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Neonatal Adrenal Hemorrhage

KEY FACTS Terminology Perinatal bleeding into normal adrenal gland Associated with many perinatal stressors: Asphyxia, sepsis, birth trauma, coagulopathies ↑ frequency in full-term & large infants You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Introduction to the Adrenals

Anatomy, Embryology , and Physiology The adrenal (suprarenal) glands lie in the perirenal space, usually cephalic to the kidneys. The right adrenal gland lies above the kidney, lateral to the crus of the diaphragm, medial to the liver, and touches the posterior aspect of the inferior vena cava. The left adrenal gland usually lies anterior to the upper pole of the left kidney, posterior to the…

Hemangiopericytoma

KEY FACTS Terminology Hemangiopericytomas are group of neoplasms that arise from pericytes in walls of capillaries and can occur in various tissues Rare, vascular neoplasms of variable clinical behavior You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Retroperitoneal Fibrosis

KEY FACTS Imaging Irregular, periaortic soft tissue mass extending from renal vessels to iliac bifurcation Aorta not typically displaced from spine in primary retroperitoneal fibrosis Soft tissue can surround inferior vena cava and medially displace ureters Soft tissue may extend to renal hila and into pelvis NECT: Isoattenuating to muscle CECT or MR: Enhancement varies with stage of disease Early/active disease: Avid enhancement Late/chronic disease: Minimal…

Introduction to the Retroperitoneum

Relevant Anatomy and Embryology The parietal peritoneum separates the peritoneal cavity from the retroperitoneum. The retroperitoneum contains all the abdominal contents located between the parietal peritoneum and the transversalis fascia. It is divided into 3 compartments by 2 well-defined fascial planes: The renal and lateroconal fasciae. The perirenal space contains the kidney, adrenal, proximal ureter, and abundant fat, and it is enclosed by the renal fascia,…

Imaging Approaches

Renal Mass Evaluation CT : Although rapid improvements in scanner technology have resulted in dramatic increases in spatial and temporal resolution, the imaging marker for potential neoplasia (enhancement of soft tissue components of renal masses after contrast administration) has not changed over several generations of CT scanners. Typical renal mass protocols consist of NECT of the kidneys followed by contrast-enhanced images obtained during nephrographic and excretory…

Piriformis Steroid Injection

KEY FACTS Terminology Selective image-guided injection of long-acting anesthetic and corticosteroid into piriformis muscle adjacent to sciatic nerve in treatment of piriformis syndrome Some advocate intramuscular botulinum toxin A injection Preprocedure Injection is generally reserved for cases in which conservative measures/physical therapy have failed Preprocedure imaging Look for signs of lumbosacral plexus compression Evaluate sacroiliac joints Rule out hip joint abnormality Evaluate for pelvic musculature abnormality/asymmetry…

Sacral Nerve Root Block

KEY FACTS Terminology Selective corticosteroid and long-acting anesthetic injection of sacral nerve root at level of neural foramen Preprocedure Malignant or benign neoplasm Imaging Evaluate relevant anatomic landmarks Search for other causes of patient pain Procedure Anchor 22-gauge spinal needle in subcutaneous tissue and confirm trajectory with fluoroscopy Right side: Target foramen at 1-2 o'clock Left side: Target foramen at 10-11 o'clock Pain score Note patient…

Sacroiliac Joint Injection

KEY FACTS Terminology Image-guided injection of corticosteroid and long-acting anesthetic into sacroiliac (SI) joint Preprocedure Indications Diagnostic injection for hip/back/buttock pain Sacroiliitis Synovial cyst associated with SI joint Procedure Prone Oblique tube angulation to “open” SI joint Advance needle under intermittent imaging until “pop” into joint space is felt or bone is reached Inject small amount of contrast under fluoroscopy to confirm intraarticular needle placement Should…