new content
This commit is contained in:
Ross
@@ -1,4 +1,21 @@
|
||||
[
|
||||
{
|
||||
"label": "'pericardial' (exact)",
|
||||
"queries": [
|
||||
{
|
||||
"qval": "pericardial",
|
||||
"mode": "exact",
|
||||
"targets": [
|
||||
"Title",
|
||||
"Content",
|
||||
"Breadcrumbs",
|
||||
"Keywords",
|
||||
"Category",
|
||||
"Type"
|
||||
]
|
||||
}
|
||||
]
|
||||
},
|
||||
{
|
||||
"label": "'torsion' (exact)",
|
||||
"queries": [
|
||||
|
||||
@@ -1,5 +0,0 @@
|
||||
# This directory is a Syncthing folder marker.
|
||||
# Do not delete.
|
||||
|
||||
folderID: esbxq-xqntf
|
||||
created: 2026-02-18T21:35:44Z
|
||||
@@ -576,5 +576,8 @@
|
||||
"c626ca7ea79624f166b010bbcb2b323864fa7469c4197e11a320bec5b58cb228": "docs_md/articles/langerhans-cell-histiocytosis-skull-and-brain_d4ceb50c-b678-490e-b948-6e939ac9b3b3.md",
|
||||
"89958c0c3d35450d72a801293eefd1d39d64f35230c94a0934eb1d237bf40cf8": "docs_md/articles/acute-adnexal-torsion_4a3f1b29-7eeb-470d-855d-56d4bd842ff4.md",
|
||||
"d6f48252dc9d66ea3dc6724ce74bea17bb76ad25b3e821c238d3d8057e49b06b": "docs_md/articles/cardiac-anatomy_c11f5b0b-90b4-4db9-acf9-356af5e5bb00.md",
|
||||
"0ff104b9ed84a340edf0dd08fd9bf1d3a0572c2a79a2d8b9497e4f1fd0a4970e": "docs_md/articles/aortic-sarcomas_773f978e-3e39-4f1f-9e1e-13d587c11c74.md"
|
||||
"0ff104b9ed84a340edf0dd08fd9bf1d3a0572c2a79a2d8b9497e4f1fd0a4970e": "docs_md/articles/aortic-sarcomas_773f978e-3e39-4f1f-9e1e-13d587c11c74.md",
|
||||
"f7aeb21f1e24f2c27a78051a7af7cc763ee2a7a1e8f2d5a2f968029d744f5345": "docs_md/articles/hypermetabolic-lesion-bone_194f9465-68f4-45ec-a66d-1cd0c0c1e869.md",
|
||||
"6a74fb5f1d5348a660d1803fdb2e1c7db3f92ae4a628d40d8a1091cef4dcabf5": "docs_md/articles/acquired-seminal-vesicle-lesions_aa72c8c0-fa60-4c7b-ac6c-4a44420da769.md",
|
||||
"8e47d2ffb6e4f4799cee4c5a389bff5aa6909e95f2f03a27609db6e735f2472c": "docs_md/articles/prostate-and-seminal-vesicles_b0f47093-297b-4b4d-a974-389c3ba9649e.md"
|
||||
}
|
||||
@@ -8674,5 +8674,45 @@
|
||||
"images/app.statdx.com_image_thumbnail_efc67a40-a8d1-42bd-96fa-de57105bce28_annotated_true_size_900_quality_90_77cb063b59fa1093aa6b6091fe8eae9bb1eb1823.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_a455b335-108a-4a11-93aa-f79a23f75d6f_annotated_true_size_900_quality_90_0b9de3605d7b512e7a9a2f38070132f7413da6df.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_80091e46-04a8-4134-b7f8-0aebb98062da_annotated_true_size_900_quality_90_42f9d37b5198dd50ad79530be23937bf8c4a89a0.jpg"
|
||||
],
|
||||
"docs_md/articles/hypermetabolic-lesion-bone_194f9465-68f4-45ec-a66d-1cd0c0c1e869.md": [
|
||||
"images/app.statdx.com_image_thumbnail_ea27db29-5a7a-4e5e-95d6-cc4d2c2545ff_annotated_true_size_900_quality_90_0136e0e9afc97b3421c7a92afaa76e8f93aa6603.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_ea27db29-5a7a-4e5e-95d6-cc4d2c2545ff_size_174_quality_85_1b87a5a7eebdbd3846037a197f653b4c76672d20.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_0443c803-2b1b-4103-bda0-9123bd748597_annotated_true_size_900_quality_90_a61be93ff6712e729ef3a8586e8accee4f21ebc8.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_608465b6-a82a-4842-8fbb-ab665dd0ec03_annotated_true_size_900_quality_90_568c6d443f0251f691d5a5380d6df1115a4a976e.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_aa66bd6c-a00a-4141-8d27-3c3f97f85c04_annotated_true_size_900_quality_90_bff3305b6cb49e142395596e9ad65645b6614fc6.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_7cb92893-602f-4635-a23a-8eb548828f2f_annotated_true_size_900_quality_90_c9c8553b764955081836995c7d89f01239ac5c63.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_15bbb609-3273-47ef-9a9b-75f5c74a96ca_annotated_true_size_900_quality_90_ac16559a7468ad9b3ee5a55d2ddb427ae3edee17.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_f3e89b29-53cc-456f-9f08-56f3c7c1ebfc_annotated_true_size_900_quality_90_1d4e06e578115ecdd145b8f8508c3a96db297bf1.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_515e11b9-d0f2-4ee8-9931-e51403748557_annotated_true_size_900_quality_90_80d5bd698c93da0789016306e800835312d414de.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_0177c1d1-6e5a-403b-9495-9f27a66a7467_annotated_true_size_900_quality_90_034a9fd4579800bc24e3b67b3ba944a66db32e00.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_91568315-d498-4d7a-a124-3da8578fc1d6_annotated_true_size_900_quality_90_f186711f48398f41108b8d1c1bd072e4ad993fc2.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_a71bad6c-b142-4f12-8631-bc936a3a9c51_annotated_true_size_900_quality_90_36eb93501f11c5e5d2ebcf17680215800a5168f8.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_a690a208-2f3a-47e2-a47c-b58ab0ae151c_annotated_true_size_900_quality_90_70185440d7a2e6644680585dbfaa36fe76304132.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_b653ac73-79e3-424e-b8e0-67007a978b55_annotated_true_size_900_quality_90_1968a184c77c0a1507f148b68902eedaa5f079fe.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_e2dd4fc1-e5c4-4f0a-ae19-469d2390961b_annotated_true_size_900_quality_90_fc7e7da2be728e1ab5649e9fcf8e4d2a6e1b4ecb.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_a5671b20-79c7-427e-8e04-6fa5e2b0d5eb_annotated_true_size_900_quality_90_a286f53f19de8a4253a4df85363916408b306971.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_38ceafd2-1631-469b-a8e0-f7e47bce7f06_annotated_true_size_900_quality_90_906b1b1da8252e1f7ad999bccae5d5fc03976961.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_829eb034-2b8b-4f4a-9c4b-85426f8d23ae_annotated_true_size_900_quality_90_9d4d937f3aad95a1655eeeb0ba856f5b495e6caf.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_33f962b8-5c2f-4bf8-8991-ba8b54b79f2d_annotated_true_size_900_quality_90_d97a404bc9e8e4094d132fb2ff3c686bbd544770.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_2843d508-265d-4afc-ba43-06c20ec3bc9f_annotated_true_size_900_quality_90_9373753e83d47edb29f61d572f496e3e55bbdcf6.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_ef91a88d-94cf-4a5a-ab4b-0fd3749f7194_annotated_true_size_900_quality_90_b7dbb422abbe71c9f1bd1e2808422675f6eee94d.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_63b72a5c-8114-4511-98a4-9c3d078180b8_annotated_true_size_900_quality_90_35102cf4f5748561eda718a32c14c50263b63891.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_225c211f-85a5-48a8-9b52-1200716bbe4e_annotated_true_size_900_quality_90_b3b0101495685e3260804dd648ac0421b5bdab78.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_90832730-7a50-4954-a79b-6a5351073a26_annotated_true_size_900_quality_90_eb8e5a35c01d7b1ae386b1723ef1f6eb4a27ac7b.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_33934ed6-2183-4cff-ab6e-85ae9ee8d04b_annotated_true_size_900_quality_90_8451a4ab8a9fdb586a0432b10a15a9f77f2d067e.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_09fc04c4-b245-460e-8e3d-479718527fdb_annotated_true_size_900_quality_90_4234ebef2cd0353ab5f3df9a6dfc73ac0b11f3d9.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_45ac7e12-b4dc-46c2-8b9d-d9155969f5e5_annotated_true_size_900_quality_90_d8976a377182f6a8f0efb178189255f339413e3e.jpg"
|
||||
],
|
||||
"docs_md/articles/acquired-seminal-vesicle-lesions_aa72c8c0-fa60-4c7b-ac6c-4a44420da769.md": [
|
||||
"images/app.statdx.com_image_thumbnail_bbba09f9-b88c-4906-aa16-4d4363bc8079_annotated_true_size_900_quality_90_dc350a2e02c7d82307cb8a0e5e459c57a1c15c52.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_0f965738-e17f-4ede-b006-185898dedbec_annotated_true_size_900_quality_90_faee022003b5855ff14605735275c9c08257b40f.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_571bf6ab-449f-4797-b34a-88dcdd10e7b4_annotated_true_size_900_quality_90_736abd7aeadb1fe6bc2734c25a60630143bd9566.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_ac8fcd0e-fd35-42c8-8d93-6e150338bbfa_annotated_true_size_900_quality_90_f49934356fd20d0dac99e1f37a608ee4498dd90b.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_822ccbdb-1a5e-431a-9401-03ecc225fc1b_annotated_true_size_900_quality_90_6af33c58ca1e971f1c3d69f6879a0999b179a303.jpg",
|
||||
"images/app.statdx.com_image_thumbnail_36997a6a-d10a-4c04-84d1-f28a35b32953_annotated_true_size_900_quality_90_15196231fd2bf53700c37ebb57977b9a7f86e32f.jpg"
|
||||
],
|
||||
"docs_md/articles/prostate-and-seminal-vesicles_b0f47093-297b-4b4d-a974-389c3ba9649e.md": [
|
||||
"images/app.statdx.com_image_thumbnail_b1e39735-6e62-41ba-80ce-c5f8ad47cd3b_size_168_quality_85_2f0a57cac0cda5a7b0464ba1d08831d82246c4dd.jpg"
|
||||
]
|
||||
}
|
||||
+289
@@ -0,0 +1,289 @@
|
||||
---
|
||||
title: "Acquired Seminal Vesicle Lesions"
|
||||
docid: "aa72c8c0-fa60-4c7b-ac6c-4a44420da769"
|
||||
authors:
|
||||
- key: "0389ffc0-8ffe-4f79-97b5-60d751edb902"
|
||||
value: "Bryan R. Foster, MD"
|
||||
- key: "f911d0b4-2aab-4ec4-b5ac-8af8013272e7"
|
||||
value: "Amir A. Borhani, MD"
|
||||
breadcrumbs:
|
||||
-
|
||||
name: "Genitourinary"
|
||||
slug: "genitourinary"
|
||||
treeNodeId: "3b7e2daf-6a7c-4af6-b5af-e665002794df"
|
||||
-
|
||||
name: "Diagnosis"
|
||||
slug: "diagnosis"
|
||||
treeNodeId: "eba1b4c2-412d-44e1-80e2-6148c34a5767"
|
||||
-
|
||||
name: "Seminal Vesicles"
|
||||
slug: "seminal-vesicles"
|
||||
treeNodeId: "a3d60d0d-9b3f-4b69-8047-eafed00e8699"
|
||||
-
|
||||
name: "Acquired Seminal Vesicle Lesions"
|
||||
slug: "acquired-seminal-vesicle-lesions"
|
||||
treeNodeId: null
|
||||
category: "Genitourinary"
|
||||
documentVersionId: "1fddaccb-2273-47ab-98f6-1c325e992938"
|
||||
imageCount: 14
|
||||
lastUpdated: "08/25/25"
|
||||
pageDescription: "Acquired Seminal Vesicle Lesions"
|
||||
pageKeywords: "Genitourinary, Diagnosis, Seminal Vesicles, Acquired Seminal Vesicle Lesions"
|
||||
pageTitle: "Acquired Seminal Vesicle Lesions | STATdx"
|
||||
enhancedTitle: "Acquired Seminal Vesicle Lesions"
|
||||
type: "DX"
|
||||
references: true
|
||||
anatomy:
|
||||
- "{'authors': 'Bryan R. Foster, MD; Paula J. Woodward, MD, FSRU; Akram M. Shaaban, MBBCh', 'bookmarked': False, 'bookmarkUrl': '/document/bookmark/b0f47093-297b-4b4d-a974-389c3ba9649e', 'category': 'Genitourinary', 'compareUrl': '/compare/document/b0f47093-297b-4b4d-a974-389c3ba9649e/related-anatomy/treeNode?subContext=Prostate and Seminal Vesicles', 'documentId': 'b0f47093-297b-4b4d-a974-389c3ba9649e', 'documentType': 'ANATOMY', 'documentUrl': '/document/prostate-and-seminal-vesicles/b0f47093-297b-4b4d-a974-389c3ba9649e', 'enhancedTitle': 'Prostate and Seminal Vesicles', 'entryDate': '07/24/23', 'imageCount': 43, 'imageUrl': '/image/thumbnail/e0c2da28-2f1d-4901-b634-35dafd8e5dfa?size=174&quality=85', 'inCompareCart': False, 'rank': 1, 'referenceCount': 0, 'showCompareButton': False, 'title': 'Prostate and Seminal Vesicles'}"
|
||||
breadcrumbs:
|
||||
- "Genitourinary"
|
||||
- "Diagnosis"
|
||||
- "Seminal Vesicles"
|
||||
- "Acquired Seminal Vesicle Lesions"
|
||||
---
|
||||
## KEY FACTS
|
||||
|
||||
- ### Imaging
|
||||
|
||||
|
||||
- **Infectious/inflammatory conditions**
|
||||
- **Acute seminal vesiculitis**
|
||||
- Usually caused by bacterial infection and seen in association with prostatitis &/or epididymitis
|
||||
- Imaging is insensitive: Enlarged seminal vesicles (SVs); diffuse wall thickening with diffuse enhancement; surrounding inflammatory changes
|
||||
- **Chronic seminal vesiculitis**
