Today’s cases: January 9th, 2016

  1. Billiary duct cancer, after PPPD, drainage tube in pancreatic duct, check for metastasis, no lung metastasis, mass in descending colon benign, dissection of thoracic aorta

Pylorus-Preserving Pancreaticoduodenectomy (Whipple Procedure) –

The Whipple procedure (pancreatoduodenectomy) is a complex operation to remove part of the pancreas, part of the small intestine and the gallbladder.

The Whipple procedure is most often used to treat pancreatic cancer that’s confined to the head of the pancreas. But it may also be used to treat tumors and other abnormalities of the pancreas, small intestine and bile duct.

Below: Common bile duct cancer MIP coronary section showed a soft tissue lump in the common bile duct. MIP images showed that the portal vein was normal and was pressed slightly by the common bile duct without invasion. MIP, maximum intensity projection.

2016-01-13_22-32-04

Below: Figure 1. A) Pre-operative three-dimensional reconstruction of computed tomography scan of the chest in a patient with a 5 cm aneurysm of the descending thoracic aorta associated with a chronic Type B aortic dissection. B) Post-operative three-dimensional computed tomography scan of the chest following endovascular repair of a 5cm aneurysm of the descending thoracic aorta associated with a chronic Type B aortic dissection which demonstrates a proximal Type I endoleak and a amall retrograde Type I endoleak in the false lumen.


 

2. Tongue cancer, after Chemoradiotherapy, pleural dissemination was the same when copared with previous study, lung nodule present

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Above: Dry Pleural Dissemination in Non–Small Cell Lung Cancer


 

3. Parotid gland cancer, post-surgery, mass/bone destruction, pneumonitis, radiation – occurs with area of radiation, noticed straight margin

Pneumonitis is a general term that refers to inflammation of lung tissue. Although pneumonia is technically a type of pneumonitis because the infection causes inflammation, most doctors are referring to other causes of lung inflammation when they use the term “pneumonitis.”


 

4. Emergency case: 100 yo female, infection with heart failure, cardiomegaly, 不明熱 – FUO fever of unknown origin, has balloon catheter in her bladder, thickened bladder wall, cystitis exists, needs labs for further Dx, looking and lungs – incr. pleural effusion, DIFFUSE GROUND GLASS appearance = when we see this, it could be:

  1. Infection, pneumonia
  2. Lung edema from heart failure

Below: Interstitial cystitis

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5.  55 yo male, parotid gland tumor, could see the scar, follow-up study, if the mass is larger it is RECURRENT – but it was not, pt had skin metastasis, bone metastasis in lumbar spine, thyroid mass – probably benign as not change from previous study

Below are examples of lumbar spine metastasis:


 

6. 41 yo female, possible serous cystic tumor – ovarian serous cystadenoma? Left ovary mass

Serous Cystic Neoplasm (SCN)

T1 – low intensity

T2 – high intensity

Ovary

Increased T1 – hemorrhage

Decreased T2- endometriosis

SOLID MASS is enhanced, diffusion – low
CYST is not enhanced (just the wall is enhanced) b/c fluid can’t be enhanced
LOBULATED, MURAL NODULE – not enhanced


 

7. 62 yo male, prostate cancer, tough to visualize on CT, so look at metastasis, check bone

Below: Radiography of bone metastasis in a prostate cancer patient

 

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