RSNA Sunday Night

Film Panel 2015

<div class="sg" id="s18" data-sgid="Subtitle 2" style="z-index:3;left:62.13px;top:0.00px;width:595.26px;height:96.05px" data-valign="top"> <img class="sg" src="44DEA97B.png" id="s18_i" style="z-index:1;left:0px;top:0px;width:595.26px;height:96.05px" > <div id="s18_t" class="sg" style="z-index:2;left:0.00px;top:-9.36px;width:595.26px;height:146.19px;"><div><p para="{al:2}"><span data-textwidth="206.43" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:244%; left:199.63px;top:18.08px;">2015 RSNA </span><span data-textwidth="514.17" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:244%; left:40.73px;top:70.89px;">Image Interpretation Session</span></p></div></div></div> <div class="sg sgTitle" id="s16" data-sgid="Rectangle 2" style="z-index:1;left:92.49px;top:99.89px;width:534.57px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s16_t" class="sg" style="z-index:2;left:-0.37px;top:-0.36px;width:535.28px;height:78.31px;"><div><p para="{al:2}"><span data-textwidth="385.74" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:200%; left:74.95px;top:16.57px;">Jonathan Kruskal, MD PhD</span></p></div></div></div> <div class="sg" id="s19" data-sgid="Picture 2" style="z-index:4;left:44.50px;top:163.81px;width:209.66px;height:202.16px"> <img class="sg" src="C521D9CF.png" id="s19_i" title="" alt="\\duhsnas-pri\home\frush943\FSDesktop\Desktop\Kruskal 2014.jpg" style="z-index:1;left:0px;top:0px;width:209.66px;height:202.16px" > </div> <div class="sg" id="s17" data-sgid="Rectangle 3" style="z-index:2;left:257.39px;top:189.83px;width:450.62px;height:180.84px" data-valign="top" data-pointer-events="none"> <div id="s17_t" class="sg" style="z-index:2;left:-8.98px;top:-5.03px;width:459.97px;height:186.24px;"><div><p para="{bl:{ch:167},spbf:0.20}"><span data-textwidth="424.87" class="sg nowrap f3" style="z-index:2;color:#FFFFFF;font-size:161%; left:16.83px;top:12.36px;">&#61607;<span class="f2" ><span style="letter-spacing:3.13px"> </span>Chairman and Radiologist-in-Chief</span></span></p><p para="{in:2,bl:{ch:8722},spbf:0.20}"><span data-textwidth="371.10" class="sg nowrap f4" style="z-index:8;color:#FFFFFF;font-size:128%; left:61.84px;top:51.57px;">−<span class="f2" > Beth Israel Deaconess Medical Center</span></span></p><p para="{bl:{ch:167},spbf:0.40}"><span data-textwidth="293.58" class="sg nowrap f3" style="z-index:10;color:#FFFFFF;font-size:161%; left:16.83px;top:94.22px;">&#61607;<span class="f2" ><span style="letter-spacing:3.13px"> </span>Professor of Radiology </span></span></p><p para="{in:2,bl:{ch:8722},spbf:0.20}"><span data-textwidth="192.63" class="sg nowrap f4" style="z-index:12;color:#FFFFFF;font-size:128%; left:61.84px;top:133.43px;">−<span class="f2" > Harvard University</span></span></p></div></div></div> <div class="sg sgTitle" id="s26" data-sgid="Rectangle 2" style="z-index:1;left:53.49px;top:21.95px;width:612.55px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s26_t" class="sg" style="z-index:2;left:-0.34px;top:-5.89px;width:613.26px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="472.28" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:70.59px;top:18.11px;">Jonathan Kruskal, MD PhD</span></p></div></div></div> <div class="sg" id="s27" data-sgid="Rectangle 3" style="z-index:2;left:101.47px;top:93.90px;width:546.56px;height:282.77px" data-valign="top" data-pointer-events="none"> <div id="s27_t" class="sg" style="z-index:2;left:-8.39px;top:-4.81px;width:555.32px;height:287.95px;"><div><p para="{bl:{ch:167},spbf:0.30}"><span data-textwidth="400.38" class="sg nowrap f3" style="z-index:2;color:#FFFFFF;font-size:156%; left:16.14px;top:12.17px;">&#61607;<span class="f2" ><span style="letter-spacing:8.40px"> </span>Medical School: U of Cape Town</span></span></p><p para="{bl:{ch:167},spbf:0.30}"><span data-textwidth="501.68" class="sg nowrap f3" style="z-index:4;color:#FFFFFF;font-size:156%; left:16.14px;top:55.86px;">&#61607;<span class="f2" ><span style="letter-spacing:8.40px"> </span>PhD: South African Liver Research Center </span></span><span data-textwidth="296.09" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:43.62px;top:88.91px;">(liver tumor angiogenesis)</span></p><p para="{bl:{ch:167},spbf:0.30}"><span data-textwidth="381.06" class="sg nowrap f3" style="z-index:7;color:#FFFFFF;font-size:156%; left:16.14px;top:133.16px;">&#61607;<span class="f2" ><span style="letter-spacing:8.40px"> </span>Post-doc: Vanderbilt University</span></span></p><p para="{bl:{ch:167},spbf:0.30}"><span data-textwidth="421.51" class="sg nowrap f3" style="z-index:11;color:#FFFFFF;font-size:156%; left:16.14px;top:176.85px;">&#61607;<span class="f2" ><span style="letter-spacing:8.40px"> </span>Residency: NE Deaconess Hospital</span></span></p><p para="{bl:{ch:167},spbf:0.30}"><span data-textwidth="519.92" class="sg nowrap f3" style="z-index:13;color:#FFFFFF;font-size:156%; left:16.14px;top:220.54px;">&#61607;<span class="f2" ><span style="letter-spacing:8.40px"> </span>Faculty: Beth Israel Deaconess Med Center</span></span></p></div></div></div> <div class="sg sgTitle" id="s34" data-sgid="Rectangle 2" style="z-index:2;left:53.49px;top:21.95px;width:612.55px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s34_t" class="sg" style="z-index:2;left:-0.34px;top:-5.89px;width:613.26px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="472.28" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:70.59px;top:18.11px;">Jonathan Kruskal, MD PhD</span></p></div></div></div> <div class="sg" id="s33" data-sgid="Rectangle 3" style="z-index:1;left:41.50px;top:93.90px;width:690.49px;height:285.88px" data-valign="top" data-pointer-events="none"> <div id="s33_t" class="sg" style="z-index:2;left:-6.24px;top:-3.48px;width:697.10px;height:289.73px;"><div><p para="{bl:{ch:167},spbf:0.20}"><span data-textwidth="410.94" class="sg nowrap f3" style="z-index:2;color:#FFFFFF;font-size:133%; left:13.95px;top:9.60px;">&#61607;<span class="f2" ><span style="letter-spacing:11.04px"> </span>Multiple publications, honors &amp; awards</span></span></p><p para="{bl:{ch:167},spbf:0.20}"><span data-textwidth="287.92" class="sg nowrap f3" style="z-index:4;color:#FFFFFF;font-size:133%; left:13.95px;top:44.17px;">&#61607;<span class="f2" ><span style="letter-spacing:11.04px"> </span>RSNA Research Scholar ’99</span></span></p><p para="{bl:{ch:167},spbf:0.20}"><span data-textwidth="505.65" class="sg nowrap f3" style="z-index:6;color:#FFFFFF;font-size:133%; left:13.95px;top:78.74px;">&#61607;<span class="f2" ><span style="letter-spacing:11.04px"> </span>Deputy Editor, </span><span class="f5" style="font-style:italic; ">RadioGraphics (Quality Initiatives)</span></span></p><p para="{bl:{ch:167},spbf:0.20}"><span data-textwidth="380.22" class="sg nowrap f3" style="z-index:9;color:#FFFFFF;font-size:133%; left:13.95px;top:113.31px;">&#61607;<span class="f2" ><span style="letter-spacing:11.04px"> </span>Past Chair: RSNA Quality Committee</span></span></p><p para="{bl:{ch:167},spbf:0.20}"><span data-textwidth="501.68" class="sg nowrap f3" style="z-index:11;color:#FFFFFF;font-size:133%; left:13.95px;top:147.87px;">&#61607;<span class="f2" ><span style="letter-spacing:11.04px"> </span>ARRS: Executive Committee, Secretary/treasurer</span></span></p><p para="{bl:{ch:167},spbf:0.20}"><span data-textwidth="480.68" class="sg nowrap f3" style="z-index:13;color:#FFFFFF;font-size:133%; left:13.95px;top:182.44px;">&#61607;<span class="f2" ><span style="letter-spacing:11.04px"> </span>Society Abdominal Radiology: Exec Committee</span></span></p><p para="{bl:{ch:167},spbf:0.20}"><span data-textwidth="635.74" class="sg nowrap f3" style="z-index:15;color:#FFFFFF;font-size:133%; left:13.95px;top:217.01px;">&#61607;<span class="f2" ><span style="letter-spacing:11.04px"> </span>Chair, ACR Quality Management and Inter-society Committees</span></span></p></div></div></div> <div class="sg sgTitle" id="s36" data-sgid="Rectangle 2" style="z-index:2;left:53.49px;top:3.96px;width:612.55px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s36_t" class="sg" style="z-index:2;left:-0.34px;top:-5.88px;width:613.26px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="472.28" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:70.59px;top:18.08px;">Jonathan Kruskal, MD PhD</span></p></div></div></div> <div class="sg" id="s38" data-sgid="Rectangle 2 (2)" style="z-index:4;left:35.52px;top:81.91px;width:300.68px;height:68.36px" data-valign="middle"> <div id="s38_t" class="sg" style="z-index:2;left:-14.52px;top:0.00px;width:315.19px;height:77.95px;"><div><p><span data-textwidth="237.76" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:200%; left:22.21px;top:16.19px;">Enduring Legacy</span></p></div></div></div> <div class="sg" id="s37" data-sgid="Picture 8" style="z-index:3;left:408.75px;top:58.15px;width:243.85px;height:183.36px"> <img class="sg" src="2D0182A4.png" id="s37_i" title="" alt="E:\frush\DSC00597_2.jpg" style="z-index:1;left:0px;top:0px;width:243.85px;height:183.36px" > </div> <div class="sg" id="s35" data-sgid="Rectangle 5" style="z-index:1;left:34.18px;top:158.30px;width:432.76px;height:153.38px" data-valign="top" data-pointer-events="none"> <div id="s35_t" class="sg" style="z-index:2;left:-9.61px;top:-5.52px;width:442.37px;height:171.85px;"><div><p para="{bl:{ch:8226}}"><span data-textwidth="188.19" class="sg nowrap f4" style="z-index:2;color:#FFFFFF;font-size:167%; left:17.32px;top:12.94px;">•<span class="f2" ><span style="letter-spacing:5.28px"> </span>Patient safety</span></span></p><p para="{bl:{ch:8226}}"><span data-textwidth="172.58" class="sg nowrap f4" style="z-index:5;color:#FFFFFF;font-size:167%; left:17.32px;top:48.94px;">•<span class="f2" ><span style="letter-spacing:5.28px"> </span>Peer review </span></span></p><p para="{bl:{ch:8226}}"><span data-textwidth="350.93" class="sg nowrap f4" style="z-index:8;color:#FFFFFF;font-size:167%; left:17.32px;top:84.95px;">•<span class="f2" ><span style="letter-spacing:5.28px"> </span>Performance improvement</span></span></p><p para="{bl:{ch:8226}}"><span data-textwidth="351.17" class="sg nowrap f4" style="z-index:10;color:#FFFFFF;font-size:167%; left:17.32px;top:120.96px;">•<span class="f5" style="font-style:italic; "><span style="letter-spacing:5.28px"> </span>“Do as I say, not as I do…?”</span></span></p></div></div></div> <div class="sg" id="s39" data-sgid="Picture 2" style="z-index:5;left:452.77px;top:203.38px;width:258.47px;height:196.20px"> <img class="sg" src="EB282A2A.png" id="s39_i" title="" alt="E:\frush\P1020430.jpg" style="z-index:1;left:0px;top:0px;width:258.47px;height:196.20px" > </div> <div class="sg" id="s40" data-sgid="Picture 2" style="z-index:1;left:57.20px;top:7.81px;width:633.66px;height:358.54px"> <img class="sg" src="6C683BB.png" id="s40_i" title="" alt="E:\frush\moon over newton.jpg" style="z-index:1;left:0px;top:0px;width:633.66px;height:358.54px" > </div> <div class="sg sgTitle" id="s41" data-sgid="Rectangle 2" style="z-index:2;left:305.13px;top:321.74px;width:414.87px;height:55.04px" data-valign="middle" data-pointer-events="none"> <div id="s41_t" class="sg" style="z-index:2;left:-0.37px;top:-0.36px;width:415.61px;height:55.77px;"><div><p para="{al:2}"><span data-textwidth="310.49" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:122%; left:52.78px;top:16.81px;">Photography by Jonny Kruskal, MD</span></p></div></div></div> <div class="sg" id="s42" data-sgid="TextBox 1" style="z-index:1;left:35.52px;top:15.95px;width:672.50px;height:39.68px" data-valign="top"> <div id="s42_t" class="sg" style="z-index:2;left:-8.54px;top:-4.18px;width:686.55px;height:55.63px;"><div><p><span data-textwidth="654.83" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:144%; left:16.23px;top:10.91px;">Annual lupus walk with wife Pam, daughter Jessy and son Josh</span></p></div></div></div> <div class="sg" id="s43" data-sgid="Picture 10" style="z-index:2;left:148.84px;top:59.48px;width:421.85px;height:318.86px"> <img class="sg" src="39312F68.png" id="s43_i" title="" alt="C:\Users\jkruskal\Desktop\100_0970.JPG" style="z-index:1;left:0px;top:0px;width:421.85px;height:318.86px" > </div> <div class="sg" id="s48" data-sgid="Subtitle 2" style="z-index:2;left:62.50px;top:0.37px;width:594.55px;height:124.47px" data-valign="top"> <div id="s48_t" class="sg" style="z-index:2;left:0.00px;top:-9.73px;width:594.55px;height:146.19px;"><div><p para="{al:2}"><span data-textwidth="206.43" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:244%; left:199.26px;top:18.08px;">2015 RSNA </span><span data-textwidth="514.17" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:244%; left:40.36px;top:70.89px;">Image Interpretation Session</span></p></div></div></div> <div class="sg sgTitle" id="s47" data-sgid="Rectangle 2" style="z-index:1;left:92.49px;top:99.89px;width:534.57px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s47_t" class="sg" style="z-index:2;left:-0.37px;top:-0.36px;width:535.28px;height:78.31px;"><div><p para="{al:2}"><span data-textwidth="385.74" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:200%; left:74.95px;top:16.57px;">Jonathan Kruskal, MD PhD</span></p></div></div></div> <div class="sg" id="s49" data-sgid="Picture 2" style="z-index:3;left:248.41px;top:180.84px;width:209.52px;height:202.31px"> <img class="sg" src="9416D38F.png" id="s49_i" title="" alt="\\duhsnas-pri\home\frush943\FSDesktop\Desktop\Kruskal 2014.jpg" style="z-index:1;left:0px;top:0px;width:209.52px;height:202.31px" > </div> <div class="sg" id="s52" data-sgid="Oval 3" style="z-index:3;left:109.86px;top:122.21px;width:26.02px;height:25.88px" data-fillcolor="16189699"> <img class="sg" src="9914E3F5.png" id="s52_i" style="z-index:1;left:0px;top:0px;width:26.02px;height:25.88px" > </div> <div class="sg" id="s55" data-sgid="Oval 6" style="z-index:6;left:314.14px;top:128.21px;width:25.65px;height:26.50px" data-fillcolor="16189699"> <img class="sg" src="16404078.png" id="s55_i" style="z-index:1;left:0px;top:0px;width:25.65px;height:26.50px" > </div> <div class="sg" id="s53" data-sgid="Oval 4" style="z-index:4;left:201.50px;top:182.17px;width:30.36px;height:28.40px" data-fillcolor="16189699"> <img class="sg" src="C393CB8A.png" id="s53_i" style="z-index:1;left:0px;top:0px;width:30.36px;height:28.40px" > </div> <div class="sg" id="s50" data-sgid="Picture 1" style="z-index:1;left:0.48px;top:-0.48px;width:716.66px;height:405.57px"> <img class="sg" src="D9D9EC90.jpg" id="s50_i" style="z-index:1;left:0px;top:0px;width:716.66px;height:405.57px" > </div> <div class="sg" id="s54" data-sgid="Oval 5" style="z-index:5;left:188.18px;top:212.15px;width:31.66px;height:31.87px" data-fillcolor="16189699"> <img class="sg" src="4EE05385.png" id="s54_i" style="z-index:1;left:0px;top:0px;width:31.66px;height:31.87px" > </div> <div class="sg" id="s56" data-sgid="Oval 7" style="z-index:7;left:367.74px;top:266.11px;width:27.10px;height:25.88px" data-fillcolor="16189699"> <img class="sg" src="EF7AB3D3.png" id="s56_i" style="z-index:1;left:0px;top:0px;width:27.10px;height:25.88px" > </div> <div class="sg" id="s51" data-sgid="Oval 2" style="z-index:2;left:595.63px;top:278.10px;width:26.16px;height:25.06px" data-fillcolor="16189699"> <img class="sg" src="C76C030B.png" id="s51_i" style="z-index:1;left:0px;top:0px;width:26.16px;height:25.06px" > </div> <div class="sg sgTitle" id="s57" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s57_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="509.60" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:69.99px;top:18.09px;">Distinguished Panelists 2015</span></p></div></div></div> <div class="sg" id="s58" data-sgid="Content Placeholder 2" style="z-index:2;left:77.49px;top:102.64px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s58_t" class="sg" style="z-index:2;left:-9.83px;top:-5.38px;width:658.69px;height:273.78px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="65.42" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:156%; left:17.55px;top:12.08px;">•<span style="letter-spacing:6.61px"> </span>GI: </span><span data-textwidth="172.95" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:161.58px;top:12.08px;">Jorge Soto, MD</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="551.26" class="sg nowrap f2" style="z-index:5;color:#FF6319;font-size:156%; left:17.55px;top:52.41px;">•<span style="letter-spacing:6.61px"> </span>Chest: <span style="color:#FFFFFF;"><span style="letter-spacing:33.01px"> </span>Melissa Rosado de Christenson, MD</span></span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="92.18" class="sg nowrap f2" style="z-index:8;color:#FF6319;font-size:156%; left:17.55px;top:92.74px;">•<span style="letter-spacing:6.61px"> </span>MSK: </span><span data-textwidth="207.75" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:161.58px;top:92.74px;">Bruce Forster, MD</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="76.34" class="sg nowrap f2" style="z-index:11;color:#FF6319;font-size:156%; left:17.55px;top:133.07px;">•<span style="letter-spacing:6.61px"> </span>GU: </span><span data-textwidth="333.53" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:156%; left:161.58px;top:133.07px;">Michelle McNicholas, MBBCh</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="471.20" class="sg nowrap f2" style="z-index:17;color:#FF6319;font-size:156%; left:17.55px;top:173.40px;">•<span style="letter-spacing:6.61px"> </span>Neuro: <span style="color:#FFFFFF;"><span style="letter-spacing:25.69px"> </span>Christine Glastonbury, MBBS</span></span></p></div></div></div> <div class="sg sgTitle" id="s59" data-sgid="Title 3" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s59_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="282.29" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:183.65px;top:18.09px;">Program details</span></p></div></div></div> <div class="sg" id="s60" data-sgid="Content Placeholder 4" style="z-index:2;left:35.52px;top:81.91px;width:672.50px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s60_t" class="sg" style="z-index:2;left:-7.57px;top:-4.08px;width:680.43px;height:276.29px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="498.44" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Each panelist received 2 cases three months ago</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="624.10" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.26px;top:45.56px;">•<span style="letter-spacing:9.60px"> </span>All <span style="color:#FF6319;">assumed</span> …. that they’d be shown the same 2 cases today!</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="606.82" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:15.26px;top:80.12px;">•<span style="letter-spacing:9.60px"> </span>Panelist will present their observations, will summarize the </span><span data-textwidth="540.45" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:42.26px;top:108.93px;">findings, provide a brief differential and the most likely </span><span data-textwidth="90.38" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:133%; left:42.26px;top:137.74px;">diagnosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="503.72" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:15.26px;top:172.30px;">•<span style="letter-spacing:9.60px"> </span>NO could be’s, either or’s, top 2’s or most likely’s</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="632.74" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:133%; left:15.26px;top:206.87px;">•<span style="letter-spacing:9.60px"> </span>The actual diagnosis will then be revealed, followed by a brief </span><span data-textwidth="228.88" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:133%; left:42.26px;top:235.68px;">overview of each entity</span></p></div></div></div> <div class="sg sgTitle" id="s61" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s61_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="282.29" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:183.65px;top:18.09px;">Program details</span></p></div></div></div> <div class="sg" id="s62" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s62_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:656.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="585.33" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Our primary objective is to learn how recognized experts </span><span data-textwidth="304.37" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:42.26px;top:39.80px;">approach a diagnostic dilemma</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="607.66" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:133%; left:15.26px;top:74.37px;">•<span style="letter-spacing:9.60px"> </span>The cases are all challenging – getting the diagnosis correct </span><span data-textwidth="334.98" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:133%; left:42.26px;top:103.17px;">may not be possible in some cases</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="603.94" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:15.26px;top:137.74px;">•<span style="letter-spacing:9.60px"> </span>Panelists have received no clues, no hints and there are no </span><span data-textwidth="172.23" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:42.26px;top:166.55px;">additional images</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="624.58" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:15.26px;top:201.11px;">•<span style="letter-spacing:9.60px"> </span>If a panelist gets their first case correct, move on to a second </span><span data-textwidth="58.81" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:42.26px;top:229.92px;">round</span></p></div></div></div> <div class="sg sgTitle" id="s63" data-sgid="Title 1" style="z-index:1;left:83.47px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s63_t" class="sg" style="z-index:2;left:-19.30px;top:-5.86px;width:668.19px;height:93.16px;"><div><p><span data-textwidth="272.57" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:27.05px;top:18.09px;">Jorge Soto, MD</span></p></div></div></div> <div class="sg" id="s66" data-sgid="Cloud Callout 4" style="z-index:4;left:176.44px;top:25.31px;width:524.48px;height:159.85px" data-fillcolor="16777215"> <div id="s66_t" class="sg" style="z-index:2;left:0px;top:0px;width:524.48px;height:159.85px;"><div><p para="{al:2}"><span data-textwidth="188.91" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:260.79px;top:32.06px;">I’d give anything to </span><span data-textwidth="162.03" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:133%; left:274.24px;top:60.87px;">be swinging at a </span><span data-textwidth="175.59" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:264.75px;top:89.67px;">golf ball right now</span></p></div></div><img class="sg" src="1EA0F713.png" id="s66_i" style="z-index:1;left:0px;top:0px;width:524.48px;height:159.85px" > </div> <div class="sg" id="s65" data-sgid="Picture 6" style="z-index:3;left:47.50px;top:87.90px;width:304.87px;height:228.81px"> <img class="sg" src="18B7C10E.jpg" id="s65_i" style="z-index:1;left:0px;top:0px;width:304.87px;height:228.81px" > </div> <div class="sg" id="s64" data-sgid="Content Placeholder 2" style="z-index:2;left:359.35px;top:189.83px;width:408.64px;height:220.04px" data-valign="top" data-pointer-events="none"> <div id="s64_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:418.81px;height:225.70px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="336.66" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.75px;top:12.18px;">•<span style="letter-spacing:6.61px"> </span>Interim Chair of Radiology, </span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="89.53" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:53.64px;top:51.67px;">–<span style="letter-spacing:5.28px"> </span>BUMC </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="282.17" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.75px;top:87.08px;">•<span style="letter-spacing:6.61px"> </span>Professor of Radiology</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="295.37" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:53.64px;top:126.57px;">–<span style="letter-spacing:5.28px"> </span>Boston University School of </span><span data-textwidth="90.98" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:76.32px;top:155.37px;">Medicine</span></p></div></div></div> <div class="sg sgTitle" id="s67" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s67_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="272.57" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:188.57px;top:18.09px;">Jorge Soto, MD</span></p></div></div></div> <div class="sg" id="s68" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s68_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:656.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="571.17" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Med School: Instituto de Ciencias de la Salud, Medellin, </span><span data-textwidth="92.42" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:42.26px;top:39.80px;">Columbia</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="554.37" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:133%; left:15.26px;top:74.37px;">•<span style="letter-spacing:9.60px"> </span>Residency: Instituto de Ciencias de la Salud, Medellin, </span><span data-textwidth="92.42" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:133%; left:42.26px;top:103.17px;">Columbia</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="427.03" class="sg nowrap f2" style="z-index:20;color:#FFFFFF;font-size:133%; left:15.26px;top:137.74px;">•<span style="letter-spacing:9.60px"> </span>Fellowship: Body Imaging, BUMC, Boston</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="530.00" class="sg nowrap f2" style="z-index:22;color:#FFFFFF;font-size:133%; left:15.26px;top:172.31px;">•<span style="letter-spacing:9.60px"> </span>Multi author, multi honored, multi awarded scholar</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="298.01" class="sg nowrap f2" style="z-index:24;color:#FFFFFF;font-size:133%; left:15.26px;top:206.88px;">•<span style="letter-spacing:9.60px"> </span>RSNA Honored educator x 2</span></p></div></div></div> <div class="sg" id="s69" data-sgid="Content Placeholder 3" style="z-index:1;left:269.38px;top:57.92px;width:228.48px;height:200.13px"> <img class="sg" src="D48DF06B.jpg" id="s69_i" style="z-index:1;left:0px;top:0px;width:228.48px;height:200.13px" > </div> <div class="sg" id="s71" data-sgid="Picture 4" style="z-index:3;left:58.76px;top:57.19px;width:176.22px;height:201.60px"> <img class="sg" src="9ECBA2B4.jpg" id="s71_i" style="z-index:1;left:0px;top:0px;width:176.22px;height:201.60px" > </div> <div class="sg" id="s72" data-sgid="Picture 11" style="z-index:4;left:533.27px;top:57.92px;width:150.76px;height:203.01px"> <img class="sg" src="71CFB4E4.jpg" id="s72_i" title="" alt="http://ecx.images-amazon.com/images/I/51Z96b99KSL._SX368_BO1,204,203,200_.jpg" style="z-index:1;left:0px;top:0px;width:150.76px;height:203.01px" > </div> <div class="sg" id="s70" data-sgid="Title 1" style="z-index:2;left:303.08px;top:262.86px;width:149.20px;height:50.37px" data-valign="middle"> <img class="sg" src="E74CA97F.png" id="s70_i" style="z-index:1;left:0px;top:0px;width:149.20px;height:50.37px" > <div id="s70_t" class="sg" style="z-index:2;left:-1.92px;top:0.00px;width:153.06px;height:50.37px;"><div><p para="{al:2}"><span data-textwidth="128.42" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:111%; left:12.69px;top:15.08px;">Cartagena 2013</span></p></div></div></div> <div class="sg" id="s73" data-sgid="TextBox 1" style="z-index:5;left:267.71px;top:312.27px;width:222.84px;height:32.38px" data-valign="top"> <div id="s73_t" class="sg" style="z-index:2;left:-4.79px;top:-2.52px;width:227.63px;height:43.05px;"><div><p><span data-textwidth="188.55" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.65px;top:8.52px;">Ana, Andrea, Alejandro</span></p></div></div></div> <div class="sg" id="s74" data-sgid="Picture 9" style="z-index:1;left:35.52px;top:94.75px;width:151.24px;height:192.69px"> <img class="sg" src="4A6FD1FF.jpg" id="s74_i" title="" alt="http://ecx.images-amazon.com/images/I/41nsziIiBGL._SX389_BO1,204,203,200_.jpg" style="z-index:1;left:0px;top:0px;width:151.24px;height:192.69px" > </div> <div class="sg" id="s76" data-sgid="Picture 5" style="z-index:3;left:197.42px;top:94.75px;width:256.57px;height:192.69px"> <img class="sg" src="48240BDC.jpg" id="s76_i" style="z-index:1;left:0px;top:0px;width:256.57px;height:192.69px" > </div> <div class="sg" id="s77" data-sgid="Picture 5 (2)" style="z-index:4;left:461.30px;top:79.02px;width:244.55px;height:237.69px"> <img class="sg" src="5A7EE13A.jpg" id="s77_i" style="z-index:1;left:0px;top:0px;width:244.55px;height:237.69px" > </div> <div class="sg" id="s75" data-sgid="Title 1" style="z-index:2;left:233.41px;top:303.76px;width:174.74px;height:56.96px" data-valign="middle"> <img class="sg" src="E8D0E893.png" id="s75_i" style="z-index:1;left:0px;top:0px;width:174.74px;height:56.96px" > <div id="s75_t" class="sg" style="z-index:2;left:-6.23px;top:-7.81px;width:187.21px;height:79.98px;"><div><p para="{al:2}"><span data-textwidth="64.45" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:133%; left:61.59px;top:10.48px;">Soccer</span><span data-textwidth="157.71" class="sg nowrap f2" style="z-index:3;color:#FFFF00;font-size:133%; left:14.90px;top:39.28px;">World Cup 2014</span></p></div></div></div> <div class="sg" id="s78" data-sgid="Rectangle 4" style="z-index:1;left:53.49px;top:93.90px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s78_t" class="sg" style="z-index:2;left:-0.34px;top:-0.37px;width:613.26px;height:97.49px;"><div><p para="{al:2}"><span data-textwidth="433.87" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:89.79px;top:22.37px;">Gastrointestinal Case #1</span></p></div></div></div> <div class="sg sgSubtitle" id="s79" data-sgid="Subtitle 1" style="z-index:2;left:143.45px;top:189.83px;width:444.61px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s79_t" class="sg" style="z-index:2;left:-2.04px;top:-5.88px;width:455.78px;height:144.86px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="314.57" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:71.03px;top:13.77px;">45 year old female with </span><span data-textwidth="416.71" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:178%; left:19.90px;top:52.18px;">intermittent stabbing RUQ pain </span><span data-textwidth="283.85" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:82.67px;top:90.59px;">and elevated bilirubin</span></p></div></div></div> <div class="sg" id="s80" data-sgid="Picture 2" style="z-index:1;left:205.81px;top:17.62px;width:345.32px;height:353.17px"> <img class="sg" src="76DAC5CA.jpg" id="s80_i" title="" alt="C:\Users\jkruskal\Desktop\Picture8.jpg" style="z-index:1;left:0px;top:0px;width:345.32px;height:353.17px" > </div> <div class="sg" id="s81" data-sgid="Picture 2" style="z-index:1;left:54.08px;top:69.80px;width:342.94px;height:284.55px"> <img class="sg" src="C5EA7B3E.png" id="s81_i" title="" alt="Export2006092608150528" style="z-index:1;left:0px;top:0px;width:342.94px;height:284.55px" > </div> <div class="sg" id="s82" data-sgid="Picture 2 (2)" style="z-index:2;left:366.66px;top:69.80px;width:342.20px;height:284.55px"> <img class="sg" src="38DAC454.png" id="s82_i" style="z-index:1;left:0px;top:0px;width:342.20px;height:284.55px" > </div> <div class="sg" id="s88" data-sgid="Picture 4" style="z-index:2;left:42.69px;top:60.67px;width:354.33px;height:294.54px"> <img class="sg" src="D36AA337.png" id="s88_i" style="z-index:1;left:0px;top:0px;width:354.33px;height:294.54px" > </div> <div class="sg" id="s87" data-sgid="Picture 3" style="z-index:1;left:367.62px;top:60.67px;width:341.24px;height:295.24px"> <img class="sg" src="FA101FE1.png" id="s87_i" style="z-index:1;left:0px;top:0px;width:341.24px;height:295.24px" > </div> <div class="sg sgTitle" id="s89" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s89_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s90" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s90_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:670.45px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="631.06" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>ERCP: abrupt cutoff of left hepatic duct with a </span><span data-textwidth="539.13" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:47.05px;top:52.94px;">polypoid filling defect, lobulated surface. </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="367.26" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:178%; left:20.05px;top:99.03px;">•<span style="letter-spacing:3.84px"> </span>NO filling of a cystic lesion</span></p></div></div></div> <div class="sg sgTitle" id="s91" data-sgid="Title 1" style="z-index:1;left:35.52px;top:3.96px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s91_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:649.22px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.08px;">Findings</span></p></div></div></div> <div class="sg" id="s92" data-sgid="Content Placeholder 2" style="z-index:2;left:41.50px;top:69.91px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s92_t" class="sg" style="z-index:2;left:-9.84px;top:-5.28px;width:672.75px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="637.06" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.55px;top:12.07px;">•<span style="letter-spacing:6.60px"> </span>CT: Complex cystic lesion in left hepatic lobe, smooth </span><span data-textwidth="611.27" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:44.55px;top:45.67px;">margins, internal septations, with possible enhancing </span><span data-textwidth="190.59" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:44.55px;top:79.28px;">solid component</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="459.07" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:17.55px;top:119.61px;">•<span style="letter-spacing:6.60px"> </span>Dilated left hepatic ducts and ? direct </span><span data-textwidth="581.62" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:44.55px;top:153.22px;">communication between cystic lesion and bile duct</span></p></div></div></div> <div class="sg sgTitle" id="s93" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s93_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s94" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s94_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:675.50px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="636.10" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Possible communication with left hepatic duct </span><span data-textwidth="106.22" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:47.05px;top:52.94px;">and soft</span><span data-textwidth="230.44" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:178%; left:47.05px;top:91.35px;">tissue within duct</span></p></div></div></div> <div class="sg" id="s96" data-sgid="Straight Arrow Connector 2" style="z-index:4;left:483.61px;top:230.25px;width:80.58px;height:28.06px" data-pointer-events="none"> <img class="sg" src="B4F72CB2.png" id="s96_i" style="z-index:1;left:0px;top:0px;width:80.58px;height:28.06px" > </div> <div class="sg" id="s95" data-sgid="Picture 2" style="z-index:3;left:344.10px;top:128.54px;width:292.80px;height:284.81px"> <img class="sg" src="811B8CA8.png" id="s95_i" style="z-index:1;left:0px;top:0px;width:292.80px;height:284.81px" > </div> <div class="sg sgTitle" id="s97" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s97_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="327.66" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:160.96px;top:18.09px;">Intraop US Images</span></p></div></div></div> <div class="sg" id="s101" data-sgid="Straight Arrow Connector 2" style="z-index:5;left:147.76px;top:188.28px;width:80.61px;height:28.06px" data-pointer-events="none"> <img class="sg" src="29583EAE.png" id="s101_i" style="z-index:1;left:0px;top:0px;width:80.61px;height:28.06px" > </div> <div class="sg" id="s98" data-sgid="Picture 3" style="z-index:2;left:20.27px;top:103.12px;width:285.34px;height:235.06px"> <img class="sg" src="F25CE87F.png" id="s98_i" title="" alt="C:\Users\jkruskal\Desktop\Picture2.jpg" style="z-index:1;left:0px;top:0px;width:285.34px;height:235.06px" > </div> <div class="sg" id="s99" data-sgid="Picture 2" style="z-index:3;left:242.17px;top:105.04px;width:294.55px;height:240.80px"> <img class="sg" src="5C692113.png" id="s99_i" title="" alt="C:\Users\jkruskal\Desktop\Picture3.jpg" style="z-index:1;left:0px;top:0px;width:294.55px;height:240.80px" > </div> <div class="sg" id="s100" data-sgid="Picture 3 (2)" style="z-index:4;left:476.04px;top:106.74px;width:265.56px;height:241.14px"> <img class="sg" src="E4E179B4.png" id="s100_i" title="" alt="C:\Users\jkruskal\Desktop\Picture4.jpg" style="z-index:1;left:0px;top:0px;width:265.56px;height:241.14px" > </div> <div class="sg sgTitle" id="s102" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s102_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="258.40" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:195.65px;top:18.09px;">Findings: IOUS</span></p></div></div></div> <div class="sg" id="s103" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:84.65px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s103_t" class="sg" style="z-index:2;left:-9.84px;top:-5.37px;width:673.94px;height:273.78px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="621.22" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.06px;">•<span style="letter-spacing:6.60px"> </span>Complex cystic lesion with septations, debris, mural </span><span data-textwidth="432.31" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:44.53px;top:45.67px;">nodule with possible solid component</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="418.87" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:17.53px;top:86.00px;">•<span