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54 Cards in this Set
- Front
- Back
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What are CT signs of gangrenous cholecystitis?
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Sloughed membranes, intramural/luminal gas, absent gallbladder wall, abscess
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DDx Linitis plastica...
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Scirrhous carcinoma
Lymphoma Breast CA mets |
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Hallmark feature of gastric lymphoma...
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Marked mural thickening, more than 4 cm
Gastric carcinoma is more likely to have an ulcerated mass or polypoid lesion |
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Diffuse ribbon like, featureless bowel...
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GVH disease; toothpaste bowel
Occurs within 3 months of transplant |
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DDx diffuse Small Bowel fold thickening with LNA...
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MAI
Lymphoma |
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DDx - mesenteric desmoplasia
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Retractile mesenteritis
Carcinoid Desmoid Treated Lymphoma |
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Cronkhite-Canada syndrome...
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Hyperplastic in- fl ammatory polyps and is mostly associated with loss of hair and nails as well as hyperpigmentation.
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Cowden syndrome
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Hamartomas and may occur in the entire GI tract, tongue, and skin. Assoc. with follicular thyroid CA, breast CA, L. Duclos in cerebellum.
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Peutz Jeghers syndrome
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Multiple GI polyps, large or small, associated with increased risk of malignancies
Assoc. with GI complications |
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Where are Barrett strictures located?
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Lower esophagus near squamocolumnar junction
Upper strictures are most commonly Barrett strictures |
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DDx upper/mid esophageal strictures...
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Barrett - Most common, even though these types of strictures more commonly occur in the lower esophagus
Tumor Radiation Caustic ingestion Drug ingestion |
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Most common met to gallbaldder...
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melanoma
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DDx gallbladder carcinoma
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Xanthogranulomatous cholecystitis
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Progressive imaging features of Candida esophagitis...
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linear oriented nodules to shaggy erosions
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Where do Killian-Jamieson diverticula occur?
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Just below the transverse portion of the cricopharyngeus muscle
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Smoothly marginated, heterogenously enhancing mesenteric mass should make you think...
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GIST
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Where is the obturator foramen?
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Between the obturator externus and pectineus muscle
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What is the CT enhancement pattern of small vs. large intrahepatic cholangiocarcinoma?
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Small lesions - enhance like HCC
Large lesions - delayed/persistent enhancement |
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Ultrasound sign seen with Caroli's disease...
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Central dot sign
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DDx intra/extra hepatic bile duct irregularity
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PSC
HIV cholangiopathy PBC (intrahepatic ducts only) Recurrent pyogenic cholangitis |
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DDx Coned cecum
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Lymphoma
Infection – amebiasis, Yersinia Abscess from appendicitis/diverticulitis Crohn’s dz |
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Cobblestoning on barium study...
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Active Crohn disease
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Most common location of small bowel adenoma?
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Periampullary (80%)
Increased freq proximally in small bowel |
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MEN I syndrome...
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Pituitary
Parathyroid Pancreas - gastrinoma |
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Plaque like indentation on one side of the colon...
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Endometriosis, implants on colon causing pain in young patient
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What is pneumatosis cystoides coli?
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Benign form of pneumatosis in which nitrogen cas collects in the sbuserosal space...seen with CF, scleroderma, steroid use, COPD
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What does scleroderma of the GI tract look like?
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Esophageal and colonic dilation, constipation
Enhancing small bowel wall with stack of coins on barium study |
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What syndromes are associated with GI polyps?
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Canada-Cronkhite - hyperplastic inflammatory polyps
Peutz-Jeghers - Hamartomas, incr. risk of # Ca Hyperplastic gastric polyposis FAP - adenomas and hamartomas, incr. risk of # Ca Cowden - GI hamartomas, lermit duclos, br CA, foll. thyroid CA |
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MC location of small bowel lymphoma?
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Ileum then jejunum, then duodenum
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What are three benign tranverse esophageal folds?
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Feline esophagus - thin folds, diffuse, entire width of esophagus
Peptic strictures - distal, smooth, concentric B ring/Schatzki ring - at esophagogastric junction, below Z line (mucosal epithilium change) |
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Polygonal shape of stomach lining suggests...