|
||||
- Rare entity caused by chronic or repetitive bacterial infection of SV, usually in association with chronic prostatitis
|
||||
- Imaging is nonspecific: Enlargement of SVs or atrophy and loss of convolutions; thickening (± enhancement) of SV septations and walls
|
||||
- **Degenerative processes**
|
||||
- **Acquired SV cyst**
|
||||
- Obstruction at level of excretory duct or ejaculatory duct can result in acquired cystic dilatation of SV
|
||||
- **SV calcification**
|
||||
- Diabetic-related diffuse calcification of walls or discrete calcification in setting of intraluminal stones
|
||||
- **Neoplastic lesions**
|
||||
- **Primary neoplasms**: Exceedingly rare
|
||||
- Benign: Cystadenoma, papillary adenoma, leiomyoma, teratoma
|
||||
- Malignant: Adenocarcinoma, leiomyosarcoma, cystosarcoma phyllodes, angiosarcoma, seminoma, carcinoid
|
||||
- **Secondary neoplasms**
|
||||
- Most commonly imaged tumor is prostate cancer invasion; stage T3b
|
||||
- Endorectal coil MR affords best staging; moderate sensitivity and high specificity
|
||||
- Coronal images often show SVs best for evaluation of tumor invasion
|
||||
- Loss of convoluted tubular structure, restricted diffusion, and enhancement similar to cancer in prostate gland
|
||||
- Rectal or bladder cancer involvement by local invasion; stage T4
|
||||
- Metastatic lesions to SVs are rare
|
||||
|
||||
## TERMINOLOGY
|
||||
|
||||
- ### Abbreviations
|
||||
|
||||
|
||||
- Seminal vesicle (SV)
|
||||
- ### Definitions
|
||||
|
||||
|
||||
- Noncongenital conditions affecting SVs
|
||||
|
||||
## IMAGING
|
||||
|
||||
- ### Normal Seminal Vesicle
|
||||
|
||||
|
||||
- US: Normal SV appears as elongated, septate, cystic structure on TRUS
|
||||
- SV cannot be adequately evaluated by transabdominal US due to its depth
|
||||
- CT: Due to convoluted nature of SV, its cystic nature is not well appreciated on CT unless distended
|
||||
- SVs appear as paired soft tissue density structures with bow tie configuration
|
||||
- MR: ↓ T1 and ↑ T2 signal with thin septations, convoluted tubular appearance
|
||||
- SV wall and septations show ↓ T1 and ↓ T2 signal with mild enhancement on T1 C+
|
||||
- Recent ejaculation affects SV size
|
||||
- ### Infectious/Inflammatory Conditions
|
||||
|
||||
|
||||
- **Acute seminal vesiculitis**
|
||||
- Usually caused by bacterial infection and seen in association with prostatitis &/or epididymitis (so-called prostatovesiculitis and prostate-vesiculo-epididymitis)
|
||||
- Some authors use umbrella term of male accessory gland infection (MAGI) to refer to this spectrum
|
||||
- *Escherichia coli*, *Neisseria gonorrhea*,*Ureaplasma urealyticum*, *Staphylococcus epidermidis*, *Pseudomonas*, and *Chlamydia trachomatis*are common microbial agents cultured in these patients
|
||||
- Patients present with lower abdominal/perineal pain
|
||||
- Imaging: Enlarged SVs; diffuse wall thickening with diffuse enhancement; complex fluid content; surrounding inflammatory changes
|
||||
- MR, with use of endorectal coil, has superior contrast resolution for evaluation of SVs
|
||||
- Proteinaceous and hemorrhagic fluid contents appear as fluid-fluid level with ↑ T1 and variable T2 signal
|
||||
- Findings of associated prostatitis, such as prostatomegaly and periprostatic stranding, may also be seen
|
||||
- Acute seminal vesiculitis can rarely be complicated by abscess formation
|
||||
- Abscess is more common in diabetics and in patients with history of GU instrumentation
|
||||
- Treatment: Systemic antibiotics; large abscess might need surgical drainage
|
||||
- **Chronic seminal vesiculitis**
|
||||
- Rare entity caused by chronic or repetitive bacterial infection of SV
|
||||
- *E. coli*, *S. epidermidis*, *Pseudomonas*, and *N. gonorrhea*are common microbial agents cultured in these patients
|
||||
- Tuberculosis and schistosomiasis are other infectious etiologies in endemic regions
|
||||
- Usually seen in association with chronic prostatitis ("prostatovesiculitis")
|
||||
- Patients usually present with chronic hematospermia, pyospermia, and perineal pain
|
||||
- Imaging: Enlargement of SVs or atrophy and loss of convolutions; thickening (± enhancement) of SV septations and walls
|
||||
- Imaging findings are nonspecific and usually indistinguishable from acute seminal vesiculitis or amyloidosis
|
||||
- Treatment: Systemic antibiotics
|
||||
- ### Degenerative Processes
|
||||
|
||||
|
||||
- **Amyloidosis**
|
||||
- Localized SV amyloidosis (common finding in older patients) is senile process caused by localized amyloid deposition in lamina propria of SV convolutions
|
||||
- Usually incidental finding with no clinical significance; can present with hematospermia
|
||||
- Imaging: Nodular (more common) or diffuse (less common) wall thickening with markedly ↓ T2 signal of convolutions; ± SV hemorrhage
|
||||
- SV amyloidosis may mimic tumoral invasion on T2 MR in patients with prostate cancer
|
||||
- Areas of amyloid deposit do not show enhancement following contrast administration
|
||||
- **Acquired SV cyst**
|
||||
- Obstruction at level of excretory duct or ejaculatory duct can result in acquired cystic dilatation of SV
|
||||
- Obstruction is caused by scarring (sequela of prior infection) or tumor
|
||||
- Symptoms: Recurrent infections, painful ejaculation, hematuria, hematospermia, pelvic pain
|
||||
- Acquired SV cysts are indistinguishable from congenital cysts on imaging
|
||||
- MR: ↑ T2 signal, variable T1 signal, no enhancement
|
||||
- Look for associated findings and absence of renal anomalies
|
||||
- May protrude into bladder and mimic ureterocele
|
||||
- **SV calcification**
|
||||
- Calcification of SV and vas deferens walls is highly associated with diabetes (unclear etiology)
|
||||
- Other less common causes are hyperparathyroidism, senile calcification, and postinflammatory dystrophic calcification
|
||||
- SV calcification in setting of diabetes is intramural and symmetric
|
||||
- **SV stones**
|
||||
- Rare entity of stones in lumen, similar to prostatic and vas deferens calculi, thought to be caused by urine reflux &/or stasis
|
||||
- Usually incidental finding on imaging; patient may present with hematospermia
|
||||
- Imaging: SV calculi have typical imaging characteristics of urinary stones
|
||||
- Echogenic with posterior shadow on TRUS; discrete and hyperdense on CT; ↓ signal on T1 and T2 MR
|
||||
- ### Neoplastic Lesions
|
||||
|
||||
|
||||
- **Primary neoplasms**
|
||||
- Primary SV tumors are exceedingly rare
|
||||
- Benign: Cystadenoma, papillary adenoma, leiomyoma, teratoma
|
||||
- Malignant: Adenocarcinoma, leiomyosarcoma, cystosarcoma phyllodes, angiosarcoma, seminoma, carcinoid
|
||||
- **Adenocarcinoma**: Most common primary SV tumor
|
||||
- Patients aged 13-90 years in reported cases; most patients present with obstructive urinary symptoms and hematospermia
|
||||
- Tumors are usually large at time of presentation and show cystic and necrotic areas; ± local invasion into adjacent structure
|
||||
- In advanced infiltrative cases, differentiation from locally advanced prostate or rectal cancer might be difficult based on imaging
|
||||
- Tissue sampling with immunohistochemical staining required to establish primary source
|
||||
- Surgical excision ± radiation therapy is treatment of choice; prognosis is poor
|
||||
- **Cystadenoma**: Most common benign primary SV tumor
|
||||
- Patients aged 37-66 years in reported cases; patients asymptomatic or presented with pain, hematospermia, or irritative urinary symptoms
|
||||
- Tumors are usually large and have mixed solid and cystic appearance
|
||||
- **Secondary neoplasms**
|
||||
- Secondary neoplastic involvement of SV, by local invasion or metastasis, is much more common than primary neoplasm
|
||||
- **Local invasion**from prostate, rectal, and bladder cancers
|
||||
- Prostate: Stage T3b
|
||||
- Rectal and bladder: Stage T4
|
||||
- MR, with endorectal coil, has high specificity and low to moderate sensitivity for detection of SV invasion by prostate cancer
|
||||
- Coronal images often show tumor invasion best
|
||||
- Loss of normal SV architecture/convolutions, SV wall thickening (with ↓ T2 signal, restricted diffusion, enhancement/washout), and obliteration of SV-prostate angle are clues to SV invasion by prostate cancer
|
||||
- Ohori et al (1993) classified different pathways of SV invasion by prostate cancer
|
||||
- SV invasion can be "internal" (through plane around ejaculatory ducts), transcapular (with extension of tumor from base of prostate through prostatic capsule and then into SV), or metastatic (noncontiguous tumor deposits remote from primary tumor), though this has little clinical or imaging relevance
|
||||
- Detection of SV invasion has significant impact on treatment strategy and outcome
|
||||
- **Metastases**
|
||||
- Metastatic involvement from distant organs is extremely rare
|
||||
- Metastases appear as focal soft tissue mass or diffuse enlargement of SV
|
||||
- Peritoneal metastasis in retrovesical space can mimic SV tumor
|
||||
- ### Iatrogenic
|
||||
|
||||
|
||||
- Hemorrhage is common post prostate biopsy
|
||||
- Hematospermia can persist for weeks post biopsy
|
||||
- ↑ T1 and ↓ T2 fluid in SVs
|
||||
|
||||
## PATHOLOGY
|
||||
|
||||
- ### Anatomy
|
||||
|
||||
|
||||
- SVs are paired, **extraperitoneal,**convoluted tubular structures that secrete seminal fluid (stabilizing pH and necessary for function and nourishment of spermatozoa)
|
||||
- SV forms as outpouching from lateral wall of ampulla of vas deferens
|
||||
- **Excretory duct**(very distal aspect of SV) joins vas deferens to form **ejaculatory duct**
|
||||
- Ejaculatory ducts course through substance of prostate and open through verumontanum into prostatic urethra
|
||||
|
||||
## CLINICAL ISSUES
|
||||
|
||||
- ### Presentation
|
||||
|
||||
|
||||
- #### Most common signs/symptoms
|
||||
|
||||
|
||||
- Inflammatory SV lesions present with perineal pain, hematospermia, and irritative urinary symptoms
|
||||
- Small SV tumors are usually asymptomatic; large tumors result in urinary irritative/obstructive symptoms (due to mass effect) and hematospermia
|
||||
|
||||
3ae83f3d-b73a-416d-b064-25d346c0f4c4
|
||||
|
||||
## References
|
||||
|
||||
## Selected References
|
||||
|
||||
1. [Carvalho M et al: Seminal vesiculitis: a rare cause of unilateral ureteric obstruction. Cureus. 16(11):e73796, 2024](http://www.ncbi.nlm.nih.gov/pubmed/?term=39691121%5Bpmid%5D)
|
||||
1. [Mohsen Y et al: Imaging of seminal vesicles: a pictorial review. Abdom Radiol (NY). 48(11):3469-87, 2023](http://www.ncbi.nlm.nih.gov/pubmed/?term=37624375%5Bpmid%5D)
|
||||
1. [Corongiu E et al: Large primary leiomyosarcoma of the seminal vesicle: a case report and literature revision. Arch Ital Urol Androl. 91(1):55-7, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=30932433%5Bpmid%5D)
|
||||
1. [Dong X et al: Laparoscopic vesiculectomy for large seminal vesicle cystadenoma. Andrologia. 51(3):e13209, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=30488974%5Bpmid%5D)
|
||||
