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Clinical Radiology 2A > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is a Schatzki?

A

When B ring (mucosal ring below vestibule) is narrowed (<13mm) AND symptomatic (dysphagia)

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2
Q

Level of upper oesophageal sphincter

A

C5-6

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3
Q

Muscle which makes up the upper oesophageal sphincter

A

Cricopharyngeus

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4
Q

Barrett’s is a precursor to what malignancy?

A

Adenocarcinoma

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5
Q

Reticular mucosal pattern is found in what?

A

Barrett’s oesophagus

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6
Q

High stricture with an associated hiatal hernia

A

Barrett’s oesophagus

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7
Q

Young patient with atopia and eosinophilia with long history of dysphagia

A

Eosinophilic oesophagitis

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8
Q

Ringed oesophagus is feature of what?

A

Eosinophilic oesophagitis

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9
Q

Treatment for eosinophilic oesophagitis

A

Steroids

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10
Q

Concentric rings in oesophagus on barium?

A

Eosinophilic oesophagitis

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11
Q

Where is the most common location of oesophageal squamous cell carcinoma?

A

Middle third oesophagus

Arises from mucosa

(More common in afro-Caribbean males)

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12
Q

What are the risk factors for squamous cell carcinoma of the oesophagus?

A

Drinking

Smoking

Radiotherapy

Alkaloid ingestion

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13
Q

Where is the most common location for an oesophageal adenocarcinoma?

A

Majority in lower third of the oesophagus and arises from columnar epithelium or submucosal glands

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14
Q

What are the risk factors for oesophageal adenocarcinoma?

A

Reflux

Scleroderma

Drinking

Smoking

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15
Q

What is the difference between T3 and T4 cancer of oesophagus?

A

T3 is invasion of adventitia

T4 is invasion to adjacent structures

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16
Q

What are the risk factors for oesophageal candidiasis?

A

Immunocompromised (HIV/ transplant)

Achalasia

Scleroderma

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17
Q

What are the barium findings of oesophageal candidiasis?

A

Discrete plaque-like lesions.

Muscosal inflammation and oedema (nodularity, granularity, fold thickening).

Looks “shaggy” when severe.

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18
Q

What is the diagnosis in an asymptomatic elderly patient with imaging findings similar to that of oesophageal candidiasis?

A

Glycogen acanthosis

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19
Q

What are the barium findings in oesophageal herpes ulcer?

A

Small/ multiple punctate or linear ulcers with surrounding radiolucent halo

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20
Q

What are the risk factor(s) for herpes oesophagitis?

A

Immunocompromised patients, particularly those with AIDS

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21
Q

What are the cause(s) of uphill varices?

A

Portal hypertension

(confined to bottom half of oesophagus)

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22
Q

What are the cause(s) of downhill varices?

A

SVC obstruction (catheter related or tumour related)

Confined to top half of oesophagus

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23
Q

How can you differentiate between varices and varicoid carcinoma on imaging?

A

Varices will flatten out with a large barium bolus.

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24
Q

What are the appearances of varices on barium?

A

Linear, serpentine filling defects causing scalloped contour.

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25
Q

Water density posterior mediastinal cyst. Diagnosis?

A

Oesophageal duplication cyst

(Most common location is ileum)

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26
Q

What is the name given to a posterior hypopharyngeal diverticulum at the site of Killian dehiscence?

A

Zenker diverticulum

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27
Q

Dilated submucosal glands that cause multiple small out-pouchings usually due to chronic reflux. Diagnosis?

A

Oesophageal pseudodiverticulosis

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28
Q

What is the difference between traction and pulsion diverticulum?

A

Traction- triangular and will empty.

Pulsion- round and will not empty (contain no muscle in their walls).

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29
Q

What is a “feline oesophagus”?

A

Fine transverse folds coursing the oesophagus

Can be normal or associated with oesophagitis

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30
Q

Oesophageal web is a risk factor for what?

A

Oesophageal and hypopharyngeal carcinoma

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31
Q

What are the features of Plummer-Vinson syndrome?

A

Oesophageal web

Dysphagia

Weight loss

Thyroid issues

Iron deficiency anaemia

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32
Q

What is achalasia?

A

Motor disorder of distal 2/3 of the oesophagus where the lower oesophageal sphincter won’t relax.

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33
Q

What is the differential for a dilated oesophagus with smooth stricture at the GOJ junction?

