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153 Cards in this Set

  • Front
  • Back
What percent of esophageal cancer in SCC
85-90%
What type of cancer results from esophageal cancer after barretts
adeno (10%)
What are the 4 basic radiographic patterns of esophageal cancer
annular constricting
polypoid
infiltrative
ulcerated mass
What is the least common pattern of esophageal cancer
ulcerated mass
What is the appearance of the annular constricting pattern
irregular ulcerated stricture
What is the appearance of the polypoid pattern of esophageal cancer
intraluminal filling defect
What is the appearance of the infiltrative pattern of esophageal cancer
grows in the submucosa and may simulate a benign stricture and may also have a varicoid appearance
What is the most common pattern of esophageal cancer
annular constricting (ulcerated mass is the least commmon)
What is the ddx of a large intraluminal esophageal neoplastic mass
4
spindle cell ca, squamous cell ca, leiomyosarcoma, fibrovascular polyp
Are fibrovascular polyps diffuclt to diagnose with an esophagram
yes, Pedunculated fibrovascular polyps are rare lesions, that are difficult to diagnose on esophagrams. Their movement during the examination producing an inconstant position and shape may be suggestive. The stalk is often difficult to identify.
What are the findings in a patients that has an esophageal leimyoma
intramural mass
calcification
ulcerations possible
What is the most common benign esophageal mass
leiomyoma (50%)
What is the ddx of a leiomyoma
8
fibroma
neuroma
neurofibroma
lipoma
hemangioma
enetric duplication cyst
lymphoma
can a leimyoma have an exophytic component
yes (outside the esophagus lumen)
What does a GIST arise from
smooth muscle of the stomach wall
Where with in the stomach wall can a GIST be located
3
submucosal
subserosal
exophytic
What is common characteristic of a GIST
2
large and ulcerated
Do GIST tumors commonly bleed
yes
What is the DDX of a solitary doudenal mass
9
Met
adenocarcinoma
lymphoma
leiomyoma
GIST
adenoma
prolapsing gastric mucosa
brunner gland adenoma
ectopic pancreatic rest
gastric polyp
What does a ectopic pancreatic commonly have
a central dimple
What is the DDx of nodular doudenal mucosa
ectopic gastric mucosa
brunner gland hyperplasia
nodular lymphoid hyperplasia
villous adenoma
varicies
edema/hematoma
doudenitis
Name 3 types of internal hernias
paraduodenal (left or right)
paracecal lesser sac
transmesenteric
What is the most common internal hernia
paradoudenal (left)
What is the cause of a paraduodenal hernia
related to abnl development of transverse mesocolon, with bowel loops becoming trapped
Where is the location of a right and left paraduodenal hernia
R: lies behind hepatic flexure, extends through fossa of Waldeyer
L: extends through fossa of Landzert, with jejunal loops in the LUQ
Where is the pathway of a direct inguinal hernia
Direct: passes medial to inferior epigastric vessels
What is the pathway fo an indirect inguinal hernia
Indirect: more frequent, 15% of all SBOs, passes lateral to inferior epigastric vessels
What is a paradoudenal hernia
Protrusion of bowel loops through mesenteric defect within abdominal cavity
What are the pathways of a left and right paradoudenal hernia
Left: Herniation via abnormal mesenteric fossa of Landzert
Right: Herniation via abnormal mesentericoparietal fossa of Waldeyer
What is the appearance of a paradoudenal hernia
it appears as if the bowel loops are in a sac
If a patient has mass affect on the cecum and wbc what should be suspected
mass effect from abscess from diverticulitis or appendicitis
What muscle margings might be obscured with appendicitis on KUB
psoas or obturator margins
What might percent of normal be will showing non-filling of the appendix
20%
What are some radiographic of appendinx in a barium enema
2
mass effect on medial cecum or TI
non-filling of appendix
What is considered an enlarged appendix by CT
diameter of >6mm
What are the CT findings of appendicitis
thick walled/dilated appendix
wall enhancement
periappenciceal stranding
appendicolith
abscess/phlegmon
What are three descriptive terms for an adenoma
tubular
villous
tubulovillous
What type of adenoma has the highest malignant potential
villous
Describe a villous adenoma
Adenomatous polyp that contains predominantly villous ("shaggy" surface) elements
What does a villous adenoma look like on a CT or BE
Polypoid lesion with nodular or frond-like surface on BE or CT colonography
What is frond like
the leaves of a fern
Are villous adenomas almost alway sessile
yes
Where do 50% of adenomas occur
the rectosigmoid
What is the colon cancer risk with a villous adenoma
< 5 mm = < 0.5%
5-10 mm = 1%
10-20 mm = 10%
> 2 cm = 50%
What does sessile refer to
a broad based lesion (not on a stalk)
What is a bowlers had a sign of in a double contrast study
a sessile polyp
What is the mexican hat a sign of in a double contrast study
Pedunculated polyps: Arise from narrow stalk
Do villous adenoma have a bowlers had sign
no they have a fern like luminal margin
Where do 50% of adenomas occur
recto-sigmoid
What are the risk factors for colon cancer
7
adenomatous polyps
family history
crohns
UC
breast cancer
endometrial cancer
pelvic irradiation
What causes a greater increase of colon ca; UC or Crohns
UC
What is the duke staging criteria of colon ca (a-d)
A: limited to mucosa
B: into (B1) or through (B2) muscularis propria w/o nodes
C: with nodes (C1 and C2 as in B)
D: distant mets
What is BI in the duke staging criteria
into the muscularis propia
What is B2 in the duke staging criteria
through the muscularis propia
What is C in the duke staging for colon ca
Nodes
What is by far the MC of an annular constricting lesion of the colon
colon ca
What is the ddx of annular constricting lesion of the colon
3
colon ca
ameboma
mets
What is the ddx of colonic mass or filling defect
9
benign tumor
malignant tumor
colitis cystica profunda
pseudopolyps
normal lymphoid tissue
post inflammatory polyps
endometriosis
mucocele
pneumotosis coli
Name 2 benign colonic masses
polyp
lipoma
Name 3 malignant tumors of the colon
adenoCa
lymphoma
mets
What demographic most commonly gets hyperplasia of normal lymphoid tissue
children
What part of the colon will typically get endometriosis
inferior sigmoid
Describe the classic findings of a mucocele of the colon
smooth filling defect at the base of the cecum
Is the 'mass' caused by endometrosis in the colon intraluminal
no,it is extrinsic mass effect associated with colonic implant
What is the density of a mucocele on CT
low density (less than muscle more than fat)
What is another name of postinflammatory polyps
filiform polys
What patient will classicaly have filiform polyps
UC
Do filiform polyps occur in crohns patients
yes
What is a filiform polyp
A projection of normal mucosa, which is usually comma shaped left by UC or other inflammatory condition
What is thumbprinting a sign of
submucosal edema or hemorrhage
What study do you classically see thumbprinting
single contrast barium enema
What is the accordion sign
this is what is seen on oral/barium contrast CT when there is significant wall thickeing
Is it OK to do a barium enema if a patient has Pseudomembranous colitis
NO! (risk of perf)
What are the barium enema findings if one happend to be done in pseudomembranous colitis
BE: shaggy, irregular colonic contour due to pseudomembranes w/barium filling clefts b/w them
What is the DDX of pseudomembranous colitis
3
DDx: ischemia, UC, other infectious colitis
What is the accordian sign
CT: accordion sign (intraluminal contrast interposed b/w markedly thickened haustra), marked bowel wall thickening involving entire colon, low attenuation bowel wall
What are the radiographic findings of CMV colitis
Marked ulceration and nodularity of mucosal surface, similar to Crohn disease.
What finding in a DC BE for UC
5
granular or stippled appearance
distribution of dz is continous from rectum with out skip lesion