1. [Grivas N et al: Seminal vesicle invasion on multi-parametric magnetic resonance imaging: correlation with histopathology. Eur J Radiol. 98:107-12, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=29279147%5Bpmid%5D)
|
||||
1. [Ozmen Z et al: Magnetic resonance imaging and clinical findings in seminal vesicle pathologies. Int Braz J Urol. 44(1):86-94, 2018](http://www.ncbi.nlm.nih.gov/pubmed/?term=28853814%5Bpmid%5D)
|
||||
1. [Mittal PK et al: Role of imaging in the evaluation of male infertility. Radiographics. 37(3):837-54, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28410062%5Bpmid%5D)
|
||||
1. [Terrisse S et al: Primary adenocarcinoma of the seminal vesicle. Rare Tumors. 9(3):7074, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=29081928%5Bpmid%5D)
|
||||
1. [Mittal PK et al: Hematospermia evaluation at MR imaging. Radiographics. 36(5):1373-89, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27517360%5Bpmid%5D)
|
||||
1. [Reddy MN et al: Lesions of the seminal vesicles and their MR characteristics. J Clin Imaging Sci. 4:61, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=25396077%5Bpmid%5D)
|
||||
1. [Kim B et al: Imaging of the seminal vesicle and vas deferens. Radiographics. 29(4):1105-21, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19605659%5Bpmid%5D)
|
||||
1. [Soylu FN et al: Seminal vesicle invasion in prostate cancer: evaluation by using multiparametric endorectal MR imaging. Radiology. 267(3):797-806, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=23440325%5Bpmid%5D)
|
||||
1. [Furuya S et al: Magnetic resonance imaging is accurate to detect bleeding in the seminal vesicles in patients with hemospermia. Urology. 72(4):838-42, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18692870%5Bpmid%5D)
|
||||
1. [Jung DC et al: Preoperative MR imaging in the evaluation of seminal vesicle invasion in prostate cancer: pattern analysis of seminal vesicle lesions. J Magn Reson Imaging. 28(1):144-50, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18500714%5Bpmid%5D)
|
||||
1. [Torigian DA et al: Hematospermia: imaging findings. Abdom Imaging. 32(1):29-49, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=16802198%5Bpmid%5D)
|
||||
1. [Lee CB et al: Cystadenoma of the seminal vesicle. Int J Urol. 13(8):1138-40, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16903949%5Bpmid%5D)
|
||||
1. [Patel B et al: Seminal vesicle cysts and associated anomalies. BJU Int. 90(3):265-71, 2002](http://www.ncbi.nlm.nih.gov/pubmed/?term=12133063%5Bpmid%5D)
|
||||
1. [Potter SR et al: Seminal vesicle invasion by prostate cancer: prognostic significance and therapeutic implications. Rev Urol. 2(3):190-5, 2000](http://www.ncbi.nlm.nih.gov/pubmed/?term=16985773%5Bpmid%5D)
|
||||
1. [Botash RJ et al: Senile seminal vesicle amyloidosis associated with hematospermia: demonstration by endorectal MRI. J Comput Assist Tomogr. 21(5):748-9, 1997](http://www.ncbi.nlm.nih.gov/pubmed/?term=9294568%5Bpmid%5D)
|
||||
1. [Jager GJ et al: Amyloidosis of the seminal vesicles simulating tumor invasion of prostatic carcinoma on endorectal MR images. Eur Radiol. 7(4):552-4, 1997](http://www.ncbi.nlm.nih.gov/pubmed/?term=9204338%5Bpmid%5D)
|
||||
1. [Ohori M et al: The mechanisms and prognostic significance of seminal vesicle involvement by prostate cancer. Am J Surg Pathol. 17(12):1252-61, 1993](http://www.ncbi.nlm.nih.gov/pubmed/?term=8238732%5Bpmid%5D)
|
||||
1. [Krane RJ et al: Seminal vesicle amyloidosis. Urology. 2(1):70-2, 1973](http://www.ncbi.nlm.nih.gov/pubmed/?term=4766858%5Bpmid%5D)
|
||||
|
||||
## Anatomy
|
||||
|
||||
### Prostate and Seminal Vesicles
|
||||
Genitourinary/ANATOMY:b0f47093-297b-4b4d-a974-389c3ba9649e
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
|
||||
*Coronal T2 MR in a man with Gleason 4+5 prostate cancer shows diffuse, hypointense signal and loss of normal, convoluted tubular architecture in the right seminal vesicle <img src='img/arrows/WS.png' alt='white solid arrow'/>, consistent with seminal vesicle invasion.*
|
||||
|
||||
|
||||
*Axial CECT in a septic patient shows an enlarged right seminal vesicle <img src='img/arrows/WS.png' alt='white solid arrow'/> with enhancement and surrounding fat stranding, consistent with acute vasitis.*
|
||||
|
||||
|
||||
*Axial T2 MR shows a multiloculated, complex cystic mass <img src='img/arrows/WS.png' alt='white solid arrow'/> of the right seminal vesicle with different signal intensities, which was proven to be a benign cystadenoma.*
|
||||
|
||||
|
||||
*Coronal T2 MR shows hypointense stones <img src='img/arrows/WS.png' alt='white solid arrow'/> in the seminal vesicles. These are generally asymptomatic though can indicate stasis or urine reflux.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
*Axial T2 MR shows normal seminal vesicles with fluid-filled, convoluted tubules. Note that the size of the seminal vesicles is quite variable and decreases with recent ejaculation.*
|
||||
|
||||
|
||||
*Coronal T2 MR shows diffuse prostate cancer in the peripheral zone <img src='img/arrows/WS.png' alt='white solid arrow'/> with bilateral seminal vesicle invasion <img src='img/arrows/WO.png' alt='white open arrow'/> at the base. Notice loss of the normal, convoluted tubular appearance <img src='img/arrows/WC.png' alt='white curved arrow'/> of the seminal vesicle.*
|
||||
|
||||
|
||||
*Coronal T2 MR in a patient with Gleason 4+4 prostate cancer shows right seminal vesicle invasion <img src='img/arrows/WS.png' alt='white solid arrow'/>. Note the loss of normal, hyperintense, convoluted tubular appearance <img src='img/arrows/WO.png' alt='white open arrow'/>.*
|
||||
|
||||
|
||||
*Axial T2 MR in a patient with history of hematospermia shows fluid-fluid levels in the right seminal vesicle <img src='img/arrows/CS.png' alt='cyan solid arrow'/>.*
|
||||
|
||||
|
||||
*Axial T1 MR in the same patient shows hyperintensity of contents of the right seminal vesicle, compatible with blood.*
|
||||
|
||||
|
||||
*Transverse US of the seminal vesicles in a 13-year-old boy with a prostate abscess (not shown) shows enlargement, hypoechoic appearance, and hypervascularity of the seminal vesicles, consistent with acute seminal vesiculitis. Note that the seminal vesicles are typically not seen on US.*
|
||||
|
||||
|
||||
*Axial NECT in a 52-year-old patient with history of hematospermia shows a large, mixed solid and cystic mass in the rectovesical space.*
|
||||
|
||||
|
||||
*Sagittal T2 MR in the same patient better shows the mixed solid/cystic nature of the tumor <img src='img/arrows/CS.png' alt='cyan solid arrow'/>. There was no invasion to adjacent organs. The mass was resected and the pathology result was consistent with low-grade sarcoma. (Courtesy P. Woodward, MD.)*
|
||||
|
||||
|
||||
*Axial CECT in a man with dysuria and infectious symptoms shows hyperenhancement and fat stranding involving the left seminal vesicle <img src='img/arrows/WS.png' alt='white solid arrow'/> and vas deferens <img src='img/arrows/WC.png' alt='white curved arrow'/>. Acute vesiculitis may be seen at CT, though findings are subtle, as in this case.*
|
||||
|
||||
|
||||
*Axial T2 MR shows multiple hypointense stones <img src='img/arrows/WS.png' alt='white solid arrow'/> in the left seminal vesicle. Note intravesical prostatic protrusion of BPH <img src='img/arrows/WO.png' alt='white open arrow'/>, which can lead to stasis and stone formation.*
|
||||
|
||||
@@ -0,0 +1,299 @@
|
||||
---
|
||||
title: "Hypermetabolic Lesion, Bone"
|
||||
docid: "194f9465-68f4-45ec-a66d-1cd0c0c1e869"
|
||||
authors:
|
||||
- key: "7b6947ba-2052-499d-8c03-ce99daa6a4fd"
|
||||
value: "Carol L. Andrews, MD"
|
||||
- key: "7195a100-a031-4947-b61a-c7fe063ba65c"
|
||||
value: "Kirkland W. Davis, MD, FACR"
|
||||
- key: "e23b9dec-f988-4aaf-b2c3-40dd061c244e"
|
||||
value: "Stephanie A. Bernard, MD"
|
||||
breadcrumbs:
|
||||
-
|
||||
name: "Musculoskeletal"
|
||||
slug: "musculoskeletal"
|
||||
treeNodeId: "6236c1b2-2af5-420e-99d2-501dc8bc7552"
|
||||
-
|
||||
name: "Differential Diagnosis"
|
||||
slug: "differential-diagnosis"
|
||||
treeNodeId: "f1c76f51-71eb-455b-a4d7-125b7842c98e"
|
||||
-
|
||||
name: "Image Based"
|
||||
slug: "image-based"
|
||||
treeNodeId: "53dbb269-a7e6-4693-ad17-7cc982cdbf54"
|
||||
-
|
||||
name: "Nuclear Medicine"
|
||||
slug: "nuclear-medicine"
|
||||
treeNodeId: "04a8c04a-420e-4b79-9467-bc83f144a0ca"
|
||||
-
|
||||
name: "Hypermetabolic Lesion, Bone"
|
||||
slug: "hypermetabolic-lesion-bone"
|
||||
treeNodeId: null
|
||||
category: "Musculoskeletal"
|
||||
documentVersionId: "45b314bb-e11c-4f8f-8a91-65565bb6b090"
|
||||
imageCount: 26
|
||||
lastUpdated: "10/01/24"
|
||||
pageDescription: "Hypermetabolic Lesion, Bone"
|
||||
pageKeywords: "Musculoskeletal, Differential Diagnosis, Image Based, Nuclear Medicine, Hypermetabolic Lesion, Bone"
|
||||
pageTitle: "Hypermetabolic Lesion, Bone | STATdx"
|
||||
enhancedTitle: "Hypermetabolic Lesion, Bone"
|
||||
type: "DDX"
|
||||
breadcrumbs:
|
||||
- "Musculoskeletal"
|
||||
- "Differential Diagnosis"
|
||||
- "Image Based"
|
||||
- "Nuclear Medicine"
|
||||
- "Hypermetabolic Lesion, Bone"
|
||||
---
|
||||
## ESSENTIAL INFORMATION
|
||||
|
||||
- ### Key Differential Diagnosis Issues
|
||||
|
||||
|
||||
- F-18 FDG radiotracer
|
||||
- Most commonly encountered PET radiotracer in musculoskeletal imaging
|
||||
- Hypoxia stimulates transcription factor to reduce oxygen consumption
|
||||
- Hypoxia-inducible factor 1 α (HIF1α) regulates glucose transporters, hexokinase; related to increased FDG uptake
|
||||
- Increased glucose metabolism results in increased FDG uptake
|
||||
- Neoplasms
|
||||
- Cells outgrow capillary supply; results in hypoxia
|
||||
- Stimulates HIF1α in hypoxic state; mediates cancer cell metabolism/reduced oxygen consumption
|
||||
- Results in increased FDG uptake
|
||||
- Inflammatory tissue
|
||||
- HIF1α needed for myeloid (granulocyte, macrophage) cell infiltration and activation
|
||||
- Activated macrophages: FDG avid
|
||||
- Newly formed granulation tissue: FDG avid
|
||||
- Arthritis/synovitis
|
||||
- Activated macrophages/proliferating fibroblasts related to cytokine stimulation and relative hypoxia of joint environment
|
||||
- Results in increased FDG uptake
|
||||
- Measurement may be qualitative or quantitative
|
||||
- Qualitative imaging based on presence of uptake in unexpected region or marked increased uptake compared to adjacent tissues
|
||||
- Quantitative imaging has known limitations
|
||||
- Standardized uptake value (SUV), commonly used measurement
|
||||
- Absolute SUV thresholds (e.g., ≥ 2.5) may be invalid
|
||||
- Inflammatory processes may have substantial FDG uptake with high SUV
|
||||
- Neoplastic processes may be slow growing, indolent with minimal FDG uptake and low SUV
|
||||
- PET is qualitative study with poor spatial resolution
|
||||
- Resolution of lesions < 3 cm may result in volume averaging and inaccurate SUV
|
||||
- CT used in concert with PET (PET/CT) to improve correlation of uptake with anatomy
|
||||
- ### Helpful Clues for Common Diagnoses
|
||||
|
||||
|
||||
- **Bone Metastasis**
|
||||
- Commonly used in staging and therapy response in breast, lung, thyroid, GI, cervical cancer, etc.