A

Achalasia

Chagas disease

Pseudoachalasia

Scleroderma

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34
Q

Dilated oesophagus with signs of reflux and lung changes (NSIP). Diagnosis?

A

Scleroderma

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35
Q

What are the causes of a long stricture?

A

NG tube in too long

Radiation

Caustic ingestion

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36
Q

Dilated oesophagus due to cancer at GOJ junction is called what?

A

Pseudoachalasia

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37
Q

Name the three variants of familial adenomatous polyposis (FAP)?

A

Gardner syndrome

Attenuated familial adenomatous polyposis

Familial polyposis coli

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38
Q

Syndrome characterised by multiple colonic polyps and increased risk of colon and CNS tumours (glioblastoma/ medulloblastoma).

A

Turcot syndrome

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39
Q

Autosomal dominant polyposis syndrome resulting in cancer pretty much everywhere.

A

Lynch syndrome

(hereditary non-polyposis colorectal cancer)

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40
Q

What is the most common benign tumour of the stomach?

A

Leiomyoma

(can be calcified)

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41
Q

A patient undergoes a double-contrast barium meal examination which demonstrates multiple filling defects. On endoscopy, the filling defects were confirmed as multiple gastric polyps.

What is the most likely histological pattern?

A. Adenomatous polyps
B. Metastases
C. Hyperplastic polyps
D. Leiomyoma
E. Hamartomatous polyps

A

Hyperplastic polyps.

(Occur mainly in the body and fundus, measure less than 1cm, make up around 80-90% of gastric polyps and are a recognised complication of long term PPI use)

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42
Q

A gastric ulcer was visible during a double-contrast barium meal examination.

Which of the features below favour a benign aetiology?

A. Irregular modular folds
B. Shallow
C. Hamptons line
D. No protrusion beyond the stomach
E. Asymmetry

A

Hamptons line

(thin translucent line at the edge of an ulcer)

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43
Q

What is the most common benign tumour of the duodenum?

A

Adenoma

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44
Q

“Hide bound pattern” is seen in which condition?

A

Scleroderma

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45
Q

What cancers are people with achalasia more at risk of?

A

Squamous cell carcinoma

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46
Q

Oesophageal stricture with dilated submucosal gland. Diagnosis?

A

Pseudodiverticulosis.

Usually due to chronic reflux oesophagitis

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47
Q

What is the most common mesenchymal tumour of the GI tract?

A

Gastrointestinal stromal tumour (GIST)

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48
Q

“Jejunal ulcers” is buzzword for which syndrome?

A

Zollinger-Ellison syndrome

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49
Q

What is Carney’s triad?

A

Chondroma

Extra-adrenal pheochromocytoma

GIST

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50
Q

Which cancers most frequently metastasise to liver?

A

Colorectal, lung, breast

Less frequently:

Thyroid, Ewing’s sarcoma, neuroendocrine, renal cell, prostate

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51
Q

What are the CT findings in focal nodular hyperplasia (FNH)?

A

Arterial phase-low attenuation “scar” in centre of large hypervascular mass

No wash out

Venous phase-same scar “fills in”- as it contains central veins

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52
Q

What is the most common type of hypervascular liver metastasis?

A

Neuroendocrine

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53
Q

What are Aphthoid ulcers?

A

Shallow puncate “spot” with mucosal oedema

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54
Q

Aphthoid ulceration is found in which disorders?

A

Crohn’s disease

Yersinia enterocolitis

CMV enterocolitis

Amoebic enterocolitis

Polyarteritis nodosa (PAN)

Ischaemic colitis

Behçet’s disease

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55
Q

What are the causes of pseudosacculations?

A

Scleroderma

Crohn’s disease

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56
Q

What is Mirizzi syndrome?

A

When the hepatic duct is obstructed secondary to an impacted cystic duct stone. The stone can eventually erode into the CHD or GI tract.

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57
Q

Mirizzi syndrome occurs more in patients with which anatomical variant?

A

Low insertion of the cystic duct

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58
Q

What are the 5 types of choledochal cysts?

A

Type 1 : focal dilation of CBD (most common)

Type 2 : diverticulum of bile duct

Type 3 : choledochocele

Type 4 : intra + extra-hepatic

Type 5 : Caroli’s - intrahepatic only

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59
Q

“Comet-tail” artefact in the gallbladder is specific for what?

A

Adenomyomatosis

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60
Q

What other conditions are associated with Caroli disease?

