Image exposure | Imaging | 08-2010
Some common imaging tests and associated approximate radiation patient dose natural annual background radiation 3-5 mSv CT abdo-pel axial old CT, non-spiral 22 mSv CT abdo-pel 64-slice spiral 8-11 mSv ...
Small meningiomas unlikely to cause symptoms | Neurology | 08-2010
It s hard to be dogmatic about this without knowing more about the patient s individual circumstances. A meningioma that small is unlikely to cause symptoms but I suppose that ...
A PET is not a toy | Imaging | 08-2010
Nuclear medicine positron emission tomography PET scanning is a relatively new imaging modality, using radioactively labelled fluorine 18F-FDG , that can provide information about the location and metabolic activity of ...
If you see it, it’s too far gone | Imaging | 06-2010
Avascular necrosis AVN , also known as osteonecrosis, aseptic necrosis and ischemic necrosis, results from temporary or permanent loss of blood supply to a section of bone that, if undetected ...
White matter, red flag | Imaging | 04-2010
Multiple white matter hyperdense lesions WMLs describes a vague general pattern that can be associated with a myriad of etiologies, some benign, some more concerning. Of course the significance of ...
Sedating kids for scary MRIs | Imaging | 03-2010
The need for anesthesia for pediatric MRI procedures depends greatly on the age and character of the pediatric patients involved. At our community hospital, we don t have a dedicated ...
Neurofibromas and families | Dermatology | 12-2009
The neurocutaneous syndromes are uncommon but not rare. Neurofibromatosis is one of the more common conditions seen, with an estimated incidence of 1 in 3,000 individuals. Diagnosis is usually made ...
How to choose the best imaging modality | Imaging | 06-2009
A computed tomography scanner uses radiation and high-level computer programming to produce accurate, detailed axial images that can be reformatted to provide similarly detailed coronal, sagittal, oblique or even 3-D ...
Endometrium: how thick is too thick? | Imaging | 04-2009
It s not just a matter of absolute thickness of the uterine endometrial lining but also the presence or absence of symptoms in these peri- and post-menopausal women. There s ...
Nipple discharge: when to order a galactogram | Imaging | 10-2008
Galactography mammary ductogram ductography is a procedure entailing retrograde injection of water-soluble contrast into a breast duct following canalization of a single duct orifice on the nipple surface by the ...
A less invasive alternative to angiograms | Imaging | 07-2008
Both 16-slice and 64-slice CT coronary angiography CTCA have proven useful in the detection of greater than 50 stenosis of coronary arteries, without the inherent increased morbidity and mortality associated ...
Coronary calcium score for arterial disease | Imaging | 06-2008
Calcium scoring is an imaging exam that's non-contrast, uses a low radiation dose and is performed with electron beam CT. As it provides a useful risk estimate of atherosclerotic changes ...
Incidental fatty liver finding: is it serious? | Gastroenterology | 05-2008
An incidental finding of a fatty liver on an ultrasound is important -- rather like other silent conditions like hyperlipidemia and hypertension. It can progress to steatohepatitis and cirrhosis in ...
Follow-up on thyroid cancer patients | Oncology | 05-2008
Thyroid cancer follow-up recommendations are available through the American Thyroid Association. Guidelines vary somewhat from one institute to another and depend on the risk of recurrence based on stage and ...
Heart patients: when to order a stress test | Cardiology | 04-2008
Patients with an uncomplicated, successful PCI who remain symptom-free probably don't need routine stress testing unless they're at a high risk for recurrence. Such factors would include decreased left ventricular ...
When to check out microscopic hematuria | Urology | 04-2008
The condition is common but I don't think there's unanimous consensus. Some urologists will insist on cystoscopy and, if negative, upper tract imaging, like doing an ultrasound on every single ...
How to prevent headaches after exercise | Neurology | 04-2008
Primary exertional headache usually occurs during strenuous exercise that involves a Valsalva manoeuvre. Most of the patients I see with this type of headache are young men who've recently started ...
Undescended adult testicles: remove them? | Urology | 03-2008
At 61, the risk of cancer in an abdominal testis is quite remote. And, like an impacted wisdom tooth after age 40, or appendix after 50, surgery is probably not ...
For shoulder pain, when is ultrasound best? | Imaging | 02-2008
Shoulder disorders are common, with as many as 20 of people experiencing shoulder problems at some stage in life. These account for 5 of all consultations with family physicians. In ...
Breast implants: annual mammo's? | Imaging | 02-2008
Absolutely The presence of breast implants isn't a contraindication for annual screening mammography. An implant displacement technique was developed by Dr. G.W. Eklund in 1988 that significantly improves accuracy. In ...
