KEYS OF RADIOLOGY SPOTTERS GIT
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Transcript of KEYS OF RADIOLOGY SPOTTERS GIT
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SPOTTERS-KEYSDR. ANISH CHOUDHARY, JR 3
30.05.16
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Zenker’s diverticulum
Findings:
Focal contrast collection along the posterior lateral proximal esophagus connecting by a thin neck
Found at the cricopharyngeus, the Killian’s dehiscence
ddx:
NONE!
This is an Aunt Minnie!
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Gastric carcinoma
Findings:
Large mass projecting into the fundus with a large central ulcer
loss of normal folds and wall contour
ddx:
leiomyosarcoma
lymphoma
metastasis
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Long esophageal stricture
Findings:
long segment of esophageal narrowing
loss of normal mucosal pattern
ddx:
Long-term nasogastric intubation
radiation
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Achalasia
Findings:
tight stenosis of the distal gastroesophageal junction = “bird’s beak” appearance
dilated proximal esophagus
ddx:
pseudoachalasia
Malignant stricture
Benign stricture
Chagas disease
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Pancreatitis
Findings:
diffuse narrowing of the duodenum
splaying of the “C-loop
loss of normal mucosal pattern
ddx:
large tumor
pseudocyst
hemorrhage
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Area gastrica
Findings:
Fine linear polygonal pattern of the gastric body seen on a double contrast study
This is a normal fold pattern
ddx:
NONE!
This is an Aunt Minnie!
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7.
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Ascariasis
Findings:
serpentine intraluminal foreign bodies = ascaris worms
thin ribbon of contrast = barium WITHIN worm GI tract
ddx:
NONE!
This is an Aunt Minnie!
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8.
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Barrett’s esophagus
Findings:
Segmental narrowing of the distal esophagus with smooth tapering margins, ulcerations, and loss of normal mucosal pattern
ddx:
GERD
radiation
malignancy
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Boerhaave’s syndrome
Findings:
focal horizontal contrast extravasation in the posterior distal esophagus
surrounding abnormal posterior mucosa
ddx:
Iatrogenic
Tumor
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Brunner’s gland hyperplasia
Findings:
multiple smooth and round filling defects up to 1cm involving the bulb and descending duodenum
due to increased acidity in the duodenal bulb
ddx:
Hyperplastic polyps
Familial polyposis syndromes
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Bezoar
Findings:
mass-like gastric luminal filling defect composed of undigested or partially digested food
may cause obstruction
ddx:
NONE!
This is an Aunt Minnie!
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Pseudomembranous colitis
Findings:
numerous thickened folds of the transverse and descending colon
sloughed mucosa or debris within the lumen
ddx:
Ischemic colitis
Ulcerative colitis
Crohn’s disease
Infectious colitis
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13.
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Candida esophagitis
Findings:
numerous plaque-like filling defects of the distal esophagus
no erosions or narrowing seen
may appear worse with disease severity
ddx:
NONE!
This is an Aunt Minnie!
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14.
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Caroli’s disease
Findings:
percutaneous cholangiogram shows marked dilated and beaded appearance of the intrahepatic biliary system
ddx:
NONE!
This is an Aunt Minnie!
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Cholangiocarcinoma
Findings:
percutaneous cholangiogram shows smooth narrowing of the biliary duct confluence and proximal common hepatic duct
ddx:
NONE!
This is an Aunt Minnie!
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16.
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Lye stricture & colonic interposition
Findings:
Long segmental distal esophageal narrowing
Anteriorly located bowel loop connecting mouth of stomach = interposed colonic loop
ddx:
NONE!
This is an Aunt Minnie!
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17.
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Apthous ulcers
Findings:
Numerous shallow mucosal defects with a surrounding mound of edema = “bull’s eye” or “target” lesions
do NOT penetrate beyond the muscularis mucosa
ddx:
Crohn’s disease
Infectious colitides
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Inflammatory polyps
Findings:
islands of normal or edematous mucosa seen during active inflammation
they protrude into the lumen because the surrounding mucosa is sloughed or deeply ulcerated
ddx:
ulcerative colitis
Infectious colitis
Crohn’s disease (“cobblestone pattern”)
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Crohn’s disease
Findings:
multiple loops of small bowel show segmental narrowing, loss of normal mucosal pattern (cobblestone), and fistula formation
striking involvement of the terminal ileum
ddx:
lymphoma
Tuberculosis
Yersinia (TI only)
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20.
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Duodenal adenocarcinoma
Findings:
eccentric sessile lesion with an irregular, ulcerated surface along the lateral wall of the descending duodenum
ddx:
sessile polyp
leiomyoma / leiomyosarcoma
metastasis
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21.
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Heterotopic gastric mucosaof the duodenal bulb
Findings:
numerous, slightly elevated lesions measuring a few millimeters clustered in a small segment of the duodenal bulb
may have angulated or plaque-like margins
occur in up to 20% of pts.
no clinical significance
ddx:
benign lymphoid hyperplasia (if 1-2mm smooth filling defects)
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22.
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Erosive gastritis
Findings:
numerous 3-4mm shallow mucosal defects with a surrounding mound of edema = “bull’s eye” or “target”
do NOT penetrate beyond the muscularis mucosa
ddx:
Idiopathic (50%)
NSAIDs (greater curve)
Crohn’s disease (apthous ulcers)
Alcohol ingestion
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23. A 35 yo in a motor vehicle accident with severe injuries.
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23. CT Hypotension ComplexShock Bowel
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23.
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24.
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24. HISTOPLASMOSIS
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25. 81 YEAR OLD WITH HISTORY OF NON VEG DIET.
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25. Foreign Body (Chicken
Bone) Perforation of Bowel
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25. Foreign Body (Chicken
Bone) Perforation of Bowel
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THANK YOU