Injury to the ACL

Injury to the ACL is one of the most common types of knee injuries, especially in athletes. This type of injury can occur when the knee is in a stationary position and knocked either sideways or backwards causing motion other than normal flexion and extension.

There are varying degrees of ACL injury from a little tear to completely tearing in half. The symptoms of an ACL injury include:
-"popping" of the knee when it is hit
-pain in lateral or posterior aspects of the knee
-swelling of the knee
-inability to properly support the bodies weight

-limited range of motion

For diagnosis of ACL injury, MRI is the most useful imaging technique. There are several treatment options available for injury to the ACL including physical therapy and surgery, these of course are dependant upon the severity of the injury.

All of my information for this blog was found at webmd.com
My images were found at factotem.org/.../Knee-MRI-and-Xray-images.shtml

<-----Normal ACL

<-----Torn ACL

Shoulder Dislocation

The most common type of shoulder dislocation is anterior dislocation which occurs when the shoulder is moved too far superiorly and posteriorly. Most of the time this happens with some type of fall or running into something too hard. Unfortunately though it can also happen just by reaching for something too high or rotating the shoulder too far backward. Dislocation of the shoulder is the most common type of joint dislocation in the entire body.

Symptoms of a shoulder dislocation include severe pain in the shoulder (DUH!), difficulty moving the affected arm even the slightest bit, and a "mushy" feeling when the shoulder is touched from the side as the humeral head is no longer located in the correct place. It almost feels like the bone has been taken out completely.

For most people, this type of injury means a trip to the hospital where x-rays will be ordered to confirm type and severity of the dislocation. The delay of treatment not only means severe suffering for the patient but can cause permanent damage to the tendons, blood vessels, muscles, and nerves that surround the shoulder joint. While x-rays are the most common diagnostic tool for shoulder dislocations, CT and MRI are both beneficial to evaluate occult fractures or other tissue injuries that may have occurred.

Most shoulder dislocations can be fixed in the emergency room. The patient is given conscious sedation to help them relax and allow the physician to relocate the joint. Of course in more severe cases, the patient must go under general anesthetic and an orthopedic surgeon will relocate the joint under fluoro in surgery.

After a shoulder dislocation has been reduced, the patient will be put in a sling, given pain medication, and most often follow up with an orthopedic doctor. Some injuries can even require physical therapy. The worst part about a shoulder dislocation is that it will most likely happen again due to weakening of the muscles and ligaments that surround the shoulder.

houstonshoulderclinic.com

imagingpathways.health.wa.gov.au

sumerdoc.blogspot.com

emedecinehealth..com/shoulder_dislocation

For this pathology blog I thought I would write about shoulder dislocations as my husband suffers from chronic dislocation of his left shoulder. Approximately 6 years ago he fell and dislocated his left shoulder while working. Since then, he's dislocated it approximately 10 times. The first time it happened, he went to a urgent care facility and they put it in a sling and gave him some pain medication. He had all ready managed to get his shoulder back in place before he arrived. He followed up with an orthopedic surgeon but was basically told they could do nothing for him. So, due to the underlying injuries that occurred to his shoulder ligaments and muscles, every once in a while he'll move his arm too far up and back and out it pops. Luckily for him, he is able to lay flat on the floor get it back in to place. Sounds horrible I know but it's better than making a trip to the emergency room. His shoulder is sore for a few days afterwards but otherwise he suffers no ill effects.... for now anyway... no telling how bad of shape his shoulder will be in as he gets older and continues his very physically demanding job. My husband is kind of accident prone if I've never talked about his adventures before!

Ovarian Cysts

I decided for this week's pathology blog to write about a case which I actually saw while I was working. A patient came to the ER complaining of severe abdominal pain. A pelvic ultrasound was performed and it was determined that she had a 12 cm ovarian cyst. A CT was the performed to take a closer look. The image on the left is a sagittal reformatted image of this patient's exam. The report read that this was too large to be a simple cyst and was most likely a neoplasm. The patient had a complete hysterectomy the next day and that's all I know about this particular case.

