MRI T1, precontrast showing solitary myeloma involving the second cervical vertebra,notice the T1 hypointensity.D.D.:
Spinal metastases.
Tuesday, July 6, 2010
Mnemonic = FOGMACHINES
Differential Diagnosis of Solitary Lucent Bone Lesions
1- Fibrous Dysplasia
2-Osteoblastoma
3-Giant Cell Tumor
4-Metastasis / Myeloma
5-Aneurysmal Bone Cyst
6-Chondroblastoma / Chondromyxoid Fibroma
7- Hyperparathyroidism (brown tumors) / Hemangioma
8-Infection
9-Non-ossifyingFibroma
10-Eosinophilic Granuloma / Enchondroma
11- Solitary Bone Cyst
This is a fairly long differential diagnosis. However, it is one that you must learn.
I still run through it every time I see one of these lesions, just to make sure that I consider all of the important possibilities.
The discussion that follows will dwell almost totally on the plain radiographic findings of these lesions.
CT and MRI are wonderful tools for tumor workups, but they are fairly non-specific. Their place in the workup is to tell us where the lesion is: what its extent is; whether there are any metastases (either in the same bone or elsewhere); and whether an adjacent joint, nerve or blood vessel is involved. However, to tell us what a lesion is, the plain radiograph is still supreme. We've been looking at the darned things for almost a century now, and the plain film findings of most bone tumors are fairly well known. Plain films are not terribly sensitive, but they do have a decent specificity. Therefore, any workup of a bone tumor should start with a good set of plain films
http://www.google.com.eg/imgres?imgurl=http://www.rad.washington.edu/staticpix/mskbook/Location.gif&imgrefurl=http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/online-musculoskeletal-radiology-book/lucent-lesions-of-bone&usg=__wP6FfqdHC_x5-14iuBiS46jwruQ=&h=320&w=300&sz=13&hl=en&start=1&itbs=1&tbnid=_RhbW5cUuf-JqM:&tbnh=118&tbnw=111&prev=/images%3Fq%3Dbone%2Blesions%26hl%3Den%26gbv%3D2%26tbs%3Disch:1
Differential Diagnosis of Solitary Lucent Bone Lesions
1- Fibrous Dysplasia
2-Osteoblastoma
3-Giant Cell Tumor
4-Metastasis / Myeloma
5-Aneurysmal Bone Cyst
6-Chondroblastoma / Chondromyxoid Fibroma
7- Hyperparathyroidism (brown tumors) / Hemangioma
8-Infection
9-Non-ossifyingFibroma
10-Eosinophilic Granuloma / Enchondroma
11- Solitary Bone Cyst
This is a fairly long differential diagnosis. However, it is one that you must learn.
I still run through it every time I see one of these lesions, just to make sure that I consider all of the important possibilities.
The discussion that follows will dwell almost totally on the plain radiographic findings of these lesions.
