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161 Cards in this Set
- Front
- Back
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What are the radiographic findings in a pt with toxic megacolon
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marked dilation and thickening of transverse colon with nodular haustral pattern
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What is the clinical presentation of toxic megacolon
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Pts systemically toxic (very ill)
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What is the MC clinical cause of toxic megacolon
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Usually the result of fulminant IBD
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What is the DDX of toxic megacolon
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ischemia
infectious colitis (esp in AIDS: CMV) pseudomembranous colitis |
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What is very important to look for in a pt with toxic megacolon
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perforation.
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What are the 2 MC causes of colonic volvulus
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Sigmoid #1
Cecal #2 |
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What are the radiographic findings in cecal volvulus
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-Single large dilated loop (by its size must be colon), which usually lies upward and to the left
-Small bowel usually is dilated, rest of colon is not -BE shows a bird’s beak at the site of obstruction |
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What is a major hit that bowel is colon in volvus
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it is so large it must be colon
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What is the cause of pancreatic divisum
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Failure of fusion of dorsal and ventral pancreatic buds
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What does the santorini duct drain
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Santorini drains body, tail, superior portion of head into minor papilla during development but after fusion becomes the acessory duct
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What does wirsungs duct drain
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Wirsungs drains inferior head and uncinate via major papilla during development but becomes main duct
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What duct is known as the ascessory duct
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santorini
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What is the main duct
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wirsung
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What are the findings in pancreatic divisum on ercp
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If major papilla cannulated, only ventral duct fills
If the minor papila is cannulated only the dorsal duct fills |
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What is the 2nd MC benign liver tumor
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FNH
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What demogrphaic commonly get FNH
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women
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What liver tumor contains kupffer cells
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FNH
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How does FNH appear on NCCT
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hypodense
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How to does an FNH appear on CECT
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intense rim enhancement during arterial and portal phases with rapid wash out except in the scar.
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What are FNH known for
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the central scar
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What may be seen in a HIDA with TC DISIDA
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FNH
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What is the appearance of FNH on angiograms
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hypervascular spoke wheel appearance
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How does FNH appear on MR?
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iso or slightly hyperintense on T2
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Although the non-scar portion of an FNH appears iso/slightly hypertense on T2, how does the scar look on T2
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bright.
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What other difference between the scar of FNH and other portion
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rapid enhancement and washout but the scar has delayed enhancement and washout
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What other neoplasm of the liver often has a central scar
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fibrolamellar hcc
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What is a typical pattern of whipple disease
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Findings: thickened proximal SB folds with micronodularity (1-2 mm) and low density mesenteric adenopathy
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What is whipples disease
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Rare chronic bacterial infectious and systemic disease leading to chronic diarrhea, malabsorption
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What findings outside of the intestines are expected to be found in whipples disease
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mesenteric adenopathy
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What is the ddx of nodular fold thickening and adenopathy
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opportunistic infections
Dysgammaglobulinemia lymphoma |
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Name 2 opportunistic infections that may have a nodular appearance
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giardiasis
cryptosporidium |
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What is the appearance of giardiasis
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duodenum/jejunum, thickened irregular folds
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What is the appearance of cryptosporidium
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duodenum/jejunum, thickened folds
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What is the appearance of MAI
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Low density nodes, thickened folds, no nodules
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What opportunistic infection will have low density nodes
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MAI
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What is Budd-Chiari syndrome
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obstruction of hepatic venous outflow at level of the hepatic veins or IVC
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What is the cause of bud chiari syndrome
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congenital obstructing membrane
secondary |
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What are the secondary cause of budd chiari syndrome
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tumor (HCC, hepatic mets, RCC)
OCPs chemo polycythemia vera hypercoagulable state parasites |
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What are the findings of budd chiari
