ABDO/IR Flashcards

Question

GIST imaging

Answer 1

Location - stoamch - SI - anorectum - colon - oesophagus (uncommon) - extra GI - mesentery, omentu, retroperitoneum (uncom) CT - soft tissue, central necrosis - often exophytic - screscent ulceration with air fluid level (torricelli bernoulli sign) - peripheral enhancment - calcs uncommon MR variable due to necrosis, haemorrhage, cystic change Concerning; exogastric growth, >5cm, central necrosis and extension to other organs

Answer 2

Fluoro Early - elevated, superficial or shallow lesions Advanced - polypoid - ulcerating CT - polypoid +/- ulceration - focal wall thickening - ulceration - infiltrating

Answer 3

a rare idiopathic hypertrophic gastropathy present with acholhydria, hypoproteinaemia and oedema. typically fundal region. fluoro - enlarged and tortuous folds in the fundus and body, sparing the antrum - diluted barium due to mucus hypersecretion CT - thickened rugae, resembling convolutions of brain - wall thickness normal between folds

Answer 4

a clinical syndrome secondary to a gastrinoma secrete gastrin, hypersecretion of gastric acid leads to diarrhea, gastritis, GORD and PUD assoc with MEN 1

Answer 5

Fluoro - thickened rugael folds - multinodular gastric contour - erosions and ulcers CT - thickened rugal folds - multiple gastric nodules ddx - other gastritises - gastric lymphoma - menetrier - outlet obstruction

Answer 6

Indirect - lateral to inferior epigastric vessels - deep inguinal ring - anterior to spermatic cord in males - follows round lig in females Direct - medial to inferior epigastric vessels - through a defect in hesselbachs triangle - weakness in the fascial floor of the inguinal canal - inguinal canal is usually compressed/displaced (lateral crescent sign)

Answer 7

a congenital intestinal diverticulum due to fibrous degeneration of the umbilical end of the vitelline duct that occurs around the dital ileum

Answer 8

2% population 2 inches 2 feet from IC valve 2/3 ectopic mucosa 2 types of ectopic tissue 2% symptomatic

Answer 9

Haemorrhage Obstruction - adhesion - luminal - intussception - Littres hernia Inflammation Perforation Neoplasm

Answer 10

CT - blind ending small bowel pouch - antimesenteric side of the distal ileum - can invert and cause an internal polypoid lesion NM - pertechnetate - only if gastric mucosa present, mucin secreting cells-

Answer 11

Can be primary (mucosa) or secondary (entire wall) Can be periampullary Can be intraluminal (duodenal web) Complications - diverticulitis - haemorrhage - perforation - biliary obstruction (Lemmel symdrome)

Answer 12

Periduodenal abscess Duodenal ulcer Duodenitis Head of pancreas cystic lesion Pseudocyst

Answer 13

obstruction at the duodenum due to a membranous web or intraluminal diverticulum. small central aperture, different to atresia ddx - duodenal stenosis - duodenal atresia

Answer 14

a congenital malformation fo the duodenum with complete obstruction of the lumen assoc - downs - vacterl - annular pancreas - other atresias

Answer 15

XR double bubble - if distal gas, stenosis US double bubble - ?connection, might be a foregut duplication DDX - stenosis or web - malrotation and volvulus - choledochal cyst - omental cyst - duplication cyst

Answer 16

extraabdominal herniation of fetal/neonatal bowel loops into the amniotic cavity through a paraumbilical defect. no surrounding membrane. no strong associations

Answer 17

herniated content to right side of cord small AC ddx - omphalocoele - physiological herniation (before 11 weeks)

Answer 18

congenital midline abdominal wall defect at the base of the umbilical cord insertion

Answer 19

Chromosomal Other syndromes - BW - pent cantrell - OEIS - lethel omph cleft palate Other anomalies - CNS, cardiac, GU, skeletal

Answer 20

mulitple bowel loops in membrane covered defet direct cord insertion small AC polyhydram allantoic cyst often present can rupture ddx - pseudoomph - gastroschisis - physiological herniation - limb body wall complex - umbilical hernia

Answer 21

Hereditary - Hereditary nonpolyposis colorectal cancer HNPCC - Familial adenomatous polyposis syndromes FAPS ( incl, classic,. Gardner, Turcot) - Bannayan riley ruvalcaba - Cowden - Peutz jeghers - TS - Juvenile polyposis syndromes Non hereditary - Serrated polyposis syndrome - Cronkite Canada syndrome - Juvenile polyposis syndrome Can also be adenomatous or hamartomatous Adenomatous - FAPS - Gardner - (HNPCC - cancers come from adenomatous polyps) Hamartomatous - JPS - BRR - Cowden - Peutz Jegher - Cronkhite Canada

Answer 22

an AD condition which predisposes to malignancies, including colorectal. Due to mutations in DNA mistamtch repair (MMR) geners Cancers - CRC - GU (endometrial, ovarian, prostate, urothelial) - SB - Gastric - hepatobiliary - CNS Diffuse polyposis is characteristically absent

Answer 23

characterised by presnece of hundreds of adenomatous polyps in the colon, mutation of the tumour suppressor APC gene, though can be MUTYH. <5mm. rectum typically spared. can have extracolonic (duodenal, gastric) polyps associations - CRC - hepatoblastoma - extracolonic polyps (stomach, duodenum) - desmoid tumours - osteomas - dental anomalies - papillary thyroid ca Variants - gardners - attenuated FAP - familial polyposis colli

Answer 24

FAP Multiple osteomas Epidermal cysts Fibromatoses Desmoid tumours Supernumery deeth, odontomas, dentigerous cysts Ampullary carcionoma Papillary thyroid ca

Answer 25

characterised by multiple colonic polyps and increased risk of colonic and primary brain tumours; commonly medulloblastomas or GBM APC gene - CRC by 40 - medulloblastomas HNPCC gene - not as much CRC - GBM

Answer 26

AD disorder caused by mutation of the PTEN gene Features - hamartomatous intestinal polyps, typically terminal ileum and large bowel - macrocephaly - lipomatosis - dermal and deep visceral lipomas - angiolipomas - haemangiomata - speckled penis - hypotonia - scoliosis - pectus - woman:::: breast ca, MR screening

Answer 27

caused by mutation of the PTEN gene and characterised by hamartomas throughout the body and increased risk of ca Features - mucocutaneous lesions, including trichilemmomas - GI polyps, large and small bowel - glyucogenic acnathosis - thyroid goitres - fibrocystic breast disease - testicular lipomatosis Cancers - breast - thyroid - dysplastic cerebellar gangliocytoma, in assoc with Lhermitte duclos disease

Answer 28

AD polyposis syndrome characterised by - multiple hamartomatous polyps (SB/jejenum), also colon, stomach - mucocutaneous melanin pigmentation mouth/fingers/toes Proliferation of all three layers of the mucosa Cancers - CRC, stomach, small intestine - adenoma malignum - breast - pancreas - ovary sec cord - uterus - cervix - testis (sertolis) - lung

Answer 29

characterised by presence of multiple serrated polyps. heterogenous genetic with BRAF and KRAS most common. CRC in 50%.

Answer 30

hundreds of hamartomatous polyps containing fluid or mucus. SMAD4 and BMPR1A implicated. end up with CRC Assoc - malrotation - meckels - hydrocephalus - congenital heart - mesenteric lymphangioma - pulm AVM

Answer 31

a non neoplastic non hereditary hamartomatous polyposis syndrome characterised by rash, alopecia and watery diarrhea predominantly stomach, large intestine and small bowel. not assoc with malig.

Answer 32

Proximal: giarida, stronglyloides Distal: salmonella, shigella, yersinia Distal ileum/caecum: TB, typhlitis, amebiasis

Answer 33

most common GI TB, third most common extrapulmon TB Barium - flieschner (narrowing of the ileum, thickening of the valve) - thickening and hypermotility of the caercum - stierlin sign (empty caecum) - chronic; fixed rigid valve, conical caecum, pulled caecum from fiorbosis) CT ileocaecal thickening asymmetric valve thickening mesenteric adenoaptyh with central low attenuation ddx - crohns (more ileal, less ascites, more vascularity) - caecal carcinoma (eccentric, mets) - small bowel lymphoma (thick, no stricture, lymphadenopathy/hepatosplenomegaly) - amoebic colitis

Answer 34

necrotising inflammatory conditions originating in the caecum and extending out in immunocompromised bowel wall thiickening hypoechoic wall, echoic thick mucosa fat stranding, pneumatosis small bowel obstruction

Answer 35

IBD Infectious - cdiff - salmonella - yersinia - tb - typhlitis Spondyloarthopathies Ischaemia Radiation Vasculitidies - SLE/PAN/HSP/Behcet and others Neoplasic - adenocarc, lymphoma, carcinoid Drug related Infiltrative - EG - sarcoid - amyloid - mastocytosis Endometriosis

Answer 36

a t cell mediated autoimmune gluten intolerance characterised by loss of villi in the proximal small bowel and malabsorption

Answer 37

Pulmonary haemosiderosis (Lane Hamilton) IgA def Cavitating mesenteric lymph node syndrome Small bowel lymphoma Down syndrome CEC/Gobbi syndrome IBD

Answer 38

Fluoro - Small bowel dilatation - dilution of contrast - multiple non obstructing intussusceptions (coiled spring) - jejunoileal fold pattern reversal - moulage sign - mosaic pattern - flocculation - segmentation CT - jejunoileal fold pattern reversal - small bowel dilatation/thickening - stranding - intussusceptions - strictures - vascular engorgement - prominent nodes - submucosal fat - hyposplenism

Answer 39

an uncommon cause of mechanical bowel obstruction, occuring as a complication of chronic cholecystitis. stone fistula to small bowel and impaction at ileocaecal valve

Answer 40

Gallstone ileus but causing gastric outlet obstruction

Answer 41

XR - Rigler triad: obstruction, gas in biliary tree, gallstone CT - riglers again - fistula site - complications

Answer 42

pathologic communication between the aorta and GIT. Can be primary (assoc with a complicated aneurysm) or secondary (assoc with graft repair)

Answer 43

Primary Direct signs: - ectopic gas in aorta - presence of vascular contrast in GIT Indirect signs: - bowel thickening over aneurysm - disruption of periarotic fat - bowel/periaortic haematoma Secondary - increased perigraft soft tissue - pseudoaneurysm formation - disruption of aneurysmal wrap - increased soft tissue between the graft and the wrap ddx - perigraft infection - retroperitoneal fibrosis - infected mycotic aortic aneurysm - infectious aortitis

Answer 44

most common primary malignancy of the duodenum risk factors; - polyposis syndromes - inflammatory disorders ie crohns, coeliac - non hered polyps ddx - lymphoma - NET - pancreatic tumours - periampullary tumours - lower cbd tumours - leiomyosarcoma - benign polyp/adenoma/leimyoma/lipoma

Answer 45

those which arise within 2cm of the ampulla of vater four main types - pancreatic head/uncinate tumours - lower common bile duct tumours - ampullary tumours - periampullary duodenal adenocarcinoma

Answer 46

normal variant patulous ampulla of vater tumours - IPMN - ampullary - periampullary - cholang - pancreatic papillitis autoimmune panc choledochocele impacted stone

Answer 47

functional or non functional TYPES Insulinoma - 50% of nets - usually <2cm - mostly pancreas - 15% malig Gastrinoma - pancreas, LN, duodenum - 20-30% - variable size - 75% malig Non functioning - pancrease - 15% - usually large and malignant VIPoma - pancreas, adrenal - 3% - 50% malignant Glucagonomas and somatostatinomas - rare - pancreas - malginant

Answer 48

most common pancreatic net, develop from ductal pluripotent cells into unregulated insulin secreting cells. equally distributed in pancreas whipples triad - hypoglycaemia - sx of hypo - immediate relief with glucagon Assoc with MEN1

Answer 49

small hypervascular can have calcs equal pancreas distribution

Answer 50

second most common pancreatic endocrine tumour associated with MEN1, and the most common type associated with it associated with PUD - zollinger ellison syndrome often malignant, extrapancreatic (duodenal) occur in gastrinoma triangle

Answer 51

Confluence of cystic and common bile ducts Junction of D2/D3 Junction of pancreatic head/neck

Answer 52

a very rare pancreatic endocrine tumour that secrete vasoactive intestinal peptide. WDHA syndrome; watery diarrhea, hypokalemia, achorhydria location - intrapancreatic, commonly tail - extrapancreatic neurogenic; symp chain - extrapancreatic non neurogenic; oesophagus, bowel, liver, kidney

Answer 53

a pancreatic endocrine tumour that secretes glucagon. commonly malignant. 4d syndrome - dermatitis - diabetes - DVT - depression typically large and metastatic at time of diagnosis. hypervascular.

