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PART 2 > ABDO/IR > Flashcards

ABDO/IR Flashcards

1
Q

Achalasia is

A

failure of organised oesophageal peristalsis causing impaired relaxation of the lower sphincter resulting in stasis and dilatation

due to loss/destruction of neurones in the auerbach/myenteric plexus

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2
Q

Achalasia imaging

A

short segment 3ish cm

xr
convex opacity overlapping mediastinum
air fludi level
small absent gastric bubble
displaced trachea on lateral

FLUORO
bird beak/rat tail
dilatation
tram track
incomplete relaxation
pooling/stasis
tertiary contractions
failure of clearance

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3
Q

Achalasia ddx

A

central/peripheral neuropathy
scleroderma
malignancy
stricture
chagas disease
non spec dysmotility
diffuse spasm
presbyoesophagus

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4
Q

Chagas disease is, and manifestations

A

tropical parasite infection (trypanosomiasis)

Cardiac
- myocarditis
- dilated cardiomyopathy

GI
- dysmotility and megaoesophagus
- megaduodenum and small bowel
- megacolon

GU
- megaureter

CNS
- meningoencephalitis
- chagoma

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5
Q

Presbyoesophagus is

A

manigestations of degenerating motor function in the aging oesophagus

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6
Q

Diffuse oesophageal spasm is

A

a motility disorder of the opesopahgus. may appear as a corkscrew esophagus

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7
Q

nutcracker oesopahgus is

A

a motility disorder, uisually normal swallow study

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8
Q

Schatzki ring is

A

a symptomatic narrow b ring occuring in the distal oesophagus and usually assoc with a hiatus hernia

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9
Q

Oesophageal web is

A

a constriction caused by a thin membrane projecting into the oesophagus, typically cervical

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10
Q

Oesophageal stricture aetiology

A

Upper and middle
- Barrett
- radiation
- caustic ingestion
- congenital
- intramural pseudodiverticulosis
- skin diseases, eg pemphigoid

Distal
- usually in the setting of GORD or
- scleroderma
- post NGT
- zollinger ellison
- post gastrectomy

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11
Q

Barrets oesophagus is and imaging

A

metaplasia of the oesophagus, a precursor for adenocarcinoma

imaging
- signs of reflux oesophagitis
- reflux
- long stricture
- large deep ulcer
- reticular mucosal pattern
- thickened folds

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12
Q

Oesophagitis causes

A

Infective
- HIV
- CMV
- Herpes
- Candida

Non infective
- drugs
- reflux
- corrosive
- idiopathic eosinophilic
- radiation

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13
Q

Oesophagitis imaging

A

mucosal irreg
erosions and ulcers
abnormal motility
thickened folds
limited distensibility
strictures
pseudodiverticulosis

small ulcers
- reflux
- herpes
- radiation
- drug induced

large ulcers
- cmv
- hiv
- carcinoma

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14
Q

Corrosive oesophagitis imaging

A

acute
- oedema
- ulceration
- sloughing
- dilatation
- atony

chronic
- single long or multiple stricutres

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15
Q

Idiopathic oesinophilic oesophagitis is

A

an inflammatory disease characterised by eosiniophilia of the oesophagfus layers

imaaing
- ringed oesophagus
- may coexist with longer stricutres

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16
Q

feline oesophagus is

A

transient transverse bands seen in the mid and lower oesophagus - almost always associated with reflux

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17
Q

Oesophageal carcinoma subtypes

A

Squamous (80%)
Adeno (20ish)
- mostly related to barretts, lower GOJ
Other
- mucoepidermoid
- adenoid cystic
- spindle cell
- leiomyosarcoma
- rhabdomyosarcoma
- fibrosarcoma
- lymphoma

Macroscopic
- polypoid
- ulcerating
- infiltrating
- superficial spreading

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18
Q

Oesophageal carcinoma imaging

A

XR
- wide azygooesophageal recess
- thick posterior stripe/right paratracheal striple
- tracheal deviation
- retrocardiac/posterior mediastinal mass
- air fludi level
- mass in gastric bubble (Kirklin)

Fluoro
- irregular stricture
- dilatation and hold up
- shouldering

CT
- eccentric wall thickneing >5mm
- perioesohpageal stransing/soft tissue
- dilated
- tracheobronchial invasion
- aortic invasion

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19
Q

Oesophageal leiomyoma is

A

a benign smooth muscle neoplasm of the oesophagus

imaging
- discrete ovoid mass, well outlined
- obtuse angles
- intramural, smooth
- calcifications are pathognomonic
- moderate enhancement
- no invasion

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20
Q

Oesophageal fibrovascular polyps are

A

benign intraluminal submucosal pedunculated tumours, usually occuring in the upper third of the oesophagus at the level of the upper sphincter

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21
Q

Peptic ulcer disease imaging

A

pocket of barium filling crater
- post bulbar; zollinger ellison
oedematous collar of swollen mucosa
radiating folds of mucosa away from ulcer

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22
Q

Acute gastritis causes and imaging

A

aetiology
- infection; hpylori
- systemic illness
- nsaids
- autoimmune
- caustic
- immunosuppression
- eosinophilic

imaging
- gastric wall oedema
- halo sign; enhancing mucosa

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23
Q

Atrophic gastritis imaging

A

decreased/absent fundal folds
narrow tubular stomach
small absent areae gastricae

linitis plastica - usually nodular

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24
Q

GISTs are

A

the most common mesenchymal tumours of the GI tract

c KIT histopath

assoc
- carney triad
- NF1
- carney striakis

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25
Q

GIST imaging

A

Location
- stoamch
- SI
- anorectum
- colon
- oesophagus (uncommon)
- extra GI - mesentery, omentu, retroperitoneum (uncom)

CT
- soft tissue, central necrosis
- often exophytic
- screscent ulceration with air fluid level (torricelli bernoulli sign)
- peripheral enhancment
- calcs uncommon

MR
variable due to necrosis, haemorrhage, cystic change

Concerning; exogastric growth, >5cm, central necrosis and extension to other organs

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26
Q

Gastric adenocarcinoma imaging

A

Fluoro
Early
- elevated, superficial or shallow lesions
Advanced
- polypoid
- ulcerating

CT
- polypoid +/- ulceration
- focal wall thickening
- ulceration
- infiltrating

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27
Q

Menetrier disease is

A

a rare idiopathic hypertrophic gastropathy

present with acholhydria, hypoproteinaemia and oedema. typically fundal region.

fluoro
- enlarged and tortuous folds in the fundus and body, sparing the antrum
- diluted barium due to mucus hypersecretion

CT
- thickened rugae, resembling convolutions of brain
- wall thickness normal between folds

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28
Q

Zollinger ellison syndrome is

A

a clinical syndrome secondary to a gastrinoma

secrete gastrin, hypersecretion of gastric acid

leads to diarrhea, gastritis, GORD and PUD

assoc with MEN 1

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29
Q

Zollinger ellison syndorme imaging

A

Fluoro
- thickened rugael folds
- multinodular gastric contour
- erosions and ulcers

CT
- thickened rugal folds
- multiple gastric nodules

ddx
- other gastritises
- gastric lymphoma
- menetrier
- outlet obstruction

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30
Q

Inguinal hernia types

A

Indirect
- lateral to inferior epigastric vessels
- deep inguinal ring
- anterior to spermatic cord in males
- follows round lig in females

Direct
- medial to inferior epigastric vessels
- through a defect in hesselbachs triangle
- weakness in the fascial floor of the inguinal canal
- inguinal canal is usually compressed/displaced (lateral crescent sign)

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31
Q

Meckels diverticulum is

A

a congenital intestinal diverticulum due to fibrous degeneration of the umbilical end of the vitelline duct that occurs around the dital ileum

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32
Q

Meckels rule of 2

A

2% population
2 inches
2 feet from IC valve
2/3 ectopic mucosa
2 types of ectopic tissue
2% symptomatic

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33
Q

Meckels presentation

A

Haemorrhage
Obstruction
- adhesion
- luminal
- intussception
- Littres hernia
Inflammation
Perforation
Neoplasm

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34
Q

Meckels imaging

A

CT
- blind ending small bowel pouch
- antimesenteric side of the distal ileum
- can invert and cause an internal polypoid lesion

NM
- pertechnetate
- only if gastric mucosa present, mucin secreting cells-

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35
Q

Duodenal diverticulum types and complications

A

Can be primary (mucosa) or secondary (entire wall)

Can be periampullary

Can be intraluminal (duodenal web)

Complications
- diverticulitis
- haemorrhage
- perforation
- biliary obstruction (Lemmel symdrome)

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36
Q

Duodenal diverticulum ddx

A

Periduodenal abscess
Duodenal ulcer
Duodenitis
Head of pancreas cystic lesion
Pseudocyst

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37
Q

Duodenal web is

A

obstruction at the duodenum due to a membranous web or intraluminal diverticulum. small central aperture, different to atresia

ddx
- duodenal stenosis
- duodenal atresia

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38
Q

Duodenal atresia is and assoc

A

a congenital malformation fo the duodenum with complete obstruction of the lumen

assoc
- downs
- vacterl
- annular pancreas
- other atresias

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39
Q

Duodenal atresia imaging and ddx

A

XR
double bubble
- if distal gas, stenosis

US
double bubble
- ?connection, might be a foregut duplication

DDX
- stenosis or web
- malrotation and volvulus
- choledochal cyst
- omental cyst
- duplication cyst

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40
Q

Gastroschisis is

A

extraabdominal herniation of fetal/neonatal bowel loops into the amniotic cavity through a paraumbilical defect. no surrounding membrane. no strong associations

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41
Q

Gastroschisis imaging

A

herniated content to right side of cord
small AC

ddx
- omphalocoele
- physiological herniation (before 11 weeks)

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42
Q

Omphalocoele is

A

congenital midline abdominal wall defect at the base of the umbilical cord insertion

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43
Q

Omphalocoele assocaitions

A

Chromosomal
Other syndromes
- BW
- pent cantrell
- OEIS
- lethel omph cleft palate
Other anomalies
- CNS, cardiac, GU, skeletal

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44
Q

Omphalocoele imaging

A

mulitple bowel loops in membrane covered defet
direct cord insertion
small AC
polyhydram
allantoic cyst often present
can rupture

ddx
- pseudoomph
- gastroschisis
- physiological herniation
- limb body wall complex
- umbilical hernia

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45
Q

Polyposis syndromes

A

Hereditary
- Hereditary nonpolyposis colorectal cancer HNPCC
- Familial adenomatous polyposis syndromes FAPS ( incl, classic,. Gardner, Turcot)
- Bannayan riley ruvalcaba
- Cowden
- Peutz jeghers
- TS
- Juvenile polyposis syndromes

Non hereditary
- Serrated polyposis syndrome
- Cronkite Canada syndrome
- Juvenile polyposis syndrome

Can also be adenomatous or hamartomatous

Adenomatous
- FAPS
- Gardner
- (HNPCC - cancers come from adenomatous polyps)

Hamartomatous
- JPS
- BRR
- Cowden
- Peutz Jegher
- Cronkhite Canada

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46
Q

HNPCC/Lynch syndrome is

A

an AD condition which predisposes to malignancies, including colorectal. Due to mutations in DNA mistamtch repair (MMR) geners

Cancers
- CRC
- GU (endometrial, ovarian, prostate, urothelial)
- SB
- Gastric
- hepatobiliary
- CNS

Diffuse polyposis is characteristically absent

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47
Q

FAPS is

A

characterised by presnece of hundreds of adenomatous polyps in the colon, mutation of the tumour suppressor APC gene, though can be MUTYH.

<5mm. rectum typically spared. can have extracolonic (duodenal, gastric) polyps

associations
- CRC
- hepatoblastoma
- extracolonic polyps (stomach, duodenum)
- desmoid tumours
- osteomas
- dental anomalies
- papillary thyroid ca

Variants
- gardners
- attenuated FAP
- familial polyposis colli

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48
Q

Gardner syndrome is

A

FAP
Multiple osteomas
Epidermal cysts
Fibromatoses
Desmoid tumours

Supernumery deeth, odontomas, dentigerous cysts
Ampullary carcionoma
Papillary thyroid ca

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49
Q

Turcot syndrome is

A

characterised by multiple colonic polyps and increased risk of colonic and primary brain tumours; commonly medulloblastomas or GBM

APC gene
- CRC by 40
- medulloblastomas

HNPCC gene
- not as much CRC
- GBM

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50
Q

Bannayan Riley Ruvalcaba syndrome is

A

AD disorder caused by mutation of the PTEN gene

Features
- hamartomatous intestinal polyps, typically terminal ileum and large bowel
- macrocephaly
- lipomatosis
- dermal and deep visceral lipomas
- angiolipomas
- haemangiomata
- speckled penis
- hypotonia
- scoliosis
- pectus
- woman:::: breast ca, MR screening

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51
Q

Cowden syndrome is

A

caused by mutation of the PTEN gene and characterised by hamartomas throughout the body and increased risk of ca

Features
- mucocutaneous lesions, including trichilemmomas
- GI polyps, large and small bowel
- glyucogenic acnathosis
- thyroid goitres
- fibrocystic breast disease
- testicular lipomatosis

Cancers
- breast
- thyroid
- dysplastic cerebellar gangliocytoma, in assoc with Lhermitte duclos disease

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52
Q

Peutz Jeghers syndrome is

A

AD polyposis syndrome characterised by
- multiple hamartomatous polyps (SB/jejenum), also colon, stomach
- mucocutaneous melanin pigmentation mouth/fingers/toes

Proliferation of all three layers of the mucosa

Cancers
- CRC, stomach, small intestine
- adenoma malignum
- breast
- pancreas
- ovary sec cord
- uterus
- cervix
- testis (sertolis)
- lung

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53
Q

Serrated polyposis syndrome is

A

characterised by presence of multiple serrated polyps. heterogenous genetic with BRAF and KRAS most common. CRC in 50%.

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54
Q

Juvenile polyposis sydrome is

A

hundreds of hamartomatous polyps containing fluid or mucus. SMAD4 and BMPR1A implicated. end up with CRC

Assoc
- malrotation
- meckels
- hydrocephalus
- congenital heart
- mesenteric lymphangioma
- pulm AVM

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55
Q

Cronkhite canada syndrome is

A

a non neoplastic non hereditary hamartomatous polyposis syndrome characterised by rash, alopecia and watery diarrhea

predominantly stomach, large intestine and small bowel. not assoc with malig.

