1. The peritoneum is a serous membrane that lines the abdominal wall and covers the abdominal organs.
2. It secretes peritoneal fluid which reduces friction between organs and helps fight infection by containing it through adhesions.
3. Ultrasound, CT, and MRI can help identify peritoneal carcinomatosis but have limitations in detecting small tumor deposits. Diagnosis requires direct visualization during laparoscopy or laparotomy.
Este documento discute vários tipos de lesões mamárias benignas do ponto de vista histopatológico, incluindo: (1) lesões inflamatórias como mastite aguda e granulomatosa, ectasia ductal e esteatonecrose; (2) alterações fibrocísticas como cistos, adenose esclerosante, hiperplasia sem atipias e com atipias; e (3) outras lesões como cicatriz radial e papiloma. O documento descreve os aspectos clínicos, histológicos e riscos associados a
O documento descreve os principais aspectos do exame ultrassonográfico da tireóide, incluindo: a sistematização da análise, os achados normais e patológicos mais comuns e a importância do Doppler colorido.
O documento lista as idades ósseas de acordo com o Atlas de Greulich Pyle, começando com recém-nascido até 19 anos, fornecendo uma referência para avaliar o desenvolvimento ósseo em diferentes idades.
Este documento fornece um resumo sobre ultrassom renal, abordando a anatomia, embriologia, técnica, variações anatômicas, anomalias congênitas e nefropatias parenquimatosas.
O documento descreve o protocolo FAST (Focused Assessment with Sonography for Trauma), um exame ultrassonográfico rápido utilizado para detectar sangramento interno em pacientes traumatizados. O FAST permite identificar líquido livre abdominal, pleural ou pericárdico em apenas 3 minutos. Atualmente, o FAST é amplamente utilizado e integrado no treinamento de médicos de emergência, apesar de ser tradicionalmente realizado por radiologistas. A ecografia de emergência tem revolucionado o diagnóstico rápido de pacientes cr
O documento discute o uso da ultrassonografia no diagnóstico de doenças renais. A ultrassonografia é a modalidade de imagem mais utilizada para avaliar as doenças dos rins. Lesões renais focais, como massas, são achados cada vez mais comuns e podem ser benignas, malignas ou inflamatórias. O carcinoma de células renais é a malignidade renal mais comum e pode ser detectado incidentalmente por ultrassonografia, geralmente em estágio mais precoce.
Painel digital varicocele - Aula do Dr Décio Prando - Conrado Alvarenga
1. O documento discute a importância da avaliação do refluxo venoso na varicocele por meio de ultrassonografia Doppler. 2. A varicocele é uma dilatação das veias do plexo pampiniforme e é a principal causa de distúrbios de fertilidade no homem, podendo resultar em hipotrofia testicular. 3. A ultrassonografia Doppler é útil para detectar e classificar a varicocele e o refluxo, assim como identificar pacientes em risco de desenvolver hipotrofia testicular.
Radiografia de tórax aula2-padrãoacinar-intersticialFlávia Salame
Curso de Pneumologia - Módulo de Radiografia de Tórax. Aula 2: Padão acinar e Padrão Intersticial.
Fonte das imagens:
1 -Pneumoatual (Aulas de radiologia)
2- http://chestatlas.com/cover.htm
Este documento discute vários tipos de lesões mamárias benignas do ponto de vista histopatológico, incluindo: (1) lesões inflamatórias como mastite aguda e granulomatosa, ectasia ductal e esteatonecrose; (2) alterações fibrocísticas como cistos, adenose esclerosante, hiperplasia sem atipias e com atipias; e (3) outras lesões como cicatriz radial e papiloma. O documento descreve os aspectos clínicos, histológicos e riscos associados a
O documento descreve os principais aspectos do exame ultrassonográfico da tireóide, incluindo: a sistematização da análise, os achados normais e patológicos mais comuns e a importância do Doppler colorido.
O documento lista as idades ósseas de acordo com o Atlas de Greulich Pyle, começando com recém-nascido até 19 anos, fornecendo uma referência para avaliar o desenvolvimento ósseo em diferentes idades.
Este documento fornece um resumo sobre ultrassom renal, abordando a anatomia, embriologia, técnica, variações anatômicas, anomalias congênitas e nefropatias parenquimatosas.
O documento descreve o protocolo FAST (Focused Assessment with Sonography for Trauma), um exame ultrassonográfico rápido utilizado para detectar sangramento interno em pacientes traumatizados. O FAST permite identificar líquido livre abdominal, pleural ou pericárdico em apenas 3 minutos. Atualmente, o FAST é amplamente utilizado e integrado no treinamento de médicos de emergência, apesar de ser tradicionalmente realizado por radiologistas. A ecografia de emergência tem revolucionado o diagnóstico rápido de pacientes cr
O documento discute o uso da ultrassonografia no diagnóstico de doenças renais. A ultrassonografia é a modalidade de imagem mais utilizada para avaliar as doenças dos rins. Lesões renais focais, como massas, são achados cada vez mais comuns e podem ser benignas, malignas ou inflamatórias. O carcinoma de células renais é a malignidade renal mais comum e pode ser detectado incidentalmente por ultrassonografia, geralmente em estágio mais precoce.
Painel digital varicocele - Aula do Dr Décio Prando - Conrado Alvarenga
1. O documento discute a importância da avaliação do refluxo venoso na varicocele por meio de ultrassonografia Doppler. 2. A varicocele é uma dilatação das veias do plexo pampiniforme e é a principal causa de distúrbios de fertilidade no homem, podendo resultar em hipotrofia testicular. 3. A ultrassonografia Doppler é útil para detectar e classificar a varicocele e o refluxo, assim como identificar pacientes em risco de desenvolver hipotrofia testicular.
Radiografia de tórax aula2-padrãoacinar-intersticialFlávia Salame
Curso de Pneumologia - Módulo de Radiografia de Tórax. Aula 2: Padão acinar e Padrão Intersticial.
Fonte das imagens:
1 -Pneumoatual (Aulas de radiologia)
2- http://chestatlas.com/cover.htm
Endometriose na RM: 10 perolas de imagemBrenda Lahlou
[1] O documento discute dez achados na imagem por ressonância magnética que são específicos para o diagnóstico de endometriose, incluindo múltiplos cistos anexiais hiperintensos no T1, hematossalpinge e massas sólidas fibróticas. [2] Também aborda como obstruções no fluxo menstrual aumentam o risco de endometriose e como endometriomas podem se transformar em carcinomas ovariano. [3] Resume que protocolos de RM da pelve devem incluir sequências T1
O documento discute a avaliação ultrassonográfica do fígado e vasos hepáticos, incluindo parâmetros normais, sinais de hipertensão portal, avaliação de TIPS e transplante hepático. É apresentado o protocolo completo de exame com ênfase na análise Doppler para avaliar fluxos sanguíneos. Complicações pós-transplante também são revisadas.
Presentation1.pptx. ultrasound examination of the ankle joint.Abdellah Nazeer
This document provides an ultrasound protocol for examining the ankle joint, including descriptions of normal anatomy and potential abnormalities. It discusses scanning techniques for the lateral, anterior, medial, and posterior aspects of the ankle. Common tendon injuries and conditions such as tenosynovitis, tendinosis, ruptures, and bursitis are described. The roles of ultrasound in ankle examination and its limitations are also noted. Key structures like the peroneal and posterior tibial tendons are highlighted.
O documento discute a radiologia do abdome, incluindo técnicas como radiografia simples do abdome e aspectos a serem observados, como posição de órgãos, calcificações e presença de gás. É abordada a detecção de possíveis obstruções intestinais, pneumoperitônio e abscessos através da análise de imagens radiográficas.
O documento descreve o sistema BI-RADS para classificação de achados em mamografia. O BI-RADS fornece categorias de 0 a 5 para classificar lesões de acordo com a probabilidade de malignidade e recomendações de acompanhamento ou biópsia. O resumo do laudo deve conter a indicação, achados, comparação com exames anteriores e classificação BI-RADS.
