R*******t
发帖数: 367 | 1 第一个
31yo cf who is s/p bilateral reduction mammoplasty POD #19 presents to
breast clinic for bilateral fullness and tenderness more on the right than
the left, which started three days ago and has been progressively more
intense. She admits some tenderness to the touch diffusely over the right
breast, but can not pinpoint focal pain. She states the discomfort is worse
than freshly post-op. There is some drainage from the left breast incision
from the incomplete healing of the incisions.
She is currently on keflex her plastic surgeon gave her, and her surgeon re-
assured her that it is not an infection. "i think my doctor thinks I am
crazy, and I am making everything up".
Her plastic surgeon sent her from her office after the followup exam, and
wanted me to evaluate her, and do what needs to be done.
PMH: G6p3, breastfed all the three kids, youngest child 4yo. Adenomyosis,
left ovarian dermoid
PSxH: 1 c-section, hysterectomy with left oophorectomy in 2010, from which
she developed staph infection and was hospitalized for 1 month. appy, chole
Social hx: lives with husband, three kids, no tob/etoh/illicit drug
Famhx: mother and maternal cousin with premenopausal breast Ca
ROS: intermittent low fever, denies SOB, GU symptoms
PE: typical inverted -T incisions on both breasts lower quadrants, with mild
inflammatory changes with healing. Minimal yellowish fluid drainage on the
left breast. The right breast is larger comparing to the left, firm and
tender to touch. Skin appears stretched and scaly. Minimal erythema, both
breasts are normal body temp. No nipple discharge on either side.
Labs... Don't know much except for borderline elevated white count.
What imaging exam would you do next? And images are coming.... |
A*******s
发帖数: 9638 | 2 I just guess. Mammogram or sonogram for infection? |
R*******t
发帖数: 367 | |
h*******l
发帖数: 1542 | 4 先做哪个呢？
use a coin, head or tail.
【在 R*******t 的大作中提到】
: 我就这么两把刷子...lol
: 先做哪个呢？
|
h*********t
发帖数: 116 | |
s******v
发帖数: 477 | 6 Just for my curiosity, the breasts are still very dense in 31 yo female.
What is the yield of mammogram for 31 yo?
If she got breast implant instead of reduction, can you do mammogram on her?
Is there a risk of leaking or broken of the implants? |
R*******t
发帖数: 367 | 7 I started with ultrasound. Any DDx? |
i*d
发帖数: 2640 | 8 无菌性脂肪液化
worse
re-
【在 R*******t 的大作中提到】
: 第一个
: 31yo cf who is s/p bilateral reduction mammoplasty POD #19 presents to
: breast clinic for bilateral fullness and tenderness more on the right than
: the left, which started three days ago and has been progressively more
: intense. She admits some tenderness to the touch diffusely over the right
: breast, but can not pinpoint focal pain. She states the discomfort is worse
: than freshly post-op. There is some drainage from the left breast incision
: from the incomplete healing of the incisions.
: She is currently on keflex her plastic surgeon gave her, and her surgeon re-
: assured her that it is not an infection. "i think my doctor thinks I am
|
z****o
发帖数: 368 | 9 +1
【在 i*d 的大作中提到】
: 无菌性脂肪液化
:
: worse
: re-
|
z****o
发帖数: 368 | 10 sonogram findings: solitary cystic mass with irregular boarder. low echo+
some echogenic bands inside. No vessel found inside the mass.
Since it is cystic mass, do we still need biopsy?
I guess draining the mass is important for healing. Plus it provide sample
for pathology. Numerous fatty drops will support the diagnosis of fat
necrosis. |
|
|
b******a
发帖数: 704 | 11 谢谢楼上的老师们。 看见ultrasound就傻眼了。
If it's cystic mass, fine needle aspiration cytology (FNAC) is required
according to my review book.
DDX: fat necrosis of the breast;
breast infection, abscess, mastitis;
Fibrocystic lesion;
Fibroadenomas;
Breast cancer
I also found a review about fat necrosis of the breast :
http://www.ncbi.nlm.nih.gov/pubmed/16198567
Breast. 2006 Jun;15(3):313-8
The aetiological factors includes trauma (21–70%), radiotherapy,
anticoagulation (war farin),cyst aspiration, biopsy, lumpectomy, reduc tion
mammoplasty, implant removal, breast reconstruction with tissue transfer,
duct ectasia and breast infection.
