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Diagnostic pearls: Marked abdominal and retroperitoneal collaterals and nonenhancing (clotted) splenic vein. Bilateral enlarged superficial inguinal lymph nodes (arrows) from metastatic vulvar carcinoma. The transverse mesocolon lies in the inframesocolic abdomen, contains middle colic vessels, and is a common site for spreading of pancreatic or colic processes. Comments Failure of developmental closure of the caudal neural tube results in an unfolded neural tube (neural placode) covered by a lipoma that is contiguous with the subcutaneous fat. With a positive family history, a patient may develop endometriosis at an earlier age than the family member. Metastatic lobular carcinoma of the breast to the stomach infiltrating in the gastrocolic ligament. Defining the actual size, degree of tortuosity, and continuity of the collateral with the recipient vessel are all critical steps in planning the procedure. The substrate for such an effect is unclear, but the new science of epigenetics could hold the key. Contrast media enhances solid components and improves the visibility of the septations. Inherited (autosomal dominant) neurocutaneous dysplasia complex with onset in the second to third decade. Bone resorption along the fracture margins becomes evident and in undisplaced fractures may allow at this stage (several days after the injury incidence) an unequivocal radiographic diagnosis. With the diagnosis of protraction or arrest disorder of labor, assess the following: Contraction strength: Start or pitocin to obtain stronger contractions. Adhesions are fibrous tissue that forms between two internal organs and may be a source of pain. Over 90% of these hernias are located on the left side, usually in the central or posterior portion of the diaphragm. Thus, the surface layers have high tensile strength and resilience whereas the lower layers have higher deformability and compressibility. The vascular blood supply of the scaphoid occurs by volar and dorsal branches of the radial artery entering the Shoulder Girdle and Upper Extremity 553. After contrast enhancement, a patchy inhomogeneous enhancement is evident that is, however, less than in the nonaffected part of the kidney. The tricuspid valve directs blood flow from the right atrium to the right ventricle. Cancers of the anterior tonsillar pillar tend to spread superiorly in to the soft and hard palate, nasopharynx, pterygoid muscles, and skull base; anteriorly in to the buccinator muscle; and inferiorly along the palatoglossus muscle in to the base of the tongue. Diagnostic pearls: Omental caking, bowel obstruction (subileus), and enlarged mesenteric lymph nodes. Pacemakers have a built-in indicator to signal when the battery is approaching depletion. Compressive symptoms may result from sudden rapid enlargement or following infection or posttraumatic hemorrhage. Some segments persist (Wolffian duct) and develop in to portions of the genital system: in males to the vas deferens, epididymis, and efferent ductules of the testes and in females in to the epoophoron and paroophoron. Contiguous tumor extension Squamous cell carcinoma may extend outside the pharyngeal mucosal space. Secondary amyloidosis is associated with chronic renal disease, rheumatoid arthritis, lupus erythematosus, ulcerative colitis, chronic suppurative disease, and lymphoproliferative disorders. Blurred and engorged mesenteric vessels converge toward the orifice of the hernial sac. Pseudoarthrosis occurs also in fibrous dysplasia, which often demonstrates bone changes radiographically similar to neurofibromatosis. Comments Bone metastases are by far the most common skeletal malignancy occurring either by hematogenous spread or direct tumor extension.

