Adult with cough and bilateral ankle swelling
|
|
- Roderick Sutton
- 5 years ago
- Views:
Transcription
1 WHAT S YOUR DIAGNOSIS? Adult with cough and bilateral ankle swelling Bimal Parameswaran, Jamila Al Dossary A 53-year-old Bahraini businessman, known to have hypertension and diabetes, presented with complaints of cough with scanty white sputum, bilateral knee pain and painful bilateral ankle swelling, all of 2-months duration. He also had streaky hemoptysis of 2 days duration. He was a chronic smoker who had smoked about 30 cigarettes a day for the past 30 years and also complained of weight loss of about 5 kilograms over the past few months. General examination revealed clubbing of the fingers of both hands and bilateral symmetric tender pitting edema of the lower limbs. There was no thickening of the skin of the face. The breath sounds were reduced over the right mammary and inframammary region with dullness on percussion. Examination of other systems were normal. Figure 1 is an anteroposterior [AP] radiograph of both knees and Figure 2 is a lateral radiograph of both ankles. What do these radiographs show? Figure 3 is a frontal radiograph of the chest and Figure 4 is a selected image from a CT scan of the chest. Do these lead you to a specific diagnosis? Salmaniya Medical Complex, Correspondence and reprint requests: Bimal Kumar Parameswaran, MD Department of Radiology, Salmaniya Medical Complex T: F: drbimalkumar@yahoo.com Ann Saudi Med 2006;26(6): Answer on page 489. Figure 1. Anteroposterior [AP] radiograph of both knees (right). Figure 2. Lateral radiograph of both ankles (below). 484 Ann Saudi Med 26(6) November-December
2 Figure 3. Frontal radiograph of the chest. Figure 4. CT scan of the chest. Ann Saudi Med 26(6) November-December
3 WHAT S YOUR DIAGNOSIS? DIAGNOSIS: Hypertrophic pulmonary osteoarthropathy due to carcinoma of the right lung Bimal Parameswaran, Jamila Al Dossary The radiograph of the knees (Figure 1) shows periosteal thickening at the metadiaphysis of the distal femur and proximal tibia and fibula on both sides. The knee joint space is maintained and there are no periarticular erosions. The radiograph of ankles (Figure 2) reveals a similar periosteal reaction in the distal tibia and fibula, which is most conspicuous along the dorsal aspect with a normal appearance of the joints. The differential diagnosis for this pattern of bilateral periosteal reaction includes hypertrophic pulmonary osteoarthropathy (HOA), pachydermoperiostosis, thyroid acropachy and vascular insufficiency. The chest radiograph (Figure 3) reveals a mass without air bronchogram in the right paracardiac region and right pleural effusion. CT of the chest (Figure 4) shows the mass as a lobulated lesion in the right middle and lower lobe abutting the mediastinum associated with right pleural effusion. The features in chest imaging are those of a lung carcinoma. The combination of all radiological findings leads us to the diagnosis of hypertrophic pulmonary osteoarthropathy (HOA) due to carcinoma of the right lung. Biopsy of the lung mass revealed the lesion to be a moderately differentiated adenocarcinoma. Salmaniya Medical Complex, Correspondence and reprint requests: Bimal Kumar Parameswaran, MD Department of Radiology, Salmaniya Medical Complex T: F: drbimalkumar@yahoo.com Ann Saudi Med 2006;26(6): Discussion HOA is a syndrome charecterized by digital clubbing and periostosis of the tubular bones. 1 The syndrome occurs in two forms primary and secondary. The primary form, also termed pachydermoperiostosis, is an autosomal dominant condition characterized by coarsening of facial features, Figure 2. Radiograph of the ankles showing a periosteal reaction, especially along the dorsal aspect of the tibia and fibula (below). Figure 1. Radiograph of the knees showing irregular periosteal thickening of the metadiaphysis of the tibia, fibula and femur bilaterally, which is most marked in the femora (above). Ann Saudi Med 26(6) November-December
4 HYPERTROPHIC PULMONARY OSTEOARTHROPATHY Figure 3. Chest radiograph showing right lung mass and pleural effusion (left). Figure 4. CT of the chest showing lobulated mass in the right middle lobe abutting the mediastinum and right pleural effusion (above). mild bone and joint involvement and early onset of disease, usually in the second decade of life. Secondary HOA occurs mostly in adults and is associated with an underlying disease, usually an intrathoracic malignancy or infection. 2 Pulmonary causes for HOA include bronchogenic carcinoma, pleural mesothelioma, chronic bronchitis, bronchiectasis, pulmonary fibrosis, and pneumoconiosis. Though the syndrome was originally referred to as pulmonary hypertrophic osteoarthropathy, the term hypertrophic osteoarthropathy is becoming more common as there are many extrapulmonary diseases that cause HOA. These include cardiovascular diseases like cyanotic congenital heart disease, bacterial endocarditis and aortic aneurysm; gastrointestinal diseases like inflammatory bowel disease, Whipple s disease, gastrointestinal tract malignancies and amebic dysentery; hepatobiliary diseases, thyroid acropachy, acquired immune deficiency syndrome, cystic fibrosis and sarcoidosis. 2 HOA may be associated with any cell type of lung cancer, most frequently with squamous and adenocarcinoma and least frequently with small cell lung carcinoma. 3 In our patient, biopsy of the lung tumor revealed it to be a well differentiated adenocarcinoma. Hypertrophic osteoarthropathy may affect up to 10% of patients with adenocarcinoma of the lung. 4 Clinically, HOA presents as clubbing of the digits, oligoarthritis or polyarthritis of the distal joints, tender periostitis of the distal long bones, and noninflammatory synovial effusions. 4 Positive laboratory findings in HOA include an elevated erythrocyte sedimentation rate and if there is considerable new bone formation, elevated serum alkaline phosphatase. Rheumatoid factor and antinuclear antibody are negative. 