Abdo Flashcards
1
Q
Carcinoid nuc med
A
octreotide concentrates in GIT carcinoid as well as liver mets
MIBG concentrates in carcinoid tumors, including low percentage that are negative on octreotide
2
Q
MALT lymphoma
A
low grade non Hodgkins
associated he pylori and sjogrens (salivary glands)
3
Q
cholesterol stones vs pigmented. causes
A
cholesterol. OCP, pregnancy, obesity, hyperlipidaemia, GB stasis, disorder of bile acid metabolism.
pigmented. hemolytic anemia, biliary infection, GI absorption disorders (crohns, ileal bypass), CF with Pancreatic insufficiency
4
Q
renal calculi types
A
Calcium oxalate - most common, radio opaque
struvite - urea splitting bacteria. stag horn Calc 》xanthogranulomatous pyelonephritis.
uric acid - gout and leukaemia. not radio opaque, but still appear dense on CT.
5
Q
cystic kidneys
A
simple cyst
tumour. MLCN (multilocular cystic nephroma), cystic RCC, cystic Wilms
genetic. AD/AR polycystic kidney disease, AD/AR medullary cystic disease, glomerulocystic. (AD are adult onset, AR are paeds onset)
syndrome. TS, VHL, Medullary sponge
post dialysis.
6
Q
medullary nephrocalcinosis
A
HAMHOP
Hyperparathyroid, renal tubular acidosis,medullary sponge kidney, hypercalcaemia, oxalosis (saturation of calcium oxalate genetic), Papillary necrosis.
causes papillary necrosis. NSAID. Nsaids, Sickle cell, Amyloid, Infection, Diabetes (most common)
7
Q
Cortical nephrocalcinosis
A
COAG Cortical necrosis Oxalosis Alport syndrome (genetic collagen mutation disorder) Glomerulonephritis (chronic)
8
Q
wilms association
A
WAGR. wilms, aniridia (no iris), genitourinary malformation, retardation
Beckwith widerman
pearl man (overgrowth disorder)
denyrs drash. gonadotropin dysgenesis and wilms
9
Q
renal mass.
cystic
vascular
kids
A
cystic. RCC, wilms, MLCN
vascular. RCC, AML, Oncocytoma, AVM
Kids. Wilms (<5yo)》clear cell sarcoma (3-5yo) 》 RCC 》rhabdoid (<1yo)
mets. lung, breast, melanoma
lymphoma
10
Q
AML asdociations
A
80% sporadic
20% syndromic. TS, NF1, ADPCKD
**fat, mm, vascular
11
Q
Testicular infection
A
Epididymis only: Tb
Orchitis only: Mumps, syphilis
both: e.coli, chlamydia, gonococcus, Tb
12
Q
DTPA vs Mag 3
A
renal blood flow MAG3 Tc99
glomerular filtration DTPA Tc99
Reflux scars DMSA (cortical agent)
** in neonates, the DTPA is unreliable until at least 1 month old, so MAG 3 is used for GFR initially.
13
Q
neuroblastoma recommend..
A
MIBG
Urinary VMA
14
Q
Retroperitoneal mass
A
1.Liposarcoma Lipoma 3.Leiomysarcoma 2.Malignant fiborous histiocytoma 4.Rhabdomyosarcoma 1. in kids
15
Q
oesophageal diverticulum
A
zenkers- posteromedial above cricopharyngeus Killen Jamieson - lateral at level cricopharyngeus epiphrenic diverticulum - at GOJ secondary to motility traction diverticulum - adhesions in mediastinum. Tb, malignancy pseudodiverticulum - dilated mucous glands
16
Q
renal mass lesion
A
Tumour. Infection - lobar nephronia, abscess, xgp Congenital - duplicated collecting system, foetal lobular ion, dromedary hump, column bertin Trauma - haematoma
17
Q
Solid renal tumour. Malignant and Benign
A
Malignant. - RCC - TCC - Wilms in child. can be cystic - Mets. multiple. lung, colon, melanoma RCC - lymphoma - SCC Benign - AML. fat density locules - Oncocytoma
18
Q
Suggestions a mass is not an RCC
A
- Contains fat. AML. Ca+ Think RCC again or wilms in kids - Fever. pyeloneohritis or abscess - Immunocompromised. Lymphoma - Known primary elsewhere. Mets
19
Q
Bilateral renal lesions
A
- Lymphoma - RCC - Mets - AML - Oncocytoma
20
Q
Hypervascular mass
A
RCC AML. Bizarre with tortuous feeding aa circumferential Oncocytoma. Central spoke wheel AVM or AVF. HHT
21
Q
Cystic mass
A
RCC, Wilms, MLCN Cortical cyst, dialysis, MCDK, ADPCKD Syndromic. TS, VHL, NF. Look for liver and panc disease Other. Abscess, hydronephrosis, Hydatid, AVM
22
Q
Bosniak
A
I. Simple cyst. II. Thin septa, Fine Ca+, Hyperdense (>60) >3cm IIF. Multiple septa with percieved flow or ca+, HyperdenHyperdense >3cm III. Thick septa with flow. Need partial resection IV. Soft tissue component. Need nephrectomy
23
Q
Multiple renal cysts
A
ADPCKD. Look for liver, panc, spleen or lung Dialysis TS. Plus AMLs VHL. Plus RCC or panc cysts.