style="letter-spacing:6.60px"> </span>Communication with hepatic duct </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="639.46" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:17.53px;top:126.33px;">•<span style="letter-spacing:6.60px"> </span>Echogenic nodule within hepatic duct, no shadowing: </span><span data-textwidth="158.07" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:156%; left:44.53px;top:159.93px;">tumor, sludge</span></p></div></div></div> <div class="sg sgTitle" id="s104" data-sgid="Title 1" style="z-index:1;left:35.52px;top:8.51px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s104_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:649.22px;height:93.19px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:17.97px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s105" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:90.65px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s105_t" class="sg" style="z-index:2;left:-9.84px;top:-5.38px;width:658.69px;height:273.78px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="155.90" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.07px;">•<span style="letter-spacing:6.60px"> </span>Congenital:</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="581.62" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:53.41px;top:52.40px;">–<span style="letter-spacing:2.29px"> </span>Caroli disease with sludge or cholangiocarcinoma</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="135.50" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.53px;top:92.73px;">•<span style="letter-spacing:6.60px"> </span>Infection:</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="440.96" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:53.41px;top:133.06px;">–<span style="letter-spacing:2.29px"> </span>Hydatid cyst with bile duct “rupture”</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="201.16" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:53.41px;top:173.39px;">–<span style="letter-spacing:2.29px"> </span>Amebic abscess</span></p></div></div></div> <div class="sg sgTitle" id="s106" data-sgid="Title 1" style="z-index:1;left:35.52px;top:9.96px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s106_t" class="sg" style="z-index:2;left:-0.37px;top:-5.89px;width:649.22px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s107" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s107_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="148.70" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Neoplasm:</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="536.97" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:144%; left:53.41px;top:51.94px;">–<span style="letter-spacing:3.85px"> </span>Polypoid mass in bile duct with associated cystic </span><span data-textwidth="517.16" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:144%; left:76.10px;top:83.15px;">lesion: intraductal papillary neoplasm (IPN), cyst-</span><span data-textwidth="136.46" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:144%; left:76.10px;top:114.35px;">forming type</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="565.17" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:144%; left:53.41px;top:151.80px;">–<span style="letter-spacing:3.85px"> </span>Cystic lesion with intraductal polypoid component: </span><span data-textwidth="386.70" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:144%; left:76.10px;top:183.01px;">cystadenoma/carcinoma, metastasis</span></p></div></div></div> <div class="sg sgTitle" id="s108" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s108_t" class="sg" style="z-index:2;left:-0.37px;top:-2.15px;width:649.22px;height:84.79px;"><div><p para="{al:2}"><span data-textwidth="310.49" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:222%; left:169.60px;top:15.90px;">Dr Soto’s Diagnosis</span></p></div></div></div> <div class="sg" id="s109" data-sgid="Content Placeholder 3" style="z-index:2;left:35.52px;top:90.65px;width:648.52px;height:268.03px" data-valign="top"> <div id="s109_t" class="sg" style="z-index:2;left:-9.84px;top:-5.38px;width:658.35px;height:273.41px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="513.80" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.07px;">•<span style="letter-spacing:6.60px"> </span>Cystadenoma/carcinoma with intra-ductal </span><span data-textwidth="137.66" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:44.53px;top:45.68px;">component </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="588.22" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:17.53px;top:86.01px;">•<span style="letter-spacing:6.60px"> </span>Cyst-forming intraductal papillary neoplasm (IPN)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="584.98" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:156%; left:17.53px;top:126.34px;">•<span style="letter-spacing:6.60px"> </span>Hydatid cyst: If native from or travel to endemic </span><span data-textwidth="56.77" class="sg nowrap f2" style="z-index:18;color:#FFFFFF;font-size:156%; left:44.53px;top:159.94px;">area </span></p></div></div></div> <div class="sg sgTitle" id="s110" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s110_t" class="sg" style="z-index:2;left:-0.37px;top:-2.15px;width:649.22px;height:84.79px;"><div><p para="{al:2}"><span data-textwidth="310.49" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:222%; left:169.60px;top:15.90px;">Dr Soto’s Diagnosis</span></p></div></div></div> <div class="sg" id="s111" data-sgid="Content Placeholder 3" style="z-index:2;left:35.52px;top:90.65px;width:648.52px;height:268.03px" data-valign="top"> <div id="s111_t" class="sg" style="z-index:2;left:-9.84px;top:-5.38px;width:658.35px;height:273.41px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="513.80" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.07px;">•<span style="letter-spacing:6.60px"> </span>Cystadenoma/carcinoma with intra-ductal </span><span data-textwidth="137.66" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:44.53px;top:45.68px;">component </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="588.22" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:17.53px;top:86.01px;">•<span style="letter-spacing:6.60px"> </span>Cyst-forming intraductal papillary neoplasm (IPN)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="584.98" class="sg nowrap f2" style="z-index:13;color:#7F7F7F;font-size:156%; left:17.53px;top:126.34px;">•<span style="letter-spacing:6.60px"> </span>Hydatid cyst: If native from or travel to endemic </span><span data-textwidth="56.77" class="sg nowrap f2" style="z-index:18;color:#7F7F7F;font-size:156%; left:44.53px;top:159.94px;">area </span></p></div></div></div> <div class="sg sgTitle" id="s112" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s112_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="242.68" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:203.45px;top:18.09px;">The diagnosis</span></p></div></div></div> <div class="sg" id="s113" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s113_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="596.01" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Biliary cystadenoma prolapsed into the LHD</span></p></div></div></div> <div class="sg sgTitle" id="s114" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s114_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="571.42" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:39.02px;top:18.09px;">Intraductal Biliary Cystadenoma</span></p></div></div></div> <div class="sg" id="s115" data-sgid="Content Placeholder 2" style="z-index:2;left:41.50px;top:105.89px;width:642.54px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s115_t" class="sg" style="z-index:2;left:-7.54px;top:-4.07px;width:650.41px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="608.50" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.25px;top:11.00px;">•<span style="letter-spacing:9.60px"> </span>Rare case reports of primary intraductal cystadenomas and </span><span data-textwidth="408.91" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:42.25px;top:39.81px;">intra- extending to extrahepatic bile ducts</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="549.93" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:15.25px;top:74.38px;">•<span style="letter-spacing:9.60px"> </span>Mostly located in the liver (84%), but also arise in the </span><span data-textwidth="545.73" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:133%; left:42.25px;top:103.18px;">common bile duct (6%), the hepatic ducts (4%), and the </span><span data-textwidth="158.19" class="sg nowrap f2" style="z-index:20;color:#FFFFFF;font-size:133%; left:42.25px;top:131.99px;">gallbladder (2%)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="396.07" class="sg nowrap f2" style="z-index:22;color:#FFFFFF;font-size:133%; left:15.25px;top:166.56px;">•<span style="letter-spacing:9.60px"> </span>Variable elevation of CA 19-9 and CEA</span></p></div></div></div> <div class="sg sgTitle" id="s116" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s116_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="571.42" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:39.02px;top:18.09px;">Intraductal Biliary Cystadenoma</span></p></div></div></div> <div class="sg" id="s117" data-sgid="Content Placeholder 2" style="z-index:2;left:29.51px;top:87.90px;width:678.50px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s117_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:686.44px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="525.69" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.27px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Cysts are lined with mucinous columnar epithelium</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="412.63" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:111%; left:51.15px;top:43.60px;">–<span style="letter-spacing:8.17px"> </span>Thought to originate from the biliary epithelium</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="404.35" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:111%; left:51.15px;top:72.40px;">–<span style="letter-spacing:8.17px"> </span>Possibly from a congenitally aberrant bile duct </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="548.73" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:15.27px;top:103.17px;">•<span style="letter-spacing:9.60px"> </span>Mucinous (as opposed to serous) cystadenoma is the </span><span data-textwidth="537.45" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:133%; left:42.27px;top:131.98px;">predominant type (95% of cases) that occurs in women</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="654.71" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:133%; left:15.27px;top:166.54px;">•<span style="letter-spacing:9.60px"> </span>Deeper <span style="color:#FF6319;">ovarian stroma </span>seen in 85% of cases, exclusively females</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="509.48" class="sg nowrap f2" style="z-index:23;color:#FFFFFF;font-size:133%; left:15.27px;top:201.11px;">•<span style="letter-spacing:9.60px"> </span>Prognosis worse in those without ovarian stroma </span></p></div></div></div> <div class="sg sgTitle" id="s118" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s118_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="571.42" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:39.02px;top:18.09px;">Intraductal Biliary Cystadenoma</span></p></div></div></div> <div class="sg" id="s119" data-sgid="Content Placeholder 2" style="z-index:2;left:83.47px;top:96.64px;width:558.58px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s119_t" class="sg" style="z-index:2;left:-7.54px;top:-4.07px;width:566.46px;height:272.47px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="276.04" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.29px;top:10.89px;">•<span style="letter-spacing:9.60px"> </span>Unusual features include;</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="248.32" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:111%; left:51.17px;top:43.50px;">–<span style="letter-spacing:8.16px"> </span>Multiple intraductal masses</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="241.12" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:111%; left:51.17px;top:72.31px;">–<span style="letter-spacing:8.16px"> </span>Communication with ducts</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="253.25" class="sg nowrap f2" style="z-index:13;color:#FF6319;font-size:111%; left:51.17px;top:101.11px;">–<span class="f5" style="font-style:italic; "><span style="letter-spacing:8.16px"> </span>Prolapse into the main ducts</span></span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="509.36" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:133%; left:15.29px;top:131.88px;">•<span style="letter-spacing:9.60px"> </span>Treatment is surgical because cannot confidently </span><span data-textwidth="331.38" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:133%; left:42.29px;top:160.69px;">exclude malignant transformation</span></p></div></div></div> <div class="sg sgTitle" id="s120" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:678.50px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s120_t" class="sg" style="z-index:2;left:-7.83px;top:-5.86px;width:704.07px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="650.87" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:26.80px;top:18.09px;">Melissa Rosado de Christenson, MD </span></p></div></div></div> <div class="sg" id="s122" data-sgid="Cloud Callout 5" style="z-index:3;left:151.84px;top:103.26px;width:495.12px;height:166.33px" data-fillcolor="16777215"> <div id="s122_t" class="sg" style="z-index:2;left:0px;top:0px;width:495.12px;height:166.33px;"><div><p para="{al:2}"><span data-textwidth="236.20" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:159.01px;top:32.09px;">I saw every rare and unusual </span><span data-textwidth="250.96" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:111%; left:151.57px;top:56.09px;">chest disorder at the AFIP, and </span><span data-textwidth="231.64" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:161.41px;top:80.10px;">now Jonny throws me these </span><span data-textwidth="91.34" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:111%; left:229.22px;top:104.11px;">curveballs?</span></p></div></div><img class="sg" src="16EEACFD.png" id="s122_i" style="z-index:1;left:0px;top:0px;width:495.12px;height:166.33px" > </div> <div class="sg" id="s121" data-sgid="Picture 6" style="z-index:2;left:59.49px;top:107.33px;width:165.39px;height:231.07px"> <img class="sg" src="BC392DA4.jpg" id="s121_i" title="" alt="C:\Users\jkruskal\Desktop\RgrIQT-Q66FbDId43if1JhlPrs-rOEHjrMapvlstg3Q,lNQuoosZUX5fbRK-AH9TdRghZwExpSAEoBQqEzEDXEQ,EaIQCaR-sYRTyiY8fSvRAR9HW2_lkpipHjK4EhxGiZc.jpg" style="z-index:1;left:0px;top:0px;width:165.39px;height:231.07px" > </div> <div class="sg sgTitle" id="s124" data-sgid="Title 1" style="z-index:2;left:35.52px;top:15.70px;width:678.50px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s124_t" class="sg" style="z-index:2;left:-7.83px;top:-5.86px;width:704.07px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="650.87" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:26.80px;top:18.09px;">Melissa Rosado de Christenson, MD </span></p></div></div></div> <div class="sg" id="s126" data-sgid="Picture 6" style="z-index:4;left:59.49px;top:107.33px;width:165.39px;height:231.07px"> <img class="sg" src="BC392DA4.jpg" id="s126_i" title="" alt="C:\Users\jkruskal\Desktop\RgrIQT-Q66FbDId43if1JhlPrs-rOEHjrMapvlstg3Q,lNQuoosZUX5fbRK-AH9TdRghZwExpSAEoBQqEzEDXEQ,EaIQCaR-sYRTyiY8fSvRAR9HW2_lkpipHjK4EhxGiZc.jpg" style="z-index:1;left:0px;top:0px;width:165.39px;height:231.07px" > </div> <div class="sg" id="s125" data-sgid="Picture 5" style="z-index:3;left:491.29px;top:104.33px;width:196.57px;height:254.35px"> <img class="sg" src="9D496527.jpg" id="s125_i" title="" alt="http://image.slidesharecdn.com/carcinomabroncogenicol-110109232807-phpapp01/95/carcinoma-broncogenic-ol-1-728.jpg?cb=1294616411" style="z-index:1;left:0px;top:0px;width:196.57px;height:254.35px" > </div> <div class="sg" id="s123" data-sgid="Picture 2" style="z-index:1;left:251.38px;top:107.33px;width:221.91px;height:248.35px"> <img class="sg" src="3B487744.jpg" id="s123_i" style="z-index:1;left:0px;top:0px;width:221.91px;height:248.35px" > </div> <div class="sg" id="s128" data-sgid="Title 1" style="z-index:2;left:35.52px;top:15.95px;width:678.50px;height:68.36px" data-valign="middle"> <div id="s128_t" class="sg" style="z-index:2;left:-7.83px;top:-5.88px;width:704.07px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="650.87" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:26.80px;top:18.10px;">Melissa Rosado de Christenson, MD </span></p></div></div></div> <div class="sg" id="s127" data-sgid="Content Placeholder 3" style="z-index:1;left:23.50px;top:93.90px;width:672.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s127_t" class="sg" style="z-index:2;left:-7.54px;top:-4.07px;width:685.45px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="204.03" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.25px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>BA, Johns Hopkins</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="653.86" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.25px;top:45.56px;">•<span style="letter-spacing:9.60px"> </span>MD, Uniformed Services University of Health Sciences, Bethesda</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="432.31" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:15.25px;top:80.13px;">•<span style="letter-spacing:9.60px"> </span>Radiology: George Washington University</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="491.48" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:15.25px;top:114.69px;">•<span style="letter-spacing:9.60px"> </span>Chief, Pulmonary &amp; Mediastinal Radiology, AFIP</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="583.77" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:15.25px;top:149.26px;">•<span style="letter-spacing:9.60px"> </span>Chairman, Dept of Radiologic Pathology, AFIP, 1995-2001</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="655.91" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:15.25px;top:184.31px;">•<span style="letter-spacing:9.60px"> </span>Section chief, Thoracic Radiology, St Luke<span class="f6" style="position:relative;bottom:1px;">’</span>s Hospital, Kansas City</span></p></div></div></div> <div class="sg" id="s129" data-sgid="AutoShape 2" style="z-index:1;left:240.95px;top:12.84px;width:24.94px;height:24.95px" data-pointer-events="none"> <div style='width:100%;height:100%;background:rgba(0,0,0,0)'></div></div> <div class="sg" id="s130" data-sgid="AutoShape 4" style="z-index:2;left:376.13px;top:21.83px;width:24.94px;height:24.95px" data-pointer-events="none"> <div style='width:100%;height:100%;background:rgba(0,0,0,0)'></div></div> <div class="sg" id="s131" data-sgid="AutoShape 7" style="z-index:3;left:672.38px;top:24.69px;width:24.94px;height:24.95px" data-pointer-events="none"> <div style='width:100%;height:100%;background:rgba(0,0,0,0)'></div></div> <div class="sg" id="s132" data-sgid="Picture 8" style="z-index:4;left:400.36px;top:32.50px;width:254.28px;height:254.35px"> <img class="sg" src="C7511DDC.jpg" id="s132_i" title="" alt="C:\Users\jkruskal\Desktop\wODT6LmYzLXlioGCukVkpafzjTcJ7FrNaRGRP_TLpf8,5cMe_-VM0D0G74b7yODZ5WtTlX-TpeYQyYiHjAbd3Ng.jpg" style="z-index:1;left:0px;top:0px;width:254.28px;height:254.35px" > </div> <div class="sg" id="s134" data-sgid="Picture 2" style="z-index:6;left:81.80px;top:44.26px;width:231.12px;height:231.07px"> <img class="sg" src="B1C9A9D0.jpg" id="s134_i" title="" alt="C:\Users\jkruskal\Desktop\wdyyWux4fIdpsZLgU0Ic0CbMs8H3oH9pS91RoxLL4_w,ZM1Im2Nw1EiaM8YYy3dBF5lFPQbg-rUHEEhtFLGnz6o.jpg" style="z-index:1;left:0px;top:0px;width:231.12px;height:231.07px" > </div> <div class="sg" id="s135" data-sgid="TextBox 3" style="z-index:7;left:81.80px;top:285.88px;width:231.12px;height:56.59px" data-valign="top"> <div id="s135_t" class="sg" style="z-index:2;left:0.00px;top:-2.40px;width:231.12px;height:66.92px;"><div><p para="{al:2}"><span data-textwidth="175.11" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:30.30px;top:8.50px;">Engagement, Dorado </span><span data-textwidth="202.71" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:111%; left:14.46px;top:32.51px;">Beach, Puerto Rico, 1987</span></p></div></div></div> <div class="sg" id="s133" data-sgid="TextBox 7" style="z-index:5;left:456.85px;top:304.94px;width:141.30px;height:56.62px" data-valign="top"> <div id="s133_t" class="sg" style="z-index:2;left:-3.82px;top:-2.51px;width:149.09px;height:66.92px;"><div><p para="{al:2}"><span data-textwidth="123.85" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.89px;top:8.52px;">Melissa &amp; Paul,</span><span data-textwidth="122.78" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:111%; left:13.49px;top:32.52px;">Air Force, 1987</span></p></div></div></div> <div class="sg sgTitle" id="s137" data-sgid="Title 1" style="z-index:2;left:35.52px;top:15.70px;width:678.50px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s137_t" class="sg" style="z-index:2;left:-7.83px;top:-5.86px;width:704.07px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="650.87" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:26.80px;top:18.09px;">Melissa Rosado de Christenson, MD </span></p></div></div></div> <div class="sg" id="s136" data-sgid="Content Placeholder 2" style="z-index:1;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s136_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:656.42px;height:282.03px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="193.47" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>President, AAWR</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="412.75" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.26px;top:46.04px;">•<span style="letter-spacing:9.60px"> </span>Chair, ABR<span class="f6" style="position:relative;bottom:1px;">’</span>s Thoracic MOC Committee </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="440.23" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:15.26px;top:80.13px;">•<span style="letter-spacing:9.60px"> </span>President, American Roentgen Ray Society</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="473.72" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:15.26px;top:114.69px;">•<span style="letter-spacing:9.60px"> </span>President, Associación de Radiología Torácica </span><span data-textwidth="162.87" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:42.26px;top:143.50px;">Latinoamericana</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="420.91" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:133%; left:15.26px;top:178.07px;">•<span style="letter-spacing:9.60px"> </span>President, Society of Thoracic Radiology </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="546.45" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:133%; left:15.26px;top:212.64px;">•<span style="letter-spacing:9.60px"> </span>Innumerable honors, awards, visiting professorships, </span><span data-textwidth="182.67" class="sg nowrap f2" style="z-index:18;color:#FFFFFF;font-size:133%; left:42.26px;top:241.44px;">chapters, books…..</span></p></div></div></div> <div class="sg" id="s138" data-sgid="Picture 7" style="z-index:1;left:137.44px;top:33.94px;width:225.99px;height:294.76px"> <img class="sg" src="AF68C9E3.jpg" id="s138_i" title="" alt="http://www.sauramps-medical.com/wp-content/uploads/2012/04/di_chest.jpg" style="z-index:1;left:0px;top:0px;width:225.99px;height:294.76px" > </div> <div class="sg" id="s139" data-sgid="Picture 5" style="z-index:2;left:395.32px;top:33.94px;width:230.04px;height:294.76px"> <img class="sg" src="55EEA4E5.jpg" id="s139_i" title="" alt="511mWz3GcEL._SX387_BO1,204,203,200_.jpg" style="z-index:1;left:0px;top:0px;width:230.04px;height:294.76px" > </div> <div class="sg" id="s140" data-sgid="Picture 3" style="z-index:1;left:41.50px;top:27.94px;width:372.19px;height:231.07px"> <img class="sg" src="A0813AF4.jpg" id="s140_i" title="" alt="C:\Users\jkruskal\Desktop\aFRcXjHA7zjUo2G1niudG3lv8eX58joMysLrjm5ntEQ,WIxGhjyJ3txwYwaSTjsNAa25uYJMXzBqwcImc68t2SA.jpg" style="z-index:1;left:0px;top:0px;width:372.19px;height:231.07px" > </div> <div class="sg" id="s142" data-sgid="Picture 5" style="z-index:3;left:431.31px;top:29.50px;width:255.10px;height:255.08px"> <img class="sg" src="46D29DAC.jpg" id="s142_i" title="" alt="C:\Users\jkruskal\Desktop\bQX8tzc2eGEDDkIBmTM8Vo6HYXgRiArAsh0AMJHyqhc,vnPjEfIMipp17ElVCJmnMmFwWO65dFj6SVlDYKFUEAk.jpg" style="z-index:1;left:0px;top:0px;width:255.10px;height:255.08px" > </div> <div class="sg" id="s141" data-sgid="TextBox 4" style="z-index:2;left:71.37px;top:270.66px;width:312.55px;height:32.36px" data-valign="top"> <div id="s141_t" class="sg" style="z-index:2;left:-4.93px;top:-2.51px;width:319.41px;height:43.05px;"><div><p><span data-textwidth="294.53" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.65px;top:8.47px;">With members of STR in Puerto Rico</span></p></div></div></div> <div class="sg" id="s143" data-sgid="TextBox 5" style="z-index:4;left:423.15px;top:290.92px;width:274.80px;height:56.62px" data-valign="top"> <div id="s143_t" class="sg" style="z-index:2;left:-3.49px;top:-2.52px;width:281.88px;height:67.03px;"><div><p para="{al:2}"><span data-textwidth="256.84" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.89px;top:8.51px;">Heather, Mellissa, Jennifer, Paul</span><span data-textwidth="126.02" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:111%; left:78.30px;top:32.51px;">Christmas 2014</span></p></div></div></div> <div class="sg" id="s144" data-sgid="Title 1" style="z-index:1;left:47.50px;top:71.47px;width:612.52px;height:87.65px" data-valign="middle" data-pointer-events="none"> <div id="s144_t" class="sg" style="z-index:2;left:-0.36px;top:-0.37px;width:613.26px;height:97.38px;"><div><p para="{al:2}"><span data-textwidth="243.64" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:184.98px;top:22.24px;">Chest case #1</span></p></div></div></div> <div class="sg" id="s145" data-sgid="Title 1 (2)" style="z-index:2;left:59.49px;top:171.85px;width:612.55px;height:126.88px" data-valign="top"> <div id="s145_t" class="sg" style="z-index:2;left:0.00px;top:-7.19px;width:612.55px;height:162.82px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="366.54" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:200%; left:127.14px;top:14.94px;">78-year-old woman with </span><span data-textwidth="383.94" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:200%; left:118.62px;top:58.15px;">2-3 months of weight loss </span><span data-textwidth="212.44" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:200%; left:200.23px;top:101.36px;">and chest pain</span></p></div></div></div> <div class="sg" id="s147" data-sgid="Straight Arrow Connector 3" style="z-index:2;left:412.72px;top:153.49px;width:43.76px;height:26.61px" data-pointer-events="none"> <img class="sg" src="C4C163B9.png" id="s147_i" style="z-index:1;left:0px;top:0px;width:43.76px;height:26.61px" > </div> <div class="sg" id="s146" data-sgid="Picture 2" style="z-index:1;left:197.42px;top:33.94px;width:330.69px;height:330.74px"> <img class="sg" src="29609B27.jpg" id="s146_i" title="" alt="Chest radiograph 1 crop.tif" style="z-index:1;left:0px;top:0px;width:330.69px;height:330.74px" > </div> <div class="sg" id="s148" data-sgid="TextBox 7" style="z-index:3;left:395.32px;top:219.81px;width:29.51px;height:56.59px" data-valign="top"> <div id="s148_t" class="sg" style="z-index:2;left:-16.90px;top:-8.40px;width:68.96px;height:84.90px;"><div><p><span data-textwidth="20.04" class="sg nowrap f7" style="z-index:2;font-size:222%; left:24.85px;top:17.80px;">*</span></p></div></div></div> <div class="sg" id="s149" data-sgid="Picture 2" style="z-index:1;left:188.18px;top:18.69px;width:376.75px;height:376.81px"> <img class="sg" src="1C6820A3.png" id="s149_i" title="" alt="Chest radiograph 2 bone algorithm crop.tif" style="z-index:1;left:0px;top:0px;width:376.75px;height:376.81px" > </div> <div class="sg" id="s152" data-sgid="Picture 6" style="z-index:3;left:464.05px;top:42.68px;width:275.14px;height:275.81px"> <img class="sg" src="262FB06E.png" id="s152_i" title="" alt="Coronal CT crop.tif" style="z-index:1;left:0px;top:0px;width:275.14px;height:275.81px" > </div> <div class="sg" id="s151" data-sgid="Picture 5" style="z-index:2;left:241.92px;top:52.89px;width:255.61px;height:255.53px"> <img class="sg" src="493E4496.png" id="s151_i" title="" alt="Chest CT 3 crop.tif" style="z-index:1;left:0px;top:0px;width:255.61px;height:255.53px" > </div> <div class="sg" id="s150" data-sgid="Picture 4" style="z-index:1;left:20.27px;top:53.11px;width:255.13px;height:255.08px"> <img class="sg" src="82BF129A.png" id="s150_i" title="" alt="Chest CT 1 crop.tif" style="z-index:1;left:0px;top:0px;width:255.13px;height:255.08px" > </div> <div class="sg" id="s154" data-sgid="Straight Arrow Connector 8" style="z-index:5;left:158.08px;top:184.20px;width:25.57px;height:37.87px" data-pointer-events="none"> <img class="sg" src="9C8CEF87.png" id="s154_i" style="z-index:1;left:0px;top:0px;width:25.57px;height:37.87px" > </div> <div class="sg" id="s153" data-sgid="Straight Arrow Connector 7" style="z-index:4;left:155.07px;top:224.73px;width:38.04px;height:32.38px" data-pointer-events="none"> <img class="sg" src="8E82013B.png" id="s153_i" style="z-index:1;left:0px;top:0px;width:38.04px;height:32.38px" > </div> <div class="sg" id="s159" data-sgid="Straight Arrow Connector 9" style="z-index:5;left:367.14px;top:161.18px;width:39.94px;height:26.50px" data-pointer-events="none"> <img class="sg" src="23DC3729.png" id="s159_i" style="z-index:1;left:0px;top:0px;width:39.94px;height:26.50px" > </div> <div class="sg" id="s157" data-sgid="Picture 6" style="z-index:3;left:464.05px;top:42.68px;width:275.14px;height:275.81px"> <img class="sg" src="262FB06E.png" id="s157_i" title="" alt="Coronal CT crop.tif" style="z-index:1;left:0px;top:0px;width:275.14px;height:275.81px" > </div> <div class="sg" id="s155" data-sgid="Picture 4" style="z-index:1;left:20.27px;top:53.11px;width:255.13px;height:255.08px"> <img class="sg" src="82BF129A.png" id="s155_i" title="" alt="Chest CT 1 crop.tif" style="z-index:1;left:0px;top:0px;width:255.13px;height:255.08px" > </div> <div class="sg" id="s156" data-sgid="Picture 5" style="z-index:2;left:241.92px;top:52.89px;width:255.61px;height:255.53px"> <img class="sg" src="493E4496.png" id="s156_i" title="" alt="Chest CT 3 crop.tif" style="z-index:1;left:0px;top:0px;width:255.61px;height:255.53px" > </div> <div class="sg" id="s158" data-sgid="Straight Arrow Connector 7" style="z-index:4;left:281.74px;top:224.62px;width:39.82px;height:26.50px" data-pointer-events="none"> <img class="sg" src="90EDCFD.png" id="s158_i" style="z-index:1;left:0px;top:0px;width:39.82px;height:26.50px" > </div> <div class="sg sgTitle" id="s160" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s160_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s161" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s161_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="393.42" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Low left hemithorax volume</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="563.25" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:20.05px;top:60.62px;">•<span style="letter-spacing:3.84px"> </span>Left basilar-predominant circumferential </span><span data-textwidth="542.37" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:178%; left:47.05px;top:99.03px;">nodular pleural thickening with mass-like </span><span data-textwidth="493.64" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:178%; left:47.05px;top:137.44px;">calcifications and fissural involvement</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="448.03" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:178%; left:20.05px;top:183.53px;">•<span style="letter-spacing:3.84px"> </span>Asbestos-related pleural disease</span></p></div></div></div> <div class="sg" id="s164" data-sgid="Picture 6" style="z-index:3;left:464.05px;top:42.68px;width:275.14px;height:275.81px"> <img class="sg" src="262FB06E.png" id="s164_i" title="" alt="Coronal CT crop.tif" style="z-index:1;left:0px;top:0px;width:275.14px;height:275.81px" > </div> <div class="sg" id="s163" data-sgid="Picture 5" style="z-index:2;left:242.17px;top:53.11px;width:255.10px;height:255.08px"> <img class="sg" src="A7C3B616.png" id="s163_i" title="" alt="Chest CT 3 crop.tif" style="z-index:1;left:0px;top:0px;width:255.10px;height:255.08px" > </div> <div class="sg" id="s162" data-sgid="Picture 4" style="z-index:1;left:20.27px;top:53.11px;width:255.13px;height:255.08px"> <img class="sg" src="82BF129A.png" id="s162_i" title="" alt="Chest CT 1 crop.tif" style="z-index:1;left:0px;top:0px;width:255.13px;height:255.08px" > </div> <div class="sg sgTitle" id="s165" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s165_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s167" data-sgid="Straight Connector 4" style="z-index:3;left:65.36px;top:120.77px;width:446.42px;height:5.63px" data-pointer-events="none"> <img class="sg" src="55BD04C2.png" id="s167_i" style="z-index:1;left:0px;top:0px;width:446.42px;height:4.63px" > </div> <div class="sg" id="s166" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s166_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="441.55" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Calcifying fibrous pseudotumor </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="399.66" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:20.05px;top:60.62px;">•<span style="letter-spacing:3.84px"> </span>Malignant pleural thickening</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="393.19" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:55.93px;top:104.75px;">–<span style="letter-spacing:2.29px"> </span>Malignant pleural mesothelioma</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="235.13" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:55.93px;top:145.08px;">–<span style="letter-spacing:2.29px"> </span>Metastatic disease</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="299.82" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:55.93px;top:185.41px;">–<span style="letter-spacing:2.29px"> </span>Primary pleural sarcoma</span></p></div></div></div> <div class="sg sgTitle" id="s168" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s168_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="539.85" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:54.87px;top:18.09px;">Dr. de Christenson’s Diagnosis</span></p></div></div></div> <div class="sg" id="s169" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s169_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:675.98px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="636.58" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Malignant pleural mesothelioma, sarcomatoid </span><span data-textwidth="104.06" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:47.05px;top:52.94px;">subtype</span></p></div></div></div> <div class="sg sgTitle" id="s170" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s170_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="539.85" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:54.87px;top:18.09px;">Dr. de Christenson’s Diagnosis</span></p></div></div></div> <div class="sg" id="s171" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s171_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:675.98px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="636.58" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Malignant pleural mesothelioma, sarcomatoid </span><span data-textwidth="104.06" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:47.05px;top:52.94px;">subtype</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="501.33" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:55.93px;top:97.07px;">–<span style="letter-spacing:2.29px"> </span>Osteosarcomatous / chondrosarcomatous</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="299.82" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:55.93px;top:137.40px;">–<span style="letter-spacing:2.29px"> </span>Osseous or cartilaginous</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="162.99" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:55.93px;top:177.73px;">–<span style="letter-spacing:2.29px"> </span>Osteoblastic</span></p></div></div></div> <div class="sg sgTitle" id="s172" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s172_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="246.