Answer 54

a rare NET. assoc; - MEN1 - VHL - NF1 Inhibitory syndrome - DM - cholelithiasis - diarrhea typically in the pancreas, but can also be duodenum/ampulla or vater

Answer 55

a rare infectious multisystem disorder caused by actinobacteria tropheryma whipplei presents with migratory arthritis, weight loss, diarrhea, abdominal pain. can have hepatosplenomegaly and lymphadenopathy

Answer 56

GI - jejunal micronodules - thickened mucosal folds - low density mesenteric nodes CNS - cortical or subcortical atrophgy - hydrocephalus - lesions; t2 hyper and mildly enhancing, no restriction - midbrain, mesial temporal, hypothalamus and corticospinal tracts\ thoracic - diffuse/focal infiltrates - basal opacities - nodules - adhesions - effusion - nodes

Answer 57

disproportionate overgrowth of Brunner Glands in the duodenum from yperacidity. Multiple nodular filling defects, cobblestoning. ddx duodenitis.

Answer 58

Oesophagus - Dilated distally - dysmotility - reflux Small bowel - luminal dilatation - reduced peristalsis - hidebound bowel (crowding of valv c) - accordion sign (evenly spaced mucosal folds) - sacculation Large bowel - psedosacculation - loss of haustra - dilatation - reduced transit

Answer 59

Long segment concentric thickening Mural stratification Mild mesenteric oedema Ascites No nodes

Answer 60

Proximal - right of SMV Distal - left of SMV Deep - to level of duct Superficial - before duct 1: haematoma with minor contusion or superficial lac 2: major contusion or lac without ductal injury 3: distal transection or deep injury with duct injury 4: proximal transection or deep injury involving the ampulla or cbd 5: shattered head

Answer 61

Absent necrosis - Acute peripancreatic fludi collection <4w - Pseudocyst (encapsulated) >4 weeks Necrosis - acute necrotic collection <4w - Walled off necrosis (encapsulated) >4w Necrotic pancreatitis - can lead to emphysematous pancreatitis Vascular - haemorrhage - pseudoaneurysm - splenic/portal vein thrombosis Fistula into peritoneal cavity Abdominal compartment syndrome

Answer 62

Balthazar score A-E A normal 0 B enlargement 1 C inflammatory 2 D single collection 3 E two or more collections 4 Necrosis none 0 <30% 2 30-50% 4 >50% 6 Score /10

Answer 63

a short segment of adynamic ileus close to an inflammatory process on xr. upper abdomen - pancreatitis. right lower quadrant - appendicitis.

Answer 64

distension proximal colon, abrupt termination at splenic flexure, decompression distally LUQ pathologies; - pancreatitis (phrenicocolic lig via tv mesocolon) - carcinoma - IBD - mesenteric ischaemia - abdominal aortic aneurysm rupture - stomach tumorus

Answer 65

Igg4 sclerosing disease RA Sjogrens IBD

Answer 66

Sausage shape Minimal stranding, confined to peripancreatic Peripancreatic low rim/halo MR T1 low T2 minimally incre C+ delayed DWI restricts MRCP ?strictures Other sites - nodes - renal inflamm pseudotumours - retroperitoneal fibrosis - pleural effusions - CBD strictures -mediastinal nodes

Answer 67

Diffuse - lymphoma - plasmacytoma - mets - infiltrative ductal adeno Focal - ductal adenocarcinoma

Answer 68

SPINK1 mutation Tropical countries Younger Large ductal calculi

Answer 69

complications of acute caused by secondary necrotising infection. gas forming bacteria.

Answer 70

XR Bowel obstruction. Affected bowel is smaller in calibre Fluoro Affected segment small calibre with proximal dilatation Saw tooth irregularity of the segment Reversed rectosigmoid ratio

Answer 71

functional colonic obstruction in a newborn due to an obstructing meconium plug. Usually tyransient and affects the left colon (small left colon syndrome)

Answer 72

XR multiple dilated loops Fluoro small calibre left colon with filling defects due to retained meconium rectum is normal in size

Answer 73

XR dilated bowel loops loss of the normal gas shapes thumbprinting pneumatosis portal venous gas pneumoperitoneum

Answer 74

colonic pseudo obstruction. acute distension without an underlying mechanical obstruction

Answer 75

PSC Moya moya Ank spon CRC Coeliacs Lung disease Uveitis and iritis Erytheme nodosum and pyoderma gangrenosum Thrombotic comps fatty liver Seronegative spondyloarthropathies Chronic hepatitis

Answer 76

XR Thumbprinting toxic megacolon Fluoro Granular mucosa Lead piping CRC CT Lead piping Wall thickening Mural stratification Submucosal fat deposition Thickening perirectal fat CRC Pneumatosis MR Wall thickening Diffusion restriction Enhancement of the mucosa Loss of haustra

Answer 77

Acute complication in IBD. Fulminant colitis cuases neurogenic loss tone of the colon leading to severe dilation and perforation Causes UC Crohn Infectious, particularly cdiff Neutropaenic colitis Ischamia Radiation Lymphoma GVHD Hypothyroidism Hrischsprungs

Answer 78

Wall thickening with homogenous enhancement Ascites Stranding Right colon; yersinia, salmonella Diffuse; CMV, e coli Left; shigella, schistosomiasis Rectosigmoid; gonorrhea, herpes, trchomatis

Answer 79

T0 no evidence Tis in situ T1 into submucosa T2 into muscularis T3 into subserosa or into non peritonealised tissues T4a visceral peritoneal layer T4b adjacent organs N0 none N1a 1 regional N1b 2-3 regional N1c serosa/non peritoneal tissue without regional N2a 4-6 N2b >7 M0 no M1a one organ without peritoneal M1b multiple organs no peritoneal M1c peritoneum with or without others

Answer 80

Premalignant - adenoma - serrated polyp Uncertain - low grade appendiceal mucinouss neoplasm - high grade appendiceal mucinous neoplasm Malignant - appendiceal mucinous adenocarcinoma - poorly diff mucinous with signet ring cells - mucinous signet ring cell carcinoma

Answer 81

a syndrome of progressive accumulation of mucinous ascites related to a mucin producing neoplasm, usually appendix.

Answer 82

Loculated collections of fluid accumulating along the peritoneal surfaces rsulting in scalloped appearance of teh coated organs and omental caking

Answer 83

TB Lymphoma Malignant peritoneal mesothelioma usually from ovaries, gastric or colon

Answer 84

abnormal accumulation of mucin causing distention of the vermiform appendix Causes - mucus retention cyst - mucosal hyperplasia - mucinous cystadenoma of the appendix - mucinous adenocarcinoma of the appendix

Answer 85

XR peripheral calcs US onion sign (layering) can have some shadowing CT low attenuation at caecum mural calcs nodular - cancer gas - infection MR T1 variable T2 yperintense

Answer 86

rare mucinous tumours of the appendix showing low cytoligc atypia. Distinguished from HAMN on histo grounds. Suspcious features of HAMN - soft tissue thickening - wall irregularity - PMP

Answer 87

Intersphinteric - does not cross external Transpincteric - from intersphincteric space through external into ischiorectal fossa Suprasphincteric - superiorly into intersphincteric space, over puborectalis and through iliococcygeus into ischiorectal fossa Extrasphincteric - perineal skin through ischiorectal fossa and levator ani muscle complex into rectum

Answer 88

second most common splenic lesion after cyst. slow flow venous malformation. similar imaging to hepatic haemangioma.

Answer 89

rare benign tumours corresponding to abnormal dilation of lymphatic channels. can be congenital or acquired. present as lobulated or multiloculated cystic lesions. can have curvilinear mural calcifications

Answer 90

variable US CT heterogenous enhancemnt iso or hypodense MR T1 iso T2 heterogenously hjyper C+ vivid immediately post con (unlike haemangioma), delayed uniform with central hypovascular

Answer 91

US hypoechoic CT homgenous, hypodense or isodense enhancing rim and radiating enhancing tissue (spoke wheel) MR T1 heterogenous low to intermediate T2 low C+ peripheral and septal enhancement spoke wheel. non enhancing stellate scar.

Answer 92

hepatosplenomebgaly US miliary nodules or larger masses CT miltple low attenuaiting eventually calcify can have large lesion with target sign DDX Micronodular - lymphoma - fungal - mets - sarcoid Macro - abscess - mets - primary

Answer 93

gamna gandy bodies microhaemorrhage with haemosidering dep usually seen in PH but also haematolgoical conditions US multiple echoic with shadowing CT look like granuloms MR siderotic foci punctate througout

Answer 94

migration of the spleen abnormality of its suspendosry ligaments can infarct aetiology - sickle cell - heterotaxy - trauma - mono

Answer 95

Cigs Chronic pancr Diet Obesity/DM Family hx Hereditary syndromes - BRCA2 - HNPCC - FAMMM - peutz jehger

Answer 96

Fluoro - inverted three sign - wide sweep US - double duct - mass CT - poorly defined - surrounding desmo reaction - enhance poorly - double duct MR T1 hypo T1FS hypo C+ delayed T2 variable MRCP DD

Answer 97

T1 <2cm T2 2-4cm T3 >4cm T4 encasing SMA/Coeliac aa N0 none N1 1-3 regional N2 4 or more regional M0 M1

Answer 98

polycystic honeycomb macrocystic (<10%) Associated with VHL

Answer 99

Location - distributed throughout CT multicystic lobulated bunch of grapes >6 cysts <2cm in size enhancing central scar stellate central calcification MR T1 low T2 low fibrous scar, high signal cysts C+ fibrous septa enhance No communication with duct

Answer 100

IPMN - communicates Pseudocyst Mucinous - peripheral calcs, bigger cysts, usually unilocular SPPN

Answer 101

Mostly body/tail, can be head CT - rounded contour - peripheral calcs - heterogenous attenuation - internal septa - can be uni or multilocular

Answer 102

Numerous large cysts Smooth contour Thicker walls Amorphous calcs, septations, solid excrescences can be seen No central scar MR Mucin high T1 Cysts high T2 Calcs low

Answer 103

Main duct - Dorsal duct proximal to dorsal ventral fusion - drains at the ampulla of vater - connects with the accessory pancreatic duct Duct of Wirsung - distal main duct - segment of ventral duct between fusion and major papilla - continuous with the main duct proximally Accessory duct of Santorini - Portion of dorsal duct distal to dorsal ventral fusion - Drains anterior superior head - Can drain to minor papilla - Can persist as a branch of the main duct

Answer 104

Failure of dorsal/ventral fusion Dorsal duct drains most of pancreas via the minor papilla Can result in a santorinicoele Types - Classic; no connection - Absent; no Wirsung, major papilla only drains CBD - Functional; filamentous connection

Answer 105

Main pancreatic duct that drains into major papilla after performing a reverse Z type or Loop turn in the pancreatic head

Answer 106

Communication between the duct of wirsung and duct of santorini Arises as a brnach duct from the main, descends down, loops upward and terminates at the minor papilla

