Glioblastoma Multiforme on CT Scan

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Neuroimaging&labelpk=84a3cf36-44c2-4370-9522-50369eb830e3&pk=672b8da7-2a8d-43a2-a608-7fef8194b9bb

Findings

• The CT scan shows a large oval mass in the right frontal lobe with surrounding edema.
• There is a leftward midline shift and compression of the right lateral and third ventricles.

Discussion

There is a differential for low-attenuation supratentorial lesions on CT as well as for corpus callosum edema. This patient has glioblastoma multiforme, the most common primary brain malignancy in adults (20% of all primary brain tumors). MRI is more sensitive than CT for detecting brain tumors. CT is superior for detecting calcifications within the lesion.

Glioblastoma Multiforme on CT Scan

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Neuroimaging&labelpk=84a3cf36-44c2-4370-9522-50369eb830e3&pk=672b8da7-2a8d-43a2-a608-7fef8194b9bb

Findings

• The CT scan shows a large oval mass in the right frontal lobe with surrounding edema.
• There is a leftward midline shift and compression of the right lateral and third ventricles.

Discussion

There is a differential for low-attenuation supratentorial lesions on CT as well as for corpus callosum edema. This patient has glioblastoma multiforme, the most common primary brain malignancy in adults (20% of all primary brain tumors). MRI is more sensitive than CT for detecting brain tumors. CT is superior for detecting calcifications within the lesion.

eradiology

Epidural Hematoma on CT scans

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Neuroimaging&labelpk=84a3cf36-44c2-4370-9522-50369eb830e3&pk=e56ebea9-dcd1-44d4-9aea-bd6bfe3df54e

Findings

• The CT scans demonstrate a left frontal epidural hematoma.

Discussion

Epidural hematomas arise in the potential space between the dura and the skull and do not cross sutural margins; the bleeding is mostly due to rupture of the middle meningeal artery. The major cause for EDH is trauma and skull fractures are present in 75 to 95 percent of patients. Epidural bleeds produce a bi-convex (lens-shaped) hematoma on CT because the collection is limited by dural attachments at the cranial sutures.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) Complications: Berry Aneurysm on CT Scan, Diverticulitis on BE

Findings

• The CT demonstrates a berry aneurysm off the Circle of Willis.
• The BE demonstrates diverticulosis of the sigmoid with eccentric mass effect due to an intramural diverticular abscess i.e. diverticulitis.

Discussion

ADPKD is one of three major inherited cystic diseases of the kidney. The kidneys become markedly enlarged with cysts. These distort the calyces and renal outline and cause mass effect on surrounding organs. The kidneys are abnormal and frequently show dystrophic calcifications. The liver and pancreas frequently contain cysts. There is an increased incidence of diverticular disease of the colon. There is an increased incidence of cerebral artery aneurysms.

Thickened Bladder Wall. Axial US of a neurogenic bladder (B) demonstrates marked thickening (arrows) of the bladder wall with trabeculation. The patient had an indwelling Foley catheter, the tip of which is evident (open arrow).

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Ectopic Ureterocele. US images in left sagittal (A) and transverse (B) planes demonstrate an ectopic ureterocele (u) of the left upper pole ureter (lu) protruding into the lumen of the bladder base. The upper pole collecting system was hydronephrotic, but the lower pole collecting system was normal. The wall of the ureterocele (arrows) is clearly seen. A ureterocele changes in size with peristalsis of the ureter. B, bladder.

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Bladder Diverticulum. Axial-plane image shows a urine-filled diverticulum (D) projecting through a defect (arrow) in the bladder wall. B, bladder.

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Enlarged Prostate. Midline sagittal US image shows an enlarged prostate (P) protruding into and elevating the base of the bladder (B). The urethral orifice (long arrow) forms a V-shaped depression in the prostate. The seminal vesicles (open arrow) are also seen. The bladder wall is mildly thickened (between short arrows).

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Prostate Abscess. Transverse transrectal US reveals an abscess (arrows) in the right side of the prostate gland in a patient with fever, pelvic pain, and pyuria. The abscess contained purulent debris, which was seen on US as floating particulate matter.

