The Common Vein

Wiki Leonardo da Vinci

Size of the Universe

In this model, the sun is a very tiny speck of dust indeed—a speck less than a three-thousandth of an inch in diameter … Think of the sun as something less than a speck of dust in a vast city, of the earth as less than a millionth part of such a speck of dust, and we have perhaps as vivid a picture as the mind can really grasp of the relation of our home in space to the rest of the universe. —

Sir James Jeans In The Universe Around Us (1953), 96.

Relative Size of Things

structure	size of structure
coffee bean	12 X 8mm
grain of rice	8 X 2.5mm
sesame seed	3 X 2mm
grain of salt	.5mm
ameba	500 microns
paramecium	210X60 microns
human ovum	130 microns
photoreceptor	100 X 2.5 microns
sperm	60 X 5 microns
skin cell	30 microns
red cell	8 microns
X chromosome	7 microns
baker’s yeast	3 X 4 microns
E Coli bacterium	3 X .6 microns
mitochondrion	4 X .8 microns
lysosyme	.1 micron
measles virus	220 nanometers
influenza virus	130 nm
hiv virus	130 nm
coated vesicle	90 nm
hepatitis virus	45nm
rhinovirus	30nm
ribosome	30nm
ribosome	30nm
antibody	12 nm
tRNA	7nm
phospholipid	.9 X 3.4nm
methionine	1100 X 700pm
adenine	1300 X 760pm
glucose	900pm
water molecule	275pm
carbon atom	340pm

References

Carl Sagan  http://www.youtube.com/watch?feature=fvwp&v=t4Tst9DZFPI

Introduction Davidoff The Common Vein Copyright 2014 Size is one of the most important universal descriptors of structure.   It is a measurable entity, and determining whether a structure is normal or abnormal can be verified against a normal standard.  The red cell is about 5-7 microns in diameter, and the normal liver weighs 1400grams, for example.  Size and weight of many organs differ  between the sexes and among age groups.  Measurements may be linear, portray a volume, mass, rate or frequency.  Size may be reflected as a ratio, such as the very important nuclear/cytoplasmic ratio of the cell.  The relevant concept is that it is important to group these facets under the umbrella of “size” and to understand that all descriptors relating to magnitude can be viewed as being a descriptor of size, whether in grams, cms/sec, or nuclear cytoplasmic ratio.  By grouping all these quantifications under the concept of “size”, a framework is provided for the detail, which will enhance understanding.  (or “standing under” the detail).  ** This is the “lumpers”, rather than the “splitters” approach described  and referenced to McKusick in chapter 1. Learning about structure requires an understanding and knowledge of the normal size. In the clinical realm, the size of  examinable organs eg  the heart liver or spleen is an essential consideration in the the evaluation of its health.

The evaluation of size can take many forms.  Most the time in medical imaging we consider a linear measurement since it is the easiest for us to measure.  Yet other dimensions including mass, weight, velocity, volume, frequency, velocity, and concentration, are in some way a reflection of size as well.

As a reference it is useful top review the size of some normal structures both at a microspcopic level and a anatomic level

capillaries which average 8 microns in diameter but may be as small as 4 microns –

red blood cells (7.8 micron x 2.6 micron biconcave disks) must fold in half to pass, single-file.

average animal cell is 10 -20 microns

human hair is about 80 microns

human eye can see up to 50  microns

sperm 60 X 5 nm

Nuclear-Cytoplasmic Ratio
The normal (left) and the abnormally large nucleus (right)
Two histological sections above show a normal nuclear cytoplasmic ratio of some liver cells on the left and cells with an increased nuclear cytoplasmic ratio on the right indicating malignant change.  The experienced eye and mind of the pathologist develops a geshtalt of what the normal ratio.  This  is a difficult measurement to make objectively.
13440 13447Courtesy Barbara Banner MD

In this instance, making the assessment of an increase in the nuclear to cytoplasmic ratio is of the highest importance in the patient’s prognosis.  If the nuclear cytoplasmic ratio is increased then a major criterion in the diagnosis of malignancy is recorded by the pathologist.  The distinction between making a diagnosis of life threatening malignancy or not is as simple yet profound as that.  It has its basis in the assessment of size.