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:201.53px;top:18.09px;">The Diagnosis</span></p></div></div></div> <div class="sg" id="s173" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s173_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:668.05px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="485.12" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Osteoblastic sarcomatoid mesothelioma</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="514.17" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:53.41px;top:51.58px;">–<span style="letter-spacing:5.29px"> </span>Rare sarcomatous differentiation in mesothelioma</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="320.22" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:53.41px;top:86.15px;">–<span style="letter-spacing:5.29px"> </span>“Heterologous mesothelioma”</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="303.53" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:53.41px;top:120.72px;">–<span style="letter-spacing:5.29px"> </span>Asbestos-related malignancy</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="600.35" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:53.41px;top:155.28px;">–<span style="letter-spacing:5.29px"> </span>Imaging findings as expected from prior asbestos exposure </span><span data-textwidth="141.86" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:133%; left:76.10px;top:184.09px;">and asbestosis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="441.80" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:53.41px;top:218.66px;">–<span style="letter-spacing:5.29px"> </span>May involve the pleura or peritoneal cavity</span></p></div></div></div> <div class="sg sgTitle" id="s174" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s174_t" class="sg" style="z-index:2;left:-0.37px;top:-0.34px;width:649.22px;height:78.29px;"><div><p para="{al:2}"><span data-textwidth="593.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:200%; left:27.86px;top:16.49px;">Osteoblastic Sarcomatoid Mesothelioma</span></p></div></div></div> <div class="sg" id="s175" data-sgid="Content Placeholder 2" style="z-index:2;left:47.50px;top:96.64px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s175_t" class="sg" style="z-index:2;left:-9.83px;top:-5.37px;width:659.91px;height:273.78px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="370.50" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.54px;top:12.07px;">•<span style="letter-spacing:6.60px"> </span>Three mesothelioma subtypes</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="322.49" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:53.43px;top:51.56px;">–<span style="letter-spacing:5.28px"> </span>Epithelioid and mixed varieties</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="591.93" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:53.43px;top:86.13px;">–<span style="letter-spacing:5.28px"> </span>Sarcomatoid subtype is rarest and has the worst prognosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="544.89" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:17.54px;top:121.54px;">•<span style="letter-spacing:6.60px"> </span>Suspect OSM in the context of prior asbestos </span><span data-textwidth="556.65" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:156%; left:44.54px;top:155.14px;">exposure, coupled with atypical appearance and </span><span data-textwidth="319.13" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:156%; left:44.54px;top:188.75px;">location of thickened pleura</span></p></div></div></div> <div class="sg sgTitle" id="s176" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s176_t" class="sg" style="z-index:2;left:-0.37px;top:-0.34px;width:649.22px;height:78.29px;"><div><p para="{al:2}"><span data-textwidth="593.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:200%; left:27.86px;top:16.49px;">Osteoblastic Sarcomatoid Mesothelioma</span></p></div></div></div> <div class="sg" id="s177" data-sgid="Content Placeholder 2" style="z-index:2;left:29.51px;top:81.91px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s177_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.72px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="557.13" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.54px;top:12.08px;">•<span style="letter-spacing:6.60px"> </span>Imaging features as exemplified with this case:</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="281.09" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:53.42px;top:51.57px;">–<span style="letter-spacing:5.29px"> </span>Contraction of hemithorax</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="203.20" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:53.42px;top:86.14px;">–<span style="letter-spacing:5.29px"> </span>Unilateral effusion</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="496.17" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:133%; left:53.42px;top:120.70px;">–<span style="letter-spacing:5.29px"> </span>Nodular pleural and interlobar fissure thickening</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="558.94" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:53.42px;top:155.27px;">–<span style="letter-spacing:5.29px"> </span>Ossification, an independent neoplastic process rather </span><span data-textwidth="290.21" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:76.11px;top:184.08px;">than incorporation of plaques</span></p></div></div></div> <div class="sg sgTitle" id="s178" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s178_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="326.81" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:161.44px;top:18.09px;">Bruce Forster, MD</span></p></div></div></div> <div class="sg" id="s180" data-sgid="Picture 2" style="z-index:3;left:497.27px;top:105.89px;width:162.75px;height:213.70px"> <img class="sg" src="F5A85773.jpg" id="s180_i" style="z-index:1;left:0px;top:0px;width:162.75px;height:213.70px" > </div> <div class="sg" id="s179" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s179_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="422.71" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>BSc, MSc and MD: UBC, Vancouver</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="344.57" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:17.53px;top:52.42px;">•<span style="letter-spacing:6.60px"> </span>Residency Program Director</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="280.12" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.53px;top:92.75px;">•<span style="letter-spacing:6.60px"> </span>Vice Chair of Research</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="282.16" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:17.53px;top:133.08px;">•<span style="letter-spacing:6.60px"> </span>Professor of Radiology</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="288.28" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:17.53px;top:173.41px;">•<span style="letter-spacing:6.60px"> </span>Head of UBC Radiology</span></p></div></div></div> <div class="sg" id="s182" data-sgid="Rectangle 2" style="z-index:2;left:71.48px;top:10.66px;width:636.53px;height:37.19px" data-valign="top" data-pointer-events="none"> <div id="s182_t" class="sg" style="z-index:2;left:-7.31px;top:-3.59px;width:643.84px;height:51.33px;"><div><p><span data-textwidth="609.46" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.04px;top:10.33px;">Bruce with his wife Kelly and daughter Taylor in their backyard </span></p></div></div></div> <div class="sg" id="s183" data-sgid="Cloud Callout 3" style="z-index:3;left:30.47px;top:55.63px;width:397.24px;height:262.26px" data-fillcolor="16777215"> <div id="s183_t" class="sg" style="z-index:2;left:0px;top:0px;width:397.24px;height:262.26px;"><div><p para="{al:2}"><span data-textwidth="151.35" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:74.67px;top:47.23px;">It will be a cold </span><span data-textwidth="141.38" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:133%; left:79.59px;top:76.04px;">day in Canada </span><span data-textwidth="166.71" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:66.99px;top:104.84px;">before I agree to </span><span data-textwidth="118.10" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:133%; left:91.35px;top:133.65px;">serve on an </span><span data-textwidth="144.62" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:78.03px;top:162.46px;">unknown case </span><span data-textwidth="119.42" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:87.99px;top:191.26px;">panel again!</span></p></div></div><img class="sg" src="5A30AB7A.png" id="s183_i" style="z-index:1;left:0px;top:0px;width:397.24px;height:262.26px" > </div> <div class="sg" id="s181" data-sgid="Picture 6" style="z-index:1;left:209.41px;top:63.92px;width:451.95px;height:301.46px"> <img class="sg" src="DFC66CBD.jpg" id="s181_i" title="" alt="C:\Users\jkruskal\Desktop\IMG_3485.JPG" style="z-index:1;left:0px;top:0px;width:451.95px;height:301.46px" > </div> <div class="sg" id="s187" data-sgid="Picture 8" style="z-index:4;left:56.38px;top:33.94px;width:168.62px;height:126.88px"> <img class="sg" src="50157AF3.png" id="s187_i" title="" alt="http://lf.hatworld.com/hwl?set=sku%5B20673308%5D,c%5B2%5D,w%5B500%5D,h%5B375%5D&amp;load=url%5Bfile:product%5D" style="z-index:1;left:0px;top:0px;width:168.62px;height:126.88px" > </div> <div class="sg" id="s184" data-sgid="Rectangle 1" style="z-index:1;left:47.14px;top:33.57px;width:349.40px;height:133.61px" data-fillcolor="16777215"> <img class="sg" src="18E6058E.png" id="s184_i" style="z-index:1;left:0px;top:0px;width:349.40px;height:133.61px" > </div> <div class="sg" id="s186" data-sgid="Picture 6" style="z-index:3;left:245.40px;top:26.50px;width:143.93px;height:158.30px"> <img class="sg" src="75639056.png" id="s186_i" title="" alt="https://photon-101medialablimit.netdna-ssl.com/s3.store.hypebeast.com/media/image/2013/07/The_Genesis_project_Hats_8_1.jpg?fit=1400%2C1820" style="z-index:1;left:0px;top:0px;width:143.93px;height:158.30px" > </div> <div class="sg" id="s185" data-sgid="Picture 2" style="z-index:2;left:429.39px;top:26.50px;width:258.36px;height:344.17px"> <img class="sg" src="A2FD3DEF.jpg" id="s185_i" title="" alt="C:\Users\jkruskal\Desktop\P1020797.JPG" style="z-index:1;left:0px;top:0px;width:258.36px;height:344.17px" > </div> <div class="sg" id="s188" data-sgid="Rectangle 3" style="z-index:5;left:35.52px;top:204.82px;width:360.65px;height:95.45px" data-valign="top" data-pointer-events="none"> <div id="s188_t" class="sg" style="z-index:2;left:-4.45px;top:-3.48px;width:374.94px;height:108.89px;"><div><p para="{al:2}"><span data-textwidth="198.87" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:88.11px;top:10.51px;">Director of Imaging, </span><span data-textwidth="345.42" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:133%; left:14.66px;top:39.31px;">Vancouver Olympics &amp; Paralympics </span></p><p para="{al:2}"><span data-textwidth="48.49" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:160.60px;top:68.12px;">2010</span></p></div></div></div> <div class="sg" id="s189" data-sgid="Title 1" style="z-index:1;left:53.49px;top:66.92px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s189_t" class="sg" style="z-index:2;left:-0.34px;top:-0.37px;width:613.26px;height:97.49px;"><div><p para="{al:2}"><span data-textwidth="438.31" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:87.63px;top:22.35px;">Musculoskeletal Case #1</span></p></div></div></div> <div class="sg sgSubtitle" id="s190" data-sgid="Subtitle 2" style="z-index:2;left:89.48px;top:171.85px;width:582.56px;height:156.86px" data-valign="top" data-pointer-events="none"> <div id="s190_t" class="sg" style="z-index:2;left:-1.44px;top:-7.19px;width:593.47px;height:164.41px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="549.57" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:200%; left:22.26px;top:14.94px;">58 year old woman with proximal leg </span><span data-textwidth="480.56" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:200%; left:52.62px;top:58.15px;">pain and difficulty climbing stairs</span></p></div></div></div> <div class="sg" id="s196" data-sgid="Straight Arrow Connector 10" style="z-index:6;left:243.73px;top:81.43px;width:33.08px;height:38.97px" data-pointer-events="none"> <img class="sg" src="CC24BFDD.png" id="s196_i" style="z-index:1;left:0px;top:0px;width:33.08px;height:38.97px" > </div> <div class="sg" id="s191" data-sgid="Picture 3" style="z-index:1;left:56.26px;top:-15.70px;width:338.57px;height:246.54px"> <img class="sg" src="3F8C2124.png" id="s191_i" title="" alt="F:\NERRS Bone Cases\SarcoidMyositis\B2187103SarcoidMyositis_img00032.jpg" style="z-index:1;left:0px;top:0px;width:338.57px;height:246.54px" > </div> <div class="sg" id="s197" data-sgid="Straight Arrow Connector 11" style="z-index:7;left:657.53px;top:129.39px;width:33.08px;height:38.97px" data-pointer-events="none"> <img class="sg" src="9AEF2C.png" id="s197_i" style="z-index:1;left:0px;top:0px;width:33.08px;height:38.97px" > </div> <div class="sg" id="s198" data-sgid="Straight Arrow Connector 12" style="z-index:8;left:460.68px;top:135.39px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="4ABB2506.png" id="s198_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s193" data-sgid="Picture 6" style="z-index:3;left:428.08px;top:36.68px;width:304.76px;height:304.86px"> <img class="sg" src="11A7B01.png" id="s193_i" title="" alt="F:\Bone Images\Collagen Vascular Disease and Inflammatory Processes\Polymyositis\B0815222MuscleEdemaPolymyositis\B0815222MuscleEdema_img00020a.jpg" style="z-index:1;left:0px;top:0px;width:304.76px;height:304.86px" > </div> <div class="sg" id="s199" data-sgid="Straight Arrow Connector 14" style="z-index:9;left:207.73px;top:237.32px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="70C60E53.png" id="s199_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s200" data-sgid="Straight Arrow Connector 15" style="z-index:10;left:351.67px;top:267.30px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="70C60E53.png" id="s200_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s192" data-sgid="Picture 4" style="z-index:2;left:134.32px;top:194.39px;width:328.65px;height:238.87px"> <img class="sg" src="654A4465.png" id="s192_i" title="" alt="F:\NERRS Bone Cases\SarcoidMyositis\B2187103SarcoidMyositis_img00074.jpg" style="z-index:1;left:0px;top:0px;width:328.65px;height:238.87px" > </div> <div class="sg" id="s194" data-sgid="Straight Arrow Connector 7" style="z-index:4;left:172.84px;top:303.27px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="ED72C072.png" id="s194_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s195" data-sgid="Straight Arrow Connector 8" style="z-index:5;left:387.64px;top:309.27px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="6AB48065.png" id="s195_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg sgTitle" id="s201" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s201_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s202" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s202_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="605.14" class="sg nowrap f2" style="z-index:2;color:#FFC000;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Bilateral<span style="color:#FFFFFF;">, </span>slightly asymmetric homogenous high T2 </span><span data-textwidth="592.19" class="sg nowrap f2" style="z-index:6;color:#FFC000;font-size:156%; left:44.53px;top:45.70px;">signal <span style="color:#FFFFFF;">in gluteus maximus, iliacus and psoas muscles</span></span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="467.95" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:156%; left:17.53px;top:86.03px;">•<span style="letter-spacing:6.60px"> </span>No significant fatty infiltration/atrophy</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="426.19" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:156%; left:17.53px;top:126.36px;">•<span style="letter-spacing:6.60px"> </span>No mass, calcification, hemorrhage</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="143.90" class="sg nowrap f2" style="z-index:18;color:#FFFFFF;font-size:156%; left:17.53px;top:166.69px;">•<span style="letter-spacing:6.60px"> </span>No fascitis</span></p></div></div></div> <div class="sg sgTitle" id="s203" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s203_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s204" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s204_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="481.04" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Acquired myopathy: many possibilities!</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="496.40" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.53px;top:52.42px;">•<span style="letter-spacing:6.60px"> </span>Assume sub-acute/chronic, no sensory sx</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="516.92" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:156%; left:17.53px;top:92.75px;">•<span style="letter-spacing:6.60px"> </span>NOT neoplastic, traumatic, infectious, toxic</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="556.17" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:156%; left:17.53px;top:133.08px;">•<span style="letter-spacing:6.60px"> </span>Most likely <span style="color:#FFC000;">inflammatory</span>: PM, DM, related to </span><span data-textwidth="206.55" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:156%; left:44.53px;top:166.69px;">systemic diseases </span></p></div></div></div> <div class="sg sgSubtitle" id="s205" data-sgid="Subtitle 2" style="z-index:1;left:125.45px;top:105.89px;width:504.58px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s205_t" class="sg" style="z-index:2;left:-0.34px;top:-5.88px;width:505.29px;height:110.56px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="459.56" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:23.11px;top:13.69px;">2 months later, develops hand pain</span></p></div></div></div> <div class="sg" id="s207" data-sgid="Straight Arrow Connector 3" style="z-index:2;left:309.69px;top:63.44px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="950CA51B.png" id="s207_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s208" data-sgid="Straight Arrow Connector 4" style="z-index:3;left:273.69px;top:75.43px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="2B96342.png" id="s208_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s209" data-sgid="Straight Arrow Connector 5" style="z-index:4;left:603.53px;top:81.17px;width:39.00px;height:27.24px" data-pointer-events="none"> <img class="sg" src="C52AE204.png" id="s209_i" style="z-index:1;left:0px;top:0px;width:39.00px;height:27.24px" > </div> <div class="sg" id="s210" data-sgid="Straight Arrow Connector 7" style="z-index:5;left:561.56px;top:81.31px;width:44.98px;height:33.09px" data-pointer-events="none"> <img class="sg" src="69522751.png" id="s210_i" style="z-index:1;left:0px;top:0px;width:44.98px;height:33.09px" > </div> <div class="sg" id="s206" data-sgid="Picture 2" style="z-index:1;left:128.23px;top:-9.22px;width:568.61px;height:440.70px"> <img class="sg" src="AF1A25B4.png" id="s206_i" title="" alt="F:\Bone Images\Collagen Vascular Disease and Inflammatory Processes\Sarcoidosis\B2046417SarcoidHands\B2046417SarcoidHands_img01002.jpg" style="z-index:1;left:0px;top:0px;width:568.61px;height:440.70px" > </div> <div class="sg" id="s221" data-sgid="Straight Arrow Connector 14" style="z-index:11;left:609.54px;top:93.42px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="E22354A8.png" id="s221_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s223" data-sgid="Straight Arrow Connector 17" style="z-index:13;left:161.19px;top:117.15px;width:44.76px;height:21.24px" data-pointer-events="none"> <img class="sg" src="DC507FAF.png" id="s223_i" style="z-index:1;left:0px;top:0px;width:44.76px;height:21.24px" > </div> <div class="sg" id="s217" data-sgid="Straight Arrow Connector 10" style="z-index:7;left:213.74px;top:111.41px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="9C0AB11A.png" id="s217_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s220" data-sgid="Straight Arrow Connector 13" style="z-index:10;left:441.63px;top:129.39px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="9C0AB11A.png" id="s220_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s219" data-sgid="Straight Arrow Connector 12" style="z-index:9;left:375.65px;top:147.38px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="9C95C973.png" id="s219_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s218" data-sgid="Straight Arrow Connector 11" style="z-index:8;left:165.76px;top:159.37px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="950CA51B.png" id="s218_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s216" data-sgid="Picture 7" style="z-index:6;left:266.15px;top:-8.99px;width:273.10px;height:393.58px"> <img class="sg" src="380BC4AA.png" id="s216_i" title="" alt="F:\Bone Images\Collagen Vascular Disease and Inflammatory Processes\Sarcoidosis\B2046417SarcoidHands\B2046417SarcoidHands_img00008.jpg" style="z-index:1;left:0px;top:0px;width:273.10px;height:393.58px" > </div> <div class="sg" id="s214" data-sgid="Picture 3" style="z-index:4;left:52.07px;top:-8.99px;width:236.99px;height:397.17px"> <img class="sg" src="83B860D5.png" id="s214_i" title="" alt="F:\Bone Images\Collagen Vascular Disease and Inflammatory Processes\Sarcoidosis\B2046417SarcoidHands\1aaa.jpg" style="z-index:1;left:0px;top:0px;width:236.99px;height:397.17px" > </div> <div class="sg" id="s215" data-sgid="Picture 6" style="z-index:5;left:515.75px;top:-8.99px;width:199.09px;height:398.50px"> <img class="sg" src="6AAC5CFF.png" id="s215_i" title="" alt="F:\Bone Images\Collagen Vascular Disease and Inflammatory Processes\Sarcoidosis\B2046417SarcoidHands\B2046417SarcoidHands_img00004.jpg" style="z-index:1;left:0px;top:0px;width:199.09px;height:398.50px" > </div> <div class="sg" id="s222" data-sgid="Straight Arrow Connector 15" style="z-index:12;left:388.74px;top:176.29px;width:39.09px;height:39.09px" data-pointer-events="none"> <img class="sg" src="EBC576D2.png" id="s222_i" style="z-index:1;left:0px;top:0px;width:39.09px;height:39.09px" > </div> <div class="sg" id="s212" data-sgid="TextBox 8" style="z-index:2;left:343.99px;top:356.16px;width:111.42px;height:37.16px" data-valign="top"> <div id="s212_t" class="sg" style="z-index:2;left:-3.83px;top:-3.48px;width:118.96px;height:51.19px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="89.53" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:14.98px;top:10.52px;">T2 fat sat</span></p></div></div></div> <div class="sg" id="s213" data-sgid="TextBox 9" style="z-index:3;left:551.83px;top:356.16px;width:111.31px;height:37.16px" data-valign="top"> <div id="s213_t" class="sg" style="z-index:2;left:-3.82px;top:-3.48px;width:119.10px;height:51.19px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="89.53" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.24px;top:10.52px;">T2 fat sat</span></p></div></div></div> <div class="sg" id="s211" data-sgid="TextBox 7" style="z-index:1;left:155.44px;top:356.16px;width:45.95px;height:46.75px" data-valign="top"> <div id="s211_t" class="sg" style="z-index:2;left:-3.71px;top:-3.48px;width:53.37px;height:51.19px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="23.76" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:14.86px;top:10.52px;">T1</span></p></div></div></div> <div class="sg sgTitle" id="s224" data-sgid="Title 1" style="z-index:1;left:35.52px;top:9.96px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s224_t" class="sg" style="z-index:2;left:-0.37px;top:-5.89px;width:649.22px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s225" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:75.91px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s225_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="550.77" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.08px;">•<span style="letter-spacing:6.60px"> </span><u>XR:</u><span style="color:#FFC000;"><span style="letter-spacing:6.60px"> </span>lace-like permeative lytic pattern </span>of D3/4 </span><span data-textwidth="590.02" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:44.53px;top:45.69px;">crossing but not involving joints, with associated ST </span><span data-textwidth="91.82" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:44.53px;top:79.29px;">swelling</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="623.86" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:17.53px;top:119.62px;">•<span style="letter-spacing:6.60px"> </span><u>MR:</u><span style="color:#FFC000;"> BM infiltration </span>with extension beyond cortex in </span><span data-textwidth="534.93" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:156%; left:44.53px;top:153.23px;">a <span style="color:#FFC000;">‘periostitis’ pattern</span>. Possible involvement of </span><span data-textwidth="368.46" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:156%; left:44.53px;top:186.84px;">extensor &gt; deep flexor tendons. </span></p></div></div><img class="sg" src="639F6276.png" id="s225_tt" style="left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;z-index:1" > </div> <div class="sg sgTitle" id="s226" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s226_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s228" data-sgid="Picture 6" style="z-index:3;left:227.41px;top:117.88px;width:299.97px;height:187.80px"> <img class="sg" src="5151E4A7.jpg" id="s228_i" title="" alt="http://www.desktophdphotos.com/wp-content/uploads/2014/12/Funny-Mouse-Helmet-With-Cheese-Trap.jpg" style="z-index:1;left:0px;top:0px;width:299.97px;height:187.80px" > </div> <div class="sg" id="s227" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s227_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="107.65" class="sg nowrap f2" style="z-index:2;color:#FFC000;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>None!</span></p></div></div></div> <div class="sg sgTitle" id="s229" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s229_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="389.10" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:130.24px;top:18.09px;">Dr Forster’s Diagnosis</span></p></div></div></div> <div class="sg" id="s230" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:111.89px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s230_t" class="sg" style="z-index:2;left:-0.37px;top:-5.89px;width:649.22px;height:274.26px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="605.26" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:22.10px;top:13.71px;">Extra-pulmonary manifestations of <span style="color:#FFC000;">Sarcoidosis</span></span><span data-textwidth="460.64" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:178%; left:107.91px;top:52.11px;">with myopathy and osseous lesions</span></p></div></div></div> <div class="sg sgTitle" id="s231" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s231_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="246.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:201.53px;top:18.09px;">The Diagnosis</span></p></div></div></div> <div class="sg" id="s232" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s232_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="454.15" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Sarcoid myopathy and periostitis</span></p></div></div></div> <div class="sg sgTitle" id="s233" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s233_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="495.80" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:76.83px;top:18.09px;">Extrapulmonary Sarcoidosis</span></p></div></div></div> <div class="sg" id="s234" data-sgid="Content Placeholder 2" style="z-index:2;left:77.49px;top:96.64px;width:672.50px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s234_t" class="sg" style="z-index:2;left:-7.56px;top:-4.07px;width:680.43px;height:272.47px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="448.28" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.28px;top:10.89px;">•<span style="letter-spacing:9.61px"> </span>Almost every organ system can be involved</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="215.31" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:51.17px;top:43.50px;">–<span style="letter-spacing:8.16px"> </span>Cutaneous involvement</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="139.10" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:111%; left:51.17px;top:72.31px;">–<span style="letter-spacing:8.16px"> </span>Ocular: uveitis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="210.87" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:111%; left:51.17px;top:101.11px;">–<span style="letter-spacing:8.16px"> </span>Upper respiratory tract</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="142.10" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:111%; left:51.17px;top:129.92px;">–<span style="letter-spacing:8.16px"> </span>Cardiovascular</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="268.60" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:111%; left:51.17px;top:158.73px;">–<span style="letter-spacing:8.16px"> </span>Lymph nodes, liver and spleen</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="310.25" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:111%; left:51.17px;top:187.53px;">–<span style="letter-spacing:8.16px"> </span>Exocrine glands, renal, neurological</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="458.83" class="sg nowrap f2" style="z-index:16;color:#FF6319;font-size:111%; left:51.17px;top:216.34px;">–<span style="letter-spacing:8.16px"> </span>Musculoskeletal involvement in up to 10% of patients</span></p></div></div></div> <div class="sg" id="s236" data-sgid="Title 1" style="z-index:2;left:47.50px;top:21.95px;width:648.52px;height:68.36px" data-valign="middle"> <div id="s236_t" class="sg" style="z-index:2;left:-8.75px;top:-5.89px;width:666.03px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="612.94" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:26.78px;top:18.11px;">Muscle Involvement in Sarcoidosis</span></p></div></div></div> <div class="sg" id="s235" data-sgid="Content Placeholder 2" style="z-index:1;left:35.52px;top:105.89px;width:660.51px;height:186.83px" data-valign="top" data-pointer-events="none"> <div id="s235_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:675.61px;height:213.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="645.82" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:11.00px;">•<span style="letter-spacing:9.60px"> </span>Ranges from chronic proximal myopathy to less common acute </span><span data-textwidth="330.78" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:42.26px;top:39.81px;">myopathy mimicking polymyositis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="633.22" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:15.26px;top:74.38px;">•<span style="letter-spacing:9.60px"> </span>Symptomatic in only 0.5-2.5%, mostly when the diaphragm or </span><span data-textwidth="326.93" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:42.26px;top:103.18px;">extra-ocular muscles are involved</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="310.13" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:15.26px;top:137.75px;">•<span style="letter-spacing:9.60px"> </span>Indicates progressive disease</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="348.77" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:15.26px;top:172.32px;">•<span style="letter-spacing:9.60px"> </span>Associated with a poor prognosis</span></p></div></div></div> <div class="sg" id="s238" data-sgid="Title 1" style="z-index:2;left:47.50px;top:21.95px;width:648.52px;height:68.36px" data-valign="middle"> <div id="s238_t" class="sg" style="z-index:2;left:-8.75px;top:-5.89px;width:666.03px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="612.94" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:26.78px;top:18.11px;">Muscle Involvement in Sarcoidosis</span></p></div></div></div> <div class="sg" id="s237" data-sgid="Content Placeholder 2" style="z-index:1;left:29.51px;top:105.89px;width:672.50px;height:294.76px" data-valign="top" data-pointer-events="none"> <div id="s237_t" class="sg" style="z-index:2;left:-5.05px;top:-2.77px;width:677.91px;height:297.90px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="286.24" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.75px;top:8.70px;">•<span style="letter-spacing:12.48px"> </span>Myopathic and nodular variants</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="637.43" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:12.75px;top:37.51px;">•<span style="letter-spacing:12.48px"> </span>50-80% of patients have skeletal muscle granulomas, even if asymptomatic</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="627.22" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:111%; left:12.75px;top:66.32px;">•<span style="letter-spacing:12.48px"> </span>Myopathic type: symmetric proximal myositis, atrophy, fatty replacement</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="400.86" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:89%; left:48.63px;top:94.28px;">–<span style="letter-spacing:11.05px"> </span>Increased signal on T2WI, and post-contrast enhancement</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="626.14" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:111%; left:12.75px;top:118.17px;">•<span style="letter-spacing:12.48px"> </span>Nodular pattern myopathy manifests as single or multiple painful nodules</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="598.43" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:89%; left:48.63px;top:146.13px;">–<span style="letter-spacing:11.05px"> </span>Characteristic MR appearance: focal intramuscular masses at musculotendinous junction</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="444.32" class="sg nowrap f2" style="z-index:18;color:#FFFFFF;font-size:89%; left:48.63px;top:169.18px;">–<span style="letter-spacing:11.05px"> </span>Tend to be multiple and bilateral, lower extremity predominance</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="579.94" class="sg nowrap f2" style="z-index:20;color:#FFFFFF;font-size:89%; left:48.63px;top:192.47px;">–<span class="f6" ><span style="letter-spacing:9.73px"> </span>“</span>Dark star<span class="f6" >”</span> appearance on MRI: central fibrosis shows low SI on all sequences, bright </span><span data-textwidth="140.42" class="sg nowrap f2" style="z-index:25;color:#FFFFFF;font-size:89%; left:71.32px;top:211.43px;">peripheral SI on T2WI</span></p></div></div></div> <div class="sg sgTitle" id="s239" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s239_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="349.86" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:149.80px;top:18.09px;">Skeletal Sarcoidosis</span></p></div></div></div> <div class="sg" id="s240" data-sgid="Content Placeholder 2" style="z-index:2;left:29.51px;top:114.63px;width:672.50px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s240_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:680.43px;height:272.47px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="625.66" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.27px;top:10.91px;">•<span style="letter-spacing:9.60px"> </span>Acute polyarthritis usually a/c erythema nodosum and uveitis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="393.43" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:111%; left:51.15px;top:43.51px;">–<span style="letter-spacing:8.17px"> </span>Periarthritis more common than true arthritis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="496.64" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:111%; left:51.15px;top:72.32px;">–<span style="letter-spacing:8.17px"> </span>Acute arthritis is isolated or presents as <span style="color:#FF6319;">Lofgren syndrome</span></span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="527.49" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:111%; left:51.15px;top:101.13px;">–<span style="letter-spacing:8.17px"> </span>EN, hilar LN, migratory polyarthralgia, fever, usually in women</span></p></div></div></div> <div class="sg sgTitle" id="s241" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s241_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="349.86" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:149.80px;top:18.09px;">Skeletal Sarcoidosis</span></p></div></div></div> <div class="sg" id="s242" data-sgid="Content Placeholder 2" style="z-index:2;left:29.51px;top:108.63px;width:672.50px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s242_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:680.43px;height:272.47px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="604.90" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.27px;top:10.90px;">•<span style="letter-spacing:9.60px"> </span>When hands are affected, lace-like pattern of metaphyseal </span><span data-textwidth="265.72" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:42.27px;top:39.71px;">periosteal bone resorption </span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="616.18" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:111%; left:51.15px;top:72.32px;">–<span style="letter-spacing:8.17px"> </span>Cystic bone lesions with well defined margins and lytic bone lesions with </span><span data-textwidth="321.53" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:111%; left:73.84px;top:96.32px;">periosteal reaction; mimics rheumatoid</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="583.90" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:111%; left:51.15px;top:125.13px;">–<span style="letter-spacing:8.17px"> </span>Remodeling of the cortex of phalanges, in which the concave shaft is </span><span data-textwidth="277.01" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:111%; left:73.84px;top:149.14px;">converted into a tubular structure</span></p></div></div></div> <div class="sg sgTitle" id="s243" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s243_t" class="sg" style="z-index:2;left:-6.72px;top:-2.15px;width:661.95px;height:84.79px;"><div><p para="{al:2}"><span data-textwidth="613.30" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:222%; left:24.49px;top:15.90px;">Michelle McNicholas, MB, BCh, BAO…</span></p></div></div></div> <div class="sg" id="s245" data-sgid="Picture 7" style="z-index:3;left:35.52px;top:93.90px;width:136.96px;height:204.94px"> <img class="sg" src="F665910B.jpg" id="s245_i" title="" alt="https://www.materprivate.ie/wp-content/uploads/2012/04/Michelle-McNicholas.jpg" style="z-index:1;left:0px;top:0px;width:136.96px;height:204.94px" > </div> <div class="sg" id="s244" data-sgid="Content Placeholder 2" style="z-index:2;left:173.44px;top:111.89px;width:360.65px;height:180.84px" data-valign="top" data-pointer-events="none"> <div id="s244_t" class="sg" style="z-index:2;left:-7.57px;top:-4.08px;width:368.59px;height:218.74px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="241.48" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.36px;top:11.02px;">•<span style="letter-spacing:9.60px"> </span>Trinity College, Dublin</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="329.45" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.36px;top:46.06px;">•<span style="letter-spacing:9.60px"> </span>Radiology: St Vincent<span class="f6" style="position:relative;bottom:1px;">’</span>s, Dublin</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="320.33" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:15.36px;top:80.15px;">•<span style="letter-spacing:9.60px"> </span>Fellowship Abd Imaging: MGH</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="317.93" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:15.36px;top:114.72px;">•<span style="letter-spacing:9.60px"> </span>Chief of GU Radiology, BIDMC</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="312.53" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:15.36px;top:149.29px;">•<span style="letter-spacing:9.60px"> </span>Currently: Consultant, Mater </span><span data-textwidth="134.18" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:133%; left:42.36px;top:178.09px;">Misericordiae</span></p></div></div></div> <div class="sg" id="s246" data-sgid="Picture 2" style="z-index:4;left:521.25px;top:105.89px;width:186.76px;height:224.85px"> <img class="sg" src="19D778CF.jpg" id="s246_i" style="z-index:1;left:0px;top:0px;width:186.76px;height:224.85px" > </div> <div class="sg" id="s252" data-sgid="TextBox 6" style="z-index:6;left:100.99px;top:42.93px;width:200.90px;height:32.38px" data-valign="top"> <div id="s252_t" class="sg" style="z-index:2;left:-4.93px;top:-3.96px;width:214.34px;height:44.86px;"><div><p><span data-textwidth="189.51" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.68px;top:10.20px;">Michelle and her boy<span class="f6" >’</span>s</span></p></div></div></div> <div class="sg" id="s249" data-sgid="11D42DAC-EF82-4FF3-BDF8-4ABDB2804990" style="z-index:3;left:412.72px;top:58.77px;width:287.61px;height:256.86px"> <img class="sg" src="D2A3F2C9.jpg" id="s249_i" title="" alt="7E80F54C-5DC3-4247-AB58-85F582E71E7D" style="z-index:1;left:0px;top:0px;width:287.61px;height:256.86px" > </div> <div class="sg" id="s247" data-sgid="9624046C-546F-422B-86DF-70D90A6B4A30" style="z-index:1;left:41.50px;top:87.90px;width:319.89px;height:198.57px"> <img class="sg" src="C7DFF1D2.jpg" id="s247_i" title="" alt="FF0494B5-87F0-4ACD-A5C0-6BF67CED455D" style="z-index:1;left:0px;top:0px;width:319.89px;height:198.57px" > </div> <div class="sg" id="s251" data-sgid="9624046C-546F-422B-86DF-70D90A6B4A30 (2)" style="z-index:5;left:281.37px;top:243.43px;width:54.82px;height:13.07px"> <img class="sg" src="D60B97EE.png" id="s251_i" title="" alt="FF0494B5-87F0-4ACD-A5C0-6BF67CED455D" style="z-index:1;left:0px;top:0px;width:54.82px;height:13.07px" > </div> <div class="sg" id="s253" data-sgid="Cloud Callout 7" style="z-index:7;left:138.52px;top:107.93px;width:471.14px;height:251.72px" data-fillcolor="16777215"> <div id="s253_t" class="sg" style="z-index:2;left:0px;top:0px;width:471.14px;height:251.72px;"><div><p para="{al:2}"><span data-textwidth="158.91" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:51.23px;top:82.79px;">Is it still too late </span><span data-textwidth="136.82" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:133%; left:62.39px;top:111.60px;">to bale out of </span><span data-textwidth="137.30" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:62.15px;top:140.40px;">this unknown </span><span data-textwidth="113.54" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:133%; left:71.27px;top:169.21px;">case panel?