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Benign Prostatic Hypertrophy. Transrectal axial US view through the midprostate demonstrates excellent differentiation of a normal peripheral zone (pz, solid arrows). The inner gland (IG) demonstrates mild enlargement and heterogeneity that is characteristic of benign prostatic hypertrophy. A small prostatic cyst is evident (open arrow). The hypoechoic fibromuscular zone (FM) is anterior. A, anterior; P, posterior.

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Prostate Cancer. Right sagittal transrectal US image shows a distinct hypoechoic nodule (arrows) in the peripheral zone. US-guided transrectal needle biopsy confirmed prostate carcinoma. sv, seminal vesicle.

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Normal Seminal Vesicles. Transrectal US image shows the normal hypoechoic convoluted tubular appearance of the seminal vesicle (arrow). B, bladder.

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Prostate Anatomy. Transrectal US images of the prostate are routinely viewed inverted. The transducer is at the bottom rather than the top of the image. This sagittal image shows the normal peripheral zone (arrow) to be slightly echogenic compared to the hypoechoic, more heterogeneous central gland (G).

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Chronic Epididymitis. The epididymis (arrows) is grossly enlarged and has a large central echogenic area, representing fibrosis and chronic inflammation. The testis (T) is diffusely hypoechoic because of diffuse orchitis.

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Spermatocele. US image displays a complex, septated extratesticular cyst (arrows) at the superior pole of the testicle (T). Debris within the spermatocele produces floating particles within the fluid.

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Varicocele. Sagittal view of the scrotum demonstrates a network of curving tubular structures (between arrows) at the superior pole of the testis (T). Color Doppler US confirmed slow venous flow within these dilated vessels.

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Large Hydrocele. An US image through the long axis of the testis (T) demonstrates its homogeneous midlevel echogenicity. The head of the epididymis is seen as a small nodular structure (curved arrow) at the superior aspect of the testis. The tunica albuginea (straight arrow) is the tough fibrous capsule that covers the testis. The hydrocele (H) surrounds all portions of the testis except its posterior portion, where the testis is attached to the scrotal wall.

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Fractured Testis. The testis (T) is heterogeneous and its normal shape is disrupted. Multiple areas of hemorrhage (arrowheads) are evident. This man had been injured in a motorcycle accident.

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Dilated Rete Testis. A complex-appearing mass is made up of numerous tiny cystic tubular structures and is located in the mediastinum of the testis.

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Testicular Cyst. A benign testicular cyst is viewed as a well-defined, spherical, uniformly anechoic mass (arrow) within the testis. Care must be taken to differentiate simple testicular cysts from cystic necrosis within testicular tumors.

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Testicular Microlithiasis. Innumerable tiny echogenic spots (arrows) are evident throughout the testicular parenchyma. This benign condition is associated with a significant risk of testicular carcinoma.

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Malignant Melanoma Metastasis. Long-axis view of the testis reveals complete replacement of parenchyma by an inhomogeneous, predominantly hypoechoic tumor (between arrows). No recognizable normal parenchyma remains.

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Choriocarcinoma. An US view of a testis in long axis demonstrates a large tumor (between open arrows) replacing the testicular parenchyma. Note the marked inhomogeneity of the tumor with large areas of necrosis (n). The residual testicular parenchyma is indicated by the black arrows.

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Seminoma. Longitudinal US demonstrates near-complete replacement of the testes (betweenwide arrows) by a homogeneous hypoechoic mass (S) that proved to be seminoma. Only a thin rim of normal testicular parenchyma remains (between thin arrows).

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Acute Orchitis. Transverse US view of the scrotum demonstrates the left testis (LT) to be diffusely hypoechoic compared to the right testis (RT). A small hydrocele (H) is seen in the left hemiscrotum. The midline septum (arrow) dividing the scrotum into two separate compartments is evident.

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Acute Epididymo-orchitis. Color flow US image (shown in grayscale) demonstrates enlargement and marked hypervascularity of the epididymis (arrow). The testis (T) is mildly increased in vascularity as well.

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Testicular Torsion. Spectral Doppler shows no evidence of blood flow within the testis (T). Careful examination with color flow US confirmed this finding.

