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Radiology > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Liver segments by portal and hepatic veins

A

Portal vein: superior/inferior
Middle hepatic vein: right/left
Left hepatic vein: 2,3/4
Right hepatic vein: 5,8/6,7

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2
Q

Hepatic segment vasculature

A

Central:
portal triad—> portal vein, hepatic artery, bile duct

Peripheral:
venous —>hepatic vein—>IVC

Caudate:
Direct to the IVC

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3
Q

Routine contrast enhanced CT usage

A

Portal venous phase(70s after injection)
Hepatic steatosis, cirrhosis
Most metastasis ( not hyper vascular)

Some breast Mets are iso in portal phase/detected on unenhanced

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4
Q

Arterial phase CT usage in liver

A

20-25 s after injection
Primary liver masses (hyper vascular)

Optimal view—> late arterial (35 s)

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5
Q

NAFLD categories

A

Steatosis

Steatohepatitis

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6
Q

Metabolic syndrome

A

NAFLD
Obesity
Insulin resistance
Dyslipidemia

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7
Q

Hepatic steatosis on CT

A

Un-enhanced:
Liver attenuated 10 HU less than spleen

Contrast enhanced: liver 25 HU less than spleen in pvp

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8
Q

Fatty liver on MRI

A

In and out of phase GRE MRI
complete signal loss on out of phase

In phase: water+fat
Out of phase:water-fat

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9
Q

Decreased signal on in phase MRI

A

Hepatic iron overload

Increases TE—> longer dephasing—> exaggerated T2*

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10
Q

Focal liver fat characteristics

A

No mass effect
Vessels run through it
Location:
Gallbladder fossa/ subcapsular/periportal/

Hyper echo on US and hypo on CT

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11
Q

Liver amyloidosis

A

Decreased attenuation on CT

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12
Q

Wilson disease on CT

A

Copper : basal ganglia/cornea/liver

Liver:
Hyper on CT—> multiple nodules—>hepatomegaly—>cirrhosis

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13
Q

Excess hepatic iron accumulation pathways

A

Within hepatocytes: hemochromatosis

Increased uptake in RES: kupffer cells/ hemosiderosis

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14
Q

Iron overload liver imaging

A

MRI: hypo compared to paraspinal muscle

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15
Q

Hemochromatosis vs Hemosiderosis

A

Hemochromatosis: spleen and bone marrow are spared
Involves pancreas,myocardium,skin,joint/ cause cirrhosis/ tx: phlebotomy

Hemosiderosis: spleen and bone marrow are involved/ no cirrhosis/ tx: iron chelator

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16
Q

Hypo-attenuated liver on CT

A 
Fatty liver
Hepatic amyloid ( rare)
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17
Q

Hyper attenuated liver on CT

A 
>75 HU
iron overload
Medication: amiodarone, gold, methotrexate
Copper overload
Glycogen excess
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18
Q

Viral hepatitis imaging

A

Normal CT
Gallbladder wall thickening
Periportal edema

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19
Q

DDx for multiple tiny hypo hepatic lesions

A

Candidiasis (involves spleen/ rim enhanced/ immunocompromised)
Mets
Lymphoma
Biliary hamartoma

Caroli disease (dilatation of intrahepatic bile ducts/fibrocystic anomalies of the kidneys)

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20
Q

Causes of liver abscess

A 
Diverticulitis
Appendicitis
Crohn
Bowel surgery
Ascending cholangitis ( less common)

E.Coli

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21
Q

Hepatic abscess on imaging

A

Mimics Mets
CT: ring enhanced
MRI: central hyper on T2/ irregular wall with late enhancement/ perilesional enhancement

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22
Q

Hepatic echinococcosis on imaging

A

CT: well defined hypo mass with floating membrane and peripheral calcification

US: hypoechoic mass with hyperechoic undulating membrane

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23
Q

Cirrhosis forms

A

Micronodular: metabolic causes
Macronodular: post viral

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24
Q

Cirrhosis on imaging

A 
Early: 
preportal space expansion
Caudate enlargement
Caudate/right lobe>0.65
Empty gallbladder fossa sign