A

Hepatic fibrosis (Caroli syndrome)

Polycystic kidney disease (AD and AR)

Medullary sponge kidney

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61
Q

Southeast Asian patient with dilated biliary ducts full of pigmented stones.

Ducts were described as “straight rigid intrahepatic ducts”

What is the diagnosis?

A

Recurrent pyogenic cholangitis

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62
Q

Which antibodies are present in primary biliary cirrhosis?

A

Antimitochondrial antibodies

(in 95%)

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63
Q

How can you differentiate between AIDs cholangiopathy and primary sclerosing cholangitis (PSC)?

A

Both have intrahepatic and extrahepatic strictures, AIDS is also associated with papillary stenosis

Extrahepatic strictures in AIDs > 2cm, whereas they are rarely > 5mm in PSC.

PSC has saccular deformities of the ducts.

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64
Q

What are the normal vascular US findings following liver transplant?

A

Rapid systolic upstroke (diastolic → systolic in less than 0.08s)

Resistive index 0.5 - 0.7

Hepatic artery peak velocity < 200 cm/sec

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65
Q

The liver and which other organ is involved in primary haemochromatosis?

(genetic increased gastrointestinal uptake of iron)

A

Primary = pancreas

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66
Q

The liver and which other organ is involved in secondary haemochromatosis?

(chronic inflammation/ multiple transfusions)

A

Secondary = spleen

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67
Q

What are the causes of massive caudate lobe hypertrophy?

A

Budd Chiari

Primary sclerosing cholangitis

Primary biliary sclerosis

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68
Q

What is the differential for decreased early enhancement of the periphery of the liver with delayed enhancement of the periphery, also called “nutmeg liver”?

A

Budd Chiari

Hepatic veno-occlusive disease

Congenstive hepatopathy(right heart failure, constrictive pericarditis, pulmonary hypertension)

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69
Q

What are the imaging features of the liver in haemochromatosis?

A

Liver is T1 and T2 dark

Drop out on IN phase imaging (opposite of fat)
Iron = in

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70
Q

What are the causes of hypervascular liver metastases?

A

Renal

Melanoma

Carcinoid

Choriocarcinoma

Thyroid

Islet cell

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71
Q

What are the risk factors for hepatic angiosarcoma?

A

Polyvinyl chloride

Arsenic

Radiation

Thorotrast

Associated with haemochromotosis and neurofibromatosis type 1

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72
Q

What are the risk factors for cholangiocarcinoma?

A

Primary sclerosing cholangitis

Recurrent pyogenic cholangitis

Clonorchis sinensis (East China)

HIV, Hep B&C

Alcohol

Thorotrast

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73
Q

What are the imaging features of a fibrolamellar HCC (subtype seen in younger patients <35)?

A

T2 dark with a non-enhancing central scar

Gallium avid

Calcifies more than conventional HCC

Not associated with elevated AFP or cirrhosis

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74
Q

In which situations would you find a hepatic adenoma?

A

Oral contraceptive use

Anabolic steroids

Glycogen storage disease

Obesity

Metabolic syndrome

Diabetes

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75
Q

What is the only hepatic lesion that is avid on sulfur colloid scan?

A

Focal nodular hyperplasia (FNH)

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76
Q

What is the difference between the central scar of focal nodular hyperplasia vs central scar of fibrolamellar HCC?

A

The central scar of FNH is T2 bright and enhances on delayed scans

The central scar of fibrolamellar HCC is usually T2 dark with no enhancement.

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77
Q

What are the imaging features of focal nodular hyperplasia (FNH)?

A

Well defined with a central scar

On arterial phase there is centrifugal filling (opposite to haemangioma/adenoma)

On portal venous phase the lesion will be isointense to background liver

Central scar can be high on T2 and can enhance on delayed scans

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78
Q

What are the imaging features of a hepatic haemangioma?

A

Bright on ultrasound with no internal doppler signal

CT/MRI : peripheral discontinuous nodular enhancement with progressive filling in

T2 bright

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79
Q

Patient with massively dilated hepatic artery and multiple AVMs in liver and lungs.
Diagnosis?

A

Hereditary haemorrhagic telangiectasia

(Osler-Weber-Rendu syndrome)

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80
Q

What are the MRI characteristics of regenerative hepatic nodules?

A

T1 & T2 dark with no enhancement

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81
Q

What are the MRI features of dysplastic hepatic nodules?

A

T2 dark, T1 bright, usually no enhancement.

