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KEVIN BURANT IV > Chapter 25 - Abdomen and Pelvis > Flashcards

Chapter 25 - Abdomen and Pelvis Flashcards

1
Q

Usual cause of ascites with attenuation values averaging +45 HU (p.673)

A

ACUTE BLEEDING

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2
Q

Two most gravity dependent portions of the peritoneal cavity? (p.673)

A

MORISON POUCH and PELVIS

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3
Q

UTZ appearance of simple ascites (p.673)

A

ANECHOIC

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4
Q

Exudative; hemorrhagic and neoplastic ascites often contains _______ in UTZ. (p.673)

A

FLOATING DEBRIS

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5
Q

Septations in ascites are associated with an ___ or ____ process.
(p.673)

A

INFLAMMATORY or MALIGNANT PROCESS

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6
Q

MR finding of Serous Ascites: in T1WI? In T2WI? In GRE?

p.673

A

T1WI: low signal intensity
T2WI: markedly increased in signal intensity
GRE: commonly bright due to fluid motion

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7
Q

_____refers to gelatinous ascites that occurs as a result
of intraperitoneal spread of mucin-producing cells resulting from rupture of appendiceal mucocele; intraperitoneal spread of benign or mucinous cysts of the ovary; or mucinous adenocarcinoma of the colon or rectum (p.673)

A

PSEUDOMYXOMA PERITONEI
(JELLY BELLY)

CR: punctate or ringlike calcifications scattered through the peritoneal cavity.
CT: mottled densities; septations and calcifications
US: intraperitoneal nodules that range from hypoechoic
to strongly echogenic within the fluid

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8
Q

Pneumoperitoneum is most commonly caused by _______ or __________. (p.673)

A

DUODENAL or GASTRIC ULCER PERFORATION

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9
Q

3 other additional causes pneumoperitoneum (p.673)

A
  1. TRAUMA
  2. RECENT SURGERY OR LAPAROSCOPY
  3. INFECTION OF THE PERITONEAL CAVITY WITH GAS-PRODUCING ORGANISMS
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10
Q

This refers to free air within the peritoneal cavity (p.673)

A

PNEUMOPERITONEUM

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11
Q

Post-operative pneumoperitoneum usually resolve in ___ to ___ days (p.673)

A

3 to 4 days

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12
Q

Failure of progressive resolution of post-operative pneumoperitoneum or an increase in air; suggests
________ (p.673)

A

LEAK OF BOWEL ANASTOMOSIS or SEPSIS

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13
Q

______ chest radiographs are the most sensitive

for free air or pneumoperitoneum. (p.674)

A

UPRIGHT Chest Radiograph

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14
Q

2 xray views that may be used with very ill patients to demonstrate air outlining the liver (p.674)

A
  1. LEFT LATERAL DECUBITUS view

2. CROSS-TABLE LATERAL view

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15
Q

Four signs of pneumoperitoneum on Supine radiographs

p.674

A 
1. gas on both sides of the bowel wall
(RIGLER SIGN)
2. gas outlining the falciform ligament
3. gas outlining the peritoneal cavity
(FOOTBALL SIGN)
4. triangular or linear localized extraluminal gas in the right upper quadrant
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16
Q

A good place to look for pneumoperitoneum on CT?

p. 674

A

PERITONEAL RECESS BETWEEN THE LIVER

AND THE DIAPHRAGM

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17
Q

2 modalities sensitive in detecting abdominal calcifications

than conventional radiographs (p.674)

A

CT and US

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18
Q

Aneurysms of the aorta are manifest by luminal diameter
exceeding ___ cm as measured between calcifications
in the aortic wall (p.675)

A

3 cm

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19
Q

Ringlike calcified aneuryms most commonly involve

the ___ or ____ arteries (p. 675)

A

SPLENIC or RENAL arteries

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20
Q

____ are calcfied thrombi in the veins most common visualized in the lateral aspects of the pelvis. (p._____)

A

PHLEBOLITHS

  • round or oval calcifications up to 5 mm in size
    that commonly contain a central lucency
  • may be mistaken for urinary tract calculi
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21
Q

Calcified Lymph nodes result most commonly from

granulomatous diseases such as _____ or ____ (p.675)

A

TUBERCULOSIS or HISTOPLASMOSIS

-calcified lymph nodes are usually mottled
and 10 to 15 mm in size

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22
Q

Most commonly calcified lymph node group?

p.675

A

MESENTERIC NODES

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23
Q

Most calcified gallstones contain ________
and have a _____ appearance with a dense outer rim
and more radiolucent center. (p. 675)

A

CALCIUM BILIRUBINATE;

LAMINATED appearance

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24
Q

Term for calcifications in the gallbladder wall

p.675

A

PORCELAIN GALLBLADDER

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25
Q

This term is a suspension of radiopaque crystals within

the gallbladder bile. (p.675)

A

MILK OF CALCIUM BILE

  • layering of the suspension can be
    demonstrated on ERECT radiographs
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26
Q

Urinary calculi which assumes the shape

of the renal collecting system (p. 675)

A

STAGHORN CALCULI

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27
Q

RENAL CALCULI versus GALLSTONES

(p. 675)

