Ovarian cysts

In the year 2000, my aunt and my mother convinced my grandmother to go to the doctor to have a check up. They had been noticing that my grandmother was looking sick and gaining a lot of weight in a short period of time. She only complained of having some minor back pain, but after not going to a doctor for about 30 years, one would start to get used to pain. After being examined by the doctor, she had a CT scan that showed a huge ovarian cyst. The doctor soon scheduled her an appointment with a general surgeon to remove the cyst. They took pictures before and during the surgery. I have uploaded actual pictures of my grandmothers cyst! Recently when I was talking to my grandmother, she said her cyst weighed 29.5 lbs! The doctors that performed the surgery said they had only seen one that was larger, which was 30 lbs.

Ovarian cyst are composed of fluid such as blood, mucous, etc. found inside the ovaries. There are two types of ovarian cysts, one being a follicular cyst, which is basically enlarged follicles, and the other known as a corpus luteum cyst, which is basically a hemorrhage of the corpus luteum (the lining within the ovary). Ovarian cysts are more common in females around childbearing age, but is definitely not uncommon to find them in older women.

Lower pelvic pain, back pain, abnormal bleeding, fullness or a heavy feeling in pelvic area, and painful intercourse are just some of the main symptoms of having ovarian cysts. There can be one or multiple. Misdiagnosis can often occur because doctors mistake it for menstrual cramps. If a cyst ruptures it can cause extreme pain and

Ultrasound is the best diagnostic imaging tool to use, but cysts can also be seen in CT or MRI exams. I have uploaded MRI images. The top image is an example of an ovarian cyst in a T1-weighted image, the bottom is a T2-weighted image (shows a greater signal intensity).

Surgery is done in extreme cases, but the pain can be masked with a narcotic or even ibuprofen. Birth control pills can be given to the patient to help prevent the formation of new cyst.

References:

http://www.medicinenet.com/ovarian_cysts

Eisenberg, Ronald & Johnson, Nancy (2003) Comprehensive Radiographic

http://www.glowm.com

A special thanks is given to my grandmother for letting me use these images.

Appendicitis

When I was 12 years old, it seemed like I was sick all the time. My stomach/abdomen would hurt off and on for months. My primary care physician ordered an upper GI and small bowel follow through, but there were no abnormal findings. Then, one morning I woke up with excruciating abdominal pain and could not get out of the fetal position. I was running a temperature, nausea, vomiting, and it burned so badly to urinate. My mother just thought that I had the flu because flu season was going around, but the reality was, I had chronic appendicitis for a few months until the day my appendix ruptured. I developed gangrene and had it for three days! When I got out of my 4-hr surgery to remove my appendix and some of my bowel, the doctors said I was less than 4 hours from dying! I am so lucky to still be alive today. If it wasn't for the surgeons that day, I would've been dead!

Appendicitis is an inflammation of the appendix, which is found at the junction of the small and large intestines and is located on the cecum. It can be either acute (sudden onset) or chronic (happens over a period of time). Genetic predisposition plays a small role in developing appendicitis, especially if the person has a mother, father, or sibling that has had appendicitis. Anatomy position of their appendix plays another role.

Appendicitis occurs because of food particles or other types of particles gets lodged in the appendix and causes an obstruction that eventually leads to infection. Also lymph nodes can enlarge and cause an obstruction. If the obstruction is left untreated it can cause peritonitis, which is what I experienced. Surgery to remove the appendix is always performed. In my case they had to completely open me up to remove my appendix, but in a lot of cases where the appendix has not been ruptured, they can remove it laproscopically.

Symptoms include: nausea, vomiting, pain originating in periumbilical area toward the right lower quadrant or as it is commonly referred as "McBurney's point", low-grade fever, elevated white blood cell count, etc.

CT scans are probably one of the better modalities for looking at the appendix. Coronal re formats in CT are very helpful in reading these exams. Radiologist measure the appendix by its' width and if it measures over 6 mm, it is appendicitis. It can sometimes be tricky to determine whether or not a patient has appendicitis because the position of the appendix is located in differently in every patient. Sometimes the appendix can be so large, it looks like a continuation of the large bowel and sometimes it can lie directly on the psoas muscle and be very long. Radiologist can sometimes mistake appendicitis for a specific lymph node enlargement called mesenteric lymphadenitis, because its appearance is similar to appendicitis.

I have uploaded an example of a CT coronal image. The red arrow is pointing to the enlarged appendix.

References:

Dr. Mitchell, MD
www.emedmag.com
http://radiology.rsna.org