Chapter 25 - Abdomen and Pelvis Flashcards by Enrhico Rivera

Usual cause of ascites with attenuation values averaging +45 HU (p.673)

ACUTE BLEEDING

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Two most gravity dependent portions of the peritoneal cavity? (p.673)

MORISON POUCH and PELVIS

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UTZ appearance of simple ascites (p.673)

ANECHOIC

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Exudative; hemorrhagic and neoplastic ascites often contains _______ in UTZ. (p.673)

FLOATING DEBRIS

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Septations in ascites are associated with an ___ or ____ process.
(p.673)

INFLAMMATORY or MALIGNANT PROCESS

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MR finding of Serous Ascites: in T1WI? In T2WI? In GRE?

p.673

T1WI: low signal intensity
T2WI: markedly increased in signal intensity
GRE: commonly bright due to fluid motion

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_____refers to gelatinous ascites that occurs as a result
of intraperitoneal spread of mucin-producing cells resulting from rupture of appendiceal mucocele; intraperitoneal spread of benign or mucinous cysts of the ovary; or mucinous adenocarcinoma of the colon or rectum (p.673)

PSEUDOMYXOMA PERITONEI
(JELLY BELLY)

CR: punctate or ringlike calcifications scattered through the peritoneal cavity.
CT: mottled densities; septations and calcifications
US: intraperitoneal nodules that range from hypoechoic
to strongly echogenic within the fluid

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Pneumoperitoneum is most commonly caused by _______ or __________. (p.673)

DUODENAL or GASTRIC ULCER PERFORATION

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3 other additional causes pneumoperitoneum (p.673)

TRAUMA
RECENT SURGERY OR LAPAROSCOPY
INFECTION OF THE PERITONEAL CAVITY WITH GAS-PRODUCING ORGANISMS

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This refers to free air within the peritoneal cavity (p.673)

PNEUMOPERITONEUM

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Post-operative pneumoperitoneum usually resolve in ___ to ___ days (p.673)

3 to 4 days

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Failure of progressive resolution of post-operative pneumoperitoneum or an increase in air; suggests
________ (p.673)

LEAK OF BOWEL ANASTOMOSIS or SEPSIS

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______ chest radiographs are the most sensitive

for free air or pneumoperitoneum. (p.674)

UPRIGHT Chest Radiograph

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2 xray views that may be used with very ill patients to demonstrate air outlining the liver (p.674)

LEFT LATERAL DECUBITUS view

2. CROSS-TABLE LATERAL view

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Four signs of pneumoperitoneum on Supine radiographs

p.674

1. gas on both sides of the bowel wall
(RIGLER SIGN)
2. gas outlining the falciform ligament
3. gas outlining the peritoneal cavity
(FOOTBALL SIGN)
4. triangular or linear localized extraluminal gas in the right upper quadrant

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A good place to look for pneumoperitoneum on CT?

p. 674

PERITONEAL RECESS BETWEEN THE LIVER

AND THE DIAPHRAGM

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2 modalities sensitive in detecting abdominal calcifications

than conventional radiographs (p.674)

CT and US

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Aneurysms of the aorta are manifest by luminal diameter
exceeding ___ cm as measured between calcifications
in the aortic wall (p.675)

3 cm

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Ringlike calcified aneuryms most commonly involve

the ___ or ____ arteries (p. 675)

SPLENIC or RENAL arteries

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____ are calcfied thrombi in the veins most common visualized in the lateral aspects of the pelvis. (p._____)

PHLEBOLITHS

round or oval calcifications up to 5 mm in size
that commonly contain a central lucency
may be mistaken for urinary tract calculi

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Calcified Lymph nodes result most commonly from

granulomatous diseases such as _____ or ____ (p.675)

TUBERCULOSIS or HISTOPLASMOSIS

-calcified lymph nodes are usually mottled
and 10 to 15 mm in size

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Most commonly calcified lymph node group?

p.675

MESENTERIC NODES

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Most calcified gallstones contain ________
and have a _____ appearance with a dense outer rim
and more radiolucent center. (p. 675)

CALCIUM BILIRUBINATE;

LAMINATED appearance

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Term for calcifications in the gallbladder wall

p.675

PORCELAIN GALLBLADDER

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This term is a suspension of radiopaque crystals within | the gallbladder bile. (p.675)

MILK OF CALCIUM BILE - layering of the suspension can be demonstrated on ERECT radiographs

Urinary calculi which assumes the shape | of the renal collecting system (p. 675)

STAGHORN CALCULI

RENAL CALCULI versus GALLSTONES | (p. 675)

