Muscular and Digestive

7/28/2019 Muscular and Digestive

1/31

RADIOLOGIC PATHOLOGY


2/31

MUSCULAR SYSTEM


3/31

Dermatofibrosarcoma Protuberans

CT non contrast. Lobulated mass, just in the edge of FOV. Lobulated,similar density


4/31

CT scans shows a well-defined lesion with a distinct lobularor nodular architecture and tissue attenuation approximatelyequal to or greater than that of skeletal muscle. Moderateenhancement is seen on CT scans obtained after injection ofcontrast material.

Dermatofibrosarcoma protuberans is a distinctclinicopathologic entity characterized by fibroblasts with aprominent storiform pattern. It accounts for about 6% of all soft-tissue sarcomas. The lesion is typically superficial, and thediagnosis can be suspected on the basis of the tumor's clinicalappearance. Consequently, the imaging appearance of this entity

is essentially unreported. Large lesions, however, can infiltrate thedeep soft tissue and be confused with higher-grade sarcomas.


5/31

Intra-muscular Hemangioma


6/31

Enhancing mass in the anconius muscle with multiple flowvoids on T1 and T2 weighted images.

Hemangiomas are a type of benign neoplasm closelyresembling normal blood vessels at histology. Hemangiomas are

generally homogeneous although they may contain variouscomponents of fat, vascular thromcosis, phlebolith formation, andfibrosis. They are generally isointense to muscle on T1 andhyperintense on T2. They can be bright on both with large amountsof adipose tissue. They often contain serpintine structures with flowvoids or phelboliths.


7/31

Intra-muscular Lipoma


8/31

Fatty lesion with low signal intensity (isointense with muscleon T1WI, STIR, and T1 fat sat post gad.


9/31

Semitendinosus Tears


10/31

Diagnosis: Grade II strain involving the musculotendinousjunction of the semitendinosus. However, spontaneous hemorrhageinto an underlying muscle sarcoma could not be excluded.

Semitendinosus tears are a relatively infrequently injured

structure in hamstring injuries. In Koulouris et al (SkeletalRadiology 2003; 32: 582-9), their retrospective review of hamstringmuscle complex injuries demonstrated biceps femoris injuries in 124cases, semimembranosus in 21 cases, and semitendinosis in only 9cases.

- Grade I muscle strains: increased interstitial fluid signal between

muscle fibers.- Grade II strains: in addition, there is increased signal betweenmuscles. A focal muscular defect may or may not be seen. Thetendon is thinned and irregular, with surrounding abnormal signal.- Grade III strains: there is a complete muscle disruption, withassociated gap between retracted components.


11/31

Spinal muscular atrophy


12/31

There is atrophy of the entire rotator cuff and deltoid. Highsignal on T1 and T2 sequences is present within the muscles.

Note that there is no mass or lesion involving the spinoglenoid

notch or suprascapular notch. Differential for muscle atrophy of therotator cuff / deltoid includes Parsonage-Turner, QuadralateralSpace Syndrome, and mass effect in one of the areas listed above.


13/31

DIGESTIVE SYSTEM


14/31

Ulcerative Colitis


15/31

Multiple small colonic ulcers seen on films 07-07-93.

Flat / upright films from 07-24-73 demonstrated dilated transversecolon with obstruction.

Radiographically - rectum normal in 20% although almost alwaysinvolved; isolated right colon diseaseleft colon does not occur; TI involved (backwash ileitis (20-25%) -minimal inflammatory changes

Earliest Abnormal - fine granularity of mucosa hazy, fuzzy bowelcontourLoss of haustral markings nonspecificMultiple, symmetric ulcers - "collar button" nonspecificPseudopolyps - islands of edematous mucosa and re-epithelialized

granulation tissue in betweenulcersChronic changes - fibrosis and muscular spasm - "lead pipe"


16/31

Colon Cancer


17/31

Cancerous growths in the colon, rectum and appendix. It is thethird most common form of cancer and the second leading cause ofcancer-related death in the Western world. Colorectal cancer causes655,000 deaths worldwide per year. Many colorectal cancers arethought to arise from adenomatous polyps in the colon. Thesemushroom-like growths are usually benign, but some may develop

into cancer over time. The majority of the time, the diagnosis oflocalized colon cancer is through colonoscopy. Colorectal cancer cantake many years to develop and early detection of colorectal cancergreatly improves the chances of a cure. Therefore, screening for thedisease is recommended in individuals who are at increased risk.