Secondary:
Portal HTN—> splenomegaly, portosystemic collaterals, varies
Gall bladder wall thickening
Gamna-Gandy bodies( splenic microhemorrhage)

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25
Q

Regenerative liver nodules on imaging

A

Supplied by portal vein/ non pre malignant
No enhancement on arterial phase
Low on T2
Contrast enhanced MRI: iso to liver parenchyma

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26
Q

Dysplastic liver nodule on imaging

A 
Premalignant/ supplied by portal vein
Mostly don’t enhance
Hypo on T2
High grade: hyper on T2
Contrast enhanced: 
Low grade—> iso to liver
High grade—> arterial enhancement
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27
Q

Siderotic liver nodule on imaging

A

Iron rich regenerative or dysplastic nodule
Hypo on T1 and T2*
Hyper on CT

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28
Q

HCC on CT and MRI

A

Encapsulate
Enhances on arterial and washes out on portal venous
Hyper on T2
10-20% of HCCs are hypoenhancing

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29
Q

Nodule in nodule appearance

A

Enhancing nodule in a dysplastic nodule

Early HCC

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30
Q

HCC invasion pattern

A

Port, portal veins, IVC and bile ducts

Mets to the liver are less locally invasive

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31
Q

HCC treatment

A

Hepatectomy
Transplant
Percutaneous ablation
Transcatheter embolization

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32
Q

Fibrolamellar carcinoma

A

HCC subtype
Young patient without cirrhosis
AFP not elevate
Better prognosis

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33
Q

Fibrolamellar carcinoma on imaging

A 
Large, heterogenous
Fibrotic central scar: hypo on T1 and T2
Focal nodular hyperplasia: T2 hyper with delayed enhancement
Capsular retraction in 10%
Do not have capsule
Have pseudocapsule
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34
Q

Liver metastasis imaging

A

Mostly hypovascular
Seen on portal venous phase

Calcification: mucinous colorectal/ ovarian serous

MRI: hypo T1/hyper T2

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35
Q

Hyper vascular liver metastasis

A 
Neuro endocrine tumors
RCC
Thyroid carcinoma
Melanoma
Sarcoma
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36
Q

Pseudocirrhosis

A

Multiple hepatic metastasis
Treated breast cancer

Can have capsular retraction

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37
Q

Hepatic lymphoma

A

Primary is rare

Usually secondary with splenomegaly and LAP

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38
Q

Epithelioid hemangioendothelioma

A

Vascular malignancy
Multiple round subcapsular masses that can be confluent
Can have halo or target
Capsular retraction

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39
Q

DDx for capsular retraction

A 
Metastatic tumors
Fibrolamellar HCC
HCC
epithelioid hemangioendothelioma
Intrahepatic cholangiocarcinoma
Confluent hepatic fibrosis: 
wedge shaped
Cirrhosis
Medial left/ anterior right
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40
Q

Focal nodular hyperplasia

A

Disorganized tissue
Not malignant
More in women
Not associated with OCP

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41
Q

FNH in imaging

A

Central scar (not true scar) is T2hyper ductules and venules, with delayed enhancement

Avid enhancement on arterial with quick wash out

Has kupffer cells (sulfur colloid study) and bile duct (HIDA scan)

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42
Q

Hepatic hemangioma

A

Benign
Hepatic artery at the periphery
More female
Uncommon in cirrhosis

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43
Q

Hepatic hemangioma

A

Nonenhancing center ( cystic degeneration)
Peripheral, discontinuous, progressive, nodular enhancement
SI is identical to aorta
Hyper on T2 with even subtle areas of even higher SI ( cystic degeneration)

On CT: hypo mass

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44
Q

Hepatic adenoma

A 
Benign
Hepatocyte
Kupffer cells
No bile ducts
More in females
With OCP
High risk of hemorrhage
Multiple: von Gierke disease
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45
Q

Hepatic adenoma on imaging

A

Might have pseudocapsule with late enhancement
Hyper on arterial
Microscopic fat on in and out phase
Internal hemorrhage: T1 hyper