Answer 107

abnormal junction of the pancreatic duct and CBD outside the duodenum to form a long common channel >15mm Can have associated biliary dilatation, or - choledochal cyst - stricture - pancreatic anomalies - synchronous biliary cancer

Answer 108

a morphological anomaly that results in pancreatic tissue completely or incompletely encircling the duodenum. can cause duodenal obstruction. develops due to failure of the ventral bud to rotate with the duodenum causing encasement

Answer 109

Unilocular - pseudocyst - simple cyst Diffuse - VHL - CF - ADPKD Macro multi - hydatid Cystic/solid - WON

Answer 110

epithelial pancreatic cystic tumours of mucin producing cells that arise from pancreatic ducts

Answer 111

Main - segemental or diffuse - higher malig potential - look like chronic pancr Branch - head and uncinate - localised and mass like - can be multifocal - macro or microcystic - typically indolent Mixed

Answer 112

Communicate with a duct CT single or multiple cystic lesions dilatation of the main duct do not calcify MR Main - Main duct >5mm - segment or diffuse dilation - mucin signal - thin parenchyma - solid mural nodules concerning - mucin dependantly in the duct Branch - single or multiple side branches with dilation - cystic mass like appearance - bunch of grapes

Answer 113

Main - duct 5-9mm worrisome - >10mm high risk - enhancing components Branch - main duct >5mm - cyst >3cm - >5mm enhancing nodule - solid mass - thickened/enhancing cyst wall - growth rate >5mm/year Nodes Abrupt change in calibre with distal atrophy Elevated CA19 9

Answer 114

a rare and usually benign pancreatic cystic neoplasm most commonly seen in young females

Answer 115

Pancreatic tail CT encapsulated lesion solid/cystic cystic usually more central Calcifications and enhancing solid components MR T1 low T2 heterogeneous to high C_ heterogenous and slowly progressive

Answer 116

CT enhancing oval solid often NO biliary duct dilatation can have calcifications can invade adjacent organs

Answer 117

rare paediatric tumours of the pancreas. around 4yo. assoc with beckwith wiedemann syndrome

Answer 118

CT well defined heterogenous solid/multilocular cystic components enhancing septa fine calcifications MR T1 low T2 hetero high

Answer 119

MR T1 low to muscle T2 high to muscle T1 <2cm T2 2-5cm T3 >5cm T4 invasion of adjacent organ N1a inguina, mesorectal, internal iliac N1b external iliac N1c N1a + N1b M0 M1

Answer 120

US hepatosplenomegaly starry sky GB thickening periportal oedema decreased echotexture CT hepatomegaly periportal oedema decreased attenuation on NC lymphadenopathy MR T1 periportal oedema C+ delayed periportal enhancement IP/OP steatosis

Answer 121

extrinsic compression of the extrahepatic biliary duct from calculi in the cystic duct or gallbladder. may have an associated cholecystodochal or cholecystoenteric fistula

Answer 122

gangrenous perforation emphysematous abscess fistula vascular

Answer 123

cholecystitis without stones or where stones arent contributory. typically critically unwell patients or injured patients.

Answer 124

NM/HIDA delayed visualisation bw 1-4 hours ?EF after cholecystokinin

Answer 125

a rare form of cholecystis with wall necrosis causing gas formation in the lumen/wall. surgical emergency. usually older and diabetic patients

Answer 126

US Ring down Champagne sign CT Gas

Answer 127

an uncommon inflammatory cause, characterised by multiple intramural nodules. rupture of rokitansky aschoff sunses

Answer 128

US thickening intramural hypoechoic nodules or bands stones infiltration of liver CT small intramural hypoattenuating nodules poor enhancement local infiltration

Answer 129

an uncommon inflammatory condition affecting the biliary tree resulting in multiple strictures and cirrhosis unlike PBC, ab titers are low

Answer 130

IBD, especially UC Autoimmune hepatitis Sjogrens Retroperitoneal fibrosis Mediastinal fibrosis Riedels thyroiditis Orbital pseudotumour

Answer 131

General: multiple strictures entire tree cirrhosis, with left lobe atrophy caudate hypertrophy US cirrhosis irregular ducts bright portal triads ?GB ca CT atrophy involving left caudate hypertrophy bile duct dilatations/strictures MRCP/ERCP multiple short segment structures beading intervening biliary diverticula mural irregs

Answer 132

hepatic osteodystrophy cholangiocarcinoma CRC HCC GB ca

Answer 133

Cirrhosis - left lobe usually hypertrophied - caudate not as large IgG4 related SC - older - more systems - elevated igg4 Secondary sclerosing - aids - other strictures Cholangiocarcinoma PBC - younger women - high ab titres Alagille syndrome Hepatic sarcoid

Answer 134

Chronic obstruction/recurrent cholangitis Ischaemic cholangiopathy Infectious, especially aids

Answer 135

E coli typically obstructive - choledocholithiasis - malig - sclerosing cholangitis - biliary procedures Imaging - duct dilation - bile duct wall thickenning - stones

Answer 136

commonly found in SE asia patients characterised by bile duct strictures and dilatation with intraductal pigmented stone formation

Answer 137

dilatation and multilevel strictures intraductal pigmented calculi regions of segmental atrophy CT hyperdense stones focal fibrosis, heterogenous enhancement and focal steatosis MR reduced arborisation of peripheral ducts (arrowhead) multiple strictures

Answer 138

also known as autoimmune and is part of the igG4 spectrum. can also occur in isolation

Answer 139

common endpoint of chronic liver diseases which cause hepatocellular necrosis Causes: - alcohol - viral - NASH - biliary disease (PBC, PSC) - metabolic (haemochromatosis, wilsons, alpha 1) - autoimmune - vascular (congenstive, budd chiari) - CF

Answer 140

General - caudate/left lobe hypertrophy US - surface nodules - coarse/heterogenous - segmental hypertrophy/atrophy - enlarged PV - slow/reversed PV flow - cavernous malformation - recanalisation - collaterals - portal hepatic vein waveform - splenomegaly - ascites - fatty change CT - surface and parenchymal nodularity - fatty change - parecnhymal heterogeneity - PV supply to dysplastic nodules - lobar hypertrophy/atrophy - signs of portal hypertension MR Regen nodules - T1 iso or hyper - T2 iso - no early enhancement/washout Siderotic - T2 hypo Dysplastic - can look like regen of hcc HCC - arterial enhancement and washout - late enhancing capsule - T2 hyper

Answer 141

Pseudocirrhosis Miliary liver mets Budd chiari Hepatic failure Sarcoid PBC Chronic portal vein thrombosis Nodular regnerative hyperplasia

Answer 142

hepatic encephalopathy alcohol - osmotic demyelination - wernickes - marchaifava bignami Wilsons (siderosis) Haemochromatosis (hypopituitarism and parkinsons)

Answer 143

varices haematomas infective complications osteodystrophy avn sarcopenia

Answer 144

Hepatopulm syndrome - dilation of pulm vasculature Portopulmonary hypertension (PAH) hepatic hydrothorax ARDS

Answer 145

chronic progressive cholestatic liver disease. destruction of small intrahepatic bile ducts, portal inflammation and progressive scarring. AMA high. causes cirrhosis

Answer 146

cholelithisis autoimmune diseases interstitial lung disease pulmonary hypertension hcc

Answer 147

MR T2 - parenchymal lace like fibrosis and periportal halo sign periportal halo sign; low signal intensity around portal venous branches Other - periportal hyperintensity - segmental hypertrophy of the caudate - hepatic surface irregularity

Answer 148

Reduced flow - cirrhosis - malignancy Hypercoagulability - inherited conditions - malignancy - myeloproliferative disorders - IBD - dehydration - OCP - pregnancy - trauma Endothelial disturbance - local inflammation

Answer 149

US - filling defect - internal flow in tumour thrombus CT - dilling defect - enhancement of the wall (dilated vasa vasorum) - THAD - enhancement; tumour - cavernous transformation in chronic - bowel ischaemia acute - portal hypertension MR T1 - acute high signal T2 - acute high signal - chronic low signal C+ - may enhance post con in tumour - THID

Answer 150

sequla of portal vein thrombus. replcement of PV with numerous tortuous venous channels

Answer 151

General - dilated vessels - left atrophy - hypertrophy segment 4 and caudate US - numerous vessels occupying the portal vein bed CT - numerous vascular structures - calcs in the thrombus

Answer 152

Grade 1 - subcap haematoma <10% - laceration <1cm Grade 2 - subcap haematoma 10-50% - intra haematoma <10cm - laceration 1-3cm Grade 3 - subcap haematoma >50% - intra haematoma >10cm - laceration >3cm - vascular injury contained to parenchyma Grade 4 - laceration 25-75% lobe or 1-3 segments - vascular injury into peritoneum Grade 5 - laceration >75% - vascular; juxtahepatic venous injurie

Answer 153

VHL ADPCKD

Answer 154

hydatid abscess biloma biliary cystadenoma choledochal cyst mets biliary hamartoma

Answer 155

seen in chronic liver disease. cystic formation around the biliary ducts, typically hilar. dont communicate with the biliary tree.

Answer 156

benign vascular liver lesions. congenital, non neoplastic and typically cavernous subtype.

Answer 157

extra hepatic haemangiomata hereditary haemorrhagic telangiectasisa kasabach merritt syndrome hepatic arterioportal shunt

Answer 158

US - well defined - hyperechoic - peripheral feeders CT - discontinous nodular peripheral enhancement - progressive centripedal fill in - bright dot sign MR T1 hypo T2 hyper Gad peripheral nodular discontinuous. retain on delayed Prim variable on delayed DWI high, with high or mixed ADC

Answer 159

CT heterogenous, central low attenuation typical enhancement but less consistent may never totally fill in MR T1 - hypo - clefts of low T2 - clefts high C+ - hypo clefts - otherwise similar

Answer 160

variants of haemangiomas which contain extensive fibrous tissue and thrombosed vascular channels giving an unusual imaging appearance that cant be differentiated from malignancy

Answer 161

MR T1 - hypo T2 - variable, typically lower than a regular C+ - absent or mild arterial - slight peripheral late - usually a thin peripheral rim Can have some retraction and THID

Answer 162

atypical haemangiomas, benign, with imaging features that can be suspcious for malignancy

Answer 163

Small US hyper CT intense homogenous arterial enhancement isodense on delayed can have phleboliths MR T1 hypo T2 hyper C+ enhancement no washout ddx - hcc - hypervascular met - fnh

Answer 164

a regenerative mass of the liver, second most common benign liver lesion. thought due to hyperplastic growth of normal hepatocytes with malformed biliary drainage

Answer 165

Hepatic haemangioma HHT AVM Hepatic adenoma PV atresia Budd chiari Portal hypertension

Answer 166

Typical and atypical Typical - poorly encapsulated - central scar with radiating fibrous septa - large central artery - absent portal veins Atypical - lacks a central scar and central artery - pseudocapsule - lesion heterogeneity - non enhnacing central scar - intralesional fat

Answer 167

US - variable CT - bright homogenous arterial - non enhancing central scar - hypo to iso attenuaitng on portal venous - no fat, calc, haemorrhage - delayed scar enhancement 80% MR T1 - iso to hypo - hypo scar T2 - iso to hyper - hyperintense scar Gad - intense arterial enhancement - iso on portal venous - central scar enhancement on delayed Prim - early arterial enhancement - enhancement persists on delayed - fades on delayed - central scar does not enhance on hepatobiliary

Answer 168

Sulfar colloid - taken up by kuppfer cells of reticuloendothelial system - photopaenic 30% HIDA - should be taken up in about 90%

