Multitechnique Imaging Findings of Prolene Plug Hernia Repair
|
|
- Kerry Walton
- 6 years ago
- Views:
Transcription
1 Genitourinary Imaging Pictorial Essay Cronin et al. Imaging of Prolene Plug Hernia Repair Genitourinary Imaging Pictorial Essay Carmel G. Cronin 1 Mukesh G. Harisinghani Onofrio Catalano Michael. lake Cronin CG, Harisinghani MG, Catalano O, lake M Keywords: inguinal hernia, polypropylene, Prolene plug repair system, Prolene plugs DOI: /JR Received December 17, 2009; accepted after revision February 11, ll authors: Department of bdominal Imaging and Interventional Radiology, Massachusetts General Hospital and Harvard Medical School, White 270, 55 Fruit St., oston, M ddress correspondence to C. G. Cronin. JR 2010; 195: X/10/ merican Roentgen Ray Society Multitechnique Imaging Findings of Prolene Plug Hernia Repair OJECTIVE. The objective of this article is to illustrate the spectrum of imaging findings of polypropylene (Prolene) plug hernia repair. CONCLUSION. Knowledge of patient history and awareness of postsurgical imaging appearances are of importance because Prolene plugs are often incidentally encountered and if misdiagnosed may lead to erroneous patient disease staging and management. I nguinal hernias are very common. The lifetime risk of developing an inguinal hernia is 27% for men and 3% for women [1]. Patient symptoms, such as groin fullness and pain, and complications including bowel obstruction and incarceration are not rare. Their significant morbidity and possible mortality have resulted in patients frequently undergoing repair, making herniorrhaphy one of the most common surgical operations. Mesh systems used at inguinal hernia repair as well as for other abdominal wall hernias are now well recognized as linear 1-mmthick high-density foreign bodies at the site of repair [2]. newer mechanism of hernia repair includes filling the hernial orifice with a nonabsorbable material such as a polypropylene (Prolene, ard) plug to reinforce the defect [3]. The Prolene mesh plug is placed into inguinal hernia defects, and flat mesh is used to cover the defect [4] (Fig. 1). The plug is readily and often seen on cross-sectional imaging; however, its typical appearance has been described infrequently [2, 4]. Identification of the normal postsurgical appearance at ultrasound, CT, PET/CT, and MRI is essential to avoid misdiagnosis. Knowledge of patient history and identification of an inguinal surgical scar may be helpful in the diagnosis. wareness of the postsurgical imaging appearance is of importance because Prolene plugs are often incidentally encountered. In addition, pertinent surgical history is not usually highlighted and is sometimes unavailable and, if misinterpreted, may lead to erroneous patient disease staging, intervention, and management. Imaging Findings Prolene plugs are not routinely appreciated at radiography. t ultrasound, Prolene plugs appear as hyperechoic lines with distal shadowing [2] (Fig. 2). On cross-sectional imaging (ultrasound, CT, and MRI), Prolene plugs appear as focal masses that may be unilateral or bilateral (Fig. 3). They may be small or large depending on the size requirement at surgery and have a mean long-axis diameter up to 2.6 cm [3] (Figs. 4 and 5). t CT, Prolene plugs have a slightly nodular or smooth outline (Figs. 4 6). The density is similar to (Fig. 4) or slightly lower than (Fig. 5) the adjacent muscle. Occasionally two distinct plugs may be seen if multiple or recurrent hernia defects are being repaired (Fig. 5). They are usually located anterior to the iliac vessels at the inguinal canal. Prolene plugs have been reported to appear as a ringlike density with central fat attenuation (Figs. 6 and 7] and a rim of higher attenuation in up to 39% of repairs [4]. When this appearance is seen in a left-sided inguinal hernia repair that abuts the sigmoid colon, it can potentially mimic epiploic appendagitis [4]. When the plugs are of soft-tissue density, they may simulate an area of fat necrosis or an inflamed diverticulum (Fig. 8). ir may be seen within the plug, which may represent postoperative change if within the postoperative period in the presence of local inflammation or infection in the correct clinical setting (Fig. 9). The location of Prolene plugs in the inguinal regions and their soft-tissue density may lead to their being misdiagnosed by the unwary as lymphadenopathy [4] (Figs. 10 and 11). This JR:195, September
