Radiology Nexus

***A Case Of Tenosynovial Giant Cell Tumor Of The Tendon Sheath***

Clinical History:~ 45 years old male patient present with long-standing lump over the right thumb.
No pain, tenderness, discoloration, or functional limitation.

Findings:~
• At the pollex, adjacent to the joint space, an oval-shaped solid lesion is noted in the soft tissues.
• The lesion is hypoechoic, well defined, with mildly opacified / slightly lobulated margins.
• Located close to the joint space and tendon sheath.
• Posterior acoustic enhancement is seen, likely related to the adjacent joint or dense tissue interface.
• No definite internal cystic component, calcification, or liquefaction noted.
• Color Doppler shows no significant internal vascularity.
• Underlying bone cortex appears intact, with no erosion.
• Surrounding soft tissues are unremarkable.

Impression:~ A oval-shaped hypoechoic solid mass at the right thumb near the joint space, likely representing an epidermal inclusion cyst; tenosynovial giant cell tumor of the tendon sheath is a close differential.

Other differentials:~
• Fibroma of tendon sheath
• Glomus tumor (less likely given painless, long-standing nature)

Recommendations:~
• Clinical correlation advised.
• MRI of the right thumb may be considered for further tissue characterization and pre-operative planning, if required.
• Orthopedic / Surgeon opinion for definitive management.

Second- to Third-Trimester Obstetric Structural Ultrasound”

CT of the lumbar spine
what is your diagnosis?
Recap...

Zebras in a snowstorm: ultrasound guidance for differentiating placental mesenchymal dysplasia from hydatidiform mole - Serial imaging from the second and third trimesters of pregnancy
A, Enlarging anechoic cysts now measuring 1.5 cm at 23 weeks of gestation. B, Early signs of dilated chorionic plate vessels at 29 weeks of gestation, the largest measuring 2.48 cm. C, Progressive enlargement of dilated chorionic plate vessels at 30 weeks of gestation, the largest now measuring 2.59 cm. D, Even further progressive enlargement of dilated chorionic plate vessels at 31 weeks of gestation, the largest dimension at 4.82 cm.

courtesy of journal of obstetrics & gynecology

DIAGNOSE

All about multiple hemangioma of the liver.

Multiple Hemangiomas of Liver:

Definition: Benign vascular liver tumors; multiple lesions present in both lobes.

Cause: Congenital vascular malformation; etiology often unknown.

Incidence: Seen in up to 20% of adults; multiple hemangiomas are less common.

Ultrasound Imaging:

Well-defined, hyperechoic lesions.

Posterior acoustic enhancement.

No internal vascularity or minimal flow on color Doppler.

Typically < 3 cms but may vary.

Often incidental finding.

At 23 weeks of gestation, a 32-year-old female with gravida 1 parade 0 abortion 0 (G1P0Ab0) was referred for the detection of a suspicious thoracic cyst during a routine second-trimester fetal anatomy scan.
what are your findings?

🔴Only an expert can tell what the problem is ⤵️ 🔹
What do you see?

🔴Chest X-ray Interpretation ⤵️ 🔹


courtesy of

Shoulder x-ray.
what are your findings?

Chest x-ray.
what do you see?

# # # **Pancreas: Normal vs. Pathologies on Ultrasound**

The **pancreas** is a retroperitoneal organ that can be visualized on ultrasound, though its entirety may be obscured by bowel gas. Below is a comparison of **normal pancreatic features** versus **common pathologies** seen on ultrasound.

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# # **Normal Pancreas on Ultrasound**
# # # **1. Location & Anatomy**
- Lies **transversely** in the epigastrium, posterior to the stomach.
- Divided into **head** (near duodenum), **uncinate process**, **body**, and **tail** (extends toward spleen).
- **Main pancreatic duct (Wirsung duct)**:
- Normal diameter: **≤2–3 mm** (may increase with age).

# # # **2. Echotexture & Size**
- **Echogenicity**:
- **Isoechoic** or **hyperechoic** compared to the liver (due to fatty infiltration).
- Becomes more hyperechoic with age (fatty replacement).
- **Size**:
- **Head**: ≤3 cm
- **Body**: ≤2.5 cm
- **Tail**: ≤2 cm
- **Margins**: Smooth and well-defined.

# # # **3. Vascular Landmarks**
- **Head**: Encased by the **C-loop of the duodenum**, adjacent to **IVC** and **right renal vein**.
- **Body**: Anterior to **SMA (superior mesenteric artery)** and **splenic vein**.
- **Tail**: Extends toward the **splenic hilum**.

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# # **Pathologies of the Pancreas on Ultrasound**
# # # **1. Acute Pancreatitis**
- **Causes**: Gallstones, alcohol, hypertriglyceridemia.
- **Ultrasound Findings**:
- **Hypoechoic, swollen pancreas** (due to edema).
- **Peripancreatic fluid** (anechoic collections).
- **Indistinct margins** (loss of fat planes).
- **Gallstones or CBD dilation** (if biliary cause).
- **Complications**:
- **Pseudocyst** (encapsulated fluid collection).
- **Necrosis** (heterogeneous areas with debris).

# # # **2. Chronic Pancreatitis**
- **Causes**: Long-term alcohol abuse, recurrent acute pancreatitis.
- **Ultrasound Findings**:
- **Atrophic pancreas** (small, fibrotic).
- **Hyperechoic foci**