Transcript Mammography,

Interesting Cases
Dr. WALEED AL HAJJI
History
Thirty years old male patient who is
experiencing left extensive femoro-popliteal
DVT.
 Hospitalized
 One day later he developed chest pain and
shortness of breath
 Chest X-ray was obtained


CT angiography of the pulmonary
arteries was done
Case was diagnosed as pulmonary embolism;
IVC filter was inserted to guard against further
PE
The patient survived that attack of PE, with
follow up CT angiography of the pulmonary
artery revealing complete resolution of the
embolization of the right pulmonary artery.
 Two days later, the patient experienced
similar attack of chest pain, that found to be
due to another attack of PE.
 That was inspite of the IVC filter inserted in
place!!!


CT of the chest and abdomen was
performed
A
B
Diagnosis
Double IVC
Duplication of the IVC
results from persistence
of both supracardinal
veins. The prevalence is
0.2%–3%

A double IVC can be associated with
other conditions, such as a horseshoe
kidney, a circumaortic renal vein, a
retroaortic left renal vein, and a
retroaortic right renal vein with
hemiazygos continuation of the IVC
Case 2
Diagnosis
Fenestration of the septum pellucidum.
This is one of the findings in chronic obstructive
hydrocephalus.
 Also known as non-communicating hydrocephalus is
simply hydrocephalus due to obstruction of CSF flow out
of the ventricles.
 Frequent causes of obstructive hydrocephalus
include:
-aqueduct stenosis
-meningitis
Features of long standing obstructive hydrocephalus are:
-Marked dilatation of the lateral and third ventricles.
-Thinned and elevated corpus callosum.
-Depression of the fornices.
-Rounding of the infundibular, optic and pineal recesses.
-Ballooning of the suprapineal recess.
-Fenestration of the septum pellucidum.
Case 3
This is an incidental finding during
an angiography procedure
Case 4
History: Upper chest discomfort.
Diagnosis:
 Carcinoma of the gastric fundus (pseudoachalasia
presentation) with direct invasion of the GEJ.
Differential Diagnosis for Pseudoachalasia:
Carcinoma of the gastric cardia or fundus with direct
invasion of the GEJ or distal esophagus.
 Hematogenous metastases from breast, lung, or
pancreatic cancer.
Lymphoma.
 Chagas.
Malignancy-induced secondary achalasia is an
uncommon condition, accounting for only 2 to 4% of
patient with findings of achalasia at manometry.
Most patients with primary achalasia are between 20
and 50 years of age and have symptoms of dysphagia
for an average of 4 to 6 years. Whereas, most patients
with secondary achalasia are older than 50 years and
have symptoms, on average, less than 6 months.
Case 5
28 years old male patient
 Admitted to the casualty with a stab
injury to the left popliteal fossa
 No much bleeding was noted on
admission!!

Traumatic (stab)
pseudoaneurysm Pop. A
Case 6

A 76-year-old woman presented with:
– Vague abdominal pain (persistent for over
two years)
– Recent (over the previous three months),
unwanted 8 kg weight loss
Differential Diagnosis
Gallbladder carcinoma
 Adenomyomatosis
 Chronic inflammation
 Metastastic disease (metastatic
melanoma)
 And less likely, multiple polyps

Diagnosis
Adenocarcinoma of the gallbladder
Discussion
Pathology Discussion
Cholecystectomy
 Diffuse
thickening of the
wall but no
obvious focal
lesion.


Diffuse papillary
projections of
epithelium
 Diffuse, adenomatous
epithelial change
 In some areas,
dysplastic changes
consistent with
adenocarcinoma in
situ
 The tumor focally
invades into
muscularis propria
only superficially
Radiology Discussion:

GB carcinoma, a highly lethal condition
 Sixth most common gastrointestinal
malignancy (after colon, pancreas, stomach,
liver, and esophagus)

Because symptoms are often vague, this
carcinoma is frequently detected late; in fact,
detection is typically related to invasion of
adjacent organs
Risk factors
Post-menopausal status
 Cigarette smoking
 Gallstones (seen in 85% of cases of
gallbladder carcinoma)


The presence of a choledochal cyst,
anomalous junction of the
pancreaticobiliary ducts, and low
insertion of the cystic duct are also
associated with higher incidence. It is
thought, in these cases, that gallbladder
carcinoma may develop in response to
chronic biliary reflux of pancreatic
secretions
Imaging appearances

Mass replacing the gallbladder (55%) most
common (DD hepatocellular carcinoma,
cholangiocarcinoma, and metastatic disease
of the gallbladder fossa)
 Focal or diffuse wall thickening (25%) (DD
congestive heart disease, hypoalbuminemia,
cirrhosis, hepatitis, cholecystitis, and
adenomyomatosis)
 Polypoid mass (DD polyps (adenomatous,
hyperplastic, or cholesterol), carcinoid tumor,
melanoma metastasis, and hematoma)
References

Levy AD, Murakata LA, Rohrmann CA. AFIP
Archives. Gallbladder Carcinoma: RadiologicPathologic Correlation. Radiographics 2001;
21: 295-314.
 Bang Huu Huynh, MD - Case Coordinator
Amy Ho Huang, MD - Radiology Discussion
Jian Shen, MD, PhD - Pathology Discussion
Steven E Seltzer, MD - Attending Radiologist
 May 12, 2003
Thank You