Does TIA need ER workup? | Neurology | 01-2008
The answer to this question depends on how quickly the necessary investigations are available in your area. We know that TIA carries with it a high risk of subsequent stroke ...
When does back pain require surgery? | Imaging | 01-2008
Although I can't speak for a neurosurgeon or an orthopedic surgeon, I can tell you what the radiologist looks for on an imaging study that would be of importance with ...
How can heparin cause blood clots? | Hematology | 01-2008
About half of the patients with heparin-induced thrombocytopenia HIT have symptomatic HIT-associated thrombosis HAT at the time of diagnosis. The frequency of HIT depends on the category of patient, gender ...
Finding the occult mesenchymal tumour | Imaging | 12-2007
Oncogenic osteomalacia is an uncommon paraneoplastic condition associated with mesenchymal tumours. These are known to produce a protein called phosphatonin that accelerates phosphate excretion from the kidneys. The resulting hypophosphatemia ...
Is electrogastrography state-of-the-art? | Gastroenterology | 11-2007
EGG is the gastroenterologist's electrocardiogram ECG . Basically, the myoelectrical activity of the stomach is studied with ECG-type skin electrodes. The recording documents impaired gastric motility in conditions like diabetic ...
Is electrogastrography state-of-the-art? | Gastroenterology, Imaging | 11-2007
Numerous clinical trials and studies have shown that EGG is an accurate measurement of gastric myoelectrical activity, as our gastroenterologist has mentioned above. This test clinically falls within the realm ...
When the cord's wrapped around baby's neck | Imaging | 09-2007
The management of nuchal cord in third-trimester pregnancy and labour has been debated for many years. The concern that entanglement could cause cord compression leading to intrapartum complications dates back ...
Call for investigations after high CA-125 | Oncology | 08-2007
CA-125 is a marker known mostly for its association with ovarian cancer. It's not specific, though, and may be elevated in a number of conditions including endometriosis, pregnancy, pancreatitis, pelvic ...
When is knee MRI in order? | Rheumatology | 07-2007
MRIs are powerful imaging tools that may reveal a multitude of findings that aren't necessarily significant. Care must be taken to interpret the results in the light of the clinical ...
Can CT scans diagnose MI? | Cardiology, Imaging | 06-2007
I recently attended a round on this subject and the overall sensitivity of CT for detecting significant coronary artery disease is only 60 . What is truly remarkable is the ...
Ruling out bone infection post-cellulitis | Imaging | 06-2007
The decision to investigate for potential osteomyelitis, either as a cause or end result of massive cellulitis of the lower extremity, should be based on clinical parameters and perhaps referred ...
Don't forget about transient global amnesia | Neurology | 06-2007
TGA is a fascinating condition. Once seen, it's never forgotten by the examining physician and never remembered by the patient. A previously well person, usually over 50, suddenly develops a ...
Best imaging for esophageal cancer staging | Imaging | 05-2007
Accurate pre-therapy staging is very important for the treatment of esophageal carcinoma. For centres that provide the service, EUS is considered a vital part of the initial protocol for those ...
Investigating headache in kids: pineal cyst finding | Neurology | 05-2007
A pineal cyst is not an uncommon incidental finding on neuroimaging. In one study, 1 of 49 neurologically normal children presenting with headache had a pineal cyst on MRI. In ...
Best imaging for esophageal cancer staging | Oncology | 05-2007
Transesophageal ultrasound, or EUS, is a valid staging tool for esophageal cancer but it's not yet routinely used. It's able to detect the preoperative depth of tumour penetration, the presence ...
Is thermography a good screen for breast Ca? | Imaging | 04-2007
Breast cancer BC is now the leading form of cancer in North American women. Its incidence has increased from 1 in 20 in 1960 to 1 in 7 today. International ...
Free peritoneal fluid on pelvic ultrasound | Imaging | 01-2007
Ultrasound is an extremely sensitive modality for detecting free fluid FF in the abdomen and pelvis. It has the added advantage over CT of not using ionizing radiation. What it ...
Diagnosing arcuate ligament syndrome | Imaging | 11-2006
The median arcuate ligament is a fibrous arch that joins the diaphragmatic crura on either side of the aortic hiatus at the thoracoabdominal junction. It usually passes superior to the ...
The lowdown on Tarlov cysts | Imaging | 10-2006
Pelvic perineural cysts, better known as Tarlov cysts due to his published description in 1932, are a common incidental finding on CT studies and magnetic resonance imaging MRI of the ...
When MIBI scan conflicts with angiogram | Imaging | 10-2006
In discussions with our cardiologists, this is a common problem, and one that's generally dealt with by reassuring the patient that there's no cause for concern. The conventional catheter angiogram ...
