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GI DDx Flashcards

(108 cards)

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1
Q

Hypo-attenuating Liver

A

Fatty liver / hepatic steatosis

Hepatic amyloid

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2
Q

Hyper-attenuating Liver

A

Absolute attenuation > 75HU on non-con.

Iron overload.
- primary haemochromatosis: liver and pancreas
- secondary haemochromotosis: Liver and spleen.
Medications - amiodarone, gold, methotrexate.
- check lung bases for ILD.
Wilsons disease (Copper)
Glycogen excess.
Thoratrast

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3
Q

Multiple tiny hypo-attenuating hepatic lesions:

A 
Candidiasis: immunocompromised.
Mets.
Lymphoma
Biliary hamartomas.
Caroli Disease.
Sarcoidosis - check spleen for same.
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4
Q

Hypervascular hepatic Mets:

A 
Neuroendocrine tumours: pancreatic neuroendocrine and carcinoid.
RCC
Thyroid carcinoma
Melanoma
Sarcoma
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5
Q

Hepatic Capsular retraction:

A 
Metastatic tumor (commonly post Tx)
Fibrolamellar HCC
HCC (rare)
Epitheloid haemangioendothelioma
Intrahepatic cholangiocarcinoma
Confluent hepatic fibrosis
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6
Q

Pancreatic Mass without ductal dilation:

A 
Autoimmune pancreatitis
Groove pancreatitis
Cystic pancreatic tumour
Neuroendocrine tumour
GIST
Peri-pancreatic lymph node
Pancreatic Mets: RCC, thyroid, melanoma.
Lymphoma
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7
Q

Cystic Pancreatic Neoplasm:

A

Serous cystadenoma: Senile Grandmother, hypervascular, no duct dilation or tail atrophy, central stellate Ca++. (seen in VHL)

Mucinous cystic neoplasm: mother, benign with malignant potential, single / few large cysts, commonly body / tail, capsule.

Solid Papillary Epithelial Neoplasm (SPEN): daughter, low malignant potential, heterogenous solid cystic mass, haemorrhage, capsule.

Intraductal Papillary Mucinous Neoplasm (IPMN): grandfather, variable - can be malignant, main duct or side branch.

Pancreatic neuroEndocrine neoplasm: commonly central necrosis and Ca++, hypervascular. Hypervascular liver mass with associated pancreatic mass most likely metastatic pancreatic endocrine neoplasm. (Seen in VHL)

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8
Q

Hepatic lesion with a scar:

A 
Focal nodular hyperplasia
Fibrolamellar HCC: wild looking, T2 hypointense scar.
Cholangiocarcinoma
Haemangioma
HCC
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9
Q

Liver lesion with a capsule:

A

Adenoma
HCC
Cystadenoma / cystadenocarcinoma.

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10
Q

Liver lesion with central calcification:

A

Metastases (especially in colorectal tumors - mucinous)
Fibrolamellar carcinoma (FLC) - wild and large
Cholangiocarcinomas
Hemangiomas

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11
Q

Liver lesion containing fat:

A 
Adenoma
HCC
Metastatic liposarcoma
Angiomyolipoma
Glissons capsule lipoma / pseudo lipoma

Consider Dropped gall stone.

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12
Q

Liver lesion containing blood / haemorrhage

A

Adenoma

HCC

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13
Q

Cystic liver lesion:

A 
Simple cyst
Traumatic cyst
Bilioma
Caroli's disease
Cystic Mets
Abscesses
Hydatid disease
Biliary cystadenoma
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14
Q

Hypervascular liver lesion:

A

Benign:
Focal nodular hyperplasia
Adenoma
Haemangioma (looks like fire on PV, peripheral discontinuous nodular enhancement)

Aggressive:
HCC
Hypervascular Mets: RCC, thyroid, melanoma, neuroendocrine, breast, sarcomas.

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15
Q

Common causes liver capsule retraction:

A

Cholangiocarcinoma
Mets - commonly treated breast.
Focal atrophy due to biliary or venous obstruction.

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16
Q

Stomach Rams Horn Deformity:

A

Scarring from peptic ulcer disease.
Granulomatous disease: Crohns, sarcoid, TB, Syphillis.
Scirrhous Carcinoma.