2 Cronin et al. imaging similarity may result in unnecessary interventions, including radiologic or surgical biopsy to provide a tissue diagnosis, or may result in erroneous diagnoses of lymphomatous disease or false upstaging of disease. The appearance of Prolene plugs has not been described at PET/CT. The CT features are similar to those already described at CT. The PET features vary from showing no significant 18 F-FDG uptake (Fig. 12) to increased FDG uptake (Fig. 13). Without the correct clinical history of a Prolene plug hernia repair, moderate to intensely avid uptake may be misdiagnosed as lymphomatous disease and patient disease erroneously upstaged and treated (Fig. 13). The appearance of Prolene plugs has not yet been described at MRI. In our experience, Prolene plugs appear to have a low signal on T1-weighted and low to intermediate or slightly high signal on T2-weighted images relative to the adjacent musculature (Figs. 14 and 15). The periphery or majority of the Prolene plug may enhance (Figs. 14 and 15). The presence of a herniorrhaphy scar and susceptibility artifact and surgical clips indicate surgery as the cause (Fig. 15). gain, Fig. 1 Photograph shows polypropylene mesh plug and sheet. Mesh plug is placed into inguinal hernia defects, and flat mesh is used to cover defect. this finding may pose similar clinical dilemmas if not correctly identified. Complications The recurrence rate after primary inguinal hernia repair is 4% and for repair of recurrent inguinal hernia is 11% [5]. Other complications associated with Prolene plugs include postoperative seromas (Figs. 9, 11, and 16), mesh infection [6] (Fig. 7), plug migration (Fig. 16), bowel injury with small-bowel obstruction [7], recurrent herniation, and testicular atrophy [8]. Conclusion Knowledge of patient history and awareness of the expected postsurgical imaging appearance is of importance because Prolene plugs are often incidentally encountered and if unrecognized by radiologists may lead to erroneous patient disease staging and management. References 1. Jenkins JT, O Dwyer PJ. Inguinal hernias. MJ 2008; 336: Parra J, Revuelta S, Gallego T, et al. Prosthetic mesh used for inguinal and ventral hernia repair: Fig year-old woman with atypical lymphocytes raising possibility of lymphoma. This patient was found to have soft-tissue-density mass in left inguinal region. History of distant hernia repair was unknown, and mass was biopsied. Lesion later was diagnosed correctly as polypropylene (Prolene, ard) plug. Ultrasound image obtained at time of needle biopsy shows characteristic appearance of Prolene plugs at ultrasound that of hyperechoic lines with distal shadowing (arrow). normal appearance and complications in ultrasound and CT. r J Radiol 2004; 77: llan SM, Heddle RM. Prolene plug repair for femoral hernia. nn R Coll Surg Engl 1989; 71: Yeung VH, Pearl JM, Coakley FV, Joe N, Westphalen C, Yeh M. Computed tomographic appearance of Prolene Hernia System and polypropylene mesh plug inguinal hernia repair. J Comput ssist Tomogr 2008; 32: Staarink M, van Veen RN, Hop WC, Weidema WF. 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 2008; 22: Hasegawa S, Yoshikawa T, Yamamoto Y, et al. Long-term outcome after hernia repair with the Prolene hernia system. Surg Today 2006; 36: Lo DJ, ilimoria KY, Pugh CM. owel complications after Prolene hernia system (PHS) repair: a case report and review of the literature. Hernia 2008; 12: Faraj D, Ruurda JP, Olsman JG, van Geffen HJ. Five-year results of inguinal hernia treatment with the Prolene Hernia System in a regional training hospital. Hernia 2010; 14: JR:195, September 2010
3 Imaging of Prolene Plug Hernia Repair Fig. 3 Polypropylene (Prolene, ard) plugs., 45-year-old man with right-sided unilateral Prolene plug (arrow)., 50-year-old man with left-sided unilateral Prolene plug (arrow). C, 40-year-old man with bilateral Prolene plugs (arrows). Fig year-old man who underwent CT for upper abdominal pain. Image shows incidental small cm polypropylene (Prolene, ard) plugs bilaterally (arrows). Fig year-old man after hernia repair. CT image shows bilateral polypropylene (Prolene, ard) plugs (arrows) to reinforce large hernial defects. C Fig year-old man with history of lung cancer who underwent staging CT that shows polypropylene (Prolene, ard) plug with fat peripherally (arrow). Fig year-old man with bilateral polypropylene (Prolene, ard) plugs (black arrows). Postoperative seroma (curved arrow) around and anterior to right Prolene plug gradually resolved on follow-up imaging. Eccentric fat is seen within left Prolene plug (straight white arrow). JR:195, September
4 Cronin et al. Fig year-old man who underwent CT for evaluation of lymphoma. Location of polypropylene (Prolene, ard) plugs in inguinal regions and their soft-tissue or lower density may be misdiagnosed by unwary as lymphadenopathy. This patient has not undergone hernia repair, and lymphadenopathy is identified in inguinal regions (white and black arrows). Lymphadenopathy (white arrows) may have similar appearance to Prolene plugs in their location anteromedial to iliac vessels. Further lymph nodes also are seen alerting to correct diagnosis of lymphoma (black arrows). Fig year-old man who underwent CT for assessment of abdominal pain. and, Patient was found to have diverticulosis and low-density nodular soft-tissue lesion inseparable from sigmoid colon, indistinguishable from inflamed diverticulum with