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The Common Vein copyright 2009

Introduction

Shape is not at all a difficult concept to understand and appreciate.  After all, shape is at the epicenter in the description of form.  Intuitively shape is understood from our own physical experiences, from the beauty of the body, which we adorn and lust for, sometimes purely based on its shape.  Shape lends innate beauty in nature, functional value in physiology, molecular biology and chemistry, as providing relevance in geometry, and architecture.  Abstract concepts like “shaping an idea” for example carry  intellectual, scholalrly, literary and philosophical implications.

Georgia O Keefe an American photographer and painter is quoted as having said that “I found I could say things with color and shapes that I couldn’t say any other way – things I had no words for.”

Lewis Carroll said “When you are describing a shape, or sound, or tint; Don’t state the matter plainly, but put it in a hint; And learn to look at all things with a sort of mental squint”.  This quote has a sense of creativity, while the quote ‘The devil hath power to assume a pleasing shape” by Shakespeare has a more ominous message.

At an anatomical level, we are not unlike the ancient anatomists who struggled with the descriptors of shape and could only describe the form of anatomical structures by comparing them to known shapes in their environment.  Famous reference shapes were the moon and stars, foods, animals, plants, musical instruments, tools, weapons of war, boats, and letters of the alphabet.   Hooks are common: the hook of the hamate, uncinate process of the pancreas, or the falciform ligament all describe a characteristic curve.  The tibia is supposed to look like a trumpet, the navicular like a ship, the sella turcica like a Turkish saddle, and the deltoid muscle like the Greek letter delta.  Anatomists and clinicians have employed terms from nature’s bounty such as pear (or pyriform shape) for the uterus and gallbladder, almond shape for the ovary, tonsil and amygdala, and pea shape for the pisiform bone of the hand. While some of these names are quite helpful and have been retained in our modern medical minds, others have been forgotten.  Most doctors and laymen alike would be surprised to learn the origin of the word muscle – from the Latin word “musculus” which means little mouse reminding the ancients of little mice under the skin.

At a biochemical level shape of molecules is also highly important and relevant.  There is the linear shape of hydrogen, HCl, and CO2, the triagonal planar shape of BCl3  and AlCl3, the tetrahedral shape of CH4 and SiF4, the bent shape of H20, and the octahedral shape of SF6.  All have molecular consequence

“Our goal is to control the shapes of new materials with the same level of precision that we exercise when controlling the stereo chemical relationships in a natural products synthesis.”  said Joseph M Fox Assistant Professor of Organic Chemistry University of Delaware

Shape is difficult to quantify, and judgment is often invoked when calling it normal or not.  Despite our difficulty with defining the shape of structure, objectively it is of supreme importance in the diagnosis of structural disease since a minor deformity could be the earliest sign of disease.  If the diagnosis is made in the early stages then treatment can be more timely and more effective.

In clinical medicine there are instances where identifying abnormal shapes will lead to a diagnosis or a differential diagnosis.

As the patient walks into the office or is visited in a hospital room, the task of the astute clinician begins.  We are focusing on the shapes of health and disease, but of course the practiced expert is able to take in all the components needed for accurate evaluation.  The global shape of the patient is the first observation that begins the interaction, before a word has been spoken.  It may tell the whole story.  . The obese patient, asthenic patient, muscle wasting and muscle bound patient all have distinct shapes that are relatively easy to identify.  The presence of a kyphosis is easy to spot.  Thoughts of osteoporosis and compression fractures start to become checks on the list relevant conditions in the elderly.  Scoliosis in the young will bring a whole differential of birth defects, muscular dystrophy, cerebral palsy, or Marfan’s disease.  The patient doubled over in pain may have life threatening peritonitis, appendicitis, or an ectopic pregnancy.  Sometimes leaning forward like in pericarditis provides some relief of the pain.  The demeanor and body form in the depressed patient is in sharp distinction to the perky upright bright patient.

As the patient is greeted with eye to eye contact the astute physician takes in the shape of the face.  In Cushing’s syndrome the facies are described as “moon like” because of a rotund appearance caused by subcutaneous deposition of fat.  Acromegaly and gigantism are characterized by a protuberant jaw and thick features. A droop of muscles and unusual premature aging of the skin may speak to an excessive exposure to sun, excessive exposure to nicotine, or an excess of stress.  The triangular face with sunken cheeks, sunken eyes (enopthalmos) is the shape of severe dehydration originally described by Hippocrates 2,000 years ago in patients who were in the late stages disease and were close to death.  The bulging eyes of exopthalmos on the other hand should activate a quick look to the neck at the thyroid gland as a diagnosis of thyrotoxicosis is entertained.

As the patient is greeted with a handshake, the shape of the hands may also be a clue to a variety of diagnoses.  The large, strong, broad, thick spade like hand is characteristic of acromegaly. Short stubby fingers of almost equal length are seen in achondroplasia, a cartilagenous disorder, while clinodactyly, a curved shape to the fifth finger may be a benign normal variant but is also seen in patients with Down’s syndrome and other unusual genetic syndromes.   Clubbing of the fingers is an entity that was known to Hippocrates.  It is characterized by increased curvature of the nails and a bulbous appearance to the distal phalanx that has been called a “drumstick” deformity.  This sign is seen in chronic suppurative conditions of the lung such as cystic fibrosis and cancer of the lung, and cyanotic heart disease.  The barrel shaped chest is seen in emphysema, the diamond shaped murmur in aortic stenosis, and the water bottle shaped heart is seen in pericardial effusion.  The shapes of deformity and illness go on and on and make the study of form and function in health and disease so interesting and important in clinical medicine.

The pathologist has also used the shape of structure to describe disease as seen macroscopically as well as under the microscope.   The word cancer derives from the Greek word “kanker” which means crab.  The Roman physician Galen, is purported to have coined the term since he noted that the disease had a central rounded appearance reminiscent of the crabs body from which emanated irregular “veins” reminiscent of the crab’s legs.

