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Gastrointestinal Flashcards

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1
Q

Liver segments by portal and hepatic veins

A

Portal vein: superior/inferior
Middle hepatic vein: right/left
Left hepatic vein: 2,3/4
Right hepatic vein: 5,8/6,7

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2
Q

Hepatic segment vasculature

A

Central:
portal triad—> portal vein, hepatic artery, bile duct

Peripheral:
venous —>hepatic vein—>IVC

Caudate:
Direct to the IVC

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3
Q

Routine contrast enhanced CT usage

A

Portal venous phase(70s after injection)
Hepatic steatosis, cirrhosis
Most metastasis ( not hyper vascular)

Some breast Mets are iso in portal phase/detected on unenhanced

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4
Q

Arterial phase CT usage in liver

A

20-25 s after injection
Primary liver masses (hyper vascular)

Optimal view—> late arterial (35 s)

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5
Q

NAFLD categories

A

Steatosis

Steatohepatitis

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6
Q

Metabolic syndrome

A

NAFLD
Obesity
Insulin resistance
Dyslipidemia

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7
Q

Hepatic steatosis on CT

A

Un-enhanced:
Liver attenuated 10 HU less than spleen

Contrast enhanced: liver 25 HU less than spleen in pvp

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8
Q

Fatty liver on MRI

A

In and out of phase GRE MRI
complete signal loss on out of phase

In phase: water+fat
Out of phase:water-fat

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9
Q

Decreased signal on in phase MRI

A

Hepatic iron overload

Increases TE—> longer dephasing—> exaggerated T2*

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10
Q

Focal liver fat characteristics

A

No mass effect
Vessels run through it
Location:
Gallbladder fossa/ subcapsular/periportal/

Hyper echo on US and hypo on CT

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11
Q

Liver amyloidosis

A

Decreased attenuation on CT

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12
Q

Wilson disease on CT

A

Copper : basal ganglia/cornea/liver

Liver:
Hyper on CT—> multiple nodules—>hepatomegaly—>cirrhosis

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13
Q

Excess hepatic iron accumulation pathways

A

Within hepatocytes: hemochromatosis

Increased uptake in RES: kupffer cells/ hemosiderosis

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14
Q

Iron overload liver imaging

A

MRI: hypo compared to paraspinal muscle

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15
Q

Hemochromatosis vs Hemosiderosis

A

Hemochromatosis: spleen and bone marrow are spared
Involves pancreas,myocardium,skin,joint/ cause cirrhosis/ tx: phlebotomy

Hemosiderosis: spleen and bone marrow are involved/ no cirrhosis/ tx: iron chelator

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16
Q

Hypo-attenuated liver on CT

A 
Fatty liver
Hepatic amyloid ( rare)
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17
Q

Hyper attenuated liver on CT

A 
>75 HU
iron overload
Medication: amiodarone, gold, methotrexate
Copper overload
Glycogen excess
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18
Q

Viral hepatitis imaging

A

Normal CT
Gallbladder wall thickening
Periportal edema

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19
Q

DDx for multiple tiny hypo hepatic lesions

A

Candidiasis (involves spleen/ rim enhanced/ immunocompromised)
Mets
Lymphoma
Biliary hamartoma

Caroli disease (dilatation of intrahepatic bile ducts/fibrocystic anomalies of the kidneys)

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20
Q

Causes of liver abscess

A 
Diverticulitis
Appendicitis
Crohn
Bowel surgery
Ascending cholangitis ( less common)

E.Coli

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21
Q

Hepatic abscess on imaging

A

Mimics Mets
CT: ring enhanced
MRI: central hyper on T2/ irregular wall with late enhancement/ perilesional enhancement

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22
Q

Hepatic echinococcosis on imaging

A

CT: well defined hypo mass with floating membrane and peripheral calcification

US: hypoechoic mass with hyperechoic undulating membrane

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23
Q

Cirrhosis forms

A

Micronodular: metabolic causes
Macronodular: post viral

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24
Q

Cirrhosis on imaging

A 
Early: 
preportal space expansion
Caudate enlargement
Caudate/right lobe>0.65
Empty gallbladder fossa sign

Secondary:
Portal HTN—> splenomegaly, portosystemic collaterals, varies
Gall bladder wall thickening
Gamna-Gandy bodies( splenic microhemorrhage)

