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231 Cards in this Set
- Front
- Back
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What is the appearance of carcinoid on US
2 |
echogenic
well defined |
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What is the ddx of multiple echogenic liver masses
3 |
Mets
mutifocal HCC multiple hemangioma |
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What are rare causes of multiple hyperechoic liver lesions
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multiple adenomas
lipomas FNH |
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What additional exam should be done if you see multiple liver lesions
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get an MR
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What is the cause carcinoid tumor
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Primary malignant neoplasm, arise from enterochromaffin cells of Kulchitsky
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Where do 90% of carcinoid arise from
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distal ileum
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Does carcinoid result from in a mesenteric mass
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yes it can
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Is carcinoid considered a vascular tumor
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yes
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When carcinoid presents as a mesenteric mass what percent have calcifications
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70%
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When does carcinoid syndrome occur
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when carcinoid tumor metastasis to the liver
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What is the ddx of hypervascular liver tumors
7 |
carcinoid, islet cell, melanoma, choriocarcinoma, pheochromocystoma, breast, thyroid
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What is krukenberg tumor
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mets to the ovary which is usually from the stomach, colon, appendix, breast.
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In the setting of gastric or colon cancer what should a solid tumor of the ovary be considered
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mets til proven otherwise
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What occurs in the earliest phase of cirrhosis
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liver becomes fatty and enlarged
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What study are regenerating nodules most easily seen
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MR
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What two metals do regenerating nodules sometimes contain
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iron, copper
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What is the MR appearance of iron and copper
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iron (low T2), copper (high T1)
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are regenerating nodules bright on T2
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no
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What is a dysplastic nodule
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similiar to regenerative nodules but have varying degree of atypia
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What is a key ratio finding in cirrhosis of the liver
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increased caudate to right lobe ratio
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What are 6 varices that occur with cirrhosis
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paraesophageal
gastrohepatic ligament gastrorenal splenorenal recannulization of the portal vein |
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What is peritoneal carcinomatosis
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intra-abdominal spread of malignant tumor
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What are common causes of peritoneal carcinomatosis
3 |
ovarian
gastric colon ca |
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What are the findings of peritoneal carcinomatosis
3 |
mesenteric mass
aciites omental caking |
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What is the ddx of peritoneal carcinomatosis
3 |
pseudomyxoma peritonei
malignant mesothelioma TB peritonitis |
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What is a good way to differentiate pseudomyoxma peritonei
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pseudomyxoma will have scalloping of the liver edges
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If you see a micronodular pattern of the jejunum what should be suspected
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whipples
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Are there often low density retroperitneal LN associated with whipples
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yes
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What is the DDX for irregular/nodular fold thickening
11 |
Mets
Lymphoma Infections (segmental) Crohn (segmental) Nodular lymphoid hyperplasia Polyposis syndromes Eosinophilic enteritis Amyloid Mastocytosis Waldenstrom macroglobulinemia Lymphangiectasia |
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Are infectious related irregular/nodular fold thickening typically segmental
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yes
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What are the infectious causes of irregular/nodular fold thickening
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Giardia and strongyloides
Salmonella, yersinia, TB, campylobacter (distal bowel/ileum) In AIDS: CMV, MAC, cryptosporidium, isospora belli Whipple (low density lymph nodes) |
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Where do giardia and strongyloides typically effect in the small bowel
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duodenum and proximal jejunum
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Where do salmonella, yersinia, tb and campylobacter typicaly effect
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distal bowel/ileum
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If a pt has AIDS what will cause irregularity of the folds or nodules of the SB
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CMV, MAC, cryptosporidium, isospora belli
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Is crohns SB fold thickening and nodular typicaly segmental
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yes
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What part of the small bowel does giardiasis cause small bowel thickening and nodularity
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the proximal
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Is crohns SB fold thickening and nodular typicaly segmental
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yes
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Can lymphangiectasia cause dilution of barium because of increased intraluminal secretion
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yes
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What part of the small bowel does giardiasis cause small bowel thickening and nodularity
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the proximal
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What is causes the SB wall thickening and nodules in lymphangiectasia
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dilated lymphatics
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Can lymphangiectasia cause dilution of barium because of increased intraluminal secretion