surrounding fat stranding or fat necrosis (arrow). However, correct diagnosis of polypropylene (Prolene, ard) plug was made on further review of history. Fig year-old man after repair of incarcerated right inguinal hernia., ir (black arrow) is seen within polypropylene (Prolene, ard) plug (straight white arrow), which in presence of local inflammation and subcutaneous air and seroma (curved arrow) may represent postoperative findings or infection in correct clinical setting., In this case, the findings represented postsurgical changes and resolved on follow-up imaging. rrow = prolene plug. Fig year-old man under evaluation for fevers and weight loss. Within abdomen, solitary soft-tissue mass was seen anterior to left iliac vessels. Its appearance is similar to that of polypropylene (Prolene, ard) plug; however, patient did not have relevant history of hernia repair and this was correctly diagnosed as lymph node (arrow). 704 JR:195, September 2010
5 Imaging of Prolene Plug Hernia Repair Fig year-old man with lung cancer who underwent staging PET/CT examination. PET/CT image shows soft-tissue mass (arrow) anterior to right iliac vessels without 18 F-FDG uptake. Clinical history revealed that this mass was polypropylene (Prolene, ard) plug. Fig year-old man who underwent MR enterography for evaluation of suspected flare of known Crohn s disease. and, Polypropylene (Prolene, ard) plugs (arrows) are seen to have low signal on 3D T1-weighted fat-saturated volumetric interpolated breath-hold examination image () and slightly high signal on T2- weighted fat-saturated image (). C and D, Periphery of Prolene plug may enhance (white arrows, C). Presence of herniorrhaphy scar and susceptibility artifact (black arrows, C) and surgical clips (arrows, D) indicate surgery as cause. Fig year-old man who underwent staging PET/CT for lung cancer. PET/ CT image shows intense uptake in left inguinal soft-tissue mass (arrow). Without correct clinical history of polypropylene (Prolene, ard) plug, this mass may have been misdiagnosed as metastatic disease and patient erroneously upstaged. C D JR:195, September
6 Cronin et al. Fig year-old woman who underwent pelvic MRI for evaluation of uterine lesion. She had recent right inguinal hernia repair. C, MR images show T1-weighted low signal (), T2-weighted intermediate to low (), and signal enhancing (C) polypropylene (Prolene, ard) plug in right inguinal region (white arrow). Postoperative peripherally enhancing seroma is also visualized (black arrow). Fig year-old man who underwent prior polypropylene (Prolene, ard) plug hernia repair. t follow-up imaging, Prolene plug had migrated into and distally within right inguinal canal (arrow). C 706 JR:195, September 2010
elical CT plays an important role
bdominal Imaging Yu et al. Helical CT of cute RLQ Pain Pictorial Essay Jinxing Yu 1 nn S. Fulcher Mary nn Turner Robert. Halvorsen Yu J, Fulcher S, Turner M, Halvorsen R Helical CT Evaluation of cute Right
More informationPitfalls in the CT diagnosis of appendicitis
The British Journal of Radiology, 77 (2004), 792 799 DOI: 10.1259/bjr/95663370 E 2004 The British Institute of Radiology Pictorial review Pitfalls in the CT diagnosis of appendicitis 1 C D LEVINE, 2 O
More informationPitfalls in CT diagnosis of appendicitis: Pictorial essay
bs_bs_banner Journal of Medical Imaging and Radiation Oncology 57 (2013) 329 336 RADIOLOGY PICTORIAL ESSAY Pitfalls in CT diagnosis of appendicitis: Pictorial essay Ashkan Shademan and Rafel FR Tappouni
More informationobjectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University
objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand
More informationSTAGING AND FOLLOW-UP STRATEGIES
ATHENS 4-6 October 2018 European Society of Urogenital Radiology STAGING AND FOLLOW-UP STRATEGIES Ahmet Tuncay Turgut, MD Professor of Radiology Hacettepe University, Faculty of Medicine Ankara 2nd ESUR
More informationImaging Features of Encapsulating Peritoneal Sclerosis in Continuous Ambulatory Peritoneal Dialysis Patients
Genitourinary Imaging Pictorial Essay Ti et al. Encapsulating Peritoneal Sclerosis in CPD Patients Genitourinary Imaging Pictorial Essay Joanna P. Ti 1 li l-radi 2 Peter J. Conlon 2 Michael J. Lee 1 Martina
More informationCharacteristic Locations of Inguinal Region and Anterior Abdominal Wall Hernias: Sonographic Appearances and Identification of Clinical Pitfalls
Sonography of Inguinal Region and bdominal Wall Hernias Gastrointestinal Imaging Pictorial Essay David. Jamadar 1 Jon. Jacobson 1 Yoav Morag 1 Gandikota Girish 1 Qian Dong 1 Mahmoud l-hawary 1 Michael
More informationUpdate on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD
Update on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD Section of Pediatric Radiology C.S. Mott Children s Hospital University of Michigan ethans@med.umich.edu Disclosures No relevant
More informationKeyhole Laparoscopic Hernia Repairs: What s the Benefit for Your Patients?