 

Crab Like?

The post mortem specimen of the lung and overlying pleura is from a patient who died of metastatic cancer.  A surface metastasis  to the pleura causes obstruction and distension of the pleural lymphatics as seen as white irregular vessels coursing to (or from) the mass. These lymphatics are normally about the thickness of a hair and not commonly visualized.  In this instance they are obstructed by the tumor, and are therefore distended with white lymph and at about .05mm (thickness of the pin) they are readily seen. This image to the authors eye has a crab like shape with the nodule representing the body, and the lymphatics reminiscent of the legs.

Courtesy Ashley Davidoff and Jeffrey Peirce A86-215 32317 code lungs pulmonary pleura secondary lobules interlobular septa thickened parenchymal nodules neoplasm lymphatics distended metastases lymphangitis obliterans grosspathology crab cancer shape copyright 2009 all rights reserved 32317.8s

The body of the crab is always the nodule or the mass, and the legs may be caused by tumor extending into the surrounding tissue, lymphatics or veins.  On the other hand one every shape on imaging that is crab like is not definitely a cancerous growth.  The suspicion is raised and the patient then requires a biopsy to confirm the diagnosis. Two examples below with the characteristic crab like shape both proved to be cancer.  Radiologists have preferred the adjective “spiculated” or “stellate” to describe this shape rather than the adjective “crab like”.  The reasons for this avoidance are uncertain, but possibly because the visual pattern is not absolutely pathognomonic for the diagnosis of cancer or simply because “spiculated” or “stellate” lesion is a more accurate description.

Spiculated Lung Nodule

The shape of the lung nodule seen on the chest CT in the right upper lobe with radiating spokes or spicules is characteristic a lung carcinoma and was proven to be a primary cancer of the lung.  The spicules represent sheets of tumor cells extending into lymphatics or interstitium, or obstructed vessels.

 46361 46361b01 lung fx spiculated nodule dx carcinoma CTscan Courtesy Ashley Davidoff MD

Spiculated Mass in the Right  Breast

This is an MRI of the right breast of a 78 year old patient with a remote history of invasive lobular carcinoma.  The finding on the MRI is characterized by an enhancing spiculated mass.  Recurrent carcinoma was present at pathology.

Courtesy Priscilla Slanetz MD MPH 42977

Cancer does not always look like a crab.  The morphology of a particular disease process depends not only on the disease process itself, but also on the tissue and organ from which it arises, the restrictions or freedom with which it is allowed to occupy space, and the pattern of growth that is innate to the biology of a particular malignancy.  A more common manifestation of colon cancer, for example, is growth and spreading within in the layer below the inner lining called the submucosa.  The initial space occupation occurs in a circumferential manner creating a broad band or belt around the bowel.  Progressive tightening and advances to obstruction. When barium is instilled into the colon, the shape created by the band of this cancer in the colon has been termed “applecore” deformity.  Based on the shape of the sigmoid colon there is almost no other differential diagnosis for this radiological finding but adenocarcinoma of the colon.  Narrowed lumen and irregular mucosa with heaped up edges on either end are characteristic of a malignancy.

 

Apple Core Lesion in the Sigmoid Colon

The images are from a double contratst barium enema.  Contrast and air have been instilled into the rectum and images of the sigmoid colon were taken with fluoroscopic guidance.  The first image reveals a narrow lumen, the second shows the applecore deformity (green)and the third has the overlay of where the tumor (light orange is positioned), and reveals how it causes the tight band like constriction of the lumen (green) to result in in the applecore deformity described.

barium 00878 00877 colon large bowel sigmoid colon fx apple core apple-core lesion fx circumferential mass fx stricture constriction narrowing stenosis dx carcinoma malignant primary malignancy cancer tumor BE barium enema Courtesy Ashley Davidoff MD 5star aka applecore

 

Pathological Specimen of an Applecore Deformity

Portion of left colon with a constricting applecore carcinoma. The carcinoma has infiltrated the full thickness of the wall. This can be seen on the cut portion of the wall, where the wall is much paler than the surrounding mucosa.

colon large bowel fx apple core fx constriction fx narrowing fx wall thickening fx mass dx carcinoma malignant stricture grosspathology Courtesy Barbara Banner MD aka applecore 12313

The importance of shape in health and disease continues down to the cellular level.  Receptors in a cell membrane and the molecules that act upon them are highly dependent upon specific conformations.  Enzymes fit into their receptors and activate them just as a key fits into a lock.A lock and key morphology is the parallel drawn to our human experience.  They first have to fit, and then they can interact and be effective. If the shape fits the reactions follow  If the shapes do not fit, there is no go.     This is a “key” concept at many levels, in the world of biochemical interactions.

Shape of course plays an important role in cosmetic surgery.  The patient whose appears below had had a mastectomy for breast carcinoma .  Reconstruction mammoplasty was performed by bringing a skin and adipose tissue flap from her abdominal wall to her chest wall.   The intent was to retain her image as a woman with significant implications of psychological wellbeing. The aim of the surgeon was to create a breast that was similar in shape, size and character to her remaining healthy breast.

Reconstructing the Shape of the Breast – TRAM operation Left Breast

In this case the right breast of this 44 year old patient  (as seen to your left) is the normal breast and the normal gray glandular tissue can be seen within the darker background consisting of adipose (fatty) tissue.  The left breast (to your right) is the reconstructed breast that was surgically created from skin and adipose tissue from the abdomen.  The shape and form created by the surgeon is remarkably close to the normal breast.