24
Q
Hyperechoic renal mass
A
AML RCC Milk of ca+ cyst Nephritis Hamartoma Infarct
25
Peripheral enhancing met
carcinoid, islet cell of pancread
26
Pneumatosis
CPPV, COPD, asthma, cf, Ischaemia, Endoluminal surgery (is colonoscopy), GvH, Toxic magacolon, colagen vascular disease, steroids, trauma
27
Collitis by location
Diffuse. Toxic MC/Pseudomembranous collitis, UC or CMV Right side. Crohns, salmonella, Tb, Typhlitis, SMA ischaemia Left. UC, shigella, Ghonorrhoea, IMA isch (uncommon as dual supply)
28
LBO
Mass (adeno), Stricture (duvertic), Pseudo (anti Parkinson, trauma, burns, DM or metabolic abno, Ileus ), Volvulus (sigmoid to RUQ, Caecal to LUQ or Bastule)
29
GIH
Angiodysplasia (multifocal mucosal c+ on PV <5mm, >60yo), Diverticulitis, giant sigmoid diverticulum, stercoral proctitis (impacted rectum with perireftal stranding)
30
Hypoperfusion complex
thick bowel wall >3mm, increased c+ of walls cf psoas on c-, IVC <0mm in 3 parts, aorta <13mm above and below renal aa, hypo c+ spleen and liver
31
gas in biliary tree
ercp, biliary fistula or gallstone Ileus, incompetent sphincter oddi
32
GB wall thickening
>5mm Acute cholecystitis, Empyema ( echogenic, DM), Xanthogranulomatosis cholecystitis (60yo female, can't ddx from malig), Acalculus cholecystitis (ICU), Gangrenous cholecystitis (painless, over distended, no c+), Neoplasm ( porcelain, focal or diffuse), Adenomyomatosis (ring down), Secondary (aids, Cirrhosis, ascities)
33
Crohns cf UC
Crohns. Male, 15 to 35, skips, anywhere in GI, Transmural with strictures and fistulas UC. Female, 15-35, starts rectum and heads rt, continuous, Mucosal and submucosal only, +/- backwash Ileus
34
complications of crohns and uc
Cirrhosis, PSC, primary colonic cancer, gallstones, arthritis (SIJ symmetric), pancreatitis
35
Liver cysts
Caroli. connect with bile duct, central dot Polycystic disease. VHL, PCKD, medullary sponge Harmartomas. high on us. Von meyenberg, not cw ducts Hydatid. Few, daughter, Lilly pad on us Abscess. fever, gas, rind c+, Cystic mets. Biliary cystaednomas
36
Periportal hypoecho
Congestion!! Cirrhosis, hepatitis, pancreatitis, Budd chiari, Tx rejection, low protein, trauma
37
Periportal hyperechoic
Inflammation Recurrent ascending cholangitis, cholecystitis, air in tree, fibrosis, schistosomiasis
38
perfusion abno in liver
Portal htn (big spleen, PV >13mm, varicies), shunt (areas of C+ during aa. cirrhosis, HCC or big haemangioma), PV thrombus, Congestion, infarct (rare as has dual supply), HELLP
39
Portal vv thrombus
HCC, hepatitis, Chronic pancreatitis, pregnancy, hypercoagulable
40
Hepatic congestion
CCF, Budd chiari, nutmeg liver, IVC occlusion (thrombus, tumor)
41
Aortitis
Acute. Infectious. syphilis, tb,pyogenic (salmonella), bacteraemia, HIV Non infectious. Vasculitis (giant cell >60yo, Takayasu <60yo, bechets), CTD (RA, SLE, wegners) Chronic. IgG4, Rxt., autoimmune.