-lesions precipitated by trauma;
-Fat necrosis is commonly found in the superficial breast tissues and
subareolar regions in obese women with pendulous breasts.
Ultrasound：
The ultrasound appearance of fat necrosis range from solid nodules with
posterior shadowing, to complex intra-cystic masses that evolve over time.
These features depict the histological evolution of fat necrosis.
Sonographically, fat necrosis may appear as cystic or solid masses. Cystic
lesions appear complex with mural nodules or with internal echogenic bands.
Solid masses have well-circumscribed or ill-defined margins, and are often
associated with distortion of the breast parenchyma.
Common features of fat necrosis on ultrasono-gram are increased echogenicity
of subcutaneous tissue (27%), as an anechoic cyst with posterior acoustic
enhancement (17%), hypoechoic mass with
posterior acoustic shadowing (16%), solid mass (14%), cyst with internal
echoes (11%), normal appearance (11%) or cystic mural nodule (4%).
The oil cyst, which shows posterior acoustic shadowing, corresponds to the
round radiolucent lesion with curvilinear wall calcification on mam-
mography. Ultrasound can reliably diagnose oil cysts. Soo et al. defined an
echogenic band that shifted in orientation with changes in patient position
as being diagnostic of oil cysts.
【在 z****o 的大作中提到】
: sonogram findings: solitary cystic mass with irregular boarder. low echo+
: some echogenic bands inside. No vessel found inside the mass.
: Since it is cystic mass, do we still need biopsy?
: I guess draining the mass is important for healing. Plus it provide sample
: for pathology. Numerous fatty drops will support the diagnosis of fat
: necrosis.
|
R*******t
发帖数: 367 | 12 The main reason for starting with ultrasound for young patients is to avoid radiation. Besides they present as
symptomatic patients and targeted ultrasound can usually be performed. If mammogram is indicated after the
ultrasound exam, they can always have it done too.
her?
【在 s******v 的大作中提到】
: Just for my curiosity, the breasts are still very dense in 31 yo female.
: What is the yield of mammogram for 31 yo?
: If she got breast implant instead of reduction, can you do mammogram on her?
: Is there a risk of leaking or broken of the implants?
|
R*******t
发帖数: 367 | 13 No DDx?
【在 i*d 的大作中提到】
: 无菌性脂肪液化
:
: worse
: re-
|
R*******t
发帖数: 367 | 14 From your description of the US findings, is it an auntminnie case? If not,
what are your differentials? Would you only put fat necrosis as the one and
only impression and cover all your liability?
Yes it needs to be drained.
【在 z****o 的大作中提到】
: sonogram findings: solitary cystic mass with irregular boarder. low echo+
: some echogenic bands inside. No vessel found inside the mass.
: Since it is cystic mass, do we still need biopsy?
: I guess draining the mass is important for healing. Plus it provide sample
: for pathology. Numerous fatty drops will support the diagnosis of fat
: necrosis.
|
R*******t
发帖数: 367 | 15 Great differentials! That's what I want to see when taking most of the
radiology cases.
Would you narrow it down given the fact that she is freshly post-op? :)
FNA was exactly what I did. The images are to follow.
【在 b******a 的大作中提到】
: 谢谢楼上的老师们。 看见ultrasound就傻眼了。
: If it's cystic mass, fine needle aspiration cytology (FNAC) is required
: according to my review book.
: DDX: fat necrosis of the breast;
: breast infection, abscess, mastitis;
: Fibrocystic lesion;
: Fibroadenomas;
: Breast cancer
: I also found a review about fat necrosis of the breast :
: http://www.ncbi.nlm.nih.gov/pubmed/16198567
|
R*******t
发帖数: 367 | 16 那天居然只剩一个六十毫升的针筒，就又用掉了17个10毫升的。 |
s**********t
发帖数: 217 | 17 how can you see the needle on your ultrasound machine, I can not see the
needle on mine?
