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Intrapartum During the second stage of labor, much of the pain arises from the lower genital tract: Painful stimuli from the lower genital tract are primarily transmitted by the pudendal nerve, which passes beneath the posterior surface of the sacrospinous ligament (just as the ligament attaches to the ischial spine). Neurofibroma may arise from the facial nerve trunk or its branches and may therefore lie within the parotid gland. The head of the pancreas and the duodenum share similar drainage pathways by following arteries around the head of the pancreas. Periarterial and Perineural Spread this mode of tumor spread is commonly seen in patients with malignant tumors such as in hilar cholangiocarcinoma, carcinoma of the gallbladder, and lymphoma. Cervical biopsy: Neoplastic and dysplastic areas are then biopsied under colposcopic guidance. May be distinguished from focal steatosis (poorly discernible, blood vessels crossing through lesions) and metastases from liposarcoma (heterogeneous lesions with distinct attenuation on postcontrast scans). A relatively poorly defined mass with inhomogeneous, hypodense central areas is evident in the thigh. Below the diaphragm, lymph drains in to the nodes along the inferior phrenic vessels near the diaphragmatic crura and to the cisterna chyli and thoracic duct on the right side of the aorta. The nurse and monitor technician need to be proficient in recognizing monitoring problems, identifying probable causes, and seeking solutions to correct the problem. Transvenous pacing - Transvenous pacing refers to the delivery of a pacing stimulus to the heart through a vein (transvenous approach). In vulvar carcinoma, early metastatic nodal involvement of inguinal and subsequently pelvic nodes occurs. Mestasis of Cervical Cancer Small-cell carcinoma: Small, round, or spindle-shaped cell with poorly defined tumor-stromal borders. During this time, patients are encouraged to maintain healthy practices and abstain from practices that are harmful for the pregnancy. Mechanisms of Spread of Disease in the Abdomen and Pelvis 4 Introduction the perspective afforded by Oliphant and colleagues of the holistic paradigm forms the basis for a comprehensive understanding to visualize the abdomen and pelvis as a single space, the subperitoneal space. Lutein Cysts There are two types of lutein cysts: corpus luteum cysts and theca lutein cysts. After stent deployment, final angiographic images should include two orthogonal views with the guidewire removed. Type 3: Divergent form: the first metatarsal stays in place or is medially subluxed or dislocated. Lesion is often asymptomatic until large in patients over 40 y of age (M F) with a history of alcohol and tobacco use. A woman that is gravida 3, para 1201 (G3P1201) has been pregnant three times, has had one term birth, two preterm births, no abortions, and has one live child. She reports an in vaginal discharge for the past day, but denies any other symptoms. Instead, the accompanying vessels can be used as a reliable landmark to identify the various free and fused mesenteries. Demonstration of fluid collections within the thickened pleural peel is highly suspicious of a still ongoing and active infection. Diagnostic pearls: May be hypo- or hyperattenuating on postcontrast scans; calcified in 30% of cases. For provisional side-branch treatment, decide whether to predilate the side branch after the main branch is predilated. These measurements, however, are not completely reliable because of an enormous variation in the normal population. 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. Malignant tumors of the sublingual gland, and minor salivary gland origin include adenoid cystic carcinoma, mucoepidermoid carcinoma, malignant mixed tumor (carcinoma ex pleomorphic adenoma), metastasizing benign mixed tumor, and carcinosarcoma.