Circumferential bowel wall symmetry is maintained
Mucosal ulcerations affect both sides of the bowel with equal severity
Lead-pipe colon: short, narrow, tubular, and lacks haustrations
Do pt with UC have increased risk of colon ca
yes
What is the DDX of an ahaustral colon
cathartic colon
infectious colitis
What are the extraintestinal manifestations of UC
8
Erythema nodosum
pyoderma gangrenosum
Primary sclerosing cholangitis cholangioCA
Arthritis
sacroiliitis
spondylitis
Iritis
What are the MSK of UC
3
arthritis
sacroilitis
spondylitis
What is mirizzi syndrome
large stone at the junction of cystic and common hepatic duct resulting in obstruction of both these ducts
Describe the narrowing of mirizzi syndrome
Usually narrowing is eccentric, worse on the right side
Do pt with mirizzi syndrome usually have cholecystitis
yes
Is there intrahepatic duct dilation in mirizzi syndrome
yes
What is an annular pancreas
a pancreas that encircles the 2nd portion of the doudenum
What are complications of annular pancreas
pancreatitis, obstruction
What are 3 causes of liver abscess
pyogenic
amebic
echinococcal
Where do most pyogenic abscess originate
the billiary tree
What are other areas of origin for pyogenic abscess
portal vein
hepatic artery
direct spread from adjacent organ
What do pyogenic liver abscess look like on CT
hypoattenuating lesion with rim enhancement
What percent of hepatic pyogenic abscess have gas
20%
Are septations common in pyogenic liver abscess
yes
What percent of pyogenic liver abscess are right lobe
80%
What percent of pyogenic liver abscess are multiple
66%
What is the mc location of amebic abscess of the liver
Usually peripheral, in right lobe
Do amebic abscess tend to be unilocular or multilocular
unilocular
What is the configuration of echinococcal cyst
usually have smaller daugther cyst within a larger cyst
What is the water lily sign of hydatid cyst
detached cyst membrane may float inside the cyst
What is another name for echinococcus
hydatid
What is generally seen surrounding an amebic abscess on CECT
low attenuation rim of edema
Where are the daughter cyst in relation to a hydatid cyst
peripheral “daughter” cysts
What neoplasm is in the ddx for hydatid cyst
biliary cystadenoma will be multilocular with peripheral cyst.
What should you suspect if a pancreas does not enhance post contrast
necrotizing pancreatitis
What is necrotizing pancreatisis
Devitalized pancreatic tissue secondary to acute pancreatitis and resultant ischemia
Describe necrotizing pancreatitis finding on NCCT
Diffuse or localized decrease in density of pancreatic parenchyma
Does necrotizing pancreatitis require surgery for debridement
yes
What is a good way to differentiate steatosis of the liver from a mass
look for normal branching vessels traversing the fatty area.
What do you expect to see in out of phase GRE in fatty areas
loss of signal in high fat areas.
What is the causes of hepatic steatosis
8
DM, pancreatitis, obesity, alcoholism, malnutrition, steroids, glycogen storage disease, chemotherapy
What are the 2 most common areas of fatty liver (and fat sparring)
adjacent to the ligamentum teres and GB fossa
Name 5 characteristics that might help differentiate focal fat from tumor
geographic borders
interdigitation of borders with adjacent nl liver
lack of mass effect
normal branching vessels
rapid change over time
If extensive retroperitoneal LAD is seen what should be suspected
lymphoma
What does lymphoma look like on CT or MRI
Multiple enlarged individual nodes or conglomerate nodal masses
What organ is commonly enlarged in lymphoma
the spleen.
Can lymphoma encase vessels, displace organs, or obstruct ureters
yes
What are the 3 spaces of the retroperitoneum
perirenal
anterior pararenal
posterior pararenal
What is the difference between the radiographic appearance of a pneumoperitoneum and a pneumretroperitoneum
Retroperitoneal air is more fixed in location than peritoneal air and tends to be linear in shape
What type of enhancement does a cavernous hemangioma have on CECT
nodular pattern of enhancement with central fill in
What is the 2nd mc liver mass
cavernous hemangioma