Answer 169

Adenoma - more heterogenous on portal and delayed - no gad retention on delayed - assoc wth fat/calc/haemorrhage - inflammatory type looks similar on Prim - no scar HCC - cirrhosis - washout - capsule Fibrolamellar - more distinct on T1/T2 - larger - calcification, necrosis - mets, local invasion - decreased activity on HIDA/sulphur Hypervascular mets - multiple - washout on PV/Delayed - older Haemangioma - peripheral discontinuous - flash filling can look similar Cholangio - hypo in art/venous with delayed enhancement - dominant large central scar - capsular retraction

Answer 170

two or more FNH's with - haemangioma or - vascular malformation or - intracranial tumour Assoc - meningiomas - astrocytoms - liver haemangiomata - phaes, gist - klipper trenauanay weber

Answer 171

benign hormone induced liver tumours. typically solitary, predilection from haemorrhage

Answer 172

OCP Anabolic steroids Glycogen storage disease Obesity Metabolic syndrome Diabetes mellitus

Answer 173

Usually solitary and large Typically subcapsular and commonly right lobe Can have dystrophic calcs Classification 1. inflammatory - most common - highest bleed rate 2. HNF1 alpha mutated - women, OCP - often multiple 3. Beta catenin mutated - men on steroids - glycogen storage diosrders of FAP 4. unclassified

Answer 174

US variable echogenicity hypoechoic halo seen CT variable depending on fat and hamorrhage well marginated iso to liver transient relatively homogenous arterial iso dense on PV and delayed calcs can be seen from old haemorrhage MR T1 - variable T2 - mildly hyper IP/OP - signal drop due to fat Gad - early arterial enhancement - iso on delayed Prim - usually hypointense on hepatobiliary phase due to redcued uptake NM photopaenic on sulphur colloid 75% increased on HIDA cold on gallium

Answer 175

HCC - washout - rim enhancement persists on delayed FLHCCC - central scar - calcs more common FNH - t2 bright scar with late enhancement - retains primovist Mets - hypo on T1, moderately hyper t2 - fat and haemorrhage less common Haemangioma

Answer 176

loads (>10) of hepatic adenomas.

Answer 177

most common OCP metabolic syndrome highest rate of haemorrhage MR Prim - enhancement on hepatobiliary agent, due to OATP receptors - similar to FNH IP/OOP - no signal drop T2 hyper atoll sign

Answer 178

second most common only women on OCP multiple 50% MR Gad - Moderate arterial, less than inflammatory - less likely to have persistent PV/delayed enhancement T2 iso to mildly hyper IP/OP signal drop

Answer 179

adenoma. men. male hormon. glycogen storage. FAP. imaging overlaps with the others

Answer 180

viral hepatitis alcohol biliary cholangitis congenital biliary atresia errors of metabolism - haemochromatosis - alpha 1 antitrypsin - type 1 glyco stroage - wilsons obesity and DM

Answer 181

Massive/focal - large mass - necrosis, fat, calcs Nodular - multifocal - central necrosis Infiltrative - diffuse - can be hard to distinguish from cirrhosis supply from hepatic artery - early enhancement and washout can have a central scar rim enhancement on delayed post con causing a capsule appearance propensity to invade vascular structures

Answer 182

vivid arterial washous out rapidly can have assocaited wedge shaped perfusion abnormality due to arterioportal shunts focal fatty sparing halo portal vein thrombus

Answer 183

T1 - variable - iso to hypo - hyper from fat or decreased background T2 - variable Gad - arterial enhancement - washout - persistent rim enhancement Prim - arterial with PV washout DWI - high

Answer 184

hypervascular mets - less common in cirrhotics - less vascular invasion FNH - no vascular invasion - non enhnacing halo - central scar - prim persists on delayed - sulphur colloid 80% positive Cholangio - peripehral - bilairy obstruction - delayed enhancement THADS Lymphoma TB

Answer 185

Major - non rim arterial hyperenhancement - non peripheral washout - enhancing capsule/pseudocapsule - threshold growth >50% <6months, >100% >6 months, new >1cm <24months Ancillary Favouring malignancy not HCC in particular: - US visibility - subthreshold growth - corona enhancement - fat sparing in a solid mass - restriction - mild to moderate T2 hyper - iron sparing in a solid mass - transitional phase hypo - hepatobilairy phase hypo Favouring HCC in particular - non enhancing capsule - nodule in nodule - mosaic architecture - fat in mass - blood in mass Favouring benign - stable size >2years - size reduction - marked T2 hyper homogenous - undistorted vessels - parallels blood pool - hepatobiliary isointensity

Answer 186

Benign - focal fat - adenoma - fnh (rare) - angiomyolipoma - teratoma - adrenal rest tumour - glisson capsule pseudolpoma Malignant - HCC - met liposarc - primary liposarc - other fat containing liver mets

Answer 187

a histoligcal variant of HCC with laminated fibrous layers between the tumour cells. typically younger adults, no cirrhosis/hepatitis

Answer 188

US variable CT Single, large Fibrous central scar Arterial enhancement Central scar persistent enhancement Can have calc MR Scar hypo on all sequences Scar can occassionally be T2 bright T1 iso to hypo T2 hypo to hyper Gad - arterial heterogenous - PV/delayed; iso to hypo, delayed scar enhancement Prim - uptake not reported Sulphur colloid - wont take up tracer

Answer 189

Uses performance status, Child Pugh score and radiologic extent Stage 0 - PS 0 - CP A - Solitary <2cm Stage A - PS 0-2 - CP A-C - Solitary >2cm or - Multiple <3cm Stage B - PS 0 - CP A-C - Multifocal >3 lesions or - Multifocal with one >3cm Stage C - PS 1-2 - CP A-C - Vascular invasion and/or nodal and/or mets Stage D - PS >2 - CP C - No radiology

Answer 190

malignant epithelial tumour arising from the biliary tree excluding GB or AoV

Answer 191

Carolis Choledocholithiasis PSC Oriental cholangitis Cirrhosis Toxins Hepatitis, HIV IBD Fibropolycystic liver disease

Answer 192

Intrahepatic Extrahepatic - perihilar (incl Klatskin) - distal (to cystic insertion) Macroscopic appearance - Mass forming - Periductal infiltrating - Intraductal growth Mass forming - intrahepatic - peripheral - central fibrosis Periductal infiltrating - most common at hilum - combo with mass forming seen - longitudinal growth along wall Intraductal - papilla or tumour thrombus endophytic - alterations in calibre - can be mural/polypoid - mucin prodn

Answer 193

US - homogenous - intermediate echos - peripheral hypoechoic halo - capsular retraction CT - homogenously low on NC - heterogenous minor peripheral enhancement - gradual centripedal fill in - capsular retraction - distal duct dilation - vascular compression wo invasion MR Similar to CT DWI Target sign Prim - can reflect differention - hypo; poor - rim; intermediate - diffuse; well diff

Answer 194

US - altered bile ducts without a clear mass CT - regions of duct wall thickening or of the periductal parenchyma with altered calibre of the involved duct - common at the hilum - longer than benign strictures - contrast enhancement - proximal/peripheral dilation

Answer 195

US - alterations in calibre - can have a polypoid intraluminal mass CT - alterations in calibre - enhancing polypoid mass

Answer 196

Mass forming - mets - HCC - other primary liver tumours - abscess Periductal - benign stricture Intraductal cholangiocarcinoma - intraductal HCC invasion - hepatolithiasis - biliary cystadenoma or cystadnocarcinoma - benign stricture

Answer 197

for perihilar cholangiocarcinomas based on extent of ductal infiltration type 1 - CHD below confluence type 2 - involves confluence type 3a - 2 with right duct origin involvement type 3b - 2 with left duct origin involvement type 4 - 3a + 3b type 5 - CBD/cystic junction

Answer 198

T1 a; <5cm no vascular b; >5cm no vascular T2 - solitary with intrahepatic vascula - multiple +/- vascular T3 - visceral peritoneum T4 - local extrahepatic structure invasion

Answer 199

T1 confined to duct T2 a; beyond duct into fat b; beyond duct into liver T3 branches of portal vein or hepatic artery invovlement T4 invades PV or bilateral branches or unilateral second order radicals with contralateral PV/HA invovlement

Answer 200

T1 wall invasion <5mm T2 wall invasion 5-12mm T3 wall invasion >12mm T4 involves coeliac, SM or CH artery

Answer 201

congenital hepatic fibrosis ADPCKD biliary hamartomas carolis disease choledochal cysts

Answer 202

also known as von meyenberg complexes. multiple benign biliary hamartomas. assocaited with dom/recess polycystic kidney and liver disease.

Answer 203

US variable echogenic when small hypoechoic when larger ct no enhancement 5-30mm predilection for subcapsular liver MR T1 hypo T2 hyper C+ non enhancing

Answer 204

a congenital disorder of multifocal cystic dilation of the segmental intrahepatic ducts also a type 5 todani choledochal cyst associated with hepatic fibrosis, medullary sponge kidneyy, polycystic kidney disease

Answer 205

US may show dilated ducts intraductal bridging septa dilated ducts surrounding portal vein branch calculi CT multiple hypodense rounded foci inseparable from dilated intrahepatic ducts central enhancing dot represent portal vein radicles MR T1 hypo T2 hyper C+ central portal radicle enhancment MRCP continuity with ducts

Answer 206

Type 1 A: entire extrahepatic duct B: focal extrahepatic duct C: CBD portion extrahepatic duct Type 2 True diverticulum Type 3 Within duodenal wall, choledochocoele Type 4 A: Intra and extra hepatic ducts B: Multiple of the extra hepatic ducts Type 5 Multiple intrahepatic ducts Type 6 Cystic duct

Answer 207

Congenital cystic dilatations of the biliary tree Assoc - biliary atresia - hepatic fibrosis (5) - Anomalous pancreaticobiliary ductal junction Complications - Stones - Cholangiocarcinoma - Perforation

Answer 208

XR curvilinear/ring calc overlying the liver US sepated with daugther cysts and echogenic material souble echogenic shadow CT cyst peripheral calcs Septa and daughter cysts watter lilly sign, detached endocyst variable attenuation MR T1 mixed low T2 mixed high C+ walls and septa enhance

Answer 209

hepatic abscess

Answer 210

a condition arising from obstruction of heaptic venules sloughing of endothelial vells empbolise venules cause fibrosis assoc with BMT, chemo, jamaican bush tea

Answer 211

US hepatomegaly portal vein dilation/pulsatility hepatofugal flow elevated HA RI GB wall thicekning ascites CT hepatomegaly nutmeg liver portal vein dilation ascites

Answer 212

occurs with partial or complete hepatic vein obstruction

Answer 213

Idiopathic Congenital - web - interrupted diaphragm Venous thrombosis Injury/inflammation - BMT/Chemo - autoimmune disease - behcets - tumour invasion - IVC leiomyosarcoma

Answer 214

US hepatosplenomegaly heterogenous echotexture hypertrophy caudate regen nodules GB wall thickening ascites Dopler lack of flow reversed flow collaterals thrombus HP RI increase CT early enhancement of the caudate and central liver delayed peripheral enhancement (flip flop) nutmeg liver hepatic vein non idendification caudate enlargement

Answer 215

focal, segmental or diffuse US comet tail mural thickening CT rosary sign thickening MR thickening pearl necklace sign

Answer 216

Benign - cholesterol - inflammatory Neoplastic - papilary neoplasms - pyloric gland adenomas Malignant - adenocarcinoma ++ - mets, scc, angiosarc

Answer 217

>10mm Sessile morphology Solitary Growth Hyperenhancement

Answer 218

a type of gb cancer, referring to primary epthelial malignancies. vast majority are adeno, can be squamous. risk factors - chronic cholecystitis - stones - fap - IBD - polyps - porcelin gb - PSC

Answer 219

Beckwith wiedemann syndrome Hemihypertrophy FAP FAS Prematurity Gardner Glycogen storage disease Biliary atresia