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Periampullary carcinoma with nodal metastasis along the inferior pancreaticoduodenal route. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Cystic metastases observed particularly in ovarian carcinoma and sometimes melanoma. The tumor is often homogeneous, solid, and hypodense and shows only minor enhancement. Narrow neck outpouching of the posterior bladder wall near the ureteral insertion (a) eventually fills with contrast on delayed imaging (b): a Hutch diverticulum. The anterior vagus nerve is formed from the left vagus branch of the esophageal plexus. On occasion, the tumor with its invasion to the surrounding organs may form a confluent mass that makes it difficult to define the site of the primary. Intrahepatic extension of a pancreatic pseudocyst (continues on page 688) Focal Liver Lesions 687. The displaced pancreas body is the triangular hyperattenuating structure cranial to it (arrow). Jejunal and ileal folds may be visible but usually measure at most 2 to 3 mm in thickness. Further spread occurs in to the retromolar trigone, parapharyngeal, and submandibular spaces and the floor of the mouth. Further extension of tumor can involve the orbit, cavernous sinus, and even the brainstem. They are mainly used to treat coronary perforations, cover aneurysms, and close fistulas. Femoroacetabular impingement: radiographic diagnosis-what the radiologist should know. The adverse effects of corticosteroids limit their long-term use, especially in high doses. It is bounded inferiorly by the transverse colon and the mesocolon, although a well-defined inferior recess persists in a few individuals between the anterior and the posterior reflections of the greater omentum. Expansile blood/debris-filled lesions that may be primary or occur secondary to other bone lesions, such as giant cell tumor, fibrous dysplasia, and chondroblastoma. Takahashi T, Ishikura H, Motohara T, Okushiba S, Dohke M, Katoh H: Perineural invasion of ductal adenocarcinomas of the pancreas. Regardless of its cause, complete heart block is a serious and potentially life-threatening arrhythmia. Always rule out inflammation, tumors (benign and malignant), and diverticula (Meckel diverticulum). Diagnostic pearls: Pulmonary valve stenosis: Thickening, fusion with or without calcification of valve cusps or anulus; also, normal-sized heart and dilated pulmonary artery. A comparison of the transradial and the transfemoral approach in chronic total occlusion percutaneous coronary intervention. A typical finding is the target sign with a punctate high attenuation centrally surrounded by peripheral low attenuation within multiple small tumor nodules. Laminaria: Organic/synthetic material that slowly hygroscopically expands when placed in the cervix. Desire: Begins in the brain with perception of erotogenic stimuli via the special senses or through fantasy. Type 3 is a talar neck fracture with dislocation of both the ankle and subtalar joint. Blood is also accumulated within the two layers of the posterior renal fascia (arrows).

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A well-defined osteolytic lesion with pathologic fracture depicting a "fallen fragment" (arrow) is seen in the intratrochanteric/subtrochanteric area. First Stage the first stage of labor begins with onset of uterine contractions of sufficient frequency, intensity, and duration to result in effacement and dilation of the cervix, and ends when the cervix is fully/completely dilated to 10 cm. An exception to unilateral confinement in the upper abdomen has been seen in gas-producing pancreatitis, presumably by virtue of the digestive enzymes involved. By pacing both ventricles, the pacemaker can resynchronize a heart whose opposing walls do not contract in synchrony (a problem that occurs in 25% to 50% of heart failure patients). Lingual (ectopic) thyroid gland Well-circumscribed midline or paramedian lobulated tongue mass along the course of the thyroglossal duct (foramen cecum area), less commonly in the sublingual space or tongue root. Bone scintigraphy shows an unusual intense uptake in the center of the lesion (nidus) surrounded by the less intense uptake of the adjacent sclerotic bone (double density sign), differentiating it from chronic cortical osteomyelitis with small abscess formation. Type B: Fracture originates at the joint line and progresses superiorly and posteriorly. Neuroblastoma with extensive subperitoneal space extension and spread to the thorax. Ventrally, the anterior pararenal space is anatomically continuous with the roots of the small bowel mesentery and transverse mesocolon. Accounts for 15% of liver cancers, but only 10% of all cholangiocarcinomas are intrahepatic. Uncommon disease in which various tissues (including bone, muscle, tendons, tendon sheaths, ligaments, and synovium) are infiltrated with extracellular eosinophilic material composed of insoluble proteins with beta-pleated sheet configurations (amyloid protein). Predisposing conditions: cirrhosis due to ethanol or virus hepatitis, hemochromatosis, Wilson disease, Gaucher disease, glycogen storage disease (type 1), tyrosinosis, and biliary atresia. It contains areolar and connective tissue, devoid of vascular, nervous, or lymphatic structures. The posterior pararenal space extends from the posterior renal fascia to the transversalis fascia. Prepare a Talk on a Topic You may be asked to give a small talk once or twice during your rotation. Comments Inflammation of the submandibular gland results from ductal obstruction due to sialolithiasis, fibrous strictures, or a neoplasm obliterating the orifice of Wharton duct. Other studies suggest an even higher rate of work disability, with a third of patients ceasing work within 2 years of diagnosis, although early biological therapy has had a major impact on job retention and employment prospects. The atlas (C1) has a horizontal ringlike configuration with lateral masses that articulate with the occipital condyles superiorly and the superior facets of C2 inferiorly. Rectal carcinoma with metastatic nodes in the mesorectum and lateral nodes outside the mesorectum. Aggressive tumors of the testis and tumors of mesenchymal origin may spread in to the vein or along the inguinal canal to the extraperitoneum. Inferior Phrenic Nodal Pathways Tumors involving the esophagogastric junction or the gastric cardia may invade the diaphragm as they penetrate beyond its wall. The anterior column consists of the anterior half of the vertebral body and disk, along with the anterior longitudinal ligament. The anterior (interrupted line) and posterior (dotted line) osseous rim of the acetabulum do not cross over. Other people may point out areas that you have not studied enough and may help you focus on the goal. The descending colon lies in the far left lateral abdomen and stretches from the splenic flexure to the pelvic brim. On plain films, loss of visualization of the complete muscle border is often misleading and must be carefully evaluated. Compression at this site then leads to distention of the ascending colon and cecum as well. The postcricoid region extends from the cricoarytenoid joints to the lower edge of the cricoid cartilage (cricopharyngeus muscle).

