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Imaging of Abdominal Pathology

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Title: Imaging of Abdominal Pathology


1
Imaging of Abdominal Pathology
  • J.J. Jimenez M.D.
  • Carle Clinic Department of Radiology

2
Methods of Abdominal Imaging
  • Plain Film
  • Fluoroscopy
  • Ultrasound
  • CT
  • MR
  • Nuclear Medicine
  • Angiography

3
Plain Film
  • Limited Usefulness
  • Free Air
  • Obstruction
  • Stones
  • Tube Placement

4
Approach to Plain Abdominal Films
  • Stones
  • Bones
  • Mass
  • Gas
  • Look at the corners to cover your

5
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6
Fluoroscopy
  • Largely replaced by endoscopy
  • Still useful for small bowel
  • Viable alternative for colon cancer screening
  • Dynamic study ie. Swallowing, esophageal motility

7
Upper GI and Small Bowel
8
Ultrasound
  • More widely available
  • Excellent anatomic detail in the right hands
  • Superior for Gallbladder disease
  • Vascular Structures ie. Liver Transplant
  • Aneurysm Screening
  • Female Pelvis
  • Bad for Pancreas---So-So for kidneys

9
Computed Tomography
  • Workhorse of abdominal imaging
  • Great anatomic detail esp. with multislice
  • Numerous protocols tailored to clinical problem
  • Relatively easy to obtain
  • Contrast ?????
  • Renal stones no all else YES!!!

10
Contrast vs Non Contrast
11
Magnetic Resonance Imaging
  • Good anatomic detail
  • Susceptible to respiratory motion artifacts
  • Good for problem solving or when contrast allergy
  • Liver masses, adrenal masses, renal masses
  • MRCP???
  • MR angio??? CT superior

12
Nuclear Medicine
  • Limited usefulness
  • Gallbladder
  • Gastric emptying
  • Meckels
  • GI bleeding
  • Oncologic imaging octreotide, PET, CEA,
    Prostascint

13
Angiography
  • Not used much for diagnostic purposes
  • Can be used in GI bleeding and tumors when
    intervention is planned

14
Normal CT Anatomy
15
Normal CT Anatomy
16
Normal CT Anatomy
17
Normal CT Anatomy
18
Normal CT Anatomy
19
Normal CT Anatomy
20
MRI Anatomy
21
MRI Anatomy
22
Coronal Recon at 1.25mm
23
Coronal Recon at 1.25mm
24
Sagittal Recon at 1.25mm
25
Coronal Recon at 1.25mm
26
Coronal Recon at 0.625mm
27
Sagittal Recon at 0.625mm
28
3-D Reformat
29
3-D Reformat
30
3-D Reformat
31
3-D Reformat
32
Normal Sonographic Anatomy
33
Normal Sonographic Anatomy
34
Normal Sonographic Anatomy
35
Normal Sonographic Anatomy
36
Normal Sonographic Anatomy
37
Normal Sonographic Anatomy
38
Normal Sonographic Anatomy
39
Evaluating For Pathology
  • Inflammation
  • Mass
  • Congential/Structural
  • Vascular

40
IN ORDER TO RECOGNIZE PATHOLOGY
  • YOU MUST RECOGNIZE WHAT IS NORMAL

41
Inflammation/Infection
  • Fat stranding
  • Thickening of structures-edema
  • Fluid
  • Abnormal Enhancement

42
Mass
  • Displacement of Normal Anatomical Structures
  • Abnormal Enhancement
  • Use HU measurements to help determine tissue of
    origin
  • Enlargement of Normal Structures

43
Evaluating for Pathology
  • There will be overlap of findings among different
    disease categories
  • THIS IS WHY WE HAVE DIFFERENTIAL DIAGNOSES
  • THIS IS WHY CLINICAL HISTORY IS IMPORTANT

44
40 YO Female RLQ Pain
Fat stranding
45
40 YO Female RLQ Pain
More fat stranding
46
40 YO Female RLQ Pain
Calcified appendicolith
47
Differential Diagnosis
  • Appendicitis
  • Inflammatory bowel disease
  • Infectious Colitis
  • Diverticulitis