InTouch ARTICLE Keyhole Laparoscopic Hernia Repairs: What s the Benefit for Your Patients? Author: Mr Steve Warren Date: Mary 2015 17 19 View Road, Highgate, London, N6 4DJ Tel. 020 8341 4182 Email. enquiries@highgatehospital.co.uk
More informationConsecutive, Bilateral Obturator Hernia in a Single Case HO Aydın¹, EHA Soy¹, T Avcı¹, T Tezcaner¹, S Yıldırım ABSTRACT
Consecutive, Bilateral Obturator Hernia in a Single Case HO Aydın¹, EHA Soy¹, T Avcı¹, T Tezcaner¹, S Yıldırım ABSTRACT Obturator hernia (OH) is a rare pelvic hernia. It is diffucult to make an early diagnosis
More informationGenitourinary Imaging Pictorial Essay
Genitourinary Imaging Pictorial Essay Patil et al. PET/CT of Transitional Cell Carcinoma Genitourinary Imaging Pictorial Essay Downloaded from www.ajronline.org by 37.44.193.45 on 01/04/18 from IP address
More informationUNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN
UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN Radiology Enterprises radiologyenterprises@gmail.com www.radiologyenterprises.com STOMACH AND SMALL BOWEL STOMACH AND SMALL BOWEL Swallowed air is a
More informationPET-CT findings in surgically transposed ovaries
The British Journal of Radiology, 79 (2006), 110 115 1,2,3 R ZISSIN, MD, 1 U METSER, MD, 1 H LERMAN, MD, 1 G LIEVSHITZ, MD, 4 T SAFRA, MD and 1,3 E EVEN-SAPIR, MD, PhD Department of 1 Nuclear Medicine
More informationCT Findings of Rupture, Impending Rupture, and Contained Rupture of Abdominal Aortic Aneurysms
Schwartz et al. CT of bdominal ortic neurysms bdominal Imaging Pictorial Essay W57.FM 12/7/06 Downloaded from www.ajronline.org by 46.3.194.182 on 01/02/18 from IP address 46.3.194.182. Copyright RRS.
More informationBowel Obstructions in Older Children
Residents Section Pattern of the Month Hryhorczuk et al. owel Obstructions in Older Children Residents Section Pattern of the Month Residents inradiology nastasia Hryhorczuk 1 Edward Y. Lee 1,2 Ronald
More informationLos Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010
Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010 Self Assessment Module on Nuclear Medicine and PET/CT Case Review FDG PET/CT IN LYMPHOMA AND MELANOMA Submitted
More informationAmyand's Hernia: A Case Report
Haris N. Shekhani 1*, Saurabh Rohatgi 1, Tarek Hanna 1, Jamlik-Omari Johnson 1 1. Division of Emergency Radiology, Emory University, Atlanta, GA 30308, USA * Correspondence: Haris Naseem Shekhani, Emory
More informationMimics of Appendicitis: Alternative Nonsurgical Diagnoses with Sonography and CT
van reda Vriesman and Puylaert Mimics of ppendicitis bdominal Imaging Pictorial Essay Downloaded from www.ajronline.org by 46.3.193.220 on 12/27/17 from IP address 46.3.193.220. Copyright RRS. For personal
More informationHernia. emoryhealthcare.org
Hernia Have you noticed a bulge or pain in your abdominal wall or groin? If so you may have a hernia. You may be in the process of confirming this diagnosis with your Primary Care Physician or already
More informationOpen Tension-Free Mesh Repair for Adult Inguinal Hernia: Eight Years of Experience in a Community Hospital
Original Articles Asian Journal of Surgery Excerpta Medica Asia Ltd Open Tension-Free Mesh Repair for Adult Inguinal Hernia: Eight Years of Experience in a Community Hospital Shunji Yamamoto, Toshiki Maeda,
More informationPET/CT Frequently Asked Questions
PET/CT Frequently Asked Questions General Q: Is FDG PET specific for cancer? A: No, it is a marker of metabolism. In general, any disease that causes increased metabolism can result in increased FDG uptake
More informationThe nontraumatic acute abdomen
CT features of acute appendicitis: pictorial review Marco ntonio Cura, MD The nontraumatic acute abdomen is one of the most common presentations to the emergency room, with appendicitis being one of the
More informationRadiology-Pathology Conference
July 31, 2009 Radiology-Pathology Conference Daniel T Ginat, M.D., M.S. Sharlin Johnykutty,, M.D. Presentation material is for education purposes only. All rights reserved. 2009 URMC Radiology Page 1 of
More informationMDCT of Abdominal Wall Hernias: Is There a Role for Valsalva s Maneuver?
bdominal Imaging Jaffe et al. s Maneuver in MDCT of Hernia Tracy. Jaffe 1 Martin J. O Connell John P. Harris Erik K. Paulson David M. DeLong Received May 10, 2004; accepted after revision July 23, 2004.
More informationImaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationClinical summary. Male 30 year-old with past history of non-seminomous germ cell tumour. Presents with retroperitoneal lymphadenopathy on CT.