42
In and out of phase
Macro fat doesn't loose signal Microfat does loose signal out of phase. Adenoma, fatty liver
43
Cirrhosis
Etoh, hepatitis, biliary (PSC, PBC. intra only), Cardiac (RhF or hep vv/IVC obtstrn), Wilsons, Alpha 1 (cystic lungs), Cystic fibrosis (panc atrophy and bronchiectesis lungs) Caudate, II and III increase in size, Lt>Rt
44
High density liver CT
Haemachromatosis (high risk HCC, also panc and heart iron depo), Haemosiderrhosis (no cirrhosis, spleen also iron depo) Wilson's (spares caudate, BG and thalami high T2), Iron overload, Amiodarone (UIP lung), Glycogen storage (elmeyer flask Neiman pick and gauchers )
45
Nutmeg liver
Budd chiari. diffuse, hep vv occlusion. caudate can hypertrophy and also c+ as has own supply Hepato-veno occlusion disease. Budd chiari 2* Toxic insult (chemo, bone marrow tx, jiamacan tea) RHF, constructive pericarditis Infection/inflammation
46
Portal HTN
Pre hepatic. PV thrombus, PV compression, schistosomiasis Hepatic. Cirrhosis, sclerosing cholangitis Post hepatic. Budd chiari, RHF, Hepato-veno occlusion disease
47
Liver mass with cirrhosis
Not a met!! HCC, Cholangioca (capsule retraction), Haemangioma (peripheral puddling)
48
LB Polyp
FAP. >100, adolescent onset, anywhere Peutz jagher. hamartomas, Intussusception, ovarian, stomach or duodenal ca Gardners. FAP with osteoma or Desmoid +/- thyroid ** look for bowel resection Turcot. FAP + Medulloblastoma or GBM Juvenile polyposis. Single or 100s rectal polyps
49
High T1 liver
Fat. Lipoma, AML, Focal fat depo, HCC (usually ca+ also) Blood. SWI/ GE Melanoma mets Relative. Normal, but liver is reduced elsewhere. hemachromatosis, oedema, regenerating nodule
49
High T1 liver
Fat. Lipoma, AML, Focal fat depo, HCC (usually ca+ also) Blood. SWI/ GE Melanoma mets Relative. Normal, but liver is reduced elsewhere. hemachromatosis, oedema, regenerating nodule
50
Rim c+ lesions liver
Hydatid, met with capsule, abscess, haematoma, primary with capsule (HCC)
51
Misty mesentry
Lymphoma, Messenteric panniculitis, IgG4, oedema, haemorrhage, mets (carcinoid, peritoneal) If no LN then lymphoma unlikely. do f/u in 6-12 months
52
peritoneal ca+
Previous peritonitis/mec, dialysis, prior tb, rx ovarian ca
53
Intra peritoneal mass
Desmoid. young female, look for bowel resection FAP Desmoplastic small cell tumour (child, rare) Rhabdo. child Leiomyoma. Fat Lymphoma. Most common Paraganglioma. iliac bifurcation.
54
Liver solid mass BENIGN
BENIGN Haemangioma. US. hyperechoic with periph vasc. CT hypo noncon, periphearl puddling and fill in on PV so iso on delayed. MR Light bulb bright T2, DWI and ADC high, peripheral fill in on c+ FNH. US central scar, may be undetectable, CT hypo on noncon with bright aa C+ except for scar. washes out to iso/hypo on PV and delayed but scar hold c+. MR same as CT for gad, central scar is high on T2. With primovist it's only lesion that high or iso on delayed. rest are hypo. Adenoma. US well defined heterogenous of variable echo. CT well defined lesion +/- hyperdense haem or hypo fat. homog C+ and return to iso on PV and delayed. MR loose signal in out-of-phase. Also hypo on hepatobiliary phase. AML Regenerative nodule Focal fatty infiltration. Pseudotumor that looses on out-of-phase
55
Liver solid mass MALIGNANT
HCC. Cirrhosis. doesn't cause capsule retraction. look for tumor thrombus in vv and aa. US hypo to heterogenous. can have a hypo capsule/halo. CT low on noncon with vivid c+ aa and rapid washout, so low on PV and Delayed. MRI same, can retain c+ in capsule. DWI high. Fibrolamella HCC. young, normal liver Mets. No c+ and liver not cirrhotic Cholangiocarcinoma. Capsule retraction and bile duct dilatation. Peripheral target DWI.
56
hypervascular liver mets
Melanoma, Sarcoma, carcinoid (can have peripheral c+), RCC, neuroendocrine (islet cell, phaeo, carcinoid), thyroid, breast, chorioca
57
Aa c+ lesion in liver
Benign. FNH (retains c+ in delayed), Adenoma (looses in out-of-phase), Flash haemangioma Malig. HCC, Cholangioca (usually peripheral c+) Hypervascular mets. RCC, neuroendocrine, thyroid, melanoma, breast, sarcoma, chorioca
58
Hyperechoic liver lesion US
haemangioma, hyper mets, HCC, adenoma, lipoma, fical fat, aml (ts), fnh, Hamartoma (von meyenberg)
59
ca+ liver lesions
Mets. mucinous adeno colon, stomach, ovary (+ pseudomyxoma peritoni), treated mets Fibrolamella HCC, HCC, Cholangioca (peripheral) Granulomatous infection. Tb, fungal, Hydatid Haemangioma. punctuate foci ca+
60
Mass in cirrhotic liver
Regen nodule. Iso T1 and T2 (HCC is low T1 and high T2) Dysplastic nodule. High T1 and iso T2 and post gad HCC. High T2, c+ aa and low on delayed.
