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115 Cards in this Set
- Front
- Back
DDx – Gastric Fold Thickening
|
* Inflammation (eosinophilic, post RTx, corrosive, Crohn's)
* Infiltration (including CA) * Ménétrier’s disease * Varices (fundus) Zollinger-Ellison syndrome Amyloidosis Lymphoid hyperplasia |
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DDx - Small bowel filling defect
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* INFLAMMATION: - Nodular lymphoid hyperplas - Crohn's
* INFILTRATION: - Whipple's - Mastocytosis - Waldenstrom's * NEOPLASM: - Lymphoma - Polyposis syndromes |
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DDx - Gastric filling defect (s)
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* Mets (lung, breast, melanoma, renal)
* Polyps (syndromes) * Gastroesoph varices * Pancreatic rest (single, inf antrum) |
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DDx - Duodenal Filling Defects
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*Benign mass (usu prox)- Adenoma, leiomyoma
*Malignancy (usu distal)- AdenoCA, mets *Ectopic gastric mucosa, Prolapsed antral mucosa *Brunner gland hyperplasia, lymphoid hyperplasia *Varices *Ectopic pancreas (usu distal) *Other: Choledococele, annular panc [distal] |
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DDx – Coned Cecum
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*Crohn’s (TI always involved)
*TB (TI usu involved) *Amebiasis (TI not involved) *UC (w/ backwash Ileitis) *Appx, R-sided ticitis *CA of cecum (and mets) |
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DDx – Dilated SB with Normal Folds
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*Sprue
*Scleroderma *Lactase Deficiency *Obstruction / Ileus *Vagotomy *Meds: MSO4, Atropine, etc. *Chaga’s disease |
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DDx – Regular Thickening of SB Folds
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*Hemorrage (anticoag, hemophilia)
*Edema (low protein, angioneurotic) *Lymphangiectasia *Radiation *Early Crohn's |
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DDx – Irregular SB Fold Thickening
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WAG CLEM
*Whipple’s Dz *Amyloid *Giardiasis, Graft vs. Host *Cryptosporidiosis *Lymphoma *Eosinophilic gastroenteritis *MAI |
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DDx - Mesenteric mass
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CRADLE
* Carcinoid -“spoke wheel” (DDx: desmoid) * Retractile Mesenteritis * Adenocarcinoma * Desmoid * LAD (Lymphoma, TB, Yers, Whipple’s, MAI) * Everyone forgets metastases |
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DDx – Liver Lesion with Central Scar
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*FNH - brief enh, scar hiT2, hot SC scan
*Fibrolamellar HCC - scar loT2, calcs *Adenoma - heterogeneous enh *Hemangioma - centripetal enh |
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Causes of HCC
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WHAT causes HCC?
Wilson’s dz Hemochromatosis Alpha-1-antitrypsin Tyrosinosis Hepatitis Cirrhosis Carcinogens (aflatoxin, sex hormones, thorotrast) |
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DDx – Multiple Intestinal Polyps
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*Adenomatous polyps
--FP (MC, screening) --Gardner's (osteomas) --Turcot (a/w CNS glioma) *Hamartomatous Polyps --Peutz-Jegher’s(usually SB) --Cowden’s dz --Juvenile polyposis --Cronkhite-Canada syndrome --Bannayan-Riley-Ruvalcaba *Post-Inflammatory (filiform) *Pseudopolyps |
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Staging – Colorectal CA
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A: Limited to mucosa
B: Muscularis propria -B1 into muscularis propria -B2 thru muscularis propria C: Lymph node mets -C1 limited to bowel wall -C2 into adipose tissue D: Distant Metastases |
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DDx – Cholangitis
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* Sclerosing (1° and 2° forms)
- Irreg bile ducts, "tics" - 1°-idiopath. 10% get CA - 2°-65% a/w IBD (usu UC) * Oriental Cholangitis - Postinf (clonorchis/ascaris) - Extra & Intra dilat, calculi * Ascending Cholangitis - infection of obstructed ducts (E. coli > Klebs > Pseudom) |
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DDx – Hypervascular Liver Masses (seen in arterial phase)
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Primary
- HCC (esp. Fibrolamellar) - Hemangioma - FNH - Hepatic adenoma - Hemangioendothelioma, hemangiopericyt Metastases - Neuroendocr: islet, carcinoid - RCC - Breast CA - Thyroid - Sarcoma - Melanoma |
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DDx – Cystic Pancreatic Lesions:
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Microcystic adenoma (Lil old ladies...)