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46
Q

Budd Chiari causes

A 
Hepatic venous obstruction
Hypercoag state
Hematologic disease, pregnancy, OCP
Malignancy, infection,trauma
Congenital vein anomaly
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47
Q

Budd Chiari symptoms

A

Acute: hepatomegaly, ascites, abdominal pain

Lack of flow in hepatic vein
Thrombus in IVC
Collateral vessels
Edematous periphery 
Caudate sparing
Prominent regen nodules
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48
Q

Veno-occlusive disease

A

Destruction of post sinusoid all venules
Patent hepatic vein

In BM transplant due to chemo

Imaging: peripheral edema
Narrow hepatic vein
Hepatomegaly
Hetero enhancement
Caudate is not spared
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49
Q

Cardiac hepatopathy

A

Heart failure
Constrictive pericarditis
Right valvular disease

Imaging: enlarged vein and IVC
reflux of contrast from Right atrium into IVC
Mottled enhancement

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50
Q

Biliary hamartomas

Von Meyenburg complex

A

Incidental
Small cystic lesions
Embryologic failure
Smaller and more irregular than simple cysts

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51
Q

ADPLD

A

40% of ADPKD
Similar findings
Failure is rare

Imaging: innumerable no enhancing simple cyst

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52
Q

MDCT hepatic trauma

A

Grade1: superficial laceration,subcapsular hematoma<1cm
Grade 2: laceration, subcapsular/intraparenchymal hematoma>1 <3 cm
Grade3: >3cm
Grade 4: hematoma>10cm or destruction of one lobe
Grade 5: destruction of both lobes

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53
Q

Magnetic resonance cholangiopancreatography

A

Heavy T2 weighted
Increase contrast between biliary tract and surroundings
Fast spin echo sequences

Intermediate T2: evaluate extraluminal structures

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54
Q

Gad contrasts with biliary excretion

A 
Gadoxetic acid disodium ( Eovist)
Gadobenate dimeglumine (Multihance)

Require 20-45 minutes delay

T1 hyper biliary fluid

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55
Q

Choledochal cysts classification

A

Todani system:
Type1: CBD fusiform/ most common
Type2:extrahepatic saccular
Type3:intraduodenal
Type4:multiple segments
Type5:intrahepatic/ caroli/ associated with PKD
Caroli syndrome: disease+hepatic fibrosis
Imaging:central dot sign(portal vein and hepatic artery bridging bile ducts)

Increase risk of cholangiocarcinoma

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56
Q

Cholecystitis

A 
Obstruction of GB neck or cystic duct
 Acute: 
Wall thickness >3cm
Pericholecystic fluid
GB hyperemia
GB calculi
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57
Q

Acute cholecytitis complications

A

Gangrenous: asymmetric GB wall thickening/ intraluminal membrane

Acute perforation: high mortality/ bile peritonitis
Subacute:pericholecystic abscess
Chronic:cholecystoenteric fistula

Emphysematous: gas forming bacteria,in lumen or wall/ elderly diabetic

58
Q

Porcelain GB

A

Peripherally calcified
Chronic cholecystitis
Increased carcinoma

59
Q

Ascending cholangitis

A

Fever, abdominal pain, jaundice

Imaging: hyper and thickened wall of bile ducts+ CBD stone

Tx: AB and fluid then endoscopy

60
Q

PSC

A

Destruction of bile ducts
Associated with UC, most male

Imaging: beaded, irregular CBD and intrahepatic ducts

Complications: cirrhosis, cholangiocarcinoma,recurrent biliary infection

61
Q

PBC

A

Destruction of smaller bile ducts
Middle aged women, pruritus

Hepatic cirrhosis

62
Q

AIDS cholangitis

A

Cryptosporidium and CMV

RUQ pain, fever, LFT

Imaging: identical to PSC, distinguished: papillary stenosis

63
Q

Recurrent pyogenic cholangitis

A

Oriental cholangiohepatitis
Clonorchis sinesis
Pigment stone, biliary stasis, cholangitis

Southeast Asia

Recurrent jaundice and fever
Imaging: pnemobilia, lamellated bile duct filling defect, intra and extra bile dilation and strictures

