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RRC DDx 2 > GI - HPB & Mesentery > Flashcards

GI - HPB & Mesentery Flashcards

1
Q

Patchy / heterogeneous liver

A 
Hepatitis
Infiltrative neoplasm
Outflow obstruction 
- right heart failure
- Budd-Chiari
- veno-occlusive disease
Heterogeneous steatosis
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2
Q

Hyperdense liver (>75 HU)

A 
Amiodarone deposition (iodine)
Hemochromatosis / hemosiderosis (iron)
Wilson’s (copper)
Glycogen storage diseases
(Gold deposition / therapy for RA)
(Thorotrast)
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3
Q

Hypodense liver

A

Steatosis

Amyloid

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4
Q

Nutmeg liver (mottled enhancement)

A 
Budd Chiari
Hepatic veno-occlusive disease
Cardiac hepatopathy:
- right heart failure
- constrictive pericarditis
- cardiac surgery
- right-sided valvular disease
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5
Q

Massive caudate lobe hypertrophy

A

Budd-Chiari
Primary sclerosing cholangitis (central regenerative hypertrophy)
Primary biliary cirrhosis

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6
Q

Cirrhosis - etiologies

A

Metabolic

  • alcohol
  • steatohepatitis
  • hemochromatosis
  • Wilson disease

Infectious

  • chronic hepatitis B
  • chronic hepatitis C

Inflammatory

  • primary biliary cirrhosis
  • primary sclerosing cholangitis
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7
Q

Hepatic steatosis - etiologies

A

Idiopathic / obesity / diabetes / metabolic syndrome (NAFLD)
Alcohol
Chemotherapy / steroids
TPN

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8
Q

Hemosiderosis - etiologies

A 
Chronic transfusion
Chronic liver disease
Thalassemia
(Sideroblastic anemia)
(Pyruvate kinase deficiency)
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9
Q

Solitary hyperechoic hepatic mass

A 
Hemangioma
Other neoplasm: 
- primary: adenoma, FNH, HCC 
- metastatic: neuroendocrine tumour
Focal fatty change
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10
Q

Solitary hypoechoic hepatic mass

A 
Neoplasm:
- primary, secondary
- lymphoma
Collection:
- abscess 
- hematoma
Focal fatty sparing
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11
Q

Hepatic cystic lesion

A 
Simple cyst
Neoplasm:
- biliary cystadenoma / cystadenocarcinoma
- giant hemangioma
- necrotic tumour
- cystic / treated met
Collection:
- abscess (pyogenic or amebic) / echinococcal cyst
- biloma
- hematoma
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12
Q

Hyperenhancing hepatic lesion

A 
Primary liver neoplasm:
- FNH
- adenoma
- hemangioma
- HCC
Hypervascular metastasis
Vascular abnormality:
- THAD
- portovenous shunt
- AVM 
- peliosis hepatis
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13
Q

Fat containing hepatic lesion

A 
HCC
Adenoma
Focal fatty change
(AML, esp in TS)
(Myelolipoma)
(Metastatic liposarcoma)
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14
Q

Capsular retraction

A

Cholangiocarcinoma
Confluent hepatic fibrosis
Sclerotic hemangioma (esp in cirrhotic liver)
Epithelioid hemangioendothelioma (usually multiple)
Treated mets / pseudocirrhosis (esp breast, likely multiple)

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15
Q

Multiple solid hepatic lesions in non-cirrhotic

A 
Neoplastic:
- multiple primary hepatic
- mets
- lymphoma
Granulomatous process:
- fungal / mycobacterial infection
- sarcoid
Nodular hepatic steatosis or sparing
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16
Q

Multiple solid hepatic lesions in a cirrhotic

A

Multifocal HCC
Regenerative / dysplastic nodules
Mets

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17
Q

Multiple tiny hepatic lesions

A

Biliary hamartomas
Microabscesses
Sarcoid
Mets / lymphoma

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18
Q

Multiple cystic hepatic lesions

A 
Polycystic liver disease
Caroli’s
Biliary hamartomas
Abscesses
Cystic mets
19
Q

Wedge shaped hepatic lesions

A

Infarct
Perfusional
Focal confluent fibrosis

20
Q

Linear hepatic lesions

A

Laceration
Subacute infarct
Thrombosed veins
Intrahepatic biliary dilatation

21
Q

Diffuse mural thickening (gallbladder)

A 
Cholecystitis
Edema 
- CHF
- cirrhosis/hypoalbuminemia
- third spacing
- nephrotic syndrome
Reactive
- hepatitis
- pancreatitis
Non-fasting / postprandial state
Adenomyomatosis
Neoplasm (GB carcinoma, consider lymphoma & metastasis)
22
Q

Focal / mass-like mural thickening (gallbladder)

A 
Adenomyomatosis
Malignancy
- gallbladder carcinoma
- mets (melanoma)
Xanthogranulomatous or chronic cholecystitis
Vascular: varices
23
Q

Intraluminal mass (gallbladder)