2 The exact etiology of HOA is unknown. Roles have been proposed for reflex vagal stimulation, growth factors, hormonal and immune mechanisms. 2 It has been suggested that vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) released after platelet clusters impact in the distal vasculature may induce the stromal and vascular changes present in digital clubbing. 5 The primary and secondary types of HOA display similar radiographic changes. 6 The radiographic findings of HOA may occur in the absence of any clinical findings, and uncommonly, radiographs are normal in the presence of florid clinical disease. 2 Periosteal proliferation is the hallmark of HOA. 7 Changes are most often seen in the tibia, radius, ulna, fibula, and femur. 2 The short and flat bones are involved in about 18.5% of patients and show less pronounced periosteal reaction than in the long bones. 8 A three-dimensional pattern of evolution of periostosis has been described in HOA, with the three dimensions being (1) the number of bones affected (2) the area of involvement of a given bone and (3) the shape of the periostosis. In early and mild cases few bones are affected and the periosteal bone apposition is limited to the diaphysis with a monolayer configuration. Advanced cases are characterized by involvement of practically all tubular bones with an irregular periosteal reaction that extends to involve the metaphysis and even the epiphysis. The 490 Ann Saudi Med 26(6) November-December
5 HYPERTROPHIC PULMONARY OSTEOARTHROPATHY adjacent joints characteristically do not show any narrowing of the joint space, in particular osteoporosis or erosions. 7 Radiographic changes described in the terminal phalanges include osteolysis with truncation, overgrowth with mushrooming of the tuft and tapering of the bones. 7 In our patient, advanced changes of periostosis were seen in the leg bones while the forearm bones showed mild involvement. Radionuclear scans are more sensitive than radiographs and reveal the bone involvement by HOA at an earlier stage. 9 Radionuclide scintigraphy shows diffuse symmetrical increased uptake along the cortical margins of the diaphysis of the involved bones, referred to as the tramline sign, parallel tract sign or double stripe sign. 10,11 Associated synovitis may produce increased uptake in juxta-articular bone and increased uptake is also seen in the distal phalanges affected with marked clubbing. 11 Magnetic resonance imaging (MRI) of patients with HOA shows, in addition to the periosteal reaction, significant soft tissue changes, which are not well appreciated with other diagnostic modalities. The soft tissue changes depicted with MRI are extensive swelling in the tissues surrounding the bone without involving the bone itself and muscular and preseptal edema, all seen as hyperintense signal in T2-weighted images. 12 When newly discovered, the presence of clubbing, with or without HOA, warrants a chest roentgenogram to look for a pulmonary neoplasm, which may still be localized and therefore curable. If the plain film is unrevealing, a CT scan of the thorax is indicated. 13 The most effective treatment for the pain and discomfort of secondary HOA is cure of the underlying condition. Tumor ablation or chemosuppressive therapy of an associated malignancy often results in prompt reversal of symptoms and resolution or disappearance of the radiographic and radionuclide imaging findings. 2,11 References 1. Martinez-Lavin M, Matucci-Cerinic M, Jajic I, Pineda C. Hypertrophic osteoarthropathy. Consensus on its definition, classification, assessment and diagnostic criteria. J Rheumatol 1993; 20: Altman RD, Tenenbaum J. Hypertrophic osteoarthropathy. In: Harris ED Jr, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge SB (editors). Kelley s Textbook of Rheumatology. 7th ed. Elsevier Saunders. Philadelphia p Beckles MA, Spiro SG, Colice GL, and Rudd RM. The physiologic evaluation of patients with lung cancer being considered for resectional surgery. Chest (1): 105S-114S. 4. Rugo HS. Paraneoplastic syndromes and other non-neoplastic effects of cancer. In Goldman L, Ausiello D (editors). Cecil Textbook of Medicine. 22 nd edition WB Saunders. p Atkinson S, Fox SB. Vascular endothelial growth factor (VEGF)-A and platelet-derived growth factor (PDGF) play a central role in the pathogenesis of digital clubbing. J Pathol. 2004; 203(2): Pineda CJ, Martinez- Lavin M, Goober JE, Sartris DJ, Clopton P, Resnick D. Periostitis in hypertrophic osteoarthropathy: relationship to disease duration. Am J Roentgenol 1987; 148: Pineda C, Fonesca C, Martinez- Lavin M. The spectrum of soft tissue and skeletal abnormalities of hypertrophic osteoarthropathy. J. Rheumatol 1990; 17(5): Jajic Z, Jajic I. Radiological changes of short and flat bones in primary hypertrophic osteoarthropathy. Ann Rheum Dis 1998; 57: Lopez-Majano V, Sobti P: Early diagnosis of pulmonary osteoarthropathy in neoplastic disease. J Nucl Med Allied Sci. 1984; 28: Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide Bone Imaging: An Illustrative Review. Radiographics. 2003; 23: Rosenthal L, Kirsch J. Observation of radionuclide imaging in hypertrophic pulmonary osteoarthropathy. Radiology. 1976; 120: Capelastegui A, Astigarraga E, and Garcia-Iturraspe C. MR findings in pulmonary hypertrophic osteoarthropathy. Clin Rad. 2000; 55(1): Murray FJ. History and Physical Examination. In. Murray FJ, Nadel JA (eds). Textbook of Respiratory Medicine. 3 rd edition. WB Saunders p 601. Ann Saudi Med 26(6) November-December
Hypertrophic Osteoarthropathy
September 2005 Hypertrophic Osteoarthropathy Roxanne Landesman, Harvard Medical School Year III Hypothetical Patient A patient presents with persistent right ankle pain, and no history of trauma. As the
More informationA 64 y.o. man presents to the hospital with persistent cough and hemoptysis. Fernando Mut Montevideo - Uruguay
A 64 y.o. man presents to the hospital with persistent cough and hemoptysis Fernando Mut Montevideo - Uruguay Teaching case Bone # 1 A 64 y.o. man presents to the hospital with persistent cough and hemoptysis.