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25
Regenerative liver nodules on imaging
Supplied by portal vein/ non pre malignant No enhancement on arterial phase Low on T2 Contrast enhanced MRI: iso to liver parenchyma
26
Dysplastic liver nodule on imaging
``` Premalignant/ supplied by portal vein Mostly don’t enhance Hypo on T2 High grade: hyper on T2 Contrast enhanced: Low grade—> iso to liver High grade—> arterial enhancement ```
27
Siderotic liver nodule on imaging
Iron rich regenerative or dysplastic nodule Hypo on T1 and T2* Hyper on CT
28
HCC on CT and MRI
Encapsulate Enhances on arterial and washes out on portal venous Hyper on T2 10-20% of HCCs are hypoenhancing
29
Nodule in nodule appearance
Enhancing nodule in a dysplastic nodule | Early HCC
30
HCC invasion pattern
Port, portal veins, IVC and bile ducts Mets to the liver are less locally invasive
31
HCC treatment
Hepatectomy Transplant Percutaneous ablation Transcatheter embolization
32
Fibrolamellar carcinoma
HCC subtype Young patient without cirrhosis AFP not elevate Better prognosis
33
Fibrolamellar carcinoma on imaging
``` Large, heterogenous Fibrotic central scar: hypo on T1 and T2 Focal nodular hyperplasia: T2 hyper with delayed enhancement Capsular retraction in 10% Do not have capsule Have pseudocapsule ```
34
Liver metastasis imaging
Mostly hypovascular Seen on portal venous phase Calcification: mucinous colorectal/ ovarian serous MRI: hypo T1/hyper T2
35
Hyper vascular liver metastasis
``` Neuro endocrine tumors RCC Thyroid carcinoma Melanoma Sarcoma ```
36
Pseudocirrhosis
Multiple hepatic metastasis Treated breast cancer Can have capsular retraction
37
Hepatic lymphoma
Primary is rare | Usually secondary with splenomegaly and LAP
38
Epithelioid hemangioendothelioma
Vascular malignancy Multiple round subcapsular masses that can be confluent Can have halo or target Capsular retraction
39
DDx for capsular retraction
``` Metastatic tumors Fibrolamellar HCC HCC epithelioid hemangioendothelioma Intrahepatic cholangiocarcinoma Confluent hepatic fibrosis: wedge shaped Cirrhosis Medial left/ anterior right ```
40
Focal nodular hyperplasia
Disorganized tissue Not malignant More in women Not associated with OCP
41
FNH in imaging
Central scar (not true scar) is T2hyper ductules and venules, with delayed enhancement Avid enhancement on arterial with quick wash out Has kupffer cells (sulfur colloid study) and bile duct (HIDA scan)
42
Hepatic hemangioma
Benign Hepatic artery at the periphery More female Uncommon in cirrhosis
43
Hepatic hemangioma
Nonenhancing center ( cystic degeneration) Peripheral, discontinuous, progressive, nodular enhancement SI is identical to aorta Hyper on T2 with even subtle areas of even higher SI ( cystic degeneration) On CT: hypo mass
44
Hepatic adenoma
``` Benign Hepatocyte Kupffer cells No bile ducts More in females With OCP High risk of hemorrhage Multiple: von Gierke disease ```
45
Hepatic adenoma on imaging
Might have pseudocapsule with late enhancement Hyper on arterial Microscopic fat on in and out phase Internal hemorrhage: T1 hyper
46
Budd Chiari causes
``` Hepatic venous obstruction Hypercoag state Hematologic disease, pregnancy, OCP Malignancy, infection,trauma Congenital vein anomaly ```
47
Budd Chiari symptoms
Acute: hepatomegaly, ascites, abdominal pain ``` Lack of flow in hepatic vein Thrombus in IVC Collateral vessels Edematous periphery Caudate sparing Prominent regen nodules ```
48
Veno-occlusive disease
Destruction of post sinusoid all venules Patent hepatic vein In BM transplant due to chemo ``` Imaging: peripheral edema Narrow hepatic vein Hepatomegaly Hetero enhancement Caudate is not spared ```
49
Cardiac hepatopathy
Heart failure Constrictive pericarditis Right valvular disease Imaging: enlarged vein and IVC reflux of contrast from Right atrium into IVC Mottled enhancement
