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Abdominal Radiology > Pancreas and Spleen > Flashcards

Pancreas and Spleen Flashcards

1
Q

administration of this substance increases pancreatic secretions and improves visualization of the pancreatic duct during MRCP

A

secretin

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2
Q

tongue-shaped organ approximately 12 to 15 cm in length that lies within the anterior pararenal compartment of the retroperitoneum

A

pancreas

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3
Q

pancreas is posterior to the

A

left lobe of liver, stomach and lesser sac

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4
Q

head of the pancreas wraps around what vessel

A

junction of SMV and splenic vein

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5
Q

uncinate process of the pancreatic head extends under what vessel

A

SMV

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6
Q

vessel that courses through the pancreatic bed in an often tortuous course

A

splenic artery

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7
Q

maximum dimenstion of pancreas are

A

3.0 cm for the head, 2.5 cm for body and 2.0 cm for the tail

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8
Q

normal size of pancreatic duct

A

3 to 4 mm in the head and tapers smoothly to the tail

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9
Q

what part of the duodenum cradles the pancreatic head

A

C-loop

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10
Q

appearance of pancreatic tumors in MRI

A

lower signal than parenchyma on T1, on cystic lesions are bright on T2

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11
Q

normal retroperitoneal fat infiltrates pancreatic lobule in older patients because

A

it lacks capsule

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12
Q

most comprehensive initial imaging study for acute pancreatitis

A

contrast-enhanced MDCT

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13
Q

2 morphologic types of acute pancreatitis

A

interstitial edematous pancreatitis and acute necrotizing pancreatitis

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14
Q

appears as localized or diffuse enlargement of the pancreas with normal homogeneous parenchymal enhancement or slightly heterogeneous enhancement due to edema. mild fat stranding and peripancreatic inflammatory changes may be present with cvarying volumes of peripancreatic fluid

A

interstitial edematous pancreatitis

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15
Q

most common cause of chronic pancreatitis

A

alcohol abuse

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16
Q

most common cause of acute pancreatitis

A

gallstone passage/impaction

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17
Q

type of hyperlipidemia that is susceptible to pancreatitis

A

Type 1 and 5

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18
Q

infections that are susceptible to pancreatitis

A

mumps, hepatitis, infectious mononucleosis, AIDS, ascariasi, clonorchis

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19
Q

structural disorders that may be susceptible to pancreatitis

A

choledochocele, pancreas divisum

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20
Q

most common form of acute necrotizing pancreatitis

A

pancreatic parenchymal necrosis with peripancreatic necrosis

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21
Q

appearing as a lack of pancreatic parenchymal enhancement associated with nonliquefied heterogeneous areas of nonenhancement in peripancreatic tissues, most commonly in the lesser sac and retroperitoneum

A

pancreatic parenchymal necrosis with peripancreatic necrosis

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22
Q

pancreatic necrosis is best determined by what modality at 72 hours following onset of symptoms

A

CT

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23
Q

pancreatic pseudocyts are defined as simple collections with perceptible walls seen in how many weeks

A

after 4 weeks

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24
Q

true or false: pancreatic pseudocysts usually do not require drainage

A

true

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25
Q

Drainage is often required for pancreatic pseudocysts if there is

A

infected fluid collection

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26
Q

an enhancing wall may develop around an acute pancreatic necrotic collections and if seen after 4 weeks the collection is termed

A

“walled-off” necrosis

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27
Q

thin-walled peripancreatic collection peristing after 4 weeks without necrosis

A

pseudocyts

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28
Q

secondary infection in pancreatitis usually occurs at what week

A

2-3 weeks

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29
Q

this complication of pancreatitis is caused by autodigestion of arterial walls by pancreatic enzymes results in pulsatile mass that is lined by fibrous tissue and maintains communication with parent artery

A

pseudoaneurysm

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30
Q

this complication of pancreatitis is due to pancreatic necrosis resulting in a viable segment of the pancreas (most common in the neck) being disconnected from the intestinal tract and a persistent fistual with continuing leakage of fluid into peripancreatic spaces

A

disconnection of the pancreatic duct

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31
Q

common congenital variant pancreatic anatomy that serves as a predisposition to pancreatitis in which the ventral and dorsal ductal systems of the pancreas fail to fuse

A

pancreas divisum

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32
Q

In pancreatic divisum, the major portion of the pancreatic secretions from the body and tail via the

A

dorsal pancreatic duct (Santorini) into the minor papilla while the minor portion of pancreatic secretions from the head and uncinate process (ventral duct of Wirsung)

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33
Q

recurrent and prolonged bouts of acute pancreatitis that cause parenchymal atrophy and progressive fibrosis. Both the exocrine and endocrine function of the pancreas may be impaired