|
||||
- 90% sensitivity and 97% specificity for bone metastasis identification
|
||||
- PSMA is newer specific tracer used for PET in prostate cancer
|
||||
- Prostate carcinoma is also FDG avid, though PET is seldom used for this diagnosis
|
||||
- Lytic, blastic, and mixed lytic/blastic bone metastases show increased FDG uptake
|
||||
- FDG PET not typically used to stage renal cell carcinoma but may be useful to evaluate for metastatic disease
|
||||
- 89% sensitivity, 83% specificity, 86% accuracy
|
||||
- **Multiple Myeloma**
|
||||
- Useful in diagnosis, staging, therapy response, and prognosis
|
||||
- Variable patterns of FDG uptake from intense uptake to no uptake
|
||||
- Myeloma PET/CT detection sensitivity 85, specificity 92%
|
||||
- Concurrent corticosteroid treatment at time of imaging may result in false-positive scan
|
||||
- Clinical: anemia, bone pain, elevated creatine, fatigue, hypercalcemia, and weight loss
|
||||
- **Osteoarthritis**
|
||||
- Increased FDG uptake at locations of active inflammation, including subchondral bone
|
||||
- Variable uptake reflects degree of active synovitis
|
||||
- Commonly seen about shoulders and hips
|
||||
- **Healing Fracture**
|
||||
- Uptake during healing typically returns to normal within 3 months in normal bone
|
||||
- Though F-18-fluoride ion is reflection of osteoblastic activity; FDG is not particularly useful in assessing delay in fracture healing
|
||||
- ### Helpful Clues for Less Common Diagnoses
|
||||
|
||||
|
||||
- **Rheumatoid Arthritis**
|
||||
- Higher number of FDG-positive joints identified; activity centered on joint synovium
|
||||
- Tracer intensity not significantly different than in osteoarthritis
|
||||
- Distribution: relative bilateral symmetry
|
||||
- Wrists, proximal hands, shoulders, elbows, ankles, feet
|
||||
- Uptake may persist even in clinical remission, suggesting ongoing subclinical disease
|
||||
- **Spondyloarthropathy**
|
||||
- Includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis
|
||||
- Appendicular enthesitis with FDG uptake in affected joints as well as adjacent tendon and muscle
|
||||
- May distinguish spondyloarthropathies from rheumatoid arthritis
|
||||
- Distribution: sacroiliac joints, spine, hips, knees
|
||||
- **Hyperplastic Bone Marrow**
|
||||
- Diffuse, homogeneous FDG uptake
|
||||
- Hyperplastic bone marrow may result as response/recovery of bone marrow following recent chemotherapy
|
||||
- **Osteosarcoma**
|
||||
- Moderate FDG uptake
|
||||
- FDG PET useful in assessing presence of distant disease
|
||||
- Direct correlation between SUV and tumor grade
|
||||
- May be useful in therapy response: increased uptake may occur initially after therapy, resulting from inflammation or reactive fibrosis
|
||||
- Drop in SUV after neoadjuvant chemotherapy but before surgical resection is good prognostic indicator for overall survival
|
||||
- **Ewing Sarcoma**
|
||||
- Strong FDG uptake
|
||||
- SUV between 3-10 in higher grade tumors
|
||||
- FDG PET is best for evaluation of metastases and lymph node involvement
|
||||
- FDG PET correlates with response to therapy
|
||||
- **Lymphoma**
|
||||
- Strong FDG uptake
|
||||
- FDG uptake strongly correlates with response to therapy, with decreased uptake representing excellent response
|
||||
- Well-established literature for Hodgkin and non-Hodgkin lymphoma staging and restaging
|
||||
- **Chondrosarcoma**
|
||||
- Low FDG uptake
|
||||
- Variable glycolytic activity results in variable uptake
|
||||
- High-grade tumors have increased uptake, and metastases may be higher uptake than primary tumor
|
||||
- **Osteomyelitis**
|
||||
- 95% sensitivity, 75-99% specificity in acute/subacute bone and soft tissue infection
|
||||
- 100% sensitivity, 92% specificity in chronic infection
|
||||
- Accumulates in activated macrophages, primary cell type in chronic infection
|
||||
- Spinal osteomyelitis: effective method of assessment
|
||||
- Sensitivity and specificity decreased in presence of spinal implants
|
||||
- Similar sensitivity/specificity/accuracy between subgroup having recent surgery (within 6 months) and those who had surgery > 6 months prior to FGD PET study
|
||||
- Diabetic foot: useful to distinguish neuropathic arthropathy (SUV < 2.0) from osteomyelitis (SUV > 4.4)
|
||||
- Prosthetic joint infection: intensity of FDG uptake does not correlate with either infectious or aseptic loosening
|
||||
- Differentiating infection from aseptic loosening can be very difficult as both incite inflammatory response, which leads to FDG uptake
|
||||
- ### Helpful Clues for Rare Diagnoses
|
||||
|
||||
|
||||
- **Osteonecrosis**
|
||||
- May demonstrate increased uptake in very early-stage disease when radiography is normal
|
||||
- **Benign Bone Tumors**
|
||||
- Enchondroma, osteochondroma, osteoid osteoma, hemangioma: not FDG avid
|
||||
- Tumors with high giant cell content may be FDG avid: giant cell tumors, osteoblastoma, aneurysmal bone cyst, and fibrous dysplasia
|
||||
- **Paget Disease**
|
||||
- Typically shows no uptake at all
|
||||
- May show avid uptake, mimicking metastatic disease
|
||||
- Mixed-phase Paget may show "mosaic" FDG uptake
|
||||
- No correlation between FDG uptake and serum alkaline phosphatase
|
||||
- **Adult-Onset Still Disease**
|
||||
- Uptake in bone marrow, spleen, lymph nodes, joints as well as pericardium, pleura, muscle, major blood vessels
|
||||
- Useful for assessment of activity over time
|
||||
- Overlap with lymphoma; requires additional data to distinguish
|
||||
- ### Other Essential Information
|
||||
|
||||
|
||||
- Quantification of uptake is typically performed with SUV
|
||||
- Calculation of uptake SUV not necessarily reliable
|
||||
- Many variables affect reliability of SUV measure
|
||||
- Patient body weight, blood glucose, time from injection to scan, limited spatial resolution
|
||||
- Equipment calibration, voxel size, field of view, number of iterations
|
||||
- Standardization important to decrease variability in quantification (SUV)
|
||||
- Scan in same imaging center, same (calibrated) scanner, same display station
|
||||
- Same protocol for preparation, acquisition, processing, analysis
|
||||
- Imaging acquisition with uptake duration within 15 minutes of uptake duration of prior scan
|
||||
- Patient weighed using calibrated scale
|
||||
- Blood glucose concentration maintained within published guidelines
|
||||
- SUV measurement
|
||||
- SUVmean = average SUV within region of interest: useful in large lesions and in center of small lesions
|
||||
- SUVmax = more reproducible; useful in lesions < 2 cm as accurate estimate of true SUV but based on single pixel
|
||||
- SUV compared to "reference" tissue
|
||||
- Mediastinal blood pool (least variance in measurement) followed (in accuracy and reproducibility) by liver, lung, and cerebellum
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
|
||||
**Bone Metastasis**
|
||||
*Axial FDG PET/CT fused image reveals intense FDG uptake in the sternum <img src='img/arrows/WS.png' alt='white solid arrow'/>. This scan was performed for restaging in a patient with known breast cancer. Note the chest wall reconstruction <img src='img/arrows/WO.png' alt='white open arrow'/> after prior bilateral mastectomies. The maximum standardized uptake value (SUV) is 9.6.*
|
||||
|
||||
|
||||
**Bone Metastasis**
|
||||
*Axial FDG PET/CT fused image reveals intense FDG uptake in the sternum <img src='img/arrows/WS.png' alt='white solid arrow'/>. This scan was performed for restaging in a patient with known breast cancer. Note the chest wall reconstruction <img src='img/arrows/WO.png' alt='white open arrow'/> after prior bilateral mastectomies. The maximum standardized uptake value (SUV) is 9.6.*
|
||||
|
||||
|
||||
**Bone Metastasis**
|
||||
*Sagittal CT through the sternum in the same patient demonstrates the corresponding sclerotic destructive lesion of breast cancer metastasis <img src='img/arrows/WS.png' alt='white solid arrow'/>.*
|
||||
|
||||
|
||||
**Bone Metastasis**
|
||||
*Coronal CT demonstrates multiple sclerotic lesions in the axial skeleton in a patient with metastatic cervical carcinoma.*
|
||||
|
||||
|
||||
**Bone Metastasis**
|
||||
*Coronal FDG PET/CT fused image in the same patient demonstrates patchy areas of FDG uptake. This patient has undergone prior treatment for metastatic disease, and this restaging scan distinguished active from treated metastases.*
|
||||
|
||||
|
||||
**Bone Metastasis**
|
||||
*Axial CT (left) shows a single, partially circumscribed, lytic lesion in the acetabular roof <img src='img/arrows/WS.png' alt='white solid arrow'/>. Corresponding FDG PET/CT fused image (right) confirms FDG uptake <img src='img/arrows/WO.png' alt='white open arrow'/>. Subsequent biopsy confirmed thyroid cancer metastasis.*
|
||||
|
||||
|
||||
**Multiple Myeloma**
|
||||
*Axial CT (left) reveals a lytic lesion of the humeral head with endosteal scalloping and cortex destruction. FDG PET/CT fused image (right) shows the diffuse FDG uptake throughout the lesion in this patient with multiple myeloma.*
|
||||
|
||||
|
||||
**Osteoarthritis**
|
||||
*Axial CT (top) and FDG PET/CT fused image (bottom) demonstrate increase FDG uptake <img src='img/arrows/WS.png' alt='white solid arrow'/> related to secondary osteoarthritis <img src='img/arrows/WC.png' alt='white curved arrow'/> resulting from advanced-stage osteonecrosis in the right hip. There is left hip osteonecrosis <img src='img/arrows/WO.png' alt='white open arrow'/> but not significant osteoarthritis.*
|
||||
|
||||
|
||||
**Healing Fracture**
|
||||
*Axial CT reveals a discrete, nondisplaced rib fracture <img src='img/arrows/WS.png' alt='white solid arrow'/> that occurred 5 days prior to this examination in a patient with a known lung carcinoma <img src='img/arrows/WC.png' alt='white curved arrow'/>.*
|
||||
|
||||
|
||||
**Healing Fracture**
|
||||
*Axial FDG PET in the same patient demonstrates the FDG uptake corresponding to the 5-day-old fracture <img src='img/arrows/WS.png' alt='white solid arrow'/>. Uptake is also visible in the lung mass <img src='img/arrows/WC.png' alt='white curved arrow'/>.*
|
||||
|
||||
|
||||
**Rheumatoid Arthritis**
|
||||
*FDG PET MIP, acquired for tumor staging, reveals FDG uptake in the bilateral wrists and proximal hands <img src='img/arrows/WO.png' alt='white open arrow'/>, representing active synovitis in a patient with known rheumatoid arthritis.*
|
||||
|
||||
|
||||
**Hyperplastic Bone Marrow**
|
||||
*FDG PET MIP is acquired for restaging in a patient with esophageal cancer who has undergone a chemotherapy regimen and is in recovery phase. The visible bones demonstrate increased FDG uptake, typical of the rebound response in recovering marrow.*
|
||||
|
||||
|
||||
**Hyperplastic Bone Marrow**
|
||||
*Axial FDG PET/CT fused image in the same patient emphasizes the diffuse FDG uptake resulting from the hyperplastic bone marrow.*
|
||||
|
||||
|
||||
**Osteosarcoma**
|
||||
*Axial CT (upper) and FDG PET/CT fused image (lower) in a patient with prior successfully treated neuroblastoma now presents intense FDG uptake with treatment-related osteosarcoma in the right maxilla <img src='img/arrows/WS.png' alt='white solid arrow'/> and humerus <img src='img/arrows/WO.png' alt='white open arrow'/>.*
|
||||
|
||||
|
||||
**Ewing Sarcoma**
|
||||
*PA radiograph demonstrates aggressive periosteal new bone <img src='img/arrows/WS.png' alt='white solid arrow'/> perpendicular to the lateral proximal tibial metadiaphysis and a large associated mass <img src='img/arrows/WC.png' alt='white curved arrow'/> in biopsy-proven Ewing sarcoma.*
|
||||
|
||||
|
||||
**Ewing Sarcoma**
|
||||
*FDG PET MIP in the same patient reveals FDG uptake in the mass (SUVmax = 4.49) arising from the right proximal tibia and extending into the soft tissues.*
|
||||
|
||||
|
||||
**Ewing Sarcoma**
|
||||
*Coronal fused FDG PET/CT imaging in the same patient following chemotherapy reveals substantial reduction of the FDG uptake overall (SUVmax = 1.8) and essentially complete resolution of the surrounding soft tissue mass <img src='img/arrows/WO.png' alt='white open arrow'/>.*
|
||||
|
||||
|
||||
**Lymphoma**
|
||||
*Axial FDG PET/CT fused image (top) shows marked FDG uptake in the left pubic bone and surrounding soft tissues <img src='img/arrows/WO.png' alt='white open arrow'/>. Axial CT (bottom) clearly delineates the destructive lytic lesion <img src='img/arrows/WC.png' alt='white curved arrow'/> and surrounding soft tissue mass <img src='img/arrows/WS.png' alt='white solid arrow'/> of non-Hodgkin lymphoma.*
|
||||
|
||||
|
||||
**Lymphoma**
|
||||
*Axial FDG PET/CT fused image (top) in the same patient reveals a substantial decrease in the soft tissue mass <img src='img/arrows/WO.png' alt='white open arrow'/> after 9 months of chemotherapy and radiation. Axial CT (bottom) shows the healing underlying bone <img src='img/arrows/WC.png' alt='white curved arrow'/>.*
|
||||
|
||||
|
||||
**Chondrosarcoma**
|
||||
*Axial CT (left) and FDG PET/CT fused image (right) of the right chest wall reveals a large mass arising from the costochondral region. The mass contains chondroid matrix <img src='img/arrows/WS.png' alt='white solid arrow'/>, representing chondrosarcoma. FDG uptake is minimal and seen only along the margins of the tumor mass <img src='img/arrows/WC.png' alt='white curved arrow'/> because of the myxoid nature of the mass.*
|
||||
|
||||
|
||||
**Osteonecrosis**
|
||||
*Axial CT (top) shows a sclerotic, serpentine lesion <img src='img/arrows/WS.png' alt='white solid arrow'/> in the left humerus, typical of a bone infarct. Axial FDG PET/CT fused image (bottom) shows mild FDG uptake in this focus of osteonecrosis <img src='img/arrows/WO.png' alt='white open arrow'/>.*
|
||||
|
||||
|
||||
**Benign Bone Tumors**
|
||||
*Axial CT demonstrates an expanded lesion in the posterior left iliac bone with mild expansion and ground-glass matrix <img src='img/arrows/WC.png' alt='white curved arrow'/>, typical of fibrous dysplasia.*
|
||||
|
||||
|
||||
**Benign Bone Tumors**
|
||||
*Axial FDG PET/CT fused image in the same patient reveals very mild FDG uptake <img src='img/arrows/WC.png' alt='white curved arrow'/>. This lesion was found incidentally when the scan was acquired for other reasons.*
|
||||
|
||||
|
||||
**Benign Bone Tumors**
|
||||
*Axial CT demonstrates a pedunculated osteochondroma arising from the dorsal aspect of the proximal femoral diaphysis <img src='img/arrows/WO.png' alt='white open arrow'/>.*
|
||||
|
||||
|
||||
**Benign Bone Tumors**
|
||||
*Axial FDG PET/CT fused image in the same patient reveals FDG uptake associated with this lesion <img src='img/arrows/WO.png' alt='white open arrow'/>. Though there was no malignant transformation, the uptake is associated with focal pain. The lesion is located in an anatomic region where this benign tumor is repeatedly traumatized.*
|
||||
|
||||
|
||||
**Paget Disease**
|
||||
*Axial CT demonstrates an enlarged right iliac bone with mild cortical thickening and disordered trabeculae <img src='img/arrows/WO.png' alt='white open arrow'/>, typical of Paget disease.*
|
||||
|
||||
|
||||
**Paget Disease**
|
||||
*Axial FDG PET/CT fused image in the same patient reveals minimal FDG uptake in the right iliac bone <img src='img/arrows/WO.png' alt='white open arrow'/>. The FDG uptake is similar throughout all the visible bones <img src='img/arrows/WS.png' alt='white solid arrow'/>.*
|
||||
|
||||
BIN
Binary file not shown.
|
After Width: | Height: | Size: 50 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 86 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 106 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 115 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 74 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 63 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 76 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 69 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 146 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 143 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 49 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 61 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 72 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 109 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 68 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 68 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 112 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 104 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 143 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 43 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 72 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 39 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 58 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 53 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 85 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 114 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 6.5 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 72 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 106 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 60 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 78 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 6.3 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 95 KiB |
BIN
Binary file not shown.