【在 R*******t 的大作中提到】
: 那天居然只剩一个六十毫升的针筒，就又用掉了17个10毫升的。
|
R*******t
发帖数: 367 | 18 你们是什么样的超声波机器啊？
【在 s**********t 的大作中提到】
: how can you see the needle on your ultrasound machine, I can not see the
: needle on mine?
|
i*d
发帖数: 2640 | 19 没穿刺结果前，只能瞎猜一个。
穿刺前，不会采取什么治疗措施，没必要DDX。
懒啊。
【在 R*******t 的大作中提到】
: No DDx?
|
i*d
发帖数: 2640 | 20 损伤淋巴管了？
还有个问题。
这个病例能顶回外科医生处理么？一定要帮 外科 扫尾么？
【在 R*******t 的大作中提到】
: 那天居然只剩一个六十毫升的针筒，就又用掉了17个10毫升的。
|
|
|
R*******t
发帖数: 367 | 21 穿刺后呢？
Maybe okay for the clinicians, but we need to dictate the report before
path/lab results come back. Under some circumstances even clinicians won't wait until
the results come back and have to start the treatment.
【在 i*d 的大作中提到】
: 没穿刺结果前，只能瞎猜一个。
: 穿刺前，不会采取什么治疗措施，没必要DDX。
: 懒啊。
|
i*d
发帖数: 2640 | 22 说得对。
回想一下，是先粗略鉴别了一下，排除了需要紧急处理的 感染和大出血（外科的那么
自信，估计不用紧急处理。）
然后继续检查，继续鉴别诊断。
就 一元论 出发， 根据年龄和病史，极大可能是术后并发症。然后 google， 查 up
to date。。。
wait until
【在 R*******t 的大作中提到】
: 穿刺后呢？
: Maybe okay for the clinicians, but we need to dictate the report before
: path/lab results come back. Under some circumstances even clinicians won't wait until
: the results come back and have to start the treatment.
|
R*******t
发帖数: 367 | 23 Chylous leak would be very rare, and most are associated with axillary nodal
dissection, which this patient did not have.
It all depends on the hospital tradition, and how cooperative the two
departments are. I haven't said no to a surgeon if there is anything I could
help in a case. It is not for the surgeon or 帮 外科 扫尾, it is for the
patient.
【在 i*d 的大作中提到】
: 损伤淋巴管了？
: 还有个问题。
: 这个病例能顶回外科医生处理么？一定要帮 外科 扫尾么？
|
R*******t
发帖数: 367 | 24 感染完全排除了吗？
【在 i*d 的大作中提到】
: 说得对。
: 回想一下，是先粗略鉴别了一下，排除了需要紧急处理的 感染和大出血（外科的那么
: 自信，估计不用紧急处理。）
: 然后继续检查，继续鉴别诊断。
: 就 一元论 出发， 根据年龄和病史，极大可能是术后并发症。然后 google， 查 up
: to date。。。
:
: wait until
|
i*d
发帖数: 2640 | 25 当然不可能完全排除。所有能造成乳房积液的原因，一个都不能完全排除。
我的意思是感染休克直接送急诊。如果病人不用送急诊，还能等，就等检查结果。对诊
断有巨大帮助。
术后并发症可能最大。
【在 R*******t 的大作中提到】
: 感染完全排除了吗？
|
i*d
发帖数: 2640 | 26 你做的细致彻底。对外科和病人都很负责。
我前一阵碰到一大姐。她帮忙处理一个术后病人，没啥错。可是外科的漏诊延误治疗。
病人告外科医生和医院。她的名字也在列某处，不是被告。她正在找工作，每次填表，
都要在一些项目上打勾，还要附上和长的说明。工作找的极其艰难。
上面都是她一面之词。
正好问问前辈，遇到这类事怎么处理。
nodal
could
【在 R*******t 的大作中提到】
: Chylous leak would be very rare, and most are associated with axillary nodal
: dissection, which this patient did not have.
: It all depends on the hospital tradition, and how cooperative the two
: departments are. I haven't said no to a surgeon if there is anything I could
: help in a case. It is not for the surgeon or 帮 外科 扫尾, it is for the
: patient.
|
A*******s
发帖数: 9638 | 27 What is the result of body fluid analysis?