Ovarian cysts are most often tiny fluid collections that form in or on the outside of the ovaries in many women. From what I have learned from the Radiologists at the hospital where I work, they are actually quite common. Most are small and don't cause any symptoms or harm to the women who have them. For those that do experience symptoms they usually include abdominal pain, abnormal vaginal bleeding, pain during intercourse, or weight gain. The most common type of ovarian cyst is a functional cyst which often forms while a woman is having her period.

Ovarian cysts most often go unnoticed until they rupture causing severe abdominal/pelvic pain, fever, nausea, and vomiting. Usually a pain medication is prescribed to help with this until symptoms go away.

The most common diagnostic tool for diagnosing ovarian cysts is a pelvic ultrasound. But like the patient I mentioned earlier, CT or MRI can be useful in diagnosing more large and complex cysts.

Most ovarian cysts go away on their own and no treatment is needed. For others, surgery is necessary to remove the cysts. There is no way to prevent an ovarian cyst and some women are unfortunately just more likely to get them than others.

The image used in this blog is from OMHS and my information was found on womenshealth.gov

Splenic Laceration

For this week's blog I decided to write about splenic lacerations because they fascinate me. It's so crazy to me that a laceration means removal of an organ! How is it possible that we have an organ that we can totally live without?

Injuries to the spleen are the most common abdominal injury after many forms of trauma including motor vehicle accidents, serious falls and sports injuries.

A lacerated spleen can present with many symptoms depending on the severity of the injury. The most common symptoms include right upper quadrant (RUQ) pain and rebound abdominal tenderness. A paler than normal complexion and low blood pressure can also be signs of a laceration to the spleen.

The most commonly used diagnostic exam for the diagnosis of a lacerated spleen is a CT of the abdomen with IV contrast. The use of IV contrast is very important to determine the severity of the injury.

I was surprised to find that there are actually multiple treatment options for a patient with a splenic laceration. I had always thought that removal of the spleen was the only option. But this is not the case. In fact, a splenectomy is often the last step in the treatment of this injury. One type of treatment is splenic angioembolization under fluoro, but not all hospitals have the facilities and staff necessary to perform this type of procedure. If this type of treatment is chosen, a surgeon and OR staff must be on standby if the injury is determined to be too severe for embolization. When surgery is deemed necessary, and exploratory laparotomy is performed to determine severity and helps the doctor decide whether the spleen can be repaired of if it needs to be removed. Follow up CT scans are necessary to determine if repair was successful and make sure there is no re-bleeding.

The most common problem associated with splenic lacerations is the increased chance of infection for the patient after treatment. Patients are encouraged to receive the pneumococcus vaccine after surgery and to take preventitive antiobiotics before any type of invasive surgery. These treatments of course are if a patient's spleen can be saved. If the spleen is removed, a patient must remain on medications such as steroids to promote platelet production and be continuously monitored for infection and blood loss. If these things are not monitored closely, a patient can suffer serious consequences, even death.

I found my image for this blog on ajronline.org and my information on emedicine.medscape.com

Pulmonary Embolism

Since one of my favorite exams to do is a chest angio, I thought that for this blog I would talk about pulmonary emboli.

A pulmonary embolism occurs when a blood clot from somewhere in the body travels into the pulmonary arteries and causes a blockage. A person can have one or many PE's at the same time and most of the clots originate in the legs and travel upwards into the lungs.

Some symptoms of a pulmonary embolus include chest pain, shortness of breath, irregularly fast heartbeat, wheezing, and swelling of the legs among others. Some of the risk factors for the development of a pulmonary emobolus include recent surgery, lack of activity such as a person flying in an airplane or a person who is on bed rest, and history of a heart attack or stroke. Women who are pregnant or who have just given birth are also more susceptible to the development of a PE. Another possible sign of a pulmonary embolism is an elevated D-Dimer blood test.

The most widely used radiologic test for the diagnosis of a pulmonary embolism is at CTA of the chest or chest angio. A nuclear medicine lung scan can also be used if the patient is allergic to contrast or has lab work that makes a chest angio contraindicated.

While most pulmonary embolisms are not fatal they can lead to serious complications such as pulmonary hypertension and damage to the muscles of the heart when left untreated.

