Practise viva Flashcards
Budd-Chairi
Nodular liver contour Idiopathic, congenital (venous web), thrombosis (pregnant, OC, polycythaemia, antiphospholipid, sickle cell disease, other) Phlebitis - BMT, chemo Autoimmune Tumour invasion - RCC, HCC, adrenal Ca Leiomyosarc of IVC
Calcific mets
BOTOM Breast Osteosarc Papillary thyroid Ovary Mucinous adenocarcinoma (esp colorectal)
Random points
Second unrelated sign
Common condition on uncommon exam
Talk about findings being persistent or not with fluoroscopy
Random cases
Aspiration on barium swallow
Double cystic duct and other anatomical variants
Renal scarring
Reflux nephropathy
Infarct
Chronic infection
Sigmoid volvulus
Large bowel obstruction
Ahaustral wall, lower end points to pelvis
More common in elderly - associated with chronic neuro conditions, meds for psych conditions, Chagas, chronic laxatives or constipation, fibre rich diet
Rectal tube insertion succesful in treating 90%
Caecal volvulus
Younger patients than sigmoid
Laparotomy for reduction, may need caecoplexy, or hemicolectomy if ischaemic
Emphysematous pyelonephritis
Diabetes E coli, klebsiella, proteus. Retroperitoneal air or air over renal shadow High mortality Drain collections and IV antibiotics
Emphysematous cholecystitis
Diabetes
More common in men
50% acalculous
High rate of perforation
Biliary gas v portal venous gas
Biliary central, portal venous peripheral
Small bowel obstruction radiograph
Herniae
Appendicoliths
Gallstones
Staghorn calculi
Struvite stone
Setting of recurrent infection with urease producing organisms
Proteus, klebsiella, pseudomonas, enterobacter
More common in women, cord injury, renal tract anamoly, reflux
May progress to xanthogranulomatous pyelonephritis
Xanthogranulomatous pyelonephritis
Associated with staghorn calculi
Chronic granulomatous pyelonephritis
E coli, proteus
Surgical nephrectomy
Sclerosing encapsulating peritonitis
Rare benign cause of acute or subacute bowel obstruction
Total or partial encasement of small bowel by thick fibrocollagenous membrane
Idiopathic or secondary to peritoneal dialysis, shunts e.g. VP
And rarely other causes e.g. TB, sarcoid
Wall may calcify
Relative washout
PV - delayed / PV
>40% suggests adenoma
Absolute washout
PV - delayed / PV - unenhanced
>60% suggests adenoma
Abdominal calcification
Don’t forger aneurysm as possible cause
Hypervascular liver mets
Renal, thyroid, breast, lung, melanoma, carcinoid, chodiocarcinoma, other
Central scar
FNH, large haemangioma, fibrolamellar HCC
May also be seen in normal HCC, some mets, cholangiocarc
Hypervascular liver lesion
HCC, haemangioma, FNH, adenoma, mets
FNH
T2 hyperintense scar Delayed enhancement of central scar Takes up hepatobiliary contrast agent - iso cf adenoma hypo Spoke wheel on doppler, DSA Usually soitary, subcapsular mass
Fibrolamellar HCC
May resemble FNH
Will not take up sulphur colloid (Kuppfer cells)
Young adults without cirrhosis
FNH has T2 scar and has less calcs and is less heterogeneous
Better prognosis - 60% 5yr
Washout of hypervascular liver lesion
Malignancy until proven otherwise
Pancreatic trauma
Treat duct injuries with stenting
Complications of pseudocyst, pancreatitis
Duct injury makes grade 3 AAST or above
MRCP can image the duct
Horseshoe kidney associations
Turners, and trisomies (esp 18)
VACTERL
PUJ obstruction Susceptibility to trauma Calculi Wilms, TCC, renal carcinoid Infection Renovascular hypertension
Bilateral renal fossa clips and calcification in pelvis
Bilateral ureteronephrectomy and failed trasplant kidney
Small bowel ischaemia
With embolus in SMA ileocolic
Retroperitoneal tumour
Outside major organs
90% sarcomas
40-50
Extragonadal GCT, and primary retroperitoneal adeno much rarer
Liposarc, PUS, leiomyosarc, rhabdoymyosarc
Radiotherapy increases risk (e.g. to neuroblastoma as a child)
AMLs and TS
Previous plain film with nephrectomy one side, embolisation coils the other
Multiple commonly with TS
TS get RCC at same rate as general population but at a younger age. Also associated with renal cysts
Can have retroperitoneal LAM
Testicular epidermoid
Also known as keratocyst Benign, germ cell origin Most common benign testicular neoplasm Painless Keratinous debris lined by squamous epithelium, layers Non-vascular, onion skin appearance Treatment controversial
Bile duct injury in hepatic trauma
May lead to bile peritonitis or biloma
Retroperitoneal colletion, large bowel obstruction, bone and lung mets
Colon ca
Colon ca location
Recotsigmoid - 55%
Caecum and ascendeing - 20%
Transverse - 10%
Descending - 5%
Small bowel dilatations and strictures with intervening normal bowel
Crohns
Haemoperitoneum
Layering dense fluid
Cause may be hepatic mass e.g. adenoma (usually surgically removed to take away risk and confirm diagnsis)
FMD
Renal arteries most common, then carotids
Can affect mesenterics and coeliacs
Saw viva case with occluded SMA with supply by marginal artery of Drummond or arc of Riolan
SMA IMA anastomoses
Marginal artery of Drummond, arc or Riolan
Retrocaval ureter
On right
May have obstruction or infection secondary to stasis
Saw viva case with stone posterior to IVC
Spina bifida
May lead to neurogenic bladder
Therefor increased risk of stones (may see both on same plain radiograph)
Malignant v benign gastric ulcer - barium
Benign: exoluminal, smooth folds to edge, Hamptons line (radiolucent normal mucosa at neck)
Malignant: endoluminal, nodular folds don’t reach edge,, Carman meniscus sign - inner margin convex towards gastric lumen, “Heaped edged”
Herniae causing small bowel obstruction
CT and x-ray appearance
Splenic cysts
Epidermoid cyst (most common) Haemangioma (second most common) Lymphangioma Cystic mets Hydatic cyst Bacterial abscess Pancreatic pseudocyst
Fat containing liver lesion
If Cirrhosis, most likely HCC Other differentials: Focal fat Adenoma Lipoma Hepatic AML and other rarer causes
Liver trauma grading
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Renal trauma grading
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Splenic trauma grading
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Pancreatic trauma grading
.
Hyperechoic liver met
CRC
RCC
Neuroendocrine (pancreatic or carcinoid)
Choriocarcinoma
Hypoechoic liver met
Most common (65%) Lung Breast Pancreatic Lymphoma
ADPKD
Associated with: Berry anuerysms HTN Liver cysts Multiple biliary hamartomas Bicuspid aortic valve Aortic dissection Intracranial dolichoectasia Cr 16 or 4
Striated nephrogram
Ureteric obstruction
Pyelonephritis
Renal vein thrombosis
ATN (bilateral)
Renal vein thrombosis
.
Cortical nephrocalcinosis
.
Medullary nephrocalcinosis
.
Renal papillary necrosis
.
Polycystic kidneys
On plain film, may see fairly diffuse abdominal calcs (in calcified cysts), and masses displacing bowel
Linitis plastica
Distorted folds or thickened or nodular, and indistensible stomach
Most commonly scirrhous adeno
Also mets (breast, lung), or lymphoma
Infiltrative diseases (/ granulomatous e.g. Crohn’s, TB, sarcoid) or scarring (e.g. caustic) also in diffential
