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55 Cards in this Set

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ominous cause of L hydrocele
RCC involving the L renal vein, to which the L gonadal vein drains
cysts in the kidney
The classic appearance of cysts on CT are homogenous non-enhancing water-density masses. The presence of pancreatic and renal cysts in this patient suggests Von Hippel Lindau (VHL) syndrome, though additional studies and family history should be obtained. VHL is a rare autosomal dominant syndrome affecting multiple organ systems. Common manifestations are multiple cysts and tumors of the kidney and pancreas, CNS hemangioblastomas, adrenal pheochromocytomas, retinal angiomatosis, and café au-lait spots. Renal cysts in VHL often progress into renal cell carcinoma, the second most common cause of death in these patients, who are screened annually beginning at age 20. Of note, if this patient had presented with multiple cysts in kidneys alone, differential diagnosis expands to include polycystic kidney disease, Von Hippel Lindau (VHL) syndrome, tuberous sclerosis, acquired renal cysts (e.g. dialysis), and hepatic fibrosis-renal cystic disease.
interposition of the colon between liver and diaphragm
Multiple air fluid levels in the bowel without dilation?
Think diarrhea.
What do you think of when you see a dystrophic calcification?
TTIII - tumor, trauma, infection, Inflammation, Infarction
OR of course, stones
What's the main significance of a porcelain gall bladder?
Increased risk of cholangiocarcinoma! Due to chronic dysplastic cholecystitis
ground glass appearance to the abdomen?
ascites - bowel loops float up and obstruct your view of everything else
Appendicitis on CT
appendix is dilated and NOT filled with contrast (blocked)
--look for fat stranding (fluid) in the surroundings
abscess, perforation, phlegmon are complications
How do you find the appendix on CT?
look for the ileocecal valve, which is surrounded by a ring of fat in the cecum; about 2cm below that
DIfference between air in the portal venous system and air in the biliary tree
portal system - periphery of liver; smaller, linear, branching
biliary tract - central, Y-shaped, tubular
Cause of air in the portal venous system?
bowel ischemia/infarction
CAuse of air in biliary tract
improper connection between bowel and biliary tract OR emphysematous infection
Riggler Sign
both sides of the bowel wall are outlined by air - white line seen with black on either side - sign of pneumoperitoneum
Football sign
visible abdominal ligaments ("Seams") on plain film - falciform (RUQ in the liver, by the spine) and lateral umbilical ligaments
relevance of the phrenicocolic ligament
a single white line seen in the LUQ that can be mistaken for haustra of Chalaiditis syndrome; only seen with massive pneumoperitoneum
air-fluid level within the abdomen and outside the bowel wall; common location
abscess - common under the R diaphragm, mimicing a stomach - due to R paracolic gutter, along which infection can traverse; the phrenicocolic ligament blocks on the L
What typically causes a sentinel loop of bowel?
local inflammation from an "-itis": pancreatitis, appendicitis, etc.
most common cause of functional ileus?
Progression of bowel ischemia on radiograph
1. thumbprinting - focal area of gas with infiltration by soft tissue
2. Rigler's sign from pneumoperitoneum
3. pneumatosis coli
What causes thumbprinting?
ischemia, anti-coagulation, diverticulitis, trauma, IBD, CMV
cauliflour calfication in the pelvis?
chronic prostatitis
"popcorn" calcifications in the pelvis?
What likes to metastasize to the stomach
breast and lung
Hampton's line
thin mucosal overhanging flap over and ulcer - indicative of a benign ulcer
If an ulcer projects outside the expected lumen in profile, is it benign or malignant?
Carmen Kirklin meniscus complex
indicates a malignant stomach ulcer - nodular rolled up edges of the ulcer crater overlap when a paddle is placed over them, forming a meniscoid filling defect
"wild folds" in the stomach?
signs of obstruction of ampulla of vater
double duct sign - two adjacent dilated ducts (bile and pancreatic)
dilated pancreatic duct in the tail of the pancreas
dilated bile ducts in the liver
A process in what other organ can involve the splenic flexure of the colon?
the pancreas
What is a pseudocyst
complication of acute pancreatitis - looks like an abscess - fluid filled density on CT
What should never be in the bladder?