Answer 220

XR Right upper quadrant mass calcs CT heterogenous hypoattenuating necrosis and haemorrhage chunky dense calcs MR T1 hypo C+ hjetero T2 heterogenously hyper

Answer 221

an uncommon benign hepatic lesion, children <2 admixture of ductal structures within loose stroma typically low afp

Answer 222

disorganised solid cystic lesion with septations XR non calc mass CT heterogenous swiss cheese solid/septal enhancement MR cystic unifocal

Answer 223

liver lesiosn with large endothelial lined vascular channels can present with CCF, hydrops, kasabach merrit 3% have high afp asspc with other haemangiomas

Answer 224

XR hepatomegaly 15% calcs US variable vascular channels CT peripheral enahncement with fill in mid aortic calibre change coeliac and hepatic artery large MR T1 hypo T2 hyper flow voids similar enhancement to CT

Answer 225

a rare aggressive malignant liver tumour. paeds 6-10. afp not elevated

Answer 226

right lobe under 15yo necrotic/cystic normal afp XR non calc large US variable CT hypodense solid elements multiople hyperdense septa heterogenous enhancement rim enhancing pseudocapsule MR T1 hypo T2 hyper C+ hetero areas of haemorrhage pseudocapsule

Answer 227

normal - perihepatic haematoma - right sided effusion - minimal ascites - periportal oedema Complications - rejection - arterial thrombus - hepatic abscess - biliary ischaemia/stricture - pseudoaneurysm - venous thrombus - bile leak/obstruction - PTLD - biliary cast syndrome

Answer 228

suitability for liver transplant in cirrhosis and HCC single tumour <5cm or up to 3 tumours <3cm no extra hepatic no major vessel involvemnt

Answer 229

a transjugular intrahepatyic portosystemic shunt, a treatement for protal hypertension in which direct communication is formed between a hepatic vein and a branch of the portal vein to allow flow to bypass the liver

Answer 230

a secondary opportunistic cholangitis that occurs in aids patients from immunosuppression. can look like PSC

Answer 231

chronic result of egg deposition into small portal venules leading to periportal fibrosis and cirrhosis US Common - irregular contour - mosaic pattern - septal fibrosis - spleomegaly/GG bodies S Japonicum - septa and capsular calc S Mansoni portal vein wall thickening, Bulls eye appearance CT common - irregular contour - splenomegaly and GG bodies S Japonicum - turtle back sign - capsular calcification - periportal fat deep into liver S Mansoni - low attenuation surrounding portal vein branches assocaited with marked contrast enhancement

Answer 232

clinical diagnosis of portal hypertension without cirrhosis, vascular obstruction, schisto, metabolic or other chronic liver disease

Answer 233

a histopath entity chracterised by transformation of normal hepatic parenchyma into small nodules of hyperplastic hepatocytes without intervening fibrosis. falls in the spectrum of porto-sinusoidal vascular disease, one of the morphological lesions seen with idiopathic non cirrhotic portal hypertension

Answer 234

a rare benign vascular condition characterised by dilatation of sinusoidal blood filled spaces in the liver. can also happen in spleen and bone marrow. Appearance is variable, with multiple lesions and variable enhancement pattern. Can be globular centrifugal, centripedal. usually continuous unlike haemangioma.

Answer 235

a pregnancy related condition with haemolysis, elevated liver enzymes and low platelets imaging - hepatomegaly - haemorrhage - hepatic infarct

Answer 236

Depends on severity - fatty change - hepatitis - cirrhosis - hepatic necrosis CT - hepatic attenuation can be increased - cirrhosis with multiple nodular lesions and perihepatic fat layer and normal caudate MR - NOT ferromagnetic - cirrhotic change

Answer 237

rare. third most common liver primary. variable appearance on CT and MR. heterogenous with haemorrhage typically.

Answer 238

a rare benign hepatic lesion. associated with oriental cholangitis. Variable and heterogenous on imaging.

Answer 239

an uncommon benign lesion of the liver. Assocaited with renal AML and TS. well circumscribed, macroscopic fat US hyper "discontinuous diaphragm" from artefact CT homogenous fat MR T1/2 high with suppression marginal india ink

Answer 240

an uncommon benign hamartomatous hepatic lesion. bloo, muscle and fat components. associated with TS.

Answer 241

fat and prominent vasculairty CT heterogenous with macro fat arterial enhancement hypo on PV MR T1 hyper T2 hyper Suppression in/out of phase for smaller fat vascular part hyper enhancement

Answer 242

rare low to intermediate grade neoplasm multiple solid tumour nodulars, coalesce CT multiple nodules with congolmerate confluent perigion peripheral or subcapsular distribution halo or target enhancement of larger can have capsular retraction vessels terminate at edge "lollipop sign" MR T1 hypo T2 heterogenous increased C+ peripheral halo or target type enhacnement

Answer 243

congenital absence of one or both kidneys. if bilateral Potter syndrome. failure of meta nephros indevelopment

Answer 244

trisomies turners mullerian anomalies CHD skeletal anormalies potter sequence vacterl

Answer 245

absent kidney and renal artery contralteral hypertrophy lying down adrenal

Answer 246

the most common renal fusion anomaly. typically between lower poles but can be lower and upper (sigmoid). isthmus gets caught on the IMA

Answer 247

where the kidneys are fused and located on the same side

Answer 248

types - inferior - sigmois - lump - disc - L shaped - superior imaging - anteiror or posterior notch

Answer 249

Congenital - idiopathic - abnromal muscle arrangement - collagen collar - extrinsic compression - crossing vessel Adult - trauma - calculus - scarring - malignancy - extrsinc compression

Answer 250

US dilated pelvis with collapsed ureter CT same MAG3 - with diuretic - high extraction rate - evaluation between obstructive and non obstructive - non obstructive; excretion, downsloping - obstructive; no excretion, no downsloping DTPA - predominantly glomerular filtration

Answer 251

congenital megacaliectasis - central renal pelvis relatively collapsed extrarenal pelvis - no calyceal distention parapelvic cyst

Answer 252

a non heritable paediatric cystic renal disease. multiple cysts formed in utero. bilateral is fatal can be pelvi infundibular (multiple small cysts) or hydroneprhotic obstructive (domiannt cyst in pelvis)

Answer 253

VUR PUJO ureteral ectopia VUJO urterocoele Meckel gruber Zellweger syndrome Joubert syndrome related disorders

Answer 254

encephalocoele/holoprosencephaly cystic kdineys postaxial polydactyl

Answer 255

multiple cysts or varying sizes parenchyma fibrous/echogenic

Answer 256

acute kidney injury with renal tubular damange. deposition of depbris in the tubules results in oliguria. On imaging, there is perfusion without excretion NM in transplant assessment to differentiate from renal cortical necrosis. can cause persistent or striated neprhogram on CT.

Answer 257

hypovolaemia/ischaemia - dehydration - blood loss - septic shock drugs - amphtericin - contrast - cisplatin and other chemo - immunosuppressants - antivirals

Answer 258

Hypotension Bilateral intrarenal obstruction - ATN - acute urate uropathy Vascular - renal artery stenosis - renal vein thrombosis Other - myeloma kidney - contrast nephropathy

Answer 259

contrast stuck in oedematous or necrosed tubules Unillateral - ureteric obstruction - acute pyelo - renal vein thrombosis - renal contusion - radiation Bilateral - ARPCKD - acute pyelo - ATN - hypotension

Answer 260

segmental or subsegmental corticomedullary hypoattenuation secondary to multiplem small vessel infracts vasculitis, embolic disease

Answer 261

enhancing cortex, absent medullary seen weeks following global infarction, due to collaterals

Answer 262

absent cortical, normal medullary enhancement indicates acute cortical necrosis

Answer 263

Thin subcapsular cortex enhancement. Differentiates pyelo from renal infarct. Renal artery/vein thrombosis ATN Acute cortical necrosis

Answer 264

a result of severe systemic illness and can cause permanent impairment severe shock microangiopathic haemolysis (HUS) renal transplant

Answer 265

CT non enhancing cortex and enhancing medulla (reverse rim) may have cortical rim sign eventually cortical nephrocalcinosis MR low T1/T2 affective inner cortex

Answer 266

haemolysis infection vascular disease - vein - cortical necrosis - arterial - rejection of t/p

Answer 267

ischaemic necrosis of the renal papillae and medullary pyramids. sloughing off of papillary tissue. NSAID Non steroidals Sickle cell Acetaminophen (paracetamol) and phencetin Infection Diabetes or dehydration

Answer 268

filling defects in the collecting system - ball on tee - lobster claw sign - signet ring

Answer 269

Grade 1 - subcap haematoma or contusion Grade 2 - Superficial laceration <1cm, no collecting - perirenal haematoma confined to fascia Grade 3 - lac >1cm, no collecting system - vascular injury/bleeding, confined to fascia Grade 4 - lacerating involving collecting system - lacteration of the renal pelvis - vascular injury to segmental artery or vein - segmental infarcts without assoc bleeding - active bleeding beyond perirenal fascia Grade 5 - shattered - avulsion or renal hilum, lac main renal artery or vein - devascularised with active bleeding

Answer 270

dehydration malformations UTIs cystinuria hypercalcuria - pth - sodium - hyper vit d - cushing - sarcoid - milk alkali hyperoxaluria - low absorption/intake calc hypocitraturia - rta, diarrhea hyperuricosuria - gout - myeloprolif - idioapthic

Answer 271

Calcium oxalate Struvite Calcium phophate Uric acid Cystine Lithogenic medications

Answer 272

Opaque - calcium - struvite - cystine Lucent - uric acid - medication US lower sens echogenic acoustic shadowing twinkle artifact colour comet tail artefact slower jets elevated RI CT opaque/non opaque. opaque can varyy in density 99% opaque dual energy to chekc comp

Answer 273

Surgical indications - larger - long duration sx - proximal location - trucks/pilots - infection - solitary kidney Intervention types - retrograde stent and laser - PCN with antegrade stent and laser - ESWL for larger PCNL for large near junction like staghorn Calcium - ESWL - perc nephrostomy Struvite - need to be surgical, residual can harbour infection Uric acid - elevation of ph Cystine - alkalisation

Answer 274

HAM HOP Hyper pth Acidosis, renal tubular Medullary sponge Hypercalcaemia Oxalosis Papillary necrosis

Answer 275

COAG Cortical necrosis Oxalosis Alport syndrome Glomerulonephritis

Answer 276

a hereditary form of adult polycystic kidney disease. associated with aneurysms, hypertension, biliary hamartomoas, other visceral cysts. PKD 1 and PKD 2 genes, GANAB gene

Answer 277

VHL ARPKD - enlarged kidneys - smaller cysts - present in childhood - CM diff lost Acquired cystic kidney disease - occurs in dialysis Medullary cystic - at medulla cortex junction MCDK - can be unilateral, younger

Answer 278

a paediatric cystic renal disease. liver involvement, proportional to age of onset with hepatic firbosis. associated with carolis and biliary hamartomos.

Answer 279

VHL (bilateral, younger, clear cell) TS (younger) Birt Hogg Dube (chromophobe, bilateral) Paraneoplastic syndromes - hypercalcaemia - hypertension - polycythaemia - stauffer (LFT) - limbic encephalitis

Answer 280

Clear cell/conventional - prox convulted tubules - clear cytoplasm - vascular - clear cell multilocular rcc variant Papillary - distal convoluted tubules - can be multifocal and bilateral - type 1; sporadic, good prog - type 2; inhertid, bilateral, multifocal Clear cell papillary Chromophobe - intercalated cells of collecting ducts - similar to oncocytomas Collecting duct Renal medullary - sickle cell Sarcomatoid - advanced, can de diff

Answer 281

CT - soft tissue - necrosis/calcs - enhance, variably - also hypervascular or canonball mets MR T1 heterogenous T2 - clear; hyper - papillary; hypo C+ arterial enhancement Pseudocapsule - lower grade, adenomas or oncocytomas Macroscopic fat in RCC almost always occurs in the presence of ossification/calcification I/OOP loss suggests microscopic fat, common in clear cell carcinomas

Answer 282

CT - exophytic - more enhancing - more heterogenosu MR T1 heterogenous T2 hyperintense I/OP; microscopic fat

Answer 283

a low grade adult renal tumour composed entirely of numerous cysts

Answer 284

Tend to be smaller CT less vascular thna clear cell, hypo compared to normal cortex in CM phase MR pseudocapsule T1 hypo T2 hypo C+ less entence DWI restriction

Answer 285

associated with BHD CT homogenous can be spoke wheel like oncocytoma MR T2 iso to hypo homogenous enhancement uncommon to have necrosis

Answer 286

the most common primary tumour of the urinary tract and can be found along its entire length. associated with horseshoe, calculi, pseudodiverticulosis and ureteritis cystica can be papillary or non papillary.

