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Pyosalpinx

Schematic shows distended , thick walled pus filled distal half of the fallopian tube 

Figure 4

COLOR DOPPLER – Hypoechoic tube like structure with echogenic material and surronding vascularity.

 

Figure 5a

Axial Pelvic CT  post contrast shows B/L distended , thick walled fallopian tubes with wall enhancement and filled with pus

 

Figure 5b

Axial Pelvic CT demonstrates tubular salpinx , dilated and thick walled with enhancement

 

Coronal T2W image demonstrates distended , thickened and folded fallopian tube (solid arrows) indicating pyosalpinx and a round thick walled cystic structure (open arrows) indicating tubo ovarian abscess

 

Axial T2W image demonstrates distended , thickened  fallopian tube (solid arrows)with semi-effaced plicae(arrowheads) and fluid level(black arrow), indicating pyosalpinx and a round  cystic structure (open arrows) indicating tubo ovarian abscess

 

Axial contrast-enhanced fat-suppressed T1-weighted MR images show the thickened enhancing wall of the dilated fallopian tube (solid arrows) and ovary (open arrow ), findings suggestive of pyosalpinx and tubo-ovarian abscess.

In MRI

1.Semi-effaced plicae(arrowheads) in axial image above

2. Sausage shape due distention on coronal and axial images   (solid arrows) help in identifying distended fallopian tube

In tubo ovarian abscess the tube is adherent to the ovary and forms a complex cystic mass , where as in pyosalpinx the tube can be delineated as mentioned above. Both conditions co-exist most of the time.

 

Reference :

1.Fallopian Tube Disease in the Nonpregnant Patient Maryam Rezvani, MD and Akram M. Shaaban, MD

http://radiographics.rsna.org/content/31/2/527.full

2.MR Imaging Findings of Hydrosalpinx: A Comprehensive Review

  1. Mi Young Kim, MD,
  2. Sung Eun Rha, MD,
  3. Soon Nam Oh, MD,
  4. Seung Eun Jung, MD,
  5. Young Joon Lee, MD,
  6. You Sung Kim, MD,
  7. Jae Young Byun, MD,
  8. Ahwon Lee, MD and
  9. Mee-Ran Kim, MD

 

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Testicular Seminoma -USG,CT and MRI

USG – Homogenous hypoechoic mass 

 

CT – Homogenous mass with slightly low attenuation

CT – Para aortic lymphadenopahy  Fig. 6A

 

T2W MRI – Homogenous Low Signal Mass in left testis 

  Fig. 1A

 

T1W Post Contrast – Enhancement of septa of low signal mass

  Fig. 1B

 

PET-CT Para aortic lymphadenopathy

 

DIFFERENTIAL DIAGNOSIS of testicular mass

1.Testicular Tumors
2.Testicular Cyst
3.Testicular abscess

 
TESTICULAR TUMORS

1.GERM CELL TUMOUR  – 95%
A.SEMINOMA – 50% OF GCT
Most common Testicular Cancer
Most common cancer in undescended testes

B.EMRYONAL CARCINOMA – 25% OF Germ cell tumor
More aggressive than seminomas

C.CHORIOCARCINOMA
D.TERATOMA

2.NON GERM CELL TUMORS 
SERTOLI CELL TUMORS – secretes oestrogens
LEYDIG CELL TUMOR – secretes  testosterone

3.METASTASIS : Most common tumors in males > 50 years

 

4. STAGING:

Reference:

1.Aids to radiological differential diagnosis – Chapman & Nakielny

2.MRI in the histological characterization of testicular neoplasm

http://www.ajronline.org/content/189/6/W331.full

3.The Role of Imaging in the Diagnosis, Staging, and Management of Testicular Cancer S. Aslam Sohaib1, Dow-Mu Koh1 and Janet E. Husband1

http://www.ajronline.org/content/191/2/387.full

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CHEMICAL SHIFT MRI – Physics and Clinical Application

Chemical shift MRI utilises the difference in local environment of the proton. The proton in H2O is more exposed and free compared to the proton in lipid which is more protected by the electrons surrounding it. The water protons experience more magnetic field than the lipid protons.So the water proton resonate faster and the fat protons slower.

The net effect is that the signals from water and lipid cancel each other and there is signal loss. The signal drop depends on the lipid content.

The best application of CHEMICAL SHIFT imaging is differentiating between Adrenal adenoma , a lipid containing tumor from ,adrenal metastases which are devoid of lipids. On T1W out of phase and in-phase imaging  imaging ,adrenal adenoma shows signal drop in out of phase images and no signal drop in in-phase images,whereas in adrenal metastases there is no signal drop and thus there is no difference in signal between out and in-phase imaging.

