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Gastrointestinal Imaging (Beri) > Biliary Tree (for PBR 2) > Flashcards

Biliary Tree (for PBR 2) Flashcards

1
Q

Imaging signs of biliary duct dilation

A
  1. Multiple branching tubular, round, or oval structures that course toward the porta hepatis
  2. Diameter of IHBD larger than 40% of the diameter of the adjacent portal vein
  3. Dilation of the common duct greater than 6 mm
  4. Gallbladder diameter greater than 5 cm, when obstruction is distal to the cystic duct
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2
Q

An imaging sign that refers to dilatation of both the common bile duct and the pancreatic duct in the head of the pancreas

A

“double duct” sign

Dilatation of both ducts is usually caused by a tumor at the ampulla

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3
Q

Gradual tapering of a dilated CBD suggest:

a. Benign stricture
b. Malignant process

A

a. benign

Abrupt termination is characteristic of a malignant process

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4
Q

Imaging signs of stones within the bile ducts

A
  1. Stones layer dependently within allowing a crescent of bile to outline the anterior portion of the stone (the “crescent sign”)
  2. Stones are usually geometric or angulated in shape and lamellated in appearance
  3. Periductal edema and thickening and enhancement of the wall of the bile duct occur with impacted stones or infection

Wall thickening and enhancement are also seen with tumors

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5
Q

Causes of benign stricture

A 
Trauma
Surgery
Prior biliary interventional procedures
Recurrent cholangitis
Chronic pancreatitis 
Previous passage of stones 
Radiation therapy
Perforated duodenal ulcer

*Creator’s note: Iatrogenic and inflammation

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6
Q

This refers to an idiopathic, fibrosing, chronic inflammatory disease characterized by insidious onset of jaundice with progressive disease affecting both IHBD and EHBD

A

Primary sclerosing cholangitis

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7
Q

Imaging findings of primary sclerosing cholangitis

A
  1. IHBD dilatation
  2. IHBD strictures
  3. EHBD wall thickening, wall enhancement, and stenosis
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8
Q

Key diagnostic finding of primary sclerosing cholangitis

A

Alternating dilation and stenosis produce a characteristic beaded pattern of intrahepatic ducts

Small saccular outpouchings (duct diverticula), demonstrated on cholangiography, are also considered to be pathognomonic

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9
Q

Complications of primary sclerosing cholangitis

A

Biliary cirrhosis

Cholangiocarcinoma

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10
Q

This occurs in the setting of biliary obstruction

Patients present with fever, pain, and jaundice (Charcot triad)

A

Acute bacterial cholangitis

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11
Q

Imaging findings of acute bacterial cholangitis

A

Biliary dilatation, usually caused by a stone in the duct, associated with peribiliary contrast enhancement and periductal edema reflecting spread of the inflammatory process to adjacent parenchyma

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12
Q

Also known as Oriental cholangiohepatitis because it is endemic disease in Southeast Asia

Characterized by recurrent attacks of jaundice, abdominal pain, fever, and chills

Associated with parasitic infestation (Clonorchis sinensis, Ascaris) and nutritional deficiency

A

Recurrent pyogenic cholangitis

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13
Q

Imaging findings of recurrent pyogenic cholangitis

A 
Intraductal stones
Severe extrahepatic biliary dilation
Focal strictures
Pneumobilia
Straightening and rigidity of intrahepatic ducts

*Creators notes: almost similar to acute bacterial cholangitis

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14
Q

An uncommon congenital anomaly of the biliary tract characterized by saccular ectasia of the IHBD without biliary obstruction

Only one hepatic lobe or segment, or the entire liver may be affected

A

Caroli disease

Intrahepatic bile duct involvement only

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15
Q

Findings of Caroli disease

A
  1. Saccular dilatation of IHBD
    (giving the appearance on cross-sectional imaging of scattered intrahepatic cysts at communicate with the biliary tree)
  2. Enhancing fibrovascular bundles are seen centrally within many of the dilated ducts
    (producing the characteristic “central dot sign”)
  3. Segmental distribution of the bile duct abnormality with normal appearance of unaffected liver segments
  4. Cholangiography shows a characteristic pattern of focal biliary narrowing and saccular dilatation
  5. Dilatation of the CBD (10 to 30 mm) in half the cases.
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16
Q

Caroli disease is associated with what renal disease?