【在 R*******t 的大作中提到】
: 感染完全排除了吗？
|
A*******s
发帖数: 9638 | 28 不是我的责任， 我不会在那些问题上打勾。
【在 i*d 的大作中提到】
: 你做的细致彻底。对外科和病人都很负责。
: 我前一阵碰到一大姐。她帮忙处理一个术后病人，没啥错。可是外科的漏诊延误治疗。
: 病人告外科医生和医院。她的名字也在列某处，不是被告。她正在找工作，每次填表，
: 都要在一些项目上打勾，还要附上和长的说明。工作找的极其艰难。
: 上面都是她一面之词。
: 正好问问前辈，遇到这类事怎么处理。
:
: nodal
: could
|
R*******t
发帖数: 367 | 29 SITE OF BIOPSY:A: Fine needle aspiration of Breast, right
FINAL CYTOPATHOLOGICAL DIAGNOSIS
Interpretation: NEGATIVE FOR MALIGNANT CELLS.
See microscopic.
MICROSCOPIC:
This aspirate contains small, mature appearing lymphocytes. The
differential
diagnosis includes seroma and intramammary lymph node. Clinical
correlation
suggested.
***Electronically Signed Out***
, MD, Senior Staff Pathologist
dss/4/23/2012
======================================================================
==
PROCEDURES/ADDENDA
CBL 1
Date Ordered: 4/20/2012 Date Reported: &#
160; 4/23/2012
Interpretation
Review completed, cell block(s) and other cytological preparations are
in
agreement.
***Electronically Signed Out***
, MD, Senior Staff Pathologist
SPECIMEN DESCRIPTION
Part B: # slide(s), # cytospin(s) from 50 mL of bloody rinse received.
Part C: # cell block(s) and # slides prepared.
Collect Date: 04/20/2012 11:22 Sample: F4*****
WOUND/ ABSC/DRN CULT &
#160;
; &#
160;
SPECIMEN DESCRIPTION &
#160; Drainage Right Breast &
#160;
;
SPECIAL REQUESTS
; Culture with gram stain &#
160;
GRAM STAIN
; Few PMNs
&#
160;
&#
160;
No epithelial cells seen &#
160;
&#
160;
; No organisms seen &#
160;
&#
160;
RESULTS &#
160;
Many Staphylococcus aureus Susceptibility not
&#
160;
done, identical isolate, see
accession no. T219***
REPORT STATUS &
#160; Final 04/21/2012 &
#160;
; &#
160;
【在 A*******s 的大作中提到】
: What is the result of body fluid analysis?
|
R*******t
发帖数: 367 | 30 Sometimes the presentation of infection is not typical. However, infection
is the most severe complication and therefore, I suggest all the
radiologists, as well as other clinicians, remember to consider it and put it in the report,
at least that "infectious process cannot be excluded." which I am very
happy I did in this case.
【在 i*d 的大作中提到】
: 当然不可能完全排除。所有能造成乳房积液的原因，一个都不能完全排除。
: 我的意思是感染休克直接送急诊。如果病人不用送急诊，还能等，就等检查结果。对诊
: 断有巨大帮助。
: 术后并发症可能最大。
|
|
|
R*******t
发帖数: 367 | 31 Conclusion of this case:
There is no doubt post-op fluid has component of fat necrosis. The fluid I
drained looks like those from liposuction. In training, we always take cases
with a final diagnosis of A or B. But in real life, A and B can happen
simultaneously, since patients come in without reading a textbook first.
This case is seroma/fat necrosis with superimposed infection. Patient was
put on vanco and has been doing well.
I remember A++ once showed a case with MS and spinal stenosis. The lesson I
learned from that case is, before jumping into a conclusion too fast, give a
differential to the clinician, and let them rule out one or the other,
because they have the patient in front of them. Of course, for cases without
differentials, we should not be hesitating to call it! :) |
R*******t
发帖数: 367 | 32 姜还是老的辣。给你自己发包子吧！
这个病人症状并不是典型脓肿。Had her waited for several more days, No doubt
she would have full-blown symptoms for sure. I praised her for being in
charge of her own body and came in in time.
Practicing medicine is like the attitude toward life, hope for the best but
prepare for the worst. Obviously the worst possibility for her is infection.
And I can't exclude that just by her PE or the non-foul fluid I drained. At
this very brand new stage of my practice, I don't exclude a differential,
unless I can be 100% confident to exclude it.