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17
Q

Dilated oesophagus:

A

Achalasia
Pseudoachalsia
Scleroderma.

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18
Q

Liver mass with capsule retraction

A 
Focal confluent fibrosis
Peripheral cholangiocarcinoma
Mets / lymphoma.
HCC
Epithelioid haemangioendothelioma
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19
Q

Fat containing liver mass

A 
Steatosis (normal traversing vessels)
Pericaval fat deposition
HCC (small foci)
Hepatic adenoma
Hepatic Mets
Hepatic angiomyolipoma (TS, renal AMLs)
Alcohol ablated liver tumour
Teratoma
Liposarcoma
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20
Q

Mosaic / patchy hepatogram:

A 
Passive hepatic congestion
Hepatitis
Cirrhosis
Steatosis
Budd Chiari syndrome
Hereditary Haemorrhagic Telangiectasia
Congenital Hepatic Fibrosis
Hepatic sarcoidosis
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21
Q

Hepatic Ca++:

A

Calcified granuloma (histoplasmosis > Tb)
Hepatic Mets (mucinous colon, breast, ovary, stomach)
Arterial Ca++
Ethiodol treated lesions
Cavernous Haemangioma
Hydatid cyst
Fibrolamellar HCC

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22
Q

Dysmorphic Liver with abnormal Bile Ducts:

A 
PSC
Cholangiocarcinoma
Cholangitis
AIDS cholangiopathy
Fibropolycystic liver disease (Caroli disease)
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23
Q

T1 hyperintense Liver lesions:

A 
Steatosis
Hepatic adenoma
HCC
Haemorrhagic hepatic cyst
Dysplastic and regenerative nodules
Liver haematoma
Hepatic Mets
Pyogenic abscess
Focal nodular hyperplasia
Hepatic angiomyolipoma
Peliosis
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24
Q

Liver lesion with capsule / Halo:

A 
Hepatic Mets
Pyogenic abscess
HCC
Haematoma
Adenoma
Hydatid cyst
Amebic abscess
Focal nodular hyperplasia
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25
Focal Hyperdense Hepatic Mass on Non enhanced CT
``` Cirrhotic Regenerating Nodule Mass within fatty liver Focal sparing in fatty liver Mets Haematoma Haemorrhage within adenoma / HCC ```
26
Focal hepatic echogenic lesion +/- acoustic shadowing:
``` Focal steatosis Calcified granuloma Haemangioma Mets Pneumobilia Intra hepatic biliary calculi Pyogenic hepatic abscess Portal venous gas HCC Fibrolamellar HCC Cholangiocarcinoma ```
27
Pancreatic duct dilation
Chronic pancreatitis Pancreatic ductal adenocarcinoma Periampullary tumour Obstructing distal common bile duct stone Intra ductal papillary mucinous neoplasm.
28
Hypovascular Pancreatic Mass:
``` Pancreatic ductal adenocarcinoma Chronic pancreatitis Mucinous cystic neoplasm Serous cystadenoma Ampullary carcinoma. ```
29
Hypervascular Pancreatic Mass:
``` Pancreatic neuroendocrine tumour Pancreatic Met (RCC) Pancreatic serous cystedoma with multiple enhancing septations. ```
30
Cystic Pancreatic Mass:
Intraductal papillary Mucinous Neoplasm (elderly men) Pancreatic psuedo cyst Pancreatic serous cystadenoma ("senile head of family") Mucinous cystic neoplasm (Mother, body/tail) Solid Psuedopapillary Neoplasm (Daughter, Race minor)
31
Atrophy or Fatty replacement pancreas:
``` Chronic pancreatitis Senescent change Obesity Cystic Fibrosis Cushing syndrome / steroid use Lipomatous pseudohypertrophy Shwachman-Diamond syndrome Agenesis dorsal pancreas. ```
32
Infiltration of peripancreatic fat planes:
``` Acute pancreatits Pancreatic ductal carcinoma Anascara and portal HTN Traumatic pancreatitis Duodenal / gastric ulcer Shock pancreatits Sclerosising mesenteritis Autoimmune pancreatitis Lymphoma ```
33
Pancreatic calcifications:
*Pancreatic adenocarcinoma alsomost never shows Ca++. Chronic pancreatitis Senescent change Peripancreatic vascular calcification - splenic artery Choledocholithiasis Pancreatic neuroendocrine tumour Pancreatic serous cystadenoma - central Ca++ Pancreatic muscinous cystic neoplasm - septation Ca++ Solid pseudopapillary Neoplasm - Ca++ common. Pseudocyst
34
Distended Gall bladder:
``` Cholecystits Obstruction of CBD: choledocholithiasis, pancreatic ductal carcinoma, ampullarf carcinoma. Acute pancreatitis. Hepatitis. Gall bladder empyema AIDs Cholangiopathy ```
35
Pneumobilia / Pneumo-gall bladder:
``` Sphincterotomy Choledocholithiasis Patulous Sphincter of Oddi Biliary Enteric Anastomosis Emphysematous cholecystitis. Gass within gall stones. Gall stone ileus / cholecysto-enteric fistula Pyogenic cholangitis. ``` *Portal venous gas mimic: gas flows toward and collects in periphery of liver, on US causes spiky appearance on portal vein doppler. Biliary gas collects near porta hepatis.
36
Hyper dense bile within Gall bladder:
``` Vicarious excretion Layering of small gall stones. Gall bladder sludge. Hepatic / biliary trauma. Milk of calcium bile. ```
37
Asymmetric Dilation of Intrahepatic Bile Ducts:
``` PSC Cholangiocarcinoma ascending cholangitis HCC Hepatic mets or lymphoma AIDs cholangiopathy Recurrent pyogenic cholangitis. Gall bladder carcinoma, with infiltration. ``` IgG4 disease causes a more diffuse picture of biliary involvement.
38
Hypointense Lesions in biliary tree on MRCP:
Choledocholithiasis Pneumobilia Surgical clip Post transplantation biliary stricture.
39
Hypervascular Liver Mets:
``` Islet cell tumour Carcinoid Thyroid Renal Pheochromocytoma ```
40
Liver mass with scar:
FNH: scar T2 bright, delayed enhancement. Haemangioma Fibrolamellar HCC: scar T2 dark, delayed partial C+, large wild looking. HCC Peripheral cholangiocarcinoma
41
Focal liver lesion with haemorrhage:
``` Trauma Hepatic adenoma HCC Hepatic cyst AD polycystic disease ```
42
Cystic hepatic Mass:
``` Hepatic cyst AD polycystic disease Pyogenic abscess Amebic abscess Biliary hamartoma Bilioma Mets. ```
43
Focal Hypervascular Liver lesion:
