belajar ujian magang
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bull Tampak lesi blastik di metafisis hingga proksimal diafisis tibia kanan disertai dengan zone transisi lebar dan gambaran reaksi periosteal tipe agresif di sisi posterior dan tampak perluasan ke jaringan lunak di sekitarnya dengan gambaran matriks osteoid
bull Osteosarcomas are malignant bone forming tumours and the second most common primary bone tumour after multiple myeloma They account for ~20 of all primary bone tumours
bull Patients usually present with bone pain occasionally accompanied by a soft-tissue mass or swelling At times the first symptoms are related to pathologic fracture
osteosarcoma
The distribution of primary and secondary osteosarcomas is also different
bull Primary tumours typically occur in the metaphyseal regions of long bones and have a striking predilection for the knee with up to 60 occurring there
bull Secondary tumours on the other hand have a much wider distribution largely mirroring the combined incidence of their underlying condition and thus much have a higher incidence in flat bones especially the pelvis (a favourite site of Pagets disease)
Clinical presentation
bull Osteosarcomas can be divided into a number of sub types according to degree of differentiation location within the bone and histological variants 3
bull These sub types vary in imaging findings demographics and biological behaviour and include
bull Intramedullary ~ 80ndash conventional high-grade - most common and discussed in this articlendash telangiectatic osteosarcomandash low-grade osteosarcoma
bull Surface or juxtacortical ~ 10-15ndash intracortical osteosarcomandash parosteal osteosarcomandash periosteal osteosarcoma
bull Extra skeletal ~ 5ndash extra skeletal osteosarcoma
Pathology
bull They typically occur at the metadiaphysis of tubular bones in the appendicular skeleton Common sites include
bull femur ~ 40 (especially distal femur)bull tibia ~ 16 (especially proximal tibia)bull humerus ~ 15 bull Other less common sites includebull fibulabull innominate bonebull mandible (gnathic osteosarcoma)bull maxillabull vertebrae
Location
Plain Filmbull Conventional radiography continues to play an important role in
diagnosis Typical appearances of conventional high grade osteosarcoma include
bull medullary and cortical bone destructionbull wide zone of transition permeative or moth-eaten appearancebull aggressive periosteal reaction
ndash sunburst typendash Codman trianglendash lamellated (onionskin) reaction - less frequently seen
bull soft-tissue massbull tumour matrix ossification calcification
ndash variable reflects a combination of the amount of tumour bone production calcified matrix and osteoid
Radiological Features
bull The role of CT is predominantly in assisting biopsy and staging but adds little to plain radiography and MRI in direct assessment of the tumour The exception to this rule is predominantly lytic lesions in which small amounts of mineralized material may be inapparent on both plain film and MRI
CT
bull MRI is proving essential in accurate local staging and assessment for limb sparing resection particularly for evaluation of intraosseous tumour extension and soft-tissue involvement Assessment of the growth plate is also essential as up to 75 - 88 of metaphyseal tumours do cross the growth plate into the epiphysis
bull T1ndash soft tissue non-mineralized component intermediate signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema intermediate signal intensityndash scattered regions of haemorrhage will have variable signal (see ageing
blood on MRI)ndash enhancement solid components enhance
bull T2ndash soft tissue non-mineralized component high signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema high signal intensity
MRI
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull Osteosarcomas are malignant bone forming tumours and the second most common primary bone tumour after multiple myeloma They account for ~20 of all primary bone tumours
bull Patients usually present with bone pain occasionally accompanied by a soft-tissue mass or swelling At times the first symptoms are related to pathologic fracture
osteosarcoma
The distribution of primary and secondary osteosarcomas is also different
bull Primary tumours typically occur in the metaphyseal regions of long bones and have a striking predilection for the knee with up to 60 occurring there
bull Secondary tumours on the other hand have a much wider distribution largely mirroring the combined incidence of their underlying condition and thus much have a higher incidence in flat bones especially the pelvis (a favourite site of Pagets disease)