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Vulvar dystrophies are a group of disorders characterized by various pruritic, white lesions of the vulva. Thus, prevesical effusions can extend laterally around the parietal peritoneum to come in to contact with the iliopsoas muscles and external iliac vessels and then extend superiorly from the infrarenal retroperitoneal space in to pararenal compartments. Pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum may be concomitant after perforation of the colon. Thus, the elderly person living alone will be more disabled than if they have a partner to help them dress. Extension injury from posterior displacement of the head and upper cervical spine resulting in fractures of the arch (laminae) and/or posterior elements, with or without disruption of anterior longitudinal ligament. False negatives may occur if: the test is performed too early (ie, before the first missed period). Rare congenital abnormality characterized by segmental dilation of intrahepatic bile ducts. Symptoms include progressive dyspnea, nonproductive cough, weight loss, and fatigue. Histologically, well-defined granulomas with a rim consisting of fibroblasts and lymphocytes. Fractures involving the posterior column from extension, flexion-distraction, or flexionrotation mechanisms. Epidermoid: Low-density, unilocular, well-demarcated mass localized in the buccal space, with fluid contents only, a thin wall, and no significant surrounding inflammatory changes. Varicose bronchiectasis with peribronchial cuffing and mucous plugging, particularly affecting the middle lobe of the right lung (a). A 21-gauge needle (short or 7-cm long depending on the kit) is introduced in to the vessel using the same technique for both femoral and radial access; then a 0. Large heterogeneous, solid mass typically with cystic spaces representing necrosis. Acute suppurative parotitis and abscess (continues on page 319) Parotid Space Lesions 319 Table 8. A membrane separates the inside of the cardiac cell (intracellular) from the outside (extracellular). 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. However, patient preference, anatomic reasons (presence of hernia or infected/indurated groin area), and previous scars and surgeries-especially bypass grafts-are important considerations to keep in mind when selecting the appropriate groin site. Diagnostic pearls: Pleural and pericardial effusions; bilateral subpleural reticular opacities with or without honeycombing; bronchocentric micronodular pattern (tree-in-bud); bronchiectasis/bronchial wall cuffing; lupus pneumonitis with coarse linear bands and patchy ground-glass opacities in the periphery of the lung. Cicatrization (scar) atelectasis is associated with pulmonary fibrosis that may be localized or generalized. Gas has diffused caudally in the left lateral abdomen in the subperitoneal space (arrow 5). The patient is then discharged home on an oral anticoagulant for several more weeks. The principal contents of the submandibular space are the superficial portion of the submandibular gland, the submandibular and submental lymph nodes, the anterior belly of the digastric muscle, the facial vein and artery, and the inferior loop of the hypoglossal nerve and fat. Symptomatic junctional tachycardia may respond to diltiazem, beta blockers (use caution in patients with pulmonary disease or heart failure), or amiodarone. If the conduction ratio remains constant (2:1), the ventricular rhythm will be regular, and the rhythm is described as atrial flutter with 2:1 conduction. Fibroma, benign fibrous histiocytoma, giant cell tumor of the tendon sheath (hands and feet), rhabdomyoma, and mesenchymoma. This method can be more effective than either of the other two methods because it uses a variety of signs.