``` Haemangioma FNH arterial portal shunt THAD HCC Hepatic Mets Hepatic adenoma Hepatic AV malformation (Osler Weber Rendu) Dysplastic Nodular Regenerative nodules Fibrolamellar HCC Peliosis Hepatitis ```
44
Periportal lucency:
``` Hypervolaemia Passive hepatic congestion Acute hepatitis Ascending cholangitis POst transplant biliary necrosis. ```
45
Diffuse gall bladder wall thickening: (>3mm)
Fluid overload / oedema: - Cirrhosis - CHF - Protein wasting nephropathy Inflammatory / Infectious: - Cholecystitis - Hepatitis - Pancreatitis - Diverticulitis Infiltrative neoplastic diseases: - GB carcinoma - GB mets - melanoma (rare)
46
Focal GB wall thickening
Adenomyomatosis and cholesterol polyp Varices Adenomatous polyp GB carcinoma Xanthogranulomatous cholecystitis. Porcelain GB Melanoma Mets.
47
Hypervascular pancreatic Mass:
Pancreatic islet cell tumour Pancreatic Met Serous cyst adenoma accessory spleen.
48
Multiple Biliary strictures:
``` PSC Ascending cholangitis AIDS cholangiopathy Post transplant liver Recurrent pyogenic cholangitis Caroli disease. Chemotherapy cholangitis. ```
49
Pancreatitis Complications
Interstitial oedematous pancreatitis. Necrotising pancreatitis. Infected pancreatic necrosis Central necrosis (disconnected duct syndrome) Extra hepatic fat necrosis Pseudoaneursym (splenic, gastroduodenal, pancreaticoduodenal arteries). Venous thrombosis (splenic vein, portal vein, SMV). Fluid collections: - Acute peripancreatic fluid collection: < 4 weeks post oedematous pancreatitis. - Pseudocyst: persisting > 4 weeks post oedematous pancreatitis. - Acute post necrotic fluid collection: <4weeks post necrotising pancreatitis. - Walled off necrosis: > 4 weeks post necrotising pancreatitis.
50
Multiple splenic Ca++:
``` Histoplasmosis TB arterial Ca++ and aneurysm Pneumocystis Carinii Splenic infarction Splenic cyst Hydatid cyst ```
51
Solid Splenic Mass or Masses:
``` Splenic trauma Splenic infarction Splenic mets Lymphoma Sarcoidosis Infection / abscess. ```
52
Cystic Splenic Mass:
``` Splenic cyst: acquired or congenital. Splenic trauma Splenic infarction Splenic Mets Splenic lymphoma Infection / abscess. ```
53
Diffuse increased spleen attenuation:
Haemochromatosis secondary form. Splenic infarction: sickle cell anaemia. Opportunistic infection.
54
Multiple Colonic Filling Defects:
``` Feacal material Colonic Polyps Colon Carcinoma UC Familial polyposis Gardner syndrome ```
55
Colonic Fistula:
``` Diverticulitis Colon Carcinoma Cervical Carcinoma Endometrial Carcinoma Ovarian Carcinoma Cystitis Crohn Disease ```
56
Segmental Colonic narrowing:
``` Colon Carcinoma Diverticulitis Ischaemic colitis Colonic Mets colonic Spasm Infectious colitis Ulcerative colitis. TB Radiation colitis ```
57
Smooth Ahaustral Colon
``` UC Cathartic abuse Crohn Disease Senescent change Toxic megacolon Ischaemic colitis Radiation Colitis ```
58
Multiple masses or filling defects in Small Bowel:
``` Lymphoid follicles Intestinal parasitic disease Intestinal Mets Intramural benign intestinal tumours. Hamartomatous polyposis syndromes Gardner syndrome. ```
59
Aneurysmal dilation of small bowel lumen:
``` Small bowel lymphoma. Small bowel Mets. Bowel-bowel anastomosis. GIST. Small bowel diverticula. Meckel diverticulum. ```
60
Irregular Diffuse Small Bowel Fold Thickening:
``` Celiac disease Oppurtunistic intestinal infections. Whipple disease. Portal HTN varices. Ischaemic enteritis. Mets. ```
61
Occult GI bleeding:
``` Intestinal Vascular ectasia Crohn Disease Mets / lymphoma GIST Carcinoid. Small bowel carcinoma. Small bowel vasculitis. Ischaemic enteritis. ```
62
Splenomegaly:
Massive: - Myeloproliferative disorders, CLL, Hairy cell leukaemia - Lymphoma - Malaria - Gaucher disease. Moderate: - Chronic congestive: portal HTN, splenic vein obstruction. - Hereditary spherocytosis - Thalassemia - Autoimmune haemolytic anaemia - Acute leukaemia - Amyloidosis - Niemann Pick disease - LCH - TB - Sarcoidosis - Mets. Mild to moderate: - Cirrhosis with Portal HTN. - Acute Congestion. - Inflammatory / infection: mononucleosis, hepatitis, SLE.