Air or colonic contrast material; sign of a sigmoid or rectovesicular fistula; often diverticulitis, IBD, cancer
Common complications of diverticulae?
fistulae; abscess formation near the bowel; peritonitis
Rigler's triad of gallstone ileus?
1. dilated loops of small bowel
2. stone in the distal ileum
3. Air in the biliary tract - due to a cholecystoduodenal fistula that allows the stone to pass into the bowel
lucency between the heart and the diaphragm?
likely a pneumothorax - equivalent to deep sulcus sign
Sign of intussusception on CT scan, barium enema
dilated loop of bowel with a fat density crescent inside it - this is the mesenteric fat from the telescoping bowel
--coiled spring of barium
Two types of "polyps" in IBD
inflammatory psuedopolyps - occur in the acute phase of disease - rounded filling defects
filiform pseudopolyps - linear and roundish polyps
creeping mesenteric fat
sign of Crohn's - the bowel is really highlighted because of increased mesenteric fat
comb sign
sign of Crohn's the vessels in the mesentery are accentuated because of increased fat and inflammation
Diverticulitis - thickened wall, air levels representing the diverticuli themselves
What is this?
Diverticulitis - notice the mass effect on the colon and the air collections
Characteristics of TCC as contrasted to RCC
TCC tends to involve the calyceal system if it involves the kidney; multifocal tumors are common; strictures and stenosis in the kidney or ureters are common
Differentiate pyelonephritis from kidney infarcts
both are wedge shaped filling defects on pyelogram phase of CT; pyelonephritis the wedges will originate at the papilla of the calcyes; infarcts are BETWEEN papillae
what is the classic appearance of chronic pyelonephritis?
wedge shaped defect pointing toward a clubbed calyx
Bosniak classification
Category I Classic simple cysts described above Benign, ignore
Category II

a) 1 or 2 internal septae less than 1mm thick
b) Small amount of delicate calcification in wall of septum
c) Hyperdense cysts that are less than 3cm in diameter, homogenous, sharply marginated, non-enhancing, at least � exophytic
Benign, ignore
Category IIF Minimally complicated cysts, thought to be benign but somewhat suspicious Follow up 3, 6 and 12 months
Category III Primarily cystic but with features such as thickened or enhanced septi, thick irregular calcification, irregular margination, multilocular mass, uniform wall thickening or non-enhancing areas of nodularity 50% malignant, requires surgical treatment
Category IV Cystic neoplasms or necrosis of solid tumor, solid and enhancing areas of nodularity Malignant, requires surgical treatment
How many septae are you allowed in Bosniak II renal cysts
only one or two; not thick
analgesic abuse increases the risk of what cancer
Two broad categories that cause clubbed calcyces?
hydronephrosis and papillary necrosis
Differential of papillary necrosis
*Sickle cell disease
Cirrhosis (alcoholism)
*Analgesic nephropathy
Renal vein thrombosis
*Diabetes mellitus
4 presentations of papillary necrosis
calcifications in the bladder wall
TCC, schistosoma hematobium
psammomatous calcification
sand-like: red flag for cystadenocarcinoma - primary in bowel or ovary; see this in the liver as a met
Acute pyelonephritis on US
The kidney is enlarged with inhomogenous echotexture and loss of corticomedullary differentiation.
Pathogenesis of angioedema?
overactivation of complement factor C1 - lack of an inhibitor
WHere to look for hydronephrosis on US?
The dilation will be black and will be found in the central hilar area; the calyceal system is dilating
WHere to look for hydronephrosis on US?
The dilation will be black and will be found in the central hilar area; the calyceal system is dilating