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yes
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What is causes the SB wall thickening and nodules in lymphangiectasia
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dilated lymphatics
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Does lymphoma tend to be diffuse or segmental
What is waldenstrom Macroglobulinemia |
diffuse (nodular and fold thickening)
Waldenstrom's macroglobulinemia is a rare type of cancer; specifically it is a type of non-Hodgkin Lymphoma. Waldenstrom's macroglobulinemia symptoms begins in the B-lymphocytes which are white blood cells. |
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Does lymphoma tend to be diffuse or segmental
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diffuse (nodular and fold thickening), but can be segmental
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Does a serous cystadenoma of the pancreas require surgery
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no it is a benign lesion
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What does a serous cystadenoma look like on US
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Usually lobulated mass with mixed hypoechoic and echogenic areas, with cysts too small to resolve
Central scar may be seen |
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Can u see the cyst of a serous cystadenoma on US
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to small to resolve
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What is the appearance of a serous cystadenoma on CECT
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Swiss cheese appearance b/c of tiny cysts
Central Ca+ and central stellate scar may be seen |
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What is the contour of a serous cystadenoma
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lobulated
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What is the most common age and race of a pseudopapillary neoplasm of the pancreas
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24y
black men asian women |
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Are pseudopapillary neoplasm of the pancreas common
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no they are rare
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Do you see peripheral Ca in a pseudopapillary neoplasm of the pancreas
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yes
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What is the appearance of a pseudopapillary neoplasm of the pancreas on US
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well-demarcated solid mass with hypoechoic areas (mixed solid/cystic) due to necrosis and hemorrhage
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What is the appearance of a pseudopapillary neoplasm of the pancreas on CT
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CT: muscle density mass with hypodense areas, usually surrounded by thick, well-defined rim
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What is the prognosis of a pseudopapillary neoplasm of the pancreas
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Low grade malignancy, curable with surgery
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What are the radiographic findings of IPMT
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Multicystic" lesion in uncinate process or pancreatic head contiguous with dilated MPD on CECT
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Does IPMT involve the main duct or the branch ducts
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both
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What is the ddx of IPMT
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serous cystadenoma
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What are the findings of IPMT on ERCP
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dilation of the main pancreatic duct as well as the side branches. Note the cyst-like focal dilations of side branches. mural nodules possible
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What is the ddx of a dilated main pancreatic duct
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chronic pancreatitis
IPMT Aging tumor (dilation of duct proximal to a mass) |
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Does chronic pancreatitis usualy have areas of bandlike narrowing
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yes
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What is a tumor that may cause obstruction of the pancreatic ampulla
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ampullary carcinoma
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What should be suspected if you see intrahepatic duct dilation without dilation of the CBD and cystic duct
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klatskin tumor
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What is a Klatskin tumor
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a cholangioCA arising from the confluence of the left and right hepatic ducts
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What is the appearance of cholangiocarcinoma
3 |
-stricture
-polypoid mass -liver mass |
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Where is the MC location of cholangiocarcinoma
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porta hepatis (Klatskin)
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Where tends to happen to liver with cholangiocarcinoma
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lobar atrophy and dilated intrahepatic ducts
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What percent of cholangiocarcinoma have vascular involvement
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45%
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What is most typical for cholangiocarcinoma
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dilated ducts
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Is it possible to see a mass or bile wall thickening with cholangiocarcinoma
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yes
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What is a typical finding of cholangioCA with US
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Lobar liver atrophy with crowded dilated bile ducts
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What are the radiographic findings of a cholangioCA on MR
3 |
Low T1, high T2
Characteristic delayed Gd enhancement (10-15 min) Focal liver atrophy, liver capsule retraction |
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What are the T1 and T2 findings of a cholangiocarcinma on MR
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Low T1
High T2 |
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Do you see delayed enhancement of cholangiocarcinoma
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yes (10-15 min)
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What is the ddx of multiple renal cyst
5 |
VHL
ADPKD Echinococcus pseudocyst cystic mets |
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What are 6 potentially cystic mets
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RCC
Lung breast melanoma HCC ovarian |
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What is polyarteritis nodosa?
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Systemic vasculitis causing necrotizing inflammation of small and medium-sized vessels, resulting in microaneurysms, occlusions, and strictures
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What is takayasu arteritis
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Granulomatous inflammatory vasculitis affects walls of medium and large vessels, especially aorta and branches
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What is polyarteritis nodosa?