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Depolarization and repolarization Cardiac cells are surrounded and filled with an electrolyte solution. Diagnostic pearls: Large, ill-defined, lobulated anterior mediastinal mass with heterogeneous attenuation depending on predominant soft tissue component. Two "yes" answers has a sensitivity of 93% and a specificity of 76% for alcoholism. Other common locations are the submandibular, anterior cervical, and parotid spaces. Diagnostic pearls: Low-attenuation intraperitoneal fluid collection with rim enhancement and gas bubbles. Solitary or multiple soft tissue masses with erosions of the adjacent bone or osteolytic lesions. Usually are slow-growing neoplasms associated with long duration of back pain, sensory deficits, motor weakness, and bladder and bowel dysfunction; with or without chronic erosion of bone with scalloping of vertebral bodies and enlargement of intervertebral foramina. Other malignant tumors of the cartilaginous skeleton occur, including osteosarcoma and multiple myeloma, but they are even more unusual. The thyroglossal duct cyst, found along the course of the embryonic thyroglossal duct, is the most common midline neck mass. Most common primary tumors are carcinomas of lung, breast, colon, pancreas, kidney, uterus, and skin. Sagittal (a) and axial (b) images show extensive proliferative osseous changes involving the right sides of multiple cervical vertebrae with resultant narrowing of the spinal canal. The vertical lines measure the voltage or amplitude of the waveform in millimeters (mm). They can be divided in two groups: the first three determine the dominance, the total number of lesions, and the vessel segments involved per lesion, and they appear once. Vocational (work, school, homemaking) and avocational (recreational and/or leisure) activities are patient-desired and age- and sex-specific. The ascending and descending mesocolon fuse with posterior parietal peritoneum and form the colonic compartment of the anterior pararenal space. Consist of four parts: First maneuver answers the question: "What fetal part occupies the fundus A longitudinal (99% of term or near-term births) lie can be vertex (head first) or breech (buttocks first). T3: Invades skin of cheek, posterior wall maxillary sinus, floor of medial wall orbit, masticator space, pterygoid plates, or ethmoid sinus. If symptomatic, the rhythm is treated the same as in symptomatic sinus bradycardia. Even though single-chamber atrial pacing and dual-chamber pacing can be done, single-chamber ventricular pacing is the most reliable and preferred choice for transvenous pacing. The occasional development of abscess in the bare area of the liver secondary to extraperitoneal infection, most commonly from appendicitis, is explained by this anatomic continuity with the anterior pararenal space. In the mandible, radiolucent lesions about the teeth may lead to the "floating teeth" appearance. Symptomatic patients may have increasing pain and possible bowel pain and possible bowel complications. Hilar cholangiocarcinoma and periarterial/perineural infiltration along the replaced left hepatic artery in the gastrohepatic ligament. Note that both the anterior wall (3) and anterior column (4) fractures are associated with a superior pubic ramus fracture, but the difference is that the former originates below and the latter above the anteroinferior iliac spine. Predominantly osteolytic osteosarcomas (60%), malignant fibrous histiocytoma/ fibrosarcomas (25%), and chondrosarcomas (10%) are the most frequent tumors found in sarcomatous degeneration. Absent ipsilateral internal jugular vein and sternocleidomastoid muscle from radical neck dissection and an ipsilateral jugular foramen mass are findings of underlying cause. When symptomatic, they may be associated with airway obstruction, hoarseness, and dysphagia and present endoscopically as a submucosal supraglottic mass or cause a compressible swelling of the neck. Radial artery anomaly and its influence on transradial coronary procedural outcome. The transverse mesocolon constitutes the major barrier dividing the abdominal cavity in to M. The neural placode is usually located at the lower lumbar-sacral region with resultant tethering of the spinal cord. The only time the recesses of the peritoneal cavity are imaged is when they contain abnormal amounts of fluid (ascites), gas (pneumoperitoneum), or tumor.