Increased cholangiocarcinoma

64
Q

Biliary cyst adenoma

A

Middle aged women
Benign

Abdominal pain, nausea, vomiting and obstructive jaundice

Imaging: large loculated cystic mass, with septation

Rarely turns into cystadenocarcinoma( large solid, thick calcification)

65
Q

Cholangiocarcinoma

A

Hilar tumor: right and left biliary ducts/ Klatskin
Bile duct obstruction/intrahepatic dilation
Lobar atrophy

66
Q

Risk factors for cholangiocarcinoma

A 
Choledochal cyst
PSC
FAP
Clonorchis Sinesis
Thorium dioxide
67
Q

Cholangiocarcinoma on imaging

A

Intrahepatic mass at confluence of central bile ducts
Bile duct dilation
Capsular retraction
Tumor fingers in bile ducts

68
Q

Gallbladder carcinoma

A

Chronic cholecystitis
Gallstone
Porcelain gallbladder

Scirrhous infiltrating mass(most common)
Polyploid mass
Mural thickening

Direct invasion to liver
Poor prognosis

69
Q

Gallbladder metastasis

A

Melanoma

70
Q

Pancreatic neoplasm

A

Solid epithelial: Ductal Adenocarcinoma, Acinar cell carcinoma

Cystic: serous, mucinous,solid and papillary epithelial neoplasm, intraductal papillary mucinous neoplasm

Endocrine: insulinoma, gastrinoma, glucagonoma, VIPoma, Somatostatinoma

71
Q

Ductal adenocarcinoma

A

80-90% of tumors
CT: unenhanced, late arterial phase, PVP
Late arterial: best phase
Pancreatic head
Imaging: hypo on CT and T1, ill defined, hypovascular,ductal obstruction and tail atrophy
Double duct sign: CBD and pancreatic duct

72
Q

Pancreatic mass with no ductal dilation

A 
Autoimmune pancreatitis
Groove pancreatitis
Cystic tumor
Neuroendocrine tumor
Duodenal GIST
Peripancreatic LN
Mets (RCC, Thyroid, melanoma)
Lymphoma
73
Q

Unresectable PDAC

A

Encasement of SMA
Extensive venous invasion
Mets

74
Q

Resectable PDACs

A

No SMA or celiac or portal invasion
Limited duodenum, distal stomach, CBD
Limited venous

75
Q

Acinar cell carcinoma

A

Rare, aggressive
Elderly males
Lipase hyper secretion syndrome: Sub Q fat necrosis, bone infarcts—> polyarthralgias, eosinophilia

76
Q

Serous cystadenoma

A

Benign, elderly women
> 6 cysts <2 cm
Maybe solid on CT—> do MRI

Hyper vascular
No ductal dilation or tail atrophy
Central stellate calcification

77
Q

Mucinous cystic neoplasm

A 
Middle aged women
Benign with malignant potential
Resection
<6 cysts >2 cm in body and tail
Capsulated
78
Q

Capsulated pancreatic tumors

A

SPEN

Mucinous cystic neoplasm

79
Q

Solid and papillary epithelial neoplasm

A

Young women and children
Abdominal pain
Low malignancy
Imaging: large, heterogenous solid and cystic, hemorrhage, capsule

80
Q

Intraductal papillary mucinous neoplasm

A 
Elderly male
Main pancreatic duct or sidebranch
Main duct more malignancy
Endoscopy: fish-mouth papilla
Imaging: cystic in contiguity with duct
Nodular or enhancing —> malignancy
<1 cm annual follow up
>3 , mural nodule, ductal dilation—> resection
81
Q

Pancreatic endocrine tumors

A

Hyper vascular
Late arterial phase
Solid

Hyper vascular liver+ pancreatic mass—> Pancreatic endocrine tumors Mets

82
Q

Insulinoma

A

Presents early

Whipped triad: hypoglycemia, symptoms, better with glucose

83
Q

Gastrinoma

A

Zollinger- Ellison
If in MEN 1–> duodenum

Location: gastrinoma triangle/ junction of cystic duct and CBD, duodenum (inferior),pancreas neck(medial)

