Achalasia

Male , 73 yo , clinical information  dysphagia , ask from Upper GI study


Upper GI  Study:
contrast barium oral   filling entry esophageal, gastric until duodenum. no additional or filling defect .
There is presence dilatation  esophagus, with a picture  of shoulder sign and rat tail appearance in the distal part .

Conclusion :
supporting achalasia

Bronchiectasis

Bronchiectasis 

Bronchiectasis is defined as localized, irreversible dilatation of part of the bronchial tree. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders, but it usually results from necrotizing bacterial infections, such as infections caused by the Staphylococcus orKlebsiella species or Bordetella pertussis.

Hemoptysis is common and may occur in as many as 50% of patients. Episodic hemoptysis with little to no sputum production (dry bronchiectasis) is usually a sequela of tuberculosis. However, massive hemoptysis may occur; bleeding usually originates in dilated bronchial arteries, which contain blood at systemic (rather than pulmonary) pressures.

Diagnosis of bronchiectasis is based on a clinical history of daily viscid sputum production and characteristic computed tomography (CT) scan findings

Sub types

According to macroscopic morphology, three types have been described, which also represent a spectrum of severity .

• cylindrical : bronchi have a uniform calibre, do not taper and have parallel walls (tram track sign and signet ring sign)
• varicose : relatively uncommon, with a beaded appearances where dilated bronchi have interspersed sites of relative narrowing
• cystic : severe form with cyst-like bronchi that extend to the pleural surface; air-fluid levels are commonly present

Additionally bronchiectasis can result from the traction of fibrotic lung surrounding an airway. This is known as traction bronchiectasis

Type of Bronchiectasis 

Gross patology 

Signs described on CT include:

• tram-track sign
• signet ring sign
• string of pearls sign 
• cluster of grapes sign 

Cystic and Cylindrical bronchiectasis 

cystic bronchiectasis 

 cylindrical bronchiectasis

Courtesy of radiopaedia.org 

Hepatoblastoma

9 month baby girl with intraabdominal mass. 

From MSCT scan reformated 3 dimensions, we get a hepatomegaly with large masses inside .

support  to  hepatoblastoma

What is hepatoblastoma?
Hepatoblastoma is a very rare cancerous tumor that originates in the liver. The liver is one of the largest organs in the body. The primary functions of the liver include filtering and storing blood. The liver consists of right and left lobes. Most hepatoblastoma tumors originate in the right lobe.

This disease primarily affects children from infancy to about 3 years of age. Hepatoblastoma cancer cells can spread (metastasize) to other areas of the body. The most common sites of metastasis are the lungs, into the abdomen and abdominal structures, and rarely to bone, the central nervous system, and the bone marrow.

Anatomy of the liver:

The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm and on top of the stomach, right kidney, and intestines. Shaped like a cone, the liver is a dark reddish-brown organ that weighs about three pounds.

Illustration of the anatomy of the biliary system
Click Image to Enlarge

The liver consists of two main lobes, both of which are made up of thousands of lobules. These lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct. The hepatic duct transports the bile produced by the liver cells to the gallbladder and duodenum (the first part of the small intestine). The liver regulates most chemical levels in the blood and excretes a product called "bile," which helps carry away waste products from the liver.

What causes hepatoblastoma?

Although the exact cause of liver cancer is unknown, there are a number of genetic conditions that are associated with an increased risk for developing hepatoblastoma, including Beckwith-Wiedemann syndrome, hemihypertrophy, and familial adenomatous polyposis. Other genetic conditions associated with liver cancer include several inborn errors of metabolism such as tyrosinemia, glycogen storage disease type I, galactosemia, and alpha₁-antitrypsin deficiency.

Children who are exposed to hepatitis B infection at an early age, or those who have biliary atresia, are also at increased risk for developing hepatocellular carcinoma. Some hepatoblastomas have genetic alterations in tumor suppressor genes, which would explain the uncontrolled cell growth.

What are the symptoms of hepatoblastoma?

The following are the most common symptoms of hepatoblastoma. However, each child may experience symptoms differently. Symptoms may vary depending on the size of the tumor and the presence and location of metastases. Symptoms may include:

• a large abdominal mass, or swollen abdomen
• weight loss, decreased appetite
• abdominal pain
• vomiting
• jaundice (yellowing of the eyes and skin)
• fever
• itching skin
• anemia (pale skin and lips from decreased number of red blood cells)
• back pain from compression of the tumor

The symptoms of hepatoblastoma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is hepatoblastoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for hepatoblastoma may include:

• biopsy - a sample of tissue is removed from the tumor and examined under a microscope.
• complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood.
• additional blood tests - may include blood chemistries, evaluation of liver and kidney functions, and genetic studies.
• multiple imaging studies, including:
• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
• bone scans - pictures or x-rays taken of the bone after a dye has been injected that is absorbed by bone tissue. These are used to detect tumors and bone abnormalities.
• alpha-fetoprotein (AFP) test - alpha-fetoprotein (AFP) levels in the blood can be used to diagnose and follow response to treatment.