CT and MRI are wonderful tools for tumor workups, but they are fairly non-specific. Their place in the workup is to tell us where the lesion is: what its extent is; whether there are any metastases (either in the same bone or elsewhere); and whether an adjacent joint, nerve or blood vessel is involved. However, to tell us what a lesion is, the plain radiograph is still supreme. We've been looking at the darned things for almost a century now, and the plain film findings of most bone tumors are fairly well known. Plain films are not terribly sensitive, but they do have a decent specificity. Therefore, any workup of a bone tumor should start with a good set of plain films
http://www.google.com.eg/imgres?imgurl=http://www.rad.washington.edu/staticpix/mskbook/Location.gif&imgrefurl=http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/online-musculoskeletal-radiology-book/lucent-lesions-of-bone&usg=__wP6FfqdHC_x5-14iuBiS46jwruQ=&h=320&w=300&sz=13&hl=en&start=1&itbs=1&tbnid=_RhbW5cUuf-JqM:&tbnh=118&tbnw=111&prev=/images%3Fq%3Dbone%2Blesions%26hl%3Den%26gbv%3D2%26tbs%3Disch:1
causes of pneumomediastinum
Pneumomediastinum
1. Ruptured esophagus
2. Ruptured trachea/bronchus
3. Iatrogenic
4. Asthma
5. Pneumoperitoneum
1. Ruptured esophagus
2. Ruptured trachea/bronchus
3. Iatrogenic
4. Asthma
5. Pneumoperitoneum
rupture esophagus
Blue arrow points to "continuous diaphragm sign." The entire diaphragm is visualized from one side to the other because air in the mediastinum outlines the central portion which is usually obscured by the heart and mediastinal soft tissue structures that are in contact with the diaphragm. The red arrow points to the air beneath and posterior to the hearthttp://www.learningradiology.com/archives05/COW%20132-Pneumomediastinum/pneumomedcorrect.htm
rupture trachea
19-year-old man with blunt tracheal rupture. Anteroposterior chest radiograph shows large right-sided pneumothorax, pneumomediastinum, subcutaneous emphysema, and chest wall injuries (arrowheads).http://www.ajronline.org/cgi/content-nw/full/180/6/1670/FIG1
iatrogenic pneumomediastinum
This chest radiograph shows pneumomediastinum (radiolucency noted around the left heart border) in this patient who had a respiratory and circulatory arrest in the ED after experiencing multiple episodes of vomiting and a rigid abdomen. The patient was taken immediately to the operating room, where a large rupture of the esophagus was repaired.http://emedicine.medscape.com/article/808162-media
bronchial asthma
Posteroanterior chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Mediastinal air is noted adjacent to the anteroposterior window and airtrapping extends to the neck, especially on the right side.emedicine.medscape.com/article/353436-overview
Monday, July 5, 2010
Sunday, July 4, 2010
anteror mediastinal masses could be remembered by nemonic
4 T's and 2 L
4 T's are Thymoma,Terrible lymphoma,Thyroid masses and Teratoma
while 2 L are
2 L are Lipoma,Lipomatosis and
Lymphangioma
CT scan of chest showing an anterior mediastinal mass (thymoma) in a patient with myasthenia gravis.
emedicine.medscape.com/article/1171206-diagnosis
2-Mediastinal teratoma: Enhanced CT scan of the chest shows large, septated anterior
4 T's and 2 L
4 T's are Thymoma,Terrible lymphoma,Thyroid masses and Teratoma
while 2 L are
2 L are Lipoma,Lipomatosis and
Lymphangioma
CT scan of chest showing an anterior mediastinal mass (thymoma) in a patient with myasthenia gravis.emedicine.medscape.com/article/1171206-diagnosis
2-Mediastinal teratoma: Enhanced CT scan of the chest shows large, septated anterior mediastinal mass containing fat and bony elements
3-Substernal thyroid. Axial contrast-enhanced CT scan reveals an enlarged thyroid gland extending inferiorly to the level of, and posterior to, the sternum (arrow). There is mass effect on the trachea, which is compressed and displaced toward the right.
3-Substernal thyroid. Axial contrast-enhanced CT scan reveals an enlarged thyroid gland extending inferiorly to the level of, and posterior to, the sternum (arrow). There is mass effect on the trachea, which is compressed and displaced toward the right.http://www.google.com.eg/imgres?imgurl=http://download.imaging.consult.com/ic/images/S1933033207755118/gr2-midi.jpg&imgrefurl=http://imaging.consult.com/image/topic/dx/Head%2520and%2520Neck%3Ftitle%3DTrachea,%2520Tumor-like%2520Conditions%26image%3Dfig2%26locator%3Dgr2%26pii%3DS1933-0332(07)75511-8&usg=__uLfFVRE3__7U0tMAo_b468-jhbc=&h=152&w=200&sz=5&hl=en&start=3&itbs=1&tbnid=jHnWESUzdpIIyM:&tbnh=79&tbnw=104&prev=/images%3Fq%3Dsub%2Bsternal%2Bthyroid,ct%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1
4-Mediastinal lymphoma: Esophageal involvement by mediastinal lymphoma. CT scan in a patient with large cell lymphoma of the mediastinum shows extensive mediastinal adenopathy compressing the esophagus (arrowhead) and superior vena cava (arrow).