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Represents atrial contraction and relaxation followed by ventricular contraction and relaxation. It should be kept in mind that spontaneous recoil of a separated sacroiliac joint may occur that may result in underestimation of the pelvic injury. Seventy percent of the lesions occur in the middle or posterior mediastinum, rarely in the retroperitoneum. Treatment of certain neoplastic diseases, rheumatoid arthritis, psoriasis, and ectopic pregnancies. Mass appears spindle-shaped, with a shorter anteroposterior and a longer mediolateral diameter. The tumor invaded the extraprostatic fat at the angle of the right seminal vesicle (arrow), as well as the right seminal vesicle. Lesions usually have sharp margins that may be slightly lobulated and often have low to intermediate attenuation; can be intraosseous radiolucent lesions or extradural soft tissue lesions. Comments Outpouching of mucosa and submucosa at the pharyngoesophageal junction through a weaker area in the posterior pharyngeal wall (Kilian dehiscence). A young woman who passes grape-like vesicles from her vagina should be diagnosed with hydatidiform mole. The compression of the ulnar artery is then released and the time to achieve maximal palmar blush is noted: normal is <5 seconds, abnormal is >10 seconds, anything in between is intermediate. Fifty percent of patients are asymptomatic, 30% present with myasthenia gravis, 20% with symptoms due to mediastinal infiltration or compression. Sexual abuse occurs in approximately two-thirds of relationships involving physical abuse. Diagnostic evaluation of the spleen should be performed preferentially during the parenchymal phase when there is homogeneous enhancement of the organ. Solid periosteal reactions and cortical thickening may be associated with both conditions, but in the case of chondroid matrix tumor suggest a low-grade chondrosarcoma rather than enchondroma. Occurs frequently in the fifth and sixth decade of life and is almost always asymptomatic. The third number defines the group the fracture belongs to (fracture groups are different for each fracture type, with a scale ranging from 1 to 3). Infectious: Other infectious etiologies such as tuberculosis, salmonella, amebiasis, schistosomiasis, shigellosis can cause diffuse or regional colitis. In addition, the tumors from the posterior wall of the gastric fundus and upper segment of the body may drain along the posterior gastric artery to the nodes along the splenic artery that are known as the suprapancreatic nodes10 or the nodes in the splenorenal ligament and then to the nodes at the celiac axis. Sagittal (a) and axial (b) images show an intraosseous osteosarcoma within a vertebral body that has malignant ossified mineralization with extension in to the spinal canal. Cystometry provides measurements of the relationship of pressure and volume in the bladder. A beak on the cyst pointing medially between the internal and external carotid arteries is present (arrow). The functioning tumors are distinguished by hormonal secretion and present as Cushing syndrome, adrenogenital syndrome, precocious puberty, or Conn syndrome. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. A neck mass (due to jugular or spinal accessory lymphadenopathy) may be the first presenting symptom (at presentation, up to 90% of patients have regional nodal metastases, and at least 20% will have distant metastases). Near occlusion of the superior vena cava due to infiltration of central bronchogenic carcinoma with collateral flow through an enlarged azygos vein (visible on the left side, just above the left atrial appendage). The maxillary sinus drains through the sinus ostium, infundibulum, and hiatus semilunaris in to the middle nasal meatus. Progression of the lesion can lead to vertebra plana (a collapsed flattened vertebral body), with minimal or no kyphosis and relatively normalsized adjacent disks. A solid mass within the cyst may indicate either associated ectopic thyroid tissue or carcinoma.

