Radiology Case Presentation

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Radiology Case Presentation

• byBrad Moatz

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CC

• 19-year-old female with right lower quadrant pain
  and vomiting.

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Uterine Anomalies

• Congenital anomalies of the uterus are often
  asymptomatic and therefore unrecognized
• The incidence of congenital uterine anomalies is
  difficult to determine since many women with such
  anomalies are not diagnosed, especially if they
  are asymptomatic. Uterine anomalies occur in 2 to
  4 percent of fertile women with normal
  reproductive outcomes

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Septate/Arcuate Uterus

•  A septate uterus has a normal external surface
  but two endometrial cavities
• The septate uterus develops from a defect in
  canalization or resorption of the midline septum
  between the two müllerian ducts. The degree of
  septation varies from a small midline septum to
  total failure in resorption resulting in a
  septate uterus with longitudinal vaginal septum

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Pregnancy

• There appears to be a higher risk of recurrent
  miscarriage associated with longer septa, but
  this is controversial and many untreated women
  have good pregnancy outcomes. Pregnancy outcomes
  reported in such women revealed spontaneous
  abortion in 21-44 percent, preterm delivery in
  12-33 percent, and live birth in 50-72 percent.

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Treatment

• Hysteroscopic metroplasty has become the method
  of choice for repair of most uterine septa.
  Benefits to the transcervical approach include
  less morbidity, no abdominal or transmyometrial
  incisions, and faster return to normal activity.
• Various techniques and instruments are used
  either to incise or remove the septum. Two of the
  most common instruments are the semirigid or
  rigid scissors (7 French) or the 8 mm wire loop
  urologic resectoscope operated through the 21
  French sheath. Potassium-titan-phosphate
  (KTP/532), neodynamicyttrium aluminum garnet
  (NdYAG), and argon lasers also have been used.
• If however the septum cannot be safely removed
  hysteroscopically, then an abdominal or
  laparoscopic approach, such as the Jones or
  Tompkins metroplasty, can be used.

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42 Foot

• Two views of the right foot, two views of the
  left foot, two views of the right hand, two views
  of the left hand
• history Psoriasis.
• Findings There are no prior studies available
  for comparison.
• Right hand There is no fracture or dislocation.
  There is significant narrowing of the multiple
  joints in many wrist and hand, especially the
  radiocarpal, all of the carpal, metacarpal
  phalangeal joints, as well as proximal and distal
  interphalangeal joints. There are multiple
  erosions in the distal radius and ulna, with
  complete erosion of the ulna styloid. There are
  also multiple erosions in the carpus. Several
  subchondral lucency/erosions are visualized in
  the distal 2nd-5th metacarpals, as well as distal
  aspect of the third and fifth proximal phalanges.
  There is productive bony change at the
  metacarpophalangeal and interphalangeal joints.
  There is bony ankylosis of several of the carpal
  bones, specifically the lunotriquetral,
  lunocapitate, and lunohamate articulations. The
  bony mineralization is within normal limits.
• Left hand There is no fracture or dislocation.
  There is significant narrowing of the multiple
  joints in many wrist and hand, especially the
  radiocarpal, all of the carpal, metacarpal
  phalangeal joints, as well as proximal and distal
  interphalangeal joints. There are multiple
  erosions in the distal radius and ulna, with
  complete erosion of the ulna styloid. There are
  also multiple erosions in the carpus. Several
  subchondral lucency/erosions are visualized in
  the distal 2nd-5th metacarpals, as well as distal
  aspect of the third and fifth proximal phalanges.
  There is productive bony change at the
  metacarpophalangeal and interphalangeal joints.
  There is bony ankylosis of several of the carpal
  bones, specifically the lunotriquetral,
  lunocapitate, and lunohamate articulations. The
  bony mineralization is within normal limits.
• Right foot There is no fracture or dislocation.
  There are large central erosions in the first --
  fifth metatarsophalangeal joints, with resultant
  pencil in cup deformity in these joints. There
  is metatarsus adductus primus, measuring 18.
  There is also hallux valgus, measuring
  approximately 52. There is also mild to
  moderate lateral deviation at the second - fourth
  metatarsophalangeal joints. There is bony
  ankylosis in the midfoot, specifically at the
  naviculocuneiform articulation, as well as
  navicular cuboid joint. There are diffuse
  enthesopathic changes throughout the foot, most
  prominent at the medial and lateral aspect of the
  hindfoot and midfoot. There is a prominent
  erosion in the dorsal aspect of the calcaneus at
  the site of the Achilles' tendon insertion.
  There is a small calcaneal enthesophyte at the
  site of the plantar fascia insertion. There is
  no ankle joint effusion. Bony mineralization is
  within normal limits.
• Left foot there is no fracture or dislocation.
  There are large central erosions in the 2nd
  metatarsophalangeal joint, with resultant pencil
  in cup deformity. There are marginal erosions at
  the medial and lateral aspect of the fifth
  metatarsal. There is bony ankylosis at the first
  interphalangeal joint. There is bony ankylosis in
  the midfoot, specifically at the
  naviculocuneiform articulation, as well as
  navicular cuboid joint. There are diffuse
  enthesopathic changes throughout the foot, most
  prominent at the medial and lateral aspect of the
  hindfoot and midfoot. There is a prominent
  erosion in the dorsal aspect of the calcaneus at
  the site of the Achilles' tendon insertion.
  There is a small calcaneal enthesophyte at the
  site of the plantar fascia insertion. There is
  no ankle joint effusion. Bony mineralization is
  within normal limits.
• Impression Findings consistent with psoriatic
  arthritis in both hands and both feet, as
  described above.