RENAL CALCULI: more POSTERIOR in position; | GALLSTONE: more ANTERIOR in position

3 most common areas of ureteral narrowing? | p.675

1. URETEROPELVIC JUNCTION 2. PELVIC BRIM 3. VESICOURETERAL JUNCTION

Colonic calcium deposition often due | to an undigestible material such as fruit pit

ENTEROLITHS

Calcified adrenal glands are associated with adrenal | hemorrhage in the __ ; ___ and ____. (p.676)

1. NEWBORN 2. TUBERCULOSIS 3. ADDISON DISEASE - calcification is mottled in the location of the adrenal glands on either side of the first lumbar vertebra

The calcification due to pancreatic calculi are usually | ___ and of varying size (p.676)

COARSE

Calcification in the wall of a cyst is ___ or ____ - shaped | p. 676

CURVILINEAR or RING-SHAPED - ECHINOCOCCUS CYSTS commonly calcify and may be found in any intra-abdominal organ as well as within the peritoneal cavity.

Most characteristic tumor calcification in uterine | leiomyomas. (p.____)

COARSE POPCORN CALCIFICATIONS

Calcified injection granuloma from quinine; bismuth; and calcium salts of penicillin is commonly evident in the ______. (p. 676)

BUTTOCKS

__________ causes characteristic rice-grain | calcifications in muscles. (p. 676)

CYSTICERCOSIS

Neoplastic ascites is associated with ___ (p. 673)

INTRAPERITONEAL TUMORS

Normal gas in the abdomen is predominantly | ________ (p. 677)

SWALLOWED AIR

Normal air-fluid levels are in the _____ and _____; | but never in the _______. (p.677)

STOMACH and SMALL BOWEL; but never in the COLON DISTAL TO THE HEPATIC FLEXURE

Normal air-fluid levels in the small bowel | should not exceed ____ in length. (p.677)

2.5 cm

Small bowel is dilated when it exceeds _____. The colon is dilated when it exceeds ____ in diameter. The cecum is dilated when it exceeds ____ in diameter. (p.677)

2.5 to 3.0 cm in diameter; 5 cm in diameter; 8 cm in diameter

Small bowel is more ___ in the abdomen | and is characterized by ________ (p.677)

CENTRAL; | VALVULAE CONNIVENTES

Large bowel is more ______ in abdomen | and is characterized by ______. (p.678)

PERIPHERAL; | HAUSTRA

``` _____ has the largest normal diameter of the large bowel (p.678) ```

CECUM - always dilates to the greatest extent irrespective of the site of obstruction

____; _____ and ______ are used interchangeably and refer to stasis of bowel contents because of decreased or absent peristalsis (p.678)

ADYNAMIC ILEUS; PARALYTIC ILEUS | and NON-OBSTRUCTIVE ILEUS

_____ typically demonstrates diffuse symmetric; | predominantly gaseous; distension of bowel (p.678)

ADYNAMIC ILEUS - small bowel; stomach and colon are proportionally dilated without an abrupt transition

_____ refers to a segment of intestine that becomes paralyzed and dilated as it lies next to an inflamed intraabdominal organ. (p.678)

SENTINEL LOOP - in essence; it is a short segment of adynamic ileus that appears as an isolated loop of distended intestine that remains in the same general position on serial images -alerts one to the presence of an adjacent inflammatory process

A sentinel loop in the RUQ suggest ___; ____ and___. | p.678

1. ACUTE CHOLECYSTITIS 2. HEPATITIS 3. PYELONEPHRITIS

A sentinel loop in the LUQ suggest ___; ____ and___. | p.678

1. PANCREATITIS 2. PYELONEPHRITIS 3. SPLENIC INJURY

``` A sentinel loop in the LOWER QUADRANTS suggest ___ (give 5). (p.678) ```

1. DIVERTICULITIS 2. APPENDICITIS 3. SALPINGITIS 4. CYSTITIS 5. CROHN DISEASE

______ is a manifestation of fulminant colitis characterized by extreme dilation of all or a portion of the colon. (p. 678)

TOXIC MEGACOLON - absent peristalsis - large bowel loses all tone and contractility - bowel wall becomes like wet blotting paper - risk of perforation is extreme

Most common cause of toxic megacolon | p.678

ACUTE ULCERATIVE COLITIS

Most striking finding in Toxic Megacolon | p. 678

DILATION OF THE TRANSVERSE COLON | UP TO 15 cm IN DIAMETER

Toxic megacolon diagnosis is suggested when the diameter of the colon exceeds ___ cm and the mucosa appears abnormal. (p.678)

exceeds 5 cm

TRUE OR FALSE. Barium enema is absolutely contraindicated in TOXIC MEGACOLON because of the risk of perforation. (p.678)

