ANATOMY OF TEMPORAL BONE

الرحيم الرحمن الله بسم

Acute appendicitis• clinical diagnosis may be straightforward in patients with classic signs

and symptoms.• Atypical presentations may result in diagnostic confusion and delay in

treatment more in young and elderly patients.DD• Acute Mesenteric Adenitis• Acute gastroenteritis• Meckel's Diverticulitis• Intussusception• Perforated peptic ulcer• Diverticulitis• Epiploic appendagitis• Ureteric stone• Gynecologic disorders: Pelvic inflammatory disease (PID)• Ovarian cyst or torsion• Ruptured ectopic pregnancy• Cholecystitis

Clinical D• -ve rate 20%.• US & CT results in lower false-negative rates .Conventional Radiography• Abnormalities in 50% of patients , not specific and can be misleading. findings• Appendicolith.• Right lower quadrant gas• Localized ileus Barium enema is performed on an unprepared bowel gently

without any external pressure. Complete filling of a appendix excludes the diagnosis of appendicitis specially in children

US• Initial imaging study in children, in young women,

and during pregnancy.• sensitivities of 75%-90%, specificities of 86%-

100%, accuracies of 87%-96%,Graded compression US.• The inflamed appendix is seen as a blind-ended ,

aperistaltic, noncompressible, tubular structure that arises from the base of the cecum having a diameter greater than 6 mms. Presence of a fecalith .

• late (supportive) stage the lumen of the appendix is distended with pus/ fluid and there is increased thickening of the submucosa and muscular wall in the range of 3-6 mm.

• Loculated pericecal fluid, phlegmon or abscess, prominent pericecal fat and absence of color flow are associated with appendiceal perforation.

CT• sensitivities of 90%-100%, specificities of 91%-99%Normal appendix • tubular or ringlike pericecal structure • totally collapsed or partially filled with fluid, contrast

material, or air. • Normal diameter = 6mms or less. T• periappendiceal fat clear.acute appendicitis • diameter greater than 6.0-7.0 mm, • periappendiceal inflammatory changes• calcified appendicolith • Arrowhead sign Complications: • Perforation• pericecal phlegmon or abscess formation.• peritonitis, and small-bowel obstruction

MRI• If CT is contraindicated like in pregnancy or in

children.• T1, T2, fat-sat, post contrast T1.• IN T2 markedly hyperintense center and a

slightly hyperintense thickened wall with markedly hyperintense periappendiceal tissue. On post contrast study, intense contrast enhancement of the inflamed appendiceal wall .There is also significant enhancement of surrounding fat on gadolinium-enhanced T1-weighted fatsuppressed

DERMOID CYST(Mature cystic teratoma)• The most common ovarian neoplasm

• derived from more than one germ layer• they can include hair, teeth, fat, skin, muscle, ..etc• benign, rarely (1-3%), undergo malignant change

• Peak incidence from 20-40– During adolescence, constitutes 50% of adnexal

neoplasms• Locations• Ovary, most commonly,• Bilateral 8-25 %• also occur in ;

– Mediastinum– Retroperitoneum– Cervical region– Brain

• Incidentally discovered. Imaging Findings• Conventional radiography

– Relatively insensitive,• A fat-containing mass of lower density• Characteristic calcifications(tooth or other bone

(e.g. clavicle)• Ultrasound

– TAS or TVS is the study of choice– Complex mass with echogenic components– “dirty acoustic shadowing”– purely cystic (9-15%) or purely solid (10-31%)

• CT– Mass containing fat,–  frequently calcification (e.g. a  tooth– Fat-fluid level

• MRI– Hyperintense fat on T1 & T2– Fat suppresion on FS sequences

•  Treatment surgical

• Complications• Torsion is most common• Rupture • Infection• Autoimmune hemolytic anemiaDifferential Diagnosis• immature teratomas : predominantly solid with small foci of fat.-

ascitis – deposits• Endometrioma• Tuboovarian abscess• Pedunculated uterine fibroid

Thank youdr. WALID AGAMY