【在 A*******s 的大作中提到】
: I just guess. Mammogram or sonogram for infection?
|
R*******t
发帖数: 367 | 33 Unfortunately things like that might happen. The only way to avoid potential
lawsuit is not practicing medicine at all. We took the oath that we will help and do no harm before we put hands on
any patient, and there is a potential of a lawsuit there.
We do our job, keep the communications with other specialties in a timely
manner, document all the phone and in-person encounters, and hope other
people will do their job too. What else can we do? medicine is a teamwork and the best we can do is not dropping the
ball on our part.
You can hardly practice medicine alone, and you always have to deal with other specialties. In some
severe complicated cases, it might be wise not to get involved. But so far I haven
't seen one. I know in the future there will for sure be cases I would say that "There is really not much I can do for the
patient".
【在 i*d 的大作中提到】
: 你做的细致彻底。对外科和病人都很负责。
: 我前一阵碰到一大姐。她帮忙处理一个术后病人，没啥错。可是外科的漏诊延误治疗。
: 病人告外科医生和医院。她的名字也在列某处，不是被告。她正在找工作，每次填表，
: 都要在一些项目上打勾，还要附上和长的说明。工作找的极其艰难。
: 上面都是她一面之词。
: 正好问问前辈，遇到这类事怎么处理。
:
: nodal
: could
|
A*******s
发帖数: 9638 | 34 You have so many 包子.... The richer, the more stingy. lol
Fatty necrosis with superimposed infection. Very well concluded.
I like to see a radiology report with a format like this:
1. Working diagnosis.
2. DDxs
3. Further workup recommendations.
4. Clinical correlation is recommended. lol
but
infection.
At
【在 R*******t 的大作中提到】
: 姜还是老的辣。给你自己发包子吧！
: 这个病人症状并不是典型脓肿。Had her waited for several more days, No doubt
: she would have full-blown symptoms for sure. I praised her for being in
: charge of her own body and came in in time.
: Practicing medicine is like the attitude toward life, hope for the best but
: prepare for the worst. Obviously the worst possibility for her is infection.
: And I can't exclude that just by her PE or the non-foul fluid I drained. At
: this very brand new stage of my practice, I don't exclude a differential,
: unless I can be 100% confident to exclude it.
|
R*******t
发帖数: 367 | 35 这是版上活动，答的好的当然版主从国库发包子，我一届草民怎敢越苞代厨？lol
Bythesea也应该发个大包子。
Correlate clinically? 这句话已经 by default都成了报告结束语了。lol
【在 A*******s 的大作中提到】
: You have so many 包子.... The richer, the more stingy. lol
: Fatty necrosis with superimposed infection. Very well concluded.
: I like to see a radiology report with a format like this:
: 1. Working diagnosis.
: 2. DDxs
: 3. Further workup recommendations.
: 4. Clinical correlation is recommended. lol
:
: but
: infection.
|
z****o
发帖数: 368 | 36 多谢Ruby老大，从你那儿总能学到新的东西。非常感谢。 |
b******a
发帖数: 704 | 37 谢谢Ruby糖大夫。 包子不敢当，我就是学习练捧哏的。你们多发言，像我这样的书呆
子菜鸟们才会收益.
比如， ultrasound里有可能看到针头，偶觉得心安不少，减少焦虑了， lol |
R*******t
发帖数: 367 | 38 Any time！
Taking a case usually starts with what study it is, followed by findings,
ddx if not aunt Minnie, most possible diagnosis, and further recommendations
, as well as calling the clinicians if there are critical results.
【在 z****o 的大作中提到】
: 多谢Ruby老大，从你那儿总能学到新的东西。非常感谢。
|
R*******t
发帖数: 367 | 39 我真该打，忘了你爱吃的明明是馅饼。让老大先把包子先拍扁成馅饼，再用精致的竹盒
装着，绑上丝带，再发给你。lol
【在 b******a 的大作中提到】
: 谢谢Ruby糖大夫。 包子不敢当，我就是学习练捧哏的。你们多发言，像我这样的书呆
: 子菜鸟们才会收益.
: 比如， ultrasound里有可能看到针头，偶觉得心安不少，减少焦虑了， lol
|
R*******t
发帖数: 367 | 40 Case 2
46 yo cm，with given history as Poland Syndrome, a pretty frequent topic of rad boards.