O documento descreve a técnica e anatomia da ultrassonografia do olho. Resume os principais pontos da anatomia do olho, indicações do exame, abordagem da câmara anterior, cristalino, vítreo, úvea e possíveis achados patológicos como hemorragia, descolamentos e cataratas.
O documento discute o protocolo FAST (Focused Assessment with Sonography for Trauma), que utiliza ultrassom para detectar hemorragias internas em pacientes traumatizados. O protocolo FAST permite detectar rapidamente líquidos no abdome, tórax e pericárdio, tendo alta sensibilidade e especificidade. Atualmente, o uso de ultrassom de emergência por médicos não radiologistas é amplamente aceito e integrado no treinamento de urgência e emergência.
O documento discute os protocolos de relatório para mamografia e ultrassonografia segundo o sistema BI-RADS. O BI-RADS padroniza a terminologia dos laudos e classifica os achados em categorias preditoras de malignidade que orientam a conduta clínica. Os relatórios devem conter informações clínicas, descrição e classificação dos achados de acordo com o protocolo BI-RADS.
O documento descreve vários sinais radiológicos no tórax, incluindo o sinal da silhueta, sinal do broncograma aéreo, sinal da asa de borboleta, sinal do duplo contorno, sinal cervicotorácico, sinal de Golden "S", sinal de Luftsichel, e sinal do halo, fornecendo imagens de exemplo para cada um.
This document discusses the role of MRI in evaluating rectal carcinoma. It provides details on rectal anatomy and landmarks important for staging rectal cancer using MRI. Key points include:
- MRI is useful for local tumor staging, treatment planning, and assessing surgical margins after chemoradiation.
- Important landmarks include the anal verge, anorectal junction, peritoneal reflections, and mesorectal fascia.
- MRI is used to determine tumor distance from these landmarks, size, circumferential extent, and relationship to surrounding structures to accurately stage rectal cancers.
- High resolution imaging with proper angulation is important to assess subtle tumor invasion or clear fat planes between the tumor and adjacent organs.
O documento descreve a tomografia computadorizada do crânio, incluindo sua utilidade no diagnóstico de condições neurológicas, o posicionamento correto do paciente e as informações essenciais coletadas, como espessura de corte e parâmetros de imagem.
Este documento resume os principais pontos da ultrassonografia do joelho, incluindo a anatomia normal dos tendões, ligamentos, bolsas e meniscos, e como avaliar patologias comuns como tendinopatias, roturas, cistos e bursites.
O documento discute os parâmetros normais e alterações patológicas avaliadas no exame de Doppler hepático, incluindo a veia porta, artéria hepática e veias hepáticas. Detalha os calibres, direção do fluxo, velocidade e padrões normais destas estruturas, assim como possíveis achados patológicos como trombose, estenose e formação de colaterais. O documento fornece referências bibliográficas sobre os valores de velocidade de fluxo esperados nestas estruturas.
This document provides an overview of ultrasound techniques for examining the hip. It discusses using ultrasound to view structures like the hip joint, labrum, muscles like the sartorius and rectus femoris, and the femoral nerve bundle. For each structure, it provides tips on patient positioning and transducer orientation as well as the equivalent MRI imaging plane. It also shows examples of pathologies like a labral tear or adductor strain visible on ultrasound. The document aims to describe the ultrasound technique for comprehensively examining the anterior, medial, lateral and posterior aspects of the hip.
O documento discute a semiologia vascular periférica, descrevendo os exames físicos para avaliar insuficiência venosa, trombose venosa profunda e doença arterial periférica. Detalha sinais e sintomas, incluindo dor, edema, úlceras e alterações de pulso e temperatura. Também fornece detalhes sobre a avaliação do índice tornozelo-braço para diagnóstico de doença arterial obstrutiva crônica.
Ultrassom na cirrose, hepatite crônica e nas anormalidades vasculares hepáticasFernanda Hiebra Gonçalves
O documento descreve as anormalidades vasculares hepáticas e padrões ultrassonográficos associados à cirrose e hepatite crônica, incluindo hipertensão portal, dilatação de vasos como veia porta e esplênica, e desenvolvimento de vasos colaterais. Também discute a classificação e etiologias da cirrose hepática, além de abordar aspectos da hepatite crônica e complicações como ascite e esplenomegalia.
O documento descreve várias lesões de pele observadas em um paciente, incluindo manchas pigmentadas, placas branco-acinzentadas, úlceras circulares, espessamento da pele, entre outras. O resumo fornece as principais características das lesões descritas no documento de forma concisa.
O documento discute a anatomia e desenvolvimento ósseo do cotovelo, com foco em lesões traumáticas. Ele descreve a anatomia do cotovelo, ângulo de condução ideal, e os principais centros de ossificação e suas idades de aparecimento em crianças.
Small intestine/Intestinal obstruction/crohns disease/ileostomy/viscous organ...RajeevPandit10
all about small intestine, anatomy, physiology, intestinal obstruction, crohns disease/ileostomy/viscous organ perforation, meckels diverticulum, mysenteric ischemia, short bowel syndrome, celiac disease
Presentation1.pptx imaging of the peritoneum and mesentry.Abdellah Nazeer
The document provides an overview of peritoneal anatomy and imaging of peritoneal lesions. It describes the layers of the peritoneum and defines anatomical structures like the mesentery and omentum. Common pathologies seen in imaging are summarized, including cystic lesions like pseudomyxoma peritonei and lymphangiomas. Solid lesions such as peritoneal metastases, gastrointestinal stromal tumors, and mesothelioma are also reviewed. Imaging features of various peritoneal diseases are presented along with illustrations to aid diagnosis.
Endometriose na RM: 10 perolas de imagemBrenda Lahlou
[1] O documento discute dez achados na imagem por ressonância magnética que são específicos para o diagnóstico de endometriose, incluindo múltiplos cistos anexiais hiperintensos no T1, hematossalpinge e massas sólidas fibróticas. [2] Também aborda como obstruções no fluxo menstrual aumentam o risco de endometriose e como endometriomas podem se transformar em carcinomas ovariano. [3] Resume que protocolos de RM da pelve devem incluir sequências T1
O documento discute a avaliação ultrassonográfica do fígado e vasos hepáticos, incluindo parâmetros normais, sinais de hipertensão portal, avaliação de TIPS e transplante hepático. É apresentado o protocolo completo de exame com ênfase na análise Doppler para avaliar fluxos sanguíneos. Complicações pós-transplante também são revisadas.
Presentation1.pptx. ultrasound examination of the ankle joint.Abdellah Nazeer
This document provides an ultrasound protocol for examining the ankle joint, including descriptions of normal anatomy and potential abnormalities. It discusses scanning techniques for the lateral, anterior, medial, and posterior aspects of the ankle. Common tendon injuries and conditions such as tenosynovitis, tendinosis, ruptures, and bursitis are described. The roles of ultrasound in ankle examination and its limitations are also noted. Key structures like the peroneal and posterior tibial tendons are highlighted.
O documento discute a radiologia do abdome, incluindo técnicas como radiografia simples do abdome e aspectos a serem observados, como posição de órgãos, calcificações e presença de gás. É abordada a detecção de possíveis obstruções intestinais, pneumoperitônio e abscessos através da análise de imagens radiográficas.
O documento descreve o sistema BI-RADS para classificação de achados em mamografia. O BI-RADS fornece categorias de 0 a 5 para classificar lesões de acordo com a probabilidade de malignidade e recomendações de acompanhamento ou biópsia. O resumo do laudo deve conter a indicação, achados, comparação com exames anteriores e classificação BI-RADS.
O documento descreve a técnica e anatomia da ultrassonografia do olho. Resume os principais pontos da anatomia do olho, indicações do exame, abordagem da câmara anterior, cristalino, vítreo, úvea e possíveis achados patológicos como hemorragia, descolamentos e cataratas.
