Podcast
Questions and Answers
What is the term used to describe tumors that arise from the nerve sheath?
What is the term used to describe tumors that arise from the nerve sheath?
What is the characteristic shape of a peripheral nerve sheath tumor on imaging?
What is the characteristic shape of a peripheral nerve sheath tumor on imaging?
What is the most common symptom of peripheral nerve sheath tumors?
What is the most common symptom of peripheral nerve sheath tumors?
What is the average age of diagnosis for Schwannoma?
What is the average age of diagnosis for Schwannoma?
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What is the treatment for peripheral nerve sheath tumors?
What is the treatment for peripheral nerve sheath tumors?
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What is the 5-year survival rate for patients with Malignant Peripheral Nerve Sheath Tumor (MPNST)?
What is the 5-year survival rate for patients with Malignant Peripheral Nerve Sheath Tumor (MPNST)?
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What type of injury is most common in blunt trauma?
What type of injury is most common in blunt trauma?
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What is the primary method of treatment for rib fractures?
What is the primary method of treatment for rib fractures?
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What is the main association with malignant pleural mesothelioma?
What is the main association with malignant pleural mesothelioma?
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What is the most common location of lung metastases?
What is the most common location of lung metastases?
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What is the most common primary anterior mediastinal neoplasm?
What is the most common primary anterior mediastinal neoplasm?
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What is the typical prognosis for malignant pleural mesothelioma?
What is the typical prognosis for malignant pleural mesothelioma?
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What is the typical shape of a thymoma on imaging?
What is the typical shape of a thymoma on imaging?
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What is a common symptom of tuberculous pleurisy?
What is a common symptom of tuberculous pleurisy?
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What is a characteristic imaging feature of malignant pleural mesothelioma?
What is a characteristic imaging feature of malignant pleural mesothelioma?
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What is the primary symptom of thymoma in most patients?
What is the primary symptom of thymoma in most patients?
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What is the primary method of diagnosis for rib fractures?
What is the primary method of diagnosis for rib fractures?
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What is the treatment for stage I and II thymoma?
What is the treatment for stage I and II thymoma?
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What is the primary role of PET/CT in lymphoma?
What is the primary role of PET/CT in lymphoma?
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What is the key difference between thymoma and lymphoma on imaging?
What is the key difference between thymoma and lymphoma on imaging?
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What is the definition of a Fibroadenoma?
What is the definition of a Fibroadenoma?
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Where can Fibroadenomas be located?
Where can Fibroadenomas be located?
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What is the typical size of an adult Fibroadenoma?
What is the typical size of an adult Fibroadenoma?
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What is a characteristic feature of Fibroadenomas on a mammogram?
What is a characteristic feature of Fibroadenomas on a mammogram?
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What is the characteristic appearance of Fibroadenomas on ultrasound?
What is the characteristic appearance of Fibroadenomas on ultrasound?
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What is the definition of Invasive Ductal Carcinoma?
What is the definition of Invasive Ductal Carcinoma?
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What percentage of breast cancer is IDC?
What percentage of breast cancer is IDC?
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What is the main feature of a breast mass on mammography?
What is the main feature of a breast mass on mammography?
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What is the purpose of US in breast cancer diagnosis?
What is the purpose of US in breast cancer diagnosis?
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What is the significance of BRCA2 mutations in breast cancer?
What is the significance of BRCA2 mutations in breast cancer?
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What is the 5-year disease-free survival rate for Stage I breast cancer?
What is the 5-year disease-free survival rate for Stage I breast cancer?
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What is the treatment option for Stage III breast cancer?
What is the treatment option for Stage III breast cancer?