More informationMedication induced periostitis resembling hypertrophic osteoarthropathy in lung transplant patients
Medication induced periostitis resembling hypertrophic osteoarthropathy in lung transplant patients Poster No.: C-3370 Congress: ECR 2010 Type: Topic: Authors: Keywords: DOI: Educational Exhibit Musculoskeletal
More informationHypertrophic osteoarthropathy (HOA) 1 is manifest clinically
ORIGINAL ARTICLE Hypertrophic Pulmonary Osteoarthropathy as a Paraneoplastic Manifestation of Lung Cancer Takeo Ito, MD,* Koichi Goto, MD, Kiyotaka Yoh, MD, Seiji Niho, MD, Hironobu Ohmatsu, MD, Kaoru
More informationBronchogenic Carcinoma
A 55-year-old construction worker has smoked 2 packs of ciggarettes daily for the past 25 years. He notes swelling in his upper extremity & face, along with dilated veins in this region. What is the most
More informationPigmented Villonodular Synovitis PVNS
February 2002 Pigmented Villonodular Synovitis PVNS Amy Gillis, Harvard Medical School Year III 47 year old female Our Patient Right hip pain since age 20 No history of trauma Diagnosed with DJD of R hip
More informationThe Radiology Assistant : Bone tumor - ill defined osteolytic tumors and tumor-like lesions
Bone tumor - ill defined osteolytic tumors and tumor-like lesions Henk Jan van der Woude and Robin Smithuis Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital,
More informationMRI XR, CT, NM. Principal Modality (2): Case Report # 2. Date accepted: 15 March 2013
Radiological Category: Musculoskeletal Principal Modality (1): Principal Modality (2): MRI XR, CT, NM Case Report # 2 Submitted by: Hannah Safia Elamir, D.O. Faculty reviewer: Naga R. Chinapuvvula, M.D.
More informationOsteomyelitis in infancy and childhood: A clinical and diagnostic overview M. Mearadji
Osteomyelitis in infancy and childhood: A clinical and diagnostic overview M. Mearadji International Foundation for Pediatric Imaging Aid Introduction Osteomyelitis is a relative common disease in infancy
More informationSecondary Hypertrophic Osteoarthropathy: New Insights on Pathogenesis and Management.
Rheumatic syndromes associated with cancer are generally thought to occur by one of the following mechanisms: paraneoplastic; direct invasion of bone, joint, or muscle by tumor; altered immune surveillance
More informationBad to the Bone: A Case of Camurati-Engelmann Disease
Bad to the Bone: A Case of Camurati-Engelmann Disease Jose Aliling MD, Tetyana Gorbachova MD, Lawrence H Brent MD Division of Rheumatology Einstein Medical Center Philadelphia, PA Case Presentation A 56
More informationISPUB.COM. Spectrum Of MRI Findings In Musculoskeletal Tuberculosis: Pictoral Essay. P Chudgar INTRODUCTION SPINE
ISPUB.COM The Internet Journal of Radiology Volume 8 Number 2 Spectrum Of MRI Findings In Musculoskeletal Tuberculosis: Pictoral Essay P Chudgar Citation P Chudgar.. The Internet Journal of Radiology.
More informationBrain Atrophy. Brain Atrophy
Aging Central Nervous System Processes Age related brain atrophy Non-age related brain atrophy Cerebrovascular disease Cerebral infarction Hypertensive hemorrhage Carotid artery stenosis and occlusion
More informationVascular endothelial growth factor and hypertrophic osteoarthropathy
Vascular endothelial growth factor and hypertrophic osteoarthropathy L.H. Silveira, M. Martínez-Lavín 1, C. Pineda 1, M.-C. Fonseca 2, C. Navarro 2, A. Nava 1 Department of Biochemistry, 1 Department of
More informationHypertrophic Pulmonary Osteoarthropathy in Anaplastic Lymphoma Kinase (ALK)-positive Lung Cancer
CASE REPORT Hypertrophic Pulmonary Osteoarthropathy in Anaplastic Lymphoma Kinase (ALK)-positive Lung Cancer Masamichi Komatsu 1, Masanori Yasuo 1, Nobumitsu Kobayashi 1, Kazunari Tateishi 1, Atsuhito
More information4/28/2010. Fractures. Normal Bone and Normal Ossification Bone Terms. Epiphysis Epiphyseal Plate (physis) Metaphysis
Fractures Normal Bone and Normal Ossification Bone Terms Epiphysis Epiphyseal Plate (physis) Metaphysis Diaphysis 1 Fracture Classifications A. Longitudinal B. Transverse C. Oblique D. Spiral E. Incomplete
More informationPULMONARY MEDICINE BOARD REVIEW. Financial Conflicts of Interest. Question #1: Question #1 (Cont.): None. Christopher H. Fanta, M.D.