TRUE

___ means stasis of bowel contents above a focal | lesion. (p.678)

MECHANICAL BOWEL OBSTRUCTION - obstruction may be due to obturation (occlusion by a mass in the lumen); stenosis due to intrinsic bowel disease; compression of the lumen by extrinsic disease

3 goals in imaging mechanical bowel obstruction. | p. 678

1. Confirm the presence of obstruction 2. Identify its level 3. Demonstrate its cause

Radiographs can confirm the presence of bowel obstruction _____ hours before the diagnosis can usually be made clinically. (p.678)

6 to 12 hours before

Type of obstruction which means that the lumen | is totally occluded. (p.678)

COMPLETE OBSTRUCTION

Type of obstruction which means some bowel | contents pass through. (p.678)

PARTIAL OBSTRUCTION

Type of obstruction which refers to blockage of the luminal contents without interference of blood supply. (p.678)

SIMPLE OBSTRUCTION

Type of obstruction which means that the blood supply | to the bowel wall is impaired. (p.678)

STRANGULATION OBSTRUCTION - most strangulation obstruction are closed-loop obstructions.

Type of obstruction which means blockage of a bowel loop segment at both ends. (p.678)

CLOSED-LOOP OBSTRUCTIONS

______ is the term applied to necrotizing fasciitis of the perineum; perianal and genital regions (p.679)

FOURNIER GANGRENE

In the western world; ___ account for 75% | of the small bowel obstruction (p.679)

POST-SURGICAL ADHESIONS

In developing nations; 80% of small bowel | obstruction is caused by ____ (p.679)

INCARCERATED HERNIA - but only 10% is caused by adhesions

DIAGNOSIS. Radiographic findings: (p.679) 1. DILATED LOOPS OF SMALL BOWEL (> 3 cm) disproportionate to more distal small or colon 2. SMALL BOWEL AIR-FLUID LEVELS that exceed 2.5 cm in width 3. AIR-FLUID LEVELS AT DIFFERING HEIGHTS (> 5 mm) within the same loop (dynamic air-fluid levels) 4. TWO OR MORE AIR-FLUID LEVELS 5. SMALL BUBBLES OF GAS TRAPPED BETWEEN FOLDS IN DILATED ; FLUID-FILLED LOOPS PRODUCING THE STRING OF PEARLS sign

small bowel obstruction

___ is a row of small gas bubbles oriented horizontally | or obliquely across the abdomen (p.679)

STRING OF PEARLS sign

CT DIAGNOSTIC FINDING of small bowel obstruction | p.679-680

demonstration of a transition site between small bowel loops dilated with fluid or air and collapsed bowel loops distal to the obstruction

____ sign is strong CT evidence of bowel obstruction. | p.680

SMALL-BOWEL FECES sign

DIAGNOSIS. CT FINDINGS: (p.680) 1. CIRCUMFERENTIAL WALL THICKENING (>3mm) 2. EDEMA OF THE BOWEL WALL (Target or Halo appearance of the bowel wall) 3. LACK OF ENHANCEMENT OF THE BOWEL WALL (most specific sign) 4. HAZINESS OR OBLITERATION OF THE MESENTERIC VESSELS 5. INFILTRATION OF THE MESENTERY WITH FLUID OR HEMORRHAGE

Strangulation Obstruction

DIAGNOSES (2). 4 CT signs: (p. 680) 1. Radial distribution of dilated small bowel with mesenteric vessels converging toward a focus of torsion 2. U-shaped or C-shaped dilated small bowel loop 3. BEAK sign at the site of torsion seen as fusiform tapering of a dilated bowel loop 4. WHIRL sign to tightly twisted mesentery seen with volvulus - presence of a whirl sign in patient with small bowel obstruction correlates strongly with the need for surgery.

SMALL BOWEL VOLVULUS and | CLOSED-LOOP OBSTRUCTION

_____ is a major cause of small bowel obstruction | in children but is less common in adults. (p.680)

INTUSSUSCEPTION - in adults; it is often chronic; intermittent or subacute and is usually caused by a polypoid tumor ; such as lipoma

Other 4 causes of Intussusception aside from | polypoid tumor or lipoma? (p.680)

1. Meckel Diverticulum 2. Lymphoma 3. Mesenteric nodes 4. Foreign bodies

ILEOCOLIC INTUSSUSCEPTION is usually ____ in children but is caused by a __ in adults (p.680)

IDIOPATHIC; MASS

COLOCOLIC INTUSSUSCEPTION is ____ in adults | but ____ in children. (p.680)