|
After Width: | Height: | Size: 101 KiB |
+439
@@ -0,0 +1,439 @@
|
||||
---
|
||||
title: "Prostate and Seminal Vesicles"
|
||||
docid: "b0f47093-297b-4b4d-a974-389c3ba9649e"
|
||||
authors:
|
||||
- key: "0389ffc0-8ffe-4f79-97b5-60d751edb902"
|
||||
value: "Bryan R. Foster, MD"
|
||||
- key: "961f3a7f-ad62-43bc-98f4-5116b17ab812"
|
||||
value: "Paula J. Woodward, MD, FSRU"
|
||||
- key: "96e7516f-0dbd-469f-bc87-09754506e3f2"
|
||||
value: "Akram M. Shaaban, MBBCh"
|
||||
breadcrumbs:
|
||||
-
|
||||
name: "Genitourinary"
|
||||
slug: "genitourinary"
|
||||
treeNodeId: "3b7e2daf-6a7c-4af6-b5af-e665002794df"
|
||||
-
|
||||
name: "Anatomy"
|
||||
slug: "anatomy"
|
||||
treeNodeId: "72be6c04-36fc-42f4-87f5-d3dc8a909b38"
|
||||
-
|
||||
name: "Prostate and Seminal Vesicles"
|
||||
slug: "prostate-and-seminal-vesicles"
|
||||
treeNodeId: null
|
||||
category: "Genitourinary"
|
||||
documentVersionId: "7fff9ee1-9344-4156-8508-94ded3f51262"
|
||||
imageCount: 43
|
||||
lastUpdated: "07/24/23"
|
||||
pageDescription: "Prostate and Seminal Vesicles"
|
||||
pageKeywords: "Genitourinary, Anatomy, Prostate and Seminal Vesicles"
|
||||
pageTitle: "Prostate and Seminal Vesicles | STATdx"
|
||||
enhancedTitle: "Prostate and Seminal Vesicles"
|
||||
type: "ANATOMY"
|
||||
breadcrumbs:
|
||||
- "Genitourinary"
|
||||
- "Anatomy"
|
||||
- "Prostate and Seminal Vesicles"
|
||||
---
|
||||
## TERMINOLOGY
|
||||
|
||||
- ### Abbreviations
|
||||
|
||||
|
||||
- Anterior fibromuscular stroma (AFMS)
|
||||
- Central zone (CZ)
|
||||
- Peripheral zone (PZ)
|
||||
- Transition zone (TZ)
|
||||
- Neurovascular bundle (NVB)
|
||||
- Benign prostatic hyperplasia (BPH)
|
||||
|
||||
## GROSS ANATOMY
|
||||
|
||||
- ### Prostate
|
||||
|
||||
|
||||
- Walnut-sized gland located beneath bladder and in front of rectum
|
||||
- Lies above superior fascia of urogenital diaphragm
|
||||
- Surrounds uppermost part of urethra
|
||||
- Normal prostate ~ 5 cm craniocaudal x 3 cm transverse x 3 cm anteroposteriorly
|
||||
- Normal volume ≤ 25 mL
|
||||
- From superior to inferior
|
||||
- **Base**refers to wider, superior 1/3
|
||||
- **Midgland** refers to middle 1/3
|
||||
- **Apex**refers to narrower, inferior 1/3
|
||||
- Multiple points of contact with surrounding structures
|
||||
- Base closely related to inferior surface of bladder
|
||||
- Apex in contact with superior fascia of urogenital diaphragm
|
||||
- **Posterior surface** separated from rectum by rectovesical septum (**Denonvilliers fascia**)
|
||||
- 2 **ejaculatory ducts** enter prostate through posterior surface
|
||||
- Posterosuperiorly, seminal vesicles lie between bladder base and rectum
|
||||
- **Anterior surface** separated from symphysis pubis by extraperitoneal fat and plexus of veins
|
||||
- Connected to pubic bone on either side by puboprostatic ligaments
|
||||
- **Inferolateral surfaces** separated from levator ani by periprostatic plexus of veins
|
||||
- **Prostate capsule**
|
||||
- Surgically and radiographically, capsule-like structure is seen; however, prostate lacks true capsule
|
||||
- Pathologically, capsule is made up of loose smooth muscle fibers and interspersed connective tissue
|
||||
- For this reason some authors have therefore termed it pseudocapsule
|
||||
- Capsule surrounds posterior and lateral portions of prostate
|
||||
- Anteriorly, it merges with AFMS
|
||||
- **Prostatic urethra**
|
||||
- Prostatic utricle, prostatic ducts, and ejaculatory ducts enter prostatic urethra
|
||||
- **Urethral crest**
|
||||
- Narrow longitudinal ridge on posterior wall
|
||||
- Formed by elevation of mucosal membrane and its subjacent tissue
|
||||
- 15-17 mm in length, ~ 3 mm in height
|
||||
- **Verumontanum**(colliculus seminalis)
|
||||
- Median elevation of urethral crest below its summit
|
||||
- Openings of prostatic utricle and ejaculatory ducts
|
||||
- **Prostatic sinus**
|
||||
- Slightly depressed fossae on each side of verumontanum
|
||||
- Multiple openings of prostatic ducts
|
||||
- **Prostatic utricle**
|
||||
- Small vestigial blind pouch of prostate gland, ~ 6 mm long
|
||||
- Developed from united lower ends of atrophied müllerian ducts
|
||||
- Homologous with uterus and vagina in females
|
||||
- Prostatic urethra is divided into proximal and distal parts by verumontanum
|
||||
- Midway between prostatic apex and bladder neck
|
||||
- Sharp anterior angulation of urethra of ~ 35° at verumontanum
|
||||
- **NVBs**
|
||||
- Lie posterolaterally to prostate
|
||||
- Separated from prostate by Denonvilliers fascia
|
||||
- Carries nerve and vascular supply to corpora cavernosa
|
||||
- Critical for normal erectile function
|
||||
- Increasing evidence that nerves important for erectile function and continence surround prostate and are not just present posterolaterally at bundles
|
||||
- **Arterial supply**derived from internal pudendal, inferior vesicle, and middle rectal arteries
|
||||
- All branches of internal iliac arteries
|
||||
- **Prostatic venous plexus**
|
||||
- Receives blood from dorsal vein of penis
|
||||
- Drains into internal iliac veins
|
||||
- Prostatic venous plexus communicates with internal vertebral venous plexus (**Batson plexus**)
|
||||
- **Nerve supply**
|
||||
- Parasympathetic fibers from pelvic splanchnic nerves (S2-S4)
|
||||
- Sympathetic fibers from inferior hypogastric plexuses
|
||||
- **Lymphatic drainage** chiefly to internal iliac and sacral lymph nodes
|
||||
- Some drainage from posterior surface joins with bladder lymphatics and drains to external iliac lymph nodes
|
||||
- ### Zonal Anatomy (McNeal)
|
||||
|
||||
|
||||
- Prostate is histologically composed of glandular (acinar) and nonglandular elements
|
||||
- 2 nonglandular elements:**** Prostatic urethra and AFMS
|
||||
- AFMS is contiguous with bladder muscle and external sphincter
|
||||
- Proximal 1/2 of prostatic urethra is surrounded by cuff of smooth muscle ("**preprostatic sphincter**"****)
|
||||
- **Glandular prostate** consists of outer and inner components
|
||||
- **Inner prostate** has 2 parts: Periurethral glandular tissue and TZ
|
||||
- **Periurethral glands**
|
||||
- < 1% of normal glandular prostate
|
||||
- Small glands confined to submucosal layer of proximal prostatic urethra above verumontanum and deep to preprostatic sphincter
|
||||
- Ducts drain into proximal posterolateral wall of prostatic urethra in 2 rows
|
||||
- **TZ**
|
||||
- ~ 5% of normal glandular prostate
|
||||
- Enlarges in setting of BPH
|
||||
- Surrounds anterior and lateral aspects of proximal urethra
|
||||
- **Outer prostate** has 2 parts: CZ and PZ
|
||||
- **CZ**
|
||||
- ~ 25% of normal glandular prostate, becomes much smaller with aging and BPH
|
||||
- Surrounds ejaculatory ducts
|
||||
- Funnel-shaped with its widest portion making up majority of prostatic base
|
||||
- Tapered tip extends inferiorly to level of verumontanum
|
||||
- Encloses both periurethral glands and TZ
|
||||
- Ducts of CZ drain to region of verumontanum, clustered around entry of ejaculatory ducts
|
||||
- **PZ**
|
||||
- ~ 70% of normal glandular prostate, becomes much smaller with aging and BPH
|
||||
- Surrounds both CZ and distal prostatic urethra
|
||||
- Ducts of PZ drain exclusively to distal prostatic urethra
|
||||
- Ducts are arranged in 2 vertical lines along posterolateral urethral wall
|
||||
- **Prostate pseudocapsule** ("surgical capsule")
|
||||
- Visible boundary between TZ and PZ
|
||||
- ### Seminal Vesicles and Ejaculatory Ducts
|
||||
|
||||
|
||||
- **Seminal vesicles**
|
||||
- Sac-like structures located superolaterally to prostate
|
||||
- Between fundus of urinary bladder and rectum
|
||||
- **Secrete fructose-rich**,**alkaline fluid**, which is major component of semen
|
||||
- Secretions are energy source for sperm
|
||||
- Do not store sperm****
|
||||
- **Arterial supply**
|
||||
- Inferior vesicle and middle hemorrhoidal arteries
|
||||
- **Venous drainage**accompanies arteries
|
||||
- **Lymphatic drainage**
|
||||
- Superior portion → external iliac nodes
|
||||
- Inferior portion → internal iliac nodes
|
||||
- **Ejaculatory ducts**
|
||||
- Located on either side of midline
|
||||
- Formed by union of seminal vesicle duct and ductus deferens
|
||||
- ~ 2.5 cm long
|
||||
- Start at base of prostate and run forward and downward through gland
|
||||
- Terminate as separate slit-like openings close to utricle
|
||||
|
||||
## IMAGING ANATOMY
|
||||
|
||||
- ### Prostate
|
||||
|
||||
|
||||
- MR
|
||||
- T1 MR: Homogeneous intermediate signal intensity
|
||||
- Often best sequence for NVB, which are 5 and 7 o'clock positions
|
||||
- Best depicts areas of hemorrhage (usually related to recent biopsy) and T1-hyperintense cysts
|
||||
- T2 MR depicts zonal anatomy best
|
||||
- AFMS is low signal intensity band of tissue, of variable thickness, along anterior gland
|
||||
- PZ is high signal intensity, ≥ periprostatic fat
|
||||
- PZ is posterior, wraps laterally and extends anteriorly in midgland to apex in some men
|
||||
- PZ is surrounded by thin, low-signal "capsule" (though there is no true capsule)
|
||||
- CZ and TZ are of similar T2 signal intensity, < PZ
|
||||
- TZ easily recognized by variable-sized BPH nodules in most men > 50 years of age
|
||||
- CZ easily recognized in older man with BPH as symmetric dumbbell-shaped T2-hypointense areas at base surrounding paired ejaculatory ducts
|
||||
- Tumor is typically homogenously T2 hypointense in both TZ and PZ
|
||||
- Diffusion-weighted imaging (DWI)
|
||||
- Diffusion properties of tissue are related to amount of interstitial free water and permeability
|
||||
- Cancer has more restricted diffusion 2° to high cellular density and reduced extracellular space
|
||||
- High b values (≥ 1,400 sec/mm²) give best contrast between normal prostate and cancer
|
||||
- Tumor is markedly bright on DWI
|
||||
- Tumor is markedly dark on apparent diffusion coefficient (ADC) map
|
||||
- Dynamic contrast enhancement
|
||||
- Normal PZ typically shows low-level slow enhancement; however, in some men, diffuse avid enhancement is seen and may be due to chronic inflammation or fibrosis
|
||||
- TZ often shows avid early enhancement; BPH nodules show variable enhancement from low level to avid (mimicking tumor)
|
||||
- Tumor in both PZ and TZ enhances early and often washes out rapidly over minutes
|
||||
- Transrectal ultrasound (TRUS)
|
||||
- Zones of normal prostate may not be sonographically evident
|
||||
- TZ becomes distinguishable in BPH as well-demarcated area of heterogeneity
|
||||
- May contain visible nodules, cysts, and calcifications
|
||||
- TRUS-guided biopsy for suspected prostate cancer is historically gold standard but is blind biopsy, as tumor is usually not visualized
|
||||
- CT
|
||||
- Prostate has homogeneous density similar to muscles
|
||||
- Not used for evaluation of prostate because of poor tissue characterization
|
||||
- BPH is seen when moderate to large, and some large or aggressive prostate cancer can be seen, especially since they are hypervascular
|
||||
- Prostate calcifications best seen by CT but of little clinical significance
|
||||
- Prostate volume measurement
|
||||
- Prolate ellipse volume for 3 unequal axes
|
||||
- Width x height x length x 0.523
|
||||
- 1 cc of prostate tissue ~ 1 g
|
||||
- Prostatic enlargement when gland is >25 mL
|
||||
- Prostate volume can be useful to calculate PSA density, which helps predict likelihood of cancer
|
||||
- ### Seminal Vesicles and Vasa Deferentia
|
||||
|
||||
|
||||
- MR is excellent modality to evaluate seminal vesicles
|
||||
- Fluid-containing structures are therefore of low signal intensity on T1 MR, high signal intensity on T2 MR
|
||||
- Evaluation of seminal vesicles is important during staging of prostate cancer
|
||||
- Recent ejaculation results in seminal vesicle collapse, and ↓ T2 MR signal and can limit interpretation
|
||||
- Cystic appearance on TRUS
|
||||
- Vasography****
|
||||
- Injection of contrast into vas deferens to evaluate patency
|
||||
- Performed intraoperatively or by retrograde injection during cystoscopy
|
||||
- Seminal vesiculography
|
||||
- Injection of contrast material into seminal vesicle
|
||||
- Performed under TRUS guidance
|
||||
- Largely replaced vasography for diagnosis of ejaculatory duct obstruction
|
||||
|
||||
## CLINICAL IMPLICATIONS
|
||||
|
||||
- ### Zonal Distribution of Prostatic Disease
|
||||
|
||||
|
||||
- Prostatic diseases have zonal distribution
|
||||
- **Prostate carcinoma**
|
||||
- 70% of adenocarcinomas arise in PZ
|
||||
- 20% in TZ
|
||||
- 10% in CZ
|
||||
- **BPH**
|
||||
- Originates in TZ
|
||||
- Compresses CZ and PZ
|
||||
- May extend into bladder base (intravesical prostatic protrusion)
|
||||
- Associated with bladder outlet obstruction
|
||||
- Not to be confused with bladder mass
|
||||
- May extrude into PZ as focal heterogenous encapsulated nodules
|
||||
- ### Prostate Carcinoma
|
||||
|
||||
|
||||
- Predictors of extracapsular extension of tumor
|
||||
- Asymmetry of NVB
|
||||
- Nerve-sparing procedure can leave positive margins if NVB invaded
|
||||
- Obliteration of rectoprostatic angle
|
||||
- Irregular bulge in prostatic contour
|
||||
- Tumor-capsule interface > 1.5 cm
|
||||
- Patterns of spread
|
||||
- Direct invasion of seminal vesicles common
|
||||
- Tumor at base may spread to bladder neck and change surgical approach