A

Medullary sponge kidney

Autosomal recessive polycystic kidney disease

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17
Q

Complications of Caroli disease

A

Pyogenic cholangitis
Liver abscess
Biliary stones
Cholangiocarcinoma - 7% of cases

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18
Q

Uncommon congenital anomalies of the biliary tree characterized by cystic dilation of the bile ducts

A

Choledochal cysts

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19
Q

Most common type of choledochal cysts

A

Type I

Confined to the EHBD and appear as fusiform or saccular dilatations of the CHD, CBD, or segments of each

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20
Q

What type of choledochal cyst which demonstrates a CBD diverticula attached to a narrow stalk

A

Type II

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21
Q

Type of choledochal cyst which is termed choledochoceles

They are termed focal dilatations of the intraduodenal portion of the CBD, closely resembling ureteroceles

A

Type III

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22
Q

Type of choledochal cyst defined as multiple focal dilatations of the IHBD and EHBD usually with a focal large cystic dilation of the CBD

A

Type IV

23
Q

Type of choledochal cyst referred to as Caroli disease

A

Type V

24
Q

Most common primary tumors associated with intraluminal biliary metastases

A

Colorectal cancers

25
Q

What finding favors metastases over cholangiocarcinoma?

A

The presence of a contiguous parenchymal mass and expansion of the duct at the site of the intraluminal mass in a patient with known colorectal cancer

26
Q

This is the second most common malignant primary hepatic tumor

Growth patterns include mass-forming, periductal infiltrating, and intraductal polypoid

A

Cholangiocarcinoma

27
Q

Growth pattern of cholangiocarcinoma that presents as an intrahepatic hypodense mass some sometimes causing peripheral biliary dilatation

It demonstrates a homogeneous low attenuation mass with delayed, mild, thin, incomplete, rim-like enhancement

A

Peripheral cholangiocarcinoma

28
Q

Findings of peripheral cholangiocarcinoma over HCC

A
  1. Arterial phase target enhancement
  2. Portal venous and delayed-phase central enhancement
  3. Retraction of the liver surface
  4. Biliary obstruction disproportionate to the size of the mass
  5. Elevated cancer antigen 19 -9 and CEA
*Creator's notes:
#1 = ? That is very similar to HCC! 
#3 - HCC can contract when there is underlying cirrhosis!
29
Q

Also known as Klatskin tumor

Occurs near the junction of the right and left bile ducts

A

Hilar cholangiocarcinoma

The tumor is usually small, poorly differentiated, aggressive, and causes obstruction of both ductal systems

30
Q

Growth pattern of cholangiocarcinoma that causes stenosis or obstruction of the common bile duct in most cases (95%) and presents as an intraductal polypoid mass in 5%.

Infiltrating cholangiocarcinoma shows thickening of the wall of the involved bile duct with hyperenhancement during arterial phase

A

Extrahepatic cholangiocarcinoma

*Most common (65%)

Abrupt stricture with thickening of duct wall may be the only findings

31
Q

Predisposing conditions of extrahepatic cholangiocarcinoma

A 
Choledochal cyst
Ulcerative colitis
Caroli disease
Clonorchis sinensis infection
PSC
32
Q

This neoplasm may produce large amount of mucin that markedly dilates the biliary tree and impairs the flow of bile

This tumors are intraductal, polypoid, and characterized by innumerable tiny-front-like papillary projections

A

Intraductal papillary mucinous tumor

33
Q

Gas in the biliary tract (pneumobilia) is the most commonly encountered in what cases?

A

Patient with surgically created biliary-enteric anastomosis, or who had a sphincterotomy to facilitate stone passage

34
Q

Most common cause of cholecystoduodenal fistula

A

Most commonly due to erosion of the gallstone through the gallblader and into the duodenum

When the gallstone is large, it may cause small bowel obstruction, that is, “gallstone ileus”

35
Q

Most common cause of choledochoduodenal fistula

A

Caused by a penetrating peptic eroding into the common bile duct

36
Q

Differential considerations for lesions in the gallbladder that may be mistaken for gallstones

A
  1. Sludge balls/ tumefactive biliary sludge
  2. Cholesterol polyps
  3. Adenomatous polyps
  4. Gallbladder carcinoma
  5. Adenomyomatosis
37
Q

