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Rad video > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Benign liver cyts
Demo
RF
Complications

A 
Developmental
Common 14%
Round/ovoid
Fluid SI
imperceptible, non CE wall
Single/multiple
Haemorrhage is rare
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2
Q

High T2 liver lesions mistaken for cysts

A

Cystic metastases (hypervascular tumours; colon, ovarian cystadenocarcinoma, squamous cell lung cancer.
sarcomas, melanoma.
GIST,pancreatic mucinous cystadenocarcinoma.

Metastatic NET
Haemangioma
Biliary cystadenoma/carcinoma

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3
Q

Liver haemangioma

demo

A 
Common (7-20%)
F>M
R>L lobe
Lobulated, clefted appearance
T2 very bright
CE follows blood pool -continues to enhance on delayed

Interrupted peripheral nodular enhancement
Homogeneous CE by 10-20”

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4
Q

DDx for nodular interrupted CE - liver

A

Treated mets
Haemangioendothelioma: paed, (periph, confluent lesions)
Angiosarcoma : heterogeneous

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5
Q

Focal liver fat
locations
RF

A

Classic locations : falciform ligament, GB fossa, periportal

Geographic low density

Geographic inc CE

No mass effect
Non displaced vessels

Out of phase signal loss

Central high density on CECT

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6
Q

Focal nodular hyperplasia
Demo
RF

No underlying CLCD

A 
3%
Young females (80-95%)
Solitary 80%
Lobulated
Subcapsular

iso/low T1; iso/sl high T2

Central scar 50-75%) : low T1/high T2(cf fibrolam HCC)
Homogeneous CE
Scar : delayed CE

Do sulphur colloid if unsure (55%)
Hepatocyte specific contrast

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7
Q

Liver adenomas

A 
OCP
Heterogen T1/T2
Can have Haem / FAT
Hetero CE
Can undergo malignant Tx
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8
Q

Hepatic metastases

A

usually hypovascular
HA supply ( high CE in arterial followed by washout - no PV supply)
Hypo on CT - no normal liver cells
High T2, low T! unless blood/melanin

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9
Q

Calcified liver mets

2

A

Serous ovarian Ca

Mucinous CRC

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10
Q

Hypervascular liver lesions
Benign 4
Malignant 2

A

Haemangioma
FNH
Adenoma
Hyperplastic regenerative nodules in Budd-Chiari

HCC
Hypervascular mets

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11
Q

Cholangiocarcinoma

types 3

A

Intrahepatic (20-30%) : mass forming, periductal infiltrating, intraductal

Peripheral

Hilar

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12
Q

Cirrhosis - early RF 5

A

Maybe inapparent

Hepatomegaly

Heterogeneous perfusion

Enlargement of hilar periportal space

Expansion of intersegmental fissure

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13
Q

Regenerating nodules

imaging

A

T1/T2 low
May contain Fe ( siderotic ) - SWI artefact
May contain Cu - non fero

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14
Q

Cirrhosis - advanced

Measure

A

Atrophy - Right lobe, medial segment of left lobe ( expanded GB fossa )

Hypertrophy :
Caudate, lateral seg LL

Caudate: RL ratio > 0.65 ratio

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15
Q

Dysplastic nodules

RF

A

Classically:
T1 high,
T2 low/iso
Does NOT enhance

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16
Q

Focal confluent fibrosis

A 
Anterior/medial segments
Wedge shaped
May involve entire segment
Capsular retraction
Delayed Gad enhancement
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17
Q

Hyperattenuating liver on CT

5

A 
Haemachromatosis
Amiodarone
Type IV glycogen storage disease
Wilsons
Thorotrast
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18
Q

Haemosiderosis

A

Dyseryhtropoesis
Transfusion
Excessive Fe accumulation in RES ie
Liver ( kuppfer cells), spleen, bone marrow

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19
Q

Budd Chiari
Presentation
Causes 5
Types 3

A

Hepatomegaly, ascites, jaundice
Causes : Idiopathic, IVC webs, tumours, pregnancy, hypercoaguable states

Type
I : IVC +/- secondary HV
II : HV +/- secon IVC
III - venoocclusive

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20
Q

Budd Chiari

RF

A

Delayed of reversed PV inflow

Hepatomegaly
Congestion - low T1/high T2 "nutmeg' liver
Patchy central CE
Peripheral hypoperfusion
Reversed on delays

Small HV/IVC
Intravascular thrombi
Hepatic infarcts
PV thrombosis (20%)