</span></p></div></div><img class="sg" src="EBFAECED.png" id="s253_i" style="z-index:1;left:0px;top:0px;width:471.14px;height:251.72px" > </div> <div class="sg" id="s248" data-sgid="TextBox 1" style="z-index:2;left:54.34px;top:309.75px;width:294.10px;height:32.38px" data-valign="top"> <div id="s248_t" class="sg" style="z-index:2;left:-4.79px;top:-2.40px;width:300.93px;height:42.93px;"><div><p><span data-textwidth="276.05" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.50px;top:8.52px;">Billy, Barry, Jack, Sam and Michael</span></p></div></div></div> <div class="sg" id="s250" data-sgid="TextBox 2" style="z-index:4;left:451.69px;top:333.37px;width:209.55px;height:32.38px" data-valign="top"> <div id="s250_t" class="sg" style="z-index:2;left:-4.90px;top:-2.52px;width:217.32px;height:43.05px;"><div><p><span data-textwidth="192.51" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.89px;top:8.54px;">Three generation jump!</span></p></div></div></div> <div class="sg" id="s254" data-sgid="Title 1" style="z-index:1;left:53.49px;top:66.92px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s254_t" class="sg" style="z-index:2;left:-0.34px;top:-0.37px;width:613.26px;height:92.71px;"><div><p para="{al:2}"><span data-textwidth="360.42" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:222%; left:126.64px;top:23.87px;">Genitourinary Case #1</span></p></div></div></div> <div class="sg sgSubtitle" id="s255" data-sgid="Subtitle 2" style="z-index:2;left:113.46px;top:183.84px;width:510.59px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s255_t" class="sg" style="z-index:2;left:-0.37px;top:-5.89px;width:511.33px;height:110.56px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="288.89" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:115.07px;top:13.77px;">43 year old male with </span><span data-textwidth="247.00" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:178%; left:132.35px;top:52.18px;">painless hematuria</span></p></div></div></div> <div class="sg" id="s256" data-sgid="Picture 4" style="z-index:1;left:239.40px;top:45.93px;width:261.96px;height:269.22px"> <img class="sg" src="D5AD5824.jpg" id="s256_i" title="" alt="_img00q" style="z-index:1;left:0px;top:0px;width:261.96px;height:269.22px" > </div> <div class="sg" id="s258" data-sgid="Picture 8" style="z-index:2;left:83.36px;top:80.94px;width:283.05px;height:206.38px"> <img class="sg" src="425F7848.jpg" id="s258_i" title="" alt="_imgw" style="z-index:1;left:0px;top:0px;width:283.05px;height:206.38px" > </div> <div class="sg" id="s257" data-sgid="Picture 2" style="z-index:1;left:365.58px;top:82.27px;width:300.93px;height:205.05px"> <img class="sg" src="F78A7823.jpg" id="s257_i" style="z-index:1;left:0px;top:0px;width:300.93px;height:205.05px" > </div> <div class="sg" id="s260" data-sgid="Picture 2" style="z-index:2;left:363.43px;top:61.63px;width:349.85px;height:238.76px"> <img class="sg" src="D1B99DB5.jpg" id="s260_i" style="z-index:1;left:0px;top:0px;width:349.85px;height:238.76px" > </div> <div class="sg" id="s259" data-sgid="Picture 6" style="z-index:1;left:41.98px;top:61.63px;width:324.09px;height:240.69px"> <img class="sg" src="418BB86F.jpg" id="s259_i" title="" alt="_imgr" style="z-index:1;left:0px;top:0px;width:324.09px;height:240.69px" > </div> <div class="sg" id="s261" data-sgid="Picture 3" style="z-index:1;left:41.50px;top:82.87px;width:336.79px;height:233.95px"> <img class="sg" src="3CC60062.jpg" id="s261_i" style="z-index:1;left:0px;top:0px;width:336.79px;height:233.95px" > </div> <div class="sg" id="s262" data-sgid="Picture 2" style="z-index:2;left:401.33px;top:55.29px;width:286.79px;height:289.10px"> <img class="sg" src="2952DEE0.jpg" id="s262_i" style="z-index:1;left:0px;top:0px;width:286.79px;height:289.10px" > </div> <div class="sg" id="s264" data-sgid="Picture 2" style="z-index:2;left:170.55px;top:76.50px;width:189.88px;height:141.16px"> <img class="sg" src="A283B52C.jpg" id="s264_i" style="z-index:1;left:0px;top:0px;width:189.88px;height:141.16px" > </div> <div class="sg" id="s263" data-sgid="Picture 3" style="z-index:1;left:387.52px;top:78.43px;width:176.56px;height:140.79px"> <img class="sg" src="F65EBBC2.jpg" id="s263_i" style="z-index:1;left:0px;top:0px;width:176.56px;height:140.79px" > </div> <div class="sg" id="s265" data-sgid="Picture 2 (2)" style="z-index:3;left:269.64px;top:230.62px;width:180.75px;height:145.68px"> <img class="sg" src="68A46D34.jpg" id="s265_i" style="z-index:1;left:0px;top:0px;width:180.75px;height:145.68px" > </div> <div class="sg sgTitle" id="s266" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s266_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="213.16" class="sg nowrap f8" style="z-index:2;color:#FF6319;font-size:244%; left:218.21px;top:20.81px;">Findings</span></p></div></div></div> <div class="sg" id="s267" data-sgid="Content Placeholder 2" style="z-index:2;left:80.95px;top:93.90px;width:681.03px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s267_t" class="sg" style="z-index:2;left:-5.27px;top:-3.59px;width:686.67px;height:281.44px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="621.47" class="sg nowrap f8" style="z-index:2;color:#FFFFFF;font-size:133%; left:13.01px;top:11.11px;">• T2 bright solitary expansile small renal </span><span data-textwidth="58.09" class="sg nowrap f8" style="z-index:6;color:#FFFFFF;font-size:133%; left:40.02px;top:39.92px;">mass</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="462.08" class="sg nowrap f8" style="z-index:7;color:#FFFFFF;font-size:133%; left:13.01px;top:74.49px;">• Cortical or medullary location</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="549.10" class="sg nowrap f8" style="z-index:9;color:#FFFFFF;font-size:133%; left:13.01px;top:109.05px;">• Moderate (&lt;cortex) enhancement early</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="650.52" class="sg nowrap f8" style="z-index:11;color:#FFFFFF;font-size:133%; left:13.01px;top:143.62px;">• Progressive enhancement of band-like areas </span><span data-textwidth="319.01" class="sg nowrap f8" style="z-index:15;color:#FFFFFF;font-size:133%; left:40.02px;top:172.43px;">in nephrographic phase</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="404.11" class="sg nowrap f8" style="z-index:18;color:#FFFFFF;font-size:133%; left:13.01px;top:207.00px;">• Washout on excretory phase</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="433.04" class="sg nowrap f8" style="z-index:20;color:#FFFFFF;font-size:133%; left:13.01px;top:241.56px;">• Arising in horse-shoe kidney</span></p></div></div></div> <div class="sg sgTitle" id="s268" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s268_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="585.94" class="sg nowrap f8" style="z-index:2;color:#FF6319;font-size:244%; left:31.82px;top:20.81px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s269" data-sgid="Content Placeholder 2" style="z-index:2;left:192.51px;top:74.36px;width:449.54px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s269_t" class="sg" style="z-index:2;left:-3.60px;top:-1.93px;width:453.48px;height:305.20px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="285.77" class="sg nowrap f4" style="z-index:2;color:#FFFFFF;left:11.40px;top:8.39px;">•<span style="letter-spacing:15.73px"> </span>Renal Cell Cancer likely cc-RCC</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="127.59" class="sg nowrap f4" style="z-index:6;color:#FFFFFF;left:11.40px;top:34.31px;">•<span style="letter-spacing:15.73px"> </span>Oncocytoma</span></p><p para="{spbf:0.20}"><span data-textwidth="304.01" class="sg nowrap f4" style="z-index:8;color:#FFFFFF;left:11.40px;top:60.24px;">…but it couldn’t be that easy, could it?</span></p><p para="{bl:{ch:8226},spbf:0.20}"></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="281.21" class="sg nowrap f4" style="z-index:9;color:#FFFFFF;left:11.40px;top:112.09px;">•<span style="letter-spacing:15.73px"> </span>T2 bright Mesenchymal Tumour</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="238.48" class="sg nowrap f4" style="z-index:11;color:#FFFFFF;font-size:89%; left:47.41px;top:137.54px;">–<span style="letter-spacing:9.24px"> </span>Reninoma…does not enhance</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="237.52" class="sg nowrap f4" style="z-index:13;color:#FFFFFF;font-size:89%; left:47.41px;top:160.58px;">–<span style="letter-spacing:9.24px"> </span>Schwannoma…arises in hilum</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="245.20" class="sg nowrap f4" style="z-index:15;color:#FFFFFF;font-size:89%; left:47.41px;top:183.63px;">–<span style="letter-spacing:9.24px"> </span>Hemangioma…..usually &lt; 1 cm</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="178.72" class="sg nowrap f4" style="z-index:17;color:#FFFFFF;left:11.40px;top:207.15px;">•<span style="letter-spacing:15.73px"> </span>Enhancing Lesions</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="267.16" class="sg nowrap f4" style="z-index:19;color:#FFFFFF;font-size:89%; left:47.41px;top:232.60px;">–<span style="letter-spacing:9.24px"> </span>Leiomyoma/solitary fibrous tumour</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="90.01" class="sg nowrap f4" style="z-index:21;color:#FFFFFF;font-size:89%; left:47.41px;top:255.64px;">–<span style="letter-spacing:9.24px"> </span>Carcinoid</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="165.62" class="sg nowrap f4" style="z-index:23;color:#FFFFFF;font-size:89%; left:47.41px;top:278.69px;">–<span style="letter-spacing:9.12px"> </span>Vascular metastasis</span></p></div></div></div> <div class="sg" id="s270" data-sgid="Picture Placeholder 13" style="z-index:1;left:173.44px;top:57.92px;width:354.67px;height:283.84px"> <img class="sg" src="905091D2.jpg" id="s270_i" title="" alt="sherlock.jpg" style="z-index:1;left:0px;top:0px;width:354.67px;height:283.84px" > </div> <div class="sg sgTitle" id="s277" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s277_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="359.94" class="sg nowrap f4" style="z-index:2;color:#FF6319;font-size:244%; left:144.88px;top:19.81px;">Horseshoe Kidney</span></p></div></div></div> <div class="sg" id="s278" data-sgid="Content Placeholder 2" style="z-index:2;left:95.46px;top:111.89px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s278_t" class="sg" style="z-index:2;left:-7.54px;top:-4.08px;width:656.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="324.89" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.30px;top:11.02px;">•<span style="letter-spacing:9.60px"> </span>Increased risk of Wilm’s tumor</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="312.29" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.30px;top:45.58px;">•<span style="letter-spacing:9.60px"> </span>Increased risk of oncocytoma</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="229.11" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:15.30px;top:80.15px;">•<span style="letter-spacing:9.60px"> </span>Increased risk of TCC</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="400.50" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:15.30px;top:114.72px;">•<span style="letter-spacing:9.60px"> </span>Increased risk of squamous cell cancer</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="483.92" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:15.30px;top:149.29px;">•<span style="letter-spacing:9.60px"> </span>60 times increased incidence of renal carcinoid</span></p></div></div></div> <div class="sg sgTitle" id="s279" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s279_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="313.37" class="sg nowrap f4" style="z-index:2;color:#FF6319;font-size:244%; left:168.16px;top:19.81px;">Renal Carcinoid</span></p></div></div></div> <div class="sg" id="s280" data-sgid="Content Placeholder 2" style="z-index:2;left:101.47px;top:108.63px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s280_t" class="sg" style="z-index:2;left:-9.83px;top:-5.37px;width:658.72px;height:273.78px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="331.25" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.58px;top:12.08px;">•<span style="letter-spacing:6.60px"> </span>T2 bright, variably vascular</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="549.69" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:17.58px;top:52.41px;">•<span style="letter-spacing:6.60px"> </span>Carcinoid tumours may be ‘oncocytic’ in their </span><span data-textwidth="537.34" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:44.58px;top:86.02px;">histologic and ultrastructural pattern - nests of </span><span data-textwidth="518.73" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:156%; left:44.58px;top:119.63px;">eosinophilic cells with anastomosing cords of </span><span data-textwidth="253.48" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:156%; left:44.58px;top:153.24px;">fibrovascular stroma…</span></p></div></div></div> <div class="sg sgTitle" id="s281" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s281_t" class="sg" style="z-index:2;left:-0.37px;top:-32.25px;width:649.22px;height:146.05px;"><div><p para="{al:2}"><span data-textwidth="426.07" class="sg nowrap f8" style="z-index:2;color:#FF6319;font-size:244%; left:124.96px;top:20.79px;">Dr McNicholas’s </span><span data-textwidth="239.80" class="sg nowrap f8" style="z-index:3;color:#FF6319;font-size:244%; left:204.89px;top:73.60px;">Diagnosis</span></p></div></div></div> <div class="sg" id="s282" data-sgid="Content Placeholder 2" style="z-index:2;left:70.52px;top:111.89px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s282_t" class="sg" style="z-index:2;left:-7.54px;top:-4.08px;width:656.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="337.62" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.27px;top:11.02px;">•<span style="letter-spacing:9.61px"> </span>Either Oncocytoma or Carcinoid</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="170.06" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:111%; left:51.16px;top:43.62px;">–<span style="letter-spacing:8.16px"> </span>Both are T2 bright</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="135.38" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:111%; left:51.16px;top:72.43px;">–<span style="letter-spacing:8.16px"> </span>Both enhance</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="585.45" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:111%; left:51.16px;top:101.24px;">–<span style="letter-spacing:8.16px"> </span>Both may have fibrovascular bands which may enhance progressively</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="377.46" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:111%; left:51.16px;top:130.04px;">–<span style="letter-spacing:8.16px"> </span>Both occur with increased frequency in HSK</span></p></div></div></div> <div class="sg sgTitle" id="s283" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s283_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="469.28" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:90.15px;top:18.09px;">Dr McNicholas’s Diagnosis</span></p></div></div></div> <div class="sg" id="s284" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s284_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="573.69" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Either Oncocytoma or Carcinoid arising in </span><span data-textwidth="231.65" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:178%; left:47.05px;top:52.94px;">Horseshoe kidney</span></p></div></div></div> <div class="sg sgTitle" id="s285" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s285_t" class="sg" style="z-index:2;left:-0.37px;top:-2.15px;width:649.22px;height:84.79px;"><div><p para="{al:2}"><span data-textwidth="223.60" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:222%; left:213.05px;top:15.90px;">The Diagnosis</span></p></div></div></div> <div class="sg" id="s286" data-sgid="Content Placeholder 3" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s286_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="505.28" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Carcinoid tumor in horseshoe kidney</span></p></div></div></div> <div class="sg sgTitle" id="s287" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s287_t" class="sg" style="z-index:2;left:-1.56px;top:-2.15px;width:651.63px;height:84.79px;"><div><p para="{al:2}"><span data-textwidth="603.10" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:222%; left:24.49px;top:15.90px;">Carcinoid Tumor in horseshoe kidney</span></p></div></div></div> <div class="sg" id="s288" data-sgid="Content Placeholder 2" style="z-index:2;left:47.50px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s288_t" class="sg" style="z-index:2;left:-5.04px;top:-2.77px;width:653.93px;height:271.15px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="563.85" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.75px;top:8.69px;">•<span style="letter-spacing:12.48px"> </span>Carcinoid is rare in native kidneys, even rarer in horseshoe variant</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="382.14" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:12.75px;top:37.50px;">•<span style="letter-spacing:12.48px"> </span>Over-represented in horse shoe kidney x 60</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="494.72" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:111%; left:12.75px;top:66.30px;">•<span style="letter-spacing:12.48px"> </span>No gender or age association, and discovered incidentally</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="310.49" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:111%; left:12.75px;top:95.11px;">•<span style="letter-spacing:12.48px"> </span>Few reports of carcinoid syndrome</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="561.57" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:111%; left:12.75px;top:123.92px;">•<span style="letter-spacing:12.48px"> </span>No distinguishing imaging features: solid, with some necrosis and </span><span data-textwidth="187.23" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:111%; left:39.75px;top:147.92px;">dystrophic calcification</span></p></div></div></div> <div class="sg sgTitle" id="s289" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s289_t" class="sg" style="z-index:2;left:-1.56px;top:-2.15px;width:651.63px;height:84.79px;"><div><p para="{al:2}"><span data-textwidth="603.10" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:222%; left:24.49px;top:15.90px;">Carcinoid Tumor in horseshoe kidney</span></p></div></div></div> <div class="sg" id="s290" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s290_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:656.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="315.89" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Pathogenesis is controversial:</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="547.30" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:51.14px;top:43.60px;">–<span style="letter-spacing:8.17px"> </span>Interspersed neuroendocrine cells associated with acquired and </span><span data-textwidth="553.05" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:111%; left:73.83px;top:67.60px;">congenital anomalies such as metaplasia from chronic inflammation</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="364.51" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:111%; left:51.14px;top:96.41px;">–<span style="letter-spacing:8.17px"> </span>Metastasis from unrecognized primary, or</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="361.14" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:111%; left:51.14px;top:125.22px;">–<span style="letter-spacing:8.17px"> </span>Entrapped neural crest or pancreatic cells</span></p><p para="{in:2,bl:{ch:8226},spbf:0.20}"><span data-textwidth="604.05" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:15.26px;top:155.98px;">•<span style="letter-spacing:9.60px"> </span>Reports of coexistent teratoma favors the latter hypothesis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="614.02" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:133%; left:15.26px;top:190.55px;">•<span style="letter-spacing:9.60px"> </span>Given lack of pathognomonic features, treatment is surgical </span><span data-textwidth="78.25" class="sg nowrap f2" style="z-index:20;color:#FFFFFF;font-size:133%; left:42.26px;top:219.36px;">excision</span></p></div></div></div> <div class="sg sgTitle" id="s291" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s291_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="515.13" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:67.23px;top:18.09px;">Christine Glastonbury, MBBS</span></p></div></div></div> <div class="sg" id="s293" data-sgid="Picture 3" style="z-index:3;left:505.32px;top:71.95px;width:216.24px;height:229.29px"> <img class="sg" src="26FD5474.png" id="s293_i" style="z-index:1;left:0px;top:0px;width:216.24px;height:229.29px" > </div> <div class="sg" id="s292" data-sgid="Content Placeholder 2" style="z-index:2;left:41.50px;top:105.89px;width:486.61px;height:197.50px" data-valign="top" data-pointer-events="none"> <div id="s292_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:496.79px;height:242.61px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="224.79" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.55px;top:12.10px;">•<span style="letter-spacing:6.60px"> </span>MD &amp; Radiology, </span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="335.22" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:53.43px;top:51.59px;">–<span style="letter-spacing:5.29px"> </span>University of Adelaide, Australia</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="399.78" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.55px;top:87.00px;">•<span style="letter-spacing:6.60px"> </span>Neuro Fellowships, Salt Lake City</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="427.27" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:17.55px;top:127.33px;">•<span style="letter-spacing:6.60px"> </span>Professor of Radiology, Biomedical </span><span data-textwidth="430.87" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:44.55px;top:160.94px;">Imaging, Radiation Oncology &amp; H &amp; N </span><span data-textwidth="158.67" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:156%; left:44.55px;top:194.54px;">Surgery, UCSF</span></p></div></div></div> <div class="sg" id="s295" data-sgid="Cloud Callout 1" style="z-index:2;left:133.84px;top:49.52px;width:483.13px;height:202.19px" data-fillcolor="16777215"> <div id="s295_t" class="sg" style="z-index:2;left:0px;top:0px;width:483.13px;height:202.19px;"><div><p para="{al:2}"><span data-textwidth="225.76" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:175.21px;top:38.22px;">When I grow up I want </span><span data-textwidth="204.63" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:133%; left:185.89px;top:67.03px;">to be on the stage in </span><span data-textwidth="151.46" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:212.30px;top:95.83px;">the Arie Crown </span><span data-textwidth="75.73" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:247.58px;top:124.64px;">Theater</span></p></div></div><img class="sg" src="292AA47B.png" id="s295_i" style="z-index:1;left:0px;top:0px;width:483.13px;height:202.19px" > </div> <div class="sg" id="s294" data-sgid="Picture 8" style="z-index:1;left:65.48px;top:73.03px;width:166.38px;height:221.48px"> <img class="sg" src="EA5C605C.jpg" id="s294_i" style="z-index:1;left:0px;top:0px;width:166.38px;height:221.48px" > </div> <div class="sg" id="s298" data-sgid="Picture 1" style="z-index:3;left:269.38px;top:69.91px;width:174.77px;height:225.07px"> <img class="sg" src="677C106B.jpg" id="s298_i" title="" alt="410lISTDUyL._SX385_BO1,204,203,200_.jpg" style="z-index:1;left:0px;top:0px;width:174.77px;height:225.07px" > </div> <div class="sg" id="s297" data-sgid="Picture 8" style="z-index:2;left:65.48px;top:73.03px;width:166.38px;height:221.48px"> <img class="sg" src="EA5C605C.jpg" id="s297_i" style="z-index:1;left:0px;top:0px;width:166.38px;height:221.48px" > </div> <div class="sg" id="s296" data-sgid="Picture 5" style="z-index:1;left:485.28px;top:73.03px;width:188.55px;height:221.48px"> <img class="sg" src="1A8E214A.png" id="s296_i" style="z-index:1;left:0px;top:0px;width:188.55px;height:221.48px" > </div> <div class="sg" id="s299" data-sgid="Picture 4" style="z-index:1;left:107.45px;top:29.13px;width:230.07px;height:314.19px"> <img class="sg" src="3C121B5B.jpg" id="s299_i" style="z-index:1;left:0px;top:0px;width:230.07px;height:314.19px" > </div> <div class="sg" id="s300" data-sgid="Picture 7" style="z-index:2;left:401.33px;top:29.13px;width:235.91px;height:314.19px"> <img class="sg" src="F1CBFD60.jpg" id="s300_i" style="z-index:1;left:0px;top:0px;width:235.91px;height:314.19px" > </div> <div class="sg" id="s302" data-sgid="TextBox 3 (2)" style="z-index:4;left:101.47px;top:339.73px;width:237.13px;height:32.38px" data-valign="top"> <div id="s302_t" class="sg" style="z-index:2;left:-4.93px;top:-2.40px;width:244.70px;height:42.93px;"><div><p><span data-textwidth="219.76" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.68px;top:8.55px;">Palpating submental nodes</span></p></div></div></div> <div class="sg" id="s301" data-sgid="TextBox 3" style="z-index:3;left:419.32px;top:342.36px;width:201.61px;height:32.38px" data-valign="top"> <div id="s301_t" class="sg" style="z-index:2;left:-4.93px;top:-2.52px;width:209.55px;height:43.05px;"><div><p><span data-textwidth="184.47" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.88px;top:8.56px;">Felix, Ellie and Michael</span></p></div></div></div> <div class="sg" id="s303" data-sgid="Title 1" style="z-index:1;left:53.49px;top:66.92px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s303_t" class="sg" style="z-index:2;left:-0.34px;top:-0.37px;width:613.26px;height:97.49px;"><div><p para="{al:2}"><span data-textwidth="427.15" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:93.27px;top:22.35px;">Neuroradiology Case #1</span></p></div></div></div> <div class="sg sgSubtitle" id="s304" data-sgid="Subtitle 2" style="z-index:2;left:131.46px;top:183.84px;width:510.59px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s304_t" class="sg" style="z-index:2;left:-0.37px;top:-7.19px;width:517.20px;height:119.66px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="471.20" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:200%; left:24.22px;top:14.95px;">50 year old woman with painful </span><span data-textwidth="126.38" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:200%; left:192.72px;top:58.16px;">epistaxis</span></p></div></div></div> <div class="sg" id="s305" data-sgid="Picture 3" style="z-index:1;left:386.08px;top:6.70px;width:335.11px;height:376.67px"> <img class="sg" src="B0C90B38.png" id="s305_i" title="" alt="C:\Users\eflower\Downloads\wegener&#39;s ct_img00008.jpg" style="z-index:1;left:0px;top:0px;width:335.11px;height:376.67px" > </div> <div class="sg" id="s306" data-sgid="Picture 4" style="z-index:2;left:78.57px;top:6.70px;width:330.44px;height:376.67px"> <img class="sg" src="493784FE.png" id="s306_i" title="" alt="C:\Users\eflower\Downloads\wegener&#39;s ct_img00009.jpg" style="z-index:1;left:0px;top:0px;width:330.44px;height:376.67px" > </div> <div class="sg" id="s307" data-sgid="Picture 2" style="z-index:1;left:172.70px;top:0.71px;width:398.46px;height:398.87px"> <img class="sg" src="49DE3BC0.png" id="s307_i" title="" alt="C:\Users\eflower\Downloads\ct sinus_img00049.jpg" style="z-index:1;left:0px;top:0px;width:398.46px;height:398.87px" > </div> <div class="sg" id="s309" data-sgid="Picture 3" style="z-index:2;left:380.10px;top:3.48px;width:344.95px;height:391.18px"> <img class="sg" src="5EE6AAF2.png" id="s309_i" style="z-index:1;left:0px;top:0px;width:344.95px;height:391.18px" > </div> <div class="sg" id="s308" data-sgid="Picture 2" style="z-index:1;left:44.25px;top:4.33px;width:358.04px;height:391.18px"> <img class="sg" src="CBC3C47F.png" id="s308_i" title="" alt="C:\Users\eflower\Downloads\wegener&#39;s mri_img00039.jpg" style="z-index:1;left:0px;top:0px;width:358.04px;height:391.18px" > </div> <div class="sg sgTitle" id="s310" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s310_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s311" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:81.91px;width:672.50px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s311_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:685.22px;height:276.07px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="614.02" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.52px;">•<span style="letter-spacing:3.84px"> </span>Thoughts from Hx: <span class="f5" style="font-style:italic; ">Painful </span>epistaxis. Hmmm. </span><span data-textwidth="210.88" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:178%; left:47.05px;top:52.93px;">That’s unusual…</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="633.22" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:178%; left:20.05px;top:99.02px;">•<span style="letter-spacing:3.84px"> </span>CT: Hyperdensity along tent, soft tissue (ST) in </span><span data-textwidth="524.73" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:178%; left:47.05px;top:137.43px;">nasal vault with <u>destruction of crib plate</u></span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="634.06" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:178%; left:20.05px;top:183.52px;">•<span style="letter-spacing:3.84px"> </span>MR: ST confirmed, CE. Both cavernous sinuses </span><span data-textwidth="195.39" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:178%; left:47.05px;top:221.93px;">and along dura</span></p></div></div><img class="sg" src="CFB431E0.png" id="s311_tt" style="left:-12.36px;top:-6.73px;width:685.22px;height:276.07px;z-index:1" > </div> <div class="sg sgTitle" id="s312" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s312_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s313" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:660.51px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s313_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:673.23px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="426.31" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Inflammatory/ Granulomatous</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="459.32" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:55.93px;top:58.66px;">–<span style="letter-spacing:2.29px"> </span>Sarcoid, GPA (FKA Wegener), cocaine, </span><span data-textwidth="471.08" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:78.62px;top:92.27px;">inflammatory pseudotumor, IgG4 disease</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="163.94" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:178%; left:20.05px;top:134.56px;">•<span style="letter-spacing:3.84px"> </span>Neoplastic</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="545.86" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:156%; left:55.93px;top:178.69px;">–<span style="letter-spacing:2.29px"> </span>Lymphoma, sinonasal malignancy, metastases</span></p></div></div></div> <div class="sg" id="s314" data-sgid="TextBox 1" style="z-index:1;left:70.63px;top:33.94px;width:135.80px;height:37.30px" data-valign="top"> <div id="s314_t" class="sg" style="z-index:2;left:-1.78px;top:-3.48px;width:139.26px;height:51.19px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="109.94" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:14.80px;top:10.35px;">PET images</span></p></div></div></div> <div class="sg" id="s315" data-sgid="94CD2686-CEB7-4A9C-AAFD-902AD19846A4" style="z-index:2;left:38.26px;top:68.95px;width:351.18px;height:145.46px"> <img class="sg" src="9E41895D.png" id="s315_i" title="" alt="88098414-AD51-466E-8425-C437038A7947@bidmc" style="z-index:1;left:0px;top:0px;width:351.18px;height:145.46px" > </div> <div class="sg" id="s317" data-sgid="924E8C03-54F1-4A35-9201-5E41EA84C36F" style="z-index:4;left:368.11px;top:44.97px;width:354.53px;height:344.54px"> <img class="sg" style="z-index:5;left:15.89px;top:15.78px;width:307.75px;height:297.75px" id="s317_g" src="s8.gif" > <img class="sg" src="4D27C02.png" id="s317_i" title="" alt="8AF4EDD4-301B-4788-9536-A1C95E217862@bidmc" style="z-index:1;left:0px;top:0px;width:354.53px;height:344.54px" > </div> <div class="sg" id="s316" data-sgid="17B0E7FD-A904-498E-B70C-970DAB28180E" style="z-index:3;left:38.26px;top:212.85px;width:351.18px;height:135.39px"> <img class="sg" src="86543977.png" id="s316_i" title="" alt="ACEB8B9C-E7EA-4E6E-86F0-6583E63A634E@bidmc" style="z-index:1;left:0px;top:0px;width:351.18px;height:135.39px" > </div> <div class="sg" id="s319" data-sgid="Picture 3" style="z-index:2;left:393.76px;top:0.71px;width:322.16px;height:404.98px"> <img class="sg" src="E23466E6.png" id="s319_i" title="" alt="C:\Users\jkruskal\Desktop\_img00031.jpg" style="z-index:1;left:0px;top:0px;width:322.16px;height:404.98px" > </div> <div class="sg" id="s318" data-sgid="Picture 2" style="z-index:1;left:76.87px;top:0.71px;width:339.93px;height:406.79px"> <img class="sg" src="495353FA.png" id="s318_i" title="" alt="C:\Users\jkruskal\Desktop\_img00035.jpg" style="z-index:1;left:0px;top:0px;width:339.93px;height:406.79px" > </div> <div class="sg" id="s320" data-sgid="Picture 2" style="z-index:1;left:95.61px;top:-11.28px;width:367.37px;height:421.78px"> <img class="sg" src="470FFC29.png" id="s320_i" title="" alt="C:\Users\jkruskal\Desktop\_img00034.jpg" style="z-index:1;left:0px;top:0px;width:367.37px;height:421.78px" > </div> <div class="sg" id="s321" data-sgid="Picture 3" style="z-index:2;left:449.17px;top:-11.28px;width:266.41px;height:421.78px"> <img class="sg" src="3AF6E64F.png" id="s321_i" title="" alt="C:\Users\jkruskal\Desktop\_img00058.jpg" style="z-index:1;left:0px;top:0px;width:266.41px;height:421.78px" > </div> <div class="sg" id="s322" data-sgid="TextBox 1" style="z-index:1;left:40.19px;top:7.07px;width:126.90px;height:37.30px" data-valign="top"> <div id="s322_t" class="sg" style="z-index:2;left:-5.04px;top:-3.48px;width:136.96px;height:51.22px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="107.54" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:14.78px;top:10.33px;">MR images</span></p></div></div></div> <div class="sg" id="s328" data-sgid="Picture 3" style="z-index:7;left:410.08px;top:13.18px;width:255.83px;height:181.21px"> <img class="sg" src="4889D40D.png" id="s328_i" title="" alt="C:\Users\jkruskal\Desktop\Axial T2 fat sat - R renal mass_img00011.jpg" style="z-index:1;left:0px;top:0px;width:255.83px;height:181.21px" > </div> <div class="sg" id="s329" data-sgid="Picture 5 (2)" style="z-index:8;left:177.86px;top:6.70px;width:227.07px;height:219.11px"> <img class="sg" src="970B80A1.png" id="s329_i" title="" alt="C:\Users\jkruskal\Desktop\Coronal T2 - Two hypointense R renal masses_img00022.jpg" style="z-index:1;left:0px;top:0px;width:227.07px;height:219.11px" > </div> <div class="sg" id="s324" data-sgid="TextBox 7" style="z-index:3;left:422.56px;top:171.48px;width:215.16px;height:37.30px" data-valign="top"> <div id="s324_t" class="sg" style="z-index:2;left:0.00px;top:-2.52px;width:215.16px;height:43.05px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="156.75" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:29.68px;top:8.40px;">T2 axial with fat sat</span></p></div></div></div> <div class="sg" id="s323" data-sgid="TextBox 6" style="z-index:2;left:182.08px;top:189.83px;width:192.74px;height:37.30px" data-valign="top"> <div id="s323_t" class="sg" style="z-index:2;left:0.00px;top:-2.40px;width:192.74px;height:42.93px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="85.21" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:53.88px;top:8.41px;">T2 coronal</span></p></div></div></div> <div class="sg" id="s327" data-sgid="Picture 2" style="z-index:6;left:409.60px;top:199.05px;width:287.24px;height:210.96px"> <img class="sg" src="21E651BD.png" id="s327_i" title="" alt="C:\Users\jkruskal\Desktop\Axial T1 fatsat postcontrast - R renal mass with mild peripheral enhancement_img00075.jpg" style="z-index:1;left:0px;top:0px;width:287.24px;height:210.96px" > </div> <div class="sg" id="s326" data-sgid="Picture 5" style="z-index:5;left:172.70px;top:215.15px;width:237.13px;height:186.35px"> <img class="sg" src="53709BC4.png" id="s326_i" style="z-index:1;left:0px;top:0px;width:237.13px;height:186.35px" > </div> <div class="sg" id="s325" data-sgid="TextBox 8" style="z-index:4;left:184.24px;top:366.60px;width:198.27px;height:32.36px" data-valign="top"> <div id="s325_t" class="sg" style="z-index:2;left:-1.82px;top:-2.52px;width:201.87px;height:43.05px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="177.15" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.61px;top:8.56px;">T1 fatsat pre and post</span></p></div></div></div> <div class="sg sgTitle" id="s330" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s330_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s331" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:81.91px;width:684.48px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s331_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:697.