COMMON; RARE

Barium study finding of Intussusception? | p.680

COILED SPRING APPEARANCE - barium trapped between the intussusception and the receiving bowel

CT finding of intussusception (p.681)

TARGET-LIKE INTESTINAL MASS

Ultrasound finding of intussusception (p.681)

``` DONUT configuration of alternating hyperechoic and hypoechoic rings representing alternating mucosa; muscular wall and mesenteric fat tissues in cross section ```

___ is a cause of mechanical small bowel obstruction that should be suspected in any elderly woman with small bowel obstruction (p.____)

GALLSTONE ILEUS -bowel obstruction is caused by a large gallstone that erodes through the gallbladder wall and passes into the intestine; creating a cholecystoduodenal fistula.

GALLSTONE IN GALLSTONE ILEUS most commonly | lodges in the ____. (p. 681)

DISTAL ILEUM - causative gallstones are typically single; faceted and 2 to 5 cm in size

Components of the RIGLER TRIAD (p. 681)

``` 1. DILATED SMALL BOWEL LOOPS (80% of cases) 2. AIR IN THE BILIARY TREE OR GALLBLADDER (67%) 3. CALCIFIED GALLSTONE IN AN ECTOPIC LOCATION (50%) ```

When the cecum exceeds __ cm in diameter; it is at high risk for perforation with attendant risks of peritonitis and septic shock. (p.681)

10 cm

Most colonic obstructions occur in the ___ colon. | p. 681

SIGMOID - bowel lumen is narrower; stool is more formed

RADIOGRAPHIC FINDING diagnostic in large bowel | obstruction. (p.681)

DILATION OF THE COLON FROM THE CECUM TO THE POINT OF OBSTRUCTION - colon distal to the obstruction is devoid of gas

Air-fluid levels distal to the ______ are strong evidence of obstruction unless the patient has had an enema (p.681)

HEPATIC FLEXURE

Sigmoid volvulus is most common in the ___ and in individuals on ____ diets. (p.681) - sigmoid colon twists around its mesentery; resulting in a closed-loop obstruction

ELDERLY; HIGH-RESIDUE diets

Radiographic diagnosis when a large-gas filled loop without haustral markings arises from the pelvis and extending high into the abdomen and often to the diaphragm. (p.681)

SIGMOID VOLVULUS

Radiographic sign in SIGMOID VOLVULUS where the apex of the distended sigmoid colon may extend cephalad to the transverse colon. (p.681)