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Gastritis, associated with thickened rugal folds
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Nuc med study to diff FNH from hepatic adenoma?
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Tc 99m Sulfer colloid
FNH - warm to hot HA - usually cold |
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What is the histology of FNH?
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Disorganized normal liver tissue with central arteries but no portal supply - central scar
Usually small ~3cm Younger women Association with aneurysms, hemangiomas, SCD Sulfur colloid positive |
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What is the histology of hepatic adenoma?
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Hepatocytes with fat, often necrosis, hemorrhage and rupture
Large at presentation ~9cm, solitary Associated with glycogen storage dz, OCPs |
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Most common small bowel neoplasms that are exophytic and cavitary...
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Metastasis; if cavitary think melanoma
DDx: Leiomyosarc, Lymphoma - aneurysmal dilation Primary adenocarcinoma |
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DDx Ruggal fold thicking
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Benign
H. Pylori - most common Menetrier dz Zollinger-Ellison Renal failure (hyperchlorhydria) Portal HTN gastropathy Malignant Lymphoma, adeno CA, panc CA |
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Characteristics of fibrolamellar carcinoma and differences from HA and FNH...
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Large, encapsulated mass with irregular lobulated margins, central scar that never enhances. Calcs are common.
Distinguish from other masses in young people... FNH - small, central scar enhances, never calcifies HA - homogenous enhancement, associations with OCPs/steroids, smooth margins, no washout, vascular draping/displacement, not invasion |
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What is the signal intensity of organs for primary/secondary hemachromatosis and fatty liver infiltration...
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Primary Hemachromatosis: decreased T2 liver and PANCREAS/PRIMARY (less than muscle)
Secondary: decreased T2 liver and SPLEEN/SECONDARY Fatty: mild decrease in liver, no spleen or pancreas |
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What are the types of internal hernias?
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Paraduodenal (right or left)
Lesser sac Pericecal |
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What is the TNM staging of colon CA?
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T1: Submucosal
T2: Muscularis mucosae (MM) T3: Transmural T4: Adj organs, peritoneum N: nodes M: mets |
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Liver tumors with washout
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HCC
AML can have some washout as well |
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Liver tumors with progressive delayed enhancement
Key features? |
Intrahepatic cholangiocarcinoma - capsular retraction, peripheral biliary dilation, peripheral arterial with delayed central enhancement
Epithelioid hemangioendothelioma - same as above Solitary fibrous tumor - Central cystic areas with outer pseudocapsule |
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Liver tumors with central scar
Key features? |
FNH - delayed enhancement of scar, intense arterial enhancement, high T2
Fibrolamellar - progressive homogenous enhancement, CALCIFICATION, low T2, variable delayed enhancement Giant cavernous hemangioma - central scar never enhances |
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What makes Pancreatic adenocarcinoma unresectable vs. borderline resectable vs. resectable when considering...
Mets, SMV/PV, HA, SMA |
Mets - unresectable
SMV/PV - can't be thrombosed, must be able to reconstruct for borderline resectablility HA - if short segment involved, but not if it extends to celiac axis SMA - less than 180 degrees involvement |
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More likely to have central calcification, mucinous or serous cystadenomas of the pancreas?
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Serous, especially the spongy microcystic variety
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Small bowel adenomas and adenocarcinomas are located...
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Periampullary region
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What small bowel malignancy is associated with celiac?
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NHL T cell lymphoma "enteropathy associated lymphoma"
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What type of spread do GISTs not undergo?
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Lymphatic (very rare)
Usually hematogenous |
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What type of ulcers are associated with HSV and CMV in the esophagus?
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Small ulcers - HSV
Giant ulcers - CMV |
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Shaggy esophagus is seen with what illness?
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HIV - Candida
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What two conditions cause giant esophageal ulcers?
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HIV - most commonly
CMV |
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What are downhill esophageal varicies? Location?
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Mid esophageal varices due to SVC obstruction
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Spleen/Liver HU for fatty liver infiltration on noncontrast and PV contrast phases...
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15 HU less dense than liver on noncon
25 HU greater than liver during PV phase |
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Standard TIPS survellance frequency and thresholds?
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q3months
nl velocity btw 90 and 190 in mid and distal shunt change greater than 50 is abn proximal is unreliable |