Clinical vagaries of horseshoe kidney | Nephrology | 10-2006
Horseshoe kidney is the most common type of renal fusion abnormality. It occurs with a frequency of one in 400-800 live births. A horseshoe kidney is more prone to hydronephrosis, ...
Fetal renal lobulation | Nephrology | 10-2006
Embryologically, the kidney develops in several lobules. Incomplete fusion of these lobules can persist postnatally and may be observed in 7 of adults. This fetal lobulation is recognized incidentally on ...
Best investigations into leg cramping | Rheumatology | 10-2006
The complaint of leg cramping at rest or in the evening brings to mind a very broad differential, although most significant conditions can be identified or ruled out by a ...
Screening hep B carriers for cancer | Oncology | 09-2006
Patients who have hepatitis B are known to have a 100-fold increase in the incidence of hepatocellular cancers, so the best prevention is avoiding contracting the disease in the first ...
Little liver pain | Gastroenterology | 05-2006
Hepatic pain is unusual in a normal sized liver amp amp 151 presuming there are no lesions such as metastatic liver disease, hepatoma and other malignancies. Chronic benign liver disease ...
Appendicitis: imaging vs clinical examination | Imaging | 05-2006
This is an interesting query to be sure, although one that may be quite difficult to answer when looking at patients presenting to modern emergency departments ED in larger centres. ...
Role for 123I-MIBG imaging in diabetes | Cardiology | 04-2006
Microvascular complications of diabetes can lead to a number of findings, including autonomic dysfunction. In the heart, this manifests as inappropriate bradycardia and blood pressure in many circumstances, i.e. postural ...
Role for 123I-MIBG imaging in diabetes | Imaging | 04-2006
Diabetic cardiac autonomic neuropathy is a recognized complication of poorly controlled diabetes, developing slowly over the years and resulting in the loss of a patient's awareness of impending hypoglycemia, or ...
Where's the obstruction -- large or small bowel? | Gastroenterology | 03-2006
Clinically, bowel obstruction includes abdominal pain, distension, obstipation, vomiting, etc. But it's not always easy to tell whether the cause is in the small or large intestine. Most of these ...
Renal safety for imaging | Imaging | 03-2006
Imaging contrast-induced nephropathy is an uncommon but well-recognized risk of intravenous IV contrast administration. It can lead to increased morbidity and mortality and extended hospital stays with associated increased health ...
Weak-kneed and stiff-backed | Rheumatology | 03-2006
If the compression is focal amp amp 151 i.e. a single or at most two spinal segments amp amp 151 then surgical decompression may be feasible. Leg weakness may be ...
Working up asymptomatic microhematuria | Hematology | 02-2006
The simple answer is, yes. Before being labelled with unexplained asymptomatic hematuria, these patients should have further evaluation, especially if the finding is persistent. The extent of investigation will depend ...
Does obstetric ultrasound cause harm? | Oncology | 02-2006
Ultrasound US remains the imaging modality of choice for the assessment of the developing fetus and the mother during pregnancy. Recent articles have revealed certain advantages of fetal magnetic resonance ...
Joint replacements: recognizing failure | Rheumatology | 02-2006
Unfortunately, joint replacements, just like the people who receive them, age and sometimes fail. It's often the case of who or what fails first. In general, plain radiography is reasonably ...
What is a choroid plexus cyst? | Imaging | 01-2006
Choroid plexus cysts CPCs are fluid-filled structures of varying sizes surrounded by normal tissue in the choroid plexus of the lateral cerebral ventricles. These cysts are noted in 1-3 of ...
The low-down on piriformis muscle injury | Rheumatology | 01-2006
The piriformis syndrome may be the result of either overuse or direct muscle injury. This muscle group acts as an external rotator of the hip, but its location at the ...
Repetitive injury syndrome: can imaging help? | Imaging | 12-2005
Repetitive injury syndrome is often used as a catch-all phrase that can encompass a wide variety of medical conditions. In athletes, these may include overuse injuries that result in stress ...
Incidental granuloma finding | Imaging | 11-2005
Although you don't state in which organ the granuloma was discovered, I assume it was either the liver or the spleen. These are by far the most common areas in ...
Are gallbladder polyps significant? | Gastroenterology | 10-2005
Most gallbladder polyps aren't true polyps. They're almost always discovered on ultrasound examination. Typically, they're adenomatous hyperplasia, cholesterol polyps and inflammatory polyps. True polyps are adenomas and can be single ...
Sound advice for detecting atherosclerosis | Cardiology | 09-2005
Most acute ischemic events are unpredictable and sudden. Better tools are needed to detect, follow and manage the progression of atherosclerosis. More direct methods are being investigated and most physicians ...
