NEJM Few cases Maig 2011.ppt [Modo de compatibilidad] · Hirschsprung's disease 3. Sigmoid volvulus 4. Small-bowel obstruction 5. Trichobezoar. Answer: What is the diagnosis? 3. Sigmoid

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Sessió de formació continuadaSCC

Juny-2011

What is the diagnosis?

1. Gastric outlet obstruction2. Hirschsprung disease3. Ileal intussusception4. Ulcerative colitis5. Zollinger-Ellison syndrome

Answer:

4. Ulcerative colitis

The abdominal radiograph shows a severely dilated transverse colon and free air. The findings are typical of fulminant ulcerative colitis. The patient recovered after a total abdominal colectomy with end ileostomy.


1. Amebic liver abscess2. Diffuse bilioma3. Echinococcosis4. Hepatocellular carcinoma5. Polycystic liver disease

Answer:


3. Echinococcosis

Serologic testing for hydatid disease confirmed that the cystic mass was a result of echinococcosis. The patient recovered after treatment with albendazole.


1. Bowel infarction2. Crohn's disease3. Cystic fibrosis4. Echinococcosis5. Lead poisoning

Answer:


1. Bowel infarction

The image shows gas in the wall of the bowel, in the portal venous system, and in the superior mesenteric vein. These findings are most consistent with extensive bowel infarction.

This appearance was noticed during routine colonoscopy. What is the diagnosis?

1. Addison's disease2. Hemochromatosis3. Laxative use4. Metastatic melanoma5. von Hippel-Lindau disease

Answer:

This appearance was noticed during routine colonoscopy. What is the diagnosis?

3. Laxative use

Melanosis coli is dark brown pigmentation of the colon that occurs with the use of laxatives containing anthraquinone, such as senna. It can develop within a few months of use, and it can disappear in a few months if the use of the laxative is discontinued.


1. Diverticular abscess2. Hirschsprung's disease3. Sigmoid volvulus4. Small-bowel obstruction5. Trichobezoar

Answer:


3. Sigmoid volvulus

The coronal view of the computed tomogram reveals dilated loops of colon with a central whirl sign that is most consistent with a sigmoid volvulus.


1. Diverticulosis2. Familial adenomatous polyposis3. Foreign object ingestion4. Pneumatosis cystoides coli5. Trichinosis

Answer:


4. Pneumatosis cystoides coli

Submucosal cysts are most consistent with the diagnosis of pneumatosis cystoides coli. These characteristic cysts can be focal or diffuse and occur mainly in adults. The disease is usually asymptomatic, but can cause obstruction, pain, or pneumoperitoneum.

Richard H. Marshak E Lindner, Daniel Maklansky and Fran Espin

What underlying disease is most likely to have been present in this patient?

1. Atrial fibrillation 2. Chronic constipation3. Chronic renal insufficiency4. Diabetes mellitus5. Thalassemia

Answer:

What underlying disease is most likely to have been present in this patient?

4. Diabetes mellitus

The abdominal radiograph shows air throughout the urinary tract. Patients with diabetes mellitus have a particular predisposition for complicated urinary tract infections such as emphysematous cystitis, which is thought to be caused by fermentation of glucose by bacterial and fungal pathogens.

What is the diagnosis in this 56-year-old man with abdominal pain?

1. Acute pancreatitis2. Colonic volvulus3. Colonic carcinoma4. Mesenteric ischemia5. Pneumoperitoneum

Answer:

What is the diagnosis in this 56-year-old man with abdominal pain?

5. Pneumoperitoneum

Careful inspection of this supine plain radiograph of the abdomen reveals a small triangular pocket of air outlined by three adjacent bowel loops. This finding is consistent with the presence of free intraperitoneal air and is known as the telltale triangle sign. Abdominal computed tomography confirmed the presence of pneumoperitoneum and also showed a subdiaphragmatic abscess with an air-fluid level. During surgery, a perforated gastric ulcer and two intraabdominal abscesses were found.

This patient presented following a high-speed motor vehicle crash. Which structure has been disrupted?

1. Aorta2. Diaphragm3. Esophagus4. Myocardium5. Trachea

Answer:

This patient presented following a high-speed motor vehicle crash. Which structure has been disrupted?

2. Diaphragm

The elevated right hemidiaphragm suggests traumatic diaphragmatic rupture. The other listed structures appear to be intact. A computed tomographic scan confirmed the diaphragmatic rupture and showed that the dome of the liver had herniated into the right hemithorax.