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56
Q

Infective enteritis overview

A

Proximal: giarida, stronglyloides
Distal: salmonella, shigella, yersinia
Distal ileum/caecum: TB, typhlitis, amebiasis

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57
Q

Ileocaecal TB imaging

A

most common GI TB, third most common extrapulmon TB

Barium
- flieschner (narrowing of the ileum, thickening of the valve)
- thickening and hypermotility of the caercum
- stierlin sign (empty caecum)
- chronic; fixed rigid valve, conical caecum, pulled caecum from fiorbosis)

CT
ileocaecal thickening
asymmetric valve thickening
mesenteric adenoaptyh with central low attenuation

ddx
- crohns (more ileal, less ascites, more vascularity)
- caecal carcinoma (eccentric, mets)
- small bowel lymphoma (thick, no stricture, lymphadenopathy/hepatosplenomegaly)
- amoebic colitis

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58
Q

Typhlitis is and imaging

A

necrotising inflammatory conditions originating in the caecum and extending out in immunocompromised

bowel wall thiickening
hypoechoic wall, echoic thick mucosa
fat stranding, pneumatosis
small bowel obstruction

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59
Q

Terminal ileitis ddx

A

IBD

Infectious
- cdiff
- salmonella
- yersinia
- tb
- typhlitis

Spondyloarthopathies

Ischaemia

Radiation

Vasculitidies
- SLE/PAN/HSP/Behcet and others

Neoplasic
- adenocarc, lymphoma, carcinoid

Drug related

Infiltrative
- EG
- sarcoid
- amyloid
- mastocytosis

Endometriosis

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60
Q

Coeliac disease is

A

a t cell mediated autoimmune gluten intolerance characterised by loss of villi in the proximal small bowel and malabsorption

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61
Q

Coeliac associations

A

Pulmonary haemosiderosis (Lane Hamilton)
IgA def
Cavitating mesenteric lymph node syndrome
Small bowel lymphoma
Down syndrome
CEC/Gobbi syndrome
IBD

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62
Q

Coeliac disease imaging

A

Fluoro
- Small bowel dilatation
- dilution of contrast
- multiple non obstructing intussusceptions (coiled spring)
- jejunoileal fold pattern reversal
- moulage sign
- mosaic pattern
- flocculation
- segmentation

CT
- jejunoileal fold pattern reversal
- small bowel dilatation/thickening
- stranding
- intussusceptions
- strictures
- vascular engorgement
- prominent nodes
- submucosal fat
- hyposplenism

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63
Q

Gallstone ileus is

A

an uncommon cause of mechanical bowel obstruction, occuring as a complication of chronic cholecystitis. stone fistula to small bowel and impaction at ileocaecal valve

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64
Q

Bouveret syndrome is

A

Gallstone ileus but causing gastric outlet obstruction

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65
Q

Gallstone ileus imaging

A

XR
- Rigler triad: obstruction, gas in biliary tree, gallstone

CT
- riglers again
- fistula site
- complications

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66
Q

Aortoenteric fistula is

A

pathologic communication between the aorta and GIT.

Can be primary (assoc with a complicated aneurysm) or secondary (assoc with graft repair)

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67
Q

Aortoenteric fistula imaging and ddx

A

Primary
Direct signs:
- ectopic gas in aorta
- presence of vascular contrast in GIT
Indirect signs:
- bowel thickening over aneurysm
- disruption of periarotic fat
- bowel/periaortic haematoma

Secondary
- increased perigraft soft tissue
- pseudoaneurysm formation
- disruption of aneurysmal wrap
- increased soft tissue between the graft and the wrap

ddx
- perigraft infection
- retroperitoneal fibrosis
- infected mycotic aortic aneurysm
- infectious aortitis

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68
Q

Duodenal adenocarcinoma is, risk factors and ddx

A

most common primary malignancy of the duodenum

risk factors;
- polyposis syndromes
- inflammatory disorders ie crohns, coeliac
- non hered polyps

ddx
- lymphoma
- NET
- pancreatic tumours
- periampullary tumours
- lower cbd tumours
- leiomyosarcoma
- benign polyp/adenoma/leimyoma/lipoma

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69
Q

Periampullary tumours are

A

those which arise within 2cm of the ampulla of vater

four main types
- pancreatic head/uncinate tumours
- lower common bile duct tumours
- ampullary tumours
- periampullary duodenal adenocarcinoma

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70
Q

Bulging duodenal papilla dddx

A

normal variant
patulous ampulla of vater
tumours
- IPMN
- ampullary
- periampullary
- cholang
- pancreatic
papillitis
autoimmune panc
choledochocele
impacted stone

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71
Q

GI neuroendocrine tumours classification

A

functional or non functional

TYPES
Insulinoma
- 50% of nets
- usually <2cm
- mostly pancreas
- 15% malig

Gastrinoma
- pancreas, LN, duodenum
- 20-30%
- variable size
- 75% malig

Non functioning
- pancrease
- 15%
- usually large and malignant

VIPoma
- pancreas, adrenal
- 3%
- 50% malignant

Glucagonomas and somatostatinomas
- rare
- pancreas
- malginant

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72
Q

Insulinomas are

A

most common pancreatic net, develop from ductal pluripotent cells into unregulated insulin secreting cells. equally distributed in pancreas

whipples triad
- hypoglycaemia
- sx of hypo
- immediate relief with glucagon

Assoc with MEN1

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73
Q

Insulinoma imaging

A

small
hypervascular
can have calcs
equal pancreas distribution

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74
Q

Gastrinomas are

A

second most common pancreatic endocrine tumour

associated with MEN1, and the most common type associated with it

associated with PUD - zollinger ellison syndrome

often malignant, extrapancreatic (duodenal)

occur in gastrinoma triangle

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75
Q

Gastrinoma/Passaro triangle boundaries

A

Confluence of cystic and common bile ducts

Junction of D2/D3

Junction of pancreatic head/neck

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76
Q

VIPoma is

A

a very rare pancreatic endocrine tumour that secrete vasoactive intestinal peptide.

WDHA syndrome; watery diarrhea, hypokalemia, achorhydria

location
- intrapancreatic, commonly tail
- extrapancreatic neurogenic; symp chain
- extrapancreatic non neurogenic; oesophagus, bowel, liver, kidney

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77
Q

Glucagonoma is

A

a pancreatic endocrine tumour that secretes glucagon. commonly malignant.

4d syndrome
- dermatitis
- diabetes
- DVT
- depression

typically large and metastatic at time of diagnosis. hypervascular.

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78
Q

Somatostatinomas are

A

a rare NET.

assoc;
- MEN1
- VHL
- NF1

Inhibitory syndrome
- DM
- cholelithiasis
- diarrhea

typically in the pancreas, but can also be duodenum/ampulla or vater

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79
Q

Whipples disease is

A

a rare infectious multisystem disorder caused by actinobacteria tropheryma whipplei

presents with migratory arthritis, weight loss, diarrhea, abdominal pain. can have hepatosplenomegaly and lymphadenopathy

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80
Q

Whipples disease features (by system)

A

GI
- jejunal micronodules
- thickened mucosal folds
- low density mesenteric nodes

CNS
- cortical or subcortical atrophgy
- hydrocephalus
- lesions; t2 hyper and mildly enhancing, no restriction
- midbrain, mesial temporal, hypothalamus and corticospinal tracts\

thoracic
- diffuse/focal infiltrates
- basal opacities
- nodules
- adhesions
- effusion
- nodes

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81
Q

Brunner gland hyperplasia is

A

disproportionate overgrowth of Brunner Glands in the duodenum from yperacidity. Multiple nodular filling defects, cobblestoning. ddx duodenitis.

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82
Q

Scleroderma GI manifestations

A

Oesophagus
- Dilated distally
- dysmotility
- reflux

Small bowel
- luminal dilatation
- reduced peristalsis
- hidebound bowel (crowding of valv c)
- accordion sign (evenly spaced mucosal folds)
- sacculation

Large bowel
- psedosacculation
- loss of haustra
- dilatation
- reduced transit

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83
Q

Intestinal angioedema imaging

A

Long segment concentric thickening
Mural stratification
Mild mesenteric oedema
Ascites
No nodes

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84
Q

Pancreatic trauma AAST grading

A

Proximal - right of SMV
Distal - left of SMV
Deep - to level of duct
Superficial - before duct

1: haematoma with minor contusion or superficial lac

2: major contusion or lac without ductal injury

3: distal transection or deep injury with duct injury

4: proximal transection or deep injury involving the ampulla or cbd

5: shattered head

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85
Q

Acute pancreatitis complications

A

Absent necrosis
- Acute peripancreatic fludi collection <4w
- Pseudocyst (encapsulated) >4 weeks

Necrosis
- acute necrotic collection <4w
- Walled off necrosis (encapsulated) >4w

Necrotic pancreatitis
- can lead to emphysematous pancreatitis

Vascular
- haemorrhage
- pseudoaneurysm
- splenic/portal vein thrombosis

Fistula into peritoneal cavity

Abdominal compartment syndrome

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86
Q

CTSI pancreatitis

A

Balthazar score A-E
A normal 0
B enlargement 1
C inflammatory 2
D single collection 3
E two or more collections 4

Necrosis
none 0
<30% 2
30-50% 4
>50% 6

Score /10

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87
Q

Sentinel loop is

A

a short segment of adynamic ileus close to an inflammatory process on xr. upper abdomen - pancreatitis. right lower quadrant - appendicitis.

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88
Q

Colon cut off sign is

A

distension proximal colon, abrupt termination at splenic flexure, decompression distally

LUQ pathologies;
- pancreatitis (phrenicocolic lig via tv mesocolon)
- carcinoma
- IBD
- mesenteric ischaemia
- abdominal aortic aneurysm rupture
- stomach tumorus

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89
Q

Autoimmune pancreatitis associations

A

Igg4 sclerosing disease
RA
Sjogrens
IBD

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90
Q

Autoimmune pancreatitis imaging

A

Sausage shape
Minimal stranding, confined to peripancreatic
Peripancreatic low rim/halo

MR
T1 low
T2 minimally incre
C+ delayed
DWI restricts
MRCP ?strictures

Other sites
- nodes
- renal inflamm pseudotumours
- retroperitoneal fibrosis
- pleural effusions
- CBD strictures
-mediastinal nodes

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91
Q

Autoimmune pancreatitis ddx

A

Diffuse
- lymphoma
- plasmacytoma
- mets
- infiltrative ductal adeno

Focal
- ductal adenocarcinoma

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92
Q

Tropical pancreatitis

A

SPINK1 mutation
Tropical countries
Younger
Large ductal calculi

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93
Q

Emphysematous pancreatitis is

A

complications of acute caused by secondary necrotising infection. gas forming bacteria.

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94
Q

Hirschsprung imaging

A

XR
Bowel obstruction. Affected bowel is smaller in calibre

Fluoro
Affected segment small calibre with proximal dilatation
Saw tooth irregularity of the segment
Reversed rectosigmoid ratio

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95
Q

Meconium plug syndrome is

A

functional colonic obstruction in a newborn due to an obstructing meconium plug. Usually tyransient and affects the left colon (small left colon syndrome)

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96
Q

Meconium plug syndrome imaging

A

XR
multiple dilated loops

Fluoro
small calibre left colon with filling defects due to retained meconium
rectum is normal in size

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97
Q

Necrotising enterocolitis imaging

A

XR
dilated bowel loops
loss of the normal gas shapes
thumbprinting
pneumatosis
portal venous gas
pneumoperitoneum

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98
Q

Ogilvie syndrome is

A

colonic pseudo obstruction. acute distension without an underlying mechanical obstruction

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99
Q

Ulcerative colitis associations

A

PSC
Moya moya
Ank spon
CRC
Coeliacs

Lung disease
Uveitis and iritis
Erytheme nodosum and pyoderma gangrenosum
Thrombotic comps
fatty liver
Seronegative spondyloarthropathies
Chronic hepatitis

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100
Q

Ulcerative colitis imaging

A

XR
Thumbprinting
toxic megacolon

Fluoro
Granular mucosa
Lead piping
CRC

CT
Lead piping
Wall thickening
Mural stratification
Submucosal fat deposition
Thickening perirectal fat
CRC
Pneumatosis

MR
Wall thickening
Diffusion restriction
Enhancement of the mucosa
Loss of haustra

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101
Q

Toxic megacolon is and causes

A

Acute complication in IBD. Fulminant colitis cuases neurogenic loss tone of the colon leading to severe dilation and perforation

Causes
UC
Crohn
Infectious, particularly cdiff
Neutropaenic colitis
Ischamia
Radiation
Lymphoma
GVHD
Hypothyroidism
Hrischsprungs

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102
Q

Infectious colitis imaging

A

Wall thickening with homogenous enhancement
Ascites
Stranding

Right colon; yersinia, salmonella
Diffuse; CMV, e coli
Left; shigella, schistosomiasis
Rectosigmoid; gonorrhea, herpes, trchomatis

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103
Q

CRC staging

A

T0 no evidence
Tis in situ
T1 into submucosa
T2 into muscularis
T3 into subserosa or into non peritonealised tissues
T4a visceral peritoneal layer
T4b adjacent organs

N0 none
N1a 1 regional
N1b 2-3 regional
N1c serosa/non peritoneal tissue without regional
N2a 4-6
N2b >7

M0 no
M1a one organ without peritoneal
M1b multiple organs no peritoneal
M1c peritoneum with or without others

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104
Q

Mucinous neoplasms of the appendix include

A

Premalignant
- adenoma
- serrated polyp

Uncertain
- low grade appendiceal mucinouss neoplasm
- high grade appendiceal mucinous neoplasm

Malignant
- appendiceal mucinous adenocarcinoma
- poorly diff mucinous with signet ring cells
- mucinous signet ring cell carcinoma

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105
Q

Pseudomyxoma peritonei is

A

a syndrome of progressive accumulation of mucinous ascites related to a mucin producing neoplasm, usually appendix.

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106
Q

Pseudomyxoma peritonei imaging

A

Loculated collections of fluid accumulating along the peritoneal surfaces rsulting in scalloped appearance of teh coated organs and omental caking

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107
Q

Omental caking ddx

A

TB
Lymphoma
Malignant peritoneal mesothelioma

usually from ovaries, gastric or colon

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108
Q

Appendiceal mucocoele is and causes

A

abnormal accumulation of mucin causing distention of the vermiform appendix

Causes
- mucus retention cyst
- mucosal hyperplasia
- mucinous cystadenoma of the appendix
- mucinous adenocarcinoma of the appendix

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109
Q

Appendiceal mucocoele imaging

A

XR
peripheral calcs

US
onion sign (layering)
can have some shadowing

CT
low attenuation
at caecum
mural calcs
nodular - cancer
gas - infection

MR
T1 variable
T2 yperintense

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110
Q

Low grade appendiceal mucinous neoplasms (prev cystadenomas) are

A

rare mucinous tumours of the appendix showing low cytoligc atypia. Distinguished from HAMN on histo grounds.

Suspcious features of HAMN
- soft tissue thickening
- wall irregularity
- PMP

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111
Q

Perianal fistula classification

A

Intersphinteric - does not cross external

Transpincteric - from intersphincteric space through external into ischiorectal fossa

Suprasphincteric - superiorly into intersphincteric space, over puborectalis and through iliococcygeus into ischiorectal fossa

Extrasphincteric - perineal skin through ischiorectal fossa and levator ani muscle complex into rectum

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112
Q

Splenic haemangiomas are

A

second most common splenic lesion after cyst. slow flow venous malformation. similar imaging to hepatic haemangioma.

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113
Q

Splenic lymphangioma is and imaging

A

rare benign tumours corresponding to abnormal dilation of lymphatic channels. can be congenital or acquired. present as lobulated or multiloculated cystic lesions. can have curvilinear mural calcifications

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114
Q

Splenic hamartoma imagig

A

variable US

CT
heterogenous enhancemnt
iso or hypodense

MR
T1 iso
T2 heterogenously hjyper
C+ vivid immediately post con (unlike haemangioma), delayed uniform with central hypovascular

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115
Q

SANT imaging

A

US
hypoechoic

CT
homgenous, hypodense or isodense
enhancing rim and radiating enhancing tissue (spoke wheel)

MR
T1 heterogenous low to intermediate
T2 low
C+ peripheral and septal enhancement spoke wheel. non enhancing stellate scar.