63
Duodenal filling Defects:
``` Prolapsed astral mucosa Duodenal polyps Brunner Gandhi hyperplasia. Pancreatic ductal carcinoma Duodenal lipoma. Duodenal haematoma Duodenal carcinoma. ```
64
Gastric antral narrowing:
``` Gastritis Gastric ulcer Gastric carcinoma Pancreatitis Post surgery. GIST. ```
65
Target / Bull's Eye lesion stomach:
``` Gastric Mets Gastric lymphoma Kaposi Sarcoma Gastric carcinoma Ectopic pancreatic tissue GIST. ```
66
Gastric Ulceration without mass:
``` NSAID induced gastritis Gastritis Gastric ulcer Gastric carcinoma Zollinger Ellison syndrome. Crohn disease. ```
67
Linitis PLastica:
``` Gastric carcinoma Mets Caustic injury Gastritis Peritoneal mets. Crohns disease Oppurtunistic infection. ```
68
Oesphageal ulceration:
Reflux oesophagitis. Candida Oesophagitis. Viral oesophagitis: - CMV and HIV are large: "V" = Very large and 'V" go together. - Herpes multiple small and discrete and focal, with Halo. Drug induced, caustic, radiation oesphagitis. Oesphageal carcinoma.
69
Extrinsic mass Oesophagus:
``` Left main bronchus. Aortic arch. Aortic Aneurysms. Hiatal hernia. Mediastinal nodes. Aberrant RSCA. Enlarged thyroid. ```
70
Intraluminal Mass Oesophagus:
``` Oesphageal Carcinoma Oesophageal FB Intramural Benign Oesophageal tumour. Thrombosed oesophageal varies. Inflammatory polyp. Candida Oesphagitis. ```
71
Oesophageal Strictures:
``` Reflux Barretts Carcinoma Scleroderma Mets Radiation Caustic Drug induced. Phemagoid. ``` ``` Feline oesophagus: - Fine small rings - Distal 2/3, transient, seen with ruflux. Eosinophilic oesophaus - Thicker Ring like, not transient. ``` Oesophageal web: - Anteriorly located. - assess for Plummer Vinson syndrome.
72
Oesophageal Dysmotility:
``` Presbyesophagus Diffuse oesphageal spasm Achalasia Scleroderma Reflux Fundiplocation complication ```
73
Oesophageal Outpouching / Diverticula:
``` Zenker Diverticulum Traction Diverticulum Pulsion Diverticulum Killen Jameson diverticulum Intramural pseudo diverticulosis. ```
74
Crohn's disease Features:
``` "CROHNS" C: Cobble stone mucosa R: rose thorn ulcers O: Obstruction of bowel H: Hyperplasia of mesenteric nodes N: Narrowing of lumen S: skip lesions ```
75
Bowel Sacculations:
``` "MISC" M: Mets I: Ischaemia S: Scleroderma C: Crohn Disease ```
76
Generalised Colitis:
``` I3 NR: Infectious Colitis (E. Coli, CMV) Inflammatory (Pseudomembranous colitis, Crohn, UC) Ischaemic Neoplastic (lymphoma) Radiation ```
77
Cystic lesions of spleen:
``` "TEAM" T: Trauma E: Echinoccoal A: Abscess M: Mets ```
78
Echogenic GB wall
Porcelain GB GB packed full of stones (wall echo sign) Emphysematous cholecystitis
79
Diffuse GB wall thickening > 3mm
``` Fluid overload: - cirrhosis - CHF - Protein wasting nephropathy Inflammation / infection: - Cholecystits - Hepatitis - Pancreatitis - Diverticulitis Infiltrative Neoplastic Disease: - GB carcinoma - Mets (rare) ```
80
Focal GB wall thickening:
``` Hyperplastic cholecystoses: - Adenomyomatosis - Cholesterol Polyp Varicies Neoplastic Disease: - Adenomatous polyp - GB carcinoma - Adjacent hepatic tumour. ```
81
Non shadowing mass in gall bladder lumen:
``` Tumefactive sludge (mobile) Blood / pus (mobile) GB polyp (immobile) GB carcinoma (immobile) ```
82
Hyperechoic Hepatic Mass:
``` Haemangioma Focal steastosis Hepatic Met (colon, RCC, breast, carcinoid, choriocarcinoma) Pyogenic abscess (Usually anechoic, while early lesions can be echogenic with poorly defined margins) Hyperechoic HCC Calcified granuloma Hepatic adenoma Hepatic angiomyolipoma. ```
83
TIPS Stenosis signs on US:
High intra TIPS velocity >190cm/s or low intra TIPS velocity < 90cm/s suggests stenosis. Intra TIPS velocity change of 50cm/s or more since baseline is concerning for stenosis Low main portal vein velocity <30cm/s suggests TIPS stenosis. TIPS occluded shows re reersal of flow in left and right portal veins becoming hepato-peta.
84
Echogenic GB wall:
Porcelain GB Gall bladder full of stones - wall echo shadow sign Emphysematous cholecystitis
85
Hypoechoic hepatic Mets:
Breast Pancreas Lung Lymphoma
86
Hyperechoic hepatic mets:
``` Colon cancer RCC Breast Carcinoid Choriocarcinoma. ```
87
Calcified hepatic mets (Hyperechoic with acoustic shadowing):
Colon cancer (mucinous) Gastric adenocarcinoma Osteosarcoma
88
Cystic Hepatic Mets:
Ovarian cystadenocarcinoma | Gastrointestinal sarcoma
89
Sparse liver Calcification on AXR:
Mucinous adenocarcinoma Met Calcified giant cavernous haemangioma Granulomatosis: TB, Histoplasmosis, brucellosis Psuedomyxoma peritonei
90
Haemochromatosis: primary vs secondary
Liver dark on T1 and T2 Low signal on IN PHASE, high signal on out of phase (Opposite to steathosis / fatty liver) IRON on IN-phase. Primary: AR inherited. - Pancreas involved. Secondary: transfusions - Spleen involved, pancreas spared. - Stem cells of bone marrow involved.
91
Massive caudate lobe hypertrophy:
Budd Chiari Primary Sclerosing Cholangitis Primary Biliary Cirrhosis.
92
Splenic lesion DDx (Bayley)
Greater than 50% of the time lesions are non-specific MRI of limited use Often comes down to followup or biopsy 1) Sarcoidosis - Usually multifocal lesions - Very common - Look at lungs/nodes 2) Metastases - Most common primary is melanoma - Usually small - Look for other metastases elsewhere, rarely the only site 3) SANT (sclerosing angiomatoid nodular transformation) - Rare as hens teeth - Strange looking 4) Gamna-Gandy bodies - Look for cirrhosis and evidence of portal hypertension - Blood products in the spleen - Not important pathologically but explains unusual splenic appearance 5) Cyst - Common - Normal cyst characteristics with thin wall and no enhancement - In children differential diagnosis is epidermoid 6)Hamartoma 7) Lymphoma - Non-specific focal lesions, look a bit like liver metastases - Look for other signs, nodes, enlargement - Quite common
93
Intussesception causes:
Children - no lead point found, likely hyperplastic lymphoid tissue gastrointestinal malignancy (most common cause in adults, accounting for 65% ) - colorectal carcinoma (most common) - metastases, e.g. malignant melanoma, breast cancer, lung cancer - small bowel lymphoma/Burkitt lymphoma benign neoplasms - gastrointestinal stromal tumour (GIST) - intestinal polyps - intestinal lipoma - polypoid haemangioma - appendiceal mucocele congenital - Meckel diverticulum: think in distal small bowel! - duplication cyst - ectopic pancreas - inflammatory - periappendicitis trauma - mural haematoma
94
Nodular liver contour:
``` Cirrhosis Treated breast metastases Bud Chiari syndrome schistosoma infection Confluent hepatic fibrosis. ```
95
Oesphageal pseudodiverticula:
Reflux oesphagitis - assess for hiatal hernia. Candida - longitudinal plaques. Superficial spreading carcinoma Drug induced oesphagitis
96
Gastric fold thickening:
``` Gastritis Gastric carcinoma Lymphoma Metastatic disease menetrier disease ```
97
Ceacal pole mass:
appendicitis / appendiceal abscess Ceacal / appendiceal carcinoma Mucocele of appendix. Lymphoma.
98
Colonic wall thickening:
infectious colitis Inflammatory bowel disease Colon carcinoma Ischaemic colitis
99
Swallow: high stricture with associated hiatal hernia. Reticular mucosal pattern.
Barretts Oesphagus
100
Swallow: transient fine transverse folds mid-lower oesphagus.
Feline oesphagus.
101
Ribbon Bowel
Graft v Host
102
hide bound bowel:
scleroderma
103
Moulage sign / tube of wax:
Dilated jejunal loop with complete loss of jejunal folds = celiac
104
Fold reversal:
Celiac
105
Thread like defect in barium column in small bowel
Ascaris Suum
106
Clover leaf sign:
Healed peptic ulcer of duodenal bulb
107
Lemmel syndrome
Lemmel syndrome is defined as obstructive jaundice caused by a periampullary duodenal diverticulum compressing the intrapancreatic common bile duct with resultant bile duct dilatation.
108
Low density nodes DDx:
Cystic / necrotic: - metastatic carcinome / lymphoma. - Infectious: TB or fungal - Celiac disease. Fat containing nodes: - Whipple disease - Extra adrenal myelolipoma.

A DDx (14 decks)

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