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72 Cards in this Set
- Front
- Back
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Zenker’s diverticulum
Findings: Focal contrast collection along the posterior lateral proximal esophagus connecting by a thin neck Found at the cricopharyngeus, the Killian’s dehiscence ddx: NONE! This is an Aunt Minnie! |
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Gastric carcinoma
Findings: Large mass projecting into the fundus with a large central ulcer loss of normal folds and wall contour ddx: leiomyosarcoma lymphoma metastasis |
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Long esophageal stricture
Findings: long segment of esophageal narrowing loss of normal mucosal pattern ddx: lye ingestion Long-term nasogastric intubation radiation |
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Achalasia
Findings: tight stenosis of the distal gastroesophageal junction = “bird’s beak” appearance dilated proximal esophagus ddx: pseudoachalasia Malignant stricture Benign stricture Chagas disease |
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Pancreatitis
Findings: diffuse narrowing of the duodenum splaying of the “C-loop loss of normal mucosal pattern ddx: large tumor pseudocyst hemorrhage |
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Area gastrica
Findings: Fine linear polygonal pattern of the gastric body seen on a double contrast study This is a normal fold pattern ddx: NONE! This is an Aunt Minnie! |
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Ascariasis
Findings: serpentine intraluminal foreign bodies = ascaris worms thin ribbon of contrast = barium WITHIN worm GI tract ddx: NONE! This is an Aunt Minnie! |
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Benign gastric ulcer
Findings: Single ulcer along lesser curvature Benign features: Crater projects beyond lumen Hampton’s line Thin, regular radiating folds ddx: NONE! This is an Aunt Minnie! |
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Barrett’s esophagus
Findings: Segmental narrowing of the distal esophagus with smooth tapering margins, ulcerations, and loss of normal mucosal pattern ddx: GERD radiation malignancy |
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Boerhaave’s syndrome
Findings: focal horizontal contrast extravasation in the posterior distal esophagus surrounding abnormal posterior mucosa ddx: Iatrogenic Tumor |
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Barrett’s esophagus
Findings: Segmental narrowing of the distal esophagus with smooth tapering margins, ulcerations, and loss of normal mucosal pattern ddx: GERD radiation malignancy |
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Bezoar
Findings: mass-like gastric luminal filling defect composed of undigested or partially digested food may cause obstruction ddx: NONE! This is an Aunt Minnie! |
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Pseudomembranous colitis
Findings: numerous thickened folds of the transverse and descending colon sloughed mucosa or debris within the lumen ddx: Ischemic colitis Ulcerative colitis Crohn’s disease Infectious colitis |
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Candida esophagitis
Findings: numerous plaque-like filling defects of the distal esophagus no erosions or narrowing seen may appear worse with disease severity ddx: NONE! This is an Aunt Minnie! |
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Caroli’s disease
Findings: percutaneous cholangiogram shows marked dilated and beaded appearance of the intrahepatic biliary system ddx: NONE! This is an Aunt Minnie! |
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Cholangiocarcinoma
Findings: percutaneous cholangiogram shows smooth narrowing of the biliary duct confluence and proximal common hepatic duct ddx: NONE! This is an Aunt Minnie! |
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Lye stricture & colonic interposition
Findings: Long segmental distal esophageal narrowing Anteriorly located bowel loop connecting mouth of stomach = interposed colonic loop ddx: NONE! This is an Aunt Minnie! |
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Apthous ulcers
Findings: Numerous shallow mucosal defects with a surrounding mound of edema = “bull’s eye” or “target” lesions do NOT penetrate beyond the muscularis mucosa ddx: Crohn’s disease Infectious colitides |
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Inflammatory polyps