Confident US diagnosis of acute cholecystitis requires the presence of this three findings

A
  1. Cholelithiasis
  2. Edema of the gallbladder wall (seen as a band of echolucency in the wall)
  3. Positive sonographic Murphy sign
38
Q

CT scan findings of acute cholecystitis

A

Gallstones
Distended gallbladder
Thickened gallbladder wall
Subserosal edema
High-density bile
Intraluminal sloughed membranes
Inflammatory stranding in pericholecystic fat
Pericholecystic fluid
Blurring of the interface between gallbladder and liver
Prominent arterial phase enhancement of the liver adjacent to the gallbladder

39
Q

Risk factors for acalculous cholecystitis

A 
Biliary stasis due to lack of oral intake
Posttrauma
Postburn
Postsurgery
On total parental nutrition

*Creator’s notes: Anything that can cause biliary stasis

40
Q

Term used to described the presence of thick particulate matter in highly concentrated bile

A

Sludge

41
Q

Imaging finding of biliary sludge

A

Sludge appears as:

Echodense bile on US
High attenuation bile on CT
Layering bile of different signal on MR

42
Q

Complications of acute cholecystitis

A
  1. Gallbladder empyema
  2. Gangrenous cholecystitis
  3. Perforation of the gallbladder
  4. Emphysematous cholecystitis
  5. Mirizzi syndrome
43
Q

The gallbladder distended with pus in a patient, often diabetic, with rapid progression of symptoms suggesting an abdominal abscess

A

Gallbladder empyema

44
Q

This refers to the condition of biliary obstruction resulting from a gallstone in the cystic duct eroding into the adjacent common duct and causing an inflammatory mass that obstructs the common duct

A

Mirizzi syndrome

Visualization of a stone at the junction of the cystic duct and the CHD in a patient with biliary obstruction and gallbladder inflammation suggest the diagnosis

45
Q

Imaging finding of chronic cholecystitis

A 
Gallstones
Thickening of the gallbladder wall
Contraction of the gallbladder lumen 
Delayed visualization of the gallbladder on cholescintigraphy 
Poor contractility
46
Q

Presence of dystrophic calcification in the wall of an obstructed and chronically inflamed gallbladder

A

Porcelain gallbladder

90% is associated with gallstones
10 to 20% risk of gallbladder carcinoma

47
Q

Also called limy bile

This is associated with an obstructed cystic duct, chronic cholecystitis, and gallstones

A

Milk of calcium bile

Dependent layering of bile can be demonstrated on conventional radiographs. The bile is extremely echogenic on US and gallstones may be visualized within it

48
Q

This is uncommon variant of chronic cholecystitis characterized by nodular deposits of lipid-laden macrophages in the gallbladder wall and proliferative fibrosis

A

Xanthogranulomatous cholecystitis

49
Q

Imaging findings of xantogranulomatous cholecystitis

A

Marked wall thickening (2 cm)
Fat-density nodules in the wall
Narrowing of the lumen

50
Q

Thickening of the gallbladder wall

How many mm?

A

Wall thickness measured on the hepatic aspect of the gallbladder exceeds 3 mm in patients who have fasted at least 8 hours

51
Q

Conditions with thickened gallbladder

A

Acute and chronic cholecystitis
Hepatitis
Portal venous hypertension and congestive heart failure
AIDS

52
Q

This is a benign condition of the gallbladder characterized by wall thickening caused by hyperplasia of the mucosa and smooth muscle

A

Adenomyomatosis

It may localize usually in the fundus, segmental, or diffuse involving the entire gallbladder

53
Q

Outpouchings of mucosa into or through the muscularis form characteristic Rokitansky–Aschoff sinuses, which are
diagnostic of what disease?

A

Adenomyomatosis

54
Q

Imaging findings of gallbladder carcinoma

A
  1. Intraluminal soft tissue mass
  2. Focal or diffuse thickening of the gallbladder wall
  3. Soft tissue mass replacing
  4. Gallstones
  5. Extension of tumor into the live, bile ducts, and adjacent bowel
  6. Dilated bile ducts
  7. Metastases to periportal and peripancreatic lymph nodes and liver

Gastrointestinal Imaging (Beri) (26 decks)

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