4-Mediastinal lymphoma: Esophageal involvement by mediastinal lymphoma. CT scan in a patient with large cell lymphoma of the mediastinum shows extensive mediastinal adenopathy compressing the esophagus (arrowhead) and superior vena cava (arrow).
Acute Alveolar infiltrate
1. Pulmonary edema
2. Pneumonia
3. Aspiration
4. Hemorrhage
this means presence of fluid inside alveoli which could be water as in pulmonary edema,exudate in pneumonia,blood in hemorrhage or any kind of aspiration materials.
1) Pulmonary Alveolar Edema. There is extensive, bilateral airspaces disease with fluid in the minor fissure (blue arrow) and bilateral pleural effusions (ref arrows). Although the heart is not enlarged, the cause was still on a cardiogenic basis.
http://www.google.com.eg/imgres?imgurl=http://www.learningradiology.com/caseofweek/caseoftheweekpix2007-1/cow267arr.jpg&imgrefurl=http://www.learningradiology.com/archives2007/COW%2520267-Pulmonary%2520edema-CHF/pulmedemacorrect.html&usg=__YRtgi0C8v73xQys3usyMs9_3_Vw=&h=443&w=500&sz=38&hl=en&start=8&sig2=GWET39uAxZAeo7LW_hF9VQ&itbs=1&tbnid=DIXYRi9W8kwI2M:&tbnh=115&tbnw=130&prev=/images%3Fq%3Dpulmonary%2Bedema%2Bx%2Bray%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1&ei=nHMwTNOmOMuTjAfIjbHDBQ
2) pneumonia
1. Pulmonary edema
2. Pneumonia
3. Aspiration
4. Hemorrhage
this means presence of fluid inside alveoli which could be water as in pulmonary edema,exudate in pneumonia,blood in hemorrhage or any kind of aspiration materials.
1) Pulmonary Alveolar Edema. There is extensive, bilateral airspaces disease with fluid in the minor fissure (blue arrow) and bilateral pleural effusions (ref arrows). Although the heart is not enlarged, the cause was still on a cardiogenic basis.http://www.google.com.eg/imgres?imgurl=http://www.learningradiology.com/caseofweek/caseoftheweekpix2007-1/cow267arr.jpg&imgrefurl=http://www.learningradiology.com/archives2007/COW%2520267-Pulmonary%2520edema-CHF/pulmedemacorrect.html&usg=__YRtgi0C8v73xQys3usyMs9_3_Vw=&h=443&w=500&sz=38&hl=en&start=8&sig2=GWET39uAxZAeo7LW_hF9VQ&itbs=1&tbnid=DIXYRi9W8kwI2M:&tbnh=115&tbnw=130&prev=/images%3Fq%3Dpulmonary%2Bedema%2Bx%2Bray%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1&ei=nHMwTNOmOMuTjAfIjbHDBQ
2) pneumoniahttp://gardenrain.wordpress.com/2010/01/page/4/
3) aspiration pneumonia:Ninety percent of unilateral diffuse lung opacities are accounted for by just five conditions: pneumonia; aspiration; pulmonary oedema; lymphangitis; and radiation pneumonitis.
4)pulmonary hemorrhage:chest radiographs demonstrate extensive bilateral diffuse pulmonary consolidation with sparing of the periphery of the lungs, creating the window frame effect that is suggestive of pulmonary hemorrhage.
3) aspiration pneumonia:Ninety percent of unilateral diffuse lung opacities are accounted for by just five conditions: pneumonia; aspiration; pulmonary oedema; lymphangitis; and radiation pneumonitis.