16127 Courtesy Ashley Davidoff MD code breast TRAM imaging radiology CTscan post mammoplasty

 

28 year old Fell on Elbow

Challenge yourself with this image from a 28 year with elbow pain who fell on his elbow.  There are two findings created by shape deformities that allow one to make a diagnosis

41882b01 Courtesy Ashley Davidoff MD medical students code head elbow hemarthroses radia radius sail sign fracture

Subtle Fracture

Minor Shape Deformity

Making the diagnosis of a subtle fracture in this case is based on two minor shape deformities. The first is a rather sharp but small deformity of the radial head as the line of the cortex becomes disrupted, (white arrow) and the second is a shape deformity of the fat pad.  The small radial head fracture has caused a hemarthroses (hemorrhage into the joint space) seen as a red band in c, and it has lifted the fat pad of the distal humerus (yellow overlay) outward and upward causing a shape abnormality called the “sail sign” The triangular shape of the elevated fat pad is reminiscent of the sail of a yacht and describes exactly what it looks like.  The alternate description may have been described as the triangular transformation of the fat pad with a concave base.  It is far easier to call it the “sail sign”.  You were not expected to make this diagnosis since the anatomy is and images are foreign to you.  The point is to provide you insight hoew simple principles apply to the professionals.  In this case knowledge of shape enabled the diagnosis.

41882c05b.8s Courtesy Ashley Davidoff MD medical students code head elbow hemarthroses radia radius sail sign fracture

 Thus shape plays a very important role in the assessment of structure in the preclinical disciplines as well as in the clinical disciplines from the level of the cell to the body, not only in health but also in disease.  It is not uncommon that a minor shape deformity may be the only clue and the only abnormal finding that will be the determinant of a diagnosis, and therefore treatment.  Shape holds tremendous implications at all levels of biology and medicine, from the small malignant bump on the pancreas, to the shape of a new drug that will fit appropriately into a cellular receptor.

Principles

Below we have listed some of the anatomical structures that have been named according to their shape.  There are many more that could be added.  The extensive use of defining a structure by its shape reflects the importance applying shape to characterize structure.

Spheriodal, Tubular, and Ovoid shapes in the Chest
This artistic rendition of the heart and lungs uses the shape of fruit and vegetables to create an image of the chest. The lungs are made of grapes, the pulmonary arteries are made of carrots, the ribs are made of banana peel and the heat is made of a red pepper. 02032p Courtesy Ashley Davidoff MD. accessory cardiac heart lung bone PA grape banana peel ribs Davidoff art

 

Structures Named Based on Shape

Body Part

head

skull

 bowl

The skull was named after the anglosaxon word “skulle” which means a bowl because of its rounded nature and capacious form.

neck

thyroid

 shield

The thyroid consists of elongated right and left lobes which are connected by a band of tissue called the isthmus.  Its shape is reminiscent of a shield and it was named from the Greek word “thyreos” which means a shield, and “eidos” meaning resemblance.

chest

coronary arteries of the heart

 crown

 The word coronary is derived from the Latin word “coronarius” which means garland or crown and from the Greek word “korone” which also means crown.  At the base of the heart the coronary arteries form a ring, similar to the base of a crown, from which the arteries emanate like the crests of the crown.  This derivation is used quite frequently in naming other structures in the body including the corona of the penis and the corona radiata of the brain.
ventricles of the heart belly “Venter” means belly in Latin and the the ventricles were presumably named due to their belly -like bulbous appearance.

carina of the tracheobronchial tree of the lungs

 keel

 The carina is the first branch point of the trachea as it divides into a right and left main stem bronchus.  This branch point is called the carina which derives from the the Latin word “carina” which means keel of a boat that has the same shape.

xiphoid process

 sword

The xiphoid is the pointed lower end of the sternum that derives from the Greek word “xiphos” which means sword, and “eidos” meaning resemble.
back

cauda equina of the spinal cord

 horse’s tail The cauda equina is the last part of the spinal cord with all the last nerves conglomerating at the distal end of the spinal anal reminiscent of the long hairs on the end of a horses tail.  Cauda equina “tail of a horse” in Latin

rhomboid muscle

 rhomboid

 The rhomboid muscle is attached to the scapula and is named after its rhomboid shape from the Greek word rhombus really means a  lozenge like structure.  Rhomboid denotes a parallelogram with oblique angles and unequal sides.

quadratus lumborum

 square

The quadratus lumborum muscle are square in shape and are attached posteriorly on the bottom of the 12th rib and extend to the iliac crest.  They derive their name from the Latin term quadratus which means square in shape.

serratus anterior

 saw

The serratus muscle inserts into the lateral ribs by a series of finger like slips on tho the ribs.  It is named based on the shape of the muscles and muscular slips that have a saw tooth like appearance.  Serratus in Latin means notched, and derives from the from the word “serra” which means a saw.

abdomen

uncinate process of the pancreas

 hook

The uncinate process of the pancreas is a hook shaped medial extension off the head of the pancreas.  The name derives from the Latin word “uncus” which means hook.

antrum of the stomach

 cave

 The antrum is the distal chamber of the stamach that is open on the one end to the body of the stomach and almost closed on the other end but for the small opening of the pylorus.  This configuration suggested to early anatomists a cave like structure deriving from the Greek word “antron” which means cave.

pelvis

pelvis

 basin

 The shape of the bony pelvis with its wide superior end and funnel like exit has a basin like form and hence it was named using the Latin term for basin which is pelvis.
cornu of the uterus horn The cornu of the uterus is the region where the uterus transitions to the gracile fallopian tubes.   The change in diamtere creates a shape that resembles two horns , and hence the name of this region of the uterus. “Cornu” in Latin means horn.

vagina

 sheath

 The sheath like shape of the vagina in the basal collapsed state, composed of a relatively long transverse dimension and shert anteroposterior dimension was named after the LAtin term “vagina” which means sheath.
sigmoid colon “s” shaped The sigmoid colon is named after its characteristic sigmoid shape.

upper limbs

clavicle

 key

 The clavicle is also known as the collar bone.  The name clavicle is derived from the Latin word “clavis” which means a key and the addition of “ula” reflects the diminutive form.  The shape of the clavicle therefore supposedly reflects the shape of a small key.  This shape is difficult to recognize but presumably more akin to the shape of ancient keys.