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116
Q

Hepatic/splenic TB imaging

A

hepatosplenomebgaly

US
miliary nodules or larger masses

CT
miltple low attenuaiting
eventually calcify
can have large lesion with target sign

DDX
Micronodular
- lymphoma
- fungal
- mets
- sarcoid
Macro
- abscess
- mets
- primary

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117
Q

Splenic siderosis is and imaging

A

gamna gandy bodies
microhaemorrhage with haemosidering dep
usually seen in PH but also haematolgoical conditions

US
multiple echoic with shadowing

CT
look like granuloms

MR
siderotic foci punctate througout

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118
Q

Wandering spleen is

A

migration of the spleen
abnormality of its suspendosry ligaments
can infarct

aetiology
- sickle cell
- heterotaxy
- trauma
- mono

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119
Q

Pancreatic ductal adenocarcinoma risk factors

A

Cigs
Chronic pancr
Diet
Obesity/DM
Family hx
Hereditary syndromes
- BRCA2
- HNPCC
- FAMMM
- peutz jehger

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120
Q

Pancreatic ductal adenocarcinoma imaging

A

Fluoro
- inverted three sign
- wide sweep

US
- double duct
- mass

CT
- poorly defined
- surrounding desmo reaction
- enhance poorly
- double duct

MR
T1 hypo
T1FS hypo
C+ delayed
T2 variable
MRCP DD

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121
Q

Pancreatic ductal adenocarcinoma staging

A

T1 <2cm
T2 2-4cm
T3 >4cm
T4 encasing SMA/Coeliac aa

N0 none
N1 1-3 regional
N2 4 or more regional

M0
M1

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122
Q

Serous cystadenoma of the pancreas pathology

A

polycystic
honeycomb
macrocystic (<10%)

Associated with VHL

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123
Q

Serous cystadenoma of the pancreas imaging

A

Location
- distributed throughout

CT
multicystic
lobulated
bunch of grapes
>6 cysts
<2cm in size
enhancing central scar
stellate central calcification

MR
T1 low
T2 low fibrous scar, high signal cysts
C+ fibrous septa enhance
No communication with duct

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124
Q

Serous cystadenoma of the pancreas ddx

A

IPMN - communicates

Pseudocyst

Mucinous - peripheral calcs, bigger cysts, usually unilocular

SPPN

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125
Q

Mucinous cystadenoma of the pancreas imaging

A

Mostly body/tail, can be head

CT
- rounded contour
- peripheral calcs
- heterogenous attenuation
- internal septa
- can be uni or multilocular

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126
Q

Mucinous cystadenocarcinoma of the pancreas imaging

A

Numerous large cysts
Smooth contour
Thicker walls
Amorphous calcs, septations, solid excrescences can be seen
No central scar

MR
Mucin high T1
Cysts high T2
Calcs low

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127
Q

Pancreatic duct conventional arrangement

A

Main duct
- Dorsal duct proximal to dorsal ventral fusion
- drains at the ampulla of vater
- connects with the accessory pancreatic duct

Duct of Wirsung
- distal main duct
- segment of ventral duct between fusion and major papilla
- continuous with the main duct proximally

Accessory duct of Santorini
- Portion of dorsal duct distal to dorsal ventral fusion
- Drains anterior superior head
- Can drain to minor papilla
- Can persist as a branch of the main duct

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128
Q

Pancreas divisum is

A

Failure of dorsal/ventral fusion
Dorsal duct drains most of pancreas via the minor papilla
Can result in a santorinicoele

Types
- Classic; no connection
- Absent; no Wirsung, major papilla only drains CBD
- Functional; filamentous connection

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129
Q

Meandering main pancreatic duct is

A

Main pancreatic duct that drains into major papilla after performing a reverse Z type or Loop turn in the pancreatic head

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130
Q

Ansa pancreatica is

A

Communication between the duct of wirsung and duct of santorini

Arises as a brnach duct from the main, descends down, loops upward and terminates at the minor papilla

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131
Q

Anomalous pancreaticobiliary junction is

A

abnormal junction of the pancreatic duct and CBD outside the duodenum to form a long common channel >15mm

Can have associated biliary dilatation, or
- choledochal cyst
- stricture
- pancreatic anomalies
- synchronous biliary cancer

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132
Q

Annular pancreas is

A

a morphological anomaly that results in pancreatic tissue completely or incompletely encircling the duodenum. can cause duodenal obstruction.

develops due to failure of the ventral bud to rotate with the duodenum causing encasement

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133
Q

Non neoplastic pancreatic cysts:

A

Unilocular
- pseudocyst
- simple cyst

Diffuse
- VHL
- CF
- ADPKD

Macro multi
- hydatid

Cystic/solid
- WON

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134
Q

IPMNs are

A

epithelial pancreatic cystic tumours of mucin producing cells that arise from pancreatic ducts

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135
Q

IPMN types

A

Main
- segemental or diffuse
- higher malig potential
- look like chronic pancr

Branch
- head and uncinate
- localised and mass like
- can be multifocal
- macro or microcystic
- typically indolent

Mixed

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136
Q

IPMN imaging

A

Communicate with a duct

CT
single or multiple cystic lesions
dilatation of the main duct
do not calcify

MR
Main
- Main duct >5mm
- segment or diffuse dilation
- mucin signal
- thin parenchyma
- solid mural nodules concerning
- mucin dependantly in the duct

Branch
- single or multiple side branches with dilation
- cystic mass like appearance
- bunch of grapes

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137
Q

IPMN worrisome features

A

Main
- duct 5-9mm worrisome
- >10mm high risk
- enhancing components

Branch
- main duct >5mm
- cyst >3cm
- >5mm enhancing nodule
- solid mass
- thickened/enhancing cyst wall
- growth rate >5mm/year

Nodes
Abrupt change in calibre with distal atrophy
Elevated CA19 9

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138
Q

Solid pseudopapillary tumour of the pancreas is

A

a rare and usually benign pancreatic cystic neoplasm most commonly seen in young females

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139
Q

Solid pseudopapillary tumour of the pancreas imaging

A

Pancreatic tail

CT
encapsulated lesion
solid/cystic
cystic usually more central
Calcifications and enhancing solid components

MR
T1 low
T2 heterogeneous to high
C_ heterogenous and slowly progressive

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140
Q

Acinar cell carcinoma of the pancreas imaging

A

CT
enhancing oval solid
often NO biliary duct dilatation
can have calcifications
can invade adjacent organs

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141
Q

Pancreatoblastomas are

A

rare paediatric tumours of the pancreas. around 4yo. assoc with beckwith wiedemann syndrome

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142
Q

Pancreatoblastoma imaging

A

CT
well defined
heterogenous
solid/multilocular cystic components
enhancing septa
fine calcifications

MR
T1 low
T2 hetero high

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143
Q

Anal cancer imaging and staging

A

MR
T1 low to muscle
T2 high to muscle

T1 <2cm
T2 2-5cm
T3 >5cm
T4 invasion of adjacent organ

N1a inguina, mesorectal, internal iliac
N1b external iliac
N1c N1a + N1b

M0 M1

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144
Q

Hepatitis imaging

A

US
hepatosplenomegaly
starry sky
GB thickening
periportal oedema
decreased echotexture

CT
hepatomegaly
periportal oedema
decreased attenuation on NC
lymphadenopathy

MR
T1 periportal oedema
C+ delayed periportal enhancement
IP/OP steatosis

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145
Q

Mirizzi syndrome is

A

extrinsic compression of the extrahepatic biliary duct from calculi in the cystic duct or gallbladder. may have an associated cholecystodochal or cholecystoenteric fistula

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146
Q

Acute calculous cholecystitis complications

A

gangrenous
perforation
emphysematous
abscess
fistula
vascular

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147
Q

Acalculous cholecystitis is

A

cholecystitis without stones or where stones arent contributory. typically critically unwell patients or injured patients.

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148
Q

Chronic cholecystitis imaging

A

NM/HIDA
delayed visualisation bw 1-4 hours
?EF after cholecystokinin

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149
Q

Emphysematous cholecystitis is

A

a rare form of cholecystis with wall necrosis causing gas formation in the lumen/wall. surgical emergency. usually older and diabetic patients

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150
Q

Emphysematous cholecystitis imaging

A

US
Ring down
Champagne sign

CT
Gas

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151
Q

Xanthogranulomatous cholecystitis is

A

an uncommon inflammatory cause, characterised by multiple intramural nodules. rupture of rokitansky aschoff sunses

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152
Q

Xanthogranulomatous cholecystitis imaging

A

US
thickening
intramural hypoechoic nodules or bands
stones
infiltration of liver

CT
small intramural hypoattenuating nodules
poor enhancement
local infiltration

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153
Q

Primary sclerosing cholangitis is

A

an uncommon inflammatory condition affecting the biliary tree resulting in multiple strictures and cirrhosis

unlike PBC, ab titers are low

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154
Q

PSC associations

A

IBD, especially UC
Autoimmune hepatitis
Sjogrens
Retroperitoneal fibrosis
Mediastinal fibrosis
Riedels thyroiditis
Orbital pseudotumour

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155
Q

PSC imaging

A

General:
multiple strictures entire tree
cirrhosis, with left lobe atrophy
caudate hypertrophy

US
cirrhosis
irregular ducts
bright portal triads
?GB ca

CT
atrophy involving left
caudate hypertrophy
bile duct dilatations/strictures

MRCP/ERCP
multiple short segment structures
beading intervening
biliary diverticula
mural irregs

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156
Q

PSC complications

A

hepatic osteodystrophy
cholangiocarcinoma
CRC
HCC
GB ca

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157
Q

PSC ddx

A

Cirrhosis
- left lobe usually hypertrophied
- caudate not as large

IgG4 related SC
- older
- more systems
- elevated igg4

Secondary sclerosing
- aids
- other strictures

Cholangiocarcinoma

PBC
- younger women
- high ab titres

Alagille syndrome

Hepatic sarcoid

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158
Q

Secondary sclerosing cholangitis causes

A

Chronic obstruction/recurrent cholangitis

Ischaemic cholangiopathy

Infectious, especially aids

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159
Q

Acute ascending cholangitis causes and imaging

A

E coli
typically obstructive
- choledocholithiasis
- malig
- sclerosing cholangitis
- biliary procedures

Imaging
- duct dilation
- bile duct wall thickenning
- stones

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160
Q

Recurrent pyogenic/oriental cholangiohepatitis is

A

commonly found in SE asia patients characterised by bile duct strictures and dilatation with intraductal pigmented stone formation

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161
Q

Recurrent pyogenic/oriental cholangiohepatitis imaging

A

dilatation and multilevel strictures
intraductal pigmented calculi
regions of segmental atrophy

CT
hyperdense stones
focal fibrosis, heterogenous enhancement and focal steatosis

MR
reduced arborisation of peripheral ducts (arrowhead)
multiple strictures

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162
Q

IgG4 related sclerosing cholangitis is

A

also known as autoimmune and is part of the igG4 spectrum. can also occur in isolation

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163
Q

Cirrhosis is and aetiology

A

common endpoint of chronic liver diseases which cause hepatocellular necrosis

Causes:
- alcohol
- viral
- NASH
- biliary disease (PBC, PSC)
- metabolic (haemochromatosis, wilsons, alpha 1)
- autoimmune
- vascular (congenstive, budd chiari)
- CF

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164
Q

Cirrhosis imaging

A

General
- caudate/left lobe hypertrophy

US
- surface nodules
- coarse/heterogenous
- segmental hypertrophy/atrophy
- enlarged PV
- slow/reversed PV flow
- cavernous malformation
- recanalisation
- collaterals
- portal hepatic vein waveform
- splenomegaly
- ascites
- fatty change

CT
- surface and parenchymal nodularity
- fatty change
- parecnhymal heterogeneity
- PV supply to dysplastic nodules
- lobar hypertrophy/atrophy
- signs of portal hypertension

MR
Regen nodules
- T1 iso or hyper
- T2 iso
- no early enhancement/washout
Siderotic
- T2 hypo
Dysplastic
- can look like regen of hcc
HCC
- arterial enhancement and washout
- late enhancing capsule
- T2 hyper

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165
Q

Cirrhosis ddx

A

Pseudocirrhosis

Miliary liver mets

Budd chiari

Hepatic failure

Sarcoid

PBC

Chronic portal vein thrombosis

Nodular regnerative hyperplasia

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166
Q

Cirrhosis CNS manifestations

A

hepatic encephalopathy

alcohol
- osmotic demyelination
- wernickes
- marchaifava bignami

Wilsons (siderosis)

Haemochromatosis (hypopituitarism and parkinsons)

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167
Q

Cirrhosis MSK manifestations

A

varices

haematomas

infective complications

osteodystrophy

avn

sarcopenia

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168
Q

Cirrhosis pulmonary manifestations

A

Hepatopulm syndrome
- dilation of pulm vasculature

Portopulmonary hypertension (PAH)

hepatic hydrothorax

ARDS

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169
Q

Primary biliary cholangitis is

A

chronic progressive cholestatic liver disease. destruction of small intrahepatic bile ducts, portal inflammation and progressive scarring. AMA high. causes cirrhosis

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170
Q

PBC associations

A

cholelithisis
autoimmune diseases
interstitial lung disease
pulmonary hypertension
hcc

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171
Q

PBC imaging

A

MR
T2
- parenchymal lace like fibrosis and periportal halo sign

periportal halo sign; low signal intensity around portal venous branches

Other
- periportal hyperintensity
- segmental hypertrophy of the caudate
- hepatic surface irregularity

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172
Q

Portal vein thrombosis causes

A

Reduced flow
- cirrhosis
- malignancy

Hypercoagulability
- inherited conditions
- malignancy
- myeloproliferative disorders
- IBD
- dehydration
- OCP
- pregnancy
- trauma

Endothelial disturbance
- local inflammation

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173
Q

Portal vein thrombosis imaging

A

US
- filling defect
- internal flow in tumour thrombus

CT
- dilling defect
- enhancement of the wall (dilated vasa vasorum)
- THAD
- enhancement; tumour
- cavernous transformation in chronic
- bowel ischaemia acute
- portal hypertension

MR
T1
- acute high signal
T2
- acute high signal
- chronic low signal
C+
- may enhance post con in tumour
- THID

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174
Q

Cavernous transformation of the portal vein is

A

sequla of portal vein thrombus. replcement of PV with numerous tortuous venous channels

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175
Q

Cavernous transformation of the portal vein imaging

A

General
- dilated vessels
- left atrophy
- hypertrophy segment 4 and caudate

US
- numerous vessels occupying the portal vein bed

CT
- numerous vascular structures
- calcs in the thrombus

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176
Q

AAST liver injury scale

A

Grade 1
- subcap haematoma <10%
- laceration <1cm

Grade 2
- subcap haematoma 10-50%
- intra haematoma <10cm
- laceration 1-3cm

Grade 3
- subcap haematoma >50%
- intra haematoma >10cm
- laceration >3cm
- vascular injury contained to parenchyma

Grade 4
- laceration 25-75% lobe or 1-3 segments
- vascular injury into peritoneum

Grade 5
- laceration >75%
- vascular; juxtahepatic venous injurie

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177
Q

Multiple hepatic cysts associations

A

VHL
ADPCKD

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178
Q

Hepatic cyst ddx

A

hydatid
abscess
biloma
biliary cystadenoma
choledochal cyst
mets
biliary hamartoma

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179
Q

Peribiliary cysts are

A

seen in chronic liver disease. cystic formation around the biliary ducts, typically hilar. dont communicate with the biliary tree.