Answer 287

US hypoechoic CT soft tissue minimally enhancing can be small filling defects or invasive/obliterating can be more infiltrative disotrtion of calyces can have a dappled/stippled appearance

Answer 288

can obstruct when small filling dfect with goblet sign transition can be circumfrentially invasive

Answer 289

most common type, can be superfical or invasive CT focal thickening or masses protruding inward can have calcs

Answer 290

diffuse or multifocal invovlement of the kidneys with nephrogenic rests. foci of metanephric blastema that persist beyond 36 weeks gestation.

Answer 291

US hypoechoic nodules reniform enlargement with thick peripheral rind diffuse decrteased echoes CT low attenuation peripheral nodules with poor enhancement MR T1 low T2 low C+ hypo

Answer 292

loss of plasma proteins in the urine. hypoalbumiaemia, hyperalbuminuria, hyperlipidaemia and oedema. can be congenital or acquired. why am i writing this flashcard fuck everything

Answer 293

AVM - has a vascular nidus. typical congenital and rare. usually osler weber rendu or somethign AVF - no nidus, usually acquired/iatrogenic

Answer 294

narrowing of the renal artery , secondary htn juxtaglomerular apparetus senses low flow as low pressure and secretes renin. vasoconstriction and aldosterone causing retension and htn.

Answer 295

atherosclerosis FMD vasculitides NF1 coarctation dissection segmental arterial mediolysis

Answer 296

PSV > 180 increased renal aortic ratio RAR >3 turbulent dlow pulsus parvus et tardus (slow rising) decreased RI in severe <0.55

Answer 297

a heterogenous group of vascular lesions characterised by idiopathic non inflamm non atherosclerotic angiopathy of small and medium sized arteries causes small stenoses with intervening areas of dilatation :string of beads". most commonly affects the renal arteryes, cervicalencephalic arteries, iliac artereis, coeliac trunk and mesenteric, subclavian and axillary

Answer 298

FMD ddegenerative vasculitidies, incl behcets TS, NF intrinsic collagen def, ED, Marfans trauma

Answer 299

Children - dehydration/sepsis - sickle cell - polycythemia - UVC Adults - nephrotic syndrome - SLE - amyloid - glomerulonephritis - collagen vasc disease - dm - sepsis - tumour thrombus

Answer 300

a sporadic condition where the medullary and papillary portions of the collecting ducts are dysplastic and dilated and in most cases develop medullary nephrocalcinosis assoc with ED, hemihypertrohy and carolis

Answer 301

clusters of pyramidal medullary calcification delayed post con - paintbrush appearance to the renal medullary regions

Answer 302

Medullary calcifications - hyper pth - RTA type 1 - hypervit D - milk alkali syndrome White pyramid sign

Answer 303

paediatric cystic renal disease presents with enlarged echogenic kidneys with multiple small cysts. liver involvement with coarse echoes, biliary tract cysts, portal htn and hepatic fibrosis perinatal type - minimal fibrosis - oligohydram and pulm hypoplasia neonatal infantile juvenile - gross fibrosis

Answer 304

US multilocular cystic mass from kidney septal vasc CT multilocular cystic mass variable septal enhancement no nodular or solid enhancement can have perinephric stranding MR T1 variable T2 hyper C+ septal enhancement DDX multilocular cystic renal neoplasm of low malignant potential

Answer 305

a rare benign renal neoplasm occuring in adult femules distinct from paediatric cystic nephromas which have dicer 1

Answer 306

multilocular cystic encapsulated mass US septal vasc variable echo, usually anechoic CT multilocular cystic mass herniates to pelivs variable septal enhancement no nodular or solid enhancement MR T1 variable T2 hyper Septal enahncemnt

Answer 307

ADPKD Beckwith Wiedemann Laurence Moon Beidl Meckel gruber

Answer 308

Class 1 - being simple - hairline wall <2mm - no septa, calc, solid - water density - no enhancemnt Class 2 - minimally complex - few hairline septa or calcs <1mm - perceived enhancement - high attenuation <3cm - well marginated Class 2F - Minimally complex - multiple hairline thin septa or minimall thickened walls - perceived but no measurable enhancement - calcs, can be thick and nodular - high attenuation lesion totrally intraintranl >3cm no enhancement - follow up in reasonable timeframe Class 3 - indeterminate - thickened irregular, or smooth walls, or septa with enhancement - 55% malignant Class 4 - clearly malignant - 3 + enhancing soft tissue components to but independant of wall/septum

Answer 309

a type of benign renal neoplasm encountered sporadicially as well as TS. PEComa with vascular, muscle and fat elements. Can haemmorhage. Macroscopic fat is cornerstone of imaging but can be fat poor.

Answer 310

benign renal neoplasm. can be sporadic or related to phakomatosis (TS usually, can be in VHL or NF1). considered a perivascular epithelioid cellular differention tumour (PEComa) and are composed of vascular, muscle and fat elements. Can haemorrhage.

Answer 311

US variable can have polyhydramnios CT solid hypoattenuating with variable enhancement heterogeneity is uncommon MR T1 iso to hypo T2 variabnle DWI restricted

Answer 312

Medical - ATN - rejection - infection - pyelonephritis Surgical - renal artery stenosis - renal vein thrombosis - AVF - pseudoaneurysm - urinary obstruction - allograft compartment syndrome - allograft torsion - fluid collections Fluid collections - immediate: haematoma/seroma - 1-2 weeks urinoma - 3-4 weeks: abscess - beyond; lymphocoele

Answer 313

rare benign renal neoplasms, classicly occuring in women 40-50. distinct from paeditriac cystic nephroma.

Answer 314

US multilocular cystic mass from kidney septal vasc CT multilocular cystic mass variable septal enhancement no nodular or solid enhancement can have perinephric stranding MR T1 variable T2 hyper C+ septal enhancement DDX multilocular cystic renal neoplasm of low malignant potential

Answer 315

highly aggressive rare malig of earl childhood similar to ATRT of the brain <2yo

Answer 316

US antenatal - oligo cysts - small, rarely >1cm enlarged kidneys, reniform shape liver - coarse - carolis - portal hypertension MR enlarged kidneys with diffusely increased T2 oligo Complications - potter sequence - systemic hypertension - portal hypertension

Answer 317

ADPKD Beckwith Wiedemann Laurence Moon Beidl Meckel gruber

Answer 318

benign renal tuimours, difficult to tell from malig preop. usually older men. assoc with BHD and TS.

Answer 319

difficult to distinguish from rcc sharp central stellate scar, only 1/3 and can be seen in rcc IVP sharply demarcated large exophystic with nephrogenic enhancement US well circumscribed mass with echo similar to kidney may see scar CT homgenous large, heterogenous calc can be present enhancement non enhancing central scar can have bland renal vein thrombus segmental enhancement inversion MR T1 hypo T2 hyper, central scar C+ homo/hetero DSA spoke wheel

Answer 320

a rare life threatening condition with thrombocytopaenia, microangiopathic haemolytic anaemia and end organ damage. get PRES changes on imaging

Answer 321

US hyper with shadowing TS - numerous CT macroscpic fat (not pathognmonic) 5% fat poor - no ossification favours aml MR FS india ink DSA hypervascular, sunburst venous; onion peel

Answer 322

benign renal tumours typically occuring in utero or infancy. most common neonatal renal tumour. assoc with polyhydram, fetal hypercalc. mesenchymal. can be classic or cellular

Answer 323

XR soft tissuie mass rare to have calcs US well defined with low level homgenous echoes concentric echoic and hypoechoic rings can be more complex can have vasc can be cystic CT can be solid with variable enhancement or heterogenous typically no calcs MR T1 iso to hyper T2 variable DWI retricts in solid can be more variable ddx wilms (older) rhabdoid sarcoma

Answer 324

highly aggressive rare malig of earl childhood similar to ATRT of the brain

Answer 325

XR calculi and bowel displacement CT atrophy lipomatosis renal calculi perinephric abscess ddx lipoma liposarcoma aml xgp

Answer 326

rare disorder with dilatation of the perirenal, parapelvic and intrarenal lymphatics US perirenal collection cysts ascites poor CM diff CT perinephric fluid attenuation 0-10 cystis can have fluid retroperitoneal DDX cystic renal dysplasia ADPKD ARPKD

Answer 327

systmic hypertension secondary to extrinsic compression of the kidney by a subcapsular collection

Answer 328

a multisystem thrombotic microangiopathic disease triad of renal failure, haemolytic anemia and thrombocytopaenia typically follows GI infection with shiga toxin producintg e coli can also be assoc with collagen vascular diseases, malig and medications T2/FLAIR in BG (putamen) and centrum semiovale

Answer 329

a rare life threatening condition with thrombocytopaenia, microangiopathic haemolytic anaemia and end organ damage. get PRES changes on imaging

Answer 330

due to excess glucocorticoids which may be exogenous or endogenous. disease - ACH pituitary adenoma. syndrome- all aetiologies

Answer 331

chronic intravascular haemolytic states - sickle cell - thalassemia Paroxysmal nocturnal haemoglobinuria Mechanical haemolysis from a cardoac valve ddx - cortical nephrocalcinosis

Answer 332

characterised by progressive decline in function from direct injury to renal tubules imaging US - uniform microcysts - punctate echogenic foci CT - microcalcs within microcysts MR - abundance of microcysts in cortex and medulla

Answer 333

Haemorrhage - WFS - trauma - neonatal asphyxia - coagulopathy Infection - tb - histo tumours - mets - neuroblastoma - adrenal myeloliupoma - adrenala denoma - adrenocortical carcinoma - phae other - addison - wolman disease

Answer 334

XR calculi and bowel displacement CT atrophy lipomatosis renal calculi perinephric abscess ddx lipoma liposarcoma aml xgp

Answer 335

haemorrhagfe is most common, thought to be direct compression or increased pressure from IVC compression laceration less common lots of associated injuries. highly mortality in trauma patients

Answer 336

refers to inadequate secretion of corticosteroids. partial or complete destruction of the adrenal cortex (primary/addisons). Secondary is from lack of stimulation. Primary - autoimmune disorders - granulomatous disease TB/sarcoid - neoplastic (mets, lymphoma, leukaemia) - adrenal haemorrhage - systemic fungal infection - adrenoleukodystrophy - congenital adrenal hyperplasia - drugs - bilateral adrenlectomy Secondary - suppression of axis from glucocorticoids - hypothalamic or pit lesiosn ACTH stimulation - cortisol doesnt rise; primary - cortisol rises; secondary

Answer 337

small calibre aorta collapsed IVC IVC halo sign thickened bowel loops - hyper on non con or submucosal oedema - usually jejunal hypoenhancing spleen chock pancreas hypoenhancing liver hyperenhancing adrenals hyperenhanceing kidneys ascites shock thyroid

Answer 338

TRrauma (usually unilateral) Sepsis (esp meningococaemia) - Waterhouse Friderichsen syndrome DIC Anti phosopholipid syndrome Heparin induced thrombocytopaenia steroids/anticoags Tumour neonates - birth trauma, sepsis, hypoxia, DM - wolmans Adrenal vein thrombosis