Clinical presentation
bull Osteosarcomas can be divided into a number of sub types according to degree of differentiation location within the bone and histological variants 3
bull These sub types vary in imaging findings demographics and biological behaviour and include
bull Intramedullary ~ 80ndash conventional high-grade - most common and discussed in this articlendash telangiectatic osteosarcomandash low-grade osteosarcoma
bull Surface or juxtacortical ~ 10-15ndash intracortical osteosarcomandash parosteal osteosarcomandash periosteal osteosarcoma
bull Extra skeletal ~ 5ndash extra skeletal osteosarcoma
Pathology
bull They typically occur at the metadiaphysis of tubular bones in the appendicular skeleton Common sites include
bull femur ~ 40 (especially distal femur)bull tibia ~ 16 (especially proximal tibia)bull humerus ~ 15 bull Other less common sites includebull fibulabull innominate bonebull mandible (gnathic osteosarcoma)bull maxillabull vertebrae
Location
Plain Filmbull Conventional radiography continues to play an important role in
diagnosis Typical appearances of conventional high grade osteosarcoma include
bull medullary and cortical bone destructionbull wide zone of transition permeative or moth-eaten appearancebull aggressive periosteal reaction
ndash sunburst typendash Codman trianglendash lamellated (onionskin) reaction - less frequently seen
bull soft-tissue massbull tumour matrix ossification calcification
ndash variable reflects a combination of the amount of tumour bone production calcified matrix and osteoid
Radiological Features
bull The role of CT is predominantly in assisting biopsy and staging but adds little to plain radiography and MRI in direct assessment of the tumour The exception to this rule is predominantly lytic lesions in which small amounts of mineralized material may be inapparent on both plain film and MRI
CT
bull MRI is proving essential in accurate local staging and assessment for limb sparing resection particularly for evaluation of intraosseous tumour extension and soft-tissue involvement Assessment of the growth plate is also essential as up to 75 - 88 of metaphyseal tumours do cross the growth plate into the epiphysis
bull T1ndash soft tissue non-mineralized component intermediate signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema intermediate signal intensityndash scattered regions of haemorrhage will have variable signal (see ageing
blood on MRI)ndash enhancement solid components enhance
bull T2ndash soft tissue non-mineralized component high signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema high signal intensity
MRI
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
The distribution of primary and secondary osteosarcomas is also different
bull Primary tumours typically occur in the metaphyseal regions of long bones and have a striking predilection for the knee with up to 60 occurring there
bull Secondary tumours on the other hand have a much wider distribution largely mirroring the combined incidence of their underlying condition and thus much have a higher incidence in flat bones especially the pelvis (a favourite site of Pagets disease)
Clinical presentation
bull Osteosarcomas can be divided into a number of sub types according to degree of differentiation location within the bone and histological variants 3
bull These sub types vary in imaging findings demographics and biological behaviour and include
bull Intramedullary ~ 80ndash conventional high-grade - most common and discussed in this articlendash telangiectatic osteosarcomandash low-grade osteosarcoma
bull Surface or juxtacortical ~ 10-15ndash intracortical osteosarcomandash parosteal osteosarcomandash periosteal osteosarcoma
bull Extra skeletal ~ 5ndash extra skeletal osteosarcoma
Pathology
bull They typically occur at the metadiaphysis of tubular bones in the appendicular skeleton Common sites include
bull femur ~ 40 (especially distal femur)bull tibia ~ 16 (especially proximal tibia)bull humerus ~ 15 bull Other less common sites includebull fibulabull innominate bonebull mandible (gnathic osteosarcoma)bull maxillabull vertebrae
Location
Plain Filmbull Conventional radiography continues to play an important role in
diagnosis Typical appearances of conventional high grade osteosarcoma include
bull medullary and cortical bone destructionbull wide zone of transition permeative or moth-eaten appearancebull aggressive periosteal reaction
ndash sunburst typendash Codman trianglendash lamellated (onionskin) reaction - less frequently seen
bull soft-tissue massbull tumour matrix ossification calcification