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-thrombus in hepatic vein or IVC
-Liver enlarged -decreased density peripheral relative to central/caudate lobe during early arterial phase -“Flip flop” later, as contrast washes out centrally but persists peripherally -Caudate lobe spared b/c it has separate venous drainage to IVC, and eventually the caudate enlarges |
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Why is the caudate spared in budd chiari
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Caudate lobe spared b/c it has separate venous drainage to IVC, and eventually the caudate enlarges
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What is the cause of cardiac cirrhosis
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Venous congestion from heart failure or constrictive pericarditis
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What are the radiographic findings of cardiac cirrhosis
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-Nutmeg liver: mottled enhancement
-Reflux of contrast material into dilated hepatic veins -Cardiomegaly -Hepatomegaly -periportal lucency -Ascites -pleural and pericardial effusions -Pulsatile portal vein waveform on US |
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What is finding of CHF when contrast is given
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reflux of contrast into the IVC and hepatic veins
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How does a mesenteric hematoma appear
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injury to mesentery produces ST density in the mesentery
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What is associated with mesenteric hematoma
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bowel injury
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What should be ordered if there is a mesenteric hematoma
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a CECT to evaluate for hepatic, splenic and other visceral injury
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What is the DDX of a solitary gastric mass (less than 2 cm)
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Hyperplastic polyp (usually multiple)
Adenoma GIST (common), lipoma, neurofibroma, hemangioma (those 3 not common) Ectopic pancreas (usually on greater curve of antrum) Mets (target lesion from melanoma, breast, lung, or KS) Carcinoid |
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What radiographic findings suggest ectopic pancreatic tissue
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small intramural gastric mass with central umbilication is diagnostic
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What is the ddx of a solitary gastric mass greater than 2 cm
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Gastric CA
Adenoma GIST Mets Duplication cyst |
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What is the cause of a gastrocolic fistula along the greater curve
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NSAIDs
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add to prior
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gastric cancer
adenocarcinoma of splenic flexure and transverse colon |
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What are other less common causes of a gastrocolic fistula
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lymphoma, crohn, tb
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What is a better test to evaluate for gastrocolic fistula; BE or UGI
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BE
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What are 2 types of hiatal hernia
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paraesophageal
slidding hiatal hernia |
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What is a slidding hiatal hernia
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Gastroesophageal (GE) junction and gastric cardia pass through esophageal hiatus
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What is a paraesophageal hernia
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Gastric fundus ± other parts of stomach herniate into the chest
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What is an organoaxial gastric volvulus
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Rotation of all or part of the stomach by more than 180 degrees (greater curve is superior)
rotates at long axis |
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What are the 2 types of gastric volvulus
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organoaxial (MC) and mesenteroaxial (less common rotates left to right ..think about the hanging mesentery being the axis of rotation)
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can an organoaxial obstruction lead to a closed loop obstruction and strangulation
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yes
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Can a gastric volvulus be an incidental finding
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yes, it may also present with severe pain
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What is the MCC of doudenal hematoma
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blunt trauma
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What demographic mc gets a doudenal hematoma
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peds from abuse or a bicycle handle bar injury
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What is the cause of a meckel diverticulm
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persistane of the omphalomesenteric duct
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Where does a meckel diverticulum occur
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100cm of the IC valve
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What percent of meckels diverticulm have gastric mucosa
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less than 50%
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What may a meckels diverticulm mimic
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appendicitis
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What are the complications of meckels
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bleeding
obstruction (intussusception) diverticulitis enterolith perforation neoplastic transformation |
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What type of scan is used to visualize a meckels if there is gastric mucosa
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Tc99m pertechnetate
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What is the cause of thumbprinting of the colon
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thickened haustral folds due to submucosal edema or hemorrhage
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Where is the mc location of ischemic colitis
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splenic flexure
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What is more common cause of ischemic colitis; hypoperfusion or thrombus/embolus
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hypoperfusion
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What are the findings of ischemic colitis
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segmental wall thickening with thumbprinting
pneumotosis intestinalis PVG |
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What is primary sclerosing cholangitis associated with
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with UC
but also associated with riedel thyroiditis, crohns, retroperitoneal and medistinal fibrosis |
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What are the findings in ERCP of primary sclerosing cholangitis
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diffuse or localized narrowing with beaded appearance.
