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297 Cards in this Set
- Front
- Back
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renal mass lesions
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tumor
solid cyst infection lobar nephronia abscess xgp congenital duplicated collecting system pseudotumors fetal lobulation dromedary hump column of bertin suprahilar bump lobar dysmorphism Traum hematoma |
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solid renal neoplasm
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rcc
wilms oncocytoma adenoma angiomyolipoma transitional cell carcinoma of the renal pelvis or calyces mets, lung colon melanoma rcc lymphoma |
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cystic renal masses
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tumors
cystic/necrotic rcc multilocular rcc cystic wilm's tumor true cysts cortical cysts medullary cystic disease adult polycystic kidney disease cysts in systemic disease-vhl, ts endstage renal failure infectious cysts other hydronephrosis/duplicated renal artery aneurysm abscess |
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hyperechoic renal mass
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angiomyolipoma
rcc milk of calcium cyst nephritis xgp emphysematous pyelonephritis focal nephritis candidiasis hematoma infarction lesions that mimic renal sinus fat duplicated collecting system |
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renal sinus mass
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tumors
tcc rcc lymphoma bellini duct carcinoma other renal artery aneurysm renal sinus hemorrhage complicated parapelvic cyst |
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wedge shaped renal lesion
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renal mets
infarction lobar nephritis |
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diffusely hyperechoic kidneys
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inflammation
glomerulonephritis glomerulosclerosis-htn, dm aids related nephropathy interstitial nephritis: SLE, vasculitis ATN HUS multipl myeloma endstage renal disease medullary or cortical nephrocalcinosis infantile polycystic kidney disease |
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renal calcifications
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tumors
cysts rcc infection tb metastatic calcification medullary nephrocalcinosis cortical nephrocalcinosis collecting system calculi |
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fat in kidney
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angiomyolipoma
lipoma replacement lipomatosis |
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hypoechoic perirenal fat
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normal variant
perirenal hemorrhage (trauma, anticoagulants, adrenal hemorrhage) cyst rupture sle polyarteritis nodosa |
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filling defect in colecting system
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tumor
tcc papilloma leukoplakia, malakoplakia mobile filling defect blood clot sloughed papilla calculus fungus ball other vascular impression, collateral vessels artificial overlying bowel gas |
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papillary necrosis
POSTCARD |
pyelonephritis
obstruction (chronic) sickle cell disease TB cirrhosis, ethanol analgesic, phenacetin renal vein thrombosis diabetes |
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delayed (persistent ) neprhogram (same ddx as renal failure))
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prerenal (15%)
RAS hypotension renal (70%) acute glomerulonephritis ATN-radiodine, ab, anesthesia, ischemia, transplants acute cortical necrosis-pregnancy related, sepsis, dehydration tubular precipitation-uric acid, hemolysis, myeloma acute interstitial nephritis-antibiotics papillary necrosis-analgesic, sickle cell, DM renal vein thrombosis postrenal obstruction-stone, stricture |
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extracalyceal contrast agent
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striations
medullary sponge kidney early papillary necrosis pyelosinus or pyelovenous backflow in obstruction\ interstitial edema focal collections late papillary necrosis calyceal diverticulum cavity from cyst rupture abcess |
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dilated calyces/collecting system
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obstruction (calculi, tumor, acute, chronic)
papillary necrosis congenital megacalyces calyceal diverticulum reflux |
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bilaterally enlarged kidneys
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tumor
cystic diseaes (APCKD) malignancy leukemia lymphoma multiple myeloma inflammation (acute) glomerulonephritis interstitial nephritis collagen vascular disease ATN Metabolic amyloid DM storage disease, acromegaly Vasular bilateral renal vein thrombosis |
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bilaterally small kidneys
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chronic inflammation-pyelonephritis, glomerulonephritis, interstitial nephritis
bilateral RAS reflux (chronic infection) |
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hypercalcemia
PAM SCHMIDT |
parathyroid adenoma, hyperplasia
addison disease milk alkali sarcoid carcinomatosis hyperparathyroidism, secondary myeloma immobilization D vitamin thiazides |
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renal vein thrombosis
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tumor
rcc other-lymphoma, tcc, wilms adrenal tumors gonadal tumors pancreatic carcinoma extraluminal compression or renal vein by retroperitoneal tumors renal disease (often with nephrotic syndrome) membranous glomerulonephritis SLE amyloidosis other hypercoagulable states extension of ovarian vein, IVC thrombosis trauma, surgery transplant rejection |
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dilated ureter due to obstruction
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functional-primary megaureter
mechanical stensosis ureteral stricture bladder outlet obstruction urethral stricture |
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dilated ureter secondary to reflux
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other
diuresis |
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ureteral stricture
TIC MTV |
tumor
tcc mets lymphadenopathy inflammatory tb-corkscrew appearance schistosomiasis-compl. is scc pelvic disease-chrohns, pid congenital ectopic ureterocele primary megaureter congenital stenosis metabolic, drugs morphine methysergie, retroperitoneal fibrosis trauma iatrogenic radiation vascualr aortic, iliac artery aneurysm ovarian vein syndrome lymphocele other endometriosis-smooth, extrinsic stone |
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multiple ureteral filling defects
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wall
ureteritis cystica allergic mucosal bullae pseudodiverticulosis vascular impression multiple papillomas melanoma mets subureotheliala hemorrhage lulminal calculi (lucent, opaque) blood clot sloughed papillae fungus ball air bubbles |
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ureteral diverticula
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congenital
ureteritis cystica tb |
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deviated ureters
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lateral deviation
bulky retroperitoneal adenopathy primary retroperitoneal tumors aortic aneurysm retroperitoneal fluid collection malrotated kidney ovarian/urterine masses medial deviation posterior bladder diverticulum uterine fibroids retroperitoneal fibrosis associated with aortic aneursym, methysergide, idiopathic, malignancy-related postoperative (node dissxn) enlarged prostate (j-shaped ureter) retrocaval ureter (only on right) |
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bladder wall thickening
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tumor
tcc lymphoma inflammation radiation cystitis infectious cystitis inflammatory bowel disease, appendicitis, focal diverticulitis outlet obstruction benign prostatic hyperplasia urethral stricture neurogenic |
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bladder filling defect
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tumor
primary-tcc, scc mets endometriosis polyps infection pid parasite infection-schistosomiasis related to infection- leukoplakia, malakoplakia, cystitis cystica, cystitis glandularis luminal calculi blood clot foreign bodies bph |
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bladder neoplasm
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primary
tcc scc adenocarcinoma pheochromocytoma from bladder wall rare-rhabdomyosarcoma, leiyomyosarcoma, primary lymphoma secondary mets hematogenous-melanoma>stomach>breast direct ext-prostate>uterus>colon lymphoma |
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bladder calculi
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chronic bacterial infection
chronic bladder catheterization bladder outlet obstructin schistosomiasis renal calculi |
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bladder wall calcification
SCRITT |
schistosomiasis
cytoxan radiation interstitial cystitis tb tcc |
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air in bladder
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instrumentation, catheter
bladder fistula-diverticulitis, crohn's, colon carcinoma emphysematous cystitis |
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teardrop bladder
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physiological
normal variant iliopsoas hypertrophy fluid hematoma (usually pelvic fracture) abcess masses pelvic lymphoma pelvic lipomatosis retroperitoneal fibrosis |