NORTHERN EXPOSURE SIGN

``` Barium enema (in SIGMOID VOLVULUS) demonstrates obstruction that tapers to a beak at the point of the twist; usually approximately ___ cm above the anal verge. (p.681) ```

15 cm

DIAGNOSIS. 5 CT FINDINGS: (p.681-682) 1. Inverted; dilated U-shaped sigmoid colon 2. Absence of gas in the rectum 3. Transition zones between dilated and collapsed bowel occur at the point of twisting 4. Oblique lines created by the orientation of the transition zones create the X-MARKS THE SPOT SIGN appreciated on the sequential images 5. A single beak-shaped transition point corres- ponding to the beak sign seen on barium enema - as a closed loop-obstruction the bowel is prone to ischemia and perforation; signs of which must be carefully sought.

SIGMOID VOLVULUS

___ causes 1% to 3% of large bowel obstruction in adults and occurs most frequently in the 30 to 60 years age group (p.682)

CECAL VOLVULUS - a closed-loop obstruction that may result in ischemia; necrosis and perforation - most common type: the twist and invert with the cecum displaced to the left upper quadrant.

____ refers to a folding of the cecum to a position | anteromedial to the ascending colon; rather like folding the toe of a sock back on itself (p._____)

CECAL BASCULE

DIAGNOSIS. Four classic radiographic findings: (p.682) 1. Coffee bean-shaped loop of gas-distended bowel having haustral markings directed toward the left upper quadrant 2. Apex of the cecum in the left upper quadrant 3. Cecal distension greater than 10 cm in diameter 4. Collapse of the distal colon - proximal small bowel dilatation may or may not be present

CECAL VOLVULUS

DIAGNOSIS. Seven CT findings: (p.682) 1. Cecum in the upper mid and left abdomen 2. Volvulus in the RLQ seen as an area of swirling of the bowel and mesenteric fat (WHIRL SIGN) 3. Appendix is displaced to the left upper quadrant 4. Two transition points are present; one for the entering loop and one for the exiting loop 5. when the loops are completely wound around each other an X-MARKS THE SPOT sign is present formed by the crossing configuration of the transition zones 6. cecum is distended more than 10 cm 7. distal large bowel is decompressed

CECAL VOLVULUS

____ is the most common cause of large bowel obstruction | in elderly and bedridded patients. (p.682)

FECAL IMPACTION

___ is a rare inflammation of the wall of the colon caused by fecal impaction. (p.682)

STERCORAL COLITIS

____ is clinical disorder of acute colonic distension with abdominal pain and distension but without the presence of mechanical obstruction (p.682)

COLONIC PSEUDOOBSTRUCTION (OGILVIE SYNDROME) - radiographs demonstrate dilatation of the colon most commonly from cecum to splenic flexure - CT demonstrates the same findings with additional evaluation for wall thickening associated with colitis or findings of colonic ischemia

DIAGNOSIS. 10 CT findings: (p. 683) 1. Circumferential or nodular thickening (>5 mm) of the bowel wall with infiltration of low-density edema or high-density blood; resulting from mucosal injury. 2. thumbprinting resulting from this nodular infiltration of the bowel wall 3. dilatation of the bowel lumen (>3cm) for small bowel; >5cm for colon; > 8cm for cecum) 4. PNEUMATOSIS INTESTINALIS 5. Edema or hemorrhage into the mesentery 6. engorged mesenteric vessels 7. Thrombosis of mesenteric arteries or veins 8. poor enhancement of the bowel wall along its mesenteric border; which is evidence of ischemia 9. poor or absent mucosal enhancement with thinning of the bowel wall; which is evidence of bowel infarction 10. ascites; which is commonly present

bowel ischemia

____ refers to the presence of gas within the bowel wall (p. 683)

PNEUMATOSIS INTESTINALIS - it may occur as a benign entity without clinical significance or may be an important finding of bowel ischemia - RADIOGRAPHIC SIGN; not a disease

4 causes of Pneumatosis Intestinalis (p.683)

1. BOWEL NECROSIS; usually associated with other radiographic and clinical signs of bowel ischemia 2. MUCOSAL DISRUPTION; caused by ulcers; mucosal biopsies; trauma; enteric tubes; or inflammatory bowel disease 3. INCREASED MUCOSAL PERMEABILITY related to immunosuppression in AIDS;organ transplantation or chemotherapy 4. PULMONARY DISEASE resulting in alveolar disruption and dissection of air along interstitial pathways to the bowel wall.

TRUE OR FALSE. Pneumatosis in asymptomatic patients is very likely benign and incidental. (p.____)

TRUE

TRUE OF FALSE. Pneumatosis in seriously ill patients with abdominal pain or distension is more likely to be a sign of bowel ischemia. (p.____)

TRUE

____ appears on radiographs or CT as cystic air bubbles (few mms to several cms) or linear streaks of air within the bowel wall; esp in its most gravity-dependent aspect (p.683)

PNEUMATOSIS

meaning of the acronym FAST? (p.683)

FOCUSED ABDOMINAL SONOGRAMS FOR TRAUMA - may be used to detect the presence of intraperitoneal fluid to triage trauma patients for CT

``` DIAGNOSIS. CT findings: (p.683) 1. HEMOPERITONEUM 2. SENTINEL CLOT 3. ACTIVE BLEEDING 4. FREE AIR WITHIN THE PERITONEAL ACTIVITY 5. FREE CONTRAST WITHIN THE PERITONEAL ACTIVITY 6. SUBCAPSULAR HEMATOMAS 7. INTRAPARENCHYMAL HEMATOMAS 8. LACERATIONS 9. ABSENCE OF ORGAN ENHANCEMENT 10. INFARCTIONS ```

traumatic injury

_____ acute blood within the peritoneal cavity measuring 30 to 45 HU (p.683)

HEMOPERITONEUM

____ a focal collection of clotted blood (>60 H) that maybe seen in the peritoneal cavity adjacent to an injured organ (p.683)

SENTINEL CLOT

Active bleeding in abdominal trauma is seen as extravasated contrast (85 to 370 H); seen during ___ phase of scanning with MDCT. (p. 683)

ARTERIAL

____ an insensitive sign of bowel injury provided that diagnostic peritoneal lavage has not been performed (p.683)

FREE AIR WITHIN THE PERITONEAL CAVITY

____ this may result from oral contrast leaking from injured bowel or IV contrast leaking from a ruptured bladder. (p.___)

FREE CONTRAST WITHIN THE PERITONEAL CAVITY

______ appear as crescent-shaped collections confined by the capsule of the injured organ (p.683)

SUBCAPSULAR HEMATOMAS

____ this appears as an irregularly shaped low-density areas within a contrast-enhanced solid organ (p.683)

INTRAPARENCHYMAL HEMATOMAS

___ this appears as jagged linear defects defined by lower-density blood within a contrast-enhanced injured organ in abdominal trauma (p. 683)