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180
Q

Hepatic haemangiomas are

A

benign vascular liver lesions. congenital, non neoplastic and typically cavernous subtype.

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181
Q

Hepatic haemangioma associations

A

extra hepatic haemangiomata

hereditary haemorrhagic telangiectasisa

kasabach merritt syndrome

hepatic arterioportal shunt

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182
Q

Hepatic haemangioma imaging

A

US
- well defined
- hyperechoic
- peripheral feeders

CT
- discontinous nodular peripheral enhancement
- progressive centripedal fill in
- bright dot sign

MR
T1 hypo
T2 hyper
Gad peripheral nodular discontinuous. retain on delayed
Prim variable on delayed
DWI high, with high or mixed ADC

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183
Q

Giant hepatic haemangioma imaging

A

CT
heterogenous, central low attenuation
typical enhancement but less consistent
may never totally fill in

MR
T1
- hypo
- clefts of low
T2
- clefts high
C+
- hypo clefts
- otherwise similar

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184
Q

Hyalinised/sclerosing hepatic haemangiomas are

A

variants of haemangiomas which contain extensive fibrous tissue and thrombosed vascular channels giving an unusual imaging appearance that cant be differentiated from malignancy

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185
Q

Hyalinised/sclerosing hepatic haemangioma imaging

A

MR
T1
- hypo
T2
- variable, typically lower than a regular
C+
- absent or mild arterial
- slight peripheral late
- usually a thin peripheral rim

Can have some retraction and THID

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186
Q

Flash filling hepatic haemangiomas are

A

atypical haemangiomas, benign, with imaging features that can be suspcious for malignancy

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187
Q

Flash filling hepatic haemangioma imaging

A

Small

US
hyper

CT
intense homogenous arterial enhancement
isodense on delayed
can have phleboliths

MR
T1 hypo
T2 hyper
C+ enhancement no washout

ddx
- hcc
- hypervascular met
- fnh

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188
Q

Focal nodular hyperplasia is

A

a regenerative mass of the liver, second most common benign liver lesion. thought due to hyperplastic growth of normal hepatocytes with malformed biliary drainage

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189
Q

FNH associations

A

Hepatic haemangioma
HHT
AVM
Hepatic adenoma
PV atresia
Budd chiari
Portal hypertension

190
Q

FNH types

A

Typical and atypical

Typical
- poorly encapsulated
- central scar with radiating fibrous septa
- large central artery
- absent portal veins

Atypical
- lacks a central scar and central artery
- pseudocapsule
- lesion heterogeneity
- non enhnacing central scar
- intralesional fat

191
Q

FNH imaging

A

US
- variable

CT
- bright homogenous arterial
- non enhancing central scar
- hypo to iso attenuaitng on portal venous
- no fat, calc, haemorrhage
- delayed scar enhancement 80%

MR
T1
- iso to hypo
- hypo scar
T2
- iso to hyper
- hyperintense scar
Gad
- intense arterial enhancement
- iso on portal venous
- central scar enhancement on delayed
Prim
- early arterial enhancement
- enhancement persists on delayed
- fades on delayed
- central scar does not enhance on hepatobiliary

192
Q

FNH nuclear medicine

A

Sulfar colloid
- taken up by kuppfer cells of reticuloendothelial system
- photopaenic 30%

HIDA
- should be taken up in about 90%

193
Q

FNH DDX

A

Adenoma
- more heterogenous on portal and delayed
- no gad retention on delayed
- assoc wth fat/calc/haemorrhage
- inflammatory type looks similar on Prim
- no scar

HCC
- cirrhosis
- washout
- capsule

Fibrolamellar
- more distinct on T1/T2
- larger
- calcification, necrosis
- mets, local invasion
- decreased activity on HIDA/sulphur

Hypervascular mets
- multiple
- washout on PV/Delayed
- older

Haemangioma
- peripheral discontinuous
- flash filling can look similar

Cholangio
- hypo in art/venous with delayed enhancement
- dominant large central scar
- capsular retraction

194
Q

Multiple focal nodular hyperplasia syndrome is

A

two or more FNH’s with
- haemangioma or
- vascular malformation or
- intracranial tumour

Assoc
- meningiomas
- astrocytoms
- liver haemangiomata
- phaes, gist
- klipper trenauanay weber

195
Q

Hepatic adenomas are

A

benign hormone induced liver tumours. typically solitary, predilection from haemorrhage

196
Q

Hepatic adenoma associations

A

OCP
Anabolic steroids
Glycogen storage disease
Obesity
Metabolic syndrome
Diabetes mellitus

197
Q

Hepatic adenoma pathology/types

A

Usually solitary and large
Typically subcapsular and commonly right lobe
Can have dystrophic calcs

Classification
1. inflammatory
- most common
- highest bleed rate
2. HNF1 alpha mutated
- women, OCP
- often multiple
3. Beta catenin mutated
- men on steroids
- glycogen storage diosrders of FAP
4. unclassified

198
Q

Hepatic adenoma imaging

A

US
variable echogenicity
hypoechoic halo seen

CT
variable depending on fat and hamorrhage
well marginated
iso to liver
transient relatively homogenous arterial
iso dense on PV and delayed
calcs can be seen from old haemorrhage

MR
T1
- variable
T2
- mildly hyper
IP/OP
- signal drop due to fat
Gad
- early arterial enhancement
- iso on delayed
Prim
- usually hypointense on hepatobiliary phase due to redcued uptake

NM
photopaenic on sulphur colloid 75%
increased on HIDA
cold on gallium

199
Q

Hepatic adenoma ddx

A

HCC
- washout
- rim enhancement persists on delayed

FLHCCC
- central scar
- calcs more common

FNH
- t2 bright scar with late enhancement
- retains primovist

Mets
- hypo on T1, moderately hyper t2
- fat and haemorrhage less common

Haemangioma

200
Q

Hepatic adenomatosis is

A

loads (>10) of hepatic adenomas.

201
Q

Inflammatory hepatic adenoma is and imaging

A

most common
OCP
metabolic syndrome
highest rate of haemorrhage

MR
Prim
- enhancement on hepatobiliary agent, due to OATP receptors
- similar to FNH
IP/OOP
- no signal drop
T2
hyper
atoll sign

202
Q

HNF1 alpha is and imaging

A

second most common
only women on OCP
multiple 50%

MR
Gad
- Moderate arterial, less than inflammatory
- less likely to have persistent PV/delayed enhancement
T2
iso to mildly hyper
IP/OP
signal drop

203
Q

Beta catenin is and imaging

A

adenoma. men. male hormon. glycogen storage. FAP.

imaging overlaps with the others

204
Q

HCC risk factors

A

viral hepatitis
alcohol
biliary cholangitis
congenital biliary atresia
errors of metabolism
- haemochromatosis
- alpha 1 antitrypsin
- type 1 glyco stroage
- wilsons
obesity and DM

205
Q

HCC types and general imaging

A

Massive/focal
- large mass
- necrosis, fat, calcs

Nodular
- multifocal
- central necrosis

Infiltrative
- diffuse
- can be hard to distinguish from cirrhosis

supply from hepatic artery - early enhancement and washout

can have a central scar

rim enhancement on delayed post con causing a capsule appearance

propensity to invade vascular structures

206
Q

HCC CT features

A

vivid arterial
washous out rapidly
can have assocaited wedge shaped perfusion abnormality due to arterioportal shunts
focal fatty sparing halo
portal vein thrombus

207
Q

HCC MR features

A

T1
- variable
- iso to hypo
- hyper from fat or decreased background

T2
- variable

Gad
- arterial enhancement
- washout
- persistent rim enhancement

Prim
- arterial with PV washout

DWI
- high

208
Q

HCC ddx

A

hypervascular mets
- less common in cirrhotics
- less vascular invasion

FNH
- no vascular invasion
- non enhnacing halo
- central scar
- prim persists on delayed
- sulphur colloid 80% positive

Cholangio
- peripehral
- bilairy obstruction
- delayed enhancement

THADS

Lymphoma

TB

209
Q

LIRADS major and ancillary features

A

Major
- non rim arterial hyperenhancement
- non peripheral washout
- enhancing capsule/pseudocapsule
- threshold growth >50% <6months, >100% >6 months, new >1cm <24months

Ancillary
Favouring malignancy not HCC in particular:
- US visibility
- subthreshold growth
- corona enhancement
- fat sparing in a solid mass
- restriction
- mild to moderate T2 hyper
- iron sparing in a solid mass
- transitional phase hypo
- hepatobilairy phase hypo

Favouring HCC in particular
- non enhancing capsule
- nodule in nodule
- mosaic architecture
- fat in mass
- blood in mass

Favouring benign
- stable size >2years
- size reduction
- marked T2 hyper homogenous
- undistorted vessels
- parallels blood pool
- hepatobiliary isointensity

210
Q

Fat containing liver lesions

A

Benign
- focal fat
- adenoma
- fnh (rare)
- angiomyolipoma
- teratoma
- adrenal rest tumour
- glisson capsule pseudolpoma

Malignant
- HCC
- met liposarc
- primary liposarc
- other fat containing liver mets

211
Q

Fibrolamellar hcc is

A

a histoligcal variant of HCC with laminated fibrous layers between the tumour cells. typically younger adults, no cirrhosis/hepatitis

212
Q

Fibrolamellar HCC imaging

A

US
variable

CT
Single, large
Fibrous central scar
Arterial enhancement
Central scar persistent enhancement
Can have calc

MR
Scar hypo on all sequences
Scar can occassionally be T2 bright
T1 iso to hypo
T2 hypo to hyper
Gad
- arterial heterogenous
- PV/delayed; iso to hypo, delayed scar enhancement
Prim
- uptake not reported

Sulphur colloid
- wont take up tracer

213
Q

Barcelona clinic liver cancer staging (HCC)

A

Uses performance status, Child Pugh score and radiologic extent

Stage 0
- PS 0
- CP A
- Solitary <2cm

Stage A
- PS 0-2
- CP A-C
- Solitary >2cm or
- Multiple <3cm

Stage B
- PS 0
- CP A-C
- Multifocal >3 lesions or
- Multifocal with one >3cm

Stage C
- PS 1-2
- CP A-C
- Vascular invasion and/or nodal and/or mets

Stage D
- PS >2
- CP C
- No radiology

214
Q

Cholangiocarcinoma is

A

malignant epithelial tumour arising from the biliary tree excluding GB or AoV

215
Q

Cholangiocarcinoma RF

A

Carolis
Choledocholithiasis
PSC
Oriental cholangitis
Cirrhosis
Toxins
Hepatitis, HIV
IBD
Fibropolycystic liver disease

216
Q

Cholangiocarcinoma types

A

Intrahepatic
Extrahepatic
- perihilar (incl Klatskin)
- distal (to cystic insertion)

Macroscopic appearance
- Mass forming
- Periductal infiltrating
- Intraductal growth

Mass forming
- intrahepatic
- peripheral
- central fibrosis

Periductal infiltrating
- most common at hilum
- combo with mass forming seen
- longitudinal growth along wall

Intraductal
- papilla or tumour thrombus endophytic
- alterations in calibre
- can be mural/polypoid
- mucin prodn

217
Q

Mass forming cholangiocarcinoma imaging

A

US
- homogenous
- intermediate echos
- peripheral hypoechoic halo
- capsular retraction

CT
- homogenously low on NC
- heterogenous minor peripheral enhancement
- gradual centripedal fill in
- capsular retraction
- distal duct dilation
- vascular compression wo invasion

MR
Similar to CT
DWI Target sign
Prim
- can reflect differention
- hypo; poor
- rim; intermediate
- diffuse; well diff

218
Q

Periductal infiltrating cholangiocarcinoma imaging

A

US
- altered bile ducts without a clear mass

CT
- regions of duct wall thickening or of the periductal parenchyma with altered calibre of the involved duct
- common at the hilum
- longer than benign strictures
- contrast enhancement
- proximal/peripheral dilation

219
Q

Intraductal cholangiocarcinoma imaging

A

US
- alterations in calibre
- can have a polypoid intraluminal mass

CT
- alterations in calibre
- enhancing polypoid mass

220
Q

Cholangiocarcinoma ddx (by type)

A

Mass forming
- mets
- HCC
- other primary liver tumours
- abscess

Periductal
- benign stricture

Intraductal cholangiocarcinoma
- intraductal HCC invasion
- hepatolithiasis
- biliary cystadenoma or cystadnocarcinoma
- benign stricture

221
Q

Bismuth Corlette classification is

A

for perihilar cholangiocarcinomas based on extent of ductal infiltration

type 1
- CHD below confluence

type 2
- involves confluence

type 3a
- 2 with right duct origin involvement

type 3b
- 2 with left duct origin involvement

type 4
- 3a + 3b

type 5
- CBD/cystic junction

222
Q

Intrahepatic cholangio staging

A

T1
a; <5cm no vascular
b; >5cm no vascular

T2
- solitary with intrahepatic vascula
- multiple +/- vascular

T3
- visceral peritoneum

T4
- local extrahepatic structure invasion

223
Q

Perihilar cholangio staging

A

T1
confined to duct

T2
a; beyond duct into fat
b; beyond duct into liver

T3
branches of portal vein or hepatic artery invovlement

T4
invades PV or bilateral branches or
unilateral second order radicals with contralateral PV/HA invovlement

224
Q

Distal cholangio staging

A

T1
wall invasion <5mm

T2
wall invasion 5-12mm

T3
wall invasion >12mm

T4
involves coeliac, SM or CH artery

225
Q

Fibropolycystic liver disease includes

A

congenital hepatic fibrosis
ADPCKD
biliary hamartomas
carolis disease
choledochal cysts

226
Q

Multiple biliary hamartomas are

A

also known as von meyenberg complexes. multiple benign biliary hamartomas. assocaited with dom/recess polycystic kidney and liver disease.