4)pulmonary hemorrhage:chest radiographs demonstrate extensive bilateral diffuse pulmonary consolidation with sparing of the periphery of the lungs, creating the window frame effect that is suggestive of pulmonary hemorrhage.
Hysterosalpingogram in 40-year-old woman shows medium-sized cesarean section scar defect arising from left lower uterine cavity wall (arrow).http://www.ajronline.org/cgi/content/full/190/4/870/FIG1
Tubal polyp. Spot radiograph shows a small filling defect (arrow) in the proximal left fallopian tube, a finding that typically represents a tubal polyp.http://radiographics.rsna.org/content/26/2/419.figures-only
a
b. Irreversible tubal occlusion with a microinsert. (a) Scout radiograph obtained prior to the instillation of contrast material shows a microinsert that has been placed hysteroscopically into the proximal fallopian tube. (b) Radiograph obtained after instillation shows no contrast material filling of the fallopian tube beyond the microinsert, a finding that helps document tubal occlusion.
Peritubal adhesions. Spot radiograph demonstrates a round collection of contrast material adjacent to the left fallopian tube, a finding that suggests peritubal adhesions. Note the free contrast material spillage on the right side.http://radiographics.rsna.org/content/26/2/419.figures-only
a
b
Hydrosalpinx. (a) Steep right oblique spot radiograph shows dilatation of the ampullary portion of the right fallopian tube (arrow). The left fallopian tube is normal in caliber. Mucosal folds are visible in the ampullary portions of both fallopian tubes, a finding that helps confirm the presence of contrast material within the tubes. (b) Spot radiograph shows dilatation of the ampullary portion of the left fallopian tube, a finding that is consistent with a hydrosalpinx. No contrast material spillage is seen on the left side. The right fallopian tube is abruptly cut off, a finding that is consistent with previous tubal ligation.
a
bTubal occlusion. (a) Spot radiograph demonstrates abrupt cutoff of the left fallopian tube. (b) Spot radiograph demonstrates cutoff of contrast material in the isthmic portions of both fallopian tubes, with bulbous dilatation of the distal aspects of the opacified portions. These findings can be seen with postsurgical occlusion (eg, following tubal ligation).
Cornual spasm. (a) On an HSG spot radiograph obtained during the early filling stage of the uterus, the right fallopian tube does not opacify beyond the cornual portion (arrow), whereas the left fallopian tube opacifies to the ampullary portion. Arrowheads indicate amorphous calcifications on the right side of the pelvis. These calcifications were also present on the scout image (not shown). (b) On a spot radiograph obtained after the instillation of additional contrast material, the right fallopian tube opacifies to the ampullary portion. Right-sided SIN and a left-sided hydrosalpinx are also noted. Amorphous calcifications (arrowheads) are again seen on the right side of the pelvis. 
SIN. Spot radiograph demonstrates SIN as small outpouchings or diverticula from the isthmic portion of the fallopian tubes. SIN can be either unilateral or (as in this case) bilateral.http://radiographics.rsna.org/content/26/2/419.figures-only
Cesarean section scar. Spot radiograph shows the uterine incision from a cesarean section (arrows) in the typical location (ie, oriented transverse in the lower uterine segment in the region of the isthmus). At HSG, a cesarean section scar can have a linear appearance (as in this case) or can occasionally manifest as a wedge-shaped outpouching or diverticulum.http://radiographics.rsna.org/content/26/2/419.figures-only
a
b
c
d (a, b) Diffuse adenomyosis. (a) Spot radiograph shows irregularity of the uterine contour with small outpouchings of contrast material, findings that represent diffuse adenomyosis. (b) Sagittal T2-weighted MR image shows thickening of the junctional zone to more than 1 cm, especially in the anterior fundus. (c, d) Focal adenomyosis. (c) Spot radiograph demonstrates an irregular mass-like filling defect in the fundus with small contrast material–filled diverticula, findings that represent focal adenomyosis. (d) Transabdominal US image shows thickening of the posterior uterine fundus with a heterogeneous echotexture in the area of focal adenomyosis (cf c).