I didn't see the patient in person, so I don't have more info. Images are as follows.
What's is the first question popped in your mind? After looking at the study for the first time, I immediately gave his
ordering physician a call. |
|
|
i*d
发帖数: 2640 | 41 我碰到的绝大部分中国医生都是这样。自己勤勤恳恳，还老是四处救火。包括我本人。
就像你说的。
We do our job, keep the communications with other specialties in a timely
manner, document all the phone and in-person encounters, and hope other
people will do their job too. What else can we do?
可是，别人并不是 do their job too。帮人扫尾的时候，别人还不一定感激。觉得得
有一定的原则。至少严肃的向别人指出。
potential
help and do no harm before we put hands on
and the best we can do is not dropping the
other specialties. In some
I haven
that "There is really not much I can do for the
【在 R*******t 的大作中提到】
: Unfortunately things like that might happen. The only way to avoid potential
: lawsuit is not practicing medicine at all. We took the oath that we will help and do no harm before we put hands on
: any patient, and there is a potential of a lawsuit there.
: We do our job, keep the communications with other specialties in a timely
: manner, document all the phone and in-person encounters, and hope other
: people will do their job too. What else can we do? medicine is a teamwork and the best we can do is not dropping the
: ball on our part.
: You can hardly practice medicine alone, and you always have to deal with other specialties. In some
: severe complicated cases, it might be wise not to get involved. But so far I haven
: 't seen one. I know in the future there will for sure be cases I would say that "There is really not much I can do for the
|
A*******s
发帖数: 9638 | 42 Do not step on other's toes. lol
【在 i*d 的大作中提到】
: 我碰到的绝大部分中国医生都是这样。自己勤勤恳恳，还老是四处救火。包括我本人。
: 就像你说的。
: We do our job, keep the communications with other specialties in a timely
: manner, document all the phone and in-person encounters, and hope other
: people will do their job too. What else can we do?
: 可是，别人并不是 do their job too。帮人扫尾的时候，别人还不一定感激。觉得得
: 有一定的原则。至少严肃的向别人指出。
:
: potential
: help and do no harm before we put hands on
|
A*******s
发帖数: 9638 | 43 Is the patient able to walk?
Well, is this MRI? Do you have a sagital view of the spine?
of rad boards.
as follows.
study for the first time, I immediately gave his
【在 R*******t 的大作中提到】
: Case 2
: 46 yo cm，with given history as Poland Syndrome, a pretty frequent topic of rad boards.
: I didn't see the patient in person, so I don't have more info. Images are as follows.
: What's is the first question popped in your mind? After looking at the study for the first time, I immediately gave his
: ordering physician a call.
|
R*******t
发帖数: 367 | 44 This is a male breast MRI. Breast coil was used, and the field of view was
focused on his chest/breasts, so the spine was not imaged.
These are T2 weighted images.
【在 A*******s 的大作中提到】
: Is the patient able to walk?
: Well, is this MRI? Do you have a sagital view of the spine?
:
: of rad boards.
: as follows.
: study for the first time, I immediately gave his
|
A*******s
发帖数: 9638 | 45 ft. I thought it was spine.
What is the purpose for MRI?
【在 R*******t 的大作中提到】
: This is a male breast MRI. Breast coil was used, and the field of view was
: focused on his chest/breasts, so the spine was not imaged.
: These are T2 weighted images.
|
R*******t
发帖数: 367 | 46 History given was Poland Syndrome.
Breast MRI都是病人prone的，让breasts自然下垂在coil里面，所以影像是prone,右边
是右，左边是左。
【在 A*******s 的大作中提到】
: ft. I thought it was spine.
: What is the purpose for MRI?
|
A*******s
发帖数: 9638 | 47 这个对我说太难， 不明白为什么做MRI。
好像是两侧的胸廓， 中间应该是sternum， 看上去有两个cavity， 还有fluid level
。 中间那个好像还heterogeneous， 你是不是问病人有没有CP/fever？
No idea.
【在 R*******t 的大作中提到】
: History given was Poland Syndrome.