Many diseases result in structures getting bigger.  These encompass a variety of structural changes including neoplasia, hyperplasia, and hypertrophy.  Diseases may also be caused by smallness of structure, with examples such as atrophy, hypoplasia, aplasia and atresia.  Other disorders that may be associated with smallness include infarctions of the brain or spleen, congenital disorders such as hypoplastic right heart syndrome and esophageal atresia (esophagus is small and not formed) and immune disorders where tissue is destroyed such as sprue, or atrophic gastritis.

Evaluation of the magnitude of structure (and function in many ways) is a fundamental aspect of medicine.  It is difficult to have a sense of how size fits into the clinical picture when it is learned in the context of basic science, but it always holds tremendous importance in the clinical realm.

The evaluation of size can take many forms.  Most the time in medical imaging we consider a linear measurement since it is the easiest for us to measure.  Yet other dimensions including mass, weight, velocity, volume, frequency, velocity, and concentration, are in some way a reflection of size as well

It may be useful to review the size of some common structures both at an anatomic level as well as a microscopic level in order to get a perspective.

The largest organ in the body is the skin, and the largest gland in the body is liver.  The liver weighs about 1200 grams.  Other large organs include the lungs which by volume are the largest, but by weight are not.  The femur is the largest and longest bone in the body. The intermediate size organs include the brain heart, spleen and kidneys.  The smaller organs include the pancreas, gallbladder uterus, and smaller than they are ovaries, thyroid and testes.  Yet smaller are the adrenal glands, parotids, submandibular glands and the parathyroids.

 Organs – Adults

structure	length	widthant-post	trv	weight	volume	other	comment
adrenal	3-5cms			8gms
aorta		3cms proximal1.75cms distal
breasts				30-500gms
bile duct		5mm					CHD at level of right hepatic artery
brain				1400gms	1000-15000mls
cervix	2.5cms	5cms	2.5cms
colon	150cms5ft	5cms
duodenum	25cms
esophagus	25-30cms	2cms
fallopian tube
femur
gallbladder	8-10cms	3-4cms			50-70mls
heart	12cms	6	8-9cms	230-340gms
IVC
kidney	11.25cms		5-7.5cms	125-170gms
liver	12-15cms	10-12.5cms	20-22.5cms	1200-1800gms			largest gland in the body accounting for 2% of body weight and aslo the largest abdominal organ
lungs	24cms			630gms right570gms left900-1200gms	4200-6300mls		40% to 50% of the weight is bloodthe right lung is slightly heavier than the left lung
lymph node	<1cms
ovary	2.5-5cms	1.5-3cms	1.5-3cms		3-18mls
pancreas	12-15cms	1.5-3cms		60-100gms
pancreatic duct		1-3mms
parathyroid
pituitary	8-9mms
prostate
pulmonary vein
pulmonary artery
spinal cord
spleen	12cms	7cms	4cms	80-300gms	250-350mls
small bowel	700cms23feet	2.5cms
stomach
thyroid	4-6cms	1-2cms	2-3cms	10-20gms
testis	5cms	3cms	2cms		15-20ccs
trachea	2cms
ureter	25-30cms
urethra	4cms F17-20cms M	6mms
urinary bladder	12cms				250 – 500mls
uterus	5-8cms	1.5-3cms	2.5-5cms
vein

Fom Freitas RA Junior Nanomedicine Volume 1 Basic Capabilities

Philip B. Hawk, Bernard L. Oser, William H. Summerson, Practical Physiological Chemistry, 12th Edition, The Blakiston Company, New York NY, 1951.

Peter L. Williams, Roger Warwick, Mary Dyson, Lawrence H. Bannister, eds., Gray’s Anatomy, Thirty-Seventh Edition, Churchill Livingstone, New York, 1989.

International Commission on Radiation Protection, Committee II, 1959, “Permissible Dose for Internal Radiation,” Health Phys. 3(1960):1.

