Inner Visions Answer

We concluded that the cigarette-lighter-shaped-device was after all an Insertable  Loop Recorder called Reveal Plus and produced by Medtronics®, with the purpose of monitoring patients at increased risk of cardiac arrhythmias. This device is leadless and MRI compatible and placed subcutaneously with minimally invasive procedure. It has a remote controller allowing in-office device programming and data retrieval using the Medtronic Software.

Innner Visions

A middle-aged woman went to her breast cancer screening (every two year) and had 4-incidence mammograms. These were unremarkable except for the device seen on the MLO incidence and located in the upper outer quadrant closed to the left axilla.  

Although this location is most often chosen to place cardiac devices such as pacemakers or implantable cardioverter defibrillators sometimes chemotherapy catheters are placed here. Either way, both have wires and connections, the first to the right auricle and the former to superior cava vein or subclavia vein.  The lack of wires and the resemblance to a cigarette lighter or to a memory pen led to further investigation, as we had access to the following exams where the device was again seen.

Christmas Time

16/12/2011 às 13h- Biblioteca do Serviço de Radiologia IPOL

Apresentação dos seguintes trabalhos (referentes à Jornadas de Coimbra)

Doenças Hepáticas Difusas - Revisão das principais características imagiológicas

1ºAutor: João Niza (Apresentado em Coimbra como Poster)

 

Infecção Fúngica Hepato-Esplénica Nos Doentes Hemato-Oncológicos Adultos Do IPOLFG Nos Últimos 10 Anos

1ºAutor: Marta Morna Palmeiro (Apresentado em Coimbra como Poster)

 

TUMORES NEUROENDÓCRINOS DO PÂNCREAS: CASUÍSTICA E ANÁLISEDE ASPETOS CLÍNICO/RADIOLÓGICOS SOB A RECENTE CLASSIFICAÇÃO DA WHO

1ºAutor: Elisa Melo Abreu (Apresentado em Coimbra como Comunicação)

 

Tumor Quísticos do Pâncreas – Espectro Imagiológico

1º Autor: Joana Ip (Apresentado em Coimbra como Comunicação)

Case 4

Doente de 60 anos, sexo masculino.
Operado a tumor neuroendócrino do íleon em 2003.
Ecografia abdominal. de Novembro 2008.

Fundamentals of Diagnostic Radiology

Published:05 March 2012

Case - Abdominal Pain

26-year-old man otherwise healthy.
Lower abdominal pain started 6 hours ago
38ºC, elevetad WBC
Ultrasound of lower abdominal quadrant performed on ER.

Chicago News

CT Artifacts

On the way to Coimbra!

Answer to - Spleen Focal Lesions

Focal lesions of the spleen can be classified as benign or malignant. Benign lesions are more common, including cysts, infarcts, abscesses, haemangioma, hamartomas and calcifications. Malignant lesions are less frequent and include primary lymphoma, sarcomas and metastatic involvement.

Splenic metastases are very rare and most often appear asymptomatic. The literature reports an incidence in autopsy of 0, 6% and in splenectomy of 1, 1%. The most common primary tumour sites are breast and lung, followed by GI tract tumours (oesophagus, stomach and colon), along with few female reproductive organ malignancies (ovary), head and neck neoplasias (pharyngeal) and malignant melanoma. They may appear as a unique focal lesion or multiple lesions within the spleen. Splenic metastases are usually part of wide-spread disseminated malignancies however primary lesions can also occur.

On CT splenic metastases are round masses, very well circumscribed, spontaneously hypodense and fail to enhance after the IV contrast uptake. Carcinoid tumours in general tend to be hypervascularised and may demonstrate intense enhancement during arterial phase. However, spleen metastases from primary neuroendocrine can appear isodense or slightly hyperdense after contrast uptake, since the healthy spleen normally demonstrates heterogeneous enhancement during the parenchymal phase of opacification.