radius

 ray

 The radius is a long bone of the forearm.  Radius in Latin means a ray or a radius spoke of a wheel. This description has been found in the writings of Galen

olecranon

 helmet

 The olecranon is the the most proximal portion of the ulna bone and it wraps around the condyles of the humerus. Its name derives fromm the Greek word olenokranon, the first part of which is “olene” meaning elbow, and the second part “kranos” means helmet.  The helmet shape to the olecranon is the source of the use of this word.

scaphoid

 hollow

The scaphoid is one of the small bones of the wrist.  Scaphoid derives form the Greek word skaphe which means a skiff or anything similarly hollowed out.  The distal surface of the scaphoid bone is hollowed or concave and hence its name.  Scaphoid is also given to the hollowed out shape of the abdomen in extremely emaciated individuals.

navicular

 ship

 The navicular is also one of the small bones of the wrist which is shaped like a boat, deriving from the Latin word “navis ” (boat) and “cula” which means small, hence “small boat”.  The navicular also is a bone in the foot positioned in the

pisiform

 pea

 The pisiform is another small boen of the proximal carpal row in the wrist.  It is a sesamoid bone.  Sesamoid means that it located within a tendon, and the word sesame means that it is shaped like a sesame seed.  The pisiform is more pea shaped and is named accordingly since “pisum” is the Latin word for pea.

lower limbs

gracilis muscle

 gracile

 The gracilis muscle is a thin muscle on the medial aspect of the thighattached above to the pubic symphisis and below to the medial surface of the tibia. Its name derives from the LAtin term “gracilis” which means delicate and graceful.

tibia

 flute

The tibia is the shin bone which is widened at the knee joint.  “Tibia” is the Latin word for flute.

cuboids

 cube

 The cuboid bone is one of the larger tarsal bones which is cuboid in shape. It articulates with the calcaneus proximally and 4th and 5th metatarsals distally.  Its name derives from the Greek word “kybos” which means a cube, and “eidos” which means resemble.  It thus resembles a cube or square.

cuneiform

 wedge

 The three wedge shaped cuneiform bones of the foot form  part of the distal tarsal row, articulating with the navicular proximally and  the first, second, and third metatarsals  distally.  Their name derives from the French word cunéiforme, and from the Latin word “cuneus” meaning a wedge.  Cuneiform was an ancient wedge shaped script that was used in Mesopotamia and Persia.
 tissues alveolus of the lung cavity The alveolus is the biologic unit that allows for gas exchange in the lung.  Its name derives from the Latin word “alveolus” which means a little trough or a little cavity.  Alveoli are also found in the jaw and are sockets or cavities in which the roots of the teeth reside.
acinus – gland grape

An acinus is the berry shaped structure of an exocrine gland that consists of a rosette of cells surrounding a duct.  The shape is reminiscent of a grape and is appropriately named since “acinus” means grape in Latin.
 cells astrocytes star

Astrocytes are multifunctional cells found in the brain and spinal cord.  The Greek word “astron” means star is used to reflect this characyteristic shape.
columnar cells column rectangle Cells that are taller than they are wide are known as columnar cells since they look like columns or upright rectangles.  The word column derives from the Latin word “columna”.   These cells are found in many epithelia including the respiratory tract and the gastrointestinal tract.
cuboidal cells cube Cuboidal cells are cubes, with their height being about the same lengthas as depth and width.  Eaxamples of cuboidal epithelia are found in the ovaries, renal tubules and the thyroid.  The Greek for cube is “kybos” and since the cells are not exactly square “eidos” meaning resembling is added as a suffix “oidal” ie cuboidal.
squamous cells fish scale

Squamous cells are flat and broad and have a fissh scale appearance.  Squamous epithelia are found on the skin, and in the esophagus.  The Latin term “squama” means fish scale.

  More recent adjectives describing structure have focused on describing the shapes found in disease, clinical medicine and in imaging.  Interesting terms such as sago spleen, numular sputum, peaud’orange, spider naevi, arachnodactyly, leonine facies, tree in bud, apple core, double bubble, stack of coins, are established and evolving descriptors of changing shapes characteristic of certain diseases.

Shapes of Major Structures
body part
head brain  

 oval
skull  

skull AS. skulle = a bowl.
spinal cord  

 tapering tube with cauda equina at the end of the spinal cord reminiscent of a horses tail
neck thyroid thyroid Gr. thyreos = a shield, and eidos = resemblance
chest heart    overall spheroidal with right ventricle being triangular and left ventricle oval
coronary arteries  

 L.  coronarius = garland = crown  Gr. korone = crown
lungs  

 funnel, conical, to pyramidal.  The inverted chest appears like a wine glass, or sometimes bell shaped
tracheobronchial tree  

 asymmetric arborisng pattern, irregular dichotomous branching pattern
xiphoid process xiphoid Gr. xiphos = sword, and eidos = resemblance
rhomboid muscle  rhomboid Gr. rhombus = a lozenge, and eidos = resemblance. Rhomboid denotes a parallelogram with oblique angles and unequal sides.
quadratus lumborum quadratus L. quadratus = a square in shape.
serratus anterior   serratus L. serratus = notched, from serra = a saw.
abdomen liver  

 pyramidal
biliary tree  

 asymmetric arborisng pattern, irregular dichotomous branching pattern
gallbladder pyriform L. pirum = a pear, and forma = shape or form.
pancreas  