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the femal prostate
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urethral diverticulum
urethral tumor periurethritis pubic bone lesion |
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adrenal masses
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tumor
adenoma 50% mets 30% pheochromocytoma 10% lymphoma neuroblastom <2yo fatty lesions myelolipoma lipoma cystic tumors simple cyst pseudocyst after previous hemorrhage other lesions hemorrhage tb wolman's disease bilateral masses mets lymphoma bilateral pheochromocytoma in men 2, vhl, and neurofibromatosis granulomatous masses-tb, histo |
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adrenal calcifications
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tumor-neuroblastoma, pheochromocytoma
infection-tb, histo, waterhouse-friederichson syndrome trauma-hemorrhage congenital-wolamn's disease |
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adrenal pseudotumors
soft tissue density in location of adrenal glands on plain films |
gastric fundus
accessory spleen retroperitoneal varices other lesions liver mass gallbladder mass renal mass by CT gastric fundus or fundal diverticulum varices tortuous splenic artery pancreatic tail medial splenic lobulation |
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solid testicular masses
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tumor
primary-germinal 95%, nongerminal 5% mets-prostate, kidney, leukemia, lymphoma infection orchitis, abcess, granuloma trauma-fracture, rupture, hemorrhage, torsion other-atrophy, dilated rete testes |
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extratesticular abnormalities
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epididymitis-diffuse or focal
spermatocele, epididymal cyst hydrocele, hematocele, varicocele tunical or mesothelial cyst paratesticular hemorrhage, abcess hernia neoplasm (primary or mets) benign-adenomatoid tumor, fibroma, leiomyoma malignant-mesothelioma, sarcoma |
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prostate
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cystic lesions
utricle cyst cowper's duct cyst ejaculatory duct cyst prostatic retention cyst seminal vesicle cyst vas deferens cyst mullerian duct cyst |
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hypoechoic structures in hyperechoic endometrium
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premenopausal
molar pregnancy retain placenta, abortus degenerated placenta degenerated fibroid postmenopausal cystic glandular hyperplasia endometrial polyps endometrail carcinoma |
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fluid in uterine cavity
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acquired (cervical stenosis)
tumors-cervical cancer, endometrial cancer inflammatory-endometritis, pid, radiation pregnancy related early iup pseudogestational sac blighted ovum congenital imperforate hymen vaginal septum vaginal atresia rudimentary uterine horn |
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uterine enlargement or distortion
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fibroids
adenomyosis less common congenital uterine anomalies inflammation-pid, surgery endometriosis malignant tumors |
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uterine bleeding
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endometrial hyperplasia or polyp
cancer estrogen withdrawal adenomyosis submucosal fibroid cervical cancer |
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small uterus
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hypoplasia
nulliparity synechiae des exposure |
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large uterus
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multiparity
pregnancy molar pregnancy neoplasm |
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uterine and vaginal cystic masses
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nabothian cyst
gartners duct cyst (vaginal wall) bartholin cyst-perineal cyst hydrometrocolpos |
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shadowing structures in endometrial cavity
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iud
calcifications from fibroids, tb pyometra (gas) |
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ovarian cystic masses
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normal cysts (physiological)
follicle, follicular cyst corpus luteum cyst too many follicles polycystic ovary, hyperstimulation syndrome theca lutein cyst (with high levels of bhcg) cystic adnexal masses hemorrhagic cyst endometrioma ectopic pregnancy cystadenocarcinoma toa |
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tube cyst
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hydrosalpinx
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other cysts
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paraovarian cyst
fluid in cul-de-sac pelvic varices lymphocele bowel pelvic abcess |
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complex ovarian, paraovarian mass
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ectopic pregnancy
toa endometrioma, hemorrhagic cyst ovarian torsion tumor benign-dermoid malignant-adenocarcinoma |
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complex tubal mass
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pyosalpinx
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complex uterine mass
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pedunculated fibroid
extruded IUD endometrial, cervical carcinoma |
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other complex masses
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pelvic abcess
appendicitis diverticulitis hematoma pelvic kidneys iliac aneurysm |
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masses with homogenous low-level echoes
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TOA
endometrioma hemorrhagic cyst |
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solid ovarian mass lesions
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benign tumor-fibroma, thecoma, endometrioma, germ cell tumor
malignant ovarian tumors mets masses simulation ovarian tumor pedunculated fibroid lymphadenopathy |
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dilated tubes (hydrosalpinx, pyosalpinx, hematosalpinx)
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infection
tumor-endometrial or tubal carcinoma endometriosis iatrogenic ligation |
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tubal filling defects (hsg)
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polyp
neoplasm silicone implant tubal pregnancy air bubble from injection |
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tubal irregularity
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SIN
tubal diverticula endometriosis postoperative changes TB |
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pseudokidney sign on US
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inflammatory bowel disease
crohn's disease infectious collitis tumor intussusception always exclude pelvic kidney |
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luminal narrowing
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webs
idiopathic plummer vinson syndrome rings congenital-vascular, muscular rings schatzki's ring strictures skin lesions (epidermolysis, pemphigoid), proximal 1/3 of esophagus tumor esophagitis (lye, barret's, infection) achalasia, scleroderma, chagas extrinsic compression vascular aortic arch, arch anomalies, aneurysm, left atrium left bronchus mediastinal tumors |
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megaesophagus
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achalasia
scleroderma dilatation secondary to distal narrowing tumor, stricture chagas diabetic or alcoholic neuropathy bulbar palsy |
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esophageal tears (contrast extravavasation, fistula)
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esophagitis
tumor vomiting mallory-weiss boerhaaves tracheoesophageal fistula bronchopulmonary forgut malformation with communication to esophagus bronchogenic cysts extralobar sequestration |
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solitary filling defect
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neoplasm
benign leiomyoma 50% pedunculated fibrovascular polyp cysts, papilloma, fibroma, hemangioma malignant squamous cell carcinoma 95% adenocarcinoma carcinosarcoma lymphoma mets foreign bodies varices uphill varices (phtn), predominantly inferior location downhill varices (SVC obstruction), predominantly superior location extrinsic lesions (lymph nodes, engorged vessels, aneurysms, cysts) |
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thickened folds
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early forms of esophagitis
neoplasm lymphoma varicoid carcinoma varices |
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air-fluid level
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hiatal hernia
esophageal diverticulum any esophageal lesion caused by a motility disorder or a stricture cancer achalasia scleroderma |
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gastritis
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erosive (corrosives, alcohol, stress, drugs)
granulomatous (crohns, sarcoid, syphillis, tb, histo) eosinophilic (peripheral eosinophilia 60%, hypoalbuminemia, hypogammaglobulinemia, hyperplastic polyps) hypertrophic gastritis menetriers disease ZE syndrome idiopathic recurrent gastric ulcer ze syndrome peptic ulcer disease retained gastric antrum drugs miscellaneous radiation (>4000 rad, 6 months to 2 years after) ulcer corrosives rare pseudolymphoma suture line ulceration intraarterial chemo |
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target lesions of stomach