O documento discute o protocolo FAST (Focused Assessment with Sonography for Trauma), que utiliza ultrassom para detectar hemorragias internas em pacientes traumatizados. O protocolo FAST permite detectar rapidamente líquidos no abdome, tórax e pericárdio, tendo alta sensibilidade e especificidade. Atualmente, o uso de ultrassom de emergência por médicos não radiologistas é amplamente aceito e integrado no treinamento de urgência e emergência.
O documento discute os protocolos de relatório para mamografia e ultrassonografia segundo o sistema BI-RADS. O BI-RADS padroniza a terminologia dos laudos e classifica os achados em categorias preditoras de malignidade que orientam a conduta clínica. Os relatórios devem conter informações clínicas, descrição e classificação dos achados de acordo com o protocolo BI-RADS.
O documento descreve vários sinais radiológicos no tórax, incluindo o sinal da silhueta, sinal do broncograma aéreo, sinal da asa de borboleta, sinal do duplo contorno, sinal cervicotorácico, sinal de Golden "S", sinal de Luftsichel, e sinal do halo, fornecendo imagens de exemplo para cada um.
This document discusses the role of MRI in evaluating rectal carcinoma. It provides details on rectal anatomy and landmarks important for staging rectal cancer using MRI. Key points include:
- MRI is useful for local tumor staging, treatment planning, and assessing surgical margins after chemoradiation.
- Important landmarks include the anal verge, anorectal junction, peritoneal reflections, and mesorectal fascia.
- MRI is used to determine tumor distance from these landmarks, size, circumferential extent, and relationship to surrounding structures to accurately stage rectal cancers.
- High resolution imaging with proper angulation is important to assess subtle tumor invasion or clear fat planes between the tumor and adjacent organs.
O documento descreve a tomografia computadorizada do crânio, incluindo sua utilidade no diagnóstico de condições neurológicas, o posicionamento correto do paciente e as informações essenciais coletadas, como espessura de corte e parâmetros de imagem.
Este documento resume os principais pontos da ultrassonografia do joelho, incluindo a anatomia normal dos tendões, ligamentos, bolsas e meniscos, e como avaliar patologias comuns como tendinopatias, roturas, cistos e bursites.
O documento discute os parâmetros normais e alterações patológicas avaliadas no exame de Doppler hepático, incluindo a veia porta, artéria hepática e veias hepáticas. Detalha os calibres, direção do fluxo, velocidade e padrões normais destas estruturas, assim como possíveis achados patológicos como trombose, estenose e formação de colaterais. O documento fornece referências bibliográficas sobre os valores de velocidade de fluxo esperados nestas estruturas.
This document provides an overview of ultrasound techniques for examining the hip. It discusses using ultrasound to view structures like the hip joint, labrum, muscles like the sartorius and rectus femoris, and the femoral nerve bundle. For each structure, it provides tips on patient positioning and transducer orientation as well as the equivalent MRI imaging plane. It also shows examples of pathologies like a labral tear or adductor strain visible on ultrasound. The document aims to describe the ultrasound technique for comprehensively examining the anterior, medial, lateral and posterior aspects of the hip.
O documento discute a semiologia vascular periférica, descrevendo os exames físicos para avaliar insuficiência venosa, trombose venosa profunda e doença arterial periférica. Detalha sinais e sintomas, incluindo dor, edema, úlceras e alterações de pulso e temperatura. Também fornece detalhes sobre a avaliação do índice tornozelo-braço para diagnóstico de doença arterial obstrutiva crônica.
Ultrassom na cirrose, hepatite crônica e nas anormalidades vasculares hepáticasFernanda Hiebra Gonçalves
O documento descreve as anormalidades vasculares hepáticas e padrões ultrassonográficos associados à cirrose e hepatite crônica, incluindo hipertensão portal, dilatação de vasos como veia porta e esplênica, e desenvolvimento de vasos colaterais. Também discute a classificação e etiologias da cirrose hepática, além de abordar aspectos da hepatite crônica e complicações como ascite e esplenomegalia.
O documento descreve várias lesões de pele observadas em um paciente, incluindo manchas pigmentadas, placas branco-acinzentadas, úlceras circulares, espessamento da pele, entre outras. O resumo fornece as principais características das lesões descritas no documento de forma concisa.
O documento discute a anatomia e desenvolvimento ósseo do cotovelo, com foco em lesões traumáticas. Ele descreve a anatomia do cotovelo, ângulo de condução ideal, e os principais centros de ossificação e suas idades de aparecimento em crianças.
Small intestine/Intestinal obstruction/crohns disease/ileostomy/viscous organ...RajeevPandit10
all about small intestine, anatomy, physiology, intestinal obstruction, crohns disease/ileostomy/viscous organ perforation, meckels diverticulum, mysenteric ischemia, short bowel syndrome, celiac disease
Presentation1.pptx imaging of the peritoneum and mesentry.Abdellah Nazeer
The document provides an overview of peritoneal anatomy and imaging of peritoneal lesions. It describes the layers of the peritoneum and defines anatomical structures like the mesentery and omentum. Common pathologies seen in imaging are summarized, including cystic lesions like pseudomyxoma peritonei and lymphangiomas. Solid lesions such as peritoneal metastases, gastrointestinal stromal tumors, and mesothelioma are also reviewed. Imaging features of various peritoneal diseases are presented along with illustrations to aid diagnosis.
The document discusses various types of pancreatic tumors including benign and malignant exocrine tumors as well as endocrine tumors. It provides details on:
- The embryology, anatomy, blood supply, nerve supply and functions of the pancreas.
- Classification systems for benign exocrine tumors such as serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms.
- Signs, investigations and management of insulinomas, which are the most common pancreatic endocrine tumors causing hypoglycemia.
This document discusses secondary tumors and tumor-like lesions of the peritoneal cavity. It begins by introducing the three broad categories of pathologies that can affect the peritoneum - metastatic neoplasms, infectious/inflammatory lesions, and miscellaneous tumors. It then focuses on metastatic neoplasms, describing carcinomatosis, pseudomyxoma peritonei, lymphomatosis, and sarcomatosis in 1-3 sentences each. Imaging features are provided for each condition. The document emphasizes the importance of identifying subtle lesions on imaging for staging and treatment planning.
Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...Chirantan MD
This document discusses various imaging modalities used to diagnose intestinal obstruction including radiography, computed tomography, magnetic resonance imaging, ultrasonography, nuclear imaging, and angiography. Plain X-rays can show dilated bowel loops and air-fluid levels. CT provides more detail of bowel wall abnormalities. MRI is useful for assessing strangulation. Ultrasound evaluates bowel peristalsis. Nuclear imaging detects inflammation. Angiography diagnoses internal hernias. Barium studies demonstrate characteristic signs of intussusception and volvulus. Imaging plays a key role in evaluating intestinal obstructions.
RADIOLOGIC ANATOMY OF SMALL INTESTINE AND INTRODUCTION TO SMALL BOWEL OBSTRUC...Mohammad Naufal
1) The document provides an overview of the radiologic anatomy of the small intestine and introduces small bowel obstruction.
2) Key details include the anatomy and relations of the duodenum, jejunum, and ileum. Valvulae conniventes are described.
3) Small bowel obstruction is a common condition that can be evaluated using plain radiography, ultrasound, CT, or CT enterography. Findings suggestive of obstruction include dilated bowel loops and air-fluid levels.
various congenital gastrointestinal diseases manifesting in childhood or even in adults, their radiographic findings on various imaging modalities such as radiograph, barium, ultrasound etc.
The document discusses carcinoma of the rectum, including its incidence, risk factors, anatomy, staging, and treatment options. It notes that rectal cancer is the third most common cancer in men worldwide and the second most common in women. Treatment depends on the stage of the cancer, with more advanced or lower tumors typically requiring removal of part of the rectum and sphincter muscles via procedures like abdominoperineal resection or low anterior resection.
1) The document provides an overview of the radiologic anatomy of the small intestine and introduces small bowel obstruction. It describes the anatomy of the duodenum, jejunum, and ileum in detail.
2) Key findings that suggest small bowel obstruction on plain radiography include dilated bowel loops, increased number of fluid levels, and differential height of fluid levels. Sonography and CT are also used to identify and characterize obstruction.