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41 hand

• Opon review of the study, there is swelling and
  mild enthesopathy of the fifth proximal
  interphalangeal joint on the right.
• Small erosions and enthesophytes are noted at the
  second metacarpal phalangeal joint on the right
  and the fifth metacarpal phalangeal joint on the
  left.
• Addendum Ends
• Two views of the right hand, two views of the
  left hand, three views of the right and left
  foot, two views of the right and left heel
• History Psoriasis versus tophaceous gout.
• Findings There are no prior studies for
  comparison.
• Left foot There is no fracture or dislocation.
  There are moderate to severe degenerative changes
  of the first MTP joint, with joint space
  narrowing, osteophytosis, and subchondral cystic
  changes and sclerosis. There also osteophytes at
  the tibiotalar joint anteriorly and posteriorly.
  There is mild osteophytosis at the talonavicular
  and naviculocuneiform joints. There is a small
  calcaneal enthesophyte at the site of the plantar
  fascia insertion. There are no marginal or
  peri-articular erosions, periosteal reaction,
  joint space narrowing, soft tissue swelling, or
  abnormal soft tissue calcifications. Bony
  mineralization is within normal limits.
• Left heel There is degenerative change at the
  tibiotalar and talonavicular articulations, as
  above. A small calcaneal enthesophyte is seen
  and the plantar fashion distortion. There are no
  erosive changes were abnormal soft tissue
  swelling.
• Right foot There is no fracture or dislocation.
  There are moderate to severe degenerative changes
  of the first MTP joint, with joint space
  narrowing, osteophytosis, and subchondral cystic
  changes and sclerosis. There also osteophytes at
  the tibiotalar joint anteriorly and posteriorly.
  There is mild osteophytosis at the talonavicular
  and naviculocuneiform joints. There is a small
  calcaneal enthesophyte at the site of the
  Achilles' tendon insertion. There are no
  marginal or peri-articular erosions, periosteal
  reaction, joint space narrowing, soft tissue
  swelling, or abnormal soft tissue calcifications.
  Bony mineralization is within normal limits.
• Right heel There is degenerative change at the
  tibiotalar and talonavicular articulations, as
  above. A small calcaneal enthesophyte is seen
  and the plantar fashion distortion. There are no
  erosive changes were abnormal soft tissue
  swelling.
• Right hand There is no fracture, dislocation,
  subluxation, marginal or periarticular erosions,
  soft tissue swelling, or soft tissue
  calcifications. Bony mineralization is within
  normal limits.
• Left hand There is no fracture, dislocation,
  subluxation, marginal or periarticular erosions,
  soft tissue swelling, or soft tissue
  calcifications. There is a degenerative cyst in
  the distal pole of the scaphoid. Bony
  mineralization is within normal limits.
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• Impression Degenerative changes in both feet
  and in the left hand, as above. There are no
  radiographic findings to suggest gout or
  psoriasis.