|
||||
- Rarely spreads posterior to seminal vesicles across Denonvilliers fascia to involve rectum
|
||||
- Lymph nodes: Pelvic sidewall > common iliac > retroperitoneal
|
||||
- Perirectal nodes increasingly recognized as harboring disease
|
||||
- 90% of prostatic metastases involve pelvic bones and spine usually in ascending fashion
|
||||
- Lumbar spine affected 3x > cervical spine
|
||||
|
||||
ea7270db-697a-42f0-9657-f83632c98d35
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Prostate Gland
|
||||
|
||||
|
||||
*Graphic illustrates the relationship between the prostate and the male pelvic organs. The prostate surrounds the upper part of the urethra (prostatic urethra). The base of the prostate is in direct contact with the neck of the urinary bladder, and its apex is in contact with the urogenital diaphragm. The posterior surface is separated from the rectum by rectovesical septum (Denonvilliers fascia).*
|
||||
|
||||
|
||||
*Graphic illustrates the topography of the posterior wall of the prostatic urethra. The urethral crest is a mucosal elevation along the posterior wall with the verumontanum being a mound-like elevation in the midportion of the crest. The utricle opens midline onto the verumontanum with the ejaculatory ducts opening on either side. The prostatic ducts are clustered around the verumontanum and open into the prostatic sinuses, which are depressions along the sides of the urethral crest.*
|
||||
|
||||
|
||||
### Vas Deferens and Seminal Vesicles
|
||||
|
||||
|
||||
*Lateral view shows the position of the prostate deep in the pelvis. The vas deferens leaves the scrotum as a component of the spermatic cord, which courses through the inguinal canal into the pelvis.*
|
||||
|
||||
|
||||
*Posterior view of the prostate gland and seminal vesicles is shown. The cut surface of the seminal vesicle shows its highly convoluted fold pattern. The vas deferens crosses superior to the ureterovesical junction and continues along the posterior surface of the urinary bladder medial to the seminal vesicle. In the base of the prostate, it is directed forward and joined at an acute angle by the duct of the seminal vesicle to form the ejaculatory duct. The ejaculatory ducts course anteriorly and downward through the prostate to slit-like openings on either side of the orifice of the prostatic utricle.*
|
||||
|
||||
|
||||
### Prostate Zonal Anatomy
|
||||
|
||||
|
||||
*3D graphic depiction of the prostate shows axial drawings of the zonal anatomy at 3 different levels. The transition zone (TZ) (in blue) is anterolateral to the verumontanum. The central zone (CZ) (in orange) surrounds the ejaculatory ducts and encloses the periurethral glands and the TZ. It is conical in shape and extends downward to about the level of the verumontanum. The peripheral zone (PZ) (in green) surrounds the posterior aspect of the CZ in the upper 1/2 of the gland and the urethra in the lower 1/2, below the verumontanum. The prostatic pseudocapsule is a visible boundary between the CZ and PZ. The anterior fibromuscular stroma (AFMS) (in yellow) covers the anterior part of the gland and is thicker superiorly and thins inferiorly in the prostatic apex.*
|
||||
|
||||
|
||||
*Graphic illustrates the zonal anatomy of the prostate in the coronal plane. The proximal 1/2 of the prostatic urethra is surrounded by a cuff of smooth muscle, the preprostatic sphincter. This cuff extends inferiorly to the level of the verumontanum. The periurethral glands are confined to the urethral submucosa deep to the preprostatic sphincter. The TZ is a downward extension of the periurethral glands around the verumontanum. It surrounds the anterior and lateral portions of the proximal urethra in a horseshoe-like fashion.*
|
||||
|
||||
|
||||
*Graphic illustrates the zonal anatomy of the prostate in the sagittal plane. The outer prostate is composed of CZ and PZ. The CZ surrounds the proximal urethra posterosuperiorly, enclosing both the periurethral glands and the TZ. It forms most of the prostatic base. The PZ surrounds both the CZ and the distal prostatic urethra.*
|
||||
|
||||
|
||||
### Normal Prostate and Benign Prostatic Hyperplasia
|
||||
|
||||
|
||||
*First of 2 graphics comparing zonal anatomy in a young man to an older man with benign prostatic hyperplasia (BPH) is shown. The TZ in young men is small in size, composing 5% of the volume of the glandular tissue of the prostate. It surrounds the anterolateral aspect of the urethra at the level of verumontanum in a horseshoe fashion.*
|
||||
|
||||
|
||||
*With the development of BPH, there is enlargement of the TZ. This causes enlargement of the prostate and compression of the CZ and PZ. BPH mainly involves the TZ, though other zones may also be involved. The enlarged TZ causes compression of the prostatic urethra, the primary reason for development of urinary obstructive symptoms in patients with BPH.*
|
||||
|
||||
|
||||
### Gross Photographs, Prostate
|
||||
|
||||
|
||||
*Anterior-superior view of a resected prostate shows the urethra at the base. Paired bilateral seminal vesicles are attached to the posterior aspect of the base, lateral to the tubular vas deferens. (From DP: Genitourinary.)*
|
||||
|
||||
|
||||
*These different views of the prostate depict the course of the prostatic urethra (yellow), which has a 35° anterior angulation halfway between base and apex, at the level of the verumontanum; this divides the prostatic urethra into proximal and distal segments. The ejaculatory ducts (blue) have a straighter course from the base of the seminal vesicles to the verumontanum. (From DP: Genitourinary.)*
|
||||
|
||||
|
||||
*Cross section of the prostate at the verumontanum shows the PZ, which has a more spongy appearance, surrounding the hypertrophied, nodular TZ. (From DP: Genitourinary.)*
|
||||
|
||||
|
||||
### T1 MR, Prostate
|
||||
|
||||
|
||||
*Coronal T1 MR of the prostate in a normal young adult shows the conical-shaped prostate with the wide base in contact with the urinary bladder neck and the apex in contact with the urogenital diaphragm.*
|
||||
|
||||
|
||||
*Image is immediately below the bladder neck, just entering the base of the prostate gland. The anterior surface of the prostate is separated from the symphysis pubis by extraperitoneal fat and a venous plexus. Posteriorly, it is separated from the rectum by the rectovesical septum (Denonvilliers fascia).*
|
||||
|
||||
|
||||
*Slightly inferiorly, the complete contour of the prostate is well seen. It is homogeneous and intermediate to low signal intensity, similar to the pelvic floor muscles. T1 images are not helpful in depicting prostate zonal anatomy, but the neurovascular bundles are usually well seen at the 5 and 7 o'clock positions.*
|
||||
|
||||
|
||||
### Axial T2 MR, Prostate
|
||||
|
||||
|
||||
*First of 3 axial T2 MR images of the prostate of a 45-year-old man with mild prostatic obstructive symptoms is shown. This image, at the level of the prostatic base, shows the AFMS continuous with the bladder muscle and external sphincter. The PZ encloses the CZ, which forms a large part of the prostatic base.*
|
||||
|
||||
|
||||
*The tapered end of the funnel-shaped CZ extends to the level of verumontanum. The neurovascular bundles lie posterolaterally to the prostate, at roughly the 5 and 7 o'clock positions. They supply the corpora cavernosa and are critical for normal erectile function. The periurethral glands are not discernible on imaging.*
|
||||
|
||||
|
||||
*At the level of the verumontanum, the slightly prominent TZ can be identified as an area of heterogeneous low signal intensity with scattered, small areas of high signal.*
|
||||
|
||||
|
||||
### Different Grades of Benign Prostatic Hyperplasia
|
||||
|
||||
|
||||
*Axial image of the prostate shows mild BPH. The hypertrophied TZ is heterogeneous with areas of high and low signal.*
|
||||
|
||||
|
||||
*Axial T2 MR shows moderate BPH with an enlarged, heterogenous, and nodular TZ. The gland measures 52 mL.*
|
||||
|
||||
|
||||
*Axial T2 MR shows a markedly enlarged, 147-mL prostate due to BPH. Notice the compressed and thinned PZ. Areas of T2 dark signal in the TZ represent stromal elements of BPH, whereas bright signal represents glandular elements. BPH is often arranged into nodules, which are typically heterogenous and show encapsulation.*
|
||||
|
||||
|
||||
*Consecutive cross sections of a prostate gland with BPH shows marked nodular enlargement of the TZ. It is compressing the prostatic urethra, which was the cause of the patient's bladder-obstructive symptoms. The PZ is compressed and attenuated by the hyperplastic TZ. (From DP: Genitourinary.)*
|
||||
|
||||
|
||||
*Sagittal T2 MR of the prostate shows BPH with a lobulated midline structure protruding into the bladder neck. This represents hyperplastic periurethral glands. The periurethral glands are less commonly involved with BPH but, when enlarged, can form what is termed intravesical prostatic protrusion (formerly known as median lobe hypertrophy).*
|
||||
|
||||
|
||||
*Coronal T2 MR of the prostate shows intravesical prostatic protrusion extending from BPH. This can cause severe obstructive voiding symptoms by creating a ball-valve mechanism of obstruction of the urethra. This is distinguished from a bladder mass by its typical appearance and location.*
|
||||
|
||||
|
||||
### Sagittal and Coronal T2 MR, Prostate
|
||||
|
||||
|
||||
*Sagittal T2 MR in the midline shows the bladder neck and proximal prostatic urethra, which has a posterior course. It makes a 35° anterior angulation at the level of the verumontanum.*
|
||||
|
||||
|
||||
*Parasagittal image along the lateral margin of the prostate gland shows a much larger PZ as it extends anteriorly around the central portion of the gland. It abuts the CZ, but in the setting of BPH, as in this patient, the TZ and CZ cannot be distinguished as separate structures and can be referred to collectively as the central gland.*
|
||||
|
||||
|
||||
*In the coronal plane, the PZ forms a cone extending down to the apex and surrounding the central zone at the base and the transition zone at the base and midgland.*
|
||||
|
||||
|
||||
### Seminal Vesicles, Vas Deferens
|
||||
|
||||
|
||||
*Two consecutive coronal T2 MR images show the vas deferens as they course medially over the posterior bladder to the seminal vesicles. The walls are thick and muscular and are low signal on T2 imaging.*
|
||||
|
||||
|
||||
*Axial T2 MR shows the seminal vesicles between the urinary bladder and the rectum. The low-signal walls of the vas deferens should not be confused with tumor extension from prostate carcinoma.*
|
||||
|
||||
|
||||
*Coronal T2 MR through the PZ of the prostate shows the vesicular appearance of the seminal vesicles with high signal intensity similar to fluid. The seminal vesicles secrete and store a fructose-rich, alkaline fluid, which is the major constituent of semen. They do not store sperm, which are transported from the testes via the vasa deferens during ejaculation. The duct of the seminal vesicle and the vas deferens join to form the ejaculatory duct.*
|
||||
|
||||
|
||||
### Endorectal Ultrasound, Prostate
|
||||
|
||||
|
||||
*Transverse transrectal ultrasound (TRUS) at the level of the midprostate shows the 2 lobes of the TZ on either side of the urethra. The more homogeneous PZ is along the posterolateral aspects of the prostate. Note the periurethral calcifications.*
|
||||
|
||||
|
||||
*First of 2 transverse TRUS images shows a heterogeneous, slightly enlarged TZ. As BPH begins to develop, the TZ becomes distinguishable by ultrasound. It has a heterogeneous echogenicity with visible cysts, nodules, and calcifications.*
|
||||
|
||||
|
||||
*Focal areas of calcifications with shadowing are seen in this patient.*
|
||||
|
||||
|
||||
### Endorectal Ultrasound, Seminal Vesicles
|
||||
|
||||
|
||||
*Parasagittal TRUS shows the seminal vesicle adjacent to the base of the prostate.*
|
||||
|
||||
|
||||
*Parasagittal TRUS shows the ejaculatory duct entering the prostate base. The ejaculatory ducts are surrounded by the CZ, which is not readily distinguishable on TRUS. Calcifications are seen within the more anterior TZ. The PZ runs along the posterolateral aspect of the prostate.*
|
||||
|
||||
|
||||
*Two consecutive transverse TRUS show the vas deferens converging with the seminal vesicles. Their union will form the ejaculatory ducts, which enter the prostate base and course within the prostate enclosed within the CZ. The ejaculatory ducts empty into the urethra at the verumontanum.*
|
||||
|
||||
|
||||
### Diffusion-Weighted Imaging
|
||||
|
||||
|
||||
*This sequence of diffusion-weighed images (DWI) shows a tumor near the apex of the gland. With low b values (strength of diffusion sensitizing gradient), the signal is similar to a T2 MR with high signal observed in the PZ, bladder, and seminal vesicles. As the b value increases, there is a diffusion of water molecules except in highly cellular areas, such as cancer, which has restricted diffusion. With a b value of 1,500, the tumor is well seen with loss of signal in the surrounding structures. The apparent diffusion coefficient gradient (ADC) map shows low signal (lack of diffusion) in the tumor.*
|
||||
|
||||
|
||||