The most common treatment for a PE is a combination of the drugs heparin and warfarin. Even after the clot has gone away most patients will continue anticoagulant therapy for the rest of their lives in order to prevent development of another clot. Other treatments include clot dissolving medications or placement of an IVC filter which prevents clots from travelling from the legs to the lungs.

I found my information at mayoclinic.org and my picture from ajronline.org

Herniated Nucleus Pulposus of the Lumbar Spine

For the final pathology blog of the semester I decided to find out some more information on a herniated nucleus pulposus. This disorder, where the soft spongy center of our intervertebral discs pushes out into our spinal canal, is often very painful. This disorder also goes by many other names such as lumbar radiculopathy, herniated intervertebral disc, slipped disc or ruptured disc. While a herniated nucleus pulposus can occur anywhere in the spine, it is more likely to occur in our lumbar spine region, 15 times more likely!



There can be many causes of a herniated nucleus pulposus. Any type of trauma to the body such as a car wreck or fall or even from putting too much strain on our lumbar spine area such as incorrectly lifting something too heavy or twisting our spine the wrong way.



A herniated nucleus pulposus can lead to compression of our spinal nerves often causing lower back, leg, and pelvic pain, or even numbness in the legs just to name a few. The demographic most likely to suffer from a herniated nucleus pulposus are middle aged men who engage in a lot of heavy physical activity.



Initially, treatment for a herniated nucleus pulposus includes rest and pain medication followed by physical therapy. If this does not relieve the patient's symptoms, sugery to remove to bulging disc would be required.



I found my information for this blog on http://www.umm.edu/ and my picture

Thoracic Compresson Fracture

A compression fracture of the thoracic spine most often happens when there is too much pressure placed on the body of a vertebrae. The most common causes of a thoracic compression fracture are osteoporosis, car accidents, falls, or some type of metastases.

When a thoracic vertebrae is compressed, it most often takes on the shape of a wedge which you can see in the image to the left. Sometimes this wedging can be severe enough that the fractured vertebral body has nowhere to go and ends up pushing out into the spinal canal and compressing the spinal cord.

Thoracic compression fractures are usually pretty apparent right away. They often cause pain not only in the back itself but also in the legs and arms. In some cases when the spinal nerves surrounding the vertebrae are involved in the injury weakness and numbness of the legs and arms can also occur.

The most common treatments for thoracic compression fractures are pain medicines, a lowering of a patient's activity level, or wearing a brace. Surgery is very unlikely for compression fractures unless the case is extremely severe.

CT is usually the modality of choice for the imaging of these types of fractures but MRI can be used in order to determine if surrounding nerves or ligaments are involved.

I found my information for this blog at www.umm.edu/spinecenter and my image at www.learningradiology.com

Hangman's Fracture

A hangman's fracture is unique in that it can only occur in one place in our bodies, the axis or C-2 vertebrae. A hangman's fracture occurs when the arch of C-2, most commonly involving both pedicles or pars interarticularis. This is most commonly the result after execution by hanging or anytime the neck is severely hyperextended such as in a car accident. Oddly enough, when a person uses hanging as a means of suicide, the victim most often dies from lack of oxygen, not a hangman's fracture because there is not enough force exerted on the neck. Sublaxation of C-2 on C-3 commonly occurs along with a Hangman's Fracture.

The most frequent sign of a Hangman's fracture is some type of motor function most often due to a compressed cervical nerve or more seriously, compression of the spinal cord. Unfortunately, if the spinal cord is cut, the patient will most likely not survive.

The most common treatment for a hangman's fracture is some type of immobilization. Whether with a stiff C-Collar in the case of stable fractures or with a halo in the case of unstable fractures.

Surgical repair is also sometimes necessary to relieve pressure from the spinal cord and ensure proper alignment. Whether the patient has a stable or unstable fracture, many weeks of bed rest are in their future. The patient recovering from a Hangman's Fracture should consider themselves very lucky to be alive.

I found my picture at imaging.consult.com and my information about Hangman's Fractures on wikipedia.org and in the book Radiographic Pathology for Technologists by Mace and Kowalczyk.

Goiter

For pathology of the neck I decided to research goiters. I have never actually seen one while working in CT but thought it might be interesting to find out more about them. While doing my research, I had a hard time finding any radiologic images but did actually find a LOT of regular pictures of people with goiters. I never realized how big they could get!!

