Title: Imaging of Abdominal Pathology
1Imaging of Abdominal Pathology
- J.J. Jimenez M.D.
- Carle Clinic Department of Radiology
2Methods of Abdominal Imaging
- Plain Film
- Fluoroscopy
- Ultrasound
- CT
- MR
- Nuclear Medicine
- Angiography
3Plain Film
- Limited Usefulness
- Free Air
- Obstruction
- Stones
- Tube Placement
4Approach to Plain Abdominal Films
- Stones
- Bones
- Mass
- Gas
- Look at the corners to cover your
5(No Transcript)
6Fluoroscopy
- Largely replaced by endoscopy
- Still useful for small bowel
- Viable alternative for colon cancer screening
- Dynamic study ie. Swallowing, esophageal motility
7Upper GI and Small Bowel
8Ultrasound
- 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
9Computed 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!!!
10Contrast vs Non Contrast
11Magnetic 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
12Nuclear Medicine
- Limited usefulness
- Gallbladder
- Gastric emptying
- Meckels
- GI bleeding
- Oncologic imaging octreotide, PET, CEA,
Prostascint
13Angiography
- Not used much for diagnostic purposes
- Can be used in GI bleeding and tumors when
intervention is planned
14Normal CT Anatomy
15Normal CT Anatomy
16Normal CT Anatomy
17Normal CT Anatomy
18Normal CT Anatomy
19Normal CT Anatomy
20MRI Anatomy
21MRI Anatomy
22Coronal Recon at 1.25mm
23Coronal Recon at 1.25mm
24Sagittal Recon at 1.25mm
25Coronal Recon at 1.25mm
26Coronal Recon at 0.625mm
27Sagittal Recon at 0.625mm
283-D Reformat
293-D Reformat
303-D Reformat
313-D Reformat
32Normal Sonographic Anatomy
33Normal Sonographic Anatomy
34Normal Sonographic Anatomy
35Normal Sonographic Anatomy
36Normal Sonographic Anatomy
37Normal Sonographic Anatomy
38Normal Sonographic Anatomy
39Evaluating For Pathology
- Inflammation
- Mass
- Congential/Structural
- Vascular
40IN ORDER TO RECOGNIZE PATHOLOGY
- YOU MUST RECOGNIZE WHAT IS NORMAL
41Inflammation/Infection
- Fat stranding
- Thickening of structures-edema
- Fluid
- Abnormal Enhancement
42Mass
- Displacement of Normal Anatomical Structures
- Abnormal Enhancement
- Use HU measurements to help determine tissue of
origin - Enlargement of Normal Structures
43Evaluating 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
4440 YO Female RLQ Pain
Fat stranding
4540 YO Female RLQ Pain
More fat stranding
4640 YO Female RLQ Pain
Calcified appendicolith
47Differential Diagnosis
- Appendicitis
- Inflammatory bowel disease
- Infectious Colitis
- Diverticulitis
48Appendicitis
- Appendix gt 6mm
- Fat Stranding
- Fluid
4954 YO Male w/Abd Pain
5054 YO Male w/Abd Pain
51Differential Diagnosis
- Gastric Adenocarcinoma
- Lymphoma
- GIST Leiomyoma, leiomyosarcoma
- Lipoma
- Vascular Malformation/Varices
5228 YO Female with RUQ Abdominal Pain
5328 YO Female with RUQ Abdominal Pain
Area of hypodensity in medial spleen
54Differential Diagnosis
- Gastric Adenocarcinoma
- Lymphoma
- GIST Leiomyoma, leiomyosarcoma
- Lipoma
- Vascular Malformation/Varices
- Actual diagnosis benign Nissen Fundoplication
defect with splenic infarct
5574 YO Female With Gastric Lymphoma
56PET- CT of Same Patient
5735 YO Male With Left Flank Pain
Fat stranding
5835 YO Male With Left Flank Pain
Dilated ureter
5935 YO Male With Left Flank Pain
Calcification at ureter and bladder junction
60Differential Diagnosis
6169 YO Male With Flank Pain
Perinephric fat stranding and fluid collection
and escaping contrast
62Obstructive Uropathy
- Helical CT 3.75mm cuts with recons at 3mm
- NO CONTRAST
- Prone positioning
- Imaging Clues
- Stone in ureter
- Perinephric stranding
- Hydronephrosis or hydroureter
6357 YO Male with Pancreatitis
Dilated stomach
6457 YO Male with Pancreatitis
65Duodenal Mass
- Tumors
- Adenocarcinoma
- Lymphoma
- Leiomyoma/Sarcoma/GIST
- Inflammatory
- Infection
- Crohns
- Lymphoid Hyperplasia
6653 YO Female w/Abd Pain
6753 YO Female w/Abd Pain
6853 YO Female w/Abd Pain
Dilated right ureter
69Ureteral Mass
- Stone
- Infectious Debris
- Inflammatory
- Blood
- Tumor TCC, SCC
7073 YO Male s/p Colectomy with Abdominal
Distention and Pain
7173 YO Male s/p Colectomy with Abdominal
Distention and Pain
Parastomal hernia
72Small Bowel Obstruction
- Adhesions
- Hernia
- Tumor
- Gallstone ileus
7365 YO Male S/P Right Nephrectomy
7465 YO Male S/P Right Nephrectomy
75Intraabdominal Hemorrhage
- Intra v. extraperitoneal
- Fluid (may be hyperdense)
- Stranding
- Hematocrit effect