 uncinate process  – uncus L. uncus = a hook
spleen  spheroidal
esophagus  tube like
stomach  antrum Gr. antron = a cave.
duodenum  C shaped
small bowel  tube like
colon  tube like
kidney  reniform shape, or bean shaped
pelvis pelvis  pelvis L. pelvis = basin. The pelvis is a basin-like structure.
urinary bladder  round to ovoid depending on volume of urine
uterus pyriform L. pirum = a pear, and forma = shape or form.
ovary  almond shaped
vagina  vagina L vagina = a sheath.
spine gentle sigmoid curve Gr. sigma = the Greek letter S, and eidos = resemblance.
upper limbs clavicle  clavicle L. clavicula, diminutive of clavis = a key.
radius  radius L. radius = spoke of a wheel. Found in the writings of Galen
olecranon  olecranon Gr. olenokranon, from olene = elbow, and kranos = helmet.
scaphoid scaphoid Gr. skaphe = a skiff or anything similarly hollowed out, and eidos = resemblance.
navicular  navicular L. navis = boat, and the diminutive suffix -cula
pisiform  pisiform L. pisum = a pea shaped
lower limbs gracilis  Latin “gracilis” delicate, graceful
tibia tibia L. tibia = a flute;
cuboids  cuboid Gr. kybos = a cube, and eidos = resemblance. square bone
cuneiform  “wedge shaped,” from Fr. cunéiforme, from L. cuneus “a wedge,”
tissues
liver cords cells lined up in cords like spokes of a wheel
liver lobule hexagon
secondary lobule of the lung polyhedral
alveolus Latin for a trough or a cavity
acinus – gland rosette of cells centered around a duct and resembling a grape shaped structure
crypts of Lieberkuhn colon test tube
cells
astrocytes star shaped
columnar cells rectangular
cuboidal cells cube like – almost square
squamous cells squama is Latin for fish scale
liver cells polyhedral
red cells biconcave discs
smooth muscle cells spindle shaped
fibroblasts spindle shaped

 

Sphericals in the Round

Round and Oval Nuclii  – Polygonal Liver Cells
13440b liver hepatic nucleus cytoplasm polygonal shape hepatocytes Kuppfer cells TCV concepts histology cytology Courtesy Barbara Banner MD

Malignancy in the Round
Small Cell Carcinoma of the lung Pleural fluid cytology preparation showing group of dark blue cells with scant cytoplasm consistent with small cell carcinoma. Courtesy Armando Fraire MD. 32825 code lung pulmonary pleura neoplasm malignant malignancy primary lung small cell carcinoma cytopathology

Blastocyst – Pre- embryonic ball – Division after Division Multiplication to a Unit
Units to unity – a blastocyst  is formed

13275b01i01e01b03   Davidoff oneness

 

Epididymal Cyst
47006 testis testes epididymis epididymal cysts through transmission backwall enhancement parts anatomy USscan Davidoff MD

Grapes of the lung – alveoli
This artistic rendition of the workhorses of the lung – the alveoli – the appearance of the alveoli around the terminal airways has been likned to bunch of grapes.

Davidoff art 13440c06i07

Sperm and Egg
13275b01i01e08u08 ovum sperm fusion conception TCV Davidoff Oneness

Splenic Vein
72458 splenic vein spleen pancreas shape sperm shape color flow doppler force flow direction normal blood flow SMV superior mesenteric vein confluens normal anatomy USscan Davidoff MD

Spheres and Tubes
Courtesy Ashley Davidoff MD 01218 code esophagus + vein + Sengstaken Blakemore tube + dx coronary varix + imaging angiography

Hydrocele Testis Rounded Under Pressure Reduced Flow
47735 elderly man with left testicular pain testis hydrocele under pressure fx spherical round reduced blood flow shape USscan Davidoff MD

Round in Disorder
49671c01 abdomen fat adipose tissue storage rotund belly umbilicus belly button surface rendring CTscan Davidoff MD

Educational Excercise – Approach to the Diagnosis of Lung Nodules  

Half a Round

Reconstructing the Shape of the Breast – TRAM operation Left Breast
 

16127 Courtesy Ashley Davidoff MD code breast TRAM imaging radiology CTscan post mammoplasty
The Spleen
46569c02 spleen shape normal anatomy Davidoff art Davidoff MD
Nephrolithiasis and  Milk of Calcium Urine
16045 kidney renal nephrolithiasis fx calcifications calcified fluid fluid level dx milk of calcium urine CTscan Davidoff MD 16046b01 16046

Stack of Coins
00512 small bowel intussusception upper GI UGI imaging radiology contrast X-Ray fx coil of springs stack of coins dx Peutz- Jeghers Courtesy Ashley Davidoff MD DB

Almost Round

 

 

Ovals

Almond Shape

Amygdala
72120c01 brain cerebrum cerebral normal amygdala amygdaloid emotion shape almond normal anatomy Davidoff MD

 

Normal Almond Shaped Ovary with Follicles
71689 ovary follicles normal anatomy function physiology TCV Applied Biology Cycle time USscan Davidoff MD

Oval shaped Glands of the Breast
42707b03b45b05 breast mammary gland ducts ductules extralobular terminal duct intralobular terminal duct terminal ductule acini acinus alveoli alveolus surface epithelium luminal cell myoepithelial cell lobule terminal ductal lobular unit TDLU drawing anatomy histology normal Courtesy Ashley Davidoff MD
Normal Testes
47002c01 testis testes normal size blood flow normal anatomy USscan Davidoff MD

Fig. 1                                                                         Fig. 2

Smooth Margins Well Circumscribed Benign Mass
A mammogram on the left shows an ovoid mass which is hypoechoic with smooth margins.  These findings are characteristic of a benign lesion and could represent a cyst or fibroadenoma as the most likely causes.  The US on the right shows a well circumscribed solid mass characteristic of an adenoma.  Courtesy Priscilla Slanetz MD MPH 42913 42914

Can you see the oval evil seed that caused obstruction – a vegetable bezoar?d
24411 small bowel fx air fx oval shape dx small bowel obstruction dx vegetable bezoar imaging radiology CTscan Courtesy Ashley Davidoff MD DB

 

Flask Shapes

Fornix of Vagina
47668c01 uterus hyperemic endometrium soft tissue in vagina patient during menstruation menses normal physiology shape fornix flask shaped cycles time CTscan Davidoff MD

