Space occupying lesion

Evaluate other possible causes space-occupying lesion (which may or may not be malignant), drug-induced CNS disease, autoimmune disease, and trauma.8,9... 

Surgery may be needed to remove destroyed lung tissue, space-occupying lesions, and some extrapulmonary lesions. 

Figure 3.4 Graph showing mean values for cardiac index (Cl) and heart rate (HR) in young (n=20) and elderly (n=20) patients during induction of anaesthesia with isoflurane (1 MAC) in 100% oxygen. Data from McKinney MS, Fee JPH, Clarke F J. British Journal of Anaesthesia 1993 71 696-701.) anaesthesia. Marked cerebral vasodilation occurs with an increase in intracranial pressure. This can be mitigated by hyperventilation even in the presence of a space-occupying lesion.

Lumbar puncture is considered mandatory in patients with suspected bacterial meningitis but the procedure can be hazardous with a risk of brain herniation in patients with raised intracranial pressure, and imaging with computed tomography or MRI is recommended for selected patients to detect brain shift. Patients who are in an immunocompromised state, have new-onset seizures, moderate-to-severe impairment of consciousness or signs that are suspicious of space-occupying lesions (e.g. papilloedema - oedema of the optic disk) should undergo neuroimaging prior to lumbar puncture. 

Arteriovenous malformations present most commonly with signs consistent with a space-occupying lesion or seizures and consist of an abnormal fistulous connection(s) between one or more hypertrophied feeding arteries and dilated draining veins (Clatterbuck et al. 2005) (Fig. 7.5). The blood supply is derived from one cerebral artery or, more often, several, sometimes with a contribution from branches of the external carotid artery. Arteriovenous malformations vary from a few millimeters to several centimeters in diameter. Approximately 15% are associated with aneurysms on their feeding arteries. Some grow during life but a few shrink or even disappear, and some are multiple. These fistulae occur in or on the brain, or in the dura of the intracranial sinuses. 

Increased ICR and, thus, papilledema have many causes. Any intracranial space-occupying lesion may create increased ICR. Superior sagittal sinus thrombosis, spinal cord tumors with associated elevated CSF protein, spinal cord injuries, and traumatic brain injmy may all cause papilledema. 

The Increase In AP activity is stimulated by bile acids. A rise in bile acids, which is considered to be the most sensitive and earliest marker of cholestasis, precedes any elevation in AP. The latter derives from enzyme synthesis with increased secretion into the blood. Under pathological conditions, bile duct AP is formed, which is a sensitive marker for hepatobiliary diseases, cholestasis and space-occupying lesions of the liver. The sensitivity is 80-100% in cholestatic diseases. AP activity is usually higher in obstructive jaundice and cholangitis than in intrahepatic obstructions, and it is highest in the vanishing bile duct disease or in complete obstruction. (13, 39, 41) (s. tabs. 5.9 13.2-13.4)... 

N., Matsaidonls, D., Papadoponlos, A., Papavasiliou, C. Differential diagnosis of space-occupying lesions of the hver with MR imaging. Hepato-Gastroenterol. 1992 39 461—465... 

Encephalopathy can occur in a number of extrahepatic diseases, such as toxic, metabolic or circulatory disorders, intracranial space-occupying lesions, hypothyroidism (35) and neurological/psychiatric diseases, (s. tab. 15.2) Identification of neuropsychiatric symptoms always calls for careful differential diagnosis. 

There are usually no subjective complaints - except when there are large space-occupying lesions which cause anorexia, weight loss, upper abdominal pain upon pressure, haemorrhaging in the tumour or tumour rupture. Febrile conditions and pain may point to infection, liver abscess or echinococcosis. 

Morphological clarification of the findings is necessary if differential diagnosis of a hepatic space-occupying lesion is unclear. Cytological or histological confirmation of tumour malignancy is likewise required prior to palliative therapy, even in patients with no chance of curative treatment. 

CT scanning reveals a hypodense to hyperdense focal space-occupying lesion, with the hyperdense parts corresponding to the thrombotic structures within the aneurysm. Diagnostic accuracy is considerably improved by using contrast-medium CT. 

Jennett WB, Barker J, Fitch W, McDowaU DG. Effect of anaesthesia on intracranial pressure in patients with space-occupying lesions. Lancet 1969 l(7585) 61-4. 

Many body and head CT studies (Figs. 13-14 and 13-IS) U.SC intravenous contrast material to improve the quality of the study. The type of contra.st material and their doses are similar to those in excretory urography except that higher volumes of conlrast and a more rapid injection system arc often used. The contrast material increases the relative conlrast between space-occupying lesions (tumors, cy.sts. and... 

Possible stones, strictures, or space-occupying lesion... 

Small space-occupying lesions may also be identified. Endoscopic retrograde cholangiopancreatography (ERCP) ... 

Mass effect—An increase in intracranial pressure due to a space-occupying lesion in the brain, usually leading to a shift in brain contents, evident by imaging techniques. 

Space occupying lesions of the liver, partial biliary obstruction and hepatotoxic drugs, may raise serum alkaline phosphatase in the presence of normal serum bilirubin (see Fig. 11). 

Marked elevation of serum alkaline phosphatase in an alcoholic patient usually denotes the presence of biliary tract obstruction or space occupying lesions within the liver. However, in a few patients, alcoholic hepatitis and cirrhosis may be present, with marked hyperphosphatasemia due to intrahepatic cholestasis (PIO). 

Morphological studies of the renal cortex indicating space-occupying lesions and areas of reduced function kidney localization, delineating size and shape of the kidneys as well as defects... 

Increases in alkaline phosphatase activity in liver disea.se are the result of increased synthesis of the en/yme by cells lining the bile canaliculi. usually in response to cholestasis, which may be either intra- or extra-hepatic. Cholestasis, even of short duration, results in an increased en/yme activity to at least twice the upper end of the reference interval. High alkaline phosphatase activity may also occur in inllltrativediseusesof the liver, w hen space occupying lesions (e.g. tumours) are present. It also occurs in cirrhosis. 

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