LACERATIONS

___ reflects damage to the organ's arterial supply in abdominal traumas. (p.683)

ABSENCE OF ORGAN ENHANCEMENT

_____ are seen as zones of decreased contrast enhancement that extend to the capsule of a solid organ in abdominal traumas. (p.683)

INFARCTIONS

The abdomen and pelvis contain more than __ lymph nodes that may be involved in a wide variety of neoplastic and inflammatory diseases.(p. 684)

230

____ measurements of lymph node size are preferred to determine abnormal enlargement. (p. 684)

SHORT-AXIS

3 Morphologic patterns of PATHOLOGIC lymphadenopathy include ___; ___ or ____. (p. 684)

1. SINGLE ENLARGED NODES 2. MULTIPLE SEPARATE LOBULATED ENLARGED NODES 3. BULKLY CONGLOMERATE MASSES OF LYMPH NODES

Calcifications in enlarged nodes may be seen with __ ; ___; ___ and ___. (p. 684)

1. INFLAMMATORY ADENOPATHY 2. MUCINOUS CARCINOMAS 3. SARCOMAS 4. TREATED LYMPHOMA

TRUE OR FALSE. Normal nodes are oblong in shape.(p.684)

TRUE

Most pathologically enlarged nodes have CT densities ____ than skeletal muscle. (p.684)

SLIGHTLY LESS

Low-density nodal metastases are commonly seen with __;___ and ___. (p.684)

1. NON-SEMINOMATOUS TESTICULARCARCINOMA 2. TUBERCULOSIS 3. occasionally LYMPHOMA

Radiographic sign wherein masses of retroperitoneal nodes may silhoutte segments of the normally echogenic wall of the aorta. (p.685)

SONOGRAPHIC SILHOUTTE SIGN

Radiographic sign which refers to entrapment of mesenteric vessels by masses of enlarged lymph nodes in the mesentery. (p.685)

SANDWICH SIGN

LYMPH NODE MRI SIGNAL CHARACTERISTICS: in T1WI? In T2WI? (p.___)

T1WI: low signal intensity compared to surrounding fat; T2WI: high signal intensity compared to muscle

______ is responsible for 20% to 40% of all lymphoma and is characterized histologically by the presence of REED-STERNBERG CELL. (p.685)

HODGKIN LYMPHOMA - has a bimodal age distribution most commonly affecting patients aged 25 to 30 years and older than 50 years

____ is responsible for 60% to 80% of lymphoma.(p.685)

NON-HODGKIN LYMPHOMA - a heterogeneous group of disorders with a confusing array of changing names and classifications - particularly common in immunocompromised patients

Solid organ involvement of Non-Hodgkin lymphoma primarily affects the following organs (6). (p. 685)

1. SPLEEN 2. LIVER 3. PANCREAS 4. KIDNEYS 5. ADRENAL GLANDS 6. TESTES

DIAGNOSIS. 5 manifestations: (p.685) 1. Solitary or multiple homogeneous well-defined nodules; 2. Confluent masses; 3. Mild uniform contrast enhancement of nodules and masses; 4. Diffuse involvement producing only organomegaly; 5. Organ invasion from adjacent tissue.

Non-Hodgkin's Lymphoma

5 GI involvement of Non-Hodgkin Lymphoma (p.685)

1. Wall involvement deep to the mucosa that may be missed at endoscopy; 2. Circumferential wall thickening; 3. Luminal dilatation; narrowing or cavitation 4. Nodules; polyps and ulcers 5. Impaired peristalsis

____ is a spectrum of lymphoid hyperplasias and neoplasias in patients who have received solid organ transplants and immunosuppresive therapy. (p.685)

POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER (PTLD) - the disorder results from an Epstein-Barr virus-induced proliferation of B lymphocytes that is usually opposed by functioning T cells.