Answer 339

Cortical carcinoma Phae Adrenal mets - HCC and RCC can contain fat Myelolipoma

Answer 340

steroids rest are endogenous: adrenal adenoma primary pigmented nodular adrenal dysplasia acth secreting tumour - pit adenoma - small cell lung - bronchial carcinoid - small cell thymus - pancreatic neuroendocrine - pahaeo - benign ovarian adrenocorticotropin independant macronodular-adrenocortical hyperplasia AIMAH corticotropin releasing hormone secreting trumour

Answer 341

Haemorrhage - WFS - trauma - neonatal asphyxia - coagulopathy Infection - tb - histo tumours - mets - neuroblastoma - adrenal myeloliupoma - adrenala denoma - adrenocortical carcinoma - phae other - addison - wolman disease

Answer 342

excess aldosterone production occurs secondary to adenomas, hyperplasia or carcinoma when primary due to adenoma - Conn syndrome clinical; diastolic hypertension, met alkalosis, hypokalemia. musuclar weakness, paraesthesia, headache, polyuria and polydipsia primary - low renin secondary - high renin

Answer 343

adrenal adeomas unilateral and small hypodense minimal enhancement can do venous sampling

Answer 344

a rare benign adrenal tumour. fat components. non fx, but assoc with endocrine disorders (cushings, conn, CAH) can rarely be extra adrenal; retroperitoneum, perirenal space and thorax

Answer 345

CT fat components can have calcs MR T1 hyper FS suppression T2 intermediate to high C+ vivid

Answer 346

Typical - small - round low density smooth Atypical - haemorrhage - calc - necrosis - large CT - fat; highly sensitive and specific <0 100sp, <10 98 sp - lipid poor; assess washout. typically washout rapidly. - >120HU on PV, washout should be ignored Washout - >60% absolute - >40% relative MR - chemical shift drop; >16.5% diagnostic - 10-30 HU 100 spc and 89% sn - 10-20 HU CT 100/100

Answer 347

Cortical carcinoma Phae Adrenal mets - HCC and RCC can contain fat Myelolipoma

Answer 348

most common congenital obstructive lesion of the urethra and common cause of obstructive uropathy in infancy result from formation of thick valve like membrane of wolffian duct origin that courses obliquely from the verumontanum to the most distal portion of the prostatic urethra

Answer 349

CT large irregular heterogenous calc 30% venous invasion mets MR high T2 heterogenous hetergenous enahcnement

Answer 350

US bladder distention hydronephrosis oligohydramnios and renal dysplasia (severe) keyhole sign Postnatal US keyhole sign hydronephrosis mild renal dysplasia urethral diameter >6mm VCUG dilation and elongation of the posterior urethra (keyhole) linear radiolucent band VUR 50% bladder trabeculation

Answer 351

tend to be large >3cm US variable CT large, heterogenous necrosis and cystic change enhance avidly can have calcs MR T1 hypo, hetero T2 markedly hyper i/oop no loss C+ heterogenous, prolonged NM octreotide MIBG Dotate PET and DOPA pet

Answer 352

a rare benign adrenal tumour. fat components. non fx, but assoc with endocrine disorders (cushings, conn, CAH)

Answer 353

CT fat components can have calcs MR T1 hyper FS suppression T2 intermediate to high C+ vivid

Answer 354

non malignant growth of the afrenal glands. rare cause of ACTH independant cushings, and conn syndrome. can be congenital or acquired micronodular or macronodular congenital - CAH - primary pgimented nodular macronodular - adrenocorticotropin independant macronodular adrenocortical hyperplasia AAIMAH

Answer 355

Enlarged limbs of one or both adrenals >10mm Normal morphology Nodular or uniform MRI may have drop on on out of phase due to lipid content, like an adenoma

Answer 356

TCC ureteritis cystica vascular indentation multiple stones blood clots Stevens johnsons syndrome

Answer 357

US bladder distention hydronephrosis oligohydramnios and renal dysplasia (severe) keyhole sign Postnatal US keyhole sign hydronephrosis mild renal dysplasia urethral diameter >6mm VCUG dilation and elongation of the posterior urethra (keyhole) linear radiolucent band VUR 50% bladder trabeculation

Answer 358

abnormal flow of urine from bladder to upper tract in young children primary maturation abnormality of the VUJ reslting in a short submucosal tunnel and loss of the normal pinchcock mechanism during micturition assoc - congenital obstructive posterior urthral membrnae - bulbar urethral obstruction (Cobb collar) - ureteral partail obsturction - duplex collecting system

Answer 359

VCUG - confirm refleuxc and grading - ?during filing or micturition - presence or absence of associated abnormalities - length of ureteric tunnel - width of lower ureter NM mag 3

Answer 360

Infection - gonococcal vs non Inflammatory Trauma Iatrogenic - intraumentation - turp Congenital

Answer 361

focal outpouchings of the urethra. occur more commonly in women. broad range of LUTS. can develop stones, infection and malignancy

Answer 362

benign condition of hte ureters representing multiple small submucosal cysts results from chronic irreitation from stones or infection imaging - multiple small smooth walled rounded lucent filling defects projecting into lumen

Answer 363

TCC ureteritis cystica vascular indentation multiple stones blood clots Stevens johnsons syndrome

Answer 364

proliferative disorder with glandular metaplasia of the transitional cells lining the urinary bladder. seen with chronic outlet, infection, calculi. differentiate to goblet cells imaging fluoro - filling defect us - polypoid thickning trigone ct - hypervasc polypoid mass MR T1 low T2 low with central branching hyper which enhances - intact muscle layer

Answer 365

congenital diverticula seen at the VUJ in absence of posterior urethral valves or neurogenic bladder. assoc VUR. micky mouse appearance.

Answer 366

CREST Cystitis Radiation Eosiniophilic cystitis Schistosomiasis TB

Answer 367

focal outpouchings of the urethra. occur more commonly in women. broad range of LUTS. can develop stones, infection and malignancy

Answer 368

dysfunctional urinary bladder due to lack of neurologic coordination Stroke, MS, parkinsons, cauda equina Lapides classification - sensory (posterior column or afferent tracts) - motor (motor neurones) - unihibited neurogenic bladder (incomplete above S2) - reflex neurogenic bladder (complete above S2), pine cone/christmas tree - autonumous neurgenic bladder (conus/cauda lesions)

Answer 369

markedly contracted or distended bladder Sensory - inability to sense fullness, large rounded smooth - voiding is preserved Motor - atonic bladder Uninhibited - rounded with trabeculation from detrusor contractions. large interureteric ridge Reflex - detrusor hyperreflexia with dyssynergic sphincter. contrast to posterio urethra and elonfated pointed urethra with pseudodiverticula - pine cone Autonumous - intermediatye between contracts and atonic

Answer 370

Congenital: - hutch diverticulum in paraureteral region Secondary: Outlet obstruction - stenosis - neurogenic - posterior urethral valve - prostatic enlargement - ureterocoele - urethral stricture Congenital syndromes - diamond blackfan - ehlers danlos - menkes - prune belly - williams Post op can be assoc with stones, rupture, malignancy

Answer 371

congenital diverticula seen at the VUJ in absence of posterior urethral valves or neurogenic bladder. assoc VUR. micky mouse appearance.

Answer 372

US tunica albuginea - hyper, covering corpora cavernosa and spongiosum. hypoechoic breach may be seen in longituindnal axis. haematoma either side MR tunica albuginea hypo on all sequences tear T2 hyperintense Grading 0 - haematyoma 1 - tunica/cavernosa defect 2 - tunica/cavernosa defect with haematoma 3 - defect in tunica, buck gascia and corpus spongiosum 4 - corpus with urethra and/or vascular injury

Answer 373

common cuase of painful penile induration. plaques form in tunica alburginea causing deformity and shortening and pain. plantar fibromatosis and dupytrens contracts. assoc with trauma, dm, bb's, pagets of bone and phenytoin

Answer 374

TCC Squamous Adeno Small cell

Answer 375

most common non tcc bladder cancer. m risk factors - schisto - chronic irritation - chronic infection - intravesical bcg

Answer 376

Persistent urachal remnant Cystitis glandularis Schisto Exstrophy Urachal - midline at dome or along course remannt - peripheral calcs - mixed solid cystic Non urachal - diffuse thickening - paravesical fat stranding

Answer 377

normal afp can have incr bhcg classic anaplastic or spermatocytic (older) US homogenous flow larger can be heterogenous CT nodes and mets MR T2 hypo C+ heterogenous DWI restricts non seminomatous; more heterogenous, with cysts and calcifications

Answer 378

common cuase of painful penile induration. plaques form in tunica alburginea causing deformity and shortening and pain. plantar fibromatosis and dupytrens contracts. assoc with trauma, dm, bb's, pagets of bone and phenytoin

Answer 379

hydrocoele epididymal cyst spermatocele haematocele hernia abscess pyocele varicocele

Answer 380

Seminoma Non seminoma - embyronal - choriocarcinoma - yolk sac - teratoma - mixed 1st decade; YS and tera 2nd; chorio 3rd; embryonal 4th; seminoma >7th; lymphoma

Answer 381

benign solid extratesticular lesions of the epidiymis/tunica vaginalis or spermatic cord

Answer 382

Sertoli Leydig Granulosa Fibroma thecoma

Answer 383

AFP - yolk sac bhcg - chorio LDH can be up

Answer 384

hydrocoele epididymal cyst spermatocele haematocele hernia abscess pyocele varicocele

Answer 385

repreents dilated testicular mediastinal tubles. often bilateral, older dudes. assoc with spermatocoeles and may occur after a vasectomy. results from obliteration of the efferent ducts. US small cystic tubular strctures that replace and enlarge teh testicular mediastinum lack of vascularity/mass effect MR cystic dilation hyper on T2 no enhancement ddx - intratesticular varicocoele - cystadenoma

Answer 386

benign solid extratesticular lesions of the epidiymis/tunica vaginalis or spermatic cord

Answer 387

US focal hypoechoic region abscess formation increased flow CT best for abscess; peripherally enhancing MR Acute T1 peripheral hypo or transitional hypo T2 hyper Diffuse enhancing abscess should restrict

Answer 388

an area of focal dilatation that occurs within the prostate utricle/verumontanum. midline cystic masses difficult to distinguish from mullerian duct cysts. assoc with hypospadius, cryptorchidism, unilateral renal agenesis

Answer 389

uncommon sex cord stromal tumours. less common than leydigs. have a large calcifying subtype. assoc with PJ and carney complex

Answer 390

US volume >30 enlarged central gland of mixed echoes calc may be seen pseudocapsule representing compressed peripheral zone elevated post mic volume assoc bladder hypertrophy IVP fishhook ureter bladder trabec/diverticula CT MR enlarged transition zone heterogenous signal with intact low signal pseudocapusle

Answer 391

US TRUS to assess and guide bx typically hypoechoic lesion, can be hyper/iso systematic sextant bx MR T1; prostate contour, neurovascular bundle encasement, post bx haemorrhage T2 low signal in high signal peripheral zone DWI often shows restriction DCE shows enhancement EPE; look for - asymmetry NV buncles - obliteration of the rectoprostatic angle - involvement of the urethra - seminal vesicle invasion

Answer 392

US focal hypoechoic region abscess formation increased flow CT best for abscess; peripherally enhancing MR Acute T1 peripheral hypo or transitional hypo T2 hyper Diffuse enhancing abscess should restrict

Answer 393

an area of focal dilatation that occurs within the prostate utricle/verumontanum. midline cystic masses difficult to distinguish from mullerian duct cysts. assoc with hypospadius, cryptorchidism, unilateral renal agenesis