A

RENAL CALCULI: more POSTERIOR in position;

GALLSTONE: more ANTERIOR in position

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28
Q

3 most common areas of ureteral narrowing?

p.675

A
  1. URETEROPELVIC JUNCTION
  2. PELVIC BRIM
  3. VESICOURETERAL JUNCTION
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29
Q

Colonic calcium deposition often due

to an undigestible material such as fruit pit

A

ENTEROLITHS

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30
Q

Calcified adrenal glands are associated with adrenal

hemorrhage in the __ ; ___ and ____. (p.676)

A
  1. NEWBORN
  2. TUBERCULOSIS
  3. ADDISON DISEASE
  • calcification is mottled in the location of the
    adrenal glands on either side of the first lumbar
    vertebra
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31
Q

The calcification due to pancreatic calculi are usually

___ and of varying size (p.676)

A

COARSE

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32
Q

Calcification in the wall of a cyst is ___ or ____ - shaped

p. 676

A

CURVILINEAR or RING-SHAPED

  • ECHINOCOCCUS CYSTS commonly calcify
    and may be found in any intra-abdominal
    organ as well as within the peritoneal cavity.
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33
Q

Most characteristic tumor calcification in uterine

leiomyomas. (p.____)

A

COARSE POPCORN CALCIFICATIONS

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34
Q

Calcified injection granuloma from quinine;
bismuth; and calcium salts of penicillin
is commonly evident in the ______. (p. 676)

A

BUTTOCKS

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35
Q

__________ causes characteristic rice-grain

calcifications in muscles. (p. 676)

A

CYSTICERCOSIS

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36
Q

Neoplastic ascites is associated with ___ (p. 673)

A

INTRAPERITONEAL TUMORS

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37
Q

Normal gas in the abdomen is predominantly

________ (p. 677)

A

SWALLOWED AIR

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38
Q

Normal air-fluid levels are in the _____ and _____;

but never in the _______. (p.677)

A

STOMACH and SMALL BOWEL;
but never in the COLON
DISTAL TO THE HEPATIC FLEXURE

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39
Q

Normal air-fluid levels in the small bowel

should not exceed ____ in length. (p.677)

A

2.5 cm

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40
Q

Small bowel is dilated when it exceeds _____.
The colon is dilated when it exceeds ____ in diameter.
The cecum is dilated when it exceeds ____ in diameter.
(p.677)

A

2.5 to 3.0 cm in diameter;
5 cm in diameter;
8 cm in diameter

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41
Q

Small bowel is more ___ in the abdomen

and is characterized by ________ (p.677)

A

CENTRAL;

VALVULAE CONNIVENTES

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42
Q

Large bowel is more ______ in abdomen

and is characterized by ______. (p.678)

A

PERIPHERAL;

HAUSTRA

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43
Q 
\_\_\_\_\_ has the largest normal diameter of the
 large bowel (p.678)
A

CECUM

  • always dilates to the greatest extent
    irrespective of the site of obstruction
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44
Q

____; _____ and ______ are used interchangeably
and refer to stasis of bowel contents because of
decreased or absent peristalsis (p.678)

A

ADYNAMIC ILEUS; PARALYTIC ILEUS

and NON-OBSTRUCTIVE ILEUS

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45
Q

_____ typically demonstrates diffuse symmetric;

predominantly gaseous; distension of bowel (p.678)

A

ADYNAMIC ILEUS

  • small bowel; stomach and colon
    are proportionally dilated without
    an abrupt transition
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46
Q

_____ refers to a segment of intestine that becomes
paralyzed and dilated as it lies next to an inflamed
intraabdominal organ. (p.678)

A

SENTINEL LOOP

  • in essence; it is a short segment of adynamic ileus
    that appears as an isolated loop of distended intestine
    that remains in the same general position on serial
    images
    -alerts one to the presence of an adjacent inflammatory
    process
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47
Q

A sentinel loop in the RUQ suggest ___; ____ and___.

p.678

A
  1. ACUTE CHOLECYSTITIS
  2. HEPATITIS
  3. PYELONEPHRITIS
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48
Q

A sentinel loop in the LUQ suggest ___; ____ and___.

p.678

A
  1. PANCREATITIS
  2. PYELONEPHRITIS
  3. SPLENIC INJURY
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49
Q 
A sentinel loop in the LOWER QUADRANTS
 suggest \_\_\_ (give 5). (p.678)
A
  1. DIVERTICULITIS
  2. APPENDICITIS
  3. SALPINGITIS
  4. CYSTITIS
  5. CROHN DISEASE
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50
Q

______ is a manifestation of fulminant colitis
characterized by extreme dilation of all or a portion
of the colon. (p. 678)

A

TOXIC MEGACOLON

  • absent peristalsis
  • large bowel loses all tone and contractility
  • bowel wall becomes like wet blotting paper
  • risk of perforation is extreme
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51
Q

Most common cause of toxic megacolon

p.678

A

ACUTE ULCERATIVE COLITIS

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52
Q

Most striking finding in Toxic Megacolon

p. 678

A

DILATION OF THE TRANSVERSE COLON

UP TO 15 cm IN DIAMETER

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53
Q

Toxic megacolon diagnosis is suggested when the
diameter of the colon exceeds ___ cm
and the mucosa appears abnormal. (p.678)