Tear Drop and Pear

Tear Drop
02504pb03 water droplets window glass teardrop shape Davidoff photography water

Pear Shaped Gallbladder
17084 gallbladder + fx distended + wall edema dx distal common bile duct stone imaging radiology MRI

Pear
85370pb01.8s pear fruit food gallbladder shape Davidoff photography Davidoff art Copyright 2008

 

Normal Pear Shaped Uterus
46749 hx young female presentingwith vaginal bleeding for 2 weeks, hematocrit of 25, left lower quadrant pain, and LLQ mass HCG 7000 fx uterus endometrial stripe ovary fx no intrauterine pregnancy Davidoff MD

PEar Shaped Head of the Caudate Nucleus
38481c01 brain caudate nucleus caudate body basal ganglion basal ganglia normal anatomy applied biology CTscan Davidoff MD 38484c01

Premenstrual
46317 uterus endometrium shape size normal anatomy USscan Davidoff MD

 

Pear shaped Female body
60644 elderly female shape pear shaped body normal abdomen chest anatomy applied biology TCV the common vein surface rendering CTscan Davidoff MD

Waterbottle

Waterbottle Heart
22265 chest heart cardiac pericardium enlarged fx waterbottle shape dx pericardial effusion left atrial enlargement CXR plain film Davidoff MD

Candy Cane Shape of the Arch
47677c03 candy cane shape aorta aortic valve sinotubular junction ascending aorta aortic arch descending aorta normal

Bean Shape

Bean

Bean Shape
39532 kidney adrenal anatomy drawing 5star Cortesy Ashley Davidoff MD Davidoff art

Kidney Shape
25198 kidney renal abdomen abdominal cavity large bowel descending colon fx colonic hernia through posterior wall of abdominal cavity dx incisional hernia following nephrectomy note also how the small bowel in the LUQ has taken on the shape and form of the kidney but the vessels that are supplying it are from the SMA and SMV CTscan Courtesy Ashley Davidoff MD

The Kidney – Bean Shaped
47021 kidney size character echogenicity fat shape normal anatomy USscan Davidoff MD

Curves

Sigmoid Curve

Lumber and Sacral Spine
46834 bone lumbar spine sacrum shape sigmoid s-shape normal anatomy Davidoff Art Davidoff MD

Tubular Shapes

Zuchini Gallbladder
76764c.81s elderly female gallbladder elongated sausage shape zuchini shape transverse dimension 4.5 cms longitudinal dimension 12.5cms aging gallbladder vs enlarged? food in the body CTscan Courtesy Ashley DAvidoff MD Davidoff art Davidoff photography copyright 2008
Sigmoid
Sigmoid Shape
24872 sigmoid colon rectum fx normal anatomy fx straight rectal shape CTscan Courtsy Ashley Davidoff MD

Congenital Pulmonary Venolobar Syndrome
The chest series are characterised by an abnormal curving vascular structure that appears to get large as it approaches the diaphragm.  In addition the volume of the right lung is smaller and there is anodd shape to the right hilum.  The findings are consistent with a diagnosis of congenital hypoplasia of the right lung associated wth partial anomalous venous return to the IVC below the diaphragm. (aka congenital pulmonary venolobar syndrome)  The curved  anomalous vein is known as the scimitar sign since it has the shape of a scimitar.

01714c03 Courtesy Ashley Davidoff MD

Serpiginous

Moray Eels – Serpiginous
83076.800 eels biology serpiginous snake like shape anatomy the common vein applied biology zoology applied anatomy Courtesy Ashley Davidoff MD

Serpiginous Splenic Artery
22014b spleen + fx irregular scar wedge defect calcification + dx chronic splenic infarction + imaging radiology CTscan splenic artery calcified calcification serpigenous atherosclerosis abdomen aorta AAA

 

Serpiginous Splenic Artery – Da Vinci
This is a drawing of the “meseraic vessels” – presumably the celiac axis. Da Vinci was able to interview and perform an autopsy on a centenarian. He describes the dessicated and tortuos state of the vessels of this patient accurately depicting the atherosclerotic process. He describes the narrowed lumen and the consequences of poor blood flow.The translation of da Vinci’s text accompanying this one inch image is remarkably insightful and pioneering. (see atherosclerosis hisrorical da Vinci) 13045b

 

Serpiginous Spenic Artery
04953 Courtesy Ashley Davidoff MD pancreas blood supply splenic artery hepatic artery capillary phase normal anatomy angiogram spleen liver hepatic artery angiogram

Straightening of the Splenic Artery Caused by Adrenal Hemorrhage
39829 Courtesy Ashley Davidoff MD code pancreas 39k pancreatic artery blood supply dorsal pancreatic artery pancreatica magna transverse pancreatic artery splenic artery imaging radiology angiography

66F with Post MEnopausal Bleeding
49708 66 F Russian uterus endometrial stripe shadowing with regularity fibroid calcified shadowing device dx IUD Lippy’s loop comprehension perception shape USscan radiologists and detectives diagnosis Davidoff MD 49711 49711c01

Sepiginous Shape in the Uterus
49711.800 49708 66 F Russian uterus endometrial stripe serpiginous structure devices dx IUD Lippy’s loop comprehension perception shape MRI radiologists and detectives diagnosis Davidoff MD

 

IUD
49711c01 49711 49708 66 F Russian uterus endometrial stripe serpiginous structure devices dx IUD Lippy’s loop comprehension perception shape MRI T1 fat suppression USscan radiologists and detectives diagnosis Davidoff MD Courtesy Rolina Levin MD

Serpiginous Anomalous Coronary Artery
This gray scale echo of the heart showing a serpiginous vessel on the heart surface The patient has a diagnosis of an anomalous coronary artery. Courtesy Philips Medical Systems 33129 code cardiac heart echo coronary aretery congenital anaolaous imaging cardiac echo see color image 33128

Tubular

 

Tubular Shape of the Metatarsals
46713b02 bone foot feet metatarsals normal anatomy tubular shape applied biology X-ray plain film Davidoff MD