50
Biliary hamartomas | Von Meyenburg complex
Incidental Small cystic lesions Embryologic failure Smaller and more irregular than simple cysts
51
ADPLD
40% of ADPKD Similar findings Failure is rare Imaging: innumerable no enhancing simple cyst
52
MDCT hepatic trauma
Grade1: superficial laceration,subcapsular hematoma<1cm Grade 2: laceration, subcapsular/intraparenchymal hematoma>1 <3 cm Grade3: >3cm Grade 4: hematoma>10cm or destruction of one lobe Grade 5: destruction of both lobes
53
Magnetic resonance cholangiopancreatography
Heavy T2 weighted Increase contrast between biliary tract and surroundings Fast spin echo sequences Intermediate T2: evaluate extraluminal structures
54
Gad contrasts with biliary excretion
``` Gadoxetic acid disodium ( Eovist) Gadobenate dimeglumine (Multihance) ``` Require 20-45 minutes delay T1 hyper biliary fluid
55
Choledochal cysts classification
Todani system: Type1: CBD fusiform/ most common Type2:extrahepatic saccular Type3:intraduodenal Type4:multiple segments Type5:intrahepatic/ caroli/ associated with PKD Caroli syndrome: disease+hepatic fibrosis Imaging:central dot sign(portal vein and hepatic artery bridging bile ducts) Increase risk of cholangiocarcinoma
56
Cholecystitis
``` Obstruction of GB neck or cystic duct Acute: Wall thickness >3cm Pericholecystic fluid GB hyperemia GB calculi ```
57
Acute cholecytitis complications
Gangrenous: asymmetric GB wall thickening/ intraluminal membrane Acute perforation: high mortality/ bile peritonitis Subacute:pericholecystic abscess Chronic:cholecystoenteric fistula Emphysematous: gas forming bacteria,in lumen or wall/ elderly diabetic
58
Porcelain GB
Peripherally calcified Chronic cholecystitis Increased carcinoma
59
Ascending cholangitis
Fever, abdominal pain, jaundice Imaging: hyper and thickened wall of bile ducts+ CBD stone Tx: AB and fluid then endoscopy
60
PSC
Destruction of bile ducts Associated with UC, most male Imaging: beaded, irregular CBD and intrahepatic ducts Complications: cirrhosis, cholangiocarcinoma,recurrent biliary infection
61
PBC
Destruction of smaller bile ducts Middle aged women, pruritus Hepatic cirrhosis
62
AIDS cholangitis
Cryptosporidium and CMV RUQ pain, fever, LFT Imaging: identical to PSC, distinguished: papillary stenosis
63
Recurrent pyogenic cholangitis
Oriental cholangiohepatitis Clonorchis sinesis Pigment stone, biliary stasis, cholangitis Southeast Asia Recurrent jaundice and fever Imaging: pnemobilia, lamellated bile duct filling defect, intra and extra bile dilation and strictures Increased cholangiocarcinoma
64
Biliary cyst adenoma
Middle aged women Benign Abdominal pain, nausea, vomiting and obstructive jaundice Imaging: large loculated cystic mass, with septation Rarely turns into cystadenocarcinoma( large solid, thick calcification)
65
Cholangiocarcinoma
Hilar tumor: right and left biliary ducts/ Klatskin Bile duct obstruction/intrahepatic dilation Lobar atrophy
66
Risk factors for cholangiocarcinoma
``` Choledochal cyst PSC FAP Clonorchis Sinesis Thorium dioxide ```
67
Cholangiocarcinoma on imaging
Intrahepatic mass at confluence of central bile ducts Bile duct dilation Capsular retraction Tumor fingers in bile ducts
68
Gallbladder carcinoma
Chronic cholecystitis Gallstone Porcelain gallbladder Scirrhous infiltrating mass(most common) Polyploid mass Mural thickening Direct invasion to liver Poor prognosis
69
Gallbladder metastasis
Melanoma
70
Pancreatic neoplasm
Solid epithelial: Ductal Adenocarcinoma, Acinar cell carcinoma Cystic: serous, mucinous,solid and papillary epithelial neoplasm, intraductal papillary mucinous neoplasm Endocrine: insulinoma, gastrinoma, glucagonoma, VIPoma, Somatostatinoma
71
Ductal adenocarcinoma
80-90% of tumors CT: unenhanced, late arterial phase, PVP Late arterial: best phase Pancreatic head Imaging: hypo on CT and T1, ill defined, hypovascular,ductal obstruction and tail atrophy Double duct sign: CBD and pancreatic duct