227
Q

Multiple biliary hamartomas imaging

A

US
variable
echogenic when small
hypoechoic when larger

ct
no enhancement
5-30mm
predilection for subcapsular liver

MR
T1 hypo
T2 hyper
C+ non enhancing

228
Q

Caroli disease is

A

a congenital disorder of multifocal cystic dilation of the segmental intrahepatic ducts

also a type 5 todani choledochal cyst

associated with hepatic fibrosis, medullary sponge kidneyy, polycystic kidney disease

229
Q

Caroli disease imaging

A

US
may show dilated ducts
intraductal bridging septa
dilated ducts surrounding portal vein branch
calculi

CT
multiple hypodense rounded foci
inseparable from dilated intrahepatic ducts
central enhancing dot represent portal vein radicles

MR
T1 hypo
T2 hyper
C+ central portal radicle enhancment
MRCP continuity with ducts

230
Q

Todani classification

A

Type 1
A: entire extrahepatic duct
B: focal extrahepatic duct
C: CBD portion extrahepatic duct

Type 2
True diverticulum

Type 3
Within duodenal wall, choledochocoele

Type 4
A: Intra and extra hepatic ducts
B: Multiple of the extra hepatic ducts

Type 5
Multiple intrahepatic ducts

Type 6
Cystic duct

231
Q

Choledochal cyst is, associations and complications

A

Congenital cystic dilatations of the biliary tree

Assoc
- biliary atresia
- hepatic fibrosis (5)
- Anomalous pancreaticobiliary ductal junction

Complications
- Stones
- Cholangiocarcinoma
- Perforation

232
Q

Hepatic hydatid imaging

A

XR
curvilinear/ring calc overlying the liver

US
sepated with daugther cysts and echogenic material
souble echogenic shadow

CT
cyst
peripheral calcs
Septa and daughter cysts
watter lilly sign, detached endocyst
variable attenuation

MR
T1 mixed low
T2 mixed high
C+ walls and septa enhance

233
Q

Double target sign seen in

A

hepatic abscess

234
Q

Sinusoidal obstruction syndrome/hepatic veno occlusive disease is

A

a condition arising from obstruction of heaptic venules

sloughing of endothelial vells empbolise venules cause fibrosis

assoc with BMT, chemo, jamaican bush tea

235
Q

Sinusoidal obstruction syndrome/hepatic veno occlusive disease imaging

A

US
hepatomegaly
portal vein dilation/pulsatility
hepatofugal flow
elevated HA RI
GB wall thicekning
ascites

CT
hepatomegaly
nutmeg liver
portal vein dilation
ascites

236
Q

Budd chiari syndrome is

A

occurs with partial or complete hepatic vein obstruction

237
Q

Budd chiari causes

A

Idiopathic

Congenital
- web
- interrupted diaphragm

Venous thrombosis

Injury/inflammation
- BMT/Chemo
- autoimmune disease
- behcets
- tumour invasion
- IVC leiomyosarcoma

238
Q

Budd chiari imaging

A

US
hepatosplenomegaly
heterogenous echotexture
hypertrophy caudate
regen nodules
GB wall thickening
ascites

Dopler
lack of flow
reversed flow
collaterals
thrombus
HP RI increase

CT
early enhancement of the caudate and central liver
delayed peripheral enhancement (flip flop)
nutmeg liver
hepatic vein non idendification
caudate enlargement

239
Q

Gallbladder adenomyomatosis imaging

A

focal, segmental or diffuse

US
comet tail
mural thickening

CT
rosary sign
thickening

MR
thickening
pearl necklace sign

240
Q

Gallbladder polyp types

A

Benign
- cholesterol
- inflammatory

Neoplastic
- papilary neoplasms
- pyloric gland adenomas

Malignant
- adenocarcinoma ++
- mets, scc, angiosarc

241
Q

GB polyp malignant features

A

> 10mm
Sessile morphology
Solitary
Growth
Hyperenhancement

242
Q

Gallbladder carcinoma is

A

a type of gb cancer, referring to primary epthelial malignancies. vast majority are adeno, can be squamous.

risk factors
- chronic cholecystitis
- stones
- fap
- IBD
- polyps
- porcelin gb
- PSC

243
Q

Hepatoblastoma associations

A

Beckwith wiedemann syndrome
Hemihypertrophy
FAP
FAS
Prematurity
Gardner
Glycogen storage disease
Biliary atresia

244
Q

Hepatoblastoma imaging

A

XR
Right upper quadrant mass
calcs

CT
heterogenous
hypoattenuating
necrosis and haemorrhage
chunky dense calcs

MR
T1 hypo
C+ hjetero
T2 heterogenously hyper

245
Q

Hepatic mesenchymal hamartoma is

A

an uncommon benign hepatic lesion, children <2
admixture of ductal structures within loose stroma
typically low afp

246
Q

Hepatic mesenchymal hamartoma imaging

A

disorganised solid cystic lesion with septations

XR
non calc mass

CT
heterogenous
swiss cheese
solid/septal enhancement

MR
cystic
unifocal

247
Q

Infantile hepatic haemangiomas are

A

liver lesiosn with large endothelial lined vascular channels
can present with CCF, hydrops, kasabach merrit
3% have high afp
asspc with other haemangiomas

248
Q

Infantile hepatic haemangioma imaging

A

XR
hepatomegaly
15% calcs

US
variable
vascular channels

CT
peripheral enahncement with fill in
mid aortic calibre change
coeliac and hepatic artery large

MR
T1 hypo
T2 hyper
flow voids
similar enhancement to CT

249
Q

Undifferentiated embryonal sarcoma of the liver is

A

a rare aggressive malignant liver tumour. paeds 6-10. afp not elevated

250
Q

Undifferentiated embryonal sarcoma of the liver imaging

A

right lobe
under 15yo
necrotic/cystic
normal afp

XR
non calc
large

US variable

CT
hypodense
solid elements
multiople hyperdense septa
heterogenous enhancement
rim enhancing pseudocapsule

MR
T1 hypo
T2 hyper
C+ hetero
areas of haemorrhage
pseudocapsule

251
Q

Post transplant liver evaluation

A

normal
- perihepatic haematoma
- right sided effusion
- minimal ascites
- periportal oedema

Complications
- rejection
- arterial thrombus
- hepatic abscess
- biliary ischaemia/stricture
- pseudoaneurysm
- venous thrombus
- bile leak/obstruction
- PTLD
- biliary cast syndrome

252
Q

Milan criteria is

A

suitability for liver transplant in cirrhosis and HCC

single tumour <5cm or up to 3 tumours <3cm
no extra hepatic
no major vessel involvemnt

253
Q

TIPS is

A

a transjugular intrahepatyic portosystemic shunt, a treatement for protal hypertension in which direct communication is formed between a hepatic vein and a branch of the portal vein to allow flow to bypass the liver

254
Q

AIDS cholangiopathy is

A

a secondary opportunistic cholangitis that occurs in aids patients from immunosuppression. can look like PSC

255
Q

Hepatic schistosomiasis is and imaging

A

chronic result of egg deposition into small portal venules leading to periportal fibrosis and cirrhosis

US
Common
- irregular contour
- mosaic pattern
- septal fibrosis
- spleomegaly/GG bodies
S Japonicum
- septa and capsular calc
S Mansoni
portal vein wall thickening, Bulls eye appearance

CT
common
- irregular contour
- splenomegaly and GG bodies
S Japonicum
- turtle back sign
- capsular calcification
- periportal fat deep into liver
S Mansoni
- low attenuation surrounding portal vein branches assocaited with marked contrast enhancement

256
Q

Idiopathic noncirrhotic portal hypertension/portosinusoidal vascular disease is

A

clinical diagnosis of portal hypertension without cirrhosis, vascular obstruction, schisto, metabolic or other chronic liver disease

257
Q

Nodular regenerative hyperplasia is

A

a histopath entity chracterised by transformation of normal hepatic parenchyma into small nodules of hyperplastic hepatocytes without intervening fibrosis. falls in the spectrum of porto-sinusoidal vascular disease, one of the morphological lesions seen with idiopathic non cirrhotic portal hypertension

258
Q

Hepatic peliosis is

A

a rare benign vascular condition characterised by dilatation of sinusoidal blood filled spaces in the liver. can also happen in spleen and bone marrow.

Appearance is variable, with multiple lesions and variable enhancement pattern.

Can be globular centrifugal, centripedal. usually continuous unlike haemangioma.

259
Q

HELLP syndrome is

A

a pregnancy related condition with haemolysis, elevated liver enzymes and low platelets

imaging
- hepatomegaly
- haemorrhage
- hepatic infarct

260
Q

Wilsons disease hepatobiliary manifestationss

A

Depends on severity
- fatty change
- hepatitis
- cirrhosis
- hepatic necrosis

CT
- hepatic attenuation can be increased
- cirrhosis with multiple nodular lesions and perihepatic fat layer and normal caudate

MR
- NOT ferromagnetic
- cirrhotic change

261
Q

Hepatic angiosarcoma is

A

rare. third most common liver primary. variable appearance on CT and MR. heterogenous with haemorrhage typically.

262
Q

Hepatic inflammatory pseudotumour is

A

a rare benign hepatic lesion. associated with oriental cholangitis. Variable and heterogenous on imaging.

263
Q

Hepatic lipoma is and imaging

A

an uncommon benign lesion of the liver. Assocaited with renal AML and TS.

well circumscribed, macroscopic fat

US
hyper
“discontinuous diaphragm” from artefact

CT
homogenous fat

MR
T1/2 high with suppression
marginal india ink

264
Q

Hepatic AML is

A

an uncommon benign hamartomatous hepatic lesion. bloo, muscle and fat components. associated with TS.

265
Q

Hepatic AML imaging

A

fat and prominent vasculairty

CT
heterogenous with macro fat
arterial enhancement
hypo on PV

MR
T1 hyper
T2 hyper
Suppression
in/out of phase for smaller fat
vascular part hyper enhancement

266
Q

Hepatic epithelioid haemangioendothelioma is and imaging

A

rare low to intermediate grade neoplasm

multiple solid tumour nodulars, coalesce

CT
multiple nodules with congolmerate confluent perigion
peripheral or subcapsular distribution
halo or target enhancement of larger
can have capsular retraction
vessels terminate at edge “lollipop sign”

MR
T1 hypo
T2 heterogenous increased
C+ peripheral halo or target type enhacnement

267
Q

Renal agenesis is

A

congenital absence of one or both kidneys. if bilateral Potter syndrome. failure of meta nephros indevelopment

268
Q

Renal agenesis associations

A

trisomies
turners

mullerian anomalies
CHD
skeletal anormalies
potter sequence
vacterl

269
Q

Renal agenesis imaging

A

absent kidney and renal artery
contralteral hypertrophy
lying down adrenal

270
Q

Horseshoe kidney is

A

the most common renal fusion anomaly. typically between lower poles but can be lower and upper (sigmoid). isthmus gets caught on the IMA

271
Q

Crossed fused renal ectopia is

A

where the kidneys are fused and located on the same side

272
Q

Crossed fused renal ectopia types and imaging

A

types
- inferior
- sigmois
- lump
- disc
- L shaped
- superior

imaging
- anteiror or posterior notch

273
Q

PUJ obstruction types

A

Congenital
- idiopathic
- abnromal muscle arrangement
- collagen collar
- extrinsic compression
- crossing vessel

Adult
- trauma
- calculus
- scarring
- malignancy
- extrsinc compression

274
Q

PUJ obstruction imaging

A

US
dilated pelvis with collapsed ureter

CT
same

MAG3
- with diuretic
- high extraction rate
- evaluation between obstructive and non obstructive
- non obstructive; excretion, downsloping
- obstructive; no excretion, no downsloping

DTPA
- predominantly glomerular filtration

275
Q

PUJO ddx

A

congenital megacaliectasis
- central renal pelvis relatively collapsed

extrarenal pelvis
- no calyceal distention

parapelvic cyst

276
Q

MCDK is

A

a non heritable paediatric cystic renal disease. multiple cysts formed in utero. bilateral is fatal

can be pelvi infundibular (multiple small cysts) or hydroneprhotic obstructive (domiannt cyst in pelvis)

277
Q

MCDK associations

A

VUR
PUJO
ureteral ectopia
VUJO
urterocoele

Meckel gruber
Zellweger syndrome
Joubert syndrome related disorders

278
Q

Meckel gruber

A

encephalocoele/holoprosencephaly
cystic kdineys
postaxial polydactyl

279
Q

MCDK imaging

A

multiple cysts or varying sizes
parenchyma fibrous/echogenic

280
Q

Acute tubular necrosis is

A

acute kidney injury with renal tubular damange. deposition of depbris in the tubules results in oliguria.

On imaging, there is perfusion without excretion NM in transplant assessment to differentiate from renal cortical necrosis. can cause persistent or striated neprhogram on CT.

281
Q

Acute tubular necrosis causes

A

hypovolaemia/ischaemia
- dehydration
- blood loss
- septic shock

drugs
- amphtericin
- contrast
- cisplatin and other chemo
- immunosuppressants
- antivirals

282
Q

Persistent nephrogram causes

A

Hypotension

Bilateral intrarenal obstruction
- ATN
- acute urate uropathy

Vascular
- renal artery stenosis
- renal vein thrombosis

Other
- myeloma kidney
- contrast nephropathy

283
Q

Striated nephrogram causes

A

contrast stuck in oedematous or necrosed tubules

Unillateral
- ureteric obstruction
- acute pyelo
- renal vein thrombosis
- renal contusion
- radiation

Bilateral
- ARPCKD
- acute pyelo
- ATN
- hypotension

284
Q

Spotted nephrogram

A

segmental or subsegmental corticomedullary hypoattenuation
secondary to multiplem small vessel infracts
vasculitis, embolic disease

285
Q

Rim nephrogram

A

enhancing cortex, absent medullary
seen weeks following global infarction, due to collaterals

286
Q

Reverse rim nephrogram

A

absent cortical, normal medullary enhancement
indicates acute cortical necrosis

287
Q

Cortical rim sign

A

Thin subcapsular cortex enhancement. Differentiates pyelo from renal infarct.

Renal artery/vein thrombosis
ATN
Acute cortical necrosis

288
Q

Renal cortical necrosis is

A

a result of severe systemic illness and can cause permanent impairment

severe shock
microangiopathic haemolysis (HUS)
renal transplant

289
Q

Renal cortical necrosis imaging

A

CT
non enhancing cortex and enhancing medulla (reverse rim)
may have cortical rim sign
eventually cortical nephrocalcinosis

MR
low T1/T2 affective inner cortex

290
Q

Low intensity renal parenchyma causes

A

haemolysis
infection
vascular disease
- vein
- cortical necrosis
- arterial
- rejection of t/p

291
Q

Renal papillary necrosis is and causes

A

ischaemic necrosis of the renal papillae and medullary pyramids. sloughing off of papillary tissue.

NSAID
Non steroidals
Sickle cell
Acetaminophen (paracetamol) and phencetin
Infection
Diabetes or dehydration

292
Q

Renal papillary necrosis imaging

A

filling defects in the collecting system
- ball on tee
- lobster claw sign
- signet ring

293
Q

AAST kidney injury scale

A

Grade 1
- subcap haematoma or contusion

Grade 2
- Superficial laceration <1cm, no collecting
- perirenal haematoma confined to fascia

Grade 3
- lac >1cm, no collecting system
- vascular injury/bleeding, confined to fascia

Grade 4
- lacerating involving collecting system
- lacteration of the renal pelvis
- vascular injury to segmental artery or vein
- segmental infarcts without assoc bleeding
- active bleeding beyond perirenal fascia

Grade 5
- shattered
- avulsion or renal hilum, lac main renal artery or vein
- devascularised with active bleeding

294
Q

Urolithiasis RFs

A

dehydration

malformations

UTIs

cystinuria

hypercalcuria
- pth
- sodium
- hyper vit d
- cushing
- sarcoid
- milk alkali

hyperoxaluria
- low absorption/intake calc

hypocitraturia
- rta, diarrhea

hyperuricosuria
- gout
- myeloprolif
- idioapthic

295
Q

Urolithiasis types

A

Calcium oxalate
Struvite
Calcium phophate
Uric acid
Cystine
Lithogenic medications

296
Q

Urolithiasis imaging

A

Opaque
- calcium
- struvite
- cystine

Lucent
- uric acid
- medication

US
lower sens
echogenic
acoustic shadowing
twinkle artifact
colour comet tail artefact
slower jets
elevated RI

CT
opaque/non opaque. opaque can varyy in density
99% opaque
dual energy to chekc comp

297
Q

Urolithiasis treatment

A

Surgical indications
- larger
- long duration sx
- proximal location
- trucks/pilots
- infection
- solitary kidney

Intervention types
- retrograde stent and laser
- PCN with antegrade stent and laser
- ESWL for larger
PCNL for large near junction like staghorn

Calcium
- ESWL
- perc nephrostomy

Struvite
- need to be surgical, residual can harbour infection

Uric acid
- elevation of ph

Cystine
- alkalisation

298
Q

Medullary nephrocalcinosis causes

A

HAM HOP

Hyper pth
Acidosis, renal tubular
Medullary sponge
Hypercalcaemia
Oxalosis
Papillary necrosis

299
Q

Cortical nephrocalcinosis

A

COAG

Cortical necrosis
Oxalosis
Alport syndrome
Glomerulonephritis

300
Q

ADPCKD is

A

a hereditary form of adult polycystic kidney disease. associated with aneurysms, hypertension, biliary hamartomoas, other visceral cysts.