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="610.18" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.52px;">•<span style="letter-spacing:3.84px"> </span>PET: intense avidity of sinonasal disease and </span><span data-textwidth="459.08" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:47.05px;top:52.93px;">right renal mass (other small foci…)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="644.26" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:178%; left:20.05px;top:99.02px;">•<span style="letter-spacing:3.84px"> </span>CT &amp; MR: heterogeneous and heterogeneously </span><span data-textwidth="617.38" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:178%; left:47.05px;top:137.43px;">CE infiltrative right renal mass, relatively low SI </span><span data-textwidth="72.85" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:178%; left:47.05px;top:175.83px;">on T2</span></p></div></div></div> <div class="sg sgTitle" id="s332" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s332_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s333" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s333_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="426.31" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Inflammatory/ Granulomatous</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="459.32" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:55.93px;top:58.66px;">–<span style="letter-spacing:2.29px"> </span>Sarcoid, GPA (FKA Wegener), cocaine, </span><span data-textwidth="471.08" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:78.62px;top:92.27px;">inflammatory pseudotumor, IgG4 disease</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="163.94" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:178%; left:20.05px;top:134.56px;">•<span style="letter-spacing:3.84px"> </span>Neoplastic</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="545.86" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:156%; left:55.93px;top:178.69px;">–<span style="letter-spacing:2.29px"> </span>Lymphoma, sinonasal malignancy, metastases</span></p></div></div></div> <div class="sg sgTitle" id="s334" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s334_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="585.94" class="sg nowrap f8" style="z-index:2;color:#FF6319;font-size:244%; left:31.82px;top:20.81px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s336" data-sgid="Straight Connector 5" style="z-index:3;left:101.47px;top:156.86px;width:99.80px;height:6.96px" data-pointer-events="none"> <img class="sg" src="2EDD4679.png" id="s336_i" style="z-index:1;left:0px;top:0px;width:99.80px;height:5.96px" > </div> <div class="sg" id="s337" data-sgid="Straight Connector 8" style="z-index:4;left:491.29px;top:156.86px;width:105.78px;height:6.96px" data-pointer-events="none"> <img class="sg" src="BC09F8A9.png" id="s337_i" style="z-index:1;left:0px;top:0px;width:105.78px;height:5.96px" > </div> <div class="sg" id="s335" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s335_t" class="sg" style="z-index:2;left:-9.39px;top:-6.00px;width:683.21px;height:293.06px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="549.45" class="sg nowrap f8" style="z-index:2;color:#FFFFFF;font-size:178%; left:17.08px;top:15.60px;">•<span style="letter-spacing:-11.64px"> </span>Inflammatory/ Granulomatous</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="495.09" class="sg nowrap f8" style="z-index:4;color:#FFFFFF;font-size:156%; left:53.08px;top:59.37px;">–<span style="letter-spacing:-11.27px"> </span>Sarcoid, GPA (FKA Wegener), </span><span data-textwidth="590.74" class="sg nowrap f8" style="z-index:6;color:#FFFFFF;font-size:156%; left:75.65px;top:92.98px;">cocaine, inflammatory pseudotumor, </span><span data-textwidth="202.83" class="sg nowrap f8" style="z-index:7;color:#FFFFFF;font-size:156%; left:75.65px;top:126.59px;">IgG4 disease</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="220.11" class="sg nowrap f8" style="z-index:8;color:#FFFFFF;font-size:178%; left:17.08px;top:169.24px;">•<span style="letter-spacing:-11.64px"> </span>Neoplastic</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="562.54" class="sg nowrap f8" style="z-index:10;color:#FFFFFF;font-size:156%; left:53.08px;top:213.01px;">–<span style="letter-spacing:-11.27px"> </span>Lymphoma, sinonasal malignancy, </span><span data-textwidth="169.11" class="sg nowrap f8" style="z-index:12;color:#FFFFFF;font-size:156%; left:75.65px;top:246.61px;">metastasis</span></p></div></div></div> <div class="sg" id="s338" data-sgid="Straight Connector 9" style="z-index:5;left:101.47px;top:276.77px;width:135.77px;height:6.96px" data-pointer-events="none"> <img class="sg" src="ECD2C9C4.png" id="s338_i" style="z-index:1;left:0px;top:0px;width:135.77px;height:5.96px" > </div> <div class="sg" id="s339" data-sgid="Straight Connector 10" style="z-index:6;left:257.39px;top:276.77px;width:255.72px;height:6.96px" data-pointer-events="none"> <img class="sg" src="F5852953.png" id="s339_i" style="z-index:1;left:0px;top:0px;width:255.72px;height:5.96px" > </div> <div class="sg" id="s340" data-sgid="Straight Connector 11" style="z-index:7;left:533.27px;top:276.77px;width:141.75px;height:6.96px" data-pointer-events="none"> <img class="sg" src="24D51906.png" id="s340_i" style="z-index:1;left:0px;top:0px;width:141.75px;height:5.96px" > </div> <div class="sg sgTitle" id="s341" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s341_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="479.84" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:84.87px;top:18.09px;">Dr Glastonbury’s Diagnosis</span></p></div></div></div> <div class="sg" id="s342" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s342_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="611.26" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Granulomatosis with polyangiitis of the skull </span><span data-textwidth="332.46" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:178%; left:47.05px;top:52.94px;">base, sinuses and kidneys</span></p></div></div></div> <div class="sg sgTitle" id="s344" data-sgid="Title 2" style="z-index:2;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s344_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="246.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:201.53px;top:18.09px;">The Diagnosis</span></p></div></div></div> <div class="sg" id="s343" data-sgid="TextBox 1" style="z-index:1;left:161.45px;top:129.87px;width:396.65px;height:32.38px"> <div style='width:100%;height:100%;background:rgba(0,0,0,0)'></div></div> <div class="sg" id="s345" data-sgid="Content Placeholder 3" style="z-index:3;left:35.52px;top:98.45px;width:648.52px;height:267.89px" data-valign="top" data-pointer-events="none"> <div id="s345_t" class="sg" style="z-index:2;left:-12.36px;top:-6.70px;width:661.21px;height:274.96px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="535.40" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.39px;">•<span style="letter-spacing:3.84px"> </span>Granulomatosis with polyangiitis (GPA)</span></p></div></div></div> <div class="sg sgTitle" id="s346" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s346_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="585.93" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:31.82px;top:18.09px;">Granulomatosis with polyangiitis</span></p></div></div></div> <div class="sg" id="s347" data-sgid="Content Placeholder 2" style="z-index:2;left:23.50px;top:93.90px;width:672.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s347_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:682.73px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="368.94" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.55px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Systemic necrotizing vasculitis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="504.20" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:17.55px;top:52.42px;">•<span style="letter-spacing:6.60px"> </span>Diagnostic criteria: 2 or more 92% specific</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="282.28" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:53.43px;top:91.91px;">–<span style="letter-spacing:5.28px"> </span>Nasal or oral inflammation</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="552.33" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:53.43px;top:126.48px;">–<span style="letter-spacing:5.28px"> </span>Abnormal chest radiograph: nodules, consolidation or </span><span data-textwidth="72.97" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:76.11px;top:155.28px;">cavities</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="414.91" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:133%; left:53.43px;top:189.85px;">–<span style="letter-spacing:5.28px"> </span>Abnormal urinary sediment – hematuria</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="599.50" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:53.43px;top:224.42px;">–<span style="letter-spacing:5.28px"> </span>Granulomatous inflammation of artery or perivascular area</span></p></div></div></div> <div class="sg sgTitle" id="s348" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s348_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="585.93" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:31.82px;top:18.09px;">Granulomatosis with polyangiitis</span></p></div></div></div> <div class="sg" id="s349" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s349_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="403.26" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Nasal and skull base involvement</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="159.39" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:53.41px;top:51.58px;">–<span style="letter-spacing:5.29px"> </span>Occurs in 90%</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="589.42" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:53.41px;top:86.15px;">–<span style="letter-spacing:5.29px"> </span>Range from sinusitis, otitis, ulcers and polychondritis with </span><span data-textwidth="282.77" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:76.10px;top:114.95px;">bone or cartilage destruction</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="497.24" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:156%; left:17.53px;top:150.36px;">•<span style="letter-spacing:6.60px"> </span>Orbital masses, cranial nerve entrapment</span></p></div></div></div> <div class="sg sgTitle" id="s350" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s350_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="585.93" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:31.82px;top:18.09px;">Granulomatosis with polyangiitis</span></p></div></div></div> <div class="sg" id="s351" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:684.48px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s351_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:692.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="482.72" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Renal cell carcinoma has been reported in GPA</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="320.69" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.26px;top:45.56px;">•<span style="letter-spacing:9.60px"> </span>Renal involvement is common</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="555.94" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:111%; left:51.14px;top:78.17px;">–<span style="letter-spacing:8.17px"> </span>Up to 75% develop glomerulonephritis within 2 years of diagnosis</span></p><p para="{in:3,bl:{ch:8226},spbf:0.20}"><span data-textwidth="366.66" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;left:87.27px;top:106.49px;">•<span style="letter-spacing:4.92px"> </span>Range from subnephrotic to rapidly progressive</span></p><p para="{in:3,bl:{ch:8226},spbf:0.20}"><span data-textwidth="395.70" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;left:87.27px;top:132.42px;">•<span style="letter-spacing:4.92px"> </span>Mostly pauci-immune GN in ANCA-positive patients</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="610.06" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:133%; left:15.26px;top:160.79px;">•<span style="letter-spacing:9.60px"> </span>Masses include pseudotumors, RCC, lymphoma and abscess</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="641.02" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:133%; left:15.26px;top:195.35px;">•<span style="letter-spacing:9.60px"> </span>Association between immunosuppressive therapy for GPA and </span><span data-textwidth="231.04" class="sg nowrap f2" style="z-index:21;color:#FFFFFF;font-size:133%; left:42.26px;top:224.16px;">development of tumors</span></p></div></div></div> <div class="sg" id="s352" data-sgid="Picture 2" style="z-index:1;left:184.83px;top:13.18px;width:379.25px;height:378.59px"> <img class="sg" src="ABE687AB.jpg" id="s352_i" style="z-index:1;left:0px;top:0px;width:379.25px;height:378.59px" > </div> <div class="sg" id="s353" data-sgid="Title 1" style="z-index:1;left:41.50px;top:51.93px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s353_t" class="sg" style="z-index:2;left:-0.37px;top:-0.37px;width:613.26px;height:97.49px;"><div><p para="{al:2}"><span data-textwidth="433.99" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:89.81px;top:22.34px;">Gastrointestinal Case #2</span></p></div></div></div> <div class="sg sgSubtitle" id="s354" data-sgid="Subtitle 2" style="z-index:2;left:59.49px;top:165.85px;width:606.54px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s354_t" class="sg" style="z-index:2;left:-11.99px;top:-5.88px;width:637.72px;height:190.91px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="288.40" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:174.90px;top:13.75px;">51 year old male with </span><span data-textwidth="598.78" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:19.71px;top:52.16px;">sudden onset LUQ pain after lifting heavy box </span><span data-textwidth="270.29" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:178%; left:184.02px;top:90.56px;">of tiles last Summer, </span></p><p para="{al:2,spbf:0.20}"><span data-textwidth="548.61" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:178%; left:44.92px;top:136.66px;">1 week after completing Appalachian trail </span></p></div></div></div> <div class="sg" id="s355" data-sgid="Picture 3" style="z-index:1;left:383.33px;top:72.91px;width:298.55px;height:238.51px"> <img class="sg" src="9C90A32.jpg" id="s355_i" title="" alt="C:\Users\jkruskal\Desktop\_img00023.jpg" style="z-index:1;left:0px;top:0px;width:298.55px;height:238.51px" > </div> <div class="sg" id="s356" data-sgid="Picture 4" style="z-index:2;left:53.49px;top:72.91px;width:306.46px;height:238.51px"> <img class="sg" src="E884CAB1.jpg" id="s356_i" title="" alt="C:\Users\jkruskal\Desktop\_img00021.jpg" style="z-index:1;left:0px;top:0px;width:306.46px;height:238.51px" > </div> <div class="sg" id="s357" data-sgid="Picture 3" style="z-index:1;left:365.33px;top:51.93px;width:343.16px;height:234.80px"> <img class="sg" src="BD6DF592.jpg" id="s357_i" title="" alt="C:\Users\jkruskal\Desktop\_img00050.jpg" style="z-index:1;left:0px;top:0px;width:343.16px;height:234.80px" > </div> <div class="sg" id="s358" data-sgid="Picture 2" style="z-index:2;left:28.54px;top:51.93px;width:326.72px;height:234.80px"> <img class="sg" src="65AF93E6.jpg" id="s358_i" title="" alt="C:\Users\jkruskal\Desktop\_img00026.jpg" style="z-index:1;left:0px;top:0px;width:326.72px;height:234.80px" > </div> <div class="sg" id="s359" data-sgid="Picture 5" style="z-index:1;left:371.34px;top:66.92px;width:276.70px;height:257.23px"> <img class="sg" src="9E6C0A11.jpg" id="s359_i" title="" alt="C:\Users\jkruskal\Desktop\_img00069.jpg" style="z-index:1;left:0px;top:0px;width:276.70px;height:257.23px" > </div> <div class="sg" id="s360" data-sgid="Picture 6" style="z-index:2;left:65.48px;top:66.92px;width:293.28px;height:261.78px"> <img class="sg" src="1EF59FEF.jpg" id="s360_i" title="" alt="C:\Users\jkruskal\Desktop\_img00070.jpg" style="z-index:1;left:0px;top:0px;width:293.28px;height:261.78px" > </div> <div class="sg" id="s361" data-sgid="Picture 2" style="z-index:1;left:200.20px;top:30.69px;width:358.72px;height:330.03px"> <img class="sg" src="DEB53A3A.png" id="s361_i" title="" alt="C:\Users\jkruskal\Desktop\_img00305.jpg" style="z-index:1;left:0px;top:0px;width:358.72px;height:330.03px" > </div> <div class="sg sgTitle" id="s362" data-sgid="Title 1" style="z-index:1;left:35.52px;top:20.50px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s362_t" class="sg" style="z-index:2;left:-0.37px;top:-9.58px;width:649.22px;height:101.82px;"><div><p para="{al:2}"><span data-textwidth="161.07" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:267%; left:244.26px;top:19.17px;">Findings</span></p></div></div></div> <div class="sg" id="s363" data-sgid="Content Placeholder 2" style="z-index:2;left:71.48px;top:99.89px;width:624.54px;height:305.20px" data-valign="top" data-pointer-events="none"> <div id="s363_t" class="sg" style="z-index:2;left:-9.83px;top:-5.28px;width:634.74px;height:310.83px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="192.40" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.56px;top:12.09px;">•<span style="letter-spacing:6.61px"> </span>Splenomegaly </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="188.08" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:17.56px;top:52.42px;">•<span style="letter-spacing:6.61px"> </span>Splenic infarct</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="574.66" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.56px;top:92.75px;">•<span style="letter-spacing:6.61px"> </span>Multiple intrasplenic pseudoaneurysms (CT and </span><span data-textwidth="70.81" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:156%; left:44.57px;top:126.36px;">angio)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="254.69" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:156%; left:17.56px;top:166.69px;">•<span style="letter-spacing:6.61px"> </span>Left pleural effusion</span></p></div></div></div> <div class="sg" id="s366" data-sgid="Title 1 (2)" style="z-index:3;left:35.52px;top:2.52px;width:648.52px;height:68.36px"> <div style='width:100%;height:100%;background:rgba(0,0,0,0)'></div></div> <div class="sg sgTitle" id="s364" data-sgid="Title 1" style="z-index:1;left:35.52px;top:27.94px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s364_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:649.22px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="523.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:62.91px;top:18.11px;">Findings: Pertinent Negatives</span></p></div></div></div> <div class="sg" id="s365" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:96.64px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s365_t" class="sg" style="z-index:2;left:-9.84px;top:-5.37px;width:658.69px;height:273.78px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="460.03" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.07px;">•<span style="letter-spacing:6.60px"> </span>No other CT evidence of trauma: ribs, </span><span data-textwidth="506.48" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:44.53px;top:45.68px;">chest/abdominal wall, other organs involved</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="573.69" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:17.53px;top:86.01px;">•<span style="letter-spacing:6.60px"> </span>No other infarcts or other evidence of vasculitis </span><span data-textwidth="260.44" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:44.53px;top:119.62px;">(vessels or end organs)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="490.64" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:17.53px;top:159.95px;">•<span style="letter-spacing:6.60px"> </span>No evidence of pancreatitis, diverticulitis</span></p></div></div></div> <div class="sg sgTitle" id="s367" data-sgid="Title 1" style="z-index:1;left:35.52px;top:-2.04px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s367_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:649.22px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.08px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s368" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:75.91px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s368_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:656.42px;height:282.52px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="365.46" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.98px;">•<span style="letter-spacing:9.60px"> </span>Multiple splenic pseudoaneurysms</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="522.93" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:133%; left:51.14px;top:45.55px;">–<span style="letter-spacing:5.29px"> </span>TRAUMA: Major or minor in trail, with pre-existent </span><span data-textwidth="145.82" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:133%; left:73.83px;top:74.35px;">splenomegaly </span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="544.54" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:51.14px;top:108.92px;">–<span style="letter-spacing:5.29px"> </span>Septic emboli, endocarditis, diverticulitis, pancreatitis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="113.79" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:51.14px;top:143.49px;">–<span style="letter-spacing:5.29px"> </span>Vasculitis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="470.25" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:133%; left:51.14px;top:178.05px;">–<span style="letter-spacing:5.29px"> </span>Malignancy: non-Hodgkin lymphoma, chronic </span><span data-textwidth="225.15" class="sg nowrap f2" style="z-index:18;color:#FFFFFF;font-size:133%; left:73.83px;top:206.86px;">myelogenous leukemia</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="215.56" class="sg nowrap f2" style="z-index:20;color:#FFFFFF;font-size:133%; left:51.14px;top:241.43px;">–<span style="letter-spacing:5.29px"> </span>Portal hypertension</span></p></div></div></div> <div class="sg sgTitle" id="s369" data-sgid="Title 1" style="z-index:1;left:35.52px;top:21.95px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s369_t" class="sg" style="z-index:2;left:-0.37px;top:-0.37px;width:649.22px;height:78.31px;"><div><p para="{al:2}"><span data-textwidth="578.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:200%; left:35.30px;top:16.51px;">History: Is Appalachian Trail Important?</span></p></div></div></div> <div class="sg" id="s370" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:138.61px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s370_t" class="sg" style="z-index:2;left:-9.84px;top:-5.37px;width:658.69px;height:273.78px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="486.32" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.11px;">•<span style="letter-spacing:6.60px"> </span>Trauma with normal or abnormal spleen</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="392.58" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:17.53px;top:52.44px;">•<span style="letter-spacing:6.60px"> </span>If previously healthy, what else?</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="610.06" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.53px;top:92.77px;">•<span style="letter-spacing:6.60px"> </span>Appalachian trail: Maine to Georgia, longest hiking-</span><span data-textwidth="305.45" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:44.53px;top:126.38px;">only footpath in the world.</span></p></div></div></div> <div class="sg sgTitle" id="s371" data-sgid="Title 1" style="z-index:1;left:35.52px;top:14.51px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s371_t" class="sg" style="z-index:2;left:-0.37px;top:-0.37px;width:649.22px;height:78.31px;"><div><p para="{al:2}"><span data-textwidth="603.34" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:200%; left:23.06px;top:16.39px;">Tick-borne Infections in Appalachian Trail</span></p></div></div></div> <div class="sg" id="s373" data-sgid="Content Placeholder 2 (2)" style="z-index:3;left:23.50px;top:93.90px;width:348.69px;height:268.01px" data-valign="top"> <div id="s373_t" class="sg" style="z-index:2;left:-7.54px;top:-4.07px;width:361.25px;height:272.08px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="220.83" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.25px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Three primary ticks:</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="297.89" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:51.13px;top:43.96px;">–<span style="letter-spacing:8.16px"> </span>Deer tick (<span class="f6" >“</span>black legged<span class="f6" >”</span>), <span class="f5" style="font-style:italic; ">Ixodes </span></span><span data-textwidth="81.01" class="sg nowrap f5" style="z-index:11;color:#FFFFFF;font-style:italic; font-size:111%; left:73.81px;top:67.60px;">scapularis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="248.44" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:111%; left:51.13px;top:96.41px;">–<span style="letter-spacing:8.16px"> </span>Lone star tick, <span class="f5" style="font-style:italic; ">Amblyomma </span></span><span data-textwidth="102.14" class="sg nowrap f5" style="z-index:15;color:#FFFFFF;font-style:italic; font-size:111%; left:73.81px;top:120.42px;">americanum</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="253.12" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:111%; left:51.13px;top:149.22px;">–<span style="letter-spacing:8.16px"> </span>American dog or Wood tick, </span><span data-textwidth="183.39" class="sg nowrap f5" style="z-index:18;color:#FFFFFF;font-style:italic; font-size:111%; left:73.81px;top:173.23px;">Dermacentor variabilis</span></p></div></div></div> <div class="sg" id="s372" data-sgid="Content Placeholder 2" style="z-index:2;left:377.35px;top:96.64px;width:348.66px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s372_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:356.57px;height:272.47px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="156.75" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.48px;top:10.89px;">•<span style="letter-spacing:9.61px"> </span>Lyme disease</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="159.99" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.48px;top:45.46px;">•<span style="letter-spacing:9.61px"> </span>Anaplasmosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="127.83" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:15.48px;top:80.03px;">•<span style="letter-spacing:9.61px"> </span>Babesiosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="124.83" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:15.48px;top:114.60px;">•<span style="letter-spacing:9.61px"> </span>Tularemia</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="82.58" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:15.48px;top:149.16px;">•<span style="letter-spacing:9.61px"> </span>STARI</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="322.38" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:15.48px;top:183.73px;">•<span style="letter-spacing:9.61px"> </span>Rocky Mountain spotted fever</span></p></div></div></div> <div class="sg sgTitle" id="s374" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s374_t" class="sg" style="z-index:2;left:-0.37px;top:-0.34px;width:649.22px;height:78.29px;"><div><p para="{al:2}"><span data-textwidth="592.18" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:200%; left:28.70px;top:16.49px;">Tick-borne diseases on Appalachian Trail</span></p></div></div></div> <div class="sg" id="s375" data-sgid="Content Placeholder 2" style="z-index:2;left:72.93px;top:87.90px;width:648.63px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s375_t" class="sg" style="z-index:2;left:-7.45px;top:-4.07px;width:656.45px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="156.75" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.29px;top:10.99px;">•<span style="letter-spacing:9.61px"> </span>Lyme disease</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="159.99" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.29px;top:45.56px;">•<span style="letter-spacing:9.61px"> </span>Anaplasmosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="127.83" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:15.29px;top:80.13px;">•<span style="letter-spacing:9.61px"> </span>Babesiosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="135.87" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:15.29px;top:114.69px;">•<span style="letter-spacing:9.61px"> </span>Ehrlichiosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="124.83" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:15.29px;top:149.26px;">•<span style="letter-spacing:9.61px"> </span>Tularemia</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="82.58" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:15.29px;top:183.83px;">•<span style="letter-spacing:9.61px"> </span>STARI</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="322.38" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:133%; left:15.29px;top:218.40px;">•<span style="letter-spacing:9.61px"> </span>Rocky Mountain spotted fever</span></p></div></div></div> <div class="sg sgTitle" id="s376" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s376_t" class="sg" style="z-index:2;left:-0.37px;top:-0.34px;width:649.22px;height:78.29px;"><div><p para="{al:2}"><span data-textwidth="592.18" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:200%; left:28.70px;top:16.49px;">Tick-borne diseases on Appalachian Trail</span></p></div></div></div> <div class="sg" id="s377" data-sgid="Content Placeholder 2" style="z-index:2;left:72.93px;top:87.90px;width:648.63px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s377_t" class="sg" style="z-index:2;left:-12.36px;top:-4.07px;width:661.36px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="156.75" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:20.20px;top:10.99px;">•<span style="letter-spacing:9.61px"> </span>Lyme disease</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="159.99" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:20.20px;top:45.56px;">•<span style="letter-spacing:9.61px"> </span>Anaplasmosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="161.43" class="sg nowrap f2" style="z-index:6;color:#FFFF00;font-size:178%; left:20.20px;top:82.93px;">•<span style="letter-spacing:3.85px"> </span>Babesiosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="135.87" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:20.20px;top:126.22px;">•<span style="letter-spacing:9.61px"> </span>Ehrlichiosis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="124.83" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:20.20px;top:160.78px;">•<span style="letter-spacing:9.61px"> </span>Tularemia</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="82.58" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:20.20px;top:195.35px;">•<span style="letter-spacing:9.61px"> </span>STARI</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="322.38" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:133%; left:20.20px;top:229.92px;">•<span style="letter-spacing:9.61px"> </span>Rocky Mountain spotted fever</span></p></div></div></div> <div class="sg sgTitle" id="s378" data-sgid="Title 1" style="z-index:1;left:35.52px;top:-2.04px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s378_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:649.22px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="342.42" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:153.64px;top:18.08px;">Dr Soto’s Diagnosis</span></p></div></div></div> <div class="sg" id="s379" data-sgid="Content Placeholder 2" style="z-index:2;left:47.50px;top:90.65px;width:648.52px;height:268.03px" data-valign="top"> <div id="s379_t" class="sg" style="z-index:2;left:-9.83px;top:-5.38px;width:658.35px;height:273.41px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="604.30" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.54px;top:12.07px;">•<span style="letter-spacing:6.60px"> </span>Babesiosis: previously healthy, acquired disease in </span><span data-textwidth="191.67" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:44.54px;top:45.68px;">Appalachian trail</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="593.61" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.54px;top:86.01px;">•<span style="letter-spacing:6.60px"> </span>Trauma, maybe minor with preexistent abnormal </span><span data-textwidth="74.41" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:44.54px;top:119.61px;">spleen</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="617.15" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:17.54px;top:159.94px;">•<span style="letter-spacing:6.60px"> </span>Subacute endocarditis (? history of valvular disease)</span></p></div></div></div> <div class="sg sgTitle" id="s380" data-sgid="Title 1" style="z-index:1;left:35.52px;top:-2.04px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s380_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:649.22px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="342.42" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:153.64px;top:18.08px;">Dr Soto’s Diagnosis</span></p></div></div></div> <div class="sg" id="s381" data-sgid="Content Placeholder 2" style="z-index:2;left:47.50px;top:90.65px;width:648.52px;height:268.03px" data-valign="top"> <div id="s381_t" class="sg" style="z-index:2;left:-9.83px;top:-5.38px;width:658.35px;height:273.41px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="604.30" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.54px;top:12.07px;">•<span style="letter-spacing:6.60px"> </span>Babesiosis: previously healthy, acquired disease in </span><span data-textwidth="191.67" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:44.54px;top:45.68px;">Appalachian trail</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="593.61" class="sg nowrap f2" style="z-index:6;color:#7F7F7F;font-size:156%; left:17.54px;top:86.01px;">•<span style="letter-spacing:6.60px"> </span>Trauma, maybe minor with preexistent abnormal </span><span data-textwidth="74.41" class="sg nowrap f2" style="z-index:8;color:#7F7F7F;font-size:156%; left:44.54px;top:119.61px;">spleen</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="617.15" class="sg nowrap f2" style="z-index:9;color:#7F7F7F;font-size:156%; left:17.54px;top:159.94px;">•<span style="letter-spacing:6.60px"> </span>Subacute endocarditis (? history of valvular disease)</span></p></div></div></div> <div class="sg sgTitle" id="s382" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s382_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="284.21" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:182.69px;top:18.09px;">The diagnosis….