Transcript Radiology Case Presentation

Radiology Case Presentation
by:Brad Moatz
CC:
• 19-year-old female with right lower
quadrant pain and vomiting.
Uterine Anomalies
• Congenital anomalies of the uterus are often
asymptomatic and therefore unrecognized
• The incidence of congenital uterine anomalies is
difficult to determine since many women with
such anomalies are not diagnosed, especially if
they are asymptomatic. Uterine anomalies occur
in 2 to 4 percent of fertile women with normal
reproductive outcomes
Septate/Arcuate Uterus
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A septate uterus has a normal
external surface but two
endometrial cavities
• The septate uterus develops
from a defect in canalization or
resorption of the midline
septum between the two
müllerian ducts. The degree of
septation varies from a small
midline septum to total failure
in resorption resulting in a
septate uterus with longitudinal
vaginal septum
Pregnancy
• There appears to be a higher risk of
recurrent miscarriage associated with
longer septa, but this is controversial and
many untreated women have good
pregnancy outcomes. Pregnancy
outcomes reported in such women
revealed spontaneous abortion in 21-44
percent, preterm delivery in 12-33 percent,
and live birth in 50-72 percent.
Treatment
• Hysteroscopic metroplasty has become the method of
choice for repair of most uterine septa. Benefits to the
transcervical approach include less morbidity, no
abdominal or transmyometrial incisions, and faster return
to normal activity.
• Various techniques and instruments are used either to
incise or remove the septum. Two of the most common
instruments are the semirigid or rigid scissors (7 French)
or the 8 mm wire loop urologic resectoscope operated
through the 21 French sheath. Potassium-titanphosphate (KTP/532), neodynamic:yttrium aluminum
garnet (Nd:YAG), and argon lasers also have been used.
• If however the septum cannot be safely removed
hysteroscopically, then an abdominal or laparoscopic
approach, such as the Jones or Tompkins metroplasty,
can be used.
42 Foot
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Two views of the right foot, two views of the left foot, two views of the right hand, two views of the left hand
history: Psoriasis.
Findings: There are no prior studies available for comparison.
Right hand: There is no fracture or dislocation. There is significant narrowing of the multiple joints in many wrist and hand, especially the
radiocarpal, all of the carpal, metacarpal phalangeal joints, as well as proximal and distal interphalangeal joints. There are multiple
erosions in the distal radius and ulna, with complete erosion of the ulna styloid. There are also multiple erosions in the carpus. Several
subchondral lucency/erosions are visualized in the distal 2nd-5th metacarpals, as well as distal aspect of the third and fifth proximal
phalanges. There is productive bony change at the metacarpophalangeal and interphalangeal joints. There is bony ankylosis of several
of the carpal bones, specifically the lunotriquetral, lunocapitate, and lunohamate articulations. The bony mineralization is within normal
limits.
Left hand: There is no fracture or dislocation. There is significant narrowing of the multiple joints in many wrist and hand, especially the
radiocarpal, all of the carpal, metacarpal phalangeal joints, as well as proximal and distal interphalangeal joints. There are multiple
erosions in the distal radius and ulna, with complete erosion of the ulna styloid. There are also multiple erosions in the carpus. Several
subchondral lucency/erosions are visualized in the distal 2nd-5th metacarpals, as well as distal aspect of the third and fifth proximal
phalanges. There is productive bony change at the metacarpophalangeal and interphalangeal joints. There is bony ankylosis of several
of the carpal bones, specifically the lunotriquetral, lunocapitate, and lunohamate articulations. The bony mineralization is within normal
limits.
