scholarly journals Adrenal Incidentaloma: A Cautionary Tale of Three Cases of Adrenocortical Carcinoma Arising from Apparently Benign Incidentalomas

2011 ◽  
Vol 3 (3) ◽  
pp. 137-143
Author(s):  
Chris Armstrong ◽  
Janice L Pasieka ◽  
Adrian Harvey
Keyword(s):  
Adrenocortical Carcinoma ◽  
Surgical Intervention ◽  
Adrenal Incidentaloma ◽  
Adrenal Incidentalomas ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Biochemical Testing ◽  
Average Size

ABSTRACT Unexpected incidental findings on cross-sectional imaging are becoming more commonplace in today's medical practice. These are likely due to ongoing improvements in the resolution of cross-sectional imaging and our increasing use of these tests combined with an aging population. In the case of the adrenal incidentalomas the majority of these represent benign nonfunctional adenomas and these are believed to have no malignant potential. On the contrary adrenocortical carcinoma (ACC) is an uncommon malignancy that carries a high mortality. Current biochemical and radiological follow-up investigations are expensive and are of limited benefit in the majority of cases of adrenal incidentalomas. This has created a dilemma for the proper diagnostic, clinical and radiologic follow-up as well as the triggers for surgical intervention. We present a series of three patients presenting with ACC that retrospectively arose from a small incidentally found adrenal lesion. Three patients were identified with ACC arising from an apparently benign adrenal incidentaloma. The average size of the original lesion was 1.6 cm whereas the average size of their adrenal tumor was 9.3 cm when they presented with ACC. Two of the three cases were found to develop functional tumors at the time of the diagnosis of ACC. Two of the three cases underwent surgical resection. The third patient was found to have metastatic disease at presentation and declined surgical intervention. We agree that current follow-up guidelines result in an increasing burden on our healthcare system; with expensive biochemical testing and imaging for what in most cases will prove to be a benign adenoma, these three cases have influenced our current strategies for follow-up. At the present time, we continue to follow the AAES/AACE guidelines. The development of improved methods of biochemical, radiologic and tissue diagnosis may help to improve our ability to recognize an ACC in this population at an earlier and potentially curable stage.

State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 6-26 ◽  
Author(s):  
Fabian Rengier ◽  
Philipp Geisbüsch ◽  
Paul Schoenhagen ◽  
Matthias Müller-Eschner ◽  
Rolf Vosshenrich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Repair ◽  
Imaging Modality ◽  
Open Surgical Repair ◽  
Cross Sectional ◽  
Transcatheter Aortic Valve ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

Cross-Sectional Imaging of Small Bowel Malignancies

2012 ◽  
Vol 63 (3) ◽  
pp. 215-221 ◽  
Author(s):  
Dellano D. Fernandes ◽  
Ram Prakash Galwa ◽  
Najla Fasih ◽  
Margaret Fraser-Hill
Keyword(s):  
Small Bowel ◽  
Accurate Diagnosis ◽  
Imaging Features ◽  
Cross Sectional ◽  
Conventional Endoscopy ◽  
Cross Sectional Imaging ◽  
Pretreatment Staging ◽  
Sectional Imaging ◽  
Histologic Subtypes

Small bowel malignancies are rare neoplasms, usually inaccessible to conventional endoscopy but detectable in many cases by cross-sectional imaging. Modern multidetector computed tomographies permit accurate diagnosis, complete pretreatment staging, and follow-up of these lesions. In this review, we describe the cross-sectional imaging features of the most frequent histologic subtypes of the small bowel malignancies.

scholarly journals Adrenal lesions encountered in current medical practice − a review of their radiological imaging

2013 ◽  
Vol 17 (4) ◽  
pp. 128-138
Author(s):  
Vanesha Naidu ◽  
Bhugwan Singh
Keyword(s):  
Adult Population ◽  
Adrenal Incidentaloma ◽  
Current Medical ◽  
Radiological Imaging ◽  
Cross Sectional ◽  
Current Medical Practice ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Radiological Studies ◽  
Adrenal Disease

Modern radiological technology has transformed the way that adrenal lesions are currently investigated. The contemporary radiologist has been catapulted to the forefront in the management of adrenal disease. With the increasing use of cross-sectional imaging, adrenal lesions are being serendipitously discovered in radiological studies undertaken for non-adrenal-related conditions – the so-called adrenal ‘incidentaloma’. This review discusses the imaging modalities available for characterising these lesions, highlighting current concepts and controversies in differentiating benign from malignant pathology. The article also provides a brief overview of the spectrum of adrenal pathology commonly encountered in the adult population.

scholarly journals Erratum to: Branch duct IPMTs: value of cross-sectional imaging in the assessment of biological behavior and follow-up