Findings: islands of normal or edematous mucosa seen during active inflammation they protrude into the lumen because the surrounding mucosa is sloughed or deeply ulcerated ddx: ulcerative colitis Infectious colitis Crohn’s disease (“cobblestone pattern”) |
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Crohn’s disease
Findings: multiple loops of small bowel show segmental narrowing, loss of normal mucosal pattern (cobblestone), and fistula formation striking involvement of the terminal ileum ddx: lymphoma Tuberculosis Yersinia (TI only) |
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Duodenal adenocarcinoma
Findings: eccentric sessile lesion with an irregular, ulcerated surface along the lateral wall of the descending duodenum ddx: sessile polyp leiomyoma / leiomyosarcoma metastasis |
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Heterotopic gastric mucosaof the duodenal bulb
Findings: numerous, slightly elevated lesions measuring a few millimeters clustered in a small segment of the duodenal bulb may have angulated or plaque-like margins occur in up to 20% of pts. no clinical significance ddx: benign lymphoid hyperplasia (if 1-2mm smooth filling defects) |
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Erosive gastritis
Findings: numerous 3-4mm shallow mucosal defects with a surrounding mound of edema = “bull’s eye” or “target” do NOT penetrate beyond the muscularis mucosa ddx: Idiopathic (50%) NSAIDs (greater curve) Crohn’s disease (apthous ulcers) Alcohol ingestion |
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Benign gastric ulcer
Findings: single ulcer along lesser curvature benign features: Crater projects beyond lumen Hampton’s line Thin regular radiating folds ddx: NONE! This is an Aunt Minnie! |
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Colon carcinoma
Findings: Circumferential narrowing of sigmoid colon with loss of normal mucosal pattern = “apple core lesion” ddx: Diverticulitis Ischemic stricture |
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Whipple’s disease
Findings: Mild thickening of the small bowel folds = ? due to mild lymphangiectasia Fine micronodular pattern (1-2mm) Low density LAN on CT ddx: Primary Lymphangiectasia Protein-losing enteropathy Hypoalbuminemia MAI |
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Heterotopic gastric mucosaof the duodenal bulb
Findings: numerous, slightly elevated lesions measuring a few millimeters clustered in a small segment of the duodenal bulb may have angulated or plaque-like margins occur in up to 20% of pts. no clinical significance ddx: benign lymphoid hyperplasia (if 1-2mm smooth filling defects) |
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Villous adenomaof the rectum
Findings: Sessile filling defect with a papillary surface along the lateral wall of the rectum ddx: Villous adenocarcinoma |
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Esophageal atresia
Findings: Abrupt transition of the esophageal barium column Smooth, rounded inferior margin Associated with tracheo-esophageal fistula and VATER ddx: NONE! This is an Aunt Minnie! |
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Gastric varicies
Findings: Numerous serpentine thickened folds in the cardia and fundus along the greater curvature Isolated – think splenic vein thrombosis ddx: Gastric adenocarcinoma Lymphoma Menetirier’s disease |
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Esophageal carcinoma
Findings: Long segmental severe narrowing of the distal esophagus Irregular, ulcerated mucosa ddx: Lymphoma Severe GERD stricture |
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Ulcerative colitis &inflammatory polyps
Findings: Ahaustral, granular mucosa of the hepatic flexure Numerous scattered polypoid filling defects ddx: NONE! This is an Aunt Minnie! |
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Esophageal diverticulumfilled with debris
Findings: Pulsion diverticulum of the anterior esophagus filled with food and debris Chronic halitosis ddx: NONE! This is an Aunt Minnie! |
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Ulcerative colitis &malignant stricture
Findings: Ahaustral, granular mucosa = UC Focal stricture of the sigmoid ddx: Benign stricture Ischemic stricture |
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Familial adenomatous polyposis
Findings: Innumerable small round and oval filling defects measuring approximately 2-3mm distributed throughout the colon = “carpet” High risk of carcinoma Prophylactic colectomy ddx: NONE! This is an Aunt Minnie! |
