Recognizing GI, Hepatic, and Urinary Tract Abnormalities. Flashcards
What’s this?
Tertiary waves, which are a common but non-specific abnormality of esophageal motility, representing disordered and non-propulsive contractions of teh esophagus. They can be observed fluoroscopically and captured on spot images, as seen here.
Based on the location of this outpouching, this patient most likely has what co-existing disease?
TB. An esophageal diverticula located in the mdi-esophagus occurs from extrinsic disease like TB that causes fibrosis, which pulls on the esophagus forming a TRACTION diverticulum. This is the only true diverticulum that contains all layers of te esophagus whereas Zenker and epiphrenic diverticula are false because mucosa and submucosa herniate through defects in muscular layer.
Patient presents with long-standing history of GERD. What 2 factors aid in the extension and dissemination of this patient’s disease? Initial study of choice ?
This is esophageal CA and the lack of an esophageal serosa and a rich supply of lymphatics aid in extension and dissemination of this particular CA. Initial study of choice is a barium esophagram.
What do you see here?
This is a sliding hiatal hernia, in which teh esophagogastric junction lies above the diaphragm. Usually asymptomatic. Note the esophagus does not narrow as it passes through the esophageal hiatus. The schatzki ring (marks the position of teh EG junction; thin, circumfertential filling defect in distal esophagus) is indicated by the arrowheads.
ID. Is this most likely benign or malignant?
This is a gastric ulcer, located in the lseser curvature (most occur on lesser curvature or posterior wall i nregion of body or antrum). 95% of all gastric ulcers are benign. The mound of edematous tissue that surrounds the ulcer is called an ulcer COLLAR.
An ulcer collection present on multiple views is called what?
Persistence. This is an importance characteristic of an ulcer.
What do you see here?
There is a large filling defect that displaces the barium around it. Contained within the mass is an irregularly shaped collection of barium that represents an ulceration. This is an adenocarcinoma. Most occur along lesser curvature of stomach, as seen here.
What do you see here?
The entire body of the stomach displays a lack of distensibility, losing normal ballooning outward that every portion of GI tract demonstrates when filled with enough barium or air. Instead, walls concave inward and are RIGID – sign of malignancy. This is typical for linitis plastica, caused by infiltrating adenoCA of stomach.
What do you see?
Acute duodenal ulcer. When duodenal ulcers heal, they are likely to do so with scarring that deforms the normal triangular contour of the bulb.
What is abnormal about this CT?
There is thickening and enhancement of the bowel. THe normal small bowel lumen does not exceed 2.5 cm in diameter and the wall is usually no thicker than 3 mm.
What is the arrow pointing to?
This is a sign known as THUMBPRINTING, or nodular indentations into the bowel lumen representing focal areas of submucosal infiltration by edema, hemorrhage, inflammatory cells, tumor (lymphoma) or amyloid. In this case, pt had ischemic colitis.
What disease is this?
Crohn’s disease. Arrow is pointing to enterocolic fistula.
What do you see in this CT ?
Colonic diverticula containing air and appear as small, round outpouchings. This is diverticulosis, which is usually asymptomatic but is the most common cause of massive lower GI bleeding –generally from the RIGHT side.
Can you figure out what happened here
This is intussusception (ileocolic) with a coiled spring appearance on barium enema.
Most favorite location for this to occur :(
This is classic apple core lesion of colon CA – annular constriction of the colonic lumen that loves to occur in the rectosigmoid region as seen here.
What is the arrow pointing to?
An fecalith inside the appendix – > acute appendicitis. Appendicitis is classified as dilated >6 mm which does NOT fill with oral contrast.
What labs do you expect the patient to have elevated?
Amylase and lipase, because this is acute pancreatitis. Note the body of the pancreas is enlarged and there is infiltration of the peripancreatic fat.
What is being shown here?
Pancreatic pseudocyst –this occurs when fibrous tissue encapsulates a walled off collection of pancreatic juices released from the inflamed pancreas. The indentation on a loop of bowel by an extrinsic mass also seen here is called a PAD sign.
What is the arrow pointing to?
The head of the pancreas is enlarged by a mass. Normally, the head of the pancreas should roughly be the same size as the width of the lumbar vertebral body visible on the same cut. Most pancreatic adenoCA are located in the head. Jaundice is a common presenting sign. ULTRASOUND is the initial workup of jaundiced pt.
Is this ascites or pleural effusion?
Ascites. Note ascites never completely encircles liver due to bare area. not covered by peritoneum. Fluid posterior to bare area must be in the pleural space.
Is this a pleural effusion or ascites?
Pleural effusion along with hematoma and multiple lacerations of liver. Note that the pleural effusion is located along hemidiaphragm, posterior to it.
What is seen on this MRI
GIANT cavernous hemangioma of the liver. Characteristic nodular enhancement from the periphery inward following injection of IV contrast. These are the most common primary liver tumor and second in frequecy to mets for localized liver masses; more common in women, usually solitary and are almost always asymptomatic.
Where is this likely to metastasize?
This is clear cell CA. They have propensity for extending into renal vv. into IVC and producing nodules in the lungs.
What do you expect to find in this patients history?
This is transitional cell CA of the bladder on CT urogram. There is a filling defect in the left lateral wall of the contrast filled bladder representing tumor. The defect at teh base of teh bladder is caused by the prostate gland. SMOKING is the most common cause; additional causes include working in petroleum industry, aniline dyes, and the use of cyclophosphamide.