Right foot: There is no fracture or dislocation. There are large central erosions in the first -- fifth metatarsophalangeal joints, with
resultant pencil in cup deformity in these joints. There is metatarsus adductus primus, measuring 18°. There is also hallux valgus,
measuring approximately 52°. There is also mild to moderate lateral deviation at the second - fourth metatarsophalangeal joints. There is
bony ankylosis in the midfoot, specifically at the naviculocuneiform articulation, as well as navicular cuboid joint. There are diffuse
enthesopathic changes throughout the foot, most prominent at the medial and lateral aspect of the hindfoot and midfoot. There is a
prominent erosion in the dorsal aspect of the calcaneus at the site of the Achilles' tendon insertion. There is a small calcaneal
enthesophyte at the site of the plantar fascia insertion. There is no ankle joint effusion. Bony mineralization is within normal limits.
Left foot: there is no fracture or dislocation. There are large central erosions in the 2nd metatarsophalangeal joint, with resultant pencil in
cup deformity. There are marginal erosions at the medial and lateral aspect of the fifth metatarsal. There is bony ankylosis at the first
interphalangeal joint. There is bony ankylosis in the midfoot, specifically at the naviculocuneiform articulation, as well as navicular cuboid
joint. There are diffuse enthesopathic changes throughout the foot, most prominent at the medial and lateral aspect of the hindfoot and
midfoot. There is a prominent erosion in the dorsal aspect of the calcaneus at the site of the Achilles' tendon insertion. There is a small
calcaneal enthesophyte at the site of the plantar fascia insertion. There is no ankle joint effusion. Bony mineralization is within normal
limits.
Impression: Findings consistent with psoriatic arthritis in both hands and both feet, as described above.
41 hand
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Opon review of the study, there is swelling and mild enthesopathy of the fifth proximal interphalangeal joint on the right.
Small erosions and enthesophytes are noted at the second metacarpal phalangeal joint on the right and the fifth metacarpal phalangeal
joint on the left.
Addendum Ends
Two views of the right hand, two views of the left hand, three views of the right and left foot, two views of the right and left heel
History: Psoriasis versus tophaceous gout.
Findings: There are no prior studies for comparison.
Left foot: There is no fracture or dislocation. There are moderate to severe degenerative changes of the first MTP joint, with joint space
narrowing, osteophytosis, and subchondral cystic changes and sclerosis. There also osteophytes at the tibiotalar joint anteriorly and
posteriorly. There is mild osteophytosis at the talonavicular and naviculocuneiform joints. There is a small calcaneal enthesophyte at the
site of the plantar fascia insertion. There are no marginal or peri-articular erosions, periosteal reaction, joint space narrowing, soft tissue
swelling, or abnormal soft tissue calcifications. Bony mineralization is within normal limits.
Left heel: There is degenerative change at the tibiotalar and talonavicular articulations, as above. A small calcaneal enthesophyte is
seen and the plantar fashion distortion. There are no erosive changes were abnormal soft tissue swelling.
Right foot: There is no fracture or dislocation. There are moderate to severe degenerative changes of the first MTP joint, with joint space
narrowing, osteophytosis, and subchondral cystic changes and sclerosis. There also osteophytes at the tibiotalar joint anteriorly and
posteriorly. There is mild osteophytosis at the talonavicular and naviculocuneiform joints. There is a small calcaneal enthesophyte at the
site of the Achilles' tendon insertion. There are no marginal or peri-articular erosions, periosteal reaction, joint space narrowing, soft
tissue swelling, or abnormal soft tissue calcifications. Bony mineralization is within normal limits.
Right heel: There is degenerative change at the tibiotalar and talonavicular articulations, as above. A small calcaneal enthesophyte is
seen and the plantar fashion distortion. There are no erosive changes were abnormal soft tissue swelling.
Right hand: There is no fracture, dislocation, subluxation, marginal or periarticular erosions, soft tissue swelling, or soft tissue
calcifications. Bony mineralization is within normal limits.
Left hand: There is no fracture, dislocation, subluxation, marginal or periarticular erosions, soft tissue swelling, or soft tissue calcifications.
There is a degenerative cyst in the distal pole of the scaphoid. Bony mineralization is within normal limits.
Impression: Degenerative changes in both feet and in the left hand, as above. There are no radiographic findings to suggest gout or
psoriasis.