On ultrasound most splenic metastases may appear similar to those depicted in the liver. Most often they have round and well circumscribed shape and are usually hypoechoic. Despite splenic lesions with increase of echogenicity are uncommon in patients with lymphoma, they can often develop as metastatic involvement from neuroendocrine cancers. Commonly these metastases may increase the overall spleen size as well as causing complains of compression or further capsule rupture.

At MRI splenic metastases are typically hyperintense nodules or masses on T2-weighted images and hypo / isointense on T1-weighted sequences. The degree and characteristics of enhancement depend on the nature and type of the underlying primary neoplasm. These features are also applicable to carcinoid tumours.

The SPECT often depicts splenic enhanced spots attributable to metastatic disease.

Spleen Focal Lesions

Abdominal Contrast-enhanced CT

 Abdominal Ultrasound - Spleen

Answer to "Resident's Ultrasound Fear"

Chilaiditi syndrome

Chilaiditi syndrome is a rare condition when pain occurs due to transposition of a loop of large intestine (usually transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest X-ray.

Normally this causes no symptoms, and this is called Chilaiditi's sign. The sign can be permanently present, or sporadically. This anatomical variant is sometimes mistaken for the more serious condition of having air under the diaphragm (pneumoperitoneum) which is usually an indication of bowel perforation. This may lead to unnecessary surgical interventions.

Chilaiditi syndrome refers only to complications in the presence of Chilaiditi's sign. These include abdominal pain,torsion of the bowel (volvulus) or shortness of breath.

Resident's Ultrasound Fear!

ESR Facebook Page!

We've got 6000 likes and right now more of them are from Portugal than from anywhere else!

http://www.facebook.com/myESR

Prof. Caceres @ ESR Blog

http://blog.myesr.org

ECR 2012 Abstract Submission

Become part of Europe's leading imaging meeting and submit your abstract online now!
Abstract submission for scientific papers (oral presentations) has closed. You can still submit an abstract for an electronic posters by December 31, 2011.

For information on year-round submission of ECR 2012 poster abstracts to EPOS^TM please click here or submit your poster abstract at www.myESR.org/epos_submission

All abstracts for scientific papers for ECR 2012 had to be submitted by September 18, 2011 at the latest, in order to be considered by the board of reviewers.
Scientific paper abstracts must not exceed 250 words and should be structured as follows:
Purpose – Methods and Materials – Results – Conclusion

Resposta ao Caso 3 - Pneumonia Pós-Radiógena

A radioterapia pulmonar é actualmente utilizada com fins terapêuticos curativos e adjuvantes em várias neoplasias: pulmão, mama, esófago e mediastino (tumores hematológicos).

As manifestações da doença pulmonar induzida pela radioterapia podem assumir vários aspectos radiológicos, de acordo com: o total dose de radiação, o volume torácico irradiado e fraccionamento das doses.

Consideram-se duas fases de aparecimento de alterações após a conclusão do tratamento

• Fase precoce (4-12 semanas) com pneumonite de radiação traduzindo-se por opacidades em vidro-despolido ou consolidações; 
• Fase tardia (6-24 meses) com alterações de fibrose com bronquiectasias, perda de volume e aspectos de cicatrização.

A utilização de novas técnicas em Radioterapia: definição de novas portas, equipamentos com software 3D e estereotaxia originou um espectro de lesões pulmonares menos comuns neste contexto, e que podem mimetizar outras patologias pulmonares, tais como: infecções, recidiva tumoral, carcinomatose linfangítica ou tumores com aparecimento de novo.

A TC é o método de imagem mais sensível e eficaz para avaliar este tipo de patologia numa fase inicial, permitindo estabelecer uma orientação terapêutica e prognóstica.

