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34 Cards in this Set

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Non Visualization of the Gall Bladder

During oral cholecystography
Technical failure (no fatty meal prior, vomiting, Bilirubin > 34 mmol)
Previous Cholecystectomy
Ectopic gallbladder
Cholcystitis
Cystic duct obstruction
Non Visualization of the Gall Bladder

During IV Cholangiography
Technical failure (contarst medium given too rapidly, Bilirubin > 50 mmol)
Previous Cholecystectomy
Ectopic gallbladder
Cholcystitis
Cystic duct obstruction
Filling Defect in the GB

Multiple
Calculi
Cholesterosis (strawberry GB, multiple fixed mural filling defects)
Filling Defect in the GB

Single and small
calculus
adenomyomatosis
Filling Defect in the GB

Single and large
calculus
carcinoma
Gas in Biliarry tract

Within the Bile Ducts
Incompetence of Spincter of Oddi (following sphincterotomy, passage of gallstone, patulous in elderly)

Postoperative
cholecystoenterostomy
choledochoendorostomy

Sponataneous Biliarry Fistula
Passage of gallstone directly from an inflammed GB
Duodenal ulcer perforation the bile ducr
malignancy or trauma
Gas in Biliarry tract

Within the Gall Bladder
All of the above
Emphysematous cholecystitis ( gas forming organism DM)
Gas in the Portal Veins

Children
Necrotizing Enterocolitis
umbilical vein catheterization
erythroblastosis fetalis
Gas in the Portal Veins

Adults
Mesenteric Infarction
Air embolus during double contrast barium enema
acute gastric dilation (may recover following placememt of NG tube)
Hepatomegaly
Neoplastic
Mets
Hepatoma
Lymphoma

Raised Venous Pressure
congestive heart failure
constrictive pericarditis
tricuspid stenosis
Bud Chiari synd.

Degenerative
Cirrhosis
Fatty Infiltrate

Myeloproliferative Disorder
Polycthaemia Rubra Vera
Myelofibrosis

Infective
Viral
Bacterial
Protozoal (amebic abscess, malaria, trypanosomiasis and kalar azar
Parasitic hytatid

Storage Disorders
Amyloid
hemochromotosis
Gauchers
Nieman Pick Disease

Congenital
Reidels Lobe
Polycystic disease
Hepatic Tumors in Children
Hepatoblastoma
Hepatocellular Ca (see comparison pg 281 Chapman)
Hemangioendothelioma
Stage IV-S neuroblastoma (increased urine VMas MIBG positive)
Adenoma (solitary or multipe associate glycogen storage disease, teenager ocp)

DDx focal nodular hyperplasia
simple cyst
choledochal cyst abscess
Hepatic Calcifications
Multiple and Small
healed granuloma

Curvilinear
Hydatid
Abscess
Calcified porcelain GB

Localized in Mass
Mets GIT (colloid CA)met, folowing Rx)
Adenoma (rare calcification punctate)

Sunray Spiculation
Hemangioma
Mets (colloid ca)
Adenoma
Fetal or Neonatal luiever calcification
Peritoneal
Meconium peritonitis
Plastic peritonitis due to rupture hydrometrocolpos

Parenchymal
Congenital Infections TORCH
Tumors (hemangioma, hamartoma, hepatoblastoma, teratoma and metaststic neuroblastoma)

Vascular
Portal Vein Thromboemboli
Ischemic Infarcts
Jaundice in Infancy
Anatomical Abnormalities
Biliary Atresia (3 types)
Choledocal Cyst (5 types)
Alagille Syndrome

Metabolic Defects alpha antitrypsin deficiency, galactosemia, tyrisonemia

Infection
Neonatal Hepatitis (probable secondary to Reovirus)
Biliary Atresia 3 types
i) focal (extemely rare)
ii) intrahepatic (uncommon)
iii) subtype 1 66% with abile duct remnant at the porta hepatis
subtype 2 34% associated multipe congenital abnormalities (polysplenia)

Chledochal cysts 5 types
i)Fusiform or focal dilation of the CBD+/- common hepatic duct80%
ii) 2% diverticulum of the CBD
iii) 2-5% Outpouching of the CBD in the wall of the 2nd part of the duodenum (choledococele)
iva)Dilation of CBD and focal dialtion of the intrahepatic ducts
ivb) Focal dialtions of the CBD
v) focal dilation of the intrahepatic ducts Caroli's Disease
Ultarsound of the Liver

Generalized Hypoechoic
Acute Hepatitis
Diffuse Malignant Infiltration
Ultrasound of the Liver

Generalized Hyperchoic (bright liver)
fatty infiltation
cirrhosis
hepatitis
infiltration / deposition (maligannt, granulomata, glycogen storage disease
Ultrasound of the Liver