A

chronic pancreatitis

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34
Q

morphologic changes of chronic pancreatitis include

A

dilation of the pancreatic duct, usually in a beaded pattern or alternating areas of dilation and constriction, decrease in visible pancreatic tissue because of atrophy, calcifications in pancreatic parenchyma that vary from finely stippled to coarse, usually associated with alcoholic pancreatitis, fluid collections that are both intra- or extrapancreatic, focal mass-like enlargement of the pancreas owing to benign inflammation and fibrosis, stricture of the bile duct because of fibrosis or mass in the pancreatic head, fascial thickening and chronic inflammatory chanegs in surrounding tissues

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35
Q

unique form of pancreatitis caused by autoimmune disease associated with elevation of IgG4. this is common in men aged 40 to 65. presentation is often obstructive jaundice with history of recurrent mild abdominal pains

A

autoimmune pancreatitis

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36
Q

extrapancreatic manifestations of autoimmune pancreatitis occur in 30 % of patients and include

A

IBD, especially UC, long-segment bile duct strictures, lung nodules, lymphadenopathy, lymphocytic infiltrates in the liver and kidneys, retroperitoneal fibrosis and Sjogren syndrome

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37
Q

in this type of pancreatitis, there is periductal infiltration by lymphocytes and plasma cells with accompanying dense fibrosis results in diffuse enlargement of the pancreas and masses closely simulating adenocarcinoma

A

autoimmune pancreatitis

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38
Q

treatment for autoimmune pancreatitis

A

steroids

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39
Q

differentiation of autoimmune pancreatitis from adenocarcinoma include

A

diffuse or focal swelling of the pancreas with characteristic tight halo of edema, extensive peripancreatic stranding and edema are absent, diffuse or segmental narrowing of the pancreatic duct and/or common bile duct, absence of dilation of the pancreatic dut and absence of parenchymal atrophy proximal to the pancreatic mass, fluid collections and parenchymal calcifications are typically absent, peripancreatic blood vessels are usually not involved, kidneys are involved in one-third of cases showing round wedge-like, or diffuse peripheral patchy areas of decreased contrast enhancement

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40
Q

uncommon form of pancreatitis that may also mimic adenocarcinoma. fibrosis in the groove between the head of the pancreas, the descending duodenum and the common bile duct produces an inflammatory mass that obstructs the common bile duct. this is most common in middle-aged men with a long history of alcohol abuse

A

Groove pancreatitis

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41
Q

a highly lethal pancreatic tumor that usually unresectable at presentation. this is second only to colorectal cancer as the most common digestive tract malignancy

A

pancreatic adenocarcinoma

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42
Q

this pancreatic malignancy appears as a hypodense mass distorting the contour of the gland, associated findings include obstruction of the CBD and pancreatic duct and atrophy of pancreatic tissue proximal to the tumor

A

adenocarcinoma

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43
Q

metastases from pancreatic adenocarcinoma would go to

A

regional node, liver and peritoneal cavity

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44
Q

signs of resectability of pancreatic adenocarcinoma include

A

isolated mass with or without dilation of the bile or pancreatic ducts, no extrapancreatic disease, encasement of celiac axis or SMA, regional nodes may be involved and limited peripancreatic extension of tumor may be present

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45
Q

evidence of arterial encasement that indicates unresectability of pancreatic adenocarcinoma

A

tumor abutting >180 degrees of the circumference of the artery, tumor abutment focally narrowing the artery and occlusion of the artery by tumor

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46
Q

characteristic pancreatic duct dilatation of chronic pancreatitis

A

beaded dilatation

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47
Q

characteristic pancreatic duct dilatation in carcinoma

A

smooth ductal dilation

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48
Q

are calcifications common in pancreatic adenocarcinoma?

A

no

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49
Q

pancreatic tumors that may be functioning producing hormones resulting in distinct clinical syndromes, or may be nonfunctional and grow to large size before presenting clinically

A

neuroendocrine (islet cell) tumors

50
Q

neuroendocrine pancreatic tumor that present with episodic hypoglycemia

A

insulinomas

51
Q

neuroendocrine pancreatic tumor that present with peptic ulcers, diarrhea caused by gastric hypersecretion, or Zollinger-Ellison syndrome

A

gastrinomas

52
Q

neuroendocrine pancreatic tumor that present as DM and painful glossitis

A

glucagonoma

53
Q

neuroendocrine pancreatic tumor that preent with DM and steatorrhea

A

somatostatinoma

54
Q

neuroendocrine pancreatic tumor that present with massive watery diarrhea

A

VIPoma

55
Q

functioning neuroendocrine pancreatic tumor vary in malignant potential from __ for insulinoma, ___ for gastrinoma, ___ for glucagonoma

