence of Cirrhosis-Induced Portal Hypertension Audrey Galey RDMS, RVT, Mary Grace Renfro RDSM, RVT, Lindsey Simon, RVT March 22, 2013 2 Abstract A recanalized umbilical
ACG Regional Postgraduate Course June 6-8, 2014. Washington, DC Pancreatic Cysts What is Benign versus Not-so-benign Asif Khalid MD Associate Professor of Medicine University of Pittsburgh Medical Center
Ultrasound assessment of women with pelvic pain Lil Valentin Department of Obstetrics and Gynecology Skåne University Hospital Malmö, Sweden How to make optimal use of ultrasound in women with pelvic pain
Bahrain Medical Bulletin, Vol. 27, No. 4, December 2005 Medullary Renal Cell Carcinoma Case Report Mohammed Abdulla Al-Tantawi MBBCH, CABS* Abdul Amir Issa MBBCH, CABS*** Mohammed Abdulla MBBCH, CABS**
Revised: 11/2/2015 LIVER ULTRASOUND EXAMINATION (WITH OR WITHOUT ELASTOGRAPHY) POLICY: Liver ultrasound will be performed with an order from a physician or other qualified clinical practitioner. The examination
Evaluation and Management of the Breast Mass Gary Dunnington,, M.D. Department of Surgery Internal Medicine Ambulatory Conference December 4, 2003 Common Presentations of Breast Disease Breast Mass Abnormal
Differential diagnosis of complex liver cysts. Poster No.: C-0801 Congress: ECR 2014 Type: Educational Exhibit Authors: S. claret loaiza, C. de la Torre, L. Renza Lozada, M. C. Cañete Moslero; Malaga/ES
High-Resolution Lung CT: Key Findings and What They Mean 2 W. Richard Webb MD Key HRCT Findings of Lung Disease interlobular septal thickening honeycombing irregular reticular opacities traction bronchiectasis