1. Anaplastic thyroid carcinoma2. Graves' disease3. Hashimoto's thyroiditis4. Medullary thyroid carcinoma 5. Thyroid lymphoma

Answer:


2. Graves' disease

The patient has a large nodular goiter, eyelid retraction, diaphoresis, and jugular venous distension. Together these are most consistent with Graves' hyperthyroidism.

What diagnosis is suggested by this barium swallow?

1. Ingested foreign body2. Esophageal diverticula3. Diffuse esophageal spasm4. Gastric linitis plastica5. Esophageal carcinoma

Answer:

What diagnosis is suggested by this barium swallow?

3. Diffuse esophageal spasm

Radiographs of the esophagus that were performed with the use of barium contrast material showed a spiral formation of the barium column up to the cervical esophagus, most consistent with diffuse esophageal spasm.

This 8-year-old girl had a 2-year history of abdominal pain. What is the diagnosis?

1. Crohn's disease2. Enteric duplication cyst3. Pancreatic pseudocyst4. Intestinal malrotation5. Wilms' tumor

Answer:

This 8-year-old girl had a 2-year history of abdominal pain. What is the diagnosis?

2. Enteric duplication cyst

The patient had an infected enteric duplication cyst, a rare lesion that usually involves the ileum and may contain ectopic gastric mucosa. Crohn's disease does not cause large abscesses, and the chronicity would not suggest a pancreatic pseudocyst. Malrotation would not explain the multicystic mass. The mass does not have the appearance of Wilms' tumor.

http://www.radiologyassistant.nl/en/4a6c7bba1ef26


1. Asbestosis2. Colonic interposition surgery3. Suppurative mediastinitis4. Pneumopericardium5. Thoracic aortic aneurysm

Answer:


4. Pneumopericardium

The chest radiograph shows pneumopericardium without evidence of pneumothorax or pneumomediastinum. This patient had a perforating esophageal ulcer. The radiograph is not consistent with the other listed diagnoses.


1. Bezoar2. Pericardial effusion3. Pneumatosis coli4. Gastric carcinoma5. Pheochromocytoma

Answer:


1. Bezoar

The computed tomography shows a large gastric mass that is separate from the gastric wall. Endoscopy revealed a large trichobezoar occluding nearly the entire stomach.

Read More: N Engl J Med 2007;357:e23

Which one of the following organs is enlarged?

1. Colon2. Ovary3. Stomach4. Spleen5. Gall bladder

Answer:

Which one of the following organs is enlarged?

3. Stomach

Massive dilation of the stomach with distal gas is most consistent with gastric outlet obstruction.

Read More: N Engl J Med 2007;356:942


1. Cholangiocarcinoma2. Cirrhosis3. Echinococcosis4. Hepatocellular carcinoma5. Tuberculosis

Answer:


2. Cirrhosis

The magnetic resonance image shows a connection between the umbilical vein and the left portal vein, as well as esophageal varices. Together these features suggest a diagnosis of portal hypertension and cirrhosis.



1. Subcutaneous metastases2. Filariasis3. Caput Medusae4. Neurofibromatosis5. Hepatocellular carcinoma

Answer:


3. Caput Medusae

These enlarged veins on his abdomen are consistent with caput medusae.



1. Pancreatic pseudocyst2. Duodenal torsion3. Cholangiocarcinoma4. Gallbladder lipomatosis5. Emphysematous cholecystitis

Answer:


5. Emphysematous cholecystitis

The computed tomogram shows an air-fluid level in the lumen of a dilated gallbladder and gas within the gallbladder wall. These findings suggest emphysematous cholecystitis.


An elderly woman presented with abdominal pain and vomiting for three days. A computed tomogram of the abdomen was obtained. What is the diagnosis?

1. Cecal volvulus2. Intussusception3. Mesenteric ischemia4. Obturator hernia5. Ovarian cancer

Answer:

An elderly woman presented with abdominal pain and vomiting for three days. A computed tomogram of the abdomen was obtained. What is the diagnosis?

4. Obturator hernia

An obturator hernia was diagnosed.


Image Challenge


1. Small-bowel obstruction 2. Echinococcosis3. Mesenteric ischemia4. Pancreatic pseudocysts5. Cecal volvulus

Q:

Answer:

Image Challenge

What is the diagnosis?Q:

1. Small-bowel obstruction

The computed tomogram reveals small-bowel obstruction by a left-sided luminal mass. The mass has a hyperdense periphery and an aerated core.


