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Explore rare radiology cases like peritoneal cysts, slipped capital femoral epiphysis, and otospongiosis. Learn diagnosis, treatment, and imaging nuances in this in-depth guide.
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SPOTS Dr. Harsha K J 3rd Yr Resident, Dept of Radiodiagnosis, Medical college, Vadodara. 4-10-08
Congenital megacalycosis - a rare, non-progressive developmental anomaly characterized by nonobstructive renal calyceal dilatation. • renal pelvis - generally not dilated, distinguishing this from hydronephrosis on imaging. • Another feature is an increased number of faceted calyces (normal 10-14). It is thought to occur due to abnormal development of the renal medulla, which leads to hypoplastic renal pyramids and blunted, dilated calyces. • Unilateral >> Bilateral • M:F = 6:1. • association with megaureter.
Excretory urography - optimal appearance of the pelvocalyceal system may be retarded in the affected kidney due to the dilutional effect of the increased volume of urine. • Number of calyces, renal length with smooth contour, & a normal or thinned NON-scarred) renal parenchyma • Radionuclide renal imaging demonstrates normal excretion and wash out with diuretic but a delay in demonstration of the collecting system due to the large number of calyces.
no impairment of normal renal function and is typically diagnosed while working patients up for recurrent UTIs. • diagnosis can only be considered when individuals have not had prior obstruction or vesicoureteral reflux. • Due to the dilation of the calyces, urine flow is impeded and patients suffer from frequent urinary tract infections and may develop renal calculi. • Rx - is generally symptomatic for recurrent urinary tract infections or stone formation and no specific treatment for megacalycosis is indicated.
Slipped capital femoral epiphysis • is a posteromedial slip of the femoral head epiphysis relative to the femoral neck at the level of the proximal femoral physis. • Age of onset tends to be during the growth spurt of puberty, or approximately 11-12 years in girls and 13-14 years in boys. • Slippage is thought to occur due to increased shear stress through a weakened proximal femoral physis. • Accordingly, risk factors include obesity, delayed skeletal maturation, family history, hip trauma, endocrinopathy, and decreased femoral anteversion. • SCFE is more common in males.
Otospongiosis • is a primary focal spongifying disease limited to the temporal bones of humans that occurs when the dense, ivorylike endochondral bone is replaced by spongy, highly vascular irregular foci of haversian bone tissue. • Lesions can arise in almost any region of the labyrinthine capsule, but about 90% of the time develops in the fissula ante fenestrum. • This so-called “area of predilection” is a cleft of fibrocartilaginous tissue just anterior to the oval window.
Noncontrast CT is the primary diagnostic tool and findings include a radiolucent focus seen at the anterior margin of the oval window which spreads through the otic capsule and thickening of the stapes footplate. • Treatment includes stapedectomy followed by prosthesis insertion. • As the disease progresses to cochlear otosclerosis, rates of success decline
Peritoneal inclusion cysts • peritoneal pseudocysts and inflammatory cysts of the pelvic peritoneum) are a fairly common entity presenting in premenopausal women with a history of previous abdominal or pelvic surgery, trauma, pelvic inflammatory disease, or endometriosis. • In cases of peritoneal infection or mechanical injury, the mesothelial transport properties are changed and a smaller peritoneal surface area is available for absorption. • With the resulting impairment of absorption, physiologic ovarian fluid becomes trapped and may result in the growth and persistence of pelvic cysts.
Imaging findings vary and are often confused with other adnexal masses of the female pelvis. As fluid accumulates within the adhesions, complex irregular multicystic masses can form. The classical ultrasound description is that of an entrapped ovary in a “spider web pattern” of surrounding adhesions. • These peritoneal adhesions tend to grow slowly and extend to the surface of the ovary but do not penetrate the ovarian parenchyma. Ultrasound or cross sectional imaging will often demonstrate an eccentrically located normal ovary. • Pitfalls include the inability to distinguish this benign entity from other pelvic masses including hydrosalpinx, pyosalpinx and ovarian neoplasms. • In particular, vessel growth within the mesothelial septations can appear nodular and can demonstrate low resistance Doppler flow. • These findings are easily confused with a similar appearance seen in malignant ovarian disease.
Jones fracture • is due to an inversion type injury, and is defined as a linear fracture of the base of the 5th metatarsal bone at the metaphyseal-diaphyseal junction. • It is typically located within 1.5 cm distal to the tuberosity. • These fractures can initially be treated with conservative management (short cast, non-weight bearing) but often result in nonunion, requiring bone grafting or intramedullary screw fixation.