Ivan Damjanov, James Linder, Anderson’s Pathology, Tenth Edition, Mosby, St. Louis MO, 1996.

capillaries which average 8 microns in diameter but may be as small as 4 microns –

red blood cells (7.8 micron x 2.6 micron biconcave disks) must fold in half to pass, single-file.

average animal cell is 10 -20 microns

human hair is about 80 microns

human eye can see up to 50  microns

sperm 60 X 5 nm

bacteria are as small as 1 micron

E Coli = 2micrometers long

ribosome 25nm diameter

cell membrane = 7.5-10nm thick

DNA molecule is about 2nanometers thick (nano = 1 billionth of a meter)

hydrogen atom = .1nanometer in diameter

0.1 nm (nanometer) diameter of a hydrogen atom
0.8 nm Amino Acid
2 nm Diameter of a DNA Alpha helix
4 nm Globular Protein
6 nm microfilaments
10 nm thickness cell membranes
11 nm Ribosome
25 nm Microtubule
50 nm Nuclear pore
100 nm Large Virus
150-250 nm small bacteria such as Mycoplasma
200 nm Centriole
200 nm (200 to 500 nm) Lysosomes
200 nm (200 to 500 nm) Peroxisomes
800 nm giant virus Mimivirus
1 µm (micrometer)
(1 – 10 µm) the general sizes for Prokaryotes
1 µm Diameter of human nerve cell process
2 µm E.coli – a bacterium
3 µm Mitochondrion
5 µm length of chloroplast
6 µm (3 – 10 micrometers) the Nucleus
9 µm Human red blood cell
10 µm
(10 – 30 µm) Most Eukaryotic animal cells
(10 – 100 µm) Most Eukaryotic plant cells
90 µm small Amoeba
100 µm Human Egg
up to 160 µm Megakaryocyte
up to 500 µm  giant bacterium Thiomargarita
up to 800 µm  large Amoeba
1 mm (1 millimeter, 1/10th cm)
1 mm Diameter of the squid giant nerve cell
up to 40mm Diameter of giant amoeba Gromia Sphaerica
120 mm Diameter of an ostrich egg (a dinosaur egg was much larger)
3 meters Length of a nerve cell of giraffe’s neck

Reference Wikibooks 

interactive relative sizes (Utah)

Principles

Linear Measurements Length Diameter Radius

Size of the Pancreas
41394size002b01 Courtesy Ashley Davidoff MD code pancreas size normal anatomy imaging drawing

 

Size and Time

Follicles in a Reproductive Female – Cyclical Phases -Size and Time

71689 ovary follicles normal anatomy function physiology TCV Applied Biology Cycle time USscan Davidoff MD

Size and Shape

Normal vs Atelectasis

74238c01 88 year old male bilateral complex effusions pleura pleural space atelecactasis space occupation normal 3D volume rendering CTscan Courtey Ashley DAvidoff MD

Normal and Enlarged Abdomen

45883.800 46133b03 abdomen skin size fx enlarged distended shape CTscan Cortesy Ashley Davidoff MD

 

Relative Sizes Relative Lengths 34769c08 heart cardiac aortic valve pulmonary valve conus infundibulum RVOT right ventricular outflow tract pulmonary artery normal size aorta to PA ratio aorta to LA ratio anatomy CTscan Davidoff MD Relative Size of Bronchus and Pulmonary Artery 42464b07 In this normal CXR a RUL segmental bronchus and artery are side by side with the lucent air filled bronchus in teal and the artery in royal blue. Note that at his stage they are the same size and they will be for many divisions until they reach the terminal bronchiole. Courtesy Ashley Davidoff MD 42464b07 lung anatomy normal size applied biology applied anatomy Normal relationship and Size – Arterioles and Bronchioles In this CT of a normal patient we see two levels of the RLL with the segmental bronchioles and arterioles branching dichotomously and simultaneously. Note again the similarity in size and shape through these levels of division, a form that is maintained in the normal person until they reach the terminal bronchiole. 42455Courtesy Ashley Davidoff MD 42455 lung artery bronchus normal anatomy size applied anatomy applied biology Which is the normal? The Nuclear-Cytoplasmic Ratio Size of the cytoplasm and Size of the Nucleus (N-C ratio) 13440 liver hepatocytes cells cytology histology normal 5star Courtesy Barbara Banner MD 13447 liver HCC hepatocellular carcinoma cytopathology  Courtesy Barbara Banner MD Length in Pathology – Nutmeg Liver 00414 metastasis liver fx nutmeg liver hepatic congestion dx chronic passive congestion CHF congestive heart failure grosspathology Courtesy Ashley Davidoff MD Thickening Schistosomiasis of the Liver  – Thickened Periportal Tracts 25170 liver vein portal fx periportal thickening dx schistosomiasis schistosoma Mansonii USscan Complex Pleural Effusion Thickened Pleura Chronic Inflammation Dystrophic Calcification 74243b01 74242 74242b01 88 year old male complex effusions pleura pleural space thickened pleura thickening unilateral atelecactasis pleural calcification calcified CTscan Courtey Ashley DAvidoff MD