PKD 1 and PKD 2 genes, GANAB gene

301
Q

ADPCKD DDX

A

VHL

ARPKD
- enlarged kidneys
- smaller cysts
- present in childhood
- CM diff lost

Acquired cystic kidney disease
- occurs in dialysis

Medullary cystic
- at medulla cortex junction

MCDK
- can be unilateral, younger

302
Q

ARPCKD is

A

a paediatric cystic renal disease. liver involvement, proportional to age of onset with hepatic firbosis. associated with carolis and biliary hamartomos.

303
Q

RCC associations

A

VHL (bilateral, younger, clear cell)

TS (younger)

Birt Hogg Dube (chromophobe, bilateral)

Paraneoplastic syndromes
- hypercalcaemia
- hypertension
- polycythaemia
- stauffer (LFT)
- limbic encephalitis

304
Q

RCC types

A

Clear cell/conventional
- prox convulted tubules
- clear cytoplasm
- vascular
- clear cell multilocular rcc variant

Papillary
- distal convoluted tubules
- can be multifocal and bilateral
- type 1; sporadic, good prog
- type 2; inhertid, bilateral, multifocal

Clear cell papillary

Chromophobe
- intercalated cells of collecting ducts
- similar to oncocytomas

Collecting duct

Renal medullary
- sickle cell

Sarcomatoid
- advanced, can de diff

305
Q

RCC imaging

A

CT
- soft tissue
- necrosis/calcs
- enhance, variably
- also hypervascular or canonball mets

MR
T1 heterogenous
T2
- clear; hyper
- papillary; hypo
C+ arterial enhancement
Pseudocapsule
- lower grade, adenomas or oncocytomas

Macroscopic fat in RCC almost always occurs in the presence of ossification/calcification

I/OOP loss suggests microscopic fat, common in clear cell carcinomas

306
Q

Clear cell RCC imaging

A

CT
- exophytic
- more enhancing
- more heterogenosu

MR
T1 heterogenous
T2 hyperintense
I/OP; microscopic fat

307
Q

Multilocular cystic renal neoplasm of low malignant potential is

A

a low grade adult renal tumour composed entirely of numerous cysts

308
Q

Papillary RCC imaging

A

Tend to be smaller

CT
less vascular thna clear cell, hypo compared to normal cortex in CM phase

MR
pseudocapsule
T1 hypo
T2 hypo
C+ less entence
DWI restriction

309
Q

Chromophobe RCC imaging

A

associated with BHD

CT
homogenous
can be spoke wheel like oncocytoma

MR
T2 iso to hypo
homogenous enhancement
uncommon to have necrosis

310
Q

TCC is

A

the most common primary tumour of the urinary tract and can be found along its entire length.

associated with horseshoe, calculi, pseudodiverticulosis and ureteritis cystica

can be papillary or non papillary.

311
Q

TCC pelvis imaging

A

US
hypoechoic

CT
soft tissue
minimally enhancing
can be small filling defects or invasive/obliterating
can be more infiltrative
disotrtion of calyces
can have a dappled/stippled appearance

312
Q

TCC ureter imaging

A

can obstruct when small
filling dfect with goblet sign transition
can be circumfrentially invasive

313
Q

TCC bladder

A

most common type, can be superfical or invasive

CT
focal thickening or masses protruding inward
can have calcs

314
Q

Nephroblastomatosis is

A

diffuse or multifocal invovlement of the kidneys with nephrogenic rests. foci of metanephric blastema that persist beyond 36 weeks gestation.

315
Q

Nephroblastomosis imaging

A

US
hypoechoic nodules
reniform enlargement with thick peripheral rind
diffuse decrteased echoes

CT
low attenuation peripheral nodules with poor enhancement

MR
T1 low
T2 low
C+ hypo

316
Q

Nephrotic syndrome is

A

loss of plasma proteins in the urine. hypoalbumiaemia, hyperalbuminuria, hyperlipidaemia and oedema. can be congenital or acquired. why am i writing this flashcard fuck everything

317
Q

Renal AVM AVF

A

AVM - has a vascular nidus. typical congenital and rare. usually osler weber rendu or somethign

AVF - no nidus, usually acquired/iatrogenic

318
Q

Renal artery stenosis is and pathology

A

narrowing of the renal artery , secondary htn

juxtaglomerular apparetus senses low flow as low pressure and secretes renin. vasoconstriction and aldosterone causing retension and htn.

319
Q

renal artery stenosis causes

A

atherosclerosis
FMD
vasculitides
NF1
coarctation
dissection
segmental arterial mediolysis

320
Q

Renal artery stenosis imaging

A

PSV > 180
increased renal aortic ratio RAR >3
turbulent dlow
pulsus parvus et tardus (slow rising)
decreased RI in severe <0.55

321
Q

Fibromuscular dysplasia is

A

a heterogenous group of vascular lesions characterised by idiopathic non inflamm non atherosclerotic angiopathy of small and medium sized arteries

causes small stenoses with intervening areas of dilatation :string of beads”.

most commonly affects the renal arteryes, cervicalencephalic arteries, iliac artereis, coeliac trunk and mesenteric, subclavian and axillary

322
Q

Renal artery aneurysm causes

A

FMD
ddegenerative
vasculitidies, incl behcets
TS, NF
intrinsic collagen def, ED, Marfans
trauma

323
Q

Renal vein thrombosis causes

A

Children
- dehydration/sepsis
- sickle cell
- polycythemia
- UVC

Adults
- nephrotic syndrome
- SLE
- amyloid
- glomerulonephritis
- collagen vasc disease
- dm
- sepsis
- tumour thrombus

324
Q

Medullary sponge kidney is

A

a sporadic condition where the medullary and papillary portions of the collecting ducts are dysplastic and dilated and in most cases develop medullary nephrocalcinosis

assoc with ED, hemihypertrohy and carolis

325
Q

Medullary sponge kidney imaging

A

clusters of pyramidal medullary calcification
delayed post con - paintbrush appearance to the renal medullary regions

326
Q

Medullary sponge kidney ddx

A

Medullary calcifications
- hyper pth
- RTA type 1
- hypervit D
- milk alkali syndrome

White pyramid sign

327
Q

Autosomal recessive polycystic kidney disease is, and types

A

paediatric cystic renal disease

presents with enlarged echogenic kidneys with multiple small cysts. liver involvement with coarse echoes, biliary tract cysts, portal htn and hepatic fibrosis

perinatal type
- minimal fibrosis
- oligohydram and pulm hypoplasia

neonatal

infantile

juvenile
- gross fibrosis

328
Q

Cystic nephroma imaging

A

US
multilocular cystic mass from kidney
septal vasc

CT
multilocular cystic mass
variable septal enhancement
no nodular or solid enhancement
can have perinephric stranding

MR
T1 variable
T2 hyper
C+ septal enhancement

DDX
multilocular cystic renal neoplasm of low malignant potential

329
Q

Cystic nephroma is

A

a rare benign renal neoplasm occuring in adult femules

distinct from paediatric cystic nephromas which have dicer 1

330
Q

Cystic nephroma imaging

A

multilocular cystic encapsulated mass

US
septal vasc
variable echo, usually anechoic

CT
multilocular cystic mass
herniates to pelivs
variable septal enhancement
no nodular or solid enhancement

MR
T1 variable
T2 hyper
Septal enahncemnt

331
Q

ARPCKD ddx

A

ADPKD
Beckwith Wiedemann
Laurence Moon Beidl
Meckel gruber

332
Q

Bosniak classification

A

Class 1 - being simple
- hairline wall <2mm
- no septa, calc, solid
- water density
- no enhancemnt

Class 2 - minimally complex
- few hairline septa or calcs <1mm
- perceived enhancement
- high attenuation <3cm
- well marginated

Class 2F - Minimally complex
- multiple hairline thin septa or minimall thickened walls
- perceived but no measurable enhancement
- calcs, can be thick and nodular
- high attenuation lesion totrally intraintranl >3cm no enhancement
- follow up in reasonable timeframe

Class 3 - indeterminate
- thickened irregular, or smooth walls, or septa with enhancement
- 55% malignant

Class 4 - clearly malignant
- 3 + enhancing soft tissue components to but independant of wall/septum

333
Q

Renal AML is

A

a type of benign renal neoplasm encountered sporadicially as well as TS. PEComa with vascular, muscle and fat elements. Can haemmorhage. Macroscopic fat is cornerstone of imaging but can be fat poor.

334
Q

Renal AMLs are

A

benign renal neoplasm. can be sporadic or related to phakomatosis (TS usually, can be in VHL or NF1). considered a perivascular epithelioid cellular differention tumour (PEComa) and are composed of vascular, muscle and fat elements. Can haemorrhage.

335
Q

Mesoblastic nephroma imaging

A

US
variable
can have polyhydramnios

CT
solid hypoattenuating with variable enhancement
heterogeneity is uncommon

MR
T1 iso to hypo
T2 variabnle
DWI restricted

336
Q

Renal transplant complications

A

Medical
- ATN
- rejection
- infection
- pyelonephritis

Surgical
- renal artery stenosis
- renal vein thrombosis
- AVF
- pseudoaneurysm
- urinary obstruction
- allograft compartment syndrome
- allograft torsion
- fluid collections

Fluid collections
- immediate: haematoma/seroma
- 1-2 weeks urinoma
- 3-4 weeks: abscess
- beyond; lymphocoele

337
Q

Cystic nephromas are

A

rare benign renal neoplasms, classicly occuring in women 40-50. distinct from paeditriac cystic nephroma.

338
Q

Cystic nephroma imaging

A

US
multilocular cystic mass from kidney
septal vasc

CT
multilocular cystic mass
variable septal enhancement
no nodular or solid enhancement
can have perinephric stranding

MR
T1 variable
T2 hyper
C+ septal enhancement

DDX
multilocular cystic renal neoplasm of low malignant potential

339
Q

Renal rhabdoid tumiours are

A

highly aggressive rare malig of earl childhood
similar to ATRT of the brain
<2yo

340
Q

ARPCKD imaging

A

US
antenatal - oligo
cysts
- small, rarely >1cm
enlarged kidneys, reniform shape
liver
- coarse
- carolis
- portal hypertension

MR
enlarged kidneys with diffusely increased T2
oligo

Complications
- potter sequence
- systemic hypertension
- portal hypertension

341
Q

ARPCKD ddx

A

ADPKD
Beckwith Wiedemann
Laurence Moon Beidl
Meckel gruber

342
Q

Renal oncocytomas are

A

benign renal tuimours, difficult to tell from malig preop. usually older men. assoc with BHD and TS.

343
Q

Renal oncocytoma imaging

A

difficult to distinguish from rcc
sharp central stellate scar, only 1/3 and can be seen in rcc

IVP
sharply demarcated large exophystic with nephrogenic enhancement

US
well circumscribed mass with echo similar to kidney
may see scar

CT
homgenous
large, heterogenous
calc can be present
enhancement
non enhancing central scar
can have bland renal vein thrombus
segmental enhancement inversion

MR
T1 hypo
T2 hyper, central scar
C+ homo/hetero

DSA
spoke wheel

344
Q

Thrombotic thrombocytopaenic purpura is

A

a rare life threatening condition with thrombocytopaenia, microangiopathic haemolytic anaemia and end organ damage. get PRES changes on imaging

345
Q

Renal AML imaging

A

US
hyper with shadowing
TS - numerous

CT
macroscpic fat (not pathognmonic)
5% fat poor
- no ossification favours aml

MR
FS
india ink

DSA
hypervascular, sunburst
venous; onion peel

346
Q

Mesoblastic nephromas are

A

benign renal tumours typically occuring in utero or infancy. most common neonatal renal tumour. assoc with polyhydram, fetal hypercalc. mesenchymal. can be classic or cellular

347
Q

Mesoblastic nephroma imaging

A

XR
soft tissuie mass
rare to have calcs

US
well defined with low level homgenous echoes
concentric echoic and hypoechoic rings
can be more complex
can have vasc
can be cystic

CT
can be solid with variable enhancement or heterogenous
typically no calcs

MR
T1 iso to hyper
T2 variable
DWI retricts in solid
can be more variable

ddx
wilms (older)
rhabdoid
sarcoma

348
Q

Renal rhabdoid tumiours are

A

highly aggressive rare malig of earl childhood
similar to ATRT of the brain

349
Q

Renal replacement lipomatosis imaging

A

XR
calculi and bowel displacement

CT
atrophy
lipomatosis
renal calculi
perinephric abscess

ddx
lipoma
liposarcoma
aml
xgp

350
Q

Renal lymphangiomatosis is

A

rare disorder with dilatation of the perirenal, parapelvic and intrarenal lymphatics

US
perirenal collection
cysts
ascites
poor CM diff

CT
perinephric fluid attenuation 0-10
cystis
can have fluid retroperitoneal

DDX
cystic renal dysplasia
ADPKD
ARPKD

351
Q

Page kidney si

A

systmic hypertension secondary to extrinsic compression of the kidney by a subcapsular collection

352
Q

Haemolytic uraemic syndrome is

A

a multisystem thrombotic microangiopathic disease

triad of renal failure, haemolytic anemia and thrombocytopaenia

typically follows GI infection with shiga toxin producintg e coli

can also be assoc with collagen vascular diseases, malig and medications

T2/FLAIR in BG (putamen) and centrum semiovale

353
Q

Thrombotic thrombocytopaenic purpura is

A

a rare life threatening condition with thrombocytopaenia, microangiopathic haemolytic anaemia and end organ damage. get PRES changes on imaging

354
Q

Cushing syndrome is

A

due to excess glucocorticoids which may be exogenous or endogenous. disease - ACH pituitary adenoma. syndrome- all aetiologies

355
Q

Renal haemosiderosis causes

A

chronic intravascular haemolytic states
- sickle cell
- thalassemia

Paroxysmal nocturnal haemoglobinuria

Mechanical haemolysis from a cardoac valve

ddx
- cortical nephrocalcinosis

356
Q

Lithium induced renal disease is and imaging

A

characterised by progressive decline in function from direct injury to renal tubules

imaging
US
- uniform microcysts
- punctate echogenic foci

CT
- microcalcs within microcysts

MR
- abundance of microcysts in cortex and medulla

357
Q

Adrenal calc ddx

A

Haemorrhage
- WFS
- trauma
- neonatal asphyxia
- coagulopathy

Infection
- tb
- histo

tumours
- mets
- neuroblastoma
- adrenal myeloliupoma
- adrenala denoma
- adrenocortical carcinoma
- phae

other
- addison
- wolman disease

358
Q

Renal replacement lipomatosis imaging

A

XR
calculi and bowel displacement

CT
atrophy
lipomatosis
renal calculi
perinephric abscess

ddx
lipoma
liposarcoma
aml
xgp

359
Q

Adrenal trauma path

A

haemorrhagfe is most common, thought to be direct compression or increased pressure from IVC compression
laceration less common

lots of associated injuries. highly mortality in trauma patients

360
Q

Adrenal insufficiency is and cuases

A

refers to inadequate secretion of corticosteroids. partial or complete destruction of the adrenal cortex (primary/addisons). Secondary is from lack of stimulation.