Friday, July 2, 2010
a
b
c
d
Leiomyomas. (a) Spot radiograph obtained during the early filling stage shows a well-defined filling defect (arrow) in the fundus. (b) On a spot radiograph obtained with the uterus more distended with contrast material, the fibroid (arrow) is less apparent. (c) Spot radiograph obtained in a different patient reveals a large leiomyoma distorting the endometrial cavity as it drapes over a mass in the left myometrium. (d) Sonohysterogram obtained in a third patient shows a retroverted uterus with fluid outlining a submucosal mass in the fundus. The balloon of an HSG catheter (arrow) is seen in the lower uterine segment.
Endometrial polyp. Sagittal sonohysterogram shows a large, well-defined mass in the fundus arising from the anterior aspect of the endometrium. Note the cystic area in the lower portion of the polyp.http://www.google.com.eg/imgres?imgurl=http://radiographics.rsna.org/content/26/2/419/F12.small.gif&imgrefurl=http://radiographics.rsna.org/content/26/2/419.figures-only&usg=__VpUj1hDYgg3gkRJ5XSe6l8I_dXA=&h=192&w=200&sz=34&hl=en&start=44&itbs=1&tbnid=bQ3pvndRAhzw_M:&tbnh=100&tbnw=104&prev=/images%3Fq%3Dhysterosalpingography%26start%3D40%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1
Uterine folds. HSG spot radiograph demonstrates uterine folds (arrows) as linear filling defects that parallel the longitudinal axis of the uterus. Uterine folds are normal findings that are occasionally seen at HSG.http://www.google.com.eg/imgres?imgurl=http://radiographics.rsna.org/content/26/2/419/F12.small.gif&imgrefurl=http://radiographics.rsna.org/content/26/2/419.figures-only&usg=__VpUj1hDYgg3gkRJ5XSe6l8I_dXA=&h=192&w=200&sz=34&hl=en&start=44&itbs=1&tbnid=bQ3pvndRAhzw_M:&tbnh=100&tbnw=104&prev=/images%3Fq%3Dhysterosalpingography%26start%3D40%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1
Septate and arcuate uterus. Spot radiograph demonstrates a depression of the uterine fundus, a finding that may represent a short septum or an arcuate deformity.http://www.google.com.eg/imgres?imgurl=http://radiographics.rsna.org/content/26/2/419/F12.small.gif&imgrefurl=http://radiographics.rsna.org/content/26/2/419.figures-only&usg=__VpUj1hDYgg3gkRJ5XSe6l8I_dXA=&h=192&w=200&sz=34&hl=en&start=44&itbs=1&tbnid=bQ3pvndRAhzw_M:&tbnh=100&tbnw=104&prev=/images%3Fq%3Dhysterosalpingography%26start%3D40%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1
Bicornuate uterus. Spot radiograph shows two markedly splayed uterine horns. The fallopian tubes are not visualized at this imaging stage.http://www.google.com.eg/imgres?imgurl=http://radiographics.rsna.org/content/26/2/419/F12.small.gif&imgrefurl=http://radiographics.rsna.org/content/26/2/419.figures-only&usg=__VpUj1hDYgg3gkRJ5XSe6l8I_dXA=&h=192&w=200&sz=34&hl=en&start=44&itbs=1&tbnid=bQ3pvndRAhzw_M:&tbnh=100&tbnw=104&prev=/images%3Fq%3Dhysterosalpingography%26start%3D40%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1
Hysterosalpingography (left image): The contrast material passes the tube from a single unicornate uterus (arrow) to the peritoneal cavity.Hysterosalpingography (right image): Bicornate uterus (arrows) with connected tubes is visible. The contrast material cannot get from the tubes into the peritoneal cavity. A winding hydrosalpinx is visible on the left side.