 

Single versus Multiple Single lesion vs Multiple Lesions 03271 Hemorrhagic primary HCC 13448b01 liver hepatic metastases metastasis primary breast carcinoma biliary staining due tooc compression grosspathology TCV the common vein Davidof MD Single lesion vs Multiple Lesions 02721 colon metastasis HCC 15764  liver hepatic metastases metastasis primary breast carcinoma Davidoff MD Volume Frequency Volume Loss on Left and Hyperinflation on the Right

This image is a combination of a plain film showing a hyperinflated and large right lung, with volume loss and cystic change in the left lung. Note the proximal trachea is pulled to the left by the contracted left lung, as welll as pushed by the hyperinflated right lung. Courtesy Ashley Davidoff MD. code lung pulmonary trachea mediastinum bronchioles pushed pulled deviated shifted hyperinflated dilated cotracted emphysema bronchiectasis imaging radiology CTscan CXR palin film chest X-ray

Volume Loss Due to Atelectasis and Effusion

74242b01 88 year old male emaciated thin 3D volume rendering CTscan Courtey Ashley DAvidoff MD

Volume

Volume Frequency

Volume Frequency

This diagram outlines the residual volume between the red lines, representing the air that is left in the airways and the alveoli after a full expiration. The air you may see on expiration CXR is the residual volume and as you can see it is about 1.8 liters in this patient. Courtesy Ashley Davidoff MD. 42529b06aa03

Flow Velocity70294 acv waves hepatic veins doppler tricuspid valve regurgitation TR velocity Ultrasound Echocardiogram Davidoff MD

Weight

Weight02300p.800 scale weight size anatomy structure applied biology Davidoff photography

A  Single Abnormal Gigantic Floret – Gigantism a Quirk of Nature

Variations in Size in Humans61229p flower allium size large elongated greater than the 90th percentile abnormally enlarged Davidoff photography

Former Olympian Olga Korbut (C) stands between Manute Bol (L) and William “The Refrigerator” Perry (R) during the weigh-in for Celebrity Boxing 2 in Los Angeles, California Tuesday, May 14, 2002. Korbut will face Darva Conger and Bol will face Perry during the boxing event which will air May 22 on Fox. REUTERS/John Hayes

54916.800

Olga 5feet 1 inch

Manut Bol 7foot 7 inches

William Perry  6’2” 370lbs

 

By Body Part The Body

Body in Health and Disease49609c02 abdomen health disease normal obese morbid obesity order disorder Davidoff MD

CNS

Size – Number

Multicentric Embolic Disease from Carotid Stenosis

72014c01 brain cerebral multicentric infarcts internal capsule parietal lobe cortex dx multicentric infarct left cerebral hemisphere associated with a left carotid stenosis with presumed showering of the embolic material embolism a = DWI b = T2 weighted

CVS

Relative Size – Small Left Kidney Normal to LArge Right Kidney13417 aorta abdomen iliac artery fx atherosclerosis kidney fx small dx RAS renal artery stenosis grosspathology Courtesy Ashley Davidoff MD

Aortic Aneurysm

42358.800 aorta fx enlarged MPA pulmonary artery aneurysm of the ascending aorta CTscan Davidoff MD

Normal and AAA

11976c01 aorta abdomen abdominal aorta renal afrteries kidney fx normal AAA abdominal aortic aneurysm horseshoe kidney angogram angiography lumbar arteries Davidoff MD

Normal and Thickened Aortic Valve over Time07953c02 heart cardiac aorta aortic valve fx normal fx thickened fx bicuspid aortic valve fx calcified fx calcification fusion of the intercoronary commisures grossanatomy grosspathology Davidoff MD b Courtesy Henri Cuenoid MD

Size Incompatible with Life

Mitral AtresiaThis pathological image of the mitral valve is a close up of image 01810, showing an atretic MV with unformed and poorly formed elements including the chordae and papillary muscles. No lumen could be identified. The heart is incompatible with life