3) CT is particularly useful for determining the level and cause of obstruction, as well as identifying complications like strangulation. It can distinguish high-grade from low-grade obstruction based on criteria like distal collapse and degree of dilatation.
The document discusses the acute abdomen and various imaging modalities used to evaluate it. It covers:
1) The causes of acute abdomen including perforation, obstruction, inflammation and others.
2) The imaging modalities used including plain films, ultrasound, CT and their roles in evaluating specific causes.
3) How different conditions present on imaging including bowel obstruction, perforation, appendicitis and others.
This document provides an overview of pancreatic pathology, focusing on pancreatitis. It describes the anatomy of the pancreas and imaging modalities used to evaluate pancreatic conditions. Acute and chronic pancreatitis are discussed in detail, including causes, classification, imaging features, and complications like fluid collections, pseudocysts, abscesses, necrosis, and hemorrhage. Other pancreatic conditions summarized include autoimmune pancreatitis and hereditary pancreatitis.
The document discusses the anatomy and sonographic appearance of the pancreas. It describes the pancreas' location and relationships to nearby structures like blood vessels. The normal sonographic features include homogeneous echotexture and absence of duct dilation. Common pathologies like pancreatic cancer and pancreatitis are also summarized, noting how they can appear on ultrasound with features like duct obstruction or diffuse swelling. Ultrasound is established as a useful initial imaging method for evaluating the pancreas.
Imaging of neoplastic lesions of esophagus including stagingBharath J
This document discusses imaging of neoplastic lesions of the esophagus. It describes the classification, risk factors, and imaging features of benign and malignant esophageal lesions. Common benign lesions include leiomyomas and fibrovascular polyps, while 80% of esophageal tumors are malignant, mainly squamous cell carcinoma and adenocarcinoma. Imaging modalities like barium swallow, EUS, CT, and PET are discussed for diagnosing and staging lesions. The document also provides an overview of the AJCC staging system and treatment options for esophageal cancer which include surgery, chemotherapy, radiation, and palliative care.
Barium swallow, endoscopy, endosonography, and manometry are key investigative tools for evaluating abnormalities of the esophagus. Barium swallow involves ingesting barium sulfate to visualize the esophagus, stomach, and surrounding structures under x-ray. Endoscopy allows direct visualization of the esophagus and biopsy of lesions. Endosonography uses high-frequency sound waves to image the esophageal walls and nearby structures. Manometry evaluates esophageal motor function by measuring pressure during swallowing. Together these investigations aid in diagnosing conditions such as gastroesophageal reflux disease, tumors, and motility disorders of the esophagus.
Barium swallow, endoscopy, endosonography, and manometry are key investigative tools for evaluating abnormalities of the esophagus. Barium swallow involves ingesting barium sulfate to visualize the esophagus, stomach, and surrounding structures on x-ray. Endoscopy allows direct visualization of the esophagus and biopsy of lesions. Endosonography uses high-frequency sound waves to image the esophageal walls and nearby structures. Manometry assesses esophageal motility and sphincter function by measuring pressure during swallowing. Together these investigations aid in diagnosing conditions such as gastroesophageal reflux disease, tumors, and motility disorders of the esophagus.
Intussusception in Adults-Submucosal Lipoma at Transverse colon-A rare causeDr.Santosh Atreya
This document discusses a rare case of lipoma at the transverse colon causing intussusception in an adult. It begins with an introduction to colonic lipomas and intussusception, noting that lipomas are a rare cause of adult intussusception. The document then covers the etiology, epidemiology, clinical presentation, radiological features, and management of adult intussusception caused by colonic lipomas. Key points include that adult intussusception is usually caused by a focal lesion acting as a lead point, and surgical removal of the lead point is typically required for treatment.
This document discusses rectal prolapse, including its anatomy, causes, types, clinical features, investigations, and management. It begins with the anatomy of the rectum and its blood supply. It then describes the causes of rectal prolapse as being related to decreased pelvic floor muscle tone. It outlines the types of rectal prolapse as partial, complete, or internal. Management involves dietary changes and injections for partial prolapse or surgery like rectopexy or STARR procedure for complete prolapse.
Semelhante a Carcinomatose Peritoneal e outras Anomalias (20)
O documento resume os principais sinais radiológicos de diagnóstico torácico, incluindo padrões de doença alveolar e intersticial, anormalidades pleurais, atelectasia e redução da densidade pulmonar. É descrito o significado de achados como consolidação alveolar, linhas de Kerley, sinal da asa de borboleta e sinais de hiperinsuflação pulmonar.
O documento discute epilepsia do lobo temporal, focando na esclerose hipocampal, sua apresentação clínica e achados de imagem característicos, como atrofia hipocampal e hipersinal em T2/FLAIR. Também aborda outras causas como desordens do desenvolvimento, neoplasias e malformações vasculares.
TUMORES DE ORIGEM HEMATOPOIETICA, LINFOIDE E HISTIOCÍTICABrenda Lahlou
O documento discute tumores linfoproliferativos, hematopoiéticos e histiocíticos. Apresenta informações sobre linfoma primário e secundário, incluindo características de imagem por TC e RM. Também aborda leucemia, doença linfoproliferativa pós-transplante e outros tipos de neoplasias.
O documento discute síndromes compressivas vasculares. Ele se concentra na síndrome do ligamento arqueado mediano, descrevendo sua anatomia, fatores de risco, sintomas e achados de imagem característicos, como a compressão focal do tronco celíaco. O documento também discute o tratamento controversal da síndrome, incluindo opções cirúrgicas e endovasculares.
Slides contendo imagens demonstrando a anatomia da parede abdominal e região inguinofemoral, com suas camadas, além das regiões e tipos de hérnias mais comuns
O documento descreve a técnica e achados de imagem da ressonância magnética do tornozelo e pé. Ele discute a anatomia dos ligamentos e tendões da região, lesões comuns como rupturas ligamentares e tendinopatias, e síndromes como a do impacto anterolateral do tornozelo e do seio do tarso.
O paciente apresentou sinais de sobrecarga do ventrículo esquerdo no eletrocardiograma. Exames de imagem revelaram coarctação da aorta associada a aneurisma da aorta ascendente e insuficiência da valva aórtica. O paciente foi submetido a correção cirúrgica com sucesso.
[1] A mediastinite fibrosante é uma doença rara e benigna que causa o crescimento excessivo de tecido fibroso no mediastino, podendo comprimir estruturas vitais e causar sintomas.
[2] Existem dois subtipos principais: a focal granulomatosa, associada a infecções, e a difusa idiopática.
[3] A tomografia computadorizada é o principal exame de imagem e pode mostrar massas mediastinais infiltrativas com ou sem calcificações, dependendo do subtipo.
Diretrizes Hipertensão - 2017 ACC AHA - O que mudou??Brenda Lahlou
Diretrizes Hipertensão - 2017 ACC AHA - O que mudou??
Apresentação abordando a Hipertensão Arterial Sistêmica e seus principais pontos, assinalando as novas modificações das Diretrizes Americanas de Hipertensão publicada em 2017
Este caso clínico descreve um paciente do sexo masculino de 45 anos que deu entrada no hospital com dispneia progressiva e edema generalizado. Exames revelaram derrame pleural volumoso e consolidação pulmonar, além de insuficiência cardíaca congestiva descompensada. A análise do líquido pleural caracterizou-o como exsudato, possivelmente decorrente de descompensação da ICC.
O documento resume informações sobre otites e amigdalites. Em três frases:
Otites incluem inflamações do conduto auditivo externo e da orelha média, com sintomas como dor, otorreia e febre. Amigdalites podem ser virais ou bacterianas, especialmente por Streptococcus pyogenes, com sintomas como dor de garganta e adenopatia dolorosa. O diagnóstico e tratamento dependem da causa provável e gravidade dos sintomas apresentados.