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If the pacemaker does not detect electrical activity, it is triggered to initiate an electrical stimulus. In the resting cardiac cell, there are more negative ions inside the cell than outside the cell. In the neonate, adrenal hemorrhage may be associated with birth trauma, hypoxia (prematurity), septicemia, and bleeding disorders. The supramesocolic space is subdivided in to the right and left subphrenic spaces, the subhepatic space, the Morison pouch, and the lesser sac. Uterosacral ligaments: Each ligament extends from an attachment posterolaterally to the supravaginal portion of the cervix and inserts in to the fascia over the sacrum. Two-, three-, and four-part fractures may be associated with either anterior or posterior glenohumeral joint dislocation. Overlying subcutaneous tissues often demonstrate linear stranding or mottled increased attenuation beneath thickened skin. Dissections may cause headache, neck or suboccipital pain, cerebral ischemia, and infarction (from either flow reduction or thromboembolic complications). The wall of the cava is adherent to the margins of the foramen and thus interrupts continuity of the subserous space. The most typical and consistent feature of the pseudocyst is that its axis conforms to the distended cone of renal fascia. Retropharyngeal space infection occurs most commonly in children (6 y), but also in adult patients. Rare, developmental mass of dysplastic neurogenic tissue sequestered and isolated from the subarachnoid space ("encephalocele" that has lost its intracranial connection). Between ages 7 and 8, most children engage in childhood sexual games, either same-gender or cross-gender play. The latter initially leads to extrahepatic cholestasis followed by intrahepatic cholestasis. Sagittal (a) and axial (b) views of a distal tibial fracture extending in to the tibial plafond. Pathologic vertebral fracture, with or without epidural tumor extension causing compression of neural tissue or vessels. Abscesses appear as single or multiloculated, lowdensity areas, with or without gas collections, and demonstrate peripheral rim enhancement. She was a restrained driver who was rear-ended while going 65 miles per hour on the freeway. A partially cystic mass with fluid layers may be observed in cases of anticoagulation-induced bleeding. Complications include vascular injuries, infection, painful internal fixation devices. If they like you, they can make your life a lot easier and make you look good in front of the residents and attendings. Can be associated with spinal cord contusion, vertebral artery injury (dissection/ occlusion), and other vertebral fractures. Ectopic ureters may open in to the urethra or genital tract, and the most distal ureter is often dilated. Intraosseous hemangiomas of the facial bones are rare and most commonly arise in the maxilla, zygoma, mandible, and nasal bone. Gallbladder carcinoma associated with "porcelain" gallbladder and chronic inflammation due to gallstones. Intracranial extension along the optic pathway through the eroded optic canal is common with a dumbbell shape. This section will review the appropriate screening and therapy for anti-D isoimmunization. Diagnostic conization is reserved for patients in whom an invasive lesion is suspected but cannot be confirmed by biopsy and the results will alter the timing or mode of delivery. Thus, the esophageal hiatus and the aortic hiatus allow continuity of the subserous space of thorax and abdomen. A cylindrical bronchiectasis viewed end on with the accompanying considerably smaller pulmonary artery branch produces the characteristic "signet ring" sign (arrow).

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However, in sarcoidosis, massive fibrosis may also present as a central homogeneous mass or large nodular lesions with irregular margins. A hyperdense enhanced node (arrowhead) between the right crus of the diaphragm and the inferior vena cava, the right inferior phrenic node, is also present as well as the nodes (curved arrows) on both sides of the celiac axis. Burgener the diagnosis of articular disorders is primarily made by conventional radiography. Vasovagal reaction - An extreme body response that causes marked bradycardia (due to vagal stimulation) and marked hypotension (due to vasodilation). An absolute neutrophil count < 500 cells/L requires prophylactic antibiotic treatment to prevent septic complications. Cervical spine plasmocytomas occur in patients older than 40 y, with male predominance; can be asymptomatic or present with local neck pain, low levels of serum/urine monoclonal proteins, and neurologic compromise from cord compression. Sexual aversion disorder: Persistent or recurrent aversion to and avoidance of genital contact with a sexual partner. Nonneoplastic extramedullary epithelialinclusion lesions filled with desquamated cells and keratinaceous debris; usually mild mass effect on adjacent spinal cord and/ or nerve roots. Less commonly, the tumor may be diffuse and invasive with extrathyroidal extension. Blood supply of normal liver parenchyma constitutes 75% of portal venous and 25% of arterial blood; that of liver tumors, 80% and 95%, respectively. Fluid levels in osseous lesions are most frequently associated with aneurysmal bone cysts, but they are also not uncommon in simple (unicameral) bone cysts and may occasionally be found in giant cell tumors, chondroblastomas, telangiectatic osteosarcomas, and a variety of other bone lesions (Table 14. Comments Asymmetric fracture involving superior and anterior end plates of vertebral body from asymmetric axial load with or without flexion. The mechanism of this rhythm is most likely multiple reentry circuits in the atria. The main part of the tumor lies within the abdominal cavity, but it also infiltrates muscle layers of the left abdominal wall. Bilateral