(mets mc)
Can lymphoma encase vessels, displace organs, or obstruct ureters
yes
What are the 3 spaces of the retroperitoneum
perirenal
anterior pararenal
posterior pararenal
What is the difference between the radiographic appearance of a pneumoperitoneum and a pneumretroperitoneum
Retroperitoneal air is more fixed in location than peritoneal air and tends to be linear in shape
What type of enhancement does a cavernous hemangioma have on CECT
nodular pattern of enhancement with central fill in
What is the 2nd mc liver mass
cavernous hemangioma

(mets mc)
Do women tend to get hemangiomas more
yes
What percent of pt with hemangiomas have multiple liver hemangiomas
10%
Describe the findings of a hemangioma on CT
Well-defined hypodense mass

Peripheral globular enhancement with gradual filling in

Retention of contrast on delayed imaging
Describe the findings of a liver hemangioma on MR
bright T2

same contrast findings as CT
What is DDX of a bright T2 liver lesion on MR
cyst
cystic mets
neuroendocrine mets
What is the ddx for the nodular peripheral enhancement as seen in a cavernous hemangioma
3
treated met
hemangioendothelioma
angiosarcoma
What is the ddx for calcified liver lesions
10
ovarian cancer mets
granulomatous dz
parasites
pcp
multiple abscesses
echinococcus
mucinous tumors
melanoma
osteosarcoma
HCC
hemangioma
cyst
multiple aneurysms
What is the ddx for mucinous tumors
colon
breast
ovary
stomach
Type 3 choledochal cyst
dilated at the ampula
Type 1 choledochocele cyst
fusiform dilation of CBD
type 2 choledochocele cyst
CBD diverticulum
type 4a choledochocele cyst
intrahepatic and extrahepatic
type 5 choledochocele cyst
intrahepatic only
What is type 5 choledochocele cyst also known as
caroli disease
Is TB associated with a psoas abscess
yes
What are common causes of psoas abscess
5
TB
surgery
hematogenous spread
IVDA
colonic process
What are 4 colonic processes that may lead to a psoas abscess
diverticulitis
crohns
appendicitis
perforating neoplasm
Is it possible to definitively differentiate from hepatic adenoma, FNH and HCC reliably on US
no
How often is fat, calcification, and hyperdense hemorrhage seen in a hepatic adenoma
Fat is demonstrated on CT in 7% of cases; coarse calcifications seen on CT in 5%; hyperdense hemorrhage is seen in up to 40%.
Do hepatic adenomas have prompt arterial enhancement and wash out
yes, and this makes it difficult to differentiate from HCC
What demographic tends to get a hepatic adenoma
females on OCP
Are hepatic adenomas usually big or small
big often >10cm and are often solitary
What is a concern about a hepatic adenoma
bleeding (usually bleed internaly but can rupture into the peritoneum)
What are the findings on NCCT in pts with hepatic adenoma
usually hypodense (often very hypodense, almost like fat), but can have hyperdense areas related to hemorrhage
What are the findings in CECT in a pt with a hepatic adenoma
peripheral and then centripetal enhancement similar to hemangioma, except there is rapid washout
What are the findings on MR in pts with hepatic adenoma
T1: usually bright due to fat, may have additional bright areas related to hemorrhage
Often heterogeneous due to hemorrhage and necrosis
Helpful feature is dilated vessels at the periphery
What are the findings on US in pts with hepatic adenoma
More often hyperechoic, and can have central hypoechoic areas of necrosis and hemorrhage