</span></p></div></div></div> <div class="sg" id="s383" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:90.65px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s383_t" class="sg" style="z-index:2;left:-12.36px;top:-6.71px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="260.68" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.40px;">•<span style="letter-spacing:3.84px"> </span>Splenic babesiosis</span></p></div></div></div> <div class="sg sgTitle" id="s384" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s384_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="185.55" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:232.01px;top:18.09px;">Babesiosis</span></p></div></div></div> <div class="sg" id="s385" data-sgid="Content Placeholder 2" style="z-index:2;left:23.50px;top:81.91px;width:642.54px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s385_t" class="sg" style="z-index:2;left:-7.54px;top:-4.08px;width:650.44px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="605.13" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.25px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Tick-borne malaria-like illness caused by protozoan Babesia</span><span data-textwidth="522.69" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:133%; left:42.25px;top:39.80px;">microti, transmitted by the deer tick ixodes scapularis</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="607.06" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:15.25px;top:74.36px;">•<span style="letter-spacing:9.60px"> </span>Mostly asymptomatic, and symptoms depend on degree of </span><span data-textwidth="156.15" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:42.25px;top:103.17px;">RBC destruction</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="526.88" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:133%; left:15.25px;top:137.74px;">•<span style="letter-spacing:9.60px"> </span>May result in multi-organ failure with ARDS in 5-6%</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="554.00" class="sg nowrap f2" style="z-index:22;color:#FFFFFF;font-size:133%; left:15.25px;top:172.30px;">•<span style="letter-spacing:9.60px"> </span>Asplenic and immunocompromised (HIV) patients are </span><span data-textwidth="119.66" class="sg nowrap f2" style="z-index:25;color:#FFFFFF;font-size:133%; left:42.25px;top:201.11px;">predisposed</span></p></div></div></div> <div class="sg sgTitle" id="s386" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s386_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="185.55" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:232.01px;top:18.09px;">Babesiosis</span></p></div></div></div> <div class="sg" id="s387" data-sgid="Content Placeholder 2" style="z-index:2;left:41.50px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s387_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.72px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="600.58" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.55px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Often report travel between May and September: </span><span data-textwidth="591.82" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:44.55px;top:46.30px;">infectious nymph stage – often don<span class="f6" >’</span>t recall tick bite</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="611.02" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:17.55px;top:86.03px;">•<span style="letter-spacing:6.60px"> </span>Splenic enlargement not uncommon, but rupture is</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="332.93" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:156%; left:17.55px;top:126.36px;">•<span style="letter-spacing:6.60px"> </span>Very few case reports exist</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="601.54" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:156%; left:17.55px;top:166.69px;">•<span style="letter-spacing:6.60px"> </span>Diagnose by seeing parasites on blood smear with </span><span data-textwidth="456.08" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:156%; left:44.55px;top:200.29px;">characteristic Maltese cross appearance</span></p></div></div></div> <div class="sg" id="s391" data-sgid="AutoShape 11" style="z-index:4;left:10.80px;top:-12.47px;width:24.83px;height:24.83px" data-pointer-events="none"> <div style='width:100%;height:100%;background:rgba(0,0,0,0)'></div></div> <div class="sg" id="s388" data-sgid="Picture 5" style="z-index:1;left:47.50px;top:57.92px;width:218.87px;height:162.85px"> <img class="sg" src="2BD1EF00.jpg" id="s388_i" title="" alt="http://web.stanford.edu/group/parasites/ParaSites2003/Babesia/parasites%20and%20pestilence%20-%20babesia%20website_files/image008.jpg" style="z-index:1;left:0px;top:0px;width:218.87px;height:162.85px" > </div> <div class="sg" id="s390" data-sgid="Picture 7" style="z-index:3;left:323.35px;top:48.45px;width:305.98px;height:238.28px"> <img class="sg" src="1B06D4E6.jpg" id="s390_i" title="" alt="http://greatercarlisleproject.dickinson.edu/wp-content/uploads/2014/04/map-of-at-1024x797.png" style="z-index:1;left:0px;top:0px;width:305.98px;height:238.28px" > </div> <div class="sg" id="s392" data-sgid="Freeform 2" style="z-index:5;left:412.35px;top:113.81px;width:130.27px;height:116.67px" data-pointer-events="none"> <img class="sg" src="4CFA124E.png" id="s392_i" style="z-index:1;left:0px;top:0px;width:130.27px;height:116.67px" > </div> <div class="sg" id="s389" data-sgid="TextBox 3" style="z-index:2;left:91.86px;top:231.80px;width:130.27px;height:32.38px" data-valign="top"> <div id="s389_t" class="sg" style="z-index:2;left:-4.90px;top:-2.40px;width:138.66px;height:42.93px;"><div><p><span data-textwidth="113.78" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.66px;top:8.45px;">Maltese Cross</span></p></div></div></div> <div class="sg sgTitle" id="s393" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s393_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="282.77" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:183.41px;top:18.09px;">Splenic Rupture</span></p></div></div></div> <div class="sg" id="s394" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:666.49px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s394_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:676.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="574.05" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Other infections can cause spontaneous splenic </span><span data-textwidth="94.10" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:44.53px;top:45.70px;">rupture:</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="592.78" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:133%; left:53.41px;top:85.19px;">–<span style="letter-spacing:5.29px"> </span>Plasmodium, CMV, EBV, Coxiella, bartonella, staph &amp; strep</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="516.69" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:133%; left:53.41px;top:119.76px;">–<span style="letter-spacing:5.29px"> </span>Results from parenchyaml destruction rather than </span><span data-textwidth="125.18" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:133%; left:76.10px;top:148.56px;">enlargement</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="544.65" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:156%; left:17.53px;top:183.97px;">•<span style="letter-spacing:6.60px"> </span>Splenomegaly is not needed for bloodstream </span><span data-textwidth="334.26" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:156%; left:44.53px;top:217.58px;">infections to result in rupture</span></p></div></div></div> <div class="sg" id="s395" data-sgid="Title 1" style="z-index:1;left:53.49px;top:66.92px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s395_t" class="sg" style="z-index:2;left:-0.34px;top:-0.37px;width:613.26px;height:97.49px;"><div><p para="{al:2}"><span data-textwidth="248.56" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:182.57px;top:22.35px;">Chest Case #2</span></p></div></div></div> <div class="sg sgSubtitle" id="s396" data-sgid="Subtitle 2" style="z-index:2;left:89.48px;top:183.84px;width:546.56px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s396_t" class="sg" style="z-index:2;left:-0.37px;top:-7.19px;width:547.30px;height:119.66px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="491.60" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:200%; left:32.11px;top:14.95px;">42 year old man with progressive </span><span data-textwidth="284.69" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:200%; left:131.49px;top:58.16px;">shortness of breath</span></p></div></div></div> <div class="sg" id="s397" data-sgid="Picture 2" style="z-index:1;left:163.49px;top:0.00px;width:420.26px;height:420.19px"> <img class="sg" src="58C4E1A.png" id="s397_i" title="" alt="HPS radiograph crop.tif" style="z-index:1;left:0px;top:0px;width:420.26px;height:420.19px" > </div> <div class="sg" id="s398" data-sgid="TextBox 1" style="z-index:2;left:239.40px;top:255.19px;width:32.74px;height:61.51px" data-valign="top"> <div id="s398_t" class="sg" style="z-index:2;left:-19.31px;top:-9.58px;width:75.79px;height:93.16px;"><div><p><span data-textwidth="22.08" class="sg nowrap f7" style="z-index:2;font-size:244%; left:27.15px;top:19.13px;">*</span></p></div></div></div> <div class="sg" id="s399" data-sgid="Picture 3" style="z-index:1;left:44.98px;top:-6.00px;width:377.94px;height:225.44px"> <img class="sg" src="11F1DE01.png" id="s399_i" title="" alt="HPS CT 1 crop.tif" style="z-index:1;left:0px;top:0px;width:377.94px;height:225.44px" > </div> <div class="sg" id="s400" data-sgid="Picture 4" style="z-index:2;left:296.85px;top:174.73px;width:406.85px;height:251.46px"> <img class="sg" src="62D21313.png" id="s400_i" title="" alt="HPS CT 2 crop.tif" style="z-index:1;left:0px;top:0px;width:406.85px;height:251.46px" > </div> <div class="sg" id="s401" data-sgid="Picture 2" style="z-index:1;left:111.05px;top:29.98px;width:521.17px;height:354.24px"> <img class="sg" src="10055041.png" id="s401_i" title="" alt="HPS CT 3 crop.tif" style="z-index:1;left:0px;top:0px;width:521.17px;height:354.24px" > </div> <div class="sg sgTitle" id="s402" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s402_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s403" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s403_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:284.35px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="247.96" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Low lung volume</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="603.46" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:20.05px;top:60.62px;">•<span style="letter-spacing:3.84px"> </span>Asymmetric central architectural distortion, </span><span data-textwidth="560.97" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:178%; left:47.05px;top:99.03px;">bronchiectasis, subpleural sparing, ground-</span><span data-textwidth="186.51" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:178%; left:47.05px;top:137.44px;">glass opacities</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="342.05" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:178%; left:20.05px;top:183.53px;">•<span style="letter-spacing:3.84px"> </span>Upper lobe involvement</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="358.02" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:178%; left:20.05px;top:229.62px;">•<span style="letter-spacing:3.84px"> </span>No basilar honeycombing</span></p></div></div></div> <div class="sg sgTitle" id="s404" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s404_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s405" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:69.91px;width:672.50px;height:300.76px" data-valign="top" data-pointer-events="none"> <div id="s405_t" class="sg" style="z-index:2;left:-11.17px;top:-6.10px;width:684.03px;height:307.23px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="149.54" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:167%; left:18.86px;top:12.89px;">•<span style="letter-spacing:5.16px"> </span>Iatrogenic</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="391.38" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:167%; left:18.86px;top:56.10px;">•<span style="letter-spacing:5.16px"> </span>Inhalational/Exposure-related</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="428.35" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:167%; left:18.86px;top:99.31px;">•<span style="letter-spacing:5.16px"> </span>Connective tissue/Autoimmunity</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="216.63" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:167%; left:18.86px;top:142.52px;">•<span style="letter-spacing:5.16px"> </span>Granulomatous</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="148.34" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:167%; left:18.86px;top:185.72px;">•<span style="letter-spacing:5.16px"> </span>Idiopathic</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="226.59" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:167%; left:18.86px;top:228.93px;">•<span style="letter-spacing:5.16px"> </span>Genetic/Familial</span></p></div></div></div> <div class="sg" id="s406" data-sgid="TextBox 3" style="z-index:3;left:305.38px;top:345.73px;width:396.39px;height:56.59px" data-valign="top"> <div id="s406_t" class="sg" style="z-index:2;left:-2.18px;top:-2.41px;width:400.84px;height:66.92px;"><div><p para="{al:2}"><span data-textwidth="376.14" class="sg nowrap f4" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.57px;top:9.36px;">Am J Respir Crit Care Med 2011; 183: 788</span></p><p para="{al:2}"><span data-textwidth="343.38" class="sg nowrap f4" style="z-index:3;color:#FFFFFF;font-size:111%; left:29.02px;top:33.36px;">Official ATS/ERS/JRS/ALAT Statement</span></p></div></div></div> <div class="sg" id="s407" data-sgid="Picture 2" style="z-index:1;left:49.55px;top:32.98px;width:336.30px;height:354.24px"> <img class="sg" src="2B92E50E.png" id="s407_i" title="" alt="HPS CT 3 crop.tif" style="z-index:1;left:0px;top:0px;width:336.30px;height:354.24px" > </div> <div class="sg" id="s408" data-sgid="Picture 3" style="z-index:2;left:371.34px;top:48.93px;width:312.55px;height:318.63px"> <img class="sg" src="604C61CA.png" id="s408_i" title="" alt="UIP cropped.tif" style="z-index:1;left:0px;top:0px;width:312.55px;height:318.63px" > </div> <div class="sg" id="s409" data-sgid="TextBox 4" style="z-index:3;left:485.28px;top:357.72px;width:117.18px;height:32.38px" data-valign="top"> <div id="s409_t" class="sg" style="z-index:2;left:-0.48px;top:-2.41px;width:118.14px;height:42.93px;"><div><p para="{al:2}"><span data-textwidth="93.14" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.80px;top:8.57px;">UIP pattern</span></p></div></div></div> <div class="sg" id="s410" data-sgid="Picture 2" style="z-index:1;left:49.55px;top:32.98px;width:336.30px;height:354.24px"> <img class="sg" src="2B92E50E.png" id="s410_i" title="" alt="HPS CT 3 crop.tif" style="z-index:1;left:0px;top:0px;width:336.30px;height:354.24px" > </div> <div class="sg" id="s412" data-sgid="Picture 4" style="z-index:3;left:365.33px;top:50.00px;width:306.71px;height:306.64px"> <img class="sg" src="C0357FEE.jpg" id="s412_i" title="" alt="NSIP use crop.jpg" style="z-index:1;left:0px;top:0px;width:306.71px;height:306.64px" > </div> <div class="sg" id="s411" data-sgid="TextBox 3" style="z-index:2;left:419.32px;top:357.72px;width:198.98px;height:32.38px" data-valign="top"> <div id="s411_t" class="sg" style="z-index:2;left:0.00px;top:-2.41px;width:198.98px;height:42.93px;"><div><p para="{al:2}"><span data-textwidth="163.59" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:18.03px;top:8.57px;">Possible UIP pattern</span></p></div></div></div> <div class="sg" id="s413" data-sgid="Picture 3" style="z-index:1;left:44.98px;top:-6.00px;width:377.94px;height:225.44px"> <img class="sg" src="11F1DE01.png" id="s413_i" title="" alt="HPS CT 1 crop.tif" style="z-index:1;left:0px;top:0px;width:377.94px;height:225.44px" > </div> <div class="sg" id="s414" data-sgid="Picture 4" style="z-index:2;left:296.85px;top:174.73px;width:406.85px;height:251.46px"> <img class="sg" src="62D21313.png" id="s414_i" title="" alt="HPS CT 2 crop.tif" style="z-index:1;left:0px;top:0px;width:406.85px;height:251.46px" > </div> <div class="sg sgTitle" id="s416" data-sgid="Title 1" style="z-index:2;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s416_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s415" data-sgid="Content Placeholder 2" style="z-index:1;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s415_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="303.29" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Inconsistent with UIP</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="149.19" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:55.93px;top:58.66px;">–<span style="letter-spacing:2.29px"> </span>Sarcoidosis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="444.56" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:55.93px;top:98.99px;">–<span style="letter-spacing:2.29px"> </span>Chronic hypersensitivity pneumonitis</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="482.37" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:55.93px;top:139.32px;">–<span style="letter-spacing:2.29px"> </span>Bronchiolocentric interstitial pneumonia</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="395.71" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:55.93px;top:179.65px;">–<span style="letter-spacing:2.29px"> </span>Inherited interstitial lung disease</span></p></div></div></div> <div class="sg sgTitle" id="s417" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s417_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="539.85" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:54.87px;top:18.09px;">Dr. de Christenson’s Diagnosis</span></p></div></div></div> <div class="sg" id="s418" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s418_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="408.06" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Hermansky-Pudlak syndrome</span></p></div></div></div> <div class="sg" id="s419" data-sgid="TextBox 3" style="z-index:3;left:146.45px;top:237.80px;width:426.61px;height:46.89px" data-valign="top"> <div id="s419_t" class="sg" style="z-index:2;left:-2.52px;top:-6.00px;width:431.54px;height:68.10px;"><div><p para="{al:2}"><span data-textwidth="392.59" class="sg nowrap f4" style="z-index:2;color:#FFFFFF;font-size:178%; left:19.78px;top:14.45px;">Si non é vero, é ben trovato</span></p></div></div></div> <div class="sg" id="s420" data-sgid="TextBox 4" style="z-index:4;left:124.86px;top:305.79px;width:471.62px;height:46.89px" data-valign="top"> <div id="s420_t" class="sg" style="z-index:2;left:0.00px;top:-5.99px;width:471.62px;height:68.10px;"><div><p para="{al:2}"><span data-textwidth="423.55" class="sg nowrap f4" style="z-index:2;color:#FFFFFF;font-size:178%; left:24.20px;top:14.39px;">If it’s not true, it’s a good story</span></p></div></div></div> <div class="sg sgTitle" id="s421" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s421_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="246.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:201.53px;top:18.09px;">The Diagnosis</span></p></div></div></div> <div class="sg" id="s422" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s422_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="407.82" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Hermansky Pudlak Syndrome</span></p></div></div></div> <div class="sg sgTitle" id="s423" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s423_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="520.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:64.47px;top:18.09px;">Hermansky Pudlak syndrome</span></p></div></div></div> <div class="sg" id="s424" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:81.91px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s424_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="586.05" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.08px;">•<span style="letter-spacing:6.60px"> </span>Autosomal recessive disorder (rare: 1 in 500,000)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="612.94" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:17.53px;top:52.41px;">•<span style="letter-spacing:6.60px"> </span>Mutated HPS gene on chromosome 10 (10q2 locus)</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="558.93" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:53.41px;top:91.90px;">–<span style="letter-spacing:5.29px"> </span>Oculocutaneus albinism, with associated complications</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="440.12" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:133%; left:53.41px;top:126.46px;">–<span style="letter-spacing:5.29px"> </span>Bleeding diathesis (platelet storage defect)</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="583.42" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:133%; left:53.41px;top:161.03px;">–<span style="letter-spacing:5.29px"> </span>Lysosomal accumulation of ceroid lipofuscin, which leads </span><span data-textwidth="325.61" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:133%; left:76.10px;top:189.84px;">to pulmonary and renal disorders</span></p></div></div></div> <div class="sg sgTitle" id="s426" data-sgid="Title 1" style="z-index:2;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s426_t" class="sg" style="z-index:2;left:-0.37px;top:-0.34px;width:649.22px;height:78.29px;"><div><p para="{al:2}"><span data-textwidth="427.87" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:200%; left:110.79px;top:16.49px;">Hermansky Pudlak Syndrome</span></p></div></div></div> <div class="sg" id="s425" data-sgid="Content Placeholder 2" style="z-index:1;left:35.52px;top:81.91px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s425_t" class="sg" style="z-index:2;left:-7.57px;top:-4.08px;width:656.91px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="575.97" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Significantly higher occurrence in Puerto Ricans (1:1800)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="563.73" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.26px;top:45.56px;">•<span style="letter-spacing:9.60px"> </span>Causes dysfunction in lungs, GI tract, kidneys and heart</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="620.14" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:15.26px;top:80.12px;">•<span style="letter-spacing:9.60px"> </span>Major complication is pulmonary fibrosis, which may be fatal</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="188.19" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:111%; left:51.14px;top:112.73px;">–<span style="letter-spacing:8.17px"> </span>Patients 40-50 years</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="268.01" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:111%; left:51.14px;top:141.54px;">–<span style="letter-spacing:8.17px"> </span>Fibrosis of inter alveolar septa</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="366.19" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:111%; left:51.14px;top:170.34px;">–<span style="letter-spacing:8.17px"> </span>Transplant is the only definitive treatment</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="627.23" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:133%; left:15.26px;top:201.11px;">•<span style="letter-spacing:9.60px"> </span>Imaging findings: reticular opacities, perihilar fibrosis, pleural </span><span data-textwidth="420.91" class="sg nowrap f2" style="z-index:21;color:#FFFFFF;font-size:133%; left:42.26px;top:229.92px;">thickening &amp; peribronchovascular opacities</span></p></div></div></div> <div class="sg sgTitle" id="s427" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s427_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="306.65" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:171.52px;top:18.09px;">Chest CT findings</span></p></div></div></div> <div class="sg" id="s428" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:96.64px;width:648.52px;height:268.03px" data-valign="top" data-pointer-events="none"> <div id="s428_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:661.24px;height:272.47px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="555.45" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.89px;">•<span style="letter-spacing:9.60px"> </span>Predominantly peripheral involvement which extends </span><span data-textwidth="84.73" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:42.26px;top:39.70px;">centrally</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="631.55" class="sg nowrap f2" style="z-index:5;color:#FF6319;font-size:133%; left:15.26px;top:74.27px;">•<span style="letter-spacing:9.60px"> </span>Minimal<span style="color:#FFFFFF;">: septal thickening, reticular &amp; ground glass opacities, </span></span><span data-textwidth="252.76" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:42.26px;top:103.07px;">subpleural honeycombing</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="507.33" class="sg nowrap f2" style="z-index:10;color:#FF6319;font-size:133%; left:15.26px;top:137.64px;">•<span style="letter-spacing:9.60px"> </span>Moderate<span style="color:#FFFFFF;">: worsening subpleural honeycombing, </span></span><span data-textwidth="326.57" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:133%; left:42.26px;top:166.45px;">bronchiectasis, pleural thickening</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="551.97" class="sg nowrap f2" style="z-index:16;color:#FF6319;font-size:133%; left:15.26px;top:201.01px;">•<span style="letter-spacing:9.60px"> </span>Severe<span style="color:#FFFFFF;">: commonly see subpleural honeycombing and </span></span><span data-textwidth="140.54" class="sg nowrap f2" style="z-index:21;color:#FFFFFF;font-size:133%; left:42.26px;top:229.82px;">bronchiectasis</span></p></div></div></div> <div class="sg" id="s429" data-sgid="Title 1" style="z-index:1;left:53.49px;top:66.92px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s429_t" class="sg" style="z-index:2;left:-0.34px;top:-0.37px;width:613.26px;height:97.49px;"><div><p para="{al:2}"><span data-textwidth="438.31" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:87.63px;top:22.35px;">Musculoskeletal Case #2</span></p></div></div></div> <div class="sg sgSubtitle" id="s430" data-sgid="Subtitle 2" style="z-index:2;left:77.49px;top:183.84px;width:528.56px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s430_t" class="sg" style="z-index:2;left:-0.37px;top:-7.19px;width:529.30px;height:119.66px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="353.10" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:200%; left:92.35px;top:14.95px;">51 year old female with </span><span data-textwidth="194.43" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:200%; left:167.60px;top:58.16px;">right hip pain</span></p></div></div></div> <div class="sg sgTitle" id="s431" data-sgid="Title 1" style="z-index:1;left:47.50px;top:-0.48px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s431_t" class="sg" style="z-index:2;left:-0.36px;top:-0.37px;width:649.25px;height:73.39px;"><div><p para="{al:2}"><span data-textwidth="229.60" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:210.06px;top:18.89px;">Initial Radiograph</span></p></div></div></div> <div class="sg" id="s432" data-sgid="Picture 2" style="z-index:2;left:181.12px;top:57.92px;width:382.96px;height:333.25px"> <img class="sg" src="FA936E32.jpg" id="s432_i" title="" alt="C:\Users\cmcmahon\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\5ULH93EL\myxoid marrow xray_img00002.jpg" style="z-index:1;left:0px;top:0px;width:382.96px;height:333.25px" > </div> <div class="sg sgTitle" id="s433" data-sgid="Title 1" style="z-index:1;left:47.36px;top:9.96px;width:648.54px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s433_t" class="sg" style="z-index:2;left:-0.34px;top:-14.03px;width:649.22px;height:106.37px;"><div><p para="{al:2}"><span data-textwidth="294.77" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:177.42px;top:13.47px;">CT – Coronal Reformat</span><span data-textwidth="387.42" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:178%; left:131.09px;top:51.88px;">Bone and Soft Tissue Window</span></p></div></div></div> <div class="sg" id="s440" data-sgid="Straight Arrow Connector 9" style="z-index:8;left:591.54px;top:141.13px;width:38.97px;height:27.24px" data-pointer-events="none"> <img class="sg" src="3339E6DA.png" id="s440_i" style="z-index:1;left:0px;top:0px;width:38.97px;height:27.24px" > </div> <div class="sg" id="s439" data-sgid="Straight Arrow Connector 8" style="z-index:7;left:448.94px;top:147.13px;width:38.86px;height:21.24px" data-pointer-events="none"> <img class="sg" src="2A35F3E2.png" id="s439_i" style="z-index:1;left:0px;top:0px;width:38.86px;height:21.24px" > </div> <div class="sg" id="s434" data-sgid="Picture 2" style="z-index:2;left:28.32px;top:99.89px;width:343.73px;height:252.79px"> <img class="sg" src="73015AEE.jpg" id="s434_i" title="" alt="C:\Users\cmcmahon\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\5ULH93EL\myxoid marrow ct coronal_img00039.jpg" style="z-index:1;left:0px;top:0px;width:343.73px;height:252.79px" > </div> <div class="sg" id="s435" data-sgid="Picture 2 (2)" style="z-index:3;left:372.41px;top:99.89px;width:347.59px;height:252.79px"> <img class="sg" src="29094922.jpg" id="s435_i" title="" alt="C:\Users\cmcmahon\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\5ULH93EL\myxoid marrow ct coronal_img00039 (2).jpg" style="z-index:1;left:0px;top:0px;width:347.59px;height:252.79px" > </div> <div class="sg" id="s438" data-sgid="Straight Arrow Connector 6" style="z-index:6;left:394.98px;top:243.06px;width:38.86px;height:21.24px" data-pointer-events="none"> <img class="sg" src="B7AF1384.png" id="s438_i" style="z-index:1;left:0px;top:0px;width:38.86px;height:21.24px" > </div> <div class="sg" id="s436" data-sgid="Straight Arrow Connector 5" style="z-index:4;left:53.15px;top:249.06px;width:38.86px;height:21.24px" data-pointer-events="none"> <img class="sg" src="1DA7741C.png" id="s436_i" style="z-index:1;left:0px;top:0px;width:38.86px;height:21.24px" > </div> <div class="sg" id="s437" data-sgid="Straight Arrow Connector 7" style="z-index:5;left:225.73px;top:302.20px;width:38.75px;height:16.06px" data-pointer-events="none"> <img class="sg" src="99AD2EC9.png" id="s437_i" style="z-index:1;left:0px;top:0px;width:38.75px;height:16.06px" > </div> <div class="sg sgTitle" id="s441" data-sgid="Title 1" style="z-index:1;left:47.50px;top:-0.48px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s441_t" class="sg" style="z-index:2;left:-0.36px;top:-0.37px;width:649.25px;height:73.39px;"><div><p para="{al:2}"><span data-textwidth="318.53" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:165.54px;top:18.89px;">Non-contrast MRI - Axial</span></p></div></div></div> <div class="sg" id="s449" data-sgid="Straight Arrow Connector 9" style="z-index:9;left:579.55px;top:147.13px;width:38.97px;height:27.24px" data-pointer-events="none"> <img class="sg" src="201168EB.png" id="s449_i" style="z-index:1;left:0px;top:0px;width:38.97px;height:27.24px" > </div> <div class="sg" id="s446" data-sgid="Oval 6" style="z-index:6;left:472.55px;top:159.12px;width:20.29px;height:32.38px" data-pointer-events="none"> <img class="sg" src="5EAC0EE2.png" id="s446_i" style="z-index:1;left:0px;top:0px;width:20.29px;height:32.38px" > </div> <div class="sg" id="s450" data-sgid="Oval 10" style="z-index:10;left:160.71px;top:165.11px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="F757544E.png" id="s450_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s445" data-sgid="Picture 3" style="z-index:5;left:381.54px;top:99.89px;width:308.47px;height:177.84px"> <img class="sg" src="28D93BFE.jpg" id="s445_i" style="z-index:1;left:0px;top:0px;width:308.47px;height:177.84px" > </div> <div class="sg" id="s444" data-sgid="Picture 2" style="z-index:4;left:62.61px;top:99.89px;width:318.45px;height:180.84px"> <img class="sg" src="154BCA24.jpg" id="s444_i" style="z-index:1;left:0px;top:0px;width:318.45px;height:180.84px" > </div> <div class="sg" id="s447" data-sgid="Oval 7" style="z-index:7;left:394.61px;top:189.10px;width:32.26px;height:26.39px" data-pointer-events="none"> <img class="sg" src="4181A55.png" id="s447_i" style="z-index:1;left:0px;top:0px;width:32.26px;height:26.39px" > </div> <div class="sg" id="s452" data-sgid="Oval 12" style="z-index:12;left:76.76px;top:195.09px;width:32.28px;height:26.39px" data-pointer-events="none"> <img class="sg" src="89E02EE9.png" id="s452_i" style="z-index:1;left:0px;top:0px;width:32.28px;height:26.39px" > </div> <div class="sg" id="s448" data-sgid="Oval 8" style="z-index:8;left:587.72px;top:209.49px;width:20.38px;height:32.38px" data-rotation = "37" data-pointer-events="none"> <img class="sg" src="748D9428.png" id="s448_i" style="z-index:1;left:0px;top:0px;width:20.38px;height:32.38px" > </div> <div class="sg" id="s451" data-sgid="Oval 11" style="z-index:11;left:275.87px;top:215.49px;width:20.38px;height:32.38px" data-rotation = "37" data-pointer-events="none"> <img class="sg" src="E345601A.png" id="s451_i" style="z-index:1;left:0px;top:0px;width:20.38px;height:32.38px" > </div> <div class="sg" id="s443" data-sgid="TextBox 7" style="z-index:3;left:401.33px;top:315.75px;width:240.73px;height:37.30px" data-valign="top"> <div id="s443_t" class="sg" style="z-index:2;left:0.00px;top:-3.48px;width:240.73px;height:51.19px;"><div><p para="{al:2}"><span data-textwidth="178.35" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:31.46px;top:10.60px;">Fat-Suppressed T2</span></p></div></div></div> <div class="sg" id="s442" data-sgid="TextBox 6" style="z-index:2;left:155.44px;top:315.75px;width:132.76px;height:37.30px" data-valign="top"> <div id="s442_t" class="sg" style="z-index:2;left:0.00px;top:-3.48px;width:132.76px;height:51.19px;"><div><p para="{al:2}"><span data-textwidth="23.76" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:54.60px;top:10.60px;">T1</span></p></div></div></div> <div class="sg sgTitle" id="s455" data-sgid="Title 1" style="z-index:3;left:47.50px;top:-0.48px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s455_t" class="sg" style="z-index:2;left:-0.36px;top:-0.37px;width:649.25px;height:73.39px;"><div><p para="{al:2}"><span data-textwidth="357.66" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:145.97px;top:18.89px;">Non-contrast MRI - Coronal</span></p></div></div></div> <div class="sg" id="s461" data-sgid="Oval 10" style="z-index:9;left:256.69px;top:129.14px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="5FF7AF34.png" id="s461_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s462" data-sgid="Oval 11" style="z-index:10;left:580.52px;top:129.14px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="5FF7AF34.png" id="s462_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s463" data-sgid="TextBox 12" style="z-index:11;left:221.40px;top:165.85px;width:18.85px;height:32.38px" data-valign="top"> <div id="s463_t" class="sg" style="z-index:2;left:-4.91px;top:-2.29px;width:34.18px;height:42.93px;"><div><p><span data-textwidth="9.24" class="sg nowrap f7" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.75px;top:8.96px;">?</span></p></div></div></div> <div class="sg" id="s464" data-sgid="Rectangle 13" style="z-index:12;left:533.27px;top:165.85px;width:24.35px;height:32.38px" data-valign="top" data-pointer-events="none"> <div id="s464_t" class="sg" style="z-index:2;left:-4.93px;top:-2.29px;width:34.18px;height:42.93px;"><div><p><span data-textwidth="9.24" class="sg nowrap f7" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.95px;top:8.96px;">?