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1. Duodenal perforation2. Emphysematous pyelonephritis3. Perinephric cyst4. Situs inversus5. Ureterocele

Answer:

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1. Duodenal perforation

The computed tomography shows air surrounding the right kidney and extending to the retroperitoneum. A duodenal ulcer with retroperitoneal perforation was diagnosed. The normal appearance of the kidney excludes emphysematous pyelonephritis.


Image Challenge


1. Ankylosing spondylitis2. Ascending cholangitis3. Intestinal obstruction4. Pancreatitis5. Perforation of a viscus

Q:

Answer:

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5. Perforation of a viscus

The plain-film radiograph of the abdomen shows several signs of free intraperitoneal gas. These include air accumulation in the right upper quadrant; the falciform-ligament sign, visible as a longitudinal linear density on the ventral surface of the liver; the ligamentum teres sign, visible as a linear density running along the inferior edge of the falciform ligament; and the visualization of air on both sides of the bowel wall. The patient had a perforated cecum.

Image Challenge

This patient had hypertension. What is the diagnosis?

1. Coarctation of the aorta2. Pheochromocytoma3. Primary hyperaldosteronism4. Renal artery stenosis5. Systemic sclerosis

Answer:

Image Challenge

This patient had hypertension. What is the diagnosis?

2. Pheochromocytoma

There is a heterogeneous (vascular), contrast-enhanced, right adrenal mass, 4.5 cm in diameter. This is most consistent with a pheochromocytoma.


This 10-year-old presented with abdominal pain. What is the diagnosis?

1. Hirschsprung's disease2. Meckel's diverticulum3. Peptic ulceration4. Pyloric outlet obstruction5. Situs inversus

Answer:

Image Challenge

This 10-year-old presented with abdominal pain. What is the diagnosis?

2. Meckel's diverticulum

Intussusception was diagnosed. Results of imaging suggested the presence of a Meckel�s diverticulum. Intussusception that presents after infancy should raise suspicion regarding a pathologic lead point, including a Meckel�s diverticulum. The child�s symptoms resolved after surgical resection.


This patient had a history of breast-cancer surgery. Which one of the following rib abnormalities is present on her follow-up imaging?

1. Absent rib2. Inferior rib notching3. Rib metastases4. Sternocostal anomaly5. Supernumerary rib

Answer:

Image Challenge

This patient had a history of breast-cancer surgery. Which one of the following rib abnormalities is present on her follow-up imaging?

5. Supernumerary rib

A vertically oriented structure similar in density to adjacent bone within the right hemithorax is visible. This finding was consistent with a supernumerary intrathoracic rib. There are right axillary surgical clips from the previous breast-cancer surgery. Supernumerary intrathoracic ribs are most common on the right side and do not warrant further evaluation or intervention.


1. Coarctation of the aorta2. Lung cancer3. Pneumothorax4. Rib fracture5. Substernal goiter

Answer:


5. Substernal goiter

The chest radiograph demonstrates tracheal deviation. Ultrasonography of the neck revealed a large goiter with the right lobe extending into the anterior superior mediastinum.

Where is the abnormality on this chest radiograph?

1. Left lower lobe2. Left upper lobe3. Right lower lobe 4. Right upper lobe5. Superior mediastinum

Answer:

Where is the abnormality on this chest radiograph?

2. Left upper lobe

A pulmonary mass is visible in the left upper lung.


1. Aspiration pneumonia2. Sarcoidosis3. Silicosis4. Idiopathic pulmonary fibrosis5. Lymphangioleiomyomatosis

Answer:


4. Idiopathic pulmonary fibrosis

The chest radiograph reveals bilateral reticular infiltrates. There is subpleural and lower-lobe predominance, consistent with idiopathic pulmonary fibrosis.


This patient developed jaundice and an enlarging neck mass. What is the diagnosis?

1. Medullary carcinoma of the thyroid2. Peripancreatic malignancy3. Scrofula4. Hodgkin's lymphoma5. Pancoast tumor

Answer:

This patient developed jaundice and an enlarging neck mass. What is the diagnosis?

2. Peripancreatic malignancy

The patient had a fungating mass around the Vater's ampulla. Abdominal cancers can metastasize through the thoracic duct to the left supraclavicular fossa.


Documents

NEJM Few cases Maig 2011.ppt [Modo de compatibilidad] · Hirschsprung's disease 3. Sigmoid volvulus 4. Small-bowel obstruction 5. Trichobezoar. Answer: What is the diagnosis? 3. Sigmoid