Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘abdomen’ Category

Hinchey Classification of Diverticulitis

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Hinchey proposed a classification for acute diverticulitis, that has been variously adapted, and is useful not only in accademia but also in outlining successive stages of severity.

Stage 1a: phlegmon

Stage 1b: diverticulitis with pericolic or mesenteric abscess

Stage 2: diverticulitis with walled off pelvic abcess

Stage 3: diverticulitis with generalised purulent peritonitis

Stage 4: diverticulitis with generalised faecal peritonitis

Written by lmwong

January 16, 2010 at 9:20 am

Posted in abdomen, classification, gi

Couinard’s Liver Segments

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Written by lmwong

January 14, 2010 at 7:44 am

Posted in abdomen, gi, liver

Renal Laceration Grading

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Grade 1

  • hematuria, normal imaging
  • contusion
  • nonexpanding subcapsular hematomas

Grade 2

  • nonexpanding perinephric hematoma confined to the retroperitoneum
  • laceration <1cm deep, collecting system not involved

Grade 3

  • laceration >1cm, collecting system not involved

Grade 4

  • laceration extending to collecting system
  • involve main renal artery or vein
  • segmental infarctions without associated lacerations
  • expanding subcapsular hematomas compressing kidney

Grade 5

  • shattered or devascularized kidney
  • ureteropelvic avulsions
  • complete laceration or thrombus or main RA or V

Written by lmwong

January 14, 2010 at 7:36 am

Posted in abdomen, GU, renal, trauma

Splenic Laceration Grading

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Grade 1

  • subcapsular hematoma <10% of surface area
  • capsular tear <1cm deep

Grade 2

  • Subcapsular hematoma 10-50% SA
  • intraparenchymal hematoma <5cm diameter
  • laceration 1-3 cm deep, not involving vessels

Grade 3

  • Subcapsular hematoma >50% SA or expanding and ruptured
  • subcapsular or parenchymal hematoma
  • Intraparenchymal hematoma >5cm or expanding
  • Laceration >3cm deep, or involving vessels

Grade 4

  • involves hilar vessels with devascularization >25% of spleen

Grade 5

  • shattered hilar vascular injury

spleen

Written by lmwong

January 14, 2010 at 7:32 am

Posted in abdomen, gi, spleen, trauma

Liver Laceration Grading

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Grade 1 (either or)

  • Subcapsular hematoma <1cm
  • Liver Laceration <1cm deep

Grade 2 SH or LL 1-3 cm

Grade 3 SH or LL >3cm

Grade 4 LL or SH >10cm Lobar destruction devascularization

Grade 5 Global destruction or devascularization

Grade 6 Hepatic avulsion

Written by lmwong

January 14, 2010 at 7:28 am

Posted in abdomen, gi, liver, trauma

Hypertrophic pyloric stenosis

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  • M>F, familial predisposition
  • nonbilous vomiting
  • 2-6 week old infant
  • pyloric channel length >17 mm
  • pyloric muscle thickness >3 mm
  • can give water if difficult to visualize
  • differentiate from pylorospasm (findings constant throughout exam, lack of peristalsis)
  • Rx: Pyloromyotomy, returns to normal in 3 months postop

Written by lmwong

January 11, 2010 at 11:28 pm

Posted in abdomen, gi, pediatrics

Gastric Volvulus

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  • commonly associated with esophageal or paraesophageal hernia
  • ~ phrenic nerve palsy, asplenia, polysplenia, diaphragmatic eventration
  • stomach normally fixed by gastrocolic and gastrosplenic ligaments and by second duodenum
  • 2 types
    • organoaxial
      • along horizontal or vertical axis of stomach
      • seen in neglected hernias in elderly
    • mesenteroaxial
      • along axis of less and greater curvature of stomach
      • less common
      • high incidence of strangulation and ischemia

read more

Written by lmwong

January 11, 2010 at 11:22 pm

Posted in abdomen, gi, stomach

Gallstone Ileus

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  • erosion of gallstone through GB wall into GI tract
  • fistula between GB and duodenum (stomach, colon)
  • large stones impact in ileum = mechanical SBO
  • Bouveret’s Syndrome = gastric outlet obstruction due to impaction of a stone
  • XR findings = Rigler’s triad
    • pneumobilia
    • dilated SB
    • ectopic calcified gallstone

