Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is the widening of the wall of the aorta. When there is a weakening in the wall of the aorta it causes swelling. Most thoracic aneurysms develop in the descending aorta. Arthersclerosis seems to be the cause of a thoracic aortic aneurysm. Long term high blood pressure, trauma, history of Marfan's syndrome and syphilis are also risk factors associated with aortic aneurysms. Most patients do not have any symptoms until the aneurysm begins to leak. A good indicator of that would be chest or back pain. Most thoracic aortic aneurysms are found incidentally. Especially if they have not presented with any of the symptoms. A chest x-ray and more importantly a CT scan can show enlargement of the aorta. A CT scan specifically determines the exact location and size of the aneurysm. An aortogram may also be utilized to determine all areas of the aorta affected. If the aortic aneurysm is in the aortic arch and is larger than 5-6 centimeters then the aorta should be replaced with a fabric substitute. This is a more risky surgery because the patient will need to be placed on a heart-lung bypass machine. This prevents blood flow during the surgery. If the patient presents with an aneurysm in the descending aorta they will have to have it replaced with fabric substitute if it is larger than 6 centimeters. The second option for descending thoracic aortic aneurysms is endovascular stenting. This stent is placed through the groin and is placed at the site of the aneurysm to help keep the aorta open. This procedure is less invasive for the patient. The prognosis is highly determined by the patients history. Their prognosis determines how many risk factors contributed to the aortic aneurysm.

Multiple Myeloma

Multiple myeloma is a cancer in which abnormal cells called myeloma cells collect in the bone marrow and form tumors. If only one single tumor forms within the bone this is referred to as a plasmacytoma. Multiple myeloma occurs when these cells collect in multiple bones and forming more than one tumor. This type of disease generally affects patients above the age of 60. Symptoms may include back pain and kidney dysfunction. MRI scans are utilized for diagnosing multiple myeloma. Typical multiple myeloma appearance is low signal intensity on a T1 weighted image. On a T2 weighted image signal intensity is high. Multiple myeloma lesions some what enhance post injection of gadolinium injections. Mulitple myeloma may present in MRI's as other musculosketal tumors so other blood tests and or bone marrow aspirations will have to be utilized for proper diagnosis. Treatment may include chemotherapy and radiation therapy. The prognosis of patients with multiple myeloma are dependant upon success of treatment and how extensive the disease has progressed.

Schmorl's Nodes

I chose Schmorl's nodes since I do MRI and have clinically seen this pathology. Schmorl's nodes are believed to be associated with trauma but a possible congenital origin of a vertebrae end plate defect can not be ruled out. A Schmorl's node is a herniation to the nucleus pulposus of the intravertebral disk through the vertebral end plate. Most patients present with back pain and usually at the thoracolumbar junction. Most patients seem to be able to recall a time when they experienced trauma or a twinge of pain in their back during some type of movement. The injury may have occurred during a sport, exercising, or even moving something while twisting their back. Some Schmorl's nodes may show up on radiographs, but CT and MRI of the spine are the modality of choice. Once diagnosed, patients may be told to take an anti-inflammatory and told to stay away from strenuous activity. Rest will aid in the repair of the disk. Traction and newer developments of non surgical spinal decompression may also be utilized. Prognosis for most patients is very good. Patients may become for susceptible to this same type of pathology in the future.

Cervical Discitis

Discitis is when the vertebral disc space becomes inflamed often related to infection. Vertebral osteomyelitis may also occur due to the fact this condition share much of the same symptoms and treatment. An infection usually does not originate with in the vertebra, but rather through the blood stream spreading from other sites. Pneumonia and urinary tract infections are just a couple of known infections which may spread to the vertebral disc space. Discitis from surgical procedures is very rare, but may occur. Symptoms include neck or back pain. Some patients may present with a fever. Discitis may be detected on x-rays, CT scans, or MRI images. MRI is the modality of choice, since an MRI is able to demonstrate the narrowing of the disk space and the edema associated with the infection. IV antibiotics are used for treatment. If left untreated, death may be the outcome.

Carotid Body Tumor

I chose to write about carotid body tumors because it is a pathology I have not seen clinically. Carotid body tumors are also called paragangilomas or chemodectomas. These particular tumors are found at the branching of the carotid artery and may occur bilaterally. Symptoms of a carotid body tumor may be painless neck masses or hoarseness with in the throat located laterally to the hyoid bone. MRI/CT angiography imaging is utilized with diagnosis of these particular tumors. Patients diagnosed with these tumors have a good prognosis. They may be aggressive, so surgical removal is the patients best option. Prior to surgery some patients might endure a trans catheter embolization. Surgeons utilize this procedure to reduce the blood supply to the tumor. Radiation therapy may also be utilized in treatment.

Carcinoma of the Tongue

Tongue cancer is more common in patients older than 40. Most patients are heavy drinkers and or smokers. Some patients with chronic viral infections may develop into any type of head and neck cancer. Oral exams performed by a dentist may be utilized to diagnosis carcinomas of the tongue. Soft tissue neck MRI's may be used to determine any lymph node involvement and size of tumor. Biopsy will also be needed to diagnosis tumors. Surgery to remove the carcinomas may result in difficulties in swallowing and speech. Radiation therapy may also be utilized. Early diagnosis is key. If caught early, patients may likelihood of developing metastatic disease decreases.

Trigeminal Neuralgia

I am very familiar with this certain pathology because we run extra scans post contrast with our head protocols if patients present with facial pain. The reason they stick out in my mind so much is because these extra scans take at least eight minutes each so I am always set back on my schedule. :) Trigeminal neuralgia is swelling or inflammation of the nerve that delivers feeling to the face. Symptoms may include pain on one side of the face. Sharp spasms may also occur. Pain may also occur while chewing, drinking, shaving, or brushing teeth. No causes can be found, however abnormal blood vessels have been linked to trigeminal neuralgia. MRI is the best modality for diagnosis. Fine cuts are ran from C3 to inferior aspect of the orbit post contrast with fat saturation. Medications may be used but many patients have had a hard time with the long term. Surgery may be utilized to relieve pressure on the nerve. Patients who are not likely candidates for surgery may undergo radiation treatment to the nerve root.