2011 ◽  
Vol 38 (6) ◽  
pp. 1466-1466
Author(s):  
G. Carbognin ◽  
G. Zamboni ◽  
L. Pinali ◽  
E. Dalla Chiara ◽  
V. Girardi ◽  
...  
Keyword(s):  
Biological Behavior ◽  
Branch Duct ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Branch duct IPMTs: value of cross-sectional imaging in the assessment of biological behavior and follow-up

2005 ◽  
Vol 31 (3) ◽  
pp. 320-325 ◽  
Author(s):  
G. Carbognin ◽  
G. Zamboni ◽  
L. Pinali ◽  
E. Dalla Chiara ◽  
V. Girardi ◽  
...  
Keyword(s):  
Biological Behavior ◽  
Branch Duct ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Kienböck’s disease: Role of cross-sectional imaging in treatment choice and patient follow-up

2018 ◽  
Vol 105 ◽  
pp. 269-282 ◽  
Author(s):  
Muhammed Yesiloz ◽  
Matthias Louis ◽  
Jacques DeVerbizier ◽  
Gilles Dautel ◽  
François Dap ◽  
...  
Keyword(s):  
Treatment Choice ◽  
Cross Sectional ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Kienbock’S Disease

scholarly journals 851 Giant Oncocytoma In A Solitary Kidney: A Case Report on Balancing Surgical Resection Against Surveillance

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Srivastava ◽  
J B Neves ◽  
M G B Tran
Keyword(s):  
Surgical Intervention ◽  
Left Kidney ◽  
Stage Iv ◽  
Solitary Kidney ◽  
Histopathological Analysis ◽  
Renal Lesion ◽  
Cross Sectional ◽  
Renal Lesions ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Abstract Renal oncocytomas are benign kidney neoplasms that are typically small, unilaterally localised (95%) and challenging to differentiate on cross-sectional imaging, hence requiring surgical intervention. We herein present the extremely rare case of a patient with giant, bilateral oncocytomas and oncocytosis, and chronic kidney disease (CKD) and discuss the associated treatment challenges. A 61-year-old male with no past medical history presented with CKD (eGFR of 32ml/min). On investigation, cross sectional imaging revealed bilateral, multifocal, solid and vascular renal lesions. The largest lesion measuring 115mm x 102mm was situated in the right kidney, with multiple lesions noted in the left kidney, measuring up to 44mm. He subsequently underwent a right radical nephrectomy and histopathological analysis reported oncocytosis of the background kidney. The largest left sided renal lesion was biopsied, also confirmatory of benign oncocytoma. eGFR after surgery was 26ml/min. Following patient-centric consultations, further surgical intervention for the left sided renal lesions was declined, aiming to avoid renal replacement therapy (RRT). He has remained on active surveillance with biannual scans for 6 years. The lesions in his remaining kidney have since grown and coalesced into a single large lesion, with axial dimensions in the most recent MRI scan of 104mm x 306mm. He has progressed to stage IV CKD (eGFR 16ml/min), but still currently without need of RRT. This case study underscores both the significance of shared decision making in urology and surgery. Ultimately, the most significant skill lies in knowing when to not operate, especially when presented with the rarest of cases.

scholarly journals A primary inferior lumbar hernia misdiagnosed as a lipoma

2019 ◽  
Vol 101 (4) ◽  
pp. e96-e98 ◽  
Author(s):  
B Kadler ◽  
A Shetye ◽  
DK Patten ◽  
A Al-Nowfal
Keyword(s):  
Laparoscopic Surgery ◽  
Gold Standard ◽  
Mesh Repair ◽  
Surgical Intervention ◽  
Lumbar Hernia ◽  
Cross Sectional ◽  
Open Mesh Repair ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Open Mesh

Lumbar hernias can be superior (Grynfelt) and inferior (Petit). Inferior lumbar hernias are extremely rare and, therefore, are associated with diagnostic difficulty. We present a case of a primary spontaneous inferior lumbar hernia in a 79-year-old woman that was initially diagnosed as a large lipoma on ultrasound. The first operation was abandoned and an open mesh repair was conducted.Lumbar hernias can be primary acquired (55%), secondary acquired (25%) or congenital (20%). Cross-sectional imaging by CT or MRI appears to be the gold standard in diagnosis as ultrasound may lead to misdiagnosis. Strangulation, incarceration and obstruction are recognised complications, requiring prompt surgical intervention. There are currently no guidelines for surgical managements, although laparoscopic surgery may give the best results. In view of the scarcity of published cases, we aim to add to the literature to raise the index of suspicion and to promote prompt surgical management of lumbar hernias.

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