Radiology jargon "What the heck do they mean by that?" an interview with Michael K. McLennan, MD

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How should we deal with unfamiliar terminology?
As with any medical specialty, there are certain terms and disease entities that seem almost specific to that realm of medicine, constituting a kind of insider knowledge that appears somewhat obscure to those outside that sphere. This is a problem commonly encountered in medical imaging, i.e. diagnostic radiology, a specialty that now plays an integral part in the screening and diagnosis of a great number of diseases and conditions. Radiologists perform studies such as plain film radiography (XR), computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), nuclear medicine (NM) and mammography, but when they interpret the results, there are many incidences where terms -- or perhaps even medical conditions -- discussed in their report are unfamiliar to the referring physician. This scenario can result in confusion and frustration, with a potential adverse effect on patient diagnosis and treatment.

I urge any physician who's unsure about the terms discussed in a radiologist's report to contact the specialist and ask for a clarification. The best course of action would be a phone call, but you can also fax the report back, with the query outlined.

How serious is a liver hemangioma found on abdominal US?
Cavernous hemangiomas of the liver are the most common benign liver tumours, making up 75-80% of the total. Until recently, they were considered the second most common liver tumour after malignant metastases, but advances in imaging -- resulting in more incidental benign abnormalities being discovered in patients of all ages -- suggest that they may in fact be the most common lesions found in the liver, after benign simple cysts. They're typically round or oval, and 90% of hemangiomas are less than 4 cm in size, but they can be huge (20+ cm). Discover--ing multiples of these lesions isn't uncommon.

Hemangiomas have no malignant potential but can cause pain and may present with hemorrhage when very large, or in a subcapsular location. The differential includes malignant tumours, but hemangiomas have a characteristic enhancement pattern on MRI and contrast CT (see Figure 1) that help to distinguish them from more serious masses. When that pattern is present, the likelihood of the finding being cancer rather than a hemangioma is low. CT or US follow-up may be indicated in first-diagnosis cases or when there's greater concern for cancer.

When the abdominal US reveals renal parapelvic cysts and/or prominent columns of Bertin in the kidney, is other imaging necessary?
Renal parapelvic cysts are round or oval benign discrete fluid collections located in the central sinus region of the kidneys, between the renal vessels and the collecting system -- with no communication to either. They're quite common and of no clinical significance, except that when multiple, they're often confused with hydronephrosis. Depending on the clinical scenario, a contrast CT may be required to confirm the lack of pelvicalyceal dilatation.

Michael K. McLennan, MD, FRCPC is a diagnostic radiologist at Markham Stouffville Hospital in Markham, Ontario, and at Uxbridge Cottage Hospital. He did his medical training and radiology residency at the University of Toronto, and has published over 600 medical imaging articles.