PULMONARY MEDICINE BOARD REVIEW Christopher H. Fanta, M.D. Pulmonary and Critical Care Division Brigham and Women s Hospital Partners Asthma Center Harvard Medical School Financial Conflicts of Interest
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 11/24/2012 Radiology Quiz of the Week # 100 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationMARK D. MURPHEY MD, FACR. Physician-in-Chief, AIRP. Chief, Musculoskeletal Imaging
ALPHABET SOUP AND CYSTIC LESIONS OF THE BONE MARK D. MURPHEY MD, FACR Physician-in-Chief, AIRP Chief, Musculoskeletal Imaging ALPHABET SOUP AND CYSTIC LESIONS OF THE BONE Giant cell tumor (GCT) Unicameral
More informationBronchial syndrome. Atelectasis Draining bronchus Bronchiectasis
Bronchial syndrome Atelectasis Draining bronchus Bronchiectasis Etienne Leroy Terquem Pierre L Her SPI / ISP Soutien Pneumologique International / International Support for Pulmonology Atelectasis Consequence
More informationLung Cancer - Suspected
Lung Cancer - Suspected Shared Decision Making Lung Cancer: http://www.enhertsccg.nhs.uk/ Patient presents with abnormal CXR Lung cancer - clinical presentation History and Examination Incidental finding
More informationSkeletal changes in endocrine disorders
Skeletal changes in endocrine disorders Poster No.: P-0100 Congress: ESSR 2015 Type: Authors: Educational Poster A. C. O'Brien 1, H. L. khosa 2, A. levai 2, N. Ramesh 2 ; 1 Dublin/IE, 2 Portlaoise/IE Keywords:
More informationDetection of Soft Tissue Tumors on Bone Scintigraphy: Report of Four Cases
Detection of Soft Tissue Tumors on Bone Scintigraphy: Report of Four Cases Fariba Akhzari 1 MD and Mahrokh Daemi MD 2 1 Nuclear Medicine Department, 2 General Surgery Department, Sina Hospital, Faculty
More informationAn Introduction to Radiology for TB Nurses
An Introduction to Radiology for TB Nurses Garold O. Minns, MD September 14, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Garold O. Minns, MD has the following disclosures
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 11/17/2012 Radiology Quiz of the Week # 99 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationIntroduction to Chest Radiography
Introduction to Chest Radiography RSTH 366: DIAGNOSTIC TECHNIQUES Alan Alipoon BS, RCP, RRT Instructor Department of Cardiopulmonary Sciences 1 Introduction Discovered in 1895 by Wilhelm Roentgen Terminology
More informationBenign Localized Pleural Mesotheliomas Presenting as Arthritis
Benign Localized Pleural Mesotheliomas Presenting as Arthritis Allen S. Hudspeth, M.D. P rimary tumors of the pleura are relatively rare, but they present many interesting pathological and clinical features.
More informationSkeletal Radiology. Solitary (unicameral) bone cyst. The fallen fragment sign revisited
Skeletal Radiol (1989) 18:261-265 Skeletal Radiology Solitary (unicameral) bone cyst The fallen fragment sign revisited S. Struhl, M.D., C. Edelson, M.D., H. Pritzker, M.D., L.P. Seimon, M.D., and H.D.
More informationCase of the Day Chest
Case of the Day Chest Darin White MDCM FRCPC Department of Radiology, Mayo Clinic 76 th Annual Scientific Meeting Canadian Association of Radiologists Montreal, QC April 26, 2013 2013 MFMER slide-1 Disclosures
More informationImaging of cardio-pulmonary treatment related damage. Radiotheraphy and Lung
Imaging of cardio-pulmonary treatment related damage Dr. Andrea Borghesi Dr. Emanuele Gavazzi Department of Radiology 2 University of Brescia Radiotheraphy and Lung The goal of radiation therapy (RT) is
More informationHYPERTROPHIC OSTEO-ARTHROPATHY IN POLYARTERITIS
Ann. rheum. Dis. (1956), 15, 46. HYPERTROPHIC OSTEO-ARTHROPATHY IN POLYARTERITIS BY R. R. H. LOVELL AND G. B. D. SCOTT From the Medical Unit and Department of Morbid Anatomy, St. Mary's Hospital, Paddington
More information8/14/2017. Objective: correlate radiographic findings of common lung diseases to actual lung pathologic features
What is that lung disease? Pulmonary Patterns & Correlated Pathology Dr. Russell Tucker, DACVR Objective: correlate radiographic findings of common lung diseases to actual lung pathologic features Improved
More informationPulmonary Manifestations Of Skeletal Disorders
Pulmonary Manifestations Of Skeletal Disorders U. A. Saeed, MBBS FCPS, J. Nair, MBBS MD, R. Khosla, MD FRCR, K. Sayegh, MD FRCPC, J. Kosiuk, MD FRCPC, J. Taylor, MD FRCPC; Department of Radiology, McGill
More informationChest Radiology Interpretation: Findings of Tuberculosis
Chest Radiology Interpretation: Findings of Tuberculosis Get out your laptops, smart phones or other devices pollev.com/chestradiology Case #1 1 Plombage Pneumonia Cancer 2 Reading the TB CXR Be systematic!