Chronic - atrophy of liver, caudate hypertrophy

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21
Q

Hepatic infarction

A 
Rare
Peripheral wedge shaped/geographic
Low density on CT
Low T1/high T2
Changes shape with time
Necrosis (air)
Bile lakes
Eventual atrophy
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22
Q

CT signs of acute appendicitis

6

A 
Fat stranding
Diameter >6mm (intraluminal air is usually normal)
Focal caecal thickening
Appendicolith
Paracolic gutter fluid
Adenopathy
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23
Q

CT signs of acute diverticulitis

4

A

Colonic wall thickening (7-10mm)
Pericolic fat infiltration
Abscesses
Extraluminal air

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24
Q

Epiploic appendagitis vs Omental infarction ( CT)

A

appendagitis : oval pericolonic dirty fat with HIGH density rim.

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25
Q

Signs of strangulation, closed loop or ischaemic bowel

A 
Excess free fluid
Hazy, paper thin walls
Mesenteric fat stranding
Distended single loop
Non enhancing, thickened walls
Pneumatosis 
(Free air)
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26
Q

Feline oesophagus
Def
Causes 3

A

Multiple thin horizontal folds in oesophagus ; corrugations

Usually normal
Reflux
Scleroderma(CREST)

27
Q

Scleroderma UGI findings

A

Dilated patulous (< achal ) oesophagus
Patulous GEJ
Free reflux
Partially adynamic cf achal(dysmotile)

28
Q

Pancreatic rest on UGI

A

Single
Umbilicated filling defect
Inferior antrum

29
Q

Crohns Disease SBFT

4

A

Ulcers
Cobblestoning
String sign of Kantor (TI)
Fistulae

30
Q

Scleroderma SBFT findings

2

A

Dilated atonic bowel

Sacculations ( broad based pseudodiverticulae in antimesenteric)

31
Q

Nodular lymphoid hyperplasia
Causes 4
SBFT RF 1

A 
Causes:
Idiopathic
Hypogammaglobinaemia
Lymphoma
Giardiasis

Submucosal nodules
Any part GIT
commonly SB

32
Q

GVHD

SBFT features 2

A

Thickened SB

Featureless “ribbon like” bowel

33
Q

Coeliac disease

SBFT features 3

A

Small bowel dilatation
Coarse or obliterated folds
Ileojejunal reversal

34
Q

Caecal volvulus

XR RF

A 
Dilated bean shaped loop
LUQ/Subhepatic
1-2 visible haustra
Collapsed left colon
Dilated small bowel
beak on contrast enema
35
Q

Sigmoid volvulus
RF
more common

A 
Dilated inverted U-shaped loop
Apex in LUQ
Ahaustral outer margin
Inferior convergence to left of S1
Descending colon behind loop
36
Q

UC

DCBE RF 6

A 
Granular mucosa
Undermined mucosa
Pseudopolyps-> " filiform' polyps
Thumbprinting
Toxic megacolon
Carcinoma
No skip lesions
37
Q

CT severity index of pancreatitis grading CTSI

Combination of Balthazar score ( 0-4)
+ necrosis (0,2,4,6)

Max score 10

A 
Balthazar
A: normal pancreas 0
B: enlarged pancreas 1
C: inflammatory changes in pancreas + fat 2
D: single fluid collection 3
E: 2 or more fluid collections 4
Necrosis:
none (0)
<30 (2)
30-50 (4)
> 50 (6)
38
Q

Pseudocyst features

4

A 
>4 weeks to develop
No enhancing internal contents (0-30HU)
Wall Ca uncommon
Can occur anywhere
DDx : pseudoaneurysm (thrombosed)
39
Q

Chronic pancreatitis

RF

A 
Pancreatic calcification
Variable size
Dilatation of PD
Dilatation of bile ducts
Pseudocyst/pseudoaneurysm
Venous thrombosis
40
Q

Indications for percutaneous drainage of pseudocysts 3

Complications (5-10%)
3

A

> 5cm or increasing in size
Symptomatic
Obstruction of bile duct, stomach or duodenum

Infection
Bleeding
Chronic cutaneous fistula

41
Q

Pancreas divisum
def
demo
CT RF

A

Failure fusion of dorsal and ventral pancreatic primordia
Dorsal–> Wirsung major papilla
Ventral –> Santorini minor papilla

Incidence 5%

CT : bulky head with fat cleft
ERCP gold standard (branches at tip).