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Systemic vasculitis causing necrotizing inflammation of small and medium-sized vessels, resulting in microaneurysms, occlusions, and strictures
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What are two ateritis that may affect the small bowel
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polyarteritis nodosa
takayasu arteritis |
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What is takayasu arteritis
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Granulomatous inflammatory vasculitis affects walls of medium and large vessels, especially aorta and branches
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What is laryngeal cancer often associated with
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laryngeal penetration
Entrance of barium into laryngeal ventricle during swallowing |
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What are two ateritis that may affect the small bowel
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polyarteritis nodosa
takayasu arteritis |
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What is polyarteritis nodosa?
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Systemic vasculitis causing necrotizing inflammation of small and medium-sized vessels, resulting in microaneurysms, occlusions, and strictures
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What is laryngeal cancer often associated with
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laryngeal penetration
Entrance of barium into laryngeal ventricle during swallowing |
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Is a closed loop obstruction a surgical emergency
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yes
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What is takayasu arteritis
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Granulomatous inflammatory vasculitis affects walls of medium and large vessels, especially aorta and branches
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Is a closed loop obstruction a surgical emergency
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yes
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What are two ateritis that may affect the small bowel
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polyarteritis nodosa
takayasu arteritis |
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What is laryngeal cancer often associated with
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laryngeal penetration
Entrance of barium into laryngeal ventricle during swallowing |
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Is a closed loop obstruction a surgical emergency
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yes
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What is the MCC of a closed loop obstruction
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MC caused by adhesive band, occasionally internal or external hernia
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What are the CT findings of a closed loop obstruction
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CT findings: C-shaped, U-shaped, or “coffee bean” configuration of bowel loops and mesenteric vessels converging toward torsion
Two adjacent collapsed, round, oval, or triangular loops, the “beak” sign, and the “whirl” sign are observed at the site of obstruction and torsion |
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Are the affected loops of a closed loop obstruction usualy filled with fluid
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yes
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What are 3 synonyms for sclerosing mesenteritis
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mesenteric panniculitis, fibrosing mesenteritis and mesenteric lipodystrophy.
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What is the pathology of sclerosing mesenteritis
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Pathologically it is a chronic inflammation of unknown etiology
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What is the DDX of misty mesentery
6 |
mesenteric pannicullitis
lymphedema inflammation hemorrhage neoplasm |
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What are neoplasms that occur in the mesentery
8 |
carcinoid
desmoid mets melanoma leukemia NHL mesothelioma GIST |
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What can be found in a XR of a pt with gallbladder Ca
3 |
calcified gallstones
porcelain GB abnormal collection of RUQ gas when tumor invades bowel creating a fistula |
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What are the CT MR patterns of gallbladder CA
3 |
mass replacing the gallbladder
focal or diffuse GB wall thickening intraluminal polypoid mass |
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What is the most common pattern found in GB CA
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mass replacing the GB occurs 40-65%
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What is the DDX of a doudenal tumor
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GIST
lipoma Doudenal Adenoma Hamartoma (Peutz-J) adenocarcinoma lymphoma mets brunners gland |
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What is the most common malignancy of the SB
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lymphoma
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What is the usual appearance of SB lymphoma
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circumferential bulky mass
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Does SB lymphoma usually result in obstruction
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no, it is uncommon
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Where do morgagni hernias usualy occur
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the right anterior chest
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What is the DDX of a benign distal esophagus stricture
4 |
scleroderma, nasogastric, ZE syndrome, reflux
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What is the DDX of upper mid esophagus stricutre
4 |
barrets, radiation, caustic/drug, skin disease
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What is the ddx of a malignant cause of esophageal narrowing
2 |
adenocarcinoma, lymphoma (from compression)
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What are rare causes of strictures
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crohns, candida, eosinophilic esophagitis, Behcet dz
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What is the cause of achalasia
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deficiency of ganglion cells in myenteric plexus throughout esophagus
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What are the peristaltic findings in achalasia
3 |
Absence of peristalsis in body of esophagus, marked
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What happens to the LES in achalasia
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increase in resting pressure of LES, failure of LES to relax with swallowing
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What are the findings in achalasia
4 |
Uniform dilatation of esophagus, usually with air-fluid level present
Absence of peristalsis, with tertiary waves common in early stages Tapered “beak” deformity at the LES because of failure of relaxation Increased incidence of epiphrenic diverticula and esophageal CA |