Este documento descreve o caso clínico de uma criança de 1 ano e 8 meses admitida em um pronto-socorro pediátrico devido a crises convulsivas recorrentes nas últimas 24 horas. Após exame físico e laboratorial, o diagnóstico foi pneumonia bacteriana complicada por faringite viral, com crise convulsiva febril complicada.
SINAIS EM RADIOLOGIA TORÁCICA 2.0
I Seminário da LARDI - Liga Acadêmica de Radiologia e Diagnóstico por Imagem
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Leonardo de Aguiar Santos
Aspectos Clínicos e Raiológicos no Câncer GástricoBrenda Lahlou
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Pênfigo Vulgar (Caso clínico Lesões Vesicobolhosas e Úlceras Orais)Brenda Lahlou
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Diabetes Mellitus - Consulta Médica e TratamentoBrenda Lahlou
O documento resume as estratégias para o cuidado de pessoas com diabetes mellitus na atenção básica, incluindo a avaliação inicial, monitoramento, metas de tratamento, opções medicamentosas e acompanhamento.
Este documento descreve a faringoamigdalite aguda, incluindo sua definição, anatomia, epidemiologia, etiologia, manifestações clínicas, diagnóstico, tratamento e complicações possíveis. A faringoamigdalite aguda é uma infecção viral ou bacteriana das amígdalas e faringe, caracterizada principalmente por dor de garganta, febre e adenomegalia cervical. O diagnóstico é geralmente clínico, mas testes como antígeno rápido ou cultura podem ser realizados, e o tratamento envolve
O documento descreve os principais pontos sobre acidente vascular encefálico isquêmico, incluindo suas causas, manifestações clínicas, exames diagnósticos e fatores de risco. Aborda os tipos de AVC isquêmico, exames de imagem, avaliação neurológica e diferenciais diagnósticos.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
3. PERITÔNIO
• Membrana serosa de células mesoteliais
lisas
• Tecido conjuntivo submesotelial
• Membrana dupla que forra a parede
abdominal (peritônio parietal)
– dela se reflete sem solução de continuidade
sobre as vísceras para revesti-las em variável
extensão (peritônio visceral),
4.
5. Peritônio
• Secreção do líquido peritoneal, que reduz o atrito entre as vísceras
• Resistência a infecção pela ação dos macrófagos existentes no líquido
peritoneal e também pela sua capacidade de confinar uma infecção. Quando esta
não é muito intensa, o peritônio através, especialmente, do omento maior, que se
desloca, a isola por tamponamento e/ou aderência.
• Acúmulo de gordura, em especial no omento maior, que atua como reserva
nutricional
• Absorção e a eliminação de substâncias para e da circulação, podendo ser
utilizado em processos terapêuticos (diálise peritoneal, administração de
medicamentos). Esta mesma propriedade explica a absorção de toxinas
bacterianas nos casos de infecções graves que afetem o peritônio
• O peritônio é muito sensível, provocando dores intensas quando traumatizado,
descolado ou fortemente distendido.
– O peritônio parietal é inervado pelos nervos das paredes a ele adjacentes: a parte
diafragmática pelos n.n. frênicos, o restante pelos n.n. tóraco-abdominais e ramos do plexo
lombo-sacral. Os estímulos dolorosos do peritônio parietal podem ser relacionados
diretamente com a região estimulada ou podem ser referidos, como, por exemplo, a
estimulação dolorosa da parte central do peritônio diafragmático que é referida no ombro. O
peritônio visceral não apresenta inervação para a dor, mas sensações de distensão ou tração
podem ser sentidos difusamente.
41. Carcinomatose Peritoneal
• Diversas malignidades gastrointestinais e ginecológicas tem o potencial
de disseminar e crescer na cavidade peritonial.
• Associado com progressão da doença e prognóstico ruim.
• Redução de sobrevida em pacientes com metástases hepáticas ou
extraperitoneais.
• Sobrevida de pacientes com carcinomatose peritoneal (CP) é apenas
levemente influenciada por quimioterapia sistêmica. Vista como
“condição terminal”.
• 10-35% de pacientes com CA colorretal recorrente e 50% de pacientes com
CA gástrico recorrente, a recorrência tumoral está confinada à cavidade
peritoneal.
42. CARCINOMATOSE PERITONEAL
The epidemiology of patients with peritoneal metastases mirrors that of affected
patients. Common primaries include :
• ovarian cancer
• gastric cancer
• esophageal cancer
• colorectal cancer
• appendiceal malignancies
• gallbladder carcinoma
• pancreatic carcinoma
• primary peritoneal malignancy
• hepatocellular carcinoma
• endometrial carcinoma
• extra-adrenal, intra-abdominal paraganglioma
• haematogenous spread
– breast cancer
– lung cancer
– malignant melanoma
• transitional cell carcinoma of the urinary tract
45. CP - DIAGNÓSTICO
• Diagnóstico pré-operatório de CP pode ser um desafio
• Técnicas de imagem (Geralmente TC e RM) podem ajudar no
– planejamento da Citorredução mas também ao
– prevenir laparotomia injustificada em pacientes com doença
irressecável
• Limitado na sua habilidade de visualizar CP localizada, tendo baixa
sensibilidade para doença de pequeno volume
• Padrão Ouro no diagnóstico de Carcinomatose Peritoneal continua
sendo a visualização peritoneal direta (Laparotomia ou
Laparoscopia).
46. CP - Imagem
• Sensitivity for CT detection of tumor nodules less than 0.5 cm and
1cm had been reported to be 11% and 25-50% respectively
• Magnetic resonance imaging (MRI), and particularly diffusion
weighted images, has been demonstrated in prospective studies to
have increased accuracy in detection of carcinomatosis within certain
areas of the abdomen [30].
– This however carries its own limitations due to the motion artifacts of
peristalsis, cost, and the need for radiologists trainedin their
interpretation and inter-observer variation.
• Additionally, positron emission technology (PET) mayhave increased
sensitivity, but similar limitations and absence of added clinical value
often precludes its use for determining resectability [24, 31-33].
48. CP – LIQUID BIOPSY
• The term “liquid biopsy” has reached prolific use as large-scale investigations seek to
identify tumor markers in the serum.
– This usually refers to molecular diagnostic studies that are performed on blood or body fluid
as opposed to cancerous tissue itself [35].
• Multiple serum tumor markers: carcinoembryonic antigen (CEA), carbohydrate
antigen CA 19-9, and CA 125, are commonly elevated in patients with PC and the
degree of elevation tends to correlate with the extent of PC [36].
• However, these serum tumor markers are inadequate for early detection of PC.
• Moreover, they lack specificity to predict the presence or risk of PC in patients with
CRC. There is a critical clinical need to identify circulating tumor biomarkers of
aggressiveness, likelihood of recurrence, risk of metastasis such as PC, or even the
presence of a malignancy to better tailor therapy for patients.
50. ACHADOS RADIOGRAFICOS
Plain film findings of ascites
• Medial displacement of cecum in 90% of patients with significant
ascites
• Pelvic "dog's ear" in 90% of patients with significant ascites
• Medial displacement of lateral liver edge (Hellmer sign) in 80% of
patients with significant ascites
• Bulging of flanks, central displacement of bowel loops, indistinct
psoas margin
Plain film findings of small bowel obstruction
• Dilated small bowel> 3 cm
• Fluid-fluid levels in small bowel on upright film
• "String of pearls" sign
• Collapsed gasless colon
53. The paravesical fossae are dependent peritoneal space recesses flanking the
superior margin of the bladder [1] (Fig. 1).
When filled with fluid, they drape the left and right superolateral edges of the
bladder with ovoid opacities whose conformation has been likened to canine aural
appendages
54. • Normal plain film of the
abdomen. We can see the
hepatic angle (H), the
splenic angle (S).
The psoas muscle (arrows) and
the
kidneys (K) shadows are
delineated by a fat shadow. The
blue arrowheads show the
properitoneal fat stripes.
55. HELLMER’S SIGN
• Free fluid (ascites) and blood can be suspect in the plain abdominal
radiograph if there is a widening of the distance between the fat stripe
and the ascending or descending colon shadow being these two portions
of the large bowel displaced medially (Fig. 5).