http://www.google.com.eg/imgres?imgurl=http://www.szote.u-szeged.hu/radio/emlo/emlo9b.gif&imgrefurl=http://www.szote.u-szeged.hu/radio/emlo/aemlo9b.htm&usg=__nxxlQBzxofO1Y1i2DSPswhMmSxU=&h=370&w=720&sz=177&hl=en&start=21&itbs=1&tbnid=ODJ0QDo-1feiuM:&tbnh=72&tbnw=140&prev=/images%3Fq%3Dhysterosalpingography%26start%3D20%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1
FINDINGS:
1-Hysterosalpingography may show normal findings, which will show a healthy, normally shaped uterus and unblocked fallopian tubes which permits egress of free inverted comma shaped contrast spillage into the peritoneal cavity bilaterally.
2-Hysterosalpingography findings include intra-uterine filling defects, congenital uterine anomalies (Mullerian anomalies), tubal disease such as proximal, middle or distal tubal occlusion with or without hydrosalpinx, endometriosis, salpingitis isthmica nodosa, T-shaped uterine deformity in females who have been exposed in utero to diethylstilbestrol, vesicovaginal fistula, uterovesical fistula and infantile uterus.
3-Intra-uterine filling defects are commonly caused by intra-uterine adhesions, submucous fibroids, and endometrial polyps.[7] Intra-uterine filling defects due to polyps and submucous fibroids are usually smooth and well-defined whereas intra-uterine filling defects due to adhesion are usually irregular and ragged and may cause reduction in size of uterine cavity depending on the severity of the intra-uterine adhesion. On the other hand, fibroids and endometrial polyps in addition to causing luminal filling defects, will also cause uterine cavity enlargement and sometimes deformities.
4-Tubal blockage are very common hysterosalpingographic findings and are usually due pelvic inflammatory disease.[1,2,3,4,5,6,7] This usually manifest as unilateral or bilateral tubal blockage and with or without hydrosalpinx. There could be contrast intravasation and visualization of uterine and ovarian veins in complete tubal blockage. Often times contrast intravasation occurs in excessive injection pressure. Findings in the tubes also include peri-tubal and peri-fimbral adhesions.
5-Hysterosalpingographic findings is accurately diagnostic in mullerian anomalies of the uterus leading to uterine septum, unicornuate uterus, biocornuate uterus and uterus didelphys.[6,7] These mullerian anomalies are cause by either absence of fusion of the two mullerian systems or partial/incomplete fusion of the mullerian system during embryogenesis.
6-Hysterosalpingography can distinguish septate uterus from bicornuate uterus by measuring the cornual angle which in bicornuate uterus is usually more than 60°.
7-Findings at hysterosalpingography include T-shaped uterus in female patients exposed to diethylstilbestrol in utero, endometriosis interna (adenomyosis) which appears as multiple flask shaped contrast-filling out-pouching, salpingitis isthmica nodosa seen as small blobs or out-pouching of contrast out of the tubal lumen in the isthmus region, presumably representing small diverticula.
8-The etiology of salpingitis isthmic nodosa is not clear there appears to be a relationship to endometrosis.
1-Hysterosalpingography may show normal findings, which will show a healthy, normally shaped uterus and unblocked fallopian tubes which permits egress of free inverted comma shaped contrast spillage into the peritoneal cavity bilaterally.
2-Hysterosalpingography findings include intra-uterine filling defects, congenital uterine anomalies (Mullerian anomalies), tubal disease such as proximal, middle or distal tubal occlusion with or without hydrosalpinx, endometriosis, salpingitis isthmica nodosa, T-shaped uterine deformity in females who have been exposed in utero to diethylstilbestrol, vesicovaginal fistula, uterovesical fistula and infantile uterus.
3-Intra-uterine filling defects are commonly caused by intra-uterine adhesions, submucous fibroids, and endometrial polyps.[7] Intra-uterine filling defects due to polyps and submucous fibroids are usually smooth and well-defined whereas intra-uterine filling defects due to adhesion are usually irregular and ragged and may cause reduction in size of uterine cavity depending on the severity of the intra-uterine adhesion. On the other hand, fibroids and endometrial polyps in addition to causing luminal filling defects, will also cause uterine cavity enlargement and sometimes deformities.