Answer 394

TZ/PZ 1: normal 2: linear/wedge shaped ADC hypo and/or DWI hyper 3: focal, mild or moderate ADC hypo and/or mild/moderate DWI hyper. Can be marked on either ADC or DWI but not both. 4: focal marked ADC hypo and marked DWI hyper <1.5cm 5: same as 4 but >1.5cm or definite EPE TZ lesions with a T2 score of 2 or 3, DWI score 2 high (4 or 5) can upgrade PIRADS by 1 point

Answer 395

Negative - no early/contemp enhancement or - diffuse multifocal enhancing, no corresponding T2/DWI or - focal enhancement corresponding to a benign prostatic hyperplasia lesion Positive - focal and - earlier or contemp and - corresponds to sus finding on T2/DWI for PZ lesions of 3, DCE can upgrade to 4

Answer 396

US TRUS to assess and guide bx typically hypoechoic lesion, can be hyper/iso systematic sextant bx MR T1; prostate contour, neurovascular bundle encasement, post bx haemorrhage T2 low signal in high signal peripheral zone DWI often shows restriction DCE shows enhancement EPE; look for - asymmetry NV buncles - obliteration of the rectoprostatic angle - involvement of the urethra - seminal vesicle invasion

Answer 397

reporting scheme for suspected prostate cancer in treatment naive glands. each lesion can be scored 1-5 on DWI and T2, as well as presence of absence of DCE. TZ: primarily determined by T2 score. can be modified by DWI score. PZ: primarily determined by the DWI score. can be modified by DCE

Answer 398

Smooth - peritonitis - carcinomatosis - PH - familial mediterranean fever - sarcoid Irregular - carcinomatosis - TB (dry) - encapsulating peritoneal sclerosis - PMP - mesothelioma Nodular - carcinomatosis - TB (FF) - actinomycosis - primary pertoneal neoplasms

Answer 399

TZ/PZ 1: normal 2: linear/wedge shaped ADC hypo and/or DWI hyper 3: focal, mild or moderate ADC hypo and/or mild/moderate DWI hyper. Can be marked on either ADC or DWI but not both.

Answer 400

a rare complication of barium studies. GI perf with spillage into peritoneal cavity resulting in peritonitis, granuloma and stone formation. Acute - chemical perotonitis. acites and shock Chronic - extensive fibrosis around barium with granuloma formation. adhesions are common

Answer 401

extrapulmonary TB affecting the peritoneum. frequently seen with other GI TB. Risk factors; HIV, dialysis, cirrhosis Can be wet, dry or fixed fibrotic. can also be mixed.

Answer 402

CT nodular or symmetrical thickening of the peritoneum and mesentery abnormal enhancement ascites enlarged low attenuation nodes Wet - exudative high attenuation ascites Dry - caseous nodes and fibrous adhesions. thickened cake like omentum fibrotic - omental cake like mass with fixed bowel loops, matted loops and mesentery with loculated ascites

Answer 403

through fossa of Waldeyer, congenital failure of fusion of the ascending colon mesentery to the peritoneum in the right lower quadrant imaging - inferior to third part duodenum - behind SMV, SMA and right colic vein

Answer 404

protrude through foramen of winslow Imaging - posterior to PV, CBD, hepatic artery and anterior to IVC - gas/fluid/vessels in lessert sac - can have abnormal position of the caecum

Answer 405

a rare complication of barium studies. GI perf with spillage into peritoneal cavity resulting in peritonitis, granuloma and stone formation. Acute - chemical perotonitis. acites and shock Chronic - extensive fibrosis around barium with granuloma formation. adhesions are common

Answer 406

small bowel loops protrude into a peritoneal pocket formed between two adjacent sigmoid segments and their mesentery

Answer 407

Can be transmesenteric or intramesenteric Transmesenteric - through defect in mesentery - much more common Intra - into the mesentery through a mesenteric defect - predominantly paeds Imaging - Trans might not be sac like - Intra; sac like, with anterior and superior displacement of the SMA

Answer 408

through fossa of Waldeyer, congenital failure of fusion of the ascending colon mesentery to the peritoneum in the right lower quadrant

Answer 409

protrude through foramen of winslow Imaging - posterior to PV, CBD, hepatic artery and anterior to IVC - gas/fluid/vessels in lessert sac

Answer 410

Roux en Y three potential sites for hernia - at TV mesocolon defect through which the roux limb passes, if retrocolic - mesenteric defect at enteroenterostomy - behind the roux limb mesentery placed in a retrocolic or antecolic position (retro or ante petersen type)

Answer 411

small bowel loops protrude into a peritoneal pocket formed between two adjacent sigmoid segments and their mesentery

Answer 412

Can be transmesenteric or intramesenteric Transmesenteric - through defect in mesentery - much more common Intra - into the mesentery through a mesenteric defect - predominantly paeds Imaging - Trans might not be sac like - Intra; sac like, with anterior and superior displacement of the SMA

Answer 413

hernias through defects in the lumbar muscles or posterior fascia can be superior or inferior superior (grenfeltt lesshaft) - superior lumbar triangle inferior (petit) - inferior lumbar triangle

Answer 414

small bowel through congenital or acquried defect in the broad ligament

Answer 415

Roux en Y three potential sites for hernia - at TV mesocolon defect through which the roux limb passes, if retrocolic - mesenteric defect at enteroenterostomy - behind the roux limb mesentery placed in a retrocolic or antecolic position (retro or ante petersen type)

Answer 416

hernias through the spigelian fascia. between the lateral border of the rectus abdominaus and the semilunar line, through the transversus abdominus aponeurosis, close to the level of the arcuate line

Answer 417

rare type where more than one loop enters the hernial sac with an intervening intra abdominal loop

Answer 418

an uncommon idiopathic disorder characterised by chronic non spec inflammation invovling the adipose tissue of the bwoel mesentery Associations: malignancy - lymphoma, lung, melanoma, CRC, RCC, myeloma abdominal surgery systemic inflamm conditions - retroperitoneal fibrosis, sclerosing cholangitis, riedel thyroiditis, orbital pseudotumour

Answer 419

lymphatic - simple and lymphangioma mesothelial - simple, benign, malignant enteric urogenital mature cystic teratoma non pancreatic pseudocysts

Answer 420

a rare benign cause of bowel obstruction characterised by total or partial encasement of the small bowel within a thick fibrocollagenous membrane can be idiopathic or secondary to - dialysis - tb - shunts

Answer 421

CT solid heterogenous mass calcified pleural plques nodular, irregular peritoneal and omental thickening, progressing to cake peritoneal/omental masses variable ascites direct invasion of viscera concurrent pleural involvement MR T1 low T2 high C+ enhances Gallium avid ddx carcinomatosis - dystrophic calc PMP Lymphoma TB

Answer 422

rare benign subtype of mesothelioma. no assoc with asbestos. CT well defined low attenuating cystic pelvic masses no calcs MR T1 low T2 high septal enhancement

Answer 423

an uncommon idiopathic disorder characterised by chronic non spec inflammation invovling the adipose tissue of the bwoel mesentery assoc

Answer 424

US distortion and thickening of echogenic mesnetery halo sparing vessels CT well or ill defined mesenteric mass with surrounding mist misty attenuation fat halo around traversing mesenteric veseels and soft tissue nodules "fat ring sign" punctate or coarse calcs hyperattenuating pseudocapsule small soft tissue nodes

Answer 425

XR bowel obstr wall may calcify CT enhancing peritoneum, thickened obstruction dixation of loops ascites or localised fluid collections bwoel wall thckenign peritoneal or mural calc calcified or reactive adenopathy

Answer 426

vascular disease in middle age causing spontaneous intrabdominal haemorrhage. characterised by aneurysms, stenoses, dissections and occlusions within splanchnic arterial branches. not atherosclerotic or inflammatory

Answer 427

branches of visceral arteries aneurysms, stenoses, dissections, occlusiosn

Answer 428

cyst like structure that appears in relatio to the peritoneal surfaces resulting from a non neoplastic reactive mesothelial proliferation. usually caused by the accumulation of ovarian fluid that is contained by a peritoneal adhesion. assoc - previous trauma - pid - endometriosis - ibd

Answer 429

US - large ovoid irreg anechoic - invaginates surrounding structures - lack of a discrete wall - no nodularity - minmal debris - can range from small to v large

Answer 430

a bening non inflammatory fibroblastic tumour with a tendency to local invade without mets assoc - gardner syndrome - fap - pregnnacy/oestrogen therapy b catenin gene ctnnb1 or apc gene

Answer 431

US hypo CT well circumscribed can be more aggressive homo or focally hyperattenuating enahnce MR T1/T2 low C+ variable

Answer 432

FAP osteomas Epidermal cysts fibromatoses desmoid tumours supernumery teeth, odontomas, dentigerous cysts duodenal/ampulla tumours papillary thyroid ca

Answer 433

part of a spectrum of entities with a common pathogenic process of inflammatory response to atherosclerosis combined with autoimmune factors

Answer 434

Idiopathic (Ormond) Radiation Medication Inflammation - pancreatitis, pyloe - igg4 Malignant Asbestos

Answer 435

fibrosis encasing retro structures causing ureteric and vascular obstruction/displacement aorta/ivc away from VBs implied malignant, as does local invasion IVU - medial deviation (maiden waist sign) - tapering of the lumen - uni/bilateral hydro CT soft tissue mass around aorta and iliac vessels encasing without invading variable enhancement starts at bifurcation adn extends up MR T1/T2 dark, unless active inflammation DDX - lymphoma - erdheim chest - emh

Answer 436

also known as Ormond syndrome. subtype with no cause found. assoc; other autoimmune processes - pbc - fibrosing mediastinitis - ra - ank spond - PAN - SLE - hashimoto

Answer 437

a non aneurysmal form of chronic periaortitis. related to atherosclerosis or igg4 related disease. low densitive soft tissue mantle with or without dilation may have branch vessel narrowing

Answer 438

a non aneurysmal form of chronic periaortitis. related to atherosclerosis or igg4 related disease. low densitive soft tissue mantle with or without dilation may have branch vessel narrowing

Answer 439

a variant of AAA characterised by inflammatory thickening, perianeurysmal fibrosis an adherence to surrounding structures

Answer 440

CT dilation thickened wall cuff of perianeurysmal soft tissue and inflammatory changes sparing the posterior wall enahnces with contrast entrapement of retroperitoneal structures ddx mycotic aneurysm - usually more saccular with nodulairt, irregular config and may contain air

Answer 441

Liposarcoma Undifferentiated pleomorphic sarcoma Leiomyosarcoma Rhabdomyosarcoma Fibrosarcoma Malignant peripheral nerve sheath tumour Solitary fibrous tumour Extragonadal germ cell tumour primary retroperitoneal adenocarcinoma

Answer 442

malignant tumour of mesenchymal origin that may arise in any fat containing region of the body well diff - lipoma like - inflammatory - sclerosing myxoid pleomorphic round cell dedifferentiated

Answer 443

lieomyosarcoma UPS fibrosarcoma lipoma (rare) exophytic aml

Answer 444

one of the most common types of primary retroperitoneal neoplasms. high grade can be storiform, pleomorphic, myxoid, giant cell, inflammatory and angiomatoid 25% have dystrophic calc, otherwise non spec imaging features

Answer 445

one of the commonest retroperitoneal neoplasms. most common extra uterine site of leiomyosarcomas. freq involve the IVC. can be intravasc, extra vasc or mixed. imaging is non spec. tend to develop massive cystic components. no fat no calcs.

Answer 446

other retroperitoneal tumours should compress ivc at the periphery (negative embedded organ sign) mesenchymal tumours involving the ivc - angiosarc - liposarc - leiomyomatosis - ups tumours extending to ivc - cardiac angiosarc - hccc - acc - rcc

Answer 447

dysphagia, iron def anemia, upper oesophageal webs

ABDO/IR Flashcards

(471 cards)