Can cause stomach carcinoid

84
Q

Pancreatic duct anatomy

A

Main duct drains the tail(always)—>duct of Wirsung—> major papilla (ampulla of Vater)
CBD always meets Wirsung at major papilla

Santorini, superior, always goes to minor papilla

Sphincter of Oddi at ampule of Vater

85
Q

Pancreas divisum

A

Failure of fusion of dorsal (main) and ventral duct(Wirsung)
Majority drains by Santorini

Pancreatitis, santorinicelr

Imaging: crossing sign: CBD crossing over main duct to join Wirsung

86
Q

Annular pancreas

A

Failure of ventral bud rotation
Pancreas around duodenum

Neonate: double bubble sign
Adults: pancreatitis,PUD, duodenum obstruction

87
Q

Common channel syndrome

A

Pancreaticobiliary maljunction

Usually: CBD and Wirsung are separate

Common channel syndrome: no septum, reflux between two systems

Cholangiocarcinoma

88
Q

Pancreas in von Hippel Lindau

A

Serous cystadenoma

Pancreatic neuroendocrine tumors

89
Q

Pancreas in cystic fibrosis

A

Childhood atrophy

Fatty atrophy or pancreatic cystosis

90
Q

Pancreas in Schwachman Diamond

A

Fatty replacement
Exocrine insufficiency
Neutropenia
Bone dysplasia

91
Q

Intrapancreatic accessory spleen

A 
1-3 cm
Well defined
Pancreatic tail
DDx: MRI
Tc-99m sulfur colloid or Tc-99m RBC scintigraphy
92
Q

Imaging of pancreatitis

A

Late arterial (40 s after injection)

CT is key

Not indicated in mild acute pancreatitis

93
Q

Acute pancreatitis Balthazar classification

A 
A: normal
B: enlargement
C: mild peripancreatic inflammation 
D: single fluid
E: two or more fluid
A,B,C: 0 mortality, 4 morbidity
D, E: 14 mortality, 54 morbidity
94
Q

Acute pancreatitis CT severity classification

A

0-4 for Balthazar A-E

0: 0 necrosis
2: <30
4: 30-50
6: >50

CTSI: 0-3: 3 mortality, 8 morbidity
7-10: 17 mortality, 92 morbidity

95
Q

Pancreatitis pancreatic complications

A

Necrosis: focal or diffuse nonenhancing/ after 48-72 hours/ late arterial phase/ risk of infection
Fluid collection: peripancreatic
Pseudocyst: enzyme collection, fibrous wall, 4-6 weeks
Abscess: purulent, thicker, irregular wall, gas locales

96
Q

Pancreatitis extrapancreatic complication

A

Pseudocyst: anywhere below diaphragm
Perihilar renal inflammation: venous compression, thrombosis
Bowel:transverse colon

Adjacent vascular inflammation:
Arterial bleeding—> splenic artery erosion
Pseudoaneurysm—> splenic artery
Venous thrombosis—> splenic vein—> portal HTN

97
Q

Chronic pancreatitis

A

Long term alcohol, pancreas divisum

Calcification along pancreatic duct

98
Q

Autoimmune pancreatitis

A

Lymphoplasmacytic infiltrate
Sjogren syndrome, IgG4

Imaging: diffuse, sussage shaped entire pancreas
Focal—> mimics mass

Tx: steroid

99
Q

Groove pancreatitis

A

Focal pancreatitis
Between head, duodenum and CBD
Heavy drinker young man
Fibrosis in pancreaticoduodenal groove

Can cause: duodenal stenosis, cystic change of duodenal wall
Imaging: duodenal thickening, cystic changes on MRI
DDx: adenocarcinoma

100
Q

Peritoneum

A

Single layer of mesothelial cells supported by subserosal fat, lymphatic cells and WBC