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Critical contents of the pharyngeal mucosal space are the mucosa, lymphoid tissue of Waldeyer ring (adenoids and faucial and lingual tonsils), minor salivary glands, superior and middle constrictor muscles, salpingopharyngeus muscle, pharyngobasilar fascia (a tough aponeurosis that connects the superior constrictor muscle to the skull base), levator palatini muscle, and the cartilaginous end of the eustachian tube. Group 1 are lymph nodes around the stomach including the left cardiac, right cardiac, greater and lesser curvature, and supra- and infrapyloric nodes. Later extranodal progression may cause the lymphomatous tissue to fill the entire retropharyngeal space. A permeative destructive lesion associated with a large soft tissue mass is evident in the left ischiopubic ramus. Speculum is inserted for visualization of the cervix and the Pap smear is repeated. Alternatively, after cholecystectomy, a long remnant may cause symptoms similar to cholecystolithiasis. The presence of ascites, however, indicates these findings as part of peritoneal carcinomatosis. Developmental variation with potential predisposition to spinal cord injury from traumatic injuries or disk herniations, as well as early symptomatic spinal stenosis from degenerative changes. Absence of abnormal feeding and draining vessels may differentiate this condition from sequestration. Uncommon benign cartilaginous lesion occurring between the ages of 5 and 25 y with slight male predominance. Contraindications: Maternal hypotension, cardiac disease; use with caution with renal disease. Inflammatory disease involving synovium resulting from deposition of monosodium urate crystals. The result does not indicate that the fetus does or does not have the indicated condition, only the risk. Biliary ascites, biloma Usually iatrogenic or posttraumatic, rarely spontaneous rupture of the gallbladder. Closed-cell designs tend to have more uniform coverage and subsequently more homogenous drug delivery. Diagrammatic drawing transverse section through a 4-week embryo in which the pleural and pericardial regions are forming. Relatively well-defined radiolucent areas with endosteal scalloping with or without slight bone expansion and varying degrees of periosteal new bone formation and sclerosis are typical in the long bones. Isolated orbital rim, orbital roof, and lateral orbital wall fractures are relatively uncommon. Urinomas can occur at any time after transplantation and are caused by an anastomotic leak or are secondary to a vascular injury causing a focal necrosis with subsequent leak in the urinary system. Hemorrhagic and protein-rich cysts may also be hyperdense as compared with normal spleen. Twice as frequent in men as women and rare in patients younger than 40 y (peak age 55 y). The involved vertebral bodies may be wedgeshaped, biconcave ("fish vertebrae"), or compressed. Although the method offers high diagnostic accuracy in experienced hands, its clinical relevance is usually still restricted to assessment of patients in whom conventional colonoscopy is either not possible. This is important in both obese and lean patients, and retraction of the pannus with the help of tape is important in obese patients to keep the tissue layer over the arteriotomy site thin and taut. Menstrual abnormalities include: Polymenorrhea: Uterine bleeding occurring at regular intervals of < 21 days. In renal fusion, the fused kidneys are located in the midline and may assume the shape of a horseshoe, disk, or pancake. In the chronic jugular vein thrombosis phase (10 d after acute event), patients present with a tender, vague, deep, nonspecific neck mass, in comparison to a palpable cord encountered when the external vein is thrombosed. They function in secreting mucous to provide vaginal lubrication and are homologous to the bulbourethral glands in males. This can be assessed using conventional X-rays, according to a number of semi-quantitative grading systems such as the Larsen and Sharp scores. Approximately one-third of germ cell tumors found in women < 21 years old are malignant. Delivery may not be in the best interest of the premature baby, but it is indicated to prevent worsening maternal disease.

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The differential diagnosis of biliary tract abnormalities is discussed in Table 20. Pulmonary and supraclavicular nodal metastasis common; yearly screening chest x-ray recommended. Hydrops tubae perfluens is the pathognomonic finding, defined as cramping pain relieved with watery discharge. A poorly defined lesion with less contrast enhancement than the adjacent normal renal parenchyma is seen in the lateral aspect of the kidney. Usually not associated with significant proteinuria or end-organ damage if well controlled. The presence of tumor thrombus in microscopic section of the resected specimen or explanted liver indicates a poor prognosis. The best indicator of a hypopharyngeal malignancy is a bulky mass with invasion and destruction of submucosal and deep structures, as well as associated necrotic lymph nodes. Insert the end of the bridging cable in to matching terminals on the pulse generator, and turn pulse generator on to verify proper functioning of the battery and unit. May extend inferiorly from lesion in cerebellum, ganglioglioma (contains glial and neuronal elements), ganglioneuroma (contains only ganglion cells), gangliocytoma (contains only neuronal elements). The larger the size, the more pain they cause and the higher the risk of ovarian torsion. Enlarged hilar and mediastinal lymph nodes with dense, coarse, or popcorn-like calcifications. The high attenuation value