Clinical summary Male 30 year-old with past history of non-seminomous germ cell tumour. Presents with retroperitoneal lymphadenopathy on CT. For restaging PET/CT. PET/CT findings No significant FDG uptake
More information34 yo M presented in ER of KCH at 7/06/10 Painful lump lt groin + vomiting Pain started 2 hrs before presentation. PMH known left inguinal hernia PSH
Case Presentation 34 yo M presented in ER of KCH at 7/06/10 Painful lump lt groin + vomiting Pain started 2 hrs before presentation. PMH known left inguinal hernia PSH negative NKDA Case Presentation VS:
More informationInguinal and Femoral Hernias. August 10, 2016 Basic Science Lecture Department of Surgery University of Tennessee Health Science Center
Inguinal and Femoral Hernias August 10, 2016 Basic Science Lecture Department of Surgery University of Tennessee Health Science Center Background Approximately 20 million groin hernias are repaired each
More informationTechnique Guide. Bard MK Hernia Repair. Featuring Modified Onflex Mesh SOFT TISSUE REPAIR. Anterior Approach to a Preperitoneal Inguinal Hernia Repair
Bard MK Hernia Repair Featuring Modified Onflex Mesh Technique Guide Anterior Approach to a Preperitoneal Inguinal Hernia Repair SOFT TISSUE REPAIR Right Procedure. Right Product. Right Outcome. The opinions
More informationMetastatic colon cancer derived from a diverticulum incidentally found at herniorrhaphy: a case report
Kimura et al. Surgical Case Reports (2018) 4:47 https://doi.org/10.1186/s40792-018-0455-y CASE REPORT Open Access Metastatic colon cancer derived from a diverticulum incidentally found at herniorrhaphy:
More informationII.- PLUG. NAME of the products. Premilene Mesh Plug MANUFACTURER. B Braun DESCRIPTION. Polypropylene mesh for plug technique
II.- PLUG Premilene Mesh Plug B Braun Polypropylene mesh for plug technique Premilene Mesh Plug is a monofilament polypropylene mesh plug designed for the repair of recurrent hernias and can also be used
More informationRadiology Pathology Conference
Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights
More informationCT of the Abdominal Wall
1207 CT of the Abdominal Wall PhilipGoodma& 2 and Bharat Raval1 CT is an excellent method for evaluating the abdominal wall. Various abnormalities including hernia, hematoma, abscess, tumor, and neuromuscular
More informationHybrid Laparoscopic and Anterior Approach for Postsurgical Inguinal Hernia After Iliofemoral Arterial Bypass
Int Surg 2015;100:431 435 DOI: 10.9738/INTSURG-D-14-00226.1 Case Report Hybrid Laparoscopic and Anterior Approach for Postsurgical Inguinal Hernia After Iliofemoral Arterial Bypass Tomoya Tsukada 1,2,
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal injuries clinical presentation of, 23 24 Abdominal trauma evaluation for pediatric surgeon, 59 74 background of, 60 colon and
More informationMDCT Features of Angiotensin- Converting Enzyme Inhibitor Induced Visceral Angioedema
Gastrointestinal Imaging Pictorial Essay Vallurupalli and Coakley MDCT of Visceral ngioedema Gastrointestinal Imaging Pictorial Essay Kalyani Vallurupalli 1 Kevin J. Coakley 2 Vallurupalli K, Coakley KJ
More informationAlison Douglass Gillian Lieberman, MD. November. Colon Cancer. Alison Douglass, Harvard Medical School Year III Gillian Lieberman, MD
November Colon Cancer Alison Douglass, Harvard Medical School Year III Our Patient Mr. K. is a 67 year old man with no prior medical problems other than hemorrhoids which have caused occasional rectal
More information2015 General Surgery Survival Guide
2015 General Surgery Survival Guide Chapter 10: Hernia Repair Know What to Look for When Coding Hernia Repair Reporting hernia repair can be tricky. But if you know what to look for then half the work
More informationEncysted Spermatic Cord Hydroceles: A Report of Three Cases in Adults and a Review of the Literature
Acta Radiologica ISSN: 0284-1851 (Print) 1600-0455 (Online) Journal homepage: https://www.tandfonline.com/loi/iard20 Encysted Spermatic Cord Hydroceles: A Report of Three Cases in Adults and a Review of
More informationTHE INS AND OUTS OF HERNIAS WHERE TO START? WHAT IS A HERNIA? CLINICAL INDICATIONS THE INGUINAL CANAL THE CLINICAL QUESTION 18/09/2018
THE INS AND OUTS OF HERNIAS Cassandra Harrison BA/BSc, MMRU, AMS WHERE TO START? The Clinical Question Essential anatomy Inguinal hernia Scanning technique Variations WHAT IS A HERNIA? CLINICAL INDICATIONS
More informationPictorial Essay. Imaging of Urinary Bladder Hernias. Genitourinary Imaging Bacigalupo et al. Urinary Bladder Hernias
Genitourinary Imaging acigalupo et al. Urinary ladder Hernias Downloaded from www.ajronline.org by 148.251.232.83 on 05/14/18 from IP address 148.251.232.83. Copyright RRS. For personal use only; all rights
More informationFDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave
FDG PET/CT STAGING OF LUNG CANCER Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER FDG PET/CT is used in all patients with lung cancer who are considered for curative treatment to exclude occult disease.
More informationUtility of FDG PET/CT in the Assessment of Myeloid Sarcoma
Nuclear Medicine and Molecular Imaging Pictorial Essay Nuclear Medicine and Molecular Imaging Pictorial Essay Elaine Yuen Phin Lee 1 Marina-Portia nthony 1 nskar Yu-Hung Leung 2 Florence Loong 3 Pek-Lan
More informationHernias Umbilical Hernia When to See a Surgeon? What Are Symptoms of an Umbilical Hernia? How is Repair Performed?