Written by lmwong

January 11, 2010 at 11:17 pm

Posted in abdomen, gallbladder, gi, Phalen

Colonic Volvulus

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  • third MC form of LB obstruction (after carcinoma and diverticulitis)
  • redundant colon
    • sigmoid, cecum, transverse
  • elderly
  • XR findings
    • coffee bean sign
    • bird-beak sign with BE
  • Rx: BE or tube decompression

Written by lmwong

January 9, 2010 at 7:11 pm

Posted in abdomen, gi

Choledocal cyst

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  • congenital focal or diffuse dilation of bile ducts
  • females
  • 5 categories
    • type 1 cysts
      • 80-90%
      • saccular or fusiform
    • type 2
      • diverticula of duct
    • type 3
      • choledochoceles
      • dilation of terminal, intraduodenal portion of CBD
    • type 4
      • intrahepatic and extrahepatic cysts
    • type 5 = Caroli’s disease
      • multiple cystic dilations of the intrahepatic bile ducts
      • ~ medullary sponge kidney, AR PCKD
      • complications: liver abscess, portal vein thrombosis, biliary cirrhosis with portal hypertension
      • 100% risk of cholangiocarcinoma
      • MRCP, cholangiography, ERCP shows biliary origins of cysts
  • marked biliary stasis: get infection, inflammation, stone disease
  • risk of cholangiocarcinoma with age
  • in neonates, disorder ~ extrahepatic biliary atresia
  • Rx: surgical resection (Kasai procedure: portoenterostomy)

    Written by lmwong

    January 9, 2010 at 9:40 am

    Posted in abdomen, cystic, gi, liver

    Cavernous transformation of portal vein

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    • long standing portal hypertension from portal thrombosis
      • causes of portal thrombosis
        • HCC
        • cirrhosis
        • pancreatitis
        • hypercoagulable states
        • splenectomy
    • dilated periportal veins
    • collaterals run along free edge of less omentum
    • flow is hepatopedal or bidirectional

    Written by lmwong

    January 9, 2010 at 9:32 am

    Posted in abdomen, gi, liver

    Budd Chiari Syndrome

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    • partial or complete obstruction of one or more hepatic veins or IVC
    • no flow or reversed flow on US/Doppler in hepatic veins
    • causes
      • idiopathic
      • tumor thrombus
      • pregnancy
      • hypercoagulation states
      • trauma
      • sepsis
      • dehydration

    Written by lmwong

    January 9, 2010 at 9:28 am

    Posted in abdomen, gi, liver

    Polyposis Syndromes

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    Familial adenomatous polyposis Hyperplastic stomach, adenomatous bowel AD Includes Gardner syndrome and Turcot syndrome
    Gardner syndrome FAP + desmoid tumors, osteomas, epidermoid cysts, papillary thryoid cancer
    Turcot syndrome FAP + CNS tumors, gliomas, medulloblastomas
    Lynch syndrome (hereditary nonpolyposis colon cancer) Adematous AD Endometrial, stomach, SB, liver, brain, ovary, ureterm and renal pelvis cancers
    Peutz-Jeghers syndrome Hamartomatous; usually SB AD Skin lesions, gastroduodenal and colon malignancy, gynecologic neoplasms
    Cowden disease Hamartomatous AD Mucocutaneous lesions, thyroid, breast
    Cronkhite-Canada syndrome Hamartomatous Sp Stomach, SB, colon, ectodermal changes (skin, hair, nails)
    Juvenile polyps Hamartomatous AD 1=isolated JP of childhood; 2=JP of GI tract; 3=JP of infnacy

    Mayo Clinic: Gastrointestinal Imaging Review

    Written by lmwong

    January 6, 2010 at 10:02 am

    Posted in abdomen, gi, Phalen

    Zollinger-Ellison syndrome

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    • gastrin-secreting islet cell tumor of stomach
    • hypersecretion of hydrochloric acid
    • mets to liver and lymph nodes, 50% at presentation
    • primary hypervascular tumor in pancreas
    • thickened stomach folds, ulcers
    • octreotide scan diagnostic