Focal Hyperechoic
Mets (GIT,ovary,pancreas urogenital
Capillary hemangioma
Focal Nodular Hyperplasia
Debris within lesion
Hepatoma (can be hypo or hyperechoic)
Ultrasound of the Liver

Focal Hypoechoic
Mets (cystic mets ovary, pancreas stomach)
Lymphoma
Hepatoma
Cysts
Abscess
hematoma
Cavernous hemangioma
Ultrasound of the Liver

Periportal Hyperechoic
Air in biliary tree schistosomiasis
cholecystitis
recurrent pyogenic cholangitis (oriental)
Ultrasound of the Liver

Periportal Hypeoechogenicity (collar sign)
periportal low attenuation on CT
Orthotopic liver transpalnt rejection
Congestive hepatomegaly
malignant lymphatic obstruction
blunt abdominal trauma
cholangitis
viral hepatitis
Thickened BB Wall >3mm
cholecystitis hepatitis
hypoalbunemia
cirrhosis
congestive heart failure renal failure
CT Liver Focal Hyperenhancincing Lesion
During Arterial Phase
heoatocellular ca
hemangioma
FNH
Adenoma
Mets (particlar carcinoid panceatic islet cells)

During Portal Phase
Hemangioma
HCC
Venous Collaterals (from obstructed IVC/SVC)

During Equilibrium Phase
Hemangioma
Cholangiocarcinoma
Solitary fibrous tumor
treated Mets
CT Liver Focal Hyperdense Lesion
Pre IV contarst
calcification in: (mets, primary tumor, infective lesion)
Acute hemorrhage

Post IV contrast
Hypervascualr Masses
Mets (carcinoid, RCC, melanoma)
Adenoma ? FNH enhancement seen only in arterial phase after this thery may appear hyperdense
Vascular Abnormalities (arterioportal shunts may occur in hepatoma)
CT Liver Generalized Low Density Pre-IV contrast Medium

Assess by comparing liver with spleen
Fatty Infiltrate
Malignant Infitration
Budd Chiari
Amyloid
CT Liver Generalized Increase in Density Pre-IV contrast Medium
hemochromatosis
hemosiderosis
iron overload
glycogen storage disease
amiodorone
CT Liver Patchy Areas of Low Density Post-IV contrast Medium
cirrhosis
hepatitis
portal vein thrombosis
Budd Chiari
lymphoma Sarcoid
MR Liver Focal Hyperintense Lesion on T1W
Fat
blood (acute stage methemoglobin)
proteinacious material
melanoma mets
chemical Gadolinium
relative
artefact 'ghost artefact'
MR Liver Ringed Hepatic Lesions
Capsules of Primary Liver Tumors
Mets
suacute hematoma
Hydatid cyst
Amebic abscess
Splenomegaly
Huge Spleen
CML
Myelofibrosis
Malaria
Kal-azar
Gaucher's
Lymphoma

Moderately Large Spleen
All of the above
Storage Diseases
hemolytic anemia
portal hypertension
leukemias

Slightly Large Spleen
All of above
Infections (hepatitis, mononucleosis, ricketstial typhus, histoplasmosis)
Sarcoid
Amyloid
RA (Felty's Syndrome)
SLE
Splenic Calcification
Curvilinear
Splenic Artery calcification
cyst (HYDATID)

Multiple Small Nodular
phleboliths
hemangioma
TB
histoplasmosis
Brucellosis
Sickle cell Disease

Diffues Homogenous or Finely Granular
Sickle cell anemia
PCP

Solitary > than 1 cm
Healed infarct
healed abscess
TB
CT Spleen Foacal Low Density Lesion
Lymphoma
Mets
Hemangioma
Abscess
Pancreatic Calcification
Alcoholic Pancraetitis
Pseudocyst
Ca Panreas
Hyperparthyroidism
CF
Tumors (calcificationin 10% of cystadenomas.carcinomas)
CT Pancreas Focal Mass
Adenocarcinoma (60% head, 10% body, 5% tail 20% diffuse)
Focal Pancreatitis
Mets
Islet Cell Tumor (equal incidence head/body/tail 80% non fuctioning large size)
Mucinous cystadenoma and cystadenocarcinoma
Beta Cell
Insulinoma 90% benign, 10% multiple, *0%, 2cm

Non beta cell
Gastrinoma 60% amlignant
30 benign adenoma 10% hyperplasia 90% loacted in pancreas 5% duodenum
Glucagonoma usually < 4cm since endocrine disturbance is often less marked
Non Visualization of GB with TBIDA
No Bowel Activity
CBD obstruction
severe hepatitis
opiates

With Bowel Activity
Acute cholecystitis
chronic cholecystitis
cholecystectomy
inadequate fasting
Bialry pancreatitis
severe diffuse hepatocellular disease