Hernias Umbilical Hernia An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They
More informationRole of imaging in RCC. Ultrasonography. Solid lesion. Cystic RCC. Solid RCC 31/08/60. From Diagnosis to Treatment: the Radiologist Perspective
Role of imaging in RCC From Diagnosis to Treatment: the Radiologist Perspective Diagnosis Staging Follow up Imaging modalities Limitations and pitfalls Duangkamon Prapruttam, MD Department of Therapeutic
More information11/21/13 CEA: 1.7 WNL
Case Scenario 1 A 70 year-old white male presented to his primary care physician with a recent history of rectal bleeding. He was referred for imaging and a colonoscopy and was found to have adenocarcinoma.
More informationCT Findings in Posttransplantation Lymphoproliferative Disorder of Renal Transplants
Downloaded from www.ajronline.org by 37.44.207.92 on 12/15/17 from IP address 37.44.207.92. opyright RRS. For personal use only; all rights reserved Pictorial Essay T Findings in Posttransplantation Lymphoproliferative
More informationFusion Ultrasound: Characterization of Abdominal Masses with MR, CT, PET, and Contrast Ultrasound
Fusion Ultrasound: Characterization of Abdominal Masses with MR, CT, PET, and Contrast Ultrasound Mollie Rashid, MD Corinne Deurdulian, MD Hisham Tchelepi, MD Keck School of Medicine, University of Southern
More informationMultidisciplinary management of retroperitoneal sarcomas
Multidisciplinary management of retroperitoneal sarcomas Eric K. Nakakura, MD UCSF Department of Surgery UCSF Comprehensive Cancer Center San Francisco, CA 7 th Annual Clinical Cancer Update North Lake
More informationContrast-enhanced small bowel ultrasound in the assessment of the small bowel in patients with Crohn s Disease
Contrast-enhanced small bowel ultrasound in the assessment of the small bowel in patients with Crohn s Disease C.F. Healy 1, D. Ferguson 1, S. Jepson 1, B. Salh 2, F. Donnellan 2, N. Chatur 2, A. C. Harris
More informationRadiologic Pathologic Correlation of Intraosseous Lipomas. Tim Propeck 1, Mary Anne Bullard 1, John Lin 1, Kei Doi 2, William Martel 1
Downloaded from www.ajronline.org by 148.251.232.83 on 04/10/18 from IP address 148.251.232.83. opyright RRS. For personal use only; all rights reserved Radiologic Pathologic orrelation of Intraosseous
More informationIndex. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic
More informationperformed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.
Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician
More informationFive Views of Transitional Cell Carcinoma: One Man s Journey
September 2006 Five Views of Transitional Cell Carcinoma: One Man s Journey Amsalu Dabela, Harvard Medical School III Outline Overview: Renal Anatomy Our Patient s Story Diagnostic Imaging Studies Appearance
More information4/30/2010. Options for abdominal wall reconstruction. Scott L. Hansen, MD
Components Separation Scott L. Hansen, MD University of California, San Francisco Chief, Plastic and Reconstructive Surgery San Francisco General Hospital Overview Options for abdominal wall reconstruction
More informationIncarcerated obturator hernia: pitfalls in the application of ultrasound
Crit Ultrasound J (2009) 1:59 63 DOI 10.1007/s13089-009-0017-4 ORIGINAL ARTICLE Incarcerated : pitfalls in the application of ultrasound Masaaki Ogata Published online: 18 November 2009 Springer-Verlag
More informationAdvances in Emergency Imaging
Hampton Symposium,, October 16 th, 2010 Advances in Emergency Imaging Robert A. Novelline, MD Professor of Radiology, Harvard Medical School Director of Emergency Radiology, Massachusetts General Hospital
More information42 yr old male with h/o Graves disease and prior I 131 treatment presents with hyperthyroidism and undetectable TSH. 2 hr uptake 20%, 24 hr uptake 50%
Pinhole images of the neck are acquired in multiple projections, 24hrs after the oral administration of approximately 200 µci of I123. Usually, 24hr uptake value if also calculated (normal 24 hr uptake
More informationPosterior Rectus Sheath Hernia Causing Intermittent Small Bowel Obstruction
Posterior Rectus Sheath Hernia Causing Intermittent Small Bowel Obstruction Scott Lenobel 1*, Robert Lenobel 2, Joseph Yu 1 1. Department of Radiology, The Ohio State University Wexner Medical Center,
More informationLichtenstein mesh hernioplasty: the extreme refinement in hernia surgery
International Surgery Journal Srinivas NM et al. Int Surg J. 2018 Jan;5(1):87-91 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20175523
More informationUse of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer
November 2010 Use of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer Laura Myers, Harvard Medical School, Year III Clinical Presentation 79yo woman with cough productive of green
More informationCT Appearance of Acute Appendagitis
CT Appearance of Acute Appendagitis Poster No.: C-0673 Congress: ECR 2013 Type: Scientific Exhibit Authors: J. SAAD, F. Marrakchi, Y. M. Abdou ; Monastir, TN/TN, 1 2 2 3 1 3 Monastir/TN, Nejran, Nejran/SA
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 4 2013 Article 6 Case report: Intussusception of the colon through a colostomy: A rare presentation of colonic intussusception. Dr. Nora Trabulsi Dr.