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gastritis (aphthoid type, tiny ulcer)
erosive-nsaid, alcohol granulomatous-crohns infections-candidiasis, herpes, syphillis, cmv submucosal mets (lareg ulcer) melanoma, kaposi's>>all others ie breast lung pancreas lymphoma solitary, giant bull's eye (very large ulcer) leiomyoma sarcoma |
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filling defect of stomach
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neoplasm
adenocarcinoma lymphoma leiomyosarcoma mets kaposi's others endometriosis carcinoid benign tumors: leiomyoma>lipoma, fibroma, schwannoma polyps varices extramedullary hematopoiesis ectopic pancreas extrinsic compression spleen pancreas liver |
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giant rugal folds
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tumor
lymphoma inflammation menetrier's disease ze syndrome gastritis associated with pancreatitis bile reflux gastritis eosinophilic gastroenteritis |
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linitis plastica
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tumor
scirrhous cancer lymphoma mets (breast most common) pancreatic carcinoma inflammation erosive gastritis radiotherapy infiltrative disease sarcoid amyloid (rare) intramural gastric hematoma infection tb, syphillis |
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antral lesions
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tumor
adenocarcinoma lymphoma mets inflammatory crohns peptic ulcer disease tb sarcoid other (less extensive) hypertrophic pyloric stenosis pylorospasm antral web |
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free intraperitoneal air
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surgery and laparoscopy and other radiologic interventions
perforated gastric or duodenal air cecal perforation from colonic obstruction pneumotosis coli air through genital tract in females perforated distal bowel (ie ibd, diverticulitis tumor) |
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duodenal filling defects
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benign neoplasm
adenoma (<1cm) leiomyoma carcinoid villous adenoma-near papilla, high malignant potential malignant adenocarcinoma at or distal to papilla mets (direct invasion from stomach, pancreas, colon, kidney, etc. or hematgenous such as melanoma) other bulb ectopic gastric mucosa prolapsed antral mucosa brunner gland hyperplasia varices distal benign lymphoid hyperplasia ectopic pancreas annular pancreas papilla of vater tumor edema with impacted or passed gallstone choledochocele malignancy of duodenal lesions based on location -bulb 90% benign -2nd and 3rd portion 50% malignant -4th 90% malignant |
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luminal outpouchings
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ulcer
ulcer with contained perf malignant ulcer diverticulum pseudodiverticulum-ulcer scarring choledochoduodenal or cholecystoduodenal fistula true diverticulum medial, 2nd part of duodenum |
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postbulbar narrowing
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neoplastic
adenocarcinoma lymphoma mets (direct invasion from colon, kidney, pancreas, gb) inflammatory intrinsic posbulbar ulcer duodenitis crohns disease extrinsic pancreatitis other annular pancreas intramural diverticulum duodenal duplication cyst duodenal hematoma aortic aneurysm (3rd portion) SMA syndrome |
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papillary enlargement
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normal variant
choledochocele papillary edema pancreatitis acute duodenal ulcer impacted stone ampullary cancer adenomatous polyp CA |
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paralytic ileus
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postoperative (most common)
vascular IBD inflammatory (often localized) pancreatitis appendicitis cholecystitis diverticulitis peritonitis metabolic hypokalemia hypocalcemia hypomagnesemia medication morphine, diphenoxylate |
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mechanical SBO
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adhesions
hernias tumors gallstones inflammation with strictures |
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predominantly thick, irregular small bowel folds
WAG CLEM |
whipple's
amyloid giardiasis (largerly jejunum, graft vs host, gammaglobulinopathy cryptosporidiosis (jejunum) lymphoma, lymphangiectasia, lactase deficiency eosinophilic gastroenteritis mycobacterium avium complex |
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predominantly dilated loops, normal folds
SOSO |
sprue
obstruction or ileus scleroderma other medication morphine lomotil atropine pro-banthine vagotomy |
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thick folds without malabsorption (edema, tumor, hemorrhage)
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diffuse uniformly thickened folds
focal: nodular thickening, analogous to thumbprinting |
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thick folds without malabsorption (edema, tumor, hemorrhage)
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submucosal edema
ischemia enteritis infectious radiation hypoproteinemia GVH reaction submucosal tumor lymphoma, leukemia infiltrating carcinoid causing venous stasis submucosal hemorrhage henoch-schonlein disease hemolytic uremic syndrome coagulopathies (ie hemophilia, vitamin k, anticoagulants) thrombocytopenia, DIC |
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mucosal nodules
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mastocytosis
lymphoid hyperplasia lymphoma metastases polyps crohns disease |
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benign small bowel tumors
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adenoma (most common)
leiyomyoma (second most common) lipoma hemangioma neurogenic tumors (usually in neurofibromatosis) other brunner gland hyperplasia heterotopic pancreatic tissue |
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malignant small bowel tumors
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metastases
melanoma kidney breast kaposi lymphoma carcinoid (most common primary, 50% malignant and have mets at dx) sarcoma(sarcomatous degen of benign tumors such as leiomyosarcoma, lymphosarcoma) usually large ulcerating tumors adenocarcinoma |
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mesenteric bowel ischemia
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occlusive disease
emboli (afib, ventricular aneurysm) arterial thrombosis (atherosclerosis) venous thrombosis (portal hypertension, pancreatitis, tumor) nonocclusive disease (low flow) hypotension hypovolemia |
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shortened bowel transit time
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anxiety
hyperthyroidism medication metoclopramide neostigmine quinidine metacholine partial SBO |
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colonic mass lesions
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nonneoplastic polypoid abnormalities of the colon
normal lymphofollicular pattern pneumatosis coli colitis cystica profunda amyloidosis endometriosis ischemic colitis polyps polyposis syndromes benign neoplasm lipoma (common) leiomyoma (rare) malignant neoplasm adenocarcinoma mets lymphoma |
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polyps
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hyperplastic polyps (90%)
not true tumors no malignant potential adenomatous polyps (2nd most common) true tumors malignant transformation types tubular viloous tubulovillous hamartomatous polyps (rare; peutz-jeghers syndrome) |
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colonic ulcers
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aphthoid ulcers (superficial)
crohns disaese (50%) amebiasis behcet's syndrome cmv herpes deep ulcers inflammatory colitis UC crohns behcets infectious amebiasis tb salmonella shigella histoplasmosis AIDS, candida, herpes, cmv ischemic colitis radiation colitis |
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colonic bowel wall thickening (thumbprinting)
due to edema, tumor, or hemorrhage, luminal indentations size of thumb |
edema
infectious colitis pseudomembranous colitis cmv colitis ecoli, shigella, salmonella, amebiasis neutropenic colitis (typhlitis) ibd tumor lymphoma, leukemia hemorrhage ischemia henoch-schonlein disease, thrombocytopenia, dic coagulopathies (ie hemophilia, vitamin k, anticoagulants) |
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tumorlike colonic deformity
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tumor
adenocarcinoma saddle shapped if asym apple core if circum mets (common serosal implants-gastric, ovarian) inflammation diverticulitis focal inflammation ibd infectious: ameboma, tb other endometriosis pelvic abscess epiploic appendagitis |
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long (>10cm) colonic narrowing
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scirrhous adenocarcinoma
lymphoma UC w or w/o ca crohns ischemic stricture radiation |
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ahaustral colon
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cathartic abuse (often right)
uc, crohns amebiasis aging (usually left) |
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colonic obstruction
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carcinoma 65%
diverticulitis 20% volvulus 5% other impaction hernia |
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megacolon
abnormally distended transverse colon (>6cm); most commonly used with toxic megacolon |
toxic megacolon (haustral deformity, pseudopolyps, risk of perf, systemic signs)