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82
Q

What are the prehepatic, hepatic and post-hepatic causes of portal hypertension?

A

Pre-hepatic : portal vein thrombosis, tumour compression

Hepatic : cirrhosis, schistosomiasis

Post-hepatic : Budd-Chiari

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83
Q

What is McKittrick-Wheelock syndrome?

A

Villous adenoma which causes a mucous diarrhoea leading to severe fluid and electrolyte depletion.

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84
Q

Cowdry type A intranuclear inclusion bodies can be seen on pathology in which colitis?

A

Colonic CMV

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85
Q

What are the ultrasound features of an appendix mucocele?

A

Layering within a cystic mass “onion sign”.

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86
Q

What are the common associations with ulcerative colitis?

A

Primary sclerosing cholangitis

Ankylosing spondylitis

Colorectal carcinoma

Moyamoya phenomenon.

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87
Q

What are the barium appearances of ulcerative colitis?

A

Colon “ahaustral” with a diffuse granular appearing mucosal

“Lead pipe”

88
Q

Pseudodiverticula in Crohns is typically found where?

A

Anti-mesenteric border of the colon

89
Q

The hernial sac of a left paraduodenal internal hernia typically contains which vessels?

A

IMV and left colic artery

90
Q

A right paraduodenal hernia results from bowel herniating through which fossa?

A

Fossa of Waldeyer

91
Q

Lesser sac hernias result in herniation of abdominal contents through which foramen?

A

Foramen of Winslow

92
Q

A left paraduodenal internal hernia results from bowel herniating through which fossa?

A

Fossa of Landzert

93
Q

Which factors during a Roux-en-Y gastric bypass increase the risk of subsequent internal hernia?

A

Laparoscopic approach

Greater degrees of weight loss following procedure

94
Q

What are the 3 potential sites for an internal hernia following Roux-en-Y gastric bypass?

A

Defect in the transverse mesocolon through which the Roux limb passes (if retrocolic)

Mesenteric defect at the enteroenterostomy

Behind the Roux limb mesentery (retrocolic/anterocolic Peterson types)

95
Q

Which abdominal wall hernia is located lateral to the inferior epigastric artery + passes through deep inguinal ring.

A

Indirect inguinal hernia

96
Q

Which abdominal wall hernia is located medial to the inferior epigastric artery and passes through a defect in Hesselbach triangle?

A

Direct inguinal hernia

97
Q

What are the features of a femoral hernia?

A

Medial to the femoral vein

Posterior to the inguinal ligament

(most common in elderly ladies)

98
Q

Which conditions increase the risk of small bowel lymphoma?

A

Coeliac disease

Crohn’s disease

AIDs

SLE

99
Q

Coeliac disease is associated with which conditions?

A

Idiopathic pulmonary haemosiderosis (Lane Hamilton syndrome)

Dermatitis herpetiformis

IgA deficiency

Small bowel lymphoma

CEC syndrome (coeliac, epilepsy, cerebral calcification)

100
Q

What is the difference between SMA syndrome and nutcracker syndrome?

A

SMA syndrome is where the SMA compresses the 3rd part of duodenum (normally following severe weight loss)

Nutcracker syndrome is compression of the left renal vein, usually between the SMA and aorta

101
Q

What are the imaging features of coeliac disease?

A

Fold reversal

Dilated bowel with effaced folds

Coiled spring appearance (intussusceptions)

Low density lymphadenopathy

Splenic atrophy

102
Q

What is the differential for loop separation on fluoroscopy without tethering?

A

Ascites

Wall thickening (Crohns, lymphoma)

Adenopathy

Mesenteric tumours

103
Q

A 54 year old man has imaging which finds diffuse “sand-like” micronodules in the jejunum with enlarged low density nodes. What is the diagnosis?

A

Whipple’s (Tropheryma Whipplei)

104
Q

What is the diagnosis for loop separation on fluoroscopy with tethering?

A

Carcinoid

105
Q

What is the differential for diffuse thick small bowel folds > 3 mm on fluoroscopy?

A

Low protein

Venous congestion

Cirrhosis

106
Q

Multiple uniform discrete nodules along the mucosal surface of the terminal ileum.

What is the diagnosis?

A

Gastrointestinal nodular lymphoid hyperplasia.

107
Q

What is the differential for segmental fold thickening of the small bowel on fluoroscopy?

A

Ischaemia

Radiation

Haemorrhage

Adjacent inflammation

108
Q

Which medication can cause multiple gastric ulcers?

