cases_GIT common spots radiology _v.EX.ppt

Spots
Cases
GIT

1. GI Cases 26-50

2. 26 27 28 29 30
31 32 33 34 35
36 37 38 39 40
41 42 43 44 45
46 47 48 49 50
Case directory

3. Case 26

4. Omental infarction
Case findings:
Normal appendix
Fatty lesion with hyper-attenuating streaks
anterior to the cecum
Thickening of the peritoneum
Case directory

5. Case 27

6. Axial T1WI
Axial T2WI with fat saturation

7. Axial T1 portal venous enhancement
Axial T1 delayed enhancement

8. Retractile mesenteritis
CT:
Inhomogeneous mass of soft-tissue density interspersed with
areas of fat, arising from the small bowel mesentery
Moderate enhancement of the non-fatty aspects of the process
Mass surrounds mesenteric vessels and displaces adjacent small
bowel loops
MR:
Mesenteric mass with irregular borders and low T1 SI
T2 intermediate signal intensity
Ascites in paracolic gutters and between mesenteric folds
PV enhancement: mild enhancement with a radiating pattern of
strands and enhanced mesenteric vessels penetrating the lesion

9. Retractile mesenteritis
Also called: sclerosing mesenteritis, systemic nodular
panniculitis, liposclerotic mesenteritis
Represents fibrous evolution of mesenteric panniculitis
Associated with:
SLE
Lymphoma
Gardner's syndrome
Thoracic mesothelioma
Retroperitoneal fibrosis

10. Retractile mesenteritis
MC presents as a single mass
Small bowel series:
Separation of loops, with kinking and angulation, suggesting a serosal
process
CT:
Mesenteric mass with a variable amount of fat and soft tissue with
radiating linear strands reflecting the fibrous reaction of the mesentery
May see calcifications
MR:
Low T1, low or intermediate T2
Mild and gradual contrast enhancement suggesting a fibrotic reaction

11. Retractile mesenteritis
DDX:
Liposarcoma: invasion of adjacent structures
Desmoidtumor:
Associated with Gardner's syndrome
MC occur in injured or surgically traumatized sites
Lymphoma
Carcinomatosis
Case directory

12. Case 28

13. Peritoneal tuberculosis
Case findings:
Marked inhomogeneous thickening of the anterior peritoneal wall and
SB
Marked enhancement
Mesenteric lymphadenopathy
Peritoneal infection can appear as:
Wet type
Dry type
Fibroadhesive type
Combination of above types
Wet type (this case): high-density ascitic fluid with exudative
content and thickened mesentery
Case directory

14. Case 29

15. Intramural hematoma
Case findings:
Thickening of jejunal loops
Etiology: anticoagulation
MC occurs in duodenum
Case directory

16. Case 30

18. Emphysematous cholecystitis
Case findings:
Gas in GB wall that forms a low-attenuation ring outlining the
gallbladder
Gas is also seen in the left intrahepatic and extrahepatic biliary
ducts
DDX:
Emphysematous cholecystitis
Ascending cholangitis
Biliary-enteric fistula
Paraduodenal abscess
Periappendiceal abscess in malpositioned appendix
Gallbladder lipomatosis:Plain-film mimmick of GB wall gas

19. Emphysematous cholecystitis
Acute infection of GB wall caused by gas-forming
organisms
Unlike other biliary tract disorders, MC in men
(65-70%)
Four proposed pathogenetic factors:
Vascular compromise
Gallstones
Impaired immune protection
Infection with gas-forming organisms
Case directory

20. Case 31
History of adenomatous polyposis and fundal gastric polyps

22. Gardner’s syndrome
(with desmoid tumors)
Case findings:
Multiple mesenteric and omental masses,
which are ill-defined causing a tethered
appearance to the mesentery
Bowel is displaced but not obstructed
Large pelvic mass
Mass in the soft tissues of the lower
abdominal wall