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Does primary sclerosing cholangitis involve intra or extrahepatic ducts
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extrahepatic and intrahepatic
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What is the ddx of the beaded appearance of the biliary ducts seen in PSC
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AIDS cholangiopathy
recurrent pyogenic cholangitis hepatic arterial chemoembolization post liver transplant hepatic arterhy thrombosis |
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What percent of PSC get cholangiocarcinoma
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15%
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Does chronic pancreatitis lead to irregularities and dilation of the pancreatic duct
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yes
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What are the MCC of chronic pancreatitis
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alcohol and gallstones
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3 findings in chronic pancreatitis
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dilated pancreatic duct
calc atrophic pancrease |
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can chronic pancreatitis lead to a CBD stricture
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yes
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What are the findings of choledocholithiasis
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bile duct dilation
eccentric filling defect |
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What is a concern if there is an irregular abrupt transition at the ampulla
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malignancy
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What is a concern if there is a focal circumferential stricture post cholectomy
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benign stricture
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What are the 4 categories of ddx of biliary stricture
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inflammation
neoplasm trauma extrinsic compression |
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What are the inflammatory of biliary stricture
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pancreatitis, stone passage, ischemia, recurrent infection/cholangitis
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What are the neoplastic causes of biliary stricture
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cholangioCA, pancreatic CA
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What are the traumatic causes of biliary strictures
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surgery or otherwise
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What are the extrinsic causes of biliary narrowing
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pancreatitis, mets (lung, breast, GI) in porta hepatis, peripancreatic or periduodenal nodes from lymphoma or reactive, Mirizzi, GB CA, liver tumor
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What is the ddx of a pancreatic head mass with biliary dilation
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pancreatic cancer
pancreatitis |
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What are the radiographic finding of pancreatic ca
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focal enlargement of pancreas,
-hypoechoic/ hypodense/ hypointense mass - possible duct dilation parenchymal atrophy |
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What is the double duct sign
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dilation of the PD and the CBD
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What are the findings in an UGI of pancreatic carcinoma
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-compression invasion of stomach, doudenum or transverse colon
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What are the risk factors of pancreatic ca
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smoking
alcohol DM pancreatitis fm hx |
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What is the criteria for unresectability of pancreatic ca
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-greater than 5 cm
-adjacent tissue or organ invastion (not including doudenum) -arterial stenosis, occlussion or encasement -liver mets -adenopathy -peritoneal carcinomatosis -venous invasion |
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What are causes of portal vein thrombosis
7 |
tumor
budd-chiari passive hepatic congestion polycythemia vera hypercoagulable state sepsis abdominal abscess |
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What are tumors that may cause PVT
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hcc
liver mets pancreatic ca |
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What tends to happen to the portal vein if there is a thrombosis
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increases (>13mm is suggestive)
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What are the radiographic findings of PV thrombosis
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low density thrombus in the pv
portal vein not enhancing ca in portal vein cavernous transformation portal htn |
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What are ss of chronic pv thrombosis
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cavernous transfromation
portal htn |
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What is the ddx of multiple hyodense solid liver lesions
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lymphoma
multifocal hcc hemangiomas adenomas mets |
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If there are multiple hyodense lesion what lab may be useful
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afp
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What is the finding of lymphomatous invasion of the cecum
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thickening of the cecum with surrounding stranding
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Where is the MC location of typhlitis
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cecum
right colon |
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Can typhylitis involve the TI
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yes
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What is the ddx of right colon wall thickening
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typhlitis
infection inflammation neoplasm ischemia (atypical) crohns |
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What are the MC infectious causes of right sided colon thickening
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amebiasis
TB actinomycosis |
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What are the inflammatory causes of right sided colonic wall thickeing
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appendicitis
diverticulitis |
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What are the mc neoplasms that cause right sided colonic wall thickening
3 |
colon ca
lymphoma mets |
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What is a common vascular complication of pancreatitis
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pseudoaneruysms
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Name 5 complications of pancreatiis
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psuedoaneurysm
fluid collections pancreatic necrosis pancreatic hemorrhage thrombosis of adjacent vessels |
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What are 4 fluid collections that may result as a result of pancreatisis
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ascites, pseudocyst, phlegmon
abscess |
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What are the 3 MC pseudoaneurysms
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splenic artery
GDA superior pancreaticodoudenal |
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What percent of cases of cholecystitis have gallstones
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95%
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What is considered a dilated gb which may be seen in cholecystisi
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greater than 5cm
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What is considered an enlarged gb wall
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greater than 3mm
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Is there often a halo of subserosal edema seen on CT in cholecytitis
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yes
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Can there be increased GB wall enhancement and increased density of the bile in the GB
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yes (bile may be greater than 20 Hu)
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Most obvious finding for cholecystitis
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stranding
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What do you see in emphysematous cholecystitis
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air in lumen or wall.