A

exceeds 5 cm

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54
Q

TRUE OR FALSE. Barium enema is absolutely contraindicated in TOXIC MEGACOLON because of the risk of perforation.
(p.678)

A

TRUE

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55
Q

___ means stasis of bowel contents above a focal

lesion. (p.678)

A

MECHANICAL BOWEL OBSTRUCTION

  • obstruction may be due to obturation
    (occlusion by a mass in the lumen);
    stenosis due to intrinsic bowel disease;
    compression of the lumen by extrinsic disease
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56
Q

3 goals in imaging mechanical bowel obstruction.

p. 678

A
  1. Confirm the presence of obstruction
  2. Identify its level
  3. Demonstrate its cause
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57
Q

Radiographs can confirm the presence of bowel
obstruction _____ hours before the diagnosis
can usually be made clinically. (p.678)

A

6 to 12 hours before

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58
Q

Type of obstruction which means that the lumen

is totally occluded. (p.678)

A

COMPLETE OBSTRUCTION

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59
Q

Type of obstruction which means some bowel

contents pass through. (p.678)

A

PARTIAL OBSTRUCTION

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60
Q

Type of obstruction which refers to blockage of the
luminal contents without interference of blood supply.
(p.678)

A

SIMPLE OBSTRUCTION

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61
Q

Type of obstruction which means that the blood supply

to the bowel wall is impaired. (p.678)

A

STRANGULATION OBSTRUCTION

  • most strangulation obstruction
    are closed-loop obstructions.
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62
Q

Type of obstruction which means blockage
of a bowel loop segment at both ends.
(p.678)

A

CLOSED-LOOP OBSTRUCTIONS

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63
Q

______ is the term applied to necrotizing fasciitis
of the perineum; perianal and genital regions
(p.679)

A

FOURNIER GANGRENE

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64
Q

In the western world; ___ account for 75%

of the small bowel obstruction (p.679)

A

POST-SURGICAL ADHESIONS

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65
Q

In developing nations; 80% of small bowel

obstruction is caused by ____ (p.679)

A

INCARCERATED HERNIA

  • but only 10% is caused by adhesions
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66
Q

DIAGNOSIS.
Radiographic findings: (p.679)
1. DILATED LOOPS OF SMALL BOWEL (> 3 cm)
disproportionate to more distal small or colon
2. SMALL BOWEL AIR-FLUID LEVELS that exceed
2.5 cm in width
3. AIR-FLUID LEVELS AT DIFFERING HEIGHTS
(> 5 mm) within the same loop (dynamic air-fluid
levels)
4. TWO OR MORE AIR-FLUID LEVELS
5. SMALL BUBBLES OF GAS TRAPPED BETWEEN FOLDS
IN DILATED ; FLUID-FILLED LOOPS PRODUCING THE
STRING OF PEARLS sign

A

small bowel obstruction

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67
Q

___ is a row of small gas bubbles oriented horizontally

or obliquely across the abdomen (p.679)

A

STRING OF PEARLS sign

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68
Q

CT DIAGNOSTIC FINDING of small bowel obstruction

p.679-680

A

demonstration of a transition site between
small bowel loops dilated with fluid or
air and collapsed bowel loops distal to
the obstruction

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69
Q

____ sign is strong CT evidence of bowel obstruction.

p.680

A

SMALL-BOWEL FECES sign

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70
Q

DIAGNOSIS.
CT FINDINGS: (p.680)
1. CIRCUMFERENTIAL WALL THICKENING
(>3mm)
2. EDEMA OF THE BOWEL WALL
(Target or Halo appearance of the bowel wall)
3. LACK OF ENHANCEMENT OF THE BOWEL WALL
(most specific sign)
4. HAZINESS OR OBLITERATION OF THE MESENTERIC VESSELS
5. INFILTRATION OF THE MESENTERY WITH FLUID OR
HEMORRHAGE

A

Strangulation Obstruction

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71
Q

DIAGNOSES (2).
4 CT signs: (p. 680)
1. Radial distribution of dilated small bowel
with mesenteric vessels converging toward a
focus of torsion
2. U-shaped or C-shaped dilated small bowel loop
3. BEAK sign at the site of torsion seen as fusiform tapering
of a dilated bowel loop
4. WHIRL sign to tightly twisted mesentery seen with volvulus
- presence of a whirl sign in patient with small bowel obstruction
correlates strongly with the need for surgery.

