Body Flashcards
Hypervascular lymph nodes ddx
- Castleman disease
- Kaposi sarcoma
- hypervascular metastases
- Kimura disease
- angioimmunoblastic T-cell lymphoma
Bosniak 3 cysts (indeterminate) ddx:
- cystic nephroma (benign)
- cystic clear cell renal carcinoma (malignant)
- complex benign hemorrhagic cysts
Note Bosniak 3 features:
thick irregular calcification, irregular margins, thick or enhancing septa, areas of nodularity, thick walls, and multilocular mass
Hyperechoic renal lesion ddx
- AML (many have posterior acoustic shadowing)
- RCC (33% hyperechoic, rarely posterior acoustic shadowing)
- lymphoma
- metastases
- oncocytoma
- milk of calcium cyst
Toxic megacolon ddx
- Ulcerative colitis (top cause)
- Crohn disease
- infectious colitis (especially C. difficile colitis)
- neutropenic colitis
- ischaemic colitis
- radiation-induced colitis
- colonic lymphoma
- gastrointestinal graft-versus-host disease (post BMT)
- hypothyroidism (myxoedema megacolon)
Medullary calcinosis ddx
- medullary sponge kidney
- renal tubular acidosis type 1
- hyperoxaluria
- hyperparathyroidism
Similar appearance:
- emphysematous pyelonephritis
- renal stones
- papillary necrosis
Hepatic adenoma subtypes
- inflammatory/gp-130 mutated (T2 hyperintense and avidly arterially enhancing)
- TCF-1/HNF1-alpha mutated (oral contraceptive use and are only seen in females, contain fat)
- beta-catenin activated (associated with male hormone use)
- other
distinct clinical and imaging characteristics, usually allowing for the accurate classification of lesions without the need for a biopsy
Pediatric liver tumor ddx
- HCC: - peak incidence 10-15yo - solid arterially enhancing mass in a CIRRHOTIC liver eg post neonatal biliary atresia, ELEVATED AFP
If <5yrs
- Mesenchymal Hamartoma: - masses have prominent CYSTIC components - normal AFP
- Infantile Hemangioendothelioma: - highly vascular solid mass with areas of HIGH DOPPLER FLOW representing arteriovenous fistulas (may cause high output heart failure) - AFP normal, but VEGF elevated
- Hepatoblastoma: - solid enhancing lesion, ELEVATED AFP (90% of cases)
Polyposis syndromes ddx
Adenomatous
- FAP (auto dominant, 400x risk of hepatoblastima, need prophylactic colectomy)
— Gardner (DOPE, desmoid, osteoma, papillary thyroid Ca, epidermoid)
— Turcot (APC mutation get medulloblastoma, HNPCC gene get glioblastoma)
Hamartomatous
- Peutz-Jegher (AD, 10yrs, small bowel and stomach polyps, risk of many Ca increased, polyps not precancerous, perioral pigmentation, intussusception presentation)
- Cowden syndrome (AD, PTEN hamartoma syndrome, fibrocystic breast change and breast Ca, folllicular thyroid Ca, multinodular goitre, cerebellar dysplastic gangliocytome aka L’hermitte Duclos, trichellemomas, other Ca)
- Cronkite Canada syndrome (no inheritance pattern, Ernest 68yrs man water diarrhea, nail dystrophy alopecia)
Calcified hepatic lesion ddx
- granuloma (prev TB/fungal infection)
- calcified hyatid cyst
- fibrolamellar HCC
- cholangiocarcinoma
- metastases from mucin-producing primary malignancy eg ovarian/colorectal
Calcified liver lesion
- granuloma (TB)
- ecchinococcal cyst
- large hemangioma
- hepatocellulr adenoma (eccentric)
- fibrolamellar HCC (up to 25%)
- cholangiocarcinoma
- metastases (especially mucin producing tumor eg colon)
Dilated esophagus ddx
- achalasia
- systemic sclerosis
- Chagas disease
- esophageal stricture
- anti-Hu antibodies from lung cancer
Diffusely increased liver attenuation on CT
- iron deposition (haemosiderosis, thalassaemia, haemochromatosis: one paper suggests investigation for iron overload if unenhanced liver density is >75 HU)
- copper deposition (Wilson disease)
- glycogen storage diseases
- medications/drugs (amiodarone, gold, previous Thorotrast)
Lower oesophageal narrowing/bolus holdup ddx
- intrinsic or extrinsic mass, benign (eg leiomyoma, abherrant subclavian a.) or malignant (carcinoma, mediastinal mass)
- inflammatory stricture (eg Crohn’s, acid related eg Zollinger Ellison)
- achalasia (inc acquired Chagas)
Infections that cross tissue planes
- tuberculosis
- actinomycosis (a/w IUD in pelvis, oral flora aspirated in chest)