RSNA 2011 @ Chicago

Journées Françaises de Radiologie 2011

Journées Françaises de Radiologie 2011

21 - 25 octobre 2011

Adresse: Palais des Congres - Porte Maillot Ville: Paris Pays: France Organisateur: Société Française de Radiologie Contact: SFR@sfradiologie.org

Les 59e Journées Françaises de Radiologie et les 32e Journées Francophones sont un lieu de rencontres des acteurs de santé et également des Journées de formation très denses dans tous les domaines de l'imagerie (116 conférences scientifiques et thématiques, 300 heures d'enseignement et d'ateliers, 642 posters électroniques ...). Aussi dans le F et le R des JFR, peut-on également entendre Formation et Rencontres qui restent et resteront les objectifs majeurs de nos journées.

Formation : Pour appréhender les évolutions technologiques en matière de radiologie et mesurer leur impact pratique, organisationnel et économique, la SFR, organisme agréé de FMC n° 100132, offre des formations pratiques en France, en région, à l’international. Pour bien soigner un médecin, doit continuellement se former et évaluer ses pratiques professionnelles.

Caso 3

Doente de 60 anos, sexo feminino


História Actual - cansaço, dispneia ligeira e alteração laboratorial dos parâmetros inflamatórios.


Antecedentes Pessoais - Carcinoma da mama esquerda submetida a cirurgia em Abril/2010, Radioterapia de Jan/2011 a final de Fev/2011.

By ID

Resposta ao Caso 2

Tarsal coalition

Tarsal coalition is an abnormal connection between two tarsal bones of the feet. Tarsal coalition is seen in nearly 1% of the population and most often seen between the calcaneus and navicular (calcaneonavicular) or the talus and calcaneus (talocalcaneal). The union can be bony, fibrous or cartilaginous and is a result of abnormal development. As the child matures, the abnormal union can ossify and create abnormal stress on the foot. As a result, children will often experience a loss of mobility and foot pain that presents during the adolescent period. More than half of cases will be bilateral.

 

Radiologic Overview of the Diagnosis:

Radiographs: Talonavicular coalition is difficult to visualize on radiographs, as in this case, and is suggested by secondary findings such as "talar beaking", irregular joint margins, and degenerative change at other joints. Visualization of the talonavicular joint on the lateral view excludes coalition. CT is usually performed to make the diagnosis.

 

Calcaneonavicular coalition is usually easily demonstrated on radiographs. The abnormal connection between the calcaneous and navicular is best demonstrated on the oblique view. The lateral view can demonstrate an elongated anterosuperior calcaneous which extends towards the navicular and termed "anteater’s nose."

 

CT: CT is often used to make the final diagnosis of coalition following radiographic evaluation. Coronal and axial images are usually obtained. CT will demonstrate bony bridging at the respective joints or narrowed irregular margins of the joint in the case of fibrous and cartilaginous coalitions.

 

Key points:

• Coalition often presents in adolescence with foot stiffness and pain.
• Coalition is difficult to see directly on radiographs and often suggested by secondary signs
• CT is often performed to make the final diagnosis.

ESUR 2011 @ Dubrovnik

General Info

ESUR – SUR 2011
International Urogenital Radiology
Joint Meeting of European Society of Urogenital Radiology and Society of Uroradiology

Congress Chairman: Boris Brkljačić, Zagreb, HR
President ESUR: Gertraud Heinz-Peer,  Wien, AT
President SUR: Ronald J. Zagoria, Winston-Salem, NC, US
SUR Honorary Lecture: Hedvig Hricak, New York, NY, US

MAIN TOPICS: Renal and Female Imaging

October 13-16, 2011
Hotel Dubrovnik Palace

Caso 2

História Actual: 22 anos, queixas álgicas em ambos pés com dificuldade na marcha


Antecendentes Pessoais: LLA aos 13 anos

By JPCS

Abdominal Cross-Sectional Imaging - ESOR

Course type: advanced course

Course date:
October 13-14, 2011


Local organiser:
J. Venancio

Course venue:
Hotel Sofitel Lisbon Liberdade
Avenida da Liberdade, 127
1269038 Lisboa
Portugal