uc, crohns infectious-amebiasis, shigellosis, clostridium difficile acute colonic distention obstructive cancer paralytic ileus volvulus chronic megacolon (no or small risk of perf) cathartic colonic pseudoobstruction (ogilvie's syndrome, colonic ileus) psychogenic congenital (hirschsprungs) chagas neuromuscular disorders parksonism diabetes scleroderma amyloid metabolic, drugs hypothyroidism electrolyte imbalances |
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adult intussusception
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ileoileal (40%)>ileocolic (15%)>others
idiopathic 20% tumors 35% polyps, lipoma 25% malignant tumors (mets, lymphoma, carcinoid), 10% other meckel's diverticulum adhesions aberrant pancreas |
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pneumatosis coli
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pneumatosis cystoides
copd patients on vent mucosal injury (rectal tube, colonoscopy, surgery) scleroderma steroids chemotherapy pneumatosis intestinalis infarcted bowel necrotizing enterocolitis toxic megacolon typhilitis |
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chrohns disease
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apthous ulcers->linear fissures->nodules->cobblestone->strictures->spasm (string sign), fistula
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ulcerative colitis
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valve wide open, labia atrophied, terminal ileum dilated
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amebiasis
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predominantly affects cecum, not terminal ileum
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TB
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narrow cecum (fleischner sign), narrow crohns may produce same appearance, terminal ileum (stierlins sign)
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typhlitis
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inflammatory changes of cecum and/or ascending colon in neutropenic patients; caused by infection, bleeding, ischemia
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ileocecal deformities due to tumor
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lymphoma
adenocarcinoma carcinoid of ileum (desmoplastic response) or appendix intussusception |
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proctitis
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condylomata acuminata
lymphogranuloma venereum gonococcal proctitis uc, crohns |
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liver masses
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solid masses
neoplasm benign: hemangioma malignant: primary, secondary focal fatty liver (pseudotumor) regenerating nodules in cirrhosis cystic masss infectious echinococcus amebiasis other abscesses benign masses simple liver cysts polycystic disease of liver biliary cystadenoma ostructed intrahepatic GB malignant masses cystadenocarcinoma cystic metastases ovarian tumors necrotic tumors cholangiocarcinoma |
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increased liver density
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hemachromatosis
glycogen storage disease wilson's disease drugs-amiodarone, cisplatin apparent increased density of liver parenchyma in patients with anemia |
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decreased liver density
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fatty liver (comon)
obesity, nutritional alcohol diabetes steroids chemotherapy |
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hypervascular liver lesions
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hemangioma
hemangioendothelioma, hemangiopericytoma, angiosarcoma (all rare), intarhepatic cholangiocarcinoma metastases islet cell melanoma carcinoid renal cell cancer thyroid breast sarcoma |
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hyperechoic liver lesions
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round livers
hemangioma hyperechoic liver mets hypervascular mets, sarcoma calcified mets primary liver tumors (contain fat) hcc fibrolamellar hcc focal fat, lipoma, aml in ts gaucher's disease linear lesions air in biliary tree air in portal vein biliary ascariasis |
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multiple hypoechoic liver lesions
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tumor
mets lymphoma multifocal hcc infection multiple pyogenic abscesses amebic abscesses echinococcus candidiasis schistosomiasis other regenerating nodules, cirrhosis sarcoid extramedullary hematopoiesis hematomas hemangioma |
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gas in liver
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biliary gas (ercp, surgery, central)
portal venous gas (bowel necrosis, diverticulitis, peripheral) emphysematous cholecystitis |
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extrahepatic biliary dilatation
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intrapancreatic obstruction (most common)
pancreatic cancer calculus chronic pancreatitis suprapancreatic primary biliary ductal carcinoma metastatic lymph node portal invasive GB carcinoma surgical strictures hepatoma cholangiocarcinoma |
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types of biliary obstruction
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tumor
abrupt termination of duct mass adjacent to duct pancreatitis smooth, long tapering lithiasis related disease calculus visible meniscus sign and intrahepatic dilatating cholangitis sclerosing cholangitis (50% have us) aids cholangitis intrahepatic biliary calculi (oriental cholangiohepatitis) caroli's disease intrahepatic biliary neoplasm (rare) cystadenoma cystadenocarcinoma |
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ultrasound signs of intrahepatic biliary dilatation
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collor dopple flow absent in dilated ducts
acoustic enhancement behind dilated ducts; blood, in contrast attenuates acoustic beam double duct sign-dilated biliary vessel accopanies portal veins caliber irregularity and tortuosity of dilated ducts; veins are always smooth and taper gradually spoke-wheel appearance at points of conversion of ducts |
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diffuse (concentric) gb wall thickening in order of decreaseing frequency
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nonfasting gb
acute cholecystitis (50-75% have thickening) chronic cholecystitis (<25% have thickening) portal hypertension hypoalbuminemia (<2.5 g/dl) hepatitis AIDS (cryptosporidiosis, cmv, mai) ascites benign ascites-gb wall thickening malignant ascites-no gb wall thickening |
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focal (eccentric) gb wall thickening
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gb carcinoma (40% present with focal thickening)
mets (melanoma >> gastric, pancreas) benign tumors polyps (cholesterol, adenomatous) adenomyomatosis tumefactive sludge adherent to wall AIDS |
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hyperechoic foci in gb wall
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calculus
polyp cholesterol emphysematous cholecystitis porcelain gb |
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dense gb on ct
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hepatobiliary (vicarious excretion of contrast material)
calculi milk of calcium bile reflux of oral contrast agent after surgery oral cholecystogram hemorrhage (hematocrit effect) |
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focal pancreatic signal abnormality
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focal hypoechoic or hypodense pancreatic lesion
tumor focal pancreatitis adenopathy |
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cystic pancreatic lesions
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neoplasm
benign microcystic adenoma aka serous cystadenoma (pre) malignant mucinous cystadenoma mucinous cystadenocarcinoma ductic ectatic mucinous cystadenocarcinoma iPMT epithelial cyst simple cyst pseudo cyst VHL duct ectasia |
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hyperechoic pancreas
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cystic fibrosis
pancreatic lipomatosis |
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focal splenic lesions
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tumor
mets-lymphoma, melanoma, ovary hemangioma lymphangioma hamartoma rare lesions-myxoma, chondroma, osteoma, hemangiosarcoma, fibrosarcoma infection (often ca++) abcess candidiasis (common in aids) tb, mai schistosomiasis pneumocystitis carinii other infarcts hematoma (trauma) cysts-simple, hyatid fatty nodules in gauchers disease |
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splenomegaly
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tumor
leukemia lymphoma infection infectious mononucleosis histoplasmosis metabolic disorders gauchers amyloid hemochromatosis trauma vascular portal hypertension hematological disorders (anemias, sickle cell, thalassemia, myelofibrosis, myelosclerosis) |
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peritoneal fluid collections
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water density
ascites urinoma biloma seroma lymphocele pancreatic pseudocyst csf from vp shunt complex abcess hematoma pseudomyxoma peritonei pancreatic necrosis |
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intraperitoneal calcifications
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arterial calcification
appendicolith mesenteric node cholelithiasis pancreatic calcification porcelain gb renal/ureteral calculi old hematoma, abscess uterine leiomyoma fetal skeletal part pelvic phlebolith teratoma liver-echinococcal cyst |
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common gastrointestinal manifestations caused by AIDS