A

SMALL BOWEL VOLVULUS and

CLOSED-LOOP OBSTRUCTION

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72
Q

_____ is a major cause of small bowel obstruction

in children but is less common in adults. (p.680)

A

INTUSSUSCEPTION

  • in adults; it is often chronic; intermittent
    or subacute and is usually caused
    by a polypoid tumor ; such as lipoma
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73
Q

Other 4 causes of Intussusception aside from

polypoid tumor or lipoma? (p.680)

A
  1. Meckel Diverticulum
  2. Lymphoma
  3. Mesenteric nodes
  4. Foreign bodies
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74
Q

ILEOCOLIC INTUSSUSCEPTION is usually
____ in children but is caused by a __ in adults
(p.680)

A

IDIOPATHIC; MASS

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75
Q

COLOCOLIC INTUSSUSCEPTION is ____ in adults

but ____ in children. (p.680)

A

COMMON; RARE

76
Q

Barium study finding of Intussusception?

p.680

A

COILED SPRING APPEARANCE

  • barium trapped between the intussusception
    and the receiving bowel
77
Q

CT finding of intussusception (p.681)

A

TARGET-LIKE INTESTINAL MASS

78
Q

Ultrasound finding of intussusception (p.681)

A 
DONUT configuration of alternating 
hyperechoic and hypoechoic rings 
representing alternating mucosa; 
muscular wall and mesenteric fat tissues
 in cross section
79
Q

___ is a cause of mechanical small bowel obstruction
that should be suspected in any elderly woman
with small bowel obstruction (p.____)

A

GALLSTONE ILEUS

-bowel obstruction is caused by a large gallstone
that erodes through the gallbladder wall and
passes into the intestine; creating a cholecystoduodenal
fistula.

80
Q

GALLSTONE IN GALLSTONE ILEUS most commonly

lodges in the ____. (p. 681)

A

DISTAL ILEUM
- causative gallstones are typically single;
faceted and 2 to 5 cm in size

81
Q

Components of the RIGLER TRIAD (p. 681)

A 
1. DILATED SMALL BOWEL LOOPS
(80% of cases)
2. AIR IN THE BILIARY TREE OR GALLBLADDER
(67%)
3. CALCIFIED GALLSTONE IN AN 
ECTOPIC LOCATION (50%)
82
Q

When the cecum exceeds __ cm in diameter;
it is at high risk for perforation with attendant risks
of peritonitis and septic shock. (p.681)

A

10 cm

83
Q

Most colonic obstructions occur in the ___ colon.

p. 681

A

SIGMOID

  • bowel lumen is narrower;
    stool is more formed
84
Q

RADIOGRAPHIC FINDING diagnostic in large bowel

obstruction. (p.681)

A

DILATION OF THE COLON FROM THE CECUM
TO THE POINT OF OBSTRUCTION

  • colon distal to the obstruction is devoid of gas
85
Q

Air-fluid levels distal to the ______ are strong evidence of obstruction unless the patient has had an enema
(p.681)

A

HEPATIC FLEXURE

86
Q

Sigmoid volvulus is most common in the ___
and in individuals on ____ diets. (p.681)

  • sigmoid colon twists around its mesentery;
    resulting in a closed-loop obstruction
A

ELDERLY; HIGH-RESIDUE diets

87
Q

Radiographic diagnosis when a large-gas filled loop
without haustral markings arises from the pelvis
and extending high into the abdomen and often to the diaphragm. (p.681)

A

SIGMOID VOLVULUS

88
Q

Radiographic sign in SIGMOID VOLVULUS where the
apex of the distended sigmoid colon may
extend cephalad to the transverse colon. (p.681)

A

NORTHERN EXPOSURE SIGN

89
Q 
Barium enema (in SIGMOID VOLVULUS)
demonstrates obstruction that tapers to a beak 
at the point of the twist; usually
approximately \_\_\_ cm above the anal verge. (p.681)
A

15 cm

90
Q

DIAGNOSIS.
5 CT FINDINGS: (p.681-682)
1. Inverted; dilated U-shaped sigmoid colon
2. Absence of gas in the rectum
3. Transition zones between dilated and
collapsed bowel occur at the point of twisting
4. Oblique lines created by the orientation
of the transition zones create the X-MARKS
THE SPOT SIGN appreciated on the sequential
images
5. A single beak-shaped transition point corres-
ponding to the beak sign seen on barium enema

  • as a closed loop-obstruction the bowel is prone
    to ischemia and perforation; signs of which must
    be carefully sought.
A

SIGMOID VOLVULUS

91
Q

___ causes 1% to 3% of large bowel obstruction
in adults and occurs most frequently in the
30 to 60 years age group (p.682)

A

CECAL VOLVULUS

  • a closed-loop obstruction that may result
    in ischemia; necrosis and perforation
  • most common type: the twist and invert
    with the cecum displaced to the left upper quadrant.
92
Q

____ refers to a folding of the cecum to a position

anteromedial to the ascending colon; rather like folding the toe of a sock back on itself (p._____)

A

CECAL BASCULE

93
Q

DIAGNOSIS.
Four classic radiographic findings: (p.682)
1. Coffee bean-shaped loop of gas-distended bowel having haustral
markings directed toward the left upper quadrant
2. Apex of the cecum in the left upper quadrant
3. Cecal distension greater than 10 cm in diameter
4. Collapse of the distal colon

  • proximal small bowel dilatation may or may not be present
A

CECAL VOLVULUS

94
Q

DIAGNOSIS.
Seven CT findings: (p.682)
1. Cecum in the upper mid and left abdomen
2. Volvulus in the RLQ seen as an area of swirling of the bowel and mesenteric fat (WHIRL SIGN)
3. Appendix is displaced to the left upper quadrant
4. Two transition points are present; one for the entering loop and one for the exiting loop
5. when the loops are completely wound around each other an X-MARKS THE SPOT sign is present formed by the crossing
configuration of the transition zones
6. cecum is distended more than 10 cm
7. distal large bowel is decompressed