More informationRadiology. Undergraduate Radiology Sample Questions
Radiology Undergraduate Radiology Sample Questions April 2012 The following examples are offered of questions that might be used to assess undergraduate radiology. There are 3 different styles: An OSCE
More informationLugano classification: Role of PET-CT in lymphoma follow-up
CAR Educational Exhibit: ID 084 Lugano classification: Role of PET-CT in lymphoma follow-up Charles Nhan 4 Kevin Lian MD Charlotte J. Yong-Hing MD FRCPC Pete Tonseth 3 MD FRCPC Department of Diagnostic
More informationSubacute Granulomatous (de Quervain) Thyroiditis
ORIGINL RESERCH Subacute Granulomatous (de Quervain) Thyroiditis Grayscale and Color Doppler Sonographic Characteristics Mary C. Frates, MD, Ellen Marqusee, MD, Carol. enson, MD, Erik K. lexander, MD Received
More informationInguinal Hernia. Incarcerated hernia
Inguinal Hernia An inguinal hernia occurs when soft tissue usually part of the membrane lining the abdominal cavity (omentum) or part of the intestine protrudes through a weak point in the abdominal muscles.
More informationCOMPLICATIONS OF HERNIA REPAIR
COMPLICATIONS OF HERNIA REPAIR Stanley Rogers, MD Associate Clinical Professor of Surgery University of Califronia, San Francisco Paré was respected as a hernia specialist, and was known to have elevated
More informationCT PET SCANNING for GIT Malignancies A clinician s perspective
CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset
More informationPET CT for Staging Lung Cancer
PET CT for Staging Lung Cancer Rohit Kochhar Consultant Radiologist Disclosures Neither I nor my immediate family members have financial relationships with commercial organizations that may have a direct
More informationTraumatic and Non Traumatic Adrenal Emergencies
Traumatic and Non Traumatic Adrenal Emergencies Michael N. Patlas, MD, FRCPC (1), Christine O. Menias, MD (2), Douglas S. Katz, MD, FACR (3), Ania Z. Kielar, MD, FRCPC (4), Alla M. Rozenblit, MD (5), Jorge
More informationContents. Basic Ultrasound Principles and Terminology. Ultrasound Nodule Characteristics
Contents Basic Ultrasound Principles and Terminology Basic Ultrasound Principles... 1 Ultrasound System... 2 Linear Transducer for Superficial Images and Ultrasound-Guided FNA... 3 Scanning Planes... 4
More informationPrimary epiploic appendagitis versus omental infarction : The role of MDCT
Primary epiploic appendagitis versus omental infarction : The role of MDCT e-poster: EE-125 Congress: ESGAR 2010 Type: Educational Exhibit Topic: Diagnostic / Mesentery and Peritoneum Authors: P. Kraniotis,
More informationLymphoma Read with the experts
Lymphoma Read with the experts Marc Seltzer, MD Associate Professor of Radiology Geisel School of Medicine at Dartmouth Director, PET-CT Course American College of Radiology Learning Objectives Recognize
More informationJournal of Radiology Case Reports
Bilateral cryptorchidism mimicking external iliac lymphadenopathy in a patient with leg melanoma: role of FDG-PET and ultrasound in management Samuel Kyle 1,2*, W Phillip Law 1,2 1. Department of Radiology,
More informationAbdomen Sonography Examination Content Outline
Abdomen Sonography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 Anatomy, Perfusion, and Function Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy
More informationObjectives. Hesselbach s Triangle 11/30/2009. Myopectineal Orifice of Fruchaud. Hernias: Who, What, When, Where, Why?
Objectives Hernias: Who, What, When, Where, Why? J. Scott Roth, MD Chief, Gastrointestinal Surgery Director, Minimally Invasive Surgery University of Kentucky June 16, 2009 Identify patients at risk for
More informationOriginal Report. Stercoral Colitis Leading to Fatal Peritonitis: CT Findings. Gastrointestinal Imaging Heffernan et al. CT of Stercoral Colitis
Gastrointestinal Imaging Heffernan et al. CT of Stercoral Colitis Cathleen Heffernan 1 H. Leon Pachter 2 lec J. Megibow 1 Michael Macari 1 Hefferman C, Pachter HL, Megibow J, Macari M Received pril 21,
More informationGroin Pain Beyond the Hip: How Anatomy Predisposes to Injury as Visualized by Musculoskeletal Ultrasound and MRI
Musculoskeletal Imaging Pictorial Essay randon et al. Groin Pain eyond the Hip Musculoskeletal Imaging Pictorial Essay Downloaded from www.ajronline.org by 46.3.204.36 on 12/30/17 from IP address 46.3.204.36.