Courtesy Ashley Davidoff MD. 01813 (see 01810) code heart cardiac congenital grosspathology MV mitral atresia

Normal Abdominal AortaThis is an angiogram of a normal abdominal aorta. It consists of a suprarenal and an infrarenal component separated by the origin of the renal arteries. See image 24877d for color overlay. Courtesy Ashley Davidoff MD. 24877b

Infrarenal Abdominal Aortic Aneurysm

The digitally subtracted angiogram shows a fusiform infrarenal abdominal aortic aneurysm. There is mild ectasia of the right common iliac artery. Courtesy Ashley Davidoff MD 24590

Ascending Aortic Aneurysm

This series of images are from a CTscan showing an ascending aortic thoracic aneurysm. There is evidence of heavy calcification of the aortic valve (aortic sclerosis), an aneurysm confined to the ascending aorta (b,c,d), and tortuosity of the descending aorta (d). The cause for the aneurysm is probably a combination of systemic hypertension, aortic stenosis and atherosclerotic degeneration of the wall. Courtesy Ashley Davidoff MD 19426c

Multicentric and Diffuse Narrowing of the Abdominal AortaIn this patient, the MRI shows narrowing of the abdominal aorta segmentally and diffusely in this patient who has Takayasu’s arteritis and aortitis – an inflammatory condition affecting the aorta and large arteries.  16917b Courtesy Ashley Davidoff MD

Normal and ongenitally Stenotic Pulmonary ValveThese two pathological specimens of the pulmonary valve show the normal delicate leaflets of the normal valve (a) in comparison to the thickened leaflets of the bicuspid pulmonary valve Courtesy Ashley Davidoff MD 00272c01.800

Severe Congenital Pulmonary StenosisThe lateral projection of this right ventricular angiogram reveals a case of severe pulmonary stenosis.  The catheter enters the RV from the RA via the SVC.  The  RV inflow tract (purple) is hypoplastic.  The vessels emanating and theRV inflow are coronary arteries that are filling in retrograde fashion are due to the suprasystemic pressures in the RV indicating svere pulmonary stenosis with prssures in the RV that probably exceed 100mmhg.  The infundibulum (right ventricular out flow tract (blue) is slightly narrow since it is hyperdynamic in an attempt to force the blood through the stenotic valve.  The valve (green) is doming into the PA due the severe narrowing.  The narrowing causes turbulence which causes the post stenotic dilatation.

 15036c01  Courtesy Ashley Davidoff MD

Size and Shape – Play it again Sam

This angiogram in RAO projection shows a hypercontractile left ventricle that has a ballet shoe appearance, with mitral regurgitation filling the left atrium. The drawing shows the significant LVH small cavity of the LV, the area of subaortic muscle bundle (green) and the mitral regurgitation caused by the systolic anterior motion of the mitral valve. Courtesy Ashley Davidoff 34805

Venturi –

Flow in this tube is demonstrated by the arrows going from right to left through a narrowingin the tube (red) demonstrating a vacuum or suction effect caused by the sudden acceleration of the fluid as it goes through the narrowing or stenosis. This is seen in the U shaped monometer with the fluid level in blue being relatively higher at the site of the stenosis in relation to the pressure more upstream. The suction phenomenon is kown as the Venturi effect is seen in IHSS where the narrowing of the LVOT causes a vacuum effect on the anterior leaflet of the MV resulting in mitral regurgitation. The Venturi effect is also utilised in the functioning of carburettors in fuel driven engines. 34807b05

Left Heart Failure46786c01 heart cardiac pulmonary arteries arteries fx enlarged fx corkscrew interstitial edema LAE left atrial enlargement dx cardiac failure cardiac congestion CTscan Davidoff MD

Varicose Veins – Aging BodyLegs and feet seated at a bench in Quincy market in downtown Boston Massachusetts. – What story can you tell? Courtesy Ashley Davidoff MD. 02012p code foot accessory interesting vein varicose age time elderly shoe Davidoff photography

Size related to Volume and Pressure

This injection into the base of the aorta showing filling of a dilated right coronary artery, collateral flow through the septal perforators, into a dilated LAD and then into the main pulmonary artery. (MPA) This is a case of anomalous origin of the left coronary from the MPA. Courtesy Ashley Davidoff MD. 07024