renal involvement Centrally located, heterogeneous renal mass with indistinct borders and frequent central necrosis. Optic nerve dysfunction results from inflammation of the perineural tissue or compression on the optic nerve from mass effect. The extremities initially turn white, then blue and ultimately pink from reactive hyperemia. Mediastinal lymph node calcifications occur in 3% to 10% of patients with sarcoidosis. Cirrhosis: Excessive bleeding secondary to the reduced capacity of the liver to metabolize estrogens. Fungal infections (mucormycosis, aspergillosis) may occur as a complication of diabetic ketoacidosis and in immuncompromised and debilitated patients. Dysfunctional uterine bleeding: Bleeding that occurs after organic, systemic, and iatrogenic causes have been ruled out. Radiation enteritis may occur up to 20 y after treatment, radiation colitis within 2 y after radiation. In addition, we will need more research as to how to use these newer therapies in combination with more traditional medications such as methotrexate. Other noninfectious inflammatory diseases involving the spinal cord Sarcoid Intramedullary lesion or multiple lesions in spinal cord. Infectious: Other infectious etiologies such as tuberculosis, salmonella, amebiasis, schistosomiasis, shigellosis can cause diffuse or regional colitis. It is uncommonly seen on imaging studies unless thin-section techniques are used, or it is thickened by pathologic processes. Comments the time span for development and resolution of pulmonary changes depends on the mechanism involved and thus is extremely variable, ranging from a few hours to several months. A focal projection of cyst extending between the carotid bifurcation, termed a "notch" sign, is considered pathognomonic for a second branchial cleft cyst. This kind of debulking surgery has been shown to improve survival in patients with any stage ovarian cancer. On the left figure, 1, inferior tilt; 2, normal orthogonal origin; and 3, superior tilt.

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Characterized by infiltration of the myometrium by intermediate trophoblasts, which stain positive for human placental lactogen. A structure of particular significance in the left upper quadrant of the abdomen is the phrenicocolic ligament. Bronchogenic carcinoma metastases are typically osteolytic or mixed and occasionally expansile. Note lymphomatous mass around the left kidney (K) and in the jejunal mesentery (J). It is essential to note that these component parts are in continuity and interconnected. Meyers noted that adhesions developing along the peritoneal fold raised by the left gastric artery often clearly partition an abscess to one of its two major compartments. Comments Congenital nonunion of the upper margin of the dens with a terminal ossicle located superior to the transverse ligament. Anterior and posterior renal fasciae fuse behind the colon and form a single lateroconal fascia. These muscle cells contract after delivery thereby constricting the blood vessels. A large body of knowledge is accumulating concerning prosthetic joint loosening, which should result in the development of techniques and strategies to prolong the life of artificial joints. It is not possible to provide a completely accurate picture for each patient, but a number of prognostic factors have now been defined. Diagnostic pearls: Usually asymmetric nodular septal thickening confined to one lung/lobe (may also involve both lungs; may resemble edema: Kerley B lines on radiographs); centrilobular micronodules involving the subpleural space (lymphatic distribution pattern); nonspecific patchy ground-glass opacities with or without septal thickening (crazy paving). The triquetrum is the second most fractured carpal bone, accounting for almost 20%. Paraorbital osteomas are more common in men, most often in the second to fourth decades of life. The onset is gradual, with several days of upper and lower respiratory tract symptoms followed by the development of a classic barking cough and stridor. If you are expected to "pre-round," you should give yourself at least 10 minutes per patient that you are following to see the patient and learn about the events that occurred overnight. The atrophic uterus (asterisk) and adnexa (arrowheads) lie posteriorly in this postmenopausal woman. In addition, heart rates higher than normal decrease the amount of time the heart spends in diastole, leading to a decrease in coronary artery perfusion (coronary arteries are perfused during diastole). Coronal multiplanar reconstruction shows involvement not only of the left lateral chest wall but also the left diaphragmatic pleura (b). A cluster of thick-walled cysts in the left lower lobe with variable fluid levels. Patient with abdominal pain and hematochezia has a thickened descending colon wall (arrow). In the later months of pregnancy, the fetus assumes a characteristic posture ("attitude/habitus"), which typically describes the position of the arms, legs, spine, neck, and face. In the case of uncharged particles, movement proceeds until the particles are uniformly distributed within the solution. The cells are smeared on a glass slide, fixative spray is applied, and the cells are examined. Diagnostic pearls: Characterized by solitary peripheral or central mass, usually with irregular or spiculated border. The pancreas is embedded in the extraperitoneum except for the most distal portion of the tail, where it remains within the dorsal mesogastrium to become the splenorenal ligament. Occasionally, however, a frank fracture line cannot be demonstrated in nondisplaced fractures even when conventional images in several projections are taken. Early hydronephrosis can be differentiated from an extrarenal pelvis and postobstructive uropathy by the persistent nephrogram and delayed urinary contrast material excretion after contrast enhancement.