A

Chronic aspirin therapy

(doesn’t cause duodenal ulcers)

109
Q

Describe mesenteroaxial gastric volvulus.

A

Rotation around short axis perpendicular to the cardiopyloric line

Displacement of antrum above GOJ

Stomach “upside down” with antrum + pylorus above fundus

110
Q

Describe organoaxial gastric volvulus.

A

Stomach is rotated along its long axis

Antrum rotates anterosuperiorly

Fundus rotates posteroinferiorly

111
Q

Gastric volvulus seen in old ladies with paraoesophageal hernias?

A

Organoaxial volvulus

112
Q

Which gastric volvulus type is more common in children?

A

Mensentero-axial volvulus

113
Q

What is the most common extra-nodal site for non-Hodgkins lymphoma?

A

Stomach

114
Q

Linitis plastica tends to result from adenocarcinoma of which two primaries?

A

Breast

Lung

115
Q

Where would you find a Virchow node?

A

Left supraclavicular region

(sign of metastatic abdominal malignancy)

116
Q

Name two associations with gastrointestinal stromal tumours (GIST)

A

Carneys triad (chordoma, extraadrenal pheochromocytoma, GIST)

NF-1

117
Q

Which malignancies are associated with Cowden syndrome?

A

Breast

Thyroid (usually follicular)

Dysplastic cerebellar gangliocytoma (AKA Lhermitte-Duclos disease)

118
Q

Which polyposis syndromes are associated with multiple hamartomatous polyps?

A

Peutz-Jeghers (mucocutaneous hyperpigmentated macules of nose, buccal, axilla, genetalia)

Cowden’s (breast cancer_)_

Cronkhite - Canada (rash, alopecia + watery diarrhoea)

119
Q

Hereditary nonpolyposis colorectal cancer (HNPCC), AKA Lynch syndrome is associated with which malignancies?

A

Colorectal cancer

Small bowel (most commonly duodenum)

Gastric

Genitourinary (endometrial, ovarian, urothelial)

Hepatobiliary

Pancreatic

CNS (most often gliomas)

120
Q

Gardner syndrome is characterised by what?

A

Familial adenopolyposis

Multiple osteomas (skull and mandible)

Desmoid tumours of mesentry + abdominal wall

Supernumerary teeth

Papillary thyroid carcinoma

121
Q

Which gastric malignancy tends to cross the pyloris and NOT result in gastric outlet obstruction despite extensive involvement?

A

Lymphoma

122
Q

Mucosa-associated lymphoid tissue (MALT) lymphoma is associated with what?

A

Helicobacter pylori (and may regress following treatment of this)

123
Q

Menetrier’s disease (AKA giant hypertrophic gastritis) classically affects and spares which parts of the stomach?

A

Usually affects the fundus (enlarged and tortuous folds esp. along greater curvature)

Classically spares the antrum

124
Q

What is the classic triad of Menetrier’s disease?

A

Achlorhydria

Hypoproteinameia (ascites + pleural effusions)

Oedema

(Also characterised by excessive mucus production)

125
Q

MEN 1 is an autosomal dominant condition characterised by what?

A

Pituitary adenomas

Pancreatic islet cell tumours (gastrinoma/glucagonoma)

Parathyroid disease (hyperplasia, adenoma, carcinoma)

126
Q

Zollinger-Ellison syndrome is associated with which other syndrome?

A

Multiple endocrine neoplasia type 1

(Wermer syndrome)

127
Q

What are the imaging features in the pancreas in patients with cystic fibrosis?

A

Complete fatty replacement (lipomatous pseudohypertrophy)

Small 1-3mm pancreatic cysts

Pancreatic duct strictures

128
Q

Progressive submucosal fibrosis of the proximal colon (fibrosing colonopathy) is associated with what?

A

High dose lipase supplementation used to treat exocrine insufficiency of the pancreas (e.g. in CF)

129
Q

What are the features of Shwachman-Diamond syndrome?

A

Exocrine pancreatic insufficiency (lipomatous pseudohypertrophy)

Metaphyseal chondroplasia (short stature)

Eczema

130
Q

How do you differentiate between pancreatic agenesis and pancreatic lipomatosis?

A

Lipomatosis will have a duct, agenesis will not

131
Q

What is pancreatic divisum and why is this important?