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Hydrosalpinx. Transvaginal US demonstrates the tubular nature of an adnexal mass, confirming hydrosalpinx.

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Metastatic Ovarian Carcinoma. A. US image of the pelvis in a 68-year-old woman presenting with sudden onset of ascites confirmed ascites (A) with tumor implants (T) on the peritoneal surfaces. The uterus (U) is seen in transverse section, with the broad ligaments (arrows) outlined by fluid. B. Sagittal US image from the upper abdomen demonstrates tumor implantation (T) on the greater omentum outlined by fluid (A). This appearance has been called “omental cake.”

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Ovarian Carcinoma. Transvaginal sonogram of an adnexal mass shows it to be predominantly cystic but with prominent septations of irregular thickness and nodularity. Color Doppler USshowed blood vessels coursing through the nodules and septa, confirming neoplastic tissue. Pathologic diagnosis was clear cell carcinoma of the ovary.

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Signs of Malignancy of pelvic tumors:

Because most pelvic masses are discovered, or initially evaluated, by US, every effort should be made to assess the risk of malignancy (13,14). Transvaginal US aids substantially in the evaluation. The following signs correlate with an increased risk of malignancy (15):

• Solid consistency: the more solid tissue present, the greater the risk of malignancy. Solid tissue includes thick walls, thick septations, papillary projections, and solid tumor mass (Fig. 37.16). Unilocular cysts or cysts with thin septations are likely to be benign. Thick-walled, multilocular masses with solid nodules are likely to be malignant. Echogenic solid masses, or portions of masses, that transmit sound poorly are likely to be malignant.
• Size greater than 10 cm correlates with a 64% risk of malignancy in postmenopausal women. Masses under 5 cm are more likely to be benign.
• Color flow US demonstration of blood vessels within papillary projections is evidence of neoplasm and provides differentiation from avascular blood clots adherent to the cyst wall. Vascularized papillary projections are more common with malignant neoplasms.
• Color flow US demonstration of blood vessels within septations is strong evidence of neoplasm. Hemorrhagic functional cysts may be complex in appearance

  
  

  
  but lack internal vascularity. Blood flow in the wall of cystic masses is commonly seen with both benign and malignant lesions.

Benign Mucinous Cystadenoma. This ovarian tumor caused a huge mass, filling the pelvis and lower abdomen. US examination confirmed a cystic mass (C) with a network of fine septations (arrow). The absence of detectable solid components suggests a benign tumor.

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Benign Cystic Teratoma. US of a pelvic mass demonstrates a fluid–fluid layer (curved arrow) and a large area of calcification (black arrow) with acoustic shadowing (S, between white arrows). Surgery confirmed a benign cystic teratoma containing teeth (the calcified portion) along with fat and hair (the fluid–fluid layer).

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Endometrioma. Transvaginal sonogram shows an adnexal cyst (between calipers) with uniform thin wall and homogeneous fine internal echoes. This appearance may be seen with either a hemorrhagic ovarian cyst or an endometrioma. Endometrioma should be suspected if the cyst fails to resolve within 2 months.

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Tubo-ovarian Abscess. US of the adnexa reveals a complex mass (arrowheads) enveloping the ovary (O) and tube (arrow). Physical examination revealed marked pelvic tenderness with fixation of the pelvic organs.

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Hemorrhagic Functional Cyst. Transvaginal US shows the complex internal echogenicity of a hemorrhagic functional cyst (between calipers), which resolved on follow-up US examination 2 months later. The lacy internal appearance is characteristic of evolving hemorrhage.

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Functional Ovarian Cyst. Transvaginal US demonstrates a well-defined, thin-walled, anechoic ovarian cyst (between calipers) in a 36-year-old woman. A small portion of the ovary (arrow) is visible on this image. The appearance is typical of functional ovarian cyst. On follow-up US examination 10 weeks later, the cyst had resolved.

Adenomyosis. The junctional zone myometrium is irregularly thickened (arrowheads), poorly marginated, and markedly hypoechoic on this transvaginal US image in a woman with abnormal vaginal bleeding and pelvic pain. MR and pathology at hysterectomy confirmed adenomyosis.