More informationThe Radiology Assistant : Bone tumor - well-defined osteolytic tumors and tumor-like lesions
Bone tumor - well-defined osteolytic tumors and tumor-like lesions Henk Jan van der Woude and Robin Smithuis Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital,
More informationDisseminated Primary Non-Hodgkin s Lymphoma of Bone : A Case Re p o r t 1
Disseminated Primary Non-Hodgkin s Lymphoma of Bone : A Case Re p o r t 1 Hee-Jin Park, M.D., Sung-Moon Lee, M.D., Hee-Jung Lee, M.D., Jung-Sik Kim, M.D., Hong Kim, M.D. Primary lymphoma of bone is uncommon
More informationLung Cancer-a primer. Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo
Lung Cancer-a primer Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo CLINICAL CATEGORIES THE SOLITARY PULMONARY NODULE MULTIPLE PULMONARY NODULES Differential Diagnosis Malignant
More informationWomen s Imaging ICD-10-CM
Women s Imaging ICD-10-CM Clinical Documentation Guides Brought to you by www.codingstrategies.com The Resource for Physician and Outpatient Coding, Compliance & ICD-10-CM OTHER CLINICAL DOCUMENTATION
More informationBRONCHOGENIC CARCINOMA CHALLENGES IN EVALUATION
BRONCHOGENIC CARCINOMA CHALLENGES IN EVALUATION GRAND ROUND WARD 7C DATE: 25 TH MARCH 2015 PRESENTER: DR E. SAYO FACILITATOR: DR J MECHA DEMOGRAPHIC DATA NAME : CM AGE: 69 YEARS ADDRESS : KIAMBU OCCUPATION:
More informationMonostotic Paget s Disease: A Case Report
Chin J Radiol 2002; 27: 117-121 117 CASE REPORT Monostotic Paget s Disease: A Case Report CHI-CHEN HOU 1 CHI WEI LO 2 JINN-MING CHANG 1 CHING-CHERNG TZENG 3 Department of Diagnostic Radiology 1, Orthopedics
More informationApproach to Pulmonary Nodules
Approach to Pulmonary Nodules Edwin Jackson, Jr., DO Assistant Professor-Clinical Director, James Early Detection Clinic Department of Internal Medicine Division of Pulmonary, Allergy, Critical Care and
More informationScintigraphic Findings and Serum Matrix Metalloproteinase 3 and Vascular Endothelial Growth Factor Levels in Patients with Polymyalgia Rheumatica
The Open General and Internal Medicine Journal, 29, 3, 53-57 53 Open Access Scintigraphic Findings and Serum Matrix Metalloproteinase 3 and Vascular Endothelial Growth Factor Levels in Patients with Polymyalgia
More informationTB Radiology for Nurses Garold O. Minns, MD
TB Nurse Case Management Salina, Kansas March 31-April 1, 2010 TB Radiology for Nurses Garold O. Minns, MD April 1, 2010 TB Radiology for Nurses Highway Patrol Training Center Salina, KS April 1, 2010
More informationSeronegative spondyloarthropathies : A Pictorial Review
Seronegative spondyloarthropathies : A Pictorial Review Poster No.: P-0008 Congress: ESSR 2012 Type: Scientific Exhibit Authors: J. Acosta Batlle, B. Palomino Aguado, M. D. Lopez Parra, S. 1 2 3 2 4 1
More informationImaging Choices in Occult Hip Fracture
Introduction Imaging Choices in Occult Hip Fracture Jesse Cannon, MD; Salvatore Silvestri, MD; Mark Munro, MD J Emerg Med. 2009;32(3):144-152 Reporter PGY 宋兆家 Supervisor VS 侯勝文 990220 High dependence on
More informationChealon Miller, HMS IV Gillian Lieberman, MD. November Stress Fractures. Chealon Miller, Harvard Medical School Year IV Gillian Lieberman, MD
November 2005 Stress Fractures Chealon Miller, Harvard Medical School Year IV Our Patient G.F. 29 year old female runner c/o left shin pain and swelling Evaluated at OSH with MRI showing a mass Referred
More informationSeptember 2014 Imaging Case of the Month. Michael B. Gotway, MD. Department of Radiology Mayo Clinic Arizona Scottsdale, AZ
September 2014 Imaging Case of the Month Michael B. Gotway, MD Department of Radiology Mayo Clinic Arizona Scottsdale, AZ Clinical History: A 57-year-old non-smoking woman presented to her physician as
More informationPathologic Fracture of the Femur in Brown Tumor Induced in Parathyroid Carcinoma: A Case Report
CASE REPORT Hip Pelvis 28(3): 173-177, 2016 http://dx.doi.org/10.5371/hp.2016.28.3.173 Print ISSN 2287-3260 Online ISSN 2287-3279 Pathologic Fracture of the Femur in Brown Tumor Induced in Parathyroid
More informationSynovial hemangioma of the suprapatellar bursa