Extranodal involvement in solid organs with discrete solitary; multiple or infiltrative masses is most common in what condition. (p.685)

POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER (PTLD) - GI involvement is similar to NHL and includes wall thickening; luminal narrowing;eccentric extraluminal mass; luminal ulceration and stranding in the mesentery. - Treatment is reduction of immunosuppresive therapy

____ is an uncommon primary tumor of the peritoneal membrane (p.685)

PERITONEAL MESOTHELIOMA - all are closely associated with asbestos exposure - US demonstrate the sheetlike superficial masses - prognosis is poor; with most patients dying within 1 year of diagnosis

One-third of all mesotheliomas arise from the ______ with most of the remainder arising from the ____. (p.685)

PERITONEUM; PLEURA

Cake-like thickening of the omentum (p.686)

OMENTAL CAKE - In PERITONEAL mesothelioma; CT demonstrates nodular; irregular peritoneal and omental thickening and masses; which merge to large plaques

Peritoneal metastases are most commonly associated with these four carcinomas.(p.686)

OVARIAN, COLON, STOMACH and PANCREAS CARCINOMA | MNEMONIC: PM PaCOS

Three preferential sites for tumor implantation of peritoneal metastases (p.686)

1. PELVIC CUL-DE-SAC 2. RIGHT PARACOLIC GUTTER 3. GREATER OMENTUM

``` DIAGNOSIS. 5 CT findings: (p.686) 1. Tumor nodules on peritoneal surfaces 2. Omental Cake 3. Tumor nodules in the mesentery 4. Thickening and nodularity of the bowel wall due to serosal implants 5. Ascites; that is commonly loculated ```

PERITONEAL METASTASES

____ occurs when the primary sites of hematopoiesis in the bone marrow fail as a result of myelofibrosis or when hemolytic anemias overwhelm blood cell production (sickle cell disease and thalassemia) (p.686)

EXTRAMEDULLARY HEMATOPOIESIS - bilateral; relatively symmetric and enhance mildy; and homogeneously postcontrast

The most obvious manisfestations of EXTRAMEDULLARY HEMATOPOIESIS are homogeneous well-marginated paraspinal masses that favor the _____ spine. (p.686)

THORACIC spine

____ are benign cystic lesions that arise from lymphatic vascular channels. (p.686)

LYMPHANGIOMAS - cystic mass contains septations and multiple loculations - lesions occur in the omentum; mesentery; mesocolon and retroperitoneum

CT finding in Lymphangiomas (p.686)

Fluid density mass with enhancing wall and septa - US shows better multilocular nature of the mass

____ arise in the retroperitoneal tissues outside of the retroperitoneal organs. (p.686)

PRIMARY RETROPERITONEAL NEOPLASMS

Most common sarcoma of the retroperitoneum (p.686)

LIPOSARCOMAS -containts distinct fat density (other example: TERATOMAS)

______ is rare condition manifest by formation of a fibrous plaque in the lower retroperitoneum that encases and compresses the aorta; inferior vena cava and ureters. (p.686)

RETROPERITONEAL FIBROSIS - 2/3 of cases are idiopathic. - the fibrotic plaque is usually located over the anterior surfaces of the L4 and L5 vertebrae. - plaques are typically of low signal intensity on both T1WI and T2WI; - plaques that shows high signal intensity on T2WI should be considered suspicious for malignancy as a cause

____ an ergot prescribed for migraine headache; causes 12% of RETROPERITONEAL FIBROSIS cases. (p.686)

METHYSERGIDE

TRUE OR FALSE. On US; retroperitoneal fibrosis is easily confused with lymphoma (p.___)

TRUE

TRUE OR FALSE. Wooden foreign bodies are usually not visualized on conventional radiographs. (p.686)

TRUE - CT shows high attenuation of the wooden object.

_______ are a rare but dreaded complication of surgery. (p.687)

RETAINED SURGICAL SPONGES (gossypiboma) - retained sponges may be asymptomatic; causes an abscess; or abscess; or generate a granulomatous response; inducing fibrosis and calcification

_____ occur within the peritoneal cavity because of spillage of contaminated material from perforated bowel or as a complication of surgery; trauma; pancreatitis; sepsis; or AIDS (p.____)

ABSCESSES

_____ is the most common site for abscess formation.(p.688)

PELVIS

``` DIAGNOSIS. 7 Radiographic findings: (p.688) 1. Soft tissue mass 2. Collection of extraluminal gas 3. Displacement of bowel 4. localized or generalized ileus 5. elevation of the diaphragm 6. pleural effusion 7. Atelectasis or consolidation at the lung bases ```

ABSCESSES

Most SPECIFIC sign of ABSCESS; but is UNCOMMON (p.688)

A FOCAL COLLECTION OF EXTRALUMINAL GAS - CT shows a loculated fluid collection; often with internal debris and fluid-fluid levels.