4-Tubal blockage are very common hysterosalpingographic findings and are usually due pelvic inflammatory disease.[1,2,3,4,5,6,7] This usually manifest as unilateral or bilateral tubal blockage and with or without hydrosalpinx. There could be contrast intravasation and visualization of uterine and ovarian veins in complete tubal blockage. Often times contrast intravasation occurs in excessive injection pressure. Findings in the tubes also include peri-tubal and peri-fimbral adhesions.
5-Hysterosalpingographic findings is accurately diagnostic in mullerian anomalies of the uterus leading to uterine septum, unicornuate uterus, biocornuate uterus and uterus didelphys.[6,7] These mullerian anomalies are cause by either absence of fusion of the two mullerian systems or partial/incomplete fusion of the mullerian system during embryogenesis.
6-Hysterosalpingography can distinguish septate uterus from bicornuate uterus by measuring the cornual angle which in bicornuate uterus is usually more than 60°.
7-Findings at hysterosalpingography include T-shaped uterus in female patients exposed to diethylstilbestrol in utero, endometriosis interna (adenomyosis) which appears as multiple flask shaped contrast-filling out-pouching, salpingitis isthmica nodosa seen as small blobs or out-pouching of contrast out of the tubal lumen in the isthmus region, presumably representing small diverticula.
8-The etiology of salpingitis isthmic nodosa is not clear there appears to be a relationship to endometrosis.
TECHNIQUE
1-The patient must be booked for the examination according to 10-day rule to avoid performing the examination in a pregnant patient or during active menstruation. Hysterosalpingography is an out-patient radiologic procedure under fluoroscopic guidance by a radiologist, with spot films taken at different intervals during the examination. The total fluoroscopic exposure is usually kept to 30 seconds to minimize radiation exposure to the radiologist.
2-As with other types of pelvic examinations, the woman will lie on her back on a radiographic table with her legs sometimes raised in stirrups. The x-ray equipment is placed above the abdomen and the central beam centred at the mid-point of the line drawn from the anterior-superior iliac spine and the pubic symphysis in the mid-line or mid-point between the pubic symphysis and the umbilicus.
3-A bi-valve speculum is inserted into the vagina and opened to expose the cervix. A special hysterosalpingography cannula or a paediatric self retaining catheter is used to inject about 10ml of contrast media piece-meal under fluoroscopic vision by the supervising radiologist.
4-As the contrast media usually urografin which is an ionic contrast media commonly used by radiologists including the author, spreads through reproductive tract the radiologist screens for tubal blockages or other uterine abnormalities fluoroscopically.
5-Commonly, three spot film are taken accompanied by a scout film obtained before instillation of contrast medium. The cost of hysterosalpingography in Nigeria is between N3000 – N10,000.
http://www.google.com.eg/imgres?imgurl=http://www.medikkajournal.com/images/hsg1.png&imgrefurl=http://www.medikkajournal.com/hsg.htm&usg=__DQKk7xNpPSokaaWD7pPUjHwZsMU=&h=291&w=385&sz=519&hl=en&start=29&itbs=1&tbnid=BKV86m6xL6I4XM:&tbnh=93&tbnw=123&prev=/images%3Fq%3Dhysterosalpingography%26start%3D20%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1
1-The patient must be booked for the examination according to 10-day rule to avoid performing the examination in a pregnant patient or during active menstruation. Hysterosalpingography is an out-patient radiologic procedure under fluoroscopic guidance by a radiologist, with spot films taken at different intervals during the examination. The total fluoroscopic exposure is usually kept to 30 seconds to minimize radiation exposure to the radiologist.
2-As with other types of pelvic examinations, the woman will lie on her back on a radiographic table with her legs sometimes raised in stirrups. The x-ray equipment is placed above the abdomen and the central beam centred at the mid-point of the line drawn from the anterior-superior iliac spine and the pubic symphysis in the mid-line or mid-point between the pubic symphysis and the umbilicus.