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What is the cause of gangrenous cholecystisis
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severe GB inflammation
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What are 3 findings of gangrenous cholecystitis
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pronounced intramural edema
sloughing of GB mucosa in lumen pericholecytic fluid from perforation |
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What percent of HCC arise in cirrhotic livers
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80%
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What are the risk factors of HCC
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alcoholic, hepatitis, parasitic infx, hemochromatosis
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Can HCC present focal, multifocal or infiltrative
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yes, Focal is MC
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What is the appearance of HCC on CT
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hypodense
enhances in arterial phase early washout |
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What percent of HCC have calcification
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25%
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Is necrosis common in HCC
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yes
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What vessels should be evaluated for invasion if you suspect HCC
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portal vein
hepatic veins IVC |
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How do you differentiate an abscess from a psuedocyst
3 |
thicker wall
may have gas clinical signs of infection |
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Name 3 unusual location that a pancreatic pseudocyst can be located
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liver
spleen thorax |
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Can a pseuodcyst have septations
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yes
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What are complications of a pseudocyst
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rupture
bleeding infection |
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What are the CT findings of acute pancreatitis
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focal or diffuse gland enlargement
focal or diffuse decrease density blurring of pancreatic margins peripancreatic stranding thickening of retroperitoneal fascial planes |
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What type of mesenteric mass is associated with gardners polyposis
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desmoid tumors
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Is gardners syndrome AD
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yes
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What types of polyps are present in a pt with gardners syndrome
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adenomatous
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Where is the MC location of polyps in gardners syndrome
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colon and doudenum
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What percent of pts with gardners get colon ca
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100%
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What are the extra-intestinal findings of gardners syndrome
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sinus osteomas
epidermoid cyst abdominal desmoid |
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What is the treatment for gardners syndrome
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colectomy
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Name the polypsis syndromes
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FAP
gardners turcots hereditary non-polyposis colon cancer syndrome (lynch syndrome) peutz-jeghers cowdens cronkhite-canada syndrome juvenile polyposis |
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Which syndromes have hyperplastic and adenomatous polyps
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FAP
gardners turcots |
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What is the only syndrome that has adenomatous polyps but not hyperplastic
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Lynch syndrome
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Which polyposis syndromes have hamartomas
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peutz jeghers
cowdens cronkhite-canada juvenile polyps |
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Is familial adenomatous polyposis an umbrella term that also includes gardners and turcots syndromes
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yes
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What is FAP and extraintestinal manifestations such as desmoid tumors, osteomas, epidermoidcyst and papillary thyroid cancer
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gardners
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What is FAP and extraintestinal manifestations such as CNS tumurs; gliomas and medulloblastomas
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turcots
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What polyposis is associated with gynecologic malignancies
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peutz jeghers
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Do pts with peutz jegher have increased risk of gastrodoudenal and colonic malignancy
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yes
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What cancers is lynch syndrome (HNPCCS) associated with
6 |
endometerium
stomach small bowel liver biliary brain ovarian uretere renal pelvis cancer |
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What 2 polyposis syndromes have mucocutaneous abnormalities
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peutz-jeghers and cowden
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What are the findings in cronkhite canada
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stomach, small bowel, colon and ectodermal changes (skin, hair and nails)
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What percent of intussusception are idiopathic
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90%
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What are some common causes of intussusception in adults
6 |
benign tumors
malignant tumors meckels ectopic pancreatic rest fb feeding tubes |
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What are benign tumors which may lead to intussusception in an adult
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lipoma, leiomyoma, GIST, adenoma
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What are 3 complications of an intussusception
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obstruction
ischemia perforation |
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What diseases may lead to intussusception
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celiacs
whipples scleroderma |
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What is the appearance of intussusception in a enema
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coiled appearance
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What is the appearance of an intussusception in a US
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target sign
pseudokidney |
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What is the appearance of a intussusception on CT
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donut sign with fat b/w the 2 loops
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