Genitourinary Radiology: Case Review

Dr. Vijayanadh Ojili Associate Professor and Fellowship Program Director Body Imaging and Intervention UT Health San Antonio DISCLOSURE OF COMMERCIAL INTEREST

Neither I nor my immediate family members have a financial relationship with a commercial organization that may have a direct or indirect interest in the content

Case: 1 Case: 1

Companion Case

Penile Malignancy versus Penile Fracture with Hematoma

Teaching Point: Contrast-Enhanced MRI (especially the subtraction images) play a crucial role in differentiation; although, clinical history provides a diagnostic clue in most cases

Case: 3

USG-Penis

Case 3: Peyronie’s Disease

Teaching Point: Penile deformity and calcifications (calcified penile plaques) are important pointers to the diagnosis of Peyronie’s disease. Case: 4 Case: 4

Large RP Mass – Metastatic Testicular Cancer on a Background of Testicular Microlithiasis Related Case : Burnt Out Testicular Tumor with Extensive Pulmonary Metastases Companion Case Companion Case

USG-Testis

Case Provider: V Surabhi Companion Case

Right Testis Left Testis Companion Cases

Testicular Lymphoma Testicular Epidermoid Testicular Hamartomas RightTeaching Testis Points: Lymphoma-Homogenous, Bilateral, Increased Vascularity Epidermoid- Classic “onion skin “ appearance Hamartomas-Multiple, hyperechoic, Cowdens Syndrome Case: 9

Case 9: Adenomatoid Tumor of the Epidydimis

Teaching Point: Intra-testicular tumors are usually malignant whereas extra-testicular tumors are usually benign Case: 10

Case 10: Dilated/Ectasia of the Rete Testis

Teaching Point: Ectasia of the Rete Testis may be unilateral or bilateral and may be associated with spermatoceles. Intra-testicular varicocele which is a rare entity, may mimic this on gray scale sonography Case: 11

USG Scrotum

Case 11: Fournier’s Gangrene

Teaching Point: Absence of subcutaneous air in the scrotum or perineum does not exclude the diagnosis of Fournier’s gangrene. Up to 90% of patients have been reported to have subcutaneous emphysema and 10% do not demonstrate this finding clinically Companion Case

USG-Scrotum Companion Case Companion Case Companion Case

Case Provider: Sreeharsha Tirumani Companion Cases

Scrotal Cellulitis Acute Epidydimoorchitis Focal Orchitis

Right Testis Companion Case: Chronic Tuberculous Epidydimoorchitis Case: 19

Case 19: Meigh’s Syndrome Meigs syndrome is defined as the presence of ascites and right pleuural effusion in association with a benign, usually solid ovarian tumour. In the vast majority (80-90%) of cases, the primary tumor is an ovarian fibroma. Other primary tumours include: •ovarian fibrothecoma •ovarian thecoma •granulosa cell tumours of the ovary •Brenner tumour

Differential diagnosis •malignant ascites and pleural effusion in the presence of an aggressive ovarian tumour •pseudo-Meigs syndrome: benign reversible pleural effusion in the presence of a primary tumor other than solid ovarian tumors, e.g. broad ligament leiomyoma

Treatment and prognosis The condition is benign and the ascites and pleural effusion resolve after resection of the primary pelvic tumour.

Companion Case Companion Case Companion Case Companion Cases

Hydatidiform Mole with Ovarian Hyperstimulation Krukenburg Tumors B/L Theca Lutein Cysts

RightTeaching Testis Points: Ovarian Hyperstimulation-Bilateral ovarian enlargement with multiple cysts with associated ascites and pleural effusiony Hydatidiform Mole-Heterogenous uterine contents with bilateral theca lutein cysts Krukenburg Tumors-Metastatic tumors to the ovary, typically seen as bilateral solid ovarian masses with well circumscribed margins Case: 23

T2 T1 post Gad

Case Provider: Sreeharsha Tirumani

Case 23: Endometrial Cancer and Submucosal Fibroid

T2 T1 post Gad Teaching Point: Endometrial cancers are typically hypointense compared to the bright endometrium on T2-WI and are hypoenhancing in comparison to the uterime myometrium Companion Case Companion Case Companion Cases Companion Case Companion Cases

Endometrial Hyperplasia Uterine Adenomyosis (Diffuse)

Uterine Adenomyosis (Focal) Uterine Lipoleiomyoma and Submucosal Fibroid Case: 28

Pre-Embo

Post-Embo

Case 16: Uterine Fibroid Embolisation

Case 29: Young Female with pelvic pain

Torsion of Ovarian Teratoma

Axial (A, B, C) and coronal (D) contrast enhanced CT images in a young female presenting with severe pelvic pain demonstrate a torsed left ovarian A B teratoma (red arrow) which is seen to lie in the right hemipelvis with associated mild fat stranding and fluid (black arrows). There is an additional uncomplicated right ovarian teratoma (yellow arrow)

C D Case 29A: Companion Question

The incidence of the above mentioned complication of ovarian teratomas is • A. Less than 5 % • B. 10 to 20 % • C. Approximately 50% • D. More than 75 %

Case 29A: Companion Question

The incidence of the above mentioned complication of ovarian teratomas is • A. Less than 5 % • B. 10 to 20 % • C. Approximately 50% • D. More than 75 % ANSWER: B Case 29B: Companion Question

Ovarian teratomas can be bilateral in • A. Less than 5 % • B. 10 to 20 % • C. Approximately 50% • D. More than 75 %

Case 29B: Companion Question

Ovarian teratomas can be bilateral in • A. Less than 5 % • B. 10 to 20 % • C. Approximately 50% • D. More than 75 % ANSWER: B Torsion of Ovarian Teratoma

 Teratomas are cystic tumors derived from at least two of the three germ cell layers  They account for 20% of adult ovarian tumors and 50% of pediatric ovarian tumors  Teratomas are also the most common cause of ovarian torsion. This is because the ovary is extremely mobile due to long pedicle and common ligamentous attachment to the fallopian tube  16% of ovarian teratomas torse. This results in acute devascularization by obstructing venous and lymphatic drainage, which results in ovarian edema that eventually results in arterial obstruction. The process increases the risk of hemorrhage and rupture Case: 30

Axial T2W TSE DWI ADC

eADC DCE

Case 30: Central Zone Prostate Cancer

Axial T2W TSE DWI ADC

eADC DCE Thank You !

Vijayanadh Ojili, MD Associate Professor, Fellowship Program Director Body Imaging & Intervention Department of Radiology UT Health San Antonio 7703 Floyd Curl Dr, MC 7800 San Antonio, Texas 78229

Email: [email protected] Phone: (210) 567-6470