A

CECAL VOLVULUS

95
Q

____ is the most common cause of large bowel obstruction

in elderly and bedridded patients. (p.682)

A

FECAL IMPACTION

96
Q

___ is a rare inflammation of the wall of the colon caused by fecal impaction. (p.682)

A

STERCORAL COLITIS

97
Q

____ is clinical disorder of acute colonic distension with abdominal pain and distension but without the presence of mechanical obstruction (p.682)

A

COLONIC PSEUDOOBSTRUCTION (OGILVIE SYNDROME)

  • radiographs demonstrate dilatation of the colon most commonly from cecum to splenic flexure
  • CT demonstrates the same findings with additional evaluation for wall thickening associated with colitis or findings of colonic ischemia
98
Q

DIAGNOSIS.
10 CT findings: (p. 683)
1. Circumferential or nodular thickening (>5 mm) of the bowel wall with infiltration of low-density edema or high-density blood; resulting from mucosal injury.
2. thumbprinting resulting from this nodular infiltration of the bowel wall
3. dilatation of the bowel lumen (>3cm) for small bowel; >5cm for colon; > 8cm for cecum)
4. PNEUMATOSIS INTESTINALIS
5. Edema or hemorrhage into the mesentery
6. engorged mesenteric vessels
7. Thrombosis of mesenteric arteries or veins
8. poor enhancement of the bowel wall along its mesenteric border; which is evidence of ischemia
9. poor or absent mucosal enhancement with thinning of the bowel wall; which is evidence of bowel infarction
10. ascites; which is commonly present

A

bowel ischemia

99
Q

____ refers to the presence of gas within the bowel wall (p. 683)

A

PNEUMATOSIS INTESTINALIS

  • it may occur as a benign entity without clinical significance or may be an important finding of bowel ischemia
  • RADIOGRAPHIC SIGN; not a disease
100
Q

4 causes of Pneumatosis Intestinalis (p.683)

A
  1. BOWEL NECROSIS; usually associated with other radiographic and clinical signs of bowel ischemia
  2. MUCOSAL DISRUPTION; caused by ulcers; mucosal biopsies; trauma; enteric tubes; or inflammatory bowel disease
  3. INCREASED MUCOSAL PERMEABILITY related to immunosuppression in AIDS;organ transplantation or chemotherapy
  4. PULMONARY DISEASE resulting in alveolar disruption and dissection of air along interstitial pathways to the bowel wall.
101
Q

TRUE OR FALSE. Pneumatosis in asymptomatic patients is very likely benign and incidental. (p.____)

A

TRUE

102
Q

TRUE OF FALSE. Pneumatosis in seriously ill patients with abdominal pain or distension is more likely to be a sign of bowel ischemia. (p.____)

A

TRUE

103
Q

____ appears on radiographs or CT as cystic air bubbles (few mms to several cms) or linear streaks of air within the bowel wall; esp in its most gravity-dependent aspect (p.683)

A

PNEUMATOSIS

104
Q

meaning of the acronym FAST? (p.683)

A

FOCUSED ABDOMINAL SONOGRAMS FOR TRAUMA

  • may be used to detect the presence of intraperitoneal fluid to triage trauma patients for CT
105
Q 
DIAGNOSIS.
CT findings: (p.683)
1. HEMOPERITONEUM
2. SENTINEL CLOT
3. ACTIVE BLEEDING
4. FREE AIR WITHIN THE PERITONEAL ACTIVITY
5. FREE CONTRAST WITHIN THE PERITONEAL ACTIVITY
6. SUBCAPSULAR HEMATOMAS
7. INTRAPARENCHYMAL HEMATOMAS
8. LACERATIONS
9. ABSENCE OF ORGAN ENHANCEMENT
10. INFARCTIONS
A

traumatic injury

106
Q

_____ acute blood within the peritoneal cavity measuring 30 to 45 HU (p.683)

A

HEMOPERITONEUM

107
Q

____ a focal collection of clotted blood (>60 H) that maybe seen in the peritoneal cavity adjacent to an injured organ (p.683)

A

SENTINEL CLOT

108
Q

Active bleeding in abdominal trauma is seen as extravasated contrast (85 to 370 H); seen during ___ phase of scanning with MDCT. (p. 683)

A

ARTERIAL

109
Q

____ an insensitive sign of bowel injury provided that diagnostic peritoneal lavage has not been performed (p.683)

A

FREE AIR WITHIN THE PERITONEAL CAVITY

110
Q

____ this may result from oral contrast leaking from injured bowel or IV contrast leaking from a ruptured bladder. (p.___)

A

FREE CONTRAST WITHIN THE PERITONEAL CAVITY

111
Q

______ appear as crescent-shaped collections confined by the capsule of the injured organ (p.683)

A

SUBCAPSULAR HEMATOMAS

112
Q

____ this appears as an irregularly shaped low-density areas within a contrast-enhanced solid organ (p.683)

A

INTRAPARENCHYMAL HEMATOMAS

113
Q

___ this appears as jagged linear defects defined by lower-density blood within a contrast-enhanced injured organ in abdominal trauma (p. 683)