*This sequence of DWIs shows a tumor in the TZ of the prostate gland. These tumors can be particularly difficult to diagnose, as they can be masked by surrounding BPH. One of the features described on T2 MR is a "smudgy," charcoal-like appearance in comparison to the more well-defined, encapsulated nodules seen in BPH. With increasing b values, the tumor becomes evident. It is important to note that at low b values, the tumor may be isointense to the rest of the prostate (b 400 in this case); therefore, high b values (> 1,200 sec/mm²) are recommended for prostate cancer imaging.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
*First of 2 axial, endorectal T2 images of a prostate carcinoma extending into the seminal vesicles is shown. A large tumor is seen on the right side of the peripheral zone.*
|
||||
|
||||
|
||||
*An image above the prostate shows the low-signal tumor involving both seminal vesicles. Seminal vesicle invasion is a common mode of spread for prostate carcinoma; therefore, the seminal vesicles should be thoroughly evaluated in every case.*
|
||||
|
||||
|
||||
*First of 2 images of a patient with congenital absence of the left kidney and left seminal vesicle is shown. Axial CT at the level of the right kidney shows absence of the left kidney. The descending colon occupies the left renal fossa. Note the presence of the left adrenal gland, which has a separate embryological origin.*
|
||||
|
||||
|
||||
*Axial CT of the pelvis shows absence of the left seminal vesicle. The combination of absence of a seminal vesicle or seminal vesicle cysts and ipsilateral renoureteral agenesis is explained by the close embryologic development of these structures.*
|
||||
|
||||
|
||||
*Transrectal T2 MR shows absence of the left seminal vesicle in another patient with ipsilateral renal agenesis.*
|
||||
|
||||
+361
-283
@@ -1,191 +1,30 @@
|
||||
[
|
||||
{
|
||||
"path": "docs_md/articles/acute-left-abdominal-pain_65c32297-ce9e-41dd-80b5-60fd7160f2a6.md",
|
||||
"title": "Acute Left Abdominal Pain",
|
||||
"docid": "65c32297-ce9e-41dd-80b5-60fd7160f2a6",
|
||||
"path": "docs_md/articles/pericardial-calcification_102d1a2a-5968-4ccc-bb39-13ea2e395a88.md",
|
||||
"title": "Pericardial Calcification",
|
||||
"docid": "102d1a2a-5968-4ccc-bb39-13ea2e395a88",
|
||||
"breadcrumbs": [
|
||||
"Gastrointestinal",
|
||||
"Cardiac",
|
||||
"Differential Diagnosis",
|
||||
"Colon",
|
||||
"Clinically Based Differentials",
|
||||
"Acute Left Abdominal Pain"
|
||||
"Pericardial Calcification"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "6c5a9e0e-9dea-461b-9ad4-c00f5c4c2bbf",
|
||||
"value": "Atif Zaheer, MD, FSAR"
|
||||
},
|
||||
{
|
||||
"key": "e987d3d3-1206-48d6-824b-3347c2968855",
|
||||
"value": "Michael P. Federle, MD, FACR"
|
||||
"key": "df804626-c042-4296-96e3-836a6da50fd6",
|
||||
"value": "Gregory Kicska, MD, PhD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Gastrointestinal, Differential Diagnosis, Colon, Clinically Based Differentials, Acute Left Abdominal Pain",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...- Enlarged edematous ovary ± absence of Doppler flow→ torsion - **Uterine fibroids** - May torse, undergo degenerati...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/acute-right-lower-quadrant-pain_0cf67a29-c8c8-4ffc-83d6-99f0ee0b8dd8.md",
|
||||
"title": "Acute Right Lower Quadrant Pain",
|
||||
"docid": "0cf67a29-c8c8-4ffc-83d6-99f0ee0b8dd8",
|
||||
"breadcrumbs": [
|
||||
"Gastrointestinal",
|
||||
"Differential Diagnosis",
|
||||
"Colon",
|
||||
"Clinically Based Differentials",
|
||||
"Acute Right Lower Quadrant Pain"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "6c5a9e0e-9dea-461b-9ad4-c00f5c4c2bbf",
|
||||
"value": "Atif Zaheer, MD, FSAR"
|
||||
},
|
||||
{
|
||||
"key": "e987d3d3-1206-48d6-824b-3347c2968855",
|
||||
"value": "Michael P. Federle, MD, FACR"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Gastrointestinal, Differential Diagnosis, Colon, Clinically Based Differentials, Acute Right Lower Quadrant Pain",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...cute pain - **Hemorrhagic ovarian cyst or ovarian torsion** - High-attenuation (CT) or echogenic (US) material within sphe...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/acute-adnexal-torsion_4a3f1b29-7eeb-470d-855d-56d4bd842ff4.md",
|
||||
"title": "Acute Adnexal Torsion",
|
||||
"docid": "4a3f1b29-7eeb-470d-855d-56d4bd842ff4",
|
||||
"breadcrumbs": [
|
||||
"Gynecology",
|
||||
"Diagnosis",
|
||||
"Adnexa",
|
||||
"Adnexal Torsion",
|
||||
"Acute Adnexal Torsion"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "96e7516f-0dbd-469f-bc87-09754506e3f2",
|
||||
"value": "Akram M. Shaaban, MBBCh"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Gynecology, Diagnosis, Adnexa, Adnexal Torsion, Acute Adnexal Torsion",
|
||||
"pageKeywords": "Cardiac, Differential Diagnosis, Pericardial Calcification",
|
||||
"reasons": [
|
||||
"Breadcrumbs",
|
||||
"Content",
|
||||
"Keywords",
|
||||
"Title"
|
||||
],
|
||||
"snippet": "## KEY FACTS - ### Terminology - Adnexal torsion is more accurate term than ovarian torsion, as torsion usually also includes fallo...",
|
||||
"snippet": "...- Any cause of chronic or prior pericarditis may cause pericardial calcification - Calcification features or distribution limited in identify...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": true,
|
||||
"links": [
|
||||
{
|
||||
"title": "Anatomy Document",
|
||||
"docid": "768ca129-7f1f-436c-97a5-ecd0f63f6441"
|
||||
},
|
||||
{
|
||||
"title": "Anatomy Document",
|
||||
"docid": "19736b1f-b15c-4275-8f1d-52fab6873235"
|
||||
},
|
||||
{
|
||||
"title": "Anatomy Document",
|
||||
"docid": "2d5c024d-0613-45e5-a741-6bb222aa26eb"
|
||||
}
|
||||
]
|
||||
},
|
||||
"differential": {
|
||||
"exists": true,
|
||||
"links": [
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "1fc7c531-ac70-43f7-91a7-a6e01b8e616b"
|
||||
},
|
||||
{
|
||||
"title": "Acute Left Abdominal Pain",
|
||||
"docid": "65c32297-ce9e-41dd-80b5-60fd7160f2a6"
|
||||
},
|
||||
{
|
||||
"title": "Acute Right Lower Quadrant Pain",
|
||||
"docid": "0cf67a29-c8c8-4ffc-83d6-99f0ee0b8dd8"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "3f581609-2dac-4456-ac58-01b68c7535aa"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "a912daa3-bd98-43dd-8310-290393f4def9"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "88a31011-4bc5-45b0-8aea-e7872b12257c"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "373571ed-1233-42d9-a38f-5158d7a41ab9"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "6848b567-4e17-4acd-8afc-7341d24ae30b"
|
||||
}
|
||||
]
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/trochlear-nerve-cniv_cc69e654-b9cd-465b-8437-fba44f3c034b.md",
|
||||
"title": "Trochlear Nerve (CNIV)",
|
||||
"docid": "cc69e654-b9cd-465b-8437-fba44f3c034b",
|
||||
"breadcrumbs": [
|
||||
"Brain",
|
||||
"Anatomy",
|
||||
"Skull Base and Cranial Nerves",
|
||||
"Trochlear Nerve (CNIV)"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "94f835c8-fa13-4e8a-995b-53048e6b0605",
|
||||
"value": "Philip R. Chapman, MD"
|
||||
},
|
||||
{
|
||||
"key": "b0a6efa4-ad68-430c-b5da-f5c904adf809",
|
||||
"value": "Ryan P. Cabeen, PhD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Brain, Anatomy, Skull Base and Cranial Nerves, Trochlear Nerve (CNIV)",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...- Paralysis of superior oblique muscle results in **extorsion** (outward rotation) of affected eye - Extorsion is secondary to unopposed act...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": true,
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
@@ -196,14 +35,14 @@
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/traumatic-aortic-injury_061b04b5-e37e-4f63-a198-1020a984e041.md",
|
||||
"title": "Traumatic Aortic Injury",
|
||||
"docid": "061b04b5-e37e-4f63-a198-1020a984e041",
|
||||
"path": "docs_md/articles/aortic-dissection_57e3428e-1f18-4f38-95c6-f7fe2d93c00a.md",
|
||||
"title": "Aortic Dissection",
|
||||
"docid": "57e3428e-1f18-4f38-95c6-f7fe2d93c00a",
|
||||
"breadcrumbs": [
|
||||
"Cardiac",
|
||||
"Diagnosis",
|
||||
"Aorta",
|
||||
"Traumatic Aortic Injury"
|
||||
"Aortic Dissection"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
@@ -211,31 +50,30 @@
|
||||
"value": "Prabhakar Rajiah, MBBS, MD, FACR, FRCR, FACC, FAHA, FSCCT"
|
||||
},
|
||||
{
|
||||
"key": "8b719ccc-d695-4377-9afb-2b399714d382",
|
||||
"value": "Terrance Healey, MD"
|
||||
"key": "3d1e4c57-c1cf-4c89-b0f0-5d82b29a31e1",
|
||||
"value": "Suhny Abbara, MD, FACR, MSCCT, FNASCI"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Cardiac, Diagnosis, Aorta, Traumatic Aortic Injury",
|
||||
"pageKeywords": "Cardiac, Diagnosis, Aorta, Aortic Dissection",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...- Multivariate hypothesis likely: Shearing, torsion, stretching, hydrostatic forces - ## Gross Pathologic & Surgical Features...",
|
||||
"snippet": "...ronchus, esophageal deviation, loss of paratracheal stripe, pericardial effusion, and hemothorax - Progressive aortic enlargement on serial...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": true,
|
||||
"links": [
|
||||
{
|
||||
"title": "Aortic Arch and Great Vessels",
|
||||
"docid": "a7a252f0-2ac6-402a-8c87-cfce8adc799b"
|
||||
}
|
||||
]
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": true,
|
||||
"links": [
|
||||
{
|
||||
"title": "Ductus Diverticulum",
|
||||
"docid": "9b1101bc-83a2-445c-aef5-53d633e5bec0"
|
||||
"title": "Aortic Intramural Hematoma",
|
||||
"docid": "128bc4cc-a26d-47d5-90e7-b1a1f608e657"
|
||||
},
|
||||
{
|
||||
"title": "Penetrating Atherosclerotic Ulcer",
|
||||
"docid": "63f6cba2-2200-456a-8d03-ac3111e420c8"
|
||||
}
|
||||
]
|
||||
}
|
||||
@@ -243,15 +81,16 @@
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/right-upper-quadrant-pain_33f29d78-0099-4ee9-85da-d0c70c1e0ce6.md",
|
||||
"title": "Right Upper Quadrant Pain",
|
||||
"docid": "33f29d78-0099-4ee9-85da-d0c70c1e0ce6",
|
||||
"path": "docs_md/articles/high-attenuation-hyperdense-bile-in-gallbladder_9f2314d3-b994-4a19-84cf-810daa04fd59.md",
|
||||
"title": "High-Attenuation (Hyperdense) Bile in Gallbladder",
|
||||
"docid": "9f2314d3-b994-4a19-84cf-810daa04fd59",
|
||||
"breadcrumbs": [
|
||||
"Gastrointestinal",
|
||||
"Differential Diagnosis",
|
||||
"Gallbladder",
|
||||
"Clinically Based Differentials",
|
||||
"Right Upper Quadrant Pain"
|
||||
"Modality-Specific Imaging Findings",
|
||||
"Computed Tomography",
|
||||
"High-Attenuation (Hyperdense) Bile in Gallbladder"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
@@ -259,11 +98,11 @@
|
||||
"value": "Siva P. Raman, MD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Gastrointestinal, Differential Diagnosis, Gallbladder, Clinically Based Differentials, Right Upper Quadrant Pain",
|
||||
"pageKeywords": "Gastrointestinal, Differential Diagnosis, Gallbladder, Modality-Specific Imaging Findings, Computed Tomography, High-Attenuation (Hyperdense) Bile in Gallbladder",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...**Epiploic Appendagitis** - Primary thrombosis or torsion of epiploic appendage - Can occur anywhere, but much more common in left...",
|
||||
"snippet": "...rm=27444785%5Bpmid%5D) 1. [Avery LL et al: High attenuation pericardial fluid on CT following cardiac catheterization. Emerg Radiol. 21(4):381-6, 2014...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
@@ -277,32 +116,25 @@
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/dilated-gallbladder_e247f853-a5c2-4535-b071-33f6b89acd80.md",
|
||||
"title": "Dilated Gallbladder",
|
||||
"docid": "e247f853-a5c2-4535-b071-33f6b89acd80",
|
||||
"path": "docs_md/articles/left-ventricular-enlargement_fbb972de-3e13-4c67-b7a4-f8901aa2efb8.md",
|
||||
"title": "Left Ventricular Enlargement",
|
||||
"docid": "fbb972de-3e13-4c67-b7a4-f8901aa2efb8",
|
||||
"breadcrumbs": [
|
||||
"Gastrointestinal",
|
||||
"Cardiac",
|
||||
"Differential Diagnosis",
|
||||
"Gallbladder",
|
||||
"Modality-Specific Imaging Findings",
|
||||
"Ultrasound",
|
||||
"Dilated Gallbladder"
|
||||
"Left Ventricular Enlargement"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "07469ec4-05aa-4d65-a788-08b4d64048af",
|
||||
"value": "Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU, FSAR"
|
||||
},
|
||||
{
|
||||
"key": "6c5a9e0e-9dea-461b-9ad4-c00f5c4c2bbf",
|
||||
"value": "Atif Zaheer, MD, FSAR"
|
||||
"key": "df804626-c042-4296-96e3-836a6da50fd6",
|
||||
"value": "Gregory Kicska, MD, PhD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Gastrointestinal, Differential Diagnosis, Gallbladder, Modality-Specific Imaging Findings, Ultrasound, Dilated Gallbladder",
|
||||
"pageKeywords": "Cardiac, Differential Diagnosis, Left Ventricular Enlargement",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...Helpful Clues for Rare Diagnoses - **Gallbladder Torsion/Volvulus** - Older, thin women with wandering gallbladder - Fe...",
|
||||
"snippet": "...- Radiographic LV enlargement may be mimicked by pericardial effusion, expiration, poor lateral positioning or projection angle, or pericar...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
@@ -316,30 +148,29 @@
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/cniv-trochlear-nerve_52486223-9cb5-43f5-b9af-c46431ae6637.md",
|
||||
"title": "CNIV (Trochlear Nerve)",
|
||||
"docid": "52486223-9cb5-43f5-b9af-c46431ae6637",
|
||||
"path": "docs_md/articles/thoracic-aorta-and-great-vessel-anatomy_a87ab2f8-5c92-4e50-9fe6-d9e63d2b8cab.md",
|
||||
"title": "Thoracic Aorta and Great Vessel Anatomy",
|
||||