A

Anatomical variant where the main portion of the pancreas is drained by the minor/ accessory papilla

Importance: increased risk of pancreatitis

132
Q

What are the imaging characteristics of late chronic pancreatitis?

A

Small atrophic pancreas - may have focal enlargement

Pseudocyst formation

Dilation and beading of the pancreatic duct with calcifications

133
Q

Autoimmune pancreatitis is associated with elevation of what?

A

IgG4

134
Q

What are the imaging findings of autoimmune pancreatitis?

A

Sausage shaped pancreas

Capsule like delayed rim enhancement around pancreas

135
Q

What are the imaging features of tropical pancreatitis?

A

Multiple large calculi within a dilated pancreatic duct

136
Q

Which conditions are associated with IgG4?

A

Autoimmune pancreatitis

Retroperitoneal fibrosis

Sclerosing cholangitis

Inflammatory pseudotumour

Riedels thyroiditis

137
Q

Serous cystadenoma is associated with what?

A

Von Hippel Lindau

138
Q

What are the imaging features of a serous cystadenoma?

A

Located in the pancreatic head

Heterogenous mixed density lesion made up of multiple small cysts

Do NOT communicate with the pancreatic duct

Can have a central scar

If calcification present, will be central

139
Q

Mucinous cystic neoplasm of the pancreas is a pre-malignant lesion found in woman in their 50s.
What are the typical imaging features?

A

Located in the pancreatic body/ tail

No communication with the pancreatic duct

Typically unilocular

If calcification present, tend to be peripheral

140
Q

What are the imaging features of a solid pseudopapillary tumour of the pancreas?

A

Large solid lesion with cystic parts in the tail of the pancreas

Thick capsule

Progressive fill in of the solid component

141
Q

Migratory thrombophlebitis is associated with malignancy is which syndrome?

A

Trousseau’s syndrome

142
Q

Which hereditary syndromes are associated with pancreatic cancer?

A

HNPCC

BRCA mutation

Peutz-Jeghers sydrome

143
Q

There is an increased risk of ampullary carcinoma in which polyposis syndrome?

A

Gardner syndrome

144
Q

Islet cell/ neuroendocrine pancreatic tumours are associated with which conditions?

A

MEN 1

Von Hippel Lindau

145
Q

“Shrinking transplant” in regards to the pancreas is a buzzword for what?

A

Chronic rejection

146
Q

What are the features of LEFT isomerism?

A

Bilateral bilobed lungs

Bilateral hyparterial bronchi

Bilateral left atria

Multiple splenules (without parent spleen)

Midline/ transverse liver

Intestinal malrotation

147
Q

What are the features of RIGHT isomerism?

A

Bilateral trilobed lungs

Bilateral eparterial bronchi

Bilateral right atria

Absent spleen

Severe congenital heart disease

Midline/ transverse liver

Intestinal malrotation

148
Q

A wandering spleen is associated with what?

A

Splenic torsion/ infarction

Intestinal malrotation

149
Q

Gamma gandy bodies (siderotic nodules) are small foci of haemorrhage in the splenic parenchyma.

They are associated with what?

A

Portal hypertension

150
Q

Splenic abscess in the immunocompetent patient, normally in the setting of underlying splenic damage (trauma/ sickle cell) is caused by which infection?

A

Salmonella

151
Q

Feltys syndrome consists of which triad?

A

Splenomegaly

Rheumatoid arthritis

Neutropenia

152
Q

What is the most common primary neoplasm to metastasise to the spleen?

A

Melanoma

153
Q

Small bowel dilatation without increase in fold thickness is the pattern seen in which condition?

A

Coeliac disease

154
Q

Small bowel dilatation without loss of the valvulae conniventes and prolonged transit time is the pattern seen in which condition?

A

Scleroderma

155
Q

Dilatation of the proximal small bowel due to hypersecretion is seen in what syndrome?

A

Zollinger-Ellison syndrome

156
Q

Small bowel fold thickening and lymph node enlargement is the pattern seen in what condition?

A

Lymphoma

157
Q

Nodular small bowel fold thickening with sclerotic bone lesions is a pattern seen in what condition?

A

Mastocytosis

158
Q

Thickened small bowel folds with or without nodularity, with NO dilatation and normal transit time is a pattern seen in which condition?

A

Whipple disease

159
Q

Which infections cause diffuse involvement of the whole colon?

A

CMV

E. coli

160
Q

Which infections affect the right colon?

A

Salmonella

Shigella

161
Q

Which infections affect the left colon?