reflects subtle calcifications within the lesion that are not discernible on the images. Occurs in children younger than 5 y (M:F 3:1) and in 40- to 70-y-old adults with strong female predominance. Primary or secondary bone tumor from the sacrum or coccyx may also involve this space. Malignant melanoma and lung and breast carcinoma are the most common primary tumors with a hematogenous spread to the stomach. If the pacemaker detects electrical activity, it is inhibited from delivering a stimulus. Includes the sympathetic and parasympathetic nervous systems, each producing opposite effects when stimulated. If prodromal symptoms or lesions are present, patient should be offered a cesarean delivery to the risk of vertical transmission. The second category includes prophylactic surgery to prevent deformity and loss of function. The posterior vagus nerve courses medial and posterior to the distal esophagus and produces the greater posterior gastric nerve to supply the posterior wall of the gastric fundus and the celiac plexus. Monitor for the development of more severe symptoms (ie, postpartum depression or psychosis). Extraperitoneal gas (arrows) extends anterior to the psoas muscle toward the spine within the anterior pararenal space. Prepare a Talk on a Topic You may be asked to give a small talk once or twice during your rotation. A comminuted distal femoral metaphysis fracture with extension in to the knee is seen. Fracture rotation may be internal (distal fracture fragment rotates medially) or external (distal fracture fragment rotates laterally). Epidermoids are less common and can be differentiated from dermoids by features similar to fluid and more homogeneous appearance. May in advanced stages spread bronchogenically to other lobes and thus lead to numerous bronchocentric air-space consolidations (tree-in-bud sign). Posterior orbital extension may lead to superior orbital fissure syndrome, cavernous sinus thrombosis, and other intracranial complications. A swab at 72 hr after starting treatment is necessary; retreat if this swab is positive. Diagnostic pearls: Vessel tortuosity, intimal calcification, noncalcified atheromatous plaques, and sometimes thrombus formation. Primary sclerotic form is extremely rare, but sclerosis may occur after proper treatment.

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Osteoporosis and rheumatoid arthritis are the two most common conditions in which insufficiency fractures are encountered. Extranodal disease is common in the upper respiratory tract, orbit, and salivary glands. Dominance is a term commonly used to describe coronary vasculature and refers to the distribution of the terminal portion of the arteries. Adenoid cystic carcinoma Extraconal, irregular, isodense, solid, homogeneous, diffuse enhancing mass arising within the lacrimal gland, with invasion of the adjacent bony orbit. Sagittal (a) and coronal (b) images show a vertebra with two pedicles on the left side and one pedicle on the right. Excitability - the ability of a cardiac cell to respond to an electrical stimulus. In the fingertips, the lesion is indistinguishable on plain radiographs from an epidermoid (inclusion cyst). Color Doppler sonography may demonstrate the actual site of the fistula to the distended cava in selected patients. Symptomatic junctional tachycardia may respond to diltiazem, beta blockers (use caution in patients with pulmonary disease or heart failure), or amiodarone. Diagnostic pearls: Mesenteric mass of soft tissue density with spiculated margins; retraction of the bowel loops toward itself is characteristic. Worm infestation (Ascaris and Trichuris): Bolus of ascariasis may cause a solitary filling defect. It is not uncommon for orbital involvement to be the initial site of clinical presentation of lymphoma. Leukemia may involve every tissue of the eye; the choroids are the most consistently involved layer on histopathology. Preferential flow is downward to the iliac fossa, and the collection demonstrates several diagnostic features: 1. Congenital malrotation of the bowel usually is an incidental finding and may include transposition of the superior mesenteric artery. Solitary, large, expansile, osteolytic lesion with scalloped, poorly marginated, nonsclerotic margins, associated with soft tissue masses, with mild/moderate homogeneous contrast enhancement. Sagittal image shows comminuted fractures of adjacent thoracic vertebrae involving all three columns (unstable). Infertility: Supplement with glucocorticoids to suppress androgens and allow ovulation. Bony deformity of the adjacent mandible or posterolateral wall of the maxillary antrum may occur, as well as fat hypertrophy in adjacent soft tissues. Obstetrical: Gravidity, parity, prior labor/deliveries (vaginal, cesareans), complications, infant status, birth weight. Men and women of childbearing age must be made aware that methotrexate is teratogenic; they should practice effective birth control during use and for at least 6 months after the drug has been discontinued. Remove gonads after puberty to avoid risk of malignancy (gonadoblastoma or dysgerminoma). Tracheomalacia has a variety of etiologies, including polychondritis, complication of tracheal intubation, tumors, foreign bodies, and congenital tracheal stenosis. It occurs as a result of sudden loss in blood flow to the colonic wall caused by myocardial infarction, arrhythmia, shock, thromboembolic lesion, trauma, iatrogenic injury, or post-surgery. A prominent cervical transverse process is probably a form of supernumerary cervical rib developing at a level above the lowest cervical vertebra. Normal sinus rhythm with sinus arrest; rate suppression is present following pause.