"docid": "a87ab2f8-5c92-4e50-9fe6-d9e63d2b8cab",
|
||||
"breadcrumbs": [
|
||||
"Head and Neck",
|
||||
"Vasculature",
|
||||
"Anatomy",
|
||||
"Cranial Nerves",
|
||||
"CNIV (Trochlear Nerve)"
|
||||
"Thoracic Aorta and Great Vessel Anatomy"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "b2e6dabb-ee1c-42a4-a332-9f0814c1c607",
|
||||
"value": "Surjith Vattoth, MD"
|
||||
"key": "3d1e4c57-c1cf-4c89-b0f0-5d82b29a31e1",
|
||||
"value": "Suhny Abbara, MD, FACR, MSCCT, FNASCI"
|
||||
},
|
||||
{
|
||||
"key": "94f835c8-fa13-4e8a-995b-53048e6b0605",
|
||||
"value": "Philip R. Chapman, MD"
|
||||
"key": "2f6bbf02-1f58-4c88-94b9-48328b94d527",
|
||||
"value": "Michael T. Lu, MD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Head and Neck, Anatomy, Cranial Nerves, CNIV (Trochlear Nerve)",
|
||||
"pageKeywords": "Vasculature, Anatomy, Thoracic Aorta and Great Vessel Anatomy",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...- Paralysis of superior oblique muscle results in **extorsion** (outward rotation) of affected eye due to unopposed action of inferior oblique m...",
|
||||
"snippet": "...ntercostal arteries at T6-T12 (75%) - Esophageal, pericardial, superior phrenic, and other miscellaneous mediastinal branches - Central...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": true,
|
||||
@@ -353,119 +184,366 @@
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/hepatic-cavernous-hemangioma_b6861694-7bb0-4730-860d-4c78c1cdb38b.md",
|
||||
"title": "Hepatic Cavernous Hemangioma",
|
||||
"docid": "b6861694-7bb0-4730-860d-4c78c1cdb38b",
|
||||
"path": "docs_md/articles/cardiac-mass_fa1f894a-4619-4657-b99b-a967a3e4e871.md",
|
||||
"title": "Cardiac Mass",
|
||||
"docid": "fa1f894a-4619-4657-b99b-a967a3e4e871",
|
||||
"breadcrumbs": [
|
||||
"Gastrointestinal",
|
||||
"Diagnosis",
|
||||
"Liver",
|
||||
"Benign Neoplasms and Tumor-Like Conditions",
|
||||
"Hepatic Cavernous Hemangioma"
|
||||
"Cardiac",
|
||||
"Differential Diagnosis",
|
||||
"Cardiac Mass"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "6c5a9e0e-9dea-461b-9ad4-c00f5c4c2bbf",
|
||||
"value": "Atif Zaheer, MD, FSAR"
|
||||
},
|
||||
{
|
||||
"key": "e987d3d3-1206-48d6-824b-3347c2968855",
|
||||
"value": "Michael P. Federle, MD, FACR"
|
||||
"key": "df804626-c042-4296-96e3-836a6da50fd6",
|
||||
"value": "Gregory Kicska, MD, PhD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Gastrointestinal, Diagnosis, Liver, Benign Neoplasms and Tumor-Like Conditions, Hepatic Cavernous Hemangioma",
|
||||
"pageKeywords": "Cardiac, Differential Diagnosis, Cardiac Mass",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...such as gastrointestinal stromal tumor - Torsion, infarction, and subsequent calcification may occur - ### MR Findings -...",
|
||||
"snippet": "...s (benign) are usually heterogeneous - Pleural or pericardial effusion suggests primary cardiac malignancy or metastasis - In abse...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": true,
|
||||
"links": [
|
||||
{
|
||||
"title": "Liver",
|
||||
"docid": "e4fdb09c-d20f-407d-b563-499124541261"
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"title": "Liver",
|
||||
"docid": "236fb145-0c29-4362-be57-06401bf337aa"
|
||||
"path": "docs_md/articles/pericardial-mass_39979947-4afb-4370-86ed-6b6d196bca78.md",
|
||||
"title": "Pericardial Mass",
|
||||
"docid": "39979947-4afb-4370-86ed-6b6d196bca78",
|
||||
"breadcrumbs": [
|
||||
"Cardiac",
|
||||
"Differential Diagnosis",
|
||||
"Pericardial Mass"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "df804626-c042-4296-96e3-836a6da50fd6",
|
||||
"value": "Gregory Kicska, MD, PhD"
|
||||
}
|
||||
]
|
||||
],
|
||||
"pageKeywords": "Cardiac, Differential Diagnosis, Pericardial Mass",
|
||||
"reasons": [
|
||||
"Breadcrumbs",
|
||||
"Content",
|
||||
"Keywords",
|
||||
"Title"
|
||||
],
|
||||
"snippet": "...plastic etiology - Loculated fluid can mimic neoplastic pericardial mass - Focal thickening is equally likely to be metastatic tumor vs. other...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"path": "docs_md/articles/rhabdomyoma_2915b0ba-a2fc-425c-beb7-2566dd945aed.md",
|
||||
"title": "Rhabdomyoma",
|
||||
"docid": "2915b0ba-a2fc-425c-beb7-2566dd945aed",
|
||||
"breadcrumbs": [
|
||||
"Pediatrics",
|
||||
"Diagnosis",
|
||||
"Cardiac",
|
||||
"Miscellaneous",
|
||||
"Rhabdomyoma"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "7e393d6e-f8be-4315-b1cd-b4639ee57a5f",
|
||||
"value": "Randy R. Richardson, MD"
|
||||
},
|
||||
{
|
||||
"key": "db1ca0c5-292f-4acd-847d-c73a4f4ba734",
|
||||
"value": "Ryan A. Moore, MD"
|
||||
},
|
||||
{
|
||||
"key": "961f3a7f-ad62-43bc-98f4-5116b17ab812",
|
||||
"value": "Paula J. Woodward, MD, FSRU"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Pediatrics, Diagnosis, Cardiac, Miscellaneous, Rhabdomyoma",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...ve TSC - ## Top Differential Diagnoses - Fibroma; pericardial teratoma - ## Clinical Issues - Cardiac tumors are rare in children...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": true,
|
||||
"links": [
|
||||
{
|
||||
"title": "Cholangiocarcinoma (Peripheral)",
|
||||
"docid": "47b55423-1d41-4790-86bd-cb233ceaa180"
|
||||
"title": "Fibroma",
|
||||
"docid": "8ed96e48-c833-4244-87b3-6c34b6ee34f1"
|
||||
},
|
||||
{
|
||||
"title": "Hepatic Metastases and Lymphoma",
|
||||
"docid": "248db898-197a-4555-a14d-eef5ca2f8967"
|
||||
"title": "Teratoma",
|
||||
"docid": "c115823c-1a05-4185-9ce4-774cd0984249"
|
||||
},
|
||||
{
|
||||
"title": "Hepatic Angiosarcoma",
|
||||
"docid": "df71fca2-b3dc-4890-87ce-ddd0de4f6e96"
|
||||
"title": "Lipoma",
|
||||
"docid": "c332f74f-e3cd-47ba-9ff5-5bce83e0e595"
|
||||
},
|
||||
{
|
||||
"title": "Right Upper Quadrant Pain",
|
||||
"docid": "33f29d78-0099-4ee9-85da-d0c70c1e0ce6"
|
||||
"title": "Myxoma",
|
||||
"docid": "f9b6c595-ff7b-4731-a799-666983e7f4ed"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "6b7939de-9506-4ee2-944d-65766e04e5cf"
|
||||
"title": "Papillary Fibroelastoma",
|
||||
"docid": "7081571d-9b34-4b8e-9bfa-d08e375a1919"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "482d9968-2c80-4ea1-9562-8dfbabb4e517"
|
||||
"title": "Cardiac Malignancies",
|
||||
"docid": "62ce81d0-f7c9-4a17-9ccf-6204aff4f62e"
|
||||
}
|
||||
]
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "db4385a3-b724-4ad2-91b1-44332d70914f"
|
||||
"path": "docs_md/articles/aortic-aneurysm-rupture_e64e6a27-0c8d-4b4f-8ca5-d2e65c9f2e9a.md",
|
||||
"title": "Aortic Aneurysm: Rupture",
|
||||
"docid": "e64e6a27-0c8d-4b4f-8ca5-d2e65c9f2e9a",
|
||||
"breadcrumbs": [
|
||||
"Cardiac",
|
||||
"Diagnosis",
|
||||
"Aorta",
|
||||
"Aortic Aneurysm: Rupture"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "b00d2bdb-66e1-41ed-90b4-c52904f4d598",
|
||||
"value": "Seth Kligerman, MD, MS"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "69ce0141-f34e-49d9-a70f-e4da8af391f7"
|
||||
"key": "9ad9af12-61a1-44d6-af52-0ee1f38eb298",
|
||||
"value": "Davis Vigneault, MD, DPhil"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "325a4527-e4dc-485b-9f89-2cfd5f0a311c"
|
||||
"key": "5de0df07-7b3e-4678-8767-1519e1153f29",
|
||||
"value": "Dominik Fleischmann, MD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Cardiac, Diagnosis, Aorta, Aortic Aneurysm: Rupture",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...effusion (hemothorax) if ruptured into pleural space - Pericardial effusion (hemopericardium) if ruptured into pericardial space - Following...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": true,
|
||||
"links": []
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "6805354c-8246-45dc-aa61-c84f0dab6d16"
|
||||
"path": "docs_md/articles/thoracic-aorta-and-great-vessel-anatomy_67498b94-770a-47ee-bd74-622b5e0b6817.md",
|
||||
"title": "Thoracic Aorta and Great Vessel Anatomy",
|
||||
"docid": "67498b94-770a-47ee-bd74-622b5e0b6817",
|
||||
"breadcrumbs": [
|
||||
"Cardiac",
|
||||
"Anatomy",
|
||||
"Thoracic Aorta and Great Vessel Anatomy"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "9fea2857-d729-4fe4-b4fd-3b7bf1db23cf",
|
||||
"value": "Mortadha Al-Kinani, MD, MBChB"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "75912629-c3e6-4960-9e4d-513fa23779ac"
|
||||
"key": "3d1e4c57-c1cf-4c89-b0f0-5d82b29a31e1",
|
||||
"value": "Suhny Abbara, MD, FACR, MSCCT, FNASCI"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Cardiac, Anatomy, Thoracic Aorta and Great Vessel Anatomy",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...ntercostal arteries at T6-T12 (75%) - Esophageal, pericardial, superior phrenic, and other miscellaneous mediastinal branches - Central...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": true,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"title": "Multiple Hypodense Liver Lesions",
|
||||
"docid": "5178ae9c-1ea9-4e06-9e8a-91e98d8708f6"
|
||||
"path": "docs_md/articles/cardiac-calcifications_c53ad786-4464-4a04-a3e9-ccd286e1f8fc.md",
|
||||
"title": "Cardiac Calcifications",
|
||||
"docid": "c53ad786-4464-4a04-a3e9-ccd286e1f8fc",
|
||||
"breadcrumbs": [
|
||||
"Cardiac",
|
||||
"Differential Diagnosis",
|
||||
"Cardiac Calcifications"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "df804626-c042-4296-96e3-836a6da50fd6",
|
||||
"value": "Gregory Kicska, MD, PhD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Cardiac, Differential Diagnosis, Cardiac Calcifications",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...- ## Helpful Clues for Less Common Diagnoses - **Pericardial** - Associated with constrictive pericarditis - **Myocardial**...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "caf98eea-48d6-4a0f-a747-1c162f945fed"
|
||||
"path": "docs_md/articles/aortic-intramural-hematoma_128bc4cc-a26d-47d5-90e7-b1a1f608e657.md",
|
||||
"title": "Aortic Intramural Hematoma",
|
||||
"docid": "128bc4cc-a26d-47d5-90e7-b1a1f608e657",
|
||||
"breadcrumbs": [
|
||||
"Cardiac",
|
||||
"Diagnosis",
|
||||
"Aorta",
|
||||
"Aortic Intramural Hematoma"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "b66f94a2-4335-4ce8-a3ba-8c5527f8774c",
|
||||
"value": "Domenico Mastrodicasa, MD"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "cf8a471a-3174-43e2-98a5-dce76a3512e5"
|
||||
"key": "5de0df07-7b3e-4678-8767-1519e1153f29",
|
||||
"value": "Dominik Fleischmann, MD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Cardiac, Diagnosis, Aorta, Aortic Intramural Hematoma",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...esents coexistent AD - Common ancillary findings: Pericardial effusion and periaortic hematoma (↑ risk of rupture) - Common featur...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": true,
|
||||
"links": [
|
||||
{
|
||||
"title": "Aortic Dissection",
|
||||
"docid": "57e3428e-1f18-4f38-95c6-f7fe2d93c00a"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "70fea150-3a7b-4f5c-a8f5-9ecc5c6df6e4"
|
||||
"title": "Aortic Intramural Abnormality",
|
||||
"docid": "75d7b37f-bc37-493b-8961-8b2a9001fb94"
|
||||
}
|
||||
]
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "5a0f58f1-beb9-459d-8246-83d6ddaf76db"
|
||||
"path": "docs_md/articles/enlarged-cardiac-silhouette_13d59c6a-0f7f-4389-8d8c-f19ca039e446.md",
|
||||
"title": "Enlarged Cardiac Silhouette",
|
||||
"docid": "13d59c6a-0f7f-4389-8d8c-f19ca039e446",
|
||||
"breadcrumbs": [
|
||||
"Cardiac",
|
||||
"Differential Diagnosis",
|
||||
"Enlarged Cardiac Silhouette"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "df804626-c042-4296-96e3-836a6da50fd6",
|
||||
"value": "Gregory Kicska, MD, PhD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Cardiac, Differential Diagnosis, Enlarged Cardiac Silhouette",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...RMATION - ## Key Differential Diagnosis Issues - Pericardial space fluid: Globular enlargement - Cardiac chamber enlargement: Character...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
}
|
||||
},
|
||||
"is_cached": true
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "14cf45b2-0ff4-42c9-9302-54af7ca6ee03"
|
||||
"path": "docs_md/articles/limited-intimal-tear_bb253de9-ab48-4740-89bd-0036fb8c12f5.md",
|
||||
"title": "Limited Intimal Tear",
|
||||
"docid": "bb253de9-ab48-4740-89bd-0036fb8c12f5",
|
||||
"breadcrumbs": [
|
||||
"Cardiac",
|
||||
"Diagnosis",
|
||||
"Aorta",
|
||||
"Limited Intimal Tear"
|
||||
],
|
||||
"authors": [
|
||||
{
|
||||
"key": "5de0df07-7b3e-4678-8767-1519e1153f29",
|
||||
"value": "Dominik Fleischmann, MD"
|
||||
},
|
||||
{
|
||||
"title": "Differential Diagnosis",
|
||||
"docid": "adbcbcd1-d849-45a5-ba3e-01ac759daca2"
|
||||
"key": "5a4d7c03-82a7-4740-947a-9638213aec4a",
|
||||
"value": "Mohammad H. Madani, MD"
|
||||
}
|
||||
],
|
||||
"pageKeywords": "Cardiac, Diagnosis, Aorta, Limited Intimal Tear",
|
||||
"reasons": [
|
||||
"Content"
|
||||
],
|
||||
"snippet": "...y be similar to those seen in aortic dissection - Pericardial fluid or hemopericardium (in type A lesions) - Pulmonary artery suba...",
|
||||
"linked_info": {
|
||||
"anatomy": {
|
||||
"exists": false,
|
||||
"links": []
|
||||
},
|
||||
"differential": {
|
||||
"exists": true,
|
||||
"links": [
|
||||
{
|
||||
"title": "Aortic Intramural Hematoma",
|
||||
"docid": "128bc4cc-a26d-47d5-90e7-b1a1f608e657"
|
||||
},
|
||||
{
|
||||
"title": "Penetrating Atherosclerotic Ulcer",
|
||||
"docid": "63f6cba2-2200-456a-8d03-ac3111e420c8"
|
||||
}
|
||||
]
|
||||
}
|
||||
|
||||
Reference in New Issue
Block a user