A

Schistosomiasis

162
Q

Which infections affect the rectosigmoid colon?

A

Gonorrhoea

Herpes

Chlamydia

163
Q

What are the features of familial adenomatous polyposis?

A

Colonic carpet of polyps

Stomach hamartomas

Duodenal adenomas

Periampullary carcinoma

Desmoid tumours

164
Q

What are the features of Turcot syndrome?

A

Diarrhoea (colonic polyps)

Seizures (glioblastoma)

165
Q

What are the features of Cowden syndrome?

A

Rectosigmoid polyps

Fibrocystic breast disease

Dysplastic cerebellar gangliocytoma

Trichilemmomas

166
Q

What are the features of Peutz-Jegher syndrome?

A

Hamartomatous polyps

Mucocutaneous pigmentation

Increased risk of multiple cancers

167
Q

Clinical syndrome which occurs secondary to functional gastrinoma resulting in GORD and peptic ulcer disease

A

Zollinger-Ellison syndrome

168
Q

What are the causes of achalasia?

A

Idiopathic

Chagas disease (parasite in the jungle)

Allgrove syndrome

169
Q

What are the fluoroscopic findings of a double aortic arch?

A

Frontal: “reverse S” sign. Upper indentation from right aortic arch. Lower indentation from left arch.

Lateral: posterior indentation (mostly right arch)

170
Q

What are the fluoroscopic findings in pulmonary sling/ aberrant left pulmonary artery?

A

Mass between trachea + oesophagus just above the level of the carina

Indentation on anterior oesophagus

171
Q

What are the fluoroscopic findings of an aberrant right subclavian artery?

A

“Bayonet sign”

Obliquely orientated posterior indentation of the oesophagus

172
Q

What is the most common symptomatic vascular ring?

A

Double aortic arch

173
Q

Which is the only vascular ring to pass between the oesophagus and the trachea?

A

Pulmonary sling

AKA aberrant left pulmonary artery

174
Q

What are the two types of hiatal hernia and how do you differentiate them?

A

Sliding (axial) where the GOJ will be above the diaphragm

Rolling (paraoesophageal) with the GOJ below the diaphragm and piece of stomach above it

175
Q

Pulmonary sling is associated with which other cardiopulmonary and systemic anomalies?

A

Tracheal stenosis

Complete tracheal rings

Tracheo-oesophageal fistula

Hypoplastic right lung

Imperforate anus

176
Q

Which type of hiatus hernia has a higher rate of incarceration?

A

Rolling (paraoesophageal)

177
Q

What is the most common benign mucosal lesion of the oesophagus?

A

Papilloma

178
Q

Lower oesophageal pulsion diverticula with a strong association with oesophageal dysmotility. What is it and which side does it usually occur?

A

Epiphrenic diverticula

Usually on the right

179
Q

Where does a Killian-Jamieson diverticulum arise?

A

Anterolateral cervical oesophagus

Below attachment of cricopharyngeus

Lateral to ligaments that help suspend the oesophagus on the cricoid cartilage

180
Q

What is a traction diverticulum (oesophagus)?

A

True diverticulum occurring secondary to pulling forces on the outer aspect of the oesophagus.

181
Q

What is the barium findings of CMV oesophagitis?

A

Large approx 2cm superficial mid-oesophageal ulcers (characteristic)

Small well-circumscribed ulcers with normal mucosal between them

182
Q

CMV infection of the GI tract can be seen in HIV patients with what CD4 count?

A

CD4 < 100

183
Q

What are the common infective causes of oesophagitis in a patient with HIV?

A

CMV

Herpes

Candida

184
Q

“Corkscrew” oesophagus appearance is seen in what?

A

Diffuse oesophageal spasm

185
Q

Severe forms of glycogen acanthosis can be seen in what syndrome?

A

Cowden syndrome

186
Q

Multiple small nodules and plaques in the upper to mid oesophagus in asymptomatic elderly patient. What is the diagnosis?

A

Glycogen acanthosis

187
Q

What is the most common reason for recurrent reflux following nissen fundoplication?

A

Slipped nissen wrap which is seen as narrowed oesophagus over a length of >2cm

188
Q

“Ribbon like” bowel is a buzzword for what condition?

A

Graft vs host disease

189
Q

What is the likely diagnosis of multifocal peripheral portal nodules with variable attenuation in a patient with AIDS?

A

Kaposi sarcoma

190
Q

What is the most common islet cell tumour?

