Revise Radiology GI Flashcards
Rosary bead or corkscrew appearance on barium swallow
Diffuse oesophageal spasm
Median arcuate ligament stenosis
Focal stenosis of coeliac trunk due to indentation at superior surface by the median arcuate ligament
Incidental solitary bone lesion on CT Colon
Likely clinically unimportant, further follow up may be warranted
Double target sign in liver
Pyogenic abscess
Superficial spreading oesophageal carcinoma
Small plaque like nodularities which resemble pseudodiverticula
Pancreatic tumours: Islet cell vs carcinoid
Carcinoid tumours are hypovascular
Exophytic, heterogenously enhancing stomach mass
GIST
Specific to venous gut ischamia
Mesenteric fat stranding and ascites
Liver mass, non enhancing scar, normal AFP
Fibrolamellar HCC
FNH has delayed scar enhancement
Aspirin before liver biopsy
Stop for 7-10 days
Cholangiocarcinoma classification
Bismuth 1: Involves common hepatic duct
Bismuth 2: Confluence of right and left hepatic duct
Bismuth 3a: right hepatic duct
Bismuth 3b: left hepatic duct
Bismuth 4: Multifocal, right and left hepatic ducts
Bismuth 5: Junction of CBD and cystic duct.
1 and 2 are resectable
> 3cm circumscribed area of fat stranding in mesentery with swirling vessels
Omental infarct
Pancreatic tumoural growth into the GDA, prognosis
Can still be resected
Gasless abdomen TOF
Can happen in type A and B
Localised oesophageal pseudodiverticulosis
Can suggest peptic strictures or oesophageal cancer
Tapering and nodularity of distal oesophagus
Oesophageal cancer
C-rads scoring for ct colonoscopy
C0: Inadequate study
C1: Normal
C2: Indeterminate polyp 6-9mm, <3 in number. CTC in <3 years
C3: >10mm or >3 6-9mm or C2 gotten worse.
C4: >30mm mass likely malignant
Killian Jamieson vs Zenker
Zenker are usually larger and more often symptomatic
large, multilocular cystic lesion in pancreas with peripheral calcifications
Mucinous cystadenoma
Non propulsive disorganised contractions in the oesophagus
Tertiary contractions
Soft tissue mass around aorta, pushing aorta forwards
Lymphoma
Decreased perfusion and contractility at rest, increased FDG uptake, redistribution of thallium
Hibernating myocardium
Intense peripherally washout of liver lesion
Most specific for mets
Cystic lesion, not arising from bowel
Lymphangioma
Grade 3 splenic lac, not actively bleeding
Observation and conservative Rx
Posterior vaginal wall involvement of rectal cancer
Not considered high risk
Soft tissue mass arising from small bowel mesentery, mass effect on bowel
Mesenteric fibromatosis
Spongiform lesion with peripheral enhancement and gas locules 1 month post surgery with dense linear structures
Gossypiboma
High T1 signal within ablation zone (HCC)
Successful ablation
Caecal vs sigmoid volvulus
Caecal volvulus has haustral markings
Serous vs mucinous cystadenoma of pancreas
Serous consists of many smaller cysts with central stellate scar
Mucinous of fewer bigger cysts
Cowden syndrome
Hamartomatous GI polups, skin, external mucous membranes.
Increased risk of thyroid (follicular), oral, breast, skin and uterine malignancy
Intraluminal mass in ileum, spreads to mesentery by direct extension or lymphatic spread
Carcinoid
Most common small bowel tumour
Carcinoid
Regional nodes for rectal cancer
Mesorectal, Obturator, Internal iliac, Inguinal (if low rectal)
Inverted umbrella
Cone shaped caecum, narrowed TI, enlarged gaping IC valve)
colonic TB
Malabsorbtion, abdominal pain, arthralgia, skin pigmentation
Whipple’s disease
Thickening and nodularity of duodenal and proximal small bowel folds
Whipple’s disease
FNH vs Fibrolamellar HCC
FNH scar is T2 hyperintense, Fibrolamellar is T2 hypo
HCC has calcifications
T1 hypo. T2 hyperintense liver lesion with centrifugal enhancement
Peliosis hepatis
Attenuation around small bowel mesentery with preservation of fat around vessels and nodes
Sclerosing mesenteritis
?Adenomyosis on US, next step
Contrast US
Regenerative vs Dysplastic nodules
Dysplastic usually show arterial enhancement
Predictor of post op HCC recurrence and invastion
VICT2
Venous hypointensity
Incomplete capsule
Corona enhancement
T2 hyperintensity peritumourally
Lateral outpouching at the lower oesophagus
Epiphrenic diverticulum
Polyposis syndrome with increased risk of endometrial cancer
HNPCC
Periappendicitis can cause
Small bowel obstruction
starry sky appearance of liver
Liver oedema
Ix to rule out malignancy with dermatomyositis
CTCAP
Low density liver lesions with continuous rim of enhancement
Mets
Dromedary hump vs prominent column of Bertin
Dromedary hump is a bulge facing outwards
Multiple, non enhancing, tiny T2 bright lesions in the liver
Bile duct hamartomas
Chronic PSC can lead to
Cirrhosis
Blunt trauma, CT shows contrast extravasation, next step
Laparotomy
HCC Peritumoural hypointensity in HPB phase
Suggests aggressive behaviour and vascular invasion
AIDS, thickened jejunal folds with jejunal spasm
Giardiasis
Flask shaped ulcers, cone shaped caecum
Entamoeba histolytica
Poorly defined heterogeneity and low density in spleen
Angiosarcoma
Commonest malignancy of spleen
Angiosarcoma
Multiple sessile polyps throughout jejunum and ileum
Peutz Jehger
Ventral embryonic pancreatic ducrt becomes
Distal main duct, aka duct of wirsung
Multilocular cyst posterior to rectum with no enhancement. Some T1 bright areas
Recto-rectal cystic hamartoma or tailgut cyst
RFA vs HCC Resection
RFA used for smaller lesions or non surgical candidates
MRI appearances of autoimmune pancreatitis
Diffuse diffusion restriction
May Thurner syndrome
LEFT common iliac vein compressed by RIGHT common iliac artery
Gallbladder wall thickening with discontinuous enhancement
Gangrenous cholecystitis
Most likely portion of bowel to perforate in intussception reduction
Rectum
Mass like area associated with diverticular disease on CT colon
Likely benign, repeat CTC in 5 years
Low T1/T2 liver lesion in cirrhosis
Ciderotic nodule
Desmoid tumours associated with
Gardners syndrome
RECIST criteria for measurable lesion
Must be larger than 10mm
Pseudosacculation in terminal ileum
Crohns
Commonest cause of pseudomyxoma peritonii
Appendix cystadenoma
Commonest location for carcinoid tumour
Distal ileum
3 polyps 6-9mm on CTC
Recall for colonoscopy
Hepatic adenoma enhancement
early arterial enhancement, hypointense on hepatobilliary phase
Parenchymal vs reticulendothelial pattern haemochromatosis
Parenchymal is primary, increased iron resorbtion (not transfusions) and spares spleen and bone marrow
Commonest cause of echogenic liver mets
Colon adenocarcinoma