VHL (renal & liver cysts) Mucinous Cystadenoma /CA Epithelial Simple cyst Pseudocyst Duct Ectasia |
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DDx – Hypervascular Pancreatic Mass
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Primary
- Islet cell - SPEN - Microcystic adenoma METS Adrenal, Thyroid, RCC, melanoma |
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Crohn's mimics
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TCbY
Tuberculosis Campylobacter Yersinia enterocolitica |
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UC mimics
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Amebiasis
Salmonella / Shigella Ischemia Pseudomembranous Colitis Behcet’s |
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Esophagus
Diverticular disease: |
pharyngocele
Zenker Killian Jamieson pseudodiverticula epiphrenic |
|
Esophagus shows
Luminal narrowing DDx? |
Webs
Plummer-Vinson Vascular ring - Pulm sling anterior, aberrant R subclav posterior Schatzki ring Strictures (long list) Cancer Extrinsic compr (Ao, L bronch, L atrium, mediast mass) |
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Causes of esophageal strictures
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*Reflux
*Tumor, Mets, Barrett's *Meds, RTX, NGT, Lye *Crohn's, Eosinophilic GEitis *Scleroderma, Achalasia, Chagas |
|
Esophagus shows
high stricture DDx? |
Barrett’s
RTX, meds caustic ingestion CA, mets skin dz Crohn’s |
|
Esophagus shows
Low stricture DDx? |
Peptic stricture
Lower esophageal ring Barrett’s |
|
Esophagus shows
Nodules/plaques DDx? |
DIFFUSE - reflux, Candida, glycogenic acanthosis
LOCALIZED – Candida, superficial spreading CA, Barrett’s |
|
Esophagus shows ulcers
DDx? |
*DISTAL – reflux, Crohn’s
*SMALL, MID – Crohn’s, HSV, meds (tetra/doxycycline, KCl, Fe, quinidine, NSAIDs, vit C, Fosamax) *GIANT – CMV, HIV |
|
Esophagus shows megaesophagus
DDx? |
Achalasia
Scleroderma Chagas Distal tumor or stricture |
|
Esophagus shows contrast extravasation
DDx? |
Esophagitis
Tumor Vomiting (MW tear, Boerhaave) TE fistula Foregut dupl cyst w/comm to esophagus Iatrogenic Trauma |
|
Esophagus shows
corkscrew esophagus DDx |
Diffuse esophageal spasm
Presbyesophagus |
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Esophagus shows
Air-fluid level DDx |
Hiatal hernia
Esophageal diverticulum CA Achalasia Scleroderma |
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Esophagus shows
Thickened folds DDx |
Esophagitis
Lymphoma Varicoid carcinoma Varices |
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Esophagus shows
Solitary filling defect |
INTRALUMINAL – food, foreign body, fibrovasc polyp, spindle cell tumor, leiomyosarc, adenoCA
TUMOR – leiomyoma, fibrovasc polyp, duplication cyst, papilloma, fibroma, hemangioma, SCC, adenoCA, spindle cell tumor, lymphoma, mets (breast, lung, KS, melanoma, RCC) VARICES – uphill (portal HTN), downhill (SVC obstruction) EXTRINSIC – lymph nodes, vessels, aneurysms, cysts |
|
Gastritis
seen in the stomach. DDx |
H pylori
Erosive (lye, EtOH, stress, NSAIDS) Granulomatous (Crohn’s, sarcoid, TB, histo, syphilis) Eosinophilic Hypertrophic (Menetrier’s, ZE syndrome) Gastric ulcer (ZE syndrome, PUD, drugs) RTX Emphysematous |
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Target lesions
seen in the stomach. DDx |
Gastritis (aphthoid) – erosive (NSAID, EtOH), Crohn’s, infection (Candida, HSV, CMV)
Submucosal mets (large ulcer) – melanoma, KS > breast, lung, lymphoma Solitary giant bullseye (very large ulcer) – leiomyoma, sarcoma, CA, solitary met, ectopic pancr, benign ulcer |
|
UGI surgery
seen in the stomach. DDx |
*plication defect, afferent loop syndrome
*marginal ulcer, leak *bezoar *chronic gastritis, *malabsorption *obstruction, intussusception (jejunogastric) *gastric CA |
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Filling defect
seen in the stomach. DDx |
*bezoar, adenoCA
*lymphoma, leiomyoma/sarc, mets, KS *endometriosis, carcinoid, lipoma *polyps (hyperplastic #1), *varices *ectopic pancreas, extrinsic compr from spleen/panc/liver |
|
Free air seen adj to the stomach.