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A well thought-out strategy with regard to equipment and approach is highly recommended. Fifty-four percent are present in the major salivary glands, 46% in the intraoral minor salivary glands. Water-density, thin-walled, nonattenuating mass in the upper posterior mediastinum near the neural foramen (arrow). The most common type of presentation is the vertex presentation in which the posterior fontanel is the presenting part. Diseases commonly spreading in this fashion are liver abscess, pericholecystic abscess. Syringohydromyelia in 20% to 40%; hydrocephalus in 25%; basilar impression in 25%. Pleural disease usually is induced after penetration of these fibers through the lung in to the pleural space. Normal sinus rhythm with one premature atrial contraction changing to ventricular standstill. The main challenges are identifying optimal growth factors and conditions, and methods to guide the ultimate structure of laboratory-grown tissues, including the use of artificial scaffolds. Postinflammatory dystrophic calcifications within the tonsils exist in as much as 10% of the population (men women, mean age 55 y). Although the remaining pelvic structures, such as the rectum, anus, distal ureters, bladder, cervix, vagina, seminal vesicles, prostate, and sidewall structures, do not readily protrude in to the pelvic peritoneal cavity, they are often associated with fascial planes that frequently confine pathologic processes. Direct hernias protrude via the Hesselbach triangle and usually extend in to the scrotum or the labium majus. Cortical thickening affecting mandible and zygomatic arch may be observed, or a rough bony projection of cortical bone along the anterior surface of the mandible at the site of the masseter insertion; also, normally preserved fascial and soft tissue planes. The Right Subphrenic Space the right subphrenic space is a large continuous compartment extending over the diaphragmatic surface of the right lobe of the liver to its margination posteriorly and inferiorly by the right. Supraglottic (30%) and subglottic (5%) carcinomas are symptomatic late in the course of the disease and therefore usually present in the advanced stage. Patients usually present with a rapidly enlarging thyroid mass and obstructive symptoms related to compression of the aerodigestive tract. The natural spread is inferior and lateral because of gravity, lumbar lordosis, and the fact that this space is open toward the flanks. Sagittal image shows a fracture of the inferior end plate of C2 with teardrop fragment. Type 3: Divergent form: the first metatarsal stays in place or is medially subluxed or dislocated. Vasovagal reaction - An extreme body response that causes marked bradycardia (due to vagal stimulation) and marked hypotension (due to vasodilation). Unusual complications of extraperitoneal abscess include rupture in to the free peritoneal cavity and progressive dissection in the soft tissues. The thoracolumbar junction with T12, L1, and L2 is the most common site of involvement. Lactation Suppression A 26-year-old female, 1 month postpartum, presents to the office with complaints of fever of 100. Unilateral laminar or facet fracture with ligament disruption (anterior annular and capsular ligaments) from combined hyperextension and rotation mechanism of injury. Fluid within the peritoneal cavity outlines the small intestine mesentery (large arrow) and the transverse mesocolon (small arrow). However, a correct diagnosis usually is possible by analyzing the relationship of both fluid collection and the lower lobe on subsequent transverse images and multiplanar reformations. Notice the paper-thin appearance, bilateral distribution, and pale color, with a loss of architecture. The mesenteric portions of the gut have been removed, including the stomach, small bowel, transverse colon, and sigmoid colon.