42
Q

Cystic pancreatic malignancies

5-10%

A 
Serous adenoma
Mucinous cystic neoplasm
Solid and papillary epithelial neoplasms
IPMN
Anaplastic
Cystic islet cell
Cystic met
Lymphoma
43
Q

Serous pancreatic adenoma

A 
Benign
F>M, 65y mean
1/3rd Ca + central stellate scar
Cysts >6, <2cm
Honeycomb appearance
Ass. VHL
44
Q

mucinous cystic pancreatic neoplams

A 
frank or potentially malignant
F>M
mean50y
Tail > body
Ca 15% periphery
Cysts < 6, > 2cm
MUCIN
45
Q

Solid and papillary epithelial neoplasm (SAPEN)

A

rare, low grade malig
young women mean 24yr
Large encapsulated solid/cystic mass with haemm and necrosis

Tail (50%)
Ca 30%
Fluid debris level

Resection curative

46
Q

IPMN

types 3

A

hyperplasia— carcinoma
mean 65y

  1. main duct : diffuse or segmental dilatation
  2. Branch duct : cystic dilatation
  3. Combined

ERCP : patulous papilla, mucin, mural nodules

47
Q

Islet cell tumours

A

85% functional
Insulinoma MC, > 90% benign and resectable

Gastrinoma: 2nd MC,
60% malignant, small
causes ZE syndrome

Non functioning (15%)
80-90% malignant, large size, ca 25%
48
Q

Pancreatic Carcinoma

Unresectability criteria

A

> 5cm
Adjacent tissue/organ invasion except duodenum

Arterial involv
+/- venous invasion

Hepatic mets
Distant adenopathy
Peritoneal carcinomatosis

49
Q

Bosniak II

RF 4

A

hairline thin septa +/- minimal perceived CE
fine ca in walls or septa
short segment of slightly thickened Ca
Uniform high attenuation (<3cm)

50
Q

Bosniak IIF

4

A

Incresed number of thin septa
minimal smooth thickening of wall or septa
No enhancing solid components
Intra renal high at cysts > 3cm

51
Q

Bosniak III

3

A

complex cyst
Thickened irregular walls or septa
enhancement of wall or septa
Chunky Calcium

52
Q

Bosniak IV

1

A

Enhancing soft tissue components adjacent to but independent of wall or septum

53
Q

Solid renal mass

4

A

RCC
TCC
Lymphoma
Mets

54
Q

Renal TCC

RF

A 
80-90% prior bladder cancer
Polypoid filling defect
Circumferential wall thickening
Infiltrating or discrete mass
\+/- calyceal dilatation
55
Q

CT patterns of renal lymphoma

5

A 
Multiple small masses
Spread from retroperitoneal disease
Diffuse infiltration
Perinephric encasement
Single homogeneous mass
56
Q

Renal oncocytoma

2

A

Rare, benign
RF
Central stellate scar
Spoke wheel pattern of vessels on angio

57
Q

Renal angiomyolipoma
Demo
RF 3

A 
Rare, benign hamartomatous
80% sporadic
20% syndrome assoc _ TS, NF
95% contains macro fat
well defined cortical mass
Typically < 5cm
58
Q

von Hippel Lindau

organ involvement

A 
AD
Haemiangioblastoma ( retina, cerebellum)
Phaeochromocytoms (multiple, sctopic)
Pancreatic cysts , islet cell tum
Renal cysts (60%)
RCC 25-50%, usually multiple
59
Q

Lipid poor adrenal adenoma
(indeterminate lesions 1-4cm with washout)

washout pitfalls

A

Unenhanced HU > 10
Rapid contrast washout
___ absolute washout > 60%
___relative washout > 40%

Pitfalls
Hypervascular mets
phaeochromo
adrenocortical Ca

60
Q

Indeterminate adrenal lesions with NO washout

A

Phaeo
Adrenocortical carcinoma
Mets
Lipid poor adenoma

61
Q

Adrenal adenoma

A 
most common adrenal mass
Usually not hyperfunctioning
usually < 4cm
Hypointense on T2
Variable CE
loss of signal on opp phase
(compare with spl or sk muscle)
NB: macroscopic fat does not show signal drop on OP MRI cf microscopic fat in adenoma
62
Q

Phaeochromocytoma

demo

A 
90% adrenal medulla
usually > 3cm at presentation
10% B/L
10% malignant
lightbulb bright T2 not always
late CE
usually no signal drop out opp
63
Q

Macroscopic fat containing adrenal mass

A

myelolipoma

Rad video (10 decks)

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