Linear Shapes

Gastrocnemius Muscle
47029 muscle normal gastrocnemius linear fibers normal anatomy USscan Davidof f MD

Radiation Hepatitis – Hyperemia
The straight line and the hyperemia are characteristis features radiation induced change

22975 Courtesy Ashley Davidoff MD

Surgical Cut of Body of VErtebra – Anterior Decompression
49477 cervical spine bone C5 fx bony defect shape straight iatrogenic dx anterior decompression of disc herniation CTscan Davidoff MD

 

Branching

Branching Ducts and Glands of the Breast
13513 breast lobule terminal duct gland normal histology DB

The Shape of the Grape – Branching Systems in Nature
Snow covered red berries – the contrats between the cherry red and the snow white make them look delicious. Davidoff . 02160p

Horse Shoe
42636b02 Normal chest CT of the upper lobes of both lungs. The trachea is horse shoe shaped. Courtesy Ashley Davidoff M.D. 32158 42636b02 horseshoe Davidoff art

Tortuous

Left Heart Failure
46786c01 heart cardiac pulmonary arteries arteries fx enlarged fx corkscrew interstitial edema LAE left atrial enlargement dx cardiac failure cardiac congestion CTscan Davidoff MD

Triangular

Adrenal – Wishbone Shape
39502 The crura of the diaphragm (maroon overlay) can be seen as muscle bundles alongside the vertebral body and surrounding the aorta. The limbs of the adrenal gland (yellow overlay)should not be thicker than the crura. In this instance, the right adrenal gland is normal. The knobbly appearance of the left gland is also normal. At first glance it does appear thickened and concerning, but when the bend of the medial limb is recognised as a structural consequence of compression, the appearance becomes less concerning. The distinction between “knobbly normal” and “knobbly hyperplasia” is sometimes difficult. (Image courtesy of Ashley Davidoff M.D.) adrenal gland bilateral nodules adenomas neoplasm benign CTscan imaging radiology

39540
39540 In general the adrenal glands are triangular in shape and are reminiscent of the shape of the “wishbone” or the breast bone of the chicken. (Image courtesy of Ashley Davidoff M.D.) code adrenal gland shape normal chicken breast drawing

Adrenals
39509 As a paired organ you would think that they would be perfectly symmetrical, like the hands or feet, but in fact they look quite different, particularly in cross-section. The right tends to be long and thin and the left short and stout. adrenal shape size anatomy Davidoff art

 

Triangular Shape of the Distal Phalanges
46713b01b bone foot feet phalanges interphalangeal joints metatarsophalangeal joints normal anatomy applied biology X-ray plain film Davidoff MD

Bat Wing – Two Triangles

Batwing Shape of Perihilar Congestion in Acute CHF
49451c01 heart cardiac batwing distribution afx interstitial and alveolar edema air bronchogram shape pacemaker dx acute congestive cardiac failure CHF bilateral effusions CTscan Davidoff MD 49448 49451 49451c01

Star shape

Starfish
83062.800 starfish shape stellate structure the common vein anatomy applied biology Courtsey Ashley Davidoff MD

Stellate Lung Nodule
46361 lung fx spiculated nodule dx carcinoma CTscan Courtesy Ashley Davidoff MD
Click screen to close

Stellate Mass in the Right  Breast – Carcinoma
This is an MRI of the right breast of a 78 year old patient with a remote history of invasive lobular carcinoma.  The finding on the MRI is characterized by an enhancing spiculated mass.  Recurrent carcinoma was present at pathology. Courtesy Priscilla Slanetz MD MPH 42977

Heart Shaped Bladder
46702 abdomen pelvis kidney bladder heart shaped uterus normal anatomy applied biology Davidoff MD

Wedge Shaped Infarction
46772c01.800 spleen splenic fx wedge shaped defects dx emboli dx systemic embolization dx splenic infarcts CTscan Davidoff MD

 

Wedge Compression Fractures
47368c01 spine bone thoracic spine ospeopenia osteoporosis fx wedge compression fractures shape mechanical forces kyphosis CXR plain film X-ray Davidoff MD
Sperm Shaped
24796c Courtesy Ashley Davidoff MD pancreas pancreatic anatomy normal relations splenic vein SMV IVC renal vein kidney relations drawing Davidoff art

Rectangles

The Columnar Mucosa
The mucosa consists of a simple columnar epithelium which means it is a single layer of epithelial cells that are each shaped like a column – similar to a tall rectangular block of apartments.

 

Courtesy Ashley Davidoff MD 32347

 
An artistic rendition of columnar epithelium
An artistic rendition of a simple columnar epithelium (left) is compared to the columnar appearance of a block of apartments. The photograph taken from theKennedy Museum in Boston frames the columnar shaped apartments. (right)

Courtesy Ashley Davidoff MD

 

32347b10 02549p01
Rectangular Cuneiforms
46713c02.800 bone foot feet tarsals tarsal bones cuneiform cuboid talus navicular calcaneus tibia fibula X-ray plain film Davidoff MD
Shapes of the Carpals
46616 bone hand carpals wrist triquetral lunate scaphoid hamate capitate trapezoid trapezium radius ulna normal anatomy normal CTscan Davidoff MD
Carpal Bones
46613 bone hand carpals wrist triquetral lunate scaphoid hamate capitate trapezoid trapezium radius ulna normal anatomy normal CTscan Davidoff MD
Hook of the Hamate
46613c01.800 bone hand carpals wrist hook of hamate shape anatomy normal CTscan Davidoff MD

 

Hook of the Uncinate
39861c06 pancreas 12 year old female uncinate process head neck body tail CTscan normal anatomy applied biology Davidoff MD

Crypts
44953c04.800 colon large bowel chyme feces stool mucus normal function physiology water absorbtion electrolyte mucus secretion mucus drawing Davidoff art Courtesy Ashley Davidoff MD
 

