POSTER SECTIONS Coverpage Learning objectives Background Findings and procedure details Conclusion Personal information and conflict of interest References

ECR 2022 / C-17480

Oncological emergencies: what the radiologist should not miss

Congress:

ECR 2022

Poster Number:

C-17480

Type:

Educational Exhibit

Keywords:

CNS, Oncology, Thorax, CT, Fluoroscopy, MR, Chemotherapy, Contrast agent-intravenous, Contrast agent-oral, Cancer, Metastases, Neoplasia

Authors:

M. A. Aranda Hernández, D. A. Guerrero Gomez, N. Plata, R. E. Guatibonza, W. Aponte

DOI:

10.26044/ecr2022/C-17480

DOI-Link:

https://dx.doi.org/10.26044/ecr2022/C-17480

Learning objectives

To review imaging findings in cancer patients that present with urgent complications. To present an approach by systems for the understanding of oncological emergencies' imaging. To provide imaging pearls that help the radiologist to diagnose them accurately and promptly.

Background

There has been an important increase in the incidence of cancer worldwide with a concomitant rise in the probability of developing oncologic complications. About 33% of cancers present with oncologic emergencies and 80% of clinical emergencies in cancer patients are secondary to direct complications [1]. Oncologic emergencies are defined as acute, life-threatening conditions that develop directly or indirectly by the disease or treatment [2]. We can classify these emergencies into metabolic, hematologic, and structural [Fig 1]. Structural emergencies are the entities in which the radiologist...

Findings and procedure details

A.CENTRAL NERVOUS SYSTEM 1.CEREBRAL HERNIATION Mass effect from tumor lesions or vasogenic edema are the two main causes of cerebral herniation [3,4]. [Fig 2] Slow growing tumors can produce minor symptoms, unlike fast growth lesions that produce sudden neurological deficit and high intracranial pressure. Herniations may be supratentorial or infratentorial; the key to identify them is to define brain tissue displacement by looking at the midline, ventricles, and cisterns. It’s important that the radiologist reports these entities since they may have certain specific complications. [Fig...

Conclusion

Knowledge of oncological emergencies is key for accurate interpretation of images in cancer patients. Computed tomography is the study of choice in cancer patients with abdominal and thoracic complaints due to its availability, rapidness, and non-invasive approach. For the evaluation of the central nervous system the preferred image is MRI since it gives the most accurate depiction of anatomy and tissue characterization.

Personal information and conflict of interest

M. A. Aranda Hernández: Nothing to disclose D. A. Guerrero Gomez: Nothing to disclose N. Plata: Nothing to disclose R. E. Guatibonza: Nothing to disclose W. Aponte: Nothing to disclose

References

Bosscher MRF, van Leeuwen BL, Hoekstra HJ. Mortality in Emergency Surgical Oncology. Annals of Surgical Oncology. 2014. Bosscher MRF, van Leeuwen BL, Hoekstra HJ. Current Management of Surgical Oncologic Emergencies. 2015. PLoS ONE 10(5): e0124641. doi:10.1371/journal.pone.0124641 Landis SH, Murray T, Bolden S, et al. Cancer statistics. CA Cancer J Clin 1999;49(1):8–31, 31. Smedby KE, Brandt L, Backlund ML, et al. Brain metastases admissions in Sweden between 1987 and 2006. Br J Cancer 2009;101(11):1919–24 Chamberlain MC. Carcinomatous meningitis. Arch Neurol 1997;54(1):16–7. Chamberlain MC. Neoplastic meningitis. Oncologist...

Fig 1: Oncologic emergencies classification.

Fig 2: Cerebral herniation etiologies.

Fig 3: Supratentorial herniation – types and complications.

Fig 4: Infratentorial herniation – types and complications.

Fig 5: A. Axial T2-weighted image through the head shows an intra-axial right frontal...

Fig 6: A. Axial T1-weighted images with IV contrast of a 68-year-old patient with...

Fig 7: A. Most frequent localization of spinal metastases with corresponding primary...

Fig 8: Imaging differences of osteomyelitis and bone metastases.

Fig 9: A. Sagittal T1 and T2-weighted images through the lumbar spine show a...

Fig 10: Coronal T2-weighted image of a 3-year-old male shows a heterogenous mass (red...

Fig 11: A. Imaging findings in pulmonary embolism. B. Axial and coronal pulmonary...

Fig 12: A. Coronal IV-contrast enhanced CT image through the neck shows a large mass...

Fig 13: Most frequent localizations of esophago-respiratory fistulas (ERF).

Fig 14: A. Coronal views of the esophagus of a swallow study performed with hydro...

Fig 15: Common bleeding origins in massive hemoptysis.

Fig 16: Axial non-enhanced CT through the chest in a 40-year-old female patient shows a...

Fig 17: A. Imaging findings in superior vena cava syndrome according to obstruction...

Fig 18: Classification of abdominal oncologic emergencies.

Fig 19: A. Most common sites of intestinal obstruction with their etiologies. B....

Fig 20: A. Axial and coronal IV-contrast enhanced CT through the abdomen from a...

Fig 21: A. Malignancies related with increased intestinal perforation risk. B. Coronal...

Fig 22: A. Intraabdominal bleeding causes in oncologic patients. B. Axial...

Fig 23: A. Malignant neoplasms that may cause bowel ischemia. B. Imaging findings of...

Fig 24: A. Coronal T2-weighted image through the abdomen of a 56-year-old male shows a...

Fig 25: A. Most common oncologic causes of acute vascular obstruction in the...

Fig 26: A. Coronal and axial IV-contrast enhanced CT images through the abdomen of a...

Fig 27: Origin sites of abdominal malignancies that may cause biliary syndromes.

Fig 28: A. Coronal and axial MRCP images in a 48-year-old male patient with pancreatic...

Fig 29: Pelvic and retroperitoneal malignant causes of urinary obstruction.

Fig 30: A. Coronal oral and IV-contrast enhanced CT images through the abdomen evidence...