Best call for breast cysts | Imaging | 09-2005
Breast cysts are very common and can occur in women of all ages, with the highest incidence in individuals aged 35-45. In most people, the cysts are asymptomatic and discovered ...
The latest on screening for aneurysm | Imaging | 08-2005
An aneurysm is said to occur with focal or diffuse persistent dilatation of the abdominal aorta to a transverse diameter greater than 3 cm. The diagnosis of abdominal aortic aneurysm ...
When to use gadolinium contrast for MRI | Imaging | 07-2005
In computed tomography CT , intravenous iodinated contrast is used to enhance the image with information on the vascularity and characteristics of organs and pathologic lesions. The iodine density blocks ...
Are prostatic calcifications significant? | Imaging | 07-2005
In general, in a patient with acute bacterial prostatitis, the presence of dystrophic calcifications within the prostate gland is incidental, with no clinical significance. amp lt br amp gt amp ...
What is arachnoiditis? | Rheumatology | 05-2005
The arachnoid, as a critical structural component of the nervous system, can be the site of infectious, inflammatory and mechanical injury, for instance from viral infections, multiple lumbar punctures, myelographic ...
Hematometry vs hematometra -- the oo's and ah's | Imaging | 03-2005
The term hematometry describes the counting in a blood analysis number, types and proportions of blood cells and of non-cellular components in the serum, and the percentage of hemoglobin present ...
Osteochondral bar on spine report | Imaging | 02-2005
Degenerative processes in the cervical spine can lead to osteophyte formation involving the posterolateral uncovertebral joints and along the posterior margins of the cervical vertebra, at the levels of the ...
Incidence of Schmorl's nodes | Rheumatology | 02-2005
A Schmorl's node represents fibrocartilaginous herniation through a softened vertebral end plate, resulting in a cystic area with reactive sclerosis in the vertebral body. Recent pathologic studies suggest that the ...
Loose bodies in the knee | Imaging | 01-2005
Intra-articular loose bodies LBs are chondral, osseous or osteochondral fragments located within the joint cavity. They originate from the internal surfaces of synovial joints, including both hyaline cartilage covered bone ...
Elevated prolactin in teen | Obstetrics Gynecology | 01-2005
It's not particularly uncommon to find elevated prolactin levels in an otherwise healthy woman. My first course of action is to repeat the blood test, ensuring that no breast stimulation ...
The deal on renal angiomyolipoma | Nephrology | 12-2004
First of all, there should be no amp quot routine ultrasound. amp quot Especially with increasing healthcare costs, you must have a strong indication for performing these imaging studies. amp ...
Update on atypical facial neuralgia | Neurology | 12-2004
Patients presenting with facial pain may be displaying one of several conditions including atypical facial pain, atypical odontalgia, trigeminal neuralgia, trigeminal neuropathy, glossopharyngeal neuralgia, geniculate neuralgia, burning mouth syndrome, temporomandibular ...
Pneumothorax: chest tube vs x-rays | Imaging | 11-2004
The size of the pneumothorax, the presence of tension and the condition of the underlying lung help to determine the pathophysiologic consequences, the degree of symptoms, and ultimately the need ...
What's the gold standard for PE diagnosis? | Imaging | 10-2004
In fact, the gold standard for the diagnosis of PE has long been conventional pulmonary angiography, with nuclear medicine V Q and chest radiography as the most common first-line imaging ...
Is an asymptomatic disc bulge significant? | Imaging | 10-2004
Degeneration of intervertebral discs, particularly in the lower lumbar region, is a process that commences relatively early in life, beginning with dehydration and desiccation of the disc, followed by gradual ...
What's the gold standard for PE diagnosis? | Respirology | 10-2004
The gold standard is and was the pulmonary angiogram, while the V Q scan was a convenient, easy, non-invasive means of diagnosis despite its poor specificity in patients with underlying ...
Palate pain puzzle | Neurology | 09-2004
The approach to cranial pain should begin with a regular oral examination and a general neurologic one. Most somatic sensation from the face and oral cavity is provided by the ...
Can US screen for renal cancer? | Imaging | 08-2004
I believe the answer to your query is in the second portion of your question. Renal cell carcinoma RCC is diagnosed in more than 30,000 North Americans each year, leading ...
How to diagnose diverticulitis | Imaging | 06-2004
CT is the imaging modality of choice for the diagnosis of diverticulitis and its potential complications. The primary diagnostic sign is pericolonic inflammation. Complications include the presence of pericolic abscesses, ...
When is complete body scanning useful? | Imaging | 05-2004
At present, spiral CT body scans performed for cancer screening without oral or intravenous contrast in asymptomatic patients don't amount to much more than a combination of expensive gimmicks and ...
