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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3679_Библиотеки_им_академика_М_И_Перельмана
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( c ) CT image of lower chest/upper abdomen, ascites ( yellow boxes ), left pleural
effusion ( orange box )
The Pertinent Findings
• Chest
– Skeleton: ■ hot □ cold
– Pleura: □ hot ■ cold
• Abdomen
– Peritoneum: □ hot ■ cold
– Liver: □ hot ■ cold
– Biliary system and gallbladder: ■ hot □ cold
– Spleen: ■ hot □ cold
– Stomach: ■ hot □ cold
• Abdomen
– Abdominal wall:
□ normal □ urine contamination
– Peritoneum: □ normal □ ascites
– Liver: □ normal □ cirrhosis
– Biliary system and gallbladder: □ normal □ acute cholecystitis
– Spleen: □ normal □ splenomegaly
– Stomach: □ normal □ gastropathy
27.11.2 Solution
Additional Annotated Images
c
27 Self-Assessment Cases: Basic
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The Relevant Diagnosis(es)
• Chest
– Skeleton: ■ anemia
– Pleura: ■ effusion
• Abdomen
– Peritoneum: ■ ascites
– Liver: ■ cirrhosis
– Biliary system and gallbladder: ■ normal
– Spleen: ■ splenomegaly
– Stomach: ■ gastropathy
Discussion
Chest
Both sets of images (a, b) demonstrate a “cold” left hemithorax. Left pleural fl uid is
confi rmed by CT (c).
Abdomen
Both sets of images (a, b) demonstrate a “cold” protuberant abdomen; ascites is
confi rmed by CT (c). Note the small liver, normal gallbladder, large spleen, and
“hot” stomach (cirrhosis-associated gastropathy). Due to the large volume ascites,
the stomach appears more horizontally oriented (a, b).
Relevant Chapter(s)
Chapters 8, 9, 18, 19, 20, 21, and 22
27.11 Case Challenge #11
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27.12 Case Challenge #12
27.12.1 Problem
Clinical Highlights
A 59-year-old female has chest pain, hypertension, and hyperlipidemia. She exercised on the treadmill for 4 minutes, achieving 7 METS, and had no symptoms nor
ECG changes.
Images for Review
( a ) Rest raw projection images (Video 27.12a, frame 1),
99m
Tc sestamibi
( b ) Stress raw projection images (Video 27.12b, frame 1),
99m
Tc sestamibi
Characterize the Pertinent Finding(s)
• Chest
– Thyroid gland: □ hot □ cold
– Parathyroid glands: □ hot □ cold
– Breasts: □ hot □ cold
– Lungs: □ hot □ cold
– Myocardium and pericardium: □ hot □ cold
– Vascular system: □ hot □ cold
ab
See Video 27.12a See Video 27.12b
Fig. 27.12
27 Self-Assessment Cases: Basic
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• Abdomen
– Liver: □ hot □ cold
– Biliary system and gallbladder: □ hot □ cold
– Spleen: □ hot □ cold
– Stomach: □ hot □ cold
– Small intestine and large intestine: □ hot □ cold
– Vascular system: □ hot □ cold
State Your Relevant Diagnosis(es)
• Chest
– Thyroid gland: □ normal □ multinodular goiter
– Parathyroid glands: □ normal □ cystic adenoma
– Breasts: □ normal □ soft-tissue attenuation
– Lungs: □ normal □ pneumonia
– Myocardium and pericardium: □ normal □ effusion
– Vascular system: □ normal □ retention in central venous catheter
• Abdomen
– Liver: □ normal □ cirrhosis
– Biliary system and gallbladder: □ normal □ chronic cholecystitis
– Spleen: □ normal □ splenomegaly
– Stomach: □ normal □ duodenogastric refl ux
– Small intestine and large intestine: □ normal □ hyperperistalsis
– Vascular system: □ normal □ extravasation at injection site
27.12.2 Solution
Additional Annotated Images
None
The Pertinent Findings
• Chest
– Thyroid gland: ■ hot □ cold
– Breasts: □ hot ■ cold
• Abdomen
– Stomach: ■ hot ■ cold
The Relevant Diagnosis(es)
• Chest
– Thyroid gland: ■ multinodular goiter
– Breasts: ■ soft-tissue attenuation
• Abdomen
– Stomach: ■ duodenogastric refl u x
27.12 Case Challenge #12
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Discussion
Chest
There is a prominent, enlarged thyroid gland at the top of the fi eld-of-view (a, b).