Primary
- autoimmune disorders
- granulomatous disease TB/sarcoid
- neoplastic (mets, lymphoma, leukaemia)
- adrenal haemorrhage
- systemic fungal infection
- adrenoleukodystrophy
- congenital adrenal hyperplasia
- drugs
- bilateral adrenlectomy

Secondary
- suppression of axis from glucocorticoids
- hypothalamic or pit lesiosn

ACTH stimulation
- cortisol doesnt rise; primary
- cortisol rises; secondary

361
Q

CT hypoperfusion complex imaging

A

small calibre aorta
collapsed IVC
IVC halo sign
thickened bowel loops
- hyper on non con or submucosal oedema
- usually jejunal
hypoenhancing spleen
chock pancreas
hypoenhancing liver
hyperenhancing adrenals
hyperenhanceing kidneys
ascites
shock thyroid

362
Q

Adrenal haemorrhage aetiology

A

TRrauma (usually unilateral)

Sepsis (esp meningococaemia)
- Waterhouse Friderichsen syndrome

DIC

Anti phosopholipid syndrome

Heparin induced thrombocytopaenia

steroids/anticoags

Tumour

neonates
- birth trauma, sepsis, hypoxia, DM

Adrenal vein thrombosis

363
Q

Adrenal adenoma ddx

A

Cortical carcinoma

Phae

Adrenal mets
- HCC and RCC can contain fat

Myelolipoma

364
Q

Cushinds causes

A

steroids

rest are endogenous:

adrenal adenoma
primary pigmented nodular adrenal dysplasia
acth secreting tumour
- pit adenoma
- small cell lung
- bronchial carcinoid
- small cell thymus
- pancreatic neuroendocrine
- pahaeo
- benign ovarian
adrenocorticotropin independant macronodular-adrenocortical hyperplasia AIMAH
corticotropin releasing hormone secreting trumour

365
Q

Adrenal calc ddx

A

Haemorrhage
- WFS
- trauma
- neonatal asphyxia
- coagulopathy

Infection
- tb
- histo

tumours
- mets
- neuroblastoma
- adrenal myeloliupoma
- adrenala denoma
- adrenocortical carcinoma
- phae

other
- addison
- wolman disease

366
Q

Primary hyperaldosteronism is

A

excess aldosterone production

occurs secondary to adenomas, hyperplasia or carcinoma

when primary due to adenoma - Conn syndrome

clinical; diastolic hypertension, met alkalosis, hypokalemia. musuclar weakness, paraesthesia, headache, polyuria and polydipsia

primary - low renin
secondary - high renin

367
Q

Primary hyperaldosteronism imaging

A

adrenal adeomas unilateral and small
hypodense
minimal enhancement
can do venous sampling

368
Q

Adrenal myelolipoma is

A

a rare benign adrenal tumour. fat components. non fx, but assoc with endocrine disorders (cushings, conn, CAH)

can rarely be extra adrenal; retroperitoneum, perirenal space and thorax

369
Q

Adrenal myelolipoma imaging

A

CT
fat components
can have calcs

MR
T1 hyper
FS suppression
T2 intermediate to high
C+ vivid

370
Q

Adrenal adeoma imaging

A

Typical
- small
- round low density smooth

Atypical
- haemorrhage
- calc
- necrosis
- large

CT
- fat; highly sensitive and specific <0 100sp, <10 98 sp
- lipid poor; assess washout. typically washout rapidly.
- >120HU on PV, washout should be ignored

Washout
- >60% absolute
- >40% relative

MR
- chemical shift drop; >16.5% diagnostic
- 10-30 HU 100 spc and 89% sn
- 10-20 HU CT 100/100

371
Q

Adrenal adenoma ddx

A

Cortical carcinoma

Phae

Adrenal mets
- HCC and RCC can contain fat

Myelolipoma

372
Q

Posterior urethral valves are

A

most common congenital obstructive lesion of the urethra and common cause of obstructive uropathy in infancy

result from formation of thick valve like membrane of wolffian duct origin that courses obliquely from the verumontanum to the most distal portion of the prostatic urethra

373
Q

Adrenal cortical carcinoma imaging

A

CT
large
irregular
heterogenous
calc 30%
venous invasion
mets

MR
high T2
heterogenous
hetergenous enahcnement

374
Q

Posterior urethral valves imaging

A

US
bladder distention
hydronephrosis
oligohydramnios and renal dysplasia (severe)
keyhole sign

Postnatal US
keyhole sign
hydronephrosis
mild renal dysplasia
urethral diameter >6mm

VCUG
dilation and elongation of the posterior urethra (keyhole)
linear radiolucent band
VUR 50%
bladder trabeculation

375
Q

Phaeochromocytoma imaging

A

tend to be large >3cm

US
variable

CT
large, heterogenous
necrosis and cystic change
enhance avidly
can have calcs

MR
T1 hypo, hetero
T2 markedly hyper
i/oop no loss
C+ heterogenous, prolonged

NM
octreotide
MIBG
Dotate PET and DOPA pet

376
Q

Adrenal myelolipoma is

A

a rare benign adrenal tumour. fat components. non fx, but assoc with endocrine disorders (cushings, conn, CAH)

377
Q

Adrenal myelolipoma imaging

A

CT
fat components
can have calcs

MR
T1 hyper
FS suppression
T2 intermediate to high
C+ vivid

378
Q

Adrenal hyperplasia is

A

non malignant growth of the afrenal glands. rare cause of ACTH independant cushings, and conn syndrome.

can be
congenital or acquired

micronodular or macronodular

congenital
- CAH
- primary pgimented nodular

macronodular
- adrenocorticotropin independant macronodular adrenocortical hyperplasia AAIMAH

379
Q

Adrenal hyperplasia imaging

A

Enlarged limbs of one or both adrenals >10mm
Normal morphology
Nodular or uniform

MRI may have drop on on out of phase due to lipid content, like an adenoma

380
Q

Multiple ureter filling defects ddx

A

TCC
ureteritis cystica
vascular indentation
multiple stones
blood clots
Stevens johnsons syndrome

381
Q

Posterior urethral valves imaging

A

US
bladder distention
hydronephrosis
oligohydramnios and renal dysplasia (severe)
keyhole sign

Postnatal US
keyhole sign
hydronephrosis
mild renal dysplasia
urethral diameter >6mm

VCUG
dilation and elongation of the posterior urethra (keyhole)
linear radiolucent band
VUR 50%
bladder trabeculation

382
Q

Vesicoureteric reflux is and associations

A

abnormal flow of urine from bladder to upper tract in young children

primary maturation abnormality of the VUJ reslting in a short submucosal tunnel and loss of the normal pinchcock mechanism during micturition

assoc
- congenital obstructive posterior urthral membrnae
- bulbar urethral obstruction (Cobb collar)
- ureteral partail obsturction
- duplex collecting system

383
Q

Vesicoureteric reflux imaging

A

VCUG
- confirm refleuxc and grading
- ?during filing or micturition
- presence or absence of associated abnormalities
- length of ureteric tunnel
- width of lower ureter

NM
mag 3

384
Q

Urethral stricture causes

A

Infection
- gonococcal vs non
Inflammatory
Trauma
Iatrogenic
- intraumentation
- turp
Congenital

385
Q

Urethral diverticulum are

A

focal outpouchings of the urethra. occur more commonly in women. broad range of LUTS. can develop stones, infection and malignancy

386
Q

Ureteritis cystica is and imaging

A

benign condition of hte ureters representing multiple small submucosal cysts

results from chronic irreitation from stones or infection

imaging
- multiple small smooth walled rounded lucent filling defects projecting into lumen

387
Q

Multiple ureter filling defects ddx

A

TCC
ureteritis cystica
vascular indentation
multiple stones
blood clots
Stevens johnsons syndrome

388
Q

Cystitis glandularis is and imaging

A

proliferative disorder with glandular metaplasia of the transitional cells lining the urinary bladder. seen with chronic outlet, infection, calculi. differentiate to goblet cells

imaging
fluoro
- filling defect
us
- polypoid thickning trigone
ct
- hypervasc polypoid mass

MR
T1 low
T2 low with central branching hyper which enhances
- intact muscle layer

389
Q

Hutch diverticulum are

A

congenital diverticula seen at the VUJ in absence of posterior urethral valves or neurogenic bladder. assoc VUR. micky mouse appearance.

390
Q

Bladder wall calcification causes

A

CREST

Cystitis
Radiation
Eosiniophilic cystitis
Schistosomiasis
TB

391
Q

Urethral diverticulum are

A

focal outpouchings of the urethra. occur more commonly in women. broad range of LUTS. can develop stones, infection and malignancy

392
Q

Neurogenic bladder is and causes

A

dysfunctional urinary bladder due to lack of neurologic coordination

Stroke, MS, parkinsons, cauda equina

Lapides classification
- sensory (posterior column or afferent tracts)
- motor (motor neurones)
- unihibited neurogenic bladder (incomplete above S2)
- reflex neurogenic bladder (complete above S2), pine cone/christmas tree
- autonumous neurgenic bladder (conus/cauda lesions)

393
Q

Neurogenic bladder imaging

A

markedly contracted or distended bladder

Sensory
- inability to sense fullness, large rounded smooth
- voiding is preserved

Motor
- atonic bladder

Uninhibited
- rounded with trabeculation from detrusor contractions. large interureteric ridge

Reflex
- detrusor hyperreflexia with dyssynergic sphincter. contrast to posterio urethra and elonfated pointed urethra with pseudodiverticula
- pine cone

Autonumous
- intermediatye between contracts and atonic

394
Q

Bladder diverticula causes

A

Congenital:
- hutch diverticulum in paraureteral region

Secondary:
Outlet obstruction
- stenosis
- neurogenic
- posterior urethral valve
- prostatic enlargement
- ureterocoele
- urethral stricture

Congenital syndromes
- diamond blackfan
- ehlers danlos
- menkes
- prune belly
- williams

Post op

can be assoc with stones, rupture, malignancy

395
Q

Hutch diverticulum are

A

congenital diverticula seen at the VUJ in absence of posterior urethral valves or neurogenic bladder. assoc VUR. micky mouse appearance.

396
Q

Penile trauma imaging and grading

A

US
tunica albuginea - hyper, covering corpora cavernosa and spongiosum. hypoechoic breach may be seen in longituindnal axis. haematoma either side

MR
tunica albuginea hypo on all sequences
tear T2 hyperintense

Grading
0 - haematyoma
1 - tunica/cavernosa defect
2 - tunica/cavernosa defect with haematoma
3 - defect in tunica, buck gascia and corpus spongiosum
4 - corpus with urethra and/or vascular injury

397
Q

Peyronie disease is

A

common cuase of painful penile induration. plaques form in tunica alburginea causing deformity and shortening and pain.

plantar fibromatosis and dupytrens contracts. assoc with trauma, dm, bb’s, pagets of bone and phenytoin

398
Q

Types of bladder ca

A

TCC
Squamous
Adeno
Small cell

399
Q

Squamous cell bladder ca is

A

most common non tcc bladder cancer. m

risk factors
- schisto
- chronic irritation
- chronic infection
- intravesical bcg

400
Q

Adenocarcinoma bladder causes and imaging

A

Persistent urachal remnant
Cystitis glandularis
Schisto
Exstrophy

Urachal
- midline at dome or along course remannt
- peripheral calcs
- mixed solid cystic

Non urachal
- diffuse thickening
- paravesical fat stranding

401
Q

Testicular seminoma facts and imaging

A

normal afp
can have incr bhcg

classic anaplastic or spermatocytic (older)

US
homogenous
flow
larger can be heterogenous

CT
nodes and mets

MR
T2 hypo
C+ heterogenous
DWI restricts

non seminomatous; more heterogenous, with cysts and calcifications

402
Q

Peyronie disease is

A

common cuase of painful penile induration. plaques form in tunica alburginea causing deformity and shortening and pain.

plantar fibromatosis and dupytrens contracts. assoc with trauma, dm, bb’s, pagets of bone and phenytoin

403
Q

Extratesticular cystic lesion ddx

A

hydrocoele
epididymal cyst
spermatocele
haematocele
hernia
abscess
pyocele
varicocele

404
Q

Testicular germ cell tumours

A

Seminoma

Non seminoma
- embyronal
- choriocarcinoma
- yolk sac
- teratoma
- mixed

1st decade; YS and tera
2nd; chorio
3rd; embryonal
4th; seminoma
>7th; lymphoma

405
Q

Adenomatoid tumours are

A

benign solid extratesticular lesions of the epidiymis/tunica vaginalis or spermatic cord

406
Q

Testicular sex cord stromal tumours

A

Sertoli
Leydig
Granulosa
Fibroma thecoma

407
Q

Non seminomatous biochemical

A

AFP - yolk sac

bhcg - chorio

LDH can be up

408
Q

Extratesticular cystic lesion ddx

A

hydrocoele
epididymal cyst
spermatocele
haematocele
hernia
abscess
pyocele
varicocele

409
Q

Tubular ectasia of rete testes is and imaging

A

repreents dilated testicular mediastinal tubles. often bilateral, older dudes. assoc with spermatocoeles and may occur after a vasectomy. results from obliteration of the efferent ducts.

US
small cystic tubular strctures that replace and enlarge teh testicular mediastinum
lack of vascularity/mass effect

MR
cystic dilation
hyper on T2
no enhancement

ddx
- intratesticular varicocoele
- cystadenoma

410
Q

Adenomatoid tumours are

A

benign solid extratesticular lesions of the epidiymis/tunica vaginalis or spermatic cord

411
Q

Prostatitis imaging

A

US
focal hypoechoic region
abscess formation
increased flow

CT
best for abscess; peripherally enhancing

MR
Acute
T1 peripheral hypo or transitional hypo
T2 hyper
Diffuse enhancing
abscess should restrict

412
Q

Prostatic utricle cyst is

A

an area of focal dilatation that occurs within the prostate utricle/verumontanum. midline cystic masses difficult to distinguish from mullerian duct cysts. assoc with hypospadius, cryptorchidism, unilateral renal agenesis

413
Q

Sertoli tumours of the tests are

A

uncommon sex cord stromal tumours. less common than leydigs. have a large calcifying subtype. assoc with PJ and carney complex

414
Q

BPH imaging

A

US
volume >30
enlarged central gland of mixed echoes
calc may be seen
pseudocapsule representing compressed peripheral zone
elevated post mic volume
assoc bladder hypertrophy

IVP
fishhook ureter
bladder trabec/diverticula

CT

MR
enlarged transition zone
heterogenous signal with intact low signal pseudocapusle

415
Q

Prostate cancer imaging

A

US
TRUS to assess and guide bx
typically hypoechoic lesion, can be hyper/iso
systematic sextant bx

MR
T1; prostate contour, neurovascular bundle encasement, post bx haemorrhage

T2
low signal in high signal peripheral zone

DWI
often shows restriction

DCE
shows enhancement

EPE; look for
- asymmetry NV buncles
- obliteration of the rectoprostatic angle
- involvement of the urethra
- seminal vesicle invasion

416
Q

Prostatitis imaging

A

US
focal hypoechoic region
abscess formation
increased flow

CT
best for abscess; peripherally enhancing

MR
Acute
T1 peripheral hypo or transitional hypo
T2 hyper
Diffuse enhancing
abscess should restrict

417
Q

Prostatic utricle cyst is

A

an area of focal dilatation that occurs within the prostate utricle/verumontanum. midline cystic masses difficult to distinguish from mullerian duct cysts. assoc with hypospadius, cryptorchidism, unilateral renal agenesis

418
Q

Pirads DWI score

A

TZ/PZ
1: normal

2: linear/wedge shaped ADC hypo and/or DWI hyper

3: focal, mild or moderate ADC hypo and/or mild/moderate DWI hyper. Can be marked on either ADC or DWI but not both.