DDx |
* Surgery & laparoscopy
* Perforated ulcer * Perf distal bowel (IBD, diverticulitis, CA) |
|
Antral lesions seen in the stomach.
DDx |
AdenoCA, lymphoma, mets
Crohn’s, PUD TB, sarcoid HPS, pylorospasm Antral web Ectopic pancreas Erosive gastritis, caustics |
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Gastroenteric fistula
DDx |
PUD
Crohn’s CA Iatrogenic Surgery |
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Double pylorus seen
DDx |
Lesser curve antral ulcer
Crohn’s Lymphoma |
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Linitis plastica
DDx |
Scirrhous CA (#1)
Lymphoma, mets (esp breast), Pancreatic CA (direct invasion) RTX, corrosive ingestion Crohn’s, eosinophilic GEitis TB, sarcoid Syphilis |
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Giant rugal folds in the stomach.
DDx |
* Lymphoma, mets
* Menetrier’s * ZE syndrome * Gastritis, eosinophilic GEitis, Crohn’s * RTX * infection * varices (mimic) |
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Filling defect in distal duodenum
DDx |
*benign lymphoid hyperplasia
*ectopic / annular pancreas *ampulla of Vater *malignancy *edema w/impacted or passed gallstone *choledochocele |
|
Filling defect in the duodenum which is soft and changing
DDx |
*choledochocele
*lipoma *duplication cyst |
|
Duodenal benign tumors
(often 1st portion, asx) |
* Adenoma
* Leiomyoma * Lipoma * Villous adenoma * Ectopic pancreas |
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Malignant tumors of duodenum
(distal to 1st portion, sx) |
* AdenoCA at or distal to papilla
* Leiomyosarcoma * Lymphoma * Mets (melanoma, breast, KS, carcinoid) |
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Target lesion in duodenum
DDx |
* Leiomyoma
* Leiomyosarcoma * Met (melanoma, KS, breast, lung, lymphoma) * Ulcer, ZE syndrome |
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Luminal outpouchings in the duodenum
DDx |
* Ulcer
* Diverticulum * Fistula (with GB or bile duct) |
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Reverse figure 3 sign of the duodenum
DDx |
pancreatitis
pancreatic CA |
|
Notched duodenum
DDx |
Annular pancreas
Post-bulbar ulcer Crohn’s Post-op Pancreatitis Pancreatic CA |
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Postbulbar narrowing of the duodenum
DDx |
*AdenoCA, lymphoma, mets
*Ulcer, duodenitis, Crohn’s *Pancreatitis, pancr CA, annular panc *Intramural tic, duplication cyst *Hematoma, aortic aneurysm, SMA syndr |
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Enlargement of Ampulla of Vater
(>15mm) DDx |
Papillary edema (pancreatitis, ulcer, stone)
Ampullary CA Choledochocele Normal variant |
|
Adynamic ileus
DDx |
* Postoperative (#1)
* Inflammatory (often sentinel loop) – pancr, appy, GB, tics, peritonitis * Metabolic – low K+, Ca++, Mg++ * Medication – morphine |
|
Mechanical SBO causes
|
Adhesions
Hernia Tumor Gallstone Inflammation w/stricture |
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SB shows malabsorption with mainly thickened irregular folds
DDx |
* Whipple’s
* MAI, Strongyloides (prox), Giardia (jej), Cryptosp (jej) * Amyloid * GVH, lymphoma, mastocytosis eosinophilic GEitis |
|
SB shows malabsorption with mainly dilated loops and normal folds
DDx |
* Sprue (#1)
* Obstruction / Ileus * Scleroderma * Medication |
|
SB shows thickened folds without malabsorption pattern
DDx |
Submucosal...