• The hepatic angle may be obscured or displaced medially, the
“Hellmer`s sign”.
• A diffuse increase density of the pelvis or of all the abdomen is suggestive
of large amounts of free fluid.
57. FLUOROSCOPIA
Barium studies
• Small bowel follow through (SBFT): Dilated bowel with
transition zone; partial small bowel obstruction
• Mural extrinsic filling defects due to serosal implants in
small bowel
• Spiculated extrinsic impression due to tethering of
rectosigmoid from intraperitoneal mets to pouch of Douglas
• Scalloping of cecum from peritoneal implants
• "Omental caking" may cause invasion of transverse
mesocolon with nodularity & spiculation of superior contour.
58. Ultrassom
• Complex ascites with septations
• Malignant ascites may be anechoic or have low-level echoes, and
aids in the identification of deposits.
• Nodules are of intermediate echogenicity, hypoechoic compared to
the peritoneum, whereas infiltration of the omentum results in
hyperechogenicity.
• Not sensitive for peritoneal implants in absence of ascites.
59.
60. CP - ULTRASSONOGRAFIA
Most accessible anatomical areas to identify
peritoneal metastases by US visualization
technique:
• Greater omentum,
• Right subphrenic place,
• Pelvis Douglas pouch and
• Surfaces of diaphragm
61. CP - ULTRASSONOGRAFIA
TIPOS/Padrões DE ACHADOS (segundo ESR)
• Echo type1
– Nodular solid peritoneal implants with clear regular boundaries
(hypoechoic usually).
– This echo type of peritoneal masses (Fig.1) is typically
hypoechoic and common for epithelial ovarian neoplasm.
• Echo type 2.
– Nodular solid peritoneal implants without clear regular
boundaries ("plaquelike" implants).
– This echo type of peritoneal masses (Fig.2) is typically
hypoechoic or isoechoic with indistinct rough contours.
– Implants size in this type is highly variable from 7 up to 45mm.
– Sonographic image is common recurrent ovarian tumors and
recurrent colorectal cancer.
62. CP - ULTRASSONOGRAFIA
TIPOS/Padrões DE ACHADOS
• Echo type1
– Nodular solid peritoneal implants with clear regular boundaries
(hypoechoic usually).
– This echo type of peritoneal masses (Fig.1) is typically
hypoechoic and common for epithelial ovarian neoplasm.
• Echo type 2.
– Nodular solid peritoneal implants without clear regular
boundaries ("plaquelike" implants).
– This echo type of peritoneal masses (Fig.2) is typically
hypoechoic or isoechoic with indistinct rough contours.
– Implants size in this type is highly variable from 7 up to 45mm.
– Sonographic image is common recurrent ovarian tumors and
recurrent colorectal cancer.
63. CP - ULTRASSONOGRAFIA
• Echo type 3.
– Thickening of the peritoneum (local or extended).
– Peritoneum thickened locally (for example, only in Douglas
pouch) or thickened extendedly (pelvic and abdominal) evenly
or unevenly.
– This echo type of peritoneal carcinomatosis (Fig.3)quite often
combined with others, for example with echo type 2 (Fig.4).
• Echo type 4
– Solid filamentary masses between two peritoneal layers.
– This echo type of peritoneal masses appear as hyperechoic
or isoechoic "loose“ filamentary masses between parietal and
visceral layers of the peritoneum (Fig.5).
– Production of intra- and extracellular secretion (mucin) which
provides a typical macroscopic and sonographic pattern is
common for malignant colorectal tumors and mucinous ovarian
tumors.
64. CP - ULTRASSONOGRAFIA
• Echo type 3.
– Thickening of the peritoneum (local or extended).
– Peritoneum thickened locally (for example, only in Douglas
pouch) or thickened extendedly (pelvic and abdominal) evenly
or unevenly.
– This echo type of peritoneal carcinomatosis (Fig.3)quite often
combined with others, for example with echo type 2 (Fig.4).
• Echo type 4
– Solid filamentary masses between two peritoneal layers.
– This echo type of peritoneal masses appear as hyperechoic
or isoechoic "loose“ filamentary masses between parietal and
visceral layers of the peritoneum (Fig.5).
– Production of intra- and extracellular secretion (mucin) which
provides a typical macroscopic and sonographic pattern is
common for malignant colorectal tumors and mucinous ovarian
tumors.
65. CP - ULTRASSONOGRAFIA
• Echo type 5
– Inhomogeneous free liquid with suspended separated
cancer cells
– This type of echo pattern is the most frequent in the studied
patients, on the one hand.
– On the other hand, it may be the greatest difficulties in
determining its nature.
– Sonographic image of peritoneal liquid may vary from
homogeneous anechoic echo structure with a small amount
of suspended non-fixed cancer cells to inhomogeneous
with a significant amount of suspended cells.
– In the first case it may be required to evacuate a large
amount of liquid (up to 200 ml or more) for adequate
cytological analysis, while in the second case, 20 ml liquid
may be sufficient to morphological diagnosis.
66. CP - ULTRASSONOGRAFIA
• Echo type 5
– Inhomogeneous free liquid with suspended separated
cancer cells
– This type of echo pattern is the most frequent in the studied
patients, on the one hand.
– On the other hand, it may be the greatest difficulties in
determining its nature.
– Sonographic image of peritoneal liquid may vary from
homogeneous anechoic echo structure with a small amount
of suspended non-fixed cancer cells to inhomogeneous
with a significant amount of suspended cells.
– In the first case it may be required to evacuate a large
amount of liquid (up to 200 ml or more) for adequate
cytological analysis, while in the second case, 20 ml liquid
may be sufficient to morphological diagnosis.
67. Tomografia
• Peritoneal metastases can range in appearance from invisible to multiple large
masses, and
• historically CT can only detect 60-80% of peritoneal metastases later shown to be
present at surgery, although more recent studies reported detection rates of 85-93%
• Sensitivity for CT detection of tumor nodules less than 0.5 cm and 1cm had been
reported to be 11% and 25-50% respectively.
Endometrioid ovarian carcinoma
68. Tomografia
Appearances include:
• Ascites, especially if loculated
• Thickening and enhancement of peritoneal reflections (especially if nodular)
• Hipovascular Omental Masses
– soft tissue nodules
– stranding and thickening of the omentum (omental cake)
• Spiculated Mesentery
– stranding and distortion of the small bowel mesentery
• Evidence of Bowel Obstruction with delineation of transition zone from dilated
to non-dilated bowel.
• Calcifications (particularly in cystadenocarcinoma of the ovary)
– nodular with the non-calcified component are typical
– nodal calcification
• Intraperitoneal contrast has been investigated as a way of improving sensitivity
to the presence of small deposits, and may improve detection but has not been
widely adopted .
69. Tomografia
Appearances include:
• Ascites, especially if loculated
• Thickening and enhancement of peritoneal reflections (especially if nodular)
• Hipovascular Omental Masses
– soft tissue nodules
– stranding and thickening of the omentum (omental cake)
• Spiculated Mesentery
– stranding and distortion of the small bowel mesentery
• Evidence of Bowel Obstruction with delineation of transition zone from dilated
to non-dilated bowel.
• Calcifications (particularly in cystadenocarcinoma of the ovary)
– nodular with the non-calcified component are typical
– nodal calcification
• Intraperitoneal contrast has been investigated as a way of improving sensitivity
to the presence of small deposits, and may improve detection but has not been
widely adopted .
70. Tomografia
• Imaging after administration of intravenous contrast and water density
oral contrast is usually all that is required to allow detection of small
peritoneal deposits[13].
• Use of positive oral contrast agents may, in some instances,
– be advantageous in the detection of small bowel serosal deposits (particularly if cystic) by
increasing contrast resolution.
– However, this may consequently limit the identification of calcified serosal or peritoneal
deposits[13].
Calcified implants. A Axial contrast-enhanced CT scan of a 76-
year-old patient with ovarian cancer shows several implants of
peritoneal carcinomatosis involving the greater omentum and
appearing partially hyperdense due to calcifications (arrow).