61
Liver lesions with central scar
FNH. High T2 scar. stays high on delayed Fibrolamella HCC. Low T2 scar Giant haemangioma. Puddling fill in HCC
62
Fat containing liver lesions
Micro fat. looses signal in out-of-phase but no fat suppressed. Adenoma and multifocal Steatosis Macro fat. No signal loss in out-of-phase, but fat suppresses. Lipoma, liposarcoma, teratoma, HCC
63
Low liver signal on MR
** cw mm... should be iso to mm haemachromatosis. also low signal in panc and heart. spleen ok. higher signal out of phase cw in Haemosiderrhosis. Spleen also low. panc and heart ok. Wilson's disease.
64
Biliary obstruction by level
Intra pancreatic. Panc ca, calculus, chronic pancreatitis Supra pancreatic. Cholangiocarcinoma, met LNs Portal. Invasive GB ca, surgical stricture, Cholangioca, hepatoma, calculus, mirizzi, LNs
65
Bile duct narrowing/irregularity
Cholangioca, ampulla or panc adenoca, mets, cystadenoma, PSC (intra and extra, Uc/crohns), Ascending cholangitis (bacterial, intra and extra), Aids Cholangiopathy (can't ddx from PSC), Pancreatitis, PBC (intra only, caroli
66
Inflammatory lesions bile ducts
PSC. IHD and EHD beaded/pruned tree appearance. UC and crohns. young adult male. PBC. IHD autoimmune. cirrhosis with crowding and deformity of ducts. middle aged female. Bacterial ascending cholangitis. Strictures, small abscesses and cavities that communicate with ducts. fever or hx recent cholecystitis Caroli. IHD only. cw ducts. central dot sign Choledochal cyst. focal.
67
echogenic shadowing GB wall
Gallbladder full of stones, porcelain GB, Emphysematous cholecystitis (dirty shadowing)
68
Pancreatitis
GETSMASHED Gallstones, etoh, trauma (check L1#),steroids, mumps, autoimmune, hyperlipidaemia, ercp, drugs/divisium
69
Pancreatic cysts Grandpa, Grandma, Mum, Daughter
Grandpa. IPMN.Main or branch. Main >3mm, branch is bunch grapes in head/uncinate. * these are cw duct, whereas rest aren't. Grandma. Serous cystadenoma, cut orange, lots small cysts in head. usually <2cm size Mother. Mucinous cystadenoma. Bigger cysts in body/tail. can have peripheral ca+ . usually >2cm size Daughter. Solid pseudo papillary. tail. solid to cystic Other. Pseudocyst post pancreatitis (>6wks post), True cyst (VHL, TS, ADPCKD, CF),Lymphangioma
70
Big spleen
>13mm Mild. Sarcoid, amyloid, viral (mono, hepatitis), bacterial (tb), fungal (candida), RA (felt sx RA, big spleen and reduced neutrophils) Moderate. Portal htn, Haemolytic disorder- sickle cell. (CRF, stroke, bone infarct, h vert, autosplenectomy, recurrent chest infection), thalassemia Severe. Lymphoma, leukaemia, myelofibrosis, myeloproliferative (polycythaemia, mastocytosis, gauchers ), malaria
71
Splenic lesions general
Haemangioma. Most common cystic Lymphoma. Most common solid. Angisarcoma. Most common primary malignancy Infarct. wedge Simple cyst
72
splenic cyst
Abscess, lymphangioma, tb, post trauma, epidermoid, Hydatid, schistosomiasis.
73
Splenic solid lesion
Lymphoma, LCH, mets (melanoma,ovary, lung, breast), Hamartoma, sarcoid, siddherosis
74
Solid pancreatic mass
Ductal adenoca. hypo mass. vascular >180sma means inoperable. Smv depends on length involved. Islet cell tumour. hyper c+ mass. ca+. Clincal sx (diarrhoea, etc), hypervascular mets (for GI ask if any sx as need liver mets for sx) Solid pseudo papillary. young women. solid/ cystic. ca+ common Acinar cell ca. hypo mass. larger than ductal. older men. Lymphoma. Large and well defined. homog and mild c+ with LNs or spleenomegaly Mets. RCC. hypervascular. Focal pancreatitis. Hypo or iso. inflamm change and clinical correlation.