 

RS

Normal Alveoli of the Lung and EmphysemaThis diagram illustrates the branching pattern of the tracheobronchial tree that extends from the bronchi to the terminal bronchioles transitioning into the alveoli via the alveolar sacs. Courtesy Ashley Davidoff MD 32645b04b04

This diagram shows alveoli and respiratory bronchioles that are too large due to loss of elasticity, so that air cannot be moved efficiently through them This is a diagram of emphysema causing hyperinflated lungs lung volumes 32645b01.800

Davidoff art

Large lungs

A patient with hyperinflated lung volumes, COPD, and emphysema with surgical removal of a lung carcinoma from the LUL.  Note how flattened the hemidiaphragms are and note the large retrosternal air space and the shapoe of the chest – like a barrel – called pectus carinatum – or pigeon chest.  The lungs are literally so large that they are pushing the chest wall forward.

Courtesy Ashley Davidoff MD 30672c

CT of emphysema

This high resolution image of the lung shows “Swiss cheese” like black holes in the lung characterizing early cetrilobular emphysema in the right upper lobe. This degree of emphysema may be seen in a patient who has smoked and is in the their late 40’s or early fifties or in an elderly patient as an age related change in their 70’s or 80’s who has not smoked. Courtesy Ashley Davidoff MD. 01b 32170

Segmental emphysema

This is a chest CT of a 29 year old man man who has segmental emphysema in the right lower lobe and midle lobe characterised by lucencies at 3 and 12 oclock where there has been air trapping in the alveoli.  The left lung is normal  This condition is called Swyer James syndrome Courtesy Ashley Davidoff MD. (30314 )

Emphysema

This is an image of an emphysematous lung. Note the larger air spaces where the septae between the alveoli, alveolar sac, salveolar ducts and respiratory bronchioles have been broken down. 19932e

Stenting the Obstructions0916030018 This is a case of a central squamous carcinoma causing obstruction of the right mainstem bronchus and SVC requiring stents in both. This image tells the story of how tubular transport function is compromised by reduced size, and how size can be restored by modern technology. 0916030018 Courtesy Ashley Davidoff MD size tracheobronchial tree SVC vein stent anatomy applied biology applied anatomy CXR

Allergic Bronchopulmonary Aspergillosis

47114c01 bronchi lungs fx dilated enlarged impacted with sft tissue finger in glove dx allergic bronchopulomonary aspergillosis ABPA aspergillus dx infection inflammation CTscan Davidoff MD

Big Lung Small Lung Big Bronchi Small BronchiThis CT image shows a hyperinflated and large right lung, with volume loss and cystic change in the left lung. Note the trachea is pulled to the left by the contracted left lung, and is pushed by the hyperinflated right lung. Courtesy Ashley Davidoff MD. (30079 30084 30085 30085b) code lung pulmonary trachea mediastinum bronchioles pushed pulled deviated shifted hyperinflated dilated cotracted emphysema bronchiectasis imaging radiology CTscan

 

GIT 13 mm stricture in Esophagus 49430c01 esopagus GE junction stricture hiatis hernia barium swsllow upper GI size Davidoff MD

Stricture of the Esophagus

73406.800 esophagus narrowing stenosis stricture distal esophageal stricture peptic stricture endoscopy Courtesy Joshua Namias

Big Stomach17191 stomach gastric + fx dilated + enlarged gastrinoma + imaging radiology CTscan

Big Stone00136 gallbladder stone large shadowing cholelithiasis imaging radiology USscan

Small Stones  – Cholecystitis00405 gallbladder multiple small dependant stones shadowing cholelithiasis gallbladder fossa fluid thickening acute cholecystitis positive Murphy’s sign imaging radiology USscan

Small Pancreas Big Pancreas41394csize04 Courtesy Ashley Davidoff MD code pancreas size abnormal small enlarged anatomy imaging radiology CTscan

Normal Liver and Cirrhosis

Parts of the liver changing in size reflecting disease.  The first image reflects a normal liver  In the second image the left lobe is relatively large while the right lobe is small.  These finding are characteristic of alcoholic cirrhosis.  Note the shape of the surface of the liver has also changed from being smooth to being nodular and the presence of aciteds reflects a combination of increased portal pressure and low proteins.

