Random_9 Flashcards
Pancreas divisum
and
Santorinicele
- pancreas divisum - most common congenital pancreatic anomaly
- 10% of the general population
- only 5% will become symptomatic
- Santorinicele - cystic dilation of the terminal portion of the dorsal pancreatic duct in patients with pancreas divisum
- due to distal obstruction or duct wall weakness
- associated with recurrent pancreatitis
- although santorinicele can occur in pediatric patients without prior pancreatitis or with normal pancreatic anatomy
- Dx - MRCP - T-shaped configuration, dorsal duct of Santorini cross over the CBD to drain into the minor papilla
- Rx - endoscopic drainage procedure, such as minor papilla sphincterotomy
“Crenated” cyst
“Crenated cyst”
having a margin with rounded scallops.
On MR, which sequence to you use to examine
whether the kidneys have preserved corticomedullary differentiation?
T1
How do you differentiate
chronic inflammation (fibrosis)
from
active/acute inflammation
of Crohn’s disease?
- both chronic inflammation (fibrosis) and acute inflammation can have enhancement post gad administration
- but only acute inflammation will demonstrate edema signal on T2 WI
What is the best sequence to examine the pancreas
- Use unenhanced T1 to examine the bulk and signal intensity of the pancreas - normal pancreatic parenchyma should be T1 hyperintense
- Anything abnormal will be T1 hypointense on MR
If a tumor is very dark on T2 - very hypointense T2 signal intensity corresponds to post treatment changes
Very bad, active mets shoudl be T2 “gray”
If a tumor is very dark on T2 - very hypointense T2 signal intensity corresponds to post treatment changes
Very bad, active mets shoudl be T2 “gray”
Xanthogranulomatous cholecystitis (XGC)
- uncommon
- chronic inflammatory condition characterized by infiltration of the gallbladder by destructive lipid-laiden macrophages
- imaigng features
- diffuse gallbladder wall thickening
- hypodense intramural nodules - containing lipid-laiden macrophages
- continuous enhancing gallbladder mucosa (as opposed to gallbladder carcinoma where mucosa is disrupted)
- women > men
- often associated w/ cholelithiasis
- Rx: cholesystostomy and then cholecystectomy
- DDx:
- acute / chronic cholecystitis
- gallbladder carcinoma
Demographics of gallbladder carcinoma?
Female:Male = 3:1
There is also diffuse intrahepatic biliary dilatation commensurate with the degree of the CBD dilatation.
There is also diffuse intrahepatic biliary dilatation commensurate with the degree of the CBD dilatation.
What to say about CBD dilatation without a cause identified?
No intraluminal filling defect, mural thickening, or extrinsic mass lesion.
This appearance is presumably on the basis of an underlying benign ampullary stricture, which remains the diagnosis of exclusion.
Biliary manifestations of CF?
- cholelithiasis
- stricturing
- narrowing and dilatation of biliary tree
Innocuous
Innocuous
not harmful, safe, non-offensive, innocent
3 head of gastrocnemius muscle
- most often innocuous
- but can cause popliteal vascular entrapment syndrome
Typical findings of fat or silicone
embolism syndrome
- Peripheral consolidations and ground glass opacities
- Silicone deposits in small arterioles and can increase pulmonary artery pressures sufficiently to precipitate cor pulmonale
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DDx for arterial enhancing focal liver lesions
- FNH
- adenoma
- vascular shunt
- HCC
- hypervascular mets
- MRCT
- carcinoid
- neuroendocrine tumors
wording
…, in combination of …, most strongly favor the diagnosis of …
…, in combination of …, most strongly favor the diagnosis of …
A Richter hernia is an abdominal hernia in which comprise 10% of strangulated hernias. These hernias progress more rapidly to gangrene than other strangulated hernias, and obstruction is less frequent.
Pathology
Only the antimesenteric wall of the bowel has herniated without compromising the entire lumen. This herniation is usually through a small defect in the abdominal wall. The most often entrapped part of bowel is the terminal ileum, however any part of the bowel can be involved.
A Richter hernia is an abdominal hernia in which comprise 10% of strangulated hernias. These hernias progress more rapidly to gangrene than other strangulated hernias, and obstruction is less frequent.
Pathology
Only the antimesenteric wall of the bowel has herniated without compromising the entire lumen. This herniation is usually through a small defect in the abdominal wall. The most often entrapped part of bowel is the terminal ileum, however any part of the bowel can be involved.
What to think about when presented with
CT AP ? appendicitis
but appendix is normal
but thickened small bowel loops
with fluid in the colon???
Infectious enteritis
affecting the small bowel
and dirarrhea!!!
If you can’t make out the liver parenchyma against the vessels – fatty liver!!!
Don’t just compare with the spleen!!!
If you can’t make out the liver parenchyma against the vessels – fatty liver!!!
Don’t just compare with the spleen!!!
Adrenal lesion 6 months of no growth
– adrenal adenoma!!!
Adrenal lesion 6 months of no growth
– adrenal adenoma!!!
Renal collecting system duplication
Renal duplication
- upper obstructs
- lower refluxes
Renal collecting system duplication
Renal duplication
- upper obstructs
- lower refluxes
Ischemic bowel – look for non-enhancement and pneumatosis!!
Ischemic bowel – look for non-enhancement and pneumatosis!!
Fibrofatty proliferation
vs
Submucosal fat deposition
Fibrofatty proliferation - lots of mesenteric fat proliferation; separate the diseased small bowel (often the TI) from other bowel loops
Submucosal fat deposition
“2.9 x 2.3 x 1.9 cm soft tissue density mass adherent to the posterior urinary bladder dome, and the diagnosis of exclusion is a primary bladder neoplasm. Urology consult is recommended. If this soft tissue mass is ultimately proven to be a bladder neoplasm, no evidence of intra-abdominal metastatic disease is demonstrated within the limitations of this unenhanced CT.”
