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Borderline Ovarian Tumor

Synonyms/Description Tumor of low malignant potential (LMP tumor) Etiology Ten to fifteen percent of epithelial ovarian tumors are considered borderline malignancies. They tend to occur in women in their forties and fifties, younger than those with frankly invasive tumors, and they are not thought to be related to hereditary breast/ovarian cancer syndromes. These tumors are stage I at diagnosis in more than 90% of patients, have…

Bladder Masses

Synonyms/Description Bladder tumor Focal bladder lesion Etiology Transitional Cell Cancer In the United States, bladder cancer is reportedly the fourth most common malignancy. The vast majority of bladder neoplasms arise from the epithelium, with urothelial (transitional cell) carcinoma accounting for 90% of cases. Squamous cell carcinoma is rare and accounts for 2% to 15% of bladder cancers. The least common is adenocarcinoma, which may be primary…

Atrophic Endometrium

Synonyms/Description Endometrial atrophy Etiology Endometrial atrophy is most often the result of postmenopausal status, although it may also occur in premenopausal women with lack of estrogen from other etiologies. 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

Appendiceal Mucocele

Synonyms/Description A mucocele is an appendiceal mass characterized by hypersecretion of mucus contained within the appendix causing dilatation of the lumen. Etiology Mucoceles of the appendix are caused by excessive mucous production secondary to retention cyst (simple) (18%), mucosal hyperplasia (20%), mucinous cystadenoma (52% to 84%), or mucinous cystadenocarcinoma (10% to 20%). They occur in males twice as frequently as females and most often in the…

Adhesions (Peritoneal Inclusion Cyst)

Synonyms/Description Benign adhesions trapping fluid Etiology Peritoneal inclusion cysts develop from peritoneal adhesions trapping fluid, often generated from an active ovary. The normal peritoneum absorbs fluid regularly. When the peritoneum is injured, as can occur with surgery, infection, or endometriosis, normal fluid absorption is hampered. This results in fluid accumulation within adhesions or peritoneal inclusion cysts. Reportedly at least 70% of all patients with peritoneal inclusion…

Adenomyosis

Synonyms/Description Endometriosis of the uterus or myometrium Etiology Adenomyosis is defined pathologically when endometrial glands and stroma are found in the myometrium, distant from the endometrial cavity itself. This ectopic endometrial tissue has the ability to induce hypertrophy of the surrounding myometrium. This process can be focal or diffuse and thus accounts for the variability in the ultrasound appearances noted. The endometrium-myometrium junctional zone is jagged…

General Pearls

Intravascular Contrast Media Barium based contrast agents For assessment of the GI tract Based on very poorly soluble barium sulphate (BaSo 4 ) ▸ administered PO or PR Can lead to barium peritonitis if leaks into the peritoneal cavity Iodine based contrast media For general use in angiography and CT No marked pharmacological actions – can interfere with clotting times (avoid clotting tests for 6 hours…

Woman’s Imaging – Interventional radiology

Obstetric Haemorrhage Fibroid Embolization – Uterine Artery Embolization (UAE) Definition Uterine fibroids are the commonest tumour found in reproductive women – the prevalence increases up to the menopause (up to 80% in Afrocarribean women) 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

Genitourinary Interventional Radiology

Percutaneous Renal Access The safest point for calyceal puncture is the centre of the calyx, approached through the relatively avascular plane (Brödel's line) between the branches of the anterior and posterior divisions of the renal artery Puncturing the centre of the calyx avoids injury to the arcuate divisions that course around the infundibulum – puncture into the infundibulum or renal pelvis may lacerate larger arterial branches…

Hepatobiliary Intervention

Liver Biopsy Spring-powered cutting sheath biopsy devices collect more consistent core biopsies with less crush artefact than a manually operated system The traditional route for liver intervention uses a horizontal right lateral intercostal approach ▸ an anterior subcostal approach (that does not traverse the pleura) is less likely to cause pulmonary complications It is preferable to biopsy lesions using a route through intervening normal liver as…

Principles of Tumour Ablation

Radiofrequency Ablation (RFA) Monopolar RFA involves the application of high frequency (460-500 kHz) alternating current to the target tissue using a needle like applicator (dispersive grounding pads are attached to the patient's trunk / thigh) ► the resultant alternating electric field around the uninsulated probe tip causes ‘radiofrequency’ agitation of water molecules (inherently polarized) and local frictional heating within a few mm of the probe tip Coagulative…

Specific Drainage Techniques

Chest Pleural drainage catheters are smaller than surgical drains (up to 16Fr) – haemothorax is better treated with surgical drains (36–38Fr) USS is adequate for uncomplicated collections, but CT is usually needed for drainage of multiloculated pleural collections It is recommended that the dependent portion of the collection is accessed just above the adjacent rib (away from the neurovascular bundle) and avoiding insertion close to the…

Cross-Sectional Vascular Imaging

Multidetector CT Angiography (MDCTA) Rapid IV injection of contrast (3-5 mL/s) ▸ automated contrast bolus detection techniques: the ‘arrival of contrast medium is measured within a vessel at a single level, and data acquisition initiated when a certain density threshold is reached ▪ Multiplanar reconstruction (MPR): useful for the rapid review of blood vessels in any plane (and assessment of vessel walls that might be obscured in…

Interventional Vascular Radiology Techniques

Catheter Angiography Vascular Access Contraindications Very few absolute contra-indications – caution with patients on anticoagulants / systemic hypertension / prolonged steroid treatment / connective tissue disorders The right common femoral arterial approach is preferred (other sites include the axillary, brachial or radial artery) this allows good access with well defined puncture landmarks and a low complication rate Arterial puncture technique: can use a single (anterior artery…

Functional Imaging

Positron Emission Tomography – CT (PET-CT) General principles PET imaging is based on the detection of an injected positron-emitting radioactive tracer – PET relies on the co-incidence detection of the annihilation photons (γ) released when a positron combines with an electron; it cannot differentiate individual species that are radiolabelled PET has a high sensitivity but low spatial resolution – PET-CT combines cross sectional anatomic information (CT)…

Lymphoma

9 Lymphoma 894 Introduction 894 Lymph node disease in lymphoma 898 CNS lymphoma 900 Pulmonary lymphoma 902 Lymphoma of the gastrointestinal tract 904 Musculoskeletal lymphoma 906 Extranodal manifestations of lymphoma 908 Monitoring the response to therapy in lymphoma 912 Lymphoma Introduction Definition The lymphomas are caused by the malignant clonal expansion of either T or B lymphocytes – these can accumulate within lymph nodes (causing lymphadenopathy)…