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52 Cards in this Set

  • Front
  • Back
what separates left and right lobes superiorily?
middle hepatic vein
what divide segments of left and right lobes of the liver at the superior level?
LEFT: left hepatic vein seperates lateral and medial segments; RIGHT: r hepatic vein separates anterior and posterior segments
what proportion of bloodflow to liver from hepatic A. and portal V.?
hepatic artery: 20%; portal vein: 80%
attentunation of abdominal organs on C- CT
Liver > Spleen > Pancreas > Kidney
three types of malignant primary liver tumors
HCC (hepatocellular), CHOLANGIOCARCINIMA (biliary epithelium), ANGIOSARCOMA (mesenchymal)
three types of benign primary liver tumors
focal nodular hyperplasia (hepatocellular), simple hepatic cyst (biliary epithelium), hemangioma (mesenchymal)
findings in autosomal dominant polycystic dz
multiple cysts in liver and kidney, with secondary splenomegaly
charactersitics of simple cyst on CT
homogenous waterdense lesions with imperceptible wall
what liver pathology causes diffuse increased echogenicity?
fatty infiltration, cirrhosis, diffuse HCC, AIDS
what liver pathology causes diffuse decreased echogenicity?
hepatitis, amyloid
what does hemangioma look like on CT, US, and MRI?
CT: C+ early dense PERIPHERAL ENHANCEMENT with delayed centripetal filling; US: hyperechoic with enhanced through transmission; MRI: T1 hypointense T2 hyperintense
most common benign tumor of the liver
hemangioma
fat and fluid on T1 and T2
fat: bright, fluid: dark (opposite on T2)
characteristic feature of focal nodular hyperplasia (FNH)
central stellate scar; also, has functional kupffer cells / hepatocytes --> can use uptake imaging
Focal nodular hyperplasia (FNH) on CT/US/MRI
CT: C- hypodense +/- CENTRAL SCAR (30%), C+ early enhancement; US: hypoechoic with inc flow from central feeding vessel; MRI: Gd-BOPTA test of choice, ISOINTENSE with liver on 2 hr delay due to similar excretion into biliary tract
what is Gd-BOPTA
used for liver MRI; taken up by hepatocytes and then excreted into biliary system
hepatocellular adenoma vs FNH on Gd-BOPTA
both take up Gd-BOPTA, but adenoma is not connected to biliary system --> low signal on delayed views, unlike FNH which maintains isodensity
hepatocellular adenoma on CT/US/MRI
consists of fat and glycogen --> CT: hypodense with hyperdense enhancment on C+; US: HYPERechoic, heterogenous if necrosis/hemorrhage; MRI: fat --> darkens on T1 from in phase to out of phase, low signal on delayed GdBOPTA
which is more common, liver mets or primary liver tumors?
liver mets 20x as common, unless cirrhosis or hemochromatosis --> HCC more common than mets
radiologic test of choice for HCC
triple-phase CT: C- low attenuation; C+: ARTERIAL phase: hyperdense; PORTAL phase: hypodense; EQUILIBRIUM phase: hypodense with hyperdense pseudocapsule [because HCC receives blood from hepatic artery, while liver only receives 20% from hepatic a.]
what does leiomyosarcoma look like on CT?
large, noncalcified, homogenous mass with inhomogenous peripheral enhancement
what hepatic pathology more common in young women on OCP
hepatic adenoma and FNH
causes of psammomatous calcification of hepatic mets
mucinous cystadenocarcinoma of the GI tract (colon, stomach, pancreas); serous cystadenocarcinoma of the ovaries
radiologic findings with cirrhosis
early: hepatomegaly +/- fatty infiltration; late: shrunken, nodular liver with portal HTN, hypertrophied caudate lobe and sometimes left lobe (dual blood supply),
what do regenerating nodules and fibrosis look like on MRI?
regen nodules bright on t1, fibrosis dark; opposite for t2
where do varices of portal HTN tend to cluster?
splenic hilum
how to diagnose fatty infiltration by imaging
MRI: T1 --> fat changes from bright (in phase) to dark (out of phase)
causes of high attenuation liver (CT)
infiltration: hemosiderosis, hemochromatosis, amiodarone, gold therapy, wilson's disease, glycogen storage disease, thorotrast
diff between hemochromatosis and hemosiderosis
hemochromatosis: Fe in parenchyma (not RES) --> liver and panc with end-organ dystruction, no spleen involvement; HEMOSIDEROSIS: Fe in RES only --> liver and SPLEEN, pancreas spared, no end-organ dysfunction
how to dx iron deposition in the liver (imaging)
MRI: T1 --> dark out of phase, even darker in phase (opposite of fat)
mcc biliary tract air
iatrogenic or fistula
only potentially curative tx for HCC
surgical resection
blood supply to HCC vs liver parenchyma
HCC is 100% hepatic artery; parenchyma is 20% hepatic a., 80% portal v
regenerating nodules vs siderotic nodules on imaging
regen nodules bright on t1, siderotic nodules dark on t1
between what two arteries is the pancreas found?
below the celiac trunk, above the SMA, anterior to the aorta
in what renal space is the pancreas found?
anterior pararenal space (along with duodenum and descending colon)
what risk increased with pancreas divisum? What is it?
most commong congenital variant -- failure to fuse of dorsal and ventral pancreatic heads --> 2 openings into duodenum --> INCREASED risk of PANCREATITIS, perhaps b/c second opening too small --> backup of enzymes
Balthazar's grading system for pancreatitis (5)
A: NORMAL pancreas; B: focal or diffuse pancreatic EDEMA; C: ABNORMAL pancreas + peripancreatic INFLAMMATION; D: small, single FLUID collection; E: >=2 large fluid collections +/- gas
what characteristic radiologic finding on plain film for pancreatitis
"splenic cutoff sign:" abrupt tapering in proximal descending colon (due to spasm); also, "sentinal small bowel loop" with air fluid levels
what is the "renal halo sign"
seen with pancreatitis: fluid collection develops in anterior pararenal space, makes perirenal fat more promient, looks like a halo around the kidneys
what does pancreatic necrosis look like on CT?
no enhancement on C+ CT
what causes diffuse changes in echotexture of pancreas?
diffuse hyperechoic: fatty replacement; diffuse hypoechoic: edema
most common pancreatic neoplasm
ductal adenocarcinoma (75%), usu located in the head
CT appearance of pancreatic cancer
hypodense -- usu poorly vascular
US apperance of pancreatic cancer
almost always hypoechoic or with hypoechoic areas
CT criteria of unresectability of pancreatic mass (4)
1) INVASION of surrounding organs; 2) enlarged LYMPH NODES; 3) distant METS; 4) VASCULAR encasement/occlusion
"double duct sign"
both CBD and pancreatic duct dilated -- often seen with pancreatic cancer (other causes: ampullary carcinoma, cholangiocarcinoma, stones)
what is meig's syndrome?
benign ovarian fibroma a/w hydrothorax and ascites
what is krukenberg tumor?
primary GI tumor (pancreatic or stomach) with mets to both ovaries
two big groups of cystic neoplasms
mucinous macrocystic (MALIGNANT) and serous microcystic (BENIGN); both increased freq in women
what is whipple's procedure?
pancreaticoduodenectomy (duodenum/jejunum attached directly to stomach body
how to assess transplant vasculature
color doppler