72
Pancreatic mass with no ductal dilation
``` Autoimmune pancreatitis Groove pancreatitis Cystic tumor Neuroendocrine tumor Duodenal GIST Peripancreatic LN Mets (RCC, Thyroid, melanoma) Lymphoma ```
73
Unresectable PDAC
Encasement of SMA Extensive venous invasion Mets
74
Resectable PDACs
No SMA or celiac or portal invasion Limited duodenum, distal stomach, CBD Limited venous
75
Acinar cell carcinoma
Rare, aggressive Elderly males Lipase hyper secretion syndrome: Sub Q fat necrosis, bone infarcts—> polyarthralgias, eosinophilia
76
Serous cystadenoma
Benign, elderly women > 6 cysts <2 cm Maybe solid on CT—> do MRI Hyper vascular No ductal dilation or tail atrophy Central stellate calcification
77
Mucinous cystic neoplasm
``` Middle aged women Benign with malignant potential Resection <6 cysts >2 cm in body and tail Capsulated ```
78
Capsulated pancreatic tumors
SPEN | Mucinous cystic neoplasm
79
Solid and papillary epithelial neoplasm
Young women and children Abdominal pain Low malignancy Imaging: large, heterogenous solid and cystic, hemorrhage, capsule
80
Intraductal papillary mucinous neoplasm
``` Elderly male Main pancreatic duct or sidebranch Main duct more malignancy Endoscopy: fish-mouth papilla Imaging: cystic in contiguity with duct Nodular or enhancing —> malignancy <1 cm annual follow up >3 , mural nodule, ductal dilation—> resection ```
81
Pancreatic endocrine tumors
Hyper vascular Late arterial phase Solid Hyper vascular liver+ pancreatic mass—> Pancreatic endocrine tumors Mets
82
Insulinoma
Presents early | Whipped triad: hypoglycemia, symptoms, better with glucose
83
Gastrinoma
Zollinger- Ellison If in MEN 1–> duodenum Location: gastrinoma triangle/ junction of cystic duct and CBD, duodenum (inferior),pancreas neck(medial) Can cause stomach carcinoid
84
Pancreatic duct anatomy
Main duct drains the tail(always)—>duct of Wirsung—> major papilla (ampulla of Vater) CBD always meets Wirsung at major papilla Santorini, superior, always goes to minor papilla Sphincter of Oddi at ampule of Vater
85
Pancreas divisum
Failure of fusion of dorsal (main) and ventral duct(Wirsung) Majority drains by Santorini Pancreatitis, santorinicelr Imaging: crossing sign: CBD crossing over main duct to join Wirsung
86
Annular pancreas
Failure of ventral bud rotation Pancreas around duodenum Neonate: double bubble sign Adults: pancreatitis,PUD, duodenum obstruction
87
Common channel syndrome
Pancreaticobiliary maljunction Usually: CBD and Wirsung are separate Common channel syndrome: no septum, reflux between two systems Cholangiocarcinoma
88
Pancreas in von Hippel Lindau
Serous cystadenoma | Pancreatic neuroendocrine tumors
89
Pancreas in cystic fibrosis
Childhood atrophy | Fatty atrophy or pancreatic cystosis
90
Pancreas in Schwachman Diamond
Fatty replacement Exocrine insufficiency Neutropenia Bone dysplasia
91
Intrapancreatic accessory spleen
``` 1-3 cm Well defined Pancreatic tail DDx: MRI Tc-99m sulfur colloid or Tc-99m RBC scintigraphy ```
92
Imaging of pancreatitis
Late arterial (40 s after injection) CT is key Not indicated in mild acute pancreatitis
93
Acute pancreatitis Balthazar classification
``` A: normal B: enlargement C: mild peripancreatic inflammation D: single fluid E: two or more fluid A,B,C: 0 mortality, 4 morbidity D, E: 14 mortality, 54 morbidity ```
94
Acute pancreatitis CT severity classification
0-4 for Balthazar A-E 0: 0 necrosis 2: <30 4: 30-50 6: >50 CTSI: 0-3: 3 mortality, 8 morbidity 7-10: 17 mortality, 92 morbidity
95
Pancreatitis pancreatic complications
Necrosis: focal or diffuse nonenhancing/ after 48-72 hours/ late arterial phase/ risk of infection Fluid collection: peripancreatic Pseudocyst: enzyme collection, fibrous wall, 4-6 weeks Abscess: purulent, thicker, irregular wall, gas locales