48
Appendicitis
  • Appendix gt 6mm
  • Fat Stranding
  • Fluid

49
54 YO Male w/Abd Pain
50
54 YO Male w/Abd Pain
51
Differential Diagnosis
  • Gastric Adenocarcinoma
  • Lymphoma
  • GIST Leiomyoma, leiomyosarcoma
  • Lipoma
  • Vascular Malformation/Varices

52
28 YO Female with RUQ Abdominal Pain
53
28 YO Female with RUQ Abdominal Pain
Area of hypodensity in medial spleen
54
Differential Diagnosis
  • Gastric Adenocarcinoma
  • Lymphoma
  • GIST Leiomyoma, leiomyosarcoma
  • Lipoma
  • Vascular Malformation/Varices
  • Actual diagnosis benign Nissen Fundoplication
    defect with splenic infarct

55
74 YO Female With Gastric Lymphoma
56
PET- CT of Same Patient
57
35 YO Male With Left Flank Pain
Fat stranding
58
35 YO Male With Left Flank Pain
Dilated ureter
59
35 YO Male With Left Flank Pain
Calcification at ureter and bladder junction
60
Differential Diagnosis
  • NONE

61
69 YO Male With Flank Pain
Perinephric fat stranding and fluid collection
and escaping contrast
62
Obstructive Uropathy
  • Helical CT 3.75mm cuts with recons at 3mm
  • NO CONTRAST
  • Prone positioning
  • Imaging Clues
  • Stone in ureter
  • Perinephric stranding
  • Hydronephrosis or hydroureter

63
57 YO Male with Pancreatitis
Dilated stomach
64
57 YO Male with Pancreatitis
65
Duodenal Mass
  • Tumors
  • Adenocarcinoma
  • Lymphoma
  • Leiomyoma/Sarcoma/GIST
  • Inflammatory
  • Infection
  • Crohns
  • Lymphoid Hyperplasia

66
53 YO Female w/Abd Pain
67
53 YO Female w/Abd Pain
68
53 YO Female w/Abd Pain
Dilated right ureter
69
Ureteral Mass
  • Stone
  • Infectious Debris
  • Inflammatory
  • Blood
  • Tumor TCC, SCC

70
73 YO Male s/p Colectomy with Abdominal
Distention and Pain
71
73 YO Male s/p Colectomy with Abdominal
Distention and Pain
Parastomal hernia
72
Small Bowel Obstruction
  • Adhesions
  • Hernia
  • Tumor
  • Gallstone ileus

73
65 YO Male S/P Right Nephrectomy
74
65 YO Male S/P Right Nephrectomy
75
Intraabdominal Hemorrhage
  • Intra v. extraperitoneal
  • Fluid (may be hyperdense)
  • Stranding
  • Hematocrit effect

76
65 YO Female with Abdominal Pain
Thickened sigmoid colon with fat stranding
77
65 YO Female with Abdominal Pain
78
Differential Diagnosis
  • Infectious Colitis
  • Diverticulitis
  • Inflammatory Bowel Disease
  • Neoplasm

79
69 YO Male With Abdominal Pain
80
Differential Diagnosis
  • Carcinoid
  • Lymphoma
  • Adenocarcinoma
  • Inflammation
  • Mesenteric lypodystrophy

81
19 YO Female With Upper Abdominal Pain
82
19 YO Female With Upper Abdominal Pain
83
Differential Diagnosis
  • Appendicitis w/abscess
  • Inflammatory bowel disease
  • Infectious Colitis

84
26 YO Female With Sudden Onset RLQ Pain
85
26 YO Female With Sudden Onset RLQ Pain
86
26 YO Female With Sudden Onset RLQ Pain
87
Differential Diagnosis
  • Trauma
  • Ectopic Pregnancy
  • Ovarian cyst

88
73 YO Female With Lymphoma and Fever
Hypodensities within spleen
89
73 YO Female With Lymphoma and Fever
Hypodensity in liver
90
Differential Diagnosis
  • Lymphomatous involvement
  • Opportunistic infection fungal

