0:00

So let's look at the workup and Diagnostic Imaging of

0:03

lesions at the biopsy site.

0:05

So when we look at the appropriate criteria for

0:08

probable abdominal masses as shared with

0:11

us by the American College of radiology. It actually helps

0:14

to guide selection of proper Imaging modalities that

0:17

will support us in really evaluating these

0:20

palpable abdominal masses in the setting of suspect and neoplasm.

0:23

So in both suspected interbdominal and

0:26

abdominal wall masses ultrasonous recommended as an

0:29

appropriate first line Imaging modality.

0:32

However, cross-sectional Imaging CT itself

0:35

is the preferred first

0:38

line.

0:39

MRI can actually be used for further characterization which

0:42

is important for us to know.

0:44

So let's talk about cross-sectional Imaging in the

0:47

setting of abdominal pathology. What do we use? We consider

0:50

CT again first line.

0:53

And then we also have MRI for further evaluation.

0:57

In the use of CT for evaluation of the extra visceral

1:00

abdominal pathology. These are sites outside.

1:03

The solid organs CT really

1:06

is particularly helpful as a cross-sectional evaluation

1:09

tool. One of the things that we want to keep in

1:12

mind is what are the differential diagnoses as we

1:15

move forward. We want to be thinking about things features characteristics

1:18

that help us to discern between

1:21

what may be in this particular compartment. We're

1:24

looking at the location IE the

1:27

compartment where it is within the abdomen what's

1:30

the size of the lesion our reporters

1:33

Claire and well delineated. Is

1:36

it infiltrative in nature? Does it appear

1:39

as if that particular site is actually invading another site.

1:43

Does it move and displace actual adjacent

1:46

organs? Is there

1:49

calcification involved?

1:51

These are things that help us to really understand whether we're

1:54

dealing with something that's aggressive in the

1:57

case of something that's invading something that's more

2:00

malignant IE in the retroperitoneal things

2:03

that sort of move and displace the blood vessels

2:06

for example or calcification which tends to be

2:09

more of a benign characteristic.

2:12

So here we're looking at primary versus secondary pathologies

2:15

on cross-section Imaging. So when we're looking

2:18

at these extra visceral masses, they're more

2:21

often secondary rather than primary processes. So

2:24

what are the sort of things that could

2:27

clue Us in to concomitant primary pathologies? So

2:30

when we're looking for multifocality this

2:34

of course can suggest that if they're more

2:37

than one site more than one lesions and question

2:40

perhaps this is a metastasis.

2:43

If there is widespread lymphadenopathy, perhaps there's

2:46

lymphoma bilateral for example or systemic

2:49

when we're thinking about edema particularly

2:52

within the mesentery perhaps this

2:55

could be something benign like mesenteric paniculitis.

2:59

It's particularly important to distinguish if a mass is arising secondarily

3:02

from an interabdominal organ.

3:05

Because this may be a mass that's primary nature

3:08

as we mentioned is particularly unusual in the abdomen or if

3:11

it's actually emanating from an organ which

3:14

would help to sort of delineate the

3:17

path essentially accessing it.