Syphilis

1. cardiovascular syphilis
2. syphylitic aortitis
3. skeletal syphilis
4. Charcot's joint
5. cerebral cortex syphilis
   

Description:

• chronic, sexually transmitted systemic infection caused by the spirochete (Treponema pallidum)
• congenital syphilis- baby contracting from mom
• primary stage- chancre (ulceration) develops on genitals (vulva=females penis=males)
• secondary stage- nonitching rash affecting any part of the body; may be dormant
• tertiary stage- incurable; radiographic abnormalities may become apparent

Rad appearance:

1. ascending aorta becomes aneurysmally dilated; shows linear calcification of the wall
2. aortic valvular ring; aortic regurgitation with enlarged Lt ventricle
3. osteomyelitis; dense sclerosis of surrounding tissue
4. neuropathic joint disease in which bone resorption and total disorganization of the joint are assoc. with calcific & bony debris
5. contains lesions causing mental disorders, deafness, and blindness

Treatment:

• primary and secondary stages- antibiotics cure it (penicillin, doxycycline, or tetracycline)

Description:

• most common bacterial infection, venerial disease, & occurs mostly in men
• acute urethritis w/ copius discharge of pus in men; women can be asymptomatic/minimal urethral or cervical inflammation
• untreated: chronic, spread upward, produce fibrosis (men=urethral stricture women=PID/sterility)
• fibrous scarring of fallopian tubes=sterility or ectopic pregnancy

Rad appearance:

• can cause septic arthritis leading to articular erosion & joint space narrowing

Treatment:

• rapid antibiotic therapy (penicillin)
• penicillin resistant requires inrtamuscular dose of (ceftriaxone)

• spermatogenesis- begins at 13
• folicle stimulating hormone (FSH) is secreted by anterior lobe of pituitary gland
• testes secrete testosterone
• epididymus- sperm spends 1-3 weeks here until capable of fertilization
• sperm can remain in the vas deferens for 1 month w/ no loss of fertility
• vasectomy- severing of the vas deferens to be sterile
• sterility- sperm count below 50 million/ml of semen

Description:

• enlargement of prostate gland
• common in men >60yrs
• result=inability to empty bladder completely, partial urinary tract obstruction, bilateral ureteral dilation, hydronephrosis

Rad appearance:

• elevation & smooth impression on the floor of contrast filled bladder
• transrectal US- circumferential surgical pseudocapsule, discrete nodules, thickened bladder wall
• excretory urography- elevation of ureters on the trigone of bladder shows J-shaped/fish hook appearance of the distal ureters
• residual urine in bladder can cause cystitis or pyelonephritis

Treatment:

• transurethral resection of the prostate gland (TURP)- going through urethra to remove parts of the bladder; uses a brodney clamp
• TUIP: transurethral incision of the prostate gland
• TUMT: transurethral microwave thermotherapy
• PSA- blood test that measures prostate specific antigen; elevated indicates cancer; distinguish between prostate cancer and hyperplasia

Description:

• second most common malignancy in men (mostly black men)
• occurs most often in the peripheral zone (70%)
• routine rectal exam- hard, nodular, irregular mass
• elevated serum PSA (prostate specific antigen)

Rad appearance:

• elevates & irregularly impresses floor of contrast filled bladder
• transrectal US is preferred technique to detect
• Staging the cancer: MRI= spin-echo technique
• carcinoma can spread by direct extension, lymphatic system, or blood stream (hematogenous)
• most common hematogenous metastases: pelvis, thoracolumbar, femurs, & ribs
• common lesions are osteoblastic- multiple rounded foci of sclerotic density or occasionally diffuse sclerosis involving the entire bone (ivory vertebra)

Treatment:

• confined: radical prostatectomy or radiation therapy
• local invasion: both radical prostatectomy and radiation therapy
• stage D: most progressive; requires antiandrogen drugs to slow spread of disease
• orchiectomy: removal of testes

Description:

• most common in premature males; can cause infertility
• malignancy is 40 times higher for intraabdominal

Rad appearance:

• US- accurate in demonstrating in the inguinal canal

Treatment:

• orchiopexy- surgical fixation of an undescended testis into the scrotum through the inguinal canal for pts younger than 10yrs
• orchiectomy- surgical removal for those after puberty

Description:

• twisitng of the gonad on its pedicle, leads to no circulation & severe scrotal pain

Rad appearance:

• doppler US- most common; adults; shows intratesticular arterial pulsations (Test. Tors.=arterial perfusion will be absent; Epid=increased blood flow)
• radionuclide studies- (superior to US) children; Test. Tors.=cold rounded area replacing testicle; Epid.=hot area

Treatment:

• immediate surgery within 5-6 hours of onset of pain

Description:

• most common neoplasm in men 20-35 yrs
• almost all are malignant & metastasize to the lymphatics (drains into paraaortic lymph nodes at level of kidneys)
• 2 major types: seminomas- 45% are germ cell tumors; nonseminomas- 55% are teratomas and other germ cell tumors

Rad appearance:

• US is most accurate/best; localized- circumscribed mass
• teratoma- inhomogeneous w/ cystic & solid areas of calcification & cartilage
• CT- best detects lymphatic metastases that occur at the level of the hilum (gonadal veins drainage)

Treatment:

• orchiectomy- all cancers are totally removed
• seminomas- radiosensitive, early detection can be cured
• teratomas- all are surgically removed followed by radiation therapy and chemotherapy

• menarche- onset of menstruation; occurs between 11-15 yrs old
• corpus luteum- enlarged cells of the ruptured follicle; golden colored pigment (lutein); grows for 7-8 days and secretes progesterone
• corpus albicans- diminished corpus luteum; white scar (corpus albicans) moves into the central portion of the ovary and disappears
• ectopic pregnancy- implantation of embryo in fallopian tube or pelvic cavity; not in endometrium
• chorion- fetal membrane for exchange of nutrients
• menstrual cycle- last 28 days
• 3 phases: proliferative- b/t end of menses & ovulation, secretory- b/t ovulation & onset of menses (14 days), & menstrual- flow of blood, mucus, & sloughed endometrium (4-6 days)
• menopause- cessation of menstrual periods; women 40+ yrs

Description:

• inflammation of pelvic reproductive organs caused by venerial disease (most common=gonorrhea)
• spread of infection to the fallopian tubes = fibrous adhesions = obstructs the inner portion near uterus
• pyosalpinx- outer ends close and fill with pus
• hydrosalpinx- after antibiotics, watery fluid remains

Rad appearance:

• transabdominal US is best; shows thickened endometrium
• endovaginal US- good for detecting dilated tubes, inflammatory changes, & abscesses
• pyosalpinx & tubo-ovarian abscesses are seen as tubular adnexal masses; thick & irregular shaggy walls

Treatment:

• antibiotic therapy and abstinence

Description:

• most common in female infants and childbearing women
• include follicular cysts (unruptured, enlarged follicles) & corpus luteum cysts which occur after continued hemorrhage or lack of resolution of the corpus luteum
• polycystic ovarian syndrome (PCOS)- benign; "Stein-Leventhal Syndrome" multiple ovarian cysts; most common genital disorder found in young women
• common malignancies involving the ovaries: metastatic tumors which arise from carcinomas of the breast, colon, and stomach

Rad appearance:

• US: cysts- rounded adnexal masses; PCOS- 10 or more cysts peripherally
• cystadenoma- benign; the more solid & irregular areas are within the mass, the more likely its malignant; ascites along with an ovarian mass=underlying malignancy

Treatment:

• cysts larger than 10mm require drainage or surgery (25-30% survival rate)

Description:

• most common type of germ cell tumor; benign
• contains skin, hair, teeth, & fatty elements from ectodermal tissue
• no clinical significance

Rad appearance:

• calcification combined with the relative radiolucency of the lipid material within the lesion is pathognomonic

Treatment:

• surgical removal recommended in case of malignancy

Description:

• uterine leiomyomas- fibroids of the uterus; benign tumors arising from myometrium/smooth muscle of the uterus

Rad appearance:

• most common calcified lesions of the female genital tract; diagnosed using CT, MRI, & US
• mottled, mulberry, or popcorn type calcifications; plain x-rays: smooth lobulated nodules with a stippled or whorled appearance
• tumor presses on the fundus of the bladder causing lobulated extrinsic impression thats different from smooth impression seen on ovarian cysts
• transvaginal US- best demonstrates small submucosal uterine fibroids

Treatment:

• young women- myomectomy (removal of leiomyoma) for superficial fibroids to preserve uterus
• childbearing complete- hysterectomy for large or multiple tumors
• others: multilaser technique, myolysis (electric coagulation of myoma), uterine artery embolization- cuts off blood supply to fibroid
  

Description:

• adenocarcinoma of the endometrium- predominant neoplasm of the uterine body; most common invasive gynecologic neoplasm; malignant
• occurs in postmenopausal women who have never had children
• hyperplasia is a lesser version of adenocarcinoma

Rad appearance:

• excretory urography- enlarged uterus impressing/invading the posterior wall and fundus of the bladder
• endovaginal US- measures endometrial thickness to decide if dilation & surgical curettage is necessary

Treatment:

• hysterectomy with resection of the enlarged lymph nodes is a must

Description:

• presence of normal-appearing endometrium in sites other than inside the uterus; can also affect the GI and Urinary tracts
• causes: 1. reflux of endometrial fragments backward thru fallopian tubes during menstruation, into pelvis. 2. transformation of multipotential cells in the abdomen & pelvis. 3. implantation of fragments during surgery or delivery. 4. spread of tissue by bloodstream or lymphatic system

Rad appearance:

• clinical symptoms: abnormal bleeding, dysmenorrhea, dyspareunia (painful sex)
• age 20-45 symptomatic
• US- cystic masses filled with old blood; "chocolate cysts"
• involvement of urinary tract- ureteral obstruction below the pelvic brim; GI tract- affects rectosigmoid colon
• repeated shedding of endo tissue & blood into peritoneal cavity = dense adhesive bands causing small bowel obstructrion
• recurrent catamenial pneumothorax- intrathoracic implants, usually right sided, occurs during menstrual flow

Treatment:

• pain management, reduction of disease progression, & prevention or reversal of infertility thru drugs, surgical, & laser treatment
• complete hysterectomy (removal of uterus) if widespread; oophorectomy: removal of the ovaries

Description:

• 3rd most common form of reproductive system cancer in women 15-34
• result of chronic irritation, poor hygiene
• Pap smear detects this disease
• carcinoma in situ- confined to the site of origin

Rad appearance:

• most common cause of death in pts with this is b/c of impaired renal function caused by ureteral obstruction
• US- solid mass behind the bladder
• MRI- detecting and staging cervical carcinoma
• Radiation therapy can lead to dvlpmnt of fibrous inflammatory adhesions b/t loops of bowel & bladder; results in dvlpmnt of fistulas b/t bowel loops (enteric-enteric) & a bowel loop & the urinary bladder (enteric-vesicular)
• most common: vesicovaginal fistula

Treatment:

• hysterectomy w/ resection of the involved nodes & surrounding tissue and followed by radiation is recommended for stage I and II cervical cancers
• pelvic exenteration- removal of all pelvic organs to debulk tumor; last resort

Description:

• most common malignancy among women ages 44-50 that have no commonly acknowledged risk factors
  
• most tumors are classified (infiltrating duct carcinomas) which occur in the upper outer quadrant
• Stage I- if diagnosed has 98% survival rate
• later diagnosis results in spread to lymph nodes or systemically; leading cause of cancer death in women
• mammography- most effective diagnostic procedure
• tumor size- 1 inch found in self examination; 1/4 inch found in mammograms

Rad appearance:

• digital mammo- advantage: faster image acquisition, lower dose, inc. contrast
• mammo- seen as a tumor mass, clustered calcifications, or both
• secondary changes include skin thickening and nipple retraction
• typical malignant tumor mass- poorly defined w/ areas of distortion, irregular margins, & numerous fine linear strands radiating out from mass
• benign mass- well defined, smooth margins, round/oval/ gently lobulated contour
• clustered calcifications- numerous, very small, & localized to one segment of the breast indicates malignancy
• wide variety of shapes- fine linear, curvilinear, & branching
• ruptured silicone implants- inflammatory process causing silicone granulomas; "snowstorm" shadowing posteriorly obscuring the posterior border
• gynecomastia: 1 in 100 men develop breast cancer; enlargement results from a proliferation of the glandular component, estrogen stimulation cirrhosis, neoplasms, marijuana, digitalis, and Kleinfelter syndrome

Treatment:

• lumpectomy- removes isolated lesions
• mastectomy- removes all breast tissue & dissection lymph nodes
• radical mastectomy- removal of axillary nodes also

Description:

• fibrocystic disease of the breast, occur in 20% of premenopausal women
• usually bilateral, various sized cysts, fibrous tissue

Rad appearance:

• fibroadenoma- most common benign breast tumor
• smooth, well circumscribed mass, no invasion of surrounding tissue
• US- permits differentiation of a solid fibroadenoma from a fluid-filled breast cyst

Treatment:

• pain management, reduce caffeine intake, cyst drainage

• measurement of fetal age by US include:
• BPD (biparietal diameter: outer margin of skull on 1 side to inner margin on other side at level of thalami; 12-26 weeks)
• crown to rump length (tip of head to bottom of fetal trunk; gestational age; <11 weeks)
• fetal femur length (determine fetal age in 2nd & 3rd trimester with epiphyseal cartilage of knee; 33-35 weeks)
• polyhydraminos- excessive amniotic fluid caused by maternal disorder (diabetes mellitus, Rh isoimmunization), fetal abnormalities of CNS, dwarfism
• oligohydraminos- little amniotic fluid, results from fetal urinary tract disorders (renal aplasia, renal dysplasia, & urethral obstruction); associated with intrauterine growth retardation
• prenatal sonography- can detect and often treat in utero: osseous & neural anomalies of the fetal cranium and spine, GI atresias & developmental cysts, cysts & obstructive lesions of GU tract, and congenital cardiac diseases & skeletal anomalies