* Edema – ischemia, infection, RTx, hypoproteinemia, GVH * Tumor – lymphoma, leukemia * Hemorrhage – HSP, hemophilia, anticoag |
|
"Tubular" appearance of small bowel
DDx |
Cryptosporidium
Sprue (proximal) Lymphoma GVH RTx Ischemia Strongyloides (proximal) |
|
Nodules of small bowel (multiple, but not "tiny" in size)
DDx |
*Mastocytosis, lymphoid hyperplasia
*Lymphoma, mets *Polyps *Crohn’s, eosinophilic GEitis *TB or other infection *Amyloid, lymphangiectasia *Whipple’s, Waldenstrom’s |
|
Diffuse tiny nodules of small bowel
DDx |
Lymphoid hyperplasia (#1)
Hypogammaglobulinemia Giardia Whipple’s Waldenstrom’s |
|
Shortened transit time seen in small bowel
DDx |
anxiety
hyperthyroid medication (reglan) partial SBO |
|
Small bowel tumors
Benign and maligant types |
BENIGN – adenoma (#1), leiomyoma (#2), lipoma, hemangioma, neurogenic, Brunner glands, heterotopic pancr tissue
MALIGNANT – mets (melanoma, RCC, breast, KS), carcinoid (#1 1ary tumor), lymphoma, leiomyosarc (large ulcerating), adenoCA |
|
Small bowel stricture:
DDx overall, and for focal stricture with "shouldering" |
* Crohn’s
* Lymphoma, mets, adenoCA * Infection, RTX * Ischemia * Extrinsic compression * NSAIDs *** Focal w/shouldering – adenoCA (#1), breast mets, TB |
|
Coiled spring appearance of small bowel
DDx |
Intussusception
Intramural hematoma |
|
Large ulcerated mass (endoexoenteric)
DDx |
* Lymphoma
* Leiomyosarcoma * Mets (melanoma) * Interloop abscess |
|
Intraluminal filling defects of small bowel
|
* Parasites (Ascaris, tapeworm)
* Bezoar * Foreign body * Gallstone * Lipoma |
|
Causes of enteric fistulas
|
Crohn’s
diverticulitis CA TB radiation surgery |
|
Serosal lesions of small bowel
|
Carcinoid
Serosal mets Diverticulitis Appendicitis Endometriosis |
|
Causes of mesenteric ischemia
|
*occlusive – emboli (Afib, LV aneur), art thrombosis (athero), venous thrombosis (portal HTN, pancreatitis, tumor, hypercoag state, drugs)
*nonocclusive – low flow state |
|
Features of Crohn's dz in the colon
|
Fold and wall thickening
Nodular pattern (cobblestone) Aphthoid ulcers Filiform polyps Fistulas, strictures, pseudosacc Mesenteric fat stranding, LAD String sign, separated loop (omega sign) Asymmetric, skip lesions |
|
Polypoid filling defects of the colon
DDx |
*Polyps - hyperplastic (#1), adenomatous (#2), hamartomatous, post-inflamm
*Polyposis – FAP, Peutz-Jeghers, juv polyposis, Turcot, Cronkhite-Canada, Cowden *lymphoma *pneumatosis |
|
Colonic wall thickening (thumbprinting)
DDx |
HEMORRHAGE – ischemia, HSP, hemophilia, anticoag
TUMOR– lymphoma, leukemia EDEMA– IBD, infection (pseudomembr colitis, CMV, E Coli, Salm/Shigella, amebiasis, typhlitis) |
|
Long segment narrowing of colon
DDx |
scirrhous adenoCA
lymphoma IBD ischemic stricture radiation |
|
Pseudosacculations of colon
|
Crohn's
scleroderma ischemia |
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Pneumatosis coli
DDx |
Pneumatosis cystoides
- COPD - asthma - CF - CVD - steroids Pneumatosis intestinalis - infarct - NEC - toxic megacolon - typhlitis |
|
Deep ulcers of colon
|
*UC, Crohn’s
*Behcet’s *infectious (amebiasis, TB, Salm/Shigella, histo, Candida, herpes, CMV) *Ischemic colitis *RTx |
|
Circumferential (apple core) or asymmetric narrowing of colon
DDx for single and multiple |
Tumor – adenoCA, serosal mets (stom, ova, colon, panc)
Inflamm – diverticulitis, IBD, TB, amebiasis Other – endometriosis, pelvic abscess, epiploic appendagitis Multifocal – lymphoma, serosal mets, TB, amebiasis, Crohn’s, endometriosis |