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Esophageal varicies
Findings: Numerous thickened and irregular folds along the entire length of esophagus Appearance may change with luminal distention ddx: Varicoid esophageal carcinoma |
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Esophageal traction diverticulum
Findings: Focal triangular contour abnormality of the anterior mid-esophagus Loss of normal mucosal pattern ddx: Mediastinal LAN Metastatic (breast) Infectious (TB) |
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Celiac sprue
Findings: Mild small bowel dilation Decreased number of normal thickness jejunal folds (< 5/inch) Paradoxical increase of ileal folds = “jejunization” Transient small bowel intussusceptions Increased risk of lymphoma and carcinoma ddx: NONE! This is an Aunt Minnie! |
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Linitis plastica
Findings: Smooth narrowing of the gastric lumen with loss of normal mucosal pattern = “leather bottle stomach” ddx: Scirrhous gastric Ca Metastatic disease Breast, pancreas, ovarian Lymphoma syphilis Crohn’s disease |
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Collar-button ulcers in ulcerative colitis
Findings: Numerous outpouchings of contrast perpendicular to the lumen with a narrow neck and a board base = submucosal penetration = “collar-button ulcer” Ahaustral, granular mucosa of the colon = UC ddx: Collar-button ulcers can occur with virtually any type of ulceration from any cause This case, however, is an Aunt Minnie for UC! |
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Sclerosing cholangitis
Findings: Cholangiogram shows multiple segments of smooth biliary narrowing “shaggy” appearance of the CBD Increased risk of cholangiocarcinoma Causes: Ulcerative colitis Ascending cholangitis AIDS cholangiopathy Parasitic infections |
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Gastric leiomyosarcoma
Findings: Large fundal mass protruding into the gastric lumen with an irregular central crater ddx: Leiomyoma Gastric adenocarcinoma Lymphoma |
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Familial adenomatous polyposis
Findings: Innumerable small round and oval filling defects measuring approximately 2-3mm distributed throughout the colon = “carpet” High risk of carcinoma Prophylactic colectomy ddx: NONE! This is an Aunt Minnie! |
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Pancreatic adenocarcinoma
Findings: Splaying of the duodenal C-loop and mass effect on the gastric antrum Underlying duodenal mucosa unaffected ddx: Pancreatitis Lymphoma / LAN Hematoma Leiomyoma / leiomyosarcoma of the distal stomach |
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Esophageal web
Findings: Thin horizontal filling defect along the anterior margin of the proximal esophagus ddx: NONE! This is an Aunt Minnie! |
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Coned cecum
Findings: Circumferential narrowing of the cecum with loss of the normal mucosal fold pattern ddx: Infectious Tuberculosis Amebiasis Inflammatory Crohn’s disease Appendicitis Neoplastic Adenocarcinoma Lymphoma |
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Paraesophageal hernia
Findings: Hiatus hernia with a small paraesophageal component If large enough, increased risk of gastric volvulus and strangulation ddx: NONE! This is an Aunt Minnie! |
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Hypertrophic pyloric stenosis
Findings: Barium study in an infant shows a tight stenosis of the gastric pylorus = “string sign” ddx: NONE! This is an Aunt Minnie! |
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Meckel’s diverticulum
Findings: Enteroclisis shows a single diverticulum along the antimesentic side of the distal small bowel ddx: NONE! This is an Aunt Minnie! |
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Ischemic colitis
Findings: Loss of normal mucosal pattern with segmental narrowing involving the splenic flexure ddx: Ulcerative colitis |
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Gastric polyps
Findings: Multiple large (~1cm) smooth round filling defects throughout the stomach ddx: Hyperplastic Inflammation FAPS Adenomatous Hamartomatous |
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Gastric carcinoma
Findings: Segmental narrowing of the antrum with loss of the normal mucosal pattern ddx: Peptic stricture Lymphoma |
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Spigelian hernia