A

10% of insulinoma, 60% for gastrinoma, 80% for glucagonoma

56
Q

functioning neuroendocrine tumors are usually less than what size

A

3 cm

57
Q

how many percent of nonfunctioning neuroendocrine pancreatic tumor are malignant

A

80%

58
Q

neuroendocrine pancreatic tumors that are nonfunctioning tend to be of what size

A

much larger (6-20 cm in diameter

59
Q

metastatses to the pancreas are most frequent with what primary neoplasms

A

RCC and bronchogenic carcinoma

60
Q

metastases to the pancreas may appear as

A

solitary, well-defined, heterogeneously enhancing mass as diffuse heterogeneous enlargement of pancreas or as multiple nodules

61
Q

metastases from this primary malignancy appears hyperintense on T1

A

melanoma because of paramagnetic properties of melanin

62
Q

associated finding in pancreatic lymphoma

A

enlarged peripancreatic lymph nodes

63
Q

diffuse infiltration of the pancreas is associated with

A

aging and obesity, pancreatic atrophy

64
Q

refers to unusual occurrence of macrocysts of varying size distributed throughout the pancreas in patients with cystic fibrosis

A

pancreatic cystosis

65
Q

most common pancreatic cystic lesions representing up to 85% to 90% of cystic lesions. most are unilocular fluid collections confined by a fibrous wall that does not contain epithelium

A

pancreatitis-associated fluid collections

66
Q

cyst fluid aspiration of pancreatitis-associated fluid collections reveal elevated

A

amylase levels

67
Q

these are benign tumors not requiring treatment that most commonly occurs in women and distributed uniformly throughout the head, body and tail of pancreas. they appear as honeycomb microcysts (microcystic adenoma) with innumerable small cysts 1 mm to 2 cm in size, a macrocystic form with larger cysts is seen in 10% overlapping the appearance of mucinous cystadenoma

A

serous cystadenomas

68
Q

highly diagnostic feature of serous cystadenoma of pancreas

A

central stellate scar that may calcify

69
Q

diagnosis of serous cystadenoma of pancreas is confirmed if the aspirated cystic fluid shows

A

clear fluid without mucin and without tumor markers seen with cystic mucinous neoplasms of the pancreas such as CEA or carbohydrate antigen (CA 19-9, CA 72-4, CEACAM6)

70
Q

classification of cystic mucinous neoplasms of pancreas

A

intraductal papillary mucinous neoplasms and mucinous cystic neoplasms

71
Q

characterized pathologically by mucin-producing epithelial tumor cells that tend to form papillae and grow as cystic lesions

A

cystic mucinous neoplasms

72
Q

recommended imaging for cystic mucinous neoplasms of pancreas larger or equal to 10 mm and cysts producing symptoms to check for “high-risk stigmata” or “worrisome features”

A

contrast-enhanced MDCT or MR with MRCP

73
Q

worrisome features of cystic mucinous neoplasms include

A

cysts > or = o 3 cm diameter, enhancing thickened cyst walls, main pancreatic duct diameter of 5 to 9 mm, mural nodules without enhancement, abrupt narrowing of main pancreatic duct with proximal atrophy of pancreatic parenchyma and regional lymphadenopathy

74
Q

“high-risk” stigmata of cystic mucinous neoplasms include

A

CBD obstruction with jaundice associated with cystic tumor in the pancreatic head, enhancement of solid components and main pancreatic duct diameter of > or = 10 mm

75
Q

intraductal papillar mucinous neoplasms are divided into 3 morphologic types

A

branch duct, main duct, mixed type

76
Q

type of IPMN that is characterized by diffuse or segmental dilatation of main pancreatic duct >5 mm in diameter without evidence of other causes of obstruction

A

main duct IPMN

77
Q

most common type of IPMN

A

mixed type

78
Q

rare type of pancreatic neoplasm that is low-grade, presents as a large (mean 9 cm) encapsulated mass with a mixture of fluid, hemorrhagic, necrotic and solid components. it is not truly papillary or cystic

A

solid pseudopapillary tumor

79
Q

tumor that is often asymptomatic even though the lesions may exceed 20 cm in size. it closely resembles neuroendocrine tumors. it is heterogeneous, well-encapsulated tumor with variable cystic and solid components. solid areas in the periphery, enhance, peripheral calcifications may be present

A

solid pseudopapillary tumor

80
Q

cystic change in pancreatic adenocarcinoma are usually from

A

necrosis, hemorrhage, or formation of pseudocysts

81
Q

unilocular pancreatic cysts that are smaller than 10 mm are usually benign or malignant?