    Written by lmwong

    January 6, 2010 at 9:49 am

    Posted in abdomen, gi, stomach

    Acalculous Cholecystitis CT criteria

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    2 major or 1 major + 2 minor

    Major criteria:

    • Gallbladder wall thickening greater than 3 mm
    • Subserosal halo (ie, gallbladder wall edema)
    • Pericholecystic fatty inflammation
    • Pericholecystic fluid (without ascites or hypoalbuminemia)
    • Mucosal sloughing
    • Intramural gas

    Minor criteria:

    • Gallbladder distention (>5 cm transverse)
    • High-attenuation bile (sludge)

    Written by lmwong

    December 19, 2009 at 2:18 am

    Posted in abdomen, ct, gallbladder, gi

    Abdominal walls and spaces

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    Walls

    • falciform ligament
    • lesser omentum
    • greater omentum
    • anterior and posterior renal fascia

    Spaces

    • peritoneal space
    • left subphrenic space
    • right subphrenic space
    • Morrion’s pouch
    • lesser sac
    • retroperitoneal space
    • anterior pararenal
    • perirenal
    • pelvis
    • pouch of Douglas (cel-de-sac)
    • retrovesical
    • extraperitoneal space

    Written by lmwong

    December 19, 2009 at 2:12 am

    Posted in abdomen, gi

    Infectious Esophagitis

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    • Candidiasis – plaquelike, shaggy
    • Herpes – multiple discrete ulcers
    • CMV – large, flat, solitary ulcer
    • HIV – indistinguishable from CMV

    Written by lmwong

    September 25, 2008 at 1:39 am

    Peptic and Inflammatory Esophagitis

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    • mild reflux – thickened folds only
    • mod reflux – thickened folds and tiny ulcers
    • severe reflux – folds and moderate to large ulcers
    • chronic reflux – stricture above GEJ, scarring deformity, transverse folds
    • Barrett esophagus – stricture at high location, transition zone, reticulated mucosal pattern
    • Medication-induced – ulcer with edema, level or arch or distal
    • Crohn esophagitis – aphthous ulcers, confluent

    Written by lmwong

    September 25, 2008 at 1:34 am

    Hirschsprung’s Disease, BE findings

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    • Transition zone (often subtle during first week of life)
    • Abnormal, irregular contractions of aganglionic segment (rare)
    • Thickening and nodularity of colonic mucosa proximal to transition zone; cobblestone (rare)
    • Delayed evacuation of barium
    • Mixed barium-stool pattern on delayed radiographs
    • Distended bowel loops on plain radiographs that almost fill after contrast enema
    • Question mark–shaped colon in total colonic aganglionosis

    Written by lmwong

    September 9, 2008 at 6:56 pm

    Posted in abdomen, gi, pediatrics

    Neuroblastoma

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    • most common extracranial solid tumor in kids
    • from neural crest tissue, sympathetic nervous system
    • 50% fatal; 2/3 have mets at diagnosis
    • ages 2-4 yo, 90% diagnosed at 5 yo; younger diagnosed, better outcome
    • 65% abdominal, 2/3 of which are adrenal; remainder in neck
    • fever, malaise, bone pain, racoon eyes (periordbital ecchymosis and proptosis), blueberry muffin baby (skin mets)
    • associated syndromes: myoclonic encephalopathy of infancy (MEI), watery diarrhea, heterochromia and Horner’s syndrome
    • mets to lymph nodes, liver, bone, cns, skin (blueberry muffin)
    • prognosis: age, state, histology, site of primary
    • NM MIBG: increased uptake in tissue, photpenia in bone mets, hot on bone scan
    • X-ray: calcifications, moth-eaten bony mets
    • CT: calcification, necrosis, LAD, mets, IVC thrombus, encases mesenteric vessels

    Staging

    1: tumor localized, resected
    2A: tumor localized, non-resectable
    2B: tumor unilateral, ipsilateral nodes
    3: tumor crosses midline, +/- nodes
    4: tumor crosses midline, + nodes, distant mets
    4S: mets to skin, liver, bone marrow

    Written by lmwong

    September 9, 2008 at 1:24 pm

    Posted in abdomen, gi, pediatrics, tumor