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infection
cmv candida herpes cryptococcus MAI tumor kaposi lymphoma |
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common gi manifestations of AIDS by organ system
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esophagus
ulcers-candida, cmv, herpes sinus tracts-tb, actinomycosis proximal small bowel ulcers-cryptococcosis nodules-kaposis sarcoma, mai distal small bowel enteritis-tb, mai, cmv colon colitis-cmv, pseudomembranous colitis typhilitis biliary strictures-cmv, cryptococcosis |
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abdominal trauma
|
injuries in decreasing order of frequency
liver laceration splenic laceration renal trauma bowel hematoma pancreatic fracture rare-gb injury, adrenal hemorrhage |
|
|
abdominal calcifications after cardiac surgery
0.2-2%, complications related to ischemia (ie intraoperative hypotension, hemorrhage, vasculopathy, emboli, clotting abnormalities) |
gi hemorrhage 50%
cholecystitis (emphysematous, acalculous, or calculous) 20% pancreatitis 10% perforated peptic ulcer 10% mesenteric ischemia 5% perforated diveritcular disease 5% |
|
|
feline esophagus
|
horizontal corrugations on upper GI
reflux scleroderma |
|
|
esophageal stricture
|
common causes
esophageal cancer peptic stricture corrosive ingestion |
|
|
esophageal diveritculum
|
zenkers-cervical esophagus in killians triangle
epiphrenic-most are pulsion, treated with resection and myotomy |
|
|
achalasia
|
distal spastic narrowing, esophageal dilatation, long air filled esophagus on cxr, +/- absent gastric air bubble
bird's beak, disordered motility on barium ddx-colonic interposition |
|
|
scleroderma
|
dilated patulous esophagus
patulous ge junction free reflux adynamic |
|
|
esophagitis
|
common causes
reflux corrive ingestion candida and herpes in immunocompromised barium swallow-ragged mucosa, +/- discrete ulcers |
|
|
food bolus impactin
|
acute dysphagia with obstructing filling defect
effervescent agents and/or muscle relaxants may help |
|
|
diffuse esophageal spasm
|
motility disorder-spastic contractions
test with manometry, medical treatment corkscrew/nutcracker appearance on barium |
|
|
linitis plastica
|
diffuse narrowing and loss of pliability of stomach
leather bottle stomach causes infiltrative gastric cancer metstatic breast cancer corrosive ingestion lymphoma sarcoidosis |
|
|
thickened gastric folds (>1cm)
|
common causes
inflammation infiltration, including tumor menetriers disease varices (fundus) menetriers disease hypoproteinemic (edema), self limiting in childhood, progressive in adults |
|
|
gastric filling defects
|
metastases (lung, breast, melanoma, renal cell)
polyps (syndromes) gastroesophageal varices pancreatic rest (single, umbilicated, inferior antrum) |
|
|
duodenal ulcer, barium findings
|
round pools, rarely linear
edematous ring radiating folds scarred/spastic duodenum |
|
|
crohns disease
|
transmural inflammation
chronic recurrent aphthous ulcers->cobblestoning sbft-ulcers/cobblestoning, string sign of kantor, long tight stricture of TI, fistulae |
|
|
small bowel diverticulosis
|
clinical
diveriticulitis hemorrhage obstruction perforation bacterial overgrowth sbft-multiple outpouching on mesenteric border |
|
|
scleroderma of smantiall bowel
|
esophagus 75-90%
anorectum 50-70% SB 40% colon 10-50% sbft dilated atonic bowel, antimesenteric "sacculations", broad based peudodiverticula |
|
|
nodular lymphoid hyperplasia
|
idiopathic
hypogammaglobulinemia lymphoma giardiasis sbft-submucosal nodules, any part of GI tct, commonly sb |
|
|
small bowel filling defects
|
inflammation
nodular lymphoid hyperplasia crohns disease infiltration whipples diseaes mastocytosis waldenstroms neoplasia lymphoma polyposis syndrome |
|
|
small bowel wall thickening
|
"saw-tooth" or stack of coins appearance
causes edema hematoma crohns disease radiation |
|
|
graft versus host disease of small bowel
|
after allogenic BMT
GI tract major target sbft-thickened small bowel, featureless, ribbon like bowel |
|
|
celiac disease
|
aka nontropical sprue
gluten intolerant antigliadin ab biopsy dx sbft-small bowel dilatation, coarse or obliterated folds, ileojejunal reversal |
|
|
sigmoid volvulus treatment
|
nonstrangulated-tube deflation + elective resection
40-90% recurrence with tube deflation alone strangulated-emergency resection 50% mortality |
|
|
cystic pneumatosis coli
|
asx or nonspecific GI dx, unknown etiology
associations copd peptic ulceration pyloric stenosis intestinal bypass surgery transplant surgery BE: small intramural gas filled cysts grape like clusts on xr multiple polyp like defects on BE |
|
|
ischemic pneumatosis
|
disproportionate pain
lactic acidosis XR: pneumtaosis (linear not cystic) portal venous gas |
|
|
ulcerative colitis
|
granular mucosa
undermined mucosa pseudopolyps-filiform thumbprinting toxic megacolon cancer |
|
|
T2 hyperintense liver lesions
|
cysts
cystic metastases cystic primary may not enhance progress metastatic neuroendocrine tumor hemangioma biliary cystadenoma or cystadenocarcinoma (large/septae), single large cyst, thik these deiagnoses |
|
|
liver hemangiomas
|
7-20%
f>m right lobe>left slow flow attenuation and enhancement follows blood pool low T1, very high T2, maintains high SI with heavey T2 weighting interrupted peripheral nodular enhancement-sensitivity 88%, specificity 84-100% homogenous enhancement by 10-20 min (range = immediate to 60 minutes sharply lobulated can have central scar ddx hypervascular tumors cystic mets atypical features incomplete filling due to fibrosis and thrombosis <1 cm, homogenous flash hyperenhancement arterial which will persist on delayed images |
|
|
peripheral nodular interrupted enhancing liver lesions
|
hemangioma
treated metastases, rare hemangioendothelioma-pediatric, multiple confluent lesions that coalesce in the periphery with capsular retraction angiosarcoma rare, lung, spleen mets multifocal small nodules/large dominant mass radium, inorganic arsenic, vinyl chloride, thorotrast, hemochromatosis |
|
|
focal fat infiltration in liver
|
falciform ligament, gb foss, periportal
geographic low density on venous phase geographic increased enhancement low signal on out of phase T1 GRE fat-suppressed no mass effect/non-displaced vessels run through it |
|
|
nodular focal fatty infiltration
|
usuall geographic and periportal
can mimic mets opposed GRE diagnostic central high density reported on CECT |
|
|
nodular focal fatty sparing
|
dark on T2
drops out on fat-sat bright on out-of phase (rest of liver fatty and dark) |
|
|
FNH
|
3%-incidental
30-40 years 80-95% young women 80% solitary well, defined lobular subcapsular MRI iso to slightly low T1 iso to slightly high T2 50-75% central scar containing vascular channels, bile ductules-low T1/high T2 hypervascular, homogenous arterial enhancement, variable washout (also on CT) central scar-low SI precontrast and arterial phase with delayed enhancement |
|
|
differentiating troublesome FNH
|
ddx
adenoma-can bleed large hemangioma-40-50 yo fibrolamellar HCC-younger 55% sulfur colloid scan positive because of Kupffer cells if scan negative-biopsy |
|
|
adenoma
|
similar epidemiology, young women
ocp, steroids heterogenous T1/T2: hemorrhage, fat (SI on out of phase) heterogenous, hyperenhancing or homogenous enhancing. |
|
|
FNH vs HCC
|
can have similar characteristics, so if underlying cirrhosis, still raise possibility of hcc
|
|
|
liver metastases
|
hypovascular-colon, pancreas, lung; breast
hypervascular (with washout)-neuroendocrine tumors ie islet cell, carcinoid, pheo; thyroid ca; sarcoma;rcc; breast high T2, low T1 melanin, blood-high T1 (paramagnetic effects atypical features cystic-necrosis, rapid growth, hypervascular cystic primaries mucinous adenocarcinoma colorectal ovarian calcifcation (CT>MR) serous ovarian ca mucin producing colorectal |
|
|
hcc
|
in setting of cirrhosis, or without cirrhosis in chronic HBV infection
hypervascular lesion in high risk patient particularly >2cm (<2cm 50% diagnostic accuracy) if hypervascular, <2 cm, not bright on T2 ddx, hepatoma, dysplastic nodule, and shunt-->f/u in 3 months (3cm cut off) washout on venous phase more specific then arterial hyperenhancement atypical HCC-multifocal, or infiltrating, not T2 right 90% high T2 (50% mosaic) 30% high T1 due to copper, hemorrhage, fat, glycogen variable T1 and T2 due to fat, hemorrhage, necrosis 5-10% calcifcy, central fibrous scar/septae venous invasion- tumor invasion enlarges vein and enhances, can't rely on T1 and T2 signal |
|
|
hypervascular focal liver mass
|
ddx
benign hemangioma fnh adenoma hyperplastic, regenerative nodules in budd chiari malignant hcc hypervascular mets MRCTN melanoma RCC choriocarcinoma thyroid neuroendocrine |
|
|
cholangiocarcinoma
|
second most common liver primary
desmoplastic (causes scarring)- biliary epithelial cells etiologies psc carolis choledochal cyst thorotrach clonorchis sinensis delayed enhancement (10 min) due to scarring, capsular retraction bile duct dilatation tumor fingers in bile ducts types intrahepatic 20-30% mass forming periductal infiltrating intraductal peripheral: beyond secondary ducts hilar: large duct cancer MRI infiltrating mass irregular margins peripheral bile duct dilatation (high T2) low T1/high T2 delayed enhancement |
|
|
cirrhosis-general
|
etoh/viral hepatitis
biliary obstruction/congestion drugs autoimmune disease hematochromatosis wilsons advanced cirrhosis atrophy right lobe, medial segment left lobe, expanded gb fossa hypertrophy caudate lateral segment left lobe |
|
|
cirrhosis-dysplastic nodules
|
MRI
similar features to RN but may be high T1 typically low T2 4-12% hypervascular |
|
|
cirrhosis-regenerating nodules
|
regenerating nodules
low T1/T2, enhance like liver may have excess iron (siderotic nodules, dark) or copper (bright) siderotic nodules (MRI>CT) |
|
|
cirrhosis-fibrosis
|
diffuse or focal