The left lobe appears larger than the right. Medical record review confi rmed known
euthyroid multinodular goiter evaluated by ultrasonography with biopsies of the
larger nodules 4 years ago. The left breast creates the usual attenuation artifact on
the heart. The processed SPECT MPI images (not shown) are normal.
Abdomen
The stomach lumen appears “hot” on the rest images and “cold” on the stress images
after water ingestion to clear duodenogastric activity (a, b). Incidental note is made
of a physiologically normal gallbladder (a, b).
Relevant Chapter(s)
Chapters 4, 6, and 22
27 Self-Assessment Cases: Basic
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© Springer International Publishing Switzerland 2017
M.E. Oates, V.L. Sorrell, Myocardial Perfusion Imaging - Beyond the Left
Ventricle: Pathology, Artifacts and Pitfalls in the Chest and Abdomen,
DOI 10.1007/978-3-319-25436-4_28
2 8
Self-Assessment Cases: Intermediate
Electronic supplementary material The online version of this chapter (doi: 10.1007/978-3-319-
25436-4_28
) contains supplementary material, which is available to authorized users.
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28.1 Case Challenge #13
28.1.1 Problem
Clinical Highlights
A 59-year-old male presents for preoperative risk assessment.
Images for Review
Fig. 28.1
ab
c
See Video 28.1a See Video 28.1b
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( a ) Rest raw projection images (Video 28.1a, frame 1),
99m
Tc sestamibi
( b ) Stress raw projection images (Video 28.1b, frame 1),
99m
Tc sestamibi
( c ) Stress/rest processed SPECT images (SA, HLA, VLA) (without and with AC)
( d ) Stress and rest gated SPECT images (Video 28.1c, frame 1) (SA, VLA, HLA)
Characterize the Pertinent Finding(s)
• Chest
– Parathyroid glands: □ hot □ cold
– Breasts: □ hot □ cold
– Chest wall: □ hot □ cold
– Skeleton: □ hot □ cold
– Pleura: □ hot □ cold
– Lungs: □ hot □ cold
– Mediastinum: □ hot □ cold
– Myocardium and pericardium: □ hot □ cold
– Right atrium and right ventricle: □ hot □ cold
d
See Video 28.1c
Fig. 28.1 (continued)
28.1 Case Challenge #13
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• Abdomen
– Peritoneum: □ hot □ cold
– Liver: □ hot □ cold
– Biliary system and gallbladder: □ hot □ cold
– Spleen: □ hot □ cold
– Stomach: □ hot □ cold
– Small intestine and large intestine: □ hot □ cold
– Adrenal glands: □ hot □ cold
– Kidneys and female reproductive system: □ hot □ cold
State Your Relevant Diagnosis(es)
• Chest
– Parathyroid glands: □ normal □ mediastinal adenoma
– Breasts: □ normal □ malignancy
– Chest wall: □ normal □ arms by sides
– Skeleton: □ normal □ anemia
– Pleura: □ normal □ effusion
– Lungs: □ normal □ emphysema
– Mediastinum: □ normal □ malignancy
– Myocardium and pericardium: □ normal □ effusion
– Right atrium and right ventricle: □ normal □ pulmonary hypertension
• Abdomen
– Peritoneum: □ normal □ ascites
– Liver: □ normal □ cirrhosis
– Biliary system and gallbladder: □ normal □ prolonged fasting
– Spleen: □ normal □ splenomegaly
– Stomach: □ normal □ gastropathy
– Small intestine and large intestine: □ normal □ large intestine across upper
abdomen
– Adrenal glands: □ normal □ malignancy
– Kidneys and female reproductive system: □ normal □ polycystic disease
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28.1.2 Solution
Additional Annotated Images
( e ) Stress/rest processed SPECT images (SA, HLA, VLA) (without and with AC),
right ventricle ( yellow ovals ) on selected SA and HLA images
The Pertinent Findings
• Chest
– Skeleton: ■ hot □ cold
– Right atrium and right ventricle: ■ hot ■ cold
• Abdomen
– Peritoneum: □ hot ■ cold
– Liver: □ hot ■ cold
– Biliary system and gallbladder: ■ hot □ cold
– Spleen: ■ hot □ cold
– Stomach: ■ hot □ cold
e
28.1 Case Challenge #13
https://t.me/med1917
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