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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
Q

Intraluminal filling defect on MRCP (bile ducts)

A

Choledocholithiasis
Pneumobilia
Hematobilia
CholangioCa

26
Q

Diffuse intrahepatic strictures / dilatations (bile ducts)

A 
PSC (no papillary strictures)
PBC
Recurrent pyogenic cholangitis
AIDS cholangiopathy (can have papillary strictures)
IgG4 disease
Caroli’s disease (mimic)
27
Q

Cystic structure in porta

A 
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
Q

Obstruction at the porta

A 
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
Q

Diffuse thickening of pancreas

A 
Pancreatitis
- autoimmune / IgG4
- acute
Neoplasm
- lymphoma
- infiltrative adenoca
30
Q

Pancreatic head mass / abnormal signal

A 
Neoplasm
- Pancreatic / Duodenal / Cholangio / Ampullary
- Mets / Lymphoma
Pancreatitis (groove or focal)
Laceration / contusion
31
Q

Cystic pancreatic mass

A 
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
Q

Hyperdense pancreatic mass

A 
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
Q

Fatty pancreas

A 
Young people
- CF
- T1DM
- Schwachman Diamond syndrome
Old people
- obese
- chronic pancreatitis
- obstructing mass
34
Q

Pancreatic duct dilation

A

Pancreatic adenocarcinoma
Chronic pancreatitis
Main duct IPMN

35
Q

Solid splenic lesion(s)

A 
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
Q

Cystic splenic lesion

A

Post insult pseudocyst (trauma, infection, infarct)
Congenital true cyst (epidermoid)
Abscess / echinococcal cyst
Splenic artery aneurysm or pseudoaneurysm
Hematoma

37
Q

Wedge shaped / linear lesion(s) in spleen

A

Infarct
Laceration
Cleft

38
Q

Splenic calcification

A

Granulomatous disease (scattered or diffuse)
Infarct (remote)
Hematoma
Calcified splenic artery aneurysm

39
Q

Splenomegaly

A 
Mild to moderate
- portal hypertension
- infection
- AIDS
Moderate to marked
- leukemia/lymphoma
- infectious mononucleosis
Marked
- myelofibrosis
40
Q

Complex / loculated ascites, peritoneal thickening / mass

A 
Neoplastic
- pseudomyxoma peritonei
- peritoneal carcinomatosis / lymphomatosis
- peritoneal mesothelioma
Infectious
- TB / Actinomyces
- bacterial peritonitis
- phlegmon
Sclerosing mesenteritis
41
Q

Pelvic cyst

A 
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
Q

Big fucking mass

A 
Malignant primary
- sarcoma
- ovarian neoplasm
- GIST
Benign
- desmoid
- uterine fibroids
Mets / Lymphoma
43
Q

Spiculated mesenteric mass

A 
Neoplastic
- desmoid
- metastatic carcinoid or mucinous neoplasms (GI / ovary)
- treated lymphoma
Sclerosing mesenteritis
44
Q

Low attenuation lymphadenopathy

A 
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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