Findings: LLQ hernia of the descending colon through the linea semilunaris (between the rectus and transverse muscles) Large hernia orifice, less likely to obstruct ddx: NONE! This is an Aunt Minnie! |
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Ulcerative colitis
Findings: Ahaustral, granular mucosa of the rectum and sigmoid Transverse colon spared ddx: Other inflammatory or infectious colitides Ischemia (but very unlikely in the lower rectum) |
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Congenital lymphangiectasia
Findings: Diffuse and regular small bowel fold thickening Malabsorption & protein-loosing enteropathy Fine micronodular pattern (1-2mm) ddx: Whipple’s disease Secondary lymphangiectasia Protein-losing enteropathy Hypoalbuminemia MAI |
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Malignant gastric ulcer
Findings: Large ulcer of the gastric body Malignant features: Spiculated central crater Thick heaped-up margin Irregular radiating folds ddx: NONE! This is an Aunt Minnie! |
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Metastatic melanoma
Findings: At least two large “bull’s eye” lesions of the small bowel ddx: Other metastases Breast Lung Pancreas Lymphoma Kaposi sarcoma |
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Benign gastric ulcer
Findings: single small ulcer of the gastric fundus benign features: Well-defined crater Thin, regular radiating folds ddx: NONE! This is an Aunt Minnie! |
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Hypertrophic pyloric stenosis
Findings: Barium study in an infant shows a tight stenosis of the gastric pylorus = “string sign” ddx: NONE! This is an Aunt Minnie! |
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Papillary adenocarcinoma
Findings: Abnormal enlargement of the papilla ddx: Edema from instrumentation or stone passage Pancreatitis Choledochocele Polyp Leiomyoma |
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Lymphoma
Findings: multiple segments of small bowel narrowing with mild separation of the loops numerous “bull’s eye” lesions ddx: GIST Metastatic carcinoma |
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Peutz Jeghers syndrome
Findings: numerous polypoid filling defects in the stomach and colon ddx: FAPS (Gardener’s) Juvenile polyposis syndrome Cronkhite-Canada |
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Scleroderma
Findings: small bowel dilation = “pseudoobstuction” Increased number of normal thickness folds (> 5/inch) = “hide bound” appearance may see pneumatosis and pseudosacculations ddx: NONE! This is an Aunt Minnie! |
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Reflux esophagitis &Schatzki ring
Findings: mild narrowing of the lower esophagus small hiatus hernia circumferential ring at the squamo-columnar junction = “B” ring symptomatic if lumen diameter < 13 mm ddx: NONE! This is an Aunt Minnie |
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Adenomatous polyp
Findings: Single round lesion along the lateral sigmoid wall projecting into the lumen Possible ulcerated mucosa ddx: Adenocarcinoma |
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Rectal carcinoma
Findings: Large “apple-core” lesion of the rectum Loss of normal mucosal pattern ddx: NONE! This is an Aunt Minnie! |
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Peptic stricture
Findings: Tight stricture of the antrum ddx: Gastric adenocarcinoma Lymphoma |
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Posterior gastric diverticulum
Findings: Single diverticulum along the posterior gastric cardia Normal mucosal pattern No radiating folds No clinical significance ddx: NONE! This is an Aunt Minnie! |
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Gastric carcinoma
Findings: Hourglass narrowing of the gastric body Loss of normal mucosal pattern ddx: NONE! This is an Aunt Minnie! |
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Radiation colitis
Findings: Long segmental narrowing of the rectosigmoid colon Focal sinus tract at the point of maximal narrowing Loss of normal mucosal pattern Evidence of prior abdominal surgery ddx: Crohn’s disease TB Mets Lymphoma |
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Duodenal hematoma
Findings: Pencil-thin luminal narrowing of the descending duodenum and bulb ddx: Duodenal tumor Adenocarcinoma Leiomyosarcoma Lymphoma Pancreatitis Metastases |
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Radiation gastritis
Findings: Hourglass narrowing of the gastric fundus Complete loss of normal gastric mucosal pattern ddx: Crohn’s disease ? Caustic ingestion |