91
43 YO Female With Abdominal Pain and Distention
Fluid
Hypodensity in right lobe of liver
92
43 YO Female With Abdominal Pain and Distention
Ascites
Soft tissue density
93
43 YO Female With Abdominal Pain and Distention
Enhancing fluid posterior to uterus
94
Differential Diagnosis
  • Portal Hypertension/liver disease
  • Omental Carcinomatosis ovary, pancreas, stomach

95
51 yo Male with RUQ pain
Distended gallbladder
96
51 yo Male with RUQ pain
97
51 yo Male with RUQ pain
98
51 yo Male with RUQ pain
Emphysematous Cholecystitis
99
54 YO Female With RLQ Pain
Intussusception
100
54 YO Female With RLQ Pain
101
74 YO Male With RUQ Pain and Rectal Cancer
102
74 YO Male With RUQ Pain and Rectal Cancer
Enhancing vessel (superior mesenteric vein) with
hypodense thrombus
103
74 YO Male With RUQ Pain and Rectal Cancer
Hypodensity in branch of portal veinportal
venous thrombosis
104
80 YO Male W/ Abd Pain
Air in distended bowel wallpneumotosis colitis
Apple core lesion in cecum
Colon carcinoma
105
61 YO Male With Abd Pain
Ascites
Varicesenhancing vessels in esophageal wall.
Severe portal hypertension.
Small nodular liver and large spleen, bowel wall
thickening
106
61 YO Male With Abd Pain
Bowel wall thickeningportal hypertension
107
42 YO Male With Dysphagia
Thickening of esophageal wall
108
78 YO Male With RUQ Pain
Distended gallbladder with pericholecystic fat
stranding
Acute cholecystitis
109
19 YO With Abd Pain
Fat stranding and rim-enhancing fluid
Periappendiceal abscess (ruptured appendix)
110
68 YO Male With Abn Urine Cytology
Papillary areas of thickening at base of bladder
with wall thickening
Transitional cell carcinoma
111
62 YO Male With Abd Pain
112
64 YO Male With Abd Mass on U/S
Ectopic atrophic kidney
113
73 Female With Ovarian Ca
Loculated fluid collection with calcifications
Omental carcinomatosis secondary to ovarian cancer
Hypodensity in spleen
Ascites, nodular appearing liver
114
12 YO Sledding Accident
3 weeks later showing healing
Low density fluid collection--splenic
laceration, acute
115
24 YO Male With Mono and Abdominal Pain
Fluid behind bladderspontaneous splenic
hemorrhage
Enlarged spleen with surrounding fluid
116
33 YO Gravid Female With RLQ Pain
Large mass with complex cystsovarian cancer
117
54 YO Male With Abd Pain
Enlarged aorta with concentric thrombus--AAA
Small mass in adrenal gland
118
54 YO Male With Adrenal Mass
Good washoutlikely benign adenoma
119
42 yo Female with Mass
Defect in abdominal wallspigelian hernia
120
52 YO F With Abnl Colonoscopy
DD appendicitis, mucocele, or peritoneal
inclusion cyst
Fluid filled structuremucocele of the appendix
121
20 YO Male In Head-On MVA
Hyperdense fluid around liver and spleentrauma
pt. with ruptured spleen
122
20 YO In Head-On MVA
Loops of small bowel with shock bowel enhancing
pattern
Small aorta and inferior vena cava
Hypovolemic shock due to splenic rupture
123
73 YO F With Epigastric Pain
Mass in head of pancreas
DD Pancreatic neoplasm vs. pseudocyst
124
82 YO Male With Abd Pain
Apple core lesioncolon cancer
Dilated thick-walled bowel loop
125
76 YO F With Breast Cancer
Multiple hepatic metastatic lesions
T1
T2
126
76 YO F With Breast Cancer
T1 LAVA sequence with gadoliniumdiffuse
metastatic disease
127
65 YO Male With Prostate Ca
T1
Abnormal base of bladder
T2
128
4 week old with vomiting
Pyloric muscle5 mm in thickness
129
Ruling out pyloric stenosis
  • Pyloric muscle should be less than 3.5 mm
    thickness
  • Should be less than 17 mm in length

130
82 YO RUQ Pain and Fever
Distended gallbaldder with enhancing wall and air
in gallbladder, small stonescholecystitis with
probable secondary liver involvement
Gallbladder with echogenic material and edema
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