high T2 low T1 slight enhancement diffuse illdefined/patchy thin/thick bands perivacular cuffin (PBC) focal confluent anterior segment right lobe medial segment left lobe wedge-shaped capsular retraction may involve entire segment ddx: HCC |
|
|
diffuse fatty liver disease
|
obesity
tpn alcohol pregnancy steroids chemotherapy malnutrition |
|
|
primary hemochromatosis
|
AR
abnormal iron gi absorpt RES unable to store RE Fe deposition in hepatocytes, pancreas, myocardium, joints, endocrine glands, skin hyperdense CT (70-130 HU) T2 and T1 GRE, T2* GRE dark compared to paraspinal muscle |
|
|
hyperdense liver on CT
|
hemochromatosis
amiodaron type IV glycogen storage dz wilsons dz thorotrast |
|
|
hemosiderosis
|
dyserythropoeisis
excessive transfusion excessive iron accumulation in RES liver spleen bone marrow reduced signal on T2, T1 GRE, and T2*GRE |
|
|
budd chiari syndrome
|
pain, tender hepatomegaly, acute ascites, jaundice
causes idiopathic ivc webs/membranes tumors (hcc,rcc,adrenocoritlcal ca) pregnancy hypercoaguable state (PCV, OCP) |
|
|
budd chiari types
|
type 1-IVC +/- secondary HV occlusion
type 2-HV +/- secondary IVC type III-veno-occlusive disease (centrilobular veins) severe centrilobular congestion leads to delayed or reversed portal venous flow low density/hight T2 (congested) ascites large liver patchy central enhancement peripheral hypoperfusion reversed on delays small HV/IVC intravascular thrombi hepatic infarcts portal vein thrombosis 20% chronic-atrophied liver, large caudate |
|
|
portal vein thrombosis
|
causes
pancreatitis ascending cholangitis post-splenectomy stasis (cirrhosis) tumor (hcc, pancreatic, gastric, cholangiocarcinoma) myeloproliferative or connective tissue disease trauma/sepsis |
|
|
portal vein thrombosis imaging
|
lack of central pv enhancement
peripheral enhancement of vaso vasorum chronic-cavernous transformation, atrophy flow sensitive GRE seq/Gd wedge shaped low T1/high T2 THAD: decreased local PV perfusion triangular increased hepatic arterial perfusion transient increased segmental/lobar late arterial/early pv attenuation can be idiopathic or due to tumor? |
|
|
nutmeg liver
|
Passive hepatic congestion usually secondary to
congestive heart failure constrictive pericarditis tricuspid insufficiency right heart failure CT early retrograde enhancement of dilated IVC and hepatic veins due to contrast reflux from RA to IVC heterogeneous, mottled, reticulated, mosaic parenchymal pattern linear and curvilinear areas of poor enhancement due to delayed enhancement of small and medium-sized hepatic veins peripheral, large, patchy areas of poor or delayed enhancement periportal low attenuation (perivascular lymphedema) decreased attenuation around intrahepatic IVC hepatomegaly and ascites MR periportal high T2 (periportal edema) reticulated mosaic pattern of low signal intensity linear markings within 1-2 minutes liver becomes more homogeneous |
|
|
hepatic infarction
|
uncommon-dual supply
causes liver transplant, lap choly hepatic artery occlusion shock sepsis embolism vasculitis eclampsia OCP peripheral wedge shaped/geographic areas of low attenuation, low T1/high T2 new ascites change shape/atrophy over time bile lakes necrosis (air) |
|
|
major causes of sbo
|
adhesions
malignancy crohns disease hernias intussusception |
|
|
major causes of lbo
|
colorectal carcinoma
volvulus intussusception hernia diverticular disease |
|
|
warning signs of strangulation/closed loop/ischemia
|
excessive free fluid
mesenteric fat stranding/edema disproportionate dilatation of one loop mural non-enhancement +/-bowel wall thickening/pneumatosis +/-clustering "balloons on a string" |
|
|
risk of aortic aneurysm rupture within 5 years by aortic aneurysm
|
3-3.9 cm 2%
4-4.9 cm 3-12% 5-5.9 cm 25% 6-6.9 cm 35% 7+ cm 75% |
|
|
biliary stone disease
|
20%
risk factors female obesity estrogen hypercholesteremia middle age to elderly things to look out for mirrizi's syndrome-causes taper narrowing of the cbd stones with air crescent density MRI cholesterol-T2 dark, T1 dark pigment-T2 dark, T1 bright |
|
|
secondary signs of CBD
|
bile duct dilatation
eccentric filling defect dependent crescent sign of air (useful when stone is same density as bile) |
|
|
acalculous cholecystitis
|
10-15% of cholecystitis findings
dilated gb gb wall thickening areas of nonenhancement, sloughed wall associations prolonged fasting chronic infection ischemia obstruction of cystic duct ICU patient |
|
|
gallstone ileus
|
risk factors
female advanced age, mean 74-80 10-25% mortality riglers triad sbo pneumobilia ectopic gallstone |
|
|
small irregular bile ducts
|
PSC
intrahepatic duct involvement beaded ducts strictures pruning biliary diverticula AIDS cholangiopathy papillary stenosis otherwise similar to PSC recurrent pyogenic cholangitis |
|
|
PSC
|
progressive inflammation, fibrosis, destruction of bile ducts
70% male 75% have IBD, 4-5% of UC have PSC 40 yo mean age complications cirrhosis recurrent bacterial cholangitis cholangiocarcinoma |
|
|
primary biliary cirrhosis
|
idiopathic, autoimmune
young/middle aged women, pruritis inflammatory progressive destruction of small bile ducts ->cirrhosis, PHTN 2 years life expectancy |
|
|
recurrent pyogenic cholangitis (oriental cholangiohepatitis)
|
>30 yo
recurrent bacterial cholangitis intrahepatic pigment stones and obstruction coliform bacterial seeding of biliary tree parasite infection ascaris lumbricoides clonorchis sinensis opsithorchis vivemini central, dilated bile ducts with peripheral tapering bile duct stones liver abscesses |
|
|
ascending cholangitis
|
biliary bacterial infection-gram -'s
risk factors choledocholithiasis indwelling stents tumors acute pancreatitis charcot's triad pain fever jaundice |
|
|
choledochal cyst
|
ask to look at the pancreatic duct/main duct confluence to look for cholangiocarcinoma
stones |
|
|
biliary cystadenoma
|
f:m 4:1, caucasian
ovarian stroma at histology middle aged >30 yo multiloculated fluid collection, often big enhancing mural nodules, septae may have thin calcifications ddx hydatid cyst hematoma simple cyst |
|
|
biliary hamartomas aka von myenberg complexes
|
CT
diffuse small low attenuation foci <1cm each MRI low to slightly high T1 high T2 US hyperechoic comet tail artifacts |
|
|
right posterior biliary duct variants
|
normal, drains into right main 55%
low insertion of duct onto main 5% accessory right to GB (common)-predisp to bile leak right posterior duct to cystic 1% |
|
|
inadvertant common duct ligation
|
bismuth classification
1-CBD> 2 cm from confluence 2-<2 cm from confluence 3-entire CHD 4-involves confluence 5-right variant branch increasing grade, more difficult repair after complicated cholecystectomy |
|
|
focal gb wall thickening
|
adenomyomatosis
gb polyps gallbladder cancer |
|
|
adenomyomatosis
|
focal wall thickening due to mucosal herniations
small cystic spaces-dilated rotikansy aschoff spaces (string of pearls) mostly fundus usually associated with gallstones |
|
|
gallbladder polyp
|
enhancing lesion
surgery >1.0 cm age > 50 symptomatic coexisting gallstones otherwise US surveillance every 3 to 6 months for 1 year |
|
|
gallbladder cancer
|
eldery (70s)
gallstones 60-90% adenocarcinoma infiltrative or endoluminal, fundus or neck mets to local LN, peritoneum, gi tract, lungs 5 year survival 1% |
|
|
bile duct strictures
|
malignant
proximal (superior) abrupt shoulders associated mass eccentric mets benign distal (inferior) gradual tapering concentric ERCP dx cytology/brushings sensitivity 44-70% specificity 100% |
|
|
pain jaundice/biliary stricture
|
ddx
malignant cholangiocarcinoma gallbladder carcinoma LAD pancreatic cancer benign trauma gallstone ischemic |
|
|
bosniak type 1
|
simple cyst (benign)
thin wall no septa no calcifications fluid density (-20 to +20 HU) no enhancement |
|
|
bosniak type 2
|
minimally complicated cyst
hariline thin septa +/- minimal perceived enhancement fine calcifications in walls or septa short segment of slightly thickened calcification uniform high attenuation (<3 cm) |
|
|
boniak 2f
|
follow-up if needed
increased # of thin septa minimal smooth thickening of wall or septa no enhancing solid components intrarenal high attn cysts>3cm |
|
|
bosniak 3
|
complex (indeterminate)
thickened irregular walls or septa enhancement of wall or septa chunky ca++ |
|
|
bosniak 4
|
malignant cystic masses
enhancing soft tissue components adjacent to but independent of wall or septum |
|
|
staging of RCC
|
1-confined to capsule
2-extranrenal but confined to gerotas fascia 3a-vascular invasion 3b-local node mets 3c-both 4a-invasion of distant organs 4b-distant mets distinguish between 3 and 4 because of px |
|
|
solid renal mass without obvious fat
|
ddx
rcc tcc lymphoma mets pyelonephritis fungus ball infarct |
|
|
renal tcc
|
6th to 7th decades, m/f 3/1
risk-aniline dyes, aromatic amines, xrt, cigarettes, cytotoxan, artificial sweetners 80-90% current or prior bladder ca imaging features polypoid filling defect circumferential wall thickening infiltrating or discrete mass mimicking RCC +/- caliceal dilatation |
|
|
renal lymphoma
|
ct incidence of 3-8%
autopy 30-60% primary renal lymphoma rare multiple small masses spread from retroperitoneum diffuse infiltration perinephric encasement single homogenous mass maybe mixed |
|
|
oncocytoma
|
rare benign
can be difficult to distinguish from RCC central stellate scar spoke wheel pattern of vessels on angio not specific enough to avoid resection up to 30% contain focci of rcc radical or partial nephrectomy |
|
|
angiomyolipoma
|
rare, benign hamartomatous
80% sporadic, 20% syndromic blood vessels, muscle, fat 95% contain demonstratable fat, -20HU well defined, cortical (+/- exophytic) usually<5cm fat-containing RCC has small amount of fat |
|
|
rcc risk factors
|
history of rcc
vhl cystic dz of dialysis adpckd not an increased risk |
|
|
adrenal cyst
|
rare
45% endothelial lined 39% pseudocysts (prior hemorrhage) CT-fluid density, no enhancement MR-bright T2, dark T1, no enhancement maybe hemorrhagic |