ndash variable reflects a combination of the amount of tumour bone production calcified matrix and osteoid
Radiological Features
bull The role of CT is predominantly in assisting biopsy and staging but adds little to plain radiography and MRI in direct assessment of the tumour The exception to this rule is predominantly lytic lesions in which small amounts of mineralized material may be inapparent on both plain film and MRI
CT
bull MRI is proving essential in accurate local staging and assessment for limb sparing resection particularly for evaluation of intraosseous tumour extension and soft-tissue involvement Assessment of the growth plate is also essential as up to 75 - 88 of metaphyseal tumours do cross the growth plate into the epiphysis
bull T1ndash soft tissue non-mineralized component intermediate signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema intermediate signal intensityndash scattered regions of haemorrhage will have variable signal (see ageing
blood on MRI)ndash enhancement solid components enhance
bull T2ndash soft tissue non-mineralized component high signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema high signal intensity
MRI
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull Osteosarcomas can be divided into a number of sub types according to degree of differentiation location within the bone and histological variants 3
bull These sub types vary in imaging findings demographics and biological behaviour and include
bull Intramedullary ~ 80ndash conventional high-grade - most common and discussed in this articlendash telangiectatic osteosarcomandash low-grade osteosarcoma
bull Surface or juxtacortical ~ 10-15ndash intracortical osteosarcomandash parosteal osteosarcomandash periosteal osteosarcoma
bull Extra skeletal ~ 5ndash extra skeletal osteosarcoma
Pathology
bull They typically occur at the metadiaphysis of tubular bones in the appendicular skeleton Common sites include
bull femur ~ 40 (especially distal femur)bull tibia ~ 16 (especially proximal tibia)bull humerus ~ 15 bull Other less common sites includebull fibulabull innominate bonebull mandible (gnathic osteosarcoma)bull maxillabull vertebrae
Location
Plain Filmbull Conventional radiography continues to play an important role in
diagnosis Typical appearances of conventional high grade osteosarcoma include
bull medullary and cortical bone destructionbull wide zone of transition permeative or moth-eaten appearancebull aggressive periosteal reaction
ndash sunburst typendash Codman trianglendash lamellated (onionskin) reaction - less frequently seen
bull soft-tissue massbull tumour matrix ossification calcification
ndash variable reflects a combination of the amount of tumour bone production calcified matrix and osteoid
Radiological Features
bull The role of CT is predominantly in assisting biopsy and staging but adds little to plain radiography and MRI in direct assessment of the tumour The exception to this rule is predominantly lytic lesions in which small amounts of mineralized material may be inapparent on both plain film and MRI
CT
bull MRI is proving essential in accurate local staging and assessment for limb sparing resection particularly for evaluation of intraosseous tumour extension and soft-tissue involvement Assessment of the growth plate is also essential as up to 75 - 88 of metaphyseal tumours do cross the growth plate into the epiphysis
bull T1ndash soft tissue non-mineralized component intermediate signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema intermediate signal intensityndash scattered regions of haemorrhage will have variable signal (see ageing
blood on MRI)ndash enhancement solid components enhance
bull T2ndash soft tissue non-mineralized component high signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema high signal intensity
MRI
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull They typically occur at the metadiaphysis of tubular bones in the appendicular skeleton Common sites include
bull femur ~ 40 (especially distal femur)bull tibia ~ 16 (especially proximal tibia)bull humerus ~ 15 bull Other less common sites includebull fibulabull innominate bonebull mandible (gnathic osteosarcoma)bull maxillabull vertebrae
Location
Plain Filmbull Conventional radiography continues to play an important role in
diagnosis Typical appearances of conventional high grade osteosarcoma include
bull medullary and cortical bone destructionbull wide zone of transition permeative or moth-eaten appearancebull aggressive periosteal reaction
ndash sunburst typendash Codman trianglendash lamellated (onionskin) reaction - less frequently seen