Most dependent
For women: pouch of Douglas
Men: retrovesical area

101
Q

Mesentry

A

Blood vessels and lymphatic between peritoneal layers
True:connects to posterior abdominal wall
Small bowel—>jejunum and ileum/from ligament of Treitz (LUQ) to ileocecal junction( RLQ)
Transverse—>posterior transverse to posterior wall
Sigmoid—>sigmoid colon
Omentum: specialized, attach to stomach, not to posterior wall
Greater—>anterior abdomen/ stomach to anterior transverse colon
Lesser—>stomach to liver

102
Q

Misty mesentry

A

Mesenteries are fatty fold—> normally not seen on CT

Fluid or inflammation —>mesenteric vasculature become in distinct

103
Q

Mesenteric edema

A

Systemic: diffuse edema, CHF, low protein, third spacing

Intra abdominal: focal edema, vessel thrombosis, Budd Chiari, IVC obstruction

104
Q

Bowel ischemia

A

Vascular insult

Imaging: bowel wall thickening, pneumatosis, mesenteric venous gas

105
Q

Mesenteric inflammation

A

Most common: acute pancreatitis
Appendicitis, IBD, diverticulitis,
Local misty mesentery

106
Q

Neoplastic infiltration

A

Misty mesenteric after tx limited to treated LN
Most common: NHL, bulky adenopathy
Pancreatic, colon, breast,GIST, mesothelioma

107
Q

Carcinoid

A

Most common small bowel tumor
Distal ileum
Intraluminal—>mesentery(direct or lymphatic)

Imaging: enhancing mass with radiating linear bands into mesenteric fat (intense desmoplastic reaction by serotonin), calcification

108
Q

Sclerosing mesenteric mass

A

Carcinoid
Desmoid tumor
Sclerosing mesenteritis

109
Q

Desmoid tumor

A

Benign, locally aggressive
Fibrous tissue
Gardner syndrome( FAP)

CT: iso to muscle, central necrosis, strands of tissue radiating to mesenteric fat

110
Q

Sclerosing mesenteritis

A

Fatty necrosis and fibrosis of mesenteric root

Mesenteric mass with striation of ST, calcification

111
Q

Panniculitis

A

idiopathic inflammation
Acute abdominal pain

CT: diffuse misty mesentery, linear bands of ST

112
Q

Mesenteric Mets

A

Gastric, ovarian, breast, lung,pancreatic,biliary, colon, melanoma

Mesenteric lymphoma: Sandwich sign

113
Q

Peritoneal carcinomatosis

A

Disseminated metastasis
Omental caking
Mucinous adenocarcinoma

114
Q

Pseudomyxoma peritoneal

A

Low grade/ copious mucus in peritoneal cavity
Mucin producing adenoma or adenocarcinoma
Appendix(20%), ovaries(30%) or colon
Involves entire peritoneal cavity
Recurrent mucinous ascites ( jelly belly)
CT: lobular ascites, higher attenuation than fluid
Advanced: scalloping of hepatic margin
Tx: surgery, hyperthermia intra peritoneal chemotherapy lovage

115
Q

Splenule

A

Accessory spleen
Splenic Hilum

MRI: follows splenic tissue
Tc-99m sulfur colloid/ heat damaged Tc-99m RBC

116
Q

Polysplenia syndrome

A

Visceral heterotaxia
Multiple Foci of splenic tissue on the same side as the stomach
Severe cardiac anomalies
Venous anomalies( interruption of IVC with azygos or hemiazygos, preduodenal portal vein)

117
Q

Wandering spleen

A

Abnormal laxity
Presents as abdominal mass
Acute abdominal pain due to torsion

118
Q

Hemangioma of spleen

A

Most common
Kasabach-Merritt: anemia, thrombocytopenia, consumptive coagulopathy)
Klippel-Trenaunay-Weber:cutaneous hemangioma, varicose vein, extremity hypertrophy
Associated with phleboliths

CT: pre—> iso/ hypo hyperenhancing
MR: T2–> hyper Peripheral/ homogenous enhancement
NM: Tc-99m RBC—> delayed images

119
Q

Spleen hamartoma

A

Malformed red pulp
Tuberous sclerosis

CT: pre: iso/ hypo mass heterogenous enhancement
MR: T2: iso, heterogenous early enhancement—> homogeneous delayed enhancement