18135.800 46136 Davidoff MD

 

Normal Liver above Cirrhotic Liver belowThis diagram reflects the large left lobe of the liver in cirrhosis and the small right lobe.  The caudate lob is not depicted.  42649c01 Davidoff art

GUT

Normal and Small  – Kidneys46566c01 kidney kidneys size normal small anatomy physiology Davidoff MD

Follicles in a Reproductive Female – Cyclical Phases -Size and Time

71689 ovary follicles normal anatomy function physiology TCV Applied Biology Cycle time USscan Davidoff MD

Sinle Kidney Bicornuate Uterus

46527c01 uterus kidney renal bicornuate uterus single kidney congenital abnormality congenital growth disorder USscan MRI Davidoff MD

Normal Empty and Overdistended Symptomatic Full Urinary Bladder

70363c09 urinary bladder normal enlarged abdominal pain induration abnormal urinary reterention CTscan sagittal reformat Davidoff MD

Hydrosalpinx

43 old female with right adnexal discomfort and prior history of pelvic inflammatory disease Findings on a transvaginal ultrasound show a dilated fallopian tube consistent with hydrosalpinx

uterus fallopian tube distended hydrosalpinx ultrasound USscan 83331.8s Courtesy Ashley Davidoff MD copyright 2009

 

 

RES

Big Lymph Nodes Small AortaThis cross sectional image of the mid abdmen shows an aorta with an expanded diameter, which in this case is associated with an extremely small lumen. Note the wall of atherosclerotic calcification is on the inside of the soft tissue surrounding it. The case represents non-Hodgkins abdominal lymphoma that masquerades as an abdominal aortic aneurysm. The positioning of the calcification is key to this recognition. Courtesy Ashley Davidoff MD 15657

Skin

Gynecomastia

46621 hx 77 year old male with SOB breast pleura fx gynecomastia pleural calcification dx asbestos related disease dx asbestosis CTscan Davidoff MD 46621 46623 46624 46622

Gallbladder Polyp surrounded by fluid – 3mms47017c01 gallbladder fx nodule fx adeherent fx non dependant size character through transmission dx gallbladder polyp Davidoff MD

Varicose Veins in SVC syndrome38078  38078b01 this middle aged female with breast carcinoma skin veins pericardiophrenic veins pericardium pericardial fx collaterals varicocity varicose abdomen ascites dx SVC obstruction imaging radiology CTscan Courtesy Ashley Davidoff MD also code SVC syndrome

Obesity pre and post bypass48433c01.800 55 F s/p gastric bypass 4 years prior a, c pre bypass b,d post bypass adipose tissue subcutaneous fat size stomach nutrition metabolic fatty liver steatosis morbid obesity gallbladder fossa fatty sparing CTscan Courtesy Ashley Davidoff MD

Large Abnormal Pushing and Squeezing

61 year olsd female post op repair of ascending aortic aneurysm with Bental procedure with dropping blood pressure and odecreasing oxygen saturation aorta left atrium

47752c01  LA heart cardiacmediastinum fx compression of left atrium from anterior post operative nediastinal hematoma and posterior aneurysm of the descending aorta fx lingula atelectatasis and left lower lobe atelectasis bilateral pleural effusions dx supravalvular mitral stenosis CTscan Davidoff MD

 

Size and Death46592c01 uterus OB pregnancy fetal demise spontaneous abortion shape size position heart rate USscan Davidoff MD death

Size in Numbers

Satellite Nodules affect Staging of Cancer28980 chest lung spiculated mass satellite nodules malignant carcinoma CTscan Davidoff MD 28979 28980 28981 28984 28985 28986c01

 

 

Relative Sizes

 

Ascending Aortic Aneurysm

42358.800 aorta fx enlarged MPA pulmonary artery aneurysm of the ascending aorta CTscan Davidoff MD

Malignant Behaviour – Size and Doubling Time

Growth of a lung lesion over 7 months 48380c01 chest lung fx mass fx growth in 7 months dx metastattic squamous cell carcinoma head and neck primary primary larynx metastasis time size CTscan Davidoff MD 48383c01 48380c01 48383c02 malignant malignancy

 

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Golden Ratio