A

Polyp: cholesterol or adenomatous
Malignancy: gallbladder carcinoma or mets
Adherent sludge / stone

24
Q

Dense shadowing (gallbladder)

A

Stones (wall-echo-shadow sign)
Porcelain gallbladder
Emphysematous cholecystitis

25
Intraluminal filling defect on MRCP (bile ducts)
Choledocholithiasis Pneumobilia Hematobilia CholangioCa
26
Diffuse intrahepatic strictures / dilatations (bile ducts)
``` PSC (no papillary strictures) PBC Recurrent pyogenic cholangitis AIDS cholangiopathy (can have papillary strictures) IgG4 disease Caroli’s disease (mimic) ```
27
Cystic structure in porta
``` Choledochal cyst / dilated duct Vascular (put on flow) Collection (biloma, abscess, pancreatic pseudocyst, resolving hematoma) Cystic mass - lymphangioma - GI duplication cyst - cystic adenopathy - exophytic cystic mass from liver, duodenum, pancreas ```
28
Obstruction at the porta
``` Malignancy (external) - cholangio (Klatskin) - mets (liver or portal nodes) Benign stricture (mural) - post chole - prior passage of stone - prior pancreatitis Stone (intraluminal) - Mirrizi syndrome - choledocholithiasis ```
29
Diffuse thickening of pancreas
``` Pancreatitis - autoimmune / IgG4 - acute Neoplasm - lymphoma - infiltrative adenoca ```
30
Pancreatic head mass / abnormal signal
``` Neoplasm - Pancreatic / Duodenal / Cholangio / Ampullary - Mets / Lymphoma Pancreatitis (groove or focal) Laceration / contusion ```
31
Cystic pancreatic mass
``` Neoplasm - IPMN - serous microcystic adenoma - mucinous cystic neoplasm - solid pseudopapillary neoplasm - cystic neuroendocrine Non-neoplastic Acute - acute peripancreatic collection - acute necrotic collection Chronic - pseudocyst - walled off necrosis Cyst related to VHL, CF ```
32
Hyperdense pancreatic mass
``` Neoplasm - neuroendocrine tumour - hypervascular met (esp renal cell) - solid serous cystadenoma (esp VHL) Ectopic splenic tissue (splenule or splenosis) Splenic artery aneurysm / pseudoaneurysm Complex cystic mass ```
33
Fatty pancreas
``` Young people - CF - T1DM - Schwachman Diamond syndrome Old people - obese - chronic pancreatitis - obstructing mass ```
34
Pancreatic duct dilation
Pancreatic adenocarcinoma Chronic pancreatitis Main duct IPMN
35
Solid splenic lesion(s)
``` Malignant neoplasm - angiosarcoma - leukemia / lymphoma (T2 dark) - mets Benign neoplasm - hemangiomas (Kasabach-Merritt, Klippel-Trenauny-Weber, Beckwith-Weideman) - hamartomas / sclerosing angiomatoid nodular transformation (SANTs) - Littoral cell angioma (T2 dark) Infection - mycobacterial / fungal - pyogenic abscess Sarcoid (T2 dark) ```
36
Cystic splenic lesion
Post insult pseudocyst (trauma, infection, infarct) Congenital true cyst (epidermoid) Abscess / echinococcal cyst Splenic artery aneurysm or pseudoaneurysm Hematoma
37
Wedge shaped / linear lesion(s) in spleen
Infarct Laceration Cleft
38
Splenic calcification
Granulomatous disease (scattered or diffuse) Infarct (remote) Hematoma Calcified splenic artery aneurysm
39
Splenomegaly
``` Mild to moderate - portal hypertension - infection - AIDS Moderate to marked - leukemia/lymphoma - infectious mononucleosis Marked - myelofibrosis ```
40
Complex / loculated ascites, peritoneal thickening / mass
``` Neoplastic - pseudomyxoma peritonei - peritoneal carcinomatosis / lymphomatosis - peritoneal mesothelioma Infectious - TB / Actinomyces - bacterial peritonitis - phlegmon Sclerosing mesenteritis ```
41
Pelvic cyst
``` Related to ovaries - ovarian cyst or cystic neoplasm - parovarian cyst - peritoneal inclusion cyst Cyst - GI duplication cyst - mesenteric cyst Collection - lymphocele - loculated ascites - abscess Neoplasm - cystic adenopathy - lymphangioma ```
42
Big fucking mass
``` Malignant primary - sarcoma - ovarian neoplasm - GIST Benign - desmoid - uterine fibroids Mets / Lymphoma ```
43
Spiculated mesenteric mass
``` Neoplastic - desmoid - metastatic carcinoid or mucinous neoplasms (GI / ovary) - treated lymphoma Sclerosing mesenteritis ```
44
Low attenuation lymphadenopathy
``` Cystic / necrotic lymph nodes - TB - treated lymphoma - cavitating mesenteric lymph node syndrome (celiac sprue) Fat-containing lymph nodes - Whipple disease ```

RRC DDx 2 (8 decks)

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