Learning objectives:

• to refresh knowledge of cross sectional anatomy and diseases of the abdominal organs


• to get familiar with the most up-to-date abdominal imaging techniques including virtual endoscopy


• to learn more about most important findings and diagnostic algorithm in acute abdomen and diseases of the liver, pancreas, bowels and abdominal vessels

VII Jornadas Temáticas da SPRMN

VII Jornadas Temáticas da SPRMN
II Jornadas Ibéricas de Radiologia


http://www.sprmn.pt

Coimbra
9 a 11 de Novembro de 2011

Find the Differences!

By Jip.

Caso 1

Dados Clínicos

Doente 66 anos de idade, sexo masculino.

Antecedentes Pessoais carcinoma pavimento celular da laringe em Dezembro 2010 e AVC há 4 meses.

História Actual abdómen timpazinado e insuficiência renal aguda

 

Hipóteses de Diagnóstico

By ABB

Radiology and Nobel Prize

1901 - Rontgen receives the Nobel Prize in Physics for the discovery of x-rays.
1914 - Von Laue receives the Nobel Prize in Physics for x-ray diffraction from crystals.
1915 - Bragg and Bragg receive the Nobel Prize in Physics for crystal structure derived from x-ray diffraction.
1917 - Barkla receives the Nobel Prize in Physics for characteristic radiation of elements.
1924 - Siegbahn receives the Nobel Prize in Physics for x-ray spectroscopy.
1927 - Compton receives the Nobel Prize in Physics for scattering of x-rays by electrons.
1936 - Debye receives the Nobel Prize in Chemistry for diffraction of x-rays and electrons in gases.
1979 - Comack and Hounsfield receive the Nobel Prize in Medicine for computed axial tomography
1981 - Siegbahn receives the Nobel Prize in Physics for high resolution electron spectroscopy.

IPO de Lisboa

O Instituto Português de Oncologia foi fundado em 29 de Dezembro de 1923, através do Decreto n.º 9333, com a designação de Instituto Português para o Estudo do Cancro. No momento da sua criação, o Instituto ficou na dependência do Ministério da Instrução Pública, antiga designação do actual Ministério da Educação, onde permaneceu até 1987, ano que foi integrado no Ministério da Saúde.

Guiam a sua criação os seguintes objectivos:

• Organizar a luta contra o cancro em Portugal;
• Manter e desenvolver o Centro Regional de Luta Contra o Cancro em Lisboa e promover e desenvolver a criação de outros Centros Regionais;
• Praticar o estudo do Cancro, promover pesquisas científicas, fazer publicações e organizar uma biblioteca especial;
• Divulgar os conhecimentos e preceitos úteis ao público, realizando uma propaganda eficaz contra o “perigo do cancro”;
• Melhorar as condições de trabalho e de estudo do seu pessoal científico e técnico, fundar laboratórios de investigação científica e adquirir o material necessário ao estudo e tratamento do cancro.

O projecto tem como seu principal mentor o Prof. Francisco Gentil (1878 – 1964), que cedo percebeu que o estudo do cancro e o projecto de uma assistência atenta, personalizada e de elevada qualidade aos doentes cancerosos, exigia uma organização independente, a exemplo do que se passava noutros países, de uma enfermagem eficiente e um indispensável elevado nível cientifico.

[...]

O Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E. é a actual designação de uma organização com mais de oito décadas de tradição no tratamento de doentes com cancro e na investigação e ensino da Oncologia. O IPO foi crescendo à medida das necessidades, sendo hoje uma unidade hospitalar distribuída por diversos edifícios.

Tribute - Wilhelm Roentgen

Físico alemão que durante as suas experiências com raios catódicos descobriu em 1895 uma forma anteriormente desconhecida de radiação electromagnética, os Raios X. Recebe por esta razão o primeiro Prémio Nobel da Física em 1901.