96
Pancreatitis extrapancreatic complication
Pseudocyst: anywhere below diaphragm Perihilar renal inflammation: venous compression, thrombosis Bowel:transverse colon Adjacent vascular inflammation: Arterial bleeding—> splenic artery erosion Pseudoaneurysm—> splenic artery Venous thrombosis—> splenic vein—> portal HTN
97
Chronic pancreatitis
Long term alcohol, pancreas divisum | Calcification along pancreatic duct
98
Autoimmune pancreatitis
Lymphoplasmacytic infiltrate Sjogren syndrome, IgG4 Imaging: diffuse, sussage shaped entire pancreas Focal—> mimics mass Tx: steroid
99
Groove pancreatitis
Focal pancreatitis Between head, duodenum and CBD Heavy drinker young man Fibrosis in pancreaticoduodenal groove Can cause: duodenal stenosis, cystic change of duodenal wall Imaging: duodenal thickening, cystic changes on MRI DDx: adenocarcinoma
100
Peritoneum
Single layer of mesothelial cells supported by subserosal fat, lymphatic cells and WBC Most dependent For women: pouch of Douglas Men: retrovesical area
101
Mesentry
Blood vessels and lymphatic between peritoneal layers True:connects to posterior abdominal wall Small bowel—>jejunum and ileum/from ligament of Treitz (LUQ) to ileocecal junction( RLQ) Transverse—>posterior transverse to posterior wall Sigmoid—>sigmoid colon Omentum: specialized, attach to stomach, not to posterior wall Greater—>anterior abdomen/ stomach to anterior transverse colon Lesser—>stomach to liver
102
Misty mesentry
Mesenteries are fatty fold—> normally not seen on CT | Fluid or inflammation —>mesenteric vasculature become in distinct
103
Mesenteric edema
Systemic: diffuse edema, CHF, low protein, third spacing | Intra abdominal: focal edema, vessel thrombosis, Budd Chiari, IVC obstruction
104
Bowel ischemia
Vascular insult | Imaging: bowel wall thickening, pneumatosis, mesenteric venous gas
105
Mesenteric inflammation
Most common: acute pancreatitis Appendicitis, IBD, diverticulitis, Local misty mesentery
106
Neoplastic infiltration
Misty mesenteric after tx limited to treated LN Most common: NHL, bulky adenopathy Pancreatic, colon, breast,GIST, mesothelioma
107
Carcinoid
Most common small bowel tumor Distal ileum Intraluminal—>mesentery(direct or lymphatic) Imaging: enhancing mass with radiating linear bands into mesenteric fat (intense desmoplastic reaction by serotonin), calcification
108
Sclerosing mesenteric mass
Carcinoid Desmoid tumor Sclerosing mesenteritis
109
Desmoid tumor
Benign, locally aggressive Fibrous tissue Gardner syndrome( FAP) CT: iso to muscle, central necrosis, strands of tissue radiating to mesenteric fat
110
Sclerosing mesenteritis
Fatty necrosis and fibrosis of mesenteric root | Mesenteric mass with striation of ST, calcification
111
Panniculitis
idiopathic inflammation Acute abdominal pain CT: diffuse misty mesentery, linear bands of ST
112
Mesenteric Mets
Gastric, ovarian, breast, lung,pancreatic,biliary, colon, melanoma Mesenteric lymphoma: Sandwich sign
113
Peritoneal carcinomatosis
Disseminated metastasis Omental caking Mucinous adenocarcinoma
114
Pseudomyxoma peritoneal
Low grade/ copious mucus in peritoneal cavity Mucin producing adenoma or adenocarcinoma Appendix(20%), ovaries(30%) or colon Involves entire peritoneal cavity Recurrent mucinous ascites ( jelly belly) CT: lobular ascites, higher attenuation than fluid Advanced: scalloping of hepatic margin Tx: surgery, hyperthermia intra peritoneal chemotherapy lovage
115
Splenule
Accessory spleen Splenic Hilum MRI: follows splenic tissue Tc-99m sulfur colloid/ heat damaged Tc-99m RBC
116
Polysplenia syndrome
Visceral heterotaxia Multiple Foci of splenic tissue on the same side as the stomach Severe cardiac anomalies Venous anomalies( interruption of IVC with azygos or hemiazygos, preduodenal portal vein)
117
Wandering spleen
Abnormal laxity Presents as abdominal mass Acute abdominal pain due to torsion