4: focal marked ADC hypo and marked DWI hyper <1.5cm

5: same as 4 but >1.5cm or definite EPE

TZ lesions with a T2 score of 2 or 3, DWI score 2 high (4 or 5) can upgrade PIRADS by 1 point

419
Q

Pirads DCE

A

Negative
- no early/contemp enhancement or
- diffuse multifocal enhancing, no corresponding T2/DWI or
- focal enhancement corresponding to a benign prostatic hyperplasia lesion

Positive
- focal and
- earlier or contemp and
- corresponds to sus finding on T2/DWI

for PZ lesions of 3, DCE can upgrade to 4

420
Q

Prostate cancer imaging

A

US
TRUS to assess and guide bx
typically hypoechoic lesion, can be hyper/iso
systematic sextant bx

MR
T1; prostate contour, neurovascular bundle encasement, post bx haemorrhage

T2
low signal in high signal peripheral zone

DWI
often shows restriction

DCE
shows enhancement

EPE; look for
- asymmetry NV buncles
- obliteration of the rectoprostatic angle
- involvement of the urethra
- seminal vesicle invasion

421
Q

PiRADS is

A

reporting scheme for suspected prostate cancer in treatment naive glands.

each lesion can be scored 1-5 on DWI and T2, as well as presence of absence of DCE.

TZ: primarily determined by T2 score. can be modified by DWI score.

PZ: primarily determined by the DWI score. can be modified by DCE

422
Q

Peritoneal thickening ddx

A

Smooth
- peritonitis
- carcinomatosis
- PH
- familial mediterranean fever
- sarcoid

Irregular
- carcinomatosis
- TB (dry)
- encapsulating peritoneal sclerosis
- PMP
- mesothelioma

Nodular
- carcinomatosis
- TB (FF)
- actinomycosis
- primary pertoneal neoplasms

423
Q

Pirads DWI score

A

TZ/PZ
1: normal

2: linear/wedge shaped ADC hypo and/or DWI hyper

3: focal, mild or moderate ADC hypo and/or mild/moderate DWI hyper. Can be marked on either ADC or DWI but not both.

424
Q

Barium peritonitis is

A

a rare complication of barium studies. GI perf with spillage into peritoneal cavity resulting in peritonitis, granuloma and stone formation.

Acute - chemical perotonitis. acites and shock

Chronic - extensive fibrosis around barium with granuloma formation. adhesions are common

425
Q

TB peritonitis is

A

extrapulmonary TB affecting the peritoneum. frequently seen with other GI TB.

Risk factors; HIV, dialysis, cirrhosis

Can be wet, dry or fixed fibrotic. can also be mixed.

426
Q

TB peritonitis imaging

A

CT
nodular or symmetrical thickening of the peritoneum and mesentery
abnormal enhancement
ascites
enlarged low attenuation nodes

Wet
- exudative high attenuation ascites

Dry
- caseous nodes and fibrous adhesions. thickened cake like omentum

fibrotic
- omental cake like mass with fixed bowel loops, matted loops and mesentery with loculated ascites

427
Q

Right paraduodenal hernia

A

through fossa of Waldeyer, congenital failure of fusion of the ascending colon mesentery to the peritoneum in the right lower quadrant

imaging
- inferior to third part duodenum
- behind SMV, SMA and right colic vein

428
Q

Lesser sac hernia

A

protrude through foramen of winslow

Imaging
- posterior to PV, CBD, hepatic artery and anterior to IVC
- gas/fluid/vessels in lessert sac
- can have abnormal position of the caecum

429
Q

Barium peritonitis is

A

a rare complication of barium studies. GI perf with spillage into peritoneal cavity resulting in peritonitis, granuloma and stone formation.

Acute - chemical perotonitis. acites and shock

Chronic - extensive fibrosis around barium with granuloma formation. adhesions are common

430
Q

Sigmoid mesocolon hernia

A

small bowel loops protrude into a peritoneal pocket formed between two adjacent sigmoid segments and their mesentery

431
Q

Small bowel mesentery internal hernia

A

Can be transmesenteric or intramesenteric

Transmesenteric
- through defect in mesentery
- much more common

Intra
- into the mesentery through a mesenteric defect
- predominantly paeds

Imaging
- Trans might not be sac like
- Intra; sac like, with anterior and superior displacement of the SMA

432
Q

Right paraduodenal hernia

A

through fossa of Waldeyer, congenital failure of fusion of the ascending colon mesentery to the peritoneum in the right lower quadrant

433
Q

Lesser sac hernia

A

protrude through foramen of winslow

Imaging
- posterior to PV, CBD, hepatic artery and anterior to IVC
- gas/fluid/vessels in lessert sac

434
Q

Internal hernia due to gastric bypass surgery

A

Roux en Y three potential sites for hernia
- at TV mesocolon defect through which the roux limb passes, if retrocolic
- mesenteric defect at enteroenterostomy
- behind the roux limb mesentery placed in a retrocolic or antecolic position (retro or ante petersen type)

435
Q

Sigmoid mesocolon hernia

A

small bowel loops protrude into a peritoneal pocket formed between two adjacent sigmoid segments and their mesentery

436
Q

Small bowel mesentery internal hernia

A

Can be transmesenteric or intramesenteric

Transmesenteric
- through defect in mesentery
- much more common

Intra
- into the mesentery through a mesenteric defect
- predominantly paeds

Imaging
- Trans might not be sac like
- Intra; sac like, with anterior and superior displacement of the SMA

437
Q

Lumbar hernia is

A

hernias through defects in the lumbar muscles or posterior fascia

can be superior or inferior

superior (grenfeltt lesshaft)
- superior lumbar triangle

inferior (petit)
- inferior lumbar triangle

438
Q

Broad ligament hernia

A

small bowel through congenital or acquried defect in the broad ligament

439
Q

Internal hernia due to gastric bypass surgery

A

Roux en Y three potential sites for hernia
- at TV mesocolon defect through which the roux limb passes, if retrocolic
- mesenteric defect at enteroenterostomy
- behind the roux limb mesentery placed in a retrocolic or antecolic position (retro or ante petersen type)

440
Q

Spigelian hernias are

A

hernias through the spigelian fascia.

between the lateral border of the rectus abdominaus and the semilunar line, through the transversus abdominus aponeurosis, close to the level of the arcuate line

441
Q

Maydl hernia

A

rare type where more than one loop enters the hernial sac with an intervening intra abdominal loop

442
Q

Sclerosing mesenteritis is

A

an uncommon idiopathic disorder characterised by chronic non spec inflammation invovling the adipose tissue of the bwoel mesentery

Associations:
malignancy
- lymphoma, lung, melanoma, CRC, RCC, myeloma
abdominal surgery
systemic inflamm conditions
- retroperitoneal fibrosis, sclerosing cholangitis, riedel thyroiditis, orbital pseudotumour

443
Q

Mesenteric cysts aetiology

A

lymphatic - simple and lymphangioma

mesothelial - simple, benign, malignant

enteric

urogenital

mature cystic teratoma

non pancreatic pseudocysts

444
Q

Encapsulating peritoneal sclerosis is

A

a rare benign cause of bowel obstruction characterised by total or partial encasement of the small bowel within a thick fibrocollagenous membrane

can be idiopathic or secondary to
- dialysis
- tb
- shunts

445
Q

Malignant peritoneal mesothelioma imaging

A

CT
solid heterogenous mass
calcified pleural plques
nodular, irregular peritoneal and omental thickening, progressing to cake
peritoneal/omental masses
variable ascites
direct invasion of viscera
concurrent pleural involvement

MR
T1 low
T2 high
C+ enhances

Gallium
avid

ddx
carcinomatosis
- dystrophic calc
PMP
Lymphoma
TB

446
Q

Multicystic peritoneal mesothelioma is and imaging

A

rare benign subtype of mesothelioma. no assoc with asbestos.

CT
well defined low attenuating cystic pelvic masses
no calcs

MR
T1 low
T2 high
septal enhancement

447
Q

Sclerosing mesenteritis is

A

an uncommon idiopathic disorder characterised by chronic non spec inflammation invovling the adipose tissue of the bwoel mesentery

assoc

448
Q

Sclerosing mesenteritis imaging

A

US
distortion and thickening of echogenic mesnetery
halo sparing vessels

CT
well or ill defined mesenteric mass with surrounding mist
misty attenuation
fat halo around traversing mesenteric veseels and soft tissue nodules “fat ring sign”
punctate or coarse calcs
hyperattenuating pseudocapsule
small soft tissue nodes

449
Q

Encapsulating peritoneal sclerosis imaging

A

XR
bowel obstr
wall may calcify

CT
enhancing peritoneum, thickened
obstruction
dixation of loops
ascites or localised fluid collections
bwoel wall thckenign
peritoneal or mural calc
calcified or reactive adenopathy

450
Q

Segmental arterial mediolysis is

A

vascular disease in middle age causing spontaneous intrabdominal haemorrhage. characterised by aneurysms, stenoses, dissections and occlusions within splanchnic arterial branches. not atherosclerotic or inflammatory

451
Q

Segmental arterial mediolysis imaging

A

branches of visceral arteries

aneurysms, stenoses, dissections, occlusiosn

452
Q

Peritoneal cysts are

A

cyst like structure that appears in relatio to the peritoneal surfaces resulting from a non neoplastic reactive mesothelial proliferation.

usually caused by the accumulation of ovarian fluid that is contained by a peritoneal adhesion.

assoc
- previous trauma
- pid
- endometriosis
- ibd

453
Q

Peritoneal inclusion cyst imaging

A

US
- large ovoid irreg anechoic
- invaginates surrounding structures
- lack of a discrete wall
- no nodularity
- minmal debris
- can range from small to v large

454
Q

Desmoid tumour is

A

a bening non inflammatory fibroblastic tumour with a tendency to local invade without mets

assoc
- gardner syndrome
- fap
- pregnnacy/oestrogen therapy

b catenin gene ctnnb1 or apc gene

455
Q

Desmoid tumour imaging

A

US
hypo

CT
well circumscribed
can be more aggressive
homo or focally hyperattenuating
enahnce

MR
T1/T2 low
C+ variable

456
Q

Gardner syndrome

A

FAP
osteomas
Epidermal cysts
fibromatoses
desmoid tumours

supernumery teeth, odontomas, dentigerous cysts
duodenal/ampulla tumours
papillary thyroid ca

457
Q

Retroperitoneal fibrosis is

A

part of a spectrum of entities with a common pathogenic process of inflammatory response to atherosclerosis combined with autoimmune factors

458
Q

Retroperitoneal fibrosis aetiology

A

Idiopathic (Ormond)
Radiation
Medication
Inflammation
- pancreatitis, pyloe
- igg4
Malignant
Asbestos

459
Q

Retroperitoneal fibrosis iamging and ddx

A

fibrosis encasing retro structures causing ureteric and vascular obstruction/displacement

aorta/ivc away from VBs implied malignant, as does local invasion

IVU
- medial deviation (maiden waist sign)
- tapering of the lumen
- uni/bilateral hydro

CT
soft tissue mass around aorta and iliac vessels
encasing without invading
variable enhancement
starts at bifurcation adn extends up

MR
T1/T2 dark, unless active inflammation

DDX
- lymphoma
- erdheim chest
- emh

460
Q

Idiopathic retroperitoneal fibrosis is and assoc

A

also known as Ormond syndrome. subtype with no cause found.

assoc; other autoimmune processes
- pbc
- fibrosing mediastinitis
- ra
- ank spond
- PAN
- SLE
- hashimoto

461
Q

Isolated periaortitis is

A

a non aneurysmal form of chronic periaortitis. related to atherosclerosis or igg4 related disease.

low densitive soft tissue mantle with or without dilation
may have branch vessel narrowing

461
Q

Isolated periaortitis is

A

a non aneurysmal form of chronic periaortitis. related to atherosclerosis or igg4 related disease.

low densitive soft tissue mantle with or without dilation
may have branch vessel narrowing

462
Q

Inflammatory abdominal aortic aneurysm is

A

a variant of AAA characterised by inflammatory thickening, perianeurysmal fibrosis an adherence to surrounding structures

463
Q

Inflammatory abdominal aortic aneurysm imaging

A

CT
dilation
thickened wall
cuff of perianeurysmal soft tissue and inflammatory changes sparing the posterior wall
enahnces with contrast
entrapement of retroperitoneal structures

ddx
mycotic aneurysm
- usually more saccular with nodulairt, irregular config and may contain air

464
Q

Primary retroperitoneal neoplasms ddx

A

Liposarcoma

Undifferentiated pleomorphic sarcoma

Leiomyosarcoma

Rhabdomyosarcoma

Fibrosarcoma

Malignant peripheral nerve sheath tumour

Solitary fibrous tumour

Extragonadal germ cell tumour

primary retroperitoneal adenocarcinoma

465
Q

Retroperitoneal liposarcoma is and subtypes

A

malignant tumour of mesenchymal origin that may arise in any fat containing region of the body

well diff
- lipoma like
- inflammatory
- sclerosing
myxoid
pleomorphic
round cell
dedifferentiated

466
Q

Retroperitoneal liposarcoma ddx

A

lieomyosarcoma
UPS
fibrosarcoma
lipoma (rare)
exophytic aml

467
Q

UPS retroperitoneum is

A

one of the most common types of primary retroperitoneal neoplasms. high grade

can be storiform, pleomorphic, myxoid, giant cell, inflammatory and angiomatoid

25% have dystrophic calc, otherwise non spec imaging features

468
Q

Retroperitoneal leiomyosarcoma is and imaging

A

one of the commonest retroperitoneal neoplasms. most common extra uterine site of leiomyosarcomas.

freq involve the IVC. can be intravasc, extra vasc or mixed.

imaging is non spec. tend to develop massive cystic components. no fat no calcs.

469
Q

IVC leiomyosarcoma ddx

A

other retroperitoneal tumours should compress ivc at the periphery (negative embedded organ sign)

mesenchymal tumours involving the ivc
- angiosarc
- liposarc
- leiomyomatosis
- ups

tumours extending to ivc
- cardiac angiosarc
- hccc
- acc
- rcc

470
Q

plummer vinson is

A

dysphagia, iron def anemia, upper oesophageal webs

PART 2 (11 decks)

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