</span></p></div></div></div> <div class="sg" id="s465" data-sgid="Oval 14" style="z-index:13;left:204.87px;top:184.80px;width:20.38px;height:32.24px" data-rotation = "311" data-pointer-events="none"> <img class="sg" src="D05E0E32.png" id="s465_i" style="z-index:1;left:0px;top:0px;width:20.38px;height:32.24px" > </div> <div class="sg" id="s458" data-sgid="Oval 6" style="z-index:6;left:520.54px;top:189.10px;width:20.27px;height:32.38px" data-rotation = "311" data-pointer-events="none"> <img class="sg" src="D9A780C6.png" id="s458_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s456" data-sgid="Picture 3" style="z-index:4;left:81.32px;top:57.33px;width:287.98px;height:309.50px"> <img class="sg" src="8D2E6FFB.jpg" id="s456_i" style="z-index:1;left:0px;top:0px;width:287.98px;height:309.50px" > </div> <div class="sg" id="s457" data-sgid="Picture 4" style="z-index:5;left:398.80px;top:57.33px;width:291.21px;height:313.71px"> <img class="sg" src="DD5A795E.jpg" id="s457_i" style="z-index:1;left:0px;top:0px;width:291.21px;height:313.71px" > </div> <div class="sg" id="s459" data-sgid="Oval 7" style="z-index:7;left:627.88px;top:257.46px;width:20.41px;height:32.38px" data-rotation = "25" data-pointer-events="none"> <img class="sg" src="CEA804FE.png" id="s459_i" style="z-index:1;left:0px;top:0px;width:20.41px;height:32.38px" > </div> <div class="sg" id="s466" data-sgid="Oval 15" style="z-index:14;left:310.06px;top:257.46px;width:20.38px;height:32.38px" data-rotation = "25" data-pointer-events="none"> <img class="sg" src="2438AE98.png" id="s466_i" style="z-index:1;left:0px;top:0px;width:20.38px;height:32.38px" > </div> <div class="sg" id="s467" data-sgid="Oval 16" style="z-index:15;left:184.72px;top:279.04px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="33BBE877.png" id="s467_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s460" data-sgid="Oval 8" style="z-index:8;left:496.56px;top:285.03px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="33BBE877.png" id="s460_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s454" data-sgid="TextBox 11" style="z-index:2;left:497.27px;top:363.35px;width:108.79px;height:37.30px" data-valign="top"> <div id="s454_t" class="sg" style="z-index:2;left:0.00px;top:-3.48px;width:108.79px;height:51.22px;"><div><p para="{al:2}"><span data-textwidth="41.65" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:33.94px;top:10.53px;">STIR</span></p></div></div></div> <div class="sg" id="s453" data-sgid="TextBox 10" style="z-index:1;left:155.44px;top:363.35px;width:132.76px;height:37.30px" data-valign="top"> <div id="s453_t" class="sg" style="z-index:2;left:0.00px;top:-3.48px;width:132.76px;height:51.22px;"><div><p para="{al:2}"><span data-textwidth="23.76" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:54.60px;top:10.53px;">T1</span></p></div></div></div> <div class="sg sgTitle" id="s468" data-sgid="Title 1" style="z-index:1;left:47.50px;top:-0.48px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s468_t" class="sg" style="z-index:2;left:-0.36px;top:-0.37px;width:649.25px;height:73.39px;"><div><p para="{al:2}"><span data-textwidth="357.66" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:145.97px;top:18.89px;">Non-contrast MRI - Coronal</span></p></div></div></div> <div class="sg" id="s479" data-sgid="Straight Arrow Connector 15" style="z-index:12;left:112.87px;top:153.38px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="10A318B.png" id="s479_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s477" data-sgid="Oval 13" style="z-index:10;left:190.70px;top:159.12px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="F757544E.png" id="s477_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s478" data-sgid="Oval 14" style="z-index:11;left:508.55px;top:165.11px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="682185E4.png" id="s478_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s474" data-sgid="Straight Arrow Connector 8" style="z-index:7;left:430.72px;top:165.37px;width:33.11px;height:38.97px" data-pointer-events="none"> <img class="sg" src="ED61CFC1.png" id="s474_i" style="z-index:1;left:0px;top:0px;width:33.11px;height:38.97px" > </div> <div class="sg" id="s471" data-sgid="Picture 2" style="z-index:4;left:86.96px;top:53.48px;width:279.22px;height:312.75px"> <img class="sg" src="D97DD0E6.jpg" id="s471_i" title="" alt="C:\Users\cmcmahon\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\5ULH93EL\myxoid marrow MR_img00011.jpg" style="z-index:1;left:0px;top:0px;width:279.22px;height:312.75px" > </div> <div class="sg" id="s472" data-sgid="Picture 2 (2)" style="z-index:5;left:401.33px;top:53.48px;width:294.69px;height:312.75px"> <img class="sg" src="803C341A.jpg" id="s472_i" title="" alt="C:\Users\cmcmahon\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\5ULH93EL\myxoid marrow MR_img00011 (3).jpg" style="z-index:1;left:0px;top:0px;width:294.69px;height:312.75px" > </div> <div class="sg" id="s473" data-sgid="Straight Arrow Connector 7" style="z-index:6;left:471.62px;top:212.26px;width:21.23px;height:38.86px" data-pointer-events="none"> <img class="sg" src="F45C103C.png" id="s473_i" style="z-index:1;left:0px;top:0px;width:21.23px;height:38.86px" > </div> <div class="sg" id="s475" data-sgid="Oval 9" style="z-index:8;left:634.49px;top:231.07px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="D9A780C6.png" id="s475_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s476" data-sgid="Oval 10" style="z-index:9;left:508.55px;top:315.01px;width:20.27px;height:32.38px" data-rotation = "30" data-pointer-events="none"> <img class="sg" src="4A4A614B.png" id="s476_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s469" data-sgid="TextBox 3" style="z-index:2;left:155.44px;top:363.71px;width:132.76px;height:37.30px" data-valign="top"> <div id="s469_t" class="sg" style="z-index:2;left:0.00px;top:-3.47px;width:132.76px;height:51.19px;"><div><p para="{al:2}"><span data-textwidth="23.76" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:54.60px;top:10.64px;">T1</span></p></div></div></div> <div class="sg" id="s470" data-sgid="TextBox 5" style="z-index:3;left:497.27px;top:363.83px;width:108.79px;height:37.30px" data-valign="top"> <div id="s470_t" class="sg" style="z-index:2;left:0.00px;top:-3.48px;width:108.79px;height:51.22px;"><div><p para="{al:2}"><span data-textwidth="41.65" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:33.94px;top:10.65px;">STIR</span></p></div></div></div> <div class="sg sgTitle" id="s480" data-sgid="Title 1" style="z-index:1;left:47.50px;top:-0.48px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s480_t" class="sg" style="z-index:2;left:-0.36px;top:-0.37px;width:649.25px;height:73.39px;"><div><p para="{al:2}"><span data-textwidth="357.66" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:145.97px;top:18.89px;">Non-contrast MRI - Coronal</span></p></div></div></div> <div class="sg" id="s487" data-sgid="Oval 8" style="z-index:8;left:556.54px;top:129.14px;width:20.27px;height:32.38px" data-pointer-events="none"> <img class="sg" src="33BBE877.png" id="s487_i" style="z-index:1;left:0px;top:0px;width:20.27px;height:32.38px" > </div> <div class="sg" id="s485" data-sgid="Straight Arrow Connector 7" style="z-index:6;left:477.60px;top:147.13px;width:32.88px;height:21.24px" data-pointer-events="none"> <img class="sg" src="83C0E6B7.png" id="s485_i" style="z-index:1;left:0px;top:0px;width:32.88px;height:21.24px" > </div> <div class="sg" id="s490" data-sgid="Oval 12" style="z-index:11;left:244.67px;top:147.13px;width:20.29px;height:32.38px" data-pointer-events="none"> <img class="sg" src="FFCA4FF.png" id="s490_i" style="z-index:1;left:0px;top:0px;width:20.29px;height:32.38px" > </div> <div class="sg" id="s486" data-sgid="Straight Arrow Connector 9" style="z-index:7;left:538.88px;top:164.29px;width:32.88px;height:21.21px" data-pointer-events="none"> <img class="sg" src="AFA1C505.png" id="s486_i" style="z-index:1;left:0px;top:0px;width:32.88px;height:21.21px" > </div> <div class="sg" id="s484" data-sgid="Picture 3" style="z-index:5;left:395.32px;top:67.62px;width:300.82px;height:286.62px"> <img class="sg" src="3A3CD264.jpg" id="s484_i" style="z-index:1;left:0px;top:0px;width:300.82px;height:286.62px" > </div> <div class="sg" id="s483" data-sgid="Picture 2" style="z-index:4;left:77.49px;top:67.62px;width:300.68px;height:287.80px"> <img class="sg" src="A130DCAB.jpg" id="s483_i" style="z-index:1;left:0px;top:0px;width:300.68px;height:287.80px" > </div> <div class="sg" id="s488" data-sgid="Oval 11" style="z-index:9;left:514.53px;top:225.07px;width:20.29px;height:32.38px" data-pointer-events="none"> <img class="sg" src="449BF1E0.png" id="s488_i" style="z-index:1;left:0px;top:0px;width:20.29px;height:32.38px" > </div> <div class="sg" id="s489" data-sgid="Oval 10" style="z-index:10;left:202.69px;top:243.06px;width:20.29px;height:32.38px" data-pointer-events="none"> <img class="sg" src="5EAC0EE2.png" id="s489_i" style="z-index:1;left:0px;top:0px;width:20.29px;height:32.38px" > </div> <div class="sg" id="s481" data-sgid="TextBox 7" style="z-index:2;left:162.75px;top:351.72px;width:132.91px;height:37.30px" data-valign="top"> <div id="s481_t" class="sg" style="z-index:2;left:0.00px;top:-3.48px;width:132.91px;height:51.19px;"><div><p para="{al:2}"><span data-textwidth="23.76" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:54.73px;top:10.64px;">T1</span></p></div></div></div> <div class="sg" id="s482" data-sgid="TextBox 8" style="z-index:3;left:497.27px;top:351.72px;width:108.79px;height:37.30px" data-valign="top"> <div id="s482_t" class="sg" style="z-index:2;left:0.00px;top:-3.48px;width:108.79px;height:51.19px;"><div><p para="{al:2}"><span data-textwidth="41.65" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:33.94px;top:10.64px;">STIR</span></p></div></div></div> <div class="sg sgTitle" id="s491" data-sgid="Title 1" style="z-index:1;left:41.50px;top:-0.48px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s491_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:649.25px;height:93.19px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.88px;top:17.96px;">Findings</span></p></div></div></div> <div class="sg" id="s492" data-sgid="Content Placeholder 2" style="z-index:2;left:41.50px;top:57.92px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s492_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.72px;height:296.68px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="446.47" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.55px;top:12.06px;">•<span style="letter-spacing:6.60px"> </span>Multiple <span style="color:#FFC000;">insufficiency #’s/osteopenia</span></span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="285.04" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:17.55px;top:52.39px;">•<span style="letter-spacing:6.60px"> </span>Right hip joint effusion</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="314.45" class="sg nowrap f2" style="z-index:7;color:#FFC000;font-size:156%; left:17.55px;top:92.72px;">•<span style="letter-spacing:6.60px"> </span>Profound muscle wasting</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="494.48" class="sg nowrap f2" style="z-index:9;color:#FFC000;font-size:156%; left:17.55px;top:133.05px;">•<span style="letter-spacing:6.60px"> </span>Odd BM signal <span style="color:#FFFFFF;">?technical vs replacement</span></span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="398.11" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:111%; left:53.43px;top:175.26px;">–<span style="letter-spacing:8.17px"> </span>Favour <span style="color:#FFC000;">replacement</span>: seen with STIR and T2 FS</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="106.45" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:156%; left:17.55px;top:207.95px;">•<span style="letter-spacing:6.60px"> </span>Ascites</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="247.24" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:156%; left:17.55px;top:248.28px;">•<span style="letter-spacing:6.60px"> </span>?soft tissue edema </span></p></div></div></div> <div class="sg sgTitle" id="s493" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s493_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s495" data-sgid="Right Arrow 4" style="z-index:3;left:58.53px;top:144.38px;width:25.79px;height:14.88px" data-fillcolor="16777215"> <img class="sg" src="B067752F.png" id="s495_i" style="z-index:1;left:0px;top:0px;width:25.79px;height:14.88px" > </div> <div class="sg" id="s494" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:87.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s494_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="512.84" class="sg nowrap f2" style="z-index:2;color:#FFC000;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Systemic disease <span style="color:#FFFFFF;">which is wasting, </span></span></p><p para="{spbf:0.20}"><span data-textwidth="430.51" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:62.17px;top:52.42px;">osteomalacia, muscle atrophy, ascites</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="311.10" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:53.41px;top:91.91px;">–<span style="letter-spacing:5.29px"> </span>CA, lymphoma, leukemia, <span style="color:#FFC000;">HIV</span></span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="469.04" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:133%; left:53.41px;top:126.48px;">–<span style="letter-spacing:5.29px"> </span>Metabolic: <span style="color:#FFC000;">Vit D def </span>(extrinsic), CRF, CLD, BIS, </span><span data-textwidth="395.95" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:76.10px;top:155.28px;">malabsorption, AN. How to explain BM?</span></p><p para="{in:3,bl:{ch:8226},spbf:0.20}"><span data-textwidth="425.83" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:111%; left:89.54px;top:187.89px;">•<span style="letter-spacing:3.48px"> </span>Post-radiation—but homogenous throughout FOV</span></p><p para="{in:3,bl:{ch:8226},spbf:0.20}"><span data-textwidth="385.26" class="sg nowrap f2" style="z-index:20;color:#FFC000;font-size:111%; left:89.54px;top:216.70px;">•<span style="letter-spacing:3.48px"> </span>‘Starvation marrow’ (serous atrophy or GTM)</span></p></div></div></div> <div class="sg sgTitle" id="s496" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s496_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="389.10" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:130.24px;top:18.09px;">Dr Forster’s Diagnosis</span></p></div></div></div> <div class="sg" id="s497" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s497_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:664.11px;height:274.26px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="570.33" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:43.34px;top:13.68px;">Non-neoplastic metabolic disorder, causing </span><span data-textwidth="605.98" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:178%; left:39.02px;top:52.09px;">insufficiency fractures (pt’s sx) with starvation </span><span data-textwidth="310.61" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:178%; left:183.05px;top:90.50px;">marrow/serous atrophy</span></p></div></div></div> <div class="sg sgTitle" id="s498" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s498_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="246.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:201.53px;top:18.09px;">The Diagnosis</span></p></div></div></div> <div class="sg" id="s499" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s499_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="604.54" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Starvation marrow: serous atrophy and gelatinous </span><span data-textwidth="579.82" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:44.53px;top:45.70px;">degeneration of marrow due to Anorexia Nervosa, </span><span data-textwidth="554.01" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:44.53px;top:79.31px;">with insufficiency fracture of right femoral neck, </span><span data-textwidth="432.55" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:44.53px;top:112.91px;">bilateral sacral ala and left pubic rami </span></p></div></div></div> <div class="sg sgTitle" id="s500" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s500_t" class="sg" style="z-index:2;left:-16.70px;top:-5.86px;width:681.88px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="628.66" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:26.79px;top:18.09px;">Pathophysiology of Serous Atrophy</span></p></div></div></div> <div class="sg" id="s501" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:81.91px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s501_t" class="sg" style="z-index:2;left:-7.57px;top:-4.08px;width:656.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="515.24" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Reflects systemic illness with weight loss/cachexia</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="559.77" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.26px;top:45.56px;">•<span style="letter-spacing:9.60px"> </span>Hypoplasia of fat and hematopoietic cells, replaced by </span><span data-textwidth="204.63" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:42.26px;top:74.36px;">gelatinous substance</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="204.03" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:15.26px;top:108.93px;">•<span style="letter-spacing:9.60px"> </span>Underlying causes</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="308.10" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:111%; left:51.14px;top:141.54px;">–<span style="letter-spacing:8.17px"> </span>Malnutrition – eg anorexia nervosa</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="519.33" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:111%; left:51.14px;top:170.34px;">–<span style="letter-spacing:8.17px"> </span>Maldigestion – eg. post gastrectomy, pancreatic insufficiency</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="65.18" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:111%; left:51.14px;top:199.15px;">–<span style="letter-spacing:8.17px"> </span>AIDS </span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="263.21" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:111%; left:51.14px;top:227.96px;">–<span style="letter-spacing:8.17px"> </span>Malignancy – NHL, carcinoma</span></p></div></div></div> <div class="sg sgTitle" id="s502" data-sgid="Title 3" style="z-index:1;left:23.50px;top:3.96px;width:648.54px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s502_t" class="sg" style="z-index:2;left:-0.34px;top:-5.88px;width:668.07px;height:93.30px;"><div><p para="{al:3}"><span data-textwidth="276.29" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:365.34px;top:18.08px;">Serous Atrophy</span></p></div></div></div> <div class="sg" id="s514" data-sgid="Rectangle 28" style="z-index:13;left:29.51px;top:9.59px;width:301.04px;height:81.54px" data-valign="top" data-pointer-events="none"> <img class="sg" src="CC27774.png" id="s514_i" style="z-index:1;left:0px;top:0px;width:301.04px;height:81.54px" > <div id="s514_t" class="sg" style="z-index:2;left:-4.57px;top:-2.04px;width:305.61px;height:90.90px;"><div><p><span data-textwidth="259.00" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.63px;top:8.25px;">Diffuse replacement of marrow </span><span data-textwidth="250.96" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:111%; left:12.63px;top:32.26px;">with fluid signal intensity. May </span><span data-textwidth="255.64" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:12.63px;top:56.26px;">mimic failure of fat suppression</span></p></div></div></div> <div class="sg" id="s507" data-sgid="Straight Arrow Connector 2" style="z-index:6;left:325.76px;top:47.49px;width:159.63px;height:92.94px" data-pointer-events="none"> <img class="sg" src="E19BB7ED.png" id="s507_i" style="z-index:1;left:0px;top:0px;width:159.63px;height:92.94px" > </div> <div class="sg" id="s512" data-sgid="Rectangle 12" style="z-index:11;left:29.51px;top:101.45px;width:302.49px;height:81.43px" data-valign="top" data-pointer-events="none"> <img class="sg" src="A3AF8368.png" id="s512_i" style="z-index:1;left:0px;top:0px;width:302.49px;height:81.43px" > <div id="s512_t" class="sg" style="z-index:2;left:-4.57px;top:-2.15px;width:307.05px;height:91.01px;"><div><p><span data-textwidth="230.44" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.63px;top:8.32px;">In this case a T2-FS was also </span><span data-textwidth="256.36" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:111%; left:12.63px;top:32.33px;">performed, with similar diffuse </span><span data-textwidth="149.90" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:111%; left:12.63px;top:56.33px;">signal abnormality</span></p></div></div></div> <div class="sg" id="s504" data-sgid="Picture 2 (2)" style="z-index:3;left:427.12px;top:75.32px;width:278.26px;height:138.02px"> <img class="sg" src="BA71F649.jpg" id="s504_i" title="" alt="C:\Users\cmcmahon\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\5ULH93EL\myxoid marrow MR_img00011 (3).jpg" style="z-index:1;left:0px;top:0px;width:278.26px;height:138.02px" > </div> <div class="sg" id="s508" data-sgid="Straight Arrow Connector 10" style="z-index:7;left:326.84px;top:139.24px;width:183.98px;height:161.41px" data-pointer-events="none"> <img class="sg" src="358D7480.png" id="s508_i" style="z-index:1;left:0px;top:0px;width:183.98px;height:161.41px" > </div> <div class="sg" id="s505" data-sgid="TextBox 6" style="z-index:4;left:629.21px;top:214.52px;width:96.80px;height:32.27px" data-valign="top"> <div id="s505_t" class="sg" style="z-index:2;left:-4.93px;top:-2.37px;width:101.73px;height:42.90px;"><div><p><span data-textwidth="43.45" class="sg nowrap f7" style="z-index:2;color:#FFFFFF;font-size:111%; left:13.03px;top:8.98px;">STIR</span></p></div></div></div> <div class="sg" id="s511" data-sgid="Rectangle 11" style="z-index:10;left:29.51px;top:198.23px;width:325.05px;height:81.54px" data-valign="top" data-pointer-events="none"> <img class="sg" src="C0B62FCD.png" id="s511_i" style="z-index:1;left:0px;top:0px;width:325.05px;height:81.54px" > <div id="s511_t" class="sg" style="z-index:2;left:-4.57px;top:-2.17px;width:336.67px;height:91.04px;"><div><p><span data-textwidth="311.81" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.63px;top:8.42px;">The subcutaneous fat is also bright on </span><span data-textwidth="299.69" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:111%; left:12.63px;top:32.43px;">FS images. This in addition to ascites </span><span data-textwidth="272.92" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:12.63px;top:56.44px;">in this example is due to anasarca</span></p></div></div></div> <div class="sg" id="s509" data-sgid="Straight Arrow Connector 13" style="z-index:8;left:349.63px;top:236.13px;width:119.70px;height:86.80px" data-pointer-events="none"> <img class="sg" src="17981F8E.png" id="s509_i" style="z-index:1;left:0px;top:0px;width:119.70px;height:86.80px" > </div> <div class="sg" id="s503" data-sgid="Picture 2" style="z-index:2;left:425.08px;top:254.35px;width:276.47px;height:132.76px"> <img class="sg" src="1E9F7044.jpg" id="s503_i" title="" alt="C:\Users\cmcmahon\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\5ULH93EL\myxoid marrow MR_img00027 (3).jpg" style="z-index:1;left:0px;top:0px;width:276.47px;height:132.76px" > </div> <div class="sg" id="s510" data-sgid="Rectangle 8" style="z-index:9;left:29.51px;top:290.32px;width:340.98px;height:81.54px" data-valign="top" data-pointer-events="none"> <img class="sg" src="887CC74E.png" id="s510_i" style="z-index:1;left:0px;top:0px;width:340.98px;height:81.54px" > <div id="s510_t" class="sg" style="z-index:2;left:-4.57px;top:-2.15px;width:349.74px;height:91.01px;"><div><p><span data-textwidth="325.01" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.63px;top:8.50px;">Note apparent moderate subcutaneous </span><span data-textwidth="299.57" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:111%; left:12.63px;top:32.50px;">fat despite Anorexia Nervosa , this is </span><span data-textwidth="231.04" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:12.63px;top:56.51px;">due to subcutaneous edema</span></p></div></div></div> <div class="sg" id="s513" data-sgid="Straight Arrow Connector 24" style="z-index:12;left:365.95px;top:327.63px;width:106.49px;height:25.17px" data-pointer-events="none"> <img class="sg" src="D5D6E843.png" id="s513_i" style="z-index:1;left:0px;top:0px;width:106.49px;height:25.17px" > </div> <div class="sg" id="s506" data-sgid="TextBox 8" style="z-index:5;left:629.21px;top:361.68px;width:84.81px;height:32.24px" data-valign="top"> <div id="s506_t" class="sg" style="z-index:2;left:-4.93px;top:-2.41px;width:89.74px;height:42.93px;"><div><p><span data-textwidth="51.24" class="sg nowrap f7" style="z-index:2;color:#FFFFFF;font-size:111%; left:13.03px;top:9.13px;">T2-FS</span></p></div></div></div> <div class="sg sgTitle" id="s515" data-sgid="Title 4" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s515_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="319.61" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:165.04px;top:18.09px;">Take home points</span></p></div></div></div> <div class="sg" id="s516" data-sgid="Content Placeholder 5" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s516_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.69px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="596.97" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Consider serous marrow atrophy when marrow is </span><span data-textwidth="314.57" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:44.53px;top:45.70px;">high signal on all sequences</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="486.19" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:17.53px;top:86.63px;">•<span style="letter-spacing:6.60px"> </span>Beware attributing this to <span class="f6" >“</span>failure of fat </span><span data-textwidth="591.58" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:44.53px;top:120.24px;">suppression<span class="f6" >”</span> – in this case the persistence of signal </span><span data-textwidth="506.72" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:156%; left:44.53px;top:153.24px;">abnormality on both frequency selective fat-</span><span data-textwidth="422.11" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:156%; left:44.53px;top:186.85px;">suppression and STIR is a key finding.</span></p></div></div></div> <div class="sg" id="s518" data-sgid="Title 1" style="z-index:2;left:53.49px;top:66.92px;width:612.55px;height:87.79px" data-valign="middle"> <div id="s518_t" class="sg" style="z-index:2;left:0.00px;top:0.00px;width:612.55px;height:97.12px;"><div><p para="{al:2}"><span data-textwidth="396.78" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:108.06px;top:21.98px;">Genitourinary Case #2</span></p></div></div></div> <div class="sg sgSubtitle" id="s517" data-sgid="Subtitle 2" style="z-index:1;left:119.47px;top:176.40px;width:510.56px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s517_t" class="sg" style="z-index:2;left:-0.37px;top:-7.33px;width:511.30px;height:119.69px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="361.74" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:200%; left:79.05px;top:14.97px;">48 year old woman with </span><span data-textwidth="277.73" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:200%; left:116.98px;top:58.18px;">painless hematuria</span></p></div></div></div> <div class="sg" id="s519" data-sgid="Picture 4" style="z-index:1;left:74.23px;top:-11.28px;width:327.21px;height:232.29px"> <img class="sg" src="F52DE19E.png" id="s519_i" title="" alt="C:\Users\jkruskal\Desktop\_img00025.jpg" style="z-index:1;left:0px;top:0px;width:327.21px;height:232.29px" > </div> <div class="sg" id="s520" data-sgid="Picture 5" style="z-index:2;left:359.72px;top:-11.28px;width:324.65px;height:232.29px"> <img class="sg" src="340FAA17.png" id="s520_i" title="" alt="C:\Users\jkruskal\Desktop\_img00042.jpg" style="z-index:1;left:0px;top:0px;width:324.65px;height:232.29px" > </div> <div class="sg" id="s521" data-sgid="Picture 6" style="z-index:3;left:80.36px;top:179.88px;width:321.08px;height:237.91px"> <img class="sg" src="7E132EC6.png" id="s521_i" title="" alt="C:\Users\jkruskal\Desktop\_img00061.jpg" style="z-index:1;left:0px;top:0px;width:321.08px;height:237.91px" > </div> <div class="sg" id="s522" data-sgid="Picture 7" style="z-index:4;left:359.72px;top:179.88px;width:326.36px;height:237.91px"> <img class="sg" src="34F4BB98.png" id="s522_i" title="" alt="C:\Users\jkruskal\Desktop\_img00065.jpg" style="z-index:1;left:0px;top:0px;width:326.36px;height:237.91px" > </div> <div class="sg" id="s524" data-sgid="Picture 3" style="z-index:2;left:392.09px;top:-5.29px;width:297.70px;height:412.05px"> <img class="sg" src="531243DE.png" id="s524_i" title="" alt="C:\Users\jkruskal\Desktop\_img00018.jpg" style="z-index:1;left:0px;top:0px;width:297.70px;height:412.05px" > </div> <div class="sg" id="s523" data-sgid="Picture 2" style="z-index:1;left:92.23px;top:-4.81px;width:298.18px;height:412.76px"> <img class="sg" src="3028550.png" id="s523_i" title="" alt="C:\Users\jkruskal\Desktop\_img00024.jpg" style="z-index:1;left:0px;top:0px;width:298.18px;height:412.76px" > </div> <div class="sg sgTitle" id="s525" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s525_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="213.16" class="sg nowrap f8" style="z-index:2;color:#FF6319;font-size:244%; left:218.21px;top:20.81px;">Findings</span></p></div></div></div> <div class="sg" id="s526" data-sgid="Content Placeholder 2" style="z-index:2;left:95.46px;top:93.90px;width:576.58px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s526_t" class="sg" style="z-index:2;left:-9.83px;top:-5.29px;width:586.75px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="505.28" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.59px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Multiseptated cystic mass lower pole Left </span><span data-textwidth="483.32" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:44.59px;top:45.70px;">kidney, enhancing septae, capsular vessels</span></p><p para="{bl:{ch:8226},spbf:0.20}"></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="304.97" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:17.59px;top:126.36px;">•<span style="letter-spacing:6.60px"> </span>Previous R nephrectomy</span></p><p para="{bl:{ch:8226},spbf:0.20}"></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="351.78" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:156%; left:17.59px;top:207.02px;">•<span style="letter-spacing:6.60px"> </span>Truncal asymmetry, scoliosis</span></p></div></div></div> <div class="sg sgTitle" id="s527" data-sgid="Title 1" style="z-index:1;left:132.54px;top:14.51px;width:479.53px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s527_t" class="sg" style="z-index:2;left:-10.55px;top:-41.86px;width:500.73px;height:162.85px;"><div><p para="{al:2}"><span data-textwidth="282.77" class="sg nowrap f8" style="z-index:2;color:#FF6319;font-size:200%; left:120.33px;top:17.31px;">Differential </span><span data-textwidth="456.56" class="sg nowrap f8" style="z-index:3;color:#FF6319;font-size:200%; left:22.27px;top:60.52px;">Diagnosis for Truncal</span><span data-textwidth="195.51" class="sg nowrap f8" style="z-index:5;color:#FF6319;font-size:200%; left:152.86px;top:103.73px;">Asymmetry</span></p></div></div></div> <div class="sg" id="s528" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s528_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:662.77px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="228.15" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Hemihypertrophy</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="486.08" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:17.53px;top:51.58px;">•<span style="letter-spacing:9.60px"> </span>Genetic syndrome with overgrowth of one side</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="594.95" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:53.41px;top:86.15px;">–<span style="letter-spacing:5.29px"> </span>Associations: renal cysts and renal agenesis, increased risk </span><span data-textwidth="66.97" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:76.10px;top:114.95px;">Wilm’s</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="176.06" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:17.53px;top:150.36px;">•<span style="letter-spacing:6.60px"> </span>Hemiatrophy</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="411.67" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:133%; left:53.41px;top:189.85px;">–<span style="letter-spacing:5.29px"> </span>Seen secondary to childhood irradiation</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="560.50" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:53.41px;top:224.42px;">–<span style="letter-spacing:5.29px"> </span>Scoliosis secondary to partial vertebral body irradiation</span></p></div></div></div> <div class="sg" id="s529" data-sgid="Picture 4" style="z-index:1;left:74.23px;top:-11.28px;width:327.21px;height:232.29px"> <img class="sg" src="F52DE19E.png" id="s529_i" title="" alt="C:\Users\jkruskal\Desktop\_img00025.jpg" style="z-index:1;left:0px;top:0px;width:327.21px;height:232.29px" > </div> <div class="sg" id="s530" data-sgid="Picture 5" style="z-index:2;left:359.72px;top:-11.28px;width:324.65px;height:232.29px"> <img class="sg" src="340FAA17.png" id="s530_i" title="" alt="C:\Users\jkruskal\Desktop\_img00042.jpg" style="z-index:1;left:0px;top:0px;width:324.65px;height:232.29px" > </div> <div class="sg" id="s531" data-sgid="Picture 6" style="z-index:3;left:80.36px;top:179.88px;width:321.08px;height:237.91px"> <img class="sg" src="7E132EC6.png" id="s531_i" title="" alt="C:\Users\jkruskal\Desktop\_img00061.jpg" style="z-index:1;left:0px;top:0px;width:321.08px;height:237.91px" > </div> <div class="sg" id="s532" data-sgid="Picture 7" style="z-index:4;left:359.72px;top:179.88px;width:326.36px;height:237.91px"> <img class="sg" src="34F4BB98.png" id="s532_i" title="" alt="C:\Users\jkruskal\Desktop\_img00065.jpg" style="z-index:1;left:0px;top:0px;width:326.36px;height:237.91px" > </div> <div class="sg sgTitle" id="s533" data-sgid="Title 1" style="z-index:1;left:132.54px;top:14.51px;width:479.53px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s533_t" class="sg" style="z-index:2;left:-10.55px;top:-41.86px;width:500.73px;height:162.85px;"><div><p para="{al:2}"><span data-textwidth="282.77" class="sg nowrap f8" style="z-index:2;color:#FF6319;font-size:200%; left:120.33px;top:17.31px;">Differential </span><span data-textwidth="456.56" class="sg nowrap f8" style="z-index:3;color:#FF6319;font-size:200%; left:22.27px;top:60.52px;">Diagnosis for Truncal</span><span data-textwidth="195.51" class="sg nowrap f8" style="z-index:5;color:#FF6319;font-size:200%; left:152.86px;top:103.73px;">Asymmetry</span></p></div></div></div> <div class="sg" id="s534" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s534_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:662.77px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="228.15" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Hemihypertrophy</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="486.08" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:17.53px;top:51.58px;">•<span style="letter-spacing:9.60px"> </span>Genetic syndrome with overgrowth of one side</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="594.95" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:53.41px;top:86.15px;">–<span style="letter-spacing:5.29px"> </span>Associations: renal cysts and renal agenesis, increased risk </span><span data-textwidth="66.97" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:133%; left:76.10px;top:114.95px;">Wilm’s</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="176.06" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:17.53px;top:150.36px;">•<span style="letter-spacing:6.60px"> </span>Hemiatrophy</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="411.67" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:133%; left:53.41px;top:189.85px;">–<span style="letter-spacing:5.29px"> </span>Seen secondary to childhood irradiation</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="560.50" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:53.41px;top:224.42px;">–<span style="letter-spacing:5.29px"> </span>Scoliosis secondary to partial vertebral body irradiation</span></p></div></div></div> <div class="sg" id="s535" data-sgid="Title 1" style="z-index:1;left:30.58px;top:14.88px;width:648.63px;height:68.36px" data-valign="middle"> <div id="s535_t" class="sg" style="z-index:2;left:0.00px;top:-5.89px;width:648.63px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="213.16" class="sg nowrap f4" style="z-index:2;color:#FF6319;font-size:244%; left:217.98px;top:19.70px;">Discussion</span></p></div></div></div> <div class="sg" id="s536" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top"> <div id="s536_t" class="sg" style="z-index:2;left:-8.54px;top:-4.81px;width:657.05px;height:272.81px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="577.65" class="sg nowrap f4" style="z-index:2;color:#FFFFFF;font-size:156%; left:16.23px;top:13.25px;">•<span style="letter-spacing:9.48px"> </span>Nephrectomy and high dose irradiation as a </span><span data-textwidth="73.21" class="sg nowrap f4" style="z-index:4;color:#FFFFFF;font-size:156%; left:43.23px;top:46.86px;">child </span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="207.52" class="sg nowrap f4" style="z-index:5;color:#FFFFFF;font-size:156%; left:52.23px;top:87.19px;">– Wilm’s Tumour</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="212.56" class="sg nowrap f4" style="z-index:7;color:#FFFFFF;font-size:156%; left:52.23px;top:127.52px;">– Neuroblastoma</span></p></div></div></div> <div class="sg sgTitle" id="s538" data-sgid="Title 2" style="z-index:2;left:29.51px;top:21.95px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s538_t" class="sg" style="z-index:2;left:-0.37px;top:-5.89px;width:649.25px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="232.60" class="sg nowrap f4" style="z-index:2;color:#FF6319;font-size:244%; left:208.50px;top:19.83px;">Renal Mass</span></p></div></div></div> <div class="sg" id="s537" data-sgid="Rectangle 1" style="z-index:1;left:47.50px;top:107.45px;width:636.53px;height:197.98px" data-valign="top" data-pointer-events="none"> <div id="s537_t" class="sg" style="z-index:2;left:-9.83px;top:-5.41px;width:646.36px;height:214.78px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="358.02" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.54px;top:12.10px;">•<span style="letter-spacing:6.60px"> </span>Multilocular cystic nephroma</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="170.90" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:17.54px;top:52.43px;">•<span style="letter-spacing:6.60px"> </span>Adult Wilm’s</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="595.90" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.54px;top:92.76px;">•<span style="letter-spacing:6.60px"> </span>Cystic RCC - childhood radiation increases risk RCC</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="606.82" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:17.54px;top:133.09px;">•<span style="letter-spacing:6.60px"> </span>Subtype of RCC which is associated with childhood </span><span data-textwidth="171.87" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:156%; left:44.54px;top:166.70px;">neuroblastoma</span></p></div></div></div> <div class="sg sgTitle" id="s539" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s539_t" class="sg" style="z-index:2;left:-0.37px;top:-32.25px;width:649.22px;height:146.05px;"><div><p para="{al:2}"><span data-textwidth="426.07" class="sg nowrap f8" style="z-index:2;color:#FF6319;font-size:244%; left:124.96px;top:20.79px;">Dr McNicholas’s </span><span data-textwidth="239.80" class="sg nowrap f8" style="z-index:3;color:#FF6319;font-size:244%; left:204.89px;top:73.60px;">Diagnosis</span></p></div></div></div> <div class="sg" id="s540" data-sgid="Content Placeholder 2" style="z-index:2;left:41.50px;top:105.89px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s540_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.72px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="572.02" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.55px;top:12.10px;">•<span style="letter-spacing:6.60px"> </span>Hemitruncal hypoplasia secondary to high dose </span><span data-textwidth="513.09" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:156%; left:44.55px;top:45.71px;">radiotherapy in childhood for neuroblastoma</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="580.53" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:17.55px;top:86.04px;">•<span style="letter-spacing:6.60px"> </span>Neuroblastoma-Associated Renal Cell Carcinoma</span></p></div></div></div> <div class="sg sgTitle" id="s541" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s541_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="246.