|
|
adrenal myelolipoma
|
rare, benign
hyperintense T1, fat saturation due to macroscopic fat, no drop out on out of phase |
|
|
CT criteria for adenoma
|
hu < 10-18 on noncontrast
rapid contrast washout >60% decreased between pv and 15 min delayed <52HU on 10 min delayed |
|
|
MR criterial for adenoma
|
>20% signal drop on out of phase
or compared with muscle or spleen if lipid poor, use washout characteristics hypointense on T2, variably enhances |
|
|
adrenal mets
|
most common malignancy of adrenal gland
often bilateral do no fat sat also consider adrenal lymphoma |
|
|
pheochromocytoma
|
90% in medulla
>3cm at presentation 10% bilateral 10% malignant T2 lightbulb bright but not common, no fat sat, late enhancement |
|
|
adrenal carcinoma
|
rare aggressive tumor
large (90%>6cm) heterogenous, necrosis, hemorrhage can invade IVC |
|
|
cross fused ectopia
|
one or both kidneys on wrong side
ureter crosses midline to insert on correct side with normal insertion at bladder trigone ectopic kidney associated with reflux |
|
|
horsehoe kidney
|
lower poles directed toward midline
lp calyces overlap spine prominent extrarenal pelvis kidneys joint by parenchyma or fibrous tissue below IMA predisposed to trauma stones uti association upj obstruction wilms tumor, carcinoid, rcc? turners other anomalies such as skeletal, cardiac, and vater look for mullerian duct anomalies |
|
|
unilateral renal enlargement
|
ddx
obstruction renal vein thrombosis pyelonephritis cystic renal disease developmental contralateral renal atrophy klippel trenauny webber |
|
|
bilateral renal enlargement
|
edema-ie those things that cause unilateral enlargement
deposition disease ie amyloid leukemia SLE HIV nephropathy cystic renal disease |
|
|
adpckd
|
1/1000
cysts of nephrons and collecting tubules htn, renal failure 3rd decade 10% die of berry aneurysm |
|
|
acquired renal cystic disease
|
20% <40 yo
>33% >60 yo cysts may enlarge and cause sx's from mass effect lap decortication alcohol ablation increased risk of RCC |
|
|
simple renal cyst
|
ddx
calyceal diverticulum-fills on delay, retains stone focal caliectasis peripelvic cyst/hydro upj obstruction aneurysm/pseudoaneurysm-follows blood pool on ct AVM/AVF lymphoma on US |
|
|
renal ptosis
|
hypermobile kidney
may cause upj obstruction normal number of calices distinguish from "drooping lily" (duplicated ureters with upper pole obstruction) |
|
|
proximal blind ending ureter
|
associations
dysplastic kidney prior nephrectomy ureteral diverticulum (congenital) |
|
|
megacalicosis
|
dilated calices
too many calices nondilated pelvis renal enlargement associations ureterocele megaureter contralateral upj |
|
|
upj obstruction
|
primary
congenital narrowing secondary crossing vessel (artery or vein) mass retroperitoneal fibrosis circumcaval ureter-hairpin turn in ureter and crosses medial to spinal tv processes |
|
|
congenital megaureter
|
looks like hirschsprungs-tight distally, dilated proximally
|
|
|
ureteral filling defect
|
tcc
clot sloughed papilla calculus fungus polyp |
|
|
multiple small mucosal lesions in upper urinary tract
|
pyelouretritis cystica-related to infection, no premalignant
multifocal tc malakoplakia-not premalignant leukoplakia-more common in bladder, premalignant vascular impressions edema due to stent |
|
|
focal pyelonephritis
|
focal illdefined perfusion anomaly
striated nephrogram focal contour bulge urothelium thick or enhancing perinephric edema (beware obstruction/hydronephrosis) |
|
|
xanthogranulomatous pyelonephritis
|
renal enlargement
calyces and papilla replaced by low density masses cortical atrophy extension into perirenal space staghorn calculus uncommon form of chronic renal parenchymal infection yellow nodules componsed of foamy lipid macrophages usually diffuse, maybe focal extension into the perirenal space (abscess/fistula) is common |
|
|
prolonged nephrogram
|
ddx
unilateral renal vein thrombosis ureteral obstruction severe RAS bilateral systemic hypotension ATN (contrast toxicity) intratubular obstruction ie myeloma, uric acid crystals, tamm-horsefall |
|
|
striated nephrogram
|
ddx
multiple infarctions pyelonephritis hypotension/ATN renal vein obstruction contusion intratubular obstruction |
|
|
medullary nephrocalcinoisis
|
increased medullary Ca++, increased medullary hyperechogenicity with shadowing
ddx hyperparathyroidism 40% distal RTA medullary sponge kidney papillary necrosis lasix treatment (#1 in infants and premies) |
|
|
papillary necrosis
POSTCARD |
ivp signs
ball on a t elongated lobster claw calyces ddx pyelonephritis obstruction sickle cell tb coagulopathies/christmas dz analgesics (NSAIDS) renal vein thrombosis diabetes |
|
|
cortical nephrocalcinosis
|
chronic glomerulonephritis
ischemia/cortical necrosis aids nephropathy other oxalosis alport syndrome hypercalcemia |
|
|
acute renal cortical necrosis
|
peripheral nonenhancing cortex before calcifying
|
|
|
renal tb
|
putty kidney-shrunken calcified amorphous kidney mimics staghorn calculi, caseous necrosis
75% unilateral shrunken calcified bladder-"thimble" bladder IVP big round distorted cottonball calyces with infindibular narrowing papillary necrosis developing countries usually secondary to another primary infection |
|
|
acute pancreatitis
|
etiologies
etoh, cholelithiasis >90% hyperlipidemia drugs (steroids, AZT, DDI, diurections, antibiotics) post ercp or surgery infectious (measles, mumps, viral) familial |
|
|
acute pancreatitis CT grading
|
grade A-normal pancreas
grade b-enlarged heterogenous gland, no peripancreatic inflammation grad c-intrinsic pancreatic abnormalities + peripancreatic inflammation grade d-single fluid collection grade e->=2 large fluid collections and/or pancreatic or peripancreatic gas complications pseudocyst pseudoaneurysm splenic or pv thrombosis abscess-fluid with air necrosis hemorrhage |
|
|
pseudocyst features
|
>4 weeks to develop
0-30 HU, no enhancing contents or nodules wall ca++ common ddx thrombosed pseudoaneurysm can occur anywhere |
|
|
chronic pancreatitis
|
permanent structural and functional damage
75% etoh other etiologies-hyperlipidemia, hyperPTH, pancreas divisum 2-4% will develop pancreatic CA imaging findings: ca++ variable size dilatation of pancreatic duct and bile ducts (double duct sign) pseudocysts, pseudoaneurysms venous thrombosis and collaterals |
|
|
drainage of noninfected pancreatic pseudocysts indications
|
>5cm, esp if increasing in size
symptomatic obstruction of bile duct, stomach, or duodenum complications 5-10% infection bleeding chronic cutaneous fistula |
|
|
pancreas divisum
|
5%
failure of fusion of dorsal and ventral pancreatic buds head drained by duct of wirsung body and tail drained by santorini recurrent pancreatitis +/-bulky pancreatic head with fat cleft ERCP dx |
|
|
pancreas divisum imaging findings
|
ERCP injection of major papilla demonstrates truncated duct of wirsung with branching in head (as opposed to pancreatic CA which has no branching)
|
|
|
annular pancreas
|
band of pancreatic tissue encircles the second portion of the duodenum
50% obstruction in neonates (double bubble) 50% periampullary ulcers and pancreatitis in adults ERCP-main duct of wirsung circles around and then crosses midline UGI-short segment duodenal narrowing ddx-pancreatic adenocarcinoma of head |
|
|
pancreatic carcinoma
|
5th leading cause of cancer deaths, 28000/year
90% of pancreatic neoplasms elderly males 70% head, 20% body, 10% tail 5 year survival <5% 90% cases unresectable at time of dx |
|
|
pancreatic carcinoma imaging features
|
low density mass, occasionally isodense
hypoechoic mass dilated PD and/or bile duct distal to mass (double duct sign) pancretic atrophy perivascular cuffing-sign of unresectability teardrop sign-tethering of vessels, sign of unresectability interrupted duct sign |
|
|
criteria for unresectability of pancreatic carcinoma
|
>5cm
adjacent tissue or organ invasion excluding duodenum arterial stenosis, occlusion, or encasement (celiac + branches, SMA) +/- venous invasion (PV, SMV) hepatic mets distant adenopathy peritoneal carcinomatosis |
|
|
pancreatic carcinoma ddx
|
mets
islet cell tumor lymphoma tumor from adjacent organ focal fat focal pancreatitis necrosis |
|
|
cystic pancreatic tumors
|
5-10% of pancreatic malignancies
microcystic adenoma (serous) mucinous cystic neoplasm solid and papillary epithelial neoplasm IPMT anaplastic CA cystic islet cell tumor cystic met lymphoma |
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microcystic adenoma
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benign
f/m 4:1 mean 65 yo head=body=tail 35% ca++ +central stellate scar cysts>6, each <2cm honeycomb appearance glycogen vhl |
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mucinous cystic neoplasms (macrocystic)
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frankly or potentially malignant
f/m 9:1 mean age 50 yo tail>body 15% peripheral ca++ solitary small or large or if multiple cysts <6, >2 cm mucin |
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solid and papillary epithelial neoplasm (SAPEN)
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rare, low grade malignancy
young women, mean age 24 yo large, well encapsulated solid and cystic mas, hemorrhage and necrosis, fluid-debris level pancreatic tail complete resection curative |
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intraductal papillary mucinous tumor (IMPN, mucinous ductal ectasia)
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epithelial hyperplasia--carinoma
mean age 65yo main duct-diffuse or segmental dilatation branch duct-cystic dilatation, multiple cysts combined types ERCP-patulous dilated papilla with mucin pouring from it, mural nodules ipmt branch duct type less likely to have malignancy if <3cm, can follow-up diffuse duct type-more likely malignant and need resection, suspect if absent findings of chronic pancreatitis ddx chronic pancreatitis cystic tumors |