120
Q

True splenic cyst

A

Epithelial lining
Increased CA 19-9, CA125 , CEA
Septation
Calcification uncommon

121
Q

Post-traumatic pseudocyst

A

End result of hematoma

Imaging: well circumscribed, fluid density, no peripheral enhancement
Septation uncommon
Calcification common

122
Q

Intrasplenic pancreatic pseudocyst

A

Post pancreatitis pseudocyst at tail extends into spleen
Like post traumatic
Can cause splenic rupture

123
Q

Spleen lymphangioma

A

Childhood
Solitary or multiple
Multilocular cystic structure with thin septation
Post contrast—> septal enhancement

124
Q

Spleen sarcoidosis

A

Multiple nodule with noncaseating granulomas
Splenomegaly, hepatomegaly, LAP

Multi nodular pattern: numerous hypo 1-3 cm lesions no enhancement
Imaging: hypo on all MR sequences
Better seen on T2 and early post -T1

DDx: lymphoma

125
Q

Inflammatory pseudotumor in the spleen

A

Focal collection of immune cells and exudate
Fever and malaise

Imaging: well circumscribed, heterogenous enhancing

126
Q

Pyogenic abscess in spleen

A

Immunocompromised
Solitary—> bacterial
Multi focal—>fungal

CT: irregular, enhancing wall
Gas—> bacteria
US—>wheel within a wheel, bull’s eye

Tx: drainage

127
Q

Fungal abscess in spleen

A

Multiple <1cm
Immunocompromised
Candida, aspergillus, cryptococcal

CT: hypo
Pneumocystis jiroveci—> advanced AIDS, multi calcified lesions

128
Q

Echinococcal cyst in spleen

A

Associated with other organs
True cyst
Imaging: internal undulating membrane and daughter cysts

129
Q

Splenic lymphoma

A

Most common malignancy
Primary: rare, solitary, hypo, extends beyond capsule
Secondary:
Miliary masses, multiple small to moderate, one large,splenomegaly without mass

Best on post T1/involved portion will be hypo
US—> cystic Color—> internal flow

130
Q

Splenic Mets

A

Low rate of Mets

Most common—> breast,lung,ovarian,melanoma

Ovarian and melanoma—> cystic

Calcification—> mucinous adenocarcinoma

131
Q

Angiocarcinoma of spleen

A

Rare
Aggressive
20% 6month survival

Enlarged, heterogenous
Variable enhancement

132
Q

Splenic infarct

A

Emboli(older)
Thrombosis(young with hematologic disease)

Wedge shaped peripheral region non enhancement

MR: acute—> T1 hyper. Chronic—> T2 hyper

Lack of enhancement of entire spleen—> torsion(wandering spleen)

133
Q

Gamma Gandy bodies

A

Tiny foci of hemosiderin—> portal HTN

Hypo on all sequences
In phase—> blooming

134
Q

Portal HTN

A 
Splenomegaly
Varices
Recanalized umbilical vein
Ascites
Nodular liver contour
135
Q

Gaucher disease

A

AR deficiency of glucocetebrosidase

Splenomegaly, multiple splenic nodules
Bone: Erlenmeyer flask deformity of distal femurs, femoral head AVN, H shaped vertebral bodies

136
Q

Evaluating spleen trauma

A

Portal venous phase

137
Q

Splenic hematoma

A

Most—> subcapsular

Hypo to enhanced spleen

138
Q

Splenic laceration

A

Only on contrast enhanced

Linear or branching hypo

139
Q

Splenic vessel injury

A

Active extravas—> area of hyper which increases in size on delayed phase
Pseudoaneurysm/AV fistula—> well circumscribed hyper but do not increase on delayed ( differentiate with splenic arteriography)

140
Q

MDCT based splenic injury grading system

A 
Grade 1: <1cm subcap
Grade 2: >1 and <3 subcap
Grade 3: splenic capsular, >3 cm lac
Grade IVA: active extravas, vascular injury, shattered spleen
Grade IVB: active intraperitoneal bleed

Radiology (3 decks)

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