Lecture 20: GI Radiology

Question 1

What is the search strategy for image interpretation of the abdomen?

Answer 1

• Solid organs: Liver, spleen, pancreas, adrenal glands, and kidney
• Gallbladder/biliary system
• Lymph node chains: hepatogastric lig, periportal region, mesentery
• Stomach, duodenum, rest of small bowel, colon
• Fat planes, abdominal wall, bones

Question 2

In a T1-weighted vs T2-weighted MRI, how does fluid show up?

Answer 2

T1: fluid is dark

T2: fluid is bright (best for fluid)

Question 3

Which structures on CT will show up best at level of T11?

Answer 3

Spleen, stomach, liver, aorta, IVC, inferior aspects of lung well defined

Question 4

Which structures on CT will show up best at level of T12?

Answer 4

• Pancreas, spleen, kidney (particularly left)
• Gallbladder, portal triad
• Bifurcation of celiac trunk, possibly SMA, left renal vein, aorta, IVC
• View of small bowel, stomach

Question 5

Identify this structure; seen best at what level?

Answer 5

Gastric fundus (stomach)

*Seen best at T11

Question 6

Identify this structure; seen best at what level?

Answer 6

• Gallbladder
• Seen best at T12

Question 7

Identify this structure; seen best at what level?

Answer 7

• Colon
• At T12

Question 8

Which structures are seen at level of T12-L1?

Answer 8

• Pancreas, spleen, kidneys (particularly left)
• Gallbladder, portal triad, biliary tree
• SMA, left renal vein, aorta, IVC
• View of small bowel, left colon, duodenum

Question 9

Identify this structure; seen best at which level?

Answer 9

• SMA
• T12-L1

Question 10

Which strucutres are seen at level of L3-L4?

Answer 10

• Right kidney
• Gallbladder
• View of small bowel, ascending/descending colon, 3rd part of duodenum
• Abdominal and post-abdominal musculature well visulaized

Question 11

Identify this structure; well visualized at what level?

Answer 11

• Psoas Muscle
• L3-L4

Question 12

What is the modality of choice for diagnosing problems w/ the Biliary Tree?

Answer 12

• Endoscopic retrograde cholangiopanreatography (ERCP)

Question 13

What is the imaging modality of choice for visualizing the abdominal aortic vasculature?

Answer 13

• Digital subtraction arteriography

Question 14

What is the pathology seen here; causes?

Answer 14

• Ascites (fluid accumulation in abdomen)
• Liver cirrhosis, salt/water retention, heart failure, cancer

Question 15

What is a mid-sagittal view in CT useful in identifying?

Answer 15

Useful in assessing the SMA and “Nutcracker” syndrome

Question 16

What is SMA syndrome?

Answer 16

• 3rd part of the duodenum is compressed between aorta and SMA
• Results in partial or complete blockage of the duodenum

Question 17

What is Nutcracker Syndrome?

Answer 17

• Compression of the left renal vein between the SMA and aorta

Question 18

What type of hernia is this?

Answer 18

• Sliding hiatal hernia
• Bulge of stomach through esophageal hiatus into thorax

Question 19

What type of hernia is showed here?

Answer 19

• Paraesophageal hiatal hernia

Question 20

What pathology is seen here; common presenting sx’s?

Answer 20

• Zenker’s Diverticulum
• Diverticular formation in the esophageal wall adjacent to the inferior pharyngeal constrictor and cricopharyngeus muscle
• Severe halitosis (bad breath)

Question 21

What pathology is seen here?

Answer 21

• Ulcerative Colitis
• Classic “lead pipe” apperance due to loss of the haustral marking throughout the colon

Question 22

What pathology is seen here; cause?

Answer 22

• Cholithiasis (gall stones)
• High concentrations of bilirubin in bile and/or inefficient emptying

Question 23

What is this pathology?

Answer 23

• Shatzki Ring
• Narrowing of esophagus caused by ring of mucosal tissue