: Breast MRI都是病人prone的，让breasts自然下垂在coil里面，所以影像是prone,右边
: 是右，左边是左。
|
s*******w
发帖数: 1879 | 48 中间那个很亮得东西看着像血管啊，但是胸前得部分不应该有血管得啊。
瞎猜了，瘤子么？ |
n*******c
发帖数: 501 | 49 糖姐的病例高难度啊...
sternum should be one only. What is the other one? Actually the right one
looks more like sternum. Not sure about the left one.
Looks like bones with fluid/collection inside? If it is an artery (it is
huge!!)then maybe dissection? Could not believe it... |
R*******t
发帖数: 367 | 50 再多解释一下。这个病人的病史写的是Porland syndrome。可是粗略看过一次这个
study后，我认为病史给错了，病人根本没有Porland syndrome, 而是pectus
excavatum.
这个提示有用吗？ |
|
|
A*******s
发帖数: 9638 | 51 有用， 我决定放弃猜测。 lol
Porland syndrome or pectus excavatum， too much for me。 只能崇拜一下了。
【在 R*******t 的大作中提到】
: 再多解释一下。这个病人的病史写的是Porland syndrome。可是粗略看过一次这个
: study后，我认为病史给错了，病人根本没有Porland syndrome, 而是pectus
: excavatum.
: 这个提示有用吗？
|
R*******t
发帖数: 367 | 52 不是瘤子，不是血管。查查pectus excavatum?
【在 s*******w 的大作中提到】
: 中间那个很亮得东西看着像血管啊，但是胸前得部分不应该有血管得啊。
: 瞎猜了，瘤子么？
|
R*******t
发帖数: 367 | 53 我给他的医生打电话，跟他讲病人并不是Porland syndrome，因为两边的胸大肌都在，
算是对称了。病人因为胸骨内陷，去看的这个医生，是整形外科医生。
【在 n*******c 的大作中提到】
: 糖姐的病例高难度啊...
: sternum should be one only. What is the other one? Actually the right one
: looks more like sternum. Not sure about the left one.
: Looks like bones with fluid/collection inside? If it is an artery (it is
: huge!!)then maybe dissection? Could not believe it...
|
R*******t
发帖数: 367 | 54 这个男的去做了breast implant 来修正胸骨内陷。
【在 A*******s 的大作中提到】
: 有用， 我决定放弃猜测。 lol
: Porland syndrome or pectus excavatum， too much for me。 只能崇拜一下了。
|
A*******s
发帖数: 9638 | 55 男的做隆胸，cerebrity？ lol
这个病人有临床症状吗？
【在 R*******t 的大作中提到】
: 这个男的去做了breast implant 来修正胸骨内陷。
|
R*******t
发帖数: 367 | 56 他的两个implants还在，触压有痛感。
【在 A*******s 的大作中提到】
: 男的做隆胸，cerebrity？ lol
: 这个病人有临床症状吗？
|
A*******s
发帖数: 9638 | 57 中间那两个cavity是什么啊？
【在 R*******t 的大作中提到】
: 他的两个implants还在，触压有痛感。
|
s*******w
发帖数: 1879 | 58 你一提示我就google过了。
但是不知道那个是什么啊，但是我同意你说的，不是poland syndrome，因为bilateral
pectoral muscles are symmetrical，我也没看到a++说的胸内infection，也没看到
sternum到底有啥异常。／／jiong
我觉得，我猜的哈，这个东西好像在皮下脂肪层，出了状况的样子，但是看不出具体是
啥，看上去圆圆的，难倒只是个cyst，但是cyst的话里面为啥会有象瓣膜一样的东西分
成两部分呢，这个长的太规矩了。
诶诶，mri，我想了好久mri里面是啥亮，想了半天是含水量高的亮吧？
不知道，彻底一外行，乱猜。
【在 R*******t 的大作中提到】
: 不是瘤子，不是血管。查查pectus excavatum?
|
z****o
发帖数: 368 | 59 First time heard of Poland syndrome. Wiki says it is unilateral development
deficiency of pectoralis major. This pt has symmetrical pectoralis major,
so it is less likely Poland syndrome?
This is a T2 weighted MRI imaging with surface coil, without fat sat. My
guess is that the 2 well demarcated subcutaneous masses are silicon implants
, presumably to cosmetically correct the chest cavity deformity (pectus
excavatum).