: Metastatic breast carcinoma (peritoneal disease)
71. MRI
• MRI can be very sensitive, probably more so than CT (85-90%) 1.
• Peritoneal metastases show up as increased enhancement
(greater than liver), best seen after 5-10 minutes 1.
• T1WI:
– Low signal ascites
– Low signal intensity masses.
– Medium signal omental caking
• T2WI:
– High signal ascites
– Intermediate signal peritoneal mass
• T1 C+
– Abnormal enchancement of peritoneum
with gadolinium.
– Hypointense nodules and masses.
72. MRI
• The intraperitoneal fluid accumulations tend to occur at:
– Pouch of Douglas,
– Sigmoid mesocolon,
– Distal small bowel mesentery,
– Right paracolic gutter.
• By using air to distend the gastrointestinal tract, the normal
bowel walls were barely visible or even invisible between
intraluminal air and extraluminal fat. Focal or segmental wall
thickenings with intermediate signals can be easily identified
between these two extremes of signal intensity (
73. MRI
• The intraperitoneal fluid accumulations tend to occur at:
– Pouch of Douglas,
– Sigmoid mesocolon,
– Distal small bowel mesentery,
– Right paracolic gutter.
• By using air to distend the gastrointestinal tract, the normal
bowel walls were barely visible or even invisible between
intraluminal air and extraluminal fat. Focal or segmental wall
thickenings with intermediate signals can be easily identified
between these two extremes of signal intensity (
75. MRI
• Normal peritoneal enhancement should be equal to or less than that of
the liver.
– Enhancement greater than the liver is abnormal – a sign that is not readily
appreciable with postiodinated contrast MDCT.
• The high contrast conspicuity of fat-suppressed and delayed gadolinium-
enhanced MRI makes it the imaging modality of choice in depicting not
only subcentimetre deposits (including those <5 mm), but also
deposits in anatomically difficult sites (e.g. subphrenic, mesenteric
and bowel serosa)
76. MRI
• Small subcentimetre deposits (in the absence of ascites) are
best visualized using
– fat-suppressed T2-weighted and
– fat-suppressed T1-weighted delayed postcontrast imaging.
• MRI is the imaging modality of choice in local staging of
primary pelvic/gynaecological malignancies due to its
superior contrast resolution.
77. MRI – Diffusion
Diffusion-weighted MRI
• DWI has been shown to improve detection of peritoneal disease by
showing restricted diffusion when combined with conventional contrast-
enhanced MRI.
• Sensitivity and specificity of 90% and 95.5% have been reported by Fujii
et al.[34].
• Sala et al.[35] have recently demonstrated the value of qualitative DWI
using 3-T MRI in the evaluation of peritoneal metastases in ovarian
cancer.
• Site-specific disease may be better evaluated with DWI particularly with
small deposits involving mesentery, bowel serosa, perihepatic and
peripancreatic being more conspicuous due to increased contrast
resolution[36].
78. MRI - Spectroscopy
Magnetic resonance spectroscopy
• The emerging use of MR proton spectroscopy (MRS) has been applied
in the characterization of in vivo primary and metastatic ovarian cancer
by McLean et al.[38].
• Detection of choline metabolites (a tumour biomarker) was limited in
peritoneal/omental deposits mainly due to tumour morphology and
location[38].
• Evolving protocols combined with detection and quantification of various
surrogate tumour metabolites provide promising future potential.
79. PET CT
• The combination of imaging both tumour function and anatomy has
clear advantages in oncological imaging.
• [18F]-2-deoxy-2-fluoro-D-glucose ([18F]FDG), a glucose analogue, is the
most commonly used radiotracer in oncological practice with uptake
associated in various malignant processes, but also in hypermetabolic
physiological and inflammatory conditions[23].
• Fusion of PET and CT images allows accurate localization of increased
metabolic activity, therefore differentiating normal physiological uptake
(bowel and urinary tract) from disease processes.
• Imaging features of peritoneal malignancy on PET shows avid [18F]FDG
uptake within well-circumscribed nodules, to diffuse [18F]FDG uptake
over peritoneal and serosal surfaces (Fig. 5).
• Previously occult nodal and extraabdominal disease may also
become detectable with PET/CT, potentially changing patient
management.
• However, false-negative results may occur due to small tumour deposits,
mucinous tumours (ovarian or colonic) or signet ring gastric cancers not
taking up [18F]FDG[31–33].
• Non-malignant and inflammatory lesions have been shown to take up
[18F]FDG, giving rise to false-positive results[33].
80. PET CT
• The combination of imaging both tumour function and anatomy has
clear advantages in oncological imaging.
• [18F]-2-deoxy-2-fluoro-D-glucose ([18F]FDG), a glucose analogue, is the
most commonly used radiotracer in oncological practice with uptake
associated in various malignant processes, but also in hypermetabolic
physiological and inflammatory conditions[23].
• Fusion of PET and CT images allows accurate localization of increased
metabolic activity, therefore differentiating normal physiological uptake
(bowel and urinary tract) from disease processes.
• Imaging features of peritoneal malignancy on PET shows avid [18F]FDG
uptake within well-circumscribed nodules, to diffuse [18F]FDG uptake
over peritoneal and serosal surfaces (Fig. 5).
• Previously occult nodal and extraabdominal disease may also
become detectable with PET/CT, potentially changing patient
management.
• However, false-negative results may occur due to small tumour deposits,
mucinous tumours (ovarian or colonic) or signet ring gastric cancers not
taking up [18F]FDG[31–33].
• Non-malignant and inflammatory lesions have been shown to take up
[18F]FDG, giving rise to false-positive results[33].
81. PET CT
Novel PET radiotracers
• PET radiotracers allow the utilization of various different metabolic pathways to
[18F]FDG in the imaging of tumours.
• Preliminary studies have demonstrated uptake of [16α-18F]fluoro-17β-estradiol
([18F]FES), an oestrogen analogue, in primary and metastatic sites of advanced
ovarian and endometrial cancer[39,40].
• [18F]FES therefore allows oestrogen receptor quantification and surveillance of
these tumours following hormonal therapy.
• Its use has also been evaluated in breast cancer.
82. “OMENTAL CAKE”
• Omental cake refers to infiltration of the omental fat by material
of soft-tissue density. The appearances refer to the contiguous
omental mass simulating the top of a cake. Masses on the
peritoneal surfaces and malignant ascites may also be present.
• Diffuse thickening of the omentum, such that it changes from a
barely discernible fatty band to a mass that can displace underlying
bowel from the abdominal wall, i.e., the so-called “omental cake”.
83. “OMENTAL CAKE”
• Normal greater omentum appears as a band
of fatty tissue with variable width.
• Early omental disease manifests as a
smudged or permeated appearance of the
omental fat (Fig. a).
• Enhancing soft tissue nodules form within
the omentum as the disease progresses.
• An omental cake arises when these nodules
coalesce to form a diffusely thickened mass
and replace the normal fat (Fig. b).
• Depending on the cause of the omental cake
and the extent of intraperitoneal disease,
ascites may be an accompanying feature.
85. “OMENTAL CAKE”
• Metastatic involvement is the most common cause of omental cakes.
• Along with peritoneal fluid (74%) and peritoneal thickening with
enhancement (62%), omental involvement is a frequently encountered
finding with peritoneal carcinomatosis on CT.
• While ovarian carcinoma is the most common cause of omental cakes,
colonic, pancreatic, and gastric cancers are other common
malignancies that may result in omental metastases. However, virtually
any tumour capable of intraperitoneal spread, such as endometrial or
bladder cancer, may cause an omental cake.
91. A significant proportion of gastrointestinal carcinoid tumours spread to the
mesentery giving rise to an enhancing soft tissue mass with surrounding fibrotic
radiating linear bands (desmoplastic reaction) (Fig. 11). Gastric, pancreatic,
biliary and colon cancer may directly involve leaves of mesentery.