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islet cell tumors
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85% functional
insulinoma most common >90% benign and resectable small gastrinoma 2nd most common 60% malignant small cause of ZE syndrome 15% nonfunctioning 3rd most common 80-90% malignant large, mean size >5cm 25% ca++ CECT-immediate intense enhancment, can be more il-defined, less enhancing if not insulinoma? US-hypoechoic mass MRI-T1GRE + FS +C shows immediate intense enhancement, can be more il-defined, less enhancing if not insulinoma? |
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calcified liver mass
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mucinous adenoCA
gi tumors (colon) breast prostate ovarian serous adenoCA mets which engulf granulomas other treated lymphoma osteo/chondrosarcoma mets tx with lipiodol |
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foregut duplication cysts
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CT
fluid density MRI high T2 signal, low to slightly high T1 signal if see vertebral involvement, suggest neurenteric cyst surgical management ddx pseudocyst |
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focal solid splenic lesions
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ddx
hemangioma #1 melanoma lymphoma, often infiltrative sarcoid phlegmon,abscess |
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gastric polypoid filling defects
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ddx
polyp fb, clot, bezoar mets lymphoma leiomyoma, lipoma, fibroma ectopic pancreas |
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colonic wall thickening
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ddx
immunocompetent pseudomembranous colitis ischemic inflammatory lymphoma (look for LAD) if immunocompromised CMV colitis other typhillitis gvhd |
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gastric fundal lesions
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GIST
lymphoma gastic adenocarcinoma |
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fatty pancreatic replacement
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ddx
cystic fibrosis obesity/old age (cryptogenic) diabetes chronic pancreatitis TPN corticosteroids |
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bladder ca
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2% of cancer deaths
risk factors tcc 90%-smoking, aniline dyes, age scc 8%-stones, chronic inflammation acc 2%-congenital defect (urachal defects), chronic inflammation |
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bladder ca imaging
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variable morphology
polypoid papillary mass in low grade tumors focal wall thickening in high grade tumors +/- surface ca++ (tcc) cystoscopy is gold standard for can, moderate imaging detection rate (CT 70% detection rate) field cancerization-increased risk of tcc in other areas of uroethlium pelvic sidewall recurrence is typical tends to seed along needle tracks |
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bladder masses ddx
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hematoma
leiomyoma-smooth, dumbell shaped schistosomiasis-diffusely calcified bladder wall, may track ca++ up ureter, assoc w scc pheochromocytoma-smooth very enhancing mass |
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neurogenic bladder
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spastic-small trabeculated, conical, "christmas tree" bladder
atonic or flaccid-large, smooth |
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prostate cancer
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most common noncutaneous man cancer
second most common cause of cancer death in men low T2 signal in peripheral zone findings of T3 cancer focal irregular bulge NVB invasion RP angle obliteration SV invasion |
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prostate cancer staging and treatment
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stage 1/2, organ confined-surgery, radiation, observation
stage 3-radiation therapy only stage 4-systemic tx |
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urethral anatomy
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anterior part
bulbar segment penile segment posterior part membranous segment prostatic segment |
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urethral stricture
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post-traumatic, post-inflammatory, idiopathic
length influences tx-measure between shoulders, >1.5 cm precludes primary anastomosis need RUG and VUG |
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urethral diverticulum
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1-6% adult women
unknown etiology nonspecific urethral sx may not be seen on vcug double ballooon urethrogram t2 and t1 post gad (enhancing mucosa) |
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circumcaval ureter
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congenital anomaly
ivc derives from subcardinal or postcardinal vein ureter trapped behind ivc pain, hematuria, utis, stones ureter lies medial to lower lumbar pedicle, crosses anterior to right iliac vessels associations-horsehoe, turners, double vena cavae ddx normal oblique impression of crossing iliac vessels at l5 or s1 adenopathy retroperitoneal fibrosis pelvic lipomatosis |
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renal infarcts
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wedg shaped peripheral defects
emboli from arrythmias, myxomas, s/p myocardial infarct emboli bilateral in 50% after xrt arteritides-polyarteritis nodosa, methamphetamine ddx acute focal bacterial nephritis infiltrating neoplasm |
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horshoe kidney
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1/400, ima crosses isthmus
multiple arteries, double ureters complications-injury, upj obstruction, lower pole moiety, stones, wilms tumor assoc-turners, trisomy 18, fanconis anemia, vater ddx cross fused ectopia disc (cake, lump) kidney-usually lower than horseshoe, often in pelvis, may have single ureter |
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unopacified kidney
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ddx
renal artery embolus-large smooth unopacifiefd kidney, with cortical rim of contrast, shrink after 2-3 weeks obstruction renal vein thrombus absent or ectopic kidney infection (xgpn) tumor mcdk |
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renal cell ca
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m/f 2/1, 50-70, 2% bilateral, 7-9% esrd
familial rcc, mult, bilateral vhl-38% rcc, multiple 75% mass, flank pain, hematuria clear cell 80%-enhances a lot papillary 15%-not as much enhancement calcification 8-18% iuv-bulge, hypervascular mass us-86% isoechoic, 10% hypo ct/mr-enhances less than parench |
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rcc staging
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t1 tumor <=7cm, limit to kidney
t1a <=4cm t1b between 4 and 7cm t2 tumor >7cm, limited to kidney *t1 and t2 surgical t3 tumor into renal vein, ivc, adrenal, but confined to gerotas fascia t3a adrenal gland/perinephric tissues t3b renal vein t3c ivc or its wall above diaphragm t4 tumor beyond gerotas fascia/distant mets |
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renal mass
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ddx
rcc oncocytoma angiomyolipoma mets xgpn acute focal bacterial nephritis |
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persistent or increased density nephrogram
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contrast reaction
acute tubular necrosis 60& acute tubular blockage ie mm, urate nephropathy, tamm horsfall protein acute gmn |
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nephrocalcinosis
STADIM DITCH |
sarcoid
tb a-vitamin d-vitain immobilization milk alkali medullary sponge diuretics lasix idiopathic thyrotoxicosis carcinoma hyperparathyroidism |
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upj obstruction
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congenital
functional stenosis acquired scarring, reflux tumor intraluminal lesion 5% have a contralateral renal agenesis or mcdk lower segment of duplex kidney has upj more often than upper |
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urethral diverticulum complications
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infection
stones bladder outlet obstruction adenocarcinoma ddx anterior vaginal mass/cyst gartner duct cyst paramesonephric remnant cyst epithelial inclusion cyst ectopic ureterocele endometrioma urethral tumo-scca |
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unilateral enlarged kidney
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compensatory hypertrophy
obstruction acute bacterial nephritis duplex kidney cross fused ectopia tumor mcdk, adpck traum renal vein thrombosis acute arterial infarction |
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xanthogranulomatous pyelonephritis
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focal or diffuse, middle aged females
secondary to chronic uti's 80% have calculi, usually struvite lipid laden macrophages (xanthoma cells) replace normal parenchyma hypovascular, may not have renal function nephrectomy ddx abscess renal cell ca lymphoma tcc |
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duplicated bladder
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type 1 involves mucosa and muscle wall; peritoneal fold separates 2 bladders
type 2 internal septum of mucosa or mucosa and muscle divides bladder type 3 transverse band of muscle; hourglass shape associated anomalies-duplicaed penis, urethra, vagina, uterus, colon; rectourethral fistula |