|
Ahaustral colon
DDx |
Cathartic abuse (usu R colon)
UC, Crohn’s Amebiasis Scleroderma RTx Prior ischemia |
|
Aphthoid ulcers of colon
DDx |
Crohn’s
amebiasis Behcet’s CMV herpes TB Yersinia (TI) |
|
Characteristics of ulcerative colitis
|
*ahaustral, granular mucosa
*filiform polyps, crypt abscesses *starts in rectum, continuous spread, backwash ileitis *strictures (worrisome) |
|
Presacral space widening:
( >2cm ) DDx |
*rectal inflammation (colitis, RTX)
*infection *tumor *pelvic lipomatosis *edema or hemorrhage |
|
Megacolon DDx
|
*toxic – pseudomemb colitis, IBD, amebiasis
*acute distension – obstructive CA, ileus, volvulus *chronic – laxative abuse, Ogilvie syn, congenital Hirschsprung’s, Chagas, neuromuscular dz (Parkinson, DM, scleroderma, amyloid), hypothyroid |
|
Cecal filling defect and nonfilling appendix
DDx |
carcinoid
appendicitis appendix stump mucocele |
|
Coned cecum DDx
|
Crohn’s
lymphoma / mets TB amebiasis typhlitis |
|
Ileocecal deformities
DDx |
IBD
amebiasis (spares TI), TB typhlitis lymphoma, adenoCA carcinoid intussusception |
|
Solid mass in liver
DDx |
* Hemangioma, FNH, adenoma
* HCC, mets, lymphoma * Regenerating nodules * Focal fat |
|
Cystic mass in liver
DDx |
* Infectious – pyogenic abscess, amebiasis, Echinococcus
*Benign – simple cysts, ADPKD, biliary cystadenoma, biloma, intrahepatic GB *Malignant – necrotic tumors, cystic mets, cholangioCA |
|
Increased density of liver
|
*Hemochromatosis, Wilson’s
*Glycogen storage dz *amiodarone, chemo, thorotrast *anemia *regenerative nodules - cirrhosis (low T2) |
|
Enlarged ileocecal valve
( >3cm ) DDx |
Lipomatous infiltration (#1)
lipoma Crohn’s lymphoma prolapsing ileal neoplasms |
|
Gas in liver:
|
*pneumobilia – ERCP, surgery, penetrating ulcer, gallstone ileus, CA, bowel obstr
*PV GAS– necrosis > IBD, abscess, obstruction, ulcer, iatrogenic, liver transplant *abscess *emphysematous cholecystitis |
|
Decreased density of liver
|
fatty liver – obesity, alcohol, DM, steroids, chemotherapy
radiation-induced |
|
Liver shows mottled density without a focal mass
DDx |
*passive congestion
*Budd-Chiari *geographic fatty infiltration *hepatoma *lymphoma |
|
Hypervascular liver mass
DDx |
Hemangioma, hemangioendothelioma
CholangioCA HCC Mets (melanoma, RCC, sarcoma, islet cell, thyroid, carcinoid, breast, pheo) |
|
Hyperechoic liver lesion
DDx |
ROUND
-- hemangioma -- mets (hypervasc & Ca++) -- HCC, fibrolamellar HCC -- focal fat, lipoma, AML LINEAR – pneumobilia, PV gas, biliary ascariasis MULT PUNCTATE FOCI – hepatitis, granulomatous inf, PCP, biliary hamartomas, pneumobilia, PV gas, vascular calcs |
|
Multiple hypoechoic foci in the liver
DDx |
TUMOR– mets, lymphoma, HCC
INFECTION– pyogenic, amebic, Echinococcus, Candida, Schistosomiasis OTHER– regenerative nodules in cirrhosis, sarcoid, extramedullary hematopoiesis, hematomas, hemangiomas |
|
Delayed retention of contrast in a liver lesion
|
CholangioCA
Hemangioma Fibrous tumor Scar (FNH, adenoma, fibrolam HCC, hemangioma) |
|
Hepatic hemorrhage
DDx |
iatrogenic
trauma adenoma HCC pregnancy |
|
Extrahepatic biliary dilatation
DDx |
*Intrapancreatic (#1) – pancr CA, calculus, chronic p-itis
*Suprapancreatic – cholangioCA, metastatic LNs *Portal – cholangioCA, GB CA, surgical strictures, hepatoma *Choledochal cyst |
|
Types of biliary obstruction
|
*Tumor – abrupt duct termination, mass adj to duct. Bil dil in one lobe of liver - Klatzkin tumor!