75
ca+ panc mass
mucinous or serous cystadenoma, islet cell, pseudo papillary, sarcoid, Granulomatous infection
76
hyperechoic pancreas
CF or lipomatosis of pancreas
77
Emphysematous nephritis, cholecystitis, cystitis, gastritis
Trauma, infection (DM, etoh, immunosup), Ischaemia, increased intraluminal pressure (recent endoscopy)
78
Appendix lesion
Carcinoid (+/- ca+), Mucocele (+/- pseudomyxoma peritoni), Mucinous cystadenoma
79
Terminal Ileus thickening
Tb. TI only Salmonella. Caecum Typhlitis. TI +/- ca ecumenical and whole colon Yersinia. TI and caecum
80
Vascular syndrome
SMA. d3 compression secondary to SMA acute angle. aa angle <25° on swallow Median arcuate. Med arc lig compresses coeliac trunk. increased when lie supine Nutcracker. SMA compressed by L renal vv. May turner. L IMV compressed by R IMA
81
Meckels
2s 2" long, 2% population, 2ft from ileocaecal, 2% symptomatic, 2/3 contain ectopic panc or gastric tissue
82
Malrotation
LB left and SB right DJ flexure doesn't cross midline at level of VB and remains inferior to D1 bulb SMA/SMV cross over/swirl Corkscrew on swallow +/- Volvulus
83
Hiatus hernia
Sliding. common Para oesophageal. GOJ stays in normal location and stomach slides up alongside. increased risk obstruction
84
Gastric volvulus
Organoaxial. Organoaxial Ok. Over top. Most common, not increased risk isch, greater curve goes over top lesser curve Mesenteroaxial. Increased risk of isch. fundus higher than an trim thick walled and non c+
85
Oesophageal ulcers
GORD ( lower 1/3), Adenoca (lower 1/3), SCC (upper 2/3, etoh or hpv), rxt, crohns, coeliac, ingested caustic (long segment), Infection (CMV big >2cm, HSV diffuse small, candida plaque like whole oesoph)
86
Stomach mass
Malignant, polyp, mimic
87
Malignant stomach mass
Adenoca. most common. nodular or diffuse Lymphoma. MALT. most common 1* outside LNs. GIST. <2cm nodule benign, big is ugly, necrotic and bad Carcinoid Mets Leiomyoma. Fat density Lipoma
88
Gastric polyps
Hamartoma. Peutz jagher Hyperplastic. FAP. 90% Adenomatous. 1-4cm. single.
89
Mass mimic in stomach
Bezoa (moves), nissen fundoplication, lymphoid hyperplasia
90
Thickened gastric folds
Inflammatory. gastritis, zollinger Ellison (pancreatic gastrinoma ca) crohns, tb Infiltration. Lymphoma, Adenoca, sarcoid, eosinophiloa, amyloid Varices
91
Colon fat halo
IBD, isch (chronic ), SLE vasculitis, chronic infection, rxt enteritis, gvh
92
Oesophageal diverticulum
Zenkers. midline posterior above cricopharyngeus Killen Jamieson. Lateral at level cricopharyngeus Pharyngocele. lateral hypopharyngeal Epiphrenic. Motility disorder Traction. pulling from mediastinal adhesions. all layers (tb, rxt, malig) Pseudodiverticulum intramural. dilated mucous glands from chronic irritation or reflux
93
Thickened oesoph folds (longitudinal)
oesophagitis. scleroderma, reflux, zollinger Ellison Neoplasm. Varicoid carcinoma, lymphoma Varices
94
Oesophageal strictures by location
Upper to mid. web (shelf like), vascular ring, Barrett, caustic ingestion, rxt, extrinsic compression, skin diseases (wry them a multiforme) Lower. Reflux, scleroderma, NGT, zollinger Ellison, adenoca , schatzzki ring
95
Dilated oesophagus
Achalasia (tight LOS) Scleroderma (patios LOS) Malignancy Stricture Chaggas Post vagotomy DM or Etoh neuropathy
96
Oesophageal tear/contrast extravasation
Oesophagitis, tumour, Mallory Weiss vomiting (only mucosa), borehave vomiting (entire wall), tracheoesoph fistula, bronchopulm forget malformation
97
Oesophageal filling defect
Benign. SMOOTH. leiomyoma (most common +/-ca+), GIST, fibrovascular, neurofibroma, lipoma, Hamartoma Malignant. SCC (upper 2/3), adenoca (lower 1/3), mets, lymphoma Non neoplastic. duplication cyst, Fb, varices, extrinsic lesion (LN or mediastinal mass)
98
Gastric erosion/ulcer
Solitary. peptic ulcer (h. pylori), ectopic panc, adenocarcinoma, lymphoma, mets, gist Multiple. Erosive gastritis (aspirin, etoh, steroids, stress), crohns, h. pylori, candida, hsv, CMV, submucosal mets.
