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26 Cards in this Set
- Front
- Back
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Differential
Increased attenuation of mesentery |
* Mesenteric lipodystrophy
* Mesenteric desmoid tumor * Carcinoid * Retractile mesenteritis * Acute pancreatitis * Inflammatory bowel disease * Sarcoma |
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Adrenal Masses
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Adenoma
Metastases Hemorrhage Myelolipoma Cyst Carcinoma Granulomatous Disease Wolman's Disease |
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Adrenal Myelolipoma
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Usually asymptomatic
4-5 cm echogenic macroscopic fat on CT, MR |
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Adrenal Hemorrhage
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bilateral - anticoagulation, stress, sepsis, surgery
unilateral - blunt trauma high attenuation hyperechoic calcify within 15 days |
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Adrenal Cysts
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Epithelial - 5-10%
Pseudocysts - 45%; prior hemorrhage; wall calcification Endothelial - 45%; multilocular DO NOT ENHANCE (unlike adenoma) |
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Adrenal Adenoma
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F>M
2-8% incidence homogeneous intracellular lipid >50% washout in 10 minutes. |
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Adrenal Metastases
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Lung, breast, lymphoma, kidney, ovary
Sold Enhancing Slow washout (<50% in 10-15 min) |
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Differential for Bilateral Adrenal Masses
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Metastasis
Hemorrhage Pheochromacytoma (MEN, VHL) |
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Adrenal Carcinoma
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30% calcify
50% hyperfunctioning (Cushing) Masquerade as upper pole RCC Mets to liver, lung, bone Associated with tumor thrombus in renal vein, IVC, right atrium |
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Adrenal Granulomatous disease
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#1 cause of calcification
Can result in Addison's disease |
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Wolman's Disease
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Lipid storage disease.
Grossly calcified gland. usually hypofunctioning. |
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CUSHING SYNDROME
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Excess cortisone production
70-85% - excess ACTH (pituitary, ectopic [MCT, oat cell]) 10-20% - Adrenal adenoma 5-10% - Adrenal Carcinoma |
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CONN SYNDROME
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Excess aldosterone.
HTN, Hypokalemia, Hypernatremia, Hyper-renin Treat with SPIRONOLACTONE |
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Pheochromocytoma
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10% bilateral
10% malignant 10% extra-adrenal (most commonly organ of Zuckerkandl at IMA) |
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Pheochromocytoma - associated syndromes
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MEN 2A, MEN 2B, VHL, NF2, TS, Sturge Weber, Carney syndrome
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Carney Syndrome
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1. Gastric Leiomyosarcoma
2. Functioning adrenal (or extra-adrenal) paraganglioma (pheo) 3. Pulmonary chondroma |
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Appendix Mucocele
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* result from chronic obstruction.
* Etiology may be benign or malignant. * mucinous cystadenoma or mucinous cystadenocarcinoma, although apendiceal carcinoid and obstructing cecal neoplasms can cause a mucocele. * The diffuse form of pseudomyxoma peritonei usually results from perforation of a malignant mucocele of the appendix. |
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Brunner's Gland Hyperplasia
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Located in submucosa of the proximal two-thirds of the duodenum.
Secrete alkaline substance to buffer gastric acid. Nodular Gland Hyperplasia -multiple filling defects -associated with hyperacidity Gland Adenoma -solitary filling defect |
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Colonic Polyps
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Malignancy correlates with size
<1 cm (<1%) >2 cm (~50%) Etiology: Idiopathic Adenoma (FAP=Gardner's) Metastases Lymphoma Pseudopolyps (inflammatory) Gardner's |
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Gardner's Syndrome
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Adenomas
Sebaceous cysts Osteomas Desmoid tumors |
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Benign Hepatic Neoplasms
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➢Hemangioma
➢Focal nodular hyperplasia (FNH) ➢Hepatocellular adenoma ➢Bile duct cyst ➢Biliary cystadenoma/cystadenocarcinoma ➢Lipomatous tumors |
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Liver Hemangioma - features
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Most common benign hepatic tumor
• More common in women, 5:1 ➢Estrogen influences ➢May enlarge during pregnancy |
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Focal Nodular Hyperplasia - CT Features
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• Noncontrast
➢Iso- or hypodense ➢Hypodense scar • Arterial ➢Rapid enhancement ➢Hypodense scar • Portal venous ➢Iso- or hypo- or hyperdense ➢Delayed enhancement of scar |
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Focal Nodular Hyperplasia - MR Features
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• T1 isointense
➢Low signal scar • T2 iso or slightly hyperintense ➢High signal scar • Gd-DTPA ➢Rapid homogeneous enhancement ➢May have flash enhancement ➢Delayed enhancement of the scar ➢Rim-like enhancement late • T2 with ferumoxide ➢Lesion decreases signal ➢Except scar |
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Lipomatous Liver Tumors
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• Angiomyolipoma
➢Benign ➢Composed of adipose, smooth muscle, and blood vessels ➢Most cases sporadic ➢Tuberous sclerosis in 6% • Myelolipoma ➢Rare ➢Benign ➢Composed of myeloid, adipose, and blood vessels |
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DDx Hepatic Calcifications
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* INFXN: granulomatous, echinococcal cyst,
CMV, Toxo, old pyogenic/amebic abscess, schistosomiasis, cysticercosis * VASCULAR: hepatic artery aneurysm, portal vein thrombosis, hematoma. * BILIARY: intrahepatic calculi, ascariasis, clonorchiasis * BENIGN TUMOR: congenital cyst, cavernous hemangioma, adenoma, capsule of regenerating nodule. * PRIMARY MALIGNANCY: HCC, hepatoblastoma, intrahepatic cholangiocarcinoma, hemangioendothelioma, cystadenocarcinoma * MET: Mucin producing neoplasms (colon, breast, stomach), ovarian, melanoma, thyroid, chondro/osteosarcoma, neuroblastoma |