Synovial hemangioma of the suprapatellar bursa Poster No.: P-0040 Congress: ESSR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit A. YESILDAG, S. Keskin, H. Kalkan, S. Kucuksen, U. Kerimoglu; Konya/TR
More informationGIANT CELL-RICH OSTEOSARCOMA: A CASE REPORT
Nagoya J. Med. Sci. 59. 151-157, 1996 CASE REPORTS GIANT CELL-RICH OSTEOSARCOMA: A CASE REPORT KEIJI SATO!, SHIGEKI YAMAMURA!, HISASHI IWATA!, HIDESHI SUGIURA 2, NOBUO NAKASHIMA 3 and TETSURO NAGASAKA
More informationTHE CONNECTIVE TISSUE AND EPITHELIUM
THE CONNECTIVE TISSUE AND EPITHELIUM The focus of this week s lab will be pathology of connective tissue and epithelium. The lab will introduce you to the four basic tissue types: epithelium, connective
More informationSpondyloperipheral dysplasia
JOSEF VANEK Journal of Medical Genetics, 1983, 20, 117-121 From the Clinic of Orthopaedics, Medical Faculty of Charles University, County Hospital, Plzeh, Czechoslovakia. SUMMARY Skeletal dysplasia with
More informationCase Report Solitary Osteolytic Skull Metastasis in a Case of Unknown Primary Being latter Diagnosed as Carcinoma of Gall Bladder
Cronicon OPEN ACCESS CANCER Case Report Solitary Osteolytic Skull Metastasis in a Case of Unknown Primary Being latter Diagnosed as Carcinoma of Gall Kartik Mittal 1, Rajaram Sharma 1, Amit Dey 1, Meet
More informationProf. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.
Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,
More informationCase Report Hypertrophic osteoarthropathy secondary to thymoma: rare presentation in childhood
Int J Clin Exp Med 2017;10(9):13856-13860 www.ijcem.com /ISSN:1940-5901/IJCEM0054985 Case Report Hypertrophic osteoarthropathy secondary to thymoma: rare presentation in childhood Manqiong Yang *, Shuping
More informationSyndrome of Remitting Seronegative Symmetrical Synovitiswith Pitting Edema (RS3PE): A Case Report and Review of the Literature
Syndrome of Remitting Seronegative Symmetrical Synovitiswith Pitting Edema (RS3PE): A and Review of the Literature Semra Akturk Adiyaman University Education and Research Hospital, Clinic ofphysical Therapy
More informationARDS - a must know. Page 1 of 14
ARDS - a must know Poster No.: C-1683 Congress: ECR 2016 Type: Authors: Keywords: DOI: Educational Exhibit M. Cristian; Turda/RO Education and training, Edema, Acute, Localisation, Education, Digital radiography,
More informationPulmonary Manifestations of Ankylosing Spondylitis
Pulmonary Manifestations of Ankylosing Spondylitis PULMONARY MEDICINE. DR. R. ADITYAVADAN FINAL YEAR PG, DEPT. OF ETIOLOGY AS is a chronic multisystem disease characterized by inflammation of the spine,
More informationKey Difference - Pleural Effusion vs Pneumonia
Difference Between Pleural Effusion and Pneumonia www.differencebetween.com Key Difference - Pleural Effusion vs Pneumonia Pleural effusion and pneumonia are two conditions that affect our respiratory
More informationIntracapsular and para- articular chondroma of knee: a report of four cases and review of the literature
Intracapsular and para- articular chondroma of knee: a report of four cases and review of the literature Milan Samardziski, Marta Foteva, Aleksandar Adamov, George Zafiroski University Clinic for Orthopaedic
More informationA case of extensive synovial involvement by tophaceous gout
A case of extensive synovial involvement by tophaceous gout Nausheen Khan, MB BS, FCRad (D) Irma van de Werke, MB ChB, FRCR Farzanah Ismail, MB ChB, FCRad (D) Department of Radiology, Kalafong Hospital,
More informationTumor Board Discussions: Case 1
Tumor Board Discussions: Case 1 David S. Ettinger, MD The Alex Grass Professor of Oncology Johns Hopkins University School of Medicine Baltimore, Maryland Case #1 50-year-old Asian female, never smoker
More informationBronchiectasis in Adults - Suspected
Bronchiectasis in Adults - Suspected Clinical symptoms which may indicate bronchiectasis for patients Take full respiratory history including presenting symptoms, past medical & family history Factors
More informationCase Scenario 1. The patient agreed to a CT guided biopsy of the left upper lobe mass. This was performed and confirmed non-small cell carcinoma.
