Case of the Week From 10/30/2022

History: Renal mass.
What are the findings? Rounded exophytic left renal mass  greater than fluid density without significant enhancement on CT scan (<10 Hounsfield units).  Heterogenous well circumscribed mass on MRI that does not enhance upon MRI contrast administration. Nonhypermetabolic left real mass on FDG-PET scan.
What is the most likely diagnosis and how should it be managed? Complex hemorrhagic cyst. (Bosniak IIF cyst- 5 percent chance of malignancy). Followup study in 6 months, then 1 year, and then annually for five years.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case of the Week From 10/23/2022

History: Increasing hydrocephalus.
What are the findings? Grossly intact shunt. Dial/setting is in the 8:00 position.
How and what do you need to tell the neurosurgeon? You need to tell the neurosurgeon the position of the dial as a clock face. There are many types of programmable shunts with different values at different settings, so you are typically unable to give a specific number.
Why is this information critical to the patient? The neurosurgeons uses this information whether to dial up or down the shunt to increase or decrease the flow of fluid/CSF.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case of the Week From 10/16/2022

History: Chest pain and shortness of breath.
What are the findings? Moderate reversibility at the anterior apical and mid ventricular wall. Accompanying hypokinesis stress imaging compared to rest imaging.
What is the most likely diagnosis? Moderate region of moderate ischemia in the mid LAD/diagonal distribution with myocardial stunning.
How does this diagnosis potentially change management for the patient? Myocardial stunning is a more specific finding for ischemia. Could increase likelihood of sending the patient for catheterization depending on clinical situation.

 

 

Case of the Week From 10/9/2022

History: Thumb stiffness and pain.
What are the findings? Increased signal within the abductor pollicis longus tendon with increased adjacent fluid. Adjacent subcutaneous edema.
What is the most likely diagnosis? De Quevain tenosynovitis.
How is it treated? Conservative treatment with anti-inflammatories/rest. More aggressive treatment- corticosteroid injection. Most aggressive treatment- surgical decompression..

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case of the Week From 10/2/2022

History: History of Prostate Cancer with rising PSA levels. First study is PMSA. Second study is FDG 4 weeks later. No treatment between the two studies.
What are the findings on the first and second studies? First study showed a PMSA avid left para aortic top normal node on axial imaging. Second study showed a nonhypermetabolic node at the same location. First study showed PMSA avid right iliac chain nodes on coronal image and right iliac chain nonhypermetoblic nodes on FDG imaging.
What is the significance of the discrepant findings? PMSA avid nodes suggest most likely prostate cancer related adenopathy. Differential can also less likely include granulomatous disease, sarcoidosis, lymphoma, renal cell cancer, thyroid cancer, and lung cancer. Nonhypermetabolic nodes suggest differentiated disease. (dedifferentiated aggressive cancers tend to be more hypermetabolic). Taken together, these findings add specificity to the diagnosis of differentiated type prostate cancer adenopathy.

 

First Study

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Second Study

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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