A

benign pseudocysts or retention cysts

82
Q

largest lymphoid organ

A

spleen

83
Q

true or false: there is no hematopoietic activity in the spleen

A

true

84
Q

this organ sequesters abnormal and aged RBC and WBC and platelets and serves as a reservior for RBC

A

spleen

85
Q

spleen size varies with

A

age, nutrition and hydration

86
Q

spleen is relatively large at what age group

A

children

87
Q

spleen size matures by what age

A

15

88
Q

average spleen dimensions in adults

A

12 cm in length, 7 cm width, 3 to 4 cm in thickness

89
Q

splenic artery occlusion instantly produces infarction of the spleen because

A

splenic arteries are end arteries without anastomosis or collateral supply

90
Q

during arterial phase contrast enhancement of spleen, the parenchyma appears as alternating bands of high and low density, which is called

A

arciform pattern

91
Q

resistance pattern of splenic vessels

A

low resistance fast-flow circulation with high-resistance slow flow filtering circulation

92
Q

these are round masses, 1 to 3 cm in size and of the same imaging features as normal splenic parenchyma.they may be single or multiple and are usually located near the splenic hilum

A

accessory spleens

93
Q

used to confirm suspected accessory spleens as functioning splenic tissue

A

technetium sulfur colloid radionuclide scans

94
Q

term applied to normal spleen positioned outside of its normal location in the LUQ. may present as a palpable abdominal mass, atho most cause no symptoms

A

wandering spleen

95
Q

pathophysiology of wandering spleen

A

laxity of splenic ligaments, commonly found in association with abnormalities of intestinal rotation

96
Q

diagnosis of wandering spleen is made by

A

identifying the blood supply from splenic vessels and radionuclide scans

97
Q

refers to multiple implants of ectopic splenic tissue that may occur after traumatic splenic rupture

A

splenosis

98
Q

clinical sign of splenic regeneration

A

absence or disappearance Howell-Jolly bodies from PBS

99
Q

rare congenital anomaly that features multiple small spleens, usually located in the right abdomen and associated with situs ambiguous. Both lungs are two-lobes. Most patients also have cardiovascular anomalies

A

Polysplenia

100
Q

congenital absence of spleen, found in association with bilateral right-sidedness, midline liver and bilateral three-lobed lungs. most patients die before age 1

A

asplenia

101
Q

50% of cases of splenomegaly are from

A

portal hypertension

102
Q

30% of cases of splenomegaly are from

A

lymphoma

103
Q

splenomegaly has a splenic size of

A

more than 14 cm

104
Q

other helpful findings to diagnose splenomegaly

A

projection of spleen ventral to the anterior axillary line, inferior spleen tip extending more caudally than the inferior liver tip, inferior spleen tip extending below the lower pole of left kidney

105
Q

most common malignant tumor involving the spleen either as primary or as part of systemic disease

A

lymphoma

106
Q

patterns of splenic lymphoma include

A

diffuse splenomegaly, multiple masses of varying size, miliary nodules resembling microabscesses, large solitary mass, and direct invasion from adjacent lymphomatous nodes

107
Q

common predisposing condition for splenic infarction

A

lymphoma

108
Q

most common tumors to metastasize to the spleen are

A

malignant melanoma, lung, breast, ovary, prostate and stomach carcinoma

109
Q

key finding of splenic infarct

A

extension of abnormal parenchymal zone to an intact splenic capsule

110
Q

complications of splenic infarctions

A

subcapsular hematomas, infection, splenic rupture with hemoperitoneum

111
Q

small foci of hemosiderin resulting from focal hemorrhages in the spleen caused by portal hypertension

A

Gamma-Gandy bodies or siderotic nodules

112
Q

most common primary neoplasm of speen

A

hemangioma

113
Q

very rare but is still most common malignancy arising in the spleen. tumor is aggressive, usually presenting with widespread metastases especially to the liver

A

angiosarcoma

114
Q

1/4 of splenic angiosarcoma present with

A

spontaneous splenic rupture

115
Q

patients with exposure to this substance has increased risk for splenic angiosarcoma

A

thorotrast exposure

116
Q

false splenic cysts with fibrous walls that lack an epithelial lining. walls are thick and commonly become calcified

A

posttraumatic cysts

117
Q

posttrauamatic splenic cysts occur from

A

previous hemorrhage, infarction or infection

118
Q

true epithelial lined cysts that are probably developmental in origin

A

epidermoid cysts

119
Q

bacterial splenic abscesses result from

A

hematogeneous spread of infection, trauma, or infarction

120
Q

causes of splenic microabscesses

A

fungi, TB, pneumocystis jiroveci, histoplasmosis, CMV

121
Q

size of splenic microabscesses

A

5 to 10 mm up to 20 mm

Abdominal Radiology (14 decks)

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