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What is the treatment of achalasia
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balloon dilation or Heller myotomy
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What is the ddx of achalasia
3 |
pseudoachalasia (mets, adeno), chagas, peptic stricture
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What is the descriptive term used to describe the stricture of achalasia
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beak like
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What percent of pt with preeclampsia or eclampsia develop HEELP syndrome
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4-12%
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What are the radiographic findings of HEELP syndrome
4 |
fatty liver
hepatomegaly ascites pleural effusions |
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What are is a rare hepatic finding in HEELP syndrome
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hepatic hemorrhage
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What is esophageal psueodiverticulosis
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Dilated excretory ducts of deep mucous glands of the esophagus
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What are the findings of esophageal pseudodiverticulosis
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-Flask-shaped barium collections that extend from lumen or lines and flecks of barium outside esophageal wall
-Tend to occur in clusters and in association with strictures -Linear tracks of barium (“intramural tracking”) commonly bridge adjacent pseudodiverticula |
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Do pseudodiverticula of the esophagus tend to occur in conjunction with a stricture
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yes
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What is the ddx of esophageal diverticula
|
lateral pharyngeal diverticula
Zenkers Killian Jamieson Mid-esophageal and epiphrenic pulsion or traction diverticula pseudodiverticula |
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Where do lateral pharyngeal diverticula occur
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region of tonsillar fossa, thyrohyoid membrane
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Where do Zenker diverticula occur
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posterior midline at Killian dehiscence b/w circular and oblique fibers of cricopharyngeus
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Where do killian Jamieson diverticula occur
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anterolateral wall of proximal cervical esophagus just below level of cricopharyngeus muscle
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What percent of zenkers diverticulum are on the left
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90%
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What is a pt complication of a zenkers diverticulum
|
aspiration
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Where does a killan jamieson diverticulum protrude off of
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the lateral wall of the esophagus
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What is the ddx of a widened doudenal loop
7 |
normal variant
pancreatic mass adenopathy mesenteric cyst choledochal cyst retroperitoneal mass AAA |
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Can a lipoma serve as a lead point of an intususception
|
yes
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What is the ddx of a small bowel mass
9 |
adenoma
GIST lipoma hemangioma neurofibroma adenoCA lymphoma carcinoid Met |
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What is the finding in a pt with graft V host disease
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ribbon bowel: small bowel fold effacement with tubular appearance
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What are other findings besides ribbon bowel in G Vs H dz
4 |
Loss of haustra, spasm, edema, ulceration, granular mucosa in colon
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What is the small bowel cast that is associated with G vs H dz
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“Small bowel cast”: prolonged coating of abnormal bowel for hours to days
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What is the tx for G vs H disease
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steriods
cyclosporines |
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What is the most common mesenchymal tumor of the retroperitoneum
|
liposarcoma
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What are the findings in a pt with a liposarcoma
|
Calicification
high fat (80-90%) |
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If you see a large fatty mass with calcification is the retropertineum what should you consider
|
a liposarcoma
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What is the ddx GB polyps
|
cholesterol polyps
adenomatous polyps adherent stones tumefactive sludge papillloma CA mets |
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What are the US findings of a gallbladder cholesterol polyp
|
US: echogenic mural polypoid lesions, fixed, nonshadowing
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When does milk of calcium bile occur
|
chronic cholecystitis
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What is recurrent pyogenic cholangitis associated with
4 |
Cause unknown, assoc w/clonorchiasis, ascariasis, nutritional deficiency
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What are the clinical SS of recurrent pyogenic cholangitis
4 |
Recurrent attacks of abdominal pain, fever, and jaundice
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What are the findings of recurrent pyogenic cholangitis on US
4 |
-dilation of intrahepatic and extrahepatic
-Gallstones -increased periportal echogenicity -lobar atrophy |
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What are the radiogrphic findings of recurrent pyogenic cholangitis on cholangiogram
5 |
dilation of intrahepatic and extrahepatic ducts containing pigment stones
-areas of stenosis -gallstones -acute tapering and decreased arborization of intrahepatic bile ducts |
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Can Segmental ductal stenosis with upstream dilatation occur, esp in lateral segment of left lobe or posterior segment of right hepatic lobe in recurrent pyogenic cholangitis
|
yes
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Is adenomyomatosis a type of hyperplastic cholecystosis
|
yes
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What are the findings of adenomyomatosis
2 |
-thickening of the GB wall
-rokitansky-aschoff sinuses |
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What are the US of adenomyomatosis
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Thickened wall with small anechoic spaces that show ring down comet-tail artifact when filled with debris
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What is a oral cholecystogram
|
a study that contrast is taking PO and excreted into the Gb
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What do you see in adenomyomatosis during a oral cholecstogram
|
sinuses may fill resulting in extraluminal contrast collections