18/31

Achalasia


19/31

In this disorder, the smooth muscle layer of theesophagus has impaired peristalsis (muscularability to move food down the esophagus), andthe lower esophageal sphincter (LES) fails torelax properly in response to swallowing.Themost common form is primary achalasia, whichhas no known underlying cause. Due to thesimilarity of symptoms, achalasia can be

misdiagnosed as other disorders, such asgastroesophageal reflux disease (GERD), hiatushernia, and even psychosomatic disorders.


20/31

Ascariasis


21/31

Perhaps as many as one quarter of the world's people areinfected, and ascariasis is particularly prevalent in tropical regionsand in areas of poor hygiene. Other species of the genus Ascaris areparasitic and can cause disease in domestic animals.

Infection occurs through ingestion of food contaminated withfeces containing Ascaris eggs. The larvae hatch, burrow through theintestine, reach the lungs, and finally migrate up the respiratorytract. From there they are then reswallowed and mature in theintestine, growing up to 30 cm (12 in.) in length and anchoringthemselves to the intestinal wall.

Infections are usually asymptomatic, especially if the numberof worms is small. They may however be accompanied byinflammation, fever, and diarrhea, and serious problems maydevelop if the worms migrate to other parts of the body.


22/31

Barretts Esophagus


23/31

Barrett's esophagus is marked by the presence of columnarepithelia in the lower esophagus, replacing the normal squamouscell epitheliuman example of metap asia. The columnar

epithelium is better able to withstand the erosive action of thegastric secretions; however, this metaplasia confers an increasedcancer risk of the adenocarcinoma type.

The metaplastic columnar cells may be of two types: gastric(similar to those in the stomach, which is NOT technically Barrett's

esophagus) or colonic (similar to cells in the intestines). A biopsy ofthe affected area will often contain a mixture of the two. Colonic-type metaplasia is the type of metaplasia associated with risk ofmalignancy in genetically susceptible people.

The metaplasia of Barrett's esophagus is visible grossly

through a gastroscope, but biopsy specimens must be examinedunder a microscope to determine whether cells are gastric or colonicin nature. Colonic metaplasia is usually identified by finding gobletcells in the epithelium and is necessary for the true diagnosis ofBarrett's.


24/31

Hiatal Hernia


25/31

A hiatal hernia is an anatomical abnormality in which part ofthe stomach protrudes through the diaphragm and up into thechest. Although hiatal hernias are present in approximately 15% ofthe population, they are associated with symptoms in only aminority of those afflicted.

Normally, the esophagus or food tube passes down throughthe chest, crosses the diaphragm, and enters the abdomen through ahole in the diaphragm called the esophageal hiatus. Just below thediaphragm, the esophagus joins the stomach. In individuals withhiatal hernias, the opening of the esophageal hiatus (hiatal opening)is larger than normal, and a portion of the upper stomach slips up or

passes (herniates) through the hiatus and into the chest. Althoughhiatal hernias are occasionally seen in infants where they probablyhave been present from birth, most hiatal hernias in adults arebelieved to have developed over many years.


26/31

Hypertrophic Pyloric Stenosis


27/31

On the upper GI study, there is a lactobezoar present in thestomach. Also present are the antral "teat" sign and "double track"sign. Muscular thickening of the pylorus is seen on?ultrasound at4mm with lengthening of the pyloric channel to 1.8cm.

Diffuse hypertrophy and hyperplasia of the smooth muscle ofthe antrum of the stomach and pylorus proper narrow the channel,which then can become easily obstructed. The antral region iselongated and thickened to as much as twice its normal size. Inresponse to outflow obstruction and vigorous peristalsis, stomachmusculature becomes uniformly hypertrophied and dilated.Gastritis may occur after prolonged stasis. Hematemesis is

occasionally noted. The patient may become dehydrated as a resultof vomiting and develop marked hypochloremic alkalosis.


28/31

Pseudolymphoma


29/31

An inflammatory response that results in a lymphomatous-appearing but benign accumulation of inflammatory cells. It mayexhibit histological and sometimes clinical features suggestive ofmalignant lymphoma. Unlike lymphomas, pseudolymphomasusually undergo spontaneous remission. Causes include idiopathic,drugs, contact allergens, photosensitivity, insect bites, scabies and

infections. The term "pseudo" means "not real", and "lymphoma"means "a cancerous tumor of lymphocytes".


30/31

Stomach Cancer


31/31

Can develop in any part of the stomach and may spreadthroughout the stomach and to other organs; particularly theesophagus and the small intestine. Stomach cancer is oftenasymptomatic or causes only nonspecific symptoms in its earlystages. By the time symptoms occur, the cancer has generally

metastasized to other parts of the body, one of the main reasons forits poor prognosis.

Muscular and Digestive

Documents