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:201.53px;top:18.09px;">The Diagnosis</span></p></div></div></div> <div class="sg" id="s542" data-sgid="Content Placeholder 2" style="z-index:2;left:59.49px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s542_t" class="sg" style="z-index:2;left:-11.99px;top:-5.88px;width:660.87px;height:274.26px;"><div><p para="{spbf:0.20}"><span data-textwidth="555.82" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:19.71px;top:13.68px;">Neuroblastoma-associated adult renal cell </span><span data-textwidth="135.62" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:178%; left:19.71px;top:52.09px;">carcinoma</span></p></div></div></div> <div class="sg sgTitle" id="s543" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s543_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="560.73" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:44.42px;top:18.09px;">Neuroblastoma-associated RCC</span></p></div></div></div> <div class="sg" id="s544" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s544_t" class="sg" style="z-index:2;left:-5.05px;top:-2.77px;width:653.90px;height:271.15px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="309.53" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.74px;top:8.69px;">•<span style="letter-spacing:12.48px"> </span>A unique histologic subtype of RCC</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="496.16" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:12.74px;top:37.50px;">•<span style="letter-spacing:12.48px"> </span>Occurs in long-term survivors of pediatric neuroblastoma </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="560.73" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:111%; left:12.74px;top:66.30px;">•<span style="letter-spacing:12.48px"> </span>Most occur about ten years after the diagnosis of neuroblastoma</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="418.27" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:111%; left:12.74px;top:95.11px;">•<span style="letter-spacing:12.48px"> </span>Rare cases reported without radiation or chemo</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="564.33" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:111%; left:12.74px;top:123.92px;">•<span style="letter-spacing:12.48px"> </span>Treatment for neuroblastoma may predispose to genetic changes </span><span data-textwidth="158.91" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:111%; left:39.74px;top:147.92px;">responsible for RCC</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="386.22" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:111%; left:12.74px;top:176.73px;">•<span style="letter-spacing:12.48px"> </span>Accounts for 2.5% of RCC in young patients. </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="352.85" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:111%; left:12.74px;top:205.54px;">•<span style="letter-spacing:12.48px"> </span>Males and females are equally involved.</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="608.74" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:111%; left:12.74px;top:234.34px;">•<span style="letter-spacing:12.48px"> </span>Age range of patients with neuroblastoma-associated RCC is 2–35 years</span></p></div></div></div> <div class="sg sgTitle" id="s545" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s545_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="560.73" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:44.42px;top:18.09px;">Neuroblastoma-associated RCC</span></p></div></div></div> <div class="sg" id="s546" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s546_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:656.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="309.29" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Histologically heterogeneous</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="453.44" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:51.14px;top:43.60px;">–<span style="letter-spacing:8.17px"> </span>Some tumors contain solid and papillary architecture</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="467.84" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:111%; left:51.14px;top:72.41px;">–<span style="letter-spacing:8.17px"> </span>Most cells containing abundant eosinophilic cytoplasm</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="583.90" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:111%; left:51.14px;top:101.21px;">–<span style="letter-spacing:8.17px"> </span>Typically composed of oncocytic cells so must distinguish these from </span><span data-textwidth="137.78" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:111%; left:73.83px;top:125.22px;">oncocytomas by:</span></p><p para="{in:3,bl:{ch:8226},spbf:0.20}"><span data-textwidth="228.40" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;left:87.27px;top:153.54px;">•<span style="letter-spacing:4.92px"> </span>No history of neuroblastoma</span></p><p para="{in:3,bl:{ch:8226},spbf:0.20}"><span data-textwidth="132.74" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;left:87.27px;top:179.47px;">•<span style="letter-spacing:4.92px"> </span>Rare in children</span></p><p para="{in:3,bl:{ch:8226},spbf:0.20}"><span data-textwidth="238.00" class="sg nowrap f2" style="z-index:22;color:#FFFFFF;left:87.27px;top:205.40px;">•<span style="letter-spacing:4.92px"> </span>Minimal papillary component </span></p></div></div></div> <div class="sg sgTitle" id="s547" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s547_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="560.73" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:44.42px;top:18.09px;">Neuroblastoma-associated RCC</span></p></div></div></div> <div class="sg" id="s548" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s548_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:656.42px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="433.87" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Very few cases are reported as aggressive</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="440.35" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:15.26px;top:45.56px;">•<span style="letter-spacing:9.60px"> </span>Imaging findings reflect histologic features</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="437.35" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:111%; left:51.14px;top:78.17px;">–<span style="letter-spacing:8.17px"> </span>No specific radiologic findings have been described</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="568.29" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:133%; left:15.26px;top:137.74px;">•<span style="letter-spacing:9.60px"> </span>As with this case, the diagnosis is suggested based on a </span><span data-textwidth="593.14" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:133%; left:42.26px;top:166.55px;">history of, or imaging features prior treatment for childhood </span><span data-textwidth="148.58" class="sg nowrap f2" style="z-index:23;color:#FFFFFF;font-size:133%; left:42.26px;top:195.35px;">neuroblastoma</span></p></div></div></div> <div class="sg" id="s549" data-sgid="Title 3" style="z-index:1;left:59.49px;top:57.92px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s549_t" class="sg" style="z-index:2;left:-0.36px;top:-0.36px;width:613.26px;height:97.49px;"><div><p para="{al:2}"><span data-textwidth="427.15" class="sg nowrap f2" style="z-index:2;color:#FFFF00;font-size:244%; left:93.30px;top:22.34px;">Neuroradiology Case #2</span></p></div></div></div> <div class="sg sgSubtitle" id="s550" data-sgid="Subtitle 4" style="z-index:2;left:77.49px;top:141.87px;width:600.53px;height:204.82px" data-valign="top" data-pointer-events="none"> <div id="s550_t" class="sg" style="z-index:2;left:-0.62px;top:-5.89px;width:609.06px;height:211.07px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="216.52" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:189.21px;top:13.73px;">63 year old male</span></p><p para="{al:2,spbf:0.20}"><span data-textwidth="256.60" class="sg nowrap f2" style="z-index:3;color:#FFFFFF;font-size:178%; left:172.77px;top:59.82px;">h/o DMII, HTN, HLD</span></p><p para="{al:2,spbf:0.20}"><span data-textwidth="570.10" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:178%; left:19.75px;top:105.91px;">Presents with rapidly progressive dementia </span><span data-textwidth="264.76" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:178%; left:168.69px;top:144.32px;">and gait impairment</span></p></div></div></div> <div class="sg" id="s552" data-sgid="Group 7" style="z-index:2;left:216.00px;top:5.00px;width:348.25px;height:391.00px" data-shape="group"> <div class="sg" id="s553" data-sgid="ss552_shd" style="z-index:1;left:-15.80px;top:-15.80px;width:395.06px;height:437.70px"> <img class="sg" src="82D855BB.png" id="s553_i" style="z-index:1;left:0px;top:0px;width:395.06px;height:437.70px" > </div> <div class="sg" id="s554" data-sgid="Picture 10" style="z-index:4;left:176.94px;top:186.39px;width:202.32px;height:225.55px"> <img class="sg" src="7C97746D.png" id="s554_i" style="z-index:1;left:0px;top:0px;width:202.32px;height:225.55px" > </div> <div class="sg" id="s555" data-sgid="Picture 8" style="z-index:3;left:-14.39px;top:186.39px;width:210.63px;height:235.51px"> <img class="sg" src="32226E4F.png" id="s555_i" style="z-index:1;left:0px;top:0px;width:210.63px;height:235.51px" > </div> <div class="sg" id="s556" data-sgid="Picture 6" style="z-index:2;left:176.94px;top:-14.47px;width:199.34px;height:238.39px"> <img class="sg" src="4F0ADCB7.png" id="s556_i" style="z-index:1;left:0px;top:0px;width:199.34px;height:238.39px" > </div> <div class="sg" id="s557" data-sgid="Picture 5" style="z-index:1;left:-15.80px;top:-15.80px;width:212.04px;height:239.72px"> <img class="sg" src="8E524B4E.png" id="s557_i" style="z-index:1;left:0px;top:0px;width:212.04px;height:239.72px" > </div> </div> <div class="sg" id="s551" data-sgid="TextBox 2" style="z-index:1;left:575.25px;top:348.84px;width:107.93px;height:37.30px" data-valign="top"> <div id="s551_t" class="sg" style="z-index:2;left:0.00px;top:-3.48px;width:107.93px;height:51.22px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="54.13" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:27.25px;top:10.64px;">FLAIR</span></p></div></div></div> <div class="sg sgTitle" id="s558" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s558_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s559" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:81.91px;width:684.48px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s559_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:703.45px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="626.38" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.08px;">•<span style="letter-spacing:6.60px"> </span>Pre-image thoughts from Hx: ?NPH, ?paraneoplastic </span><span data-textwidth="388.98" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:44.53px;top:45.69px;">syndrome, ?cerebellar form CJD …</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="608.86" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:17.53px;top:86.02px;">•<span style="letter-spacing:6.60px"> </span>FLAIR: abnormal assym hyperintensity optic tracts, </span><span data-textwidth="642.11" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:156%; left:44.53px;top:119.62px;">hypothalami, left lentiform nucleus. Overall volume loss </span><span data-textwidth="281.57" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:44.53px;top:153.23px;">for age with vents &gt; sulci</span></p></div></div></div> <div class="sg" id="s560" data-sgid="Group 10" style="z-index:1;left:126.00px;top:4.50px;width:498.00px;height:395.00px" data-shape="group"> <div class="sg" id="s561" data-sgid="ss560_shd" style="z-index:1;left:-15.77px;top:-15.78px;width:544.63px;height:441.80px"> <img class="sg" src="8CF09C74.png" id="s561_i" style="z-index:1;left:0px;top:0px;width:544.63px;height:441.80px" > </div> <div class="sg" id="s562" data-sgid="Picture 4" style="z-index:2;left:247.49px;top:180.19px;width:246.11px;height:245.83px"> <img class="sg" src="97A53FD6.png" id="s562_i" style="z-index:1;left:0px;top:0px;width:246.11px;height:245.83px" > </div> <div class="sg" id="s563" data-sgid="Group 11" style="z-index:1;left:0.00px;top:0.00px;width:498.00px;height:393.08px" data-shape="group"> <div class="sg" id="s564" data-sgid="Picture 12" style="z-index:4;left:57.87px;top:176.45px;width:216.61px;height:247.64px"> <img class="sg" src="D397718E.png" id="s564_i" style="z-index:1;left:0px;top:0px;width:216.61px;height:247.64px" > </div> <div class="sg" id="s565" data-sgid="Picture 11" style="z-index:3;left:326.77px;top:-15.78px;width:202.09px;height:244.28px"> <img class="sg" src="65214DAB.png" id="s565_i" style="z-index:1;left:0px;top:0px;width:202.09px;height:244.28px" > </div> <div class="sg" id="s566" data-sgid="Picture 9" style="z-index:2;left:153.47px;top:-15.78px;width:222.47px;height:245.01px"> <img class="sg" src="B23A46B2.png" id="s566_i" style="z-index:1;left:0px;top:0px;width:222.47px;height:245.01px" > </div> <div class="sg" id="s567" data-sgid="Picture 7" style="z-index:1;left:-15.77px;top:-15.78px;width:216.24px;height:245.01px"> <img class="sg" src="5700EFC7.png" id="s567_i" style="z-index:1;left:0px;top:0px;width:216.24px;height:245.01px" > </div> </div> </div> <div class="sg" id="s568" data-sgid="Group 6" style="z-index:1;left:182.00px;top:7.88px;width:394.00px;height:392.63px" data-shape="group"> <div class="sg" id="s569" data-sgid="ss568_shd" style="z-index:1;left:-15.87px;top:-15.80px;width:440.78px;height:439.40px"> <img class="sg" src="9A77BF6D.png" id="s569_i" style="z-index:1;left:0px;top:0px;width:440.78px;height:439.40px" > </div> <div class="sg" id="s570" data-sgid="Picture 3" style="z-index:4;left:182.73px;top:-15.80px;width:242.17px;height:253.98px"> <img class="sg" src="1FBBBC1A.png" id="s570_i" style="z-index:1;left:0px;top:0px;width:242.17px;height:253.98px" > </div> <div class="sg" id="s571" data-sgid="Picture 2" style="z-index:3;left:-15.87px;top:-15.80px;width:231.35px;height:254.46px"> <img class="sg" src="428C7475.png" id="s571_i" style="z-index:1;left:0px;top:0px;width:231.35px;height:254.46px" > </div> <div class="sg" id="s572" data-sgid="Picture 13" style="z-index:2;left:182.73px;top:197.18px;width:234.49px;height:226.43px"> <img class="sg" src="2DF6CB2.png" id="s572_i" style="z-index:1;left:0px;top:0px;width:234.49px;height:226.43px" > </div> <div class="sg" id="s573" data-sgid="Picture 3 (2)" style="z-index:1;left:-15.87px;top:196.59px;width:230.16px;height:227.02px"> <img class="sg" src="643C41F7.png" id="s573_i" style="z-index:1;left:0px;top:0px;width:230.16px;height:227.02px" > </div> </div> <div class="sg" id="s574" data-sgid="Group 4" style="z-index:1;left:54.00px;top:55.50px;width:656.75px;height:255.00px" data-shape="group"> <div class="sg" id="s575" data-sgid="ss574_shd" style="z-index:1;left:-15.74px;top:-15.82px;width:703.33px;height:301.86px"> <img class="sg" src="54954F5D.png" id="s575_i" style="z-index:1;left:0px;top:0px;width:703.33px;height:301.86px" > </div> <div class="sg" id="s576" data-sgid="Picture 3" style="z-index:2;left:317.71px;top:-15.82px;width:369.89px;height:301.86px"> <img class="sg" src="473311BF.png" id="s576_i" title="" alt="C:\Users\rbhadeli\Downloads\_img00083.jpg" style="z-index:1;left:0px;top:0px;width:369.89px;height:301.86px" > </div> <div class="sg" id="s577" data-sgid="Picture 2" style="z-index:1;left:-15.74px;top:-15.82px;width:362.47px;height:301.61px"> <img class="sg" src="76C0359B.png" id="s577_i" title="" alt="C:\Users\rbhadeli\Downloads\_img00089.jpg" style="z-index:1;left:0px;top:0px;width:362.47px;height:301.61px" > </div> </div> <div class="sg sgTitle" id="s578" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s578_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s579" data-sgid="Content Placeholder 2" style="z-index:2;left:47.50px;top:87.90px;width:636.53px;height:270.78px" data-valign="top" data-pointer-events="none"> <div id="s579_t" class="sg" style="z-index:2;left:-9.83px;top:-5.29px;width:646.70px;height:276.43px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="515.36" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.54px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>GAD T1: intense nodular asymmetric CE of </span><span data-textwidth="550.89" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:44.54px;top:45.70px;">hypothalami (?+ mammill. bodies), left caudate, </span><span data-textwidth="242.20" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:44.54px;top:79.31px;">putamen, GP externa</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="459.44" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:17.54px;top:119.63px;">•<span style="letter-spacing:6.60px"> </span>No CE ventricles, leptomeninges, dura</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="585.93" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:156%; left:17.54px;top:159.96px;">•<span style="letter-spacing:6.60px"> </span>Confirms ventricles look enlarged relative to sulci</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="134.78" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:156%; left:17.54px;top:200.29px;">•<span style="letter-spacing:6.60px"> </span>WTF case</span></p></div></div></div> <div class="sg sgTitle" id="s580" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s580_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="147.98" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:250.86px;top:18.09px;">Findings</span></p></div></div></div> <div class="sg" id="s581" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:81.91px;width:642.51px;height:264.78px" data-valign="top" data-pointer-events="none"> <div id="s581_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:654.01px;height:270.44px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="608.86" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.53px;top:12.08px;">•<span style="letter-spacing:6.60px"> </span>FLAIR: abnormal assym hyperintensity optic tracts, </span><span data-textwidth="592.54" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:156%; left:44.53px;top:45.69px;">hypothalami, left lentiform nucleus. Overall volume </span><span data-textwidth="331.14" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:156%; left:44.53px;top:79.29px;">loss for age with vents &gt; sulci</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="494.24" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:156%; left:17.53px;top:119.62px;">•<span style="letter-spacing:6.60px"> </span>GAD T1: intense nodular asymmetric CE -</span><span data-textwidth="550.89" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:156%; left:44.53px;top:153.23px;">hypothalami (?+ mammill. bodies), left caudate, </span><span data-textwidth="455.96" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:156%; left:44.53px;top:186.84px;">putamen, GPexterna but not ventricles, </span><span data-textwidth="258.89" class="sg nowrap f2" style="z-index:22;color:#FFFFFF;font-size:156%; left:44.53px;top:220.45px;">leptomeninges or dura</span></p></div></div></div> <div class="sg sgTitle" id="s582" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s582_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s583" data-sgid="Content Placeholder 2" style="z-index:2;left:65.48px;top:93.90px;width:648.54px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s583_t" class="sg" style="z-index:2;left:-9.84px;top:-5.29px;width:658.72px;height:273.66px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="138.99" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:156%; left:17.57px;top:12.09px;">•<span style="letter-spacing:6.61px"> </span>Infectious</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="187.96" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:17.57px;top:52.42px;">•<span style="letter-spacing:6.61px"> </span>Inflammatory </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="141.75" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:17.57px;top:92.75px;">•<span style="letter-spacing:6.61px"> </span>Traumatic</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="146.55" class="sg nowrap f2" style="z-index:8;color:#FFFFFF;font-size:156%; left:17.57px;top:133.08px;">•<span style="letter-spacing:6.61px"> </span>Neoplastic</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="147.99" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:156%; left:17.57px;top:173.41px;">•<span style="letter-spacing:6.61px"> </span>Metabolic </span><span data-textwidth="123.14" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:156%; left:334.43px;top:12.09px;">•<span style="letter-spacing:6.60px"> </span>Vascular</span><span data-textwidth="176.06" class="sg nowrap f2" style="z-index:14;color:#FFFFFF;font-size:156%; left:334.43px;top:52.42px;">•<span style="letter-spacing:6.60px"> </span>Autoimmune</span><span data-textwidth="135.14" class="sg nowrap f2" style="z-index:16;color:#FFFFFF;font-size:156%; left:334.43px;top:92.75px;">•<span style="letter-spacing:6.60px"> </span>Radiation</span><span data-textwidth="179.07" class="sg nowrap f2" style="z-index:18;color:#FFFFFF;font-size:156%; left:334.43px;top:133.08px;">•<span style="letter-spacing:6.60px"> </span>Degenerative</span><span data-textwidth="92.53" class="sg nowrap f2" style="z-index:20;color:#FFFFFF;font-size:156%; left:334.43px;top:173.41px;">•<span style="letter-spacing:6.60px"> </span>Drugs</span></p></div></div></div> <div class="sg" id="s584" data-sgid="TextBox 1" style="z-index:3;left:173.44px;top:334.81px;width:306.32px;height:34.65px" data-valign="top"> <div id="s584_t" class="sg" style="z-index:2;left:-6.01px;top:-3.00px;width:315.44px;height:47.01px;"><div><p><span data-textwidth="288.53" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:122%; left:13.80px;top:9.15px;">[WID → surgical sieve approach]</span></p></div></div></div> <div class="sg sgTitle" id="s585" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s585_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s586" data-sgid="Content Placeholder 2" style="z-index:2;left:77.49px;top:81.91px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s586_t" class="sg" style="z-index:2;left:-12.35px;top:-6.73px;width:661.21px;height:285.54px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="155.19" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.07px;top:14.52px;">•<span style="letter-spacing:3.85px"> </span>Infectious</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="296.09" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:55.96px;top:58.65px;">–<span style="letter-spacing:2.28px"> </span>Toxo, cryptococcus, IRIS</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="433.52" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:178%; left:20.07px;top:100.94px;">•<span style="letter-spacing:3.85px"> </span>Inflammatory / Granulomatous</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="163.95" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:178%; left:20.07px;top:147.03px;">•<span style="letter-spacing:3.85px"> </span>Neoplastic</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="144.39" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:178%; left:20.07px;top:193.12px;">•<span style="letter-spacing:3.85px"> </span>Vascular </span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="125.42" class="sg nowrap f2" style="z-index:15;color:#FFFFFF;font-size:156%; left:55.96px;top:237.25px;">–<span style="letter-spacing:2.28px"> </span>vasculitis</span></p></div></div></div> <div class="sg" id="s589" data-sgid="Rectangle 2" style="z-index:3;left:33.47px;top:-48.82px;width:34.89px;height:46.78px" data-valign="top" data-pointer-events="none"> <div id="s589_t" class="sg" style="z-index:2;left:-12.01px;top:-6.81px;width:58.79px;height:68.10px;"><div><p><span data-textwidth="19.32" class="sg nowrap f8" style="z-index:2;color:#FFFFFF;font-size:178%; left:19.71px;top:15.46px;">c</span></p></div></div></div> <div class="sg sgTitle" id="s587" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s587_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="382.62" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:133.48px;top:18.09px;">Differential Diagnosis</span></p></div></div></div> <div class="sg" id="s588" data-sgid="Content Placeholder 2" style="z-index:2;left:95.46px;top:99.89px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s588_t" class="sg" style="z-index:2;left:-12.35px;top:-6.73px;width:661.24px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="433.51" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.11px;top:14.54px;">•<span style="letter-spacing:3.84px"> </span>Inflammatory / Granulomatous</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="148.35" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:156%; left:55.99px;top:58.67px;">–<span style="letter-spacing:2.29px"> </span>#1: Sarcoid</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="334.26" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:156%; left:55.99px;top:99.00px;">–<span style="letter-spacing:2.29px"> </span>Rarer ddx: Behҫet, Whipple</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="163.94" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:178%; left:20.11px;top:141.29px;">•<span style="letter-spacing:3.84px"> </span>Neoplastic</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="191.20" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:156%; left:55.99px;top:185.42px;">–<span style="letter-spacing:2.29px"> </span>#1: Lymphoma</span></p></div></div></div> <div class="sg sgTitle" id="s590" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s590_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="479.84" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:84.87px;top:18.09px;">Dr Glastonbury’s Diagnosis</span></p></div></div></div> <div class="sg" id="s591" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:111.89px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s591_t" class="sg" style="z-index:2;left:-12.36px;top:-6.74px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="247.60" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.56px;">•<span style="letter-spacing:3.84px"> </span>Whipple disease </span></p></div></div></div> <div class="sg sgTitle" id="s592" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s592_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="246.64" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:201.53px;top:18.09px;">The Diagnosis</span></p></div></div></div> <div class="sg" id="s593" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s593_t" class="sg" style="z-index:2;left:-12.36px;top:-6.73px;width:661.21px;height:275.11px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="358.26" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:178%; left:20.05px;top:14.53px;">•<span style="letter-spacing:3.84px"> </span>Cerebral Whipple disease</span></p></div></div></div> <div class="sg sgTitle" id="s594" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.95px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s594_t" class="sg" style="z-index:2;left:-0.37px;top:-5.88px;width:649.22px;height:93.30px;"><div><p para="{al:2}"><span data-textwidth="473.00" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:88.23px;top:18.10px;">Cerebral Whipples disease</span></p></div></div></div> <div class="sg" id="s595" data-sgid="Content Placeholder 2" style="z-index:2;left:59.49px;top:99.89px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s595_t" class="sg" style="z-index:2;left:-7.56px;top:-4.07px;width:656.45px;height:272.45px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="444.31" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.28px;top:11.00px;">•<span style="letter-spacing:9.61px"> </span>Caused by bacterium <span class="f5" style="font-style:italic; color:#FF6319;">Tropheryma whipplei</span></span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="624.47" class="sg nowrap f2" style="z-index:6;color:#FFFFFF;font-size:133%; left:15.28px;top:45.57px;">•<span style="letter-spacing:9.61px"> </span>Occurs in 10-40% of patients with WD (but Whipple is rare; 1 </span><span data-textwidth="114.86" class="sg nowrap f2" style="z-index:10;color:#FFFFFF;font-size:133%; left:42.29px;top:74.38px;">in 1 million)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="426.92" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:133%; left:15.28px;top:108.94px;">•<span style="letter-spacing:9.61px"> </span>Can be fatal if antibiotics not begun early</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="499.28" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:15.28px;top:143.51px;">•<span style="letter-spacing:9.61px"> </span>No pathognomonic patterns of CNS involvement</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="441.44" class="sg nowrap f2" style="z-index:17;color:#FFFFFF;font-size:133%; left:15.28px;top:178.08px;">•<span style="letter-spacing:9.61px"> </span>Symptoms depend on area of involvement</span></p><p para="{in:2,bl:{ch:8211},spbf:0.20}"><span data-textwidth="449.11" class="sg nowrap f2" style="z-index:19;color:#FFFFFF;font-size:122%; left:51.17px;top:211.29px;">–<span style="letter-spacing:6.72px"> </span>Oculomasticatory myorhythmia is characteristic</span></p></div></div></div> <div class="sg sgTitle" id="s596" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s596_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="459.92" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:94.83px;top:18.09px;">Cerebral Whipple Disease</span></p></div></div></div> <div class="sg" id="s597" data-sgid="Content Placeholder 2" style="z-index:2;left:35.52px;top:93.90px;width:648.52px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s597_t" class="sg" style="z-index:2;left:-7.57px;top:-4.07px;width:656.42px;height:272.45px;"><div><p para="{in:2,bl:{ch:8226},spbf:0.20}"><span data-textwidth="619.30" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:133%; left:15.26px;top:10.99px;">•<span style="letter-spacing:9.60px"> </span>Pathologic studies showing predominant involvement of the </span><span data-textwidth="473.00" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:133%; left:42.26px;top:39.80px;">basilar telencephalon, thalamus, hypothalamus, </span><span data-textwidth="516.81" class="sg nowrap f2" style="z-index:5;color:#FFFFFF;font-size:133%; left:42.26px;top:68.60px;">quadrigeminal plate, and periaqueductal gray matter</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="497.84" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:133%; left:15.26px;top:103.17px;">•<span class="f5" style="font-style:italic; "><span style="letter-spacing:9.60px"> </span>T Whipplei</span> remains asymptomatic in the GI tract</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="581.97" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:133%; left:15.26px;top:137.74px;">•<span style="letter-spacing:9.60px"> </span>Acquired or congenital immunological defect allows it to </span><span data-textwidth="192.87" class="sg nowrap f2" style="z-index:13;color:#FFFFFF;font-size:133%; left:42.26px;top:166.55px;">become pathogenic</span></p></div></div></div> <div class="sg sgTitle" id="s598" data-sgid="Title 1" style="z-index:1;left:35.52px;top:15.70px;width:648.52px;height:68.36px" data-valign="middle" data-pointer-events="none"> <div id="s598_t" class="sg" style="z-index:2;left:-0.37px;top:-5.86px;width:649.22px;height:93.16px;"><div><p para="{al:2}"><span data-textwidth="301.25" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:244%; left:174.16px;top:18.09px;">Imaging features</span></p></div></div></div> <div class="sg" id="s599" data-sgid="Content Placeholder 2" style="z-index:2;left:41.50px;top:93.90px;width:624.54px;height:268.01px" data-valign="top" data-pointer-events="none"> <div id="s599_t" class="sg" style="z-index:2;left:-5.05px;top:-2.77px;width:633.78px;height:271.15px;"><div><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="608.86" class="sg nowrap f2" style="z-index:2;color:#FFFFFF;font-size:111%; left:12.76px;top:8.69px;">•<span style="letter-spacing:12.48px"> </span>Lesions are symmetric and are primarily in the midline of the midbrain, </span><span data-textwidth="511.89" class="sg nowrap f2" style="z-index:4;color:#FFFFFF;font-size:111%; left:39.76px;top:32.70px;">hypothalamus, the mesial temporal lobes and occasionally the </span><span data-textwidth="164.55" class="sg nowrap f2" style="z-index:7;color:#FFFFFF;font-size:111%; left:39.76px;top:56.70px;">corticospinal tracts. </span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="581.37" class="sg nowrap f2" style="z-index:9;color:#FFFFFF;font-size:111%; left:12.76px;top:85.51px;">•<span style="letter-spacing:12.48px"> </span>May demonstrate high T2 signal with minimal enhancement and no </span><span data-textwidth="482.96" class="sg nowrap f2" style="z-index:11;color:#FFFFFF;font-size:111%; left:39.76px;top:109.51px;">restricted diffusion (most conspicuous on FLAIR sequences)</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="287.44" class="sg nowrap f2" style="z-index:12;color:#FFFFFF;font-size:111%; left:12.76px;top:138.32px;">•<span style="letter-spacing:12.48px"> </span>MR imaging may also be normal</span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="241.48" class="sg nowrap f2" style="z-index:14;color:#FF6319;font-size:111%; left:12.76px;top:167.13px;">•<span style="letter-spacing:12.48px"> </span>Diagnosis<span style="color:#FFFFFF;">: PCR of CSF fluid</span></span></p><p para="{bl:{ch:8226},spbf:0.20}"><span data-textwidth="581.49" class="sg nowrap f2" style="z-index:17;color:#FF6319;font-size:111%; left:12.76px;top:195.93px;">•<span style="letter-spacing:12.48px"> </span>Treatment<span style="color:#FFFFFF;">: Ceftriaxone followed by trimethoprim-sulfamethoxazole</span></span><span data-textwidth="92.66" class="sg nowrap f2" style="z-index:22;color:#FFFFFF;font-size:111%; left:39.76px;top:219.94px;">for 2 years!</span></p></div></div></div> <div class="sg" id="s600" data-sgid="Title 3" style="z-index:1;left:53.49px;top:93.90px;width:612.55px;height:87.79px" data-valign="middle" data-pointer-events="none"> <div id="s600_t" class="sg" style="z-index:2;left:-0.34px;top:-40.53px;width:613.26px;height:180.84px;"><div><p para="{al:2}"><span data-textwidth="431.95" class="sg nowrap f2" style="z-index:2;color:#FF6319;font-size:222%; left:90.87px;top:16.04px;">Thank you to the audience</span><span data-textwidth="464.84" class="sg nowrap f2" style="z-index:3;color:#FF6319;font-size:222%; left:78.99px;top:64.06px;">Congratulations to all of our </span><span data-textwidth="156.99" class="sg nowrap f2" style="z-index:4;color:#FF6319;font-size:222%; left:228.30px;top:112.07px;">panelists!</span></p></div></div></div> <div class="sg sgSubtitle" id="s601" data-sgid="Subtitle 4" style="z-index:2;left:107.45px;top:243.80px;width:504.61px;height:104.33px" data-valign="top" data-pointer-events="none"> <div id="s601_t" class="sg" style="z-index:2;left:-0.34px;top:-5.89px;width:505.29px;height:110.56px;"><div><p para="{al:2,spbf:0.20}"><span data-textwidth="134.06" class="sg nowrap f5" style="z-index:2;color:#FFFFFF;font-style:italic; font-size:178%; left:185.86px;top:13.83px;">Thank you</span></p></div></div></div>