118
Hemangioma of spleen
Most common Kasabach-Merritt: anemia, thrombocytopenia, consumptive coagulopathy) Klippel-Trenaunay-Weber:cutaneous hemangioma, varicose vein, extremity hypertrophy Associated with phleboliths CT: pre—> iso/ hypo hyperenhancing MR: T2–> hyper Peripheral/ homogenous enhancement NM: Tc-99m RBC—> delayed images
119
Spleen hamartoma
Malformed red pulp Tuberous sclerosis CT: pre: iso/ hypo mass heterogenous enhancement MR: T2: iso, heterogenous early enhancement—> homogeneous delayed enhancement
120
True splenic cyst
Epithelial lining Increased CA 19-9, CA125 , CEA Septation Calcification uncommon
121
Post-traumatic pseudocyst
End result of hematoma Imaging: well circumscribed, fluid density, no peripheral enhancement Septation uncommon Calcification common
122
Intrasplenic pancreatic pseudocyst
Post pancreatitis pseudocyst at tail extends into spleen Like post traumatic Can cause splenic rupture
123
Spleen lymphangioma
Childhood Solitary or multiple Multilocular cystic structure with thin septation Post contrast—> septal enhancement
124
Spleen sarcoidosis
Multiple nodule with noncaseating granulomas Splenomegaly, hepatomegaly, LAP Multi nodular pattern: numerous hypo 1-3 cm lesions no enhancement Imaging: hypo on all MR sequences Better seen on T2 and early post -T1 DDx: lymphoma
125
Inflammatory pseudotumor in the spleen
Focal collection of immune cells and exudate Fever and malaise Imaging: well circumscribed, heterogenous enhancing
126
Pyogenic abscess in spleen
Immunocompromised Solitary—> bacterial Multi focal—>fungal CT: irregular, enhancing wall Gas—> bacteria US—>wheel within a wheel, bull’s eye Tx: drainage
127
Fungal abscess in spleen
Multiple <1cm Immunocompromised Candida, aspergillus, cryptococcal CT: hypo Pneumocystis jiroveci—> advanced AIDS, multi calcified lesions
128
Echinococcal cyst in spleen
Associated with other organs True cyst Imaging: internal undulating membrane and daughter cysts
129
Splenic lymphoma
Most common malignancy Primary: rare, solitary, hypo, extends beyond capsule Secondary: Miliary masses, multiple small to moderate, one large,splenomegaly without mass Best on post T1/involved portion will be hypo US—> cystic Color—> internal flow
130
Splenic Mets
Low rate of Mets Most common—> breast,lung,ovarian,melanoma Ovarian and melanoma—> cystic Calcification—> mucinous adenocarcinoma
131
Angiocarcinoma of spleen
Rare Aggressive 20% 6month survival Enlarged, heterogenous Variable enhancement
132
Splenic infarct
Emboli(older) Thrombosis(young with hematologic disease) Wedge shaped peripheral region non enhancement MR: acute—> T1 hyper. Chronic—> T2 hyper Lack of enhancement of entire spleen—> torsion(wandering spleen)
133
Gamma Gandy bodies
Tiny foci of hemosiderin—> portal HTN Hypo on all sequences In phase—> blooming
134
Portal HTN
``` Splenomegaly Varices Recanalized umbilical vein Ascites Nodular liver contour ```
135
Gaucher disease
AR deficiency of glucocetebrosidase Splenomegaly, multiple splenic nodules Bone: Erlenmeyer flask deformity of distal femurs, femoral head AVN, H shaped vertebral bodies
136
Evaluating spleen trauma
Portal venous phase
137
Splenic hematoma
Most—> subcapsular | Hypo to enhanced spleen
138
Splenic laceration
Only on contrast enhanced | Linear or branching hypo
139
Splenic vessel injury
Active extravas—> area of hyper which increases in size on delayed phase Pseudoaneurysm/AV fistula—> well circumscribed hyper but do not increase on delayed ( differentiate with splenic arteriography)
140
MDCT based splenic injury grading system
``` Grade 1: <1cm subcap Grade 2: >1 and <3 subcap Grade 3: splenic capsular, >3 cm lac Grade IVA: active extravas, vascular injury, shattered spleen Grade IVB: active intraperitoneal bleed ```

Radiology (3 decks)

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