bull soft-tissue massbull tumour matrix ossification calcification
ndash variable reflects a combination of the amount of tumour bone production calcified matrix and osteoid
Radiological Features
bull The role of CT is predominantly in assisting biopsy and staging but adds little to plain radiography and MRI in direct assessment of the tumour The exception to this rule is predominantly lytic lesions in which small amounts of mineralized material may be inapparent on both plain film and MRI
CT
bull MRI is proving essential in accurate local staging and assessment for limb sparing resection particularly for evaluation of intraosseous tumour extension and soft-tissue involvement Assessment of the growth plate is also essential as up to 75 - 88 of metaphyseal tumours do cross the growth plate into the epiphysis
bull T1ndash soft tissue non-mineralized component intermediate signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema intermediate signal intensityndash scattered regions of haemorrhage will have variable signal (see ageing
blood on MRI)ndash enhancement solid components enhance
bull T2ndash soft tissue non-mineralized component high signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema high signal intensity
MRI
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
Plain Filmbull Conventional radiography continues to play an important role in
diagnosis Typical appearances of conventional high grade osteosarcoma include
bull medullary and cortical bone destructionbull wide zone of transition permeative or moth-eaten appearancebull aggressive periosteal reaction
ndash sunburst typendash Codman trianglendash lamellated (onionskin) reaction - less frequently seen
bull soft-tissue massbull tumour matrix ossification calcification
ndash variable reflects a combination of the amount of tumour bone production calcified matrix and osteoid
Radiological Features
bull The role of CT is predominantly in assisting biopsy and staging but adds little to plain radiography and MRI in direct assessment of the tumour The exception to this rule is predominantly lytic lesions in which small amounts of mineralized material may be inapparent on both plain film and MRI
CT
bull MRI is proving essential in accurate local staging and assessment for limb sparing resection particularly for evaluation of intraosseous tumour extension and soft-tissue involvement Assessment of the growth plate is also essential as up to 75 - 88 of metaphyseal tumours do cross the growth plate into the epiphysis
bull T1ndash soft tissue non-mineralized component intermediate signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema intermediate signal intensityndash scattered regions of haemorrhage will have variable signal (see ageing
blood on MRI)ndash enhancement solid components enhance
bull T2ndash soft tissue non-mineralized component high signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema high signal intensity
MRI
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull The role of CT is predominantly in assisting biopsy and staging but adds little to plain radiography and MRI in direct assessment of the tumour The exception to this rule is predominantly lytic lesions in which small amounts of mineralized material may be inapparent on both plain film and MRI
CT
bull MRI is proving essential in accurate local staging and assessment for limb sparing resection particularly for evaluation of intraosseous tumour extension and soft-tissue involvement Assessment of the growth plate is also essential as up to 75 - 88 of metaphyseal tumours do cross the growth plate into the epiphysis
bull T1ndash soft tissue non-mineralized component intermediate signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema intermediate signal intensityndash scattered regions of haemorrhage will have variable signal (see ageing
blood on MRI)ndash enhancement solid components enhance
bull T2ndash soft tissue non-mineralized component high signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema high signal intensity
MRI
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull MRI is proving essential in accurate local staging and assessment for limb sparing resection particularly for evaluation of intraosseous tumour extension and soft-tissue involvement Assessment of the growth plate is also essential as up to 75 - 88 of metaphyseal tumours do cross the growth plate into the epiphysis
bull T1ndash soft tissue non-mineralized component intermediate signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema intermediate signal intensityndash scattered regions of haemorrhage will have variable signal (see ageing