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Because fractures are not immobilized in abused (battered) child syndrome, excessive callus formation is common in that condition too. In the original three-column classification system, one-column fractures are considered stable and three-column fractures unstable, whereas two-column fractures may be stable or unstable (Table 15. Tubular mass along the course of the mandibular division of the trigeminal nerve and its primary branches within the masticator space. Irregular 140 beats/minute Vary in size, shape, and direction across rhythm strip 0. Transitional deformity, which can occur in the sagittal and/or coronal planes, is the hallmark of this injury. Interpretation: Ventricular paced rhythm with eight intrinsic beats (normal pacemaker function) Answer key to Chapters 5 through 11 359 Strip 10-13 Analysis: All complexes are pacemaker induced. In that case, the anterior column fracture may also originate below the anteroinferior iliac spine. Below the arcuate line, the aponeuroses of all three oblique muscles pass anterior to the rectus muscle. Adverse events include bone marrow toxicity, reversible alopecia, skin rash, stomatitis, diarrhea, hypertension and elevation in liver enzymes. If the pacemaker detects electrical activity, it is inhibited from delivering a stimulus. General principles of treatment: Patients may undergo definitive treatment only if disease is confined to pelvis. The sites of involvement are maxillary sinus ethmoid sinus frontal sinus nasal cavity sphenoid sinus. Examine the patient in both the supine and standing position to help determine the severity Pelvic Relaxation of the prolapse. A fatty lesion with barely perceptible sclerotic margin is seen in the anterior calcaneus. While useful for monitoring clinical trials, these scores have not been validated in the routine clinical setting. Signs of remaining activity or reactivation include a change from the previous exam, poorly defined areas of osteolysis, laminated periosteal reaction, poorly defined bony excrescences, and demonstration of a sequestrum, sinus tract, or soft tissue abscess. The internal and external pelvic muscular and bony frameworks are relevant, as disease processes arising in these structures sometimes manifest within the pelvic cavity. Characteristic clinical history Synovial chondromatosis/osteochondromatosis (juvenile or idiopathic) Trauma (chondral and osteochondral fractures) Septic or tuberculous arthritis Degenerative joint disease None Evidence of trauma None Evidence of joint destruction and deformity Osteophytosis, sclerosis, subchondral cysts, and joint space narrowing Similar to degenerative joint disease, but more destructive and progressive. Sclerosis of the subchondral bone, especially on the anterior iliac side, tiny osteophyte formations, and a pneumatocyst (arrow) are seen. Rarely, osteomas arise from the cortical surface of the clavicle, pelvis, and tubular bones. Focal or multiple sclerotic lesions are an unusual initial presentation but may develop after chemotherapy, irradiation, or pathologic fracture. Round intrahepatic cystic mass or tubular lucencies simulating dilated bile ducts (see also. With or without convex outward angulated configuration of compressed vertebral bodies, with or without spinal cord and/or spinal canal compression related to fracture deformity, with or without retropulsed bone fragments in to spinal canal, with or without subluxation, with or without kyphosis, with or without epidural hematoma. Hypopharyngeal carcinoma (continued) Pharyngocele Air-filled saccular formation arising either from the lateral side of the pyriform sinus (ostium of junction located between the middle and inferior constrictor muscles) or from the vallecula (ostium of junction located between the superior and middle pharyngeal constrictor muscles). Epidermoids seem to involve the sublingual space more commonly; dermoids, the submandibular space. One-column fractures are stable, two-column fractures stable or unstable, and threecolumn fractures unstable. The degree of subchondral depression and fracture fragment displacement are crucial factors in the selection of the treatment modality. Do not touch lesions; antimicrobial therapy and cytotoxic drugs are treatment of choice.