Case Scenario 1 An 89 year old male patient presented with a progressive cough for approximately six weeks for which he received approximately three rounds of antibiotic therapy without response. A chest
More informationResidents Teaching Files
SPECIAL EXHIBIT Residents Teaching Files Epithelioid Hemangioendothelioma of the Lower Extremity 1 Elizabeth A. Ignacio, MD Kathryn M. Palmer, MD Sharad C. Mathur, MD Arnold M. Schwartz, MD, PhD Wayne
More informationIsolated congenital anterolateral bowing of the fibula : A case report with 24 years follow-up
Acta Orthop. Belg., 2009, 75, 842-846 CASE REPORT Isolated congenital anterolateral bowing of the fibula : A case report with 24 years follow-up Karolien LELIEFELD, Hans VAN DER SLUIJS, Ibo VAN DER HAVEN
More informationRadiographic features of Ollier s disease two case reports
Sadiqi et al. BMC Medical Imaging (2017) 17:58 DOI 10.1186/s12880-017-0230-8 CASE REPORT Radiographic features of Ollier s disease two case reports Jamshid Sadiqi 1,3*, Najibullah Rasouly 1, Hidayatullah
More informationWF RESPIRATORY SYSTEM. RESPIRATORY MEDICINE
WF RESPIRATORY SYSTEM. RESPIRATORY MEDICINE 1 Societies 11 History 13 Dictionaries. Encyclopaedias. Bibliographies Use for general works only. Classify with specific aspect where possible 15 Classification.
More informationLong Case Set 02. Dr Raviraj Uppoor. Dr Sameer Shamshuddin. Consultant Radiologist Cumberland Infirmary, Carlisle, UK
Long Case Set 02 www.frcrtutorials.com Dr Raviraj Uppoor MBBS, DMRD, DNB, FRCR Consultant Radiologist Cumberland Infirmary, Carlisle, UK Dr Sameer Shamshuddin MBBS, DMRD, FRCR Consultant Radiologist Royal
More informationHypertrophic osteoarthropathy following aortic surgery
Ann Rheum Dis 1996;55:863-867 863 CASE STUDIES IN DIAGNOSTIC IMAGING Hopital de Nancy-Brabois, France: Clinique de Rhumatologie and URA CNRS 1288 F Dellestable P Nre A Gaucher Departement de Radiologie
More informationMonophasic Synovial Carcinoma of knee joint- A Case Report and Review of Literature
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 3 Ver.5 March. (2018), PP 13-17 www.iosrjournals.org Monophasic Synovial Carcinoma of knee
More informationRespiratory Pathology. Kristine Krafts, M.D.
Respiratory Pathology Kristine Krafts, M.D. Normal lung: alveolar spaces Respiratory Pathology Outline Acute respiratory distress syndrome Obstructive lung diseases Restrictive lung diseases Vascular
More informationRadiographic Positioning Summary (Basic Projections RAD 222)
Lower Extremity Radiographic Positioning Summary (Basic Projections RAD 222) AP Pelvis AP Hip (Unilateral) (L or R) AP Femur Mid and distal AP Knee Lateral Knee Pt lies supine on table Align MSP to Center
More informationB. Cystic Teratoma: Refer to virtual microscope slide p_223 ovary, teratoma and compare to normal virtual microscope slide 086 ovary.
LAB 2: THE CONNECTIVE TISSUE AND EPITHELIUM The focus of this week s lab will be pathology of connective tissue and epithelium. The lab will introduce you to the four basic tissue types: epithelium, connective
More informationInternational Journal of Research in Health Sciences ISSN: Available online at: Case Study
International Journal of Research in Health Sciences ISSN: 2321-7251 Available online at: http://www.ijrhs.org/ Case Study Foreign body granuloma mimicking a soft tissue neoplasm *Rohan Sawant, Abhishek
More informationThoracic Imaging: A Case of Metastatic Adenocarcinoma of Unknown Primary
January 28, 2009 Thoracic Imaging: A Case of Metastatic Adenocarcinoma of Unknown Primary Kristina Mirabeau-Beale, Harvard Medical School Year III Gillian Lieberman, MD Agenda Introduce Patient RS Discuss
More informationTibial stress injury: MRI findings
Tibial stress injury: MRI findings Poster No.: P-0047 Congress: ESSR 2013 Type: Scientific Exhibit Authors: A. Castrillo 1, J. J. Fondevila 2, B. Canteli 3, A. Urresola Olabarrieta 1, A. I. Ezquerro 2,
More informationCase reports CASE 1. A 67-year-old white man had back pain since the age. our clinic several years later with progressive symptoms.