The CT image above shows a large goiter that is actually compressing this patient's trachea and making breathing very difficult.

The two most common causes of a goiter are a lack of iodine in the diet or more frequently for people here in the United States, an overproduction of thyroid stimulating hormone or TSH.

Goiters can cause several types of complications including compression or the esophagus and trachea which could mean difficulty swallowing or breathing. Other problems can include a cough that won't go away or changes in the pitch of a person's voice.

Treatments for goiter can be as simple as medication to control TSH production or even surgery to remove the goiter. The problem with using medication as a treatment is that it usually will not shrink the goiter, but instead prevent it from growing any larger. In this case, surgery would be the treatment option of choice.

I found the information for this blog on endocrineweb.com.

AVM

For this week's pathology blog I decided to talk about arteriovenous malformations or AVM. In the image seen, this patient's AVM, which was not previously known about, ruptured, causing an acute bleed and was subsequently treated with surgery. During this surgery, the patient's AVM was discovered and also surgcially treated.

An AVM is a defect where the arteries and veins of the brain are not connected properly. The arteries and veins pretty much become a big jumble of vessels and of course can't function properly. This causes increased blood flow and subsequently higher blood pressure in the area of the AVM. Unlike an aneurysm, there are no set "risk factors" for an AVM. They are considered to be congenital as most people who suffer from an AVM are born with them.

The most common symptom of an AVM is an acute brain bleed. Other symptoms may include seizures, loss of motor functions, loss of senses, mass effect seen on a CT scan, severe head or facial pain. These types of symptoms are often confused with those of a stroke therefore proper screening is very important!!

Treatment for AVM's vary and depend greatly upon several factors including the age of the patient, the location of the AVM, the size of the AVM, and whether or not the patient is at risk for an acute bleed. Treatments may include surgery, radiation, embolization, or a combination of these.

I found my information at www.brain-aneurysm.com

Facial Bone Fractures

Fractures of the bones of the face are most often the result of some type of trauma including motor vehicle accidents, falls, or altercations. The images to the right show fractures of the right maxilla, zygoma and orbital rim.

Most facial fractures are easily diagnosed but some symptoms may include pain, swelling, bruising, facial deformity, facial tenderness or bleeding from the nose. Fractures of the nasal bones, the zygoma, and the mandible are the most common, but others can occur depending upon the location of the blow to the face. In fact, if a person is hit hard enough in the nose, it can cause fractures of the ethmoid bone!

The most common imaging method for the diagnosis of facial fractures is a non contrast CT exam. Both bone and soft tissue algorithms are used in order to determine the extent of the damage.

There are many different treatment options for those who have facial fractures. Fractures of the nose can sometimes be left to heal on their own, depending upon the severity of the damage and whether or not the fractures interferes with breathing. Surgery for the treatment of orbital rim fractures is often only necessary if the patient experiences persistent double vision or if the patient's eye begins to recede into the eye socket. Fractures of the maxillae, mandible, and zygoma almost always require surgery.

I found the information for this blog at emedicinehealth.com.

Blowout Fracture

This week, I decided to find out some more information on blowout fractures of the orbit. A blowout fracture often results when there is some type of trauma to the medial wall or floor of the orbit. This often causes an increase in intraorbital pressure. Blowout fractures most often occur as a result of a motor vehicle accident or an altercation.

Most of the time when a person experiences a blowout fracture of the medial wall of the orbit, they will have some other type of facial fracture, either of the nose or cheekbone. A "pure" orbital blowout fracture is most often a fracture of only the floor of the orbit.

While the fracture itself is a problem, the most worrisome complications of a blowout fracture occur when the soft tissues of the eye herniate down into the maxillary sinuses or when air becomes trapped in the orbit leading to an increase in intraorbital pressure. This increase in pressure can cause the inferior rectus muscle to become compressed reducing motion of the eye. The person may also suffer from a "black eye", double vision, enophthalmos (a condition where the eyeball is drawn back into the orbital cavity), and nosebleeds along with many other complications.

The modality of choice for imaging an orbital blowout fracture is CT. Both bone and soft tissue windows should be used to see the fracture itself and to see the resulting soft tissue complications. The most common treatment of a blowout fracture is surgical repair.