A

Insulinoma

191
Q

What is the most common islet cell tumour associated with MEN?

A

Gastrinoma

192
Q

Which cystic pancreatic lesion has an elevated CEA?

A

Mucinous cystadenoma

(serous cystadenoma does not)

193
Q

What are the imaging features of a flash haemangioma?

A

Immediate and uniform enhancement which persists on delayed sequences

194
Q

Lymph from the bare area of the liver drain into which lymph node group?

A

Mediastinal

195
Q

What are the imaging features of angiodysplasia?

A

Most common in the caecum and ascending colon

Cluster of arterially enhancing vessels on the anti-mesenteric border

Early opacification of the draining ileocolic vein

196
Q

What conditions may cause low T2 signal in the spleen?

A

Haemochromotosis

Spherocytosis

Sickle cell disease

MRI safe prosthetic heart valve

197
Q

What is the diagnosis in an immunosupressed patient with thickened and markedly oedematous caecum?

A

Neutropenic colitis

(typhlitis)

198
Q

Liver cirrhosis and a grossly dilated hepatic artery are suggestive of what diagnosis?

A

HHT

(Osler-Weber-Rendu syndrome)

199
Q

What is the syndrome associated with hamartomatous polyps in the stomach and colon as well as alopecia and nail atrophy?

A

Cronkhite-Canada syndrome

200
Q

What are the causes of Budd-Chiari syndrome?

A

Thrombocytosis

OCP

Pregnancy

Polycythaemia rubra vera

Right atrial myxoma

Mechanical compression by a tumour

Constrictive pericarditis

201
Q

In which types of oesophageal atresia will have no gas in the bowel?

A

Type A: pure oesophageal atresia with no fistula

Type B: oesophageal atresia with fistula between proximal pouch and tracheal

202
Q

What is the most common type of oesophageal atresia?

A

Type C: oesophageal atresia with fistula from the trachea or main bronchus to the distal oesophageal segment

203
Q

What is a type D oesophageal atresia?

A

Oesophageal atresia with both proximal and distal fistulas

204
Q

Which conditions increase the risk of duodenal cancer?

A

Crohns

Coeliac

205
Q

What are the predisposing factors of gastric malignancy?

A

H.pylori

Pernicious anaemia

Gastric polyps

Atrophic gastritis

Diet

Partial gastrectomy

206
Q

What are the fluoroscopy features of gastric lymphoma?

A

Diffusely thickened irregular mucosal folds

Multiple ulcers associated with a mass and polypoid lesions

207
Q

Which condition causes small evenly distributed filling defects throughout the duodenal cap on fluoroscopy?

A

Lymphoid hyperplasia

208
Q

Which condition causes irregular filling defects within the duodenum, spreading from the pylorus and referred to as “crazy pavement”?

A

Gastric metaplasia

209
Q

Which condition causes a cobblestone appearance of the duodenal cap with large nodules which are not effaced with distension?

A

Brunner’s gland hyperplasia

(duodenitis causes similar appearance but will be effaced with distension)

210
Q

Simple hepatic cysts are associated with which conditions?

A

Polycystic liver disease

Polycystic kidney disease

Tuberous sclerosis

Von Hippel-Lindau

211
Q

What are the imaging features of a benign hepatic cystadenoma?

A

Arise from bile ducts, often in the right lobe

Multi-locular with internal septa (which can enhance)

Mural papillary projections (characteristic)

212
Q

What are the imaging appearances of a hepatic adenoma?

A

Well defined and mixed echogenicity on US

High on T2, low in T1 (can be mixed if haemorrhage/ fat)

Rapid homogenous arterial enhancement that becomes isointense on later phase imaging

Cold on sulphur colloid scans (unlike FNH)

213
Q

Conventional hepatocellular carcinomas are hyper-enhancing in the arterial phase and washout in the portal-venous. What is the reason for this?

A

They are supplied by the hepatic arteries not the portal system

214
Q

What is the difference between adenoma and FNH when using hepatocyte specific contrast?

A

FNH will have enhancement which persists into the delayed phases due to the presence of hepatocytes

Hepatic adenomas do not retain hepatocyte specific contrast on the delayed phase as they do not have hepatocytes

215
Q

Which nodal groups are deemed “local nodes” in regards to gastric cancer?

A

Perigastric, lesser and greater curve, common hepatic, splenic, left gastric and coeliac nodes

Clinical Radiology 2A (8 decks)

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