7665 YO Female with Abdominal Pain
Thickened sigmoid colon with fat stranding
7765 YO Female with Abdominal Pain
78Differential Diagnosis
- Infectious Colitis
- Diverticulitis
- Inflammatory Bowel Disease
- Neoplasm
7969 YO Male With Abdominal Pain
80Differential Diagnosis
- Carcinoid
- Lymphoma
- Adenocarcinoma
- Inflammation
- Mesenteric lypodystrophy
8119 YO Female With Upper Abdominal Pain
8219 YO Female With Upper Abdominal Pain
83Differential Diagnosis
- Appendicitis w/abscess
- Inflammatory bowel disease
- Infectious Colitis
8426 YO Female With Sudden Onset RLQ Pain
8526 YO Female With Sudden Onset RLQ Pain
8626 YO Female With Sudden Onset RLQ Pain
87Differential Diagnosis
- Trauma
- Ectopic Pregnancy
- Ovarian cyst
8873 YO Female With Lymphoma and Fever
Hypodensities within spleen
8973 YO Female With Lymphoma and Fever
Hypodensity in liver
90Differential Diagnosis
- Lymphomatous involvement
- Opportunistic infection fungal
9143 YO Female With Abdominal Pain and Distention
Fluid
Hypodensity in right lobe of liver
9243 YO Female With Abdominal Pain and Distention
Ascites
Soft tissue density
9343 YO Female With Abdominal Pain and Distention
Enhancing fluid posterior to uterus
94Differential Diagnosis
- Portal Hypertension/liver disease
- Omental Carcinomatosis ovary, pancreas, stomach
9551 yo Male with RUQ pain
Distended gallbladder
9651 yo Male with RUQ pain
9751 yo Male with RUQ pain
9851 yo Male with RUQ pain
Emphysematous Cholecystitis
9954 YO Female With RLQ Pain
Intussusception
10054 YO Female With RLQ Pain
10174 YO Male With RUQ Pain and Rectal Cancer
10274 YO Male With RUQ Pain and Rectal Cancer
Enhancing vessel (superior mesenteric vein) with
hypodense thrombus
10374 YO Male With RUQ Pain and Rectal Cancer
Hypodensity in branch of portal veinportal
venous thrombosis
10480 YO Male W/ Abd Pain
Air in distended bowel wallpneumotosis colitis
Apple core lesion in cecum
Colon carcinoma
10561 YO Male With Abd Pain
Ascites
Varicesenhancing vessels in esophageal wall.
Severe portal hypertension.
Small nodular liver and large spleen, bowel wall
thickening
10661 YO Male With Abd Pain
Bowel wall thickeningportal hypertension
10742 YO Male With Dysphagia
Thickening of esophageal wall
10878 YO Male With RUQ Pain
Distended gallbladder with pericholecystic fat
stranding
Acute cholecystitis
10919 YO With Abd Pain
Fat stranding and rim-enhancing fluid
Periappendiceal abscess (ruptured appendix)
11068 YO Male With Abn Urine Cytology
Papillary areas of thickening at base of bladder
with wall thickening
Transitional cell carcinoma
11162 YO Male With Abd Pain
11264 YO Male With Abd Mass on U/S
Ectopic atrophic kidney
11373 Female With Ovarian Ca
Loculated fluid collection with calcifications
Omental carcinomatosis secondary to ovarian cancer
Hypodensity in spleen
Ascites, nodular appearing liver
11412 YO Sledding Accident
3 weeks later showing healing
Low density fluid collection--splenic
laceration, acute
11524 YO Male With Mono and Abdominal Pain
Fluid behind bladderspontaneous splenic
hemorrhage
Enlarged spleen with surrounding fluid
11633 YO Gravid Female With RLQ Pain
Large mass with complex cystsovarian cancer
11754 YO Male With Abd Pain
Enlarged aorta with concentric thrombus--AAA
Small mass in adrenal gland
11854 YO Male With Adrenal Mass
Good washoutlikely benign adenoma
11942 yo Female with Mass
Defect in abdominal wallspigelian hernia
12052 YO F With Abnl Colonoscopy
DD appendicitis, mucocele, or peritoneal
inclusion cyst
Fluid filled structuremucocele of the appendix
12120 YO Male In Head-On MVA
Hyperdense fluid around liver and spleentrauma
pt. with ruptured spleen
12220 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
12373 YO F With Epigastric Pain
Mass in head of pancreas
DD Pancreatic neoplasm vs. pseudocyst
12482 YO Male With Abd Pain
Apple core lesioncolon cancer
Dilated thick-walled bowel loop
12576 YO F With Breast Cancer
Multiple hepatic metastatic lesions
T1
T2
12676 YO F With Breast Cancer
T1 LAVA sequence with gadoliniumdiffuse
metastatic disease
12765 YO Male With Prostate Ca
T1
Abnormal base of bladder
T2
1284 week old with vomiting
Pyloric muscle5 mm in thickness
129Ruling out pyloric stenosis
- Pyloric muscle should be less than 3.5 mm
thickness - Should be less than 17 mm in length
13082 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