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In premenopausal women, considerations include ectopic pregnancy, ruptured functional cysts, and endometriosis. In later disease, erosions spread to the subchondral areas, joint-space narrowing occurs and ultimately subluxation, secondary osteoarthritis and even bony ankylosis may ensue. Involvement of subpleural space is indicative of lymphatic or hematogenous spread (lymphatic pattern). If the lesion extends distally in to the bifurcation, then it becomes more complex and challenging. Comments Congenital hamartomatous lymphatic and venous vascular malformation; orbital lymphangiomas tend to populate the extraconal space but are often transspatial. Patients experience gradually progressive loss of vision either to blindness or surgical intervention, as well as proptosis with a dull eye pain. Higher regret rate is associated in women younger than age 25, women not married at the time of their tubal ligation, or women whose tubal ligation was performed less than a year after delivery. Optimal visualization of malignancies is usually achieved on portal venous scans, when pancreatic tumors appear hypodense in contrast to typically strong enhancing pancreatic tissue. Inflammatory changes are also seen in the adjacent right posterolateral abdominal wall, affecting the muscle (arrows), subcutaneous fat, and dermal layer (arrowheads) despite a ``clean' posterior pararenal space. The puerperium is the period of confinement between birth and 6 weeks after delivery. Sagittal (a) and axial (b) images show destructive changes at the upper dorsal portion of a vertebral body with epidural extension (arrows). When there is no cutaneous component, and the lesion is deep in the orbit, it has a tendency to involve the superomedial portion of the orbit, but extensive ones infiltrate most of the orbit and may extend intracranially. There are, however, some situations when a pregnant woman should contact her obstetrician immediately: Vaginal bleeding. Saucer-like defect in the posteromedial cortex of the distal femur, often associated with adjacent sclerosis, periostitis, and soft tissue swelling. The gonads should be removed after puberty to allow for breast development and adequate bone growth. This period corresponds to the down slope of the T wave (relative refractory period). Oocytes that are able to develop in to teratomas undergo an arrest in development after meiosis I. Viral adenitis may present as bilateral diffuse lymph node enlargement without necrosis, similar in appearance to lymphoma and sarcoidosis. Middle rectal and inferior vaginal branches of the hypogastric artery (internal iliac artery) are secondary blood supplies. These neoplasms are most often found in the retroperitoneum or thigh or may be associated with major blood vessels. When the ventricular rate is less than 100 beats per minute, the rhythm is called controlled atrial fibrillation. Associated cellulitis with obliteration of adjacent fat planes, thickening of the platysma, and infiltration of the subcutaneous fat are present. Ischemia - Reduced blood flow to tissue caused by narrowing or occlusion of the artery supplying blood to it. Submandibular space infections are often precipitated by submandibular gland inflammation secondary to ductal stenosis or calculus, or it may result directly from odontogenic infection. Amyloidosis Mitral stenosis Two- to 8-mm noduli within alveolar spaces constituting mature bone. The left ventricle has the thickest wall, because it must eject blood through the aorta against a much greater resistance to flow (the arterial pressure in the systemic circulation). Consequently, the left ventricle is forced to empty against an inflated balloon; the corresponding increase in afterload may increase myocardial oxygen demands and worsen systolic function. Findings include osteitis, sydesmophytosis, diskovertebral erosions, calcifications along the anterior and posterior longitudinal ligaments, osseous fusion across joints, and osteoporosis. The posterior pararenal space itself does not include organs from which infection can arise directly. She should undergo additional blood work to ensure there are no blood dyscrasias and be able to have regular follow-up.