99
Linus plastica
Tumor, Granulomatous, iatrogenic, infiltrating Tumour. Adenoca (most common), lymphoma, mets (breast, lung, melanoma), panc carcinoma invasion Granulomatous. Crohns (rams horn diffuse narrowing), sarcoid, eosinophiloa gastroenteritis, tb Iatrogenic. Rxt, corrosive ingestion, haematoma Infiltration. Amyloid
100
Gastric dilation
inflammatory, obstructing mass, Volvulus, hypertrophic pyloric stenosis, proximal SBO, post op, post vagotomy, anticholinergic drugs
101
Thick duodenal folds BADHELP
Brunner gland hyperplasia, Amyloid, Duodenitis, Haemorrhage/ haematoma, Edema/eosinophilic enteritis, Lymphoma, Pancreatitis
102
Duodenal mass
BENIGN. Gist, lipoma, carcinoid MALIG. Usually distal to ampulla. adenoca, amullary ca, lymphoma, gist, mets (stomach, panc, colon, kidney, melanoma, lung)
103
Duodenal narrowing
Inflammatory. Chronic peptic ulcer, crohns, pancreatitis Neoplasia. Adenoca, lymphoma, gist, mets Annular pancreas Haematoma SMA syndrome. worse when supine
104
Small bowel fold types
-Type 1. Dilated lumen with thin <3mm straight folds. SOS Sprue (coeliac, floccules), Obst, (scleroderma) -Type 2. Thick >3mm fold. Haem with oedema (vascular). Segmental. Isch (vv or aa), Rxt enteritis, intramural haem (trauma, isch, vasculitis) Diffuse. Venous congestion (ccf), lymph obst, low protein -Type 3. Thick nodular folds. Infection, inflammation, neoplasm Crohns, lymphoma, amyloid, infection (Giardia proximal, Yersinia and tb if distal), whipples, eosinophilic gastroenteritis, mastocytosis, mets
105
Thick c+ bowel with ascities
eosinophilic enteritis, tb, lymphangectasia (ascities chylous), whipples
106
Malabsorptive pattern sb
dilution of barium (hypersecretion), floccules, segmentation of barium column, delay in transit time Coeliac, sprue
107
Bowel ischaemia causes
Occlusion. aa thrombus (atherosclerosis), emboli (AF or ventricular aneuysm), Venous thrombus (portal htn, pancreatitis, tumour) Hypotension Hypovolaemia
108
SB dilation
Sprue (coeliac), Obstruction, Scleroderma Localized. inflamm. pancreatitis, Appendicitis, cholecystitis, diverticulitis Metabolic. Hypovolaemia, magnesia, calcaemia
109
SBO
Adhesions, Hernia, Neoplasm, Intussusception, gallstone Ileus, Malrotation with volvulus, inflamm with stricture ** look for -free gas - hernia. inguinal, obturator, femoral - previous sx - pneumobilia - bony mets
110
SB tumours
Adenoma (most common,assoc with FAP, HNPCC) Lipoma, gist, leiomyoma, haemangioma, neurogenic (in NF 1) Mets (melanoma, kidney, breast), carcinoid (most common malig, if have sx look for liver mets), adenoca (FAP, NF 1), lymphoma, sarcoma (malignant gist)
111
Separated SB loops
Ascities, Thickening (Crohns, radiation, tb, haemorrhage), Lymphoma, Carcinoid, Peritoneal carcinomatosis, Inflamm (abscess, GvH)
112
Caecal mass
Appendicitis or abscess, appendix mucocele, adenoca, carcinoid, lymphoma, mets, gist, adnexal mass.
113
Fat containing ileocaecal mass
ileocaecal valve lipoma, Intussusception, lipoma to us infiltration
114
Appendix mass
carcinoid (desmoplastic reaction ), Mucocele, adenoca, lymphoma, abscess
115
LB polyps
Hyperplastic (90%), adenomatous (malig potential), Hamartomaous (rare, peutz jager)
116
LB filling defect
lymphoid follicle (<4mm), polyp (adenomatous or post inflammatory UC/crohns), lipoma, adenoca, mets, lymphoma, endometriosis, foreign body
117
LB stricture
Short segment. neoplasm (carcinoma, lymphoma, mets), Ischaemia. splenic flexure > sigmoid Infectious. Tb (ikeocaecal), Typhlitis (ileocaecal) schistosomiasis (desc colon) Inflamm. UC, CD Iatrogenic. Rxt, post op
118
Megacolon
Toxic. UC, Pseudomembranous Non toxic. Obstruction, Ileus, purgative abuse, cathartic colon, Ischaemic. splenic flexure or deacending
119
Thumbprint in colon
Infection. Pseudomembranous collitis (c. diff ), CMV, Typhlitis (rt), Diverticulitis Inflamm. Crohns (skips), UC Vascular. ischaemia, portal htn (PV thrombus) Neoplasia. Colorectal ca, lymphoma Hemorrhage. Henoch schonlein (thrombocytopenia), coagulopathy
120
Colon thickening by side
Rt side. Crohns, Typhlitis, SMA obst Lt side. Pseudomembranous colitis, diverticulitis, UC, IMA obst, adj Messenteric ischaemia with reactive