23. Gardner’s syndrome
(with desmoid tumors)
DDX tethered mesenteric folds:
Post-operative changes
Post-radiation changes
Desmoplastic reaction: carcinoid, peritoneal implants,
leiomyosarcoma, lymphoma
DDX large solid pelvic mass in adult male:
Prostate / bladder / bowel neoplasm
Desmoid tumor
Malignant fibrous histiocytoma
Leiomyosarcoma
Neural tumor

24. Gardner’s syndrome
Autosomal dominant
Polyposis:
MC colon (100%), stomach (5%), SB (<5
Malignant transformation risk is 100%
Osteomas:
MC mandible, calvarium, maxilla
Soft tissue tumors:
Desmoid tumor
Sebaceous cysts
Neurofibroma, fibroma
Leiomyoma, lipomas
Surgical trauma predisposes Gardner patient to desmoid formation

25. AD= autosomal dominant, AR= autosomal recessive, NH= nonhereditary
Polyposis syndromes
Case directory

26. Case 32

27. Cecal and appendiceal
adenocarcinoma
Case findings:
Asymmetric thickening of cecum and ascending colon
Inflammatory changes of posterior perirenal fascia extending
into right colic gutter
Thickened appendix
DDX:
Appendicitis with phlegmon
Cecal malignancy with rupture and associated appendicitis
Cecal diverticulitis
Crohn’s disease

28. Appendiceal neoplasm
Rare to have appendiceal involvement with
adenocarcinoma
Lymphoma and adenocarcinoma of appendix are
less common
Appendiceal carcinoid:
90% of all appendiceal tumors are carcinoids
MC distal tip of the appendix
Produces a solid bulbous swelling 2 to 3 cm in
diameter
Case directory

29. Case 33

30. Malignant fibrous histiocytoma
Case findings:
Mass centered in right retroperitoneum that is separate from
right kidney and adrenal gland
No clear fat plane is identified between the mass and the right
psoas muscle
Enhances heterogeneously with areas of non-enhancement
(necrosis)
DDX:
Malignant fibrous histiocytoma
Leiomyosarcoma
Lymphoma
Liposarcoma

31. Malignant fibrous histiocytoma
MC sarcoma in adults, 5
th
–7
th
decades
Mesenchymal origin, potential to be in all organs:
MC lower extremities (50%)
Upper extremities (about 20%)
Abdominal cavity, retroperitoneum (20%)
> 5 cm at presentation
May erode into adjacent bony structures
Metastatic disease and local recurrence are common
Case directory

32. Case 34

33. Hepatic angiomyolipoma
Case findings:
CT: mass in the posterior segment of the right
hepatic lobe composed mostly of fatty tissue
MC solitary mass in liver
Hemorrhage uncommon complication

34. DDX fatty liver lesion
Lipoma
Hepatic adenoma
Focal fatty infiltration
Angiomyolipoma
Metastasis (malignant teratoma, liposarcoma)
HCC with fatty metamorphosis
HCC: well differentiated, hypovascular
Angiomyolipoma: hypervascular
Case directory

35. Case 35

36. Mesenteric panniculitis
Case findings:
CT: hazy infiltration of the mesentery
Also called: sclerosing mesenteritis, mesenteric
lipodystrophy, and liposclerotic mesenteritis
Benign inflammatory condition of the mesentery, which
is frequently asymptomatic and self-limiting
MC left side of the abdomen along the orientation of the
jejunal mesentery
Case directory

37. Case 36

39. Pelvic lipomatosis
Case findings:
BE:
Ascending curvature of the sigmoid colon
Elongation and deformity of the rectum by
extrinsic compression
CT:
Deposits of fat in the perivesical and perirectal
spaces causing extrinsic compression of the
bladder, sigmoid, and rectum

40. Pelvic lipomatosis
DDX tear-drop bladder:
Pelvic lipomatosis
Hypertrophy of the iliopsoas muscles
Retroperitoneal fibrosis
Large pelvic abscess
Large hematoma, usually due to trauma or
anticoagulation therapy
Collateral venous circulation from IVC obstruction
Large iliac artery aneurysms
Adenopathy from lymphoma, and prostatic carcinoma
Case directory

41. Case 37