“2.9 x 2.3 x 1.9 cm soft tissue density mass adherent to the posterior urinary bladder dome, and the diagnosis of exclusion is a primary bladder neoplasm. Urology consult is recommended. If this soft tissue mass is ultimately proven to be a bladder neoplasm, no evidence of intra-abdominal metastatic disease is demonstrated within the limitations of this unenhanced CT.”
“Incidental lipid rich left adrenal adenoma. Note that imaging cannot differentiate functioning from nonfunctioning adrenal adenomas.”
“Incidental lipid rich left adrenal adenoma. Note that imaging cannot differentiate functioning from nonfunctioning adrenal adenomas.”
“Somewhat unusual submucosal fat deposition in the stomach, duodenum, several segments of small bowel, and rectosigmoid colon. This appearance is nonspecific, but has been described in the literature in patients with remote inflammatory disease of the bowel. No active inflammatory changes involving the GI tract on today’s study.”
“Somewhat unusual submucosal fat deposition in the stomach, duodenum, several segments of small bowel, and rectosigmoid colon. This appearance is nonspecific, but has been described in the literature in patients with remote inflammatory disease of the bowel. No active inflammatory changes involving the GI tract on today’s study.”
Pancreatic AVM
- rare
- most often congenital, such as Osler-Weber-Rendu syndrome
- complications - high flow -> portal hypertension –> gastric/esophageal varices and GI bleed
DDx for
focal, small (<1cm), low attenuation lesions in the liver
in an AIDS pt?
- TB
- AIDS-related lymphoma
- Kaposi’s sarcoma
- histoplasmosis
DDx for
focal, small (<1cm) low-attenuation lesions in the spleen
in an AIDS pt?
- TB
- MAI
- coccidiomycosis
- candidiasis
- bacillary peliosis
- Kaposi’s sarcoma
- AIDS-related lymphoma
- PJP
Focal bowel wall thickening
or
focal bowel mass
in an AIDS pt?
NEARLY ALWAYS
AIDS-related lymphoma
HIV nephropathy?
Nephromegaly
with striated nephrogram
Muscle labelled 10?
Quadratus Lumborum
Peutz-Jeghers Syndrome
PJS
- autosomal dominant
- pigmented mucocutaneous lesions
- hamartomatous polyps in the GI tract
- most common: small bowel and colon
- associated with low malignnat potential (<3%)
- elevated risk of developing multiple forms of cancer - colorectal, gastric, esophageal, pancreatic, hepatic, pulmonary, breast, cervical, ovarian, uterine, testicular, etc…
- 93% will get cancer in lifetime
- due to mutated tumor suppressor gene STK11
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Paget–Schroetter disease,
also known as
Paget–von Schrötter disease
is a form of upper extremity deep vein thrombosis (DVT), a medical condition in which blood clots form in the deep veins of the arms. These DVTs typically occur in the axillary or subclavian veins.
Paget–Schroetter disease,
also known as
Paget–von Schrötter disease
is a form of upper extremity deep vein thrombosis (DVT), a medical condition in which blood clots form in the deep veins of the arms. These DVTs typically occur in the axillary or subclavian veins.
J Sign
- Elongated, narrow axillary recess. Discontinuous inferior glenohumeral ligament with “J sign” (J-shaped axillary pouch).
- Definition: Humeral avulsion glenohumeral ligament (HAGL) is a tear of the inferior glenohumeral ligament (IGHL) at its humeral attachment with torn capsule at the humeral attachment.
- Signs/symptoms: Recent anterior dislocation. Continued pain and recurrent dislocations. Recurrent instability.
- Discontinuous IGHL fibers at the humeral surface. Capsule assumes “J” shape on coronal images. (normal axillary pouch has a U-shaped contour).
- Elongated, narrow axillary pouch.
- Often associated with Bankart fracture and Hill-Sachs deformity.
Hill-Sachs
Bankart
Accessory soleus muscle
- deep to gastrocnemius muscle
- inserts anterior and medial to the Achilles tendon
- manifests as a soft tissue mass in the posteromedial ankle
- may be associated with pain
- localized compartment syndrome
- poor blood supply (posterior tibial artery)
- accessory soleus hypertrophy - compress posterior tibial nerve
- X-ray - obscuration of the triangular Kager’s fat pad anterior to the Achilles tendon (normal Kager’s fat pad below)
Proximal Femoral Insufficiency Fractures in Patients Receiving Bisphosphonate Therapy
Proximal Femoral Insufficiency Fractures in Patients Receiving Bisphosphonate Therapy
- proximal femoral diaphyseal location
- lateral cortex
- transverse fracture with localized thickening
Bouthillier classification of ICA segments
Bouthillier classification of ICA segments
- cervical segment
- petrous segment
- caroticotympanic artery
- vidian artery
- lacerum segment
- cavernous segment
- meningohypophyseal trunk
- inferolateral trunk
- clinoid segment
- ophthalmic (supraclinoid) segment
- ophthalmic artery
- superior hypophyseal artery
- communicating (terminal) segment
- posterior communicating artery
- anterior choroidal artery
- ACA
- MCA
Chylous ascites as a complication of laparoscopic nephrectomy
- Postoperative chylous ascites, an accumulation of milk-like, triglyceride-rich lymph in the abdominal cavity, is a relatively uncommon complication of retroperitoneal surgery.
- The presence of a fat-fluid level within ascitic fluid is diagnostic of chylous ascites.
- Most cases of traumatic chylous ascites resolve with nonoperative treatment (dietary restrictions, total parenteral nutrition, and somatostatin analogues), but refractory cases may require surgical intervention.
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