No experiences on the implant MRI. The T2 hyperintensity area should be high
water content-> silicon gel? what is the hypointensity area? plastic holder
? |
R*******t
发帖数: 367 | 60 Awesome!!
That's exactly what he had, two silicone implants to correct his pectus
excavatum. The crescent shaped dark signal structures are silicone implants.
The more medial one is kinked and has fluid around it due to the
inflammation. It is not uncommonly seen that silicone implants have fluid
filled cavity around the capsule. There is no silicone leak to suggest
rupture yet.
He needs surgical removal and replacement of his implant, since now his
anterior chest wall has a bulging contour, which looks deformed.
You will hear Poland syndrome as well as swyer-James syndrome in your chest
rotation and case conference over and over again. They love the topics.
Nice job!! :)
development
,
implants
high
holder
【在 z****o 的大作中提到】
: First time heard of Poland syndrome. Wiki says it is unilateral development
: deficiency of pectoralis major. This pt has symmetrical pectoralis major,
: so it is less likely Poland syndrome?
: This is a T2 weighted MRI imaging with surface coil, without fat sat. My
: guess is that the 2 well demarcated subcutaneous masses are silicon implants
: , presumably to cosmetically correct the chest cavity deformity (pectus
: excavatum).
: No experiences on the implant MRI. The T2 hyperintensity area should be high
: water content-> silicon gel? what is the hypointensity area? plastic holder
: ?
|
|
|
R*******t
发帖数: 367 | 61 Btw these images are T2 weighted with silicone suppression, that's why
silicone is dark signal, so we can tell the abnormal fluid collection from
silicone itself. |
A*******s
发帖数: 9638 | 62 So there is a cavity,a fluid lever and inflammation/infection. The most of
us are right. lol
Silicone art is amazing.
【在 R*******t 的大作中提到】
: Btw these images are T2 weighted with silicone suppression, that's why
: silicone is dark signal, so we can tell the abnormal fluid collection from
: silicone itself.
|
R*******t
发帖数: 367 | 63 Yes MRI can suppress the signal of literally any material.
Without looking at a study, the ddx are most likely infection, inflammation,
neoplasm, the big three, isn't it?
【在 A*******s 的大作中提到】
: So there is a cavity,a fluid lever and inflammation/infection. The most of
: us are right. lol
: Silicone art is amazing.
:
|
z****o
发帖数: 368 | 64 Thanks. Very interesting case.
So the hyper-intensity areas are fluid collection due to inflammation? Is it
fluid collection inside the capsule and outside of the silicon body? What
I don't understand is how did the fluid get into the capsule. Is the
capsule man-made material that designed to tightly cover the silicon body?
implants.
chest
【在 R*******t 的大作中提到】
: Awesome!!
: That's exactly what he had, two silicone implants to correct his pectus
: excavatum. The crescent shaped dark signal structures are silicone implants.
: The more medial one is kinked and has fluid around it due to the
: inflammation. It is not uncommonly seen that silicone implants have fluid
: filled cavity around the capsule. There is no silicone leak to suggest
: rupture yet.
: He needs surgical removal and replacement of his implant, since now his
: anterior chest wall has a bulging contour, which looks deformed.
: You will hear Poland syndrome as well as swyer-James syndrome in your chest
|
R*******t
发帖数: 367 | 65 The capsule is a predominantly fibrous shell formed by our body against
foreign bodies. It can cause many complications, such as contractures and
calcifications. If there is adjacent inflammation, fluid can accumulate
around and inside the capsule.
The most common indication for implant study is if there is intracapsular or
extra capsular implant rupture. Intracapsular rupture is less worrisome
since the free silicone is still contained in the capsule. However, extra
capsular rupture can lead to silicone granulomas which mimic malignancy and
are frequently biopsied. In many cases, implants with extra capsular rupture
need to be removed.
it
What
【在 z****o 的大作中提到】
: Thanks. Very interesting case.
: So the hyper-intensity areas are fluid collection due to inflammation? Is it
: fluid collection inside the capsule and outside of the silicon body? What
: I don't understand is how did the fluid get into the capsule. Is the
: capsule man-made material that designed to tightly cover the silicon body?
:
: implants.
: chest
|
z****o
发帖数: 368 | 66 Thanks Ruby. It makes much more sense now. |