92. Serosal deposits. (a) Axial contrast-enhanced MDCT shows small bowel
serosal deposits from metastatic ovarian carcinoma (arrows). Note
involvement of the greater omentum and extensive ascites. In a different case,
96. DIAGNÓSTICO DIFERENCIAL
Differential diagnosis depends on the dominant pattern.
• Peritoneal sarcomatosis: if the primary tumor is of
mesenchymal origin (i.e. sarcoma)
– most commonly metastases from a gastrointestinal sarcoma
• Peritoneal lymphomatosis
– most commonly metastases from a primary (e.g. non-Hodgkin
lymphoma) elsewhere
• Peritonitis/sepsis
– smooth thickening and enhancement of the peritoneum, with
stranding of the omentum and mesentery may be seen in intra-
abdominal sepsis
– benign calcifications tend to be sheetlike, and nodal calcifications in
these patients less common
– a history of peritoneal dialysis or recent abdominal sepsis is usually
easily obtained
• Peritoneal tuberculosis
97. Peritonitis/sepsis
• Smooth thickening and enhancement of the
peritoneum, with stranding of the omentum and
mesentery may be seen in intra-abdominal sepsis
• benign calcifications tend to be sheetlike, and
nodal calcifications in these patients less common
• a history of peritoneal dialysis or recent abdominal
sepsis is usually easily obtained
TB Peritonitis
• Abnormal enhancement of peritoneum and
mesentery
• Nodular or symmetric thickening of peritoneum
and mesentery
• Ascites, low attenuation mesenteric nodes
• Calcification in 14% of cases
• Ileo-cecal mural thickening
• Splenomegaly
• TB mimics CT appearance of peritoneal
metastases
Papillary Serous Carcinoma of Peritoneum
• Peritoneal metastases (implants, ascites, omental
• caking) without other source
• No ovarian or GI tract primary tumor
• Identical CT, US, MR findings to peritoneal
metastases from ovarian CA
Peritoneal Mesothelioma
• Usually no primary neoplasm is known
• 1/5 of all mesotheliomas are peritoneal
• Large solid omental and mesenteric masses
often infiltrating bowel and mesentery
• very similar to peritoneal carcinomatosis
Pseudomyxoma Peritonei
• Diffuse accumulation of gelatinous masses
within peritoneum
• CECT: Scalloping of lateral contour of liver and
spleen
• Etiology related to perforation of mucinous
neoplasm of appendix
• Treatment involves cytoreduction of peritoneal
mass and intraperitoneal chemotherapy
Peritoneal sarcomatosis:
• if the primary tumor is of mesenchymal origin
(i.e. sarcoma)
• most commonly metastases from a
gastrointestinal sarcoma
Peritoneal lymphomatosis
• most commonly metastases from a primary
(e.g. non-Hodgkin lymphoma) elsewhere
DIAGNÓSTICO DIFERENCIAL
106. Tratamento
Treatment and prognosis
• Peritoneal metastases per se are not locally treated, although
systemic treatment may have some effect. Complications do
however frequently require treatment for palliation:
• bowel obstruction: bypass enterostomies may be required
• malignant ascites: repeated ascitic drainage
107. Carcinomatose Peritoneal
• Em CA ovariano epitelial – a retirada completa de implantes tumorais é
associada com melhora da sobrevida, já CA colorretal e gástrico
geralmente é associado a recorrência em curto prazo (pctes geralmente
tratados paliativamente com bypass gastrointestinal).
• 15% dos pctes com CA colorretal e 40% dos pacientes com CA gástrico
estágio II e III, se apresentam com CP na exploração abdominal.
• Cirurgias variam de simples exploração com biópsia à ressecção
paliativa do tumor primário (o último podendo estar associado a
interrupção da integridade peritoneal e propicia implantação de
células neoplásicas)
108. Carcinomatose Peritoneal
• Foi definido que a Carcinomatose Peritoneal é
uma doença locorregional:
Na ausência de outras metástases sistêmicas, abordagens
multimodais combinando cirurgia citorredutiva agressiva,
quimioterapia intraperitoneal hipertérmica e quimioterapia
sistêmica tem sido proposta e são considerados métodos para
melhorar o controle da doença locorregional e aumentar a
sobrevida.
109. Schematic illustration of the different therapies involving nanomedicines from left to right.
a) Nanoparticles (NP) loaded with chemotherapeutics or other macromolecules.
b) Sustained release of NPs loaded with anti-cancer drugs from a depot system (e.g.
hydrogel).
c) Nebulization of NPs using , Pressurized IntraPeritoneal Aerosol Chemotherapy
(PIPAC).
d) Hyperthermic intraperitoneal chemoperfusion (HIPEC) of NPs.
e) Continuous administration of NPs loaded with chemotherapeutics at low doses
without drug-free breaks known as metronomic therapy.
Triade portal – veia porta, arteria hepatica e ducto coledoco
Gastrolienal
Lieno-renal
Redondo do fígado
Apêndice fibroso do fígado
Cava inferior
• Suspensor do ovário
• Próprio do ovário
Retroperitoneal Organs
Retroperitoneal organs are not associated with visceral peritoneum; they are only covered in parietal peritoneum, and that peritoneum only covers their anterior surface.
They can be further subdivided into two groups based on their embryological development:
Primarily retroperitoneal organs developed and remain outside of the parietal peritoneum. The oesophagus, rectum and kidneys are all primarily retroperitoneal.
Secondarily retroperitoneal organs were initially intraperitoneal, suspended by mesentery. Through the course of embryogenesis, they became retroperitoneal as their mesentery fused with the posterior abdominal wall. Thus, in adults, only their anterior surface is covered with peritoneum. Examples of secondarily retroperitoneal organs include the ascending and descending colon.
A useful mnemonic to help in recalling which abdominal viscera are retroperitoneal is SAD PUCKER:
S = Suprarenal (adrenal) Glands
A = Aorta/IVC
D =Duodenum (except the proximal 2cm, the duodenal cap)
P = Pancreas (except the tail)
U = Ureters
C = Colon (ascending and descending parts)
K = Kidneys
E = (O)esophagus
R = Rectum
O saco menor se comunica com o saco maior via forame epiplóico (forame omental), que encontra-se posterior à borda livre do omento menor. Este forame tem bordas bem definidas:
Anterior – ligamento hepatoduodenal
Posterior – veia cava inferior e pilar direito do diafragma
Superior – lobo caudal do fígado
Inferior – parte superior do duodeno
Aprenda mais sobre a bolsa omental com os recursos abaixo.
the pelvis to the right supramesocolic space.
Small bowel mesentery
The small bowel mesentery suspending a large proportion of the small bowel is fixed to the retroperitoneum. It is a fan-shaped shaped structure which extends from the left upper quadrant, attaching at the ligament of Treitz, to the ileocaecal junction[53]. Mesenteric tumour deposition may arise by a number of different modes of spread as described earlier. Flow of ascites pools in the small bowel mesentery, eventually collecting close to the terminal ileum and is often an early detectable site of peritoneal metastases. CT and MR imaging appearances may vary greatly from generalized mistiness of the mesentery to focal nodules or masses producing separation, angulation and/or thickening of the small bowel. A significant proportion of gastrointestinal carcinoid tumours spread to the mesentery giving rise to an enhancing soft tissue mass with surrounding fibrotic radiating linear bands (desmoplastic reaction) (Fig. 11). Gastric, pancreatic, biliary and colon cancer may directly involve leaves of mesentery.
Survival of patients with colorectal cancer who receive less than complete cytoreduction (CC-1 or CC-2) or have a higher burden of disease as indicated by the peritoneal carcinomatosis index (PCI) (see Figure 1) is significantly diminished compared to that of a CC-0 resection [17-19].
Extensive disease burden at identification often leaves patients with only palliative treatment options [20]. Despite the benefit of CRS/HIPEC, only about 25% of patients with PC will be eligible for this approach given the late presentation and burden of disease. In order to expand patient eligibility and offer treatment with a curative intent, early detection of PC, before significant tumor burden develops, is essential.