A

LACERATIONS

114
Q

___ reflects damage to the organ’s arterial supply in abdominal traumas. (p.683)

A

ABSENCE OF ORGAN ENHANCEMENT

115
Q

_____ are seen as zones of decreased contrast enhancement that extend to the capsule of a solid organ in abdominal traumas. (p.683)

A

INFARCTIONS

116
Q

The abdomen and pelvis contain more than __ lymph nodes that may be involved in a wide variety of neoplastic and inflammatory diseases.(p. 684)

A

230

117
Q

____ measurements of lymph node size are preferred to determine abnormal enlargement. (p. 684)

A

SHORT-AXIS

118
Q

3 Morphologic patterns of PATHOLOGIC lymphadenopathy include ___; ___ or ____. (p. 684)

A
  1. SINGLE ENLARGED NODES
  2. MULTIPLE SEPARATE LOBULATED ENLARGED NODES
  3. BULKLY CONGLOMERATE MASSES OF LYMPH NODES
119
Q

Calcifications in enlarged nodes may be seen with __ ; ___; ___ and ___. (p. 684)

A
  1. INFLAMMATORY ADENOPATHY
  2. MUCINOUS CARCINOMAS
  3. SARCOMAS
  4. TREATED LYMPHOMA
120
Q

TRUE OR FALSE. Normal nodes are oblong in shape.(p.684)

A

TRUE

121
Q

Most pathologically enlarged nodes have CT densities ____ than skeletal muscle. (p.684)

A

SLIGHTLY LESS

122
Q

Low-density nodal metastases are commonly seen with __;___ and ___. (p.684)

A
  1. NON-SEMINOMATOUS TESTICULARCARCINOMA
  2. TUBERCULOSIS
  3. occasionally LYMPHOMA
123
Q

Radiographic sign wherein masses of retroperitoneal nodes may silhoutte segments of the normally echogenic wall of the aorta. (p.685)

A

SONOGRAPHIC SILHOUTTE SIGN

124
Q

Radiographic sign which refers to entrapment of mesenteric vessels by masses of enlarged lymph nodes in the mesentery. (p.685)

A

SANDWICH SIGN

125
Q

LYMPH NODE MRI SIGNAL CHARACTERISTICS: in T1WI? In T2WI? (p.___)

A

T1WI: low signal intensity compared to surrounding fat;
T2WI: high signal intensity compared to muscle

126
Q

______ is responsible for 20% to 40% of all lymphoma and is characterized histologically by the presence of REED-STERNBERG CELL. (p.685)

A

HODGKIN LYMPHOMA

  • has a bimodal age distribution most commonly affecting patients aged 25 to 30 years and older than 50 years
127
Q

____ is responsible for 60% to 80% of lymphoma.(p.685)

A

NON-HODGKIN LYMPHOMA

  • a heterogeneous group of disorders with a confusing array of changing names and classifications
  • particularly common in immunocompromised patients
128
Q

Solid organ involvement of Non-Hodgkin lymphoma primarily affects the following organs (6). (p. 685)

A
  1. SPLEEN
  2. LIVER
  3. PANCREAS
  4. KIDNEYS
  5. ADRENAL GLANDS
  6. TESTES
129
Q

DIAGNOSIS.
5 manifestations: (p.685)
1. Solitary or multiple homogeneous well-defined nodules;
2. Confluent masses;
3. Mild uniform contrast enhancement of nodules and masses;
4. Diffuse involvement producing only organomegaly;
5. Organ invasion from adjacent tissue.

A

Non-Hodgkin’s Lymphoma

130
Q

5 GI involvement of Non-Hodgkin Lymphoma (p.685)

A
  1. Wall involvement deep to the mucosa that may be missed at endoscopy;
  2. Circumferential wall thickening;
  3. Luminal dilatation; narrowing or cavitation
  4. Nodules; polyps and ulcers
  5. Impaired peristalsis
131
Q

____ is a spectrum of lymphoid hyperplasias and neoplasias in patients who have received solid organ transplants and immunosuppresive therapy. (p.685)

A

POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER
(PTLD)

  • the disorder results from an Epstein-Barr virus-induced proliferation of B lymphocytes that is usually opposed by functioning T cells.
132
Q

Extranodal involvement in solid organs with discrete solitary; multiple or infiltrative masses is most common in what condition. (p.685)

A

POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER
(PTLD)

  • GI involvement is similar to NHL and includes wall thickening; luminal narrowing;eccentric extraluminal mass; luminal ulceration and stranding in the mesentery.
  • Treatment is reduction of immunosuppresive therapy
133
Q

____ is an uncommon primary tumor of the peritoneal membrane (p.685)

A

PERITONEAL MESOTHELIOMA

  • all are closely associated with asbestos exposure
  • US demonstrate the sheetlike superficial masses
  • prognosis is poor; with most patients dying within 1 year of diagnosis
134
Q