ADRENAL ADENOMA :CHEMICAL SHIFT IMAGING 

IN PHASE T1W MRI – HIGH SIGNAL  Figure

OUT OF PHASE T1W MRI – LOW SIGNAL Figure

 

 

 

 

 

Reference:

http://radiographics.rsna.org/content/21/4/995.full?sid=c62ec6f4-1980-48ae-b805-046472646ba0#F21

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Adrenal Cortical Carcinoma

Adrenal cortical carcinomas (ACC) are rare and have a bimodal age distribution with peak incidence in the first year and fourth decade of life.
On CT, adrenal carcinomas appear as heterogenous masses. Half are calcified. Sometimes ACC’s can be confused with renal cell carcinomas.
95% of ACC’s are functioning tumors. Most cause virilization. Many cause Cushing’s syndrome.

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Orbital Pseudotumor vs Thyroid Ophthalmopathy

 

 

 

 

Orbital Pseudotumour

Pseudotunor Imaging reveals an enlargement of one or more extraocular muscles along with enlargement of their tendons. Mostly unilateral.Thyroid horone levels normal

 

THYROID OPHTHALMOPATHY

Patients who have Graves’ ophthalmopathy may have symptoms
similar to those of patients who have orbital myositis,(pseudotumor)
but usually have enlargement of the extraocular muscles without
involvement of the tendons. Mostly bilateral. Thyroid function test abnormal.

 

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Brain Metastases

Brain metastases account for approximately a third of all intracranial tumours and are the most common intracranial neoplasm. They characteristically occur at the corticomedullary junction of the brain and have surrounding oedema that typically exceeds the tumour volume.  Multiple lesions are present in approximately two-thirds of cases and should be searched for with administration of intravenous contrast. Most are hypodense on CT unless haemorrhagic or hypercellular, hence the lesion in this case is haemorrhagic.  This lends itself to a differential of primary neoplasms which includes melanoma, renal cell carcinoma, thyroid carcinoma, bronchogenic carcinoma and breast carcinoma.

D/D :

Glioblastoma multiforme usually appears as an irregular, heterogeneous, low-density mass. Abscesses typically demonstrate ring enhancement post-contrast and may show loculation and specules of gas.

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Difference between Neuroblastoma and Wilm’s tumor

WILM’S TUMOR

NEUROBLASTOMA


1)NB usually crosses midline, Wilm’s usually dont
2)Calcification common in NB90%, rare in Wilm’s, 10 – 15%
3)vessel encasement common in NB, displacement common in Wilm’s
4)wilms intrarenal, nb extrarenal
5)Retroperitoneal lymphadenopathy or contiguous
extension of the primary tumor in the retroperitoneal space
occurred frequently in neuroblastoma, and seldom seen in Wilms tumor
6)Distortion of the renal calyces isvery specific for
Wilms tumor; hydronephrosis can occcur in both
7)NB younger age group (< 2 years of age), Wilm’s slightly older age group : peak 3 – 4 years of age
8)NB poorly marginated, wilm’s=well circumscribe

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Basal Ganglia Calcification

 

Causes of basal ganglia calcification include:
 1- Physiological aging.
 2- Infections/inflammatory: TORCH, TB, cysticercosis, measles, chickenpox, pertussis, Coxsackie B virus, AIDS, SLE.
 3- Toxins: lead, carbon monoxide, birth anoxia/hypoxia, chemotherapy/radiotherapy, nephrotic syndrome.
 4- Congenital: Cockayne’s, Fahr’s and Down’s syndromes, neurofibromatosis, tuberous sclerosis, methaemaglobinopathy.
 5- Endocrine: hypothyroidism, hypoparathyroidism, pseudhypoparathyroidism, pseudopseudohypoparathyroidism, hyperparathyroidism.
 6- Metabolic: Leigh disease, mitochondrial cytopathies.
 7- Trauma: infarction.

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HEMANGIOENDOTHELIOMA

 

Most common benign vascular hepatic tumor in the first year of life and most common symptomatic tumor in the first 6 months of life

CT:

Well-defined solid mass that often has central areas of necrosis and fibrosis
Low attenuation on noncontrast images relative to normal surrounding hepatic parenchyma

Contrast enhancement may resemble that of a large cavernous hemangioma in an adult
Early peripheral enhancement with more nodular puddling of contrast due to pooling in larger vascular spaces. Delayed central enhancement is variable.

 

Ultrasound :

may show a complex mostly solid mass, predominantly hypo echoic.
Anechoic regions may be related to dilated vascular spaces with prominent high flow vascular structures

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MALIGNANT OVARIAN TUMOUR