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What does an adenomyoma look like in its focal form
|
True benign neoplasm of gallbladder
Account for < 5% of gallbladder polyp Solitary lesion Larger size (> 10 mm) Usually pedunculated in appearances |
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What are the two forms of adenoma of the GB
|
focal and annular forms
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What does an adenomyoma look like in its annular form
|
hourglass GB with transverse congenital septum (rare)
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What are the findings in a feline esophagus
|
multiple thin folds
(esophagus looks corrugated) |
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What are the causes of feline esophagus
3 |
normal variant
reflux scleroderma |
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What diffuse esophageal spasm
|
a motility disorder of spastic contractions
|
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What is the gold standard for diagnosing DES
|
manometry
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What is the cause small bowel diverticulosis
|
May result in bacterial overgrowth,
vitamin B12 deficiency macrocytic anemia Malabsorption due to bile acid deconjugation |
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Where is the MC location of small bowel diverticulum
|
proximal small bowel
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What side does small bowel diverticulosis MC occurr; mesenteric or antimesenteric
|
the mesenteric side (the inside of a V if a loop was curved)
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What are the complications of small bowel diverticulosis
5 |
bleeding
perforation diverticulitis enterolith formation, pneumoperitoneum |
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What is the ddx of a liver with increased density (bright)
|
amiodarone therapy
hemochromatosis wilsons thorium contrast glycogen storage diseae gold therapy |
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What are the MR findings suggestive of hemochromatosis on T2
|
T2-weighted MRI of the liver. The liver and pancreas are of diffusely low-signal intensity. The spleen is enlarged and is predominantly of high-signal intensity.
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What are the findings of hemosiderosis on T2
|
T2-weighted MRI. The liver, spleen, and bone marrow are of abnormally decreased signal intensity. The pancreas has a normal appearance. No focal masses are present.
|
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What are the findings of primary hemochromatosis
|
decreased density on T2 of
Parenchymal cells of liver, pancreas, and heart |
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What are the findings of secondary hemochromatosis
|
Secondary hemochromatosis: decreased density on T2 of
Reticuloendothelial system (RES): Liver and spleen |
|
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What is hemosiderosis
|
Hemosiderosis
Increased iron deposition without organ damage |
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What are causes of secondary hemochromatosis
2 |
increased iron intake
transfusions |
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What is another name for biliary hamartomas
|
AKA von Meyenburg complexes
|
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|
What is the typical size of biliary hamartomas
|
Small (usually < 1 cm) benign lesions
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Do biliary hamartomas have clinical significance
|
no
|
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What is a pitfall of biliary hamartomas
|
accidentally diagnosing as mets
|
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What is the appearance of biliary hamartomas on CT
|
hypodense
|
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What is the appearance of biliary hamartomas on US
|
hypoechoic
may have echogenic foci with ring down artifact (cholesterol crystals) |
|
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What is the appearance of biliary hamartomas on MR T2
|
very high T2
no rim enhancement |
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What should be suspected if you see a hypervascular tumor in the pancreas
|
islet cell tumor
|
|
|
What percent of insulinomas are functional
|
85%
|
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What is the mc islet cell tumor
|
insulinoma
gastrinoma is 2nd mc |
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What percent of insulinomas are benign
|
90
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What percent of gastrinomas are malignant
|
60%
|
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What is worse a islet cell tumor or gastrinoma
|
gastrinoma (60% malignant)
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What is the result of a gastrinoma
|
zollinger ellison syndrome
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What percent of islet cell tumors are non-function
|
15%
|
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If an islet cell tumor is non-function is it a good or bad thing
|
bad....80-90% are malignant
|
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What percent of non-functioning islet cell tumors have calcification
|
25%
|
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What is the mean size of a non-functioning islet cell tumor
|
>5cm (big)
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What is a tell tale sign of a non-functioning islet cell tumor on MR and CT
|
a large pancreatic tumor that enhances immediately
|
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What is the ddx of islet cell tumor of the pancreas
|
hypervascular met
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What are the radiographic findings of a islet cell tumor on US
|
hypoechoic mass,
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What is epiplic appendagitis
|
Torsion of epiploic appendages with secondary ischemia
|
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Where is the MC site for epiploic appendages
|
sigmoid
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What is the clinical presentation and tx
|
self limited and tx with pain relievers
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What is the ddx of epiploid appendagitis
|
omental infarction
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Describe omental infarction
|
a large fatty region usually located on the right side of the abdomen with stranding
|
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What is the ddx of a splenic mass
10 |
hemangioma
cyst hamartoma inflammatory pseudotumor siderotic nodule infarct candidiatis echinococcal cyst sarcoid mets lymphoma |
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What is the mc benign tumor of the spleen
|
hamartoma
|
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What are common mets that go to the spleen
|
melanoma
breast ovary lung |
|
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What is the appearance of disseminated candidiasis on US, MR (T2), CT
|
target lesions (hyperechoic with hypoechoic halo)
T2 bright CT hypodense |
|
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What is the appearance of an echinococcal cyst in the spleen on CT and US
|
Contrast-enhanced CT. The peripherally calcified masses contain water-attenuation fluid.