One-third of all mesotheliomas arise from the ______ with most of the remainder arising from the ____. (p.685)

A

PERITONEUM; PLEURA

135
Q

Cake-like thickening of the omentum (p.686)

A

OMENTAL CAKE

  • In PERITONEAL mesothelioma; CT demonstrates nodular; irregular peritoneal and omental thickening and masses; which merge to large plaques
136
Q

Peritoneal metastases are most commonly associated with these four carcinomas.(p.686)

A

OVARIAN, COLON, STOMACH and PANCREAS CARCINOMA

MNEMONIC: PM PaCOS

137
Q

Three preferential sites for tumor implantation of peritoneal metastases (p.686)

A
  1. PELVIC CUL-DE-SAC
  2. RIGHT PARACOLIC GUTTER
  3. GREATER OMENTUM
138
Q 
DIAGNOSIS.
5 CT findings: (p.686)
1. Tumor nodules on peritoneal surfaces
2. Omental Cake
3. Tumor nodules in the mesentery
4. Thickening and nodularity of the bowel wall due to serosal implants
5. Ascites; that is commonly loculated
A

PERITONEAL METASTASES

139
Q

____ occurs when the primary sites of hematopoiesis in the bone marrow fail as a result of myelofibrosis or when hemolytic anemias overwhelm blood cell production (sickle cell disease and thalassemia) (p.686)

A

EXTRAMEDULLARY HEMATOPOIESIS

  • bilateral; relatively symmetric and enhance mildy; and homogeneously postcontrast
140
Q

The most obvious manisfestations of EXTRAMEDULLARY HEMATOPOIESIS are homogeneous well-marginated paraspinal masses that favor the _____ spine. (p.686)

A

THORACIC spine

141
Q

____ are benign cystic lesions that arise from lymphatic vascular channels. (p.686)

A

LYMPHANGIOMAS

  • cystic mass contains septations and multiple loculations
  • lesions occur in the omentum; mesentery; mesocolon and retroperitoneum
142
Q

CT finding in Lymphangiomas (p.686)

A

Fluid density mass with enhancing wall and septa

  • US shows better multilocular nature of the mass
143
Q

____ arise in the retroperitoneal tissues outside of the retroperitoneal organs. (p.686)

A

PRIMARY RETROPERITONEAL NEOPLASMS

144
Q

Most common sarcoma of the retroperitoneum (p.686)

A

LIPOSARCOMAS

-containts distinct fat density (other example: TERATOMAS)

145
Q

______ is rare condition manifest by formation of a fibrous plaque in the lower retroperitoneum that encases and compresses the aorta; inferior vena cava and ureters. (p.686)

A

RETROPERITONEAL FIBROSIS

  • 2/3 of cases are idiopathic.
  • the fibrotic plaque is usually located over the anterior surfaces of the L4 and L5 vertebrae.
  • plaques are typically of low signal intensity on both T1WI and T2WI;
  • plaques that shows high signal intensity on T2WI should be considered suspicious for malignancy as a cause
146
Q

____ an ergot prescribed for migraine headache; causes 12% of RETROPERITONEAL FIBROSIS cases. (p.686)

A

METHYSERGIDE

147
Q

TRUE OR FALSE. On US; retroperitoneal fibrosis is easily confused with lymphoma (p.___)

A

TRUE

148
Q

TRUE OR FALSE. Wooden foreign bodies are usually not visualized on conventional radiographs. (p.686)

A

TRUE

  • CT shows high attenuation of the wooden object.
149
Q

_______ are a rare but dreaded complication of surgery. (p.687)

A

RETAINED SURGICAL SPONGES (gossypiboma)

  • retained sponges may be asymptomatic; causes an abscess; or abscess; or generate a granulomatous response; inducing fibrosis and calcification
150
Q

_____ occur within the peritoneal cavity because of spillage of contaminated material from perforated bowel or as a complication of surgery; trauma; pancreatitis; sepsis; or AIDS (p.____)

A

ABSCESSES

151
Q

_____ is the most common site for abscess formation.(p.688)

A

PELVIS

152
Q 
DIAGNOSIS.
7 Radiographic findings: (p.688)
1. Soft tissue mass
2. Collection of extraluminal gas 
3. Displacement of bowel
4. localized or generalized ileus
5. elevation of the diaphragm
6. pleural effusion
7. Atelectasis or consolidation at the lung bases
A

ABSCESSES

153
Q

Most SPECIFIC sign of ABSCESS; but is UNCOMMON (p.688)

A

A FOCAL COLLECTION OF EXTRALUMINAL GAS

  • CT shows a loculated fluid collection; often with internal debris and fluid-fluid levels.
154
Q

_________ within the fluid collection is strong evidence of abscess. (p.688)

A

GAS

155
Q

Gas within the fluid collection is evidenced by echogenic foci producing ___ or ___ artifacts. (p.688)

A

COMET-TAIL or REVERBERATION artifacts

156
Q

A ___ of the abdominal wall is a protrusion of bowel; omentum; or mesentery through a defect in the wall of the abdomen or pelvis. (p.____)