Annals of the Rheumatic Diseases, 1982, 41, 574-578 Late-onset peripheral joint disease in ankylosing spondylitis MARC D. COHEN AND WILLIAM W. GINSBURG From the Division ofrheumatology and Internal Medicine,
More informationSonographic Findings of Adductor Insertion Avulsion Syndrome With Magnetic Resonance Imaging Correlation
Case Report Sonographic Findings of Adductor Insertion Avulsion Syndrome With Magnetic Resonance Imaging Correlation Jennifer S. Weaver, MD, Jon A. Jacobson, MD, David A. Jamadar, MBBS, Curtis W. Hayes,
More informationPREAMBLE GENERAL DIAGNOSTIC RADIOLOGY
PREAMBLE The General Diagnostic Radiology category is intended to cover the body of knowledge a practicing board certified Diagnostic Radiologist should know. Since the range of content relevant to the
More informationThe Dr. Jae Yang Lecture: An Overview of the Radiographic Picture of TB
The Dr. Jae Yang Lecture: An Overview of the Radiographic Picture of TB Harvey H. Wong, MD FRCPC MScCH Assistant Professor Department of Medicine Division of Respirology University of Toronto Financial
More informationThoracic CT pattern in lung cancer: correlation of CT and pathologic diagnosis
19 th Congress of APSR PG of Lung Cancer (ESAP): Update of Lung Cancer Thoracic CT pattern in lung cancer: correlation of CT and pathologic diagnosis Kazuma Kishi, M.D. Department of Respiratory Medicine,
More informationPatient #1. Rheumatoid Arthritis. Rheumatoid Arthritis. 45 y/o female Morning stiffness in her joints >1 hour
Patient #1 Rheumatoid Arthritis Essentials For The Family Medicine Physician 45 y/o female Morning stiffness in her joints >1 hour Hands, Wrists, Knees, Ankles, Feet Polyarticular, symmetrical swelling
More informationPediatric TB Intensive Houston, Texas October 14, 2013
Pediatric TB Intensive Houston, Texas October 14, 2013 Radiologic Presentation of Childhood TB Susan D. John, MD, FACR October 14, 2013 Disclosures I have no disclosures or conflicts of interest to report
More informationLung tumors & pleural lesions
Lung tumors & pleural lesions A brief introduction 95% of lung tumors are carcinomas Among the remaining 5%, we will discuss: -Hamartoma the most common benign lung tumor spherical, coin lesion on x-rays
More informationCardiac Radiology In-Training Test Questions for Diagnostic Radiology Residents
Cardiac Radiology In-Training Test Questions for Diagnostic Radiology Residents March, 2013 Sponsored by: Commission on Education Committee on Residency Training in Diagnostic Radiology 2013 by American
More informationA Case of Pediatric Plasma Cell Granuloma
August 2001 A Case of Pediatric Plasma Cell Granuloma Nii Tetteh, Harvard Medical School Year IV Our Patient 8 year old male with history of recurrent left lower lobe and lingular pneumonias since 1994.
More informationArticular disease of the hand - the target joint approach
Articular disease of the hand - the target joint approach Poster No.: C-1817 Congress: ECR 2016 Type: Educational Exhibit Authors: R. R. Domingues Madaleno 1, A. P. Pissarra 1, I. Abreu 2, A. Canelas 1,
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 informationSCLERODERMA OVERLAP SYNDROME: A CASE REPORT Diwakar K. Singh 1, Nataraju H. V 2
SCLERODERMA OVERLAP SYNDROME: A Diwakar K. Singh 1, Nataraju H. V 2 HOW TO CITE THIS ARTICLE: Diwakar K. Singh, Nataraju H. V. Scleroderma Overlap Syndrome: A Case Report. Journal of Evolution of Medical
More informationReparatory system 18 lectures Heyam Awad
Reparatory system 18 lectures 8-10 Heyam Awad These lectures cover the following topics 1. Diffuse hemorrhagic syndromes 2. Lung tumors important: theses slides are your study source for these lectures.
More informationPulmonary Patterns & Correlated Pathology
Pulmonary Patterns & Correlated Pathology Russell Tucker, DVM, DACVR Washington State University College of Veterinary Medicine Objective: correlate radiographic findings of common lung diseases to actual
More informationRadiographic Appearance Of Primary Hyperparathyroidism With Atypical Parathyroid Adenoma
ISPUB.COM The Internet Journal of Internal Medicine Volume 6 Number 2 Radiographic Appearance Of Primary Hyperparathyroidism With Atypical Parathyroid Adenoma P George, N Philip, B Pawar Citation P George,
More informationDiagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD. November 18, 2017
Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD November 18, 2017 Disclosures I do not have a financial interest/arrangement or affiliation with one or more organizations
More informationThe Respiratory System
The Respiratory System Respiratory Anatomy Upper respiratory tract Nose Nasal passages Pharynx Larynx Respiratory Anatomy Functions of the upper respiratory tract: Provide entry for inhaled air Respiratory
More informationChildhood Fractures. Incomplete fractures more common. Ligaments stronger than bone. Tendons stronger than bone. Fractures may be pathologic
Childhood Fractures Incomplete fractures more common Plastic bowing Torus / Buckle Greenstick Ligaments stronger than bone Fracture patterns different Physeal injury, not dislocation Tendons stronger than
More informationLecture (10) Bone Fractures. Resources: - Lecture by dr.alboukai - Diagnostic imaging book
Lecture (10) Bone Fractures Hanan Alsalman Hanan Alrabiah Reem Aljurayyad Ayshah Almahboob Ghadeer Alwuhyad Khawlah AlOthman Dalal Alqadi Suliman Alshammari Maha AlKubaidan Rawabi Alghamdi Resources: -
More informationEffective local and systemic therapy is necessary for the cure of Ewing tumor Most chemotherapy regimens are a combination of cyclophosphamide,
Ewing Tumor Perez Ewing tumor is the second most common primary tumor of bone in childhood, and also occurs in soft tissues Ewing tumor is uncommon before 8 years of age and after 25 years of age In the
More informationSELF-ASSESSMENT MODULE REFERENCE SPR 2018 Oncologic Imaging Course Adrenal Tumors November 10, :00 12:10 p.m.
SELF-ASSESSMENT MODULE REFERENCE SPR 2018 Oncologic Imaging Course Adrenal Tumors November 10, 2018 10:00 12:10 p.m. Staging Susan E. Sharp, MD 1. In the International Neuroblastoma Risk Group Staging
More information