*Pancreatitis - smooth, long tapering *Stone – calculus seen, meniscus, intrahepatic dil *Cholangitis *Caroli’s *Biliary cystadenoma |
|
Double duct sign
(dilated BD and PD) |
pancreatitis
pancreatic CA stone @ ampulla cholangioCA duodenal or ampullary CA |
|
Filling defects in bile duct
Possible causes |
stone
blood clot parasite sludge tumor (on ERCP - air bubble) |
|
Hemobilia DDx
|
iatrogenic
tumor trauma infection |
|
Strictures on ERCP
DDx for stricture - at hilum - 1cm from ampulla - long segment - CHD in area of cystic duct - multiple intrahepatic - mult intra & extrahepatic |
* Hilum – cholangioCA, porta hepatis nodes, GB CA
* 1cm from ampulla – pancr CA, cholangioCA, mets * long segment – chronic pancreatitis, lymphoma * CHD @ cystic duct region – Mirizzi’s, GB CA, cholangioCA * Multiple intrahepatic – sclerosing cholangitis, HIV, ischemic, primary biliary cirrhosis, liver mets (rare) * Mult intra & extrahepatic - sclerosing cholangitis, HIV, ischemia |
|
Biliary system shows irregular wall and filling defects
|
Cholangitis
- HIV - oriental - ascending |
|
Pancreatic duct disease
-Stricture -Cystic dil & side branches -Variants |
* Stricture – pancreatic CA, chronic pancreatitis
* Cystic dil & side branches – chronic pancreatitis, IPMT * Variants - annular pancr, pancr divisum |
|
Post-cholecystectomy bile leaks are caused by...
|
cystic duct remnant
duct of Luschka |
|
GB wall thickening
( >3mm) DDx |
* Diffuse – nonfasting, acute or chronic GBitis, portal HTN, low albumin, hepatitis, AIDS (cryptosp, CMV, MAI), ascites
* Focal – GB CA, mets (melanoma), cholesterol polyp, adenomyomatosis, tumefactive sludge, AIDS |
|
Hyperechoic foci in GB wall
|
Calculus
Polyp Cholesterol Emphysematous cholecystitis Porcelain GB |
|
Dense GB on CT
|
Vicarious excr of contrast
calculi milk of calcium oral cholecystogram hemorrhage |
|
Biliary enteric fistula is seen.
What are possible causes? |
* Cholecystitis (g-stone ileus)
* PUD * Tumor * Trauma / surgery * Crohn’s |
|
Cystic lesions of the pancreas
|
**Tumor **
microcystic adenoma, mucinous cystadenoma, IPMT, SPEN, islet cell tumor ** Cyst ** simple, pseudocyst, ADPKD, VHL, duct ectasia ** Abscess ** |
|
Obstruction of the colon
|
CA
diverticulitis volvulus impaction hernia |
|
Splenic cyst ddx
|
*primary (congenital, true cyst)
*secondary (Ca++, false) prior infarct, trauma, infection, echinococcus, pancreatic pseudocyst |
|
Low density lymph nodes in abdomen
|
TB / MAI
lymphoma testicular tumor mucinous adenoCA Whipple’s dz |
|
Multiple liver lesions
|
* abscess
* cystic metastases * intrahepatic biloma * Caroli disease * hepatic cysts * bile duct hamartoma * undifferentiated sarcoma * biliary cystadenoma or cystadenocarcinoma * cavernous hemangioma * hydatid cyst * intrahepatic hematoma |