Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘abdomen’ Category

Hardware

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What are those devices called and what are they used for? Here are some helpful links I use:

Gallery of Medical Devices, Part 1. Radiographics.

Gallery of Medical Devices, Part 2. Radiographics.

Ortho Atlas from University of Washington

Written by lmwong

June 12, 2013 at 9:10 am

Posted in abdomen, chest, fracture, msk, x-ray

Wilm’s Tumor

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  • Age: 80% <6yo; most common abdominal neoplasm 1-8 yo.
  • Appearance: solid mass in kidney (claw sign), pushing away vessels, not crossing mid-line
  • IVC and renal vein thrombosis
  • Mets to lung, liver, brain, bone
  • Staging
    • I = confined to kidney
    • II = local extension to perinephric space
    • III = lymph nodes
    • IV = distant mets
    • V = bilateral renal
  • DDx: neuroblastoma (crosses mid-line, encases vessels, calcify), multilocular cystic nephroma, sarcoma, RCC, nephroblastomatosis, mesoblastic nephroma, AML, renal medullary carcinoma

 

Written by lmwong

October 28, 2011 at 1:17 pm

Posted in abdomen, GU, pediatrics, renal

Liver metastasis differential

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Hypervascular Liver Metastases
  • RCC
  • Carcinoid
  • Islet cell
  • melanoma
  • thyroid
  • choriocarcinoma
  • Ovarian cystadenocarcinoma
  • pheochromocytoma
Hypovascular Liver Metastases
  • Stomach
  • Colon
  • Pancreas
  • Lung
  • Breast
Hemorrhagic Liver Metastases
  • Colon
  • Thyroid
  • Breast
  • Choriocarcinoma
  • Melanoma
  • RCC
Calcified Liver Mets
  • Mucinous tumors

Dahnert

Written by lmwong

August 15, 2010 at 12:22 pm

Posted in abdomen, differential, gi, liver

Jepperson-Wong-Lai Syndrome

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  • Bilateral fat filled inguinal hernias
  • caused by concomitant weakness in both inguinal rings plus herniation of intra-abdominal fat
  • asymptomatic
  • 50% male
  • Risk factors: obesity, midwest
  • Associations: fatty liver disease, heart disease, diabetes
  • Benign incidental finding

Written by lmwong

April 1, 2010 at 3:19 pm

Neonatal Ascites

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Written by lmwong

March 24, 2010 at 8:20 pm

Pediatric Renal Tumors

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  • Wilm’s tumor
  • nephroblastomatosis
  • Clear cell sarcoma
  • Rhabdoid tumor
  • Hamartoma
  • Angiomyolipoma
  • Ossifying Renal Tumor of Infancy
  • Metanrphric Adenoma
  • Adjacent Neuroblastoma from adrenal gland

Written by lmwong

March 20, 2010 at 10:57 am

Disease and Bowel location

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  • Amebiasis = right colon
  • Lymphoma = ileum
  • Sprue = entire colon
  • Giardiasis = proximal small bowel
  • Yersinia = terminal ileum
  • Crohn’s disease = terminal ileum
  • Ulcerative colitis = rectum

Written by lmwong

February 3, 2010 at 11:10 am

Featureless Small Bowel

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Toothpaste, tubular

  • graft-vs.-host disease (GvH)
  • Mycobacterium avium complex (MAC) (in AIDS)
  • ischemia
  • Crohn disease
  • radiation
  • Strongyloides
  • milk enteropathy
  • sprue
  • corrosive enteritis
  • lymphoma
  • amyloidosis
  • mastocytosis
  • FUDR toxicity

Written by lmwong

February 3, 2010 at 11:00 am

GI Buzz Word

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  • central scar = FNH
  • Light bulb = pheochromocytoma
  • Corkscrew = malrotation midgut volvulus
  • Leadpipe colon = ulcerative colitis
  • Featureless bowel = Graft versus Host
  • Cauliflower liver mets = colon mets
  • bird beak esophagus = achalasia
  • plaquelike mucosa = candidiasis esophagitis
  • cloverleaf deformity = healed duodenal ulcer
  • spokewheel mass in mesentery = carcinoid
  • sunburst angiography = mesenteric carcinoid
  • string sign ileium = Crohn’s disease
  • Aphthoid/cobblestone ulcers = Crohn’s disease
  • ribbon bowel = graft-vs-host disease
  • string of beads biliary system = sclerosing cholangitis
  • comet tail artifact in GB = adenomyomatosis