I found the information for this posting on e-radiography.net, wikipedia.com, emedicine.com, and from our lecture notes.

Prolactinoma

A prolactinoma is a disorder of the endocrine system and is the result of the pituitary gland producing too much of the hormone prolactin. This can cause a decrease in a woman's estrogen levels and a man's testosterone levels which often causes infertility. While prolactinomas are benign tumors, they, like many pathologies of the pituitary gland, they can lead to visual disturbances due to compression of the surrounding tissues.

Overproduction of prolactin can be contributed to many different factors:

-The use of medication to treat hypertension, nausea, and GERD.

-Under active thyroid

-Other tumors of the pituitary

-Breast feeding

An interesting fact about prolactinomas is that women are much more likely to develop them than men and they most often occur in people under 40.

Blood tests and vision tests can help detect prolactinomas but CT and MRI allow us to actually visualize the size, shape, and location of the tumor. MRI is usually the preferred method of diagnosis over a CT scan.

Most prolactinomas can be treated with medication but in some cases, surgery to remove the tumor may be necessary. If left untreated a prolactinoma can lead to vision loss, hypopituitarism, osteoporosis, and complications with pregnancies.

For this blog I obtained all of my information from mayoclinic.com.

Mastoiditis

This week for my pathology blog I decided to write about mastoiditis. Mastoiditis occurs when the epithelial tissues that lines the tiny air cavities of the temporal bones become inflamed.

Mastoiditis is most often caused by an ear infection when a person's eustachian tubes become blocked causing a buildup of bacteria and other fluids to back up into the mastoids.

Some symptoms of mastoiditis can include inflammation, tenderness, and swelling behind the ear in the regions of the mastoids. Fever and headache along with these other symptoms may also be a sign of mastoiditis. Diarrhea, irritability and pulling the the ears in infants may also be early signs of an acute mastoiditis infection. Fluid draining from the ear may also be a sign of serious mastoiditis infection. Cholesteotomas, another pathology we discussed this week can also cause mastoiditis.

In order to diagnose mastoiditis an MRI or CT of the IAC's are the exams of choice. X-rays may also be performed but give physicians far less information on the extent of the infection. MRI and CT which confirm mastoiditis will often show bone destruction or fluid buildup in the mastoids.

Mastoiditis was once the leading cause of mortality in young children. But with the advent of antibiotics, mastoiditis is pretty rare. Nowadays, antibiotics are usually prescribed at the first sign of an ear infection preventing it from spreading to the mastoids. Though if left untreated or not diagnosed soon enough, mastoiditis can lead to destruction of the mastoids and temporal bones. In the case of destruction of the mastoids as shown in the picture above, the infection is free to spread to the brain possibly leading to a brain abscess.

I found my information about mastoiditis on two different websites; wikipedia.com and emedicine.com.

Brain Abscess

A brain abscess usually originates from an infection in some other part of the body travelling through possibly the ear canal or sinuses and causing inflammation and infection to occur in the tissues of the brain. A person could also develop a brain abscess from bacteria entering the brain through a skull fracture due to trauma or after intracranial surgery.

The lesions caused by a brain abscess can cause increased intracranial pressure, infection, and damage to brain tissues. Some symptoms of a brain abscess can include headache, vomiting, confusion, fever, lack of energy, weakness on one side of the body, difficulty speaking, and in worst case scenarios, coma. All of these symptoms depend, of course, on the location of the lesion.

The most common imaging technique used to visualize a brain abscess in CT with contrast. When IV contrast is administered, it is not able to pass through the capsule of the abscess but instead forms a ring around it. This is known as a "ring enhancing lesion" and is the most tell tale sign of a brain abscess.

Treatment for brain abscesses vary according to the location and type of lesion but many include antibiotics, lowering intracranial pressure, and in some cases, surgical drainage. These treatments once again depend on the location and severity of the abscess.

I found all the information contained in this blog on the wikipedia website.

New Semester!

So this semester I am so glad to be learning more about anatomy and pathology! I think it's so awesome to watch a scan in real time and try to figure out what's wrong with the patient!

I can't wait to get started!