What are the different stages of childhood liver cancer?

Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging symptoms that are used for hepatoblastoma. Always consult your child's physician for information on staging. One method of staging hepatoblastoma is the following:

• stage I - usually a tumor that can be completely removed with surgery.
• stage II - usually a tumor that can mostly be removed by surgery but very small amounts of the cancer are left in the liver.
• stage III - usually a tumor that cannot be completely removed and the cancer cells are found in the lymph nodes.
• stage IV - cancer that has spread (metastasized) to other parts of the body.
• recurrent - the disease has returned after it has been treated. It may come back in the liver or in another part of the body.

Treatment for hepatoblastoma:

Specific treatment for hepatoblastoma will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the disease
• your child's tolerance for specific medications, procedures, and therapies
• expectations for the course of the disease
• your opinion or preference

Treatment for hepatoblastoma is generally aimed at resecting (removing) as much of the tumor as possible while maintaining adequate liver function. Liver tissue can regenerate when removed.

Other forms of treatment may include (alone or in combination):

• surgery (to remove tumor and part or all of the liver)
• chemotherapy
• liver transplant
• supportive care (for the side effects of treatment)
• antibiotics (to prevent and treat infections)
• continuous follow-up care (to determine response to treatment, detect recurrent disease and manage late effects of treatment)

Long-term outlook for a child with hepatoblastoma:

Prognosis greatly depends on:

• the extent of the disease.
• the size and location of the tumor.
• presence or absence of metastasis.
• the tumor's response to therapy.
• the age and overall health of your child.
• your child's tolerance of specific medications, procedures, or therapies.
• new developments in treatment.

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with hepatoblastoma. New methods are continually being discovered to improve treatment and to decrease side effects.

Intrapertonel Mesenteric Teratoma

Male , 40 yo ,with abdominal discomfort , no nausea, no vomiting , no defecation disorders.

Ultrasound  obtained a large cystic lesion  of unknown origin, and patients are advised to ct scan examination.

From MSCT scan Abdomen with contras administration : 

There is intraperitonel  lesions, well defined , regular  border , mixed density, consisting of  liquid, semi-solid, solid and calcification, diameter 16 cm. This lesion  attached to   some transverse colon, doudenum seem pushed to posteriorly . No bowel  obstruction . Another abdominal  organs within normal limits.

                                                   Conclusion:
Intraperitoneal mesenteric teratoma

Infiltrating Ductal Ca

Female , 63 year old , lump in the left breast















From ultrasound : 
There is hypoechoic lesion , thickening wall , with sludge and moving echo inside at the 11 o'clock left breast 
with doppler study there is increase of vascularization in the wall .

Conclusion : 
Supporting  Abcess formation  DD/ complex cyst ,  mass 

Note : 
From Ultrasound the mass very similar to  abcess formation due to thickening wall with increasing vascularization in perifer and moving echo inside  , but these patients are at risk of cancer age.
Durante operation seems chocolate cyst  looks very fragile, suspicious malignancy .
From biopsi from biopsies obtained   infiltrating ductal carsinoma 
MRM was performed on patients continued adjuvant chemotherapy

Meig's Syndrom

Female with ascites 

From MSCT scan Abdomen : 
There is solid cystic mass at the right adnexa with ascites and bilateral pleural effusion

Conclusion : 
Meig's Syndrom  

Lung Abses

Young male with clinical information : 
Suspicious lung abses 

From MSCT scan thorax  mediastinal window  : 
There are multiple cavitas , thickening wall with fluid level inside at the upper lobe right lung and anterior segment upper lobe left lung , trachea and bilateral main bronchus still patent 

Conclusion : 
Multiple lung abses 

Ultrasound of Appendicitis

Acute appendicitis in a 37-year-old man with right-lowerquadrant pain. 
(a) Long axis and (b) cross sectional US images show inflamed appendix as a blind-ended, noncompressible tubular structure filled with fluid and surrounded by a hypoechoic mass representing phlegmon.

Spondylitis TB with Paravetebral soft tissue abses

Male 26 year old , with clinical information back pain , paraparese inferior and abdominal wall tumor 

From MSCT Scan thoraxoabdominal  : 
There is destruction anterior part of the superior end plate V. Lumbal 1 and inferior end plate V.thoracal 12 ,with acute angulation that retropultion to the central canal and make  kipotic angle , with paravetebral , left psoas until subcutan mass with rim contras enchancement   

Conclusion : 
Spondylitis TB at level  V Th 12-V L 1 with paravetebral , psoas and subcutan abses 

Coxigeal Teratoma in child 5 month

Girl 5 month with lumb at coxae 
From MSCT scan pelvis : 
There is huge mass contains by fat tissue, muscle and bone density at the coxigeal --> 
Conclusion : Coxigeal teratoma 

Aorta Abdominal Aneurism

Female 60 year old with chest pain 
From MSCT Scan thorax : 
There is Aneurism of the descending aorta with calsification in the aortic wall