_________ within the fluid collection is strong evidence of abscess. (p.688)

GAS

Gas within the fluid collection is evidenced by echogenic foci producing ___ or ___ artifacts. (p.688)

COMET-TAIL or REVERBERATION artifacts

A ___ of the abdominal wall is a protrusion of bowel; omentum; or mesentery through a defect in the wall of the abdomen or pelvis. (p.____)

HERNIA

_____ refers to hernias that are not reducible. (p.688)

INCARCERATION

____ refers to hernias associated with bowel obstruction and bowel ischemia. (p.688)

STRANGULATION

____ hernias entrap only a portion of the bowel wall without compromising viability. (p.688)

RICHTER

____ hernias are most common in children and adults (p.688)

INGUINAL

_____ hernias extend throughout the internal inguinal ring in the inguinal canal LATERAL to the inferior epigastric vessels. (p.688)

INDIRECT INGUINAL hernias

___ hernias occur medial to the inferior epigastric vessels directly into the inguinal canal through a weakness in its floor (p.688)

DIRECT INGUINAL hernias

____ hernias are complications of surgery with herniation through the surgical incision.(p.688)

INCISIONAL HERNIAS

____ hernias occur in association with surgically created stomas. (p. 688)

PARASTOMAL hernias

____ hernias occur through defects in the lumbar musculature posterolaterally below the 12th rib and above the iliac crest. (p.688)

LUMBAR hernias

____ hernias occus in the lower abdominal wall lateral to rectus abdominis and inferior to the umbilicus through a defect in the aponeurosis of the transverse abdominis and internal oblique muscles. (p.688)

SPIGELIAN hernias

A CD4+ T-cell count below ____ cells/mm3 is diagnostic of AIDS. (p.689)

below 200 cells/mm3 (normal is 800 to 1000 cells/mm3)

AIDS is characterized by multiple opportunistic infections and aggressive malignancies; most commonly ____ and ___. (p.689)

KAPOSI SARCOMA (KS) and AIDS-related lymphoma. - infection by multiple organisms at multiple sites

_____ are the most useful modalities for evaluating the solid visceral organs; adenopathy and the peritoneal cavity. (p.690)

CT and US

______ causes pneumonia in nearly 80% of patients with AIDS. (p.690)

Pneumocystis carinii

______ is a cause of bulky abdominal adenopathy; hepatosplenomegaly and focal lesions in the liver and the spleen. (p.690)

ATYPICAL MYCOBACTERIUM

___ and ___ are common causes of esophagitis as well as gastric antritis and duodenitis. (p.690)

CANDIDA ALBICANS and CYTOMEGALOVIRUS

____ and ____ are protozoans; previously found only in animals; that infect the GI tract and causes severe diarrhea. (p.690)

CRYPTOSPORIDIUM and ISOSPORA BELLI

___ and ___ are causes of AIDS-related cholangitis. (p.690)

CRYPTOSPORIDIUM and CYTOMEGALOVIRUS

_______ occurs as the most common malignancy associated with AIDS and may also occur in organ transplant patients. (p.690)

KAPOSI SARCOMA

______ are extremely aggressive neoplasms that respond poorly to therapy and commonly involve the extranodal sites. (p.690)

AIDS-related Lymphomas - median survival is only 5 to 6 months - extranodal involvement is found at presentation in most patients (CNS in 27%)

_____ is serous fluid in the peritoneal cavity (p.673)

ASCITES

Ascites is most commonly caused by _____ (p.673)

1. CIRRHOSIS 2. HYPOPROTEINEMIA 3. CONGESTIVE HEART FAILURE

Exudative ascites results from inflammatory processes such as _____ (p.673)

1. ABSCESS 2. PANCREATITIS 3. PERITONITIS 4. BOWEL PERFORATION

Hemoperitoneum results from _____ (p.673)

1. TRAUMA 2. SURGERY 3. SPONTANEOUS HEMORRHAGE

Neoplastic Ascites is associated with ___ (p. 673)

INTRAPERITONEAL TUMORS

Conventional Radiographic diagnosis of ascites requires that at least ___ mL of fluid be present. (p.673)

at least 500 ml of fluid

DIAGNOSIS. Six radiographic findings: (p.673) 1. Diffuse increase in density of the abdomen (gray abdomen) 2. indistinct margins of the liver; spleen and psoas muscles 3. medial displacement of gas-filled colon; liver and spleen away from the properitoneal flank stripe 4. bulging of the flanks 5. increased separation of gas-filled small bowel loops 6. dog's ears appearance of symmetric densities in the pelvis due to fluid spilling out of the cul-de-sac on either of the bladder

ASCITES

DISGNOSIS. CT finding: (p.673) Fluid density in the recesses of the peritoneal cavity

ASCITES

Type of ascites with attenuation values near water | -10 to +10 HU) (p.673

SEROUS ASCITES

Type of ascites with attenuation values usually above +15 HU (p.673)

EXUDATIVE ASCITES

Chapter 25 - Abdomen and Pelvis Flashcards

(186 cards)