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Study Notes
Trauma: Rib Fractures
- Radiography is specific but not sensitive for diagnosing rib fractures
- Cortical break and step off are signs of rib fractures on radiography
- Ribs 4-9 are most commonly fractured, and it usually occurs in multiple ribs
- CT is more sensitive and specific for diagnosing rib fractures
Clinical Issues
- Rib fractures are the most common thoracic injury in blunt trauma
- Rib fractures are common after CPR
- Cough-induced rib fractures primarily affect women
- Rib fractures in children denote significant trauma
Treatment
- Symptomatic pain management is the primary treatment for rib fractures
- Intubation and mechanical ventilation are necessary for flail chest
Tuberculous Pleurisy
- Tuberculous pleurisy is a type of pleural disease
- Imaging features include multiple well-defined lung nodules/masses
- Variably sized nodules, from miliary to “cannonball” in size, are seen in the outer 1/3 of the lung
Malignant Pleural Mesothelioma (MPM)
- MPM is the most common primary malignant pleural neoplasm
- Strong association with asbestos exposure
- Symptoms include non-pleuritic chest wall pain and dyspnea
- Prognosis is poor, with a mean survival time of 12 months
Imaging
- Pleural effusion, nodular and/or lobular pleural thickening, and loss of volume of the affected hemithorax are seen on imaging
- Chest wall, mediastinal, and diaphragmatic invasion are also seen
- Mediastinal/thoracic lymphadenopathy and calcified pleural plaques in 25% of cases are other imaging features
Mesothelioma
- Mesothelioma is a type of malignant pleural tumor
- Imaging features include pleural effusion, nodular and/or lobular pleural thickening, and loss of volume of the affected hemithorax
Thymoma
- Thymoma is the most common primary anterior mediastinal neoplasm
- Imaging features include an anterior mediastinal, spherical/ovoid, unilateral soft tissue mass with smooth or lobular borders
- No lymphadenopathy is seen
- Invasive thymoma can cause local invasion, pleural nodules, and compression of adjacent structures
Clinical Issues
- Thymoma is most common in the 5th and 6th decades, with a male-to-female ratio of 1:1
- Symptoms are often asymptomatic, but can include compression/invasion of adjacent structures and paraneoplastic syndromes
Treatment
- Stage I and II thymoma is treated with complete surgical excision
- Stage III and IVa thymoma is treated with neoadjuvant chemotherapy and complete excision
- Stage IVb thymoma is treated with palliative chemotherapy
Lymphoma
- Lymphoma is a type of cancer that affects the lymph nodes
- Imaging features include multiple lymph node groups involved, prevascular, paratracheal, and aortopulmonary
- PET/CT is used for staging, assessment of response to therapy, and detection of active disease in residual soft tissue
Clinical Issues
- Lymphoma can cause asymptomatic lymphadenopathy, chest pain, dyspnea, cough, fever, weight loss, and sweats
- Treatment depends on the stage, with chemotherapy and radiation used for stage I and II, and combination chemotherapy for stage III and IV
Neurogenic Neoplasms of the Nerve Sheath
- Terminology includes peripheral nerve sheath tumors (PNST), schwannoma, and neurofibroma
- Malignant peripheral nerve sheath tumor (MPNST) is a type of PNST
Imaging
- Imaging features include a spherical paravertebral mass, wide neural foramen, and benign pressure erosion of adjacent skeleton
- Neurofibromatosis can cause multifocal, dumbbell tumor extension into the spinal canal, and variable contrast enhancement
Clinical Issues
- PNST is often asymptomatic, with a male-to-female ratio of 1:1
- Schwannoma is most common in the 5th decade, while neurofibroma is most common in the 2nd-4th decades
- Treatment is surgical excision, with a good prognosis and 5-year survival rate of 35%
Fibroadenoma (FA)
- Terminology includes benign fibroepithelial tumor with epithelial and stromal elements
- Location is anywhere in breast parenchyma, with rare occurrence in ectopic glandular tissue
- Size is typically 0.5-5 cm, with juvenile type and giant fibroadenoma reaching up to 15 cm
Imaging
- Imaging features include a circumscribed mass, oval shape, and coarse “popcorn” calcifications on mammogram
- US features include a circumscribed, slightly hypoechoic or isoechoic mass, with homogeneous internal echoes
- MR features include T2 hyperintense, circumscribed, enhancing mass, with non-enhancing internal septations
Invasive Ductal Carcinoma (IDC)
- Terminology includes invasive ductal carcinoma, extension of tumor cells through basement membrane, and loss of myoepithelial cell layer
- Pathology includes 75% of breast cancer being IDC, with stage increasing as tumor size and LN involvement increase
Imaging
- Imaging features include an irregular mass with spiculated or indistinct margins, Ca++ in 31-43%, and ± distortion on mammogram
- US features include an irregular, hypoechoic mass, with posterior shadowing, complex cystic and solid, and posterior enhancement (high grade)
- MR features include an irregular mass, with rapid wash-in, plateau or washout kinetics, and < 10% show persistent kinetics
- PET/CT or gamma imaging features include ↑ FDG/sestamibi uptake
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Description
This quiz covers the diagnosis and treatment of rib fractures, including radiography and CT scans, clinical issues, and pain management. It's a key topic in blunt trauma and emergency care.