3-A bi-valve speculum is inserted into the vagina and opened to expose the cervix. A special hysterosalpingography cannula or a paediatric self retaining catheter is used to inject about 10ml of contrast media piece-meal under fluoroscopic vision by the supervising radiologist.
4-As the contrast media usually urografin which is an ionic contrast media commonly used by radiologists including the author, spreads through reproductive tract the radiologist screens for tubal blockages or other uterine abnormalities fluoroscopically.
5-Commonly, three spot film are taken accompanied by a scout film obtained before instillation of contrast medium. The cost of hysterosalpingography in Nigeria is between N3000 – N10,000.
http://www.google.com.eg/imgres?imgurl=http://www.medikkajournal.com/images/hsg1.png&imgrefurl=http://www.medikkajournal.com/hsg.htm&usg=__DQKk7xNpPSokaaWD7pPUjHwZsMU=&h=291&w=385&sz=519&hl=en&start=29&itbs=1&tbnid=BKV86m6xL6I4XM:&tbnh=93&tbnw=123&prev=/images%3Fq%3Dhysterosalpingography%26start%3D20%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1
Uterus, müllerian duct abnormalities. Surgically proven case of bicornuate uterus. Correct diagnosis may be suggested based on hysterosalpingography findings, which are, most notably, the widened intercornual distance (>4 cm) and the widened intercornual angle (>60°).http://http://www.google.com.eg/imgres?imgurl=http://img.medscape.com/pi/emed/ckb/radiology/336139-405335-2058.jpg&imgrefurl=http://emedicine.medscape.com/article/405335-imaging&usg=__47tWQmkLU6UP3z8inXOFG40AEY4=&h=420&w=576&sz=87&hl=en&start=18&itbs=1&tbnid=tQTOLvSgRcPLSM:&tbnh=98&tbnw=134&prev=/images%3Fq%3Dhysterosalpingography%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1
Uterus, müllerian duct abnormalities. T-shaped uterus. Classic configuration of the uterine cavity in a typical diethylstilbestrol-exposed uterus (American Fertility Society class VII). Uteri are typically hypoplastic. In this patient, no maternal history of diethylstilbestrol exposure was found.http://http://www.google.com.eg/imgres?imgurl=http://img.medscape.com/pi/emed/ckb/radiology/336139-405335-2058.jpg&imgrefurl=http://emedicine.medscape.com/article/405335-imaging&usg=__47tWQmkLU6UP3z8inXOFG40AEY4=&h=420&w=576&sz=87&hl=en&start=18&itbs=1&tbnid=tQTOLvSgRcPLSM:&tbnh=98&tbnw=134&prev=/images%3Fq%3Dhysterosalpingography%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1
Hysterosalpingography (left image): Severe dilatation of the tubes following a short intact section (black arrows) is visible. The contrast material cannot get into the peritoneal cavity. Operation is not possible because the intact part of the tube is short.Right image: Significant dilatation of only the distal part of the tubes (arrows) is visible, therefore the abnormal part can be resected.
http://http://www.google.com.eg/imgres?imgurl=http://www.szote.u-szeged.hu/radio/emlo/emlo9c.gif&imgrefurl=http://www.szote.u-szeged.hu/radio/emlo/aemlo9c.htm&usg=__MS-RJu8NFOZKRjpw2vKugRuLzhM=&h=400&w=654&sz=187&hl=en&start=6&itbs=1&tbnid=vZeWr6VdjuIBhM:&tbnh=84&tbnw=138&prev=/images%3Fq%3Dhysterosalpingography%26hl%3Den%26sa%3DG%26gbv%3D2%26tbs%3Disch:1
normal case
Hysterosalpingography: Normal anatomical structures. The contrast material is injected through a Schultze-device placed into the cervix. The contrast material outlines the uterine cavity and the thin Fallopian tubes opening into the peritoneal cavity.
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