121
Long segment narrowing large bowel
scirrhous adenoca, lymphoma, diverticulosis smooth mm hypertrophy, UC, crohns, isch stricture, rxt
122
ahaustral colon
cathartic abuse (rt side), UC > crohns, amoebiasis, age (lt)
123
LBO
carcinoma, Stricture (divertic, crohns, isch, infection tb), Volvulus, fecal impaction, Hernia, adhesion, extrinsic (endometriosis, abscess)
124
Presacral widening
Rectal. IBD, abscess Sacral. Mets, chordoma, OM, neurofibroma Retroperitoneal. lipomatosis, fibrosis
125
Proctitis
Gonococcal, stercoral (impaction ), UC, crohns,
126
Colonic fistula
Surgery, rxt, diverticulitis, crohns, malignancy, trauma
127
Inguinal hernia
direct. med to inf epigastric indirect. lat to inf epigastric femoral. med to fem vv. narrow neck, pear shaped
128
Pelvic cystic lesions
Common. duplication cyst (double wall), mesenteric cyst (lymphagioma), Choledochal, pancreatic pseudocyst, abscess, haematoma, urachal remnant Uncommon. teratoma, cystic mesothelioma, Hydatid rupture, necrotic LNs, cystic/necrotic stromal tumour Males. seminal vesicles cyst (ADPCKD) Females. Ovarian, peritoneal inclusion
129
Peritoneal fluid collection
Water. ascities, urinoma, Biloma, lymphocyte, panc pseudocyst, csf from vp shunt Complex. abscess, haematoma, pseudomyxoma peritoni, panc necrosis
130
Intra peritoneal ca+ axr
Appendicolith, Messenteric node, dropped gallstones, panc Calc, porcelain GB, Renal Calc, uterine leiomyoma, fetal, teratoma old haematoma or abscess, aa
131
Omental mass cystic
Ascities (loculated), abscess, panc pseudocyst, peritoneal mets, lymphangioma, lymph nodes, inclusion cyst female, duplication cyst, Messenteric cyst
132
Messenteric mass solid
Mets, carcinoid (liver mets, desmoplastic reaction ca+), Desmoid (Gardners look for LB resection), lymphoma, retraction mesenteritis (panniculitis), gist, mesothelioma, sarcoma LN. Tb, mac, inflammation, ca Haematoma Splenosia Tb peritonitis. wet or dry Omental infarct Torted appendices epiploica
133
Widespread peritoneal disease
Complicated ascities, Abscess, Pseudomyxoma peritoni (gelatinous, mucinous adenoca of appendix or ovary), Peritoneal carcinomatosis (direct invasion, ovarian, colon, breast, melanoma, lung, carcinoid) Tb wet or dry Mesothelioma
134
Ca LN abdomen
Mucinous adenoca, sarcoma, rx lymphoma, tb,
135
Adrenal washout
>60% from c- HU = adenoma >4cm unlikely to be adenoma
136
Adrenal mass
>5cm with avid c+ = phaeo, hetero c+ = carcinoma or met small. cons ( increased aldosterone), adenoma, aml (fat and vascular), mets, carcinoma, haemorrhage, hyperplasia (cerebriform ), Granulomatous (tb)
137
Small kidneys
Decreased vascularity. aa (isch secondary to stenosis, vasculitis, emboli) Reduced parenchymal. hypoplasia /congenital, chronic GN MCDK involuted Post renal. chronic reflux or obstruction
138
Big kidneys
Pre renal. acute aa infarct, Acute vv thrombosis Renal. infection, lymphoma, amyloid, congenital (horseshoe or PCKD), trauma Poat renal. hydronephrosis, infection
139
Cortical nephrocalcinosis
COAG Cortical necrosis ( Nsaids, Tx rejection, infarct, preg), oxalate, alport (CvD), GN chronic
140
Rim nephrogram
Cortical supply is seperate from parenchyma Acute renal aa occlusion or severe hydronephrosis with occlusion of intra renal aa
141
Persisting nephrogram
stasis of c+ Hypotension, Acute obst, Renal vv thrombus, ATN, Pyelonephritis (acute)
142
Increased echo on us parenchyma
nephrocalcinosis. HAMHOP Hyperparathyroid, Renal tubular acidosis,Medullary sponge kidney, Hypercalcaemia, Oxalosis (increased ca+ oxalate from inherited or liver failure), polycystic ARPCKD baby
143
Decreased echo renal parenchyma US
Oedema or hypoperfusion Vascular. ischaemia (atherosclerosis, emboli), vv thrombus, vasculitis Cortical necrosis TX rejection
144
Renal pelvis filling defect
Calc, blood, TCC, fat (renal lipomatosis), pus (tb corkscrew, e.coli, Xanthogranulomatosis pyelonephritis), scar mass. TCC, RCC, SCC, papilloma
145
Retroperitoneal fibrosis
Idiopathic, IgG4, lymphoma, mets, rxt, inflammation (Crohns, pancreatitis, diverticulitis), CTD (Ank spon, pan, sle)