Written by lmwong

February 1, 2010 at 3:01 pm

Posted in abdomen, buzz, gi

Carcinoid

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  • malignant neuroendocrine tumor
  • SB (Ileum) > lung > thyroid/ovary
  • MC malignancy of appendix
  • carcinoid syndrome = secretion of serotonin:  flushing, diarrhea, wheezing, cramping, peripheral edema
  • findings
    • well defined margins
    • lobulated
    • 30% have calcifications
    • intense contrast enhancement
    • lung: typically central location
    • hot on octreotide scan
  • surgery, adjuvant chemotherapy

read more

Written by lmwong

February 1, 2010 at 2:55 pm

Posted in abdomen, chest, gi, pulmonary

Congenital Diaphragmatic Hernia

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  • MC is Bochdalek hernia
  • MC left side
  • diagnosed at prenatal US, follow with MRI
  • up to 50% mortality
  • 50% have CHD
  • most have malrotation

read more

Written by lmwong

January 30, 2010 at 9:47 am

Multiple Small Bowel Lesions Differential

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  • lymphoma
  • polyposis syndrome
  • hemangiomas
  • neurofibromas
  • metastases

Written by lmwong

January 28, 2010 at 4:15 pm

Duodenal Narrowing Differential

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Benign

  • peptic ulcer disease
  • pancreatitis
  • crohn disease
  • hematoma
  • SMA syndrome
  • annular pancreas

Malignant

  • adenocarcinoma
  • lymphoma
  • malignant GIST
  • mets

Written by lmwong

January 18, 2010 at 9:51 am

Duodenal Filling Defects

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Malignant

  • adenocarcinoma
  • ampullary carcinoma
  • lymphoma
  • malignant GIST
  • metastasis

Benign

  • villous adenoma (FAP)
  • polyps (most are gastric polyps that prolapse into duodenum)
  • GIST
  • lipoma (submucosal, smooth surface, fat density)

Nonneoplastic

  • heterotopic gastric mucosa
  • Brunner gland hyperplasia
  • Enteric duplication cyst
  • flexural pseudopolyp
  • annular pancreas

Written by lmwong

January 18, 2010 at 5:18 am

Duodenal Ulcer

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  • 2-3 times more common than stomach ulcers
  • M>F
  • increased secretion of acid
  • high incidence of H pylori, stress, smoking, caffeine, corticosteroid use
  • fixed outpouching of barium that does not change shape
  • most along anterior surface of duodenal bulb
    • only 1 in 20 occur beyond bulb
    • think Zollinger-Ellison syndrome or malignant ulcer
  • narrowing of distal and proximal duodenum
  • complications: perforation, bleeding, obstruction, penetration
  • multiple = Zollinger-Ellison syndrome
  • clover-leaf barium collection = scar from old ulcer; should change in shape
  • two pyloric channels; fistula connects stomach to duodenum through peptic ulcer

Written by lmwong

January 17, 2010 at 9:32 am

Posted in abdomen, gi, small bowel

Emphysematous Gastritis

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  • gas within stomach wall
  • causes
    • gas forming organisms: e coli, clostridium perfringens
    • gastric obstruction with increased pressure
    • severe vomiting
    • ischemia
    • infection
    • corrosive ingestion
  • corticosteroid use risk factor

read more

Written by lmwong

January 17, 2010 at 8:58 am

Posted in abdomen, gi, stomach

Postoperative Stomach Differential

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  • Marginal Ulcer
  • Afferent loop syndrome
  • Blown duodenal stump
  • Jejunogastric intussusception
  • Gastric remnant bezoar
  • Postgastrectomy carcinoma
  • Bile reflux gastritis

Written by lmwong

January 17, 2010 at 8:46 am

Small Bowel Surgery Diagrams

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From AJR article.

Whipple Procedure (Pancreaticoduodenectomy)

Puestow Procedure

Roux-en-Y Procedure

Biliopancreatic Diversion

Written by lmwong

January 17, 2010 at 2:02 am

Posted in abdomen, gi, small bowel

Afferent Loop Syndrome

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  • post Billroth II
  • obstruction of afferent loop by adhesions, ulcer, tumor, internal herniation
  • distension, pain, nausea
  • nonfilling of dilated, fluid-filled afferent limb on CT
  • perforate, peritonitis, death

Written by lmwong

January 17, 2010 at 1:48 am

Posted in abdomen, gi

Adrenal Mass Differential

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  • Lipid rich adenoma = fat density
  • Adrenocortical carcinoma
  • Pheochromocytoma = bright on T2; light bulb
  • Myelolipoma
  • Lymphoma
  • Metastasis

read more

Written by lmwong

January 16, 2010 at 11:11 am