More informationIcd 10 right inguinal pain
Icd 10 right inguinal pain Search Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg. 2016 2017 2018 Billable/Specific Code Adult Dx (15-124 years) R10.11 is
More informationImaging Decisions Start Here SM
Owing to its high resolution and wide anatomic coverage, dynamic first-pass perfusion 320-detector-row CT outperforms PET/CT for distinguishing benign from malignant lung nodules, researchers from Japan
More informationAdnexal Masses and Problem Solving Pelvic MRI
28th Congress of the Hungarian Society of Radiologists RCR Session Budapest June 2016 Adnexal Masses and Problem Solving Pelvic MRI DrSarah Swift St James s University Hospital Leeds, UK Objectives Characterisation
More informationNecrotizing Granuloma of the Lung: Imaging Characteristics and Imaging-Guided Diagnosis
Necrotizing Granuloma of the Lung Chest Imaging Clinical Observations Rennae Thiessen 1 Jean M. Seely 1 Frederick R. K. Matzinger 1 Prachi garwal 1,2 Karen L. urns 3 Carole J. Dennie 1 Rebecca Peterson
More informationRadiological staging of lung cancer. Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh
Radiological staging of lung cancer Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh Bronchogenic Carcinoma Accounts for 14% of new cancer diagnoses in 2012. Estimated to kill ~150,000
More informationPelvic Prolapse. A Patient Guide to Pelvic Floor Reconstruction
Pelvic Prolapse A Patient Guide to Pelvic Floor Reconstruction Pelvic Prolapse When an organ becomes displaced, or slips down in the body, it is referred to as a prolapse. Your physician has diagnosed
More informationExtraosseous myeloma: imaging features
Extraosseous myeloma: imaging features C. Santos Montón, R. Corrales, J. M. Bastida Bermejo, M. Villanueva Delgado, R. E. Correa Soto, J. M. Alonso Sánchez; Salamanca/ES Learning objectives -To review
More informationThe Emergency Hernia or The call you don t want at 2:00 a.m.*
or The call you don t want at 2:00 a.m.* *Or even at 8:00 a.m. Michael G. Sarr, MD Professor of Surgery Mayo Clinic South Canada WEST CANADA EAST CANADA Clinical talk Hernias Inguinal Umbilical Incisional
More informationPET/CT for Adrenal Assessment
Residents Section Structured Review rticle lake et al. PET/CT of the drenal Glands Residents Section Structured Review rticle Michael. lake 1 Priyanka Prakash Carmel G. Cronin lake M, Prakash P, Cronin
More informationStaging Colorectal Cancer
Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for
More informationThe Recurrence Rate of Inguinal Hernia Repair, use of Mesh without Fixation.
International Journal of Advanced Research in Biological Sciences ISSN: 348-8069 www.ijarbs.com DOI: 10.19/ijarbs Coden: IJARQG(USA) Volume 5, Issue 4-018 Research Article DOI: http://dx.doi.org/10.19/ijarbs.018.05.04.00
More informationCT Screening for Lung Cancer for High Risk Patients
CT Screening for Lung Cancer for High Risk Patients The recently published National Lung Cancer Screening Trial (NLST) showed that low-dose CT screening for lung cancer reduces mortality in high-risk patients
More informationNeck Imaging Reporting and Data System: An Atlas of NI-RADS Categories for Head and Neck Cancer
Neck Imaging Reporting and Data System: An Atlas of NI-RADS Categories for Head and Neck Cancer Bethany Cavazuti Patricia Hudgins Tanya Rath Char Branstetter Kristen Baugnon Amanda Corey Ashley Aiken Disclosures
More informationComputed Tomography of Normal Adrenal Glands in Indian Population
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 01 Ver. V January. (2018), PP 26-30 www.iosrjournals.org Computed Tomography of Normal Adrenal
More informationPelvic Pain? Cause Beyond the Ovary
Pelvic Pain? Cause Beyond the Ovary Catherine Kirkpatrick Consultant Sonographer United Lincolnshire Hospitals Trust Aims Consider not all pelvic pain is ovary or uterus related Explore some non gynae
More informationThe Role of Technetium Tc 99m Sestamibi in the Early Detection of Breast Carcinoma
State of the rt The Role of Technetium Tc 99m Sestamibi in the Early Detection of reast Carcinoma Leonard R. Coover, MD Technetium Tc 99m sestamibi (MII), a radionuclide, has been utilized for more than
More informationFDG-PET/CT in Gynaecologic Cancers
Friday, August 31, 2012 Session 6, 9:00-9:30 FDG-PET/CT in Gynaecologic Cancers (Uterine) cervical cancer Endometrial cancer & Uterine sarcomas Ovarian cancer Little mermaid (Edvard Eriksen 1913) honoring
More informationQuestion 1 History. Likely Diagnosis Differential. Further Investigation or Management. Requires Paediatric Surgical referral for laparotomy
Question 1 Male newborn spilling green tinged vomit day 1 of life Imaging Abdominal X-Rays performed on 03/05/2012 Upper and lower gastrointestinal contrast studies performed on 03/05/2012 Abdominal X-Rays
More informationJMSCR Vol 04 Issue 08 Page August 2016
www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i8.17 Surprises Encountered During Exploration
More informationJMSCR Vol. 03 Issue 08 Page August 2015
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x DOI: http://dx.doi.org/10.18535/jmscr/v3i8.40 Comparison of Outcome between Lightweight Mesh & Heavy Weight Mesh in Lichtenstein Groin
More informationOriginal Report. The Reverse Segond Fracture: Association with a Tear of the Posterior Cruciate Ligament and Medial Meniscus
Eva M. Escobedo 1 William J. Mills 2 John. Hunter 1 Received July 10, 2001; accepted after revision October 1, 2001. 1 Department of Radiology, University of Washington Harborview Medical enter, 325 Ninth
More information