blood on MRI)ndash enhancement solid components enhance
bull T2ndash soft tissue non-mineralized component high signal intensityndash mineralised ossified components low signal intensityndash peri-tumoural oedema high signal intensity
MRI
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull General differential considerations includebull osteomyelitisbull Other tumoursndashmetastatic lesion to bonendash Ewing sarcomandash aneurysmal bone cyst
Differential diagnosis
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull Identified in 1921 by James Ewingbull 2nd most common bone tumor in childrenbull Ewingrsquos Sarcoma Family of tumorsndash Ewingrsquos sarcoma (Bone ndash87) ndash Extraosseous Ewingrsquos sarcoma (8)ndash Peripheral PNET(5) ndash Askinrsquos tumor
13
Ewing sarcoma
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
2 of cancer childhood malignancyOccurs most commonly in 2nd decade80 occur between ages 5 and 25MF 131 lt 10 yrs
161 gt 10 yrsRare in African-Americans and Asians
Epidemiology
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull Pain amp swelling of affected area
bull May also have systemic symptomsndash Feverndash Anemiandash Weight loss ndash Elevated WBC amp ESRLDH
bull Longest lag time in diagnosis for any pediatric solid tumor (mean of 146 days)
bull Pathological fracture
Clinical Presentation
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
Location more common in diaphysis or
metadiaphysis
central axis (47) pelvis chest wall spine head amp
neck
extremities (53)
Scapula (38)
Skull(38)
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull direct extension into adjacent bone or soft tissuebull Metastases generally spread through bloodstreambull 25 present with metastatic diseasendash Lungs (38)ndash Bone (31)ndash Bone Marrow (11)
bull Nearly all pts have micromets at diagnosis so all Need chemo
Routes of spread
No mets75
Lu+BoneBM 4
Lung 13
BoneBM 7
Other 1
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
Imagingbull X-RAYndash Moth eaten lesionndash Lytic or mixed lytic-sclerotic areas
presentndash Multi-Layered subperiosteal reaction
(onion skinning)ndash Lifting of perioteum (codmanrsquos triangle)
bull CT SCAN bone destruction best seenbull Intramedullary spacebull extraosseous involvement
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
19
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull Bone scan ndash To detect polyostotic involvementndash to detect bone metastasis
bull Bone marrow biopsy
bull CXRCT of chest lung mets
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
bull Tampak erosi disisi medial metatarsal digiti 1 dan basis phalang proksimal digiti 1 dengan gambaran overhanging edge dan tampak pula penebalan jaringan lunak di sertai kalsifikasi di regio tersebut
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
Gout
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
Radiological features of gout
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
ClassificationBladder rupture be divided into three broad typesbull extra-peritonealbull intra-peritonealbull combined
Extraperitoneal bladder rupturebull Extraperitoneal rupture is the most common type of
bladder injury accounting for ~85 (range 80-90) of cases It is usually the result of pelvic fractures or penetrating trauma Cystography reveals a variable path of extravasated contrast material Treatment is with an indwelling catheter (IDCFoley)
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
Intraperitoneal bladder rupturebull Occurs in approximately ~15 (range 10-20) of major
bladder injuries and typically is the result of a direct blow to the already distended bladder Cystography demonstrates intraperitoneal contrast material around bowel loops between mesenteric folds and in the paracolic gutters Treatment is surgical repair
Combined bladder rupturebull Simultaneous intraperitoneal and extraperitoneal
injury Cystography usually demonstrates extravasation patterns that are typical for both types of injury
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-
- Slide 1
- Slide 2
- Slide 3
- osteosarcoma
- Clinical presentation
- Pathology
- Location
- Slide 8
- Radiological Features
- CT
- MRI
- Differential diagnosis
- Ewing sarcoma
- Clinical Presentation
- Location
- Routes of spread
- Imaging
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Gout
- Radiological features of gout
- Slide 25
- Slide 26
- Slide 27
- Slide 28
- Slide 29
- Slide 30
- Slide 31
- Slide 32
- Slide 33
- Slide 34
- Slide 35
- Slide 36
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
-