Radiology of IBD/Cancer Flashcards
What do you call the inner layer that invaginates in an intussusception? What do you call the outer layer that “receives” and is dilated?
Inner invaginating layer is the intussusceptum.
Outer receiving layer that dilates is the intussusceptiens.
What areas are most commonly affected in Crohn’s?
Small bowel/colon=55%
Small bowel alone=30%
Colon alone=15%
What are radiographic findings in UC? (6)
Granular mucosa Small nodules/pseudopolyps ulcers on background Tubular configuration colon Backwash ileitis Colon cancer
What are radiographic manifestations in Crohn’s on Barium study? (7)
Aphthoid ulcers Mesenteric border ulcers Sacculation Cobblestoning Wall thickening Stricture formation Fistulae
What are radiographic manifestations in Crohn’s on CT? (5)
Wall thickening Mucosal hyperenhancement Mesenteric fat stranding Fistulae Abscess
What is gliadin?
Gliadin==> portion of gluten that causes damage to small bowel mucosa
What are histo findings of celiac disease?
Loss of intestinal villi
Crypt hyperplasia
Lymphocyte/plasma cell infiltration of LP
What evidence of celiac disease is evident macroscopically?
Loss of surface area– Decreased number of folds per inch
What diseases result in acute ischemia of small bowel? (3)
Thrombization/embolization of SMA (A fib, valvular heart disease, MI, aneurysm, hyper coagulable states, vacillates, aortic dissection)
Mesenteric vein thrombosis
Low flow states (cardiac failure, trauma, sepsis, drugs)
What are CT findings of ischemia? (6)
Dilation and atony Bowel wall thickening/target sign No enhancement (infarction), increased enhancement (vascular permeability) Pneumatosis, porotomesenteric venous gas Mesenteric vascular engorgement Ascites
What is common location of small bowel adenoma/adenocarcinoma?
2nd-4th portion of duodenum or proximal jejunum
What are findings of small bowel adenoma/adenocarcinoma
Short annular lesion with shelf-like margins, central ulceration or mucosal modularity
Polypoid form less common
What is common location of small bowel carcinoid tumors?
Distal ileum
30% multifocal with extension beyond bowel wall
What are findings of small bowel carcinoid tumors?
Small smooth sessile polypoid lesion in distal ileum
Bowel “tethered” at tumor site
Speculated calcified mesenteric mass
Hypervascular masses in liver/ larger mets heterogenous
Primary small bowel lymphoma: location
Distant small bowel
Can be solitary or multiple
Lymphadenopathy confined to small bowel mesentery
What are the macroscopic types of Small bowel lymphoma? (3)
Focal area with smooth thick folds
Long annular lesion
Cavitary mass
Why does bowel dilate in lymphoma? (aneurysmal dilatation?
Because of invasion of muscular propria
Diverticular disease: what are two findings
Multiple small sacs (herniations mucosa/submucosa at sites of penetrating arterioles
Myochosis: Alteration of circular/longitudinal muscle layers due to elastin deposits
Why do diverticula only bleed into the lumen?
Because as diverticulum push into adjacent arteriole, eccentric damage to vessel occurs on side of diverticulum. When the vessel ruptures it does so into th lumen of the diverticulum
What is a hyperplastic polyp? How does it appear histologically?
Alteration in maturation of epithelium
Microscopically observe elongated crypts lined by serrated epithelium of intermediate/goblet cells
How common are polyps? Where are they most likely to appear?
Hyperplastic polyps can be seen in 75% of pts over 40yo
They occur most often in rectum (rather than colon)
Which factor determines malignant potential of adenoma?
Size or architecture
Size is largest determinant
What is most extramucosal tumor in colon?
Where is it most commonly found?
Lipoma: an encapsulated mass of mature fat
90% in submucosa
70% are in right colon