Pectinate – Comb
64011b01 cock’s comb heart colon pectinate line shape anatomy shape Courtesy Ashley Davidoff MD Davidoff photography

Pectinate Muscles of the Right Atrium
01665 heart cardiac atrial septum septum primum septum secundum sinus venosus right atrium patent foramen ovale PFO normal anatomy grosspathology Courtesy Ashley Davidoff MD

Pectinate Line
29814b012 colon rectum large bowel sigmoid colon rectosigmoid anus anal canal pectinate line rectal columns rectal sinuses anorectal junction anatomy lateral examination sacrum barium enema BE imaging radiology contrast X-Ray Davidoff art Courtesy Ashley Davidoff MD
Stellate
70142.800 tree roots stellate shape Davidoff photography New Hampshire
Stellate
69595b05.800 star stellate corona radiata spiculated aggressive cancer carcinoma Davidoff art

Davidoff photography

Spiculated Lung Nodule
46361 lung fx spiculated nodule dx carcinoma CTscan Courtesy Ashley Davidoff MD
Spiculated Lung Nodule
46361b01 lung fx spiculated nodule dx carcinoma CTscan Courtesy Ashley Davidoff MD
Click screen to closeSpiculated Mass in the Right  Breast
This is an MRI of the right breast of a 78 year old patient with a remote history of invasive lobular carcinoma.  The finding on the MRI is characterized by an enhancing spiculated mass.  Recurrent carcinoma was present at pathology. Courtesy Priscilla Slanetz MD MPH 42977

Shape and Disease
15834 liver + shape deformity portal vein gastric vein varix varices + ethiodol accumulation shunting hepatoblastoma + imaging radiology CTscan

Geographical Shapes
21322 spleen + fx wedge shaped defect hyperemiv border dx splenic infarct + grosspathology

Jagged

28 year old Fell on Elbow
Challenge yourself with this image from a 28 year with elbow pain who fell on his elbow.  There are two findings created by shape deformities that allow one to make a diagnosis

41882b01 Courtesy Ashley Davidoff MD medical students code head elbow hemarthroses radia radius sail sign fracture

Subtle Fracture

Minor Shape Deformity
Making the diagnosis of a subtle fracture in this case is based on two minor shape deformities. The first is a rather sharp but small deformity of the radial head as the line of the cortex becomes disrupted, (white arrow) and the second is a shape deformity of the fat pad.  The small radial head fracture has caused a hemarthroses (hemorrhage into the joint space) seen as a red band in c, and it has lifted the fat pad of the distal humerus (yellow overlay) outward and upward causing a shape abnormality called the “sail sign” The triangular shape of the elevated fat pad is reminiscent of the sail of a yacht and describes exactly what it looks like.  The alternate description may have been described as the triangular transformation of the fat pad with a concave base.  It is far easier to call it the “sail sign”.

41882co5b.8s Courtesy Ashley Davidoff MD medical students code head elbow hemarthroses radia radius sail sign fracture

J Shape
Courtesy Ashley Davidoff MD 24322 code abdomen stomach + fx normal + fx j-shaped + dx normal + imaging radiology plainfilm KUB anatomy 24322

Scalloped
This combination of images from a CTscan of the abdomen are of a middle aged man who presented with back pain and fever, with a remote history of AAA repair. The lateral scout film shows scalloping of vertebral bodies 2 and 3 (a) highighted in green overlay in b. The CTscan with soft tissue windows (c) and bone windows (d) show a complex fluid collection surrounding the aorta which proved to be a perigraft infection. Courtesy Ashley Davidoff MD. 22725c02

Box Shape
02018p incomplete accessory pot o’ gold box – yellow wealth rich Courtesy Ashley Davidoff MD. Davidoff photography

Box Shaped Heart
This young patient has a very large heart which is almost rectangular in shape, characterised by significant enlargement of the right atrium and coronary sinus. The pulmonary vessels, particularly at the right base are enlarged and congested. This patient has Ebstein’s anomaly. Courtesy Ashley Davidoff MD. 20019

01232.jpg

Corkscrew
Courtesy Ashley Davidoff MD 01232 code esophagus + fx corkscrew shape + dx diffuse esophageal spasm + barium swallow upper GI UGI imaging radiology contrast X-Ray

Suture
46304b04 bone skull suture shape CTscan Davidoff art

Horses Tail – Cauda Equina
46311 spinal cord cauda equina horses tail epidural space lumbar spinee MRI T2 weighted images CSF normal anatomy Davidoff MD

Cauda Equina
70125b01.800 A brown horse in a green meadow early in the spring Courtesy Ashley Davidoff MD code accessory interesting horse brown Davidoff photography

Shape Changes with Time
46663c01.800 46663c01 lung chest thymus baby adult mediastinum normal anatomy applied biology CXR chest X-ray plain film time Davidoff MD

Shape and Death
46592c01 uterus OB pregnancy fetal demise spontaneous abortion shape size position heart rate USscan Davidoff MD death

 

 

 

Sphere
13440c06i03 liver hepatic nucleus cytoplasm polygonal shape hepatocytes Kuppfer cells TCV concepts histology cytology Courtesy Barbara Banner MD Modified Ashley Davidoff MD Davidoff art

GUT

Normal and Dilated Calyces – Change in Forniceal Angle
70371c03 kidney calyces fx ureteric stricture fx blunting of the calyces calyceal blunting forniceal angle acute vs obtuse loss of the forniceal angle fornix hydronephrosis retrgrade contrast injection normal anatomy IVP Davidoff MD 70371c01

Popcorn Calcification
73656.800 pelvis lymph nodes popcorn calcification right total hip replacement X-ray plain film of the pelvis Courtesy Ashley Davidoff MD

Scoliosis with Harrington Rods
75805c01.800 15 year old with chest pain spine scoliosis Harrington rods bone shape thoracic spine CXR plain film Courtesy Ashley Davidoff MD