Trauma: Rib Fractures
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Questions and Answers

What is the term used to describe tumors that arise from the nerve sheath?

  • Neurofibroma
  • Peripheral nerve sheath tumors (correct)
  • Schwannoma
  • Malignant peripheral nerve sheath tumor
  • What is the characteristic shape of a peripheral nerve sheath tumor on imaging?

  • Irregular
  • Oval
  • Linear
  • Spherical (correct)
  • What is the most common symptom of peripheral nerve sheath tumors?

  • Numbness
  • Pain
  • Asymptomatic (correct)
  • Weakness
  • What is the average age of diagnosis for Schwannoma?

    <p>5th decade</p> Signup and view all the answers

    What is the treatment for peripheral nerve sheath tumors?

    <p>Surgical excision</p> Signup and view all the answers

    What is the 5-year survival rate for patients with Malignant Peripheral Nerve Sheath Tumor (MPNST)?

    <p>35%</p> Signup and view all the answers

    What type of injury is most common in blunt trauma?

    <p>Rib fractures</p> Signup and view all the answers

    What is the primary method of treatment for rib fractures?

    <p>Symptomatic pain management</p> Signup and view all the answers

    What is the main association with malignant pleural mesothelioma?

    <p>Asbestos exposure</p> Signup and view all the answers

    What is the most common location of lung metastases?

    <p>Outer 1/3 of the lung</p> Signup and view all the answers

    What is the most common primary anterior mediastinal neoplasm?

    <p>Thymoma</p> Signup and view all the answers

    What is the typical prognosis for malignant pleural mesothelioma?

    <p>Mean survival time of 12 months</p> Signup and view all the answers

    What is the typical shape of a thymoma on imaging?

    <p>Spherical/ovoid and unilateral</p> Signup and view all the answers

    What is a common symptom of tuberculous pleurisy?

    <p>Nonpleuritic chest wall pain</p> Signup and view all the answers

    What is a characteristic imaging feature of malignant pleural mesothelioma?

    <p>All of the above</p> Signup and view all the answers

    What is the primary symptom of thymoma in most patients?

    <p>Asymptomatic, incidental diagnosis</p> Signup and view all the answers

    What is the primary method of diagnosis for rib fractures?

    <p>Radiography</p> Signup and view all the answers

    What is the treatment for stage I and II thymoma?

    <p>Complete surgical excision</p> Signup and view all the answers

    What is the primary role of PET/CT in lymphoma?

    <p>Staging, assessment of response to therapy, and detection of active disease</p> Signup and view all the answers

    What is the key difference between thymoma and lymphoma on imaging?

    <p>Thymoma is a single mass, while lymphoma involves multiple lymph node groups</p> Signup and view all the answers

    What is the definition of a Fibroadenoma?

    <p>A benign tumor with epithelial and stromal elements</p> Signup and view all the answers

    Where can Fibroadenomas be located?

    <p>Anywhere in the breast parenchyma and rarely in ectopic glandular tissue</p> Signup and view all the answers

    What is the typical size of an adult Fibroadenoma?

    <p>0.5-5 cm</p> Signup and view all the answers

    What is a characteristic feature of Fibroadenomas on a mammogram?

    <p>Circumscribed mass with coarse 'popcorn' calcifications</p> Signup and view all the answers

    What is the characteristic appearance of Fibroadenomas on ultrasound?

    <p>Circumscribed, slightly hypoechoic or isoechoic mass with homogeneous internal echoes</p> Signup and view all the answers

    What is the definition of Invasive Ductal Carcinoma?

    <p>Extension of tumor cells through the basement membrane with loss of myoepithelial cell layer</p> Signup and view all the answers

    What percentage of breast cancer is IDC?

    <p>75%</p> Signup and view all the answers

    What is the main feature of a breast mass on mammography?

    <p>A spiculated or indistinct margin</p> Signup and view all the answers

    What is the purpose of US in breast cancer diagnosis?

    <p>To guide biopsy and assess for adenopathy</p> Signup and view all the answers

    What is the significance of BRCA2 mutations in breast cancer?

    <p>It is a genetic risk factor</p> Signup and view all the answers

    What is the 5-year disease-free survival rate for Stage I breast cancer?

    <p>88%</p> Signup and view all the answers

    What is the treatment option for Stage III breast cancer?

    <p>Primary chemotherapy</p> Signup and view all the answers

    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.

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