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Questions and Answers
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 most common symptom of peripheral nerve sheath tumors?
What is the average age of diagnosis for Schwannoma?
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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)?
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What type of injury is most common in blunt trauma?
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What is the primary method of treatment for rib fractures?
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What is the main association with malignant pleural mesothelioma?
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What is the most common location of lung metastases?
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What is the most common primary anterior mediastinal neoplasm?
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What is the typical prognosis for malignant pleural mesothelioma?
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What is the typical shape of a thymoma on imaging?
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What is a common symptom of tuberculous pleurisy?
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What is a characteristic imaging feature of malignant pleural mesothelioma?
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What is the primary symptom of thymoma in most patients?
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What is the primary method of diagnosis for rib fractures?
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What is the treatment for stage I and II thymoma?
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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?
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What is the definition of a Fibroadenoma?
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Where can Fibroadenomas be located?
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What is the typical size of an adult Fibroadenoma?
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What is a characteristic feature of Fibroadenomas on a mammogram?
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What is the characteristic appearance of Fibroadenomas on ultrasound?
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What is the definition of Invasive Ductal Carcinoma?
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What percentage of breast cancer is IDC?
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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?
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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?
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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.