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Fluid in the Endometrial Cavity. Anechoic fluid (arrow) is evident within the uterine cavity on this transvaginal US image of the uterus of a 75-year-old woman. The endometrium (arrowhead) is thin and normal. This patient has atrophic cervical stenosis.

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Endometrial Atrophy. Transvaginal sonogram in longitudinal plane reveals a very thin endometrium (arrowhead) measuring only 2 mm in a postmenopausal woman with vaginal bleeding. This is diagnostic of endometrial atrophy as the source of her bleeding. No biopsy is necessary.

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Endometrial Polyp. Transvaginal image in transverse plane taken during a sonohysterography clearly reveals the polypoid nature of the endometrial mass (arrow). Injected sterile saline fluid (f) distends the uterine cavity.

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Endometrial Carcinoma. Transvaginal US reveals a thickened endometrium measured at 14 mm between calipers in a postmenopausal woman with vaginal bleeding. Biopsy confirmed endometrial carcinoma.

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Leiomyoma. Transvaginal image of the uterus shows a hypoechoic leiomyoma (betweenarrowheads) displacing the endometrium (arrows) and impinging on the uterine cavity.

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Retroflexed Uterus. The uterus is flexed with the fundus (f) directed posteriorly toward the sacrum on this sagittal midline transbladder image. A retroflexed or retroverted uterus may be mistaken for a pelvic mass on both physical examination and US. The vagina is well seen with its hypoechoic muscular walls (long arrow) and echogenic mucosa (short arrow). c, cervix; e, endometrium.

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Normal Uterus. A. Transabdominal sagittal plane image through the urine-filled bladder (B) demonstrates the smooth contour and pear shape of the normal uterus (U). The endometrium (betweenarrowheads) is more echogenic than the surrounding myometrium. This image demonstrates the typical three-layer appearance of proliferative phase endometrium. The cervix (C) protrudes into the upper vagina (V) at the intersection between the long axis of the uterus and the axis of the vagina. B. Transvaginal sagittal-plane image of the uterus demonstrates the improved resolution of this technique. The endometrium (between arrowheads) is more sharply defined and the myometrium is more clearly evaluated. This image demonstrates the typical uniformly echogenic appearance of secretory phase endometrium.

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Nonseminomatous germ cell tumor in a 24-year-old man with painless scrotal swelling. Sagittal US image shows a large, heterogeneous intratesticular tumor with cystic areas.

http://radiographics.rsna.org/content/27/5/1239.full

Mixed nonseminomatous germ cell tumor that manifested as a cystic lesion in a 36-year-old man who presented with testicular enlargement and pain of 2 months duration. Sagittal US scan of the right testicle shows multiple cystic regions surrounded by a rim of hyperechoic testicular parenchyma distinct from the normal testicular parenchyma. Color and duplex Doppler US did not show any blood flow in the cystic areas but did show flow in the tumor stroma surrounding these cystic areas. The patient underwent orchiectomy, which confirmed the diagnosis.

http://radiographics.rsna.org/content/21/suppl_1/S273.figures-only

Fibrous pseudotumor in a 61-year-old man. (a)Longitudinal US image shows a solid mass (arrow) adjacent to the testis (TEST) and epididymis (EPI). The mass is hypoechoic compared with the testis and demonstrates faint posterior shadowing. (b)Coronal T2-weighted fat-suppressed image shows a markedly hypointense mass (arrow) with a pedunculated attachment to the tunica. It is surrounded by a high-signal-intensity hydrocele. The mass was isointense relative to the testis on a T1-weighted image (not shown). T = testis. (c) Photograph of the gross specimen shows a rubbery, slightly laminated mass. Scale is in centimeters.

http://radiographics.rsna.org/content/23/1/215.full

Polyorchidism. (a, b) Coronal T1-weighted (a) and T2-weighted (b) images show two testes within the right hemiscrotum (arrows). They are slightly smaller than, but identical in signal intensity to, the normal left testis. On both images, all three testes are surrounded by a low-signal-intensity tunica albuginea. (c)Photograph obtained after a right inguinal orchiectomy shows two ovoid testes.

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