A

HERNIA

157
Q

_____ refers to hernias that are not reducible. (p.688)

A

INCARCERATION

158
Q

____ refers to hernias associated with bowel obstruction and bowel ischemia. (p.688)

A

STRANGULATION

159
Q

____ hernias entrap only a portion of the bowel wall without compromising viability. (p.688)

A

RICHTER

160
Q

____ hernias are most common in children and adults (p.688)

A

INGUINAL

161
Q

_____ hernias extend throughout the internal inguinal ring in the inguinal canal LATERAL to the inferior epigastric vessels.
(p.688)

A

INDIRECT INGUINAL hernias

162
Q

___ hernias occur medial to the inferior epigastric vessels directly into the inguinal canal through a weakness in its floor (p.688)

A

DIRECT INGUINAL hernias

163
Q

____ hernias are complications of surgery with herniation through the surgical incision.(p.688)

A

INCISIONAL HERNIAS

164
Q

____ hernias occur in association with surgically created stomas. (p. 688)

A

PARASTOMAL hernias

165
Q

____ hernias occur through defects in the lumbar musculature posterolaterally below the 12th rib and above the iliac crest.
(p.688)

A

LUMBAR hernias

166
Q

____ hernias occus in the lower abdominal wall lateral to rectus abdominis and inferior to the umbilicus through a defect in the aponeurosis of the transverse abdominis and internal oblique muscles. (p.688)

A

SPIGELIAN hernias

167
Q

A CD4+ T-cell count below ____ cells/mm3 is diagnostic of AIDS. (p.689)

A

below 200 cells/mm3 (normal is 800 to 1000 cells/mm3)

168
Q

AIDS is characterized by multiple opportunistic infections and aggressive malignancies; most commonly ____ and ___. (p.689)

A

KAPOSI SARCOMA (KS) and AIDS-related lymphoma.

  • infection by multiple organisms at multiple sites
169
Q

_____ are the most useful modalities for evaluating the solid visceral organs; adenopathy and the peritoneal cavity. (p.690)

A

CT and US

170
Q

______ causes pneumonia in nearly 80% of patients with AIDS. (p.690)

A

Pneumocystis carinii

171
Q

______ is a cause of bulky abdominal adenopathy; hepatosplenomegaly and focal lesions in the liver and the spleen. (p.690)

A

ATYPICAL MYCOBACTERIUM

172
Q

___ and ___ are common causes of esophagitis as well as gastric antritis and duodenitis. (p.690)

A

CANDIDA ALBICANS and CYTOMEGALOVIRUS

173
Q

____ and ____ are protozoans; previously found only in animals; that infect the GI tract and causes severe diarrhea. (p.690)

A

CRYPTOSPORIDIUM and ISOSPORA BELLI

174
Q

___ and ___ are causes of AIDS-related cholangitis. (p.690)

A

CRYPTOSPORIDIUM and CYTOMEGALOVIRUS

175
Q

_______ occurs as the most common malignancy associated with AIDS and may also occur in organ transplant patients.
(p.690)

A

KAPOSI SARCOMA

176
Q

______ are extremely aggressive neoplasms that respond poorly to therapy and commonly involve the extranodal sites. (p.690)

A

AIDS-related Lymphomas

  • median survival is only 5 to 6 months
  • extranodal involvement is found at presentation in most patients (CNS in 27%)
177
Q

_____ is serous fluid in the peritoneal cavity (p.673)

A

ASCITES

178
Q

Ascites is most commonly caused by _____ (p.673)

A
  1. CIRRHOSIS
  2. HYPOPROTEINEMIA
  3. CONGESTIVE HEART FAILURE
179
Q

Exudative ascites results from inflammatory processes such as _____ (p.673)

A
  1. ABSCESS
  2. PANCREATITIS
  3. PERITONITIS
  4. BOWEL PERFORATION
180
Q

Hemoperitoneum results from _____ (p.673)

A
  1. TRAUMA
  2. SURGERY
  3. SPONTANEOUS HEMORRHAGE
181
Q

Neoplastic Ascites is associated with ___ (p. 673)

A

INTRAPERITONEAL TUMORS

182
Q

Conventional Radiographic diagnosis of ascites requires that at least ___ mL of fluid be present. (p.673)

A

at least 500 ml of fluid

183
Q

DIAGNOSIS.
Six radiographic findings: (p.673)
1. Diffuse increase in density of the abdomen
(gray abdomen)
2. indistinct margins of the liver; spleen and psoas muscles
3. medial displacement of gas-filled colon; liver and spleen away from the properitoneal flank stripe
4. bulging of the flanks
5. increased separation of gas-filled small bowel loops
6. dog’s ears appearance of symmetric densities in the pelvis
due to fluid spilling out of the cul-de-sac on either of the bladder

A

ASCITES

184
Q

DISGNOSIS.
CT finding: (p.673)
Fluid density in the recesses of the peritoneal cavity

A

ASCITES

185
Q

Type of ascites with attenuation values near water

-10 to +10 HU) (p.673

A

SEROUS ASCITES

186
Q

Type of ascites with attenuation values usually above +15 HU (p.673)

A

EXUDATIVE ASCITES

KEVIN BURANT IV (20 decks)

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