Splenic sonogram. A large mass is present in the spleen. The rim of the mass is hyperechoic, and there is a strong acoustic shadow from the rim indicating calcification. |
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What is the appearance of disseminated sarcoidosis in the spleen on CT
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reticularly hypodense
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What is the appearnce of siderotic nodules of the spleen on MR (T2)
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T2 low signal
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What are the 2 causes of bile duct necrosis
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Caused by either severe hepatic artery stenosis or hepatic artery thrombosis post transplant
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What are 2 findings of bile duct necrosis
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Branching biloma resulting from diffuse, extensive extravasation of bile from ischemic ducts
Irregular fluid-density material surrounding portal vein and tracking along the portal triads |
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What are complications of gastric bypass
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leaks
anastomotic narrowing degradation of pouch restriction gastrogastric fistula distension of excluded stomach ulcers |
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What is cause of a gastrogastric fistula
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(staple line dehiscence)
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What SB and adbominal wall complicatons are associated with gastric bypass
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SBO
incisional hernia internal hernia |
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What is the sentinel clot sign
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serpiginous areas of high attenuation surrounded by lower-attenuation areas of hematoma
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What is a grade 1 splenic trauma
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Subcapsular hematoma < 10% of surface area
Capsular tear of < 1 cm in depth |
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What is grade 2 splenic trauma
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Subcapsular hematoma of 10-50% of surface area
Intraparenchymal hematoma < 5 cm in diameter Laceration of 1-3 cm in depth and not involving trabecular vessels |
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What is grade 3 splenic trauma
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Subcapsular hematoma > 50% of surface area or expanding and ruptured subcapsular or parenchymal hematoma
Intraparenchymal hematoma > 5 cm or expanding Laceration > 3 cm in depth or involving trabecular vessels |
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What is grade 4 splenic trauma
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Laceration involving segmental or hilar vessels with devascularization of > 25% of the spleen
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What is grade 5 splenic trauma
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Shattered spleen or hilar vascular injury
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What percent of grade 4 or 5 splenic trauma require intervention
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50-60%
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What is the tx of splenic trauma (grade 4 or 5)
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Acute w/diffuse injury: proximal occlusion
Focal extravasation: targeted occlusion |
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What is the DDX of multiple gastric filling defects
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hyperplastic polyps
adenomatous polyps hamartomatous polyps mets lymphoma varices |
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Do hyperplastic polyps have malignant pt
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no
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What is the mc gastric polyp
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hyperplastic (by far...80%)
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What conditions do you see hamartomatous polyps
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peutz jeghers, cowden, cronkhite candada
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When do you get a focal hepatic hot spot
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SVC obstruction via collateral pathway
internal mammary vein to paraumbilical vein to left portal vein |
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Where is the focal hot spot
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Focally increased blood flow to segment IV of liver
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What nuclear medicine test will you see the focal hot spot
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Tc-99m sulfur colloid: increased activity in segment IV
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History: Elderly male with difficult eating steak.
Findings: Double contrast esophogram demonstrates a small sliding hiatal hernia and a prominent circumferential shelf to the esophageal B ring. A 12.5mm barium tablet would not pass through during the examination. |
Diagnosis: Schatzki Ring.
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What ring is dilated with schatzki ring
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B
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What is the treatment of shatzkis ring
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esophageal dilation
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What is boerhaaves syndrome
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subcutaneous/mediastinal emphysema caused by vomitting, straining childbirht or blunt trauma
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What are the plain films finding of boerhaaves
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: pneumomediastinum, pleural effusion, mediastinal widening
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What are the UGI findings of boerhaaves
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extraluminal contrast
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Where do most tears of Boerhaaves occur
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Almost all tears (90%) occur along left posterolateral wall of distal esophagus
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