Description:

• life threatening condition; 1/4 of maternal deaths; 3/4 of cases due to missed diagnosis
• 95% occur in the fallopian tubes, more than half of these pts have a history of pathologic PID
• associated with low urine or plasma levels of human chorionic gonadotropin (HCG)

Rad appearance:

• US- best for diagnosis; enlarged uterus that doesn't contain a gestational sac; associated with an irregular adnexal mass, ectopic fetal head, fluid in the cul-de-sac

Treatment:

• emergency surgical intervention before a fatal hemorrhage occurs

Description:

• has many disorders such as: benign hydatidiform mole- results from abnormal fertilization when there's an absence of female chromosome, malignant hydatidiform mole and metastatic hydatidiform mole
• choriocarcinoma- half of these occur after hydatidiform moles

Rad appearance:

• hydatidiform mole- appears on US as a large, soft tissue mass of placental (trophoblastic) tissue filling the uterine cavity (bunch of grapes) & no signs of fetal movement
• choriocarcinoma- on US resembles benign hydatidiform mole with large complex mass of central hemorrhage, necrosis in expected position of uterus; tends to metastasize to the lungs resulting in multiple large masses

Treatment:

• hydatidiform moles- removal of all placental tissue by suction/curettage of the uterus
• choriocarcinoma- folic acid antagonists have a cure rate of 80% if trtmnt begins before brain metastasis occurs

Description:

• abnormal uterus that cannot hold a fetus, obstructed fallopian tubes, ovaries unable to produce mature ova, & disruption of ova path to uterus

Rad appearance:

• HSG- assesses tubal patency by filling fallopian tubes with contrast material thru the uterus, demo's intrauterine fibroids, severe uterine flexion or retroversion, & other acquired and congenital malformations

Treatment:

• ovulation induction agents
• Pergonal therapy- menotropins, can develop bilateral multicystic ovarian enlargement in the ovarian hyperstimulation syndrome

• 20% of women have uterus retroversion (uterine fundus tipped backwards); asymptomatic; disease, tumor, scarring from infection, & endometriosis can cause this
• anteflexion- fundus of the uterus flexed forward too much; 60% of women
• retroflexion- backward flexion of uterine body
• uterine aplasia- absence of uterus
• unicornate uterus- only 1/2 of the uterus and 1 uterine tube forms
• didelphic uterus- a complete duplication of the uterus, cervix, and uterine tubes
• bicornate uterus- 1 vagina, 2 cervixes, 2 uterine cavities, and 2 fundus; partial fusion of the lower uterine segment and persistently separated upper uterine segments
• arcuate uterus- nonfusion of the mullerian ducts begins at the level of the fundus; mild form of bicornate uterus; fundus is saddle-shaped
• septate uterus- septum extends throughout the normal uterine body to cervix, dividing uterus into 2 complete compartments
• subseptate uterus- a partial septum dividing the body only

Description:

• malignant contains psammomatous bodies, calcium carbonate deposits in the fibrous stroma are seen in plain x-rays
• large cystic mass with internal septa; "silent killer" like pancreatic cancer
• diagnosed by: pelvic exam, US, CA 125 blood test, biopsy

Rad appearance:

• US: cysts- rounded adnexal masses; PCOS- 10 or more cysts peripherally
• these calcifications appear as scattered, fine, amorphous shadows that are barely denser then normal soft tissue
• cystadenoma- benign; the more solid & irregular areas are within the mass, the more likely its malignant; ascites along with an ovarian mass=underlying malignancy
• CT: irregular sheet of soft tissue densities beneath the anterior abdominal wall; modality of choice for staging & surgical planning
• spread on the omental & peritoneal surfaces; "omental cake"
• with surgical treatment, ovarian carcinoma currently has a 25-30% survival rate

1. Varicocele
2. Spermatocele
3. Hydrocele

1. benign; less likely able to reproduce; swelling occurs more on the left side

- when standing, scrotal mass feels like a "bag of worms"

- mass is made up of enlarged, twisted varicose veins that fill and engorge with standing and drain when lying down

2. painless, fluid-filled cyst develops at the top of the testicle, near the epididymis

- originates in the loose supportive tissues of the spermatic cord that tethers the testicle to the interior of the pelvis

- US used to diagnose

3. collection of watery fluid around the testicle

- common in newborn males and goes away in the first year of life

- cause: toxic condition of the system