146
Bladder ca+
Schistosomiasis, Tb, Rxt, Infection (chronic), Calc, TCC
147
Bladder gas
Instrumentation, fistula, infection, pnet rating trauma, emphasematous cystitis (DM or immunocompromised)
148
Bladder mass
TCC. Most common. smoker. do IVP for higher lesion SCC. Chronic irritation, schistosomiasis or Calc, large and solitary mass Adenoca. Urachus. diffuse thickening, cystic/solid Rhabdo. kids
149
stag horn calculus
xanthogranulomatosis pyelonephritis. DM, ecoli, proteus Pyonephrosis with obstructing stone Ca+ neoplasm
150
Renal vv thrombus
tumour. RCC, adrenal, pancreatic, gonadal Renal disease. SLE, PAN, amyloid sis, sarcoidosis, diabetes, pyonephritis/abscess Extra luminal compression hypoperfusion from Hypovolaemia Trauma/sx Extension from ovarian vv or IVC thrombus sickle cell anaemia
151
Striated nephrogram
acute pyelonephritis, Acute Ureteric obst, Renal vv thrombosis, Hypotension, medullary sponge, ARPCKD
152
Renal aa aneurysm
FMD (most common), atherosclerosis, mycotic, trauma, congenital, rxt
153
Renal aa stenosis
atherosclerosis (most common). at osteum or proximal 2cm. >50yo FMD. mid to distal aa. young adults Mechanical thromboembolism or congenital stenosis Neurofibromatosis Arteritis (PAN or takayasu) Rxt
154
Dilated ureter
Obstruction. Calculus, Stricture, neoplasm, bladder outlet obst, urethral stricture, retroperitoneal fibrosis, retro caval ureter Functional. VUR, primary mega ureter, prune belly sx Extrinsic compression
155
Ureteral stricture
Neoplasm. TCC, mets, lymphadenopathy, extrinsic Infection. Tb (corkscrew appearance), schistosomiasis Inflammatory. Retroperitoneal fibrosis, endometriosis, diverticulitis, Appendicitis VUR, ectopic ureterocele, congenital stenosis/PUJ, retro caval ureter (rt), primary megaureter
156
Ureteral diverticula
Congenital, Ureteritis cystica, pseudodiverticulum, Tb
157
Medial deviated ureters
Retroperitoneal fibrosis. primary idiopathic, inflammatory aaa, medications (migraine drugs), desmoplastic malignancy (lymphoma, carcinoid), autoimmune, rxt Psoas mm hypertrophy Pelvic lipomatosis Retro caval ureter Post op Posterior bladder diverticulum Enlarged prostate (J ureter)
158
Lateral deviated ureter
Retroperitoneal adenopathy, aortic aneurysm, retroperitoneal fluid collection, Malrotation kidney, ovarian or uterine mass
159
Reflux grade
1. within ureter 2. ureter and collecting system. reaches renal pelvis 3. bunting of calyces 4. Tortuous dilatation 5. very tortuous dilated ureter
160
Bladder wall ca+
TCC, urachal adenoca, schistosomiasis, Tb, rxt
161
Adrenal mass solitary
Adenoma (HU <30), mets, phaeo, lymphoma, neuroblastoma (<2yo), fatty lesions (myelolipoma, lipoma), cystic tumours (simple cyst, pseudocyst post haem), Haem (trauma, coagulopathy, sepsis, neonatal) Tb
162
Adrenal mass bilateral
mets lymphoma granulomatous infection. Tb adenoma phaeo. NF, VHL, MEN II Adrenal hyperplasia. cerebriform haemorrhage in neonates, DM or sepsis
163
Adrenal ca+
neuroblastoma phaeo cyst (peripheral) tb haemorrhage wolman's disease. AR fat deposition with bilateral enl adrenals and punctuate foci ca+
164
Solid testicular mass
Primary Germinal. Yolk sac (<2yo), teratoma (child), Seminoma (adult, homog), lymphoma (old man) Mets. prostate, kidney, lymphoma Infection. orchitis, abscess, granuloma trauma fracture
165
Ca+ testicular lesion
Microlithiasis Previous trauma Resolved infarct Sertoli cell tumour burnt out
166
Cystic testicular mass
Intra testicular cyst, tubal ectasia of rete testes, epidermoid, NSCGT (teratoma), necrosis or haemorrhage in tumour
167
Epididymal mass
epididymitis, epididymal cyst, spermatocele, adenomatoid tumour
168
Spermatocele cord mass
varicocoele, rhabdomyosarcoma
169
Scrotal.fluid
hydrocele (post trauma, Inflam, vasectomy, epididymitis, tumour) Pyocele. septate with low level.echos Haematocele. Trauma, torsion, infarct
170
paratesticular mass
rhabdomyosarcoma in kids, lipoma, liposarcoma. Uncommon - mesothelioma
171
free gas/pneumoperitineum
riglers, falciform, lucencies over liver, triangles between bowel loops. Any concern, do erect cxr
